A minimally invasive surgical method of approximating tissue includes coupling an adjustable loop of suture around an inserter. The loop can be coupled to the inserter by applying tension to a tail of the suture to collapse the loop around the inserter, then the inserter and loop are passed through a first location in tissue. The loop is decoupled from the inserter, the inserter is retracted from the first location, and reinserted into a second location in the tissue, after which the loop is recoupled to the inserter while the loop is distal of the tissue. The decoupling, retraction, and reinsertion can occur without withdrawing the inserter from the patient's body. The inserter and loop are then withdrawn together from the tissue through this second location and outside of the patient's body. The tails and loop can form a luggage knot to be reduced around the tissue.

An implanted tongue pulling device including a pull plate, a pull line, a retractor and a method thereof are provided. The tongue pulling device is implanted in the mandible and tongue of a human body, respectively, for tightening the tongue dorsum and/or the tongue base for treating obstructive sleep apnea/hypopnea syndrome (OSAHS). At least three pull lines are used for positioning the pull plate, which is a flat object implanted beneath the tongue dorsum and/or the mucous membrane of the tongue base and includes through holes for the growth of tissues and pull line fixing mechanisms. The pull line includes a draw line and a sleeve. The retractor includes a casing, a control switch and a pull line fixing device mounted on the casing. A patient after surgery can adjust the tightening extent of the implanted tongue pulling device by pressing the skin outside the control switch, thereby preventing OSAHS.

Among other things, methods and apparatus for inserting devices for closing tissue openings are disclosed. Examples may include a handle, sheath and/or sleeve for insertion into a patient and through or adjacent a tissue defect, fistula, or other tissue opening to be closed. Winding mechanisms for operation in or with such inserting devices are also described.

Among other things, there are disclosed embodiments of belts or bands that can be used in treatments for tricuspid valve regurgitation. In some embodiments, such belts may be heat-set in a particular configuration to effectively decrease tricuspid annulus when deployed around the atrioventricular groove. Embodiments include one or more tensioning sutures for applying cinching or tightening to belts when deployed, and structure for effectively distributing force during such tightening.

A knotless self-cinching suture construct device includes a continuous loop and a self-cinching suture member. The suture is configured for insertion into a passage hole in injured soft tissue, such as a torn or damaged meniscus in the knee. The suture and continuous loop are passed entirely through the passage hole in the tissue, and the self-cinching suture member is inserted through the continuous loop to form a hitch using the continuous loop around the tissue. The self-cinching suture member is then pulled tight, allowing a first strand to slide through both the hitched continuous loop and a self-cinching sleeve on the suture member. When tension is applied, the sleeve tightens around the strand much like a finger trap, preventing inadvertent release of the applied suture tension. The suture construct is configured for use through a transosseous tunnel with a detent structure in some embodiments.

Systems and methods for sealing an opening in a wall within the body of a patient are disclosed. In one embodiment, the system has an elongated body coupled to a vascular closure device and a resisting member, the elongated body having a high resistance portion and a low resistance portion and being constructed and arranged to interface with a resisting member to apply a conforming force to a vascular closure device. In some exemplary embodiments, the elongated body comprises a large diameter portion positioned in a proximal end region of the elongated body. Methods and other embodiments are disclosed.

Tissue repair systems which use knotless all-suture anchors and have the ability to lock multiple repair sutures within the anchor construct. The anchor construct includes a tension suture wrapped or looped upon itself to create an open eyelet, through which multiple repair sutures originating in soft tissue are passed. The location of the eyelet may be anywhere inside the all-suture anchor or adjacent to the exterior of the anchor body. Tensioning of the tension suture causes the eyelet to restrict movement of the repair sutures and secures them within or against the anchor body.

Devices, systems, and methods to improve both the reliability of soft tissue repair procedures and the speed at which the procedures are completed are provided. The devices and systems include one or more tissue augmentation constructs, which include constructs that are configured to increase a footprint across which suture applied force to tissue when the suture is tied down onto the tissue. The tissue augmentation constructs can be quickly and easily associated with the repair suture, and can be useful in many different tissue repair procedures that are disclosed in the application. In one exemplary embodiment, one or more constructs are disposed on a suture threader, which can be used to associate the construct(s) with a repair suture(s) being used to repair the soft tissue. Tissue augmentation constructs can include various blocks and patches, among other formations. Exemplary methods for manufacturing the tissue augmentation constructs are also provided.

A suture anchor driver has an elongated shaft, a handle at a proximal end of the shaft an anchor engagement at a distal end of the shaft and a clutch between the handle and the shaft. The clutch includes a slot for frictionally engaging a suture an engagement with the shaft and an engagement with the handle. The engagement with the shaft and the engagement with the handle are located with respect to one another such that driving torque applied to the handle urges open the slot to release its frictional engagement of the suture.

Apparatus is provided that includes first and second tissue-engaging elements, and first and second flexible longitudinal members, coupled at respective first end portions thereof to the first and the second tissue-engaging elements, respectively. The apparatus further includes a first flexible-longitudinal-member-coupling element coupled to a second end portion of the first flexible longitudinal member, a second flexible-longitudinal-member-coupling element coupled to a second end portion of the second flexible longitudinal member, and a flexible longitudinal guide member reversibly coupled to the first flexible-longitudinal-member-coupling element. The first and second flexible-longitudinal-member-coupling elements are configured to be couplable together to couple together the first and the second flexible longitudinal elements. Other applications are also described.