Abstract: A surgical instrument and method for facilitating the resection of an anatomic structure in a minimally invasive procedure. The resection instrument includes an inflatable enveloping sleeve member that has an inflation chamber lying between an outer sleeve and an inner sleeve thus providing an inflatable chamber that surrounds an "organ lumen" extending along the member's longitudinal axis. The enveloping member typically is of non-elastomeric sheet material and in the collapsed state is folded and stored in the instrument's handle by turning both the inner and lumen sleeves "inside-out". The instrument is disposed proximate to the anatomic structure to be resected and the enveloping member is inflated. As the inflation chamber is inflated, the enveloping member deploys distally turning itself "right-side-out" and is capable of circumferentially enveloping the anatomic structure (or portion thereof) thus progressively capturing the structure within the organ lumen.

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: 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: A method and apparatus for mechanically lifting the abdominal wall away from underlying abdominal organs for laparoscopic surgery without insufflation. In the method an expansible device is inserted in the abdominal cavity through a small incision in a collapsed state and then expanded into engagement with an extensive area of the abdominal wall. Lifting force is then applied to the device for peritoneal retraction. The device takes the form of mechanical rods or arms and/or balloons. In the balloon embodiments lifting force may be applied externally of the abdominal cavity, or internally of the cavity by balloon inflation. Certain of the balloon embodiments are of an annular or U-shaped configuration and include a membrane for draping the internal organs and/or a centrally located balloon for lateral expansion. The balloons may be provided with an internal endoscope for viewing. The method also provides for laparoscopic gallbladder removal, either to the interior or exterior of the balloons.

Abstract: A disposable uterine manipulator including a pivotable tip support at the distal end of an elongated insertion rod for carrying a manipulator tip assembly, the tip support being rotatable by a manual drive at the proximal end of the insertion rod via a drive linkage to effectuate a range of rotation of the tip support of at least greater than 90.degree. anteversion and at least greater than 30.degree. retroversion. The manual drive may be an articulated linkage, a belt drive, or an axle drive. Several designs for a manipulator tip assembly including a balloon and a dye injection passage are also disclosed.

Abstract: A method and apparatus for mechanically lifting the abdominal wall away from underlying abdominal organs for laparoscopic surgery without insufflation. In the method an expansible device is inserted in the abdominal cavity through a small incision in a collapsed state and then expanded into engagement with an extensive area of the abdominal wall. Lifting force is then applied to the device for peritoneal retraction. The device takes the form of mechanical rods or arms and/or balloons. In the balloon embodiments lifting force may be applied externally of the abdominal cavity, or internally of the cavity by balloon inflation. Certain of the balloon embodiments are of an annular or U-shaped configuration and include a membrane for draping the internal organs and/or a centrally located balloon for lateral expansion. The balloons may be provided with an internal endoscope for viewing. The method also provides for laparoscopic gallbladder removal, either to the interior or exterior of the balloons.

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 impede 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 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 expansible laparoscopic tunneling apparatus for creating an anatomic working space. The apparatus provides laparoscopic observation both during tunneling operations, when the apparatus is advanced bluntly to a desired location within the body of a patient, and during subsequent tissue dissection when a balloon associated with the apparatus is inflated to create the working space. In a preferred embodiment, the apparatus comprises a hollow tunneling member and an inflatable balloon disposed at the distal end of the tunneling member to cooperatively form a blunt tipped obturator. The tunneling member has a bore sized to accept a conventional laparoscope, and a blunt distal end to facilitate tunneling. A trocar can be inserted into the incision to provide access back to the previously created space where the surgical procedure is to be performed.

Abstract: A balloon dissection apparatus for forming an anatomic working space alongside an elongate vessel in a body having a tunneling shaft having proximal and distal extremities. A flexible elongate substantially cylindrical balloon is carried by the tunneling shaft and has proximal and distal extremities. The balloon has at least a portion of the distal extremity folded inwardly into the balloon to shorten the length of the balloon so that the folded balloon has a length which is not substantially greater than the length of the tunneling shaft. An inflation tube is coupled to the balloon for inflating the balloon to cause the distal folded extremity to evert and roll outwardly to provide an inflated balloon having a length greater than the length of the tunneling shaft.

Abstract: Cannulas for surgical and medical use expand along their entire lengths. The cannulas are inserted through tissue when in an unexpanded condition and with a small diameter. The cannulas are then expanded radially outwardly to give a full-size instrument passage. Expansion of the cannulas occurs against the viscoelastic resistance of the surrounding tissue. The expandable cannulas do not require a full depth incision, or at most require only a needle-size entrance opening.

Abstract: An inflatable endoscopic retractor is disclosed for retracting organs and tissues in the body. The inflatable retractor comprises an inflatable balloon configured to retract specific organs and tissues at the site of the endoscopic procedure, with attached inflation and deflation means. In one embodiment, the inflatable balloon has an attached support rib to provide additional strength and rigidity during retraction. In another embodiment, the inflatable balloon has multiple projections, each with an attached support rib, to provide retraction in several directions. A retractor having an endoscopic housing with separate channels is also disclosed which provides retraction as well as the means for inserting a second endoscopic surgical tool.

Abstract: A device for radially distending a soft tissue space comprising a finger sheath for covering at least one finger. The sheath has a proximal and distal end. A distention balloon is attached to the distal end of the sheath. The balloon has a relative deflatable position in relation to the finger sheath and a relative inflatable position in relation to the sheath. An inflation source for inflating the distention balloon to a preferred volume thereby dilating the desired the soft tissue space is provided. A valve member for deflating the balloon is also provided.

Abstract: Apparatus for retracting an organ to gain access to treat a tissue. The apparatus has a main envelope, a second envelope, a first inflation device and a second inflation device. The main envelope encloses a main chamber, and includes a window and a removable window. The second envelope covers substantially all the main envelope, except the window and the removable window. The second envelope and the main envelope enclose a second chamber outside the main chamber. The first inflation device passes a fluid into the main chamber to expand the main chamber and the second chamber from a compacted state to retract the organ. The second inflation device passes a fluid into the second chamber to further expand the second chamber to maintain the organ in its retracted state after fluid has been released from the main chamber.

Abstract: An apparatus is described for laparoscopically retracting an organ inside the body to provide surgical access to adjacent tissue. The apparatus includes a thin, flexible envelope which encloses a chamber. The envelope is laparoscopically insertable in a collapsed state into a body cavity, and the chamber is inflatable to an expanded state following introduction of the envelope into the body. Inflation of the chamber causes retraction of adjacent tissue. An elastomeric seal is insertable into the chamber following inflation and is attachable to part of the envelope inside the chamber following inflation of the chamber. The seal provides a gas-tight seal to maintain the chamber in the expanded state, and to maintain the organ in the retracted state, notwithstanding the piercing of an aperture in the part of the envelope covered by the seal.

Abstract: A speculum comprises a pair of elongated blades having elongated hollow bills therein. Each bill is at least partly covered by a flexible expandable bladder. One or more ports communicate between the interior of each bill and the interior of the bladder. Gas lines are connected to each bill for supplying compressed gas to a valve to each bill to expand each bladder. A second valve can be activated for deflating each bladder. For use, the speculum blades are inserted into a body cavity and the bladders inflated to gently expand the body cavity. Blades can then be moved apart to perform an examination. When the examination is completed, the blades are moved toward each other and the bladders are deflated before the blades are withdrawn from the body cavity.

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: In a method for retracting an organ inside the body to provide access for treating a tissue, a retractor having a main envelope which defines a main chamber is positioned in a collapsed state adjacent to the organ to be retracted. The main chamber is subsequently inflated to retract the adjacent organ. A surgical instrument is passed through the main envelope into the main chamber to contact the tissue for treatment.

Abstract: An abdominal retractor comprising a deformable annular-shaped member with an opening therethrough, which is structured and dimensioned for retracting a linear incision in the abdomen and forming the surrounding tissue into a generally circular configuration, thereby providing an access opening into the abdominal cavity large enough for a hand. The annular member is also adapted to contact the retracted abdominal tissues so as to provide a sealing engagement therebetween. A collapsible sleeve is joined to the annular member and is disposed for extension exterior to the abdomen. The sleeve is structured to enable an arm member to be sealingly yet movably enclosed therein such that a hand at the end of the arm member can be introduced through the access opening into the abdominal cavity. The retractor further includes means through which the abdominal cavity can be inflated with gas such as carbon dioxide (CO.sub.2).

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: A method and apparatus for mechanically lifting the abdominal wall away from underlying abdominal organs for laparoscopic surgery without insufflation. In the method an expansible device is inserted in the abdominal cavity through a small incision in a collapsed state and then expanded into engagement with an extensive area of the abdominal wall. Lifting force is then applied to the device for peritoneal retraction. The device takes the form of mechanical rods or arms and/or balloons. In the balloon embodiments lifting force may be applied externally of the abdominal cavity, or internally of the cavity by balloon inflation. Certain of the balloon embodiments are of an annular or U-shaped configuration and include a membrane for draping the internal organs and/or a centrally located balloon for lateral expansion. The balloons may be provided with an internal endoscope for viewing. The method also provides for laparoscopic gallbladder removal, either to the interior or exterior of the balloons.

Abstract: An active cannula or sleeve which does more than merely maintain a channel or passage is usable to create and/or enlarge a channel or passage, to position a scope or instrument, to move or locate tissue, etc. The cannula can vary in size or shape as needed, intraoperatively. Because a cannula of the present invention is expandable, the surgeon can make a small relatively small incision, stretch the tissue with the expandable cannula, contract the cannula and remove it, allowing the skin to come back to its unstretched condition. Thus, a smaller incision can be made to fit the same size instrument. This results in less trauma and scarring and an easier operation. The cannulas are or can assume such a non-circular shape, to fit into a natural skin opening and cause less trauma. The devices can be used to seal off a space; to expand an existing space or a potential space for working or visualization; to move tissue (for example, to stretch an incision) or to protect it.

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 expansible tunneling apparatus for tunneling bluntly to a desired location within the human body and for creating an anatomic working space for the performance of a surgical procedure by utilizing an inflatable balloon to dissect tissue along natural separation planes once the desired space has been reached. In a disclosed embodiment, a tubular member has a bore extending therethrough to provide an open distal end. A rigid tunneling shaft is insertable into the bore of the tubular member to provide a blunt tipped obturator. A balloon associated with the apparatus is disposed such that it surrounds the tunneling shaft when the balloon is deflated, as it would be when tunneling bluntly through tissue. A sheath surrounds the balloon and has a weakened region that permits the sheath to be released thereby permitting the balloon to expand to dissect tissue layers and create the anatomic working space.

Abstract: A system for separating a first layer of tissue from a second layer of tissue and for maintaining separation of the first layer of tissue from the second layer of tissue while providing access to at least one of the layers of tissue. The system comprises a main envelope which defines a main inflatable chamber, an introducing means and an insufflating means. The introducing means includes a main cannula portion to which the main envelope is attached. The introducing means is for introducing the main envelope in a collapsed state between the first layer of tissue and the second layer of tissue, and for inflating 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 first layer of tissue and the second layer of tissue. The insufflating means includes an auxiliary cannula portion to which an auxiliary envelope defining an auxiliary inflatable chamber is attached.

Abstract: Retraction of an organ or tissue plane to be retracted is performed to gain access for a surgical instrument to treat an organ or tissue plane to be treated. An inflatable retractor, including a main envelope enclosing a main chamber, is provided with the main envelope in a collapsed state. The main envelope of the retractor is placed adjacent the organ or tissue plane to be retracted. The main chamber is inflated to an expanded state to retract the organ or tissue plane to be retracted. An aperture is pierced in the main envelope to provide access for the surgical instrument passed into the main chamber to contact an organ or tissue plane to be treated while the main chamber is maintained in the expanded state, notwithstanding the aperture pierced in the main envelope. The organ or tissue plane to be retracted and the organ or tissue plane to be treated may be different parts of the same organ or tissue plane.

Abstract: An inflatable retractor including a main envelope enclosing a main chamber is provided. The main envelope is provided in a collapsed state. An elastomeric window is also provided. The main envelope of the inflatable retractor is placed adjacent the organ inside the body, and the main chamber is expanded to an expanded state to retract the organ. Following inflation of the main chamber to the expanded state, the elastomeric window is attached to the main envelope inside the main chamber to cover part of the main envelope. The surgical instrument is passed into the main chamber. An aperture is pierced in the pan of the main envelope covered by the elastomeric window to provide access for the surgical instrument to contact the tissue. The elastomeric window provides a gas-tight seal to maintain the main chamber in the expanded state.

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 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 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: A medical instrument for effective atraumatic retraction of abdominal organs during laparoscopic surgery is described. The device consists of a rigid rod with a bore running from an air valve at the proximal end to multiple perforations at the distal end of the rod. An inflatable balloon covers the multiple perforations on the distal end of the rod. The balloon is constructed from a relatively stiff plastic material, and it is firmly attached to the rod, such that the balloon inflates in substantially one direction in order to provide a relatively wide palmated anterior surface, and a relatively narrow cross-section. The outer surface is smooth, and may be further covered with a soft nylon mesh, in order to provide a wide, soft, atraumatic surface for retraction. The device may also include an introducer tube for passing the balloon through a laparoscopic cannula.

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