Abstract: A surgical instrument for holding a piece of tissue in a configuration of an open circulatory system valve to facilitate surgical attachment of the tissue to the patient's valve annulus. The instrument includes an inner member having a handle portion at one end and an inner tissue holding portion at the opposite end. The inner tissue holding portion includes one or more of inner leaves. An outer member disposed about the inner member includes an outer tissue holding portion having one or more of outer leaves that are complementary and can be engaged with the inner leaves. A collet or other actuator moves the outer leaves radially inward and outward with respect to the inner leaves. The outer leaves are separated from the inner leaves to allow placement of the tissue on the inner leaves. The outer leaves are then moved radially inward to hold the tissue between the leaves in a configuration of one or more leaflets of an open circulatory system valve to facilitate surgical attachment.

Abstract: A method for tensioning incisions made in a target vessel during an anastomosis procedure is provided. After an incision is made in a target vessel, incision tensioners are placed within the incision in order to tension the incision. The incision is tensioned when the incision tensioners are pulled taut in order to stretch the incision to a predetermined length or a predetermined force. The tensioners allow for proper grafting of a graft vessel to the target vessel in an end to side anastomosis. In addition, the incision tensioners allow the incision to have a known geometry, thereby allowing precise grafting of the graft vessel to the target vessel during the anastomosis procedure. After the incision is tensioned, the graft vessel is grafted to the target vessel using clips, sutures, staples or other anastomosis devices. One example of anastomosis clips are configured to capture the graft vessel and the target vessel such that the graft vessel grafts with the target vessel.

Abstract: An external tissue expansion device applies constant continuous low grade force to skin to obtain additional tension free skin and subcutaneous tissue prior to a surgical procedure. The device consists of two suture plates each being laminated structure of steel and an adhesive attached foam cushion. On the each end of one suture plate is a housing that contains a constant force spring placed over a post. The ends of the constant force spring protrude from the housing and there is a hook attached to the end of the constant force spring. On each end of the other suture plate there is a housing, with a opening that can accept the hook of the opposite suture plate. These suture plates are constructed so that they can be manually shaped to conform to the topography of the body part to be corrected and are attached to skin near the defect to be corrected prior to a surgical procedure.

Abstract: A bipolar electrosurgical instrument has first and second clamp members, each comprising an electrically conductive clamping surface, a clamp support and an intermediate electrically insulative spacing layer for joining the clamping surface to the blade support. The first and second clamp members are pivotally joined such that the respective clamping surfaces of each of the first and second clamp members are in facing relation and define a space between the first and second clamp member for capturing tissue. The instrument regulates the space between the first and second clamp member such that only a certain amount of tissue may be captured. The instrument further includes a mechanism for applying a voltage between the metal clamp supports of the first and second clamp members to coaptate the captured tissue.

Abstract: An improved surgical stapler for closing wounds, having an approximation device connected to a side of the surgical stapler. The approximation device is a hook positioned adjacent the stapled ejection port and is adapted to grip one side of a wound and enable the operator to temporarily close the wound, while precisely positioning the staple ejection port over the closed wound. Subsequent actuation of the stapler causes the wound to be precisely stapled closed. In an alternative embodiment, the approximation device is integrally formed from one leg of a surgical staple, and provides an asymmetric staple configuration. The longer staple leg is designed with a hook end. When the stapler is partially actuated, the staple legs partially protrude from the staple ejection port, and the longer staple leg can engage the skin on one side of a wound, and enable the temporary closing of the wound for accurate positioning.

Abstract: A suture needle guide and a method of use therefor. A suture needle guide comprises a needle guide member connected to a manually-graspable handle. The needle guide member is inserted, via an arteriotomy, into the lumen of a host blood vessel. The needle guide member includes a portion which is shaped to guide a suture needle so that anastomosis can be more accurately and easily performed, compared to free-handed suturing.

Abstract: An assembly for holding a substantially flexible suture guide of predetermined length in a substantially taut position used to achieve a suture line having a dimension equal to the length of the suture guide, such as the circumference about a heart valve annulus. The assembly includes a rigid suture guide holder having a surface against which the length of suture guide is releasably positioned. The guide holder can have a shape or geometry, such as a circumference or circumferential segment, equivalent to the shape or geometry of the intended suture line. The shape of the guide holder can therefore be selected to hold the suture guide in the shape most advantageous to placing the desired suture line.

Abstract: Apparatus and method are described for selective cutting of the transverse carpal ligament of a patient. The instrument includes spaced-apart teeth which are supported on a first arm and a press member which is carried by a second arm. The teeth are prevented from contacting tissue when the first arm is inserted into, or retracted from, the carpal tunnel. After insertion of the first arm into the carpal tunnel, the teeth are exposed to the transverse carpal ligament and the first and second arms are moved towards each other to force the teeth into the transverse carpal ligament to perforate the ligament and enable it to elongate.

Abstract: A trocar gripper with means for facilitating suturing of an insertion site thereof. The gripper includes a tubular housing provided with gripping structure for gripping a trocar guide tube. The housing is also provided with structure for fixing the axial position of the housing within an incision in a patient. A pair of opposed openings are formed through the tubular wall of the housing into the axial bore thereof. A plug is provided which may be inserted the axial bore of the housing, and fixed in place by the gripping structure of the housing. The plug is provided with an elastomeric seal which engages the surface of the axial bore through the housing. Radially outwardly extending lugs are formed on a second end of the plug. The plug is provided with a pair of opposed, longitudinally extending recesses formed in the outer surface thereof. Each recess extends from the second end of the plug to a point adjacent the associated opening through the wall of the housing.

Abstract: An apparatus for closing wide skin defects may be used with two long interdermal needles configured for insertion underneath skin close to margins of a skin defect. The skin closing apparatus may include two U-shaped retaining members configured as a flange connecting two legs and forming a U-shaped profile. Each of the legs may include a sharp hook at the end of the leg adapted for piercing the skin and engaging one of the long interdermal needles. Each retaining member may include a pivoting platform that pivots up to 20.degree. from an initial position indicated by a detent mechanism. A contracting mechanism such as a screw may connect the retaining members and approximate the interdermal needles, while bringing the skin margins together until final closure of the skin defect results. The skin closing apparatus may also include a clutch mechanism configured to disengage the screw from a knob or handle, when a predetermined force is met or exceeded.

Abstract: Disposable approximator for approaching nerve-endings particularly to facilitate sewing and replacement of injured nerves. The disposable approximator according to the invention comprises surgical metal hooks (3) known in the artwork. The approximator has a sliding leg (1) made of a synthetic material suitable for sanitary and surgical purposes. One surface thereof is designed with a structural formation allowing unidirectional displacement. At the end of the sliding leg (1) lying in direction of motion a fixed carrier-console (2) is arranged, into which one or more surgical metal hooks (3) are built-in that their ends are facing the direction of motion. Onto the sliding leg (1) a slide (4) is arranged, movable towards the fixed carrier-console (2), with a clearance enabling displacement. One or more surgical hooks (3) are built-in into the slide (4) so that their ends are facing the fixed carrier-console (2).

Abstract: This invention comprises an instrument for peritoneal approximation following the application of mesh in a laparoscopic herniorrhaphy or for approximating any tissues that could physically reach each other during the performance of any laparoscopic procedure. The Maritsa Tissue Approximator comprises an elongated cylinder which is divided into two elongated compartments by a central plate which extends outwardly from the bottom of the cylinder. The head of the instrument comprises the outwardly extending fixed plate and two independently controlled jaws which close separately over the fixed central plate. The jaws are pivotally mounted onto a lateral extension of the center plate by pin-means about which they rotate thus opening or closing over the fixed central plate. The rotation about the pin is caused by a control wire which extends through a compartment of the cylinder and is affixed to a pivotal member at the other end of the instrument.

Abstract: A method and apparatus for applying optical or other thermal energy to tissue using a clamp. The energy is supplied at a frequency which biologically welds or fuses tissue. A material that is transmissive to the energy treatment frequency is embedded in one or more jaws of the clamp and engage the tissue during the tissue fusion process. The transmissive material has a thickness selected to insure that the energy source is spaced at the proper distance from the tissue so that the tissue receives the proper amount of energy for sealing. The transmissive material holds the tissue in the jaw to maintain the edges of the tissue in tight approximation. The energy may be coupled to the clamp by one or more optical fibers. These fibers are recessed in or placed adjacent to the jaw at a specified distance from the surface of the transmissive material and directs treatment energy through the transmissive material to weld the edges of the tissue together.

Abstract: An assembly for holding a substantially flexible suture guide of predetermined length in a substantially taut position used to achieve a suture line having a dimension equal to the length of the suture guide, such as the circumference about a heart valve annulus. The assembly includes a rigid suture guide holder having a surface against which the length of suture guide is releasably positioned. The guide holder can have a shape or geometry, such as a circumference or circumferential segment, equivalent to the shape or geometry of the intended suture line. The shape of the guide holder can therefore be selected to hold the suture guide in the shape most advantageous to placing the desired suture line.

Abstract: A transanal insertion device for surgically inserting an anastomosis ring having two unitary members into a tubular anatomic member comprises a distal adapter, a proximal adapter and an actuator. The distal adapter includes a hollow distal sleeve and a spring-loaded distal spool axially movable within the distal sleeve. The distal spool is biased in a first direction by a distal spring and includes alignment fingers pivotably connected thereon for aligning a first unitary member. The proximal adapter has a hollow proximal sleeve and a spring-loaded proximal spool axially movable within the proximal sleeve. The proximal spool is biased in a second direction by a proximal spring and includes alignment fingers connected thereon for aligning a second unitary member. The proximal member also includes a proximal gripper for securing the second unitary member on the proximal hollow sleeve.

Abstract: A method for use in performing an anastomosis includes the steps of juxtaposing free ends of two sections of a ressected tubular organ of a patient so as to form a continuous lumen through the sections, placing a strip of a biocompatible material over the sections along a seam therebetween, and bonding the strip to outer surfaces of the sections so as to form a seal about the sections at the seam. The juxtaposition of the organ sections is facilitated by inserting an inflatable balloon made of bioabsorbable material into the sections at their free ends, inflating the ballon and pulling the sections over the inflated balloon.

Abstract: A tendon approximator employs two connected, normally closed clamps, which are each formed from two extruded elements. The two extruded elements are connected together in their mid-region by means of non-circular cam on a base element and a corresponding non-circular cam surface on a clamping element. In the normally closed position of the individual clamps, the cam and cam surface urge the device into a jaw-closed position with the handles being spaced apart. In a preferred embodiment two of the clamps are connected by means of rods extending through corresponding handle portions of the two clamps.

Abstract: An improved, disposable, inexpensive vessel holder suitable for use in coronary artery surgery for impaling the cut end of a vessel graft on three sharpened wire prongs, two if that can be made to extend laterally for holding the cut end of the graft in an open position for suturing to the obstructed coronary artery, is disclosed.

Abstract: A vessel approximator for use in anastomosis has a pair of opposed arms, each adapted to fit within the end of a vessel segment to be anastomosed. The tips of the arms are tapered to assist in placing an end of a vessel segment onto the arm. A stem extends from the junction of the arms to form a T shape. The stem is substantially thinner than the arms to permit the ends of the vessel segments placed over the arms to be proximate to each other to be sutured together. A ring on the end of the stem allows the device to be sutered in place in the surgical field. A notch at the junction of the arms opposite the stem permits the arms to collapse together when the device is removed from the vessel segments by pulling on the stem.

Abstract: An anastomosis device for interconnecting the ends of two tubular organs has, in a preferred embodiment, two circular members, each member having an outer region engagable against the contact surface of the outer region of the other member. When so engaged, both members are concentrically disposed about a common axis. Both members also have an inner region disposed concentrically within the outer region and including a concentric opening for receiving the end of a tubular organ. Both members also have a series of pins mounted in the inner region, disposed around the periphery of the opening and nearly parallel to the common axis so that the exposed ends of the pins approximately define a plane, for holding the ends of the tubular organ inserted into concentric opening.