Abstract: A target tissue localization device (28) has outer and inner members (30, 32) which are longitudinally movable relative to one another. An anchor (42) is secured to the outer and inner members and is movable from a radially-contracted configuration to a radially-expanded configuration. The anchor may be a tubular mesh anchor. The anchor may have a sufficiently large cross-sectional area when in the radially-expanded configuration to substantially eliminate inadvertent dislodgment of the anchor once radially-expanded. In use, the location of the target tissue (56) is determined and the distal end of the localization device is passed through the patient's skin (58) and to the target tissue to create a tissue track (60) between the patient's skin and the target tissue. The target tissue includes near and far sides (62, 64). The anchor element, located at the target tissue is expanded to an expanded configuration. The method the anchor element may be located on the far side of the target tissue.

Abstract: An apparatus and method for forming and enlarging percutaneous penetrations comprises an elongate dilation member which receives an elongate expansion member in an axial lumen thereof. The dilation tube includes a tubular braid which usually comprises a mesh of non-elastic filaments which are radially expandable from a small diameter configuration to a large diameter configuration and which is optionally covered by a removable sheath. The dilation tube is percutaneously introduced to a target site within a patient's body, usually within the abdomen in a laparoscopic procedure. The sheath (if present) is then removed, and the tubular braid thereafter radially expanded by axial insertion of the expansion member through its lumen. The tubular braid is anchored by axial shortening of the mesh and remains in place to permit subsequent exchange of dilation members to provide for different diameter access lumens.

Abstract: Medical guidewires have coiled proximal ends which allow and facilitate management of guidewires during use in an operating room.

Abstract: Devices and methods for providing access to a body cavity without substantial loss of inflation gas therein. The device comprises an access assembly 10 that may have a tubular member 12, at least one sleeve 16 coaxially disposed over the tubular member, a pneumostasis valve 13 attached to the tubular member, and an obturator 11 removably received in the tubular member. Sleeve 16 comprises expandable region 19 capable of forming an anchor 30 upon axial compression. A method to provide access using assembly 10 comprises insertion of the assembly 10 into the body cavity, expanding region 19, and insufflating the cavity with gas. Expandable region 19 on assembly 10 is axially compressed to form anchor 30 to seal against an interior wall of the body cavity. The method may further comprise either a second expanded anchor 50 or a non-expanding anchor 40 which clamps against an exterior wall of the body cavity to securely position and seal the access assembly 10.

Abstract: A thermal ablation catheter includes an elongate body member having a heating element disposed over a predetermined length of its distal end or within an axial lumen. The heating element is suspended away from an exterior surface of the elongate member to form a circulation region thereunder. Alternatively, the heating element is distributed over some or all of the axial lumen. Thermally conductive fluid can be introduced through the lumen in the elongate member and into the circulation region to effect heat transfer. The catheter is used to introduce the thermally conductive medium to a hollow body organ where the heating element raises the temperature of the medium sufficiently to induce injury to the lining of the organ. Optionally, an expandable cage in the catheter or on an associated introducer sheath may be used in combination with a thermal ablation catheter.

Abstract: A cervical access device includes a tubular body having a proximal end, a distal end, and a lumen extending therebetween. A first expansible occlusion member is disposed near the distal end of the tubular body, and a second occlusion member is proximally spaced apart from the first occlusion member. Together, the first and second occlusion members define a reduced diameter neck for receiving the cervical os. In an exemplary aspect, the first occlusion member includes an evertible cylindrical surface which assumes a conical configuration which diverges in the distal direction when actually compressed. The second occlusion member can also be provided with a conical configuration which diverges in the proximal direction so that the first and second occlusion members when brought together define a neck having opposed tapered walls. A catheter for providing thermal treatment to the uterus can be introduced through the cervical access device to perform thermal treatment on the uterus.

Abstract: An apparatus and method for percutaneous placement of access tubes, such as feeding and drainage tubes, vascular catheters, and the like, comprises an elastic access tube in an internal stylet. The stylet is received within a central lumen of the access tube and is used to axially elongate the tube, resulting in a reduced diameter. In a first embodiment, the diameter of the access tube is reduced sufficiently so that it can be placed through a relatively narrow penetration and so that it will radially expand by an amount sufficient to cause a tight anchor and seal against the penetration when the stylet is removed. In a second embodiment, the stylet has a sharpened distal tip which extends beyond the distal end of the access tube when in its axially extended configuration. The sharpened tip allows self-introduction of the assembly of access tube and stylet. In a third embodiment, a distal portion of the access tube is covered with a lubricous sheath.

Abstract: A thermal ablation catheter includes an elongate body member having a heating element disposed over a predetermined length of its distal end. The heating element is suspended away from an exterior surface of the elongate member to form a circulation region thereunder. Thermally conductive fluid can be introduced through a lumen in the elongate member and distributed within the circulation region to improve heat transfer. The catheter is used to introduce the thermally conductive medium to a hollow body organ where the heating element raises the temperature of the medium sufficiently to induce injury to the lining of the organ. Optionally, an introducer sheath having an expandable cage at its distal end may be used in combination with a thermal ablation catheter. The expandable cage helps center the heating element on the catheter within the body organ and prevents direct contact between the heating element and the wall of the organ.

Abstract: An apparatus and method for forming and enlarging percutaneous penetrations comprises an elongate dilation member which receives an elongate expansion member in an axial lumen thereof. The dilation tube includes a tubular braid which usually comprises a mesh of non-elastic filaments which are radially expandable from a small diameter configuration to a large diameter configuration and which is optionally covered by a removable sheath. The dilation tube is percutaneously introduced to a target site within a patient's body, usually within the abdomen in a laparoscopic procedure. The sheath (if present) is then removed, and the tubular braid thereafter radially expanded by axial insertion of the expansion member through its lumen. The tubular braid is anchored by axial shortening of the mesh and remains in place to permit subsequent exchange of dilation members to provide for different diameter access lumens.

Abstract: Percutaneous access devices are provided with cleaning elements for in situ cleaning of viewing scope lenses during surgical procedures. The access devices will comprise a cannula having an access lumen therethrough. The cleaning element will be disposed at or near the distal end of the cannula, preferably over or across a distal port of the cannula. The cleaning element may comprise an elastomeric membrane, an open cell foam pad, one or more articulated plates, or a combination thereof. Cleaning of the lens of the viewing scope is effected by moving the lens between positions proximal of and distal to the cleaning element.

Abstract: An apparatus for forming and enlarging percutaneous penetrations comprises an elongate dilation tube which receives an elongate expansion member in an axial lumen thereof. The dilation tube is radially expandable from a small diameter configuration to a larger diameter configuration. The dilation tube is percutaneously introduced to a desired target site within a patient's body and thereafter radially expanded by axial insertion of the expansion member through the axial lumen of the tube. The tube prevents the application of axial forces on the surrounding tissue as the expansion member is introduced. The expansion member may include a separate outer sleeve member which remains in place to maintain the enlarged access channel. Optionally, an inflatable balloon at the distal end of the dilation tube may be provided to enhance retention of the device and sealing of the penetration.

Abstract: A tissue expander device comprising a thin expandable cover and a concave base is disclosed. Together, the cover and the base form an envelope with a cambered interior chamber concave on the base and convex on the cover. The volume of the envelope is adjusted by introducing fluid into the chamber. As the device is inflated, the radius of curvature of the cambered base is gradually increased until the base becomes substantially planar when the device is fully inflated. Since the concave base becomes planar when the device is fully inflated, the surface of the device contacting the thin overlying skin is smooth and continuous thus reducing erosion of the skin flap by the edge of the base.

Abstract: An injection reservoir or button is adapted for implantation beneath the skin of human and animal patients in conjuction with tissue expanders and drug delivery devices. The injection reservoir includes a base and an exterior wall which define a chamber of liquid reservoir. A duct connects the chamber with an expandable bag of the tissue expander. An elastic rubber member is affixed within the interior of the chamber to act as a sealing member. The rubber member is an inverted dome and is self-sealing to needle punctures because it has a concave interior side which is under compression as a result of having been manufactured into a substantially dome-shaped configuration and thereafter inverted. A metal guard plate is included within the interior of the chamber to guard the base against accidental puncture by an over extended hypodermic needle.

Abstract: An injection reservoir or button is disclosed which is adapted for implantation beneath the skin of human and animal patients in conjunction with tissue expanders and drug delivery devices. The injection reservoir includes a base and an exterior wall which define a chamber or liquid reservoir. A suitable duct connects the chamber with an expandable bag of the tissue expander. An elastic rubber member is affixed within the interior of the chamber in a configuration wherein its side abutting the chamber is in compression, thereby rendering the member self-sealing to punctures by a hypodermic needle. A metal guard plate is included within the interior of the chamber to guard the base against accidental puncture by an over-extended hypodermic needle.

Abstract: An injection reservoir or button is disclosed which is adapted for implantation beneath the skin of human and animal patients in conjunction with tissue expanders and drug delivery devices. The injection reservoir includes a base and an exterior wall which define a chamber or liquid reservoir. A suitable duct connects the chamber with an expandable bag of the tissue expander. An elastic rubber member is affixed within the interior of the chamber in a configuration wherein its side abutting the chamber is in compression, thereby rendering the member self-sealing to punctures by a hypodermic needle. A metal guard plate is included within the interior of the chamber to guard the base against accidental puncture by an over-extended hypodermic needle.

Abstract: A tissue expander, of the type containing within the interior of its expandable shell an injection reservoir self-sealing to punctures by a hypodermic needle, is disclosed. The tissue expander includes a reinforcing member or insert which is substantially more rigid than the expandable shell, is larger than the injection reservoir, and is mounted to the expandable shell with its center substantially at the apex of the shell and substantially superimposed with the center of injection reservoir. The reinforcing member substantially prevents folding of the expandable shell over the injection reservoir and thereby substantially prevents inadvertent puncture of the expandable shell by a needle which is directed into the injection reservoir. Magnetically detectable material is mounted into the injection reservoir to enable an externally applied magnet locator to find the injection reservoir when the entire tissue expander assembly is temporarily implanted in a patient.