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: The present invention provides an anti-thrombogenic and cellular-adhesion coating composition for blood-contacting surfaces. The coating comprises a covalent complex of from 1 to 30 hydrophobic silyl moieties of Formula I: wherein R1 is an C1-18 alkyl or C6-32 aryl group, each R2 is independently selected from the group consisting of C1-18 alkyl and C6-32 aryl, R3 is N or O, n is a number from 1 to 10, directly bound to a heparin molecule via covalent bonding, with an adhesive molecule directly bound to the heparin molecule. In one embodiment, the coating comprises benzyl-(1,2 dimethyl)disilyl heparin, wherein an adhesive molecule, such as fibronectin, is bound to the heparin.

Abstract: Methods, systems, and kits for subcutaneously implanting articles, such as drug inserts and reservoirs. The methods rely on percutaneously forming a tissue tract and radially dilating the tract to a diameter which permits introduction of the article. By fully expanding the lumenal diameter of the tissue tract prior to introduction of the article, damage to the article resulting from passage through a partially expanded tissue tract can be avoided. In the exemplary embodiment, a radially expandable sleeve is first percutaneously introduced to the subcutaneous target site. An assembly of a cannula and dilator is then passed through the sleeve, effecting radial expansion. The dilator is removed and the article is then introduced through a lumen of the cannula.

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: Combination radiation delivery and chemotherapy devices comprise bioabsorbable structures with radionuclides and chemotherapeutic agents immobilized on said structures. The bioabsorbable structures have a predefined persistence period which is usually substantially greater than the half-life of the radionuclides, thus assuring that the radionuclides remain localized and sequestered at a desired target site while significant radioactivity remains. The radiation delivery and chemotherapy devices are suitable for a wide variety of medical purposes, being particularly suitable for the treatment of solid tumors by injection or open surgical introduction of the devices at a target site. Kits comprising the devices together with instructions for use are also provided.

Abstract: Methods, systems, and kits for subcutaneously implanting articles, such as drug inserts and reservoirs. The methods rely on percutaneously forming a tissue tract and radially dilating the tract to a diameter which permits introduction of the article. By fully expanding the lumenal diameter of the tissue tract prior to introduction of the article, damage to the article resulting from passage through a partially expanded tissue tract can be avoided. In the exemplary embodiment, a radially expandable sleeve is first percutaneously introduced to the subcutaneous target site. An assembly of a cannula and dilator is then passed through the sleeve, effecting radial expansion. The dilator is removed and the article is then introduced through a lumen of the cannula.

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: The present invention provides an anti-thrombogenic coating composition for blood-contacting surfaces. The coating comprises a covalent complex of from 1 to 30 hydrophobic silyl moieties of Formula I: ##STR1## wherein R.sub.1 is a C.sub.1-8 alkyl or C.sub.6-32 aryl group, each R.sub.2 is independently selected from the group consisting of C.sub.1-8 alkyl and C.sub.6-32 aryl, R.sub.3 is N or O, and n is a number from 1 to 10, directly bound to a heparin molecule via covalent bonding.

Abstract: The invention provides improved methods and devices for heating a thermally conductive fluid within an internal body organ to thermally ablate or necrose the body organ. In an exemplary embodiment, the invention provides a thermal ablation device having an elongate member with a proximal end and a distal end. A heating apparatus is provided near the distal end of the elongate member which is constructed to heat a thermally conductive fluid without substantial direct heating of the heating apparatus. A fluid circulator is provided near the heating apparatus which circulates the thermally conductive fluid past the heating apparatus.

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: An access system comprises a radially expandable sleeve, a pneumoperitoneum needle, a cannula assembly, and an obturator. Methods for reconstructing and reusing the access system comprise replacing the radially expandable sleeve and cannula valve cap components of the system, both of which are disposable. All remaining system components may be sterilized and reused one or more times. The pneumoperitoneum needle can be separated into tubular needle body and needle stylet components, which may be separately replaced or sterilized and reused. Similarly the cannula comprises both a cannula hub and a cannula tube, where the hub and tube may be separately replaced or sterilized.

Abstract: An adjustable pnemostasis valve and method for providing a fluid seal around the periphery of endoscopic viewing scopes and instruments having a wide variety of cross-sectional sizes. The valve (8) comprises a first valve member (50) having an opening for receiving an elongated object, such as a percutaneous access device, viewing scope or an endoscopic instrument, and a flexible membrane (60) defining an aperture substantially aligned with the opening in the first valve member. A second valve member (40) is coupled to the flexible membrane for moving the membrane relative to the first valve member. As the membrane is moved by the second valve member, the size of the aperture varies so that the membrane can accommodate various sized instruments.

Abstract: Methods and systems for introducing articles and surgical instruments to target body cavities utilize conformable sleeves which are percutaneously positioned within the cavity. Articles may then be passed directly through the conformable sleeve, without use of a rigid cannula, either by pushing the articles inwardly through the sleeve using an introducer or pulling the articles inwardly through the sleeve using a tapered carrier. Surgical instruments are also passed directly inwardly through the sleeve. Such systems and methods may be used in a variety of minimally invasive surgical procedures.

Abstract: Several poly(ethylene glycol) mixed carbonates and their preparation are closed. These carbonates are synthesized by conversion of polyethylene glycol first to the chloroformate then by reaction with the hydroxyl group of N-hydroxybenzotriazole or 2-hydroxypyrimidine or N-hydroxy-2-pyrrolidinone. These mixed carbonate analogs smoothly react with amino groups in aminoglycans and protein and amino containing surfaces to form stable, hydrolysis resistant carbamate linkages.

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: Plasma polymerized membranes comprising polymerized aliphatic hydrocyclosiloxane monomers optionally copolymerized with co-monomers and methods for their preparation are described. These methods may be used to coat substrates to impart properties such as hydrophobicity, thromboresistance, gas permeability and biocompatibility.

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.