Abstract: Apparatus and methods for applying fasteners during endoscopic surgery are provided. The apparatus generally comprises a handle portion, a triggering mechanism and a fastener applicator. One embodiment of the invention forms the fastener around a single focal point on an anvil. Another embodiment vertically stacks the fasteners in a fastener applicator which is readily detachable from the handle portion by virtue of a rotational locking system and which may be replaced with a new fastener applicator having a fresh load of vertically stacked fasteners. The various embodiments may be variously combined together in a single device. The methods generally include the following steps: forming a fastener by placing it over a single focal point anvil and pressing the fastener against the single focal point anvil using a slide.

Abstract: A device for administering brachytherapy to a patient includes a vessel that may be in the form of a hollow cylindrical cup, for fleshing into and substantially filling the open-ended cavity. The vessel has a closed outer end, which may be a removable cover, and a source guide penetrates the closed outer end so as to extend deep into the vessel, to receive a radiation source in the source guide. A manipulator can be connected to the radiation source, and also to the source guide, for allowing several different types of manipulation of the source orientation and position within the vessel during the brachytherapy procedure.

Abstract: Brachytherapy treatment of a patient's lung tissue following resection is effected using a balloon applicator which is inserted, normally through the same opening used for the surgery, through the chest wall and into the cavity. The lung and chest openings are closed around the applicator and generally sealed around the applicator. A suction port is provided, in a suction circuit of the applicator, to withdraw fluid from the pleural cavity, at intervals as needed, to assure that the lung can be inflated. Different embodiments of suction circuits are disclosed. A bronchial applicator and method are also disclosed.

Abstract: A device for administering brachytherapy to a patient includes a vessel that may be in the form of a hollow cylindrical cup, for fleshing into and substantially filling the open-ended cavity. The vessel has a closed outer end, which may be a removable cover, and a source guide penetrates the closed outer end so as to extend deep into the vessel, to receive a radiation source in the source guide. A manipulator can be connected to the radiation source, and also to the source guide, for allowing several different types of manipulation of the source orientation and position within the vessel during the brachytherapy procedure.

Abstract: An expansible tunneling apparatus and associated methods for creating an anatomic working space for a surgical procedure. Various apparatus permitting observation during tunneling and balloon dissection are disclosed. In one embodiment, a tubular member has a bore extending therethrough and an open distal end. A lip is formed in the distal end of the tubular member to capture the distal tip of a laparoscope inserted into the tubular member to permit observation of the procedure during tunneling to a desired location and balloon inflation. An elongated neck of the balloon is secured to the tunneling member, and permits the tubular member to be withdrawn slightly from the balloon after inflation to facilitate observation. After the balloon has been advanced to the desired location in the body it is inflated to dissect tissue and create an operating space. Various balloon constructions and a reusable design are also disclosed.

Abstract: Radiation treatment methods for breast cancer following resection, both intraoperative and post operative, involve mapping preferably using an electronic x-ray source, and can include rotation of a direction source. By using a very rapid, near-instantaneous method of pathology of tissue margins following resection, the invention carries out intraoperative radiation treatment, preferably with the patient remaining anesthetized. Whether or not radiation is intraoperative, the invention preferably includes a mapping procedure using an electronic source that is progressed through the resection cavity while radiation dose is sensed at one or more points, to determine the shape of the resection cavity.

Abstract: A laparoscopic apparatus for tunneling dissection including a hollow tunneling member and an inflatable balloon disposed at the distal end of the tunneling member to form together a blunt tipped obturator. The tunneling member has a bore sized allow the insertion of a conventional laparoscope therein to provide observation during surgical procedures. The laparoscope provides direct observation of dissection through the open distal end of the tunneling member. Observation is provided both when the device is used to tunnel between tissue layer to a region of interest within the body of a patient, and during subsequent balloon inflation when the tissue layers are dissected to cause separation of the tissue layers and the creature of an anatomical working space. After the anatomic space has been created, the device and laparoscope are withdrawn through the incision.

Abstract: Apparatus and methods for applying fasteners during endoscopic surgery are provided. The apparatus generally comprises a handle portion, a triggering mechanism and a fastener applicator. One embodiment of the invention forms the fastener around a single focal point on an anvil. Another embodiment vertically stacks the fasteners in a fastener applicator which is readily detachable from the handle portion by virtue of a rotational locking system and which may be replaced with a new fastener applicator having a fresh load of vertically stacked fasteners. The various embodiments may be variously combined together in a single device. The methods generally include the following steps: forming a fastener by placing it over a single focal point anvil and pressing the fastener against the single focal point anvil using a slide.

Abstract: A blood vessel clip applicator includes two twist pins at one end, between which a blood vessel is placed before occlusion. A magazine in the blood vessel clip applicator holds a plurality of blood vessel clips and can be rotated independently from a grip assembly, whereby the twist pins can be rotated to compress a blood vessel held between them. The blood vessel clip is placed on the blood vessel after it has been flattened. The blood vessel clip includes spring quality material, and has a head connected to a first leg and a second leg. The magazine has a constricted region adjacent to an exit aperture. As the head enters the constricted region, the compressive force exerted on the head by the constricted region opens the blood vessel clip to an open position.

Abstract: A fastening apparatus for use in endoscopic surgery is provided and includes a fastener applicator having a first half-section and a second half-section. The first half-section includes a flat side having a first recessed region formed therein, the recessed region being configured and dimensioned to retain the plurality of vertically stacked fasteners therein. The second half-section includes a flat side having a second recessed region formed therein. The fastener applicator includes a fastener positioning spring attached to and flush with the first recessed region, wherein the fastener positioning spring is biased to extend beyond the first recessed region and the flat side of the first half-section; and a stop spring housed within the second recessed region, wherein the stop spring is biased such that when unrestrained the stop spring extends beyond the second recessed region and into the first recessed region.

Abstract: The suture retainer according to one aspect of the invention has a retainer body and a plurality of suture attachment mechanisms spaced circumferentially about the retainer body, each of the suture attachment mechanisms (such as a pair of teeth) being adapted to hold a suture strand at a discrete attachment point. Another aspect of the invention provides a method of securing a suture in a suture retainer, including the following steps: providing a suture retainer having a retainer body and a plurality of suture attachment mechanisms spaced circumferentially about the retainer body; and attaching a suture strand to the retainer body at each of the suture attachment mechanisms.

Abstract: This invention relates generally to retainers and methods of using retainers. In particular, the invention relates to a suture retainer adapted for application on a subject by use of an introducing device, such as a catheter. The suture retainer comprises two elements, such as wedge-shaped or substantially wedge-shaped elements, that are positioned such that the elements are juxtaposed with respect to each other. In operation the two elements are engaged by a spring which forces the two elements into contact. Additionally, a housing can be provided.

Abstract: An everting applicator for brachytherapy of body cavities such as the vagina has a flexible sleeve secured to a distal mandrel, both the sleeve and the mandrel having internal lumens. The flexible sleeve has a diverging opening at its distal end, preferably bell-shaped or cone-shaped, such that when the open end is pushed against the mouth of a vagina, the sleeve will evert back upon itself, progressively unrolling to an inside out configuration wherein, fully inserted, the sleeve is fully everted back over the exterior surface of the mandrel. A radiation source, isotopic or electronic, is then inserted into the mandrel lumen to commence a therapeutic irradiation procedure of tissues of the vagina.

Abstract: A method and apparatus for dissecting a first layer of tissue from a second layer of tissue and thereafter holding open an anatomic space for the performance of a surgical procedure. The method includes steps of making an incision in a body, introducing a deflated balloon dissector into the incision, inflating the balloon dissector to effect dissection of the first layer of tissue from the second layer of tissue, deploying a retractor within the anatomic space in order to hold open the anatomic space, and optionally deflating or evacuating the balloon dissector to open a cavity for surgical manipulations. The apparatus includes a combined dissector-retractor having a balloon retractor disposed upon the surface of the balloon dissector and integrated therewith.

Abstract: This invention relates generally to retainers and methods of using retainers. In particular, the invention relates to a suture retainer adapted for application on a subject by use of an introducing device, such as a catheter. The suture retainer comprises two elements, such as wedge-shaped or substantially wedge-shaped elements, that are positioned such that the elements are juxtaposed with respect to each other. In operation the two elements are engaged by a spring which forces the two elements into contact. Additionally, a housing can be provided.

Abstract: A method and apparatus for dissecting a first layer of tissue from a second layer of tissue and thereafter holding open an anatomic space for the performance of a surgical procedure. The method includes steps of making an incision in a body, introducing a deflated balloon dissector into the incision, inflating the balloon dissector to effect dissection of the first layer of tissue from the second layer of tissue, deploying a retractor within the anatomic space in order to hold open the anatomic space, and optionally deflating or evacuating the balloon dissector to open a cavity for surgical manipulations. The apparatus includes a combined dissector-retractor having a balloon retractor disposed upon the surface of the balloon dissector and integrated therewith.

Abstract: A balloon brachytherapy applicator has either a single or double chambers, with the capability of “blistering” outwardly at a specified area on one side of the balloon. This is useful to move sensitive tissue farther away from a radiation source within a source guide inside the balloon. In one case a secondary compartment is formed on the primary balloon, and is separately inflatable so as to allow blistering as desired when needed. In another form the balloon comprises a single chamber but with a “window” or area in which the balloon wall is elastic, or substantially more elastic than the main balloon wall, so that inflation of the balloon up to a certain point forms a substantially regular balloon shape, and the addition of further pressure will blister out the elastic area to increase the distance between the shaft and the sensitive tissue in a desired orientation of the balloon.

Abstract: Methods and applicator apparatus are disclosed for brachytherapy treatment of tissue surrounding a cavity in a patient, particularly a resection cavity. In treatment regimes requiring recovery time between successive radiation treatments, applicators of the invention are retained under the skin, with the skin allowed to at least partially heal, and are re-accessed later for one or more subsequent treatments. To reduce patient discomfort an anesthetic agent can be infused through the applicator to patient tissue, for insertion, balloon inflation or removal of the applicator.

Abstract: Apparatus and methods for applying fasteners during endoscopic surgery. The apparatus generally comprises a handle portion, a triggering mechanism and a fastener applicator. One embodiment of the invention forms the fastener around a single focal point on an anvil. Another embodiment vertically stacks the fasteners in a fastener applicator which is readily detachable from the handle portion by virtue of a rotational locking system and which may be replaced with a new fastener applicator having a fresh load of vertically stacked fasteners. A third embodiment of the invention has a fastener applicator having only one actuated part in its. Application mechanism, and makes use of biased springs controlled by position of the actuated part for the remaining part of the mechanism.

Abstract: Apparatus and method for applying fasteners during endoscopic surgery. The apparatus vertically stacks fasteners in a fastener applicator which is detachable and replaceable from a handle portion by a rotational locking system. The fasteners are applied by moving them to a driving channel by a biased fastener positioning spring as a slide is retracted; the slide is then advanced until it engages a fastener in the driving channel and drives the fastener over an anvil. During advancement of the slide a biased stop spring is forced back into a recess thereby allowing the next fastener to move forward in the storage channel; the slide is then retracted, freeing biased ejector springs to kick the formed fastener off the anvil; finally the slide is further retracted, until the fastener positioning spring is once again free to move the distal-most fastener from the storage channel into the driving channel.