Abstract: Methods and apparatus are provided for selective surgical removal of tissue. In one variation, tissue may be ablated, resected, removed, or otherwise remodeled by standard small endoscopic tools delivered into the epidural space through an epidural needle. The sharp tip of the needle in the epidural space, can be converted to a blunt tipped instrument for further safe advancement. The current invention includes specific tools that enable safe tissue modification in the epidural space, including a barrier that separates the area where tissue modification will take place from adjacent vulnerable neural and vascular structures. A nerve stimulator may be provided to reduce a risk of inadvertent neural abrasion.

Abstract: A method of pumping fluid including the steps of providing an electrokinetic pump comprising a pair of double-layer capacitive electrodes having a capacitance of at least 10?2 Farads/cm2 and being connectable to a power source, a porous dielectric material disposed between the electrodes and a reservoir containing pump fluid; connecting the electrodes to a power source; and moving pump fluid out of the reservoir substantially without the occurrence of Faradaic processes in the pump. The invention also includes an electrokinetic pump system having a pair of double-layer capacitive electrodes having a capacitance of at least 10?2 Farads/cm2; a porous dielectric material disposed between the electrodes; a reservoir containing pump fluid; and a power source connected to the electrodes; the electrodes, dielectric material and power source being adapted to move the pump fluid out of the reservoir substantially without the occurrence of Faradaic processes in the pump.

Abstract: Methods and devices for deploying an endoluminal implant in a curved vessel. The devices include steerable catheters having a control member that extends to the distal end and operates to bend the catheter. In other cases, the stent includes a longitudinal adjustment member attached near the leading edge of the stent and operates to shorten or lengthen the stent and thereby induce a curvature. The stent is carried in a distal region of the catheter that is advanced into a curved region of a vessel. The catheter is bent and/or the stent is curved using the longitudinal adjustment member, and the stent is deployed to achieve uniform wall contact with the endoluminal surface of the vessel at the lesser curvature.

Abstract: Methods and devices for treating an aortic dissection having an entry point downstream of the takeoff of the left subclavian artery. The devices include a catheter that carries an endoluminal implant at a distal region of the catheter. The implant is a self-expanding tubular mesh or strutted stent. A capture sheath holds the stent in a compressed state for percutaneous delivery. The catheter is advanced to position the stent adjacent the entry point of the dissection. The stent is released by withdrawing the capture sheath. The stent expands to engage the intimal lining and press the intima into contact with the outer layers of the aorta and thereby promote healing of the dissection.

Abstract: The present invention relates to a minimally invasive method of performing annuloplasty. According to one aspect of the present invention, a method for performing annuloplasty includes accessing a left ventricle of a heart to provide a discrete plication element to the left ventricle, and engaging the plication element to tissue near a mitral valve of the heart. Engaging the plication element includes causing the plication element to gather a portion of the tissue to create a plication. In one embodiment, accessing the left ventricle of the heart to provide the plication element includes accessing the left ventricle of the heart using a catheter arrangement.

Abstract: A retractor and a surgical tool are positioned at the distal end of the cannula. A dissection cradle is located at the distal end of a distal portion of the retractor that is resiliently skewed relative to the cannula axis, and includes two substantially parallel, spaced legs with the retractor shaped in a loop therebetween. The procedure includes locating a vessel and side branch of interest and extending the retractor to retain the vessel in the dissection cradle to urge the vessel away from the axis of the cannula in order to isolate a side branch for exposure to the surgical tool.

Abstract: The present invention relates to a minimally invasive method of performing annuloplasty. According to one aspect of the present invention, a method for performing annuloplasty includes creating a first plication in the tissue near a mitral valve of a heart, using at least a first plication element, and creating a second plication in the tissue near the mitral valve such that the second plication is substantially coupled to the first plication.

Abstract: The present invention relates to a minimally invasive method of performing annuloplasty. According to one aspect of the present invention, a method for performing annuloplasty includes accessing a left ventricle of a heart to provide a discrete plication element to the left ventricle, and engaging the plication element to tissue near a mitral valve of the heart. Engaging the plication element includes causing the plication element to gather a portion of the tissue to create a plication. In one embodiment, accessing the left ventricle of the heart to provide the plication element includes accessing the left ventricle of the heart using a catheter arrangement.

Abstract: The present invention relates to a minimally invasive method of performing annuloplasty. According to one aspect of the present invention, a method for performing a procedure on a mitral valve of a heart includes inserting an implant into a left ventricle and orienting the implant in the left ventricle substantially below the mitral valve. The implant and tissue around the mitral valve are connected and tension is provided to the implant, in one embodiment, in order to substantially reduce an arc length associated with the mitral valve. In another embodiment, the implant is inserted into the left ventricle through the aorta and the aortic valve.

Abstract: The present invention relates to a minimally invasive method of performing annuloplasty. According to one aspect of the present invention, a method for performing annuloplasty includes accessing a left ventricle of a heart to provide a discrete plication element to the left ventricle, and engaging the plication element to tissue near a mitral valve of the heart. Engaging the plication element includes causing the plication element to gather a portion of the tissue to create a plication. In one embodiment, accessing the left ventricle of the heart to provide the plication element includes accessing the left ventricle of the heart using a catheter arrangement.

Abstract: The present invention relates to a minimally invasive method of performing annuloplasty. According to one aspect of the present invention, a method for performing a procedure on a mitral valve of a heart includes inserting an implant into a left ventricle and orienting the implant in the left ventricle substantially below the mitral valve. The implant and tissue around the mitral valve are connected and tension is provided to the implant, in one embodiment, in order to substantially reduce an arc length associated with the mitral valve. In another embodiment, the implant is inserted into the left ventricle through the aorta and the aortic valve.

Abstract: The present invention relates to a minimally invasive method of performing annuloplasty. According to one aspect of the present invention, a method for performing a procedure on a mitral valve of a heart includes inserting an implant into a left ventricle and orienting the implant in the left ventricle substantially below the mitral valve. The implant and tissue around the mitral valve are connected and tension is provided to the implant, in one embodiment, in order to substantially reduce an arc length associated with the mitral valve. In another embodiment, the implant is inserted into the left ventricle through the aorta and the aortic valve.

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 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, when the surgeon locates a vessel and side branch of interest, the surgeon extends the retractor to cradle the vessel in the dissection cradle. Once cradled, the retractor may be fully extended to urge the vessel away from the axis of the cannula to isolate the side branch for exposure to the surgical tool.

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: A lifting apparatus for deployment through a laparoscopic incision in a body wall to apply an external lifting force over a large area of the body wall. The apparatus provides a broad lifting surface that is capable of applying a lifting force of at least 40 pounds (180 Newtons) to an area of a body wall sufficiently extensive to reduce the lifting pressure exerted on the body wall to well below that which could cause pressure trauma to the body wall, yet delivers this broad lifting surface through the body wall via an incision about 14 mm long. The apparatus comprises a body wall engaging element capable of passing in a packaged state through the laparoscopic incision, and being inflatable to an inflated state. In the inflated state, the body wall engaging element is substantially toroidal, provides a broad lifting face, and bounds a central hole. The body wall engaging element includes an equatorial portion facing into the central hole.

Abstract: A side-load tolerant instrument, comprising an outer part and an inner part, for use in laparoscopic procedures in a body cavity. The inner part is elongate and includes a housed portion, which is part of the length of the inner part. The outer part is elongate, houses the housed portion of the inner part, and permits the housed portion to move freely axially relative to it. The outer part bends lengthways when an external side load is applied to it. The outer part exerts an internal side load on the housed portion of the inner part to bend the housed portion lengthways to conform to the lengthways bending of the outer part. Side-load tolerance is provided by reducing the internal side load between outer part and the inner part resulting from the outer part bending lengthways in response to the external side load. The reduced internal side load reduces friction between the outer part and the inner part when the instrument is subject to the external side load.

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, is transparent and either rigid or non-rigid but sufficiently strong to retain a desired optical shape while 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. In other embodiments, the invention is a dissection balloon assembly including a long-necked dissection balloon having a viewing window at its distal end, and a housing to which the dissection balloon's mouth is attached.

Abstract: A lifting apparatus for deployment through a laparoscopic incision in a body wall to apply an external lifting force over a large area of the body wall. The apparatus provides a broad lifting surface that is capable of applying a lifting force of at least 40 pounds (180 Newtons) to an area of a body wall sufficiently extensive to reduce the lifting pressure exerted on the body wall to well below that which could cause pressure trauma to the body wall, yet delivers this broad lifting surface through the body wall via an incision about 14 mm long. The apparatus comprises a body wall engaging element capable of passing in a packaged state through the laparoscopic incision, and being inflatable to an inflated state. In the inflated state, the body wall engaging element is substantially toroidal, provides a broad lifting face, and bounds a central hole. The body wall engaging element includes an equatorial portion facing into the central hole.

Abstract: An apparatus for suturing deep puncture wounds utilizes a capturing member which is pivotally mounted to the distal end of an elongate rod. During use, the capturing member is inserted into a body cavity through a trocar sheath positioned in a wound and pivoted into a position in which it extends beneath the tissue surrounding the wound. A membrane or other suture-capturing surface is formed on the surface of the capturing member. A suture to be applied to the wound has anchors on each of its ends, and suture-carrying needles carry each of the suture ends and their corresponding anchors. The suture-carrying needles are individually passed through the tissue layers surrounding the wound and subsequently passed through the membrane of the capturing member. The suture ends and corresponding anchor means are released from the needles.

Abstract: A seal for use in a surgical instrument to provide a gas-tight seal with an instrument passed through the seal. The seal can form a gas-tight seal with an instrument having a diameter within a wide range of diameters. The seal comprises a seal body, an instrument seal, and a laterally-compliant seal mounting. The seal body includes a bore through which the instrument is passed. The instrument seal is made of an elastic material. The instrument seal extends radially outwards from an instrument port formed in the instrument seal through which the instrument is passed. The instrument port is substantially perpendicular to the axis. The instrument seal also extends axially from the instrument port in the direction opposite to that in which the instrument is passed through the instrument port.