Abstract: A method and apparatus for thoracoscopic surgery uses a hinged, ring-handled forceps having a length of approximately 12-13 inches inserted through a small incision without a cannula. Portions of the forceps extending from the hinge are straight and substantially parallel to each other when the jaws are closed. The forceps is then inserted into the patient's thoracic cavity through the incision until the hinge axis is approximately at the location of the incision. The jaws are then spread apart without significantly expanding the incision. Straight, side-curved, C-shaped and S-shaped instruments are described. Ratchet teeth disposed at a pitch of less than 0.1 inch are used to achieve small steps in jaw positioning.

Abstract: A ring-handled bypass clamp provide a spoon-shaped blade insertable through a temporary incision in the ascending aorta and a cooperating ring positionable on the exterior of the aorta opposite to the blade. An aortotomy is performed on the portion of the aorta wall inside the ring to provide an annular portion of the wall to which a graft is sutured.

Abstract: A laryngoscope, for use with a binocular operating microscope, has a tube with a flared distal end and a narrow intermediate portion allowing manipulation of the tube. The proximal end of the tube is flared horizontally to an extent such that the centerlines of both objective lenses of the microscope enter the proximal opening of the tube even when the microscope is moved to the left and right to view portions of the larynx spaced laterally from the central axis of the tube. When the microscope is moved laterally, the centerline of one of the lenses intersects the interior wall of the tube, which is dark. Therefore the annoying effect of seeing objects external to the laryngoscope tube with one eye is avoided.

Abstract: An esophageal dilator comprises a hollow, flexible tube filled with a dispersion of Tungsten particles in a fluid silicone material for treating cardiospasm, esophagitis, stenosis and other esophageal diseases.

Abstract: A surgical instrument for use in operative cholangiography associated with a laparoscopic cholecystectomy. A catheter guide and clamp are combined in a single instrument manipulatable through a conventional trocar. The guide includes a straight elongate tube with an oblique exit opening for introducing a catheter tip through an incision in the cystic duct and laterally deflecting the inserted tip toward the common duct. The clamp longitudinally movable, and is operated from the proximal end of an actuator tube and stem to seal the duct around the catheter to prevent any fluid injected into the duct from leaking out through the incision.

Abstract: An improved tunneler for placement of an arteriovenous graft in subcutaneous tissue of a patient, includes a shaft with opposite ends carrying a penetrating tip and a handle. The shaft is manually bendable but has sufficient rigidity for retaining a desired curvature when in use. The tip and handle are interchangeable. In implanting a graft, the shaft is passed through an incision near the distal end of a patient's limb to a proximal incision, to form a first tunnel. With the shaft in place in the tunnel, the tip and handle are interchanged, and a graft is attached to the tip and pulled toward the proximal incision until its end is exposed. A second tunnel is then formed, again by passing the instrument through the distal incision toward the proximal incision. The tip and handle are again interchanged, and, with the tip attached to the other end of the graft, the graft is pulled into place to form a loop.

Abstract: Apparatus and method for detecting the presence of friable atheromatous deposits in or near the aortic arch of a patient. Fluid aspirated from the aorta in the region of the inner curvature of the transverse arch and the descending aorta through a cannula attached to a handle is drawn by suction through a filter in the handle, and any particulate is trapped for determining the presence of atherosclerotic plaque. A manually operated valve in the handle controls the suction and an elastomeric check valve prevents fluid backflow.

Abstract: A valvulotome for surgically removing venous valves in order to convert a vein into an arterial bypass, comprises a thin, elongated, flexible wire of Nickel-Titanium alloy coated with PTFE and having a head secured to its distal end. The head has a single, narrow, laterally extending arm, with a blade edge facing in the proximal direction and extending transverse to the wire. The head also has a blunt tip projecting in the distal direction and laterally spaced from the wire axis. The head has a pair of edges which are oblique with respect to the wire axis and which converge toward each other so that the width of the head is continuously tapered from locations adjacent to the ends of the blade edge toward the tip. The head has a blunt element adjacent to the end of the blade edge farthest from the wire axis, with at least a portion of said blunt element extending proximally relative to said end of the blade edge.

Abstract: A valvulotome for surgically removing venous valves in order to convert a vein into an arterial bypass, comprises a thin, elongated rod capable of insertion into a vein and a head having a blunt tip secured to the distal end of the rod. The head has two sharp-pointed blades extending in the proximal direction from the proximal side of the tip. The point of each blade is located radially inwardly with respect to the outer surface of the tip, and each blade is defined by a pair of surfaces which are respectively parts of intersecting right, circular, cones, both coaxial with the rod but having different apex angles, and by a pair of surfaces lying in planes intersecting each other on a line peripendicular to and intersecting the axis of the rod. The planes and conical surfaces all intersect at the point of the blade.

Abstract: A vascular clamp for temporary occlusion in the infrarenal region of the abdominal aorta during performance of surgery associated with abdominal aneurysms. Pivoted handles are operatively connected to respective one ends of relatively slidable elongate members, and parallel jaws laterally extend from the other ends. Manipulating the handles in scissors-like motion causes the jaws to translate between open and close positions. A ratchet-and-tooth arrangement interengages the handles as the jaws close.

Abstract: A table-mounted surgical retractor support includes a wishbone-shaped structure comprising two identical rods which are separately attachable to a clamp located at the end of a supporting rod. The supporting rod is, in turn, connected to a similar clamp located at the top of a table-mounted post. The two parts of the wishbone structure are small enough to be sterilized conveniently.The wishbone rods cannot be rotated in their clamp, nor can the supporting rod be rotated in its clamp. However, the wishbone clamp, when loosened, allows rotation of the wishbone structure about the supporting rod axis and also about an axis mutually perpendicular to the supporting rod axis and the wishbone plane. Likewise the supporting rod clamp allows rotation of the supporting rod about the axis of the post and about an axis mutually perpendicular to the supporting rod and the post. Each clamp is designed to apply a shear to the rod on which it is supported, thereby achieving a tight clamping action.

Abstract: A cartridge for holding and dispensing hemostatic clips, comprises a plurality of generally U-shaped hemostatic clips, and a unitary, molded cartridge body having clip-receiving slots with internal clip-supporting posts, and retaining projections in each slot formed on the opposed walls defining the slot. The retaining projections are located adjacent to the top of the post within the slot and extend toward the opposite wall. Each retaining projection has a clip-engaging surface and is tapered so that it gradually increases in thickness, from a narrow bottom portion adjacent the top of the post means to a wider intermediate portion above the narrow bottom portion, so that the clip engaging surface overhangs the post to provide secure retention of the clip in the slot.

Abstract: The flexible sheath of a fiberoptic cable is clamped to an externally grooved tubular insert by an O-ring engaged by a frusto-conical portion of the internal wall of a compression fitting. The compression fitting applies an inward force to the O-ring, urging the sheath into the groove on the insert. The compression fitting is secured to a termination connector by adhesive and also by a cooperating ridge and groove which snap together. The termination connector engages the tubular insert. The compression fitting, which is secured to the termination connector cannot back away from the termination connector. Therefore, the frusto-conical portion of the inner wall of the compression fitting maintains inward pressure on the O-ring and the ring presses the sheath tightly into the groove.

Abstract: A sternal retractor for use in internal mammary artery dissection comprises a rack bar having fixed and movable spreader arms, the blade-carrying parts of which are rotatable to, and lockable in, several discrete positions. The blades are carried by slides on the spreader arms, and are pivotable about two mutually perpendicular axes which are also perpendicular to the arms, but restrained against rotation about axes extending lengthwise of the arms. One of the slides disclosed is provided with an undercut slot to receive a post for mounting auxiliary retractors. This makes the retractor especially useful for various operation in addition to internal mammary artery dissection.

Abstract: A neonatal subglottiscope set for emergency use comprises a plurality of subglottiscope tubes of various sizes suitable for neonatal use and a handle. These tubes are detachably connectable to the handle by means of a lever-operated latch. Each tube has a passage along its wall for receiving a fiberoptic light carrier, which is bent 90 degrees near its proximal end, and which has a locating pin receivable in a hole located in an ear on the handle. The entrance opening of the light carrier-receiving passage on its subglottiscope tube is positioned on the wall of the tube so that when the tube is attached to the handle, the entrance opening in all cases is at a uniform predetermined distance from the hole in the ear on the handle which receives the locating pin of the light carrier. Consequently, the same light carrier and handle can be used with all of the tubes in the set.

Abstract: An adapter for attaching atrial blades to a sternal spreader comprises an elongated bar having blade attaching means on an oblique surface, and having a heel, hook and adjusting screw on its bottom surface. The heel and the head of the adjusting screw are engageable with the upper surface of a spreader arm, and the hook is engageable with the lower surface thereof. The screw has a wheel formed on it, which is located between the bar and the spreader arm. When this wheel is turned to cause the screw to extend, the hook and heel of the bar and the head of the screw are pressed against the spreader arm, causing the adapter to be firmly secured to the spreader.

Abstract: A termination for fiberoptic or liquid-filled light-conducting cables comprises a fitting which extends into the end of the cable sheath, and on which is threaded a ferrule. In one version, the ferrule and fitting have opposed frusto-conical surfaces which pinch the sheath to provide a secure connection between the sheath and the fitting and to prevent the entry of foreign matter into the interior of the cable or the leakage of liquid out of the cable, if liquid-filled. In another version of the invention, the ferrule and fitting have opposed radial walls which compress an auxiliary elastomeric ring. The ring, when compressed, pushes the sheath radially inwardly into a groove in the fitting to provide a secure attachment of the sheath to the fitting and an effective seal of the interior of the cable.

Abstract: A gauge for use in determining the extent to which the cutting blade of an extensible-blade keratotomy knife projects beyond the end of a cutting depth limiting foot, comprises a base, a knife-holding cradle slidable on the base, a clamping screw for clamping the cradle to the base in any selected position within a range, a block fixed to the base, and a gauge element slidable on the base and adjustably movable with respect to the block toward and away from the cradle. With a knife mounted on the cradle, and the gauge element at a predetermined reference position, the cradle is moved until the foot of the knife abuts one face of the gauge element. The gauge element is then moved away from the foot by an adjusting screw, until an edge of the gauge element underlies the tip of the knife blade. The top face of the gauge element and the base surface on which the gauge element slides are of contrasting colors.

Abstract: Decompression of herniated discs in the lumbar spine is carried percutaneously by the insertion of a specially designed cannulated trocar over a guide wire extending through the patient's back toward the herniated disc at an angle of approximately 35 degrees with respect to the patient's perpendicular line. A thin-walled cannula is passed over the trocar, and a hollow cutting instrument is inserted through the cannula to form a window in the disc. Disc fragments are removed through the cannula by means of a special punch forceps, after the application of suction to the disc nucleus through the cutting instrument.