Nipple areolar grafting methods and apparatus are described herein where one variation of a tissue transfer apparatus may generally comprise a first support structure having an elliptical or circular configuration sized to encircle a region of tissue and defining a first opening through the first support structure, a first plurality of piercing features projecting from a first side of the first support structure, a second support structure having an elliptical or circular configuration sized to encircle the region of tissue and defining a second opening which is further configured to encircle the first support structure, and a second plurality of piercing features projecting from a first side of the second support structure such that the first and second piercing features are adjacent to one another.

A surgical stapling system for stapling the tissue of a patient is disclosed. The stapling system comprises a housing, a shaft extending from the housing, and an end effector extending from the shaft. The end effector comprises a plurality of staples removably stored therein and, also, an anvil configured to deform the staples. The stapling system further comprises a firing mechanism configured to deploy the staples along a staple firing path longer than 60 mm, a camera configured to capture an image of the patient tissue, a display, and a controller configured to generate an image of the staple firing path, wherein the images are displayed on the display.

In one embodiment, a method of repairing a heart valve accesses an interior of a patient's beating heart minimally invasively and inserts one or more sutures into each of a plurality of heart valve leaflets with a suturing instrument. The suture ends of the sutures are divided into suture pairs, with each pair including one suture end from a suture inserted into a first valve leaflet and one suture end from a suture inserted into a second valve leaflet. One or more tourniquet tubes is advanced over the suture pairs to the leaflets to draw the sutures together to coapt the leaflets and then the sutures are secured in that position.

A clip for leaflet tissue includes a substantially cylindrical hollow body having a proximal end and a distal end. In an initial configuration of the clip, the distal end has a diameter that is smaller than the diameter of the hollow body. The distal end is held in an expanded condition for delivery into a patient. When deployed, the distal end collapses to its initial configuration to grasp onto captured leaflet tissue.

An endoscopic cap assembly may include a sleeve and a cap. The cap may include a cap channel extending along an external surface of the cap. The cap may also include an engagement feature extending radially outwardly from the external surface of the cap.

A system may comprise a first catheter having a first steerable segment and a second catheter disposed within the first catheter. The second catheter may have a second steerable segment. The system may also comprise an imaging element supported at a distal end of the second catheter, a coil reference sensor supported at a distal portion of the second catheter, and a processor in electrical communication with the coil reference sensor. The processor may be configured to determine a position of a distal portion of the first catheter with reference to the coil reference sensor.

Disclosed is an endoscopic device comprising an insertion tube, a distal tip, and at least one camera located at an initial location on or in the distal tip or the insertion tube. The endoscopic device is characterized in that it comprises a mechanical arrangement that is activated from the proximal end of the endoscopic device and is configured to do at least one of the following: (a) to move the at least one camera from the initial location to one or more different locations on, in or spaced away from the distal tip or the insertion tube; and (b) to change the direction of view of the at least one camera. Also disclosed are methods of performing endoscopic procedures using embodiments of the endoscopic device.

An endoscopic suturing system and method are disclosed as are devices for use with the system and method such as a suture dispenser, a cinch device, and a tissue grasper. In one embodiment the suturing system includes a cap assembly arranged at the distal end portion of an endoscope or guide member, with the cap assembly including a rotatable needle holder. The needle holder is actuated through a transmission element extending outside the endoscope or guide member. A needle capture device may be inserted through a channel of the endoscope or guide member in order to capture a needle held in the needle holder when the needle holder is rotated so that the needle punctures tissue.

Rolling tractor tube mechanical thrombectomy apparatuses that may be deployed from out of a catheter in situ are described herein. These apparatuses may be delivered out of a catheter from a collapsed delivery configuration within the catheter to a deployed configuration out of the catheter, in which the same catheter is re-inserted between a tubular tractor and an elongate puller. In particular, any of these methods and apparatuses may be adapted to work with a tractor tube having an open end that is biased open, including using an annular bias.

A sleeve can be adapted to reinforce a bone anchor, and can include a body, a lock, and an actuator. The body can include a first sleeve arm and a second sleeve arm, where each can extend longitudinally along opposing sides of a longitudinal bore open at a distal end of the sleeve. The lock can be coupled to the body and releasably securable to a channel of a head of the bone anchor to secure the sleeve to the anchor.