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.

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: 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: An apparatus is described for laparoscopically retracting an organ inside the body to provide surgical access to adjacent tissue. The apparatus includes a thin, flexible envelope which encloses a chamber. The envelope is laparoscopically insertable in a collapsed state into a body cavity, and the chamber is inflatable to an expanded state following introduction of the envelope into the body. Inflation of the chamber causes retraction of adjacent tissue. An elastomeric seal is insertable into the chamber following inflation and is attachable to part of the envelope inside the chamber following inflation of the chamber. The seal provides a gas-tight seal to maintain the chamber in the expanded state, and to maintain the organ in the retracted state, notwithstanding the piercing of an aperture in the part of the envelope covered by the seal.

Abstract: The invention provides an apparatus and method for manipulating parts of the body in surgical procedures, particularly useful for peritoneal distension in laparoscopic surgery. The apparatus comprises a positionable support structure having an extendible horizontal arm rotatably mounted to an extendible vertical post, the post having a clamp at its lower end for mounting to a surgical table. An end segment at the distal end of the horizontal arm has a mount for mounting end-of-arm tooling, for example, peritoneal distension instruments. Locking mechanisms are disposed in the horizontal arm, vertical post and end segment to lock the support structure in a desired position. A motor is disposed within the vertical post for power-assisted extension and retraction of the vertical post. Preferably, the locking mechanisms and motor are controllable using switches mounted on the end segment.

Abstract: According to the present invention, apparatus are provided for applying surgical clips to body tissue with a safety stop for preventing tissue damage resulting from closure of the clip closing mechanism when a clip is not present therein. In one embodiment, the apparatus comprises a shaft having a distal end and a proximal end; means for closing clips having a pair of forming surfaces, and means for limiting closure of the closing means when a clip is absent therefrom such that a gap separates the forming surfaces in the closed position.

Abstract: A trocar for placement in the lumen of a cannula to facilitate inserting the cannula through tissue is disclosed. The trocar has an improved trigger/obturator assembly wherein the trigger comprises tissue cam parts each having (a) planar outer surfaces, and (b) an arcuate end portion at the distal end of the trigger including a distal edge surface that is arcuate about an axis normal to the outer surfaces. The arcuate end portions intersect at edge surfaces which are obscured by the arcuate end portions.

Abstract: An inflatable apparatus for organ retraction includes a main envelope which forms a main chamber. An additional chamber is formed by attaching the periphery of an additional envelope to the outside or the inside of the main envelope. The part of the surface of the main envelope that is not covered by the additional envelope provides a plurality of windows, which, after the additional chamber is inflated, may be at least partially removed to provide apertures through which treatment or observation can be carried out.

Abstract: In a method for retracting an organ inside the body to provide access for treating a tissue, a retractor having a main envelope which defines a main chamber is positioned in a collapsed state adjacent to the organ to be retracted. The main chamber is subsequently inflated to retract the adjacent organ. A surgical instrument is passed through the main envelope into the main chamber to contact the tissue for treatment.

Abstract: A cannula is extended through the wall of a body cavity by a trocar having a piercing head slidable through the cannula between a condition extending distally from the cannula and a condition retracted within the cannula. A latch releasably secures the piercing head in the extended condition against the force of a spring which normally biases the piercing head to the retracted condition. Resiliently biased plungers extend longitudinally of the piercing head for retraction in response to counterforce as the piercing head advances through the wall of a body passage and extension upon the release of the counterforce. Extension of the plungers upon release of the counterforce functions to release the piercing head for retraction.

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 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 fan retractor has a pair of angle-shaped elements moveable relative to one another. The angle-shaped elements include first legs disposed in a generally parallel relationship, and second legs that extend laterally from the first legs, and are adapted for engaging with the abdominal wall. The second legs fan out upon rotation of the first legs relative to one another and have an effective thickness, measured in the direction defined by the first legs, that decreases distally from the first legs. The retractor also includes a lifting device that applies a lifting force to the angle-shaped elements.In variations, the second legs have a stiffness that decreases distally from the first legs; the first legs are linked so as to contrarotate relative to one another; the retractor includes a lifting force indicator; and the lifting device unidirectionally applies the lifting force to the angle-shaped elements.

Abstract: Apparatus for coupling a light beam from a light source to a light fibre with reduced heating of the light fibre. The light source has a lamp, a condenser lens, and a dichroic infra-red filter disposed along an optical axis between the lamp and the light fibre. The apparatus is adapted for operation with plastic light fibres that have a softening temperature of less than 100 degrees Celsius. The apparatus comprises light fibre connector that secures the light fibre on the optical axis. A non-visible radiation filter is located on the optical axis in a broad part of the light beam between the dichroic filter and the light fibre and reduces non-visible radiation energy remaining in the light beam following the dichroic filter. A beam restrictor is located on the optical axis adjacent to, and thermally isolated from, the light fibre connector.

Abstract: An apparatus for suturing deep puncture wounds utilizes a capturing member which is pivotally mounted to the distal end of an elongate rod. During use, the capturing member is inserted into a body cavity through a trocar sheath positioned in a wound and pivoted into a position in which it extends beneath the tissue surrounding the wound. A membrane or other suture-capturing surface is formed on the surface of the capturing member. A suture to be applied to the wound has anchors on each of its ends, and suture-carrying needles carry each of the suture ends and their corresponding anchors. The suture-carrying needles are individually passed through the tissue layers surrounding the wound and subsequently passed through the membrane of the capturing member. The suture ends and corresponding anchor means are released from the needles.

Abstract: A fan retractor for laparoscopic surgery has a pair of angle-shaped elements with first legs disposed in parallel relationship to one another and second legs extending laterally from the first legs for movement between a juxtaposed collapsed condition and a fanned-out expanded condition responsive to rotation of the first legs about their longitudinal axes. Actuators are provided on the first legs to move the second legs between the collapsed and extended conditions. A first lock engages the actuators to lock the second legs in the extended condition and against movement toward or away from one another. A second lock in the form of a block slidably received on the first legs is selectively engageable between the second legs when in the extended condition. When engaged, the second lock serves both to block the second legs from movement toward one another and to restrain the first legs against movement away from one another.

Abstract: A method and apparatus for creating a surgical work space by lifting the abdominal wall and retracting abdominal organs during surgery utilizes a pair of lifting rods each hinged at their distal ends to opposite ends of an elongate cross-member. One of the lifting rods is slidable within a strap fastened to the proximal end of the other of the rods. The hinged relation of the lifting rods to the cross members and the sliding relation of the lifting rods to each other allow the apparatus to be pivoted into a streamlined configuration to facilitate insertion into a puncture opening in an abdominal cavity, and then to be pivoted into a triangular frame for defining an area of the abdominal wall to be lifted. After insertion the apparatus is locked into the triangular configuration, connected to a lifting arm, and lifted to cause the retraction rods to lift and support the abdominal wall.