Method and device for inserting suture

Abstract

To load and remove a suture without the need to remove a device from a surgical site.SOLUTION: A device is disclosed which is capable of boring and holding a tissue and then inserting a suture into the tissue. The device can include a shuttle removably attachable to the suture, and a jaw part that is rotatably openable and closable with each other. There is also disclosed a method for repetitively inserting a suture into a tissue by using the device without removing the suture or the device from a target site.SELECTED DRAWING: Figure 49A

Description

[Technical Field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application is a continuation of U.S. Patent Application No. 16 / 733,740, filed January 3, 2020, and is hereby incorporated by reference in its entirety for all purposes. [Background technology]

[0002] 1.Technical Field The present invention relates to systems, methods, and devices for enhancing the advancement and retention of sutures through tissue.

[0003] 2. Description of Related Technology Past 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 contained opposing jaws that clamp onto the tissue to be sutured. An end segment of the suture is pre-positioned and secured to the distal end of one jaw member. Beyond the clamping action, the mechanism for threading the suture between the jaws and through the tissue incorporates a bendable needle. The bendable needle advances distally within the jaw members, bringing it into contact with the suture segment.

[0004] The needle engages and secures the suture, carrying it forward. This distal advancement of the bendable needle also causes the leading end of the needle to approach and engage the angled surface 44 of the jaw member, deflecting the bendable needle toward the opposing jaw. Bending the needle requires a large force, causing excessive strain on the needle components. Breakage and failure of the bendable needle are a concern.

[0005] Furthermore, after being deflected, the bendable needle advances further in a direction extending away from the jaws and potentially into unintended anatomy. Extending the needle in this manner is a safety concern. Even after the device has completed threading the suture through tissue, the suture end segment must be retrieved by retracting the entire device from the cannula.

[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 pass (rather than load and unload) sutures through tissue without having to remove the device from the surgical site. It would also be advantageous for the suture shuttle mechanism (either the needle or shuttle) to be completely contained within the device during surgery to improve the accuracy of suture placement and improve the security of the needle or shuttle position during surgery. Summary of the Invention

[0008] FIELD OF THE DISCLOSURE The present disclosure relates generally to suturing devices and methods of suturing.

[0009] A suture manipulation device is disclosed. For example, a suture manipulation device is disclosed having a first jaw having a first jaw channel and a first jaw first stopper. The suture manipulation device can have a shuttle. The shuttle can have a shuttle longitudinal axis and a shuttle first stopper. The shuttle can be slidable within the first jaw channel. The shuttle first stopper can extend away from the shuttle longitudinal axis. The shuttle first stopper can have a shuttle first stopper proximal end and a shuttle first stopper distal end. The shuttle first stopper proximal end can be narrower than the shuttle first stopper distal end. The shuttle first stopper distal end can be deflectable into the first jaw first stopper. The shuttle first stopper can be engageable with the first jaw first stopper. When the shuttle first stopper is engaged with the first jaw first stopper, the shuttle first stopper distal end can contact the first jaw first stopper. When the shuttle first stopper distal end is in contact with the first jaw first stopper, the shuttle can be passively held in the first jaw.

[0010] A suture manipulation device is disclosed. For example, a suture manipulation device is disclosed having a jaw structure with a shuttle channel having a shuttle channel first stop. The suture manipulation device can have a shuttle. The shuttle can have a shuttle longitudinal axis and a shuttle first stop. The shuttle can be slidable within the shuttle channel. The shuttle first stop can extend away from the shuttle longitudinal axis. The shuttle first stop can have a shuttle first stop proximal end and a shuttle first stop distal end. The shuttle first stop proximal end can be narrower than the shuttle first stop distal end. The shuttle first stop can be movable into the shuttle channel first stop. The shuttle first stop can be engageable with the shuttle channel first stop. When the shuttle first stop is not engaged with the shuttle channel first stop, the shuttle first stop can have an undeflected shape of the shuttle first stop. When the shuttle first stopper is engaged with the shuttle channel first stopper, the shuttle first stopper can have a deflected shape of the shuttle first stopper.

[0011] A suture manipulation device is disclosed. For example, a suture manipulation device is disclosed having jaws with a shuttle channel having a female stopper. The suture manipulation device can have a shuttle. The shuttle can have a shuttle longitudinal axis and a female stopper. The shuttle can be translatable within the shuttle channel. The male stopper can be engageable with the female stopper. The male stopper can extend away from the shuttle longitudinal axis. The male stopper can have a male stopper proximal end and a male stopper distal end. The male stopper distal end can be wider than the male stopper proximal end. The male stopper can be translatable into and out of the female stopper. The male stopper can be deflectable into and out of the female stopper. [Brief explanation of the drawings]

[0012] The drawings shown and described are of exemplary embodiments and are not limiting. Like reference numbers indicate identical or functionally equivalent features throughout.

[0013] [Figures 1a-1c] 1A-1C are perspective, top, and side views, respectively, of a variation of a suture passing device. [Figure 2a-2b] 1A and 1B are perspective and close-up views, respectively, of a shuttle variant in a straight configuration. [Figure 2c] FIG. 2c is an enlarged view of a variation of the shuttle from FIGS. 2a and 2b in a curved configuration. [Figure 3a] FIG. 10 is an enlarged perspective partial transparent view of the distal end of a variation of the suture passing device attached to a length of suture. [Figure 3b] FIG. 3b is an enlarged view of a portion of FIG. 3a. [Figure 4a-b] 10A and 10B are enlarged perspective and side views, respectively, of the distal end of a variation of the suture passing device in a closed configuration; [Figure 4c] FIG. 4b is an enlarged view of the distal end of FIGS. 4a and 4b. [Figure 4d] FIG. 4b is an enlarged perspective view of the distal end of the device of FIG. 4a in a closed configuration. [Figure 5] FIG. 1B is a variation of cross section AA of FIG. 1a, in which the device is attached to a length of suture. [Figures 6a-6d] 10 illustrates a variation of a method for creating stitches in a piece of tissue using a variation of a suture passing device. [Figure 7a-7b] 1A-1C are side perspective and close-up views, respectively, 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 7c] FIG. 7b is an enlarged view of a variant of the shuttle in FIG. 7a. [Figure 7d] FIG. 7b is an enlarged view of the distal end of a variation of the device shown in FIG. 7a. [Figure 8a] 1 illustrates a shuttle variation. [Figure 8b]10 illustrates a close-up view of a variation of the distal end of the device. [Figures 9a-10a] 1A-1C are side perspective and partially see-through side perspective views, respectively, of various devices in an open configuration. [Figures 9b-11a] 9b and 9c are side perspective and side cross-sectional views, respectively, of various methods for closing the jaws of the device of FIG. 9a. [Fig. 9c-11b] 9b are a close-up view and a side perspective view, respectively, of the distal end of the device in FIG. 9b. [Figure 10b] FIG. 10b is an enlarged, partially perspective view of the distal end of the mandible of FIG. 10a. [Figures 12a-12c] 1A-1C are side, top, and bottom views, respectively, of a shuttle variation. [Figure 13a-13b] 1 illustrates a shuttle variation. [Figures 14a-14c] 1A-1C are top, front and bottom perspective views, respectively, of a shuttle variation. [Figures 15a-15c] 10A-10C are side, bottom, and side perspective views of a shuttle variation. [Figures 16a-16b] 10A and 10B are top and side perspective views of a variant of the shuttle; [Figure 17a] 12a-12c illustrate variations of the device with the shuttle; [Figure 17b] 17b illustrates a variation of the device of FIG. 17a with a pusher. [Figures 17c-17d] 17b illustrates a variation of the device of FIG. 17a with two pushers in different configurations. [Figure 18a-18b] 1A and 1B are side perspective and side views, respectively, of a variation of the distal end of the device. [Figures 19a-19b] 1A and 1B are side perspective and side views, respectively, of a variation of the distal end of the device. [Figures 20a-20b] 1A and 1B are side perspective and side views, respectively, of a variation of the distal end of the device. [Figure 21a-21b] 1A and 1B are side perspective and side views, respectively, of a variation of the distal end of the device. [Figure 22a-22b]10A-10C illustrate variations of the distal end and distal mandible of the device, respectively. [Figure 22c] FIG. 22b is a side view of the device of FIG. 22a with a shuttle. [Figure 23a-23b] 23b shows variations of the distal end of the device in open and closed configurations, respectively, with the device of FIG. 23b having a shuttle. [Figures 24a-24c] 1A-1C are a side perspective view, a side view, and a distal end view, respectively, of a variation of the device. [Figures 25a-25f] 25f show a bottom perspective view, a side perspective view, a partial perspective view (showing the upper jaw), a longitudinal cross-sectional view, a partial cut-away close-up view, and a partial cut-away view of the distal end of a variation of the device, with the jaws in an open configuration, the shuttle and pusher in various positions, and for illustrative purposes the compressive cover is not shown in FIG. 25f. [Figure 26a] FIG. 10 is a side perspective view of a variation of the distal end of the device with the jaws in a closed configuration and the shuttle in the upper jaw and not engaged with the lower jaw. [Figures 26b-26c] 26a and 26b are longitudinal cross-sectional and side perspective views, respectively, of the device of FIG. 26a with the shuttle in the top and bottom jaws, and FIG. 26b does not show the pusher for illustrative purposes. [Figure 26d] FIG. 26c is a partial cutaway view. [Figure 27] FIG. 10 is an enlarged partial cross-sectional 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 the upper jaw and partially into the lower jaw. [Figure 28] FIG. 13c is an enlarged end perspective view of a variation of the device with shuttle and suture of FIG. 13a or 13b. [Figure 29] FIG. 14c is an enlarged end perspective view of a variation of the shuttle and suture device of FIGS. [Figure 30a-30b] 1A and 1B are respectively a right rear view and a left cross-sectional view of a variation of the device. [Figure 31] FIG. 10 is a partial cross-sectional and partial perspective view of the proximal end of a variation of the device. [Figure 32a-32b]10A-10C are left and right perspective views of a variation of the pusher drive gear of the device. [Figure 33A] 10 illustrates a shuttle variation of the mandible, with half of the mandible shown in transparency; [Figure 33B] 10 illustrates a shuttle variation of the mandible, with half of the mandible shown in transparency; [Figure 34A] 10 illustrates a shuttle variation of the upper jaw, with half of the upper jaw shown in transparency; [Figure 34B] 10 illustrates a shuttle variation of the upper jaw, with half of the upper jaw shown in transparency. [Figure 35] 1 illustrates a variation of the device, with half of the mandible and half of the maxilla shown in transparency. [Figure 36A] 10 illustrates a perspective view of a shuttle variant. [Figure 36B] 36B illustrates a bottom view of the shuttle of FIG. 36A. [Figure 36C] 36B illustrates a side view of the shuttle of FIG. 36A. [Figure 37A] 10A and 10B illustrate top and bottom views of shuttle variants. [Figure 37B] 10A and 10B illustrate top and bottom views of shuttle variants. [Figure 37C] 10A and 10B illustrate top and bottom views of shuttle variants. [Figure 37D] 10A and 10B illustrate top and bottom views of shuttle variants. [Figure 37E] 10A and 10B illustrate top and bottom views of shuttle variants. [Figure 38A] 10 illustrates a perspective view of a shuttle variant. [Figure 38B] 38B illustrates a bottom view of the shuttle of FIG. 38A. [Figure 38C] 38B illustrates a side view of the shuttle of FIG. 38A. [Figure 39A] 10 illustrates a side view of a variation of the pusher. [Figure 39B] 10 illustrates a side view of a variation of the pusher. [Figure 39C]10 illustrates a side view of a variation of the pusher. [Figure 39D] 10 illustrates a side view of a variation of the pusher. [Figure 40A] 39B illustrates a perspective view of the pusher of FIG. 39A with a shuttle seat. [Figure 40B] 39C illustrates a perspective view of the pusher of FIG. 39B with a shuttle seat. [Figure 40C] 39D illustrates a perspective view of the pusher of FIG. 39C with a shuttle seat. [Figure 40D] 39D with a shuttle seat. FIG. [Figure 41A] 10A and 10B illustrate top and bottom views of variations of the pusher. [Figure 41B] 10A and 10B illustrate top and bottom views of variations of the pusher. [Figure 41C] 10A and 10B illustrate top and bottom views of variations of the pusher. [Figure 41D] 10A and 10B illustrate top and bottom views of variations of the pusher. [Figure 41E] 10A and 10B illustrate top and bottom views of variations of the pusher. [Figure 41F] 10A and 10B illustrate top and bottom views of variations of the pusher. [Figure 42A] 1 illustrates a variation of the pusher. [Figure 42B] 10 illustrates a variation of the pusher. [Figure 42C] 1 illustrates a variation of the pusher. [Figure 42D] 10 illustrates variations in pusher components. [Figure 43A] 1 illustrates variations of the upper and lower jaws. [Figure 43B] 1 illustrates variations of the upper and lower jaws. [Figure 43C] 1 illustrates variations of the upper and lower jaws. [Figure 43D] 1 illustrates variations of the upper and lower jaws. [Figure 43E] 1 illustrates variations of the upper and lower jaws. [Figure 43F] 1 illustrates variations of the upper and lower jaws. [Figure 43G] 1 illustrates variations of the upper and lower jaws. [Figure 43H] 1 illustrates variations of the upper and lower jaws. [Figure 43I] 1 illustrates variations of the upper and lower jaws. [Figure 43J] 1 illustrates variations of the upper and lower jaws. [Figure 43K] 1 illustrates variations of the upper and lower jaws. [Figure 43L] 1 illustrates variations of the upper and lower jaws. [Figure 43M] 1 illustrates variations of the upper and lower jaws. [Figure 43N] 1 illustrates variations of the upper and lower jaws. [Figure 44A] 10 illustrates a side view of a variation of the device, with half of the device shown in transparency. [Figure 44B] FIG. 44B illustrates a perspective view of the device of FIG. 44A. [Figure 45A] 1 illustrates variations of the device. [Figure 45B] 1 illustrates variations of the device. [Figure 45C] 10 illustrates variations in the handle of the device. [Figure 45D] 10 illustrates variations in the handle of the device. [Figure 45E] 10 illustrates variations in the handle of the device. [Figure 45F] 10 illustrates variations in the handle of the device. [Figure 45G] 10 illustrates variations in the handle of the device. [Figure 45H] 10 illustrates variations in the handle of the device. [Figure 45I] 10 illustrates variations in the handle of the device. [Figure 45J] 10 illustrates variations in the handle of the device. [Figure 45K]10 illustrates variations in the handle of the device. [Figure 45L] 10 illustrates variations in the handle of the device. [Figure 45M] 10 illustrates variations in the handle of the device. [Figure 46A] 10 illustrates a variation of the tube of the device. [Figure 46B] 10 illustrates a variation of the upper pusher. [Figure 46C] 10 illustrates a variation of the lower pusher. [Figure 46D] 10 illustrates a variation of the tube of the device. [Figure 46E] 10 illustrates a variation of the compression cover. [Figure 46F] 1 illustrates a variation of a first side of the mandible. [Figure 46G] 10 illustrates a variation of the second side of the mandible. [Figure 46H] 1 illustrates a variation of a first side of the upper jaw. [Figure 46I] 10 illustrates a variation of the second side of the upper jaw. [Figure 46J] 10 illustrates variations of the connector. [Figure 46K] 46A illustrates the pins of the connector of FIG. 46J. [Figure 47A] 1 illustrates variations of the mandible and various components within the mandible, with half of the mandible shown in transparent view. [Figure 47B] 1 illustrates variations of the mandible and various components within the mandible, with half of the mandible shown in transparent view. [Figure 47C] 1 illustrates variations of the upper jaw and various components therein, with half of the upper jaw shown in transparent form. [Figure 47D] 1 illustrates variations of the upper jaw and various components therein, with half of the upper jaw shown in transparent form. [Figure 47E] 1 illustrates a variation of the device in which half of the mandible and upper jaw are shown in transparent form. [Figure 47F]10 illustrates variations of the upper and / or lower jaw with half of the upper and / or lower jaw shown in see-through, along with various components within the upper and / or lower jaw; [Figure 47G] 10 illustrates variations of the upper and / or lower jaw with half of the upper and / or lower jaw shown in see-through, along with various components within the upper and / or lower jaw; [Figure 47H] 10A and 10B illustrate perspective views of variants of the shuttle stopper; [Figure 47I] 10 illustrates variations of the upper and / or lower jaw with half of the upper and / or lower jaw shown in see-through, along with various components within the upper and / or lower jaw; [Figure 47J] 10 illustrates variations of the upper and / or lower jaw with half of the upper and / or lower jaw shown in see-through, along with various components within the upper and / or lower jaw; [Figure 47K] 10 illustrates variations of the upper and / or lower jaw with half of the upper and / or lower jaw shown in see-through, along with various components within the upper and / or lower jaw; [Figure 47L] 10 illustrates variations of the upper and / or lower jaw with half of the upper and / or lower jaw shown in see-through, along with various components within the upper and / or lower jaw; [Figure 47M] 10 illustrates variations of the shuttle and shuttle stopper controller. [Figure 47N] 1 illustrates variations of the upper and / or lower jaw with various components within the upper and / or lower jaw. [Figure 47O] 10 illustrates variations of the upper and / or lower jaw with the upper and / or lower jaw shown in transparent form, along with various components within the upper and / or lower jaw; [Figure 47P] This is a perspective view of Figure 47N. [Figure 47Q] 1 illustrates variations of the upper and / or lower jaw with various components within the upper and / or lower jaw. [Figure 47R] 10 illustrates variations of the upper and / or lower jaw with the upper and / or lower jaw shown in transparent form, along with various components within the upper and / or lower jaw; [Figure 47S] This is a perspective view of Figure 47Q. [Figure 47T] FIG. 10 is a side view of a variation of the device. [Figure 47U] FIG. 10 is a side view of a variation of the device. [Figure 47V] FIG. 10 is a side view of a variation of the device. [Figure 47W] FIG. 10 is a side view of a variation of the device. [Figure 48A] 1 illustrates a variation of the device having a perforator. [Figure 48B] 1 illustrates a variation of the device having a perforator. [Figure 48C] 1 illustrates a variation of the device having a perforator. [Figure 48D] 1 illustrates a variation of the device having a perforator. [Figure 48E] 1 illustrates a variation of the device having a perforator. [Figure 48F] 1 illustrates a variation of the device having a perforator. [Figure 48G] 1 illustrates a variation of the device having a perforator. [Figure 48H] 1 illustrates a variation of the device having two perforators. [Figure 48I] 1 illustrates a variation of the device having two perforators. [Figure 49A] 10 illustrates a perspective view of a shuttle variant. [Figure 49B] FIG. 49B is an enlarged view of the shuttle at section 49B-49B (dashed box) of FIG. 49A. [Figure 49C] 49B illustrates a perspective view of the shuttle of FIG. 49A with a suture attached. [Figure 49D] 49B illustrates a bottom view of the shuttle of FIG. 49A. [Figure 49E] 49B illustrates a side view of the shuttle of FIG. 49A. [Figure 49F] 49B illustrates a top view of the shuttle of FIG. 49A in a flat configuration. [Figure 49G] 49F illustrates a side view of the shuttle of FIG. 49F. [Figure 49H1] 49B illustrates the shuttle of FIG. 49A within the upper jaw, with half of the upper jaw shown in transparency. [Figure 49H2] 49B illustrates the shuttle of FIG. 49A within the mandible, with half of the mandible shown in transparency. [Figure 49H3] 49B illustrates a variation of the device with the shuttle of FIG. 49A in the upper jaw, with half of the upper and lower jaws shown in transparent form. [Figure 49H4] 49B illustrates a variation of the device with the shuttle of FIG. 49A in the lower jaw, with half of the lower and upper jaws shown in transparent view. [Figure 50A] 10 illustrates a top view of a variation of the shuttle in a flat configuration. [Figure 50B] 50B illustrates a side view of the shuttle of FIG. 50A in a shape-set configuration. [Figure 50C] 50C illustrates an end view of the shuttle of FIG. 50B. [Figure 50E] 50C illustrates a top view of the shuttle variation of FIG. 50B and a variation of the mandibular pusher within the mandibular shuttle track, with the mandibular shuttle track shown in transparency. FIG. [Figure 50D] 50C illustrates a top view of the shuttle variation of FIG. 50B and a maxillary pusher variation within the maxillary shuttle track, with the maxillary shuttle track shown in transparency. FIG. [Figure 50F] 50C illustrates a top view of the shuttle variation of FIG. 50B and a variation of the mandibular pusher within the mandibular shuttle track, with the top of the mandibular jaw shown in transparency. [Figure 50G] 50C illustrates a top view of the shuttle variation of FIG. 50B and a variation of the upper jaw pusher within the upper jaw shuttle track, with the top of the upper jaw shown in transparency. [Figure 50H1] 10 illustrates a perspective view of a variation of the mandible, with half of the mandible shown in transparency; [Figure 50H2]50H illustrates a perspective view of the mandible of FIG. 50H1 with a shuttle variation and with half of the mandible shown in transparency. [Figure 50H3] 10 illustrates a perspective view of a variation of the upper jaw, with half of the upper jaw shown in transparency; [Figure 50H4] 50H illustrates a perspective view of the upper jaw of FIG. 50H4 with a modified shuttle configuration and with half of the upper jaw shown in transparency. [Figures 51A-51L] 10 illustrates a top view of a shuttle variation and a male stopper variation. [Figure 52A] FIG. 10 is a perspective view of a modified male stopper. [Figure 52B] 52B is a side view of the lower jaw and the upper jaw of FIG. 52A with the male stopper in a disengaged configuration, with the upper jaw shown in transparent view. [Figure 52C] FIG. 52C is a side view of the upper jaw of FIG. 52B with the male stopper in an engaged configuration. [Figure 52D] FIG. 52D is an enlarged view of FIG. 52C without the shuttle or male stopper. [Figure 52E] FIG. 52C is an enlarged perspective view of FIG. 52B. DETAILED DESCRIPTION OF THE INVENTION

[0014] 1a-1c illustrate a suture passing device 188 that can be used to pass a suture 70 through soft or hard tissue 74 while creating one or more complete stitches without removing the device 188 or the suture 70 from the target site.

[0015] 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 upper pusher 86 and / or the lower pusher 76.

[0016] The sliding tube actuator 6 can have an outer compression cover 34 and an inner rod (not shown because it is obstructed 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, e.g., translated distally and proximally relative to the handle 104 when the trigger 8 is squeezed or released.

[0017] 2a and 2b illustrate 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 multiple slits 20 along one or both sides of the shuttle rail 16. The slits 20 can be positioned at regular or irregular length intervals along the rail 16.

[0018] 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 side of the device 188. The suture holder 18 can have a generally flat, isosceles trapezoidal configuration. The suture holder 18 can have a suture retention notch 100. The notch 100 can have an inner bore 17a, an outer bore 17b contiguous with the inner bore 17a, and a first cleat 97a positioned between the inner bore 17a and the outer bore 17b. The notch 100 can have a second cleat 97b on the side of the outer bore away from the inner bore. The notch 100 can be configured to secure to the suture 70. For example, the suture 70 can be compressed to friction fit within the inner cleat 97a.

[0019] The suture holder 18 can have a front raised edge and a rear raised edge. The edges can be angled perpendicular or non-perpendicular to the longitudinal axis of the rail 16. One or both of the edges can be sharpened to traumatize the tissue 74, for example, to cut through soft tissue 74. The edges can cut through the tissue 74, allowing the suture holder 18 to pull the suture 70 through the tissue 74 directly behind the respective edge.

[0020] The shuttle 14 can be made from a flexible polymer such as PEEK, a resilient metal such as Nitinol, any material 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 negotiating curves in the track.

[0021] FIG. 2c illustrates that the rail 16 can be curved at the location of the slit 20 and / or the rail 16 can be pre-curved.

[0022] 3a and 3b illustrate that the suture threading device 188 can capture or removably attach the suture 70 at the inner cleat 97a and / or the outer cleat 97b of the suture holder 18. The suture 70 can be loaded or held laterally of the jaw structure 28 out of plane by rotation of the jaws. The device 188 can pass the suture 70 through tissue 74 multiple times without withdrawing or reloading the suture threading device 188. The jaw structure 28 does not have a hinge and can elastically deform open at the proximal end of the jaw structure 28. The jaws can open and / or close without any mechanical pivot or linkage to the jaw structure 28.

[0023] 4a illustrates that the suture threader device 188 can have a jaw structure 28 having 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 cut element of nitinol, other resilient metal or polymer, any other material listed 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).

[0024] 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.

[0025] The channel inside the compression cover 34 can be sized and shaped to fit over the jaw structure 28 with minimal clearance when the jaw structure 28 is in the closed configuration. When the compression cover is translated distally 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 longitudinal axis 42 of the jaw structure. The jaw structure 28 can be fully compressed into the closed configuration, as shown in FIGS. 4a-4c. In this manner, when an actuation lever, such as trigger 8, is actuated, the channel or compression cover 34 can advance to cam the jaws closed. The jaws can be pre-pierced through tissue to establish a continuous track for the shuttle to pass through the tissue.

[0026] A compressible cover 34 may be attached to the open bowl 32 positioned between the first and second jaws.

[0027] FIG. 4b illustrates 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 outward from a lateral 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 the closed configuration, the ball axle 52 abuts against the proximal end of the axle slot 50, providing an interference fit to, for example, prevent the compression cover 34 from overextending beyond the jaw structure 28. When the jaw structure 28 is in the open configuration, the ball axle 52 abuts against the distal end 2 of the axle slot 50, providing an interference fit to, for example, prevent the jaws from over-rotating and / or pulling the ball 32 beyond the inner ramp 44 of the jaw structure 28.

[0028] FIG. 4c illustrates 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 the closed configuration and the first jaw tip 46 is interdigitated with the second jaw tip 48, the top track port 60 can be aligned adjacent to or in contact with the bottom track port 62 (as shown). When the jaw structure 28 is in the closed configuration, 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 adjacent to or in contact with the second jaw tip 48.

[0029] FIG. 4d illustrates that the compression cover 34 can translate proximally 126 relative to the jaw structure 28, as indicated 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, proximally. The open ball 32 can then be pushed against the inner beveled surface 44 of the first jaw and / or second jaw. The first jaw tip 46 and / or second jaw tip 48 can then rotate away from the opposing jaw tip. The jaw structure 28 can then be placed in the open configuration, as shown.

[0030] 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 the open configuration. The entire jaws or just the proximal ends of the jaws can be made from nitinol, for example, with the distal ends of the jaws being made from stainless steel.

[0031] 5 illustrates that the lateral 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 lateral slot 72. The rail 16 can be too large to fit through the lateral slot 72. The suture holder 18 can extend laterally from the rail 16 through the lateral slot 72. The suture holder 18 can hold the suture 70 in a direction that is laterally away from the jaw.

[0032] FIG. 6 a illustrates that the upper jaw 78 and the lower jaw 80 can be closed, as indicated by the arrows, and compressed through tissue 74, such as the soft tissue 74 of a 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 interdigitate with each other within or adjacent to the tissue 74. The hole created by the contact or engagement 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 distally 138 to further compress the first jaw toward the second jaw, for example, to push the jaw tips to pierce the tissue 74.

[0033] The lower pusher 76 can be advanced distally, as shown by the arrow, as controlled by the handle 104. The lower pusher 76 can be pushed or urged through the track to move the shuttle 14 distally and carry the suture 70 with it.

[0034] 6b illustrates that the lower pusher 76 can be pushed by the handle 104. The lower pusher 76 can push the shuttle 14 through tissue 74. The leading edge 22 of the suture holder 18 can cut through the tissue 74, and the suture holder 18 can pull the suture through the cut made in the tissue 74 by the leading edge 22 and / or through the perforation made by the tissue 74 at the tip of the jaw. The pusher and shuttle 14 can move along the longitudinal axis of the jaw.

[0035] The shuttle 14 can then be fully positioned within the track of the upper jaw 78. The lower pusher 76 can then be withdrawn from the track of the upper and / or lower jaw 80, and / or the lower pusher 76 can be left in place but the resistance force can be removed, allowing the lower pusher 76 to slide freely within the track.

[0036] 6c illustrates that the compressive cover can be translated proximally 126 (e.g., by releasing or squeezing trigger 8), as shown by arrow 83. The ball axle 52 can be pulled proximally, which can force the opening ball 32 against the inner surfaces of the top and / or bottom jaws 38. The opening ball 32 can thus resiliently force the top and / or bottom jaws 38 open. The jaws can then be unclamped (i.e., rotated open, as shown by arrow 82) and removed from the tissue 74.

[0037] The device 188 can then be moved to a position where the distal end 2 of the device 188 is adjacent (eg, lateral to) the location where the suture was originally passed through the tissue 74 .

[0038] FIG. 6d illustrates that the jaws can then be closed to pierce the tissue 74 adjacent to the initial pass of the suture 70 therethrough. The upper pusher 86 can then be urged distally by the handle 104, as indicated by the arrow. The upper pusher 86 can then urge or push the shuttle 14 along the track in the opposite direction from that shown in FIGS. 6a and 6b. The trailing edge 24 of the suture holder 18 then cuts the tissue 74 as the suture holder 18 passes through the tissue 74, thereby carrying the suture 70 through the tissue 74. Thus, a mattress stitch of the suture 70 through the tissue 74 can be created.

[0039] Next, the shuttle 14 can be placed in a home position, as shown in FIG. 6a. The upper pusher 86 can then be withdrawn from the track of the upper and / or lower jaws 80, and / or the upper pusher 86 can be left in place but the resistance 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 create another stitch repeating the method shown in FIGS. 6a-6d. When the stitch is completed, or to perform a second stitch, the jaws can be reopened and removed from the target site.

[0040] 7a illustrates that the device 188 can have a base 102 and a handle 104 extending from the base 102. The device 188 can have a rotatable 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 from the base 102.

[0041] The distal end 2 of the device 188 can have an upper jaw and a lower jaw 80. The upper jaw 78 can be rotatable relative to the lower jaw 80, or vice versa.

[0042] The compression cover 34 can be slidably attached to one or both jaws. A rotatable lever 106 can be attached to the compression cover 34. For example, squeezing and rotating the lever 106 toward the handle 104 can push the compression cover distally 138 relative to the jaws. The compression cover can be slid distally over the jaws, thereby rotating the upper jaw 78 toward the lower jaw 80 and closing the jaws. The lever 106 can be spring-loaded to rotate away from the handle 104, retracting the compression cover 126 proximally and returning the jaws to an open configuration when external pressure or squeezing is no longer applied to the lever 106.

[0043] 7b illustrates that the pusher shaft or button can extend distally from the base 102 or the 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 and / or pull one or both pushers. Pushing or pulling the pusher shaft can translate the pushers. A single pusher shaft or button can be switched between both pushers.

[0044] A pusher toggle, such as a lateral paddle 112, can extend from the side of the base 102. The lateral paddle 112 can be positioned on the top or bottom of the base 102 or the handle 104. The lateral paddle 112 can be rotated 110 relative to the base 102, as indicated by the arrow. The lateral paddle 112 can be configured to orient a pusher shaft or button to translate either the upper pusher 86 or the lower pusher 76, depending on the position of the lateral paddle 112.

[0045] The device 188 can have a lock 120 for the lever 106. The lock 120 for the lever 106 can extend laterally from the base 102. The lock 120 can rotate 118 relative to the base 102 as shown by the arrow. The lock 120 can be configured to lock or secure the lever 106 in a closed or particular angular position relative to the base 102. For example, the lock for the lever 106 can lock the lever 106 in a closed position, which in turn locks the jaws in a closed configuration.

[0046] 7c illustrates that the shuttle 14 can have rails 16, which can be cylindrical tubes or sleeves. The rails 16 can be made from nylon, other materials disclosed herein, or combinations thereof. The rails 16 can have rounded (e.g., hemispherical) or flat-ended longitudinal ends.

[0047] 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 plane. The distal end of the wire can be removably or fixedly attached to the rail 16, for example, through a port or slot in the lateral 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.

[0048] 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 lateral slot 72 and into the retaining notch 100 with the shuttle 14 in position for loading and / or removing the suture 70 to and / or 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 lateral slot 72 can terminate in a loading dock 96, for example, with the walls of the loading dock 96 providing an interference fit against the shuttle 14 and / or suture holder 18 to prevent the shuttle 14 from further translating proximally along the jaws.

[0049] The lower jaw 80 and / or the upper jaw 78 can have a septum 90 that can cover the inner end 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.

[0050] 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.

[0051] The septum 90 may have a septum slot 94. The septum slot 94 may be aligned with the lateral side slots 72 of the bottom track 66 and / or the top track 264.

[0052] The septum 90 can be configured to wipe or clean debris, such as tissue 74 and bodily fluids, from the shuttle 14 as it passes through the septum 90, for example, to prevent or minimize debris and fluids from entering the top and / or bottom tracks 66.

[0053] 8a illustrates that the shuttle 14 can have a rail 16 that can have a cylinder, and the suture holder 18 can be as described in FIGS. 2b and 2c. The retention notch 100 can have an angled cleat 97. The retention notch 100 can extend to the side of the rail 16.

[0054] 8b illustrates that shuttle 14 can be positioned such that retention notch 100 of suture holder 18 can be within loading dock 96 when suture 70 is being attached to or removed from retention notch 100. Suture 70 can be pushed into (e.g., for attachment) or pulled out (e.g., for removal, separation, or repositioning) retention notch 100. The pair of longitudinally opposed first cleats 97 can laterally friction-fit or interference-fit onto suture 70 within retention notch 100. The longitudinally opposed pair of second cleats 97 may frictionally or interference-fit the suture 70 inwardly into the retaining notch 100 (i.e., the suture 70 may be radially secured between the first pair of cleats 97 on the outside of the suture 70 and the second pair of cleats 97 on the inside of the suture 70).

[0055] The suture 70 may be radially secured between a pair of longitudinally opposed cleats 97 that may bite into, compress or puncture the outer surface of the suture 70 .

[0056] The shuttle 14 may be interference-fit or otherwise stopped by the lower jaw 80 from moving proximally to a position where the retention notch 100 is exposed within the loading dock 96 .

[0057] 9a, 10a, and 10b illustrate that the device 188 can be in an open configuration in which the upper jaw 78 is rotated and positioned 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 to and / or collinear with the longitudinal axis of the compressive cover. 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 between about 30° and about 45°, or more narrowly between about 30° and about 40°.

[0058] The compression cover 34 can be translated proximally and retracted away from the jaws as shown by arrow 126. The upper jaw 78 can have a slotted sliding pin 130 that can extend laterally from one or both lateral sides of the proximal end of the upper jaw 78.

[0059] The distal end 2 of the compression cover 34 can have one or more beveled slots 134 on one or both lateral sides of the compression cover 34. The beveled slots 134 can narrow as the beveled slots 134 extend proximally (i.e., widen as the beveled slots 134 extend distally). The beveled slots 134 can be at a non-zero angle (i.e., not aligned) with respect to the longitudinal axis of the compression cover 34.

[0060] The slotted sliding pin 130 can be configured to extend through the ramped slot 134. The slotted sliding pin 130 can slide within the ramped slot 134. The slotted sliding pin 130 can frictionally fit into the narrower proximal end of the ramped slot 134, for example, to frictionally fit the jaws in a closed configuration and provide tactile feedback to the user of the jaw angle 128.

[0061] FIG. 10a illustrates that the upper track can pass through a hinge tube 149 where it extends beyond the distal opening of the compression cover 34 into the upper jaw. The hinge tube 149 can be made from, for example, Nitinol. The hinge tube 149 can flex as the upper jaw rotates. The hinge tube 149 can be a unitary length of the entire upper track or can be a separate length of tube with one or each end attached to the remainder of the upper track.

[0062] 9b and 11a illustrate that the compression cover 34 can be translated distally relative to the jaws, as indicated by arrow 138. The compression cover 34 can rotate the jaws 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 rotatably fixed position relative to the compression cover 34, or vice versa, or the jaws can rotate both ways relative to the compression cover 34. Thus, a lever, such as trigger 8, can be actuated to advance the outer tube or the compression cover 34, camming the jaws closed.

[0063] When the jaws are in a closed configuration, the jaw angle 128 can be between about 0° and about 3°, more narrowly between about 0° and about 2°, for example about 0°.

[0064] 9c and 11b illustrate that the upper jaw tip 206 can be pressed into and through the septum rail port 92. The top or upper track 264 can form a continuous lumen 152 with the bottom or lower track 148, for example, through which the shuttle 14 can slide.

[0065] The lateral slots 72 of the upper jaw 78 can be aligned with the lateral slots 72 of the lower jaw 80. The suture holder 18 can extend through the lateral slots 72 to hold the suture 70 in the lateral slots 72. The suture holder 18 can translate the suture 70 back and forth between the upper part 78 of the lateral slots 72 and the lower jaw 80 as the shuttle 14 is translated back and forth between the upper part 78 and the lower jaw 80.

[0066] 12a-12c illustrate that the shuttle 14 can have rails 16, e.g., a shuttle spine 160, and lateral arms or fingers of the shuttle 14 extending laterally and / or inwardly from the shuttle spine 160. The shuttle fingers 156 can extend laterally, downwardly, and inwardly relative to the shuttle spine 160, as shown. 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.

[0067] The shuttle 14 is aligned with the longitudinal axis 157 of the shuttle (the longitudinal axis 14 of the shuttle). A1 The shuttle longitudinal axis 157 can be flat or curved, for example, having a shuttle radius of curvature 154 of about 3 mm to about 5 mm, more narrowly about 3 mm to about 4 mm, e.g., about 3.5 mm.

[0068] The shuttle spine 160 can be flexible or rigid. The shuttle 14 can be fabricated from a single panel of material (e.g., metal), for example, by bending and laser cutting the panel.

[0069] The suture holder 18 may be one, two, or more circular, oval, or otherwise elongated longitudinal slots in the shuttle back 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 slot 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 having a first end attached to a first slot in the shuttle back 160 and a second end attached to an adjacent second slot in the shuttle back 160.

[0070] 13a illustrates that the suture holder 18 can be an arc that is integral with the shuttle back 160. For example, the shuttle 14 can be made from a single panel of material (e.g., metal). The lateral sides of the suture holder 18 can be cut off, and the longitudinal ends can remain integral with the shuttle back 160. The suture holder 18 can then be bent or otherwise deformed away from the plane of the shuttle back 160, for example, to form an arc that is out of the plane of the shuttle back 160.

[0071] The suture 70 may have a suture loop 162 at the distal end of the suture 70. The suture loop 162 may extend around and completely or partially encircle 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.

[0072] 13b illustrates 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 lateral side of the shuttle. The shuttle notches 166 can also be spaced apart longitudinally and distributed along the shuttle 14. The shuttle notches 166 can be curved. The sides of the shuttle 14 can be straight except at the locations of the notches.

[0073] The radius of curvature of the shuttle notch 166 can be about 1 mm to about 2 mm.

[0074] 14a-14c illustrate that one or both of the longitudinal ends of the shuttle 14 can be a curved or sharp shuttle tip 164. For example, the shuttle tip 164 can have an angled chisel tip or a needle tip.

[0075] The shuttle holder can have a holder leader 170 extending away from the shuttle spine 160. The end of the holder leader 170 away from the shuttle spine 160 can be a closed wire loop 98 configured to attach to the suture 70. A loop neck 172, such as a double clamp, can secure a first end of a leader wire at a midpoint on the holder leader 170, as shown. A second end of the holder leader 170 can extend through a longitudinal slot 174 of the shuttle and terminate in a leader tether 168, such as a crimped or swaged ball or disk having a diameter greater than the width of the shuttle longitudinal slot 174, for slidably attaching 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 tether 168.

[0076] The holder leader 170 can be translatably and / or rotatably fixed within the shuttle's longitudinal slot 174, or can slide and / or rotate within the shuttle's longitudinal slot 174. For example, the wire loop 98 can extend beyond the first end of the shuttle spine 160 when the shuttle 14 is translated in a first direction (e.g., from the upper jaw 78 toward the lower jaw 80), and the holder leader 170 then passively rotates and translates when the shuttle 14 is translated in a second direction (e.g., from the lower jaw 80 toward the upper jaw 78).

[0077] 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.

[0078] The suture 70 can be passed through and / or tied to the wire loop 98. The wire loop 98 can be elevated 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 sharp edges to minimize the risk of cutting or damaging the suture 70.

[0079] 15a and 15b illustrate that the suture 70 can be attached directly to or fused to the shuttle spine 160 at a suture attachment 176 located in the longitudinal and lateral center of the shuttle 14. The suture 70 can be braided.

[0080] For example, the entire shuttle 14 can be made of plastic and can be molded, overmolded, or otherwise bonded to a plastic suture. The suture can be thermally formed into the shuttle 14. The suture 70 can extend through the shuttle 14, for example, at a suture tether 178. The suture tether 178 can be the terminal end of the suture 70 that extends through and is attached to the shuttle 14.

[0081] 16a and 16b illustrate that the leader or wire loop 98 can extend partially or entirely in a plane perpendicular to the plane of the shuttle back 160. A first end of the wire loop 98 can have a leader first tether 184. A second end of the wire loop 98 can have a leader second tether 186. The shuttle back 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.

[0082] The wire loop 98 can extend through a longitudinal slot 174 in the shuttle. The first and second tethers of the leader can be on the underside (e.g., on the concave side or radially inward) of the shuttle spine 160. The wire loop 98 can be on the outside (e.g., on the convex side or radially outward) of the shuttle spine 160. None of the leader tethers 168 can be fixed or integral (e.g., fused or welded) to the shuttle spine 160, but one or both of the leader tethers 168 can be so. None of the leader tethers 168 can be slidably attached to the longitudinal slot, but one or both of the leader tethers 168 can be so. The wire loop 98 can be fixed or slidable longitudinally relative to the shuttle spine 160.

[0083] The wire loop 98 can have a longitudinally symmetric or asymmetric (as shown) shape. 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 protrude asymmetrically toward one of the longitudinal shuttle ends (as shown).

[0084] 17a illustrates that the device 188 can have a shuttle 14 positioned across the upper jaw 78 and the lower jaw 80. The jaws can have jaw lateral ridges 190. The shuttle fingers 156 can wrap around the jaw lateral ridges 190, e.g., to slidably attach the shuttle to the jaws. The jaw lateral ridges 190 at the ends of the upper jaw 78 or top jaw 30 and the bottom or lower jaw 80 can be aligned, e.g., to allow the shuttle 14 to slide along the continuous ridge between the upper jaw 78 and the lower jaw 80 when the jaws are in the closed configuration.

[0085] 17b illustrates that the device 188 can have a lower pusher 76 slidably mounted to an outer jaw ridge 190 on the lower jaw 80. The lower pusher 76 can abut the shuttle 14.

[0086] 17c illustrates that the device 188 can have an upper pusher 86 slidably mounted on a lateral jaw ridge 190 of the upper jaw 78. The upper pusher 86 and / or the lower pusher 76 can be shaped like a shuttle 14. The shuttle 14 can be pushed into the straight length of the lower jaw 80. The shuttle 14 can be deformed into a straight configuration when in the straight length of the jaw and into a curved configuration when in the curved length of the jaw.

[0087] The pusher may be shaped generally similar to the shuttle 14, having fingers, longitudinal slots, a back, and transverse slots between the fingers. For example, two or more pushers may be used simultaneously on a single device 188 to deliver multiple sutures 70 to the same target site (e.g., if the pusher in FIGS. 17b-17d were shuttle 14 and additional pushers were used).

[0088] 17d illustrates that the shuttle 14 can be pushed by the lower pusher 76 onto the upper jaw 78 as shown. The lower pusher 76 can then be retracted onto the lower jaw 80.

[0089] 18a and 18b illustrate that the upper and / or lower jaws 80 can each have a jaw dorsum 208. The jaw dorsum 208 can extend inwardly from the remainder of the jaws (as shown) or away from the longitudinal axis of the jaw control device extension. For example, the jaw dorsum can extend from the remainder of the jaws to the distal end 2 of the jaws, distal to where the jaws extend from the jaw longitudinal extensions 191, 202 to inwardly curved jaw medial extensions near the respective jaw tips.

[0090] The jaws may have lateral jaw ridges 190 or rails 16 as described elsewhere herein. The jaws may have a T-shaped cross section.

[0091] 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 each have a shuttle downward extension 196, each of which can extend downward (e.g., toward the longitudinal axis of the jaw structure) from a lateral end of the lateral extension. The shuttle fingers 156 can have a shuttle inward extension 194, each of which can extend inward from the shuttle downward extension 196. The shuttle spine 160 and / or the lateral extensions, downward extensions, and inward extensions can slidably embrace the jaw lateral ridge 190.

[0092] The upper jaw tip 206 and / or the lower jaw tip 198 can have a blunt, beveled (e.g., needle point), chisel (e.g., chamfered on opposite sides as shown in FIGS. 18a and 18b), conical, sprocket, 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 distal bevel of the jaw tips can have the same angle and length, or a smaller angle and longer length than the proximal bevel of the jaw tips.

[0093] The upper jaw tip 206 can have a tip gap 290 or contact the lower jaw tip 198 when the jaws are in the closed configuration.

[0094] 19a and 19b illustrate that the jaw dorsum 208 of one or both jaws can terminate before the respective jaw tip or medial jaw extension.

[0095] The proximal bevel of the jaw tip may have a smaller angle and a longer length than the distal bevel of the jaw tip.

[0096] 20a and 20b illustrate that the jaw dorsum 208 on the maxillary portion 78 can extend along the linear length of the maxillary portion 78 and can terminate at or proximal to the maxillary medial extension 204 or maxillary tip 206. The jaw lateral ridge 190 on the maxillary portion 78 can extend to terminate at the distal tip of the maxillary portion 78.

[0097] The dorsum 208 on the mandible 80 can extend to the terminal distal tip of the mandible 80 .

[0098] The outer jaw ridge 190 on the mandible 80 can extend along the linear length of the mandible 80 and can terminate at or proximal to the inner mandibular extension 200 or the mandibular tip 198.

[0099] When the jaws are in the closed configuration, the mandibular tip 198 is disposed proximal to and can overlap the maxillary tip 206. The maxillary tip 206 and mandibular tip 198 can overlap along a tip contact surface 211. For example, the distal end 2 of the jaw dorsum 208 on the mandibular 80 can overlap and slide against the proximal side of the maxillary tip 206. The maxillary tip 206 can contact the mandibular tip 198 at the tip contact surface 211, or there can be a gap between the maxillary tip 206 and the mandibular tip 198 at the tip contact surface 211.

[0100] The tip contact surface 211 can have a tip contact surface axis 214 relative to the longitudinal axis 42 of the jaw structures. The tip contact surface axis 214 can intersect the longitudinal axis 42 of the jaw structures at a tip contact surface angle 212 of approximately 90°.

[0101] The maxillary tip 206 may be distal to the mandibular tip 198 at a tip contact surface 211 .

[0102] The distal end of the jaw lateral ridge 190 of the upper jaw 78 may or may not contact the distal end of the jaw lateral ridge 190 of the lower jaw 80 when the jaws are in a closed configuration.

[0103] 21a and 21b illustrate that the tip contact surface 211 can have a tip contact surface axis 214 relative to the longitudinal axis 42 of the jaw structure. The mandibular tip 198 can be distal to the maxillary tip 206 at the tip contact surface 211. The tip contact surface angle 212 can be between about 30° and about 60°, more narrowly between 30° and about 45°, for example, about 35°.

[0104] 22a-22c illustrate that the distal end 2 of the mandibular tip 198 (as shown) or the maxillary tip 206 can have a tip bearing surface 216. The tip bearing surface 216 can be shaped to receive the shape of the opposing mandibular tip. For example, the tip bearing surface 216 can be triangular (e.g., A-shaped or V-shaped).

[0105] When the jaws are in the closed configuration, the tip bearing surface 216 can surround the lateral and distal sides of the maxillary tip 206. When the jaws are in the closed configuration, the tip bearing surface 216 can or cannot contact the maxillary tip 206 (i.e., a gap can exist).

[0106] The jaw lateral ridge 190 of the jaw with the tip bearing surface 216 (as shown, the bottom jaw 38) can extend to the mandibular tip 198 and the distal end of the tip bearing surface 216. The jaw lateral ridge 190 of the jaw opposite the tip bearing surface 216 (as shown, the upper jaw 78) can narrow to a point at the distal end of the respective jaw tip. The narrowed jaw lateral ridge 190 can be received within the tip bearing surface 216.

[0107] 23a and 23b illustrate that the upper jaw 78 and / or the lower jaw 80 can have a circular or oval cross section. The upper jaw 78 and / or the lower jaw 80 can be made from a solid or hollow rod having a diameter of, for example, about 0.030 inches to about 0.100 inches, e.g., about 0.060 inches.

[0108] The distal end of the maxillary and / or mandibular tip 198 can have a conical shape. The distal end of the mandibular tip 198 can have a tip bearing surface 216 that can be, for example, an inverse or negative of the cone sized and shaped to receive the maxillary tip 206.

[0109] The shuttle 14 may have a circular or elliptical cross section.

[0110] 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.

[0111] 24a-24c illustrate that the distal end 2 of the device 188 can be inserted into a cannula 226 and can be deployed percutaneously, for example, through a cannula 226 inserted into a patient at a target site. The cannula 226 can have a cannula inner diameter 228. The cannula inner diameter 228 can be 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)).

[0112] 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.

[0113] The compression cover 34 can be attached to or integral with one or more jaw control device extensions 40. For example, the jaw control device extensions 40 can extend from the lateral distal end 2 of the compression cover 34. The jaw control device extensions 40 can be slidably attached to or contact the jaws directly or indirectly. The jaw control device extensions 40 can push the jaws apart toward each other when the jaw control device extensions 40 are translated proximally relative to the jaws and when the jaw control device extensions 40 are translated distally relative to the jaws.

[0114] One or more upper cam pins 222 can extend laterally from one or both lateral sides of the proximal end of the upper jaw 78. One or more lower cam pins 232 can extend laterally from one or both lateral sides of the proximal end of the lower jaw 80 at the same or different longitudinal positions as the upper cam pins 222.

[0115] The jaw control device 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 the lower cam slots 224 can be straight, curved, angled (as shown), or a combination thereof. A cam pin can be positioned inside and through each cam slot. The cam pin can slide within the cam slot.

[0116] When the jaw control device extension 40 is translated distally relative to the jaws, the cam pins slide proximally within their respective cam slots and can rotate the jaws away from each other. When the jaw control device extension 40 is translated proximally relative to the jaws, the cam pins slide distally within the cam slots and can rotate the jaws toward each other.

[0117] 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 device extension 40 to the proximal side of the jaw tip. When the jaws are in a closed configuration, the jaw extension length 234 can be between about 5 mm and about 30 mm, for example, about 16 mm and 15.95 mm.

[0118] The jaws can have a jaw linear gap 236 along the linear length of the jaws. The jaw linear gap 236 can be about 1 mm to about 3.5 mm, e.g., 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.

[0119] The jaws can be separate or integral to a jaw body, which can rotatably deform away from each other when moved to the open configuration.

[0120] 25a-25f illustrate 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 within or outside the suture holder slot 238.

[0121] The upper track 264 can terminate distally at the upper jaw tip shuttle port 240. The lower track 148 can terminate distally at the lower jaw tip shuttle port 256. The shuttle 14 can extend into and through each of the shuttle 14 ports. In use, when the jaws are rotated to the closed configuration, the sharp shuttle tip 164 extending from the shuttle port can pierce, cut, and incise tissue 74.

[0122] 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 the compressive cover 34 relative to the jaws to stop distal translation. For example, the distal end of the compressive cover 34 can abut the jaw stop 242 when the jaws are in the closed configuration.

[0123] The radially inner surface of the jaw may have a radially inner bevel 250 .

[0124] 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 compressive cover 34 when the compressive cover 34 is in the proximally retracted position 126 relative to the jaws and / or when the jaws are in the open configuration. The jaw slide 244 can have an increasing radius in the distal longitudinal direction from the longitudinal axis 42 of the jaw structure (e.g., the larger the longitudinal dimension of the jaw slide 244, the larger the radial dimension of the jaw slide 244). When the compressive cover is translated distally 138 relative to the jaws, a radially inner distal edge of the compressive cover 34 can slide along the jaw slide 244, pushing the jaw slide 244 toward the longitudinal axis 42 of the jaw structure. The radial compressive force transmitted from the compression cover 34 to the jaw slide 244 creates a torque on each jaw, causing it to rotate toward the longitudinal axis 42 of the jaw structure and the opposing jaw.

[0125] The device 188 can have a jaw control device extension 40. The jaw control device extension 40 can extend along a longitudinal axis 42 of the jaw structure. The jaw control device extension 40 can extend between the jaws proximal to the jaw tips. The jaw control device extension 40 can terminate in a jaw control device extension head 254.

[0126] The jaw control device extension head 254 can have one or two lobes or cams. Each lobe can extend from the longitudinal axis of the jaw control device 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 the lower jaw 80 can have upper and inner jaw radially inward ramps 250, respectively. When the jaw control device extension head 254 is in a proximal, retracted position relative to the jaws, the inward ramps can be the radially inner surfaces of the jaws proximal to the jaw tips and distal to the jaw control device extension head 254. The radially inward ramps 250 can have an increasing radius in the longitudinal direction distal to the longitudinal axis 42 of the jaw structure (e.g., the greater the longitudinal dimension of the radially inward ramps 250, the greater the radial dimension of the radially inward ramps 250). When the jaw control device extension 40 translates proximally or retracts relative to the jaws, the lobes can slide against the radially inner ramps 250 of the jaws, pushing the jaws away from each other into an open configuration.

[0127] When the jaws are in the open configuration, the compression cover 34 can be positioned proximally at or beyond the proximal end of the jaw slide 244, and the jaw extension head can be positioned proximally at or beyond the proximal end of the radially inner ramp 250.

[0128] The jaw control device extension 40 can be attached to or integral with a control rail 248. The control rail 248 can extend radially from one or both lateral sides of the jaw control device extension 40, for example, in a plane perpendicular to the plane defined by the opposing jaws or opposing extension head lobes 252.

[0129] The compression cover 34 can have a control rail slot 246. The control rail slot 246 can extend to the distal end of the compression cover 34. The control rail 248 can be fixed within the control rail slot 246 or can translate longitudinally. For example, the control rail 248 can be an interference fit, abut, or stop against the proximal end of the control rail slot 246 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 coordination with (i.e., simultaneously with) the compression cover 34. The control rail 248 can move longitudinally distally and / or longitudinally in coordination with the jaw control device extension 40.

[0130] 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). The jaw control device extension 40 can extend longitudinally between the upper and lower socket arms 258, 270, or within a hollow channel inside the integral socket arm (with the upper and lower socket arms 258, 270 as integral elements). The distal ends of the socket arms can extend to or proximal to the distal ends of the compression cover 34 when the jaws are in the open configuration.

[0131] The proximal end of the upper jaw 78 may have a transversely 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.

[0132] 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 have a diameter approximately equal to or slightly larger than the diameter of the upper jaw bearing 262.

[0133] The hinge of the upper jaw 78 can include an upper jaw bearing 262 and an upper jaw socket 260. The upper jaw 78 can rotate about a transverse axis of the upper jaw bearing 262. The upper jaw bearing 262 can rotate within the upper jaw socket 260.

[0134] The proximal end of the mandible 80 may have a transversely elongated mandible bearing 266. The mandible bearing 266 may extend radially outward from the remainder of the proximal end of the mandible 80.

[0135] The distal end 2 of the lower socket arm 270 can have a laterally elongated mandibular socket 268. The mandibular socket 268 can open inwardly and can have a diameter approximately equal to or slightly larger than the diameter of the mandibular bearing 266.

[0136] The hinge of the lower jaw 80 can include a lower jaw bearing 266 and a lower jaw socket 268. The lower jaw 80 can rotate about a transverse axis of the lower jaw bearing 266. The lower jaw bearing 266 can rotate within the lower jaw socket 268.

[0137] The upper pusher 86 and / or the lower pusher 76 can have an entire length or only a distal end 2 that can have articulated segmentations 286. The articulated segments 286 can rotate relative to one another about an axis perpendicular to the longitudinal axis of the respective pushers. The articulated segments 286 can be connected by separate hinges (e.g., pin or snap connections) or can be longitudinally coincident or longitudinally alternating lateral slots cut into the sides of the pushers, similar to the shape of the lateral slots 158 in the shuttle. The proximal ends of either or both the upper pusher 86 and the lower pusher 76 can have a continuous, non-segmented, flat, uniform ribbon of material.

[0138] The upper pusher 86 and / or the lower pusher 76 can have a distal end that can have a shuttle bearing surface 274. The shuttle bearing surface 274 can be the inverse shape of the shuttle tip 164. For example, if the shuttle tip 164 has an angled end, the shuttle bearing surface 274 can have an opposite angle. If the shuttle tip 164 has a convexly curved end, the shuttle bearing surface 274 can have a concavely curved end with the same radius of curvature as the shuttle tip 164.

[0139] 26a-26d illustrate that the compression cover 34 can translate distally relative to the jaws, as indicated by the arrows. The compression cover 34 can transmit a translational force to the control rail 248 through the edges of the control rail slot 246. The control rail 248 can transmit a translational force to the jaw control device extension 40. The jaw control device extension 40 can translate distally simultaneously with the compression cover 34, as indicated by the arrows. The compression cover 34 can translate 138 over the jaw slide 244, pushing the jaw slide 244 radially inward. The jaw control device extension head 254 can move distally relative to the jaws, as indicated by the arrow 280, to allow for, for example, closure of the jaws without an interference fit or abutment against the jaw control device extension head 254. The upper jaw 78 and / or the lower jaw 80 can rotate radially inward, as indicated by the arrows.

[0140] When the jaws are in the closed configuration, the compression cover 34 can be positioned at or adjacent to the jaw stopper 242 and the jaw extension head can be positioned at or proximally beyond the proximal end of the radially inner ramp 250.

[0141] When the jaws are in the closed configuration and the shuttle 14 is within 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 shuttle port 240 in the upper jaw tip, and into the shuttle port 256 in the lower jaw tip.

[0142] When the jaws are in the closed configuration and the shuttle 14 is within 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, out of the shuttle port 256 in the mandibular tip and into the shuttle port 240 in the maxillary tip.

[0143] When the shuttle 14 is pushed from the upper track 264 to the lower track 148 or vice versa, the shuttle 14 can translate 282 following the path of the upper track 264 and the lower track 148 in a curvilinear manner, as shown by the arrows.

[0144] When the jaws are in the closed configuration, the shuttle 14 can move from the upper jaw 78 to the lower jaw 80 and back to the upper jaw 78, as shown 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, once, twice or more times.

[0145] 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.

[0146] The device 188 can have a jaw lockout that prevents the jaws from opening when either pusher extends out of the respective jaw tip shuttle port and / or when the shuttle 14 is simultaneously within the upper jaw 78 and lower jaw 80.

[0147] FIG. 27 illustrates that the upper pusher 86 can translate distally relative to the jaws. The upper pusher 86 can translate in a serpentine manner along the upper track 264, as indicated by arrows 284 and 288. The distal end of the upper pusher 86 can extend out from the maxillary tip shuttle port 240. A V-shaped (or A-shaped) or curved (e.g., U-shaped) shuttle bearing surface 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 maxillary tip shuttle port 240 and the mandibular tip shuttle port 256, and into the lower track 148. The shuttle 14 can have a curvilinear translation 282 along the track, as indicated by the arrow.

[0148] The lower pusher 76, like the upper pusher 86 of FIG. 27, can have zero, one, or several lower pusher articulation segments (as shown).

[0149] 28 illustrates that the suture 70 can be tied or glued directly to the suture holder 18, for example, as shown in FIGS. 13a and 13b. The suture 70 can have a suture loop 162. The suture loop 162 can circumnavigate the suture holder 18.

[0150] 29 illustrates that when the jaws are in a closed configuration, the distal end of the upper jaw tip 206 can contact the distal end of the lower jaw tip, or have a tip gap 290. The tip gap 290 can be between about 0 inches and about 0.020 inches, for example, about 0.008 inches.

[0151] The shuttle 14 can have a shuttle width 292. The shuttle width 292 can be from about 0.030 inches to about 0.100 inches, such as about 0.060 inches, or as another example, about 0.055 inches. As another example, the shuttle width 292 can be from about 0.053 inches to about 0.057 inches, or more broadly, from about 0.35 inches to about 0.075 inches, including 0.001 inch increments within these ranges (e.g., 0.055 inches).

[0152] The shuttle 14 can be made from a nickel-titanium alloy (eg, Nitinol), stainless steel, other materials disclosed herein, or combinations thereof.

[0153] Figures 30a, 30b and 31 illustrate that a lever 106 or handle 104 can control the rotation and opening and closing of the jaws.

[0154] The handle 104 can have a handle pivot 302. The handle pivot 302 can be a rotatable pin joint that allows the handle 104 to be rotatably attached to the base 102. The handle 104 can rotate about the handle pivot 302 relative to the base 102.

[0155] The handle 104 can be attached to the socket arm (as shown) and / or the compression cover 34. For example, the compression cover 34 can have radially and / or laterally extending cover pins 304. The cover pins 304 can be attached to the jaw control device extension 40. The handle 104 can have one or two transfer ports 314 or loops 296 on opposite lateral sides of the compression cover 34. The cover pins 304 can extend through the transfer loops 296.

[0156] The other socket arm (as shown) and compression cover 34 not attached to the handle 104 may be attached to the base 102 .

[0157] Squeezing and rotating the handle 104 toward the base 102 can extend 138 the compression cover 34 and jaw control device extension 40 distally relative to the jaws or retract 126 the jaws proximally relative to the compression cover 34 and jaw control device extension 40. As the handle 104 is rotated, the jaws can move to an open configuration. For example, as the bottom of the handle 104 is rotated 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 urge the compression cover 34 and / or jaw control device extension 40, for example, to translate distally to close the jaws.

[0158] 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 .

[0159] The distal proximal end of the upper pusher 86 can be attached to or integral with the upper pusher 86 shaft and / or upper pusher button 210a. The distal proximal end of the lower pusher 76 can be attached to or integral with the lower pusher shaft and / or 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-by-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 upper pusher button 210 can retract lower pusher 76 and / or lower pusher button 210b proximally. Pressing lower pusher button 210b can retract upper pusher 86 and / or upper pusher button 210 proximally.

[0160] The inside of the distal end 2 of the upper pusher button 210b and the lower pusher button 210b can respectively have an upper pusher button gear 310 and a lower pusher button gear 306. The upper pusher button gear 310 can face the lower pusher button gear 306.

[0161] 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 be in rotatable contact with and interdigitate with an upper pusher button gear 310 on a first side and with a lower pusher button gear 306 on an opposite side of the upper pusher button gear 310.

[0162] As the upper pusher button translates 284 distally, the upper pusher button gear 310 can rotate the pusher toggle gear, which, for example, also rotates the top of the pusher toggle knob 294 to a position indicating that the upper pusher button 210a has translated distally 284. The top surface or circumference of the pusher toggle knob 294 can have an indicator, such as an arrow, that can indicate whether the upper pusher 86 or the lower pusher 76 has translated and by how much, for example, indicating the position of the shuttle 14 in the upper track 264, the lower track 148, extension from one track, or extension across both tracks simultaneously. The pusher toggle gear can simultaneously translate the lower pusher button gear 306 proximally. For example, when the upper pusher 86 is translated distally, the lower pusher 76 can simultaneously translate proximally at the same rate.

[0163] As lower pusher button 210b translates distally, lower pusher button gear 306 can rotate the pusher toggle gear, e.g., also rotate the top of pusher toggle knob 294, to a position indicating upper pusher button 210a has translated distally 284. The pusher toggle gear can simultaneously translate upper pusher button gear 310 proximally. For example, when lower pusher 76 is translated distally, upper pusher 86 can simultaneously be translated proximally at the same rate.

[0164] The pusher toggle knob 294 can be rotated to transmit torque applied to the pusher toggle knob 294 through the pusher toggle knob gear 308 to the upper pusher button gear 310 and / or the lower pusher button gear 306 to translate the upper pusher 86 and the lower pusher 76, regardless of whether the proximal end of the pusher button is depressed.

[0165] 32a and 32b illustrate that pusher toggle knob 294 can be rotated to transmit torque applied to pusher toggle knob 294 through pusher toggle knob gear 308 to upper pusher button gear 310 and / or lower pusher button gear 306 to translate upper pusher 86 and lower pusher 76, regardless of whether the torque is applied to the proximal end of the pusher button.

[0166] The diameter of the pusher toggle knob 294 can be smaller than the width of the base 102, as shown in Figures 30a, 30b and 31, or 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.

[0167] 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. When 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. Rotating 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 distal end 206 of the upper jaw and the distal tip 198 of the lower jaw. The handle 104 can then be squeezed and rotated toward the base 102. Rotating the handle toward the base 102 can move the jaws to a closed configuration to pinch tissue 74 together at the target site. The shuttle 14 can be fully embedded in the jaw in which it is loaded, or the shuttle tip 164 can extend from whichever jaw it is currently loaded in. The shuttle tip 164 can perforate the tissue 74 when the jaws are closed, or after the jaws are closed when the shuttle 14 is translated.

[0168] After the jaws are closed, the upper 210a or lower pusher button 210b (e.g., respectively, in the track in which the shuttle 14 is currently located) can be pressed to advance the respective pusher distally. The respective pusher can push the shuttle 14 distally, through a gap between the upper and lower jaws 78 and 80, if one 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 a path adjacent to the shuttle 14. When the respective pusher button is fully depressed, the device 188 can emit an audible and / or tactile response (e.g., from a snap or detent in the button or pusher and track), and the pusher toggle knob 294 can have an indicator (e.g., a line or arrow) that indicates the shuttle 14 has fully translated between the jaws.

[0169] The handle 104 can then be rotated away from the base 102. For example, the handle 104 can be released and spring loaded back to the position from which it was rotated away from the base 102. The rotating handle can translate the transfer loop 296 proximally. The transfer loop 296 can pull and translate the compression cover 34 and jaw control device extension 40 proximally, opening the jaws.

[0170] The device 188 can then be repositioned so that the jaw tips are fully disengaged, for example, when the stitch is completed, or moved adjacent to their previous position to place a new stitch. The handles 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 move to the opposite jaw as described above, and the suture 70 can be pulled through the tissue 74 to form a stitch.

[0171] The above method can be repeated as necessary to create the desired stitch length and position.

[0172] 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 alloys, for example), tungsten-rhenium alloys, polyethylene terafate (PET) / polyester (e.g., EI Du Pont de Nemours and Polymers such as polypropylene (PET), polytetrafluoroethylene (PTFE), expanded PTFE (ePTFE), polyetherketone (PEK), polyetheretherketone (PEEK), polyetherketoneketone (PEKK) (polyaryletherketoneketone), nylon, polyether block copolyamide polymers (e.g., PEBAX®, ATOFINA, Paris, France), aliphatic polyether polyurethanes (e.g., Thermedics Polymer Absorbable or resorbable polymers such as TECOFLEX® (Tecoflex®) from BioScience Products, Wilmington, MA), polyvinyl chloride (PVC), polyurethane, thermoplastic, fluorinated ethylene propylene (FEP), polyglycolic acid (PGA), polylactic acid (PLA), polycaprolactone (PCL), polyethyl acrylate (PEA), polydioxanone (PDS), and pseudo-polyaminotyrosine-based acids, extruded collagen, silicone, zinc, echogenic, radioactive, radiopaque materials, biomaterials (e.g., cadaveric tissue, collagen, allograft, autograft, xenograft, bone cement, morselized bone, osteogenic powder, bone beads), any of the other materials described herein, or combinations thereof.Examples of radiopaque materials are barium sulfate, zinc oxide, titanium, stainless steel, nickel-titanium alloys, tantalum, and gold.

[0173] The shuttle 14 throughout this disclosure 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 attached and detached from the shuttle 14, for example, before the desired stitch or suturing is completed.

[0174] The shuttle 14 can be translatable (e.g., slidable) in the jaw structure 28, e.g., in the jaw tracks (e.g., jaw tracks 66 and 64). The shuttle can be configured to translate (e.g., slide) in the jaw structure 28, e.g., in the jaw tracks (e.g., jaw tracks 66 and 64).

[0175] 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 lateral side of the shuttle and a second lateral 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 located at the longitudinal center of the shuttle 14, at the proximal end of the shuttle 14, or at the distal end of the shuttle 14. The center of the suture holder 18 can be located at the lateral center of the shuttle 14, at the first lateral side of the shuttle, or at the second lateral side of the shuttle. The suture holder 18 may be in the plane of the shuttle back 160, may extend away from the plane of the shuttle back 160, or both. For example, FIG. 33A illustrates that the suture holder 18 does not extend away from the plane of the shuttle back 160. The plane of the suture holder 18 may be flush or coincident with the plane of the shuttle back 160. This may advantageously allow the shuttle 14 and suture holder 18 to occupy less space, thereby bringing the base of the suture 70 closer to the shuttle 14 and minimizing trauma to surrounding tissue as the shuttle 14 passes between the upper jaw 30 and the lower jaw 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 70 is connected to a structure outside the plane of the shuttle back 160 (e.g., the suture holder 18 of FIGS. 13a and 13b). The shuttle and suture holder 18 may be a monolithic structure. The suture loop 162 may extend around and completely or partially enclose 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 attached to or integral with the suture 70 at the suture junction 73.The suture joint 73 can be knotted, braided, or both. The suture loop 162 can be circular, oval, or stadium shaped.

[0176] The shuttle 14 can have zero, one, or multiple suture holes 404, e.g., zero to four or more suture holes 404, including increments of one within this range. For example, FIG. 33A illustrates 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 suture hole 404a and the second suture hole 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., 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., 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-shaped, horseshoe-shaped, star-shaped, slotted, or any combination thereof. The suture holes 404 can have such cross-sectional shapes when the shuttle is curved or flat. The suture holes 404 can have a constant cross-sectional area or a tapered cross-sectional area.

[0177] The shuttle tip 164 can be beveled, non-beveled, or both. For example, FIG. 33A illustrates that the shuttle tip 164 can be non-beveled. The shuttle tip 164 can have one or more tip faces 406, e.g., one to four or more tip faces 406, including increments of one tip face within this range (e.g., one tip face, two tip faces). For example, FIG. 33A illustrates that the shuttle tip 164 can have a first tip face 406a (e.g., a first non-beveled tip face as shown in FIG. 33A) and a second tip face 406b (e.g., a second non-beveled tip face as shown in FIG. 33A). The non-beveled portions of the shuttle tip 164 can advantageously improve the transmission of force from the upper pusher 86 and the lower pusher 76, thereby making it easier to push the pushers 86 and 76 against the shuttle 14. When shuttle tip 164 has a non-ramp surface 406 (e.g., the beveled surface shown in FIGS. 14a-14c) compared to a beveled surface, a larger component of the force from the pusher (e.g., pushers 86 and 76) can be transmitted along the longitudinal axis of shuttle 14. With a beveled surface, a portion of the force applied to shuttle 14 is directed perpendicularly away from the beveled surface against the surfaces defining lower track 66 and upper track 64. When the pusher applies a longitudinal force against the beveled surface, a portion of the longitudinal force applied by the pusher to shuttle 14 is converted into a lateral component away from the longitudinal axis of shuttle 14.

[0178] 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 at a first beveled angle, e.g., a first lateral beveled angle 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 beveled angle referred to in the preceding paragraph can refer to a second beveled angle, e.g., a second lateral beveled angle angled relative to a transverse axis perpendicular to the transverse axis of the first beveled angle and toward the longitudinal axis (e.g., the central longitudinal axis) of the shuttle 14. Such a second beveled angle is shown in FIGS. 14a-14c. The second bevel angle can define a second beveled surface along the taper facing a second direction different from the first direction. The second bevel angle 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 tip surface 406 (e.g., tip surfaces 406a and 406b) can pierce or cut tissue. When the shuttle tip 164 has first and second bevel angles, the first and second bevel angles can pierce or cut tissue. FIG. 33A illustrates that the shuttle tip 164 can be blunt, meaning that the edge is tapered to form the first cutting surface, but the cutting surface 406 itself can be chamfered or unanchor-edged. The shuttle tip 164 can cut or pierce tissue even when it is blunt, and being sharp or blunt can refer to the presence or absence of a second bevel, respectively (e.g., as shown in Figures 14a-14c).

[0179] 33A further illustrates that device 188 can have one or more male stoppers 412 (also referred to as male catches, male detents, stoppers, catchers, or detents) and one or more female stoppers 416 (also referred to as female catches, female detents, stoppers, catchers, or detents). Device 188 can have, for example, 1 to 10 or more male stoppers 412, including single increments of male stoppers within this range (e.g., 1, 2, 3, 4, or more male stoppers). Device 188 can have, for example, 1 to 10 or more female stoppers 416, including single increments of female stoppers within this range (e.g., 1, 2, 3, 4, or more female stoppers).

[0180] The male stoppers 412 can be attached to or integral with the device 188. For example, the male stoppers 412 can be part of, attached to, or integral with the shuttle 14. As another example, the male stoppers 412 can be part of, attached to, or integral with the jaws (e.g., jaws 30, 38, 78, 80). As yet another example, the device 188 can have several male stoppers 412 that are part of, attached to, or integral with the shuttle 14 and several male stoppers 412 that are part of, attached to, or integral with the jaws (e.g., jaws 330, 38, 78, 80). As yet another example, the male stoppers 412 can be part of, attached to, or integral with the pushers (e.g., lower pusher 76 and upper pusher 86).

[0181] The female stopper 416 can be attached to or integral with the device 188. For example, the female stopper 416 can be part of, attached to, or integral with the shuttle 14. As another example, the female stopper 416 can be part of, attached to, or integral with a jaw (e.g., jaws 330, 38, 78, 80). As yet another example, the device 188 can have several female stops 416 that are part of, attached to, or integral with the shuttle 14 and several female stops 416 that are part of, attached to, or integral with a jaw (e.g., jaws 330, 38, 78, 80). As yet another example, the female stopper 416 can be part of, attached to, or integral with a pusher (e.g., lower pusher 76 and upper pusher 86).

[0182] 33A-34B illustrate, for example, that the shuttle 14 can have a male stopper 412 and the jaws (eg, jaws 330, 38, 78, 80) can have a female stopper 416. For example, Figures 33A-34B illustrate that the shuttle 14 can have a first male stopper 412a and a second male stopper 412b, that the lower jaw (e.g., jaws 38, 80) can have a first female stopper 416a (also referred to as the lower jaw first female stopper 416a and other similar terms) configured to removably engage with or be removably attached to the first male stopper 412a, and that the upper jaw (e.g., jaw 30, jaw 78) can have a second female stopper 416b (also referred to as the upper jaw first female stopper 416b and other similar terms) configured to removably engage with or be removably attached to the second male stopper 412b. In Figures 33A-34B, half of the lower and upper jaws are shown in transparent form to allow a better view of the shuttle 14 in the jaw tracks (e.g., lower track 66 and upper track 64) and to allow a better view of the male stopper 412 and female stopper 416.

[0183] Each male stopper 412 can be removably mated, attached, or engaged with a female stopper 416 via, for example, a friction fit, a snap fit, a magnetic fit, a ratchet fit, or any combination thereof. For example, a first male stopper 412a can be configured to removably attach to a first female stopper 416a, and a second male stopper 412b can be configured to removably attach to a second female stopper 416b. When two stoppers (e.g., male stopper 412 and female stopper 416) are removably attached to one another, a threshold release force may be required to release the stoppers from one another. The threshold release force may be from about 1.0 Newtons to about 10.0 Newtons or greater, 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 lb to about 1.5 lb, including 0.1 lb increments within this range (eg, 1.0 lb).

[0184] The male stopper 412 can be a positive feature such as a ridge, bump, ridge, arm, extension, bend, detent bend, or any combination thereof. The male stopper 412 can be straight and / or curved. The male stopper 412 can be flexible, rigid, or both (e.g., a first portion can be flexible and a second portion can be rigid). The male stopper 412 can be one or more springs. The female stopper 416 can be a negative feature such as a cavity, space, pocket, notch, hole, through-hole, recess, detent recess, or any combination thereof. The female stopper 416 can be flexible, rigid, or both (e.g., a first portion can be flexible and a second portion can be rigid). The male stopper 412 and the female stopper 416 can include magnets to attract the male stopper and the female stopper to each other and remain removably attached together.

[0185] The male stopper 412 can have a male surface 414, and the female stopper 416 can have a female surface 418. The male surface 414 and the female surface 418 can be configured to engage with one another, slidably engage with one another, contact one another, or any combination thereof. The female stopper 416 can have a lip 420 configured to engage with, slidably engage with, or contact the male stopper 412, or any combination thereof. The male stopper 412 can be configured to engage with, slidably engage with, or contact the lip 420, or any combination thereof.

[0186] For each male-female stopper pair, the male surface 414 and the female surface 418 can engage with each other and / or the male stopper 412 can engage with the lip 420, for example, when the male stopper 412 is press-fit into the female stopper 416, when the male stopper 412 is being withdrawn from the female stopper 416, when the female stopper 416 is pressed over or onto the male stopper 412, when the female stopper 416 is being withdrawn from the male stopper 412, when the male stopper 412 and the female stopper 416 are attached to each other (also referred to as a stop position, a captured position, or a locked position), or any combination thereof. As another example, the two female stoppers 416 can engage with each other, for example, if the two female stoppers 416 include magnets. As yet another example, the two male stoppers 412 can engage with each other, for example, if the two male stoppers include magnets. The male stopper 412 and / or the female stopper 416 may be formed with hooks or hook-like features for releasably capturing the other stopper.

[0187] The male stopper 412 can be moved relative to the female stopper 416, vice versa, or both. The female stopper 416 can be moved relative to the male stopper 412, vice versa, or both. For example, FIG. 33A illustrates that the male stopper 412 can be translatable (e.g., slidably translatable) within the mandible track, e.g., in a first direction toward the first female stopper 416a and a second direction away from the first female stopper 416a, or vice versa, such that the first female stopper 416a can be translatable toward and away from the male stopper 412 (e.g., in a configuration where the female stopper 416 is integral with or attached to the shuttle 14 and the male stopper 412 is integral with or attached to the mandible). 34A illustrates that the male stopper 412 can be translatable (e.g., slidably translatable) within the upper jaw track, for example, in a first direction toward the second female stopper 416b and in a second direction away from the second female stopper 416b, or vice versa, such that the second female stopper 416b is translatable toward and away from the male stopper 412 (e.g., in a configuration where the female stopper 416 is integral with or attached to the shuttle 14 and the male stopper 412 is integral with or attached to the upper jaw). The first and second directions can be reversed.

[0188] 33A-33B illustrate that as the shuttle 14 translates in a first direction within the mandible track toward the first female stopper 416a (e.g., being pushed by the upper jaw pusher 86, pulled by the lower jaw pusher 76, or both), the lip 420 can exert a force against the first male stopper 412a, deflecting the first male stopper 412a toward the longitudinal axis of the shuttle 14. This deflection can allow the first male stopper 412a to mate with the first female stopper 416a. Upon overcoming the lip 420, the first male stopper 412a can spring back to its neutral or less deflected position, releasably locking the shuttle 14 to the mandible between the first male stopper 412a and the first female stopper 416a via a detachable attachment. 33A and 33B further illustrate that when the shuttle 14 is translated (e.g., pulled by the upper jaw pusher 86, pushed by the lower jaw pusher 76, or both) in a second direction (e.g., the opposite first direction) within the mandibular track away from the first female stopper 416a, the female surface 418 can exert a force on the first male stopper 412a, deflecting the first male stopper 412a toward the longitudinal axis of the shuttle 14. This deflection can allow the first male stopper 412a to slide under and past the lip 420. Upon moving past the lip 420 in the second direction, the first male stopper 412a can spring back to its neutral position (also referred to as the undeflected position). When deflected, the first male stopper 412a can bias toward the first suture hole 404a.

[0189] 34A and 34B illustrate that as the shuttle 14 translates in a first direction within the upper jaw track toward the second female stopper 416b (e.g., being pushed by the lower jaw pusher 76, being pulled by the upper jaw pusher 76, or both), the lip 420 can exert a force against the second male stopper 412b, deflecting the second male stopper 412b toward the longitudinal axis of the shuttle 14. This deflection can allow the second male stopper 412b to engage with the second female stopper 416b. Upon overcoming the lip 420, the second male stopper 412b can spring back to its neutral or less deflected position, releasably locking the shuttle 14 to the upper jaw via a detachable attachment between the second male stopper 412b and the second female 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 lower jaw pusher 76, or both) in a second direction (e.g., the opposite first direction) within the upper jaw track away from the second female stopper 416b, the female surface 418 can exert a force on the second male stopper 412b, deflecting the second male stopper 412b toward the longitudinal axis of the shuttle 14. This deflection can allow the second male stopper 412b to slide under and past the lip 420. Upon passing the lip 420 in the second direction, the second male stopper 412b can spring back to its neutral position (also referred to as the undeflected position). The first male stopper 412a can bias into the second suture hole 404b when deflected.

[0190] The lip 420 can resist passage of the first male stopper 412a and the second male stopper 412b along the second direction out of the first female stopper 416a and the second female stopper 416b with a threshold release force. The female surface 418 can be on an inner surface of the lip 420. The lip 420 can resist passage of the first male stopper 412a and the second male stopper 412b along the first direction into the first female stopper 416a and the second female stopper 416b with the threshold release force or a lesser force (e.g., 10% to 75% of the threshold release force).

[0191] The device 188 can have zero, one, or more male stoppers 412 and zero, one, or more female stoppers 416 on the distal end 2 of the device (e.g., closer to the jaws than the handle 104) and / or on 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 stoppers 412, one or more female stoppers 416, or any combination thereof. The lower jaw (e.g., lower jaw 80) can have one or more male stoppers 412, one or more female stoppers 416, or any combination thereof. The male stoppers 412 and / or female stoppers 416 can be attached to or integral with the jaws, the jaw track, or both. The shuttle 14 can have one or more male stoppers 412, one or more female stoppers 416, or any combination thereof. The male stopper 412 can extend away from and / or toward the longitudinal axis of the shuttle 14. The male stopper 412 can extend away from and / or toward the longitudinal axis of the jaw tracks (e.g., tracks 66 and 64). The female stopper 416 can extend away from and / or toward the longitudinal axis of the shuttle 14. The female stopper 416 can extend away from and / or toward the longitudinal axis of the jaw tracks (e.g., tracks 66 and 64).

[0192] 33A illustrates that the shuttle 14 can have a first male stopper 412a and a second male stopper 412b, and that the lower jaw track and the upper jaw track (e.g., tracks 66 and 64) can each define a female stopper 416 (e.g., a first female stopper 416a in the lower jaw and a second female stopper 416b in the upper jaw). The lower jaw and the upper jaw can each define one or more female stoppers 416. For example, the first male stopper 412a can be removably attached to the first female stopper 416a, and the second male stopper 412b can be removably attached to the second female stopper 416b. 33A illustrates that the first male stopper 412a and the second male stopper 412b can extend away from the shuttle's longitudinal axis (e.g., the central longitudinal axis) and toward the longitudinal center of the shuttle 14. The first male stopper 412a and the second male stopper 412b can have the same or different dimension away from the longitudinal center of the shuttle 14 as the other detents.

[0193] 33A-34B further illustrate surfaces 422 of the jaw suture slots 238, for example, mandibular suture slot 238a and maxillary suture slot 238b.

[0194] 33B and 34B illustrate that the shuttle tip 164 can have a shuttle tip thickness 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 thickness 408 can be the width of the non-beveled surface 406. As another example, the shuttle tip thickness 408 can be about 0.0080 inches to about 0.0090 inches (e.g., 0.0085 inches).

[0195] 33B and 34B show that the shuttle 14 has a shuttle thickness 410 of about 0.05 mm to about 0.75 mm (also shown as a shuttle thickness 14 T) and includes 0.05 mm increments within this range (e.g., 0.15 mm, 0.20 mm, 0.25 mm). Shuttle tip thickness 408 can be the same as or different from shuttle thickness 410. Shuttle tip thickness 408 can be less than, equal to, or greater than shuttle thickness 410. For example, shuttle tip thickness 408 can be approximately 0.15 mm and shuttle thickness 410 can be approximately 0.25 mm, or vice versa.

[0196] 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 14 and the male stopper 412. The shuttle 14 can then be curved, which can result in the male stopper 412 extending from the plane of the shuttle spine 160.

[0197] 33A-34B further illustrate that a portion 423 of the shuttle tip 164 can remain exposed outside the jaws when the shuttle 14 is fully translated into the jaws. The exposed portion 423 can have an exposed length 424 of, for example, 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 be aligned with the lower and upper jaws when the jaws are closed. The exposed portion 423 can pierce tissue when the lower and upper jaws are closed relative to each other and before the shuttle 14 is translated to the other jaw. This can advantageously utilize the clamping force of the jaws to cut tissue with the shuttle 14. A portion of the exposed portion 423 can pierce tissue when the shuttle 14 is translated from the lower jaw to the upper jaw or vice versa.

[0198] 35 illustrates that all or a portion of exposed portion 423 may be within the other jaw when the lower and upper jaws are closed and before shuttle 14 translates to the other jaw via lower pusher 76 or upper pusher 86. For example, as shown in FIGS. 33A and 33B , when the jaws move from an open configuration to a closed configuration in which exposed portion 423 extends from the upper jaw (e.g., jaw 30, jaw 78), exposed portion 423 can move into the lower jaw (e.g., jaw 38, jaw 80) via the closing of the jaws, with or without shuttle 14 translating (e.g., simultaneously translating) into the lower jaw via the upper and / or lower pushers while the jaws are closed.

[0199] FIG. 35 further illustrates that the female 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 a sloped surface against which the male stopper 412 flexes. The outer surface 419 can define a plane that is angled 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 a sloped surface against which the male stopper 412 flexes.

[0200] 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. When the jaw structure 28 is in the closed configuration, the tracks of the upper and bottom jaws can form a continuous path.

[0201] FIG. 35 further illustrates that a first jaw tip (e.g., jaw tip 46, jaw tip 206) can be configured to interdigitate with a second jaw tip (e.g., jaw tip 48, jaw tip 198). For example, when the jaw structure 28 is in the closed configuration, the first jaw tip can interdigitate, abut, or contact the second jaw tip. The jaw tips can be sharp. The jaw tips can be tapered. When the jaw structure 28 is in the closed configuration, the jaw tips can be sharp and can seat together to form a continuous track. The jaw tips can seat together to connect the mandibular track 66 and the maxillary track 64 to each other.

[0202] FIG. 36A illustrates that the shuttle 14 can have a shuttle first tip 164a and a shuttle second tip 164b.

[0203] FIG. 36A further illustrates that the shuttle 14 can include zero, one, or multiple shuttle holes 405, e.g., from one to six or more shuttle holes 405, with increments of one 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 stopper 412 and / or female stopper 416 can move in and out of the shuttle holes 405, suture holes 404, or any combination thereof, for example, via flexing, bending, translating, and / or rotating in and out of the holes 405 and / or 404.

[0204] 36A further illustrates that the male stopper 412 can have one or more bends 426. For example, FIG. 36A illustrates that the male stopper 412 can have a first bend 426a and a second bend 426b. The male stopper 412 has an inflection point 426 where the curvature of the male stopper 412 changes direction or its concavity. IF For example, FIG. 36A shows a male stopper 412 having an inflection point 426 between two bends 426 (e.g., between a first bend 426a and a second bend 426b). IF 36A, where the male stopper 412 changes concavity (e.g., from concave up for the first bend 426a to concave down for the second bend 426b, as shown in FIG. 36A).

[0205] 36A further illustrates that one or more magnets 428 can be attached to or integrated with the male stopper 412 on a first side of the detent, for example, above or below the first surface 414 (also referred to as the male face). The magnet 428 can be configured to be magnetically attracted to a magnet attached to or integrated with the upper or lower jaw that has an opposite dipole to the magnet 428.

[0206] FIG. 36B illustrates that one or more magnets 428 can be attached to or integral with the second surface 415 of the male stopper 412, for example, on the underside of the male stopper 412.

[0207] FIG. 36B further illustrates that a gap G may exist on each side of the male stopper 412 between the male stopper 412 and the shuttle body 160. The gap G may advantageously inhibit or prevent pressure from building in the jaws by allowing gas, liquid, or solid to flow or pass through the gap G as the shuttle 14 advances into the jaws. As shown in FIG. 36B, a gap may exist on each lateral side of the male stopper 412. As another example, there may not be any gap G between the male stopper 412 and the shuttle body 160, or the gap G may be on only one side of the male stopper 412, rather than on both sides as shown in FIG. 36B. The gap G may have a gap width G that may be constant or tapered (e.g., as shown in FIG. 36B). W As another example, the gap G may have a plurality of gap widths G W For example, Figure 36B further illustrates that the gap G can have a constant width, for example, as measured between a lateral edge or surface of the male stopper 412 and a lateral edge or surface of the shuttle body 160.

[0208] 36B further illustrates that terminal tip 165 can have a sharpened edge, which can be configured to pierce tissue.

[0209] FIG. 36C illustrates that the male stoppers 412 (e.g., first male stopper 412a and second male stopper 412b) can extend out of the plane of the shuttle spine 160 and away from the longitudinal axis of the shuttle 14.

[0210] The shuttle's longitudinal axis (e.g., longitudinal axis 157) can be flat or curved. Figure 36C illustrates that the shuttle radius of curvature 154 can 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).

[0211] Shuttle 14 can be straight or can have a preformed bend or curve (e.g., having a radius of curvature 154). Shuttle 14 can have a preformed bend with a radius of curvature of about 40% to about 200% of radius of curvature 154, including 1% increments within this range (e.g., 50%).

[0212] 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 14 can transition between a curved and a straight configuration. Having a preformed bend within this range can reduce distortion of the shuttle 14. For example, distortion can be reduced for deformed configurations where the shuttle 14 shifts between a straight and a curved configuration when moving in and / or between the jaws.

[0213] Figures 37A-37E illustrate that the shuttle 14 can have a male stopper 412 positioned as shown. Figures 37A-37D illustrate that the male stopper 412 can be an arm that extends away from the body of the shuttle 14. Figure 37E illustrates that the male stopper 412 can be a bump on the surface of the shuttle 14.

[0214] 38A and 38B illustrate that the shuttle 14 can have one or more female stops 416, e.g., first, second, third, and fourth female stops 416a, 416b, 416c, and 416d. The female stops 416 can be slots that extend partially (e.g., recesses) or completely (e.g., through-holes) through the shuttle spine 160. The male stop 412 can be attached to or integral with the jaw and can be configured to removably attach to the female detents shown in FIGS. 38A and 38B.

[0215] 38B further illustrates that shuttle 14 can have one or more male stoppers 412 and female stoppers 416. For example, shuttle 14 can have first, second, third, and fourth female stoppers 416a, 416b, 416c, and 416d, and can have first, second, third, and fourth male stoppers 412a, 412b, 412c, and 412d. Male stoppers 412 (e.g., 412a, 412b, 412c, and 412d) can be configured to be removably attached to female stoppers 416 integrated with or attached to jaw structure 28, for example, within or defining shuttle tracks (e.g., 64 and 66). The female stops 416 (e.g., 416a, 416b, 416c, and 416d) can be configured to be removably attached to male stops 412 integral with or attached to jaw structure 28, for example, within or defining shuttle tracks (e.g., 64 and 66). FIG. 38B further illustrates that shuttle 14 can define one or more female stops 416 along the circumference of shuttle 14. For example, fifth female stop 416e can be defined between first male stop 412a and third male stop 412c. As another example, sixth female stop 416f can be defined between second male stop 412b and fourth male stop 412d. The shuttle 14 can have any combination of male and / or female stoppers (e.g., 412a, 412b, 412c, 412d, 416a, 416b, 416c, 416d, 416e and / or 416f).

[0216] 38B and 38C illustrate that the shuttle 14 can have male and / or female stoppers (e.g., male stopper 412 and / or female stopper 416) that extend away from the longitudinal axis of the shuttle 14 along a first horizontal axis that is parallel to the plane of the shuttle spine 160. FIG. 38C illustrates that the male and / or female stoppers (e.g., male stopper 412 and / or female stopper 416) can remain in the plane of the shuttle spine 160 along a second horizontal axis that is perpendicular to the first horizontal axis.

[0217] FIG. 39A illustrates that the lower jaw pusher 76 and the upper jaw pusher 86 can have a linear configuration.

[0218] FIG. 39B illustrates that the mandibular pusher 76 and the maxillary pusher 86 are bendable and can assume a curved configuration when in one or both of the jaw tracks (66 and 64), for example. The mandibular pusher 76 and the maxillary pusher 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, while the distal portion can change between the straight and curved configurations. 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 the maximum pusher radius of curvature.

[0219] FIG. 39C illustrates that the mandibular pusher 76 and the maxillary pusher 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 when it transitions from a straight to a curved configuration, or when it transitions from a less curved to a more curved configuration, or 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%.

[0220] Figure 39D illustrates that the preformed mandibular and maxillary pushers 76, 86 are bendable and can assume more or less curved configurations, for example, when in one or both of the jaw tracks (66 and 64). They can change between the straight configuration shown in Figure 39A and the curved configuration shown in Figure 39D. The mandibular pusher 76 and maxillary pusher 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.

[0221] 40A-40D are perspective views of the pushers shown in FIGS. 39A-39D, respectively. FIGS. 40B-40D illustrate that pushers 76 and 86 can have shuttle bearing surfaces 274 as shown. The shuttle bearing surfaces 274 can be male or female and can be the inverse of the shape of the shuttle tip 164. For example, FIGS. 40B-40D illustrate that the shuttle bearing surfaces 274 can have a notch shape configured to receive the shuttle tip 164. The shuttle bearing surfaces 274 can have a beveled or non-beveled surface 438 configured to press against the distal end surface of the shuttle tip 164, for example, against the non-beveled surface 406, against the beveled surface, or both.

[0222] Preformed pushers 76 and 86 can be formed with or without slots. For example, the slots can be longitudinally coincident or longitudinally alternating transverse slots cut into the sides of the pusher, similar to the shape of shuttle transverse slots 158.

[0223] 41A-41E illustrate that the non-preformed pusher 76 and the preformed pusher 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 lateral slots 158 of the shuttle, 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 lateral components relative to the longitudinal axis 444 of the pusher. The fenestrations 442 can have a constant cross-sectional area, a tapered cross-sectional area, or both. The fenestrations 442 can have regular or irregular shapes, e.g., curved shapes, polygonal shapes, or both. The fenestrations 442 can be defined by one or more curved surfaces or edges, such as one or more curved surfaces or edges of a pusher. The fenestrations 442 can have a cross-sectional shape that is circular, oval, rectangular, stadium-shaped, horseshoe-shaped, star-shaped, slotted, or any combination thereof. The pushers 76 and 86 can have any combination of the features shown in Figures 41A-41E.

[0224] FIG. 41A illustrates that the slot 440 can be a transverse slot.

[0225] FIG. 41B illustrates that the slot 440 can be a longitudinal slot.

[0226] Figure 41C illustrates that the slots 440 can be transverse slots, longitudinal slots, and / or can extend 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).

[0227] Figure 41D illustrates that the fenestrations 442 can be in the longitudinal center of the pusher, at the edge of the pusher, between the center and the edge of the pusher, or any combination thereof. Figure 41D further illustrates that the shuttle bearing surface 274 can have a curved surface or edge.

[0228] 41A, 41B, 41E and 41F illustrate that the distal tips of the pushers 76 and 86 can have slots 440 and / or fenestrations 442. FIG.

[0229] FIG. 41F illustrates various orientations of slots 440 and fenestrations 442 through the distal tips of pushers 76 and 86.

[0230] 42A-42D illustrate that pushers 76 and 86 can include multiple links 445 connected together, for example, 2 to 50 or more links 445, with increments of one link within this range (e.g., 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 illustrates that distal end link 445a can have a male connector 446 or a female connector 448 (e.g., female connector 448), an intermediate link 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 a male connector 446 or a female connector 448 (e.g., male connector 446). Link 445 allows pushers 76 and 86 to bend. For example, link 445 allows pushers 76 and 86 to assume the curves shown in FIGS. 39B-39C. As another example, link 445 can be the same as or different from articulated segmentation 286.

[0231] FIG. 42B illustrates that the link 445 can have a link thickness 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 thickness 450 can be the same as or different from the shuttle tip thickness 408 and / or the shuttle thickness 410. The link thickness 450 can be less than, equal to, or greater than the shuttle tip thickness 408 and / or less than, equal to, or greater than the shuttle thickness 410. For example, the link thickness 450 can be about 0.30 mm, and the shuttle tip thickness 408 and / or the shuttle thickness 410 can be about 0.15 mm, or vice versa.

[0232] 42C illustrates that the distal end link 445a can have the shuttle bearing surface 274 of the shown shape. The shuttle bearing surface can have a first bearing surface 274a and a second bearing surface 274b. The second bearing surface can further prevent undesired movement between the shuttle 14 and the pushers 76 and 86. The second bearing surface 274b can provide space around the distal end of the shuttle tip 154 to help prevent or inhibit the pusher and shuttle from sticking together due to, for example, suction created by compression between the two components and the moist tissue environment.

[0233] 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 within this range (e.g., 0.02 mm). As another example, the links 445 can be cut separately and then permanently or removably attached together using, for example, a snap fit, a friction fit, a magnetic fit, or any combination thereof.

[0234] The shuttle 14, first pusher 76 (also referred to as the mandibular pusher), and second pusher 86 (also referred to as the maxillary pusher) can be made from a flexible polymer such as PEEK, Nitinol, any material disclosed herein, or a combination thereof. The shuttle and pushers 14, 76, 86 can be coated with a strain-reducing coating.

[0235] 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, when the jaw structure 28 is in the closed configuration, the first jaw tip can interdigitate, abut, or contact the second jaw tip. The jaw tips can be sharp. The jaw tips can be tapered. When the jaw structure 28 is in the closed configuration, the jaw tips can be sharp and can seat together to form a continuous track. The jaw tips can seat together to connect the mandibular track 66 and the maxillary track 64 to each other.

[0236] The interdigitable jaws can, for example, align the shuttle tracks 66 and 64 to form a single, continuous track. As another example, the interdigitable jaws can align the shuttle tracks 66 and 64 so that there is a space between them. The interdigitable jaws can inhibit or prevent the first and second jaws from moving relative to each other when the jaw structure 28 is in a closed configuration, as shown, for example, in FIG. 43A . The movement that can be inhibited or prevented can include any lateral movement away from the longitudinal axis (e.g., the central longitudinal axis) of the opposing jaws. The interdigitable jaws can pre-penetrate tissue. In this manner, the jaws can function as track aligners and tissue cutters.

[0237] A first jaw tip (e.g., jaw tip 46, jaw tip 206) can have a first jaw motion control device 453 having a first jaw seating surface 454 configured to abut against a second jaw when jaw structure 28 is in the closed configuration, tissue cutting surface 456, and tissue release pocket 458. For example, the first jaw can have first and second cutting surfaces 456a and 456b. A second jaw tip (e.g., jaw tip 48, jaw tip 198) can have a first jaw motion control device 459 having a second jaw seating surface 460 configured to abut against the second jaw when jaw structure 28 is in the closed configuration, tissue cutting surface 462, and tissue release pocket 464 (not shown). For example, the second jaw can have first and second cutting surfaces 462a and 462b.

[0238] When the jaws are moved from the open configuration to the closed configuration, the first cutting surface 456a of the first jaw and the first cutting surface 462a of the second jaw can slide past each other to cut tissue. When the jaws are closed, the second cutting surface 456b of the first jaw and the second cutting surface 462b of the second jaw can slide past each other to cut tissue. When the jaws are in the closed configuration, the jaw teeth 463 of the second jaw defining the first cutting surface 462a of the second jaw can abut the first jaw seating surface 454. When the jaws are in the closed configuration, the jaw teeth 457 of the first jaw defining the second cutting surface 456b of the first jaw can abut the first jaw seating surface 454. As tissue is cut by the cutting surfaces, the tissue release pockets 458 and 464 can provide space for the cut tissue to move into. The pockets 458 and 464 can reduce the holes that the jaws create in the tissue (e.g., tissue 74). The tissue release pockets 458 and 464 allow the jaws to compress less tissue when the jaws are moved from the open configuration to the closed configuration.

[0239] Figure 43B illustrates jaw teeth 463 of the second jaw seated against first jaw motion control 453. Figure 43B further illustrates that first cutting surface 456a of the first jaw and first cutting surface 462a of the second jaw can contact one another when the jaws are in the closed configuration.

[0240] 43C illustrates the tissue release pocket 464 visible through the outer half 470a of the first jaw, which is shown as transparent. The other outer half 470b of the first jaw is not transparent and defines the tissue release pocket 464.

[0241] 43D illustrates variations of tissue release pockets 458 and 464. FIG. 43D further illustrates an opening 472 to the second jaw track 66.

[0242] 43E and 43F illustrate the first and second jaws moving from a partially closed configuration to a fully closed configuration.

[0243] 43G-43I illustrate the sequential movement of first and second jaws with a shuttle within the mandible from a partially closed configuration to a fully closed configuration such that the jaw teeth and shuttle exposed portion 423 perforate tissue as the jaws are moved from the configuration shown in FIG. 43G to the configuration illustrated in FIG. 43I. Shuttle 14 can be any of the shuttles described and / or illustrated herein.

[0244] FIG. 43J illustrates a variation of jaw structure 28 in which the shuttle rests on the tip of the mandible.

[0245] FIG. 43K illustrates the shuttle 14 in motion between the first and second jaws as the shuttle translates from the lower jaw to the upper jaw or vice versa in a continuous track (e.g., defined by tracks 66 and 64).

[0246] 43L illustrates the shuttle 14 seated on the mandibular portion with the shuttle tip 164 in contact with the shuttle seating surface 274 of the maxillary pusher 86. This can be the maximum extent to which the maxillary pusher 86 can expand to remain within the maxillary track at full extension, or it can continue to push the shuttle 14 so that the maxillary pusher 86 extends out of the maxillary track at full extension. At full extension, the maxillary pusher 86 can expand into the mandibular track. For example, the shuttle seating surface 274 on the maxillary portion can extend out of the maxillary track and into the mandibular track (e.g., track 66).

[0247] 43M illustrates the shuttle 14 seated on the upper jaw portion with the shuttle tip 164 in contact with the shuttle seating surface 274 of the mandibular pusher 76. This can be the maximum extent to which the mandibular pusher 76 can extend so that it remains within the mandibular track at full extension, or it can continue to push the shuttle 14 so that the mandibular pusher 76 extends out of the mandibular track at full extension. At full extension, the mandibular pusher 76 can extend into the mandibular track. For example, the shuttle seating surface 274 on the mandibular portion can extend out of the mandibular track and into the maxillary track (e.g., track 64).

[0248] Figures 43L and 43M further illustrate that 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 with each other and the pushers 76 and 86 when the shuttle 14 is in contact.

[0249] 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 is in contact with the pushers 76 and 86, the shuttle and the pushers 14, 76, 86 are at an angle to each other.

[0250] 44A and 44B illustrate a variation of device 188 in a fully closed and fully open configuration, respectively.

[0251] 44A and 44B illustrate that the jaw control device extension 40 can be fixed and that the jaws 78 and 80 can be moved relative to the jaw control device extension 40. For example, the jaws 78 and 80 can be moved distally and proximally relative to the jaw control device extension 40 to open and close, respectively. The jaws 78 and 80 can move longitudinally along a longitudinal axis 476 of the device. 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 illustrate 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 close the jaws. Movement of the jaws 78 and 80 in a first direction relative to the jaw control device extension 40 (e.g., distal movement) causes the jaws to open, moving from the closed configuration shown in FIG. 44A to the open configuration shown in FIG. 44B. Movement of the jaws 78 and 80 in a second direction relative to the compressive cover 34 (e.g., proximal movement) causes the jaws to close, moving from the open configuration shown in FIG. 44B to the closed configuration shown in FIG. 44A. The first and second directions can be reversed. As another example, the jaws can be fixed and the jaw control device extension can move relative to the jaws. The compressive cover 34 can be longitudinally fixed or longitudinally movable.

[0252] The extension head 254 can have the shape shown so that the jaws open toward each other when they move out of the compression cover 34 over the extension head 254 .

[0253] 44A illustrates the device 188 without the shuttle 14 for illustrative purposes, and FIG. 44B illustrates the device 188 of FIG. 44A with the shuttle 14.

[0254] 45A and 45B illustrate a variation of device 188 in a fully open and fully closed configuration, respectively.

[0255] 45A and 45B illustrate that the handle 104 can have a jaw control device 8 (also referred to as a trigger), a jaw control device release 478, and a shuttle control device 479. The jaw control device 8 can be pulled with one or more fingers in direction 484 to move the jaw control device 8 to the configuration shown in FIG. 45B. The jaw control device 8 can translate and / or rotate. When the jaw control device 8 moves in direction 484, the jaws 78 and 80 can move from an open configuration to a less open configuration (e.g., to the closed configuration shown in FIG. 45B). When the jaw control device 8 moves in a direction opposite 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 illustrated in FIG. 45A).

[0256] 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.

[0257] The jaw control device release 478 can be a push button, a switch, a knob, or any combination thereof. The jaw control device 8 can be locked when the jaws 78 and 80 are in a fully closed configuration. Activating the jaw control device release 478 can release the jaw control device 8 from the locked position. The jaw control device release 478 can be activated, for example, by pressing it. Pressing the jaw control device release 478 can manually return the jaw control device 8 to the position shown in FIG. 45A to fully open the jaws, or the jaw control device 8 can automatically return to the position shown in FIG. 45A.

[0258] The shuttle control 479 can be a button, a switch, a knob, or any combination thereof. For example, FIGS. 45A and 45B illustrate that the shuttle control 479 can be a pivotable switch. The shuttle control 479 can be locked when the jaws 78 and 80 are in the open configuration of FIG. 45A . When the jaws are closed, the shuttle control can rotate in directions 486 and 488. The directions 486 and 488 can be oriented opposite each other. When the shuttle control 479 moves (e.g., rotates) in direction 486, the upper pusher 86 can move the shuttle 14 toward the lower jaw 80. When the shuttle control 479 moves (e.g., rotates) in direction 488, the lower pusher 76 can move the shuttle 14 toward the upper jaw 78. The shuttle control 479 can have a bat-wing shape, which can provide ergonomic benefits.

[0259] 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.

[0260] 45A and 45B further illustrate that the device 188 can have a flush port 482 with a luer connection. A cleaning fluid (e.g., an enzymatic cleaner) can be flowed through the device through the flush port 482 to clean it.

[0261] 45C illustrates that the shuttle control device 479 can have a neutral position. When the shuttle control device 479 is in the neutral position, one or neither of the pushers 76 and 86 can contact the shuttle 14. When the shuttle control device 479 is in the neutral position, the shuttle 14 can be ejected from the jaws.

[0262] 45D illustrates the shuttle control device 479 in a fully forward position as moved in direction 486. When the shuttle control device 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 advanced 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 detents on the shuttle 14 (male stopper 412 and / or female stopper 416) releasably engage with detents on the lower jaw 80 (male stopper 412 and / or female stopper 416).

[0263] 45E illustrates the shuttle control device 479 in a fully forward position as moved in direction 488. When the shuttle control device 479 is in a fully forward position in 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 advanced 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 stopper 412 and / or female stopper 416) on the shuttle 14 releasably engage with the detents (male stopper 412 and / or female stopper 416) on the upper jaw 78.

[0264] FIG. 45F illustrates 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 illustrates 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. When the shuttle control 479 is moved in direction 486, the upper pusher slider 492 can move toward the jaws, thereby forcing the upper pusher distal end toward and / or into the lower jaw 80. When the shuttle control 479 is moved in direction 488, the lower pusher slider 490 can move toward the jaws, thereby forcing the lower pusher distal end toward and / or into the upper jaw 78.

[0265] Figures 45G and 45H illustrate the position of linkage 491 when shuttle control 479 is in the position shown in Figures 45D and 45E, respectively.

[0266] 45I and 45J illustrate variations of the shuttle control locking pin 494. The locking pin 494 can lock the shuttle control device 494 in place with the upper or lower jaw shuttle 14 when the jaws (e.g., jaws 78 and 80) are in an open configuration, for example, as shown in FIG. 45A . The jaw control device 8 can have a lock pin controller 496 configured to rotate and / or translate to engage the locking pin 494 and push the locking pin 494 into a locking pin channel 497 to unlock the shuttle control device 479 when the jaw control device 8 is retracted and the jaws are in a fully closed configuration. The locking pin 494 can be biased into the locked position using a biasing element 495, such as a spring.

[0267] 45K and 45L illustrate that device 188 can have an overstroke compensation cam path 502 and an overstroke compensation cam 504. When jaw control release 478 is actuated, jaw control 8 can move in direction 506, thereby retracting the pusher slider from its fully advanced position by about 0.2 mm to about 1.0 mm to compensate for and correct overstroke caused by tension and compression forces in various structures between handle 104 and the distal end of device 188.

[0268] FIG. 45M illustrates the jaw control 8 when the jaws are in a fully open configuration.

[0269] 46A-46K illustrate exploded versions of some of the components of device 188. FIG.

[0270] FIG. 46A illustrates a variation of the tube 510 of the device 188.

[0271] FIG. 46B illustrates a variation of the upper pusher 86.

[0272] FIG. 46C illustrates a variation of the lower pusher 76.

[0273] 46D illustrates a variation of tube 512 of device 188. Tube 512 can fit over tube 510.

[0274] FIG. 46E illustrates a variation of the compression cover 34.

[0275] 46F and 46G illustrate variations of the first and second sides of the mandible 80. FIG.

[0276] 46H and 46I illustrate variations on the first and second sides of upper jaw 78. FIG.

[0277] FIG. 46J illustrates the connector 514.

[0278] FIG. 46K illustrates pins 516 of connector 514.

[0279] 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.

[0280] 47A-47D illustrate that device 188 can have one or more shuttle stops 520. Device 188 can have, for example, 1 to 10 or more shuttle stops 520, including increments of 1 within this range (e.g., 1, 2, 3, 4, or more shuttle stops 520). The upper jaw (e.g., jaw 30, jaw 78) and / or lower jaw (e.g., jaws 38, 80) can each have one or more shuttle stops 520. The upper jaw can have, for example, 1 to 5 or more shuttle stops 520 (e.g., 1, 2, 3, 4, 5, or more shuttle stops 520). The lower jaw can have, for example, 1 to 5 or more shuttle stops 520 (e.g., 1, 2, 3, 4, 5, or more shuttle stops 520). The upper and lower jaws can have the same or different number of shuttle stops. For example, the lower and upper jaws can each have one, two, three, or more shuttle stops. Figures 47A and 47B illustrate that a lower jaw (e.g., jaws 38, 80) can have a lower jaw shuttle stopper 520a configured to releasably engage with the shuttle 14, and Figures 47C and 47D illustrate that an upper jaw (e.g., jaw 30, jaw 78) can have an upper jaw shuttle stopper 520b configured to releasably engage with the shuttle 14. Half of the lower and upper jaws in Figures 47A-47D (e.g., the lateral halves of the lower and upper jaws on one side of the device's longitudinal axis) are shown in transparent form so that the shuttle 14 can be more easily seen in the jaw tracks (e.g., lower track 66 and upper track 64) and so that the shuttle stoppers 520 (e.g., shuttle stoppers 520a and 520b) can be more easily seen.

[0281] The shuttle stoppers 520 (e.g., the lower jaw shuttle stopper 520a and the upper jaw shuttle stopper 520b) can be protrusions, arms, ridges, extensions, bends, detents, detent bends, female detents, or any combination thereof. The shuttle stoppers 520 can be straight and / or curved. The shuttle stoppers can be open (e.g., bars, arcs, plates) or closed (e.g., ring-shaped). The shuttle stoppers 520 can be flexible, rigid, or both (e.g., a first portion can be flexible and a second portion can be rigid). The shuttle stoppers 520 can be one or more springs. The shuttle stoppers 520 can be made from a nickel-titanium alloy (e.g., Nitinol), stainless steel, a composite material, or any combination thereof. The shuttle stoppers 520 can have a shuttle stopper first longitudinal end 521a and a shuttle stopper second longitudinal end 521b. The first longitudinal end 521a of the shuttle stopper is a terminal end 521a of the first longitudinal end of the shuttle stopper. TE The second longitudinal end 521b of the shuttle stopper may have a terminal end 521b of the second longitudinal end of the shuttle stopper. TE It can have:

[0282] 47A-47D further illustrate that each shuttle stopper 520 (e.g., shuttle stoppers 520a, 520b) can be located within a shuttle stopper groove 522. Each shuttle stopper groove 522 can be located within a jaw (e.g., first jaw, second jaw, lower jaw, upper jaw). For example, each lower jaw shuttle stopper 520a can be located within a lower jaw shuttle stopper groove 522a, and each upper jaw shuttle stopper 520b can be located within an upper jaw shuttle stopper groove 522b. The lower jaw shuttle stopper 520a can be received within the lower jaw shuttle stopper groove 522a, and the upper jaw shuttle stopper 520b can be received within the upper jaw shuttle stopper groove 522b. The shuttle stop groove 522 can have a shuttle stop groove opening 523 that leads into the shuttle tracks (e.g., the lower jaw shuttle track 66 and the upper jaw shuttle track 64) such that the shuttle stop groove 522 intersects with the shuttle tracks. The shuttle stoppers 520 (e.g., shuttle stoppers 520a, 520b) can extend from the shuttle stop groove 522 into the shuttle tracks. For example, the shuttle stop groove openings can be at the longitudinal ends of the shuttle stop groove such that the longitudinal ends (e.g., 521a, 521b) of the shuttle stoppers 520 can extend from the shuttle stop groove into the shuttle tracks. In such a case, the longitudinal ends (e.g., 521a, 521b) of the shuttle stoppers can extend from the shuttle stop groove into the shuttle tracks. TE , 521b TE ) can be in the shuttle track. As another example, the shuttle stopper groove opening can be between the first longitudinal end of the shuttle stopper and the second longitudinal end of the shuttle stopper such that the longitudinally inner portion of the shuttle stopper 520 between the first longitudinal end and the second longitudinal end of the shuttle stopper extends (e.g., arcs) into the shuttle track. For example, FIGS. 47A-47D show the first longitudinal end of the shuttle stopper, end portion 521a TE5 illustrates that first longitudinal end 521 a of the shuttle stopper can extend into a shuttle track (e.g., shuttle tracks 66, 64), such that first longitudinal end 521 a of the shuttle stopper can be located within the shuttle track. First longitudinal end 521 a of the shuttle stopper can be farther from longitudinal axis 476 of the device than second longitudinal end 521 b of the shuttle stopper. First longitudinal end 521 a of the shuttle stopper can be configured to contact shuttle 14 when the shuttle is on shuttle stopper 520, for example, when shuttle 14 passes shuttle stopper 520 and when the shuttle is at rest on shuttle stopper 520.

[0283] The shuttle stop grooves 522 (e.g., grooves 522a, 522b) can open into the curved portion of the shuttle track. The shuttle stop grooves 522 (e.g., grooves 522a, 522b) can open into the straight portion of the shuttle track. For example, FIGS. 47A and 47B illustrate that the lower jaw shuttle groove 522a can intersect the lower jaw shuttle track at a curved portion of the lower jaw shuttle track. FIGS. 47C and 47D illustrate that the upper jaw shuttle groove 522b can intersect the upper jaw shuttle track at a curved portion of the upper jaw shuttle track. As another example, a first shuttle stop groove can open into the straight portion of the first jaw shuttle track, and a second shuttle stop groove can open into the curved portion of the first jaw shuttle track. As yet another example, the first shuttle stop groove can open into a straight portion of the second jaw shuttle track, and the second shuttle stop groove can open into a curved portion of the second jaw shuttle track.

[0284] The shuttle stops 520 (e.g., stops 520a, 520b) can be at an angle 528 relative to the longitudinal axis 476 of the device. The shuttle stop grooves 522 (e.g., grooves 522a, 522b) can be at an angle 528 relative to the longitudinal axis 476 of the device. An axis 529 through the shuttle stops 520 and / or shuttle stop grooves 522 can intersect the longitudinal axis of the device at the angle 528. The axis 529 can be a longitudinal axis (e.g., a central longitudinal axis) that passes through the shuttle stops 520, the shuttle stop grooves 522, or both. Angle 528 can be from about 10 degrees to about 170 degrees, or more narrowly from about 10 degrees to about 80 degrees, or even more narrowly from about 30 degrees to about 60 degrees, including single degree increments within these ranges (e.g., 10 degrees, 30 degrees, 40 degrees, 45 degrees, 50 degrees, 60 degrees, 80 degrees).

[0285] The angle 528 of the shuttle stop 520 can allow all or part of the shuttle 14 to pass through the shuttle stop 520 as the shuttle 14 is moved into the jaws (e.g., along the shuttle track), including moving from distal to proximal along the longitudinal axis 476 of the device. When the shuttle 14 is driven (e.g., pushed, pulled, or both) into the jaws, the shuttle stop 520 can flex, capture the shuttle 14, and hold it in place. The shuttle stop 520 can 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. Figures 47A and 47B illustrate the inward and outward directions 524 and 526 of the lower jaws. Figures 47C and 47D illustrate the inward and outward directions 524 and 526 of the upper jaws. The inward direction 524 and the outward direction 526 can be opposite to one another, for example, along the longitudinal axis of the shuttle track. The shuttle 14 can be passively held by the shuttle stopper 520, for example, by virtue of the placement of the shuttle stopper 520 relative to the jaws and the shuttle 14. For example, the shuttle stopper 520 can passively engage the shuttle 14 as it advances into the jaws and actively disengage the shuttle 14 to allow the shuttle 14 to advance out of the jaws.

[0286] 47b and 47D further illustrate that the shuttle 14 can have one or more suture holes 404, e.g., first suture hole 404a and second suture hole 404b. FIGS. 47B and 47D further illustrate that the shuttle stopper 520 does not contact or engage the suture holes 404 (e.g., first suture hole 404a and second suture hole 404b) or the suture when the shuttle 14 is fully advanced into the mandible and upper jaws. As another example, the shuttle stopper 520 can contact one or more of the suture holes 404, the suture, or any combination when the shuttle 14 is fully advanced into the mandible and upper jaws. For example, the shuttle stopper 520 can contact one or more of the suture holes 404 by extending into one or more suture holes 404.

[0287] 47A-47D illustrate that when the shuttle 14 is engaged with 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 be moved into 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 into 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 from one jaw into 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 surface and the shuttle surface may be overcome, regardless of whether the shuttle stopper 520 is deflected. Deflection of the shuttle stopper 520 can include buckling, bending, flexing, compression (e.g., longitudinal compression, lateral compression, shortening), tension (e.g., stretching, lengthening) of the shuttle stopper 520, or any combination thereof. Once the threshold release force is achieved or exceeded, static friction between the shuttle stopper face and the shuttle face can be overcome regardless of whether one or more walls of the shuttle stopper groove 522 are deflected. Deflection of the shuttle stopper groove 522 can include buckling, bending, flexing, stretching of the shuttle stopper groove 522, or any combination thereof, with or without deformation of one or more of the walls defining the shuttle stopper groove 522 due to the shuttle stopper 520 being forced against 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 greater, 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 lb to about 1.5 lb, 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., a threshold release force) can be applied 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 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, causing it 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, causing it to move in the shuttle track toward the first jaw.

[0288] The device 188 can have a shuttle stopper release (also referred to as a shuttle stopper controller). The shuttle stopper release can press on the shuttle stopper 520, allowing the shuttle 14 to release from the shuttle stopper 520. The shuttle stopper release 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, allowing the shuttle 14 to become a shuttle stopper release. The release force can be applied to the shuttle 14 (e.g., from a pusher) to release the shuttle 14 from the shuttle stopper 520, allowing the shuttle 14 to function both as a shuttle 14 (e.g., carrying suture back and forth between the jaws) and as a shuttle stopper release. As another example, the shuttle stopper release can be other than the shuttle 14, whereby the shuttle stopper release can selectively engage and disengage with the shuttle stopper 520. In such cases, the shuttle stopper release may reduce or eliminate the threshold release force that 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 shuttle stopper release may selectively engage and disengage the shuttle stopper 520 when the shuttle 14 is in contact with the shuttle stopper 520. The shuttle stopper release may selectively engage and disengage the shuttle stopper 520 when the shuttle 14 is not in contact with the shuttle stopper 520. The shuttle stopper release may selectively engage and disengage 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 can selectively engage and disengage the shuttle stopper 520 before an inward force is applied to the shuttle 14 (e.g., via the pusher), while an inward force is applied to the shuttle 14 (e.g., via the pusher), after an inward force is applied to the shuttle 14 (e.g., via the 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 can push on the shuttle stopper 520 to release the shuttle 14 from its grip.

[0289] FIG. 47A further illustrates that when the shuttle 14 is moved into a jaw (e.g., a lower jaw 38, 80), the shuttle 14 can contact and slide against the shuttle stopper 520. As the shuttle can move in direction 524, the shuttle stopper 520 can deflect when the shuttle 14 contacts and slides against it, or both. For example, the first longitudinal end 521a of the shuttle stopper can deflect in a first direction of deflection. The first direction of deflection can include a translational component, a rotational component, or both. For example, FIG. 47A illustrates that the first direction of deflection can include rotation 530a, translation 531a, or both rotation 530a and translation 531a. Rotation 530a can rotate clockwise in the orientation shown in FIG. 47A, and translation 531a can translate to the right in the orientation shown in FIG. 47A. 47A further illustrates that the shuttle stopper 520 can be biased in a first direction when the shuttle is in a fully advanced position within the jaws (e.g., lower jaws 38, 80). The shuttle stopper 520 can have the shuttle stopper first deflected position when the shuttle 14 slides relative to the shuttle stopper 520 in a direction 524. The shuttle stopper can have the shuttle stopper first deflected position when the shuttle 14 is fully advanced within the jaws and in contact with the shuttle stopper 520.

[0290] FIG. 47A further illustrates that the shuttle 14 can contact and slide against the shuttle stopper 520 when the shuttle 14 is moved out of the jaws (e.g., the lower jaws 38, 80). The shuttle 14 can translate past and pass through the shuttle stopper 520 when the shuttle 14 exceeds a threshold release force and / or when a shuttle stopper releaser disengages the shuttle stopper 520 from the shuttle 14. As the shuttle moves in direction 526, the shuttle stopper 520 can deflect when the shuttle 14 contacts and slides against the shuttle stopper 520. For example, the first longitudinal end 521a of the shuttle stopper can deflect in a second direction of deflection. The second direction of deflection can include a translational component, a rotational component, or both. For example, FIG. 47A illustrates that the second direction of deflection can include rotation 530b, translation 531b, or both rotation 530b and translation 531b. Rotation 530b can rotate counterclockwise in the orientation shown in FIG. 47A, and translation 531b can translate to the left in the orientation shown in FIG. 47A. When shuttle 14 slides in direction 526 relative to shuttle stopper 520, shuttle stopper 520 can have a shuttle stopper second deflection position. When the shuttle is fully retracted or advanced beyond shuttle stopper 520, shuttle stopper 520 can be in a shuttle stopper neutral position. The shuttle stopper neutral position can be a position between the shuttle stopper first deflection position and the shuttle stopper second deflection position.

[0291] 47A further illustrates that when the first longitudinal end 521a of the shuttle stopper is deflected, the second longitudinal end 521b of the shuttle stopper can be fixed. When the first longitudinal end 521a of the shuttle stopper is deflected, the second longitudinal end 521b of the shuttle stopper can be deflected.

[0292] FIG. 47C further illustrates that when the shuttle 14 is moved into a jaw (e.g., upper jaw 30, 78), the shuttle 14 can contact and slide against the shuttle stopper 520. As the shuttle can move in direction 524, the shuttle stopper 520 can deflect when the shuttle 14 contacts and slides against it, or both. For example, the first longitudinal end 521a of the shuttle stopper can deflect in a first direction of deflection. The first direction of deflection can include a translational component, a rotational component, or both. For example, FIG. 47C illustrates that the first direction of deflection can include rotation 530a, translation 531a, or both rotation 530a and translation 531a. Rotation 530a can rotate clockwise in the orientation shown in FIG. 47C, and translation 531a can translate to the right in the orientation shown in FIG. 47C. 47C further illustrates that the shuttle stopper 520 can be biased in a first direction when the shuttle is in a fully advanced position within the jaws (e.g., upper jaws 30, 78). The shuttle stopper 520 can have the shuttle stopper first deflected position when the shuttle 14 slides relative to the shuttle stopper 520 in a direction 524. The shuttle stopper can have the shuttle stopper first deflected position when the shuttle 14 is fully advanced within the jaws and in contact with the shuttle stopper 520.

[0293] FIG. 47C further illustrates that when the shuttle 14 is moved from the jaw (e.g., upper jaw 30, 78), the shuttle 14 can contact and slide against the shuttle stopper 520. The shuttle 14 can translate past and pass through the shuttle stopper 520 when the shuttle 14 exceeds a threshold release force and / or when a shuttle stopper releaser disengages the shuttle stopper 520 from the shuttle 14. When the shuttle 14 contacts and slides against the shuttle stopper 520 as the shuttle moves in direction 526, the shuttle stopper 520 can deflect. For example, the first longitudinal end 521a of the shuttle stopper can deflect in a second direction of deflection. The second direction of deflection can include a translational component, a rotational component, or both. For example, FIG. 47C illustrates that the second direction of deflection can include rotation 530b, translation 531b, or both rotation 530b and translation 531b. Rotation 530b can rotate counterclockwise in the orientation shown in FIG. 47A, and translation 531b can translate to the left in the orientation shown in FIG. 47A. When shuttle 14 slides in direction 526 relative to shuttle stopper 520, shuttle stopper 520 can have a shuttle stopper second deflection position. When the shuttle is fully retracted or advanced beyond shuttle stopper 520, shuttle stopper 520 can be in a shuttle stopper neutral position. The shuttle stopper neutral position can be a position between the shuttle stopper first deflection position and the shuttle stopper second deflection position.

[0294] 47C further illustrates that when the first longitudinal end 521a of the shuttle stopper is deflected, the second longitudinal end 521b of the shuttle stopper can be fixed. When the first longitudinal end 521a of the shuttle stopper is deflected, the second longitudinal end 521b of the shuttle stopper can be deflected.

[0295] The shuttle stopper groove 522 can have a constant width or a tapered width. The tapered width can accommodate deflection of the first longitudinal end 521 a of the shuttle stopper. As another example, the shuttle stopper groove can have a constant width portion and a tapered width portion. For example, the portion of the shuttle stopper groove 522 that accommodates the first longitudinal end 521 a of the shuttle stopper can have a tapered width that widens toward the opening 523, and the portion of the shuttle stopper groove 522 that accommodates the second longitudinal end 521 b of the shuttle stopper can have a constant width to prevent or minimize deflection of the second longitudinal end 521 b of the shuttle stopper.

[0296] 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 deflects, the portion of the shuttle stopper 520 that is within the chamber 532 deflects the distal end 521a of the shuttle stopper first longitudinal end relative to the remainder of the shuttle stopper 520. TE The shuttle stop groove 522 can be deflected to correspond to the deflection of the shuttle stopper (e.g., shuttle stopper 520a). 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 within the jaw.

[0297] 47A-47D further illustrate that the lower and upper jaws can have a first suture stop 534a, a second suture stop 534b, or both. The first suture stop 534a can be configured to contact the suture 70. The first suture stop 534a can be configured to contact the suture loop 162. The first suture stop 534a can function as a primary or secondary shuttle stop by capturing the suture 70 or the suture loop 162. When the suture 70 or the suture loop 162 contacts the first suture stop 534a, further movement of the shuttle 14 into the jaws can be inhibited or prevented. The second suture stop 534b can be configured to contact the suture 70. The second suture stop 534b can be configured to contact the suture loop 162. The second suture stop 534b can function as a primary or secondary 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 inhibit or prevent further movement of the shuttle 14 into the jaws. The first suture stop 534a and the second suture stop 534b can inhibit or prevent the suture 70 from passing beyond the suture holder slot and into the shuttle track. The shuttle tracks (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. First height 536a can decrease to second height 536b at second suture stop 534b, which can be a tapered surface (e.g., a smooth slope) or a vertical plane (e.g., a step). Second height 536b can be less than first height 536a, for example, to inhibit or prevent suture 70 from being pulled or pushed past suture holder slot 238 into the shuttle track.

[0298] 47B and 47D further illustrate that the shuttle holes 404 must not 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 distal end 521a of the first longitudinal end of the shuttle stopper. TE 10 further illustrates that the axial length of the shuttle 14 can extend across the width of the shuttle 14.

[0299] Device 188 can have zero, one, or multiple stoppers. For example, the shuttle can have zero, one, or multiple stoppers (e.g., stoppers 412, 413, 416), the upper jaw can have zero, one, or multiple stoppers (e.g., stopper 520), and the lower jaw can have zero, one, or multiple stoppers (e.g., stopper 520), or any combination thereof.

[0300] FIG. 47E illustrates the upper and lower jaws with half of the upper and lower jaws shown in see-through so that the shuttle 14 and shuttle stopper 520 are visible.

[0301] 47A-47E illustrate the pusher in the transparent and / or retracted position.

[0302] FIG. 47F illustrates that the device 188 can have a shuttle stopper controller 537 (also referred to as a shuttle stopper engager and a shuttle stopper releaser). The shuttle stopper controller 537 can have a shuttle stopper engager 538. The shuttle stopper engager 538 can interact with the shuttle stopper 520, for example, to engage and disengage the shuttle stopper 520. The shuttle stopper controller 537 can be within the chamber 532. A portion of the shuttle stopper groove 522 can overlap the chamber 532. For example, the second portion 522b of the shuttle stopper groove 522 can overlap the chamber 532. The shuttle stopper engager 538 can be movable in and out of the shuttle stopper groove 522. The shuttle stopper engager 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 engager 538 may be movable from the first end of the chamber 532 towards the second end of the chamber 532 and vice versa.

[0303] FIG. 47G illustrates that the shuttle stopper engager 538 can extend across the width of the shuttle stopper 520 .

[0304] 47F and 47G further illustrate the shuttle stopper 520 in a neutral position within the chamber 532 and the shuttle stopper engager 538 in a disengaged position within the shuttle stopper groove 522. For example, as shown in FIGS. 47F and 47G, when the shuttle stopper engager 538 is in the disengaged position, the shuttle stopper engager 538 may or may not contact the shuttle stopper 520. For example, FIGS. 47F and 47G illustrate that the shuttle stopper engager 538 does not contact the shuttle stopper 520 when the shuttle stopper engager 538 is in the disengaged position. For example, when the shuttle stopper 520 is in the neutral position, the shuttle stopper 520 can be partially deflected or have zero deflection, as shown in FIGS. 47F and 47G. For example, Figures 47F and 47G illustrate that when the shuttle stopper 520 is in a neutral position, the shuttle stopper 520 can have an unbiased configuration (also referred to as a relaxed configuration).

[0305] When the shuttle stopper engager 538 is in the released position, Figure 47F illustrates that the shuttle stopper engager 538 can move in direction 539a (e.g., toward the shuttle stopper 520) to contact or engage the shuttle stopper 520. When the shuttle stopper engager 538 engages the shuttle stopper 520 (e.g., pushes against the shuttle stopper 520), the shuttle stopper 520 can deflect (e.g., bend) and release the shuttle 14. When the shuttle stopper engager 538 is in the engaged position, Figure 47F illustrates that the shuttle stopper engager 538 can move in direction 539b (e.g., away from the shuttle stopper 520) to disengage the shuttle stopper 520.

[0306] 47F and 47G show that the chamber 532 is a deflection space 532 D It is further illustrated that a portion of the shuttle stopper 520 (e.g., the terminal portion 521a of the first end of the shuttle stopper) can be TE and the terminal portion 521b of the second end TEThe shuttle stopper 520 (the intermediate portion between the shuttle stopper 520) is engaged with the deflection space 532, for example, via the shuttle stopper engager 538, via the shuttle 14, or both. D The deflector may be inwardly deflectable.

[0307] 47F and 47G further illustrate that the shuttle 14 can be in other jaws. As another example, FIGS. 47F and 47G further illustrate that the shuttle 14 is within the jaw shown, but is transparent.

[0308] 47F and 47G further illustrate that half of the jaws (eg, the lateral half on one side of the longitudinal axis 476 of the device) are shown in transmission.

[0309] 47F and 47G illustrate the pusher in the transparent and / or retracted position.

[0310] 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.

[0311] Figure 47H illustrates an exemplary shuttle stopper 520 having the indicated shape and features. The shuttle stopper can be, for example, a rod or a plate. For example, Figure 47H illustrates that the shuttle stopper 520 can be a flexible plate.

[0312] 47I and 47J illustrate the shuttle stopper 520 and shuttle 14 engaged with one another. The shuttle stopper 520 can become engaged with the shuttle 14 when the shuttle 14 is moved or attempted to be moved (e.g., pushed, pulled) out of the jaws in direction 526 from an advanced position in the jaws, similar to how a speed nut functions. The advanced position of the jaws shown in FIGS. 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 is engaged with the shuttle 14 (e.g., when in a partially or fully advanced position), the shuttle stopper 520 can block or inhibit the shuttle 14 from moving (e.g., pulled, pushed) out of the jaws in direction 526. When the shuttle stopper 520 is engaged with the shuttle 14 (e.g., in a partially advanced position), the shuttle stopper 520 can allow the shuttle 14 to be moved (e.g., pulled, pushed) further in the jaw direction 524, for example, until the fully advanced position is reached. For example, when the shuttle 14 is engaged with the shuttle stopper 520, movement of the shuttle in an outward direction 526 toward the other jaw is blocked or inhibited. Figures 47I and 47J illustrate that the shuttle 14 is attempting to move in direction 526 into and out of the other jaw (e.g., from the first jaw to the second jaw), but is inhibited or prevented from moving in or further in direction 526 until the shuttle stopper 520 disengages from the shuttle 14 (e.g., via the shuttle stopper engager 538) and / or a threshold release force is reached between the shuttle 14 and the shuttle stopper 520.

[0313] To engage shuttle 14 with shuttle stopper 520, shuttle 14 may travel a shuttle capture distance of about 0.25 mm to about 2.00 mm along the shuttle track in direction 526, for example, from a fully advanced position to a partially advanced position, or from a first partially advanced position to a second partially advanced position, where the first partially advanced position is closer to the fully advanced position than the second advanced position, including increments of 0.05 mm and 0.25 mm within this range. The shuttle capture distance may be the distance shuttle 14 may travel in direction 526 until shuttle stopper 520 fully inhibits or prevents further movement along direction 526. The shuttle capture distance may be the actuation distance shuttle 14 may travel in the shuttle track (e.g., in direction 526) before movement of shuttle 14 fully engages shuttle stopper 520, thereby inhibiting or preventing further movement along direction 526 until shuttle stopper 520 disengages from shuttle 14.

[0314] Figure 47I further illustrates that when the shuttle stopper 520 and the shuttle 14 are engaged with each other, the shuttle stopper 520 can have a first deflection configuration of the shuttle stopper, in which the first longitudinal end 521a of the shuttle stopper (e.g., the terminal end 521aTE of the first longitudinal end of the shuttle stopper) is deflected in a second direction of deflection (e.g., rotationally 530b, translating 531b, or both rotationally 530b and translating 531b). The force of the shuttle 14 on the shuttle stopper 520 when the shuttle 14 moves in the direction 526 to actuate or otherwise engage the shuttle stopper 520 can cause a deflection in a second direction (e.g., rotational 530b, translational 531b, or both rotational 530b and translational 531b) of the shuttle stopper's first longitudinal end 521a (e.g., distal end 521aTE of the shuttle stopper's first longitudinal end), e.g., from a shuttle stopper neutral configuration (e.g., as shown in Figures 47F-47H) to a first deflected configuration of the shuttle stopper, or from a second deflected configuration of the shuttle stopper to a first deflected configuration of the shuttle stopper. The second deflected configuration can be determined by the force of the shuttle 14 on the first longitudinal end 521a (e.g., distal end 521aTE of the shuttle stopper's first longitudinal end) of the shuttle stopper. TE ) is deflected in a first direction of deflection (e.g., rotational 530a, translational 531a, or both rotational 530a and translational 531a) (which may occur, for example, when the shuttle 14 moves in direction 524 on the shuttle stopper 520 during advancement of the shuttle 14 into the jaws, and / or when the shuttle 14 is in a rest position on the shuttle stopper 520 after having advanced partially or fully into the jaws).

[0315] FIG. 47J further illustrates that the shuttle stopper engager 538 can extend across the width of the shuttle stopper 520 .

[0316] 47I and 47J further illustrate the shuttle stopper 520 and shuttle engager 538 in a disengaged configuration.

[0317] 47I and 47J further illustrate that half of the jaws (eg, the lateral half on one side of the longitudinal axis 476 of the device) are shown in transmission.

[0318] 47I and 47J illustrate the pusher in the transparent and / or retracted position.

[0319] 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.

[0320] 47K and 47L illustrate that the shuttle stopper 520 and the shuttle stopper engager 538 are engaged with each other. When the shuttle stopper 520 and the shuttle stopper engager 538 are engaged with each other, the first longitudinal end 521 a of the shuttle stopper (e.g., the terminal end 521 a TE of the first longitudinal end of the shuttle stopper) may or may not be in contact with the shuttle 14. For example, FIGS. 47I and 47J illustrate that when the shuttle stopper 520 and the shuttle stopper engager 538 are engaged with each other, a portion of the first longitudinal end 521 a of the shuttle stopper (e.g., the terminal end 521 a TE of the first longitudinal end of the shuttle stopper) can contact the shuttle 14. To engage the shuttle stopper engager 538 with the shuttle stopper 520, the shuttle stopper engager 538 can move within the chamber 532 toward the shuttle stopper 520 (e.g., in the direction 539 a). When the shuttle stopper engager 538 engages the shuttle stopper 520 (e.g., pushes on the shuttle stopper 520), the shuttle stopper engager 538 can deflect (e.g., bend, flex, or buckle) the shuttle stopper 520 to release the shuttle 14. For example, the shuttle stopper engager 538 can bend or flex a middle portion of the shuttle stopper 520, such that the first longitudinal end 521 a of the shuttle stopper can be deflected away from the shuttle 14, for example, in a first direction of deflection (e.g., rotation 530 a, translation 531 a, or both rotation 530 a and translation 531 a). The shuttle stopper engager 538 can deflect the shuttle stopper 520 from the shuttle stopper's first deflected configuration to the shuttle stopper's neutral configuration. As another example, the shuttle stopper engager 538 can bias the shuttle stopper 520 from a first deflected shuttle stopper configuration to a second deflected shuttle stopper configuration.As yet another example, the shuttle stopper engager 538 can deflect the shuttle stopper 520 from the shuttle stopper's first deflected configuration to any deflected position resulting from deflection in a first direction of deflection (e.g., rotation 530a, translation 531a, or both rotation 530a and translation 531a), such as a deflected configuration between the shuttle stopper's first deflected configuration and a shuttle stopper's neutral configuration, and a deflected configuration between the shuttle stopper's neutral configuration and the shuttle stopper's second deflected configuration. Figures 47K and 47L further illustrate that the chamber 532 can have a deflection space 532D for deflection of an intermediate portion of the shuttle stopper 520 when the shuttle stopper 520 disengages from the shuttle 14 via engagement with the shuttle stopper engager 538. To disengage the shuttle stopper engager 538 from the shuttle stopper 520, the shuttle stopper engager 538 can be moved within the chamber 532 away from the shuttle stopper 520 (eg, in direction 539b).

[0321] FIG. 47L illustrates that the shuttle stopper engager 538 can extend across the width of the shuttle stopper 520 .

[0322] 47K and 47L further illustrate that half of the jaws (eg, the lateral half on one side of the longitudinal axis 476 of the device) are shown in transmission.

[0323] 47K and 47L illustrate the pusher in the transparent and / or retracted positions.

[0324] The jaws shown in Figures 47K and 47L may be upper jaws. The jaws shown in Figures 47K and 47L may be lower jaws.

[0325] FIG. 47M illustrates that the shuttle stopper controller 537 can have a control arm 540. The shuttle stopper engager 538 can be attached to or integral with the control arm 540. The shuttle control device 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 controller 537 can be a shuttle stopper tape. The control arm 540 can engage and disengage the shuttle stopper engager 538 with the shuttle stopper 520, for example, by moving the shuttle stopper engager 538 toward the shuttle stopper 520 (e.g., in direction 539a) and by moving the shuttle stopper engager 538 away from the shuttle stopper 520 (e.g., in direction 539b), respectively. The shuttle stopper controller 537 can be activated and / or deactivated by the jaw control device extension 40 (also called a jaw separator) or by a mechanism in the handle of the device. For example, the shuttle stopper controller 537 can be controlled by one or more of the controls in or on the handle of the device, e.g., by pushing, pulling, or rotating the controls to an articulated position of the shuttle stopper controller. The shuttle stopper controller 537 can be controlled, e.g., by being engageable and disengageable with the jaw control device extension 40 (also referred to as a jaw separator) or by a mechanism in the handle of the device. For example, the jaw control device extension 40 or one or more of the controls on the handle of the device can be releasably engageable with the shuttle stopper controller 537 (e.g., control arm 540) and control the movement of the shuttle stopper controller 537. The shuttle stopper controller 537 (and thereby the shuttle stopper engager 538) can be actuated by the jaw control device extension 40 (also referred to as 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.

[0326] The shuttle stopper controller 537 can be straight or curved. For example, Figure 47M illustrates that the shuttle stopper controller 537 can have an L-shape, with the shuttle stopper engager 538 being the short leg of the L and the control arm 540 being the long leg of the L.

[0327] FIG. 47M further illustrates that either the lower or upper jaw is shown in perspective, and half of the other jaw (e.g., the upper or lower jaw, respectively) is shown in perspective, so that the shuttle and shuttle stopper controller 537 are visible.

[0328] FIG. 47M further illustrates the pusher in the transparent and / or retracted position.

[0329] The shuttle 14 and shuttle stopper controller 537 (e.g., shuttle stopper engager 538, shuttle stopper controller control arm 540) can be in the upper jaw, the lower jaw, or both jaws. The jaw shown in FIG. 47M can be the lower jaw. The jaw shown in FIG. 47M can be the upper jaw.

[0330] FIG. 47N illustrates that the shuttle stopper controller 337 (also referred to as a shuttle stopper tape) can be within the jaw track 542 (also referred to as a shuttle stopper controller track or controller track). The shuttle stopper engager 538, or a portion thereof, can be within the controller track 542. The controller arm 540, or a portion thereof, can be within the controller track 542. The track 542 can be a groove. The track 542 can be a channel. The controller 537 can be advanceable within the track 542 (e.g., in direction 539a) and retractable within the track 542 (e.g., in direction 539b). For example, the controller 537 can advance and retract within the track 542 to engage and disengage the shuttle stopper 520, or vice versa. The controller 337 (e.g., the shuttle stopper engager 538, the controller arm 540, or both) can be moveable (e.g., slidable, translatable) within the controller track 542. When a user wishes to release the shuttle stopper 520, the control arm 540 can be slid (e.g., translated) forward within the controller track 542 to press the shuttle stopper engager 538 against the shuttle stopper 520, bending the shuttle stopper 520, for example, from a first deflected configuration of the shuttle stopper to a neutral configuration of the shuttle stopper, or from the first deflected configuration of the shuttle stopper to a second deflected configuration of the shuttle stopper. The shuttle stopper controller 537 can be actuated by the jaw separator 40 or by a mechanism within the handle of the device 188. When the shuttle stopper controller 537 is actuated, the shuttle stopper controller 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 slide (e.g., translated) forward on the shuttle stopper 520 while the shuttle stopper engager 538 is disengaged from the shuttle stopper 520. When the shuttle stopper engager 538 is disengaged from the shuttle stopper 520, the shuttle stopper controller 537 may be in a retracted position.The forward position of the shuttle stopper controller can be the neutral position of the shuttle stopper controller 537. The retracted position of the shuttle stopper controller can be the neutral position of the shuttle stopper controller 537. A position between the forward and retracted positions of the shuttle stopper controller can be the neutral position of the shuttle stopper controller 537.

[0331] The shuttle stopper controller 537 may or may not have the short leg of the L-shape. For example, FIG. 47N illustrates a shuttle stopper controller 537 with the short leg of the L-shape, such as the shape shown in FIG. 47M. As another example, FIG. 47N illustrates a shuttle stopper controller 537 without the short leg of the L-shape (e.g., L-shape), where the distal end of the control arm 540 can be the shuttle stopper engager 538. The portion of the shuttle stopper controller 537 configured to contact the shuttle stopper 520 can be the shuttle stopper engager 538. Any portion of the shuttle stopper controller 537 configured to contact the shuttle stopper 520 can be the shuttle stopper engager 538.

[0332] FIG. 47N further illustrates that the chamber 532 can be isolated from or part of the controller track 542.

[0333] FIG. 47N further illustrates that the shuttle stopper 520 and the shuttle 14 are engaged with one another.

[0334] FIG. 47N further illustrates that the shuttle stopper 520 and the shuttle stopper engager 538 are not engaged with one another.

[0335] 47N further illustrates the shuttle stopper controller 537 in a disengaged position such that the shuttle stopper 520 is not deflected by the shuttle stopper engager 538. When the shuttle stopper controller 537 is in the disengaged position, the shuttle stopper controller 537 may be in a retracted position. The retracted position may be the default position of the shuttle stopper controller 537.

[0336] Figure 47N further illustrates that the shuttle stopper controller 537 can move in direction 539a (e.g., towards the shuttle stopper 520) to contact the shuttle stopper 520, and that the shuttle stopper controller 537 can move in direction 539b (e.g., away from the shuttle stopper 520) to disengage from the shuttle stopper 520.

[0337] FIG. 47N further illustrates that half of the jaws (e.g., the lateral half on one side of the longitudinal axis 476 of the device) are shown in see-through. As another example, FIG. 47N further illustrates a removable cover on the side of the removed jaw. The removable cover can advantageously improve access to the internal components of the jaws, for example, for repair, replacement, cleaning, or any combination thereof. As yet another example, FIG. 47N can be a side view of device 188 so that controller 537 and controller track 542 can be seen without taking a cross-section of device 188.

[0338] The jaw shown in Figure 47N can be the upper jaw. The jaw shown in Figure 47N can be the lower jaw.

[0339] Figure 47O shows through the jaws so that the shuttle 14, shuttle stopper 520, and shuttle stopper controller 537 can be seen relative 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 engager 538 are not engaged with each other.

[0340] Figure 47P illustrates the perspective view of Figure 47N with half of the jaws (e.g., the lateral half on one side of the longitudinal axis 476 of the device) shown in see-through to reveal the shuttle 14. Figure 47P further illustrates that the distal end of the control arm 540 can be a shuttle stop engager 538.

[0341] Figure 47Q further illustrates the shuttle stopper 520 and the shuttle 14 contacting each other. As another example, Figure 47Q further illustrates the shuttle stopper 520 and the shuttle 14 not contacting each other.

[0342] 47Q further illustrates that the shuttle stopper 520 and the shuttle stopper engager 538 are engaged with one another. When a user desires to engage the shuttle stopper engager 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 controller track 542 to press the shuttle stopper engager 538 against the shuttle stopper 520 and deflect the shuttle stopper 520, for example, from the shuttle stopper's first deflected configuration to the shuttle stopper's neutral configuration, or from the shuttle stopper's first deflected configuration to the shuttle stopper's second deflected configuration.

[0343] FIG. 47R illustrates that the jaws are transparent so that the shuttle 14, shuttle stopper 520, and shuttle stopper controller 537 are visible relative to each other when the shuttle stopper 520 and shuttle stopper engager 538 are engaged with each other.

[0344] Figure 47S illustrates the perspective view of Figure 47Q with half of the jaws (e.g., the lateral half on one side of the longitudinal axis 476 of the device) shown in see-through so that the shuttle 14 is visible. Figure 47S further illustrates that when a first portion of the shuttle stopper engager 538 engages the shuttle stopper 520, a second portion of the shuttle stopper engager may or may not engage the shuttle stopper 520. For example, Figure 47S illustrates that when the first portion of the shuttle stopper engager 538 (the portion hidden by the jaws in Figure 47S) contacts the shuttle stopper 520, the second portion of the engager 538 (the portion labeled 538 in Figure 47S) does not contact the shuttle stopper 520.

[0345] FIG. 47T illustrates that the shuttle stopper controller 337 can have a proximal engager 544 (also referred to as a shuttle stopper controller proximal engager). The proximal engager 544 can be attached to or integral with the control arm 540. The proximal engager 544 can be on the proximal end of the controller 337. The proximal engager 544 can be at the proximal end of the controller 337. The proximal engager 544 is a protuberance, e.g., an arm or leg, that extends away from the control arm 540 toward the longitudinal axis 476 of the device. For example, the proximal engager 544 can be a leg with a notch. A mechanism on the jaw control device extension 40 or the handle of the device can activate the shuttle stopper controller 537 by engaging the proximal engager 544. A mechanism in the jaw control device extension 40 or the handle of the device can stop the shuttle stopper controller 537 by disengaging from the proximal engager 544. For example, FIG. 47T illustrates that the proximal engager can have a surface 546 that the jaw control device extension can engage. The jaw control device extension 40 can have a jaw control device extension arm 548. The jaw control device extension arm 548 can engage the proximal engager 544, for example, with surface 546. Surface 546 can be part of a notch in the proximal engager 544. The notch in the proximal engager can be a catch on the jaw control device extension 40.

[0346] FIG. 47T further illustrates that when the jaws are open, the shuttle stopper controller 537 is not engaged with the shuttle stopper 520. When the jaws are open, the shuttle stopper controller 537 may or may not be in contact with the shuttle stopper 520. For example, FIG. 47T illustrates that when the jaws are open, the shuttle stopper controller 537 is not in contact with the shuttle stopper 520.

[0347] FIG. 47T further illustrates that when the jaws are open, the jaw control device extension 40 is not engaged with the shuttle stopper controller 537 (e.g., not engaged with the proximal engager 544 and / or not engaged with the control arm 540). When the jaws are open, the jaw control device extension 40 may or may not be in contact with the shuttle stopper controller 537 (e.g., not engaged with the proximal engager 544 and / or not engaged with the control arm 540). For example, FIG. 47T illustrates that when the jaws are open, the jaw control device extension 40 is not in contact with the shuttle stopper controller 537.

[0348] FIG. 47T further illustrates that the shuttle stopper control device 537 can be in a retracted position within the track 542 when the jaws are open. When the shuttle stopper control device 537 is in the retracted position within the track 542, a first end of the shuttle stopper controller 537 (e.g., a first end of the proximal engager 544) can contact and / or rest on a first surface 551 a of the jaw. When the shuttle stopper controller 537 is in the retracted position within the track 542, a space 552 (also referred to as a gap) can exist between the proximal engager 544 and a second surface 551 b of the jaw. When the shuttle stopper control device 537 advances within the track 542 from the retracted position shown in FIG. 47T, the proximal engager 544 can advance through the space 552 until the second end of the proximal engager 544 contacts the second surface 551 b of the jaw. The first surface 551 a of the jaw can limit movement of the shuttle stopper controller 537 in the direction 539 b. For example, when a first end of the shuttle stopper controller 537 (e.g., a first end of the proximal engager 544) contacts a first surface 551 a of the jaw, the shuttle stopper controller 537 can be in a fully retracted position. A second surface 551 b of the jaw can limit movement of the shuttle stopper controller 537 in direction 539 a. For example, when a second end of the proximal engager 544 contacts the second surface 551 b of the jaw, the shuttle stopper controller 537 can be in a fully advanced position. The second surface 551 b of the jaw can prevent the shuttle stopper controller 537 from over-deflecting the shuttle stopper 520 and disengaging the shuttle stopper 520 from the shuttle 14.

[0349] FIG. 47T further illustrates that the jaws are advanceable in direction 550a and retractable in direction 550b. The jaws are movable in directions 550a and 550b, e.g., translatable or slidable in these directions. The jaws may be movable relative to the compression cover 34 and the jaw control device extension 40. When the jaws are moved in directions 550a and 550b, the compression cover 34 and the jaw control device extension 40 may be in fixed positions. For example, when the jaws are advanced and retracted in directions 550a and 550b, respectively, the compression cover 34 and the jaw control device extension 40 may remain fixed so that the jaws can be advanced and retracted relative to the compression cover 34 and the jaw control device extension 40. As another example, when the jaws are moved in directions 550a and 550b, the jaws, the compression cover 34, the jaw control device extension 40, or any combination thereof, may be movable 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 device extension 40 can be movable in directions 550a and / or 550b before, after, or simultaneously with the jaws advancing or retracting.

[0350] 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 the partially open configuration, the jaws can be partially advanced from the compression cover 34 past the jaw control device extension 40, as shown in FIG. 47T. When the jaws are in the fully open configuration, the jaws can be in a fully advanced position, as shown in FIG. 47T. When the jaws are in the partially open or fully open configuration, a first end of the shuttle stop controller 537 (e.g., a first end of the proximal engager 544) can contact and / or rest at a first surface 551 a of the jaws.

[0351] FIG. 47T further illustrates that the shuttle stopper controller 537 can ride on a track 542, which can be on the jaw. The track 542 can be on the outside of the jaw (e.g., as shown in FIG. 47T) or on the inside of the jaw.

[0352] FIG. 47U illustrates that when the jaws are closed (e.g., retracted into the compression cover 34), the jaw control device extension 40 can be driven into the proximal engagers 544 of the lower and upper jaws. For example, when the jaws are closed, the jaw control device extension 40 can passively contact and press against the proximal engagers 544 of the upper and lower jaws. Retraction of the jaws can thereby drive the shuttle controller 537 to the jaw control device extension 40. As another example, FIG. 47U illustrates that when the jaws are closed (e.g., retracted into the compression cover 34), the jaw control device extension 40 can be driven forward into the proximal engagers 540 of the lower and upper jaws. Advancement of the jaw control device extension 40 can thereby be driven into the shuttle controller 537. For example, as the jaws close or after the jaws are closed, the jaw control device extension 40 can be advanced from the compression cover 34 to contact and push against the proximal engagers 544 of the upper and lower jaws.

[0353] FIG. 47U further illustrates that 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 in a fully closed, partially retracted position. When the jaws are in a fully closed, partially retracted position, the jaw control device extension 40 can begin to contact a proximal engager 544 (e.g., surface 546 of the proximal engager 544) extending from the shuttle stopper controller 537. The space 554 can have a longitudinal length (e.g., as measured along the longitudinal axis 476 of the device) of about 0.01 inches to about 0.10 inches, including 0.01 inch increments within this range (e.g., 0.02 inches).

[0354] FIG. 47V illustrates that jaw stopper 242 can contact the distal end of compression cover 40 when the jaws are fully retracted into compression cover 34. Once the jaws are fully retracted into compression cover 34, for example, from the partially retracted position shown in FIG. 47U, the jaws can move in direction 550b (e.g., can move 0.01 inches to 0.10 inches in direction 550b) to close space 554. As the jaws are retracted into compression cover 34 the final distance to close space 554, the jaws can move shuttle stop controller 537 into jaw control device extension 40 the same amount. Once the jaws have retracted into the compression cover 34 a final distance to close the space 554, the jaw control device extension 40 can be driven forward the same amount (e.g., as caused by relative movement between the jaws and jaw control device extension 40 when the jaw control device extension 40 is in a fixed position, or as caused by relative movement between the jaws and jaw control device extension 40 when the jaws are in a fixed position, or as caused by movement of both the jaws and jaw control device extension 40). This allows the tip of the jaw control device extension arm 548 to drive the shuttle stop controller 537 forward, bending the shuttle stop 520 and disengaging it from the shuttle 14. This design advantageously allows the shuttle 14 to automatically disengage from the shuttle stop 520 once, but not before, the jaws can be considered fully clamped when they are fully retracted into the compression cover 34, as shown in FIG. 47V.

[0355] 47U, once the jaws are partially retracted into compression cover 34, compression cover 34 can be moved in direction 550a (e.g., 0.01 inches to 0.10 inches in direction 550b) to close space 554 and fully retract the jaws into compression cover 34. Once the jaws are retracted into compression cover 34 the final distance to close space 554, the jaws can move shuttle stop controller 537 into jaw control device extension 40 the same amount.

[0356] FIG. 47V further illustrates that when the shuttle stopper controller 537 is in the advanced position of the track 542, there can be a space 553 (also referred to as a gap) between the proximal engager 544 and the jaw first surface 551 a. When the shuttle stopper controller 537 is retracted within the track 542 from the advanced position shown in FIG. 47V, the proximal engager 544 can be retracted through the space 553 until the first end of the proximal engager 544 contacts the jaw first surface 551 a. The shuttle stopper controller 537 can be retracted when the jaws are opened, for example, when the jaws exit the compression cover 34 and advance beyond the jaw controller extension 40. When the jaws are opened from the closed configuration, the shuttle stopper controller 537 can be passively retracted and returned to its retracted position, for example, by sliding in the track 542 in a direction 539 b. As another example, when the jaws are opened from a closed configuration, a mechanism on the jaw control device extension 40 or the device handle can retract the shuttle stop controller 537 by engaging the proximal engager 544. For example, the proximal engager 44 and the tip of the jaw control device extension arm 548 can be magnetically attracted to one another such that the jaw control device extension 40 can remain attached to the shuttle stop controller 537 as the jaws advance out of the compression cover 34. In this manner, the jaw control device extension 40 can pull the shuttle stop controller 537 back to the retracted position as the jaws advance, while not retracting itself. Other release attachment configurations, such as friction-fit and snap-fit arrangements, can be used in addition to or instead of magnets. Such detachable engagement between the jaw control device extension and the shuttle stop controller 537 can be overcome when the proximal engager 544 contacts the first surface 551 a of the jaws and the jaws continue to advance, e.g., fully opening the jaws.

[0357] FIG. 47W illustrates that a cover 556 can be placed on the exterior of the jaws to encase, shield, and / or protect the shuttle stop controller 537. FIG. 47W illustrates that a portion of the proximal engager 544 can be left exposed when the cover 556 is in the jaws.

[0358] FIG. 48A further illustrates that the device 188 can have perforators 558. The perforators 558 can have sharp tips. The perforators 558 can have sharp tips. Each jaw can accommodate a sharpened nitinol or other flexible tape with a sharp tip (also referred to as a perforator 558). The perforators 558 can be, for example, a perforator tape. Each jaw can have a perforator track 560 along which the perforators 558 are movable. For example, the perforators 558 can be translatable or slidable within the perforator track 560. The perforators 558 can be advanceable and retractable within the perforator track 560. The first jaw can have the perforator track 560. The second jaw can have the perforator track 560.

[0359] The perforators 558 can, for example, pre-perforate tissue to provide a path for passage of the shuttle 14. Once the shuttle 14 is retracted and the jaws are closed, the perforators 558 can be driven forward to perforate the tissue. The perforators 558 can then be retracted, allowing the shuttle 14 to pass between the jaws.

[0360] The device 188 can have one perforator 558. The perforator 558 can be in the first jaw or the second jaw. For example, FIG. 48A illustrates that the device 188 can have one perforator 558. The perforator 558 can be in the lower jaw or the upper jaw. For example, FIG. 48A illustrates that the perforator 558 can be in the upper jaw.

[0361] The device 188 can have two perforators 558, e.g., a first perforator and a second perforator. For example, FIG. 48A illustrates that an upper jaw (e.g., jaws 30, 78) can have a perforator 558. The perforator 558 can extend into a lower jaw (e.g., 38, 80) to perforate tissue and then retract back into the upper jaw to allow room for the shuttle 14 to enter the lower jaw.

[0362] 48A further illustrates that the shuttle 14 can be radially outward of the perforators 558. As another example, the perforators 558 can be radially outward of the perforators 558.

[0363] FIG. 48B illustrates the perforator 558 in a partially advanced position.

[0364] FIG. 48C illustrates the perforator 558 in a fully advanced position.

[0365] 48D and 48E illustrate the perforator in a fully retracted position.

[0366] Figures 48F and 48G illustrate the perforator 558 advancing to perforate the tissue and then retracting (e.g., fully retracting) to allow the shuttle 14 to pass between the jaws, after which the shuttle 14 passes from one jaw to the other.

[0367] 48H and 48I illustrate that the device 188 can have a first perforator 558 on the upper jaw and a second perforator 558 on the second jaw.

[0368] 48A-48I further illustrate that, for example, the perforator track 560 can merge with the shuttle tracks of the mandibular and upper jaws, allowing the shuttle 14 to pass through the same holes in the tissue created by the perforators 558. As another example, the perforator track 560 and the shuttle tracks of the mandibular and upper jaws may not merge at the jaws, and the exit angles of the perforators 558 from the jaws and the exit angles of the shuttle 14 from the jaws may intersect such that the shuttle 14 perforates less tissue after the perforators 558 have pre-perforated the tissue. In such cases, the paths of the shuttle 14 and the perforators 558 may intersect within the space between the jaws.

[0369] FIG. 49A shows the male stopper 412 at its first longitudinal end 412 FE , and the second longitudinal end 412 of the male stopper SE and the first longitudinal end 412 of the male stopper FE and second longitudinal end 412 SE The first longitudinal end 412 of the male stopper can have different sizes and / or shapes. FE , for example, along one or more dimensions of the male stopper 412. SE For example, FIG. 49A shows a portion of the second longitudinal end 412 of the male stopper. SE along one or more dimensions (e.g., width, thickness) of the male stopper 412. FE FIG. 49A illustrates, for example, that the male stopper 412 can be larger (e.g., wider, thicker) than a portion of the distal end (the second longitudinal end 412 of the male stopper). SE a smaller (e.g., narrower) proximal end (also referred to as the first longitudinal end 412 of the male stopper) than the FE 1 illustrates that the flexure may have a hammerhead shape (also called a T-shape) having a flexure.

[0370] Male stopper first longitudinal end 412 FE and the second longitudinal end 412 of the male stopper SE may be first and second longitudinal halves of the male stopper 412. The first longitudinal end 412 of the male stopper FE and No. 2412 SE can have the same longitudinal length. For example, FIG. 49A shows a first longitudinal end 412 of the male stopper. FE can include a first portion of the hammerhead-shaped narrow portion, and the second longitudinal end 412 of the male stopper SE 4 illustrates that the first longitudinal end 412 of the male stopper can include a second portion of a narrow hammerhead-shaped section and a wider hammerhead-shaped section. FE and second longitudinal end 412 SE can form a T-shape, and the first longitudinal end 412 of the male stopper FE forms the base of the T-shape and the second longitudinal end 412 of the male stopper SE forms the top of the T-shape.

[0371] FIG. 49A further illustrates that the male stopper 412 may have, for example, 2 to 10 or more sections 412 S a plurality of sections 412 having different sizes and / or shapes, including S (Male stopper section 412 S 49A illustrates that the male stopper 412 can have a first section 412 of the male stopper, also referred to as a first section 412 of the male stopper, including increments of one section within this range (e.g., 2 sections, 3 sections, 10 sections). S1 and a second section 412 of the male stopper. S2 The first section 412 of the male stopper can have the following structure: S1 is the second section 412 of the male stopper S2 For example, FIG. 49A shows a first section 412 of the male stopper.S1 can be the base of the T-shape, and the upper second section 412 of the male mold. S2 The first section 412 of the male stopper can be the apex of the T-shape. S1 and second section 412 S2 can have one or more different dimensions. For example, the first section 412 of the male stopper S1 is the second section 412 of the male stopper S2 The male stopper second section 412 may be longer, wider, and / or thicker than the first section 412, or vice versa. S2 The first section 412 of the male stopper S1 For example, FIG. 49A shows a first section 412 of the male stopper. S1 The second section 412 of the male stopper S2 As another example, FIG. 49A illustrates that the first section 412 of the male stopper can be narrower than the first section 412 of the male stopper. S1 However, the second section 412 of the male stopper S2 412 of the male stopper. S1 A portion of the first longitudinal end 412 of the male stopper FE and the first section 412 of the male stopper. S1 A portion of the second longitudinal end 412 of the male stopper SE and the second section 412 of the male stopper. S2 All of the male stopper second longitudinal end 412 SE Illustrate the multiple sections 412 S may be attached to or integral with one another. Section 412 S can be monolithically formed with one another. The male stopper 412 and the shuttle body 160 (also referred to as the shuttle spine 160) can be monolithic structures.

[0372] For male stoppers 412 having a straight shape or a straight diving board design (e.g., as shown in FIGS. 33A-36C), male stoppers 412 having a distal end that is larger (e.g., wider) than their proximal end (e.g., the hammerhead shape shown in FIG. 49A) can increase the retention force of the male stopper 412 in the female stopper 416 while keeping the bending force of the male stopper 412 the same for a straight shape (e.g., the straight shape shown in FIGS. 33A-36C). The wider distal end can increase the surface area of the male stopper 412 that engages with the female stopper 416, while the narrower proximal end can keep the deflection force of the male stopper 412 the same (e.g., for the straight male stopper 412 of FIGS. 33A-36C having male stoppers 412 with the same width at the proximal and distal ends). As another example, the larger surface area of the wide distal end of the hammerhead shape can advantageously increase the tactile feedback to the user of device 188 by increasing the resistance that allows translation into and out of female stopper 416.

[0373] FIG. 49A shows the male stopper 412 at the first end 412 of the male stopper. TE1 and the second end portion 412 of the male stopper TE2 The male stopper 412 can have a first end portion 412 of the male stopper. TE1 The male stopper 412 may be attached to, integrated with, or integrally formed with the shuttle 14 such that it may be flush with or coincident with the shuttle body 160. The male stopper 412 may be, for example, aligned with the longitudinal axis 14 of the shuttle. A1 For example, FIG. 49A shows a male stopper 412 extending away from and / or along the longitudinal axis 14 of the shuttle. A1 It is suggested that the second end portion 412 of the male stopper may be an extension of the shuttle body 160 extending away from the TE2The second end portion 412 of the male stopper may be an edge, a surface, or both. The edge may be straight, curved, or both. The surface may be straight, curved, or both. For example, FIG. 49A shows the second end portion 412 of the male stopper. TE2 FIG. 49A illustrates that the first section 412 of the male stopper can be a flat surface. S1 However, the first end portion 412 of the first section of the male stopper S1TE1 , and the second end portion 412 of the first section of the male stopper. S1TE2 and the second section 412 of the male stopper. S2 However, the first end portion 412 of the second section of the male stopper S2TE1 and the second end portion 412 of the second section of the male stopper. S2TE2 As shown in FIG. 49A, the first end 412 of the first section of the male stopper S1TE1 The first end portion 412 of the male stopper TE1 and the second end portion 412 of the second section of the male stopper. S2TE2 The second male stopper end 412 TE2 As further shown in FIG. 49A, the second end 412 of the first section of the male stopper S1TE2 is connected to the first end portion 412 of the second section of the male stopper. S2TE1 begins (e.g., in FIG. 49A, the second end 412 of the first section of the male stopper S1TE2 and the first end portion 412 of the second section of the male stopper. S2TE1 as indicated by the dashed line labeled as ).

[0374] FIG. 49A shows the second longitudinal end 412 of the male stopper. SE However, the first longitudinal end 412 of the male stopper FE This further illustrates that the second longitudinal end 412 of the male stopper can be closer to the longitudinal center of the shuttle 14 (e.g., suture holder 18) than the first longitudinal end 412 of the male stopper.SE is the first longitudinal end 412 of the male stopper FE The first longitudinal end 412 of the male stopper can be closer to the suture holder 18 than the first longitudinal end 412 of the male stopper. FE The second longitudinal end 412 of the male stopper SE 49A shows the second section 412 of the male stopper. S2 However, the first section 412 of the male stopper S1 This further illustrates that the second section 412 of the male stopper can be closer to the longitudinal center of the shuttle 14 than the first section 412 of the male stopper. S2 The first section 412 of the male stopper S1 The first section 412 of the male stopper can be closer to the suture holder 18 than the first section 412 of the male stopper. S1 is the second section 412 of the male stopper S2 49A shows the second end 412 of the male stopper. TE2 However, the first end portion 412 of the male stopper TE1 This further illustrates that the second end portion 412 of the male stopper can be closer to the longitudinal center of the shuttle 14 than the first end portion 412 of the male stopper. TE2 The first end portion 412 of the male stopper TE1 The first end portion 412 of the male stopper can be closer to the suture holder 18 than the first end portion 412 of the male stopper. TE1 The second end portion 412 of the male stopper TE2 can be closer to the shuttle tip 164 than

[0375] One or more portions of the male stopper 412 may be engagable with the female stopper 416. For example, the second end portion 412 of the male stopper TE2 The first end portion 412 of the male stopper may be engageable with the female stopper 416. TE1 and the second end portion 412 of the male stopper TE2 The surface between the first end 412 of the male stopper (e.g., male surface 414) can be engageable with the female stopper 416. TE1and the second end portion 412 of the male stopper TE2 The edge between the first section 412 of the male stopper can be engageable with the female stopper 416, or any combination thereof can be engageable with the female stopper 416. For example, FIG. 49A illustrates that the male surface 414 can be engageable with the female stopper 416. The first section 412 of the male stopper S1 and / or the second section 412 of the male stopper S2 can be engageable with the female stopper 416. For example, FIG. 49A shows the second section 412 of the male stopper. S2 4 illustrates that the female stopper 416 can be engageable with the female stopper 416.

[0376] Male stopper first section 412 S1 For example, the first end portion 412 of the male stopper TE1 At or near the first section 412 of the male stopper. S1 The second section 412 of the male stopper may be bendable or deflectable around the base of the male stopper 412 anywhere along its length. S2 When the first section 412 of the male stopper is moved into contact with the female stopper 416, S1 The first section 412 of the male stopper can be deflected to allow the male stopper 412 to enter the female stopper 416. In this manner, the female stopper 416 can passively hold the shuttle 14 in the jaws of the device 188 by passively holding the male stopper 412. For example, the first section 412 of the male stopper S1 The deflection of the male stopper 412 may allow the male stopper 412 to be translatable into and out of the female stopper 416, for example, by the second section 412 of the male stopper. S2 may be capable of engaging and disengaging with female stopper 416. In this manner, male stopper 412 may be a spring that may be biasable from a neutral or non-neutral configuration (e.g., the configuration shown in FIG. 49A) to a compressed or tensioned configuration.

[0377] FIG. 49A shows the shuttle 14 aligned along its longitudinal axis 14 A1 , the first horizontal axis 14 of the shuttle A2 , and the second transverse axis 14 of the shuttle A3 It is further illustrated that the

[0378] Longitudinal axis of the shuttle 14 A1 The length of the shuttle 14 (e.g., the length of the shuttle 14 measured between the two distal tips 165) may be the central longitudinal axis of the shuttle 14 (e.g., as shown in FIG. 49) or may be offset from the central longitudinal axis of the shuttle 14. A1 along or along the longitudinal axis 14 of the shuttle A1 For clarity of the other labels shown in FIG. 49A, the shuttle's longitudinal axis 14 A1 Only a portion of the shuttle longitudinal axis 14 of FIG. A1 The remainder of the shuttle is shown in phantom for illustrative purposes only. A1 12A (i.e., the shuttle longitudinal axis 157 of FIG. 12A (i.e., the shuttle longitudinal axis 14 A1 ) or the longitudinal axis 14 of the shuttle as shown in FIG. 49D. A1 , which may extend along the length of the shuttle 14.

[0379] First horizontal axis 14 of the shuttle A2 The shuttle width 292 may be the first horizontal axis of the shuttle 14 or may be offset from the first horizontal axis of the shuttle 14 as shown in FIG. A2 along or along the first transverse axis 14 of the shuttle A2 The first transverse axis 14 of the shuttle can be measured along an axis parallel to the A2 is the longitudinal axis 14 of the shuttle A1 The first horizontal axis 14 of the shuttle may be perpendicular to the A2can be linear or curved. For example, FIG. 49A shows the first transverse axis 14 of the shuttle. A2 The first transverse axis 14 of the shuttle can be linear. A2 If the first transverse axis 14 of the curved shuttle is curved, the shuttle 14 can have a first side (e.g., top side) that is convex and a second side (e.g., bottom side) of the shuttle 14 that is concave, or vice versa. A2 may have a radius of curvature. Having a shuttle 14 with a concave side and a convex side can advantageously inhibit or prevent lateral movement of the shuttle 14 as it advances through tissue and / or can facilitate longitudinal movement of the shuttle 14 as it advances through tissue.

[0380] Second horizontal axis 14 of the shuttle A3 may be the central second transverse axis of the shuttle 14, or may be offset from the central second transverse axis of the shuttle 14, as shown in FIG. 49A. T is the second horizontal axis 14 of the shuttle A3 along or along the second transverse axis 14 of the shuttle A3 The shuttle thickness can be measured along an axis parallel to the T may be the same as or different from shuttle thickness 408. For example, T is equal to the shuttle tip thickness 408 (e.g., as shown in FIG. 49A), and can be greater than or less than it. A3 is the longitudinal axis 14 of the shuttle A1 The second transverse axis 14 of the shuttle may be perpendicular to the A3 is the first horizontal axis 14 of the shuttle A2 The second transverse axis 14 of the shuttle may be perpendicular to the A3 can be linear or curved. For example, 49A is the second transverse axis 14 of the shuttle. A3 can be linear.

[0381] FIG. 49A shows the male stopper 412 aligned along the longitudinal axis 412 of the male stopper. A1 , the first horizontal axis 412 of the male stopper A2 , and the second transverse axis 412 of the male stopper A3 It is further illustrated that the

[0382] Male stopper longitudinal axis 412 A1 For example, Figure 49A shows that when the male stopper 412 is in a neutral position, the longitudinal axis 412 of the male stopper A1 is the first longitudinal end 412 of the male stopper FE and the second longitudinal end 412 of the male stopper may be curved. SE The longitudinal axis 412 of the male stopper can be linear. A1 may be a central longitudinal axis that extends down the middle of the male stopper 412. A1 is the longitudinal axis 14 of the shuttle A1 The male stopper 412 may be in the same plane as the longitudinal axis 412 of the male stopper. A1 For example, FIG. 49A shows a male stopper 412 with its longitudinal axis 412 aligned with the male stopper's longitudinal axis 412. A1 The length of the male stopper 412 is symmetrical about the longitudinal axis 412 of the male stopper. A1 along, for example, the first end portion 412 of the male stopper. TE1 and the second end portion 412 of the male stopper TE2 As further shown in FIG. 49A, the longitudinal axis 412 of the male stopper A1 The base of the male stopper 412 may extend onto and / or from the shuttle body 160. The male stopper's longitudinal axis 412 extends onto the shuttle body 160. A1 The part of the longitudinal axis 14 of the shuttle A1 can be coincident with or parallel to

[0383] Male stopper first transverse axis 412 A2 The first transverse axis 412 of the male stopper can be linear and / or curved. A2 is the longitudinal axis 412 of the male stopper A1 The first transverse axis 412 of the male stopper may be perpendicular to the A2 is the longitudinal axis of the shuttle (e.g., the longitudinal axis 14 of the shuttle) A1 The male stopper 412 may be perpendicular to the first transverse axis 412 of the male stopper. A2 For example, FIG. 49A shows a cross-sectional view of a male stopper 412, where the male stopper 412 is symmetrical or asymmetrical about its first transverse axis 412. A2 The width of the male stopper 412, for example, the first section 412 of the male stopper, can be asymmetric. S1 width of the second section of the male stopper 412 S2 The width of the first transverse axis 412 of the male stopper A2 The shuttle width 292 can be measured along the first transverse axis 14 of the shuttle. A2 along or along the first transverse axis 14 of the shuttle A2 The second end 412 of the male stopper can be measured along an axis parallel to the TE2 is, for example, the first transverse axis 14 of the shuttle A2 For example, the second end 412 of the male stopper may be parallel to the first end 412 (e.g., as shown in FIG. 49A). TE2 The flat surface of the first horizontal axis 14 of the shuttle A2 can be parallel to

[0384] Male stopper second transverse axis 412 A3 The second transverse axis 412 of the male stopper can be linear and / or curved. A3 is the longitudinal axis 412 of the male stopper A1 The second transverse axis 412 of the male stopper may be perpendicular to the A3 is the first horizontal axis 412 of the male stopper A2 The male stopper 412 can be perpendicular to the second transverse axis 412 of the male stopper. A3For example, FIG. 49A shows a cross-sectional view of a male stopper 412, where the male stopper 412 is symmetrical or asymmetrical about its second transverse axis 412. A3 (e.g., the first half of the T-shape is symmetrical about the second transverse axis 412 of the male stopper. A3 and the second half of the T-shape is aligned with the second transverse axis 412 of the male stopper. A3 The thickness of the male stopper 412 can be on a second side of the second transverse axis 412 of the male stopper. A3 can be measured along the

[0385] 49A further illustrates that a male stopper 412 can extend from the shuttle body 160. For example, FIG. 49A illustrates that the male stopper 412 can extend from the shuttle body 160 into and / or onto a suture hole (e.g., suture holes 404a, 404b), e.g., at the first end 412 of the male stopper. TE1 to the second end portion 412 of the male stopper. TE2 This illustrates that the distance can be extended up to

[0386] FIG. 49A shows, for example, a male stopper 412, e.g., a longitudinal axis 412 of the male stopper. A1 , extending away from the shuttle body 160 (e.g., along the shuttle longitudinal axis 14 A1 The male stopper 412 can extend along the male stopper longitudinal axis 14. A1 along the longitudinal axis 14 of the shuttle A1 As shown in FIG. 49A, the male stopper 412 can extend radially and / or longitudinally away from the male stopper. A1 along the longitudinal axis 14 of the shuttle A1 As another example, FIG. 49A shows a male stop 412 extending radially away from the longitudinal axis 14 of the shuttle. A1 The longitudinal axis 412 of the male stopper is aligned radially away from the A14 illustrates that the first longitudinal end 412 of the male stopper can be a radial male stopper extending longitudinally along the first longitudinal end 412 of the male stopper. FE and second longitudinal end 412 SE One or both of the shafts 162 may be spaced apart from the shuttle body 160 and / or may be spaced apart from the shuttle's longitudinal axis 14 A1 For example, FIG. 49A shows a first longitudinal end 412 of the male stopper. FE and second longitudinal end 412 SE Both of these are aligned along the longitudinal axis 14 of the shuttle. A1 4, e.g., radially away from the longitudinal axis 412 of the male stopper. A1 As another example, FIG. 49A illustrates that the first longitudinal end 412 of the male stopper can extend along the FE and second longitudinal end 412 SE Both of the longitudinal axis 14 of the shuttle A1 away from the longitudinal axis 412 of the male stopper, for example. A1 As yet another example, FIG. 49A illustrates that the first longitudinal end 412 of the male stopper can extend longitudinally along the FE and second longitudinal end 412 SE Both of these are aligned with, for example, the longitudinal axis 412 of the male stopper. A1 along the longitudinal axis 14 of the shuttle A1 and extending longitudinally from the shuttle longitudinal axis 14 A1 For example, the second transverse axis 14 of the shuttle may be moved away from the A2 4 illustrates that the first section 412 of the male stopper can extend radially along the S1 and second section 412 S2 One or both of the shafts 162 may be spaced apart from the shuttle body 160 and / or may be spaced apart from the shuttle's longitudinal axis 14 A1 For example, FIG. 49A shows a first section 412 of the male stopper. S1 and second section 412 S2 Both of these are aligned along the longitudinal axis 14 of the shuttle.A1 4, e.g., along the longitudinal axis 412 of the male stopper, so as to be radially away from the A1 As another example, FIG. 49A illustrates that the first section 412 of the male stopper can extend along the S1 and second section 412 S2 Both of these are aligned along the longitudinal axis 14 of the shuttle. A1 away from the longitudinal axis 412 of the male stopper, for example. A1 As yet another example, FIG. 49A illustrates that the first section 412 of the male stopper can extend longitudinally along the S1 and second section 412 S2 Both of these are aligned with, for example, the longitudinal axis 412 of the male stopper. A1 along the longitudinal axis 14 of the shuttle A1 and extending longitudinally from the shuttle longitudinal axis 14 A1 For example, the second transverse axis 14 of the shuttle may be moved away from the A2 10 illustrates that the axial direction of the slit 10 can extend radially along the axial direction of the slit 10.

[0387] As another example, the first longitudinal end 412 of the male stopper FE is the longitudinal axis 14 of the shuttle A1 and the second longitudinal end 412 of the male stopper can extend away (e.g., radially away) from the SE is the longitudinal axis 14 of the shuttle A1 As yet another example, the first longitudinal end 412 of the male stopper may extend (e.g., radially) toward the first longitudinal end 412 of the male stopper. FE is the first longitudinal end 412 of the male stopper FE is the longitudinal axis 14 of the shuttle A1 The longitudinal axis 14 of the shuttle is aligned so that it does not extend radially from the A1 and a second longitudinal end 412 of the male stopper that can extend away from the shuttle body 160 parallel to the SE is the shuttle body 160 or the shuttle longitudinal axis 14 A1As yet another example, the first longitudinal end 412 of the male stopper may extend away (e.g., radially away) from the first longitudinal end 412 of the male stopper. FE is the longitudinal axis 14 of the shuttle A1 and the second longitudinal end 412 of the male stopper can extend away (e.g., radially away) from the SE The second longitudinal end 412 of the male stopper SE is the longitudinal axis 14 of the shuttle A1 The longitudinal axis 14 of the shuttle is aligned so as not to extend radially away from the A1 It can extend parallel to the

[0388] As another example, the first section 412 of the male stopper S1 is the longitudinal axis 14 of the shuttle A1 and the second section 412 of the male stopper can extend away (e.g., radially away) from the S2 is the longitudinal axis 14 of the shuttle A1 As yet another example, the first section 412 of the male stopper may extend (e.g., radially) toward the S1 The first section 412 of the male stopper S1 is the longitudinal axis 14 of the shuttle A1 The longitudinal axis 14 of the shuttle is aligned so that it does not extend radially from the A1 and a second section 412 of the male stopper. S2 is the shuttle body 160 or the shuttle longitudinal axis 14 A1 As yet another example, the first section 412 of the male stopper may extend away from the first section 412 (e.g., radially away from the first section 412). S1 is the longitudinal axis 14 of the shuttle A1 and the second section 412 of the male stopper can extend away (e.g., radially away) from the S2 is the second section 412 of the male stopper S2 is the longitudinal axis 14 of the shuttle A1The longitudinal axis 14 of the shuttle is aligned so as not to extend radially away from the A1 It can extend parallel to the

[0389] FIG. 49A further illustrates that male stopper 412 is aligned with longitudinal axis 14 of the shuttle. A1 away from and / or towards, for example, the first transverse axis 412 of the male stopper. A2 The male stopper 412 can extend laterally along, for example, the first side 14 of the shuttle. L1 laterally towards and / or the second side 14 of the shuttle L2 For example, the first transverse axis 412 of the male stopper may be A2 49A shows the second longitudinal end 412 of the male stopper. SE However, the first longitudinal end 412 of the male stopper FE Further than the first horizontal axis 412 of the male stopper A2 4 illustrates that the second longitudinal end 412 of the male stopper can extend along the SE The first side of the male stopper is the first longitudinal end 412 FE From the first side of the shuttle 14 L1 Towards the second side of the shuttle 14 L2 The second longitudinal end 412 of the male stopper can extend away from the SE The second side of the male stopper is the first longitudinal end 412 FE From the second side of the shuttle 14 L2 Towards the first side of the shuttle 14 L1 In this manner, the male stopper 412 can define a hammerhead shape as shown in FIG. 49A. FIG. 49A shows the second section 412 of the male stopper. S2 However, the first section 412 of the male stopper S1 The first horizontal axis 412 of the male stopper A2 4 illustrates that the second section 412 of the male stopper can extend further along theS2 a first side (e.g., longitudinal axis 412 of the male stopper) of the A1 The first side of the male stopper is the first section 412 S1 From the first side of the shuttle 14 L1 Towards the second side of the shuttle 14 L2 The second section 412 of the male stopper can extend away from the S2 a second side (e.g., longitudinal axis 412 of the male stopper) of the A1 The second side of the male stopper is the first section 412 S1 From the second side of the shuttle 14 L2 Towards the first side of the shuttle 14 L1 In this manner, the male stopper 412 can define a hammerhead shape as shown in FIG. 49A. FIG. 49A shows the male stopper 412 extending away from the longitudinal axis 14 of the shuttle. A1 The shuttle's first side is 14 L1 However, the longitudinal axis 14 of the shuttle A1 half of the shuttle 14 on a first side thereof and a second half of the shuttle 14 on a second side thereof L2 However, the longitudinal axis 14 of the shuttle A1 It is further illustrated that the central longitudinal axis can be the second half of the shuttle 14.

[0390] 14 on the first side of the shuttle L1 and the second lateral side 14 L2 The shuttle's first side is 14 L1 is half of the first lateral side of the shuttle 14 and half of the second lateral side of the shuttle 14 L2 is the second lateral half of the shuttle 14, A1 The first and second lateral sides of the shuttle 14 may be portions of the shuttle 14 on the first and second lateral sides of the shuttle. L1 and the second lateral side 14 L2 The lateral end 14 of the shuttle LTE The shuttle lateral ends 14 LTEcan be edges or surfaces, or both. For example, FIG. 49A shows the lateral end 14 of the shuttle. LTE 49A illustrates that the surfaces 406 and the lateral ends 14 of the shuttle 14 may be perpendicular to each other, for example, the top and bottom surfaces of the shuttle 14, may be flat (e.g., as shown in FIG. 49A), or may be chamfered. LTE may form a surface and / or edge around the periphery of the shuttle 14.

[0391] FIG. 49A shows the shuttle 14 being attached to the first longitudinal side 14 of the shuttle. S1 and the second longitudinal side 14 of the shuttle S2 The first longitudinal side 14 of the shuttle may have S1 may be the first longitudinal half of the shuttle 14 and the second longitudinal side 14 of the shuttle S2 may be the second longitudinal half of the shuttle 14. For example, the first longitudinal side 14 of the shuttle S1 may include half of a suture holder 18 and the second longitudinal side 14 of the shuttle S2 may include the other half of the suture holder 18. The first longitudinal side 14 of the shuttle S1 The shuttle may have zero, one, or more male stops 412, and the shuttle may have a second longitudinal side 14 S2 can have zero, one, or multiple male stops 412. For example, FIG. 49A shows a first longitudinal side 14 of the shuttle. S1 The shuttle may have one male stopper 412 (e.g., first male stopper 412a) on the second longitudinal side 14 of the shuttle. S2 FIG. 49A illustrates that the shuttle 14 can have one male stopper 412 (e.g., second male stopper 412b). TE1 and the second end portion 14 of the shuttle TE2 The first longitudinal side 14 of the shuttle can have a S1 is attached to the first end 14 of the shuttle.TE1 and the second longitudinal side 14 of the shuttle S2 is attached to the second end 14 of the shuttle. TE2 The first end 14 of the shuttle may have TE1 and second end portion 14 TE2 may be located at the distal tip 165 at each end of the shuttle 14, or at any other point on the shuttle 14, or along the longitudinal axis 14 of the shuttle, for example. A1 The shuttle tip 164 may be the shuttle tip 164 furthest from the longitudinal center of the shuttle 14 (e.g., from the suture holder 18, as shown in FIG. 49A) measured along any axis including the longitudinal center of the shuttle 14. For example, FIG. 49A shows the first end 14 of the shuttle. TE1 is, for example, the distal tip 165 of the first tip 164a of the shuttle and the distal tip 165 of the second tip 14 of the shuttle. TE2 10 illustrates that the second tip 164b of the shuttle may be, for example, the distal end 165 of the shuttle's second tip 164b.

[0392] FIG. 49A shows the male stopper 412 at the first end 412 of the male stopper. TE1 and second end portion 412 TE2 male stopper transition area 412 TR The male stop transition region 412 can also have a TR The male stop transition region 412 can be straight, curved, or both. TR The male stopper 412 is a single male stopper section 412 S Another male stopper section from 412 S For example, FIG. 49A shows a male stop transition area 412. TR However, the male stopper 412 is the first section 412 of the male stopper. S1 to the second section 412 of the male stopper S2 The male stop transition area 412 is an example of a location where the male stop transition area 412 can change. TRFor example, FIG. 49A illustrates a male stopper transition region 412 such that a narrow proximal end transitions to a wide distal end in a single step, e.g., such that the male stopper 412 has or resembles a hammerhead shape. TR As another example, the male stop transition region 412 can be a single step. TR The male stop transition region 412 may be tapered instead of having one or more steps, or may be tapered in addition to having one or more steps. TR may be located anywhere along the length of the male stopper 412, for example, at the second end 412 of the male stopper. TE2 The first end portion 412 of the male stopper TE1 near the first end 412 of the male stopper TE1 The second end portion 412 of the male stopper TE2 (e.g., as shown in FIG. 49A), or near the first end 412 of the male stopper. TE1 and second end portion 412 TE2 the half between (e.g., the longitudinal axis 412 of the male stopper) A1 along the first end portion 412 of the male stopper. TE1 and second end portion 412 TE2 (as measured between

[0393] FIG. 49A shows the male surface 414 of the male stopper 412 facing the second longitudinal end 412 of the male stopper. SE and the male surface 414 may be the surface of the second longitudinal end 412 of the male stopper. SE a first side of the shuttle (e.g., a first lateral side 14 of the shuttle) L1 (the side closest to the first end 412 of the male stopper) SE the second side (e.g., shuttle second lateral side 14 L2 FIG. 49A further illustrates that the male surface 414 of the male stopper 412 can extend laterally to the second longitudinal end 412 of the male stopper. S2and the male surface 414 may be the surface of the second section 412 of the male stopper. S2 a first side of the shuttle (e.g., a first lateral side 14 of the shuttle) L1 (the side closest to the male stopper) to the second section 412 S2 a second side of the shuttle (e.g., a second lateral side 14 of the shuttle) L2 This is further exemplified by the fact that the septum may extend laterally to the side closer to the septum.

[0394] The male stopper 412 can have one or more bends 426 (e.g., one, two, three, four, or more bends 426) along the length of the male stopper 412. The first section 412 of the male stopper S1 and / or the second section 412 of the male stopper S2 Each of the first and second sections 412 of the male stopper can have zero, one, or multiple bends 426. For example, FIG. 49A illustrates that the base of the male stopper 412 can have bends 426. For example, FIG. 49A illustrates that the first section 412 of the male stopper can have bends 426. S1 4 illustrates that the first end portion 412 of the male stopper can have a bent portion 426. The bent portion 426 can be formed, for example, at the first end portion 412 of the male stopper. TE1 For example, FIG. 49A shows that the male stopper 412 can have one bend 426, and the one bend 426 is located near the first end 412 of the male stopper. TE1 4. The bend 426 may bend more or less when the male stopper 412 enters the female stopper 416, when it is in the female stopper 416, when it exits the female stopper 416, or any combination thereof. For example, the male stopper 412 may have a first bend when the male stopper 412 is in the neutral configuration and a second bend when the male stopper 412 is in the deflected configuration, and the first bend may be more or less than the second bend.

[0395] 49A further illustrates that the shuttle 14 can have an arrangement of male stoppers 412 as shown, including, for example, a first male stopper 412a and a second male stopper 412b. The first male stopper 412a can have a T-shape and the second male stopper 412b can have a T-shape. As another example, the first male stopper 412a can have a different shape than the second male stopper 412b, or vice versa.

[0396] FIG. 49A shows the first male stopper 412a. TE1 , the first longitudinal end 412a of the first male stopper FE , first male stopper transition region 412a TR , the second longitudinal end 412a of the first male stopper SE , and the second end portion 412a of the first male stopper TE2 The first male stopper 412a may have a first end portion 412 TE1 is the first end portion 412a of the first male stopper. TE1 The first longitudinal end 412 of the first male stopper 412a FE is the first longitudinal end 412a of the first male stopper FE The first male stopper transition region 412a can be TR is the first male stopper transition region 412a TR The second longitudinal end 412 of the first male stopper 412a SE is the second longitudinal end 412a of the first male stopper SE The second end portion 412 of the first male stopper 412a may be TE2 The second end portion 412a of the first male stopper TE2 It can be said that:

[0397] FIG. 49A shows the second male stopper 412b.TE1 , the first longitudinal end 412b of the second male stopper FE , second male stopper transition region 412b TR , the second longitudinal end 412b of the second male stopper SE , and the second end portion 412b of the second male stopper TE2 The second male stopper 412b may have a first end portion 412 of the male stopper. TE1 is the first end portion 412b of the second male stopper. TE1 The first longitudinal end 412 of the second male stopper 412b FE is the first longitudinal end 412b of the second male stopper FE The male stopper transition region 412 of the second male stopper 412b can be TR is the second male stopper transition region 412b TR The second longitudinal end 412 of the second male stopper 412b SE is the second longitudinal end 412b of the second male stopper. SE The second end portion 412 of the second male stopper 412b may be TE2 The second end portion 412b of the second male stopper TE2 It can be said that:

[0398] FIG. 49B shows, for example, the longitudinal length 412 of the first section of the male stopper. S1L , male stopper first section width 412 S1W , the first section thickness 412 of the male stopper S1T , the length of the second section of the male stopper 412 S2L , male stopper second section width 412 S2W , the second section thickness of the male stopper 412 S2T , Male stopper length 412 X , and male stopper thickness 412 T 4 illustrates various dimensions that the male stopper 412 (eg, first male stopper 412a and / or second male stopper 412b) may have, including:

[0399] Male stopper first section length 412 S1L The male stopper first section length 412 can be, for example, from about 0.0050 inches to about 0.1250 inches, including 0.0001 inch increments within this range (e.g., 0.0050 inches, 0.0225 inches, 0.1250 inches). S1L is the longitudinal axis 412 of the male stopper A1 The male stopper first section length 412 can be measured along S1L For example, the first end 412 of the first section of the male stopper S1TE1 to the second end portion 412 of the first section of the male stopper. S1TE2 It can be measured up to.

[0400] Male stopper first section width 412 S1W The male stopper first section width 412 can be, for example, from about 0.0030 inches to about 0.0450 inches, including 0.0001 inch increments within this range (e.g., 0.0030 inches, 0.0130 inches, 0.0450 inches). S1W As shown in FIG. 49A, the first transverse axis 412 of the male stopper A2 along, for example, the first section 412 of the male stopper. S1 the first section 412 of the male stopper from the first side S1 It can be measured to the second lateral side.

[0401] Male stopper first section thickness 412 S1T can be from about 0.0080 inches to about 0.0090 inches, or more broadly from about 0.0050 inches to about 0.0125 inches, including 0.0001 inch increments within these ranges (e.g., 0.0050 inches, 0.0085 inches, 0.0125 inches). Male stopper first section thickness 412 S1T is the second horizontal axis 412 of the male stopper A3The male stopper first section thickness 412 can be measured along the S1T The shuttle is 14mm thick T (e.g., as shown in FIG. 49A), can be greater than, or less than. S1T can be equal to, greater than, or less than the shuttle tip thickness 408 (eg, as shown in FIG. 49A).

[0402] Male stopper second section length 412 S2L The male stopper second section length 412 can be, for example, from about 0.0050 inches to about 0.1250 inches, including 0.0001 inch increments within this range (e.g., 0.0050 inches, 0.0100 inches, 0.1250 inches). S2L is the longitudinal axis 412 of the male stopper A1 The male stopper second section length 412 can be measured along S2L For example, the first end 412 of the second section of the male stopper S2TE1 to the second end portion 412 of the second section of the male stopper. S2TE2 The male stopper second section length 412 can be measured up to S2L is the length 412 of the first section of the male stopper S1L It can be less than (eg, as shown in FIG. 49A), equal to, or greater than.

[0403] Male stopper second section width 412 S2W The male stopper second section width 412 can be, for example, from about 0.0120 inches to about 0.0550 inches, including 0.0001 inch increments within this range (e.g., 0.0120 inches, 0.0220 inches, 0.0550 inches). S2W As shown in FIG. 49A, the first transverse axis 412 of the male stopper A2 along, for example, the second section 412 of the male stopper.S2 the second section 412 of the male stopper from the first side S2 The second section width 412 of the male stopper can be measured to the second lateral side of the S2W is the width 412 of the first section of the male stopper S1W , can be equal to, greater than (eg, as shown in FIG. 49A), or less than.

[0404] Male stopper second section thickness 412 S2T can be from about 0.0080 inches to about 0.0090 inches, or more broadly from about 0.0050 inches to about 0.0125 inches, including 0.0001 inch increments within these ranges (e.g., 0.0050 inches, 0.0085 inches, 0.0125 inches). S2T is the second horizontal axis 412 of the male stopper A3 The male stopper second section thickness 412 can be measured along the S2T The shuttle is 14mm thick T (e.g., as shown in FIG. 49A), can be greater than, or less than. S2T is the first section thickness 412 of the male stopper S1T (e.g., as shown in FIG. 49A), greater than, or less than the male stopper second section thickness 412. S2T can be equal to, greater than, or less than the shuttle tip thickness 408 (eg, as shown in FIG. 49A).

[0405] Male stopper length 412 X The male stopper length 412 can be from about 0.0150 inches to about 0.2000 inches, including 0.0001 inch increments within this range (e.g., 0.0150 inches, 0.0325 inches, 0.2000 inches). X is the longitudinal axis 412 of the male stopper A1For example, the first section length 412 of the male stopper can be measured along S1L and the second section of the male stopper is 412 mm long S2L It can be the sum of and.

[0406] Male stopper thickness 412 T The male stopper thickness 412 can be from about 0.0080 inches to about 0.0090 inches, or more broadly from about 0.0050 inches to about 0.0125 inches, including 0.0001 inch increments within these ranges (e.g., 0.0050 inches, 0.0085 inches, 0.0125 inches). T The shuttle is 14mm thick T (e.g., as shown in FIG. 49A), greater than, or less than the male stopper thickness 412. As shown in FIG. 49B, the male stopper 412 may have a constant or uniform male stopper thickness 412 T (e.g., male stopper first section thickness 412 S1T and the second section thickness of the male stopper 412 S2T (The thicknesses 412 of the first section of the male stopper may be equal to each other.) S1T is the second section thickness 412 of the male stopper S2T For example, the diameter may be about 0.0050 inches to about 0.0150 inches less or more than the diameter, including 0.0001 inch increments within this range (eg, 0.0050 inches, 0.0150 inches).

[0407] The first male stopper 412a can have the dimensions and features shown in Figure 49B.

[0408] The second male stopper 412b can have the dimensions and features shown in Figure 49B.

[0409] 49A and 49B illustrate that male stoppers 412 (e.g., their length, width, and / or thickness) are aligned with, for example, the longitudinal axis 14 of the shuttle. A1along (e.g., lengthwise) a first transverse axis 14 of the shuttle A2 (e.g., along the width) and / or second transverse axis 14 of the shuttle A3 It is further illustrated that the length, width, and / or thickness of the shuttle 14, as measured along the length, width, and / or thickness (e.g., in the case of the thickness), can be shorter than the length, width, and / or thickness of the shuttle 14. The male stoppers 412 (e.g., their length, width, and / or thickness) can be shorter than the shuttle width (e.g., shuttle width 292).

[0410] FIG. 49C illustrates that the suture 70 can be attached to the shuttle 14, for example, via a suture loop 162 to a suture holder 18.

[0411] 49C further illustrates that the male stopper 412 may be a suture stopper, whereby the male stopper 412 may be engageable with the suture 70 and / or the suture loop 162. When the suture 70 or suture loop 162 is engaged with the male stopper 412, the suture 70 or suture loop 162 may contact the male stopper 412. When the suture 70 or suture loop 162 is contacting the male stopper 412 (e.g., with the first male stopper 412a or the second male stopper 412b), movement of the shuttle 14 into the jaws may be inhibited or prevented. When the suture 70 or suture loop 162 is in contact with the male stopper 412 (e.g., with the first male stopper 412a or the second male stopper 412b), it can inhibit or prevent movement of the suture 70 or suture loop 162 into the jaws. The male stopper 412 can, for example, inhibit or prevent the suture 70 and / or suture loop 162 from passing over the suture holder slot and into the shuttle track. In this manner, the male stopper 412 can advantageously inhibit or prevent the device 188 from jamming with the suture 70 or suture loop 162 by inhibiting or preventing the suture 70 or suture loop 162 from passing over the suture holder slot and into the shuttle track. Thereby, the male stopper 412 may be, for example, a single-function and / or dual-function male stopper, which limits the movement of the shuttle 14 when engaged with the jaws and / or limits the movement of the suture 70 and / or suture loop 162.

[0412] FIG. 49A shows a male stopper 412, for example, when the suture 70 or suture loop 162 is attached to the first lateral side 14 of the shuttle. L1 and the second lateral side 14 L2 49A further illustrates that the shuttle 14 can guide and / or limit where the fold can occur over the suture zone line 70. For example, FIG. ZL A stitching zone 70 defined within Z (e.g., four suture zone lines 70 ZL, for example, three are shown, with the fourth being interrupted by the first male stopper 412a, forming a fourth stitching zone line 70 ZL The stitching zone line 70 shown next to the first male stopper 412a ZL 1 and 2, the suture 70 or suture loop 162 is on the first side 14 of the shuttle. L1 or the second side of the shuttle 14 L2 When or as the male stoppers 412 (e.g., first male stopper 412a and second male stopper 412b) are folded over the suture zone 70 Z guiding the suture 70 or suture loop 162 to fold or bend upward and / or downward and / or to guide the suture 70 or suture loop 162 toward the suture zone 70 Z The outer shuttle 14 can be inhibited or prevented from folding or bending onto or above it.

[0413] Male stopper second longitudinal end 412 SE The second longitudinal end 412 of the male stopper SE One or more portions of the suture 70 and / or suture loop 162 (e.g., first section 412 of the male stopper) S1 and / or second section 412 S2 ) can be engageable with the suture 70 and / or suture loop 162. For example, the suture 70 and / or suture loop 162 can be engaged with the male surface 414, the second end portion 412 of the male stopper. TE2 , and / or may be engagable with another surface of the male stopper 412. For example, Fig. 49C illustrates that the first male stopper 412a may be the first suture stopper of the shuttle, and the second male stopper 412b may be the second suture stopper of the shuttle.

[0414] FIG. 49C shows the first horizontal axis 14 of the shuttle. A2divides the shuttle 14 into two halves (e.g., a first longitudinal side 14 of the shuttle S1 and the second longitudinal side 14 S2 The first half of the suture holder 18 is connected to the first transverse axis 14 of the shuttle. A2 1, and that half of the suture holder 18 is on the first side of the first transverse axis 14 of the shuttle. A2 For example, FIG. 49C shows a first longitudinal side 14 of the shuttle. S1 can include a first half of a suture holder 18, and the second longitudinal side 14 of the shuttle S2 1 illustrates that the second half of the suture holder 18 can be included.

[0415] 49A-49C further illustrate that there can be a male stopper 412 on each longitudinal side of the shuttle 14. For example, FIGS. 49A-49C show a first male stopper 412a on a first longitudinal side 14 of the shuttle. S1 and a second male stopper 412b may be located on the second longitudinal side 14 of the shuttle. S2 The above illustrates what is possible.

[0416] 49A-49C further illustrate that there may be a male stopper 412 on each lateral side of the shuttle 14. The male stopper 412 is located on the first side 14 of the shuttle. L1 and second aspect 14 L2 For example, FIGS. 49A-49C illustrate a first half of the first male stopper 412a (e.g., a first longitudinal end 412a of the first male stopper). FE and the first half of the first male stopper, and the second longitudinal end 412a of the first male stopper. SE The first half of the shuttle is on the first side of the shuttle. L1 and the second half of the first male stopper 412a (e.g., the first longitudinal end 412a of the first male stopper FE and the second longitudinal end 412a of the first male stopper. SE The second half of the shuttle is on the second side of the shuttle. L249A-49C illustrate the first half of the second male stopper 412b (e.g., the first longitudinal end 412b of the second male stopper). FE and the second longitudinal end 412b of the second male stopper. SE The first half of the shuttle is on the first side of the shuttle. L1 and the second half of the second male stopper 412b (e.g., the first longitudinal end 412b of the second male stopper FE and the second longitudinal end 412b of the second male stopper. SE The second half of the shuttle is on the second side of the shuttle. L2 This further illustrates what can be done.

[0417] 49A-49C show the shuttle 14 with a first longitudinal side 14 of the shuttle 14, e.g., S1 and the second longitudinal side 14 of the shuttle S2 4 further illustrates that the connector 400 may have another hammerhead shaped male stopper 412.

[0418] 49A-49C show the first male stopper 412a attached to the second end 14 of the shuttle. TE2 than the first end portion 14 of the shuttle TE1 The first male stopper 412a is located between the shuttle center (e.g., the longitudinal midpoint of the shuttle) and the first end 14 of the shuttle. TE1 The longitudinal midpoint of the shuttle can be between the first end 14 of the shuttle. TE1 and the second end portion 14 TE2 For example, Figures 49A and 49C illustrate that the longitudinal midpoint of the shuttle can be midway between the suture holder 18 and Figure 49C illustrates that the longitudinal axis 14 of the shuttle can be midway between the suture holder 18 and the A1 and the first horizontal axis 14 of the shuttle A2 are the central axes, the longitudinal midpoint of the shuttle is the longitudinal axis 14 of the shuttle. A1 The first horizontal axis 14 of the shuttle A2This is further exemplified by the fact that the intersection of

[0419] 49A-49C show the second male stopper 412b attached to the first end 14 of the shuttle. TE1 than the second end portion 14 of the shuttle TE2 The second male stopper 412b is located between the shuttle center (e.g., the longitudinal midpoint of the shuttle) and the second end 14 of the shuttle. TE2 It could be between.

[0420] 49A-49C further illustrate that the first male stopper 412a and the second male stopper 412b can each extend toward a midpoint (e.g., longitudinal center) of the shuttle 14, for example, toward the suture holder 18. However, as another example, the first male stopper 412a and the second male stopper 412b can extend away from the center of the shuttle 14. For example, the first male stopper 412a and the second male stopper 412b can both extend from the suture holder 18, with the first male stopper 412a and the second male stopper 412b each extending away from the suture holder 18. In this example, the first male stopper 412a and the second male stopper 412b can be integral with or formed integrally with the suture holder 18.

[0421] 49A-49C further illustrate that the first male stopper 412a can extend toward the second male stopper 412b, and the second male stopper 412b can extend toward the first male stopper 412a. As another example, the first male stopper 412a and the second male stopper 412b can extend away from each other. As another example, the first male stopper 412a and the second male stopper 412b can extend away from each other and away from the longitudinal center of the shuttle (also referred to as the longitudinal midpoint of the shuttle).

[0422] FIG. 49D illustrates that a gap G can be between the male stopper 412 and the shuttle body 160. The width of the gap G can be constant. The gap G can have multiple widths. For example, FIG. 49D illustrates that the gap G can have, for example, a first gap width G W1 and the second gap width G W2 Multiple gap widths G W The first gap width G W1 is, for example, the first transverse axis 14 of the shuttle A2 and / or along the first transverse axis 412 of the male stopper. A2 The first section 412 of the male stopper as measured along S1 and the shuttle body 160. A second gap width G W2 is, for example, the first transverse axis 14 of the shuttle A2 and / or along the first transverse axis 412 of the male stopper. A2 The second section 412 of the male stopper as measured along S2 and the shuttle body 160. A first gap width G W1 is the second gap width G W2 For example, in the case of a hammerhead shape, the second gap width G W2 is the first gap width G W1 As another example, the first gap width G W1 The first section 412 of the male stopper S1 so that the first section 412 of the male stopper is flush with the shuttle body 160 (e.g., S1 deflects into and out of holes 404 and / or 405), and the second section 412 of the male stopper S2 The first side of the shuttle is 14 L1 and / or the second lateral side 14 L2 The second section 412 of the male stopper can be zero or very small so that it can extend beyond the S2 The first side of the shuttle is 14 L1 and / or the second lateral side 14 L2When extending upward, the second section 412 of the male stopper S2 For example, the shuttle body 160 may be engageable with the shuttle body 160 to inhibit or prevent excessive deflection of the male stopper 412. The shuttle body 160 may thereby act as a stop for the male stopper 412 and limit the range of motion of the male stopper 412.

[0423] FIG. 49E shows a male stopper 412, e.g., along the longitudinal axis 14 of the shuttle. A1 towards and / or the longitudinal axis 14 of the shuttle A1 The male stopper 412 can be moved (e.g., deflected) away from the first direction 412 of the male stopper, for example, by bending (e.g., linear bending), twisting, or both. For example, the male stopper 412 can be moved (e.g., deflected) away from the first direction 412 of the male stopper. FD 14 along the longitudinal axis of the shuttle A1 and / or the second direction 412 of the male stopper. SD 14 along the longitudinal axis of the shuttle A1 The first direction 412 of the male stopper can be moved toward the FD is, for example, the longitudinal axis 14 of the shuttle A1 The second direction 412 of the male stopper can be a rotation and / or translation of the male stopper 412 towards the SD is, for example, the longitudinal axis 14 of the shuttle A1 For example, FIG. 49E illustrates a first orientation 412 of the male stopper relative to the first male stopper 412a. FD may be a clockwise rotation, the first direction 412 of the male stopper relative to the second male stopper 412b FD may be a counterclockwise rotation, the second direction 412 of the male stopper relative to the first male stopper 412a SD may be a counterclockwise rotation, and the second direction 412 of the male stopper relative to the second male stopper 412b SDIllustrated in an orientation showing that rotation may be clockwise.

[0424] The male stopper 412 is in the first direction 412 of the male stopper. FD and / or second direction 412 SD When moving to the first end 412 of the male stopper, the male stopper 412 rotates around their base (e.g., the first end 412 of the male stopper). TE1 The first end portion 412 of the male stopper can pivot (about the first end portion 412) and can bend along their length. TE1 can be a fulcrum about which the male stopper 412 rotates when the male stopper 412 is moved (e.g., deflected) from the neutral configuration to the deflected configuration or vice versa. When the male stopper 412 is deflected by the female stopper 416, the male stopper 412 can bend distal to the fulcrum (e.g., at bend 426) as the male stopper 412 pivots about the fulcrum. When the male stopper 412 is deflected by the female stopper 416, the male stopper 412 can be rigid and cannot bend distal to the fulcrum (e.g., at bend 426) as the male stopper 412 pivots about the fulcrum.

[0425] FIG. 49E further illustrates that the male stoppers 412 (e.g., first male stopper 412a and second male stopper 412b) can be movable (e.g., deflectable) back and forth between a male stopper first configuration and a male stopper second configuration. The male stopper first configuration can be a male stopper neutral configuration (also referred to as a male stopper undeflected configuration). The male stopper neutral configuration can be, for example, the configuration of the male stopper 412 shown in FIGS. 49A-49E. The male stopper 412 can have the male stopper first configuration (e.g., neutral configuration) when, for example, the male stopper 412 is not engaged with the female stopper 416, when the male stopper 412 is fully engaged with the female stopper 416, or both. The second configuration of the male stopper can be a male stopper biased configuration in which the male stopper 412 is in a configuration different from the neutral configuration of the male stopper. For example, the second configuration of the male stopper can be a male stopper biased configuration in which the male stopper 412 (e.g., the first section 412 of the male stopper) is in a configuration different from the neutral configuration of the male stopper. S1 and / or the second section 412 of the male stopper S2 ) is closer to the longitudinal axis 14 of the shuttle than when the male stopper 412 is in the first configuration of the male stopper. A1 As another example, the second configuration of the male stopper may be a deflection configuration that approximates the first section 412 of the male stopper. S1 and / or the second section 412 of the male stopper S2 ) is closer to the longitudinal axis 14 of the shuttle than when the male stopper 412 is in the first configuration of the male stopper. A1 The male stopper 412 can have a second male stop configuration (e.g., a biased configuration) when, for example, the male stopper 412 is partially engaged with the female stopper 416, when the male stopper 412 is fully engaged with the female stopper 416, or both.

[0426] FIG. 49E shows, for example, exemplary dimensions D1-D7, shuttle thickness 14 T, and the arrangement of features shown at shuttle tip thickness 408.

[0427] Dimension D1 can be the distance between the ends 165 of the first shuttle tip 164a and the second shuttle tip 164b. For example, dimension D1 can be the shortest distance between the ends 165 of the first shuttle tip 164a and the second shuttle tip 164b (e.g., when measured along a straight line). Dimension D1 can be, for example, 0.150 inches to about 0.500 inches, including 0.001 inch increments within this range (e.g., 0.257 inches).

[0428] Dimension D2 can be the angle between first tip 164a and second tip 164b of the shuttle. Dimension D2 can be, for example, between 60 degrees and about 85 degrees, or more narrowly, between about 70 degrees and about 80 degrees, including single degree increments within these ranges (e.g., 70 degrees, 75 degrees, 80 degrees).

[0429] Dimension D3 can be the radius of curvature of shuttle 14. Dimension D3 can be the radius of curvature of shuttle body 160, shuttle first tip 164a, and / or shuttle second tip 164b. For example, FIG. 49E illustrates that dimension D3 can be the radius of curvature of shuttle body 160 between shuttle first tip 164a and shuttle second tip 164b, and that shuttle first tip 164a and shuttle second tip 164b can be linear. Dimension D3 can be, for example, from 0.075 inches to about 0.300 inches, including 0.001 inch increments within this range (e.g., 0.118 inches). A shuttle 14 having two straight sections (e.g., the shuttle's first tip 164a and second tip 164b) and a curved section therebetween (e.g., the shuttle body 160 between the shuttle's first tip 164a and second tip 164b) can advantageously flex the shuttle 14 when it is in the jaw track. This can advantageously keep the shuttle 14 engaged with the jaw track and inhibit or prevent the shuttle from floating in the jaw track. The straight section (e.g., the shuttle tip 164) can flex the shuttle 14 when it is in the jaw track such that the dimension D3 is smaller when the shuttle 14 is in the jaw track than when the shuttle 14 is not in the jaw track. For example, the dimension D3 can be reduced by approximately 0.010 inches to approximately 0.075 inches when the shuttle 14 is in the jaw track, including 0.001 inch increments within this range (e.g., 0.015 inches). In addition to or instead of the two straight sections, the radius of curvature of the jaw track when the shuttle 14 is in a neutral position outside the jaws can be less than dimension D3. The radius of curvature of the jaw track can be, for example, from about 0.010 inches to about 0.075 inches, including 0.001 inch increments within this range (e.g., 0.015 inches).Thereby, the shuttle 14, when in the jaw track, can be spring-loaded, urging the male stopper 412 radially outwardly into the female stopper 416 as the shuttle 14 is moved (e.g., translated) therein.

[0430] Dimension D4 may be the height between shuttle tip 164 and the apex of shuttle body 160. Dimension D4 may be, for example, from 0.050 inches to about 1.350 inches, including 0.001 inch increments within this range (e.g., 0.092 inches).

[0431] Dimension D5 can be the height between shuttle tip 164 and the apex of male stopper 412. Dimension D5 can be, for example, from 0.050 inches to about 1.350 inches, including 0.001 inch increments within this range (e.g., 0.095 inches).

[0432] Dimension D6 can be the height between the bottom of shuttle 14 and the apex of male stopper 412. Dimension D6 can be, for example, 0.0175 inches to about 0.0205 inches, or more broadly, about 0.0100 inches to about 0.1250 inches, including 0.0001 inch increments within these ranges (e.g., 0.0190 inches).

[0433] Dimension D7 can be, for example, the length of masked area MA, measured from the distal tip 165 of shuttle tip 164 as shown. Dimension D7 can be, for example, 0.055 inches to about 0.095 inches, including 0.001 inch increments within this range (e.g., 0.075 inches). A coating or finish can be applied to the masked area, for example, around the perimeter of shuttle 14 within masked area MA.

[0434] FIG. 49E shows the shuttle tip thickness 408 and the shuttle thickness 14 Tand can be, for example, from about 0.0080 inches to about 0.0090 inches, or more broadly, from about 0.0050 inches to about 0.0125 inches, including 0.0001 inch increments within these ranges (e.g., 0.0050 inches, 0.0085 inches, 0.0125 inches).

[0435] 49F illustrates that the shuttle 14 can have a straight configuration (also called a flat configuration). When the shuttle 14 is in the straight configuration, the longitudinal axis 14 of the shuttle A1 can be linear. The linear configuration can be a non-shaped configuration or a pre-shaped configuration. The shuttle 14 in a flat configuration can be shaped to have a non-flat shape (e.g., a shape having a curve). For example, the shuttle 14 shown in FIG. 49F can be shaped to have the shape shown in FIGS. 49A-49E. FIGS. 49A-49F thereby illustrate that the shuttle 14 can have a flat configuration and a non-flat configuration, and thereby the shuttle 14 can be shaped from a flat configuration to have a non-flat configuration.

[0436] FIG. 49F shows, for example, exemplary dimensions D8-D 16 , the first section length of the male stopper 412 S1L , male stopper first section width 412 S1W , the second section length of the male stopper 412 S2L , the width of the second section of the male stopper 412 S2W , Male stopper length 412 X , and the width 292 of the shuttle.

[0437] Dimension D8 is the length of suture holder 18 and may be, for example, from about 0.0050 inches to about 0.0200 inches, including 0.0001 inch increments within this range (e.g., 0.0050 inches, 0.0110 inches, 0.0200 inches).

[0438] Dimension D9 can be the width of apertures 404 and / or 405 through which male stopper 412 resides, extends above, and / or into, for example, shuttle body 160. Dimension D9 can be, for example, from about 0.0110 inches to about 0.540 inches, including 0.0001 inch increments within this range (e.g., 0.0110 inches, 0.0260 inches, 0.0540 inches). Male stopper 412 can extend into and / or up from any point around apertures 404 and / or 405 into shuttle body 160. For example, FIG. 49F illustrates that male stopper 412 can extend from the longitudinal ends of apertures 404 and / or 405 toward suture holder 18.

[0439] Dimension D 10 may be the length of the holes 404 and / or 405 between the suture holder 18 and the male stopper 412. 10 can be, for example, from about 0.0150 inches to about 0.0410 inches, including 0.0001 inch increments within this range (eg, 0.0150 inches, 0.0280 inches, 0.0410 inches).

[0440] Dimension D 11 is the length of shuttle 14 and may be, for example, from about 0.200 inches to about 0.400 inches, including 0.001 inch increments within this range (eg, 0.200 inches, 0.317 inches, 0.400 inches).

[0441] Dimension D 12 may be the radius of curvature of shuttle body 160 and holes 404 and / or 405 at the location shown, and may be, for example, from about 0.007 inches to about 0.019 inches, including 0.001 inch increments within this range (e.g., 0.007 inches, 0.012 inches, 0.019 inches).

[0442] Dimension D 13 is the male stop transition region 412 in the position shown. TRThe radius of curvature may be, for example, from about 0.001 inches to about 0.005 inches, including 0.001 inch increments within this range (eg, 0.001 inches, 0.002 inches, 0.007 inches).

[0443] Dimension D 14 may be the radius of curvature of shuttle body 160 and holes 404 and / or 405 at the location shown, and may be, for example, from about 0.002 inches to about 0.008 inches, including 0.001 inch increments within this range (e.g., 0.002 inches, 0.005 inches, 0.008 inches).

[0444] Dimension D 15 may be the radius of curvature of the shuttle body 160 and holes 404 and / or 405 at the location shown, and may be, for example, from about 0.001 inches to about 0.005 inches, including 0.001 inch increments within this range (e.g., 0.001 inches, 0.002 inches, 0.005 inches).

[0445] Dimension D 16 can be the angle of the shuttle tip 164 (e.g., the first tip 164a and the second tip 164b of the shuttle). 16 may be, for example, the angle between the first tip surface 406a and the second tip surface 406b of the shuttle tip 164. 16 can be, for example, from 25 degrees to about 85 degrees, or more narrowly, from about 45 degrees to about 75 degrees, including single degree increments within these ranges (e.g., 25 degrees, 45 degrees, 60 degrees, 75 degrees, 85 degrees).

[0446] FIG. 49F further illustrates that the shuttle 14, male stopper 412, and shuttle tip 164 can be a monolithic piece of material.

[0447] FIG. 49G shows the longitudinal axis 14 of the shuttle when the shuttle is in a straight configuration. A1 This example illustrates that the

[0448] 49A-49G show the features and dimensions shown and illustrate that the shuttle 14 can have these features and dimensions, for example, in the configuration shown. As another example, the shuttle 14 can have the features and dimensions shown in FIGS. 49A-49G when the shuttle 14 is in the jaw track.

[0449] FIG. 49H1 illustrates that when the shuttle 14 is moved (e.g., translated, slid) into the upper jaw shuttle track 64, as indicated by arrow 602, one or more male stoppers 412 can move (e.g., deflect) into the female stopper 416, for example, by moving over (e.g., under) the lip 420. For example, FIG. 49H1 illustrates that when the shuttle 14 is moved into the upper jaw shuttle track 64, a male stopper 412 (e.g., second male stopper 412b) can move into and / or engage with a female stopper 416 (e.g., second female stopper 416b), for example, by moving (e.g., deflecting) under the lip 420. FIG. 49H1 further illustrates that when the shuttle 14 is moved (e.g., translated, slid) out of the upper jaw shuttle track 64, one or more male stoppers 412 can move (e.g., deflect) away from the female stopper 416, for example, by moving over (e.g., below) the lip 420, as indicated by arrow 604. For example, FIG. 49H1 illustrates that when the shuttle 14 is moved out of the upper jaw shuttle track 64, a male stopper 412 (e.g., second male stopper 412b) can move under the lip 420 and disengage from a female stopper 416 (e.g., second female stopper 416b). In FIG. 49H1, half of the upper jaw is shown in see-through so that the shuttle 14 can be more easily seen within the upper jaw 30 and so that the engagement between the male stopper 412 and the female stopper 416 can be more easily seen.

[0450] When the second male stopper 412b is between the lip 420 and the upper jaw pusher 86, the second male stopper 412b can be engaged with the second female stopper 416b. When the second male stopper 412b is engaged with the second female stopper 416b, the second male stopper 412b can contact the second female stopper 416b. For example, when the second male stopper 412b is engaged with the second female stopper 416b, the male surface 414 can contact the female surface 418. As another example, when the second male stopper 412b is engaged with the second female stopper 416b, the second male stopper 412b does not have to contact the second female stopper 416b. For example, when the second male stopper 412b is engaged with the second female stopper 416b, the male surface 414 may not contact the female surface 418, allowing the second male stopper 412b to float within the second female stopper 416b. When the second male stopper 412b is engaged with the second female stopper 416b, the second male stopper 412b may have a first male stopper configuration or a second male stopper configuration. The first male stopper configuration may be a neutral male stopper configuration (e.g., the configuration of the second male stopper 412b shown in FIGS. 49A-49E). The second male stopper configuration may be a biased male stopper configuration.

[0451] When the second male stopper 412b is engaged with the lip 420, for example, as the shuttle 14 moves in and out of the second female stopper 416b, the second male stopper 412b can have a second male stopper configuration or a third male stopper configuration. The third male stopper configuration can be a biased male stopper configuration. When the second male stopper 412b is in the third male stopper configuration, the second male stopper 412b can be biased further than when it is in the second male stopper configuration.

[0452] When the second male stopper 412b is in the upper jaw portion 30 and before the second male stopper 412b contacts the lip 420, the second male stopper 412b can have a first configuration of a male stopper.

[0453] The first male stopper 412a can have a first configuration of male stoppers while the second male stopper 412b has a first, second, or third configuration of male stoppers. As another example, the first configuration of the second male stopper 412b can be the first configuration of the second male stopper, the second configuration of the second male stopper 412b can be the second configuration of the second male stopper, the third configuration of the second male stopper 412b can be the third configuration of the second male stopper, the first configuration of the first male stopper 412a can be the first configuration of the first male stopper, the second configuration of the first male stopper 412a can be the second configuration of the first male stopper, and the third configuration of the first male stopper 412a can be the third configuration of the first male stopper. The first configuration of the first male stopper can be, for example, a neutral configuration that is the same as or different from the first configuration of the second male stopper. The second configuration of the first male stopper can, for example, be the same or a different amount of deflection as the second configuration of the second male stopper. The third configuration of the first male stopper can, for example, be the same or a different amount of deflection as the third configuration of the second male stopper.

[0454] The female stopper 416 can be flexible and / or rigid. For example, the female stopper 416 can have the same configuration when the male stopper 412 is in the first, second, and / or third male stopper configuration. As another example, the female stopper 416 can have the first female stopper configuration (also referred to as the neutral female stopper configuration or the undeflected female stopper configuration) when the male stopper 412 is not engaged with the female stopper 416, and can have the second female stopper configuration (also referred to as the deflected female stopper configuration) when the male stopper 412 is engaged with the female stopper 416.

[0455] The male stopper 412 can be spring-biased to have the first male stopper configuration. For example, when the second male stopper 412b is in the second male stopper configuration, the second male stopper 412b can be biased to return (e.g., passively return) to the first male stopper configuration. For example, when the second male stopper 412b is in the second male stopper configuration, the second male stopper 412b can be biased to spring or jump back to the first male stopper configuration. This can advantageously allow the second male stopper 412b to passively engage with the second female stopper 416b as the second male stopper 412b moves past the lip 420 into the upper jaw 30 and into the second female stopper 416b.

[0456] FIG. 49H2 illustrates that when the shuttle 14 is moved (e.g., translated, slid) into the mandibular shuttle track 66, as indicated by arrow 604, one or more male stoppers 412 can move (e.g., deflect) into the female stopper 416, for example, by moving over (e.g., under) the lip 420. For example, FIG. 49H2 illustrates that when the shuttle 14 is moved into the mandibular shuttle track 66, a male stopper 412 (e.g., first male stopper 412a) can move into and / or engage a female stopper 416 (e.g., first female stopper 416a), for example, by moving (e.g., deflecting) under the lip 420. FIG. 49H2 further illustrates that when the shuttle 14 is moved (e.g., translated, slid) out of the mandible shuttle track 66, one or more male stoppers 412 can move (e.g., deflect) away from the female stopper 416, for example, by moving over (e.g., below) the lip 420, as indicated by arrow 602. For example, FIG. 49H2 illustrates that when the shuttle 14 is moved out of the mandible shuttle track 66, the male stopper 412 (e.g., the first male stopper 412a) can move under the lip 420 and disengage from the female stopper 416 (e.g., the first female stopper 416a). In FIG. 49H2, half of the mandible jaw is shown in see-through so that the shuttle 14 can be more easily seen within the mandible 38 and so that the engagement between the male stopper 412 and the female stopper 416 can be more easily seen.

[0457] When the first male stopper 412a is between the lip 420 and the mandible pusher 76, the first male stopper 412a can be engaged with the first female stopper 416a. When the first male stopper 412a is engaged with the first female stopper 416a, the first male stopper 412a can contact the first female stopper 416a. For example, when the first male stopper 412a is engaged with the first female stopper 416a, the male surface 414 can contact the female surface 418. As another example, when the first male stopper 412a is engaged with the first female stopper 416a, the first male stopper 412a may not contact the first female stopper 416a. For example, when the first male stopper 412a is engaged with the first female stopper 416a, the male surface 414 may not contact the female surface 418, allowing the first male stopper 412a to float within the first female stopper 416a. When the first male stopper 412a is engaged with the first female stopper 416a, the first male stopper 412a may have a first male stopper configuration or a second male stopper configuration. The first male stopper configuration may be a neutral male stopper configuration (e.g., the configuration of the first male stopper 412a shown in FIGS. 49A-49E). The second male stopper configuration may be a biased male stopper configuration.

[0458] When the first male stopper 412a is engaged with the lip 420, for example, as the shuttle 14 moves into and out of the second female stopper 416b, the first male stopper 412a can have a second male stopper configuration or a third male stopper configuration. The third male stopper configuration can be a biased male stopper configuration. When the first male stopper 412a is in the third male stopper configuration, the first male stopper 412a can be biased further than when it is in the second male stopper configuration.

[0459] When the first male stopper 412a is in the lower jaw 38 and before the first male stopper 412a contacts the lip 420, the first male stopper 412a can have a first configuration of a male stopper.

[0460] The male stopper 412 may be spring biased to have the first male stopper configuration. For example, when the first male stopper 412a is in the second male stopper configuration, the first male stopper 412a may be biased to return (e.g., passively return) to the first male stopper configuration. For example, when the first male stopper 412a is in the second male stopper configuration, the first male stopper 412a may be biased to bounce or jump back to the first male stopper configuration. This may advantageously allow the first male stopper 412a to passively engage the first female stopper 416a as the second male stopper 412b moves into the lower jaw 38, past the lip 420, and into the first female stopper 416a.

[0461] 49H3 illustrates that when the second male stopper 412b is engaged with the second female stopper 416b, the male surface 414 of the second male stopper 412b can contact the female surface 418. When the male surface 414 is in contact with the female surface 418 of the second female stopper 416b, the second male stopper 412b can have, for example, a first second male stopper configuration (e.g., a non-deflected configuration) or a second second male stopper configuration (e.g., a partially deflected configuration).

[0462] Figure 49H3 further illustrates that when second male stopper 412b is engaged with second female stopper 416b, suture loop 162 can be engaged with first suture stopper 534a. Figure 49H3 further illustrates that outer surface 419 can be a surface of first suture stopper 534a.

[0463] 49H3 further illustrates that when the second male stopper 412b is engaged with the second female stopper 416b, tissue can be moved (e.g., pushed) by the second male stopper 412b out of, away from, or out of and away from the second female stopper 416b. The second male stopper 412b can thereby be a tissue moving device that can advantageously hold tissue away from (or minimize the amount of tissue in) the second female stopper 416b that might otherwise jam the shuttle 14 within the upper jaw 30, for example. The first suture stopper 534a, outer surface 419, and / or lip 420 can be a tissue barrier that can inhibit or prevent tissue from entering the second female stopper 416b. The longitudinal axis 14 of the shuttle as the second male stopper 412b passes by (e.g., under) the lip 420. A1 The deflection to the shuttle may occur, for example, when the second male stopper 412b lip 420 contacts the shuttle longitudinal axis 14 as the second male stopper 412b moves into the second female stopper 416b. A1 As the second male stopper 412b is moved into the second female stopper 416b, the tissue that may be in the holes 404 and / or 405 may be advantageously forced apart by gradually clamping the tissue toward the suture holder 18. The second male stopper 412b may clear the tissue from the second female stopper 416b, may inhibit or prevent the tissue from entering the second female stopper 416b, or any combination thereof.

[0464] FIG. 49H3 further illustrates that the outer surface 419, lip 420, and / or first shuttle stopper 534a can engage with the first male stopper 412a to inhibit or prevent the shuttle 14 from overextending into the upper jaw 30. For example, the outer surface 419, lip 420, and / or first shuttle stopper 534a can engage with the first male stopper 412a to inhibit or prevent the shuttle 14 from overextending into the upper jaw 30. For example, the outer surface 419, lip 420, and / or first shuttle stopper 534a can engage with the first male stopper 412a to inhibit or prevent the shuttle 14 from overextending into the upper jaw 30. SD This can advantageously inhibit or prevent the first male stopper 412a from moving past (e.g., down) the lip 420 of the upper jaw 30.

[0465] 49H4 illustrates that when the first male stopper 412a is engaged with the first female stopper 416a, the male surface 414 of the first male stopper 412a can contact the female surface 418 of the first female stopper 416a. When the male surface 414 is in contact with the female surface 418, the first male stopper 412a can have, for example, a first configuration of a second male stopper (e.g., a non-deflected configuration) or a second configuration of a second male stopper (e.g., a partially deflected configuration).

[0466] Figure 49H4 further illustrates that when first male stopper 412a is engaged with first female stopper 416a, suture loop 162 can be engaged with first suture stopper 534a. Figure 49H4 further illustrates that outer surface 419 can be a surface of first suture stopper 534a.

[0467] 49H4 further illustrates that when the first male stopper 412a is engaged with the first female stopper 416a, tissue can be moved (e.g., pushed) by the first male stopper 412a out of, away from, or out of and away from the first female stopper 416a. The first male stopper 412a can thereby be a tissue-moving device that can advantageously keep tissue out of (or minimize the amount of tissue in) the first female stopper 416a that might otherwise jam the shuttle 14 within the mandible 38, for example. The first suture stopper 534a, outer surface 419, and / or lip 420 can be a tissue barrier that can inhibit or prevent tissue from entering the first female stopper 416a. The longitudinal axis 14 of the shuttle of the first male stopper 412a as the first male stopper 412a passes (e.g., under) the lip 420 A1 The bias toward the longitudinal axis 14 of the shuttle is caused, for example, by the lip 420 as the first male stopper 412a moves into the first female stopper 416a. A1 As the first male stopper 412a moves into the first female stopper 416a, the tissue that may be in the h...

Claims

1. 1. A suture manipulation device comprising: a first jaw having a first jaw channel and a first jaw first stop; a shuttle having a shuttle longitudinal axis and a shuttle first stop, the shuttle being slidable within the first jaw channel; the shuttle first stopper extends in a direction away from the shuttle longitudinal axis, the shuttle first stopper has a shuttle first stopper proximal end and a shuttle first stopper distal end, the shuttle first stopper proximal end is narrower than the shuttle first stopper distal end, the shuttle first stopper distal end is deflectable into the first jaw first stopper, the shuttle first stopper is engageable with the first jaw first stopper, the shuttle first stopper distal end contacts the first jaw first stopper when the shuttle first stopper is engaged with the first jaw first stopper, and the shuttle is passively retained within the first jaw when the shuttle first stopper distal end contacts the first jaw first stopper.

2. a second jaw having a second jaw channel and a second jaw first stop, the shuttle being slidable within the second jaw channel; the shuttle further comprises a shuttle second stopper, the shuttle first stopper being slidable in and out of the first jaw first stopper, and the shuttle second stopper being slidable in and out of the second jaw first stopper; the shuttle second stopper extends in a direction away from the shuttle longitudinal axis, the shuttle second stopper has a shuttle second stopper proximal end and a shuttle second stopper distal end, the shuttle second stopper proximal end is narrower than the shuttle second stopper distal end, the shuttle second stopper distal end is deflectable against the second jaw first stopper, the shuttle second stopper is engageable with the second jaw first stopper, the shuttle second stopper distal end contacts the second jaw first stopper when the shuttle second stopper is engaged with the second jaw first stopper, and the shuttle is passively held within the second jaw when the shuttle second stopper distal end contacts the second jaw first stopper; 2. The suture manipulation device of claim 1, wherein the shuttle first stopper distal end is closer to a center of the shuttle than the shuttle first stopper proximal end, and the shuttle second stopper distal end is closer to the center of the shuttle than the shuttle second stopper proximal end.

3. The suture manipulation device of claim 2 , wherein at least one of the shuttle first stop and the shuttle second stop has a hammerhead shape.

4. The suture manipulation device of claim 2 , wherein the shuttle first stop extends radially away from the shuttle longitudinal axis and the shuttle second stop extends radially away from the shuttle longitudinal axis.

5. The suture manipulation device of claim 2, wherein the shuttle first stop extends radially away from the shuttle longitudinal axis and the shuttle second stop extends laterally away from the shuttle longitudinal axis.

6. The suture manipulation device of claim 2 , wherein the shuttle first stop extends laterally away from the shuttle longitudinal axis and the shuttle second stop extends laterally away from the shuttle longitudinal axis.

7. 2. The suture manipulation device of claim 1, wherein tissue is movable through the shuttle first stopper in a direction away from the first jaw first stopper when the shuttle first stopper is engaged with the first jaw first stopper.

8. 2. The suture manipulation device of claim 1, wherein the shuttle has a shuttle first section, a shuttle second section, and a shuttle third section, the shuttle first section being straight, the shuttle second section being curved, and the shuttle third section being straight.

9. 2. The suture manipulation device of claim 1, wherein the shuttle has a first radius of curvature before the shuttle is loaded into the first jaw channel, and the shuttle has a second radius of curvature after the shuttle is loaded into the first jaw channel, the second radius of curvature being smaller than the first radius of curvature, and the shuttle is biased to have the first radius of curvature.

10. 1. A suture manipulation device comprising: a jaw structure having a shuttle channel with a shuttle channel first stop; a shuttle having a shuttle longitudinal axis and a shuttle first stop, the shuttle being slidable within the shuttle channel; a shuttle first stop extending in a direction away from the shuttle longitudinal axis, the shuttle first stop having a shuttle first stop proximal end and a shuttle first stop distal end, the shuttle first stop proximal end being narrower than the shuttle first stop distal end, the shuttle first stop movable within the shuttle channel first stop, the shuttle first stop engageable with the shuttle channel first stop, the shuttle first stop having an undeflected shape of the shuttle first stop when the shuttle first stop is not engaged with the shuttle channel first stop, and the shuttle first stop having a deflected shape of the shuttle first stop when the shuttle first stop is engaged with the shuttle channel first stop.

11. the shuttle channel has a shuttle channel second stop; the shuttle has a shuttle second stopper; 11. The suture manipulation device of claim 10, wherein the shuttle second stop extends in a direction away from the shuttle longitudinal axis, the shuttle second stop has a shuttle second stop proximal end and a shuttle second stop distal end, the shuttle second stop proximal end is narrower than the shuttle second stop distal end, the shuttle second stop is movable within the shuttle channel second stop, the shuttle second stop is engageable with the shuttle channel second stop, the shuttle second stop has an undeflected shape of the shuttle second stop when the shuttle second stop is not engaged with the shuttle channel second stop, and the shuttle second stop has a deflected shape of the shuttle second stop when the shuttle second stop is engaged with the shuttle channel second stop.

12. 12. The suture manipulation device of claim 11, wherein the shuttle first stopper distal end is closer to a center of the shuttle than the shuttle first stopper proximal end, the shuttle second stopper distal end is closer to the center of the shuttle than the shuttle second stopper proximal end, when the shuttle first stopper is engaged with the shuttle channel first stopper, movement of the shuttle within the shuttle channel is restricted, and when the shuttle second stopper is engaged with the shuttle channel second stopper, movement of the shuttle within the shuttle channel is restricted.

13. The suture manipulation device of claim 11 , wherein at least one of the shuttle first stop and the shuttle second stop has a hammerhead shape.

14. 12. The suture manipulation device of claim 11, wherein the shuttle first stop extends radially or laterally away from the shuttle longitudinal axis and the shuttle second stop extends radially or laterally away from the shuttle longitudinal axis.

15. The suture manipulation device of claim 11 , wherein the shuttle channel first stop and the shuttle channel second stop are within the suture manipulation device first jaw.

16. The suture manipulation device of claim 11 , wherein the shuttle channel first stop is in the suture manipulation device first jaw and the shuttle channel second stop is in the suture manipulation device second jaw.

17. 1. A suture manipulation device comprising: a jaw having a shuttle channel with a female stopper; a shuttle having a shuttle longitudinal axis and a male stopper, said shuttle translatable within said shuttle channel, said male stopper engageable with said female stopper; a male stopper extending in a direction away from the shuttle longitudinal axis, the male stopper having a male stopper proximal end and a male stopper distal end, the male stopper distal end being wider than the male stopper proximal end, the male stopper being translatable into and out of the female stopper, and the male stopper being deflectable into and out of the female stopper.

18. 18. The suture manipulation device of claim 17, wherein the first male stop extends radially or laterally away from the shuttle longitudinal axis to inhibit movement of the shuttle within the shuttle channel when the male stop is within the female stop.

19. The suture manipulation device of claim 18, wherein the male stopper distal end is closer to a center of the shuttle than the male stopper proximal end.

20. The suture manipulation device of claim 19, wherein the male stopper has a hammerhead shape.

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