US20100174149A1 - Endoscopic inflatable retraction device, method of using, and method of making - Google Patents
Endoscopic inflatable retraction device, method of using, and method of making Download PDFInfo
- Publication number
- US20100174149A1 US20100174149A1 US12/725,105 US72510510A US2010174149A1 US 20100174149 A1 US20100174149 A1 US 20100174149A1 US 72510510 A US72510510 A US 72510510A US 2010174149 A1 US2010174149 A1 US 2010174149A1
- Authority
- US
- United States
- Prior art keywords
- retraction device
- main
- envelope
- additional
- flexible sheath
- 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
Images
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
- A61B17/02—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
- 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
- A61B17/34—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
- 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
- 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
- A61B17/32—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
- A61B17/34—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
Definitions
- the word “organ” will be used to mean an organ or a tissue that is retracted by the retraction device.
- the word “treat” will be used to mean both treat and observe, and the word “treatment” will be used to mean both treatment and observation.
- the word “tissue” or the phrase “tissue to be treated” will both be used to mean the organ or the tissue that is treated through or inside the retraction device.
- the inflated additional chamber provides enough force to maintain an organ that has been retracted by the more powerful main inflatable chamber in its retracted position.
- the additional inflatable chamber is thus able to maintain the retraction effect of the retraction device after the retraction effect of the main inflatable chamber has been destroyed by piercing an aperture in the envelope of the main chamber to provide access to the tissue to be treated.
- a Type I or a Type II retraction device may be provided, according to a further aspect of the invention, with tabs attached to the interior surface of the envelope of the device.
- the tabs are gripped with a suitable gripping tool to adjust the position and orientation of the inflated retraction device relative to the tissue to be treated.
- the retraction device may be partially deflated to enable adjustments to be more easily made.
- FIG. 18 is a longitudinal cross sectional elevational view of the abdomen illustrating the use according to the invention of a retraction device according to the invention to retract the liver to gain access to the gastroesophageal junction prior to sectioning the vagus nerve or to treating gastroesophageal reflux.
- FIGS. 25A , 25 B, 25 C, and 25 D show a Type IA retraction device in the shape of a triangular prism particularly suitable for use in the upper abdomen.
- a low irritation Dacron® mesh is installed on the inside of the peritoneum, the retraction device with a piece of mesh covering one of its windows being inserted into the peritoneal cavity before the retraction device is inflated, as shown in FIG. 20B .
- the main envelope and the additional envelope of the retraction device are both made of a relatively inelastic and tough film of a plastic such as Mylar®, polyethylene, or polyurethane.
- the preferred material is a polyethylene and nylon composite.
- the thickness of the main envelope is typically from 0.5 to 5 mils (13 to 130 microns).
- the additional envelope is made from a film of the same thickness of the same plastic as the main envelope. However, in some applications it may be advantageous make the additional envelope from a film of a different thickness of the same plastic, or from a film of the same or a different thickness of a different plastic.
Abstract
A method of providing access to tissue for a surgical instrument through a body wall is provided. The method includes providing an expandable retractor having a flexible sheath, the retractor being in a collapsed state; introducing the retractor into the body and placing the retractor adjacent the tissue; expanding the retractor; deploying the flexible sheath by engaging the flexible sheath with a tool and driving the flexible sheath through the body wall with the tool; and inserting the surgical instrument from outside the body through the flexible sheath to provide access to the tissue by the surgical instrument.
Description
- This application is a Continuation of application Ser. No. 10/638,854, filed Aug. 11, 2003, which is a Continuation of application Ser. No. 09/179,008, filed 26 Oct. 1998 (U.S. Pat. No. 6,605,037), which is a Continuation of application Ser. No. 08/561,160, filed 21 Nov. 1995 (U.S. Pat. No. 5,865,728), which is a Continuation-in-Part of application Ser. No. 08/106,231, filed 13 Aug. 1993 (now abandoned), which is a Divisional of application Ser. No. 07/794,590, filed 19 Nov. 1991 (U.S. Pat. No. 5,309,896), which is a Continuation-in-Part of application Ser. No. 706,781, filed 29 May 1991 (now abandoned), of inventors Frederic H. Moll, Albert K. Chin, Diane E. Caramore, and Frank T. Watkins III.
- Laparoscopy dates back to the turn of the 20th Century. Early laparoscopic techniques were used primarily for diagnostic purposes to view the internal organs, without the necessity of conventional surgery. Since the 1930s, laparoscopy has been used for sterilization and, more recently, for the suturing of hernias. U.S. Pat. Nos. 4,919,152 and 4,944,443 are concerned with techniques for suturing hernias. Another very recent innovation is the use of laparoscopic surgery for removing the gallbladder.
- U.S. patent application Ser. No. 706,781, the application of which this application is a Continuation-in-Part, describes an apparatus and method wherein the abdominal wall is lifted away from the underlying abdominal organs by an inflatable device which is introduced laparoscopically and, once in place, inflated to engage and lift an extensive area of the abdominal wall.
- Even when such lifting techniques are used, it is still necessary to retract other organs to gain access to the organ or tissue to be treated or observed. In other procedures, to gain access to the organ or tissue to be treated or observed, it is necessary to separate the organ to be treated from tissue surrounding it. For example, to be able to observe the outer surface the heart, the outer surface of the heart has to be separated from the pericardium. To obtain the necessary retraction, current laparoscopic procedures use several small retractors inserted though a plurality of incisions. Because such retractors have a relatively small surface area, they tend to damage and/or cause trauma to the retracted organs or tissue. Moreover, the requirement for a plurality of incisions to heal may delay the patient's recovery.
- It is known to use a modified Foley catheter to retract organs and tissue with less damage. The modified Foley catheter comprises a small, substantially spherical balloon on the end of a catheter which is inserted through a small incision into the body. After insertion, the balloon is inflated. The modified Foley catheter is used in a similar manner to a conventional retractor, but the retracted organ or tissue is contacted by the relatively large surface area of the balloon. Such a retractor reduces damage to retracted organs or tissues, but is inconvenient to use because it has to be kept in place by means of an external clamping arrangement, and its relatively large balloon tends to obstruct access to the site to be treated.
- The present invention relates to an inflatable retraction device that mechanically retracts organs and tissues to provide access to treat or observe other organs or tissues. More specifically, the invention is concerned with a retraction device that retracts organs or tissues by means of an inflatable chamber. The retraction device is introduced laparoscopically in a collapsed state into the body and, once in place, inflated to engage an extensive area of the organ or tissue to be retracted, and to gently retract or displace the organ or tissue without damaging it. During laparoscopic treatment and observation procedures, a retraction device according to the invention retains its expanded condition, and hence its ability to provide retraction, while providing access for surgical instruments through itself to the organ or tissue being treated or observed, or allowing an organ or tissue to be brought inside itself for observation or treatment.
- In the following description, the word “organ” will be used to mean an organ or a tissue that is retracted by the retraction device. The word “treat” will be used to mean both treat and observe, and the word “treatment” will be used to mean both treatment and observation. The word “tissue” or the phrase “tissue to be treated” will both be used to mean the organ or the tissue that is treated through or inside the retraction device.
- To provide the large surface area required to retract organs gently, the inflatable retraction device according to the invention is relatively large. As a result, the retraction device is normally juxtaposed between the entry through which surgical instruments pass into the body and the tissue to be treated. An inflatable retraction device according to the invention avoids obstructing the access of surgical instruments to the tissue to be treated by providing one or more apertures in the envelope of the device. Such apertures allow instruments to pass into and out of the interior of the retraction device, or allow the tissue to be treated to enter the interior of the retraction device for treatment by instruments passed into the interior of the device. Treatment is thus carried out working through or inside the retraction device according to the invention.
- In those procedures in which the tissue to be treated enters the interior of retraction device through an aperture, the material of the retraction device surrounding the aperture may form a seal around the tissue, isolating it from the body outside the retraction device. Treatment of the tissue is carried out inside the retraction device.
- According to different aspects of the invention inflatable retraction devices according to the invention employ different ways to retain their ability to provide retraction while providing access for surgical instruments to the tissue to be treated or observed. An inflatable retraction device according to one aspect of the invention, such a retraction device being designated generally as a Type I retraction device, maintains its ability to provide retraction by means of an additional inflatable chamber, which forms a cage structure inside or outside the main inflatable chamber. The additional inflatable chamber is normally inflated after the main inflatable chamber of the retraction device has been inflated, and the retraction device has produced its desired retraction effect. Such an additional inflatable chamber is smaller and less powerful than the main inflatable chamber. Inflating the additional chamber alone would not always produce sufficient force to provide the desired retraction of the organ. However, the inflated additional chamber provides enough force to maintain an organ that has been retracted by the more powerful main inflatable chamber in its retracted position. The additional inflatable chamber is thus able to maintain the retraction effect of the retraction device after the retraction effect of the main inflatable chamber has been destroyed by piercing an aperture in the envelope of the main chamber to provide access to the tissue to be treated.
- The tube used to inflate the main chamber provides primary access for surgical instruments to the interior of the retraction device. If more instruments than can be accommodated by the inflation tube are needed, or if the inflation tube is not conveniently aligned with the tissue to be treated, instruments can additionally or alternatively be inserted through additional incisions. The instruments enter the retraction device through additional apertures in the envelope of the main chamber. The apertures are cut in the part of the envelope of the main chamber that does not form part of the additional inflatable chamber.
- In an alternative embodiment of a retraction device according to the invention, the ability of the retraction device to provide a retraction effect during the treatment or observation procedure is maintained by keeping the main chamber of the retraction device in an inflated state during the treatment procedure. Such a retraction device, designated generally as a Type II retraction device, does not require an additional inflation chamber to maintain its retraction effect. An elastomeric window is attached to the inside of the retraction device after the device has been inflated. The elastomeric window provides a gas-tight seal around instruments passed through it, and around a tissue brought into the interior of the retraction device through it.
- After the window has been installed, an instrument is passed through the window to pierce an aperture in the part of the envelope of the retraction device covered by the window to provide access to the organ to be treated. Surgical instruments are passed into the interior of the retraction device, primarily through the main inflation tube. The instruments can pass out of the retraction device to the tissue to be treated through the elastomeric window and the aperture in the envelope of the main chamber. Alternatively, the tissue to be treated enters the interior of the retraction device through the aperture and the elastomeric window. The elastomeric window provides a seal around the tissue to be treated enabling the retraction device to be maintained in its inflated state while treatment is carried out.
- A Type I or a Type II retraction device according to the invention may be provided, according to a further aspect of the invention, with tabs attached to the interior surface of the envelope of the device. The tabs are gripped with a suitable gripping tool to adjust the position and orientation of the inflated retraction device relative to the tissue to be treated. The retraction device may be partially deflated to enable adjustments to be more easily made.
- According to a further aspect of the invention, a Type I or a Type II retraction device may be provided, when in its collapsed state prior to inflation, with markings on its surface to aid proper orientation prior to inflation.
- According to a further aspect of the invention, a Type I or a Type II retraction device according to the invention may further be provided with a flexible sheath for providing a port to allow surgical instruments to pass from outside the body to the main chamber of the retraction device. The interior of the flexible sheath communicates with the main chamber of the retraction device. The flexible sheath is deployed after the retraction device has been inflated. According to one aspect of this invention, a flexible sheath attached to the envelope of the retraction device driven outward through the body wall. According to an alternative aspect of this invention, the flexible sheath is driven inward through the body wall to pierce, and to lock into engagement with, the envelope of the retraction device.
- According to a further aspect of the invention, in a retraction device according to the invention, the part of the envelope of the retraction device that is lower-most when the retraction device is deployed in the body is fitted with an integral tubular suction skirt. The suction skirt is connected to the operating room suction line and allows continuous or intermittent drainage of fluid that collects in the bottom of the cavity created by the retraction device during laparoscopic surgery.
- An inflatable retraction device according to the method of the invention is used according to the invention by forming a small opening in the wall of the body and laparoscopically inserting the retraction device into the body in a contracted state. After insertion and orientation, the retraction device is inflated. During the inflation process, the relatively large surface area of the retraction device gently retracts the organ obstructing access to the tissue to be treated.
- After the retraction device has been inflated, surgical instruments are passed from outside the body into the retraction device. One or more apertures are created by piercing, and possibly at least partially removing, the envelope of the retraction device adjacent to the tissue to be treated. The one or more apertures in the envelope of the retraction device provide access for the instruments to the tissue to be treated. Treatment is then carried out by working through the one or more apertures in the retraction device. The apertures may also provide access to the interior of the retraction device for surgical instruments passed from outside the body. Alternatively, the tissue to be treated can enter the main chamber of the retraction device through the one or more apertures and be treated inside the retraction device.
- After the treatment has been completed, the retraction device is deflated and evacuated prior to its removal from the body in a collapsed state.
- When a inflatable retraction device is used in the abdominal cavity, a inflatable retraction device according to the invention may be used alone to provide both retraction and lifting of the abdominal wall, or it may be used together with the abdominal lifting devices disclosed in the application Ser. No. 706,781, of which application this application is a Continuation-in-Part, or together with known insufflation techniques for lifting the abdomen.
- The invention is also concerned with methods of using inflatable retraction devices according to the invention in new procedures for suturing hernias without breaching the peritoneum, anterior resection of herniated intervertebral discs, resecting the lung, lung lobectomies, and for procedures for observing or treating the heart, the brain, the esophagus, and the prostate.
- The various procedures according to the invention involve placing an inflatable retraction device according to the invention inside a part of the body, such as the abdomen, the chest, or the skull via a small, limited incision or puncture site. The inflatable retraction device is placed adjacent to the organ to be displaced. Inflating the retraction device retracts the organ and exposes the tissue to be treated. Treatment of the tissue to be treated is then carried out using instruments passed into the interior of the retraction device. The tissue to be treated may remain outside the retraction device, or can enter the retraction device during treatment.
- In a procedure according to the invention to repair a hernia by placing a mesh over the site of the hernia, an inflatable retraction device is used to provide retraction and, additionally, to hold the mesh in place over the site of the hernia while the mesh is stapled in place.
- In a first method of construction according to the invention, a Type II polyhedral retraction device is made from suitably shaped pieces of flat plastic film connected together to form a polyhedral main envelope enclosing the main chamber. Such a construction can be used to approximate a spherical or spheroidal shape. A main inflation tube is attached to the main envelope such that the interior of the main inflation tube is in communication with the main chamber.
- In a first method for constructing a polyhedral Type I retraction device, a segmented additional envelope is formed from suitably shaped pieces of flat plastic film. The pieces are shaped to provide the required cage structure of the additional chamber. The additional chamber is formed by attaching the periphery of the additional envelope to the outside or the inside of the main envelope. The part of the surface of the main envelope that is not covered by the additional envelope provides a plurality of windows, which, after the additional chamber is inflated, may be at least partially removed to provide apertures through which treatment or observation can be carried out. An additional inflation tube is attached to the additional envelope such that the interior of the additional inflation tube is in communication with the additional chamber.
- In an alternative method of making an inflatable Type II retraction device according to the invention, two curved pieces of plastic film are attached to one another at their peripheries to form a main envelope enclosing a main chamber. A main inflation tube is attached to the main envelope such that the interior of the main inflation tube is in communication with the main chamber.
- In an alternative method for constructing a Type I retraction device, an additional envelope is formed from two more pieces of curved plastic film shaped to form the required cage structure of the additional chamber. The two pieces of the additional envelope are attached to one another either outside or inside the main envelope. The additional chamber is formed by attaching the periphery of the additional envelope to the outside or the inside of the main envelope. The part of the surface of the main envelope that is not covered by the additional envelop provides a plurality of windows which, after the additional chamber is inflated, may be at least partially removed to provide apertures through which treatment or observation can be carried out. An additional inflation tube is attached to the additional envelope such that the interior of the additional inflation tube is in communication with the additional chamber.
-
FIG. 1 is a perspective view of a polyhedral Type IA inflatable retraction device according to a first embodiment of the invention; -
FIG. 2 is vertical cross section, along the line 2-2 inFIG. 1 , of a polyhedral Type IA inflatable retraction device according to a first embodiment of the invention; -
FIG. 3 is horizontal cross section, along the line 3-3 inFIG. 1 , of a polyhedral Type IA inflatable retraction device according to a first embodiment of the invention; -
FIG. 4A is a longitudinal cross sectional elevational view of a body showing a packaged collapsed Type IA retraction device according to a first embodiment of the invention ready for insertion into the abdominal cavity; -
FIG. 4B is a longitudinal cross sectional elevational view of a body showing a packaged collapsed Type IA retraction device according to a first embodiment of the invention after it has been inserted into the abdominal cavity; -
FIG. 4C is a longitudinal cross sectional elevational view of a body showing a Type IA retraction device according to a first embodiment of the invention during the inflation of its main chamber in the abdominal cavity; -
FIG. 4D is a longitudinal cross sectional elevational view of a body showing a Type IA retraction device according to a first embodiment of the invention after the additional chamber has been inflated and the inflation pressure has been removed from the main chamber in the abdominal cavity; -
FIG. 5 is a longitudinal cross sectional elevational view of a body showing a Type IA retraction device according to a first embodiment of the invention used to retract the bowel and lift the liver to expose the gall bladder for observation by an endoscope inserted into the main chamber of the retraction device through the main inflation tube; -
FIG. 6 is a perspective view of a polyhedral Type II inflatable retraction device according to a second embodiment of the invention showing an elastomeric window attached to the inner surface of its main envelope; -
FIG. 7 is a perspective view of an elastomeric window suitable for attaching to the inner surface of the main envelope of a polyhedral Type II inflatable retraction device according to a second embodiment of the invention. The elastomeric window includes an electrical element for heating temperature sensitive adhesive applied to one of the surfaces of the elastomeric window. -
FIG. 8 is a perspective view of the elastomeric window ofFIG. 7 packaged prior to insertion into the retraction device. -
FIG. 9 is a perspective view of the outer surface of the main envelope of a polyhedral Type II inflatable retraction device according to a second embodiment of the invention. An elastomeric window has been attached to the inside of the main envelope and an aperture has been cut in the part of the main envelope covered by the elastomeric window. -
FIG. 10A is a longitudinal cross sectional elevational view of a body showing a packaged collapsed Type II retraction device according to a second embodiment of the invention ready for insertion into the abdominal cavity; -
FIG. 10B is a longitudinal cross sectional elevational view of a body showing a packaged collapsed Type II retraction device according to a second embodiment of the invention after it has been inserted into the abdominal cavity; -
FIG. 10C is a longitudinal cross sectional elevational view of a body showing a Type II retraction device according to a second embodiment of the invention during the inflation of its main chamber in the abdominal cavity; -
FIG. 10D is a longitudinal cross sectional elevational view of a body showing a Type II retraction device according to a second embodiment of the invention in its fully inflated condition in the abdominal cavity; -
FIG. 11A is a transverse cross sectional elevational view of the abdomen showing a Type IB retraction device according to a third embodiment of the invention during the inflation of its main chamber in the abdominal cavity; -
FIG. 11B is a transverse cross sectional elevational view of the abdomen showing a Type IB retraction device according to a third embodiment of the invention in its fully inflated condition in the abdominal cavity; -
FIG. 11C is a perspective view of a Type IS retraction device according to a third embodiment of the invention showing an alternative form of additional cavity having tacked sidewalls. -
FIG. 12A is a vertical cross sectional view of a polyhedral inflatable retraction device according to the invention fitted with a first embodiment of flexible sheath according to the invention installed in the abdominal cavity with the flexible sheath in its collapsed state. -
FIG. 12B is a vertical cross sectional view of a polyhedral inflatable retraction device according to the invention fitted with a first embodiment of flexible sheath according to the invention installed in the abdominal cavity showing the flexible sheath being driven through the abdominal wall. -
FIG. 12C is a vertical cross sectional view of a window of a polyhedral inflatable retraction device according to the invention showing a second embodiment of a flexible sheath according to the invention. -
FIG. 13A is a perspective view of a polyhedral Type IA inflatable retraction device fitted with a suction skirt according to the invention; -
FIG. 13B is vertical cross section, along the line 2-2 inFIG. 1 , of a polyhedral Type IA inflatable retraction device fitted with a suction skirt according to the invention; -
FIG. 14A is a longitudinal cross sectional elevational view of a body illustrating the use according to the invention of a retraction device according to the invention in the abdomen to retract the bowel to gain anterior access to the intravertebral discs, the aorta, or the kidneys for treatment or observation. -
FIG. 14B is a transverse cross sectional elevational view of a body illustrating the use according to the invention of a retraction device according to the invention in the abdomen to retract the bowel to gain anterior access to the intravertebral discs, the aorta, or the kidneys for treatment or observation. -
FIG. 15 is a transverse cross sectional plan view of the chest illustrating the use according to the invention of a retraction device according to the invention to retract the pericardium from the heart to gain access to the surface of the heart for treatment or observation. -
FIG. 16A is a transverse cross sectional elevational view of the chest illustrating the use according to the invention of a retraction device according to the invention to retract the lung away from the pleura to gain access to the surface of the lung for treatment or observation. -
FIG. 16B is a transverse cross sectional plan view of the chest illustrating the use according to the invention of a retraction device according to the invention to retract the lung away from the pleura, part of the lung entering the main chamber of the retraction device for treatment or observation. -
FIG. 17 is a longitudinal cross sectional elevational view of the chest illustrating the use according to the invention of a retraction device according to the invention to retract one lobe of the lung away from the rest of the lung to gain access to occlude part of the bronchial tree during a lobectomy. -
FIG. 18 is a longitudinal cross sectional elevational view of the abdomen illustrating the use according to the invention of a retraction device according to the invention to retract the liver to gain access to the gastroesophageal junction prior to sectioning the vagus nerve or to treating gastroesophageal reflux. -
FIG. 19 is a longitudinal cross sectional elevational view of the head illustrating the use according to the invention of a retraction device according to the invention to retract the brain away from the dura mater to gain access to the brain for treatment or observation. -
FIG. 20A is a transverse cross sectional elevational view of the lower abdomen illustrating the use according to the invention of a retraction device according to the invention between the abdominal wall and the peritoneum to retract the peritoneum to provide laparoscopic access to the site of a hernia without penetrating the peritoneum. A piece of mesh is shown being held in place over the site of the hernia by the retraction device. -
FIG. 20B is a transverse cross sectional elevational view of the lower abdomen showing a retraction device according to the invention in its fully inflated condition holding a piece of mesh in position on the inside of the peritoneum over the site of the hernia. -
FIG. 21 is a perspective view of a retraction device according to the invention with a piece of mesh attached to the outer surface of the main envelope. -
FIG. 22A is an exploded perspective view of the components of a polygonal Type IA retraction device illustrating the construction of such a device according to the invention. -
FIG. 22B is a plan view of the additional envelope blank of a polygonal Type IA retraction device. -
FIG. 23A is a perspective view of the additional envelope blank of a polygonal Type IA retraction device showing how a suction skirt according to the invention is formed from the additional envelope blank. -
FIG. 23B is a plan view of the additional envelope blank of a polygonal Type IA retraction device showing how a suction skirt according to the invention is formed from the additional envelope blank. -
FIG. 24A is an exploded perspective view of the components of a flat Type IA retraction device illustrating the construction of such a device according to the invention. -
FIG. 24B is a perspective view of the assembled and inflated flat Type IA retraction device. -
FIG. 25A is a perspective view of an inflated triangular prism-shaped Type IA retraction device according to the invention. -
FIG. 25B is a vertical cross sectional view of an inflated the assembled triangular prism-shaped Type IA retraction device according to the invention along theline 25B-25B inFIG. 25A . -
FIG. 25C is an exploded perspective view of the components of a triangular prism-shaped Type IA retraction device illustrating the construction of such a device according to the invention. -
FIG. 25D is a plan view of the additional envelope blank of a triangular prism-shaped Type IA retraction device according to the invention. -
FIG. 26 is an exploded perspective view of the components of a polygonal Type II retraction device illustrating the construction of such a device according to the invention. -
FIG. 27 is an exploded perspective view of the components of a substantially hemispherical Type IA retraction device illustrating the construction of such device according to the invention. -
FIG. 28 is a cross sectional view of a substantially hemispherical Type IA retraction device. -
FIGS. 1 , 2, and 3 show perspective, and vertical and horizontal cross sectional views, respectively, of afirst embodiment 1 of a retraction device according to the invention. This type of retraction device has an additional inflatable chamber and will be designated as a Type I retraction device. The Type I retraction device shown inFIGS. 1 , 2, and 3 with a segmented additional chamber will be designated a Type IA retraction device. The retraction device is shown in its inflated condition. Theretraction device 1 comprises amain envelope 6 enclosing a maininflatable chamber 11. Themain envelope 6 is made of a relatively inelastic and tough film of a plastic such as Mylar®, polyethylene, or polyurethane. The preferred material for themain envelope 6 is a polyethylene and nylon composite. The thickness of themain envelope 6 is typically from 0.5 to 5 mils (13 to 130 microns). The proximal end of amain inflation tube 16 is sealed into themain envelope 6. Themain inflation tube 16 allows an inflation gas to pass into and out of themain chamber 11. The inflation gas is typically air, nitrogen or carbon dioxide, although other suitable gases may be used. Typical inflation gas pressures are in the range 0.3 to 0.7 pounds per square inch (psi) (0.21 to 0.48 kPa), the preferred pressure being 0.5 psi (0.35 kPa). Themain inflation tube 16 is provided with aport 51 on its distal end, through which endoscopes and/or surgical instruments can be passed into themain chamber 11. Theport 51 allows the inflation pressure of themain chamber 11 to be maintained when surgical instruments are passed through the port. - The
main envelope 6 of the Type IA retraction device is a polyhedral structure constructed from two segmented, substantially flat pieces of plastic film, which gives the retraction device a substantially polyhedral shape. Alternatively, two non-segmented, substantially flat pieces of plastic film can be used to make a relatively flat Type IA retraction device. In a further alternative, the retraction device can be constructed from curved pieces of plastic film, which gives the retraction device a substantially spherical, spheroidal, or ellipsoidal shape. - The size of retraction devices according to the invention can range from about 2″ (50 mm) wide by about 0.5″ (12 mm) high, for use inside the pericardium, to 10″-14″ (250-350 mm) wide by 4″-8″ (100-200 mm) high, for use in the abdominal cavity. The size of retraction device required for a given application depends on the application and the size of the patient.
- In the preferred embodiment, the
additional envelope 21 is made from a film of the same thickness of the same plastic as themain envelope 6. However, in some applications it may be advantageous make theadditional envelope 21 from a film of a different thickness of the same plastic, or the same or a different thickness of a different plastic. - The
periphery 26 of theadditional envelope 21 is attached to the surface of themain envelope 6. Theadditional envelope 21 has a segmented shape such that, when itsperiphery 26 is attached to themain envelope 6, and theadditional chamber 31 formed between the outside of themain envelope 6 and the inside of theadditional envelope 21 is inflated, theadditional chamber 31 forms a cage structure inside or outside themain chamber 11, as shown in the figures. When themain envelope 6 is a polyhedral structure, the cage structure is preferably formed on the faces of the polyhedron. The parts of themain envelope 6 that do not form part of the wall of theadditional chamber 31 provide a plurality ofwindows 46 that can be punctured to provide access for surgical instruments into and out of themain chamber 11. - The
additional envelope 21 is attached, preferably to the outer surface of themain envelope 6, by welding along theperiphery 26 of the additional envelope; alternatively, an adhesive may be applied to theperiphery 26 of theadditional envelope 21, and theadditional envelope 21 brought into contact with themain envelope 6. Other methods that produce a flexible, gas-tight seal between theperiphery 26 of theadditional envelope 21 and themain envelope 6 may also be used. - One end of an
additional inflation tube 41 is sealed into theadditional envelope 21. Theadditional inflation tube 41 allows an inflation gas to pass into and out of theadditional chamber 31. The inflation gas is typically air, nitrogen or carbon dioxide, although other suitable gases may be used. Typical inflation gas pressures are in the range 4 to 6 psi (2.8 to 4.1 kPa), the preferred pressure being 5 psi (3.5 kPa). The inflation gas pressure in the additional chamber is considerably higher than that in the main chamber to enable the additional chamber to exert sufficient force to keep already retracted organs in their retracted state despite the much smaller surface area of the additional chamber. Themain inflation tube 16 is sealed through theadditional envelope 21. - In an embodiment of the Type I retraction device designed for use in an insufflated body cavity, the
main inflation tube 16 and theadditional inflation tube 41 are contained within aninflation tube shield 61, which forms a gas-tight seal with the retraction device. The outer wall of theinflation tube shield 61 forms a gas-tight seal with the trocar or sheath through which it passes into the body cavity. Theinflation tube shield 61 can be a separate component. Preferably, an extrusion can provide theinflation tube shield 61, themain inflation tube 16 and theadditional inflation tube 41 in a unitary structure. - The basic embodiment of a Type I retraction device has a single
additional chamber 31. In alternative embodiments,additional chamber 31 is divided into a plurality of sub-chambers (not shown). The sub-chambers are isolated from one another, so that if one or more of them is accidentally punctured while the retraction device is in use, deflation of all of the retraction device can be avoided. Each sub-chamber can be equipped with its own additional inflation tube. Alternatively, each sub-chamber can be connected to an inflation manifold (not shown) through a non-return valve (not shown). This arrangement requires that each sub-chamber be deliberately punctured to deflate the retraction device in preparation for withdrawing the retraction device from the body at the end of the treatment procedure. - In a further alternative embodiment of the Type IA retraction device, the
additional envelope 21 may be attached to the inner surface of themain envelope 6. In this embodiment, themain inflation tube 16 passes through the additional chamber and forms a gas-tight seal with theadditional envelope 21 in addition to themain envelope 6. - In a further alternative embodiment of the Type IA retraction device, the
additional envelope 21 need not be segmented. Theadditional chamber 31 is formed by attaching theadditional envelope 21 to themain envelope 6, the line of attachment forming the periphery of the cage structure of theadditional chamber 31. With this arrangement, eachwindow 46 comprises a double thickness of film. This makes it somewhat more difficult to cut an aperture in a window. - In a further alternative embodiment providing a relatively flat Type IA retraction device shown in
FIG. 248 , neither themain envelope 6 nor theadditional envelope 21 are segmented. Theadditional envelope 21 has a number of holes cut in it. Theadditional chamber 31 is formed by attaching the periphery of each hole in theadditional envelope 21 to themain envelope 6. - In a further alternative embodiment,
FIGS. 25A , 25B, 25C, and 25D show a Type IA retraction device in the shape of a triangular prism particularly suitable for use in the upper abdomen. - In this embodiment, the
main envelope 6 and theadditional envelope 21 are serrated rectangles, as shown inFIGS. 25C and 25D . The additional envelope has three large holes cut in it. Theadditional chamber 31 is formed by attaching the periphery of each hole in theadditional envelope 21 to themain envelope 6. Opposite ends of the long axis of the rectangle and the serrations are joined together to form the triangular structure. - All embodiments of the Type IA retraction device may be provided with
tabs 56 on the inside the main envelope in accordance with a further aspect of the invention, as shown inFIGS. 2 and 3 . Thetabs 56 may be separate components attached to the inside of themain envelope 6 by welding, an adhesive, or some other suitable method. Alternatively, thetabs 56 can be an integral part of themain envelope 6 suitably extended into themain chamber 11.Tabs 56 provide points inside themain chamber 11 that can be gripped by a suitable gripping tool (not shown) inserted intomain chamber 11 through themain inflation tube 16. The gripping tool allows the inflated retraction device to be manipulated to change its position so that, for instance, one of its windows can be aligned with the organ or tissue to be treated or observed. Partially deflating the inflated retraction device makes repositioning easier. - In the following description, the word “organ” will be used to mean an organ or a tissue that is retracted by the retraction device. The word “treat” will be used to mean both treat and observe, and the word “treatment” will be used to mean both treatment and observation. The word “tissue” or the phrase “tissue to be treated” will both be used to mean the organ or the tissue that is treated through or inside the retraction device.
-
FIGS. 4A through 4D show a cross sectional elevational view of the abdomen A to illustrate the method by which a Type IA retraction device according to the invention is inserted into the body and used to retract an organ within the body to gain access to treat a tissue. In the method illustrated inFIGS. 354A through 4D , the retraction device is inserted into the abdomen A and is used to retract an organ, the bowel B, to gain access to treat a tissue, the gall bladder GB. Similar methods are used to insert a retraction device according to the invention into other parts of the body. -
Inflatable retraction device 1 is supplied in a collapsed state, as shown inFIG. 4A , in which it is tightly packaged in a configuration that makes it essentially a linear extension of theinflation tube shield 61. Theretraction device 1 is packed so that when pressure is applied to themain inflation tube 16, theretraction device 1 deploys without tangling. Depending on the size of theretraction device 1, the packaged retraction device will fit through an insertion tube (usually a trocar tube) of between 3 and 20 mm (0.12″-0.8″) in diameter, a typical diameter being 14 mm (0.55″). Theretraction device 1 is retained in its collapsed state by thesleeve 100 which, in turn, is held together by one-pull lacing 105. Alternatively, thesleeve 100 can be fitted with a tear-off strip (not shown). Pulling on thethread 125 detaches the one-pull lacing 105 or the tear-off strip from thesleeve 100, releasing thecollapsed retraction device 1. - The
sleeve 100 can be provided withsuitable markings 115 to enable its orientation to be determined and, if necessary, adjusted, after insertion into the body and before inflation. - Prior to starting the procedure, the abdomen A may be lifted to provide additional working space by gas insufflation, or by one of the mechanical devices disclosed in U.S. patent application Ser. No. 706,781, of which application this application is a Continuation-in-Part. The insufflated condition of the abdomen A is indicated by the broken line A′.
- A small incision is made in the skin of the abdomen A and a trocar (not shown) and
trocar tube 120 are inserted into the incision and are driven through the wall of the abdomen A. The trocar is withdrawn. A second small incision is made in the skin of the abdomen A and a trocar (not shown) andtrocar tube 122 are inserted into the incision and driven through the wall of the abdomen. The trocar is withdrawn and anendoscope 110 is inserted into thetrocar tube 122. The second incision is located so that theendoscope 110 can observe the intended placement site of theretraction device 1. Alternatively, a small endoscope (not shown), preferably about 2 mm (0.1″) in diameter, may be attached to the collapsed retraction device so that the location of the retraction device inside the abdomen may be determined. With this approach, theendoscope 110 is not used, and the second incision need not be made. - The
collapsed retraction device 1 is threaded, with the aid of itsinflation tube shield 61, through thetrocar tube 120 into the abdominal cavity AC, as shown inFIG. 4B , and manipulated into its correct position. The position ofcollapsed retraction device 1 in the abdominal cavity AC is observed through the endoscope 110: themarkings 115 enable the orientation ofretraction device 1 to be determined and adjusted if necessary. Alternatively, the position of the collapsed retraction device is determined by means of the small endoscope (not shown) attached to the retraction device. - The
thread 125 is then pulled to release thesleeve 100 from around collapsedretraction device 1, and the sleeve 101 is withdrawn from the abdominal cavity AC through thetrocar tube 120 by means of thethread 125. - Once the
retraction device 1 is correctly positioned, and released from itssleeve 100, themain inflation tube 16 is connected to a source of inflation gas (not shown) and the gas supply is slowly turned on to inflate themain chamber 11. Theretraction device 1 slowly expands, as shown inFIG. 4C , progressively displacing the bowel B as its size increases. Throughout the expansion process, theretraction device 1 presents a relatively large surface area to the bowel B, and thus displaces the bowel B gently, progressively, and without trauma. Although theretraction device 1 retracts the bowel B gently, the main chamber of the retraction device is capable of exerting the force necessary to effect the displacement the bowel B. - Once the
retraction device 1 has reached its fully-inflated condition, its position is checked by viewing it through theendoscope 110 and/or an endoscope (not shown) inserted into itsmain chamber 11 via themain inflation tube 16 and theport 51. The tissue to be treated must be covered by one of thewindows 46 ofretraction device 1. - If the
retraction device 1 is not correctly positioned, the inflation gas pressure is reduced slightly to partially deflateretraction device 1. A suitable gripping tool is passed through theport 51 and themain inflation tube 16 into the interior of theretraction device 1, to grip one of the tabs 56 (FIGS. 2 and 3 ). The gripping tool is manipulated to correct the positioning error while the position of theretraction device 1 is observed through theendoscope 110 or the endoscope (not shown) in themain chamber 11. Once the error is corrected, themain chamber 11 of theretraction device 1 is reinflated by means of themain inflation tube 16. - Once the
retraction device 1 is correctly positioned, theadditional inflation tube 41 is connected to a source of inflation gas (not shown) and theadditional chamber 31 is inflated to the required pressure, as shown inFIG. 4D . After theadditional chamber 31 is fully inflated, the source of inflation pressure can be removed from themain chamber 11 and themain inflation tube 16. Theport 51 can be removed from themain inflation tube 16 since a gas-tight seal is no longer required around instruments inserted into themain inflation tube 16, themain chamber 11 now being at atmospheric pressure. - A cutting
instrument 52 is then passed through themain inflation tube 16 into themain chamber 11 to cut asuitable aperture 54 in thewindow 46 that covers of the tissue to be treated, as shown inFIG. 5 . Alternatively, an additional puncture may be made in the abdominal wall and a cuttinginstrument 62 passed through this puncture to cut anaperture 54A in awindow 58 to gain access to themain cavity 11, and thence to cut asuitable aperture 54 in thewindow 46. Theaperture 54 provides an access to the tissue to be treated; for example, the gall bladder GB. Theaperture 54 may simply be a cut in thewindow 46, or all or part of thewindow 46 may be removed to provide theaperture 54. Those procedures that are carried out using instruments passed through theaperture 54 in thewindow 46 require that more of thewindow 46 be removed than those procedures in which the tissue to be treated is pulled inside the retraction device. When the tissue to be treated is treated inside the retraction device, the periphery of theaperture 54 through which the tissue is pulled may form a seal around the tissue and isolate it from the body outside the retraction device. - If the main inflation tube is not conveniently placed relative to the tissue to be treated, or if more surgical instruments than can be accommodated by the
main inflation tube 16 are needed to perform the treatment, an alternative way of passing instruments into themain chamber 11 is to make at least one further incision in the body wall, the further incision being made in a location adjacent afurther window 58 of the retraction device, as shown inFIG. 5 . A trocar (not shown) with tube 60 is inserted into the further incision and is driven through the body wall to pierce thefurther window 58. The trocar is withdrawn leaving the trocar tube 60 in place. Instruments, e.g.,instrument 62 are then inserted into the retraction device as required through the trocar tube 60 and thefurther window 58. -
FIG. 5 additionally shows theretraction device 1 in place in the abdominal cavity AC in its fully inflated form. Themain chamber 11 is not pressurized; the shape of the retraction device is maintained by the inflatedadditional chamber 31. InFIG. 5 ,retraction device 1 was placed before inflation such that when themain chamber 11 was inflated, the expansion of theretraction device 1 displaced the bowel B to the right of the drawing and lifted the liver L upwards to expose the tissue to be treated, i.e., the gall bladder GB. - After the treatment is completed, the
additional chamber 31 is disconnected from the source of inflation pressure and the pressure in theadditional chamber 31 is released to collapse the retraction device. Collapsing the retraction device is assisted by connecting theadditional inflation tube 41 to a vacuum line (not shown) to evacuate theadditional chamber 31. Once theretraction device 1 is fully collapsed, thetrocar tube 120 is withdrawn from the abdominal cavity, theretraction device 1 is withdrawn through the small abdominal opening, and the openings in the abdominal wall are closed in the normal way. -
FIG. 6 shows analternative embodiment 201 of a retraction device that maintains its shape while allowing treatment to be carried out working through or inside it. The alternative embodiment lacks the second inflatable chamber of the Type I embodiment shown inFIGS. 1 through 5 , and has only amain envelope 206 enclosing amain chamber 211. The single chamber embodiment of the retraction device will be designated as a Type II retraction device. Themain chamber 211 remains inflated throughout the treatment process, access to the tissue to be treated being provided by anelastomeric window 261 attached to themain envelope 206. Theelastomeric window 261 is self-sealing and maintains inflation pressure in themain chamber 211 by forming a substantially gas-tight seal around instruments passed through it. Theelastomeric window 261 also forms a substantially gas-tight seal around the tissue to be treated if the tissue to be treated is pulled through theelastomeric window 261 into themain chamber 211 for treatment. - The
main envelope 206 is made of a relatively inelastic and tough film of a plastic such as Mylar®, polyethylene, or polyurethane. The preferred material for the main envelope is a polyethylene and nylon composite. The thickness of themain envelope 206 is typically from 0.5 to 5 mils (13 to 130 microns). The proximal end of amain inflation tub 216 is sealed into themain envelope 206. Themain inflation tube 216 allows an inflation gas to pass into and out of themain chamber 211. The inflation gas is typically air, nitrogen or carbon dioxide, although other suitable gases may be used. Typical inflation gas pressures are in the range 0.3 to 0.7 psi (0.21 to 0.48 Pa), the preferred pressure being 0.5 psi (0.35 kPa). Once themain chamber 211 is fully inflated, the inflation gas pressure can be reduced to about 0.3 psi (0.21 kPa). Themain inflation tube 216 is provided with aport 251 on its distal end, through which endoscopes and other surgical instruments can be passed into themain chamber 211. Theport 251 provides a gas-tight seal around instruments passed through it and allows inflation pressure to be maintained in themain chamber 211 with instruments present. - The
main envelope 206 of the Type II retraction device shown inFIG. 6 is a polyhedral structure constructed from two segmented, substantially flat pieces of plastic film, which gives the retraction device a substantially polyhedral shape. Alternatively, two non-segmented substantially flat pieces of plastic film can be used to make a relatively flat Type II retraction device. In a further alternative, the retraction device can be constructed from curved pieces of plastic film, which gives the retraction device a substantially spherical or spheroidal shape. - The size of Type II retraction devices according to the invention can range from about 2″ (50 mm) wide by about 0.5″ (12 mm) high, for instance for use inside the pericardium, to 10″-14″ (250-350 mm) wide by 4″-8″ (100-200 mm) high, for use in the abdominal cavity. The size of retraction device required for a given application depends on the application and the size of the patient.
- The lack of a additional chamber in the
retraction device 201 shown inFIG. 6 makes orientation less critical. If themain envelope 206 is constructed from one or two curved pieces of film, orientation is particularly uncritical. If themain envelope 206 is a polyhedral structure having a number of faces, some orientation is required because the tissue to be treated must be substantially centered on one of the faces. Theretraction device 201 can be provided withtabs 256 on the inside themain envelope 206.Tabs 256 may be separate components attached to the inside of themain envelope 206 by welding, an adhesive, or some other suitable method. Alternatively,tabs 256 can be an integral part of themain envelope 206 suitably extended into themain chamber 211.Tabs 256 provide points on the inside of themain chamber 211 that can be gripped by a suitable gripping tool (not shown) inserted intomain chamber 211 through theinflation tube 216 andport 251. The gripping tool allows theinflated retraction device 201 to be manipulated to change its position so that the desired point on the tissue to be treated can be substantially centered on one of its faces. Partially deflating the inflated retraction device makes repositioning easier. - The
elastomeric window 261 is installed on the inside of themain envelope 206 aft theretraction device 201 has been placed in the body and inflated. Theelastomeric window 261 is shown inFIG. 7 and comprises aflat piece 266 of a film of an elastomeric material such as latex or silicone rubber about 0.5″ to 1.5″ (12 to 37 mm) in diameter. The periphery of theelastomeric film 266 is attached by means of a suitable adhesive, such as an acrylic cement or a silicone adhesive to one of the flat faces of aring 271 having a square or rectangular cross section. Thering 271 is circular or elliptical in shape and is of a springy material such as polyethylene or stainless steel, so that will regain its circular or elliptical shape after being compressed across one of its diameters to enable it to be passed through theinflation tube 216. The otherflat face 276 of thering 271 is coated with an adhesive. A pressure-sensitive adhesive such as a contact rubber adhesive may be used. In the preferred embodiment a hot-melt adhesive of the type used in woodworking glue guns is used. If a hot-melt adhesive is used, aheating element 281, made of a suitable resistance wire, such as Nichrome, is inserted into a narrow groove in theface 276 of thering 271 to which the adhesive is applied. Suitableelectrical leads 291 are connected to theheating element 281. - Before it can be inserted into the
retraction device 201, the elastomeric window must be wrapped across one of its diameters to reduce its width so that it can pass through themain inflation tube 216, as shown inFIG. 8 . A one-pull lacing arrangement 205, or a sleeve with a tear strip (not shown) can be used. Wrappedelastomeric window 261 is attached to amanipulation rod 286 for insertion into the retraction device. Also attached to the manipulation rod is the thread 225 to release the one-pull lacing 205 or the tear strip (not shown) and, if a temperature-sensitive adhesive is used, theelectrical leads 291 for the heating element 281 (FIG. 7 ). - The wrapped
elastomeric window 261 on the end of the manipulatingrod 286 is passed through theport 251 and themain inflation tube 216 into themain chamber 211. The lacing 205 or tear-strip is released, which allows theelastomeric window 261 to resume its circular shape. Theelastomeric window 261 is then manipulated to bring it into contact with themain envelope 206 such that theelastomeric window 261 covers the tissue to be treated. If a pressure-sensitive adhesive is used, theface 276 of the elastomeric window is pushed against themain envelope 206 to affix theelastomeric window 261 in place. If a hot-melt adhesive is used, theface 276 of the elastomeric window is placed against themain envelope 206 and a suitable source of electric current (not shown) is applied to theelectrical leads 291 for the time required to melt the adhesive and affix theelastomeric window 261 to themain envelope 206. - Once the
elastomeric window 261 is firmly affixed to themain envelope 206, the manipulatingrod 286 is detached from it and withdrawn from themain chamber 211. Asuitable cutting instrument 252 is passed through theport 251 and themain inflation tube 216 into themain chamber 211 and through theelastomeric window 261, as shown inFIG. 6 . Theelastomeric window 261 forms a gas-tight seal around the cuttinginstrument 252, and re-seals itself after thecutting instrument 252 is withdrawn. The cuttinginstrument 252 is used to cut an aperture in thepart 296 of themain envelope 206 that is covered by theelastomeric window 261. Thepart 296 of themain envelope 206 is shown by shading inFIG. 9 . Theaperture 254 may simply be a cut in thepart 296 of theenvelope 206, or all or part of thepart 296 of theenvelope 206 may be removed to provide theaperture 254. Procedures that are carried out using instruments passed through theelastomeric window 261 require removing more of thepart 296 of theenvelope 206 than procedures in which the tissue to be treated enters the retraction device through theaperture 254 and theelastomeric window 261. When the tissue to be treated is treated inside theretraction device 201, theelastomeric window 261 forms a seal around the tissue and isolates it from the body outside the retraction device. The treatment procedure is then carried out by inserting instruments through theport 251 and themain inflation tube 216 into themain chamber 211 and either working through theelastomeric window 261 or working on the tissue to be treated inside thecavity 211. - The
retraction device 201 is inserted into the abdomen using a procedure similar to that used to insert a Type IA retraction device.Inflatable retraction device 201 is supplied in a collapsed state, as shown inFIG. 10A , in which it is tightly packaged in a configuration that makes it essentially a linear extension of themain inflation tube 216. Theretraction device 201 is packed so that when inflation pressure is applied to themain inflation tube 216,retraction device 201 deploys without tangling. Depending on the size of theretraction device 201, the packaged retraction device will fit through an insertion tube of between 3 and 20 mm (0.12″-0.8″) in diameter, a typical diameter being 14 mm (0.55″). Theretraction device 201 is retained in its collapsed state by asleeve 100 which, in turn, is held together by one-pull lacing 105 or a tear strip (not shown). - The
sleeve 100 can be provided withsuitable markings 115 to enable its orientation to be determined and, if necessary, adjusted, after insertion into the abdomen and before inflation. - Prior to inserting the retraction device, the abdomen A may be lifted to provide additional working space by gas insufflation, or by one of the mechanical devices disclosed in U.S. patent application Ser. No. 706,781, of which application this application is a Continuation-in-Part. The insufflated state of the abdomen A is indicated by the broken line A′.
- A small incision is made in the skin of the abdomen A and a trocar (not shown) and
trocar tube 120 are inserted into the incision and are driven through the wall of the abdomen A. The trocar is withdrawn. A second small incision is made in the skin of the abdomen A and a trocar (not shown) andtrocar tube 122 are inserted into the incision and driven through the wall of the abdomen. The trocar is withdrawn and anendoscope 110 is inserted into thetrocar tube 122. The second incision is located so that theendoscope 110 can observe the intended placement site of theretraction device 1. Alternatively, a small endoscope (not shown), preferably about 2 mm (0.1″) in diameter, may be attached to the collapsed retraction device so that the location of the retraction device inside the abdomen may be determined. With this approach, theendoscope 110 is not used, and the second incision need not be made. - The
collapsed retraction device 201 is threaded, with the aid of itsmain inflation tube 216, through thetrocar tube 120 into the abdomen A, and manipulated into its correct position. The position ofcollapsed retraction device 201 is observed through the endoscope 110: themarkings 115 enable the orientation of the retraction device to be determined and adjusted if necessary. Alternatively, the position of the collapsed retraction device is determined by means of the small endoscope (not shown) attached to the retraction device. - The
thread 125 is then pulled to release thesleeve 100 from around thecollapsed retraction device 201, as shown inFIG. 10B , and thesleeve 100 is withdrawn from the abdominal cavity AC through thetrocar tube 120 by means of thethread 125. Themain inflation tube 216 is connected to a source of inflation gas (not shown). The inflation gas pressure is slowly increased to inflate themain chamber 211. Theretraction device 201 slowly expands, progressively displacing the bowel B as its size increases, as shown inFIG. 10C . Throughout the expansion process, theretraction device 201 presents a relatively large surface area to the bowel B, and thus displaces the bowel gently, progressively, and without trauma. Although theretraction device 201 retracts the bowel B gently, the main chamber of theretraction device 201 is capable of exerting the force necessary to effect the displacement of the bowel. - Once
retraction device 201 has reached its fully-inflated condition, its position is checked by viewing it through either theendoscope 110 and/or an endoscope (not shown) inserted into themain chamber 211 of theretraction device 201 via theport 251 and themain inflation tube 216. The tissue to be treated should be in contact with themain envelope 206 and lie substantially directly in line with themain inflation tube 216. Further, if the retraction device is a polyhedron, the tissue to be treated should be substantially centered in one of its faces. The position of theretraction device 201 can be adjusted by gripping one or more of thetabs 256 with a suitable gripping tool (not shown), as described above. Once theretraction device 201 is correctly positioned, theelastomeric window 261 may be installed as described above.FIG. 10D shows theretraction device 201 in its fully inflated state with theelastomeric window 261 installed, and theinstrument 252 passed through theelastomeric window 261 and theaperture 254 in themain envelope 206 to treat the tissue to be treated, the gall bladder, GB. - After the treatment is completed, the
main chamber 211 is disconnected from the source of inflation pressure and the pressure in themain chamber 211 is released to collapse the retraction device. Collapsing the retraction device is assisted by connecting themain inflation tube 216 to a vacuum line (not shown) to evacuate themain chamber 211. Once fully collapsed, theretraction device 201 is withdrawn from the abdominal cavity through the opening in the abdominal wall that remains after withdrawing thetrocar tube 120. Theelastomeric window 261 is sufficiently flexible to be withdrawn through the opening in the abdominal wall along with theretraction device 201. The openings in the abdominal wall are then closed in the normal way. - A further embodiment of the invention, which is a variation on the Type I retraction device, designated Type IB, is shown in
FIGS. 11A , 11B, and 11C. This variation has the advantage of providing two large, flat windows, but has the disadvantage that it does not allow any access to tissues lying to the side of the retraction device. Theretraction device 301 shown inFIGS. 11A and 11B is substantially cylindrical in shape. A stack of one or more toroidal chambers forms the additional chamber 331. The example shown inFIGS. 11A and 11B has 3toroidal chambers FIG. 11C , a singlechamber having sidewalls 333 that are tacked together can be used for the additional chamber 331. In this alternative embodiment, the tacked sidewalls form an enclosure having a height that is considerably greater than its width. InFIGS. 11A , 11B, and 11C, thediaphragms retraction device 301. Thediaphragms toroidal chambers main chamber 311. - The
main inflation tube 316 is sealed into themain chamber 311 and allows the main chamber to be inflated. Theadditional inflation tube 341 is sealed into the additional chamber 331. If more than one toroidal chamber is used to provide the additional chamber, the toroidal chambers may be interconnected and a singleadditional inflation tube 341 used, or each toroidal chamber may be provided with its own additional inflation tube (not shown). The latter approach prevents theretraction device 301 from collapsing completely if one of thetoroidal chambers toroidal chambers - The Type IB retraction device shown in
FIGS. 12 and 13 is constructed from similar materials to the Type IA retraction device, and may be fitted withtabs 356, similar totabs 56 in the Type IA retraction device, to enable it to be properly positioned after inflation. A similar procedure is used to deploy the Type IB retraction device in the body as is used to deploy the Type IA retraction device, and will not be described in detail. A similar inflation procedure is used, except that the additional chamber may be inflated at least partially at the same time as the first cavity is inflated. The Type IB retraction device depends more for its shape on the additional chamber than the Type IA retraction device. Hence, at least partial inflation of the additional chamber is necessary to enable the retraction device to displace organs to the side of the retraction device. Inflation pressures similar to those used for the Type IA retraction device are used. - Treatment procedures using the Type IB retraction device are similar to those using the Type IA retraction device, except that the Type IB retraction device does not provide access to tissues to the side of the device. The
diaphragms FIG. 1 ) of the Type IA retraction device. Either or both of the windows provided by thediaphragms main chamber 311. - A further aspect of the invention is the provision in a retraction device according to the invention, of one or more flexible sheaths to interconnect the main chamber of the retraction device and the outside of the body into which the retraction device is inserted. The flexible sheath provides a tract through the body wall that allows additional surgical instruments or endoscopes to be introduced into the main chamber of the retraction device, and/or allows tissue and the like to be removed. In one embodiment of this aspect of the invention, the flexible sheath is attached to a window of a Type I retraction device or to the main envelope of a Type II retraction device.
FIG. 12A shows a flexible sheath according to the invention attached to awindow 46 of a TypeIA retraction device 1, which is shown as an example. A flexible sheath according to this aspect of the invention can also be used with Type IB and Type II retraction devices. Theflexible sheath 3 is substantially cylindrical in shape with a closeddistal end 8. Theproximal end 13 of the flexible sheath is attached to the outer surface of thewindow 46. The sidewall 18 of theflexible sheath 3 is folded concertina-style when the retraction device is packaged, and remains folded after the retraction device has been inflated. After theretraction device 1 has been deployed in the body, as shown inFIG. 12B , a suitablepointed tool 23 is fed into themain chamber 11 to pierce ahole 28 in the part of thewindow 46 that is covered by theflexible sheath 3. Thepointed tool 23 is pushed through thehole 28 to engage with thedistal end 8 of theflexible sheath 3. Thedistal end 8 is first pressed against the inner surface of the body wall W using the pointedtool 23. The resulting bulge in the skin S on the outside of the body indicates where theflexible sheath 3 will emerge. Asmall incision 33 is made in the skin S at that point. Theflexible sheath 3 is then driven by the pointedtool 23 through the body wall W to emerge through theincision 33. - With a Type I retraction device, the
distal end 8 of theflexible sheath 3 is then opened to provide access to themain chamber 11. The flexible sheath does not have to be gas-tight in the manner of conventional trocar sheaths, and permits ordinary surgical instruments to be used. - With a Type II retraction device, the flexible sheath is fitted with a gas-tight port similar to the port 251 (
FIG. 6 ) before thedistal end 8 is opened. - The alternative embodiment of a
flexible sheath 43 according to the invention, shown inFIG. 12C , is not initially attached to the retraction device. A TypeIA retraction device 1 is shown inFIG. 12C as an example. A flexible sheath according to this aspect of the invention can also be used with Type IB and Type II retraction devices. Theflexible sheath 43 comprises a cylindrical piece of flexible plastic 48 with acoaxial locking device 53 on its proximal end. The distal end of the flexible sheath for a Type II retraction device must be closed by a port (not shown) similar to the port 251 (FIG. 6 ) so that pressurization of the main cavity can be maintained after theflexible sheath 43 has been installed. - The
flexible sheath 43 is installed after theretraction device 1 has been deployed in the body. Asmall incision 58 is made in the skin S of the body. Theflexible sheath 43 is then driven through the body wall W by a sharp trocar point (not shown). The trocar point pierces ahole 63 in thewindow 46 of theretraction device 1, and pushes thelocking device 53 of theflexible sheath 43 through thehole 63 to engage thelocking device 53 with thewindow 46. When used with a Type II retraction device, the lockingdevice 53 forms a gas-tight seal with thewindow 46. - According to a further aspect of the invention, a retraction device according to the invention may be fitted with a tubular suction skirt on the part of the retraction device that is lower-most when the retraction device is deployed in the body.
FIGS. 13A and 13B show, as an example, a polygonal Type 1A retraction device of the type used in the abdominal cavity. The suction skirt of this aspect of the invention can be used with other type I and type II retraction devices. - Irrigation is often used during surgery to clear away bleeding or blood clots. This fluid collects in the bottom of the cavity in the body created by the retraction device and needs to be cleared away. The
suction skirt 12 on the bottom of the retraction device is connected to a suction line and removes such fluid during the treatment procedure, keeping the cavity clear of accumulated fluids. In the example shown, the suction skirt is a tubular appendage attached to the lower-most extremity of the retraction device. In the retraction device shown inFIGS. 13A and 13B , the suction skirt is formed from part of theadditional envelope 21 around thebottom window 46. The bottom or sides of the suction skirt is pierced with between six and twelveholes 17. In the embodiment shown, the suction skirt is about ¼″ (6.2 mm) in diameter, and theholes 17 are about ⅛″ (3.1 mm) in diameter. - The suction skirt is made of the polyethylene-nylon composite that is the preferred material for the
main envelope 6 of the retraction device. This material is sufficiently resilient that a tubular structure made from it can retain its open cross section under a low vacuum. One end of the suction skirt is closed; the other is connected to a thin-wall polyethylene tube 22 that runs up the side of the retraction device to exit the body through the same incision as is used for the inflation tubes. If, as is shown inFIGS. 13A and 13B , the retraction device is used in an insufflated body cavity, thesuction skirt tube 22 passes inside theinflation tube sheath 61. The distal end of thesuction skirt tube 22 has attached to it a connector suitable for attaching to an operating room suction line. - 1. Retracting the Bowel to Provide Anterior Access to the Spine, the Aorta, the Kidneys, Etc.
- The method according to the invention of using a retraction device according to the invention in a procedure to perform an anterior resection of a herniated intervertebral disc is illustrated in
FIG. 14 . A method can be adapted to gain anterior access to the aorta, the kidneys, and other tissues that lie outside the peritoneum.FIG. 14A shows a longitudinal cross section of the body; andFIG. 14B shows a transverse cross section along theline 14B-14B inFIG. 14A . Anterior access to the spine is normally difficult due to the difficulty of retracting the overlying bowel using conventional laparoscopic retractors. A Type I or a Type II retraction device according to the invention is used according to the invention to retract the bowel by forming asmall incision 420 in the abdominal wall W and inserting a trocar (not shown) withtrocar tube 430 into theincision 420 and driving the trocar into the abdominal cavity AC. The trocar is removed and theretraction device 401 is passed through thetrocar tube 430 into the abdominal cavity AC in its contracted state with the aid of its inflation tube or inflation tube shield (theinflation tube shield 461 of a Type IA retraction device is shown). After insertion and orientation, themain chamber 411 of theretraction device 401 is inflated with a suitable inflation gas passed thoughinflation tube 416. During the inflation process, the relatively large surface area of themain chamber 411 of the retraction device gently retracts thebowel 431, either upwards or downwards, depending on the position of the disc to be treated. The positioning of the retraction device is checked and adjusted, if necessary, as previously described. - If a Type I retraction device is used, it must be positioned such that the disc that it is desired to treat is centered in one of its windows. The
additional chamber 431 is inflated, and the inflation gas pressure in the 411 main chamber is released. The inflated additional chamber maintains the shape of the retraction device. - If a Type II device is used, an elastomeric window (not shown) is installed, as previously described, on the inside of the main envelope in a position that will provide access to the disc to be treated.
- The
main envelope 406 of both types of retraction device can then be pierced, and partially removed, if necessary. An incision is made in the peritoneum exposed by the retraction device to gain access to and to resect the disc to be treated. - One or more flexible sheaths may be inserted through the abdominal wall to provide access to the interior of the retraction device for surgical instruments. If a Type I retraction device is used, normal surgical instruments may be used, and such tools may be freely manipulated in the space created by the retraction device. Because the main chamber of the retraction device is not under pressure, there is no need to use laparoscopic instruments through rigid trocar tubes.
FIGS. 14A and 14B show instrument 452 passed from outside the body through themain inflation tube 416 into themain chamber 411. Theinstrument 452 passes out of themain chamber 411 through an aperture (not shown) pierced in the window 446. - Once treatment has been completed, the retraction device is deflated and removed from the body, and the small incisions in the abdominal wall repaired, as already described.
- 2. Retracting the Pericardium
- A procedure according to the invention in which a small, oblate version of a Type I or Type II retraction device according to the invention is used to displace the
pericardium 403 from theheart 408 is shown inFIG. 15 , which shows a transverse cross section of the chest. Displacement of the pericardium allows theouter surface 413 of theheart 408 to be observed, and such procedures as endocardial mapping, ablation, transmyocardial revascularization, and defibrillation to be carried out. These procedures have until now been difficult to do laparoscopically because access to the surface of theheart 408 is obstructed by thepericardium 403. - In the procedure according to the invention, a
small puncture 418 is made in thechest wall 423 and through thepuncture 418, asmall incision 428 is made in thepericardium 403. An introducer tube (not shown) is inserted to connect thepericardial cavity 453 to outside the patient. Aretraction device 401 according to the invention is inserted using its inflation tubes (themain inflation tube 416 is shown) through the introducer tube into thepericardial cavity 453 so that it rests between thesurface 413 of the heart and thepericardium 403. Theretraction device 401 is then released from its packing (not shown), as described above, and itsmain chamber 411 is inflated. During the inflation process, themain envelope 406 of the retraction device gently displaces theheart 408 from thepericardium 403. The position of the retraction device is checked and, if necessary, adjusted. - If a Type I retraction device is used, it must be positioned such that the part of the heart that it is desired to treat is centered in one of its windows. The
additional chamber 431 is then inflated and the inflation pressure removed from the main chamber. - If a Type II device is used, an elastomeric window is installed, as previously described, on the inside of the main envelope in a position that will provide access to the part of the heart to be treated.
- Once the retraction device is in position, the introducer tube (not shown) can be withdrawn and the
main inflation tube 416 used as a path for endoscopes and instruments to pass in to the main chamber of the retraction device. - 3. Retracting the Pleura
-
FIG. 15 shows anendoscope 433 passed through themain inflation tube 416 to observe theouter surface 413 of the heart.FIG. 15 also shows aninstrument probe 438 that has been passed through thechest wall 423 to contact thesurface 413 of the heart. Theinstrument probe 438 is passed through thepericardium 403 and themain chamber 411 of theretraction device 401, piercing afirst window 443 and asecond window 448 of the retraction device. After the treatment is completed, the retraction device is withdrawn from the pericardial cavity, as already described, and the small incisions in the pericardium and the chest wall are repaired. -
FIG. 16 shows a further procedure according to the invention in which a retraction device according to the invention is used in the pleural cavity to retract the lung from the pleura to allow observation and manipulation.FIG. 16A shows a vertical cross sectional view of the chest andFIG. 16B shows a transverse cross section along the line 168-16B inFIG. 16A . A small, oblate version of a Type I or TypeII retraction device 401 according to the invention is used to displace thelung 402 from thepleura 407 to allow resection of alobe 412 of thelung 402. - In the procedure, a
small incision 417 is made in thechest wall 423 and, through theincision 417, a trocar (not shown) is inserted to connect thepleural cavity 432 to outside the patient. The trocar point (not shown) is removed leaving the trocar tube (not shown) connecting thepleural cavity 432 to outside the patient. Aretraction device 401 according to the invention is inserted using its inflation tubes (inflation tube 416 is shown) through the trocar tube into the pleural cavity, so that it rests between the surface of thelung 402 and thepleura 407. Theretraction device 401 is then released from its packing (not shown), as described above, and itsmain chamber 411 is inflated. During the inflation process themain envelope 406 of the retraction device gently displaces thelung 402 from thepleura 407. The position of the retraction device is checked and, if necessary, adjusted. - If a Type I retraction device is used, it must be positioned such that the part of the lung that it is desired to treat is centered in one of its windows. The
additional chamber 431 is then inflated and the inflation pressure removed from themain chamber 411. - If a Type II device is used, an elastomeric window is installed, as previously described, on the inside of the main envelope in a position that will provide access to the part of the lung to be treated.
- Once the retraction device is in position, the trocar tube (not shown) can be withdrawn and the
main inflation tube 416 used as a path for endoscopes and instruments to pass to the inside of the retraction device. -
FIG. 16 shows anendoscope 433 passed through themain inflation tube 416 into the main chamber of theretraction device 401. In the embodiment of theretraction device 401 shown, themain inflation tube 416 enters themain chamber 411 through afirst window 443. Part of asecond window 448 has been removed, as already described, to allow apart 437 of thelung 402 to enter themain chamber 411 of retraction device for treatment. Atrocar tube 447 passes through thechest wall 423 and enters the retraction device by piercing athird window 452, and aninstrument 442 is passed through thetrocar tube 447 to section part of thelung 437. The part of thewindow 448 that has not been removed forms a seal around thepart 437 of the lung inside the retraction device, and prevents sectioned tissue from entering the pleural cavity. After the treatment of the lung is completed, the retraction device is withdrawn from the pleural cavity, as already described, and the small incisions in the pleura and the chest wall are repaired. - 4. Retracting a Lobe of the Lung
- In a further procedure according to the invention, a retraction device according to the invention is used to retract one lobe of a lung in a lobectomy. This is shown in
FIG. 17 , which shows a longitudinal cross section of the chest. The lobes of the lung overlay one another: in performing a lobectomy, access to the hilar portion of the bronchial tree is required so that the branches of the bronchial tree feeding the lobe to be sectioned can be occluded. A Type IA or TypeII retraction device 401 according to the invention is used to displace thelobe 404 away from the rest of thelung 409 to provide access to the bronchial tree 414. - In the procedure, a
small incision 419 is made in thechest wall 423, and through theincision 419, a trocar (not shown) is inserted through thechest wall 423 andpleura 429. The trocar (not shown) is removed and the trocar tube is maneuvered to place its distal end between thelobe 404 and the rest of thelung 409. Aretraction device 401 according to the invention is inserted using its inflation tubes (inflation tube 416 is shown) through the trocar tube into position between thelobe 404 and the rest of thelung 409. Theretraction device 401 is then released from its packing (not shown), as described above, and itsmain chamber 411 is inflated. During the inflation process, themain envelope 406 of the retraction device gently displaces thelobe 404 away from the rest of thelung 409. The position of the retraction device is checked and, if necessary, adjusted. - If a Type I retraction device is used, it must be positioned such that the part of the bronchial tree that it is desired to occlude is centered in one of its windows. The
additional chamber 431 is then inflated and the inflation pressure removed from the main chamber. - If a Type II retraction device is used, a elastomeric window (not shown) is applied to the inside of the
main chamber 411 in a position such that the part of the bronchial tree that it is desired to occlude can accessed through the elastomeric window. - With both types of retraction device, an aperture is cut in the
main envelope 406 through which the procedure for occluding a part of the bronchial tree can be carried out using instruments passed into themain chamber 411 through theinflation tube 416. Additional instruments can be inserted into the main chamber through flexible sheaths (not shown) and/or, in a Type I retraction device, through apertures pierced in other windows (not shown) of themain envelope 406. After the bronchial tree has been occluded, the retraction device is deflated and withdrawn, as already described, from between thelobe 404 and the rest of thelung 409. The procedure for sectioning the lobe is carried out before the small incisions in the pleura and the chest wall are repaired. - 5. Retracting the Liver to Gain Access to the Gastroesophageal Junction
- Another procedure according to the invention is shown in
FIG. 18 . It is necessary to gain access to the gastroesophageal junction between thestomach 405 and theesophagus 410 to be able to section the vagus nerve, or to treat gastroesophageal reflux. The gastroesophageal junction is normally obscured by the liver 415, which must be retracted provide access for treating this area. A Type I or TypeII retraction device 401 according to the invention is used to displace the liver 415 away from theesophagus 410. According to the procedure, asmall incision 420 is made in theabdominal wall 425. A trocar (not shown) and trocar tube 440 is inserted through theincision 420 and is driven through theabdominal wall 425 into the abdominal cavity AC and the trocar is removed. The trocar tube is maneuvered to place its distal end between the liver 415 and theesophagus 410. Aretraction device 401 according to the invention is inserted using its inflation tubes (inflation tube 416 is shown) through the trocar tube into position between the liver 415 and theesophagus 410. Theretraction device 401 is then released from its packing (not shown), as described above, and itsmain chamber 411 is inflated. During the inflation process themain envelope 406 of the retraction device gently displaces the liver 415 away from theesophagus 410. The position of the retraction device is checked and, if necessary, adjusted. - If a Type I retraction device is used, it must be positioned such that the gastroesophageal junction is centered in one of its windows. The
additional chamber 431 is then inflated and the inflation pressure removed from the main chamber. - If a Type II retraction device is used, a elastomeric window (not shown) is applied to the inside of the
main chamber 411 in a position such that the gastroesophageal junction can accessed through the elastomeric window. - With both types of retraction device, an aperture is cut in the
main envelope 406 through which the treatment procedure can be carried out using instruments (e.g., instrument 452) passed into themain chamber 411 through at least theinflation tube 416. Additionally or alternatively, instruments can be inserted into themain chamber 411 through flexible sheaths (not shown) and/or, in a Type I retraction device, through apertures pierced in other windows (not shown) in themain envelope 406. After the treatment procedure has been carried out, the retraction device is deflated and withdrawn, as already described, from between the liver 415 and theesophagus 410, the small incisions in abdominal wall are repaired. - 6. Retracting the Dura Mater
- Another procedure according to the invention is shown in
FIG. 19 , which shows a vertical cross section of the head. To observe and treat thebrain 450, it is necessary to separate the brain from theoverlying dura mater 455. A small, very oblate version of a Type I or TypeII retraction device 401 according to the invention is used in this procedure. According to the procedure, asmall incision 460 is made in the skin of the head, and, working through the incision, asmall hole 465 is drilled in the skull to provide access to thedura mater 455. Anincision 470 is made in the dura mater to expose the surface of thebrain 450. Aretraction device 401 according to the invention is inserted using forceps through theincision 460, thehole 465, and theincision 470 into the skull between the surface of thebrain 450 and thedura mater 455. Theretraction device 401 is then released, as described above, from its packing (not shown), and itsmain chamber 411 is inflated. During the inflation process themain envelope 406 of the retraction device gently displaces thebrain 450 away from thedura mater 455. The position of the retraction device is checked and, if necessary, adjusted. - If a Type I retraction device is used, it must be positioned such that part of the brain that it is desired to treat is centered in one of its windows. The additional chamber (not shown) is then inflated and the inflation pressure removed from the main chamber.
- If a Type II retraction device is used, a elastomeric window (not shown) is applied to the inside of the
main chamber 411 in a position such that the part of the brain that it is desired to treat can be accessed through the elastomeric window. - With both types of retraction device, an aperture is cut in the
main envelope 406 through which the treatment procedure can be carried out, using instruments passed into themain chamber 411 through theinflation tube 416. Additionally or alternatively, instruments can be inserted into the main chamber, in a Type I retraction device, through apertures pierced in other windows (465, 470) of themain envelope 406. After the treatment procedure has been carried out, the retraction device is deflated and withdrawn, as already described, from between thebrain 450 and thedura mater 455. Finally, the small incisions in the dura mater and the scalp and the hole in the skull are repaired. - 7. Hernia Repair
- Laparoscopic techniques are already being used to repair hernias, but conventional techniques require that two incisions be made in the peritoneum, the second incision being a relatively large one, and the peritoneum around the second incision be retracted. These unnecessary incisions delay recovery and provide the opportunity for complications. A procedure according to the invention enables hernia repair to be carried out without having to breach the peritoneum.
FIG. 20A shows a vertical cross section of the lower abdomen. A flat, substantially elliptical or rectangular Type IA or TypeII retraction device 501 according to the invention is used to retract theperitoneum 502 away from theabdominal wall 517. In the procedure according to the invention, asmall incision 522 is made in theabdominal wall 517 near theumbilicus 507, and the layers of tissue are cut through as far as the peritoneum. Aretraction device 501 according to the invention is inserted using forceps through theincision 522 into position between theabdominal wall 517 and theperitoneum 502. Theretraction device 501 is then released, as described above, from its packing (not shown), and itsmain chamber 511 is inflated. During the inflation process themain envelope 506 of the retraction device spreads inferiorly towards the inguinal area, and gently displaces theperitoneum 502 back from theabdominal wall 517. The position of the retraction device is checked and, if necessary, adjusted. - If a Type I retraction device is used, it must be positioned such that the site of the hernia is centered in one of its windows. The
additional chamber 531 is then inflated and the inflation pressure removed from the main chamber. - If a Type II retraction device is used, a elastomeric window (not shown) is applied to the inside of the
main chamber 511 in a position such that the site of the hernia can be accessed through the elastomeric window. - With both types of retraction device, an aperture is cut in the
main envelope 506 through which the treatment procedure can be carried out using instruments passed into themain chamber 511 through theinflation tube 516. Additionally or alternatively, instruments can be inserted into the main chamber through flexible sheaths (not shown) and/or, in a Type I retraction device, through apertures (not shown) pierced in other windows of themain envelope 506. After the hernia has been repaired, the retraction device is deflated and withdrawn, as already described, from between theperitoneum 502 and theabdominal wall 517 and the small incision in theabdominal wall 517 is repaired. - One known technique for repairing a hernia is by suturing or stapling a fine mesh over the site of the hernia. The mesh is preferably installed on the abdominal wall outside the peritoneum to prevent the mesh and its sutures or staples from irritating the bowel. Using conventional laparoscopic techniques to hold the mesh in place while it is cut to size and stapled in position is a very difficult procedure. In a procedure according to the invention, a piece of
mesh 527 is attached, for instance by a suitable adhesive applied to the perimeter of the piece of mesh, to substantially cover thewindow 532 of theretraction device 501, as shown inFIG. 21 . Thewindow 532 is the window that will contact the site of thehernia 512 when the retraction device has been deployed. The retraction device with the mesh is then packaged as previously described, and the retraction device is inserted between theperitoneum 502 and theabdominal cavity 517 and inflated, also as previously described. - The position of the
retraction device 501 is then adjusted, usingtabs 556 and a suitable gripping tool (not shown) to position the mesh-covered window so that themesh 527 covers the site of thehernia 512. Once the retraction device is properly positioned, theadditional chamber 531 is inflated and the inflation pressure removed from the main chamber. Theretraction device 501 holds themesh 527 in place over the site of the hernia while the mesh is stapled in place and excess mesh is cut off. Part of thewindow 532 is cut away, using a suitable tool inserted into themain chamber 511 through theinflation tube 516, to expose the area of the mesh into which staples will be placed. The mesh is stapled to the site of thehernia 512 using staples (not shown) inserted by means of a conventional laparoscopic stapler (not shown). More of thewindow 532 is then cut away and a suitable laparoscopic cutting tool is inserted into themain chamber 511 to cut the mesh around the stapled area. The excess mesh is removed when the retraction device is removed from the body, as previously described. - In a variation on this procedure, a low irritation Dacron® mesh is installed on the inside of the peritoneum, the retraction device with a piece of mesh covering one of its windows being inserted into the peritoneal cavity before the retraction device is inflated, as shown in
FIG. 20B . - In a variation on both of the above procedures, the mesh is cut to the required size before it is attached to the window of the retraction device. The mesh is attached to the window of the retraction device by one-pull lacing, and the thread for the one-pull lacing is fed through the main inflation tube. After the mesh has been correctly positioned and stapled in place, as previously described, the thread is pulled to release the one-pull lacing, which releases the mesh from the window of the retraction device. The retraction device is then withdrawn as previously described. This variation does not require the mesh to be cut to size after it has been stapled in place.
- 1. Polygonal Type IA Retraction Device
- The construction according to the invention of a polygonal Type IA retraction device is illustrated in
FIGS. 22A and 22B . The construction of a dodecahedral retraction device is illustrated. A dodecahedral retraction device gives a good compromise between approximating a spherical or spheroidal shape, and complexity. Increasing the number of faces makes a shape that is more nearly spherical but is more complex to make. The additional chamber of a retraction device that is more nearly spherical provides more retraction force than the additional chamber of a polyhedral retraction device that is more nearly cubic. - The main envelope and the additional envelope of the retraction device are both made of a relatively inelastic and tough film of a plastic such as Mylar®, polyethylene, or polyurethane. The preferred material is a polyethylene and nylon composite. The thickness of the main envelope is typically from 0.5 to 5 mils (13 to 130 microns). In the preferred embodiment, the additional envelope is made from a film of the same thickness of the same plastic as the main envelope. However, in some applications it may be advantageous make the additional envelope from a film of a different thickness of the same plastic, or from a film of the same or a different thickness of a different plastic.
- Two segmented circular
main envelope blanks additional envelope blanks - The main envelope blank 600, the additional envelope blank 625, and the formation of an envelope half from them will now be described. A similar explanation applies to the main envelope blank 601, the additional envelope blank 626, and the formation of an envelope half from them.
- The number of segments in the two
main envelope blanks segments 605. The width and depth of thesegments 605 determines the shape of the retraction device: wide, shallow segments result is a relatively flat retraction device, whereas narrow, deep segments result in a relatively tall retraction device. - The number of
segments 630 in the additional envelope blank 625 is preferably equal to the number ofsegments 605 of the main envelope blank 600; thus, the additional envelope blank 625 has fivesegments 630 to match the fivesegments 605 of themain envelope blank 600. The shape of thesegments 630 is substantially the same as that of thesegments 605, except the parts of eachsegment 630 indicated by shading and thereference numeral 655 inFIG. 22B are cut away compared with thesegment 605 in the main envelope blank. When the additional envelope blank 625 is assembled with the main envelope blank 600, the cut awayareas 655 provide the windows 46 (FIG. 1 ) in the side of the retraction device. Eacharea 655 will therefore be called aside window area 655. Anotherarea 645 in the center of the additional envelope blank 625 is cut away. When theadditional envelope 625 is assembled with the main envelope blank 600, the cut awayarea 645 forms the window 46 (FIG. 1 ) in the top end or the bottom end of the retraction device, and will thus be called theend window area 645. The end window area is shown with a circular shape inFIG. 22B ; alternatively, it could have a polygonal shape. The side and end window areas are preferably cut in the same die-cutting operation in which the additional envelope is die cut from the plastic film. - An envelope half is made by laying the additional envelope blank 625 on the main envelope blank 600 such that the
segments 630 coincide with thesegments 605. Thebroken line 650 inFIG. 22A indicates the position of eachside window area 655 when the additional envelope blank 625 is correctly positioned on themain envelope bank 600. The periphery of eachside window area 655 of the additional envelope blank 625 is attached to the main envelope blank 600, preferably by welding. Alternatively, a line of adhesive applied to the periphery of eachside window area 655 can be used. The periphery of theend window area 645 in the additional envelope blank 625 is also attached to the main envelope blank 600, preferably by welding. Alternatively, a line of adhesive applied to the periphery of theend window area 645 can be used. - The envelope half is then given a 3-dimensional form by joining the
edge 610 of eachsegment 605 in the main envelope blank 600 to theedge 615 of the adjacent segment, and by joining theedge 635 of eachsegment 630 in the additional envelope blank 625 to theedge 640 of the adjacent segment. The preferred method of joining in this step and the following steps involving joining is overlap welding. Alternatively, butt welding or a line of a suitable adhesive can be used. The envelope half may be formed so that the additional envelope blank 625 is inside or outside themain envelope blank 600. In the preferred embodiment, the additional envelope blank is inside the main envelope blank. - A second envelope half is made from the main envelope blank 601 and the additional envelope blank 626, as described above. One of the two envelope halves is then inverted relative to the other, and the two envelope halves are joined together with the
periphery 620 in contact with the periphery 621 (main envelope) and theperiphery 660 in contact with the periphery 661 (additional envelope). The peripheries of the envelope blanks on the inside are joined first. In the preferred embodiment, which has the additional envelope outside the main envelope, the envelope halves are joined as follows: theperipheries main envelope blanks peripheries main inflation tube 616 is a piece of polyethylene tubing with an outside diameter in the range of 2.5 to 19.5 mm (0.1″ to 0.77″) and of suitable length. The distal end of themain inflation tube 616 is fitted with aport 651 that allows surgical instruments to be passed into the main inflation tube while maintaining inflation pressure in the main chamber of the retraction device. Theport 651 also includes a fitting (not shown) suitable for connecting the port to a source of inflation gas (not shown). The proximal end of themain inflation tube 616 is inserted into the unjoined part of theperipheries additional envelope blanks periphery 620 to theperiphery 621 is completed. Where theperipheries main inflation tube 616, they are joined to the outer wall of the main inflation tube to form a gas-tight seal. - The
peripheries additional envelope blanks main inflation tube 616, to the outer wall of the main inflation tube to form a gas-tight seal. A small part of theperipheries additional envelope blanks additional inflation tube 641 is a piece of polyethylene tubing with an outside diameter in the range of 2.5 to 5 mm (0.1″ to 0.2″) and of suitable length. The distal end of theadditional inflation tube 641 is fitted with a fitting (not shown) suitable for connecting it to a source of inflation gas (not shown). The proximal end of theadditional inflation tube 641 is inserted into the unjoined part of theperipheries additional envelope blanks periphery 660 to theperiphery 661 is completed. Where theperipheries additional inflation tube 641, they are joined to the outer wall of the additional inflation tube to form a gas-tight seal. - In the alternative embodiment, with the additional envelope inside the main envelope, the
peripheries additional envelope blanks main inflation tube 616. Theperipheries main envelope blanks main inflation tube 616 and to the outer wall of theadditional inflation tube 641. - If the retraction device is for use in an insufflated body cavity, the main and additional inflation tubes must be surrounded by an inflation tube shield. The additional envelope blanks for such a retraction device are cut to include an
inflation tube seal - An alternative method of making a polygonal type IA retraction device is the same as the method just described, except that the
additional envelope blanks main envelope blanks broken lines 650 and 665 (FIG. 22A ). Alternatively, a main envelope blank can be attached to an additional envelope blank by a line of a suitable adhesive spread along thebroken lines 650 and 665. The envelope halves are then formed and attached to one another using the method described above. - The additional chamber of a retraction device in which the additional envelope blank and the main envelope blank are cut using the same die is substantially the same shape as the additional chamber of a retraction device in which the additional envelope blank is cut using its own die. The alternative method of construction saves the tooling cost of the die to cut the additional envelope blank. A retraction device made according to this method has a double thickness of film on its windows 46 (
FIG. 1 ), which makes it somewhat more difficult to cut apertures in the windows prior to carrying out the treatment process. - 2. Polygonal Type IA Retraction Device with Suction Skirt
- The construction according to the invention of a polygonal Type IA retraction device including a suction skirt according to the invention is illustrated in
FIGS. 23A and 23B . A plurality ofholes 608, preferably between 6 and 12, are cut around the periphery of theend window area 646 of the additional envelope blank 631. Eachhole 608 is preferably about ⅛″ (3 mm) in diameter. When the retraction device is deployed in the body, it must be oriented such that the additional envelope blank 631 is lower-most. Additionally, a short radial cut 613 is made in the additional envelope blank 631. Preferably, theholes 608 and the radial cut 613 are die cut, preferably by the same die used to cut the additional envelope blank 631. - The method of constructing the retraction device is the same as that described above, except that the step of attaching the periphery of the
end window 646 of the additional envelope blank 631 to the main envelope blank 601 is changed as follows: additional envelope blank 631 is attached to the main envelope blank 601 by welding along a circular line concentric with theend window area 646 and displaced radially outward by about 0.5″ (12.5 mm) to lie outside the line of theholes 608. The weld line is indicated inFIG. 23 by thebroken line 618. The part of the additional envelope blank 631 forming the periphery of theend window area 646 is then displaced radially outwards by about ⅛″ (3 mm) and is attached to the main envelope blank 601 by a circular weld, indicated by thebroken line 623, inside the line of theholes 608. Displacing the periphery of the end window area radially outward moves the part of the additional envelope blank 631 between the two welds indicated by thebroken lines - Construction of the retraction device is completed as described above. The proximal end of the
suction tube 638, which is a piece of thin-wall polyethylene tubing about ¼″ (6 mm) in outside diameter is inserted into the open end of the tubular structure provided by the radial cut 613. In a retraction device for use in an insufflated body cavity, thesuction tube 638 is sealed into the inflation tube sheath. - The method described above can be adapted to provide a suction skirt around one of the side windows of a polygonal Type IA retraction device. Such a suction skirt would be useful if the retraction device is oriented with a side window lower-most when in use. The method can also be adapted to make a flat retraction device with a suction skirt around one or more of its holes or around the junction between its envelope halves. The method can also be adapted to make a triangular prism-shaped Type IA retraction device with a suction skirt around one of its holes or along one or both of the sides of its lower-most face.
- 3. Relatively Flat Type IA Retraction Device
- The construction according to a further aspect of the invention of a simpler, relatively flat Type IA retraction device according to the invention is illustrated in
FIGS. 24A and 24B . The main envelope and the additional envelope of the retraction device are both made of a relatively inelastic and tough film of a plastic such as Mylar®, polyethylene, or polyurethane. The preferred material is a polyethylene and nylon composite. The thickness of the main envelope is typically from 0.5 to 5 mils (13 to 130 microns). In the preferred embodiment, the additional envelope is made from a film of the same thickness of the same plastic as the main envelope. However, in some applications it may be advantageous make the additional envelope from a film of a different thickness of the same plastic, or from a film of the same or a different thickness of a different plastic. - Two substantially circular or elliptical
main envelope blanks additional envelope blanks main envelope blanks holes additional envelope blanks holes additional envelope blanks main envelope blanks holes FIG. 248 ) in the retraction device. Increasing the proportion of the additional envelope removed to formholes - An envelope half is made by laying the additional envelope blank 625 on the
main envelope blank 600. The positions of the periphery of eachhole 670 when the additional envelope blank 625 is properly positioned on themain envelope bank 600 is indicated by thebroken line 650 inFIG. 24A . The periphery of eachhole 670 of the additional envelope blank 625 is attached to the main envelope blank 600, preferably by welding. Alternatively, a line of adhesive applied to the periphery of eachhole 670 can be used. A second envelope half is made from the main envelope blank 601 and the additional envelope blank 626, using the method described above. - One of the two envelope halves is then inverted relative to the other, and the two envelope halves are joined together with the
periphery 620 in contact with the periphery 621 (main envelope) and theperiphery 660 in contact with the periphery 661 (additional envelope). The envelope halves may be joined such that theadditional envelope blanks main envelope blanks FIG. 24B . - In an alternative embodiment of the relatively flat Type IA retraction device, the main inflation tube may be connected to the main chamber by piercing a hole in one of the
windows 646 and attaching the periphery of the hole to the outer wall of the inflation tube. This embodiment is more useful than the basic embodiment, in which the main inflation tube is connected between the perimeters of the two envelope halves, in procedures in which the convenient entry point in the body for instruments lies more or less directly across the short dimension of the retraction device from the tissue to be treated. Examples of such procedures are shown inFIGS. 15 , 16A, 16B, and 19. - In the alternative embodiment with the additional envelope outside the main envelope, the
peripheries peripheries - The flat Type IA retraction device can also be made with its additional envelope blanks and its main envelope blanks cut using the same die, as described in connection with the polygonal Type IA retraction device. The main and additional envelope blanks are attached by welding or a line of adhesive along the
broken lines 650. - 4. Triangular Prism-Shaped Type IA Retraction Device
- The triangular prism Type IA retraction device is constructed according to the invention from two flat envelope blanks, as shown in
FIG. 25C . The main envelope and the additional envelope of the retraction device are both made of a relatively inelastic and tough film of a plastic such as Mylar®, polyethylene, or polyurethane. The preferred material is a polyethylene and nylon composite. The thickness of the main envelope is typically from 0.5 to 5 mils (13 to 130 microns). In the preferred embodiment, the additional envelope is made from a film of the same thickness of the same plastic as the main envelope. However, in some applications it may be advantageous make the additional envelope from a film of a different thickness of the same plastic, or from a film of the same or a different thickness of a different plastic. - A substantially rectangular main envelope blank 700, and a substantially rectangular additional envelope blank 725, substantially the same size as the main envelope blank 700, are cut from a piece of film, preferably by die cutting. Each envelope blank 700 and 725 can be regarded as being divided lengthwise into three panels. At least the two outer panels have equal length. Each panel is serrated as shown in
FIG. 25C . If the outer panels are larger than the inner panel, their serrations are truncated, as shown. The serrations are preferably die cut at the same time as the envelope panels are die cut. The die cutting process also cuts onehole 770 in each panel of the additional envelope blank 725, as shown inFIG. 25D . Substantially circular holes are shown inFIG. 25D : holes of a different shape, or more than one hole per panel can be cut, depending on the intended application of the retraction device. When the additional envelope blank 725 is assembled with the main envelope blank 700, theholes 770 form the windows 746 (FIG. 25A ) in the retraction device. Increasing the proportion of the additional envelope removed to form theholes 770 increases the window area through which treatment procedures can be carried out, but reduces the ability of the additional cavity of the retraction device to maintain retraction after the main cavity has been punctured. - Assembly is begun by laying the additional envelope blank 725 on the main envelope blank 700 so that their peripheries overlap. The positions of the periphery of each
hole 770 when the additional envelope blank 725 is properly positioned on themain envelope bank 700 is indicated by thebroken line 750 inFIG. 25C . The periphery of eachhole 770 of the additional envelope blank 725 is joined to themain envelope blank 700. The preferred method of joining in this step and the following steps involving joining is overlap welding. Alternatively, a line of adhesive applied to the periphery of the pieces being joined, for example, the periphery of eachhole 770, can be used. The periphery 760 of the additional envelope blank 725 is joined to theperiphery 720 of the main envelope blank 700 by welding along thebroken line 740. A small part of theperipheries 720 and 760 is left unjoined. - The
additional inflation tube 741 is a piece of polyethylene tubing with an outside diameter in the range of 2.5 to 5 mm (0.1″ to 0.2″) and of suitable length. The distal end of theadditional inflation tube 741 is fitted with a fitting (not shown) suitable for connecting it to a source of inflation gas (not shown). The proximal end of theadditional inflation tube 741 is inserted into the unjoined part of theperiphery 720 of the main envelope blank 700 and the periphery 760 of the additional envelope blank 725, and joining theperiphery 720 to the periphery 760 is completed. Where theperipheries 720 and 760 contact theadditional inflation tube 741, they are joined to the outer wall of the additional inflation tube to form a gas-tight seal. - The retraction device is then folded, as shown by the
arrows lines edge 722 into contact withedge 727 with the main envelope blank 700 on the inside. The following parts of the periphery of the retraction device are then joined: 736 to 741, 737 to 742, 746 to 751, 747 to 752, 756 to 761, 757 to 762, 766 to 771, 767 to 772, and 722 to 727. A small part of theperipheries - The
main inflation tube 716 is a piece of polyethylene tubing with an outside diameter in the range of 2.5 to 19.5 mm (0.1″ to 0.77″) and of suitable length. The distal end of themain inflation tube 716 is fitted with a port (not shown) that allows surgical instruments to be passed into the main inflation tube while maintaining inflation pressure in the main chamber of the retraction device. The port also includes a fitting (not shown) suitable for connecting the port to a source of inflation gas (not shown). The proximal end of themain inflation tube 716 is inserted into the unjoined part of theperipheries periphery 722 to theperiphery 727 is completed. Where theperipheries main inflation tube 716, they are joined to the outer wall of the main inflation tube to form a gas-tight seal. - If the retraction device is for use in an insufflated body cavity, the main and additional inflation tubes must be surrounded by an inflation tube shield. The main and additional envelope blanks for such a retraction device are each cut to include an
inflation tube seal - The triangular prism-shaped Type IA retraction device can also be made with its additional envelope blank and its main envelope blank cut using the same die, as described in connection with the polygonal Type IA retraction device. The additional envelope blank is attached to the main envelope blank by welding or a line of adhesive along the
broken lines 750. - 5. Polygonal Type II Retraction Device
- The construction according to the invention of a polygonal Type II retraction device is illustrated in
FIG. 26 . The construction of a dodecahedral retraction device is illustrated. A dodecahedral retraction device gives a good compromise between approximating a spherical or spheroidal shape, and providing windows of a useful size. Increasing the number of faces makes a shape that is more nearly spherical but has smaller faces, which limits the size of elastomeric window that can be used. - The main (and only) envelope of the Type II retraction device is made of a relatively inelastic and tough film of a plastic such as Mylar®, polyethylene, or polyurethane. The preferred material for the main envelope is a polyethylene and nylon composite. The thickness of the main envelope is typically from 0.5 to 5 mils (13 to 130 microns). To form the main envelope, two segmented circular
main envelope blanks segments 605 in the twomain envelope blanks main envelope blanks segments 605. The width and depth of thesegments 605 determines the shape of the retraction device: wide, shallow segments result is a relatively flat retraction device, whereas narrow, deep segments result in a relatively tall retraction device. - An envelope half is formed by joining the
edge 610 of eachsegment 605 in the main envelope blank 600 to theedge 615 of the adjacent segment. The preferred method of joining is overlap welding, but butt welding or a suitable adhesive can also be used. A second envelope half is made using themain envelope blank 601. One of the two envelope halves is then inverted relative to the other, and the two envelope halves are joined together with theperiphery 620 in contact with theperiphery 621. Again, the preferred method of joining is overlap welding, but butt welding or a suitable adhesive can also be used. A small part of theperipheries main envelope blanks - The
main inflation tube 616 is a piece of polyethylene tubing with an outside diameter in the range of 2.5 to 19.5 mm (0.1″ to 0.77″) and of suitable length. The distal end of themain inflation tube 616 is fitted with aport 651 that allows surgical instruments to be passed into the main inflation tube while maintaining inflation pressure in the main chamber of the retraction device. The proximal end of themain inflation tube 616 is inserted into the unjoined part of theperipheries periphery 620 to theperiphery 621 is completed. Where theperipheries inflation tube 616, they are joined to the outer wall of the inflation tube such that a gas-tight main envelope is formed in contact with the bore of the main inflation tube. - The methods described above for making relatively flat and triangular prism-shaped Type IA retraction devices can easily be adapted to make relatively flat and triangular prism-shaped Type II retraction devices respectively.
- 6. Curved Type IA and Type II Retraction Devices
- Substantially full- or hemispherical, spheroidal, or ellipsoidal Type IA and Type II retraction devices can be made from curved pieces of plastic film. The construction according to the invention of a hemispherical Type IA retraction device from curved plastic film is illustrated in
FIGS. 27 and 28 . The method can easily be adapted to make a substantially spherical, spheroidal or ellipsoidal Type IA retraction device by interconnecting two envelope halves made according to the method to be described below using the method for joining envelope halves described above. - The
main envelope 602, theadditional envelope 607, and the bottom diaphragm 647 of the retraction device are all made of a relatively inelastic and tough film of a plastic such as Mylar®, polyethylene, or polyurethane. The preferred material is a polyethylene and nylon composite. The thickness of themain envelope 602 is typically from 0.5 to 5 mils (13 to 130 microns). In the preferred embodiment, theadditional envelope 607 and the bottom diaphragm 647 are made from a film of the same thickness of the same plastic as the main envelope. However, in some applications it may be advantageous make the additional envelope and/or the bottom diaphragm from a film of a different thickness of the same plastic, or a film of the same or a different thickness of a different plastic. - A main envelope blank 602, an additional envelope blank 607 and a bottom diaphragm 647 are cut from a piece of film, preferably by die cutting. The envelope blanks are similar, except that holes 612 are cut in the additional envelope blank 607. The
holes 612 are cut preferably by the same die that is used to cut the additional envelope blank 607. When the additional envelope is assembled with the main envelope blank, theholes 612 form the windows 646 (FIG. 28 ). InFIG. 27 , holes 612 are shown as having a circular shape, but they could have other suitable shapes. - According to one aspect of the method, the main envelope blank 602 and the additional envelope blank 607 are stretched over the surface of a former. The surface of the former is the hemispherical, hemispheroidal, hemiellipsoidal, or other shape that it is desired to impart on the envelope blank. The surface of the former is heated and its temperature sufficiently high, and the envelope blank remains in contact with the surface of the former for sufficiently long a time, for the plastic film of the envelope blank to soften, such that when the envelope blank cools, it adopts the shape of the surface of the former. The surface of the former is cooled, the periphery of the envelope blank is trimmed to the periphery of the surface, and the envelope blank is removed from the former. An envelope blank can also be curved by blowing the envelope blank into a suitably-shaped, heated concavity, or by pressing the envelope blank between suitably-shaped, heated male and female dies.
- An envelope half is made by laying the curved additional envelope blank 607 on the curved
main envelope blank 602. The periphery of eachhole 612 in the additional envelope blank 607 is attached to the main envelope blank 602, preferably by welding. Alternatively, a line of adhesive applied to the periphery eachhole 612 can be used. - In an alternative method, an envelope half is made by laying the additional envelope blank 607 on the
main envelope blank 602. The periphery of eachhole 612 in the additional envelope blank 607 is attached to the main envelope blank 602, preferably by welding. Alternatively, a line of adhesive applied to the periphery of eachhole 612 can be used. The resulting flat envelope half is then curved and trimmed around its periphery using one of the methods described above. - In either of the above methods, the main envelope blank and the additional envelope blank can cut using the same die, and the second chamber can be formed by attaching the additional envelope blank to the main envelope blank by welding or applying adhesive along the
broken lines 627. This method produces a retraction device with a double layer of plastic film on the windows 646 (FIG. 28 ), which makes it somewhat less convenient to use. - A substantially hemispherical retraction device can be made by attaching the
periphery 632 of the main envelope blank 602 to theperiphery 637 of the additional envelope blank 607, and to theperiphery 642 of the bottom diaphragm 647, preferably by welding, as shown inFIG. 28 . Alternatively, a line of adhesive applied to the periphery of one or both the envelope halves and to theperiphery 642 of the bottom diaphragm 647 can be used. A small part of theperipheries additional inflation tube 641 is a piece of polyethylene tubing with an outside diameter in the range of 2.5 to 5 mm (0.1″ to 0.2″) and of suitable length. The distal end of theadditional inflation tube 641 is fitted with a fitting (not shown) suitable for connecting it to a source of inflation gas (not shown). The proximal end of theadditional inflation tube 641 is inserted into the unjoined part of theperipheries periphery 632 to theperiphery 637 is completed. Where theperipheries additional inflation tube 641, they are joined to the outer wall of the additional inflation tube to form a gas-tight seal. - A small part of the joint between the
periphery 637 of the additional envelope blank 607 and theperiphery 642 of the bottom diaphragm 647 is also left unjoined. Themain inflation tube 616 is a piece of polyethylene tubing with an outside diameter in the range of 2.5 to 19.5 mm (0.1″ to 0.77″) and of suitable length. The distal end of themain inflation tube 616 is fitted with aport 651 that allows surgical instruments to be passed into the main inflation tube while maintaining inflation pressure in the main chamber of the retraction device. Theport 651 also includes a fitting (not shown) suitable for connecting the port to a source of inflation gas (not shown). The proximal end of themain inflation tube 616 is inserted into the unjoined part of theperipheries periphery 637 of the additional envelope blank 607 to theperiphery 642 of the bottom diaphragm 647 is completed. Where theperipheries main inflation tube 616, they are joined to the outer wall of the main inflation tube such that a gas-tight seal is formed. - The methods described above for making curved envelope halves can also be used to make the envelope halves used in constructing a Type II retraction device.
Claims (21)
1. (canceled)
2. A method of providing access to tissue for a surgical instrument through a body wall, comprising:
providing an expandable retractor having a flexible sheath, the retractor being in a collapsed state;
introducing the retractor into the body and placing the retractor adjacent the tissue;
expanding the retractor;
deploying the flexible sheath by engaging the flexible sheath with a tool and driving the flexible sheath through the body wall with the tool; and
inserting the surgical instrument from outside the body through the flexible sheath to provide access to the tissue by the surgical instrument.
3. The method of claim 2 , wherein the retractor comprises an inflatable retractor and wherein expanding the retractor includes inflating the retractor.
4. The method of claim 3 , wherein the inflatable retractor has a main envelope defining a main chamber and wherein the main chamber is inflated to an expanded state.
5. The method of claim 4 , further comprising the step of piercing an aperture in the main envelope to provide access to the tissue by the further surgical instrument.
6. The method of claim 4 , wherein the flexible sheath communicates with the main chamber and further comprising the step of inserting the surgical instrument into the main chamber through the flexible sheath.
7. The method of claim 4 , wherein the flexible sheath is deployed after the retraction device has been inflated.
8. The method of claim 2 , wherein the flexible sheath is attached to the retractor and the flexible sheath is deployed by being driven outward through the body wall.
9. The method of claim 2 , wherein the flexible sheath is deployed by being driven inward through the body wall to pierce and to lock into engagement with, the retraction device.
10. The method of claim 2 , wherein the flexible sheath has a sidewall, the sidewall being folded, and wherein deploying the flexible sheath includes unfolding the sidewall.
11. The method of claim 8 , wherein the tool comprises a pointed tool and wherein the step of deploying includes piercing a hole in the retractor and pushing the pointed tool through the hole.
12. The method of claim 11 , wherein the pointed tool is pressed against the inner surface of the body wall.
13. The method of claim 12 , further comprising the step of making a skin incision at the location of the tool and then driving the flexible sheath through the body wall to emerge through the incision.
14. The method of claim 2 , further comprising the step of opening a distal end of the flexible sheath, after the flexible sheath is driven through the body wall.
15. The method of claim 14 , further comprising the step of fitting the flexible sheath with a gas-tight port.
16. The method of claim 2 , wherein the flexible sheath has a locking device disposed on a proximal end thereof.
17. The method of claim 9 , wherein, before the step of driving the flexible sheath, a skin incision is made in the body wall.
18. The method of claim 17 , wherein the step of driving includes driving through the body wall with a sharp trocar point.
19. The method of claim 18 , further comprising the step of piercing the retractor with the trocar point.
20. The method of claim 18 , wherein the flexible sheath has a locking device and further comprising the step of pushing the locking device of the flexible sheath through the skin incision to engage the retractor.
21. The method of claim 20 , wherein the locking device forms a gas-tight seal with the skin incision.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US12/725,105 US20100174149A1 (en) | 1991-05-29 | 2010-03-16 | Endoscopic inflatable retraction device, method of using, and method of making |
Applications Claiming Priority (7)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US70678191A | 1991-05-29 | 1991-05-29 | |
US07/794,590 US5309896A (en) | 1991-05-29 | 1991-11-19 | Retraction methods using endoscopic inflatable retraction devices |
US10623193A | 1993-08-13 | 1993-08-13 | |
US08/561,160 US5865728A (en) | 1991-05-29 | 1995-11-21 | Method of using an endoscopic inflatable lifting apparatus to create an anatomic working space |
US09/179,008 US6605037B1 (en) | 1991-05-29 | 1998-10-26 | Endoscopic inflatable retraction device |
US10/638,854 US7766823B2 (en) | 1991-05-29 | 2003-08-11 | Endoscopic inflatable retraction device, method of using, and method of making |
US12/725,105 US20100174149A1 (en) | 1991-05-29 | 2010-03-16 | Endoscopic inflatable retraction device, method of using, and method of making |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US10/638,854 Continuation US7766823B2 (en) | 1991-05-29 | 2003-08-11 | Endoscopic inflatable retraction device, method of using, and method of making |
Publications (1)
Publication Number | Publication Date |
---|---|
US20100174149A1 true US20100174149A1 (en) | 2010-07-08 |
Family
ID=27380071
Family Applications (4)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US08/561,160 Expired - Lifetime US5865728A (en) | 1991-05-29 | 1995-11-21 | Method of using an endoscopic inflatable lifting apparatus to create an anatomic working space |
US09/179,008 Expired - Fee Related US6605037B1 (en) | 1991-05-29 | 1998-10-26 | Endoscopic inflatable retraction device |
US10/638,854 Expired - Fee Related US7766823B2 (en) | 1991-05-29 | 2003-08-11 | Endoscopic inflatable retraction device, method of using, and method of making |
US12/725,105 Abandoned US20100174149A1 (en) | 1991-05-29 | 2010-03-16 | Endoscopic inflatable retraction device, method of using, and method of making |
Family Applications Before (3)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US08/561,160 Expired - Lifetime US5865728A (en) | 1991-05-29 | 1995-11-21 | Method of using an endoscopic inflatable lifting apparatus to create an anatomic working space |
US09/179,008 Expired - Fee Related US6605037B1 (en) | 1991-05-29 | 1998-10-26 | Endoscopic inflatable retraction device |
US10/638,854 Expired - Fee Related US7766823B2 (en) | 1991-05-29 | 2003-08-11 | Endoscopic inflatable retraction device, method of using, and method of making |
Country Status (1)
Country | Link |
---|---|
US (4) | US5865728A (en) |
Cited By (13)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20110112373A1 (en) * | 2009-11-10 | 2011-05-12 | Trans1 Inc. | Soft tissue access apparatus and methods for spinal surgery |
US20110118551A1 (en) * | 2009-11-14 | 2011-05-19 | SPI Surgical, Inc. | Collateral soft tissue protection surgical device |
US20110313250A1 (en) * | 2010-06-16 | 2011-12-22 | Tyco Healthcare Group Lp | Seal port with blood collector |
US20120203069A1 (en) * | 2009-11-14 | 2012-08-09 | Blake Hannaford | Surgical shield for soft tissue protection |
US8814788B2 (en) * | 2010-05-13 | 2014-08-26 | Livac Pty Ltd | Suction retractor |
US8986201B2 (en) | 2009-11-14 | 2015-03-24 | Spiway Llc | Surgical tissue protection sheath |
US9011326B2 (en) | 2009-11-14 | 2015-04-21 | Spiway Llc | Soft tissue shield for trans-orbital surgery |
US9451981B2 (en) | 2009-11-14 | 2016-09-27 | Spiway Llc | Surgical tissue protection sheath |
US20170000470A1 (en) * | 2015-07-02 | 2017-01-05 | Atlantic Health System, Inc., a NJ non-profit corporation | Lighted Polyhedral Retractor |
US10136881B2 (en) | 2014-02-11 | 2018-11-27 | Mayo Foundation For Medical Education And Research | Laparoscopic retractor devices |
US10986984B2 (en) | 2013-03-13 | 2021-04-27 | Spiway Llc | Surgical tissue protection sheath |
US11039735B2 (en) | 2013-03-13 | 2021-06-22 | Spiway Llc | Surgical tissue protection sheath |
US11583313B1 (en) | 2018-12-06 | 2023-02-21 | Spiway Llc | Surgical access sheath and methods of use |
Families Citing this family (220)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US7744617B2 (en) * | 1991-05-29 | 2010-06-29 | Covidien Ag | Method and inflatable chamber apparatus for separating layers of tissue |
US20060100635A1 (en) * | 1994-01-26 | 2006-05-11 | Kyphon, Inc. | Inflatable device for use in surgical protocol relating to fixation of bone |
RU2147213C1 (en) * | 1994-01-26 | 2000-04-10 | А. Рейли Марк | Improved filled device for use in surgical protocol as applied to bone fixation |
US6248110B1 (en) * | 1994-01-26 | 2001-06-19 | Kyphon, Inc. | Systems and methods for treating fractured or diseased bone using expandable bodies |
US20030229372A1 (en) * | 1994-01-26 | 2003-12-11 | Kyphon Inc. | Inflatable device for use in surgical protocols relating to treatment of fractured or diseased bone |
US7384423B1 (en) | 1995-07-13 | 2008-06-10 | Origin Medsystems, Inc. | Tissue dissection method |
US20040176763A1 (en) * | 1996-03-22 | 2004-09-09 | Foley Kevin T. | Methods for percutaneous surgery |
US5792044A (en) * | 1996-03-22 | 1998-08-11 | Danek Medical, Inc. | Devices and methods for percutaneous surgery |
US5954713A (en) | 1996-07-12 | 1999-09-21 | Newman; Fredric A. | Endarterectomy surgical instruments and procedure |
US7326178B1 (en) | 1998-06-22 | 2008-02-05 | Origin Medsystems, Inc. | Vessel retraction device and method |
US6976957B1 (en) | 1998-06-22 | 2005-12-20 | Origin Medsystems, Inc. | Cannula-based surgical instrument and method |
US6830546B1 (en) | 1998-06-22 | 2004-12-14 | Origin Medsystems, Inc. | Device and method for remote vessel ligation |
EP0979635A2 (en) | 1998-08-12 | 2000-02-16 | Origin Medsystems, Inc. | Tissue dissector apparatus |
US6187000B1 (en) | 1998-08-20 | 2001-02-13 | Endius Incorporated | Cannula for receiving surgical instruments |
US6740122B1 (en) | 1998-09-11 | 2004-05-25 | C. R. Bard, Inc. | Preformed curved prosthesis that is adapted to the external iliac vessels |
US6723133B1 (en) | 1998-09-11 | 2004-04-20 | C. R. Bard, Inc. | Performed curved prosthesis having a reduced incidence of developing wrinkles or folds |
US7559893B2 (en) | 1998-12-01 | 2009-07-14 | Atropos Limited | Wound retractor device |
ATE308277T1 (en) * | 1998-12-01 | 2005-11-15 | Atropos Ltd | SURGICAL DEVICE FOR RETRACTION AND/OR CLOSING A PITCH |
US7537564B2 (en) * | 1998-12-01 | 2009-05-26 | Atropos Limited | Wound retractor device |
US6860892B1 (en) | 1999-05-28 | 2005-03-01 | General Surgical Innovations, Inc. | Specially shaped balloon device for use in surgery and method of use |
US8229549B2 (en) | 2004-07-09 | 2012-07-24 | Tyco Healthcare Group Lp | Surgical imaging device |
ATE415867T1 (en) | 1999-10-14 | 2008-12-15 | Atropos Ltd | SURGICAL WOUND RETRACTOR |
US6302897B1 (en) | 1999-11-19 | 2001-10-16 | Ethicon, Inc. | Device for deploying medical textiles |
AU5326701A (en) * | 2000-04-05 | 2001-10-23 | Kyphon Inc | Methods and devices for treating fractured and/or diseased bone |
US7815649B2 (en) * | 2000-04-07 | 2010-10-19 | Kyphon SÀRL | Insertion devices and method of use |
NZ521800A (en) | 2000-04-07 | 2004-06-25 | Kyphon Inc | Insertion devices and directing the expansion of an expandable structure of the device within a bone |
US7985247B2 (en) | 2000-08-01 | 2011-07-26 | Zimmer Spine, Inc. | Methods and apparatuses for treating the spine through an access device |
US7056321B2 (en) | 2000-08-01 | 2006-06-06 | Endius, Incorporated | Method of securing vertebrae |
DE10040774A1 (en) * | 2000-08-21 | 2002-03-28 | Ebert Dieter | Device for enabling a clear view of a surgical treatment site |
WO2002096278A1 (en) * | 2000-08-25 | 2002-12-05 | Neoseed Technology Llc | Prostate visualization device and methods of use |
US6422997B1 (en) * | 2000-08-25 | 2002-07-23 | Neoseed Technology Llc | Prostate visualization device and methods of use |
EP1326524B1 (en) | 2000-10-19 | 2010-09-01 | Applied Medical Resources Corporation | Surgical access apparatus and method |
JP4348427B2 (en) * | 2000-10-25 | 2009-10-21 | カイフォン・ソシエテ・ア・レスポンサビリテ・リミテ | System and method for reducing fractured bone using a fracture reduction cannula |
US7033373B2 (en) | 2000-11-03 | 2006-04-25 | Satiety, Inc. | Method and device for use in minimally invasive placement of space-occupying intragastric devices |
US6558313B1 (en) | 2000-11-17 | 2003-05-06 | Embro Corporation | Vein harvesting system and method |
US6890295B2 (en) * | 2002-10-31 | 2005-05-10 | Medtronic, Inc. | Anatomical space access tools and methods |
SE520368C2 (en) * | 2001-04-09 | 2003-07-01 | Saab Barracuda Ab | Camouflage, masking balloon as well as input and output device for a refillable masking balloon |
ES2307745T3 (en) * | 2001-04-20 | 2008-12-01 | Power Medical Interventions, Inc. | IMAGE FORMATION DEVICE. |
US6558400B2 (en) | 2001-05-30 | 2003-05-06 | Satiety, Inc. | Obesity treatment tools and methods |
JP4346910B2 (en) * | 2001-05-31 | 2009-10-21 | タイコ ヘルスケア グループ エルピー | Balloon cannula with over-center clamp |
CA2457687C (en) | 2001-08-14 | 2013-01-15 | 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 |
ES2361151T3 (en) | 2002-01-30 | 2011-06-14 | Tyco Healthcare Group Lp | SURGICAL DEVICE FOR IMAGE FORMATION. |
US9155544B2 (en) | 2002-03-20 | 2015-10-13 | P Tech, Llc | Robotic systems and methods |
EP1509142B8 (en) * | 2002-05-17 | 2012-03-07 | Tyco Healthcare Group LP | Endoscopic organ retraction system and method of using the same |
US7650887B2 (en) | 2002-06-05 | 2010-01-26 | Applied Medical Resources Corporation | Wound retractor |
ES2293009T3 (en) * | 2002-07-31 | 2008-03-16 | Power Medical Interventions, Inc. | INTRODUCTORY DEVICE IN HOLES. |
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 |
US7033384B2 (en) | 2002-08-30 | 2006-04-25 | Satiety, Inc. | Stented anchoring of gastric space-occupying devices |
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 |
DE60314464T2 (en) * | 2002-09-19 | 2008-02-14 | Atropos Ltd., Bray | SURGICAL WOUND RETRACTOR |
CN1684626A (en) * | 2002-09-30 | 2005-10-19 | 能量医学介入公司 | Self-contained sterilizable surgical system |
US7220237B2 (en) | 2002-10-23 | 2007-05-22 | Satiety, Inc. | Method and device for use in endoscopic organ procedures |
US20060052669A1 (en) * | 2003-01-24 | 2006-03-09 | Hart Charles C | Internal tissue retractor |
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 |
US7122003B2 (en) * | 2003-04-16 | 2006-10-17 | Granit Medical Innovations, Llc | Endoscopic retractor instrument and associated method |
US7175638B2 (en) | 2003-04-16 | 2007-02-13 | Satiety, Inc. | Method and devices for modifying the function of a body organ |
WO2004093690A1 (en) * | 2003-04-22 | 2004-11-04 | Patrick Leahy | A device for use in parietal surgery |
WO2005013803A2 (en) | 2003-08-06 | 2005-02-17 | Applied Medical Resources Corporation | Surgical device with tack-free gel and method of manufacture |
US7163510B2 (en) | 2003-09-17 | 2007-01-16 | Applied Medical Resources Corporation | Surgical instrument access device |
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 |
US20060161050A1 (en) * | 2003-10-15 | 2006-07-20 | John Butler | A surgical sealing device |
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 |
US7708684B2 (en) | 2004-02-27 | 2010-05-04 | Satiety, Inc. | Methods and devices for reducing hollow organ volume |
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 |
US8252009B2 (en) | 2004-03-09 | 2012-08-28 | Ethicon Endo-Surgery, 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 |
WO2005097012A2 (en) | 2004-03-26 | 2005-10-20 | Satiety, Inc. | Systems and methods for treating obesity |
WO2005102185A1 (en) * | 2004-04-26 | 2005-11-03 | Patrick Leahy | A surgical device |
JP2008515523A (en) | 2004-10-11 | 2008-05-15 | アトロポス・リミテッド | Instrument access device |
US20070078476A1 (en) * | 2004-10-12 | 2007-04-05 | Hull Wendell C Sr | Overweight control apparatuses for insertion into the stomach |
IL164591A0 (en) | 2004-10-14 | 2005-12-18 | Hernia repair device | |
US9216015B2 (en) | 2004-10-28 | 2015-12-22 | Vycor Medical, Inc. | Apparatus and methods for performing brain surgery |
US20060106288A1 (en) | 2004-11-17 | 2006-05-18 | Roth Alex T | Remote tissue retraction device |
US9510732B2 (en) | 2005-10-25 | 2016-12-06 | Intuitive Surgical Operations, Inc. | Methods and apparatus for efficient purging |
US8137333B2 (en) | 2005-10-25 | 2012-03-20 | Voyage Medical, Inc. | Delivery of biological compounds to ischemic and/or infarcted tissue |
US10064540B2 (en) | 2005-02-02 | 2018-09-04 | Intuitive Surgical Operations, Inc. | Visualization apparatus for transseptal access |
US11478152B2 (en) | 2005-02-02 | 2022-10-25 | Intuitive Surgical Operations, Inc. | Electrophysiology mapping and visualization system |
US20080015569A1 (en) | 2005-02-02 | 2008-01-17 | Voyage Medical, Inc. | Methods and apparatus for treatment of atrial fibrillation |
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 |
US20060217756A1 (en) * | 2005-03-28 | 2006-09-28 | Horndeski Gary M | Device and method of weight control via indirect abdominal cavity volume reduction |
US20060217757A1 (en) * | 2005-03-28 | 2006-09-28 | Horndeski Gary M | Device and method of weight control via indirect abdominal cavity volume reduction |
US20090222032A1 (en) * | 2005-03-28 | 2009-09-03 | Horndeski Gary M | Device and method of weight control via indirect abdominal cavity volume reduction |
US20060287583A1 (en) * | 2005-06-17 | 2006-12-21 | Pool Cover Corporation | Surgical access instruments for use with delicate tissues |
WO2007002251A2 (en) * | 2005-06-22 | 2007-01-04 | Vycor Medical, Inc. | Surgical access instruments for use with spinal or orthopedic surgery |
JP2009501045A (en) | 2005-07-15 | 2009-01-15 | アトロポス・リミテッド | Wound retractor |
EP1933730B1 (en) | 2005-10-14 | 2010-02-24 | Applied Medical Resources Corporation | Split hoop wound retractor with gel pad |
US8221310B2 (en) * | 2005-10-25 | 2012-07-17 | Voyage Medical, Inc. | Tissue visualization device and method variations |
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 |
US8152721B2 (en) * | 2005-12-15 | 2012-04-10 | Microdel Idea Center Ltd. | Radial expansible retractor for minimally invasive surgery |
US8147453B2 (en) | 2006-03-13 | 2012-04-03 | Applied Medical Resources Corporation | Balloon trocar |
US8287503B2 (en) * | 2006-03-13 | 2012-10-16 | Applied Medical Resources Corporation | Balloon trocar |
US7998128B2 (en) * | 2006-05-15 | 2011-08-16 | Therataxis, LLC. | Active delivery and flow redirection: novel devices and method of delivery of materials to patients |
US20070270908A1 (en) * | 2006-05-19 | 2007-11-22 | Stokes Michael J | Suture locking method |
US9770230B2 (en) | 2006-06-01 | 2017-09-26 | Maquet Cardiovascular Llc | Endoscopic vessel harvesting system components |
US8517933B2 (en) * | 2006-06-13 | 2013-08-27 | Intuitive Surgical Operations, Inc. | Retraction of tissue for single port entry, robotically assisted medical procedures |
US9055906B2 (en) | 2006-06-14 | 2015-06-16 | Intuitive Surgical Operations, Inc. | In-vivo visualization systems |
US20110144441A9 (en) * | 2006-08-31 | 2011-06-16 | Catholic Heathcare West (CHW) | Inflatable surgical retractor |
US9138137B2 (en) | 2006-08-31 | 2015-09-22 | Dignity Health | Inflatable surgical retractor |
US8491471B2 (en) | 2006-08-31 | 2013-07-23 | Dignity Health | Inflatable surgical retractor |
AU2007290415B2 (en) * | 2006-08-31 | 2013-09-26 | Dignity Health | Inflatable surgical retractor |
US20080097476A1 (en) | 2006-09-01 | 2008-04-24 | Voyage Medical, Inc. | Precision control systems for tissue visualization and manipulation assemblies |
WO2008028149A2 (en) | 2006-09-01 | 2008-03-06 | Voyage Medical, Inc. | Electrophysiology mapping and visualization system |
US10004388B2 (en) | 2006-09-01 | 2018-06-26 | Intuitive Surgical Operations, Inc. | Coronary sinus cannulation |
US7544213B2 (en) * | 2006-09-12 | 2009-06-09 | Adams Jason P | Inflatable hernia patch |
US20080097469A1 (en) * | 2006-10-18 | 2008-04-24 | Gruber William H | Intrauterine access and procedure system with laterally deflectable sheath |
US8025656B2 (en) | 2006-11-07 | 2011-09-27 | Hologic, Inc. | Methods, systems and devices for performing gynecological procedures |
US20080146872A1 (en) * | 2006-11-07 | 2008-06-19 | Gruber William H | Mechanical distension systems for performing a medical procedure in a remote space |
EP2099385B1 (en) * | 2006-11-27 | 2021-02-24 | Davol Inc. | A device especially useful for hernia repair surgeries |
US8758229B2 (en) | 2006-12-21 | 2014-06-24 | Intuitive Surgical Operations, Inc. | Axial visualization systems |
WO2008124650A1 (en) * | 2007-04-06 | 2008-10-16 | Interlace Medical, Inc. | Method, system and device for tissue removal |
US9095366B2 (en) | 2007-04-06 | 2015-08-04 | Hologic, Inc. | Tissue cutter with differential hardness |
US9259233B2 (en) * | 2007-04-06 | 2016-02-16 | Hologic, Inc. | Method and device for distending a gynecological cavity |
US20090270812A1 (en) | 2007-04-06 | 2009-10-29 | Interlace Medical , Inc. | Access device with enhanced working channel |
US8657805B2 (en) | 2007-05-08 | 2014-02-25 | Intuitive Surgical Operations, Inc. | Complex shape steerable tissue visualization and manipulation catheter |
JP5231534B2 (en) * | 2007-05-11 | 2013-07-10 | アプライド メディカル リソーシーズ コーポレイション | Surgical retractor |
JP5441890B2 (en) | 2007-05-11 | 2014-03-12 | アプライド メディカル リソーシーズ コーポレイション | Surgical retractor with gel pad |
WO2008149332A1 (en) | 2007-06-05 | 2008-12-11 | Atropos Limited | An instrument access device |
US8657740B2 (en) | 2007-06-05 | 2014-02-25 | Atropos Limited | Instrument access device |
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 |
US20090082633A1 (en) * | 2007-09-25 | 2009-03-26 | Biten Kishore Kathrani | Inflatable medical device |
US8500762B2 (en) | 2007-10-17 | 2013-08-06 | Davol, Inc. (a C.R. Bard Company) | Fixating means between a mesh and mesh deployment means especially useful for hernia repair surgeries and methods thereof |
WO2009059005A1 (en) * | 2007-10-31 | 2009-05-07 | Vanderbilt University | Device and method for positioning a surgical prosthesis |
US8128559B2 (en) | 2007-11-26 | 2012-03-06 | Ethicon Endo-Surgery, Inc. | Tissue retractors |
US8517931B2 (en) * | 2007-11-26 | 2013-08-27 | Ethicon Endo-Surgery, Inc. | Tissue retractors |
WO2009094476A1 (en) | 2008-01-22 | 2009-07-30 | Applied Medical Resources Corporation | Surgical instrument access device |
US20090326518A1 (en) * | 2008-02-14 | 2009-12-31 | Rabin Barry H | Devices and methods for manipulating tissue |
US8317808B2 (en) | 2008-02-18 | 2012-11-27 | Covidien Lp | Device and method for rolling and inserting a prosthetic patch into a body cavity |
US9393093B2 (en) | 2008-02-18 | 2016-07-19 | Covidien Lp | Clip for implant deployment device |
US9833240B2 (en) | 2008-02-18 | 2017-12-05 | Covidien Lp | Lock bar spring and clip for implant deployment device |
US9044235B2 (en) | 2008-02-18 | 2015-06-02 | Covidien Lp | Magnetic clip for implant deployment device |
US8808314B2 (en) * | 2008-02-18 | 2014-08-19 | Covidien Lp | Device and method for deploying and attaching an implant to a biological tissue |
US8758373B2 (en) | 2008-02-18 | 2014-06-24 | Covidien Lp | Means and method for reversibly connecting a patch to a patch deployment device |
US9398944B2 (en) | 2008-02-18 | 2016-07-26 | Covidien Lp | Lock bar spring and clip for implant deployment device |
US9034002B2 (en) | 2008-02-18 | 2015-05-19 | Covidien Lp | Lock bar spring and clip for implant deployment device |
US9301826B2 (en) | 2008-02-18 | 2016-04-05 | Covidien Lp | Lock bar spring and clip for implant deployment device |
WO2009104182A2 (en) | 2008-02-18 | 2009-08-27 | Polytouch Medical Ltd | A device and method for deploying and attaching a patch to a biological tissue |
US9393002B2 (en) | 2008-02-18 | 2016-07-19 | Covidien Lp | Clip for implant deployment device |
US8920445B2 (en) * | 2008-05-07 | 2014-12-30 | Davol, Inc. | Method and apparatus for repairing a hernia |
US8764630B2 (en) * | 2008-05-19 | 2014-07-01 | Olympus Medical Systems Corp. | Endoscopic surgical procedure and surgical apparatus |
EP3275386B1 (en) | 2008-10-13 | 2024-01-03 | Applied Medical Resources Corporation | Single port access system |
CA2730547C (en) * | 2008-10-20 | 2013-08-06 | Polytouch Medical Ltd. | A device for attaching a patch to a biological tissue |
US9504548B2 (en) | 2008-11-21 | 2016-11-29 | C.R. Bard, Inc. | Soft tissue repair prosthesis, expandable device, and method of soft tissue repair |
US8375955B2 (en) | 2009-02-06 | 2013-02-19 | Atropos Limited | Surgical procedure |
GB2467960A (en) * | 2009-02-23 | 2010-08-25 | Neosurgical Ltd | Laparoscopic surgical retraction device with expanding element and anchor arrangement |
US11903602B2 (en) | 2009-04-29 | 2024-02-20 | Hologic, Inc. | Uterine fibroid tissue removal device |
WO2011011372A2 (en) * | 2009-07-20 | 2011-01-27 | Ams Research Corporation | Needleless injection device components, systems, and methods |
AU2010276239B2 (en) * | 2009-07-21 | 2015-08-06 | Applied Medical Resources Corporation | Surgical access device comprising internal retractor |
US9999424B2 (en) * | 2009-08-17 | 2018-06-19 | Covidien Lp | Means and method for reversibly connecting an implant to a deployment device |
WO2011021083A1 (en) * | 2009-08-17 | 2011-02-24 | PolyTouch Medical, Inc. | Articulating patch deployment device and method of use |
WO2011033495A1 (en) | 2009-09-17 | 2011-03-24 | Atropos Limited | An instrument access device |
GB201006079D0 (en) * | 2010-04-13 | 2010-05-26 | Central Manchester University | Surgical device and methods |
US8702592B2 (en) | 2010-09-30 | 2014-04-22 | David Allan Langlois | System and method for inhibiting injury to a patient during laparoscopic surgery |
US9289200B2 (en) | 2010-10-01 | 2016-03-22 | Applied Medical Resources Corporation | Natural orifice surgery system |
US9289115B2 (en) | 2010-10-01 | 2016-03-22 | Applied Medical Resources Corporation | Natural orifice surgery system |
US9358073B2 (en) * | 2010-10-04 | 2016-06-07 | George Piligian | Expandable devices, rail systems, and motorized devices |
US9808331B2 (en) | 2010-10-05 | 2017-11-07 | C.R. Bard, Inc. | Soft tissue repair prosthesis and expandable device |
CN103281971B (en) * | 2011-01-04 | 2017-02-15 | 约翰霍普金斯大学 | minimally invasive laparoscopic retractor |
US8900135B2 (en) * | 2011-03-29 | 2014-12-02 | Covidien Lp | Single incision deployable platform |
ES2822115T3 (en) | 2011-05-10 | 2021-04-29 | Applied Med Resources | Wound retractor device |
WO2013009795A1 (en) | 2011-07-13 | 2013-01-17 | Cook Medical Technologies Llc | Foldable surgical retractor |
US8888692B1 (en) | 2011-08-26 | 2014-11-18 | Applied Medical Resources Corporation | Trocar cannula assembly and method of manufacture |
GB2495522B (en) * | 2011-10-12 | 2016-12-21 | Central Manchester Univ Hospitals Nhs Found Trust | Surgical device and methods |
US20130184535A1 (en) | 2012-01-10 | 2013-07-18 | The Board Of Trustees Of The Leland Stanford Junior University | Expandable tissue retraction devices |
US20130225920A1 (en) * | 2012-02-23 | 2013-08-29 | Covidien Lp | Surgical support assembly |
EP2830416A4 (en) | 2012-03-29 | 2015-12-16 | Lapspace Medical Ltd | Tissue retractor |
WO2013183058A2 (en) | 2012-06-07 | 2013-12-12 | Tulip Medical Ltd. | Expanded device |
KR102300866B1 (en) | 2013-03-15 | 2021-09-13 | 어플라이드 메디컬 리소시스 코포레이션 | Mechanical gel surgical access device |
EP2967648B1 (en) | 2013-03-15 | 2018-11-28 | Applied Medical Resources Corporation | Trocar cannula assembly with low profile insertion configuration and method of manufacture |
US10166376B2 (en) | 2013-06-11 | 2019-01-01 | Covidien Lp | Restricted expansion dissector |
CN104605900B (en) * | 2013-11-04 | 2017-04-12 | 上海交通大学医学院附属第九人民医院 | Skin expander capable of simultaneously providing biological additive effect |
CN103565483B (en) * | 2013-11-12 | 2016-08-17 | 广西大学 | Inflated type laparoscope pneumoperitoneum-free device |
EP3071134A1 (en) | 2013-11-19 | 2016-09-28 | Ethicon, Inc. | Thoracoscopic methods for treatment of bronchial disease |
EP3091962B1 (en) | 2013-12-05 | 2022-06-08 | Epitomee Medical Ltd. | Retentive devices and systems for in-situ release of pharmaceutical active agents |
WO2015118433A1 (en) | 2014-02-10 | 2015-08-13 | Darecchio Antonio | A pneumatic prosthetic positioner for videolaparoscopic laparoplasty |
US20150245828A1 (en) * | 2014-03-02 | 2015-09-03 | Lapspace Medical Ltd. | Tissue retractor |
US9044210B1 (en) | 2014-04-24 | 2015-06-02 | University Of South Florida | Power morcellation in a protected environment |
JP2017515593A (en) | 2014-05-13 | 2017-06-15 | ビコール メディカル,インコーポレイティド | Guide system attachment for a surgical introducer |
ES2703184T3 (en) | 2014-07-18 | 2019-03-07 | Applied Med Resources | Method for manufacturing gels that have permanent tack-free coatings |
US9801692B2 (en) * | 2014-08-07 | 2017-10-31 | Biomet Manufacturing, Llc | Instrument deployed tissue protector |
EP4101405A1 (en) | 2014-08-15 | 2022-12-14 | Applied Medical Resources Corporation | Natural orifice surgery system |
WO2016044072A1 (en) | 2014-09-18 | 2016-03-24 | Mayo Foundation For Medical Education And Research | Soft tissue cutting device and methods of use |
TR201412735A2 (en) | 2014-10-30 | 2016-05-23 | T C Ege Ueniversitesi | A laparoscopic closed morselayon bag and its method of use. |
US10028734B2 (en) * | 2014-11-13 | 2018-07-24 | Soft Robotics, Inc. | Soft robotic retractors |
EP3223718A2 (en) | 2014-11-25 | 2017-10-04 | Applied Medical Resources Corporation | Circumferential wound retraction with support and guidance structures |
US10272229B2 (en) | 2015-06-08 | 2019-04-30 | Endovention, Inc. | Method and apparatus for allowing inflation of inflatable elements within medical devices |
US10758218B2 (en) * | 2015-07-02 | 2020-09-01 | Atlantic Health System, Inc. | Lighted polyhedral retractor |
ES2836282T3 (en) | 2015-09-15 | 2021-06-24 | Applied Med Resources | Surgical robotic access system |
BR112018006815B1 (en) * | 2015-10-05 | 2022-11-22 | Bvw Holding Ag | MICROSTRUCTURED RETRACTOR |
EP3359057B1 (en) | 2015-10-07 | 2023-07-05 | Applied Medical Resources Corporation | Wound retractor with multi-segment outer ring |
US10058393B2 (en) | 2015-10-21 | 2018-08-28 | P Tech, Llc | Systems and methods for navigation and visualization |
US10391325B2 (en) | 2016-05-04 | 2019-08-27 | Cardiac Pacemakers, Inc. | Electrode designs in implantable defibrillator systems |
US10722265B1 (en) | 2016-09-09 | 2020-07-28 | Rebound Therapeutics Corporation | Expandable and collapsible brain cannula |
US11690604B2 (en) | 2016-09-10 | 2023-07-04 | Ark Surgical Ltd. | Laparoscopic workspace device |
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 |
WO2018064402A1 (en) * | 2016-09-30 | 2018-04-05 | Boston Scientific Scimed, Inc. | Pouch forming catheter |
US10543016B2 (en) | 2016-11-07 | 2020-01-28 | Vycor Medical, Inc. | Surgical introducer with guidance system receptacle |
US10376258B2 (en) | 2016-11-07 | 2019-08-13 | Vycor Medical, Inc. | Surgical introducer with guidance system receptacle |
US11235145B2 (en) | 2016-11-17 | 2022-02-01 | Cardiac Pacemakers, Inc. | Directional subcutaneous implantable cardioverter defibrillator electrode |
WO2018118818A1 (en) | 2016-12-21 | 2018-06-28 | Cardiac Pacemakers, Inc. | Lead with integrated electrodes |
EP3648703B1 (en) | 2017-07-04 | 2023-04-26 | Dentlytec G.P.L. Ltd. | Dental scanner with ultrasonic sensor component for augmentation of optical data |
EP3658069A4 (en) | 2017-07-26 | 2021-03-24 | Dentlytec G.P.L. Ltd. | Intraoral scanner |
EP3681408A1 (en) | 2017-09-10 | 2020-07-22 | Ark Surgical Ltd. | Laparoscopic workspace device |
US10864055B2 (en) | 2017-10-13 | 2020-12-15 | Sonex Health, Inc. | Tray for a soft tissue cutting device and methods of use |
US10463396B2 (en) * | 2017-10-23 | 2019-11-05 | Conmed Corporation | Devices for performing minimally invasive surgery having bellows support housing |
WO2019094502A1 (en) | 2017-11-07 | 2019-05-16 | Prescient Surgical, Inc. | Methods and apparatus for prevention of surgical site infection |
US11013501B2 (en) * | 2017-12-08 | 2021-05-25 | Davol, Inc. | Method of protecting the peritoneum against tearing and other injury before an active surgical intervention at or near the peritoneum |
CN112040880A (en) | 2018-02-15 | 2020-12-04 | 米奈特朗尼克斯神经有限公司 | Medical device for accessing the central nervous system |
EP3908215B1 (en) | 2019-01-11 | 2023-08-02 | Mayo Foundation for Medical Education and Research | Micro-invasive surgical device |
US11103228B2 (en) | 2019-03-29 | 2021-08-31 | Globus Medical Inc. | Tissue retractors |
US11413129B2 (en) | 2020-06-19 | 2022-08-16 | Davol Inc. | Implantable prosthesis |
USD989961S1 (en) | 2021-04-30 | 2023-06-20 | Sonex Health, Inc. | Soft tissue cutting device |
Citations (86)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US1060250A (en) * | 1912-06-06 | 1913-04-29 | Hawaiian Pineapple Co Ltd | System of treating fruit. |
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 |
US1947649A (en) * | 1931-12-05 | 1934-02-20 | Godfrey J Kadavy | Surgical instrument |
US2663020A (en) * | 1950-12-20 | 1953-12-22 | Cecil A Cushman | Pneumatic injury pad |
US2854983A (en) * | 1957-10-31 | 1958-10-07 | Arnold M Baskin | Inflatable catheter |
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 |
US3626949A (en) * | 1969-01-23 | 1971-12-14 | Wallace B Shute | Cervical dilator |
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 |
US3863639A (en) * | 1974-04-04 | 1975-02-04 | Richard N Kleaveland | Disposable visceral retainer |
US3882852A (en) * | 1974-01-11 | 1975-05-13 | Manfred Sinnreich | Surgical dilators having insufflating means |
US3961632A (en) * | 1974-12-13 | 1976-06-08 | Moossun Mohamed H | Stomach intubation and catheter placement system |
US4137906A (en) * | 1977-05-05 | 1979-02-06 | Koken Co., Ltd. | Catheter apparatus with occlusion and flow diverting means |
US4157085A (en) * | 1978-03-24 | 1979-06-05 | Dow Corning Corporation | Surgically implantable tissue expanding device and the method of its use |
US4183102A (en) * | 1977-09-08 | 1980-01-15 | Jacques Guiset | Inflatable prosthetic device for lining a body duct |
US4198981A (en) * | 1978-03-27 | 1980-04-22 | Manfred Sinnreich | Intrauterine surgical device |
US4209228A (en) * | 1977-09-28 | 1980-06-24 | Machida Endoscope Co., Ltd. | Pressure-light endoscope |
US4217889A (en) * | 1976-09-15 | 1980-08-19 | Heyer-Schulte Corporation | Flap development device and method of progressively increasing skin area |
US4240433A (en) * | 1977-07-22 | 1980-12-23 | Bordow Richard A | Fluid aspiration device and technique for reducing the risk of complications |
US4254762A (en) * | 1979-10-23 | 1981-03-10 | Inbae Yoon | Safety endoscope system |
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 |
US4291687A (en) * | 1978-03-02 | 1981-09-29 | Manfred Sinnreich | Inflatable packing for surgical use having auxiliary intestinal supporting member |
US4318410A (en) * | 1980-08-07 | 1982-03-09 | Thomas J. Fogarty | Double lumen dilatation catheter |
US4357940A (en) * | 1979-12-13 | 1982-11-09 | Detroit Neurosurgical Foundation | Tissue pneumatic separator structure |
US4430076A (en) * | 1982-02-04 | 1984-02-07 | Harris James H | Combined uterine injector and manipulative 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 |
US4517979A (en) * | 1983-07-14 | 1985-05-21 | Cordis Corporation | Detachable balloon catheter |
US4535773A (en) * | 1982-03-26 | 1985-08-20 | Inbae Yoon | Safety puncturing instrument and method |
US4574780A (en) * | 1984-11-13 | 1986-03-11 | Manders Ernest K | Tissue expander and method |
US4598699A (en) * | 1985-06-10 | 1986-07-08 | Garren Lloyd R | Endoscopic instrument for removing stomach insert |
US4601710A (en) * | 1983-08-24 | 1986-07-22 | Endotherapeutics Corporation | Trocar assembly |
US4612938A (en) * | 1982-09-04 | 1986-09-23 | Gesellschaft Fur Strahlen- Und Umweltforschung Mbh, Munchen | Method for illuminating cavities |
US4615704A (en) * | 1984-11-26 | 1986-10-07 | Dow Corning Corporation | Shape retention tissue expander and method of using |
US4648383A (en) * | 1985-01-11 | 1987-03-10 | Angelchik Jean P | Peroral apparatus for morbid obesity treatment |
US4651717A (en) * | 1985-04-04 | 1987-03-24 | Dow Corning Corporation | Multiple envelope tissue expander device |
US4654030A (en) * | 1986-02-24 | 1987-03-31 | Endotherapeutics | Trocar |
US4666447A (en) * | 1985-01-30 | 1987-05-19 | Mentor Corporation | Skin expansion device and method of making the same |
US4709697A (en) * | 1980-12-09 | 1987-12-01 | Joseph J. Berke | Tissue pneumatic separator structure and method |
US4719918A (en) * | 1986-05-08 | 1988-01-19 | Cox-Uphoff Corporation | Subperiosteal tissue expander |
US4723549A (en) * | 1986-09-18 | 1988-02-09 | Wholey Mark H | Method and apparatus for dilating blood vessels |
US4739762A (en) * | 1985-11-07 | 1988-04-26 | Expandable Grafts Partnership | Expandable intraluminal graft, and method and apparatus for implanting an expandable intraluminal graft |
US4763653A (en) * | 1985-02-19 | 1988-08-16 | Rockey Arthur G | Medical sleeve |
US4775371A (en) * | 1986-09-02 | 1988-10-04 | Advanced Cardiovascular Systems, Inc. | Stiffened dilatation catheter and method of manufacture |
US4779611A (en) * | 1987-02-24 | 1988-10-25 | Grooters Ronald K | Disposable surgical scope guide |
US4800901A (en) * | 1987-09-09 | 1989-01-31 | Lior Rosenberg | Balloon-type Tissue expansion device |
US4803029A (en) * | 1986-01-28 | 1989-02-07 | Pmt Corporation | Process for manufacturing an expandable member |
US4863440A (en) * | 1985-12-23 | 1989-09-05 | Thomas J. Fogarty | Pressurized manual advancement dilatation catheter |
US4878495A (en) * | 1987-05-15 | 1989-11-07 | Joseph Grayzel | Valvuloplasty device with satellite expansion means |
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 |
US4966583A (en) * | 1989-02-03 | 1990-10-30 | Elie Debbas | Apparatus for locating a breast mass |
US4976710A (en) * | 1987-01-28 | 1990-12-11 | Mackin Robert A | Working well balloon method |
US4984564A (en) * | 1989-09-27 | 1991-01-15 | Frank Yuen | Surgical retractor device |
US5002557A (en) * | 1989-04-06 | 1991-03-26 | Hasson Harrith M | Laparoscopic cannula |
US5007898A (en) * | 1988-06-02 | 1991-04-16 | Advanced Surgical Intervention, Inc. | Balloon dilatation catheter |
US5049132A (en) * | 1990-01-08 | 1991-09-17 | Cordis Corporation | Balloon catheter for delivering therapeutic agents |
US5082005A (en) * | 1990-12-18 | 1992-01-21 | New England Deaconess Hospital | Surgical access device |
US5084061A (en) * | 1987-09-25 | 1992-01-28 | Gau Fred C | Intragastric balloon with improved valve locating means |
US5083576A (en) * | 1989-04-19 | 1992-01-28 | Inamed Development Company | Elongation of linear and tubular tissue |
US5103804A (en) * | 1990-07-03 | 1992-04-14 | Boston Scientific Corporation | Expandable tip hemostatic probes and the like |
US5109875A (en) * | 1986-10-20 | 1992-05-05 | City Of Hope | Ring tissue expanders and their method of use |
US5116357A (en) * | 1990-10-11 | 1992-05-26 | Eberbach Mark A | Hernia plug and introducer apparatus |
US5122122A (en) * | 1989-11-22 | 1992-06-16 | Dexide, Incorporated | Locking trocar sleeve |
US5158548A (en) * | 1990-04-25 | 1992-10-27 | Advanced Cardiovascular Systems, Inc. | Method and system for stent delivery |
US5163949A (en) * | 1990-03-02 | 1992-11-17 | Bonutti Peter M | Fluid operated retractors |
US5176697A (en) * | 1989-04-06 | 1993-01-05 | Hasson Harrith M | Laparoscopic cannula |
US5178133A (en) * | 1991-03-26 | 1993-01-12 | Pena Louis T | Laparoscopic retractor and sheath |
US5183464A (en) * | 1991-05-17 | 1993-02-02 | Interventional Thermodynamics, Inc. | Radially expandable dilator |
US5183468A (en) * | 1991-04-02 | 1993-02-02 | Mclees Donald J | Snap ring needle guard |
US5188596A (en) * | 1990-09-27 | 1993-02-23 | Mentor Corporation | Transparent prostate dilation balloon and scope |
US5188630A (en) * | 1991-03-25 | 1993-02-23 | Christoudias George C | Christoudias endospongestick probe |
US5195507A (en) * | 1990-11-06 | 1993-03-23 | Ethicon, Inc. | Endoscopic surgical instrument for displacing tissue or organs |
US5197948A (en) * | 1991-01-03 | 1993-03-30 | Kamran Ghodsian | Intra-abdominal organ manipulator, irrigator and aspirator |
US5197971A (en) * | 1990-03-02 | 1993-03-30 | Bonutti Peter M | Arthroscopic retractor and method of using the same |
US5275610A (en) * | 1991-05-13 | 1994-01-04 | Cook Incorporated | Surgical retractors and method of use |
US5290249A (en) * | 1990-10-09 | 1994-03-01 | Vance Products Incorporated | Surgical access sheath |
US5331975A (en) * | 1990-03-02 | 1994-07-26 | Bonutti Peter M | Fluid operated retractors |
US5361752A (en) * | 1991-05-29 | 1994-11-08 | Origin Medsystems, Inc. | Retraction apparatus and methods for endoscopic surgery |
US7083369B2 (en) * | 2004-12-08 | 2006-08-01 | Bradford Company | Collapsible container with dunnage erection biaser |
Family Cites Families (25)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US1060350A (en) * | 1911-12-18 | 1913-04-29 | Robert E L Miller | Intestine-protector. |
DE502331C (en) | 1928-08-14 | 1930-07-15 | Still Fa Carl | Charging chamber furnaces |
GB502331A (en) * | 1937-09-16 | 1939-03-15 | Wolf Gmbh Georg | Improvements in oesophagoscopes |
US3417745A (en) * | 1963-08-23 | 1968-12-24 | Sheldon Edward Emanuel | Fiber endoscope provided with focusing means and electroluminescent means |
US4083369A (en) * | 1976-07-02 | 1978-04-11 | Manfred Sinnreich | Surgical instruments |
AU516114B2 (en) * | 1977-03-29 | 1981-05-21 | Frank Baskind Allen | Apparatus for obtaining oytological specimens |
JPS6051913B2 (en) * | 1977-11-04 | 1985-11-16 | オリンパス光学工業株式会社 | balloon catheter |
US4240443A (en) * | 1978-05-10 | 1980-12-23 | Institutul de Stiinte Biologice--Bucharest | Selective preamplifier of cell potentials |
SU797668A1 (en) * | 1978-06-13 | 1981-01-23 | Петрозаводский Государственныйуниверситет Им. O.B.Куусинена | Device for limiting surgery field on small pelvis |
US4207891A (en) * | 1978-10-10 | 1980-06-17 | Population Research Incorporated | Dispensing instrument with supported balloon |
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 |
GB2071502A (en) * | 1980-03-14 | 1981-09-23 | Nat Res Dev | Surgical retractors |
SU1367947A1 (en) * | 1985-03-21 | 1988-01-23 | Петрозаводский государственный университет им.О.В.Куусинена | Arrangement for restricting the operational field |
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 |
US4762130A (en) * | 1987-01-15 | 1988-08-09 | Thomas J. Fogarty | Catheter with corkscrew-like balloon |
FR2649324B1 (en) * | 1989-07-06 | 1991-10-31 | Dow Corning Sa | FLEXIBLE ARTICLE FOR SURGICAL TREATMENT, ASSEMBLY COMPRISING SAME AND METHOD OF USING SAME |
WO1991001687A1 (en) | 1989-07-31 | 1991-02-21 | Israel Barken | Ultrasound-laser surgery apparatus and method |
US5101814A (en) * | 1989-08-11 | 1992-04-07 | Palti Yoram Prof | System for monitoring and controlling blood glucose |
DE9104383U1 (en) * | 1991-04-10 | 1991-06-06 | Wisap Gesellschaft Fuer Wissenschaftlichen Apparatebau Mbh, 8029 Sauerlach, De | |
US5370134A (en) * | 1991-05-29 | 1994-12-06 | Orgin Medsystems, Inc. | Method and apparatus for body structure manipulation and dissection |
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. |
US6312442B1 (en) * | 1992-06-02 | 2001-11-06 | General Surgical Innovations, Inc. | Method for developing an anatomic space for laparoscopic hernia repair |
US5269753A (en) * | 1992-07-14 | 1993-12-14 | Wilk Peter J | Method for use in laparoscopic hernia repair |
-
1995
- 1995-11-21 US US08/561,160 patent/US5865728A/en not_active Expired - Lifetime
-
1998
- 1998-10-26 US US09/179,008 patent/US6605037B1/en not_active Expired - Fee Related
-
2003
- 2003-08-11 US US10/638,854 patent/US7766823B2/en not_active Expired - Fee Related
-
2010
- 2010-03-16 US US12/725,105 patent/US20100174149A1/en not_active Abandoned
Patent Citations (89)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US1060250A (en) * | 1912-06-06 | 1913-04-29 | Hawaiian Pineapple Co Ltd | System of treating fruit. |
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 |
US1947649A (en) * | 1931-12-05 | 1934-02-20 | Godfrey J Kadavy | Surgical instrument |
US2663020A (en) * | 1950-12-20 | 1953-12-22 | Cecil A Cushman | Pneumatic injury pad |
US2854983A (en) * | 1957-10-31 | 1958-10-07 | Arnold M Baskin | Inflatable catheter |
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 |
US3626949A (en) * | 1969-01-23 | 1971-12-14 | Wallace B Shute | Cervical dilator |
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 |
US4077412A (en) * | 1974-12-13 | 1978-03-07 | Moossun Mohamed H | Stomach intubation and catheter placement system |
US4217889A (en) * | 1976-09-15 | 1980-08-19 | Heyer-Schulte Corporation | Flap development device and method of progressively increasing skin area |
US4137906A (en) * | 1977-05-05 | 1979-02-06 | Koken Co., Ltd. | Catheter apparatus with occlusion and flow diverting means |
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 |
US4209228A (en) * | 1977-09-28 | 1980-06-24 | Machida Endoscope Co., Ltd. | Pressure-light endoscope |
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 |
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 |
US4357940A (en) * | 1979-12-13 | 1982-11-09 | Detroit Neurosurgical Foundation | Tissue pneumatic separator structure |
US4318410A (en) * | 1980-08-07 | 1982-03-09 | Thomas J. Fogarty | Double lumen dilatation catheter |
US4709697A (en) * | 1980-12-09 | 1987-12-01 | Joseph J. Berke | Tissue pneumatic separator structure and method |
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 |
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 |
US4612938A (en) * | 1982-09-04 | 1986-09-23 | Gesellschaft Fur Strahlen- Und Umweltforschung Mbh, Munchen | Method for illuminating cavities |
US4517979A (en) * | 1983-07-14 | 1985-05-21 | Cordis Corporation | Detachable balloon catheter |
US4601710B1 (en) * | 1983-08-24 | 1998-05-05 | United States Surgical Corp | Trocar assembly |
US4601710A (en) * | 1983-08-24 | 1986-07-22 | Endotherapeutics Corporation | Trocar assembly |
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 |
US4648383A (en) * | 1985-01-11 | 1987-03-10 | Angelchik Jean P | Peroral apparatus for morbid obesity treatment |
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 |
US4651717A (en) * | 1985-04-04 | 1987-03-24 | Dow Corning Corporation | Multiple envelope tissue expander device |
US4598699A (en) * | 1985-06-10 | 1986-07-08 | Garren Lloyd R | Endoscopic instrument for removing stomach insert |
US4739762B1 (en) * | 1985-11-07 | 1998-10-27 | Expandable Grafts Partnership | Expandable intraluminal graft and method and apparatus for implanting an expandable intraluminal graft |
US4739762A (en) * | 1985-11-07 | 1988-04-26 | Expandable Grafts Partnership | Expandable intraluminal graft, and method and apparatus for implanting an expandable intraluminal graft |
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 |
US4775371A (en) * | 1986-09-02 | 1988-10-04 | Advanced Cardiovascular Systems, Inc. | Stiffened dilatation catheter and method of manufacture |
US4723549A (en) * | 1986-09-18 | 1988-02-09 | Wholey Mark H | Method and apparatus for dilating blood vessels |
US5109875A (en) * | 1986-10-20 | 1992-05-05 | City Of Hope | Ring tissue expanders and their method of use |
US4976710A (en) * | 1987-01-28 | 1990-12-11 | Mackin Robert A | Working well balloon method |
US4779611A (en) * | 1987-02-24 | 1988-10-25 | Grooters Ronald K | Disposable surgical scope guide |
US4919152A (en) * | 1987-03-02 | 1990-04-24 | Ralph Ger | Method of closing the opening of a hernial sac |
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 |
US5084061A (en) * | 1987-09-25 | 1992-01-28 | Gau Fred C | Intragastric balloon with improved valve locating means |
US4944443A (en) * | 1988-04-22 | 1990-07-31 | Innovative Surgical Devices, Inc. | Surgical suturing instrument and method |
US5007898A (en) * | 1988-06-02 | 1991-04-16 | Advanced Surgical Intervention, Inc. | Balloon dilatation catheter |
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 |
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 |
US5163949A (en) * | 1990-03-02 | 1992-11-17 | Bonutti Peter M | Fluid operated retractors |
US5331975A (en) * | 1990-03-02 | 1994-07-26 | Bonutti Peter M | Fluid operated retractors |
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 |
US5188596A (en) * | 1990-09-27 | 1993-02-23 | Mentor Corporation | Transparent prostate dilation balloon and scope |
US5290249A (en) * | 1990-10-09 | 1994-03-01 | Vance Products Incorporated | Surgical access sheath |
US5116357A (en) * | 1990-10-11 | 1992-05-26 | Eberbach Mark A | Hernia plug and introducer apparatus |
US5195507A (en) * | 1990-11-06 | 1993-03-23 | Ethicon, Inc. | Endoscopic surgical instrument for displacing tissue or organs |
US5082005A (en) * | 1990-12-18 | 1992-01-21 | New England Deaconess Hospital | Surgical access device |
US5197948A (en) * | 1991-01-03 | 1993-03-30 | Kamran Ghodsian | Intra-abdominal organ manipulator, irrigator and aspirator |
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 |
US5275610A (en) * | 1991-05-13 | 1994-01-04 | Cook Incorporated | Surgical retractors and method of use |
US5183464A (en) * | 1991-05-17 | 1993-02-02 | Interventional Thermodynamics, Inc. | Radially expandable dilator |
US5361752A (en) * | 1991-05-29 | 1994-11-08 | Origin Medsystems, Inc. | Retraction apparatus and methods for endoscopic surgery |
US7083369B2 (en) * | 2004-12-08 | 2006-08-01 | Bradford Company | Collapsible container with dunnage erection biaser |
Cited By (16)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20110112373A1 (en) * | 2009-11-10 | 2011-05-12 | Trans1 Inc. | Soft tissue access apparatus and methods for spinal surgery |
US9011326B2 (en) | 2009-11-14 | 2015-04-21 | Spiway Llc | Soft tissue shield for trans-orbital surgery |
US20110118551A1 (en) * | 2009-11-14 | 2011-05-19 | SPI Surgical, Inc. | Collateral soft tissue protection surgical device |
US9451981B2 (en) | 2009-11-14 | 2016-09-27 | Spiway Llc | Surgical tissue protection sheath |
US20120203069A1 (en) * | 2009-11-14 | 2012-08-09 | Blake Hannaford | Surgical shield for soft tissue protection |
US8986201B2 (en) | 2009-11-14 | 2015-03-24 | Spiway Llc | Surgical tissue protection sheath |
US8814788B2 (en) * | 2010-05-13 | 2014-08-26 | Livac Pty Ltd | Suction retractor |
US9421032B2 (en) * | 2010-06-16 | 2016-08-23 | Covidien Lp | Seal port with blood collector |
US20110313250A1 (en) * | 2010-06-16 | 2011-12-22 | Tyco Healthcare Group Lp | Seal port with blood collector |
US20160338686A1 (en) * | 2010-06-16 | 2016-11-24 | Covidien Lp | Seal port with blood collector |
US10986984B2 (en) | 2013-03-13 | 2021-04-27 | Spiway Llc | Surgical tissue protection sheath |
US11039735B2 (en) | 2013-03-13 | 2021-06-22 | Spiway Llc | Surgical tissue protection sheath |
US10136881B2 (en) | 2014-02-11 | 2018-11-27 | Mayo Foundation For Medical Education And Research | Laparoscopic retractor devices |
US20170000470A1 (en) * | 2015-07-02 | 2017-01-05 | Atlantic Health System, Inc., a NJ non-profit corporation | Lighted Polyhedral Retractor |
US10123791B2 (en) * | 2015-07-02 | 2018-11-13 | Atlantic Health System, Inc. | Lighted polyhedral retractor |
US11583313B1 (en) | 2018-12-06 | 2023-02-21 | Spiway Llc | Surgical access sheath and methods of use |
Also Published As
Publication number | Publication date |
---|---|
US5865728A (en) | 1999-02-02 |
US7766823B2 (en) | 2010-08-03 |
US20040097792A1 (en) | 2004-05-20 |
US6605037B1 (en) | 2003-08-12 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US5743850A (en) | Endoscopic inflatable retraction device with additional inflatable chamber | |
US5531856A (en) | Endoscopic inflatable retraction devices | |
US6605037B1 (en) | Endoscopic inflatable retraction device | |
US5527264A (en) | Methods of using endoscopic inflatable retraction devices | |
US5562603A (en) | Endoscopic inflatable retraction device with fluid-tight elastomeric window | |
EP0637223B1 (en) | Retraction apparatus for endoscopic surgery | |
US5836871A (en) | Method for lifting a body wall using an inflatable lifting apparatus | |
US5304117A (en) | Closure method for use in laparoscopic surgery | |
US8328839B2 (en) | Balloon dissector with balloon tip cannula | |
US5211624A (en) | Surgical closure device method | |
US20060241651A1 (en) | Surgical port device and associated method | |
JP2003524471A (en) | Balloon incision device with improved visualization | |
WO1995030375A1 (en) | Inflatable surgical retracting apparatus and method |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
STCB | Information on status: application discontinuation |
Free format text: ABANDONMENT FOR FAILURE TO CORRECT DRAWINGS/OATH/NONPUB REQUEST |