Abstract: Anastomosis devices, methods and apparatus for installing the devices in the performance of an anastomosis. One example of a device includes a central ring portion from which malleable tines and optionally also fastener elements extend. Each tine may have a weakened section at which it preferentially folds or buckles when subjected to bending force. Each tine can grab and evert tissue around an orifice in which it is installed, as it is moved from an initial to a final configuration. To install a device, the tines are advanced against an anvil to cause them to grab tissue around the orifice and curl radially. The anvil is then retracted to fold the tines so their curled ends move radially outward.

Abstract: An anastomosis is performed using a flexible mounting structure mounted on the outside of at least one vessel. Fasteners extend through the vessel and are bent towards the incision to attach the flexible mounting structure to the vessel in a manner that controls the edge of the vessel adjacent to the incision. The mounting structures are oriented on each vessel so fasteners on one mounting structure interdigitate with fasteners on the other mounting structure at the location of contact between the vessels when the two vessels are brought together. This creates two complementary sinusoidal-shaped vessel edges with peaks of one edge being accommodated in the valleys of the other edge. The peak-to-valley orientation forms a sinusoidal-shaped joint which is leak free. The fasteners are spaced so proper pressure is applied to the tissue to promote healing without leaking. Furthermore, the fasteners are sized and shaped to properly engage the tissue and bend in a desired manner.

Abstract: A retractor and a surgical tool are positioned at the distal end of the cannula. A dissection cradle is located at the distal end of a distal portion of the retractor that is resiliently skewed relative to the cannula axis, and includes two substantially parallel, spaced legs with the retractor shaped in a loop therebetween. The procedure includes locating a vessel and side branch of interest and extending the retractor to retain the vessel in the dissection cradle to urge the vessel away from the axis of the cannula in order to isolate a side branch for exposure to the surgical tool.

Abstract: An assembly of cannula and endoscope and dissection tip facilitate surgical procedures at remote surgical site in tissue of a patient. Relative rotation of the cannula about the endoscope from clamped rotational fixation of the cannula and endoscope is made possible by flexing a resilient clamping segment, and such relative rotation promotes convenient positioning of an eccentric tissue-dissecting tip about a vessel being harvested from within tissue of a patient. Color tinting of the tip or color-tinted illumination of tissue at a remote surgical site enhances contrasting visualization through the tip via the endoscope among the tissue types encountered at the surgical site within a patient. A tool bridge or lateral support mounts to a more rigid component such as an endoscope that extends from the proximal end of a cannula to support a more flexible surgical instrument also extending from the proximal end of the cannula.

Abstract: Forming a proximal anastomosis on an aortic wall includes method and instrumentation and apparatus for forming an aortic puncture and inserting a fluid-impervious sealing element with a lateral flange and central stem into the vessel through the puncture. An anastomosis of a graft vessel over the puncture is partially completed with the central stem of the sealing element protruding through the partial anastomosis. A removal instrument attaches to the central stem and retrieves the sealing element that disassembles in helical disassociation of the flange and stem into a continuous strand that is withdrawn from the partial anastomosis prior to completion of the procedure.

Abstract: A ring for use in anastomosis. Preferably, the ring is integrally formed from metal, and includes a ring portion and tines and docking members that extend from the ring portion. The ring portion and tines are malleable, and preferably also the docking members are malleable. The ring portion and tines are malleable in the sense that once deformed from a first shape into a second shape, they will not relax back into the first shape from the second. To install the ring in a vessel with the ring portion extending around an incision or other orifice, the tines pierce the tissue around the orifice and are curled against an anvil. The action of curling the tines inverts the tissue near the orifice edges to expose the inside surface of the vessel or organ.

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: 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: 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 flexible locking arm for use in an organ manipulator apparatus. The flexible locking arm has a flexible state, used to position the organ manipulator as needed, and a fixed state for mounting the manipulator in a desired orientation. Even in the fixed state, the organ manipulator maintains a limited freedom of movement, to allow the organ held to continue to move substantially according to its natural motion during functioning. For example, in an embodiment where a suction member exerts suction to retract a beating heart and suspend it in a retracted position during surgery by setting the flexible arm to the fixed state, as the retracted heart beats, a complaint joint allows it to expand and contract freely (and otherwise move naturally) at least in the vertical direction so that hemodynamic function is not substantially compromised.

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: 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: Apparatus and method for dilation of tissue utilize a tissue expansion device positioned on an inner cannula with an outer overlying expansive sheath that expands upon translation of the tissue expansion device therethrough. The tissue expansion device may be an olive or wedge formed near the tip of the cannula, and the expansible sheath includes two elongated shells that are fixably attached near proximal ends, and that are resiliently connected near distal ends. Translating the tissue expansion device through the expansible sheath expands the dimension of the shells to provide even dilation of surrounding tissue. Additionally, tissue dilation is performed in one continuous motion of retracting the inner cannula through the expansible sheath or pushing the tissue expansion device through the expansible sheath. The outer expansible sheath may be removed from the inner cannula to provide a dissection instrument having minimal outer diameter.

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: 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: 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: 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: A valve assembly. The valve assembly can include valve members with passageways partially non-overlapping. A compression member can be, provided adjacent the valve members. The valve assembly can be incorporated into a medical access device.

Abstract: Apparatus and method for dilation of tissue utilize a tissue expansion device positioned on an inner cannula with an outer overlying expansive sheath that expands upon translation of the tissue expansion device therethrough. The tissue expansion device may be an olive or wedge formed near the tip of the cannula, and the expansible sheath includes two elongated shells that are fixably attached near proximal ends, and that are resiliently connected near distal ends. Translating the tissue expansion device through the expansible sheath expands the dimension of the shells to provide even dilation of surrounding tissue. Additionally, tissue dilation is performed in one continuous motion of retracting the inner cannula through the expansible sheath or pushing the tissue expansion device through the expansible sheath. The outer expansible sheath may be removed from the inner cannula to provide a dissection instrument having minimal outer diameter.