According to an aspect of the present disclosure, an end effector for use with a surgical device is provided. The end effector includes a drive assembly, a driver, a needle assembly and a biasing element. The driver is disposed in mechanical cooperation with the drive assembly. Rotation of the drive assembly in a first direction causes distal translation of the driver with respect to the drive assembly. The needle assembly is disposed in mechanical cooperation with the driver. Distal translation of the driver causes a corresponding distal translation of the needle assembly. The biasing element is disposed in mechanical cooperation with the needle assembly and is configured to bias the needle assembly proximally.

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. Tissue augmentation constructs can include various blocks and scaffolds, among other formations. The present disclosure includes, among other disclosures, methods for using tissue augmentation scaffolds, including folding scaffolds, and descriptions and methods associated with extra-wide tissue augmentation blocks.

A clip and a clip deployment and delivery system. The clip may be engaged with a clip spreader such that simple relative movement, such as sliding movement, between the clip and clip spreader causes the clip and clip spreader to disengage from each other. A clip spreader actuator may be coupled to one arm of the clip spreader, extend distally around a distal end of the clip spreader, proximally along the other clip spreader arm, and to a proximal end at which the actuator may be controlled to open or close the clip spreader. The clips may be leaflet clips having teeth on one arm thereof and bumps on another arm thereof. The arms of the leaflet clip may be biased into a closed configuration by a flex zone which has an expanded portion extending laterally away from only one of the clip arms.

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.

A toggle-type suture anchor that incorporates individual suture tensioning and locking without knot tying. The anchor includes several exemplary designs of toggle bodies having a working suture pre-threaded through one or more passages therethrough. A locking suture loop is pre-threaded relative to the working suture and includes a collapsible loop that encircles a portion of the length of suture running longitudinally adjacent the side of the anchor. With the loop open, the working suture can slide through the anchor, however, when the loop is closed the working suture is locked in position to retain tension on the working suture. Alternatively, the locking suture loop can be replaced with a mechanical locking member that moves from a first unlocked to a second locked position. The exemplary anchors can be utilized in a pre-strung connected array of anchors.

Methods and apparatus for creating a seam like array of suture stitches joined in series by sequential anchors in bone. The anchors are transtendon implants positioned through the tendon in the original tendon footprint and each array includes four or more anchors. The seam like array extends across at least a portion of the tendon. The stitches can extend generally perpendicular to the direction of the tendon orientation. In rotator cuff repair, the anchors are positioned in the original footprints of the infraspinatus and/or supraspinatus tendons and the seam like array extends in an anterior to posterior direction across the particular tendons torn and repaired. The entire array of anchors can be positioned in the medial half of the original footprints.

A system of toggle type suture anchors is disclosed. The plurality of suture anchors is connected in series by a plurality of independently cinchable working suture loops with one working suture loop connecting each pair of anchors in series to form a chain. Each of the suture anchors as connected by working suture loops allows tensioning of the working suture between itself and the prior anchor implanted in the serial string. Further, each anchor includes a loop type locking mechanism to lock the cinchable working suture loop subsequent to tensioning so that the loop remains fixed in size during cyclic loading during joint use. This creates an independently tensioned suture stitch between each implanted suture anchor and the just previously implanted anchor. In total the system as implanted creates a high density, continuous array of anchor-to-anchor stitches for robust securement of soft tissue to bone.

A distal end of a guide catheter is transvascularly advanced into a left ventricle of a heart of a subject. While the distal end of the guide catheter remains disposed in the left ventricle, a first tissue anchor of an implant is deployed from the distal end of the guide catheter. Subsequently, the guide catheter is retracted while progressively exposing the implant. Subsequently, a second tissue anchor of the implant is anchored to a posterior annulus of a mitral valve of the heart by deploying at least part of the second anchor within a left atrium of the heart, such that the implant extends from the first tissue anchor, over an atrial side of a posterior leaflet of the mitral valve, and to the second tissue anchor. Other embodiments are also described.

Disclosed are radially expanding debridement tools configured to pass through an access channel present in a first tissue of a living being, expand radially, and create a void in a second tissue of the living being upon being advanced distally through the access channel and into the second tissue while being rotated, wherein the shape of the void comprises at least one step. Further disclosed are debridement systems and methods of treating tissue defects in living beings.

Systems, devices and methods for securing tissue including the annulus of a mitral valve. The systems, devices and methods may employ catheter based techniques and devices to plicate tissue and perform an annuloplasty.