Abstract: A surgical port for use during a thoracic surgery includes a first port element and a second port element. The first port element includes a first sidewall and a first flange that is positioned adjacent a proximal portion of the first sidewall. The first flange extends in a laterally outward direction. The second port element includes a second sidewall and a second flange that is positioned adjacent a distal portion of the second sidewall. The second flange extends in a laterally outward direction. The first port element is configured to securely couple to the second port element and each of the first and second sidewalls defines a passageway to allow a surgical instrument to pass therethrough.

Abstract: Pedicle screw apparatuses each including a pedicle screw assembly and an attached pedicle screw extender are placed in a true percutaneous manner, thereby overcoming issues resulting from placing pedicle screw assemblies through a retractor. Thus, a retractor can advantageously be built off of the pedicle screw apparatuses, thereby allowing visualization of the spine anatomy directly. Furthermore, such a method for performing surgery ensures ideal placement of the retractor for additional procedures that are often required such as, for example, decompression, interbody device placement, etc.

Abstract: A soft tissue retractor includes a retractor body and a proximal projection extends generally perpendicular to the proximal end of the retractor body. An illumination waveguide engages a slot in the retractor blade to provide illumination to a surgical site while maintaining total internal reflection in the waveguide. An illumination input is formed into the proximal end of the illumination waveguide for conducting light from a source to the illumination waveguide. The proximal projection is configured for application of counter traction without the need for squeezing the retractor body. The proximal projection may be weighted to balance the soft tissue retractor as well as enabling the retractor to provide counter traction by itself. The configuration of the proximal projection further enables self-retraction by including a flat foot to prevent rolling and sliding of the retractor when it is providing self-retraction.

Abstract: A retractor (101) for retracting the margins of a wound opening (103) comprises an inner anchoring O-ring (105) attached to a cylindrical sleeve (106) at a distal end and a reinforcing O-ring (109) attached to a proximal end of the sleeve (106). The sleeve (106) is led between an inner ring part (110) and a corresponding recess (116) in an outer ring part (111). The outer ring part (111) has anchor formations (120) over which the proximal end of the sleeve (106) is attached to anchor the sleeve (106). To retract the wound opening (103) the sleeve (106) is pulled while the guide rings (110, 111) are moved against the tissue surrounding the wound opening (103). This pulls the inner O-ring (105) against the inside of the tissue adjacent the wound opening (103), and retracts the wound opening (103). The sleeve (106) is manipulated locally for maximum retraction efficiency.

Abstract: A surgical access device has a surgical retractor having a noncompliant outer ring with an annular axis, an inner ring, and a sleeve coupling the outer ring to the inner ring. The noncompliant outer ring is adapted to roll over itself around the annular axis to roll the sleeve around the outer ring to retract and seal an opening in a biological body wall. The access device may include a lid adapted for being coupled to the noncompliant outer ring of the surgical retractor. The outer ring of the surgical retractor has a cross-sectional shape that prohibits the lid from being partially or incorrectly coupled to the outer ring of the surgical retractor.

Abstract: An improved radial expansible retractor and a method of minimally invasive surgery, by opening a channel in the brain or other soft tissue of a patient, by inserting the radial expansible retractor into the body of the patient, and by widening the channel at a continuous and gentle rate. The use of the improved radial expansible retractor renders surgical procedures, including neurosurgical procedures, shorter, less traumatic, and more reliable, reducing risk and the need for subsequent surgery and reducing recovery time. Procedures are carried out with real time monitoring of the retracted brain perfusion pressure. A plurality of improved radial expansible retractors may be used in a single operation. The improved radial expansible retractor allows access to areas of the brain previously almost impossible to access.

Abstract: A retractor for use in spinal procedures is disclosed. The retractor includes a first frame member defining a first recess and a second frame member pivotally connected to the first frame member. The second frame member defines a second recess. The retractor further includes a first blade assembly operably received within the first recess and a second blade assembly operably received within the second recess. The first blade assembly includes a first blade configured to pivot relative to the first frame member and a first blade extender selectively extendable from the first blade. The second blade assembly includes a second blade configured to translate within the second recess and a second blade extender selectively extendable from the second blade.

Abstract: A suction retractor including an elongated tube that is operable to be inserted through a tubular retractor used in minimally invasive surgical procedures. One end of the tube is coupled to a handle having a chamber and the other end of the tube is coupled to a curved retractor portion, where the retractor portion allows the surgeon to hold back various anatomies during the surgical procedure. Thus, the suction retractor provides two functions that may otherwise require two different instruments. The retractor portion includes a series of parallel groves that allow liquids, such as blood, to flow along the retractor portion and into a suction port at the end of the tube. A suction device can be coupled to an outlet port in the handle that causes the blood and other surgical material to be sucked through the tube and out of the handle.

Abstract: A system for performing vascular surgery includes a first retractor blade and a second retractor blade and a fulcrum device. The first retractor blade includes a first grasping bar, and the second retractor blade comprises a second grasping bar. The first retractor blade and the second retractor blade are adapted to engage opposing edges of a subcostal incision in a patient. The fulcrum device includes a first fulcrum slot and a second fulcrum slot formed through opposing edges of the fulcrum device. The first fulcrum slot is adapted to receive the first grasping bar and the second fulcrum slot is adapted to receive the second grasping bar, such that the fulcrum device is adapted to apply leverage from the first retractor blade and the second retractor blade to spread the edges of the incision and to allow access to a chest cavity of the patient.

Abstract: A surgical access system including a tissue distraction assembly and a tissue refraction assembly, both of which may be equipped with one or more electrodes for use in detecting the existence of (and optionally the distance and/or direction to) neural structures before, during, and after the establishment of an operative corridor to a surgical target site.

Abstract: A device serves for temporarily immobilizing a tissue in an area of a pulsating blood vessel during a cardiac and thoracic surgical intervention. A pod of the device can be placed onto a tissue beneath a pulsating blood vessel. The pod has a rigid holder supporting a flexible element. The flexible element has suction openings in an area of contact with said tissue. The pod has a connector piece for the connecting to an underpressure source. A flexibility of said flexible element is in that said flexible element adapts to a shape of said tissue in said area of contact when placed on said tissue.

Abstract: Improved instruments (tools) and surgical techniques are provided for use in surgical procedures that treat femoroacetabular impingement of both the Cam and Pincer types.

Abstract: A retractor device for cervical spinal fusion surgery. The retractor device includes a first post assembly having a first pin for mounting the first post assembly to a first vertebral body and a first rod coupled thereto in a multi-axial manner so that the first rod can be pivoted relative to the first pin. The retractor device also includes a second post assembly having a second pin for mounting the second post assembly to a second vertebral body and a second rod coupled thereto in a multi-axial manner so that the second rod can be pivoted relative to the second pin. The retractor device also includes a first retractor blade having a first retractor blade arm slideably engageable to the first rod, and a second retractor blade having a second retractor blade arm slideably engageable to the second rod. The first retractor blade is slid down the first rod and the second retractor blade is slid down the second rod to be positioned and separate the anatomical structures.

Abstract: Surgical methods and devices allow closed-chest surgery to be performed on a heart of a patient while the heart is beating. A region of the heart is stabilized by engaging a surface of the heart with a stabilizer without having to stop the heart. Motion of the target tissues is inhibited sufficiently to treat the target tissues with robotic surgical tools which move in response to inputs of a robotic system operator. A stabilizing surface of the stabilizer is coupled to a drive system to position the surface from outside the patient, preferably by actuators of the robotic servomechanism. Exemplary stabilizers includes a suture or other flexible tension member spanning between a pair of jointed bodies, allowing the member to occlude a coronary blood vessel and/or help stabilize the target region between the stabilizing surfaces.

Abstract: A device, system and method for dilating a patient during a minimally invasive surgical procedure is disclosed. A surgical dilation system includes a dilator having an outer tubular member and an inner tubular member sized to be movably received within an inside diameter of the outer tubular member. The outer tubular member includes a vertical slot running through a side of the outer tubular member. The inner tubular member has an upper portion and a lower portion. The retractor has a proximal end including at least one mounting member protruding outwardly from a side surface of the retractor and a distal end including at least one fanned blade protruding outwardly from the side surface.

Abstract: An apparatus and method for an examination apparatus that includes a manually movable structure having a first movement from a free state to a compressed state and a second reversing movement from the compressed state to the free state. Also included is a plurality of fingers that are disposed adjacent to the structure. The fingers having a stowed state and an open state, the stowed state having a nested relationship between the fingers to reduce a silhouette profile size. In moving from the stowed state to the open state of the plurality of fingers requires a selected sequential movement of each the fingers to proceed from the nested relationship to the open state that is accommodated by an assemblage for moving the fingers sequentially utilizing the manually operated structure, wherein the fingers are moved from the stowed state to the open state and reversed manually.

Abstract: Implants, instruments, and methods for performing surgical procedures on the spine, including one or more of creating an operative corridor to the spine, delivering implants to the spine, fusing one or more segments of the spine, and fixing one or more segments of the spine.

Abstract: Methods and devices are provided to assist in providing multiple devices access to a surgical site through a single port. In one exemplary embodiment an access device includes a body having a plurality of ports. The ports can include at least one primary instrument port and at least one secondary instrument port. A self-sealing passageway can be disposed between the primary and secondary instrument ports to allow communication between the two ports. As a result, a surgical instrument can be repositioned from one port to another without removing the instrument from the access device. In one embodiment a combined end effector nominal width of surgical instruments disposed in the ports can be greater than a diameter of the primary instrument port and/or a diameter of the body of the access device. Exemplary systems and methods for performing procedures using multiple devices in a single surgical opening are also provided.

Abstract: A pannus retraction device includes a pannus contacting portion and a femoral region access opening. The device is positioned on the patient's thigh, and is moved to press the pannus away from the femoral access region, and to position the access opening in a desired zone. The device is secured in position so that the pannus is held away during a medical procedure requiring access to the femoral head.

Abstract: A system, method and apparatus for regulating vacuum applied to surgical suction devices allowing the use of a single vacuum regulator and associated canister to provide vacuum to two suction devices, such as a suction stabilizer and a suction retractor. Vacuum controllers may be placed in the vacuum lines provided to each of two or more suction devices, or may be placed only in the vacuum line of the suction device believed most likely to detach during the procedure. Each vacuum controller is provided with a primary vacuum line, coupling its associated suction device to the output of the vacuum regulator and a pilot passage, also coupling the suction device to the vacuum regulator. The controller closes a valve in the main vacuum line in response to loss of vacuum attachment, which valve remains closed until attachment is reestablished. Closure of the valve results in substantial or complete blockage of the main vacuum line.

Abstract: A method and device for endoscopic harvesting of blood vessels from a patient for use in subsequent procedures. The device having a two piece headpiece. A vessel to be removed is inserted into the headpiece and the top and bottom portions of the headpiece are alternatively extended in reciprocating fashion to dissect above and below the vessel. The headpiece having electrodes for ligation of any side branch vessels which are uncovered in the dissection process.

Abstract: A device auxiliary to surgery, for anchoring and lifting cavity walls or internal organs of a patient. The device provides a virtual port, that is an instrument that can be non-invasively, or minimally invasively and removably attached to the undersurface of a patient's cavity, or to various tissues within a cavity, and to which various retracting means are attached. The device includes means allowing it to be moved from one position to another and reattached to the undersurface of the abdominal wall, or to various tissues within a cavity, without creating any additional openings in the cavity wall. The device includes means for attaching various retractors.

Abstract: The present disclosure relates to a surgical instrument having a first elongated member and a second elongated member and a connector pivotably interconnecting the first elongated member and the second elongated member, where the first elongated member includes a partially or completely circumscribed opening, and the second elongated member includes a partially or completely circumscribed opening, or a support configured to correspond to the partially or completely circumscribed opening of the first elongated member that when operated between an open or closed state, engages or disengages an object to fix, confine and/or extrude the object with or through the partially or completely circumscribed opening of the first elongated member.

Abstract: A tissue retractor for displacing body tissue during surgery includes a tissue piercing member such as a surgical needle, a wire-like filament such as a suture line affixed to the surgical needle, a fixed element such as an anchoring port being associated with a stable surgical platform such as a sternum retractor and a movable element such as an anchoring plug cooperating with anchoring port to engage a portion of suture line after the suture line is threaded through the body tissue with the surgical needle and after the suture wire is tensioned to effect a predetermined displacement of the body tissue. The predetermined displacement of body tissue is maintained by retention of the engaged portion of suture line by the fixed anchoring port and the movable anchoring plug.

Abstract: Surgical retractors, retractor insertion tools, and methods of use are disclosed. The surgical retractor includes a first protrusion end, a second insertion end opposite the first protrusion end, and an opening extending through the retractor body from a first end opening located at the first protrusion end of the retractor body to a second end opening located at the second insertion end of the retractor body. The first and second end openings may have different sizes and shapes. The first and second end openings may be arranged out of alignment with each other.

Abstract: Methods and devices for performing percutaneous surgery in a patient are provided. A retractor includes a working channel formed by a first portion coupled to a second portion. The first and second portions are movable relative to one another from an unexpanded configuration to an expanded configuration to increase the size of the working channel along the length of the working channel while minimizing trauma to skin and tissue.

Abstract: An external fixator for treating a fracture of a long bone has six extension arms which are extendable out of and retractable into a main body. The six extension arms are arranged into two sets of three out opposing sides of the main body, with each set of three extension arms being able to support a fixation ring. Each extension arm is pivotable at a joint and extendable so as to allow the ring to be set at a wide range of angular positions relative to the main body. The three extension arms and the ring each define a wrap angle about the axis of the long bone being treated. The longitudinal position of each extension arm can be changed either with a coarse adjustment capability or with a fine adjustment capability, with the coarse adjustment capability being through rotation of a thumb wheel.

Abstract: A retraction apparatus and method are disclosed that provide optimized access to a surgical site. In one form, a retraction frame has a retraction opening with two sets of blades operating therein. The blades are used to sequentially retract the tissue from about an incision. The sequential retraction of the blades generates only narrow gaps between the blades so that tissue and blood encroachment during the surgical procedure are minimized.

Abstract: Methods and devices retract tissue for minimally invasive surgery in a patient. A retractor includes a working channel formed by a first portion and a second portion. The first and second portions are movable relative to one another from a first configuration for insertion that minimizes trauma to skin and tissue to an enlarged configuration after insertion to further retract skin and tissue in a minimally invasive manner. Instruments are engageable to the first and second portions and operable to move the first and second portions relative to one another.

Abstract: Methods and devices for performing percutaneous surgery in a patient are provided. A retractor includes a working channel formed by a first portion coupled to a second portion. The first and second portions are movable relative to one another from an unexpanded configuration to an expanded configuration to increase the size of the working channel along the length of the working channel while minimizing trauma to skin and tissue.

Abstract: Methods and devices retract tissue for minimally invasive surgery in a patient. A retractor includes a working channel formed by a first portion and a second portion. The first and second portions are movable relative to one another from a first configuration for insertion that minimizes trauma to skin and tissue to an enlarged configuration after insertion to further retract skin and tissue in a minimally invasive manner. An optional intermediate retractor assembly is positionable between the first and second retractor portions to provide further tissue retraction capabilities.

Abstract: The invention provides devices and methods for performing closed-chest surgical intervention within an internal cavity of a patient's heart or great vessel. A scope extending through a percutaneous intercostal penetration in the patient's chest is used to view an internal portion of the patient's chest. An internal penetration is formed in a wall of the heart or great vessel using cutting means introduced through a percutaneous penetration in an intercostal space in the patient's chest. An interventional tool is inserted through the internal penetration to perform a surgical procedure under visualization using the scope. A cutting tool is introduced into the patient's left atrium from a right portion of the patient's chest to remove the patient's mitral valve. A replacement valve is then introduced through an intercostal space in the right portion of the chest and through the internal penetration in the heart, and the replacement valve is attached in the mitral valve position.

Abstract: Methods and devices are provided for providing access through tissue to a surgical site. Generally, the methods and devices allow adjustment of a surgical access port's longitudinal length. In one embodiment, a surgical access port is provided that includes a housing having a cannula distally extending therefrom. The housing can be configured to cut a proximal portion of the cannula to adjust a longitudinal length of the cannula and hence of the surgical access port. In another embodiment, a surgical access port is provided that includes a cannula formed of a plurality of modular segments removably coupled together. One or more of the segments can be configured to be removable from the cannula to change the cannula's longitudinal length.

Abstract: A laryngoscope blade is provided. The blade includes a base, a relatively straight main blade portion and a distal tip. The relatively straight main blade portion has a length that extends from the base. The distal tip has a length that extends from the main blade portion. The distal tip further has a width that extends out beyond the width of the main blade in a select direction. The distal tip further yet has a bend at a select location about its length.

Abstract: A method and instruments for performing breast augmentation mammaplasty in a patient are provided. The method includes making an incision to gain access to an area underneath the breast of the patient, and providing a retractor including a shaft and a tubular member connected to the shaft. The tubular member includes a hollow endoscope guide portion and a generally flattened blade portion, where the endoscope guide portion transitions into the blade portion such that an end of the blade extends beyond an end of the endoscope guide. The method further includes inserting the retractor at least partially through the incision to aid in placing a breast implant within the patient.

Abstract: A surgical apparatus includes a seal anchor member. The seal anchor member includes a leading end, a trailing end, and at least one longitudinal port extending between the two ends. The at least one longitudinal port is dimensioned for reception of a surgical object. One end of the at least one longitudinal port is closed by a membrane, which can be pierced through by a sharp-pointed device. The at least one longitudinal port further includes at least one lip therein. The at least one lip is configured to establish a substantially sealed relation with the surgical object entered therethrough, thereby inhibiting the loss of insufflation gas between the at least one longitudinal port and the surgical object.

Abstract: A surgical portal system for a surgical procedure incorporating the use of one or more sutures includes a portal housing and a portal sleeve extending from the portal housing. The portal housing includes an internal wall. The portal housing and the portal sleeve define a longitudinal axis and has a longitudinal opening for passage of a surgical instrument and one or more sutures. The portal sleeve is dimensioned for insertion within tissue to provide access to an underlying body site. A seal is mounted to the internal wall of the portal housing and arranged to intersect the longitudinal axis.

Abstract: A retractor system for percutaneous surgery in a patient includes first and second retractor portions positionable opposite one another in an incision of the patient. The system also includes at least one actuating member operable to provide an oscillating motion to at least one of the first and second retractor portions. The actuating member is in communication with a controller and is responsive to the controller to oscillate at least one of the first and second retractor portions between a first position and a second position. In another form, a method is directed to retracting tissue for percutaneous access to a surgical site in a patient. However, other embodiments, forms and applications are also envisioned.

Abstract: A surgical retractor device. The surgical retractor device includes a frame having an outer frame member and an inner frame member coupled to the outer frame member for relative movement about a frame pivot axis, and a frame driver operable to rotate the outer frame member relative to the inner frame member about the frame pivot axis.

Abstract: A surgical retractor system includes a first retractor and a second retractor. The first retractor comprises a first working channel for receiving a tool therethrough. The second retractor is capable of being advanced through the first working channel, and its proximal end is positioned in the vicinity of the distal end of the first retractor. The second retractor includes a second working channel for receiving a tool therethrough. In another aspect, a method for accessing a surgical site comprises inserting a first retractor into a first tissue, advancing a second retractor through a first working channel in the first retractor, and inserting the second retractor into a second tissue to retract the second tissue, with the distal end of the first retractor remaining in the vicinity of the proximal end of the second retractor sufficiently to allow access to the target tissue by a surgical tool. A tool for operating a second retractor located distally in a first retractor is described.

Abstract: A first surgical retractor (302) according to the invention includes a handle (308) that defines an axis (320) and has first and second ends. A retractor blade (306) is secured to the second end of the handle. The blade is of a size and shape to engage the mitral valve of a heart so as to be able to retract the mitral valve and adjacent tissues. A second retractor (304) according to the invention has a relatively narrow, elongate blade (352) that can extend deep into the heart to engage the heart in the region of the atrial appendage so as to be able to retract the atrium and expose the pulmonary veins. The retractors are especially adapted to perform an atrial fibrillation surgical procedure.

Abstract: A blade for a surgical retractor. The blade includes a base portion and a distal portion. The base portion may be attached to a frame of a surgical retractor. The distal portion may be removably coupled to the base portion and may be unitarily constructed of a translucent material. A light source may be removably coupled to the distal portion. The distal portion may be disposable.

Abstract: Medical devices, systems and methods are disclosed that serve to guide one or more medical devices through a port formed in bodily tissue to access a bodily cavity. One embodiment of the medical device includes a connection member, a rail, and a carrier. The connection member is structured for attachment to the port. The rail is attached to the connection member, and has a first portion extending distally through the port opening, and a second portion extending at an angle relative to the first portion. The carrier is structured to selectively connect to the first portion of the rail, and is slidable along the first and second portions of the rail.

Abstract: A tissue retractor and guide device for use in securing a spinal fixation plate to a spine is provided. In general, the device includes an elongate member having a guide member formed thereon or mated thereto with at least one lumen extending therethrough for receiving a tool. The guide member is adapted to couple to a spinal implant, while the distal portion of the elongate member is effective to retract tissue disposed adjacent to the guide member.

Abstract: The invention provides a system and method for harvesting a vessel section. The system comprises an endoscope, at least one harvesting tool, and an elongated instrument comprising a shaft and a housing. The shaft includes a viewable region along a length of the shaft and a lumen to slidably receive the endoscope. The housing is releasably engaged with the shaft and includes an elongated opening to provide a working area adjacent to a vessel for the harvesting tool. The method includes making an incision at a point corresponding to the proximal end of the vessel section to be harvested. A shaft is inserted through the incision and adjacent to the vessel section. A housing is slidably engaged with the inserted shaft. Harvesting operations are performed in a working area defined by sidewalls of the housing. The harvesting operations are visually monitored through the shaft.

Abstract: A retractor for placement in a wound to hold the wound open during a surgical procedure comprising a closed loop formed of a plastic material permeable to X-ray radiation, said closed loop having two opposite members that can be brought together from a starting position to enable insertion of wound edge gripping elements of the retractor into the wound and thereafter through resilience return towards the starting position and brought in contact with the edges of the wound and hold the wound edges apart and in a self-holding way retain the retractor in the wound.

Abstract: A self-retaining retractor and surgical method of retracting integument at a surgical site comprising a medial arm moveably connected to a first end of an extension arm. The extension arm is connected to a lateral arm. The connection may be made after the medial arm is in the surgical site. The extension arm may be moved from an undeployed position to a deployed position. The medial arm or the lateral arm may include a surgical instrument holder, such as a holder for an endoscope. A locking mechanism may be used to lock the retractor in a deployed position. A strap may also be used to secure the retractor.

Abstract: A surgical portal apparatus includes a portal, a seal, a plurality of restricting members, and a lockout assembly. The portal defines a longitudinal axis and has a longitudinal opening. The seal is disposed in mechanical cooperation with the portal and defines a passage for reception of a surgical object. The plurality of restricting members are arranged about the longitudinal axis to define a passage therethrough and positioned to contact the surgical object. The restricting members have contacting segments adapted for radial movement relative to the longitudinal axis from a rest position to a displaced position. The lockout assembly includes a locking member disposed distal of the restricting members. The locking member is positioned to intersect the longitudinal opening and engage the surgical object. The locking member is operatively coupled with the restricting members to minimize offset manipulation of the surgical object.

Abstract: The present invention generally provides methods and devices for removing fluid from a surgical instrument. Surgical access devices and seal systems are generally provided having one or more valves or seal assemblies to create a closed system between the outside environment and the environment in which the surgical access device is being inserted. The devices of systems can also include a fluid remover in the form of a sorbent element, a scraper element, a wicking element, or any combination thereof that is configured to remove fluid from a working channel of the device or system and/or from a surgical instrument inserted therethrough.

Abstract: A surgical access system including a tissue distraction assembly and a tissue retraction assembly, both of which may be equipped with one or more electrodes for use in detecting the existence of (and optionally the distance and/or direction to) neural structures before, during, and after the establishment of an operative corridor to a surgical target site.