Abstract: A medical apparatus and method of use for implanting a percutaneous catheter in a patient's body which catheter can be easily positioned, repositioned, and replaced. The apparatus includes an elongate sleeve having a tapered forward portion to facilitate its insertion through an undersized incision. The sleeve provides an interior elongate passageway which extends from a sleeve proximal end to a sleeve distal end. The sleeve is intended to be percutaneously implanted through an incision in the patient's skin so that the sleeve distal end resides subcutaneously. The sleeve outer peripheral surface carries a layer of porous material intended to be placed under the patient's outer skin layer in contact with the dermis to promote tissue ingrowth for anchoring the sleeve and forming an infection resistant barrier. The sleeve passageway is dimensioned to snugly accommodate the outer surface of catheter while permitting the catheter to slide relative to the sleeve.

Abstract: Methods of reinforcing annulus fibrosis tissue within an intervertebral disc include the implantation of a support member also functioning as a barrier to resist damage to the tissue or herniation of tissue outside the disc. The device may be anchored to the surrounding tissue. The device is compressible and may be delivered in a minimally invasive manner through a cannula.

Abstract: An apparatus and method for facilitating the implantation of a medical device through an incision so as to promote soft tissue ingrowth into a biocompatible porous layer, e. g, titanium, carried on the periphery of the medical device. The method utilizes an incision (either percutaneous or subcutaneous) which is intentionally undersized by 10-20% relative to the width dimension of the porous layer. Accordingly, a physician must stretch the surrounding tissue to maximize the size of the opening to insert the device. Because the opening is undersized relative to the porous layer, the surrounding tissue remains physically stressed, i.e., radially and/or circumferentially, and acts to enhance cell proliferation and healing. A surgical cutting tool is preferably provided to assist the physician to form a properly dimensioned opening.

Abstract: A method and apparatus for facilitating the management of indwelling conduits to avoid and/or treat infections associated with long term implantation. A sleeve carrying a layer of porous material on its outer surface is percutaneous implanted to place the layer of porous material just under the patient's outer skin in contact with the patient's dermis where it functions to promote soft tissue ingrowth. A catheter passes through the sleeve passageway and along an interior body path to an interior destination site, e.g., an opening into a vein, i.e., venotomy site. Within about 3-6 weeks after implantation, the patient's dermal tissue integrates sufficiently with the sleeve porous material to physically anchor the sleeve and create an infection resistant barrier. Further, a tunnel, characterized by an epithelialized capsule, typically forms around the catheter along the interior body path extending to the interior destination site.

Abstract: The present invention is directed to an improved anesthesia manifold and an improved induction valve mechanism. A plurality of induction valve elements may be joined or “ganged” together in order to define a manifold. In the preferred embodiment of the induction manifold, at least two individual valve elements are combined to form the manifold. Each of the plurality of valve elements includes the following components: (1) a valve body; (2) a first inlet port carried by the valve body and defining at least in part a central fluid communication flow path for supplying intravenous fluid to patient; and (3) a second inlet port carried said valve body and at least in part defining an anesthesia drug inlet.

Abstract: Reinforcement of annulus fibrosis tissue within an intervertebral disc can be achieved through implantation of a support member also functioning as a barrier to resist damage to the tissue or herniation of tissue outside of the disc. The device may be anchored to the surrounding tissue. The device is compressible and may be delivered in a minimally invasive manner through a cannula.

Abstract: A medical valve includes a valve body having a central fluid passageway defined therein. A movable piston adapted in size and shape to be located within said central fluid passageway of said valve body. A sealing interface is defined between said movable piston and said central fluid passageway. An upper seal is located at an upper portion of said sealing interface. It is formed by a seal carried by said valve body. A lower seal is located at a lower portion of said sealing interface, and is formed by a seal carried by said movable piston. The lower seal remains intact until after said upper seal is broken.

Abstract: The present invention relates generally to intervertebral disc devices and methods and instrumentation for intervertebral disc procedures. An intervertebral disc repair and diagnostic device that is minimally invasive, actively guided, and provides direct and consistent access to the inner surface of the posterior anulus, which will not unintentionally exit the posterior anulus and cause harm to the spinal cord, is provided.

Abstract: Methods, devices, and systems for a) revascularization and/or b) performing other medical procedures at vascular or non-vascular intracorporeal locations within a mammalian body. The methods generally comprise the formation of at least one extravascular passageway from a blood vessel to a vascular or non-vascular target location. In the revascularization methods the extravascular passageway is utilized for blood flow. In the medical procedure methods the extravascular passageway is utilized as a conduit for accessing or performing procedures at the vascular or non-vascular target location. Also disclosed are catheter devices and systems which are useable to form the extravascular passageways of the invention, as well as apparatus for modifying, maintaining and/or closing such extravascular passageways.

Abstract: Apparatus and methods are directed at stabilizing somatic implants. A site within a body is selected that has a first region having a tight and/or changing curvature bordered by a second region or regions having minimal or constant curvature.

Abstract: Methods of reinforcing annulus fibrosis tissue within an intervertebral disc include the implantation of a support member also functioning as a barrier to resist damage to the tissue or herniation of tissue outside the disc. The device may be anchored to the surrounding tissue. The device is compressible and may be delivered in a minimally invasive manner through a cannula.

Abstract: Methods, devices, and systems for a) revascularization and/or b) performing other medical procedures at vascular or non-vascular intracorporeal locations within a mammalian body. The methods generally comprise the formation of at least one extravascular passageway from a blood vessel to a vascular or non-vascular target location. In the revascularization methods the extravascular passageway is utilized for blood flow. In the medical procedure methods the extravascular passageway is utilized as a conduit for accessing or performing procedures at the vascular or non-vascular target location. Also disclosed are catheter devices and systems which are useable to form the extravascular passageways of the invention, as well as apparatus for modifying, maintaining and/or closing such extravascular passageways.

Abstract: Apparatus and methods are directed at stabilizing somatic implants. A site within a body is selected that has a first region having a tight and/or changing curvature bordered by a second region or regions having minimal or constant curvature. An apparatus that has a flexible portion and one or more relatively rigid portions may then be implanted such that the flexible portion is situated in the first region and the rigid portion lies in the second region whereby the implant will remain dynamically stable and resist migration.

Abstract: An intraluminal prosthesis is provided with a plurality of annular elements. Each annular element includes a plurality of struts and apices connected to form an annular configuration. Each annular element has a compressed state and an expanded state, and has a longitudinal dimension which is smaller in the expanded state than in the compressed state. A plurality of connecting members connect the apices of adjacent annular elements. The connecting members have a plurality of alternating segments that function to compensate for the smaller longitudinal dimension of each annular element in the expanded state. The stent may be provided with varying flexibility along its length and/or circumference, and may include segments that have different diameters.

Abstract: The present invention relates generally to intervertebral disc devices and methods and instrumentation for intervertebral disc procedures. An intervertebral disc repair and diagnostic device that is minimally invasive, actively guided, and provides direct and consistent access to the inner surface of the posterior anulus, which will not unintentionally exit the posterior anulus and cause harm to the spinal cord, is provided.

Abstract: An implantable device including a housing having a stud projecting percutaneously through an incision in the patient's skin. The stud defines a peripheral surface extending longitudinally inwardly from the stud outer end. The longitudinal peripheral surface is used as a substrate to carry a peripheral fibrous layer which extends longitudinally along the stud from its outer end adjacent to the skin incision to below the patient's epidermal and dermal skin layers for promoting laterally directed soft tissue ingrowth. The housing also defines a lateral shoulder surface oriented substantially perpendicular to the longitudinal peripheral surface. The shoulder surface, when implanted, is located just inwardly from the patient's outer skin surface. The shoulder surface also carries a porous layer conducive to promoting tissue ingrowth. The provision of both lateral and longitudinal porous layers on the device allows tissue ingrowth, i.e.

Abstract: A surgical instrument with articulated jaw structure includes a frame and two jaws. The jaws have proximal portions that are mounted to each other for movement in a substantially parallel relation between a fully open position wherein the jaws are separated for receiving tissue therebetween and an approximated position wherein the jaws are closer together. Preferably, the jaws are in the fully open position when the distal portion of at least of the jaws is located in an extended position and are in the approximated position when the distal portion of the extended jaw or jaws is located in a retracted position. The surgical instrument may further include a detachable knife assembly and knife actuating mechanism.

Abstract: A percutaneous tissue track closure assembly (2) includes a semipermeable barrier (26) mounted to the distal end of a tubular barrier carrier (20). The barrier is passed down a tissue track (12) and into a blood vessel (18) where the barrier is expanded to close off the blood vessel opening (14). A syringe device is used to drive a hemostatic flowable material (30) through a delivery tube (34) and into the tissue track. The semipermeable barrier permits blood to flow therethrough but prevents passage of the hemostatic flowable material therethrough. The hemostatic material includes a material which swells upon contact with blood, and a blood clotting agent. After an appropriate period of time, the barrier is collapsed and the barrier carrier and delivery tube are removed from the tissue track.

Abstract: An intraluminal prosthesis is provided with a plurality of annular elements. Each annular element includes a plurality of struts and apices connected to form an annular configuration. Each annular element has a compressed state and an expanded state, and has a longitudinal dimension which is smaller in the expanded state than in the compressed state. A plurality of connecting members connect the apices of adjacent annular elements. The connecting members have a plurality of alternating segments that function to compensate for the smaller longitudinal dimension of each annular element in the expanded state. The stent may be provided with varying flexibility along its length and/or circumference, and may include segments that have different diameters.

Abstract: The present invention relates generally to intervertebral disc devices and methods and instrumentation for intervertebral disc procedures. An intervertebral disc repair and diagnostic device that is minimally invasive, actively guided, and provides direct and consistent access to the inner surface of the posterior anulus, which will not unintentionally exit the posterior anulus and cause harm to the spinal cord, is provided. A method for lateral probe advancement in bodily tissue, including an intervertebral disc, is also provided.