Abstract: The trocar system includes a cannula insertable through a body wall using an obturator having a distal tip. A traction tread disposed interiorly of the obturator inverts at the distal tip and extends proximally along the outer surface of the obturator or cannula. At the distal tip the tread can facilitate parting rather than cutting the tissue. Along the outer surface, the tread can engage the tissue to pull it proximally along the advancing obturator. This produces counter forces which can result in a net proximal force facilitating distention of the abdominal wall and separation of the abdominal wall from internal organs. The traction tread can be axially and/or radially continuous. An associated method of operation includes the steps of contacting the body wall with the traction tread at the distal tip, and engaging the body wall with the traction tread along wall portions facing the outer surface.

Abstract: A urological guidewire includes a core formed of a first metallic material and extending toward an end of the guidewire. A coil having a plurality of convolutions is disposed around the core at the end of the guidewire, the coil being formed of a second metallic material different than the first metallic material. A mechanical interlock is formed to inhibit separation of the different materials forming the coil and the core. The mechanical interlock may include an enlargement at the end of the core and a bonding material fixing the enlargement to the coil. The convolutions may include a penultimate convolution with a first radius of curvature and an ultimate convolution having a second, shorter radius of curvature to form a bridge. In this case, portions of the core can be bent back on themselves and directed over or around the bridge to form the mechanical interlock.

Abstract: A surgical wound retractor is adapted to dilate a wound stretchable to a desired diameter, the retractor includes a first ring having a diameter treater than that desired for the wound and being adapted for disposition interiorly of the wound. A second ring has a diameter greater than that desired for the wound and is adapted for disposition exteriorly of the wound. A plurality of retraction elements are disposed in a generally cylindrical relationship to each other, between the first ring and the second ring. These elements extend through the wound to exert a radial retraction force on the wound which is dependent on the distance separating the first ring and the second ring. Retraction elements, both distensible and non-distensible are contemplated with appropriate attachment means at the rings to provide for variations in the retraction force. With a suitable retraction sleeve, a third ring can be provided to form a circumferential retainer to vary the retraction force.

Abstract: A surgical access device includes a single valve that forms a seal with the body wall and provides an access charnel into a body cavity. The valve has properties for creating a zero seal in the absence of an instrument as well as an instrument seal with instruments having a full range of instrument diameter. The valve can include a gel and preferably an ultragel comprised of an elastomer and an oil providing elongation greater than 1000 percent and durometer less than 5 Shore A. The shore valve can be used as a hand port where the instrument comprises the arm of a surgeon, thereby providing hand access into the cavity.

Abstract: A urological guidewire includes a core formed of a first metallic material and extending toward an end of the guidewire. A coil having a plurality of convolutions is disposed around the core at the end of the guidewire, the coil being formed of a second metallic material different than the first metallic material. A mechanical interlock is formed to inhibit separation of the different materials forming the coil and the core. The mechanical interlock may include an enlargement at the end of the core and a bonding material fixing the enlargement to the coil. The convolutions may include a penultimate convolution with a first radius of curvature and an ultimate convolution having a second, shorter radius of curvature to form a bridge. In this case, portions of the core can be bent back on themselves and directed over or around the bridge to form the mechanical interlock.

Abstract: A pneumatic tissue dissector 10 useful for cutting or dissecting living tissue during endoscopic or laparoscopic procedures includes a dissector tip 16 for exuding a flow of pressurized gas, an inlet arrangement 24 for controlling the flow of gas from the tip 16, and an exhaust system 30 for exhausting the gas exuded from the tip 16. The exhaust system includes an inlet 32 adjacent to the tip 16 and an outlet spaced from the inlet 32. The outlet 34 is operable in coordination with the inlet arrangement 24 and is capable of exhausting a flow of gas about equal to that exuded by the tip 16, ensuring that the pressure in the cavity in which the procedure is performed does not increase or fluctuate. The flow of pressurized gas from the tip 16 is preferably compatible with an insufflation cavity pressure of no more than about 15 mm Hg, and the inlet arrangement 24 preferably supplies gas to the tip 16 at a pressure of no more than about 50 psi.

Abstract: A rotational surgical instrument including a working head connected to a rotatable, pencil-like handle. The handle includes a casing with distal and proximal end caps, an elongated outer member extending into the casing, and a actuation link extending from the distal end cap through the casing and elongated member to the working head. An actuating mechanism is positioned distally from the distal end cap about the proximal portion of the elongated member for slidably actuating the working head between and open and closed positions. A compression spring is included in the passageway of the casing around the actuation link between the proximal end cap and the proximal end of the elongated member to return the working head to the nonactuated position. Keyed surfaces are included within the passageway of the casing and attached to the distal end of the casing and the proximal end of the elongated member for preventing rotation of the elongated member with respect to the casing and actuation link.

Abstract: A percutaneously insertable, needle-sized retractor and system for grasping and retracting tissue in a cavity of a patient. The system comprises a needle-sized trocar sheath having an outside diameter in a range from 10 to 22 gauge, a pointed distal end stylet insertable into the trocar sheath, and a tissue-grasping retractor also insertable through the trocar sheath. The stylet is inserted through the trocar sheath with the pointed distal end extending therefrom. The trocar sheath and stylet are then inserted through a patient's skin and subtending tissue and organs into a desired cavity. When the trocar sheath is inserted, the stylet is removed and the tissue grasping retractor inserted through the sheath and into the cavity. A retaining cap at the proximal end of the sheath fixedly positions the retractor with respect to the trocar sheath while a retention flange positioned around the outside surface of the sheath fixedly positions the sheath with respect to the patient.

Abstract: A surgical trocar access sheath having a laterally expandable retention mechanism for percutaneous insertion through a body cavity wall. The expandable retention mechanism is positioned about the distal end of the sheath for retaining the access sheath within the body cavity. The access sheath has an inner elongated member cannula and an outer elongated member tube having a slick surface for ready insertion through a puncture site. The laterally expandable retention mechanism includes a plurality of strips extending and formed longitudinally in the outer tube. The retention mechanism has an expanded state and a retracted state. In the expanded state, the longitudinal strips extend radially from the outer elongated member tube to engage the interior surface of the body cavity wall. The expandable retention mechanism is actuated by sliding an actuating mechanism hub attached to the distal end of the outer elongated member tube against another hub fixedly attached to the inner elongated member cannula.

Abstract: A surgical cutting instrument is disclosed for percutaneously debulking tissue through an access sheath commonly used in minimally invasive laparoscopic or endoscopic surgical procedures. The cutting instrument includes a inner rotary member tube having a cutting edge at the distal end thereof for cutting and slicing tissue. The distal end of the cutting member tube extends from the distal end of a stationary sheath which prevents tissue from wrapping around the inner cutting member tube. The inner cutting member tube includes a hollow passageway for suctioning and aspirating tissue and fluid through the tube and into a collection chamber or out through a vacuum or suction line attached thereto. The instrument further includes an outer safety shield having a rounded distal end for preventing the puncture of a surgical tissue bag or from unintentionally cutting tissue by the attending physician.

Abstract: A surgical cutting instrument is disclosed for percutaneously debulking tissue through an access sheath commonly used in minimally invasive laparoscopic or endoscopic surgical procedures. The cutting instrument includes a inner rotary member tube having a cutting edge at the distal end thereof for cutting and slicing tissue. The outside surface of the rotary inner cutting member tube and outer sheath annularly close about the distal ends thereof for preventing perforation of the surgical tissue bag in which the tissue is contained. The inner cutting member tube includes a hollow passageway for suctioning and aspirating tissue and fluid through the tube and into a collection chamber or out through a vacuum or suction line attached thereto. Vacuum or suction control ports are included at the proximal end of the inner cutting member tube and stationary sheath for also controlling the amount of vacuum or suction applied to the tissue.

Abstract: A rotational surgical instrument including a working head connected to a rotatable, pencil-like handle. The handle includes a casing with distal and proximal end caps, an elongated outer member extending into the casing, and a actuation link extending from the distal end cap through the casing and elongated member to the working head. An actuating mechanism is positioned distally from the distal end cap about the proximal portion of the elongated member for slidably actuating the working head between and open and closed positions. A compression spring is included in the passageway of the casing around the actuation link between the proximal end cap and the proximal end of the elongated member to return the working head to the nonactuated position. Keyed surfaces are included within the passageway of the casing and attached to the distal end of the casing and the proximal end of the elongated member for preventing rotation of the elongated member with respect to the casing and actuation link.

Abstract: A surgical tissue bag for percutaneously debulking large volumes of tissue contained within the bag. The tissue bag comprises two layers of material, an inner layer of a puncture-resistant material and an outer layer of moisture-proof material for containing cells and fluid therein. The bag material is foldable and flexible for insertion through an access sheath into the surgical site and for forming a gas-tight seal when extended through the access sheath or puncture site. A drawstring is attached to the open end of the bag to close the bag when the tissue is contained therein and pulled through the puncture site in the outer surface of the skin. After the closed open end of the bag is pulled through the puncture site, the closed end is fanned out against the outer layer of the skin, and a morcellator is inserted into the bag for debulking the large volume of tissue. The open end of the bag is continually fanned out to maintain a compact and tight containment of the tissue and fluid remaining in the bag.