A surgical access device includes a seal housing and a roller disposed in the housing and defining a working channel. The roller may be stationary or moveable within the seal housing to form both a zero seal in the absence of an instrument, and an instrument seal in the presence of an instrument. Rotation of the roller is contemplated and low-friction surfaces are discussed to reduce instrument insertion forces. Multiple rollers, wiper elements, low-friction braid, pivoting elements and idler rollers are contemplated. The rollers will typically be formed of a gel material in order to facilitate the desired compliance, stretchability and elongation desired.

A method for treating a patient having thrombus includes providing a manipulation device including a housing configured to be supported by the hand of a user and having a distal and proximal end, a drive system disposed within the housing, and configured to rotate a rotation member, an engagement member coupled to the rotation member and configured to be removably coupled to an elongate medical device, an activation member carried by the housing such that it can be operated by at least a portion of the hand of the user when the housing is supported by the hand of the user, the drive system configured to apply motive force to the engagement member, securing an elongate member to the engagement member, introducing at least the distal end of the elongate member into a blood vessel adjacent a thrombus, operating the activation member to cause at least some rotation of the rotation member, which in turn causes at least some rotation of the distal end of the elongate member at or near the thrombus, and aspirating at least some of the thrombus with an aspiration catheter.

A drill guide handle configured to engage a variable angle drill guide, including: a handle grip; a first cannula extending from a proximal end of the drill guide handle to a distal end of the drill guide handle, wherein the first cannula is configured to provide a zero degree insertion angle for a drill bit; and a body including: a first tab and a second tab wherein the first and second tabs include a first and second tab protrusion, respectively, wherein each of the first tab and the second is configured to flex so that the first and second tab protrusions engage a horizontal groove on a variable angle drill guide; and a body protrusion on an inner surface of the body, wherein the body protrusion is configured to engage a vertical grove on the variable angle drill guide.

An elongate endovascular element for crossing through an obstruction in a blood vessel comprises: a proximal section; a distal tip section of smaller diameter than the proximal section; and a distally-tapering intermediate section extending between the proximal and distal tip sections; wherein the tapered intermediate section has a length that is substantially λ/2 or a multiple of λ/2 , where λ is a wavelength of a driving frequency that will produce longitudinal resonance in the element.

An extractor for removing an implanted lead from a patient, the extractor comprising a proximal portion, a distal portion, a lumen dimensioned to receive the lead therein, a cutter at the distal portion for cutting tissue adjacent the implanted lead, and a first clamping member movable between a clamping position to clamp the lead and an unclamping position to unclamp the lead. The extractor and lead are relatively movable to remove the lead.

The invention relates to an interventional apparatus comprising an interventional device with a handle (6). The handle comprises a) a first guide (20, 51) guiding an optical fiber, which is also guided within the interventional device, from a first proximal opening (14) of the handle to a distal portion (21) of the handle, wherein the first guide only has radii of curvature being larger than 10 mm, and b) a second guide (22) for guiding an elongated interventional instrument from a second proximal opening (13) of the handle to the distal portion of the handle. Since the first guide is relatively straight, the optical fiber is substantially not bent or only slightly bent and the likelihood that the interventional instrument and the optical fiber press against each other can be significantly reduced. This allows for an improved accuracy of determining the position of the interventional device by optical shape sensing.

This disclosure relates to surgical instruments with selectively rotating handles. In certain aspects, the surgical device includes a conduit having a longitudinal axis and configured to extend into a body lumen, and a handle coupled to the conduit and configured to selectively rotate relative to the conduit. The handle is coupled to the conduit by a connection including a clutch mechanism, and the handle is configured to rotate in response to a user activation of the clutch mechanism.

Systems for providing access across a site of obstruction and methods for manufacturing and using such systems. Such systems may include a sleeve having an inflation lumen; a bushing disposed in a distal section of the sleeve; and an everting member coupled to the sleeve with the bushing, the everting member being movable from an inverted position inside the sleeve to an everted position outside the sleeve in response to an increase in pressure in the inflation lumen.

The present disclosure pertains to devices and methods for diagnosis and treatment of biological tissue in which the tissue is accessed by a catheter through a working channel of an endoscope and in which the degree of extension of a distal tip of the catheter beyond a distal tip of the endoscope is controlled.

Apparatus and methods for delivery of an implant at a target site in an interior of a bone. The apparatus may include a plate. The plate may include a bottom surface complementing a surface contour of a bone. The plate may define first holes sized for receiving screws. The plate may define second holes sized for receiving fixation elements. The plate may define an opening. The opening may be sized for providing passage of the implant through the plate. When the bottom surface is seated complementarily against the surface contour, the first holes may point into an interior of the bone and into a volume occupied by the implant in the interior when the implant is positioned at a target site and radially expanded to form a mesh cage.