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, is transparent and either rigid or non-rigid but sufficiently strong to retain a desired optical shape while 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. In other embodiments, the invention is a dissection balloon assembly including a long-necked dissection balloon having a viewing window at its distal end, and a housing to which the dissection balloon's mouth is attached.

Abstract: An apparatus and method for separating tissue layers and providing a working space for performing a medical procedure. A first balloon is inserted between the tissue layers and inflated to dissect the tissue layers. A second balloon is also positioned between the tissue layers and inflated to retract the tissue layers. The first balloon is then deflated and punctured with a sharp instrument to created an opening in the first balloon. The second balloon is positioned to impeded the escape of insufflation fluid from the working space and the working space is then insufflated. An instrument for performing the medical procedure may then be introduced into the working space through the opening in the first balloon.

Abstract: An apparatus and method for cauterizing small vessels through small incisions or puncture openings is described. The apparatus is comprised of a pair of elongate electrodes capable of being inserted into a hollow needle. In a preferred embodiment, the elongate electrodes are disposed within a tube that is slidable in a longitudinal direction between a proximal position, in which the tube releases the electrodes into an outwardly biased position, and a distal position in which the electrodes are enclosed by the tube. The device is introduced into a body cavity with the tube in the distal position. The tube is then moved to its proximal position to release the electrodes, and a vessel is grasped using hooks at the electrode tips. A different electrical polarity is applied to each electrode, causing current to pass through the vessel from one electrode to the other to cauterize the vessel.

Abstract: A method and apparatus for creating a surgical work space by lifting the abdominal wall and retracting abdominal organs during surgery utilizes a lifting body having two or more retraction rods supported by the lifting body. The rods are designed to be introduced into the abdominal cavity through a laparoscopic puncture opening and to be extended within the abdominal cavity to provide a lifting area. In the preferred embodiment, a pair of retraction rods disposed with the bores and substantially parallel to each other are inserted into the abdominal cavity through an incision in the abdominal wall. The retraction rods are spread apart from each other while their parallel orientation is maintained. The lifting body is connected to a lifting arm and lifted, causing the retraction rods to lift and support the abdominal wall.

Abstract: An apparatus for separating a first layer of tissue, such as the peritoneum, from a second layer of tissue, such as the properitoneal fascia. The apparatus includes a main envelope that defines a main inflatable chamber. The apparatus also includes an introducing device that introduces the main envelope in a collapsed state between the first layer of tissue and the second layer of tissue. The introducing device also inflates 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 two layers of tissue. Finally, the apparatus includes an insufflating device that introduces insufflation gas into the working space between the two layers of tissue.A method for separating a first layer of tissue from a second layer of tissue provides a main envelope and insufflation gas. The main envelope defines a main inflatable chamber.

Abstract: A balloon anchor provides for the anchoring of a surgical instrument, such as conventional trocar sheath, within a puncture opening formed by a trocar. When used on a trocar sheath, the anchor is secured to the smooth outer surface of the sheath for extension through the puncture opening as the trocar within the sheath forms the opening. Adhesive or mechanical means are provided to secure the balloon the instrument. No modification to the structure of the instrument is required. Once in place within the opening, the balloon is inflated to the interior of the tissue to anchor the instrument in place. Certain embodiments also provide for inflation of the balloon within and/or to the exterior of the opening.

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: 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 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 seal for use in a surgical instrument to provide a gas-tight seal with an instrument passed through the seal. The seal can form a gas-tight seal with an instrument having a diameter within a wide range of diameters. The seal comprises a seal body, an instrument seal, and a laterally-compliant seal mounting device. The seal body includes a bore through which the instrument is passed. The instrument seal is made of an elastic material and is disposed substantially perpendicular to the axis defined by the bore in the seal body. The instrument seal includes an instrument port through which the instrument is passed. The laterally-compliant seal mounting device mounts the instrument seal to the seal body, forms a gas-tight seal between the instrument seal and the seal body, and allows the instrument seal to move freely laterally in response to lateral movement of the instrument.

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: An apparatus and method for separating tissue layers and providing a working space for performing a medical procedure. A first balloon is inserted between the tissue layers and inflated to dissect the tissue layers. A second balloon is also positioned between the tissue layers and inflated to retract the tissue layers. The first balloon is then deflated and punctured with a sharp instrument to created an opening in the first balloon. The second balloon is positioned to impede the escape of insufflation fluid from the working space and the working space is then insufflated. An instrument for performing the medical procedure may then be introduced into the working space through the opening in the first balloon.

Abstract: A gas-sealed instrument for use in laparoscopic procedures in a gas-insufflated body cavity. The instrument comprises a static portion, a moving portion, and a sealing means for preventing gas from escaping from the body cavity through the static portion. The static portion includes a handle, and an elongate outer tube having a bore, a proximal portion attached to the handle, and a distal portion adapted for inserting into the body cavity. The moving portion includes an operating lever pivotally mounted in the handle, and an elongate operating rod mounted in the bore of the elongate outer tube, and sliding axially relative thereto in response to the operating lever.The sealing means includes a cylinder in the handle and a piston slidably mounted in the cylinder. The cylinder is in gas-tight communication with the bore of the outer tube, and the piston interconnects the operating lever and the operating rod.

Abstract: A double-lumen balloon cannula and method for performing blunt dissection of an elongated, non-spherical cavity under visual control includes a tubular lumen to slidably support an endoscope therewithin, and a second lumen having an inverted, nonelastomeric, transparent balloon attached at one end and contained therewithin that is capable of being everted in response to fluid under pressure applied thereto. The endoscope is selectively advanced within the everting balloon to visualize tissue in the elongated cavity through the balloon.

Abstract: A hand-held apparatus and method for insufflating an abdominal cavity includes a compact gas supply unit comprised of a gas cartridge which has a pair of tandem piercable seals positioned inside the cartridge neck and which contains a predetermined mass of compressed gas. A cap having a puncture stem is engaged with the gas supply unit, causing the puncture stem to penetrate the piercable seals and release gas through the puncture tube and into a hollow needle positioned inside the abdomen. The tandem piercable seals are arranged such that as the gas supply unit is engaged with the cap, the puncture stem punctures the first piercable seal and the first piercable seal seals around it before the puncture stem punctures the second piercable seal, thereby preventing accidental loss of gas and preserving the entire mass of gas for insufflation.

Abstract: The present invention provides a multiple cannula assembly which includes an inner cannula having a first balloon for making an elongated cavity by progressive dissection, an endoscope for visually monitoring the dissection, and an outer cannula having a second balloon for enlarging the elongated cavity. The inner cannula is independently movable from the outer cannula and is reversibly extendible beyond the distal end of the outer cannula. The present invention also includes a method of using such a cannula assembly for dissecting an elongated cavity along the course of a small blood vessel and subsequently harvesting the blood vessel.

Abstract: A method for deriving an output signal from an input video signal generated by an image sensor having an image formed on a part of it. The input video signal includes an image portion generated by the part of the image sensor on which the image is formed, and an external portion generated by the part of the image sensor on which the image is not formed. In the method according to the invention, the input video signal is received, the external portion of the input video signal is identified, and the output signal is generated from the input signal by replacing the external portion with a synthesized portion. The synthesized portion may set the external area to black level, to a predetermined luminance and/or hue, or to a luminance and/or hue adaptively determined in response to the image portion of the input signal. A position-dependent variation may also be imposed on the external area. The external area may also be rearranged to change the displayed location of the image.

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: Apparatus for retracting an organ to gain access to treat a tissue. The apparatus has a main envelope, a second envelope, a first inflation device and a second inflation device. The main envelope encloses a main chamber, and includes a window and a removable window. The second envelope covers substantially all the main envelope, except the window and the removable window. The second envelope and the main envelope enclose a second chamber outside the main chamber. The first inflation device passes a fluid into the main chamber to expand the main chamber and the second chamber from a compacted state to retract the organ. The second inflation device passes a fluid into the second chamber to further expand the second chamber to maintain the organ in its retracted state after fluid has been released from the main chamber.