Abstract: A surgical instrument that includes a rigid outer member within which is disposed a hollow inner member having rigid proximal and distal ends and a region disposed between the rigid proximal and distal ends that is relieved to render such region relatively flexible. The flexible region is integral with a portion of the proximal end disposed adjacent to the flexible region. The inner member transmits force (such as torsion) applied to its proximal end to move a cutting implement disposed at its distal end and cause it to cut tissue admitted through an opening in the distal region of the outer member. In another aspect, a region of the inner member is weakened (e.g., by relieving an integral region of the member) with respect to the remainder of the inner member to cause this region to break if the force (e.g., torque) applied to the inner member exceeds a predetermined threshold.

Abstract: Cardiac ventricular assist apparatus adapted to be placed by insertion through an incision in the wall of the upper abdomen below the rib cage and an incision in the inferior aspect of the pericardium proximate the heart apex comprises a distensible flexible bladder adapted to be passed through the incision in the pericardium to a position between the pericardial sac and the epicardium. The bladder is of a size such and shape such as to be engageable with a substantial portion of the outer surface of the left ventricle of a heart and is attached to a tube through which a gas can be introduced into it to compress the left ventricle and withdrawn from it to allow the ventricle to fill. A non-dietensible tube joined to the distal edge of the bladder is connected to a source of a fluid by which it can be inflated after insertion of the bladder to deploy the distal edge of the bladder from a collapsed condition in which it is emplaced within the pericardium to an extended condition partly encircling the heart.

Abstract: The balloon catheter comprises a basic tubular body having a distal end and a proximal end. A balloon member is arranged on the distal end and, close to the balloon member, is arranged an elongate, elastic balloon protection sheath. A pull thread is connected to an end of the sheath facing toward the balloon member and extends to the proximal end of the basic tubular body. The sheath can be pulled over the balloon member by pulling the pull thread.

Abstract: A method and devices are provided for performing end-to-side anastomoses between the severed end of a first hollow organ and the side-wall of a second hollow organ utilizing transluminal approach with endoscopic assistance. In particular, the method utilizes a catheter, having a selectively operable cutter, which is introduced into the first hollow organ until the distal end of the catheter is substantially adjacent to the severed end of the first hollow organ. The severed end of the first hollow organ is positioned in proximity to the site for anastomoses on the side wall of the second hollow organ and the severed end is secured in sealing engagement with the side-wall, thereby defining a region of securement on the side wall of the second hollow organ.

Abstract: The invention provides a method of repairing tears or ruptures in an anterior cruciate ligament of the human knee, by reattaching the ligament to its anatomic insertion site on the intercondylar notch of the femur using a suture anchor, with healing at the insertion site being enhanced by formation of a cancellous bleeding bed.

Abstract: An ophthalmic implant for treatment of glaucoma, a delivery device for implanting such an implant, and a method of implanting such an implant. The implant includes a tube having an inlet end, an outlet end, and a tube passage therebetween, and a disk connected to the tube at the outlet end of the tube. The tube passage has a cross-sectional area sufficiently small to inhibit the flow of aqueous humor through the tube passage. The implant provides a bleb of aqueous humor under the conjunctiva so that the bleb and the elasticity of the conjunctiva assist in regulating the flow of aqueous humor through the tube as a function of the IOP. The tube at its inlet end has a beveled surface facing away from the iris and one or more circumferential holes. One or more retention projections are provided for anchoring and may be extended outwardly when the implant is implanted in the eyeball. The disk has an outer rim and one or more inner uprights.

Abstract: A stent delivery system includes a catheter with an axially extending inner core and outer sheath. Axially spaced rings extending from a relatively narrow diameter portion of the inner core proximate the distal end thereof. The rings engage proximal portions of a compacted stent disposed within the sheath and over the core and rings. A proximal handle of the system has a first portion that supports the sheath and a second portion that supports the core for relative displacement of the core and the sheath. Retraction of the sheath relative to the core uncovers the stent engaged by the rings which tends to remain stationary relative to the core so that upon partial retraction of the sheath a distal end of the stent expands to its expanded form. Further retraction of the sheath deploys the stent, retracting the core returns the distal portion of the stent into the sheath.

Abstract: A device for incising and dilating a stenosis in a vessel of a patient includes a dilator housing and a plurality of blades which can be selectively extended from the housing. Specifically, the housing is formed to surround a chamber and the chamber contains an inflatable balloon. The plurality of blades are mounted on the inflatable balloon and pass through slits in the housing. The housing is attached to a placement catheter which includes a lumen for inflating and deflating the balloon. In the operation of the device, the balloon is selectively inflated within the chamber to move the device between a retracted and an expanded configuration. In the retracted configuration, the balloon is deflated and the blades are withdrawn into the housing and the housing is used as a dilator. In the expanded configuration, the balloon is inflated and the blades are extended through the slits in the housing and the device is used as an incisor.

Abstract: An apparatus and method for removing a cataract lens from an eye, the apparatus comprising a surgical handpiece capable of phacoemulsification, irrigation and aspiration, for insertion into the eye, an infusion reservoir containing infusion fluid, the infusion reservoir being connected to the surgical handpiece by an infusion line, an evacuation line having a first end connected to the surgical handpiece and a second end which lead to a collection container, and a free flow valve, located along the evacuation line, for controlling the flow of fluid through the evacuation line, wherein the infusion reservoir is placed above the level of the eye and the level of the evacuation line so that, when the free flow valve is in the open position, infusion fluid is permitted to flow from the infusion reservoir into the eye, through the evacuation line and into the collection container.

Abstract: The invention provides an expanded vascular stent having a non-circular cross-section. The expanded stent may have, for example, a "D" shaped cross-section for collateral deployment within a common body lumen. A curved edge of the stent engages a body lumen while an alignment edge engages a collaterally deployed stent. A segment of graft material having at least one end cut on a bias may be attached to the stent so that the graft material extends substantially between the proximal and distal ends of the stent along its alignment edge, yet only partially along its curved edge to assist in forming a hemostatic seal. The apparatus may also be used for collaterally deploying stents within the common body lumen.

Abstract: Disclosed is an improved ultrasonic knife of a type for incising various types of material. The knife has a reduced thermal footprint to tailor thermally induced tissue effects. Tooth configuration on the knife cooperates with the stroke of the ultrasonic drive to produce efficient cutting, as well as tactile feedback to the surgeon with respect to the rate of cutting, and changes in tissue density. Ultrasonic knife tip extenders are also disclosed for advancing the ultrasonic knife tip through the working channel of an endoscope or trocar sheath. Methods utilizing the foregoing apparatus are also disclosed.

Abstract: A surgical cutter intended for use in endoscopic procedures utilizes at least one shape-memory-effect (SME) alloy actuator to move one or more blades or other surgical tips in a reciprocal, rotational, or scissors-type motion to incise or excise tissue. Such cutters have a cutter assembly, mounted in a shaft connected to a handle, with a blade or blades that are moved individually or in concert. The actuator is formed of one or more wire SME alloy loops and optional bias spring. Application of an appropriate voltage waveform in a specified time sequence causes each wire loop to contract and return to its original length. Each actuator is mechanically linked to the cutting blade or other surgical tip.

Abstract: A ophthalmic hand piece having a phaco needle or YAG laser is provided with a balloon nucleofractis irrigation sleeve. The balloon nucleofractis irrigation sleeve includes an irrigation conduit, a balloon fluid conduit, a balloon, and a connector for coupling the balloon nucleofractis irrigation sleeve to the distal end of the ophthalmic hand piece. The balloon fluid conduit is coupled adjacent to the irrigation conduit and the balloon is sealed to the distal end of the balloon fluid conduit. In practice, with the balloon contracted, the phaco needle or YAG laser is first used to carve a groove in the cataract. Once a groove has been carved, the balloon is positioned into the groove and swelled. Expansion of the balloon causes the cataract to fracture into halves or quarters. Each half or quarter can similarly be carved with a groove and fractured using swelling of the balloon.

Abstract: A distal intravascular filter is disclosed for filtering blood flow therethrough and entrapping and retaining embolic debris. The intravascular filter including a small diameter hollow guide wire or tube capable of percutaneous placement of the distal end thereof beyond a carotid stenosis. The distal portion of the tube includes a filter mounted thereon. The filter is deployable from a tightly closed configuration to an open circumference for blocking the unfiltered flow of blood beyond the carotid stenosis. The filter is deployable between open and closed positions by manipulation of an actuating wire extending from the filter and out the proximal end of the tube.

Abstract: A mounting and transfer device and method for installing a stent on a delivery device that inserts the stent into a body lumen. The device includes a generally cylindrical mandrel for receiving and frictionally holding a stent, a handle at a first end of the mandrel and a guide rod extending axially from the second of the mandrel. The second end of the mandrel has a conical recess surrounding the guide rod exit. In use, a stent is placed on the mandrel, the distal end of the guide rod is fully inserted into a guide wire lumen at an end a delivery system such as a catheter and the stent is slid from the mandrel onto the balloon and crimped in place. A tube of heat shrinkable material may be placed over the stent on the mandrel and heat shrunk to lightly press against the stent. The tube and stent are transferred to the balloon and crimped.

Abstract: A multi-element occlusion device (10, 20, 30, 40) provides an improvement over existing systems by increasing the occupation of a vascular lumen. The device (10, 20, 30) comprises an anchoring element (12, 22, 32), a lead element (14, 24, 34) and at least one fiber (16, 26, 36) attaching said elements. The elements and fibers produce a cumulative occlusive effect greater than the sum of the individual elements. When placed in the blood stream, the anchoring element (12, 22, 32) lodges against the vessel wall and the lead element (14, 24, 34) is carried to a position distal thereto. In another embodiment, an"umbrella" of support members extend from the lead element. A fabric web extends between these support members. The umbrella intravascular device expands upon its exit from the catheter. The fabric web produces complete occlusion of the vessel without the need for thrombosis to form between the elements.

Abstract: An embolic element comprises a filament composed of a shape memory material having an unexpanded coil configuration and an expanded random matrix configuration. The embolic element may be delivered to a blood vessel treatment site in its coiled configuration over a delivery wire through a guide catheter. Usually, the coiled embolic element will be disposed over a helical section of the delivery wire prior to release. In that way, proper positioning of the embolic element may be confirmed prior to release. The embolic element is then expanded to its enlarged configuration by heating or otherwise exposing to a temperature over the transition temperature of the shape memory material.

Abstract: A surgical device for altering the curvature of an eye includes a base which carries a transparent insert, a drive device, a knife edge coupled to the drive device and movable to a plane immediately adjacent the under surface of the transparent insert. The transparent insert includes a face having a surface portion shaped according to a predetermined correction. The base further includes a suction ring which forms a vacuum chamber with the eye. The suction ring is placed against the eye. Application of vacuum results in the cornea of the eye being urged into engagement with the shaped surface portion. Actuation of the drive device moves the knife edge whereby the cornea is cut. Only the knife edge traverses the insert.

Abstract: In a surgical instrument having at least one jaw part which is attached to at least one handle part by a pulling or pushing element which is movable along its lengthwise axis (A), there is associated with the pulling or pushing element a pin or the like which engages into a recess which is associated with the handle part and the axis (B) of which extends at an angle (w) to the lengthwise axis (A) of the pulling or pushing element.

Abstract: The adjustable variable length vaginal dilator is assembled from selected parts of parts of various length so as to achieve a selected desired length, and at least two of the parts are threaded. The distal threaded joint secures a selected length tip and the proximal adjustable threaded base provides infinite length adjustments between the main body coupler and the base. An intermediate extender may also be used for added length. The dilator permits self-treatment sessions over a long period of time that permits slow small interval stretching with maximum patient comfort. Another embodiment provides a tapered transition section and a tip of smaller diameter which is also of selectable length for more comfort during therapy and the like.