Abstract: Described here are brachytherapy applicators that comprise a modular support matrix. The modular support matrix may define the arrangement of radiation source lumens within the brachytherapy applicator. The modular support matrix can be adjusted to position the radiation sources to obtain a certain dose and dose profile. A series of modular support matrices may be operably connected according to patient anatomy or dosing requirements. Systems and methods for using such modular brachytherapy applicators are also described.

Abstract: A vaginal speculum apparatus includes a portable illumination assembly that is releasably attached to one of the upper blade and lower blade of a disposable vaginal speculum. The portable illumination assembly is defined by a housing that retains at least one LED and a portable power supply. The portable illumination assembly can be energized by an externally accessible member after the illuminator has been attached to the speculum.

Abstract: This application presents minimally-obstructive and structurally-adjustable retractors which afford an open work area of desirable size and enhanced visualization for a surgeon about the perineum and the posterior vaginal wall of the patient. The retractors may be lightweight and compact, and also configured and dimensioned to minimize slippage during use. The retractors may retract the engorged labia of the postpartum patient as well as the vaginal walls. The device may also be used as a speculum.

Abstract: Various embodiments of a laparoscopic trocar assembly are disclosed. The port assemblies include inserted parts that protect the patient's tissues at the point of deployment. The port assemblies include seals for maintaining pneumoperitoneum both when instrument are being used and when instruments are not inserted.

Abstract: A retraction device for retracting an incision in a body wall includes a sheath that traverses through the incision from outside the body to a body cavity inside the body. The retraction device may include a first, distal retention ring, a second, proximal retention ring, a circumferential, tubular sheath that is coupled to the first and second retention rings, a plurality of tensioning straps, and a proximal lock ring, wherein each of the plurality of straps is coupled to the distal retention ring and extends proximally through the lumen of the sheath and the proximal retention ring. The lock ring is sized and configured to capture the straps between an inner surface of the proximal retention ring and an outer surface of the lock ring. The lock ring is adapted to be positioned within a lumen of the proximal retention ring with the straps exiting between the proximal retention ring and the lock ring.

Abstract: A vaginal speculum is provided that has an upper arm with a handle and jaw. A cross-sectional shape of a longitudinally extending portion may be constant along its entire longitudinal length so that the height of the portion is likewise constant along its length. Right and left side flanges may extend downward from the longitudinally extending portion and a tip of the jaw. The distance between the outer surfaces of the right and left side flanges in the lateral direction may be constant along their entire lengths in the longitudinal direction. A lower arm with a jaw and handle may be included and arranged with the upper arm so that their relative position to one another can be modified.

Abstract: Instrumentation for retracting tissue comprising a retractor member including a sidewall defining an axial passage extending along a length thereof and a lateral opening in transverse communication with the passage. A pin member is disposed within the passage and includes a distal end portion positionable adjacent the distal end of the retractor member, with at least a portion of the pin member positioned adjacent and visible through the lateral opening. In another embodiment, the retractor member includes a sidewall having a main sidewall portion defining a first wall thickness, and an enlarged sidewall portion extending axially along a length of the sidewall and defining a second wall thickness greater than the first wall thickness, with the sidewall defining an axial passage extending through the enlarged sidewall portion. A pin member is disposed within the passage and includes a distal end portion positionable adjacent the distal end of the retractor member.

Abstract: A vaginal manipulator includes a shaft and a head. The head includes a central plate having a distal end connected to the shaft, an expansion plate coupled to and configured to move radially away from the central plate, and a door having a constrained end and a free end. The constrained end of the door is hinged to the central plate and the free end of the door is configured to move away from the central plate. When the vaginal manipulator is inserted into a vagina, the expansion plate is movable relative to the central plate to displace an anterior wall of the vagina and the door is movable relative to the central plate to displace a posterior wall of the vagina into a trans-abdominal line of sight.

Abstract: A foldable retractor is provided. The retractor includes an arcuate deformable frame that is defined from a first arm extending through a first portion of an outer circumference of the frame, and a second arm that defines a remaining portion of the outer circumference. The first and second arms each include opposite first and second end portions, wherein the respective first end portions and the respective second end portions are hingedly connected together. The first and second arms of the frame are biased toward a first configuration wherein the combined first and second arms are aligned substantially continuously through the combined first and second end portions and the frame extends through substantially a single plane.

Abstract: A surgical device includes a rigid shaft connected between a handle and a head. The head of the surgical device is sized for insertion into an organ such as a vagina, a uterus, a rectum, or an esophagus. The head includes an expansion plate and a door coupled to a central plate. The central plate has a distal end connected to the rigid shaft, an anterior surface, and a recess formed in a posterior side of the central plate that provides a posterior surface opposite the anterior surface. The expansion plate is coupled to and movable relative to the anterior surface of the central plate. The door is coupled disposed within the recess of the central plate and movable relative to the posterior surface of the central plate. The expansion plate is movable independently of the door to allow the head to expand and move the organ.

Abstract: A surgical retractor has a rail, a first arm protruding from the rail at an angle, a second arm being movably mounted on the rail and extending substantially parallel to the first arm, and a multiplicity of holding elements mounted on the first and second arms. A holding element has a multi-axis joint for pivotably holding a blade for engaging tissue to be retracted. In this way, a most flexible surgical retractor is provided.

Abstract: A surgical retractor and a method of minimally invasive surgery, wherein the surgical retractor includes ribs and a mechanism for transferring of linear and rotational movements of the ribs and wherein each rib can be easily replaced without use of any additional tools. According to embodiments of the present invention, specific parts composing the surgical retractor are made of materials transparent to Röntgen rays (x-rays).

Abstract: A tissue support device is provided for managing access through tissue. The tissue support device engages the tissue proximate an opening in the tissue and biases the tissue support device to bring the engaged tissue together.

Abstract: A retractor assembly for surgery in a patient includes at least one retractor member removably engageable to a support member. The retractor assembly includes a housing assembly engaged to the support member and to an arm that extends from a retraction portion of the retractor member. A drive mechanism in the housing assembly is coupled to the retractor member and is operable to rotate the retraction portion of the retractor member relative to the support member to a desired angular orientation.

Abstract: A surgical retractor including a pair of handles mounted for pivotal movement about a pivot pin, a pair of arm members each terminating at a distal end in a downwardly depending blade and attachable to a respective handle at a proximal end. On application of hand pressure by an operator to the pair of handles of the surgical retractor rotates each handle and arm member about the pivot pin and causes the blades to move apart so that in use in a surgical site the blades abut against and retract tissue matter.

Abstract: A surgical retractor and a method of minimally invasive surgery, wherein the surgical retractor includes ribs and a mechanism for transferring of linear and rotational movements of the ribs and wherein each rib can be easily replaced without use of any additional tools. According to embodiments of the present invention, specific parts composing the surgical retractor are made of materials transparent to Röntgen rays (x-rays).

Abstract: A speculum insertable into a body cavity of a person including a support member having an opening, provided with elongated arm sections each disposed in a plane including a centerline of such opening, blade members each lying in the plane of an arm section and having an intermediate section pivotally connected to the support member, a first end section displaceable into and out of engagement with the end section of another blade member and a second end section displaceable relative to one of the arm sections, means for releaseably biasing the first end sections of the blade members into engagement, permitting such end sections to be inserted into and removed from a body cavity, and means mounted on each arm member, engageable by a second end section of a blade member, for caroming such blade member to pivot about the axis thereof.

Abstract: A surgical instrument, generally in the form of an expandable elongate conduit, for use as a distractor and/or retractor. The conduit generally includes a first elongate trough and a second elongate trough movable between an expanded state and a collapsed state wherein the second trough is nestable with the first trough. The first and second troughs may be fastened to vertebrae to facilitate distraction and/or compression of the vertebrae relative to one another.

Abstract: A method of performing an operation, e.g. a spinal operation, on a patient using a retractor comprising a pair of blade assemblies which are adapted to open about a set of axes that are not parallel to a third spatial axis, and further comprising a pair of arms, which are adapted to move the pair of blade assemblies apart from one another in the third spatial axis. In the method, the blade assemblies are closed to assume a low profile, inserted into a relatively small incision, and stretched apart from each other, thereby stretching the skin about the incision to form an aperture longer than the incision. The blade assemblies are then opened by rotating the blades about the set of axes, stretching the skin around the incision in a second direction that is substantially perpendicular to the first direction (i.e. the direction of the incision.).

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: A retraction device for retracting an incision in a body wall includes a sheath that traverses through the incision from outside the body to a body cavity inside the body. The retraction device may include a deployable, adjustable frame that supports the sheath and that, together with the sheath, retracts the incision. The retraction device may include an outer ring and an inner ring coupled to opposing ends of the sheath and further include means to place the sheath in tension between the inner and outer rings, thereby retracting the incision.

Abstract: A surgical access device includes a body having a first member and a second member relatively movable between open and closed configurations. Each member is positionable within an opening in tissue to provide access to an interior space of a patient. Each member includes a top surface, a bottom surface, a leading end, and a trailing end. The top surfaces are positioned in close cooperative alignment when the first and second members are in the closed configuration. The trailing ends are positioned in close cooperative alignment when the first and second members are in the open configuration. In the open position, the first and second members define a passage therethrough to permit access to the interior space for passage of a surgical instrument therethrough.

Abstract: A retraction apparatus and method are provided including slider assemblies for being slidably connected to a retractor body with end portions of the slider assemblies disposed within a central retractor opening. A retractor blade is slidably connected to one of the slider assembly end portions such that the depth of the retractor blade can be readily adjusted. Once the retractor blade is at the desired depth within the incision, a handle is pivoted to a locked position to fix the blade relative to the slider assembly. A cantilever lock between the blade and the slider assembly pivots the blade relative to the slider assembly to fix the blade thereto. In one form, the retractor body has a substantially flat surface configured to be placed adjacent a bone and slide connections which position slider assemblies such that the connected blades avoid contact with the bone during retraction.

Abstract: An assembly for tissue retraction in surgery includes a pair of arm members removably positioned on and movable along an elongate support member. The arm members each include an external housing, a locking member positioned within the external housing and a passageway extending through the external housing and the locking member. The elongate support member extends through the passageways and the locking members are releasably biased into engagement with the elongate support member to allow the arm members to move in opposite directions along the elongate support member and prevent the arm members from moving toward one another. Each arm member further includes a rotatable engagement portion engageable with a respective retractor portion and a locking element releasably biased into engagement with the engagement portion to limit rotation of the engagement portion to a first direction relative to the arm member.

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

Abstract: A surgical retractor has a rail, a first arm protruding from the rail at an angle, a second arm being movably mounted on the rail and extending substantially parallel to the first arm, and a multiplicity of holding elements mounted on the first and second arms. A holding element has a multi-axis joint for pivotably holding a blade for engaging tissue to be retracted. In this way, a most flexible surgical retractor is provided.

Abstract: Disclosed herein are various embodiments that related to a surgical retractor. In certain embodiments, the retractor may include a blade holder with a single blade tilting mechanism capable of adjusting the angle of a plurality of pivoting blades relative to the blade holder. In certain embodiments, the adjustment occurs from the proximal face or top of the retractor. In other embodiments, blade supports are used to couple the blade holder to a variety of removable blades of different lengths. In certain embodiments, the blades may be a translucent material capable of transmitting light from a proximal portion of the blade to a distal portion. In some embodiments, the distance between the blade holder and the removable blades may be adjusted.

Abstract: A method for providing treatment at or near a cervical region of the spine of a patient is provided. An incision is formed in the skin of a patient above the cervical region. An elongate body is inserted into the patient through the incision, the elongate body having a distal portion, a proximal portion, an outer surface, and an inner surface, the inner surface defining a passage extending through the elongate body. The elongate body is advanced until a distal end thereof resides at or near the cervical region of the spine. The size of the passage in the distal portion is increased relative to the size of the proximal portion.

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

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

Abstract: 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 surgical retractor system having a frame and a plurality of arms connected thereto is disclosed. At least one arm is moveable relative to the frame and the relative movement is constrained to a direction along the longitudinal axis of the arm. At least one retractor blade is removably connected to each of the plurality of arms. The blade is fixably rotatable about an axis normal to the longitudinal axis of the arm to which it is connected.

Abstract: A minimal incision maximal access system allows for maximum desirable exposure along with maximum access to the operative field utilizing a minimum incision as small as the METRx and Endius systems. 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 hinged bi-hemispherical or oval working tubes applied over an introducer obturator which is controllably dilated to slowly separate muscle tissue. Deeper end working and visualization areas with maximum proximal access and work dimensions are provided to makes the operative procedure safer in application and shorten the surgeons's learning curve because it most closely approximates the ability to use open microdiskectomy techniques. a dual frame system enables full or partial spreading of a working tube set, while an open frame facilitates a four point retraction system.

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

Abstract: A lordotic guard and method for guiding a bone removal device to form an implantation space in the human spine and, if desired, for inserting a spinal implant into the implantation space.

Abstract: The present invention discloses a safe surgical mouth gag (MG) having a substantially planar frame larger than the maximal mouth aperture which is defined by at least two cross members, i.e., a longitudinal maxillary cross member and a mandibular cross member and by at least one rod connecting said maxillary and said mandibular cross members; and modules maneuverably interconnected to the same. The modules are selected from a tongue blade approximately perpendicular to the frames' plane, which is vertically displaceable with respect to said mandibular cross member; a retaining member within which said tongue blade shaft is slidably displaceable; retraction elements for urging the cheeks away from the oral cavity; abutment members for contacting the upper teeth or upper maxilla; and at least one light auxiliary located adjacent to oral cavity, adapted to illuminate the same effectively.

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: A coupled pair of retractors which are coupled at the distal end to allow the handles at the proximal end to be urged apart to increase the distance between handles to allow for direct line of sight to the surgical site while also allowing the use of curved tools and curved access to the surgical site. A cannula with a cross section taken perpendicular to a straight portion of the cannula that increases between the proximal end of the cannula and the distal end of the cannula allows for direct line of sight to the surgical site while also allowing the use of curved tools and curved access to the surgical site. These tools may be used in a postero-lateral approach from an incision in the back to a target position adjacent to the spine.

Abstract: A surgical retractor assembly that utilizes a tubular shaft and a connection nub. A pivot joint connects one end of the tubular shaft to the connection nub. The pivot joint enables the connection nub to move relative the tubular shaft along a path that is coplanar to the axis of the tubular shaft. Together, the tubular shaft and the connection nub create an elongated element that can be introduced into a small incision. A retractor blade is provided. A bearing joint extends from the retractor blade. The retractor blade and bearing joint are introduced into a surgical site independent of the elongated element. Within the surgical site, the connection nub interconnects with the bearing joint, therein joining the retractor blade to the tubular shaft and a handle.

Abstract: A speculum provides visual access to a body cavity, and such instrument is used by physicians for vaginal examination. The speculum comprises a handle having a frontal portion and a rear portion slidingly secured to the frontal portion. A blade angle positioner is pivotally connected by a pivot connection in a top end portion of the handle rear portion, whereby to angulate a top blade removably secured to a top blade connector anchor at a forward projecting end of the blade angle positioner. The handle frontal portion has a bottom blade connector anchor in a top forward end portion thereof. The top and bottom blades each have a connecting end provided with clamp connectors for removable engagement with a respective one of the top and bottom blade connector anchors.

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 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: 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: 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: 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: The present invention provides hingeable side wall support blades integral with any of vaginal speculum parts that operatively lie circumferential to the view of the vagina, whereby the side wall support blades are movable from a collapsed position near the top or bottom blade to an upright position to press back the vaginal walls.

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 apparatus and method for laparoscopically lifting the abdominal wall utilizes a pair of lifting rods each having a substantially straight proximal portion mounted to a lifting body and an arcuate distal portion joined to the proximal portion. The rods have an insertion configuration, in which their arcuate portions are nested such that the rods may be simultaneously extended into an abdominal cavity, and a lifting configuration in which one of the rods is pivoted such that the arcuate distal portions form a substantially circular lifting area between them. An inflatable balloon is disposed around the lifting arms and is inflated within the abdominal cavity to push abdominal tissue away from the abdominal cavity and to thereby prevent the tissue from catching on the lifting rods during pivoting.

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: Apparatus are provided for manipulating various internal tissue and organ structures of a patient incident to a variety of medical procedures. Organ or tissue manipulation is obtained through the use of one or more radially displaceable members such as balloons, expandable sponges, and various other resilient members that can be positioned about at least a portion of the periphery of a generally elongated tubular member that is insertable into the interior of the body of a patient through a portal or similar aperture formed in the body surface.