Abstract: A surgical access system includes retractor for creating an access path between an incision site and a surgical site. The retractor includes a frame having a base member and a pair of generally curved rails extending therefrom. A tubular member is coupled to the frame and includes first and second blade portions that are capable of relative movement with respect to each other by movement on the curved rails. A method of inserting the retractor into a patient includes inserting a guide rod over a guide wire, locating an obturator in the retractor, inserting the obturator and retractor over the guide rod, and removing both the guide rod and obturator to leave the retractor in the body to provide the access path.

Abstract: Methods and apparatus provide for: coupling an elongate guide substantially at a first end to at least one vertebral body of a spinal column of a patient; and extending a second end of the guide to a structure of the patient spaced in an anterior direction away from the at least one vertebral body towards an entry incision.

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 blade system configured for use with a surgical retractor comprising a blade body and a blade body surround. The blade body includes a retractor attachment structure engagable with a blade body mounting structure of the surgical retractor. The retractor attachment structure is configured for allowing the blade body to be independently pivotable about and translatable along the blade body mounting structure. The blade body surround includes a slot within a sidewall thereof. The blade body surround and the blade body are jointly configured to form a generally cylindrical-shaped structure when the blade body is in a seated position within the slot.

Abstract: A surgical portal device having enhanced retention characteristics includes a body portion dimensioned for insertion within a tissue tract. The body portion includes an outer wall defining a longitudinal axis and having a proximal end, a distal end, and a lumen configured to allow a surgical instrument to pass therethrough. A thread segment extends at least partially along the outer wall of the body portion. At least one of the outer wall and the thread segment has a textured surface. The textured surface may define irregularities. The irregularities are dimensioned to engage or receive tissue segments adjacent the tissue tract to thereby facilitate retention of the body portion relative thereto.

Abstract: The disclosure is directed to a needle system configured to enlarge an access path in a patient without further cutting into the tissue of the patient so as to reduce recovery time and trauma to the patient. Also provided are methods of using the needle system provided.

Abstract: A Surgical retractor, designed in particular for minimally invasive operations, consisting essentially of an elastic plate rolled up about an axis so as to form the side wall of a substantially truncated cone shape, the narrowest cross section of the truncated cone constituting the distal part of this retractor, when the retractor is in place, and delimiting an operating field, the widest cross section of the truncated cone forming the proximal part, through which instruments can be introduced, said plate being able to be rolled up into a substantially cylindrical shape with a diameter smaller than or equal to the narrowest cross section of its truncated cone shape.

Abstract: A device for retracting internal tissue comprises a base section and an elongated section adapted to fit within a surgical portal coupled to and extending away from the base section. The elongated section comprises an elongated section tip, a top section, an outer bottom shell, an inner cavity, and an extendable gripping mechanism. The extendable gripping mechanism is adapted to hold and release internal tissue and comprises a telescoping section and a biasing device. The biasing device in one embodiment is substantially located in the cavity and comprises a proximal end operatively coupled to at least one of the base section, top section, and the outer shell. The biasing device also comprises a distal end operatively coupled to the telescoping section.

Abstract: A surgical assembly including a flexible shell that defines a flexible sheet-like structure with a major top wall opposite a major bottom wall. The top wall is impermeable to air flow therethrough and has a first set of holes that allow for air flow therethrough. The bottom wall is impermeable to air flow therethrough and has a second set of holes that allow for air flow therethrough. A first fluid path supplies a source of suction to the first set of holes in a manner that is independent to suction supplied the second set of holes. A second fluid path supplies a source of suction to the second set of holes in a manner that is independent to suction supplied to the first set of holes. The supply of suction to the first set of holes is used to engage and hold tissue adjacent the top wall by suction forces applied through the first set of holes. The supply of suction to the second set of holes is used to engage and hold tissue adjacent the bottom wall by suction forces applied through the second set of holes.

Abstract: Suction assisted tissue stabilizers that include portions that deflect when force is applied thereto and return to their initial shape when the force is removed.

Abstract: A minimal incision maximal access system allows for maximum desirable work space exposure within the incision along with maximum access to the operative field utilizing a minimum incision as small as the width of the working tube. Instead of multiple insertions of dilating tubes the design is a streamlined single entry device to avoid repetitive skin surface entry. The system offers the capability to expand to optimum exposure size for the surgery utilizing retractors depending from a bi-hinged frame having internal or external controls to control the angle and separation of the retractors. Interchangeable retractor blades can be attached to the frame. At least one retractor blade is independently controlled.

Abstract: The surgical retractor of the present invention includes a proximal base frame having an opening for overlying an operative site on a patient. A plurality of tissue engaging retractor blades are arrayed and disposed about and extend downwardly from the frame about a central axis of the opening to distal blade ends. Each blade has an outwardly and generally horizontally extending blade handle at their proximal ends which handles are slidably mounted to the frame whereby the blades may be selectively retracted by the handles from the central axis for thereby retracting tissue. The blade handles pass through guide slots in the frame, and more particularly through guide slots provided in respective pivotal segments that are pivotally secured to the frame on respective horizontal axes thereby the blades may be thereby independently pivoted downwardly and outwardly from the central axis.

Abstract: An apparatus is provided for performing spinal surgery having a handle assembly, a screw guide, and a retractor. A shaft is provided with a handle, a neck portion and a connecting portion. The screw guide is provided with a connecting element coupled to the connecting portion of the handle assembly. A retractor for retracting tissue is coupled to the screw guide, wherein the neck portion of the handle assembly is provided with a spring loaded sleeve adapted to engage one of a plurality of holes positioned on a portion of the connecting element. The connecting portion is pivotably coupled to the connecting element.

Abstract: A blunt dissector for endoscopic vein harvesting has a generally-cylindrical sheath for retaining an elongated endoscope. The sheath is elongated between a distal end and a proximal end. A transparent tip is disposed at the distal end of the sheath. A handle is disposed at the proximal end of the sheath. The sheath includes a selectably closable longitudinal slot having an opened configuration such that the endoscope can be inserted radially into the sheath. The longitudinal slot has a closed configuration that retains the endoscope within the sheath and presents a substantially smooth outer surface for use during dissection.

Abstract: Methods and devices are provided for providing access through tissue to a surgical site. In one embodiment, a surgical access device can be configured to move between a first, expanded configuration, and a second, compressed configuration. As the device moves from the first configuration to the second configuration, a longitudinal length of the device can decrease, thereby allowing the device to be securely positioned in tissue and reducing a distance that the device extends into a body cavity.

Abstract: A surgical access device including a lower portion having a central opening spaced from a lower portion outer wall, an upper portion adjacent to the lower portion and having a central opening spaced from an upper portion outer wall, and at least one flange portion extending outwardly from the upper and lower portions. The device can further include a gap extending from the central openings of the lower and upper portions and through their outer walls.

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.

Abstract: An expansion mechanism for minimally invasive lumbar operation has a support member, a plurality of sliders movably assembled on the support member, at least a couple of outside muscle hook members mounted on adjacent sliders, an inside muscle hook member assembled on the slider, and a nerve hook member assembled on the slider. The expansion mechanism for minimally invasive operation makes small incisions and hurts less tissues. Furthermore, the expansion mechanism protects nerve tissues from repeated stirring. Muscles can be drawn apart without the need of removing ligament, obtaining clear and large operation vision.

Abstract: A surgical access portal includes a seal housing and a sleeve mounted to the sleeve housing having an internal longitudinal passage adapted to provide access to underlying tissue. A seal is in mechanical cooperation with an inner wall of the seal housing and has an opening for reception and passage of a surgical instrument in a substantially sealed relation. A sponge is disposed distally of the seal and absorbs fluids that enter the seal housing.

Abstract: Surgical retractor systems including removable angling devices and methods of use are provided. A surgical retractor system can include a head with an opening, a blade including a nipple, and an angling device including a handle. The nipple can include a first recess that runs circumferentially around an exterior surface of the nipple and terminates at a flange. The opening can be configured to receive the nipple. The nipple can be longer than the opening such that the flange and at least a portion of the recess extend beyond an end of the opening when the blade is attached to the head. The angling device can be configured to receive the flange such that the angling device can be removably attached to the flange. The angling device can be used to manipulate the position of the blade when the angling device is attached to the flange.

Abstract: A surgical retractor includes a first component and a second component. The first component includes a ring structure and a conical outer wall. The ring structure has a first opening and defines a first plane. The outer wall forms a second opening in communication with the first opening and extends below the ring structure at an acute angle with respect to the first plane. The second component includes a top structure and conical inner wall. The top structure has a third opening and defines a second plane. The inner wall forms a fourth opening in communication with the third opening and extends below the top structure at an acute angle with respect to the second plane. The top structure of the second component is disposed at least partially inside the ring structure of the first component such that the second component is rotatably adjustable with respect to the first component.

Abstract: A medical instrument serves for creating an access for a minimally invasive intervention and has a body having a longitudinal axis. The body is assembled of at least two parts, each of said parts having edges extending along a direction of said axis. Each of said parts having edges extending along a direction of said axis. Each part has a distal section merging into a proximal section standing outwardly from said longitudinal axis. In a first position, the distal end section of the parts are joined along said edges to form a distal body with the proximal section standing away. In a second position, the proximal sections of said parts are joined along said edges to form a hollow proximal body with said distal end section spreaded outwardly. The edges are provided with interacting features which are designed to block a lateral sliding of said joined parts transversely to said edges.

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.

Abstract: A surgical lift device includes a suction member for detachably contacting an external skin surface of a human body wall and holding the external skin surface by application of negative pressure between the suction member and the external skin surface. The suction member has a gripping force sufficient to permit lifting of the human body wall to an elevated position and to hold the human body wall in the elevated position. The suction member has a load-bearing domed structure which determines the lifting of the human body wall during application of negative pressure. The surgical lift device further includes a low friction entry port device arranged on the dome structure, wherein the low friction entry port device has a low friction port fixture for inserting a tool.

Abstract: Surgical devices for stabilizing the heart are disclosed which facilitate anastomosis under beating heart conditions. Various instruments or devices may be maneuvered and secured on a retractor device to provide stabilization of the heart. An instrument mount is provided which is preferably configured to accept a surgical instrument, such as a tissue stabilizer, and to allow the instrument to be easily maneuvered to a desired position and subsequently locked into position with a simple operation of a single locking actuator. Further disclosed are stabilizer devices each having at least one surface for contacting the heart and each being adapted to be mounted to the retractor while having the ability to be positioned in the desired location against the heart.

Abstract: Sinusitis, enlarged nasal turbinates, tumors, infections, hearing disorders, allergic conditions, facial fractures and other disorders of the ear, nose and throat are diagnosed and/or treated using minimally invasive approaches and, in many cases, flexible catheters as opposed to instruments having rigid shafts. Various diagnostic procedures and devices are used to perform imaging studies, mucus flow studies, air/gas flow studies, anatomic dimension studies, endoscopic studies and transillumination studies. Access and occluder devices may be used to establish fluid tight seals in the anterior or posterior nasal cavities/nasopharynx and to facilitate insertion of working devices (e.g., scopes, guidewires, catheters, tissue cutting or remodeling devices, electrosurgical devices, energy emitting devices, devices for injecting diagnostic or therapeutic agents, devices for implanting devices such as stents, substance eluting devices, substance delivery implants, etc.

Abstract: A surgical portal apparatus for use during a surgical procedure involving at least one suture is provided. The surgical portal apparatus includes a portal member defining a longitudinal axis and having a longitudinal opening therethrough for receiving a surgical object, and a suture management device associated with the portal member. The suture management device includes a base segment and at least one spring element mounted to the base segment. The at least one spring is configured to selectively retain at least one suture in predetermined relation relative to the portal member.

Abstract: The invention provides a system and method for harvesting a vessel section. The system includes an endoscope, at least one harvesting tool, and an elongated instrument including 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 method for holding a hollow internal organ in a desired location during a medical procedure uses a retractor device and a gripper element, each of which includes a magnetic member, one being a first magnet and the other being either a second magnet or a non-magnetized magnetically permeable member. The retractor device is placed into the lumen of the organ and the gripper element is located outside the body cavity of the patient. The magnetic members of the gripper element and the retractor device are brought into proximity with each other to capture a wall of the hollow organ and a body wall of the patient between them, with the gripper element being held at a location that secures the organ at the desired location. In another embodiment, the gripper element is placed inside the body cavity of the patient and outside the organ, with the magnetic members of the gripper element and the retractor device in proximity with each other to capture a wall of the hollow organ between them.

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 method of interconnecting first and second longitudinal members extending along a spinal column of a patient includes inserting an access port into the body of the patient. A transverse connector is moved through the access port. A first end of the transverse connector is connected to the first longitudinal member. A second end of the transverse connector is connected to the second longitudinal member.

Abstract: Surgical devices for stabilizing the heart are disclosed which facilitate anastomosis under beating heart conditions. Various instruments or devices may be maneuvered and secured on a retractor device to provide stabilization of the heart. An instrument mount is provided which is preferably configured to accept a surgical instrument, such as a tissue stabilizer, and to allow the instrument to be easily maneuvered to a desired position and subsequently locked into position with a simple operation of a single locking actuator. Further disclosed are stabilizer devices each having at least one surface for contacting the heart and each being adapted to be mounted to the retractor while having the ability to be positioned in the desired location against the heart.

Abstract: A system for accessing a surgical target site and related methods, involving an initial distraction system for creating an initial distraction corridor, and an assembly capable of distracting from the initial distraction corridor to a secondary distraction corridor and thereafter sequentially receiving a plurality of retractor blades for retracting from the secondary distraction corridor to thereby create an operative corridor to the surgical target site, 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 surgical retractor apparatus having one or more independent, removable extension members adapted to be mounted at the distal end of the retractor, or between the blades of a spreadable retractor, after the retractor has been positioned in the patient, such that a significant portion of the extension member extends beyond the distal end of the retractor to preclude or minimize intrusion of tissue into the access area created by the retractor. The extension members may vary in size and shape so that the most appropriate extension member can be chosen to address the intrusion problem, and the extension members may be mounted at various fixed locations, using clips, mechanical interlocking structures or the like.

Abstract: A method of retracting and/or manipulating tissue is provided. The method includes providing access to a body cavity, providing a retractor including a elongated body portion, a needle formed on a proximal end of the elongated body portion and an anchor means formed on a distal end of the elongated body portion, directing the needle of the retractor through a section of tissue to be retracted, drawing the retractor though the tissue until the anchor means engages the tissue, and pulling the body portion of the retractor to manipulate the tissue.

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.

Abstract: Various devices are provided for allowing multiple surgical instruments to be inserted through a single surgical access device at variable angles of insertion, allowing for ease of manipulation within a patient's body while maintaining insufflation. Safety shields and release mechanisms are also provided for use with various surgical access devices.

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: The device for examining and surgically operating on body cavities, in particular the anal and vaginal cavities, comprises an elongate hollow body (2) exhibiting an insertion portion (3) for at least a partial insertion of the device (1) internally of the cavity and an open portion (4), through which the doctor or surgeon can operate. The hollow body (2) exhibits a longitudinal window (5) through which the pathological site of interest on the cavity wall can be isolated. The hollow body (2) exhibits, along the longitudinal window, a transversal section constituted by a curved sector, ends of which extend in a substantially parallel directions which diverge in such a way as to stretch the affected portion of cavity without invading the viewing space and/or the manoeuvring space defined by the hollow body (2).

Abstract: A surgical access device includes a base having two or more ports or apertures that provide for the insertion of surgical instruments. The multi-port insert may be used with a laparoscopic access device. The multi-port insert may also include one or more instrument supports that are attached to the base to fix the position of one or more surgical instruments inserted through the multi-port insert.

Abstract: Surgical instruments providing access to delicate tissue, such as brain tissue or breast tissue, through a transcutaneous incision. A surgical apparatus may have a hollow sleeve retractor extending along a longitudinal axis from a proximal retractor end to a distal retractor end and an introducer having a proximal introducer end and a distal introducer end. The proximal introducer end is configured to install within the hollow sleeve with its distal end extending beyond the distal retractor end. The distal introducer end is tapered and may have a rounded profile in a plane parallel to the longitudinal axis to displace delicate brain tissue transversely to the longitudinal axis without damage to the tissue. The distal retractor end may be blunt and adapted to support adjacent brain tissue while minimizing disruption to the tissue after the retractor is positioned at a surgery site and the introducer is removed from the retractor.

Abstract: A method of, and surgical instrument for accessing first and second pedicle locations of a spinal column area. The surgical instrument including a blade member slidably positionable along first and second wires. The instrument having a nested arrangement of members, including a portal member having an elongated aperture to access the first and second pedicle locations. The nested arrangement further including a plurality of members configured and sized to incrementally expand the access opening to the spinal column area.

Abstract: Surgical methods providing access to delicate tissue, such as brain tissue or breast tissue, through a transcutaneous incision. A method may include making an incision adjacent a region containing delicate tissue, and providing a surgical assembly having: a retractor having a hollow sleeve extending from a proximal end to a distal end, and an introducer having a proximal end installed within the hollow sleeve and a distal end extending beyond the distal retractor end. The surgical assembly is advanced into the region containing delicate tissue, and the distal introducer end gently displaces the delicate tissue as the surgical assembly is advanced to thereby avoid damage to the delicate tissue. The introducer is removed from the retractor to leave the distal retractor end at a surgical site located in the physical region containing delicate tissue. One or more surgical instruments are then used through the hollow sleeve.

Abstract: Access to a greater area of surgical site with minimally invasive procedure is obtained by using two sets of sequentially placed tissue dilators oriented with their axes in a plane parallel to the spinal axis and a final non-circular dilator encompassing the two sets, followed by a non-circular tubular retractor providing a working channel extending longitudinally of the spine.

Abstract: A three-prong retractor is disclosed which is inserted into an incision in a patient in order to create an area for surgery. The retractor opens such that two blades move away from a first blade to create an elongated opening. The two blades may then move away from each other in a direction that intersects the direction of the movement of the first blade away from the two blades. The ends of the two blades remote from the retractor body may then move away from the end of the first blade remote from the retractor body to further open the incision. The retractor may also have an elastomeric sheath surrounding the blades in order to create a barrier between the surgical area and the patient's skin.

Abstract: A connector for a surgical retractor is shown. The connector includes a body member having an opening for receiving a nipple of a retractor blade. The connector also includes a retainer pivotally attached to the body member between an open position and a closed position. A lock mechanism locks the retainer in the closed position so that the nipple of the retractor blade is locked in the connector. A safety latch constrains the lock mechanism when the retainer is in the closed position.

Abstract: A reconfigurable modular retractor system including a set of interchangeable body modules, the body modules including mechanisms for forming retractors and slot mechanisms for connecting blades, and blades including locking mechanisms for locking inside the slot mechanisms. A method of using the retractor system by forming a retractor by using at least one body module, attaching blades to the body module, inserting the retractor into a surgical area, retracting tissue, removing retraction from the tissue, and removing the retractor.

Abstract: Methods and devices which a surgeon may use to stabilize the beating heart during a surgical procedure on the heart. A stabilizing device may be introduced through an opening in the chest and brought into contact with the beating heart. By contacting the heart with the device and by exerting a stabilizing force on the device, the motion of the heart caused by the contraction of the heart muscles in a vicinity of a site of surgery to be performed, is effectively eliminated. A surgeon may contact the heart with the stabilizing means, assess the degree of movement of the anastomosis site, and exert a force on the stabilizing means such that the contraction of the beating heart causes only minimal excess motion at the surgery site. The stabilizing means may be attached to a rigid support or may be attached to a semi-rigid support which is rendered motionless mechanically, chemically, or by human intervention.

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: The present invention is directed to a device for minimizing or preventing damages due to ischemia that can occur within supported or retracted dermal and/or subdermal living tissue, most particularly during surgical procedures, by one or a combination of several means including cyclically applying and reducing supporting or retracting pressure at each of at least two tissue sections into which the supported or retracted tissue is subdivided, bathing these tissue sections with gases and/or liquids such as oxygen and oxygenated blood, presenting low-pressure regions or partial vacuum to areas within these tissue-sections to stimulate bleeding to encourage blood perfusion, controlling the temperature of these tissue sections to forestall ischemic damage, and mechanically moving at least a portion of these tissue sections to stimulate blood perfusion with, for example, a vibrating mechanism.