CA2248090A1 - Suture spring device applicator - Google Patents

Suture spring device applicator Download PDF

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Publication number
CA2248090A1
CA2248090A1 CA002248090A CA2248090A CA2248090A1 CA 2248090 A1 CA2248090 A1 CA 2248090A1 CA 002248090 A CA002248090 A CA 002248090A CA 2248090 A CA2248090 A CA 2248090A CA 2248090 A1 CA2248090 A1 CA 2248090A1
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CA
Canada
Prior art keywords
guide
spring device
suture
applicator
suture spring
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
CA002248090A
Other languages
French (fr)
Inventor
Samuel C. Yoon
Inbae Yoon
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Individual
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Individual
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Filing date
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Publication of CA2248090A1 publication Critical patent/CA2248090A1/en
Abandoned legal-status Critical Current

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064Surgical staples, i.e. penetrating the tissue
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/08Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound
    • A61B17/083Clips, e.g. resilient
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/128Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
    • A61B17/1285Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips for minimally invasive surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06066Needles, e.g. needle tip configurations
    • A61B2017/06076Needles, e.g. needle tip configurations helically or spirally coiled
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06166Sutures
    • A61B2017/06171Sutures helically or spirally coiled
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064Surgical staples, i.e. penetrating the tissue
    • A61B2017/0649Coils or spirals

Abstract

A suture spring device applicator (20) includes a storage portion (32) configured to hold one or more suture spring devices (38) in a substantially relaxed, contracted state and a guide (36) disposed distally of the storage portion to receive a suture spring device in an elastically deformed, expanded state for positioning in or in relation to anatomical tissue. A pusher (26) is used to bias the suture spring device distally so that, when the guide is rotated and moved proximally relative to the suture spring device, the device will be loaded into the guide in the elastically deformed, expanded state. The guide is then positioned in or in relation to anatomical tissue and is retracted or moved proximally relative to the suture spring device which is held in place by the force of the pusher. When the guide is removed, the suture spring device is no longer restrained and can move from the elastically deformed, expanded state toward the substantially relaxed, contracted state to apply a predetermined force to compress the anatomical tissue. The applicator preferably includes a central channel (159) through which instruments, such as tissue penetrating instruments and tissue grasping instruments can be inserted prior to or during operative procedure.

Description

WO g7/32527 PCr/US97102979 Suture Spring Device Applicator BACKGROUND OF THE INVENTION
Field of the Invention:
The ~reaont invention relates to surgical devices and proc6.1ures and, more particularly, to a suture spring device s~rpli~or, that is, an apparatus for applying at least one suture sprin~ device, for example a suture spring device of the type ~;r~:lQssd in my co pending U.S. Patent A~plication Serial No. 08/610,951, e"litled ~Suture Spring Device,~ the discl~s~ ~e of which is inco(purdled herein by refe~nce.

Disu~ssion of the Prior Art:
Suturir~ of bodily tissue is a Ume cor~uming part of most sur~ical procedures including both open surgery and ellJoscopic or minimally invasive surgery. By W O 97~2S27 PCTrUS97~2g79 "open" surgery is meant sur~ery wherein the sur~eon gains ~ss to the surgical site via a relatively large inc;sion and by ~ndosoopic surgery is meant sur~ery wherein the sur~eon gains access to the surgical site via one or more portals through which e(-d-~s are introd~qcl to view the sur~ical site and through which variousins~s are intro~luc~cl to the surgical site. There are many co")mo., endoscopic surgical procedlJres including al 11 .r~,tcopy, laparoscopy (pclvi500py), ~astr~, Itn~5COp~ and lar~"~obrt,r,choscGp~, for e~,ople.
In the past suturing was ac~ plished with the use of a sharp suture needle attached to the end of a length of suture material. Depending on the size of the~re needle and the type of sur~ery bein~ pe. rOlllle~l~ the suture needle was either ~,~sped manually or with a needle holding instrument and moved to cause a sharp tip of the needle to pe"el~ale and pass through andtOllliCal tissue. When the sharp tip of the needle e",ergeJ from the tissue the body of the needle was rela~ ed so that the distal end of the body adjacent the tip could be ~ras~d to pull the needle and the suture l-.al~lial dtlach6d to the needle throu~h the tissue. Once the suture material was pulled throu~h the tissue, the sur~eon tied a knot in the suture ",ale, ial and ad~usted the lensi~ l on the suture material to aco~ Gddte the particular tissue bein~ sutured and to oontrol app,o~",~tion, oa~ icn, dt~l;lnllellt or other conditions of the tissue. However, the ~n~cess of tissue ~, .etration and l~notlin~ of the suture material can be time consuming and tedious work, particularly when pel F~ll l-le~l in co ~n~tiGI ~ with microsur~ery and en~os~ic surgery, and can unduly prolong the duration d sur~ery and U ,e~ror~ the period in which the patient is under an~.U ,esia.
Nevertheless, e~ esc~ic sur~ery is pr~fe.~ ed over open sur~ery due to the ~reatly red~ wl trauma and wound healing time for the patient and due to concGn,ita, It cost ~v;"~s associated with shorter hospital stays and p~ F~ ming surgery in non~os~i~PI
or out-patient sùrgery sites.
Accordin~ly, there has been much effort spent to dev~lop techniques for facilitatin~ the suturin~ normally pe-~"-,ed by use of a suture needle and a length of suture ",d~rial. One technique, eAe",~lified by U.S. Patent Nos. 3,545,4~4 to W O 97132S27 ~n~97~2~79 Green and 4,595,007 to Mericle, employs elon~.Jt~J wire sutures f~l,.,ed of ductile materials that are bent into coiled shapes by a curved tip of a suturin~ instrument.
The wire sutures can be bent around tubular structures or throu~h anatomical tissue and will tend to remain in the bent condition to hold the tissue to~U .er, however, once bent, the wire sutures will not co""~ress the tubular strudures or tissue so that ~ it is n~a~y to ~o,u.-~te the tubular structures or tissue prior to or concurrently with bendin~ of the sutures.
The use of staplin~ insln~ts has also been prs~>osed, as exe"lpli~,ed by U.S.
Patent Nos. 4,979,954 to Gwatll.l-ey et al, 5,465,894 to Clark et al, 5,465,895 to Knodel et al, 5,465,896 to Atlen et al, 5,467,991 to Tsuruta et al, 5,480,089 to Blewen and 5,486,187 to S~lc; however, stapli,-g instruments typically include sepal-~te staple driving and staple forming or anvil pol lions for positioning on orposite sides of the tissue to be sbpled. This requires access to both sides of the tissue andin~ses the size of the instruments and the portals throu~h which the instrumentsare pACsacl in en~hs~pic procedures. Some slaplin5a instruments do not have a separate anvil portion and are thus capable of a~",ly;ng staples from one side of the tissue; however, the staples must still be fo.ll.~l of a ductile n,atelial and bentto a finsl shape by such instruments requiring relatively complex ~-.eoha--;sl,-s which i ~ the cost of such instruments. Ano~r disadvanta~c of st~pl ng instruments is that the staples have sharp, tissue p~ ~ti, ~ tips which remain in the tissue after the staples have been bent into their final shape.
Other techniques that have been proposed include elecl,ical e4a~ ion, .~l~nical dovicas such as dips and clamps, and Issers; ~)o~avor, no a.temative l~, .ique has yet been well AC ~pted by sur~eons to produce the results obtainedby suturin~ and tyin~. Thus, there is a ~reat need for suturing techniques us~ful in G.- '_.~piC sur~ery that permit s~.,geons to suture anatomical tissue in a time efficient, consistent and pr~is~ .naaner.

W O 97~2S27 PCTnUS97~2979 SUMMARY OF THE INvFl~lTloN
Aecordingly, it is a primary ob~ct of the ~ Yl invention to over~",e the above-~,~nlion~l disadvanta,aes of the prior art and to provide an ap,var~t.Js and " ,eU ,oJ
for applyin~ a suture sprin~ device in or in relation to anatomieal tissue.
Another ob~ct of the pr~nl invention is to use an applicator to position a suture sprin~ device in or in relation to around ~lo--lieal tissue in an ~Iq6tically d~fo",~
expanded state and to allow the suture sprin~ device to move toward a relaxed eo,~t~a~t~ state to cG-n~,,ess a~p,oAi",ate o~e fasten or control other eonditions of the ~ t~-~ical tissue.
A further object of the pr~s~. It invention is to apply a plurality of suture spring devices to analo,-lical tissue using a suture sprin~ deviee applicator without havin~
to remove the applicator from the body for reloadin~.
Some of the adva-ha~s of the pres~nt inve.ltion over the prior art are that ~oc~J-Jres such as suturin~ dtil~ and fastenin~ of a..dtu.-licsl tissue can be p~ F.n.l~cl in less time with fewer instruments and with ~reater consiste. .c~ that the suture sprin~ device applicator permits suture sprin~ devices to be applied from one side of the a.~tcl.lical tissue without the need of having to ~sition or r~sitioo instrurnents on an opposite side of the tissue that the suture sprin~ device appliGnter can apply suture spring devices made of bicabsG-bable and non-bioabso.L.dl)le materials that the suture sprin~ device applicator can be ~-lartecl for use in a~.Jos~pic and non cn-Joscopic pr~ceclures snd that a plurality of suture springdevices can be carried by the suture sprin~ device ~r plic~'or to permit suture spring devices to be appJied at multiple bcatiùns within ~e body without the need of having to withdraw the ~ppliG~'er from the body for reloading.
The pr~3e. ~t invention is ~3G. ,c~ally cl)ar~cteri~ed in an applicator for applying a suture sprin~ device in reldtion to anatûmical tissue including a slur~ye portion confi~ured to hold at least one suture spring dsvice in a s~l,s~3.nt;ally rela~e~l cG-It~auleJ state a guide ~i5pose-J distally of the sloraye portion and including a hollow tubular body configured to ,e,cei~fe therein a suture spring device in an W O g7132~27 PCTnUS97~2979 elqstic~'ly d~f~ ded state for positionin~ in or in relation to ~nstomical tissue, and a pusher movable in relation to the guide to control the ,~s-tion of a suture spring device relative to the guide. An e~ndar is preferably ~14posed between the st~ra~e portion and the guide to el-~tically e~and the suture sprin~device as it is moved distally from the ~t~ a po lion to the ~uide. The e~ander can be fomled separately or inte~rally with the ~uide and can be a tubular e~te. ~sion of the ~uide or a solid surface with a ~roove extendin~ from the stora~e portion to communicate with an openin~ in the guide. For example, the e~.~ander could define a conical sur~ace of i- ~~eas;n~ diameter in a distal dire~lion with the groove defining a h~lical path around the conical surFac~ between the ~toraye po, t;GI I and the guide so that a suture spring device advanced alon~ the groove will be axially andlor radially ex~dnded. The pusher is p~efer~l,ly movable in relalion to the guide to~ ~e a suture spring device and can be made to lock in a retracted position behind the suture spring device so that as the guide is moved ~JIw(illldlly relative to the suture spring device, the device will be advanced distally or loaded into the guide.
The pusher is prdfe~ly biased to move distally so that, when the pusher is unlocked, it will continue to en~a~e the suture sprin~ device as the guide is moved distally to be posilioned in or in r~lalion to anato.YIical tissue. The pusher holds the suture spring device sul~tantially slatia~-~ as the guide is moved ~ uAilllally relative to the tissue or removed, thereby albwing the suture spring device to move from the ela~:i~'ly ~l~f~.ne-J, e~nd~ state toward the relaxed, c~-ltract~J state in or in relation to the tissue in order to apply a prddete. ,.lined c~...pressi~e force U .ereto. In one embodiment, the pusher int~lucles a tubular body with inwardly biased fingers at a distal end for engagin~ the suture spring device. In an~lther ei-lbodi...e,lt, the pusher includes a flexible rod or finger slidingly movable throu~h the hollow, tubular body of the guide.
Yet ,.--oU.er aspect of the pre~enl invention is ~onerally cl~aracteri~ed in an applicator fw apply;n~ a suture device in or in relation to al ldtGmical tissue including a slora~a pG- tiun configured to hold at least one suture device, a guide clisposed s W O 97n2s27 PCTnUS97J0297g distally of the slora~a portion and ineludin~ a hollow, tubular body of coiled eonfi~uration with a ~rl~Ai~lal openin~ to reo~ivc a suture device ll-e,rain, and a pushe~r movable in relation to the guide to eontrol the po~ition of the suture device in relation to the ~uide. The pusher ean be made to loek in a ret~;ta~l positionbehind 8 suture deviee so that, if the guide is retraeted, the suture deviee will be advaneed distally or loaded into the ~uide. The pusher is pr~,feratJly biased to move distally so that, when it is unlocl(ed, the pusher will eontinue to e, ~ G the suture deviee as the ~uide is moved .'is'-'ly to be po~itio.~-J in or in relalion to anatonlieal tissue. The pusher will hold the suture deviee s~ s'~-utially sl~liona, y so that, when the ~uide is removed, the suture deviee will remain in or in ~elalion to the anato,.lieal tissue and be allc~wed to move from the ~anded state toward the ~ontra~ed state.A furU~er aspeet of the presenl invention is ~e,.erally chara~e.i~ad in an applieator for a~,ply;n~ a suture sprin~ deviee in or in relation to anaton~ieal tissue ineludin~ a housing, an outer tubular ,~e"lber havin~ a proAi,l,al end mounted by the housin~ and terminatin~ distally at a distal end, an inner ~el~ber movably d;s~osecl in the outer tubular l..e..~r and ineludin~ a slora~e ~.lion eonfi~ured to hold at least one suture sprin~ device in a svhst~ntially r~ ecl cont-~d state and a ~uide ~; ,pos6J distally of the 8tw~e portion to recciv~ a suture sprin~ device in an el~ically delomNd, e~J state, a pusher movably ~ os~J in the outer tubular ",e7,ober to en~aye a suture spring device so that the poEitio" of the suture spring device relative to the inner ",e,.~ber can be cont~lled, and a drive .,.ecl)a..i;,.~
coupled with the inner .-~-~6er to move the inner ~-~l~r relative to the outer tubular me..lber when ope~te~J. The applicator can also include a locb,n~ ")ecl~anism selectively o. .ya~eable with the pusher to lock the pusher in a r~t~a~led positiv. .
where a distal end ~f the pusher e"ga~es a suture spring device in the ~lorage portion of the applicator so that, when the inner ",e"~ber is moved pru)~i" ,ally relative to the pusher, the suture spring device will be advanced distally into the guide. The inner ~~ ber can be rotale-l as it is retl~oted, for e,.a,npl~s using splines fo, ."ed on a drive shafl of the drive ",~hanlsr". If provided with splines, the drive shaft is wo g7132S27 rcrluss7/02s7s rotated as it is advanced to facilitate positioning of the guide and suture spring device .~ ,osed therein in or in reldti~n to anatomical tissue. The pusher is unlocked or rel3f ss~ when the inner ~"6"~er is moved distally and is prefera~lybiased distally to hold the suture sprin~ device s~ nlially station.l, ~ in relation to the anatomical Ussue as the ~uide is retracted or moved ,c.,o,o."all~ so that the suture sprin~ device will move from the elastically Wormed, e~unded state toward the relaxed, contracted state to apply a pleJetell~li,led c~""~ss.ve force to the tissue.
Still another aspect of the pr~-ent invention is ~e"erYIlly ~I,ara~l6ri~ed in a method of applyin~ a suture sprin~ device in relation to anat~"lical tissue including the stsps of storin~ the suture spring device in a s~ s~ tially rela~ad, conlracte~l state, elaslioally deforrning the suture spring device from the re'~Yed, cont~a.~ted stats to an e'~ ic-~"y Wormed, e~nded stats, loadin~ the suture sprin~ device into a guide in the elastically Wom~ed, ~and~J state, positionin~ ths suture spring device ,elati~ to anatornical tissue in the elastically deformsd, eA~anJeJ state using the guide, and re",o~/;.~ the guide to allow the suture spring devioe to move resiliently from the elastically d~fol~l~ed, a~anJed state toward the r~'~Y.~l, c~ntra~,1eJ state to apply a pr~dete.",ineJ co""~ressive force to the tissue. The loading step can, for example, include holding the suture spring device in a s~ s~ ~-nially s~aliGna~ ~silion and moving the guide relative to the suture spring devics, in which case the guids can be rotated andlor moved proximally relative to the suture sprin~ device. Simibrly, the guide can be removed from the suture spring device by holding the suture spring device s~ lPntially slationd"r and moving the guids relativs to the suhne sprin~ dsvice, for example by roldti,.~ and/or moving the guide p~u~"~aJly relative to ths suture spring device. In both cases, the suture spring device can be held in a s~ s~anlially slalivnafy posilio,- by positioning a pusher behind the suturs spring devics and either IGckin~ the pusher in place or biasi, ~a the pusher ~ tr'ly relstive to the guide.
Other objects and adv~n~3s of the p~3enl invention will become app~renl from the following des~iptiûn of the pref2~red er.l~di."ents taken in conjunction with the WO 97132S27 PCTlUS97tO2Y79 ac~""~n~ drawin~s, wherein like parts in each of the sever~l flgures are identified by the same reference numerals.

BRIEF ~ESCRIPTION OF TI~F DRAWINGS
Fi~. 1 is a broken side view, partly in se~tiG~I, of a suture spring device awlicator acoordin~ to ths present inv~. Ition.
Fi~. 2 is an exploded side view, partly in sectior., of an inner m6~ r for the suture spring device applicator according to the ~,r~seot in~ntiGn.
Fi~. 3 is a front view, in elevation, of the inner ~--e.-lber of Fig. 2.
Fi~. 4 is a side view, in broken lon~itudinal elevation, of a pusher for the suture sprin~ device applicator according to the present invention.
Fi~. 5 is a front view, in elevation, of the pusher shown in Fi~. 4 Fi~. 6 is an enlar~ed pc.specti~e view of a pusher locl~in~ ,..eehan;sn~ for thesuture sprin~ device applicator accordin~ to the p(G5ent invention.
Fi~s. 7 and 8 are side views, in broken lon~itudinal elevation, illustl ati, .~ Ioadin~
of a suture sprin~ device into the ~uide of an applicator according to the pr~se. ,~
invention.
Fi~. 9 is an enlar~eJ tf~")enta- ~ side view, partly in section, of a suture spring device disl~oseJ within a guide.
Fi~. 10 is a ~Jy~ lta~y side view, partly in s~Aion, illuatratill~ uper~tion of the l~;ing l.~cllal,is", of Fig. 6.
Fi~s. 11 - 13 are side views, in broken longitudinal elevation, illuslratin~ use of the applicator to position a suture spring dsvice in relation to analo"lical tissue.
Fig. 14 is an eYrlc~le~ per~peu e view illuslratil.y a modification of the inner.~..~Ler and pusher accordin~ to the present invention.
Fi~. 15 is a flay -~ n~" side view, in elevation, illusl(aliny a further m~,~lealiûn of the inner ,.,e,.l~er according to the present invention.
Fi~. 16 is a ~..~nt~y side view, partly in s~tion, of the .nodified inner "~.lber of Fig. 15 showing a modified pusher for use therewith.

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WO 97132S27 PCTIUS97/029'J9 Fi~. 17 is a fr~.n~y p~AiYe view of the pro,.i".al end of the ~uide shown in Figs. 15 and 16.
Fi~. 18 is a broken side view, in elevation, of a tissue p~netr~tin~ instrument for use with the spplicator according to the p(esenl inve.-lion.
Figs. 19 and 20 are enlarged ha~...enta,y po~s~_ti-/e views of l--~ified tissue penet,dtin~ tips for the instrument shown in Fi~. 18.
Fi~. 21 is a ha~ ~y side view in elevation of a tissue grasping instrument for use with the a~ ator accordin~ to the ~,rese, It invention.
Fi~. 22 is a broken side vicw, partly in se~ion, illus~atin~ a modified ap pli~tor according to the pr~sent invention.
Fig. 23 is an enlar~ed, hd~...enta"~ side view, partly in section, of the distal end of the applicator shc~wn in Fi~. 22.

DESCRIPTION OF THE PREFERRED EMBODIMENTS
The applicator of the ~t,so~t invention is desc~ ibed h~reiadner as an apparal.ls for apply;. na suture sprin~ devices of coiled configuration such as those desc iL,ed in my afore"~e~nio~d co pendin~ U.S. Patent ~p~ ion Serial No. 08/610,951, e.~tiUed ~Suture Sprin~ Device~; it will be appreci~'eJ, however, that the ~ppli~tor can be used to 8pply a wide variety of suture devices, including sutur~ devices of coiled and non-coiled configuration which are e'~sticrlly or pl~~ti~11y J~on.,able or which rigidly maintain a predale..,lined shape when applied.
A suture sprin~ device awlicator 20 a rording to the p.~s~n~ invention, as shownin F4 1, includes an outer tubular ~~-enlber 22 extending distally from a housing 24, a middle tubular "Rj.nber ~ pusher 26 .~i~ed wi~in ~ outer tubular n.ember, and an elon~a~e inner n.~ ber 28 r~c~3ived within the middle tubular menlber and coupled with a drive m6.~;1 Rnism 30 in the housing.
As best seen in Fi~. 2, inner ,~ er 28 includes an elongate st~rage pGI lion 32,a fr~stocG.i-cal e~anJer 34 at the distal end of the slo~ge portion and a hollow, W O 97~2~27 PCTnUS97/02979 tubular guide 36 of coiled cor~l~uration extendin~ distally from the expander. Storage liGn 32 is shown as an elon~ate, hollow cylinder with an extemally lh~ade~
"al end 37 snd an outer diameter of pred~temlined di-l~nsion so that a pluralityof centrally apertured suture devices, for example suture sprin~ devices 38, may be iv0d U ~6r~) in an une~, relsxed or con~ aeteJ state in end-to-end series fashion as shown. For pul~osas of illu~tr~ation, each of the suture devices is shown as a centrally apertured suture sprin~ device of coiled confi~uration includin~ an elastic, wire-like body defining a series of connect6cl coils or rin~s 40 of ~enerally circular confi~uration, the rings bsing of like diall~ter and extendin~ een ,u-oxi,.~al and distal ends of the elastic body concent- ic with a longitudinal axis of the device. A knob or handle 42 in the form of a ball is ean ied on an outer peri~l .eral, convex ed~e or surface of the body of the suture sprin~ device near the proxi",al end and exl~s radially or laterally outward relative to the longitudinal axis of the device.
The body of the suture spring device is formed of an elastic or resilient material, that is, a ~-~al6rial able to recover its G-i~inal shape or position after having been defo,..-e~. Any medically S~cceptA~ le b.aa~-L,dble or non~io~hsG,bable elastic material can be used for the body of the device including, but not limited to, titanium, nicl~l ti'rnium alloys, stainless steel and plqstics such as nylon. Further details of suturc spring device 38 are set forth in my above-r~fer~nced c~pending U.S. Patent Application Serial No. 08/610,951 and several embodiments of suit~hle suture spring devices are dis~losed therein.
FnJstoconical expander 34 dQr" ,es an annular step or shoulder 44 at the distal end of st~rase po, lion 32 and a sl ~l,slPnlially conical surface 46 ex~eudi, ~y from the shoulder to ~uide 36. A groove 48 in the conical surface def,nes a helical path around the e~"Jer extending from shoulder 44 at the distal end of the alorage portion to ~uide 36. As best seen in Figs. 2 and 3, the hollow, cylind~ical ~lora~e portion and frustoconical ~r coo~ate to define a central pessa.~e or ~ ,an.)el 50 along a iongitudinal axis of the inner "~"lber to permit l~s~e of surgical instruments, andto"lical tissue and various types of fluids ll-eretl"uugh.

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W O 97/32527 PCTnUSg7~29n Guide 36 inçll~es a tubular body 50 of coiled configuration defining a series ofc~ ,. ~ted rin6~s or coils 52 of ~nerally circular configuration brminatin~ at a sharp, tissue pen~ til ~~ tip 54 at the distal end of the ~uide. Rings 52 of the ~uide have a predetermined radius of curvature and a predetermined axial ~. ~ r~between which are ~reater than the diameter and axial spa~n~ behNeen rings 40 of the suture spring device in the un~nd~l, ~ ad state. Rings 52 of the guide are also hollow to define a lumen therethrough in communication with groove 48 in the e~ar,cJer. A slot 56 ~ J alon~ an outer ~oriph~r~l, convex ed~e of the guide body communicates between an outer surface of the guide and the lumen and is of sufficient ske to n~ive and hold the body of a suture spring device while preferably being V-sl ~ped in transverse cross section and some~at narrower in width than the diameter of the suture sprin~ device body to allow knob 42 of the suture spring device to slide along the slot while preventin~ the body of the device from slipping U ~r~hluugh. The guide can be made of any suitable medically ~c~pt~ble Illalel ial, such as stainless steel, so long as it is cor~lgured to have a sliffuess suitable for maintaining the suture sprin~ device in an elastically ~fo,l-,ed, eA~,andecl stab.
The helical path de~ned by groove 48 sround the eA~ ar,cler commlJ"i~ates with the open p.u,~i..~l end of ~uide 36 to f~oilit~te loading of a suture spring device into the guide. Rec~lse the e~a,.Jer is frl,s~?nically shap~d, the dia-"ater of the helical path ir,cre~es in the dire~io" of the guide so that a suture spring device advanced along the ~roove will be receivcd by the guide in an elaslically defo,l"ed, radially e~nded state. Alten~t;,~ely, or in addition to i"~asing the dia,neter of the helical path about the e~ ander, the axial spaci"~, of the helical path may be gradually increaseJ in the distal direction so that the suture spring device will be axially expa"J.,d as it is advanced along tne ~roove into the guide.
Referrin~ a~ain to Fi~. 1, housing 24 includes lon~itudinally s~l front and rearwaîls 58 and 60 of rounded configuration, a top wall 62 in configuration parallel to a longi'tudinal axis of the outer tubular n~er, and a bottom wall 64 having a concave W O 97~2S27 PCTnUS97~297g portion 66 curvin~ d~ from the front wall to con,~e~l with a handle 68 or ented 0~ slnntially per~,er dicular to the lor~itudinal axis of the outer tubular " ~" l~er.
Out~r tubular ~-,e-,l~er 22 is open at both ends and extends from an openi ,~ inthe housin~ front wall 58 to terminate distally at a blunt distal end 70. It will be app-~ated, however, that distal end 70 of outer tubular ...e.,~ar 22 can be t~pered or chamfered as desired or have any other suitable distal cor~ uration dep4. ~a, ll upon the ~Jwe to be ~ f~rn.e~. Preferably, the outer tubular ",e.,lber is made of a s~l,sl~-ltially cylinJ~ical len~th of a sl~ ntially ri~id r"aterial such as a medically ~c~pt~ble plastic or metal ~-,aterial. The outer tubular me,.lber and housin~ can be of inte~ral on~-picce construction ~s shown or can be fon"ed s~bly and joined lo~eU,ar by any suitable l.-eU.od includin~ but not limited to U ,. ~Jed en~a~--~nl, ~JI ~sive bonding or friction fit.
Pusher 26 includes a tubular body 72 telescopically ntted within the outer tubular ..,o~nber 22. The tubular body of the pusher terminates PI~A;IIIaIIY at a transverse flan~e 74 ~i ~os~ within housing 24 b~t~ oen front and rear walls 58 and 60 of the housin~; and, as best seen in Figs. 4 and 5, a distal end of tubular body 72 is split lon~itudinally to form a plurality of fin~ers or flaps 76 which are ..o-.,-ally biased radially inward as shown to enSta~e the ~A.,--al end of a suture sprin~ device as will be des~ iL~J in ~reater detail below. Fingers 76 are generally b~apeLoidal in shape with taper~ sides 78 and a flat distal end 80. When biased lo~etl ~er as shown in Fig. 4, distal ends of the fingers coope d~e to defne a generdll)/ circular abutment surface of ~,redete.,.-ined clia-neter havin~ a dil--ensio.. to abut knob 42 of a suture spring device while ,ec~ coils 40 of an adjacent"~o,u,.~lly SpA~ suture spring device therein. A post 82 ~ l6nJs upwardly from flange 74 of the pusher through a slot 84 f~n.led in the top wall of housin~ 24 parallel to the longitudinal axis of the instrument and brminates at a knob or handle 86 ~ os~ e,~te" ,ally of the housing.
Pusher 26 can be fon,-ed of any medically Ac~4~t~ 1e metal or plastic material having sufficient elastic ~-,e.--o~y to bias the fi")~ars into the normally closed configuration as shown. A bias ,~"lber 88 is held in co""~ressio-- beh~een nange W 097~2S27 PCTnUS97~2979 74 of tho pusher and an inner wall 90 of the housin~ to bias the pusher distallyt~d an ~1 pOSitiOI~ where post 82 of the pusher abuts the disbl end of slot 84 in the housin~ and didal end 80 of the pusher is disposed adjacent the distal end o~ outor tubular ,~ml~r ~. Bias ...~")l~er 88 is shown as a helical coil sprin~ but can include various other types of sp.i"~s as well as other types of bias J~vices ~ includin~ co,~"~s~ien spr;"~s bnsion spri"~s, torsion sprin~s pan s~ri-~s leaf sp. in~s rubber, plastic or ",~. ~ls for example.
Drive ..~n:~-, 30 includes a drive shaft 92 oa~led with a tri~er 94 via a rack 96 snd pinon 98. Drive shaft 92 includes a distsl p~ lion 100 with spli. ,es 102 and a ~ i"~l portion 104 carryin~ the rack. Distal pol liGn 100 is inte" .ally th, e~cJ6.J at 106 to couple with the ~.nal end 37 of inner ~ Ler 28 and is of ~- oater di.-,-~ter than slor~ge pGI liGn 32 to define an snnular step or shoulder 108 at the pr~xi.nal end of the slu~e portion. A rotator 110 with an inten ~ally U-reacle.l pAS,S.i3j)e 1 t2 U ~ ~U u~u~h is mounted at the distal end of a tubular support ..,e,-lber 1 t 4 ~;5pos~1 within pusher 26 and secured to inner wall 90 to U .,~I~ ,ec~i~e the splined, distal pGlliGIl of driv~ shaft 92. ~r~Ai"~al portion 104 of the drive shaft is of smaller diameter than distal portion 1 00 so that a radial step or shoulder 116 is f~ ."~J at the int~iu n U .e~, and the rack 96 is disposed L.e~osn the shoulder and a flange 118 ~n~Ai~dlly sp5"~i.1 from thc shouldcr and Gl iented transverse or pe~endicular to a lon~itudinal aAis of the drive shaft.
Rack 96 is ~ene, ~ lly U-sl ape~l in transverse cross-secliG, ~ with axially spac~
teeth 126 def~ alon~ a bottom su~cs of the rack and a slot extending downward, lookin4 at Fi~. 1, from an upper surface of the rack. The rack fits under the drive shaft between shoulder 116 and flange 118 with clearance to permit ir..lependenlotational movelT~nt of the drive shaft within the slot which is at the same timesufflciently narrow to assure that upstandin~ legs of the rack on opposite sides of the shaft will abut the shoulder and flan~e to permit a~dal movo~-.ent to be ka,~sn.itled between the rack and the shaft.

wo s~r~ls~7 PCT/US9'7/02979 Trigger 94 is ph~ohlly mounted on a pin 120 secured to a wall or walls of the housing and is generally trian~ular in shape with a cut-out or openin~ 122 f~,..eJ
therethrough to ac~chln~ate one or more fin~ers of the user if desir~. Looking at Fi~. 1, pinion 98 is ~is~o~ co- ~cer,b ic with pin t 20 at the upper end of trig~er 94.
The pinion is generally circular with a plurality of circumferentially s~oacl teeth 124 and a ~Jian.~tar to cause the teeth to mesh with teeth 126 of the rack. A torsion spring 128 is ~I sl~o~d around pin 120 and con~cted between pinion 98 and housing 24 to bias the tri~ger in a doc~urise direclion, lookin~ at Fi~. 1. A sprin~-lo=~ud button 130 is carried at a lower, pro~i...al end of the tri~er and is radially aligned with a circular openin~ 132 in the handle 68 to lock the tri~ger within the handle in a manually releasable manner when the tti~er is dQpr~ss~d or moved counter-cloc~wise lookin~ at Fi~. 1.
As best seen in Fi~. 6 a locking n,ecl,anis--, 134 for locl~in~ pusher 26 in a retracted position and releasin~ the pusher to be moved distally by the bias ..-en~ber 88 upon depression of tri~ger 94 indudes a latch or locl~in~ spring 136 made of a strip of resilient material formed to have a s~ ~b~"~n:i,lly flat base 138 secured to the botborn wall 64 of the housin~ and a bend 140 joining the distal end of the base with an upwardiy an~led arm 142 s~l from the base. Arm 142 carries or forms a latch 144 havin~ a disbl an~led latchin~ sur~ace 146 joining a p,o,~ al latchin~ surface 148 ~ osqd snb~l~ntially lran~erse to the lon~itudinal axis of the instrument and s~ tially parallel to the pusher flan~e 74. Arm 142 has an extension 150 positio.~J p,~J,u~ally of latch 148 and a releasin~ r-~e~ er 152 pivotally mounted on a pin 154 secured to an upper surface of the er~tdllSiOn. R~ in~ n,e,.ll~er 152 extends frorn pivot pin 154 in a prox;.-~l direction to be disposed between teeth 124 of pinion 98. A torsion spring (not shown) is coiled around pin 154 and fixed toreleasin~ ~.e,-~ber 152 to bias the releasing r.n5"~ber cloclcwise, l~ .ing at Fi~. 6 sud~ that the reieasing .ne..lber is biased toward extension 150.
Referring again to Fig. 2, a plural~ty of suture spring devices 38 are received and loaded onto st~na~e portion 32 of the inner i"e"~ber. A cylindrical abutment r"enll~er W 0 97~2S27 P~n~97~979 156 is baded onto s~3,ae portion 32 behind ffle last of the suture sprin~ devices 38.
Member 156 is oentrally apertured so that it can slide along sll ra~a po-liG-) 132. A
~n~r~ssiQn spring 158 is coiled around storaye portion 32 and is held in c~."xess~n bet~ sen abutment ",ernl,er 156 and the annular step or shoulder 108 defined by the drive shaft at the pro,.in-al end of the stora~e ~lio-- when the ~ exter"ally tl"ea~J ~o<i.nal p~lion 37 of the inner .ne"lber is lhreaJ~ into the tl "e~J~J disbl p~ tiOI~ 106 of drive shaft 92. It will be appl ec~ l that spring 158 biases the abutment m~ l,er 156 and, thus, suture spring dGvio~s 38 distaHy until a distalmost suture sprin~ device abuts the shoulder 44 f~.m~l by the frl~stoconical ~r 34 at ~e distal end of ~lora~a portion 32. Drive shafl 92 J~f,nes a central ~q~ or ~)arb ,el 159 alon~ a lon~itudinal axis of the shaft which is communicated with central cl.annel ~0 of inner ,..enlber 28 when the con,~"ents are coupled, thereby establishin~ a continuous central ~,an,.al through the length of the a~>lic- '~r for I~A5SP~ of additional instruments, tissue and/or fluids. The central .~;1.6--r,el is communicated with a tubular ..~ml~r 160 having a distal end 162 telescopically re~ i.~ the drive shaft within housing 24 and a ~ruxi".al end 164~s,~ed externally of the housing to define a valve 166, such as a stop cock valve, and a coupling 168, for ~ ple a Luer finin~ 5pos~1 ~;ùJci, l~ally of the valve.
As best soQn in Fbs. 1 and 9, an electrical conn~1or 169 is mounted on the top wall 62 of the housing and co.~"e~ted via wires 171 ~nth electrically conductive~.~n~ of the applicatorfor pe~""in~ ebctrosurgical ~,~Jures such as unipolar or bipolar elect~ical cQa~u~ion, for example usin~ guide 36 as a conductive ebment It ~nll be app~iated, h~wever, that the position of electrical connector 169 c,,~s t~ handle 68 is merely G,~c~."~la"~ of the many various loc~ions at which an el~ ical connector can be positio,~. Also, inner surfaces of any of the tubular i"e.nb~r~, such as inner, middle and outer tubular "~"l~ers 2~, 26 and 22, can be electrically insulated to permit ~ ~c~e of electrosur~ical instruments ll ,ereU~rough as a b~ r *rB

W 0 97132S27 rCTnUS97/02979 In use, applicator 20 is p-~fo~ly supplied in the rest conditio-. shown in ~ig. 1 with tri~er 94 pro~udin~ distally from handle 68 in an unlocked p~ sition. Pinion 98 at the end of tri~er 94 en~a~es a distal end of rack 96 which is biased pr~xi..,ally toward a rG~a~eJ ,~sition by the clock~ ota~iGr~l bias of the to~5-0n sprin~
actin~ on the pinhn. Rack 96 en~d~s flan~e 118 to bias drive shaft 92 and inner ,n~..~bar 28 to a retracted ~osition where guide 36 is disposed within outer tubular n~"~L,er 22 to pr~t~l the sharp tip of the guide. Pusher 26 is unlocked in the rest condition and biased distally toward an extended position where knob 86 abuts a distal end of slot 84 and fir~ets 76 at the distal end of the pusher en~a~e the ~uide.
Flan~e 74 at the p~ximal end of the pusher is ~-~t~lly spAce~l from latch 144 oflocking ~-~J ~nism 134 when the pusher is in the G~lu~ded position. As n-e.ltioned preYiously, suture sprin~ Je~ s 38 are held on the storaç,~e po.lion of inner .ne "ber 28 in an u-.c~--~d, relaxed state. Cc,--.~r~s6i~n sprin~ 158 pushes abutment member 156 forward in a distal direction into abuttin~ relation the ~,ro.<i..~almost suture spring device which, in tum, is pushed d;sl~lly into the next suture sprin~
device until the distalmost suture spring device abuts shoulder 44 at the distal end of storage po. lion 32.
A suture sprin~ d~vice 38 is loaded into ~uide 36 by l~in~ pusher 26 in a retracted position where fingers 76 ~ s~a knob 42 of the suture sprin~ device and retractin~ inner n-e--lber 28 ~fo.~i...ally relative to the suture spring device while maintainin~ the pusher in the locked ~ o sition. Refen i. .~ to Fi~. 7, inner .~ L er 28 is moved to an e~t~fi.bd ,~sition by dep~ssin~ tri~ger 94 into handle 68 to cause pinion 98 to rotate co~"~cl~Nise about pin 120, loch:n~ at ~is. 7, U.ereb~ forcing rack 96 to move in a distaî direction. Rack 96 pushes against shoulder 116 of the drive shaft, for~ the drive shaft to move distally throu~h block 110 which rotates the shaft in a clockwise direction looking distally. Inner "~."~r 28 is also moved distally to an e~t~. .J6J po5ilio-) where ~uide 36 is ~ cl distally of outcr tubular , ber 22. When tri~er 94 is completely Jepresse~ as shown, button 130 in the tri~er will be ali~ned with opening 132 in the handle and will thus be able to spring *rB

WO 97t32S27 PCr/US97102979 outwardly of the trig~er into the opening to lock the trig~er in the depr~.ssed condition. Pusher 26 is then retracted to en~a~ a suture spring device 38 by pullin~
handle 86 raarwardly or in a ~ ~l direction against the distal bias of bias ...e.,lber 88 to force flan8e 74 a~ainst arm 146 of the lochi..~ ~-.eCI.3nian.. Arm 146 is pushed downwardly by nan~e 74 as handle 86 is drawn back, allowin~ the flange to slide ~ over latch 144. When flange 74 is d;~owd p~)~ ~lly of the latch, arm 142 will spring upwardly pOsnionin~ ~ro)~imal latchir~ surface 148 in front of the flange.
Wnen handle 86 is released, bias ..~n~bar 88 will bias flan~e 74 distally into cont~t with the pro)~i...al latchin~ surface which prevents the flan~e from moving further distally. As the handb is drawn back, fingers 76 at the distal end of the pusher slide along the periphe-y of inr~r ~--anlber 28 and over the suture spring device 38 until they are l,ositioned i.-,--~di~tely behind knob 42 of the distalmosl suture spring device. Since fi"~ers 76 are biased radially inward, distal ends of the r,. .~ers will abut the knob and prevent the knob from movinQ p. ~"ci.nally past the finyGrs.
Referring now to Fig. 8, pusher 26 is maintained in a locked position with fingers 76 enga~ing knob 42 at the ~..~l end of suture spring device 38, and button 130 is ~rass~ to perrnit trig~er g4 to be moved in a clockv~isa directio.. about pin 120 under the influence of torsion spring 128. ~ l~ise moven,6, It of the tri~ger ~nses pinion 98 to move in a clocl~Nise direction thereby forcing rack 96 to move p~i--,ally toward the .~t~acl~d, ~sition. r, o~i"~al movement of rack 96 c~ ~ses drive shan 92 to move pr~"~in,ally throu~h blo~ 110 which rotates the shaft in a colJn~erclG~nN~se directlon lookin~ distally. Inner ~ er 28 ~acls with drive shaft 92 and is rotaled in the same direction. Suture spring device 38 is ~,~v~uted from moving ~,-o-(i-..ally by pusher 26 and will thus be ~~ceivoiJ in and e~a,~d along the groove 48 in ther and be loaded or fed into guide 36 as shown in Fig. 9. In the loaded position shc~wn, suture spring device 38 is held in an eln~ti~lly defo,..~ed, e3~ancJed state within guide 36, and knob 42 at the p~i,..al end of the suture spring device is aligned with and made to slide alon~ slot 56 in the guide.

WO 97/32S27 PCTAUS97~2979 With suture sprin~ device 38 loaded within ~uide 36 as shown in Fi~s. 8 and 9 applicator 20 can be used to suture and/or li~ate ~natomicsl tissue within the body as described in my afo.~.,-,ntion6J co~n-Ji..~ U.S. Patent Arplic~tion Serial No.
08Jff10,951 entitled ~Suture Sprin~ Device~. For p~J",oses of illustration suturing of layered tissue structures T, and T2 will be Je~ il~l it being u"Jerstoocl thst the applicator can be used in a similar fashion to suture other types of tissue and/or to li~ate tissue within the body usin~ a suture sprin~ device.
Ref~., ing still to Fi~. 8 distal end 70 of outer tubular ...e..l~er 22 is positioned adjacent the tissue to be u~d while tri~er 94 is dopr~sad. As shown in Fi~. 11 depression of tri~er 94 into handle 68 ~ ~s~s pinion 98 to rotate in a countef~ wise direction about pin 120. Rack 96 is moved distally by count~rolocl~4isa rolation of the pinion causin~ drive shafl 92 to be moved distally throu~h block 110 and rotated in a clockwise direction lookiny ~ t~ly alon~ the lon~itudinal axis of the applicator. Co~.nler~ vise rot~tion of pinion 98 also ~ ses teeth 124 of the pinion to press dow-~ ~.dly against rcla-~ing mem~er 152 at the pf~,.i-"al end of Gxtension 150 as shown in Fi~. 1û causing arm 142 of the locking "~1~ -;~.. to be moved downwardly toward base 138. Down~rd movement of arm 142 cP~ ~ses latch 144 to move away from nange 74 of pusher 26 allowing the pusher to be moved in the distal direction under the influence of bias ",e,nber 88.
hner ,-~-lber 28 moves distally and is rotated with drive shaft 92 causing sharp tip 54 of the guide to penetrate into the pro~in~al tissue structure T,. As inner ~-.e"~ber 28 is moved further distally and lotaled, ~uide 36 will penet,ate through analo",ical stnJc~res T, s~nd T2 like a o~lhscr~w thereby ~st-~lishing a helical path through the structures as shown in Fi~. 11. Pusher 26 is biased distally under the influence of bias ~--e..ll~r 88 and will thus maintain co-ltact with knob 42 at the pro~i...al end of WO g7132S27 ~ ,7102g7g suture sprin~ device 3B to assure retention of the device within the guide as itpenetrates into the tissue.
Peneb~tion is oompleb when tri~er 94 is fully Je,~eJ within I ~a. ~Jle 68 and button 130 is en~a~ed within openin9 132 of the handle. Guide 36 holds suture sprino device 38 in the elastically Juf~)eJ, expanded state for positioning in or in relation to the ~nat~ r.lical tissue and is removed from the suture sprin~ device by pressin~ button 132 into openin~ 130 to allow the tri~er to be moved in the clockwise dir~t;on under the force of torsion spring 128 as shown in Fig. 12. Astri~er 94 moves dockwise about pin 120, rack 96 is moved proximally once more, causing drive shaft 9Q to be moved p~Ai~l~ally through rotator block 110 and f~tatecl in a countercloc~wise direction lookin~ disblly alon~ the longitudinal axis of the appliG-~'or. rr~Ai-,-al movement of suture spring device 38 is prevented by ~,~. ~t of fin~e. ~ 76 with the knob 42 at the pr~il"al end of the suture springdevice. Guide 36 is thus ulltl-r.-~ or r~...oJed from suture sprin~ device 38 with knob 42 sliding along slot 56 in the guide to permit the guide to move pr~"ci,--ally rebtive to the suture spring device. As the ~uide is removed, rings 40 of the suture sprin~ device move from the el~ llc~ y ~fo- "~ed, GApan~d condition toward theirori~inal relaxed, c~lt~ J condition. When guide 36 is removed e"tir~ly from suture spring device 38, as shown in Fi~. 13, rin~s 40 of the suture spring device will en~a~e tissue structures T, and ~ d;~osed between the coils and exert a predeterrnined axially COIll~aS5 JC force to app(oxi,nale the tissue structures. ît will be apprec ~ted that suture spring devices 38 remainin~ in applicator 20 are biased distally by con~essien sprin~ 28 and are thus r~sitioned for loading and use in the ",J~nu J~ il~J above without the need of havin~ to remove the appli~ ~r from the body for reloadin~.
While the npplTc~tor accordin~ to the pr~se.~t invontion has been desc~ibeJ as applyin~ a particular suture sprin~ device, it will be appr~ that the arplic~r cz~n be adapted to apply a vanety of dmerent types of suture sprin~ devices. In Fi~.
14, for exalr~le, a modified ~uide 36' and pusher 26' are shown for applyin~ one or more suture sprin~ devices 38 similar to the suture sprin~ davic6s previously J~ iL~J but wi~out knobs. Each suture spring devioe 38 incluclss an elastic bodyof coiled confi~uration definin~ a plurality of rin~s or coils 40 extending between plw.Y~al and distal ends 39 and 41 of the device. F~ --al and distal ends 39 and41 are bent at an an~le relative to the coils and extend in axially o~ost-J dire-lions alon~ a longitudinal axis of the device. Tubular ~uide 36 is similar to the ~uide previously d~s~il~ but does not include a slot. A pruA---~I end 44 of the ~uide is bent at an angle relative to rin~s or coils 52 of the ~uide to extend alon~ abn~itudinal axis of the ~uide and to be axially ali~ned with the disbl end 41 of the suture spring device 38 . Rin~s 52 of the ~uide are of in~easin~ diameter in a distal direction so that the ~uide will function to elaslically deform the suture sprin~ device as it is loaded into the ~uide tl-er~y obviatin~ the need for a separat3 e~nder.Pusher 26 ir~' ~~~s an elastic rod or fin~er 76 extendin~ distally from a peripl~e.dl edge of tubular body 72~ in axial ali~- ~..-e. ~t with pr~ximal end 39~ of suture sprin~
device 38'. The hr~r 76' has a cor~l~uration to fit co ~ro.--~ably within and to move or slide along the ~uide. In use, finger 76' of pusher 26' is ali~ned with and made to abut l~r~Ai,.-al end 39' of suture sprin~ device 38' in order to move the suture sprin~ device in the distal di-~i~ relative to ~uide 36'. ff more than one suture sprirlg device 38~ is ~ os~J within the appli~tor, the suture sprin~ devices can be IO ~d~d in end-to-end series fashion as indicated in Fi~. 14 by the p- usel .ce of the second suture sprin~ device which can be ;-~S6- ted ~tw~n the distalmost suture sprin~ device and the pusher. The distalmost suture spring device is loaded into the ~uide in the ~).anner des~ i~d above, for example by usin~ the pusher to hold the suture sprin~ device in place while the ~uide is relr~teJ. As the suture spring device is lo~led, finger 76' will enter the P~A;~al end 44' of the guide and be elastically deformed within the guide in order to maintain co,~tact with the proAi...al end 39' of the suture spring device. A~ the suture sprin~ device 38' is advanceddistally throu~h ~uide 36', it will be elastically d~for,.,ed by the coils of the guide and will be held in the elastically Ju~o. ---ed, e~and~J sbte as the ~uide is positie, .~1 in -or in relation to anatomical tissue. Once the ~uide i8 positionel, the suture sprin~
device is held in a sub~blly ~lat~y position in relation to anatomical tissue bythe fin~r d the pusher while the guide is remoYed by slidin~ along the fin~er of the pusher in a pr~)~i."al direc~n.
Ano~er modification of the applicator according to the ~nt invention, shown in Figs. 15 -17, in~ s~ an inner me.n~r 28~ havin~ a hollow stora~e ~GI tion 32~of cylindrical confi~uration, a hollow, tubular ~uide 36~ of coiled configuration with a ~r~mal pGIliGn 171~ extendin~ into the intc.ior of the stora~e portion and a pusher 26~ similar to that shown in Fi~. 14, havin~ a hollow, tubular body 72 ly r~ceiYod within ~tDra~e portion 32~ and an elastic rod or fin~er 76~
extending distally from a peripl .6~al ed~e of the tubular body to be axially ali~ned with an open P~J~;"~I end 173~ of the ~uide. As best seen in Fi~. 17, ,~roxi",alon 171~ inolu~s a first tubular extension 175~ extendin~ radially inward from ahrst bend 177~ in the proximalmost coil to a se~,d bend 179~ conn~ti..~ the first tubular extension wtth a seco(~ tubular extension 181 n ~isF!osed alon~ the interior of slora~e pG,lion 32~ in axial ali~an",ent with fin~er 76~. The second tubular ex~ension terminates proximally at open prOAimal end 173~. Stora~e pG.Iion 32n is received tc'es~opically within the lon~itudinal ~ s~e Je~,ne.l by rin~s 52~ of the ~uide and can be connecbd thereto in any suitable ,--a. .. er includin~, but not limited to, ~Jhe5;VG bondin~ and friction fit. An openin~ 183~ is f~""~l in an outer po.ipl.aral, convex surface of the ~uide ~ cenl bend 51 u and is confi~ured to ive the distal end 41 u of a suture sprin~ devioe, for example suture sprin~ device 38n, carried on an outer surface of the cylindrical ~to~a pGI tion. A plurality of ~re sprin~ davic~s 38U are shown, each bein~ similar to suture sprin~ device 38 but without knobs or handles. The suture sprin~ JEvioas are preferably biased distally relative to the ~uide so that, when the ~uide is r~tated relative to the distalmost suture sprin~ device as de~ iL~J above, the device will be loaded into the ~uide. Pusher 26~ is movable throu~h the tubular body of the guide to control movement of the suture sprin~ device relative to the ~uide once the device is within W O 97~2S27 PCT~USg7~2g7g the ~uide; and, it will be appreaated that the fin~er of the pusher can be used to nt udbsequent suture ~prin~ devices 38~ frorn bein~ loaded into the guide by blocking opening 183~ when advanced distally beyond the opening to push the suture sprin~ device already loaded within the guide. However, under cortain circun)sl~nc~s it may be desi,~le to have more than one suture spring device disposed within a ~uide, in which case o Ih~l ~ently loaded suture sprin~ devioes will be disposed between the pusher and the distalmost suture sprin~ device, forexample in the additional rin~s 52~ at the p~,-i-,~l end of the guide, and the additional devices can be used to push the distalmost device in relation to the ~uide.
Fi~s. 18 and 19 show a pen~tin~ instrument 174 which can be asse.~.bled as part d the applicator 20 or inse, l~l throu~h the central ~;1 ,an"al of the applicator by the user durin~ an o~,eralive ~ce.Jure. The instrument 174 inc'udes an elon~ate,tubulsr body 176 havin~ an outer diamebr of predetermined dil..ensio" to fit within the oentral ~ ~1 of the applicator and a len~th to protrude distally beyond the tip 54 of the ~uide when fully inserted. Body 176 <Jef~nes a lumen 187 which e).ler,d,.
from a con~r~ntiG"al couplin~ 180, such as a Luer fittin~ at a proxi",al end of the body to a sharp tissue pen~trdtin~ tip 182 at a distal end of the body. A valve 184 for example a stop~srll; valve is ~J;sroseJ near the couplin~ at the proxi" al end o~
the body and communicated wffl the lumen to control p~~~a of instruments, fluidsandlor tissue throu~h the lumen. An electrical conneclor 186 protrudes ,endicularly from the body of the ,oe"~alin~ instrument throu~h an ele.b ically insulative layer 188 which is fGIllled about the p4ri~1,e,~ of the body and made to e~end all or substantially all of the len~th of the instrument to fA~.il '~te use of the tip of the instrument for electrosur~ical procedures. It will be a~re~ated that instrument 174 can also be used to pe~bate and ~issecl anatomical tissue to pc.for", i,.i~aati.~ and aspiratin~ fu-l~tions and to administer medica",en~s to the Gpordli~e site.
A modification of the penJ~tin~ instrument is shown in Fig. 20 wherein the modified penetrating instrument 174' inç~des an alon~ate solid body 176' W O 97~2S27 ~ 97~2979 terminatin~ at a sharp, ti~ue ~- le~t;nU tip 182' which can, for example, be used to pene~ate and dissect anatomical tissue as well as for electrosur~ical ~r~Jures.
Another instrument usable with the applicator 20 accordin~ to the pr~ t invention, as shown in Fi~ 21, ir~ ules an elon~ate body 192 terminatin~ distally in a pair of arms 1~4. Each arm o~n~nd~ distally from the body to a bend 196 connectin~ the aml with a tissue en~a~in~ tip or pincer 198 ~ ;GnteJ substantially perpendicular or transverse to the arm. A~ms 194 are an~ularly -spsc~d from one another in ~PI ~3~J relation and are normally biased apart as shown with a ~ap or spac;nU between the arms in~er sin~ in a distal di(eution. Tips 198 extend toward one a~U ~ from the arms in op~,osed relation and can have any confi~uration useful for graspin~ tissue and medical devices. The grasping inslrument 190 is p,~erably formed of an elastic l-~t,_.ial so that arms 194 and tips 196 can be straiJhten6J to pass thru ~e central d ~ I of the applicator, for example by advan~ng a tubular e (not shown) distally relativ~ to the arms and ;. ~. tin~ th~ sleeve throu~h lhe nth the arrns ~;sp~ therein. Wnen the distal end of the sleeve protrudes beyond the ~uide, the sleeve is r~a~teJ to allow arms 194 to spreacl apart as ~wn. Arms 194 can be drawn tG~U ,er to ~rasp a-,alG"lical tissue and/or devices disposed be~en the arms by advancin~ a sleeve distally relative to the arms and/or by movin~ ffle instrument pr~,,u,,-ally relative to the ~uide. The graspin~ instmment can be f~.~d with more than two arms, for example to ~rab weakened po. lior,s ofa~tomical tissue. Body 192 of ffie tissue ~raspin~ instrument 190 can be of hollow, c~ylindrical conf~uration as shown or have any other solid or hollow configuration as desired. H hollaw, the body of the instrument can be used to allow pAssa~e of tissue or fluids 11 ~U ~h or to acoor""~hle other instruments, such as the ~ ali, ~~
instruments d~ d above.
Another "~ f;~tion of the applicator accordin~ to the p,esont inven~ion, shown in Fi~. 22 at 20"', is similar to appl;~t~ 20 but is shown without a prole~ti~,e outer tubular ,-,o.l~lLer. The rnodified applicator inrludes a housing 24"', a first pusher 26a"' of tubular configuration ~xtendir~ distally from the housin~, and the elongate W 0 97m 527 rCTnUS97~2979 inner .-.e..~or 28"' ~03iYed within the first pusher and coupled with a drive mechani~m 30"' in the housin~, and a c3cond pusher 26b"' ~coivad within the inner .~.k~- and ooupled with a handle 8S"'. Inner ~-~-~r 28"' inrl~les a hollowtubular sto~e portion 32"' of c~lindrical confi~uration extendir~ between a transverse proximal nan~o 200"' dispo~od within housin~ 24"' and a ~uide 36"' ~imilar to ~uide 36~ but with fewer rin~ 52"' to acc~.h~GJate a sin~le suture sprin~
device. An outwardly probudir~ peo, post or pin 202"' extends po",o~)dicularly from a ~--~1 end of stora~e po-lion 32"' adjacent flange 200"'. Housin~ 24"~
int~ ss a pr~xi---al cylindrical portion 204"' whidl is internally U--~deJ, ~rooved or splined at 206"' to n3c~ re pin 202"' of the ;.tora~a "~e,.ll~r, and a distalcylindrical pG.ti~ 208"' of smaller diameter than the ,,r~A,---al poftien which is e~ernally tth~J~I at 210"' and which terminates dlstally at an outwardly protrudin~
transverse flan~e 212"'. Tlans~arse pr~Ai."al flange 200"' of st~ e pG-lion 32"'i8freely rotatably l~i~r~d wffllin a circular or ring-like collar 214" ', and a generally U ~h,~ handle 68"' is co..nect~,~l between the collar and a forward wall 216~ ofhousin~ p~lion 204"' to bias the inner m~7"lt~er PrOA;IIIallY relative to the housin~.
Handle 68"' aAt~nds throu~h a slot 220"' f~"~ in the bottom wall of housin~
pG.tion 204"' parallel to a longitudinal axis of the inner ...e..~ber to con.)acl with collar 214"' and is prereraLly f~r,.,eJ as an inte~ral one-piece unit from an elastic material, such as sprin~ steel, but can be made of other ,..dhrials and/or be made af separate, pivotally ~ted pieces which are biased apart. A pair of finger loops 218a"' and 218b"' of ~enerally circular corhl~uration are pr~erably provided on opposite sides of the handle to ac~..-- odat~ one or more r.. .~..r~ of the user and to permit expansive forces to be applied to the handle if required. A lock 222"' islhreaJedl~ mounted on the top of housing portion 204"' and is manually rotatablethrou~h the housin~ to be ~ posGtl ~xi.,.ally of collar 214"' when the collar is in an ~dend~d po~ition adjacent forward wall 216"'. The lock prevents prOAilllal movement of the inner ...e.-~ber, thereby holdin~ the ~uide at the distal end of the inner r...".lber in an ext~n.J~cl rcsition as will described further below.

W O 97~2527 rcTnusg7~2979 A plurality of suture spring ~wic~, for example suture s~ri- ~s gsvicas 38"', are received on ~tora~ ber 32" ' in a relaxed, u. ~and_J ~tate and are biased didally in the direction of ~uide 36"' by a sprin~ 158"' held in cc"--~ession between a ~e or shoulder 224"' on an inte, ..~liate secli~ ~ of storage ",~.lber 32" ' and an abutment ~ er 156"' slldably disposed behind the suture sprin~ 35.
Sutwe sprin~ devices 38"' are similar to suture spring ~e~;Ce5 38~ in that they do not carry a knob or handle, but differ in that they are shown with only two rin~s.
When biased didally, distal end 41 "' of the distalmost suture sprin~ device will be lon~itudinally or axially aligned with opening 183"' in the guide.
Outer, tubular pusher 26a"' e~derds from a cylin~ical hub 226"' at a pr~Ai.,~l end to a plurality of inwardly biased fin~ers 76a"' at a distal end. ~Ith pusher 26a~"
in the rJt,~ Yition shown, at least one of the fin~ers will extend throu~h the space between sutwe spring ~ioas to conla~,1 storage portion 32"' i").ne~ ely ~nt or behind the pr~,.i,..al end 39"' of the distalmost suture sprin~ device.
Cylindrical hub 226"' terminates pr~Ai".ally in an inwardly protrudin~ transverse flange 228"' which is internally th~l to couple with the extemally ll ,reaJeJ distal housin~ portion 208"'. Hub 226" ' is rotatable about housin~ ~GIlion 208" ' to move pusher 26a"' distally relative to the housing while at the same time rotat;n~ the pusher, and thus the distalmost suture sprin~ device, about a lon~itudinal axis of the housino. When pusher 26a"' is in an Gxl~nded position or cGndition, inwardly probudin~ flan~e 228"' of the hub will abut out~lvardly protrudin~ flan~e 212"' of the housin~ to prevent further distal movement of the pusher. The threaded length ofhousin~ pG. tion 208"' and of hub ~6"' can be varied to obtain a desired position for the distal end of the pusher in the extended r ~ition. For example, the distal end of the pusher can be made to protrude distally beyond the ~uide when ~,.ler ~d if it is desirable to protect the tip of the guide, for example when passio~ the appli~ t.or throu~h an ou~Joscopic sleeve or portal with inte".al c6..ponen~s that can be dur~a~d by the sharp tip of the ~uide. A sprir~ 230"' can be held in o~",pression behNeen flan~es 212"' and 228"' if desired to bias the hub ~Jro,~i-.-dlly relative to the W O 971~2~7 PCTnUSg7~2979 housin~ in order to reduce play in the hub and to p~VG.~t the hub from bein~
inad~e. t~ltly rotated.
The second, inner pusher 26b" ' incl~ ~des a hollow, tubular body 72" ' extendin~
1~n a ~o~ -al nange 74b"' disposed in housin~ ~ti~ 204"' to a flexible rod or fin~er 76b"' mounted on a ~ l ~- al ed~e at the distal end of the tubular body in axial ali~ t with the open pro;~(i--~l end 173"' of ~uide 36"'. P~Ai---al flan~e74b"' is ~i~d within a hollow rin~ or collar 232"' which is c~n--ected to one le~
of an elastic, U-sh~reJ handle 86" ' similar to handle 68" '. Handle 86" ' eAtends upwardly, lookin~ at Fb. ~, from collar 232~ through a slot 234"~ in the upper wall of the housin~ and tums downwardly to conne ~ with housin~ po tion 204"' to biastt e collar, and thus the pusher, pluAill~ally relative to the housin~ toward a retr~ct~i position where a distal end of fin~er 76b"' is 81i~hUy prOAimally sp~eed from PrOA;~al end 173"' of ~uide 36"'. The handle includes a lockinu ~"e,.~ber 236"' which extends longitudinally behleen legs of the handle and ~sss throu~h an opening 238"' in the pr~ in~al leg. The locl;in~ ".~filber is biased upwardly, lookin~ at Fig.
22, and has teeth 240"' on an upper surface ll .er_~ that en~a~a an upper ed~e of the openin~ 238"' to lock the handle in any position and stab of con)pr~ssion orexpansion. A handle extension 242"' extends down~rdly, looking at Fi~. 2 2, fro m collar 232"' through a slot 2 4 4 " ' in the bottom wall of the housing to brminate at a semi4ircular finger loop 2 4 6 "' havin~ a conc~ve portion axially aligned with and facin~ finger loops 218a"' and 218b"' of handle 68"'.
It will be app~e~iated that since st~a~e portion 32"' and pusher 2 6 b " ' d;s p o s ecl therein are hollow, a central ~,annal is def~n~ through the ~pplic~'or, for example to be communicated with a tubular ..-e.,lL,er 160"' having a distal end 1 6 2 " ' di~osad in the hollow, tubular body of pusher 26b"' and a pn~i."al end 1 6 4 " '~;s~sed ext~n.ally of the housing to mount with a coupling 168"', such as a Luerfittin~.
To load a suture sprin~ devioe 38"' into ~uide 36"', the suture sprin~ device is advanoed distally relative to the ~uide and rotated in a clocl~vise Ji,~c~ion, looking WO 971~S~7 rcrluss7l02s7s distally, by ~raspin~ hub 226"' at the ~UAil~al end of outer pusher 26a"' and byrotatin~ the hub in the cloc~ise direction. Hub 226"' moves distally as it is rotated, causin~ pusher 26a"' and fin~ers 76a"' at the distal end of the pusher to rotate and move distally as well. As Ille-~tiGned above, in the retracted position, at least one fin~er 76a"' is ~;~posed adjacent to or behind proAi.l,al end 39"' of the distalmost ~re sprin~ device 38"' so that as ~e hub is rotated, the fin~er adjacent the sutwe sprin~ device will bear a~ainst ~e proAimal end of the device to advance the device distally toward ~uide 36"' while at the same time n,tatin~ the device. As suturespring device 38"' is advanced, distal end 41 "' of the device will l~co...e ali~ned with opening 183"' in the ~uide and will pass throu~h the openin~ into the interior of the ~uide as shown in Fig. 23. Finger 76a"' will continue to push suture sprin~
device 38"' into the ~uide until preAi~lR3l snd 39"' of the device ~ssas throu~hopenin~ 183"', after which the outer pusher will no lon~er en~a~a the device.
Guide 36"' can then be positioned in or in relation to anatomical tissue or, if the suture sprir~ device 38"' is proximally sp~ceJ from the distal end of the guide, the suture spring device can be advanced futher distally within the ~uide to be ~I sposed aJjac~nl the distal end.
To position guide 36"' in or in relation to anat~.."ical tissue, distal tip 54" ' of the ~uide is moved to a po~;tion adjacent the anato-,lical tissue and handle 68"' s~îee~sd or cG~Ilp~essecî to move collar 214"', and thus flange 200"' of the inner ...~albar, distally relative to housing 24"', thereby drivin~ pin 202"' on the inner .,~,~er along ll.reads or ~rooves 206"' f~.l.~1 in the housin~ to rotate and move the inner ..~..~ar distally relative to the tissue. Guide 36"' is mounted at the distal end of inner ,.~..~er 28"' and is thus rnoved with the inner ~--e,-~bsr to be ~ ~ sitioned in or in l~le~ion to the anatomical tissue with the suture spring devics d:sposed therein in an elastically deformed, expanded state as des~ il~d above. If the suture spring device is ~Ai..,ally ~J from the distal end of the guide, inner ",ember 28"' can be locked in place relative to the anat~-lical tissue by deploying lockin~
mo..lbar 222"' in the housing to form a pn"~ al abutment surface behind collar W O 97132S27 PCTnUSg7~g7g 214"' d the handle. hner pusher 26b"' may then be operated to move finger 76b"~
distally into open ~---al end 173"' of the guide and along rings 52 ' of the guide to ~ ~e the ~ end of the suture spring devioe and to push the device furtherdistally within the ~uide. Pusher 26b"' is advanced by sq~ or co-.,pr~ssinghandle ~6 or drawin~ handle 246" toward finger loop 21 8b of handle 68" . In either case, oollar 232 " i8 moved distally relative to the housin~ to move flange 74 ", and thus pwher 26b", distally relative to the inner ,-,em~r and the housin~.
Teeth 240"' have distal faces o, i~.~t~l s~ ~h~'qntially pe",e. Idicular to a longitudinal axis of the n~plio~tor and pro~i--,al faces disposed at an an~le relative to thebn~itudinal axis in order to permit distal movement or co"",ressio.. of handles 86 and 246 " while preventin~ p, wd,, ~I movement lhereo~. Pusher 26b can thus be held in an extended position j"ll-~ ely ~ ~ut the ~ruximal end of suture sprin~
device 38 ' by locl~i.~ ,-~--~ber 236 ".
To apply the suture spring device to the a.,dto"lical tissue guide 36" is retracted while maintaining the suture sprin~ device in a substantially stationary position in or in ralation to the anatomical tissue. Ratr~ctio-, of ~uide 36"' is a~,.plished by releasin~ lockin~ "~,ber 222"' to albw the U~l~d handle 68 to sp~in~ apart lh~ y drawing collar 214"' and inner ".ember 28" proximally while at the same time r~tati,~ the inner ",e..~ber to allow ~uide 36" to be unthreaded from the suture sprin~ device. As Jer~ iL~J previously ret.a~lion of ~uide 36" oPu~s suture sprin~ device 38 ' to no lon~er be oonstrained and allowsthe suture sprin~ device to contuJ~A from the e'~~ y deformed e~a~ l~ed state toward a r~ ed co.lt~acted state to exert a cGIllpr~ssivo foroe on the analo"lical tissue.
From the above it will be appre~ated ttlat the applicator accor~ to the present invGntio., can be used to position a sutwe sprin~ device in or in relatioo to anatomical tissue in an elastically de~d, ~nJ~ state so that the suture sprin~
device may then be allowed to move towd a relaxed cout ~t~l state to col~press approxi".~le occh~de fasten or secure the ~natomical tissue. The appli~-or W O 97~2S27 PCTnUS97~2979 p~eferably incl~ ~s a st~ portion for holdin~ at least one suture spring device in a substantially relaxed, co.~bdcted state, a ~uide dis~loseJ distally of the stora~e portion to r~3~g a suture spring device in an elastically Wormed, a~and~d state for positioning in or in relation to ~at~ ical tissue, and a pusher for enga~in~ the suture sprin~ device to perrnit relative movement between the ~uide and the suture sprin~ device. The ~uide can have a U~sue penetratin~ tip as shown, a blunt tip or the disbl end of the sutur~ device can be used as a tissue penetratin~ tip either alor~ or in combination with the distal end of the ~uide.
The ~uide can be used to, ~ ~'ion any type of suture device in or in relation toanatomical Ussue by cr~ali. ,~ a path in or in relation to the tissue which the suture ctevice will c~ ~y when the ~uide is removed. Hence, in aJ~I~fiu- ~ to apptyin~ suture devices havin~ an elastic body of coiled confi~uration, where by ~elastic~ is meant havin~ an ability to recover an ori~inal shape or ~ ~ition after havin~ been d~, ~-~d and by ~coiled~ is meant definin~ a sin~le ooil or rin~, a po. lion of a coil or rin~ or a series of connecled 00il8 or rings, the - ppli~e'or can be used to apply rigid suture clevices havin~ substantially the same shape and size as the guide, len~U.s of hl~-~t~y suture material as well as suture dG~ices ~-~J of shape mel~lG~ alloys,such as nitinol, soft materials which can be l.u~ ~Je. ~~ by application of energy once applied, or ductile materials, where by ~ductile~ is meant having a le~ n3enc~r, once bent, to remain in the bent condition. The guide can also be used like a probe to p~bate and dissect anatomical Uswe and to wpply energy to tissue or devices as re~uired; and, w,hen the guide is used as a probe, instruments such as the graspin~
instrument shown in Fig. 21 can be used to brin~ the tissue or device to the probe.
The ~uide can be made of any suitable medically ~cco~t~le material, such as stainless steeJ, so bn~ as it is configured to have a stifh .~ss suitable for maintaining a suture sprin~ device in an e~KleJ state for positionin~ in or in f~latioo to anatomical tissue. The ~uide preferably inc~s a tubular body of coiled configuration as shown but can also be of straight or angular configuration as desired. Ulhen the ~uide of the applicator is of coiled configuration, the coils can be WO g7132527 PCr/US97/02g79 circular, elliptical, poly~nal or have any othor curved or angular confi~uration and, when a ~uide has more than one coil, adjacent coils can be of bhe same size and shape or Ji~renl ske and shape dependin~ on the type of ~r~lure to be ~f~..~. The tubular body of bhe guide can have any confi~uration in ba..s~erse cross-section indudin~, but not limited to, circular, elliptical, pol~onal and open confi~urations. A150, ~e shape of bhe lumen in trL.~./~se cross wction can be dillerent than the *lape of ~e outer surface of the ~uide in b~s~erse cross Se~tiQn so that, for example, the outer surface may be circular and the inner surface poly~onal or vice versa. Dependin~ upon the ~-~. ~ner in which the ~uture device is moved relative to the ~uide, the ~uide can be fo, ~--ed with or without a slot. When k..nei with a slot, the slot will preferably extend from a pro;~i...al end of the guide to a distal end of the guide and will communicate between an exterior surface of the guide and an interior lumen. The slot can have ta~r~J or V-s~a"eJ sides to a~----~Jab a ball-shaped knob as shown, or the size of the slot can be strai~ht.Furth~-.~, alU~h the slot is shaNn on the outer, convex side of the ~uide, it can be formed on the inner, concave side or anywhere inbetween or the slot can be made to spiral around the coiled body of the ~uide. The guide can be co, ¢ ic with a longitudinal axis of the inner ,~-e--lber or offset ll~r~hom.
If an elastic suture sprin~ device is to be applied, an a~a. ~ ier can be positiGn6J
between the sl~age portion and the guide to elastically e~a--J the suture sprin~device in an axial and/or radial direction as it is adva,~ distally toward the ~uide.
The a~a, .J~r can be a solid surface with a ~roove or a tubular e)~1e, ~sion of the ~uide with or without a slot.
Although the pusher i8 shown and cle~;~d herein as includin~ one or more fin~;e. a mounted on a tubular body, it will be appr~iabd that the pusher can have any configurstion to on~a~e a suture device including, but not limited to, tubular oonfigur~ions with fingers biased radially inward at a distal end of the tubular body, tubular oor~igurations with rod like hn~ers confi~ured to slide within a hollow, tubular ~uide and configurations where ~e body of the pusher is not of tubular configuration.

.
W O 97~2~27 r~-lrJ~n2g7g The pusher can be disposed alon~ an exterior or interior of the inner ~ ber or a~liGII of the pusher can be d,s~sed alon~ the exterior and anoU.ar p~.li~.
di~J alon~ the ir~br of the ir~r ..~.~ . While the pusher is shown as bein~
biased, it will be appreciated that any type of force can be used to move the ~uture sprino device relative to the ~uide includir~, but not limited to, mechanical forces provided by sp, in~s, .--a~. ~GtiC forces and/or hydraulic or pneumatic forces.
The pusher can also be made to rotate to~- -.her with or i- ,clepend-J. nly of the suture sp~in~ device ~~ desired.
The inner ,-~.-1~ and drive ~ft preferably coop4-~te to define a central ~;1 ~u~el ttuou~h the applicator throu9h which instruments, such as penetrators and ~raspers can be passed durin~ an op~ative proc~Jure. Sove~al instruments or implements which can be ~i t~ou~h such a central d ~nnal are di~ losecl in my co~ndin~ application Serial No. 081376,186, e/ltiUeJ~Multifi nctiGnal InstrumentW~h Int~le Operating Units For re.f~"lin~ Cndos~pic P,~ures,~ the ~lisclosJre of which is incG,~ora~ed herein by r~r~nce. The central c;l.annel can also be used for irri~ation and aspiration as well as for administerin~ medicame,nts and fluids to the operd~ e site.
~ he handle and drive ..~l~nism sh~rwn and des_,il~J herein are exe.,.plc,.y of the types of handles and driw ..~;I.anisms suitable for p6,fc..~lin~ ~he function of ",ovin~ the inner ",~"lber and w the suture sprin~ device relative to one another, accordin~ly, the handle and drive "~i.sm can have any configuration to produce robtional andJor linear movement of the inner .,~,.~er and/or the suture spring device, including, but not limibd to, confi~urations employin~ a pair of pivoted le~s with fin~er loops, one fixed and one pivoteJ le~ with fin~er loops, or resilient U-~ .,~I~L~r:s con,~_teJ between outer and inner ..,e",lber~ of the arplic~'~r or between the inner ~e~ er and the pusher. Moreover, the handle can have any cri~nlalion ~GIat;~e to the lon~itudinal axis of the applicator includin~, for example, o ~ ntially b ~"s~erse o, ienlations where the handle e~tend~ transYersely from a L~tIGIII of the housin~ or sul,s'~-ltially lon~itudinal Grient~tions where the handle W O 971~L5~7 P~ v~1~2979 extends bn~itudinally 1~orn a rear wall d the housin~ and is operated like a sc"ssor~, or r~tatable conf~ where the handbs can be rnoved between tr_. .s~0rse and lon~itudinal orientations as desired. While a rack and pinion has been shown formovin~ the inner ,-~-~er linearly alon~ a lon~itudinal axis of the applicator, it will be appreciated that any type of for~e can be used to move the inner ~~ er includin~, but not lirnited to, ..-eol ~anical forces pn,~ickd by rods, pulleys or sp i. ~~s, ~l~a~ ie~tic forces and/or hydraulic or pneurnatic for~s.
The ~n~ As d the applic~tor can be made of any &uibble rnedical ~rade rnaterials to permit derilization for r~use orfor sin~le patient use. The Co...po~Kat~
can be made of multiple parts of various configu.~tions and materials to reduce cost.
The housir~ can have various valves and/or seals to control fluid flow and the pas~,~o of instruments therethrough, such as the stop~k valve shown at the ~rOAillldl end of the applicator, and conventional locl~ I.~d-ani .-.s can be used to hold the tri~er within the handle in the fully de~ EJ position or at any other position relative to the handle. In addition, the outer tubular ,.~ber can be provided with scale l.~hi.~ on an exterior sufaoe to assist the user in determinin~ dislances within the body.
It will also be appreciated that . ~tali~, of the ~uide can be combined with linear on by use of suitable ç,~ea, in~, and that the guide or any other oc."ponent of the F~ppli~or can be configured to rotate in a clockwise or coLnleroloc~ isa direction when bein~ a~v~c~l distally along the longitudinal axis of the ap~,licator dependin~ upon the configuration of the ~uide or c~npol~enl. Also, the applicator housin~ can be adapted to allow re---o~al of the inner .--e-.ll.ar frorn a pr~Ai,..al end of the housin~ to permit reloading of the inner ",ehl~er without removin~ the applicator from the o~rati~re site. The applicator can also be mGdifi~d to simply rotate the ~uide without linear lran~l~tion or, conversely, to linearly translate the ~uide without lot~tiG-., both modific~tiuns requirin~ manual opor~tiG"s to be .~J in order to p~ition the suture device in or in relation to anatu"lical tissue.

Once ~e suture device is positioned in or with res~l to the tissue, the retum of the suture device taward the rest position, can be ~r~hanccd, Jependent upon the material from which thc suture device is constructed, by bmperature ~ ~a. ~~,,e and/or by the appl caUon of electricity, Ibht or o~er ener~y to alter the c;har~,~ri-~ti.,s of the material.
The features of the various embodiments described above can be combined in any "u~mer desired ~ ~t upon the G~ ati~ ~al requin...~ents of the ~ cJure to be ~rf~,n.-ed and the complexi~ of the particular desi~n.
Inasmuch as the pr~~ant invention is ~ject to many variations, mod~fications and ehan~es in detail, it is intended that all subject matter di6c:ussed above or shown in the aca~mpaorin~ drawin~s be inter~,reted as illustrative only and not be taken in a limitin~ sense.

Claims (38)

What Is Claimed Is:
1. An applicator for applying a suture spring device in or in relation to anatomical tissue, said applicator comprising a storage portion configured to hold at least one suture spring device in a substantially relaxed, contracted state;
a guide disposed distally of said storage portion and including a hollow, tubular body configured to receive therein a suture spring device in an elastically deformed, expanded state for positioning in or in relation to the anatomical tissue; and a pusher movable in relation to said guide to control the position of the suturespring device relative to said guide.
2. An applicator as recited in claim 1 and further comprising an expander disposed between said storage portion and said guide to elastically expand the suture spring device as it is moved distally from said storage portion relative to said guide.
3. An applicator as recited in claim 2 wherein said expander includes a solid surface with a groove leading from said storage portion to said guide.
4. An applicator as recited in claim 3 wherein said expander defines a conical surface of increasing diameter in a distal direction and said groove defines a helical path around said conical surface between said storage portion and said guide.
5. An applicator as recited in claim 4 wherein a distal end of said groove communicates with an opening in said guide so that a suture spring device will be loaded into said guide as the device advances distally along said groove.
6. An applicator as recited in claim 1 and further comprising bias means for biasing said pusher distally relative to said guide.
7. An applicator as recited in claim 1 wherein said pusher includes a distal portion slidingly movable through said tubular body of said guide to push a suture spring device distally therein.
8. An applicator as recited in claim 7 wherein said distal portion of said pusher includes a finger formed of a flexible material.
9. An applicator as recited in claim 1 wherein said tubular body of said guide includes a slot communicating between interior and exterior surfaces of said tubular body so that, if the suture spring device includes a knob, the knob can extend laterally through said slot when the suture spring device is disposed within said guide.
10. An applicator as recited in claim 9 wherein a distal end of said pusher includes inwardly biased fingers.
11. An applicator as recited in claim 6 and further comprising a locking mechanism engageable with said pusher to lock said pusher in a retracted position engaging a suture spring device.
12. An applicator as recited in claim 1 wherein an opening is formed in an outer, convex surface of said guide distally of said proximal end of said guide to receive a suture spring device therethrough.
13. An applicator as recited in claim 12 wherein said pusher includes a distal portion movable within said guide to block said opening when advancing a suture spring device through said guide.
14. An applicator as recited in claim 1 and further comprising a drive mechanism coupled with said guide to move said guide relative to a suture springdevice engaged by said pusher.
15. An applicator as recited in claim 14 wherein said drive mechanism is operable to move said guide linearly along a longitudinal axis of said guide.
16. An applicator as recited in claim 15 wherein said drive mechanism includes a rotator coupled with said guide to rotate said guide about said longitudinal axis as said guide is moved linearly.
17. An applicator as recited in claim 1 wherein said storage portion, said expander and said guide cooperate to define a central channel through said applicator.
18. An applicator as recited in claim 1 wherein said guide includes an elongate tubular body of coiled configuration.
19. An applicator as recited in claim 1 wherein said tubular body of said guide terminates distally at a tissue penetrating tip.
20. An applicator for applying a suture device in or in relation to anatomical tissue, said applicator comprising a storage portion configured to hold at least one suture device;
a guide disposed distally of said storage portion and including a hollow, tubular body of coiled configuration with an opening to receive therein a suture device; and a pusher movable in relation to said guide to control the position of a suture device relative to said guide.
21. An applicator as recited in claim 20 and further comprising a drive mechanism coupled with said guide to move said guide relative to the anatomical tissue.
22. An applicator for applying a suture spring device in or in relation to anatomical tissue, said applicator comprising a housing;
an outer tubular member having a proximal end mounted by said housing and terminating distally at a distal end;
an inner member movably disposed in said outer tubular member and including a storage portion configured to hold a suture spring device in a substantially relaxed, contracted state and a guide disposed distally of said storage portion to receive the suture spring device in an elastically deformed, expanded state;
a pusher movably disposed in said outer tubular member to engage the suture spring device so that the position of the suture spring device relative to said guide can be controlled; and a drive mechanism coupled with said inner member to move the inner member relative to said outer tubular member when operated.
23. An applicator as recited in claim 22 wherein said pusher includes a tubular body telescopically received within said outer tubular member and said inner member is received within said tubular body of said pusher.
24. An applicator as recited in claim 23 wherein said inner member is movable between a retracted position where a distal end of said guide is disposed proximally of the distal end of the outer tubular member and an extended position where said distal end of said guide protrudes distally from said outer member.
25. An applicator as recited in claim 24 wherein said pusher is movable distally from a retracted position where a distal end of said pusher engages a suture spring device held by said storage portion when said inner member is in said extended position.
26. An applicator as recited in claim 25 end further comprising a locking mechanism which engages said pusher in said retracted position to prevent distalmovement of said pusher so that, when said inner member is moved from said extended position to said retracted position, a suture spring device engaged by said pusher will be loaded into said guide.
27. An applicator as recited in claim 26 and further comprising bias means for biasing said pusher distally relative to said outer tubular member so that said pusher will maintain engagement with a suture spring device loaded in said guide as said guide is moved from said retracted position to said extended position in or in relation to anatomical tissue, said pusher holding the suture spring device substantially stationary in relation to the anatomical tissue when said guide is moved from said extended position back to said retracted position.
28. An applicator as recited in claim 25 and further comprising a handle mounted on said pusher to permit manual movement of said pusher from said extended position to said retracted position.
29. An applicator as recited in claim 22 and further comprising an expander of frustoconical configuration disposed between said storage portion and said guide.
30. An applicator as recited in claim 29 wherein a helical groove is formed in said frustoconical expander to communicate with an opening in said guide.
31. A method of applying a suture spring device comprising the steps of storing the suture spring device in a substantially relaxed, contracted state;
elastically deforming the suture spring device from the relaxed, contracted state to an elastically deformed, expanded state;
holding the suture spring device in the elastically deformed, expanded state within a guide;
positioning the suture spring device in relation to anatomical tissue in the elastically deformed, expanded state using the guide; and removing the guide to allow the suture spring device to move resiliently from the elastically deformed, expanded state toward the relaxed, contracted state to apply a predetermined compressive force to the anatomical tissue.
32. A method of applying a suture spring device as recited in claim 31 wherein said step of holding the suture spring device includes holding the suture spring device substantially stationary and moving the guide relative to the suture spring device to load the device into the guide.
33. A method of applying a suture spring device as recited in claim 32 wherein said step of moving the guide includes moving the guide in a proximal direction relative to the suture spring device.
34. A method of applying a suture spring device as recited in claim 33 wherein said step of moving the guide further includes rotating the guide relative to the suture spring device.
35. A method of applying a suture spring device as recited in claim 31 wherein said step of removing the guide includes holding the suture spring device substantially stationary and moving the guide relative to the suture spring device.
36. A method of applying a suture spring device as recited in claim 35 wherein said step of moving the guide relative to the suture spring device includes moving the guide in a proximal direction relative to the suture spring device.
37. A method of applying a suture spring device as recited in claim 36 wherein said step of moving the guide further includes rotating the guide relative to the suture spring device.
38. A method of applying a suture spring device as recited in claim 37 wherein said step of holding the suture spring device stationary includes positioning a pusher behind the suture spring device to resist movement of the device.
CA002248090A 1996-03-05 1997-03-05 Suture spring device applicator Abandoned CA2248090A1 (en)

Applications Claiming Priority (2)

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US08/610,735 US5782844A (en) 1996-03-05 1996-03-05 Suture spring device applicator
US610,735 1996-03-05

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US (1) US5782844A (en)
EP (1) EP0955903A1 (en)
AU (1) AU2137697A (en)
CA (1) CA2248090A1 (en)
WO (1) WO1997032527A1 (en)

Families Citing this family (427)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0955933B1 (en) 1995-10-13 2009-08-26 Medtronic Vascular, Inc. A device for interstitial transvascular intervention
WO1997027898A1 (en) 1996-02-02 1997-08-07 Transvascular, Inc. Methods and apparatus for connecting openings formed in adjacent blood vessels or other anatomical structures
US6984241B2 (en) * 1996-09-13 2006-01-10 Tendon Technology, Ltd. Apparatus and methods for tendon or ligament repair
US7611521B2 (en) * 1996-09-13 2009-11-03 Tendon Technology, Ltd. Apparatus and methods for tendon or ligament repair
ES2267152T3 (en) * 1996-09-20 2007-03-01 United States Surgical Corporation HELICOIDAL CLAMP APPLICATOR.
US5766183A (en) * 1996-10-21 1998-06-16 Lasersurge, Inc. Vascular hole closure
US6071292A (en) * 1997-06-28 2000-06-06 Transvascular, Inc. Transluminal methods and devices for closing, forming attachments to, and/or forming anastomotic junctions in, luminal anatomical structures
US5944750A (en) * 1997-06-30 1999-08-31 Eva Corporation Method and apparatus for the surgical repair of aneurysms
US5919199A (en) * 1998-01-14 1999-07-06 Mers Kelly; William Charles Suture device
US7491232B2 (en) 1998-09-18 2009-02-17 Aptus Endosystems, Inc. Catheter-based fastener implantation apparatus and methods with implantation force resolution
US6517566B1 (en) 1998-05-11 2003-02-11 Surgical Connections, Inc. Devices and methods for treating e.g. urinary stress incontinence
US20050021085A1 (en) * 1998-05-11 2005-01-27 Surgical Connections, Inc. Surgical stabilizer devices and methods
US6740098B2 (en) 1998-05-11 2004-05-25 Surgical Connections, Inc. Surgical stabilizer devices and methods
US6641593B1 (en) * 1998-06-03 2003-11-04 Coalescent Surgical, Inc. Tissue connector apparatus and methods
US6945980B2 (en) 1998-06-03 2005-09-20 Medtronic, Inc. Multiple loop tissue connector apparatus and methods
US6613059B2 (en) 1999-03-01 2003-09-02 Coalescent Surgical, Inc. Tissue connector apparatus and methods
US6656192B2 (en) 1998-09-25 2003-12-02 United States Surgical Corporatioin Site marker device
US6951564B2 (en) * 1998-10-23 2005-10-04 United States Surgical Corporation Site marker device
WO2000028902A1 (en) * 1998-11-18 2000-05-25 General Surgical Innovations, Inc. Helical fastener and applicator for surgical procedures
US8118822B2 (en) 1999-03-01 2012-02-21 Medtronic, Inc. Bridge clip tissue connector apparatus and methods
US6695859B1 (en) 1999-04-05 2004-02-24 Coalescent Surgical, Inc. Apparatus and methods for anastomosis
US20050222665A1 (en) * 1999-04-23 2005-10-06 Ernest Aranyi Endovascular fastener applicator
US7273497B2 (en) * 1999-05-28 2007-09-25 Anova Corp. Methods for treating a defect in the annulus fibrosis
US20070038231A1 (en) 1999-05-28 2007-02-15 Ferree Bret A Methods and apparatus for treating disc herniation and preventing the extrusion of interbody bone graft
US20060247665A1 (en) 1999-05-28 2006-11-02 Ferree Bret A Methods and apparatus for treating disc herniation and preventing the extrusion of interbody bone graft
US7998213B2 (en) 1999-08-18 2011-08-16 Intrinsic Therapeutics, Inc. Intervertebral disc herniation repair
US7220281B2 (en) * 1999-08-18 2007-05-22 Intrinsic Therapeutics, Inc. Implant for reinforcing and annulus fibrosis
US7717961B2 (en) 1999-08-18 2010-05-18 Intrinsic Therapeutics, Inc. Apparatus delivery in an intervertebral disc
US7553329B2 (en) 1999-08-18 2009-06-30 Intrinsic Therapeutics, Inc. Stabilized intervertebral disc barrier
EP1624832A4 (en) 1999-08-18 2008-12-24 Intrinsic Therapeutics Inc Devices and method for augmenting a vertebral disc nucleus
US7972337B2 (en) 2005-12-28 2011-07-05 Intrinsic Therapeutics, Inc. Devices and methods for bone anchoring
US8323341B2 (en) 2007-09-07 2012-12-04 Intrinsic Therapeutics, Inc. Impaction grafting for vertebral fusion
WO2009033100A1 (en) 2007-09-07 2009-03-12 Intrinsic Therapeutics, Inc. Bone anchoring systems
MXPA03003600A (en) 1999-08-18 2004-12-02 Intrinsic Orthopedics Inc Devices and method for nucleus pulposus augmentation and retention.
US6425919B1 (en) 1999-08-18 2002-07-30 Intrinsic Orthopedics, Inc. Devices and methods of vertebral disc augmentation
US8529583B1 (en) 1999-09-03 2013-09-10 Medtronic, Inc. Surgical clip removal apparatus
US7004970B2 (en) 1999-10-20 2006-02-28 Anulex Technologies, Inc. Methods and devices for spinal disc annulus reconstruction and repair
US7935147B2 (en) 1999-10-20 2011-05-03 Anulex Technologies, Inc. Method and apparatus for enhanced delivery of treatment device to the intervertebral disc annulus
US6592625B2 (en) * 1999-10-20 2003-07-15 Anulex Technologies, Inc. Spinal disc annulus reconstruction method and spinal disc annulus stent
US7052516B2 (en) 1999-10-20 2006-05-30 Anulex Technologies, Inc. Spinal disc annulus reconstruction method and deformable spinal disc annulus stent
US8632590B2 (en) 1999-10-20 2014-01-21 Anulex Technologies, Inc. Apparatus and methods for the treatment of the intervertebral disc
US8128698B2 (en) 1999-10-20 2012-03-06 Anulex Technologies, Inc. Method and apparatus for the treatment of the intervertebral disc annulus
US7615076B2 (en) 1999-10-20 2009-11-10 Anulex Technologies, Inc. Method and apparatus for the treatment of the intervertebral disc annulus
US7951201B2 (en) 1999-10-20 2011-05-31 Anulex Technologies, Inc. Method and apparatus for the treatment of the intervertebral disc annulus
US6926730B1 (en) 2000-10-10 2005-08-09 Medtronic, Inc. Minimally invasive valve repair procedure and apparatus
US6780197B2 (en) 2000-01-05 2004-08-24 Integrated Vascular Systems, Inc. Apparatus and methods for delivering a vascular closure device to a body lumen
US6391048B1 (en) 2000-01-05 2002-05-21 Integrated Vascular Systems, Inc. Integrated vascular device with puncture site closure component and sealant and methods of use
US6942674B2 (en) * 2000-01-05 2005-09-13 Integrated Vascular Systems, Inc. Apparatus and methods for delivering a closure device
US6197042B1 (en) 2000-01-05 2001-03-06 Medical Technology Group, Inc. Vascular sheath with puncture site closure apparatus and methods of use
US8758400B2 (en) 2000-01-05 2014-06-24 Integrated Vascular Systems, Inc. Closure system and methods of use
US6461364B1 (en) 2000-01-05 2002-10-08 Integrated Vascular Systems, Inc. Vascular sheath with bioabsorbable puncture site closure apparatus and methods of use
US7842068B2 (en) 2000-12-07 2010-11-30 Integrated Vascular Systems, Inc. Apparatus and methods for providing tactile feedback while delivering a closure device
US9579091B2 (en) 2000-01-05 2017-02-28 Integrated Vascular Systems, Inc. Closure system and methods of use
IL153753A0 (en) * 2002-12-30 2003-07-06 Neovasc Medical Ltd Varying-diameter vascular implant and balloon
US6953476B1 (en) 2000-03-27 2005-10-11 Neovasc Medical Ltd. Device and method for treating ischemic heart disease
US6551332B1 (en) 2000-03-31 2003-04-22 Coalescent Surgical, Inc. Multiple bias surgical fastener
US6805695B2 (en) 2000-04-04 2004-10-19 Spinalabs, Llc Devices and methods for annular repair of intervertebral discs
WO2002017796A1 (en) 2000-09-01 2002-03-07 Advanced Vascular Technologies, Llc Vascular bypass grafting instrument and method
AU2001288006A1 (en) 2000-09-08 2002-03-22 Thomas Anthony Device for locating a puncture hole in a liquid-carrying vessel
US6626918B1 (en) 2000-10-06 2003-09-30 Medical Technology Group Apparatus and methods for positioning a vascular sheath
EP1331887A4 (en) 2000-10-20 2006-07-12 Dvl Acquisition Sub Inc Surgical suturing instrument and method of use
US6663633B1 (en) * 2000-10-25 2003-12-16 Pierson, Iii Raymond H. Helical orthopedic fixation and reduction device, insertion system, and associated methods
US7033373B2 (en) 2000-11-03 2006-04-25 Satiety, Inc. Method and device for use in minimally invasive placement of space-occupying intragastric devices
US6719777B2 (en) 2000-12-07 2004-04-13 Integrated Vascular Systems, Inc. Closure device and methods for making and using them
US7211101B2 (en) 2000-12-07 2007-05-01 Abbott Vascular Devices Methods for manufacturing a clip and clip
US6695867B2 (en) 2002-02-21 2004-02-24 Integrated Vascular Systems, Inc. Plunger apparatus and methods for delivering a closure device
US6623510B2 (en) 2000-12-07 2003-09-23 Integrated Vascular Systems, Inc. Closure device and methods for making and using them
US7806904B2 (en) 2000-12-07 2010-10-05 Integrated Vascular Systems, Inc. Closure device
US8690910B2 (en) 2000-12-07 2014-04-08 Integrated Vascular Systems, Inc. Closure device and methods for making and using them
US7905900B2 (en) 2003-01-30 2011-03-15 Integrated Vascular Systems, Inc. Clip applier and methods of use
US20040059376A1 (en) * 2001-01-31 2004-03-25 Helmut Breuniger Device for the introduction and fashioning of skin clips
US7144413B2 (en) 2001-04-20 2006-12-05 Synthes (U.S.A.) Graft fixation system and method
US6558400B2 (en) 2001-05-30 2003-05-06 Satiety, Inc. Obesity treatment tools and methods
US7083629B2 (en) * 2001-05-30 2006-08-01 Satiety, Inc. Overtube apparatus for insertion into a body
IES20010547A2 (en) 2001-06-07 2002-12-11 Christy Cummins Surgical Staple
JP4166691B2 (en) * 2001-08-03 2008-10-15 タイコ ヘルスケア グループ エルピー Tissue marking apparatus and method
US7104949B2 (en) * 2001-08-31 2006-09-12 Ams Research Corporation Surgical articles for placing an implant about a tubular tissue structure and methods
RU2194274C1 (en) * 2001-09-18 2002-12-10 ЗАО "Нефтегазкомплектсервис" Technology of intratube ultrasonic flaw detection
CA2981561C (en) 2001-10-04 2020-08-25 Neovasc Medical Ltd. Flow reducing implant
US20030216755A1 (en) * 2001-10-22 2003-11-20 Oleg Shikhman Wound suturing device
US20030078601A1 (en) * 2001-10-22 2003-04-24 Oleg Shikhman Crimping and cutting device
US20050177180A1 (en) 2001-11-28 2005-08-11 Aptus Endosystems, Inc. Devices, systems, and methods for supporting tissue and/or structures within a hollow body organ
US9320503B2 (en) 2001-11-28 2016-04-26 Medtronic Vascular, Inc. Devices, system, and methods for guiding an operative tool into an interior body region
EP1448117B1 (en) * 2001-11-28 2013-05-22 Aptus Endosystems, Inc. Endovascular aneurysm repair system
US8231639B2 (en) * 2001-11-28 2012-07-31 Aptus Endosystems, Inc. Systems and methods for attaching a prosthesis within a body lumen or hollow organ
US20070073389A1 (en) 2001-11-28 2007-03-29 Aptus Endosystems, Inc. Endovascular aneurysm devices, systems, and methods
US20090099650A1 (en) * 2001-11-28 2009-04-16 Lee Bolduc Devices, systems, and methods for endovascular staple and/or prosthesis delivery and implantation
US10098640B2 (en) 2001-12-04 2018-10-16 Atricure, Inc. Left atrial appendage devices and methods
WO2003088815A2 (en) * 2002-04-17 2003-10-30 Tyco Healthcare Group, Lp Tacking tool and tack
AU2003231752A1 (en) 2002-04-22 2003-11-03 Tyco Healthcare Group, Lp Tack and tack applier
JP4508866B2 (en) 2002-06-04 2010-07-21 アボット ヴァスキュラー デヴァイシス Vascular closure clip and delivery device
US7125413B2 (en) * 2002-06-20 2006-10-24 Scimed Life Systems, Inc. Endoscopic fundoplication devices and methods for treatment of gastroesophageal reflux disease
US20120145765A1 (en) 2002-06-25 2012-06-14 Peterson James A Mechanical method and apparatus for bilateral tissue fastening
US6746460B2 (en) 2002-08-07 2004-06-08 Satiety, Inc. Intra-gastric fastening devices
US20060106449A1 (en) * 2002-08-08 2006-05-18 Neovasc Medical Ltd. Flow reducing implant
AU2003219503A1 (en) * 2002-08-08 2004-02-25 Neovasc Medical Ltd. Geometric flow regulator
US7214233B2 (en) 2002-08-30 2007-05-08 Satiety, Inc. Methods and devices for maintaining a space occupying device in a relatively fixed location within a stomach
US7033384B2 (en) 2002-08-30 2006-04-25 Satiety, Inc. Stented anchoring of gastric space-occupying devices
JP4660714B2 (en) * 2002-09-06 2011-03-30 シー・アール・バード・インク Endoscopic tissue acquisition system
US8066724B2 (en) 2002-09-12 2011-11-29 Medtronic, Inc. Anastomosis apparatus and methods
US8105345B2 (en) 2002-10-04 2012-01-31 Medtronic, Inc. Anastomosis apparatus and methods
CA2500785C (en) * 2002-10-04 2011-04-26 Philip C. Roy Pneumatic powered surgical stapling device
US7229428B2 (en) * 2002-10-23 2007-06-12 Satiety, Inc. Method and device for use in endoscopic organ procedures
US7220237B2 (en) 2002-10-23 2007-05-22 Satiety, Inc. Method and device for use in endoscopic organ procedures
US7108710B2 (en) 2002-11-26 2006-09-19 Abbott Laboratories Multi-element biased suture clip
US8398656B2 (en) 2003-01-30 2013-03-19 Integrated Vascular Systems, Inc. Clip applier and methods of use
US8905937B2 (en) 2009-02-26 2014-12-09 Integrated Vascular Systems, Inc. Methods and apparatus for locating a surface of a body lumen
US8202293B2 (en) 2003-01-30 2012-06-19 Integrated Vascular Systems, Inc. Clip applier and methods of use
US7857828B2 (en) 2003-01-30 2010-12-28 Integrated Vascular Systems, Inc. Clip applier and methods of use
US8821534B2 (en) 2010-12-06 2014-09-02 Integrated Vascular Systems, Inc. Clip applier having improved hemostasis and methods of use
US8758398B2 (en) 2006-09-08 2014-06-24 Integrated Vascular Systems, Inc. Apparatus and method for delivering a closure element
ES2616695T3 (en) 2003-03-11 2017-06-14 Covidien Lp Staple application device with inclined jaw
WO2004091377A2 (en) * 2003-03-28 2004-10-28 Downey Earl C Surgical instrument with trigger control
US7753912B2 (en) * 2003-03-31 2010-07-13 Spine Wave, Inc. Tissue distraction device
US7175638B2 (en) 2003-04-16 2007-02-13 Satiety, Inc. Method and devices for modifying the function of a body organ
US7670362B2 (en) 2003-06-13 2010-03-02 Tyco Healthcare Group Lp Multiple member interconnect for surgical instrument and absorbable screw fastener
US8926637B2 (en) * 2003-06-13 2015-01-06 Covidien Lp Multiple member interconnect for surgical instrument and absorbable screw fastener
DK1638485T3 (en) 2003-06-20 2011-05-02 Intrinsic Therapeutics Inc Device for delivery of an implant through an annular defect in an intervertebral disc
US7182769B2 (en) 2003-07-25 2007-02-27 Medtronic, Inc. Sealing clip, delivery systems, and methods
US20050043749A1 (en) 2003-08-22 2005-02-24 Coalescent Surgical, Inc. Eversion apparatus and methods
US8394114B2 (en) 2003-09-26 2013-03-12 Medtronic, Inc. Surgical connection apparatus and methods
US7914543B2 (en) 2003-10-14 2011-03-29 Satiety, Inc. Single fold device for tissue fixation
US7097650B2 (en) * 2003-10-14 2006-08-29 Satiety, Inc. System for tissue approximation and fixation
US7879047B2 (en) * 2003-12-10 2011-02-01 Medtronic, Inc. Surgical connection apparatus and methods
US20050177176A1 (en) 2004-02-05 2005-08-11 Craig Gerbi Single-fold system for tissue approximation and fixation
US8828025B2 (en) 2004-02-13 2014-09-09 Ethicon Endo-Surgery, Inc. Methods and devices for reducing hollow organ volume
US8882786B2 (en) * 2004-02-17 2014-11-11 Lawrence Livermore National Security, Llc. System for closure of a physical anomaly
MXPA06009971A (en) 2004-02-27 2007-08-08 Satiety Inc Methods and devices for reducing hollow organ volume.
US9028511B2 (en) 2004-03-09 2015-05-12 Ethicon Endo-Surgery, Inc. Devices and methods for placement of partitions within a hollow body organ
US8628547B2 (en) 2004-03-09 2014-01-14 Ethicon Endo-Surgery, Inc. Devices and methods for placement of partitions within a hollow body organ
US8449560B2 (en) 2004-03-09 2013-05-28 Satiety, Inc. Devices and methods for placement of partitions within a hollow body organ
US8252009B2 (en) 2004-03-09 2012-08-28 Ethicon Endo-Surgery, Inc. Devices and methods for placement of partitions within a hollow body organ
AU2005231323B2 (en) 2004-03-26 2011-03-31 Ethicon Endo-Surgery, Inc Systems and methods for treating obesity
US10478179B2 (en) 2004-04-27 2019-11-19 Covidien Lp Absorbable fastener for hernia mesh fixation
US20050251178A1 (en) * 2004-05-03 2005-11-10 Tirabassi Michael V Hooked rod delivery system for use in minimally invasive surgery
IES20040368A2 (en) 2004-05-25 2005-11-30 James E Coleman Surgical stapler
US7645285B2 (en) * 2004-05-26 2010-01-12 Idx Medical, Ltd Apparatus and methods for occluding a hollow anatomical structure
US20050288664A1 (en) * 2004-06-21 2005-12-29 Curon Medical, Inc. Systems and methods for treating tissue regions of the body
US9138228B2 (en) 2004-08-11 2015-09-22 Emory University Vascular conduit device and system for implanting
EP1799120B1 (en) 2004-09-23 2017-11-01 Covidien LP Clip applying apparatus and ligation clip
WO2006042110A2 (en) 2004-10-08 2006-04-20 Tyco Healthcare Group, Lp Apparatus for applying surgical clips
ES2388673T3 (en) 2004-10-08 2012-10-17 Tyco Healthcare Group Lp An endoscopic clip or surgical clip applier
US9763668B2 (en) 2004-10-08 2017-09-19 Covidien Lp Endoscopic surgical clip applier
US8409222B2 (en) 2004-10-08 2013-04-02 Covidien Lp Endoscopic surgical clip applier
US7819886B2 (en) 2004-10-08 2010-10-26 Tyco Healthcare Group Lp Endoscopic surgical clip applier
US8876820B2 (en) 2004-10-20 2014-11-04 Atricure, Inc. Surgical clamp
US20060106288A1 (en) 2004-11-17 2006-05-18 Roth Alex T Remote tissue retraction device
CH697177A5 (en) * 2004-12-17 2008-06-25 Zuercher Hochschule Winterthur Helix needle.
US8608797B2 (en) 2005-03-17 2013-12-17 Valtech Cardio Ltd. Mitral valve treatment techniques
US8906039B2 (en) * 2005-03-21 2014-12-09 Design Standards Corporation Suturing device
WO2006115689A1 (en) 2005-04-22 2006-11-02 Rex Medical, L.P. Closure device for left atrial appendage
US8926633B2 (en) 2005-06-24 2015-01-06 Abbott Laboratories Apparatus and method for delivering a closure element
WO2007000754A2 (en) * 2005-06-27 2007-01-04 Roei Medical Technologies Ltd Rotational/linear motion coverter for medical device
US8313497B2 (en) 2005-07-01 2012-11-20 Abbott Laboratories Clip applier and methods of use
US8951285B2 (en) 2005-07-05 2015-02-10 Mitralign, Inc. Tissue anchor, anchoring system and methods of using the same
JP2009501570A (en) * 2005-07-14 2009-01-22 アイディエックス・メディカル・エルティーディー Apparatus and method for occluding a hollow anatomical structure
US8100939B2 (en) 2005-07-15 2012-01-24 Incisive Surgical, Inc. Mechanical method and apparatus for sequential tissue fastening
CN100431500C (en) * 2005-07-26 2008-11-12 张祖仁 Surgical suture device
CN1330277C (en) * 2005-07-26 2007-08-08 张祖仁 Surgical stitch device
US9456811B2 (en) 2005-08-24 2016-10-04 Abbott Vascular Inc. Vascular closure methods and apparatuses
US20070060895A1 (en) 2005-08-24 2007-03-15 Sibbitt Wilmer L Jr Vascular closure methods and apparatuses
US8920442B2 (en) 2005-08-24 2014-12-30 Abbott Vascular Inc. Vascular opening edge eversion methods and apparatuses
CN101466316B (en) 2005-10-20 2012-06-27 阿普特斯内系统公司 Devices systems and methods for prosthesis delivery and implantation including the use of a fastener tool
US8080004B2 (en) * 2005-10-26 2011-12-20 Earl Downey Laparoscopic surgical instrument
USD625009S1 (en) 2006-03-24 2010-10-05 Tyco Healthcare Group Lp Surgical clip applier
USD629101S1 (en) 2006-03-24 2010-12-14 Tyco Healthcare Group Lp Surgical clip applier
US8808310B2 (en) 2006-04-20 2014-08-19 Integrated Vascular Systems, Inc. Resettable clip applier and reset tools
WO2010062971A1 (en) 2008-11-26 2010-06-03 Anova Corporation Methods and apparatus for anulus repair
US9232938B2 (en) 2006-06-13 2016-01-12 Anova Corp. Method and apparatus for closing fissures in the annulus fibrosus
US8834496B2 (en) 2006-06-13 2014-09-16 Bret A. Ferree Soft tissue repair methods and apparatus
US8764835B2 (en) 2006-06-13 2014-07-01 Bret A. Ferree Intervertebral disc treatment methods and apparatus
USD611144S1 (en) 2006-06-28 2010-03-02 Abbott Laboratories Apparatus for delivering a closure element
US8556930B2 (en) 2006-06-28 2013-10-15 Abbott Laboratories Vessel closure device
EP2314232B1 (en) 2006-10-17 2015-03-25 Covidien LP Apparatus for applying surgical clips
US11259924B2 (en) 2006-12-05 2022-03-01 Valtech Cardio Ltd. Implantation of repair devices in the heart
US9883943B2 (en) 2006-12-05 2018-02-06 Valtech Cardio, Ltd. Implantation of repair devices in the heart
CN100463659C (en) * 2006-12-06 2009-02-25 梁振星 Surgical anastomat
US8372121B2 (en) 2007-02-08 2013-02-12 Warsaw Orthopedic, Inc. Adjustable coupling systems for spinal stabilization members
US20080208214A1 (en) * 2007-02-26 2008-08-28 Olympus Medical Systems Corp. Applicator and tissue fastening method through natural orifice
US11660190B2 (en) 2007-03-13 2023-05-30 Edwards Lifesciences Corporation Tissue anchors, systems and methods, and devices
CN101641051B (en) 2007-03-26 2011-11-23 Tyco医疗健康集团 Endoscopic surgical clip applier
US20080243141A1 (en) 2007-04-02 2008-10-02 Salvatore Privitera Surgical instrument with separate tool head and method of use
JP5318086B2 (en) * 2007-04-06 2013-10-16 インターベンショナル セラピーズ Suture, crimping and cutting device
EP2671519B1 (en) 2007-04-11 2014-12-17 Covidien LP Surgical clip applier
US7846123B2 (en) * 2007-04-24 2010-12-07 Emory University Conduit device and system for implanting a conduit device in a tissue wall
US8220689B2 (en) * 2007-05-02 2012-07-17 Endogene Pty Ltd Device and method for delivering shape-memory staples
US8226681B2 (en) 2007-06-25 2012-07-24 Abbott Laboratories Methods, devices, and apparatus for managing access through tissue
US8235983B2 (en) * 2007-07-12 2012-08-07 Asthmatx, Inc. Systems and methods for delivering energy to passageways in a patient
US20110106113A1 (en) * 2007-07-13 2011-05-05 The Brigham And Women's Hospital, Inc. System and method for hernia mesh fixation
US8893947B2 (en) 2007-12-17 2014-11-25 Abbott Laboratories Clip applier and methods of use
US20090157101A1 (en) 2007-12-17 2009-06-18 Abbott Laboratories Tissue closure system and methods of use
US7841502B2 (en) 2007-12-18 2010-11-30 Abbott Laboratories Modular clip applier
US8177836B2 (en) 2008-03-10 2012-05-15 Medtronic, Inc. Apparatus and methods for minimally invasive valve repair
US8382829B1 (en) 2008-03-10 2013-02-26 Mitralign, Inc. Method to reduce mitral regurgitation by cinching the commissure of the mitral valve
EP2278927A2 (en) * 2008-04-25 2011-02-02 Downey, Earl C. Laparoscopic surgical instrument
US9282965B2 (en) 2008-05-16 2016-03-15 Abbott Laboratories Apparatus and methods for engaging tissue
US8162958B2 (en) 2008-07-11 2012-04-24 Olympus Medical Systems Corp. Tissue fastening tool and applicator for indwelling the same within body, and tissue fastening method through natural orifice
US20100010520A1 (en) 2008-07-11 2010-01-14 Olympus Medical Systems Corp. Tissue fastener
US8828026B2 (en) 2008-07-11 2014-09-09 Olympus Medical Systems Corp. Tissue fastening apparatus
WO2010011661A1 (en) 2008-07-21 2010-01-28 Atricure, Inc. Apparatus and methods for occluding an anatomical structure
US8465502B2 (en) 2008-08-25 2013-06-18 Covidien Lp Surgical clip applier and method of assembly
US20110208212A1 (en) 2010-02-19 2011-08-25 Zergiebel Earl M Surgical clip applier
US8056565B2 (en) 2008-08-25 2011-11-15 Tyco Healthcare Group Lp Surgical clip applier and method of assembly
US8267944B2 (en) 2008-08-29 2012-09-18 Tyco Healthcare Group Lp Endoscopic surgical clip applier with lock out
US8585717B2 (en) 2008-08-29 2013-11-19 Covidien Lp Single stroke endoscopic surgical clip applier
US9358015B2 (en) 2008-08-29 2016-06-07 Covidien Lp Endoscopic surgical clip applier with wedge plate
US8409223B2 (en) 2008-08-29 2013-04-02 Covidien Lp Endoscopic surgical clip applier with clip retention
US8163022B2 (en) 2008-10-14 2012-04-24 Anulex Technologies, Inc. Method and apparatus for the treatment of the intervertebral disc annulus
CA2740867C (en) 2008-10-16 2018-06-12 Aptus Endosystems, Inc. Devices, systems, and methods for endovascular staple and/or prosthesis delivery and implantation
US8398676B2 (en) 2008-10-30 2013-03-19 Abbott Vascular Inc. Closure device
US10517719B2 (en) 2008-12-22 2019-12-31 Valtech Cardio, Ltd. Implantation of repair devices in the heart
US8241351B2 (en) 2008-12-22 2012-08-14 Valtech Cardio, Ltd. Adjustable partial annuloplasty ring and mechanism therefor
US8715342B2 (en) 2009-05-07 2014-05-06 Valtech Cardio, Ltd. Annuloplasty ring with intra-ring anchoring
US8858594B2 (en) 2008-12-22 2014-10-14 Abbott Laboratories Curved closure device
WO2010073246A2 (en) 2008-12-22 2010-07-01 Valtech Cardio, Ltd. Adjustable annuloplasty devices and adjustment mechanisms therefor
US8323312B2 (en) 2008-12-22 2012-12-04 Abbott Laboratories Closure device
US8545553B2 (en) 2009-05-04 2013-10-01 Valtech Cardio, Ltd. Over-wire rotation tool
US9089311B2 (en) 2009-01-09 2015-07-28 Abbott Vascular Inc. Vessel closure devices and methods
US9414820B2 (en) 2009-01-09 2016-08-16 Abbott Vascular Inc. Closure devices, systems, and methods
US9173644B2 (en) 2009-01-09 2015-11-03 Abbott Vascular Inc. Closure devices, systems, and methods
US20100179589A1 (en) 2009-01-09 2010-07-15 Abbott Vascular Inc. Rapidly eroding anchor
US9486191B2 (en) 2009-01-09 2016-11-08 Abbott Vascular, Inc. Closure devices
US9393023B2 (en) 2009-01-13 2016-07-19 Atricure, Inc. Apparatus and methods for deploying a clip to occlude an anatomical structure
US20100185234A1 (en) 2009-01-16 2010-07-22 Abbott Vascular Inc. Closure devices, systems, and methods
US8353956B2 (en) 2009-02-17 2013-01-15 Valtech Cardio, Ltd. Actively-engageable movement-restriction mechanism for use with an annuloplasty structure
WO2010107698A2 (en) 2009-03-14 2010-09-23 Vasostitch, Inc. Vessel access and closure device
US8518060B2 (en) 2009-04-09 2013-08-27 Medtronic, Inc. Medical clip with radial tines, system and method of using same
US20100270354A1 (en) * 2009-04-22 2010-10-28 Ofir Rimer Ergonomic rotary tacker
US8668704B2 (en) 2009-04-24 2014-03-11 Medtronic, Inc. Medical clip with tines, system and method of using same
US9968452B2 (en) 2009-05-04 2018-05-15 Valtech Cardio, Ltd. Annuloplasty ring delivery cathethers
WO2013069019A2 (en) 2011-11-08 2013-05-16 Valtech Cardio, Ltd. Controlled steering functionality for implant-delivery tool
WO2010148388A2 (en) * 2009-06-19 2010-12-23 Interventional Therapies Crimping and cutting device
US8474679B2 (en) * 2009-07-13 2013-07-02 C.R. Bard, Inc. Instrument for applying a surgical fastener
US8459524B2 (en) 2009-08-14 2013-06-11 Covidien Lp Tissue fastening system for a medical device
US8342378B2 (en) 2009-08-17 2013-01-01 Covidien Lp One handed stapler
US20110054492A1 (en) 2009-08-26 2011-03-03 Abbott Laboratories Medical device for repairing a fistula
AU2010286524B2 (en) * 2009-08-28 2014-09-04 Medtronic 3F Therapeutics, Inc. Surgical delivery device and method of use
US8734469B2 (en) 2009-10-13 2014-05-27 Covidien Lp Suture clip applier
US9180007B2 (en) 2009-10-29 2015-11-10 Valtech Cardio, Ltd. Apparatus and method for guide-wire based advancement of an adjustable implant
US10098737B2 (en) 2009-10-29 2018-10-16 Valtech Cardio, Ltd. Tissue anchor for annuloplasty device
CA2780156A1 (en) * 2009-11-09 2011-05-12 Entourage Medical Technologies, Inc. System and method for providing access and closure to tissue
WO2011055700A1 (en) 2009-11-09 2011-05-12 オリンパスメディカルシステムズ株式会社 Implant placement device, connection support tool, treatment tool for endoscope, and implant placement method
EP2506777B1 (en) 2009-12-02 2020-11-25 Valtech Cardio, Ltd. Combination of spool assembly coupled to a helical anchor and delivery tool for implantation thereof
US9186136B2 (en) 2009-12-09 2015-11-17 Covidien Lp Surgical clip applier
US8545486B2 (en) 2009-12-15 2013-10-01 Covidien Lp Surgical clip applier
US8460319B2 (en) 2010-01-11 2013-06-11 Anulex Technologies, Inc. Intervertebral disc annulus repair system and method
US10058314B2 (en) 2010-01-20 2018-08-28 Micro Interventional Devices, Inc. Tissue closure device and method
US10959840B2 (en) 2010-01-20 2021-03-30 Micro Interventional Devices, Inc. Systems and methods for affixing a prosthesis to tissue
US10743854B2 (en) 2010-01-20 2020-08-18 Micro Interventional Devices, Inc. Tissue closure device and method
US9980708B2 (en) 2010-01-20 2018-05-29 Micro Interventional Devices, Inc. Tissue closure device and method
CA2825186A1 (en) 2010-01-20 2011-07-28 Michael P. Whitman Tissue repair implant and delivery device and method
US8683895B2 (en) * 2010-02-23 2014-04-01 Kensey Nash Corporation Single revolution snap action drive for surgical fasteners
US8403945B2 (en) 2010-02-25 2013-03-26 Covidien Lp Articulating endoscopic surgical clip applier
US20110218191A1 (en) * 2010-03-03 2011-09-08 Boehringer Ingelheim Vetmedica Gmbh Use of meloxicam for the long term-treatment of kidney disorders in cats
US8303624B2 (en) 2010-03-15 2012-11-06 Abbott Cardiovascular Systems, Inc. Bioabsorbable plug
US8747425B2 (en) * 2010-04-23 2014-06-10 Venx, Llc Percutaneous vein removal device
CN103118602B (en) 2010-06-11 2016-04-27 随行医疗技术公司 For getting involved and closed system and method through the apex of the heart
US9161778B2 (en) * 2010-06-11 2015-10-20 Entourage Medical Technologies, Inc. System and method for transapical access and closure
JP5869565B2 (en) 2010-06-26 2016-02-24 バソスティッチ, インコーポレイテッド Method and apparatus for transapical access and closure
US8968337B2 (en) 2010-07-28 2015-03-03 Covidien Lp Articulating clip applier
US8403946B2 (en) 2010-07-28 2013-03-26 Covidien Lp Articulating clip applier cartridge
US8758399B2 (en) 2010-08-02 2014-06-24 Abbott Cardiovascular Systems, Inc. Expandable bioabsorbable plug apparatus and method
US8603116B2 (en) 2010-08-04 2013-12-10 Abbott Cardiovascular Systems, Inc. Closure device with long tines
US20120053598A1 (en) * 2010-08-26 2012-03-01 Pavilion Medical Innovations Helical Fasteners and Methods for Deploying Same
US20120150193A1 (en) * 2010-09-15 2012-06-14 Pavilion Medical Innovations System and methods for hysteroscopic tubular ligation
US9675338B2 (en) 2010-09-20 2017-06-13 Entourage Medical Technologies, Inc. System for providing surgical access
US9017349B2 (en) 2010-10-27 2015-04-28 Atricure, Inc. Appendage clamp deployment assist device
US9066741B2 (en) 2010-11-01 2015-06-30 Atricure, Inc. Robotic toolkit
US9011464B2 (en) 2010-11-02 2015-04-21 Covidien Lp Self-centering clip and jaw
US8636754B2 (en) 2010-11-11 2014-01-28 Atricure, Inc. Clip applicator
US8961519B2 (en) * 2010-11-19 2015-02-24 Zimmer, Inc. Surgical rotary cutting tool and tool guard assembly
BR112013013448A2 (en) * 2010-11-30 2016-10-18 Fabian Hermann Urban Füglister helical inserter
CA2824936A1 (en) 2011-01-28 2012-08-02 Apica Cardiovascular Limited Systems for sealing a tissue wall puncture
US9186153B2 (en) 2011-01-31 2015-11-17 Covidien Lp Locking cam driver and jaw assembly for clip applier
WO2012106422A2 (en) 2011-02-01 2012-08-09 Georgia Tech Research Corporation Systems for implanting and using a conduit within a tissue wall
US8617184B2 (en) 2011-02-15 2013-12-31 Abbott Cardiovascular Systems, Inc. Vessel closure system
US9149276B2 (en) 2011-03-21 2015-10-06 Abbott Cardiovascular Systems, Inc. Clip and deployment apparatus for tissue closure
US9775623B2 (en) 2011-04-29 2017-10-03 Covidien Lp Surgical clip applier including clip relief feature
WO2012151543A1 (en) 2011-05-05 2012-11-08 Ams Research Corporation Tools and methods for treatment of pelvic conditions
US8556932B2 (en) 2011-05-19 2013-10-15 Abbott Cardiovascular Systems, Inc. Collapsible plug for tissue closure
US10792152B2 (en) 2011-06-23 2020-10-06 Valtech Cardio, Ltd. Closed band for percutaneous annuloplasty
US9265486B2 (en) 2011-08-15 2016-02-23 Atricure, Inc. Surgical device
EP2747679B1 (en) 2011-08-23 2016-12-21 Simcha Milo Device for creating temporary access and then closure
US8858623B2 (en) 2011-11-04 2014-10-14 Valtech Cardio, Ltd. Implant having multiple rotational assemblies
US20130131697A1 (en) 2011-11-21 2013-05-23 Covidien Lp Surgical clip applier
US9332976B2 (en) 2011-11-30 2016-05-10 Abbott Cardiovascular Systems, Inc. Tissue closure device
US9364239B2 (en) 2011-12-19 2016-06-14 Covidien Lp Jaw closure mechanism for a surgical clip applier
US9364216B2 (en) 2011-12-29 2016-06-14 Covidien Lp Surgical clip applier with integrated clip counter
US9282973B2 (en) 2012-01-20 2016-03-15 Atricure, Inc. Clip deployment tool and associated methods
US9408610B2 (en) 2012-05-04 2016-08-09 Covidien Lp Surgical clip applier with dissector
US9532787B2 (en) 2012-05-31 2017-01-03 Covidien Lp Endoscopic clip applier
CA2885354A1 (en) 2012-09-29 2014-04-03 Mitralign, Inc. Plication lock delivery system and method of use thereof
US10376266B2 (en) 2012-10-23 2019-08-13 Valtech Cardio, Ltd. Percutaneous tissue anchor techniques
EP3517052A1 (en) 2012-10-23 2019-07-31 Valtech Cardio, Ltd. Controlled steering functionality for implant-delivery tool
US9730793B2 (en) 2012-12-06 2017-08-15 Valtech Cardio, Ltd. Techniques for guide-wire based advancement of a tool
US9364209B2 (en) 2012-12-21 2016-06-14 Abbott Cardiovascular Systems, Inc. Articulating suturing device
US9113892B2 (en) 2013-01-08 2015-08-25 Covidien Lp Surgical clip applier
US9968362B2 (en) 2013-01-08 2018-05-15 Covidien Lp Surgical clip applier
US9750500B2 (en) 2013-01-18 2017-09-05 Covidien Lp Surgical clip applier
US9351733B2 (en) 2013-01-18 2016-05-31 Covidien Lp Surgical fastener applier
EP2948104B1 (en) 2013-01-25 2019-07-24 Apica Cardiovascular Limited Systems for percutaneous access, stabilization and closure of organs
US9737294B2 (en) 2013-01-28 2017-08-22 Cartiva, Inc. Method and system for orthopedic repair
AU2014209124A1 (en) 2013-01-28 2015-09-17 Cartiva, Inc. Systems and methods for orthopedic repair
WO2014134183A1 (en) 2013-02-26 2014-09-04 Mitralign, Inc. Devices and methods for percutaneous tricuspid valve repair
US9358010B2 (en) 2013-03-12 2016-06-07 Covidien Lp Flex cable and spring-loaded tube for tacking device
US9867620B2 (en) 2013-03-14 2018-01-16 Covidien Lp Articulation joint for apparatus for endoscopic procedures
US10449333B2 (en) 2013-03-14 2019-10-22 Valtech Cardio, Ltd. Guidewire feeder
EP2968847B1 (en) 2013-03-15 2023-03-08 Edwards Lifesciences Corporation Translation catheter systems
JP6302992B2 (en) 2013-03-15 2018-03-28 エーピーケー アドバンスド メディカル テクノロジーズ,インコーポレイテッド Connector for implantation into the tissue wall
US9655621B2 (en) 2013-03-15 2017-05-23 Covidien Lp Surgical instrument for dispensing tacks and solution
US9925366B2 (en) * 2013-03-15 2018-03-27 The Spectranetics Corporation Surgical instrument for removing an implanted object
US9351728B2 (en) 2013-06-28 2016-05-31 Covidien Lp Articulating apparatus for endoscopic procedures
US9668730B2 (en) 2013-06-28 2017-06-06 Covidien Lp Articulating apparatus for endoscopic procedures with timing system
US10085746B2 (en) 2013-06-28 2018-10-02 Covidien Lp Surgical instrument including rotating end effector and rotation-limiting structure
US9358004B2 (en) 2013-06-28 2016-06-07 Covidien Lp Articulating apparatus for endoscopic procedures
US20150032130A1 (en) 2013-07-24 2015-01-29 Covidien Lp Expanding absorbable tack
US9775624B2 (en) 2013-08-27 2017-10-03 Covidien Lp Surgical clip applier
US10070857B2 (en) 2013-08-31 2018-09-11 Mitralign, Inc. Devices and methods for locating and implanting tissue anchors at mitral valve commissure
US9526498B2 (en) 2013-09-17 2016-12-27 Covidien Lp Surgical device with a trigger lockout mechanism device
US10299793B2 (en) 2013-10-23 2019-05-28 Valtech Cardio, Ltd. Anchor magazine
WO2015066243A2 (en) 2013-10-29 2015-05-07 Entourage Medical Technologies, Inc. System for providing surgical access
US9610162B2 (en) 2013-12-26 2017-04-04 Valtech Cardio, Ltd. Implantation of flexible implant
WO2015149292A1 (en) 2014-04-02 2015-10-08 Covidien Lp Surgical fastener applying apparatus, kits and methods for endoscopic procedures
US9844377B2 (en) 2014-04-25 2017-12-19 Incisive Surgical, Inc. Method and apparatus for wound closure with sequential tissue positioning and retention
WO2016059639A1 (en) 2014-10-14 2016-04-21 Valtech Cardio Ltd. Leaflet-restraining techniques
US10485909B2 (en) 2014-10-31 2019-11-26 Thoratec Corporation Apical connectors and instruments for use in a heart wall
US10702278B2 (en) 2014-12-02 2020-07-07 Covidien Lp Laparoscopic surgical ligation clip applier
US9931124B2 (en) 2015-01-07 2018-04-03 Covidien Lp Reposable clip applier
WO2016112509A1 (en) 2015-01-15 2016-07-21 Covidien Lp Endoscopic reposable surgical clip applier
US10292712B2 (en) 2015-01-28 2019-05-21 Covidien Lp Surgical clip applier with integrated cutter
US20160256269A1 (en) 2015-03-05 2016-09-08 Mitralign, Inc. Devices for treating paravalvular leakage and methods use thereof
US10159491B2 (en) 2015-03-10 2018-12-25 Covidien Lp Endoscopic reposable surgical clip applier
US11090097B2 (en) 2015-03-17 2021-08-17 Covidien Lp Connecting end effectors to surgical devices
CN111265335B (en) 2015-04-30 2022-03-15 瓦尔泰克卡迪欧有限公司 Valvuloplasty techniques
EP3310268A4 (en) * 2015-05-26 2019-06-26 Lmt, Llc Systems and methods for fixing soft tissue
US10092286B2 (en) 2015-05-27 2018-10-09 Covidien Lp Suturing loading unit
US10028733B2 (en) * 2015-05-28 2018-07-24 National University Of Ireland, Galway Fistula treatment device
US11701096B2 (en) 2015-05-28 2023-07-18 National University Of Ireland, Galway Fistula treatment device
US10085747B2 (en) 2015-09-11 2018-10-02 Incisive Surgical, Inc. Surgical fastening instrument
CN107072662B (en) * 2015-09-17 2020-04-07 奥林巴斯株式会社 Treatment tool for endoscope
EP3351188B1 (en) 2015-09-17 2021-04-07 Olympus Corporation Endoscope treatment instrument
US10702279B2 (en) 2015-11-03 2020-07-07 Covidien Lp Endoscopic surgical clip applier
EP3373826A4 (en) 2015-11-10 2019-11-06 Covidien LP Endoscopic reposable surgical clip applier
US10390831B2 (en) 2015-11-10 2019-08-27 Covidien Lp Endoscopic reposable surgical clip applier
WO2017079895A1 (en) 2015-11-10 2017-05-18 Covidien Lp Endoscopic reposable surgical clip applier
US10828160B2 (en) 2015-12-30 2020-11-10 Edwards Lifesciences Corporation System and method for reducing tricuspid regurgitation
US10751182B2 (en) 2015-12-30 2020-08-25 Edwards Lifesciences Corporation System and method for reshaping right heart
EP3402417A4 (en) 2016-01-11 2019-12-04 Covidien LP Endoscopic reposable surgical clip applier
CA3011262A1 (en) 2016-01-18 2017-07-27 Covidien Lp Endoscopic surgical clip applier
CA2958160A1 (en) 2016-02-24 2017-08-24 Covidien Lp Endoscopic reposable surgical clip applier
CA3021683A1 (en) 2016-04-21 2017-10-26 Applied Medical Resources Corporation Laparoscopic clip applier
US10702274B2 (en) 2016-05-26 2020-07-07 Edwards Lifesciences Corporation Method and system for closing left atrial appendage
GB201611910D0 (en) 2016-07-08 2016-08-24 Valtech Cardio Ltd Adjustable annuloplasty device with alternating peaks and troughs
WO2018027788A1 (en) 2016-08-11 2018-02-15 Covidien Lp Endoscopic surgical clip applier and clip applying systems
AU2016420481A1 (en) 2016-08-25 2019-01-17 Covidien Lp Endoscopic surgical clip applier and clip applying systems
US11298123B2 (en) 2016-10-21 2022-04-12 Covidien Lp Surgical end effectors
US10743859B2 (en) 2016-10-21 2020-08-18 Covidien Lp Surgical end effectors
US10617409B2 (en) 2016-10-21 2020-04-14 Covidien Lp Surgical end effectors
US11344294B2 (en) * 2016-10-24 2022-05-31 ReViable Surgical, Inc. Laparoscopic suturing devices, needles, sutures, and drive systems
US10639044B2 (en) 2016-10-31 2020-05-05 Covidien Lp Ligation clip module and clip applier
US10660651B2 (en) 2016-10-31 2020-05-26 Covidien Lp Endoscopic reposable surgical clip applier
US10610236B2 (en) 2016-11-01 2020-04-07 Covidien Lp Endoscopic reposable surgical clip applier
US10426489B2 (en) 2016-11-01 2019-10-01 Covidien Lp Endoscopic reposable surgical clip applier
US10492795B2 (en) 2016-11-01 2019-12-03 Covidien Lp Endoscopic surgical clip applier
US10888309B2 (en) 2017-01-31 2021-01-12 Covidien Lp Surgical fastener devices with geometric tubes
US10709455B2 (en) 2017-02-02 2020-07-14 Covidien Lp Endoscopic surgical clip applier
WO2018141110A1 (en) 2017-02-06 2018-08-09 Covidien Lp Surgical clip applier with user feedback feature
US10758244B2 (en) 2017-02-06 2020-09-01 Covidien Lp Endoscopic surgical clip applier
US10660725B2 (en) 2017-02-14 2020-05-26 Covidien Lp Endoscopic surgical clip applier including counter assembly
US10603038B2 (en) 2017-02-22 2020-03-31 Covidien Lp Surgical clip applier including inserts for jaw assembly
US11583291B2 (en) 2017-02-23 2023-02-21 Covidien Lp Endoscopic surgical clip applier
US10548602B2 (en) 2017-02-23 2020-02-04 Covidien Lp Endoscopic surgical clip applier
US11045627B2 (en) 2017-04-18 2021-06-29 Edwards Lifesciences Corporation Catheter system with linear actuation control mechanism
US10675043B2 (en) 2017-05-04 2020-06-09 Covidien Lp Reposable multi-fire surgical clip applier
US10722235B2 (en) 2017-05-11 2020-07-28 Covidien Lp Spring-release surgical clip
WO2018223324A1 (en) * 2017-06-08 2018-12-13 Covidien Lp Adjustable rotation assembly for surgical instruments
EP3541298B1 (en) 2017-06-09 2021-08-18 Signum Surgical Limited An implant for closing an opening in tissue
US10660723B2 (en) 2017-06-30 2020-05-26 Covidien Lp Endoscopic reposable surgical clip applier
US10639032B2 (en) 2017-06-30 2020-05-05 Covidien Lp Endoscopic surgical clip applier including counter assembly
US10675112B2 (en) 2017-08-07 2020-06-09 Covidien Lp Endoscopic surgical clip applier including counter assembly
US10863992B2 (en) 2017-08-08 2020-12-15 Covidien Lp Endoscopic surgical clip applier
US10932790B2 (en) 2017-08-08 2021-03-02 Covidien Lp Geared actuation mechanism and surgical clip applier including the same
US10786262B2 (en) 2017-08-09 2020-09-29 Covidien Lp Endoscopic reposable surgical clip applier
US10786263B2 (en) 2017-08-15 2020-09-29 Covidien Lp Endoscopic reposable surgical clip applier
US10835341B2 (en) 2017-09-12 2020-11-17 Covidien Lp Endoscopic surgical clip applier and handle assemblies for use therewith
US10835260B2 (en) 2017-09-13 2020-11-17 Covidien Lp Endoscopic surgical clip applier and handle assemblies for use therewith
US10758245B2 (en) 2017-09-13 2020-09-01 Covidien Lp Clip counting mechanism for surgical clip applier
US10653429B2 (en) 2017-09-13 2020-05-19 Covidien Lp Endoscopic surgical clip applier
US10835221B2 (en) 2017-11-02 2020-11-17 Valtech Cardio, Ltd. Implant-cinching devices and systems
US10828036B2 (en) 2017-11-03 2020-11-10 Covidien Lp Endoscopic surgical clip applier and handle assemblies for use therewith
US11376015B2 (en) 2017-11-03 2022-07-05 Covidien Lp Endoscopic surgical clip applier and handle assemblies for use therewith
US10932791B2 (en) 2017-11-03 2021-03-02 Covidien Lp Reposable multi-fire surgical clip applier
US11116513B2 (en) 2017-11-03 2021-09-14 Covidien Lp Modular surgical clip cartridge
US10945734B2 (en) 2017-11-03 2021-03-16 Covidien Lp Rotation knob assemblies and surgical instruments including the same
US11135062B2 (en) 2017-11-20 2021-10-05 Valtech Cardio Ltd. Cinching of dilated heart muscle
US10722236B2 (en) 2017-12-12 2020-07-28 Covidien Lp Endoscopic reposable surgical clip applier
US10959737B2 (en) 2017-12-13 2021-03-30 Covidien Lp Reposable multi-fire surgical clip applier
US10849630B2 (en) 2017-12-13 2020-12-01 Covidien Lp Reposable multi-fire surgical clip applier
US10743887B2 (en) 2017-12-13 2020-08-18 Covidien Lp Reposable multi-fire surgical clip applier
US11051827B2 (en) 2018-01-16 2021-07-06 Covidien Lp Endoscopic surgical instrument and handle assemblies for use therewith
CN111655200B (en) 2018-01-24 2023-07-14 爱德华兹生命科学创新(以色列)有限公司 Contraction of annuloplasty structures
EP4248904A3 (en) 2018-01-26 2023-11-29 Edwards Lifesciences Innovation (Israel) Ltd. Techniques for facilitating heart valve tethering and chord replacement
US10993721B2 (en) 2018-04-25 2021-05-04 Covidien Lp Surgical clip applier
US11298126B2 (en) 2018-05-02 2022-04-12 Covidien Lp Shipping wedge for end effector installation onto surgical devices
US11116500B2 (en) 2018-06-28 2021-09-14 Covidien Lp Surgical fastener applying device, kits and methods for endoscopic procedures
WO2020012481A2 (en) 2018-07-12 2020-01-16 Valtech Cardio, Ltd. Annuloplasty systems and locking tools therefor
US10786273B2 (en) 2018-07-13 2020-09-29 Covidien Lp Rotation knob assemblies for handle assemblies
US11259887B2 (en) 2018-08-10 2022-03-01 Covidien Lp Feedback mechanisms for handle assemblies
US11033256B2 (en) 2018-08-13 2021-06-15 Covidien Lp Linkage assembly for reusable surgical handle assemblies
US11253267B2 (en) 2018-08-13 2022-02-22 Covidien Lp Friction reduction mechanisms for handle assemblies
US11219463B2 (en) 2018-08-13 2022-01-11 Covidien Lp Bilateral spring for surgical instruments and surgical instruments including the same
US11278267B2 (en) 2018-08-13 2022-03-22 Covidien Lp Latch assemblies and surgical instruments including the same
US11344316B2 (en) 2018-08-13 2022-05-31 Covidien Lp Elongated assemblies for surgical clip appliers and surgical clip appliers incorporating the same
US11246601B2 (en) 2018-08-13 2022-02-15 Covidien Lp Elongated assemblies for surgical clip appliers and surgical clip appliers incorporating the same
US11051828B2 (en) 2018-08-13 2021-07-06 Covidien Lp Rotation knob assemblies and surgical instruments including same
US11147566B2 (en) 2018-10-01 2021-10-19 Covidien Lp Endoscopic surgical clip applier
CN113891686A (en) 2019-01-23 2022-01-04 内奥瓦斯克医疗有限公司 Flow-altering device with cover
WO2020154602A1 (en) * 2019-01-25 2020-07-30 Boston Scientific Scimed, Inc. Devices, systems, and methods for tightening, fastening, or anchoring in tissue
US11524398B2 (en) 2019-03-19 2022-12-13 Covidien Lp Gear drive mechanisms for surgical instruments
US11523817B2 (en) 2019-06-27 2022-12-13 Covidien Lp Endoluminal pursestring device
EP4193934A1 (en) 2019-10-29 2023-06-14 Edwards Lifesciences Innovation (Israel) Ltd. Annuloplasty and tissue anchor technologies
US11197675B2 (en) 2019-12-19 2021-12-14 Covidien Lp Positioning guide for surgical instruments and surgical instrument systems
USD944985S1 (en) 2019-12-19 2022-03-01 Covidien Lp Positioning guide cuff
USD944984S1 (en) 2019-12-19 2022-03-01 Covidien Lp Tubular positioning guide
US11779340B2 (en) 2020-01-02 2023-10-10 Covidien Lp Ligation clip loading device
US11723669B2 (en) 2020-01-08 2023-08-15 Covidien Lp Clip applier with clip cartridge interface
CN114159187B (en) * 2021-11-17 2022-08-09 江南大学 Diameter-winding sewing method and device

Family Cites Families (62)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US816026A (en) * 1905-03-09 1906-03-27 Albert J Meier Surgical clip.
US1123290A (en) * 1914-05-12 1915-01-05 Otto Von Herff Surgical clip.
US2817339A (en) * 1953-08-10 1957-12-24 Norman M Sullivan Rigid fascial suture
US3091828A (en) * 1961-08-11 1963-06-04 Soltis Mary Clamp
US3446212A (en) * 1965-07-19 1969-05-27 New Research & Dev Lab Inc Hemostatic clip and applicator therefor
US3545444A (en) * 1967-10-02 1970-12-08 United States Surgical Corp Wire suture wrapping instrument
US3604425A (en) * 1969-04-11 1971-09-14 New Research And Dev Lab Inc Hemostatic clip
US3735762A (en) * 1970-04-27 1973-05-29 Us Corp Baltimo E Instrument for ligating suturing and dividing organic tubular structures
US3716058A (en) * 1970-07-17 1973-02-13 Atlanta Res Inst Barbed suture
US3870048A (en) * 1973-07-30 1975-03-11 In Bae Yoon Device for sterilizing the human female or male by ligation
US3989049A (en) * 1973-07-30 1976-11-02 In Bae Yoon Method of applying an elastic ring to an anatomical tubular structure
US3939828A (en) * 1974-09-09 1976-02-24 Mohr Robert N Method and clasp for internal osseous fixation
GB1545731A (en) * 1976-09-07 1979-05-16 Vnii Ispytatel Med Tech Surgical apparatus
US4217902A (en) * 1977-05-02 1980-08-19 March Alfred L Hemostatic clip
US4337774A (en) * 1978-06-14 1982-07-06 Metatech Corporation Micro surgical clip
US4485816A (en) * 1981-06-25 1984-12-04 Alchemia Shape-memory surgical staple apparatus and method for use in surgical suturing
DE3139488C2 (en) * 1981-10-03 1984-08-16 Aesculap-Werke Ag Vormals Jetter & Scheerer, 7200 Tuttlingen Aneurysm clip
US4979954A (en) * 1981-10-21 1990-12-25 Owen Gwathmey Staple suturing method
US4548201A (en) * 1982-04-20 1985-10-22 Inbae Yoon Elastic ligating ring clip
US4535772A (en) * 1983-03-10 1985-08-20 Kells Medical, Incorporated Skin closure device
US4595007A (en) * 1983-03-14 1986-06-17 Ethicon, Inc. Split ring type tissue fastener
FR2552425B1 (en) 1983-09-22 1985-10-25 Rhone Poulenc Sante PROCESS FOR THE PREPARATION OF HYDROXY-4 TRIMETHYL-2,4,6 CYCLOHEXADIENE-2,5 ONE
US4637395A (en) * 1983-10-04 1987-01-20 Aesculap-Werke Ag Applicator for C-shaped scalp clips
US4671278A (en) * 1985-01-14 1987-06-09 Thomas J. Fogarty Scalp hemostatic clip and dispenser therefor
US4821721A (en) * 1985-01-14 1989-04-18 Thomas J. Fogarty Apparatus and method for applying hemostatic scalp clips
US4777950A (en) * 1986-04-11 1988-10-18 Kees Surgical Specialty Co. Vascular clip
US4791707A (en) * 1986-08-26 1988-12-20 Tucker Wilson H Clip applicator, spreadable clips and method for applying the clips
US4869268A (en) * 1987-05-14 1989-09-26 Inbae Yoon Multi-functional instruments and stretchable ligating and occluding devices
JP2561853B2 (en) * 1988-01-28 1996-12-11 株式会社ジェイ・エム・エス Shaped memory molded article and method of using the same
US5374261A (en) * 1990-07-24 1994-12-20 Yoon; Inbae Multifunctional devices for use in endoscopic surgical procedures and methods-therefor
US4990152A (en) * 1988-10-12 1991-02-05 Inbae Yoon Applicator device housing multiple elastic ligatures in series and for dilating and applying elastic ligatures onto anatomical tissue
US4924866A (en) * 1988-10-26 1990-05-15 Inbae Yoon Wound-closing device
US5047047A (en) * 1988-10-26 1991-09-10 Inbae Yoon Wound closing device
GB2226245A (en) * 1988-11-18 1990-06-27 Alan Crockard Endoscope, remote actuator and aneurysm clip applicator.
US4961743A (en) * 1989-01-03 1990-10-09 Codman & Shurtleff, Inc. Torsion spring
US5053047A (en) * 1989-05-16 1991-10-01 Inbae Yoon Suture devices particularly useful in endoscopic surgery and methods of suturing
US5222976A (en) * 1989-05-16 1993-06-29 Inbae Yoon Suture devices particularly useful in endoscopic surgery
US5030224A (en) * 1989-09-25 1991-07-09 Pioneering Technologies, Inc. Coronary artery retraction clip
US5007921A (en) * 1989-10-26 1991-04-16 Brown Alan W Surgical staple
US5026390A (en) * 1989-10-26 1991-06-25 Brown Alan W Surgical staple
US5026379A (en) * 1989-12-05 1991-06-25 Inbae Yoon Multi-functional instruments and stretchable ligating and occluding devices
US5226908A (en) * 1989-12-05 1993-07-13 Inbae Yoon Multi-functional instruments and stretchable ligating and occluding devices
US5217473A (en) * 1989-12-05 1993-06-08 Inbae Yoon Multi-functional instruments and stretchable ligating and occluding devices
IT1238173B (en) * 1990-01-15 1993-07-09 FOUR-TWO-TWO-TWO-CONVERGENT METAL STITCH SUITABLE FOR CONTEMPORARY SUTURE OF THE SKIN AND SUB-SKIN FABRIC
US5035692A (en) * 1990-02-13 1991-07-30 Nicholas Herbert Hemostasis clip applicator
US5207692A (en) * 1990-07-30 1993-05-04 Codman & Shurtleff, Inc. Surgical clip applier with reciprocating clip sleeve and dual ratchet mechanism
US5171252A (en) * 1991-02-05 1992-12-15 Friedland Thomas W Surgical fastening clip formed of a shape memory alloy, a method of making such a clip and a method of using such a clip
US5395034A (en) 1991-11-07 1995-03-07 American Cyanamid Co. Linear surgical stapling instrument
US5242456A (en) * 1991-11-21 1993-09-07 Kensey Nash Corporation Apparatus and methods for clamping tissue and reflecting the same
DE4217202C2 (en) * 1992-05-23 1994-06-23 Kernforschungsz Karlsruhe Surgical sewing instrument
US5342373A (en) * 1992-09-14 1994-08-30 Ethicon, Inc. Sterile clips and instrument for their placement
US5309927A (en) * 1992-10-22 1994-05-10 Ethicon, Inc. Circular stapler tissue retention spring method
US5382259A (en) * 1992-10-26 1995-01-17 Target Therapeutics, Inc. Vasoocclusion coil with attached tubular woven or braided fibrous covering
US5356424A (en) * 1993-02-05 1994-10-18 American Cyanamid Co. Laparoscopic suturing device
WO1995005778A1 (en) * 1993-08-25 1995-03-02 Life Surgery, Inc. Surgical ligation clip
US5467991A (en) 1993-11-08 1995-11-21 White, Iv; Walter Detachable golf swing training device using two light beams
US5476505A (en) * 1993-11-18 1995-12-19 Advanced Cardiovascular Systems, Inc. Coiled stent and delivery system
US5465894A (en) 1993-12-06 1995-11-14 Ethicon, Inc. Surgical stapling instrument with articulated stapling head assembly on rotatable and flexible support shaft
US5486187A (en) * 1994-01-04 1996-01-23 Schenck; Robert R. Anastomosis device and method
US5582616A (en) * 1994-08-05 1996-12-10 Origin Medsystems, Inc. Surgical helical fastener with applicator
US5480089A (en) 1994-08-19 1996-01-02 United States Surgical Corporation Surgical stapler apparatus with improved staple pockets
US5562685A (en) * 1994-09-16 1996-10-08 General Surgical Innovations, Inc. Surgical instrument for placing suture or fasteners

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EP0955903A1 (en) 1999-11-17

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