The invention provides methods and devices for treating liver cirrhosis or portal hypertension by creating an intrahepatic shunt, or new passage, from a portal vein of a patient to a hepatic vein using a device with intravascular imaging capabilities and pressure sensing capabilities or positioning mechanisms. The integration of intravascular imaging aids in the precise placement of the shunt and pressure measurement may verify successful shunt creation. An apparatus may include a catheter with an extended body for insertion into a hepatic vein of a patient, an intravascular imaging device and a needle exit port on the distal portion of the extended body, and a needle disposed within a lumen in the catheter and configured to be pushed out of the exit port and extend away from a side of the extended body, in which the needle includes a pressure sensor.

Surgical devices and systems are provided for performing wound closure. For example, a wound closure member is provided with an anchor, a spring member, and a body extending therebetween. The wound closure member is configured to apply an adjustable closure force to tissue to close a wound. Delivery instruments are additionally provided.

Devices, systems, and methods for drawing tissue walls together using a first tissue anchoring element and a second tissue anchoring element spaced apart from each other. The first tissue anchoring element is thinner than the second tissue anchoring element. The first tissue anchoring element may be a suture, optionally including a suture anchor. The second tissue anchoring element may be an expandable tissue anchoring element, such as a stent, expandable from a delivery configuration to a deployed configuration. The second tissue anchoring element may have a passage therethrough allowing passage of materials through the tissue walls, and creating an anastomosis therebetween.

A vessel closure device including a proximal end including a handle with first and second actuators, a distal end including a suturing mechanism, and first and second needles associated with the suturing mechanism. At least one of the first and second needles is coupled to the first actuator. The second actuator is coupled to the suturing mechanism. The suturing mechanism includes a pivotal element capable of being moved by the second actuator between an insertion and removal orientation, a first deployed orientation, and a second deployed orientation. The suturing mechanism is activated within the vessel through an opening in the wall of the vessel and the first and second needles are directed through the vessel wall adjacent to the opening to direct a tensile member adjacent to the opening for closing and sealing the opening.

A purse string suture passing device includes a clamp member and a suture passer housing assembly. The clamp member is dimensioned to be received within a guide channel of the suture passer housing assembly and includes two jaws that each define a longitudinal passage. The suture passer housing assembly includes two needles that are supported within the guide channel and are received within the longitudinal passages of the clamp member as the clamp member is inserted through the guide channel. Each of the needles receives a suture passer that includes a distal portion that is configured to engage a suture after the clamp member is received within the guide channel. When the suture is attached to the suture passers, the clamp member can be removed from the guide channel to apply a purse string suture to the tissue.

Tensionable, knotless, self-locking surgical constructs and methods for surgical repairs are disclosed. A tensionable, knotless, self-locking surgical construct includes two self-locking, tensionable, knotless independent mechanisms loaded onto a fixation device, one of the two self-locking, tensionable, knotless, independent mechanisms including a preformed, flexible, continuous, uninterrupted loop. The fixation device can be a knotless fixation device such as a hard-body anchor, or a knotless soft anchor such as an all-suture knotless anchor.

A suturing device includes a curved needle, a suture, an elongate body, an actuator and a curved needle holder. The suture connects with the curved needle. The actuator interacts with the elongate body and is operable between a first operating position and a second operating position. The curved needle holder extends away from a distal end portion or is provided as part of the distal end portion of the elongate body. The curved needle holder includes a distal end section having a distal-most tip. The curved needle holder includes an inner surface defining a needle passage for holding the needle and a distal opening. The curved needle has a curved needle radius and the curved needle passage has a curved needle passage radius that is different than the curved needle radius and the curved needle frictionally engages the inner surface when the needle is in a retracted position.

A suture assembly includes a translation assembly that is axially translatable within a working channel of an endoscope and is adapted to releasably secure and/or release a needle and a distal end cap that is securable to an end of the endoscope and is adapted to releasably secure and/or release the needle in order to pass the needle back and forth between the translation assembly and the distal cap. An attachment mechanism configured to releasably secure the distal endcap to an end of the endoscope.

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 suture placement system is disclosed. The suture placement system has a plate defining a first opening spaced from a second opening. The suture placement system also has a first lumen having proximal and distal ends, wherein the distal end of the first lumen is coupled to the first opening. The suture placement system further has a second lumen having proximal and distal ends, wherein the distal end of the second lumen is coupled to the second opening. The suture placement system also has a guide coupled to the plate. A method of minimally invasive suture placement is also disclosed.