US20100331623A1 - System for endoscopic suturing - Google Patents
System for endoscopic suturing Download PDFInfo
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- US20100331623A1 US20100331623A1 US12/807,259 US80725910A US2010331623A1 US 20100331623 A1 US20100331623 A1 US 20100331623A1 US 80725910 A US80725910 A US 80725910A US 2010331623 A1 US2010331623 A1 US 2010331623A1
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- suture
- tube
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- shaft
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- 0 BC1(CO)C2(C)CCCCCCCC3[C@@](CC)CCCCC[C@@](C)*C(C*C*)CCCCCC=C(CC(CC4)[C@]4C4)[*@@](CCCC)C*C4CC(CCC)C1[C@@]3C2 Chemical compound BC1(CO)C2(C)CCCCCCCC3[C@@](CC)CCCCC[C@@](C)*C(C*C*)CCCCCC=C(CC(CC4)[C@]4C4)[*@@](CCCC)C*C4CC(CCC)C1[C@@]3C2 0.000 description 2
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00131—Accessories for endoscopes
- A61B1/0014—Fastening element for attaching accessories to the outside of an endoscope, e.g. clips, clamps or bands
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
- A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0467—Instruments for cutting sutures
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0482—Needle or suture guides
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/00296—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means mounted on an endoscope
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B2017/0496—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials for tensioning sutures
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/30—Surgical pincettes without pivotal connections
- A61B2017/306—Surgical pincettes without pivotal connections holding by means of suction
Definitions
- the present invention relates to a system (and method) for endoscopic suturing, and in particular to a system for suturing through an accessory tube coupled to a flexible endoscope, which may be placed in the stomach through mouth and the esophagus of a patient utilizing a tissue suturing instrument and a suture securing instrument.
- the invention is suitable, for example, for applying at least one suture in the soft tissue lining of the stomach for different procedures such as gastroplasty, fundoplication, anterior gastropexy, or other procedures requiring suturing in the stomach, without the need for laparotomy or laparoscopy.
- sutures in the gastrointestinal tract is required for several different types of medical procedures, for example, transoral endoscopic valvuloplasty for gastroesophageal reflux disease, gastroplasty, fundoplication, anterior gastropexy, suturing esophageal perforations, or closure of esophageal side of tracheo-esophageal fistula.
- these procedures were performed by physicians, such as gastroenterologist or surgeons, either by laparoscopy or open surgical techniques.
- Such procedures are invasive, as laparoscopy requires small access incision(s) made in the body of the patient through which a laparoscope and other surgical enabling tools are provided, while open surgical techniques are traditionally invasive and can have complications and long patient recovery periods.
- gastroscopes can be provided through the gastroesophageal tract and enable illumination and visualization of tissue along the gastroesophageal tract on a video display for diagnostic purposes.
- gastroscopes often have a working channel to a port at the distal end of the gastroscope through which a biopsy tool may be provided to obtain tissue samples, they are not currently designed or typically large enough to be capable of applying sutures in tissue.
- U.S. Pat. No. 5,792,153 describes a sewing device coupled to the distal end of an endoscope, which enables suturing in the gastroesophageal tract of a patient.
- the sewing device has a single hollow needle mounted in the biopsy channel of the endoscope, and a wire extending through the needle to a T-shaped tag having one end of a suture thread which extends outside of the patient.
- suction is applied to a U-shaped opening of the sewing device via another channel of the endoscope to suck a layer (or fold) of tissue into the U-shaped opening, the needle in the biopsy channel is then pushed through the tissue, and then the wire is pushed and rotated to position the tag in a chamber along one side of the U-shaped opening. This rotates the tag into a position which captures the tag and the suture end in this chamber, and the needle and wire are retracted to the other side of the U-shaped opening.
- the endoscope and its coupled sewing device are removed from the patient, leaving a loop of suture through the tissue which must then be secured and closed.
- the patent also provides another sewing device at the end of an endoscope which enables multiple stitches in tissue with the same needle and suture thread.
- the sewing device of U.S. Pat. No. 5,792,153 to apply a single stitch is manufactured by Laboratories BARD S.A. of Voisinsle Bretonneux, France, and described in Kadirkamanathan et al., Gastrointestinal Endoscopy, August 1996, Vol. 44, No. 2, pp. 144-162.
- a further sewing device is described in U.S. Pat. No. 5,080,663 and also utilizes an operating device having tubes in a tubular sheath, such as endoscopic means, to provide suction to a slot in the device to capture a double fold of tissue and two wires extending through such tubes.
- One wire advances and retracts a needle having a tag with suture at its tip through tissue and the other wire controls capture of a tag at the other side of the opening.
- the patent provides for applying a sensor or transmitter in the body of a patient, such as the stomach.
- This sewing device is also described in Swaine et al., An endoscopically deliverable tissue-transfixing device for securing biosensors in the gastrointestinal tract, Gastrointestinal Endoscopy, November/December 1994, Vol. 40, No. 6, pp. 730-737.
- Yet a further object of the present invention is to provide an improved system for endoscopic suturing in which a suturing instrument separate from an endoscope can utilize suction to capture tissue to be sutured.
- a still further object of the present invention is to provide an improved system for remote suturing in which can readily adapted to different types of flexible endoscopes to provide an external accessory tube through which medical or surgical instruments can pass.
- a still further object of the present invention is to provide an improved system for endoscopic suturing which utilizes one or more instruments which each have a sufficient flexible shaft to pass through an external flexible accessory tube attached to a flexible endoscope.
- a further object of the present invention is to provide an improved system for endoscopic suturing using instruments having shafts with enhanced flexibility.
- a still further object of the present invention is to provide an improved system for endoscopic suturing using flexible instruments with mechanical or hydraulic steerability.
- Yet a further object of the present invention is to provide an improved system for endoscopic suturing in which remote viewing with an endoscope of suture and suture securing operations is provided in the stomach without hindering endoscope functionality.
- a preferred embodiment of this system embodying the invention includes an endoscope, such as a gastroscope, having a distal end locatable in the body of a patient, such as in the gastrointestinal or gastroesophageal tract, and a flexible shaft extending to the distal end, a flexible accessory tube coupled to the endoscope to be movable relative to the endoscope's shaft, and an attachment tip coupled to the shaft of the endoscope having an opening through which one end of the accessory tube is received.
- the accessory tube is coupled to the shaft of the endoscope with multiple tube guides enabling the accessory tube to slide through the tube guides in response to bending of the endoscope's shaft.
- the accessory tube has a cannula through which an instrument may pass in the accessory tube.
- the system includes a tissue suturing instrument having a partially flexible shaft locatable through the accessory tube, and a tissue engaging end coupled to the shaft which is viewable by the endoscope at its distal end when the instrument is fully inserted through the accessory tube.
- the tissue engaging end has a vacuum sleeve enabling suction to be selectably applied at the tissue engaging end to capture tissue in a gap of a sew tip through an opening in the vacuum sleeve.
- Suction is applied via a vacuum connection assembly to a channel which extends down the shaft to the sew tip.
- a valve is provided to close one end of the suture carrying channel to enable such suction at the sew tip.
- Two needles are provided which extends through the shaft of the suturing instrument.
- the system further includes a suture securing instrument having a partially flexible shaft locatable through the accessory tube, and a distal end coupled to the shaft which is viewable by the endoscope at its distal end when the instrument is fully inserted through the accessory tube.
- the suture securing instrument crimps the sleeve member and cuts the free ends of the suture to retain the suture closed.
- the endoscope enable an operator, such as a surgeon, gastroenterologist, or other skilled physician, to view the engaging end of the suturing instrument for selecting placement of the suture through tissue, and of the distal end of the suture securing instrument to secure the suture closed.
- the suturing instrument in the system may further include a mechanism for steering the tissue engaging end of the instrument independent of steerability of the flexible endoscope.
- a method embodying the present invention having the steps of: locating an endoscope, such as a gastroscope, coupled to an accessory tube through the gastrointestinal or gastroesophageal tract of a patient; inserting a suturing instrument through the accessory tube to place two ends of a loop of suture through tissue of the gastrointestinal or gastroesophageal tract; removing the suturing instrument to leave a loop of suture in the tissue having two free ends extending from the accessory tube; inserting a suture securing instrument having a distal end with a sleeve member through which the free ends of the suture loop are drawn to the suture in the tissue to crimp the sleeve member and cut the free ends of the suture; and removing the suture securing instrument from the accessory tube.
- an endoscope such as a gastroscope
- the suturing instrument and suture securing instrument may be used without the accessory tube when an internal working of biopsy channel is provided in the endoscope that permits the passage of the shaft of the suturing instrument and suture securing instrument, respectively.
- endoscope as a gastroscope for purposes of illustration.
- Other types of endoscopes may be used in the system and method.
- FIG. 1 is a perspective view of the system in accordance with the present invention for application of a suture in tissue
- FIG. 1A is a partial view of endoscope shaft of FIGS. 1 and 2 showing the attachment of a tube guide to the endoscope while enabling the accessory tube to be slidable through the tube guide in response to flexing of the endoscope's shaft;
- FIG. 1B is an expanded view of the distal end of the system of FIG. 1 ;
- FIG. 2 is a perspective view of the system of FIG. 1 with the suture instrument of the system removed;
- FIG. 2A is an expanded view of the distal end of the system of FIG. 2 ;
- FIG. 3 is a perspective view of the accessory tube, cannula, attachment tip and tube guides of FIGS. 1 and 2 ;
- FIG. 4 is a perspective view of the tube guide of FIG. 3 ;
- FIG. 4A is a side view of the tube guide of FIG. 4 ;
- FIGS. 5 and 5A are front and back perspective views, respectively, of the attachment tip of FIG. 3 ;
- FIG. 6 is a perspective view of the cannula of FIG. 3 ;
- FIG. 7 is cross-sectional view of the cannula along lines 7 - 7 of FIG. 6 ;
- FIG. 8 is a perspective view of the suturing instrument of FIG. 1 ;
- FIG. 9 is a side view of the suturing instrument of FIG. 1 in which the right cover of the housing of the instrument is removed;
- FIG. 10 is an exploded view of the suturing instrument of FIG. 1 in which the right cover of the housing is removed;
- FIG. 10A is a perspective view of the retainer member of the suturing instrument of FIGS. 9 and 10 ;
- FIG. 10B is a side view of the cam member of the suturing instrument of FIGS. 9 and 10 ;
- FIG. 11 is a partially exploded perspective view of the adapter, needle spreader, and gasket member of the suturing instrument of FIGS. 9 and 10 ;
- FIG. 11A is a cross-sectional view through lines 11 A- 11 A of FIG. 11 showing the gasket member of the suturing instrument of FIG. 11 without the suture tube or needles;
- FIG. 11B is an end view of the gasket member of FIG. 11 without suture tube or needles;
- FIG. 12 is a cross-sectional view along lines 12 - 12 of the suturing instrument of FIG. 9 ;
- FIG. 13 is a cross-sectional view along lines 13 - 13 of the suturing instrument of FIG. 9 ;
- FIG. 14 is a cross-sectional view along lines 14 - 14 of the suturing instrument of FIG. 9 ;
- FIG. 15 is a cross-sectional view along lines 15 - 15 of the suturing instrument of FIG. 9 ;
- FIG. 16 is a cross-sectional view along lines 16 - 16 of the suturing instrument of FIG. 9 ;
- FIG. 17 is a cross-sectional view along lines 17 - 17 of the suturing instrument of FIG. 9 ;
- FIG. 17A is an exploded view of the coupler member, sew tip, and the guide member between the coupler member and sew tip, of the suturing instrument of FIGS. 9 and 10 ;
- FIG. 17B is a perspective view showing the connection of the coupler member, sew tip, and the guide member of FIG. 17A ;
- FIG. 17C is a cross-sectional view along lines 17 C- 17 C of the FIG. 17B ;
- FIG. 18 is a perspective view of the vacuum connection assembly of the suturing instrument of FIGS. 9 and 10 for application of a vacuum or partial vacuum;
- FIG. 18A is an exploded view of the vacuum connection assembly of FIG. 18 ;
- FIG. 18B is a cross-sectional view of the vacuum connection assembly along lines 18 B- 18 B of FIG. 18 ;
- FIG. 18C is a cross-sectional view along lines 18 C- 18 C of the suturing instrument of FIG. 9 ;
- FIGS. 19A and 19B are perspective view of the valve seat and valve knob of the valve of the suturing instrument of FIGS. 9 and 10 ;
- FIG. 19C is schematic diagram of an alternative valve for the suturing instrument of FIGS. 9 and 10 ;
- FIGS. 20A , 20 B, and 20 C illustrate the valve seat in response to the rotation of the valve knob from an open state to a closed state to seal one end of the suture tube of the suturing instrument of FIGS. 9 and 10 ;
- FIG. 21 is an exploded view of the distal end of the suturing instrument of FIG. 9 ;
- FIG. 21A is an exploded view of the distal end of the FIG. 9 showing the sleeve into which the tissue engaging end of the suturing instrument is received;
- FIG. 21B is a side view of the tissue engaging end of the suturing instrument with the sleeve of FIGS. 21 and 21A ;
- FIGS. 21C and 21D are perspective views showing assembly of the sleeve of FIGS. 21 and 21A ;
- FIGS. 22A-22H illustrates at the tissue engaging end of the suturing instrument the process of applying one end of a loop of suture through tissue with either one the two needles of the instrument;
- FIG. 22I illustrates at the tissue engaging end of the suturing instrument after both of the needles of the instrument have applied the two ends of the suture loop in the tissue, such that removal of the instrument leaves the suture loop through the tissue;
- FIG. 23 illustrates the operation of the tissue engaging end of the suturing instrument in accordance with another embodiment of the instrument without the outer sleeve of the tissue engaging end, where suction is not needed to capture tissue in applying a suture;
- FIG. 24 is a perspective view of the suture securing instrument of the system in accordance with the present invention to retain close the suture applied by the suturing instrument;
- FIG. 24A is a side view of the suture securing instrument of FIG. 24 in which the right cover of the housing of the instrument is removed;
- FIG. 24B is an exploded view of the suture securing instrument of FIG. 24 in which the right cover of the housing is removed;
- FIG. 24C is a cross-sectional view through lines 24 C- 24 C of the suture securing instrument of FIG. 24A .
- FIG. 24D is a cross-sectional view through lines 24 D- 24 D of the suture securing instrument of FIG. 24A .
- FIG. 24E is a cross-sectional view through lines 24 E- 24 E of the suture securing instrument of FIG. 24A .
- FIG. 24F is a cross-sectional view through lines 24 F- 24 F of the suture securing instrument of FIG. 24A .
- FIG. 24G is a cross-sectional view through lines 24 G- 24 G of the suture securing instrument of FIG. 24A .
- FIG. 25 is exploded view of the distal end of the suture securing instrument of FIG. 24 ;
- FIGS. 25A and 25B illustrate the assembly of the distal end of the suture securing instrument of FIG. 24 ;
- FIG. 25C is a cross-section of the distal end of the suture securing instrument along lines 25 C- 25 C of FIG. 25B ;
- FIGS. 26A-26D illustrates the use of a loading device for placement of a sleeve member into the distal end of the suture securing instrument of FIG. 24 , in which FIG. 26D further illustrates a guide wire loop for loading of suture in the instrument;
- FIGS. 26E-26I illustrate use of the guide wire loop of FIG. 26D to load the suture through the sleeve member at the distal end of the suture securing instrument of FIG. 24 ;
- FIGS. 27A-27I illustrates at the distal end of the suture securing instrument the process of fastening a sleeve member to retain the sutured tissue closed and cutting of the suture
- FIGS. 28A-28M represent an example of the view through the endoscope for applying of a suture by the suturing instrument of the system of FIG. 1 and then secured in place by a suture securing instrument of the system;
- FIG. 29A is an example of the system of the present invention positioned in the gastroesophageal tract of a patient before insertion of the suturing instrument;
- FIG. 29B is an example of the system of the present invention positioned in the gastroesophageal tract of a patient showing insertion of the suturing instrument through the accessory tube of the system;
- FIG. 29C is an example of the system of the present invention positioned in the gastroesophageal tract of a patient after placement of the suture thread and removal of the suturing instrument from the accessory tube of the system;
- FIG. 29D is an example of the system of the present invention positioned in the gastroesophageal tract of a patient showing placement of the suture thread loop in the suture securing instrument;
- FIG. 29E is an example of the system of the present invention positioned in the gastroesophageal tract of a patient showing insertion of the suture securing instrument through the accessory tube of the system;
- FIG. 29F is an example of the system of the present invention positioned in the gastroesophageal tract of a patient showing the secured suture remaining after removal of the suture securing instrument;
- FIG. 30 is a perspective view of another embodiment of the suturing instrument in the system of FIG. 1 having enhanced flexibility;
- FIG. 31 is a schematic diagram of the needle assembly for each of the two needles in the embodiment of the suturing instrument of FIG. 30 ;
- FIG. 32 is an exploded view of the coupler member, sew tip, and multi-lumen tube in the embodiment of the suturing instrument of FIG. 30 in which the needles are removed;
- FIG. 32A is a partial perspective view of an example of the needles of FIG. 31 extending through one end of the multi-lumen tube of FIG. 32 ;
- FIG. 33 is an exploded view of coupler member and sew tip of the embodiment of the suturing instrument of FIG. 30 in which the multi-lumen tube of FIG. 32 is replaced by two needle carrying tubes and one suture supply tube;
- FIG. 34 is an exploded view similar to FIG. 33 showing in more detail the needle carrying tubes of FIG. 33 ;
- FIG. 35 is a schematic diagram of the needle assembly of FIG. 31 extending through one end of a needle carrying tube of FIG. 33 ;
- FIG. 35A is a schematic diagram of alternative needle carrying tubes of FIGS. 33-35 ;
- FIG. 35B shown in more detail one end of the needle carrying tube of FIG. 35A ;
- FIG. 36 is an exploded view of the tissue engaging end of a further embodiment of the suturing instrument of the system of FIG. 1 in which the vacuum connection assembly of the instrument is not required;
- FIG. 36A is a side view of the tissue engaging end of the suturing instrument of FIG. 36 with the attachment tip partially broken away;
- FIG. 37 is a perspective view of the tissue engaging end of the suturing instrument of the system of FIG. 1 without a sleeve to provide rotational locking of the tissue engaging end in the attachment tip of the accessory tube;
- FIG. 38 is a side view of the attachment tip of the accessory tube to provide rotational locking with the tissue engaging end of the suturing instrument of FIG. 37 , in which the interior of the attachment tip is partially broken away to show the slots into which the tissue engaging end can engage;
- FIG. 39 is a cross-sectional view along lines 39 - 39 of FIG. 38 ;
- FIGS. 40 , 40 A, 41 , 42 , 42 A- 42 C, and 45 A- 45 D are diagrams illustrating an optional hydraulic steering mechanism for the tissue engaging end of the suturing instrument of FIG. 1 using a cylinder of FIGS. 42 and 42A or folding piston of FIGS. 42B-C and 45 A- 45 D; and
- FIGS. 43 , 43 A, 44 , and 44 A are diagrams illustrating an optional mechanical steering mechanism for the tissue engaging end of the suturing instrument of FIG. 1 .
- a system 10 for suturing including an accessory tube 12 and an endoscope 14 , referred to herein after as a gastroscope, or other type of flexible endoscope having a shaft 14 a coupled to the accessory tube, and a suturing instrument 16 .
- the suturing instrument 16 may be inserted in the accessory tube 12 as shown in FIG. 1 , and is removable from the accessory tube 12 as shown in FIG. 2 .
- the accessory tube 12 has access tubing 18 which is sufficiently flexible to be movable with the flexible shaft 14 a of the gastroscope.
- Tubing 18 is braid reinforced with a braid of stainless steel, nylon, or Kevlar, to maintain the integrity of the tubing's circular cross-sectional shape and avoid kinking as the shaft 14 a of the gastroscope bends when placed through the mouth into the gastrointestinal tract of a patient.
- the braiding may be located between two layers of tubing 18 , which are integrated with the braiding during their extrusion forming tubing 18 .
- the outer diameter of tubing 18 may be 0.263 inches, while the internal diameter of tubing 18 may be 0.231 inches, and is such that a tissue engaging end 16 a coupled to shaft 16 b of suturing instrument 16 can pass through the tubing.
- Tubing 18 may be composed of pebax, polyurethane, or other flexible plastics of medical grade.
- the accessory tube 12 further has a cannula 20 attached to tubing 18 through which instruments, such as suturing instrument 16 , may pass.
- Cannula 20 is describe is more detail later in connection with FIGS. 6 and 7 .
- Accessory tube 12 is shown as a separate component in FIG. 2 .
- Tube guides 22 couple tubing 18 to shaft 14 a of gastroscope 14 .
- Each tube guide 22 has an opening 22 a extending through the tube guide and a curved surface 22 b along its length which abuts the outer curved surface of shaft 14 a, as shown in FIGS. 1A .
- FIGS. 4 and 4A show the tube guide 22 in more detail.
- Tube guides 22 may be attached to shaft 14 a by a band of tape 24 having an adhesive layer to fix the tube guide to shaft 14 a. Other attaching means are also be used, such as glue.
- the diameter of opening 22 a is slightly larger than the outer diameter of tubing 18 such that the tubing 18 is slidable through opening 22 a to enable the accessory tube 12 to move in concert with flexing, bending, rotation, or other movements of the gastroscope 14 .
- Tube guides 22 maintain tubing 18 substantial coaxial with shaft 14 a of gastroscope 14 .
- Preferably, four tube guides are provided as shown in FIGS. 1 , 2 , and 3 , but other number of tube guides may be used.
- attachment tip 26 having two openings 26 a and 26 b to receive one end of tubing 18 , and the distal end 14 b of gastroscope 14 , respectively.
- Attachment tip 26 is shown in more detail in FIG. 1B , and as a separate component in FIGS. 5 and 5A .
- Tubing 18 is attached to attachment tip 26 , such as by glue or insert molding, while the gastroscope's distal end 14 a is held by friction and seats in a shelf or lip 26 c ( FIG. 5 ) which forms a stop limiting forward movement of distal end 14 a.
- the attachment tip 26 may be made of urethane or other molded plastic material.
- Gastroscope 14 may be any typical gastroscope, such as that manufactured by Olympus, Inc., Pendax, Inc., Vision-Sciences, or Welch Allyn.
- gastroscope 14 has at its upper end 14 c a handle 27 a, two dials 27 b to steer the gastroscope, and various buttons/knobs to control typical gastroscope operation.
- the distal end 14 b of the gastroscope has elements for imaging optics 28 a, illumination 28 b, water for cleaning imaging optics 28 c, and a biopsy or working channel 28 d representing tubing in communication with a port 27 c at upper end 14 c.
- a video display system 193 ( FIG. 29B ) is coupled to upper end 14 a, via a cable 27 d, to allow viewing of tissue from its distal end 14 b on a display via optics 28 a.
- a gastroscope is referred to herein, any other flexible endoscope may similarly be used.
- FIGS. 2 and 2 A illustrate the accessory tube 12 and gastroscope 14 when no instrument is located in the accessory tube.
- Cannula 20 may be a typical type of cannula providing a sealable passage to tubing 18 .
- cannula 20 is shown in FIGS. 1-3 , and in more detail in FIGS. 6 and 7 .
- Cannula 20 has a housing 20 a and a cap 20 b which is received in housing 20 a.
- Two seals 20 c and 20 d are provided in cannula 20 along a passage 21 from an opening 21 a through which the shaft of an instrument may pass into tubing 18 .
- Tubing 18 is received in an opening 20 f which extends into housing 20 a.
- Seal 20 c may be a duck-bill seal as illustrated in FIG. 7 .
- An optional auxiliary port 20 e has a bore 20 f which opens to passage 21 through which water, air, or vacuum may be provided through tubing 18 .
- a cannula with two seals is described, the cannula may alternatively have a single seal.
- Seal 20 d provides sealing about the shaft of an instrument, while seal 20 c provides sealing when no instrument is located in the accessory tube 12 .
- the assembly of the gastroscope 14 and accessory tube 12 when in the gastrointestinal or gastroesophageal tract of a patient provides the feature of enabling instruments, such as the suturing instrument, and the later to be described suture securing instrument, to be insertable and retractable about the distal end of the gastroscope, without requiring removal of the gastroscope. Further, normal functionality of the gastroscope in viewing is provided without any partial obstruction or loss of use of the working channel 28 d.
- An illustration of the system 10 in a patient's body is shown in FIGS. 29A-29F .
- Suturing instrument 16 represents the S EW -R IGHT® SR ⁇ 5TM manufactured by LaserSurge, Inc. of Rochester, N.Y., which has been modified to have a longer and partially flexible shaft 16 b extending from a housing 30 , and means for selectably establishing suction to capture tissue at its tissue engaging end 16 a.
- the tissue engaging end 16 a and needles thereto may be similar to that shown in U.S. Pat. Nos. 5,431,666, 5,766,183, or European Patent No. EP 0669101, filed Feb. 23, 1995 and granted Oct. 14, 1998, which are herein incorporated by reference
- the shaft 16 b represents an assembly of components 51 - 62 described below. Shaft 16 b is rigid along a first section 32 when it extends from opening 31 in housing 30 and then is flexible along a second section 33 until coupling to the tissue engaging end 16 a.
- the housing 30 has a body shaped like a pistol having a handle portion 30 a, and may be made of a two-piece construction of molded plastic.
- a pair of needles 34 and 35 extends from housing 30 through the shaft 16 b into the tissue engaging end 16 a.
- Each needle 34 and 35 has a non-tissue engaging end in the housing having a spherical member 34 a and 35 a, such as a ball or bearing, respectively, attached thereto.
- Both needles 34 and 35 and spherical members 34 a and 35 a may be a made of metal, such as surgical stainless steel.
- the spherical member 34 a and 35 a may have a bore into which the non-tissue engaging ends of the needles 34 and 35 , respectively, extend and joined thereto, such as by welding or brazing.
- the suturing instrument 16 includes an actuator member 36 representing a lever having two pins 36 a extending into holes in the sides of housing 30 upon which the actuator member is pivotally mounted in the housing.
- Actuator member 36 has a portion which extends through an opening 30 b ( FIG. 10 ) in housing 30 to enable pivotal movement about pin 36 a.
- An extension spring 38 is provided which hooks at one end in a notch 36 b of actuator member 36 and is wound at the other end around a pin 40 located in holes in the sides of housing 30 , such that the actuator member 36 is spring biased to retain actuator member 36 normally in a forward position, as shown for example in FIG. 9 .
- the body of housing 30 has a front portion 31 ( FIG.
- a notch 36 c is provided in the actuator member 36 which is shaped to received one of the non-engaging ends of needles 34 or 35 , i.e., spherical members 34 a or 35 a, to be driven forward by an operator pulling actuator member 36 to pivot actuator member 36 towards handle portion 30 a.
- Two grooves 36 d are provided by three fingers 36 e into which the needle 34 or 35 near the spherical members 34 a or 35 a, respectively, may lie.
- a retainer member 42 is fixed in housing 30 by two flanges 42 a above actuator member 36 .
- the retainer member 42 has a chamber 42 b having a lower opening 42 c to chamber 42 b and two grooves 42 d formed by fingers 42 e which allow the spherical members 34 a or 35 a of needles 34 or 35 , respectively, to be received in chamber 42 b to restrict movement of the needle when held therein.
- the lower surface 42 f of retainer member 42 is curved and faces correspondingly curved upper surface 36 f of actuator member 36 , such that the actuator member 36 is slidable along lower surface 42 f responsive to the operator pulling the actuator member.
- the instrument 16 has a needle selection mechanism having a selector lever (or arm) 44 which is rotationally coupled with a cam member 46 .
- the cam member 46 and selector lever 44 is supported by an adapter 48 in housing 30 .
- Adapter 48 is mounted in housing 30 by two flanges 48 a.
- the selector lever 44 is pivotally mounted by a pin 48 c extending upwards from adapter 48 at a hole 44 a through the lever.
- Selector lever 44 extends through an opening 30 c in housing 30 and has a downwardly protruding member 44 b which is received in a notch 46 a of cam member 46 to rotate cam member 46 in a pocket 48 b in the adapter 48 as the selector lever 44 is moved left or right.
- the cam member 46 may have a tapered surface 46 b to facilitate its rotation in pocket 48 b and two tapered apertures 46 c through which needles 34 and 35 respectively extend, as shown in FIG. 10B .
- the selector 44 is moved right which rotates the cam member 46 to position needle 34 down and needle 35 up, such that end 34 a is located in notch 36 c and end 35 a is located in chamber 42 b of retainer member 42 .
- the selector 44 is moved left which rotates the cam member 46 to position needle 34 up and needle 35 down, such that end 35 a is located in notch 36 c and end 34 a is located in chamber 42 b of retainer member 42 .
- the needle selector 44 may further have another downwardly protruding member 44 c which rides in a slot 42 g on the upper surface of retainer member 42 .
- the slot 42 g is contoured to have angled lower regions on either side of a raised region into which member 44 c can be located to releasably lock to retain the position of lever 44 left or right.
- the adapter 48 has a bore extending there through in which a needle spreader 50 is located. Needle spreader 50 has two channels 50 b and 50 c into which needles 34 and 35 are respectively located to increase the distance between the needles 34 and 35 as they extend toward cam member 46 , such that the needles are properly aligned to apertures 46 b in the cam member.
- a suture routing tube 47 is provided for suture thread in housing 30 .
- Suture routing tube 47 has one end received in a valve assembly 19 , described later below, at the bottom of handle 30 a of housing 30 and then extends through notches 30 d ( FIG. 10 ) along the interior of the left side of housing 30 , and a groove 50 a along needle spreader 50 ( FIGS. 10 and 11 ).
- a cross-section through needle spreader 50 and adapter 48 is shown in FIG. 12 .
- the other end of the suture routing tube 47 is then mounted in a hole 51 a through gasket member 51 .
- Gasket member 51 further has two holes 51 b and 51 c through which needles 34 and 35 , respectively extend.
- a cross-section of shaft 16 b through gasket member 51 is shown in FIG. 13 .
- the gasket member 51 may be made of medical grade rubber, such as Santoprene.
- a longitudinal guide member 53 is provided multiple tracks along its length, including two needle tracks 53 a and 53 b for needles 34 and 35 , respectively, and a suture track 53 c for suture thread extending from opening 51 a of gasket member 51 .
- a cross-sectional view of shaft 16 b through guide member 53 is shown in FIG. 14 .
- the guide member 53 may be made of extruded flexible material, such as Tecoflex®.
- a rigid tube 52 is provided which is D-shaped at one end 52 a is registered into a corresponding shaped opening in adapter 48 , and a threaded nut 54 having an opening which extends over mounting tube 52 and screws onto the end of the adapter 48 to secure tube 52 to housing 30 .
- FIG. 11 shows the gasket member 51 prior to being positioned in abutment to needle spreader 50 and in end 52 a of rigid tube 52 .
- gasket member 51 has a ring 51 d which frictionally engages the interior surface of tube 52 , hole 51 a of the gasket member is of a diameter such that the suture tube 47 tightly fits therein and provides a seal around suture tube 47 .
- the suture tube 47 may be held in place in hole 51 a by friction, but adhesive may also be used.
- FIGS. 11A and 11B show gasket member 51 in more detail. Holes 51 b and 51 c are of a larger diameter than the needle, except for a small section of holes 51 b and 51 c where the diameter reduces to form flaps 51 e and 51 f, respectively of gasket material which seal around needles 34 and 35 , respectively.
- gasket member 51 This enables movement of the needles back and forth while maintaining a seal about each needle.
- One feature of the gasket member 51 is that it enables sealing the shaft 16 b, such that negative pressure, i.e., suction, may be selectively applied down the shaft via a vacuum connection assembly 64 , as described later below.
- Coupler member 56 joins the non-flexible section 32 of the shaft 16 b provided by rigid tube 52 with the flexible section 33 of the shaft 16 b ( FIG. 8 ).
- Coupler member 56 may be composed of stainless steel.
- a cross-section of shaft 16 b through coupler member 56 is shown in FIG. 15 .
- the coupler member has a track 56 b for suture, tracks 56 c and 56 d for needles 34 and 35 , respectively, and a central hole 56 e.
- Guide member 58 On the side of the coupler member 56 opposite guide member 53 is another longitudinal guide member 58 which extends through the flexible section of shaft 16 b to the tissue engaging end 16 a.
- Guide member 58 like guide member 53 , is of an extruded flexible material, such as Tecoflex®.
- Guide member 58 has multiple tracks, including two needle tracks 58 a and 58 b for needles 34 and 35 , respectively, and a suture track 58 c for suture thread extending from track 56 b of coupler member 56 .
- a cross-sectional view of shaft 16 b through guide member 58 is shown in FIG. 16 .
- Two tabs 56 f extend from the coupler member 56 into tracks 58 d of guide member 58 .
- a wire 60 extends from the tissue engaging end 16 a through a central hole 58 e of guide member 58 and the central hole 56 e of coupler member 56 , and then partly into a center hole 53 e ( FIG. 14 ) extending into guide member 53 .
- the wire 60 extends partly through central hole 53 e to facilitate registration of guide member 53 to coupler member 56 and guide member 58 .
- the wire 60 is located in a central hole which extending into a sew tip 98 at the tissue engaging end 16 a and attached thereto, such as by welding or brazing, passed through guide member 58 via hole 58 e, and then extended through and in coupler member 56 , where it is attached to the coupler member, via a tube coupler 57 , such as by welding or brazing.
- FIGS. 17A and 17B The connection of coupler member 56 , guide member 58 and a sew tip 98 of the tissue engaging end 16 a is best illustrated in FIGS. 17A and 17B in which tabs 56 f of coupler member 56 are received in tracks 58 d at one end of guide member 58 , and tabs 100 from sew tip 98 are received in tracks 58 d at the other end of guide member 58 .
- Wire 60 extends through coupler member 56 , guide member 58 into a hole 98 h extends into the rear section 98 i of the sew tip 98 ( FIG. 21B ).
- the guide member 58 with the shrink wrap enables the flexible section 33 of shaft 16 b to bend and flex while maintaining the channels extending there through, while the wire 60 provide longitudinal support to the flexible section as it is attached to non-flexible section 30 at coupler member and the sew tip. Further, needles 34 and 35 are sufficiently flexible to bend without deformation within guide member 58 .
- tabs 56 a and 56 f of coupler member are registered into tracks 53 d and 58 d of guide members 53 and 58 , respectively, and then tracks 58 d of guide member 58 into tabs 100 of sew tip 98 .
- FIG. 17C shows the attachment of wire 60 , coupler member 56 , and flexible section 33 of instrument 16 in more detail, such that possible damage to guide members from the heat of welding or brazing of metal components is avoided.
- the coupler member 56 has a recessed circular opening 56 h to central hole 56 e at the end 56 g of coupler member 56 into which one end 57 a of a wire coupler tube 57 is located.
- Wire coupler 57 represents a metal tube having an outer diameter sized to be received in recessed opening 56 h and an inner diameter sized to receive there through wire 60 .
- wire coupler 57 Prior to attachment of coupler member 56 to guide member 53 , wire coupler 57 is first attached to coupler member 56 , such as by welding or brazing, about recessed opening 56 h prior to the assembly of the flexible section 33 components, i.e., sew tip 98 , and guide member 58 , to coupler member 56 .
- wire 60 which has not yet been passed through coupler member 56 , is attached, such as by welding or brazing, into hole 98 h ( FIG. 21B ) of sew tip 98 .
- Wire 60 is then slid through central hole 58 e of guide member 58 and hole 56 e of coupler member 56 , and the sew tip 98 at two tabs 100 frictionally engages into two tracks 58 d of guide member 58 at one end of guide member 58 .
- tabs 56 e of coupler member 56 frictionally engages into tracks 58 d.
- the guide member 53 and coupler member 56 of the assembly are received into the rigid tube 52 , such that guide member 53 abuts gasket 51 , and coupler member is attached to rigid tube by mechanical fastening by forming small dents in the metal of the tube 52 with a press into recessed four pockets 56 i ( FIG. 17A ), i.e., two on each side of the coupler member 56 .
- Vacuum connection assembly 64 for suturing instrument 16 is shown.
- Vacuum connection assembly 64 includes a front housing member 66 which has a circular opening 66 a to an interior chamber 66 b, and a rear housing member 68 having a circular opening 68 a extending there through.
- Rear housing member 68 has a first extension toward housing 30 providing a shaft 68 e having an annular flange 68 b and a second extension toward front housing member 66 providing a threaded shaft 68 c.
- Shaft 68 c is screwed in a threaded opening 66 c ( FIG.
- Circular opening 66 a is coaxial with circular opening 68 a through their respective housing members.
- a rubber O-ring 71 is provided in an annular groove in opening 66 a of the front housing member 66
- another O-ring 70 is provided in an annular groove in opening 68 a of rear housing member 68 , as illustrated in FIG. 18B .
- a fitting member 72 is received in front member 66 in a recessed pocket 66 e to a threaded opening 66 f extending to chamber 66 b, such that a port 74 is provided having a bore 75 to chamber 66 b.
- Fitting member 72 is threaded along its surface 72 a to enable the fitting member to screw into threaded opening 66 f of front housing member 66 .
- the components of vacuum connection assembly 64 may be made of stainless steel.
- the vacuum connection assembly 64 is placed on rigid tube 52 so that the tube extends through openings 66 a and 68 a, O-rings 70 and 71 , and chamber 66 b, and an opening 52 c in the rigid tube lies in chamber 66 b and faces bore 75 of the fitting member.
- the diameter of apertures 66 a and 68 b are slightly larger than the outer diameter of rigid tube 52 about opening 52 c.
- O-rings 70 and 71 engage the outer surface of rigid tube 52 to seal chamber 66 b, but for bore 75 and opening 52 c to suture track 53 c ( FIG. 18C ).
- Flange 68 b from rear housing member 68 is received in a pocket 37 ( FIG.
- a vacuum source may be applied via tubing (not shown) to port 74 , such that negative air pressure is provided in chamber 66 b which may be communicated via an opening 52 c of rigid tube 52 along a suture channel formed by suture track 53 c of guide member 53 to suture track 58 d of guide member 58 through track 56 b of coupler member 56 , down to the tissue engaging end 16 a.
- Vacuum connection assembly 64 may alternatively be coupled at port 74 to a source for air to provide positive air pressure along the same suture channel, i.e., to drive air down to the tissue engaging end 16 a.
- a valve 19 is provided at the bottom of handle 30 a, as shown in FIGS. 9 and 10 , having a valve seat 19 a and a valve controller 19 b, shown as separate components in FIGS. 19A and 19B .
- Valve seat 19 a is composed of medical grade rubber, such as Santoprene®, and has a hole 76 extending into an interior chamber 78 .
- One side 79 of this chamber 78 has a lip 80 about an opening 81 .
- Protruding into the chamber 78 facing opening 81 is a raised member 82 of the valve seat 19 a through which the hole 76 extends to an opening 84 , which is recessed near a surface 82 a of the raised member 82 .
- the recess of opening 84 forms the shape of an eye having two opposing corners 86 when valve 19 is open.
- Two opposing fingers 88 of the raised member 82 extend from the top and bottom of the eye of opening 84 .
- a valve controller 19 b composed of molded plastic, or other rigid material, has a circular section 90 having an opening 92 to an interior surface forming a cam 94 , and a recessed retainer ring 95 .
- Circular section 90 is received through opening 81 such that retainer ring 90 is captured by lip 80 to retain valve controller 19 b in valve seat 19 a.
- Fingers 88 and corners 86 of the raised member 82 of the valve seat lie against the surface of cam 94 of the valve controller 19 b.
- the cam surface is wider along one dimension and narrower along a perpendicular dimension, such that when the fingers 88 lie along the narrower dimension, they compress the recess of opening 84 into a closet slit to close valve 19 , and when fingers 88 lie along the wider dimension, the recess of opening 84 returns to its normal shape and the valve 19 is open. Adjusting the dimensions of the cam surface 94 a controls the amount of pressure applied to compress opening 84 , and thus the integrity of the closed valve's seal.
- Another hole 76 b ( FIG. 9 ) extends through opening 92 to the bottom 96 a of turn knob 96 of the valve controller.
- the suture routing tube 47 is received in hole 76 of valve seat 19 a, as shown in FIG. 9 , such that suture material from the tube can pass through openings 76 and 84 of the valve seat and then through hole 76 b of the valve controller.
- valve 19 is open when the finger 88 align along surface 94 a and 94 b of the cam 94 , and corners 86 are each received in corresponding detents 94 c and 94 d of cam 94 .
- a turn knob 96 of the valve controller 19 b is rotated as shown in FIG. 20B . This starts compressing fingers 88 against the surface of the cam 94 until the fingers 88 lie in detents 94 c and 94 d compressing opening 84 of the valve seat to close the valve, as shown in FIG. 20C .
- the turn knob 96 is again rotated until the corners 86 lie in detents 94 c and 94 d.
- the turn knob 96 may be rotated clockwise or counterclockwise to open and close valve 19 .
- Valve 19 may be closed to seal the suture tube 47 when suction is applied via vacuum connection assembly 64 , but allows suture to be drawn under slight tension through the valve.
- valve 19 may alternatively be used, such as shown in FIG. 19D , which provides a seal, but enables the suture to be drawn under slight tension through the valve.
- FIG. 19C the bottom of handle 30 a is shown in which the suture tube 47 is received in a duck-bill valve 128 providing a chamber 128 a and two flaps 128 b extending into the chamber along the length of suture 105 which extends through suture tube 47 between flaps 128 b and through an opening 129 in housing 30 .
- the two flaps 128 b meet along edges 128 c providing a seal about the suture 105 in chamber 128 a.
- FIG. 19C illustrates the valve when closed, when open flaps 128 b at edges 128 c may separate from each other.
- the tissue engaging end 16 a of the suturing instrument 16 is shown having the sew tip 98 which is mounted in a tip tube 102 , such that the front section 98 a of the sew tip extends from tube 102 .
- the mounting of the tip tube 102 to the sew tip 98 may be achieved by mechanical fastening by forming small dents in the metal of the tip tube 102 with a press into recessed four pockets 98 b, i.e., two on each side of the sew tip ( FIG. 17A ).
- the sew tip 98 has a gap 104 in a C-shaped jaw having two openings 98 c at one side of the gap through which each of needles 34 and 35 may extend to capture ferrules 103 having one end of suture material 105 located in openings 107 at the other side of gap 104 , and after each needle captures a ferrule, the needle retracts back into their respective opening 98 c carrying the suture material on its tip.
- a channel 98 d is provided in the sew tip which aligns with suture track 58 c of guide member 58 , as shown in FIG. 17B .
- the channel 98 d extends along the length of the sew tip and then fork into two channels, each leading to one of the two openings 107 having ferrules 103 to which the end of the suture thread is attached. Openings 107 retain ferrules 103 but are slotted to enable release of suture after a ferrule 103 is captured.
- a vacuum sleeve 106 is provided having a tube 106 a, and a rounded cap 106 b which closes one end of tube 106 .
- the cap 106 b has an edge 106 c which mates with the edge 106 d of tube 106 a and two extending flanges 110 which are received in tube 106 a to hold the cap in place ( FIGS. 21C and 21D ). Between flanges 110 the interior surface of the cap is angled to provide a ramp 112 ( FIG. 21B ). The sew tip 98 in tip tube 102 is received through the open end 106 f of tube 106 b, such that an opening 108 of tube 106 b is located over gap 104 of the sew tip.
- the two flanges 110 of cap 106 d register with the two sides of the forward part 98 g of the sew tip 98 to properly align sew tip 98 and tip tube 102 in the vacuum sleeve 106 .
- the opening 108 represents a cut into tube 106 a to provide a oval shaped window 108 a and a forward slot 108 b which extend from window 108 a to the end of tube 106 a meeting cap 106 b, such that the forward (ferrule carrying) part 98 g of the sew tip 98 partially extends through slot 108 b ( FIG. 21B ).
- Cap 106 b has a notch 106 e located adjacent slot 108 b at edge 106 d of tube 106 a ( FIG.
- the ramp 112 is negatively sloped at an angle towards slot 108 b, as shown in FIG. 21B , to facilitate the suturing process, as will be described later.
- Two fingers or prongs 103 extend from the sides of the tip tube 102 and are received in two corresponding openings 111 of the vacuum sleeve 106 to latch the sleeve in position over the sew tip.
- Guide member 58 extends into tip tube 102 as shown in FIG. 18 B 21 B.
- Shrink wrap or tubing 114 is then applied over tube 106 a, such that openings 111 are sealed closed, to complete the assembly of the vacuum sleeve 106 , as shown in FIG. 21A .
- a short metal ring 116 is placed over the end 102 a of the tip tube 102 and the edge of the shrink wrap 62 extending along shaft 18 b.
- shrink wrap 62 is first applied over shaft 18 b and tube 102 , and then cut back to an edge 106 a of ring 116 .
- Tubes 102 and 106 a are both made of metal, such as stainless steel, and cap 106 a may be made of molded plastic.
- a cross-section of tissue engaging end 16 a through the sew tip 98 , tip tube 102 , and vacuum sleeve 106 is shown in FIG. 17 .
- This vacuum sleeve 106 enables a vacuum or partial vacuum to be applied to the path of the suture following gasket member 51 , via the vacuum connection assembly 64 , to channel 98 d of the sew tip 98 , such that the upflow of air into the gap 104 of the sew tip through opening 108 of vacuum sleeve 106 can pull the tissue into the gap.
- the suction from the vacuum or partial vacuum is applied to gap 104 of the sew tip 98 via two openings 98 e in channel 98 d to two cavities 98 f each located on opposite sides of the sew tip in the space between the sides of sew tip 98 and vacuum sleeve 106 near gap 104 ( FIG. 21 ).
- cap 106 b as described herein is preferred, cap 106 b may be provided by a metal cap 118 , such as of stainless steel attached to the end of tube 106 a, and provides a small ramp 118 a.
- the tissue engaging end of suturing instrument 16 may be as described in U.S. patent application Ser. No. 09/686,420, filed Oct. 11, 2000, which is herein incorporated by reference.
- This patent application describes the loading of a length of suture material, i.e., thread, whose ends are affixed to ferrules in the sew tip 98 .
- the vacuum sleeve 106 is removed from tube tip 102 by pushing in fingers 103 to release them from openings 111 and then simultaneously pulling the vacuum sleeve 106 away from tube tip 102 .
- the vacuum sleeve 106 is replaced and latched back (i.e., fingers 103 in openings 111 ) onto the tube tip 102 and the loop of suture extends from the ferrules through the suture tracks 53 a and 58 a of guide members 53 and 58 to suture routing tube 47 , via track 56 b of the coupler member 56 and opening 51 a of the gasket member 51 , out holes 76 and 76 a of valve 19 .
- the suture material may represent monofilament suture material or braided suture material.
- FIGS. 22A-22I the operation of the suturing instrument 16 at the tissue engaging end 16 a is shown after the suturing instrument is located, via accessory tube 12 , near the tissue to be sutured.
- FIGS. 22A-22H show the process of applying one end of the suture through tissue 120 with needle 34 , the same process is repeated for the other end of the suture for needle 35 .
- Suturing with needles 34 and 35 may be provided in any order.
- the tissue engaging end 16 a is shown with suture material 105 loaded in the sew tip 98 , such that the two free ends of the loop of suture extend from the suture track 58 a of tube guide 58 , via a passage 98 d of the sew tip 98 , to two ferrules 103 coupled to the two suture ends in the sew tip 98 .
- Opening 98 c at one end of gap 104 face ferrules 103 in openings 107 for respectively needles 34 and 35 .
- the tissue engaging end 16 a is placed adjacent a first target area 121 in tissue 120 where the first end of the suture will be placed ( FIG. 22B ).
- Suction is then applied to pull the target area 121 of tissue 120 via gap 104 of the sew tip through opening 108 in the vacuum sleeve 106 to capture a fold 124 of tissue 120 at target area 121 ( FIG. 22C ).
- a vacuum source such as a vacuum pump 200 ( FIG. 29B )
- FIG. 29B provides suction to shaft 16 b, via tubing, to port 74 of the vacuum connection assembly 64 .
- the vacuum is communicated into gap 104 via opening 52 c of rigid tube 52 to the suction channel in shaft 16 b formed by suture track 53 c of guide member 53 , track 56 b of coupler member 56 , and then suture track 58 d through coupler member 56 to channel 98 d and cavities 98 f of the sew tip 98 .
- the suction is applied to cavities 98 f, however the suction may occur elsewhere about gap 104 , such as the space between the sew tip 98 and the interior surface of the vacuum sleeve 106 , or via openings 107 .
- the needle passes through the tissue ( FIG. 22D ) and then into ferrule 103 ( FIG. 22E ), such that the tip 122 of the needle is captured in the ferrule.
- valve 19 is closed, the suture may be drawn through the valve seat 19 a.
- the actuator member 36 rotates against the bias of spring 38 until needle tip 122 engages ferrule 103 .
- the amount of rotation of actuator member 36 depends on the distance the needle must transverse before engaging a ferrule, such distance may vary depending on the degree of flexing of shaft 16 b along its flexible section 33 .
- the needle 34 is then retracted by the operator releasing actuator member 36 , to pass the needle and captured ferrule 103 back through the tissue ( FIG.
- FIG. 22F The suction generates negative air pressure near the tissue 120 sufficient to pull the tissue into gap 104 of the sew tip 98 without damaging the tissue.
- the suction is then discontinued, such as by turning off the vacuum source 200 , and the valve 19 opened to release the tissue from gap 104 of the sew tip ( FIG. 22H ).
- the end of the suture thread extends from the captured ferrule on the needle tip through tissue 120 to channel 98 d.
- the suture releases through the slot extending along opening 108 b and the suture extends from captured ferrule through the tissue to channel 98 d.
- FIG. 22I shows the result after both suture ends are placed through tissue, where one suture end extends through tissue fold 124 and the other through fold 126 .
- the second target area may be located directly after placing the first suture end through the tissue by rotating the housing 30 of the instrument 180 degree to rotate the tissue engaging end 180 degrees. The entire operation is observed by the operator via the gastroscope, and in this manner, the first and second target located by the operator in the tissue.
- the operator may be a surgeon, gastroenterologist, or other skilled physician.
- the suturing instrument may operate to apply a suture without suction if the target area of tissue can be sufficiently received in gap 104 of the sew tip 98 .
- the target area may represent a raised portion of tissue to be sutured.
- the suturing instrument operating without section may be used with the vacuum sleeve 106 removed from the tissue engaging end 16 a, such as shown for example in FIG. 23 .
- the suturing instrument 16 is removed from the accessory tube 12 , which pulls the loop of suture, which extended from housing 30 , down to tissue 120 .
- the suture follows from channel 98 d of the sew tip over the ramp 112 and notch 106 e of cap 106 b.
- the suture may then be secure by a suture securing instrument 130 described below.
- Suture securing instrument 130 of the system is shown having a housing 132 similar to housing 30 of suturing instrument 16 .
- Suture securing instrument 130 represents the Ti-K NOT® TK ⁇ 5TM manufactured by LaserSurge, Inc. of Rochester, N.Y., except that its shaft 134 is longer and partially flexible, and means are provided for calibrating the length of a drive wire to the distal end 136 of the instrument 130 .
- the distal end of instrument 130 may be similar to that described in U.S. Pat. Nos. 5,669,917, 5,643,289, 5,520,702, or European Patent Application No. 95102587.3, filed Feb. 23, 1995 and published Feb. 2, 1994 under Publication No.
- the suture securing instrument 130 includes an actuator member 138 representing a lever having two pins 138 a extending into holes in the sides of housing 132 upon which the actuator member is pivotally mounted in the housing.
- Actuator member 138 has a portion which extends through an opening 132 a in housing 132 to enable pivotal movement about pin 138 a.
- a extension spring 140 is provided which hooks at one end in a notch 138 b of actuator member 138 and is wound at the other end around a pin 141 located in holes in the sides of housing 132 , such that the actuator member 138 is spring biased to retain actuator member 138 normally in a forward position, as shown for example in FIG. 24A .
- the body of housing 132 has a front portion 132 b providing a stop that limits the pivotal movement of the actuator member 138 .
- a pivot barrel 142 is coupled by a pin 144 which extends through an opening 142 a through the pivot barrel and two holes 143 between flanges 144 of actuator member 138 .
- a turnbuckle 146 is provided representing a tubular member which has an interior surface right-hand threaded from one end and left-hand threaded from the other end. The turnbuckle 146 is attached to a threaded circular end 142 b of pivot barrel 142 and then to the threaded circular end 148 a of a ball connector 148 .
- the ball connector has a ball 148 b having a hole 148 c there through.
- Drive tube 150 has one end 150 a into which ball 148 b is received and then coupled to the tube, via a pin 149 , which extend through hole 148 c of the ball 148 b and two holes 150 c in drive tube 150 .
- An adapter 152 is received in the other end 150 b of the driver tube 150 and has a hole partially extending there through in which is received and attached a drive wire 154 .
- the adapter 152 is mounted in driver tube 150 for rotational movement about an annular groove 152 a of the adapter 152 .
- Multiple detents (not shown) are formed in the tube 150 , such as by deforming the metal by pressure, over the annular groove 152 a. The detents extend into the annular groove 152 a to form a track guide within which the adapter 152 may be rotated.
- FIG. 24A Another adapter 156 is provided which has flanges 156 a received in the two sides of housing 132 .
- a rigid tube 158 having an end 158 a which is D-shaped is registered into a corresponding shaped opening in adapter 156 , and a threaded nut 160 having an opening which extends over mounting tube 158 and screws onto the end of the adapter 156 to secure tube 158 to adapter 156 .
- Rigid tube 158 extends from housing 132 via an opening 130 d in the housing.
- the assembly of components 142 , 146 , 148 , 150 , 152 , and 154 described above are received in the adapter 156 and through rigid tube 158 , as shown in FIG. 24A .
- FIG. 24C A cross-section of the adapter 156 and rigid tube 158 at pin 149 is shown in FIG. 24C .
- Cross-section of shaft 134 through the rigid tube 158 at the drive tube is shown in FIG. 24D , and at the adapter 152 in FIG. 24E .
- the drive tube 150 is moveable through rigid tube 158 .
- At the other end 158 b of the rigid tube 158 is another adapter 162 which is cylindrical and has a central hole 162 a extending there through.
- the adapter 162 is mounted in tube 158 by mechanical fastening in which small dents in the metal of the tip tube formed with a press into two slots 162 b on either side of the adapter 162 .
- the drive wire 154 extends through hole 162 a of the adapter 162 and into an extension tube 164 which extends from the adapter 162 to the distal end 136 of instrument 130 .
- Extension tube 164 is a stainless steel tube having for example, an inner diameter of 0.041 inches and an outer diameter of 0.059 inches, and is mounted in hole 162 a of adapter 162 , such as by welding or brazing, while enabling movement of the drive wire through adapter 162 and extension tube 164 .
- Drive wire 154 may be, for example, stainless steel music wire.
- a cross-section of shaft 134 b through extension tube 164 is shown in FIG. 24F .
- Pivot barrel 142 , turnbuckle 146 , ball connector 148 , drive tube 150 , adapter 152 , rigid tube 158 , and adapter 162 may be made of metal, such as stainless steel, while adapter 156 may be made of molded plastic.
- a tip tube 166 is provided having an end 166 a into which is inserted a couple member 168 having an edge 168 a which mates along the edge 166 b of tip tube 166 .
- the end 164 a of extension tube 164 is received into a central hole 168 b through coupler member 168 in which the drive wire 154 extends through the coupler member 168 and is received and attached in opening 171 ( FIG. 25C ) in a wedge tip section 170 , where it is attached thereto, such as by welding or brazing.
- the wedge tip section 170 has a slot 170 a partially there through into which is received the hammer and anvil section 172 , such that the hammer and anvil section is slidable in slot 170 a. Sections 170 and 172 are received in the tip tube 166 .
- a pin 176 extends through two holes 166 d and an opening 172 a through hammer and anvil section 172 to retain section 172 in tube 166 .
- a chamber 173 is provided in the hammer and anvil section into which a securing sleeve member 174 ( FIG. 25B ) is located.
- the securing sleeve member 174 may be a Titanium KnotTM titanium tube manufactured by LaserSurge, Inc. of Rochester, N.Y. Cross-sections through the distal end 136 of the suture securing instrument are shown in FIGS. 24G and 25C .
- the wedge tip section has an upper member 170 b and a lower member 170 d having a knife 170 d when wedge tip section 170 is driven forward upper member 170 b abuts ramp 172 d of the hamper and anvil section 172 to first push hammer 172 b down to deform and crimp sleeve member 174 against anvil 172 c, and then knife 170 d cut sutures extending from sleeve member 174 near opening 166 e of tip tube 166 .
- wedge tip section 170 and the hammer and anvil section 172 provides for crimping the sleeve member to retain the suture and then cuts the suture in response to forward movement of the drive tube 150 and drive wire 154 .
- Drive tube 150 and drive wire 154 are moved forward by an operator pulling actuator member 138 towards handle 132 c of housing 132 , as will be described in more detail in connection with FIG. 27A-H .
- Rotation of adapter 152 in tube 150 facilitates freedom of wedge tip 170 to translate, or tilt, along its center axis, which extends in the direction of wire 154 , as the wedge tip is driven forward against the ramped surface of hammer 172 b.
- Rotational movement of actuator member 138 is enabled by pivoting of the pivot barrel 142 about the axis defined by pin 144 in flanges 145 .
- tube 164 Before attachment of the distal end 136 to extension tube 164 through which drive wire 154 extends, tube 164 is passes through a flexible plastic tubing 178 , such as of Tygon. This tubing 178 extends from end 158 b of rigid tube 158 , until distal end 136 when mounted to extension tube 164 . The diameter of tubing 178 is substantially matched to the outside diameter of tube 158 and tip tube 166 . A shrink wrap layer 180 is applied on the entire length of shaft 134 of instrument 130 until distal end 136 .
- a flexible plastic tubing 178 such as of Tygon. This tubing 178 extends from end 158 b of rigid tube 158 , until distal end 136 when mounted to extension tube 164 .
- the diameter of tubing 178 is substantially matched to the outside diameter of tube 158 and tip tube 166 .
- a shrink wrap layer 180 is applied on the entire length of shaft 134 of instrument 130 until distal end 136 .
- the entire length of the instrument 130 is such that it can extend through accessory tube 12 in which its shaft 134 has a non-flexible section 134 a defined by the extend of rigid tube 158 , and a flexible section defined by the extent of extension tube 164 in tubing 178 .
- the shaft 134 may be 31.5 inches in length, where its non-flexible section 134 a is 12.0 inches in length, and the flexible section 134 b is 19.5 inches in length.
- FIGS. 26A-26D the loading of sleeve member 174 into the distal end 136 of the suture securing instrument 130 is shown using a flexible holder 182 having a outer groove (not shown) around which a wire 184 is passed to forming a loop.
- This loading holder is commercially available as a Ti-K NOT® TK ⁇ 5TM Quick LoadTM unit from LaserSurge, Inc., Rochester, N.Y. Holder 182 may be made of molded rubber, and having an opening 182 a for the fingers of an operator.
- the ends of the wire loop 184 are attached to a C-shaped or curved handle 186 , which may be composed of metal.
- a sleeve member 174 is slid along ring 186 until reaches the end of the ring at 186 a ( FIG. 26A ).
- the ring 186 is then passed through chamber 173 of the distal end 136 between the hammer 172 b and anvil 172 c of section 172 and then exits through opening 166 e of the tip tube 166 ( FIG. 26B ), until sleeve member 174 is located in chamber 173 ( FIG. 26C ).
- the flexible holder 184 may then be removed ( FIG. 26D ). Referring to FIGS.
- FIGS. 26G-26I the loading of the two ends of a loop of suture 105 through a loaded sleeve member 174 in the distal end 136 of the suture securing instrument 130 is shown.
- the two ends of suture 105 are passed through the wire loop 184 ( FIG. 26E ), as shown by arrow 188 , and are captured by the wire loop as the C-shaped handle 186 is used to pull the wire loop through the sleeve member 174 ( FIG. 26F ) and opening 166 e of the tube tip 166 , thereby pulling the two ends of the loop of suture through the sleeve member and opening 166 e in the direction indicated by arrows 190 - 192 ( FIGS. 26G-26I ).
- FIGS. 27A-27H shows the operation of suture securing instrument 130 to secure and cut the suture.
- the instrument With the ends of the loop of suture 105 extending through the sleeve member 174 at the distal end 136 of the suture securing instrument 130 , the instrument may be inserted into the accessory tube 12 down to the tissue through which the suture loop extends. The ends of the suture are pulled through the distal end 136 , until sleeve member 174 is located adjacent the tissue ( FIG. 27A ).
- FIGS. 27B-27E illustrates the downwards movement of the hammer deforming on the sleeve member as the wedge tip section 170 is driven forward.
- the knife 170 d at the lower member 170 c of the wedge tip section 170 is also driven forward against the suture ( FIG.
- FIGS. 28A-28M and 29 A- 29 F the overall operation of system 10 will now be described in which FIGS. 28A-28M illustrate examples of the images on a display 193 provided by the gastroscope 14
- FIGS. 29A-29F illustrate the relative position of the gastroscope 14 , accessory tube 12 , and instruments 16 and 130 during suturing and suture securing.
- the gastroscope 14 and attached accessory tube 12 are inserted through the mouth 195 down the esophagus 196 and into the stomach 198 where the suturing will take place ( FIG. 29A ).
- the suturing instrument 16 with a loop of suture 105 loaded is then inserted into the accessory tube 12 via cannula 20 , until the distal end 16 a passes through attachment tip 26 ( FIGS. 28A and 29A ).
- the tissue engaging end 16 a of the suturing instrument 16 is viewable to the operator on display 193 through the gastroscope ( FIG. 28A ).
- the valve 19 With the target area of the tissue located, the valve 19 is closed, and suction is applied to instrument via a vacuum source 200 and control (or regulator) 202 via tubing 201 to pull the tissue into gap 104 of sew tip 98 , as described earlier ( FIG. 28B ).
- Control 202 may be integrated in vacuum source 200 or along tubing 201 , and is used to selectably enable and disable suction to the sew tip 98 in vacuum sleeve 106 .
- a first one of needles 34 or 35 is then extended and retracted by the operator, as described earlier, to locate the first end of the suture in the tissue.
- the suction is then disabled, valve 19 opened, and the sew tip is lifted leaving the suture extending through the tissue ( FIGS. 28C , 28 D, 28 E, and 28 F).
- the target area for the second end of the suture is then located, valve 19 closed, and vacuum again enabled to pull the tissue into the sew tip 98 ( FIG. 28F ).
- FIG. 28G shows an image of the first and second ends of the suture in the tissue.
- the suturing instrument 16 is then removed from the accessory tube as shown in FIG. 29C , pulling a loop 105 a of suture 105 through the stomach tissue ( FIGS. 28H-28J ).
- the ends of the suture material are cut from the suturing instrument 16 and then loaded through the suture securing instrument 130 which has been loaded with a sleeve member 174 , as shown in FIG. 29D .
- the suture securing instrument 130 is then inserted into the accessory tube 12 while gentle tension is applied to the free ends of the loop of suture ( FIG. 28K ).
- the distal end 136 of the suture securing instrument passes through the attachment tip 26 and is located near the suture loop extending from the tissue ( FIG. 28L ).
- the suture securing instrument 130 is positioned adjacent to the tissue, appropriate suture tension applied and the instrument is then actuated as described earlier to crimp and cut the sleeve member ( FIG. 28M ), and then the instrument 130 is removed leaving the crimped sleeve member 174 a to close the suture ( FIG. 28N ).
- FIG. 29F illustrates the patient after the suture is closed and the suture securing instrument is removed.
- the gastroscope 14 and attached accessory tube 12 remains in the patient during both the suturing and suture securing operations, and this procedure does not require the use of an overtube. If additional suturing is required, the suturing instrument 16 may be reloaded with another suture loop and above described procedure repeated with the suture securing instrument reloaded with another sleeve member to secure the suture closed. In this manner, multiple sutures may be made in the stomach tissue with a single insertion of the gastroscope 14 . When suturing is completed, the gastroscope 14 and attached accessory tube 12 are removed from the patient.
- suturing instrument 16 and suture securing instrument 130 are described for use with gastroscope 14 , instruments 16 and 130 may be used separately from the gastroscope 14 and accessory tube 12 . Further, suturing instrument 16 and suture securing instrument 130 may pass through an internal channel 28 d ( FIG. 1B ), often called a working or biopsy channel, provided in gastroscope 14 to its distal end 14 a sized to receive the respective shaft of the instrument.
- an internal channel 28 d FIG. 1B
- FIGS. 30-35 another embodiment of the suturing instrument 16 is shown to provide additional flexibility within section 33 of shaft 16 b of the instrument. This additional flexibility facilitate further freedom for section 33 to flex in the accessory tube 12 with the flexing of gastroscope shaft 14 a in positioning the distal end 14 b of the gastroscope.
- Suturing instrument 16 is the same in this embodiment except for the components in section 33 between coupler member 56 and sew tip 98 .
- Needles 34 and 35 in this embodiment are illustrated in FIG. 31 as needle assembly 203 .
- needle assembly 203 for needle 34 is shown, since needles 34 and 35 are identical.
- a needle driver 204 is coupled to ball 34 a by welding or braising into a hole in the ball.
- Needle driver 204 is a stainless steel wire or tube.
- a cable 206 is received in a hole 205 in one end 204 a of needle driver 204 .
- a spring 207 is installed at one end 207 a over the cable 206 and attached, such as welded or crimped, to end 204 a of the needle driver 204 .
- the other end of cable 206 is received in a hole 209 at end 208 a of needle 208 , and the end 207 b of spring 207 is attached such as welded or crimped, to end 208 a of the needle.
- Cable 206 is a stainless steel wire or braided cable.
- Spring 207 is a stainless steel extension spring which is normally compressed, and has an inner diameter slightly larger than the outer diameter of cable 206 .
- inner diameter of spring 207 may be 0.020 inches, and the outer diameter of cable 206 may be 0.018 inches.
- the outside diameter of spring 207 may be matched to the outside diameters of needle driver 204 and needle 208 .
- the length of needle driver 204 , needle 208 , and cable 206 in spring 207 is such that the tip 122 of the needle 208 lies in the sew tip 98 when the needle is fully retracted.
- Needle assembly 203 for each of needles 34 and 35 extends through a multi-lumen tube 210 which is attached at end 210 a to coupler member 36 by tabs 56 f being received in corresponding pockets 212 at end 210 a, and is attached to sew tip 98 by tabs 100 of sew tip 98 in pocket 214 at end 210 b.
- needles are not shown in FIG. 32 .
- Multi-lumen tube 210 is made of flexible material, such as plastic, polyurethane, or pebex, and has two holes 216 through which needles 34 and 35 , respectively, each extend, as best shown in FIG. 32A , where the spring 207 and needle 205 are shown through holes 216 .
- the holes 216 have a diameter slightly larger than the outside diameter of the spring 207 .
- the tube 210 is longitudinally reinforced, such that it cannot be substantially stretched or elongated. Such longitudinally reinforcement of the tube may be provided by a stainless steel kevlar, or nylon weave installed in the tube when it is extruded, or the weave may be adhesively bonded to the outer surface of tube 210 .
- a suture hole 218 extends through tube 210 for passage of suture, and negative or positive air pressure, similar to hole 58 d of guide member 58 .
- End 204 a of needle driver 204 and end 208 a of needle 208 are located in tube 210 for each needle in holes 216 . Attachment of tip tube 102 , ring 116 , and sew tip 98 is the same as described earlier.
- suturing instrument 16 in this embodiment is the same as described earlier, except that when actuator member 36 of instrument 16 is pulled by an operator for needle 34 or 35 , forward movement is translated to needle 208 via needle driver 204 and spring 207 , which compresses to assist in pushing forward needle 208 in sew tip 98 .
- actuator member 36 When actuator member 36 is retracted, the cable 206 and spring 207 assist in pulling needle 208 back.
- the multi-lumen tube 210 may be replaced by needle carrying tubes 220 and suture supply tube 222 .
- the needle assembly 203 for each of needles 34 and 35 extends through tubes 220 , respectively, as shown in FIGS. 33 and 34 , while the suture supply tube 222 provides a path for suture to sew tip 98 , and also can provide negative (or positive) air pressure, as described earlier via vacuum connection assembly 64 .
- Supply tube 222 extends from chamber 66 b of vacuum connection assembly 64 through hole 53 c of guide member 53 , through suture track 56 b of coupler member 56 , and then along flexible shaft section 35 to sew tip 98 .
- Tubes 220 and 222 may be made of flexible stainless steel tubing or reinforced plastic, pebex, or polyurethane tubing, or nickel titanium tubing, such as nitnol.
- FIG. 35 shows needle assembly 203 at one end of tubing 220 .
- shrink wrap 62 FIG. 10
- the tubes 220 may each represent a wound spring 234 with outer sheath 236 , such heat shrink tubing, on the outside surface of the spring 234 , as shown in FIGS. 35A and 35B .
- the interior diameter of the spring 234 is slightly greater than the outside diameter of needle assembly 203 extending there through.
- the outer sheath 236 is shrunk to the spring only at the ends 234 a and 234 b of the spring 234 , such that elongation of spring 234 is restricted.
- the interior diameter of outer sheath 236 is larger than outside diameter of spring 234 to allow flexure of spring 234 .
- FIGS. 36 and 36A a further embodiment of suturing instrument 16 is shown in which suction to the sew tip is provided without vacuum connection assembly 64 .
- both the vacuum connection assembly 64 and opening 52 c to rigid tube 52 is removed, and an opening 224 is provided through the shrink wrap 62 to suture track 58 c of guide member 58 .
- An additional ring seal 227 ( FIG. 36A ) is provided in the opening 26 b extending through attachment tip 26 .
- Ring seal 227 is composed of the same material as attachment tip 26 , and represents a ring extending from the interior surface of the opening 26 b having a diameter slightly smaller than the largest diameter of tissue engaging end 16 a.
- the tissue engaging end 16 a can pass through the seal 227 , while ring seal 227 engages the outer diameter of the tissue engaging end.
- Suction may then be applied via cannula port 20 e ( FIG. 6 ) of the accessory tube 12 and communicated through opening 224 to the suture channel, i.e., suture track 58 c and channel 98 d to cavities 98 f gap 104 of the sew tip 98 , as described earlier, when instrument 16 is located through accessory tube 12 .
- This suction may be provided from vacuum source 200 ( FIG. 29B ) through controller unit 202 and tubing 201 to port 20 e, rather than to the vacuum connection assembly 64 .
- system 10 may optionally have positional locking of tissue engaging end 16 a to lock the rotational position and to limit forward longitudinal travel of the tissue engaging end 16 a of the suturing instrument in attachment tip 26 of the accessory tube 12 .
- Such locking is provided by adding one or more protrusion members 226 to ring 116 of tissue engaging end 16 a.
- ring 116 may have two protrusion members located 180° apart along the outer circumference of ring 116 .
- These protrusion members 226 may be made of stainless steel or molded from plastic, and attached, such as adhesively bonded, or if medal by welding or brazing, to the outer surface of ring 116 .
- Protrusion members 226 are shaped to be received by slots 228 in opening 26 b extending through attachment tip 26 .
- slots 228 are provided at 30 degree increments about the interior surface of opening 26 b, such that two protrusion members 226 may be received in one of four opposing (180° apart) pairs of slots 228 . Lesser or greater numbers of slots may also be provided.
- Each slot 228 extends from end 230 of attachment tip 26 partially into opening 26 b to provide a stop 231 .
- the height of the protrusion member 226 from the outer surface of ring 116 is slightly less than the depth of the slots 228 , and width of the protrusion members 226 is slightly less than the width of slots 228 , such that protrusion members 226 can easily engage with an opposing pair of slots 228 .
- Protrusion members 226 each have a forward round-shaped end 226 a that facilitates the alignment of the protrusion members 226 in slots 228 to limit instrument 16 rotation and forward travel.
- the distal end 14 a of the gastroscope 14 can view the vacuum sleeve, and partially the sew tip therein, prior to engagement of protrusion members 226 in a pair of opposing slots 228 .
- the operator then can precisely locate the position of gap 104 of the sew tip with respect to a tissue target area 121 ( FIG. 22B ), as described earlier.
- the operator slightly rotates the instrument at housing 30 , such by handle 30 a, and pushes the instrument to locate and engage the protrusion member 226 of ring 116 of the tissue engaging end 16 a in the closest pair of opposing slots 228 in opening 26 b of the attachment tip 26 which corresponds to the desired aligned rotational position of the sew tip's gap 104 with respect to the tissue target area, until protrusion members' end 226 a abut stop 231 .
- the tissue engaging end 16 a is so rotationally locked in position, the risk of rotational misalignment of the sew tip gap 104 when tissue is captured therein is reduced.
- the operator rotationally unlocks tissue engaging end 16 a by pulling the instrument handle 30 slightly back which disengages the protrusion members 226 from slots 228 .
- the suturing instrument 16 may have a steering mechanism for flexing needle engaging end 16 a.
- This steering mechanism includes a control cylinder 238 having walls defining an interior chamber 240 having therein a plunger or piston 242 attached to the end of a threaded shaft 244 a, which is held in the chamber 240 by a threaded nut 246 ( FIG. 40A ).
- the threaded nut 246 is attached to the chamber 240 by insert molding.
- a thumb wheel 248 attached to the turn screw 244 enabled the shaft 244 a of the turn-screw to rotate along threaded nut 246 and control the position of the piston 242 in chamber 240 .
- Piston 242 has a rubber ring seal 243 which engages the interior surface 240 b of chamber 240 .
- An opening or outlet 248 at one wall of chamber 240 provides a flow path for the volume 241 of liquid 245 contained in the chamber 240 , where this volume 241 is defined by the surface 242 a of the piston 242 facing opening 248 and the interior surface 240 b of the chamber 240 .
- At least one exterior surface of a wall of control cylinder 238 is molded into housing 30 , or the control cylinder 238 is applied by adhesive to the outer surface of housing 30 .
- Shaft 244 a and nut 246 may be made of stainless steel, while walls of chamber 240 , piston 242 and thumb wheel 248 may be made of plastic, such ABS.
- a flexible tube 250 is coupled at one end to outlet 248 and extends through an opening 252 located in the rigid tube 52 after gasket member 51 and before vacuum connection assembly 64 , and then tune 250 follows a path along one of tracks 53 d of guide member 53 in rigid tube 52 , and through a hole 254 of coupler member 56 extending through its tab 56 a and 56 d (as shown in dashed lines in FIG. 41 ). From coupler member 56 , the tube 250 extends along one of tracks 58 d of guide member 58 to a cylinder 256 located in the track 58 d before sew tip 98 ( FIG. 42 ).
- tube 250 may be made of flexible plastic material. As shown in FIG.
- cylinder 256 has walls defining a interior chamber 256 a having an opening 256 b in one wall to this chamber which the other end of tube 250 is connected, such as by adhesive bonding.
- a piston or plunger 256 c in chamber 256 a is coupled to a rod 258 extending through an opening 256 d in a wall of the chamber.
- the surface 256 e of piston 256 c faces opening 256 b and is positionable in chamber 256 a to change the volume 257 of liquid 245 contained in the chamber, where volume 257 is defined by surface 256 e of the piston 256 c and the interior surface 256 f of cylinder 256 .
- Rod 258 has at its end 258 a a hole 258 b into which a flexure member 260 is attached, such as by welding or crimping.
- Flexure member 260 extends into a hole in one end of tabs 100 of sew tip 98 , and is attached thereto by welding or crimping.
- Flexure coupler 260 allows for possible misalignment between rod 258 and tab 100 of the sew tip 98 .
- Cylinder 256 is fixed in place in one of tracks 58 d, such as by frictionally engagement when shrink wrap tubing 62 is applied over guide member 58 , or may be bonded by adhesive.
- the components of cylinder 256 may be made of stainless steel, except piston 256 c which may be made of rubber.
- an operator of the suturing instrument 16 turns the thumb wheel 248 changing the volume of fluid 245 in chamber 240 , and moving the fluid into or out of outlet 248 and tube 250 .
- the volume of fluid 245 in chamber 256 c of cylinder 256 changes, and piston 256 c and rod 258 moves in cylinder 238 causing the rod to extend or retract to flex tissue engaging end 16 a, via flexure coupler 260 .
- arrows 239 indicate flexure of the tissue engaging end 16 a of instrument 16 .
- Fluid 245 may be, for example, water. This provide for a hydraulic steering mechanic which an operator of the instrument 16 can use to provide additional control in positioning the tissue engaging end during suturing, such positioning being independent of other steerability of the tissue engaging as may be provided by flexure of gastroscope's shaft 14 b.
- cylinder 256 may be replaced by a folding piston 262 , as shown in FIG. 42B and in more detail in FIG. 42C .
- Folding piston 262 has walls defining a cavity 262 a which can longitudinally expand or contract due to changes in volume 263 of liquid 245 contained in the cavity from movement of the fluid through an opening 262 b in one of the walls to which tube 250 is connected, such as by adhesive bonding.
- Rod 258 is attached to end 262 d of folding piston 262 , by adhesive bonding or is molded to end 262 d.
- Folding piston 262 may be made of plastic, stainless steel, or of heat shrink tubing.
- Folding piston 262 can be manufactured with a process using thin walled transparent or white heat shrink plastic tube 270 made from a non-elastic plastic, like polyester.
- FIG. 45A shows dark, light absorbing, lines 271 printed directly onto the tube 270 when it is collapsed flat.
- FIG. 45B shows the same tube 270 having plugs 273 with openings 262 b into the tube, and pressurized with a medium (not shown), such as water or air, through conduits to one or both openings 262 b.
- a medium such as water or air
- An appropriate fluence of light, such as produced by a laser, for a specific duration to generate heat along such dark lines of the tube 270 provides controlled radial and axial shrinkage of the tube ( FIG. 45C ).
- Such changes to the tube shape permits longitudinal folding of tube 270 , as indicated by arrow 272 ( FIG. 45D ).
- the tube can collapse in length by folding in near the heat shrunk zones 274 , and thus provide folding piston 262 .
- the folded zones 274 will reexpand longitudinally to re-establish the length of the folding piston 262 .
- piston length is readily altered.
- light activated thermal modification of heat shrink tubing can be achieved by using a well controlled circumferential application of focused light, such as laser light, or by careful masking of the heat shrink tubing, or by placing a compliant marked mandrel or tube within a clear heat shrink tube and exposing to appropriate lighting conditions.
- a wire 263 may replace tube 250 , such that a mechanical steering mechanism is provided. As shown in FIG. 44 , wire 263 follows the same path as tube 250 , except that a piston in no longer required in cylinder 238 . Instead, the wire 263 is coupled in cylinder 238 to shaft 244 a to a ball 265 , which is retained in a socket 267 formed at the end of the shaft 244 a.
- a cap 269 has a hole for wire 263 and is received and attached to the socket, such as by welding or brazing, to retain the ball onto the socket, but enable rotation of the ball so that the rotation of the shaft 244 a is not transferred to the wire 264 .
- the wire passes through a tube 266 , such as made of stainless steel extending between outlet 248 and opening 252 of the rigid tube 52 ( FIG. 44 ).
- Tube 266 is attached to opening 252 , such as by welding or brazing.
- the wire passes along one of tracks 53 d of guide member 53 extending with the guide member through rigid tube 52 , and then through hole 254 of coupler member 56 through its tab 56 a and 56 d, along one of tracks 58 d of guide member 58 to the sew tip 98 ( FIG. 44A ).
- Wire 262 is attached to a hole 268 extending into tab 100 of the sew tip 98 , such as by welding or brazing.
Abstract
A system for endoscopic suturing is provided having an endoscope, such as a gastroscope, with a distal end locatable in the body of a patient and a flexible shaft extending to the distal end, a flexible accessory tube coupled to the endoscope to be movable relative to the endoscope's shaft, and a tip coupled to the shaft of the endoscope having an opening through which one end of the accessory tube is received. A tissue suturing instrument is provided having a partially flexible shaft locatable through the accessory tube, and a tissue engaging end coupled to the shaft. The tissue engaging end has a vacuum sleeve enabling suction to be selectably applied at the tissue engaging end to capture tissue through an opening in the vacuum sleeve. Two needles are provided which extend through the shaft of the suturing instrument. Each needle is separately actuated into a gap in the instrument's tip, through tissue suctioned into the opening of the vacuum sleeve and into a ferrule at each end of a loop of suture. The system further includes a suture securing instrument having a partially flexible shaft locatable through the accessory tube, and a distal end coupled to the shaft. After removal of the suturing instrument from the accessory tube, a loop of suture extends through the tissue and the accessory tube, the suture securing instrument receives the free ends of the loop of suture at its distal end through a sleeve member, and the suture securing instrument is then inserted through the accessory tube to the location of the suture in the tissue. The suture securing instrument crimps the sleeve member and cuts the free ends of the suture to secure the suture closed. The suturing instrument and suture securing instrument are passed through the accessory tube without removal of the endoscope from the patient. The endoscope provides viewing by an operator of the engaging end of the suturing instrument for selecting placement of the suture through tissue, and of the distal end of the suture securing instrument to secure the suture closed.
Description
- The present invention relates to a system (and method) for endoscopic suturing, and in particular to a system for suturing through an accessory tube coupled to a flexible endoscope, which may be placed in the stomach through mouth and the esophagus of a patient utilizing a tissue suturing instrument and a suture securing instrument. The invention is suitable, for example, for applying at least one suture in the soft tissue lining of the stomach for different procedures such as gastroplasty, fundoplication, anterior gastropexy, or other procedures requiring suturing in the stomach, without the need for laparotomy or laparoscopy.
- Application of sutures in the gastrointestinal tract is required for several different types of medical procedures, for example, transoral endoscopic valvuloplasty for gastroesophageal reflux disease, gastroplasty, fundoplication, anterior gastropexy, suturing esophageal perforations, or closure of esophageal side of tracheo-esophageal fistula. Traditionally, these procedures were performed by physicians, such as gastroenterologist or surgeons, either by laparoscopy or open surgical techniques. Such procedures are invasive, as laparoscopy requires small access incision(s) made in the body of the patient through which a laparoscope and other surgical enabling tools are provided, while open surgical techniques are traditionally invasive and can have complications and long patient recovery periods.
- The solution to these problems is to perform these medical procedures through the gastroesophageal tract via the mouth or other naturally occurring orifices. Already available flexible endoscopes, commonly called gastroscopes, can be provided through the gastroesophageal tract and enable illumination and visualization of tissue along the gastroesophageal tract on a video display for diagnostic purposes. Although gastroscopes often have a working channel to a port at the distal end of the gastroscope through which a biopsy tool may be provided to obtain tissue samples, they are not currently designed or typically large enough to be capable of applying sutures in tissue.
- U.S. Pat. No. 5,792,153 describes a sewing device coupled to the distal end of an endoscope, which enables suturing in the gastroesophageal tract of a patient. The sewing device has a single hollow needle mounted in the biopsy channel of the endoscope, and a wire extending through the needle to a T-shaped tag having one end of a suture thread which extends outside of the patient. To apply a suture, suction is applied to a U-shaped opening of the sewing device via another channel of the endoscope to suck a layer (or fold) of tissue into the U-shaped opening, the needle in the biopsy channel is then pushed through the tissue, and then the wire is pushed and rotated to position the tag in a chamber along one side of the U-shaped opening. This rotates the tag into a position which captures the tag and the suture end in this chamber, and the needle and wire are retracted to the other side of the U-shaped opening. The endoscope and its coupled sewing device are removed from the patient, leaving a loop of suture through the tissue which must then be secured and closed. The patent also provides another sewing device at the end of an endoscope which enables multiple stitches in tissue with the same needle and suture thread. The sewing device of U.S. Pat. No. 5,792,153 to apply a single stitch is manufactured by Laboratories BARD S.A. of Voisinsle Bretonneux, France, and described in Kadirkamanathan et al., Gastrointestinal Endoscopy, August 1996, Vol. 44, No. 2, pp. 144-162.
- Once the suture thread is placed through the tissue with the sewing device of U.S. Pat. No. 5,792,153, the suture thread must be secured and then cut close to the tissue. One device also manufactured by Laboratories BARD S.A., and described in U.S. Pat. No. 5,755,730, provides for securing and cutting suture using an endoscope. The device passes through the biopsy channel of the endoscope is order to push a knot made by a physician or surgeon, which ties the ends of a loop of suture thread together, down to the tissue, and then a cutting member cut the ends of the suture. Since the sewing device of U.S. Pat. No. 5,792,153 does not allow normal use of its biopsy channel of the endoscope upon which the sewing device is mounted, a second endoscope must be used to secure and cut the suture through its biopsy channel using the device described in U.S. Pat. No. 5,755,730. This results in multiple passes of endoscopes back and forth through the gastroesophageal tract, especially if single sutures are each applied and secured at multiple locations in tissue. To reduce possible damage to the esophageal tract and to facilitate multiple instrument insertions, an overtube is first placed in the esophageal tract and each endoscope is inserted and removed through the overtube. However, the overtube may be uncomfortable to patients, and can cause complications, such as mucosal tears in the esophagus. Accordingly, it would be desirable to provide a system for suturing which does not require different endoscopes for suture placement and suture securing, and moreover can apply and secure multiple single sutures in tissue with the single insertion of a flexible endoscope, i.e., gastroscope without requiring an overtube.
- Other sewing devices or machines mounted on the end of an endoscope are described in U.S. Pat. Nos. 5,037,021 and 4,841,888. These sewing devices similarly utilize two channels of the endoscope, one to suction tissue into a slot of the device and the other to advance and retract a wire coupled to needle through the tissue. The needle has a suture loop at its tip such that when the needle is advanced through the slot it extends into a chamber where a hook or U-shaped member pivots to retain the suture loop when the needle retracts. A wire is coupled to the hook and extends through the same channel where suction is provided, such that movement of this wire pivot the hook to capture the suture thread. Removal of the sewing device then leaves a loop of suture through the tissue.
- A further sewing device is described in U.S. Pat. No. 5,080,663 and also utilizes an operating device having tubes in a tubular sheath, such as endoscopic means, to provide suction to a slot in the device to capture a double fold of tissue and two wires extending through such tubes. One wire advances and retracts a needle having a tag with suture at its tip through tissue and the other wire controls capture of a tag at the other side of the opening. The patent provides for applying a sensor or transmitter in the body of a patient, such as the stomach. This sewing device is also described in Swaine et al., An endoscopically deliverable tissue-transfixing device for securing biosensors in the gastrointestinal tract, Gastrointestinal Endoscopy, November/December 1994, Vol. 40, No. 6, pp. 730-737.
- Like the sewing devices of U.S. Pat. No. 5,792,153, those described in U.S. Pat. Nos. 5,037,021 4,841,888, and 5,080,663 have the same drawbacks as these devices are also mounted on an endoscope. Moreover, mounting on an endoscope limits the use of the endoscope for full visualization of tissue, as the sewing device partially obstructs the viewing area at the distal end of the endoscope. Further the use of the biopsy or working channel of an endoscope for needle placement does not allow use of the channel for other purposes, such as obtaining a biopsy. Accordingly, it would further be desirable to provide for suturing with a flexible endoscope which allows for more complete traditional use of the endoscope.
- Accordingly, it is the principal object of the present invention to provide an improved system for endoscopic suturing that overcomes the drawbacks of the prior art.
- It is another object of the present invention to provide an improved system for endoscopic suturing which allows single insertion of an endoscope and accessory tube assembly in the gastrointestinal tract of a patient through which multiple instruments for suturing and securing sutures can be used without removal of the endoscope between suturing and suture securing operations.
- It is a further object of the present invention to provide an improved system for endoscopic suturing which provides a channel to sew through independent of an endoscope.
- Yet a further object of the present invention is to provide an improved system for endoscopic suturing in which a suturing instrument separate from an endoscope can utilize suction to capture tissue to be sutured.
- A still further object of the present invention is to provide an improved system for remote suturing in which can readily adapted to different types of flexible endoscopes to provide an external accessory tube through which medical or surgical instruments can pass.
- A still further object of the present invention is to provide an improved system for endoscopic suturing which utilizes one or more instruments which each have a sufficient flexible shaft to pass through an external flexible accessory tube attached to a flexible endoscope.
- A further object of the present invention is to provide an improved system for endoscopic suturing using instruments having shafts with enhanced flexibility.
- And a still further object of the present invention is to provide an improved system for endoscopic suturing using flexible instruments with mechanical or hydraulic steerability.
- Yet a further object of the present invention is to provide an improved system for endoscopic suturing in which remote viewing with an endoscope of suture and suture securing operations is provided in the stomach without hindering endoscope functionality.
- Briefly described, a preferred embodiment of this system embodying the invention includes an endoscope, such as a gastroscope, having a distal end locatable in the body of a patient, such as in the gastrointestinal or gastroesophageal tract, and a flexible shaft extending to the distal end, a flexible accessory tube coupled to the endoscope to be movable relative to the endoscope's shaft, and an attachment tip coupled to the shaft of the endoscope having an opening through which one end of the accessory tube is received. The accessory tube is coupled to the shaft of the endoscope with multiple tube guides enabling the accessory tube to slide through the tube guides in response to bending of the endoscope's shaft. The accessory tube has a cannula through which an instrument may pass in the accessory tube. The system includes a tissue suturing instrument having a partially flexible shaft locatable through the accessory tube, and a tissue engaging end coupled to the shaft which is viewable by the endoscope at its distal end when the instrument is fully inserted through the accessory tube. The tissue engaging end has a vacuum sleeve enabling suction to be selectably applied at the tissue engaging end to capture tissue in a gap of a sew tip through an opening in the vacuum sleeve. Suction is applied via a vacuum connection assembly to a channel which extends down the shaft to the sew tip. A valve is provided to close one end of the suture carrying channel to enable such suction at the sew tip. Two needles are provided which extends through the shaft of the suturing instrument. Each needle is separately actuated into the gap of the sew tip through suctioned tissue to capture a ferrule having one end of a loop of suture. The system further includes a suture securing instrument having a partially flexible shaft locatable through the accessory tube, and a distal end coupled to the shaft which is viewable by the endoscope at its distal end when the instrument is fully inserted through the accessory tube. After removal of the suturing instrument from the accessory tube, a loop of suture extends through the tissue through the accessory tube, the suture securing instrument receives the free ends of the loop of suture at its distal end through a sleeve member, and the suture securing instrument is then inserted through the accessory tube to the location of the suture in the tissue. The suture securing instrument crimps the sleeve member and cuts the free ends of the suture to retain the suture closed. The endoscope enable an operator, such as a surgeon, gastroenterologist, or other skilled physician, to view the engaging end of the suturing instrument for selecting placement of the suture through tissue, and of the distal end of the suture securing instrument to secure the suture closed.
- The suturing instrument in the system may further include a mechanism for steering the tissue engaging end of the instrument independent of steerability of the flexible endoscope.
- A method embodying the present invention is also provided having the steps of: locating an endoscope, such as a gastroscope, coupled to an accessory tube through the gastrointestinal or gastroesophageal tract of a patient; inserting a suturing instrument through the accessory tube to place two ends of a loop of suture through tissue of the gastrointestinal or gastroesophageal tract; removing the suturing instrument to leave a loop of suture in the tissue having two free ends extending from the accessory tube; inserting a suture securing instrument having a distal end with a sleeve member through which the free ends of the suture loop are drawn to the suture in the tissue to crimp the sleeve member and cut the free ends of the suture; and removing the suture securing instrument from the accessory tube.
- Optionally, the suturing instrument and suture securing instrument may be used without the accessory tube when an internal working of biopsy channel is provided in the endoscope that permits the passage of the shaft of the suturing instrument and suture securing instrument, respectively.
- The following description referring to the endoscope as a gastroscope for purposes of illustration. Other types of endoscopes may be used in the system and method.
- The foregoing objects, features and advantages of the invention will become more apparent from a reading of the following description in connection with the accompanying drawings, in which:
-
FIG. 1 is a perspective view of the system in accordance with the present invention for application of a suture in tissue; -
FIG. 1A is a partial view of endoscope shaft ofFIGS. 1 and 2 showing the attachment of a tube guide to the endoscope while enabling the accessory tube to be slidable through the tube guide in response to flexing of the endoscope's shaft; -
FIG. 1B is an expanded view of the distal end of the system ofFIG. 1 ; -
FIG. 2 is a perspective view of the system ofFIG. 1 with the suture instrument of the system removed; -
FIG. 2A is an expanded view of the distal end of the system ofFIG. 2 ; -
FIG. 3 is a perspective view of the accessory tube, cannula, attachment tip and tube guides ofFIGS. 1 and 2 ; -
FIG. 4 is a perspective view of the tube guide ofFIG. 3 ; -
FIG. 4A is a side view of the tube guide ofFIG. 4 ; -
FIGS. 5 and 5A are front and back perspective views, respectively, of the attachment tip ofFIG. 3 ; -
FIG. 6 is a perspective view of the cannula ofFIG. 3 ; -
FIG. 7 is cross-sectional view of the cannula along lines 7-7 ofFIG. 6 ; -
FIG. 8 is a perspective view of the suturing instrument ofFIG. 1 ; -
FIG. 9 is a side view of the suturing instrument ofFIG. 1 in which the right cover of the housing of the instrument is removed; -
FIG. 10 is an exploded view of the suturing instrument ofFIG. 1 in which the right cover of the housing is removed; -
FIG. 10A is a perspective view of the retainer member of the suturing instrument ofFIGS. 9 and 10 ; -
FIG. 10B is a side view of the cam member of the suturing instrument ofFIGS. 9 and 10 ; -
FIG. 11 is a partially exploded perspective view of the adapter, needle spreader, and gasket member of the suturing instrument ofFIGS. 9 and 10 ; -
FIG. 11A is a cross-sectional view throughlines 11A-11A ofFIG. 11 showing the gasket member of the suturing instrument ofFIG. 11 without the suture tube or needles; -
FIG. 11B is an end view of the gasket member ofFIG. 11 without suture tube or needles; -
FIG. 12 is a cross-sectional view along lines 12-12 of the suturing instrument ofFIG. 9 ; -
FIG. 13 is a cross-sectional view along lines 13-13 of the suturing instrument ofFIG. 9 ; -
FIG. 14 is a cross-sectional view along lines 14-14 of the suturing instrument ofFIG. 9 ; -
FIG. 15 is a cross-sectional view along lines 15-15 of the suturing instrument ofFIG. 9 ; -
FIG. 16 is a cross-sectional view along lines 16-16 of the suturing instrument ofFIG. 9 ; -
FIG. 17 is a cross-sectional view along lines 17-17 of the suturing instrument ofFIG. 9 ; -
FIG. 17A is an exploded view of the coupler member, sew tip, and the guide member between the coupler member and sew tip, of the suturing instrument ofFIGS. 9 and 10 ; -
FIG. 17B is a perspective view showing the connection of the coupler member, sew tip, and the guide member ofFIG. 17A ; -
FIG. 17C is a cross-sectional view alonglines 17C-17C of theFIG. 17B ; -
FIG. 18 is a perspective view of the vacuum connection assembly of the suturing instrument ofFIGS. 9 and 10 for application of a vacuum or partial vacuum; -
FIG. 18A is an exploded view of the vacuum connection assembly ofFIG. 18 ; -
FIG. 18B is a cross-sectional view of the vacuum connection assembly alonglines 18B-18B ofFIG. 18 ; -
FIG. 18C is a cross-sectional view alonglines 18C-18C of the suturing instrument ofFIG. 9 ; -
FIGS. 19A and 19B are perspective view of the valve seat and valve knob of the valve of the suturing instrument ofFIGS. 9 and 10 ; -
FIG. 19C is schematic diagram of an alternative valve for the suturing instrument ofFIGS. 9 and 10 ; -
FIGS. 20A , 20B, and 20C illustrate the valve seat in response to the rotation of the valve knob from an open state to a closed state to seal one end of the suture tube of the suturing instrument ofFIGS. 9 and 10 ; -
FIG. 21 is an exploded view of the distal end of the suturing instrument ofFIG. 9 ; -
FIG. 21A is an exploded view of the distal end of theFIG. 9 showing the sleeve into which the tissue engaging end of the suturing instrument is received; -
FIG. 21B is a side view of the tissue engaging end of the suturing instrument with the sleeve ofFIGS. 21 and 21A ; -
FIGS. 21C and 21D are perspective views showing assembly of the sleeve ofFIGS. 21 and 21A ; -
FIGS. 22A-22H illustrates at the tissue engaging end of the suturing instrument the process of applying one end of a loop of suture through tissue with either one the two needles of the instrument; -
FIG. 22I illustrates at the tissue engaging end of the suturing instrument after both of the needles of the instrument have applied the two ends of the suture loop in the tissue, such that removal of the instrument leaves the suture loop through the tissue; -
FIG. 23 illustrates the operation of the tissue engaging end of the suturing instrument in accordance with another embodiment of the instrument without the outer sleeve of the tissue engaging end, where suction is not needed to capture tissue in applying a suture; -
FIG. 24 is a perspective view of the suture securing instrument of the system in accordance with the present invention to retain close the suture applied by the suturing instrument; -
FIG. 24A is a side view of the suture securing instrument ofFIG. 24 in which the right cover of the housing of the instrument is removed; -
FIG. 24B is an exploded view of the suture securing instrument ofFIG. 24 in which the right cover of the housing is removed; -
FIG. 24C is a cross-sectional view throughlines 24C-24C of the suture securing instrument ofFIG. 24A . -
FIG. 24D is a cross-sectional view throughlines 24D-24D of the suture securing instrument ofFIG. 24A . -
FIG. 24E is a cross-sectional view throughlines 24E-24E of the suture securing instrument ofFIG. 24A . -
FIG. 24F is a cross-sectional view throughlines 24F-24F of the suture securing instrument ofFIG. 24A . -
FIG. 24G is a cross-sectional view throughlines 24G-24G of the suture securing instrument ofFIG. 24A . -
FIG. 25 is exploded view of the distal end of the suture securing instrument ofFIG. 24 ; -
FIGS. 25A and 25B illustrate the assembly of the distal end of the suture securing instrument ofFIG. 24 ; -
FIG. 25C is a cross-section of the distal end of the suture securing instrument alonglines 25C-25C ofFIG. 25B ; -
FIGS. 26A-26D illustrates the use of a loading device for placement of a sleeve member into the distal end of the suture securing instrument ofFIG. 24 , in whichFIG. 26D further illustrates a guide wire loop for loading of suture in the instrument; -
FIGS. 26E-26I illustrate use of the guide wire loop ofFIG. 26D to load the suture through the sleeve member at the distal end of the suture securing instrument ofFIG. 24 ; -
FIGS. 27A-27I illustrates at the distal end of the suture securing instrument the process of fastening a sleeve member to retain the sutured tissue closed and cutting of the suture;FIGS. 28A-28M represent an example of the view through the endoscope for applying of a suture by the suturing instrument of the system ofFIG. 1 and then secured in place by a suture securing instrument of the system; -
FIG. 29A is an example of the system of the present invention positioned in the gastroesophageal tract of a patient before insertion of the suturing instrument; -
FIG. 29B is an example of the system of the present invention positioned in the gastroesophageal tract of a patient showing insertion of the suturing instrument through the accessory tube of the system; -
FIG. 29C is an example of the system of the present invention positioned in the gastroesophageal tract of a patient after placement of the suture thread and removal of the suturing instrument from the accessory tube of the system; -
FIG. 29D is an example of the system of the present invention positioned in the gastroesophageal tract of a patient showing placement of the suture thread loop in the suture securing instrument; -
FIG. 29E is an example of the system of the present invention positioned in the gastroesophageal tract of a patient showing insertion of the suture securing instrument through the accessory tube of the system; -
FIG. 29F is an example of the system of the present invention positioned in the gastroesophageal tract of a patient showing the secured suture remaining after removal of the suture securing instrument; -
FIG. 30 is a perspective view of another embodiment of the suturing instrument in the system ofFIG. 1 having enhanced flexibility; -
FIG. 31 is a schematic diagram of the needle assembly for each of the two needles in the embodiment of the suturing instrument ofFIG. 30 ; -
FIG. 32 is an exploded view of the coupler member, sew tip, and multi-lumen tube in the embodiment of the suturing instrument ofFIG. 30 in which the needles are removed; -
FIG. 32A is a partial perspective view of an example of the needles ofFIG. 31 extending through one end of the multi-lumen tube ofFIG. 32 ; -
FIG. 33 is an exploded view of coupler member and sew tip of the embodiment of the suturing instrument ofFIG. 30 in which the multi-lumen tube ofFIG. 32 is replaced by two needle carrying tubes and one suture supply tube; -
FIG. 34 is an exploded view similar toFIG. 33 showing in more detail the needle carrying tubes ofFIG. 33 ;FIG. 35 is a schematic diagram of the needle assembly ofFIG. 31 extending through one end of a needle carrying tube ofFIG. 33 ; -
FIG. 35A is a schematic diagram of alternative needle carrying tubes ofFIGS. 33-35 ; -
FIG. 35B shown in more detail one end of the needle carrying tube ofFIG. 35A ; -
FIG. 36 is an exploded view of the tissue engaging end of a further embodiment of the suturing instrument of the system ofFIG. 1 in which the vacuum connection assembly of the instrument is not required; -
FIG. 36A is a side view of the tissue engaging end of the suturing instrument ofFIG. 36 with the attachment tip partially broken away; -
FIG. 37 is a perspective view of the tissue engaging end of the suturing instrument of the system ofFIG. 1 without a sleeve to provide rotational locking of the tissue engaging end in the attachment tip of the accessory tube; -
FIG. 38 is a side view of the attachment tip of the accessory tube to provide rotational locking with the tissue engaging end of the suturing instrument ofFIG. 37 , in which the interior of the attachment tip is partially broken away to show the slots into which the tissue engaging end can engage; -
FIG. 39 is a cross-sectional view along lines 39-39 ofFIG. 38 ; -
FIGS. 40 , 40A, 41, 42, 42A-42C, and 45A-45D are diagrams illustrating an optional hydraulic steering mechanism for the tissue engaging end of the suturing instrument ofFIG. 1 using a cylinder ofFIGS. 42 and 42A or folding piston ofFIGS. 42B-C and 45A-45D; and -
FIGS. 43 , 43A, 44, and 44A are diagrams illustrating an optional mechanical steering mechanism for the tissue engaging end of the suturing instrument ofFIG. 1 . - Referring to
FIG. 1 , asystem 10 for suturing is shown including anaccessory tube 12 and anendoscope 14, referred to herein after as a gastroscope, or other type of flexible endoscope having ashaft 14 a coupled to the accessory tube, and asuturing instrument 16. Thesuturing instrument 16 may be inserted in theaccessory tube 12 as shown inFIG. 1 , and is removable from theaccessory tube 12 as shown inFIG. 2 . Theaccessory tube 12 hasaccess tubing 18 which is sufficiently flexible to be movable with theflexible shaft 14 a of the gastroscope.Tubing 18 is braid reinforced with a braid of stainless steel, nylon, or Kevlar, to maintain the integrity of the tubing's circular cross-sectional shape and avoid kinking as theshaft 14 a of the gastroscope bends when placed through the mouth into the gastrointestinal tract of a patient. The braiding may be located between two layers oftubing 18, which are integrated with the braiding during theirextrusion forming tubing 18. For example, the outer diameter oftubing 18 may be 0.263 inches, while the internal diameter oftubing 18 may be 0.231 inches, and is such that atissue engaging end 16 a coupled toshaft 16 b of suturinginstrument 16 can pass through the tubing.Tubing 18 may be composed of pebax, polyurethane, or other flexible plastics of medical grade. Theaccessory tube 12 further has acannula 20 attached totubing 18 through which instruments, such assuturing instrument 16, may pass.Cannula 20 is describe is more detail later in connection withFIGS. 6 and 7 .Accessory tube 12 is shown as a separate component inFIG. 2 . - Multiple tube guides 22
couple tubing 18 toshaft 14 a ofgastroscope 14. Eachtube guide 22 has anopening 22 a extending through the tube guide and acurved surface 22 b along its length which abuts the outer curved surface ofshaft 14 a, as shown inFIGS. 1A .FIGS. 4 and 4A show thetube guide 22 in more detail. Tube guides 22 may be attached toshaft 14 a by a band oftape 24 having an adhesive layer to fix the tube guide toshaft 14 a. Other attaching means are also be used, such as glue. The diameter of opening 22 a is slightly larger than the outer diameter oftubing 18 such that thetubing 18 is slidable through opening 22 a to enable theaccessory tube 12 to move in concert with flexing, bending, rotation, or other movements of thegastroscope 14. Tube guides 22 maintaintubing 18 substantial coaxial withshaft 14 a ofgastroscope 14. Preferably, four tube guides are provided as shown inFIGS. 1 , 2, and 3, but other number of tube guides may be used. - At the distal end of
accessory tube 12 is anattachment tip 26 having twoopenings tubing 18, and thedistal end 14 b ofgastroscope 14, respectively.Attachment tip 26 is shown in more detail inFIG. 1B , and as a separate component inFIGS. 5 and 5A .Tubing 18 is attached toattachment tip 26, such as by glue or insert molding, while the gastroscope'sdistal end 14 a is held by friction and seats in a shelf orlip 26 c (FIG. 5 ) which forms a stop limiting forward movement ofdistal end 14 a. Theattachment tip 26 may be made of urethane or other molded plastic material. The length of theaccessory tube 12 from itscannula 20 toattachment tip 26 may be, for example, 30 inches, but also may be of other lengths.Gastroscope 14 may be any typical gastroscope, such as that manufactured by Olympus, Inc., Pendax, Inc., Vision-Sciences, or Welch Allyn. For purposes of illustration,gastroscope 14 has at its upper end 14 c a handle 27 a, two dials 27 b to steer the gastroscope, and various buttons/knobs to control typical gastroscope operation. Thedistal end 14 b of the gastroscope has elements forimaging optics 28 a,illumination 28 b, water for cleaningimaging optics 28 c, and a biopsy or workingchannel 28 d representing tubing in communication with aport 27 c at upper end 14 c. A video display system 193 (FIG. 29B ) is coupled toupper end 14 a, via acable 27 d, to allow viewing of tissue from itsdistal end 14 b on a display viaoptics 28 a. Although a gastroscope is referred to herein, any other flexible endoscope may similarly be used.FIGS. 2 and 2A illustrate theaccessory tube 12 andgastroscope 14 when no instrument is located in the accessory tube. -
Cannula 20 may be a typical type of cannula providing a sealable passage totubing 18. For purposes of illustration,cannula 20 is shown inFIGS. 1-3 , and in more detail inFIGS. 6 and 7 .Cannula 20 has ahousing 20 a and acap 20 b which is received inhousing 20 a. Twoseals cannula 20 along apassage 21 from an opening 21 a through which the shaft of an instrument may pass intotubing 18.Tubing 18 is received in anopening 20 f which extends intohousing 20 a.Seal 20 c may be a duck-bill seal as illustrated inFIG. 7 . An optionalauxiliary port 20 e has abore 20 f which opens topassage 21 through which water, air, or vacuum may be provided throughtubing 18. Although a cannula with two seals is described, the cannula may alternatively have a single seal.Seal 20 d provides sealing about the shaft of an instrument, whileseal 20 c provides sealing when no instrument is located in theaccessory tube 12. - The assembly of the
gastroscope 14 andaccessory tube 12 when in the gastrointestinal or gastroesophageal tract of a patient provides the feature of enabling instruments, such as the suturing instrument, and the later to be described suture securing instrument, to be insertable and retractable about the distal end of the gastroscope, without requiring removal of the gastroscope. Further, normal functionality of the gastroscope in viewing is provided without any partial obstruction or loss of use of the workingchannel 28 d. An illustration of thesystem 10 in a patient's body is shown inFIGS. 29A-29F . - Referring to
FIGS. 8-10 , thesuturing instrument 16 ofsystem 10 is shown. Suturinginstrument 16 represents the SEW -RIGHT® SR· 5™ manufactured by LaserSurge, Inc. of Rochester, N.Y., which has been modified to have a longer and partiallyflexible shaft 16 b extending from ahousing 30, and means for selectably establishing suction to capture tissue at itstissue engaging end 16 a. Thetissue engaging end 16 a and needles thereto may be similar to that shown in U.S. Pat. Nos. 5,431,666, 5,766,183, or European Patent No. EP 0669101, filed Feb. 23, 1995 and granted Oct. 14, 1998, which are herein incorporated by reference Theshaft 16 b represents an assembly of components 51-62 described below.Shaft 16 b is rigid along afirst section 32 when it extends from opening 31 inhousing 30 and then is flexible along asecond section 33 until coupling to thetissue engaging end 16 a. - The
housing 30 has a body shaped like a pistol having ahandle portion 30 a, and may be made of a two-piece construction of molded plastic. A pair ofneedles housing 30 through theshaft 16 b into thetissue engaging end 16 a. Eachneedle spherical member spherical members spherical member needles - The
suturing instrument 16 includes anactuator member 36 representing a lever having twopins 36 a extending into holes in the sides ofhousing 30 upon which the actuator member is pivotally mounted in the housing.Actuator member 36 has a portion which extends through anopening 30 b (FIG. 10 ) inhousing 30 to enable pivotal movement aboutpin 36 a. Anextension spring 38 is provided which hooks at one end in anotch 36 b ofactuator member 36 and is wound at the other end around apin 40 located in holes in the sides ofhousing 30, such that theactuator member 36 is spring biased to retainactuator member 36 normally in a forward position, as shown for example inFIG. 9 . The body ofhousing 30 has a front portion 31 (FIG. 10 ) providing a stop that limits the pivotal movement of theactuator member 36. Anotch 36 c is provided in theactuator member 36 which is shaped to received one of the non-engaging ends ofneedles spherical members actuator member 36 to pivotactuator member 36 towardshandle portion 30 a. Twogrooves 36 d (FIG. 10 ) are provided by threefingers 36 e into which theneedle spherical members - A
retainer member 42 is fixed inhousing 30 by two flanges 42 aabove actuator member 36. As best shown inFIG. 10A , theretainer member 42 has achamber 42 b having alower opening 42 c tochamber 42 b and twogrooves 42 d formed byfingers 42 e which allow thespherical members needles chamber 42 b to restrict movement of the needle when held therein. Thelower surface 42 f ofretainer member 42 is curved and faces correspondingly curvedupper surface 36 f ofactuator member 36, such that theactuator member 36 is slidable alonglower surface 42 f responsive to the operator pulling the actuator member. - To select which of the
needles actuator member 36, theinstrument 16 has a needle selection mechanism having a selector lever (or arm) 44 which is rotationally coupled with acam member 46. Thecam member 46 andselector lever 44 is supported by anadapter 48 inhousing 30.Adapter 48 is mounted inhousing 30 by twoflanges 48 a. Theselector lever 44 is pivotally mounted by apin 48 c extending upwards fromadapter 48 at ahole 44 a through the lever.Selector lever 44 extends through anopening 30 c inhousing 30 and has a downwardly protrudingmember 44 b which is received in anotch 46 a ofcam member 46 to rotatecam member 46 in apocket 48 b in theadapter 48 as theselector lever 44 is moved left or right. Thecam member 46 may have a taperedsurface 46 b to facilitate its rotation inpocket 48 b and twotapered apertures 46 c through which needles 34 and 35 respectively extend, as shown inFIG. 10B . To selectneedle 34 to be driven, theselector 44 is moved right which rotates thecam member 46 to positionneedle 34 down andneedle 35 up, such thatend 34 a is located innotch 36 c and end 35 a is located inchamber 42 b ofretainer member 42. To selectneedle 35 to be driven, theselector 44 is moved left which rotates thecam member 46 to positionneedle 34 up andneedle 35 down, such thatend 35 a is located innotch 36 c and end 34 a is located inchamber 42 b ofretainer member 42. - The
needle selector 44 may further have another downwardly protrudingmember 44 c which rides in a slot 42 g on the upper surface ofretainer member 42. The slot 42 g is contoured to have angled lower regions on either side of a raised region into whichmember 44 c can be located to releasably lock to retain the position oflever 44 left or right. - The
adapter 48 has a bore extending there through in which aneedle spreader 50 is located.Needle spreader 50 has twochannels needles cam member 46, such that the needles are properly aligned to apertures 46 b in the cam member. - A
suture routing tube 47 is provided for suture thread inhousing 30.Suture routing tube 47 has one end received in avalve assembly 19, described later below, at the bottom ofhandle 30 a ofhousing 30 and then extends throughnotches 30 d (FIG. 10 ) along the interior of the left side ofhousing 30, and agroove 50 a along needle spreader 50 (FIGS. 10 and 11 ). A cross-section throughneedle spreader 50 andadapter 48 is shown inFIG. 12 . The other end of thesuture routing tube 47 is then mounted in ahole 51 a throughgasket member 51.Gasket member 51 further has twoholes shaft 16 b throughgasket member 51 is shown inFIG. 13 . Thegasket member 51 may be made of medical grade rubber, such as Santoprene. - A
longitudinal guide member 53 is provided multiple tracks along its length, including twoneedle tracks needles suture track 53 c for suture thread extending from opening 51 a ofgasket member 51. A cross-sectional view ofshaft 16 b throughguide member 53 is shown inFIG. 14 . Theguide member 53 may be made of extruded flexible material, such as Tecoflex®. Arigid tube 52 is provided which is D-shaped at oneend 52 a is registered into a corresponding shaped opening inadapter 48, and a threadednut 54 having an opening which extends over mountingtube 52 and screws onto the end of theadapter 48 to securetube 52 tohousing 30. With thegasket member 51 loaded first intorigid tube 53,guide member 53 extends from thegasket member 51 through the rigid tube. In this manner, tracks 53 a, 53 b, and 53 c each form a channel with the interior surface ofrigid tube 52.Rigid tube 52 may be made of stainless steel, or other rigid material, and has for example,rigid tube 53 has an outside diameter of 0.205 inches.FIG. 11 shows thegasket member 51 prior to being positioned in abutment toneedle spreader 50 and inend 52 a ofrigid tube 52. For insiderigid tube 52,gasket member 51 has aring 51 d which frictionally engages the interior surface oftube 52,hole 51 a of the gasket member is of a diameter such that thesuture tube 47 tightly fits therein and provides a seal aroundsuture tube 47. Thesuture tube 47 may be held in place inhole 51 a by friction, but adhesive may also be used.FIGS. 11A and 11B show gasket member 51 in more detail.Holes holes flaps gasket member 51 is that it enables sealing theshaft 16 b, such that negative pressure, i.e., suction, may be selectively applied down the shaft via avacuum connection assembly 64, as described later below. - At the
other end 52 b ofrigid tube 52, acoupler member 56 is mounted in which twotabs 56 a are received in twotracks 53 d along two opposing sides ofguide member 53.Coupler member 56 joins thenon-flexible section 32 of theshaft 16 b provided byrigid tube 52 with theflexible section 33 of theshaft 16 b (FIG. 8 ).Coupler member 56 may be composed of stainless steel. A cross-section ofshaft 16 b throughcoupler member 56 is shown inFIG. 15 . The coupler member has atrack 56 b for suture, tracks 56 c and 56 d forneedles central hole 56 e. On the side of thecoupler member 56opposite guide member 53 is anotherlongitudinal guide member 58 which extends through the flexible section ofshaft 16 b to thetissue engaging end 16 a.Guide member 58, likeguide member 53, is of an extruded flexible material, such as Tecoflex®.Guide member 58 has multiple tracks, including twoneedle tracks 58 a and 58 b forneedles suture track 58 c for suture thread extending fromtrack 56 b ofcoupler member 56. A cross-sectional view ofshaft 16 b throughguide member 58 is shown inFIG. 16 . Twotabs 56 f extend from thecoupler member 56 intotracks 58 d ofguide member 58. Awire 60 extends from thetissue engaging end 16 a through acentral hole 58 e ofguide member 58 and thecentral hole 56 e ofcoupler member 56, and then partly into acenter hole 53 e (FIG. 14 ) extending intoguide member 53. Thewire 60 extends partly throughcentral hole 53 e to facilitate registration ofguide member 53 tocoupler member 56 and guidemember 58. Thewire 60 is located in a central hole which extending into a sewtip 98 at thetissue engaging end 16 a and attached thereto, such as by welding or brazing, passed throughguide member 58 viahole 58 e, and then extended through and incoupler member 56, where it is attached to the coupler member, via atube coupler 57, such as by welding or brazing. This assembly is described in more detail below in connection withFIG. 17C . With therigid tube 52,gasket 51,guide members central wire 60 in place, a plastic shrink wrap layer ortubing 62 is installed alongshaft 16 b from thevacuum connection assembly 64 until thetissue engaging end 16 a, and shrunk in response to applied heat onto exposed surfaces ofshaft 16 b. About guidemember 58, tracks 58 a, 58 b, and 58 c each form a channel with the interior surface ofshrink wrap layer 62. - The connection of
coupler member 56,guide member 58 and a sewtip 98 of thetissue engaging end 16 a is best illustrated inFIGS. 17A and 17B in whichtabs 56 f ofcoupler member 56 are received intracks 58 d at one end ofguide member 58, andtabs 100 from sewtip 98 are received intracks 58 d at the other end ofguide member 58.Wire 60 extends throughcoupler member 56,guide member 58 into ahole 98 h extends into therear section 98 i of the sew tip 98 (FIG. 21B ). Theguide member 58 with the shrink wrap enables theflexible section 33 ofshaft 16 b to bend and flex while maintaining the channels extending there through, while thewire 60 provide longitudinal support to the flexible section as it is attached tonon-flexible section 30 at coupler member and the sew tip. Further, needles 34 and 35 are sufficiently flexible to bend without deformation withinguide member 58. In order to translate rotational motion from the non-flexible section,tabs tracks guide members guide member 58 intotabs 100 of sewtip 98. Thus rotation occurring at the non-flexible section, such as by rotation ofhousing 30, is translated totissue engaging end 16 a. -
FIG. 17C shows the attachment ofwire 60,coupler member 56, andflexible section 33 ofinstrument 16 in more detail, such that possible damage to guide members from the heat of welding or brazing of metal components is avoided. Thecoupler member 56 has a recessedcircular opening 56 h tocentral hole 56 e at the end 56 g ofcoupler member 56 into which oneend 57 a of awire coupler tube 57 is located.Wire coupler 57 represents a metal tube having an outer diameter sized to be received in recessedopening 56 h and an inner diameter sized to receive there throughwire 60. Prior to attachment ofcoupler member 56 to guidemember 53,wire coupler 57 is first attached tocoupler member 56, such as by welding or brazing, about recessedopening 56 h prior to the assembly of theflexible section 33 components, i.e., sewtip 98, and guidemember 58, tocoupler member 56. Next,wire 60, which has not yet been passed throughcoupler member 56, is attached, such as by welding or brazing, intohole 98 h (FIG. 21B ) of sewtip 98.Wire 60 is then slid throughcentral hole 58 e ofguide member 58 andhole 56 e ofcoupler member 56, and the sewtip 98 at twotabs 100 frictionally engages into twotracks 58 d ofguide member 58 at one end ofguide member 58. At the other end ofguide member 58,tabs 56 e ofcoupler member 56 frictionally engages intotracks 58 d. With thecoupler member 56 integrated withguide member 58,wire 60 is attached atend 57 b ofwire coupler 57, such as by welding or brazing, which integrates the assembly ofcoupler member 56 withflexible section 33 of theinstrument 16, as shown inFIG. 17B . Thereafter, thecoupler member 56 at itstabs 56 f frictionally engages intotracks 53 d ofguide member 53, such thatwire 60 partly extends intocentral hole 53 e ofguide member 53. Theguide member 53 andcoupler member 56 of the assembly are received into therigid tube 52, such thatguide member 53 abutsgasket 51, and coupler member is attached to rigid tube by mechanical fastening by forming small dents in the metal of thetube 52 with a press into recessed four pockets 56 i (FIG. 17A ), i.e., two on each side of thecoupler member 56. - Referring to FIGS. 18 and 18A-C, a
vacuum connection assembly 64 for suturinginstrument 16 is shown.Vacuum connection assembly 64 includes afront housing member 66 which has acircular opening 66 a to aninterior chamber 66 b, and arear housing member 68 having acircular opening 68 a extending there through.Rear housing member 68 has a first extension towardhousing 30 providing ashaft 68 e having anannular flange 68 b and a second extension towardfront housing member 66 providing a threadedshaft 68 c.Shaft 68 c is screwed in a threadedopening 66 c (FIG. 18B ) tochamber 66 b offront housing member 66, wherebysurface 68 d of the rear housing member tightly fits (mates) alongsurface 68 d of thefront housing member 66. Circular opening 66 a is coaxial withcircular opening 68 a through their respective housing members. A rubber O-ring 71 is provided in an annular groove in opening 66 a of thefront housing member 66, while another O-ring 70 is provided in an annular groove in opening 68 a ofrear housing member 68, as illustrated inFIG. 18B . Afitting member 72 is received infront member 66 in a recessedpocket 66 e to a threadedopening 66 f extending tochamber 66 b, such that aport 74 is provided having abore 75 tochamber 66 b. Fittingmember 72 is threaded along itssurface 72 a to enable the fitting member to screw into threadedopening 66 f offront housing member 66. Except for O-rings vacuum connection assembly 64 may be made of stainless steel. - The
vacuum connection assembly 64 is placed onrigid tube 52 so that the tube extends throughopenings rings chamber 66 b, and anopening 52 c in the rigid tube lies inchamber 66 b and faces bore 75 of the fitting member. The diameter ofapertures rigid tube 52 about opening 52 c. O-rings rigid tube 52 to sealchamber 66 b, but forbore 75 andopening 52 c to suturetrack 53 c (FIG. 18C ).Flange 68 b fromrear housing member 68 is received in a pocket 37 (FIG. 9 ) formed when the left and right sides ofhousing 30 are mated to each other. A vacuum source may be applied via tubing (not shown) toport 74, such that negative air pressure is provided inchamber 66 b which may be communicated via anopening 52 c ofrigid tube 52 along a suture channel formed bysuture track 53 c ofguide member 53 to suturetrack 58 d ofguide member 58 throughtrack 56 b ofcoupler member 56, down to thetissue engaging end 16 a.Vacuum connection assembly 64 may alternatively be coupled atport 74 to a source for air to provide positive air pressure along the same suture channel, i.e., to drive air down to thetissue engaging end 16 a. - A
valve 19 is provided at the bottom ofhandle 30 a, as shown inFIGS. 9 and 10 , having avalve seat 19 a and avalve controller 19 b, shown as separate components inFIGS. 19A and 19B .Valve seat 19 a is composed of medical grade rubber, such as Santoprene®, and has ahole 76 extending into aninterior chamber 78. One side 79 of thischamber 78 has alip 80 about anopening 81. Protruding into thechamber 78 facingopening 81 is a raisedmember 82 of thevalve seat 19 a through which thehole 76 extends to anopening 84, which is recessed near asurface 82 a of the raisedmember 82. The recess of opening 84 forms the shape of an eye having two opposingcorners 86 whenvalve 19 is open. Two opposingfingers 88 of the raisedmember 82 extend from the top and bottom of the eye of opening 84. Avalve controller 19 b composed of molded plastic, or other rigid material, has acircular section 90 having anopening 92 to an interior surface forming acam 94, and a recessedretainer ring 95.Circular section 90 is received throughopening 81 such thatretainer ring 90 is captured bylip 80 to retainvalve controller 19 b invalve seat 19 a.Fingers 88 andcorners 86 of the raisedmember 82 of the valve seat lie against the surface ofcam 94 of thevalve controller 19 b. The cam surface is wider along one dimension and narrower along a perpendicular dimension, such that when thefingers 88 lie along the narrower dimension, they compress the recess of opening 84 into a closet slit to closevalve 19, and whenfingers 88 lie along the wider dimension, the recess of opening 84 returns to its normal shape and thevalve 19 is open. Adjusting the dimensions of thecam surface 94 a controls the amount of pressure applied to compressopening 84, and thus the integrity of the closed valve's seal. Anotherhole 76 b (FIG. 9 ) extends through opening 92 to the bottom 96 a ofturn knob 96 of the valve controller. Thesuture routing tube 47 is received inhole 76 ofvalve seat 19 a, as shown inFIG. 9 , such that suture material from the tube can pass throughopenings hole 76 b of the valve controller. - As shown in
FIG. 20A , thevalve 19 is open when thefinger 88 align alongsurface cam 94, andcorners 86 are each received in correspondingdetents cam 94. To closevalve 19, aturn knob 96 of thevalve controller 19 b is rotated as shown inFIG. 20B . This starts compressingfingers 88 against the surface of thecam 94 until thefingers 88 lie indetents d compressing opening 84 of the valve seat to close the valve, as shown inFIG. 20C . To open thevalve 19, theturn knob 96 is again rotated until thecorners 86 lie indetents turn knob 96 may be rotated clockwise or counterclockwise to open andclose valve 19.Valve 19 may be closed to seal thesuture tube 47 when suction is applied viavacuum connection assembly 64, but allows suture to be drawn under slight tension through the valve. - Other types of
valve 19 may alternatively be used, such as shown inFIG. 19D , which provides a seal, but enables the suture to be drawn under slight tension through the valve. InFIG. 19C , the bottom ofhandle 30 a is shown in which thesuture tube 47 is received in a duck-bill valve 128 providing achamber 128 a and twoflaps 128 b extending into the chamber along the length ofsuture 105 which extends throughsuture tube 47 betweenflaps 128 b and through anopening 129 inhousing 30. In response to negative air pressure insuture tube 47, the twoflaps 128 b meet alongedges 128 c providing a seal about thesuture 105 inchamber 128 a.FIG. 19C illustrates the valve when closed, whenopen flaps 128 b atedges 128 c may separate from each other. - Referring to
FIGS. 21 , 21A and 21B, thetissue engaging end 16 a of thesuturing instrument 16 is shown having the sewtip 98 which is mounted in atip tube 102, such that thefront section 98 a of the sew tip extends fromtube 102. The mounting of thetip tube 102 to the sewtip 98 may be achieved by mechanical fastening by forming small dents in the metal of thetip tube 102 with a press into recessed fourpockets 98 b, i.e., two on each side of the sew tip (FIG. 17A ). The sewtip 98 has agap 104 in a C-shaped jaw having twoopenings 98 c at one side of the gap through which each of needles 34 and 35 may extend to captureferrules 103 having one end ofsuture material 105 located inopenings 107 at the other side ofgap 104, and after each needle captures a ferrule, the needle retracts back into theirrespective opening 98 c carrying the suture material on its tip. Achannel 98 d is provided in the sew tip which aligns withsuture track 58 c ofguide member 58, as shown inFIG. 17B . Thechannel 98 d extends along the length of the sew tip and then fork into two channels, each leading to one of the twoopenings 107 havingferrules 103 to which the end of the suture thread is attached.Openings 107retain ferrules 103 but are slotted to enable release of suture after aferrule 103 is captured. The operation of sewtip 98 will be described in more detail below in connection withFIGS. 22A-22I . Avacuum sleeve 106 is provided having atube 106 a, and arounded cap 106 b which closes one end oftube 106. Thecap 106 b has anedge 106 c which mates with theedge 106 d oftube 106 a and two extendingflanges 110 which are received intube 106 a to hold the cap in place (FIGS. 21C and 21D ). Betweenflanges 110 the interior surface of the cap is angled to provide a ramp 112 (FIG. 21B ). The sewtip 98 intip tube 102 is received through theopen end 106 f oftube 106 b, such that anopening 108 oftube 106 b is located overgap 104 of the sew tip. The twoflanges 110 ofcap 106 d register with the two sides of theforward part 98 g of the sewtip 98 to properly align sewtip 98 andtip tube 102 in thevacuum sleeve 106. Theopening 108 represents a cut intotube 106 a to provide a oval shapedwindow 108 a and aforward slot 108 b which extend fromwindow 108 a to the end oftube 106 ameeting cap 106 b, such that the forward (ferrule carrying)part 98 g of the sewtip 98 partially extends throughslot 108 b (FIG. 21B ).Cap 106 b has anotch 106 e locatedadjacent slot 108 b atedge 106 d oftube 106 a (FIG. 21D ). Theramp 112 is negatively sloped at an angle towardsslot 108 b, as shown inFIG. 21B , to facilitate the suturing process, as will be described later. Two fingers orprongs 103 extend from the sides of thetip tube 102 and are received in twocorresponding openings 111 of thevacuum sleeve 106 to latch the sleeve in position over the sew tip.Guide member 58 extends intotip tube 102 as shown in FIG. 18B21B. Shrink wrap ortubing 114 is then applied overtube 106 a, such thatopenings 111 are sealed closed, to complete the assembly of thevacuum sleeve 106, as shown inFIG. 21A . Ashort metal ring 116 is placed over theend 102 a of thetip tube 102 and the edge of theshrink wrap 62 extending along shaft 18 b. In placingring 116, shrinkwrap 62 is first applied over shaft 18 b andtube 102, and then cut back to anedge 106 a ofring 116.Tubes tissue engaging end 16 a through the sewtip 98,tip tube 102, andvacuum sleeve 106, is shown inFIG. 17 . Thisvacuum sleeve 106 enables a vacuum or partial vacuum to be applied to the path of the suture followinggasket member 51, via thevacuum connection assembly 64, to channel 98 d of the sewtip 98, such that the upflow of air into thegap 104 of the sew tip throughopening 108 ofvacuum sleeve 106 can pull the tissue into the gap. The suction from the vacuum or partial vacuum is applied togap 104 of the sewtip 98 via twoopenings 98 e inchannel 98 d to twocavities 98 f each located on opposite sides of the sew tip in the space between the sides of sewtip 98 andvacuum sleeve 106 near gap 104 (FIG. 21 ). Althoughcap 106 b as described herein is preferred,cap 106 b may be provided by a metal cap 118, such as of stainless steel attached to the end oftube 106 a, and provides a small ramp 118 a. - The tissue engaging end of suturing
instrument 16 may be as described in U.S. patent application Ser. No. 09/686,420, filed Oct. 11, 2000, which is herein incorporated by reference. This patent application describes the loading of a length of suture material, i.e., thread, whose ends are affixed to ferrules in the sewtip 98. Before such loading, thevacuum sleeve 106 is removed fromtube tip 102 by pushing infingers 103 to release them fromopenings 111 and then simultaneously pulling thevacuum sleeve 106 away fromtube tip 102. After loading, thevacuum sleeve 106 is replaced and latched back (i.e.,fingers 103 in openings 111) onto thetube tip 102 and the loop of suture extends from the ferrules through the suture tracks 53 a and 58 a ofguide members tube 47, viatrack 56 b of thecoupler member 56 and opening 51 a of thegasket member 51, out holes 76 and 76 a ofvalve 19. Proper orientation of thevacuum sleeve 106 overtube tip 102 and sewtip 98 is provided byflanges 111 ofcap 106 b, as described earlier, and also byramp 112 being angled such that it prevents upside down misalignment of the vacuum sleeve over the sew tip. Theforward section 98 g of the sew tip will be stopped byramp 112 beforefingers 103 reach to thetube tip openings 111, preventing thevacuum sleeve 106 from latching. For example, the suture material may represent monofilament suture material or braided suture material. - Referring to
FIGS. 22A-22I , the operation of thesuturing instrument 16 at thetissue engaging end 16 a is shown after the suturing instrument is located, viaaccessory tube 12, near the tissue to be sutured.FIGS. 22A-22H show the process of applying one end of the suture throughtissue 120 withneedle 34, the same process is repeated for the other end of the suture forneedle 35. Suturing withneedles FIG. 22A , thetissue engaging end 16 a is shown withsuture material 105 loaded in the sewtip 98, such that the two free ends of the loop of suture extend from thesuture track 58 a oftube guide 58, via apassage 98 d of the sewtip 98, to twoferrules 103 coupled to the two suture ends in the sewtip 98.Opening 98 c at one end ofgap 104face ferrules 103 inopenings 107 for respectively needles 34 and 35. Thetissue engaging end 16 a is placed adjacent afirst target area 121 intissue 120 where the first end of the suture will be placed (FIG. 22B ). Suction is then applied to pull thetarget area 121 oftissue 120 viagap 104 of the sew tip throughopening 108 in thevacuum sleeve 106 to capture afold 124 oftissue 120 at target area 121 (FIG. 22C ). To apply suction,valve 19 is closed and a vacuum source, such as a vacuum pump 200 (FIG. 29B ), provides suction toshaft 16 b, via tubing, to port 74 of thevacuum connection assembly 64. The vacuum is communicated intogap 104 via opening 52 c ofrigid tube 52 to the suction channel inshaft 16 b formed bysuture track 53 c ofguide member 53,track 56 b ofcoupler member 56, and then suturetrack 58 d throughcoupler member 56 to channel 98 d andcavities 98 f of the sewtip 98. Principally, the suction is applied tocavities 98f, however the suction may occur elsewhere aboutgap 104, such as the space between the sewtip 98 and the interior surface of thevacuum sleeve 106, or viaopenings 107. With the suction maintained, andneedle 34 selected by an operator usingselector lever 44, and theactuator member 36 is pulled by the operator towardshandle 30 a (FIG. 8 ), the needle passes through the tissue (FIG. 22D ) and then into ferrule 103 (FIG. 22E ), such that thetip 122 of the needle is captured in the ferrule. Althoughvalve 19 is closed, the suture may be drawn through thevalve seat 19 a. Theactuator member 36 rotates against the bias ofspring 38 untilneedle tip 122 engagesferrule 103. The amount of rotation ofactuator member 36 depends on the distance the needle must transverse before engaging a ferrule, such distance may vary depending on the degree of flexing ofshaft 16 b along itsflexible section 33. Theneedle 34 is then retracted by the operator releasingactuator member 36, to pass the needle and capturedferrule 103 back through the tissue (FIG. 22F ) and into opening 98 c (FIG. 22G ). The suction generates negative air pressure near thetissue 120 sufficient to pull the tissue intogap 104 of the sewtip 98 without damaging the tissue. The suction is then discontinued, such as by turning off thevacuum source 200, and thevalve 19 opened to release the tissue fromgap 104 of the sew tip (FIG. 22H ). The end of the suture thread extends from the captured ferrule on the needle tip throughtissue 120 to channel 98 d. The suture releases through the slot extending along opening 108 b and the suture extends from captured ferrule through the tissue to channel 98 d. The process ofFIGS. 22A-22H is then repeated at a second target area in the tissue withneedle 35 selected to place the second end of the suture in the tissue.FIG. 22I shows the result after both suture ends are placed through tissue, where one suture end extends throughtissue fold 124 and the other throughfold 126. For example, the second target area may be located directly after placing the first suture end through the tissue by rotating thehousing 30 of theinstrument 180 degree to rotate thetissue engaging end 180 degrees. The entire operation is observed by the operator via the gastroscope, and in this manner, the first and second target located by the operator in the tissue. The operator may be a surgeon, gastroenterologist, or other skilled physician. - Alternatively, the suturing instrument may operate to apply a suture without suction if the target area of tissue can be sufficiently received in
gap 104 of the sewtip 98. For example, the target area may represent a raised portion of tissue to be sutured. Further, the suturing instrument operating without section, may be used with thevacuum sleeve 106 removed from thetissue engaging end 16 a, such as shown for example inFIG. 23 . - After two ends of the suture have been placed through the tissue, as illustrated in
FIG. 22I , thesuturing instrument 16 is removed from theaccessory tube 12, which pulls the loop of suture, which extended fromhousing 30, down totissue 120. As the suture passes through thetissue engaging end 16 a, the suture follows fromchannel 98 d of the sew tip over theramp 112 and notch 106 e ofcap 106 b. The suture may then be secure by asuture securing instrument 130 described below. - Referring to
FIGS. 24 , 24A, and 24B, thesuture securing instrument 130 of the system is shown having ahousing 132 similar tohousing 30 of suturinginstrument 16. Suture securinginstrument 130 represents the Ti-KNOT® TK ·5™ manufactured by LaserSurge, Inc. of Rochester, N.Y., except that itsshaft 134 is longer and partially flexible, and means are provided for calibrating the length of a drive wire to thedistal end 136 of theinstrument 130. The distal end ofinstrument 130 may be similar to that described in U.S. Pat. Nos. 5,669,917, 5,643,289, 5,520,702, or European Patent Application No. 95102587.3, filed Feb. 23, 1995 and published Feb. 2, 1994 under Publication No. 0669103A1, which are herein incorporated by reference. Thesuture securing instrument 130 includes anactuator member 138 representing a lever having twopins 138 a extending into holes in the sides ofhousing 132 upon which the actuator member is pivotally mounted in the housing.Actuator member 138 has a portion which extends through anopening 132 a inhousing 132 to enable pivotal movement aboutpin 138 a. Aextension spring 140 is provided which hooks at one end in anotch 138 b ofactuator member 138 and is wound at the other end around apin 141 located in holes in the sides ofhousing 132, such that theactuator member 138 is spring biased to retainactuator member 138 normally in a forward position, as shown for example inFIG. 24A . The body ofhousing 132 has afront portion 132 b providing a stop that limits the pivotal movement of theactuator member 138. Apivot barrel 142 is coupled by apin 144 which extends through anopening 142 a through the pivot barrel and twoholes 143 betweenflanges 144 ofactuator member 138. Aturnbuckle 146 is provided representing a tubular member which has an interior surface right-hand threaded from one end and left-hand threaded from the other end. Theturnbuckle 146 is attached to a threadedcircular end 142 b ofpivot barrel 142 and then to the threadedcircular end 148 a of aball connector 148. The ball connector has aball 148 b having ahole 148 c there through. Drivetube 150 has oneend 150 a into whichball 148 b is received and then coupled to the tube, via apin 149, which extend throughhole 148 c of theball 148 b and twoholes 150 c indrive tube 150. Anadapter 152 is received in theother end 150 b of thedriver tube 150 and has a hole partially extending there through in which is received and attached adrive wire 154. Theadapter 152 is mounted indriver tube 150 for rotational movement about anannular groove 152 a of theadapter 152. Multiple detents (not shown) are formed in thetube 150, such as by deforming the metal by pressure, over theannular groove 152 a. The detents extend into theannular groove 152 a to form a track guide within which theadapter 152 may be rotated. - Another
adapter 156 is provided which hasflanges 156 a received in the two sides ofhousing 132. Arigid tube 158 having anend 158 a which is D-shaped is registered into a corresponding shaped opening inadapter 156, and a threadednut 160 having an opening which extends over mountingtube 158 and screws onto the end of theadapter 156 to securetube 158 toadapter 156.Rigid tube 158 extends fromhousing 132 via anopening 130 d in the housing. The assembly ofcomponents adapter 156 and throughrigid tube 158, as shown inFIG. 24A . A cross-section of theadapter 156 andrigid tube 158 atpin 149 is shown inFIG. 24C . Cross-section ofshaft 134 through therigid tube 158 at the drive tube is shown inFIG. 24D , and at theadapter 152 inFIG. 24E . Thedrive tube 150 is moveable throughrigid tube 158. At theother end 158 b of therigid tube 158 is anotheradapter 162 which is cylindrical and has acentral hole 162 a extending there through. Theadapter 162 is mounted intube 158 by mechanical fastening in which small dents in the metal of the tip tube formed with a press into twoslots 162 b on either side of theadapter 162. Thedrive wire 154 extends throughhole 162 a of theadapter 162 and into anextension tube 164 which extends from theadapter 162 to thedistal end 136 ofinstrument 130.Extension tube 164 is a stainless steel tube having for example, an inner diameter of 0.041 inches and an outer diameter of 0.059 inches, and is mounted inhole 162 a ofadapter 162, such as by welding or brazing, while enabling movement of the drive wire throughadapter 162 andextension tube 164.Drive wire 154 may be, for example, stainless steel music wire. A cross-section ofshaft 134 b throughextension tube 164 is shown inFIG. 24F .Pivot barrel 142,turnbuckle 146,ball connector 148,drive tube 150,adapter 152,rigid tube 158, andadapter 162 may be made of metal, such as stainless steel, whileadapter 156 may be made of molded plastic. - The assembly of the
distal end 136 is best shown inFIGS. 25 , 25A, and 25B. Atip tube 166 is provided having anend 166 a into which is inserted acouple member 168 having anedge 168 a which mates along theedge 166 b oftip tube 166. Theend 164 a ofextension tube 164 is received into acentral hole 168 b throughcoupler member 168 in which thedrive wire 154 extends through thecoupler member 168 and is received and attached in opening 171 (FIG. 25C ) in awedge tip section 170, where it is attached thereto, such as by welding or brazing. Thewedge tip section 170 has aslot 170 a partially there through into which is received the hammer andanvil section 172, such that the hammer and anvil section is slidable inslot 170 a.Sections tip tube 166. Apin 176 extends through twoholes 166 d and anopening 172 a through hammer andanvil section 172 to retainsection 172 intube 166. - A
chamber 173 is provided in the hammer and anvil section into which a securing sleeve member 174 (FIG. 25B ) is located. The securingsleeve member 174 may be a Titanium Knot™ titanium tube manufactured by LaserSurge, Inc. of Rochester, N.Y. Cross-sections through thedistal end 136 of the suture securing instrument are shown inFIGS. 24G and 25C . The wedge tip section has anupper member 170 b and alower member 170 d having aknife 170 d whenwedge tip section 170 is driven forwardupper member 170 b abutsramp 172 d of the hamper andanvil section 172 tofirst push hammer 172 b down to deform and crimpsleeve member 174 againstanvil 172 c, and thenknife 170 d cut sutures extending fromsleeve member 174 near opening 166 e oftip tube 166. Thus, with ends of suture extending through thesleeve member 174 and exit theopening 166 e of thetube tip 166,wedge tip section 170 and the hammer andanvil section 172 provides for crimping the sleeve member to retain the suture and then cuts the suture in response to forward movement of thedrive tube 150 and drivewire 154. Drivetube 150 and drivewire 154 are moved forward by an operator pullingactuator member 138 towardshandle 132 c ofhousing 132, as will be described in more detail in connection withFIG. 27A-H . Rotation ofadapter 152 intube 150 facilitates freedom ofwedge tip 170 to translate, or tilt, along its center axis, which extends in the direction ofwire 154, as the wedge tip is driven forward against the ramped surface ofhammer 172 b. Rotational movement ofactuator member 138 is enabled by pivoting of thepivot barrel 142 about the axis defined bypin 144 in flanges 145. - Before attachment of the
distal end 136 toextension tube 164 through which drivewire 154 extends,tube 164 is passes through a flexibleplastic tubing 178, such as of Tygon. Thistubing 178 extends fromend 158 b ofrigid tube 158, untildistal end 136 when mounted toextension tube 164. The diameter oftubing 178 is substantially matched to the outside diameter oftube 158 andtip tube 166. Ashrink wrap layer 180 is applied on the entire length ofshaft 134 ofinstrument 130 untildistal end 136. - The entire length of the
instrument 130 is such that it can extend throughaccessory tube 12 in which itsshaft 134 has anon-flexible section 134 a defined by the extend ofrigid tube 158, and a flexible section defined by the extent ofextension tube 164 intubing 178. For example, theshaft 134 may be 31.5 inches in length, where itsnon-flexible section 134 a is 12.0 inches in length, and theflexible section 134 b is 19.5 inches in length. - Referring to
FIGS. 26A-26D , the loading ofsleeve member 174 into thedistal end 136 of thesuture securing instrument 130 is shown using aflexible holder 182 having a outer groove (not shown) around which awire 184 is passed to forming a loop. This loading holder is commercially available as a Ti-KNOT® TK· 5™ Quick Load™ unit from LaserSurge, Inc., Rochester, N.Y.Holder 182 may be made of molded rubber, and having an opening 182 a for the fingers of an operator. The ends of thewire loop 184 are attached to a C-shaped orcurved handle 186, which may be composed of metal. Asleeve member 174 is slid alongring 186 until reaches the end of the ring at 186 a (FIG. 26A ). Thering 186 is then passed throughchamber 173 of thedistal end 136 between thehammer 172 b andanvil 172 c ofsection 172 and then exits throughopening 166 e of the tip tube 166 (FIG. 26B ), untilsleeve member 174 is located in chamber 173 (FIG. 26C ). Theflexible holder 184 may then be removed (FIG. 26D ). Referring toFIGS. 26E-26I , the loading of the two ends of a loop ofsuture 105 through a loadedsleeve member 174 in thedistal end 136 of thesuture securing instrument 130 is shown. The two ends ofsuture 105 are passed through the wire loop 184 (FIG. 26E ), as shown byarrow 188, and are captured by the wire loop as the C-shapedhandle 186 is used to pull the wire loop through the sleeve member 174 (FIG. 26F ) andopening 166 e of thetube tip 166, thereby pulling the two ends of the loop of suture through the sleeve member andopening 166 e in the direction indicated by arrows 190-192 (FIGS. 26G-26I ). -
FIGS. 27A-27H shows the operation ofsuture securing instrument 130 to secure and cut the suture. With the ends of the loop ofsuture 105 extending through thesleeve member 174 at thedistal end 136 of thesuture securing instrument 130, the instrument may be inserted into theaccessory tube 12 down to the tissue through which the suture loop extends. The ends of the suture are pulled through thedistal end 136, untilsleeve member 174 is located adjacent the tissue (FIG. 27A ). An operator then pulls theactuator member 138 towardshandle 132 c, driving forward thewedge tip section 170 in which the motion is translated throughshaft 134 viapivot barrel 142,turnbuckle 146,ball connection 148, throughdrive tube 150 and drivewire 154. In response, theupper member 170 b of thewedge tip section 170 slides forward againsthammer 172 b deforming the sleeve member againstanvil 170 c to retain the suture.FIGS. 27B-27E illustrates the downwards movement of the hammer deforming on the sleeve member as thewedge tip section 170 is driven forward. Theknife 170 d at thelower member 170 c of thewedge tip section 170 is also driven forward against the suture (FIG. 27F ), to cut the ends of the suture near the sleeve member 174 (FIG. 27G ). The operator then releases theactuator member 138 which automatically retracts in response to the forward bias byspring 140, and thewedge tip section 170 retracts releasing thesleeve member 174 from betweenhammer 172 b andanvil 172 c (FIG. 27H ). Thedistal end 136 ofsuture instrument 130 is then removed leaving the crimpedsleeve member 174 a to retain the sutured tissue closed (FIG. 27I ). - Referring to
FIGS. 28A-28M and 29A-29F the overall operation ofsystem 10 will now be described in whichFIGS. 28A-28M illustrate examples of the images on adisplay 193 provided by thegastroscope 14, andFIGS. 29A-29F illustrate the relative position of thegastroscope 14,accessory tube 12, andinstruments patient 194 ready for the procedure, thegastroscope 14 and attachedaccessory tube 12 are inserted through themouth 195 down theesophagus 196 and into thestomach 198 where the suturing will take place (FIG. 29A ). Thesuturing instrument 16 with a loop ofsuture 105 loaded is then inserted into theaccessory tube 12 viacannula 20, until thedistal end 16 a passes through attachment tip 26 (FIGS. 28A and 29A ). Thetissue engaging end 16 a of thesuturing instrument 16 is viewable to the operator ondisplay 193 through the gastroscope (FIG. 28A ). With the target area of the tissue located, thevalve 19 is closed, and suction is applied to instrument via avacuum source 200 and control (or regulator) 202 viatubing 201 to pull the tissue intogap 104 of sewtip 98, as described earlier (FIG. 28B ).Control 202 may be integrated invacuum source 200 or alongtubing 201, and is used to selectably enable and disable suction to the sewtip 98 invacuum sleeve 106. A first one ofneedles valve 19 opened, and the sew tip is lifted leaving the suture extending through the tissue (FIGS. 28C , 28D, 28E, and 28F). The target area for the second end of the suture is then located,valve 19 closed, and vacuum again enabled to pull the tissue into the sew tip 98 (FIG. 28F ). A second one of theneedles valve 19 opened, and the sew tip lifted leaving the suture extending through the tissue.FIG. 28G shows an image of the first and second ends of the suture in the tissue. Thesuturing instrument 16 is then removed from the accessory tube as shown inFIG. 29C , pulling aloop 105 a ofsuture 105 through the stomach tissue (FIGS. 28H-28J ). The ends of the suture material are cut from thesuturing instrument 16 and then loaded through thesuture securing instrument 130 which has been loaded with asleeve member 174, as shown inFIG. 29D . Thesuture securing instrument 130 is then inserted into theaccessory tube 12 while gentle tension is applied to the free ends of the loop of suture (FIG. 28K ). Thedistal end 136 of the suture securing instrument passes through theattachment tip 26 and is located near the suture loop extending from the tissue (FIG. 28L ). Thesuture securing instrument 130 is positioned adjacent to the tissue, appropriate suture tension applied and the instrument is then actuated as described earlier to crimp and cut the sleeve member (FIG. 28M ), and then theinstrument 130 is removed leaving the crimpedsleeve member 174 a to close the suture (FIG. 28N ).FIG. 29F illustrates the patient after the suture is closed and the suture securing instrument is removed. Thegastroscope 14 and attachedaccessory tube 12 remains in the patient during both the suturing and suture securing operations, and this procedure does not require the use of an overtube. If additional suturing is required, thesuturing instrument 16 may be reloaded with another suture loop and above described procedure repeated with the suture securing instrument reloaded with another sleeve member to secure the suture closed. In this manner, multiple sutures may be made in the stomach tissue with a single insertion of thegastroscope 14. When suturing is completed, thegastroscope 14 and attachedaccessory tube 12 are removed from the patient. - Although the
suturing instrument 16 andsuture securing instrument 130 are described for use withgastroscope 14,instruments gastroscope 14 andaccessory tube 12. Further, suturinginstrument 16 andsuture securing instrument 130 may pass through aninternal channel 28 d (FIG. 1B ), often called a working or biopsy channel, provided ingastroscope 14 to itsdistal end 14 a sized to receive the respective shaft of the instrument. - Referring to
FIGS. 30-35 , another embodiment of thesuturing instrument 16 is shown to provide additional flexibility withinsection 33 ofshaft 16 b of the instrument. This additional flexibility facilitate further freedom forsection 33 to flex in theaccessory tube 12 with the flexing ofgastroscope shaft 14 a in positioning thedistal end 14 b of the gastroscope. Suturinginstrument 16 is the same in this embodiment except for the components insection 33 betweencoupler member 56 and sewtip 98.Needles FIG. 31 asneedle assembly 203. For illustration purposes,needle assembly 203 forneedle 34 is shown, sinceneedles needle driver 204 is coupled toball 34 a by welding or braising into a hole in the ball.Needle driver 204 is a stainless steel wire or tube. Acable 206 is received in ahole 205 in oneend 204 a ofneedle driver 204. Aspring 207 is installed at oneend 207 a over thecable 206 and attached, such as welded or crimped, to end 204 a of theneedle driver 204. The other end ofcable 206 is received in ahole 209 atend 208 a ofneedle 208, and theend 207 b ofspring 207 is attached such as welded or crimped, to end 208 a of the needle.Cable 206 is a stainless steel wire or braided cable.Spring 207 is a stainless steel extension spring which is normally compressed, and has an inner diameter slightly larger than the outer diameter ofcable 206. For example, inner diameter ofspring 207 may be 0.020 inches, and the outer diameter ofcable 206 may be 0.018 inches. The outside diameter ofspring 207 may be matched to the outside diameters ofneedle driver 204 andneedle 208. The length ofneedle driver 204,needle 208, andcable 206 inspring 207, is such that thetip 122 of theneedle 208 lies in the sewtip 98 when the needle is fully retracted. -
Needle assembly 203 for each of needles 34 and 35 extends through amulti-lumen tube 210 which is attached atend 210 a tocoupler member 36 bytabs 56 f being received in correspondingpockets 212 atend 210 a, and is attached to sewtip 98 bytabs 100 of sewtip 98 inpocket 214 atend 210 b. For purposes of illustration, needles are not shown inFIG. 32 .Multi-lumen tube 210 is made of flexible material, such as plastic, polyurethane, or pebex, and has twoholes 216 through which needles 34 and 35, respectively, each extend, as best shown inFIG. 32A , where thespring 207 andneedle 205 are shown throughholes 216. Theholes 216 have a diameter slightly larger than the outside diameter of thespring 207. Thetube 210 is longitudinally reinforced, such that it cannot be substantially stretched or elongated. Such longitudinally reinforcement of the tube may be provided by a stainless steel kevlar, or nylon weave installed in the tube when it is extruded, or the weave may be adhesively bonded to the outer surface oftube 210. Asuture hole 218 extends throughtube 210 for passage of suture, and negative or positive air pressure, similar tohole 58 d ofguide member 58. End 204 a ofneedle driver 204 and end 208 a ofneedle 208 are located intube 210 for each needle inholes 216. Attachment oftip tube 102,ring 116, and sewtip 98 is the same as described earlier. - The operation of suturing
instrument 16 in this embodiment is the same as described earlier, except that when actuatormember 36 ofinstrument 16 is pulled by an operator forneedle needle 208 vianeedle driver 204 andspring 207, which compresses to assist in pushing forwardneedle 208 in sewtip 98. When actuatormember 36 is retracted, thecable 206 andspring 207 assist in pullingneedle 208 back. - Alternatively in this embodiment, the
multi-lumen tube 210 may be replaced byneedle carrying tubes 220 andsuture supply tube 222. Theneedle assembly 203 for each of needles 34 and 35 extends throughtubes 220, respectively, as shown inFIGS. 33 and 34 , while thesuture supply tube 222 provides a path for suture to sewtip 98, and also can provide negative (or positive) air pressure, as described earlier viavacuum connection assembly 64.Supply tube 222 extends fromchamber 66 b ofvacuum connection assembly 64 throughhole 53 c ofguide member 53, throughsuture track 56 b ofcoupler member 56, and then alongflexible shaft section 35 to sewtip 98.Tubes FIG. 35 shows needle assembly 203 at one end oftubing 220. In this embodiment, shrink wrap 62 (FIG. 10 ) coversmulti-lumen tube 210, ortubes guide member 58. Optionally, to enhanceneedle carrying tubes 220 flexibility, thetubes 220 may each represent awound spring 234 withouter sheath 236, such heat shrink tubing, on the outside surface of thespring 234, as shown inFIGS. 35A and 35B . The interior diameter of thespring 234 is slightly greater than the outside diameter ofneedle assembly 203 extending there through. Theouter sheath 236 is shrunk to the spring only at theends spring 234, such that elongation ofspring 234 is restricted. The interior diameter ofouter sheath 236 is larger than outside diameter ofspring 234 to allow flexure ofspring 234. - Referring to
FIGS. 36 and 36A , a further embodiment of suturinginstrument 16 is shown in which suction to the sew tip is provided withoutvacuum connection assembly 64. In this further embodiment, both thevacuum connection assembly 64 andopening 52 c torigid tube 52 is removed, and anopening 224 is provided through theshrink wrap 62 to suturetrack 58 c ofguide member 58. An additional ring seal 227 (FIG. 36A ) is provided in theopening 26 b extending throughattachment tip 26.Ring seal 227 is composed of the same material asattachment tip 26, and represents a ring extending from the interior surface of theopening 26 b having a diameter slightly smaller than the largest diameter oftissue engaging end 16 a. Thetissue engaging end 16 a can pass through theseal 227, whilering seal 227 engages the outer diameter of the tissue engaging end. Suction may then be applied viacannula port 20 e (FIG. 6 ) of theaccessory tube 12 and communicated throughopening 224 to the suture channel, i.e.,suture track 58 c andchannel 98 d to cavities 98f gap 104 of the sewtip 98, as described earlier, wheninstrument 16 is located throughaccessory tube 12. This suction may be provided from vacuum source 200 (FIG. 29B ) throughcontroller unit 202 andtubing 201 to port 20 e, rather than to thevacuum connection assembly 64. - Referring to
FIGS. 37-39 ,system 10 may optionally have positional locking oftissue engaging end 16 a to lock the rotational position and to limit forward longitudinal travel of thetissue engaging end 16 a of the suturing instrument inattachment tip 26 of theaccessory tube 12. Such locking is provided by adding one ormore protrusion members 226 to ring 116 oftissue engaging end 16 a. For example,ring 116 may have two protrusion members located 180° apart along the outer circumference ofring 116. Theseprotrusion members 226 may be made of stainless steel or molded from plastic, and attached, such as adhesively bonded, or if medal by welding or brazing, to the outer surface ofring 116.Protrusion members 226 are shaped to be received byslots 228 in opening 26 b extending throughattachment tip 26. For example, eightslots 228 are provided at 30 degree increments about the interior surface of opening 26 b, such that twoprotrusion members 226 may be received in one of four opposing (180° apart) pairs ofslots 228. Lesser or greater numbers of slots may also be provided. Eachslot 228 extends fromend 230 ofattachment tip 26 partially into opening 26 b to provide astop 231. The height of theprotrusion member 226 from the outer surface ofring 116 is slightly less than the depth of theslots 228, and width of theprotrusion members 226 is slightly less than the width ofslots 228, such thatprotrusion members 226 can easily engage with an opposing pair ofslots 228.Protrusion members 226 each have a forward round-shapedend 226 a that facilitates the alignment of theprotrusion members 226 inslots 228 to limitinstrument 16 rotation and forward travel. - In operation, when the
tissue engaging end 16 a of theinstrument 16 passes throughaccessory tube 12 and through theattachment tip 26, thedistal end 14 a of thegastroscope 14 can view the vacuum sleeve, and partially the sew tip therein, prior to engagement ofprotrusion members 226 in a pair of opposingslots 228. The operator then can precisely locate the position ofgap 104 of the sew tip with respect to a tissue target area 121 (FIG. 22B ), as described earlier. With the target area located and sewtip gap 104 aligned to face the target area, and substantially parallel thereto, the operator slightly rotates the instrument athousing 30, such byhandle 30 a, and pushes the instrument to locate and engage theprotrusion member 226 ofring 116 of thetissue engaging end 16 a in the closest pair of opposingslots 228 in opening 26 b of theattachment tip 26 which corresponds to the desired aligned rotational position of the sew tip'sgap 104 with respect to the tissue target area, until protrusion members'end 226 aabut stop 231. Once thetissue engaging end 16 a is so rotationally locked in position, the risk of rotational misalignment of the sewtip gap 104 when tissue is captured therein is reduced. To select another target area 126 (FIG. 22F ), the operator rotationally unlockstissue engaging end 16 a by pulling the instrument handle 30 slightly back which disengages theprotrusion members 226 fromslots 228. - Referring to
FIGS. 40 , 40A, 41, 42, and 42A, optionally thesuturing instrument 16 may have a steering mechanism for flexingneedle engaging end 16 a. This steering mechanism includes acontrol cylinder 238 having walls defining aninterior chamber 240 having therein a plunger orpiston 242 attached to the end of a threadedshaft 244 a, which is held in thechamber 240 by a threaded nut 246 (FIG. 40A ). The threadednut 246 is attached to thechamber 240 by insert molding. Athumb wheel 248 attached to theturn screw 244 enabled theshaft 244 a of the turn-screw to rotate along threadednut 246 and control the position of thepiston 242 inchamber 240.Piston 242 has arubber ring seal 243 which engages theinterior surface 240 b ofchamber 240. An opening oroutlet 248 at one wall ofchamber 240 provides a flow path for thevolume 241 ofliquid 245 contained in thechamber 240, where thisvolume 241 is defined by thesurface 242 a of thepiston 242 facingopening 248 and theinterior surface 240 b of thechamber 240. - As shown in
FIG. 40 , at least one exterior surface of a wall ofcontrol cylinder 238 is molded intohousing 30, or thecontrol cylinder 238 is applied by adhesive to the outer surface ofhousing 30.Shaft 244 a andnut 246 may be made of stainless steel, while walls ofchamber 240,piston 242 andthumb wheel 248 may be made of plastic, such ABS. Inhousing 30, aflexible tube 250 is coupled at one end tooutlet 248 and extends through anopening 252 located in therigid tube 52 aftergasket member 51 and beforevacuum connection assembly 64, and then tune 250 follows a path along one oftracks 53 d ofguide member 53 inrigid tube 52, and through ahole 254 ofcoupler member 56 extending through itstab FIG. 41 ). Fromcoupler member 56, thetube 250 extends along one oftracks 58 d ofguide member 58 to acylinder 256 located in thetrack 58 d before sew tip 98 (FIG. 42 ). For example,tube 250 may be made of flexible plastic material. As shown inFIG. 42A ,cylinder 256 has walls defining ainterior chamber 256 a having anopening 256 b in one wall to this chamber which the other end oftube 250 is connected, such as by adhesive bonding. A piston orplunger 256 c inchamber 256 a is coupled to arod 258 extending through anopening 256 d in a wall of the chamber. Thesurface 256 e ofpiston 256 c faces opening 256 b and is positionable inchamber 256 a to change the volume 257 ofliquid 245 contained in the chamber, where volume 257 is defined bysurface 256 e of thepiston 256 c and the interior surface 256 f ofcylinder 256. -
Rod 258 has at its end 258 a ahole 258 b into which aflexure member 260 is attached, such as by welding or crimping.Flexure member 260 extends into a hole in one end oftabs 100 of sewtip 98, and is attached thereto by welding or crimping.Flexure coupler 260 allows for possible misalignment betweenrod 258 andtab 100 of the sewtip 98.Cylinder 256 is fixed in place in one oftracks 58 d, such as by frictionally engagement when shrinkwrap tubing 62 is applied overguide member 58, or may be bonded by adhesive. For example, the components ofcylinder 256 may be made of stainless steel, exceptpiston 256 c which may be made of rubber. - To steer the sew tip, an operator of the
suturing instrument 16 turns thethumb wheel 248 changing the volume offluid 245 inchamber 240, and moving the fluid into or out ofoutlet 248 andtube 250. In response, the volume offluid 245 inchamber 256 c ofcylinder 256 changes, andpiston 256 c androd 258 moves incylinder 238 causing the rod to extend or retract to flextissue engaging end 16 a, viaflexure coupler 260. For purposes of illustration,arrows 239 indicate flexure of thetissue engaging end 16 a ofinstrument 16.Fluid 245 may be, for example, water. This provide for a hydraulic steering mechanic which an operator of theinstrument 16 can use to provide additional control in positioning the tissue engaging end during suturing, such positioning being independent of other steerability of the tissue engaging as may be provided by flexure of gastroscope'sshaft 14 b. - Alternatively,
cylinder 256 may be replaced by afolding piston 262, as shown inFIG. 42B and in more detail inFIG. 42C .Folding piston 262 has walls defining acavity 262 a which can longitudinally expand or contract due to changes involume 263 ofliquid 245 contained in the cavity from movement of the fluid through anopening 262 b in one of the walls to whichtube 250 is connected, such as by adhesive bonding.Rod 258 is attached to end 262 d offolding piston 262, by adhesive bonding or is molded to end 262 d.Folding piston 262 may be made of plastic, stainless steel, or of heat shrink tubing. -
Folding piston 262 can be manufactured with a process using thin walled transparent or white heat shrinkplastic tube 270 made from a non-elastic plastic, like polyester.FIG. 45A shows dark, light absorbing,lines 271 printed directly onto thetube 270 when it is collapsed flat.FIG. 45B shows thesame tube 270 havingplugs 273 withopenings 262 b into the tube, and pressurized with a medium (not shown), such as water or air, through conduits to one or bothopenings 262 b. Water is a preferred pressurized medium, because it also acts as heat sink to ensure localized heating of the tube only at the desired, printed sites. An appropriate fluence of light, such as produced by a laser, for a specific duration to generate heat along such dark lines of thetube 270 provides controlled radial and axial shrinkage of the tube (FIG. 45C ). Such changes to the tube shape permits longitudinal folding oftube 270, as indicated by arrow 272 (FIG. 45D ). When the intraluminal pressure and volume are decreased and direct outside pressure is applied to either or both ends of thetube 270, such as via opening 262 b, the tube can collapse in length by folding in near the heat shrunkzones 274, and thus providefolding piston 262. By increasing pressure and volume withinfolding piston 262, the foldedzones 274 will reexpand longitudinally to re-establish the length of thefolding piston 262. By controlling volume and pressure within thefolding piston 262, piston length is readily altered. Alternatively, light activated thermal modification of heat shrink tubing can be achieved by using a well controlled circumferential application of focused light, such as laser light, or by careful masking of the heat shrink tubing, or by placing a compliant marked mandrel or tube within a clear heat shrink tube and exposing to appropriate lighting conditions. - In a further alternative, a
wire 263 may replacetube 250, such that a mechanical steering mechanism is provided. As shown inFIG. 44 ,wire 263 follows the same path astube 250, except that a piston in no longer required incylinder 238. Instead, thewire 263 is coupled incylinder 238 toshaft 244 a to aball 265, which is retained in asocket 267 formed at the end of theshaft 244 a. Acap 269 has a hole forwire 263 and is received and attached to the socket, such as by welding or brazing, to retain the ball onto the socket, but enable rotation of the ball so that the rotation of theshaft 244 a is not transferred to thewire 264. The wire passes through atube 266, such as made of stainless steel extending betweenoutlet 248 and opening 252 of the rigid tube 52 (FIG. 44 ).Tube 266 is attached to opening 252, such as by welding or brazing. The wire passes along one oftracks 53 d ofguide member 53 extending with the guide member throughrigid tube 52, and then throughhole 254 ofcoupler member 56 through itstab tracks 58 d ofguide member 58 to the sew tip 98 (FIG. 44A ).Wire 262 is attached to ahole 268 extending intotab 100 of the sewtip 98, such as by welding or brazing. - From the foregoing description, it will be apparent that there has been provided an improved system and method for endoscopic suturing. Variations and modifications in the herein described system and method in accordance with the invention will undoubtedly suggest themselves to those skilled in the art. For example, the
entire shaft instruments
Claims (19)
1-44. (canceled)
45. An instrument having a steerable distal end comprising:
a proximal end;
a distal end;
an at least partially flexible shaft extending from said proximal end to said distal end;
a housing coupled to said distal end having walls with folds capable of expanding or contracting said housing along a dimension to change the length of the housing along said dimension;
a medium; and
means for controlling one or more of volume and pressure of said medium within the housing to change length of said housing along said dimension to steer said distal end, in which said housing expands along said folds responsive to increase in one or more of volume and pressure of said medium in said housing, and said housing contracts along said folds response to decrease in one or more of pressure and volume of said medium in said housing.
46. The instrument according to claim 45 wherein said means for controlling comprises a conduit for passing said medium into and out of said housing.
47. The instrument according to claim 46 wherein said means for controlling is located at said proximal end.
48. The instrument according to claim 45 wherein said housing is longitudinally expandable or contractible along said folds.
49. The instrument according to claim 45 wherein said housing is cylindrical.
50. The instrument according to claim 45 wherein said medium is a liquid.
51. The instrument according to claim 45 wherein said means for controlling comprises a chamber, a positionable piston in said chamber to change the volume of said medium in said chamber, a first opening in said chamber, a tube coupled to said opening, and said tube extending along said shaft to pass said medium between said chamber and said housing responsive to said change in volume of said medium in said chamber.
52. The instrument according to claim 45 further comprising:
a tissue engaging end coupled to said shaft at the distal end of the instrument; and
one or more needles which extend through said shaft to said tissue engaging end.
53. The instrument according to claim 52 further comprising:
means for carrying suture along said shaft to said tissue engaging end;
said tissue engaging end having an opening to a cavity through which said needles are extendable to each capture one end of the suture; and
means for applying suction along said shaft to said cavity of said tissue engaging end to enable tissue to be pulled into said opening when said needles are extended.
54. An instrument having a remotely steerable distal end comprising
a proximal end;
a distal end;
a shaft extending from said proximal end to said distal end;
a chamber at or near said proximal end having a medium;
a first piston in said chamber movable to change the volume of said medium in said chamber;
an opening in said chamber; and
a tube coupled to said opening extending along said shaft to said distal end; and
a second piston coupled to said distal end said second piston having walls which are longitudinally expandable responsive to increase pressure and volume in said second piston when communicated through said tube from said first piston, and longitudinally contractible responsive to decease in pressure and volume of said medium in said second piston when communicated through said tube from said first piston, communicated through said tube to said piston to steer said distal end.
55. An instrument having a steerable distal end comprising:
a flexible shaft having a distal end passable through a flexible internal or external conduit associated with an endoscope having a first steering means; and
second means for steering said distal end of said shaft separately operative from said first steering means when the distal end of said shaft is passed through said flexible internal or external conduit associated with the endoscope.
56. The instrument according to claim 55 wherein said second steering means is mechanically actuated.
57. The instrument according to claim 55 wherein said second steering means is hydraulically actuated.
58. The instrument according to claim 57 wherein said second steering means comprises:
a chamber at or near the proximal end of said instrument having a fluid and a piston in said chamber movable to change the volume of the fluid in said chamber, an opening to said chamber, and a tube coupled to said opening extending along said shaft to said distal end; and
a cylinder along said shaft having a piston coupled to said distal end movable responsive to changes in said volume of fluid in said chamber communicated through said tube to said cylinder to steer said distal end.
59. The instrument according to claim 57 wherein said second steering means comprises:
a housing coupled to said distal end having walls with folds capable of expanding or contracting said housing along a dimension to change the length of the housing along said dimension;
a medium; and
means for controlling one or more of volume and pressure of said medium within the housing to change length of said housing along said dimension to steer said distal end, in which said housing expands along said folds responsive to increase in one or more of volume and pressure of said medium in said housing, and said housing contracts along said folds response to decrease in one or more of pressure and volume of said medium in said housing.
60. The instrument according to claim 57 wherein said second steering means comprises:
a chamber at or near the proximal end of said instrument having a medium and a piston in said chamber movable to change the volume of said medium in said chamber, an opening in said chamber, and a tube coupled to said opening extending along said shaft to said distal end; and
a folding housing coupled to said distal end expandable and retractable responsive to changes in said volume of said medium in said chamber communicated through said tube to said piston to steer said distal end.
61. The instrument according to claim 55 further comprising:
a tissue engaging end coupled to said shaft at the distal end of the instrument; and
one or more flexible needles which extend through said shaft to said tissue engaging end.
62. The instrument according to claim 61 further comprising:
means for carrying suture along said shaft to said tissue engaging end;
said tissue engaging end having an opening to a cavity through which said needles are extendable to each capture one end of the suture; and
means for applying suction along said shaft to said cavity of said tissue engaging end to enable tissue to be pulled into said opening when said needles are extended.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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US12/807,259 US20100331623A1 (en) | 2001-02-02 | 2010-09-01 | System for endoscopic suturing |
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
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US09/776,431 US6997931B2 (en) | 2001-02-02 | 2001-02-02 | System for endoscopic suturing |
US11/085,703 US20050165419A1 (en) | 2001-02-02 | 2005-03-21 | System for endoscopic suturing |
US12/807,259 US20100331623A1 (en) | 2001-02-02 | 2010-09-01 | System for endoscopic suturing |
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US11/085,703 Division US20050165419A1 (en) | 2001-02-02 | 2005-03-21 | System for endoscopic suturing |
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US11/085,703 Abandoned US20050165419A1 (en) | 2001-02-02 | 2005-03-21 | System for endoscopic suturing |
US12/807,259 Abandoned US20100331623A1 (en) | 2001-02-02 | 2010-09-01 | System for endoscopic suturing |
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US11/085,703 Abandoned US20050165419A1 (en) | 2001-02-02 | 2005-03-21 | System for endoscopic suturing |
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US20120130403A1 (en) * | 2010-11-22 | 2012-05-24 | Brenner Jacob S | Device and method for treatment of hemorrhoids |
US20130023905A1 (en) * | 2011-07-20 | 2013-01-24 | Coloplast A/S | Suture system with capsule eyelet providing multiple suture tissue fixation |
US20130324905A1 (en) * | 2012-05-31 | 2013-12-05 | Valentx, Inc. | Devices and methods for gastrointestinal bypass |
US8882834B2 (en) | 2011-07-08 | 2014-11-11 | Smith & Nephew, Inc. | Soft tissue repair |
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US9662105B2 (en) | 2011-07-08 | 2017-05-30 | Smith & Nephew, Inc. | Suture passer and method |
US9675489B2 (en) | 2012-05-31 | 2017-06-13 | Valentx, Inc. | Devices and methods for gastrointestinal bypass |
US9757264B2 (en) | 2013-03-13 | 2017-09-12 | Valentx, Inc. | Devices and methods for gastrointestinal bypass |
US10350101B2 (en) | 2002-11-01 | 2019-07-16 | Valentx, Inc. | Devices and methods for endolumenal gastrointestinal bypass |
US10702263B2 (en) * | 2017-05-30 | 2020-07-07 | Suture Ease, Inc. | Biological tissue access and closure apparatus, systems and methods |
US11154294B2 (en) * | 2018-05-29 | 2021-10-26 | Suture Ease, Inc. | Biological tissue access and closure apparatus, systems and methods |
US20220008064A1 (en) * | 2017-05-30 | 2022-01-13 | Suture Ease, Inc. | Biological Tissue Access and Closure Apparatus, Systems and Methods |
Families Citing this family (1054)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5766183A (en) | 1996-10-21 | 1998-06-16 | Lasersurge, Inc. | Vascular hole closure |
US7435249B2 (en) | 1997-11-12 | 2008-10-14 | Covidien Ag | Electrosurgical instruments which reduces collateral damage to adjacent tissue |
US6726686B2 (en) | 1997-11-12 | 2004-04-27 | Sherwood Services Ag | Bipolar electrosurgical instrument for sealing vessels |
US6228083B1 (en) | 1997-11-14 | 2001-05-08 | Sherwood Services Ag | Laparoscopic bipolar electrosurgical instrument |
US7364577B2 (en) | 2002-02-11 | 2008-04-29 | Sherwood Services Ag | Vessel sealing system |
US7267677B2 (en) | 1998-10-23 | 2007-09-11 | Sherwood Services Ag | Vessel sealing instrument |
US7118570B2 (en) | 2001-04-06 | 2006-10-10 | Sherwood Services Ag | Vessel sealing forceps with disposable electrodes |
US7582087B2 (en) | 1998-10-23 | 2009-09-01 | Covidien Ag | Vessel sealing instrument |
US8574243B2 (en) | 1999-06-25 | 2013-11-05 | Usgi Medical, Inc. | Apparatus and methods for forming and securing gastrointestinal tissue folds |
US7618426B2 (en) | 2002-12-11 | 2009-11-17 | Usgi Medical, Inc. | Apparatus and methods for forming gastrointestinal tissue approximations |
US7416554B2 (en) | 2002-12-11 | 2008-08-26 | Usgi Medical Inc | Apparatus and methods for forming and securing gastrointestinal tissue folds |
US7637905B2 (en) | 2003-01-15 | 2009-12-29 | Usgi Medical, Inc. | Endoluminal tool deployment system |
US20040122456A1 (en) * | 2002-12-11 | 2004-06-24 | Saadat Vahid C. | Methods and apparatus for gastric reduction |
US20030109875A1 (en) * | 1999-10-22 | 2003-06-12 | Tetzlaff Philip M. | Open vessel sealing forceps with disposable electrodes |
WO2001066018A1 (en) * | 2000-03-03 | 2001-09-13 | C. R. Bard, Inc. | Endoscopic tissue apposition device with multiple suction ports |
US6679264B1 (en) | 2000-03-04 | 2004-01-20 | Emphasys Medical, Inc. | Methods and devices for use in performing pulmonary procedures |
US20030070683A1 (en) * | 2000-03-04 | 2003-04-17 | Deem Mark E. | Methods and devices for use in performing pulmonary procedures |
US7083628B2 (en) * | 2002-09-03 | 2006-08-01 | Edwards Lifesciences Corporation | Single catheter mitral valve repair device and method for use |
ES2435094T3 (en) | 2000-05-19 | 2013-12-18 | C.R. Bard, Inc. | Device and method of tissue capture and suturing |
SE0002878D0 (en) * | 2000-08-11 | 2000-08-11 | Kimblad Ola | Device and method of treatment of atrioventricular regurgitation |
US7737109B2 (en) | 2000-08-11 | 2010-06-15 | Temple University Of The Commonwealth System Of Higher Education | Obesity controlling method |
US7608578B2 (en) * | 2000-08-11 | 2009-10-27 | Temple University - Of The Commonwealth System Of Higher Education | Obesity controlling method |
US6551330B1 (en) | 2000-09-21 | 2003-04-22 | Opus Medical, Inc. | Linear suturing apparatus and methods |
US8313496B2 (en) * | 2001-02-02 | 2012-11-20 | Lsi Solutions, Inc. | System for endoscopic suturing |
US7235086B2 (en) * | 2001-02-02 | 2007-06-26 | Lsi Solutions, Inc. | Crimping instrument with motion limiting feature |
DE10105592A1 (en) | 2001-02-06 | 2002-08-08 | Achim Goepferich | Placeholder for drug release in the frontal sinus |
US8414505B1 (en) * | 2001-02-15 | 2013-04-09 | Hansen Medical, Inc. | Catheter driver system |
JP4394881B2 (en) | 2001-04-06 | 2010-01-06 | コヴィディエン アクチェンゲゼルシャフト | An electrosurgical instrument that reduces incidental damage to adjacent tissue |
AU2001249933B2 (en) | 2001-04-06 | 2006-06-08 | Covidien Ag | Vessel sealer and divider with non-conductive stop members |
CA2450662C (en) | 2001-06-14 | 2010-06-15 | Suturtek Incorporated | Apparatus and method for surgical suturing with thread management |
US6817974B2 (en) | 2001-06-29 | 2004-11-16 | Intuitive Surgical, Inc. | Surgical tool having positively positionable tendon-actuated multi-disk wrist joint |
US20060178556A1 (en) | 2001-06-29 | 2006-08-10 | Intuitive Surgical, Inc. | Articulate and swapable endoscope for a surgical robot |
US20060199999A1 (en) * | 2001-06-29 | 2006-09-07 | Intuitive Surgical Inc. | Cardiac tissue ablation instrument with flexible wrist |
US20050182298A1 (en) * | 2002-12-06 | 2005-08-18 | Intuitive Surgical Inc. | Cardiac tissue ablation instrument with flexible wrist |
US6605096B1 (en) * | 2001-07-20 | 2003-08-12 | Opus Medical Inc, | Percutaneous suturing apparatus and method |
US20030078601A1 (en) * | 2001-10-22 | 2003-04-24 | Oleg Shikhman | Crimping and cutting device |
US8142448B2 (en) * | 2001-11-26 | 2012-03-27 | Olympus Corporation | Endoscopic instruments for suturing tissues in a body cavity |
US6740030B2 (en) * | 2002-01-04 | 2004-05-25 | Vision Sciences, Inc. | Endoscope assemblies having working channels with reduced bending and stretching resistance |
CA2486550C (en) | 2002-06-12 | 2011-05-24 | Scimed Life Systems, Inc. | Suturing instruments |
US7753924B2 (en) | 2003-09-04 | 2010-07-13 | Guided Delivery Systems, Inc. | Delivery devices and methods for heart valve repair |
US20060241656A1 (en) * | 2002-06-13 | 2006-10-26 | Starksen Niel F | Delivery devices and methods for heart valve repair |
US7588582B2 (en) * | 2002-06-13 | 2009-09-15 | Guided Delivery Systems Inc. | Methods for remodeling cardiac tissue |
AU2003245507A1 (en) * | 2002-06-13 | 2003-12-31 | Guided Delivery Systems, Inc. | Devices and methods for heart valve repair |
US7753858B2 (en) * | 2002-06-13 | 2010-07-13 | Guided Delivery Systems, Inc. | Delivery devices and methods for heart valve repair |
US8641727B2 (en) | 2002-06-13 | 2014-02-04 | Guided Delivery Systems, Inc. | Devices and methods for heart valve repair |
US8287555B2 (en) * | 2003-02-06 | 2012-10-16 | Guided Delivery Systems, Inc. | Devices and methods for heart valve repair |
US7758637B2 (en) * | 2003-02-06 | 2010-07-20 | Guided Delivery Systems, Inc. | Delivery devices and methods for heart valve repair |
US7666193B2 (en) | 2002-06-13 | 2010-02-23 | Guided Delivery Sytems, Inc. | Delivery devices and methods for heart valve repair |
US7883538B2 (en) * | 2002-06-13 | 2011-02-08 | Guided Delivery Systems Inc. | Methods and devices for termination |
US7753922B2 (en) * | 2003-09-04 | 2010-07-13 | Guided Delivery Systems, Inc. | Devices and methods for cardiac annulus stabilization and treatment |
US9949829B2 (en) | 2002-06-13 | 2018-04-24 | Ancora Heart, Inc. | Delivery devices and methods for heart valve repair |
US20060122633A1 (en) * | 2002-06-13 | 2006-06-08 | John To | Methods and devices for termination |
ES2378149T3 (en) * | 2002-06-18 | 2012-04-09 | Tyco Healthcare Group Lp | Tissue removal device |
US6770084B1 (en) * | 2002-06-26 | 2004-08-03 | Opus Medical, Inc. | Suture capture device |
WO2004021873A2 (en) | 2002-09-06 | 2004-03-18 | C.R. Bard, Inc. | Integrated endoscope and accessory treatment device |
US8317816B2 (en) | 2002-09-30 | 2012-11-27 | Acclarent, Inc. | Balloon catheters and methods for treating paranasal sinuses |
US7931649B2 (en) | 2002-10-04 | 2011-04-26 | Tyco Healthcare Group Lp | Vessel sealing instrument with electrical cutting mechanism |
US7276068B2 (en) | 2002-10-04 | 2007-10-02 | Sherwood Services Ag | Vessel sealing instrument with electrical cutting mechanism |
US7270664B2 (en) | 2002-10-04 | 2007-09-18 | Sherwood Services Ag | Vessel sealing instrument with electrical cutting mechanism |
US6899672B2 (en) * | 2002-11-08 | 2005-05-31 | Scimed Life Systems, Inc. | Endoscopic imaging system including removable deflection device |
US7799026B2 (en) * | 2002-11-14 | 2010-09-21 | Covidien Ag | Compressible jaw configuration with bipolar RF output electrodes for soft tissue fusion |
US20040199169A1 (en) * | 2002-11-20 | 2004-10-07 | Koons Kirk C. | Cable clamp tool for surgical applications |
CN100389730C (en) | 2002-12-06 | 2008-05-28 | 直观外科手术公司 | Flexible wrist for surgical tool |
US7942898B2 (en) | 2002-12-11 | 2011-05-17 | Usgi Medical, Inc. | Delivery systems and methods for gastric reduction |
US7942884B2 (en) | 2002-12-11 | 2011-05-17 | Usgi Medical, Inc. | Methods for reduction of a gastric lumen |
WO2004069291A2 (en) * | 2003-02-04 | 2004-08-19 | Lsi Solutions, Inc. | Instrument for assisting in the remote placement of tied surgical knots and trimming of suture away from the knot and method of use |
US8016845B1 (en) | 2003-02-04 | 2011-09-13 | Lsi Solutions, Inc. | Instrument for guiding the surgical cutting of tissue and method of use |
US7481817B2 (en) | 2003-02-13 | 2009-01-27 | Lsi Soultions, Inc. | Instrument for surgically cutting tissue and method of use |
AU2003223284C1 (en) | 2003-03-13 | 2010-09-16 | Covidien Ag | Bipolar concentric electrode assembly for soft tissue fusion |
US7381210B2 (en) | 2003-03-14 | 2008-06-03 | Edwards Lifesciences Corporation | Mitral valve repair system and method for use |
WO2004098383A2 (en) | 2003-05-01 | 2004-11-18 | Sherwood Services Ag | Electrosurgical instrument which reduces thermal damage to adjacent tissue |
US7160299B2 (en) * | 2003-05-01 | 2007-01-09 | Sherwood Services Ag | Method of fusing biomaterials with radiofrequency energy |
EP1628586B1 (en) | 2003-05-15 | 2011-07-06 | Covidien AG | Tissue sealer with non-conductive variable stop members |
US7815565B2 (en) * | 2003-05-16 | 2010-10-19 | Ethicon Endo-Surgery, Inc. | Endcap for use with an endoscope |
MXPA05012303A (en) | 2003-05-16 | 2006-02-22 | Bard Inc C R | Single intubation, multi-stitch endoscopic suturing system. |
US7615005B2 (en) | 2003-05-16 | 2009-11-10 | Ethicon Endo-Surgery, Inc. | Medical apparatus for use with an endoscope |
US20070203393A1 (en) * | 2003-05-16 | 2007-08-30 | David Stefanchik | Apparatus for positioning a medical device |
US7615003B2 (en) * | 2005-05-13 | 2009-11-10 | Ethicon Endo-Surgery, Inc. | Track for medical devices |
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 |
WO2004107990A1 (en) * | 2003-06-06 | 2004-12-16 | Abbott Laboratories | Sizing and positioning adapter for medical instruments |
USD956973S1 (en) | 2003-06-13 | 2022-07-05 | Covidien Ag | Movable handle for endoscopic vessel sealer and divider |
US7857812B2 (en) | 2003-06-13 | 2010-12-28 | Covidien Ag | Vessel sealer and divider having elongated knife stroke and safety for cutting mechanism |
US7156846B2 (en) | 2003-06-13 | 2007-01-02 | Sherwood Services Ag | Vessel sealer and divider for use with small trocars and cannulas |
US7150749B2 (en) | 2003-06-13 | 2006-12-19 | Sherwood Services Ag | Vessel sealer and divider having elongated knife stroke and safety cutting mechanism |
US8216252B2 (en) | 2004-05-07 | 2012-07-10 | Usgi Medical, Inc. | Tissue manipulation and securement system |
US7534204B2 (en) * | 2003-09-03 | 2009-05-19 | Guided Delivery Systems, Inc. | Cardiac visualization devices and methods |
US7452363B2 (en) * | 2003-09-30 | 2008-11-18 | Ethicon Endo-Surgery, Inc. | Applier for fastener for single lumen access anastomosis |
US8211142B2 (en) * | 2003-09-30 | 2012-07-03 | Ortiz Mark S | Method for hybrid gastro-jejunostomy |
US9848938B2 (en) | 2003-11-13 | 2017-12-26 | Covidien Ag | Compressible jaw configuration with bipolar RF output electrodes for soft tissue fusion |
US7367976B2 (en) | 2003-11-17 | 2008-05-06 | Sherwood Services Ag | Bipolar forceps having monopolar extension |
US7500975B2 (en) | 2003-11-19 | 2009-03-10 | Covidien Ag | Spring loaded reciprocating tissue cutting mechanism in a forceps-style electrosurgical instrument |
US7811283B2 (en) | 2003-11-19 | 2010-10-12 | Covidien Ag | Open vessel sealing instrument with hourglass cutting mechanism and over-ratchet safety |
US7131970B2 (en) * | 2003-11-19 | 2006-11-07 | Sherwood Services Ag | Open vessel sealing instrument with cutting mechanism |
US7442193B2 (en) | 2003-11-20 | 2008-10-28 | Covidien Ag | Electrically conductive/insulative over-shoe for tissue fusion |
JP4594612B2 (en) * | 2003-11-27 | 2010-12-08 | オリンパス株式会社 | Insertion aid |
US7347863B2 (en) | 2004-05-07 | 2008-03-25 | Usgi Medical, Inc. | Apparatus and methods for manipulating and securing tissue |
US20050251189A1 (en) | 2004-05-07 | 2005-11-10 | Usgi Medical Inc. | Multi-position tissue manipulation assembly |
US7361180B2 (en) | 2004-05-07 | 2008-04-22 | Usgi Medical, Inc. | Apparatus for manipulating and securing tissue |
US20050273138A1 (en) * | 2003-12-19 | 2005-12-08 | Guided Delivery Systems, Inc. | Devices and methods for anchoring tissue |
EP1702569B1 (en) * | 2004-01-08 | 2015-10-14 | Olympus Corporation | Anastomosis device and method of excising wall portion of in vivo luminal organ |
US7211093B2 (en) * | 2004-01-14 | 2007-05-01 | Lsi Solutions, Inc. | Sew-right running stitch instrument |
US7780662B2 (en) | 2004-03-02 | 2010-08-24 | Covidien Ag | Vessel sealing system using capacitive RF dielectric heating |
US7703459B2 (en) | 2004-03-09 | 2010-04-27 | Usgi Medical, Inc. | Apparatus and methods for mapping out endoluminal gastrointestinal surgery |
JP4700384B2 (en) * | 2004-04-07 | 2011-06-15 | オリンパス株式会社 | Medical ligature suturing apparatus and medical ligature suturing system |
JP4643328B2 (en) * | 2004-04-07 | 2011-03-02 | オリンパス株式会社 | Medical ligature suturing device |
JP4923231B2 (en) * | 2004-04-15 | 2012-04-25 | クック メディカル テクノロジーズ エルエルシー | Endoscopic surgical access instrument and method for articulating an external accessory channel |
US10188413B1 (en) | 2004-04-21 | 2019-01-29 | Acclarent, Inc. | Deflectable guide catheters and related methods |
US8146400B2 (en) | 2004-04-21 | 2012-04-03 | Acclarent, Inc. | Endoscopic methods and devices for transnasal procedures |
US7559925B2 (en) | 2006-09-15 | 2009-07-14 | Acclarent Inc. | Methods and devices for facilitating visualization in a surgical environment |
US8932276B1 (en) | 2004-04-21 | 2015-01-13 | Acclarent, Inc. | Shapeable guide catheters and related methods |
US20070208252A1 (en) | 2004-04-21 | 2007-09-06 | Acclarent, Inc. | Systems and methods for performing image guided procedures within the ear, nose, throat and paranasal sinuses |
US20060063973A1 (en) | 2004-04-21 | 2006-03-23 | Acclarent, Inc. | Methods and apparatus for treating disorders of the ear, nose and throat |
US9089258B2 (en) | 2004-04-21 | 2015-07-28 | Acclarent, Inc. | Endoscopic methods and devices for transnasal procedures |
US7361168B2 (en) | 2004-04-21 | 2008-04-22 | Acclarent, Inc. | Implantable device and methods for delivering drugs and other substances to treat sinusitis and other disorders |
US7410480B2 (en) * | 2004-04-21 | 2008-08-12 | Acclarent, Inc. | Devices and methods for delivering therapeutic substances for the treatment of sinusitis and other disorders |
US9101384B2 (en) | 2004-04-21 | 2015-08-11 | Acclarent, Inc. | Devices, systems and methods for diagnosing and treating sinusitis and other disorders of the ears, Nose and/or throat |
US7654997B2 (en) | 2004-04-21 | 2010-02-02 | Acclarent, Inc. | Devices, systems and methods for diagnosing and treating sinusitus and other disorders of the ears, nose and/or throat |
US9554691B2 (en) | 2004-04-21 | 2017-01-31 | Acclarent, Inc. | Endoscopic methods and devices for transnasal procedures |
US8864787B2 (en) | 2004-04-21 | 2014-10-21 | Acclarent, Inc. | Ethmoidotomy system and implantable spacer devices having therapeutic substance delivery capability for treatment of paranasal sinusitis |
US8764729B2 (en) | 2004-04-21 | 2014-07-01 | Acclarent, Inc. | Frontal sinus spacer |
US7803150B2 (en) | 2004-04-21 | 2010-09-28 | Acclarent, Inc. | Devices, systems and methods useable for treating sinusitis |
US7462175B2 (en) | 2004-04-21 | 2008-12-09 | Acclarent, Inc. | Devices, systems and methods for treating disorders of the ear, nose and throat |
US8894614B2 (en) | 2004-04-21 | 2014-11-25 | Acclarent, Inc. | Devices, systems and methods useable for treating frontal sinusitis |
US8747389B2 (en) | 2004-04-21 | 2014-06-10 | Acclarent, Inc. | Systems for treating disorders of the ear, nose and throat |
US8702626B1 (en) | 2004-04-21 | 2014-04-22 | Acclarent, Inc. | Guidewires for performing image guided procedures |
US9351750B2 (en) | 2004-04-21 | 2016-05-31 | Acclarent, Inc. | Devices and methods for treating maxillary sinus disease |
US7419497B2 (en) | 2004-04-21 | 2008-09-02 | Acclarent, Inc. | Methods for treating ethmoid disease |
US20070167682A1 (en) | 2004-04-21 | 2007-07-19 | Acclarent, Inc. | Endoscopic methods and devices for transnasal procedures |
US9399121B2 (en) | 2004-04-21 | 2016-07-26 | Acclarent, Inc. | Systems and methods for transnasal dilation of passageways in the ear, nose or throat |
US20190314620A1 (en) | 2004-04-21 | 2019-10-17 | Acclarent, Inc. | Apparatus and methods for dilating and modifying ostia of paranasal sinuses and other intranasal or paranasal structures |
US20060004323A1 (en) | 2004-04-21 | 2006-01-05 | Exploramed Nc1, Inc. | Apparatus and methods for dilating and modifying ostia of paranasal sinuses and other intranasal or paranasal structures |
US8444657B2 (en) | 2004-05-07 | 2013-05-21 | Usgi Medical, Inc. | Apparatus and methods for rapid deployment of tissue anchors |
US8257394B2 (en) | 2004-05-07 | 2012-09-04 | Usgi Medical, Inc. | Apparatus and methods for positioning and securing anchors |
US7918869B2 (en) * | 2004-05-07 | 2011-04-05 | Usgi Medical, Inc. | Methods and apparatus for performing endoluminal gastroplasty |
US7736374B2 (en) | 2004-05-07 | 2010-06-15 | Usgi Medical, Inc. | Tissue manipulation and securement system |
US8057511B2 (en) | 2004-05-07 | 2011-11-15 | Usgi Medical, Inc. | Apparatus and methods for positioning and securing anchors |
US7520884B2 (en) * | 2004-05-07 | 2009-04-21 | Usgi Medical Inc. | Methods for performing gastroplasty |
US20050251091A1 (en) * | 2004-05-10 | 2005-11-10 | Usgi Medical Inc. | Apparatus and methods for transgastric tissue manipulation |
US7758564B2 (en) * | 2004-05-14 | 2010-07-20 | Ethicon Endo-Surgery, Inc. | Medical instrument having a catheter and a medical guidewire |
WO2005113051A2 (en) | 2004-05-14 | 2005-12-01 | Ethicon Endo-Surgery, Inc. | Medical instrument having a medical guidewire |
US7736379B2 (en) | 2004-06-09 | 2010-06-15 | Usgi Medical, Inc. | Compressible tissue anchor assemblies |
US7695493B2 (en) | 2004-06-09 | 2010-04-13 | Usgi Medical, Inc. | System for optimizing anchoring force |
US7678135B2 (en) | 2004-06-09 | 2010-03-16 | Usgi Medical, Inc. | Compressible tissue anchor assemblies |
US8206417B2 (en) | 2004-06-09 | 2012-06-26 | Usgi Medical Inc. | Apparatus and methods for optimizing anchoring force |
US7931661B2 (en) | 2004-06-14 | 2011-04-26 | Usgi Medical, Inc. | Apparatus and methods for performing transluminal gastrointestinal procedures |
US11890012B2 (en) | 2004-07-28 | 2024-02-06 | Cilag Gmbh International | Staple cartridge comprising cartridge body and attached support |
US8215531B2 (en) | 2004-07-28 | 2012-07-10 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having a medical substance dispenser |
US8172857B2 (en) | 2004-08-27 | 2012-05-08 | Davol, Inc. | Endoscopic tissue apposition device and method of use |
US7195631B2 (en) | 2004-09-09 | 2007-03-27 | Sherwood Services Ag | Forceps with spring loaded end effector assembly |
US9775600B2 (en) | 2010-10-01 | 2017-10-03 | Endoevolution, Llc | Devices and methods for minimally invasive suturing |
US7976555B2 (en) | 2008-07-17 | 2011-07-12 | Endoevolution, Llc | Apparatus and method for minimally invasive suturing |
JP4855405B2 (en) * | 2004-09-20 | 2012-01-18 | スターテック インコーポレイテッド | Apparatus and method for minimally invasive suturing |
US7993354B1 (en) | 2010-10-01 | 2011-08-09 | Endoevolution, Llc | Devices and methods for minimally invasive suturing |
US8123764B2 (en) | 2004-09-20 | 2012-02-28 | Endoevolution, Llc | Apparatus and method for minimally invasive suturing |
US7540872B2 (en) | 2004-09-21 | 2009-06-02 | Covidien Ag | Articulating bipolar electrosurgical instrument |
US7955332B2 (en) | 2004-10-08 | 2011-06-07 | Covidien Ag | Mechanism for dividing tissue in a hemostat-style instrument |
US8088132B2 (en) * | 2004-12-21 | 2012-01-03 | Davol, Inc. (a C.R. Bard Company) | Anastomotic outlet revision |
US7909823B2 (en) | 2005-01-14 | 2011-03-22 | Covidien Ag | Open vessel sealing instrument |
US7686804B2 (en) | 2005-01-14 | 2010-03-30 | Covidien Ag | Vessel sealer and divider with rotating sealer and cutter |
WO2006078805A2 (en) * | 2005-01-18 | 2006-07-27 | The Regents Of The University Of California | Endoscopic tube delivery system |
EP1845861B1 (en) | 2005-01-21 | 2011-06-22 | Mayo Foundation for Medical Education and Research | Thorascopic heart valve repair apparatus |
US7491202B2 (en) | 2005-03-31 | 2009-02-17 | Covidien Ag | Electrosurgical forceps with slow closure sealing plates and method of sealing tissue |
US7674271B2 (en) * | 2005-05-04 | 2010-03-09 | InTailor Surgical, Inc. | Endoluminal gastric ring and method |
US20060253126A1 (en) * | 2005-05-04 | 2006-11-09 | Bernard Medical, Llc | Endoluminal suturing device and method |
US7648457B2 (en) * | 2005-05-13 | 2010-01-19 | Ethicon Endo-Surgery, Inc. | Method of positioning a device on an endoscope |
US20060258903A1 (en) * | 2005-05-13 | 2006-11-16 | David Stefanchik | Method of inserting a feeding tube |
US20060258904A1 (en) | 2005-05-13 | 2006-11-16 | David Stefanchik | Feeding tube and track |
US7857754B2 (en) | 2005-05-13 | 2010-12-28 | Ethicon Endo-Surgery, Inc. | Apparatus useful for positioning a device on an endoscope |
US20060259010A1 (en) | 2005-05-13 | 2006-11-16 | David Stefanchik | Feeding tube |
US7905830B2 (en) * | 2005-05-13 | 2011-03-15 | Ethicon Endo-Surgery, Inc. | Sheath for use with an endoscope |
US8298291B2 (en) | 2005-05-26 | 2012-10-30 | Usgi Medical, Inc. | Methods and apparatus for securing and deploying tissue anchors |
US8932208B2 (en) * | 2005-05-26 | 2015-01-13 | Maquet Cardiovascular Llc | Apparatus and methods for performing minimally-invasive surgical procedures |
US9585651B2 (en) | 2005-05-26 | 2017-03-07 | Usgi Medical, Inc. | Methods and apparatus for securing and deploying tissue anchors |
US8951225B2 (en) | 2005-06-10 | 2015-02-10 | Acclarent, Inc. | Catheters with non-removable guide members useable for treatment of sinusitis |
US9545191B2 (en) * | 2005-06-13 | 2017-01-17 | Ethicon Endo-Surgery, Inc. | Method for suture lacing |
US7766925B2 (en) * | 2005-06-13 | 2010-08-03 | Ethicon Endo-Surgery, Inc. | Surgical suturing apparatus |
US7615060B2 (en) * | 2005-06-13 | 2009-11-10 | Ethicon-Endo Surgery, Inc. | Endoscopic suturing device |
US7833236B2 (en) * | 2005-06-13 | 2010-11-16 | Ethicon Endo-Surgery, Inc. | Surgical suturing apparatus with collapsible vacuum chamber |
US7628796B2 (en) * | 2005-06-13 | 2009-12-08 | Ethicon Endo-Surgery, Inc. | Surgical suturing apparatus with anti-backup system |
US8641728B2 (en) * | 2005-06-13 | 2014-02-04 | Ethicon Endo-Surgery, Inc. | Attachment apparatus for coupling with an endoscope |
US7846169B2 (en) * | 2005-06-13 | 2010-12-07 | Ethicon Endo-Surgery, Inc. | Adjustable vacuum chamber for a surgical suturing apparatus |
US8906040B2 (en) | 2005-07-13 | 2014-12-09 | Creighton University | Systems and techniques for minimally invasive gastrointestinal procedures |
US8641729B2 (en) * | 2005-07-13 | 2014-02-04 | Creighton University | Systems and techniques for minimally invasive gastrointestinal procedures |
WO2007009115A2 (en) * | 2005-07-14 | 2007-01-18 | Bernard Medical, Llc | Endoluminal suturing device and method |
US8715294B2 (en) * | 2005-08-05 | 2014-05-06 | Ethicon Endo-Surgery, Inc. | Gastric instrument sleeve to prevent cross contamination of stomach content and provide fixation and repeatable path |
US7896894B2 (en) * | 2005-08-05 | 2011-03-01 | Ethicon Endo-Surgery, Inc. | Apparatus for single pass gastric restriction |
US8252006B2 (en) * | 2005-08-05 | 2012-08-28 | Ethicon Endo-Surgery, Inc. | Single pass gastric restriction with a corkscrew style wall anchor |
US8147506B2 (en) * | 2005-08-05 | 2012-04-03 | Ethicon Endo-Surgery, Inc. | Method and clamp for gastric reduction surgery |
US7779845B2 (en) * | 2005-08-05 | 2010-08-24 | Ethicon Endo-Surgery, Inc. | Method and apparatus for endoscopically performing gastric reduction surgery |
US8029535B2 (en) * | 2005-08-05 | 2011-10-04 | Ethicon Endo-Surgery, Inc. | Fasteners for use with gastric restriction |
US8029522B2 (en) * | 2005-08-05 | 2011-10-04 | Ethicon Endo-Surgery, Inc. | Method and apparatus for sealing a gastric opening |
US7771440B2 (en) * | 2005-08-18 | 2010-08-10 | Ethicon Endo-Surgery, Inc. | Method and apparatus for endoscopically performing gastric reduction surgery in a single pass |
DE102005039601A1 (en) * | 2005-08-19 | 2007-02-22 | Karl Storz Gmbh & Co. Kg | Endoscope, especially duodenoscope for mother-baby cholangioscopy |
US7934630B2 (en) | 2005-08-31 | 2011-05-03 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US9237891B2 (en) | 2005-08-31 | 2016-01-19 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical stapling devices that produce formed staples having different lengths |
US10159482B2 (en) | 2005-08-31 | 2018-12-25 | Ethicon Llc | Fastener cartridge assembly comprising a fixed anvil and different staple heights |
US7669746B2 (en) | 2005-08-31 | 2010-03-02 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US8800838B2 (en) | 2005-08-31 | 2014-08-12 | Ethicon Endo-Surgery, Inc. | Robotically-controlled cable-based surgical end effectors |
US7673781B2 (en) | 2005-08-31 | 2010-03-09 | Ethicon Endo-Surgery, Inc. | Surgical stapling device with staple driver that supports multiple wire diameter staples |
US11484312B2 (en) | 2005-08-31 | 2022-11-01 | Cilag Gmbh International | Staple cartridge comprising a staple driver arrangement |
US11246590B2 (en) | 2005-08-31 | 2022-02-15 | Cilag Gmbh International | Staple cartridge including staple drivers having different unfired heights |
US7896890B2 (en) * | 2005-09-02 | 2011-03-01 | Ethicon Endo-Surgery, Inc. | Method and apparatus for endoscopically performing gastric reduction surgery in a single step |
US8114113B2 (en) | 2005-09-23 | 2012-02-14 | Acclarent, Inc. | Multi-conduit balloon catheter |
US7722607B2 (en) | 2005-09-30 | 2010-05-25 | Covidien Ag | In-line vessel sealer and divider |
CA2561034C (en) | 2005-09-30 | 2014-12-09 | Sherwood Services Ag | Flexible endoscopic catheter with an end effector for coagulating and transfecting tissue |
US7922953B2 (en) | 2005-09-30 | 2011-04-12 | Covidien Ag | Method for manufacturing an end effector assembly |
US7789878B2 (en) | 2005-09-30 | 2010-09-07 | Covidien Ag | In-line vessel sealer and divider |
US7879035B2 (en) | 2005-09-30 | 2011-02-01 | Covidien Ag | Insulating boot for electrosurgical forceps |
CA2561638C (en) | 2005-09-30 | 2015-06-30 | Sherwood Services Ag | Insulating boot for electrosurgical forceps |
US7798992B2 (en) * | 2005-11-04 | 2010-09-21 | Ethicon Endo-Surgery, Inc. | Lumen traversing device |
US20070106317A1 (en) | 2005-11-09 | 2007-05-10 | Shelton Frederick E Iv | Hydraulically and electrically actuated articulation joints for surgical instruments |
US8007488B2 (en) * | 2005-11-10 | 2011-08-30 | Phase One Medical Llc | Catheter device |
US9192755B2 (en) | 2005-11-10 | 2015-11-24 | Phase One Medical, Llc | Catheter device |
JP2009515598A (en) * | 2005-11-10 | 2009-04-16 | フェイズ ワン メディカル リミテッド ライアビリティ カンパニー | Catheter device |
US7651017B2 (en) * | 2005-11-23 | 2010-01-26 | Ethicon Endo-Surgery, Inc. | Surgical stapler with a bendable end effector |
US20070123917A1 (en) * | 2005-11-29 | 2007-05-31 | Ortiz Mark S | Anastomotic device promoting tissue necrosis |
JP4959579B2 (en) * | 2005-12-01 | 2012-06-27 | オリンパスメディカルシステムズ株式会社 | Elongated medical material |
US8241282B2 (en) * | 2006-01-24 | 2012-08-14 | Tyco Healthcare Group Lp | Vessel sealing cutting assemblies |
US8298232B2 (en) | 2006-01-24 | 2012-10-30 | Tyco Healthcare Group Lp | Endoscopic vessel sealer and divider for large tissue structures |
US8882766B2 (en) | 2006-01-24 | 2014-11-11 | Covidien Ag | Method and system for controlling delivery of energy to divide tissue |
US8734443B2 (en) | 2006-01-24 | 2014-05-27 | Covidien Lp | Vessel sealer and divider for large tissue structures |
US8726909B2 (en) | 2006-01-27 | 2014-05-20 | Usgi Medical, Inc. | Methods and apparatus for revision of obesity procedures |
CA2854625C (en) | 2006-01-27 | 2017-01-24 | Suturtek Incorporated | Apparatus and method for tissue closure |
US20120292367A1 (en) | 2006-01-31 | 2012-11-22 | Ethicon Endo-Surgery, Inc. | Robotically-controlled end effector |
US20110290856A1 (en) | 2006-01-31 | 2011-12-01 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical instrument with force-feedback capabilities |
US11793518B2 (en) | 2006-01-31 | 2023-10-24 | Cilag Gmbh International | Powered surgical instruments with firing system lockout arrangements |
US7845537B2 (en) | 2006-01-31 | 2010-12-07 | Ethicon Endo-Surgery, Inc. | Surgical instrument having recording capabilities |
US8708213B2 (en) | 2006-01-31 | 2014-04-29 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a feedback system |
US8820603B2 (en) | 2006-01-31 | 2014-09-02 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of a surgical instrument |
US20110024477A1 (en) | 2009-02-06 | 2011-02-03 | Hall Steven G | Driven Surgical Stapler Improvements |
US7575144B2 (en) * | 2006-01-31 | 2009-08-18 | Ethicon Endo-Surgery, Inc. | Surgical fastener and cutter with single cable actuator |
US9861359B2 (en) | 2006-01-31 | 2018-01-09 | Ethicon Llc | Powered surgical instruments with firing system lockout arrangements |
US8161977B2 (en) | 2006-01-31 | 2012-04-24 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of a surgical instrument |
US11278279B2 (en) | 2006-01-31 | 2022-03-22 | Cilag Gmbh International | Surgical instrument assembly |
US8763879B2 (en) | 2006-01-31 | 2014-07-01 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of surgical instrument |
US7753904B2 (en) | 2006-01-31 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Endoscopic surgical instrument with a handle that can articulate with respect to the shaft |
US8186555B2 (en) | 2006-01-31 | 2012-05-29 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting and fastening instrument with mechanical closure system |
US11224427B2 (en) | 2006-01-31 | 2022-01-18 | Cilag Gmbh International | Surgical stapling system including a console and retraction assembly |
US8221438B2 (en) * | 2006-02-17 | 2012-07-17 | Ethicon Endo-Surgery, Inc. | Lumen reduction methods and devices |
US7749249B2 (en) | 2006-02-21 | 2010-07-06 | Kardium Inc. | Method and device for closing holes in tissue |
US20070198032A1 (en) * | 2006-02-22 | 2007-08-23 | Ethicon Endo-Surgery, Inc. | Methods and devices for fastener removal |
US7803137B2 (en) | 2006-03-22 | 2010-09-28 | Ethicon Endo-Surgery, Inc. | Intubation system for use with an endoscope |
US7771396B2 (en) | 2006-03-22 | 2010-08-10 | Ethicon Endo-Surgery, Inc. | Intubation device for enteral feeding |
US8236010B2 (en) | 2006-03-23 | 2012-08-07 | Ethicon Endo-Surgery, Inc. | Surgical fastener and cutter with mimicking end effector |
US8992422B2 (en) | 2006-03-23 | 2015-03-31 | Ethicon Endo-Surgery, Inc. | Robotically-controlled endoscopic accessory channel |
US8721630B2 (en) | 2006-03-23 | 2014-05-13 | Ethicon Endo-Surgery, Inc. | Methods and devices for controlling articulation |
US20070225556A1 (en) * | 2006-03-23 | 2007-09-27 | Ethicon Endo-Surgery, Inc. | Disposable endoscope devices |
US20070239137A1 (en) * | 2006-03-30 | 2007-10-11 | Ethicon Endo-Surgery, Inc. | Intubation device for colonic decompression |
US7615004B2 (en) | 2006-03-30 | 2009-11-10 | Ethicon Endo-Surgery, Inc. | Endoscopic ancillary attachment devices |
US7763036B2 (en) * | 2006-03-31 | 2010-07-27 | Ethicon Endo-Surgery, Inc. | Endoscopic instrument with secondary vacuum source |
AU2007201312B2 (en) | 2006-03-31 | 2012-08-30 | Ethicon Endo-Surgery, Inc. | Method for suture lacing |
US8118820B2 (en) * | 2006-03-31 | 2012-02-21 | Ethicon Endo-Surgery, Inc. | Method for instrument insertion through a body orifice |
US7686831B2 (en) * | 2006-03-31 | 2010-03-30 | Ethicon Endo-Surgery, Inc. | Method for securing a suture |
US20070239179A1 (en) * | 2006-03-31 | 2007-10-11 | Ethicon Endo-Surgery, Inc. | Compliant Gastroplasty: Devices And Methods |
US7708747B2 (en) * | 2006-04-12 | 2010-05-04 | InTailor Surgical, Inc. | Endoscopic suturing and implant system |
US20070244494A1 (en) * | 2006-04-18 | 2007-10-18 | Downing Stephen W | Methods and devices for treating atrial septal defects |
US7731727B2 (en) | 2006-04-26 | 2010-06-08 | Lsi Solutions, Inc. | Medical instrument to place a pursestring suture, open a hole and pass a guidewire |
US7846087B2 (en) * | 2006-05-01 | 2010-12-07 | Ethicon Endo-Surgery, Inc. | Endoscopic rotation |
US7862582B2 (en) | 2006-05-02 | 2011-01-04 | Ethicon Endo-Surgery, Inc. | Suture management |
US8190389B2 (en) | 2006-05-17 | 2012-05-29 | Acclarent, Inc. | Adapter for attaching electromagnetic image guidance components to a medical device |
US7927271B2 (en) * | 2006-05-17 | 2011-04-19 | C.R. Bard, Inc. | Endoscope tool coupling |
AU2007252834B2 (en) * | 2006-05-18 | 2013-02-14 | Smart Medical Systems Ltd. | Flexible endoscope system and functionality |
US8105355B2 (en) | 2006-05-18 | 2012-01-31 | C.R. Bard, Inc. | Suture lock fastening device |
US20070270688A1 (en) * | 2006-05-19 | 2007-11-22 | Daniel Gelbart | Automatic atherectomy system |
US7635373B2 (en) * | 2006-05-25 | 2009-12-22 | Ethicon Endo-Surgery, Inc. | Absorbable gastric restriction devices and methods |
US20070276409A1 (en) * | 2006-05-25 | 2007-11-29 | Ethicon Endo-Surgery, Inc. | Endoscopic gastric restriction methods and devices |
US8322455B2 (en) | 2006-06-27 | 2012-12-04 | Ethicon Endo-Surgery, Inc. | Manually driven surgical cutting and fastening instrument |
US8449605B2 (en) | 2006-06-28 | 2013-05-28 | Kardium Inc. | Method for anchoring a mitral valve |
US11389232B2 (en) | 2006-06-28 | 2022-07-19 | Kardium Inc. | Apparatus and method for intra-cardiac mapping and ablation |
US10028783B2 (en) | 2006-06-28 | 2018-07-24 | Kardium Inc. | Apparatus and method for intra-cardiac mapping and ablation |
US9119633B2 (en) | 2006-06-28 | 2015-09-01 | Kardium Inc. | Apparatus and method for intra-cardiac mapping and ablation |
US8920411B2 (en) | 2006-06-28 | 2014-12-30 | Kardium Inc. | Apparatus and method for intra-cardiac mapping and ablation |
US8109957B2 (en) | 2006-06-30 | 2012-02-07 | Depuy Spine, Inc. | Disc nucleus removal devices and methods |
WO2008006114A2 (en) * | 2006-07-07 | 2008-01-10 | Fred Kessler | Channeled flexible sleeve for medical articles |
US8870916B2 (en) | 2006-07-07 | 2014-10-28 | USGI Medical, Inc | Low profile tissue anchors, tissue anchor systems, and methods for their delivery and use |
US7776037B2 (en) | 2006-07-07 | 2010-08-17 | Covidien Ag | System and method for controlling electrode gap during tissue sealing |
US7837610B2 (en) | 2006-08-02 | 2010-11-23 | Kardium Inc. | System for improving diastolic dysfunction |
US7740159B2 (en) * | 2006-08-02 | 2010-06-22 | Ethicon Endo-Surgery, Inc. | Pneumatically powered surgical cutting and fastening instrument with a variable control of the actuating rate of firing with mechanical power assist |
US20080045863A1 (en) * | 2006-08-17 | 2008-02-21 | Ethicon Endo-Surgery, Inc. | Guidewire structure including a medical guidewire |
US8002714B2 (en) * | 2006-08-17 | 2011-08-23 | Ethicon Endo-Surgery, Inc. | Guidewire structure including a medical guidewire and method for using a medical instrument |
WO2008027293A2 (en) * | 2006-08-25 | 2008-03-06 | Emphasys Medical, Inc. | Bronchial isolation devices for placement in short lumens |
US8597297B2 (en) | 2006-08-29 | 2013-12-03 | Covidien Ag | Vessel sealing instrument with multiple electrode configurations |
US20080097331A1 (en) * | 2006-09-05 | 2008-04-24 | Ethicon Endo-Surgery, Inc. | Guidewire structure including a medical guidewire and method for using |
US9820688B2 (en) | 2006-09-15 | 2017-11-21 | Acclarent, Inc. | Sinus illumination lightwire device |
US10568652B2 (en) | 2006-09-29 | 2020-02-25 | Ethicon Llc | Surgical staples having attached drivers of different heights and stapling instruments for deploying the same |
US10130359B2 (en) | 2006-09-29 | 2018-11-20 | Ethicon Llc | Method for forming a staple |
US7506791B2 (en) | 2006-09-29 | 2009-03-24 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with mechanical mechanism for limiting maximum tissue compression |
US8070746B2 (en) | 2006-10-03 | 2011-12-06 | Tyco Healthcare Group Lp | Radiofrequency fusion of cardiac tissue |
WO2008045376A2 (en) | 2006-10-05 | 2008-04-17 | Tyco Healthcare Group Lp | Axial stitching device |
US9072514B2 (en) | 2006-10-05 | 2015-07-07 | Thomas P. Knapp | Shape memory filament for suture management |
WO2008045374A2 (en) * | 2006-10-05 | 2008-04-17 | Tyco Healthcare Group Lp | Handle assembly for articulated endoscopic instruments |
EP2097020B1 (en) | 2006-10-05 | 2016-03-23 | Covidien LP | Flexible endoscopic stitching devices |
US20080086147A1 (en) * | 2006-10-05 | 2008-04-10 | Knapp Thomas P | Shape memory filament for suture management |
US8475453B2 (en) * | 2006-10-06 | 2013-07-02 | Covidien Lp | Endoscopic vessel sealer and divider having a flexible articulating shaft |
JP5143840B2 (en) * | 2006-10-06 | 2013-02-13 | タイコ ヘルスケア グループ リミテッド パートナーシップ | Endoscopic vessel sealer and divider with flexible articulation shaft |
US9675285B2 (en) * | 2006-10-16 | 2017-06-13 | Given Imaging Ltd. | Delivery device for implantable monitor |
US8388680B2 (en) * | 2006-10-18 | 2013-03-05 | Guided Delivery Systems, Inc. | Methods and devices for catheter advancement and delivery of substances therethrough |
US8562629B2 (en) * | 2006-10-24 | 2013-10-22 | Arthrocare Corporation | Suture device having selective needle actuation and related method |
US8747304B2 (en) | 2006-10-31 | 2014-06-10 | Ethicon Endo-Surgery, Inc. | Attachment apparatus for an endoscope |
US8591526B2 (en) * | 2006-11-03 | 2013-11-26 | The Penn State Research Foundation | Endosurgery suturing device |
CA2671030C (en) | 2006-11-30 | 2013-10-08 | Wilson-Cook Medical, Inc. | Visceral anchors for purse-string closure of perforations |
US7976458B2 (en) * | 2006-12-05 | 2011-07-12 | Ethicon Endo-Surgery, Inc. | Independent articulating accessory channel |
US8439687B1 (en) | 2006-12-29 | 2013-05-14 | Acclarent, Inc. | Apparatus and method for simulated insertion and positioning of guidewares and other interventional devices |
US11291441B2 (en) | 2007-01-10 | 2022-04-05 | Cilag Gmbh International | Surgical instrument with wireless communication between control unit and remote sensor |
US8652120B2 (en) | 2007-01-10 | 2014-02-18 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between control unit and sensor transponders |
US8684253B2 (en) | 2007-01-10 | 2014-04-01 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between a control unit of a robotic system and remote sensor |
US8459520B2 (en) | 2007-01-10 | 2013-06-11 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between control unit and remote sensor |
US11039836B2 (en) | 2007-01-11 | 2021-06-22 | Cilag Gmbh International | Staple cartridge for use with a surgical stapling instrument |
US20080169332A1 (en) | 2007-01-11 | 2008-07-17 | Shelton Frederick E | Surgical stapling device with a curved cutting member |
US20080177380A1 (en) * | 2007-01-19 | 2008-07-24 | Starksen Niel F | Methods and devices for heart tissue repair |
US8007432B2 (en) * | 2007-01-26 | 2011-08-30 | Ethicon Endo-Surgery, Inc. | Endoscopic accessory control mechanism |
US7655004B2 (en) | 2007-02-15 | 2010-02-02 | Ethicon Endo-Surgery, Inc. | Electroporation ablation apparatus, system, and method |
USD649249S1 (en) | 2007-02-15 | 2011-11-22 | Tyco Healthcare Group Lp | End effectors of an elongated dissecting and dividing instrument |
US20080200911A1 (en) * | 2007-02-15 | 2008-08-21 | Long Gary L | Electrical ablation apparatus, system, and method |
US20080200755A1 (en) * | 2007-02-15 | 2008-08-21 | Bakos Gregory J | Method and device for retrieving suture tags |
US20080200933A1 (en) * | 2007-02-15 | 2008-08-21 | Bakos Gregory J | Surgical devices and methods for forming an anastomosis between organs by gaining access thereto through a natural orifice in the body |
US20080208223A1 (en) * | 2007-02-26 | 2008-08-28 | Paul Edward Kraemer | Cable clamping device and method of its use |
US7815662B2 (en) | 2007-03-08 | 2010-10-19 | Ethicon Endo-Surgery, Inc. | Surgical suture anchors and deployment device |
US20090001130A1 (en) | 2007-03-15 | 2009-01-01 | Hess Christopher J | Surgical procedure using a cutting and stapling instrument having releasable staple-forming pockets |
WO2008115505A1 (en) * | 2007-03-21 | 2008-09-25 | The Trustees Of The University Of Pennsylvania | Natural orifice transluminal endoscopic surgery overtube and method of introducing multiple endoscopes |
US7780691B2 (en) * | 2007-03-21 | 2010-08-24 | Ethicon Endo-Surgery, Inc. | Endoscopic tissue resection device |
US8893946B2 (en) | 2007-03-28 | 2014-11-25 | Ethicon Endo-Surgery, Inc. | Laparoscopic tissue thickness and clamp load measuring devices |
US7981124B2 (en) * | 2007-04-04 | 2011-07-19 | Misder, Llc | Medical device for applying purse string sutures |
US8267935B2 (en) * | 2007-04-04 | 2012-09-18 | Tyco Healthcare Group Lp | Electrosurgical instrument reducing current densities at an insulator conductor junction |
US8075572B2 (en) | 2007-04-26 | 2011-12-13 | Ethicon Endo-Surgery, Inc. | Surgical suturing apparatus |
US8100922B2 (en) | 2007-04-27 | 2012-01-24 | Ethicon Endo-Surgery, Inc. | Curved needle suturing tool |
US8118757B2 (en) | 2007-04-30 | 2012-02-21 | Acclarent, Inc. | Methods and devices for ostium measurement |
US8753373B2 (en) * | 2007-05-08 | 2014-06-17 | Edwards Lifesciences Corporation | Suture-fastening clip |
US8485199B2 (en) | 2007-05-08 | 2013-07-16 | Acclarent, Inc. | Methods and devices for protecting nasal turbinate during surgery |
US8740937B2 (en) * | 2007-05-31 | 2014-06-03 | Cook Medical Technologies Llc | Suture lock |
US8534528B2 (en) | 2007-06-04 | 2013-09-17 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a multiple rate directional switching mechanism |
US7832408B2 (en) | 2007-06-04 | 2010-11-16 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a directional switching mechanism |
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 |
US7905380B2 (en) | 2007-06-04 | 2011-03-15 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a multiple rate directional switching mechanism |
US7753245B2 (en) * | 2007-06-22 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments |
US8308040B2 (en) | 2007-06-22 | 2012-11-13 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with an articulatable end effector |
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 |
US9861354B2 (en) | 2011-05-06 | 2018-01-09 | Ceterix Orthopaedics, Inc. | Meniscus repair |
US8663253B2 (en) | 2007-07-03 | 2014-03-04 | Ceterix Orthopaedics, Inc. | Methods of meniscus repair |
US8465505B2 (en) | 2011-05-06 | 2013-06-18 | Ceterix Orthopaedics, Inc. | Suture passer devices and methods |
US20110130773A1 (en) * | 2007-07-03 | 2011-06-02 | Saliman Justin D | Methods for continuous suture passing |
US20100130990A1 (en) * | 2007-07-03 | 2010-05-27 | Saliman Justin D | Methods of suturing and repairing tissue using a continuous suture passer device |
US10441273B2 (en) | 2007-07-03 | 2019-10-15 | Ceterix Orthopaedics, Inc. | Pre-tied surgical knots for use with suture passers |
US9314234B2 (en) | 2007-07-03 | 2016-04-19 | Ceterix Orthopaedics, Inc. | Pre-tied surgical knots for use with suture passers |
US8500809B2 (en) | 2011-01-10 | 2013-08-06 | Ceterix Orthopaedics, Inc. | Implant and method for repair of the anterior cruciate ligament |
US8911456B2 (en) | 2007-07-03 | 2014-12-16 | Ceterix Orthopaedics, Inc. | Methods and devices for preventing tissue bridging while suturing |
US8702731B2 (en) | 2007-07-03 | 2014-04-22 | Ceterix Orthopaedics, Inc. | Suturing and repairing tissue using in vivo suture loading |
US9211119B2 (en) | 2007-07-03 | 2015-12-15 | Ceterix Orthopaedics, Inc. | Suture passers and methods of passing suture |
US20090012538A1 (en) * | 2007-07-03 | 2009-01-08 | Justin Saliman | Methods and devices for continuous suture passing |
EP2178446B1 (en) * | 2007-08-17 | 2013-05-22 | Cook Medical Technologies LLC | Device to open and close a bodily wall |
US9005238B2 (en) | 2007-08-23 | 2015-04-14 | Covidien Lp | Endoscopic surgical devices |
US8157816B2 (en) | 2007-08-31 | 2012-04-17 | Kimberly-Clark Worldwide, Inc. | Gastropexy kit |
US20090062795A1 (en) * | 2007-08-31 | 2009-03-05 | Ethicon Endo-Surgery, Inc. | Electrical ablation surgical instruments |
US8579897B2 (en) | 2007-11-21 | 2013-11-12 | Ethicon Endo-Surgery, Inc. | Bipolar forceps |
US7867253B2 (en) * | 2007-08-31 | 2011-01-11 | Kimberly-Clark Worldwide, Inc. | Suture retention hub |
US20090062742A1 (en) | 2007-08-31 | 2009-03-05 | John Anthony Rotella | Blunted Safety Needle |
US8568410B2 (en) | 2007-08-31 | 2013-10-29 | Ethicon Endo-Surgery, Inc. | Electrical ablation surgical instruments |
US8262655B2 (en) | 2007-11-21 | 2012-09-11 | Ethicon Endo-Surgery, Inc. | Bipolar forceps |
US20090082766A1 (en) * | 2007-09-20 | 2009-03-26 | Tyco Healthcare Group Lp | Tissue Sealer and End Effector Assembly and Method of Manufacturing Same |
AU2008302039B2 (en) * | 2007-09-21 | 2013-07-18 | Covidien Lp | Surgical device |
US9023043B2 (en) | 2007-09-28 | 2015-05-05 | Covidien Lp | Insulating mechanically-interfaced boot and jaws for electrosurgical forceps |
US8235992B2 (en) | 2007-09-28 | 2012-08-07 | Tyco Healthcare Group Lp | Insulating boot with mechanical reinforcement for electrosurgical forceps |
US8267936B2 (en) * | 2007-09-28 | 2012-09-18 | Tyco Healthcare Group Lp | Insulating mechanically-interfaced adhesive for electrosurgical forceps |
US8236025B2 (en) | 2007-09-28 | 2012-08-07 | Tyco Healthcare Group Lp | Silicone insulated electrosurgical forceps |
US8235993B2 (en) | 2007-09-28 | 2012-08-07 | Tyco Healthcare Group Lp | Insulating boot for electrosurgical forceps with exohinged structure |
US8251996B2 (en) | 2007-09-28 | 2012-08-28 | Tyco Healthcare Group Lp | Insulating sheath for electrosurgical forceps |
US8221416B2 (en) | 2007-09-28 | 2012-07-17 | Tyco Healthcare Group Lp | Insulating boot for electrosurgical forceps with thermoplastic clevis |
US8241283B2 (en) | 2007-09-28 | 2012-08-14 | Tyco Healthcare Group Lp | Dual durometer insulating boot for electrosurgical forceps |
CA2703129C (en) * | 2007-10-18 | 2016-02-16 | Neochord Inc. | Minimially invasive repair of a valve leaflet in a beating heart |
US7922063B2 (en) | 2007-10-31 | 2011-04-12 | Tyco Healthcare Group, Lp | Powered surgical instrument |
US20090112059A1 (en) | 2007-10-31 | 2009-04-30 | Nobis Rudolph H | Apparatus and methods for closing a gastrotomy |
US8480657B2 (en) | 2007-10-31 | 2013-07-09 | Ethicon Endo-Surgery, Inc. | Detachable distal overtube section and methods for forming a sealable opening in the wall of an organ |
WO2009061504A1 (en) * | 2007-11-05 | 2009-05-14 | Revolutionary Surgical Device, Llc | Suture passing instrument and method |
US8906011B2 (en) | 2007-11-16 | 2014-12-09 | Kardium Inc. | Medical device for use in bodily lumens, for example an atrium |
US10206821B2 (en) | 2007-12-20 | 2019-02-19 | Acclarent, Inc. | Eustachian tube dilation balloon with ventilation path |
US8876701B2 (en) * | 2008-01-03 | 2014-11-04 | Cook Medical Technologies Llc | Medical systems, devices and methods for endoscopically suturing perforations |
US8287469B2 (en) * | 2008-01-09 | 2012-10-16 | Ethicon Endo-Surgery, Inc. | Articulating surgical device and method of use |
US8764748B2 (en) | 2008-02-06 | 2014-07-01 | Covidien Lp | End effector assembly for electrosurgical device and method for making the same |
WO2009100242A2 (en) | 2008-02-06 | 2009-08-13 | Guided Delivery Systems, Inc. | Multi-window guide tunnel |
US8453908B2 (en) * | 2008-02-13 | 2013-06-04 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with improved firing trigger arrangement |
US7766209B2 (en) * | 2008-02-13 | 2010-08-03 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with improved firing trigger arrangement |
US7905381B2 (en) | 2008-09-19 | 2011-03-15 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with cutting member arrangement |
US8540133B2 (en) * | 2008-09-19 | 2013-09-24 | Ethicon Endo-Surgery, Inc. | Staple cartridge |
US8561870B2 (en) | 2008-02-13 | 2013-10-22 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument |
US8622274B2 (en) | 2008-02-14 | 2014-01-07 | Ethicon Endo-Surgery, Inc. | Motorized cutting and fastening instrument having control circuit for optimizing battery usage |
US9179912B2 (en) | 2008-02-14 | 2015-11-10 | Ethicon Endo-Surgery, Inc. | Robotically-controlled motorized surgical cutting and fastening instrument |
US8584919B2 (en) | 2008-02-14 | 2013-11-19 | Ethicon Endo-Sugery, Inc. | Surgical stapling apparatus with load-sensitive firing mechanism |
US8459525B2 (en) | 2008-02-14 | 2013-06-11 | Ethicon Endo-Sugery, Inc. | Motorized surgical cutting and fastening instrument having a magnetic drive train torque limiting device |
US8657174B2 (en) | 2008-02-14 | 2014-02-25 | Ethicon Endo-Surgery, Inc. | Motorized surgical cutting and fastening instrument having handle based power source |
JP5410110B2 (en) | 2008-02-14 | 2014-02-05 | エシコン・エンド−サージェリィ・インコーポレイテッド | Surgical cutting / fixing instrument with RF electrode |
US8573465B2 (en) | 2008-02-14 | 2013-11-05 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical end effector system with rotary actuated closure systems |
US7819298B2 (en) | 2008-02-14 | 2010-10-26 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with control features operable with one hand |
US8636736B2 (en) | 2008-02-14 | 2014-01-28 | Ethicon Endo-Surgery, Inc. | Motorized surgical cutting and fastening instrument |
US8752749B2 (en) | 2008-02-14 | 2014-06-17 | Ethicon Endo-Surgery, Inc. | Robotically-controlled disposable motor-driven loading unit |
US8758391B2 (en) | 2008-02-14 | 2014-06-24 | Ethicon Endo-Surgery, Inc. | Interchangeable tools for surgical instruments |
US7866527B2 (en) | 2008-02-14 | 2011-01-11 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with interlockable firing system |
US7793812B2 (en) | 2008-02-14 | 2010-09-14 | Ethicon Endo-Surgery, Inc. | Disposable motor-driven loading unit for use with a surgical cutting and stapling apparatus |
US11272927B2 (en) | 2008-02-15 | 2022-03-15 | Cilag Gmbh International | Layer arrangements for surgical staple cartridges |
US9770245B2 (en) | 2008-02-15 | 2017-09-26 | Ethicon Llc | Layer arrangements for surgical staple cartridges |
US8623276B2 (en) | 2008-02-15 | 2014-01-07 | Covidien Lp | Method and system for sterilizing an electrosurgical instrument |
US8992417B2 (en) * | 2008-02-27 | 2015-03-31 | The Regents Of The University Of California | Feeding tube system |
US8182432B2 (en) | 2008-03-10 | 2012-05-22 | Acclarent, Inc. | Corewire design and construction for medical devices |
US8262680B2 (en) | 2008-03-10 | 2012-09-11 | Ethicon Endo-Surgery, Inc. | Anastomotic device |
US8864776B2 (en) * | 2008-04-11 | 2014-10-21 | Covidien Lp | Deployment system for surgical suture |
US7997468B2 (en) | 2008-05-05 | 2011-08-16 | Tyco Healthcare Group Lp | Surgical instrument with clamp |
WO2009137712A1 (en) | 2008-05-07 | 2009-11-12 | Guided Delivery Systems Inc. | Deflectable guide |
US20090287304A1 (en) | 2008-05-13 | 2009-11-19 | Kardium Inc. | Medical Device for Constricting Tissue or a Bodily Orifice, for example a mitral valve |
US20090287236A1 (en) * | 2008-05-16 | 2009-11-19 | Ethicon Endo-Surgery, Inc. | Endoscopic rotary access needle |
US8679003B2 (en) | 2008-05-30 | 2014-03-25 | Ethicon Endo-Surgery, Inc. | Surgical device and endoscope including same |
US8114072B2 (en) | 2008-05-30 | 2012-02-14 | Ethicon Endo-Surgery, Inc. | Electrical ablation device |
US8771260B2 (en) | 2008-05-30 | 2014-07-08 | Ethicon Endo-Surgery, Inc. | Actuating and articulating surgical device |
US8070759B2 (en) | 2008-05-30 | 2011-12-06 | Ethicon Endo-Surgery, Inc. | Surgical fastening device |
US8317806B2 (en) | 2008-05-30 | 2012-11-27 | Ethicon Endo-Surgery, Inc. | Endoscopic suturing tension controlling and indication devices |
US8652150B2 (en) | 2008-05-30 | 2014-02-18 | Ethicon Endo-Surgery, Inc. | Multifunction surgical device |
US8906035B2 (en) | 2008-06-04 | 2014-12-09 | Ethicon Endo-Surgery, Inc. | Endoscopic drop off bag |
US8403926B2 (en) | 2008-06-05 | 2013-03-26 | Ethicon Endo-Surgery, Inc. | Manually articulating devices |
US8628545B2 (en) * | 2008-06-13 | 2014-01-14 | Covidien Lp | Endoscopic stitching devices |
US20110040308A1 (en) | 2008-06-13 | 2011-02-17 | Ramiro Cabrera | Endoscopic Stitching Devices |
US11812951B2 (en) | 2008-06-17 | 2023-11-14 | Apollo Endosurgery Us, Inc. | Endoscopic needle assembly |
US8679136B2 (en) | 2008-06-17 | 2014-03-25 | Apollo Endosurgery, Inc. | Needle capture device |
US11083364B2 (en) * | 2008-06-17 | 2021-08-10 | Apollo Endosurgery Us, Inc. | Endoscopic tissue grasping systems and methods |
JP5763531B2 (en) | 2008-06-17 | 2015-08-12 | アポロ エンドサージェリー,インコーポレイティド | Endoscopic suture system |
US8579921B2 (en) * | 2008-06-18 | 2013-11-12 | Covidien Lp | Spring-type suture securing device |
US8361112B2 (en) | 2008-06-27 | 2013-01-29 | Ethicon Endo-Surgery, Inc. | Surgical suture arrangement |
US8262563B2 (en) | 2008-07-14 | 2012-09-11 | Ethicon Endo-Surgery, Inc. | Endoscopic translumenal articulatable steerable overtube |
US8888792B2 (en) | 2008-07-14 | 2014-11-18 | Ethicon Endo-Surgery, Inc. | Tissue apposition clip application devices and methods |
US8469956B2 (en) | 2008-07-21 | 2013-06-25 | Covidien Lp | Variable resistor jaw |
JP5676446B2 (en) | 2008-07-30 | 2015-02-25 | アクラレント インコーポレイテッド | Sinus mouth finder |
US8211125B2 (en) | 2008-08-15 | 2012-07-03 | Ethicon Endo-Surgery, Inc. | Sterile appliance delivery device for endoscopic procedures |
US20100042143A1 (en) * | 2008-08-15 | 2010-02-18 | Cunningham James S | Method of Transferring Pressure in an Articulating Surgical Instrument |
US8162973B2 (en) | 2008-08-15 | 2012-04-24 | Tyco Healthcare Group Lp | Method of transferring pressure in an articulating surgical instrument |
US8257387B2 (en) | 2008-08-15 | 2012-09-04 | Tyco Healthcare Group Lp | Method of transferring pressure in an articulating surgical instrument |
US9603652B2 (en) | 2008-08-21 | 2017-03-28 | Covidien Lp | Electrosurgical instrument including a sensor |
US8529563B2 (en) | 2008-08-25 | 2013-09-10 | Ethicon Endo-Surgery, Inc. | Electrical ablation devices |
US8784417B2 (en) | 2008-08-28 | 2014-07-22 | Covidien Lp | Tissue fusion jaw angle improvement |
US8795274B2 (en) | 2008-08-28 | 2014-08-05 | Covidien Lp | Tissue fusion jaw angle improvement |
US8317787B2 (en) | 2008-08-28 | 2012-11-27 | Covidien Lp | Tissue fusion jaw angle improvement |
US8241204B2 (en) | 2008-08-29 | 2012-08-14 | Ethicon Endo-Surgery, Inc. | Articulating end cap |
US8480689B2 (en) | 2008-09-02 | 2013-07-09 | Ethicon Endo-Surgery, Inc. | Suturing device |
US8409200B2 (en) | 2008-09-03 | 2013-04-02 | Ethicon Endo-Surgery, Inc. | Surgical grasping device |
US8114119B2 (en) | 2008-09-09 | 2012-02-14 | Ethicon Endo-Surgery, Inc. | Surgical grasping device |
US8303582B2 (en) * | 2008-09-15 | 2012-11-06 | Tyco Healthcare Group Lp | Electrosurgical instrument having a coated electrode utilizing an atomic layer deposition technique |
US20100069903A1 (en) * | 2008-09-18 | 2010-03-18 | Tyco Healthcare Group Lp | Vessel Sealing Instrument With Cutting Mechanism |
AU2009293312B2 (en) | 2008-09-18 | 2015-07-09 | Acclarent, Inc. | Methods and apparatus for treating disorders of the ear nose and throat |
US9005230B2 (en) | 2008-09-23 | 2015-04-14 | Ethicon Endo-Surgery, Inc. | Motorized surgical instrument |
US9386983B2 (en) | 2008-09-23 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Robotically-controlled motorized surgical instrument |
US9050083B2 (en) | 2008-09-23 | 2015-06-09 | Ethicon Endo-Surgery, Inc. | Motorized surgical instrument |
US8210411B2 (en) | 2008-09-23 | 2012-07-03 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument |
US11648005B2 (en) | 2008-09-23 | 2023-05-16 | Cilag Gmbh International | Robotically-controlled motorized surgical instrument with an end effector |
US9375254B2 (en) | 2008-09-25 | 2016-06-28 | Covidien Lp | Seal and separate algorithm |
US8535312B2 (en) | 2008-09-25 | 2013-09-17 | Covidien Lp | Apparatus, system and method for performing an electrosurgical procedure |
US8968314B2 (en) | 2008-09-25 | 2015-03-03 | Covidien Lp | Apparatus, system and method for performing an electrosurgical procedure |
CA2738426C (en) * | 2008-09-29 | 2016-03-15 | C.R. Bard, Inc. | Endoscopic suturing device |
US8337394B2 (en) | 2008-10-01 | 2012-12-25 | Ethicon Endo-Surgery, Inc. | Overtube with expandable tip |
US8142473B2 (en) | 2008-10-03 | 2012-03-27 | Tyco Healthcare Group Lp | Method of transferring rotational motion in an articulating surgical instrument |
US8469957B2 (en) | 2008-10-07 | 2013-06-25 | Covidien Lp | Apparatus, system, and method for performing an electrosurgical procedure |
US8636761B2 (en) | 2008-10-09 | 2014-01-28 | Covidien Lp | Apparatus, system, and method for performing an endoscopic electrosurgical procedure |
US8016827B2 (en) | 2008-10-09 | 2011-09-13 | Tyco Healthcare Group Lp | Apparatus, system, and method for performing an electrosurgical procedure |
US8608045B2 (en) | 2008-10-10 | 2013-12-17 | Ethicon Endo-Sugery, Inc. | Powered surgical cutting and stapling apparatus with manually retractable firing system |
EP2349019B1 (en) | 2008-10-10 | 2020-03-25 | Ancora Heart, Inc. | Termination devices and related methods |
CN102245110A (en) | 2008-10-10 | 2011-11-16 | 导向传输系统股份有限公司 | Tether tensioning devices and related methods |
US8486107B2 (en) | 2008-10-20 | 2013-07-16 | Covidien Lp | Method of sealing tissue using radiofrequency energy |
EP2348950B1 (en) * | 2008-10-29 | 2015-03-18 | Cook Medical Technologies LLC | Endoscope endcap for suturing tissue |
US8157834B2 (en) | 2008-11-25 | 2012-04-17 | Ethicon Endo-Surgery, Inc. | Rotational coupling device for surgical instrument with flexible actuators |
US8197479B2 (en) | 2008-12-10 | 2012-06-12 | Tyco Healthcare Group Lp | Vessel sealer and divider |
US8172772B2 (en) | 2008-12-11 | 2012-05-08 | Ethicon Endo-Surgery, Inc. | Specimen retrieval device |
US8828031B2 (en) | 2009-01-12 | 2014-09-09 | Ethicon Endo-Surgery, Inc. | Apparatus for forming an anastomosis |
US8361066B2 (en) | 2009-01-12 | 2013-01-29 | Ethicon Endo-Surgery, Inc. | Electrical ablation devices |
US8114122B2 (en) | 2009-01-13 | 2012-02-14 | Tyco Healthcare Group Lp | Apparatus, system, and method for performing an electrosurgical procedure |
US20100198192A1 (en) | 2009-01-20 | 2010-08-05 | Eugene Serina | Anchor deployment devices and related methods |
US20100198056A1 (en) * | 2009-01-20 | 2010-08-05 | Mariel Fabro | Diagnostic catheters, guide catheters, visualization devices and chord manipulation devices, and related kits and methods |
WO2010085793A2 (en) * | 2009-01-26 | 2010-07-29 | Synthes Usa, Llc | Bi-directional suture passer |
US8252057B2 (en) | 2009-01-30 | 2012-08-28 | Ethicon Endo-Surgery, Inc. | Surgical access device |
US9226772B2 (en) | 2009-01-30 | 2016-01-05 | Ethicon Endo-Surgery, Inc. | Surgical device |
US8037591B2 (en) | 2009-02-02 | 2011-10-18 | Ethicon Endo-Surgery, Inc. | Surgical scissors |
US8414577B2 (en) | 2009-02-05 | 2013-04-09 | Ethicon Endo-Surgery, Inc. | Surgical instruments and components for use in sterile environments |
US8517239B2 (en) | 2009-02-05 | 2013-08-27 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument comprising a magnetic element driver |
US8397971B2 (en) | 2009-02-05 | 2013-03-19 | Ethicon Endo-Surgery, Inc. | Sterilizable surgical instrument |
US8453907B2 (en) | 2009-02-06 | 2013-06-04 | Ethicon Endo-Surgery, Inc. | Motor driven surgical fastener device with cutting member reversing mechanism |
US8444036B2 (en) | 2009-02-06 | 2013-05-21 | Ethicon Endo-Surgery, Inc. | Motor driven surgical fastener device with mechanisms for adjusting a tissue gap within the end effector |
CN102341048A (en) | 2009-02-06 | 2012-02-01 | 伊西康内外科公司 | Driven surgical stapler improvements |
US20100241155A1 (en) | 2009-03-20 | 2010-09-23 | Acclarent, Inc. | Guide system with suction |
US8147505B2 (en) * | 2009-03-23 | 2012-04-03 | Arthrocare Corporation | Surgical instrument for manipulating surgical suture and methods of use |
US7978742B1 (en) | 2010-03-24 | 2011-07-12 | Corning Incorporated | Methods for operating diode lasers |
US8435290B2 (en) | 2009-03-31 | 2013-05-07 | Acclarent, Inc. | System and method for treatment of non-ventilating middle ear by providing a gas pathway through the nasopharynx |
WO2010115072A1 (en) | 2009-04-03 | 2010-10-07 | Wilson-Cook Medical, Inc. | Tissue anchors and medical devices for rapid deployment of tissue anchors |
AU2010241552B2 (en) * | 2009-05-01 | 2013-10-10 | Cook Medical Technologies Llc | Medical systems, devices and methods for suturing perforations |
US8187273B2 (en) | 2009-05-07 | 2012-05-29 | Tyco Healthcare Group Lp | Apparatus, system, and method for performing an electrosurgical procedure |
USD708746S1 (en) | 2009-06-10 | 2014-07-08 | Covidien Lp | Handle for surgical device |
SG177365A1 (en) * | 2009-06-24 | 2012-02-28 | Univ Creighton | Systems and techniques for performing gastrointestinal procedures |
US8246618B2 (en) | 2009-07-08 | 2012-08-21 | Tyco Healthcare Group Lp | Electrosurgical jaws with offset knife |
DE102009037317A1 (en) * | 2009-08-14 | 2011-02-17 | Karl Storz Gmbh & Co. Kg | Device and method for centering the inner and outer tubes of an endoscope |
US8133254B2 (en) | 2009-09-18 | 2012-03-13 | Tyco Healthcare Group Lp | In vivo attachable and detachable end effector assembly and laparoscopic surgical instrument and methods therefor |
US8112871B2 (en) | 2009-09-28 | 2012-02-14 | Tyco Healthcare Group Lp | Method for manufacturing electrosurgical seal plates |
WO2011041571A2 (en) | 2009-10-01 | 2011-04-07 | Kardium Inc. | Medical device, kit and method for constricting tissue or a bodily orifice, for example, a mitral valve |
US9301771B2 (en) * | 2009-10-01 | 2016-04-05 | Smith & Nephew, Inc. | Surgical handpiece for endoscopic resection |
US8490713B2 (en) * | 2009-10-06 | 2013-07-23 | Covidien Lp | Handle assembly for endoscopic suturing device |
US8141762B2 (en) * | 2009-10-09 | 2012-03-27 | Ethicon Endo-Surgery, Inc. | Surgical stapler comprising a staple pocket |
US20110098704A1 (en) | 2009-10-28 | 2011-04-28 | Ethicon Endo-Surgery, Inc. | Electrical ablation devices |
US8608652B2 (en) | 2009-11-05 | 2013-12-17 | Ethicon Endo-Surgery, Inc. | Vaginal entry surgical devices, kit, system, and method |
US11744575B2 (en) | 2009-11-09 | 2023-09-05 | Ceterix Orthopaedics, Inc. | Suture passer devices and methods |
WO2011057245A2 (en) | 2009-11-09 | 2011-05-12 | Suturepro Technologies, Inc. | Devices, systems and methods for meniscus repair |
US9848868B2 (en) | 2011-01-10 | 2017-12-26 | Ceterix Orthopaedics, Inc. | Suture methods for forming locking loops stitches |
US9011454B2 (en) | 2009-11-09 | 2015-04-21 | Ceterix Orthopaedics, Inc. | Suture passer with radiused upper jaw |
US9211118B2 (en) * | 2009-11-16 | 2015-12-15 | Arthrocare Corporation | Suture passer |
US8353439B2 (en) | 2009-11-19 | 2013-01-15 | Ethicon Endo-Surgery, Inc. | Circular stapler introducer with radially-openable distal end portion |
US8353487B2 (en) | 2009-12-17 | 2013-01-15 | Ethicon Endo-Surgery, Inc. | User interface support devices for endoscopic surgical instruments |
US8496574B2 (en) | 2009-12-17 | 2013-07-30 | Ethicon Endo-Surgery, Inc. | Selectively positionable camera for surgical guide tube assembly |
US9028483B2 (en) | 2009-12-18 | 2015-05-12 | Ethicon Endo-Surgery, Inc. | Surgical instrument comprising an electrode |
US8506564B2 (en) | 2009-12-18 | 2013-08-13 | Ethicon Endo-Surgery, Inc. | Surgical instrument comprising an electrode |
US8851354B2 (en) | 2009-12-24 | 2014-10-07 | Ethicon Endo-Surgery, Inc. | Surgical cutting instrument that analyzes tissue thickness |
US8220688B2 (en) | 2009-12-24 | 2012-07-17 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument with electric actuator directional control assembly |
US8267300B2 (en) * | 2009-12-30 | 2012-09-18 | Ethicon Endo-Surgery, Inc. | Dampening device for endoscopic surgical stapler |
US20110160514A1 (en) * | 2009-12-31 | 2011-06-30 | Ethicon Endo-Surgery, Inc. | Electrical ablation devices |
US9005198B2 (en) | 2010-01-29 | 2015-04-14 | Ethicon Endo-Surgery, Inc. | Surgical instrument comprising an electrode |
US8219171B2 (en) * | 2010-03-16 | 2012-07-10 | Given Imaging Ltd. | Delivery device for implantable monitor |
BR112012027381A2 (en) * | 2010-05-06 | 2017-07-18 | Synthes Gmbh | soft tissue injury device and related method |
US8926640B2 (en) | 2010-07-13 | 2015-01-06 | Lsi Solutions, Inc. | Method and apparatus for closing an opening in thick, moving tissue |
FR2962896B1 (en) * | 2010-07-26 | 2012-08-03 | Gerald Blouin | CLEANING ACCESSORY FOR VISION SYSTEM AND CORRESPONDING CLEANING ASSEMBLY |
US8789740B2 (en) | 2010-07-30 | 2014-07-29 | Ethicon Endo-Surgery, Inc. | Linear cutting and stapling device with selectively disengageable cutting member |
US8783543B2 (en) | 2010-07-30 | 2014-07-22 | Ethicon Endo-Surgery, Inc. | Tissue acquisition arrangements and methods for surgical stapling devices |
US9861350B2 (en) | 2010-09-03 | 2018-01-09 | Ancora Heart, Inc. | Devices and methods for anchoring tissue |
US8360296B2 (en) | 2010-09-09 | 2013-01-29 | Ethicon Endo-Surgery, Inc. | Surgical stapling head assembly with firing lockout for a surgical stapler |
US9155492B2 (en) | 2010-09-24 | 2015-10-13 | Acclarent, Inc. | Sinus illumination lightwire device |
US9877720B2 (en) | 2010-09-24 | 2018-01-30 | Ethicon Llc | Control features for articulating surgical device |
US11812965B2 (en) | 2010-09-30 | 2023-11-14 | Cilag Gmbh International | Layer of material for a surgical end effector |
US11925354B2 (en) | 2010-09-30 | 2024-03-12 | Cilag Gmbh International | Staple cartridge comprising staples positioned within a compressible portion thereof |
US9332974B2 (en) | 2010-09-30 | 2016-05-10 | Ethicon Endo-Surgery, Llc | Layered tissue thickness compensator |
US10945731B2 (en) | 2010-09-30 | 2021-03-16 | Ethicon Llc | Tissue thickness compensator comprising controlled release and expansion |
US9788834B2 (en) | 2010-09-30 | 2017-10-17 | Ethicon Llc | Layer comprising deployable attachment members |
US9629814B2 (en) | 2010-09-30 | 2017-04-25 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator configured to redistribute compressive forces |
US8777004B2 (en) | 2010-09-30 | 2014-07-15 | Ethicon Endo-Surgery, Inc. | Compressible staple cartridge comprising alignment members |
US9220501B2 (en) | 2010-09-30 | 2015-12-29 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensators |
US9055941B2 (en) | 2011-09-23 | 2015-06-16 | Ethicon Endo-Surgery, Inc. | Staple cartridge including collapsible deck |
US9301753B2 (en) | 2010-09-30 | 2016-04-05 | Ethicon Endo-Surgery, Llc | Expandable tissue thickness compensator |
US8940002B2 (en) | 2010-09-30 | 2015-01-27 | Kardium Inc. | Tissue anchor system |
US9364233B2 (en) | 2010-09-30 | 2016-06-14 | Ethicon Endo-Surgery, Llc | Tissue thickness compensators for circular surgical staplers |
US9241714B2 (en) | 2011-04-29 | 2016-01-26 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator and method for making the same |
US11298125B2 (en) | 2010-09-30 | 2022-04-12 | Cilag Gmbh International | Tissue stapler having a thickness compensator |
US9314246B2 (en) | 2010-09-30 | 2016-04-19 | Ethicon Endo-Surgery, Llc | Tissue stapler having a thickness compensator incorporating an anti-inflammatory agent |
US8893949B2 (en) | 2010-09-30 | 2014-11-25 | Ethicon Endo-Surgery, Inc. | Surgical stapler with floating anvil |
US9320523B2 (en) | 2012-03-28 | 2016-04-26 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator comprising tissue ingrowth features |
AU2011308701B2 (en) | 2010-09-30 | 2013-11-14 | Ethicon Endo-Surgery, Inc. | Fastener system comprising a retention matrix and an alignment matrix |
US9044228B2 (en) | 2010-09-30 | 2015-06-02 | Ethicon Endo-Surgery, Inc. | Fastener system comprising a plurality of fastener cartridges |
US9232941B2 (en) | 2010-09-30 | 2016-01-12 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator comprising a reservoir |
US9307989B2 (en) | 2012-03-28 | 2016-04-12 | Ethicon Endo-Surgery, Llc | Tissue stapler having a thickness compensator incorportating a hydrophobic agent |
US9301752B2 (en) | 2010-09-30 | 2016-04-05 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator comprising a plurality of capsules |
US9220500B2 (en) | 2010-09-30 | 2015-12-29 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator comprising structure to produce a resilient load |
US8695866B2 (en) | 2010-10-01 | 2014-04-15 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a power control circuit |
EP2658480B1 (en) | 2010-12-29 | 2017-11-01 | Neochord Inc. | Exchangeable system for minimally invasive beating heart repair of heart valve leaflets |
US9913638B2 (en) | 2011-01-10 | 2018-03-13 | Ceterix Orthopaedics, Inc. | Transosteal anchoring methods for tissue repair |
US9113940B2 (en) | 2011-01-14 | 2015-08-25 | Covidien Lp | Trigger lockout and kickback mechanism for surgical instruments |
CA2764494A1 (en) | 2011-01-21 | 2012-07-21 | Kardium Inc. | Enhanced medical device for use in bodily cavities, for example an atrium |
US11259867B2 (en) | 2011-01-21 | 2022-03-01 | Kardium Inc. | High-density electrode-based medical device system |
US9486273B2 (en) | 2011-01-21 | 2016-11-08 | Kardium Inc. | High-density electrode-based medical device system |
US9452016B2 (en) | 2011-01-21 | 2016-09-27 | Kardium Inc. | Catheter system |
US10092291B2 (en) | 2011-01-25 | 2018-10-09 | Ethicon Endo-Surgery, Inc. | Surgical instrument with selectively rigidizable features |
US9095502B2 (en) * | 2011-02-09 | 2015-08-04 | Applied Medical Technology, Inc. | Low profile G-J feeding tube |
US8968340B2 (en) | 2011-02-23 | 2015-03-03 | Covidien Lp | Single actuating jaw flexible endolumenal stitching device |
US9233241B2 (en) | 2011-02-28 | 2016-01-12 | Ethicon Endo-Surgery, Inc. | Electrical ablation devices and methods |
US9254169B2 (en) | 2011-02-28 | 2016-02-09 | Ethicon Endo-Surgery, Inc. | Electrical ablation devices and methods |
US9314620B2 (en) | 2011-02-28 | 2016-04-19 | Ethicon Endo-Surgery, Inc. | Electrical ablation devices and methods |
US8858590B2 (en) | 2011-03-14 | 2014-10-14 | Ethicon Endo-Surgery, Inc. | Tissue manipulation devices |
US9049987B2 (en) | 2011-03-17 | 2015-06-09 | Ethicon Endo-Surgery, Inc. | Hand held surgical device for manipulating an internal magnet assembly within a patient |
US9072511B2 (en) | 2011-03-25 | 2015-07-07 | Kardium Inc. | Medical kit for constricting tissue or a bodily orifice, for example, a mitral valve |
US20120265175A1 (en) * | 2011-04-14 | 2012-10-18 | Medtronic Xomed, Inc. | Malleable instrument for laparoscopic procedures |
BR112013027794B1 (en) | 2011-04-29 | 2020-12-15 | Ethicon Endo-Surgery, Inc | CLAMP CARTRIDGE SET |
US8795295B2 (en) | 2011-05-04 | 2014-08-05 | Lsi Solutions, Inc. | Multiple loop device for passing suture tails through a surgical pledget |
US9943303B2 (en) | 2011-05-04 | 2018-04-17 | Lsi Solutions, Inc. | Method of passing suture tails through a surgical pledget |
WO2012154578A1 (en) * | 2011-05-06 | 2012-11-15 | The Trustees Of The University Of Pennsylvania | Ped - endoscope image and diagnosis capture system |
US11207064B2 (en) | 2011-05-27 | 2021-12-28 | Cilag Gmbh International | Automated end effector component reloading system for use with a robotic system |
US9072535B2 (en) | 2011-05-27 | 2015-07-07 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments with rotatable staple deployment arrangements |
WO2012167120A2 (en) | 2011-06-01 | 2012-12-06 | Neochord, Inc. | Minimally invasive repair of heart valve leaflets |
US8801727B2 (en) | 2011-07-08 | 2014-08-12 | Smith & Nephew, Inc. | Orthopedic suture passer and method |
US8951263B2 (en) | 2011-07-08 | 2015-02-10 | Smith & Nephew, Inc. | Orthopedic suture passer and method |
US8888849B2 (en) | 2011-07-08 | 2014-11-18 | Smith & Nephew, Inc. | Soft tissue repair |
US9198661B2 (en) | 2011-09-06 | 2015-12-01 | Ethicon Endo-Surgery, Inc. | Stapling instrument comprising a plurality of staple cartridges stored therein |
US9050084B2 (en) | 2011-09-23 | 2015-06-09 | Ethicon Endo-Surgery, Inc. | Staple cartridge including collapsible deck arrangement |
US10524778B2 (en) | 2011-09-28 | 2020-01-07 | Ceterix Orthopaedics | Suture passers adapted for use in constrained regions |
US9060780B2 (en) | 2011-09-29 | 2015-06-23 | Covidien Lp | Methods of manufacturing shafts for surgical instruments |
US9173657B2 (en) | 2011-12-15 | 2015-11-03 | Ethicon Endo-Surgery, Inc. | Devices and methods for endoluminal plication |
US9113866B2 (en) | 2011-12-15 | 2015-08-25 | Ethicon Endo-Surgery, Inc. | Devices and methods for endoluminal plication |
US8535339B2 (en) | 2011-12-18 | 2013-09-17 | Via Surgical Ltd. | Apparatus and method for suturing |
USD680220S1 (en) | 2012-01-12 | 2013-04-16 | Coviden IP | Slider handle for laparoscopic device |
USD777926S1 (en) | 2012-01-20 | 2017-01-31 | Kardium Inc. | Intra-cardiac procedure device |
USD777925S1 (en) | 2012-01-20 | 2017-01-31 | Kardium Inc. | Intra-cardiac procedure device |
US10265062B2 (en) | 2012-02-07 | 2019-04-23 | Arthrocare Corporation | Surgical instrument for manipulating and passing suture |
US9044230B2 (en) | 2012-02-13 | 2015-06-02 | Ethicon Endo-Surgery, Inc. | Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status |
US8986199B2 (en) | 2012-02-17 | 2015-03-24 | Ethicon Endo-Surgery, Inc. | Apparatus and methods for cleaning the lens of an endoscope |
US8992547B2 (en) | 2012-03-21 | 2015-03-31 | Ethicon Endo-Surgery, Inc. | Methods and devices for creating tissue plications |
MX353040B (en) | 2012-03-28 | 2017-12-18 | Ethicon Endo Surgery Inc | Retainer assembly including a tissue thickness compensator. |
RU2014143258A (en) | 2012-03-28 | 2016-05-20 | Этикон Эндо-Серджери, Инк. | FABRIC THICKNESS COMPENSATOR CONTAINING MANY LAYERS |
US9198662B2 (en) | 2012-03-28 | 2015-12-01 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator having improved visibility |
CN104334098B (en) | 2012-03-28 | 2017-03-22 | 伊西康内外科公司 | Tissue thickness compensator comprising capsules defining a low pressure environment |
US9265514B2 (en) | 2012-04-17 | 2016-02-23 | Miteas Ltd. | Manipulator for grasping tissue |
US20150133968A1 (en) | 2012-05-01 | 2015-05-14 | Jon Einarsson | Suturing device for laparoscopic procedures |
US10575716B2 (en) | 2012-05-11 | 2020-03-03 | Ethicon Llc | Applicator instruments with imaging systems for dispensing surgical fasteners during open repair procedures |
US9364228B2 (en) * | 2012-05-11 | 2016-06-14 | Ethicon, Llc | Applicator instruments having distal end caps for facilitating the accurate placement of surgical fasteners during open repair procedures |
US9427255B2 (en) | 2012-05-14 | 2016-08-30 | Ethicon Endo-Surgery, Inc. | Apparatus for introducing a steerable camera assembly into a patient |
US9888913B2 (en) | 2012-05-31 | 2018-02-13 | Via Surgical Ltd. | Variable depth surgical fixation |
US9101358B2 (en) | 2012-06-15 | 2015-08-11 | Ethicon Endo-Surgery, Inc. | Articulatable surgical instrument comprising a firing drive |
US9125662B2 (en) | 2012-06-28 | 2015-09-08 | Ethicon Endo-Surgery, Inc. | Multi-axis articulating and rotating surgical tools |
BR112014032776B1 (en) | 2012-06-28 | 2021-09-08 | Ethicon Endo-Surgery, Inc | SURGICAL INSTRUMENT SYSTEM AND SURGICAL KIT FOR USE WITH A SURGICAL INSTRUMENT SYSTEM |
US9282974B2 (en) | 2012-06-28 | 2016-03-15 | Ethicon Endo-Surgery, Llc | Empty clip cartridge lockout |
US9561038B2 (en) | 2012-06-28 | 2017-02-07 | Ethicon Endo-Surgery, Llc | Interchangeable clip applier |
US9119657B2 (en) | 2012-06-28 | 2015-09-01 | Ethicon Endo-Surgery, Inc. | Rotary actuatable closure arrangement for surgical end effector |
US8747238B2 (en) | 2012-06-28 | 2014-06-10 | Ethicon Endo-Surgery, Inc. | Rotary drive shaft assemblies for surgical instruments with articulatable end effectors |
US20140001231A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Firing system lockout arrangements for surgical instruments |
US9072536B2 (en) | 2012-06-28 | 2015-07-07 | Ethicon Endo-Surgery, Inc. | Differential locking arrangements for rotary powered surgical instruments |
JP6290201B2 (en) | 2012-06-28 | 2018-03-07 | 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. | Lockout for empty clip cartridge |
US20140005718A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Multi-functional powered surgical device with external dissection features |
US9408606B2 (en) | 2012-06-28 | 2016-08-09 | Ethicon Endo-Surgery, Llc | Robotically powered surgical device with manually-actuatable reversing system |
US9101385B2 (en) | 2012-06-28 | 2015-08-11 | Ethicon Endo-Surgery, Inc. | Electrode connections for rotary driven surgical tools |
US11202631B2 (en) | 2012-06-28 | 2021-12-21 | Cilag Gmbh International | Stapling assembly comprising a firing lockout |
US9289256B2 (en) | 2012-06-28 | 2016-03-22 | Ethicon Endo-Surgery, Llc | Surgical end effectors having angled tissue-contacting surfaces |
US9028494B2 (en) | 2012-06-28 | 2015-05-12 | Ethicon Endo-Surgery, Inc. | Interchangeable end effector coupling arrangement |
US9078662B2 (en) | 2012-07-03 | 2015-07-14 | Ethicon Endo-Surgery, Inc. | Endoscopic cap electrode and method for using the same |
US9545290B2 (en) | 2012-07-30 | 2017-01-17 | Ethicon Endo-Surgery, Inc. | Needle probe guide |
US9572623B2 (en) | 2012-08-02 | 2017-02-21 | Ethicon Endo-Surgery, Inc. | Reusable electrode and disposable sheath |
US10314649B2 (en) | 2012-08-02 | 2019-06-11 | Ethicon Endo-Surgery, Inc. | Flexible expandable electrode and method of intraluminal delivery of pulsed power |
US9277957B2 (en) | 2012-08-15 | 2016-03-08 | Ethicon Endo-Surgery, Inc. | Electrosurgical devices and methods |
US9700310B2 (en) | 2013-08-23 | 2017-07-11 | Ethicon Llc | Firing member retraction devices for powered surgical instruments |
US10016200B2 (en) * | 2012-08-24 | 2018-07-10 | St. Jude Medical Puerto Rico Llc | Balloon bailout and bioadhesive delivery device for suture based closure and methods |
US20140088647A1 (en) * | 2012-09-21 | 2014-03-27 | Atlas Spine, Inc. | Minimally invasive spine surgery instruments: spinal rod with flange |
US9386984B2 (en) | 2013-02-08 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Staple cartridge comprising a releasable cover |
US10098527B2 (en) | 2013-02-27 | 2018-10-16 | Ethidcon Endo-Surgery, Inc. | System for performing a minimally invasive surgical procedure |
US10092292B2 (en) | 2013-02-28 | 2018-10-09 | Ethicon Llc | Staple forming features for surgical stapling instrument |
US9326767B2 (en) | 2013-03-01 | 2016-05-03 | Ethicon Endo-Surgery, Llc | Joystick switch assemblies for surgical instruments |
JP6382235B2 (en) | 2013-03-01 | 2018-08-29 | 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. | Articulatable surgical instrument with a conductive path for signal communication |
JP6345707B2 (en) | 2013-03-01 | 2018-06-20 | 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 instrument with soft stop |
WO2014177939A2 (en) | 2013-03-11 | 2014-11-06 | Via Surgical Ltd. | Surgical tacker with quantity indicator |
US9345481B2 (en) | 2013-03-13 | 2016-05-24 | Ethicon Endo-Surgery, Llc | Staple cartridge tissue thickness sensor system |
US9629629B2 (en) | 2013-03-14 | 2017-04-25 | Ethicon Endo-Surgey, LLC | Control systems for surgical instruments |
US9687230B2 (en) | 2013-03-14 | 2017-06-27 | Ethicon Llc | Articulatable surgical instrument comprising a firing drive |
US9433437B2 (en) | 2013-03-15 | 2016-09-06 | Acclarent, Inc. | Apparatus and method for treatment of ethmoid sinusitis |
US9629684B2 (en) | 2013-03-15 | 2017-04-25 | Acclarent, Inc. | Apparatus and method for treatment of ethmoid sinusitis |
US9795384B2 (en) | 2013-03-27 | 2017-10-24 | Ethicon Llc | Fastener cartridge comprising a tissue thickness compensator and a gap setting element |
US9572577B2 (en) | 2013-03-27 | 2017-02-21 | Ethicon Endo-Surgery, Llc | Fastener cartridge comprising a tissue thickness compensator including openings therein |
US9332984B2 (en) | 2013-03-27 | 2016-05-10 | Ethicon Endo-Surgery, Llc | Fastener cartridge assemblies |
BR112015026109B1 (en) | 2013-04-16 | 2022-02-22 | Ethicon Endo-Surgery, Inc | surgical instrument |
US9649110B2 (en) | 2013-04-16 | 2017-05-16 | Ethicon Llc | Surgical instrument comprising a closing drive and a firing drive operated from the same rotatable output |
US9357984B2 (en) | 2013-04-23 | 2016-06-07 | Covidien Lp | Constant value gap stabilizer for articulating links |
US9574644B2 (en) | 2013-05-30 | 2017-02-21 | Ethicon Endo-Surgery, Llc | Power module for use with a surgical instrument |
WO2015017992A1 (en) | 2013-08-07 | 2015-02-12 | Covidien Lp | Surgical forceps |
US20160206178A1 (en) * | 2013-08-20 | 2016-07-21 | Scott & White Healthcare | Surgical apparatuses for coupling elongated members to endoscopes, and related methods |
MX369362B (en) | 2013-08-23 | 2019-11-06 | Ethicon Endo Surgery Llc | Firing member retraction devices for powered surgical instruments. |
US20140171986A1 (en) | 2013-09-13 | 2014-06-19 | Ethicon Endo-Surgery, Inc. | Surgical Clip Having Comliant Portion |
US9247935B2 (en) | 2013-09-23 | 2016-02-02 | Ceterix Orthopaedics, Inc. | Arthroscopic knot pusher and suture cutter |
ES2755485T3 (en) | 2013-12-09 | 2020-04-22 | Covidien Lp | Adapter assembly for the interconnection of electromechanical surgical devices and surgical load units, and surgical systems thereof |
US10561417B2 (en) | 2013-12-09 | 2020-02-18 | Covidien Lp | Adapter assembly for interconnecting electromechanical surgical devices and surgical loading units, and surgical systems thereof |
WO2015095133A1 (en) | 2013-12-16 | 2015-06-25 | Ceterix Orthopaedics, Inc. | Automatically reloading suture passer devices having pre-tied knots and methods |
US9839428B2 (en) | 2013-12-23 | 2017-12-12 | Ethicon Llc | Surgical cutting and stapling instruments with independent jaw control features |
US20150173756A1 (en) | 2013-12-23 | 2015-06-25 | Ethicon Endo-Surgery, Inc. | Surgical cutting and stapling methods |
US9968354B2 (en) | 2013-12-23 | 2018-05-15 | Ethicon Llc | Surgical staples and methods for making the same |
US9724092B2 (en) | 2013-12-23 | 2017-08-08 | Ethicon Llc | Modular surgical instruments |
US9839424B2 (en) | 2014-01-17 | 2017-12-12 | Covidien Lp | Electromechanical surgical assembly |
US9554781B2 (en) | 2014-01-23 | 2017-01-31 | Lsi Solutions, Inc. | Minimally invasive surgical suturing device and method |
US9962161B2 (en) | 2014-02-12 | 2018-05-08 | Ethicon Llc | Deliverable surgical instrument |
US20140166725A1 (en) | 2014-02-24 | 2014-06-19 | Ethicon Endo-Surgery, Inc. | Staple cartridge including a barbed staple. |
JP6462004B2 (en) | 2014-02-24 | 2019-01-30 | エシコン エルエルシー | Fastening system with launcher lockout |
BR112016021943B1 (en) | 2014-03-26 | 2022-06-14 | Ethicon Endo-Surgery, Llc | SURGICAL INSTRUMENT FOR USE BY AN OPERATOR IN A SURGICAL PROCEDURE |
US20150272557A1 (en) | 2014-03-26 | 2015-10-01 | Ethicon Endo-Surgery, Inc. | Modular surgical instrument system |
US20150272571A1 (en) | 2014-03-26 | 2015-10-01 | Ethicon Endo-Surgery, Inc. | Surgical instrument utilizing sensor adaptation |
US9913642B2 (en) | 2014-03-26 | 2018-03-13 | Ethicon Llc | Surgical instrument comprising a sensor system |
US10013049B2 (en) | 2014-03-26 | 2018-07-03 | Ethicon Llc | Power management through sleep options of segmented circuit and wake up control |
US11116496B2 (en) | 2014-04-08 | 2021-09-14 | Lsi Solutions, Inc. | Surgical suturing device for a replacement anatomical structure and methods thereof |
CN204951031U (en) | 2014-04-08 | 2016-01-13 | 赛特里克斯整形公司 | Ware device is worn to draw by suture |
US10105126B2 (en) | 2014-04-09 | 2018-10-23 | Lsi Solutions, Inc. | Self-articulating joint for a minimally invasive surgical apparatus |
BR112016023807B1 (en) | 2014-04-16 | 2022-07-12 | Ethicon Endo-Surgery, Llc | CARTRIDGE SET OF FASTENERS FOR USE WITH A SURGICAL INSTRUMENT |
US20150297223A1 (en) | 2014-04-16 | 2015-10-22 | Ethicon Endo-Surgery, Inc. | Fastener cartridges including extensions having different configurations |
US10299792B2 (en) | 2014-04-16 | 2019-05-28 | Ethicon Llc | Fastener cartridge comprising non-uniform fasteners |
US10327764B2 (en) | 2014-09-26 | 2019-06-25 | Ethicon Llc | Method for creating a flexible staple line |
CN106456158B (en) | 2014-04-16 | 2019-02-05 | 伊西康内外科有限责任公司 | Fastener cartridge including non-uniform fastener |
JP6636452B2 (en) | 2014-04-16 | 2020-01-29 | エシコン エルエルシーEthicon LLC | Fastener cartridge including extension having different configurations |
US10736624B2 (en) | 2014-05-19 | 2020-08-11 | Lsi Solutions, Inc | Minimally invasive surgical suturing device for papillary muscles and methods thereof |
US9468434B2 (en) | 2014-06-03 | 2016-10-18 | Covidien Lp | Stitching end effector |
US10045781B2 (en) | 2014-06-13 | 2018-08-14 | Ethicon Llc | Closure lockout systems for surgical instruments |
US20160015474A1 (en) * | 2014-07-16 | 2016-01-21 | Claronav Inc. | Surgical instrument tracking assembly |
US10098628B2 (en) | 2014-07-22 | 2018-10-16 | Cook Medical Technologies Llc | Anchor deployment system, device, and method of treatment |
US9636103B2 (en) | 2014-08-28 | 2017-05-02 | Covidien Lp | Surgical suturing instrument |
JP5989277B2 (en) * | 2014-09-04 | 2016-09-07 | オリンパス株式会社 | Endoscope tip structure |
US11311294B2 (en) | 2014-09-05 | 2022-04-26 | Cilag Gmbh International | Powered medical device including measurement of closure state of jaws |
US10111679B2 (en) | 2014-09-05 | 2018-10-30 | Ethicon Llc | Circuitry and sensors for powered medical device |
BR112017004361B1 (en) | 2014-09-05 | 2023-04-11 | Ethicon Llc | ELECTRONIC SYSTEM FOR A SURGICAL INSTRUMENT |
US10105142B2 (en) | 2014-09-18 | 2018-10-23 | Ethicon Llc | Surgical stapler with plurality of cutting elements |
US11523821B2 (en) | 2014-09-26 | 2022-12-13 | Cilag Gmbh International | Method for creating a flexible staple line |
MX2017003960A (en) | 2014-09-26 | 2017-12-04 | Ethicon Llc | Surgical stapling buttresses and adjunct materials. |
US9833233B2 (en) | 2014-09-30 | 2017-12-05 | Covidien Lp | Methods and devices for tissue suturing |
US10076325B2 (en) | 2014-10-13 | 2018-09-18 | Ethicon Llc | Surgical stapling apparatus comprising a tissue stop |
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 |
US11141153B2 (en) | 2014-10-29 | 2021-10-12 | Cilag Gmbh International | Staple cartridges comprising driver arrangements |
US9844376B2 (en) | 2014-11-06 | 2017-12-19 | Ethicon Llc | Staple cartridge comprising a releasable adjunct material |
US10736636B2 (en) | 2014-12-10 | 2020-08-11 | Ethicon Llc | Articulatable surgical instrument system |
US10231723B2 (en) | 2014-12-15 | 2019-03-19 | Lsi Solutions, Inc. | Surgical rib cutter and methods thereof |
US9987000B2 (en) | 2014-12-18 | 2018-06-05 | Ethicon Llc | Surgical instrument assembly comprising a flexible articulation system |
US10085748B2 (en) | 2014-12-18 | 2018-10-02 | Ethicon Llc | Locking arrangements for detachable shaft assemblies with articulatable surgical end effectors |
BR112017012996B1 (en) | 2014-12-18 | 2022-11-08 | Ethicon Llc | SURGICAL INSTRUMENT WITH AN ANvil WHICH IS SELECTIVELY MOVABLE ABOUT AN IMMOVABLE GEOMETRIC AXIS DIFFERENT FROM A STAPLE CARTRIDGE |
US9844374B2 (en) | 2014-12-18 | 2017-12-19 | Ethicon Llc | Surgical instrument systems comprising an articulatable end effector and means for adjusting the firing stroke of a firing member |
US9844375B2 (en) | 2014-12-18 | 2017-12-19 | Ethicon Llc | Drive arrangements for articulatable surgical instruments |
US10117649B2 (en) | 2014-12-18 | 2018-11-06 | Ethicon Llc | Surgical instrument assembly comprising a lockable articulation system |
US9943309B2 (en) | 2014-12-18 | 2018-04-17 | Ethicon Llc | Surgical instruments with articulatable end effectors and movable firing beam support arrangements |
US10188385B2 (en) | 2014-12-18 | 2019-01-29 | Ethicon Llc | Surgical instrument system comprising lockable systems |
JP6138385B2 (en) * | 2015-01-20 | 2017-05-31 | オリンパス株式会社 | Insertion aids and medical devices |
US10180463B2 (en) | 2015-02-27 | 2019-01-15 | Ethicon Llc | Surgical apparatus configured to assess whether a performance parameter of the surgical apparatus is within an acceptable performance band |
US11154301B2 (en) | 2015-02-27 | 2021-10-26 | Cilag Gmbh International | Modular stapling assembly |
US20160249910A1 (en) | 2015-02-27 | 2016-09-01 | Ethicon Endo-Surgery, Llc | Surgical charging system that charges and/or conditions one or more batteries |
US10226250B2 (en) | 2015-02-27 | 2019-03-12 | Ethicon Llc | Modular stapling assembly |
EP4292551A3 (en) | 2015-03-05 | 2024-01-31 | Ancora Heart, Inc. | Devices of visualizing and determining depth of penetration in cardiac tissue |
US9895148B2 (en) | 2015-03-06 | 2018-02-20 | Ethicon Endo-Surgery, Llc | Monitoring speed control and precision incrementing of motor for powered surgical instruments |
US10245033B2 (en) | 2015-03-06 | 2019-04-02 | Ethicon Llc | Surgical instrument comprising a lockable battery housing |
US10045776B2 (en) | 2015-03-06 | 2018-08-14 | Ethicon Llc | Control techniques and sub-processor contained within modular shaft with select control processing from handle |
US9808246B2 (en) | 2015-03-06 | 2017-11-07 | Ethicon Endo-Surgery, Llc | Method of operating a powered surgical instrument |
US10617412B2 (en) | 2015-03-06 | 2020-04-14 | Ethicon Llc | System for detecting the mis-insertion of a staple cartridge into a surgical stapler |
JP2020121162A (en) | 2015-03-06 | 2020-08-13 | エシコン エルエルシーEthicon LLC | Time dependent evaluation of sensor data to determine stability element, creep element and viscoelastic element of measurement |
US9993248B2 (en) | 2015-03-06 | 2018-06-12 | Ethicon Endo-Surgery, Llc | Smart sensors with local signal processing |
US9924961B2 (en) | 2015-03-06 | 2018-03-27 | Ethicon Endo-Surgery, Llc | Interactive feedback system for powered surgical instruments |
US9901342B2 (en) | 2015-03-06 | 2018-02-27 | Ethicon Endo-Surgery, Llc | Signal and power communication system positioned on a rotatable shaft |
US10687806B2 (en) | 2015-03-06 | 2020-06-23 | Ethicon Llc | Adaptive tissue compression techniques to adjust closure rates for multiple tissue types |
US10548504B2 (en) | 2015-03-06 | 2020-02-04 | Ethicon Llc | Overlaid multi sensor radio frequency (RF) electrode system to measure tissue compression |
US10213201B2 (en) | 2015-03-31 | 2019-02-26 | Ethicon Llc | Stapling end effector configured to compensate for an uneven gap between a first jaw and a second jaw |
US10362965B2 (en) * | 2015-04-22 | 2019-07-30 | Acclarent, Inc. | System and method to map structures of nasal cavity |
JP6767999B2 (en) | 2015-04-23 | 2020-10-14 | ヴィーア サージカル リミテッド | Surgical fastener delivery and locking mechanism |
EP4074285A1 (en) | 2015-05-12 | 2022-10-19 | Ancora Heart, Inc. | Device for releasing catheters from cardiac structures |
US10092286B2 (en) | 2015-05-27 | 2018-10-09 | Covidien Lp | Suturing loading unit |
US10433831B2 (en) | 2015-06-01 | 2019-10-08 | Lsi Solutions, Inc. | Needle for a minimally invasive surgical suturing device |
US11918204B2 (en) | 2015-06-01 | 2024-03-05 | Lsi Solutions, Inc. | Suturing device for minimally invasive surgery and needles and methods thereof |
US10335149B2 (en) | 2015-06-18 | 2019-07-02 | Ethicon Llc | Articulatable surgical instruments with composite firing beam structures with center firing support member for articulation support |
US10226245B2 (en) | 2015-07-21 | 2019-03-12 | Ceterix Orthopaedics, Inc. | Automatically reloading suture passer devices that prevent entanglement |
JP6180694B2 (en) * | 2015-08-04 | 2017-08-16 | オリンパス株式会社 | Suture device |
US10213269B2 (en) | 2015-08-13 | 2019-02-26 | Lsi Solutions, Inc. | Depth limiter for suturing devices and methods thereof |
US10835249B2 (en) | 2015-08-17 | 2020-11-17 | Ethicon Llc | Implantable layers for a surgical instrument |
US10390818B2 (en) | 2015-08-19 | 2019-08-27 | Lsi Solutions, Inc. | Ferrule for use with a minimally invasive surgical suturing device |
US10835233B2 (en) | 2015-08-20 | 2020-11-17 | Lsi Solutions, Inc. | Suturing backstop for minimally invasive surgery |
WO2017031493A1 (en) * | 2015-08-20 | 2017-02-23 | Lsi Solutions, Inc. | Adjustable motion limiter for a minimally invasive surgical device |
CN108348233B (en) | 2015-08-26 | 2021-05-07 | 伊西康有限责任公司 | Surgical staple strip for allowing changing staple characteristics and achieving easy cartridge loading |
US10987159B2 (en) | 2015-08-26 | 2021-04-27 | Covidien Lp | Electrosurgical end effector assemblies and electrosurgical forceps configured to reduce thermal spread |
US10213203B2 (en) | 2015-08-26 | 2019-02-26 | Ethicon Llc | Staple cartridge assembly without a bottom cover |
US10238390B2 (en) | 2015-09-02 | 2019-03-26 | Ethicon Llc | Surgical staple cartridges with driver arrangements for establishing herringbone staple patterns |
MX2022006191A (en) | 2015-09-02 | 2022-06-16 | Ethicon Llc | Surgical staple configurations with camming surfaces located between portions supporting surgical staples. |
US10327769B2 (en) | 2015-09-23 | 2019-06-25 | Ethicon Llc | Surgical stapler having motor control based on a drive system component |
US10363036B2 (en) | 2015-09-23 | 2019-07-30 | Ethicon Llc | Surgical stapler having force-based motor control |
US10105139B2 (en) | 2015-09-23 | 2018-10-23 | Ethicon Llc | Surgical stapler having downstream current-based motor control |
US10238386B2 (en) | 2015-09-23 | 2019-03-26 | Ethicon Llc | Surgical stapler having motor control based on an electrical parameter related to a motor current |
US10076326B2 (en) | 2015-09-23 | 2018-09-18 | Ethicon Llc | Surgical stapler having current mirror-based motor control |
US10085751B2 (en) | 2015-09-23 | 2018-10-02 | Ethicon Llc | Surgical stapler having temperature-based motor control |
US10299878B2 (en) | 2015-09-25 | 2019-05-28 | Ethicon Llc | Implantable adjunct systems for determining adjunct skew |
US10980539B2 (en) | 2015-09-30 | 2021-04-20 | Ethicon Llc | Implantable adjunct comprising bonded layers |
US10478188B2 (en) | 2015-09-30 | 2019-11-19 | Ethicon Llc | Implantable layer comprising a constricted configuration |
US10736633B2 (en) | 2015-09-30 | 2020-08-11 | Ethicon Llc | Compressible adjunct with looping members |
US11890015B2 (en) | 2015-09-30 | 2024-02-06 | Cilag Gmbh International | Compressible adjunct with crossing spacer fibers |
WO2017059406A1 (en) | 2015-10-01 | 2017-04-06 | Neochord, Inc. | Ringless web for repair of heart valves |
US10405853B2 (en) | 2015-10-02 | 2019-09-10 | Ceterix Orthpaedics, Inc. | Knot tying accessory |
US10213250B2 (en) | 2015-11-05 | 2019-02-26 | Covidien Lp | Deployment and safety mechanisms for surgical instruments |
CN105361850B (en) * | 2015-11-24 | 2017-11-24 | 深圳市技领科技有限公司 | Gastroscope |
CN105361849B (en) * | 2015-11-24 | 2018-08-21 | 嵊州亿源投资管理有限公司 | Gastroscope with control terminal |
US11311285B2 (en) * | 2015-12-21 | 2022-04-26 | Lsi Solutions, Inc. | Prosthetic suturing device and methods thereof |
US10368865B2 (en) | 2015-12-30 | 2019-08-06 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10265068B2 (en) | 2015-12-30 | 2019-04-23 | Ethicon Llc | Surgical instruments with separable motors and motor control circuits |
US10292704B2 (en) | 2015-12-30 | 2019-05-21 | Ethicon Llc | Mechanisms for compensating for battery pack failure in powered surgical instruments |
JP6911054B2 (en) | 2016-02-09 | 2021-07-28 | エシコン エルエルシーEthicon LLC | Surgical instruments with asymmetric joint composition |
US10588625B2 (en) | 2016-02-09 | 2020-03-17 | Ethicon Llc | Articulatable surgical instruments with off-axis firing beam arrangements |
US11213293B2 (en) | 2016-02-09 | 2022-01-04 | Cilag Gmbh International | Articulatable surgical instruments with single articulation link arrangements |
US10258331B2 (en) | 2016-02-12 | 2019-04-16 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10448948B2 (en) | 2016-02-12 | 2019-10-22 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US11224426B2 (en) | 2016-02-12 | 2022-01-18 | Cilag Gmbh International | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US11284890B2 (en) | 2016-04-01 | 2022-03-29 | Cilag Gmbh International | Circular stapling system comprising an incisable tissue support |
US10617413B2 (en) | 2016-04-01 | 2020-04-14 | Ethicon Llc | Closure system arrangements for surgical cutting and stapling devices with separate and distinct firing shafts |
US11045191B2 (en) | 2016-04-01 | 2021-06-29 | Cilag Gmbh International | Method for operating a surgical stapling system |
US11064997B2 (en) | 2016-04-01 | 2021-07-20 | Cilag Gmbh International | Surgical stapling instrument |
US10531874B2 (en) | 2016-04-01 | 2020-01-14 | Ethicon Llc | Surgical cutting and stapling end effector with anvil concentric drive member |
US11179150B2 (en) | 2016-04-15 | 2021-11-23 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US10426467B2 (en) | 2016-04-15 | 2019-10-01 | Ethicon Llc | Surgical instrument with detection sensors |
US10405859B2 (en) | 2016-04-15 | 2019-09-10 | Ethicon Llc | Surgical instrument with adjustable stop/start control during a firing motion |
US10828028B2 (en) | 2016-04-15 | 2020-11-10 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US10456137B2 (en) | 2016-04-15 | 2019-10-29 | Ethicon Llc | Staple formation detection mechanisms |
US10357247B2 (en) | 2016-04-15 | 2019-07-23 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US11607239B2 (en) | 2016-04-15 | 2023-03-21 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US10335145B2 (en) | 2016-04-15 | 2019-07-02 | Ethicon Llc | Modular surgical instrument with configurable operating mode |
US10492783B2 (en) | 2016-04-15 | 2019-12-03 | Ethicon, Llc | Surgical instrument with improved stop/start control during a firing motion |
US20170296173A1 (en) | 2016-04-18 | 2017-10-19 | Ethicon Endo-Surgery, Llc | Method for operating a surgical instrument |
US10433840B2 (en) | 2016-04-18 | 2019-10-08 | Ethicon Llc | Surgical instrument comprising a replaceable cartridge jaw |
US11317917B2 (en) | 2016-04-18 | 2022-05-03 | Cilag Gmbh International | Surgical stapling system comprising a lockable firing assembly |
US10542970B2 (en) | 2016-05-31 | 2020-01-28 | Covidien Lp | Endoscopic stitching device |
USD847989S1 (en) | 2016-06-24 | 2019-05-07 | Ethicon Llc | Surgical fastener cartridge |
US10675024B2 (en) | 2016-06-24 | 2020-06-09 | Ethicon Llc | Staple cartridge comprising overdriven staples |
USD826405S1 (en) | 2016-06-24 | 2018-08-21 | Ethicon Llc | Surgical fastener |
USD850617S1 (en) | 2016-06-24 | 2019-06-04 | Ethicon Llc | Surgical fastener cartridge |
JP6957532B2 (en) | 2016-06-24 | 2021-11-02 | エシコン エルエルシーEthicon LLC | Staple cartridges including wire staples and punched staples |
US11051800B2 (en) | 2016-08-10 | 2021-07-06 | Apollo Endosurgery Us, Inc. | Endoscopic suturing system having external instrument channel |
US11141147B2 (en) | 2016-08-10 | 2021-10-12 | Apollo Endosurgery Us, Inc. | Endoscopic suturing system having external instrument channel |
AU2017362497B2 (en) | 2016-11-18 | 2022-07-28 | Ancora Heart, Inc. | Myocardial implant load sharing device and methods to promote LV function |
US10945727B2 (en) | 2016-12-21 | 2021-03-16 | Ethicon Llc | Staple cartridge with deformable driver retention features |
JP6983893B2 (en) | 2016-12-21 | 2021-12-17 | エシコン エルエルシーEthicon LLC | Lockout configuration for surgical end effectors and replaceable tool assemblies |
US10588632B2 (en) | 2016-12-21 | 2020-03-17 | Ethicon Llc | Surgical end effectors and firing members thereof |
US20180168598A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Staple forming pocket arrangements comprising zoned forming surface grooves |
US10426471B2 (en) | 2016-12-21 | 2019-10-01 | Ethicon Llc | Surgical instrument with multiple failure response modes |
US10524789B2 (en) | 2016-12-21 | 2020-01-07 | Ethicon Llc | Laterally actuatable articulation lock arrangements for locking an end effector of a surgical instrument in an articulated configuration |
US10588631B2 (en) | 2016-12-21 | 2020-03-17 | Ethicon Llc | Surgical instruments with positive jaw opening features |
US10485543B2 (en) | 2016-12-21 | 2019-11-26 | Ethicon Llc | Anvil having a knife slot width |
US10993715B2 (en) | 2016-12-21 | 2021-05-04 | Ethicon Llc | Staple cartridge comprising staples with different clamping breadths |
US10675026B2 (en) | 2016-12-21 | 2020-06-09 | Ethicon Llc | Methods of stapling tissue |
JP2020501779A (en) | 2016-12-21 | 2020-01-23 | エシコン エルエルシーEthicon LLC | Surgical stapling system |
JP7010956B2 (en) | 2016-12-21 | 2022-01-26 | エシコン エルエルシー | How to staple tissue |
US11134942B2 (en) | 2016-12-21 | 2021-10-05 | Cilag Gmbh International | Surgical stapling instruments and staple-forming anvils |
US10835246B2 (en) | 2016-12-21 | 2020-11-17 | Ethicon Llc | Staple cartridges and arrangements of staples and staple cavities therein |
US10980536B2 (en) | 2016-12-21 | 2021-04-20 | Ethicon Llc | No-cartridge and spent cartridge lockout arrangements for surgical staplers |
US20180168615A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Method of deforming staples from two different types of staple cartridges with the same surgical stapling instrument |
US10888322B2 (en) | 2016-12-21 | 2021-01-12 | Ethicon Llc | Surgical instrument comprising a cutting member |
US20180168625A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Surgical stapling instruments with smart staple cartridges |
US20180168647A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Surgical stapling instruments having end effectors with positive opening features |
US11684367B2 (en) | 2016-12-21 | 2023-06-27 | Cilag Gmbh International | Stepped assembly having and end-of-life indicator |
US10675025B2 (en) | 2016-12-21 | 2020-06-09 | Ethicon Llc | Shaft assembly comprising separately actuatable and retractable systems |
US10687810B2 (en) | 2016-12-21 | 2020-06-23 | Ethicon Llc | Stepped staple cartridge with tissue retention and gap setting features |
US20180168608A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Surgical instrument system comprising an end effector lockout and a firing assembly lockout |
US11419606B2 (en) | 2016-12-21 | 2022-08-23 | Cilag Gmbh International | Shaft assembly comprising a clutch configured to adapt the output of a rotary firing member to two different systems |
WO2018119459A1 (en) | 2016-12-23 | 2018-06-28 | Brigham And Women's Hospital, Inc. | Systems and methods for suturing tissue |
US10603031B2 (en) | 2017-02-03 | 2020-03-31 | Lsi Solutions, Inc. | Suturing device for minimally invasive surgery |
US10709439B2 (en) | 2017-02-06 | 2020-07-14 | Covidien Lp | Endoscopic stitching device |
AU2018225560B2 (en) | 2017-02-22 | 2020-05-14 | Boston Scientific Scimed, Inc. | Suture based closure device |
US20180242967A1 (en) | 2017-02-26 | 2018-08-30 | Endoevolution, Llc | Apparatus and method for minimally invasive suturing |
US10898181B2 (en) | 2017-03-17 | 2021-01-26 | Cypris Medical, Inc. | Suturing system |
US10213306B2 (en) | 2017-03-31 | 2019-02-26 | Neochord, Inc. | Minimally invasive heart valve repair in a beating heart |
DE102017107546A1 (en) * | 2017-04-07 | 2018-10-11 | Ovesco Endoscopy Ag | Endoscope with additional external working channel |
WO2018204937A2 (en) * | 2017-05-03 | 2018-11-08 | Lsi Solutions, Inc. | Surgical equipment holder |
US11166759B2 (en) | 2017-05-16 | 2021-11-09 | Covidien Lp | Surgical forceps |
US10470645B2 (en) | 2017-05-22 | 2019-11-12 | Gustav Lo | Imaging system and method |
US11517325B2 (en) | 2017-06-20 | 2022-12-06 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured displacement distance traveled over a specified time interval |
US10881399B2 (en) | 2017-06-20 | 2021-01-05 | Ethicon Llc | Techniques for adaptive control of motor velocity of a surgical stapling and cutting instrument |
US10888321B2 (en) | 2017-06-20 | 2021-01-12 | Ethicon Llc | Systems and methods for controlling velocity of a displacement member of a surgical stapling and cutting instrument |
US10390841B2 (en) | 2017-06-20 | 2019-08-27 | Ethicon Llc | Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation |
US11071554B2 (en) | 2017-06-20 | 2021-07-27 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on magnitude of velocity error measurements |
US11090046B2 (en) | 2017-06-20 | 2021-08-17 | Cilag Gmbh International | Systems and methods for controlling displacement member motion 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 |
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 |
USD890784S1 (en) | 2017-06-20 | 2020-07-21 | Ethicon Llc | Display panel with changeable graphical user interface |
USD879808S1 (en) | 2017-06-20 | 2020-03-31 | Ethicon Llc | Display panel with graphical user interface |
US10813639B2 (en) | 2017-06-20 | 2020-10-27 | Ethicon Llc | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on system conditions |
USD879809S1 (en) | 2017-06-20 | 2020-03-31 | Ethicon Llc | Display panel with changeable graphical user interface |
US10646220B2 (en) | 2017-06-20 | 2020-05-12 | Ethicon Llc | Systems and methods for controlling displacement member velocity for a surgical instrument |
US11653914B2 (en) | 2017-06-20 | 2023-05-23 | Cilag Gmbh International | Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument according to articulation angle of end effector |
US11382638B2 (en) | 2017-06-20 | 2022-07-12 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified displacement distance |
US10327767B2 (en) | 2017-06-20 | 2019-06-25 | Ethicon Llc | Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation |
US10624633B2 (en) | 2017-06-20 | 2020-04-21 | Ethicon Llc | Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument |
US10368864B2 (en) | 2017-06-20 | 2019-08-06 | Ethicon Llc | Systems and methods for controlling displaying motor velocity for a surgical instrument |
US10881396B2 (en) | 2017-06-20 | 2021-01-05 | Ethicon Llc | Surgical instrument with variable duration trigger arrangement |
US10980537B2 (en) | 2017-06-20 | 2021-04-20 | Ethicon Llc | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified number of shaft rotations |
US11324503B2 (en) | 2017-06-27 | 2022-05-10 | Cilag Gmbh International | Surgical firing member arrangements |
US10772629B2 (en) | 2017-06-27 | 2020-09-15 | Ethicon Llc | Surgical anvil arrangements |
US10856869B2 (en) | 2017-06-27 | 2020-12-08 | Ethicon Llc | Surgical anvil arrangements |
US10993716B2 (en) | 2017-06-27 | 2021-05-04 | Ethicon Llc | Surgical anvil arrangements |
US11141154B2 (en) | 2017-06-27 | 2021-10-12 | Cilag Gmbh International | Surgical end effectors and anvils |
US11266405B2 (en) | 2017-06-27 | 2022-03-08 | Cilag Gmbh International | Surgical anvil manufacturing methods |
US20190000461A1 (en) | 2017-06-28 | 2019-01-03 | Ethicon Llc | Surgical cutting and fastening devices with pivotable anvil with a tissue locating arrangement in close proximity to an anvil pivot axis |
US11058424B2 (en) | 2017-06-28 | 2021-07-13 | Cilag Gmbh International | Surgical instrument comprising an offset articulation joint |
US10211586B2 (en) | 2017-06-28 | 2019-02-19 | Ethicon Llc | Surgical shaft assemblies with watertight housings |
US11564686B2 (en) | 2017-06-28 | 2023-01-31 | Cilag Gmbh International | Surgical shaft assemblies with flexible interfaces |
USD869655S1 (en) | 2017-06-28 | 2019-12-10 | Ethicon Llc | Surgical fastener cartridge |
US10903685B2 (en) | 2017-06-28 | 2021-01-26 | Ethicon Llc | Surgical shaft assemblies with slip ring assemblies forming capacitive channels |
USD906355S1 (en) | 2017-06-28 | 2020-12-29 | Ethicon Llc | Display screen or portion thereof with a graphical user interface for a surgical instrument |
US11259805B2 (en) | 2017-06-28 | 2022-03-01 | Cilag Gmbh International | Surgical instrument comprising firing member supports |
US11246592B2 (en) | 2017-06-28 | 2022-02-15 | Cilag Gmbh International | Surgical instrument comprising an articulation system lockable to a frame |
USD851762S1 (en) | 2017-06-28 | 2019-06-18 | Ethicon Llc | Anvil |
EP4070740A1 (en) | 2017-06-28 | 2022-10-12 | Cilag GmbH International | Surgical instrument comprising selectively actuatable rotatable couplers |
USD854151S1 (en) | 2017-06-28 | 2019-07-16 | Ethicon Llc | Surgical instrument shaft |
US10716614B2 (en) | 2017-06-28 | 2020-07-21 | Ethicon Llc | Surgical shaft assemblies with slip ring assemblies with increased contact pressure |
US10765427B2 (en) | 2017-06-28 | 2020-09-08 | Ethicon Llc | Method for articulating a surgical instrument |
US10932772B2 (en) | 2017-06-29 | 2021-03-02 | Ethicon Llc | Methods for closed loop velocity control for robotic surgical instrument |
US10898183B2 (en) | 2017-06-29 | 2021-01-26 | Ethicon Llc | Robotic surgical instrument with closed loop feedback techniques for advancement of closure member during firing |
US10258418B2 (en) | 2017-06-29 | 2019-04-16 | Ethicon Llc | System for controlling articulation forces |
US10398434B2 (en) | 2017-06-29 | 2019-09-03 | Ethicon Llc | Closed loop velocity control of closure member for robotic surgical instrument |
US11007022B2 (en) | 2017-06-29 | 2021-05-18 | Ethicon Llc | Closed loop velocity control techniques based on sensed tissue parameters for robotic surgical instrument |
US10292698B2 (en) | 2017-07-27 | 2019-05-21 | Endoevolution, Llc | Apparatus and method for minimally invasive suturing |
US11304695B2 (en) | 2017-08-03 | 2022-04-19 | Cilag Gmbh International | Surgical system shaft interconnection |
US11471155B2 (en) | 2017-08-03 | 2022-10-18 | Cilag Gmbh International | Surgical system bailout |
US10765429B2 (en) | 2017-09-29 | 2020-09-08 | Ethicon Llc | Systems and methods for providing alerts according to the operational state of a surgical instrument |
US11399829B2 (en) | 2017-09-29 | 2022-08-02 | Cilag Gmbh International | Systems and methods of initiating a power shutdown mode for a surgical instrument |
US10796471B2 (en) | 2017-09-29 | 2020-10-06 | Ethicon Llc | Systems and methods of displaying a knife position for a surgical instrument |
US10743872B2 (en) | 2017-09-29 | 2020-08-18 | Ethicon Llc | System and methods for controlling a display of a surgical instrument |
USD907648S1 (en) | 2017-09-29 | 2021-01-12 | Ethicon Llc | Display screen or portion thereof with animated graphical user interface |
USD917500S1 (en) | 2017-09-29 | 2021-04-27 | Ethicon Llc | Display screen or portion thereof with graphical user interface |
US10729501B2 (en) | 2017-09-29 | 2020-08-04 | Ethicon Llc | Systems and methods for language selection of a surgical instrument |
USD907647S1 (en) | 2017-09-29 | 2021-01-12 | Ethicon Llc | Display screen or portion thereof with animated graphical user interface |
US11134944B2 (en) | 2017-10-30 | 2021-10-05 | Cilag Gmbh International | Surgical stapler knife motion controls |
US11090075B2 (en) | 2017-10-30 | 2021-08-17 | Cilag Gmbh International | Articulation features for surgical end effector |
US10779903B2 (en) | 2017-10-31 | 2020-09-22 | Ethicon Llc | Positive shaft rotation lock activated by jaw closure |
US10842490B2 (en) | 2017-10-31 | 2020-11-24 | Ethicon Llc | Cartridge body design with force reduction based on firing completion |
US10905411B2 (en) | 2017-11-03 | 2021-02-02 | Covidien Lp | Surgical suturing and grasping device |
CN108186163B (en) * | 2017-11-07 | 2023-07-28 | 杭州德晋医疗科技有限公司 | Artificial tendon implantation system with detection device |
US10869666B2 (en) | 2017-12-15 | 2020-12-22 | Ethicon Llc | Adapters with control systems for controlling multiple motors of an electromechanical surgical instrument |
US11033267B2 (en) | 2017-12-15 | 2021-06-15 | Ethicon Llc | Systems and methods of controlling a clamping member firing rate of a surgical instrument |
US10828033B2 (en) | 2017-12-15 | 2020-11-10 | Ethicon Llc | Handheld electromechanical surgical instruments with improved motor control arrangements for positioning components of an adapter coupled thereto |
US10779826B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Methods of operating surgical end effectors |
US10743875B2 (en) | 2017-12-15 | 2020-08-18 | Ethicon Llc | Surgical end effectors with jaw stiffener arrangements configured to permit monitoring of firing member |
US10743874B2 (en) | 2017-12-15 | 2020-08-18 | Ethicon Llc | Sealed adapters for use with electromechanical surgical instruments |
US10779825B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Adapters with end effector position sensing and control arrangements for use in connection with electromechanical surgical instruments |
US11006955B2 (en) | 2017-12-15 | 2021-05-18 | Ethicon Llc | End effectors with positive jaw opening features for use with adapters for electromechanical surgical instruments |
US11071543B2 (en) | 2017-12-15 | 2021-07-27 | Cilag Gmbh International | Surgical end effectors with clamping assemblies configured to increase jaw aperture ranges |
US10687813B2 (en) | 2017-12-15 | 2020-06-23 | Ethicon Llc | Adapters with firing stroke sensing arrangements for use in connection with electromechanical surgical instruments |
US11197670B2 (en) | 2017-12-15 | 2021-12-14 | Cilag Gmbh International | Surgical end effectors with pivotal jaws configured to touch at their respective distal ends when fully closed |
US10966718B2 (en) | 2017-12-15 | 2021-04-06 | Ethicon Llc | Dynamic clamping assemblies with improved wear characteristics for use in connection with electromechanical surgical instruments |
US10716565B2 (en) | 2017-12-19 | 2020-07-21 | Ethicon Llc | Surgical instruments with dual articulation drivers |
US11045270B2 (en) | 2017-12-19 | 2021-06-29 | Cilag Gmbh International | Robotic attachment comprising exterior drive actuator |
US11266398B2 (en) * | 2017-12-19 | 2022-03-08 | Lsi Solutions, Inc | Automated suturing adapter, assembly, and methods thereof |
US11020112B2 (en) | 2017-12-19 | 2021-06-01 | Ethicon Llc | Surgical tools configured for interchangeable use with different controller interfaces |
US10729509B2 (en) | 2017-12-19 | 2020-08-04 | Ethicon Llc | Surgical instrument comprising closure and firing locking mechanism |
USD910847S1 (en) | 2017-12-19 | 2021-02-16 | Ethicon Llc | Surgical instrument assembly |
US10835330B2 (en) | 2017-12-19 | 2020-11-17 | Ethicon Llc | Method for determining the position of a rotatable jaw of a surgical instrument attachment assembly |
US11311290B2 (en) | 2017-12-21 | 2022-04-26 | Cilag Gmbh International | Surgical instrument comprising an end effector dampener |
US11129680B2 (en) | 2017-12-21 | 2021-09-28 | Cilag Gmbh International | Surgical instrument comprising a projector |
US10682134B2 (en) | 2017-12-21 | 2020-06-16 | Ethicon Llc | Continuous use self-propelled stapling instrument |
US11076853B2 (en) | 2017-12-21 | 2021-08-03 | Cilag Gmbh International | Systems and methods of displaying a knife position during transection for a surgical instrument |
CA3089814A1 (en) | 2018-01-28 | 2019-08-08 | Lsi Solutions, Inc. | Suturing device for minimally invasive surgery and needles and methods thereof |
EP3768176B1 (en) | 2018-03-23 | 2024-03-20 | NeoChord, Inc. | Device for suture attachment for minimally invasive heart valve repair |
JP7251543B2 (en) * | 2018-03-30 | 2023-04-04 | 日本ゼオン株式会社 | External tube member for endoscope |
US10660637B2 (en) | 2018-04-06 | 2020-05-26 | Cypris Medical, Inc. | Suturing system |
US11173030B2 (en) | 2018-05-09 | 2021-11-16 | Neochord, Inc. | Suture length adjustment for minimally invasive heart valve repair |
US11253360B2 (en) | 2018-05-09 | 2022-02-22 | Neochord, Inc. | Low profile tissue anchor for minimally invasive heart valve repair |
WO2019226891A1 (en) | 2018-05-25 | 2019-11-28 | Boston Scientific Scimed, Inc. | Device and method for applying a cinch to a suture |
US11033261B2 (en) | 2018-05-31 | 2021-06-15 | Cypris Medical, Inc. | Suture system |
US11375993B2 (en) | 2018-06-19 | 2022-07-05 | Boston Scientific Scimed, Inc. | Endoscopic handle attachment for use with suture based closure device |
CN112638284A (en) | 2018-06-27 | 2021-04-09 | 波士顿科学国际有限公司 | Endoscopic attachment mechanism for use with suture-based closure device |
EP3824936B1 (en) * | 2018-07-19 | 2023-03-01 | Olympus Corporation | Puncture needle |
US11197665B2 (en) | 2018-08-06 | 2021-12-14 | Covidien Lp | Needle reload device for use with endostitch device |
US11253256B2 (en) | 2018-08-20 | 2022-02-22 | Cilag Gmbh International | Articulatable motor powered surgical instruments with dedicated articulation motor arrangements |
US11039834B2 (en) | 2018-08-20 | 2021-06-22 | Cilag Gmbh International | Surgical stapler anvils with staple directing protrusions and tissue stability features |
US11291440B2 (en) | 2018-08-20 | 2022-04-05 | Cilag Gmbh International | Method for operating a powered articulatable surgical instrument |
US10912559B2 (en) | 2018-08-20 | 2021-02-09 | Ethicon Llc | Reinforced deformable anvil tip for surgical stapler anvil |
USD914878S1 (en) | 2018-08-20 | 2021-03-30 | Ethicon Llc | Surgical instrument anvil |
US11207065B2 (en) | 2018-08-20 | 2021-12-28 | Cilag Gmbh International | Method for fabricating surgical stapler anvils |
US10779821B2 (en) | 2018-08-20 | 2020-09-22 | Ethicon Llc | Surgical stapler anvils with tissue stop features configured to avoid tissue pinch |
US11083458B2 (en) | 2018-08-20 | 2021-08-10 | Cilag Gmbh International | Powered surgical instruments with clutching arrangements to convert linear drive motions to rotary drive motions |
US10842492B2 (en) | 2018-08-20 | 2020-11-24 | Ethicon Llc | Powered articulatable surgical instruments with clutching and locking arrangements for linking an articulation drive system to a firing drive system |
US11324501B2 (en) | 2018-08-20 | 2022-05-10 | Cilag Gmbh International | Surgical stapling devices with improved closure members |
US11045192B2 (en) | 2018-08-20 | 2021-06-29 | Cilag Gmbh International | Fabricating techniques for surgical stapler anvils |
US10856870B2 (en) | 2018-08-20 | 2020-12-08 | Ethicon Llc | Switching arrangements for motor powered articulatable surgical instruments |
CN112654309A (en) | 2018-09-06 | 2021-04-13 | 波士顿科学国际有限公司 | Suture needle device and suture attachment method |
US10966709B2 (en) | 2018-09-07 | 2021-04-06 | Neochord, Inc. | Device for suture attachment for minimally invasive heart valve repair |
US11219457B2 (en) | 2018-10-11 | 2022-01-11 | Covidien Lp | Laparoscopic purse string suture device |
US11147553B2 (en) | 2019-03-25 | 2021-10-19 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11172929B2 (en) | 2019-03-25 | 2021-11-16 | Cilag Gmbh International | Articulation drive arrangements for surgical systems |
US11696761B2 (en) | 2019-03-25 | 2023-07-11 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11147551B2 (en) | 2019-03-25 | 2021-10-19 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
WO2020214818A1 (en) | 2019-04-16 | 2020-10-22 | Neochord, Inc. | Transverse helical cardiac anchor for minimally invasive heart valve repair |
US11432816B2 (en) | 2019-04-30 | 2022-09-06 | Cilag Gmbh International | Articulation pin for a surgical instrument |
US11903581B2 (en) | 2019-04-30 | 2024-02-20 | Cilag Gmbh International | Methods for stapling tissue using a surgical instrument |
US11426251B2 (en) | 2019-04-30 | 2022-08-30 | Cilag Gmbh International | Articulation directional lights on a surgical instrument |
US11471157B2 (en) | 2019-04-30 | 2022-10-18 | Cilag Gmbh International | Articulation control mapping for a surgical instrument |
US11452528B2 (en) | 2019-04-30 | 2022-09-27 | Cilag Gmbh International | Articulation actuators for a surgical instrument |
US11253254B2 (en) | 2019-04-30 | 2022-02-22 | Cilag Gmbh International | Shaft rotation actuator on a surgical instrument |
US11648009B2 (en) | 2019-04-30 | 2023-05-16 | Cilag Gmbh International | Rotatable jaw tip for a surgical instrument |
JP7279201B2 (en) | 2019-05-16 | 2023-05-22 | ボストン サイエンティフィック サイムド,インコーポレイテッド | Suture closure device for use with an endoscope |
US11224497B2 (en) | 2019-06-28 | 2022-01-18 | Cilag Gmbh International | Surgical systems with multiple RFID tags |
US11241235B2 (en) | 2019-06-28 | 2022-02-08 | Cilag Gmbh International | Method of using multiple RFID chips with a surgical assembly |
US11660163B2 (en) | 2019-06-28 | 2023-05-30 | Cilag Gmbh International | Surgical system with RFID tags for updating motor assembly parameters |
US11259803B2 (en) | 2019-06-28 | 2022-03-01 | Cilag Gmbh International | Surgical stapling system having an information encryption protocol |
US11426167B2 (en) | 2019-06-28 | 2022-08-30 | Cilag Gmbh International | Mechanisms for proper anvil attachment surgical stapling head assembly |
US11051807B2 (en) | 2019-06-28 | 2021-07-06 | Cilag Gmbh International | Packaging assembly including a particulate trap |
US11553971B2 (en) | 2019-06-28 | 2023-01-17 | Cilag Gmbh International | Surgical RFID assemblies for display and communication |
US11291451B2 (en) | 2019-06-28 | 2022-04-05 | Cilag Gmbh International | Surgical instrument with battery compatibility verification functionality |
US11298132B2 (en) | 2019-06-28 | 2022-04-12 | Cilag GmbH Inlernational | Staple cartridge including a honeycomb extension |
US11627959B2 (en) | 2019-06-28 | 2023-04-18 | Cilag Gmbh International | Surgical instruments including manual and powered system lockouts |
US11219455B2 (en) | 2019-06-28 | 2022-01-11 | Cilag Gmbh International | Surgical instrument including a lockout key |
US11771419B2 (en) | 2019-06-28 | 2023-10-03 | Cilag Gmbh International | Packaging for a replaceable component of a surgical stapling system |
US11464601B2 (en) | 2019-06-28 | 2022-10-11 | Cilag Gmbh International | Surgical instrument comprising an RFID system for tracking a movable component |
US11497492B2 (en) | 2019-06-28 | 2022-11-15 | Cilag Gmbh International | Surgical instrument including an articulation lock |
US11638587B2 (en) | 2019-06-28 | 2023-05-02 | Cilag Gmbh International | RFID identification systems for surgical instruments |
US11246678B2 (en) | 2019-06-28 | 2022-02-15 | Cilag Gmbh International | Surgical stapling system having a frangible RFID tag |
US11684434B2 (en) | 2019-06-28 | 2023-06-27 | Cilag Gmbh International | Surgical RFID assemblies for instrument operational setting control |
US11478241B2 (en) | 2019-06-28 | 2022-10-25 | Cilag Gmbh International | Staple cartridge including projections |
US11376098B2 (en) | 2019-06-28 | 2022-07-05 | Cilag Gmbh International | Surgical instrument system comprising an RFID system |
US11523822B2 (en) | 2019-06-28 | 2022-12-13 | Cilag Gmbh International | Battery pack including a circuit interrupter |
US11399837B2 (en) | 2019-06-28 | 2022-08-02 | Cilag Gmbh International | Mechanisms for motor control adjustments of a motorized surgical instrument |
US11298127B2 (en) | 2019-06-28 | 2022-04-12 | Cilag GmbH Interational | Surgical stapling system having a lockout mechanism for an incompatible cartridge |
CA3147413A1 (en) | 2019-07-15 | 2021-01-21 | Ancora Heart, Inc. | Devices and methods for tether cutting |
US11076850B2 (en) | 2019-11-26 | 2021-08-03 | Covidien Lp | Surgical instrument including an adapter assembly and an articulating surgical loading unit |
US11291446B2 (en) | 2019-12-18 | 2022-04-05 | Covidien Lp | Surgical instrument including an adapter assembly and an articulating surgical loading unit |
US11529139B2 (en) | 2019-12-19 | 2022-12-20 | Cilag Gmbh International | Motor driven surgical instrument |
US11464512B2 (en) | 2019-12-19 | 2022-10-11 | Cilag Gmbh International | Staple cartridge comprising a curved deck surface |
US11446029B2 (en) | 2019-12-19 | 2022-09-20 | Cilag Gmbh International | Staple cartridge comprising projections extending from a curved deck surface |
US11529137B2 (en) | 2019-12-19 | 2022-12-20 | Cilag Gmbh International | Staple cartridge comprising driver retention members |
US11291447B2 (en) | 2019-12-19 | 2022-04-05 | Cilag Gmbh International | Stapling instrument comprising independent jaw closing and staple firing systems |
US11576672B2 (en) | 2019-12-19 | 2023-02-14 | Cilag Gmbh International | Surgical instrument comprising a closure system including a closure member and an opening member driven by a drive screw |
US11607219B2 (en) | 2019-12-19 | 2023-03-21 | Cilag Gmbh International | Staple cartridge comprising a detachable tissue cutting knife |
US11559304B2 (en) | 2019-12-19 | 2023-01-24 | Cilag Gmbh International | Surgical instrument comprising a rapid closure mechanism |
US11911032B2 (en) | 2019-12-19 | 2024-02-27 | Cilag Gmbh International | Staple cartridge comprising a seating cam |
US11304696B2 (en) | 2019-12-19 | 2022-04-19 | Cilag Gmbh International | Surgical instrument comprising a powered articulation system |
US11234698B2 (en) | 2019-12-19 | 2022-02-01 | Cilag Gmbh International | Stapling system comprising a clamp lockout and a firing lockout |
US11504122B2 (en) | 2019-12-19 | 2022-11-22 | Cilag Gmbh International | Surgical instrument comprising a nested firing member |
US11701111B2 (en) | 2019-12-19 | 2023-07-18 | Cilag Gmbh International | Method for operating a surgical stapling instrument |
US11844520B2 (en) | 2019-12-19 | 2023-12-19 | Cilag Gmbh International | Staple cartridge comprising driver retention members |
JP2023514595A (en) | 2020-02-18 | 2023-04-06 | ボストン サイエンティフィック サイムド,インコーポレイテッド | Suture-based closure device for use with an endoscope |
JP2023515447A (en) | 2020-02-19 | 2023-04-13 | ボストン サイエンティフィック サイムド,インコーポレイテッド | High power atherectomy with multiple safety limits |
CN115916068A (en) | 2020-03-31 | 2023-04-04 | 波士顿科学国际有限公司 | Suture-based closure device |
USD967421S1 (en) | 2020-06-02 | 2022-10-18 | Cilag Gmbh International | Staple cartridge |
USD966512S1 (en) | 2020-06-02 | 2022-10-11 | Cilag Gmbh International | Staple cartridge |
USD975850S1 (en) | 2020-06-02 | 2023-01-17 | Cilag Gmbh International | Staple cartridge |
USD974560S1 (en) | 2020-06-02 | 2023-01-03 | Cilag Gmbh International | Staple cartridge |
USD975851S1 (en) | 2020-06-02 | 2023-01-17 | Cilag Gmbh International | Staple cartridge |
USD975278S1 (en) | 2020-06-02 | 2023-01-10 | Cilag Gmbh International | Staple cartridge |
USD976401S1 (en) | 2020-06-02 | 2023-01-24 | Cilag Gmbh International | Staple cartridge |
US20220031351A1 (en) | 2020-07-28 | 2022-02-03 | Cilag Gmbh International | Surgical instruments with differential articulation joint arrangements for accommodating flexible actuators |
US11452526B2 (en) | 2020-10-29 | 2022-09-27 | Cilag Gmbh International | Surgical instrument comprising a staged voltage regulation start-up system |
US11717289B2 (en) | 2020-10-29 | 2023-08-08 | Cilag Gmbh International | Surgical instrument comprising an indicator which indicates that an articulation drive is actuatable |
US11534259B2 (en) | 2020-10-29 | 2022-12-27 | Cilag Gmbh International | Surgical instrument comprising an articulation indicator |
US11517390B2 (en) | 2020-10-29 | 2022-12-06 | Cilag Gmbh International | Surgical instrument comprising a limited travel switch |
US11844518B2 (en) | 2020-10-29 | 2023-12-19 | Cilag Gmbh International | Method for operating a surgical instrument |
USD980425S1 (en) | 2020-10-29 | 2023-03-07 | Cilag Gmbh International | Surgical instrument assembly |
US11617577B2 (en) | 2020-10-29 | 2023-04-04 | Cilag Gmbh International | Surgical instrument comprising a sensor configured to sense whether an articulation drive of the surgical instrument is actuatable |
US11779330B2 (en) | 2020-10-29 | 2023-10-10 | Cilag Gmbh International | Surgical instrument comprising a jaw alignment system |
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 |
US11849943B2 (en) | 2020-12-02 | 2023-12-26 | Cilag Gmbh International | Surgical instrument with cartridge release mechanisms |
US11744581B2 (en) | 2020-12-02 | 2023-09-05 | Cilag Gmbh International | Powered surgical instruments with multi-phase tissue treatment |
US11678882B2 (en) | 2020-12-02 | 2023-06-20 | Cilag Gmbh International | Surgical instruments with interactive features to remedy incidental sled movements |
US11653920B2 (en) | 2020-12-02 | 2023-05-23 | Cilag Gmbh International | Powered surgical instruments with communication interfaces through sterile barrier |
US11653915B2 (en) | 2020-12-02 | 2023-05-23 | Cilag Gmbh International | Surgical instruments with sled location detection and adjustment features |
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 |
US11890010B2 (en) | 2020-12-02 | 2024-02-06 | Cllag GmbH International | Dual-sided reinforced reload for surgical instruments |
US11627960B2 (en) | 2020-12-02 | 2023-04-18 | Cilag Gmbh International | Powered surgical instruments with smart reload with separately attachable exteriorly mounted wiring connections |
US11701113B2 (en) | 2021-02-26 | 2023-07-18 | Cilag Gmbh International | Stapling instrument comprising a separate power antenna and a data transfer antenna |
US11730473B2 (en) | 2021-02-26 | 2023-08-22 | Cilag Gmbh International | Monitoring of manufacturing life-cycle |
US11751869B2 (en) | 2021-02-26 | 2023-09-12 | Cilag Gmbh International | Monitoring of multiple sensors over time to detect moving characteristics of tissue |
US11696757B2 (en) | 2021-02-26 | 2023-07-11 | Cilag Gmbh International | Monitoring of internal systems to detect and track cartridge motion status |
US11812964B2 (en) | 2021-02-26 | 2023-11-14 | Cilag Gmbh International | Staple cartridge comprising a power management circuit |
US11723657B2 (en) | 2021-02-26 | 2023-08-15 | Cilag Gmbh International | Adjustable communication based on available bandwidth and power capacity |
US11749877B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Stapling instrument comprising a signal antenna |
US11793514B2 (en) | 2021-02-26 | 2023-10-24 | Cilag Gmbh International | Staple cartridge comprising sensor array which may be embedded in cartridge body |
US11925349B2 (en) | 2021-02-26 | 2024-03-12 | Cilag Gmbh International | Adjustment to transfer parameters to improve available power |
US11744583B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Distal communication array to tune frequency of RF systems |
JP2024508299A (en) * | 2021-03-01 | 2024-02-26 | ジャイラス エーシーエムアイ インク ディー/ビー/エー オリンパス サージカル テクノロジーズ アメリカ | Endoscope including reinsertion sheath and suturing device |
US11826012B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Stapling instrument comprising a pulsed motor-driven firing rack |
US11759202B2 (en) | 2021-03-22 | 2023-09-19 | Cilag Gmbh International | Staple cartridge comprising an implantable layer |
US11737749B2 (en) | 2021-03-22 | 2023-08-29 | Cilag Gmbh International | Surgical stapling instrument comprising a retraction system |
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 |
US11806011B2 (en) | 2021-03-22 | 2023-11-07 | Cilag Gmbh International | Stapling instrument comprising tissue compression systems |
US11723658B2 (en) | 2021-03-22 | 2023-08-15 | Cilag Gmbh International | Staple cartridge comprising a firing lockout |
US11857183B2 (en) | 2021-03-24 | 2024-01-02 | Cilag Gmbh International | Stapling assembly components having metal substrates and plastic bodies |
US11896218B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Method of using a powered stapling device |
US11744603B2 (en) | 2021-03-24 | 2023-09-05 | Cilag Gmbh International | Multi-axis pivot joints for surgical instruments and methods for manufacturing same |
US11832816B2 (en) | 2021-03-24 | 2023-12-05 | Cilag Gmbh International | Surgical stapling assembly comprising nonplanar staples and planar staples |
US11903582B2 (en) | 2021-03-24 | 2024-02-20 | Cilag Gmbh International | Leveraging surfaces for cartridge installation |
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 |
US11786239B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Surgical instrument articulation joint arrangements comprising multiple moving linkage features |
US11849945B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Rotary-driven surgical stapling assembly comprising eccentrically driven firing member |
US11849944B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Drivers for fastener cartridge assemblies having rotary drive screws |
US11793516B2 (en) | 2021-03-24 | 2023-10-24 | Cilag Gmbh International | Surgical staple cartridge comprising longitudinal support beam |
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 |
KR102614110B1 (en) * | 2021-08-10 | 2023-12-18 | 인제대학교 산학협력단 | Endoscope with snare |
US11877745B2 (en) | 2021-10-18 | 2024-01-23 | Cilag Gmbh International | Surgical stapling assembly having longitudinally-repeating staple leg clusters |
Citations (15)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3773034A (en) * | 1971-11-24 | 1973-11-20 | Itt Research Institute | Steerable catheter |
US4403985A (en) * | 1981-05-12 | 1983-09-13 | The United States Of America As Represented By The Department Of Health And Human Services | Jet controlled catheter |
US4841888A (en) * | 1984-09-11 | 1989-06-27 | Mills Timothy N | Sewing machine |
US4890602A (en) * | 1987-11-25 | 1990-01-02 | Hake Lawrence W | Endoscope construction with means for controlling rigidity and curvature of flexible endoscope tube |
US5080663A (en) * | 1990-09-26 | 1992-01-14 | Univerity College London | Sewing device |
US5368601A (en) * | 1992-04-30 | 1994-11-29 | Lasersurge, Inc. | Trocar wound closure device |
US5431666A (en) * | 1994-02-24 | 1995-07-11 | Lasersurge, Inc. | Surgical suture instrument |
US5520702A (en) * | 1994-02-24 | 1996-05-28 | United States Surgical Corporation | Method and apparatus for applying a cinch member to the ends of a suture |
US5562686A (en) * | 1995-04-19 | 1996-10-08 | United States Surgical Corporation | Apparaus and method for suturing body tissue |
US5584861A (en) * | 1992-09-04 | 1996-12-17 | University College London | Device for use in securing a thread |
US5643289A (en) * | 1994-02-24 | 1997-07-01 | Lasersurge, Inc. | Surgical crimping device and method of use |
US5755730A (en) * | 1994-03-23 | 1998-05-26 | University College London | Device for use in cutting threads |
US5766183A (en) * | 1996-10-21 | 1998-06-16 | Lasersurge, Inc. | Vascular hole closure |
US5792153A (en) * | 1994-03-23 | 1998-08-11 | University College London | Sewing device |
US6562052B2 (en) * | 1995-08-24 | 2003-05-13 | Sutura, Inc. | Suturing device and method |
Family Cites Families (16)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3884222A (en) * | 1974-03-11 | 1975-05-20 | George Paul Moore | Laryngoscope |
US4960410A (en) * | 1989-03-31 | 1990-10-02 | Cordis Corporation | Flexible tubular member for catheter construction |
IT1233008B (en) * | 1989-09-21 | 1992-03-14 | Sgs Thomson Microelectronics | INTEGRATED DEVICE WITH PERFECTED CONNECTIONS BETWEEN THE TERMINALS AND THE PLATE OF SEMI-CONDUCTIVE MATERIAL INTEGRATING ELECTRONIC COMPONENTS |
US5503616A (en) * | 1991-06-10 | 1996-04-02 | Endomedical Technologies, Inc. | Collapsible access channel system |
US5269763A (en) * | 1991-07-18 | 1993-12-14 | Vernay Laboratories, Inc. | Self-sealing cannula cap |
US5391173A (en) | 1994-02-10 | 1995-02-21 | Wilk; Peter J. | Laparoscopic suturing technique and associated device |
US5722990A (en) * | 1995-11-08 | 1998-03-03 | Sugar Surgical Technologies, Inc. | Tissue grasping device |
US5810805A (en) * | 1996-02-09 | 1998-09-22 | Conmed Corporation | Bipolar surgical devices and surgical methods |
US5817013A (en) * | 1996-03-19 | 1998-10-06 | Enable Medical Corporation | Method and apparatus for the minimally invasive harvesting of a saphenous vein and the like |
US5910105A (en) * | 1997-04-14 | 1999-06-08 | C.R. Bard, Inc. | Control handle for an endoscope |
US5908429A (en) * | 1997-05-01 | 1999-06-01 | Yoon; Inbae | Methods of anatomical tissue ligation |
US5954731A (en) * | 1997-07-29 | 1999-09-21 | Yoon; Inbae | Surgical instrument with multiple rotatably mounted spreadable end effectors |
JP4121615B2 (en) * | 1997-10-31 | 2008-07-23 | オリンパス株式会社 | Endoscope |
US5947983A (en) * | 1998-03-16 | 1999-09-07 | Boston Scientific Corporation | Tissue cutting and stitching device and method |
US6042563A (en) * | 1998-03-27 | 2000-03-28 | Cardiothoracic Systems, Inc. | Methods and apparatus for occluding a blood vessel |
CA2289805C (en) * | 1999-11-16 | 2006-10-17 | Denis Courtemanche | Snowmobile track with heat transfer clips |
-
2001
- 2001-02-02 US US09/776,431 patent/US6997931B2/en not_active Expired - Lifetime
-
2002
- 2002-02-01 EP EP02706086A patent/EP1408809A4/en not_active Withdrawn
- 2002-02-01 WO PCT/US2002/002791 patent/WO2002062200A2/en not_active Application Discontinuation
-
2005
- 2005-03-21 US US11/085,703 patent/US20050165419A1/en not_active Abandoned
-
2010
- 2010-09-01 US US12/807,259 patent/US20100331623A1/en not_active Abandoned
Patent Citations (19)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3773034A (en) * | 1971-11-24 | 1973-11-20 | Itt Research Institute | Steerable catheter |
US4403985A (en) * | 1981-05-12 | 1983-09-13 | The United States Of America As Represented By The Department Of Health And Human Services | Jet controlled catheter |
US5037021A (en) * | 1984-07-11 | 1991-08-06 | University College London | Sewing machine |
US4841888A (en) * | 1984-09-11 | 1989-06-27 | Mills Timothy N | Sewing machine |
US4890602A (en) * | 1987-11-25 | 1990-01-02 | Hake Lawrence W | Endoscope construction with means for controlling rigidity and curvature of flexible endoscope tube |
US5080663A (en) * | 1990-09-26 | 1992-01-14 | Univerity College London | Sewing device |
US5507757A (en) * | 1992-04-30 | 1996-04-16 | Lasersurge, Inc. | Method of closing puncture wounds |
US5368601A (en) * | 1992-04-30 | 1994-11-29 | Lasersurge, Inc. | Trocar wound closure device |
US5626588A (en) * | 1992-04-30 | 1997-05-06 | Lasersurge, Inc. | Trocar wound closure device |
US5584861A (en) * | 1992-09-04 | 1996-12-17 | University College London | Device for use in securing a thread |
US5431666A (en) * | 1994-02-24 | 1995-07-11 | Lasersurge, Inc. | Surgical suture instrument |
US5520702A (en) * | 1994-02-24 | 1996-05-28 | United States Surgical Corporation | Method and apparatus for applying a cinch member to the ends of a suture |
US5643289A (en) * | 1994-02-24 | 1997-07-01 | Lasersurge, Inc. | Surgical crimping device and method of use |
US5669917A (en) * | 1994-02-24 | 1997-09-23 | Lasersurge, Inc. | Surgical crimping device and method of use |
US5755730A (en) * | 1994-03-23 | 1998-05-26 | University College London | Device for use in cutting threads |
US5792153A (en) * | 1994-03-23 | 1998-08-11 | University College London | Sewing device |
US5562686A (en) * | 1995-04-19 | 1996-10-08 | United States Surgical Corporation | Apparaus and method for suturing body tissue |
US6562052B2 (en) * | 1995-08-24 | 2003-05-13 | Sutura, Inc. | Suturing device and method |
US5766183A (en) * | 1996-10-21 | 1998-06-16 | Lasersurge, Inc. | Vascular hole closure |
Cited By (36)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US10350101B2 (en) | 2002-11-01 | 2019-07-16 | Valentx, Inc. | Devices and methods for endolumenal gastrointestinal bypass |
US9561127B2 (en) | 2002-11-01 | 2017-02-07 | Valentx, Inc. | Apparatus and methods for treatment of morbid obesity |
US9839546B2 (en) | 2002-11-01 | 2017-12-12 | Valentx, Inc. | Apparatus and methods for treatment of morbid obesity |
US8920440B2 (en) | 2009-08-21 | 2014-12-30 | Coloplast A/S | Suture assembly and system |
US20110046645A1 (en) * | 2009-08-21 | 2011-02-24 | Colophast A/S | Suture assembly and system |
US20110046642A1 (en) * | 2009-08-21 | 2011-02-24 | Coloplast A/S | Suture assembly and system |
US10631855B2 (en) | 2009-10-01 | 2020-04-28 | Covidien Lp | Wound closure device including direct-driven needle |
US9980721B2 (en) * | 2009-10-01 | 2018-05-29 | Covidien Lp | Wound closure device including direct-driven needle |
US20160287247A1 (en) * | 2009-10-01 | 2016-10-06 | Covidien Lp | Wound closure device including direct-driven needle |
US20120130403A1 (en) * | 2010-11-22 | 2012-05-24 | Brenner Jacob S | Device and method for treatment of hemorrhoids |
US9149271B2 (en) * | 2010-11-22 | 2015-10-06 | The Board Of Trustees Of The Leland Stanford, Jr. University | Device and method for treatment of hemorrhoids |
US8882834B2 (en) | 2011-07-08 | 2014-11-11 | Smith & Nephew, Inc. | Soft tissue repair |
US10335138B2 (en) | 2011-07-08 | 2019-07-02 | Smith & Nephew, Inc. | Suture passer and method |
US9662105B2 (en) | 2011-07-08 | 2017-05-30 | Smith & Nephew, Inc. | Suture passer and method |
US11006947B2 (en) | 2011-07-08 | 2021-05-18 | Smith & Nephew, Inc. | Suture passer and method |
US9357997B2 (en) | 2011-07-08 | 2016-06-07 | Smith & Nephew, Inc. | Suture passer and method |
US20130023905A1 (en) * | 2011-07-20 | 2013-01-24 | Coloplast A/S | Suture system with capsule eyelet providing multiple suture tissue fixation |
US8992550B2 (en) * | 2011-07-20 | 2015-03-31 | Coloplast A/S | Suture system with capsule eyelet providing multiple suture tissue fixation |
US20130023906A1 (en) * | 2011-07-20 | 2013-01-24 | Coloplast A/S | Suture system with capsule eyelet providing multiple suture tissue fixation |
US8623033B2 (en) * | 2011-07-20 | 2014-01-07 | Coloplast A/S | Suture system with capsule eyelet providing multiple suture tissue fixation |
US8956318B2 (en) | 2012-05-31 | 2015-02-17 | Valentx, Inc. | Devices and methods for gastrointestinal bypass |
US20130324905A1 (en) * | 2012-05-31 | 2013-12-05 | Valentx, Inc. | Devices and methods for gastrointestinal bypass |
US9681975B2 (en) | 2012-05-31 | 2017-06-20 | Valentx, Inc. | Devices and methods for gastrointestinal bypass |
US9451960B2 (en) | 2012-05-31 | 2016-09-27 | Valentx, Inc. | Devices and methods for gastrointestinal bypass |
US9039649B2 (en) | 2012-05-31 | 2015-05-26 | Valentx, Inc. | Devices and methods for gastrointestinal bypass |
US9173759B2 (en) * | 2012-05-31 | 2015-11-03 | Valentx, Inc. | Devices and methods for gastrointestinal bypass |
US9566181B2 (en) | 2012-05-31 | 2017-02-14 | Valentx, Inc. | Devices and methods for gastrointestinal bypass |
US9675489B2 (en) | 2012-05-31 | 2017-06-13 | Valentx, Inc. | Devices and methods for gastrointestinal bypass |
US9050168B2 (en) | 2012-05-31 | 2015-06-09 | Valentx, Inc. | Devices and methods for gastrointestinal bypass |
US9757264B2 (en) | 2013-03-13 | 2017-09-12 | Valentx, Inc. | Devices and methods for gastrointestinal bypass |
US10702263B2 (en) * | 2017-05-30 | 2020-07-07 | Suture Ease, Inc. | Biological tissue access and closure apparatus, systems and methods |
US20200281583A1 (en) * | 2017-05-30 | 2020-09-10 | Suture Ease, Inc. | Biological Tissue Access and Closure Apparatus, Systems and Methods |
US20220008064A1 (en) * | 2017-05-30 | 2022-01-13 | Suture Ease, Inc. | Biological Tissue Access and Closure Apparatus, Systems and Methods |
US11457913B2 (en) * | 2017-05-30 | 2022-10-04 | Suture Ease, Inc. | Biological tissue access and closure apparatus, systems and methods |
US11648003B2 (en) * | 2017-05-30 | 2023-05-16 | Suture Ease, Inc. | Biological tissue access and closure apparatus, systems and methods |
US11154294B2 (en) * | 2018-05-29 | 2021-10-26 | Suture Ease, Inc. | Biological tissue access and closure apparatus, systems and methods |
Also Published As
Publication number | Publication date |
---|---|
EP1408809A4 (en) | 2008-12-17 |
US20020107530A1 (en) | 2002-08-08 |
US20050165419A1 (en) | 2005-07-28 |
WO2002062200A2 (en) | 2002-08-15 |
WO2002062200B1 (en) | 2004-04-15 |
US6997931B2 (en) | 2006-02-14 |
WO2002062200A3 (en) | 2004-02-19 |
EP1408809A2 (en) | 2004-04-21 |
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STCB | Information on status: application discontinuation |
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