CA2110152A1 - Body structure manipulation and dissection system - Google Patents
Body structure manipulation and dissection systemInfo
- Publication number
- CA2110152A1 CA2110152A1 CA002110152A CA2110152A CA2110152A1 CA 2110152 A1 CA2110152 A1 CA 2110152A1 CA 002110152 A CA002110152 A CA 002110152A CA 2110152 A CA2110152 A CA 2110152A CA 2110152 A1 CA2110152 A1 CA 2110152A1
- Authority
- CA
- Canada
- Prior art keywords
- shaft
- tip
- distal end
- gallbladder
- organ
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0281—Abdominal wall lifters
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/22031—Gripping instruments, e.g. forceps, for removing or smashing calculi
- A61B17/22032—Gripping instruments, e.g. forceps, for removing or smashing calculi having inflatable gripping elements
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B50/00—Containers, covers, furniture or holders specially adapted for surgical or diagnostic appliances or instruments, e.g. sterile covers
- A61B50/20—Holders specially adapted for surgical or diagnostic appliances or instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/50—Supports for surgical instruments, e.g. articulated arms
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
- A61B17/32002—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3462—Trocars; Puncturing needles with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00261—Discectomy
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00278—Transorgan operations, e.g. transgastric
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
- A61B2017/00557—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated inflatable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B2017/22051—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/30—Surgical pincettes without pivotal connections
- A61B2017/306—Surgical pincettes without pivotal connections holding by means of suction
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B2017/320044—Blunt dissectors
- A61B2017/320048—Balloon dissectors
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/3209—Incision instruments
- A61B17/3211—Surgical scalpels, knives; Accessories therefor
- A61B2017/32113—Surgical scalpels, knives; Accessories therefor with extendable or retractable guard or blade
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
- A61B2017/3482—Means for supporting the trocar against the body or retaining the trocar inside the body inside
- A61B2017/3484—Anchoring means, e.g. spreading-out umbrella-like structure
- A61B2017/3486—Balloon
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
- A61B2090/306—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure using optical fibres
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2217/00—General characteristics of surgical instruments
- A61B2217/002—Auxiliary appliance
- A61B2217/005—Auxiliary appliance with suction drainage system
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2217/00—General characteristics of surgical instruments
- A61B2217/002—Auxiliary appliance
- A61B2217/007—Auxiliary appliance with irrigation system
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M25/1006—Balloons formed between concentric tubes
Abstract
Hollow body structures may be manipulated and dissected from surrounding tissue using a manipulator device (10) and a dissection device (120). The manipulator includes a rigid shaft (12) having an inflatable balloon (14) at its distal end. By inserting the balloon through a wall of the body structure and inflating the balloon (14), the body structure can be manipulated using the shaft (12) to expose a dissection plane in an optimum manner. The dissection device (120) is used to separate the body structure from its surrounding tissue. The separator device (120) includes a separator head (130) which is a cylindrical body having a plurality of axial channels (136) therein. The dissector head (130) is rotated or oscillated at a high frequency and acts to separate the body structure from the surrounding tissue with minimum damage.
Description
WO 92/~212g8 : ~ r `~ -' ' PCI/US9~-/0420~
21 iO1~2 BODY STRVCTURE MANIPULATION AND DISSECTION SYSTEM
This application is a continu~tion-in-part of applica~ion serial no. 07/762,318, filed Septe~-ber 19, 1991, which is a continuation-in-part of seri~l no. 07/706,781, filed on May 29, ~91, the full disclos~r~ of which ar~ incorporated herein by reference.
10 lo ~ ot ~
The ~resent inv~ntion relates ganerally to t.he stnlcture and use of surgical instru~ents, and more par~i~ularly to a ~ethod and apparatus f or ~anlpulating and dissecting body stru~:tur~3s during 15 surgical procedures.
P~in~ally ~nvasive ~;urgical (MIS~ techni~ues, such ,,, . . ~ .
laparoscopic, éndoscopic, and arthroscopic surgery, ara generally perf ormed 'chrough small incîsions using , E~pecialized instru~aents to ac~o~plish the desirad 20 ~;urgical procedure~ Usually, the instruments are introduced ~rough a narrow-diameter tu}:~e, such as a trocar sleeve, while the physician observes manipulation o* the instruments through specialized imaging es~uipment, such laparoscopes, endoscopes, and ~ ~ 92t2l2g8 1 0 ~ 5 2 PCT/US92/~ios .~ 2 ,~
. arthroscopes. Such MIS techniques offer significant .
advantages over conventional 'topen" surgical procedures. In particular, the MIS techniques are usually less traumatic, require a shorter recovery time, and are less costly than corresponding convantional suxgical procedures.
., .
Of particular interest to the present invention are laparoscopic cholecystectomy procedures where the gallbladder is ~urgically severed tcommonly referred to as dissected~ and withdrawn through a small trocar sleeve, typically having a diameter of about 10 mm.
In order to m~nipulate the gallbladder, several grasping for~eps are introduced through additional trocar sheaths, and the position of the gallbladder is constantly changed in order to expose the q interface between the gallbladder and surrounding i tîssue, particularly the liver, to permit dissection.
The actual dissection has usually been perfor~ed using forceps, hooks, and/or a small gauze pledget to 20 tear and te2se the gallbladder from the surr~unding tissue along the di~section plane.
:, .
'~J While laparoscopic cholecystectomy pro~edures have b~en very succe~:~;ful and have become incrsasingly common, the need to imultaneously handle Dlultiple 25 graspers as well as a discection instrument places reat demands on the physician and usually requires .' coordinatiorl with one1or Dlor~o surgical assistants The difficulty in performing the procedure is exacerbated by the slickness of the gallbladder : 30 surface, and overly ~igorous attempts to capture the ~allbladder can reE;ult in perforatisn, bile spillage, and gallbladder collapse. A collapsed ~allbladder is even more difficult to dissect from the surrounding tissue than an intact gallbladder.
WO92/21298- - 3 21~.0~ 2~ PCT/US92/04205 For these reasons, it would~be desirable to provide improved methods and appara~us for manipulating and dissecting gallbladders during laparoscopio cholecystectomy procedures. It would be particularly desirabl if suc~ methods and apparatus were suitable for performing manipulation and dissection of other body stru~tures during other surgical procedures.
The method and apparatus should provide for controlled move~ent and manipulation of the body structure, preferably using a single instrument that can be manipulated by the physician with one hand.
In the case of the gallbladder, the instrument should minimize the likelihood of bile spillage and should assure that the gallbladder remains expanded, preferably distended~ to better present the dissection plane during the procedure. The method and apparatus should further provide for improved diss ction techniques with reduced bleeding and tearing of the gallbladder, optionally providing for electrocautery capabilities.
21 iO1~2 BODY STRVCTURE MANIPULATION AND DISSECTION SYSTEM
This application is a continu~tion-in-part of applica~ion serial no. 07/762,318, filed Septe~-ber 19, 1991, which is a continuation-in-part of seri~l no. 07/706,781, filed on May 29, ~91, the full disclos~r~ of which ar~ incorporated herein by reference.
10 lo ~ ot ~
The ~resent inv~ntion relates ganerally to t.he stnlcture and use of surgical instru~ents, and more par~i~ularly to a ~ethod and apparatus f or ~anlpulating and dissecting body stru~:tur~3s during 15 surgical procedures.
P~in~ally ~nvasive ~;urgical (MIS~ techni~ues, such ,,, . . ~ .
laparoscopic, éndoscopic, and arthroscopic surgery, ara generally perf ormed 'chrough small incîsions using , E~pecialized instru~aents to ac~o~plish the desirad 20 ~;urgical procedure~ Usually, the instruments are introduced ~rough a narrow-diameter tu}:~e, such as a trocar sleeve, while the physician observes manipulation o* the instruments through specialized imaging es~uipment, such laparoscopes, endoscopes, and ~ ~ 92t2l2g8 1 0 ~ 5 2 PCT/US92/~ios .~ 2 ,~
. arthroscopes. Such MIS techniques offer significant .
advantages over conventional 'topen" surgical procedures. In particular, the MIS techniques are usually less traumatic, require a shorter recovery time, and are less costly than corresponding convantional suxgical procedures.
., .
Of particular interest to the present invention are laparoscopic cholecystectomy procedures where the gallbladder is ~urgically severed tcommonly referred to as dissected~ and withdrawn through a small trocar sleeve, typically having a diameter of about 10 mm.
In order to m~nipulate the gallbladder, several grasping for~eps are introduced through additional trocar sheaths, and the position of the gallbladder is constantly changed in order to expose the q interface between the gallbladder and surrounding i tîssue, particularly the liver, to permit dissection.
The actual dissection has usually been perfor~ed using forceps, hooks, and/or a small gauze pledget to 20 tear and te2se the gallbladder from the surr~unding tissue along the di~section plane.
:, .
'~J While laparoscopic cholecystectomy pro~edures have b~en very succe~:~;ful and have become incrsasingly common, the need to imultaneously handle Dlultiple 25 graspers as well as a discection instrument places reat demands on the physician and usually requires .' coordinatiorl with one1or Dlor~o surgical assistants The difficulty in performing the procedure is exacerbated by the slickness of the gallbladder : 30 surface, and overly ~igorous attempts to capture the ~allbladder can reE;ult in perforatisn, bile spillage, and gallbladder collapse. A collapsed ~allbladder is even more difficult to dissect from the surrounding tissue than an intact gallbladder.
WO92/21298- - 3 21~.0~ 2~ PCT/US92/04205 For these reasons, it would~be desirable to provide improved methods and appara~us for manipulating and dissecting gallbladders during laparoscopio cholecystectomy procedures. It would be particularly desirabl if suc~ methods and apparatus were suitable for performing manipulation and dissection of other body stru~tures during other surgical procedures.
The method and apparatus should provide for controlled move~ent and manipulation of the body structure, preferably using a single instrument that can be manipulated by the physician with one hand.
In the case of the gallbladder, the instrument should minimize the likelihood of bile spillage and should assure that the gallbladder remains expanded, preferably distended~ to better present the dissection plane during the procedure. The method and apparatus should further provide for improved diss ction techniques with reduced bleeding and tearing of the gallbladder, optionally providing for electrocautery capabilities.
2. .. De~qri~t~o~ of tha Baokqrou~ ~rt U.S. Patent No. 4,430,076, describes a device for manipulating the uterus during exa2ination procedures. The device is a handle h~ving a balloon at its end, where the balloon is introduced through the cervix,-inflated, and the handle is~:used to manipulate the uterus for examination purposesO
Pietrafitta et al.~l991) Gastrointestinal`Endoscopy 37:338-343, discloses the use of a dilating balloon to distend the pylorus during laparoscopic pyloromyotomy. ~~
- -WO 92/2~298 ` ` ~ ` ' 2'1~1~0 1 ~S`2 -4- PCl`/US92/04205 ` ~`
8~SARY OF THE :~NVENTIO~
According to the present invention, improved methods and apparatus are provided for manipulating and dissecting body structures during surgical 5 procedures, such as the gallbladder during laparoscopic cholecystectomy procedures. The methods co~prise introducing an expandable member disposed on the distal end of a rigid shaft into the interior of the body structure, usually through a penetration in the body s~ructure wall. The expandable member is then expanded to occupy at least a major portion of the interior volume, and the body structur~ can then be manipulated using the proximal end of the rigid shaft which remains available to the treating physician outside of the patient's body. Using the shaft, the physician can manipulate the hollow body structure with a single hand and can dissect the structure from surrounding tissue using a dissection instrument with ths other hand. Positioning of the body structure is much easier and can be more precisely control~ed than was possible usi~g multiple :~: grasping instruments. Moreover, the need to employ surgical assistants for positioning the body structure i8 reduced or eliminated entirely.
Additionally, internal expansion of the body organ : permits distention (over expansion) to better present the dissection plane~during the dissection procedure.
In a first preferred aspect of the present invention, ~ the expandable member and shaft arè introduced .
Pietrafitta et al.~l991) Gastrointestinal`Endoscopy 37:338-343, discloses the use of a dilating balloon to distend the pylorus during laparoscopic pyloromyotomy. ~~
- -WO 92/2~298 ` ` ~ ` ' 2'1~1~0 1 ~S`2 -4- PCl`/US92/04205 ` ~`
8~SARY OF THE :~NVENTIO~
According to the present invention, improved methods and apparatus are provided for manipulating and dissecting body structures during surgical 5 procedures, such as the gallbladder during laparoscopic cholecystectomy procedures. The methods co~prise introducing an expandable member disposed on the distal end of a rigid shaft into the interior of the body structure, usually through a penetration in the body s~ructure wall. The expandable member is then expanded to occupy at least a major portion of the interior volume, and the body structur~ can then be manipulated using the proximal end of the rigid shaft which remains available to the treating physician outside of the patient's body. Using the shaft, the physician can manipulate the hollow body structure with a single hand and can dissect the structure from surrounding tissue using a dissection instrument with ths other hand. Positioning of the body structure is much easier and can be more precisely control~ed than was possible usi~g multiple :~: grasping instruments. Moreover, the need to employ surgical assistants for positioning the body structure i8 reduced or eliminated entirely.
Additionally, internal expansion of the body organ : permits distention (over expansion) to better present the dissection plane~during the dissection procedure.
In a first preferred aspect of the present invention, ~ the expandable member and shaft arè introduced .
3 0 through a penetration f onmed by advancing a sharp tip at the distal e~d of the shaft through a wall or the ~ody structure. The expandable member is disposed proximally of the sharp tip and enters the interior of the body structure by continuing to ad~ance the 35 shaft in the direction of penetration. Usually, the W0~2/21298 ,2 11 0 1 5 2 PcT/u~g2/~42~` `~ -~ sharp tip will be protected immediately after the ; initial penetration in order to prevent undesired perforations or other injury to the body structure.
,` Protection can be achieved by either retraction or shielding or the tip, ~s described in more detail in connection with the apparatus hereinaf~er. In some cases, however, the dissection method of the present invention will rely on introducing the shaft and expandable member through a natural body orifice and will not require penetration of a wall of the body structure.
I n a second preferred aspect of the method of the present invention, t~e gallbladder will be drained o l bile prior to expansion of the Pxpandable member, and `J 15 the wall penetration will be aspirated during the remainder of the procedure to prevent bile leakage.
Such draina~e and aspiration are preferably effected by using particular drainage and aspiration lumens within the apparatus of the present invention, as described in ~ore detail ~ereinbelow.
- . .
Apparatus according to the present invention includ~
- a device for manipulating the hollow body structure, where the device comprises a rigid shaft having a proximal end and a distal end, and an expandable ZS ~ember disposed near the distal end of the shaft.
The expandable memb~r is ùsually an elastic ~alloon which can expand and conform to the interior of the hollow body structure, although other expansion means ~; such as expandable cages and coils would also be ! 30 ~uitable, ,j . .
A first embodiment of the manipulating device will include both a sharp tip and a blunt tip disposed near the distal end of the rigid shaft. Mean~ will be pro~ided for axially translating the sharp tip W092/2129~` 2 i i O 1 5 ~ -6- PCT/US92/B4~``'' relative to the blunt tip, ~o that the sharp tip can be advanced and exposed during the initial stages of the procedure when the wall of the body structure is to b penetrated. After the device has entered the S int~rior of the body ~tructure, the blunt tip can then be advanced relative to the sharp tip (or the sharp tip retrActed relative to the blunt tip) to protect the sharp tip and reduce the risk of unintended perforations and other injuries to the body structure.
In a second embodiment, the manipulation device of the present invention will include means for draining bile from the interior of the gallbladder and for aspirating leakage which may occur around the site of device penetration into the gallbladder. The drainage means will u~ually comprise a lumen within the rigid shaft which can be connected at its proximal end to a suitable vacuum (aspiration~
source. The aspiration means will usually comprise an:outer tube or sleeve which is coaxially ~isposed over the rigid shaft. The aspiration ~lee~e will usually include a resilient tip which can ~eal about the site of penetration, and the proximal end of the sleeve will be attached to a suitable vacuum (aspiration) ~ource. Numerous specific design~ for providing the desired drainage end aspiration-~capabilities-may be provided. , . . --Apparatus according to the present invention alsoinclude a dissection deYice comprising a shaft having a special~zed dissection head. The dissection head compri~es a cylindrical body having a plurality of axially oriented channels circumferentially spaced-apart thereabout. Means are provided for driving the - di~section head, either by rotation or oscillation, at a relatively high rate, typically in the range 21 r PC77US92~04205 1013 2 7 ~PE~1US 21DEC1~92 from about 2000 rpm to 20,000 rpm. Preferably, the dissection head will have a length in the range from about 2 mm to 20 mm, preferably from about 5 mm to 15 mm, a diameter in the range from 1 mm to 10 mm, preferably from about 1.5 mm to about 4 mm, and from about 4 to 10 axial channels disposed thereabout.
Such a dissection device has been found to effectively separate body structures, such as the gallbladder from surrounding tissues, with a minimum of tearing and bleeding in either the body structure or the ~issue.
-Methods according to the present invention willfurther comprise use of the dissection de~ice, either in combination with the manipulator device or separat~ly from the manipulation device.
BRIEF D13SCRIPT:I:ON OF T~I}3 DR~WINGS
Fig. 1 i3 a perspecti~e view of a body structure manipulator device constructed in accordance with the prlnciples of the pre~ent in~ention.
Fig. 2 i~ a ~ide elevational view of the distal end of the device of Fig. 1, shown in section with a shaxp tip element being advanced and a balloon element being deflated.
Fig. 3 is a side elevational view similar to Fig. 2, except that the harp tip element ha~ been retracted and the balloon element has been inflated.
~ig. 4 illustrates the proximal end of the manipulator device of Fig. 1, shown in partial section with portions broken away.
~B~l~E ~HEE~
lPEAlUS
W09212l2g8 ~ ;01. 5 2 PC~/US92/D420~
,,, . _ _ ,., FigO 5 illustrates an alter~ate embodiment of a manipulator device construc~ed in accordance with the principles of the present invention.
Fig. 6 is a side elevational ~iew of a dissection device constructed in accordance with the principles.
of the present invention.
Fig. 7 is a detailed view of the distal end of the dissection device of Fig. 6, illustrating the dissection head.
-~0 Figs. 8A - 8C illustrate the method of the present invention for manipulating and dissecting a gallbladder.
Figs. 9, 10 and 11 illustrate the method of the invention for manipulating and dissec~ing the gallbladder in conjunction with an abdominal lifting device to facilitate access.
Figs. 12 and 13 illustrate two e~bodiments of the manipulating devi~e of the inventionO
Fig. 14 illustrates a modification of the method illustrated in ~ig~. 9-11 wherein the gallbladder i8 viewed fr~ the exterior of the abdominal lifting d~vice~
Figs. 15, 16,--18, 18A and 19 illustrate pre~erred embodiments of the manipulating device of the invention.
.. . ...
Fi~s. 17A, ~ and C illustrate the usa o~ the devices in Fig5. 15 and 16.
WO92/21298 9_ 2 1 1 0 1 5 2 PCT/US92/n4205..
Figs. l9A and B illustrate the use of the device in Fig. 19.
D~8C~PTION_OF THE 8PE~IFIC EMBODIH~NT8 The method and apparatus of the present invention are useful for manipulating and dissecting a variety of body structures in surgical procedures, parti~ularly minimally invasive surgical (MIS) procedures where the apparatus are introduced through narrow diameter trocar sleeYes and manipulated under the control of imaging equipment, as described generally above.~
While th~ methods and apparatus are particularly useful for removing the gallbladder during laparoscopic cholecystectomy procedures, as will be described in detail below, and they will also be useful for treating other body organs and structures during other surgical procedures, both MXS and conventional open surgical procedures. For example, the ~ethods and apparatus of the present invention will be useful for the partial or total removal of 20 .the~stom~ch in gastrectomy procedures; manipulation o the intestine during bowel resection and other procedures; manipulation of the uterus in hysterectomy procedures; manipulation of a segment of the lung in lung resections; manipulation of pericardial cavity in cardiac diagnostic and .
: therapeutic procedures including endocardial mapping, ~blation,- and de~ibrillation electrode placement; and the lik~.~ Thi~ list of ~ody structures~and procedures is not meant to be sxhaustive, and the methods and apparatus of the present invention may ~.nd-a variety o~ additional uses. .
The ~ethods of the present invention rely on introducing an expandable member to the interior volume of a hollow body structure, usually thr3ugh a WOg2/21298 ~ 5` 2 lo PCT/US92/W205 ';~' penetration formed in the wall of the structure.
~.
Direct entry of the expandable member through the structure wall is usually preferable to entry through a natural orifioe, either because no natural orifice 5 is available (e~g., in the case of the gallbladder) - or be~ause the entry path through the ori~ice is so long or tortuous that ît impedes subsequent manipulation of the body structure (e.g., ~ introduction through the esophagus into the stomach b 1 0 and through the vagina and cervix into the uterus).
In some cases, however, it may be feasible to introduce the expandable member through a natural body orifice in such a way that permits ~ubsequent manipulation, although it will generally be less 15 preferred.
~jl It will be appreciated that in certain methods of utiIizing the present invention, such as during the removal of a gallbladder, a lifting device such as a ~ ~ compression balloon will be first inserted into the ;~ 20 abdo~inal cavit~ to displace the liver and gallbladder for access. ~ By providing such access to ~ the gallbladder, it ~ay be laparoscopically gripped ¦ the externally of the lifting balloon in the abdominal cavity and then dissected. Various 25 mechanical extraction schemes of the abdominal cavity ¦~ to ~llow intraperitoneal placement via s~all inci~ion~ or puncture ites, may ~e accomplished by means of either externally disposed posts or mechanical arms, or by means of-inflatable bags or balloons which are expanded within the abdomen. J A
small opening is formed in the abdominal wall and-lifting device is inserted-into the abdomen through the opening in a con~racted state. Once within in the abdomen~ the device is extended to engage an extensive area of the abdominal wall and the wall is lifted with the device. The lifting device 0~2/212g8 `` ~```'`` 2~10~12.~ P~Jvs92/o42 facilitates certain operations u~ilizing the present invention on such organs such as the gallbladder.
The expandable member will be located at the distal end of a rigid shaft whic~ permits manipulation of S the body ~tructure from its proximal end. By "rigid"
it is meant that the shaft will have minimum flexibility so that manipulation at the proximal end will be ~ransmitted with minimum deflection to the distal end (where the expandable member is disposed within the body structure). Usually, the rigid shaft will be composed of metal, such as surgical stainless steel, although rigid plastic shafts may also find use.
.
In a preferred embodiment of the present invention, a sharp tip will be provided at or near the distal end of the rigid shaft. The sharp tip may be formed as a part of or integrally with the rigid shaft, or may be formed on a ~eparate tubular or other memb~r which is a~so~iated with the:rigid shaft. The sharp tip is provided to effect the initiàl penetration thr~ugh the body structure wa}l, and the method ~f the present inven~ion will usually provide for protection or shielding of the æharp tip after the penetration has bean made. Specific approaches for prot~cting the:sharp tip will be described in more detail in connection-with the apparatus hersinafter.
Once inside the hollow body structure,(the expandable member will be expanded to fill at least a major portion o~ the interior volume. It will be appreciated that the degree of contact between the expandable member and the interior wall of the body structure will ~n large part determine the degree of control which can be exercised over the structure.
Thus, by expanding the expandable member to occupy WO92~212g8 ` ;~ 015Z -12- PCT/U~2/04~0s !`~
substantially the entire interior volume of the hollow body structure, a gr~at degree of control can be obtained. In many cases, it will be desirable to expand the expandable member sufficiently to distend the body st~ucture (i.e., stretch the structure outward in all directions) so that the structure is firmly held by the expandable member on the rigid shaft. Such distension allows highly controlled manipulation and also ~erves to expose the dissecting plane by stretching the boundary interface between the structure and the surrounding tissue. In this way, the body stru¢ture can be pushed, pulled, ~
turned, and otherwis~ manipulated during the dissection or other procedure.
The methods of the present invention further provide for removal and containment of the contents of the body structure, minimizing the risk that the contents will be a~cidentally spilled or leaked during the procedure. In conventional cholecystectomy and other procedures, the contents of the body structure are : normally not removed since they.maintain the shap~ of th2 structure and facilitate dissection. With the present inventio~, however, it is possible to remove the content~ and thereafter expand the bQdy structure from the interior to maintain the desired shape and ~acilitate dissection. Conveniently, removal of the con~ents of the b~dy structure-can be-achieved by~
drain~ge through the shaft while contain~nt around the site of penetration is achieved using a separate sealing member.
.
Referring now to Figs. 1-4, a first embodi~ent of a ma~ipulation device 10 constructed in accordance with ~he principles of the present invention will be described. The ma~ipulation device 10 comprises a rigid shaft 12 having an expandable member 14 located . W092/212~8 ~ 2,1,1`015i,2 PCT/US92r~42~`~-at its distal end. As illustrated, the expandable member 14 is an inflatable ~alloon formed from an elastic material, such as silicone rubber, latex rubber, or the liXe, which when inflated can conform to the interior surface of the hollow body structure.
It will be appreciated, however, that a variety of other expandable members, such a~ expandable coils, expandable cages, and other conformable members could be provided in place of the balloon 14. Use of the balloon is particular convenient, and it is presently contemplated as the preferred mode for carrying out the invention.
The balloon 14 can be inflated through an annular inflation lu~en 16 which is defined by an inflation . 15 tube 18 mounted coaxially about the rigid shaft 12.
The inflation tube 18 may itself be rigid, e.g., a metal tube, or may be a flexible polymeric sheath formed over the shaft 12. Polymeric inflation sheaths may be rigid or flexible, altbough flexible sheaths will usually be non-elastic so that they will not expand-~substantially under the:inflation pres~ure being applied to the inflatable balloon 14. A
preferred material for the inflation tube 18 is surgical stainles~ steel since it enhances the rigidity of t~e shaft 12.
T~e manipulation device lO will further include a A-sharp-tip 20~disposed generally at the distalrend`of rigid shaft 12.:- In this particular embodiment, the sharp tip 20 is.formed at the distal end of a rigid tube 22 which can be axially translated between a distally extended configuration:~as illustrated in-Fig. 2) where the sbarp tip 20 defines the distal tip of device lO and a retracted configuration ~as illustrated in Fig. 3) where the inflation balloon 14 is exposed at the distalmost poi~t of the device.
W092/2129~ 2 1 1; 0 1 5 2 -14- PCT/U~g2/0420s.~w The manipulation devi~e lO urther comprises a coaxial sleeve 30 formed over the tube 22 and terminating in a resilient tip element 320 The resilient tip element 32 is illustrated as a metal spring 34, typically composed of stainless steel, covered by a thin plastic or elastic membrane 36.
The purpose of the resilient tip is to seal about the penetration formed by the sharp tip 20 in the wall of the body structure. The resilient tip 30 can conform to the exterior of the wall about the penetration and will compre~s against the force of spring 34 as the tip is urged against the wall of the body structure (after penetration). Other structuresl such as bellows ~nd accordion configurations, could al~o find use. The sleeve 30 itself will be generally rigid with sufficient hoop strPngth to withstand the negative pressure of aspiratio~. Yarious polymeric materials, such as polyethyl~ne and polyvinyl chloride, will be suitable.
In a preferred aspect of the present invention, the ~leading ~dge 38 of the resilient tip 32 will be located over the balloon 14, usually-being located approximately half way down the length of the balloon as illustrat~d in Fig. 2. In this way, after the balloon is fully inserted into the desired body structure, the resilient tip will neces~arily be c~mpressed. The resulting spring force will assure that a relatively tight seal is achieved between the tip 33 anq the outside wall of the body s~ructure,:
further helping to minimize leakage.
A housing 40 is disposed at the-proximal end of rigid ~haft 12 and providPs the necessary inflation and aspiration connections for the device, as well as providing means for axial translation of the sharp tip 20. Axial translation is effected by a handle 42 .WO92/21298 2 1 1 ~ 1 5 2 PCr/US92/04205 which is ~ttached to the proximal end of the tube 22 -whic~ carries the sharp tip 20 at its distal end.
The handle 42 travel~ in a slot 44 formQd axially in the housing 40, including detents 46 and 48 for securing the tube 22 and tip 20 in their forwardmost and rearwardmQ~t positions. An O-ring 50 provided at the proxi~al end of tube 22 to . eal again~t the exterior of inflation tube 18. In this way, the open end ~f tube 22 is isolated from the outsid~ ~to i~ibit gas leakage in laparoscopic procedure~).
J
Rigid sha~t 12 terminates at its proximal end in a connector 52 which may be interconnected with a suitable aspiration ~ource (not illustrated~ in order to drain the interior of the hollow body ~tructure.
The shaft 12 will typically be a hollow tube havin~
an open distal end 54 so that the contents of the body structur can be drained by aspirating through the connector 52 after the shaft 12 has been introduced, typlcally prior to ~alloon inflation.
s~ , , ~ 20 A ~eco~d!connector 60 is for~ed on the infl~tion-tu~e f ~ ~18 and co~municates with the annular inflation lumen 16. In thi~ way, balloon 14 can be inflated by applying an appropriate inflation medium, such as ,J saline, air, or t~e l~ke, through the connector 60.
The inflation pres~ure will depend on the nature of the balloon l~ a~ well:as ~he nature of the body tructure being expanded. In the case of gallbladder6 being expanded wi~h silicone rubber balloons, ths inflation pressure will typically be in the range fro~ about 0.5 to 5 p8i, usually being in the range from-~bout-1 to `2 psi. The total expanded volume of the balloon 14 (when used for gallbladder or manipulation~ will typically be in the range from ~bout 25 to 75 ml, usually being fro~ 40 to 60 ~1.
..
wo 92/2,298 - 2 1 1 0 1 5 2 - -16- PC~US92/042~ i~
A third ~onnector port 66 is provided on the coaxial sleeve 30 and is suitable for connection to an aspiration source. In this way, the region surrounding the penetration can be aspirated through the seal formed by resilient tip 32.
.
The overall dimensions of the device 10 will be ~elected dapending on the hollow body ~tructure being trea~ed. For the tr~atment of the gallbladder, the device 10 will typically have a length in the range from about 30 to 75 cm, usually being from about 40 to 50 cm. Th~ maximum diameter of the device, i.e.~, the outside diameter of the coaxial sleeve 30, will typically be less than 10 mm, preferably being in the range from about 5 mm to 7 mm.
A second embodiment 80 of the manipulation device of the pres~nt invention is illustrated in Fig. 5. The device 80 comprises a rigid shaft 82 having a sharp tip 84 formed at its distal end. The rigid ~ha~t 12 will usually be ormed from metaI or a rigid pla~tic, typically being surgical stainle~s stael. An inflatable balloon 85 ic se~ured to the di6tal end of the rigid shaft 82 and will lie just proxi~ally of the sharp tip 84. The balloon 86 will typically be compo~ed or an elactic polymer, such as sili~one rubber, and will be inflatable through an inflàtion tube~-88 which is coaxially mounted over the rigid l:
~ha~t 84. The inflation tube 84 i~ connected throug~
a connector port 90 located at the proximal end thereof. An outer sleevs 92 i8 formed coaxially about the inflation tube 88 and terminates in a -.-res~lient tip 94, typically formed from a spring 96 and elastic membrane 98. The outer tube 92 is connected to an aspiration port 100 at its proximal end $o permit aspiration around the penetration .- ^ ~i - ` 21101S2 ~P~Us 21DE~
A third connector port 66 is provided on the coaxial sleeve 30 and is suitable for connection to an aspiration source. In this way, the region surrounding the penetration can be aspirated through the seal formed by resilient tip 32.
The overall dimension~ of the device 10 will be ~elected depending on the hollow body structure being treated. For the treatment of the gallbladder, the device 10 will typically have a length in ~he range from about 30 to 75 cm, usually being from about 40 to 50 cm. The maximum diameter of the device, -i.e., the out~ide diameter of the coaxial sleeve 30, will typically be less than 10 mm, preferably being in the range from about 5 mm to 7 mm.
A second embodiment 80 of the manipulation device of the present invention is illustrated in Fig. 5. The device 80 comprises a rigid shaft 82 having a sharp tip 84 formed at it3 distal end. The rigid sha~t 82 will u~ually be formed from metal or a rigid plastic, typically being surgical stainless steel. An inflatable balloon 86 is secured to the di3tal end of the rigid shaft 82 and will lie just proximally of the sharp tip 84. Th~ balloon 86 will typically be composed or an elastic polymer, such as silicone rubber, and will be inflatable through an inflation tube 88 which is coaxially mounted over the rigid ~haft 84. The inflation tube 84 is connected through a connector port 90 located at the proxlmal end thereof. An outer sleeve 92 i~ formed coaxially about the inflation tube 88 and terminates in a resilient tip 94, typically formed from a spring 96 and ela3tic membrane 98. The outer tube 92 i9 connected to an aspiration port 100 at its proximal end to permit aspiration around the penetration SllBSTlTUTE ~tlEE~
IPEA/US
2110152 P~c~lvs92/o42n~
17- ~ 21 ~ Cl~g2 formed by sharp tip 84 when inserted through the wall of the body structure.
A protection rod 104 is slidably mounted in an axial lumen 106 of the rigid shift 82. An 0-ring 108 provides a sliding seal between the proximal end of rigid shift and the exterior of protection rod 10~ to isolate the i~terior of the body structure when the device 80 is in use. The protection rod 104 may be extended distally from rigid shaft 82, as illustrated in broken line, in order to protect ~he hollow body structure from the charp tip 84 after the device has been inserted through the body structure wall. The protection rod 104 can be axially advanced and retracted simply by pulling on a proximal connector 110. A stop member 112 i9 provided to prevent over ex~en3ion of the protec~ion rod 104. Connector 110 al90 provides connection to a suitable aspiration source for drainage of the interior of the body structure. The protection rod 104 includes a hollow lumen which pro~ides a drainage path through the device 80.
Referring now to Fig3. 6 and 7, a dis3ection de~ice 120 constructed in accordance with the principle~ of the present invention will be de~cribed. The dis~ection de~ice 120 comprises 9 rigid ~haft 122 having a distal e~d 124 and a proximal end 126. A
drive shaft 128 extends through a central lumen of the shaft i22 and terminates in a di3section head 130 at its proximal end. A handle 132 is connected to the proximal end 126 of 3haft ~22 and includ2s a motor drive means capable of ro~ating or o~cillating the dri~e ~ha~t 128. The frequency of rotation (or Qscillation) will typically be from about 2000 rpm to 20,000 rpm, preferably being in the range from about 5000 rpm to 10,000 rpm. A switch 144 will be ~UBSTlTUTE ~HEFr IPE~/US
~1~01~2 /~/VS92/042o5 -18- , JP~S 21 DEC 1~92 ~.
provlded on handle 132 for turning on and off the dissection head 130.
The dissection head 120 is formed as a cylindrical body having a plurality of axial channels 136 formed therein. The cylindrical body has a length generally in the range from about 2 mm to 20 mm, preferably being in the range from about 5 mm to 15 mm, and a diameter in the range from about 1 mm to 10 mm, pre~erably in the range from about 1.5 mm to 4.0 mm.
Usually, from about 4 ~o 10 axial channel~ will be formed, more usually being equally circumferentially ~ spaced-apart.
The dissection device 120 i9 particularly well suited for in~roduction through a trocar sleeve for use in laparoscoplc and other minimally invasive ~urgical procedure~. The diameter of ~haft 22 will be sufficient'y small to permit 3uch introduction, typically being 5 mm or less. The dissection device 120 is u~ed by contacting the dissection head 30 at the dis~ectio~ boundary, i.e, the interface between the ti~ue and body structure to be dissected from the ti3~ue, and initiating rotation and/or Q cillation of the head. Use of the high frequency rotation or oscillation has been found to provide a relatively clean separation between the tissue and body structure with minimal risk of bleeding, perforation, or other undesirable injuries.
Preferably, the diss~ction device 20 will further include an electrode 140 at its distal tip.
Electrode 140 can be connected to a conventional electrocautery power supply, typically a monopolar power supply through a connector 142 which is dispo ed at the proximal end of the handle 132.
Thu~, the dissection deYice 20 can be used to ~3STlTUT S~.E~
IpFAJII~
~ R ._ wo g2/2l298 `~ ` 2 1 1 ~ 1 $ 2 i ~ f~ PCT/US92/042~'~
- ` --19--cauterize any cuts or tears which are accidentally caused, without need to introduce a separate electrocautery device.
Re~erring now to Figs. 8A - 8C, use of the manipulatîon device 10 and the dissection device 120.
for perfor~ing a gallbladder removal procedure (cholecystectomy) will be described. The figures illustrate the gallbladder GB being dissected fro~
the liver L. The instruments utilized, including both the manipulation device 10 and the dissection device 120, will have been introduced through conventional trocar sheaths in a well known manner for performing laparoscopic cholecystectomy.
Initially, a portisn of the outside wall of the 15 gallbladder GB is grasped with a conventional forceps grasper 150, as illustrated in Fig. 8A. The sharp : tip 20 of the manipulator device 10 is then penetrated through the wall of the gallbladder GB
: next to the region-which is held in plaGe by the ; 20 graspers:l50.~
After the penetration has been achieved, device 10 is advanced forward until the resilient tip 32 forms a seal about the site of penetration, as illustrated in Fig.~ 8B~ The sharp tip 20 will be retracted by ~x~ally.*ranslating the tube 22 in a proximal - - :
~` direction,~andithe content~ of the gallbladder (bile) will.be withdrawn through the~interior lu~en of the shaft 12.- After the contents have been largely drained, the balloon l4 i~ inflated (as illuQtrated-in broken line in Fig. 8B) to fill'the void which has . ibeen left and expand the gallbladder GB, usually : di~tending thé gallbladder slightly to improve ~ontrol ~nd access. The device 10 may then be used ts manipulate the gallbladder ~B and expose the w~ 92/21298 i ~ 2 1 ~ 2 -20- PCT/US92/042~
dissection plane DP, i.e. the interstitial plane between tbe gallbladder and the liver bed L.
The tissue dissection device 120 is next introduced, and the di~section head 130 contacted with the dissection plane DP (Fig. 8C). The dissection haad .
130 is actuated and used to carefully separate the ` exposed wall of the gallbladder GB fro~ the liver bed L. It will be appreciated that the manipulator , device 10 will be constantly repositioned to expose the dissection plane DP in an optimum manner. The dissection is continued until the gallbladder GB is completely detached from the liver bed L and other surrounding tissue. The inflated balloon 14 can then be deflated, the manipulator device lo withdrawn, and the gallbladder removed through a trocar sleeve in a i conventional manner.
~ Figs. 9, 10 and 11 are perspectiYe views of a device ,~ according to the present invention shown in place ~ within the abdo~inal cavity with a body, with part~
1 20 broken away for illustration and laparoscopic forceps extended into gripping engagement with the gall-bladder. These figures sequentially illustrate the steps of distention and manipulation device laparoscopically into the akdominal cavity and into-a gripping engagement~with the gallbladder. Referring to Fig.~9,~forceps.200.are laparoscopically~extended : into gripping èngagement with the gallbladder 20 ~ha procedure i8 ~ Yiewed.through an endo~cope 203~
located within an abdominal balloon lifting device?;
203a. With the gallbladder so gripped, a ~
laparoscopic d~ 8t8ntion, `manipulation and remo~al tool 202 according to the invention, is extended into the abdominal caYity in piercing engage~ent with the gallbladder, a6 depicted by the arrow line in Fig~
10. The tool 202 takes the form of a dual lumen ~ W092/2~2~8 ~ 3 ` ' ~ 2 l l O li~ P~T/US92/~42~-."
tubular needle having a sharpened open end through which the contents of the gallbladder may be drawn and an annular balloon which may be inflated through the lumen of the tool communicating therewith. Once the tool has been used to evacuate the contents of the gallbladder, the balloon 204 is in~lated and assu~es internal gripping engagement with the gall-bladder. The tool may then be manipulated, thu~
maneuv~riny the gallbladder within the abdominal ~0 cavity or exerting tension on it as depicted by the arrow line in Fig. 11. Depending upon the size of the gallbladder, the remo~al of the organ may require some enlargement of the incision through which the tool extends. The forceps would ~e released from the lS gallbladder to permit its manipulation using only the balloon tool. The entire procedure is viewed through the endoscope 203. Following deflation and removal of the balloon, the gallbladder is seized by forceps for further ~anipulation.
Fig~. 12 ana 13 ~how detail o~ ~he tool 202. The d~vice of Fig. 13 corresponds to that of Fig. 12 except-that the tubular needle 202a has a ~ingl~
lu~en only for inflation of the balloon 204 and that the ne~dle 202a does not extend fully through the b~lloon. Thu~, the embodiment in Fig. 13 eannot be uqed to evacuate the gallbladder. In Fig. 12, the needle-202b accommodates a separate channel 206,~
c~municating with the interior of balloon 204 ~ ~-through orifice 205. The end of the needle 202b `
39 accommodat~s orifice 207 through which th~ contents o~-gallbladder 201 may be evacuated.
:. ... .
Fig. 1~ is a cross-sectional view similar to the above, showing a modified ver~ion of the invention wherein the endoscope 203 extends fu}ly through a balloon 208 which serYes as an abdominal li~ting wog2/2l298 `~ 2i~i52 -2~- PCT/USg2/04205t}f;
device. The gallbladder 201 i~ then viewed directly, rather than through the balloon 208.
Referring to Fig. 15 there i~ ~hown an embodiment of the tool according to the invention for insertion into the gallbladder for draining the contents thereof and inflating a balloon for manipulation.
This embodiment permits removal of all rigid or semi-rigid structures from within the gallbladder ~or other organ) prior to ~anipulation to avoid the risk of organ injury. The further improvement is provided in that the needle tip used for organ entry is retracted out of the organ to prevent injury.
Referring to Fig. 15, the organ manipulator device 300 is a rigid structure which allows for control of lS the displacement of the attachsd organ. Therefore, the manipulator devic~ may be of a metallic construction or of other suitable rigid material, whereby the rigidity i~ imparted by one or more of the thr~e concentric tubular members which comprise the device. The innermost tubular member 301 hold~
an elastomeric member 302, which will be inflated in~ide the organ to hold and distend the organ for -manipulation. An elastomeric balloon is preferred because of its initial small profile upon entry into the organ ~nd its ~xpansion capacity upon inflation to fill the ingide of ~he organ. The elastomeri~
member.302 i~ shown~in an inverted position within :
the innermost-tube 30~. The elastomeric ~e~ber 302 ia everted into the organ after protrusion of a ~mall len~th of the dist~l end 303 of the innermo~t tub~
301 into the organ. This is an improvement in that it ~inimizes the length of the innermost tube which mu3t b~ placed into the organ prior to inflation.
The end of the ela~to~eric member 302 is bonded to the digtal end 303 of the innermost tube 301 in a suitable manner, for example by use of adhesive, ` W092/21298;`;i~`- 2 1`i 0 1 ~ 2 PC~/U~2/042~ -~ `~
adhesive with an outer plastic shrink wrapping, adhesive wîth an outer suture winding, and th~ like.
The inner~ost tube 301 ~ay be made of a rigid plastic material ~uch as nylon, PVC, polyethylene, and the like, or, most preferably, ~tainless steel.
: .
The inner~o~t tube 301 is concentrically di~po~ed within a tu~ular needle 304 having a sharp point for piercing the organ~ The needle 304 may extend to completely enclose the innermo~t tu~e 301, in the closed configuration of the device 300, and then may be mechanically retracted proximal to the distai end 303 of the innermost tube 301 to expofie the inner most tube to the interior of the organ. Praferably, the needle 304 is made of stainless steel.
- 15 Retraction of needle 304 is accomplished by exterior handle 305 affixed to needle 304 within the housing 306 at the proximal end of the device 300. Seal~ 307 are provided to ~llow for movement of the tubular needle 304 in a ga~ tight manner. The outer~ost tube ~0 308 i concentric with tubular needle 304 ~nd i~
fixed in position with respect to the inner~o~t tube 301, with the distal end 309 of the outer-'most tube ' 308 being approximately flush with the dist~l end 303 i o~ the inner~o~t tube 301. The outermost tube 308 is ~t~pped down to form a step 310 at it~ distal end, with.th~ inner-dia~eter at the step providing a slip ' Pit wi~h ~he outer diameter of the tubular needle -`
30~ The length of the step i~iprePerably`~out~jo.i -~to 0.15-inche~ The advantage of the step~310 i~ to provide a ~echanical stop during insertion of th~
device 300 into the organ. When the needle tip of .~,the tubular needle 304 is extended~and used~to - puncture an organ, the needle tip and t~e-stepped down portion 311 of the outer tube 308 easily ent~r 35 the organ wall. When the outer wall of the organ impacts the ~tep 310 on the outer tube 308, the W092/21~9~ 2 1-1' 0 1 5 2 -24- PCT/US92/0~2~ ~
forward progress of the organ manipulator device 300 is halted, thereby guarding against excessive needle travel and puncture of the back wall of the organ.
The stepped down portion 311 may contain radial holes 312 or slots placed around its circumference to assist in drainage of the organ contents when the needle tip is retracted. Vacuum suction ~ay be applied in the volume between the outer tube 308 and the needle 304 as well as in the volume between the needle 304 and innermost tube 301 by application of a vacuum at aspiration port 313 which is in communication with the volu~e between the innermost tube 301 and tubular needle 304. Upon retraction of the needle 304 into the outer most tube 308, aspiration will also be effective within the volume at the distal ends between the needle 304 and the outermost tube 308. The outermost tube 308 is al~o preferably made of a rigid material suc~ as plastic, ~nylon, PVC, polyethylene and ths like) or stainless steel. The housing 306 at the proximal end of the device 300 accommodates the port 313a and the fittings for,~inflation of the elastomeric member 302 - through the~interior of the-inner~ost tube 301.- The tubular needle 304 may be locked in its forward (extended) position for ~ntry~into the organ by a : suitable locking mechanism (not shown) and unlocked and:retracted prior to the balloon inflation. The tubularf-members 301,~:304 and-~308 are ~ealed on their interior ~olume~,5uch that-no-~gas leaks occur when .
the device.i~ introduce into the abdomen or organ for laparoscopic surgery. Inflation of the elastomeric me~ber 302 may be.accomplished using a separate in~lation device~uch as a syringe or a pump. A pump ~ay be built.directly into the housing 306. .
Referring to Fig. 16 there is shown an alternative embodiment o~ the device of figure 15 wherein a ~ump WO 92/2~298 ; ~ - 2il~ l 5 2 ~ PCr/US~2/04205 ~
` --2 5-- -is built into the housing 314. Pumping is actuated ~y a bellows 315 and withdrawal of contents of the interior of the organ i~; conducted through aspiration port 316. There are shown the ctep 317 and radial 5 holes 318 at the distal end 319 of the outermost tube 320. Only the tip of the tubular needle 321 i8 shown.
Referring to Figs. 17A, B and C there is ~:hown the device of Fig~. 15 or 16 in use. For convenience, 10 the same numerals on corresponding elements as described in Fig. 15 will be used in connec:tion with the description of Figure 17. Referring to Fig. 17A, the distal end 309 of the OUt8nllOSt tube 308 is advanced into an abdominal cavity (not shown) through ~5 a properly ~ized trocar with the needle 304 retracted into the tube 308 to protect the needle tip. The tros~ar seals against the tube 308 to maintain the pneumoperitoneum. The needle 304 is advanced out of the outer tube 308 (Fig. 17B~ and a grasping 20 instru~ent ~not shown) stabili2es the wall of the-org2n 400 ~s; 'che extended needle punctureæ through ~the wall and fitOpS at tha end of the outer tube step 310. The needle is then unlocked fron~ its ~xtended po~ition and retracted (dotted outline in Fig. 17B) 25 then ~;uction i8 applied through the ~spirator port ~not shown)~.~which drains the fluid content~ fro~ th~
organ. Then: air i8 pumped through the innerD~ost tube 301~ (Fig.-~ 17C) to evert the balloon 302: out of the~ -inner ~08t tube i nto the organ and pumping i~
30 continued to inflate the balloon within the organ.
The organ may now be m~nipulated for dissection and isolation. for re~oval. Following organ dissection, the balloon iE; def lated to allow detach~ent of the organ.
wo92/2l298 ~``' 2'`i'~`l`b`l`~ 2` -26- PCT/USg2/o42 ~eferring to Figs. 18 and 18A, anothex ambodiment of the device is shown having two concentric tubes instead of three, whereby electrocautery is u~ed to enter the organ instead of a needle. The inner tu~e 450 holds an inverted elastomer balloon 451 and tube 450 is csnnected to a slide arrangement within the..
handle 452 which allows for extension and retraction with respect to the outer tube 453. The mechani6m in the handle 452 provides a locking mechanism 454A and B to lock the inner tube 450 in an extended position.
The proximal end of the inner tube 450 accommodates inflation port 455 for inflating the balloon 451. A
drainage port 456 is provided for evacuating ~he contents of the organ by aspiration. The inner tube 450 i~ preferably made of a rigid material such as stainless steel with an outer insulative sleeve which is electrically insulated with a material such aæ
p~lyvinyl chloride, polyethylene nylon or other plastic. m e outer tube 453 is also preferably stainless steel but may be made of another electrically conducting ~aterial and provide~ a ~oose fit.with the inner tube 459.:-.The outer tube 453 i~
electrically insulated on the outside with insulation 453A, leaving a small portion of the distal end (preferably 2 to 3 millimeters of leng h) uninsul~ted at the-tipO Referring to the detail of the tip in ~ig. 18A, the exposed distal tip 457 is cut away, pre~rably. 50 .that:only an arc of- less than about 180 degrees of the circumference of the outer tube 453 remains. This allows for-cutting of a ~mall curve ~lit by cauterization in the org~n wall instead of a full circle, aiding in the cealing of the organ wall against the shaft of-~the device and minimizing the amount of heat-necrssed tissue that may cause ~he entry hole to enlarge upon traction and ~anipulation o~ the device. An electrocautery connector 458 is provided in the handle 452 to a}low hookup to an W092/21298 , 2 1 1 0 1 5 2 ,-.PCT/US92/042~. --27~
electrocautery generator (not shown). In use, the inner tube 450 is initially withdrawn (preferably approximately l-2 cm.) into the outer tube 453 during entrance through the wall of the organ by cauterization. This prevents the inner tube 450 and balloon 451 from being hsated ~y the tip of the ou*er tube during cautery use. Following entrance of the outer tube into the organ, suction aspiration of the organ contents is performed through port 456. The inner tube 450 is then advanced forward and locked in an extended position. Air is pumped ~hrough port 455 to evert and inflate the balloon 451 in preparatisn f or the organ manipulation .
Ref erring to Fig . l9, another embodiment of the organ 15 balloon manipulator is shown. A needle 500 is provided within a rigid inner tubP 501 and a concentric rigid outer tube 502. An elastomeric sleeve 503 is attached having one edge attached to the distal ends of the inner and outer tube~, respectively. A seal 504 is provided at the proximal end of the device to allow the inner tube 501 to translate longitudinally with respect to the outer tube 502 while maintaining a gas tight seal. A
- locking mechanism 505A and B allows the needle 500 to be po~itioned and locked with respect to inner tube 50l, ~o that the needle 500 is in an armed con~iguration. An in~lation port is proYided for 506 to provide for inflation of the elastomeric.sleeve 503 and an aspiration port 507 is provided for evacuation of t~e organ contents. In use, the needle 500 l8 locXed in a forward position and the device i~
advanced to puncture through the organ wall 510 ~Figs. l9A ~nd B). The needle 500 is unlocked and withdrawn at least partially into the inner tube 50l to prevent injury to tbe organ. Advancement o~ th~
device is continued until the outer tube 502, lies ', "i ' ` `
W092/21298 - 2l I;di 5 2 ~`' PCT/USg21042 within the cavity of the organ. The elastomeric sleeve balloon 503 is inflated (Fig. l9B) and inner tube 501 is retracted with respect to the outer tube 502 until the tips of the inner and outer tubes ~eet.
This action causes t~e balloon 503 to take on 2 toroidal shape and removes all rigid tubes fro~
inside the organ.
Although the foregoing invention has been described in detail for purposes of clarity of understanding, it will be obvious that certain modifications may be practiced within the scope of the appended claims.
.
.
,, ., .
.
,` Protection can be achieved by either retraction or shielding or the tip, ~s described in more detail in connection with the apparatus hereinaf~er. In some cases, however, the dissection method of the present invention will rely on introducing the shaft and expandable member through a natural body orifice and will not require penetration of a wall of the body structure.
I n a second preferred aspect of the method of the present invention, t~e gallbladder will be drained o l bile prior to expansion of the Pxpandable member, and `J 15 the wall penetration will be aspirated during the remainder of the procedure to prevent bile leakage.
Such draina~e and aspiration are preferably effected by using particular drainage and aspiration lumens within the apparatus of the present invention, as described in ~ore detail ~ereinbelow.
- . .
Apparatus according to the present invention includ~
- a device for manipulating the hollow body structure, where the device comprises a rigid shaft having a proximal end and a distal end, and an expandable ZS ~ember disposed near the distal end of the shaft.
The expandable memb~r is ùsually an elastic ~alloon which can expand and conform to the interior of the hollow body structure, although other expansion means ~; such as expandable cages and coils would also be ! 30 ~uitable, ,j . .
A first embodiment of the manipulating device will include both a sharp tip and a blunt tip disposed near the distal end of the rigid shaft. Mean~ will be pro~ided for axially translating the sharp tip W092/2129~` 2 i i O 1 5 ~ -6- PCT/US92/B4~``'' relative to the blunt tip, ~o that the sharp tip can be advanced and exposed during the initial stages of the procedure when the wall of the body structure is to b penetrated. After the device has entered the S int~rior of the body ~tructure, the blunt tip can then be advanced relative to the sharp tip (or the sharp tip retrActed relative to the blunt tip) to protect the sharp tip and reduce the risk of unintended perforations and other injuries to the body structure.
In a second embodiment, the manipulation device of the present invention will include means for draining bile from the interior of the gallbladder and for aspirating leakage which may occur around the site of device penetration into the gallbladder. The drainage means will u~ually comprise a lumen within the rigid shaft which can be connected at its proximal end to a suitable vacuum (aspiration~
source. The aspiration means will usually comprise an:outer tube or sleeve which is coaxially ~isposed over the rigid shaft. The aspiration ~lee~e will usually include a resilient tip which can ~eal about the site of penetration, and the proximal end of the sleeve will be attached to a suitable vacuum (aspiration) ~ource. Numerous specific design~ for providing the desired drainage end aspiration-~capabilities-may be provided. , . . --Apparatus according to the present invention alsoinclude a dissection deYice comprising a shaft having a special~zed dissection head. The dissection head compri~es a cylindrical body having a plurality of axially oriented channels circumferentially spaced-apart thereabout. Means are provided for driving the - di~section head, either by rotation or oscillation, at a relatively high rate, typically in the range 21 r PC77US92~04205 1013 2 7 ~PE~1US 21DEC1~92 from about 2000 rpm to 20,000 rpm. Preferably, the dissection head will have a length in the range from about 2 mm to 20 mm, preferably from about 5 mm to 15 mm, a diameter in the range from 1 mm to 10 mm, preferably from about 1.5 mm to about 4 mm, and from about 4 to 10 axial channels disposed thereabout.
Such a dissection device has been found to effectively separate body structures, such as the gallbladder from surrounding tissues, with a minimum of tearing and bleeding in either the body structure or the ~issue.
-Methods according to the present invention willfurther comprise use of the dissection de~ice, either in combination with the manipulator device or separat~ly from the manipulation device.
BRIEF D13SCRIPT:I:ON OF T~I}3 DR~WINGS
Fig. 1 i3 a perspecti~e view of a body structure manipulator device constructed in accordance with the prlnciples of the pre~ent in~ention.
Fig. 2 i~ a ~ide elevational view of the distal end of the device of Fig. 1, shown in section with a shaxp tip element being advanced and a balloon element being deflated.
Fig. 3 is a side elevational view similar to Fig. 2, except that the harp tip element ha~ been retracted and the balloon element has been inflated.
~ig. 4 illustrates the proximal end of the manipulator device of Fig. 1, shown in partial section with portions broken away.
~B~l~E ~HEE~
lPEAlUS
W09212l2g8 ~ ;01. 5 2 PC~/US92/D420~
,,, . _ _ ,., FigO 5 illustrates an alter~ate embodiment of a manipulator device construc~ed in accordance with the principles of the present invention.
Fig. 6 is a side elevational ~iew of a dissection device constructed in accordance with the principles.
of the present invention.
Fig. 7 is a detailed view of the distal end of the dissection device of Fig. 6, illustrating the dissection head.
-~0 Figs. 8A - 8C illustrate the method of the present invention for manipulating and dissecting a gallbladder.
Figs. 9, 10 and 11 illustrate the method of the invention for manipulating and dissec~ing the gallbladder in conjunction with an abdominal lifting device to facilitate access.
Figs. 12 and 13 illustrate two e~bodiments of the manipulating devi~e of the inventionO
Fig. 14 illustrates a modification of the method illustrated in ~ig~. 9-11 wherein the gallbladder i8 viewed fr~ the exterior of the abdominal lifting d~vice~
Figs. 15, 16,--18, 18A and 19 illustrate pre~erred embodiments of the manipulating device of the invention.
.. . ...
Fi~s. 17A, ~ and C illustrate the usa o~ the devices in Fig5. 15 and 16.
WO92/21298 9_ 2 1 1 0 1 5 2 PCT/US92/n4205..
Figs. l9A and B illustrate the use of the device in Fig. 19.
D~8C~PTION_OF THE 8PE~IFIC EMBODIH~NT8 The method and apparatus of the present invention are useful for manipulating and dissecting a variety of body structures in surgical procedures, parti~ularly minimally invasive surgical (MIS) procedures where the apparatus are introduced through narrow diameter trocar sleeYes and manipulated under the control of imaging equipment, as described generally above.~
While th~ methods and apparatus are particularly useful for removing the gallbladder during laparoscopic cholecystectomy procedures, as will be described in detail below, and they will also be useful for treating other body organs and structures during other surgical procedures, both MXS and conventional open surgical procedures. For example, the ~ethods and apparatus of the present invention will be useful for the partial or total removal of 20 .the~stom~ch in gastrectomy procedures; manipulation o the intestine during bowel resection and other procedures; manipulation of the uterus in hysterectomy procedures; manipulation of a segment of the lung in lung resections; manipulation of pericardial cavity in cardiac diagnostic and .
: therapeutic procedures including endocardial mapping, ~blation,- and de~ibrillation electrode placement; and the lik~.~ Thi~ list of ~ody structures~and procedures is not meant to be sxhaustive, and the methods and apparatus of the present invention may ~.nd-a variety o~ additional uses. .
The ~ethods of the present invention rely on introducing an expandable member to the interior volume of a hollow body structure, usually thr3ugh a WOg2/21298 ~ 5` 2 lo PCT/US92/W205 ';~' penetration formed in the wall of the structure.
~.
Direct entry of the expandable member through the structure wall is usually preferable to entry through a natural orifioe, either because no natural orifice 5 is available (e~g., in the case of the gallbladder) - or be~ause the entry path through the ori~ice is so long or tortuous that ît impedes subsequent manipulation of the body structure (e.g., ~ introduction through the esophagus into the stomach b 1 0 and through the vagina and cervix into the uterus).
In some cases, however, it may be feasible to introduce the expandable member through a natural body orifice in such a way that permits ~ubsequent manipulation, although it will generally be less 15 preferred.
~jl It will be appreciated that in certain methods of utiIizing the present invention, such as during the removal of a gallbladder, a lifting device such as a ~ ~ compression balloon will be first inserted into the ;~ 20 abdo~inal cavit~ to displace the liver and gallbladder for access. ~ By providing such access to ~ the gallbladder, it ~ay be laparoscopically gripped ¦ the externally of the lifting balloon in the abdominal cavity and then dissected. Various 25 mechanical extraction schemes of the abdominal cavity ¦~ to ~llow intraperitoneal placement via s~all inci~ion~ or puncture ites, may ~e accomplished by means of either externally disposed posts or mechanical arms, or by means of-inflatable bags or balloons which are expanded within the abdomen. J A
small opening is formed in the abdominal wall and-lifting device is inserted-into the abdomen through the opening in a con~racted state. Once within in the abdomen~ the device is extended to engage an extensive area of the abdominal wall and the wall is lifted with the device. The lifting device 0~2/212g8 `` ~```'`` 2~10~12.~ P~Jvs92/o42 facilitates certain operations u~ilizing the present invention on such organs such as the gallbladder.
The expandable member will be located at the distal end of a rigid shaft whic~ permits manipulation of S the body ~tructure from its proximal end. By "rigid"
it is meant that the shaft will have minimum flexibility so that manipulation at the proximal end will be ~ransmitted with minimum deflection to the distal end (where the expandable member is disposed within the body structure). Usually, the rigid shaft will be composed of metal, such as surgical stainless steel, although rigid plastic shafts may also find use.
.
In a preferred embodiment of the present invention, a sharp tip will be provided at or near the distal end of the rigid shaft. The sharp tip may be formed as a part of or integrally with the rigid shaft, or may be formed on a ~eparate tubular or other memb~r which is a~so~iated with the:rigid shaft. The sharp tip is provided to effect the initiàl penetration thr~ugh the body structure wa}l, and the method ~f the present inven~ion will usually provide for protection or shielding of the æharp tip after the penetration has bean made. Specific approaches for prot~cting the:sharp tip will be described in more detail in connection-with the apparatus hersinafter.
Once inside the hollow body structure,(the expandable member will be expanded to fill at least a major portion o~ the interior volume. It will be appreciated that the degree of contact between the expandable member and the interior wall of the body structure will ~n large part determine the degree of control which can be exercised over the structure.
Thus, by expanding the expandable member to occupy WO92~212g8 ` ;~ 015Z -12- PCT/U~2/04~0s !`~
substantially the entire interior volume of the hollow body structure, a gr~at degree of control can be obtained. In many cases, it will be desirable to expand the expandable member sufficiently to distend the body st~ucture (i.e., stretch the structure outward in all directions) so that the structure is firmly held by the expandable member on the rigid shaft. Such distension allows highly controlled manipulation and also ~erves to expose the dissecting plane by stretching the boundary interface between the structure and the surrounding tissue. In this way, the body stru¢ture can be pushed, pulled, ~
turned, and otherwis~ manipulated during the dissection or other procedure.
The methods of the present invention further provide for removal and containment of the contents of the body structure, minimizing the risk that the contents will be a~cidentally spilled or leaked during the procedure. In conventional cholecystectomy and other procedures, the contents of the body structure are : normally not removed since they.maintain the shap~ of th2 structure and facilitate dissection. With the present inventio~, however, it is possible to remove the content~ and thereafter expand the bQdy structure from the interior to maintain the desired shape and ~acilitate dissection. Conveniently, removal of the con~ents of the b~dy structure-can be-achieved by~
drain~ge through the shaft while contain~nt around the site of penetration is achieved using a separate sealing member.
.
Referring now to Figs. 1-4, a first embodi~ent of a ma~ipulation device 10 constructed in accordance with ~he principles of the present invention will be described. The ma~ipulation device 10 comprises a rigid shaft 12 having an expandable member 14 located . W092/212~8 ~ 2,1,1`015i,2 PCT/US92r~42~`~-at its distal end. As illustrated, the expandable member 14 is an inflatable ~alloon formed from an elastic material, such as silicone rubber, latex rubber, or the liXe, which when inflated can conform to the interior surface of the hollow body structure.
It will be appreciated, however, that a variety of other expandable members, such a~ expandable coils, expandable cages, and other conformable members could be provided in place of the balloon 14. Use of the balloon is particular convenient, and it is presently contemplated as the preferred mode for carrying out the invention.
The balloon 14 can be inflated through an annular inflation lu~en 16 which is defined by an inflation . 15 tube 18 mounted coaxially about the rigid shaft 12.
The inflation tube 18 may itself be rigid, e.g., a metal tube, or may be a flexible polymeric sheath formed over the shaft 12. Polymeric inflation sheaths may be rigid or flexible, altbough flexible sheaths will usually be non-elastic so that they will not expand-~substantially under the:inflation pres~ure being applied to the inflatable balloon 14. A
preferred material for the inflation tube 18 is surgical stainles~ steel since it enhances the rigidity of t~e shaft 12.
T~e manipulation device lO will further include a A-sharp-tip 20~disposed generally at the distalrend`of rigid shaft 12.:- In this particular embodiment, the sharp tip 20 is.formed at the distal end of a rigid tube 22 which can be axially translated between a distally extended configuration:~as illustrated in-Fig. 2) where the sbarp tip 20 defines the distal tip of device lO and a retracted configuration ~as illustrated in Fig. 3) where the inflation balloon 14 is exposed at the distalmost poi~t of the device.
W092/2129~ 2 1 1; 0 1 5 2 -14- PCT/U~g2/0420s.~w The manipulation devi~e lO urther comprises a coaxial sleeve 30 formed over the tube 22 and terminating in a resilient tip element 320 The resilient tip element 32 is illustrated as a metal spring 34, typically composed of stainless steel, covered by a thin plastic or elastic membrane 36.
The purpose of the resilient tip is to seal about the penetration formed by the sharp tip 20 in the wall of the body structure. The resilient tip 30 can conform to the exterior of the wall about the penetration and will compre~s against the force of spring 34 as the tip is urged against the wall of the body structure (after penetration). Other structuresl such as bellows ~nd accordion configurations, could al~o find use. The sleeve 30 itself will be generally rigid with sufficient hoop strPngth to withstand the negative pressure of aspiratio~. Yarious polymeric materials, such as polyethyl~ne and polyvinyl chloride, will be suitable.
In a preferred aspect of the present invention, the ~leading ~dge 38 of the resilient tip 32 will be located over the balloon 14, usually-being located approximately half way down the length of the balloon as illustrat~d in Fig. 2. In this way, after the balloon is fully inserted into the desired body structure, the resilient tip will neces~arily be c~mpressed. The resulting spring force will assure that a relatively tight seal is achieved between the tip 33 anq the outside wall of the body s~ructure,:
further helping to minimize leakage.
A housing 40 is disposed at the-proximal end of rigid ~haft 12 and providPs the necessary inflation and aspiration connections for the device, as well as providing means for axial translation of the sharp tip 20. Axial translation is effected by a handle 42 .WO92/21298 2 1 1 ~ 1 5 2 PCr/US92/04205 which is ~ttached to the proximal end of the tube 22 -whic~ carries the sharp tip 20 at its distal end.
The handle 42 travel~ in a slot 44 formQd axially in the housing 40, including detents 46 and 48 for securing the tube 22 and tip 20 in their forwardmost and rearwardmQ~t positions. An O-ring 50 provided at the proxi~al end of tube 22 to . eal again~t the exterior of inflation tube 18. In this way, the open end ~f tube 22 is isolated from the outsid~ ~to i~ibit gas leakage in laparoscopic procedure~).
J
Rigid sha~t 12 terminates at its proximal end in a connector 52 which may be interconnected with a suitable aspiration ~ource (not illustrated~ in order to drain the interior of the hollow body ~tructure.
The shaft 12 will typically be a hollow tube havin~
an open distal end 54 so that the contents of the body structur can be drained by aspirating through the connector 52 after the shaft 12 has been introduced, typlcally prior to ~alloon inflation.
s~ , , ~ 20 A ~eco~d!connector 60 is for~ed on the infl~tion-tu~e f ~ ~18 and co~municates with the annular inflation lumen 16. In thi~ way, balloon 14 can be inflated by applying an appropriate inflation medium, such as ,J saline, air, or t~e l~ke, through the connector 60.
The inflation pres~ure will depend on the nature of the balloon l~ a~ well:as ~he nature of the body tructure being expanded. In the case of gallbladder6 being expanded wi~h silicone rubber balloons, ths inflation pressure will typically be in the range fro~ about 0.5 to 5 p8i, usually being in the range from-~bout-1 to `2 psi. The total expanded volume of the balloon 14 (when used for gallbladder or manipulation~ will typically be in the range from ~bout 25 to 75 ml, usually being fro~ 40 to 60 ~1.
..
wo 92/2,298 - 2 1 1 0 1 5 2 - -16- PC~US92/042~ i~
A third ~onnector port 66 is provided on the coaxial sleeve 30 and is suitable for connection to an aspiration source. In this way, the region surrounding the penetration can be aspirated through the seal formed by resilient tip 32.
.
The overall dimensions of the device 10 will be ~elected dapending on the hollow body ~tructure being trea~ed. For the tr~atment of the gallbladder, the device 10 will typically have a length in the range from about 30 to 75 cm, usually being from about 40 to 50 cm. Th~ maximum diameter of the device, i.e.~, the outside diameter of the coaxial sleeve 30, will typically be less than 10 mm, preferably being in the range from about 5 mm to 7 mm.
A second embodiment 80 of the manipulation device of the pres~nt invention is illustrated in Fig. 5. The device 80 comprises a rigid shaft 82 having a sharp tip 84 formed at its distal end. The rigid ~ha~t 12 will usually be ormed from metaI or a rigid pla~tic, typically being surgical stainle~s stael. An inflatable balloon 85 ic se~ured to the di6tal end of the rigid shaft 82 and will lie just proxi~ally of the sharp tip 84. The balloon 86 will typically be compo~ed or an elactic polymer, such as sili~one rubber, and will be inflatable through an inflàtion tube~-88 which is coaxially mounted over the rigid l:
~ha~t 84. The inflation tube 84 i~ connected throug~
a connector port 90 located at the proximal end thereof. An outer sleevs 92 i8 formed coaxially about the inflation tube 88 and terminates in a -.-res~lient tip 94, typically formed from a spring 96 and elastic membrane 98. The outer tube 92 is connected to an aspiration port 100 at its proximal end $o permit aspiration around the penetration .- ^ ~i - ` 21101S2 ~P~Us 21DE~
A third connector port 66 is provided on the coaxial sleeve 30 and is suitable for connection to an aspiration source. In this way, the region surrounding the penetration can be aspirated through the seal formed by resilient tip 32.
The overall dimension~ of the device 10 will be ~elected depending on the hollow body structure being treated. For the treatment of the gallbladder, the device 10 will typically have a length in ~he range from about 30 to 75 cm, usually being from about 40 to 50 cm. The maximum diameter of the device, -i.e., the out~ide diameter of the coaxial sleeve 30, will typically be less than 10 mm, preferably being in the range from about 5 mm to 7 mm.
A second embodiment 80 of the manipulation device of the present invention is illustrated in Fig. 5. The device 80 comprises a rigid shaft 82 having a sharp tip 84 formed at it3 distal end. The rigid sha~t 82 will u~ually be formed from metal or a rigid plastic, typically being surgical stainless steel. An inflatable balloon 86 is secured to the di3tal end of the rigid shaft 82 and will lie just proximally of the sharp tip 84. Th~ balloon 86 will typically be composed or an elastic polymer, such as silicone rubber, and will be inflatable through an inflation tube 88 which is coaxially mounted over the rigid ~haft 84. The inflation tube 84 is connected through a connector port 90 located at the proxlmal end thereof. An outer sleeve 92 i~ formed coaxially about the inflation tube 88 and terminates in a resilient tip 94, typically formed from a spring 96 and ela3tic membrane 98. The outer tube 92 i9 connected to an aspiration port 100 at its proximal end to permit aspiration around the penetration SllBSTlTUTE ~tlEE~
IPEA/US
2110152 P~c~lvs92/o42n~
17- ~ 21 ~ Cl~g2 formed by sharp tip 84 when inserted through the wall of the body structure.
A protection rod 104 is slidably mounted in an axial lumen 106 of the rigid shift 82. An 0-ring 108 provides a sliding seal between the proximal end of rigid shift and the exterior of protection rod 10~ to isolate the i~terior of the body structure when the device 80 is in use. The protection rod 104 may be extended distally from rigid shaft 82, as illustrated in broken line, in order to protect ~he hollow body structure from the charp tip 84 after the device has been inserted through the body structure wall. The protection rod 104 can be axially advanced and retracted simply by pulling on a proximal connector 110. A stop member 112 i9 provided to prevent over ex~en3ion of the protec~ion rod 104. Connector 110 al90 provides connection to a suitable aspiration source for drainage of the interior of the body structure. The protection rod 104 includes a hollow lumen which pro~ides a drainage path through the device 80.
Referring now to Fig3. 6 and 7, a dis3ection de~ice 120 constructed in accordance with the principle~ of the present invention will be de~cribed. The dis~ection de~ice 120 comprises 9 rigid ~haft 122 having a distal e~d 124 and a proximal end 126. A
drive shaft 128 extends through a central lumen of the shaft i22 and terminates in a di3section head 130 at its proximal end. A handle 132 is connected to the proximal end 126 of 3haft ~22 and includ2s a motor drive means capable of ro~ating or o~cillating the dri~e ~ha~t 128. The frequency of rotation (or Qscillation) will typically be from about 2000 rpm to 20,000 rpm, preferably being in the range from about 5000 rpm to 10,000 rpm. A switch 144 will be ~UBSTlTUTE ~HEFr IPE~/US
~1~01~2 /~/VS92/042o5 -18- , JP~S 21 DEC 1~92 ~.
provlded on handle 132 for turning on and off the dissection head 130.
The dissection head 120 is formed as a cylindrical body having a plurality of axial channels 136 formed therein. The cylindrical body has a length generally in the range from about 2 mm to 20 mm, preferably being in the range from about 5 mm to 15 mm, and a diameter in the range from about 1 mm to 10 mm, pre~erably in the range from about 1.5 mm to 4.0 mm.
Usually, from about 4 ~o 10 axial channel~ will be formed, more usually being equally circumferentially ~ spaced-apart.
The dissection device 120 i9 particularly well suited for in~roduction through a trocar sleeve for use in laparoscoplc and other minimally invasive ~urgical procedure~. The diameter of ~haft 22 will be sufficient'y small to permit 3uch introduction, typically being 5 mm or less. The dissection device 120 is u~ed by contacting the dissection head 30 at the dis~ectio~ boundary, i.e, the interface between the ti~ue and body structure to be dissected from the ti3~ue, and initiating rotation and/or Q cillation of the head. Use of the high frequency rotation or oscillation has been found to provide a relatively clean separation between the tissue and body structure with minimal risk of bleeding, perforation, or other undesirable injuries.
Preferably, the diss~ction device 20 will further include an electrode 140 at its distal tip.
Electrode 140 can be connected to a conventional electrocautery power supply, typically a monopolar power supply through a connector 142 which is dispo ed at the proximal end of the handle 132.
Thu~, the dissection deYice 20 can be used to ~3STlTUT S~.E~
IpFAJII~
~ R ._ wo g2/2l298 `~ ` 2 1 1 ~ 1 $ 2 i ~ f~ PCT/US92/042~'~
- ` --19--cauterize any cuts or tears which are accidentally caused, without need to introduce a separate electrocautery device.
Re~erring now to Figs. 8A - 8C, use of the manipulatîon device 10 and the dissection device 120.
for perfor~ing a gallbladder removal procedure (cholecystectomy) will be described. The figures illustrate the gallbladder GB being dissected fro~
the liver L. The instruments utilized, including both the manipulation device 10 and the dissection device 120, will have been introduced through conventional trocar sheaths in a well known manner for performing laparoscopic cholecystectomy.
Initially, a portisn of the outside wall of the 15 gallbladder GB is grasped with a conventional forceps grasper 150, as illustrated in Fig. 8A. The sharp : tip 20 of the manipulator device 10 is then penetrated through the wall of the gallbladder GB
: next to the region-which is held in plaGe by the ; 20 graspers:l50.~
After the penetration has been achieved, device 10 is advanced forward until the resilient tip 32 forms a seal about the site of penetration, as illustrated in Fig.~ 8B~ The sharp tip 20 will be retracted by ~x~ally.*ranslating the tube 22 in a proximal - - :
~` direction,~andithe content~ of the gallbladder (bile) will.be withdrawn through the~interior lu~en of the shaft 12.- After the contents have been largely drained, the balloon l4 i~ inflated (as illuQtrated-in broken line in Fig. 8B) to fill'the void which has . ibeen left and expand the gallbladder GB, usually : di~tending thé gallbladder slightly to improve ~ontrol ~nd access. The device 10 may then be used ts manipulate the gallbladder ~B and expose the w~ 92/21298 i ~ 2 1 ~ 2 -20- PCT/US92/042~
dissection plane DP, i.e. the interstitial plane between tbe gallbladder and the liver bed L.
The tissue dissection device 120 is next introduced, and the di~section head 130 contacted with the dissection plane DP (Fig. 8C). The dissection haad .
130 is actuated and used to carefully separate the ` exposed wall of the gallbladder GB fro~ the liver bed L. It will be appreciated that the manipulator , device 10 will be constantly repositioned to expose the dissection plane DP in an optimum manner. The dissection is continued until the gallbladder GB is completely detached from the liver bed L and other surrounding tissue. The inflated balloon 14 can then be deflated, the manipulator device lo withdrawn, and the gallbladder removed through a trocar sleeve in a i conventional manner.
~ Figs. 9, 10 and 11 are perspectiYe views of a device ,~ according to the present invention shown in place ~ within the abdo~inal cavity with a body, with part~
1 20 broken away for illustration and laparoscopic forceps extended into gripping engagement with the gall-bladder. These figures sequentially illustrate the steps of distention and manipulation device laparoscopically into the akdominal cavity and into-a gripping engagement~with the gallbladder. Referring to Fig.~9,~forceps.200.are laparoscopically~extended : into gripping èngagement with the gallbladder 20 ~ha procedure i8 ~ Yiewed.through an endo~cope 203~
located within an abdominal balloon lifting device?;
203a. With the gallbladder so gripped, a ~
laparoscopic d~ 8t8ntion, `manipulation and remo~al tool 202 according to the invention, is extended into the abdominal caYity in piercing engage~ent with the gallbladder, a6 depicted by the arrow line in Fig~
10. The tool 202 takes the form of a dual lumen ~ W092/2~2~8 ~ 3 ` ' ~ 2 l l O li~ P~T/US92/~42~-."
tubular needle having a sharpened open end through which the contents of the gallbladder may be drawn and an annular balloon which may be inflated through the lumen of the tool communicating therewith. Once the tool has been used to evacuate the contents of the gallbladder, the balloon 204 is in~lated and assu~es internal gripping engagement with the gall-bladder. The tool may then be manipulated, thu~
maneuv~riny the gallbladder within the abdominal ~0 cavity or exerting tension on it as depicted by the arrow line in Fig. 11. Depending upon the size of the gallbladder, the remo~al of the organ may require some enlargement of the incision through which the tool extends. The forceps would ~e released from the lS gallbladder to permit its manipulation using only the balloon tool. The entire procedure is viewed through the endoscope 203. Following deflation and removal of the balloon, the gallbladder is seized by forceps for further ~anipulation.
Fig~. 12 ana 13 ~how detail o~ ~he tool 202. The d~vice of Fig. 13 corresponds to that of Fig. 12 except-that the tubular needle 202a has a ~ingl~
lu~en only for inflation of the balloon 204 and that the ne~dle 202a does not extend fully through the b~lloon. Thu~, the embodiment in Fig. 13 eannot be uqed to evacuate the gallbladder. In Fig. 12, the needle-202b accommodates a separate channel 206,~
c~municating with the interior of balloon 204 ~ ~-through orifice 205. The end of the needle 202b `
39 accommodat~s orifice 207 through which th~ contents o~-gallbladder 201 may be evacuated.
:. ... .
Fig. 1~ is a cross-sectional view similar to the above, showing a modified ver~ion of the invention wherein the endoscope 203 extends fu}ly through a balloon 208 which serYes as an abdominal li~ting wog2/2l298 `~ 2i~i52 -2~- PCT/USg2/04205t}f;
device. The gallbladder 201 i~ then viewed directly, rather than through the balloon 208.
Referring to Fig. 15 there i~ ~hown an embodiment of the tool according to the invention for insertion into the gallbladder for draining the contents thereof and inflating a balloon for manipulation.
This embodiment permits removal of all rigid or semi-rigid structures from within the gallbladder ~or other organ) prior to ~anipulation to avoid the risk of organ injury. The further improvement is provided in that the needle tip used for organ entry is retracted out of the organ to prevent injury.
Referring to Fig. 15, the organ manipulator device 300 is a rigid structure which allows for control of lS the displacement of the attachsd organ. Therefore, the manipulator devic~ may be of a metallic construction or of other suitable rigid material, whereby the rigidity i~ imparted by one or more of the thr~e concentric tubular members which comprise the device. The innermost tubular member 301 hold~
an elastomeric member 302, which will be inflated in~ide the organ to hold and distend the organ for -manipulation. An elastomeric balloon is preferred because of its initial small profile upon entry into the organ ~nd its ~xpansion capacity upon inflation to fill the ingide of ~he organ. The elastomeri~
member.302 i~ shown~in an inverted position within :
the innermost-tube 30~. The elastomeric ~e~ber 302 ia everted into the organ after protrusion of a ~mall len~th of the dist~l end 303 of the innermo~t tub~
301 into the organ. This is an improvement in that it ~inimizes the length of the innermost tube which mu3t b~ placed into the organ prior to inflation.
The end of the ela~to~eric member 302 is bonded to the digtal end 303 of the innermost tube 301 in a suitable manner, for example by use of adhesive, ` W092/21298;`;i~`- 2 1`i 0 1 ~ 2 PC~/U~2/042~ -~ `~
adhesive with an outer plastic shrink wrapping, adhesive wîth an outer suture winding, and th~ like.
The inner~ost tube 301 ~ay be made of a rigid plastic material ~uch as nylon, PVC, polyethylene, and the like, or, most preferably, ~tainless steel.
: .
The inner~o~t tube 301 is concentrically di~po~ed within a tu~ular needle 304 having a sharp point for piercing the organ~ The needle 304 may extend to completely enclose the innermo~t tu~e 301, in the closed configuration of the device 300, and then may be mechanically retracted proximal to the distai end 303 of the innermost tube 301 to expofie the inner most tube to the interior of the organ. Praferably, the needle 304 is made of stainless steel.
- 15 Retraction of needle 304 is accomplished by exterior handle 305 affixed to needle 304 within the housing 306 at the proximal end of the device 300. Seal~ 307 are provided to ~llow for movement of the tubular needle 304 in a ga~ tight manner. The outer~ost tube ~0 308 i concentric with tubular needle 304 ~nd i~
fixed in position with respect to the inner~o~t tube 301, with the distal end 309 of the outer-'most tube ' 308 being approximately flush with the dist~l end 303 i o~ the inner~o~t tube 301. The outermost tube 308 is ~t~pped down to form a step 310 at it~ distal end, with.th~ inner-dia~eter at the step providing a slip ' Pit wi~h ~he outer diameter of the tubular needle -`
30~ The length of the step i~iprePerably`~out~jo.i -~to 0.15-inche~ The advantage of the step~310 i~ to provide a ~echanical stop during insertion of th~
device 300 into the organ. When the needle tip of .~,the tubular needle 304 is extended~and used~to - puncture an organ, the needle tip and t~e-stepped down portion 311 of the outer tube 308 easily ent~r 35 the organ wall. When the outer wall of the organ impacts the ~tep 310 on the outer tube 308, the W092/21~9~ 2 1-1' 0 1 5 2 -24- PCT/US92/0~2~ ~
forward progress of the organ manipulator device 300 is halted, thereby guarding against excessive needle travel and puncture of the back wall of the organ.
The stepped down portion 311 may contain radial holes 312 or slots placed around its circumference to assist in drainage of the organ contents when the needle tip is retracted. Vacuum suction ~ay be applied in the volume between the outer tube 308 and the needle 304 as well as in the volume between the needle 304 and innermost tube 301 by application of a vacuum at aspiration port 313 which is in communication with the volu~e between the innermost tube 301 and tubular needle 304. Upon retraction of the needle 304 into the outer most tube 308, aspiration will also be effective within the volume at the distal ends between the needle 304 and the outermost tube 308. The outermost tube 308 is al~o preferably made of a rigid material suc~ as plastic, ~nylon, PVC, polyethylene and ths like) or stainless steel. The housing 306 at the proximal end of the device 300 accommodates the port 313a and the fittings for,~inflation of the elastomeric member 302 - through the~interior of the-inner~ost tube 301.- The tubular needle 304 may be locked in its forward (extended) position for ~ntry~into the organ by a : suitable locking mechanism (not shown) and unlocked and:retracted prior to the balloon inflation. The tubularf-members 301,~:304 and-~308 are ~ealed on their interior ~olume~,5uch that-no-~gas leaks occur when .
the device.i~ introduce into the abdomen or organ for laparoscopic surgery. Inflation of the elastomeric me~ber 302 may be.accomplished using a separate in~lation device~uch as a syringe or a pump. A pump ~ay be built.directly into the housing 306. .
Referring to Fig. 16 there is shown an alternative embodiment o~ the device of figure 15 wherein a ~ump WO 92/2~298 ; ~ - 2il~ l 5 2 ~ PCr/US~2/04205 ~
` --2 5-- -is built into the housing 314. Pumping is actuated ~y a bellows 315 and withdrawal of contents of the interior of the organ i~; conducted through aspiration port 316. There are shown the ctep 317 and radial 5 holes 318 at the distal end 319 of the outermost tube 320. Only the tip of the tubular needle 321 i8 shown.
Referring to Figs. 17A, B and C there is ~:hown the device of Fig~. 15 or 16 in use. For convenience, 10 the same numerals on corresponding elements as described in Fig. 15 will be used in connec:tion with the description of Figure 17. Referring to Fig. 17A, the distal end 309 of the OUt8nllOSt tube 308 is advanced into an abdominal cavity (not shown) through ~5 a properly ~ized trocar with the needle 304 retracted into the tube 308 to protect the needle tip. The tros~ar seals against the tube 308 to maintain the pneumoperitoneum. The needle 304 is advanced out of the outer tube 308 (Fig. 17B~ and a grasping 20 instru~ent ~not shown) stabili2es the wall of the-org2n 400 ~s; 'che extended needle punctureæ through ~the wall and fitOpS at tha end of the outer tube step 310. The needle is then unlocked fron~ its ~xtended po~ition and retracted (dotted outline in Fig. 17B) 25 then ~;uction i8 applied through the ~spirator port ~not shown)~.~which drains the fluid content~ fro~ th~
organ. Then: air i8 pumped through the innerD~ost tube 301~ (Fig.-~ 17C) to evert the balloon 302: out of the~ -inner ~08t tube i nto the organ and pumping i~
30 continued to inflate the balloon within the organ.
The organ may now be m~nipulated for dissection and isolation. for re~oval. Following organ dissection, the balloon iE; def lated to allow detach~ent of the organ.
wo92/2l298 ~``' 2'`i'~`l`b`l`~ 2` -26- PCT/USg2/o42 ~eferring to Figs. 18 and 18A, anothex ambodiment of the device is shown having two concentric tubes instead of three, whereby electrocautery is u~ed to enter the organ instead of a needle. The inner tu~e 450 holds an inverted elastomer balloon 451 and tube 450 is csnnected to a slide arrangement within the..
handle 452 which allows for extension and retraction with respect to the outer tube 453. The mechani6m in the handle 452 provides a locking mechanism 454A and B to lock the inner tube 450 in an extended position.
The proximal end of the inner tube 450 accommodates inflation port 455 for inflating the balloon 451. A
drainage port 456 is provided for evacuating ~he contents of the organ by aspiration. The inner tube 450 i~ preferably made of a rigid material such as stainless steel with an outer insulative sleeve which is electrically insulated with a material such aæ
p~lyvinyl chloride, polyethylene nylon or other plastic. m e outer tube 453 is also preferably stainless steel but may be made of another electrically conducting ~aterial and provide~ a ~oose fit.with the inner tube 459.:-.The outer tube 453 i~
electrically insulated on the outside with insulation 453A, leaving a small portion of the distal end (preferably 2 to 3 millimeters of leng h) uninsul~ted at the-tipO Referring to the detail of the tip in ~ig. 18A, the exposed distal tip 457 is cut away, pre~rably. 50 .that:only an arc of- less than about 180 degrees of the circumference of the outer tube 453 remains. This allows for-cutting of a ~mall curve ~lit by cauterization in the org~n wall instead of a full circle, aiding in the cealing of the organ wall against the shaft of-~the device and minimizing the amount of heat-necrssed tissue that may cause ~he entry hole to enlarge upon traction and ~anipulation o~ the device. An electrocautery connector 458 is provided in the handle 452 to a}low hookup to an W092/21298 , 2 1 1 0 1 5 2 ,-.PCT/US92/042~. --27~
electrocautery generator (not shown). In use, the inner tube 450 is initially withdrawn (preferably approximately l-2 cm.) into the outer tube 453 during entrance through the wall of the organ by cauterization. This prevents the inner tube 450 and balloon 451 from being hsated ~y the tip of the ou*er tube during cautery use. Following entrance of the outer tube into the organ, suction aspiration of the organ contents is performed through port 456. The inner tube 450 is then advanced forward and locked in an extended position. Air is pumped ~hrough port 455 to evert and inflate the balloon 451 in preparatisn f or the organ manipulation .
Ref erring to Fig . l9, another embodiment of the organ 15 balloon manipulator is shown. A needle 500 is provided within a rigid inner tubP 501 and a concentric rigid outer tube 502. An elastomeric sleeve 503 is attached having one edge attached to the distal ends of the inner and outer tube~, respectively. A seal 504 is provided at the proximal end of the device to allow the inner tube 501 to translate longitudinally with respect to the outer tube 502 while maintaining a gas tight seal. A
- locking mechanism 505A and B allows the needle 500 to be po~itioned and locked with respect to inner tube 50l, ~o that the needle 500 is in an armed con~iguration. An in~lation port is proYided for 506 to provide for inflation of the elastomeric.sleeve 503 and an aspiration port 507 is provided for evacuation of t~e organ contents. In use, the needle 500 l8 locXed in a forward position and the device i~
advanced to puncture through the organ wall 510 ~Figs. l9A ~nd B). The needle 500 is unlocked and withdrawn at least partially into the inner tube 50l to prevent injury to tbe organ. Advancement o~ th~
device is continued until the outer tube 502, lies ', "i ' ` `
W092/21298 - 2l I;di 5 2 ~`' PCT/USg21042 within the cavity of the organ. The elastomeric sleeve balloon 503 is inflated (Fig. l9B) and inner tube 501 is retracted with respect to the outer tube 502 until the tips of the inner and outer tubes ~eet.
This action causes t~e balloon 503 to take on 2 toroidal shape and removes all rigid tubes fro~
inside the organ.
Although the foregoing invention has been described in detail for purposes of clarity of understanding, it will be obvious that certain modifications may be practiced within the scope of the appended claims.
.
.
,, ., .
.
Claims (90)
1. A method for dissecting a hollow body structure, said method comprising:
introducing an expandable member on the distal end of a rigid shaft into an interior volume of the hollow body structure;
expanding the expandable member to occupy at least a major portion of the interior volume; and separating attachment of the hollow body structure from surrounding tissues while simultaneously manipulating the rigid shaft to reposition the hollow body organ.
introducing an expandable member on the distal end of a rigid shaft into an interior volume of the hollow body structure;
expanding the expandable member to occupy at least a major portion of the interior volume; and separating attachment of the hollow body structure from surrounding tissues while simultaneously manipulating the rigid shaft to reposition the hollow body organ.
2. A method as in claim 1, wherein the expandable member is introduced through a previously formed penetration through a wall of the hollow body structure.
3. A method as in claim 2, wherein the penetration was formed by advancing a sharp tip at the distal end of the shaft through the wall.
4. A method as in claim 3, further comprising protecting the sharp tip after it has entered the interior of the hollow body structure.
5. A method as in claim 1, wherein the expandable member is introduced through a natural body orifice.
6. A method as in claim 1, further comprising aspirating fluid from the interior of the hollow body structure to prevent loss to the surrounding tissue.
7. A method as in claim 6, wherein the aspirating step includes aspiration from both the interior of the hollow body structure and from the site around the penetration through the wall.
8. A method as in claim 1, wherein the expandable member is an elastic balloon which is expanded by introducing an inflation medium.
9. A method as in claim 1, wherein the separate step includes exposing a dissection plane between the structure and surrounding tissue to a rotating or oscillating dissection head, wherein said head has axial channels spaced about its periphery.
10. A method for dissecting a gallbladder from surrounding tissue, said method comprising:
forming a penetration through a wall of the gallbladder;
aspirating bile from the interior of the gallbladder;
expanding the expandable member to occupy substantially the entire interior volume of the gallbladder; and separating attachment of the gallbladder from surrounding tissues while simultaneously manipulating the rigid shaft to reposition the gallbladder in order to expose the dissection plane.
forming a penetration through a wall of the gallbladder;
aspirating bile from the interior of the gallbladder;
expanding the expandable member to occupy substantially the entire interior volume of the gallbladder; and separating attachment of the gallbladder from surrounding tissues while simultaneously manipulating the rigid shaft to reposition the gallbladder in order to expose the dissection plane.
11. A method as in claim 10, wherein the penetration is formed by advancing a sharp tip disposed at the end of the shaft through the wall of the gallbladder, wherein said sharp tip is on a tube mounted coaxially about the rigid shaft.
12. A method as in claim 11, further comprising retracting the tube to protect the sharp tip after the expandable balloon has been introduced.
13. A method as in claim 10, wherein the penetration is formed by advancing a sharp tip which is formed integrally at the distal end of the rigid shaft.
14. A method as in claim 13, further comprising extending a rod having a blunt tip proximally of the sharp tip to protect the sharp tip after the expandable balloon has been introduced.
15. A method as in claim 10, wherein the bile is aspirated through at least one lumen concentric with the rigid shaft.
16. A method as in claim 15, wherein the bile is aspirated through a first lumen interior to the rigid shaft and a second concentric lumen exterior to the rigid shaft, wherein said first lumen aspirates bile from the interior of the gallbladder and the second lumen aspirates bile from the site of shaft penetration.
17. A method as in claim 16, wherein bile is aspirated simultaneously through both the first and second lumens.
18. A method as in claim 10, wherein the expandable member is an elastic balloon which is expanded by introducing a inflation medium.
19. A method as in claim 18, wherein the balloon is expanded until the gallbladder is distended.
20. A method as in claim 10, wherein the gallbladder is separated by contacting a dissection plane between the gallbladder and surrounding tissue with a rotating or oscillating dissection head, wherein said head has axial grooves spaced apart about its periphery.
21. A method for manipulating a hollow body structure, said method employing a device including a rigid shaft and an expandable member disposed near a distal end of the shaft, said method comprising:
forming a penetration through a wall of the body structure;
introducing the distal end of the shaft through the penetration into the hollow body structure;
expanding the expandable member to occupy at least a major portion of the interior volume of the hollow body structure; and manipulating the rigid shaft to reposition the hollow body organ.
forming a penetration through a wall of the body structure;
introducing the distal end of the shaft through the penetration into the hollow body structure;
expanding the expandable member to occupy at least a major portion of the interior volume of the hollow body structure; and manipulating the rigid shaft to reposition the hollow body organ.
22. A method as in claim 21, wherein the penetration is formed by advancing a sharp tip on the distal end of the device through the wall.
23. A method as in claim 22, wherein the distal end of the device is introduced to the interior of the hollow body structure by further advancing the shaft through the penetration.
24. A method as in claim 21, wherein the expandable member is an elastic balloon which expanded by introducing an inflation medium.
25. A method as in claim 21, further comprising protecting the sharp tip after it has entered the interior of the hollow body structure.
26. A method as in claim 21, further comprising aspirating fluid from the interior of the hollow body structure to prevent loss to the surrounding tissues.
27. A device for manipulating a hollow body structure, said device comprising:
a rigid shaft having a proximal end and a distal end;
an expandable member disposed near the distal end of the shaft;
means for selectively expanding the expandable member from an unexpanded configuration to an expanded configuration;
a sharp tip and a blunt tip, disposed near the distal end of the rigid shaft; and means for axially translating the sharp tip relative to the blunt tip, whereby either tip can be selectively exposed at the distal end of the rigid shaft.
a rigid shaft having a proximal end and a distal end;
an expandable member disposed near the distal end of the shaft;
means for selectively expanding the expandable member from an unexpanded configuration to an expanded configuration;
a sharp tip and a blunt tip, disposed near the distal end of the rigid shaft; and means for axially translating the sharp tip relative to the blunt tip, whereby either tip can be selectively exposed at the distal end of the rigid shaft.
28. A device as in claim 27, wherein the means for axially translating comprises a tube mounted coaxially with the rigid shaft, wherein the tube has a sharp tip and the shaft has a blunt tip.
29. A device as in claim 28, wherein the tube is mounted coaxially over the outside of the shaft.
30. A device as in claim 27, wherein the means for axially translating comprises a tube mounted coaxially with the rigid shaft, wherein the tube has a blunt tip and the shaft has a sharp tip.
31. A device as in claim 30, wherein the rigid shaft has an axial lumen and the tube is mounted coaxially within said axial lumen.
32. A device as in claim 27, further comprising means near the distal tip of the rigid shaft for aspirating fluid to near the proximal end of the shaft.
33. A device as in claim 32, wherein the aspirating means includes an axial lumen extending from the distal end to the proximal end of the rigid shaft.
34. A device as in claim 33, wherein the a pirating means includes a separate tube coaxially mounted with an axial lumen extending from the distal end to the proximal end of the rigid shaft.
35. A device as in claim 34, further comprising sleeve mounted coaxially over the rigid shaft and means for aspirating the interior of the sleeve.
36. A device as in claim 35, wherein the sleeve has a resilient tip which can conform to the exterior of the body structure.
37. A device as in claim 36, wherein the resilient tip extends over at least a portion of the expandable member, so that the tip will be compressed when the expandable member is inserted into a body structure.
38. A device as in claim 27, wherein the expandable member is an elastic balloon and the means for selectively expanding comprises an inflation lumen extending from the proximal end of the rigid shaft to the balloon.
39. A device as in claim 38, wherein the inflation lumen is disposed coaxially about the rigid shaft.
40. A device for manipulating a hollow body structure, said device comprising:
a rigid shaft having a proximal end and a distal end;
means disposed near the distal and of the rigid shaft for piercing a wall of the hollow body structure;
an expandable member disposed near the distal end of the rigid shaft;
means for selectively expanding the expandable member from an unexpanded configuration to an expanded configuration; and means for aspirating fluid from near the distal end of the shaft to the proximal end.
a rigid shaft having a proximal end and a distal end;
means disposed near the distal and of the rigid shaft for piercing a wall of the hollow body structure;
an expandable member disposed near the distal end of the rigid shaft;
means for selectively expanding the expandable member from an unexpanded configuration to an expanded configuration; and means for aspirating fluid from near the distal end of the shaft to the proximal end.
41. A device as in claim 40, wherein the piercing means comprises a sharp tip on the rigid shaft.
42. A device as in claim 40, wherein the piercing means comprises a coaxial tube having a sharp tip.
43. A device as in claim 40, wherein the expandable member is an elastic balloon and the means for selectively expanding comprises an inflation lumen extending from the proximal end of the rigid shaft to the balloon.
44. A device as in claim 40, wherein the means for aspirating comprises an aspiration lumen within the rigid shaft.
45. A device as in claim 44, wherein the means for aspirating further comprises a sleeve mounted coaxially over the rigid shaft.
46. A device as in claim 45, wherein the sleeve has a resilient tip which can conform to the exterior of the body structure.
47. A device as in claim 46, wherein the resilient tip extends over at least a portion of the expandable member, so that the tip will be compressed when the expandable member is inserted into a body structure.
48. A tissue dissection device comprising:
a shaft having a proximal end and a distal end;
a dissection head disposed at the distal end of the shaft, said dissection head comprising a cylindrical body having a plurality of axially oriented channels circumferentially spaced-apart thereabout; and means for rotating or oscillating the dissection head relative to the shaft at from 2000 rpm to 20,000 rpm.
a shaft having a proximal end and a distal end;
a dissection head disposed at the distal end of the shaft, said dissection head comprising a cylindrical body having a plurality of axially oriented channels circumferentially spaced-apart thereabout; and means for rotating or oscillating the dissection head relative to the shaft at from 2000 rpm to 20,000 rpm.
49. A tissue dissection device as in claim 48, wherein the dissection head has an exposed length in the range from about 2 mm to about 20 mm and a diameter in the range from about 1 mm to 10 mm.
50. A tissue dissection device as in claim 49, wherein the dissection head has from 4 to 10 axial grooves.
51. A tissue dissection device as in claim 48, further comprising an electrocautery electrode at the distal tip of the dissection head and means at the proximal end of the shaft for connecting the electrode to a power supply.
52. A method for dissecting a body structure from surrounding tissue, said method comprising:
contacting an interfacial boundary between the body structure and the tissue with a dissection head comprising a cylindrical body having a plurality of axially oriented channels circumferentially spaced-apart thereabout; and oscillating or rotating the dissection head at from 2000 rpm to 20,000 rpm to separate the tissue from the body structure.
contacting an interfacial boundary between the body structure and the tissue with a dissection head comprising a cylindrical body having a plurality of axially oriented channels circumferentially spaced-apart thereabout; and oscillating or rotating the dissection head at from 2000 rpm to 20,000 rpm to separate the tissue from the body structure.
53. A method as in claim 52, wherein the dissection head has an exposed length in the range from about 2 mm to about 20 mm and a diameter in the range from about 1 mm to 10 mm.
54. A method as in claim 53, wherein the dissection head has from 4 to 10 axial grooves.
55. A method of removing the gallbladder from an abdominal cavity, said method comprising:
a) laparoscopically inserting a compression elastic balloon into the abdominal cavity and inflating said balloon to displace the liver and gallbladder for access; and b) laparoscopically gripping the gallbladder externally of the compression balloon and withdrawing the gallbladder from the body.
a) laparoscopically inserting a compression elastic balloon into the abdominal cavity and inflating said balloon to displace the liver and gallbladder for access; and b) laparoscopically gripping the gallbladder externally of the compression balloon and withdrawing the gallbladder from the body.
56. A method according to Claim 55 wherein the gallbladder is gripped and laparoscopically withdrawn by:
a) externally gripping the gallbladder;
b) laparoscopically piercing the gallbladder with a needle carrying a gripping balloon to dispose the gripping balloon within the gallbladder;
c) inflating the gripping balloon to internally grip the gallbladder;
d) manipulating the needle with the gallbladder engaged; and, e) withdrawing the needle with the gallbladder engaged therefrom the body.
a) externally gripping the gallbladder;
b) laparoscopically piercing the gallbladder with a needle carrying a gripping balloon to dispose the gripping balloon within the gallbladder;
c) inflating the gripping balloon to internally grip the gallbladder;
d) manipulating the needle with the gallbladder engaged; and, e) withdrawing the needle with the gallbladder engaged therefrom the body.
57. A method according to Claim 56, wherein the gallbladder is drained through the needle prior to inflation of the gripping balloon.
58. A gripping apparatus for removing the gallbladder from an abdominal cavity, said apparatus comprising:
a) an elongate tubular shaft having a sharpened distal end for piercing the gallbladder; and, b) a balloon carried by the shaft for insertion into the gallbladder and expansion into internal gripping engagement therewith.
a) an elongate tubular shaft having a sharpened distal end for piercing the gallbladder; and, b) a balloon carried by the shaft for insertion into the gallbladder and expansion into internal gripping engagement therewith.
59. Apparatus according to Claim 58 further comprising an opening formed in the shaft to enable to contents of the gallbladder to be drawn into the shaft upon entry of the shaft into gallbladder.
60. A device for manipulating a hollow body structure, said device comprising a first rigid tubular member having a proximal end and a distal end;
a second rigid tubular member internal to said first tubular member;
an expandable member affixed at the distal end of said second tubular member, said expandable member being inverted within said second tubular member;
a third tubular member, accommodating piercing means on the distal end thereof, said third tubular member being slidable within said first tubular member to expose said piercing means beyond the distal end of said first tubular member, and slidable to retract said piercing means into said first tubular member;
and means for selectively expanding said expandable member from an unexpanded configuration to an expanded configuration; and means for aspiration of fluid from near the distal end of said device to the proximal end of said device.
a second rigid tubular member internal to said first tubular member;
an expandable member affixed at the distal end of said second tubular member, said expandable member being inverted within said second tubular member;
a third tubular member, accommodating piercing means on the distal end thereof, said third tubular member being slidable within said first tubular member to expose said piercing means beyond the distal end of said first tubular member, and slidable to retract said piercing means into said first tubular member;
and means for selectively expanding said expandable member from an unexpanded configuration to an expanded configuration; and means for aspiration of fluid from near the distal end of said device to the proximal end of said device.
61. A device according to Claim 60 further comprising a reduction of diameter of said first tubular member at the distal end thereof to form a tip and a surface which serves as a stop when said tip is moved axially to penetrate an opening of a size smaller than the outer diameter of said first tubular member.
62. A device according to Claim 61 wherein said tip defines a primary axial opening for accommodating said third tubular member and further defines at least one orifice communicating with said axial opening.
63. A device according to Claim 60 further comprising gripping means at the proximal end thereof, said gripping means communicating with said third axial member to axially advance said piercing means to an extended position protruding from the distal end of said first tubular member.
64. A device according to Claim 63 further comprising locking means to lock said piercing means in an extended position.
65. A device according to Claim 64 further comprising a seal said third tubular member slidably contacting said second tubular member.
66. A device according to Claim 64 wherein said locking means is disengageable to disengage said second tubular member from the locked extended position to retract said second tubular member to a retracted position within said first tubular member.
67. A device according to Claim 60 further comprising pumping means for introducing gas or air through said second tubular member to inflate said.
expandable member.
expandable member.
68. A device according to Claim 67 wherein said pumping means provides gas or air to evert said expandable member out of said second tubular member.
69. A device according to Claim 67 wherein said pumping means comprises bellows.
70. A device according to Claim 67 wherein said pumping means a piston.
71. A device according to Claim 60 further comprising means for releasing pressure to deflate said expandable member.
72. A device according to Claim 60 wherein said piercing means comprises a cauterizing tip on said rigid shaft.
73. A device according to Claim 72 wherein said rigid shaft is electrically insulated.
74. A device according to Claim 73 wherein said expandable member is inverted within said lumen.
75. A device according to Claim 72 wherein said cauterizing tip comprises a tab extending from the distal end of said shaft, said tab capable of cauterizing an arc in tissue of approximately the radius of said first tubular member with a length of less than about one-half of the diameter thereof.
76. A device for manipulating a hollow body structure, said device comprising a first tubular member having a proximal end and a distal end; a second tubular member located within said first tubular member; an expandable elastomer sleeve having one edge circumferentially attached to the distal end of said first tubular member and the other edge circumferentially attached to the distal end of said second tubular member; piercing means within said second tubular member, said piercing means comprising a hollow rigid shaft with a pointed tip at the distal end thereof, said shaft comprising means for aspirating fluid from near the distal end of said device to the proximal end of said device; means for selectively expanding said expandable member from an unexpanded configuration to an expanded configuration.
77. A device according to Claim 76 wherein the distal end of said second tubular member is extendable beyond the distal end of said first tubular member to maintain a flat shape to said expandable elastomer sleeve.
78. A device according to Claim 76 further comprising a slidable seal at the proximal end of said device for longitudinal translation of said second tubular member within said first tubular member while maintaining a gas tight seal therebetween.
79. A device according to Claim 76 wherein said hollow shaft is lockable in place by a lock means at the proximal end of said device in a position wherein said pointed tip extends beyond the distal end of said first and second tubular members.
80. A device according to Claim 79 wherein said hollow shaft is unlockable for withdrawal of said pointed tip into said first or second tubular members.
81. A device according to Claim 76 wherein said second tubular member is slidable for withdrawal of the distal end thereof into the distal end of said first tubular member, thereby forming an expandable annulus from said expandable elastomeric sleeve.
82. A method of manipulating a hollow body organ comprising the steps of:
piercing said organ to form an opening with a device comprising an elongate shaft, a retractable piercing means protruding from one end of said shaft and an inverted expandable member having a peripherally sealed mouth located within said shaft;
said shaft having a reduction in diameter to define a tip at said end and stopping means for impeding entry of said shaft into said body organ when said tip is moved longitudinally through said opening;
inserting said piercing means and said tip into said body organ until insertion is impeded by said stopping means;
retracting said piercing means into said shaft;
everting said expandable member into said organ by forcing air into said mouth of said member;
inflating said expandable member within said organ; and manipulating said organ with said device.
piercing said organ to form an opening with a device comprising an elongate shaft, a retractable piercing means protruding from one end of said shaft and an inverted expandable member having a peripherally sealed mouth located within said shaft;
said shaft having a reduction in diameter to define a tip at said end and stopping means for impeding entry of said shaft into said body organ when said tip is moved longitudinally through said opening;
inserting said piercing means and said tip into said body organ until insertion is impeded by said stopping means;
retracting said piercing means into said shaft;
everting said expandable member into said organ by forcing air into said mouth of said member;
inflating said expandable member within said organ; and manipulating said organ with said device.
83. A method according to Claim 82 further comprising the step of withdrawing fluid contents from said organ through said device prior to inflating said expandable member.
84. A method according to Claim 82 wherein said stopping means comprise an annular surface
85. A method for manipulating a hollow body organ comprising the steps of piercing said organ by electrocautery with an electrocauterizing tip on a device comprising an elongate shaft having said tip at one end of said shaft and an expandable member having a peripherally sealed mouth located within said shaft;
inserting said end of said shaft into said organ through the orifice in said organ formed by said tip;
inflating said expandable member within said organ; and manipulating said organ with said device.
inserting said end of said shaft into said organ through the orifice in said organ formed by said tip;
inflating said expandable member within said organ; and manipulating said organ with said device.
86. A method according to Claim 85 wherein said step of piercing said organ comprises electrocauterizing said organ with said tip and aid tip comprises an arcuate tab extending from said end of said shaft.
87. A method according to Claim 85 further comprising the step of withdrawing fluid contents from said organ through said device prior to inflating said expandable member.
88. A method according to Claim 85 wherein said expandable member within said shaft is inverted, whereby, upon initiation of said step of inflating said expandable member, said member everts into said organ.
89. A method of manipulating a hollow body organ comprising the steps of:
piercing said organ with a device comprising interior telescoping interior and exterior shafts in an extended position whereby the open end of said interior shaft is at one end of said device, a retractable piercing means protruding from said end of said device, and an expandable elastomeric sleeve having one edge circumferentially attached to said open end of said interior shaft and having the other end circumferentially attached to an end of said exterior shaft;
retracting said piercing means into said device;
inserting said device into said organ to the extent that said end of said exterior shaft enters said organ;
retracting said interior tube into said exterior tube whereby said sleeve forms an expandable annulus; and inflating said annulus within said organ.
piercing said organ with a device comprising interior telescoping interior and exterior shafts in an extended position whereby the open end of said interior shaft is at one end of said device, a retractable piercing means protruding from said end of said device, and an expandable elastomeric sleeve having one edge circumferentially attached to said open end of said interior shaft and having the other end circumferentially attached to an end of said exterior shaft;
retracting said piercing means into said device;
inserting said device into said organ to the extent that said end of said exterior shaft enters said organ;
retracting said interior tube into said exterior tube whereby said sleeve forms an expandable annulus; and inflating said annulus within said organ.
90. A method according to Claim 89 further comprising the step of withdrawing fluid contents from said organ through said device prior to inflating said annulus.
Applications Claiming Priority (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US70678191A | 1991-05-29 | 1991-05-29 | |
US07/762,318 US5370134A (en) | 1991-05-29 | 1991-09-19 | Method and apparatus for body structure manipulation and dissection |
US762,318 | 1991-09-19 | ||
US706,781 | 1992-05-04 |
Publications (1)
Publication Number | Publication Date |
---|---|
CA2110152A1 true CA2110152A1 (en) | 1992-12-10 |
Family
ID=24839022
Family Applications (3)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CA002109937A Expired - Lifetime CA2109937C (en) | 1991-05-29 | 1992-05-26 | Apparatus and method for peritoneal retraction |
CA002109795A Expired - Lifetime CA2109795C (en) | 1991-05-29 | 1992-05-28 | Properitoneal mechanical retraction apparatus and methods of using |
CA002110152A Abandoned CA2110152A1 (en) | 1991-05-29 | 1992-05-29 | Body structure manipulation and dissection system |
Family Applications Before (2)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CA002109937A Expired - Lifetime CA2109937C (en) | 1991-05-29 | 1992-05-26 | Apparatus and method for peritoneal retraction |
CA002109795A Expired - Lifetime CA2109795C (en) | 1991-05-29 | 1992-05-28 | Properitoneal mechanical retraction apparatus and methods of using |
Country Status (12)
Country | Link |
---|---|
US (8) | US5370134A (en) |
EP (4) | EP1287786B1 (en) |
JP (2) | JP2761578B2 (en) |
AT (4) | ATE255363T1 (en) |
AU (4) | AU666855B2 (en) |
CA (3) | CA2109937C (en) |
DE (4) | DE69232998T2 (en) |
DK (2) | DK0586580T3 (en) |
ES (4) | ES2113430T3 (en) |
GR (2) | GR3021920T3 (en) |
MX (1) | MX9202597A (en) |
WO (3) | WO1992021291A2 (en) |
Families Citing this family (912)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5374261A (en) | 1990-07-24 | 1994-12-20 | Yoon; Inbae | Multifunctional devices for use in endoscopic surgical procedures and methods-therefor |
US5188630A (en) * | 1991-03-25 | 1993-02-23 | Christoudias George C | Christoudias endospongestick probe |
US7744617B2 (en) * | 1991-05-29 | 2010-06-29 | Covidien Ag | Method and inflatable chamber apparatus for separating layers of tissue |
US5836871A (en) * | 1991-05-29 | 1998-11-17 | Origin Medsystems, Inc. | Method for lifting a body wall using an inflatable lifting apparatus |
US5947895A (en) * | 1991-05-29 | 1999-09-07 | Origin Medsystems, Inc. | Abdominal retractor with rotating arms and method of using the same |
US5676636A (en) * | 1994-07-22 | 1997-10-14 | Origin Medsystems, Inc. | Method for creating a mediastinal working space |
US6361543B1 (en) | 1991-05-29 | 2002-03-26 | Sherwood Services Ag | Inflatable devices for separating layers of tissue, and methods of using |
US5728119A (en) * | 1991-05-29 | 1998-03-17 | Origin Medsystems, Inc. | Method and inflatable chamber apparatus for separating layers of tissue |
US5632761A (en) * | 1991-05-29 | 1997-05-27 | Origin Medsystems, Inc. | Inflatable devices for separating layers of tissue, and methods of using |
JP3307392B2 (en) | 1991-05-29 | 2002-07-24 | オリジン・メドシステムズ・インク | Endoscope retraction device for surgery |
US5779728A (en) * | 1991-05-29 | 1998-07-14 | Origin Medsystems, Inc. | Method and inflatable chamber apparatus for separating layers of tissue |
US5803901A (en) * | 1991-05-29 | 1998-09-08 | Origin Medsystems, Inc. | Inflatable devices for separating layers of tissue and methods of using |
US5704372A (en) * | 1991-05-29 | 1998-01-06 | Origin Medsystems, Inc. | Endoscopic inflatable retraction devices for separating layers of tissue, and methods of using |
US5865728A (en) * | 1991-05-29 | 1999-02-02 | Origin Medsystems, Inc. | Method of using an endoscopic inflatable lifting apparatus to create an anatomic working space |
US5452733A (en) * | 1993-02-22 | 1995-09-26 | Stanford Surgical Technologies, Inc. | Methods for performing thoracoscopic coronary artery bypass |
US5735290A (en) * | 1993-02-22 | 1998-04-07 | Heartport, Inc. | Methods and systems for performing thoracoscopic coronary bypass and other procedures |
US5431662A (en) * | 1992-02-12 | 1995-07-11 | United States Surgical Corporation | Manipulator apparatus |
US5571115A (en) * | 1992-02-12 | 1996-11-05 | United States Surgical Corporation | Manipulator apparatus |
US6432121B1 (en) | 1992-06-02 | 2002-08-13 | General Surgical Innovations, Inc. | Apparatus and method for guiding placement of a minimally invasive surgical instrument |
US5730756A (en) * | 1992-06-02 | 1998-03-24 | General Surgical Innovations, Inc. | Method for developing an anatomic space for laparoscopic procedures with laparoscopic visualization |
US5540711A (en) * | 1992-06-02 | 1996-07-30 | General Surgical Innovations, Inc. | Apparatus and method for developing an anatomic space for laparoscopic procedures with laparoscopic visualization |
US6312442B1 (en) | 1992-06-02 | 2001-11-06 | General Surgical Innovations, Inc. | Method for developing an anatomic space for laparoscopic hernia repair |
US6540764B1 (en) | 1992-06-02 | 2003-04-01 | General Surgical Innovations, Inc. | Apparatus and method for dissecting tissue layers |
US6364892B1 (en) | 1992-06-02 | 2002-04-02 | General Surgical Innovations, Inc. | Ballon dissector with improved visualization |
US5607443A (en) * | 1992-06-02 | 1997-03-04 | General Surgical Innovations, Inc. | Expansible tunneling apparatus for creating an anatomic working space with laparoscopic observation |
US6565589B1 (en) | 1992-06-02 | 2003-05-20 | General Surgical Innovations, Inc. | Balloon device for use in surgery and method of use |
US5443484A (en) * | 1992-06-16 | 1995-08-22 | Loma Linda University Medical Center | Trocar and method for endoscopic surgery |
US5407427A (en) * | 1992-06-16 | 1995-04-18 | Loma Linda University Medical Center | Trocar facilitator for endoscopic surgery |
US5269753A (en) * | 1992-07-14 | 1993-12-14 | Wilk Peter J | Method for use in laparoscopic hernia repair |
US6283127B1 (en) * | 1992-12-03 | 2001-09-04 | Wesley D. Sterman | Devices and methods for intracardiac procedures |
US6325067B1 (en) | 1992-12-03 | 2001-12-04 | Wesley D. Sterman | Methods and systems for performing thoracoscopic coronary bypass and other procedures |
FR2700110A1 (en) * | 1993-01-05 | 1994-07-08 | Kacenelenbogen Yves | Dilator for use in surgical operations |
US5400773A (en) * | 1993-01-19 | 1995-03-28 | Loma Linda University Medical Center | Inflatable endoscopic retractor |
US5439476A (en) * | 1993-02-04 | 1995-08-08 | Trigonon, Inc. | Inflatable laparoscopic retractor |
US5797960A (en) * | 1993-02-22 | 1998-08-25 | Stevens; John H. | Method and apparatus for thoracoscopic intracardiac procedures |
US6494211B1 (en) * | 1993-02-22 | 2002-12-17 | Hearport, Inc. | Device and methods for port-access multivessel coronary artery bypass surgery |
US6161543A (en) * | 1993-02-22 | 2000-12-19 | Epicor, Inc. | Methods of epicardial ablation for creating a lesion around the pulmonary veins |
US6346074B1 (en) * | 1993-02-22 | 2002-02-12 | Heartport, Inc. | Devices for less invasive intracardiac interventions |
US6010531A (en) | 1993-02-22 | 2000-01-04 | Heartport, Inc. | Less-invasive devices and methods for cardiac valve surgery |
US5799661A (en) * | 1993-02-22 | 1998-09-01 | Heartport, Inc. | Devices and methods for port-access multivessel coronary artery bypass surgery |
FR2706309B1 (en) * | 1993-06-17 | 1995-10-06 | Sofamor | Instrument for surgical treatment of an intervertebral disc by the anterior route. |
US5755661A (en) * | 1993-06-17 | 1998-05-26 | Schwartzman; Alexander | Planar abdominal wall retractor for laparoscopic surgery |
US6063025A (en) * | 1993-07-09 | 2000-05-16 | Bioenterics Corporation | Apparatus for holding intestines out of an operative field |
US5795290A (en) * | 1993-07-09 | 1998-08-18 | Bioplexus Corporation | Apparatus for holding intestines out of an operative field |
US5415159A (en) * | 1993-08-18 | 1995-05-16 | Ethicon, Inc. | Support structure for abdominal lift |
US5398671A (en) * | 1993-08-18 | 1995-03-21 | Ethicon, Inc. | Abdominal lift device |
ATE188364T1 (en) * | 1993-09-06 | 2000-01-15 | Encoret Ltd | DEVICE FOR USE IN SURGERY |
US5578048A (en) * | 1993-09-15 | 1996-11-26 | United States Surgical Corporation | Manipulator apparatus |
WO1995008952A1 (en) * | 1993-09-28 | 1995-04-06 | Origin Medsystems, Inc. | Abdominal wall retraction system |
US20060100635A1 (en) * | 1994-01-26 | 2006-05-11 | Kyphon, Inc. | Inflatable device for use in surgical protocol relating to fixation of bone |
US6248110B1 (en) * | 1994-01-26 | 2001-06-19 | Kyphon, Inc. | Systems and methods for treating fractured or diseased bone using expandable bodies |
US5415160A (en) * | 1994-03-15 | 1995-05-16 | Ethicon, Inc. | Surgical lift method and apparatus |
US5452732A (en) * | 1994-04-26 | 1995-09-26 | Bircoll; Mel | Method of dissecting along connective tissue lines |
WO1996001130A1 (en) * | 1994-07-01 | 1996-01-18 | Origin Medsystems, Inc. | Everting cannula apparatus and method |
FR2722084B1 (en) * | 1994-07-07 | 1997-06-27 | Michaud Jean Reymond Alain Cle | DEVICE FOR LIFTING AND HOLDING ABDOMINAL WALL SUSPENSION |
US5547458A (en) * | 1994-07-11 | 1996-08-20 | Ethicon, Inc. | T-shaped abdominal wall lift with telescoping member |
US5571172A (en) * | 1994-08-15 | 1996-11-05 | Origin Medsystems, Inc. | Method and apparatus for endoscopic grafting |
US5735845A (en) * | 1995-01-17 | 1998-04-07 | Uros Corporation | Method of treating the prostate using cryosurgery |
US5897553A (en) | 1995-11-02 | 1999-04-27 | Medtronic, Inc. | Ball point fluid-assisted electrocautery device |
US6409722B1 (en) | 1998-07-07 | 2002-06-25 | Medtronic, Inc. | Apparatus and method for creating, maintaining, and controlling a virtual electrode used for the ablation of tissue |
US5681341A (en) * | 1995-03-14 | 1997-10-28 | Origin Medsystems, Inc. | Flexible lifting apparatus |
US5607441A (en) * | 1995-03-24 | 1997-03-04 | Ethicon Endo-Surgery, Inc. | Surgical dissector |
US5738628A (en) * | 1995-03-24 | 1998-04-14 | Ethicon Endo-Surgery, Inc. | Surgical dissector and method for its use |
US6245072B1 (en) * | 1995-03-27 | 2001-06-12 | Sdgi Holdings, Inc. | Methods and instruments for interbody fusion |
US5980549A (en) * | 1995-07-13 | 1999-11-09 | Origin Medsystems, Inc. | Tissue separation cannula with dissection probe and method |
DE19516932C2 (en) * | 1995-05-09 | 1998-02-26 | Aesculap Ag & Co Kg | Surgical tensioning and lifting device |
US5814038A (en) | 1995-06-07 | 1998-09-29 | Sri International | Surgical manipulator for a telerobotic system |
EP2286729B1 (en) * | 1995-06-07 | 2013-12-18 | SRI International | Surgical manipulator for a telerobotic system |
US7384423B1 (en) | 1995-07-13 | 2008-06-10 | Origin Medsystems, Inc. | Tissue dissection method |
US5681342A (en) * | 1995-08-17 | 1997-10-28 | Benchetrit; Salomon | Device and method for laparoscopic inguinal hernia repair |
US5645530A (en) * | 1995-08-28 | 1997-07-08 | Alcon Laboratories, Inc. | Phacoemulsification sleeve |
US5582620A (en) * | 1995-09-14 | 1996-12-10 | Thomas Jefferson University | Radial distention of a soft tissue space using a finger guided distention balloon |
KR19990064070A (en) * | 1995-10-06 | 1999-07-26 | 피터 이. 외팅거 | X-ray irradiation device inside the body cavity |
US5860915A (en) * | 1995-12-11 | 1999-01-19 | Segovia-Cortes; Enrique-Gerardo | Laparoscopic elevator to simultaneously lift the four quadrants of an abdominal cavity for laparoscopic surgery |
US5816257A (en) * | 1995-12-20 | 1998-10-06 | Origin Medsystems, Inc. | Gasless retroperitoneal surgical procedure |
US5741274A (en) * | 1995-12-22 | 1998-04-21 | Cardio Vascular Concepts, Inc. | Method and apparatus for laparoscopically reinforcing vascular stent-grafts |
SE9600643D0 (en) * | 1996-02-19 | 1996-02-19 | Bo S Bergstroem | Uterus manipulator |
US6852075B1 (en) | 1996-02-20 | 2005-02-08 | Cardiothoracic Systems, Inc. | Surgical devices for imposing a negative pressure to stabilize cardiac tissue during surgery |
ATE347311T1 (en) | 1996-03-20 | 2006-12-15 | Gen Surgical Innovations Inc | COMBINED DISSECTION AND RETRACTION DEVICE |
US5743852A (en) * | 1996-04-15 | 1998-04-28 | Johnson; William T. M. | Speculums |
US6036640A (en) * | 1996-04-29 | 2000-03-14 | Medtronic, Inc. | Device and method for repositioning the heart during surgery |
NL1003024C2 (en) | 1996-05-03 | 1997-11-06 | Tjong Hauw Sie | Stimulus conduction blocking instrument. |
US5954713A (en) * | 1996-07-12 | 1999-09-21 | Newman; Fredric A. | Endarterectomy surgical instruments and procedure |
US5913870A (en) * | 1996-08-13 | 1999-06-22 | United States Surgical Corporation | Surgical dissector |
US5725545A (en) * | 1996-09-27 | 1998-03-10 | Bircoll; Melvyn | Balloon dissector |
NO303522B1 (en) * | 1996-11-08 | 1998-07-27 | Nyfotek As | probe device |
US5938681A (en) * | 1997-04-15 | 1999-08-17 | Cryolife Acquisition Corporation | Cardiac manipulator for minimally invasive surgical procedures |
US6015421A (en) * | 1997-05-15 | 2000-01-18 | General Surgical Innovations, Inc. | Apparatus and method for developing an anatomic space for laparoscopic procedures |
US6936057B1 (en) * | 1997-05-19 | 2005-08-30 | Cardio Medical Solutions, Inc. (Cms) | Device and method for partially occluding blood vessels using flow-through balloon |
US5913818A (en) * | 1997-06-02 | 1999-06-22 | General Surgical Innovations, Inc. | Vascular retractor |
US6096037A (en) | 1997-07-29 | 2000-08-01 | Medtronic, Inc. | Tissue sealing electrosurgery device and methods of sealing tissue |
US5873889A (en) * | 1997-08-08 | 1999-02-23 | Origin Medsystems, Inc. | Tissue separation cannula with dissection probe and method |
US5984944A (en) * | 1997-09-12 | 1999-11-16 | B. Braun Medical, Inc. | Introducer for an expandable vascular occlusion device |
US5895410A (en) * | 1997-09-12 | 1999-04-20 | B. Braun Medical, Inc. | Introducer for an expandable vascular occlusion device |
US6171316B1 (en) | 1997-10-10 | 2001-01-09 | Origin Medsystems, Inc. | Endoscopic surgical instrument for rotational manipulation |
US6015382A (en) * | 1997-10-16 | 2000-01-18 | General Surgical Innovations, Inc. | Inflatable manipulator for organ positioning during surgery and method of use |
US6530923B1 (en) * | 1998-02-10 | 2003-03-11 | Artemis Medical, Inc. | Tissue removal methods and apparatus |
US6270464B1 (en) * | 1998-06-22 | 2001-08-07 | Artemis Medical, Inc. | Biopsy localization method and device |
US5993461A (en) * | 1998-01-07 | 1999-11-30 | Abae; Mick | Laparoscopic instrument for manipulating the uterus during laparoscopic surgery |
US6602265B2 (en) * | 1998-02-10 | 2003-08-05 | Artemis Medical, Inc. | Tissue separation medical device and method |
EP1054634A4 (en) | 1998-02-10 | 2006-03-29 | Artemis Medical Inc | Entrapping apparatus and method for use |
US5916233A (en) * | 1998-03-05 | 1999-06-29 | Origin Medsystems, Inc. | Vessel harvesting method and instrument including access port |
US6024759A (en) * | 1998-05-08 | 2000-02-15 | Walter Lorenz Surgical, Inc. | Method and apparatus for performing pectus excavatum repair |
WO1999062457A1 (en) * | 1998-05-29 | 1999-12-09 | Theracardia, Inc. | Cardiac massage apparatus and method |
US6200280B1 (en) | 1998-05-29 | 2001-03-13 | Theracardia, Inc. | Cardiac massage apparatus and method |
US20020058882A1 (en) * | 1998-06-22 | 2002-05-16 | Artemis Medical, Incorporated | Biopsy localization method and device |
US6706039B2 (en) | 1998-07-07 | 2004-03-16 | Medtronic, Inc. | Method and apparatus for creating a bi-polar virtual electrode used for the ablation of tissue |
US6537248B2 (en) * | 1998-07-07 | 2003-03-25 | Medtronic, Inc. | Helical needle apparatus for creating a virtual electrode used for the ablation of tissue |
US6527748B1 (en) * | 1998-08-17 | 2003-03-04 | Yutaka Suzuki | Method of gastrostomy, and an infection preventive cover, kit or catheter kit, and a gastrostomy catheter kit |
USD426635S (en) * | 1998-08-18 | 2000-06-13 | Genicon, Lc | Combination trocar, cannula, and valve |
US6099518A (en) * | 1998-10-20 | 2000-08-08 | Boston Scientific Corporation | Needle herniorrhaphy devices |
US20030130563A1 (en) * | 1998-11-04 | 2003-07-10 | Loy Randall A. | Hysteroscope port and methods |
US6485410B1 (en) | 1998-11-04 | 2002-11-26 | Synergyn Technologies, Inc. | Hysteroscope port and methods |
ATE308277T1 (en) | 1998-12-01 | 2005-11-15 | Atropos Ltd | SURGICAL DEVICE FOR RETRACTION AND/OR CLOSING A PITCH |
US20050192483A1 (en) * | 1998-12-01 | 2005-09-01 | Frank Bonadio | Device |
US20070004968A1 (en) * | 1998-12-01 | 2007-01-04 | Frank Bonadio | Seal for a cannula |
US7559893B2 (en) | 1998-12-01 | 2009-07-14 | Atropos Limited | Wound retractor device |
US7537564B2 (en) | 1998-12-01 | 2009-05-26 | Atropos Limited | Wound retractor device |
US6551241B1 (en) * | 1999-12-17 | 2003-04-22 | Leonard S. Schultz | Instruments and methods for performing percutaneous surgery |
US6042539A (en) | 1999-03-26 | 2000-03-28 | Ethicon Endo-Surgery, Inc. | Vacuum-actuated tissue-lifting device and method |
US6328729B1 (en) * | 1999-04-27 | 2001-12-11 | General Surgical Innovations, Inc. | Colporrhaphy method and apparatus |
US6283912B1 (en) * | 1999-05-04 | 2001-09-04 | Cardiothoracic Systems, Inc. | Surgical retractor platform blade apparatus |
US6287290B1 (en) * | 1999-07-02 | 2001-09-11 | Pulmonx | Methods, systems, and kits for lung volume reduction |
ATE329531T1 (en) | 1999-07-02 | 2006-07-15 | Quickpass Inc | SURGICAL SEWING DEVICE |
US6338738B1 (en) | 1999-08-31 | 2002-01-15 | Edwards Lifesciences Corp. | Device and method for stabilizing cardiac tissue |
US6592602B1 (en) * | 1999-10-08 | 2003-07-15 | General Surgical Innovations, Inc. | Balloon dissection apparatus |
CN1169493C (en) | 1999-10-14 | 2004-10-06 | 阿特波斯有限公司 | A wound retractor |
US20050203346A1 (en) * | 1999-10-14 | 2005-09-15 | Frank Bonadio | Wound retractor device |
US6689062B1 (en) | 1999-11-23 | 2004-02-10 | Microaccess Medical Systems, Inc. | Method and apparatus for transesophageal cardiovascular procedures |
US6692450B1 (en) | 2000-01-19 | 2004-02-17 | Medtronic Xomed, Inc. | Focused ultrasound ablation devices having selectively actuatable ultrasound emitting elements and methods of using the same |
US7706882B2 (en) | 2000-01-19 | 2010-04-27 | Medtronic, Inc. | Methods of using high intensity focused ultrasound to form an ablated tissue area |
US8221402B2 (en) | 2000-01-19 | 2012-07-17 | Medtronic, Inc. | Method for guiding a medical device |
US7153319B1 (en) | 2000-01-26 | 2006-12-26 | Genico, Inc. | Trocar system having shielded trocar |
USD449887S1 (en) | 2000-01-26 | 2001-10-30 | Genicon Lc | Combined obturator, cannula and valve assembly |
US20020013601A1 (en) * | 2000-01-28 | 2002-01-31 | Nobles Anthony A. | Cavity enlarger method and apparatus |
US8083736B2 (en) | 2000-03-06 | 2011-12-27 | Salient Surgical Technologies, Inc. | Fluid-assisted medical devices, systems and methods |
US8048070B2 (en) | 2000-03-06 | 2011-11-01 | Salient Surgical Technologies, Inc. | Fluid-assisted medical devices, systems and methods |
USD443360S1 (en) | 2000-03-22 | 2001-06-05 | Dexterity Surgical Inc. | Distal end of obturator for a trocar |
US6514250B1 (en) * | 2000-04-27 | 2003-02-04 | Medtronic, Inc. | Suction stabilized epicardial ablation devices |
WO2001082812A1 (en) | 2000-04-27 | 2001-11-08 | Medtronic, Inc. | Vibration sensitive ablation apparatus and method |
US6488680B1 (en) | 2000-04-27 | 2002-12-03 | Medtronic, Inc. | Variable length electrodes for delivery of irrigated ablation |
JP3773050B2 (en) * | 2000-07-27 | 2006-05-10 | 株式会社ジェイ・エム・エス | Biological tissue support device for medical treatment |
DE10040774A1 (en) * | 2000-08-21 | 2002-03-28 | Ebert Dieter | Device for enabling a clear view of a surgical treatment site |
US6926669B1 (en) | 2000-10-10 | 2005-08-09 | Medtronic, Inc. | Heart wall ablation/mapping catheter and method |
CA2422782C (en) | 2000-10-19 | 2012-02-07 | Applied Medical Resources Corporation | Surgical access apparatus and method |
US7033373B2 (en) | 2000-11-03 | 2006-04-25 | Satiety, Inc. | Method and device for use in minimally invasive placement of space-occupying intragastric devices |
US6607549B2 (en) * | 2000-12-12 | 2003-08-19 | Pro David Inc. | Oral rehabilitation device |
US20040138621A1 (en) | 2003-01-14 | 2004-07-15 | Jahns Scott E. | Devices and methods for interstitial injection of biologic agents into tissue |
US7740623B2 (en) | 2001-01-13 | 2010-06-22 | Medtronic, Inc. | Devices and methods for interstitial injection of biologic agents into tissue |
US20020128571A1 (en) * | 2001-03-07 | 2002-09-12 | Brenneman Rodney A. | Method and apparatus for intercostal cardiac compression device |
US6616673B1 (en) * | 2001-04-19 | 2003-09-09 | Biomet, Inc. | Segmented joint distractor |
US7250048B2 (en) | 2001-04-26 | 2007-07-31 | Medtronic, Inc. | Ablation system and method of use |
US6648883B2 (en) | 2001-04-26 | 2003-11-18 | Medtronic, Inc. | Ablation system and method of use |
US6807968B2 (en) | 2001-04-26 | 2004-10-26 | Medtronic, Inc. | Method and system for treatment of atrial tachyarrhythmias |
US6663627B2 (en) | 2001-04-26 | 2003-12-16 | Medtronic, Inc. | Ablation system and method of use |
US6699240B2 (en) | 2001-04-26 | 2004-03-02 | Medtronic, Inc. | Method and apparatus for tissue ablation |
US7959626B2 (en) | 2001-04-26 | 2011-06-14 | Medtronic, Inc. | Transmural ablation systems and methods |
JP2002338688A (en) * | 2001-05-15 | 2002-11-27 | Sumitomo Chem Co Ltd | Method for producing purified polyethersulfone |
US6558400B2 (en) | 2001-05-30 | 2003-05-06 | Satiety, Inc. | Obesity treatment tools and methods |
US7083629B2 (en) | 2001-05-30 | 2006-08-01 | Satiety, Inc. | Overtube apparatus for insertion into a body |
CA2447100A1 (en) * | 2001-05-31 | 2002-12-05 | Tyco Healthcare Group Lp | Balloon cannula with over-center clamp |
US20050033246A1 (en) | 2002-05-14 | 2005-02-10 | Ahlberg Russell E. | Surgical device with tack-free gel and method of manufacture |
WO2003015848A1 (en) | 2001-08-14 | 2003-02-27 | Applied Medical Resources Corporation | Access sealing apparatus and method |
US6913610B2 (en) * | 2001-10-16 | 2005-07-05 | Granit Medical Innovations, Inc. | Endoscopic retractor instrument and associated method |
US6958037B2 (en) | 2001-10-20 | 2005-10-25 | Applied Medical Resources Corporation | Wound retraction apparatus and method |
US6656175B2 (en) | 2001-12-11 | 2003-12-02 | Medtronic, Inc. | Method and system for treatment of atrial tachyarrhythmias |
US7967816B2 (en) | 2002-01-25 | 2011-06-28 | Medtronic, Inc. | Fluid-assisted electrosurgical instrument with shapeable electrode |
US6827715B2 (en) | 2002-01-25 | 2004-12-07 | Medtronic, Inc. | System and method of performing an electrosurgical procedure |
US6723044B2 (en) * | 2002-03-14 | 2004-04-20 | Apple Medical Corporation | Abdominal retractor |
US7118566B2 (en) | 2002-05-16 | 2006-10-10 | Medtronic, Inc. | Device and method for needle-less interstitial injection of fluid for ablation of cardiac tissue |
US7294143B2 (en) | 2002-05-16 | 2007-11-13 | Medtronic, Inc. | Device and method for ablation of cardiac tissue |
EP1534201B1 (en) | 2002-06-05 | 2011-05-25 | Applied Medical Resources Corporation | Wound retractor |
US8287561B2 (en) * | 2002-06-28 | 2012-10-16 | Boston Scientific Scimed, Inc. | Balloon-type actuator for surgical applications |
US6746460B2 (en) | 2002-08-07 | 2004-06-08 | Satiety, Inc. | Intra-gastric fastening devices |
US9271753B2 (en) * | 2002-08-08 | 2016-03-01 | Atropos Limited | Surgical device |
US7214233B2 (en) | 2002-08-30 | 2007-05-08 | Satiety, Inc. | Methods and devices for maintaining a space occupying device in a relatively fixed location within a stomach |
US7033384B2 (en) | 2002-08-30 | 2006-04-25 | Satiety, Inc. | Stented anchoring of gastric space-occupying devices |
WO2004026153A1 (en) | 2002-09-19 | 2004-04-01 | Atropos Limited | A wound retractor system |
US7300448B2 (en) * | 2002-10-04 | 2007-11-27 | Tyco Healthcare Group Lp | Balloon dissector with cannula |
WO2004032756A2 (en) | 2002-10-04 | 2004-04-22 | Tyco Healthcare Group, Lp | Balloon dissector with cannula |
US7220237B2 (en) | 2002-10-23 | 2007-05-22 | Satiety, Inc. | Method and device for use in endoscopic organ procedures |
US7229428B2 (en) * | 2002-10-23 | 2007-06-12 | Satiety, Inc. | Method and device for use in endoscopic organ procedures |
US7083620B2 (en) | 2002-10-30 | 2006-08-01 | Medtronic, Inc. | Electrosurgical hemostat |
US6656194B1 (en) | 2002-11-05 | 2003-12-02 | Satiety, Inc. | Magnetic anchoring devices |
DE10305553B4 (en) * | 2003-02-10 | 2005-11-03 | Lothar Dr.med. Göbel | Device for tamponade of body cavities |
US20050020884A1 (en) | 2003-02-25 | 2005-01-27 | Hart Charles C. | Surgical access system |
US7162309B2 (en) * | 2003-04-07 | 2007-01-09 | Medtronic, Inc. | Epicardial lead delivery system and method |
US7175638B2 (en) | 2003-04-16 | 2007-02-13 | Satiety, Inc. | Method and devices for modifying the function of a body organ |
US7497857B2 (en) | 2003-04-29 | 2009-03-03 | Medtronic, Inc. | Endocardial dispersive electrode for use with a monopolar RF ablation pen |
US7101387B2 (en) * | 2003-04-30 | 2006-09-05 | Scimed Life Systems, Inc. | Radio frequency ablation cooling shield |
US7967835B2 (en) | 2003-05-05 | 2011-06-28 | Tyco Healthcare Group Lp | Apparatus for use in fascial cleft surgery for opening an anatomic space |
WO2004100799A2 (en) | 2003-05-08 | 2004-11-25 | Tyco Healthcare Group Lp | Balloon dissector with balloon anchor cannula |
US20070084897A1 (en) | 2003-05-20 | 2007-04-19 | Shelton Frederick E Iv | Articulating surgical stapling instrument incorporating a two-piece e-beam firing mechanism |
US9060770B2 (en) | 2003-05-20 | 2015-06-23 | Ethicon Endo-Surgery, Inc. | Robotically-driven surgical instrument with E-beam driver |
GB0315479D0 (en) | 2003-07-02 | 2003-08-06 | Paz Adrian | Virtual ports devices |
US7960935B2 (en) | 2003-07-08 | 2011-06-14 | The Board Of Regents Of The University Of Nebraska | Robotic devices with agent delivery components and related methods |
US20060079924A1 (en) * | 2003-07-24 | 2006-04-13 | Femspec Llc | Apparatus for accessing a body cavity and methods of making same |
US7758647B2 (en) * | 2003-07-25 | 2010-07-20 | Impliant Ltd. | Elastomeric spinal disc nucleus replacement |
US7163510B2 (en) | 2003-09-17 | 2007-01-16 | Applied Medical Resources Corporation | Surgical instrument access device |
EP2545861B1 (en) * | 2003-10-03 | 2014-02-12 | Applied Medical Resources Corporation | Bladeless optical obturator |
US7914543B2 (en) | 2003-10-14 | 2011-03-29 | Satiety, Inc. | Single fold device for tissue fixation |
US7097650B2 (en) | 2003-10-14 | 2006-08-29 | Satiety, Inc. | System for tissue approximation and fixation |
WO2005044111A2 (en) * | 2003-11-05 | 2005-05-19 | Atropos Limited | A surgical sealing device |
US20050101839A1 (en) * | 2003-11-11 | 2005-05-12 | Bertolero Arthur A. | Thorax mounted stabilization platform |
US7294103B2 (en) * | 2003-11-12 | 2007-11-13 | Endoscopic Technologies, Inc. | Retractor with inflatable blades |
US7524302B2 (en) * | 2003-12-17 | 2009-04-28 | Numed, Inc. | Prenatal balloon catheter |
US7344495B2 (en) * | 2004-01-27 | 2008-03-18 | Arvik Enterprises, Llc | Surgical retractor apparatus for use with a surgical port |
US7195592B2 (en) * | 2004-01-27 | 2007-03-27 | Sundaram Ravikumar | Surgical retractor apparatus for use with a surgical port |
US20050177176A1 (en) | 2004-02-05 | 2005-08-11 | Craig Gerbi | Single-fold system for tissue approximation and fixation |
US8828025B2 (en) | 2004-02-13 | 2014-09-09 | Ethicon Endo-Surgery, Inc. | Methods and devices for reducing hollow organ volume |
US8088139B2 (en) * | 2004-02-17 | 2012-01-03 | Boston Scientific Scimed, Inc. | Endoscopic tissue stabilization device and related methods of use |
US8074655B2 (en) | 2004-02-26 | 2011-12-13 | Linguaflex, Inc. | Methods and devices for treating sleep apnea and snoring |
US10524954B2 (en) | 2004-02-26 | 2020-01-07 | Linguaflex, Inc. | Methods and devices for treating sleep apnea and snoring |
NZ550020A (en) | 2004-02-26 | 2011-02-25 | Linguaflex Llc | A tissue retractor for treatment of a breathing disorder comprising a shaft, a retractor, and an anchor |
US7708684B2 (en) | 2004-02-27 | 2010-05-04 | Satiety, Inc. | Methods and devices for reducing hollow organ volume |
US8252009B2 (en) | 2004-03-09 | 2012-08-28 | Ethicon Endo-Surgery, Inc. | Devices and methods for placement of partitions within a hollow body organ |
US9028511B2 (en) | 2004-03-09 | 2015-05-12 | Ethicon Endo-Surgery, Inc. | Devices and methods for placement of partitions within a hollow body organ |
US8449560B2 (en) | 2004-03-09 | 2013-05-28 | Satiety, Inc. | Devices and methods for placement of partitions within a hollow body organ |
US8628547B2 (en) | 2004-03-09 | 2014-01-14 | Ethicon Endo-Surgery, Inc. | Devices and methods for placement of partitions within a hollow body organ |
AU2005231323B2 (en) | 2004-03-26 | 2011-03-31 | Ethicon Endo-Surgery, Inc | Systems and methods for treating obesity |
US9381009B2 (en) * | 2004-04-26 | 2016-07-05 | Patrick Leahy | Surgical device |
US8764646B2 (en) * | 2004-04-29 | 2014-07-01 | Umc Utrecht Holding B.V. | Surgical expansion device |
US8333764B2 (en) | 2004-05-12 | 2012-12-18 | Medtronic, Inc. | Device and method for determining tissue thickness and creating cardiac ablation lesions |
ATE547990T1 (en) | 2004-05-14 | 2012-03-15 | Medtronic Inc | DEVICES FOR TREATING AFRICIA BY MASS ABLATION |
DE602005021096D1 (en) | 2004-06-02 | 2010-06-17 | Medtronic Inc | COMPOUND BIPOLAR ABLATION DEVICE |
WO2005120376A2 (en) | 2004-06-02 | 2005-12-22 | Medtronic, Inc. | Ablation device with jaws |
EP1750607A2 (en) | 2004-06-02 | 2007-02-14 | Medtronic, Inc. | Loop ablation apparatus and method |
ATE516762T1 (en) | 2004-06-02 | 2011-08-15 | Medtronic Inc | ABLATION AND STAPLE INSTRUMENT |
US8663245B2 (en) | 2004-06-18 | 2014-03-04 | Medtronic, Inc. | Device for occlusion of a left atrial appendage |
US8409219B2 (en) | 2004-06-18 | 2013-04-02 | Medtronic, Inc. | Method and system for placement of electrical lead inside heart |
US8926635B2 (en) | 2004-06-18 | 2015-01-06 | Medtronic, Inc. | Methods and devices for occlusion of an atrial appendage |
US20060004398A1 (en) * | 2004-07-02 | 2006-01-05 | Binder Lawrence J Jr | Sequential dilator system |
US8215531B2 (en) | 2004-07-28 | 2012-07-10 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having a medical substance dispenser |
US11896225B2 (en) | 2004-07-28 | 2024-02-13 | Cilag Gmbh International | Staple cartridge comprising a pan |
AU2005293216A1 (en) | 2004-10-11 | 2006-04-20 | Atropos Limited | An instrument access device |
US20060079922A1 (en) * | 2004-10-12 | 2006-04-13 | Brian Creston | Balloon anchored surgical apparatus, its use and manufacture |
US20070078476A1 (en) * | 2004-10-12 | 2007-04-05 | Hull Wendell C Sr | Overweight control apparatuses for insertion into the stomach |
US20060106288A1 (en) | 2004-11-17 | 2006-05-18 | Roth Alex T | Remote tissue retraction device |
US7811253B2 (en) * | 2004-12-09 | 2010-10-12 | Applied Medical Resources Corporation | Insufflation gas warmer and humidifier |
US7785291B2 (en) * | 2005-03-01 | 2010-08-31 | Tulip Medical Ltd. | Bioerodible self-deployable intragastric implants |
US7699863B2 (en) * | 2005-03-01 | 2010-04-20 | Tulip Medical Ltd. | Bioerodible self-deployable intragastric implants |
US20060212126A1 (en) * | 2005-03-17 | 2006-09-21 | Jerry Zucker | Device and a method for extending a distal end of an anatomic tube |
US8545450B2 (en) * | 2005-04-08 | 2013-10-01 | Ethicon Endo-Surgery, Inc. | Multi-port laparoscopic access device |
NL1029010C2 (en) * | 2005-05-11 | 2006-11-14 | Robert Walter Kreis | Flexible film device for covering open abdominal wound, contains inflatable channels for stretching film |
US20070049849A1 (en) * | 2005-05-24 | 2007-03-01 | Schwardt Jeffrey D | Bone probe apparatus and method of use |
US8083664B2 (en) | 2005-05-25 | 2011-12-27 | Maquet Cardiovascular Llc | Surgical stabilizers and methods for use in reduced-access surgical sites |
US8740988B1 (en) * | 2005-06-16 | 2014-06-03 | Robert L. Hively | Bariatric balloon apparatus |
JP5186366B2 (en) | 2005-06-20 | 2013-04-17 | スーチュラ,インコーポレイテッド | Device for knotting sutures |
US8007508B2 (en) * | 2005-07-01 | 2011-08-30 | Cox John A | System for tissue dissection and retraction |
WO2007010511A1 (en) | 2005-07-15 | 2007-01-25 | Atropos Limited | A wound retractor |
US7669746B2 (en) | 2005-08-31 | 2010-03-02 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US10159482B2 (en) | 2005-08-31 | 2018-12-25 | Ethicon Llc | Fastener cartridge assembly comprising a fixed anvil and different staple heights |
US11246590B2 (en) | 2005-08-31 | 2022-02-15 | Cilag Gmbh International | Staple cartridge including staple drivers having different unfired heights |
US11484312B2 (en) | 2005-08-31 | 2022-11-01 | Cilag Gmbh International | Staple cartridge comprising a staple driver arrangement |
US9237891B2 (en) | 2005-08-31 | 2016-01-19 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical stapling devices that produce formed staples having different lengths |
US7934630B2 (en) | 2005-08-31 | 2011-05-03 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
AU2006304141B2 (en) | 2005-10-14 | 2012-07-05 | Applied Medical Resources Corporation | Gel cap for wound retractor |
US20070106317A1 (en) | 2005-11-09 | 2007-05-10 | Shelton Frederick E Iv | Hydraulically and electrically actuated articulation joints for surgical instruments |
DE102005053831A1 (en) * | 2005-11-11 | 2007-05-24 | Haindl, Hans, Dr.med. Dipl.-Ing. | Device for supporting the abdominal wall against underlying organs in minimally invasive surgery |
US20070167967A1 (en) * | 2006-01-13 | 2007-07-19 | Olympus Medical Systems Corp. | Medical procedure via natural orifice and puncture device |
US20070173855A1 (en) * | 2006-01-17 | 2007-07-26 | Sdgi Holdings, Inc. | Devices and methods for spacing of vertebral members over multiple levels |
US11224427B2 (en) | 2006-01-31 | 2022-01-18 | Cilag Gmbh International | Surgical stapling system including a console and retraction assembly |
US7753904B2 (en) | 2006-01-31 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Endoscopic surgical instrument with a handle that can articulate with respect to the shaft |
US20120292367A1 (en) | 2006-01-31 | 2012-11-22 | Ethicon Endo-Surgery, Inc. | Robotically-controlled end effector |
US8708213B2 (en) | 2006-01-31 | 2014-04-29 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a feedback system |
US7845537B2 (en) | 2006-01-31 | 2010-12-07 | Ethicon Endo-Surgery, Inc. | Surgical instrument having recording capabilities |
US8186555B2 (en) | 2006-01-31 | 2012-05-29 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting and fastening instrument with mechanical closure system |
US11793518B2 (en) | 2006-01-31 | 2023-10-24 | Cilag Gmbh International | Powered surgical instruments with firing system lockout arrangements |
US11278279B2 (en) | 2006-01-31 | 2022-03-22 | Cilag Gmbh International | Surgical instrument assembly |
US20110024477A1 (en) | 2009-02-06 | 2011-02-03 | Hall Steven G | Driven Surgical Stapler Improvements |
US8820603B2 (en) | 2006-01-31 | 2014-09-02 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of a surgical instrument |
US20110295295A1 (en) | 2006-01-31 | 2011-12-01 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical instrument having recording capabilities |
US20070213584A1 (en) * | 2006-03-10 | 2007-09-13 | Kim Daniel H | Percutaneous access and visualization of the spine |
US8147453B2 (en) | 2006-03-13 | 2012-04-03 | Applied Medical Resources Corporation | Balloon trocar |
US8133255B2 (en) * | 2006-03-13 | 2012-03-13 | Mini-Lap Technologies, Inc. | Minimally invasive surgical assembly and methods |
US8313507B2 (en) * | 2006-03-13 | 2012-11-20 | Mini-Lap Technologies, Inc. | Minimally invasive rake retractor and method for using same |
US7766937B2 (en) | 2006-03-13 | 2010-08-03 | Mini-Lap Technologies, Inc. | Minimally invasive surgical assembly and methods |
US8287503B2 (en) | 2006-03-13 | 2012-10-16 | Applied Medical Resources Corporation | Balloon trocar |
US8992422B2 (en) | 2006-03-23 | 2015-03-31 | Ethicon Endo-Surgery, Inc. | Robotically-controlled endoscopic accessory channel |
US8357085B2 (en) * | 2009-03-31 | 2013-01-22 | Ethicon Endo-Surgery, Inc. | Devices and methods for providing access into a body cavity |
US20100228096A1 (en) * | 2009-03-06 | 2010-09-09 | Ethicon Endo-Surgery, Inc. | Methods and devices for providing access into a body cavity |
US20080039746A1 (en) | 2006-05-25 | 2008-02-14 | Medtronic, Inc. | Methods of using high intensity focused ultrasound to form an ablated tissue area containing a plurality of lesions |
US20070282170A1 (en) * | 2006-05-30 | 2007-12-06 | Sundaram Ravikumar | Rake Retractor and Needle Assembly for Minimally Invasive Surgical Applications |
US8818322B2 (en) * | 2006-06-09 | 2014-08-26 | Trapeze Networks, Inc. | Untethered access point mesh system and method |
US8974440B2 (en) | 2007-08-15 | 2015-03-10 | Board Of Regents Of The University Of Nebraska | Modular and cooperative medical devices and related systems and methods |
CA2991346C (en) | 2006-06-22 | 2020-03-10 | Board Of Regents Of The University Of Nebraska | Magnetically coupleable robotic devices and related methods |
US9579088B2 (en) | 2007-02-20 | 2017-02-28 | Board Of Regents Of The University Of Nebraska | Methods, systems, and devices for surgical visualization and device manipulation |
US8679096B2 (en) | 2007-06-21 | 2014-03-25 | Board Of Regents Of The University Of Nebraska | Multifunctional operational component for robotic devices |
US20070299393A1 (en) * | 2006-06-23 | 2007-12-27 | Podmore Jonathan L | Device and method for surgical treatments |
US8322455B2 (en) | 2006-06-27 | 2012-12-04 | Ethicon Endo-Surgery, Inc. | Manually driven surgical cutting and fastening instrument |
US20080033431A1 (en) * | 2006-06-29 | 2008-02-07 | Searete Llc, A Limited Liability Corporation Of The State Of Delaware | Position augmenting mechanism |
US9492192B2 (en) | 2006-06-30 | 2016-11-15 | Atheromed, Inc. | Atherectomy devices, systems, and methods |
US9314263B2 (en) * | 2006-06-30 | 2016-04-19 | Atheromed, Inc. | Atherectomy devices, systems, and methods |
US20090018566A1 (en) * | 2006-06-30 | 2009-01-15 | Artheromed, Inc. | Atherectomy devices, systems, and methods |
US8361094B2 (en) | 2006-06-30 | 2013-01-29 | Atheromed, Inc. | Atherectomy devices and methods |
US8007506B2 (en) | 2006-06-30 | 2011-08-30 | Atheromed, Inc. | Atherectomy devices and methods |
US20080045986A1 (en) * | 2006-06-30 | 2008-02-21 | Atheromed, Inc. | Atherectomy devices and methods |
US8628549B2 (en) | 2006-06-30 | 2014-01-14 | Atheromed, Inc. | Atherectomy devices, systems, and methods |
US7981128B2 (en) * | 2006-06-30 | 2011-07-19 | Atheromed, Inc. | Atherectomy devices and methods |
EP3308725B1 (en) | 2006-06-30 | 2023-06-14 | Atheromed, Inc. | Contra-rotating cutting assembly and atherectomy device |
US20110112563A1 (en) * | 2006-06-30 | 2011-05-12 | Atheromed, Inc. | Atherectomy devices and methods |
US20100010530A1 (en) * | 2006-07-14 | 2010-01-14 | Ams Research Corporation | Balloon Dilation for Implantable Prosthesis |
JP4885640B2 (en) * | 2006-08-01 | 2012-02-29 | オリンパスメディカルシステムズ株式会社 | Endoscope insertion aid |
US7544213B2 (en) * | 2006-09-12 | 2009-06-09 | Adams Jason P | Inflatable hernia patch |
US7665647B2 (en) | 2006-09-29 | 2010-02-23 | Ethicon Endo-Surgery, Inc. | Surgical cutting and stapling device with closure apparatus for limiting maximum tissue compression force |
US10568652B2 (en) | 2006-09-29 | 2020-02-25 | Ethicon Llc | Surgical staples having attached drivers of different heights and stapling instruments for deploying the same |
US20080086166A1 (en) * | 2006-10-10 | 2008-04-10 | Sundaram Ravikumar | Minimally Invasive Surgical Assembly with Balloon Instrument |
US7763033B2 (en) * | 2006-10-18 | 2010-07-27 | Interlace Medical, Inc. | System and methods for preventing intravasation during intrauterine procedures |
US9392935B2 (en) * | 2006-11-07 | 2016-07-19 | Hologic, Inc. | Methods for performing a medical procedure |
US8025656B2 (en) | 2006-11-07 | 2011-09-27 | Hologic, Inc. | Methods, systems and devices for performing gynecological procedures |
EP2099385B1 (en) * | 2006-11-27 | 2021-02-24 | Davol Inc. | A device especially useful for hernia repair surgeries |
US11291441B2 (en) | 2007-01-10 | 2022-04-05 | Cilag Gmbh International | Surgical instrument with wireless communication between control unit and remote sensor |
US8684253B2 (en) | 2007-01-10 | 2014-04-01 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between a control unit of a robotic system and remote sensor |
US8652120B2 (en) | 2007-01-10 | 2014-02-18 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between control unit and sensor transponders |
US11039836B2 (en) | 2007-01-11 | 2021-06-22 | Cilag Gmbh International | Staple cartridge for use with a surgical stapling instrument |
US8540128B2 (en) | 2007-01-11 | 2013-09-24 | Ethicon Endo-Surgery, Inc. | Surgical stapling device with a curved end effector |
US7735703B2 (en) | 2007-03-15 | 2010-06-15 | Ethicon Endo-Surgery, Inc. | Re-loadable surgical stapling instrument |
US8893946B2 (en) | 2007-03-28 | 2014-11-25 | Ethicon Endo-Surgery, Inc. | Laparoscopic tissue thickness and clamp load measuring devices |
US8246636B2 (en) | 2007-03-29 | 2012-08-21 | Nobles Medical Technologies, Inc. | Suturing devices and methods for closing a patent foramen ovale |
US8574253B2 (en) * | 2007-04-06 | 2013-11-05 | Hologic, Inc. | Method, system and device for tissue removal |
US9095366B2 (en) * | 2007-04-06 | 2015-08-04 | Hologic, Inc. | Tissue cutter with differential hardness |
US20090270895A1 (en) * | 2007-04-06 | 2009-10-29 | Interlace Medical, Inc. | Low advance ratio, high reciprocation rate tissue removal device |
US9259233B2 (en) * | 2007-04-06 | 2016-02-16 | Hologic, Inc. | Method and device for distending a gynecological cavity |
WO2008124748A1 (en) * | 2007-04-09 | 2008-10-16 | Adrian Edward Park | Frame device |
WO2008141302A1 (en) | 2007-05-11 | 2008-11-20 | Applied Medical Resources Corporation | Surgical retractor |
WO2008141291A1 (en) | 2007-05-11 | 2008-11-20 | Applied Medical Resources Corporation | Surgical retractor with gel pad |
US20080300467A1 (en) * | 2007-05-29 | 2008-12-04 | Schaefer Robert W | Surgical wound retractor with reusable rings |
US11857181B2 (en) | 2007-06-04 | 2024-01-02 | Cilag Gmbh International | Robotically-controlled shaft based rotary drive systems for surgical instruments |
US8931682B2 (en) | 2007-06-04 | 2015-01-13 | Ethicon Endo-Surgery, Inc. | Robotically-controlled shaft based rotary drive systems for surgical instruments |
US8657740B2 (en) * | 2007-06-05 | 2014-02-25 | Atropos Limited | Instrument access device |
EP2152175B1 (en) | 2007-06-05 | 2015-10-28 | Atropos Limited | An instrument access device |
US7753245B2 (en) | 2007-06-22 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments |
US11849941B2 (en) | 2007-06-29 | 2023-12-26 | Cilag Gmbh International | Staple cartridge having staple cavities extending at a transverse angle relative to a longitudinal cartridge axis |
US20100217151A1 (en) * | 2007-07-11 | 2010-08-26 | Zach Gostout | Methods and Systems for Performing Submucosal Medical Procedures |
US8929988B2 (en) | 2007-07-11 | 2015-01-06 | Apollo Endosurgery, Inc. | Methods and systems for submucosal implantation of a device for diagnosis and treatment of a body |
US8066689B2 (en) | 2007-07-11 | 2011-11-29 | Apollo Endosurgery, Inc. | Methods and systems for submucosal implantation of a device for diagnosis and treatment with a therapeutic agent |
US8128592B2 (en) | 2007-07-11 | 2012-03-06 | Apollo Endosurgery, Inc. | Methods and systems for performing submucosal medical procedures |
US8317771B2 (en) | 2007-07-11 | 2012-11-27 | Apollo Endosurgery, Inc. | Methods and systems for performing submucosal medical procedures |
JP5591696B2 (en) | 2007-07-12 | 2014-09-17 | ボード オブ リージェンツ オブ ザ ユニバーシティ オブ ネブラスカ | Biopsy elements, arm devices, and medical devices |
US8500773B2 (en) * | 2007-08-01 | 2013-08-06 | Boston Scientific Scimed, Inc. | Spring detach joint for delivering a detachable implantable device |
US20090076536A1 (en) | 2007-08-15 | 2009-03-19 | Board Of Regents Of The University Of Nebraska | Medical inflation, attachment, and delivery devices and related methods |
WO2009024955A1 (en) * | 2007-08-20 | 2009-02-26 | Atropos Limited | A hand and instrument access device |
US8465515B2 (en) * | 2007-08-29 | 2013-06-18 | Ethicon Endo-Surgery, Inc. | Tissue retractors |
US7976497B2 (en) | 2007-09-25 | 2011-07-12 | Polyzen Inc. | Multi-layer film welded articulated balloon |
US8795326B2 (en) | 2007-10-05 | 2014-08-05 | Covidien Lp | Expanding seal anchor for single incision surgery |
WO2009046414A1 (en) | 2007-10-05 | 2009-04-09 | Synthes (U.S.A.) | Dilation system and method of using the same |
CA2702882C (en) * | 2007-10-17 | 2016-06-21 | Davol Inc. | Fixating means between a mesh and mesh deployment means especially useful for hernia repair surgeries and methods thereof |
US8070762B2 (en) | 2007-10-22 | 2011-12-06 | Atheromed Inc. | Atherectomy devices and methods |
US8236016B2 (en) | 2007-10-22 | 2012-08-07 | Atheromed, Inc. | Atherectomy devices and methods |
US8517931B2 (en) * | 2007-11-26 | 2013-08-27 | Ethicon Endo-Surgery, Inc. | Tissue retractors |
US8128559B2 (en) * | 2007-11-26 | 2012-03-06 | Ethicon Endo-Surgery, Inc. | Tissue retractors |
US20090149714A1 (en) * | 2007-12-05 | 2009-06-11 | Frank Bonadio | Surgical devices and methods |
US8016851B2 (en) * | 2007-12-27 | 2011-09-13 | Cook Medical Technologies Llc | Delivery system and method of delivery for treating obesity |
WO2009086448A1 (en) | 2007-12-28 | 2009-07-09 | Salient Surgical Technologies, Inc. | Fluid-assisted electrosurgical devices, methods and systems |
GB0800835D0 (en) * | 2008-01-17 | 2008-02-27 | Cardioprec Ltd | Retractor |
US8343047B2 (en) | 2008-01-22 | 2013-01-01 | Applied Medical Resources Corporation | Surgical instrument access device |
US8573465B2 (en) | 2008-02-14 | 2013-11-05 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical end effector system with rotary actuated closure systems |
US9179912B2 (en) | 2008-02-14 | 2015-11-10 | Ethicon Endo-Surgery, Inc. | Robotically-controlled motorized surgical cutting and fastening instrument |
US8758391B2 (en) | 2008-02-14 | 2014-06-24 | Ethicon Endo-Surgery, Inc. | Interchangeable tools for surgical instruments |
RU2493788C2 (en) | 2008-02-14 | 2013-09-27 | Этикон Эндо-Серджери, Инк. | Surgical cutting and fixing instrument, which has radio-frequency electrodes |
US7866527B2 (en) | 2008-02-14 | 2011-01-11 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with interlockable firing system |
US8636736B2 (en) | 2008-02-14 | 2014-01-28 | Ethicon Endo-Surgery, Inc. | Motorized surgical cutting and fastening instrument |
US7819298B2 (en) | 2008-02-14 | 2010-10-26 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with control features operable with one hand |
US20090326518A1 (en) * | 2008-02-14 | 2009-12-31 | Rabin Barry H | Devices and methods for manipulating tissue |
US20130153641A1 (en) | 2008-02-15 | 2013-06-20 | Ethicon Endo-Surgery, Inc. | Releasable layer of material and surgical end effector having the same |
US11272927B2 (en) | 2008-02-15 | 2022-03-15 | Cilag Gmbh International | Layer arrangements for surgical staple cartridges |
US20090275804A1 (en) * | 2008-04-30 | 2009-11-05 | Rudolf Bertagnoli | Hinged Retractor With Sheath |
CA2723705C (en) | 2008-05-07 | 2016-08-30 | Davol Inc. | Method and apparatus for repairing a hernia |
EP2291125B1 (en) | 2008-05-09 | 2021-04-21 | Nobles Medical Technologies, Inc. | Suturing devices for suturing an anatomic valve |
EP2303171A2 (en) | 2008-05-13 | 2011-04-06 | Medtronic, Inc. | Tissue lesion evaluation |
US20090287045A1 (en) | 2008-05-15 | 2009-11-19 | Vladimir Mitelberg | Access Systems and Methods of Intra-Abdominal Surgery |
GB2461201B (en) | 2008-06-13 | 2011-07-06 | Foundry Llc | Method and apparatus for joint distraction |
US8974462B2 (en) | 2008-06-13 | 2015-03-10 | Pivot Medical, Inc. | Devices and methods for minimally invasive access into a joint |
US8771170B2 (en) * | 2008-08-01 | 2014-07-08 | Microaccess, Inc. | Methods and apparatus for transesophageal microaccess surgery |
US8210411B2 (en) | 2008-09-23 | 2012-07-03 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument |
US9005230B2 (en) | 2008-09-23 | 2015-04-14 | Ethicon Endo-Surgery, Inc. | Motorized surgical instrument |
US11648005B2 (en) | 2008-09-23 | 2023-05-16 | Cilag Gmbh International | Robotically-controlled motorized surgical instrument with an end effector |
US9386983B2 (en) | 2008-09-23 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Robotically-controlled motorized surgical instrument |
US8608045B2 (en) | 2008-10-10 | 2013-12-17 | Ethicon Endo-Sugery, Inc. | Powered surgical cutting and stapling apparatus with manually retractable firing system |
WO2010042065A1 (en) * | 2008-10-10 | 2010-04-15 | Teslux Holding S.A. | Artificial stomach |
ES2659871T3 (en) | 2008-10-13 | 2018-03-19 | Applied Medical Resources Corporation | Single track access system |
MX2011004086A (en) | 2008-10-16 | 2011-06-20 | Linguaflex Llc | Methods and devices for treating sleep apnea. |
CN101401734B (en) * | 2008-11-06 | 2010-10-06 | 钱建民 | Lower abdominal region retractor |
CA2744206C (en) | 2008-11-21 | 2019-05-21 | C.R. Bard, Inc. | Soft tissue repair prosthesis, expandable device, and method of soft tissue repair |
US9254168B2 (en) | 2009-02-02 | 2016-02-09 | Medtronic Advanced Energy Llc | Electro-thermotherapy of tissue using penetrating microelectrode array |
US8517239B2 (en) | 2009-02-05 | 2013-08-27 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument comprising a magnetic element driver |
US8375955B2 (en) | 2009-02-06 | 2013-02-19 | Atropos Limited | Surgical procedure |
US8444036B2 (en) | 2009-02-06 | 2013-05-21 | Ethicon Endo-Surgery, Inc. | Motor driven surgical fastener device with mechanisms for adjusting a tissue gap within the end effector |
RU2525225C2 (en) | 2009-02-06 | 2014-08-10 | Этикон Эндо-Серджери, Инк. | Improvement of drive surgical suturing instrument |
US8632533B2 (en) | 2009-02-23 | 2014-01-21 | Medtronic Advanced Energy Llc | Fluid-assisted electrosurgical device |
JP5415925B2 (en) * | 2009-03-02 | 2014-02-12 | オリンパス株式会社 | Endoscope |
US8747297B2 (en) * | 2009-03-02 | 2014-06-10 | Olympus Corporation | Endoscopic heart surgery method |
US9737334B2 (en) | 2009-03-06 | 2017-08-22 | Ethicon Llc | Methods and devices for accessing a body cavity |
EP2408402B1 (en) * | 2009-03-17 | 2020-05-06 | Stryker Corporation | Joint-spacing balloon catheter |
US9186181B2 (en) | 2009-03-17 | 2015-11-17 | Pivot Medical, Inc. | Method and apparatus for distracting a joint |
US10426453B2 (en) | 2009-03-17 | 2019-10-01 | Pivot Medical, Inc. | Method and apparatus for distracting a joint |
US20100249521A1 (en) * | 2009-03-31 | 2010-09-30 | Shelton Iv Frederick E | Access Device Including Retractor And Insert |
US8353824B2 (en) * | 2009-03-31 | 2013-01-15 | Ethicon Endo-Surgery, Inc. | Access method with insert |
US11903602B2 (en) | 2009-04-29 | 2024-02-20 | Hologic, Inc. | Uterine fibroid tissue removal device |
US20230263514A1 (en) * | 2009-06-10 | 2023-08-24 | Conmed Corporation | Tissue specimen retrieval bag, method for retrieving tissue |
US9974528B2 (en) * | 2014-04-25 | 2018-05-22 | Conmed Corporation | Tissue specimen retrieval bag, method for retrieving tissue |
US20110028793A1 (en) * | 2009-07-30 | 2011-02-03 | Ethicon Endo-Surgery, Inc. | Methods and devices for providing access into a body cavity |
US9999531B2 (en) | 2009-08-24 | 2018-06-19 | Qualimed Innovative Medizinprodukte Gmbh | Variable scale stent deployment device |
US9439652B2 (en) * | 2009-08-24 | 2016-09-13 | Qualimed Innovative Medizinprodukte Gmbh | Implantation device with handle and method of use thereof |
US20120238806A1 (en) | 2009-08-24 | 2012-09-20 | Quali-Med Gmbh | Implantation system with handle and catheter and method of use thereof |
JP2013503723A (en) | 2009-09-08 | 2013-02-04 | サリエント・サージカル・テクノロジーズ・インコーポレーテッド | Cartridge assembly for electrosurgical devices, electrosurgical units, and methods of use thereof |
WO2011033495A1 (en) | 2009-09-17 | 2011-03-24 | Atropos Limited | An instrument access device |
JP5567840B2 (en) * | 2009-09-22 | 2014-08-06 | オリンパス株式会社 | Cell injection device |
CN102665615B (en) * | 2009-09-22 | 2015-08-19 | 奥林巴斯株式会社 | Device is guaranteed in space |
WO2011037046A1 (en) * | 2009-09-22 | 2011-03-31 | オリンパス株式会社 | Device for injecting therapeutic solution |
US9474540B2 (en) | 2009-10-08 | 2016-10-25 | Ethicon-Endo-Surgery, Inc. | Laparoscopic device with compound angulation |
US20110112373A1 (en) * | 2009-11-10 | 2011-05-12 | Trans1 Inc. | Soft tissue access apparatus and methods for spinal surgery |
US8870759B2 (en) * | 2009-12-04 | 2014-10-28 | Covidien Lp | Suspension system for minimally invasive surgery |
EP2512754A4 (en) | 2009-12-17 | 2016-11-30 | Univ Nebraska | Modular and cooperative medical devices and related systems and methods |
US8220688B2 (en) | 2009-12-24 | 2012-07-17 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument with electric actuator directional control assembly |
US8851354B2 (en) | 2009-12-24 | 2014-10-07 | Ethicon Endo-Surgery, Inc. | Surgical cutting instrument that analyzes tissue thickness |
US9326757B2 (en) | 2009-12-31 | 2016-05-03 | Teleflex Medical Incorporated | Surgical instruments for laparoscopic aspiration and retraction |
WO2011103370A1 (en) | 2010-02-17 | 2011-08-25 | Reprise Technologies, Llc | System and method for image-guided arthroscopy |
US9168063B2 (en) * | 2010-03-07 | 2015-10-27 | Faisal Mirza | Void containment apparatus and method of use for creating a sealed environment for product delivery |
US9592090B2 (en) | 2010-03-11 | 2017-03-14 | Medtronic Advanced Energy Llc | Bipolar electrosurgical cutter with position insensitive return electrode contact |
US8562592B2 (en) | 2010-05-07 | 2013-10-22 | Ethicon Endo-Surgery, Inc. | Compound angle laparoscopic methods and devices |
US9226760B2 (en) | 2010-05-07 | 2016-01-05 | Ethicon Endo-Surgery, Inc. | Laparoscopic devices with flexible actuation mechanisms |
US9173705B2 (en) * | 2010-05-13 | 2015-11-03 | Ncontact Surgical, Inc. | Subxyphoid epicardial ablation |
CN103002793B (en) * | 2010-05-13 | 2015-07-22 | Livac私人有限公司 | Suction retractor |
US20110295249A1 (en) * | 2010-05-28 | 2011-12-01 | Salient Surgical Technologies, Inc. | Fluid-Assisted Electrosurgical Devices, and Methods of Manufacture Thereof |
US8460337B2 (en) | 2010-06-09 | 2013-06-11 | Ethicon Endo-Surgery, Inc. | Selectable handle biasing |
EP3187119B1 (en) | 2010-06-14 | 2020-07-15 | Maquet Cardiovascular LLC | Surgical organ stabilizer instruments |
US9138289B2 (en) | 2010-06-28 | 2015-09-22 | Medtronic Advanced Energy Llc | Electrode sheath for electrosurgical device |
US8920417B2 (en) | 2010-06-30 | 2014-12-30 | Medtronic Advanced Energy Llc | Electrosurgical devices and methods of use thereof |
US8906012B2 (en) | 2010-06-30 | 2014-12-09 | Medtronic Advanced Energy Llc | Electrosurgical devices with wire electrode |
GB201012336D0 (en) * | 2010-07-23 | 2010-09-08 | Univ Leeds | Surgical device and procedure |
US8783543B2 (en) | 2010-07-30 | 2014-07-22 | Ethicon Endo-Surgery, Inc. | Tissue acquisition arrangements and methods for surgical stapling devices |
US8801735B2 (en) | 2010-07-30 | 2014-08-12 | Ethicon Endo-Surgery, Inc. | Surgical circular stapler with tissue retention arrangements |
EP2600758A1 (en) | 2010-08-06 | 2013-06-12 | Board of Regents of the University of Nebraska | Methods and systems for handling or delivering materials for natural orifice surgery |
US8360296B2 (en) | 2010-09-09 | 2013-01-29 | Ethicon Endo-Surgery, Inc. | Surgical stapling head assembly with firing lockout for a surgical stapler |
GB201015746D0 (en) | 2010-09-21 | 2010-10-27 | Cardioprec Ltd | Optical switch |
US9364233B2 (en) | 2010-09-30 | 2016-06-14 | Ethicon Endo-Surgery, Llc | Tissue thickness compensators for circular surgical staplers |
US8702592B2 (en) | 2010-09-30 | 2014-04-22 | David Allan Langlois | System and method for inhibiting injury to a patient during laparoscopic surgery |
US9320523B2 (en) | 2012-03-28 | 2016-04-26 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator comprising tissue ingrowth features |
US11849952B2 (en) | 2010-09-30 | 2023-12-26 | Cilag Gmbh International | Staple cartridge comprising staples positioned within a compressible portion thereof |
US9629814B2 (en) | 2010-09-30 | 2017-04-25 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator configured to redistribute compressive forces |
US11298125B2 (en) | 2010-09-30 | 2022-04-12 | Cilag Gmbh International | Tissue stapler having a thickness compensator |
US11812965B2 (en) | 2010-09-30 | 2023-11-14 | Cilag Gmbh International | Layer of material for a surgical end effector |
US9232941B2 (en) | 2010-09-30 | 2016-01-12 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator comprising a reservoir |
US9241714B2 (en) | 2011-04-29 | 2016-01-26 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator and method for making the same |
US9168038B2 (en) | 2010-09-30 | 2015-10-27 | Ethicon Endo-Surgery, Inc. | Staple cartridge comprising a tissue thickness compensator |
US10945731B2 (en) | 2010-09-30 | 2021-03-16 | Ethicon Llc | Tissue thickness compensator comprising controlled release and expansion |
US9861361B2 (en) | 2010-09-30 | 2018-01-09 | Ethicon Llc | Releasable tissue thickness compensator and fastener cartridge having the same |
US9289115B2 (en) | 2010-10-01 | 2016-03-22 | Applied Medical Resources Corporation | Natural orifice surgery system |
US8695866B2 (en) | 2010-10-01 | 2014-04-15 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a power control circuit |
US9289200B2 (en) | 2010-10-01 | 2016-03-22 | Applied Medical Resources Corporation | Natural orifice surgery system |
WO2012047939A2 (en) * | 2010-10-04 | 2012-04-12 | Ind Platforms Llc | Expandable devices, rail systems, and motorized devices |
WO2012047414A1 (en) | 2010-10-05 | 2012-04-12 | C.R. Bard, Inc. | Soft tissue repair prosthesis and expandable device |
US9023040B2 (en) | 2010-10-26 | 2015-05-05 | Medtronic Advanced Energy Llc | Electrosurgical cutting devices |
EP2637728A4 (en) | 2010-11-08 | 2015-05-06 | Pivot Medical Inc | Method and apparatus for distracting a joint |
US8968188B2 (en) * | 2010-11-24 | 2015-03-03 | Covidien Lp | Expandable segmented and sectioned access assembly |
WO2012094364A2 (en) | 2011-01-04 | 2012-07-12 | The Johns Hopkins University | Minimally invasive laparoscopic retractor |
AU2012212492B2 (en) * | 2011-02-01 | 2016-05-12 | Channel Medsystems, Inc. | Methods and apparatus for cryogenic treatment of a body cavity or lumen |
JP6023090B2 (en) | 2011-02-16 | 2016-11-09 | ザ ジェネラル ホスピタル コーポレイション | Endoscope optical coupler |
US9427281B2 (en) | 2011-03-11 | 2016-08-30 | Medtronic Advanced Energy Llc | Bronchoscope-compatible catheter provided with electrosurgical device |
US9033204B2 (en) | 2011-03-14 | 2015-05-19 | Ethicon Endo-Surgery, Inc. | Circular stapling devices with tissue-puncturing anvil features |
JP5820052B2 (en) * | 2011-03-28 | 2015-11-24 | ケイ. アルーワリア,プラバート | Organ retractor |
CN103889345B (en) | 2011-04-15 | 2016-10-19 | 心脏缝合有限公司 | For sewing up stitching devices and the method for anatomy lobe |
BR112013027794B1 (en) | 2011-04-29 | 2020-12-15 | Ethicon Endo-Surgery, Inc | CLAMP CARTRIDGE SET |
JP6005143B2 (en) | 2011-05-10 | 2016-10-12 | アプライド メディカル リソーシーズ コーポレイション | Retractor |
US9072535B2 (en) | 2011-05-27 | 2015-07-07 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments with rotatable staple deployment arrangements |
US11207064B2 (en) | 2011-05-27 | 2021-12-28 | Cilag Gmbh International | Automated end effector component reloading system for use with a robotic system |
EP3714821A1 (en) | 2011-06-10 | 2020-09-30 | Board of Regents of the University of Nebraska | Surgical end effector |
US9089353B2 (en) | 2011-07-11 | 2015-07-28 | Board Of Regents Of The University Of Nebraska | Robotic surgical devices, systems, and related methods |
WO2013010107A2 (en) | 2011-07-13 | 2013-01-17 | Cook Medical Technologies Llc | Surgical retractor device |
WO2013009795A1 (en) | 2011-07-13 | 2013-01-17 | Cook Medical Technologies Llc | Foldable surgical retractor |
US20130023896A1 (en) * | 2011-07-20 | 2013-01-24 | Quimby Jennifer C | Surgical manipulation and occlusion device |
US8888692B1 (en) | 2011-08-26 | 2014-11-18 | Applied Medical Resources Corporation | Trocar cannula assembly and method of manufacture |
US9750565B2 (en) | 2011-09-30 | 2017-09-05 | Medtronic Advanced Energy Llc | Electrosurgical balloons |
US10582973B2 (en) | 2012-08-08 | 2020-03-10 | Virtual Incision Corporation | Robotic surgical devices, systems, and related methods |
US20130085339A1 (en) * | 2011-10-04 | 2013-04-04 | Cook Medical Technologies Llc | Surgical retractor |
CN103957825B (en) | 2011-10-13 | 2018-12-07 | 阿瑟罗迈德公司 | Atherectomy device, system and method |
US8870864B2 (en) | 2011-10-28 | 2014-10-28 | Medtronic Advanced Energy Llc | Single instrument electrosurgery apparatus and its method of use |
US20140058205A1 (en) | 2012-01-10 | 2014-02-27 | Board Of Regents Of The University Of Nebraska | Methods, Systems, and Devices for Surgical Access and Insertion |
US9393005B2 (en) | 2012-01-10 | 2016-07-19 | The Board Of Trustees Of The Leland Stanford Junior University | Systems for the prevention of surgical site infections |
US9044230B2 (en) | 2012-02-13 | 2015-06-02 | Ethicon Endo-Surgery, Inc. | Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status |
JP5972599B2 (en) * | 2012-02-22 | 2016-08-17 | 株式会社リバーセイコー | Observation field expansion device |
EP2816960A4 (en) * | 2012-02-23 | 2016-01-27 | Mickey Karram | Transperitoneal prolapse repair system and method |
US9017249B2 (en) * | 2012-03-26 | 2015-04-28 | Covidien Lp | Surgical access assembly and method of use therefor |
RU2639857C2 (en) | 2012-03-28 | 2017-12-22 | Этикон Эндо-Серджери, Инк. | Tissue thickness compensator containing capsule for medium with low pressure |
BR112014024194B1 (en) | 2012-03-28 | 2022-03-03 | Ethicon Endo-Surgery, Inc | STAPLER CARTRIDGE SET FOR A SURGICAL STAPLER |
RU2014143258A (en) | 2012-03-28 | 2016-05-20 | Этикон Эндо-Серджери, Инк. | FABRIC THICKNESS COMPENSATOR CONTAINING MANY LAYERS |
US9918708B2 (en) | 2012-03-29 | 2018-03-20 | Lapspace Medical Ltd. | Tissue retractor |
US10159552B2 (en) * | 2012-05-01 | 2018-12-25 | C.R. Bard, Inc. | Self adhering implantable mesh prosthesis with reduced insertion profile |
EP4357083A2 (en) | 2012-05-01 | 2024-04-24 | Board of Regents of the University of Nebraska | Single site robotic device and related systems and methods |
EP3597115A1 (en) | 2012-05-11 | 2020-01-22 | Heartstitch, Inc. | Suturing devices for suturing an anatomic structure |
CN103462655A (en) * | 2012-06-06 | 2013-12-25 | 仁齐企业有限公司 | Non-inflatable balloon suspension system |
CN104334123B (en) | 2012-06-07 | 2019-02-12 | 意比图密医疗有限公司 | Expansion device |
CN103505251B (en) * | 2012-06-15 | 2016-03-02 | 中央大学 | Replaceable micro-surgical instrument |
US9101358B2 (en) | 2012-06-15 | 2015-08-11 | Ethicon Endo-Surgery, Inc. | Articulatable surgical instrument comprising a firing drive |
EP3189948B1 (en) | 2012-06-22 | 2018-10-17 | Board of Regents of the University of Nebraska | Local control robotic surgical devices |
US9289256B2 (en) | 2012-06-28 | 2016-03-22 | Ethicon Endo-Surgery, Llc | Surgical end effectors having angled tissue-contacting surfaces |
US9649111B2 (en) | 2012-06-28 | 2017-05-16 | Ethicon Endo-Surgery, Llc | Replaceable clip cartridge for a clip applier |
US20140001234A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Coupling arrangements for attaching surgical end effectors to drive systems therefor |
US11278284B2 (en) | 2012-06-28 | 2022-03-22 | Cilag Gmbh International | Rotary drive arrangements for surgical instruments |
BR112014032740A2 (en) | 2012-06-28 | 2020-02-27 | Ethicon Endo Surgery Inc | empty clip cartridge lock |
US20140005718A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Multi-functional powered surgical device with external dissection features |
US20140001231A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Firing system lockout arrangements for surgical instruments |
BR112014032776B1 (en) | 2012-06-28 | 2021-09-08 | Ethicon Endo-Surgery, Inc | SURGICAL INSTRUMENT SYSTEM AND SURGICAL KIT FOR USE WITH A SURGICAL INSTRUMENT SYSTEM |
US20140018836A1 (en) * | 2012-07-13 | 2014-01-16 | Top-Bound Enterprise Co., Ltd | Endo-Safe-Bag-Gasless support system |
US9770305B2 (en) | 2012-08-08 | 2017-09-26 | Board Of Regents Of The University Of Nebraska | Robotic surgical devices, systems, and related methods |
WO2014055981A1 (en) * | 2012-10-05 | 2014-04-10 | Board Of Regents, The University Of Texas System | System and method for scoring the left ventricular endocardium to increase left ventricular compliance |
EP2915558A4 (en) * | 2012-10-31 | 2016-08-10 | Univ Tokyo Womens Medical | Sheet shaped therapeutic-use substance conveyance apparatus, and method for affixing sheet shaped therapeutic-use substance |
CN103027721B (en) * | 2012-12-05 | 2014-08-06 | 广西大学 | Laparoscopic pneumoperitoneum-free mechanical device |
RU2669463C2 (en) | 2013-03-01 | 2018-10-11 | Этикон Эндо-Серджери, Инк. | Surgical instrument with soft stop |
BR112015021098B1 (en) | 2013-03-01 | 2022-02-15 | Ethicon Endo-Surgery, Inc | COVERAGE FOR A JOINT JOINT AND SURGICAL INSTRUMENT |
US9629629B2 (en) | 2013-03-14 | 2017-04-25 | Ethicon Endo-Surgey, LLC | Control systems for surgical instruments |
US9883860B2 (en) | 2013-03-14 | 2018-02-06 | Ethicon Llc | Interchangeable shaft assemblies for use with a surgical instrument |
US9743987B2 (en) | 2013-03-14 | 2017-08-29 | Board Of Regents Of The University Of Nebraska | Methods, systems, and devices relating to robotic surgical devices, end effectors, and controllers |
CA2906672C (en) | 2013-03-14 | 2022-03-15 | Board Of Regents Of The University Of Nebraska | Methods, systems, and devices relating to force control surgical systems |
US9913728B2 (en) | 2013-03-14 | 2018-03-13 | Quandary Medical, Llc | Spinal implants and implantation system |
EP2967648B1 (en) | 2013-03-15 | 2018-11-28 | Applied Medical Resources Corporation | Trocar cannula assembly with low profile insertion configuration and method of manufacture |
EP2996545B1 (en) | 2013-03-15 | 2021-10-20 | Board of Regents of the University of Nebraska | Robotic surgical systems |
JP2016512725A (en) | 2013-03-15 | 2016-05-09 | アプライド メディカル リソーシーズ コーポレイション | Mechanical gel surgical access instrument |
BR112015026109B1 (en) | 2013-04-16 | 2022-02-22 | Ethicon Endo-Surgery, Inc | surgical instrument |
US9844368B2 (en) | 2013-04-16 | 2017-12-19 | Ethicon Llc | Surgical system comprising first and second drive systems |
US10166376B2 (en) | 2013-06-11 | 2019-01-01 | Covidien Lp | Restricted expansion dissector |
EP3007630B1 (en) * | 2013-06-12 | 2017-08-30 | UMC Utrecht Holding B.V. | Surgical device for providing access to a surgical site |
EP3016598B1 (en) | 2013-07-02 | 2018-10-10 | Med-venture Investments, LLC | Suturing devices for suturing an anatomic structure |
US10966700B2 (en) | 2013-07-17 | 2021-04-06 | Virtual Incision Corporation | Robotic surgical devices, systems and related methods |
US10070853B2 (en) | 2013-08-14 | 2018-09-11 | Covidien Lp | Expandable balloon desufflation assembly |
US9283054B2 (en) | 2013-08-23 | 2016-03-15 | Ethicon Endo-Surgery, Llc | Interactive displays |
MX369362B (en) | 2013-08-23 | 2019-11-06 | Ethicon Endo Surgery Llc | Firing member retraction devices for powered surgical instruments. |
US10433861B2 (en) | 2013-08-27 | 2019-10-08 | Board Of Regents Of The University Of Texas System | System and method for cutting trabeculae carneae of the left ventricle to increase LV compliance |
CN105899198A (en) | 2013-12-05 | 2016-08-24 | 图利普医疗有限公司 | Retentive devices and systems for in-situ release of pharmaceutical active agents |
US10512458B2 (en) | 2013-12-06 | 2019-12-24 | Med-Venture Investments, Llc | Suturing methods and apparatuses |
US9962161B2 (en) | 2014-02-12 | 2018-05-08 | Ethicon Llc | Deliverable surgical instrument |
BR112016019387B1 (en) | 2014-02-24 | 2022-11-29 | Ethicon Endo-Surgery, Llc | SURGICAL INSTRUMENT SYSTEM AND FASTENER CARTRIDGE FOR USE WITH A SURGICAL FIXING INSTRUMENT |
US20150272557A1 (en) | 2014-03-26 | 2015-10-01 | Ethicon Endo-Surgery, Inc. | Modular surgical instrument system |
BR112016021943B1 (en) | 2014-03-26 | 2022-06-14 | Ethicon Endo-Surgery, Llc | SURGICAL INSTRUMENT FOR USE BY AN OPERATOR IN A SURGICAL PROCEDURE |
US9750499B2 (en) | 2014-03-26 | 2017-09-05 | Ethicon Llc | Surgical stapling instrument system |
US10013049B2 (en) | 2014-03-26 | 2018-07-03 | Ethicon Llc | Power management through sleep options of segmented circuit and wake up control |
CN104939887B (en) * | 2014-03-28 | 2019-03-26 | 上海微创电生理医疗科技有限公司 | Pericardium endoscope, lasso trick device and heart left auricle of heart closed system |
US10610279B2 (en) | 2014-04-10 | 2020-04-07 | Channel Medsystems, Inc. | Apparatus and methods for regulating cryogenic treatment |
JP6612256B2 (en) | 2014-04-16 | 2019-11-27 | エシコン エルエルシー | Fastener cartridge with non-uniform fastener |
US10542988B2 (en) | 2014-04-16 | 2020-01-28 | Ethicon Llc | End effector comprising an anvil including projections extending therefrom |
BR112016023698B1 (en) | 2014-04-16 | 2022-07-26 | Ethicon Endo-Surgery, Llc | FASTENER CARTRIDGE FOR USE WITH A SURGICAL INSTRUMENT |
US9801627B2 (en) | 2014-09-26 | 2017-10-31 | Ethicon Llc | Fastener cartridge for creating a flexible staple line |
CN106456159B (en) | 2014-04-16 | 2019-03-08 | 伊西康内外科有限责任公司 | Fastener cartridge assembly and nail retainer lid arragement construction |
US20150297225A1 (en) | 2014-04-16 | 2015-10-22 | Ethicon Endo-Surgery, Inc. | Fastener cartridges including extensions having different configurations |
US20150313633A1 (en) * | 2014-05-05 | 2015-11-05 | Rainbow Medical Ltd. | Pericardial access device |
US10178993B2 (en) | 2014-07-11 | 2019-01-15 | Cardio Medical Solutions, Inc. | Device and method for assisting end-to-side anastomosis |
ES2703184T3 (en) | 2014-07-18 | 2019-03-07 | Applied Med Resources | Method for manufacturing gels that have permanent tack-free coatings |
AU2015292526A1 (en) * | 2014-07-23 | 2017-02-23 | Dilantha B. ELLEGALA | Modifications to access ports for minimally invasive neuro surgery |
US9974599B2 (en) | 2014-08-15 | 2018-05-22 | Medtronic Ps Medical, Inc. | Multipurpose electrosurgical device |
ES2731049T3 (en) | 2014-08-15 | 2019-11-13 | Applied Med Resources | Natural hole surgery system |
US11311294B2 (en) | 2014-09-05 | 2022-04-26 | Cilag Gmbh International | Powered medical device including measurement of closure state of jaws |
BR112017004361B1 (en) | 2014-09-05 | 2023-04-11 | Ethicon Llc | ELECTRONIC SYSTEM FOR A SURGICAL INSTRUMENT |
US10111679B2 (en) | 2014-09-05 | 2018-10-30 | Ethicon Llc | Circuitry and sensors for powered medical device |
US10342561B2 (en) | 2014-09-12 | 2019-07-09 | Board Of Regents Of The University Of Nebraska | Quick-release end effectors and related systems and methods |
US10105142B2 (en) | 2014-09-18 | 2018-10-23 | Ethicon Llc | Surgical stapler with plurality of cutting elements |
US9459442B2 (en) | 2014-09-23 | 2016-10-04 | Scott Miller | Optical coupler for optical imaging visualization device |
US11523821B2 (en) | 2014-09-26 | 2022-12-13 | Cilag Gmbh International | Method for creating a flexible staple line |
BR112017005981B1 (en) | 2014-09-26 | 2022-09-06 | Ethicon, Llc | ANCHOR MATERIAL FOR USE WITH A SURGICAL STAPLE CARTRIDGE AND SURGICAL STAPLE CARTRIDGE FOR USE WITH A SURGICAL INSTRUMENT |
US10076325B2 (en) | 2014-10-13 | 2018-09-18 | Ethicon Llc | Surgical stapling apparatus comprising a tissue stop |
US9924944B2 (en) | 2014-10-16 | 2018-03-27 | Ethicon Llc | Staple cartridge comprising an adjunct material |
US11141153B2 (en) | 2014-10-29 | 2021-10-12 | Cilag Gmbh International | Staple cartridges comprising driver arrangements |
US10517594B2 (en) | 2014-10-29 | 2019-12-31 | Ethicon Llc | Cartridge assemblies for surgical staplers |
US9844376B2 (en) | 2014-11-06 | 2017-12-19 | Ethicon Llc | Staple cartridge comprising a releasable adjunct material |
WO2016077478A1 (en) | 2014-11-11 | 2016-05-19 | Board Of Regents Of The University Of Nebraska | Robotic device with compact joint design and related systems and methods |
AU2015353660A1 (en) | 2014-11-25 | 2017-05-18 | Applied Medical Resources Corporation | Circumferential wound retraction with support and guidance structures |
US10736636B2 (en) | 2014-12-10 | 2020-08-11 | Ethicon Llc | Articulatable surgical instrument system |
US9844375B2 (en) | 2014-12-18 | 2017-12-19 | Ethicon Llc | Drive arrangements for articulatable surgical instruments |
US9987000B2 (en) | 2014-12-18 | 2018-06-05 | Ethicon Llc | Surgical instrument assembly comprising a flexible articulation system |
US10004501B2 (en) | 2014-12-18 | 2018-06-26 | Ethicon Llc | Surgical instruments with improved closure arrangements |
US9844374B2 (en) | 2014-12-18 | 2017-12-19 | Ethicon Llc | Surgical instrument systems comprising an articulatable end effector and means for adjusting the firing stroke of a firing member |
US10188385B2 (en) | 2014-12-18 | 2019-01-29 | Ethicon Llc | Surgical instrument system comprising lockable systems |
US10085748B2 (en) | 2014-12-18 | 2018-10-02 | Ethicon Llc | Locking arrangements for detachable shaft assemblies with articulatable surgical end effectors |
MX2017008108A (en) | 2014-12-18 | 2018-03-06 | Ethicon Llc | Surgical instrument with an anvil that is selectively movable about a discrete non-movable axis relative to a staple cartridge. |
PL410790A1 (en) * | 2014-12-29 | 2016-07-04 | Maciej Skórski | Retractor for laparoscopic operations |
US11154301B2 (en) | 2015-02-27 | 2021-10-26 | Cilag Gmbh International | Modular stapling assembly |
US10180463B2 (en) | 2015-02-27 | 2019-01-15 | Ethicon Llc | Surgical apparatus configured to assess whether a performance parameter of the surgical apparatus is within an acceptable performance band |
US9931118B2 (en) | 2015-02-27 | 2018-04-03 | Ethicon Endo-Surgery, Llc | Reinforced battery for a surgical instrument |
US10052044B2 (en) | 2015-03-06 | 2018-08-21 | Ethicon Llc | Time dependent evaluation of sensor data to determine stability, creep, and viscoelastic elements of measures |
US9901342B2 (en) | 2015-03-06 | 2018-02-27 | Ethicon Endo-Surgery, Llc | Signal and power communication system positioned on a rotatable shaft |
US10441279B2 (en) | 2015-03-06 | 2019-10-15 | Ethicon Llc | Multiple level thresholds to modify operation of powered surgical instruments |
US10245033B2 (en) | 2015-03-06 | 2019-04-02 | Ethicon Llc | Surgical instrument comprising a lockable battery housing |
US10617412B2 (en) | 2015-03-06 | 2020-04-14 | Ethicon Llc | System for detecting the mis-insertion of a staple cartridge into a surgical stapler |
JP2020121162A (en) | 2015-03-06 | 2020-08-13 | エシコン エルエルシーEthicon LLC | Time dependent evaluation of sensor data to determine stability element, creep element and viscoelastic element of measurement |
US10687806B2 (en) | 2015-03-06 | 2020-06-23 | Ethicon Llc | Adaptive tissue compression techniques to adjust closure rates for multiple tissue types |
US9993248B2 (en) | 2015-03-06 | 2018-06-12 | Ethicon Endo-Surgery, Llc | Smart sensors with local signal processing |
US9808246B2 (en) | 2015-03-06 | 2017-11-07 | Ethicon Endo-Surgery, Llc | Method of operating a powered surgical instrument |
US9924961B2 (en) | 2015-03-06 | 2018-03-27 | Ethicon Endo-Surgery, Llc | Interactive feedback system for powered surgical instruments |
JP5940190B1 (en) * | 2015-03-25 | 2016-06-29 | 日機装株式会社 | Surgical area securing device |
US10433844B2 (en) | 2015-03-31 | 2019-10-08 | Ethicon Llc | Surgical instrument with selectively disengageable threaded drive systems |
US10433960B1 (en) | 2015-05-07 | 2019-10-08 | Cardioprecision Limited | Method and system for transcatheter intervention |
US10548467B2 (en) | 2015-06-02 | 2020-02-04 | GI Scientific, LLC | Conductive optical element |
US10123791B2 (en) * | 2015-07-02 | 2018-11-13 | Atlantic Health System, Inc. | Lighted polyhedral retractor |
US10758218B2 (en) * | 2015-07-02 | 2020-09-01 | Atlantic Health System, Inc. | Lighted polyhedral retractor |
KR20180041140A (en) | 2015-07-21 | 2018-04-23 | 지아이 사이언티픽, 엘엘씨 | Endoscope accessory with angle adjustable exhaust port |
JP6961146B2 (en) | 2015-08-03 | 2021-11-05 | バーチャル インシジョン コーポレイションVirtual Incision Corporation | Robotic surgical devices, systems and related methods |
US10835249B2 (en) | 2015-08-17 | 2020-11-17 | Ethicon Llc | Implantable layers for a surgical instrument |
US11389227B2 (en) | 2015-08-20 | 2022-07-19 | Medtronic Advanced Energy Llc | Electrosurgical device with multivariate control |
US11051875B2 (en) | 2015-08-24 | 2021-07-06 | Medtronic Advanced Energy Llc | Multipurpose electrosurgical device |
ES2937400T3 (en) | 2015-09-15 | 2023-03-28 | Applied Med Resources | Surgical Robotic Access System |
US10238386B2 (en) | 2015-09-23 | 2019-03-26 | Ethicon Llc | Surgical stapler having motor control based on an electrical parameter related to a motor current |
US10327769B2 (en) | 2015-09-23 | 2019-06-25 | Ethicon Llc | Surgical stapler having motor control based on a drive system component |
US10363036B2 (en) | 2015-09-23 | 2019-07-30 | Ethicon Llc | Surgical stapler having force-based motor control |
US10105139B2 (en) | 2015-09-23 | 2018-10-23 | Ethicon Llc | Surgical stapler having downstream current-based motor control |
US10299878B2 (en) | 2015-09-25 | 2019-05-28 | Ethicon Llc | Implantable adjunct systems for determining adjunct skew |
US10980539B2 (en) | 2015-09-30 | 2021-04-20 | Ethicon Llc | Implantable adjunct comprising bonded layers |
US11890015B2 (en) | 2015-09-30 | 2024-02-06 | Cilag Gmbh International | Compressible adjunct with crossing spacer fibers |
US20170086829A1 (en) | 2015-09-30 | 2017-03-30 | Ethicon Endo-Surgery, Llc | Compressible adjunct with intermediate supporting structures |
US11690623B2 (en) | 2015-09-30 | 2023-07-04 | Cilag Gmbh International | Method for applying an implantable layer to a fastener cartridge |
JP6953402B2 (en) | 2015-10-07 | 2021-10-27 | アプライド メディカル リソーシーズ コーポレイション | Wound retractor with multi-segment outer ring |
US10327812B2 (en) | 2015-11-04 | 2019-06-25 | Rainbow Medical Ltd. | Pericardial access device |
US10716612B2 (en) | 2015-12-18 | 2020-07-21 | Medtronic Advanced Energy Llc | Electrosurgical device with multiple monopolar electrode assembly |
US10265068B2 (en) | 2015-12-30 | 2019-04-23 | Ethicon Llc | Surgical instruments with separable motors and motor control circuits |
US10368865B2 (en) | 2015-12-30 | 2019-08-06 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10292704B2 (en) | 2015-12-30 | 2019-05-21 | Ethicon Llc | Mechanisms for compensating for battery pack failure in powered surgical instruments |
GB201601858D0 (en) * | 2016-02-02 | 2016-03-16 | Univ Leeds | Surgical retraction device and procedure |
US11213293B2 (en) | 2016-02-09 | 2022-01-04 | Cilag Gmbh International | Articulatable surgical instruments with single articulation link arrangements |
US10245030B2 (en) | 2016-02-09 | 2019-04-02 | Ethicon Llc | Surgical instruments with tensioning arrangements for cable driven articulation systems |
JP6911054B2 (en) | 2016-02-09 | 2021-07-28 | エシコン エルエルシーEthicon LLC | Surgical instruments with asymmetric joint composition |
US10448948B2 (en) | 2016-02-12 | 2019-10-22 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US11224426B2 (en) | 2016-02-12 | 2022-01-18 | Cilag Gmbh International | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10258331B2 (en) | 2016-02-12 | 2019-04-16 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10369338B2 (en) | 2016-02-23 | 2019-08-06 | Globus Medical, Inc. | Expandable tissue dilator for dilating tissue around a spinal column |
US10376263B2 (en) | 2016-04-01 | 2019-08-13 | Ethicon Llc | Anvil modification members for surgical staplers |
US10617413B2 (en) | 2016-04-01 | 2020-04-14 | Ethicon Llc | Closure system arrangements for surgical cutting and stapling devices with separate and distinct firing shafts |
US11284890B2 (en) | 2016-04-01 | 2022-03-29 | Cilag Gmbh International | Circular stapling system comprising an incisable tissue support |
US10307159B2 (en) | 2016-04-01 | 2019-06-04 | Ethicon Llc | Surgical instrument handle assembly with reconfigurable grip portion |
US10675021B2 (en) | 2016-04-01 | 2020-06-09 | Ethicon Llc | Circular stapling system comprising rotary firing system |
EP3442437B1 (en) | 2016-04-11 | 2020-11-11 | Nobles Medical Technologies II, Inc. | Tissue suturing device with suture spool |
US10335145B2 (en) | 2016-04-15 | 2019-07-02 | Ethicon Llc | Modular surgical instrument with configurable operating mode |
US10492783B2 (en) | 2016-04-15 | 2019-12-03 | Ethicon, Llc | Surgical instrument with improved stop/start control during a firing motion |
US10828028B2 (en) | 2016-04-15 | 2020-11-10 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US10405859B2 (en) | 2016-04-15 | 2019-09-10 | Ethicon Llc | Surgical instrument with adjustable stop/start control during a firing motion |
US11607239B2 (en) | 2016-04-15 | 2023-03-21 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US10456137B2 (en) | 2016-04-15 | 2019-10-29 | Ethicon Llc | Staple formation detection mechanisms |
US10357247B2 (en) | 2016-04-15 | 2019-07-23 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US10426467B2 (en) | 2016-04-15 | 2019-10-01 | Ethicon Llc | Surgical instrument with detection sensors |
US11179150B2 (en) | 2016-04-15 | 2021-11-23 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US11317917B2 (en) | 2016-04-18 | 2022-05-03 | Cilag Gmbh International | Surgical stapling system comprising a lockable firing assembly |
US20170296173A1 (en) | 2016-04-18 | 2017-10-19 | Ethicon Endo-Surgery, Llc | Method for operating a surgical instrument |
US10363037B2 (en) | 2016-04-18 | 2019-07-30 | Ethicon Llc | Surgical instrument system comprising a magnetic lockout |
CA3024623A1 (en) | 2016-05-18 | 2017-11-23 | Virtual Incision Corporation | Robotic surgical devices, systems and related methods |
EP3484421A1 (en) * | 2016-07-13 | 2019-05-22 | Boston Scientific Scimed Inc. | Apparatus and method for maintaining patency in a vessel adjacent to nearby surgery |
CN116269696A (en) | 2016-08-25 | 2023-06-23 | 内布拉斯加大学董事会 | Quick release tool coupler and related systems and methods |
CN114872081A (en) | 2016-08-30 | 2022-08-09 | 内布拉斯加大学董事会 | Robotic devices with compact joint design and additional degrees of freedom and related systems and methods |
CA3036192A1 (en) | 2016-09-12 | 2018-03-15 | Applied Medical Resources Corporation | Surgical robotic access system for irregularly shaped robotic actuators and associated robotic surgical instruments |
EP3544539A4 (en) | 2016-11-22 | 2020-08-05 | Board of Regents of the University of Nebraska | Improved gross positioning device and related systems and methods |
WO2018102430A1 (en) | 2016-11-29 | 2018-06-07 | Virtual Incision Corporation | User controller with user presence detection and related systems and methods |
US10722319B2 (en) | 2016-12-14 | 2020-07-28 | Virtual Incision Corporation | Releasable attachment device for coupling to medical devices and related systems and methods |
US10448950B2 (en) | 2016-12-21 | 2019-10-22 | Ethicon Llc | Surgical staplers with independently actuatable closing and firing systems |
US10588630B2 (en) | 2016-12-21 | 2020-03-17 | Ethicon Llc | Surgical tool assemblies with closure stroke reduction features |
US10893864B2 (en) | 2016-12-21 | 2021-01-19 | Ethicon | Staple cartridges and arrangements of staples and staple cavities therein |
JP2020501779A (en) | 2016-12-21 | 2020-01-23 | エシコン エルエルシーEthicon LLC | Surgical stapling system |
US10695055B2 (en) | 2016-12-21 | 2020-06-30 | Ethicon Llc | Firing assembly comprising a lockout |
JP7010956B2 (en) | 2016-12-21 | 2022-01-26 | エシコン エルエルシー | How to staple tissue |
US10588632B2 (en) | 2016-12-21 | 2020-03-17 | Ethicon Llc | Surgical end effectors and firing members thereof |
US10675026B2 (en) | 2016-12-21 | 2020-06-09 | Ethicon Llc | Methods of stapling tissue |
US10682138B2 (en) | 2016-12-21 | 2020-06-16 | Ethicon Llc | Bilaterally asymmetric staple forming pocket pairs |
US10426471B2 (en) | 2016-12-21 | 2019-10-01 | Ethicon Llc | Surgical instrument with multiple failure response modes |
US10856868B2 (en) | 2016-12-21 | 2020-12-08 | Ethicon Llc | Firing member pin configurations |
US11419606B2 (en) | 2016-12-21 | 2022-08-23 | Cilag Gmbh International | Shaft assembly comprising a clutch configured to adapt the output of a rotary firing member to two different systems |
US20180168615A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Method of deforming staples from two different types of staple cartridges with the same surgical stapling instrument |
US11134942B2 (en) | 2016-12-21 | 2021-10-05 | Cilag Gmbh International | Surgical stapling instruments and staple-forming anvils |
US10524789B2 (en) | 2016-12-21 | 2020-01-07 | Ethicon Llc | Laterally actuatable articulation lock arrangements for locking an end effector of a surgical instrument in an articulated configuration |
US20180168625A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Surgical stapling instruments with smart staple cartridges |
JP6983893B2 (en) | 2016-12-21 | 2021-12-17 | エシコン エルエルシーEthicon LLC | Lockout configuration for surgical end effectors and replaceable tool assemblies |
US10881401B2 (en) | 2016-12-21 | 2021-01-05 | Ethicon Llc | Staple firing member comprising a missing cartridge and/or spent cartridge lockout |
US10835245B2 (en) | 2016-12-21 | 2020-11-17 | Ethicon Llc | Method for attaching a shaft assembly to a surgical instrument and, alternatively, to a surgical robot |
IT201700060398A1 (en) * | 2017-06-01 | 2018-12-01 | Medacta Int Sa | DEVICE FOR THE RETREAT OF SOFT TISSUES IN A PATIENT SUBJECT TO ARTHROSCOPIC SURGERY |
US11839370B2 (en) | 2017-06-19 | 2023-12-12 | Heartstitch, Inc. | Suturing devices and methods for suturing an opening in the apex of the heart |
EP3641663B1 (en) | 2017-06-19 | 2022-03-02 | Heartstitch, Inc. | Suturing systems and methods for suturing body tissue |
US10881399B2 (en) | 2017-06-20 | 2021-01-05 | Ethicon Llc | Techniques for adaptive control of motor velocity of a surgical stapling and cutting instrument |
USD879809S1 (en) | 2017-06-20 | 2020-03-31 | Ethicon Llc | Display panel with changeable graphical user interface |
US10327767B2 (en) | 2017-06-20 | 2019-06-25 | Ethicon Llc | Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation |
US10624633B2 (en) | 2017-06-20 | 2020-04-21 | Ethicon Llc | Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument |
USD890784S1 (en) | 2017-06-20 | 2020-07-21 | Ethicon Llc | Display panel with changeable graphical user interface |
US11382638B2 (en) | 2017-06-20 | 2022-07-12 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified displacement distance |
US11653914B2 (en) | 2017-06-20 | 2023-05-23 | Cilag Gmbh International | Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument according to articulation angle of end effector |
US10980537B2 (en) | 2017-06-20 | 2021-04-20 | Ethicon Llc | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified number of shaft rotations |
US10368864B2 (en) | 2017-06-20 | 2019-08-06 | Ethicon Llc | Systems and methods for controlling displaying motor velocity for a surgical instrument |
US10779820B2 (en) | 2017-06-20 | 2020-09-22 | Ethicon Llc | Systems and methods for controlling motor speed according to user input for a surgical instrument |
US11071554B2 (en) | 2017-06-20 | 2021-07-27 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on magnitude of velocity error measurements |
US10888321B2 (en) | 2017-06-20 | 2021-01-12 | Ethicon Llc | Systems and methods for controlling velocity of a displacement member of a surgical stapling and cutting instrument |
US10646220B2 (en) | 2017-06-20 | 2020-05-12 | Ethicon Llc | Systems and methods for controlling displacement member velocity for a surgical instrument |
US10881396B2 (en) | 2017-06-20 | 2021-01-05 | Ethicon Llc | Surgical instrument with variable duration trigger arrangement |
US10813639B2 (en) | 2017-06-20 | 2020-10-27 | Ethicon Llc | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on system conditions |
US11517325B2 (en) | 2017-06-20 | 2022-12-06 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured displacement distance traveled over a specified time interval |
US10390841B2 (en) | 2017-06-20 | 2019-08-27 | Ethicon Llc | Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation |
US11090046B2 (en) | 2017-06-20 | 2021-08-17 | Cilag Gmbh International | Systems and methods for controlling displacement member motion of a surgical stapling and cutting instrument |
USD879808S1 (en) | 2017-06-20 | 2020-03-31 | Ethicon Llc | Display panel with graphical user interface |
US10307170B2 (en) | 2017-06-20 | 2019-06-04 | Ethicon Llc | Method for closed loop control of motor velocity of a surgical stapling and cutting instrument |
US11324503B2 (en) | 2017-06-27 | 2022-05-10 | Cilag Gmbh International | Surgical firing member arrangements |
US10993716B2 (en) | 2017-06-27 | 2021-05-04 | Ethicon Llc | Surgical anvil arrangements |
US10856869B2 (en) | 2017-06-27 | 2020-12-08 | Ethicon Llc | Surgical anvil arrangements |
US10772629B2 (en) | 2017-06-27 | 2020-09-15 | Ethicon Llc | Surgical anvil arrangements |
US10631859B2 (en) | 2017-06-27 | 2020-04-28 | Ethicon Llc | Articulation systems for surgical instruments |
US11266405B2 (en) | 2017-06-27 | 2022-03-08 | Cilag Gmbh International | Surgical anvil manufacturing methods |
US11564686B2 (en) | 2017-06-28 | 2023-01-31 | Cilag Gmbh International | Surgical shaft assemblies with flexible interfaces |
USD906355S1 (en) | 2017-06-28 | 2020-12-29 | Ethicon Llc | Display screen or portion thereof with a graphical user interface for a surgical instrument |
US10211586B2 (en) | 2017-06-28 | 2019-02-19 | Ethicon Llc | Surgical shaft assemblies with watertight housings |
US10786253B2 (en) | 2017-06-28 | 2020-09-29 | Ethicon Llc | Surgical end effectors with improved jaw aperture arrangements |
US11246592B2 (en) | 2017-06-28 | 2022-02-15 | Cilag Gmbh International | Surgical instrument comprising an articulation system lockable to a frame |
USD869655S1 (en) | 2017-06-28 | 2019-12-10 | Ethicon Llc | Surgical fastener cartridge |
US10716614B2 (en) | 2017-06-28 | 2020-07-21 | Ethicon Llc | Surgical shaft assemblies with slip ring assemblies with increased contact pressure |
EP4070740A1 (en) | 2017-06-28 | 2022-10-12 | Cilag GmbH International | Surgical instrument comprising selectively actuatable rotatable couplers |
US10903685B2 (en) | 2017-06-28 | 2021-01-26 | Ethicon Llc | Surgical shaft assemblies with slip ring assemblies forming capacitive channels |
US11259805B2 (en) | 2017-06-28 | 2022-03-01 | Cilag Gmbh International | Surgical instrument comprising firing member supports |
USD854151S1 (en) | 2017-06-28 | 2019-07-16 | Ethicon Llc | Surgical instrument shaft |
USD851762S1 (en) | 2017-06-28 | 2019-06-18 | Ethicon Llc | Anvil |
US10765427B2 (en) | 2017-06-28 | 2020-09-08 | Ethicon Llc | Method for articulating a surgical instrument |
US11000279B2 (en) | 2017-06-28 | 2021-05-11 | Ethicon Llc | Surgical instrument comprising an articulation system ratio |
US10898183B2 (en) | 2017-06-29 | 2021-01-26 | Ethicon Llc | Robotic surgical instrument with closed loop feedback techniques for advancement of closure member during firing |
US10398434B2 (en) | 2017-06-29 | 2019-09-03 | Ethicon Llc | Closed loop velocity control of closure member for robotic surgical instrument |
US10932772B2 (en) | 2017-06-29 | 2021-03-02 | Ethicon Llc | Methods for closed loop velocity control for robotic surgical instrument |
US11007022B2 (en) | 2017-06-29 | 2021-05-18 | Ethicon Llc | Closed loop velocity control techniques based on sensed tissue parameters for robotic surgical instrument |
US10258418B2 (en) | 2017-06-29 | 2019-04-16 | Ethicon Llc | System for controlling articulation forces |
US10194975B1 (en) | 2017-07-11 | 2019-02-05 | Medtronic Advanced Energy, Llc | Illuminated and isolated electrosurgical apparatus |
US11471155B2 (en) | 2017-08-03 | 2022-10-18 | Cilag Gmbh International | Surgical system bailout |
US11304695B2 (en) | 2017-08-03 | 2022-04-19 | Cilag Gmbh International | Surgical system shaft interconnection |
US11944300B2 (en) | 2017-08-03 | 2024-04-02 | Cilag Gmbh International | Method for operating a surgical system bailout |
WO2019035095A1 (en) | 2017-08-18 | 2019-02-21 | Nobles Medical Technologies Ii, Inc. | Apparatus for applying a knot to a suture |
CA3076625A1 (en) | 2017-09-27 | 2019-04-04 | Virtual Incision Corporation | Robotic surgical devices with tracking camera technology and related systems and methods |
USD917500S1 (en) | 2017-09-29 | 2021-04-27 | Ethicon Llc | Display screen or portion thereof with graphical user interface |
US10743872B2 (en) | 2017-09-29 | 2020-08-18 | Ethicon Llc | System and methods for controlling a display of a surgical instrument |
US10796471B2 (en) | 2017-09-29 | 2020-10-06 | Ethicon Llc | Systems and methods of displaying a knife position for a surgical instrument |
US10765429B2 (en) | 2017-09-29 | 2020-09-08 | Ethicon Llc | Systems and methods for providing alerts according to the operational state of a surgical instrument |
US10729501B2 (en) | 2017-09-29 | 2020-08-04 | Ethicon Llc | Systems and methods for language selection of a surgical instrument |
US11399829B2 (en) | 2017-09-29 | 2022-08-02 | Cilag Gmbh International | Systems and methods of initiating a power shutdown mode for a surgical instrument |
USD907648S1 (en) | 2017-09-29 | 2021-01-12 | Ethicon Llc | Display screen or portion thereof with animated graphical user interface |
USD907647S1 (en) | 2017-09-29 | 2021-01-12 | Ethicon Llc | Display screen or portion thereof with animated graphical user interface |
US11090075B2 (en) | 2017-10-30 | 2021-08-17 | Cilag Gmbh International | Articulation features for surgical end effector |
US11134944B2 (en) | 2017-10-30 | 2021-10-05 | Cilag Gmbh International | Surgical stapler knife motion controls |
US10779903B2 (en) | 2017-10-31 | 2020-09-22 | Ethicon Llc | Positive shaft rotation lock activated by jaw closure |
US10842490B2 (en) | 2017-10-31 | 2020-11-24 | Ethicon Llc | Cartridge body design with force reduction based on firing completion |
WO2019094502A1 (en) | 2017-11-07 | 2019-05-16 | Prescient Surgical, Inc. | Methods and apparatus for prevention of surgical site infection |
US10667842B2 (en) | 2017-11-24 | 2020-06-02 | Rainbow Medical Ltd. | Pericardial needle mechanism |
US10828033B2 (en) | 2017-12-15 | 2020-11-10 | Ethicon Llc | Handheld electromechanical surgical instruments with improved motor control arrangements for positioning components of an adapter coupled thereto |
US10869666B2 (en) | 2017-12-15 | 2020-12-22 | Ethicon Llc | Adapters with control systems for controlling multiple motors of an electromechanical surgical instrument |
US11071543B2 (en) | 2017-12-15 | 2021-07-27 | Cilag Gmbh International | Surgical end effectors with clamping assemblies configured to increase jaw aperture ranges |
US11033267B2 (en) | 2017-12-15 | 2021-06-15 | Ethicon Llc | Systems and methods of controlling a clamping member firing rate of a surgical instrument |
US10687813B2 (en) | 2017-12-15 | 2020-06-23 | Ethicon Llc | Adapters with firing stroke sensing arrangements for use in connection with electromechanical surgical instruments |
US10966718B2 (en) | 2017-12-15 | 2021-04-06 | Ethicon Llc | Dynamic clamping assemblies with improved wear characteristics for use in connection with electromechanical surgical instruments |
US10779826B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Methods of operating surgical end effectors |
US11006955B2 (en) | 2017-12-15 | 2021-05-18 | Ethicon Llc | End effectors with positive jaw opening features for use with adapters for electromechanical surgical instruments |
US11197670B2 (en) | 2017-12-15 | 2021-12-14 | Cilag Gmbh International | Surgical end effectors with pivotal jaws configured to touch at their respective distal ends when fully closed |
US10779825B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Adapters with end effector position sensing and control arrangements for use in connection with electromechanical surgical instruments |
US10743875B2 (en) | 2017-12-15 | 2020-08-18 | Ethicon Llc | Surgical end effectors with jaw stiffener arrangements configured to permit monitoring of firing member |
US10743874B2 (en) | 2017-12-15 | 2020-08-18 | Ethicon Llc | Sealed adapters for use with electromechanical surgical instruments |
US10729509B2 (en) | 2017-12-19 | 2020-08-04 | Ethicon Llc | Surgical instrument comprising closure and firing locking mechanism |
US11045270B2 (en) | 2017-12-19 | 2021-06-29 | Cilag Gmbh International | Robotic attachment comprising exterior drive actuator |
USD910847S1 (en) | 2017-12-19 | 2021-02-16 | Ethicon Llc | Surgical instrument assembly |
US10716565B2 (en) | 2017-12-19 | 2020-07-21 | Ethicon Llc | Surgical instruments with dual articulation drivers |
US10835330B2 (en) | 2017-12-19 | 2020-11-17 | Ethicon Llc | Method for determining the position of a rotatable jaw of a surgical instrument attachment assembly |
US11020112B2 (en) | 2017-12-19 | 2021-06-01 | Ethicon Llc | Surgical tools configured for interchangeable use with different controller interfaces |
US11076853B2 (en) | 2017-12-21 | 2021-08-03 | Cilag Gmbh International | Systems and methods of displaying a knife position during transection for a surgical instrument |
US11311290B2 (en) | 2017-12-21 | 2022-04-26 | Cilag Gmbh International | Surgical instrument comprising an end effector dampener |
US10682134B2 (en) | 2017-12-21 | 2020-06-16 | Ethicon Llc | Continuous use self-propelled stapling instrument |
US11129680B2 (en) | 2017-12-21 | 2021-09-28 | Cilag Gmbh International | Surgical instrument comprising a projector |
EP3735341A4 (en) | 2018-01-05 | 2021-10-06 | Board of Regents of the University of Nebraska | Single-arm robotic device with compact joint design and related systems and methods |
US11045192B2 (en) | 2018-08-20 | 2021-06-29 | Cilag Gmbh International | Fabricating techniques for surgical stapler anvils |
US11207065B2 (en) | 2018-08-20 | 2021-12-28 | Cilag Gmbh International | Method for fabricating surgical stapler anvils |
US11083458B2 (en) | 2018-08-20 | 2021-08-10 | Cilag Gmbh International | Powered surgical instruments with clutching arrangements to convert linear drive motions to rotary drive motions |
US10779821B2 (en) | 2018-08-20 | 2020-09-22 | Ethicon Llc | Surgical stapler anvils with tissue stop features configured to avoid tissue pinch |
US11291440B2 (en) | 2018-08-20 | 2022-04-05 | Cilag Gmbh International | Method for operating a powered articulatable surgical instrument |
US10912559B2 (en) | 2018-08-20 | 2021-02-09 | Ethicon Llc | Reinforced deformable anvil tip for surgical stapler anvil |
USD914878S1 (en) | 2018-08-20 | 2021-03-30 | Ethicon Llc | Surgical instrument anvil |
US10842492B2 (en) | 2018-08-20 | 2020-11-24 | Ethicon Llc | Powered articulatable surgical instruments with clutching and locking arrangements for linking an articulation drive system to a firing drive system |
US11039834B2 (en) | 2018-08-20 | 2021-06-22 | Cilag Gmbh International | Surgical stapler anvils with staple directing protrusions and tissue stability features |
US11253256B2 (en) | 2018-08-20 | 2022-02-22 | Cilag Gmbh International | Articulatable motor powered surgical instruments with dedicated articulation motor arrangements |
US10856870B2 (en) | 2018-08-20 | 2020-12-08 | Ethicon Llc | Switching arrangements for motor powered articulatable surgical instruments |
US11324501B2 (en) | 2018-08-20 | 2022-05-10 | Cilag Gmbh International | Surgical stapling devices with improved closure members |
US10932767B2 (en) | 2018-12-07 | 2021-03-02 | Covidien Lp | Surgical access assembly and method of use therefor |
JP2022516937A (en) | 2019-01-07 | 2022-03-03 | バーチャル インシジョン コーポレイション | Equipment and methods related to robot-assisted surgery systems |
US11369400B2 (en) | 2019-03-20 | 2022-06-28 | Covidien Lp | Balloon dissector |
US11147553B2 (en) | 2019-03-25 | 2021-10-19 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11172929B2 (en) | 2019-03-25 | 2021-11-16 | Cilag Gmbh International | Articulation drive arrangements for surgical systems |
US11696761B2 (en) | 2019-03-25 | 2023-07-11 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11147551B2 (en) | 2019-03-25 | 2021-10-19 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11452528B2 (en) | 2019-04-30 | 2022-09-27 | Cilag Gmbh International | Articulation actuators for a surgical instrument |
US11903581B2 (en) | 2019-04-30 | 2024-02-20 | Cilag Gmbh International | Methods for stapling tissue using a surgical instrument |
US11426251B2 (en) | 2019-04-30 | 2022-08-30 | Cilag Gmbh International | Articulation directional lights on a surgical instrument |
US11253254B2 (en) | 2019-04-30 | 2022-02-22 | Cilag Gmbh International | Shaft rotation actuator on a surgical instrument |
US11432816B2 (en) | 2019-04-30 | 2022-09-06 | Cilag Gmbh International | Articulation pin for a surgical instrument |
US11648009B2 (en) | 2019-04-30 | 2023-05-16 | Cilag Gmbh International | Rotatable jaw tip for a surgical instrument |
US11471157B2 (en) | 2019-04-30 | 2022-10-18 | Cilag Gmbh International | Articulation control mapping for a surgical instrument |
US11291451B2 (en) | 2019-06-28 | 2022-04-05 | Cilag Gmbh International | Surgical instrument with battery compatibility verification functionality |
US11627959B2 (en) | 2019-06-28 | 2023-04-18 | Cilag Gmbh International | Surgical instruments including manual and powered system lockouts |
US11298127B2 (en) | 2019-06-28 | 2022-04-12 | Cilag GmbH Interational | Surgical stapling system having a lockout mechanism for an incompatible cartridge |
US11638587B2 (en) | 2019-06-28 | 2023-05-02 | Cilag Gmbh International | RFID identification systems for surgical instruments |
US11497492B2 (en) | 2019-06-28 | 2022-11-15 | Cilag Gmbh International | Surgical instrument including an articulation lock |
US11399837B2 (en) | 2019-06-28 | 2022-08-02 | Cilag Gmbh International | Mechanisms for motor control adjustments of a motorized surgical instrument |
US11051807B2 (en) | 2019-06-28 | 2021-07-06 | Cilag Gmbh International | Packaging assembly including a particulate trap |
US11464601B2 (en) | 2019-06-28 | 2022-10-11 | Cilag Gmbh International | Surgical instrument comprising an RFID system for tracking a movable component |
US11219455B2 (en) | 2019-06-28 | 2022-01-11 | Cilag Gmbh International | Surgical instrument including a lockout key |
US11229437B2 (en) | 2019-06-28 | 2022-01-25 | Cilag Gmbh International | Method for authenticating the compatibility of a staple cartridge with a surgical instrument |
US11298132B2 (en) | 2019-06-28 | 2022-04-12 | Cilag GmbH Inlernational | Staple cartridge including a honeycomb extension |
US11771419B2 (en) | 2019-06-28 | 2023-10-03 | Cilag Gmbh International | Packaging for a replaceable component of a surgical stapling system |
US11426167B2 (en) | 2019-06-28 | 2022-08-30 | Cilag Gmbh International | Mechanisms for proper anvil attachment surgical stapling head assembly |
US11684434B2 (en) | 2019-06-28 | 2023-06-27 | Cilag Gmbh International | Surgical RFID assemblies for instrument operational setting control |
US11523822B2 (en) | 2019-06-28 | 2022-12-13 | Cilag Gmbh International | Battery pack including a circuit interrupter |
US11376098B2 (en) | 2019-06-28 | 2022-07-05 | Cilag Gmbh International | Surgical instrument system comprising an RFID system |
US11478241B2 (en) | 2019-06-28 | 2022-10-25 | Cilag Gmbh International | Staple cartridge including projections |
US11246678B2 (en) | 2019-06-28 | 2022-02-15 | Cilag Gmbh International | Surgical stapling system having a frangible RFID tag |
US11224497B2 (en) | 2019-06-28 | 2022-01-18 | Cilag Gmbh International | Surgical systems with multiple RFID tags |
US11259803B2 (en) | 2019-06-28 | 2022-03-01 | Cilag Gmbh International | Surgical stapling system having an information encryption protocol |
US11553971B2 (en) | 2019-06-28 | 2023-01-17 | Cilag Gmbh International | Surgical RFID assemblies for display and communication |
US11660163B2 (en) | 2019-06-28 | 2023-05-30 | Cilag Gmbh International | Surgical system with RFID tags for updating motor assembly parameters |
CN114728103A (en) * | 2019-09-11 | 2022-07-08 | 诺利尔斯科技公司 | Apparatus and method for improving recovery from minimally invasive surgery |
CN110680514A (en) * | 2019-10-21 | 2020-01-14 | 凌斌 | Pelvic cavity and abdominal cavity isolation protection diaphragm for laparoscope |
JPWO2021090532A1 (en) * | 2019-11-05 | 2021-05-14 | ||
US11529137B2 (en) | 2019-12-19 | 2022-12-20 | Cilag Gmbh International | Staple cartridge comprising driver retention members |
US11701111B2 (en) | 2019-12-19 | 2023-07-18 | Cilag Gmbh International | Method for operating a surgical stapling instrument |
US11304696B2 (en) | 2019-12-19 | 2022-04-19 | Cilag Gmbh International | Surgical instrument comprising a powered articulation system |
US11464512B2 (en) | 2019-12-19 | 2022-10-11 | Cilag Gmbh International | Staple cartridge comprising a curved deck surface |
US11291447B2 (en) | 2019-12-19 | 2022-04-05 | Cilag Gmbh International | Stapling instrument comprising independent jaw closing and staple firing systems |
US11504122B2 (en) | 2019-12-19 | 2022-11-22 | Cilag Gmbh International | Surgical instrument comprising a nested firing member |
US11234698B2 (en) | 2019-12-19 | 2022-02-01 | Cilag Gmbh International | Stapling system comprising a clamp lockout and a firing lockout |
US11607219B2 (en) | 2019-12-19 | 2023-03-21 | Cilag Gmbh International | Staple cartridge comprising a detachable tissue cutting knife |
US11911032B2 (en) | 2019-12-19 | 2024-02-27 | Cilag Gmbh International | Staple cartridge comprising a seating cam |
US11576672B2 (en) | 2019-12-19 | 2023-02-14 | Cilag Gmbh International | Surgical instrument comprising a closure system including a closure member and an opening member driven by a drive screw |
US11559304B2 (en) | 2019-12-19 | 2023-01-24 | Cilag Gmbh International | Surgical instrument comprising a rapid closure mechanism |
US11446029B2 (en) | 2019-12-19 | 2022-09-20 | Cilag Gmbh International | Staple cartridge comprising projections extending from a curved deck surface |
US11529139B2 (en) | 2019-12-19 | 2022-12-20 | Cilag Gmbh International | Motor driven surgical instrument |
US11844520B2 (en) | 2019-12-19 | 2023-12-19 | Cilag Gmbh International | Staple cartridge comprising driver retention members |
US11931033B2 (en) | 2019-12-19 | 2024-03-19 | Cilag Gmbh International | Staple cartridge comprising a latch lockout |
US11484337B2 (en) | 2020-02-06 | 2022-11-01 | Covidien Lp | Surgical access device including anchor with rachet mechanism |
US11672563B2 (en) | 2020-02-07 | 2023-06-13 | Covidien Lp | Surgical access device with rotatably actuated fixation mechanism |
US11547441B2 (en) | 2020-02-20 | 2023-01-10 | Covidien Lp | Retention anchor for surgical access devices |
US11786233B2 (en) | 2020-03-27 | 2023-10-17 | Covidien Lp | Retention anchor with suture tie down for surgical access devices |
US11432846B2 (en) | 2020-05-05 | 2022-09-06 | Covidien Lp | Surgical access device including alternating cutout fluid flow pathway for anchor inflation and deflation |
US11376037B2 (en) | 2020-05-08 | 2022-07-05 | Covidien Lp | Surgical access device including dual lumen cannula for anchor inflation and deflation |
US11439430B2 (en) | 2020-05-11 | 2022-09-13 | Covidien Lp | Surgical access device with air release mechanism |
US11896263B2 (en) | 2020-05-11 | 2024-02-13 | Covidien Lp | Surgical access device with fixation mechanism |
USD974560S1 (en) | 2020-06-02 | 2023-01-03 | Cilag Gmbh International | Staple cartridge |
USD966512S1 (en) | 2020-06-02 | 2022-10-11 | Cilag Gmbh International | Staple cartridge |
USD975850S1 (en) | 2020-06-02 | 2023-01-17 | Cilag Gmbh International | Staple cartridge |
USD967421S1 (en) | 2020-06-02 | 2022-10-18 | Cilag Gmbh International | Staple cartridge |
USD975278S1 (en) | 2020-06-02 | 2023-01-10 | Cilag Gmbh International | Staple cartridge |
USD975851S1 (en) | 2020-06-02 | 2023-01-17 | Cilag Gmbh International | Staple cartridge |
USD976401S1 (en) | 2020-06-02 | 2023-01-24 | Cilag Gmbh International | Staple cartridge |
US11564708B2 (en) | 2020-06-15 | 2023-01-31 | Covidien Lp | Cannula assembly including an adjustable elongate shaft assembly |
CN111887910A (en) * | 2020-07-13 | 2020-11-06 | 杭州山友医疗器械有限公司 | Abdominal cavity dilator |
US11864756B2 (en) | 2020-07-28 | 2024-01-09 | Cilag Gmbh International | Surgical instruments with flexible ball chain drive arrangements |
US11839404B2 (en) | 2020-07-28 | 2023-12-12 | Covidien Lp | Surgical access assembly having pre-filled air chamber |
US11717322B2 (en) | 2020-08-17 | 2023-08-08 | Covidien Lp | Flexible cannula having selective rigidity |
CN112022251A (en) * | 2020-09-18 | 2020-12-04 | 宁波天益医疗器械股份有限公司 | Suspension device for endoscopic surgery |
US11844549B2 (en) | 2020-10-15 | 2023-12-19 | Covidien Lp | Surgical access device including a universal fluid flow valve |
US11931025B2 (en) | 2020-10-29 | 2024-03-19 | Cilag Gmbh International | Surgical instrument comprising a releasable closure drive lock |
US11517390B2 (en) | 2020-10-29 | 2022-12-06 | Cilag Gmbh International | Surgical instrument comprising a limited travel switch |
US11452526B2 (en) | 2020-10-29 | 2022-09-27 | Cilag Gmbh International | Surgical instrument comprising a staged voltage regulation start-up system |
US11617577B2 (en) | 2020-10-29 | 2023-04-04 | Cilag Gmbh International | Surgical instrument comprising a sensor configured to sense whether an articulation drive of the surgical instrument is actuatable |
USD1013170S1 (en) | 2020-10-29 | 2024-01-30 | Cilag Gmbh International | Surgical instrument assembly |
US11717289B2 (en) | 2020-10-29 | 2023-08-08 | Cilag Gmbh International | Surgical instrument comprising an indicator which indicates that an articulation drive is actuatable |
US11471189B2 (en) | 2020-10-29 | 2022-10-18 | Covidien Lp | Surgical access device with fixation mechanism and illumination mechanism |
US11779330B2 (en) | 2020-10-29 | 2023-10-10 | Cilag Gmbh International | Surgical instrument comprising a jaw alignment system |
US11896217B2 (en) | 2020-10-29 | 2024-02-13 | Cilag Gmbh International | Surgical instrument comprising an articulation lock |
US11534259B2 (en) | 2020-10-29 | 2022-12-27 | Cilag Gmbh International | Surgical instrument comprising an articulation indicator |
US11844518B2 (en) | 2020-10-29 | 2023-12-19 | Cilag Gmbh International | Method for operating a surgical instrument |
USD980425S1 (en) | 2020-10-29 | 2023-03-07 | Cilag Gmbh International | Surgical instrument assembly |
US11751906B2 (en) | 2020-10-29 | 2023-09-12 | Covidien Lp | Adapter for use with surgical access device for evacuation of smoke |
US11583315B2 (en) | 2020-11-09 | 2023-02-21 | Covidien Lp | Surgical access device including variable length cannula |
US11678882B2 (en) | 2020-12-02 | 2023-06-20 | Cilag Gmbh International | Surgical instruments with interactive features to remedy incidental sled movements |
US11849943B2 (en) | 2020-12-02 | 2023-12-26 | Cilag Gmbh International | Surgical instrument with cartridge release mechanisms |
US11653915B2 (en) | 2020-12-02 | 2023-05-23 | Cilag Gmbh International | Surgical instruments with sled location detection and adjustment features |
US11627960B2 (en) | 2020-12-02 | 2023-04-18 | Cilag Gmbh International | Powered surgical instruments with smart reload with separately attachable exteriorly mounted wiring connections |
US11744581B2 (en) | 2020-12-02 | 2023-09-05 | Cilag Gmbh International | Powered surgical instruments with multi-phase tissue treatment |
US11737751B2 (en) | 2020-12-02 | 2023-08-29 | Cilag Gmbh International | Devices and methods of managing energy dissipated within sterile barriers of surgical instrument housings |
US11890010B2 (en) | 2020-12-02 | 2024-02-06 | Cllag GmbH International | Dual-sided reinforced reload for surgical instruments |
US11944296B2 (en) | 2020-12-02 | 2024-04-02 | Cilag Gmbh International | Powered surgical instruments with external connectors |
US11653920B2 (en) | 2020-12-02 | 2023-05-23 | Cilag Gmbh International | Powered surgical instruments with communication interfaces through sterile barrier |
US11849969B2 (en) | 2020-12-04 | 2023-12-26 | Covidien Lp | Cannula with smoke evacuation housing |
US11304723B1 (en) | 2020-12-17 | 2022-04-19 | Avantec Vascular Corporation | Atherectomy devices that are self-driving with controlled deflection |
US11950779B2 (en) | 2021-02-26 | 2024-04-09 | Cilag Gmbh International | Method of powering and communicating with a staple cartridge |
US11744583B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Distal communication array to tune frequency of RF systems |
US11950777B2 (en) | 2021-02-26 | 2024-04-09 | Cilag Gmbh International | Staple cartridge comprising an information access control system |
US11730473B2 (en) | 2021-02-26 | 2023-08-22 | Cilag Gmbh International | Monitoring of manufacturing life-cycle |
US11812964B2 (en) | 2021-02-26 | 2023-11-14 | Cilag Gmbh International | Staple cartridge comprising a power management circuit |
US11749877B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Stapling instrument comprising a signal antenna |
US11701113B2 (en) | 2021-02-26 | 2023-07-18 | Cilag Gmbh International | Stapling instrument comprising a separate power antenna and a data transfer antenna |
US11793514B2 (en) | 2021-02-26 | 2023-10-24 | Cilag Gmbh International | Staple cartridge comprising sensor array which may be embedded in cartridge body |
US11925349B2 (en) | 2021-02-26 | 2024-03-12 | Cilag Gmbh International | Adjustment to transfer parameters to improve available power |
US11751869B2 (en) | 2021-02-26 | 2023-09-12 | Cilag Gmbh International | Monitoring of multiple sensors over time to detect moving characteristics of tissue |
US11723657B2 (en) | 2021-02-26 | 2023-08-15 | Cilag Gmbh International | Adjustable communication based on available bandwidth and power capacity |
US11696757B2 (en) | 2021-02-26 | 2023-07-11 | Cilag Gmbh International | Monitoring of internal systems to detect and track cartridge motion status |
US11737749B2 (en) | 2021-03-22 | 2023-08-29 | Cilag Gmbh International | Surgical stapling instrument comprising a retraction system |
US11826012B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Stapling instrument comprising a pulsed motor-driven firing rack |
US11723658B2 (en) | 2021-03-22 | 2023-08-15 | Cilag Gmbh International | Staple cartridge comprising a firing lockout |
US11806011B2 (en) | 2021-03-22 | 2023-11-07 | Cilag Gmbh International | Stapling instrument comprising tissue compression systems |
US11759202B2 (en) | 2021-03-22 | 2023-09-19 | Cilag Gmbh International | Staple cartridge comprising an implantable layer |
US11717291B2 (en) | 2021-03-22 | 2023-08-08 | Cilag Gmbh International | Staple cartridge comprising staples configured to apply different tissue compression |
US11826042B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Surgical instrument comprising a firing drive including a selectable leverage mechanism |
US11832816B2 (en) | 2021-03-24 | 2023-12-05 | Cilag Gmbh International | Surgical stapling assembly comprising nonplanar staples and planar staples |
US11903582B2 (en) | 2021-03-24 | 2024-02-20 | Cilag Gmbh International | Leveraging surfaces for cartridge installation |
US11744603B2 (en) | 2021-03-24 | 2023-09-05 | Cilag Gmbh International | Multi-axis pivot joints for surgical instruments and methods for manufacturing same |
US11857183B2 (en) | 2021-03-24 | 2024-01-02 | Cilag Gmbh International | Stapling assembly components having metal substrates and plastic bodies |
US11786239B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Surgical instrument articulation joint arrangements comprising multiple moving linkage features |
US11786243B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Firing members having flexible portions for adapting to a load during a surgical firing stroke |
US11849944B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Drivers for fastener cartridge assemblies having rotary drive screws |
US11896218B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Method of using a powered stapling device |
US11793516B2 (en) | 2021-03-24 | 2023-10-24 | Cilag Gmbh International | Surgical staple cartridge comprising longitudinal support beam |
US11849945B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Rotary-driven surgical stapling assembly comprising eccentrically driven firing member |
US11944336B2 (en) | 2021-03-24 | 2024-04-02 | Cilag Gmbh International | Joint arrangements for multi-planar alignment and support of operational drive shafts in articulatable surgical instruments |
US11896219B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Mating features between drivers and underside of a cartridge deck |
US11944348B2 (en) | 2021-04-07 | 2024-04-02 | Covidien Lp | Surgical access device including an anchor having a suture retention mechanism |
US11751907B2 (en) | 2021-04-13 | 2023-09-12 | Covidien Lp | Surgical access device with self-inflating balloon |
US20220378424A1 (en) | 2021-05-28 | 2022-12-01 | Cilag Gmbh International | Stapling instrument comprising a firing lockout |
CN113100849B (en) * | 2021-05-31 | 2021-10-22 | 中南大学湘雅医院 | Pneumoperitoneum-free type laparoscopic abdominal wall suspension device for general surgery department operation |
WO2022269614A1 (en) * | 2021-06-24 | 2022-12-29 | Tel Hashomer Medical Research, Infrastructure And Services Ltd. | Peritoneal separation apparatus |
US11864761B2 (en) | 2021-09-14 | 2024-01-09 | Covidien Lp | Surgical instrument with illumination mechanism |
US11957337B2 (en) | 2021-10-18 | 2024-04-16 | Cilag Gmbh International | Surgical stapling assembly with offset ramped drive surfaces |
US11877745B2 (en) | 2021-10-18 | 2024-01-23 | Cilag Gmbh International | Surgical stapling assembly having longitudinally-repeating staple leg clusters |
US11937816B2 (en) | 2021-10-28 | 2024-03-26 | Cilag Gmbh International | Electrical lead arrangements for surgical instruments |
Family Cites Families (150)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US1618261A (en) * | 1927-02-22 | Viscera retainer for use in abdominal operations | ||
US1060350A (en) * | 1911-12-18 | 1913-04-29 | Robert E L Miller | Intestine-protector. |
US1275520A (en) * | 1917-06-14 | 1918-08-13 | William L Bell | Gauze-dam surgical instrument. |
US1735519A (en) * | 1926-07-17 | 1929-11-12 | Arlyn T Vance | Physician's dilator |
US1798124A (en) * | 1929-08-15 | 1931-03-24 | Josiah Brinkerhoff | Urethral sound and axis-traction prostatic retractor |
US1947649A (en) * | 1931-12-05 | 1934-02-20 | Godfrey J Kadavy | Surgical instrument |
US2243285A (en) * | 1936-01-06 | 1941-05-27 | Charles E Pope | Operating scope |
GB502331A (en) * | 1937-09-16 | 1939-03-15 | Wolf Gmbh Georg | Improvements in oesophagoscopes |
US2663020A (en) * | 1950-12-20 | 1953-12-22 | Cecil A Cushman | Pneumatic injury pad |
US2841148A (en) * | 1957-06-21 | 1958-07-01 | Godfrey J Kadavy | Viscera retainer for use in abdominal operations |
US3039468A (en) * | 1959-01-07 | 1962-06-19 | Joseph L Price | Trocar and method of treating bloat |
US3173418A (en) * | 1961-01-10 | 1965-03-16 | Ostap E Baran | Double-wall endotracheal cuff |
US3168092A (en) * | 1961-06-15 | 1965-02-02 | Silverman Daniel | Medical probing instrument having flexible, extrudable tubing adapted to be extraverted under pressure into a body cavity |
US3417745A (en) * | 1963-08-23 | 1968-12-24 | Sheldon Edward Emanuel | Fiber endoscope provided with focusing means and electroluminescent means |
DE1516411A1 (en) * | 1966-03-04 | 1969-07-24 | Albert Hauber | Dismountable belly spatula |
US3460539A (en) * | 1967-03-10 | 1969-08-12 | James E Anhalt Sr | Cautery tip |
US3626949A (en) * | 1969-01-23 | 1971-12-14 | Wallace B Shute | Cervical dilator |
US3717151A (en) * | 1971-03-11 | 1973-02-20 | R Collett | Flesh penetrating apparatus |
US3774596A (en) * | 1971-06-29 | 1973-11-27 | G Cook | Compliable cavity speculum |
US3782370A (en) * | 1972-07-12 | 1974-01-01 | B Mcdonald | Surgical retractor |
US3800788A (en) * | 1972-07-12 | 1974-04-02 | N White | Antral catheter for reduction of fractures |
US3817251A (en) * | 1972-10-04 | 1974-06-18 | H Hasson | Laparoscope cannula |
US3831587A (en) * | 1973-02-08 | 1974-08-27 | Mc Anally R | Multipurpose vaginal and cervical device |
US3882852A (en) * | 1974-01-11 | 1975-05-13 | Manfred Sinnreich | Surgical dilators having insufflating means |
US3863639A (en) * | 1974-04-04 | 1975-02-04 | Richard N Kleaveland | Disposable visceral retainer |
US3961632A (en) * | 1974-12-13 | 1976-06-08 | Moossun Mohamed H | Stomach intubation and catheter placement system |
US4148307A (en) * | 1975-12-26 | 1979-04-10 | Olympus Optical Company Limited | Tubular medical instrument having a flexible sheath driven by a plurality of cuffs |
US4052980A (en) * | 1976-06-10 | 1977-10-11 | Guenter A. Grams | Triaxial fiberoptic soft tissue retractor |
US4083369A (en) * | 1976-07-02 | 1978-04-11 | Manfred Sinnreich | Surgical instruments |
US4217889A (en) * | 1976-09-15 | 1980-08-19 | Heyer-Schulte Corporation | Flap development device and method of progressively increasing skin area |
AU516114B2 (en) * | 1977-03-29 | 1981-05-21 | Frank Baskind Allen | Apparatus for obtaining oytological specimens |
US4137906A (en) * | 1977-05-05 | 1979-02-06 | Koken Co., Ltd. | Catheter apparatus with occlusion and flow diverting means |
US4165746A (en) * | 1977-06-30 | 1979-08-28 | Burgin Kermit H | Plastic forceps |
SU736949A1 (en) * | 1977-07-12 | 1980-05-30 | 2-Ой Московский Ордена Ленина Государственный Институт Им. Н.И.Пирогова | Device for manipulations in abdominal cavity |
US4240433A (en) * | 1977-07-22 | 1980-12-23 | Bordow Richard A | Fluid aspiration device and technique for reducing the risk of complications |
US4183102A (en) * | 1977-09-08 | 1980-01-15 | Jacques Guiset | Inflatable prosthetic device for lining a body duct |
JPS6051913B2 (en) * | 1977-11-04 | 1985-11-16 | オリンパス光学工業株式会社 | balloon catheter |
US4291687A (en) * | 1978-03-02 | 1981-09-29 | Manfred Sinnreich | Inflatable packing for surgical use having auxiliary intestinal supporting member |
US4157085A (en) * | 1978-03-24 | 1979-06-05 | Dow Corning Corporation | Surgically implantable tissue expanding device and the method of its use |
US4198981A (en) * | 1978-03-27 | 1980-04-22 | Manfred Sinnreich | Intrauterine surgical device |
SU797668A1 (en) * | 1978-06-13 | 1981-01-23 | Петрозаводский Государственныйуниверситет Им. O.B.Куусинена | Device for limiting surgery field on small pelvis |
US4271830A (en) * | 1978-07-26 | 1981-06-09 | Moon Derryl E | Chiropractic table |
US4207891A (en) * | 1978-10-10 | 1980-06-17 | Population Research Incorporated | Dispensing instrument with supported balloon |
US4263900A (en) * | 1979-04-20 | 1981-04-28 | Codman And Shurtleff, Inc. | Pressure-responsive surgical tool assembly |
US4271839A (en) * | 1979-07-25 | 1981-06-09 | Thomas J. Fogarty | Dilation catheter method and apparatus |
US4254762A (en) * | 1979-10-23 | 1981-03-10 | Inbae Yoon | Safety endoscope system |
DE2948434A1 (en) * | 1979-12-01 | 1981-06-11 | Hoechst Ag, 6000 Frankfurt | 1-PIPERIDINSULFONYL UREA AND METHOD FOR THE PRODUCTION THEREOF |
US4357940A (en) * | 1979-12-13 | 1982-11-09 | Detroit Neurosurgical Foundation | Tissue pneumatic separator structure |
FR2474304A1 (en) * | 1979-12-13 | 1981-07-31 | Air Foundation | Instrument for pneumatic removal of live tissue e.g. tumour - has hollow handle and shaft with articulated tip directing pressurised fluid at tissue |
US4709697A (en) * | 1980-12-09 | 1987-12-01 | Joseph J. Berke | Tissue pneumatic separator structure and method |
GB2071502A (en) * | 1980-03-14 | 1981-09-23 | Nat Res Dev | Surgical retractors |
US4318410A (en) * | 1980-08-07 | 1982-03-09 | Thomas J. Fogarty | Double lumen dilatation catheter |
US4449519A (en) * | 1980-09-24 | 1984-05-22 | Transidyne General Corporation | Endoscope |
JPS57176079A (en) * | 1981-04-21 | 1982-10-29 | Iwatsu Electric Co Ltd | Forming device for latent image |
US4430076A (en) * | 1982-02-04 | 1984-02-07 | Harris James H | Combined uterine injector and manipulative device |
US4535773A (en) * | 1982-03-26 | 1985-08-20 | Inbae Yoon | Safety puncturing instrument and method |
US4459978A (en) * | 1982-05-17 | 1984-07-17 | Endoscopy Surgical Systems, Inc. | Medical retractor device |
US4447227A (en) * | 1982-06-09 | 1984-05-08 | Endoscopy Surgical Systems, Inc. | Multi-purpose medical devices |
US4493711A (en) * | 1982-06-25 | 1985-01-15 | Thomas J. Fogarty | Tubular extrusion catheter |
DE3323365C2 (en) * | 1982-09-04 | 1994-10-20 | Gsf Forschungszentrum Umwelt | Method and device for illuminating cavities |
DE3370132D1 (en) * | 1982-12-13 | 1987-04-16 | Sumitomo Electric Industries | Endoscope |
SU1210800A1 (en) * | 1983-01-06 | 1986-02-15 | Egorov Dmitrij F | Elevator |
US4693243A (en) * | 1983-01-14 | 1987-09-15 | Buras Sharon Y | Conduit system for directly administering topical anaesthesia to blocked laryngeal-tracheal areas |
US4465072A (en) * | 1983-02-22 | 1984-08-14 | Taheri Syde A | Needle catheter |
JPS59172621A (en) * | 1983-03-22 | 1984-09-29 | Sumitomo Electric Ind Ltd | Fiberscope |
US4919152A (en) * | 1987-03-02 | 1990-04-24 | Ralph Ger | Method of closing the opening of a hernial sac |
US4944443A (en) * | 1988-04-22 | 1990-07-31 | Innovative Surgical Devices, Inc. | Surgical suturing instrument and method |
US4601710B1 (en) * | 1983-08-24 | 1998-05-05 | United States Surgical Corp | Trocar assembly |
US4826485A (en) * | 1984-07-11 | 1989-05-02 | Concept Polymer Technologies, Inc. | Device for guiding tubings |
US4574780A (en) * | 1984-11-13 | 1986-03-11 | Manders Ernest K | Tissue expander and method |
US4615704A (en) * | 1984-11-26 | 1986-10-07 | Dow Corning Corporation | Shape retention tissue expander and method of using |
DE3443337A1 (en) * | 1984-11-28 | 1986-05-28 | Richard Wolf Gmbh, 7134 Knittlingen | INSTRUMENT FOR THE EXAMINATION AND TREATMENT OF BODY CHANNELS |
US4666447A (en) * | 1985-01-30 | 1987-05-19 | Mentor Corporation | Skin expansion device and method of making the same |
US4763653A (en) * | 1985-02-19 | 1988-08-16 | Rockey Arthur G | Medical sleeve |
SU1367947A1 (en) * | 1985-03-21 | 1988-01-23 | Петрозаводский государственный университет им.О.В.Куусинена | Arrangement for restricting the operational field |
US4608965A (en) * | 1985-03-27 | 1986-09-02 | Anspach Jr William E | Endoscope retainer and tissue retracting device |
US4651717A (en) * | 1985-04-04 | 1987-03-24 | Dow Corning Corporation | Multiple envelope tissue expander device |
DE8516286U1 (en) * | 1985-06-04 | 1986-10-02 | F.M.N. Schuster GmbH & Co KG, 5030 Hürth | Device for feeding threads, yarns and the like to a winding device |
US4598699A (en) * | 1985-06-10 | 1986-07-08 | Garren Lloyd R | Endoscopic instrument for removing stomach insert |
US4601713A (en) * | 1985-06-11 | 1986-07-22 | Genus Catheter Technologies, Inc. | Variable diameter catheter |
US4622955A (en) * | 1985-09-05 | 1986-11-18 | Mehdi Fakhrai | Surgical retractor for dissection of internal mammary artery |
US4733665C2 (en) * | 1985-11-07 | 2002-01-29 | Expandable Grafts Partnership | Expandable intraluminal graft and method and apparatus for implanting an expandable intraluminal graft |
US4705040A (en) * | 1985-11-18 | 1987-11-10 | Medi-Tech, Incorporated | Percutaneous fixation of hollow organs |
US4863440A (en) * | 1985-12-23 | 1989-09-05 | Thomas J. Fogarty | Pressurized manual advancement dilatation catheter |
US4803029A (en) * | 1986-01-28 | 1989-02-07 | Pmt Corporation | Process for manufacturing an expandable member |
US4654030A (en) * | 1986-02-24 | 1987-03-31 | Endotherapeutics | Trocar |
US4719918A (en) * | 1986-05-08 | 1988-01-19 | Cox-Uphoff Corporation | Subperiosteal tissue expander |
EP0246086A3 (en) * | 1986-05-14 | 1988-08-10 | Aldo Sergio Kleiman | A procedure for carrying out a surgical operation and a retracting laparoscope for separating organs in surgery |
US4721507A (en) * | 1986-06-05 | 1988-01-26 | Thomas J. Fogarty | Shear force gauge and method and apparatus for limiting embolectomy shear force |
US4744363A (en) * | 1986-07-07 | 1988-05-17 | Hasson Harrith M | Intra-abdominal organ stabilizer, retractor and tissue manipulator |
US4775371A (en) * | 1986-09-02 | 1988-10-04 | Advanced Cardiovascular Systems, Inc. | Stiffened dilatation catheter and method of manufacture |
US5109875A (en) * | 1986-10-20 | 1992-05-05 | City Of Hope | Ring tissue expanders and their method of use |
US5007898A (en) * | 1988-06-02 | 1991-04-16 | Advanced Surgical Intervention, Inc. | Balloon dilatation catheter |
US4762130A (en) * | 1987-01-15 | 1988-08-09 | Thomas J. Fogarty | Catheter with corkscrew-like balloon |
US4976710A (en) * | 1987-01-28 | 1990-12-11 | Mackin Robert A | Working well balloon method |
US4765331A (en) * | 1987-02-10 | 1988-08-23 | Circon Corporation | Electrosurgical device with treatment arc of less than 360 degrees |
US4779611A (en) * | 1987-02-24 | 1988-10-25 | Grooters Ronald K | Disposable surgical scope guide |
US4878495A (en) * | 1987-05-15 | 1989-11-07 | Joseph Grayzel | Valvuloplasty device with satellite expansion means |
US4800901A (en) * | 1987-09-09 | 1989-01-31 | Lior Rosenberg | Balloon-type Tissue expansion device |
SU1577769A1 (en) * | 1988-05-26 | 1990-07-15 | Ростовский научно-исследовательский онкологический институт | Surgical instrument for tumor fixation |
US5514091A (en) | 1988-07-22 | 1996-05-07 | Yoon; Inbae | Expandable multifunctional manipulating instruments for various medical procedures |
US4877016A (en) * | 1988-07-29 | 1989-10-31 | Kantor Edward A | Video endoscopic microscope |
US4949718B1 (en) * | 1988-09-09 | 1998-11-10 | Gynelab Products | Intrauterine cauterizing apparatus |
US5159925A (en) * | 1988-09-09 | 1992-11-03 | Gynelab, Inc. | Cauterizing apparatus and method for laparoscopic cholecystostomy, gallbladder ablation and treatment of benign prostate hypertrophy |
US5183463A (en) * | 1989-02-03 | 1993-02-02 | Elie Debbas | Apparatus for locating a breast mass |
US4966583A (en) * | 1989-02-03 | 1990-10-30 | Elie Debbas | Apparatus for locating a breast mass |
US5176697A (en) * | 1989-04-06 | 1993-01-05 | Hasson Harrith M | Laparoscopic cannula |
US5002557A (en) * | 1989-04-06 | 1991-03-26 | Hasson Harrith M | Laparoscopic cannula |
US5083576A (en) * | 1989-04-19 | 1992-01-28 | Inamed Development Company | Elongation of linear and tubular tissue |
DE3921886A1 (en) * | 1989-07-04 | 1991-01-17 | Wolfgang Mohr | DEVICE FOR CUTTING STACKED, SHEET-SHAPED GOODS |
FR2649324B1 (en) * | 1989-07-06 | 1991-10-31 | Dow Corning Sa | FLEXIBLE ARTICLE FOR SURGICAL TREATMENT, ASSEMBLY COMPRISING SAME AND METHOD OF USING SAME |
US5100426A (en) * | 1989-07-26 | 1992-03-31 | Fts Engineering, Inc. | Catheter for performing an atherectomy procedure |
JPH0649034B2 (en) * | 1989-08-04 | 1994-06-29 | 株式会社日立メディコ | Image reconstruction method in magnetic resonance imaging apparatus |
DE69024219T2 (en) * | 1989-08-16 | 1996-11-07 | Raychem Corp | ARRANGEMENT FOR GRIPING OR CUTTING AN OBJECT |
US4984564A (en) * | 1989-09-27 | 1991-01-15 | Frank Yuen | Surgical retractor device |
US5122122A (en) * | 1989-11-22 | 1992-06-16 | Dexide, Incorporated | Locking trocar sleeve |
US5049132A (en) * | 1990-01-08 | 1991-09-17 | Cordis Corporation | Balloon catheter for delivering therapeutic agents |
US5197971A (en) * | 1990-03-02 | 1993-03-30 | Bonutti Peter M | Arthroscopic retractor and method of using the same |
US5331975A (en) * | 1990-03-02 | 1994-07-26 | Bonutti Peter M | Fluid operated retractors |
US5163949A (en) * | 1990-03-02 | 1992-11-17 | Bonutti Peter M | Fluid operated retractors |
FR2659860B1 (en) * | 1990-03-20 | 1992-06-12 | Mouret Philippe | INSTRUMENT FOR THE IMPLEMENTATION OF MEDICAL OR SURGICAL INTERVENTIONS BY LAPAROSCOPY OR CÓOELIOSCOPY. |
IL93842A (en) | 1990-03-22 | 1995-10-31 | Argomed Ltd | Apparatus for localized thermal treatment of mammals |
US5158548A (en) * | 1990-04-25 | 1992-10-27 | Advanced Cardiovascular Systems, Inc. | Method and system for stent delivery |
US5103804A (en) * | 1990-07-03 | 1992-04-14 | Boston Scientific Corporation | Expandable tip hemostatic probes and the like |
US5201752A (en) * | 1990-09-27 | 1993-04-13 | Pod, Inc. | Cholecystectomy dissector instrument |
US5188596A (en) * | 1990-09-27 | 1993-02-23 | Mentor Corporation | Transparent prostate dilation balloon and scope |
US5141515A (en) * | 1990-10-11 | 1992-08-25 | Eberbach Mark A | Apparatus and methods for repairing hernias |
US5116357A (en) * | 1990-10-11 | 1992-05-26 | Eberbach Mark A | Hernia plug and introducer apparatus |
FR2668695B1 (en) * | 1990-11-06 | 1995-09-29 | Ethnor | ENDOSCOPIC SURGICAL INSTRUMENT FOR MOVING TISSUES OR ORGANS. |
US5159921A (en) * | 1990-11-27 | 1992-11-03 | Hoover Rocklin L | Surgical retractor |
US5082005A (en) * | 1990-12-18 | 1992-01-21 | New England Deaconess Hospital | Surgical access device |
US5195505A (en) * | 1990-12-27 | 1993-03-23 | United States Surgical Corporation | Surgical retractor |
US5062847A (en) * | 1990-12-31 | 1991-11-05 | Barnes William E | Laparoscopic retractor |
US5197948A (en) * | 1991-01-03 | 1993-03-30 | Kamran Ghodsian | Intra-abdominal organ manipulator, irrigator and aspirator |
US5176128A (en) * | 1991-01-24 | 1993-01-05 | Andrese Craig A | Organ retractor |
US5379759A (en) | 1991-02-04 | 1995-01-10 | Sewell, Jr.; Frank K. | Retractor for endoscopic surgery |
US5165387A (en) * | 1991-02-04 | 1992-11-24 | Transidyne General Corporation | Endoscope with disposable light |
US5359995A (en) | 1991-02-04 | 1994-11-01 | Sewell Jr Frank | Method of using an inflatable laparoscopic retractor |
US5188630A (en) * | 1991-03-25 | 1993-02-23 | Christoudias George C | Christoudias endospongestick probe |
US5178133A (en) * | 1991-03-26 | 1993-01-12 | Pena Louis T | Laparoscopic retractor and sheath |
US5183468A (en) * | 1991-04-02 | 1993-02-02 | Mclees Donald J | Snap ring needle guard |
DE9104383U1 (en) * | 1991-04-10 | 1991-06-06 | Wisap Gesellschaft Fuer Wissenschaftlichen Apparatebau Mbh, 8029 Sauerlach, De | |
DE9106553U1 (en) * | 1991-04-10 | 1991-08-08 | Wisap Gesellschaft Fuer Wissenschaftlichen Apparatebau Mbh, 8029 Sauerlach, De | |
US5183464A (en) * | 1991-05-17 | 1993-02-02 | Interventional Thermodynamics, Inc. | Radially expandable dilator |
US5195959A (en) * | 1991-05-31 | 1993-03-23 | Paul C. Smith | Electrosurgical device with suction and irrigation |
US5183033A (en) * | 1991-07-15 | 1993-02-02 | Wilk Peter J | Surgical instrument assembly and apparatus and surgical method |
US5242240A (en) | 1991-10-17 | 1993-09-07 | Minnesota Scientific, Inc. | Clamping device for a surgical retractor |
US5308327A (en) | 1991-11-25 | 1994-05-03 | Advanced Surgical Inc. | Self-deployed inflatable retractor |
US5176692A (en) * | 1991-12-09 | 1993-01-05 | Wilk Peter J | Method and surgical instrument for repairing hernia |
FR2688695B1 (en) * | 1992-03-20 | 1994-06-17 | Bogdanoff Joseph | MEDICAL MATTRESS. |
-
1991
- 1991-09-19 US US07/762,318 patent/US5370134A/en not_active Expired - Lifetime
- 1991-11-19 US US07/794,590 patent/US5309896A/en not_active Expired - Lifetime
-
1992
- 1992-05-26 ES ES92913303T patent/ES2113430T3/en not_active Expired - Lifetime
- 1992-05-26 AT AT02079997T patent/ATE255363T1/en not_active IP Right Cessation
- 1992-05-26 EP EP02079997A patent/EP1287786B1/en not_active Expired - Lifetime
- 1992-05-26 ES ES97202078T patent/ES2194150T3/en not_active Expired - Lifetime
- 1992-05-26 DE DE69232998T patent/DE69232998T2/en not_active Expired - Lifetime
- 1992-05-26 AT AT92913303T patent/ATE162940T1/en not_active IP Right Cessation
- 1992-05-26 AT AT97202078T patent/ATE236576T1/en not_active IP Right Cessation
- 1992-05-26 JP JP5500498A patent/JP2761578B2/en not_active Expired - Lifetime
- 1992-05-26 ES ES02079997T patent/ES2210215T3/en not_active Expired - Lifetime
- 1992-05-26 DK DK92913303T patent/DK0586580T3/en active
- 1992-05-26 EP EP97202078A patent/EP0804901B1/en not_active Expired - Lifetime
- 1992-05-26 WO PCT/US1992/004392 patent/WO1992021291A2/en active IP Right Grant
- 1992-05-26 EP EP92913303A patent/EP0586580B1/en not_active Expired - Lifetime
- 1992-05-26 DE DE69233267T patent/DE69233267T2/en not_active Expired - Lifetime
- 1992-05-26 CA CA002109937A patent/CA2109937C/en not_active Expired - Lifetime
- 1992-05-26 AU AU21587/92A patent/AU666855B2/en not_active Expired
- 1992-05-26 DE DE69224382T patent/DE69224382T2/en not_active Expired - Lifetime
- 1992-05-28 WO PCT/US1992/004456 patent/WO1992021294A1/en active IP Right Grant
- 1992-05-28 EP EP92912086A patent/EP0586516B1/en not_active Expired - Lifetime
- 1992-05-28 AU AU19992/92A patent/AU1999292A/en not_active Abandoned
- 1992-05-28 AT AT92912086T patent/ATE142453T1/en active
- 1992-05-28 JP JP50054193A patent/JP3421032B2/en not_active Expired - Lifetime
- 1992-05-28 CA CA002109795A patent/CA2109795C/en not_active Expired - Lifetime
- 1992-05-28 ES ES92912086T patent/ES2093835T3/en not_active Expired - Lifetime
- 1992-05-28 DK DK92912086.3T patent/DK0586516T3/en active
- 1992-05-28 DE DE69213734T patent/DE69213734T2/en not_active Expired - Lifetime
- 1992-05-29 WO PCT/US1992/004205 patent/WO1992021298A1/en active Application Filing
- 1992-05-29 CA CA002110152A patent/CA2110152A1/en not_active Abandoned
- 1992-05-29 MX MX9202597A patent/MX9202597A/en unknown
- 1992-05-29 AU AU21574/92A patent/AU2157492A/en not_active Abandoned
-
1993
- 1993-05-18 US US08/062,707 patent/US5520609A/en not_active Expired - Lifetime
-
1994
- 1994-08-24 US US08/295,144 patent/US5743850A/en not_active Expired - Lifetime
-
1995
- 1995-05-26 US US08/452,066 patent/US5643178A/en not_active Expired - Lifetime
- 1995-05-26 US US08/452,152 patent/US5634883A/en not_active Expired - Lifetime
- 1995-06-05 US US08/461,183 patent/US5738629A/en not_active Expired - Lifetime
-
1996
- 1996-05-28 AU AU54573/96A patent/AU696547B2/en not_active Expired
- 1996-12-05 GR GR960403324T patent/GR3021920T3/en unknown
-
1997
- 1997-06-05 US US08/869,552 patent/US5823945A/en not_active Expired - Lifetime
-
1998
- 1998-04-29 GR GR980400954T patent/GR3026755T3/en unknown
Also Published As
Similar Documents
Publication | Publication Date | Title |
---|---|---|
CA2110152A1 (en) | Body structure manipulation and dissection system | |
US5431173A (en) | Method and apparatus for body structure manipulation and dissection | |
US5383889A (en) | Tethered everting balloon retractor for hollow bodies and method of using | |
JP3332387B2 (en) | Extraluminal balloon dissection | |
US5601581A (en) | Methods and devices for blood vessel harvesting | |
US5667479A (en) | Method for resection of an anatomic structure | |
US6860892B1 (en) | Specially shaped balloon device for use in surgery and method of use | |
US20170325798A1 (en) | Wound retractor specimen bag | |
US20090270789A1 (en) | Suction dome for atraumatically grasping or manipulating tissue | |
US5578031A (en) | Laparoscopic instrument assembly and associated method | |
US9877740B2 (en) | Morcellator shield with deployable bag | |
US20170325800A1 (en) | Wound retractor and specimen bag assembly | |
EP1440705B1 (en) | Balloon dissecting instruments | |
JP6420332B2 (en) | Inflatable pneumoperitoneum device | |
JP2011156365A (en) | Surgical retrieval apparatus | |
US6129736A (en) | Expansible apparatus with back-loaded cannula | |
JP2000060862A (en) | Pallial tube for insertion of thoracoscope with cuff | |
CA2261170C (en) | Balloon dissecting instruments | |
WO1999009905A1 (en) | Expansible apparatus with back-loaded cannula |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
FZDE | Discontinued |