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: 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: 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: 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: 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.

Abstract: An access and cannulation device includes a mounting element such as the anastomosis mounting element disclosed in U.S. application Ser. No. 08/714,615 (now U.S. Pat. No. 5,868,763) and U.S. application Ser. No. 09/200,796. The device is used to provide access therethrough and via an incision to the interior of a hollow anatomical structure such as a vessel, an organ or the like during surgery, especially minimally invasive surgery. It includes a flexible sleeve with a suture therein for closing the sleeve and locating edges of the structure adjacent to the incision in position for proper healing after completion of a surgical procedure. A tool is also disclosed for manipulating the device to configure it for the surgery and to close it after completion of the surgery whereby the edges of the wall of the structure adjacent to an incision are approximated to promote proper healing.

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: 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: 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: 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: 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: 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.

Abstract: An organ-stabilizing element is covered with a layer of textile material such as cloth enhance slip-free engagement with an organ such as a beating heart during surgery thereon. The organ-stabilizing element is supported on a stacked structure of successive ball elements and rings that can be selectively flexible or rigid in response to tensioning of a flexible cable within a central bore of the structure.

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 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 system for manipulating a heart during cardiac 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 locates a suspension head near the apical region of the heart and a gross support near the base of the heart near the AV groove. A frame is positioned within the patient's thoracic region and moves with the patient, and a surgical target immobilizer can be used to assist in the movement of the heart if desired. A special suction cup is used which accommodates multiplanar movement of the heart and the myocardium while also preventing heart tissue from interrupting the suction being applied to the heart. One form of the system can be used in minimally invasive surgery.

Abstract: A method and apparatus for pressurizing the right atrium or right ventricle of a beating heart during surgery to assist cardiac function. The apparatus has an intake tube for insertion in the inferior or superior vena cava, a return tube for insertion in the right atrium or right ventricle, and a pump (e.g., a peristaltic pump). In operation, blood is pumped from the vena cava into an intake port of the intake tube, from the intake tube through the pump to the return tube, and from the return tube to the right atrium or right ventricle. Optionally, a balloon mounted around the intake tube's distal end is inflated to center the intake port in the vena cava and provide a pressure bulkhead. The pump preferably pumps blood in one direction from an input port to an output port.

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: A clip which can be temporarily clamped to a cut edge of a pericardium during heart surgery. Two or more of the clips, which may be each connected to a respective flexible member, are clipped to the pericardium and tension is applied to the connectors to suspend the clips and the pericardium, as well as the heart, form a support, while enabling the heart to continue to beat normally.

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.