Apparatus and methods are provided for occluding blood vessels and other anatomical structures. Occlusion devices are delivered percutaneously and extraluminally through a small gauge needle and include expandable elements that are deployable on opposite sides of a target vessel to be occluded. When positioned about the vessel the elements are expanded and brought together to compress and occlude the vessel. Embodiments include those adapted for temporary as well as permanent use.

Drill guides allow an implant to be partially inserted after the holes are drilled and before the drill guide has been removed from the surgical location.

An improved system for attaching devices to the distal end of endoscopic instruments is described. An attachment adapter comprises a distal stop, such as a complete or partial loop or cylinder, which limits the penetration of an endoscope into the adapter. The adapter has at least one flange protruding proximally along the endoscope. The adapter is secured on the endoscope by a securing means, which compresses the flange or flanges sufficiently to provide a friction fit. The flexibility of the inventive adapter system allows the adapter to work reliably with endoscopes that are used, damaged or repaired. The adapter may further provide a slit or window allowing viewing of the vessel wall by a lens on an endoscope, thereby improving the operator's ability to understand the location of the endoscope during operation. The adapter may carry any of a variety of devices, including devices for closing a surgical incision, or treating or manipulating tissue. Improvements are described in a number of areas to allow more flexible pairing of particular endoscopes or endoscopic instruments with devices to be carried on their exteriors, while maintaining a tightly locked position of the external device on the carrier.

A closure system configured to facilitate hemostasis at a puncture of a vessel includes a delivery sheath that extends longitudinally from a proximal end to a distal end. The delivery sheath defines a lumen extending therethrough. The delivery sheath lumen is configured to receive a first guidewire therethrough. The system also includes an introducer needle coupled to the delivery sheath at an offset relative to the delivery sheath. The introducer needle defines a lumen extending therethrough. The introducer needle lumen is configured to receive a second guidewire therethrough.

A biodegradable scaffold for wound closure including a central rod and two spaced plates. The central rod may have an engagement block on top for stabilizing a implanting tool. The two spaced plates include an upper plate connected to the central rod and a lower plate connected to the central rod. Each of the upper and lower plates may include perforations which may be useful for detachably connecting an implanting tool and which encourage growth of the tissue. The biodegradable scaffold allows tension free anatomical alignment of tissue within the plates and facilitate wound healing. The upper and lower plate may have a helical, in which each plate may extend around the central rod greater than 360 degrees. The helical shape creates a camber feature that serves to draw or pull tissue around the wound defect into the scaffold during the course when deploying the scaffold.

A vascular closure system for sealing an opening in a blood vessel may include an introducer sheath extending through the opening, the introducer sheath having a lumen extending through the introducer sheath, wherein partial withdrawal of the introducer sheath from the opening everts tissue of the blood vessel at the opening, and a shaping sheath slidably disposed over the introducer sheath, the shaping sheath having a split distal portion configured to engage the everted tissue.

A surgical instrument includes a shaft and a tissue fastener. The tissue fastener is releasably attached to the distal end portion of the shaft. The shaft is operable to rotatably drive the tissue fastener about a longitudinal axis of the shaft. The tissue fastener includes a base, first and second arms, and barbs. The first and second arms extend laterally and longitudinally from the base and are configured to be received within a first and second tissue portion, respectively. The first and second arms are configured to draw the first tissue portion against the second tissue portion. The barbs extend from the first and second arms and are configured to anchor the first and second arms within the first and second tissue portions. The shaft is configured to release the tissue fastener thereby securing the first tissue portion against the second tissue portion with the tissue fastener anchored therein.

A medical device and methods for hemostasis in a living body are disclosed. The medical device including a base configured to arranged on an upper surface of the tissue in the living body; a plurality of levers, each of the plurality of levers having a needle arranged on a lower surface thereof and configured to puncture the tissue in the living body, and wherein the plurality of lever are configured to be received with a slot or track of the base; and at least one tie, the at least one tie configured to hold together the plurality levers and needles upon compressing the tissue in the living body upon moving the plurality of levers inward in the slot or track of the base.

A fastener delivery tool may comprise a sheath assembly having at least one position retention member proximate a distal end of the sheath assembly, and a handle assembly coupled to a proximal end of the sheath assembly, the handle assembly comprising a housing, a trigger handle, and an insert connector. An external force applied to the trigger handle may cause displacement of the trigger handle relative to a rest position, and displacement of the trigger handle from the rest position within a first displacement range may impart a first amount of force on the insert connector relative to the applied external force and displacement of the trigger handle from the rest position within a second displacement range may impart a second amount of force on the insert connector relative to the applied external force, with the first amount of force being greater than the second amount of force.

A closure system configured to facilitate hemostasis at a puncture of a vessel includes a delivery sheath that extends longitudinally from a delivery sheath proximal end to a delivery sheath distal end. The delivery sheath defines a delivery sheath lumen extending therethrough and configured to receive a first guidewire therethrough. The system also includes an introducer needle configured to selectively couple to the delivery sheath for movement relative to the delivery sheath. The introducer needle is configured to form a secondary access site in the vessel at an offset from the puncture after the delivery sheath distal end is advanced through the puncture. The system further includes a stylet configured to be received through the delivery sheath lumen adjacent to the first guidewire. The stylet includes a stylet magnet configured to magnetically couple to a guidewire magnet of a second guidewire advanced through the secondary access site.