Abstract: A hand-held retractor that is adapted for endoscopic use at a predetermined area of a patient. The retractor is comprised of a longitudinally-extending blade with a proximal end, a distal end, and a top surface. A handle is connected to the proximal end of the blade by a separating member, which is preferably arcuate. The separating member is configured to allow a surgeon direct access to and visualization of the area adjacent the top surface and distal end of the blade after positioning the distal end of the blade at the predetermined area. Also provided is a method of endoscopic retrosternal adhesiolysis which utilizes a retractor to provide access to and visualization of adhesions adjacent the cranial portion of a patient's sternum while retracting away and protecting underlying tissue.

Abstract: A mechanical lifting retractor is provided which increases working space in the chest for cardiac surgery by temporarily expanding the space between the rib cage and the pericardium. The lifting device has a pair of parallel right-angled retractors. Distal portions of the retractors are insertable in side-by-side parallel relation between a pair of adjacent ribs in the rib cage and into the mediastinal space between the ribs and sternum and the pericardium beneath them. The distal portions are pivotable into a lifting position in which they are separated by a rotational angle of approximately 180.degree.. Following insertion of the distal portions into the mediastinal space, the distal portions are rotated into the lifting position and oriented in the sagittal plane such that each distal portion extends beneath one of the ribs. A lifting force is applied to the lifting retractor, causing the distal portions to engage the ribs and to lift the rib cage and thereby enlarging the mediastinal space.

Abstract: The present invention provides a retractor for providing surgical access through a passage in tissue, together with methods for its use and deployment. The retractor comprises an anchoring frame having an upper surface, a lower surface, and an opening therethrough which defines an axial axis. A flexible tensioning member is attached to the frame, and is extendable from the frame out of the body through the passage when the frame is positioned through the passage and into a body cavity. This tensioning member is selectively tensionable to spread the tissue radially outwardly from the axial axis. Hence, it is the tension imposed on the flexible liner which effects retraction of the tissue, rather than relying on the structural integrity of an artificial lumen.

Abstract: A surgical retractor comprising a base adapted to lie on the patient's skin, a handle slidably mounted with respect to the base, a tissue retracting blade extending from the handle, and a locking member movable from at least a first position to a second position to retain the tissue retracting blade in a selected position. A method for accessing the saphenous vein to facilitate harvesting the vein is also disclosed comprising the steps of making a small incision in the leg of a patient, positioning a retractor on a patient's leg such that a retractor blade extends into the incision and a base lies on the surface of the patient's leg and pulling the retractor blade away from the patient to lift the tissue away from the underlying saphenous vein.

Abstract: A retractor for placement proximate an incision for holding back the edges of the incision, the retractor comprising a pair of substantially elongate retractor portions having outer substantially irregular edges formed along substantially the entire length thereof for engaging and holding back the opposing edges of an incision, and an expansion assembly coupled to the retractor portions for moving the retractor portions between a collapsed position and an expanded position.

Abstract: The invention relates to a medical instrument with a distal end piece which is connected to a holder running through a shank and on operation of a handle, can be adjusted from a rest position into an operating position by tilting relative to the longitudinal axis of the instrument. The end piece and the holder lie facing one another in a plane running inclined to the longitudinal axis of the instrument as well as perpendicular to it, and are connected with a fastening element which forms an axis perpendicular to said plane, about which the end piece is pivotable relative to the holder.

Abstract: A sternal retractor for applying an opening force evenly along the respective edges of a patient's sternum during heart surgery comprises a curved rack having a length, a width, and a thickness, wherein the rack is curved in the thickness direction, hinged arms mounted to the rack, a cog mechanism for forcing one of the arms to move along the rack, and retractor blades pivotally mounted to the arms. An atrial retractor which are used to retract the left and right atrium connects to an arm of the sternal retractor by an H-shaped mounting rod assembly. The assembly comprises two elongated rods mounted in spaced parallel relationship by a clamp proximate the center of the rods. A ball clamp associated with the sternal retractor and atrial retractor comprises locking discoid blocks for releasably interconnecting a plurality of rods together.

Abstract: Abdominal wall retractors is made of a plurality of extension arms to define a plane when expanded. The device is inserted through a small opening in the patient's abdomen, after which it is expanded by manipulation upon the portion remaining exterior to the patient. The retractor then elevates the abdominal wall to facilitate laparoscopic surgery, thus avoiding the need for creation of a pneumoperitoneum or the use of general anesthetic.

Abstract: A surgical drill guide and retractor for treating mandibular fractures includes an adjustable length sleeve having an inner segment slidably mounted within an outer segment. The adjustable length sleeve also has a through-going lumen which connects a first opening at an end of the outer segment with a second opening at an end of the inner segment. The lumen is dimensioned for slidably receiving a drill bit or other instrument therein. A handle slidably retracts the inner segment into the outer segment to expose a preselected length of a drill bit or other instrument inserted through the lumen of the sleeve. A proximal end of the drill guide includes a mandibular retractor which is inserted intraorally or extraorally and has a retractor blade shaped to retract the cutaneous region laterally away from the bone. The retracting blade also has an aperture which allows surgical instruments to be inserted through the aperture to the bone.

Abstract: An adjustable retracting oral airway for reversibly establishing a maximum flange-blade dimension of the distal portion of an intra-oral extension with respect to a dental flange. Several alternative extension retraction means coupled to a dental flange are used to establish varying degrees of freedom of motion of the intra-oral extension (including the blade) with respect to the flange. Mating surfaces of the blade extension and the extension retraction means may be frictional or may have positive interlock (as, for example, with ratchet or gear teeth). Living hinges of plastic material are used in low-cost embodiments, including an embodiment having a single wedge-lock hinge. Self-coiling tension members are found in low-profile embodiments allowing mask ventilation with a retracting oral airway in place.

Abstract: In a surgical retractor having a frame on which at least two retractor elements are mounted, if desired, so as to be displaceable, to enable individual adjustment of the forces exerted by the retractor elements on the surrounding tissue, it is proposed that the frame have at least one support foot which carries attachment means for fixing on a bone.

Abstract: A surgical retractor retracts tissue from a body cavity in which surgery is to be performed. The retractor has a plurality of fingers or blades which extend laterally from a handle. The fingers pivot about a pivot pin between a retracted position and an extended position. Extension is achieved by rotation of a centered control plate relative to the handle. The pivot pin for the fingers is displaced from the axis of the handle, and moves relative to the handle. Each of the fingers has an arcuate slot, and a guide post within the arcuate slots controls pivoting. Because of the distance separating the pivot pin and the axis of the handle, extension of the fingers occurs a distance away from the incision into which the retractor is inserted, and undue trauma to the incision is avoided. Because the pivot point moves relative to the handle, the fingers extend longitudinally during the pivoting motion.

Abstract: A method and apparatus for creating a surgical work space by lifting the abdominal wall and retracting abdominal organs during surgery utilizes a lifting body having two or more retraction rods supported by the lifting body. The rods are designed to be introduced into the abdominal cavity through a laparoscopic puncture opening and to be extended within the abdominal cavity to provide a lifting area. In the preferred embodiment, a pair of retraction rods disposed with the bores and substantially parallel to each other are inserted into the abdominal cavity through an incision in the abdominal wall. The retraction rods are spread apart from each other while their parallel orientation is maintained. The lifting body is connected to a lifting arm and lifted, causing the retraction rods to lift and support the abdominal wall.

Abstract: A surgical lifter adapted to engage and lift the skin from the underlying tissue to create a work space in which a surgeon can operate, includes an expandable lifter head comprising at least two blades pivotally connected for relative pivotal movement between a deployed position in which the blades are fanned out, and a collapsed position in which the blades overlap one another; and a lifter shaft adapted to extend through the skin to engage the lifter head inside the body.

Abstract: The present invention provides endoscopic instrumentation and surgical techniques especially useful for accessing at least a portion of an intervertebral disc. Vertebrae spreading instruments are provided for spreading adjacent vertebrae to facilitate access to the intervertebral disc are. The disclosed surgical method uses an anterior approach to access the intervertebral disc and spreads adjacent vertebrae utilizing an endoscopic vertebrae spreading instrument.

Abstract: A retractor apparatus for use in conducting a surgical operation through an incision in a patient. The retractor includes a retractor support, a plurality of surgical retractors, and a stretchable sleeve. The surgical retractors are mounted to the retractor support such that at least two of the surgical retractors are facing each other. The stretchable sleeve encircles the surgical retractors to form a continuous surface around the surgical retractors for engagement of tissue.

Abstract: A cylindrical anal retractor for examining the inside of an anus of a living body including an inserting valve portion inside of which a substantially circular-shaped opening is formed, a handle which serves to dilate the opening by gripping it, and an auxiliary appliance for making the insertion of the inserting valve portion into the anus smooth; the trivalve inserting portion has three plate-like members, which are curved inside, and two of the members are connected to the handle so as to be rotatable about axes extended in an inserting direction of the inserting valve portion. In the anal retractor according to the present invention, therefore, the pain which is given to the patient when the anal retractor is inserted into his or her anus is remarkably reduced.

Abstract: A mechanical lifting retractor is provided which increases working space in the chest for cardiac surgery by temporarily expanding the space between the rib cage and the pericardium. The lifting device has a pair of parallel right-angled retractors. Distal portions of the retractors are insertable in side-by-side parallel relation between a pair of adjacent ribs in the rib cage and into the mediastinal space between the ribs and sternum and the pericardium beneath them. The distal portions are pivotable into a lifting position in which they are separated by a rotational angle of approximately 180.degree.. Following insertion of the distal portions into the mediastinal space, the distal portions are rotated into the lifting position and oriented in the sagittal plane such that each distal portion extends beneath one of the ribs. A lifting force is applied to the lifting retractor, causing the distal portions to engage the ribs and to lift the rib cage and thereby enlarging the mediastinal space.

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

Abstract: A surgical retractor is disclosed having a handle portion, an elongated body portion extending distally from the handle portion and including an outer tube, a fixed stabilizing member extending from a distal end of the outer tube and a pair of resilient bands pivotably connected to a distal end portion of the stabilizing member. An actuation mechanism is provided which is associated with the handle portion and proximal end portions of the bands for moving the bands between open and closed position. The surgical retractor further includes a sheath dimensioned to receive at least a portion of the stabilizing member and the bands.

Abstract: A pupil expander insertion system for eye surgery includes a pupil expander insertion tool and an iris retracting glide. The insertion tool includes a housing having forward and rearward ends, a hollow chamber in which a piston is axially movable, and an aperture formed in the forward end that communicates with the hollow chamber. A retractable blade for holding a pupil expander in an elongated condition is journaled within the aperture and connected to the piston for longitudinal movement therewith. The forward end of the blade has a slot extending rearwardly, defining a pair of tines wherebetween the expander can be slidably inserted. A stationary hollow spatula surrounds the blade in the retracted position, contacting the pupil expander to slidingly urge it off the retracting blade. The glide has an elongated tongue with a folded tab on one end slidably inserted through a slot means in the other end.

Abstract: A medical retractor having a support shaft on which is threaded a retractor arm drive that supports a retractor arm. The retractor arm drive includes a worm with threads that engage peripheral gear teeth of a worm gear; and the worm gear is threaded onto the support shaft. Rotating the worm, turns the worm gear and moves the retractor arm drive and retractor arm longitudinally along the support shaft. A stop prevents the support shaft from rotating with the worm gear in response to rotation of the worm.

Abstract: The invention provides a system and method for manipulating a tissue structure within a body cavity. In a preferred embodiment, the invention provides a system and method for retracting and supporting the heart wall to provide access into the heart during a cardiac surgical procedure. The system comprises a tissue supporting member (500) positionable through a first percutaneous intercostal penetration into the thoracic cavity. The tissue supporting member has a contact surface (502) configured for supporting a portion of the heart wall. A retractor (40a) includes a shaft (400) with a proximal end, a distal end configured for introduction through a second percutaneous penetration and a diameter less than the width and length of the contact surface. A hook (428) is slidably coupled to the distal end of the shaft for releasably holding the tissue supporting member such that the contact surface is arranged transversely to the longitudinal axis of the shaft.

Abstract: A surgical retractor, retainer, tensioner, tenaculum, spreader or stabilizer (10) useful in open surgical procedures, or in laparoscopic or other endoscopic procedures, includes a plurality of tissue-engaging elements (12, 14) (such as a plurality of atraumatic hooks (18)) connected by a central elastic member (16). The elastic member (16) is preferably composed of a medical grade rubber, silicone or fluoropolymer elastomer, and is preferably configured or shaped as an O-ring (22) or regular polygon (66, 74, 88, or 92). When the retractor (10) is intended and particularly adapted for use in laparoscopic or other endoscopic procedures, the elastic member (16) is collapsible in a direction transverse to an imaginary line drawn between the plurality of tissue engaging elements (12, 14), so as to allow the retractor (10) to be passed through a surgical cannula into and out of the patient's body during the procedure.

Abstract: A guide for a cannula extending through a tissue and into a cavity in which a surgical procedure is to be performed. The guide has first and second plates cooperatively defining a through passageway for a cannula. Structure connects between the first and second plates to allow selective altering of the relative positions of the first and second plates to thereby change the configuration of the through passageway defined cooperatively between the first and second plates. A conversion unit can be used to draw the plates away from each other to enlarge an incision into which the first and second plates extend.

Abstract: An abdominal wall elevator device including a pair of retractable tabs rotatable to 90.degree. with respect to the vertical axis of the device, and selected of a dimension to enter the port of a Trocar in allowing low pressure pneumoperitoneum laparoscopic surgery. In a preferred embodiment of the invention, a removable push-rod incorporates a flat tip to operate on the tenons of a pair of hinges to swing the retractor tabs to the desired angle, to be locked in place.

Abstract: Abdominal wall lift devices and methods are disclosed that extend a lift device through an opening in the abdominal wall in an entry configuration and subsequently transform the device to a deployed configuration within the abdominal cavity. One embodiment includes a plurality of elongated bar members that may be introduced into an abdominal cavity in a separated end-to-end orientation. The bar members are subsequently interconnected into a deployed configuration within the abdominal cavity. Another embodiment includes a device that may be introduced through a small opening in an abdominal wall in a generally L-shaped configuration and subsequently deployed into a generally T-shaped configuration within the abdominal cavity. A further embodiment includes an umbrella-like device that may be introduced in a slender generally cylindrical configuration and subsequently deployed into an open umbrella-type configuration.

Abstract: A self-retaining retractor which can be assembled and used without assistance, retracting a surgical incision, retaining the incision open, and providing for retraction of internal organs and tissues inside the patient's body through the open incision. Flexible, resilient incision retractor paddles are placed into the incision, a rigid frame consisting of two interlocking halves is laid longitudinally over the incision. The incision retractor paddles in the incision are manually clipped to each frame half then the frame halves are opened to the desired extent. Incision retractor paddles and frame provide the apparatus stability for retraction of internal organs and tissues through the open incision by the addition of mounting jigs containing attachment posts onto mounting means which radiate outward from the frame. Internal organ and tissue retraction means are affixed to the attachment posts.

Abstract: A fan retractor has a pair of angle-shaped elements moveable relative to one another. The angle-shaped elements include first legs disposed in a generally parallel relationship, and second legs that extend laterally from the first legs, and are adapted for engaging with the abdominal wall. The second legs fan out upon rotation of the first legs relative to one another and have an effective thickness, measured in the direction defined by the first legs, that decreases distally from the first legs. The retractor also includes a lifting device that applies a lifting force to the angle-shaped elements.In variations, the second legs have a stiffness that decreases distally from the first legs; the first legs are linked so as to contrarotate relative to one another; the retractor includes a lifting force indicator; and the lifting device unidirectionally applies the lifting force to the angle-shaped elements.

Abstract: A fan retractor for laparoscopic surgery has a pair of angle-shaped elements with first legs disposed in parallel relationship to one another and second legs extending laterally from the first legs for movement between a juxtaposed collapsed condition and a fanned-out expanded condition responsive to rotation of the first legs about their longitudinal axes. Actuators are provided on the first legs to move the second legs between the collapsed and extended conditions. A first lock engages the actuators to lock the second legs in the extended condition and against movement toward or away from one another. A second lock in the form of a block slidably received on the first legs is selectively engageable between the second legs when in the extended condition. When engaged, the second lock serves both to block the second legs from movement toward one another and to restrain the first legs against movement away from one another.

Abstract: An elastically deformable element having multiple stacked strips for articulation in an endoscopic surgical instrument. The deformable element is usable in a variable retractor and an instrument having an articulating housing. The working section of the retractor variably moves from a curved configuration when outside of a sheath to a substantially straightened configuration when inside the sheath.

Abstract: A surgical retractor is provided for manipulating body tissue during endoscopic and laparoscopic surgical procedures which includes a handle assembly, an elongated body extending from the handle assembly, and a retractor assembly operatively associated with the body and defining a curvilinear tissue manipulation surface having an area which is selectively variable. In operation the retractor assembly is movable between a first position wherein the area of the tissue manipulation surface is minimized and a second position wherein the area of the tissue manipulation surface is maximized. The retractor can be designed for one handed operation.