Abstract: A method of laparoscopically repairing a hernia defect comprises inserting into the patient's abdomen a surgical mesh sheet larger than the hernia defect and having a fixation fin with its proximal edge attached to a surface of the sheet. The mesh sheet is manipulated into position with the sheet surface in place at the peritoneal surface of the patient's abdominal wall and the fixation fin disposed in the hernia defect. The method reapproximates opposing edges of the defect by suturing them together with the fixation fin between them, after which the distal edge of the fixation fin is below the external surface of the patient's abdomen. The sheet is then laparoscopically positioned and anchored to the abdominal wall peritoneal surface.

Abstract: A surgical mesh for repair of incisional and or ventral hernia with a fixation fin extending from one of the surfaces of the mesh usually along the midline of the surface. The closure of the hernia defect edges involves suturing to the fin to avoid the possibility of damage to internal organs during laparoscopic suturing. An alternate embodiment involves a flexible rod mounted in a tubular structure on the mesh axis. The tubular structure includes a central opening with an attached thread that permits removal of the flexible rod, which spreads the mesh open to facilitate fixation of the mesh onto the abdominal wall surface.

Abstract: A surgical mesh for repair of incisional and or ventral hernia with a fixation fin extending from one of the surfaces of the mesh usually along the midline of the surface. The closure of the hernia defect edges involves suturing to the fin to avoid the possibility of damage to internal organs during laparoscopic suturing. An alternate embodiment involves a flexible rod mounted in a tubular structure on the mesh axis. The tubular structure includes a central opening with an attached thread that permits removal of the flexible rod, which spreads the mesh open to facilitate fixation of the mesh onto the abdominal wall surface.

Abstract: A versatile irrigation system dissector for laparoscopic surgery comprises an elongated lumen having an elongated slim tip electrode slidably mounted therein and having a cutting tip extendable therefrom at one end. The lumen is connected at the other end to a manifold mounted on a handle, which includes a pair of switches to regulate the inlet and outlet flow through the lumen for irrigation and suction purposes. A control panel on the handle regulates the current to the tip for either cutting or coagulating. Thus, several operations may be performed with a single handheld instrument in a highly efficient and rapid action.

Abstract: This invention comprises an instrument with a unique trigger mechanism for approximating any tissues that can physically reach each other during a performance of any laparoscopic procedure. The user friendly double grasper comprises an elongated cannula having visually coded jaws at one end which cooperate with an intermediate member. The visually coded jaws are connected to control means within the cannula which are coupled to tacile coded control triggers mounted to a longitudinal handle. Each trigger is spring loaded to passively close a particular jaw after manually opening the jaw. Both triggers may be operated individually or simultaneously with the same operating digit. The triggers include a dimple on one trigger and a bubble on the other trigger so that an operator may recognize which trigger corresponds to which jaw and thus control the jaws by feel. The jaws are also coded for visual recognition with different color or letter.

Abstract: An irrigation/infusion bag comprises a central bag containing irrigation/infusion fluid connected to the tubing delivery system. A peripheral bag surrounds the central bag and includes an insufflation system. When inflated with a hand pump, the peripheral bag compresses the central bag to help deliver the fluid from the irrigation system under pressure and at a desired temperature maintained by the peripheral insulation around the central bag.

Abstract: An endodissector for dissecting, wiping and cleaning tissues during laparoscopic or conventional surgery comprises an elongated or tubular instrument having a one piece molded, solid or tubular plastic mesh tip at one end and an elongated body comprising a handle at the other end. The tip is mounted on a frame and includes a threaded base extending downwardly to engage a threaded receptacle in the elongated body. The frame and mesh tip may include a straight central lumen for the insertion and use of laparoscopic instruments. Optionally, the frame may include a side port coupled to the lumen for irrigation purposes.

Abstract: A scissor comprises a rigid blade with a fixed shape and an adjustable spring blade both pinned together at the end of the blade portions. The blades also comprise elongated leg portions extending outwardly from the junction with the blade portions and terminating in curved finger loops or a manipulating handle. The adjustable spring blade comprises a blade with spring like properties of the cutting edge which is continuously maintained in rotation around the fixed axis of the non-cutting edge of said rigid blade. When the scissors are open, the line of the cutting edge of the spring blade penetrates the plane of the opposing blade. This penetration stops when the scissors are closed. The rotation of the spring blade cutting edge may be clockwise or counter-clockwise but is always directed towards the sharp edge of the opposing blade of the scissors and thus continuously engages the sharp edge of the opposing blade at the cutting point.

Abstract: A versatile endoscopic retrieval bag system comprises a collapsible bag and a cooperating manipulating instrument or grasper. The two layer bag comprises an outer layer waterproof plastic bag and an inner layer mesh plastic bag which is rolled between two sides of a firm plastic rim which includes a hinge or discontinuity at the center and each end of each rim to permit bending of the rim at four points. The limbs of the manipulating instrument fit snugly onto the rim at one end up to the discontinuity. In use, the manipulating instrument is activated causing the rim to assume a substantially square, open configuration with the collapsible bag extending outwardly therefrom within a body cavity to receive various body organs or tissues.

Abstract: The Christoudias endodissector is an instrument for dissecting, wiping, sponging or cleaning tissues during endoscopic surgery. The instrument includes a mesh gauze body at one end which is held securely and housed in a recess on the head portion of the instrument by teeth on a fixed and a pivotal jaw. The lower part of the head portion is mounted within a resiliently backed cylindrical locking sheath. The lower head portion becomes an elongated main stem which is mounted within a handle sheath at the other end of the instrument. A locking pin on the stem engages a groove on the locking sheath to maintain the jaws in position. Alternate embodiments involve a mushroom dissector and a cocoon dissector named after the configuration of the gauze body which is securely affixed on a complimentary shaft. An alternate embodiment involves a tubular instrument onto which a tubular endodissector tip is attached thus forming a working port through which additional instruments can be inserted.

Abstract: The Christoudias fascial closure device comprises an elongated penetrating instrument having a sharp conical trapping end, an elongated hollow body extending rearwardly from the solid trapping end, a stylet movable within the hollow body and an upper manipulating end including a handle mounted on the stylet and a flange grip extending outwardly from the hollow body. An opening is located in the wall of the hollow body near the conical end and a straight spring wire protrudes outwardly therefrom when the handle is compressed. The spring wire is affixed at one end to the conical tip and at the other end to the forward portion of the stylet within the hollow body. The spring wire grasps a thread within the peritoneal cavity in order to pass the thread through the tissues to the outside. The device is then introduced into the cavity in the same manner through the same layers of tissues at the opposite end of the wound in order to close the wound by grasping the other end of the thread.

Abstract: The Christoudias twin forceps approximator comprises two moveable plates that are joined together at one end and a central plate of the same length which is also joined at the one end to the two metal plates or limbs. The two flexible metal plates close in a complimentary fashion against opposite sides of the central plate either simultaneously or sequentially with the thumb controlling one plate and the index finger the other, while the central plate is held steady with the palm and remaining fingers by means of a handle which is fastened to the central plate. Thus it is possible to approximate and affix tissues with a single instrument using only one hand. An alternate embodiment of the invention includes a stapler which is mounted to the forceps to fix the tissues once they are approximated by the twin forceps. Teeth on the inside surface of the free ends of the plates or jaws engage the tissue between the jaws of the forceps so that the tissue can be manipulated, rotated, etc.

Abstract: This invention comprises an instrument for peritoneal approximation following the application of mesh in a laparoscopic herniorrhaphy or for approximating any tissues that could physically reach each other during the performance of any laparoscopic procedure. The Maritsa Tissue Approximator comprises an elongated cylinder which is divided into two elongated compartments by a central plate which extends outwardly from the bottom of the cylinder. The head of the instrument comprises the outwardly extending fixed plate and two independently controlled jaws which close separately over the fixed central plate. The jaws are pivotally mounted onto a lateral extension of the center plate by pin-means about which they rotate thus opening or closing over the fixed central plate. The rotation about the pin is caused by a control wire which extends through a compartment of the cylinder and is affixed to a pivotal member at the other end of the instrument.

Abstract: The invention comprises an elongated cylindrical instrument and a method for extracorporeal knot tying in endoscopic surgery. The Christoudias knot-transfer instrument includes a solid stem of substantially cylindrical cross section with two diametrically opposite longitudinal grooves along its outer surface. These grooves converge at an angle of 100 degrees towards the axis of the cylinder at the head of the instrument, and at an angle of 150 degrees towards the axis of the cylinder at the tail of the instrument. In accordance with the method herein, this instrument pushes a knot which is tied extracorporeally with its head, through a port and into the tissues to be ligated or on top of another knot. The ends of the surgical thread slide along the grooves. Many knots can be tied and delivered to said tissues in an extremely expeditious manner.

Abstract: A spongestick for endoscopic procedures including a hollow stem of substantially cylindrical cross-section with a longitudinal groove along its outer surface and having a handle at one end and a balloon receptor portion at the other end. The stem is surrounded by a retractable sheath having a handle at the end adjacent the stem handle. A balloon system is included having a Leur lock tip at its upper end for coupling to inflation means and an elongated tube portion which extends within the longitudinal groove in the stem to a tubular balloon which fits over the receptor portion. Circumferential grooves are provided on the upper and lower sections of the receptor portion to accommodate rubber bands which secure a tubular gauze member over the balloon. The gauze member is expanded by inflation of the balloon. The hollow interior of the stem provides a passage for endoscopic instruments such as forceps, dissectors, etc.

Abstract: An assembly to facilitate endoscopic surgery comprises an endoscopic dual head needle holder, a needle transporter, a needle guide forceps and an endoscopic suture with a terminal loop. The assembly is utilized in a unique process wherein the tissue to be sutured is grasped by the needle guide forceps and the needle inserted into and through the tissue with the assembly. The needle is inserted into a body cavity with a transporter, a first needle holder is advanced to the appropriate level and the needle transferred to the first needle holder. The needle is then passed through the tissue to a second needle holder and then back to the first needle holder. The needle is then passed through the suture loop securing the thread on the tissues. Continuous suturing is then achieved by successive passage of the needle by the first needle holder through the tissues by the first needle holder, retrieval of the needle by the second needle holder and passage of it back to the first needle holder.

Abstract: The invention relates to a technique and instrument comprising a relay rod for performing subcutaneous placement of silastic tubing or vascular grafts from incisions in different parts of the body, more particularly, peritoneovenous shunts or peripheral arterial bypass. The relay rod, which is of rigid non-toxic material, comprises a receptor bore near the tip of its head for threading through the end of the silastic tube or vascular graft. A pair of longitudinally-extended grooves, distal to the receptor bore, accommodate the end portions of the silastic tube or vascular graft, which are secured in place parallel to the rod axis by a pair of ties which rest in circumferential grooves near the upper and lower ends of the longitudinal grooves. The distal end-portion of the rod comprises a shaft and a striated handle to facilitate gripping. The relay rod, with the silastic tube or the vascular graft secured in place thereon, is passed subcutaneously between incisions in different parts of the body.

Abstract: A spongestick for .Iadd.retraction, and tissue manipulation in .Iaddend.endoscopic procedures including a hollow stem of substantially cylindrical cross-section with a longitudinal groove along its outer surface and having a handle at one end and a balloon receptor portion at the other end. The stem is surrounded by a retractable sheath having a handle at the end adjacent the stem handle. A balloon system comprises a Leur lock tip at its upper end for coupling to inflation means and an elongated tube portion which extends within the longitudinal groove in the stem to a tubular balloon which fits over the receptor portion. Circumferential grooves are provided on the upper and lower sections of the receptor portion to accommodate rubber bands which secure a tubular gauze member over the balloon. The gauze member is expanded by inflation of the balloon .Iadd.during use.Iaddend.. The hollow interior of the stem provides a passage for endoscopic instruments such as forceps, dissectors, etc.