Abstract: The invention provides systems and methods for interfering with the adhesion formation process. In some embodiments, the present invention makes use of intermittent blunt dissection of fibrin bridging adjacent tissues prior to the formation of adhesions. Dissection is generally provided by pulsing a balloon implanted between the tissues. Optionally, the balloon will comprise an elastic structure to disrupt the formation of fibrin between the balloon and the surrounding tissues. Alternatively, the balloon may be at least partially covered by a bio-active anti-adhesion material. In some embodiments, the anti-adhesion material forms an envelope which is left between the tissues when the balloon is removed.

Abstract: A combination tissue dissector and long term expander is disclosed for use in plastic surgery applications and other applications where it is desirable to dissect a tissue pocket and serially expand the dissected pocket through long term tissue expansion. The combination device performs the separate functions of dissection and long term expansion in a single balloon package. In an exemplary embodiment, three sheets of substantially inelastic material are bonded together at their outer margins to form two discrete inflatable chambers. The lower inflatable chamber defined by the middle and lower balloon sheets is further welded together at various points over the sheet's surface area to create a semi-rigid base portion which provides a flat well-defined footprint for the balloon. The semi-rigid base prevents further enlargement of the tissue pocket at the margins when the device is utilized as a tissue expander.

Abstract: A nonabsorbent holding member adapted for use within an abdominal cavity of a patient defined by an anterior wall, a posterior wall and two lateral walls to keep the patient's bowels out of the operative field during open pelvic surgery. The holding member has a peripheral edge formed of a resiliently deformable material sized to be received within the abdominal cavity. The resilient deformation of at least a portion of the peripheral edge of the holding member results in a residual reactive force against the abdominal cavity to assist in positioning the holding member in the abdominal cavity.

Abstract: A system and method for balloon-assisted retraction technique for the purposes of retraction of tissues and insertion of instruments in connection with advanced surgeries such as microscopic or endoscopic surgeries. A balloon assembly comprising an introducer, a balloon, and a sheath is inserted either manually or with the aid of stereotactic techniques. An endoscope may be used to ensure the proper docking of the introducer assembly. The balloon is then inflated slowly to retract the tissues, in order to create a corridor with minimal invasion. The corridor is expanded and retained using a series of dilators and retractor. The retractor comprises ports through which endoscope and other surgical instruments may pass. Surgical operation is performed through the corridor. The present invention overcomes the disadvantages of conventional retraction systems by providing better visualization and enhanced manual dexterity, as well as providing minimal invasion to allow a shorter recovery period.

Abstract: Methods and devices for harvesting blood vessels from the body using minimally invasive surgical techniques are disclosed. The vessel is dissected from surrounding tissue using the tip of a dissection cannula. The dissected tissue may be retracted, for example, by insufflation. The dissection cannula may further include a balloon that can be inflated after insertion between the vessel and the surrounding tissue. An imaging device may be disposed within the cannula to permit viewing through the distal tip. In another aspect, the balloon is an everting balloon that upon inflation everts and advances along the vessel.

Abstract: A fluid operated retractor for use in surgery. The retractor has a portion which is expandable upon the introduction of fluid under pressure. The expandable portion is made of a material strong enough, and is inflated to enough pressure, to spread adjoining tissues within the body. The retractor is especially useful in fiber optic surgery because it can be inserted percutaneously through a small opening then expanded to a much larger dimension when in the desired location, to retract tissue from within. The retractor may be used to spread a joint such as a knee joint or a shoulder joint, or may be used to separate tissue planes generally, to improve visualization and create a working space for the surgeon.

Abstract: An apparatus and method for laparoscopically lifting the abdominal wall utilizes a pair of lifting rods each having a substantially straight proximal portion mounted to a lifting body and an arcuate distal portion joined to the proximal portion. The rods have an insertion configuration, in which their arcuate portions are nested such that the rods may be simultaneously extended into an abdominal cavity, and a lifting configuration in which one of the rods is pivoted such that the arcuate distal portions form a substantially circular lifting area between them. An inflatable balloon is disposed around the lifting arms and is inflated within the abdominal cavity to push abdominal tissue away from the abdominal cavity and to thereby prevent the tissue from catching on the lifting rods during pivoting.

Abstract: A cardiac manipulator for minimally invasive surgical procedures. A flexible sac houses one or more inflatable chambers therein, the flexible sac permitting insertion through an access aperture into a patient when the inflatable chambers are deflated. The inflatable chambers each have a fluid conduit connected to an associated valve for introducing a fluid thereinto and removing the fluid therefrom. The flexible sac may be manipulated into a low profile configuration for insertion into and through the access aperture.

Abstract: An apparatus for tissue dissection and instrument anchoring, including a dissection balloon having a viewing window (preferably a rigid, transparent window) at its distal end, or including an anchoring or dissection balloon having nonuniform elasticity selected to achieve desired inflated shape and pressure characteristics, and methods for using such apparatus. The window, which can be a lens (such as a wide angle lens), is transparent and either rigid or non-rigid but sufficiently strong to retain a desired optical shape while (and after) being pushed against tissue layers by a rigid instrument deployed within the balloon. In preferred embodiments, the balloon is a long-necked dissection balloon deployed through a cannula.

Abstract: A method for percutaneous dissection of a segment of vascular tissue from a patient is provided which includes providing an elongated tubular member having a proximal end and a distal end, and blunt dissection structure positioned adjacent the distal end of the tubular member and remotely actuable from adjacent the proximal end of the tubular member. The method further provides for percutaneously accessing a first end portion of the vascular tissue segment, the blunt dissection structure is positioned adjacent the vascular tissue segment and is actuated to bluntly dissect the vascular tissue segment from surrounding body tissue.

Abstract: A device for retracting edges of an incision in a surface to form an opening including: a flexible, tubular skirt having an upper end, a lower end, and a channel therebetween; a ring connected to the lower end of the skirt for maintaining the lower end in an open configuration and defining an exit opening to the channel; and an inflatable collar connected to the skirt and surrounding the upper end. The ring is designed to fit through the incision and remain under the surface when it is oriented parallel to surface. The collar, when inflated, maintains the upper end in an open configuration and defines an entry opening to the channel. During use, the ring is inserted through the incision and the collar is inflated while remaining outside of the incision, thereby drawing the skirt against the edges of the incision and retracting the edges of the incision to form the opening.

Abstract: Methods and devices for harvesting blood vessels using balloons to hold the blood vessel and to dissect and mobilize the blood vessel from surrounding tissue. A small balloon catheter is inserted into the blood vessel lumen to and inflated in order to hold the blood vessel, and an everting balloon dissector is everted over the blood vessel. Eversion of the balloon dissector over the blood vessel pushing surrounding body tissue away from the blood vessel.

Abstract: A mechanically expandable retractor for use in arthroscopic surgery. The retractor has an expanding portion at its distal end for expanding against sub-surface tissues when the retractor is in use. The expanding portion includes a plurality of radially expanding arms. The radially outermost surface of each arm when expanded is longitudinally disposed approximately at the distal end of the retractor. The expanding arms can be disposed irregularly circumferentially around the retractor to expand the tissues to provide a working space between adjacent arms. The retractor is inserted through a small percutaneous opening, expanded in sub-surface tissues without significantly damaging the tissue, then collapsed after use for removal. The retractor has a projecting portion at a proximal end of the retractor for manipulating the retractor, to allow the surgeon to push or pull or lever on tissue.

Abstract: A kit for use in the surgical implantation of an shaped implant. The kit includes a shaped balloon dissector packaged with an implant which, when inflated, has a shape complimentary with the shape of the dissector. Using orientation indicia for proper orientation, the surgical site is dissected with the shaped balloon dissector. Once so prepared, a shaped deflated implant is positioned within the site and then inflated. Since the implant's shape is complementary with the dissector's shape, the implant fits within the site without requiring excess site preparation.

Abstract: A vaginal speculum having an inflatable bladder which includes a central channel and an inlet outlet port. The inflatable bladder may include optical fibers for illumination.

Abstract: A method of separating tissue layers using an inflatable balloon, in which endoscopic visualization may be carried out through the balloon during inflation.

Abstract: A fluid operated retractor for use in surgery. The retractor has a portion which is expandable upon the introduction of fluid under pressure. The expandable portion is made of a material strong enough, and is inflated to enough pressure, to spread adjoining tissues within the body. The retractor is especially useful in fiber optic surgery because it can be inserted percutaneously through a small opening then expanded to a much larger dimension when in the desired location, to retract tissue from within. The retractor may be used to spread a joint such as a knee joint or a shoulder joint, or may be used to separate tissue planes generally, to improve visualization and create a working space for the surgeon.

Abstract: An apparatus deployed through a laparoscopic incision in a body wall to apply an external lifting force over a large area of the body wall. The apparatus comprises a body wall engaging element and an elongate lifting member. The body wall engaging element is capable of passing in a packaged state through the laparoscopic incision, is inflatable to an inflated state, and includes, in the inflated state, a plane lifting surface. The elongate lifting member includes a distal portion connected to the plane lifting surface, and capable of passing through the laparoscopic incision. A proximal portion receives the external lifting force in a direction that moves the body wall engaging element into contact with the body wall. A method for lifting a body wall by applying an external lifting force to a large area of the body wall through a laparoscopic incision. The lifting device is provided that includes an body wall engaging element capable of passing through the laparoscopic incision in a packaged state.

Abstract: Apparatus for creating an anatomic space in tissue in a body including an introducer device having a tubular member with a bore extending therethrough. A tunneling shaft assembly is slidably mounted in the bore of the introducer device. The tunneling shaft assembly includes a tunneling shaft having proximal and distal extremities. A blunt tip is secured to the distal extremity of the tunneling shaft. A balloon assembly is provided. The balloon assembly is removably secured to the tunneling shaft. The balloon assembly includes a deflated collapsed balloon. A sheath encloses the balloon and is carried by the tunneling shaft. The sheath has a weakened region extending longitudinally thereof permitting the sheath to be removed to release the balloon.

Abstract: A dilatation balloon (20,98) is fabricated according to a process that yields high hoop strength and uniformity in balloon wall thickness. A length of tubing (34) is axially elongated and radially expanded in a form (36) to provide the requisite biaxial orientation and strength. Then, an excimer laser (46,66,84) is used to remove the polymeric material by photo-chemical ablation, virtually without thermal effects. Dilatation balloon walls are thinned primarily along tapered sections (26,28) between proximal and distal balloon stems (30,32) and a medial working section (24) of the balloon. Material removal, particularly near the balloon stems, enables tighter wrapping of the balloon for a reduced delivery profile, and reduces rigidity near the stems for better maneuverability of the catheter in tortuous passageways. The balloon tapered sections are reduced to a wall thickness substantially equal to that of the medial section. Alternatively, an array of grooves (96) is formed in each tapered section.

Abstract: A fluid operated retractor for use in surgery. The retractor has a portion which is expandable upon the introduction of fluid under pressure. The expandable portion is made of a material strong enough, and is inflated to enough pressure, to spread adjoining tissues within the body. The retractor is especially useful in fiber optic surgery because it can be inserted percutaneously through a small opening then expanded to a much larger dimension when in the desired location, to retract tissue from within. The retractor may be used to spread a joint such as a knee joint or a shoulder joint, or may be used to separate tissue planes generally, to improve visualization and create a working space for the surgeon.

Abstract: An expandable multifunctional instrument for creating a space at an obstructed site in the body includes an elongate member having a distal end for being introduced in the body, a proximal end for being disposed externally of the body and an expandable member for being positioned at the obstructed site. The expandable member is movable at the obstructed site from a non-expanded position to an expanded position to displace anatomical tissue to create a space at the obstructed site for performing various operative procedures. A method of creating a space at an obstructed site includes expanding an expandable member at the obstructed site and/or introducing fluid under pressure at the obstructed site to create a space where normally no space exists.

Abstract: An apparatus for retracting an organ inside the body to gain access to an adjacent tissue Includes an inflatable main chamber having a thin, flexible main envelope. Inflation of the main chamber within the body results in retraction of body tissues or organs to retracted conditions. During use an aperture may be formed in the main envelope to provide access through the main chamber to body tissue. An inflatable secondary chamber defines a cage positioned within or around the main chamber and maintains retraction of organs retracted by the main chamber notwithstanding formation of an aperture in the main envelope.

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 layers 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 creation of an anatomical working space. After the anatomic space has been created, the device and laparoscope are withdrawn through the incision.

Abstract: The present invention provides balloon dissection apparatus and methods of use in which an elongate balloon is utilized to dissect along a region that follows a naturally existing path alongside a vessel or structure, such as an artery, a vein, a lymphatic vessel, the trachea, the esophagus, or even a nerve bundle.

Abstract: A device for insufflating a body cavity preparatory to and during an intracavity procedure is provided that includes a generally cylindrical body anchorable to skin surrounding an incision into the body cavity. An elevation member permits the lifting of the device, along with the attached skin, in a proximal direction, allowing mechanical insufflation. The bore is sealable in order to maintain insufflation during insertion of a surgical implement. The method includes the steps of inserting the device into the incision, anchoring the cylindrical body to the skin, elevating the cylindrical body in a proximal direction, thereby mechanically insufflating the body cavity, and sealing the bore to admit and closely surround the surgical implement for maintaining insufflation. Then a surgical implement can be inserted into the bore of the device and the surgical procedure performed.

Abstract: An apparatus and method for separating a first layer of tissue from a second layer of tissue. A supporting part extends into the interior of the balloon during inflation to provide support for the balloon. The supporting part is retracted to a position outside the interior of the balloon after inflating the balloon. An endoscope is then inserted into the interior of the balloon. The endoscope is moved within the interior of the balloon to change the field of view of the endoscope.

Abstract: An expandable multifunctional instrument for creating a space at an obstructed site in the body includes an elongate member having a distal end for being introduced in the body, a proximal end for being disposed externally of the body and an expandable member for being positioned at the obstructed site. The expandable member is movable at the obstructed site from a non-expanded position to an expanded position to displace anatomical tissue to create a space at the obstructed site for performing various operative procedures. A method of creating a space at an obstructed site includes expanding an expandable member at the obstructed site and/or introducing fluid under pressure at the obstructed site to create a space where normally no space exists.

Abstract: A speculum is comprised of a shaft member having a cavity passing therethrough and an outer layer and an inner layer with a bladder, capable of holding a bio-acceptable liquid, disposed therebetween. At least one guide member runs along the lateral length of the shaft member within the cavity. An end cap is attached to one end of the shaft member and an expansion cap is rotatably received within the end cap. A coil spring has one end attached to one of the at least one guide members proximate the distal end of the shaft member and the opposing end attached to the expansion cap. Rotation of the expansion cap into the end cap causes lateral length reduction of the spring which increases coil diameter and thus shaft member diameter and thereby increases the lumen of the device. Counter-rotation of the expansion cap out of the end cap causes coil turn and shaft member diameter reduction.

Abstract: An expandable multifunctional instrument for performing various diverse operative procedures includes an elongate distensible member having a distal end for being introduced in an anatomical cavity via a relatively small size anatomical opening and being movable from a non-distended position facilitating introduction through the anatomical opening to a distended position wherein the cross-sectional size of the distensible member is increased and a plurality of collars disposed on portions of the distensible member for constraining movement of the distensible member portions to the distended position. The collars are movably mounted on the distensible member for adjusting the location and size of unconstrained distensible portions of the distensible member adjacent the collars.

Abstract: An apparatus for tissue dissection and instrument anchoring, including a dissection balloon having a viewing window (preferably a rigid, transparent window) at its distal end, or including an anchoring or dissection balloon having nonuniform elasticity selected to achieve desired inflated shape and pressure characteristics, and methods for using such apparatus. The window, which can be a lens (such as a wide angle lens), is transparent and either rigid or non-rigid but sufficiently strong to retain a desired optical shape while (and after) being pushed against tissue layers by a rigid instrument deployed within the balloon. In preferred embodiments, the balloon is a long-necked dissection balloon deployed through a cannula.

Abstract: An expansible tunneling apparatus and associated methods for creating an anatomic working space for a surgical procedure. Various embodiments of one and two piece apparatus that permit laparoscopic observation both during tunneling and during subsequent balloon dissection are disclosed. In a disclosed one piece 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 that is inserted into the tubular member to permit observation of the procedure both during tunneling to a desired location and during subsequent balloon inflation. An elongated neck of the balloon is secured to the tunneling member. The elongated neck permits the tubular member to be withdrawn slightly from the balloon after inflation to facilitate observation.

Abstract: A first inflatable retraction device has a first inflatable chamber and a non-pressurized chamber inside the main chamber. The non-pressurized chamber is expanded by inflating a second inflatable chamber. The non-pressurized chamber enables the main chamber to remain inflated when an aperture is cut in the envelope of the main chamber, through which treatment is carried out. A second inflatable retraction device has an inflatable retractor and a maintainer. The inflatable retractor retracts the organ and the maintainer maintains the organ in its retracted condition after the inflatable retractor is deflated. The maintainer can be inflatable, and can be inside or outside the inflatable retractor. A self-retracting endoscope has an optical assembly with an expandable retractor fitted to its distal end. The distal end of the endoscope is inserted into the body with the retractor in a collapsed condition.

Abstract: An apparatus for retracting an organ inside the body to gain access to an adjacent tissue includes a main chamber which is positionable within the body and inflatable to an expanded condition to retract a body organ. The apparatus includes an inflatable additional chamber which when inflated maintains the main chamber in the expanded condition, and the organ in the retracted condition, notwithstanding release of the main chamber from the inflated condition.

Abstract: Inflatable dual-walled speculums, used for gynecological examinations, that are controllably inflated by the patient with a warmed fluid are provided. A retaining device inserted after inflation of the speculum provides a base and safety for the use of other instruments during the examination. Control of the device by the patient results in a more comfortable examination environment for the patient.

Abstract: A first inflatable retraction device has a first inflatable chamber and a non-pressurized chamber inside the main chamber. The non-pressurized chamber is expanded by inflating a second inflatable chamber. The non-pressurized chamber enables the main chamber to remain inflated when an aperture is cut in the envelope of the main chamber, through which treatment is carried out. A second inflatable retraction device has an inflatable retractor and a maintainer. The inflatable retractor retracts the organ and the maintainer maintains the organ in its retracted condition after the inflatable retractor is deflated. The maintainer can be inflatable, and can be inside or outside the inflatable retractor. A self-retracting endoscope has an optical assembly with an expandable retractor fitted to its distal end. The distal end of the endoscope is inserted into the body with the retractor in a collapsed condition.

Abstract: The present invention is directed to new and useful methods and apparatus for improving access to the heart during cardiac surgery, while avoiding damage to the phrenic nerves. The present invention comprises a heart elevation apparatus which is soft and substantially cylindrical, with substantially flat anterior and posterior surfaces. Upon inflation, the anterior surface stabilizes the positioning of the heart and prevents the heart from falling off of the apparatus. The flat posterior surface facilitates positioning of the apparatus on the chest wall. An insulation pad on the posterior surface serves to insulate the phrenic nerves from the frigid bathes commonly employed in cardiac surgical procedures, and also protects the nerves from any compressive forces exerted during the surgery.

Abstract: Methods and devices for harvesting veins from the body. The methods and devices allow vein harvesting using laparoscopic procedures. A working space is created over the vein using standard laparoscopic procedures and a side-hooked wire is inserted into the working space and twisted to insert the side-hook under the vein. The wire is then pulled or drawn along the vein to separate the vein from the surrounding tissue. In an alternative embodiment, vein separation is accomplished by threading a soft rubber tube under the vein, grasping the ends of the tube so as to surround the vein, and then pulling the tube along the vein. In other embodiments, the working space is created with everting balloons.

Abstract: Apparatus for creating an anatomic space in tissue in a body of a patient using a cannula with proximal and distal extremities and a bore extending therethrough to provide an open end. A balloon having an inflated space is provided. The balloon is capable of assuming collapsed and inflated conditions. A retainer is carried by the balloon for forming the balloon when in a collapsed condition into a generally cylindrical roll to aid in inserting the balloon into the tissue. An obturator shaft having a rounded distal end is sized so that it extends through the cannula and into the roll. A laparoscope can be introduced into the obturator shaft to permit viewing through the obturator shaft and the balloon. An inflation tube is provided for inflating the balloon after it is disposed in the tissue to cause the balloon to progressively expand to create separation forces in the tissue to create the anatomic space.

Abstract: An expandable multifunctional instrument for performing various diverse operative procedures includes an elongate distensible member having a distal end for being introduced in an anatomical cavity via a relatively small size anatomical opening and being movable from a non-distended position facilitating introduction through the anatomical opening to a distended position wherein the cross-sectional size of the distensible member is increased and a plurality of collars disposed on portions of the distensible member for constraining movement of the distensible member portions to the distended position. The collars are movably mounted on the distensible member for adjusting the location and size of unconstrained distensible portions of the distensible member adjacent the collars.

Abstract: An apparatus for tissue dissection and instrument anchoring, including a dissection balloon having a viewing window (preferably a rigid, transparent window) at its distal end, or including an anchoring or dissection balloon having nonuniform elasticity selected to achieve desired inflated shape and pressure characteristics, and methods for using such apparatus. The window, which can be a lens, is transparent and either rigid or non-rigid but sufficiently strong to retain a desired optical shape while being pushed against tissue layers by a rigid instrument deployed within the balloon. In preferred embodiments, the balloon is a long-necked dissection balloon deployed through a cannula. In other embodiments, the invention is a dissection balloon assembly including a long-necked dissection balloon having a viewing window at its distal end, and a housing to which the dissection balloon's mouth is attached.

Abstract: An apparatus and method for separating tissue layers and providing a working space for performing a medical procedure. A first balloon is inserted between the tissue layers and inflated to dissect the tissue layers. A second balloon is also positioned between the tissue layers and inflated to retract the tissue layers. The first balloon is then deflated and punctured with a sharp instrument to created an opening in the first balloon. The second balloon is positioned to impeded the escape of insufflation fluid from the working space and the working space is then insufflated. An instrument for performing the medical procedure may then be introduced into the working space through the opening in the first balloon.

Abstract: A retractor for use in arthroscopic surgery. The retractor has a mechanical expanding portion for expanding against sub-surface tissues when the retractor is in use. The retractor also has a fluid-operated expanding portion, which may be independently controllable, for expanding against sub-surface tissues when the retractor is in use. The retractor is inserted through a small percutaneous opening, expanded in sub-surface tissues without significantly damaging the tissue, then collapsed after use for removal. The retractor can be manipulated to allow the surgeon to push or pull or lever on tissue. The retractor can be hollow like a cannula to permit the passage of one or more surgical devices through the retractor, with a side portal into the center of the retractor.

Abstract: A surgical instrument having an elongated shaft to which is attached an inflatable balloon, commonly referred to a "balloon dissector", for dissecting a desired layer of internal bodily tissue from remaining tissue layers to create an operative space is disclosed. Alternatively, an instrument without a balloon can be used to perform a manual dissection. In one embodiment, the instrument has a tissue-contacting element in communication with the shaft distal end, and at least a portion of the tissue-contacting element is transparent. The instrument is adapted to receive an endoscope through its shaft and extend to adjacent the tissue-contacting element. The endoscope is supported and positioned in an extension assembly. The instrument provides for visualization using the endoscope as the instrument is advanced through tissue, but prevents direct contact between the tip of the endoscope containing the lens and the tissue.

Abstract: An apparatus for separating a first layer of tissue, such as the peritoneum, from a second layer of tissue, such as the properitoneal fascia. The apparatus includes a main envelope that defines a main inflatable chamber. The apparatus also includes an introducing device that introduces the main envelope in a collapsed state between the first layer of tissue and the second layer of tissue. The introducing device also inflates the main envelope into an expanded state to separate the first layer of tissue from the second layer of tissue, and to create a working space between the two layers of tissue. Finally, the apparatus includes an insufflating device that introduces insufflation gas into the working space between the two layers of tissue.A method for separating a first layer of tissue from a second layer of tissue provides a main envelope and insufflation gas. The main envelope defines a main inflatable chamber.

Abstract: An apparatus for creating an anatomic space in tissue in a body includes an introducer device having a tubular member with a bore extending therethrough. A tunneling shaft assembly is slidably mounted in the bore of the introducer device. The tunneling shaft assembly includes a tunneling shaft having proximal and distal extremities. A blunt tip is secured to the distal extremity of the tunneling shaft. A balloon assembly is provided. The balloon assembly is removably secured to the tunneling shaft. The balloon assembly includes a deflated collapsed balloon. A sheath encloses the balloon and is carried by the tunneling shaft. The sheath has a weakened region extending longitudinally thereof permitting the sheath to be removed to release the balloon.

Abstract: The present invention provides balloon dissection apparatus and methods of use in which an elongate balloon is utilized to dissect along a region that follows a naturally existing path alongside a vessel or structure, such as an artery, a vein, a lymphatic vessel, the trachea, the esophagus, or even a nerve bundle.

Abstract: A mechanically expandable retractor for use in arthroscopic surgery. The retractor has an expanding portion at its distal end for expanding against sub-surface tissues when the retractor is in use. The expanding portion includes a plurality of radially expanding arms. The radially outermost surface of each arm when expanded is longitudinally disposed approximately at the distal end of the retractor. The expanding arms can be disposed irregularly circumferentially around the retractor to expand the tissues to provide a working space between adjacent arms. The retractor is inserted through a small percutaneous opening, expanded in sub-surface tissues without significantly damaging the tissue, then collapsed after use for removal. The retractor has a projecting portion at a proximal end of the retractor for manipulating the retractor, to allow the surgeon to push or pull or lever on tissue.

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

Abstract: A laparoscopic surgical separating device (1) for creating a preperitoneal workspace, for use in preperitoneal laparoscopic inguinal hernia repair, comprising a relatively rigid longitudinal element (2), a longitudinal axis (5), an interior wall (6) defining a throughbore (7), an inflatable element (8) fixedly attached to a point (9) along the length of an outer wall (10) of element (2), fluid insufflation member (11), connected to inflatable element (8), and to throughbore (7), and sealing member (12) capable of preventing fluid from escaping from element (2), wherein inflatable element (8) is of generally asymmetrical shape, having, on one side of the axis (5), a relatively large portion (13) of inflatable material, and on the other side of the axis (5) in the same plane, a relatively small portion (15) of inflatable material, the portions (13, 15) corresponding to the space available in the body after insertion and inflation of the device (1) via an incision (16) made at the antero-superior iliac crest (17