Abstract: A suction device for applying vacuum to a tissue surface is provided. The suction device including: a suction cup portion having a wall defining a cavity and an engagement surface for engaging the tissue surface; a vacuum inlet portion connected to the suction cup portion, the vacuum inlet portion having an inlet for connection to a vacuum source and a conduit in fluid communication with the vacuum inlet and the cavity such that a vacuum applied to the inlet is transferred to the cavity; and a valve disposed in the bore for selectively venting the vacuum in the cavity.

Abstract: A suction device having a vacuum inlet portion having an inlet for attachment to a vacuum source; and a suction cup portion connected to the vacuum inlet portion, the suction cup portion having a wall defining a cavity in fluid communication with the inlet and an engagement surface for engaging the tissue surface; the suction cup being configured to minimize injury to the tissue surface caused by the applied vacuum. The configuration of the suction cup having at least one of: a plurality of channels formed in the cavity on an inner surface of the wall for allowing the applied vacuum to be distributed over the tissue surface and thereby minimizing injury thereof; an elastic mesh disposed in the cavity such that it engages the tissue surface; and a closed cell foam member disposed on the suction cup portion such that it engages the tissue surface.

Abstract: To avoid traditional muscle dissection required in the placement of a screw for a pedicle screw fixation, a retractor is provided having a guide of an appropriate length to provide access from the skin surface to the dorsal aspect of the vertebra over the pedicle. The retractor has a handle to provide appropriate holding leverage and to maintain the guide so as to stabilize the guide against the lateral aspects of the facet with the paraspinous musculature. The retractor has a channel of an appropriate size to accommodate a variety of tools, including a drill bit or a tap. The channel also provides a pathway for a probe or feeler to inspect the placement of the screw. A tool groove may be provided in the channel to support the shaft of a tool, such as a tap.

Abstract: In accordance with the present invention, there is disclosed surgical methods and apparatus for accessing and stabilizing the heart. The methods and apparatus facilitate access to an anastomosis site, allows various instruments or devices to be maneuvered and secured in place, and provide stabilization of the heart. The apparatus may involve a tissue stabilizer, and in particular a tissue stabilizer for use in immobilizing or stabilizing a portion of the beating heart using a compressive force delivered to the heart via the tissue stabilizer. The stabilizer may include a stabilizer base and a shaft. The shaft may be secured within an appropriate instrument mount preferably fixed to a retractor or other stable platform as disclosed herein. The stabilizers of the present invention provide improved access to a surgical site at a target vessel on the surface of the heart and may include features which facilitate optimal presentation of the target vessel.

Abstract: The invention provides a surgical vacuum device including a vacuum cup sized for attachment to and manipulation of a target tissue. The device further includes a vacuum hose for applying a vacuum to the interior of the cup, and structure for applying a tensioning force to the cup once it has been placed and a vacuum applied. The vacuum device may be utilized with minimal or no trauma to the target tissue or surrounding tissues.

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: 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: A cooled stabilizer is provided for use in coronary bypass grafting surgical procedures. The cooled stabilizer can be attached to a surgical retractor for providing localized traction, stabilization and/or hemostasis to a predetermined area of body tissue. The stabilizer includes cooling channels and/or pads forming a continuous bottom surface for providing a chilled surface to contact body tissue. In one example, the cooled stabilizer can be shaped as a horseshoe with chilled surfaces over horseshoe sections and optionally over a heel.

Abstract: A system for manipulating a heart during cardiac surgery links lifting of the heart and regional immobilization which stops one part of the heart from moving to allow expeditious suturing while permitting other parts of the heart to continue to function whereby coronary surgery can be performed on a beating heart while maintaining cardiac output unabated and uninterrupted. Circumflex coronary artery surgery can be performed using the system for manipulating a heart during cardiac surgery of the present invention. The system is an improvement on the retractor disclosed in parent application Ser. No. 08/936,184 filed on Sep. 17, 1997 and locates a suspension head near the apical region of the heart and a gross support near the base of the heart near the AV groove. A frame is positioned within the patient's thoracic region and moves with the patient, and a surgical target immobilizer can be used to assist in the movement of the heart if desired.

Abstract: A heart retractor links lifting of the heart and regional immobilization which stops one part of the heart from moving to allow expeditious suturing while permitting other parts of the heart to continue to function whereby coronary surgery can be performed on a beating heart while maintaining cardiac output unabated and uninterrupted. Circumflex coronary artery surgery can be performed using the heart retractor of the present invention. The retractor includes a plurality of flexible arms and a plurality of rigid arms as well as a surgery target immobilizing element. One form of the retractor can be used in minimally invasive surgery, while other forms of the retractor can accommodate variations in heart size and paracardial spacing.

Abstract: A surgical device having a blade with a surface suitable for abutting against tissue, and further having an anchor guide portion for receiving an anchor. The device further includes an anchor positioned through the anchor guide portion, having a first end suitable for anchoring into bone, and a second end suitable for engagement with a surgical distractor. In addition to being using during retraction, the device may be further used to distract without any repositioning of the device.

Abstract: An surgical instrument for use during procedures to harvest saphenous veins simultaneously retracts tissue and exposes sections of the vein. Removable spacer limbs are selectively attached to the instrument to aid in retracting tissue and to make the instrument self-retaining.

Abstract: The present invention relates to surgical retractors and devices for stabilizing a predetermined area of the body during a surgical procedure, more particularly to surgical retractors and stabilizing devices used in connection with minimally invasive coronary artery bypass grafting surgical procedures, and more specifically to surgical retractors and stabilizing devices especially configured for use with each other for such surgical procedures wherein the retractor includes an external rail system which enables the surgeon to position a stabilization arm having first and second shaft segments on either of the arms or the rack segment of the retractor and also includes a connector which is spaced apart from the sled member and stabilization device to releasably control the movement and rotation of the stabilization device with respect to the stabilization arm and the rotation of the stabilization arm with respect to the retractor actuation of a single knob or actuator.

Abstract: A surgical retraction and positioning device comprises a stable platform and a flexible tape attached thereto for easier retraction and manipulation of a heart during cardiac surgery. The stable platform has an elongate body having a curved handle extending into an organ contacting base. The base is formed at the distal end of the handle and is at least partially concave to conform to the contours of the outer surface of the heart. A portion of a flexible element, such as umbilical tape, is secured to the base, leaving at least one free end to enable the surgeon to wrap, or secure, the heart against the organ contacting base.

Abstract: A cardiac stabilizer for use during cardiac surgery. The stabilizer has a cardiac engagement member having at least two vacuum ports, wherein each vacuum port is connected to a separate pressure tube. The pressure in each vacuum port is individually controlled by a multiplexing unit.

Abstract: A medical instrument for positioning an internal organ during a surgical procedure is provided. In one embodiment, the medical instrument includes a body having a tissue grasping element and at least one suspending member. The suspending member has a first end and a second end that is attached to a portion of the body. In use, the tissue grasping element penetrates a portion of the tissue on or near the body organ. Tension can then be applied to the suspending members to reposition and secure the body organ.

Abstract: A surgical retractor has a body and a socket laterally receiving a connector head. The socket cavity is offset from a loading axis extending to the mouth of the slot. The slot laterally receives the connector head as directed towards the socket cavity where it is retained in a locked configuration. The socket cavity is offset from the loading axis.

Abstract: A multipurpose retractor is disclosed for use in surgical operations. The retractor can also be used as a speculum. The retractor is made from metal plates, springs, strings, hinges, rods and a worm gear system. The retractor can expand from having a very small diameter to a very large diameter. And at the same time it can produce substantial force or pressure to keep any orifice, birth canal, surgical incision open steadily and stably. The retractor can be easily collapsed after use within seconds using a worm gear system. The worm gear system provides considerable mechanical advantage and allows for the contraction of the retractor with little applied force by the hand. It also allows for control of the retractor to remain in a certain diameter size. A locking mechanism applied to the gear system prevents the retractor from unfolding and therefore the retractor remains stable. The spring system provides the retractor to open completely with great force and remain open.

Abstract: A system for performing through port off-pump coronary artery bypass surgery includes a port insertable between ribs into a chest wall of a patient, a heart stabilizer extendable through and stably couplable to the port, and an instrument stabilizer adapted to dampen extraneous movement to which a surgical instrument extending through the stabilizer is subject.

Abstract: An illuminated deep pelvic surgical retractor for illuminating a surgical site and retracting tissue adjacent thereto, the illuminated surgical retractor having a handle member interconnected at an obtuse angle to a first elongate section and a second elongate section that is releasably connected to the first elongate section and a portion of the second elongate section defining an illumination input end portion which is optically coupled to a light source so that the second elongate section is substantially illuminated, and, a shield member is positioned adjacent to the distal end portion of the first elongate section to aid in directing light selectively from the second elongate section to the desired tissue or organ.

Abstract: A device is disclosed to retract eyelid by employing the friction and adhesion between the device and the outer surface of the eyelid of an eye without engaging the inside of the eyelid, thus without giving rise to infection, contamination, or injury to the eye. The device comprises a pair of arms joined at a joint. The arms are in a wishbone form with a size and configuration that accommodate the anatomy of the eye. The arms can be embodied in several preferred ways so that the size and configuration of the wishbone can be changed dynamically, adjusted resiliently, or fixed manually. The device is efficient enough to assist an eye care clinician to gain greater access to the exposed surface of an eyeball during an eye care procedure and is simple enough to aid contact lens patients in the process of inserting or removing contact lenses.

Abstract: An access platform having a first and a second blade interconnected to a spreader member that laterally drives the blades apart or together and a sternal pad interconnected to a blade. The superior blade is pivotally coupled to the spreader member such that it naturally rises as the blades are separated. Alternatively, a vertical displacement member is operably interconnected to a blade and the spreader member and is used to vertically displace the interconnected superior blade and, thus, increase a surgeon's working space and visual access for the dissection of an internal mammary artery. A tissue retractor is interconnected to the blades to draw the soft tissue around an incision away from the surgeon's working area.

Abstract: A spiral cervical retraction apparatus is provided to straighten out the canal to the uterus during a medical procedure which allows for placement of instruments into the cavity of the uterus such as artificial insemination devices, curettes, biopsy instruments, and radiologic devices to instill dye. The apparatus includes a rigid tube for traction assisted insertion and removal of instruments by a screw-like action. A spiral wire is secured to the tip of the device for insertion into the cervix of a patient. Preferably, the apparatus has a substantially rigid handle tor twisting the spiral tip.

Abstract: A surgical retractor comprises a pair of arms having a common pivotal connection and a pair of retractor blades, each blade detachably connected to an arm by a rotating knee joint which allows the retractor blade to rotate about an axis parallel to the arm and also about an axis perpendicular to the arm. A detent locking mechanism allows any selected pair of a plurality of pairs of retractor blades to be detachably attached to the arms. The knee joint comprises an open sleeve for easy sanitizing. The arms are opened and closed using handles having a locking ratchet mechanism and pawl allowing the arms to be locked in any open position.

Abstract: The present invention relates to surgical retractors having improved blades for use, on the retractor and devices for stabilizing a predetermined area of the body during a surgical procedure, more particularly to surgical retractors and stabilizing devices used in connection with minimally invasive coronary artery bypass grafting surgical procedures, and more specifically to surgical retractors and stabilizing devices especially configured for use with each other for such surgical procedures wherein the retractor includes a plurality of grooves on the bottom surface thereof and a plurality of blades having a member that is releasably received in the grooves and which also allows for the pivotal movement of the blades relative to the arms of the retractor and further including nesting blades having a third section which is generally linear and second sections which are preferably curved about 180 degrees to allow for the simplified insertion of the blades into the chest incision and the providing for the secur

Abstract: A surgical retraction and positioning device comprises a stable platform and a flexible tape attached thereto for easier retraction and manipulation of a heart during cardiac surgery. The stable platform has an elongate body having a curved handle extending into an organ contacting base. The base is formed at the distal end of the handle and is at least partially concave to conform to the contours of the outer surface of the heart. A portion of a flexible element, such as umbilical tape, is secured to the base, leaving at least one free end to enable the surgeon to wrap, or secure, the heart against the organ contacting base.

Abstract: The invention provides a system and method for performing less-invasive surgical procedures within a body cavity. In a preferred embodiment, the invention provides a system and method for isolating a surgical site such as an anastomosis between an internal mammary artery and a coronary artery in a thoracoscopic coronary artery bypass grafting procedure. The system comprises a foot (11) pivotally coupled to the distal end of a shaft (3) by a linkage (13). The foot has first and second engaging portions (15, 17) with contact surfaces for engaging a tissue surface. The engaging portions are movable between an open position, where the contact surfaces are separated by a gap, and a collapsed position, where the foot is configured for delivery through the percutaneous penetration.

Abstract: An instrument for broaching and dilating an incision of soft tissue in a tunnel-like shape, the instrument stretches and supports tissue to allow the insertion and passage materials, and comprises a handle, and one or more arched plate members.

Abstract: A illuminated surgical retractor for illuminating a subcutaneous surgical field in the space between a vessel, such as the saphenous vein, and the subcutaneous tissue when the illuminated retractor is used to retract the subcutaneous tissue away from the superior surface of the vessel, the illuminated surgical retractor having a handle connected at an acute angle to a distal end of a first blade section, a second blade section that is connected, and substantially co-planer, to the first blade section, a distal end of the second blade section defining an illumination input end, a connector coupled to the illumination input end so that a source of illumination can be optically coupled, via the connector, to the illumination input end so that the second blade section is substantially illuminated, and, alternatively, a bent tip extending from the proximal end of the first blade section to aid in the required dissection of the intervening tissue.

Abstract: Mechanical elements and/or adhesive is used in conjunction with or in place of suction to releasably attach elements of a system for manipulating a heart during cardiac surgery to the heart. The elements of the heart manipulation system are disclosed in the application Ser. No. 09/087,511 filed on May 29, 1998 and in the patent application Ser. No. 08/936,184 filed on Sept. 17, 1997. One form of the system can be used in minimally invasive surgery.

Abstract: A illuminated surgical retractor for illuminating a subcutaneous surgical field in the space between a vessel, such as the saphenous vein, and the subcutaneous tissue when the illuminated retractor is used to retract the subcutaneous tissue away from the superior surface of the vessel, the illuminated surgical retractor having a handle connected at an acute angle to a distal end of a first blade section, a second blade section that is connected, and substantially co-planer, to the first blade section, a distal end of the second blade section defining an illumination input end, a connector coupled to the illumination input end so that a source of illumination can be optically coupled, via the connector, to the illumination input end so that the second blade section is substantially illuminated, and, alternatively, a bent tip extending from the proximal end of the first blade section to aid in the required dissection of the intervening tissue.

Abstract: An instrument for broaching and dilating an incision of soft tissue in a tunnel-like shape, the instrument stretches and supports tissue to allow the insertion and passage materials, and comprises a handle, and one or more arched plate members.

Abstract: A port device is insertable between the ribs of a patient and functions as an entryway for surgical instruments. The port device includes a tubular body having proximal and distal portions. The distal portion of the tubular body is coupled to a swivel adapted to be moved between a first orientation in which the swivel extends in substantially a same direction as the body, and a second orientation at an angle relative to, and preferably substantially perpendicular to, the first orientation. In the second orientation, the swivel engages the inside of the chest wall. The proximal portion of the tubular body has a clamping assembly which clamps the chest wall against the swivels to secure the port in its location. The port body can be anchored in a various angular positions.

Abstract: A method and apparatus for delivery of genes, enzymes and biological agents to tissue cells, including a method and apparatus wherein treatment fluids, including genes, enzymes and biological agents, are injected into a target area of a body providing selective attachment to the specific target cells without affecting normal tissue cells. The method is used to treat prostate cancer, breast cancer, uterine cancer, bladder cancer, stomach, lung, colon, and brain cancer, etc. A hollow core needle is inserted into a body, the needle being visually guided by a selected imaging technique. A first embodiment utilizes an endoscopic instrument, wherein a probe is inserted into the body, guided by the endoscope to the vicinity of the target area. The hollow core needle is guided to the vicinity by a channel through the probe. A needle adjustment apparatus is used to extend or retract the needle and adjust needle tip orientation toward a target area.

Abstract: The present invention relates to a surgical retractor that immobilizes tissue at a surgical site. A preferred embodiment of the retractor is used during minimally invasive direct coronary bypass procedures to arrest movement of the grafting site while the heart continues pumping. Tape or thread can be used to connect the artery to the retractor with a holder.

Abstract: A medical instrument for positioning an internal organ during a surgical procedure is provided. In one embodiment, the medical instrument includes a body having a tissue grasping element and at least one suspending member. The suspending member has a first end and a second end that is attached to a portion of the body. In use, the tissue grasping element penetrates a portion of the tissue on or near the body organ. Tension can then be applied to the suspending members to reposition and secure the body organ.

Abstract: A pair of tongs are joined together by a pivot wherein one end of each of the respective tongs includes a handle portion and a spring biasing mechanism which expands against the respective handle portions so that the opposite end of the tongs carrying cantilevered prongs are normally biased together. The prongs curve at a 90° angle and extend outwardly from the instrument at the distal end in curvatures. A selected one of the prongs is provided with an elongated slot for mounting of a suction tube. One end of the suction tube terminates adjacent the curved tip while the opposite end of the suction tube is connected to a source of suction.

Abstract: The present invention discloses an improved vagina cleaning system. The improved system comprises a vagina opener, a vagina cleaning-solution sprayer, a multiple-functional vagina cleaning solution, and a health-promoting bacteria introducer. The system is used to remove semen from the vagina to prevent pregnancy, to reduce pathogenic microorganisms in the vagina to prevent sexually transmitted diseases, to remove other unwanted materials from the vagina to eliminate discomfort, and to add health-promoting bacteria into the vagina to prevent abnormal colonization of microflora in the vaginal cavity. The present invention also discloses methods of using the system for cleaning the vaginal cavity and for introducing health-promoting bacteria into the vaginal cavity.

Abstract: To avoid traditional muscle dissection required in the placement of a screw for a pedicle screw fixation, a retractor is provided having a guide of an appropriate length to provide access from the skin surface to the dorsal aspect of the vertebra over the pedicle. The retractor has a handle to provide appropriate holding leverage and to maintain the guide so as to stabilize the guide against the lateral aspects of the facet with the paraspinous musculature. The retractor has a channel of an appropriate size to accommodate a variety of tools, including a drill bit or a tap. The channel also provides a pathway for a probe or feeler to inspect the placement of the screw.

Abstract: A cardiac stabilizer for use during cardiac surgery. The stabilizer has a cardiac engagement member having at least two vacuum ports, wherein each vacuum port is connected to a separate pressure tube. The pressure in each vacuum port is individually controlled by a multiplexing unit.

Abstract: An surgical instrument for use during procedures to harvest saphenous veins simultaneously retracts tissue and exposes sections of the vein. Removable spacer limbs are selectively attached to the instrument to aid in retracting tissue and to make the instrument self-retaining.

Abstract: The invention relates to a retractor for use in endoscopic surgery, comprising a shaft (1) having a hand piece (2) arranged on the proximal end thereof and whose distal end can be moved out of an initially extended and straight position, whereby the adjustable distal end consists of several link elements (4) that can be moved into a ring-shaped structure and said ring-shaped structure can be bent in relation to the shaft (1). In order to produce a retractor which can be used atraumatically and can be handled in a highly hygienic manner, it is also proposed in accordance with this invention that the distal end of the shaft (1) should be moved into the closed ring structure and the closed ring structure be bent in a continuous manner at an angle of up to 90 degrees. The invention also relates to a medical instrument for introducing a retractor into a human or animal body and to a method for the use of a retractor in endoscopic surgery.

Abstract: The invention is methods and devices which a surgeon may use to stabilize the beating heart during a surgical procedure on the heart. Pursuant to the invention, a stabilizing device is 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 is effectively eliminated such that the heart is stabilized and the site of the surgery moves only minimally if at all. Typically, in separate steps, the surgeon contacts the heart with the stabilizing means, assesses the degree of movement of the anastomosis site, and exerts a force on the stabilizing means such that the contraction of the beating heart causes orgy minimal excess motion at the surgery site.

Abstract: A surgical device for expanding and viewing tissue is disclosed. The surgical device includes a handle, an insertion probe, and at least one window disposed within the insertion probe. The handle has a proximal end and a distal end, and the handle is sized and shaped to be held by a surgeon. The insertion probe has a proximal end, a distal end, and a longitudinal axis extending between the proximal end and the distal end. The proximal end of the insertion probe is removably attached to the distal end of the handle. The window extends along a length of the longitudinal axis, and has an opening that is sufficient in size to allow tissue to prolapse through the window and into the insertion probe.

Abstract: A device for retracting tissue that includes a cannula and a retractor positionable in the working channel of the cannula. The retractor includes a working tip configured to atraumatically displace tissue as the retractor is manipulated through the tissue.

Abstract: The present invention relates to a stabilizer that immobilizes tissue at a surgical site. A preferred embodiment of this device is used during cardiac bypass surgery and includes a preferably rectangular, oblong or similar shaped device having a width dimension that is greater than the lengthwise dimension such that an aperture area is formed along three sides of the surgical site so that a graft or anastomosis that is formed in the aperture area allows the stabilizer to be removed without disturbing the graft and the device may be used in combination with flexible tapes or threads to apply an upwardly directed force to the tissue adjacent to the surgical site.

Abstract: An apparatus for stabilizing a predetermined area on a heart or other organ of a patient to enable a surgical procedure, the apparatus comprising a bifurcated member having two elongated prongs and an elongated handle segment pivotally and rotatably attached to the bifurcated member. The handle segment can be movably attached to a rib retractor or other surgical device so that a person is not required to hold the handle segment. The preferred embodiment of the apparatus of the present invention further comprises a device to lock or frictionally hold the bifurcated member in a desired position both on the organ and relative to the handle segment during the surgical procedure.

Abstract: An instrument and method for exposing a selected area of the anterior lumbar region for a surgical procedure on the spine comprising making an incision on a human or animal body that exposes the anterior rectus sheath of the left rectus muscle, cutting the anterior rectus sheath to expose the body of the rectus muscle, and mobilizing the rectus muscle along its length by at least 3 cm in both directions from the site of the sheath incision. The rectus is then retracted medially, and the posterior rectus sheath is incised to expose the peritoneum. The peritoneum is pushed aside and tissues between the surgeon and the psoas muscle are dissected away. The ureter and the left iliac vessels are mobilized so that they are retractable from the dissected field, then the rectus muscle is moved laterally and a retractor is inserted into the dissected field.

Abstract: A bone leveler or apparatus including a first blade member having a forward end suitable for contacting the bone and a rearward end, a second blade member having a forward end suitable for contacting the bone and a rearward end, and an elastic member having one end received by the first blade member and an opposite end received by a second blade member. Each of the blade members has an identical configuration. Each of the blade members has a hole formed between the forward end and rearward end. The elastic member has one end received by the hole of the first blade member and an opposite end received by the hole of the second blade member. Each of the blade members has a slot formed at the rearward end so as to extend inwardly therefrom. The respective ends of the elastic members are fixed into the slots of the respective blade members. The elastic member is a length of surgical tubing.

Abstract: Surgical methods and instruments are disclosed for performing port-access or closed-chest coronary artery bypass (CABG) surgery in multivessel coronary artery disease. In contrast to standard open-chest CABG surgery, which requires a median sternotomy or other gross thoracotomy to expose the patient's heart, port-access CABG surgery is performed through small incisions or access ports made through the intercostal spaces between the patient's ribs, resulting in greatly reduced pain and morbidity to the patient. In situ arterial bypass grafts, such as the internal mammary arteries and/or the right gastroepiploic artery, are prepared for grafting by thoracoscopic or laparoscopic takedown techniques. Free grafts, such as a saphenous vein graft or a free arterial graft, can be used to augment the in situ arterial grafts. The graft vessels are anastomosed to the coronary arteries under direct visualization through a cardioscopic microscope inserted through an intercostal access port.