Method and apparatus for passing suture

Abstract

To provide a device that can pierce and hold tissue and then pass a suture through the tissue.SOLUTION: The device can have a shuttle that can be removably attach to a suture and jaws that can be rotatably opened and closed with respect to each other. A method for using the device to repeatedly pass the suture through the tissue without removing the suture or device from the target site is also disclosed.SELECTED DRAWING: Figure 25a

Description

[Technical field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims priority to U.S. Provisional Patent Application No. 62 / 651,066, filed March 30, 2018, which is incorporated by reference in its entirety for all purposes.

[0002]

[0002] The present invention relates to systems, methods, and devices for enhancing advancement and retention of a suture through tissue. [Background technology]

[0003]

[0003] Previous suturing devices have had elongated shafts and low profile distal clamping mechanisms to facilitate their use through a cannula 226 in less invasive procedures. These devices typically included opposing jaws that clamp the tissue to be sutured. An end segment of the suture is pre-positioned and secured at the distal end of one of the jaw members. Beyond the clamping action, the mechanism for passing the suture between the jaws and through the tissue incorporates a bendable needle. The bendable needle advances distally within the jaw members and contacts the suture segment.

[0004]

[0004] The needle engages the suture to secure it and advance it. This distal advancement of the bendable needle also results in the tip of the needle closely engaging the angled portion 44 of the jaw member, deflecting the bendable needle in a direction toward the opposite jaw. Bending the needle requires a large force, resulting in excessive strain on the needle components. Crushing and breakage of the bendable needle are a concern.

[0005]

[0005] Furthermore, after the bendable needle is deflected away from the jaws, it advances further and potentially into unintended anatomical structures. Advancing the needle in this manner presents safety concerns. Even after the device has passed the suture through tissue, the end segment of the suture must be retrieved by withdrawing the entire device from the cannula.

[0006]

[0006] It would be advantageous to have a device that can load and remove sutures without having to remove the device from the surgical site.

[0007] It would be advantageous to have a device that can repeatedly thread sutures through tissue (rather than loading and unloading) without having to remove the device from the surgical site. It would also be advantageous for the suture shuttle mechanism (needle or shuttle) to be completely contained within the device during surgery to improve accuracy of suture placement and improve safety of the needle or shuttle position during surgery. Summary of the Invention

[0008]

[0008] The present disclosure relates generally to suturing devices and methods.

[0009]

[0009] A suture manipulation device is disclosed. For example, a suture manipulation device having a jaw structure is disclosed. The jaw structure can have a longitudinal axis. The jaw structure can have a first jaw and a second jaw. The first jaw can have a first jaw tip and the second jaw can have a second jaw tip. The first jaw tip can have teeth and the second jaw tip can have a tooth seat configured to receive the teeth. The teeth can be configured to mesh with the tooth seat when the jaw structure is in a closed configuration. At least a portion of the second jaw tip can be adjacent to and overlap the first jaw tip when the jaw structure is in a closed configuration. The first jaw can have a first jaw track and a first jaw suture slot. The first jaw track can have a first jaw track straight portion and a first jaw track curved portion. The first jaw suture slot can extend along an outer surface of the first jaw such that at least a portion of the first jaw suture slot faces away from the device. The second jaw can have a second jaw track and a second jaw suture slot. The second jaw track can have a second jaw track straight portion and a second jaw track curved portion. The second jaw suture slot can extend along an outer surface of the second jaw such that at least a portion of the second jaw suture slot faces away from the device. The suture manipulation device can have a shuttle slidable within the first jaw track and the second jaw track. The suture manipulation device can have a first shuttle stopper engageable with the shuttle. The first shuttle stopper can be disposed within the first jaw. The first shuttle stopper can be configured to limit movement of the shuttle when the shuttle is in the first jaw track. The suture manipulation device can have a second shuttle stopper engageable with the shuttle. The second shuttle stopper can be disposed within the second jaw. The second shuttle stopper can be configured to limit movement of the shuttle when the shuttle is in the second jaw track. The suture manipulation device can have a jaw control extension.The suture manipulation device can have a compression cover configured to compress the first jaw towards the second jaw when the first jaw and the second jaw are translated into the compression cover. [Brief description of the drawings]

[0010] [Figure 1a]

[0010] FIG. 1 is a perspective view of a variation of the suture passing device. [Figure 1b] 1 is a top view of a variation of the suture passing device; [Figure 1c]

[0010] FIG. 1 is a side view of a variation of the suture passing device. [Figure 2a]

[0011] FIG. 13 is a perspective view of a shuttle variant in a straight configuration. [Figure 2b] FIG. 11 is a close-up view of a variation of the shuttle in a straight configuration. [Figure 2c]

[0012] FIG. 2c is a close-up view of a variation of the shuttle of FIGS. 2a and 2b in a curved configuration. [Figure 3a]

[0013] FIG. 13 is a close-up perspective partial see-through view of a distal end of a variation of a suture passing device attached to a length of suture. [Figure 3b]

[0014] FIG. 3b is a close-up view of a portion of FIG. 3a. [Figure 4a]

[0015] FIG. 13 is a close-up perspective view of a distal end of a variation of the suture passing device in a closed configuration. [Figure 4b]

[0015] FIG. 1 is a side view of the distal end of a variation of the suture passing device in a closed configuration. [Figure 4c]

[0016] FIG. 4c is a close-up view of the distal end of FIGS. 4a and 4b. [Figure 4d]

[0017] FIG. 4b is a close-up perspective view of the distal end of the device of FIG. 4a in a closed configuration. [Diagram 5]

[0018] FIG. 1b is a variation of section AA of FIG. 1a in which the device is attached to a length of suture. [Figure 6a]

[0019] 13 illustrates a variation of a method of using a variation of a suture passing device to form stitches in a piece of tissue. [Figure 6b]

[0019] A variation of the method of using a variation of the suture passing device to form a stitch in a piece of tissue is shown. [Figure 6c]

[0019] A variation of the method of using a variation of the suture passing device to form a stitch in a piece of tissue is shown. [Figure 6d]

[0019] A variation of the method of using a variation of the suture passing device to form a stitch in a piece of tissue is shown. [Figure 7a]

[0020] 1A-1C are side perspective and close-up views of a variation of the device with an exploded view of the shuttle and a close-up view of the proximal end of the device. [Figure 7b]

[0020] A side perspective view and close-up view of a modified device with an exploded view of the shuttle, and a close-up view of the proximal end of the device. [Figure 7c]

[0021] FIG. 7b is a close-up view of a variation of the shuttle of FIG. 7a. [Figure 7d]

[0022] FIG. 7b is a close-up view of the distal end of a variation of the device shown in FIG. 7a. [Figure 8a]

[0023] 1 shows a modified shuttle. [Figure 8b]

[0024] 13 shows a close-up view of a variation of the distal end of the device. [Figure 9a]

[0025] 1A-1D are side perspective and partially see-through side perspective views, respectively, of various devices in an open configuration; [Figure 9b]

[0026] 9b-9c are side perspective views of various methods for closing the jaws of the device of FIG. 9a. [Figure 9c]

[0027] FIG. 9c is a close-up view of the distal end of the device of FIG. 9b. [Figure 10a] 2A and 2B are side perspective and partially transparent side perspective views, respectively, of various devices in an open configuration; [Figure 10b]

[0028] FIG. 10b is a close-up partial perspective view of the distal end of the lower jaw of FIG. [Figure 11a] 9a-9c are side cross-sectional views of various methods for closing the jaws of the device of FIG. 9a. [Figure 11b] FIG. 9b is a side perspective view of the distal end of the device of FIG. [Figure 12a]

[0029] FIG. 13 is a side view of a modified shuttle. [Figure 12b]

[0029] FIG. [Figure 12c]

[0029] FIG. 1 is a bottom view of a modified shuttle. [Figure 13a]

[0030] 1 shows a modified shuttle. [Figure 13b]

[0030] A modified example of the shuttle is shown. [Figure 14a]

[0031] FIG. 13 is a top view of a variant of the shuttle. [Figure 14b]

[0031] FIG. 1 is a front perspective view of a modified shuttle. [Figure 14c]

[0031] FIG. 1 is a bottom perspective view of a modified shuttle. [Figure 15a]

[0032] FIG. 13 is a side perspective view of a modified shuttle; [Figure 15b]

[0032] FIG. 1 is a bottom perspective view of a modified shuttle. [Figure 15c]

[0032] FIG. 1 is a side and bottom perspective view of a modified shuttle. [Figure 16a]

[0033] FIG. 13 is a top perspective view of a modified shuttle; [Figure 16b]

[0033] FIG. 1 is a side perspective view of a modified shuttle. [Figure 17a]

[0034] 12a to 12c show a variation of the shuttle-equipped device. [Figure 17b]

[0035] 17b shows a variation of the device of FIG. 17a with a pusher. [Figure 17c]

[0036] 17b shows a variation of the device of FIG. 17a with two pushers of different configurations. [Figure 17d]

[0036] A variation of the device of Figure 17a is shown with two pushers of different configurations. [Figure 18a]

[0037] FIG. 13 is a side perspective view of a variation of the distal end of the device. [Figure 18b]

[0037] FIG. 11 is a side view of a modified distal end of the device. [Figure 19a]

[0038] FIG. 13 is a side perspective view of a variation of the distal end of the device. [Figure 19b]

[0038] FIG. 11 is a side view of a modified distal end of the device. [Figure 20a]

[0039] FIG. 13 is a side perspective view of a variation of the distal end of the device. [Figure 20b]

[0039] FIG. 11 is a side view of a modified distal end of the device. [Figure 21a]

[0040] FIG. 13 is a side perspective view of a variation of the distal end of the device. [Figure 21b]

[0040] FIG. 11 is a side view of a modified distal end of the device. [Figure 22a]

[0041] 13 shows a variation of the distal end and distal lower jaw of the device. [Figure 22b]

[0041] A variation of the distal end and distal lower jaw of the device is shown. [Figure 22c]

[0042] FIG. 22b is a side view of the device of FIG. 22a with a shuttle. [Figure 23a]

[0043] 13A-13C are variations of the distal end of the device in open and closed configurations. [Figure 23b]

[0043] A variation of the distal end of the device in the open and closed configurations, the device of Figure 23b having a shuttle. [Figure 24a]

[0044] FIG. 13 is a side perspective view of a variation of the device. [Figure 24b]

[0044] FIG. 1 is a side view of a modified example of the device. [Figure 24c]

[0044] FIG. 11 is a distal end view of a modified example of the device. [Figure 25a]

[0045] 13A-13D are bottom perspective views of the distal end of a variation of the device with the jaws in an open configuration with the shuttle and pusher in various positions. [Figure 25b]

[0045] A side perspective view of the distal end of a variation of the device with the jaws in an open configuration with the shuttle and pusher in various positions. [Figure 25c]

[0045] A partial perspective view (with the upper jaw visible) of the distal end of a variation of the device with the jaws in an open configuration with the shuttle and pusher in various positions. [Figure 25d]

[0045] A longitudinal cross-sectional view of the distal end of a variation of the device with the jaws in an open configuration with the shuttle and pusher in various positions. [Figure 25e]

[0045] A close-up, partially cut-away view of the distal end of a variation of the device with the jaws in an open configuration with the shuttle and pusher in various positions. [Fig. 25f] FIG. 25f is a partial cutaway view of the distal end of a variation of the device with the jaws in an open configuration with the shuttle and pusher in various positions, with the compression cover not shown in FIG. 25f for illustrative purposes. [Figure 26a]

[0046] FIG. 13 is a side perspective view of a variation of the distal end of the device in a jaw closed configuration with the shuttle in the upper jaw and not engaged with the lower jaw. [Figure 26b]

[0047] FIG. 26b is a longitudinal cross-sectional view of the device of FIG. 26a with the shuttle within the upper and lower jaws. [Figure 26c]

[0047] Figure 26b is a side perspective view of the device of Figure 26a with the shuttle in the upper and lower jaws, and Figure 26b does not show the pusher for purposes of illustration. [Figure 26d]

[0048] FIG. 26c is a partial cutaway view. [Figure 27]

[0049] FIG. 13 is a near partial cutaway view of the distal end of a variation of the device in which the shuttle is in the lower jaw and the upper pusher extends from and partially into the upper jaw. [Figure 28]

[0050] FIG. 13C is a proximal end perspective view of a variation of the shuttle and suture device of FIG. 13a or FIG. 13b. [Figure 29]

[0051] FIG. 14B is a proximal end perspective view of a variation of the shuttle and suture device of FIGS. 14a to 14c. [Figure 30a]

[0052] FIG. 13 is a right rear view of a variation of the device. [Figure 30b]

[0052] FIG. 1 is a left cutaway view of a modified device. [Diagram 31]

[0053] FIG. 13 is a partially cut-away and partially transparent view of the proximal end of a variation of the device. [Figure 32a]

[0054] FIG. 13 is a left perspective view of a variation of the pusher drive gear of the device. [Figure 32b]

[0054] FIG. 11 is a right-side perspective view of a modified pusher drive gear of the device. [Figure 33A]

[0055] 13 illustrates a variation of the shuttle in the lower jaw, with half of the lower jaw shown in transparency; [Figure 33B]

[0056] 13 illustrates a variation of the shuttle in the lower jaw, with half of the lower jaw shown in transparency; [Figure 34A]

[0057] 13 illustrates a variation of the shuttle in the upper jaw, with half of the upper jaw shown in transparency; [Figure 34B]

[0058] 13 illustrates a variation of the shuttle in the upper jaw, with half of the upper jaw shown in transparency; [Diagram 35]

[0059] 1 shows a variation of the device, with the lower and upper jaw halves shown in transparency; [Figure 36A]

[0060] FIG. 13 shows a perspective view of a modified shuttle; [Figure 36B]

[0061] A bottom view of the shuttle of Figure 36A is shown. [Figure 36C]

[0062] FIG. 36B shows a side view of the shuttle of FIG. 36A. [Figure 37A]

[0063] 13A and 13B show top and bottom views of a variant of the shuttle. [Figure 37B]

[0064] 13A and 13B show top and bottom views of a variant of the shuttle. [Figure 37C]

[0065] 13A and 13B show top and bottom views of a variant of the shuttle. [Figure 37D]

[0066] 13A and 13B show top and bottom views of a variant of the shuttle. [Figure 37E]

[0067] 13A and 13B show top and bottom views of a variant of the shuttle. [Figure 38A]

[0068] FIG. 13 shows a perspective view of a modified shuttle; [Figure 38B]

[0069] A bottom view of the shuttle of Figure 38A is shown. [Figure 38C]

[0070] FIG. 38B shows a side view of the shuttle of FIG. 38A. [Figure 39A]

[0071] FIG. 13 shows a side view of a modified pusher. [Figure 39B]

[0072] FIG. 13 shows a side view of a modified pusher. [Figure 39C]

[0073] FIG. 13 shows a side view of a modified pusher. [Figure 39D]

[0074] FIG. 13 shows a side view of a modified pusher. [Figure 40A]

[0075] FIG. 39B shows a perspective view of the pusher of FIG. 39A with a shuttle seat. [Figure 40B]

[0076] FIG. 39C shows a perspective view of the pusher of FIG. 39B with a shuttle seat. [Figure 40C]

[0077] FIG. 39D shows a perspective view of the pusher of FIG. 39C with a shuttle seat. [Figure 40D]

[0078] FIG. 39E shows a perspective view of the pusher of FIG. 39D with a shuttle seat. [Figure 41A]

[0079] 13A and 13B show top and bottom views of a modified example of the pusher. [Figure 41B]

[0080] 13A and 13B show top and bottom views of a modified example of the pusher. [Figure 41C]

[0081] 13A and 13B show top and bottom views of a modified example of the pusher. [Figure 41D]

[0082] 13A and 13B show top and bottom views of a modified example of the pusher. [Figure 41E]

[0083] 13A and 13B show top and bottom views of a modified example of the pusher. [Fig.41F]

[0084] 13A and 13B show top and bottom views of a modified example of the pusher. [Figure 42A]

[0085] 13 shows a modified example of the pusher. [Figure 42B]

[0086] 13 shows a modified example of the pusher. [Figure 42C]

[0087] 13 shows a modified example of the pusher. [Fig.42D]

[0088] 13 illustrates a variation of the pusher component. [Figure 43A]

[0089] 1 shows variations on the upper and lower jaws. [Figure 43B]

[0090] 1 shows variations on the upper and lower jaws. [Figure 43C]

[0091] 1 shows variations on the upper and lower jaws. [Fig. 43D]

[0092] 1 shows variations on the upper and lower jaws. [Figure 43E]

[0093] 1 shows variations on the upper and lower jaws. [Figure 43F]

[0094] 1 shows variations on the upper and lower jaws. [Figure 43G]

[0095] 1 shows variations on the upper and lower jaws. [Fig. 43H]

[0096] 1 shows variations on the upper and lower jaws. [Figure 43I]

[0097] 1 shows variations on the upper and lower jaws. [Figure 43J]

[0098] 1 shows variations on the upper and lower jaws. [Figure 43K]

[0099] 1 shows variations on the upper and lower jaws. [Figure 43L]

[0100] 1 shows variations on the upper and lower jaws. [Figure 43M]

[0101] 1 shows variations on the upper and lower jaws. [Figure 43N]

[0102] 1 shows variations on the upper and lower jaws. [Figure 44A]

[0103] 1 shows a side view of a variation of the device, with half of the device shown in transparency. [Figure 44B]

[0104] FIG. 44B shows a perspective view of the device of FIG. 44A. [Figure 45A]

[0105] 1 shows a modified example of the device. [Figure 45B]

[0106] 1 shows a modified example of the device. [Figure 45C]

[0107] 13 shows a variation of the handle of the device. [Figure 45D]

[0108] 13 shows a variation of the handle of the device. [Figure 45E]

[0109] 13 shows a variation of the handle of the device. [Fig.45F]

[0110] 13 shows a variation of the handle of the device. [Figure 45G]

[0111] 13 shows a variation of the handle of the device. [Fig. 45H]

[0112] 13 shows a variation of the handle of the device. [Fig.45I]

[0113] Shows a modification example of the handle of the device. [Figure 45J]

[0114] Shows a modification example of the handle of the device. [Figure 45K]

[0115] Shows a modification example of the handle of the device. [Figure 45L]

[0116] Shows a modification example of the handle of the device. [Figure 45M]

[0117] Shows a modification example of the handle of the device. [Figure 46A]

[0118] Shows a modification example of the tube of the device. [Figure 46B]

[0119] Shows a modification example of the upper pusher. [Figure 46C]

[0120] Shows a modification example of the lower pusher. [Figure 46D]

[0121] Shows a modification example of the tube of the device. [Figure 46E]

[0122] Shows a modification example of the compression cover. [Figure 46F]

[0123] Shows a modification example of the first side of the lower jaw. [Figure 46G]

[0124] Shows a modification example of the second side of the lower jaw. [Fig. 46H]

[0125] Shows a modification example of the first side of the upper jaw. [Figure 46I]

[0126] Shows a modification example of the second side of the upper jaw. [Figure 46J]

[0127] Shows a modification example of the connector. [Figure 46K]

[0128] Shows the pins for the connector of FIG. 46J. [Figure 47A]

[0129] Shows a modification example of the lower jaw and various components within the lower jaw, with half of the lower jaw shown in a transparent state. [Figure 47B]

[0130] 1 illustrates a variation of the lower jaw and various components within the lower jaw, with half of the lower jaw shown in transparency. [Figure 47C]

[0131] 1 illustrates a variation of the upper jaw and various components within the upper jaw, with half of the upper jaw shown in transparency. [Figure 47D]

[0132] 1 illustrates a variation of the upper jaw and various components within the upper jaw, with half of the upper jaw shown in transparency. [Figure 47E]

[0133] 1 illustrates a variation of the device, with the lower and upper jaw halves shown in transparency. [Fig.47F]

[0134] Variations of the upper and / or lower jaw are shown with various components within the upper and / or lower jaw, with half of the upper and / or lower jaw shown in transparency. [Figure 47G]

[0135] Variations of the upper and / or lower jaw are shown with various components within the upper and / or lower jaw, with half of the upper and / or lower jaw shown in transparency. [Fig. 47H]

[0136] FIG. 13 is a perspective view of a modified shuttle stopper. [Fig.47I]

[0137] Variations of the upper and / or lower jaw are shown with various components within the upper and / or lower jaw, with half of the upper and / or lower jaw shown in transparency. [Figure 47J]

[0138] Variations of the upper and / or lower jaw are shown with various components within the upper and / or lower jaw, with half of the upper and / or lower jaw shown in transparency. [Figure 47K]

[0139] Variations of the upper and / or lower jaw are shown with various components within the upper and / or lower jaw, with half of the upper and / or lower jaw shown in transparency. [Figure 47L]

[0140] Variations of the upper and / or lower jaw are shown with various components within the upper and / or lower jaw, with half of the upper and / or lower jaw shown in transparency. [Figure 47M]

[0141] 1 shows a modified example of the shuttle and shuttle stopper control device. [Figure 47N]

[0142] Variations of the upper and / or lower jaw are shown along with various components within the upper and / or lower jaw. [Fig.47O]

[0143] Variations of the upper and / or lower jaw are shown along with various components within the upper and / or lower jaw, with the upper and / or lower jaw shown in a transparent state. [Figure 47P]

[0144] FIG. 47N is a perspective view. [Figure 47Q]

[0145] Variations of the upper and / or lower jaw are shown along with various components within the upper and / or lower jaw. [Figure 47R]

[0146] Variations of the upper and / or lower jaw are shown along with various components within the upper and / or lower jaw, with the upper and / or lower jaw shown in a transparent state. [Figure 47S]

[0147] This is a perspective view of Figure 47Q. [Figure 47T]

[0148] FIG. 13 is a side view of a variation of the device. [Fig.47U]

[0149] FIG. 13 is a side view of a variation of the device. [Figure 47V]

[0150] FIG. 13 is a side view of a variation of the device. [Fig. 47W]

[0151] FIG. 13 is a side view of a variation of the device. [Figure 48A]

[0152] 1 shows a variation of the device having a punch. [Figure 48B]

[0153] 1 shows a variation of the device having a punch. [Figure 48C]

[0154] 1 shows a variation of the device having a punch. [Figure 48D]

[0155] 1 shows a variation of the device having a punch. [Figure 48E]

[0156] 1 shows a variation of the device having a punch. [Fig.48F]

[0157] 1 shows a variation of the device having a punch. [Figure 48G]

[0158] 1 shows a variation of the device having a punch. [Fig. 48H]

[0159] 1 shows a variant of the device having two punches. [Fig.48I]

[0160] 1 shows a variant of the device having two punches. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0011]

[0161] 1a-1c show a suture passing device 188 that may be used to pass a suture 70 through soft or hard tissue 74 while creating one or more complete stitches without removing either the device 188 or the suture 70 from the target site.

[0012]

[0162] The suture threading device 188 can have an ergonomic handle 104, a sliding tube actuator 6, and a distal end 2. The ergonomic handle 104 can be used to control the distal end 2. The ergonomic handle 104 can have a side knob 10. The ergonomic handle 104 can have a top knob 12. The top knob 12 and / or the side knob 10 can individually or in concert advance and / or retract the top pusher 86 and / or the bottom pusher 76.

[0013]

[0163] The sliding tube actuator 6 can have an outer compression cover 34 and an inner rod (not shown due to obstruction by the outer compression cover 34). The inner rod can be fixedly attached to the handle 104 and the proximal end of the jaw structure 28. The outer compression cover 34 can be radially outward of the inner rod. The outer compression cover 34 can be actuated by the handle 104, for example, by squeezing or releasing the trigger 8, and can be translated distally and proximally relative to the handle 104.

[0014]

[0164] 2a and 2b show that the device 188 can have a sliding ribbon shuttle 14 or needle held within the device 188. The shuttle 14 can have an elongated shuttle rail 16. The shuttle rail 16 can have a number of slits 20 along one or both sides of the shuttle rail 16. The slits 20 can be spaced at regular or irregular length intervals along the rail 16.

[0015]

[0165] The shuttle 14 can have a suture holder 18 extending laterally from the rail 16. The shuttle 14, e.g., the suture holder 18, can extend from a lateral side slot 72 in the arm structure. The suture holder 18 can extend from the left and / or right side of the device 188. The distal end 2 of the device 188 can be reversible so that the suture holder 18 can be switched from one side of the device 188 to the other. The suture holder 18 can have a generally flat isosceles trapezoid configuration. The suture holder 18 can have a suture retaining notch 100. The notch 100 can have an inner bore 17a, an outer bore 17b adjacent the inner bore 17a, and a first cleat 97a located between the inner bore 17a and the outer bore 17b. The notch 100 can have a second cleat 97b on a side of the outer bore away from the inner bore. The notch 100 can be configured to secure the suture 70. For example, the suture 70 can be compressed to provide a friction fit within the inner cleat 97a.

[0016]

[0166] The suture holder 18 can have a front leading edge and a rear leading edge. The leading edges can be angled perpendicular or non-perpendicular to the longitudinal axis of the rail 16. One or both leading edges can be sharpened to injure the tissue 74, e.g., cut through the soft tissue 74. The leading edges can cut through the tissue 74, allowing the suture holder 18 to pull the suture 70 through the tissue 74 immediately behind the respective leading edge.

[0017]

[0167] The shuttle 14 can be made from a flexible polymer such as PEEK, a resilient metal such as Nitinol, any of the materials disclosed herein, or a combination thereof. The shuttle 14 can be made from a molded polymer. The shuttle 14 can be pre-curved, for example, to reduce resistance when going around curves in the track.

[0018]

[0168] FIG. 2c shows that the rails 16 may be curved at the locations of the slits 20 and / or the rails 16 may be pre-curved.

[0019]

[0169] 3a and 3b show that the suture threading device 188 can capture or releasably attach the suture 70 within the inner cleat 97a and / or outer cleat 97b of the suture holder 18. The suture 70 can be loaded or held laterally of the jaw structure 28 and out of the plane of rotation of the holding jaw. The device 188 can pass the suture 70 through the tissue 74 multiple times without removing and reattaching the suture threading device 188. The jaw structure 28 can elastically deform open at the proximal end of the jaw structure 28 without having a hinge. The jaws can be opened and closed without the use of a mechanical pivot or linkage in the jaw structure 28.

[0020]

[0170] 4a shows that the suture passing device 188 can have a jaw structure 28 with a top jaw 30 and a bottom jaw 38. The entire jaw structure 28 can be a unitary piece of material, such as a single molded, cast, or cutting element of Nitinol, other resilient metals or polymers, any other materials described herein, or combinations thereof. The jaw structure 28 can be configured to be in an open configuration (as shown in FIG. 4d) when in an unbiased configuration (i.e., when no external force is applied).

[0021]

[0171] The jaw structure 28 may have a jaw structure longitudinal axis 42. Each jaw may also have a respective jaw longitudinal axis along the jaw.

[0022]

[0172] The inner channel of the compression cover 34 can be sized and shaped to fit the jaw structure 28 with minimal clearance when the jaw structure 28 is in a closed configuration. As the compression cover translates in a distal direction 138 relative to the jaw structure 28, as indicated by the arrow, the compression cover 34 can push the top and bottom jaws 38 toward the jaw structure longitudinal axis 42. The jaw structure 28 can be fully compressed into a closed configuration, as shown in FIGS. 4a-4c. In this manner, when an actuation lever, such as a trigger 8, is actuated, the channel or compression cover 34 can advance to cam the jaws closed. The jaws can pre-pierce the tissue and establish a continuous track for the shuttle to pass through the tissue.

[0023]

[0173] A compression cover 34 may be attached to the open-ended bowl 32 disposed between the first and second jaws.

[0024]

[0174] FIG. 4b shows that the open ball 32 can be rotatably or fixedly mounted to a ball axle 52 that passes laterally through the open ball 32. The ball axle 52 can extend out from a side of the ball 32. The ball axle 52 can be slidably received by an axle slot 50 formed through a distal arm 54 or extension 138 of the compression cover 34. When the jaw structure 28 is in a closed configuration, the ball axle 52 can abut and fit snugly against a proximal end of the axle slot 50, for example, to prevent the compression cover 34 from overextending beyond the jaw structure 28. When the jaw structure 28 is in an open configuration, the ball axle 52 can abut and fit snugly against a distal end 2 of the axle slot 50, for example, to prevent overrotation of the jaws and / or to prevent pulling the ball 32 beyond the inner ramp 44 of the jaw structure 28.

[0025]

[0175] 4c shows that the bottom track 66 can terminate distally at the bottom track port 62. The top track 64 can terminate distally at the top track port 60. When the jaw structure 28 is in a closed configuration with the first jaw tip 46 interdigitating with the second jaw tip 48, the top track port 60 can be aligned with and adjacent (as shown) or in contact with the bottom track port 62. The tracks of the top jaw 78 and the bottom jaw 38 can form a continuous path when the jaw structure 28 is in the closed configuration. The first jaw tip 46 can be interdigitated with and adjacent or in contact with the second jaw tip 48 when the jaw structure 28 is in the closed configuration.

[0026]

[0176] FIG. 4d shows that the compression cover 34 can be translated in a proximal direction 126 relative to the jaw structure 28, as shown by the arrow. The ball axle 52 can slide to the distal end 2 of the axle slot 50. The axle slot 50 can then pull the ball axle 52, and thus the open ball 32, in a proximal direction. The open ball 32 can then press against the inner surface ramp 44 of the first and / or second jaw. The first and / or second jaw tips 46 and / or 48 can then rotate away from the opposite jaw tip. The jaw structure 28 can then be in an open configuration, as shown.

[0027]

[0177] The proximal ends of the jaws can be rigid or flexible, for example, to bend around the opening in the compressive cover 34 when the jaws are in an open configuration. The entire jaws or just the proximal ends of the jaws can be made of Nitinol, for example, with the distal ends of the jaws being made of stainless steel.

[0028]

[0178] 5 shows that a side slot 72 can extend laterally from one side of the track. The rail 16 of the shuttle 14 can be taller than the height of the side slot 72. The rail 16 is too large to pass through the side slot 72. The suture holder 18 can extend laterally from the rail 16 through the side slot 72. The suture holder 18 can hold the suture 70 laterally spaced from the jaws.

[0029]

[0179] 6a shows that the upper jaw 78 and the lower jaw 80 can be closed as shown by the arrows and compressed through tissue 74, such as soft tissue 74 of the rotator cuff or other joint. The upper jaw tip 206 and / or the lower jaw tip 198 can pierce the tissue 74. The upper jaw tip 206 and the lower jaw tip 198 can intermesh within or adjacent to the tissue 74. The hole formed by the contact or intermesh of the upper jaw tip 206 and / or the lower jaw tip 198 can be a hole in the tissue 74 through which the shuttle 14 and / or suture 70 can pass. The compression cover can be pushed in the distal direction 138 to further compress the first jaw toward the second jaw, for example, causing the tips of the jaws to pierce the tissue 74.

[0030]

[0180] The lower pusher 76, when controlled by the handle 104, can be advanced in a distal direction as indicated by the arrow. The lower pusher 76 can push the shuttle 14 into or through the track, moving it in a distal direction and carrying the suture 70 with the shuttle 14.

[0031]

[0181] 6b shows that the lower pusher 76 can be continued to be pushed by the handle 104. The lower pusher 76 can push the shuttle 14 through the tissue 74. The leading edge 22 of the suture holder 18 can cut through the tissue 74 and the suture holder 18 can pull a suture through a cut made in the tissue 74 by the leading edge 22 and / or through a hole made in the tissue 74 by the tip of the jaws. The pusher and shuttle 14 can move along the longitudinal axis of the jaws.

[0032]

[0182] The shuttle 14 may then be fully positioned within the track of the upper jaw 78. The lower pusher 76 may then be pulled from the track of the upper and / or lower jaw 80, and / or the lower pusher 76 may remain in place but the resistive force may be removed, allowing the lower pusher 76 to slide freely within the track.

[0033]

[0183] 6c shows that the compressive cover can be translated in the proximal direction 126 (e.g., by releasing or squeezing the trigger 8), as shown by arrow 83. The ball axle 52 is pulled proximally, forcing the opening ball 32 against the inner surface of the top and / or bottom jaw 38. The opening ball 32 can thus resiliently open the top and / or bottom jaw 38. The jaws can then be unclamped (i.e., rotated open, as shown by arrow 82) and removed from the tissue 74.

[0034]

[0184] The device 188 may then be shifted to a position where the distal end 2 of the device 188 is adjacent (eg, to the side of) where the suture was originally passed through the tissue 74.

[0035]

[0185] FIGURE 6d shows that the jaws can then be closed to pierce the tissue 74 adjacent to the first passage of the suture 70 through the tissue 74. The upper pusher 86 can then be urged distally by the handle 104, as shown by the arrow. The upper pusher 86 can urge or push the shuttle 14 along the track in a direction opposite to that shown in FIGURES 6a and 6b. As the suture holder 18 passes through the tissue 74, the trailing edge 24 of the suture holder 18 can cut open the tissue 74 and carry the suture 70 through the tissue 74. Thus, a mattress stitch of the suture 70 through the tissue 74 can be formed.

[0036]

[0186] The shuttle 14 can then be in a reference position as shown in Figure 6a. The upper pusher 86 can then be pulled from the track of the upper and / or lower jaws 80 and / or the upper pusher 86 can be left in place but the resistive force can be removed, allowing the upper pusher 86 to slide freely within the track. The jaws can be reopened and repositioned and the device 188 can repeat the method shown in Figures 6a through 6d to form another stitch. Once the stitch is completed or to provide a second stitch, the jaws can be reopened and removed from the target site.

[0037]

[0187] 7a shows that the device 188 can have a base 102 and a handle 104 extending from the base 102. The device 188 can have a rotating lever 106 rotatably mounted to the base 102 or the handle 104. The device 188 can have a compression cover 34 translatably mounted to the base 102 and extending distally therefrom.

[0038]

[0188] The distal end 2 of the device 188 can have upper and lower jaws 80. The upper jaw 78 is rotatable relative to the lower jaw 80 and vice versa.

[0039]

[0189] The compression cover 34 may be slidably attached to one or both jaws. A rotating lever 106 may be attached to the compression cover 34. For example, the lever 106 may be squeezed and rotated toward the handle 104 to push the compression cover in a distal direction 138 against the jaws. The compression cover may slide distally over the jaws, rotating the upper jaw 78 toward the lower jaw 80 to close the jaws. The lever 106 may be spring biased to rotate away from the handle 104 and retract the compression cover 126 proximally and return the jaws to the open configuration when external pressure or a tight grip is no longer applied to the lever 106.

[0040]

[0190] 7b shows that a pusher shaft or button can extend distally from the base 102 or handle 104. The pusher shaft or button can translate relative to the base 102 and / or handle 104 as indicated by the arrows. The pusher shaft can be configured to push or pull one or both pushers. Pushing or pulling the pusher shaft can cause the pushers to translate. One pusher shaft or button can be switched between both pushers.

[0041]

[0191] A pusher toggle, such as a side paddle 112, can extend from a side of the base 102. The side paddle 112 can be located on the top or bottom of the base 102 or the handle 104. The side paddle 112 can rotate 110 relative to the base 102, as indicated by the arrow. The side paddle 112 can be configured to orient a pusher shaft or button to translate the upper pusher 86 or the lower pusher 76 depending on the position of the side paddle 112.

[0042]

[0192] The device 188 can have a lever 106 lock 120. The lever 106 lock 120 can extend laterally from the base 102. The lock 120 can rotate 118 relative to the base 102, as indicated by the arrow. The lock 120 can be configured to lock or secure the lever 106 in a closed state or at a particular angular position relative to the base 102. For example, the lever 106 lock can lock the lever 106 in a closed state and lock the jaws in a closed configuration.

[0043]

[0193] 7c shows that the shuttle 14 may have rails 16, which may be cylindrical tubes or sleeves. The rails 16 may be made of nylon, other materials disclosed herein, or combinations thereof. The rails 16 may have rounded (e.g., hemispherical) or flat-ended longitudinal ends.

[0044]

[0194] The shuttle 14 can have a suture holder 18, which can be a wire loop 98 extending laterally from the rail 16. The wire loop 98 can have a wire. The wire loop 98 can extend in a flat plane. The end of the wire can be fastened, e.g., removably or fixedly attached, to the rail 16, e.g., through a port or slot in the side of the rail 16. The suture 70 can extend through and remain within the area defined by the perimeter of the wire loop 98 while the suture 70 is held by the suture 70 threader.

[0045]

[0195] FIG. 7d illustrates that the lower jaw 80 (as shown) and / or the upper jaw 78 can have one or more loading notches or docks 96. The loading dock 96 can expose a suture holder 18, such as a wire loop 98, for loading / removing the suture 70. The suture holder 18 can extend into the loading notch. For example, the wire loop 98 can extend through the side slot 72 into the retaining notch 100 with the shuttle 14 in position for loading / removing the suture 70 into / from the shuttle 14. For example, the shuttle 14 can be in its proximal-most position on the bottom track 66 when the suture holder 18 is aligned with the loading dock 96. The side slot 72 can terminate at the loading dock 96, e.g., to provide an interference fit between the walls of the loading dock 96 and the shuttle 14 and / or the suture holder 18, preventing the shuttle 14 from translating further proximally along the jaws.

[0046]

[0196] The lower jaw 80 and / or the upper jaw 78 can have a septum 90 that can cover an inner terminal surface at the distal end 2 of the lower jaw 80 (as shown) and / or the upper jaw 78. The septum 90 can be a flexible material that can be configured to seal around all or a portion of the shuttle 14 as it passes through the septum 90. For example, the septum 90 can be made from a solid panel of fabric or a polymer such as polyurethane or polyester.

[0047]

[0197] The bulkhead 90 may have a bulkhead rail port 92. The bulkhead rail port 92 may be aligned with an end of the bottom track 66 and / or the top track 64.

[0048]

[0198] The septum 90 may have a septum slot 94. The septum slot 94 may be aligned with the side slots 72 of the bottom track 66 and / or the top track 264.

[0049]

[0199] The septum 90 can be configured to wipe or squeegee waste material, such as tissue 74 and biological fluids, from the shuttle 14 as it passes through the septum 90, for example, to prevent or minimize waste material and fluids from entering the top and / or bottom tracks 66.

[0050]

[0200] Figure 8a shows that the shuttle 14 can have a rail 16 that can have a cylinder and the suture holder 18 can be as described in Figures 2b and 2c. The retention notch 100 can have an angular cleat 97. The retention notch 100 can extend to the side of the rail 16.

[0051]

[0201] 8b shows that the shuttle 14 can be positioned such that the retention notch 100 of the suture holder 18 can be in the loading dock 96 when the suture 70 is attached to or removed from the retention notch 100. The suture 70 can be pushed into the retention notch 100 (e.g., for attachment) or pulled out of it (e.g., for removal, disengagement, or repositioning). A first pair of longitudinally opposed cleats 97 can provide an outer friction or interference fit for the suture 70 within the retention notch 100. A second pair of longitudinally opposed cleats 97 can provide an inner friction or interference fit for the suture 70 within the retention notch 100 (i.e., the suture 70 can be radially secured between a first pair of cleats 97 on the outer side of the suture 70 and a second pair of cleats 97 on the inner side of the suture 70).

[0052]

[0202] The suture 70 may be radially secured between a pair of longitudinally opposed cleats 97 which may dig into the outer surface of the suture 70 and compress or puncture it.

[0053]

[0203] The shuttle 14 may be interference-fitted or otherwise stopped from moving proximally by the lower jaw 80 to a position where the retention notch 100 is exposed in the loading dock 96 .

[0054]

[0204] 9a, 10a, and 10b show that the device 188 can be in an open configuration with the upper jaw 78 rotated away from the lower jaw 80. The upper jaw 78 can have an upper jaw longitudinal axis. The lower jaw 80 can have a lower jaw longitudinal axis 132. The lower jaw longitudinal axis 132 (as shown) or the upper jaw longitudinal axis 124 can be parallel and / or collinear with the compressive cover longitudinal axis. The upper jaw longitudinal axis 124 and the lower jaw longitudinal axis 132 can intersect at a jaw angle 128. When the jaws are in the open configuration, the jaw angle 128 can be about 30° to about 45°, more narrowly about 30° to about 40°.

[0055]

[0205] The compression cover 34 can be translated and retracted proximally, as indicated by arrow 126, away from the jaws. The upper jaw 78 can have a slotted sliding pin 130 that can extend laterally from one or both sides of the proximal end of the upper jaw 78.

[0056]

[0206] The distal end 2 of the compressive cover 34 can have one or more angled slots 134 on one or both sides of the compressive cover 34. The angled slots 134 can narrow as the angled slots 134 extend in a proximal direction (i.e., widen as the angled slots 134 extend in a distal direction). The angled slots 134 can be at a non-zero angle (i.e., non-aligned) with respect to the longitudinal axis of the compressive cover 34.

[0057]

[0207] The slotted sliding pin 130 can be configured to extend through the angled slot 134. The slotted sliding pin 130 can slide within the angled slot 134. The slotted sliding pin 130 can friction fit into the narrower proximal end of the angled slot 134, for example, to friction fit the jaws in a closed configuration and provide tactile feedback to a user of the jaw angle 128.

[0058]

[0208] 10a shows that the upper track can pass through a hinge tube 149 that extends beyond the distal opening of the compression cover 34 and into the upper jaw. The hinge tube 149 can be made from, for example, Nitinol. The hinge tube 149 can bend as the upper jaw rotates. The hinge tube 149 can be an integral length of the entire upper track or can be a separate length of tube attached to the remainder of the upper track at one or each end.

[0059]

[0209] 9b and 11a show that the compression cover 34 can be extended or advanced distally relative to the jaws, as indicated by arrow 138. The compression cover 34 can force the jaws to rotate toward one another into a closed configuration. For example, the upper jaw 78 can rotate, as indicated by arrow 136, while the lower jaw 80 remains in a rotationally fixed position relative to the compression cover 34, or vice versa, or both jaws can rotate relative to the compression cover 34. Thus, a lever, such as trigger 8, can be actuated to advance the outer tube or compression cover 34 to cam the jaws closed.

[0060]

[0210] When the jaws are in a closed configuration, the jaw angle 128 can be from about 0° to about 3°, more narrowly from about 0° to about 2°, such as about 0°.

[0061]

[0211] 9c and 11b show that the upper jaw tip 206 can be pressed into and through the bulkhead rail port 92. The top or upper track 264 can, for example, form a continuous lumen 152 with the bottom or lower track 148, for example, through which the shuttle 14 can slide.

[0062]

[0212] The side slots 72 of the upper jaw 78 may be aligned with the side slots 72 of the lower jaw 80. The suture holder 18 may extend through the side slots 72 and hold the suture 70 within the side slots 72. The suture holder 18 translates the suture 70 back and forth between the upper jaw 78 and the lower jaw 80 within the side slots 72 as the shuttle 14 translates back and forth between the upper jaw 78 and the lower jaw 80.

[0063]

[0213] 12a-c show that the shuttle 14 can have rails 16, e.g., a shuttle spine 160, and lateral arms or fingers of the shuttle 14 that extend laterally and / or inwardly from the shuttle spine 160. As shown, the shuttle fingers 156 can extend laterally, downwardly, and inwardly relative to the shuttle spine 160. The shuttle 14 can have slits 20 or shuttle lateral slots 158 between the shuttle fingers 156. The shuttle fingers 156 can be flexible or rigid.

[0064]

[0214] The shuttle 14 can have a shuttle longitudinal axis 157. The shuttle longitudinal axis 157 can be flat or curved and can have a shuttle radius of curvature 154, for example, from about 3 mm to about 5 mm, more narrowly from about 3 mm to about 4 mm, for example, about 3.5 mm.

[0065]

[0215] The shuttle spine 160 can be flexible or rigid. The shuttle 14 can be made from a single panel of material (e.g., metal), for example, by bending and laser cutting the panel.

[0066]

[0216] The suture holder 18 may be one, two, or more circular, oval, or elongated longitudinal slots in the shuttle spine 160. For example, the suture 70 may extend through one or both suture holders 18. The suture 70 may be fused to the shuttle 14 adjacent the suture holder 18. A removable or fixed frame may be attached to the slots in the shuttle 14, and the suture 70 may be attached to the removable frame. For example, the removable frame may be an arc-shaped wire attached at a first end to a first slot in the shuttle spine 160 and at a second end to an adjacent second slot in the shuttle spine 160.

[0067]

[0217] 13a shows that the suture holder 18 can be an arc that is integral with the shuttle spine 160. For example, the shuttle 14 can be made from a single panel of material (e.g., metal). The sides of the suture holder 18 can be cut, leaving the longitudinal ends integral with the shuttle spine 160. The suture holder 18 can then be bent or deformed away from the plane of the shuttle spine 160, for example forming an arc that is out of the plane of the shuttle spine 160.

[0068]

[0218] The suture 70 may have a suture loop 162 at a terminal end of the suture 70. The suture loop 162 extends around the suture holder 18 and may completely or partially surround the suture holder 18. The remainder of the suture 70 may be integral with the suture loop 162 or may be removably attached to the suture loop 162. The suture loop 162 may be circular or oval.

[0069]

[0219] 13b shows that the shuttle 14 can have one or more shuttle notches 166 or cutouts. For example, the shuttle 14 can have two shuttle notches 166 on each side of the shuttle. The shuttle notches 166 can be spaced apart and distributed longitudinally along the shuttle 14. The shuttle notches 166 can be curved. The sides of the shuttle 14 other than the notches can be straight.

[0070]

[0220] The radius of curvature of the shuttle notch 166 may be from about 1 mm to about 2 mm.

[0071]

[0221] Figures 14a-c show that one or both longitudinal ends of the shuttle 14 can be a curved or sharp shuttle tip 164. For example, the shuttle tip 164 can have an oblique chisel tip or a needle tip.

[0072]

[0222] The shuttle holder can have a holder leader 170 extending away from the shuttle spine 160. The end of the holder leader 170 remote from the shuttle spine 160 can be a closed wire loop 98 configured to be attached to a suture 70. A loop neck 172, such as a dual clamp, can secure a first end of the leader wire at a midpoint on the holder leader 170, as shown. A second end of the holder leader 170 can extend through a shuttle longitudinal slot 174 and terminate in a leader anchor 168, such as a crimp or swage ball or disk having a diameter greater than the width of the shuttle longitudinal slot 174, for example, to slidably attach the suture holder 18 to the shuttle longitudinal slot 174. The suture holder 18 can be slidably captured within the shuttle longitudinal slot 174 by the leader anchor 168.

[0073]

[0223] The holder leader 170 can be translatably and / or rotatably fixed within the shuttle longitudinal slot 174, or can slide and / or rotate within the shuttle longitudinal slot 174. For example, the wire loop 98 can extend beyond the first end of the shuttle spine 160 when the shuttle 14 translates in a first direction (e.g., from the upper jaw 78 toward the lower jaw 80), and the holder leader 170 can passively rotate and translate when the shuttle 14 translates in a second direction (e.g., from the lower jaw 80 toward the upper jaw 78).

[0074]

[0224] Holder leader 170 can be rigid or flexible. For example, holder leader 170 can be made from stainless steel, other materials disclosed herein, or combinations thereof.

[0075]

[0225] The suture 70 can be threaded and / or tied to a wire loop 98. The wire loop 98 can be at an elevation away from the shuttle spine 160. The wire loop 98 can extend proximally or distally beyond the end of the shuttle tip 164. For example, the suture 70 can be attached to the wire loop 98 away from any sharp edges to minimize the risk of cutting or damaging the suture 70.

[0076]

[0226] Figures 15a and 15b show that the sutures 70 can be attached or fused directly to the shuttle spine 160 at suture attachments 176 at the mid-longitudinal and lateral portions of the shuttle 14. The sutures 70 can be braided.

[0077]

[0227] For example, the entire shuttle 14 can be made from plastic and can be molded, overmolded, or otherwise bonded to the plastic sutures. The sutures can be thermally formed to the shuttle 14. The sutures 70 can extend through the shuttle 14, for example, at a suture anchor 178. The suture anchor 178 can be the terminus of the sutures 70 that extend through and are attached to the shuttle 14.

[0078]

[0228] 16a and 16b show that the leader or wire loop 98 can extend partially or entirely in a plane perpendicular to the plane of the shuttle spine 160. A first end of the wire loop 98 can have a leader first anchor 184. A second end of the wire loop 98 can have a leader second anchor 186. The shuttle spine 160 can have a shuttle longitudinal first slot 180 and a shuttle longitudinal second slot 182. The shuttle longitudinal slot 174 can be elongated or circular. The wire loop 98 can be made of, for example, Nitinol and / or steel, and can be tied to a suture.

[0079]

[0229] The wire loop 98 can extend through the shuttle longitudinal slot 174. The leader first and second anchors can be on the underside (e.g., concave side or radially inward) of the shuttle spine 160. The wire loop 98 can be on the outside (e.g., convex side or radially outward) of the shuttle spine 160. Neither one nor both of the leader anchors 168 can be fixed or integral (e.g., melted or welded) to the shuttle spine 160. Neither one nor both of the leader anchors 168 can be slidably attached to the longitudinal slot. The wire loop 98 can be fixed or slidable longitudinally relative to the shuttle spine 160.

[0080]

[0230] The wire loop 98 can have a longitudinally symmetric or asymmetric shape (as shown). For example, the wire loop 98 can be an arc (similar to the shape shown by the suture holder 18 in FIGS. 13a and 13b) or can flare asymmetrically toward one of the longitudinal shuttle ends (as shown).

[0081]

[0231] 17a shows that the device 188 can have the shuttle 14 in a position that straddles the upper jaw 78 and the lower jaw 80. The jaws can have jaw side ridges 190. The shuttle fingers 156 can wrap around the jaw side ridges 190, e.g., to slidably attach the shuttle to the jaws. The jaw side ridges 190 at the ends of the upper 78 or top jaw 30 and the bottom or lower jaw 80 can be aligned, e.g., when the jaws 14 are in a closed configuration, so that the shuttle 14 can slide along the continuous ridge between the upper jaw 78 and the lower jaw 80.

[0082]

[0232] 17b shows that the device 188 can have a lower pusher 76 slidably mounted on a jaw side ridge 190 on the lower jaw 80. The lower pusher 76 can abut against the shuttle 14.

[0083]

[0233] 17c shows that device 188 can have an upper pusher 86 slidably mounted to a jaw side ridge 190 on upper jaw 78. Upper pusher 86 and / or lower pusher 76 can be shaped like shuttle 14. Shuttle 14 can be pushed onto the straight length of lower jaw 80. Shuttle 14 can deform into a straight configuration when on the straight length of the jaw and into a curved configuration when on the curved length of the jaw.

[0084]

[0234] The pusher may be shaped generally similar to shuttle 14 with fingers, longitudinal slots, a spine, and transverse slots between the fingers. More than one pusher may be used simultaneously with a single device 188 (e.g., where the pusher in Figures 17b-17d is shuttle 14 and additional pushers are used), e.g., to deliver multiple sutures 70 to the same target site.

[0085]

[0235] 17d shows that the shuttle 14 can be pushed by the lower pusher 76 into the upper jaw 78 as shown. The lower pusher 76 can then be retracted onto the lower jaw 80.

[0086]

[0236] 18a and 18b show that the upper and / or lower jaws 80 can each have a jaw spine 208. The jaw spine 208 can extend inwardly from the remainder of the jaw toward the jaw control extension longitudinal axis (as shown) or away from the jaw control extension longitudinal axis. For example, the jaw spine can extend distally from the remainder of the jaw to a distal end 2 of the jaw distal to where the jaw extends from the jaw longitudinal extensions 191, 202 to inwardly curved jaw medial extensions closer to and within the respective jaw tips.

[0087]

[0237] As described elsewhere herein, the jaws may have jaw side ridges 190 or rails 16. The jaws may have a T-shaped cross section.

[0088]

[0238] The shuttle 14 can have shuttle fingers 156, each of which can have a shuttle downward extension 196. The shuttle fingers 156 can each have a shuttle lateral extension 192 extending laterally from a respective shuttle spine 160. The shuttle fingers 156 can have shuttle downward extensions 196, each of which can extend downward (e.g., toward a longitudinal axis of the jaw structure) from a lateral end of the lateral extension. The shuttle fingers 156 can have shuttle inner extensions 194, each of which can extend inward from the shuttle downward extensions 196. The shuttle spine 160 and / or the lateral, downward, and inner extensions can slidably wrap around the jaw lateral ridges 190.

[0089]

[0239] The upper jaw tip 206 and / or the lower jaw tip 198 can have a blunt, beveled (e.g., needle tip), chisel (e.g., beveled on both sides as shown in FIGS. 18a and 18b), conical, Sprotte, diamond, Tuohy tip, or combinations thereof (e.g., the upper jaw tip 206 can have a first tip shape and the lower jaw tip 198 can have a second tip shape). The bevel on the distal side of the jaw tips can have the same angle and length as the bevel on the proximal side of the jaw tips, or a smaller angle and longer length.

[0090]

[0240] The upper jaw tip 206 can have a tip gap 290 or can contact the lower jaw tip 198 when the jaws are in a closed configuration.

[0091]

[0241] 19a and 19b show that the jaw spine 208 of one or both jaws can terminate before the respective jaw tip or jaw inner extension.

[0092]

[0242] The proximal bevel of the jaw tip may have a smaller angle and a longer length than the distal bevel of the jaw tip.

[0093]

[0243] 20a and 20b show that the jaw spine 208 of the upper jaw 78 can extend along the straight length of the upper jaw 78 and can terminate at or proximal to the upper jaw medial extension 204 or the upper jaw tip 206. The jaw lateral ridges 190 of the upper jaw 78 can extend to the terminal distal tip of the upper jaw 78.

[0094]

[0244] The jaw spine 208 of the lower jaw 80 may extend to a terminal distal tip of the lower jaw 80 .

[0095]

[0245] The jaw side ridges 190 of the lower jaw 80 may extend along the straight length of the lower jaw 80 and may terminate at or proximal to the lower jaw inner extensions 200 or the lower jaw tip 198 .

[0096]

[0246] When the jaws are in a closed configuration, the lower jaw tip 198 is disposed proximal to and can overlap the upper jaw tip 206. The upper jaw tip 206 and the lower jaw tip 198 can overlap along a tip interface 211. For example, the distal end 2 of the jaw spine 208 of the lower jaw 80 can overlap proximally of the upper jaw tip 206 and slide against it. The upper jaw tip 206 can contact the lower jaw tip 198 at the tip interface 211, or there can be a gap between the upper jaw tip 206 and the lower jaw tip 198 at the tip interface 211.

[0097]

[0247] The tip interface 211 can have a tip interface axis 214 relative to the jaw structure longitudinal axis 42. The tip interface axis 214 can intersect the jaw structure longitudinal axis 42 at a tip interface angle 212 of approximately 90°.

[0098]

[0248] The upper jaw tip 206 can be distal to the lower jaw tip 198 at a tip interface 211 .

[0099]

[0249] The distal ends of the jaw side ridges 190 of the upper jaw 78 may or may not contact the distal ends of the jaw side ridges 190 of the lower jaw 80 when the jaws are in a closed configuration.

[0100]

[0250] 21a and 21b show that tip interface 211 can have a tip interface axis 214 relative to jaw structure longitudinal axis 42. Lower jaw tip 198 can be more distal than upper jaw tip 206 at tip interface 211. Tip interface angle 212 can be between about 30° and about 60°, more narrowly between 30° and about 45°, such as about 35°.

[0101]

[0251] 22a-c show that the distal end 2 of the lower jaw tip 198 (as shown) or the upper jaw tip 206 can have a tip seat 216. The tip seat 216 can be shaped to receive the shape of the opposing jaw tip. For example, the tip seat 216 can be triangular (e.g., A-shaped or V-shaped).

[0102]

[0252] The tip seat 216 can surround the lateral and distal sides of the upper jaw tip 206 when the jaws are in a closed configuration. The tip seat 216 can or can not contact the upper jaw tip 206 (i.e., there can be a gap) when the jaws are in a closed configuration.

[0103]

[0253] The jaw side ridges 190 of the jaw having the tip seat 216 (bottom jaw 38 as shown) may extend to the terminus of the lower jaw tip 198 and to the tip seat 216. The jaw side ridges 190 of the jaw opposite the tip seat 216 (top jaw 78 as shown) may narrow to the point where the respective jaw tips terminate. The narrowed jaw side ridges 190 may be received within the tip seat 216.

[0104]

[0254] 23a and 23b show that the upper jaw 78 and / or the lower jaw 80 can have a circular or elliptical cross section. The upper jaw 78 and / or the lower jaw 80 can be made from a solid or hollow rod having a diameter, for example, from about 0.030 inches to about 0.100 inches, for example about 0.060 inches.

[0105]

[0255] The terminus of the upper and / or lower jaw tip 198 can have a conical shape. The terminus of the lower jaw tip 198 can have a tip seat 216 that can be the inverse or opposite of the conical shape, e.g., sized and shaped to receive the upper jaw tip 206.

[0106]

[0256] The shuttle 14 may have a circular or elliptical cross-section.

[0107]

[0257] The pusher may have pusher fingers 219 extending from a pusher spine 218, similar to the shuttle fingers 156 and shuttle spine 160. The pusher fingers 219 may be triangular in shape.

[0108]

[0258] 24a-c show that the distal end 2 of the device 188 can be inserted into a cannula 226, for example, for percutaneous deployment through the cannula 226 inserted into a patient at a target site. The cannula 226 can have an inner cannula diameter 228. The inner cannula diameter 228 can be from about 4 mm to about 8 mm, for example, 7 mm, or 6.86 mm (0.270 inches), or 15 French gauge (5 mm (0.197 inches)).

[0109]

[0259] The shuttle 14 may have a shuttle height 220. The shuttle height 220 may be between about 0.020 inches and 0.060 inches, for example, about 0.041 inches.

[0110]

[0260] The compression cover 34 can be attached to or integral with one or more jaw control extensions 40. For example, the jaw control extensions 40 can extend from the lateral distal end 2 of the compression cover 34. The jaw control extensions 40 can be slidably attached to or in contact with the jaws, directly or indirectly. The jaw control extensions 40 can urge the jaws apart when the jaw control extensions 40 translate proximally relative to the jaws and can urge the jaws closer together when the jaw control extensions 40 translate distally relative to the jaws.

[0111]

[0261] One or more upper cam pins 222 can extend laterally from one or both sides of the proximal end of upper jaw 78. One or more lower cam pins 232 can extend laterally from one or both sides of the proximal end of lower jaw 80 at the same or different longitudinal positions as the upper cam pins 222.

[0112]

[0262] The jaw control extension 40 can have one or more upper cam slots 230 and one or more lower cam slots 224. The upper cam slots 230 and / or lower cam slots 224 can be straight, curved, angled (as shown), or a combination thereof. A cam pin can be disposed inside and through each cam slot. The cam pin can slide within the cam slot.

[0113]

[0263] As the jaw control extensions 40 translate distally relative to the jaws, the cam pins slide proximally within their respective cam slots, allowing the jaws to rotate away from one another. As the jaw control extensions 40 translate proximally relative to the jaws, the cam pins slide distally within their respective cam slots, allowing the jaws to rotate toward one another.

[0114]

[0264] The jaws can have a jaw extension length 234. The jaw extension length 234 can be the length from the distal end 2 of the jaw control extension 40 to the proximal side of the jaw tip. The jaw extension length 234 when the jaws are in a closed configuration can be from about 5 mm to about 30 mm, for example, about 16 mm and 15.95 mm.

[0115]

[0265] The jaws can have a jaw linear gap 236 along the linear length of the jaws. The jaw linear gap 236 can be from about 1 mm to about 3.5 mm, such as about 1.1 mm or about 3.2 mm. For example, the cannula inner diameter 228 can be 5 mm and the jaw linear gap 236 can be about 1.1 mm.

[0116]

[0266] The jaws may be separate or integral to a jaw body that is deformable to rotate away from one another when moved to an open configuration.

[0117]

[0267] 25a-25f show that the upper jaw tip 206 and / or the lower jaw tip 198 can have a suture holder slot 238. The suture holder slot 238 can extend inwardly along the outer surface of the respective jaw tip. The suture holder slot 238 can extend from the outer surface of the jaw tip to the respective track. The suture holder 18 can be accessible through or extend from the suture holder slot 238. The suture 70 (not shown) can be attached to or integral with the suture holder 18 inside or outside the suture holder slot 238.

[0118]

[0268] The upper track 264 can terminate distally at an upper jaw tip shuttle port 240. The lower track 148 can terminate distally at a lower jaw tip shuttle port 256. The shuttle 14 can extend out of or into and through each of the shuttle 14 ports. In use, the sharp shuttle tip 164 extending from the shuttle port can pierce, cut and incise tissue 74 as the jaws are rotated to the closed configuration.

[0119]

[0269] The upper jaw 78 and / or the lower jaw 80 can have a jaw stop 242. The jaw stop 242 can be a feature, shape, or configuration that can abut and stop distal translation of the compressible cover 34 relative to the jaws. For example, a distal end of the compressible cover 34 can abut the jaw stop 242 when the jaws are in a closed configuration.

[0120]

[0270] The radially inner surface of the jaw may have a radially inner bevel 250 .

[0121]

[0271] The upper jaw 78 and / or the lower jaw 80 can have a jaw slide 244. The jaw slide 244 can be a radially outer surface of the jaw between the jaw stop 242 and the compression cover 34 when the compression cover 34 is in the proximally retracted 126 position relative to the jaws and / or when the jaws are in an open configuration. The jaw slide 244 can increase in radius from the jaw structure longitudinal axis 42 in the distal longitudinal direction (e.g., the larger the longitudinal dimension of the jaw slide 244, the larger the radial dimension of the jaw slide 244). As the compression cover translates in the distal direction 138 relative to the jaws, a radially inner distal edge of the compression cover 34 can slide along the jaw slide 244 and push the jaw slide 244 toward the jaw structure longitudinal axis 42. A radial compressive force delivered from the compressive cover 34 to the jaw slide 244 can create a torque in each jaw, causing each jaw to rotate toward the jaw structure longitudinal axis 42 and the opposing jaw.

[0122]

[0272] The device 188 can have a jaw control extension 40. The jaw control extension 40 can extend along a jaw structure longitudinal axis 42. The jaw control extension 40 can extend between the jaws proximal to the jaw tips. The jaw control extension 40 can terminate in a jaw control extension head 254.

[0123]

[0273] The jaw control extension head 254 can have one or two lobes or cams. Each lobe can extend from the longitudinal axis of the jaw control extension 40 toward the jaw. The lobes can act similar to the open roller balls shown in FIGS. 4a, 4d, and elsewhere herein. The upper jaw 78 and lower jaw 80 can have upper and inner jaw radially inwardly inclined surfaces 250, respectively. The inwardly inclined surfaces can be the radially inner surfaces of the jaw proximal to the jaw tip and distal to the jaw control extension head 254 when the jaw control extension head 254 is in a proximally retracted position relative to the jaw. The radially inwardly inclined surfaces 250 can have an increasing radius from the jaw structure longitudinal axis 42 in the distal longitudinal direction (e.g., the greater the longitudinal dimension of the radially inwardly inclined surfaces 250, the greater the radial dimension of the radially inwardly inclined surfaces 250). As the jaw control extensions 40 are translated or retracted proximally relative to the jaws, the lobes slide against the radially inner sloped surfaces 250 of the jaws, allowing the jaws to be pushed apart into an open configuration.

[0124]

[0274] When the jaws are in the open configuration, the compression cover 34 can be positioned at or proximally past the proximal end of the jaw slide 244 and the jaw extension head can be positioned at or proximally past the proximal end of the radially inner sloped surface 250.

[0125]

[0275] The jaw control extension 40 can be attached to or integral with a control rail 248. The control rail 248 can extend radially from one or both sides of the jaw control extension 40, for example, in a plane perpendicular to the plane defined by the opposing jaw or opposite extension head lobe 252.

[0126]

[0276] The compression cover 34 can have a control rail slot 246. The control rail slot 246 can extend to a distal end of the compression cover 34. The control rail 248 can be fixed to the control rail slot 246 or can translate longitudinally therein. The control rail 248 can be interference-fitted, abut, or rest against a proximal end of the control rail slot 246, for example, when the control rail 248 is in a proximal or distal longitudinal position relative to the jaws. The control rail 248 can move longitudinally distally and / or longitudinally in unison (i.e., simultaneously) with the compression cover 34. The control rail 248 can move longitudinally distally and / or longitudinally in unison with the jaw control extension 40.

[0127]

[0277] The device 188 can have an upper socket arm 258 and a lower socket arm 270 radially inward of the compression cover 34. The upper socket arm 258 and the lower socket arm 270 can be a single integral element (e.g., a hollow cylinder) or separate elements. The upper socket arm 258 can be opposite the lower socket arm 270. The upper socket arm 258 can be translatably fixed to the lower socket arm 270 (i.e., mechanically attached to translate in unison with the lower socket arm 270). The jaw control extension 40 can extend longitudinally between the upper socket arm 258 and the lower socket arm 270 or within a hollow channel within the single socket arm (including the upper socket arm 258 and the lower socket arm 270 as integral elements). The distal ends of the socket arms can extend to or proximal to the distal end of the compression cover 34 when the jaws are in an open configuration.

[0128]

[0278] The proximal terminus of the upper jaw 78 may have a laterally elongated upper jaw bearing 262. The upper jaw bearing 262 may extend radially outward from the remainder of the proximal end of the upper jaw 78.

[0129]

[0279] The distal end 2 of the upper socket arm 258 can have a laterally elongated upper jaw socket 260. The upper jaw socket 260 can open inwardly and can have a diameter approximately equal to or slightly larger than the diameter of the upper jaw bearing 262.

[0130]

[0280] The upper jaw 78 hinge may include an upper jaw bearing 262 and an upper jaw socket 260. The upper jaw 78 may rotate about a transverse axis of the upper jaw bearing 262. The upper jaw bearing 262 may rotate within the upper jaw socket 260.

[0131]

[0281] The proximal terminus of the lower jaw 80 may have a laterally elongated lower jaw bearing 266. The lower jaw bearing 266 may extend radially outward from the remainder of the proximal end of the lower jaw 80.

[0132]

[0282] The distal end 2 of the lower socket arm 270 can have a laterally elongated lower jaw socket 268. The lower jaw socket 268 can open inwardly and can have a diameter approximately equal to or slightly larger than the diameter of the lower jaw bearing 266.

[0133]

[0283] The lower jaw 80 hinge may include a lower jaw bearing 266 and a lower jaw socket 268. The lower jaw 80 may rotate about a transverse axis of the lower jaw bearing 266. The lower jaw bearing 266 may rotate within the lower jaw socket 268.

[0134]

[0284] The top pusher 86 and / or bottom pusher 76 can have an entire length or only a distal end 2 that can have articulation segments 286. The articulation segments 286 can rotate relative to one another about an axis perpendicular to the longitudinal axis of the respective pushers. The articulation segments 286 can be connected by separate hinges (e.g., pin or snap connections) or can be longitudinally coincident or longitudinally offset lateral slots cut into the sides of the pushers, similar to the shape of the shuttle lateral slots 158. The proximal ends of either or both of the top pusher 86 and bottom pusher 76 can have a continuous, non-segmented, flat, uniform ribbon of material.

[0135]

[0285] Each of the upper pusher 86 and / or lower pusher 76 can have a distal end that can have a shuttle seat 274. The shuttle seat 274 can be an inverse shape to the shape of the shuttle tip 164. For example, if the shuttle tip 164 has an angled end, the shuttle seat 274 can have an opposite angle. If the shuttle tip 164 has a convex curved end, the shuttle seat 274 can have a concave curved end with the same radius of curvature as the shuttle tip 164.

[0136]

[0286] 26a-d show that the compression cover 34 can translate distally relative to the jaws as shown by the arrows. The compression cover 34 can deliver a translational force to the control rail 248 via the edges of the control rail slot 246. The control rail 248 can deliver a translational force to the jaw control extension 40. The jaw control extension 40 can translate distally as shown by the arrows simultaneously with the compression cover 34. The compression cover 34 can translate 138 on the jaw slide 244 while pushing the jaw slide radially inward. The jaw control extension head 254 can move distally relative to the jaws as shown by the arrows 280, for example, to close the jaws without an interference fit or abutting the jaw control extension head 254. The upper jaw 78 and / or the lower jaw 80 can rotate radially inward as shown by the arrows.

[0137]

[0287] When the jaws are in a closed configuration, the compression cover 34 can be positioned at or adjacent to the jaw stop 242 and the jaw extension head can be positioned at or proximally past the proximal end of the radially inner inclined surface 250.

[0138]

[0288] When the jaws are in a closed configuration, and the shuttle 14 is in the upper track 264, the upper pusher 86 can translate distally through the upper track 264. The distal end of the upper pusher 86 can abut the shuttle 14. The upper pusher 86 can then push the shuttle 14 through the upper track 264, out of the upper jaw tip shuttle port 240, and into the lower jaw tip shuttle port 256.

[0139]

[0289] When the jaws are in a closed configuration, with the shuttle 14 in the lower track 148, the lower pusher 76 can translate distally through the lower track 148. The distal end of the lower pusher 76 can abut the shuttle 14. The lower pusher 76 can then push the shuttle 14 through the lower track 148 and out of the lower jaw tip shuttle port 256 and into the upper jaw tip shuttle port 240.

[0140]

[0290] When the shuttle 14 is pushed from the upper track 264 to the lower track 148 or vice versa, the shuttle 14 may translate 282 in a curvilinear manner, as indicated by the arrow, following the path of the upper track 264 and the lower track 148 .

[0141]

[0291] When the jaws are in a closed configuration, the shuttle 14 moves from the upper jaw 78 to the lower jaw 80 and back to the upper jaw 78, as indicated by the arrows, and can repeat the movement from the upper jaw 78 to the lower jaw 80, and optionally from the lower jaw 80 to the upper jaw 78, two or more times.

[0142]

[0292] The device 188 can have a pusher lockout that can prevent translation of the pusher and shuttle 14 when the jaws are in the open configuration.

[0143]

[0293] The device 188 can have a jaw lockout that prevents the jaws from opening when either of the pushers extend from the respective jaw tip shuttle ports and / or when the shuttle 14 is simultaneously within the upper jaw 78 and lower jaw 80.

[0144]

[0294] 27 shows that the upper pusher 86 can translate distally relative to the jaws. The upper pusher 86 can translate curvilinearly along the upper track 264, as shown by arrows 284 and 288. The distal end of the upper pusher 86 can extend out of the upper jaw tip shuttle port 240. A V-shaped (or A-shaped) or curved (e.g. U-shaped) shuttle seat 274 at the distal end of the upper pusher 86 can abut the V-shaped (or A-shaped) or curved (e.g. U-shaped) shuttle tip 164 at the end of the shuttle. The upper pusher 86 can push the shuttle 14 through the upper track 264 across the gap between the upper jaw tip shuttle port 240 and the lower jaw tip shuttle port 256 into the lower track 148. The shuttle 14 can have a curvilinear translation 282 along the track, as shown by the arrow.

[0145]

[0295] The lower pusher 76 can have zero or one lower pusher articulation segment (as shown), or it can have multiple articulation segments similar to the upper pusher 86 of FIG.

[0146]

[0296] Figure 28 illustrates that the suture 70 can be tied or glued directly to the suture holder 18, for example as shown in Figures 13a and 13b. The suture 70 can have a suture loop 162. The suture loop 162 can encircle the suture holder 18.

[0147]

[0297] 29 shows that when the jaws are in a closed configuration, the end of the upper jaw tip 206 can touch the end of the lower tip jaw or have a tip gap 290 therebetween. The tip gap 290 can be from about 0 inches to about 0.020 inches, for example about 0.008 inches.

[0148]

[0298] The shuttle 14 may have a shuttle width 292. The shuttle width 292 may be from about 0.030 inches to about 0.100 inches, for example, about 0.060 inches.

[0149]

[0299] The shuttle 14 may be made from a nickel-titanium alloy (eg, Nitinol), stainless steel, other materials disclosed herein, or combinations thereof.

[0150]

[0300] Figures 30a, 30b and 31 show that a lever 106 or handle 104 can control the rotation and opening and closing of the jaws.

[0151]

[0301] The handle 104 can have a handle pivot 302. The handle pivot 302 can be a rotatable pin joint that can rotatably attach the handle 104 to the base 102. The handle 104 can rotate relative to the base 102 about the handle pivot 302.

[0152]

[0302] The handle 104 may be attached to the socket arm and / or the compression cover 34 (as shown). For example, the compression cover 34 may have a radially and / or laterally extending cover pin 304. The cover pin 304 may be attached to the jaw control extension 40. The handle 104 may have one or two transfer ports 314 or loops 296 on both sides of the compression cover 34. The cover pin 304 may extend through the transfer loop 296.

[0153]

[0303] The other of the socket arms (as shown) and the compression cover 34 that is not attached to the handle 104 may be attached to the base 102 .

[0154]

[0304] By squeezing and rotating the handle 104 toward the base 102, the compression cover 34 and jaw control extension 40 can be extended 138 distally relative to the jaws, or the jaws can be retracted 126 proximally relative to the compression cover 34 and jaw control extension 40. As the handle 104 rotates, the jaws can move to an open configuration. For example, as the bottom of the handle 104 rotates proximally toward the base 102, the transfer loop 296 can rotate distally toward the jaws, pushing the cover pin 304 and compression cover 34 distally. The transfer loop 296 can force the compression cover 34 and / or jaw control extension 40 to translate distally, for example, closing the jaws.

[0155]

[0305] The proximal end of the upper socket arm 258 and the proximal end of the lower socket arm 270 may be a unitary element or may be fixedly attached by a socket arm brace 300 .

[0156]

[0306] The proximal end of the upper pusher 86 can be attached to or integral with the upper pusher 86 shaft and / or the upper pusher button 210a. The proximal end of the lower pusher 76 can be attached to or integral with the lower pusher shaft and / or the lower pusher button 210b. The proximal distal ends 2 of the upper pusher button 210a and the lower pusher button 210b can be one above the other or side by side (e.g., side to side as shown). The device 188 can be configured such that pressing (e.g., translating distally) the upper pusher button 210a can advance the upper pusher 86 distally and pressing (e.g., translating distally) the lower pusher button 210b can advance the upper pusher 86 distally. Pressing the upper pusher button 210 can retract the lower pusher 76 and / or the lower pusher button 210b proximally. Depressing lower pusher button 210b can retract upper pusher 86 and / or upper pusher button 210 proximally.

[0157]

[0307] The inside of the distal ends 2 of the upper and lower pusher buttons 210b may respectively have an upper pusher button gear 310 and a lower pusher button gear 306. The upper pusher button gear 310 may face the lower pusher button gear 306.

[0158]

[0308] The pusher toggle knob 294 can be rotatably mounted to the base 102. The pusher toggle knob 294 can be integral with or rotatably fixed to a pusher toggle knob gear 308. The pusher toggle knob gear 308 can rotatably mate with and intermesh with an upper pusher button gear 310 on a first side and a lower pusher button gear 306 on an opposite side to the upper pusher button gear 310.

[0159]

[0309] As the upper pusher button translates in the distal direction 284, the upper pusher button gear 310 can rotate the pusher toggle gear, e.g., the upper portion of the pusher toggle knob 294 can also rotate to a position indicating that the upper pusher button 210a has translated in the distal direction 284. The upper surface or circumference of the upper portion of the pusher toggle knob 294 can have indicators, such as arrows, indicating the position of the shuttle 14 in the upper track 264, lower track 148 extending from one track or extending across both tracks simultaneously, that can indicate whether the upper pusher 86 or lower pusher 76 has been translated and how far it has moved. The pusher toggle gear can simultaneously translate the lower pusher button gear 306 in the proximal direction. For example, as the upper pusher 86 is translated in the distal direction, the lower pusher 76 can be simultaneously translated in the proximal direction at the same rate.

[0160]

[0310] As the lower pusher button 210b translates distally, the lower pusher button gear 306 can rotate the pusher toggle gear, e.g., to a position that also rotates the upper part of the pusher toggle knob 294 to a position that indicates that the upper pusher button 210a has translated in the distal direction 284. The pusher toggle gear can simultaneously translate the upper pusher button gear 310 in the proximal direction. For example, as the lower pusher 76 is translated distally, the upper pusher 86 can be simultaneously translated proximally at the same rate.

[0161]

[0311] By rotating the pusher toggle knob 294 and transmitting torque applied to the pusher toggle knob 294 through the pusher toggle knob gear 308 and to the upper pusher button gear 310 and / or lower pusher button gear 306, the upper pusher 86 and lower pusher 76 can be translated with or without pushing the proximal ends of the pusher buttons.

[0162]

[0312] 32a and 32b show that by rotating the pusher toggle knob 294 and transmitting torque applied to the pusher toggle knob 294 through the pusher toggle knob gear 308 and to the upper pusher button gear 310 and / or lower pusher button gear 306, the upper pusher 86 and lower pusher 76 can be translated with or without pushing the proximal ends of the pusher buttons.

[0163]

[0313] The diameter of the pusher toggle knob 294 may be smaller than the width of the base 102, as shown in Figures 30a, 30b and 31, or may be larger than the width and height of the base 102 and the same size as or larger than the handle 104 and compression cover 34, as shown in Figures 32a and 32b.

[0164]

[0314] In a variation of the method of use, the distal end 2 of the device 188 including the jaws can be inserted through a percutaneous cannula 226 when the jaws are in a closed configuration. Once the distal end 2 of the device 188 exits the distal end 2 of the cannula 226 at the target site, the handle 104 can be released and rotated away from the base 102. Rotation of the handle away from the base 102 can move the jaws to an open configuration. The distal end 2 of the device 188 can then be further positioned so that the target site is between the upper jaw distal tip 206 and the lower jaw distal tip 198. The handle 104 can then be squeezed and rotated towards the base 102. Rotation of the handle towards the base 102 can move the jaws to a closed configuration and pinch the tissue 74 together at the target site. The shuttle 14 can be fully retracted into the jaw in which the shuttle 14 is loaded, or the shuttle tip 164 can extend from whichever jaw the shuttle is currently loaded into. The shuttle tip 164 can penetrate the tissue 74 when the jaws are closed or after the jaws are closed and the shuttle 14 is translated.

[0165]

[0315] After the jaws are closed, an upper pusher button 210a or a lower pusher button 210b (e.g., each associated with whichever track the shuttle 14 is currently seated in) can be pressed to advance the respective pusher distally. The respective pusher can push the shuttle 14 distally through the gap between the upper and lower jaws 78 and 80 (if such a gap exists), or directly from one jaw to the other. The shuttle 14 can pull the suture 70 to follow the path of the shuttle 14 or to follow a path adjacent to the shuttle 14. When the respective push button is fully depressed, the device 188 emits an audio and / or tactile response (e.g., from a snap or detent of the button or pusher and track), and the pusher toggle knob 294 can have an indicator (e.g., a line or arrow) that shows that the shuttle 14 has been fully translated across the jaws.

[0166]

[0316] The handle 104 can then be rotated away from the base 102. For example, the handle 104 can be released and spring loaded back into a position away from the base 102. Rotation of the handle can translate the transfer loop 296 in a proximal direction. The transfer loop 296 can pull and translate the compression cover 34 and jaw control extension 40 in a proximal direction to open the jaws.

[0167]

[0317] The device 188 can then be repositioned so that the jaw tips are either removed completely, for example when suturing is completed, or moved adjacent to their previous position for placing a new stitch. The handle 104 can then be squeezed to close the jaws. The pusher button on the track in which the shuttle 14 is positioned can then be pressed. The shuttle 14 can then be moved to the opposite jaw as described above and the suture 70 can be pulled through the tissue 74 to form a stitch.

[0168]

[0318] The above method may be repeated as necessary to create the desired stitch length and location.

[0169]

[0319] Any or all elements of the device 188 and / or other devices 188 or apparatus described herein may be made of, for example, one or more stainless steel alloys, nickel titanium alloys (e.g., Nitinol), cobalt chromium alloys (e.g., ELGILOY® from Elgin Specialty Metals, Elgin, IL; CONICHROME® from Carpenter Metals Corp., Wyomissing, PA), nickel cobalt alloys (e.g., MP35N® from Magellan Industrial Trading Company, Inc., Westport, CT), molybdenum alloys (e.g., molybdenum TZM alloy), tungsten-rhenium alloys, polymers such as polyethylene teraphthalate (PET) / polyester (e.g., EI Du Pont de Nemours and Polypropylene (PET), polytetrafluoroethylene (PTFE), expanded PTFE (ePTFE), polyetherketone (PEK), polyetheretherketone (PEEK), polyetherketoneketone (PEKK) (also polyaryletherketoneketone), nylon, polyether block copolyamide polymers (e.g., PEBAX® from ATOFINA, Paris, France), aliphatic polyether polyurethanes (e.g., Thermedics Polymer The materials may be made from any of the following materials or combinations: absorbable or resorbable polymers such as TECOFLEX® from Biotechnology Products (Wilmington, MA), polyvinyl chloride (PVC), polyurethane, thermoplastics, fluorinated ethylene propylene (FEP), polyglycolic acid (PGA), polylactic acid (PLA), polycaprolactone (PCL), polyethyl acrylate (PEA), polydioxanone (PDS), and pseudopolyaminotyrosine-based acids, extruded collagen, silicone, zinc, echogenic, radioactive, radiopaque materials, biomaterials (e.g., cadaveric tissue 74, collagen, allografts, autografts, xenografts, bone cement, morselized bone, osteogenic powders, bone beads), and other materials listed herein.Examples of radiopaque materials are barium sulfate, zinc oxide, titanium, stainless steel, nickel-titanium alloys, tantalum, and gold.

[0170]

[0320] Throughout the disclosure herein, the shuttle 14 may be attached to a suture 70. Thus, the suture 70 may be attached to the shuttle 14 and may follow the movement of the shuttle 14. Similarly, the suture 70 may be detachable from the shuttle 14, e.g., attached before the desired suturing or suturing is completed and detached afterwards.

[0171]

[0321] The shuttle 14 can be translatable (e.g., slidable) within the jaw structure 28, for example, within the jaw tracks (e.g., jaw tracks 66 and 64). The shuttle can be configured to translate (e.g., slide) within the jaw structure 28, for example, within the jaw tracks (e.g., jaw tracks 66 and 64).

[0172]

[0322] FIG. 33A illustrates that the suture holder 18 can be attached to or integral with the shuttle 14. For example, the suture holder 18 can be a bridge integral with the shuttle spine 160. A portion of the shuttle spine 160 can define the suture holder 18. As another example, the suture holder 18 can be removably attached to the shuttle 14. The suture holder 18 can extend between a first side of the shuttle and a second side of the shuttle. The suture holder 18 can extend between a first longitudinal side of the shuttle and a second longitudinal side of the shuttle. The suture holder 18 can be at a longitudinal center of the shuttle 14, a proximal end of the shuttle 14, or a distal end of the shuttle 14. The center of the suture holder 18 can be at a lateral center of the shuttle, a first side of the shuttle, or a second side of the shuttle. The suture holder 18 may be in the plane of the shuttle spine 160, may extend away from the plane of the shuttle spine 160, or both. For example, FIG. 33A shows that the suture holder 18 does not extend out of the plane of the shuttle spine 160. The plane of the suture holder 18 may be flush or coincident with the plane of the shuttle spine 160. This may advantageously allow the shuttle and suture holder 14, 18 to occupy less space, thereby bringing the base of the suture 70 closer to the shuttle 14, thus minimizing trauma to the surrounding tissue as the shuttle 14 passes between the upper and lower jaws 30, 38. Bringing the suture 70 closer to the shuttle 14 reduces the force of the suture 70 against the surrounding tissue compared to when the suture 160 is connected to a structure out of the plane of the shuttle spine 160 (e.g., the suture holder 18 of FIGS. 13a and 13b). The shuttle and suture holder 18 may be of monolithic construction. The suture loop 162 extends around and may completely or partially encircle the suture holder 18. The remainder of the suture 70 may be integral with or removably attached to the suture loop 162. The suture loop 162 may be attached to or integral with the suture 70 at a suture joint 73. The suture joint 73 may be a knot, a braid, or both.The suture loop 162 may be circular, oval, or stadium shaped.

[0173]

[0323] The shuttle 14 can have zero, one, or multiple suture holes 404, e.g., zero to four or more suture holes 404 (including one suture hole increments within this range). For example, FIG. 33A shows that the shuttle 14 can have a first suture hole 404a and a second suture hole 404b. The shuttle holes 404 (e.g., the first and second suture holes 404a, 404b) can have regular or irregular shapes, e.g., curved, polygonal, or both. The suture holes 404 can be defined by one or more curved surfaces or edges, e.g., by one or more curved surfaces or edges of the shuttle 14. The suture holes 404 can be defined by one or more flat surfaces or straight edges, e.g., by one or more flat surfaces or straight edges of the shuttle 14. The suture holes 404 can have a cross-sectional shape that is circular, oval, rectangular, stadium, horseshoe, star, slot, or any combination thereof when the shuttle is curved or flat. The suture holes 404 can have a constant cross-sectional area or a tapered cross-sectional area.

[0174]

[0324] The shuttle tip 164 can be beveled, non-beveled, or both. For example, FIG. 33A shows that the shuttle tip 164 is non-beveled. The shuttle tip 164 can have one or more non-beveled surfaces 406, such as one to four or more non-beveled surfaces 406, including increments of one non-beveled surface within this range (e.g., one non-beveled surface, two non-beveled surfaces). For example, FIG. 33A shows that the shuttle tip 164 can have a first non-beveled surface 406a and a second non-beveled surface 406b. The non-beveled portions of the shuttle tip 164 can advantageously improve the transmission of force from the upper and lower pushers 86, 76, thereby making it easier for the pushers 86 and 76 to push the shuttle 14. When the shuttle tip 164 has a non-beveled surface 406 compared to a beveled surface (e.g., the beveled surface shown in Figures 14a-14c), a larger component of the force from the pusher (e.g., pushers 86 and 76) can be transmitted along the longitudinal axis of the shuttle 14. With a beveled surface, a portion of the force applied to the shuttle 14 is directed perpendicularly away from the beveled surface toward the surfaces that define the lower and upper tracks 66, 64. When the pusher applies a longitudinal force against the beveled surface, a portion of the longitudinal force applied by the pusher to the shuttle 14 is converted into a lateral component that is directed away from the longitudinal axis of the shuttle 14.

[0175]

[0325] FIG. 33A further illustrates that the shuttle tip 164 can be tapered to form a terminal tip 165. The terminal tip 165 can be an edge or portion of a rounded or flat surface. The tapered portion of the shuttle tip 164 can be a first bevel, e.g., a first lateral bevel toward the longitudinal axis (e.g., the central longitudinal axis) of the shuttle 14. The non-beveled surface 406 can thereby form a first tissue cutting surface that is beveled in a first direction. The bevel referred to in the previous paragraph can refer to a second bevel, e.g., a second lateral bevel that is beveled with respect to a lateral axis perpendicular to the lateral axis of the first bevel and toward the longitudinal axis (e.g., the central longitudinal axis) of the shuttle 14. Such a second bevel is illustrated in FIGS. 14a-14c. The second bevel can define a second bevel along the taper that faces in a second direction different from the first direction. The second bevel can form a second tissue cutting surface. The shuttle tip 164 can pierce or cut tissue. The tapered portion of the shuttle tip 164 can pierce or cut tissue. The non-beveled surface 406 (e.g., surfaces 406a and 406b) can pierce or cut tissue. If the shuttle tip 164 has a first and second bevel, the first and second bevels can pierce or cut tissue. FIG. 33A shows that the shuttle tip 164 can be blunt, meaning that the cutting surface 406 itself can be chamfered or non-chamfered while the edge is tapered to form the first cutting surface. The shuttle tip 164 can be blunt and still cut or pierce tissue, where sharp or non-sharp can refer to the presence or absence of a second bevel (e.g., as shown in FIGS. 14a-c), respectively.

[0176]

[0326] 33A further illustrates that the device 188 can have one or more male shuttle stoppers 412 and one or more female shuttle stoppers 416. The device 188 can have, for example, from 1 to 10 or more male shuttle stoppers 412, including increments of 1 male shuttle stopper within this range (e.g., 1, 2, 3, 4 or more male shuttle stoppers). The device 188 can have, for example, from 1 to 10 or more female shuttle stoppers 416, including increments of 1 female shuttle stopper within this range (e.g., 1, 2, 3, 4 or more female shuttle stoppers). For example, Figures 33A-34B show that the shuttle 14 can have a shuttle first stopper 412a and a shuttle second stopper 412b, the lower jaw (e.g., jaws 38, 80) can have a lower jaw female stopper 416a, and the upper jaw (e.g., jaw 30, jaw 78) can have an upper jaw stopper 416b configured to be releasably attached to the shuttle second stopper 412b. In Figures 33A-34B, halves of the lower and upper jaws are shown as transparent, allowing the shuttle 14 to be more easily viewed within the jaw tracks (e.g., lower and upper tracks 66, 64) and the male and female stops 412, 416 to be more easily viewed.

[0177]

[0327] Each male shuttle stopper 412 can be releasably fitted, attached, or engaged with a corresponding female shuttle stopper 416 via, for example, a friction fit, a snap fit, a magnetic fit, a ratchet fit, or any combination thereof. For example, the shuttle first stopper 412a can be configured to releasably attach to the lower jaw female stopper 416a, and the shuttle second stopper 412b can be configured to releasably attach to the upper jaw female stopper 416b. When two stoppers (e.g., male and female stoppers 412, 416) are releasably attached to each other, a threshold release force may be required to release the stoppers from each other. The threshold release force may be from about 1.0 Newtons to about 10.0 Newtons or more, including 0.5 Newton increments within this range (e.g., 4.0 Newtons, 4.5 Newtons, 5.0 Newtons). As another example, the release force can be from about 0.5 lbs to about 1.5 lbs, including 0.1 lb increments within this range (eg, 1.0 lb).

[0178]

[0328] The male shuttle stopper 412 (also referred to as a detent and a male detent) may be a positive feature such as a protrusion, a bump, a ridge, an arm, an extension, a bend, a detent bend, or any combination thereof. The male shuttle stopper 412 may be straight and / or curved. The male shuttle stopper 412 may be flexible, rigid, or both (e.g., a first portion may be flexible and a second portion may be rigid). The male shuttle stopper 412 may be one or more springs. The female shuttle stopper 416 (also referred to as a detent and a female detent) may be a negative feature such as a gap, a space, a pocket, a notch, a hole, a through hole, a recess, a detent recess, or any combination thereof. The female shuttle stopper 416 may be flexible, rigid, or both (e.g., a first portion may be flexible and a second portion may be rigid). The male and female shuttle stoppers 412, 416 may include magnets that attract one another to keep the male and female stoppers releasably attached to one another.

[0179]

[0329] The male shuttle stopper 412 can have a male surface 414 and the female shuttle stopper 416 can have a female surface 418. The male and female surfaces 414, 418 can be configured to engage with one another, slidably engage with one another, contact one another, or any combination thereof. The female shuttle stopper 416 can have a lip 420 configured to engage with, slidably engage with, or contact the male shuttle stopper 412, or any combination thereof. The male shuttle stopper 412 can be configured to engage with, slidably engage with, or contact the lip 420, or any combination thereof.

[0180]

[0330] For each male-female stopper pair, the male and female surfaces 414, 418 can engage with one another and / or the male shuttle stopper 412 can engage with the lip 420, for example, when the male stopper 412 is pushed into the female stopper 416, when the male stopper 412 is pulled out of the female stopper 416, when the female stopper 416 is pressed onto the male stopper 412, when the female stopper 416 is pulled out of the male stopper 412, when the male and female stoppers 412, 416 are attached to one another (also referred to as a stopped position, a captured position, a fixed position), or any combination thereof. As another example, for example, if the two female stoppers 416 include magnets, the two female stoppers 416 can engage with one another. As yet another example, for example, if the two male stoppers include magnets, the two male stoppers 412 can engage with one another. The male and / or female stoppers 412, 414 may be formed with hooks or hook-like features to releasably capture the other stopper.

[0181]

[0331] The male stopper 412 can be movable relative to the female stopper 416, or vice versa, or both. The female stopper 416 can be movable relative to the male stopper 412, or vice versa, or both. For example, Fig. 33A shows that the male shuttle stopper 412 can be translatable (e.g., slidably translatable) in the lower jaw track, e.g., in a first direction toward the lower jaw female shuttle stopper 416a and in a second direction away from the lower jaw female shuttle stopper 416a, or vice versa, such that the lower jaw female shuttle stopper 416a can translate toward and away from the male shuttle stopper 412 (e.g., in a configuration where the female shuttle stopper 416 is integral to or attached to the shuttle 14 and the male shuttle stopper 412 is integral to or attached to the lower jaw). 34A illustrates that the male shuttle stopper 412 may be translatable (e.g., slidably movable) in the upper jaw track, such as in a first direction toward the upper jaw female shuttle stopper 416b and in a second direction away from the upper jaw female shuttle stopper 416b, or vice versa, such that the upper jaw female shuttle stopper 416b is translatable toward and away from the male shuttle stopper 412 (e.g., in a configuration in which the female shuttle stopper 416 is integral to or attached to the shuttle 14 and the male shuttle stopper 412 is integral to or attached to the upper jaw). The first and second directions may be opposite to one another.

[0182]

[0332] 33A and 33B show that as the shuttle 14 is translated in a first direction within the lower jaw track toward the lower jaw shuttle stopper 416a (e.g., pushed by the upper jaw pusher 86, pulled by the lower jaw pusher 76, or both), the lip 420 exerts a force against the shuttle first stopper 412a, causing the shuttle first stopper 412a to bend toward the longitudinal axis of the shuttle 14. This bending allows the shuttle first stopper 412a to snap into the lower jaw shuttle stopper 416a. Upon passing the lip 420, the shuttle first stopper 412a may spring back to its neutral or less bent position, releasably locking the shuttle 14 to the lower jaw via the releasable attachment between the shuttle first stopper 412a and the lower jaw shuttle stopper 416a. 33A and 33B further illustrate that when the shuttle 14 is translated (e.g., pushed by the upper jaw pusher 86, pulled by the lower jaw pusher 76, or both) in a second direction (e.g., opposite to the first direction) away from the lower jaw shuttle stopper 416a within the lower jaw track, the female surface 418 can exert a force against the shuttle first stopper 412a, causing the shuttle first stopper 412a to bend toward the longitudinal axis of the shuttle 14. This bending can cause the shuttle first stopper 412a to slide under and past the lip 420. Upon passing the lip 420 in the second direction, the shuttle first stopper 412a can spring back to its neutral position (also referred to as the unbent position). As the shuttle first stopper 412a bends, it can deflect into the first suture hole 404a.

[0183]

[0333] 34A and 34B show that as the shuttle 14 is translated in a first direction within the upper jaw track toward the upper jaw shuttle stopper 416b (e.g., pushed by the upper jaw pusher 86, pulled by the upper jaw pusher 76, or both), the lip 420 exerts a force against the shuttle second stopper 412b, causing the shuttle second stopper 412b to bend toward the longitudinal axis of the shuttle 14. This bending allows the shuttle second stopper 412b to snap into the upper jaw shuttle stopper 416b. Upon passing the lip 420, the shuttle second stopper 412b springs back to its neutral or less bent position, allowing the shuttle 14 to be releasably locked to the upper jaw via the releasable attachment between the shuttle second stopper 412b and the upper jaw shuttle stopper 416b. 34A and 34B further illustrate that when the shuttle 14 is translated (e.g., pushed by the upper jaw pusher 86, pulled by the upper jaw pusher 76, or both) in the upper jaw track in a second direction (e.g., opposite to the first direction) away from the upper jaw shuttle stopper 416b, the female surface 418 can exert a force against the shuttle second stopper 412b, bending the shuttle second stopper 412b toward the longitudinal axis of the shuttle 14. This bending can cause the shuttle second stopper 412b to slide under and past the lip 420. Upon passing the lip 420 in the second direction, the shuttle second stopper 412b can spring back to its neutral position (also referred to as the unbent position). As the shuttle first stopper 412a bends, it can deflect into the second suture hole 404b.

[0184]

[0334] The lip 420 can resist passage of the shuttle first and second stoppers 412a, 412b along the second direction out of the female stoppers 416a and 416b with a threshold release force. The female surface 418 can be an inner surface of the lip 420. The lip 420 can resist passage of the shuttle first and second stoppers 412a, 412b along the first direction into the female stoppers 416a and 416b with a threshold release force or a lesser force (e.g., 10% to 75% of the threshold release force).

[0185]

[0335] The device 188 can have zero, one or more male shuttle stoppers 412 and zero, one or more female shuttle stoppers 416 at the distal end 2 of the device (e.g., closer to the jaws than the handle 104) and / or at the proximal end of the device (e.g., closer to the handle 104 than the jaws). For example, the upper jaw (e.g., upper jaw 78) can have one or more male shuttle stoppers 412, one or more female shuttle stoppers 416, or any combination thereof. The lower jaw (e.g., lower jaw 80) can have one or more male shuttle stoppers 412, one or more female shuttle stoppers 416, or any combination thereof. The shuttle stoppers 412 and / or 416 can be attached to or integral with the jaws, the jaw track, or both. The shuttle 14 can have one or more male shuttle stoppers 412, one or more female shuttle stoppers 416, or any combination thereof. The male shuttle stopper 412 can extend away from and / or towards the longitudinal axis of the shuttle 14. The male shuttle stopper 412 can extend away from and / or towards the longitudinal axis of the jaw tracks (e.g., tracks 66 and 64). The female shuttle stopper 416 can extend away from and / or towards the longitudinal axis of the shuttle 14. The female shuttle stopper 416 can extend away from and / or towards the longitudinal axis of the jaw tracks (e.g., tracks 66 and 64).

[0186]

[0336] For example, FIG. 33A shows that the shuttle 14 can have a shuttle first detent flexure 412a and a shuttle second detent flexure 412b, and that the lower and upper jaw tracks (e.g., tracks 66 and 64) can define a detent recess 416 (e.g., lower jaw detent recess 416a and upper jaw detent recess 416b). The lower and upper jaws can each define one or more detent recesses 416. For example, the shuttle first detent flexure 412a can be releasably attached to the lower jaw detent recess 416a, and the second detent flexure 412b can be releasably attached to the upper jaw detent recess 416b. FIG. 33A shows that the first and second detents 412a, 412b can extend from a longitudinal axis (e.g., a central longitudinal axis) of the shuttle toward a longitudinal center of the shuttle 14. The first and second detents 412a, 412b may be sized the same or differently away from the longitudinal center of the shuttle 14 than the other detent.

[0187]

[0337] 33A-34B further show surfaces 422 of the jaw suture slots 238, for example, lower jaw suture slot 238a and upper jaw suture slot 238b.

[0188]

[0338] 33B and 34B show that the shuttle tip 164 can have a shuttle tip width 408 of about 0.05 mm to about 0.75 mm, including 0.05 mm increments within this range (e.g., 0.15 mm, 0.20 mm, 0.25 mm). The shuttle tip width 408 can be the width of the non-beveled surface 406.

[0189]

[0339] 33B and 34B further illustrate that the shuttle 410 can have a shuttle width 410 of about 0.05 mm to about 0.75 mm, including 0.05 mm increments within this range (e.g., 0.15 mm, 0.20 mm, 0.25 mm). The shuttle tip width 408 can be the same as or different from the shuttle width 410. The shuttle tip width 408 can be less than, equal to, or greater than the shuttle width 410. For example, the shuttle tip width 408 can be about 0.15 mm and the shuttle width 410 can be about 0.25 mm, or vice versa.

[0190]

[0340] The shuttle 14 can be made from a single panel of material (e.g., metal). The suture holes 404 can be cut, leaving the shuttle and the detents 412. The shuttle 14 can then be bent so that the detents 412 extend out of the plane of the shuttle spine 160.

[0191]

[0341] 33A-34B further illustrate that when the shuttle 14 is fully translated into the jaws, a portion 423 of the shuttle tip 164 remains exposed outside the jaws. The exposed portion 423 can have an exposed length 424 that can be from about 0.25 mm to about 5.00 mm or more, including 0.25 mm increments within this range (e.g., 0.50 mm, 1.00 mm, 1.50 mm). The exposed portion 423 can align the lower and upper jaws when they are closed. The exposed portion 423 can penetrate tissue when the lower and upper jaws are closed together and before the shuttle 14 translates to the other jaw. This can advantageously utilize the clamping force of the jaws to cut tissue with the shuttle 14. When the shuttle 14 translates from the lower jaw to the upper jaw or vice versa, a portion of the exposed portion 423 can penetrate tissue.

[0192]

[0342] Figure 35 illustrates that all or a portion of exposed portion 423 may be in the other jaw before the lower and upper jaws are closed and shuttle 14 is translated to the other jaw via lower or upper pusher 76, 86. For example, when the jaws are moved from an open to a closed configuration and exposed portion 423 is extended from the upper jaw (e.g., jaw 30, jaw 78) as shown in Figures 33A and 33B, exposed portion 423 can move through the closing jaw to the lower jaw (e.g., jaw 38, jaw 80) with or without translation (e.g., simultaneous translation) of shuttle 14 to the lower jaw via the upper and / or lower pushers while the jaws are closed.

[0193]

[0343] FIG. 35 further shows that the female shuttle stopper 416 can have an outer surface 419 and an inner surface 418 (also referred to as the female surface). The outer surface 419 can be flat or curved. The outer surface 419 can define an inclined surface about which the detents 412 bend. The outer surface 419 can define a plane at an angle relative to the longitudinal axis of the shuttle. For example, the plane of the outer surface 419 can be perpendicular or substantially perpendicular to the central longitudinal axis of the shuttle. The inner surface can be flat or curved. The inner surface 418 can define an inclined surface about which the detents 412 bend.

[0194]

[0344] 35 further illustrates that when the lower and upper jaws are closed, the jaws can define a continuous track for the shuttle 14 such that the lower jaw track 66 and the upper jaw track 64 are continuous with one another. The tracks of the upper and bottom jaws can form a continuous path when the jaw structure 28 is in a closed configuration.

[0195]

[0345] FIG. 35 further illustrates that a first jaw tip (e.g., jaw tip 46, jaw tip 206) can be configured to mate with a second jaw tip (e.g., jaw tip 48, jaw tip 198). For example, the first jaw tip can mate with, abut or contact the second jaw tip when the jaw structure 28 is in a closed configuration. The jaw tips can be sharp. The jaw tips can be tapered. The jaw tips can be sharp and seated against each other to form a continuous track when the jaw structure 28 is in a closed configuration. The jaw tips can seat against each other to connect the tracks 66, 64 of the lower and upper jaws to each other.

[0196]

[0346] FIG. 36A shows that the shuttle 14 can have a first shuttle tip 164a and a second shuttle tip 164b.

[0197]

[0347] FIG. 36A further illustrates that the shuttle 14 can have zero, one, or multiple shuttle holes 405, e.g., from one to six or more shuttle holes 505 (including increments of one shuttle hole within this range (e.g., two shuttle holes, four shuttle holes)). The shuttle 14 can have a first shuttle hole 405a and a second shuttle hole 405b. The shuttle holes 405 (e.g., holes 405a and 405b) can be the same as or different from the suture holes 404 (e.g., holes 404a and 404b). The male and / or female shuttle stoppers 412, 416 can move in and out of the shuttle holes 405, suture holes 404, or any combination thereof, for example, by bending, flexing, translating, and / or rotating in and out of the holes 405 and / or 404.

[0198]

[0348] FIG. 36A further illustrates that the male shuttle stopper 412 can have an inflection point 426 .

[0199]

[0349] 36A further illustrates that one or more magnets can be attached to or integrated into detent 412 on a first side of the detent, such as on or under first surface 414 (also referred to as a male surface). Magnet 428 can be configured to be magnetically attracted to a magnet attached to or integrated into the upper or lower jaw that has an opposite dipole as magnet 428.

[0200]

[0350] FIG. 36B shows that one or more magnets 428 may be attached to or integrated into the second surface 415 of the detent 412, for example, on the underside of the detent 412.

[0201]

[0351] 36B further illustrates that the terminal tip 165 can have a sharpened edge, which can be configured to pierce tissue.

[0202]

[0352] FIG. 36C illustrates that the detents 412 (eg, detents 412 a and 412 b ) can extend away from the plane of the shuttle spine 160 and away from the longitudinal axis of the shuttle 14 .

[0203]

[0353] The shuttle's longitudinal axis (e.g., longitudinal axis 157) may be flat or curved. Figure 36C illustrates that the shuttle's radius of curvature 154 may be from about 2.00 mm to about 5.00 mm or greater, including 0.01 mm increments within this range (e.g., 2.84 mm).

[0204]

[0354] The shuttle 14 can be straight or have a preformed bend or curve (e.g., having a radius of curvature 154). The shuttle 14 can have a preformed bend with a radius of curvature of about 40% to about 200% of the radius of curvature 154 (including 1% increments within this range, e.g., 50%).

[0205]

[0355] The curvature of the shuttle 14 can be constant. The curvature of the shuttle 14 can be fixed. The shuttle 14 can be flexible. The shuttle 14 can be rigid. The shuttle can transition between curved and straight configurations. Having a preformed bend within this range can reduce distortion of the shuttle 14. For example, distortion can be reduced for variations in the shuttle 14 changing between straight and curved configurations as it moves in and / or between the jaws.

[0206]

[0356] Figures 37A-E show that the shuttle 14 can have male detents 412 arranged as shown. Figures 37A-D show that the detents 412 can be arms that extend away from the body of the shuttle 14. Figure 37E shows that the detents 412 can be bumps on the surface of the shuttle 14.

[0207]

[0357] Figures 38A and 38B show that the shuttle 14 can have one or more female shuttle stops 416, e.g., first, second, third, and fourth female shuttle stops 416a, 416b, 416c, and 416d. The shuttle stops 416 can be slots that extend partially (e.g., recesses) or completely (e.g., through holes) through the shuttle spine 160. The male shuttle stoppers 412 can be attached to or integral with the jaws and can be configured to be removably attached to the female detents shown in Figures 38A and 38B.

[0208]

[0358] 38B further illustrates that the shuttle 14 can have one or more male and female detents 412, 416. For example, the shuttle 14 can have first, second, third, and fourth female shuttle stops 416a, 416b, 416c, and 416d, and can have first, second, third, and fourth male shuttle stops 412a, 412b, 412c, and 412d. The male shuttle stops 412 (e.g., 412a, 412b, 412c, and 412d) can be configured to releasably attach to female shuttle stops 416 that are integral to or attached to jaw structure 28 within or defining the shuttle track (e.g., 64 and 66), for example. The female shuttle stoppers 416 (e.g., 416a, 416b, 416c, and 416d) can be configured to releasably attach to male shuttle stoppers 412, for example, integral with or attached to jaw structure 28 within or defining the shuttle track (e.g., 64 and 66). FIG. 38B further illustrates that shuttle 14 can define one or more female shuttle stoppers 416 along the circumference of the shuttle. For example, a fifth female shuttle stopper 416e can be defined between the first male shuttle stopper 412a and the third male shuttle stopper 412c. As another example, a sixth female shuttle stopper 416f can be defined between the second male shuttle stopper 412b and the fourth male shuttle stopper 412d. The shuttle 14 may have any combination of shuttle stoppers 412a, 412b, 412c, 412d, 416a, 416b, 416c, 416d, 416e, and 416f.

[0209]

[0359] Figures 38B and 38C show that the shuttle 14 can have detents (e.g., detents 412 and / or 416) that extend away from the longitudinal axis of the shuttle 14 along a first transverse axis that is parallel to the plane of the shuttle spine 160. Figure 38C shows that the detents (e.g., detents 412 and / or 416) can remain in the plane of the shuttle spine 160 along a second transverse axis that is perpendicular to the first transverse axis.

[0210]

[0360] FIG. 39A shows that the lower jaw and upper jaw pushers 76, 86 can have a straight configuration.

[0211]

[0361] 39B illustrates that the lower and upper jaw pushers 76, 86 can bend and assume a curved configuration, for example, when in one or both of the jaw tracks (66 and 64). The lower and upper jaw pushers 76, 86 can change between a straight configuration and a curved configuration as the pushers translate through one or both of the jaw tracks (e.g., 66 and 64). The proximal portion can remain straight and the distal portion can change from a straight and curved configuration. The pushers can have a pusher radius of curvature 432 of about 1.00 mm to about 5.00 mm, including 0.01 mm increments within this range (e.g., 2.84 mm). The pusher radius of curvature 432 can be a maximum pusher radius of curvature.

[0212]

[0362] FIG. 39C illustrates that the lower and upper jaw pushers 76, 86 can have a preformed curve 434. The preformed curve 434 can have a preformed pusher radius of curvature 436 of about 2.00 mm to about 10.00 mm, including 0.01 mm increments within this range (e.g., 5.84 mm). The shuttle 14 can have a preformed bend with a radius of curvature of about 40% to about 200% of the radius of curvature 154, including 1% increments within this range (e.g., 50%). Preforming the pusher with a curve can advantageously reduce distortion of the pusher as it transitions from a straight to a curved configuration, or from a less curved to a more curved configuration and vice versa. For example, a pusher manufactured with a preformed curve with a radius of curvature that is 50% of the maximum pusher radius of curvature can reduce distortion of the pusher by 50%.

[0213]

[0363] FIG. 39D shows that the preformed lower and upper jaw pushers 76, 86 are bendable, e.g., can assume more and less curved configurations when in one or both of the jaw tracks (66 and 64). They can change between the straight configuration shown in FIG. 39A and the curved configuration shown in FIG. 39D. The lower and upper jaw pushers 76, 86 can change between the straight and curved configurations as the pushers translate through one or both of the jaw tracks (e.g., 66 and 64). The proximal portion can remain straight and the distal portion can change from the straight and curved configurations.

[0214]

[0364] 40A-40D are perspective views of the pushers shown in FIGS. 39A-39D, respectively. FIGS. 40B-40D show that pushers 76 and 86 can have a shuttle seat 274 as shown. The shuttle seat 274 can be male or female and can be the inverse of the shape of the shuttle tip 164. For example, FIGS. 40B-40D show that the shuttle seat 274 can have a notch shape configured to receive the shuttle tip 164. The shuttle seat 274 can have a beveled or non-beveled surface 438 configured to press against a terminal distal surface of the shuttle tip 164, such as the non-beveled surface 406, the beveled surface, or both.

[0215]

[0365] The preformed pushers 76 and 86 can be formed with or without slots. For example, the slots can be longitudinally coincident or longitudinally offset lateral slots cut into the sides of the pushers, similar to the shape of the shuttle lateral slots 158.

[0216]

[0366] 41A-41E show that the non-preformed and preformed pushers 76 and 86 can have one or more slots 440 and / or one or more fenestrations 442. The slots 440 can be similar in shape to the shuttle lateral slots 158, or they can be different. The slots 440 can extend partially (e.g., recessed) or completely (e.g., through slots) through the pusher. The fenestrations 442 can extend partially (e.g., recessed) or completely (e.g., through holes) through the pusher. The slots 440 can have longitudinal and / or transverse components relative to the pusher longitudinal axis 444. The fenestrations 442 can have a constant cross-sectional area, a tapered cross-sectional area, or both. The fenestrations 442 can have a regular or irregular shape, e.g., curved, polygonal, or both. Fenestration 442 can be defined by one or more curved surfaces or edges, such as one or more curved surfaces or edges of a pusher. Fenestration 442 can have a cross-sectional shape that is circular, oval, rectangular, stadium, horseshoe, star, slot, or any combination thereof. Pushers 76 and 86 can have any combination of the features shown in Figures 41A-41E.

[0217]

[0367] FIG. 41A shows that the slot 440 can be a transverse slot.

[0218]

[0368] FIG. 41B shows that the slot 440 can be a longitudinal slot.

[0219]

[0369] Figure 41C illustrates that the slots 440 can be lateral slots, longitudinal slots, and / or can extend both longitudinally and transversely relative to the pusher longitudinal axis 444. Figure 41C further illustrates that the pusher can have curved and polygonal fenestrations 442 (e.g., circular and / or rectangular fenestrations 442).

[0220]

[0370] Fig. 41D shows that the fenestrations 442 can be at the longitudinal center of the pusher, at the ends of the pusher, between the center and ends of the pusher, or any combination thereof. Fig. 41D further shows that the shuttle seat 274 can have curved surfaces or edges.

[0221]

[0371] 41A, 41B, 41E and 41F show that the distal tips of the pushers 76 and 86 can have a slot 440 and / or a fenestration 442.

[0222]

[0372] FIG. 41F illustrates various orientation slots 440 and fenestrations 442 through the distal tips of pushers 76 and 86.

[0223]

[0373] 42A-42D show that pushers 76 and 86 can include multiple links 445 connected together, for example, 2 to 50 or more links 445 (including 1 link increments within this range, for example, 10 links). Links 445 can include a distal end link 445a, multiple intermediate links 445b, and a proximal end link 445c. Links 445 can have male connectors 446 (e.g., balls) and / or female connectors 448 (e.g., sockets). For example, FIG. 42A shows that distal end link 445a can have male or female connectors 446, 448 (e.g., female connector 448), and intermediate links can have one or more (e.g., two) male connectors 446 and one or more (e.g., two) female connectors 448, and proximal end link 445c can have male or female connectors 446, 448 (e.g., male connector 446). Link 445 may allow pushers 76 and 86 to bend. For example, link 445 may allow pushers 76 and 86 to take on the curves shown in Figures 39B-39C. As another example, link 445 may be the same as or different from articulation segment 286.

[0224]

[0374] FIG. 42B shows that the link 445 can have a link width 450 of about 0.05 mm to about 0.75 mm, including 0.05 mm increments within this range (e.g., 0.15 mm, 0.20 mm, 0.25 mm). The link width 450 can be the same as or different from the shuttle tip width 408 and / or shuttle width 410. The link width 450 can be less than, equal to, or greater than the shuttle tip width 408 and / or less than, equal to, or greater than the shuttle width 410. For example, the link width 450 can be about 0.30 mm and the shuttle tip width 408 and / or shuttle width 410 can be about 0.15 mm, or vice versa.

[0225]

[0375] 42C illustrates that the distal end link 445a can have a shuttle seat 274 having the shape shown. The shuttle seat can have a first seat 274a and a second seat 274b. The second seat can further prevent undesired movement between the shuttle 14 and the pushers 76 and 86. The second seat 274b can provide space around the distal end of the shuttle tip 154 ​​to help prevent or inhibit the pusher and shuttle from binding together, for example, due to suction caused by compression between the two components and a moist tissue environment.

[0226]

[0376] 42D illustrates that the links can be cut (e.g., laser cut) with a cut width 452 of about 0.01 mm to about 0.10 mm, including 0.01 mm increments (e.g., 0.02 mm) within this range. As another example, the links 445 can be cut separately and then permanently or removably attached together, for example, by a snap fit, friction fit, magnetic fit, or any combination thereof.

[0227]

[0377] The shuttle 14, first pusher 76 (also referred to as the lower jaw pusher), and second pusher 86 (also referred to as the upper jaw pusher) can be made from a flexible polymer such as PEEK, a resilient metal such as Nitinol, any of the materials disclosed herein, or a combination thereof. The shuttle and pushers 14, 76, 86 can be coated with a strain reducing coating.

[0228]

[0378] FIG. 43A illustrates that a first jaw tip (e.g., jaw tip 46, jaw tip 206) can interdigitate with a second jaw tip (e.g., jaw tip 48, jaw tip 198). For example, the first jaw tip can interdigitate, abut, or contact the second jaw tip when the jaw structure 28 is in a closed configuration. The jaw tips can be sharp. The jaw tips can be tapered. The jaw tips can be sharp and seated against each other to form a continuous track when the jaw structure 28 is in a closed configuration. The jaw tips can seat against each other to connect the tracks 66, 64 of the lower and upper jaws to each other.

[0229]

[0379] The intermeshable jaws can, for example, align the shuttle tracks 66 and 64 to form a single continuous track. As another example, the intermeshable jaws can align the shuttle tracks 66 and 64 such that there is a space between the shuttle tracks 66 and 64. The intermeshable jaws can inhibit or prevent the first and second jaws from moving relative to one another when the jaw structure 28 is in a closed configuration, for example as shown in FIG. 43A. The motion that can be inhibited or prevented can include lateral movement away from a longitudinal axis (e.g., a central longitudinal axis) of the opposing jaws. The intermeshable jaws can pre-penetrate tissue. In this manner, the jaws can function as a track aligner and a tissue cutter.

[0230]

[0380] The first jaw tip (e.g., jaw tip 46, jaw tip 206) can have a first jaw motion control 453 having a first jaw seat 454 configured to abut the second jaw when the jaw structure 28 is in the closed configuration, a tissue cutting surface 456, and a tissue relief pocket 458. For example, the first jaw can have first and second cutting surfaces 456a and 456b. The second jaw tip (e.g., jaw tip 48, jaw tip 198) can have a second jaw motion control 459 having a second jaw seat 460 configured to abut the first jaw when the jaw structure 28 is in the closed configuration, a tissue cutting surface 462, and a tissue relief pocket 464 (not shown). For example, the second jaw can have first and second cutting surfaces 462a and 462b.

[0231]

[0381] When the jaws move from an open configuration to a closed configuration, the first cutting surfaces 456a, 462a of the first and second jaws can slide past one another to cut tissue. When the jaws are closed, the second cutting surfaces 456b, 462b of the first and second jaws can slide past one another to cut tissue. When the jaws are in the closed configuration, the jaw teeth 463 of the second jaw that define the first cutting surface 462a of the second jaw can abut the first jaw seat 454. When the jaws are in the closed configuration, the jaw teeth 457 of the first jaw that define the second cutting surface 456b of the first jaw can abut the first jaw seat 454. The tissue relief pockets 458 and 464 can provide space for the tissue to move as the tissue is cut by the cutting surfaces. The pockets 458 and 464 can reduce the hole that the jaws form in the tissue (e.g., tissue 74). Tissue relief pockets 458 and 464 allow the jaws to compress less tissue when the jaws move from the open to the closed configuration.

[0232]

[0382] Figure 43B shows jaw teeth 463 of the second jaw seated against the first jaw motion control device 453. Figure 43B further illustrates that first cutting surfaces 456a, 462a of the first and second jaws can contact one another when the jaws are in a closed configuration.

[0233]

[0383] 43C shows tissue relief pocket 464 visible through first jaw lateral half 470a, which is shown as transparent. The other first jaw lateral half 470b is not transparent and defines tissue relief pocket 464.

[0234]

[0384] 43D illustrates a variation of the tissue relief pockets 458 and 464. FIG. 43D further illustrates an opening 472 to the second jaw track 66.

[0235]

[0385] 43E and 43F show the first and second jaws moving from a partially closed configuration to a fully closed configuration.

[0236]

[0386] Figures 43G-I show the first and second jaws moving successively from a partially closed configuration to a fully closed configuration with the shuttle within the lower jaw such that the jaw teeth and shuttle exposed portion 423 penetrate tissue as the jaws are moved from the configuration shown in Figure 43G to the configuration shown in Figure 43I. The shuttle 14 can be any of the shuttles described and / or illustrated herein.

[0237]

[0387] FIG. 43J shows a variation of the jaw structure 28 in which the shuttle sits on the lower jaw tip.

[0238]

[0388] FIG. 43K shows the shuttle 14 in motion between the first and second jaws as the shuttle translates in a continuous track (e.g., that defined by tracks 66 and 64) from the lower jaw to the upper jaw or vice versa.

[0239]

[0389] 43L shows the shuttle 14 seated in the lower jaw with the shuttle tip 164 in contact with the shuttle seat 274 of the upper jaw pusher 86. This can be the maximum extent to which the upper jaw pusher 86 can extend to remain within the upper jaw track at full extension, or it can continue to push the shuttle 14 such that the upper jaw pusher 86 extends out of the upper jaw track at full extension. At full extension, the upper jaw pusher 86 can extend into the lower jaw track. For example, the shuttle seat 274 of the upper jaw can extend out of the upper jaw and into the lower jaw track (e.g., track 66).

[0240]

[0390] 43M shows the shuttle 14 seated in the upper jaw with the shuttle tip 164 in contact with the shuttle seat 274 of the lower jaw pusher 76. This can be the maximum extent to which the lower jaw pusher 76 can extend to remain within the lower jaw track at full extension, or it can continue to push the shuttle 14 such that the lower jaw pusher 76 extends out of the lower jaw track at full extension. At full extension, the lower jaw pusher 76 can extend into the upper jaw track. For example, the shuttle seat 274 of the lower jaw can extend out of the lower jaw and into the upper jaw track (e.g., track 64).

[0241]

[0391] Figures 43L and 43M further show that when the shuttle 14 contacts the pushers 76 and 86, the planes of the shuttle and pushers 14, 76, 86 can be coplanar or substantially coplanar with each other and / or can be parallel or substantially parallel to each other.

[0242]

[0392] FIG. 43N illustrates that the shuttle 14 and the pushers 76 and 86 can contact each other out of plane such that when the shuttle 14 contacts the pushers 76 and 86, the shuttle and pushers 14, 76, 86 are at an angle to each other.

[0243]

[0393] 44A and 44B show a variation of device 188 in fully closed and fully open configurations, respectively.

[0244]

[0394] 44A and 44B show that the jaw control extension 40 can be fixed and that the jaws 78 and 80 can move relative to the jaw control extension 40. For example, the jaws 78 and 80 can move distally and proximally relative to the jaw control extension 40 to open and close, respectively. The jaws 78 and 80 can move longitudinally along the device longitudinal axis 476. The jaws 78 and 80 can move in and out of the compression cover 34. The jaws 78 and 80 can be attached to a tube 474 connected to a handle control device that can translate (e.g., slidably translate) the jaws 78 and 80 in and out of the compression cover 34. FIGS. 44A and 44B show that as the jaws 78 and 80 translate proximally toward the handle and into the compression cover 34, the compression cover 34 can engage the upper jaw surface 79 and the lower jaw surface 81 to force the jaws closed. Movement of the jaws 78 and 80 in a first direction relative to the jaw control extension 40 (e.g., in a distal direction) can move the jaws open from a closed configuration shown in FIG. 44A to an open configuration shown in FIG. 44B. Movement of the jaws 78 and 80 in a second direction relative to the compression cover 34 (e.g., in a proximal direction) can move the jaws closed from the open configuration shown in FIG. 44B to the closed configuration shown in FIG. 44A. The first and second directions can be opposite one another. As another example, the jaws can be fixed and the jaw control extension can move relative to the jaws. The compression cover 34 can be longitudinally fixed or longitudinally movable.

[0245]

[0395] The extension head 254 may have the shape shown such that when the jaws emerge from the compression cover 34 on the extension head 254, the jaws open toward each other.

[0246]

[0396] FIG. 44A shows the device 188 without the shuttle 14 for illustrative purposes, and FIG. 44B shows the device 188 of FIG. 44A with the shuttle 14.

[0247]

[0397] 45A and 45B show a variation of device 188 in fully open and fully closed configurations, respectively.

[0248]

[0398] 45A and 45B show that the handle 104 can have a jaw control 8 (also called a trigger), a jaw control release 478, and a shuttle control 479. The jaw control 8 can be pulled in a direction 484 with one or more fingers to move the jaw control 8 to the configuration shown in FIG. 45B. The jaw control 8 can translate and / or rotate. As the jaw control 8 moves in the direction 484, the jaws 78 and 80 can move from an open configuration to a less open configuration (e.g., a closed configuration shown in FIG. 45B). As the jaw control 8 moves in a direction opposite to the direction 484, the jaws 78 and 80 can move from a closed configuration to an open configuration (e.g., from the closed configuration of FIG. 45B to the fully open configuration shown in FIG. 45A).

[0249]

[0399] As another example, the handle 104 can have a first push button configured to close the jaws when pressed and a second push button configured to open the jaws when pressed.

[0250]

[0400] The jaw control release 478 can be a push button, a switch, a knob, or any combination thereof. When the jaws 78 and 80 are in a fully closed configuration, the jaw control 8 can be locked. Activating the jaw control release 478 can release the jaw control 8 from the locked position. The jaw control release 478 can be activated, for example, by pressing it. Pressing the jaw control release 478 can manually return the jaw control 8 to the position shown in FIG. 45A to fully open the jaws, or the jaw control 8 can automatically return to the position shown in FIG. 45A.

[0251]

[0401] The shuttle control 479 may be a button, a switch, a knob, or any combination thereof. For example, FIGS. 45A and 45B show that the shuttle control 479 may be a pivotable switch. When the jaws 78 and 80 are in the open configuration of FIG. 45A, the shuttle control 479 may be locked. When the jaws are closed, the shuttle control may be rotated in a direction 486 and a direction 488. The directions 486 and 488 may be oriented in opposite directions. When the shuttle control 479 moves (e.g., rotates) in the direction 486, the upper pusher 86 may move the shuttle 14 to the lower jaw 80. When the shuttle control 479 moves (e.g., rotates) in the direction 488, the lower pusher 76 may move the shuttle 14 to the upper jaw 78. The shuttle control 479 may have a batwing shape, which may provide an ergonomic advantage.

[0252]

[0402] As another example, the handle 104 can have a first push button configured to move the upper pusher 86 when pressed and a second push button configured to move the lower pusher 76 when pressed.

[0253]

[0403] 45A and 45B further show that the device 188 can have a flush port 482 with a luer connection. A cleaning solution (e.g., an enzymatic cleaner) can be flowed through the device via the flush port 482 to clean it.

[0254]

[0404] 45C shows that the shuttle control 479 can have a neutral position. When the shuttle control 479 is in the neutral position, one or neither of the pushers 76 and 86 can contact the shuttle 14. When the shuttle control 479 is in the neutral position, the shuttle 14 can be ejected from the jaws.

[0255]

[0405] 45D shows the shuttle control 479 in a fully forward position as moved in direction 486. When the shuttle control 479 is in a fully forward position in direction 486, the upper pusher 86 can be in a fully forward position and the lower pusher 76 can be in a fully retracted position. For example, the upper pusher 86 can be fully forward toward the lower jaw 80, thereby pushing the shuttle 14 into the lower jaw 80. The upper pusher 86 can push the shuttle 14 into the lower jaw 80 to a point where the detents (male and / or female detents 412, 416) of the shuttle 14 releasably engage with the detents (male and / or female detents 412, 416) of the lower jaw 80.

[0256]

[0406] 45E shows the shuttle control 479 in a fully forward position when moved in the direction 488. When the shuttle control 479 is in a fully forward position in the direction 488, the lower pusher 76 can be in a fully forward position and the upper pusher 86 can be in a fully retracted position. For example, the lower pusher 76 can be fully forward toward the upper jaw 78, thereby pushing the shuttle 14 into the upper jaw 78. The lower pusher 76 can push the shuttle 14 into the upper jaw 78 to a point where the detents (male and / or female detents 412, 416) of the shuttle 14 releasably engage with the detents (male and / or female detents 412, 416) of the upper jaw 78.

[0257]

[0407] FIG. 45F shows that the shuttle control 479 can be coupled to an upper pusher slider 492 via a linkage 491. The upper pusher slider 492 can be coupled to the upper pusher 86. FIG. 45F further shows that the shuttle control 479 can be coupled to a lower pusher slider 490 via a linkage 489. The lower pusher slider 490 can be coupled to the lower pusher 76. The upper pusher slider 492 can move towards the jaw when the shuttle control 479 is moved in the direction 486, thereby pushing the upper pusher distal end towards and / or into the lower jaw 80. The lower pusher slider 490 can move towards the jaw when the shuttle control 479 is moved in the direction 488, thereby pushing the lower pusher distal end towards and / or into the lower jaw 78.

[0258]

[0408] Figures 45G and 45H show the position of linkage 491 when shuttle control 479 is in the position shown in Figures 45D and 45E, respectively.

[0259]

[0409] 45I and 45J show variations of the shuttle control lock pin 494. The lock pin 494 can lock the shuttle control 494 in place with the shuttle 14 in the upper or lower jaw when the jaws (e.g., jaws 78 and 80) are in an open configuration, such as shown in FIG. 45A. The jaw control 8 can have a lock pin control 496 configured to rotate and / or translate to engage the lock pin 494 and push the lock pin 494 into the lock pin channel 497 to unlock the shuttle control 479 when the jaw control 8 is tensioned so that the jaws are in a fully closed configuration. The lock pin 494 can be biased into the locked position with a biasing element 495, such as a spring.

[0260]

[0410] 45K and 45L show that the device 188 can have an overstroke compensation cam path 502 and an overstroke compensation cam 504. When the jaw control release 478 is actuated, the jaw control 8 can move in a direction 506, which can cause the pusher slider in a fully extended position to retract the fully advanced pusher by about 0.2 mm to about 1.0 mm to compensate and correct for overstroke caused by tension and compression forces of various structures between the handle 104 and the distal end of the device 188.

[0261]

[0411] FIG. 45M shows the jaw control device 8 when the jaws are in a fully open configuration.

[0262]

[0412] 46A-46K show exploded views of some of the components of device 188. FIG.

[0263]

[0413] FIG. 46A shows a variation of the tube 510 of the device 188.

[0264]

[0414] FIG. 46B shows a modification of the upper pusher 86.

[0265]

[0415] FIG. 46C shows a modification of the lower pusher 76.

[0266]

[0416] 46D shows a variation of tube 512 of device 188. Tube 512 can fit into tube 510.

[0267]

[0417] FIG. 46E shows a variation of the compression cover 34.

[0268]

[0418] 46F and 46G show variations on the first and second sides of the lower jaw 80. FIG.

[0269]

[0419] 46H and 46I show variations on the first and second sides of the upper jaw 78. FIG.

[0270]

[0420] FIG. 46J shows the connector 514.

[0271]

[0421] FIG. 46K shows pin 516 of connector 514.

[0272]

[0422] Throughout this application, the upper and lower jaws may also be referred to as the first and second jaws, respectively.Throughout this application, the upper and lower jaws may also be referred to as the second and first jaws, respectively.

[0273]

[0423] 47A-47D illustrate that the device 188 can have one or more shuttle stoppers 520. The device 188 can have, for example, 1 to 10 or more shuttle stoppers 520, including increments of 1 shuttle stopper 520 within this range (e.g., 1, 2, 3, 4 or more shuttle stoppers 520). The upper jaw (e.g., jaw 30, jaw 78) and / or the lower jaw (e.g., jaw 38, 80) can each have one or more shuttle stoppers 520. The upper jaw can have, for example, 1 to 5 or more shuttle stoppers 520 (e.g., 1, 2, 3, 4, 5 or more shuttle stoppers 520). The lower jaw can have, for example, 1 to 5 or more shuttle stoppers 520 (e.g., 1, 2, 3, 4, 5 or more shuttle stoppers 520). The upper and lower jaws can have the same or different number of shuttle stoppers from each other. For example, the lower and upper jaws can each have one, two, three, or more shuttle stops. Figures 47A and 47B show that the lower jaw (e.g., jaws 38, 80) can have a lower jaw shuttle stopper 520a configured to releasably engage the shuttle 14, and Figures 47C and 47D show that the upper jaw (e.g., jaws 30, 78) can have an upper jaw shuttle stopper 520b configured to releasably engage the shuttle 14. Half of the lower and upper jaws in Figures 47A-47D (e.g., a lateral half of the lower and upper jaws on one side of the device of the device longitudinal axis) are shown in a transparent state so that the shuttle 14 can be more easily seen in the jaw tracks (e.g., lower and upper tracks 66, 64) and so that the shuttle stops 520 (e.g., shuttle stops 520a and 520b) can be more easily seen.

[0274]

[0424] The shuttle stopper 520 (e.g., lower jaw shuttle stopper 520a and upper jaw shuttle stopper 520b) can be a prong, arm, projection, extension, bend, detent, detent bend, male detent, or any combination thereof. The shuttle stopper 520 can be straight and / or curved. The shuttle stopper can be an open shape (e.g., a bar, an arc, a plate) or a closed shape (e.g., a ring). The shuttle stopper 520 can be flexible, rigid, or both (e.g., a first portion can be flexible and a second portion can be rigid). The shuttle stopper 520 can be one or more springs. The shuttle stopper 520 can be made from a nickel titanium alloy (e.g., Nitinol), stainless steel, a composite material, or any combination thereof. The shuttle stopper 520 can have a shuttle stopper first longitudinal end 521a and a shuttle stopper second longitudinal end 521b. The shuttle stopper first longitudinal end 521a is TE The shuttle stopper second longitudinal end 521b may have a shuttle stopper second longitudinal end terminal 521b. TE may have the following structure:

[0275]

[0425] 47A-47D further illustrate that each shuttle stopper 520 (e.g., shuttle stoppers 520a, 520b) can be in a shuttle stopper groove 522. Each shuttle stopper groove 522 can be in a jaw (e.g., first jaw, second jaw, lower jaw, upper jaw). For example, each lower jaw shuttle stopper portion 520a can be in a lower jaw shuttle stopper groove 522a, and each upper jaw shuttle stopper portion 520b can be in an upper jaw shuttle stopper groove 522b. The lower jaw shuttle stopper 520a can be received in the lower jaw shuttle stopper groove 522a, and the upper jaw shuttle stopper 520b can be received in the upper jaw shuttle stopper groove 522b. The shuttle stopper groove 522 can have a shuttle stopper groove opening 523 that opens into a shuttle track (e.g., lower and upper jaw shuttle tracks 66, 64) such that the shuttle stopper groove 522 intersects with the shuttle track. The shuttle stoppers 520 (e.g., shuttle stoppers 520a, 520b) can extend from the shuttle stopper groove 522 into the shuttle track. For example, the shuttle stopper groove openings can be at the longitudinal ends of the shuttle stopper grooves such that the longitudinal ends (e.g., 521a, 521b) of the shuttle stoppers 520 can extend from the shuttle stopper groove into the shuttle track. In such a case, the longitudinal ends of the shuttle stoppers (521a TE , 521b TE ) can be disposed within the shuttle track. As another example, the shuttle stopper groove opening can be between the shuttle stopper first longitudinal end terminal and the shuttle stopper second longitudinal end terminal such that a central longitudinal portion of the shuttle stopper 520 between the shuttle stopper first and second longitudinal ends extends into (e.g., arcs within) the shuttle track. For example, FIGS. 47A-47D show shuttle stopper first longitudinal end terminal 521a TE5 shows that the shuttle stopper first longitudinal end 521a can extend into a shuttle track (e.g., shuttle tracks 66, 64), such that the shuttle stopper first longitudinal end 521a can be in the shuttle track. The shuttle stopper first longitudinal end 521a can be farther from the device longitudinal axis 476 than the shuttle stopper second longitudinal end 521b. The shuttle stopper first longitudinal end 521a can be configured to contact the shuttle 14 when the shuttle 14 is on the shuttle stopper 520, such as when the shuttle 14 passes over the shuttle stopper 520 and when the shuttle is at rest on the shuttle stopper 520.

[0276]

[0426] The shuttle stopper grooves 522 (e.g., grooves 522a, 522b) can open into a curved portion of the shuttle track. The shuttle stopper grooves 522 (e.g., grooves 522a, 522b) can open into a straight portion of the shuttle track. For example, FIG. 47A and FIG. 47B show that the lower jaw shuttle groove 522a can intersect with the lower jaw shuttle track at a curved portion of the lower jaw shuttle track. FIG. 47C and FIG. 47D show that the upper jaw shuttle groove 522b can intersect with the upper jaw shuttle track at a curved portion of the upper jaw shuttle track. As another example, the first shuttle stopper groove can open into a straight portion of the first jaw shuttle track, and the second shuttle stopper groove can open into a curved portion of the first jaw shuttle track. As yet another example, the first shuttle stopper groove can open into a straight portion of the second jaw shuttle track, and the second shuttle stopper groove can open into a curved portion of the second jaw shuttle track.

[0277]

[0427] The shuttle stoppers 520 (e.g., stoppers 520a, 520b) can be at an angle 528 with respect to the device longitudinal axis 476. The shuttle stopper grooves 522 (e.g., grooves 522a, 522b) can be at an angle 528 with respect to the device longitudinal axis 476. An axis 529 through the shuttle stoppers 520 and / or shuttle stopper grooves 522 can intersect the device longitudinal axis at the angle 528. The axis 529 can be a longitudinal axis (e.g., a central longitudinal axis) through the shuttle stoppers 520, through the shuttle stopper grooves 522, or both. The angle 528 can be from about 10 degrees to about 170 degrees, more narrowly from about 10 degrees to about 80 degrees, or even narrower from about 30 degrees to about 60 degrees (including one degree increments within these ranges (e.g., 10 degrees, 30 degrees, 40 degrees, 45 degrees, 50 degrees, 60 degrees, 80 degrees)).

[0278]

[0428] The angle 528 of the shuttle stop 520 may allow all or a portion of the shuttle 14 to pass through the shuttle stop 520 as the shuttle 14 moves into the jaws (e.g., along the shuttle track), including, for example, from distal to proximal along the device longitudinal axis 476. When the shuttle 14 is driven (e.g., pushed, pulled, or both) into the jaws, the shuttle stop 520 may bend, capture the shuttle 14, and hold the shuttle 14 in place. The shuttle stop 520 may passively hold the shuttle 14 in place when an outward force (e.g., a force having a direction opposite to the direction of the force that pushed the shuttle 14 into the jaws) is applied to the shuttle 14. FIGS. 47A and 47B show the inward and outward directions 524 and 526 of the lower jaw. FIGS. 47C and 47D show the inward and outward directions 524 and 526 of the upper jaw. The inward and outward directions 524, 526 can be opposite one another, for example, along a longitudinal axis of the shuttle track. The shuttle 14 can be passively held by the shuttle stopper 520, for example, due to the positioning of the shuttle stopper 520 relative to the jaws and shuttle 14. For example, the shuttle stopper 520 can passively engage the shuttle 14 such that the shuttle 14 can be advanced into the jaws and actively disengaged from the shuttle 14 to allow the shuttle 14 to be advanced out of the jaws.

[0279]

[0429] 47b and 47D further illustrate that the shuttle 14 can have one or more suture holes 404, e.g., first and second suture holes 404a, 404b. FIGs. 47B and 47D further illustrate that when the shuttle 14 is fully advanced into the lower and upper jaws, the shuttle stopper 520 does not interface with or engage the suture holes 404 (e.g., first and second suture holes 404a, 404b) or sutures. As another example, when the shuttle 14 is fully advanced into the lower and upper jaws, the shuttle stopper 520 can interface with one or more suture holes 404, sutures, or any combination. For example, the shuttle stopper 520 can interface with one or more of the suture holes 404 by extending into one or more of the suture holes 404.

[0280]

[0430] 47A-47D illustrate that when the shuttle 14 engages the shuttle stopper 520 (e.g., stoppers 520a, 520b), a threshold release force may be required to release the shuttle 14 from the shuttle stopper 520 so that the shuttle 14 can move to the other jaw. The threshold release force may be reached and / or exceeded by applying an outward force to the shuttle 14. An outward force may be applied to the shuttle 14 to reach the release force and move the shuttle 14 to the other jaw. Once the threshold release force is reached or exceeded, the shuttle 14 may move (e.g., slide) relative to the shuttle stopper 520 so that the shuttle 14 can move out of one jaw and move to the other jaw (e.g., from the first jaw to the second jaw and vice versa). Once the threshold release force is reached or exceeded, static friction between the shuttle stopper face and the shuttle face may be overcome with or without deflection of the shuttle stopper 520. Deflection of the shuttle stopper 520 may include buckling, bending, flexing, compression (e.g., longitudinal compression, lateral compression, shortening), tension (e.g., stretching, extension) of the shuttle stopper 520, or any combination thereof. When a threshold release force is achieved or exceeded, static friction between the shuttle stopper face and the shuttle face may be overcome, with or without deflection of one or more walls of the shuttle stopper groove 522. Deflection of the shuttle stopper groove 522 may include buckling, bending, flexing, extension, or any combination thereof of the shuttle stopper groove 522, as well as in any combination with or without deformation of one or more of the walls defining the shuttle stopper groove 522 by the shuttle stopper 520 being forced against the one or more walls when an outward force is applied to the shuttle 14. The threshold release force can be from about 1.0 Newtons to about 10.0 Newtons or more, including 0.5 Newton increments within this range (e.g., 4.0 Newtons, 4.5 Newtons, 5.0 Newtons). As another example, the release force can be from about 0.5 lbs to about 1.5 lbs, including 0.1 lb increments within this range (e.g., 1.0 lb). When the shuttle 14 is in the first jaw, an outward force (e.g., the threshold release force) can be toward the second jaw.When the shuttle 14 is in the second jaw, an outward force (e.g., a threshold release force) can be applied to the shuttle 14 toward the first jaw. When the shuttle 14 is in the first jaw, an outward force (e.g., a threshold release force) can be applied to the shuttle 14 to allow the shuttle 14 to move in the shuttle track toward the second jaw. When the shuttle 14 is in the second jaw, an outward force (e.g., a threshold release force) can be applied to the shuttle 14 to allow the shuttle 14 to move in the shuttle track toward the first jaw.

[0281]

[0431] The device 188 can have a shuttle stopper release device (also referred to as a shuttle stopper control device). The shuttle stopper release device can push the shuttle stopper 520, allowing the shuttle 14 to be released from the shuttle stopper 520. The shuttle stopper release device can be the shuttle 14. For example, a release force can be applied to the shuttle 14 (e.g., via a pusher) to release the shuttle 14 from the shuttle stopper 520, such that the shuttle 14 can be the shuttle stopper release device. A release force can be applied to the shuttle 14 (e.g., from a pusher) to release the shuttle 14 from the shuttle stopper 520, such that the shuttle 14 functions as both the shuttle 14 (e.g., carrying the suture back and forth between the jaws) and the shuttle stopper release device. As another example, the shuttle stopper release device can be not the shuttle 14, such that the shuttle stopper release device can selectively engage and disengage the shuttle stopper 520. In such a case, the shuttle stopper release device can reduce or eliminate a threshold release force that may be required to release the shuttle 14 from the shuttle stopper 520 so that the shuttle 14 can be moved to the other jaw. The shuttle stopper release device may selectively engage and disengage with the shuttle stopper 520 when the shuttle 14 is in contact with the shuttle stopper 520. The shuttle stopper release device may selectively engage and disengage with the shuttle stopper 520 when the shuttle 14 is not in contact with the shuttle stopper 520. The shuttle stopper release device may selectively engage and disengage with the shuttle stopper 520 before an outward force is applied to the shuttle 14 (e.g., via a pusher), while an outward force is applied to the shuttle 14 (e.g., via a pusher), after an outward force is applied to the shuttle 14 (e.g., via a pusher), or any combination thereof.The shuttle stopper release device can selectively engage and disengage the shuttle stopper 520 before an inward force is applied to the shuttle 14 (e.g., via a pusher), while an inward force is applied to the shuttle 14 (e.g., via a pusher), after an inward force is applied to the shuttle 14 (e.g., via a pusher), or any combination thereof. For example, once the shuttle 14 is fully advanced into the first jaw and the shuttle 14 engages the shuttle stopper 520, the shuttle stopper release device can push the shuttle stopper 520 to release the shuttle 14 from its grip.

[0282]

[0432] FIG. 47A further illustrates that when the shuttle 14 moves into the jaws (e.g., lower jaws 38, 80), the shuttle 14 can contact and slide over the shuttle stopper 520. The shuttle can move in direction 524 so that when the shuttle 14 contacts and slides over the shuttle stopper 520, the shuttle stopper 520 can deflect, or both. For example, the shuttle stopper first longitudinal end 521a can deflect in a deflection first direction. The deflection first direction can have a translation component, a rotation component, or both. For example, FIG. 47A illustrates that the deflection first direction can include a rotation 530a, a translation 531a, or both a rotation 530a and a translation 531a. The rotation 530a can be a clockwise rotation in the orientation shown in FIG. 47A, and the translation 531a can be a translation to the right in the orientation shown in FIG. 47A. 47A further illustrates that when the shuttle is in a fully forward position within the jaws (e.g., lower jaws 38, 80), the shuttle stopper 520 can be biased in a first direction. When the shuttle 14 slides against the shuttle stopper 520 in a direction 524, the shuttle stopper 520 can have a shuttle stopper first biased position. When the shuttle 14 is fully forward into the jaws and contacts the shuttle stopper 520, the shuttle stopper can have a shuttle stopper first biased position.

[0283]

[0433] FIG. 47A further illustrates that when the shuttle 14 is moved out of the jaws (e.g., lower jaws 38, 80), the shuttle 14 can contact and slide over the shuttle stopper 520. When the shuttle 14 overcomes a threshold release force and / or when the shuttle stopper release device disengages the shuttle stopper 520 from the shuttle 14, the shuttle 14 can translate past the shuttle stopper 520. When the shuttle 14 contacts and slides over the shuttle stopper 520 as the shuttle moves in the direction 526, the shuttle stopper 520 can deflect. For example, the shuttle stopper first longitudinal end 521a can deflect in a deflection second direction. The deflection second direction can have a translational component, a rotational component, or both. For example, FIG. 47A illustrates that the deflection second direction can include rotation 530b, translation 531b, or both rotation 530b and translation 531b. Rotation 530b may be a counterclockwise rotation in the orientation shown in FIG. 47A, and translation 531b may be a translation to the left in the orientation shown in FIG. 47A. When shuttle 14 slides against shuttle stopper 520 in direction 526, shuttle stopper 520 may have a shuttle stopper second deflected position. When the shuttle is fully retracted or advanced past shuttle stopper 520, shuttle stopper 520 may be in a shuttle stopper neutral position. The shuttle stopper neutral position may be a position between the shuttle stopper first deflected position and the shuttle stopper second deflected position.

[0284]

[0434] 47A further illustrates that when shuttle stopper first longitudinal end 521a is deflected, shuttle stopper second longitudinal end 521b can be secured. When shuttle stopper first longitudinal end 521a is deflected, shuttle stopper second longitudinal end 521b can be deflected.

[0285]

[0435] FIG. 47C further illustrates that when the shuttle 14 moves into the jaws (e.g., upper jaw 30, 78), the shuttle 14 can contact and slide over the shuttle stopper 520. The shuttle can move in direction 524 so that when the shuttle 14 contacts and slides over the shuttle stopper 520, the shuttle stopper 520 can deflect, or both. For example, the shuttle stopper first longitudinal end 521a can deflect in a deflection first direction. The deflection first direction can have a translation component, a rotation component, or both. For example, FIG. 47C illustrates that the deflection first direction can include a rotation 530a, a translation 531a, or both a rotation 530a and a translation 531a. The rotation 530a can be a clockwise rotation in the orientation shown in FIG. 47C, and the translation 531a can be a translation to the right in the orientation shown in FIG. 47C. 47C further illustrates that when the shuttle is in a fully forward position within the jaws (e.g., upper jaw 30, 78), the shuttle stopper 520 can be biased in a first direction. When the shuttle 14 slides against the shuttle stopper 520 in a direction 524, the shuttle stopper 520 can have a shuttle stopper first biased position. When the shuttle 14 is fully forward into the jaws and contacts the shuttle stopper 520, the shuttle stopper can have a shuttle stopper first biased position.

[0286]

[0436] FIG. 47C further illustrates that when the shuttle 14 is moved out of the jaws (e.g., upper jaw 30, 78), the shuttle 14 can contact and slide over the shuttle stopper 520. When the shuttle 14 overcomes a threshold release force and / or when the shuttle stopper release device disengages the shuttle stopper 520 from the shuttle 14, the shuttle 14 can translate past the shuttle stopper 520. When the shuttle 14 contacts and slides over the shuttle stopper 520 as the shuttle moves in the direction 526, the shuttle stopper 520 can deflect. For example, the shuttle stopper first longitudinal end 521a can deflect in a deflection second direction. The deflection second direction can have a translational component, a rotational component, or both. For example, FIG. 47C illustrates that the deflection second direction can include rotation 530b, translation 531b, or both rotation 530b and translation 531b. Rotation 530b may be a counterclockwise rotation in the orientation shown in FIG. 47A, and translation 531b may be a translation to the left in the orientation shown in FIG. 47A. When shuttle 14 slides against shuttle stopper 520 in direction 526, shuttle stopper 520 may have a shuttle stopper second deflected position. When the shuttle is fully retracted or advanced past shuttle stopper 520, shuttle stopper 520 may be in a shuttle stopper neutral position. The shuttle stopper neutral position may be a position between the shuttle stopper first deflected position and the shuttle stopper second deflected position.

[0287]

[0437] 47C further illustrates that when shuttle stopper first longitudinal end 521a is deflected, shuttle stopper second longitudinal end 521b can be secured. When shuttle stopper first longitudinal end 521a is deflected, shuttle stopper second longitudinal end 521b can be deflected.

[0288]

[0438] The shuttle stopper groove 522 can have a constant width or a tapered width. The tapered width can accommodate deflection of the shuttle stopper first longitudinal end 521a. As another example, the shuttle stopper groove can have a portion of constant width and a portion of tapered width. For example, the portion of the shuttle stopper groove 522 that receives the shuttle stopper first longitudinal end 521a can have a tapered width that widens toward the opening 523, and the portion of the shuttle stopper groove 522 that receives the shuttle stopper second longitudinal end 521b can have a constant width to prevent or minimize deflection of the shuttle stopper second longitudinal end 521b.

[0289]

[0439] 47A-47D further illustrate that the shuttle groove 522 can have a chamber 532. The chamber 532 can be a shuttle stopper deflection chamber, a shuttle stopper release chamber, or both. When the shuttle stopper first longitudinal end 521a is deflected, the portion of the shuttle stopper 520 that is within the chamber 532 deflects the shuttle stopper first longitudinal end terminus 521a relative to the remainder of the shuttle stopper 520 (e.g., shuttle stopper 520a). TE 5. As another example, the shuttle stopper groove 522 can extend across the chamber 532. As yet another example, the upper jaw, the lower jaw, or both can have a groove first portion 522a, a groove second portion 522b, and a groove third portion 522c. The groove second portion 522b can include all or a portion of the chamber 532. As yet another example, the chamber 532 can be a through hole. The through hole can be an end of a shuttle stopper release track inside the jaw.

[0290]

[0440] 47A-47D further illustrate that the lower and upper jaws can have a first suture stopper 534a, a second suture stopper 534b, or both. The first suture stopper 534a can be configured to contact the suture 70. The first suture stopper 534a can be configured to contact the suture loop 162. The first suture stopper 534a can function as a first or second shuttle stopper by capturing the suture 70 or the suture loop 162. When the suture 70 or the suture loop 162 contacts the first suture stopper 534a, it can block or prevent further movement of the shuttle 14 into the jaws. The second suture stopper 534b can be configured to contact the suture 70. The second suture stopper 534b can be configured to contact the suture loop 162. The second suture stop 534b can function as a first or second shuttle stop by capturing the suture 70 or the suture loop 162. When the suture 70 or the suture loop 162 contacts the second suture stop 534b, it can block or prevent further movement of the shuttle 14 into the jaws. The first and second suture stops 534a, 534b can block or prevent the suture 70 from passing the suture holder slot and entering the shuttle track. The shuttle track (e.g., tracks 64 and 66) can have a first height 536a and a second height 536b. The first height 536a can be greater than the second height 536b. The first height 536a can decrease to the second height 536b at the second suture stop 534b, which can be a tapered surface (e.g., a smooth slope) or a vertical surface (e.g., a step). Second height 536b may be less than first height 536a, for example, to inhibit or prevent suture 70 from being pulled or pushed beyond suture holder slot 238 into the shuttle track.

[0291]

[0441] 47B and 47D further illustrate that the shuttle holes 404 do not have to extend over or engage the shuttle stopper 520. As another example, the shuttle holes can extend over and / or engage the shuttle stopper 520. 47B and 47D show the shuttle stopper first longitudinal end terminal 521a. TE 1 further illustrates that the shuttle 14 may extend across its width.

[0292]

[0442] Device 188 can have zero, one, or multiple shuttle stoppers. For example, the shuttle can have zero, one, or multiple shuttle stoppers (e.g., stoppers 412, 413), the upper jaw can have zero, one, or multiple shuttle stoppers (e.g., stopper 520), the lower jaw can have zero, one, or multiple shuttle stoppers (e.g., stopper 520), or any combination thereof.

[0293]

[0443] FIG. 47E shows the upper and lower jaws with the lower and upper jaws shown in transparency so that the shuttle 14 and shuttle stopper 520 can be seen.

[0294]

[0444] 47A-47E show the pusher as transparent and / or in a retracted position.

[0295]

[0445] FIG. 47F shows that the device 188 can have a shuttle stopper control 537 (also referred to as a shuttle stopper engager and a shuttle stopper releaser). The shuttle stopper control 537 can have a shuttle stopper engagement portion 538. The shuttle stopper engagement portion 538 can interact with the shuttle stopper 520, e.g., can engage and disengage with the shuttle stopper 520. The shuttle stopper control 537 can be within the chamber 532. A portion of the shuttle stopper groove 522 can overlap with the chamber 532. For example, the second portion 522b of the shuttle stopper groove 522 can overlap with the chamber 532. The shuttle stopper engagement portion 538 can be movable in and out of the shuttle stopper groove 522. The shuttle stopper engagement portion 538 can be movable from a first end of the chamber 532 to a second end of the chamber 532 and vice versa. The shuttle stopper engagement portion 538 may be movable from a first end of the chamber 532 towards a second end of the chamber 532 and vice versa.

[0296]

[0446] FIG. 47G shows that the shuttle stopper engagement portion 538 can extend across the width of the shuttle stopper 520.

[0297]

[0447] 47F and 47G further show the shuttle stopper 520 in a neutral position within the chamber 532 and the shuttle stopper engagement portion 538 in a disengaged position within the shuttle stopper groove 522. When the shuttle stopper engagement portion 538 is in the disengaged position, as shown, for example, in FIG. 47F and 47G, the shuttle stopper engagement portion 538 may or may not contact the shuttle stopper 520. For example, FIG. 47F and 47G show that when the shuttle stopper engagement portion 538 is in the disengaged position, the shuttle stopper engagement portion 538 does not contact the shuttle stopper 520. For example, as shown in FIG. 47F and 47G, when the shuttle stopper 520 is in the neutral position, the shuttle stopper 520 can be partially deflected or have zero deflection. For example, Figures 47F and 47G show that when the shuttle stopper 520 is in a neutral position, the shuttle stopper 520 can have an undeflected configuration (also referred to as a relaxed configuration).

[0298]

[0448] When the shuttle stopper engagement portion 538 is in the disengaged position, FIG. 47F illustrates that the shuttle stopper engagement portion 538 can be moved in a direction 539a (e.g., toward the shuttle stopper 520) to engage or engage with the shuttle stopper 520. When the shuttle stopper engagement portion 538 engages (e.g., is pressed against) the shuttle stopper 520, the shuttle stopper 520 can deflect (e.g., flex) allowing the shuttle 14 to be released. When the shuttle stopper engagement portion 538 is in the engaged position, FIG. 47F illustrates that the shuttle stopper engagement portion 538 can be moved in a direction 539b (e.g., away from the shuttle stopper 520) to disengage from the shuttle stopper 520.

[0299]

[0449] 47F and 47G further illustrate the chamber 532 being deflection space 532. D A portion of the shuttle stopper 520 (e.g., shuttle stopper first and second end terminal portions 521a TE , 521b TEShuttle stopper 520 (intermediate portion between 532 and 534) may be engaged with deflection space 532, for example, via shuttle stopper engagement portion 538, via shuttle 14, or both. D The optical axis may be deflectable to a predetermined angle.

[0300]

[0450] Figures 47F and 47G further illustrate that the shuttle 14 may be in the other jaw. As another example, Figures 47F and 47G further illustrate that the shuttle 14 is in the jaw as shown, but in a transparent state.

[0301]

[0451] 47F and 47G further show that one half of the jaw (eg, a lateral half on either side of the device longitudinal axis 476) is shown in transparency.

[0302]

[0452] 47F and 47G show the pusher as transparent and / or in a retracted position.

[0303]

[0453] The jaw shown in Figures 47F and 47G can be the upper jaw. The jaw shown in Figures 47F and 47G can be the lower jaw.

[0304]

[0454] FIG 47H shows an exemplary shuttle stopper 520 having the illustrated shape and features. The shuttle stopper can be, for example, a rod or a plate. For example, FIG 47H shows that the shuttle stopper 520 can be a flexible plate.

[0305]

[0455] 47I and 47J show the shuttle stopper 520 and shuttle 14 engaged with one another. The shuttle stopper 520 can engage with the shuttle 14 when the shuttle 14 is moved or attempts to be moved (e.g., pushed, pulled) out of the jaws in the direction 526 from an advanced position in the jaws, similar to how a speed nut functions. The advanced position in the jaws shown in FIG. 47I and 47J can be a partially advanced position of the shuttle 14 in the shuttle track or a fully advanced position of the shuttle 14 in the shuttle track. When the shuttle stopper 520 engages with the shuttle 14 (e.g., when in a partial or fully advanced position), the shuttle stopper 520 can prevent or block the shuttle 14 from moving (e.g., pulled, pushed) out of the jaws in the direction 526. When the shuttle stopper 520 engages the shuttle 14 (e.g., when in a partially forward position), the shuttle stopper 520 may allow the shuttle 14 to be moved (e.g., pulled, pushed) further into the jaws in direction 524, until, for example, the fully forward position is reached. For example, when the shuttle 14 engages the shuttle stopper 520, movement of the shuttle in an outward direction 526 toward the other jaw is prevented or blocked. FIGS. 47I and 47J illustrate that the shuttle 14 attempts to move in direction 526 from one jaw to the other jaw (e.g., from the first jaw to the second jaw), but the shuttle 14 is blocked or prevented from moving or further moving in direction 526 until the shuttle stopper 520 disengages from the shuttle 14 (e.g., via the shuttle stopper engagement portion 538) and / or a threshold release force is reached between the shuttle 14 and the shuttle stopper 520.

[0306]

[0456] To engage shuttle 14 with shuttle stopper 520, shuttle 14 may move a shuttle capture distance of about 0.25 mm to about 2.00 mm (including 0.05 mm and 0.25 mm increments within this range) along the shuttle track in direction 526, for example, from a fully forward position to a partially forward position, or from a first partially forward position to a second partially forward position (wherein the first partially forward position is closer to the fully forward position than the second partially forward position). The shuttle capture distance may be the distance shuttle 14 may move in direction 526 until shuttle stopper 520 completely blocks or prevents further movement along direction 526. The shuttle capture distance may be the working distance shuttle 14 may move within the shuttle track (e.g., in direction 526) before movement of shuttle 14 fully engages shuttle stopper 520, thereby blocking or preventing further movement along direction 526 until shuttle stopper 520 disengages from shuttle 14.

[0307]

[0457] Figure 47I further shows that when the shuttle stopper 520 and the shuttle 14 engage with each other, the shuttle stopper 520 can have a shuttle stopper first deflection configuration in which the shuttle stopper first longitudinal end 521a (e.g., the shuttle stopper first longitudinal end terminal end 521aTE) is deflected in a deflection second direction (e.g., rotation 530b, translation 531b, or both rotation 530b and translation 531b). The force of the shuttle 14 against the shuttle stopper 520 when the shuttle 14 is moved in the direction 526 to actuate or engage the shuttle stopper 520 can cause the shuttle stopper first longitudinal end 521a (e.g., shuttle stopper first longitudinal end terminal 521aTE) to be deflected in a deflection second direction (e.g., rotational 530b, translational 531b, or both rotational 530b and translational 531b), for example, from a shuttle stopper neutral configuration (e.g., as shown in Figures 47F-47H) to a shuttle stopper first deflected configuration, or from a shuttle stopper second deflected configuration to the shuttle stopper first deflected configuration. The second deflection configuration can cause the shuttle stopper first longitudinal end 521a (e.g., shuttle stopper first longitudinal end terminal 521aTE) to be deflected in a deflection second direction (e.g., rotational 530b, translational 531b, or both rotational 530b and translational 531b), for example, from a shuttle stopper neutral configuration (e.g., as shown in Figures 47F-47H) to a shuttle stopper first deflected configuration, or from a shuttle stopper second deflected configuration to a shuttle stopper first deflected configuration. TE5. The configuration of shuttle stopper 520 when deflected in a first direction of deflection (e.g., rotation 530a, translation 531a, or both rotation 530a and translation 531a), which may occur, for example, when shuttle 14 is moved in direction 524 on shuttle stopper 520 while shuttle 14 is advancing into the jaws, and / or when shuttle 14 is in a static position on shuttle stopper 520 after having been advanced partially or fully into the jaws.

[0308]

[0458] FIG. 47J further illustrates that the shuttle stopper engagement portion 538 can extend across the width of the shuttle stopper 520.

[0309]

[0459] 47I and 47J further show the shuttle stopper 520 and shuttle engagement portion 538 in a disengaged configuration.

[0310]

[0460] 47I and 47J further illustrate that one half of the jaw (eg, a lateral half on either side of the device longitudinal axis 476) is shown in a transparent state.

[0311]

[0461] 47I and 47J show the pusher as transparent and / or in a retracted position.

[0312]

[0462] The jaw shown in Figures 47I and 47J can be the upper jaw. The jaw shown in Figures 47I and 47J can be the lower jaw.

[0313]

[0463] 47K and 47L show the shuttle stopper 520 and the shuttle stopper engagement portion 538 engaged with each other. When the shuttle stopper 520 and the shuttle stopper engagement portion 538 are engaged with each other, the shuttle stopper first longitudinal end 521a (e.g., the shuttle stopper first longitudinal end terminal 521aTE) may or may not contact the shuttle 14. For example, FIGS. 47I and 47J show that when the shuttle stopper 520 and the shuttle stopper engagement portion 538 are engaged with each other, a portion of the shuttle stopper first longitudinal end 521a (e.g., the shuttle stopper first longitudinal end terminal 521aTE) may contact the shuttle 14. To engage the shuttle stopper engagement portion 538 with the shuttle stopper 520, the shuttle stopper engagement portion 538 may be moved within the chamber 532 toward the shuttle stopper 520 (e.g., in the direction 539a). When the shuttle stopper engagement portion 538 engages (e.g., presses) the shuttle stopper 520, the shuttle stopper engagement portion 538 can deflect (e.g., flex, bend, buckle) the shuttle stopper 520, thereby allowing the shuttle 14 to be released. For example, the shuttle stopper engagement portion 538 can flex or bend a central portion of the shuttle stopper 520 such that the shuttle stopper first longitudinal end 521a can be deflected away from the shuttle 14, for example in a deflection first direction (e.g., rotation 530a, translation 531a, or both rotation 530a and translation 531a). The shuttle stopper engagement portion 538 can bias the shuttle stopper 520 from a shuttle stopper first deflected configuration to a shuttle stopper neutral configuration. As another example, the shuttle stopper engagement portion 538 can bias the shuttle stopper 520 from a shuttle stopper first deflected configuration to a shuttle stopper second deflected configuration.As yet another example, the shuttle stopper engagement portion 538 can bias the shuttle stopper 520 from the shuttle stopper first deflection configuration to any deflection position resulting from deflection in a deflection first direction (e.g., rotation 530a, translation 531a, or both rotation 530a and translation 5311a), such as a deflection configuration between the shuttle stopper first deflection configuration and the shuttle stopper neutral configuration, and a deflection configuration between the shuttle stopper neutral configuration and the shuttle stopper second deflection configuration. Figures 47K and 47L further illustrate that the chamber 532 can have a deflection space 532D into which a middle portion of the shuttle stopper 520 deflects when the shuttle stopper 520 disengages from the shuttle 14 via engagement with the shuttle stopper engagement portion 538. To disengage the shuttle stopper engagement portion 538 from the shuttle stopper 520, the shuttle stopper engagement portion 538 can be moved within the chamber 532 away from the shuttle stopper 520 (eg, in the direction 539b).

[0314]

[0464] FIG. 47L shows that the shuttle stopper engagement portion 538 can extend across the width of the shuttle stopper 520.

[0315]

[0465] 47K and 47L further illustrate that one half of the jaw (eg, a lateral half on either side of the device longitudinal axis 476) is shown in a transparent state.

[0316]

[0466] 47K and 47L show the pusher as transparent and / or in a retracted position.

[0317]

[0467] The jaws shown in Figures 47K and 47L may be the upper jaws. The jaws shown in Figures 47K and 47L may be the lower jaws.

[0318]

[0468] FIG. 47M shows that the shuttle stopper control 537 can have a control arm 540. The shuttle stopper engagement portion 538 can be attached to or integral with the control arm 540. The shuttle control arm can be flexible or rigid. The control arm can be, for example, a rod or cable, such as a release rod or cable. The shuttle stopper control 537 can be a shuttle stopper tape. The control arm 540 can engage and disengage the shuttle stopper engagement portion 538 with the shuttle stopper 520, for example, by moving the shuttle stopper engagement portion 538 toward the shuttle stopper 520 (e.g., in direction 539a) and moving the shuttle stopper engagement portion 538 away from the shuttle stopper 520 (e.g., in direction 539b), respectively. The shuttle stopper control 537 can be activated and / or deactivated by a mechanism in the jaw control extension 40 (also called a jaw separator) or the handle of the device. For example, the shuttle stopper control 537 can be controlled by one or more of the controls in or on the handle of the device, for example, by pushing, retracting, or rotating the controls into an articulated position of the shuttle stopper control. The shuttle stopper control 537 can be controlled, for example, by being engageable and disengageable with the jaw control extension 40 (also called a jaw separator), or by a mechanism in the handle of the device. For example, the jaw control extension 40 or one or more of the controls on the handle of the device can be releasably engageable with the shuttle stopper control 537 (e.g., with the control arm 540) to control the movement of the shuttle stopper control 537. The shuttle stopper control 537 (and thereby the shuttle stopper engagement portion 538) can be actuated by the jaw control extension 40 (also called a jaw separator), or by a mechanism in the handle of the device. The jaw separator 40 can control jaw opening, jaw closing, or both jaw opening and jaw closing.

[0319]

[0469] The shuttle stopper control 537 can be straight or curvilinear. For example, Fig. 47M shows that the shuttle stopper control 537 can have an L-shape, with the shuttle stopper engagement portion 538 being the short leg of the L-shape and the control arm 540 being the long leg of the L-shape.

[0320]

[0470] FIG. 47M further shows that either the lower jaw or the upper jaw is shown in a transparent state so that the shuttle and shuttle stopper control device 537 are visible, and half of the other jaw (e.g., the upper jaw or the lower jaw, respectively) is shown in a transparent state.

[0321]

[0471] FIG. 47M further shows the pusher as transparent and / or in a retracted position.

[0322]

[0472] The shuttle 14 and shuttle stopper control 537 (e.g., shuttle stopper engagement portion 538, shuttle stopper control control arm 540) may be in the upper jaw, the lower jaw, or both jaws. The jaw shown in Fig. 47M may be the lower jaw. The jaw shown in Fig. 47M may be the upper jaw.

[0323]

[0473] FIG. 47N illustrates that the shuttle stopper control 337 (also referred to as a shuttle stopper tape) can be in the jaw track 542 (also referred to as a shuttle stopper control track or control track). The shuttle stopper engagement portion 538, or a portion thereof, can be in the control track 542. The control arm 540, or a portion thereof, can be in the control track 542. The track 542 can be a groove. The track 542 can be a channel. The control 537 can be advanceable (e.g., in direction 539a) and retractable (e.g., in direction 539b) in the track 542. For example, the control 537 can be advanced and retracted in the track 542 to engage and disengage the shuttle stop 520, or vice versa. The control 337 (e.g., the shuttle stopper engagement portion 538, the control arm 540, or both) can be movable (e.g., slidable, translatable) in the control track 542. When a user wishes to release the shuttle stopper 520, the control arm 540 is slid (e.g., translated) forward in the control device track 542 to press the shuttle stopper engagement portion 538 against the shuttle stopper 520, deflecting the shuttle stopper 520, for example, from a shuttle stopper first deflected configuration to a shuttle stopper neutral configuration, or from a shuttle stopper first deflected configuration to a shuttle stopper second deflected configuration. The shuttle stopper control device 537 can be actuated by the jaw separator 40 or by a mechanism in the handle of the device 188. When the shuttle stopper control device 537 is actuated, the shuttle stopper control device 537 can be in an advanced position. When a user wishes to capture the shuttle 14 with the shuttle stopper 520, for example, the shuttle 14 can be slid (e.g., translated) forward on the shuttle stopper 520 while the shuttle stopper engagement portion 538 is disengaged from the shuttle stopper 520. The shuttle stopper control 537 may be in a retracted position when the shuttle stopper engagement portion 538 is disengaged from the shuttle stopper 520. The forward position of the shuttle stopper control may be the neutral position of the shuttle stopper control 537.The retracted position of the shuttle stopper control may be the neutral position of the shuttle stopper control 537. A position between the forward and retracted positions of the shuttle stopper control may be the neutral position of the shuttle stopper control 537.

[0324]

[0474] The shuttle stopper control 537 may or may not have an L-shaped short leg. For example, FIG. 47N shows a shuttle stopper control 537 with an L-shaped short leg, such as the shape shown in FIG. 47M. As another example, FIG. 47N shows a shuttle stopper control 537 without an L-shaped short leg (e.g., an L-shape), where the distal end of the control arm 540 may be the shuttle stopper engagement portion 538. The portion of the shuttle stopper control 537 configured to contact the shuttle stop 520 may be the shuttle stopper engagement portion 538. Any portion of the shuttle stopper control 537 configured to contact the shuttle stop 520 may be the shuttle stopper engagement portion 538.

[0325]

[0475] FIG. 47N further illustrates that the chamber 532 can be separate from the controller track 542 or can be part of it.

[0326]

[0476] FIG. 47N further shows the shuttle stop 520 and shuttle 14 engaged with one another.

[0327]

[0477] FIG. 47N further illustrates the shuttle stopper 520 and shuttle stopper engagement portion 538 disengaged from one another.

[0328]

[0478] 47N further shows the shuttle stopper control 537 in a disengaged position such that the shuttle stopper 520 is not deflected by the shuttle stopper engagement portion 538. When the shuttle stopper control 537 is in the disengaged position, the shuttle stopper control 537 may be in a retracted position. The retracted position may be the default position of the shuttle stopper control 537.

[0329]

[0479] Figure 47N further shows that the shuttle stopper control device 537 can move in direction 539a (e.g., toward the shuttle stopper 520) to engage or engage with the shuttle stopper 520, and that the shuttle stopper control device 537 can move in direction 539b (e.g., away from the shuttle stopper 520) to disengage from the shuttle stopper 520.

[0330]

[0480] FIG. 47N further illustrates that one half of the jaw (e.g., a lateral half on one side of the device longitudinal axis 476) is shown in transparency. As another example, FIG. 47N further illustrates a removable cover on the side of the jaw that has been removed. The removable cover can advantageously improve access to the internal components of the jaw, for example, for repair, replacement, cleaning, or any combination thereof. As yet another example, FIG. 47N can be a side view of the device 188 such that the controller 537 and controller track 542 are visible without taking a cross-section of the device 188.

[0331]

[0481] The jaw shown in Figure 47N can be the upper jaw. The jaw shown in Figure 47N can be the lower jaw.

[0332]

[0482] Figure 47O shows the jaws in a transparent state so that the shuttle 14, shuttle stopper 520 and shuttle stopper control device 537 are visible to each other when the shuttle stopper 520 and shuttle 14 are engaged with each other and when the shuttle stopper 520 and shuttle stopper engagement portion 538 are not engaged with each other.

[0333]

[0483] FIG. 47P shows a perspective view of FIG. 47N with one half of the jaw (e.g., the half to one side of the device longitudinal axis 476) shown in transparency to allow viewing of the shuttle 14. FIG. 47P further shows that the distal terminus of the control arm 540 can be a shuttle stopper engagement portion 538.

[0334]

[0484] Figure 47Q further illustrates the shuttle stopper 520 and the shuttle 14 in contact with one another. As another example, Figure 47Q further illustrates the shuttle stopper 520 and the shuttle 14 not in contact with one another.

[0335]

[0485] 47Q further illustrates the shuttle stopper 520 and the shuttle stopper engagement portion 538 engaged with one another. When a user desires to engage the shuttle stopper engagement portion 538 with the shuttle stopper 520 to release the shuttle 14 from the shuttle stopper 520, the control arm 540 can be slid (e.g., translated) forward within the control device track 542 to press the shuttle stopper engagement portion 538 against the shuttle stopper 520 to bias the shuttle stopper 520, for example, from the shuttle stopper first deflected configuration to the shuttle stopper neutral configuration and from the shuttle stopper first deflected configuration to the shuttle stopper second deflected configuration.

[0336]

[0486] FIG. 47R shows the jaws in a transparent state so that the shuttle 14, shuttle stopper 520, and shuttle stopper control device 537 are visible to one another when the shuttle stopper 520 and shuttle stopper engagement portion 538 are engaged with one another.

[0337]

[0487] FIG. 47S shows a perspective view of FIG. 47Q with half of the jaws (e.g., a lateral half on one side of the device longitudinal axis 476) shown in transparency so that the shuttle 14 is visible. FIG. 47S further illustrates that when a first portion of the shuttle stopper engagement portion 538 engages the shuttle stopper 538, a second portion of the shuttle stopper engagement portion may or may not engage the shuttle stopper 520. For example, FIG. 47S illustrates that the second portion of the engagement portion 538 (the portion labeled 538 in FIG. 47S) does not contact the shuttle stopper 520 when a first portion of the shuttle stopper engagement portion 538 (the portion hidden by the jaws in FIG. 47S) contacts the shuttle stopper 520.

[0338]

[0488] FIG. 47T shows that the shuttle stopper control 337 can have a proximal engagement portion 544 (also referred to as a shuttle stopper control proximal engagement portion). The proximal engagement portion 544 can be attached to or integral with the control arm 540. The proximal engagement portion 544 can be at the proximal end of the control device 337. The proximal engagement portion 544 can be at the proximal end of the control device 337. The proximal engagement portion 544 is a protrusion, e.g., an arm or a leg, that extends from the control arm 540 toward the device longitudinal axis 476. For example, the proximal engagement portion 544 can be a leg with a notch. A mechanism within the jaw control extension 40 or the handle of the device can activate the shuttle stopper control 537 by engaging the proximal engagement portion 544. A mechanism within the jaw control extension 40 or the handle of the device can stop the shuttle stopper control 537 by disengaging from the proximal engagement portion 544. For example, FIG. 47T shows that the proximal engagement portion can have a surface 546 with which the jaw control extension can engage. The jaw control extension 40 can have a jaw control extension arm 548. The jaw control extension arm 548 can engage with the proximal engagement portion 544, for example with the surface 546. The surface 546 can be part of a notch in the proximal engagement portion 544. The notch in the proximal engagement portion can be a capture for the jaw control extension 40.

[0339]

[0489] FIG. 47T further illustrates that when the jaws are open, the shuttle stopper control 537 is not engaged with the shuttle stopper 520. When the jaws are open, the shuttle stopper control 537 may or may not contact the shuttle stopper 520. For example, FIG. 47T illustrates that when the jaws are open, the shuttle stopper control 537 is not in contact with the shuttle stopper 520.

[0340]

[0490] FIG. 47T further illustrates that when the jaws are open, the jaw control extension 40 is not engaged with the shuttle stopper control 537 (e.g., not engaged with the proximal engagement portion 544 and / or not engaged with the control arm 540). When the jaws are open, the jaw control extension 40 may or may not contact the shuttle stopper control 537 (e.g., not engaged with the proximal engagement portion 544 and / or not engaged with the control arm 540). For example, FIG. 47T illustrates that when the jaws are open, the jaw control extension 40 is not in contact with the shuttle stopper control 537.

[0341]

[0491] FIG. 47T further illustrates that when the jaws are open, the shuttle stopper control 537 can be in a retracted position within the track 542. When the shuttle stopper control 537 is in the retracted position within the track 542, a first end of the shuttle stopper control 537 (e.g., a first end of the proximal engagement portion 544) can contact and / or rest against a first surface 551a of the jaws. When the shuttle stopper control 537 is in the retracted position within the track 542, a space 552 (also referred to as a gap) can exist between the proximal engagement portion 544 and the second surface 551b of the jaws. When the shuttle stopper control 537 is advancing within the track 542 from the retracted position shown in FIG. 47T, the proximal engagement portion 544 can advance through the space 552 until a second end of the proximal engagement portion 544 contacts the second surface 551b of the jaws. The first surface 551a of the jaws can limit the movement of the shuttle stopper control 537 in the direction 539b. For example, when a first end of the shuttle stopper control 537 (e.g., a first end of the proximal engagement portion 544) contacts the first surface 551a of the jaw, the shuttle stopper control 537 can be in a fully retracted position. The second surface 551b of the jaw can limit the movement of the shuttle stopper control 537 in the direction 539a. For example, when a second end of the proximal engagement portion 544 contacts the second surface 551b of the jaw, the shuttle stopper control 537 can be in a fully forward position. The second surface 551b of the jaw can prevent, for example, the shuttle stopper control 537 from over-deflecting the shuttle stopper 520 and disengaging the shuttle stopper 520 from engagement with the shuttle 14.

[0342]

[0492] FIG. 47T further illustrates that the jaws may be advanceable in direction 550a and retractable in direction 550b. The jaws may be movable, e.g., translatable or slidable, in directions 550a and 550b. The jaws may be movable relative to the compressive cover 34 and the jaw control extension 40. When the jaws move in directions 550a and 550b, the compressive cover 34 and the jaw control extension 40 may be in fixed positions. For example, when the jaws advance and retract in directions 550a and 550b, respectively, the compressive cover 34 and the jaw control extension 40 may remain fixed so that the jaws can advance and retract relative to the compressive cover 34 and the jaw control extension 40. As another example, when the jaws are moved in directions 550a and 550b, the jaws, the compressive cover 34, the jaw control extension 40, or any combination thereof, may be moveable in direction 550a and / or direction 550b. For example, as the jaws advance and retract in directions 550a and 550b, respectively, the compression cover 34 and jaw control extension 40 may be movable in directions 550a and / or 550b before, after, or simultaneously with the jaws advancing or retracting.

[0343]

[0493] FIG. 47T further illustrates the jaws in an open configuration, e.g., a partially open configuration or a fully open configuration. When the jaws are in a partially open configuration, the jaws can be partially advanced from the compression cover 34 and rest on the jaw control extension 40, as shown in FIG. 47T. When the jaws are in a fully open configuration, the jaws can be in a fully advanced position, as shown in FIG. 47T. When the jaws are in a partially open configuration or a fully open configuration, a first end of the shuttle stopper control 537 (e.g., a first end of the proximal engagement portion 544) can contact and / or rest on a first surface 551a of the jaws.

[0344]

[0494] Fig. 47T further shows that the shuttle stopper control 537 can run in a track 542, which can be in the jaws. The track 542 can be on the outside of the jaws (e.g., as shown in Fig. 47T) or on the inside of the jaws.

[0345]

[0495] FIG. 47U illustrates that as the jaws are closed (e.g., retracted into the compression cover 34), the jaw control extension 40 can be pushed into the proximal engagement portion 544 of the lower and upper jaws. For example, as the jaws are closed, the jaw control extension 40 can passively contact and push against the proximal engagement portion 544 of the upper and lower jaws. Retraction of the jaws can thereby push the shuttle control device 537 into the jaw control extension 40. As another example, FIG. 47U illustrates that as the jaws are closed (e.g., retracted into the compression cover 34), the jaw control extension 40 can be pushed forward toward the proximal engagement portion 540 of the lower and upper jaws. Advancement of the jaw control extension 40 can thereby push into the shuttle control device 537. For example, as the jaws are closed or after the jaws are closed, the jaw control extension 40 can be advanced out of the compression cover 34 and can contact and push against the proximal engagement portion 544 of the upper and lower jaws.

[0346]

[0496] 47U further illustrates that when the jaws are fully closed and in a partially retracted position, a space 554 (also referred to as a gap) can exist between the distal end of the compression cover 40 and the jaw stopper 242. When the jaws are fully closed and in a partially retracted position, the jaw control extension 40 can begin to contact the proximal engagement portion 544 (e.g., surface 546 of the proximal engagement portion 544) extending from the shuttle stopper control device 537. The space 544 can have a longitudinal length (e.g., measured along the device longitudinal axis 476) of about 0.01 inches to about 0.10 inches (including 0.01 inch increments (e.g., 0.02 inches) within this range).

[0347]

[0497] FIGURE 47V shows that when the jaws are fully retracted into compression cover 34, jaw stopper 242 can contact the distal end of compression cover 40. When the jaws are fully retracted into compression cover 34, for example from the partially retracted position shown in FIGURE 47U, the jaws can move in direction 550b (e.g., can move 0.01 inch to 0.10 inch in direction 550b) to close space 554. When the jaws are retracted a final distance into compression cover 34 and close space 554, the jaws can move shuttle stopper control 537 a same amount into jaw control extension 40. When the jaws are retracted a final distance into the compression cover 34 to close the space 554, the jaw control extension 40 can be forced forward the same amount (e.g., as caused by relative motion between the jaws and the jaw control extension 40 when the jaw control extension 40 is in a fixed position, or as caused by relative motion between the jaws and the jaw control extension 40 when the jaws are in a fixed position, or as caused by motion of both the jaws and the jaw control extension 40). This allows the tip of the jaw control extension arm 548 to force the shuttle stopper control device 537 forward, deflecting the shuttle stopper 520 to disengage from the shuttle 14. This design advantageously allows the shuttle 14 to automatically disengage from the shuttle stopper 520 once the jaws are fully clamped. Here, the jaws can be considered fully clamped when the jaws are fully retracted into the compression cover 34 as shown in FIG. 47V.

[0348]

[0498] As another example, once the jaws are partially retracted into compression cover 34 as shown in FIGURE 47U, compression cover 34 can be moved in direction 550a (e.g., can move 0.01 inch to 0.10 inch in direction 550b) to close space 554 and allow the jaws to be fully retracted into compression cover 34. When the jaws are retracted a final distance into compression cover 34 to close space 554, the jaws can move shuttle stop control 537 into jaw control extension 40 the same amount.

[0349]

[0499] FIG. 47V further illustrates that when the shuttle stopper control 537 is in an advanced position within the track 542, there can be a space 553 (also referred to as a gap) between the proximal engagement portion 544 and the first surface 551a of the jaws. When the shuttle stopper control 537 is retracted into the track 542 from the advanced position shown in FIG. 47V, the proximal engagement portion 544 can be retracted through the space 553 until the first end of the proximal engagement portion 544 contacts the first surface 551a of the jaws. The shuttle stopper control 537 can be retracted when the jaws are opened, for example, when the jaws are advanced out of the compression cover 34 and on the jaw control extension 40. When the jaws are opened from a closed configuration, the shuttle stopper control 537 can be passively retracted back to its retracted position, for example, by sliding in the track 542 in a direction 539b. As another example, when the jaws are opened from a closed configuration, the jaw control extension 40 or a mechanism within the handle of the device can retract the shuttle stopper control 537 by engaging the proximal engagement portion 544. For example, the proximal engagement portion 44 and the tip of the jaw control extension arm 548 can be magnetically attracted to one another, such that the jaw control extension 40 can remain attached to the shuttle stopper control 537 as the jaws advance from the compression cover 34. In this manner, the jaw control extension 40 is not itself retracted, but can pull the shuttle stopper control 537 back to a retracted position as the jaws advance. Other releasable attachment configurations, such as friction fit and snap fit configurations, can be used in addition to or instead of magnets. Such releasable engagement between the jaw control extension and the shuttle stopper control 537 can be overcome when the proximal engagement portion 544 contacts the first surface 551a of the jaws and the jaws continue to advance, for example, to fully open the jaws.

[0350]

[0500] FIGURE 47W illustrates that a cover 556 can be placed on the exterior of the jaw to encase, shield, and / or protect the shuttle stopper control 537. FIGURE 47W illustrates that when the cover 556 is on the jaw, a portion of the proximal engagement portion 544 can be left exposed.

[0351]

[0501] FIG. 48A shows that the device 188 can have a punch 558. The punch 558 can have a sharp tip. The punch 558 can have a sharp tip. Each jaw can accommodate a sharp Nitinol or other flexible tape with a sharp tip (also referred to as a punch 558). The punch 558 can be, for example, a punch tape. Each jaw can have a punch track 560 along which the punch 558 can move. For example, the punch 558 can be translatable or slidable within the punch track 560. The punch 558 can be advanced and retracted within the punch track 560. The first jaw can have a punch track 560. The second jaw can have a punch track 560.

[0352]

[0502] The piercer 558 can, for example, pre-pierce tissue to provide a path for passage of the shuttle 14. As the shuttle 14 is retracted and the jaws are closed, the piercer 558 can be driven forward to pierce the tissue. The piercer 558 can then be retracted to allow the shuttle 14 to pass between the jaws.

[0353]

[0503] The device 188 can have one punch 558. The punch 558 can be in the first jaw or the second jaw. For example, FIG. 48A shows that the device 188 can have one punch 558. The punch 558 can be in the bottom jaw or the top jaw. For example, FIG. 48A shows that the punch 558 can be in the top jaw.

[0354]

[0504] The device 188 can have two piercers 558, e.g., a first piercer and a second piercer. For example, FIG. 48A shows that an upper jaw (e.g., jaws 30, 78) can have a piercer 558. The piercer 558 extends into a lower jaw (e.g., 38, 80) to pierce tissue and then retracts back into the upper jaw to allow space for the shuttle 14 to open into the lower jaw.

[0355]

[0505] 48A further illustrates that the shuttle 14 can be radially outward of the punch 558. As another example, the punch 558 can be radially outward of the punch 558.

[0356]

[0506] FIG. 48B shows the punch 558 in a partially advanced position.

[0357]

[0507] FIG. 48C shows the punch 558 in a fully advanced position.

[0358]

[0508] 48D and 48E show the punch in a fully retracted position.

[0359]

[0509] 48F and 48G show the shuttle 14 passing from one jaw to the other after the punch 558 has advanced to punch a hole in the tissue and then retracted (e.g., fully retracted) to allow the shuttle 14 to pass between the jaws.

[0360]

[0510] 48H and 48I show that the device 188 can have a first punch 558 in the upper jaw and a second punch 558 in the second jaw.

[0361]

[0511] 48A-I further illustrate that the punch track 560 can be integrated with the shuttle tracks in the lower and upper jaws, for example, so that the shuttle 14 can pass through the same hole in tissue that the punch 558 created. As another example, the punch track 560 and the shuttle tracks in the lower and upper jaws may not be integrated within the jaws, in which case the exit angles of the punch 558 from the jaws and the exit angles of the shuttle 14 from the jaws can intersect such that the shuttle 14 pierces less tissue after the punch 558 has pre-pierced the tissue. In such a case, the path of the shuttle 14 and the path of the punch 558 can intersect within the space between the jaws.

[0362]

[0512] It will be apparent to those skilled in the art that various changes and modifications can be made to this disclosure and equivalents used without departing from the spirit and scope of the invention. Elements shown in any variation are illustrative of that particular variation and can be used in other variations within the disclosure. Elements described in the singular herein can be made plural (i.e., anything described as "one" can be more than one). Species elements of a genus element can have characteristics or elements of other species elements of that genus. The above configurations, elements or complete assemblies and methods for carrying out the invention and their elements, as well as variations of aspects of the invention, can be combined and modified with each other in any combination.

Claims

1. a jaw structure having a longitudinal axis, the jaw structure comprising a first jaw and a second jaw, the first jaw having a first jaw tip and the second jaw having a second jaw tip, the first jaw tip having teeth, the second jaw tip having a tooth seat configured to receive the teeth, the teeth configured to interlock with the tooth seat when the jaw structure is in a closed configuration, at least a portion of the second jaw tip overlaps closely adjacent to the first jaw tip when the jaw structure is in a closed configuration, the first jaw having a first jaw track and a first jaw suture slot, the first jaw track a jaw structure having a first jaw track straight portion and a first jaw track curved portion, the first jaw suture slot extending along an outer surface of the first jaw such that at least a portion of the first jaw suture slot faces away from the device, and the second jaw having a second jaw track and a second jaw suture slot, the second jaw track having a second jaw track straight portion and a second jaw track curved portion, the second jaw suture slot extending along an outer surface of the second jaw such that at least a portion of the second jaw suture slot faces away from the device; a shuttle slidable within the first jaw track and the second jaw track; a first shuttle stop engageable with the shuttle, the first shuttle stop disposed within the first jaw and configured to limit movement of the shuttle when the shuttle is within the first jaw track; a second shuttle stop engageable with the shuttle, the second shuttle stop disposed within the second jaw and configured to limit movement of the shuttle when the shuttle is in the second jaw track; a jaw control extension; a compression cover configured to compress the first jaw toward the second jaw when the first jaw and the second jaw are translated into the compression cover.

2. The device of claim 1 further comprising a first shuttle stopper control.

3. The device of claim 2 , wherein the first shuttle stopper control is engagable with the first shuttle stopper when the shuttle is in the first jaw.

4. The device of claim 3 , wherein the shuttle is movable into the second jaw when the first shuttle stopper control is engaged with the first shuttle stopper.

5. The device of claim 4 further comprising a second shuttle stopper control.

6. The device of claim 5 , wherein the second shuttle stopper control is engagable with the second shuttle stopper when the shuttle is in the second jaw.

7. The device of claim 6 , wherein the shuttle is movable into the first jaw when the second shuttle stopper control is engaged with the second shuttle stopper.

Images