Abstract: Methods and apparatus are provided for treating congestive heart by actively or passively enhancing perfusion to the renal arteries. A first embodiment comprises a specially configured balloon catheter and extracorporeal pump, wherein the pump operates in a “once-through” fashion or alternating volume displacement mode. In another embodiment the catheter includes a pair of balloons to isolate a region of the aorta, and a third balloon that directs flow into the renal arteries. In still further embodiments, a stent or cuff having a constricted region is deployed in or around the aorta, respectively, to create a backpressure upstream of the stent or cuff. Methods of enhancing renal perfusion also are provided.

Abstract: Methods and apparatus are provided for treating congestive heart by actively or passively enhancing perfusion to the renal arteries. A first embodiment comprises a specially configured balloon catheter and extracorporeal pump, wherein the pump operates in a “once-through” fashion or alternating volume displacement mode. In another embodiment the catheter includes a pair of balloons to isolate a region of the aorta, and a third balloon that directs flow into the renal arteries. In still further embodiments, a stent or cuff having a constricted region is deployed in or around the aorta, respectively, to create a backpressure upstream of the stent or cuff. Methods of enhancing renal perfusion also are provided.

Abstract: A cardioplegia occluder and methods of using the device during cardiac surgery are disclosed. The system typically includes a substantially rigid cannula with an occluder mounted on the distal region of the cannula that expands upon activation to occlude the aorta downstream of an infusion port which delivers cardioplegia solution to arrest the heart. Systems including cutting blades, blade guards, flanges, radiopaque markers and occluder aligners are also disclosed. In use, the distal end of the cannula is inserted through an incision into the aorta, the occluder is expanded and cardioplegia solution is infused upstream of the aorta to arrest the heart. The infusion port can alternately be used to aspirate cardioplegia or embolic debris or other unwanted material from the aorta.

Abstract: An intravascular catheter with micro spines that penetrate arterial wall to delivery drug or mechanical injury to the vessel wall inducing a “stent” like healing process in the vessel.

Abstract: The present invention relates to a device and method for endoluminal delivery of fluid, such as therapeutic fluid, into the vessel wall that minimizes loss of the fluid. In one embodiment, a catheter for delivering fluid or therapeutic into a vessel wall is provided, wherein the catheter has at least one injector for delivering fluid and a sealing mechanism for preventing or minimizing passage of fluid through an unengaged injector.

Abstract: An improved tamper evident end cap assembly for a drug loaded syringe which assembly includes a syringe cap to close the discharge port in the nozzle of the syringe and an indicator ring about the nozzle connected by chads or tabs to a tubular shield which chads or tabs are adapted to break freeing the ring from the shield to loosely wobble on the nozzle indicating tampering if an axial force of separation is applied to the syringe cap to remove it from the syringe and a one way drive mechanism engaging both the shield and syringe cap so the shield may be rotated to advance the assembly onto a syringe nozzle but which is not responsive to counter rotation to withdraw the syringe cap to open the discharge port and gain access to the drug.

Abstract: A transcutaneous access tool includes a first cannula moveable along an axis, a fixed member including an elongated prong extending parallel with the axis, and a deployment member secured to the first cannula and movable along the axis away from the fixed member. The deployment member includes spaced-apart, resiliently flexible fingers extending parallel with the axis and having distal ends that are laterally enlarged with respect to the axis. The resiliently flexible fingers are received on the prong of the fixed member. A second cannula is disposed within the lumen of the first cannula, and retraction member is secured to the second cannula and is movable along the axis. The retraction member includes at least one catch catching on the laterally enlarged distal ends of the fingers of the deployment element when the fingers are laterally held apart by the prong of the fixed member.

Abstract: An infusion system packaged in a light weight nylon portable mesh container, which is also the pump of the system, includes a removable therapy bag holding the Rx to be infused into the patient. A bladder within the pump is inflatable to provide pressure onto the therapy bag to aid in the discharge of the Rx. When filling the therapy bag, the pharmacist, using his computer to comply with standards, simultaneously programs an EPROM with data specifying the Rx as well as instructions for dispensing the Rx. In one embodiment of the invention, the EPROM fits into a docking receptacle in the pump, while in a second embodiment the EPROM is integral with the therapy bag. A microcomputer mounted in the pump is programmed to control the flow of the Rx to the patient, reading the data from the EPROM in generating the control signals. The microcomputer cyclically drives a fluid control module which outputs a fixed amount of Rx for each cycle of operation.

Abstract: The invention relates to an improved hypodermic needle and to a fluid injection device. In one embodiment, a hypodermic needle (10) is disclosed, and a fluid injection device comprises the hypodermic needle (10) and driving means coupled to the needle (10). The hypodermic needle (10) itself comprises a first, hollow needle (12) adapted to have movably secured therein at least one further, hollow needle (14), the at least one further needle (14) and part of the hypodermic needle (10) being movable relative to one another between a stressed position of the at least one further needle (14), in which the at least one further needle (14) is substantially parallel to the first needle (12), and an unstressed position of the at least one further needle (14), in which the free end of the at least one further needle (14) lies beyond the axial and/or radial terminus of the first needle (12).

Abstract: An intraluminal needle injection substance delivery system includes a delivery catheter having a delivery lumen extending therethrough to provide a conduit by which a drug delivery device can extend through to inject a therapeutic drug or substance to an area of treatment in a body vessel. The delivery system includes filtering capability for capturing possible unwanted debris which may be entrained in the patient's vasculature. The filtering device used in accordance with the delivery catheter may include a filtering element placed downstream from the area in which the therapeutic drug or substance is to be administered. The delivery lumen can be attached to the filtering device for deployment within the patient's vasculature. In this fashion, as the filtering device is expanded from a collapsed, delivery position to an expanded position within the patient's vasculature, the end of the delivery lumen will be positioned near or in contact with the target area in the patient's vasculature.

Abstract: A valve assembly and diameter reduction structure for trocar employing a movable diameter reduction structure. The diameter reduction structure is positioned in proximity to a first seal and includes a plurality of stand off members movable between a first position, a second position, and a third position. The diameter reduction structure in the first position reduces the likelihood of the first seal losing its integrity by limiting excessive off-axis and angular movements of small diameter surgical instruments. When large diameter surgical instruments are positioned through the trocar, the diameter reduction structure pivots to accommodate the passage of larger diameter surgical instruments without any operational adjustments.

Abstract: A syringe for use with a powered injector to inject a fluid into a patient inclides an encoder. The encoder includes at least a first indicator positioned on the encoder. The first indicator is adapted to interact with at least a portion of energy being propagated through or adjacent the encoder in a manner that is detectable. The presence (or absence) of the first indicator provides or corresponds to information about the syringe configuration. The indicator(s) of the present invention can, for example, provide information about syringe configuration by the number and/or position thereof. A plurality or set of such syringes can be provided, with the configuration of each such syringe being represented by the presence or absence of indicator(s) of that syringe.

Abstract: A syringe for use in ophthalmic surgery includes a pair of barrels and associated plungers which are easily and readily distinguishable by the surgeon allowing for selective and sequential delivery of two different material types through the same device.

Abstract: A syringe holder has a barrel (1) with a needle shroud (4) telescopic into its leading end and urged forwardly by a spring (5). The shroud is rotatable into several set positions, being located by snap action of a nib (18) into longitudinal grooves within a forward extension (3) of the barrel (1). An abutment (21,20) on the shroud is thereby aligned with a selected one of several abutments (12,9,14) within the barrel, these all being at different axial positions. One setting prevents needle exposure; the others permit different amounts of needle exposure as the barrel (1) is urged forwardly during an injection.

Abstract: An injection device comprising an incremental clicking mechanism providing the user with an indication of the number of doses being set. For handling different types of medicaments having different dose volumes in the same type of injection device it is beneficial to provide an additional clicking means which is easy changeable. In this way different dose volumes can be dispensed by the same type of injection devices simply by utilizing different clicking means. The clicking means is preferably a curved track provided between the dose setting member and a non-rotatable clicker element.

Abstract: A syringe comprising a barrel and a plunger rod having a proximal portion and a distal portion is provided. The distal portion includes a stopper slidably positioned in fluid-tight engagement with the inside surface of the barrel. The structure is provided for holding the proximal portion and the distal portion together during normal use of the syringe and breakable upon application of an additional force applied to the proximal portion. Structure is also provided for preventing the proximal portion from applying distally directed force to the distal portion after the breakable connection is broken.

Abstract: A syringe apparatus and process for using the same is provided, the syringe apparatus having a barrel, a plunger movable within the barrel, a needle assembly attached to an end of the barrel and having a passageway therethrough, a deformable base positioned within the barrel, flexible supports included on the deformable base, a spring within the passageway of the needle assembly, a hollow needle passing through the passageway, an enlarged head on the needle, and a rupturable web on an end of the plunger, whereby when the plunger moves through the barrel toward the needle assembly, a fluid can be moved from the barrel through the hollow of the needle, and continued movement of the plunger flexes the supports and moves the deformable base downwardly until such time a sufficient force is imparted to the rupturable web by the enlarged head to tear the web, the deformable base then releasing the needle due to force applied by the spring to project the needle into the interior of the plunger.

Abstract: A locking design aims to dispose a retaining structure between a needle base and a needle head of a syringe needle barrel for eliminating any medical contamination caused by reusing the needle head. Mainly, a needle base looping disposed at the front end of the needle barrel extends convexly to form an encircling body; the inner lateral of the encircling body forms a retaining structure with a drop to prevent the jointed needle head and needle base from being pulled apart thereby allowing the needle head to be used only once but not for repetitive application through recycling.

Abstract: The invention relates to an injection syringe, comprising a housing (1) for receiving a medicament ampoule, a plunger displaceable in longitudinal direction of the housing for pushing a sealed body into a medicament ampoule; a holder (2) for an injection needle unit (3) having a cannula attachment (3.1) that is releasably inserted into the holder (2), said attachment containing an annular flange (3.2) on its back end and a cannula (3.3) being is inserted into said attachment. The injection syringe also comprises an expanding sleeve with elastic expanding elements (13), their front ends having noses (14.1) oriented radially inward, which grasp the flange ring from behind when the injection needle units are inserted into the holder, in addition to radially oriented expanding projecting elements, the back ends of said elastic expanding elements being mounted on the cylindrical ring (12) that is fixed to the housing of the syringe (1).

Abstract: An elongated tubular needle for injecting a fluid into a human body or retracting a fluid from the human body, comprising; a tubular needle cannula (1) having a skin piercing distal end (4), an opposite proximal end (5), and a tubular sidewall (2) there between having an outside diameter at the skin piercing end (4) which is smaller than the outside diameter at the opposite proximal end (5) thereof, and a cylindrical lumen (3) extending through the needle cannula (1) and having approximately the same uniform inside diameter through the needle cannula (1).

Abstract: An injection port and implantable pump for adding fluid to, or withdrawing fluid from, a surgical implant inside a patient's body is disclosed. Also disclosed is a surgical method for treating diseases using the injection port and pump. The injection port and implantable pump includes a rigid base member and an injection membrane penetrable by an injection needle and attached to the base member. The membrane and base member define a chamber for holding fluid. The membrane is displaceable relative to the base member between a first position in which the volume of the fluid chamber is maximal and a second position, in which the volume of the chamber is minimal. According to the method, the membrane is manually displaced from time to time to distribute fluid between the fluid chamber of the injection port and the implant to operate the implant, which is typically a hydraulic restriction device. The implant can be designed for treating reflux disease, urinary incontinence, impotence, anal incontinence or obesity.

Abstract: A bandage for use with a vacuum source includes a wound dressing member to be placed in contact with a wound surface and a suction port associated with the wound dressing member. The member is configured with spacers contacting the wound surface to define suction space between the member and the wound surface. The member also includes holes in communication with the suction space. Passageways of the bandage are provided between the suction port and the holes.

Abstract: A collection device for human bodily fluids includes a conventional bag constructed of a soft plastic, waterproof material. The bag consists of a hard plastic supporting mouth, proper volume of hydrophilic material such as polymer and a heat-sealed anti-backflow tri-valve in the interior of a front trunk portion of the bag. The supporting mouth is located as to cover the genitourinary area or mouth of an individual in use for urinal or vomiting purposes. This hydrophilic material allows quick absorption of human fluids and turns it into a gelled material. The gelled material is then trapped inside the heat-sealed tri-valve bag to prevent possible spillage and backflow. The versatility of the heat-sealed funnel design bag helps the direct engagement with the hydrophilic material to speed up absorption time with the human fluid and preventing spillage or backflow. It also simplifies the manufacturing process and reduces overall production costs.

Abstract: This invention relates to the field of absorbent articles in general, and more particularly to absorbent articles that have wetness/dryness indicators disposed thereon. Preferably, the disposable absorbent article, for example, a training pant, includes a disappearing wetness/dryness indicator that disappears when the article is wetted, and an appearing wetness/dryness indicator that appears when the article is wetted. The wetness/dryness indicators preferably allow a caregiver to interact with a child to promote toilet training. The wetness/dryness indicators are graphic elements that may or may not be related to one another, and that may or may not be related to other graphic elements on the article.

Abstract: A system for detecting wetness in an absorbent article has an absorbent structure, at least one sensor in contact with the absorbent structure, a remote interrogating device, and a reporting element coupled to the interrogating device. The at least one sensor provides a variable electrical output dependent upon an amount of aqueous liquid associated with the absorbent structure. The remote interrogating unit is capable of detecting changes in the variable electrical output of the at least one sensor.

Abstract: A disposable article, e.g., useful as a sanitary protection device. The disposable article has a primary structure and a liquid-sensitive signaling element in liquid communication with the primary structure. Upon exposure to fluid, the liquid-sensitive signaling element expands to signal the user that the article is approaching capacity.

Abstract: An intravaginal disposable article, e.g., useful as a sanitary protection device. The intravaginal disposable article has a primary structure and a liquid-sensitive signaling element in liquid communication with the primary structure. The liquid-sensitive signaling element is capable of expanding significantly after exposure of the signaling element to a saturating amount of 0.9 wt-% saline solution.

Abstract: The absorbent article of the invention has a liquid impervious backsheet and a liquid pervious topsheet joined to the backsheet. The topsheet has an inner surface oriented toward the interior of the absorbent article and an outer surface oriented toward the skin and hair of the wearer when the absorbent article is being worn and an absorbent core positioned between the topsheet and the backsheet. At least a portion of the topsheet outer surface comprises an effective amount of a lotion coating which is semi-solid or solid at 20 degrees C.

Abstract: An absorbent product, particularly for the absorption of body exudates, comprising an inner sheet (2) to be positioned close to the wearer's body, an outer sheet (4) to be positioned close to the wearer's garments and an absorbent core (3) positioned between said outer and inner faces (2, 4), the absorbent core (3) being enveloped by a transfer layer (5), made of an absorbent material, which comprises a polymeric material with a basis weight substantially between 8 and 20 g/m2, and, additionally, at least one permanent surfactant element. The product (1) of the present invention presents, as advantages, a higher absorption capacity and a lower liquid penetration time, even after successive discharges, continuing to rapidly absorb and conduct the body fluids from the discharge region to the absorbent core (3), allowing the correct storage thereof.

Abstract: An absorbent article includes an absorbent core (4) including a fluid storage member (18), a fluid distribution layer (17) and a fluid receiving layer (16). The distribution layer (17) is disposed to extend in the crotch portion (7) and in at least a substantial portion of one of the waist portions (5 or 6) of the article and is absent in at least a substantial part of the opposite waist portion of the article so as to promote fluid flow from the crotch portion (7) towards the one waist portion (5 or 6). A fluid barrier (19) is arranged at or in close proximity to one transverse end edge of the fluid distribution layer (17), located in or adjacent the crotch portion (7) of the article, the fluid barrier (19) extending through at least a substantial part of the thickness of the layer.

Abstract: A sanitary napkin for placement in a crotch portion of an undergarment of a wearer having a longitudinal axis and being further characterized by having a preferential bending zone extending obliquely in relation to the longitudinal axis, each preferential bending zone being located solely in an end region and does not extend into a central region of the napkin. The preferential bending zone may be created by mechanically embossing the surface of the sanitary napkin to locally density the absorbing materials of the article. The preferential bending zone causes the end regions of the sanitary napkin to resist lateral compression forces exerted by the thighs of the wearer and thereby prevents bunching of the article on the undergarment. The central region 70 of the sanitary napkin conforms to the wearer's body providing greater comfort for the wearer of the napkin.

Abstract: A disposable absorbent garment includes a front body panel having a first bodyside surface, a first garment side surface, a pair of opposite first side edges, a first waist edge and a first crotch edge defining a first lobe having a first profile in plan view that extends outwardly relative to the first waist edge. The first lobe has a first maximum rise along a first direction at substantially a centerline of the front body panel. The opposite first side edges are spaced along a second direction, with the second direction being substantially perpendicular to the first direction. A rear body panel has a second bodyside surface, a second garment side surface, a pair of opposite second side edges, a second waist edge and a second crotch edge defining a second lobe having a second profile in plan view that extends outwardly relative to the second waist edge. The second lobe has a second maximum rise along the first direction at substantially a centerline of the rear body panel.

Abstract: A stack (130) of absorbent articles (101) including at least a first absorbent article and a second absorbent article adjacent in the stack (130), each article (101) being individually wrapped in a wrapping cover (100) comprising a container part (112) and a lid part (111) releasably attached to the outside of the container part (112). The lid part (111) on the second absorbent article is attached to the wrapping cover (100) of the first absorbent article by a releasable attachment (133) which is stronger than the attachment between the lid part (111) and the container part (112) on the wrapping cover (100) of the second absorbent article.

Abstract: A disposable body fluid absorbent pad comprises a liquid-pervious topsheet, a liquid-impervious backsheet, a liquid-absorbent core interposed between these sheets and a strap adapted to pull the pad in a longitudinal direction. The strap comprises first and second straps attached to transversely opposite side edge margins of the pad, respectively, so to extend outward from an end margin of a front region. These first and second straps have inner fixed portions fixed to the topsheet, outer fixed portions fixed to the backsheet and hand-grips extending between the inner fixed portions and the outer fixed portions, respectively.

Abstract: Here is disclosed a pad being relatively large in its longitudinal direction and comprising a liquid-pervious topsheet, a liquid-impervious backsheet, a liquid-absorbent core interposed between these top- and backsheets and an cover sheet lying outside the backsheet and extending from an intermediate region to a rear region of the pad. The cover sheet has fixed side edge portions fixed to transversely opposite side edges of the pad, a fixed end portion fixed to a rear end portion of the pad and a free portion extending between the fixed side edge portions and the fixed end portion and let free from the pad so that a pocket opening from the side of the front region toward the side of the rear region is defined between the backsheet and the cover sheet.

Abstract: An extensible absorbent article or garment has an extensible top sheet layer for facing the body of the wearer; an extensible back sheet layer for an exterior layer facing away from the body of the wearer; and an absorbent core layer located between the top sheet and the back sheet. The absorbent core has a tissue layer acting as a boundary layer or web between the top sheet and the fluff pad of the absorbent core. The tissue web of the absorbent core has an adhesive discontinuously applied thereto for attachment to the top sheet or other extensible layers to avoid tearing the tissue when the extensible layers expand. The tissue web may further be pleated to allow for its extensibility. The discontinuity of the adhesive then allows the pleats to perform their expansion function unbound and thus the tissue can extend without tearing, thereby maintaining the integrity of the tissue barrier.

Abstract: A disposable absorbent article includes an absorbent chassis and a fastening system that together define a refastenable pant. The refastenable pant includes a pair of elastomeric front side panels extending from the waist opening to each leg opening, a pair of elastomeric back side panels extending from the waist opening to each leg opening, and a pair of refastenable seams extending from the waist opening to each leg opening and positioned between the elastomeric front and back side panels.

Abstract: A delivery method and implantable apparatus that allows for controlled, enhanced and (pre)-programmable administration of a biologically active agent into the spinal structures and/or the brain via the epidural space of a mammal, particularly of a human being and including a feedback regulated delivery method and apparatus specifically in the treatment of neurological diseases and chronic pain.

Abstract: A multi-lumen biliary catheter in which at least one of the lumens (14, 16) has a side opening port (24, 26) configured to guide a guidewire (32) out of that port at an angle to the longitudinal axis of the catheter. Radiopaque marker bands (34) having different lengths are placed on the distal end of the catheter adjacent the distal openings to facilitate fluoroscopic identification of the distal end orientation in the biliary tract.

Abstract: A catheter is provided for uniform distribution of fluid medication within an anatomical region. One embodiment of the catheter is comprised of an elongated, proximal tube defining a lumen and an elongated, distal tube having a closed end. The distal tube is constructed from a bio-absorbable material and also defines a lumen, which communicates with the lumen of the proximal tube. In one embodiment, at least a portion of the distal tube defines a porous side wall that permits fluid within the lumen to pass through the portion of the distal tube. In another embodiment, the proximal tube and the distal tube overlap one another and are secured to one another at the overlapping surfaces.

Abstract: A catheter having a shaft with at least two variable layers, in which the relative proportions of the two layers changes along at least a part of the multilayered shaft section. The catheter shaft includes a cotapered transition section having a first layer tapering to a decreased thickness, and a second layer inversely tapering to an increased thickness. In one embodiment, the shaft has one or more tapered outer and/or inner surfaces in addition to the cotapered transition. The tapered outer or inner surface of the shaft is typically longitudinally displaced from the cotapered transition section. In a presently preferred embodiment, the shaft having a cotapered transition section is coextruded. Another aspect of the invention includes a method of making a shaft having a cotapered transition section. The shaft of the invention provides improved transitions between shaft sections, to thereby change characteristics such as the shaft stiffness along the length of the catheter.

Abstract: The present invention provides a catheter which combines the benefits of improved drug dispersion, increased accuracy of placement and kink and collapse resistance. The catheter comprises a flexible cylindrical tube having a proximal portion open at one end and a distal portion, the portions in fluid communication, the distal portion comprising a closed, rounded tip and a diffusion area having at least one opening therein which permits fluid flow, the proximal portion including a proximal tip, and at least one reinforcement member attached at the distal tip and at the proximal tip of the flexible cylindrical tube, with the remainder of the at least one reinforcement member movable within the flexible cylindrical tube. The catheters of the present invention can find use in a variety of local, regional and peripheral pain management applications.

Abstract: A medical device is provided that encloses a wound and promotes wound drainage by suction. The device includes an enclosure to be placed over a wound, adhesively connected to the skin around the wound by a flange. Gauze type packing cylinders can be placed in the wound, and suction is provided either by a bulb type pump, or by a pair of regulators. When regulators are used, one alternates the suction that it provides, and the other is continuous, such that the level of suction is periodically varied. The suction facilitates the transfer of liquid from the wound to the packing cylinders and from the packing out of the enclosure. A leak detector is optionally provided.

Abstract: Systems and methods for non-vascular sensor implantation and for measuring physiological parameters in areas of a body where the physiological parameters are heterogeneous. An implant unit is implanted in an area of a body and a foreign body capsule is allowed to form around the implant unit area. A sensor may be directed into a body cavity such as, for example, the peritoneal space, subcutaneous tissues, the foreign body capsule, or other area. A subcutaneous area of the body may be tunneled for sensor placement. Spatially separated sensing elements may be used for detecting individual amounts of the physiological parameter. An overall amount of the physiological parameter may be determined by calculating a statistical measurement of the individual sensed amounts in the area. Another embodiment of the invention, a multi-analyte measuring device, may include a substrate having an electrode array on one side and an integrated circuit on another side.

Abstract: An expandable apparatus for use with a surgical probe having a temperature-controlled portion includes at least one thermally-conductive elongated extension member and means for thermally connecting and attaching the extension member to the surgical probe. The expandable apparatus further includes means for attaching and moving the extension member between a closed configuration in which the extension member is substantially parallel to the surgical probe and an open configuration in which the extension member extends radially outward from the surgical probe. A method of using the expandable apparatus to ablate tissue that line a body cavity is also disclosed.

Abstract: Disclosed is an ablation method and apparatus used to close veins for treatment of venous insufficiency disease. The apparatus includes a catheter proportioned for insertion into a vein, a pair of inflatable balloons spaced apart on the catheter body, and an ablation electrode array disposed between the balloons. According to the disclosed method, the catheter is introduced into the vein to be treated and the balloons are distended. Blood is flushed and aspirated from the site between the balloons. RF power is applied to the electrode array, causing scarring of the vessel walls and eventual sealing of the vein.

Abstract: This invention relates to an apparatus for incrementally advancing functional probes through tissue.

Abstract: This invention relates to a method of straddling an intraosseous nerve with an energy transmitting device to improve the therapeutic treatment of the nerve.

Abstract: The invention describes a method of treating a patient's left atrial appendage through the pericardial space. The process takes place through the pericardial space from an access point outside the pericardium or pericardial space.

Abstract: A dual-instrument resectoscope which includes an outer sheath having a distal portion that is inserted into a body cavity, a proximal portion that remains outside the body, and a longitudinal axis, referenced X; an optical system, for viewing the body cavity from said proximal portion, said optical system including an optical tube, located within said outer sheath and extending throughout the length of said outer sheath, an eye piece and a light source at said proximal portion, in communication with said optical tube, and an endoscope at said distal portion, in communication with said optical tube; first and second surgical instruments, located at said distal portion, for performing surgery in the body cavity; a first transmission mechanism, in communication with said first surgical instrument, and a second transmission mechanism, in communication with said second surgical instrument, each of said first and second transmission mechanisms providing its respective surgical instrument with independent motion, sa