The invention comprises a system, method, and apparatus for securing two ends of a ruptured or partially ruptured tendon in the hand or wrist during a repair, recession, or revision procedure. During this tenorrhaphy, anchoring material is inserted into the proximal ruptured surface of the tendon by an apparatus comprising multiple needles of at least two different types. Connecting material spans the site of tenorrhaphy of a ruptured tendon, or a multiplicity of ruptured tendons. In some embodiments, interlocking patterns of loop and helical suture are inserted by straight and helical needles, respectively.

An access system includes a proximal handle, an overtube coupled to the handle, and an endoscope port extending through handle and overtube sized for receiving an endoscope therethrough. The overtube includes anatomic wall securing system that secures a distal portion of the overtube within a hole in the anatomic wall. The overtube is provided with a shaped distal portion or a controllably shapeable distal portion that aids in directing an endoscope inserted through the port to a particular location within the peritoneal cavity. The access system includes a system for insufflating/deflating the peritoneal space separately from the body cavity accessible via a natural orifice. The access system includes a closure system to cinch closed the hole made in the anatomical wall after the access system has been removed from the hole. Methods are provided for inserting the access system through the anatomical wall to perform intra-abdominal surgery.

A loader for a surgical suturing instrument is disclosed. The loader has a head having a protrusion configured to be releasably held by a tissue bite area of a surgical suturing instrument. The loader also has a tube interface. The loader further has one or more ferrule holders. The loader also has one or more ferrules, each corresponding to and held by one of the one or more ferrule holders and coupled to a suture end that leads from a tube releasably held by the tube interface.

A medical device for installing sutures to close an incision in tissue or human skin is disclosed. The suturing device may provide first and second arcuate needles. Once properly positioned, the first and second arcuate needles are driven through the sub-dermal layer, or alternatively through a superficial surface, of two sections of skin to be joined. This is done in arcuate fashion and at identical and symmetrical rates of angular displacement. During the driving or retraction process of the first and second arcuate needles, a suture is positioned within both the first and second sections of skin and transformed from a planar or a multi-planar serpentine orientation to a helical orientation. The resulting suturing process is thus much faster than conventional or manual suturing and results in superior wound approximation/alignment that will lead to decreased scarring compared to prior art devices.

Techniques are described for closure of a defect in material, such as closure of a laparoscopic surgical defect. A defect closure device can be inserted into the defect to capture first material adjacent to the defect. The device houses at least first and second suture pins coupled together by a suture. A first interaction with a trigger structure can force the first suture pin through the captured first material and into a containment sub-assembly. After rotating the device to capture second material adjacent to the defect, a second interaction with the trigger structure can force the second suture pin through the captured second material and into the containment sub-assembly. As such, the suture is passed through the first and second portions of the material, and the ends of the suture can be cinched, and cut to form a stitch.

The double “J” laparoscopic fascial closure device has a fixed jaw and a movable jaw pivotally attached to the fixed jaw. An elongated hollow tube or cannula extends from the fixed jaw. The end of the elongated cannula distal from the jaws has two needles mounted thereon defining a double “J” configuration. A spring mechanism or cable guide is attached to the hollow tube, and a cable extends between the fixed jaw and the movable jaw. The other end of the cable extends through the elongated hollow tube, through the spacer arms, and back towards the needles at the ends of the needle mount arms. A suture thread is attached to both needles so that the thread bridges the gap between fascia on opposite sides of the laparoscopic port incision when the needles are draw back through the fascia towards the incision.

A method for closing a puncture in tissue that includes advancing a guide member into proximity with the tissue, the guide member having a needle guide, positioning a distal end of the guide member with the needle guide toward the tissue to present an opening of the needle guide toward the tissue the needle guide cooperating with a suture securing device that is slidably coupled to the guide member and a suture attached to the suture securing device, deploying the suture securing device, the suture securing device comprising a body with an anchor point for the suture and features that allow the suture securing device to pierce the tissue and resist retraction through the tissue, and establishing tension in the suture to move the suture securing device toward another suture securing device to thereby close the puncture in the tissue.

An end effector including an anvil and a staple cartridge assembly is disclosed. The staple cartridge assembly comprises a deck having steps defined thereon for compressing tissue positioned between the anvil and the staple cartridge assembly to different pressures. The staple cartridge assembly further comprises staples having different unformed heights removably stored therein. The staples are deformed against the anvil to different formed heights.

Suture passer systems for tissue suspension and tissue compression, and more particularly for tongue suspension, are described. The system can include at least a first elongate tubular body or shaft, a needle having a lateral bias carried by the elongate body, and a retrieval element operably connected to the elongate tubular body. The needle can have a substantially straight configuration when located within the elongate tubular body, and be configured to exit an opening at or near a distal end of the elongate tubular body and assume a laterally biased or curved shape to form a path through tissue. The needle is configured to carry a suture. The retrieval element can be configured to retrieve the suture carried by the needle after the needle has formed a curved or otherwise angled path through tissue. The system can also include one or more bone anchors to secure the suture loops. Methods of placing one or more suture loops into tissue, such as the base of the tongue, are also described.

A method and apparatus for positioning a locator. The method includes inserting a tissue locator through an opening in a tissue wall, and distally advancing a proximal member, positioned proximal a proximal end of a first arm of the tissue locator, to move a portion of the first arm from a first position to a second position that is separated from a longitudinal axis of the tissue locator by a greater distance than the first position.