Abstract: A system for manipulating and supporting a beating heart during cardiac surgery, including a gross support element for engaging and supporting the heart (the gross support element preferably including a head which is sized and shaped to cradle the myocardium of the left ventricle”), a suspension head configured to exert lifting force on the heart when positioned near the apical region of the heart at a position at least partially overlying the right ventricle, and a releasable attachment element for releasably attaching at least one of the gross support element and the suspension head to the heart. The releasable attachment element can be a mechanical element (such as one or more staples or sutures') or an adhesive such as glue. Alternatively, the system includes a suspension head and a releasable attachment element for releasably attaching it to the heart, but does not include a gross support element.

Abstract: Method and apparatus for dissecting tissue along a vessel include a cannula having a tubular body and at least one lumen extending the length of the body to receive an endoscope in the lumen with a viewing end disposed near the distal end of the body that is covered by a transparent, tissue-separating tapered tip. Endoscopic viewing through the tip is enhanced by tapering the inner walls thereof to a cusp adjacent the distal end of the tip in order to reduce visual distortion. Alternatively, a removable or deflectable tip exposes a dissection probe that is manipulatable along a vessel and past lateral branching vessels at the distal end of the cannula as visualized by the endoscope through the transparent tip. Tissue overlaying an artery, for example, the superior epigastric artery, is bluntly dissected to establish an elongated working cavity of bluntly-dissected tissue.

Abstract: A system for use in conducting coronary surgery permits coronary surgery on a beating heart while maintaining cardiac output unabated and uninterrupted. Circumflex coronary artery surgery can be performed using the system. The system includes a first device for engaging and repositioning the beating heart to a displaced position, and is capable of maintaining the heart in the displaced position to perform a surgical procedures. The system includes a second device adapted to engage a portion of the heart to immobilize that portion for conducting a surgical procedure in the immobilized location, while the remainder of the heart continues to beat. Both first and second devices may be adapted to be fixed to a relatively stationary object, such as a frame, which may be a sternal retractor.

Abstract: Surgical apparatus includes bipolar electrodes and tissue-shearing blades configured to electrically contact tissue for electrocauterization thereof prior to shearing contact of the cutting blades with the tissue over wide angles of presentation of the tissue to the electrodes and blades. Extensions or protrusions disposed along facing edges of the electrodes separate the level at which tissue is electrically contacted by the electrodes from the level at which tissue is sheared by the cutting blades.

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 that can be 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, a surgeon locates a vessel and side branch of interest and extends the retractor to cradle the vessel in the dissection cradle. Once cradled, the retractor may be deflected to urge the vessel away from the axis of the cannula to isolate the side branch for exposure to the surgical tool.

Abstract: Surgical procedure and surgical instruments include an electrode structure for insertion through tissue superiorly of a subxiphoid incision to a position posterior of an aspect of the sternum and anterior of the pericardium. The electrode structure may be expanded, for example, including an inflatable member to position a number of electrodes of the electrode structure in contact with the pericardium. Alternatively, an electrode structure on an insertion cannula may be retained in contact with the pericardium by the cannula positioned within the dissected tissue. Electrical conductors from the contacting electrodes are routed through the tract of dissected tissue toward the subxiphoid incision for attachment to a generator that is implanted in a subcutaneous pocket near the subxiphoid incision.

Abstract: A sliding gas-tight seal on an access port promotes insufflation of an anatomical space formed in tissue at a surgical site only during insertion of an endoscopic instrument through the access port into the anatomical space, and promotes deflation of the inflated space upon removal of the endoscopic instrument from within the access port. An inflatable balloon disposed about the port near the distal end may be selectively expanded to seal and anchor the access port within an incision through which a surgical procedure with insufflation is to be performed. Multiple resilient seals may be attached to the body of the port, and an auxiliary resilient seal may be inserted within the aperture of a seal attached to the body to accommodate a wide range of endoscopic instruments of various exterior dimensions inserted through the seals.

Abstract: Endoscopic subxiphoid surgical procedures and instruments facilitate translumination of tissue through the pericardium, and promote encircling an intrapericardial region with one or more tissue-ablating probes for ablating cardiac tissue substantially encircling the left and right pulmonary veins as a treatment for chronic atrial fibrillation. Such endoscopic subxiphoid surgical procedures and instruments also facilitate placement of epicardial tacks about the annulus of the mitral valve for supporting a tensioned suture or band that decreases the size of the mitral annulus to repair a regurgitant valve. Suction-oriented instruments facilitate temporary attachment to an organ to establish precise positioning on the organ during a surgical procedure.

Abstract: A medical punch includes a longitudinally dividable anvil with a reduced cross-sectional dimension facilitating insertion of the anvil into the vessel wall to achieve a clean aperture in the vessel wall by cooperative shearing action of a cutting edge and an anvil edge. In another embodiment, the instrument incorporates a measuring device for determining the thickness of a vessel wall between an anvil and a distal end of a cylindrical structure which together form a caliper, and the measuring device can also constitute a medical punch by cooperative shearing action of a cutting edge and an anvil to achieve a clean aperture in the vessel wall.

Abstract: An organ manipulator including at least one suction member or adhesive disk mounted to a joint providing freedom of movement of the at least one suction member or adhesive disk relative to its support. A method for retracting and suspending an organ in a retracted position using suction (or adhesive force) so that the organ is free to move normally (e.g., to beat or undergo other limited-amplitude motion) in at least the vertical direction during both steps.

Abstract: Apparatus and methods for using the apparatus are disclosed for cardiac restraint. More specifically, the apparatus and methods are directed to accessing the pericardium, accessing the heart within the pericardium, and restraining the heart by at least partially enclosing the heart with the apparatus. An embodiment of a cardiac restraint apparatus according to the present invention comprises a jacket, the jacket having a rim which defines an opening for receiving a heart. The apparatus also comprises a knot pusher that has a hollow elongate body, as well as a strand that extends around the rim of the jacket and is tied into a slipknot. The strand is positioned such that at least one end portion of the strand extends through the knot pusher such that a distal end of the knot pusher can be moved into engagement with the slipknot, whereby pulling the end portion of the strand away from the heart while pushing the knot pusher against the slipknot and reducing the diameter of the opening defined by the rim.

Abstract: A heart retractor links lifting of the heart and regional immobilization which stops one part of the heart from moving to allow expeditious suturing while permitting other parts of the heart to continue to function whereby coronary surgery can be performed on a beating heart while maintaining cardiac output unabated and uninterrupted. Circumflex coronary artery surgery can be performed using the heart retractor of the present invention. The retractor includes a plurality of flexible arms and a plurality of rigid arms as well as a surgery target immobilizing element. One form of the retractor can be used in minimally invasive surgery, while other forms of the retractor can accommodate variations in heart size and paracardial spacing.

Abstract: An apparatus and method for minimally invasive surgery using a cutting tool with rotational cutting edges. The surgical instrument includes a tube having a distal end and a cutting edge at the distal end. A handle is attached to the proximal end of the tube. Within the tube is a shaft having a longitudinally extending blade at its distal end that is adjacent to the distal end of the tube. The blade is revolvable about the longitudinal axis of the instrument to provide rotational cutting action. One or both of the blade and the cutting edge on the tube can be electrically energized to provide for electrocauterization of the body tissue being cut.

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 on the distal end of 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 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 dissection cradle that is resiliently supported along an axis skewed relative to the axis of the cannula. The dissection cradle, in operation, is extended to cradle the target vessel, and the retractor may be fully extended to urge the vessel away from the axis of the cannula to isolate a side branch for exposure to a surgical tool. The retractor includes a hollow support and a spray nozzle disposed in the distal end of the retractor to form an irrigation system and lens washer that can be selectively positioned to direct the spray of irrigation fluid at a remote surgical site or at an endoscopic lens.

Abstract: A method of cooling an organ. A portion of a body fluid bathing an organ is withdrawn while a cool fluid is infused. A separate portion of the body fluid can be cooled during the withdrawing. A volume of up to about 5% of the body fluid can be withdrawn. A catheter is provided with a cooling mechanism to contact and cool the body fluid. The catheter can have an inlet port to withdraw body fluid and an outlet port to allow infusion of a cool fluid. Additionally, an organ cooling pump assembly is provided including a pump and a catheter.

Abstract: A heart retractor links lifting of the heart and regional immobilization which stops one part of the heart from moving to allow expeditious suturing while permitting other parts of the heart to continue to function whereby coronary surgery can be performed on a beating heart while maintaining cardiac output unabated and uninterrupted. Circumflex coronary artery surgery can be performed using the heart retractor of the present invention. The retractor includes a plurality of flexible arms and a plurality of rigid arms as well as a surgery target immobilizing element. One form of the retractor can be used in minimally invasive surgery, while other forms of the retractor can accommodate variations in heart size and paracardial spacing.

Abstract: Surgical construction or bypass grafting of a target vessel includes method and instrumentation and apparatus for forming and inserting a fluid-impervious tubular conduit including a central protrusion through an aperture in the vessel to form a fluid-conducting shunt past the aperture. An anastomosis over the aperture is partially completed with the protrusion of the tubular conduit extending through the partial anastomosis. A removal tube is disposed over the protrusion for applying tensile force thereto relative to the tubular conduit for dissembling the tubular conduit along a continuous path for removal as a single strand from the vessel through the tube and aperture and the partial anastomosis prior to completion of the procedure.

Abstract: A cannula comprises a main body for accommodating both an endoscopic lumen and a working lumen. The main body of the cannula ends at a point proximal to the distal end of the cannula. Extending distally from the point at which the main body end is an endoscopic dissection shaft of decreased diameter, which houses the endoscopic lumen, but not the working lumen. A transparent tapered tip is positioned on the distal end of the endoscopic dissection shaft. Due to the decreased diameter of the endoscopic dissection shaft, the transparent tapered tip has a small diameter, The main body of the cannula ends in a smoothly contoured face that provides minimal trauma to vessel and other tissue that comes in contact with the face as the cannula is advanced through the surgical site.

Abstract: An organ manipulator including at least one suction member or adhesive disc mounted to a compliant joint, a flexible locking arm for mounting such suction member or compliant joint, and a method for retracting and suspending an organ in a retracted position using suction (or adhesive force) so that the organ is free to move normally (e.g., to beat or undergo other limited-amplitude motion) in at least the vertical direction during both steps. In preferred embodiments, a suction member exerts suction to retract a beating heart and suspend it in a retracted position during surgery. As the retracted heart beats, the compliant joint allows it to expand and contract freely (and otherwise move naturally) at least in the vertical direction so that hemodynamic function is not compromised. The suction member conforms or can be conformed to the organ anatomy, and its inner surface is preferably smooth and lined with absorbent material to improve traction without causing trauma to the organ.