Abstract: A system for creating an access portal to a surgical site generally comprises a first portal member configured to be inserted through an incision and toward the surgical site and a second portal member configured to be inserted through the incision for engagement with proximate the first portal member. Each portal member includes a body with opposed side edges. The side edges of the first portal member cooperate with the side edges of the second portal member to secure the access system within the incision with the bodies of the respective portal members defining the portal to the surgical site.

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 improved surgical retraction apparatus (and corresponding method of operation) includes a plurality of rigid retraction members disposed about a central axis that move radially with respect to the central axis between a closed state and an open state. In the closed state, the retraction members form a central opening that is adapted to closely fit around the tubular section of a surgical port device. In the illustrative embodiment, a planetary gear train, cable assemblies, lever arms or two annular slotted plates used to control radial movement of the retraction members with respect to the central axis.

Abstract: A selectively locking minimally traumatic access port which utilizes a retractor which is configured to create access to a surgical site by displacing surrounding tissues. To minimize the damaged to the displaced tissue, the retractor is further configured to be locked in at least three fixed positions. The medical professional extends and locks the retractor in a position that minimizes the displacement and damage to the surrounding tissues while allowing adequate access to the surgical site.

Abstract: A device that provides access to a surgical location within a patient has an elongate body that has a proximal end, a distal end, and an inner surface. The inner surface defines a passage that extends through the elongate body. The elongate body is capable of having a configuration when inserted within the patient wherein the cross-sectional area of the passage at a first location is greater than the cross-sectional area of said passage at a second location. The first location is distal to the second location. The passage is capable of having a generally oval shaped cross section between the second location and the proximal end.

Abstract: Spinal surgery is carried out under direct visualization through a relatively small opening formed in a patient's skin. Intervening tissue between the opening and the surgical site is displaced so as to form a keyhole channel therethrough. The channel is characterized in that it increases in width as it progresses from the opening to the surgical field. The use of the keyhole channel maximizes the surgeon's access to the surgical field while minimizing tissue trauma. Also disclosed are surgical retractors used to provide the channel.

Abstract: An improved surgical retraction apparatus (and corresponding method of operation) includes a plurality of rigid retraction members disposed about a central axis that move radially with respect to the central axis between a closed state and an open state. In the closed state, the retraction members form a central opening that is adapted to closely fit around the tubular section of a surgical port device. In the illustrative embodiments, a planetary gear train, cable assemblies and lever arms may be used to control radial movement of the retraction members with respect to the central axis.

Abstract: The present invention enables a physician to distract a previously created opening, determine the size of the opening, and alternatively, subsequently assist in inserting an implant between adjacent spinous processes. The distracting device has two prongs which separate as the handle of the device is closed. When the spinous processes are distracted to a desired diameter, the physician can lock the prongs in place, allowing him to determine and select an appropriately sized implant.

Abstract: A retractor having interchangeable or replaceable blades facilitates the expansion of a surgical site below an incision in the skin, and establishes a work-through surgical space. The retractor includes a frame connected to two collar arms, a pair of blades connected to the collar arms, a sheath for encompassing the blades and providing a circumscribed working space, and a device for rotating the collar arms, thereby displacing the blades and any tissue surrounding them.

Abstract: A retractor has an elongate body and an expandable shroud. The elongate body has an outer surface and an inner surface partially defining a passage. The elongate body also has a first longitudinal edge and a second longitudinal edge. The elongate body is capable of having an enlarged configuration when inserted within the patient. In the enlarged configuration the first longitudinal edge is spaced apart from the second longitudinal edge. The expandable shroud is configured to extend from the first longitudinal edge to the second longitudinal edge when the first and second edges are spaced apart. The shroud partially defines the passage. The cross-sectional area of said passage at a first location is greater than the cross-sectional area of the passage at a second location, wherein the first location is distal to the second location.

Abstract: Devices in accordance with certain embodiments of the present sulcus speculum are designed to be placed into the sulcus of an eye to perform one or more of the following functions: evacuation of fluid, opening of the lids, and application of drugs such as anesthetic or antibiotics. The present devices can include a sponge positioned around (a) an aspiration tube for withdrawing fluid and (b) an arm of a speculum. Other variations of the present devices include those with an aspiration tube for withdrawing fluid, the tube being positioned in a trough defined by an arm of a speculum. Alternatively, the speculum arm can define a passage for holding the aspiration tube. In that alternate embodiment, the portion of the speculum arm defining the passage has openings for passing fluid into the passage so that the aspiration tube in the passage can then remove fluid.

Abstract: A minimally invasive retractor system is shown which has a support frame having two opposing pairs of horizontally oriented sides. The sides of the frame can be adjusted to vary an interior space of the frame. Four retractor blades are mounted on the frame for engaging tissue within a surgical site. Each retractor blade has an elongate body portion with a length which is oriented perpendicularly to the frame in use. One of the retractor blades can be equipped with a light source and a suction source which are integral to the blade. The blade also has an integral power source for powering the light source. The blade can also house a tissue retractor such as a dural retractor for retracting the dural sack of a patient during spinal surgery.

Abstract: A surgical retractor comprising a laterally extending rack having a first arm connected to the rack spaced from a movable second arm connected to the rack. In the preferred embodiment, the first and second arms have first segments connected to the rack connected to intermediate segments which are connect to third segments at the end of the arms. The intermediate segments are angled toward one another which allow the ends of the arms to be closer than the stationary segments connected to the rack. Additionally, the arms are preferably rotatable along longitudinal axes relative to the rack and can be locked in a fixed angular position.

Abstract: A surgical retractor is disclosed comprising first and second arms, each arm having a utility end and a handle end; first and second blades connected to the utility end of the first and second arms, each blade being pivotally adjustable about the longitudinal axis of the utility end of the associated arm; the first and second arms are adjustably connected between a closed position and an open position. The surgical retractor has particular application as a vaginal speculum.

Abstract: A circumferential retractor apparatus including a first retractor paddle, a second retractor paddle and an elastic member. Each of the first and second retractor paddles includes a body portion with an arm extending outwardly therefrom. The arm supports a grasping surface. The arm of the retractor paddle has a hole formed therein through which the elastic member passes. A slot opens at a top edge of the body portion such that a respective end of the elastic member is received therein. The slot has a dog leg configuration with a wide opening adjacent the top edge of the body portion of the respective paddles.

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 speculum system with four blades is provided. The blades project in approximately the same direction, and each blade is connected to a handle linearly or at an angle. The handles are coupled together. In one embodiment, the distance between the blades is changeable so that a field of view defined as the viewable area between the blades can be increased or decreased. In another embodiment, the blades include texture, such as ribs, holes or teeth to grip onto surrounding muscle fiber. In yet another embodiment, a stabilizing arm attaches to a stabilizing object, such as a table or heavy or immovable object, and to one of the handles to stabilize the speculum system.

Abstract: A spinal implant insertion instrument for intervertebral implant surgery formed from a hollow first element of various external diameters, including a channel to accommodate and incorporate a vertebral pedicle, and a second element joined by a hinge to the first element, allowing reduction of the external diameter of the leading edge of the spinal implant insertion element sufficient to allow the passage of the spinal implant insertion instrument into the intervertebral disc space in a safe fashion, as the first maneuver, to be followed by activation of the second element upon the first, restoring the internal diameter of the spinal implant insertion instrument to a sufficient radius to allow successive passage of cutting, reaming, tapping instruments, and subsequent implantation of a spinal interbody implant device.

Abstract: A speculum according to the invention comprises two parts, an outer member (1) and an inner member (2). The outer member (1) comprises a tubular body (3) having an anterior end (4) with an opening (6) and a posterior end (5) with an opening (7). An elongate slot (11) is formed in the side wall (12) of the tubular body (3), extending from the opening (7) at the posterior end (5) towards the anterior end (4). The inner member (2) of the speculum comprises a cup-shaped body (13) having an anterior end (14) formed as a plug (16) and a posterior end (15) with an opening (17). An elongate key member (18) is formed in the side wall (19) of the cup-shaped body (13), extending from the opening (17) at the posterior end (15) towards the anterior end (14). The speculum is assembled by inserting the inner member (2) within the outer member (3) and aligning the key member (18) with the elongate slot (11).

Abstract: A surgical access device includes two opposed side members each of which carries a downwardly depending flange. One lateral member adjustably connects a first end of the first side member to a first end of the second side member, with at least one of these first ends being moveable along a length of the first lateral member, thereby permitting adjustment of the space between the first ends. A second lateral member adjustably connects the second end of the first side member to the second end of the second side member, with at least one of these second ends being moveable along a length of the second lateral member, thereby permitting adjustment of the space between the second ends.

Abstract: A speculum (18) including a combined first speculum blade and handle portion (20), a combined second speculum blade and link portion (62), a speculum handle portion and a plurality of combined ribs and links (76). Each of the combined ribs and links (76) is movably coupled to the combined first speculum blade and handle portion (20) and to the combined second speculum blade and link portion (62) to movably couple the combined first speculum blade and handle portion (20) to the combined second speculum blade and link portion (62). The speculum handle portion (46) is movably coupled to the combined first speculum blade and handle portion (20) and to the combined second speculum blade and link portion (62) to actuate the combined first speculum blade and handle portion (20) and the combined second speculum blade and link portion (62) relative to each other between a first orientation (illustrated in FIG.

Abstract: A distractor for separating adjacent elements, such as vertebrae. The distractor preferably has a scissors-type distracting mechanism, either in a simple scissors or double-acting scissors configuration. The distractor includes blades that are removable from the jaws of the distractor such that different blades may be used depending on the patient and situation with which the distractor is to be used. The jaws include a mating fixture and the blades include a mating portion for removable association with the mating fixture.

Abstract: A surgical retractor comprising a laterally extending rack having a first arm connected to the rack spaced from a movable second arm connected to the rack. In the preferred embodiment, the first and second arms have first segments connected to the rack connected to intermediate segments which are connect to third segments at the end of the arms. The intermediate segments are angled toward one another which allow the ends of the arms to be closer than the stationary segments connected to the rack. Additionally, the arms are preferably rotatable along longitudinal axes relative to the rack and can be locked in a fixed angular position.

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: Apparatus is provided that distracts and maintains the distracted position of adjacent vertebral bodies during a surgical procedure within a vertebral disc space. The distraction device includes a first and second plate, each of which includes at least one extension member for removably attaching to a vertebral body. The distraction device further includes a locking member for locking the first plate with respect to the second plate across a vertebral disc space and a cam mechanism for effecting relative movement of the first and second plates. Each extension member includes at least one bore for receiving a bone screw. The first and second plates are preferably crescent shaped and coupled together by a pin member. The first and second plates are rigidly locked together in a distracted position by a threaded locking screw. A method of distracting a space between vertebral body portions and a method of using a distraction device during implantation of a fusion implant is also disclosed.

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: A speculum (18) including a combined first speculum blade and handle portion (20), a combined second speculum blade and link portion (62), a speculum handle portion and a plurality of combined ribs and links (76). Each of the combined ribs and links (76) is movably coupled to the combined first speculum blade and handle portion (20) and to the combined second speculum blade and link portion (62) to movably couple the combined first speculum blade and handle portion (20) to the combined second speculum blade and link portion (62). The speculum handle portion (46) is movably coupled to the combined first speculum blade and handle portion (20) and to the combined second speculum blade and link portion (62) to actuate the combined first speculum blade and handle portion (20) and the combined second speculum blade and link portion (62) relative to each other between a first orientation (illustrated in FIG.

Abstract: A spinal implant insertion instrument for intervertebral implant surgery formed from a hollow first element of various external diameters, including a channel to accommodate and incorporate a vertebral pedicle, and a second element joined by a hinge to the first element, allowing reduction of the external diameter of the leading edge of the spinal implant insertion element sufficient to allow the passage of the spinal implant insertion instrument into the inteivertebral disc space in a safe fashion, as the first maneuver, to be followed by activation of the second element upon the first, restoring the internal diameter of the spinal implant insertion instrument to a sufficient radius to allow successive passage of cutting, reaming, tapping instruments, and subsequent implantation of a spinal interbody implant device.

Abstract: A surgical access device (10 or 10′) includes a frame defining an access port and a pair of flanges are carried on the lower surface of the frame. The flanges are pivotable between an insertion position, where their leading edges are optimally placed adjacent one another to assist in inserting the device in an incision, and a retracting position, where both flanges optimally urge upwardly against the internal surface of the patient's tissue to seat the access port. A method of the invention involves making an incision at least as long as the leading edge of such a device and inserting the leading edge of the device into the incision. The flanges are moved laterally away from one another to expand the opening in the tissue and center the access port laterally within the opening.

Abstract: An endoscopic stabilization device is provided. The device includes first and second support elements positioned opposite each other, a plurality of linkages, each linkage including a first end portion attached to the first support element and a second end portion attached to the second support element; and a cable operatively attached to the linkages at a first end to allow a user to pull a second end of the cable to move the first support element in a direction away from the second support element. Methods of using the device to stabilize and immobilize components in the body are also provided.

Abstract: A retractor system having a blade assembly with notches for receiving a portion of a surgical retractor stay. A retractor system having a cam lock mechanism and/or a ratchet mechanism to restrict movement of the paddle arms. A retractor system having pinions to engage an elastic band to aid the frame and paddle arms to automatically self-position during a surgical procedure.

Abstract: A medical device for retracting tissue allows access to the inside of the body by “prying open” an existing or created opening in a body. The device comprises a substantially transparent head having first and second head halves defining a substantially conical surface including a gap when the first and second head halves are joined. Angular motion of the first and second head halves enlarges the existing or created opening and provides an area of access to the inside of the body. The substantially transparent nature of the device allows it to function as a light pipe so that the operator can see the body cavity or tract opened by the device. The device has scissors-like handles to allow an operator to open or close the device with one hand.

Abstract: An illuminated rectal retractor for creating a working space for dissecting instruments in support of a surgical procedure such as rectal examination or for the removal of polyps or hemorrhoids or other types of procedures which require the illumination and access to tissue in the rectal area of a patient, the illuminated retractor having a handle member pivotally connected at an obtuse angle to a first cylindrical and 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, an operating channel extends along the lengthwise dimension of the first elongate section and the operating channel is illuminated by the second elongate section in use.

Abstract: A system which facilitates the closure of puncture wounds in the vasculature of a patient by helping locate and isolate the site of the puncture wound in the patient. A tube or catheter having an indicator hole for aspirating blood assists in locating the exact site of the wound. A retractor moves the surrounding tissue laterally forming an access path to the wound, and acts as a guide for the wound closure device. The retractor and accessories are preferably used in combination with a surgical clip applicator which delivers clips to the site of the wound, but can also be used with other methods of wound closure such as suturing and stapling.

Abstract: A surgical stabilizer especially adapted for use in cardiac surgery includes first and second hollow legs that are disposed generally parallel to each other, each leg having a closed end and an open end. Each leg has an upper surface and a lower surface, the lower surface including a plurality of openings that are disposed adjacent each other. A yoke extends between and connects the first and second legs. A manifold is connected to the open end of each leg. When a suction tube is connected to the manifold, a vacuum can be applied to the openings in the legs so as to attract the surface of the heart to the legs. An adjustable embodiment of the invention includes first and second support arms that are connected to first and second legs. The support arms are connected pivotally to each other to permit the legs to be moved toward or away from each other. The legs can be provided with small pins, sharpened edges, and/or suction in order to engage or grasp the heart.

Abstract: Disclosed is a spatula dissector (10) presenting a body (12) and a flat distal end (14) comprised of two jaw elements (28, 30) capable of spreading relative to the surface of the spatula.

Abstract: A vaginal lateral walls retractor for use with a vaginal speculum to retract the vaginal lateral walls during vaginal/cervical examinations includes a generally tubular sleeve having cross-sectional dimensions that allow the sleeve to fit in between blades of the speculum while the blades are inserted and opened within a vagina. The sleeve retracts the vaginal lateral walls that have pushed in under the inserted and opened speculum blades. The cross-sectional dimension also provides an inside working area for examination and sampling of the vagina and cervix area.

Abstract: A rotating and lateral expansion device with a relative lateral motion of at least two to four blades. Blades are arranged initially such that their effective forcing planes are substantially axially and facially parallel to each other in a closed position. A lateral motion forcing mechanism is operatively attached to a base plate assembly such that activation of the lateral motion forcing mechanism forces a rotation and sliding action in the base plate assembly which translates into forcing a lateral expansion of a number of the blades. The device permits an examiner to increase the effective diameter of an orifice, such as the vagina, of an examinee.

Abstract: The present invention encompasses tools and a tool-holding retractor assembly. The retractor assembly spreads an incision and holds the incision open. At least one extension device, having a tool holder on one end, attaches to the assembly. The holder includes a selectively locking multi-axis adjustable mounting element adapted to grip a tool shaft. The mounting element acts as a universal mounting providing rotational and sliding movement of the tool shaft. The extension device adjusts to position the tool holder peripherally of the surgical field. Once the retractor is placed, the extension device provides full access to regions below the incision. The extension device allows the surgeon to chose the insertion point and insertion angle of the tool shaft.

Abstract: An adjustable surgical retractor and its use for improving a surgeon's ability to perform closed-chest video-assisted exploratory, diagnostic or surgical procedures on a patient. The surgical retractor is designed to have opposable blades which can be inserted into a surgical incision in a patient undergoing a surgical procedure then spread apart to form an elongated access opening through which a instrument may be inserted to perform exploratory, diagnostic or surgical procedures. The blades used in the surgical retractor may be flexible or rigid and are attachable to the retractor. The blades are of a width, depth and thickness to provide an access to an internal cavity or subcutaneous region to allow greater degrees of freedom to the surgeon in inserting instruments into the access opening. The use of the surgical retractor forms a substantially ovoid channel, through which a medical instrument can be inserted to aid a doctor in performing surgical or other operations.

Abstract: In an episiotomy retractor, distal portions of the blades are shaped to diverge away from one another for enhanced retraction and gripping of respective adjacent vaginal walls, proximal portions of the blades are shaped to diverge away from one another to retract the labia as the blades retract respective adjacent vaginal walls, and the proximal inferior longitudinal edges of the blades cooperatively define, when the retractor is in use, an open work area for a surgeon about the perineum and the posterior vaginal wall of a patient.

Abstract: A lid speculum that operates in an anatomically correct manner. The speculum has a first blade and a second blade that can pivot about an axis of rotation. The speculum is constructed so that the axis of rotation is essentially parallel with and posterior to a line that intersects a medial canthi and lateral canthi of an eye. With such an arrangement the blades will move in a radial manner that corresponds to the shape of the globe. This movement tends to lessen kinked pressure points in the eyelid.

Abstract: Disclosed is a spatula dissector (10) presenting a body (12) and a flat distal end (14) comprised of two jaw elements (28, 30) capable of spreading relative to the surface of the spatula.

Abstract: A distractor for separating adjacent elements, such as vertebrae. The distractor preferably has a scissors-type distracting mechanism, either in a simple scissors or double-acting scissors configuration. Additionally, one or more of the blades, distracting mechanism, and handles are offset with respect to the other to facilitate visualization and to increase the space available for an implant holder. The blades are configured to enhance versatility of the distractor. In a first embodiment, the blades are removable from the jaws of the distractor such that different blades may be used depending on the patient and situation with which the distractor is to be used. In a second embodiment, curved portions are provided between the blades and jaws such that the blades are offset from the jaws in a smooth transition which does not expose sharp edges to internal organs or vasculature of the patient.

Abstract: Surgical procedures on the beating heart are enabled by an incision made in the xyphoid area and specially designed retractors and related devices to facilitate cardiac surgical procedures. Specifically, coronary artery bypass graft procedures (CABG) are achieved using a vertically offsetting retractor or access platform in combination with a beating heart stabilizer. The surgical methodology permits procedures such as the CABG procedure without penetrating the rib cage or performing a sternotomy or thorocotomy.

Abstract: Surgical procedures on the beating heart are enabled by an incision made in the xyphoid area and specially designed retractors and related devices to facilitate cardiac surgical procedures. Specifically, coronary artery bypass graft procedures (CABG) are achieved using a vertically offsetting retractor or access platform in combination with a beating heart stabilizer. The surgical methodology permits procedures such as the CABG procedure without penetrating the rib cage or performing a sternotomy or thorocotomy.

Abstract: A tissue retractor with an adjustable center claw. The retractor includes two pivoted retractor arms. An axially and angularly displaceable, spring biased clamping mechanism is positioned on the pivot axis. In a mounting position, a elongated clamping element aligns with a slot in the center claw. When the center claw is positioned and the clamp moves to its clamping position, the elongated clamping member clamps the center claw in position. The counterfacing surfaces of the center claw and the clamping member are toothed to provide a positive one-way ratchet clamp.

Abstract: An instrument for spreading the anterior leaflet of a mitral valve. The surgical instrument is designed to allow a surgeon to grip an instrument with one hand during sizing of the anterior leaflet prior to implantation of an annuloplasty ring in a heart valve. The instrument includes a pair of tines that each have an engagement tip for engaging the chordae tendinae proximate an anterior leaflet of a heart valve. The tines are coupled together by a gripping mechanism that may be easily held in one hand, while an annuloplasty ring sizer is held in the surgeon's other hand.

Abstract: An apparatus and method of use is provided for locally stabilizing an anastomotic site during a beating heart surgical procedure which includes occluding a section of the artery receiving the bypass graft vessel. An apparatus is provided to stabilize the epicardium and the operational field, and includes a platform that can be compressed onto the epicardium or tensioned by pulling the epicardium upwardly, thereby providing a stabilized operational field. At least one occluding member provides means to occlude the section of artery receiving the bypass graft vessel. An adjustable stabilizing arm can be used in conjunction with the platform to further provide stability to the epicardium during the beating heart bypass graft procedure.

Abstract: A device for minimizing displacements of the heart when performing a beating heart surgical procedure including two heart engaging members. The heart engaging members are slidably coupled to a retractor. The heart engaging members may be rotated and extended as necessary to reach the target site on the patient's heart. The heart engaging members have curved distal ends which are configured to engage a coronary shunt positioned in the coronary artery. A suture extends around the coronary and is coupled to the heart engaging members.