Abstract: A surgical instrument is configured to aid in performing a procedure of detaching an internal mammary artery (IMA) and the like, from the connecting tissues and side branch vessels which surround the artery in its native location, wherein the detaching procedure is preliminary to the performing of a coronary artery bypass grafting procedure and wherein the IMA is detached via a minimally invasive thoracotomy. To this end, an elongated slender rod includes a handle at its proximal end and an artery engaging loop, arc, fork configuration, or hook at its distal working end. Embodiments may incorporate electrosurgical capability or electrical insulation. A surgeon thus has means for harvesting an intact and undamaged graft vessel from its native location through a minimally invasive incision with enhanced speed, visibility, and freedom of motion.

Abstract: A surgical instrument is configured to aid in performing a procedure of detaching an internal mammary artery (IMA) and the like, from the connecting tissues and side branch vessels which surround the artery in its native location, wherein the detaching procedure is preliminary to the performing of a coronary artery bypass grafting procedure and wherein the IMA is detached via a minimally invasive thoracotomy. To this end, an elongated slender rod includes a handle at its proximal end and an artery engaging loop, arc, fork configuration, or hook at its distal working end. Embodiments may incorporate electrosurgical capability or electrical insulation. A surgeon thus has means for harvesting an intact and undamaged graft vessel from its native location through a minimally invasive incision with enhanced speed, visibility, and freedom of motion.

Abstract: A cannula for draining blood from a patient's heart during cardiac surgery including a main body and a pair of branches extending distally therefrom. The branches are biased to extend away from one another by pre-shaped stiffening elements, and have "D" shaped cross-sections defining flat surfaces oriented generally towards one another. The branches may be constrained in a retracted position, the flat surfaces abutting one another, and the resulting profile forming a substantially continuous extension of the main body. The branches have distal tips including drainage holes and occlusion balloons, and elbow portions including accordion-like ridges for preventing kinking. Grooves in the flat surfaces define a secondary lumen in the retracted position through which a cardioplegia delivery or an imaging device may be advanced. The cannula is directed into a trocar to constrain the branches in the retracted position, and the trocar is inserted into the right atrium.

Abstract: A plurality of embodiments of a distal perfusion device are disclosed, which device facilitates anastomosis constructions by maintaining a dry anastomosis site while simultaneously maintaining blood flow distally in the blood vessel to prevent ischemia and reduce overall patient trauma. The perfusion device is configured for installation into a blood vessel such as a left anterior descending coronary artery through an incision therein, to which is to be grafted a distal end of a blood vessel such as an internal mammary artery. The device includes a central member of selected configuration and material, terminating at either end thereof in respective selectively tapered end members. A lumen extending through the central member and end members, and selected perforations in the end members, maintain blood flow through the perfusion device.

Abstract: A surgical dissecting retractor for harvesting vascular conduits or vessels such as saphenous veins and the like is disclosed which dissects tissue and top and/or side branches from the vessel as it is advanced along a desired segment of the vessel via an entry incision in a patient's skin. The dissecting retractor is inserted while in a closed or "low profile" position to minimize trauma to the vessel and patient. Once installed above the vessel, the retractor is opened and locked to present a relatively "high profile", thereby creating and maintaining an enlarged working space or tunnel in the region between the skin and the vessel being harvested. Completion of the vessel harvesting procedure proceeds with suitable surgical instruments for dissecting, ligating, cauterizing and/or clipping, with or without visualizing devices which comprise further adjunct features of the retractors in accordance with the invention.

Abstract: An improved method and apparatus for occluding a blood vessel is shown and described. A cannula adapted for insertion through a wall of a blood vessel is provided with an expandable member on a distal end which when expanded, substantially fills a cross-sectional annular area of the lumen of the blood vessel. An external clamp is coupled to the cannula and aligned with the expandable member, such that when the clamp is engaged, it moves the annular region of the blood vessel into contact with the inflatable member, the inflatable member and clamp thereby working in cooperation to occlude the blood vessel. The cannula may further be provided with a plurality of lumens extending through the cannula to corresponding openings in a distal end of the cannula, thereby allowing the perfusion of different fluids into the lumen of the blood vessel, both upstream and downstream of the internal occluding member, as well as the venting of fluid from the lumen of the blood vessel.

Abstract: The present invention relates to a vascular clamp assembly. The vascular clamp assembly includes at least one bendable elongated shaft with a proximal part and distal part. A pair of clamping members are located at the distal part of the shaft. The clamp includes means for moving the clamping members between an open position and a clamping position.

Abstract: This invention is methods and devices for stabilizing the beating heart during a surgical procedure on the heart. Pursuant to the invention, a stabilizing device is introduced through an opening in the chest and brought into contact with the beating heart. By contacting the heart with the device and by exerting a stabilizing force on the device, the motion of the heart caused by the contraction of the heart muscles is effectively eliminated such that the heart is stabilized and the site of the surgery moves only minimally if at all. Typically, in separate steps, the surgeon contacts the heart with the stabilizing device, assesses the degree of movement of the anastomosis site, and exerts a force on the stabilizing device such that the contraction of the beating heart causes only minimal excess motion at the surgery site.

Abstract: The invention is devices and techniques which use a negative (suction) pressure or vacuum, applied through a surgical instrument, to fix the position of a portion of the surface of a beating heart so that a surgical procedure can be more easily performed. The devices apply a negative pressure at several points on the outer surface of the heart such that a portion of the heart is fixed in place by the suction imposed through the surgical instrument. Because the instrument fixes the position of the tissue, and because the instruments remain at a constant distance from the particular portion of the heart where the surgery is being performed, the device may also serve as a support or platform so that other surgical instruments or devices can be advantageously used at the site.

Abstract: A minimally invasive technique for harvesting saphenous veins and the like for use as autografts in coronary artery bypass grafting surgery include a microsurgical instrument adapted to be demountably secured to the distal end of an endoscope. The instrument is inserted through an entry incision in the patient's skin, at the end of the endoscope which is used by a surgeon to advance the instrument along the saphenous vein, using the vein as a guide for the instrument. The instrument is tapered to provide initial separation of surrounding tissues from the vein, and cutting means supported by the instrument and viewed via the endoscope allow dissection of all tissues and side branch vessels from the saphenous vein. The instrument further provides a protective hood which prevents tissues or skin from blocking the endoscope. The desired length of saphenous vein is transected and is extracted via the entry incision. The technique minimizes trauma to the patient and to the saphenous vein graft.

Abstract: Devices and methods for minimally invasive harvesting of a vessel, especially the saphenous vein for coronary artery bypass grafting, are disclosed which facilitate a minimally invasive vessel harvesting procedure. Generally, an instrument is provided which facilitates introduction of vessel harvesting tools through a minimally invasive incision, and provides the capability to separate the vessel from surrounding tissue while minimizing trauma to the patient and preserving the patency of the vessel. The instrument includes a mechanism for separating the vessel from surrounding tissue and may also include mechanisms for severing side branches from the vessel during the harvesting procedure. In one embodiment, an integrated vessel harvesting assembly is provided which may rotate around a vessel and provides a unitary mechanism for separating the vessel from surrounding tissue and for severing the side branches.

Abstract: A low profile unobtrusive occluder device is disclosed which is particularly applicable for occluding blood vessels in minimally invasive beating heart CABG surgical procedures, wherein relatively small surgical openings are provided. At least one flexible member is provided on the occluder, which is placed against the vessel. A suture thread is passed under the vessel to encompass the vessel between the occluder and suture thread. The suture thread is selectively attached to the occluder such that the flexible member, when deformed, applies continuous selected tension on the suture thread to apply a corresponding compression on the vessel which occludes the flow of blood. An applicator is attached to the occluder to enable installation thereof, but is detachable after installation such that only the low profile occluder remains on the heart surface during surgery. The applicator is re-attached to the occluder to facilitate removal of the latter.

Abstract: An access platform having a first and a second blade interconnected to a spreader member that laterally drives the blades apart or together and support pads interconnected to a blade. A torsional member is operably interconnected to a blade and the spreader member and is used to vertically displace the interconnected blade and, thus, increase a surgeon's working space and visual access for the dissection of an internal mammary artery. A tissue retractor interconnected to the blades and is used to draw the soft tissue around an incision away from the surgeon's working area.

Abstract: The invention is an apparatus and method to perform a surgical procedure within the beating heart. The instrument provides a seal to surround cardiac tissue, thereby defining a segregated surgical field within the body of the instrument. A suction device is preferred to remove blood and fluids from the surgical field so that a surgical procedure can be performed while the heart continues to beat. The instrument is particularly suitable for a procedure to repair defective or diseased cardiac valves, such as the mitral valve; a procedure which previously required that the heart be stopped so that the corrective surgical procedure could be performed.

Abstract: The invention comprises a method for performing a coronary artery bypass graft on a beating heart under thoracoscopic visualization without opening the chest wall. At least one small opening is formed in the patient's chest, a target artery for an arterial blood supply is located, instruments are introduced through one or more small openings formed in the patient's chest to prepare the target artery for fluid connection to the coronary artery, and instruments are introduced through one or more small openings formed in the patient's chest to connect the target artery to the coronary artery distal from a stenosis. In a preferred embodiment, a minimal left anterior intercostal thoracotomy provides access to form an anastomosis between the left internal mammary artery (LIMA) and the left anterior descending artery (LAD) while thoracoscopic viewing facilitates harvesting the LIMA.

Abstract: An access platform having a first and a second blade interconnected to a spreader member that laterally drives the blades apart or together and a sternal pad interconnected to a blade. The superior blade is pivotally coupled to the spreader member such that it naturally rises as the blades are separated. Alternatively, a vertical displacement member is operably interconnected to a blade and the spreader member and is used to vertically displace the interconnected superior blade and, thus, increase a surgeon's working space and visual access for the dissection of an internal mammary artery. A tissue retractor is interconnected to the blades to draw the soft tissue around an incision away from the surgeon's working area.

Abstract: Devices and methods for minimally invasive harvesting of a vessel or vascular conduit, especially the saphenous vein for coronary artery bypass grafting, are disclosed. Generally, an instrument is provided which has one or more specially designed end effectors which are permanently or detachably mounted to a harvesting implement, and may also be interchangeable with each other. The end effectors have features or elements which facilitate separation of connective tissue from the vessel and/or engagement of side branches to be separated from the vessel. In various embodiments, the instrument also provides means for quickly and easily attaching and detaching the end effectors as well as means for engaging with an endoscope, if desired. The harvesting methods provide for use of the instruments through one or more minimally invasive incisions.

Abstract: The present invention relates to an integrated cannula and vascular clamp assembly. The integrated cannula and vascular clamp assembly includes a pair of clamping members made of a physiologically acceptable material that are pivotally coupled to a cannula for movement between an open position for at least partially surrounding a portion of a blood vessel section to be occluded and a clamping position for compressing the blood vessel with pressure sufficient to occlude blood flow through the section.

Abstract: A plurality of embodiments of a distal perfusion device are disclosed, which device facilitates anastomosis constructions by maintaining a dry anastomosis site while simultaneously maintaining blood flow distally in the blood vessel to prevent ischemia and reduce overall patient trauma. The perfusion device is configured for installation into a blood vessel such as a left anterior descending coronary artery through an incision therein, to which is to be grafted a distal end of a blood vessel such as an internal mammary artery. The device includes a central member of selected configuration and material, terminating at either end thereof in respective selectively tapered end members. A lumen extending through the central member and end members, and selected perforations in the end members, maintain blood flow through the perfusion device.

Abstract: Devices and methods for minimally invasive harvesting of a vessel or vascular conduit, especially the saphenous vein for coronary artery bypass grafting, are disclosed. Generally, an instrument is provided which has one or more specially designed end effectors which are permanently or detachably mounted to a harvesting implement, and may also be interchangeable with each other. The end effectors have features or elements which facilitate separation of connective tissue from the vessel and/or engagement of side branches to be separated from the vessel. In various embodiments, the instrument also provides means for quickly and easily attaching and detaching the end effectors as well as means for engaging with an endoscope, if desired. The harvesting methods provide for use of the instruments through one or more minimally invasive incisions.