A surgical instrument includes a transducer assembly with a housing having a conduit section and a base portion. A fluid passageway is defined through the conduit and base portion, an ultrasonic transducer including a plurality of piezoelectric elements and a plurality of electrodes are arranged in a stack configuration, where an electrode is located between each pair of piezoelectric elements. A first borehole is defined through the ultrasonic transducer and an end mass having a second borehole defined therethrough. A surface of the end mass is positioned adjacent a first end of the ultrasonic transducer, the end mass is configured to engage with the housing, and the conduit section of the housing is configured to pass through the second borehole of the end mass. The end mass is configured to compress the ultrasonic transducer against a surface of the housing when the end mass is engaged with the housing.

A surgical instrument includes a transducer assembly with a housing having a conduit section and a base portion. A fluid passageway is defined through the conduit and base portion, an ultrasonic transducer including a plurality of piezoelectric elements and a plurality of electrodes are arranged in a stack configuration, where an electrode is located between each pair of piezoelectric elements. A first borehole is defined through the ultrasonic transducer and an end mass having a second borehole defined therethrough. A surface of the end mass is positioned adjacent a first end of the ultrasonic transducer, the end mass is configured to engage with the housing, and the conduit section of the housing is configured to pass through the second borehole of the end mass. The end mass is configured to compress the ultrasonic transducer against a surface of the housing when the end mass is engaged with the housing.

A fastening system includes first and second fastening members and a penetrating member. The first fastening member includes a backspan and a set of lobes that extend from the backspan. The second fastening member includes a backspan and a set of lobes that extend from the backspan. The penetrating member includes a first body which is substantially planar, a set of teeth, and a first trailing wall that extends from the first body orthogonal to a plane that is defined by the first body. The set of teeth extend from a leading edge of the first body which is opposite a trailing edge of the first body and are configured to pierce and spread tissue over the set of lobes of the first fastening member. The first trailing wall is configured to support the backspan of the first fastening member.

A fastening system includes first and second fastening members and a penetrating member. The first fastening member includes a backspan and a set of lobes that extend from the backspan. The second fastening member includes a backspan and a set of lobes that extend from the backspan. The penetrating member includes a first body which is substantially planar, a set of teeth, and a first trailing wall that extends from the first body orthogonal to a plane that is defined by the first body. The set of teeth extend from a leading edge of the first body which is opposite a trailing edge of the first body and are configured to pierce and spread tissue over the set of lobes of the first fastening member. The first trailing wall is configured to support the backspan of the first fastening member.

A device for joining two layers of tissue, comprises a substantially flat and flexible scaffold having an upper surface, a lower surface and sidewalls; a plurality of first passages penetrating said scaffold from said upper surface to said lower surface; a plurality of second passages penetrating said scaffold from said upper surface to said lower surface; a substantially flat and flexible top cover releasably attached to said upper surface and covering all of said upper surface; said top cover having a plurality of top cover passages aligned with said first plurality of passages.

Systems and methods for creating autologous monocuspid and bicuspid valves can include a catheter having a single expandable element or a double expandable element. Once the leaflets of the valve are created, various techniques can be used to fix the leaflets to the vessel wall or to each other, including clips, tissue anchors, adhesives, and heat.

Surgical tissue fusion instrument and support structure having two gripping structures which are movable relative to each other and which are designed to bring together biological tissue sections that are to be connected to each other, with heat-generating means which are assigned to the gripping structures and, during tissue fusion, cause heat to be introduced in the area of a connection site of the biological tissue sections, and also with a support structure which is held between the gripping structures and, during tissue fusion, is operatively connected to the tissue sections. The support structure has at least one additional physical functional structure for aiding or promoting the tissue fusion.

An instrument and method for applying thermal energy to targeted tissue. An instrument and method for tissue thermotherapy. In one embodiment, a method includes providing a vapor source comprising a pump configured for providing a flow of liquid media from a liquid media source into a vaporization chamber having a heating mechanism, actuating the pump to provide the liquid into the vaporization chamber, applying energy from the heating mechanism to convert a substantially water liquid media into a minimum water vapor level for causing an intended effect in tissue. For examples such levels can comprise at least 60% water vapor, at least 70% water vapor, at least 80% water vapor or at least 90% water vapor for causing an intended effect in tissue.

Systems and methods for creating autologous monocuspid and bicuspid valves can include a catheter having a single expandable element or a double expandable element. Once the leaflets of the valve are created, various techniques can be used to fix the leaflets to the vessel wall or to each other, including clips, tissue anchors, adhesives, and heat.

A method of creating an AV fistula between adjacent first and second blood vessels, includes steps of cutting a hole through the adjacent walls of the first and second blood vessels and inserting a welding catheter into the first vessel, and through the hole into the second vessel, so that a distal end of the welding catheter is disposed within the second vessel. A portion of wall defining the welding catheter is then expanded radially outwardly, and the expanded wall portion is pulled proximally to engage the wall of the second blood vessel and to pull it toward the wall of the first blood vessel. Then, a portion of wall proximal to the first expanded wall portion and disposed in the first blood vessel is expanded radially outwardly, thereby capturing the walls of each of the second and first blood vessels between the two expanded wall portions. Cutting elements on the expanded wall portions are then energized to create a tissue welded elongate aperture between the first and second blood vessels.