Abstract: An active cannula or sleeve which does more than merely maintain a channel or passage is usable to create and/or enlarge a channel or passage, to position a scope or instrument, to move or locate tissue, etc. The cannula can vary in size or shape as needed, intraoperatively. Because a cannula of the present invention is expandable, the surgeon can make a small relatively small incision, stretch the tissue with the expandable cannula, contract the cannula and remove it, allowing the skin to come back to its unstretched condition. Thus, a smaller incision can be made to fit the same size instrument. This results in less trauma and scarring and an easier operation. The cannulas are or can assume such a non-circular shape, to fit into a natural skin opening and cause less trauma. The devices can be used to seal off a space; to expand an existing space or a potential space for working or visualization; to move tissue (for example, to stretch an incision) or to protect it.

Abstract: An improved laparoscopic apparatus for tunneling to a desired anatomical location and developing a surgical space is disclosed, including a tunneling member adapted to receive a laparoscope therein and an inflatable balloon secured on the tunneling member. The tunneling member has a passage extending between its open proximal and distal ends. A lip is integrally formed on the distal end to retain a laparoscope inserted into the passage, the lip having a substantially rounded and blunt distal edge. The lip defines a recessed or open center area in the distal opening, enhancing the field of view of the laparoscope therethrough. The balloon is formed from flexible, transparent material, and is rolled and secured to the tunneling member.

Abstract: The present invention relates to an expansible tunneling apparatus suitable for tissue dissection. The apparatus is provided with a cannula-loading shaft at its proximal end such that a cannula chosen from a range of different cannulas may be loaded over the cannula-loading shaft and installed in an anatomic space created by the expansible tunneling apparatus. The apparatus is also provided with an inflatable member such as a balloon to accomplish the dissection and a sleeve covering the balloon which are removed from the apparatus before the cannula is loaded on the cannula-loading shaft.

Abstract: A fluid operated retractor for use in surgery. The retractor has a portion that is expandable upon the introduction of fluid under pressure. The expandable portion is made of a material strong enough, and is inflated to enough pressure, to spread adjoining tissues within the body. The retractor is especially useful in fiber optic surgery because it can be inserted percutaneously through a small opening then expanded to a much larger dimension when in the desired location, to retract tissue from within. The retractor may be used to spread a joint such as a knee joint or a shoulder joint, or may be used to separate tissue planes generally to spread a joint such as a knee joint or a should joint or may be used to separate tissue planes generally, to improve visualization and create a working space for the surgeon.

Abstract: Methods and devices for harvesting veins from the body. The methods and devices allow vein harvesting using laparoscopic procedures. A working space is created over the vein using standard laparoscopic procedures and a side-hooked wire is inserted into the working space and twisted to insert the side-hook under the vein. The wire is then pulled or drawn along the vein to separate the vein from the surrounding tissue. In an alternative embodiment, vein separation is accomplished by threading a soft rubber tube under the vein, grasping the ends of the tube so as to surround the vein, and then pulling the tube along the vein. In other embodiments, the working space is created with everting balloons.

Abstract: A retractor for use in arthroscopic surgery. The retractor has a mechanical expanding portion for expanding against sub-surface tissues when the retractor is in use. The retractor also has a fluid-operated expanding portion, which may be independently controllable, for expanding against sub-surface tissues when the retractor is in use. The retractor is inserted through a small percutaneous opening, expanded in sub-surface tissues without significantly damaging the tissue, then collapsed after use for removal. The retractor can be manipulated to allow the surgeon to push or pull or lever on tissue. The retractor can be hollow like a cannula to permit the passage of one or more surgical devices through the retractor, with a side portal into the center of the retractor.

Abstract: A method and apparatus for dissecting a first layer of tissue from a second layer of tissue and thereafter holding open an anatomic space for the performance of a surgical procedure. The method includes steps of making an incision in a body, introducing a deflated balloon dissector into the incision, inflating the balloon dissector to effect dissection of the first layer of tissue from the second layer of tissue, deploying a retractor within the anatomic space in order to hold open the anatomic space, and optionally deflating or evacuating the balloon dissector to open a cavity for surgical manipulations. The apparatus includes a combined dissector-retractor having a balloon retractor disposed upon the surface of the balloon dissector and integrated therewith.

Abstract: A self-supporting retractor for holding open an anatomic space for performing endoscopic surgical procedures. The retractor includes a substantially rigid elongate member, having proximal and distal ends, and having an arch shape or "C" cross-section, defining a passage and longitudinal working window along the retractor. The distal end is preferably rounded or streamlined to facilitate insertion along a dissected space with minimized tissue trauma, and may include a hooded portion enclosing the passage at the distal end. The elongate member may include radially-cooperating segments or self-retaining edges to maximize the area of the space held open by the retractor. The retractor may include a handle or a pivotable finger grip on the proximal end to manipulate the retractor during use, and/or a curved handle to tent the incision providing access to the dissected space. The retractor may also include a channel member for an endoscope, integrally formed or pivotally attached to the retractor.

Abstract: A flexible, fluid-tight envelope provides access for a hand and surgical instruments through a body tissue incision while maintaining insufflation pressure or a pneumoperitoneum within the body. The envelope is transparent and has an interior volume with opposite proximal and distal ends. A first opening in the envelope at the proximal end adjoins the incision in the body tissue and is secured and sealed to the body tissue. The second opening at the envelope distal end is provided with a closure member that seals closed the second opening on itself or around the forearm of a surgeon or a surgical instrument inserted into the interior volume of the envelope.

Abstract: A fluid operated retractor for use in surgery. The retractor has a portion which is expandable upon the introduction of fluid under pressure. The expandable portion is made of a material strong enough, and is inflated to enough pressure, to spread adjoining tissues within the body. The retractor is especially useful in fiber optic surgery because it can be inserted percutaneously through a small opening then expanded to a much larger dimension when in the desired location, to retract tissue from within. The retractor may be used to spread a joint such as a knee joint or a shoulder joint, or may be used to separate tissue planes generally, to improve visualization and create a working space for the surgeon.

Abstract: An inflatable manipulator for organ manipulation during surgery is disclosed. The system typically includes an inflatable balloon connected to an infusion source where the balloon is either coupled to a relatively rigid platform or fitted with a positioning structure such as a pocket. In open heart surgery, the platform is used to position and stabilize the balloon under the heart. In minimally invasive surgery, the balloon fitted with the pocket and can be rolled into a narrow configuration and inserted through a small incision using an insertion device. The insertion device can then be removed once the manipulator is in position. In use, the balloon of the manipulator is inflated by the infusion source thereby elevating and tilting the organ to the desired position for surgical access. Systems including multiple chamber manipulators each with a separate infusion source are also disclosed, as are combined methods for cooling organs during surgery and for using the manipulators to separate adhesions.

Abstract: An improved laparoscopic apparatus for tunneling to a desired anatomical location and developing a surgical space is disclosed, including a tunneling member adapted to receive a laparoscope therein and an inflatable balloon secured on the tunneling member. The tunneling member has a passage extending between its open proximal and distal ends. A lip is integrally formed on the distal end to retain a laparoscope inserted into the passage, the lip having a substantially rounded and blunt distal edge. The lip defines a recessed or open center area in the distal opening, enhancing the field of view of the laparoscope therethrough. The balloon is formed from flexible, transparent material, and is rolled and secured to the tunneling member.

Abstract: The present invention provides balloon dissection apparatus and methods of use in which an elongate balloon is utilized to dissect along a region that follows a naturally existing path alongside a vessel or structure, such as an artery, a vein, a lymphatic vessel, the trachea, the esophagus, or even a nerve bundle.

Abstract: Apparatus for creating an anatomic space in tissue in a body of a patient using a cannula with proximal and distal extremities and a bore extending therethrough to provide an open end. A balloon having an inflated space is provided. The balloon is capable of assuming collapsed and inflated conditions. A retainer is carried by the balloon for forming the balloon when in a collapsed condition into a generally cylindrical roll to aid in inserting the balloon into the tissue. An obturator shaft having a rounded distal end is sized so that it extends through the cannula and into the roll. A laparoscope can be introduced into the obturator shaft to permit viewing through the obturator shaft and the balloon. An inflation tube is provided for inflating the balloon after it is disposed in the tissue to cause the balloon to progressively expand to create separation forces in the tissue to create the anatomic space.

Abstract: Balloon loaded dissection devices with elongate balloons and a pushing member are disclosed for creating a tunnel alongside an elongate vessel in the body. The devices may utilize an elongate balloon of any suitable length which may be formed of an elastic or non-elastic material. The balloon may be of double walled construction and may be provided with a central lumen which may receive a guide rod, scope or other surgical instrument. The device may have a support tube secured to the inner wall of the balloon to provide columnar support for the apparatus. The support tube may have a transparent shroud attached to a distal end of the support tube. There is an open space between the distal end of the support tube and the end of the shroud allowing access to adjacent tissue. The shroud may perform blunt dissection and/or retraction to clear an open space for viewing or for performing surgical procedures.

Abstract: A skin seal or trocar stabilizer with an inflatable membrane disposed inside, whereby medical instruments may be passed through the skin seal into a endoscopic work space while the inflatable membrane is inflated, thereby allowing the use of normal short conventional open surgery instruments during endoscopic procedures and during insufflation.

Abstract: Balloon loaded dissection devices with elongate balloons and a pushing member are disclosed for creating a tunnel alongside an elongate vessel in the body. The devices may utilize an elongate balloon of any suitable length which may be formed of an elastic or non-elastic material. The balloon may be of double walled construction and may be provided with a central lumen which may receive a guide rod, scope or other surgical instrument. The device may have a support tube secured to the inner wall of the balloon to provide columnar support for the apparatus. The support tube receives the guide rod, scope or other surgical instrument and may have a stop member to translate pushing force applied to the guide rod or scope to pushing force on the apparatus. By using the guide rod or scope as a pushing member the apparatus may be advanced alongside the vessel it is desired to dissect free from attached tissue.

Abstract: A combination tissue dissector and long term expander is disclosed for use in plastic surgery applications and other applications where it is desirable to dissect a tissue pocket and serially expand the dissected pocket through long term tissue expansion. The combination device performs the separate functions of dissection and long term expansion in a single balloon package. In an exemplary embodiment, three sheets of substantially inelastic material are bonded together at their outer margins to form two discrete inflatable chambers. The lower inflatable chamber defined by the middle and lower balloon sheets is further welded together at various points over the sheet's surface area to create a semi-rigid base portion which provides a flat well-defined footprint for the balloon. The semi-rigid base prevents further enlargement of the tissue pocket at the margins when the device is utilized as a tissue expander.

Abstract: A method of exposing, ligating and dividing perforating veins endoscopically using balloon dissectors to gain access to the perforating veins, thereby avoiding large incisions required in the Linton procedure and similar open surgical procedures.

Abstract: Methods and devices for harvesting blood vessels from the body using minimally invasive surgical techniques are disclosed. The vessel is dissected from surrounding tissue using the tip of a dissection cannula. The dissected tissue may be retracted, for example, by insufflation. The dissection cannula may further include a balloon that can be inflated after insertion between the vessel and the surrounding tissue. An imaging device may be disposed within the cannula to permit viewing through the distal tip. In another aspect, the balloon is an everting balloon that upon inflation everts and advances along the vessel.