Abstract: A tissue dissector and method for welding and severing blood vessels includes advancing the tip of a tissue-dissecting surgical instrument through tissue, with a tissue welder substantially concealed within the tip during tissue dissection. Blood vessels encountered in the tissue being dissected are selectively captivated and compressed in substantial contact with the tissue welder to elevate the temperature of the compressed tissue sufficiently to hemostatically weld and sever the compressed blood vessel.

Abstract: Apparatus and surgical methods establish temporary suction attachment to a target site on the surface of a beating heart for analyzing electrical signals or hemodynamic responses to applied signals at the target sites for enhancing the accuracy of placement of cardiac electrodes at selected sites and for enhancing accurate placement of a surgical instrument maintained in alignment with the suction attachment. A suction port on the distal end of a supporting cannula carries surface-contacting electrodes and provides suction attachment to facilitate temporary positioning of the electrodes in contact with tissue at the target site, and a clamping and release mechanism to facilitate anchoring a cardiac electrode on the moving surface of a beating heart at a selected site. Analyses of sensed signals or responses to applied signals at target sites promote epicardial mapping of a patient's heart for determining optimum sites at which to attach cardiac electrodes.

Abstract: Devices, instruments and tools for minimally invasive surgical procedures. Port devices and methods for hemostatically sealing and providing a port through a tissue wall that interfaces with a fluid containing chamber, by minimally invasive techniques. Assemblies, instruments and methods for minimally invasive access to and through a tissue wall that interfaces with a fluid containing chamber, and for visualizing same. Instruments, assemblies and methods for minimally invasive surgical procedures, including ablation.

Abstract: Disclosed herein are methods, devices, and systems for folding a sealing element. A loader can receive a substantially unfolded sealing element, which when moved through the loader is configured for receipt in an insertion instrument. For example, the sealing element can be folded into a substantially prolate spheroidal shape. The folded sealing element can then be inserted into the insertion instrument. In one aspect, the loader is adapted to allow insertion of the folded sealing element into the insertion instrument when the folded sealing element is within a channel of the loader.

Abstract: Apparatus and method for harvesting selected vessels in the body of a patient include manual manipulation of a rigid dissecting endoscope and the reconfiguration thereof to facilitate tissue dissection and tissue dilation in the formation of an anatomical space about the vessel within which side-branch vessels may be manipulated in preparation for severance and removal of the vessel from the anatomical space.

Abstract: Apparatus and method for harvesting selected vessels in the body of a patient include manual manipulation of a rigid dissecting endoscope and the reconfiguration thereof to facilitate tissue dissection and tissue dilation in the formation of an anatomical space about the vessel within which side-branch vessels may be manipulated in preparation for severance and removal of the vessel from the anatomical space.

Abstract: A cannula includes a tubular body and an endoscope for viewing through a transparent, blunt, tissue-separating tip substantially covering the distal end of the body. Endoscopic viewing through the tip is enhanced by inner walls that taper 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 vessel for subsequent harvesting or other treatment of the isolated vessel. Lateral branch vessels of a main vessel to be harvested are doubly clipped or otherwise doubly occluded, and then severed to isolate the main vessel for use, for example, in revascularizing the coronary artery.

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 dissection cradle that is resiliently supported along an axis skewed relative to the axis of the cannula. The dissection cradle, in operation, is extended to cradle the target vessel, and the retractor may be fully extended to urge the vessel away from the axis of the cannula to isolate a side branch for exposure to a surgical tool. The retractor includes a hollow support and a spray nozzle disposed in the distal end of the retractor to form an irrigation system and lens washer that can be selectively positioned to direct the spray of irrigation fluid at a remote surgical site or at an endoscopic lens.

Abstract: Apparatus and method for performing surgical procedures within the mediastinum and within the pericardium include an endoscopic cannula having a transparent tip, and an endoscope for introduction into the mediastinum and optionally into the pericardium via a single subxiphoid incision. A cavity may be initially dilated for advancing the endoscopic cannula using a dilating tool that exerts a lateral-expansive force against surrounding tissue for evaluating the endoscopic cannula to be introduced into the mediastinum. Other surgical instruments are positioned through the endoscopic cannula to cut a flap of the pericardium as an opening through which other surgical apparatus may be introduced. The endoscopic cannula may be swept around selected regions of the heart through an aperture near the apex of the heart to facilitate placement of epicardial tacks about regions of the heart.

Abstract: Components for an endoscopic vessel harvesting system suitable for harvesting target vessels such as the saphenous vein or radial artery for cardiac artery bypass graft surgery. The main components of such systems include a vessel dissector and a vessel harvester, both of which work in conjunction with a separately provided endoscope. The vessel dissector is an elongated cannula having a blunt tip for separating layers of facial around vessels. The tip may be movable, and is typically transparent to permit viewing forward of the tip using the endoscope. Internal features of the tip may reduce glare back to the endoscope. Several devices improve visibility through the tip by reducing interference from tissue or fluid on the tip. The vessel harvester also has an elongated cannula for receiving the endoscope. Several tools within the harvester permit manipulation, severing, and sealing of vessels forward of the distal end.

Abstract: Described herein are methods and devices for loading an anastomotic seal into a delivery lumen. A loading device can fold the seal into a configuration for insertion into the delivery lumen. For example, the loading device can fold the seal into a prolate spheroidal shape. The delivery lumen can then be inserted into the loading device and mated with the folded seal.

Abstract: Described herein are systems and methods for inserting a hemostatic seal into a delivery device. One such system can include a loading tool and a delivery device configured to detachably mate with one another. The loading tool can house a hemostatic seal in its unfolded configuration and can fold the seal for delivery into the delivery device. The delivery device can then be advanced into the loading tool to insert the seal into the delivery device.

Abstract: A flexible connector for securing an ablation probe in a looped configuration around the pulmonary veins of a heart includes a flexible base member having first and second apertures dimensioned to receive the ablation probe and wherein the flexible base member is slidable along a length of the ablation probe when the ablation probe is positioned within the first and second apertures. The flexible base member further includes a third aperture dimensioned to receive a looped portion of the ablation probe. The flexible connector is advanced along the length of the ablation probe to form a crossover point with the returning portion of the ablation probe. A tether is secured to the flexible base member and is used to withdraw or remove the flexible connector.

Abstract: Apparatus and method for performing surgical procedures within the mediastinum or within the pericardium include an endoscopic cannula that is introduced into the mediastinum and optionally into the pericardium via a subxiphoid incision. A cavity may be initially dilated for advancing the endoscopic cannula using a dilating tool having an inner cannula and an outer expansible sheath that is expansible to exert a laterally expansive force against the surrounding tissue. Surgical instruments such as a pericardial entry device are inserted into a lumen of the endoscopic cannula to grasp a flap of the pericardium, and a cutting tool is extended to cut the flap to create a small opening through which other surgical tools may be introduced. The endoscopic cannula can then be advanced inside the pericardium to access all regions of the heart by sweeping the endoscopic cannula around the heart. Other surgical instruments may be inserted through the opening to perform surgical procedures within the pericardium.

Abstract: Numerous embodiments of a system and method for treating cardiac tissue are described. In one embodiment, bone marrow cells are extracted from a patient. The cells are then processed to isolate mononuclear cells, which can then be delivered back near the cardiac tissue of the patient.

Abstract: Method and apparatus for dissecting tissue along a vessel include a cannula having a tubular body and at least one lumen extending the length of the body to receive an endoscope in the lumen with a viewing end disposed near the distal end of the body that is covered by a transparent, tissue-separating tapered tip. Endoscopic viewing through the tip is enhanced by tapering the inner walls thereof to a cusp adjacent the distal end of the tip in order to reduce visual distortion. Alternatively, a removable or deflectable tip exposes a dissection probe that is manipulatable along a vessel and past lateral branching vessels at the distal end of the cannula as visualized by the endoscope through the transparent tip. Tissue overlaying an artery, for example, the superior epigastric artery, is bluntly dissected to establish an elongated working cavity of bluntly-dissected tissue.

Abstract: Numerous embodiments of a system and method for treating cardiac tissue are described. In one embodiment, bone marrow cells are extracted from a patient. The cells are then processed to isolate mononuclear cells, which can then be delivered back near the cardiac tissue of the patient.

Abstract: Devices, tools and methods for occluding fluid flow between two walls of tissue in a patient. Two walls of tissue are compressed together with sufficient compressive force to prevent fluid flow between the two walls, while ensuring that the compressive force is not so great as to cause tissue necrosis. The devices, tools and methods may be carried out using minimally invasive surgical techniques, such as in reduced-access surgical sites. Devices, tools and methods are provided for occluding an atrial appendix.

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 that can be skewed relative 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 axes of the legs, and with the loop directed away from the surgical tool. Thus, in operation, a surgeon locates a vessel and side branch of interest and extends the retractor to cradle the vessel in the dissection cradle. Once cradled, the retractor may be deflected to urge the vessel away from the axis of the cannula to isolate the side branch for exposure to the surgical tool.

Abstract: Surgical procedure and surgical instruments include an electrode structure for insertion through tissue superiorly of a subxiphoid incision to a position posterior of an aspect of the sternum and anterior of the pericardium. The electrode structure may be expanded, for example, including an inflatable member to position a number of electrodes of the electrode structure in contact with the pericardium. Alternatively, an electrode structure on an insertion cannula may be retained in contact with the pericardium by the cannula positioned within the dissected tissue. Electrical conductors from the contacting electrodes are routed through the tract of dissected tissue toward the subxiphoid incision for attachment to a generator that is implanted in a subcutaneous pocket near the subxiphoid incision.