Abstract: Method and apparatus for reconstructing target tissue by grafting uses a stabilizing balloon cannula having an endoscope for visualizing the placement of the graft during the procedure. The method and apparatus advances a sheathed graft to the target tissue, releases the graft at the target site, occludes the target tissue, deploys a graft stabilizing catheter, dissects a cavity outside the target tissue site, maintains the dissection site, and then secures the graft to the target tissue. Alternatively, the method and apparatus creates a cavity extending to the target tissue using an everting balloon cannula with an endoscope, maintains the dissection site, introduces the graft to the target site via the dissection site, and then secures the graft to the target tissue.

Abstract: An apparatus for allowing two retractors, preferably fan retractors, to be used to lift the abdominal wall to provide improved visualization and working space in the abdomen of obese patients, and in the lateral regions of the abdomen of normal patients. The apparatus connects a first retractor and a second retractor to a mechanical lifting arm, and comprises a bar, and first, second, and third connecting devices. The first and second connecting devices are each slidably mounted on the bar, are each lockable to the bar, and connect the first retractor and the second retractor, respectively, to the bar. The third connecting device is attached to the center of the bar and connects the bar to the mechanical lifting arm. The apparatus is used by making a first incision and a second incision in the abdominal wall at separated locations. The first retractor is inserted into the first incision, and the second retractor is inserted into the second incision.

Abstract: An apparatus is described for laparoscopically retracting an organ inside the body to provide surgical access to adjacent tissue. The apparatus includes a thin, flexible envelope which encloses a chamber. The envelope is laparoscopically insertable in a collapsed state into a body cavity, and the chamber is inflatable to an expanded state following introduction of the envelope into the body. Inflation of the chamber causes retraction of adjacent tissue. An elastomeric seal is insertable into the chamber following inflation and is attachable to part of the envelope inside the chamber following inflation of the chamber. The seal provides a gas-tight seal to maintain the chamber in the expanded state, and to maintain the organ in the retracted state, notwithstanding the piercing of an aperture in the part of the envelope covered by the seal.

Abstract: The invention provides an apparatus and method for manipulating parts of the body in surgical procedures, particularly useful for peritoneal distension in laparoscopic surgery. The apparatus comprises a positionable support structure having an extendible horizontal arm rotatably mounted to an extendible vertical post, the post having a clamp at its lower end for mounting to a surgical table. An end segment at the distal end of the horizontal arm has a mount for mounting end-of-arm tooling, for example, peritoneal distension instruments. Locking mechanisms are disposed in the horizontal arm, vertical post and end segment to lock the support structure in a desired position. A motor is disposed within the vertical post for power-assisted extension and retraction of the vertical post. Preferably, the locking mechanisms and motor are controllable using switches mounted on the end segment.

Abstract: A trocar for placement in the lumen of a cannula to facilitate inserting the cannula through tissue is disclosed. The trocar has an improved trigger/obturator assembly wherein the trigger comprises tissue cam parts each having (a) planar outer surfaces, and (b) an arcuate end portion at the distal end of the trigger including a distal edge surface that is arcuate about an axis normal to the outer surfaces. The arcuate end portions intersect at edge surfaces which are obscured by the arcuate end portions.

Abstract: An inflatable apparatus for organ retraction includes a main envelope which forms a main chamber. An additional chamber is formed by attaching the periphery of an additional envelope to the outside or the inside of the main envelope. The part of the surface of the main envelope that is not covered by the additional envelope provides a plurality of windows, which, after the additional chamber is inflated, may be at least partially removed to provide apertures through which treatment or observation can be carried out.

Abstract: In a method for retracting an organ inside the body to provide access for treating a tissue, a retractor having a main envelope which defines a main chamber is positioned in a collapsed state adjacent to the organ to be retracted. The main chamber is subsequently inflated to retract the adjacent organ. A surgical instrument is passed through the main envelope into the main chamber to contact the tissue for treatment.

Abstract: A cannula is extended through the wall of a body cavity by a trocar having a piercing head slidable through the cannula between a condition extending distally from the cannula and a condition retracted within the cannula. A latch releasably secures the piercing head in the extended condition against the force of a spring which normally biases the piercing head to the retracted condition. Resiliently biased plungers extend longitudinally of the piercing head for retraction in response to counterforce as the piercing head advances through the wall of a body passage and extension upon the release of the counterforce. Extension of the plungers upon release of the counterforce functions to release the piercing head for retraction.

Abstract: A first inflatable retraction device has a first inflatable chamber and a non-pressurized chamber inside the main chamber. The non-pressurized chamber is expanded by inflating a second inflatable chamber. The non-pressurized chamber enables the main chamber to remain inflated when an aperture is cut in the envelope of the main chamber, through which treatment is carried out. A second inflatable retraction device has an inflatable retractor and a maintainer. The inflatable retractor retracts the organ and the maintainer maintains the organ in its retracted condition after the inflatable retractor is deflated. The maintainer can be inflatable, and can be inside or outside the inflatable retractor. A self-retracting endoscope has an optical assembly with an expandable retractor fitted to its distal end. The distal end of the endoscope is inserted into the body with the retractor in a collapsed condition.

Abstract: A method and apparatus for mechanically lifting the abdominal wall away from underlying abdominal organs for laparoscopic surgery without insufflation. In the method an expansible device is inserted in the abdominal cavity through a small incision in a collapsed state and then expanded into engagement with an extensive area of the abdominal wall. Lifting force is then applied to the device for peritoneal retraction. The device takes the form of mechanical rods or arms and/or balloons. In the balloon embodiments lifting force may be applied externally of the abdominal cavity, or internally of the cavity by balloon inflation. Certain of the balloon embodiments are of an annular or U-shaped configuration and include a membrane for draping the internal organs and/or a centrally located balloon for lateral expansion. The balloons may be provided with an internal endoscope for viewing. The method also provides for laparoscopic gallbladder removal, either to the interior or exterior of the balloons.

Abstract: A fan retractor has a pair of angle-shaped elements moveable relative to one another. The angle-shaped elements include first legs disposed in a generally parallel relationship, and second legs that extend laterally from the first legs, and are adapted for engaging with the abdominal wall. The second legs fan out upon rotation of the first legs relative to one another and have an effective thickness, measured in the direction defined by the first legs, that decreases distally from the first legs. The retractor also includes a lifting device that applies a lifting force to the angle-shaped elements.In variations, the second legs have a stiffness that decreases distally from the first legs; the first legs are linked so as to contrarotate relative to one another; the retractor includes a lifting force indicator; and the lifting device unidirectionally applies the lifting force to the angle-shaped elements.

Abstract: Apparatus for coupling a light beam from a light source to a light fibre with reduced heating of the light fibre. The light source has a lamp, a condenser lens, and a dichroic infra-red filter disposed along an optical axis between the lamp and the light fibre. The apparatus is adapted for operation with plastic light fibres that have a softening temperature of less than 100 degrees Celsius. The apparatus comprises light fibre connector that secures the light fibre on the optical axis. A non-visible radiation filter is located on the optical axis in a broad part of the light beam between the dichroic filter and the light fibre and reduces non-visible radiation energy remaining in the light beam following the dichroic filter. A beam restrictor is located on the optical axis adjacent to, and thermally isolated from, the light fibre connector.

Abstract: An apparatus for suturing deep puncture wounds utilizes a capturing member which is pivotally mounted to the distal end of an elongate rod. During use, the capturing member is inserted into a body cavity through a trocar sheath positioned in a wound and pivoted into a position in which it extends beneath the tissue surrounding the wound. A membrane or other suture-capturing surface is formed on the surface of the capturing member. A suture to be applied to the wound has anchors on each of its ends, and suture-carrying needles carry each of the suture ends and their corresponding anchors. The suture-carrying needles are individually passed through the tissue layers surrounding the wound and subsequently passed through the membrane of the capturing member. The suture ends and corresponding anchor means are released from the needles.

Abstract: A fan retractor for laparoscopic surgery has a pair of angle-shaped elements with first legs disposed in parallel relationship to one another and second legs extending laterally from the first legs for movement between a juxtaposed collapsed condition and a fanned-out expanded condition responsive to rotation of the first legs about their longitudinal axes. Actuators are provided on the first legs to move the second legs between the collapsed and extended conditions. A first lock engages the actuators to lock the second legs in the extended condition and against movement toward or away from one another. A second lock in the form of a block slidably received on the first legs is selectively engageable between the second legs when in the extended condition. When engaged, the second lock serves both to block the second legs from movement toward one another and to restrain the first legs against movement away from one another.

Abstract: A method and apparatus for creating a surgical work space by lifting the abdominal wall and retracting abdominal organs during surgery utilizes a pair of lifting rods each hinged at their distal ends to opposite ends of an elongate cross-member. One of the lifting rods is slidable within a strap fastened to the proximal end of the other of the rods. The hinged relation of the lifting rods to the cross members and the sliding relation of the lifting rods to each other allow the apparatus to be pivoted into a streamlined configuration to facilitate insertion into a puncture opening in an abdominal cavity, and then to be pivoted into a triangular frame for defining an area of the abdominal wall to be lifted. After insertion the apparatus is locked into the triangular configuration, connected to a lifting arm, and lifted to cause the retraction rods to lift and support the abdominal wall.

Abstract: A trocar assembly consisting of a trocar tube subassembly and a separate interengageable trocar body subassembly is provided. The trocar body subassembly includes an elongated obturator having a sharp pointed tip which is normally housed within an elongated tube of the trocar tube subassembly. The obturator is extendable from a retracted position within the tube wherein the tip is recessed from the tube end to an operative position forward of said tube end and outside the tube. By manually advancing the trocar assembly against a body wall, the resisting force locks the obturator in the operative position. Relaxation of the force incident to passing through the body wall causes the obturator to be automatically unlocked and retracted to its initial position with the tip positioned protectively within the tube, thereby protecting body tissues and organs from being damaged by the tip when it enters a body cavity beyond the wall.

Abstract: An output video signal is derived from an input video signal generated by an image sensor in response to an image formed on only part of the image sensor. The output video signal is derived in response to only the portion of the input video signal generated by the part of the image sensor on which the image is formed. The input video signal additionally includes a portion generated by the part of the image sensor on which the image is not formed. An image signal generating apparatus is provided in which the image sensor is mounted, and which includes a detachably-attached image-forming device. When attached to the image signal generating apparatus, the image-forming device forms the image on the part of the image sensor. A frame of the input video signal is received from the image sensor.

Abstract: A system for separating a first layer of tissue from a second layer of tissue and for maintaining separation of the first layer of tissue from the second layer of tissue while providing access to at least one of the layers of tissue. The system comprises a main envelope which defines a main inflatable chamber, an introducing means and an insufflating means. The introducing means includes a main cannula portion to which the main envelope is attached. The introducing means is for introducing the main envelope in a collapsed state between the first layer of tissue and the second layer of tissue, and for inflating the main envelope into an expanded state to separate the first layer of tissue from the second layer of tissue, and to create a working space between the first layer of tissue and the second layer of tissue. The insufflating means includes an auxiliary cannula portion to which an auxiliary envelope defining an auxiliary inflatable chamber is attached.

Abstract: Retraction of an organ or tissue plane to be retracted is performed to gain access for a surgical instrument to treat an organ or tissue plane to be treated. An inflatable retractor, including a main envelope enclosing a main chamber, is provided with the main envelope in a collapsed state. The main envelope of the retractor is placed adjacent the organ or tissue plane to be retracted. The main chamber is inflated to an expanded state to retract the organ or tissue plane to be retracted. An aperture is pierced in the main envelope to provide access for the surgical instrument passed into the main chamber to contact an organ or tissue plane to be treated while the main chamber is maintained in the expanded state, notwithstanding the aperture pierced in the main envelope. The organ or tissue plane to be retracted and the organ or tissue plane to be treated may be different parts of the same organ or tissue plane.

Abstract: A trocar assembly is provided wherein the obturator having a piercing tip and a sleeve around said obturator are housed within the trocar cannula. In the extended position the obturator tip and a portion of the distal end of the sleeve extend from the distal end of the cannula. During insertion of the obturator tip, sleeve and cannula into tissue, the force of tissue as the obturator penetrates the tissue which surrounds the exposed sleeve sensitizes the sleeve. At the proximal end of the sleeve a triggering mechanism is provided whereby upon release of the force of the sleeve at its distal end upon penetration through the tissue the sensitized sleeve releases to activate the triggering mechanism which retracts the obturator tip into the housing.