Abstract: A method for percutaneous dissection of a segment of vascular tissue from a patient is provided which includes providing an elongated tubular member having a proximal end and a distal end, and blunt dissection structure positioned adjacent the distal end of the tubular member and remotely actuable from adjacent the proximal end of the tubular member. The method further provides for percutaneously accessing a first end portion of the vascular tissue segment, the blunt dissection structure is positioned adjacent the vascular tissue segment and is actuated to bluntly dissect the vascular tissue segment from surrounding body tissue.

Abstract: Methods and devices for harvesting blood vessels using balloons to hold the blood vessel and to dissect and mobilize the blood vessel from surrounding tissue. A small balloon catheter is inserted into the blood vessel lumen to and inflated in order to hold the blood vessel, and an everting balloon dissector is everted over the blood vessel. Eversion of the balloon dissector over the blood vessel pushing surrounding body tissue away from the blood vessel.

Abstract: A surgical device for dissecting and retracting tissue includes 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. A fluid carrying system is operatively connected to and communicates with the concave head and the working space for clearing particulate from the working space.

Abstract: Apparatus and method for endoscopically harvesting an elongate structure such as a blood vessel or nerve from a patient's body. A harvesting head defines a channel for receiving a blood vessel or the like and an outer surface for dissecting and retracting connective tissue surrounding a vessel received in the channel. The head may have a substantially ovate shape and may depend from an extended handle. The head has at least one slot that extends between the outer surface and channel for receiving side branches of the vessel. The slot contains a blade for cutting the side branches and electrocauterizing plates for sealing the cut ends of the side branches. An opening may be provided for application of a ligation device to the side branch. The apparatus may be inserted into an incision in a patient's body and advanced along the length of a vessel to endoscopically dissect, ligate and transect the side branches to harvest the main trunk of the vessel to support subsequent surgical procedures.

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 dissection glove for forming in a patient a tissue pocket to receive an implantable device. The dissection glove is constructed of an absorbent material formed into at least one recess with an open end for receiving a portion of a surgeon's gloved hand. A retaining mechanism is provided for releasably retaining the dissection glove to a portion of the surgeon's gloved hand. An extraction mechanism is optionally provided for extracting the dissection glove from the tissue pocket. The dissection glove may be constructed from a variety of materials, such as polypropylene nonwoven mesh or calcium alginate gauze. The present invention is also directed to a method of forming a tissue pocket in a patient for receiving an implantable device using the present dissection glove.

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: Balloon loaded dissection devices with elongate balloons and a pushing member are described 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. The support tube may have a transparent shroud attached to its distal end. 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. The support tube receives a scope or other surgical instrument.

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 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: 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 kit for use in the surgical implantation of an shaped implant. The kit includes a shaped balloon dissector packaged with an implant which, when inflated, has a shape complimentary with the shape of the dissector. Using orientation indicia for proper orientation, the surgical site is dissected with the shaped balloon dissector. Once so prepared, a shaped deflated implant is positioned within the site and then inflated. Since the implant's shape is complementary with the dissector's shape, the implant fits within the site without requiring excess site preparation.

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 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: An over the wire scalpel for performing a dermatotomy that produces a skin nick features a triangular shaped blade with a pair of cutting edges that meet to define a tip. The blade is connected to a handle and a central lumen passes through both. The leading opening of the lumen is positioned at the blade tip so that it is symmetrically abutted by the cutting edges. A blocker that limits the depth of blade travel is positioned upon the handle adjacent to the blade. A stylus may be placed within the central lumen so that the scalpel may be used without a guidewire or with a guidewire that has a diameter significantly smaller than that of the central lumen.

Abstract: A multifunctional tissue dissecting instrument for use in a surgical procedure includes a blunt dissector, a probe disposed within the blunt dissector and a handle coupled with the probe at a proximal end of the blunt dissector and operable to move a tip of the probe between a retracted position within the blunt dissector and an extended position protruding from the blunt dissector. The blunt dissector preferably includes an elongate tubular member and an absorbent body of material disposed on the distal end of the tubular member. The absorbent body at the distal end of the tubular member is configured to contact tissue for blunt dissection and, when other functions are desired or required as part of the surgical procedure, the probe tip can be moved from the retracted position to the extended position, for example to cut or penetrate tissue for sharp dissection, to transmit energy, to manipulate or pull the tissue or to otherwise treat the tissue.

Abstract: Apparatus for creating an anatomic space in tissue in a body including an introducer device having a tubular member with a bore extending therethrough. A tunneling shaft assembly is slidably mounted in the bore of the introducer device. The tunneling shaft assembly includes a tunneling shaft having proximal and distal extremities. A blunt tip is secured to the distal extremity of the tunneling shaft. A balloon assembly is provided. The balloon assembly is removably secured to the tunneling shaft. The balloon assembly includes a deflated collapsed balloon. A sheath encloses the balloon and is carried by the tunneling shaft. The sheath has a weakened region extending longitudinally thereof permitting the sheath to be removed to release the balloon.

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 surgical apparatus for removing tissue, which includes (i) an elongated body defining an opening at a distal end and forming a tissue receiving cavity in communication with the opening (ii) a blunt dilator at least partially disposed in the tissue receiving cavity and (iii) a cutting member operatively movable transverse to the elongated body in proximity to the opening.

Abstract: The Christoudias endodissector is an instrument for dissecting, wiping, sponging or cleaning tissues during endoscopic surgery. The instrument includes a mesh gauze body at one end which is held securely and housed in a recess on the head portion of the instrument by teeth on a fixed and a pivotal jaw. The lower part of the head portion is mounted within a resiliently backed cylindrical locking sheath. The lower head portion becomes an elongated main stem which is mounted within a handle sheath at the other end of the instrument. A locking pin on the stem engages a groove on the locking sheath to maintain the jaws in position. Alternate embodiments involve a mushroom dissector and a cocoon dissector named after the configuration of the gauze body which is securely affixed on a complimentary shaft. An alternate embodiment involves a tubular instrument onto which a tubular endodissector tip is attached thus forming a working port through which additional instruments can be inserted.

Abstract: A vein-branch accessing device includes at least one probe adapted for contacting a surface of a vein of the patient. The probe is further adapted for moving along the surface of the vein, to thereby guide the vein-branch accessing device over the surface of the vein and along the length of the vein, beneath the skin. The vein-branch accessing device further includes a vein branch indicator, which is adapted for indicating to an operator of the vein-branch accessing device that the probe has moved along the surface of the vein to a vein branch. The vein-branch accessing device further includes accessing structure, which is adapted for facilitating access to the vein branch. The accessing structure may include a port, which is adapted for accommodating either a clip or a clip applier therethrough. The clip is adapted for fitting around and occluding the vein branch, and the clip applier is adapted for severing the vein branch from the vein.

Abstract: A method of harvesting arterial conduits for coronary bypass grafting includes isolating the internal mammary artery and the superior and inferior epigastric arteries through a subcostal incision using a tapered tip balloon dissection cannula. A free end of the isolated artery may be anastomosed to the coronary artery, and a free graft harvested from the inferior epigastric artery may be anastomosed to the subclavian artery for an additional coronary bypass conduit.

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 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: An expansible tunneling apparatus and associated methods for creating an anatomic working space for a surgical procedure. Various embodiments of one and two piece apparatus that permit laparoscopic observation both during tunneling and during subsequent balloon dissection are disclosed. In a disclosed one piece embodiment, a tubular member has a bore extending therethrough and an open distal end. A lip is formed in the distal end of the tubular member to capture the distal tip of a laparoscope that is inserted into the tubular member to permit observation of the procedure both during tunneling to a desired location and during subsequent balloon inflation. An elongated neck of the balloon is secured to the tunneling member. The elongated neck permits the tubular member to be withdrawn slightly from the balloon after inflation to facilitate observation.

Abstract: A surgical dissector and method for facilitating fiberoptic viewing when developing a minimally invasive accessway to a surgical objective in the interior of the body. The dissector or guide is used to dissect tissues along an anatomic plane under direct fiberoptic vision. A balloon is provided to further dissect and retract tissue along the dissected accessway to provide an adequate depth of field for fiberoptic viewing through transparent walls of the balloon. The dissection allows a surgeon safely to make additional incisions into the region of the fiberoptic viewing space and to perform surgical procedures under fiberoptic vision by manipulating an accessory instrument on the exterior surface of the inflated balloon that is disposed within the dissected space.

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 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: A surgical method for creating an operative space during an endoscopic surgical procedure is disclosed. The method incorporates the use of an elongate instrument with an atraumatic tip for facilitating manual dissection of layers of tissues by advancing the instrument between the layers desired to be dissected. As the manual dissection is performed, the space between the dissected layers is enhanced by concurrently insufflating the dissected space as the instrument is advanced. Concurrently insufflating while dissecting eliminates the need to use a balloon dissector for creating the operative space. An improved surgical instrument particularly adapted to carry out this procedure is also disclosed. The improved surgical instrument is an optical obturator incorporating a contrasting imaging element displayed on the transparent tip of the obturator.

Abstract: A contamination sample collection device has a wooden dowel with a cotton swab at one end, the cotton being covered by a nylon cloth and the wooden dowel being encapsulated by plastic tubing which is heat shrunk onto the dowel and onto a portion of the cotton swab to secure the cotton in place. Another plastic tube is heat shrunk onto the plastic that encapsulates the dowel and a portion of the nylon cloth to secure the nylon cloth in place. The device may thereafter be covered with aluminum foil protector. The device may be used for obtaining samples of contamination in "clean" room environments.

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: 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, is transparent and either rigid or non-rigid but sufficiently strong to retain a desired optical shape while 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. In other embodiments, the invention is a dissection balloon assembly including a long-necked dissection balloon having a viewing window at its distal end, and a housing to which the dissection balloon's mouth is attached.

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: A surgical instrument having an elongated shaft to which is attached an inflatable balloon, commonly referred to a "balloon dissector", for dissecting a desired layer of internal bodily tissue from remaining tissue layers to create an operative space is disclosed. Alternatively, an instrument without a balloon can be used to perform a manual dissection. In one embodiment, the instrument has a tissue-contacting element in communication with the shaft distal end, and at least a portion of the tissue-contacting element is transparent. The instrument is adapted to receive an endoscope through its shaft and extend to adjacent the tissue-contacting element. The endoscope is supported and positioned in an extension assembly. The instrument provides for visualization using the endoscope as the instrument is advanced through tissue, but prevents direct contact between the tip of the endoscope containing the lens and the tissue.

Abstract: Apparatus and method of harvesting a vessel of interest use a thin-walled, dark-colored sheath inserted within the vessel with the aid of an inner, slidable support member that is removed following placement of the sheath within the length of the vessel of interest.

Abstract: A minimally invasive retractor and dissector for internal surgical use on a patent's body has a tubular support for passing into the patient's body. A proximal end on the tubular support located outside the patient's body is in position to provide assess for the surgeon. A distal end on the tubular support located inside the patient's body to provide access within the patient for surgery. A control is located at the proximal end of the tubular support. One or more articulated members are movably positioned relative to the distal end of the tubular support so each of the articulated members allows movement relative to the distal end. A rotator connects to the proximal end of the tubular support for movement relative to the control. An instrument moves independently of the tubular support when the articulated members and the distal tips cooperatively function on the tissue.

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 blunt dissector instrument for laparoscopic surgical protocols is disclosed which is adapted for defining an anatomical structure from investment tissue. The dissector is formed from an elongate member which extends longitudinally between a working end and a control end, and is provided with a tip region having a blunt dissector tip and a lateral dissector region. A rough surface is circumferentially disposed about the tip portion and is effective for tactilely retaining and abrading the investment tissue for its substantially atraumatic removal from the anatomical structure.

Abstract: An expandable multifunctional instrument for performing various diverse operative procedures includes an elongate distensible member having a distal end for being introduced in an anatomical cavity via a relatively small size anatomical opening and being movable from a non-distended position facilitating introduction through the anatomical opening to a distended position wherein the cross-sectional size of the distensible member is increased and a plurality of collars disposed on portions of the distensible member for constraining movement of the distensible member portions to the distended position. The collars are movably mounted on the distensible member for adjusting the location and size of unconstrained distensible portions of the distensible member adjacent the collars.

Abstract: For surgery, an endoscopic retrograde dissector instrument and less invasive method for bluntly dissecting tissue planes overlying and underlying a rectus abdominus muscle to mobilize the muscle in a transverse abdominal mastoplasty (breast reconstruction). The retrograde dissector includes an elongate blunt-tipped guide member that carries a distal inflatable sleeve. The blunt tip of the guide member is advanced distally along a plane in the interior of the body thereby creating a small diameter dissected track. The distal inflatable sleeve is inflated and then pulled in a retrograde movement along the track to dissect a wide tissue plane laterally on each side of the track in a single efficient step. A pulse mechanism rapidly pulsates the inflated sleeve to facilitate the dissection of connective tissues along planes of least resistance to create a relatively blood-free dissected tissue plane.

Abstract: The present invention provides a surgical technique and instrument kit that allows for subtle modification of the corneal curvature by interlamellar injection of a synthetic gel at the corneal periphery while sparing the optical zone. The gel viscosity, volume and disposition within the surgical annular track as well as the diameter of the track, width, depth, and location are all parameters in the refractive change obtained. Following ultrasonic pachymetry performed centrally and at a selected wound entrance located about 2.5 to 3.5 mm from the apex, a one millimeter or so wide, about 75-85% corneal thickness depth radial incision is performed with a micrometric diamond knife adjusted to about 86% corneal thickness. Inserted through the partial-depth incision, a corkscrew-like dissector or helicoidal spatula forms a 360.degree. annular track centered about the apex. A transparent gel is manually injected through the incision, filling the annular channel.

Abstract: This invention relates to a method for the dissection of blood vessels, lymph nodes and other body organs from the surrounding tissue and to a novel balloon dissection instrument for use in the method. The dissection instrument comprises an elongated tube having at least one inflatable balloon attached around the outer wall of a distal portion of the tube. The method of dissecting a vein, such as the saphenous vein, involves severing of the vein at two sites, defining the length of vein to be dissected. The vein is then accessed by securing the severed end, for example by a thread attached thereto and passed through the lumen of the dissection instrument to serve as a controllable anchor. The distal end of the dissection instrument, with the balloon deflated, is placed over the free end of the vein so that the vein enters the lumen of the instrument and the distal end of the instrument is pressed between the outer layer of the vein, i.e., the adventitia, and the connected fascia.

Abstract: An apparatus for performing endoscopic surgery at locations where tissue inserts into bone which includes cutting instruments having a novel knife blade with a blunted palpitation end to sever tissue without snagging while palpitating underlying tissue.

Abstract: A surgical instrument having an elongated shaft to which is attached an inflatable balloon, commonly referred to a "balloon dissector", for dissecting a desired layer of internal bodily tissue from remaining tissue layers to create an operative space is disclosed. Alternatively, an instrument without a balloon can be used to perform a manual dissection. In one embodiment, the instrument has a tissue-contacting element in communication with the shaft distal end, and at least a portion of the tissue-contacting element is transparent. The instrument is adapted to receive an endoscope through its shaft and extend to adjacent the tissue-contacting element. The endoscope is supported and positioned in an extension assembly. The instrument provides for visualization using the endoscope as the instrument is advanced through tissue, but prevents direct contact between the tip of the endoscope containing the lens and the tissue.

Abstract: A surgical probe is disclosed for use in defining and dissecting tissue planes. The operative end of the probe is defined to provide a flat wide fan-like shaped spray at the operative end which aids in lifting organs, such as the gall bladder, as well as loosening the adhesion underneath such organs. The probe can also be provided with a dissecting edge, also at the operative end of the probe. The dissecting edge can be used to cut and dissect the desired organ(s) of the patient.

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: A suction dissector for performing coronary, systemic or pulmonary thromboendarterectomy includes a unitary elongated instrument having an elongated tubular handle section and an elongated tubular probe section having a bore. The handle section has a connector at an outer end thereof for attachment to a source of vacuum. The probe section has a rounded tip and a plurality of ports in the tip for communicating with the bore. The probe section may angled relative to the handle.

Abstract: A blunt laparoscopic dissector device is provided which includes an elongate dissector element including a "finger-like" flexible distal end portion. A cylinder or barrel member disposed at one end of a pair of pivotable control arms provides rotatable mounting of the dissector element. A control assembly, including a control rod connected to the other control arm and extending along the length of dissector element, exerts a force on the dissector element so as to produce the desired curvature of the flexible distal end portion. A locking mechanism maintains the force on the dissector element so as to maintain the desired curvature. Rotation of the dissector element within the cylinder enables a surgeon to effect control of the movement of the tip thereof while holding the device in a comfortable stationary position.

Abstract: An active cannula or sleeve which does more than merely maintain a channel or passage is usable to create and/or enlarge a channel or passage, to position a scope or instrument, to move or locate tissue, etc. The cannula can vary in size or shape as needed, intraoperatively. Because a cannula of the present invention is expandable, the surgeon can make a small relatively small incision, stretch the tissue with the expandable cannula, contract the cannula and remove it, allowing the skin to come back to its unstretched condition. Thus, a smaller incision can be made to fit the same size instrument. This results in less trauma and scarring and an easier operation. The cannulas are or can assume such a non-circular shape, to fit into a natural skin opening and cause less trauma. The devices can be used to seal off a space; to expand an existing space or a potential space for working or visualization; to move tissue (for example, to stretch an incision) or to protect it.

Abstract: An elastically deformable element having multiple stacked strips for articulation in an endoscopic surgical instrument. The deformable element is usable in a variable retractor and an instrument having an articulating housing. The working section of the retractor variably moves from a curved configuration when outside of a sheath to a substantially straightened configuration when inside the sheath.