Abstract: An anastomosis is performed using a mounting structure mounted on the outside of at least one vessel. The mounting structure includes a flexible mounting structure that is attached to the vessel by a special instrument. A graft vessel is attached to the mounting structure either directly or by means of another mounting structure attached to the graft vessel. Tools for attaching a mounting structure to a vessel are disclosed, and a tool for attaching two mounting structures together is also disclosed. Methods for carrying out the anastomosis according to the invention are also disclosed.

Abstract: An anastomosis is performed using a mounting structure mounted on the outside of at least one vessel. The mounting structure includes a flexible mounting structure that is attached to the vessel by a special instrument. A graft vessel is attached to the mounting structure either directly or by means of another mounting structure attached to the graft vessel. Tools for attaching a mounting structure to a vessel are disclosed, and a tool for attaching two mounting structures together is also disclosed. Methods for carrying out the anastomosis according to the invention are also disclosed.

Abstract: The invention is directed to a medical device for endoscopically ligating and cutting a body vessel. The device may be percutaneously inserted into a patient to perform several possible procedures. The improvements to the device include a hinged jaw capable of grasping and crimping body vessels. An improved clip delivery system and an improved clip which ligate body vessels are also described. The instrument includes a rotating cutting member which provides more efficient body vessel cutting means. Furthermore, the entire system allows a simplified and more efficient method of operation.

Abstract: An anastomosis is performed using a mounting structure mounted on the outside of at least one vessels. The mounting structure includes a flexible mounting structure that is attached to the vessel by a special instrument. A graft vessel is attached to the mounting structure either directly or by means of another mounting structure attached to the graft vessel. Tools for attaching a mounting structure to a vessel are disclosed, and a tool for attaching two mounting structures together is also disclosed. Methods for carrying out the anastomosis according to the invention are also disclosed.

Abstract: A retractor and a surgical tool are positioned within a cannula, and a dissection cradle of the retractor is positioned at the distal end of the cannula. The retractor includes a first portion with an axis approximately parallel to the axis of the cannula and a second portion with an axis skewed relative to the axis of the cannula. The dissection cradle may include two substantially parallel, spaced legs with the retractor shaped in a loop between and in a plane skewed relative to the axes of the legs, and with the loop directed away from the surgical tool. Thus, in operation, when a surgeon locates a vessel and side branch of interest, the surgeon extends the retractor to cradle the vessel in the dissection cradle. Once cradled, the retractor may be fully extended to urge the vessel away from the axis of the cannula to isolate the side branch for exposure to a surgical tool.

Abstract: An endoscopic surgical instrument suitable for use with a needle-grasper having a rotational translation device for creating rotational motion at the distal end of the surgical instrument in a non 1:1 ratio to rotational energy imparted at the handle of the surgical instrument. The shaft of the surgical instrument has an articulated segment capable of remote adjustment to articulate the effector unit at the end of the surgical instrument. The effector unit may be a needle-gripper having an upwardly pointed V-shaped notch in a channeled upper jaw, a convex gripping surface on the lower jaw, such that grasping a curved suture needle between the upper and lower jaw serves to automatically orient the needle perpendicular to the needle-gripper with the curvature pointed down. Conically tapered edges on the upper jaw further facilitate this orientation.

Abstract: A retractor and a surgical tool are positioned within a cannula, and a dissection cradle of the retractor is positioned at the distal end of the cannula. The retractor includes a first portion with an axis approximately parallel to the axis of the cannula and a second portion with an axis skewed relative to the axis of the cannula. The dissection cradle is located at the distal end of the second portion of the retractor, and may include two substantially parallel, spaced legs with the retractor shaped in a loop between and in a plane skewed relative to the axes of the legs, and with the loop directed away from the surgical tool. Thus, in operation, when the surgeon locates a vessel and side branch of interest, the surgeon extends the retractor to cradle the vessel in the dissection cradle. Once cradled, the retractor may be fully extended to urge the vessel away from the axis of the cannula to isolate the side branch for exposure to the surgical tool.

Abstract: A cannula includes a tubular body having proximal closed end and distal blunt end, at least one lumen extending the length of the body, an endoscope having a lighted, viewing end disposed in the lumen near the distal end of the body, and a transparent, tissue separating member substantially covering the distal end of the body. The tissue separating member has a blunt tip disposed from and of the end distal to the body. A method of using such a cannula separates tissue to form an elongated cavity along the course of a small blood vessel and subsequently harvesting the blood vessel.

Abstract: Mechanical retractors for bluntly dissecting tissue at a remote surgical site include extendable element disposed near the distal end of an elongated cannula body with direct mechanical linkage to manual actuators disposed near the proximal end of the cannula body. Individual extendable elements may be arranged in symmetrical or asymmetrical configurations about the central axis of the body for selectively bluntly dissecting bodily tissue in patterns of greater diversity than merely omni-radially as provided by conventional pressurizable balloon tip cannulas.

Abstract: A retractor and a surgical tool are positioned within a cannula, and a dissection cradle of the retractor is positioned at the distal end of the cannula. The retractor includes a first portion with an axis approximately parallel to the axis of the cannula and a second portion with an axis at an angle to the axis of the cannula. The dissection cradle is located at the distal end of the second portion of the retractor, and may include two substantially parallel, spaced legs with the retractor shaped in a loop between and in a plane skewed relative to the axis of the legs, and with the loop directed away from the surgical tool. Thus, in operation, when the surgeon locates a vein and side branch of interest, the surgeon extends the retractor to cradle the vein in the dissection cradle. Once cradled, the retractor may be fully extended to urge the vein away from the axis of the cannula isolate the side branch for exposure to the surgical tool.

Abstract: A cannula and method provide manually manipulable orientation of a dissection probe carried eccentricity on the cannula for rotational and translational positioning relative to the field of view of an endoscope at a distal end of the cannula. Rotation of the cannula at fixed axial position relative to the endoscope, and rotational and translational positioning of the dissection probe relative to the distal end of the cannula provide wide-area access within the surgical site for bluntly dissecting connective tissue surrounding a vessel of interest being harvested.

Abstract: A cannula includes a tubular body having a proximal end and distal blunt end, at least one lumen extending the length of the body, an endoscope having a lighted, viewing end disposed in the lumen near the distal end of the body, and a transparent, tissue-separating tip substantially covering the distal end of the body. The tissue-separating tip is slightly blunted to inhibit avulsion of tissue and lateral vessels along the dissected cavity formed thereby. Endoscopic viewing through the tip is enhanced by tapering the inner walls thereof to a cusp adjacent the blunt tip in order to reduce visual distortion. Alternatively, a cannula includes a dissection probe and a removable or deflectable tip for exposing the probe and endoscope to facilitate viewing and the dissection of connective tissue and lateral vessels along the dissected cavity. Methods of using such cannulas produce an elongated cavity along the course of a blood vessel for subsequent harvesting or other treatment of the isolated blood vessel.

Abstract: A cannula includes a tubular body having a proximal end and distal blunt end, at least one lumen extending the length of the body, an endoscope having a lighted, viewing end disposed in the lumen near the distal end of the body, and a transparent, tissue-separating tip substantially covering the distal end of the body. The tissue-separating tip is slightly blunted to inhibit avulsion of tissue and lateral vessels along the dissected cavity formed thereby. Endoscopic viewing through the tip is enhanced by tapering the inner walls thereof to a cusp adjacent the blunt tip in order to reduce visual distortion. Alternatively, a cannula includes a dissection probe and a removable or deflectable tip for exposing the probe and endoscope to facilitate viewing and the dissection of connective tissue and lateral vessels along the dissected cavity. Methods of using such cannulas produce an elongated cavity along the course of a blood vessel for subsequent harvesting or other treatment of the isolated blood vessel.

Abstract: A cannula includes a tubular body having proximal closed end and distal blunt end, at least one lumen extending the length of the body, an endoscope having a lighted, viewing end disposed in the lumen near the distal end of the body, and a transparent, tissue separating member substantially covering the distal end of the body. The tissue separating member has a blunt tip disposed from and of the end distal to the body. A method of using such a cannula separates tissue to form an elongated cavity along the course of a small blood vessel and subsequently harvesting the blood vessel.

Abstract: A helical fastener having a high retentive surface area is provided and has a first end for enhancing penetration into tissue and a second end comprising a coil sectioning a diameter of the fastener for receiving longitudinal and rotational forces. The helical fasteners are attached to body tissue by a fastener applicator having a proximal portion comprising a handle and an actuator and an elongate distal portion for housing a plurality of fasteners. A transferring action of the actuator provides longitudinal and rotational movement of the fasteners out of the distal portion and into body tissue.

Abstract: An apparatus and method for laparoscopically lifting the abdominal wall utilizes a pair of lifting rods each having a substantially straight proximal portion mounted to a lifting body and an arcuate distal portion joined to the proximal portion. The rods have an insertion configuration, in which their arcuate portions are nested such that the rods may be simultaneously extended into an abdominal cavity, and a lifting configuration in which one of the rods is pivoted such that the arcuate distal portions form a substantially circular lifting area between them. An inflatable balloon is disposed around the lifting arms and is inflated within the abdominal cavity to push abdominal tissue away from the abdominal cavity and to thereby prevent the tissue from catching on the lifting rods during pivoting.

Abstract: A mechanical lifting retractor is provided which increases working space in the chest for cardiac surgery by temporarily expanding the space between the rib cage and the pericardium. The lifting device has a pair of parallel right-angled retractors. Distal portions of the retractors are insertable in side-by-side parallel relation between a pair of adjacent ribs in the rib cage and into the mediastinal space between the ribs and sternum and the pericardium beneath them. The distal portions are pivotable into a lifting position in which they are separated by a rotational angle of approximately 180.degree.. Following insertion of the distal portions into the mediastinal space, the distal portions are rotated into the lifting position and oriented in the sagittal plane such that each distal portion extends beneath one of the ribs. A lifting force is applied to the lifting retractor, causing the distal portions to engage the ribs and to lift the rib cage and thereby enlarging the mediastinal space.

Abstract: An apparatus for tissue dissection and instrument anchoring, including a dissection balloon having a viewing window (preferably a rigid, transparent window) at its distal end, or including an anchoring or dissection balloon having nonuniform elasticity selected to achieve desired inflated shape and pressure characteristics, and methods for using such apparatus. The window, which can be a lens (such as a wide angle lens), is transparent and either rigid or non-rigid but sufficiently strong to retain a desired optical shape while (and after) being pushed against tissue layers by a rigid instrument deployed within the balloon. In preferred embodiments, the balloon is a long-necked dissection balloon deployed through a cannula.

Abstract: Apparatus and method for expanding a perivascular cavity at a surgical site includes an elongated retractor having a tip at the distal end for convenient insertion into a perivascular cavity, and having a slidable coupler near the proximal end for convenient coupling to an elevator element supported in a retractor frame. The elongated retractor supports an endoscope thereon to facilitate visualization of surrounding tissue during insertion into the perivascular cavity. With the retractor inserted in the cavity, the retractor frame is positioned on the skin in alignment with and straddling the cavity, and the elevator element is selectively coupled to the retractor to elevate the retractor relative to the base of the retractor frame, thereby to expand or distend the cavity to provide ample access to tissues and vessels for surgical manipulations within the cavity.

Abstract: A prosthetic strip or patch and associated surgical procedures allow a surgeon to maneuver the strip or patch without the use of laparoscopic graspers. The prosthetic strip or patch includes pockets into which a fastener tool, used to secure the strip or patch to tissue or to ligaments in the body, is inserted in order to maneuver the strip or patch into selected position and then to tack or otherwise attach the strip or patch to tissue at the selected position.