Abstract: An improved tissue engagement device such as a suction stabilizer or retractor. The stabilizer or retractor is provided with one or more suction pods mounted to the distal end of a flexible arm. The flexible arm is coupled to a base assembly, which attaches the arm to an associated retractor or other structure that is fixedly located relative to the operative site. The base assembly includes a fixed portion, which is coupled to the retractor or other fixed mounting point and a rotatable turret, allowing rotation of the arm relative to the fixed portion of the base assembly. A tensioning mechanism mounted to the turret applies tension to compress the turret around a corresponding pivot mounted to the fixed portion of the base to rotationally lock the turret and to lock the arm in its current configuration.

Abstract: Devices, systems and methods related to endoscopic surgery, particularly related to robotic surgical operations, provide a tissue stabilizer for endoscopically stabilizing a target tissue within a patient's body. For stabilizing a beating heart during a closed-chest coronary artery bypass grafting procedure, a stabilizer is inserted through an endoscopic cannula and provides sufficient surface area to contact the heart and effectively stabilize the target tissue area. The stabilizer can straddle a blood vessel, such as a coronary artery, which is targeted for an anastomosis. Vessel occlusion fasteners may occlude the target blood vessel prior to the anastomosis procedure.

Abstract: A malleable shaft device for use in surgical procedures, having a tension fiber therein, whereby the malleable shaft transitions from a malleable state to a rigid state when a force is applied to the tension fiber, has a variable-pitch cam operatively connected to the tension fiber, and a lever operatively connected to the variable pitch cam for applying force. The mechanical advantage of the cam changes with displacement to accommodate increasing load, and to increase the rate of travel while loads are light. The force profile may provide for a constant input force to accomplish the full travel of the cam.

Abstract: A support arm assembly for assisting in the performance of cardiac surgery has an articulated arm movable axially of a support base and rotatable relative to the support base. A distal end of the articulated arm receives a contact member and the contact member is moveable relative to the distal end. A surgeon may configure the support arm assembly to contact a desired portion of a heart and fix the articulated arm, its axial position, its rotated position and the orientation of the contact member with a single control.

Abstract: A mounting assembly for mounting a surgical instrument to a base, which facilitates positioning a surgical instrument relative to the surgical site so that only the minimum portion of the instrument is positioned in the free space available around the surgical site. A surgical instrument is also provided which includes a handle, a tool member, and a segmented flexible articulating arm which operatively connects the handle and the tool member. Also provided is an instrumentation kit having a surgical instrument which includes an end effector connecting assembly disposed at the distal end portion of arm articulating arm to facilitate the removal or attachment of and end effector from the distal end of the articulating arm. The surgical instrumentation kit also includes a number of interchangeable surgical tool end effectors each having a uniform connector portion for interchangeable engagement with the end effector connecting assembly of the surgical instrument.

Abstract: Devices for stabilizing tissue during a surgical procedure. The beating heart may be stabilized during a surgical procedure on the heart, using a described stabilizing device. In one example, 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 id effectively eliminated such that the heart is stabilized and the site of the surgery moves only minimally if at all.

Abstract: A surgical arm system for holding and positioning one or more instruments during a surgical procedure includes at least one quick connect mechanism that beneficially allows for simple and expeditious, yet reliable disassembly and reassembly of the arm by any member of a surgical team without difficulty and without requiring additional tools, but while still ensuring that, following reassembly, the arm is structurally sound, properly dimensioned, and capable of functioning in a highly reliable manner.

Abstract: Surgical robots and other telepresence systems have enhanced grip actuation for manipulating tissues and objects with small sizes. A master/slave system is used in which an error signal or gain is artificially altered when grip members are near a closed configuration.

Abstract: A support arm for a heart stabilizer that can be used to stabilize a heart during a beating heart coronary artery bypass graft procedure. The support arm may have an arm that is coupled to a table mount and an end effector. The table mount is adapted to be mounted to the rail of a surgical table. The end effector is adapted to hold the heart stabilizer. The arm may be adjustable to allow an end user to adjust the position of the end effector.

Abstract: The invention includes linkage assemblies comprising coupled links with metallic contact surfaces with improved stiffness. The inventors found significant mechanical problems with all previous descriptions of metallic contact links sufficient to preclude their commercial use. These metallic contact links are a significant improvement over existing plastic ball and metal joint, or all plastic beads as found in the prior art. The invention includes methods providing these links and high friction couplings between them, as well as the linkage assemblies and flexible arms resulting from these processes.

Abstract: A positioning arm for positioning and holding a device within a medical imaging environment workspace has: (a) a free-end link in the form of a circular cylinder having a distal end face and an adjoining end face, with the adjoining end face forming a specified angle with the cylinder's centerline and the distal end face adapted to allow for the connection of the device to the free-end link, (b) a plurality of intermediate links, each in the form of a circular cylinder having end faces that form a specified angle with the links' centerline, and each of these intermediate links having a channel connecting their end faces, (c) a base link in the form of a circular cylinder having a base end face and an adjoining end face, with the adjoining end face forming a specified angle with the link's centerline and the base end face adapted to allow for the connection of the arm to a supporting surface, (d) a cable that passes through the link channels so that one cable end attaches to the free-end link and the other end

Abstract: A medical master/slave manipulator is excellent in operability and capable of reducing burden on the operator. The medical master/slave manipulator includes a master unit provided with an operation control portion, a slave unit provided with a working device, an interlocking mechanism interlocking the slave unit with the master unit, an orientation difference measuring mechanism for measuring the orientation difference between the orientation of the master unit and that of the slave unit, and a control mechanism for controlling the slave unit to adjust the orientation of the slave unit to that of the master unit so that the orientation difference is reduced to zero in a transient master/slave operation mode in which an operation mode changes from an unrestricted operation mode to a master/slave operation mode.

Abstract: An organ-stabilizing element is covered with a layer of textile material such as cloth to enhance slip-free engagement with an organ such as a beating heart during surgery thereon. The organ-stabilizing element is supported on a stacked structure of successive ball elements and rings that can be selectively flexible or rigid in response to tensioning of a flexible cable within a central bore of the structure.

Abstract: A malleable shaft device for use in surgical procedures, having a tension fiber therein, whereby the malleable shaft transitions from a malleable state to a rigid state when a force is applied to the tension fiber, has a variable-pitch cam operatively connected to the tension fiber, and a lever operatively connected to the variable pitch cam for applying force. The mechanical advantage of the cam changes with displacement to accommodate increasing load, and to increase the rate of travel while loads are light. The force profile may provide for a constant input force to accomplish the full travel of the cam.

Abstract: A first set of orange LEDs with a peak wavelength emission of about 612 nanometers, a second set of red light emitting LEDs with a peak wavelength of about 660 nanometers, and blue light LEDs. Two beam spreads, 15° and 30°, were provided for both the 660 nm LEDs and 612 nm LEDs. When directed perpendicularly upon tops of the plant leaves, 10% light transmission occurred through the leaves for the 30° LEDs, and 80% light transmission for the 15° LEDs. Thus, fully 50% of the orange/red spectrum primarily used for photosynthesis was transmitted through the upper leaf canopy, making it available to support photosynthesis in leaves below. LED lamps are positioned at varying distances from the growing plants for controlling plant growth rates that vary with these distances, thereby to control plant inventory, because growth of plants can be greatly slowed to preserve them during periods of slow sales.

Abstract: Stabilization devices, systems and methods for stabilizing tissue to perform a surgical operation while the heart of the patient continues to beat.

Abstract: Surgical methods and devices allow closed-chest surgery to be performed on a heart of a patient while the heart is beating. A region of the heart is stabilized by engaging a surface of the heart with a stabilizer without having to stop the heart. Motion of the target tissues is inhibited sufficiently to treat the target tissues with robotic surgical tools which move in response to inputs of a robotic system operator. A stabilizing surface of the stabilizer is coupled to a drive system to position the surface from outside the patient, preferably by actuators of the robotic servomechanism. Exemplary stabilizers includes a suture or other flexible tension member spanning between a pair of jointed bodies, allowing the member to occlude a coronary blood vessel and/or help stabilize the target region between the stabilizing surfaces.

Abstract: An improved stabilizer or retractor or other surgical tool having an elongated distal arm carrying a tissue-contacting mechanism at its distal end and a tensioning mechanism at its proximal end for locking functional components of the tool in a desired position or configuration. The tensioning mechanism is mounted to a turret or other structure attaching the distal arm to a base by means of a shorter, proximally extending flexible arm. The flexible proximal arm allows the tensioning mechanism to be moved relative to the base so that it can be placed more conveniently in the operative field.

Abstract: Stabilization devices, systems and methods for stabilizing tissue to perform a surgical operation while the heart of the patient continues to beat. A stabilization system including a tissue contact member having a surface adapted to contact the tissue and temporarily maintain the tissue in a relatively immobilized state; and a maneuverable arm attached to the tissue contact member, which includes at least one articulating joint formed by a link having a male articulating surface composed of angled teeth and a female articulating surface having angled trenches adapted to receive the angled teeth.

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: Apparatus and method for surgery is disclosed which includes a retractor having a substantially planar base defining an opening for overlying an operative site on a patient, and at least one retractor blade slidably mounted to the base. The base is positioned on the patient such that the opening therein overlies the operative site. The operative site is percutaneously accessed, and obstructing tissue is retracted by engaging the tissue with the retractor blade. A surgical instrument is provided which is engageable with the base and operable at the operative site through the opening in the base. A surgical procedure is carried out through the opening in the base with the surgical instrument.

Abstract: An instrument holder including a releasably lockable adjustable arm for rigidly maintaining a tool or instrument in a pre-selected orientation. The instrument holder also includes a tensioning device pivotally connected by a hinge to the arm. The arm includes a plurality of links longitudinally arranged along a common axis, wherein adjacent links are pivotally connected by a hinge, and a duct. A tensioning cable extending within the duct of the arm attaches to the distal end of the articulated arm and to the tensioning device, and applies a tension force to compress the hinges so as to rigidly lock the arm into the preset position.

Abstract: A surgical instrument includes a frame structure defining proximal and distal portions. The proximal portion has an articulating arm for repositionably mounting to a base and the distal portion supporting a stabilizing member. An attachment mounts on the stabilizing member, the attachment being configured and dimensioned such that upon contact with the heart the engaged heart tissue bulges outward. A method of surgery using the attachment includes providing a frame structure defining proximal and distal portions, the proximal portion being repositionably mountable to a base, supporting an attachment on the stabilizing member and engaging heart tissue with the attachment such that the tissue bulges outward to better present the tissue for 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 device, assesses the degree of movement of the anastomosis site, and exerts a force on the stabilizing device such that the contraction of the beating heart causes only minimal excess motion at the surgery site.

Abstract: Devices and methods are disclosed for accessing and stabilizing an unstable or moving tissue structure within a patient's body, and in particular, for temporarily stabilizing a target site on the beating heart. The devices generally involve tissue stabilizers having at least one multiple link support member operably connecting a stabilizer foot to a retractor. To minimize motion at the stabilizer foot and improve overall stabilization of the target site, the tissue stabilizer may involve the a stabilizer foot having multiple support members connected to the stabilizer foot at discreet locations. To improve the ability of an instrument support member to be easily articulated through an access incision to position the stabilizer foot as desired, the instrument support member may be operable associated with an attachment or mount which provides additional degrees of freedom at the connection to the retractor.

Abstract: A fastening mechanism of the present invention includes a docking unit partially disposed within a housing, the fastening mechanism capable of securing a docking pin attached to a retractor. The fastening mechanism is attached to a positioning arm and is capable of engaging the docking pin regardless of the position of the positioning arm.

Abstract: An improved stabilizer or retractor or other surgical tool having an elongated distal arm carrying a tissue-contacting mechanism at its distal end and a tensioning mechanism at its proximal end for locking functional components of the tool in a desired position or configuration. The tensioning mechanism is mounted to a turret or other structure attaching the distal arm to a base by means of a shorter, proximally extending flexible arm. The flexible proximal arm allows the tensioning mechanism to be moved relative to the base so that it can be placed more conveniently in the operative field.

Abstract: A mounting assembly for mounting a surgical instrument to a base, which facilitates positioning a surgical instrument relative to the surgical site so that only the minimum portion of the instrument is positioned in the free space available around the surgical site. A surgical instrument is also provided which includes a handle, a tool member, and a segmented flexible articulating arm which operatively connects the handle and the tool member. Also provided is an instrumentation kit having a surgical instrument which includes an end effector connecting assembly disposed at the distal end portion of arm articulating arm to facilitate the removal or attachment of and end effector from the distal end of the articulating arm. The surgical instrumentation kit also includes a number of interchangeable surgical tool end effectors each having a uniform connector portion for interchangeable engagement with the end effector connecting assembly of the surgical instrument.

Abstract: An articulated arm for holding surgical instruments, having elongated arm members; rotational joints connecting the arm members end to end, such that members are pivotable about the joints and at least one of the joints is selectively lockable by fluid pressure; and a plurality of tubes communicating fluid pressure between two adjacent joints. When two adjacent members are pivoted relative to one another, the tubes connecting a particular pair of joints remains substantially stationary with respect to the arm member connecting that pair of joints.

Abstract: Devices and methods are disclosed for accessing and stabilizing an unstable or moving tissue structure within a patient's body, and in particular, for temporarily stabilizing a target site on the beating heart. The devices generally involve tissue stabilizers having at least one multiple link support member operably connecting a stabilizer foot to a retractor. To minimize motion at the stabilizer foot and improve overall stabilization of the target site, the tissue stabilizer may involve the a stabilizer foot having multiple support members connected to the stabilizer foot at discreet locations. To improve the ability of an instrument support member to be easily articulated through an access incision to position the stabilizer foot as desired, the instrument support member may be operable associated with an attachment or mount which provides additional degrees of freedom at the connection to the retractor.

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 mounting assembly for mounting a surgical instrument to a base, which facilitates positioning a surgical instrument relative to the surgical site so that only the minimum portion of the instrument is positioned in the free space available around the surgical site. A surgical instrument is also provided which includes a handle, a tool member, and a segmented flexible articulating arm which operatively connects the handle and the tool member. Also provided is an instrumentation kit having a surgical instrument which includes an end effector connecting assembly disposed at the distal end portion of an articulating arm to facilitate the removal or attachment of and end effector from the distal end of the articulating arm. The surgical instrumentation kit also includes a number of interchangeable surgical tool end effectors each having a uniform connector portion for interchangeable engagement with the end effector connecting assembly of the surgical instrument.

Abstract: A segmented arm support system and method for attachment to a surgical retractor includes an arm having a plurality of segments which can be joined together in frictional, locking engagement. In an unlocked state, the flexible arm can be manually positioned and the stabilization device placed over a localized area of tissue. Upon tightening of a cable running through the segments, the segments are brought together in frictional engagement. Each segment has a convex outer wall and a concave inner surface for attachment to adjacent segments. The segments are constructed of a stainless steel substrate material and coated with a high friction plating material to permit frictional engagement of the segments, thereby allowing for adequate tightening and locking of the arm.

Abstract: The invention disclosed herein relates to a multipositional ratchet device for use in conjunction with a surgical retractor assembly. The ratchet device of the invention permits both independent and simultaneous adjustment of the longitudinal axial positioning of a retractor blade stem relative to the device as well as the vertical tilt position of the retractor blade. Furthermore, the device is structured with the adjustment tabs positioned to permit the aforementioned adjustments using continuously maintained finger contact on the tabs using a single hand. The device affords the user improved ergonomics and accuracy of use by virtue of its structural and functional features.

Abstract: A probe position sensing system for accurately determining a spatial location in a coordinate system of a distal end of a probe assembly. The probe assembly includes an articulated arm having a pair of sections interconnected by a flexible joint and at least one element. The element extends through the joint and is positioned to be subjected to a degree of flexure due to relative displacement of the sections. A flexure of the element induces a change in a physical property associated with the element. An instrument monitors the physical property and derives an angle between adjacent sections from variations of the physical property.

Abstract: A surgical system or assembly for performing cardiac surgery includes a surgical instrument; a servo-mechanical system engaged to the surgical instrument for operating the surgical instrument; and an attachment assembly for removing at least one degree of movement from a moving surgical cardiac worksite to produce a resultant surgical cardiac worksite. The surgical system or assembly also includes a motion tracking system for gathering movement information on a resultant surgical cardiac worksite. A control computer is engaged to the attachment assembly and to the motion tracking system and to the servo-mechanical system for controlling movement of the attachment assembly and for feeding gathered information to the servo-mechanical system for moving the surgical instrument in unison with the resultant surgical cardiac worksite such that a relative position of the moving surgical instrument with respect to the resultant surgical cardiac worksite is generally constant.

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: Surgical methods and devices allow closed-chest surgery to be performed on a heart of a patient while the heart is beating. A region of the heart is stabilized by engaging a surface of the heart with a stabilizer without having to stop the heart. Motion of the target tissues is inhibited sufficiently to treat the target tissues with robotic surgical tools which move in response to inputs of a robotic system operator. A stabilizing surface of the stabilizer is coupled to a drive system to position the surface from outside the patient, preferably by actuators of the robotic servomechanism. Exemplary stabilizers includes a suture or other flexible tension member spanning between a pair of jointed bodies, allowing the member to occlude a coronary blood vessel and/or help stabilize the target region between the stabilizing surfaces.

Abstract: A system for manipulating and supporting a beating heart during cardiac surgery, including a gross support element for engaging and supporting the heart (the gross support element preferably including a head which is sized and shaped to cradle the myocardium of the left ventricle), a suspension head configured to exert lifting force on the heart when positioned near the apical region of the heart at a position at least partially overlying the right ventricle, and a releasable attachment element for releasably attaching at least one of the gross support element and the suspension head to the heart. The releasable attachment element can be a mechanical element (such as one or more staples or sutures) or an adhesive such as glue. Alternatively, the system includes a suspension head and a releasable attachment element for releasably attaching it to the heart, but does not include a gross support element.

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: A stabilizer for use in surgical procedures such as coronary bypass surgery includes an elongate, rigid handle, a neck at the end of the handle, a base leg connected to the end of the neck, and first and second spaced, generally flat fingers that are disposed generally parallel with each other and which lie in a plane disposed at an angle from the longitudinal axis of the handle. The fingers can be used to press against the surface of the heart to stabilize it during surgery. In another embodiment, the handle is in the form of a flexible member that can be adjusted in a variety of positions. In either embodiment, the attachment between the fingers and the heart can be enhanced by providing serrations for the underside of the fingers, or by making the fingers hollow and forming a plurality of openings in the underside of the fingers in order to apply a vacuum to the underside of the fingers.

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 retractor blade is attached to a ratchet handle with a ball and socket joint to move with more than one degree of freedom. The surgical retractor blade can be removably attached to the handle through either a slot on the handle or a clamping mechanism attached to the handle by the ball and socket joint. In the case of the slot, the surgical retractor blade has a shaft with a first diameter narrower than the slot and a second diameter wider than the slot. The blade is turned one way for attachment and removal and another way to secure it to the handle for use.

Abstract: A system for manipulating a heart during cardiac surgery permits coronary surgery on a beating heart while maintaining cardiac output unabated and uninterrupted. Circumflex coronary artery surgery can be performed using the system. The system 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. A special suction cup is used which accommodates multiplanar movement of the heart and the myocardium while also preventing heart tissue from interrupting the suction being applied to the heart. One form of the system can be used in minimally invasive 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 only minimal excess motion at the surgery site.

Abstract: An articulation member for use in a surgical apparatus is provided. The articulation member includes a fitting for mounting to a support structure, a socket for receiving an arm of a surgical tool and a clamp moveable between a loosened position and a tightened position. In the loosened position the clamp permits movement between the fitting and the support structure, and permits rotation of the socket. In the tightened position, the clamp secures the fitting and the arm relative to the support structure.

Abstract: A surgical instrument includes a frame structure defining proximal and distal portions. The proximal portion has an articulating arm for repositionably mounting to a base and the distal portion supporting a stabilizing member. An attachment mounts on the stabilizing member, the attachment being configured and dimensioned such that upon contact with the heart the engaged heart tissue bulges outward. A method of surgery using the attachment includes providing a frame structure defining proximal and distal portions, the proximal portion being repositionably mountable to a base, supporting an attachment on the stabilizng member and engaging heart tissue with the attachment such that the tissue bulges outward to better present the tissue for surgery.

Abstract: Surgical apparatus for coronary surgery of a patient comprising contacting means being capable of providing a mechanical force against at least a portion of the patient's coronary organs according to its positioning with regard to said organs, positioning means to set said contacting means in a given substantially stable spatial position and orientation within a given volume, said contacting means being pivotally connected to a sternum retractor via said positioning means. The surgical apparatus according to the invention allows to perform coronary artery revascularization without the need for extra-corporeal circulation.

Abstract: Apparatus and method for surgery is disclosed which includes a retractor having a substantially planar base defining an opening for overlying an operative site on a patient, and at least one retractor blade slidably mounted to the base. The base is positioned on the patient such that the opening therein overlies the operative site. The operative site is percutaneously accessed, and obstructing tissue is retracted by engaging the tissue with the retractor blade. A surgical instrument is provided which is engageable with the base and operable at the operative site through the opening in the base. A surgical procedure is carried out through the opening in the base with the surgical instrument.

Abstract: A mounting assembly for mounting a surgical instrument to a base, which facilitates positioning a surgical instrument relative to the surgical site so that only the minimum portion of the instrument is positioned in the free space available around the surgical site. A surgical instrument is also provided which includes a handle, a tool member, and a segmented flexible articulating arm which operatively connects the handle and the tool member. Also provided is an instrumentation kit having a surgical instrument which includes an end effector connecting assembly disposed at the distal end portion of an articulating arm to facilitate the removal or attachment of and end effector from the distal end of the articulating arm. The surgical instrumentation kit also includes a number of interchangeable surgical tool end effectors each having a uniform connector portion for interchangeable engagement with the end effector connecting assembly of the surgical instrument.