Abstract: A blunt dissection cannula and method selectively isolate a vessel of interest within the body of a patient by dissecting connective tissue in and about the adventitial tissue plane. The procedure includes selectively advancing the cannula and transparent tapered tip along the vessel of interior to form an insufflated cavity along the course of the vessel while visualizing the vessel and side branches within the field of view of an endoscope through the transparent tip. An electrocautery electrode selectively extends through an access port at the distal end of the cannula, eccentrically relative to the transparent tip, to facilitate visualizing rotational and translational positioning of the electrode to contact and electrocauterize side branches within the field of view through the transparent tip.

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 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 method of separating tissue layers using an inflatable balloon, in which endoscopic visualization may be carried out through the balloon during inflation.

Abstract: An apparatus deployed through a laparoscopic incision in a body wall to apply an external lifting force over a large area of the body wall. The apparatus comprises a body wall engaging element and an elongate lifting member. The body wall engaging element is capable of passing in a packaged state through the laparoscopic incision, is inflatable to an inflated state, and includes, in the inflated state, a plane lifting surface. The elongate lifting member includes a distal portion connected to the plane lifting surface, and capable of passing through the laparoscopic incision. A proximal portion receives the external lifting force in a direction that moves the body wall engaging element into contact with the body wall. A method for lifting a body wall by applying an external lifting force to a large area of the body wall through a laparoscopic incision. The lifting device is provided that includes an body wall engaging element capable of passing through the laparoscopic incision in a packaged state.

Abstract: A lifting apparatus for deployment through a laparoscopic incision in a body wall to apply an external lifting force over a large area of the body wall. The apparatus provides a broad lifting surface that is capable of applying a lifting force of at least 40 pounds (180 Newtons) to an area of a body wall sufficiently extensive to reduce the lifting pressure exerted on the body wall to well below that which could cause pressure trauma to the body wall, yet delivers this broad lifting surface through the body wall via an incision about 14 mm long. The apparatus comprises a body wall engaging element capable of passing in a packaged state through the laparoscopic incision, and being inflatable to an inflated state. In the inflated state, the body wall engaging element is substantially toroidal, provides a broad lifting face, and bounds a central hole. The body wall engaging element includes an equatorial portion facing into the central hole.

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: 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 for retracting an organ inside the body to gain access to an adjacent tissue Includes an inflatable main chamber having a thin, flexible main envelope. Inflation of the main chamber within the body results in retraction of body tissues or organs to retracted conditions. During use an aperture may be formed in the main envelope to provide access through the main chamber to body tissue. An inflatable secondary chamber defines a cage positioned within or around the main chamber and maintains retraction of organs retracted by the main chamber notwithstanding formation of an aperture in the main envelope.

Abstract: A disposable seal assembly for use with a reusable cannula, where the seal assembly is designed for use with the cannula during a single medical procedure and the cannula is designed for multiple uses (each time with a different seal assembly) during a number of medical procedures. The seal assembly includes both a flapper valve fluid seal (for sealing the cannula when no medical instrument is inserted through the seal assembly) and at least one instrument seal (for sealing the cannula when a medical instrument is inserted through the seal assembly). Preferably, the seal assembly has a body with a flange which can be snapped onto the cannula before use, and readily removed after use. Also preferably, the flapper valve has an over-centered hinge. In other embodiments, the invention is a seal assembly which includes at least one double instrument seal including a sacrificial flange and a sealing flange, and optionally also a flapper valve.

Abstract: A surgical procedure includes forming an incision in a patient placed in the right lateral recumbent position to facilitate forming a retroperitoneal cavity. Dissection is formed with a balloon cannula, and the retroperitoneal cavity thus formed is then maintained by a mechanical lift or retractor positioned to elevate the wall of the cavity adjacent the patient's left side. The dissected peritoneum and the underlying bowel are displaced away from the spine by gravity with the patient thus positioned. An endoscope may be introduced into the retroperitoneal cavity to visualize surgery within the cavity including dissection of the iliopsoas muscle to facilitate discectomy and spinal fusion of adjacent vertebrae.

Abstract: A method for repairing a hernia involving utilizing a helical fastener is disclosed. The helical fastener has a length that is placed in a non-parallel relationship with the tissue in the area of the hernia and is rotated into the tissue. An applicator is provided which holds multiple fasteners and is employed to attach the fasteners to the tissue.

Abstract: An apparatus and method for separating a first layer of tissue from a second layer of tissue. A supporting part extends into the interior of the balloon during inflation to provide support for the balloon. The supporting part is retracted to a position outside the interior of the balloon after inflating the balloon. An endoscope is then inserted into the interior of the balloon. The endoscope is moved within the interior of the balloon to change the field of view of the endoscope.

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: A method of harvesting arterial conduits for coronary bypass grafting includes isolating the internal mammary artery and the superior and inferior epigastric arteries through a subcostal incision using a tapered tip balloon dissection cannula. A free end of the isolated artery may be anastomosed to the coronary artery, and a free graft harvested from the inferior epigastric artery may be anastomosed to the subclavian artery for an additional coronary bypass conduit.

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: An apparatus for retracting an organ inside the body to gain access to an adjacent tissue includes a main chamber which is positionable within the body and inflatable to an expanded condition to retract a body organ. The apparatus includes an inflatable additional chamber which when inflated maintains the main chamber in the expanded condition, and the organ in the retracted condition, notwithstanding release of the main chamber from the inflated condition.

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 side-load tolerant instrument, comprising an outer part and an inner part, for use in laparoscopic procedures in a body cavity. The inner part is elongate and includes a housed portion, which is part of the length of the inner part. The outer part is elongate, houses the housed portion of the inner part, and permits the housed portion to move freely axially relative to it. The outer part bends lengthways when an external side load is applied to it. The outer part exerts an internal side load on the housed portion of the inner part to bend the housed portion lengthways to conform to the lengthways bending of the outer part. Side-load tolerance is provided by reducing the internal side load between outer part and the inner part resulting from the outer part bending lengthways in response to the external side load. The reduced internal side load reduces friction between the outer part and the inner part when the instrument is subject to the external side load.

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.