Systems, devices and methods are provided for endoscopic procedures involving tissue manipulations beyond the capabilities of traditional endoscopic instruments. Embodiments of the systems include an elongated main body having a scope therethrough and at least one steerable tool arm which extends from the distal end of the main body. In preferred embodiments, the system includes two tool arms, each arm steerable to form a curve laterally outward which then bends laterally inward so that the arms form an angular shape. In addition, end effectors extend from the distal ends of each tool arm for use in manipulation of tissue. The angular shape brings the end effectors together in view of the scope for cooperative movements which are continuously visible by the surgeon. In addition, the tool arms may be steerable in any additional direction and may be rotateable to allow grasping, elevation and more complex manipulation of tissue.

Endoluminal tool deployment system

Adhesion to wet and dynamic surfaces, including biological tissues, is important in many fields but has proven to be extremely challenging. Existing adhesives are cytotoxic, adhere weakly to tissues, or cannot be used in wet environments. We report a bioinspired design for adhesives consisting of two layers: an adhesive surface and a dissipative matrix. The former adheres to the substrate by electrostatic interactions, covalent bonds, and physical interpenetration. The latter amplifies energy dissipation through hysteresis. The two layers synergistically lead to higher adhesion energies on wet surfaces as compared with those of existing adhesives. Adhesion occurs within minutes, independent of blood exposure and compatible with in vivo dynamic movements. This family of adhesives may be useful in many areas of application, including tissue adhesives, wound dressings, and tissue repair.

Tough adhesives for diverse wet surfaces

A device for closing an aperture in a vessel wall comprising a covering member having a longitudinal axis and positionable inside the vessel against the internal opening of the aperture and having a dimension to prevent egress of fluid through the aperture and having a first opening. A first retainer is positionable external of the vessel. A flexible connecting member operatively connects the covering member and the first retainer, wherein the first opening of the covering member is configured to restrict movement of the connecting member.

Vascular hole closure device

Contrast-Induced Acute Kidney Injury

Apparatus and methods are provided for thermally and/or mechanically treating tissue, such as valvular structures, to reconfigure or shrink the tissue in a controlled manner. The apparatus comprises a catheter in communication with an end effector which induces a temperature rise in an annulus of tissue surrounding the leaflets of a valve or in the chordae tendineae sufficient to cause shrinkage, thereby causing the valves to close more tightly. Mechanical clips can also be implanted over the valve either alone or after the thermal treatment. The clips are delivered by a catheter and may be configured to traverse directly over the valve itself or to lie partially over the periphery of the valve to prevent obstruction of the valve channel. The clips can be coated with drugs or a radiopaque coating. The catheter can also incorporate sensors or energy delivery devices, e.g., transducers, on its distal end.

Apparatus and methods for treating tissue

The invention relates to a device for closure of defect openings in the human or animal body, which device, in a first state, can assume an elongate shape with a high ratio of length to transverse extent, and, in the implanted state, has a shape with a lower ration of length to transverse extent, the device being deformable in the radial direction and comprising first arrangements (8, 24, 31) with which the device, in the implanted state, supports itself elastically against the margin of the opening which is to be closed and thereby centres itself approximately within the opening, characterized in that the device comprises second arrangements (7, 9, 20, 21, 32) which, in the implanted state, bear with positive engagement on opposite sides of the tissue surrounding the opening which is to be closed.

Device for closure of body defect openings

Currently, there are no clinically approved surgical glues that are nontoxic, bind strongly to tissue, and work well within wet and highly dynamic environments within the body. This is especially relevant to minimally invasive surgery that is increasingly performed to reduce postoperative complications, recovery times, and patient discomfort. We describe the engineering of a bioinspired elastic and biocompatible hydrophobic light-activated adhesive (HLAA) that achieves a strong level of adhesion to wet tissue and is not compromised by preexposure to blood. The HLAA provided an on-demand hemostatic seal, within seconds of light application, when applied to high-pressure large blood vessels and cardiac wall defects in pigs. HLAA-coated patches attached to the interventricular septum in a beating porcine heart and resisted supraphysiologic pressures by remaining attached for 24 hours, which is relevant to intracardiac interventions in humans. The HLAA could be used for many cardiovascular and surgical applications, with immediate application in repair of vascular defects and surgical hemostasis.

A Blood-Resistant Surgical Glue for Minimally Invasive Repair of Vessels and Heart Defects

Background— Percutaneous closure of the patent foramen ovale (PFO) is usually performed under x-ray in combination with ultrasound guidance. We tested the feasibility of applying magnetic resonance (MR) guidance for percutaneous closure of PFO in an animal model, thus avoiding the disadvantage of ionizing radiation. Methods and Results— Real-time MRI with radial or spiral k-space filling (15 frames per second) on an interventional 1.5-T high-field whole-body system was exploited to examine the feasibility of MR-guided closure of the PFO in 7 piglets weighing ≈14 kg. A specially designed prototype nonmagnetic closure device was introduced via the femoral vein. The short bore of the magnet and in-room monitors allowed for visualization and steering of the catheter with the loaded occluder. Catheterization of the left atrium and, finally, correct placement of the device was possible in all animals. Deployment of the device was depicted by real-time MR, and initial misplacement, which occurred in 2 animals, w...

Magnetic Resonance–Guided Placement of Atrial Septal Closure Device in Animal Model of Patent Foramen Ovale

A deployment device for deploying a material into a patient, said deployment device having a housing and a placement device including a retracted condition within the housing for holding a material, in a collapsed condition, within the housing and an extended condition from the housing for disposing and releasing the material at a predetermined site in an uncollapsed condition. A method of deploying a material by placing the placement device in an extended condition and affixing the material to the extended placement device, retracting the placement device into the housing with the material in a collapsed condition, extending the placement device, and placing the material at a predetermined site in an uncollapsed condition.

Franz Freudenthal

Papers

Device for closure of body defect openings

A Blood-Resistant Surgical Glue for Minimally Invasive Repair of Vessels and Heart Defects

Magnetic Resonance–Guided Placement of Atrial Septal Closure Device in Animal Model of Patent Foramen Ovale

Deployment device for cardiac surgery

Three-dimensional echo and videocardioscopy-guided atrial septal defect closure.