Abstract: A cannula includes a tubular body having a proximal end and distal blunt end, at least one lumen extending the length of the body, an endoscope having a lighted, viewing end disposed in the lumen near the distal end of the body, and a transparent, tissue-separating tip substantially covering the distal end of the body. The tissue-separating tip is slightly blunted to inhibit avulsion of tissue and lateral vessels along the dissected cavity formed thereby. Endoscopic viewing through the tip is enhanced by tapering the inner walls thereof to a cusp adjacent the blunt tip in order to reduce visual distortion. Alternatively, a cannula includes a dissection probe and a removable or deflectable tip for exposing the probe and endoscope to facilitate viewing and the dissection of connective tissue and lateral vessels along the dissected cavity. Methods of using such cannulas produce an elongated cavity along the course of a blood vessel for subsequent harvesting or other treatment of the isolated blood vessel.

Abstract: An endoscopic cardioplegic infusion cannula and its method of use is provided for occluding the ascending aorta and infusing cardioplegic fluid into the coronary arteries. A cannula is inserted suprasternally and the distal end of the cannula is inserted into the ascending aorta. An occlusion balloon on the distal end of the cannula is inflated and occludes the ascending aorta. Cardioplegic fluid is infused through the cannula proximal to the occlusion balloon and perfused into the coronary arteries. In order to effect a better seal where the distal end of the cannula is inserted into the ascending aorta, an outer sheath having a flange is advanced over the cannula into contact with the ascending aorta to compress a portion of the ascending aorta between the flange and the occlusion balloon. Cardiopulmonary bypass is effected in a known manner to supply the patient with oxygenated blood. The cannula and its method of use can be used in a closed or open chest procedure.

Abstract: A cannula includes a tubular body having a proximal end and distal blunt end, at least one lumen extending the length of the body, an endoscope having a lighted, viewing end disposed in the lumen near the distal end of the body, and a transparent, tissue-separating tip substantially covering the distal end of the body. The tissue-separating tip is slightly blunted to inhibit avulsion of tissue and lateral vessels along the dissected cavity formed thereby. Endoscopic viewing through the tip is enhanced by tapering the inner walls thereof to a cusp adjacent the blunt tip in order to reduce visual distortion. Alternatively, a cannula includes a dissection probe and a removable or deflectable tip for exposing the probe and endoscope to facilitate viewing and the dissection of connective tissue and lateral vessels along the dissected cavity. Methods of using such cannulas produce an elongated cavity along the course of a blood vessel for subsequent harvesting or other treatment of the isolated blood vessel.

Abstract: A cannula includes a tubular body having proximal closed end and distal blunt end, at least one lumen extending the length of the body, an endoscope having a lighted, viewing end disposed in the lumen near the distal end of the body, and a transparent, tissue separating member substantially covering the distal end of the body. The tissue separating member has a blunt tip disposed from and of the end distal to the body. A method of using such a cannula separates tissue to form an elongated cavity along the course of a small blood vessel and subsequently harvesting the blood vessel.

Abstract: A mechanical lifting retractor is provided which increases working space in the chest for cardiac surgery by temporarily expanding the space between the rib cage and the pericardium. The lifting device has a pair of parallel right-angled retractors. Distal portions of the retractors are insertable in side-by-side parallel relation between a pair of adjacent ribs in the rib cage and into the mediastinal space between the ribs and sternum and the pericardium beneath them. The distal portions are pivotable into a lifting position in which they are separated by a rotational angle of approximately 180.degree.. Following insertion of the distal portions into the mediastinal space, the distal portions are rotated into the lifting position and oriented in the sagittal plane such that each distal portion extends beneath one of the ribs. A lifting force is applied to the lifting retractor, causing the distal portions to engage the ribs and to lift the rib cage and thereby enlarging the mediastinal space.

Abstract: An apparatus for tissue dissection and instrument anchoring, including a dissection balloon having a viewing window (preferably a rigid, transparent window) at its distal end, or including an anchoring or dissection balloon having nonuniform elasticity selected to achieve desired inflated shape and pressure characteristics, and methods for using such apparatus. The window, which can be a lens (such as a wide angle lens), is transparent and either rigid or non-rigid but sufficiently strong to retain a desired optical shape while (and after) being pushed against tissue layers by a rigid instrument deployed within the balloon. In preferred embodiments, the balloon is a long-necked dissection balloon deployed through a cannula.

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 system for locally stabilizing an anastomotic site of a vessel of a beating heart during a surgical procedure is disclosed. The system includes bonding a pad to the myocardium and attaching a control arm to the pad, all by use of a bioabsorbable adhesive. The control arm is grasped and manipulated by a retractor thereby stabilizing the anastomotic area during the surgical procedure. The pad is optional and can be ommitted in one embodiment where the control arm has feet that are directly bonded to tissue. The pad may also have barbs or can include suction cups. The pad can include a helix-shaped fastener or a mechanical fastener that can be easily linked or hooked to a surgical instrument for manipulation.

Abstract: A prosthetic strip or patch and associated surgical procedures allow a surgeon to maneuver the strip or patch without the use of laparoscopic graspers. The prosthetic strip or patch includes pockets into which a fastener tool, used to secure the strip or patch to tissue or to ligaments in the body, is inserted in order to maneuver the strip or patch into selected position and then to tack or otherwise attach the strip or patch to tissue at the selected position.

Abstract: A blunt dissection cannula and method selectively isolate a vessel of interest within the body of a patient by dissecting connective tissue in and about the adventitial tissue plane. The procedure includes selectively advancing the cannula and transparent tapered tip along the vessel of interior to form an insufflated cavity along the course of the vessel while visualizing the vessel and side branches within the field of view of an endoscope through the transparent tip. An electrocautery electrode selectively extends through an access port at the distal end of the cannula, eccentrically relative to the transparent tip, to facilitate visualizing rotational and translational positioning of the electrode to contact and electrocauterize side branches within the field of view through the transparent tip.

Abstract: Apparatus and method for reducing a fractured long bone includes a cannula having a transparent tapered tip for facilitating visualization of the cannula being advanced along the bone from an initial incision remote from the fracture. The cannula includes a selectively inflatable balloon near the tip to expand a working cavity adjacent the bone. An arched, elongated positioning fixture is inserted into the working cavity with lower edges including facing grooves therein disposed against the bone. A support gate is slid into position across the fracture along the groove in the fixture, and holes in the support plate are referenced by the fixture from above the overlying skin. Small incisions are formed with reference to holes in the support plate for insertion of bone screws through the incisions and the fixture to secure the support plate to the bone across the fracture under visualization of an endoscope positioned within the arched space of the fixture.

Abstract: A retractor and a surgical tool are positioned within a cannula, and a dissection cradle of the retractor is positioned at the distal end of the cannula. The retractor includes a first portion with an axis approximately parallel to the axis of the cannula and a second portion with an axis at an angle to the axis of the cannula. The dissection cradle is located at the distal end of the second portion of the retractor, and may include two substantially parallel, spaced legs with the retractor shaped in a loop between and in a plane skewed relative to the axis of the legs, and with the loop directed away from the surgical tool. Thus, in operation, when the surgeon locates a vein and side branch of interest, the surgeon extends the retractor to cradle the vein in the dissection cradle. Once cradled, the retractor may be fully extended to urge the vein away from the axis of the cannula isolate the side branch for exposure to the surgical tool.

Abstract: A cannula includes a tubular body having a proximal end and distal blunt end, at least one lumen extending the length of the body, an endoscope having a lighted, viewing end disposed in the lumen near the distal end of the body, and a transparent, tissue-separating tip substantially covering the distal end of the body. The tissue-separating tip is slightly blunted to inhibit avulsion of tissue and lateral vessels along the dissected cavity formed thereby. Endoscopic viewing through the tip is enhanced by tapering the inner walls thereof to a cusp adjacent the blunt tip in order to reduce visual distortion. Alternatively, a cannula includes a dissection probe and a removable or deflectable tip for exposing the probe and endoscope to facilitate viewing and the dissection of connective tissue and lateral vessels along the dissected cavity. Methods of using such cannulas produce an elongated cavity along the course of a blood vessel for subsequent harvesting or other treatment of the isolated blood vessel.

Abstract: A method of separating tissue layers using an inflatable balloon, in which endoscopic visualization may be carried out through the balloon during inflation.

Abstract: A mechanical lifting retractor is provided which increases working space in the chest for cardiac surgery by temporarily expanding the space between the rib cage and the pericardium. The lifting device has a pair of parallel right-angled retractors. Distal portions of the retractors are insertable in side-by-side parallel relation between a pair of adjacent ribs in the rib cage and into the mediastinal space between the ribs and sternum and the pericardium beneath them. The distal portions are pivotable into a lifting position in which they are separated by a rotational angle of approximately 180.degree.. Following insertion of the distal portions into the mediastinal space, the distal portions are rotated into the lifting position and oriented in the sagittal plane such that each distal portion extends beneath one of the ribs. A lifting force is applied to the lifting retractor, causing the distal portions to engage the ribs and to lift the rib cage and thereby enlarging the mediastinal space.

Abstract: An apparatus for retracting an organ inside the body to gain access to an adjacent tissue Includes an inflatable main chamber having a thin, flexible main envelope. Inflation of the main chamber within the body results in retraction of body tissues or organs to retracted conditions. During use an aperture may be formed in the main envelope to provide access through the main chamber to body tissue. An inflatable secondary chamber defines a cage positioned within or around the main chamber and maintains retraction of organs retracted by the main chamber notwithstanding formation of an aperture in the main envelope.

Abstract: A surgical procedure includes forming an incision in a patient placed in the right lateral recumbent position to facilitate forming a retroperitoneal cavity. Dissection is formed with a balloon cannula, and the retroperitoneal cavity thus formed is then maintained by a mechanical lift or retractor positioned to elevate the wall of the cavity adjacent the patient's left side. The dissected peritoneum and the underlying bowel are displaced away from the spine by gravity with the patient thus positioned. An endoscope may be introduced into the retroperitoneal cavity to visualize surgery within the cavity including dissection of the iliopsoas muscle to facilitate discectomy and spinal fusion of adjacent vertebrae.

Abstract: An apparatus and method for separating a first layer of tissue from a second layer of tissue. A supporting part extends into the interior of the balloon during inflation to provide support for the balloon. The supporting part is retracted to a position outside the interior of the balloon after inflating the balloon. An endoscope is then inserted into the interior of the balloon. The endoscope is moved within the interior of the balloon to change the field of view of the endoscope.

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: A method of harvesting arterial conduits for coronary bypass grafting includes isolating the internal mammary artery and the superior and inferior epigastric arteries through a subcostal incision using a tapered tip balloon dissection cannula. A free end of the isolated artery may be anastomosed to the coronary artery, and a free graft harvested from the inferior epigastric artery may be anastomosed to the subclavian artery for an additional coronary bypass conduit.