Abstract: A suture package (30) including a panel having a series of superimposed subpanels (32a). A suture (20) loops back and forth on the subpanels (32a) such that adjacent loops are retained on adjacent subpanels (32a) and the adjacent subpanels separate the adjacent loops from one another. In the preferred embodiment, an accordion style panel (32) is utilized and the series of subpanels (32a) are folded into a superimposed relationship. Various features are incorporated to reduce the instances or likelihood of kinking and tangling of the suture (20) when pulled from the package (30) by a user.

Abstract: Devices for repairing and replacing a heart valve in various embodiments, the devices include at least first and second support rings connected together in a coiled configuration to abut opposite sides of a valve annulus. A replacement valve may be secured to the coil-shaped device. Various alternative fastening systems include suture fastening systems, mechanical fastening systems, shape memory alloy fastening systems and other fastening systems relying only on the resilience between adjacent coils. A method generally includes inserting a first end of the coil-shaped member through a valve annulus, rotating a first ring of the coil-shaped member into position on one side of the valve annulus and positioning at least a second ring of the coil-shaped member on an opposite side of the valve annulus.

Abstract: Devices for repairing and replacing a heart valve in various embodiments, the devices include at least first and second support rings connected together in a coiled configuration to abut opposite sides of a valve annulus. A replacement valve may be secured to the coil-shaped device. Various alternative fastening systems include suture fastening systems, mechanical fastening systems, shape memory alloy fastening systems and other fastening systems relying only on the resilience between adjacent coils. A method generally includes inserting a first end of the coil-shaped member through a valve annulus, rotating a first ring of the coil-shaped member into position on one side of the valve annulus and positioning at least a second ring of the coil-shaped member on an opposite side of the valve annulus.

Abstract: Devices and methods are disclosed for stabilizing tissue within a patient's body during a surgical operation to provide a relatively motionless surgical field, such as during a coronary artery bypass graft procedure. The devices include tissue stabilizers which engage and provide stabilization to a targeted area of tissue and further have the ability to engage and manipulate some portion of tissue within or adjacent the targeted area to improve the surgical presentation of that portion of tissue. The tissue stabilizer typically has one or more stabilizer feet which have a first foot portion configured to provide stabilization to the targeted tissue and a second foot portion moveable relative to the first foot portion for manipulating a portion of tissue to improve the surgical presentation.

Abstract: A heart valve can be replaced using minimally invasive methods which include a sutureless sewing cuff that and a fastener delivery tool that holds the cuff against the patient's tissue while delivering fasteners to attach the cuff to the tissue from the inside out. The tool stores a plurality of fasteners and is self-contained whereby a fastener is delivered and placed all from inside a vessel. The fasteners are self-forming whereby they do not need an anvil to be formed. Anchor elements are operated from outside the patient's body to cinch a prosthesis to an anchoring cuff of the valve body. The cuff is releasably mounted on the tool and the tool holds the cuff against tissue and drives the fastener through the cuff and the tissue before folding over the legs of the fastener whereby secure securement between the cuff and the tissue is assured. Fasteners are placed and formed whereby fasteners are located continuously throughout the entire circumference of the cuff.

Abstract: Apparatus and methods for replacing a heart valve within a vessel. The apparatus includes a replacement heart valve and a plurality of commisure stabilizers connected to the commisures of the heart valve in a removable manner. The commisure stabilizers position and stabilize the commisures in the proper positions as the replacement heart valve is secured within the vessel. The commisure stabilizers may be removed following securement of the replacement heart valve within the vessel. An expansion or retraction device of the invention assists in properly positioning the valve within the vessel.

Abstract: A system for manipulating a heart during cardiac surgery permits coronary surgery on a beating heart while maintaining cardiac output unabated and uninterrupted. Circumflex coronary artery surgery can be performed using the system. The system locates a suspension head near the apical region of the heart and a gross support near the base of the heart near the AV groove. A frame is positioned within the patient's thoracic region and moves with the patient, and a surgical target immobilizer can be used to assist in the movement of the heart if desired. A special suction cup is used which accommodates multiplanar movement of the heart and the myocardium while also preventing heart tissue from interrupting the suction being applied to the heart. One form of the system can be used in minimally invasive surgery.

Abstract: A heart valve can be replaced using minimally invasive methods which include a sutureless sewing cuff that and a fastener delivery tool that holds the cuff against the patient's tissue while delivering fasteners to attach the cuff to the tissue from the inside out. The tool stores a plurality of fasteners and is self-contained whereby a fastener is delivered and placed all from inside a vessel. The fasteners are self-forming whereby they do not need an anvil to be formed. Anchor elements are operated from outside the patient's body to cinch a prosthesis to an anchoring cuff of the valve body. The cuff is releasably mounted on the tool and the tool holds the cuff against tissue and drives the fastener through the cuff and the tissue before folding over the legs of the fastener whereby secure securement between the cuff and the tissue is assured. Fasteners are placed and formed whereby fasteners are located continuously throughout the entire circumference of the cuff.

Abstract: A system for manipulating a heart during cardiac surgery links lifting of the heart and regional immobilization which stops one part of the heart from moving to allow expeditious suturing while permitting other parts of the heart to continue to function whereby coronary surgery can be performed on a beating heart while maintaining cardiac output unabated and uninterrupted. Circumflex coronary artery surgery can be performed using the system for manipulating a heart during cardiac surgery of the present invention. The system is an improvement on the retractor disclosed in parent application Ser. No. 08/936,184 filed on Sep. 17, 1997 and locates a suspension head near the apical region of the heart and a gross support near the base of the heart near the AV groove. A frame is positioned within the patient's thoracic region and moves with the patient, and a surgical target immobilizer can be used to assist in the movement of the heart if desired.

Abstract: Apparatus and methods for replacing a heart valve within a vessel. The apparatus includes a replacement heart valve and a plurality of commisure stabilizers connected to the commisures of the heart valve in a removable manner. The commisure stabilizers position and stabilize the commisures in the proper positions as the replacement heart valve is secured within the vessel. The commisure stabilizers may be removed following securement of the replacement heart valve within the vessel. An expansion or retraction device of the invention assists in properly positioning the valve within the vessel.

Abstract: A surgical punch prevents tissue debris associated with punching a hole in a patient's tissue, such as an aorta during an anastomosis procedure, from reentering the patient's bloodstream. The punch includes elements that move the debris away from the cutting site and then capture that debris inside the instrument. The punch also includes means for aligning the punch with the selected site and for atraumatically holding the tissue prior to cutting. Various means for moving the tissue debris and for trapping the tissue debris in the instrument are also disclosed.

Abstract: A manipulable hand for use in laparoscopic surgery is disclosed, having a master or control hand with clamps for attaching the master hand to that of an operator, the master hand having at least one finger, the finger having at least one hinge corresponding to an interphalangeal joint in a human hand. The manipulable hand further includes a slave or controlled hand, distally disposed from the operator, the slave hand having at least one finger, the finger having at least one hinge corresponding to an interphalangeal joint of a human finger. Both the master and slave hinges are capable of movement corresponding to flexion and extension of a human finger. The master hand and the slave hand are connected by motion transmission rods or cables, and the movements of the slave hand corresponds one-for-one to the movements of the master hand.

Abstract: The present invention is directed towards an intraluminal manipulator which extends into a lumen and is operable to position and manipulate the tissue surrounding the lumen as necessary during a medical procedure. The manipulator includes a head, a handle and an interconnecting shaft. A pair of cables extend through the shaft and interconnect the head and handle. Movement of a trigger provided by the handle moves the head, which is formed by a series of articulated links, between generally straight and arched configurations. Movement of the trigger in one direction moves the head from a straightened to an arched configuration, while movement in an opposite direction moves the head from the arched to the straightened configuration. When placed in the straight configuration, the head is insertable into and removable from the lumen. When the head is in the arched configuration, it engages the walls surrounding and defining the lumen and can thereafter be used to manipulate the tissue.

Abstract: A pneumatic stapler which contains a mechanism for manual or automatic retaining pin placement. The automatic retaining pin is connected to a set of linkage plates actuable by a series of inflation of bladders in order to create instrument closure on tissue compression and simultaneously create pin placement. An optional manual, curved retaining pin is used in place of the automatic pin system. Further, because this instrument has a ramped anvil mechanism, adjustable staple height is derived. Controlled closure of the mechanism is provided with a detent spring and constant force springs. Upon stapling, the staple encounters an anvil with reduced size, which is kept closed by a latched retaining pin system to allow for reduced width of the anvil so that the stapling head becomes more versatile. Finally, after firing the staples, the mechanism is capable of rapid depressurization and simultaneous instrument opening by a spring return mechanism.

Abstract: A four-row laparoscopic surgical staper cutting mechanism is described wherein stapling and cutting are remotely accomplished. Further, there is disclosed closure means which enable closure and stapling of the apparatus. Finally, such closure can take place either using lever or collar type means. This stapling apparatus is useful in performing surgical stapling functions through the cannula of a surgical trocar.

Abstract: An improved surgical clip having first and second leg members joined at their proximal ends by resilient hinge means and terminating at their distal ends in latch means. Each leg member has an outer surface and a clamping inner surface. The outer surface of each leg member is configured to be accepted by the jaws of a clip applier. The improvement in the clip design specifically relates to the design of the clamping inner surface of each leg member of the clip. The clamping inner surface of the first leg member has a convex radius of curvature extending transversely across at least a portion of the width of the first leg member, and the clamping inner surface of the second leg member has a concave radius of curvature extending transversely across at least a portion of the width of the second leg member. The radius of curvature of the clamping inner surface of the first leg member is smaller than, and complementary to, the radius of curvature of the clamping inner surface of the second leg member.