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 au artery, a vein, a lymphatic vessel, the trachea, the esophagus, or even a nerve bundle.

Abstract: A coated wire for medical applications including a length of biocompatible wire material. The wire material can be coated along a portion of the perimeter of the wire. The deposition of the coating can cover less than the total circumference of the wire.

Abstract: An assembly of cannula and endoscope and dissection tip facilitate surgical procedures at remote surgical site in tissue of a patient. Relative rotation of the cannula about the endoscope from clamped rotational fixation of the cannula and endoscope is made possible by flexing a resilient clamping segment, and such relative rotation promotes convenient positioning of an eccentric tissue-dissecting tip about a vessel being harvested from within tissue of a patient. Color tinting of the tip or color-tinted illumination of tissue at a remote surgical site enhances contrasting visualization through the tip via the endoscope among the tissue types encountered at the surgical site within a patient. A tool bridge or lateral support mounts to a more rigid component such as an endoscope that extends from the proximal end of a cannula to support a more flexible surgical instrument also extending from the proximal end of the cannula.

Abstract: A method and apparatus for dissecting a first layer of tissue from a second layer of tissue and thereafter holding open an anatomic space for the performance of a surgical procedure. The method includes steps of making an incision in a body, introducing a deflated balloon dissector into the incision, inflating the balloon dissector to effect dissection of the first layer of tissue from the second layer of tissue, deploying a retractor within the anatomic space in order to hold open the anatomic space, and optionally deflating or evacuating the balloon dissector to open a cavity for surgical manipulations. The apparatus includes a combined dissector-retractor having a balloon retractor disposed upon the surface of the balloon dissector and integrated therewith.

Abstract: Percutaneous tissue removal apparatus comprises a flexible drill shaft, a cutting tip mounted on the shaft for placement adjacent a tissue mass for cutting the tissue, means for transmitting motion to the shaft to move the cutting tip against the tissue to cut tissue fragments from the tissue, and means for removing the tissue fragments along the shaft by suction to a location outside the tissue mass while cutting. The apparatus may include means for collecting one or more selected components of the harvested tissue fragments for implantation of the fragments preferably into the body of the patient from whom they were removed. Where the tissue to be cut is bone, a cutting tip is preferably made of a polymeric material which is softer than the cortical portion of the bone, although the cutting tip may be made of a ceramic or a composite material. A second flexible shaft may be provided either within or about the flexible drill shaft.

Abstract: An introducer comprises a sheath, a guide rod, and at least one wire stabilization guide. The guide rod is sized to fit within the inside diameter of the sheath. The guide rod has at least one slot along its length for releasably holding the wire stabilization guide. One or more wire stabilization guides are coupled to the sheath. In one exemplary embodiment, the wire stabilization guides are inserted into a wound site and are dimensioned so as to cause an outward stretching force on the wound site. In another embodiment, the wire stabilization guides may form a loop, so that when the sheath is approximated to a wound site, the loop is approximated to tissue surrounding the wound site to hold the sheath approximately centered on the wound site. In other embodiments, the wire stabilization guides may include a retention device to hold the sheath approximate to the wound site.

Abstract: A target tissue localization device (28) has outer and inner members (30, 32) which are longitudinally movable relative to one another. An anchor (42) is secured to the outer and inner members and is movable from a radially-contracted configuration to a radially-expanded configuration. The anchor may be a tubular mesh anchor. The anchor may have a sufficiently large cross-sectional area when in the radially-expanded configuration to substantially eliminate inadvertent dislodgment of the anchor once radially-expanded. In use, the location of the target tissue (56) is determined and the distal end of the localization device is passed through the patient's skin (58) and to the target tissue to create a tissue track (60) between the patient's skin and the target tissue. The target tissue includes near and far sides (62, 64). The anchor element, located at the target tissue is expanded to an expanded configuration. The method the anchor element may be located on the far side of the target tissue.

Abstract: A method and apparatus for micro-dissection of vascular occlusions are provided wherein two or more tissue expansion members are coupled with a base section and an actuation assembly so that they rotate radially outward from the central axis of the base. The actuating assembly occupies a channel within the base such that it is free to move in a longitudinal direction. As an external force is applied to the actuation assembly, the actuation assembly engages the tissue expansion members causing them to move in a radial outward direction with respect to the base section. The resulting motion causes the tissue expansion members to contact the tissue walls and/or the occlusion. The tissue expansion members can stretch the tissue walls causing the occlusion to tear, fracture or be disrupted or displaced.

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: 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 surgical method for treating urinary incontinence by securing a suture within a patient's body, retrieving a portion of the suture into the patient's vagina, and supporting the patient's urethra using the suture. A surgical method for elevating a patient's urethra in order to treat urinary incontinence, a surgical method for securing an anchor in a patient, a helical anchor and an anchor-insertion tool are also provided.

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: The present invention involves a surgical instrument for guiding a delamination instrument into the cornea of a human eye. The instrument generally includes a handle portion and an end portion. The end portion has at least two flat (or substantially flat) members extending therefrom and in different directions. Each of the members being adapted to be inserted through an incision in the cornea to form a guide for a corneal delamination instrument. With at least two members extending in different directions one may easily access either pocket formed from a corneal incision with a single tool.

Abstract: A device for guiding a medical instrument is described, which comprises a guide tube, which has a longitudinal opening extending substantially from a distal end to a proximal end of the guide tube, wherein the guide tube comprises a rounded bottom and two parallel side walls so that the guide tube is about semi-circular in cross section. The device further comprises a handle connected to the guide tube in the region of the proximal end of the guide tube. The distal end of the guide tube is open, and the handle projects laterally from said guide tube.

Abstract: A method of exposing, ligating, and dividing perforating veins endoscopically using balloon dissectors to gain access to the perforating veins thereby avoiding large incisions required in the Linton procedure and similar open surgical procedures.

Abstract: A dissection device for dissecting tissue from an elongate structure in a body is disclosed. The device comprises an elongate tubular member such as a cannula or other hollow tube and an inflatable elongate tubular balloon coupled to the elongate tubular member. The device further comprises device for connecting the elongate tubular balloon to an inflation source to inflate the elongate tubular balloon and device for deflating the elongate tubular balloon such as by a deflation valve. The elongate tubular balloon typically has multiple cylindrical chambers, is inverted during its uninflated state and everts during use.

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: Laparoscopic apparatus and method for insertion into a space or potential space in a body comprising an introducer device having a tubular member with a bore extending therethrough. A tunneling shaft assembly is provided and is slidably mounted in the bore of the introducer device. The tunneling shaft assembly includes a tunneling shaft having proximal and distal extremities. A tunneling member is mounted on the distal extremity of the tunneling shaft. A balloon assembly is provided which is removably secured to the tunneling shaft. The balloon assembly includes a balloon wrapped about said tunneling shaft. A sheath is provided which encloses the balloon on the tunneling shaft. The sheath has a slit extending longitudinally thereof permitting the sheath to be removed whereby the balloon can be released and inflated. A tubular member is provided which has a balloon inflation lumen thereon and is coupled to the balloon for inflating said balloon.

Abstract: Laparoscopic apparatus and method for insertion into a space or potential space in a body comprising an introducer device having a tubular member with a bore extending therethrough. A tunneling shaft assembly is provided and is slidably mounted in the bore of the introducer device. The tunneling shaft assembly includes a tunneling shaft having proximal and distal extremities. A tunneling member is mounted on the distal extremity of the tunneling shaft. A balloon assembly is provided which is removably secured to the tunneling shaft. The balloon assembly includes a balloon wrapped about said tunneling shaft. A sheath is provided which encloses the balloon on the tunneling shaft. The sheath has a slit extending longitudinally thereof permitting the sheath to be removed whereby the balloon can be released and inflated. A tubular member is provided which has a balloon inflation lumen thereon and is coupled to the balloon for inflating said balloon.

Abstract: Surgical methods and instruments are disclosed for performing port-access or closed-chest coronary artery bypass (CABG) surgery in multivessel coronary artery disease. In contrast to standard open-chest CABG surgery, which requires a median sternotomy or other gross thoracotomy to expose the patient's heart, port-access CABG surgery is performed through small incisions or access ports made through the intercostal spaces between the patient's ribs, resulting in greatly reduced pain and morbidity to the patient. In situ arterial bypass grafts, such as the internal mammary arteries and/or the right gastroepiploic artery, are prepared for grafting by thoracoscopic or laparoscopic takedown techniques. Free grafts, such as a saphenous vein graft or a free arterial graft, can be used to augment the in situ arterial grafts. The graft vessels are anastomosed to the coronary arteries under direct visualization through a cardioscopic microscope inserted through an intercostal access port.

Abstract: A medical instrument for endoscopic removal of the saphenous vein has an elongated shaft which has at the distal end a spatula tip and in whose proximal region is arranged a laterally projecting handle. The instrument further has an endoscopic optical system which has an eyepiece cup that is arranged at the proximal end of the instrument. The handle is joined to the shaft in such a way that an outer side of the instrument facing away from the handle continuously has a surface that, from the distal to the proximal end, is free of projections. The eyepiece cup is arranged in oblique orientation with respect to a longitudinal center axis of the shaft and encloses with the handle, with respect to the longitudinal center axis, an angle of less than 90°.

Abstract: A system for delivering a guide wire to an artery and a side branch vessel of the artery includes a delivery catheter and a pair of guide wires. The delivery catheter includes a first lumen with a first opening and a second lumen with a second opening. The first guide wire is configured to extend through the first lumen and the second guide wire is configured to extend through the second lumen. The first opening is configured to direct the first guide wire into the side branch vessel, and the second opening is configured to direct the second guide wire into the main artery.

Abstract: Surgical methods and instruments are disclosed for performing port-access or closed-chest coronary artery bypass (CABG) surgery in multivessel coronary artery disease. In contrast to standard open-chest CABG surgery, which requires a median sternotomy or other gross thoracotomy to expose the patient's heart, port-access CABG surgery is performed through small incisions or access ports made through the intercostal spaces between the patient's ribs, resulting in greatly reduced pain and morbidity to the patient. In situ arterial bypass grafts, such as the internal mammary arteries and/or the right gastroepiploic artery, are prepared for grafting by thoracoscopic or laparoscopic takedown techniques. Free grafts, such as a saphenous vein graft or a free arterial graft, can be used to augment the in situ arterial grafts. The graft vessels are anastomosed to the coronary arteries under direct visualization through a cardioscopic microscope inserted through an intercostal access port.

Abstract: Laparoscopic apparatus and method for insertion into a space or potential space in a body comprising an introducer device having a tubular member with a bore extending therethrough. A tunneling shaft assembly is provided and is slidably mounted in the bore of the introducer device. The tunneling shaft assembly includes a tunneling shaft having proximal and distal extremities. A tunneling member is mounted on the distal extremity of the tunneling shaft. A balloon assembly is provided which is removably secured to the tunneling shaft. The balloon assembly includes a balloon wrapped about said tunneling shaft. A sheath is provided which encloses the balloon on the tunneling shaft. The sheath has a slit extending longitudinally thereof permitting the sheath to be removed whereby the balloon can be released and inflated. A tubular member is provided which has a balloon inflation lumen thereon and is coupled to the balloon for inflating said balloon.

Abstract: A prostatic stent comprises a body member and a retaining member. The body member includes a distal terminating end, a proximal end portion, and a lumen extending within the body member to allow fluid drainage through the body member. The body member is sized for placement substantially within the prostatic section of the urethra, with the distal terminating end located proximal of an external sphincter to allow normal operation of the external sphincter. The retaining member extends from the proximal end portion of the body member. The retaining member is collapsible into a first state to allow passage of the prostatic stent into the urethra, and the retaining member is expandable into a second state when located in a bladder to hold the body member in place substantially within the prostatic section of the urethra.

Abstract: Surgical methods and instruments are disclosed for performing port-access or closed-chest coronary artery bypass (CABG) surgery in multivessel coronary artery disease. In contrast to standard open-chest CABG surgery, which requires a median sternotomy or other gross thoracotomy to expose the patient's heart, port-access CABG surgery is performed through small incisions or access ports made through the intercostal spaces between the patient's ribs, resulting in greatly reduced pain and morbidity to the patient. In situ arterial bypass grafts, such as the internal mammary arteries and/or the right gastroepiploic artery, are prepared for grafting by thoracoscopic or laparoscopic takedown techniques. Free grafts, such as a saphenous vein graft or a free arterial graft, can be used to augment the in situ arterial grafts. The graft vessels are anastomosed to the coronary arteries under direct visualization through a cardioscopic microscope inserted through an intercostal access port.

Abstract: Surgical devices and methods achieve a desired configuration of one or more anatomical structures, e.g. by suction or inflation, and then optionally deploy a stabilizing or fastening agent or holding device, for example a helical staple, to stabilize the anatomical structure in the desired configuration. Aspects of the invention can be used in the treatment of incontinence, coronary artery blockage, and blockages or strictures in other anatomical structures. Additionally, embodiments of the invention also can be used to create anastomoses between anatomical structures, and/or to create or reverse functional vasectomies, tubal ligations and the like. Aspects of the invention are particularly (though not exclusively) applicable in minimally invasive surgical settings.

Abstract: An intravascular device for venting an inflatable chamber and methods for using the device are disclosed. The intravascular device generally includes three components, namely a catheter or cannula, an inflatable member, and a selective degassing element. The inflatable member is typically a balloon. The catheter or cannula is typically hollow with a first lumen extending between an inflation port and the interior of the inflatable member and a second lumen extending between the interior of the inflatable member and an exhaust port. The selective degassing element is typically positioned between the inflatable member and the exhaust port and occupies the entire cross-sectional area of the second lumen. When in a closed position, the selective element prevents the passage of liquid from the interior of the inflatable member, through the exhaust port. When in an open position, the selective element permits gas entrained within the inflatable member to be expelled from the device, via the exhaust port.

Abstract: The invention provides a medical device having an elongate catheter, a balloon occluder mounted on a distal end of the catheter, and optionally a chopping mechanism associated with an aspiration port of the catheter. Continuous or intermittent suction can be applied to the aspiration port which is distal to the occluder to dislodge thromboembolic material in a carotid or cerebral artery. Oxygenated blood or other fluid, which may be hypothermic, can be perfused through at least one perfusion port proximal to the occluder to maintain and augment perfusion of the collateral vasculature proximal to the occlusive lesion. The flow rate of blood or fluid can be controlled by rotating two cylindrical members. Neuroprotective agents or t-A can also be infused distal to the occluder through the aspiration port or an infusing port. Methods of using the devices in treating patients with acute stroke or occlusive cerebrovascular disease are also disclosed.

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: A cavity-retaining tool for bone surgery includes a cavity-retaining sheath which is inserted into the body and forms a cavity to act as a work space for bone surgery, a treatment channel which is placed in the cavity-retaining sheath and guides treatment tools necessary for the treatment of a bone into the space for bone surgery, an observation tool which is attached to the cavity-retaining sheath and by which to observe the operation field within the space for bone surgery, and a fitting portion which is placed at a tip of the cavity-retaining sheath and fits the tip of the cavity-retaining sheath to a bone.

Abstract: Apparatus for creating an anatomic spade in tissue in a body comprising 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: 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 guide wire, and a method for the manufacture thereof, having a core and a plastic jacket enclosing the core. The plastic jacket comprises a proximal portion formed of a first plastic material and a distal jacket portion formed of a second plastic material. The distal end of the proximal jacket portion and the proximal end of the distal jacket portion substantially abut each other and are of substantially equal outer diameters so as to form a smooth transition between the proximal and the distal jacket portions. According to another aspect, there is provided a guide wire with a selectively formable metallic core and a plastic jacket encasing the formable core. The plastic jacket has a distal portion with a hydrophilic coating and a proximal portion without a hydrophilic coating. According to another aspect, there is provided a guide wire having a formable metallic core and a plastic jacket encasing the formable core. The plastic jacket has a distal portion that is more radiopaque than a proximal portion.

Abstract: An apparatus and method for separating a first layer of tissue from a second layer of tissue. An inflatable balloon is mounted to a delivery device. The inflatable balloon has a first, inwardly-displaced portion which everts when the balloon is inflated. The balloon is inserted into a patient between the first and second tissue layers when the balloon is in the deflated state. The balloon is then inflated so that the first portion is everted thereby minimizing trauma to the tissue layers.

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: A balloon device useful for dissecting tissue or retracting tissue for the purpose of providing space for laproscopic surgery comprising a balloon having at least two protuberances in its distal region. The present device is particularly useful in bladder neck suspension and hernia repair procedures.

Abstract: A device and method for delivering an object within a patient, wherein the object is delivered in a preferred orientation relative to the delivery site of the patient. The delivery device has an alignment member that allows the object to be delivered intravascularly to the delivery site of the patient, wherein the object is delivered in a pre-determined orientation. The object may, for example, be non-symmetric or include a configuration that requires delivery to the site in only one suitable orientation relative to the delivery site. Such objects may be used, for example, to treat certain defects or injuries in vessels or organs within a patient's body.

Abstract: The present invention relates to devices and methods for removing veins in a venous system of a patient. One device for removing undesired veins includes an elongated member having first and second lumens extending longitudinally therein. The first lumen extends from the proximal end of the elongated member to a first opening at the distal end of the member. The second lumen extends from the proximal end of the elongated member to a second opening in the side of the elongated member. The proximal end of the elongated body is coupled to a connector having two separate tubes that communicate with the respective first and second lumen for the injection and removal of fluid. A vein attachment member, attached to the elongated member, is adapted to be secured to the vein.

Abstract: An apparatus for delivering a closure element into a puncture communicating with a blood vessel includes an introducer sheath, and a locator member disposed within the sheath, the locator member having a distal portion extending distally beyond the distal end of the sheath. A plurality of splines are provided on the distal portion of the locator member, the splines being selectively expandable between an axial collapsed configuration and a transverse expanded configuration. An actuator is coupled to the locator member for controllably expanding the splines. A housing is slidably disposed on the sheath for deploying a closure element, such as a vascular clip. The locator actuator may automatically collapse the splines upon advancement of the housing.

Abstract: Laparoscopic apparatus and method for insertion into a space or potential space in a body comprising an introducer device having a tubular member with a bore extending therethrough. A tunneling shaft assembly is provided and is slidably mounted in the bore of the introducer device. The tunneling shaft assembly includes a tunneling shaft having proximal and distal extremities. A tunneling member is mounted on the distal extremity of the tunneling shaft. A balloon assembly is provided which is removably secured to the tunneling shaft. The balloon assembly includes a balloon wrapped about said tunneling shaft. A sheath is provided which encloses the balloon on the tunneling shaft. The sheath has a slit extending longitudinally thereof permitting the sheath to be removed whereby the balloon can be released and inflated. A tubular member is provided which has a balloon inflation lumen thereon and is coupled to the balloon for inflating said balloon.

Abstract: Method for developing an anatomic space for laparoscopic hernia repair comprising separating a first layer of tissue from a second layer of tissue for creating an anatomic operating space for the performance of a surgical procedure by making an incision through the first layer of tissue. A non-elastomeric deflated balloon is introduced into the incision. The balloon is inflated to cause separation of the first layer of tissue from the second layer of tissue to thereby produce an anatomic operating space. The balloon is then deflated and removed from the incision. The anatomic operating space is inflated with insufflation gas. A surgical procedure in then performed in the anatomic operating space.

Abstract: A coated wire for medical applications including a length of biocompatible wire material. The wire material can be coated along a portion of the perimeter of the wire. The deposition of the coating can cover less than the total circumference of the wire.

Abstract: The present invention provides a group or kit of surgical instruments for use in minimally invasive surgical procedures.

Abstract: A thermoformed bladder is disclosed for assisting in the application of prosthetic mesh devices. The unit is fabricated from two layers of film that have been thermoformed in one localized region and then sealed. The sealed unit has air trapped within the three dimensional portion which can be forced into the non-formed region causing the non-formed region to expand and apply force against the prosthesis to assist in deployment.

Abstract: A laparoscopic apparatus for tunneling dissection including a hollow tunneling member and an inflatable balloon disposed at the distal end of the tunneling member to form together a blunt tipped obturator. The tunneling member has a bore sized allow the insertion of a conventional laparoscope therein to provide observation during surgical procedures. The laparoscope provides direct observation of dissection through the open distal end of the tunneling member. Observation is provided both when the device is used to tunnel between tissue layers to a region of interest within the body of a patient, and during subsequent balloon inflation when the tissue layers are dissected to cause separation of the tissue layers and the creation of an anatomical working space. After the anatomic space has been created, the device and laparoscope are withdraw through the incision.

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 multifunctional device for use in an endoscopically performed operative procedure of the type where a narrow portal is established through the skin to provide access to an operative site and the multifunctional device is introduced to the operative site through the narrow portal. The multifunctional device is formed of an absorbent material, preferably expandable, having a substantially rigid dry state prior to introduction to the operative site and a soft, flexible wet state after absorbing fluids. The absorbent material can be formed with a spine therein of either a continuous or a discontinuous, segmented construction, and the spine can be branched and tubular or solid.

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 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.