Abstract: Apparatus and method for expanding a perivascular cavity at a surgical site includes an elongated retractor having a tip at the distal end for convenient insertion into a perivascular cavity, and having a slidable coupler near the proximal end for convenient coupling to an elevator element supported in a retractor frame. The elongated retractor supports an endoscope thereon to facilitate visualization of surrounding tissue during insertion into the perivascular cavity. With the retractor inserted in the cavity, the retractor frame is positioned on the skin in alignment with and straddling the cavity, and the elevator element is selectively coupled to the retractor to elevate the retractor relative to the base of the retractor frame, thereby to expand or distend the cavity to provide ample access to tissues and vessels for surgical manipulations within the cavity.

Abstract: A surgical clamp applier and a detachable clamp for temporarily occluding a vessel are disclosed. The clamp applier is designed to allow a surgeon to place and remove the clamp using only one hand. The clamp applier has a dial, a button, and a pulley actuator all accessible on the handle of the applier. The dial is used to lock the clamp onto the applier and to remove the clamp from the applier. The button is used to allow the pulley actuator to be used to manipulate the lower jaw of the clamp with respect to the upper jaw of the clamp, thus varying the amount of pressure exerted by the clamp on the vessel. The pulley actuator actuates a pulley system which engages the clamp, thereby manipulating the lower jaw of the clamp with respect to the upper jaw in a scissors-like manner, allowing the surgeon to properly clamp the target vessel. Various shapes and sizes of clamps are used for various procedures, but the clamps are all compatible with the clamp applier.

Abstract: When installed in the device, the endoprosthesis is compressed radially and located in a cylindrical chamber (14), one proximal area (A) of this endoprosthesis lies within a first outer catheter (3) and a second distal area (B) is in a second outer catheter (30). In order to release the endoprosthesis (1) in a vessel (11), for example, the second outer catheter (30) is first retracted. The endoprosthesis (1) is then held in the first outer catheter (3) by friction and can be re-folded and thus repositioned by advancing the second outer catheter (30). Finally, the endoprosthesis (1) is released by retracting the first outer catheter (3). Because the friction is distributed over at least two outer catheters (3, 30), even endoprostheses (1) that generate a high level of friction on the outer catheter, for example because of a coating, of greater expansion force, or because of great length, can be released.

Abstract: According to the invention, a novelly improved ablation device includes releasably joinable drive and catheter assemblies. The drive assembly includes a tachometer assembly and a regulator for monitoring and controlling ablating burr speed. A bifurcated drive shaft includes a coiled distal portion and a tubular proximal portion for facilitating force transfer from the proximal portion to the distal portion. A dilating member is provided in addition to an ablating burr con the catheter assembly. The catheter tube may have multiple independent lumens having axes of elongation offset parallelly in the tube. Additionally, the ablating burr may be operatively connected to the catheter tube by drive gears or releasable threads. A radiopaque member is included on the distal end of the catheter tube, thereby rendering it visible to an observer. Novel, improved methods of ablating intravascular deposits are also provided.

Abstract: An improved tongue scraper or oral hygiene tool is designed to most effectively and harmlessly remove plaque, tartar, bacteria, dead tissue, food debris, etc. from the tongue. The tool is made of a nonporous substance capable of withstanding high temperatures during repeated sterilization such as metal, and preferably stainless steel. The tool includes unique curves and smooth edges designed to define a working edge contoured similar to that of the tongue and having a nongagging and self-cleaning profile and size.

Abstract: An apparatus for reaming a bone canal, such as the medullary canal of a femur, has a flexible shaft (12, 92) with a proximal end (16) for engaging a rotary transmission source. A first reamer (14, 61) is coupled to the distal end of the flexible shaft for rotation therewith to prepare the distal portion of the canal. A second reamer (22, 93) coupled with the proximal portion of the shaft to form the proximal end of the lateral portion of the canal and/or the medial calcar region of the canal. The apparatus further comprises a metaphyseal template (70, 80) having the shape of the prosthesis for guiding the reaming apparatus in forming the calcar region of the canal.

Abstract: A surgical device for dissecting and retracting tissue includes a scope holder for holding an endoscope therein and a transparent concave head connected to the scope holder. The concave head defines a working space therein. A fluid carrying system is operatively connected to and communicates with the concave head and the working space for clearing particulate from the working space.

Abstract: Apparatus and methods for intraoperatively performing surgery to create transmural channels in tissue, for example, as in transmyocardial revascularization, are provided using a device including a mechanical end effector and means for stabilizing the end effector in contact with the tissue. The end effector is adapted to cooperate with a source of suction to evacuate tissue severed during the channel forming process, and may optionally include an electrode for cauterizing the tissue surrounding the channel.

Abstract: An endoscopic surgical instrument assembly including a support sheath, a miniature medical implement member, and a securing mechanism for securing the support sheath and the medical implement member together in fixed relationship. The securing mechanism is adapted for securing the miniature medical implement member and the support sheath to one another when the miniature medical implement member is advanced axially through the support sheath so that the implement member and the support sheath form a co-axial unit. As a result, the support sheath provides rigid support for the miniature medical implement member and prevents the elongated portion thereof from breaking during an endoscopic medical procedure.

Abstract: A nasal dilator is disclosed which is provided in various sizes to fit and be retained within a person's nostril. The device functions to dilate the nasal passage and allow easier breathing during strenuous exercise, the administration of anesthetics to keep nasal airways open before, during and after general anesthesia which requires ventilation by bag or mouth, or in the presence of some breathing disorders in nasal airways. The dilator in its several embodiments is an open framework of non-toxic, non-abrasive, compliant elongate members which is inserted into the nostril and is retained in place by gentle pressure between the nasal walls and the dilator. Prevention of deep nasal insertion is provided by a larger external end of the dilator which contacts the narrowing nasal passage toward the inner end thereof and also serves as a contact for insertion and removal.

Abstract: A stent with axial flexibility, in a preferred embodiment, has a longitudinal axis and comprises a plurality of longitudinally disposed bands, wherein each band defines a generally continuous wave along a line segment parallel to the longitudinal axis. A plurality of links maintains the bands in a tubular structure. In a further embodiment of the invention, each longitudinally disposed band of the stent is connected, at a plurality of periodic locations, by a short circumferential link to an adjacent band.

Abstract: An arterial catheter system for removing plaque from the aorta and other arteries is disclosed. The system typically includes an elongate catheter member, a filtration apparatus disposed within the distal region, and an atherectomy assembly which includes a mechanism for trapping and holding mobile or fixed plaque and an excising mechanism for removing the plaque. In use, the catheter is positioned so that the atherectomy assembly lies within a region of interest, the filtration apparatus is deployed downstream of the region of interest, the plaque is trapped and held by a snare, vacuum, or other trapping means, and then the excising mechanism is activated to remove the plaque. Methods are also disclosed for removing plaque from the aorta and other arteries.

Abstract: An aortic knife which provides multi-sided incisions within an aorta for effectuating improved aortotomies. The aortic knife includes a handle and multiple blades radiating from the handle. The handle is sized and configured to maximize grip and surgical manipulation thereof. The multiple blades radiate outwardly and proximally from a distal sharpened point. A substantially cruciate, or cross-shaped, incision results from four sharpened blades extending from the distal sharpened point. Alternatively, the multi-bladed configuration of the aortic knife may comprise three, five, or six or more blades. The blades form equal angles in radiation outwardly and proximally from the distal sharpened point. The method of the invention requires obtaining an appropriately sized aortic knife which is stabbed into a portion of an aorta. An anvil of an aortic punch is then inserted into the incision in the aorta without the stretching necessitated by the conventional single linear incision.

Abstract: A stent positioning apparatus and method are provided for the attachment of a stent to a balloon to be used in the treatment of stenosis, such as coronary angioplasty. In one preferred embodiment, a first generally cylindrical member has a radially deformable wall defining a channel within which the stent and balloon assembly are inserted. A second generally cylindrical member has an opening sufficient to receive the first member with the assembly therein. The second member is then slid longitudinally over the deformable wall of the first member causing nonuniform depressions to be formed in the inner diameter of the stent, thus crimping the stent onto the balloon. Thus, the stent is attached to the balloon without damage and without risk of the stent falling off the balloon prematurely.

Abstract: Apparatus to remove tissue. The apparatus has an outer cannula and an inner cannula received within the outer cannula. The cannula are longitudinally movable relative to each other. There is an abutment at the end of one cannula to contact the other cannula. A drive permits advancing of the other cannula to contact the abutment whereby tissue between the other cannula and the abutment is removed. The invention finds particular application in removable of lens tissue from the eye of a human or other animal.

Abstract: A balloon catheter is provided having an expandable distal portion and balloon protector means comprising a first removable sleeve having a variable inner diameter to ease sliding the first sleeve over the balloon, and an optional second removable (outer) sleeve positioned over the inner sleeve, the second (outer) sleeve having a constrictive relationship with the first (inner) sleeve, said first and second sleeves being removed prior to use of the catheter.

Abstract: An apparatus used in a method of restricting venous flow in an extremity includes a first flexible, stretchable elongate band and a first flexible, stretchable loop fixed to a first end of the first band. A second loop sized to fit about the extremity is defined by passing a free end of the first band through the first loop. Upon pulling a free end of the first band through the first loop in a direction outward from the extremity, the first band stretches against the first loop, thereby causing the second loop to tighten about the extremity to restrict venous flow therethrough. A combination of frictional engagement and stretching of the first band and of the first loop against each other releasably secures the second loop about the extremity in its tightened position, thereby eliminating the need to hold the apparatus to maintain the tightened position.

Abstract: A surgical instrument includes a manually engageable handle and a first stem section having a longitudinal axis and extending from the handle. A tip portion of the surgical instrument has a suction port for applying suction to tissue and a fluid outlet port for directing fluid to tissue. A second stem section is connected between the first stem section and the tip portion and has at least a portion which is bendable. The second stem section supports the tip portion for movement between a plurality of orientations relative to the axis and to the first stem section. The surgical instrument includes means for bending the bendable portion of the second stem section to change the orientation of the tip portion of the surgical instrument relative to the axis and to the first stem section from a first orientation to a second orientation.

Abstract: The present invention is directed to a device and methods for immobilizing a localized region of a compliant body. A device of the invention includes at least two arms, an elbow region between the arms, and a suction arrangement. During use the region of the compliant material to be immobilized is flanked by the arms and a negative pressure is applied through the suction arrangement to immobilize the flanked region. The device of the invention is suited for use in medical applications, for example, coronary bypass graft surgery.

Abstract: The present invention provides for an expandable stent (10 or 20) for use in an artery or other vessel of a human body. The stent structure (10 or 20) maintains the patency of the vessel within which the stent (10 or 20) is expanded radially outward. One embodiment of the present invention is a stent (10) having a multiplicity of frames (12) joined together by at least two undulating longitudinal structures (14L and 14R) which can readily change their length in the longitudinal direction so as to provide increased longitudinal flexibility for the stent (10) for easy passage through and placement within a curved vessel such as a coronary artery. The stent (20) is an embodiment of the present invention having frames (22) joined with longitudinal structures (24B, 24T and 24R) and formed from a single, thin-walled piece of metal by means of laser cutting or chemical etching.