Abstract: An apparatus for creating an anatomic space in tissue in a body includes an introducer device having a tubular member with a bore extending therethrough. A tunneling shaft assembly is slidably mounted in the bore of the introducer device. The tunneling shaft assembly includes a tunneling shaft having proximal and distal extremities. A blunt tip is secured to the distal extremity of the tunneling shaft. A balloon assembly is provided. The balloon assembly is removably secured to the tunneling shaft. The balloon assembly includes a deflated collapsed balloon. A sheath encloses the balloon and is carried by the tunneling shaft. The sheath has a weakened region extending longitudinally thereof permitting the sheath to be removed to release the balloon.

Abstract: Balloon loaded dissection devices with elongate balloon and a pushing member are disclosed for creating a tunnel alongside an elongate vessel in the body. The devices may utilize an elongate balloon of any suitable length which may be formed of an elastic or non-elastic material. The balloon may be of double walled construction and may be provided with a central lumen which may receive a guide rod, scope or other surgical instrument. The device may have a support tube secured to the inner wall of the balloon to provide columnar support for the apparatus. The support tube receives the guide rod, scope or other surgical instrument and may have a stop member to translate pushing force applied to the guide rod or scope to pushing force on the apparatus. By using the guide rod or scope as a pushing member the apparatus may be advanced alongside the vessel it is desired to dissect free from attached tissue.

Abstract: The present invention provides balloon dissection apparatus and methods of use in which an elongate balloon is utilized to dissect along a region that follows a naturally existing path alongside a vessel or structure, such as an artery, a vein, a lymphatic vessel, the trachea, the esophagus, or even a nerve bundle.

Abstract: A mechanically expandable retractor for use in arthroscopic surgery. The retractor has an expanding portion at its distal end for expanding against sub-surface tissues when the retractor is in use. The expanding portion includes a plurality of radially expanding arms. The radially outermost surface of each arm when expanded is longitudinally disposed approximately at the distal end of the retractor. The expanding arms can be disposed irregularly circumferentially around the retractor to expand the tissues to provide a working space between adjacent arms. The retractor is inserted through a small percutaneous opening, expanded in sub-surface tissues without significantly damaging the tissue, then collapsed after use for removal. The retractor has a projecting portion at a proximal end of the retractor for manipulating the retractor, to allow the surgeon to push or pull or lever on tissue.

Abstract: A retractor for use in arthroscopic surgery. The retractor has a mechanical expanding portion for expanding against sub-surface tissues when the retractor is in use. The retractor also has a fluid-operated expanding portion, which may be independently controllable, for expanding against sub-surface tissues when the retractor is in use. The retractor is inserted through a small percutaneous opening, expanded in sub-surface tissues without significantly damaging the tissue, then collapsed after use for removal. The retractor can be manipulated to allow the surgeon to push or pull or lever on tissue. The retractor can be hollow like a cannula to permit the passage of one or more surgical devices through the retractor, with a side portal into the center of the retractor.

Abstract: A flexible, fluid-tight envelope provides access for a hand and surgical instruments through a body tissue incision while maintaining insufflation pressure or a pneumoperitoneum within the body. The envelope is transparent and has an interior volume with opposite proximal and distal ends. A first opening in the envelope at the proximal end adjoins the incision in the body tissue and is secured and sealed to the body tissue. The second opening at the envelope distal end is provided with a closure member that seals closed the second opening on itself or around the forearm of a surgeon or a surgical instrument inserted into the interior volume of the envelope.

Abstract: An improved valve for cannulas and endoscopic access ports used during insufflation. A duckbill valve is provided which can accommodate the passage of endoscopic instruments such as endoscope, graspers and scissors and form a seal around the shaft of these instruments, thereby maintaining insufflation pressure. The access port housing around the duckbill valve is squeezable, so that the duckbill valve may be squeezed open by squeezing the access port housing, thereby facilitating removal of endoscopic instruments without the need to manipulate a valve fitting.

Abstract: A skin seal or trocar stabilizer with an inflatable membrane disposed inside, whereby medical instruments may be passed through the skin seal into a endoscopic work space while the inflatable membrane is inflated, thereby allowing the use of normal short conventional open surgery instruments during endoscopic procedures and during insufflation.

Abstract: A skin seal or trocar stabilizer with an inflatable balloon in the shape of a dumbbell, where the balloon may be stored within a cannula for easy placement in an incision and inflated to deploy the balloon inside the body, and a portion of the balloon expands inside the cannula, whereby medical instruments may be passed through the skin seal into a laparoscopic work space while the balloon is inflated, thereby allowing the use of normal short surgical instruments during laparoscopic procedures and during insufflation.

Abstract: A laparoscopic tissue removal device for use by fingers of a hand comprising an elongate tubular member with proximal and distal extremities and having a bore extending therethrough. An elongate tubular member has an outer diameter and an elongate tubular sheath is formed of a tubular woven braid material having proximal and distal extremities. A length extends between the proximal distal extremities. The elongate tubular sheath has a passage extending from the proximal extremity to the distal extremity. The tubular woven braid material of the elongate tubular sheath has an initial configuration and an open weave construction permitting the elongate tubular sheath to enlarge beyond its initial diameter to a diameter substantially greater than the initial diameter. The proximal extremity of the elongate tubular sheath is secured to the elongate tubular member.

Abstract: An expansible laparoscopic tunneling apparatus for creating an anatomic working space. The apparatus provides laparoscopic observation both during tunneling operations, when the apparatus is advanced bluntly to a desired location within the body of a patient, and during subsequent tissue dissection when a balloon associated with the apparatus is inflated to create the working space. In a preferred embodiment, the apparatus comprises a hollow tunneling member and an inflatable balloon disposed at the distal end of the tunneling member to cooperatively form a blunt tipped obturator. The tunneling member has a bore sized to accept a conventional laparoscope, and a blunt distal end to facilitate tunneling. A trocar can be inserted into the incision to provide access back to the previously created space where the surgical procedure is to be performed.

Abstract: Cannulas for surgical and medical use expand along their entire lengths. The cannulas are inserted through tissue when in an unexpanded condition and with a small diameter. The cannulas are then expanded radially outwardly to give a full-size instrument passage. Expansion of the cannulas occurs against the viscoelastic resistance of the surrounding tissue. The expandable cannulas do not require a full depth incision, or at most require only a needle-size entrance opening.

Abstract: Methods and devices for harvesting veins from the body. The methods and devices allow vein harvesting using endoscopic procedures. A working space is created over the vein using standard endoscopic procedures and a side-hooked wire is inserted into the working space and twisted to insert the side-hook under the vein. The wire is then pulled or drawn along the vein to separate the vein from the surrounding tissue. In an alternative embodiment, vein separation is accomplished by threading a soft rubber tube under the vein, grasping the ends of the tube so as to surround the vein, and then pulling the tube along the vein. In other embodiments, the working space is created with everting balloons.

Abstract: A balloon dissection apparatus for forming an anatomic working space alongside an elongate vessel in a body having a tunneling shaft having proximal and distal extremities. A flexible elongate substantially cylindrical balloon is carried by the tunneling shaft and has proximal and distal extremities. The balloon has at least a portion of the distal extremity folded inwardly into the balloon to shorten the length of the balloon so that the folded balloon has a length which is not substantially greater than the length of the tunneling shaft. An inflation tube is coupled to the balloon for inflating the balloon to cause the distal folded extremity to evert and roll outwardly to provide an inflated balloon having a length greater than the length of the tunneling shaft.

Abstract: Methods and devices for harvesting blood vessels using balloons to hold the blood vessel and to dissect and mobilize the blood vessel from surrounding tissue. A small balloon catheter is inserted into the blood vessel lumen to and inflated in order to hold the blood vessel, and an everting balloon dissector is everted over the blood vessel. Eversion of the balloon dissector over the blood vessel pushing surrounding body tissue away from the blood vessel.

Abstract: A surgical instrument for use in placing suture or fasteners in tissue at a remote location such as a laproscopic surgery is comprised of an elongated handle having a coiled projection at its distal end. The coiled projection is employed in penetrating and positioning a length of suture or fastener in tissue, for example, as in tissue proximation.

Abstract: Apparatus for creating an anatomic space in tissue in a body of a patient using a cannula with proximal and distal extremities and a bore extending therethrough to provide an open end. A balloon having an inflated space is provided. The balloon is capable of assuming collapsed and inflated conditions. A retainer is carried by the balloon for forming the balloon when in a collapsed condition into a generally cylindrical roll to aid in inserting the balloon into the tissue. An obturator shaft having a rounded distal end is sized so that it extends through the cannula and into the roll. A laparoscope can be introduced into the obturator shaft to permit viewing through the obturator shaft and the balloon. An inflation tube is provided for inflating the balloon after it is disposed in the tissue to cause the balloon to progressively expand to create separation forces in the tissue to create the anatomic space.

Abstract: A surgical instrument facilitates tying of a knot in a length of suture material at a remote surgical location. The instrument is comprised of an inner rod having a length of suture wrapped over the rod in a particular pattern. A needle may be secured to a free end of the suture and the pattern of wrapping the suture on the rod enables loops of suture to move off the rod end and over the needle to form a knot in the suture. The inner rod is received in an interior bore of an outer rod for manually controlled reciprocating movement therein. The inner rod is manually retracted into the interior bore of the outer rod to cause the outer rod to move the loops of suture off the inner rod end and over the needle in forming a knot in the suture.

Abstract: An active cannula or sleeve which does more than merely maintain a channel or passage is usable to create and/or enlarge a channel or passage, to position a scope or instrument, to move or locate tissue, etc. The cannula can vary in size or shape as needed, intraoperatively. Because a cannula of the present invention is expandable, the surgeon can make a small relatively small incision, stretch the tissue with the expandable cannula, contract the cannula and remove it, allowing the skin to come back to its unstretched condition. Thus, a smaller incision can be made to fit the same size instrument. This results in less trauma and scarring and an easier operation. The cannulas are or can assume such a non-circular shape, to fit into a natural skin opening and cause less trauma. The devices can be used to seal off a space; to expand an existing space or a potential space for working or visualization; to move tissue (for example, to stretch an incision) or to protect it.

Abstract: An expansible tunneling apparatus for tunneling bluntly to a desired location within the human body and for creating an anatomic working space for the performance of a surgical procedure by utilizing an inflatable balloon to dissect tissue along natural separation planes once the desired space has been reached. In a disclosed embodiment, a tubular member has a bore extending therethrough to provide an open distal end. A rigid tunneling shaft is insertable into the bore of the tubular member to provide a blunt tipped obturator. A balloon associated with the apparatus is disposed such that it surrounds the tunneling shaft when the balloon is deflated, as it would be when tunneling bluntly through tissue. A sheath surrounds the balloon and has a weakened region that permits the sheath to be released thereby permitting the balloon to expand to dissect tissue layers and create the anatomic working space.