Abstract: Laparoscopic instruments and cannulas are provided for performing laparoscopic procedures entirely through the umbilicus. Generally S-shaped laparoscopic instruments placed through the C-shaped trocar sleeves or through the cannula and instrument holder unit provide markedly improved degrees of instruments' freedom during trans-umbilical laparoscopic procedures.

Abstract: A ring for dilating a pupil during an ophthalmic procedure includes a series of spaced supports for engaging an iris perimeter. The supports are plate elements which form an open pocket directed outwardly for engaging the iris. The sides of the ring form a primary plane, and the plates are located in respective planes above and below the primary plane. The outer periphery of the top and bottom plates forms a lip feature which is the opening to the pocket which retains the iris.

Abstract: A wound retractor for retracting a surgical incision includes an inner ring, an outer ring and a distensible sleeve coupled to the inner and outer rings. The outer ring includes at least a pair of circular tubes coupled to each other. At least one of the circular tubes includes a lumen and a split that forms open ends. A noncompliant tubular hoop having a split therein is positioned in the lumen. The tubular hoop is oriented with its open ends positioned away from the split of the circular tubes. A core is positioned in the lumen of the tubular hoop. The core has a first end and a second end and is oriented with the ends positioned away from the split in the tubular hoop. The circular tubes may be parallel or may form a helical pattern similar to a Mobius strip.

Abstract: Methods and devices are provided for providing surgical access into a body cavity. In general, the methods and devices allow a surgical access device to be securely positioned within an opening in tissue to provide access to a body cavity underlying the tissue. An actuator can be rotatably disposed on or in a housing of a surgical access device such that rotation of the actuator relative to the housing is effective to move a cannula of the surgical access device between an insertion configuration in which the cannula has a reduced profile enabling it to easily be inserted into a tissue opening, and an expanded profile enabling it to form an anchor against and/or within the tissue opening.

Abstract: A percutaneous tube assembly is provided for performing minimally invasive surgery, the system comprising a percutaneous tube comprising a translucent main body; an external attachment fixture attached to the main body; an access channel longitudinally bored through the main body; an internal attachment channel longitudinally bored through the main body, wherein the internal attachment channel comprises a partially smooth inner surface adjacent to a partially rough inner surface; and an internal attachment, mating with the internal attachment channel.

Abstract: A retractor for manipulating an object includes a body having proximal and distal ends and a retraction device with a head connected to the distal end of the body, a connector movably disposed in the body, and flexible needles of a shape memory material having a memory shape. The needles are connected to the connector and each have a distal tip. The memory shape of the needles include a portion with an arcuate shape biasing the needles in a memory direction out and away from the head and toward the body to position the distal tip of each of the needles closer to the body when the needles are fully extended out of the head than when the needles are only partially extended out of the head. An actuation device is connected to the proximal end of the body and operatively connected to the connector through the body, the actuation device, upon actuation thereof, moves the connector to selectively extend the needles out of the head in different directions and withdraw the needles into the head.

Abstract: A steerable multi-linked device. The device includes a first multi-linked mechanism and a second multi-linked mechanism. At least one of the first and second multi-linked mechanisms is steerable and includes a modular link assembly at an end thereof. The modular link assembly includes a base, and a tip removably connected to the base.

Abstract: An access device adapted and configured to be inserted through a natural biological orifice, and related surgical methods are provided. The access device includes a body, a nozzle means and means for delivering a pressurized flow of fluid to the nozzle means. The body is configured and dimensioned to be inserted through a natural bodily orifice and has proximal and distal end portions and defines at least one lumen therethrough to accommodate passage of one or more surgical instruments. The nozzle means is operatively associated with the body for directing pressurized fluid into the lumen to develop a pressure differential in an area within a region within the lumen to form a fluid seal around the one or more surgical instruments passing therethrough.

Abstract: A retractor includes a retractor support and an elongated retractor blade. The retractor blade has a first, closed position in which ends of the blade are positioned proximal to the support and a second, open position in which ends of the blade are positioned distal to the support. The retractor support has structure for engaging the retractor blade. A handle extends from the retractor support. A method of retracting tissue is also disclosed.

Abstract: A surgical holding arm has a plurality of holding arm members which are coupled to one another and a tensioning device for tensioning the holding arm members against one another. The tensioning device is designed in such a manner that the holding arm can be brought from an operative position, in which the holding arm members are tensioned against one another so as to be immovable, into an adjusting position, in which the holding arm members can be moved relative to one another. The holding arm can be brought, in addition, into a cleaning position, in which adjacent holding arm members can be moved away from one another further than in the adjusting position. Furthermore, a surgical holding device is described.

Abstract: An extraction method and apparatus is provided for obtaining quick, safe and highly sensitive testing of a variety of body fluids including saliva, blood, urine or other fluids for drugs of abuse or other analytes. The apparatus includes a latchable extraction wand for obtaining body fluid samples from a subject which is adapted to maximize the portion of the body fluid sample that will go into a graduated bottle containing a buffer solution, and a testing device wherein the sample will be received and into which test strips can be inserted to determine levels of drugs of abuse or other analyte in the sample. In one of the methods of the invention, energy is imparted to the sample and buffer solution, such as by shaking, and this facilitates reduction of sample viscosity, such as by promoting the breakdown of mucins when the sample is saliva.

Abstract: A device, system and method for orthopedic spine surgery using a screw-based retractor, are disclosed herein and allows for access to the spine through a minimally or less invasive approach. The retractor device is designed to be coupled to a pedicle screw and then to have opposed arms of the retractor spread apart to open the wound proximally. The retractor is removed by separating the opposed blades to allow the retractor portions to be pulled out of the wound. The retractor is intended to be made of a flexible metal material, sterile packaged and disposable after one use. A system and method for using the retractor and performing a minimally invasive spine surgical procedure are also disclosed.

Abstract: An instrument access device 1 comprises a proximal member 25 for location externally of an opening into a body cavity. A first connector 20 extends between the proximal member 25 and a first instrument receiver 2. A second connector 21 extends between the proximal member and a second instrument receiver 3. Instrument seals can be housed in relatively rigid housings for added strength.

Abstract: A retractor having an elongate portion with first and second parts each with adjacent pivotally connected segments pivotable from a first configuration to a second configuration, wherein in the second configurations the adjacent segments abut each other to inhibit further movement, at least one of the parts including a control whereby a force required to move the first part from the first configuration towards the second configuration is less than the force required to move the second part from the first configuration towards the second configuration, and an actuator arranged to urge the first and second parts from the first to the second configurations at the same time.

Abstract: A foldable retractor is provided. The retractor includes an arcuate deformable frame that is defined from a first arm extending through a first portion of an outer circumference of the frame, and a second arm that defines a remaining portion of the outer circumference. The first and second arms each include opposite first and second end portions, wherein the respective first end portions and the respective second end portions are hingedly connected together. The first and second arms of the frame are biased toward a first configuration wherein the combined first and second arms are aligned substantially continuously through the combined first and second end portions and the frame extends through substantially a single plane.

Abstract: Embodiments of an access device system useful for single or limited port procedures includes a retractor and a gel cap removably coupled to the retractor. The gel cap includes a gel pad that acts as an artificial body wall, through which instruments may be inserted into a body cavity, either directly or through one or more trocars. The gel pad permits flexible instrument placement, as well as translational and angular degrees of freedom for the instruments while maintaining a gas tight seal.

Abstract: A seal device comprising: a seal housing defining a central axis, the seal housing having an inner wall and an outer wall, the inner wall defining an opening along the central axis; a rotatable head mounted to the seal housing; at least one finger pivotally mounted to the rotatable head, the fingers defining an aperture for reception of a surgical instrument; and a cam mounted to the rotatable head for pivoting the fingers upon rotation of the rotatable head, the at least one finger configured to reduce the amount by which the surgical instrument may be moved off-axis relative to the central axis.

Abstract: A device comprising an elongated conduit comprising further at least an upper profile and at least a lower profile is disclosed. The upper and lower profiles being relatively displaceable such that when a distal part of the conduit is deployed between two regions of tissue, a spacing between an upper distal surface of the upper profile and a lower distal surface of the lower profile can be varied, thereby opening a space between the two regions of tissue, and wherein the upper and lower profiles are further configured so as to define therebetween a working channel to provide access to the space between the two regions of tissue through the conduit.

Abstract: A surgical portal assembly includes a portal member adapted for positioning within a tissue tract and defining a longitudinal axis with leading and trailing ends. The portal member includes at least one longitudinal port for passage of an object. The portal member comprises a compressible material adapted to transition between a first expanded condition to facilitate securing of the portal within the tissue tract and in substantial sealed relation with tissue surfaces defining the tissue tract, and a second compressed condition to facilitate at least partial insertion of the portal within the tissue tract. The portal assembly also includes an elongated member extending through the at least one longitudinal port and mechanically couplable to the portal member adjacent the leading end thereof.

Abstract: A surgical portal and introducer assembly includes an introducer and a portal member positionable within a longitudinal passageway of the introducer. The portal member is adapted for positioning within a tissue tract and has at least one longitudinal port for passage of a surgical object. The portal member comprises a compressible material and is adapted to transition between a first expanded condition and a second compressed condition. The assembly may include an expandable restraining member that may be disposed within the longitudinal passageway. The restraining member is adapted to expand and compress the portal member to cause the portal member to transition to the compressed condition.

Abstract: Medical retractors including light guides made of cyclo olefin polymer.

Abstract: A surgical access assembly for positioning within an opening in tissue including an outer frame positionable outside a patient and defining an opening therein dimensioned to receive a surgical instrument therethrough. The outer frame includes first and second portions. The first portion is biased into locking engagement with the second portion such that a first engagement structure is in locking engagement with a second engagement structure. An inner member is positionable within a patient and a flexible member extends between the inner member and outer member and is operatively associated with the outer member. The first portion is movable to overcome the bias to move the first and second engagement structures to a disengaged position, wherein in the disengaged position at least one of the first and second portions is movable with respect to the other portion to adjust the tension on the flexible member to retract tissue.

Abstract: An incrementally adjustable wound retractor, which provides access to a body cavity, includes an inner ring having a diameter greater than the desired diameter of the wound incision, an outer ring having an annular axis and a diameter greater than the desired diameter of the wound incision, and a flexible sleeve disposed in a generally cylindrical form between the inner and outer rings. The outer ring includes first and second circular tubes spaced apart axially with each including a lumen having a rigid, noncompliant split hoop placed therein. The outer ring may be rolled over itself and around the annular axis to retract the sleeve with sufficient force to stretch the incision to the desired diameter. A gel cap seal may be coupled to the outer ring outside of the biological body to seal the opening produced by the wound retractor between the body cavity and outside the body cavity.

Abstract: A positionable internal retraction device is provided comprising a malleable ring member and a web-like structure. The retraction device operates to temporarily reposition tissues and organs from an operative site to provide a clear access and visual path for the surgeon. The ring member may be elongated, twisted, folded, bent or deformed to provide an appropriate insertion profile and subsequent functional shape. The retraction device may be shaped for both open and minimally invasive surgeries. The retraction device is atraumatic and may be used for retraction of delicate tissues and organs. The ring member may have different bending biases. The web-like structure may be constructed of any elastic material that can stretch and recover from the shaping and reshaping of the ring member.

Abstract: An incrementally adjustable wound retractor, which provides access to a body cavity, includes an inner ring having a diameter greater than the desired diameter of the wound incision, an outer ring having an annular axis and a diameter greater than the desired diameter of the wound incision, and a flexible sleeve disposed in a generally cylindrical form between the inner and outer rings. The outer ring includes first and second circular tubes spaced apart axially with each including a lumen having a rigid, noncompliant split hoop placed therein. The outer ring may be rolled over itself and around the annular axis to retract the sleeve with sufficient force to stretch the incision to the desired diameter. A gel cap seal may be coupled to the outer ring outside of the biological body to seal the opening produced by the wound retractor between the body cavity and outside the body cavity.

Abstract: A device, system and method for orthopedic spine surgery using a novel screw-based retractor, disclosed herein, that allows for access to the spine through a minimally or less invasive approach. The retractor device is designed to be coupled to a pedicle screw and then to have opposed arms of the retractor spread apart to open the wound proximally. The retractor is removed by pulling it out of the wound whereby the retractor is deformed to pass over the pedicle screw head. The retractor is intended to be made of a stiff plastic material, sterile packaged and disposable after one use. A system and method for using the retractor and performing a minimally invasive spine surgical procedure are also disclosed.

Abstract: A medical device can be used to drain fluids from the body during a medical procedure that requires the insertion of a medical instrument into an anatomical lumen or cavity. The device generally allows the simultaneous introduction of the medical instrument into the body and drainage of fluid out of the body during a medical procedure.

Abstract: Access devices and related methods are disclosed that generally involve flexible or adjustable cannulas that have a substantially cylindrical insertion configuration and a substantially conical expanded configuration. Various methods and features are provided for transitioning the cannula from the insertion configuration to the expanded configuration while the access device is inserted through tissue to form a conical opening through the tissue. Examples include cables, biasing elements, retaining elements, bimodal rings, and coil springs. The devices and methods disclosed herein can allow for improved retention of the access device, improved angulation of instruments passed through the access device, and can increase the integrity of a seal formed between the access device and surrounding tissue.

Abstract: An intra-corporeal surgical retractor for holding tissues and organs in place is provided, including a sealed container, made from a flexible material, having an interior containing a granular substance and a fluid. At least one tube may be provided with one end attached to the container in communication with the interior of the container and the other end connected to a suction mechanism. When the fluid is evacuated from the container, the container constricts around the granular substance and becomes relatively rigid. An absorbent sleeve or layer may be provided surrounding the container. The granular substance may be provided as loose fill or as a layer over at least a portion of the inner wall. Alternatively, the inner walls of the container may be provided with a very rough surface. Further, the outer surface of the bottom of the pouch is enhanced frictionally.

Abstract: A surgical access assembly includes a body having reinforcing structure. The reinforcing structure may include reinforcing panels or ribs. Various fold line configurations can be provided in the body to facilitate insertion and removal of the body through an incision in a patient. Various peripheral configurations for the body are disclosed to facilitate insertion and removal of the body.

Abstract: Surgical access devices are disclosed. In various forms, the access devices form at least one passageway through which various surgical instruments and tools may be admitted into the body cavity. Various embodiments may be configured to support an anvil for a circular stapling device therein. Various forms employ a flexible bag for retrieval of specimen from the body cavity.

Abstract: Bowel retractor devices. In various forms, the bowel retractor devices are configurable from a collapsed position wherein the retractor may be inserted through a trocar cannula or other opening in a patient's body to a second expanded position wherein at least a portion of the patient's bowel may be advantageously supported in a desired position.

Abstract: Medical systems, devices and methods are provided for accessing a bodily opening. One embodiment of a medical device generally includes a flexible sheath and an expandable member. The flexible sheath has a length suitable for forming the pathway along a longitudinal axis. The expandable member is connected to a distal portion of a sheath. The expandable member is operable between a collapsed configuration and an expanded configuration. The expandable member includes a plurality of longitudinally extending struts connected together by a wire frame. The plurality of struts move radially and circumferentially relative to one another between collapsed and expanded configurations.

Abstract: An incrementally adjustable wound retractor, which provides access to a body cavity, includes an inner ring having a diameter greater than the desired diameter of the wound incision, an outer ring having an annular axis and a diameter greater than the desired diameter of the wound incision, and a flexible sleeve disposed in a generally cylindrical form between the inner and outer rings. The outer ring includes first and second circular tubes spaced apart axially with each including a lumen having a rigid, noncompliant split hoop positioned therein. The outer ring may be rolled over itself and around the annular axis to retract the sleeve with sufficient force to stretch the incision to the desired diameter. A gel cap seal may be coupled to the outer ring outside of the biological body to seal the opening produced by the wound retractor between the body cavity and outside the body cavity.

Abstract: A retractor blade for retracting soft tissues during surgery, the blade having a blade body having a first proximal end and a second distal end, the first end including a structure to allow connection of the blade body to a blade support member; a formation at its distal end which is capable of releasably engaging a second co-operating retractor blade; and a structure to engage the retractor blade to an anchor.

Abstract: Embodiments of a surgical access system useful for single or limited port procedures comprise a trocar comprising a fixation cannula, a retractor, and a gel cap removably coupled to the retractor. The gel cap comprises a gel pad that acts as an artificial body wall, through which instruments may be inserted into a body cavity, either directly or through one or more trocars. The fixation cannula comprises a retainer and a bolster, which together, capture the artificial body wall therebetween, thereby fixing the trocar thereto. The gel pad permits flexible instrument placement, as well as translational and angular degrees of freedom for the instruments while maintaining a gas tight seal.

Abstract: A tissue retractor for retracting tissue opened by an incision, the tissue retractor including a base support unit having a topside and an underside. The topside has at least one securing mechanism and the underside is conformable and removably attachable to a surface proximate to the incision. The tissue retractor has a tissue hook having a tissue engagement portion and a mounting portion, the tissue engagement portion capable of engaging at least the periphery of the incision. The tissue retractor has a retractable member substantially inelastic in its central longitudinal axis and bendable in any axes deviating from the central longitudinal axis. The retractable member receives the mounting portion of the tissue hook, the retractable member being removably attachable to said securing mechanism on the topside of the base support unit, and being retractable away from the incision, such that the tissue engagement portion retracts tissue engaged thereto.

Abstract: A system for manufacturing a forceps is disclosed. The system includes a forceps having first and second opposing jaw members. A compression mechanism is coupled to the pair of opposing jaw members and configured to provide and maintain a compression force between the opposing jaw members. The system also includes a load cell configured to measure an initial compression force between the opposing jaw members and a controller coupled to the load cell and configured to adjust the compression force based on a comparison between the initial compression force and a predetermined range.

Abstract: Methods and devices are provided for providing surgical access into a body cavity. In one embodiment, a surgical access device is provided that includes a proximal housing and a distal retractor. At least one stability thread can extend around a perimeter of at least a portion of the distal retractor. In some embodiments, the stability thread can be mechanically adjustable to change a diameter of the distal retractor.

Abstract: A surgical apparatus for positioning within a tissue tract accessing an underlying body cavity includes a seal anchor member comprising a compressible material and being adapted to transition between a first expanded condition to facilitate securing of the seal anchor member within the tissue tract and in substantial sealed relation with tissue surfaces defining the tissue tract and a second compressed condition to facilitate at least partial insertion of the seal anchor member within the tissue tract. The seal anchor member has proximal and distal ends defining elongated perimeters. At least one port extends between the proximal and distal ends and is adapted for reception of an object whereby compressible material defining the at least one port is adapted to deform to establish a substantial sealed relation with the object.

Abstract: A device, system and method for orthopedic spine surgery using a screw-based retractor, are disclosed herein and allows for access to the spine through a minimally or less invasive approach. The retractor device is designed to be coupled to a pedicle screw and then to have opposed arms of the retractor spread apart to open the wound proximally. The retractor is removed by separating the opposed blades to allow the retractor portions to be pulled out of the wound. The retractor is intended to be made of a flexible metal material, sterile packaged and disposable after one use. A system and method for using the retractor and performing a minimally invasive spine surgical procedure are also disclosed.

Abstract: A method for managing the pericardium during intra-pericardial procedures such as the delivery of cardiac support devices. One embodiment of the method includes making an incision through the pericardium to provide access to the pericardial space, and inserting a plurality of strips of lubricious material into and through the incision. The strips of material are spaced around the edges of the incision to form a tubular barrier against the pericardium. End portions of the strips of material in the pericardial space are expanded away from the body to form a lip that lines the inside of the pericardium around the incision.

Abstract: A flexible access device for insertion through tissue is provided. The flexible access device includes a compressible body having a first collapsed configuration and a second resiliently expanded configuration. The body is compressible in both a radial dimension and a longitudinal dimension and is resilient to expand in an incision in the tissue. The body includes a trailing end defining concave receiving recess and a leading end defining a concave exiting recess. The flexible access device further includes a lumen disposed in the body and extending therethrough, the lumen communicating with the concave receiving and exiting recesses so as to receive an instrument with a non-linear shaft.

Abstract: A roll-up wound protector has a distal ring, a proximal ring, and a flexible sleeve extending between the proximal and distal rings. The proximal ring is rollable to gather the flexible sleeve around the proximal ring and shorten the length of the flexible sleeve. The cross-sectional geometry of the proximal ring may be generally s-shaped. The cross-sectional geometry may be asymmetric about the longitudinal axis and asymmetric about the lateral axis. The height along the longitudinal axis may be greater than the width along the lateral axis. The proximal ring may comprise a medial surface having a circumferential recess and a lateral surface having a circumferential recess, the two recesses being longitudinally staggered relative one another.

Abstract: Various devices and methods are provided with respect to inserting multiple surgical instruments through a single surgical access device. A medical device including a flexible tissue retractor and a releasable insert having multiple instrument openings is disclosed. The insert can be in the form of an insert assembly including multiple components. A method of using the insert is also described.

Abstract: Disclosed are embodiments of a laparoscopic access port having a head (portion 450) for use generally externally of a patient and for providing a seal around a laparoscopic tool (not shown)when said tool is inserted into the head via a (bore 408); and a sleeve portion (410) connected to the head and for accommodating the tool, the sleeve (410) extending along an axis and being adapted for inserting generally into the body of a patient in the direction of the axis;said access port being adjustable in overall length X in the direction of the axis, the sleeve portion comprising a shank (411) attached or attachable to the head (450) and a flanged piece (413) moveable relative to the shank by means of a mechanism for causing the overall length X of the port to adjust, the mechanism being operable externally of the patient at or adjacent the head, for example by means of rotation of an element of a lower head part (440), or by sliding motion of the shank (411) and flanged piece (413).

Abstract: A device for accessing a body cavity through an opening in tissue is provided. The access device includes a unitary compressible body configured to be received in an opening in tissue. The compressible body includes a central portion, an upper rim located on a proximal end of the body and a lower rim located on a distal end of the body. The central portion defines a slit configured to permit the passage of a hand therethrough in a sealing manner.

Abstract: A surgical apparatus for positioning within a tissue tract accessing an underlying body cavity includes a seal anchor member comprising a compressible material and being adapted to transition between a first expanded condition to facilitate securing of the seal anchor member within the tissue tract and in substantial sealed relation with tissue surfaces defining the tissue tract and a second compressed condition to facilitate at least partial insertion of the seal anchor member within the tissue tract. The seal anchor member defines a longitudinal axis, and has leading and trailing ends with at least one longitudinal port extending therebetween adapted for reception of an object whereby compressible material defining the at least one port is adapted to deform to establish a substantial sealed relation with the object. The seal anchor member may comprise a memory foam material and may include a plurality of longitudinal ports.

Abstract: A method of accessing an internal portion of a patient including the steps of providing an access assembly including an outer frame, an inner member and a flexible member, inserting the inner member through an opening in tissue into a body of a patient with the flexible member extending proximally through the opening in tissue, moving at least a first portion or second portion of the outer member to a select unlocked spread position to enlarge the opening in tissue and the passageway through the flexible member, and subsequently moving the locking member to move the first and second engagement structures into a locking position to lock the first portion in the select spread position.

Abstract: A surgical access assembly for positioning within an opening in a tissue to provide access to a patient's body for insertion of surgical instrumentation therethrough. The surgical access assembly includes a body portion defining a longitudinal axis and a passageway and having a proximal portion and a distal portion. At least a portion of the distal portion is configured to transition from a more flexible, first configuration for passage into a patient's body and a more rigid, second configuration to securely maintain the distal portion within the patient's body.