Disclosed are medical devices for surgical procedures, especially procedures that involve the manipulation of surgical instrument end effectors close to the skin surface at an incision site. In accordance with some embodiments, an instalment access device is configured to couple to a wound retractor at a distal end of the device and to receive a multiple instrument entry guide in a port at the proximal end of the instrument access device, with an envelope (822) between the distal (804) and proximal (812) ends defining a sealed cavity for maintaining insufflation pressure. Various embodiments provide means for rotating an assistant port in the envelope about a port that receives the instrument entry guide without twisting the envelope. Also disclosed are various envelope shapes. Also disclosed is an instrument entry guide that aligns surgical instrument shafts.

Surgical methods involving cutting and sealing tissue include affixing a first adjunct material to tissue at a treatment site, such as by stapling the adjunct to tissue. A second adjunct material is applied to at least a portion of the first adjunct material such that the second adjunct material interacts with the first adjunct material to form a seal in an area of the tissue covered by at least one of the first and the second adjunct material. The resulting tissue sealing structure, which includes a combination of the two adjuncts, is believed to be superior to the sealing properties of either adjunct alone.

A ligation clip cartridge includes a housing and one or more retaining members. The housing defines a plurality of clip recesses that receive ligation clips. The retaining members are positioned on the housing to engage the clips within the housing in an unbiased state to minimize damage to the clip material caused by strain on the clip.

Surgical methods involving cutting and sealing tissue include affixing a first adjunct material to tissue at a treatment site, such as by stapling the adjunct to tissue. A second adjunct material is applied to at least a portion of the first adjunct material such that the second adjunct material interacts with the first adjunct material to form a seal in an area of the tissue covered by at least one of the first and the second adjunct material. The resulting tissue sealing structure, which includes a combination of the two adjuncts, is believed to be superior to the sealing properties of either adjunct alone.

A bone fixation plate comprises a main body formed of a first material and a support member formed of a second, different material and attached to the main body. The main body defines a first set of openings and the support member defines a second set of openings aligned with the first set of openings. For each opening of the first set of openings, a main body circumferential surface is disposed adjacent and continuous with a support member circumferential surface of the second set of openings to define an opening circumferential surface that bounds an opening of the first set of openings and an opening of the second set of openings.

A suturing apparatus comprises an invaginating device secured to a distal end of an endoscope for invaginating two parts of the interior of a wall of a vessel, for example, a stomach to be sutured together to form a gastric sleeve. The invaginating device includes a suction chamber for forming invaginated parts of the interior of the wall of the vessel. A suturing instrument extending through an instrument channel of the endoscope extends into the invaginating device, and is urged into or adjacent the suction chamber for inserting a suture into the invaginated part in the suction chamber. The next invaginated part is then formed, and the suture is inserted into it. The suture is then tightened to draw the two invaginated parts together.

An organizer is provided for holding surgical forceps in a ready position. Each surgical forceps includes a pair of shanks with distal tips, proximal ring handles, and a ratchet mechanism adjacent the ring handles. The organizer has a base, and a wedge-shaped core projecting upwards along a vertical axis from the base. The core has a profile adapted to fit within a respective opening of each respective forceps bounded by the shanks and the ratchet mechanism when the ratchet mechanisms are engaged. A plurality of wings project radially from the core to define a plurality of substantially U-shaped channels between adjacent wings. The channels are configured to nest the shanks of the forceps so that the respective forceps are locked in the grooves by their respective ratchet mechanisms.

Staple cartridge assemblies for use with surgical stapling instruments and methods for manufacturing the same are provided. Scaffolds for use with a surgical staple cartridge and methods for manufacturing the same are also provided.

The invention provides a filter assembly including a string or wire such that a lasso type cincture is effected, said filter being openable and closeable while in deployed within a bodily vessel. A string lengthen or shorting adjustment mechanism, such as a ratchet or reel allows more length of string into the device or alternatively to shorten the length of available string in the system. The described invention, when used to ameliorate venous clots and most arterio-venous dialysis grafts, a filter-tipped aspirator is used downstream from the clot to capture and remove dislocated emboli. A method of using same is disclosed.

Treatment of an aneurysm or other vascular defect can be facilitated or enhanced by an implant delivered with a thermally activated detachment system. A delivery system can include an implant with a proximal portion that defines a port. A pusher device can include arms extending distally from a junction of the pusher device and through the port, with distal sections of the arms disposed within the implant. The arms can, at a certain temperature, transition from engagement with the implant to a shape that facilitates release of the implant. Additionally or alternatively, a coil can engage an outer surface of the implant at the proximal portion and transition to a shape that facilitates release of the implant.