Abstract: The invention provides a separating tool for undoing adhesion between a vessel, such as a blood vessel or cystic duct, and another tissue or peeling off a serous membrane.

Abstract: An apparatus is described for treating arterial occlusions combining an intraluminally operable catheter, having an occlusion-crossing working element, with a micro-invasive extraluminally operable locator for imaging the progress of the working element through the occlusion. Conical, abrasive, blunt-dissecting, and sharp-pointed, and steering and non-steering working elements including guide wires are described. Acoustic transducers and a flexible imaging tube are described for the locator. A suction cup is described for removably anchoring the imaging tube to a surface. A signal-emitting working element and cooperating signal-receiving locator are described. A method for treating arterial occlusions is described.

Abstract: A cannula includes a tubular body having a proximal end and distal blunt end, at least one lumen extending the length of the body, an endoscope having a lighted, viewing end disposed in the lumen near the distal end of the body, and a transparent, tissue-separating tip substantially covering the distal end of the body. The tissue-separating tip is slightly blunted to inhibit avulsion of tissue and lateral vessels along the dissected cavity formed thereby. Endoscopic viewing through the tip is enhanced by tapering the inner walls thereof to a cusp adjacent the blunt tip in order to reduce visual distortion. Alternatively, a cannula includes a dissection probe and a removable or deflectable tip for exposing the probe and endoscope to facilitate viewing and the dissection of connective tissue and lateral vessels along the dissected cavity. Methods of using such cannulas produce an elongated cavity along the course of a blood vessel for subsequent harvesting or other treatment of the isolated blood vessel.

Abstract: A back-up retention member drainage catheter (10) for insertion in the bladder and urethra of a patient undergoing a radical prostatectomy surgical procedure. The drainage catheter includes an elongated tubular member (11) having a drainage lumen (14) extending longitudinally therein with an external drainage port (15, 16) disposed near the distal end (12) of the tubular member. A back-up retention member (18) and, in particular, a first balloon (20) is disposed on the elongated tubular member near the distal end and proximal the external drainage port. A primary retention member (19) and, in particular, a second retention balloon (22) is also disposed on the elongated tubular member around the first retention balloon. First and second inflation lumens (21, 23) extend longitudinally through the elongated tubular member and communicate internally with the first and second retention balloons, respectively.

Abstract: A surgical instrument is provided for performing surgery to relieve the symptoms of carpal tunnel syndrome. The surgical instrument includes a pair of pivotally connected legs with each leg including a handle portion and a blade portion with the blade portions terminating in a nose. The nose is inserted through an incision in the wrist area and progressively “worked” into an area between the transverse carpal ligament. The surgical instrument is rotated approximately 90 degrees and the handle portions are then squeezed to spread the blade portions to create a surgical area fully exposing the transverse carpal ligament. One of the blade portions carries illuminating means for illuminating the surgical area or arena to assure that only the transverse carpal ligament is severed to prevent damage to the median nerve, tendons and the like passing through the carpal tunnel.

Abstract: A surgical dissecting retractor for harvesting vascular conduits or vessels such as saphenous veins and the like is disclosed which dissects tissue and top and/or side branches from the vessel as it is advanced along a desired segment of the vessel via an entry incision in a patient's skin. The dissecting retractor is inserted while in a closed or “low profile” position to minimize trauma to the vessel and patient. Once installed above the vessel, the retractor is opened and locked to present a relatively “high profile”, thereby creating and maintaining an enlarged working space or tunnel in the region between the skin and the vessel being harvested. Completion of the vessel harvesting procedure proceeds with suitable surgical instruments for dissecting, ligating, cauterizing and/or clipping, with or without visualizing devices which comprise further adjunct features of the retractors in accordance with the invention.

Abstract: Mechanical retractors for bluntly dissecting tissue at a remote surgical site include extendable elements disposed near the distal end of an elongated cannula body with direct mechanical linkage to manual actuators disposed near the proximal end of the cannula body. Individual extendable elements may be arranged in symmetrical or asymmetrical configurations about the central axis of the body for selectively bluntly dissecting bodily tissue in patterns of greater diversity than merely omni-radially as provided by conventional pressurizable balloon tip cannulas.

Abstract: A cannula includes a tubular body having proximal closed end and distal blunt end, at least one lumen extending the length of the body, an endoscope having a lighted, viewing end disposed in the lumen near the distal end of the body, and a transparent, tissue separating member substantially covering the distal end of the body. The tissue separating member has a blunt tip disposed from and of the end distal to the body. A method of using such a cannula separates tissue to form an elongated cavity along the course of a small blood vessel and subsequently harvesting the blood vessel.

Abstract: A device useful in minimally-invasive procedures involving the visualization, dissection and/or harvesting of vessels in the body includes a shaft having a handle mounted on one end and a dissecting tip on the other end. The dissecting tip optionally includes a light source for directing light transverse of the tip and structures to retain the tip in position adjacent the vessel as the tip is advanced along the vessel. Also disclosed are associated methods for transilluminating a vessel, dissecting the vessel from surrounding tissue, and transecting the vessel and side branches and removing the vessel from the body.

Abstract: A fluid operated retractor for use in surgery. The retractor has a portion which is expandable upon the introduction of fluid under pressure. The expandable portion is made of a material strong enough, and is inflated to enough pressure, to spread adjoining tissues within the body. The retractor is especially useful in fiber optic surgery because it can be inserted percutaneously through a small opening then expanded to a much larger dimension when in the desired location, to retract tissue from within. The retractor may be used to spread a joint such as a knee joint or a shoulder joint, or may be used to separate tissue planes generally, to improve visualization and create a working space for the surgeon.

Abstract: A dissector/retractor device comprising a balloon having a deflated state and an inflated state is described for performing minimally invasive surgical procedures by creating a tunnel alongside a target tissue in the body. The balloon in its inflated state forms an open space extending transversely through the balloon. The balloon is carried by an insertion assembly. The balloon may be an elongate torus shape with an elongate open area in its interior. The insertion assembly includes a blunt dissection device and a handle. In use, the dissector retractor is inserted through a small incision and bluntly tunneled through body tissue to a desired location. The balloon is inflated to create a space in the body tissue and may also dissect tissue as necessary away from the tissue to be treated. The balloon is left in place inflated to retract the space. Another incision may be made to provide more direct access to the target tissue than the original incision.

Abstract: An improved laparoscopic apparatus for tunneling to a desired anatomical location and developing a surgical space is disclosed, including a tunneling member adapted to receive a laparoscope therein and an inflatable balloon secured on the tunneling member. The tunneling member has a passage extending between its open proximal and distal ends. A lip is integrally formed on the distal end to retain a laparoscope inserted into the passage, the lip having a substantially rounded and blunt distal edge. The lip defines a recessed or open center area in the distal opening, enhancing the field of view of the laparoscope therethrough. The balloon is formed from flexible, transparent material, and is rolled and secured to the tunneling member.

Abstract: Grasping devices and articles exhibit enhanced gripping or holding power to a variety of surfaces, including surfaces that are slippery or otherwise difficult to hold. The invention involves in some aspects the discovery and use of gripping materials that have the unexpected enhanced capability to provide enhanced holding power to a variety of surfaces, including surfaces that are wet, slippery or otherwise potentially difficult to manipulate effectively, or surfaces on which it may be difficult to maintain an effective grip or traction. The gripping material is smooth and has a relative surface area roughness of between about 1.03 and about 10.5.

Abstract: The present invention provides a self-expanding stent delivery system comprising a catheter, a self-expanding stent having a plurality of interconnected expansion cells therein and concentrically arranged around the catheter near the distal end of the catheter, a retractable sheath for covering the stent constructed and arranged for retraction to release the stent to self-expand, and a stent holder abutting the stent for holding the stent in place until the retractable sheath is fully retracted. During retraction of the retractable cover, the stent holder prevents the stent from substantially moving longitudinally until the retractable sheath has been completely removed from the stent.

Abstract: A pneumatic tissue dissector 10 useful for cutting or dissecting living tissue during endoscopic or laparoscopic procedures includes a dissector tip 16 for exuding a flow of pressurized gas, an inlet arrangement 24 for controlling the flow of gas from the tip 16, and an exhaust system 30 for exhausting the gas exuded from the tip 16. The exhaust system includes an inlet 32 adjacent to the tip 16 and an outlet spaced from the inlet 32. The outlet 34 is operable in coordination with the inlet arrangement 24 and is capable of exhausting a flow of gas about equal to that exuded by the tip 16, ensuring that the pressure in the cavity in which the procedure is performed does not increase or fluctuate. The flow of pressurized gas from the tip 16 is preferably compatible with an insufflation cavity pressure of no more than about 15 mm Hg, and the inlet arrangement 24 preferably supplies gas to the tip 16 at a pressure of no more than about 50 psi.

Abstract: A surgical instrument is configured to aid in performing a procedure of detaching an internal mammary artery (IMA) and the like, from the connecting tissues and side branch vessels which surround the artery in its native location, wherein the detaching procedure is preliminary to the performing of a coronary artery bypass grafting procedure and wherein the IMA is detached via a minimally invasive thoracotomy. To this end, an elongated slender rod includes a handle at its proximal end and an artery engaging loop, arc, fork configuration, or hook at its distal working end. Embodiments may incorporate electrosurgical capability or electrical insulation. A surgeon thus has means for harvesting an intact and undamaged graft vessel from its native location through a minimally invasive incision with enhanced speed, visibility, and freedom of motion.

Abstract: A fluid operated retractor for use in surgery. The retractor has a portion that is expandable upon the introduction of fluid under pressure. The expandable portion is made of a material strong enough, and is inflated to enough pressure, to spread adjoining tissues within the body. The retractor is especially useful in fiber optic surgery because it can be inserted percutaneously through a small opening then expanded to a much larger dimension when in the desired location, to retract tissue from within. The retractor may be used to spread a joint such as a knee joint or a shoulder joint, or may be used to separate tissue planes generally to spread a joint such as a knee joint or a should joint or may be used to separate tissue planes generally, to improve visualization and create a working space for the surgeon.

Abstract: The lacrimal probe 1 of the present invention comprising a tubular narrow holding member 2, and rods 3a, 3b which extend coaxially from both ends of the narrow holding member 2, being narrower than the narrow holding member 2. As a result, a lacrimal probe which is convenient to use, does not cause false ducts, and is difficult to bend, is obtained.

Abstract: A system for evulsing subcutaneous tissue includes an endoscope adapted to be inserted into subcutaneous tissue through a skin cut portion to observe tissue to be evulsed and existing under the skin, a dissecting unit adapted to be inserted into the subcutaneous tissue through the skin cut portion so as to dissect the tissue, to be evulsed, from surrounding tissue in order to form a adapted cavity along the tissue to be evulsed and below the skin, a cavity maintaining unit adapted to be inserted from the skin cut portion into the cavity formed by the dissecting unit and to be retained in the cavity in order to maintain, around the tissue to be evulsed, a treatment space which permits the endoscope to be inserted and removed and which enables treatment of the tissue to be evulsed, and at least one treatment tool adapted to be inserted into the treatment space maintained by the cavity maintaining unit in order to perform, in the treatment space, treatment required to evulse the tissue to be evulsed.

Abstract: Methods and devices for harvesting blood vessels using balloons to dissect and mobilize the blood vessel from surrounding tissue are disclosed. A tunnel is created over the blood vessel. The tunnel is insufflated. A balloon dissector is inflated over the blood vessel. Side branches are then ligated and divided from the blood vessel. In a further aspect of the invention, the balloon may be an everting balloon which, upon inflation, advances along the blood vessel and envelops the blood vessel.

Abstract: The present invention is directed to a plug for insertion into a distal end of a ligating unit including an aspiration cylinder coupled to a distal end of an endoscope. The plug comprises a mounting portion sized to fit within an opening formed in a distal end of the aspiration cylinder and a protruding portion extending away from the mounting portion to project distally from the aspiration cylinder when the insertion plug is mounted in the aspiration cylinder.

Abstract: Methods and devices for harvesting veins from the body. The methods and devices allow vein harvesting using laparoscopic procedures. A working space is created over the vein using standard laparoscopic procedures and a side-hooked wire is inserted into the working space and twisted to insert the side-hook under the vein. The wire is then pulled or drawn along the vein to separate the vein from the surrounding tissue. In an alternative embodiment, vein separation is accomplished by threading a soft rubber tube under the vein, grasping the ends of the tube so as to surround the vein, and then pulling the tube along the vein. In other embodiments, the working space is created with everting balloons.

Abstract: A method for surgical dissection, sizing and for expansion of a tissue pocket in a naturally occurring fascial cleft for use in plastic surgery applications and other applications where it is desirable to dissect an anatomically defined and bounded tissue pocket, determine the appropriate size of a prosthesis to be implanted into the tissue pocket and, if necessary, further expand the tissue overlying the tissue pocket. An inflatable device which performs the three distinct functions of dissection, sizing and tissue expansion is used. In a preferred method, a dissecting balloon device is tunneled bluntly to a desired location within a fascial cleft in the female breast. The device is then inflated to dissect tissue layers adjacent the fascial cleft until ligaments defining boundaries of the fascial cleft are reached, to create a tissue pocket extending to the ligamentous boundaries.

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: A laparoscopic technique for harvesting the inferior epigastric artery and removing it from the body. The harvested inferior epigastric artery may be used as a bypass graft in a coronary or peripheral bypass operation.

Abstract: A endoscopic device provides improvements in the endoscopic working space by the use of a semi-tubular hood with an arched top wall and self-supporting walls that allow simultaneous manipulations of dissection, cutting, ligation, and retraction, and the like, without requiring constant application of external force; while enhancing visualization and reducing the need for cleaning the endoscopic lens.

Abstract: A retractor for use in arthroscopic surgery. The retractor has a mechanical expanding portion for expanding against sub-surface tissues when the retractor is in use. The retractor also has a fluid-operated expanding portion, which may be independently controllable, for expanding against sub-surface tissues when the retractor is in use. The retractor is inserted through a small percutaneous opening, expanded in sub-surface tissues without significantly damaging the tissue, then collapsed after use for removal. The retractor can be manipulated to allow the surgeon to push or pull or lever on tissue. The retractor can be hollow like a cannula to permit the passage of one or more surgical devices through the retractor, with a side portal into the center of the retractor.

Abstract: A cannula includes a tubular body having proximal closed end and distal blunt end, at least one lumen extending the length of the body, an endoscope having a lighted, viewing end disposed in the lumen near the distal end of the body, and a transparent, tissue separating member substantially covering the distal end of the body. The tissue separating member has a blunt tip disposed from and of the end distal to the body. A method of using such a cannula separates tissue to form an elongated cavity along the course of a small blood vessel and subsequently harvesting the blood vessel.

Abstract: A 360.degree. dissection instrument and method for accomplishing an atraumatic blunt dissection of connective tissues in 360.degree. around the circumference of a saphenous vein and branch veins to facilitate a minimally invasive harvesting of the vein. The 360.degree. pulsable dissector has an elongate body with a distal dissecting surface that is progressively "circumferential" or "wrapped" around an axial vessel-receiving passageway or channel. The dissecting surface includes a longitudinal gap that has a reduced transverse dimension in the proximal direction to funnel branch veins through the gap. The wrapped dissecting surface includes an "active" periphery incorporating a pulsable expansion structure of elastomeric material having and interior pressurizable chamber. An inflation lumen in the dissector body communicates with a pressure source and a pulse-control mechanism.

Abstract: Mechanical retractors for bluntly dissecting tissue at a remote surgical site include extendable element disposed near the distal end of an elongated cannula body with direct mechanical linkage to manual actuators disposed near the proximal end of the cannula body. Individual extendable elements may be arranged in symmetrical or asymmetrical configurations about the central axis of the body for selectively bluntly dissecting bodily tissue in patterns of greater diversity than merely omni-radially as provided by conventional pressurizable balloon tip cannulas.

Abstract: An improved laparoscopic apparatus for tunneling to a desired anatomical location and developing a surgical space is disclosed, including a tunneling member adapted to receive a laparoscope therein and an inflatable balloon secured on the tunneling member. The tunneling member has a passage extending between its open proximal and distal ends. A lip is integrally formed on the distal end to retain a laparoscope inserted into the passage, the lip having a substantially rounded and blunt distal edge. The lip defines a recessed or open center area in the distal opening, enhancing the field of view of the laparoscope therethrough. The balloon is formed from flexible, transparent material, and is rolled and secured to the tunneling member.

Abstract: The present invention provides balloon dissection apparatus and methods of use in which an elongate balloon is utilized to dissect along a region that follows a naturally existing path alongside a vessel or structure, such as an artery, a vein, a lymphatic vessel, the trachea, the esophagus, or even a nerve bundle.

Abstract: An instrument is provided for use by a surgeon to separate the nasal septum from the sphenoid sinus wall of a patient, in a procedure which may be performed very rapidly and with significantly reduced trauma to the septum. The instrument may be very usefully employed in connection with endoscopic endonasal pituitary surgery, although it is not limited thereto. The instrument comprises an elongated support member having first and second ends in opposing relationship, and further comprises pivotable and fixed jaw members respectively joined to the first end of the support member. Each of the jaw members has a length dimension measured from the support member, wherein the length of the pivotable jaw member exceeds the length of the fixed jaw member by a specified amount. A handle component joined to the second end of the support member is movable between first and second handle positions, to move the pivotable member in corresponding relationship between closed and open positions.

Abstract: Balloon loaded dissection devices with elongate balloons and a pushing member are disclosed for creating a tunnel alongside an elongate vessel in the body. The devices may utilize an elongate balloon of any suitable length which may be formed of an elastic or non-elastic material. The balloon may be of double walled construction and may be provided with a central lumen which may receive a guide rod, scope or other surgical instrument. The device may have a support tube secured to the inner wall of the balloon to provide columnar support for the apparatus. The support tube may have a transparent shroud attached to a distal end of the support tube. There is an open space between the distal end of the support tube and the end of the shroud allowing access to adjacent tissue. The shroud may perform blunt dissection and/or retraction to clear an open space for viewing or for performing surgical procedures.

Abstract: Apparatus for creating an anatomic space in tissue in a body of a patient using a cannula with proximal and distal extremities and a bore extending therethrough to provide an open end. A balloon having an inflated space is provided. The balloon is capable of assuming collapsed and inflated conditions. A retainer is carried by the balloon for forming the balloon when in a collapsed condition into a generally cylindrical roll to aid in inserting the balloon into the tissue. An obturator shaft having a rounded distal end is sized so that it extends through the cannula and into the roll. A laparoscope can be introduced into the obturator shaft to permit viewing through the obturator shaft and the balloon. An inflation tube is provided for inflating the balloon after it is disposed in the tissue to cause the balloon to progressively expand to create separation forces in the tissue to create the anatomic space.

Abstract: Balloon loaded dissection devices with elongate balloons and a pushing member are disclosed for creating a tunnel alongside an elongate vessel in the body. The devices may utilize an elongate balloon of any suitable length which may be formed of an elastic or non-elastic material. The balloon may be of double walled construction and may be provided with a central lumen which may receive a guide rod, scope or other surgical instrument. The device may have a support tube secured to the inner wall of the balloon to provide columnar support for the apparatus. The support tube receives the guide rod, scope or other surgical instrument and may have a stop member to translate pushing force applied to the guide rod or scope to pushing force on the apparatus. By using the guide rod or scope as a pushing member the apparatus may be advanced alongside the vessel it is desired to dissect free from attached tissue.

Abstract: A combination tissue dissector and long term expander is disclosed for use in plastic surgery applications and other applications where it is desirable to dissect a tissue pocket and serially expand the dissected pocket through long term tissue expansion. The combination device performs the separate functions of dissection and long term expansion in a single balloon package. In an exemplary embodiment, three sheets of substantially inelastic material are bonded together at their outer margins to form two discrete inflatable chambers. The lower inflatable chamber defined by the middle and lower balloon sheets is further welded together at various points over the sheet's surface area to create a semi-rigid base portion which provides a flat well-defined footprint for the balloon. The semi-rigid base prevents further enlargement of the tissue pocket at the margins when the device is utilized as a tissue expander.

Abstract: The invention provides systems and methods for interfering with the adhesion formation process. In some embodiments, the present invention makes use of intermittent blunt dissection of fibrin bridging adjacent tissues prior to the formation of adhesions. Dissection is generally provided by pulsing a balloon implanted between the tissues. Optionally, the balloon will comprise an elastic structure to disrupt the formation of fibrin between the balloon and the surrounding tissues. Alternatively, the balloon may be at least partially covered by a bio-active anti-adhesion material. In some embodiments, the anti-adhesion material forms an envelope which is left between the tissues when the balloon is removed.

Abstract: A cannula includes a tubular body having a proximal end and distal blunt end, at least one lumen extending the length of the body, an endoscope having a lighted, viewing end disposed in the lumen near the distal end of the body, and a transparent, tissue-separating tip substantially covering the distal end of the body. The tissue-separating tip is slightly blunted to inhibit avulsion of tissue and lateral vessels along the dissected cavity formed thereby. Endoscopic viewing through the tip is enhanced by tapering the inner walls thereof to a cusp adjacent the blunt tip in order to reduce visual distortion. Alternatively, a cannula includes a dissection probe and a removable or deflectable tip for exposing the probe and endoscope to facilitate viewing and the dissection of connective tissue and lateral vessels along the dissected cavity. Methods of using such cannulas produce an elongated cavity along the course of a blood vessel for subsequent harvesting or other treatment of the isolated blood vessel.

Abstract: A cannula includes a tubular body having a proximal end and distal blunt end, at least one lumen extending the length of the body, an endoscope having a lighted, viewing end disposed in the lumen near the distal end of the body, and a transparent, tissue-separating tip substantially covering the distal end of the body. The tissue-separating tip is slightly blunted to inhibit avulsion of tissue and lateral vessels along the dissected cavity formed thereby. Endoscopic viewing through the tip is enhanced by tapering the inner walls thereof to a cusp adjacent the blunt tip in order to reduce visual distortion. Alternatively, a cannula includes a dissection probe and a removable or deflectable tip for exposing the probe and endoscope to facilitate viewing and the dissection of connective tissue and lateral vessels along the dissected cavity. Methods of using such cannulas produce an elongated cavity along the course of a blood vessel for subsequent harvesting or other treatment of the isolated blood vessel.

Abstract: A cannula includes a tubular body having proximal closed end and distal blunt end, at least one lumen extending the length of the body, an endoscope having a lighted, viewing end disposed in the lumen near the distal end of the body, and a transparent, tissue separating member substantially covering the distal end of the body. The tissue separating member has a blunt tip disposed from and of the end distal to the body. A method of using such a cannula separates tissue to form an elongated cavity along the course of a small blood vessel and subsequently harvesting the blood vessel.

Abstract: Methods and devices for harvesting blood vessels from the body using minimally invasive surgical techniques are disclosed. The vessel is dissected from surrounding tissue using the tip of a dissection cannula. The dissected tissue may be retracted, for example, by insufflation. The dissection cannula may further include a balloon that can be inflated after insertion between the vessel and the surrounding tissue. An imaging device may be disposed within the cannula to permit viewing through the distal tip. In another aspect, the balloon is an everting balloon that upon inflation everts and advances along the vessel.

Abstract: A fluid operated retractor for use in surgery. The retractor has a portion which is expandable upon the introduction of fluid under pressure. The expandable portion is made of a material strong enough, and is inflated to enough pressure, to spread adjoining tissues within the body. The retractor is especially useful in fiber optic surgery because it can be inserted percutaneously through a small opening then expanded to a much larger dimension when in the desired location, to retract tissue from within. The retractor may be used to spread a joint such as a knee joint or a shoulder joint, or may be used to separate tissue planes generally, to improve visualization and create a working space for the surgeon.

Abstract: Balloon loaded dissection devices with elongate balloons and a pushing member are disclosed for creating a tunnel alongside an elongate vessel in the body. The devices may utilize an elongate balloon of any suitable length which may be formed of an elastic or non-elastic material. The balloon may be of double walled construction and may be provided with a central lumen which may receive a guide rod, scope or other surgical instrument. The device may have a support tube secured to the inner wall of the balloon to provide columnar support for the apparatus. The support tube receives the guide rod, scope or other surgical instrument and may have a stop member to translate pushing force applied to the guide rod or scope to pushing force on the apparatus. By using the guide rod or scope as a pushing member the apparatus may be advanced alongside the vessel it is desired to dissect free from attached tissue.

Abstract: Devices and methods for minimally invasive harvesting of a vessel or vascular conduit, especially the saphenous vein for coronary artery bypass grafting, are disclosed. Generally, an instrument is provided which has one or more specially designed end effectors which are permanently or detachably mounted to a harvesting implement, and may also be interchangeable with each other. The end effectors have features or elements which facilitate separation of connective tissue from the vessel and/or engagement of side branches to be separated from the vessel. In various embodiments, the instrument also provides means for quickly and easily attaching and detaching the end effectors as well as means for engaging with an endoscope, if desired. The harvesting methods provide for use of the instruments through one or more minimally invasive incisions.

Abstract: A method for removing a vessel from a patient's body comprises the steps of identifying the vessel to be removing and providing an incision in the patient's body near the identified vessel. An optical dissector is inserted through the incision and tissue is optically dissected away from the surface of the vessel with the optical dissector. The optical dissector is then withdrawn from the body through the incision. An optical retractor is inserted into the body through the incision and is used to retract the dissected tissue away from the surface of the vessel thereby providing space between the dissected vessel and the retracted tissue. The vessel and its side branches are then dissected, ligated and transected and the vessel is then removed from the body through the incision.

Abstract: A method for removing a vessel from a patient's body comprises the steps of identifying the vessel to be removing and providing an incision in the patient's body near the identified vessel. An optical dissector is inserted through the incision and tissue is optically dissected away from the surface of the vessel with the optical dissector. The optical dissector is then withdrawn from the body through the incision. An optical retractor is inserted into the body through the incision and is used to retract the dissected tissue away from the surface of the vessel thereby providing space between the dissected vessel and the retracted tissue. The vessel and its side branches are then dissected, ligated and transected and the vessel is then removed from the body through the incision.

Abstract: An apparatus for tissue dissection and instrument anchoring, including a dissection balloon having a viewing window (preferably a rigid, transparent window) at its distal end, or including an anchoring or dissection balloon having nonuniform elasticity selected to achieve desired inflated shape and pressure characteristics, and methods for using such apparatus. The window, which can be a lens (such as a wide angle lens), is transparent and either rigid or non-rigid but sufficiently strong to retain a desired optical shape while (and after) being pushed against tissue layers by a rigid instrument deployed within the balloon. In preferred embodiments, the balloon is a long-necked dissection balloon deployed through a cannula.

Abstract: A method for dissecting tissue includes the steps of providing a surgical device having a scope holder for holding an endoscope therein and a transparent concave head connected to the scope holder. The concave head defines a working space therein. The device also includes a particulate purging system operatively connected to and communicating with the concave head. An endoscope is positioned in the scope holder and the surgical device is placed in tissue. Tissue is dissected with the concave head of the device and particulate is purged from the working space of the concave head with a fluid flow provided through the purging system while the device remains in the tissue.

Abstract: A blunt dissection cannula and method selectively isolate a vessel of interest within the body of a patient by dissecting connective tissue in and about the adventitial tissue plane. The procedure includes selectively advancing the cannula and transparent tapered tip along the vessel of interior to form an insufflated cavity along the course of the vessel while visualizing the vessel and side branches within the field of view of an endoscope through the transparent tip. An electrocautery electrode selectively extends through an access port at the distal end of the cannula, eccentrically relative to the transparent tip, to facilitate visualizing rotational and translational positioning of the electrode to contact and electrocauterize side branches within the field of view through the transparent tip.