Devices and methods of endolumenal formation of gastric sleeves are described. Some embodiments allow templating of a gastric sleeve by a gastric bougie, exposing a selected amount of tissue for suturing access, while maintaining sufficient internal working space for suturing within the template lumen.

A suturing device is provided. The suturing device may include at least one suturing needle, a drive mechanism and an impulse mechanism. The drive mechanism may be operatively coupled to the suturing needle and configured to advance the suturing needle from a retracted position to an extended position during engagement, and retract the suturing needle from the extended position to the retracted position during disengagement. The impulse mechanism may be operatively coupled to the drive mechanism and configured to accumulate energy during engagement of the suturing needle, and instantaneously release the accumulated energy through the drive mechanism during disengagement.

A machine constructed and configured for automatic continuous suturing for reduced or minimized scarring and reduced suturing time, including methods of using the same. A device for continuous suturing. A device, method and suture for subcuticular suturing.

One embodiment is directed to a system for closing a wound created at least partially across a tissue structure wall, comprising: a helical needle; a suture member coupled to the helical needle and configured to be pulled along a helical pattern with helical movement of the helical needle; an outer delivery member rotatably coupled to the helical needle; a drive shaft axially movably coupled to the outer delivery member; and a plurality of suture guide struts projecting distally from the outer delivery member; wherein upon helical insertion of the helical needle relative to the outer delivery member, the helical needle is advanced such that it becomes disposed around the guide struts, such that the guide struts prevent radial migration of the suture as it is helically wound into the tissue structure.

A method and device for anchoring a length of self-retaining suture. The method of anchoring includes providing for an assembly having a length of self-retaining suture and a suture insertion device. The length of suture includes at least a portion of the length having a plurality of retainers thereon extending in a first direction. The insertion device has a length and a recess to receive a portion of the suture length. The method further includes placing a portion of the suture length in the recess and inserting the device into the body of a mammal until the recess reaches a predetermined location thereby forming an insertion pathway. The method further includes retrieving the insertion device from the body by moving the insertion device in a direction substantially opposed to the insertion pathway.

A suture stitch or a series of suture stitches with loops underneath and substantially parallel to the surface of a tissue for subcuticular suturing for reduced or minimized scarring and reduced suturing time. Each subsequent stitch connects with the previous suture through material across the diameter. The suture stitch or series of suture stitches include one or more knots acting as anchors for the first loop in the suture stitch or series of suture stitches, and the suture stitch or series of suture stitches are preferably administered via an automated suturing device.

Described are methods and apparatus for use in supporting tissue in a patient's body. In some embodiments, the patient's breast or another tissue is supported. One method involves introducing a superior soft tissue anchor into a patient, the anchor having an inferiorly facing total surface area; and introducing at least one inferior soft tissue anchor into the patient, such that the at least one inferior soft tissue anchor is suspended from the superior soft tissue anchor, the sum of all of the at least one inferior soft tissue anchors having a superiorly facing total surface area. The inferiorly facing total surface area of the superior anchor can be greater, such as at least two times greater than the superiorly facing total surface area of the at least one inferior anchor.

A device for suturing an incision in an artery has a handle, a supply of suture stored on spindle housed in the handle, a tube extending from the handle having a lumen through which suture extends, and a curved needle at a distal end of the handle, the curved needle having an opening through which a free end of the suture extends. A method for suturing an incision in an artery includes creating sequential openings in first and second flaps of the incision, with loops of suture extending through openings in one flap, with a free end of suture extending through the second flap being pulled through the loops and secured to another free end of suture extending through the first flap, to close the incision.

A method includes engaging a clamp over a length of tissue to be sutured. A helical needle is advanced along a length of the clamp such that the helical needle passes through the tissue to be sutured. A leading end of a suturing thread is attached at a tip of the helical needle. The leading end of the suturing thread is captured. The helical needle is retracted back through the tissue so as to leave the thread in place. The clamp is disengaged from the tissue. A device for automatic suturing includes a clamp configured to be positioned over a length of tissues to be sutured. A helical needle is configured to be advanced and retracted along a length of the clamp. The needle has a tip. A suturing thread having a leading end is attached to the tip of the helical needle.

A surgical instrument comprising a shiftable transmission is disclosed. The transmission comprises a mechanism for assuring that the transmission is in one of a plurality of predefined configurations.