A therapeutic instrument for the ergonomic, effective and safe opening and closing of targeted remote tissue sites; includes a pistol grip style handle with a hand activated lever for needle deployment and, optionally, with features to control tissue cutting and guide wire installation; also incorporates a specialized elongated rigid or flexible instrument shaft, which enables vacuum assisted holding of tissue at a uniquely contoured distal tip, where placement of a suture in a purse string configures occurs along with, if desired, tissue cutting and guide wire passage.

Described here are methods and systems for the manipulation of ovarian tissues. The methods and systems may be used in the treatment of polycystic ovary syndrome (PCOS). The systems and methods may be useful in the treatment of infertility associated with PCOS.

A method for creating a tract for percutaneous endoscopic guided gastrointestinal tube creation including the steps of providing a puncture wire having a sharp tissue penetrating tip shielded in a sheath, the puncture wire slidable within the sheath and releasably lockingly engaged thereto; inserting the puncture wire and sheath in a first direction through a working channel of an endoscope to exit the channel of the endoscope, then releasing the puncture wire from the sheath and advancing the puncture wire from the sheath while visualizing via the endoscope the position of the puncture wire, and further advancing the puncture wire through the visceral wall and then the abdominal wall of a patient. Subsequent methods to position a percutaneous gastrointestinal catheter after initial wire puncture are described.

Devices and methods that provide minimally-invasive approaches to performing treatments on soft tissue, such as that found in the bladder using various natural access paths such as transvaginal and transurethral. Treatments include the application of energy to nerves found in, under and around the trigone region of the bladder.

An apparatus for treating obesity of a patient having a stomach with a food cavity. The apparatus comprising a volume filling device adapted to be at least substantially invaginated by a stomach wall portion of the patient with the outer surface of the volume filling device resting against the stomach wall, such that the volume of the food cavity is reduced in size by a volume substantially exceeding the volume of the volume filling device. The apparatus further comprises at least one adjustable stretching device adapted to be at least substantially invaginated by a stomach wall portion of the patient with the outer surface of the stretching device resting against the stomach wall and adapted to stretch a portion of stomach wall, and a fluid connection device interconnecting the volume filling device and the stretching device.

A system can include an elongated member that includes a proximal portion and a distal portion that includes an agitator. The elongated member can extend through a working channel of an endoscope placed within a patient such that the agitator extends past a distal end of the endoscope into a target region within the patient. The agitator can include a plurality of disruption elements that can be in a low-profile state when within the working channel of the endoscope and can transition to an expanded state when advanced past the distal end of the endoscope. The plurality of disruption elements can define an empty cage configuration when in the expanded state. The system can include a driver coupled to the proximal portion of the elongated member. The driver can rotate the elongated member about a longitudinal axis of the elongated member.

A method for removing materials from a subject can include inserting an endoscope into the subject through an esophagus of the subject; introducing, through a cavity wall of a stomach of the subject to access a site within the subject outside the stomach, an endoscopic tool coupled with the endoscope; actuating a cutting assembly of the endoscopic tool to cut material at the site, the material associated with at least one of a pancreatic fluid collection in a pancreas of the subject or an extra-pancreatic fluid collection external to the pancreas; and applying suction to a first end of an aspiration channel of the endoscopic tool to remove the material through the aspiration channel, the aspiration channel extending from the first end to a second end at an opening of the cutting assembly.

Vascular access devices and methods of their use are provided. In one embodiment, a vascular access device includes a catheter (112) and at least one deployable wire (134). The catheter includes a primary lumen extending from a proximal end to a distal end of the catheter. The at least one deployable wire is secured to the catheter and configured to move relative to the catheter between a delivery configuration and a deployed configuration.

Tissue anchors comprise a woven filament braid body having an elongated tubular configuration and a foreshortened configuration where proximal and distal ends of the body expand radially into double-walled flange structures while leaving a cylindrical saddle region therebetween. The tissue anchors are deployed through penetrations between adjacent tissue layers, where the flanges engage the outer surfaces of the tissue layers and the saddle region resides within the tissue penetrations.

A device for use in bariatric surgery includes a flexible hollow tube extending from a proximal end to a distal end and defines a channel therebetween. A series of openings is defined in a distal portion of the tube allowing for fixation of tissue using suction. A flexible member has an initial position disposed alongside the tube and is deployable to a subsequent position in which the flexible member engages a greater curvature of a stomach. The flexible member is configured to be deployable to automatically assume a shape of a greater curvature of a stomach. The flexible member includes a bulging region and a tapering region when deployed. The flexible member is releasably attached to the distal end of the tube.