The problem of positioning one or more nerve ends inside a sheathing implant is solved by the use of a pulley and cinching systems that pull a nerve end into an implant and that can adjust the diameter of an implant to conform the implant to the diameter of the nerve, respectively. The pulley system utilizes a suture that traverses the wall of an implant leaving one end outside the implant wall and another end that can be attached to a nerve. Pulling the suture end outside the wall pulls the nerve attached to the other end of the suture into the bore of the implant. A cinching system utilizes specially arranged sutures within the wall of an implant to tighten or cinch up the wall after a nerve is placed therein, so as to conform at least part of the implant to the diameter of the nerve. Methods are also disclosed by which such pulley systems can be formed during an intraoperative procedure.

A surgical occluding device includes a body portion configured to radially surround a tissue lumen. The body portion includes a plurality of segments and a plurality of folds. Each fold of the plurality of folds is defined between adjacent segments of the plurality of segments. Half of the folds of the plurality of folds define acute angles, and half of the folds of the plurality of folds define obtuse angles. The body portion is movable from a first orientation where the acute angle defines a first acute angle, to a second orientation where the acute angle defines a second, smaller acute angle.

A purse-string applicator for use in an anastomosis procedure includes an introducer sleeve, a handle assembly, and a support ring. The introducer sleeve includes a tubular body portion having proximal and distal portions. A handle portion is disposed on the proximal portion of the tubular body, and an introducer portion is disposed on the distal portion of the tubular body. The handle assembly includes an elongate shaft portion and a release mechanism. The release mechanism is positionable distal of the distal portion of the introducer sleeve. The support ring is releasably engageable by the release mechanism of the handle assembly and includes an annular body portion and first and second rim portions. The release mechanism releasably retains the support ring adjacent the distal portion of the introducer sleeve. The purse-string applicator may be included in a kit along with an anvil assembly, an adapter assembly, and/or a circular stapling instrument.

A purse suturing device includes a circular stapler having a tubular stapler head adapted to be inserted inside a section of the hollow viscus to be sutured, a handle with an actuator connected to the stapler head, and an anvil against which the staples may be folded. The anvil has a pole adapted to be inserted into the tubular stapler head. A suturing thread is wound around the hollow viscus and tightened, causing a section of the hollow viscus to be tightened around the pole. The tightened section also includes a pursed, or folded, section of the wall of the hollow viscus, in which two layers of the wall of the hollow viscus are stapled together.

An endoluminal pursestring device is provided and includes a handle assembly, a shaft, an elongated fork, a plurality of surgical fasteners disposed with the shaft, and a suture engaged with the surgical fasteners. The suture is secured to a head of each of the surgical fasteners, and extends proximally through the handle assembly. In use, a distal end of the endoluminal pursestring device is positioned adjacent tissue surrounding a lumen, and the handle assembly is rotated to cause the distal-most surgical fastener to be rotated into the tissue. The following surgical fasteners are also rotated into other portions of the tissue surrounding a lumen. The suture connecting each of the surgical fasteners is then pulled such that the surgical fasteners are pulled together, thereby closing the lumen.

An apparatus includes an end effector including an anvil and lower jaw. The anvil is pivotable toward the lower jaw to capture tissue. The apparatus further includes a stapling and severing assembly configured to sever and staple tissue clamped between the anvil and the lower jaw. A staple cartridge is coupled with the lower jaw. The staple cartridge includes a deck facing the anvil, a plurality of staples positioned in a plurality of staple openings formed through the deck, and a cinching feature positioned on the deck. At least a portion of the cinching feature is configured to be captured by the staples as the staples are driven out of the staple openings in response to activation of the stapling and severing mechanism. The cinching feature is configured to cinch severed and stapled tissue.

A surgical staple cartridge is disclosed comprising a plurality of staples removably stored within the surgical staple cartridge. The staples comprise staple legs which extend from a staple base portion. The staple legs comprise staple tips configured to pierce tissue and contact a corresponding forming pocket of an anvil of surgical stapling instrument. The staples further comprise zones having different hardnesses.

A surgical instrument that includes an elongated shaft that defines defining a central axis. The elongated shaft may have a distal end portion that is configured to operably support a circular staple cartridge therein. A tissue acquisition shaft may be axially movable within the elongated shaft such that a distal end portion of the tissue acquisition shaft may be distally advanced beyond the distal end portion of the elongated shaft. At least one tissue acquisition member may be pivotally attached to the distal end portion of the tissue acquisition shaft such that at least one tissue acquisition member is selectively pivotable about a corresponding acquisition axis that is substantially parallel to the central axis from a retracted position to deployed positions upon application of a deployment motion thereto. Various embodiments include an annular cutting member that is supported by the distal end of the elongated shaft for selective axial travel relative thereto.

A suture device is utilized in forming a purse string suture during, e.g., laparoscopic end to end anastomosis procedure, to effect joining of two opposing intestinal sections. The suture device is utilized in other procedures such as, e.g., transanal total mesorectal excision (TaTME) for removal of low rectal and ultra-low rectal tumors and preservation of anal sphincters to avoid permanent stomas. In particular, the suture device is utilized in forming surgical stitches used to close an internal anal structure or to narrow a passage for performing further transanal dissection to create total mesorectal excision.

A computer-implemented method for controlling a surgical stapling instrument for stapling tissue includes advancing an anvil assembly in relation to a staple cartridge to a first position defining a tissue gap between the staple cartridge and the anvil assembly and clamping tissue, the clamped tissue including a suture, measuring a first force of tissue compression of the tissue clamped within the tissue gap with the anvil assembly at a first time point, determining whether the measured first force is greater than a threshold, measuring a second force of tissue compression of the tissue clamped within the tissue gap at a second time point in response to the determination that the first force is greater than the threshold, determining whether the suture failed based on the measured second force being an amount less than the measured first force, and stopping the advancing of the anvil assembly based on the determined suture failure.