A fixed angle instrument includes an elongate guide extending from a proximal end to a distal end, the guide having a proximal portion extending along a longitudinal axis and a distal portion extending transverse to the longitudinal axis. The instrument further includes a shaft disposed within the guide extending through the proximal portion of the guide along the longitudinal axis. The instrument further includes an intermediate element coupled to the shaft, the intermediate element having at least one bulbous link. The instrument further includes a distal element coupled to a distal end of the intermediate element.

Methods and devices are disclosed herein that generally provide protection for devices (e.g., microcatheters) having small tips. Methods and devices are also disclosed herein that generally facilitate use of commercially-available stereotactic systems with devices (e.g., microcatheters) having small tips.

A Veress needle is modified to receive a forward-looking miniature videoscope through the lumen of an insufflation tube of the Veress needle. The modified instrument enables direct viewing of progress of the instrument through tissue to the peritoneal cavity of a patient, for proper location of the needle and insufflation of the cavity via the needle. The videoscope has an elongated shaft of smaller diameter than the lumen of the insufflation tube for passage of insufflation gas with the scope in place. In another embodiment a needle is fitted with a miniature videoscope to provide the same function, with the needle's lumen serving as an insufflation tube.

A minimally invasive tissue incision system for creating joint capsulotomies and releasing/incising various tissues, tendons, and fibrous band structures is described. The system contains a penetrating needle which is retractable so as to expose a cutting element, and which may be used as a penetrating needle to pierce the skin and other soft tissue structures. The cutting element provided within the penetrating needle may be used to incise subsequent tissue structures after the initial penetration. The system facilitates such procedures by providing the cutting element with the confines of the needle which provides safe introduction of the cutting element directly to the site via the needle.

A combined system for diagnostic and therapeutic procedures includes a needle extending longitudinally from a proximal end to a distal end and including a lumen extending therethrough, the distal end including a sharp grind for cutting a tissue sample to be collected in the lumen of the needle and a protective sheath sized and shaped to be inserted through the lumen of the needle such that a distal end of the protective sheath extends distally past the distal end of the needle, the protective sheath extending longitudinally from a proximal end to the distal end and including a lumen extending therethrough.

A flexible cannula device and delivery system for use in arthroscopic surgery. The delivery system engages the flexible cannula from the inside near the distal tip and pushes it into the surgical portal, essentially pulling the proximal portion of the cannula from the distal tip while being pushed from the proximal end with the specialized driver. The delivery system provides for single point engagement at the distal tip as well as a multiplicity of engagement points along the length of the system.

A needle assembly for pleural space insufflation is disclosed. The needle assembly has an outer shaft defining one or more pliable tissue receivers. The needle assembly also has a needle moveable within the outer shaft from a retracted position to an engaged position that does not extend past a distal end of the outer shaft. A method of pleural space insufflation is also disclosed. A parietal pleura is contacted with a distal end of an outer shaft that defines one or more pliable tissue receivers. The distal end of the outer shaft is pushed against the parietal pleura so that a portion of the parietal pleura enters the one or more pliable tissue receivers. A needle is advanced within the outer shaft so that the needle pierces the parietal pleura.

An invention for transfixing a plurality of cannulas 14 through a tissue 25 for providing a plurality of entry-ports 33 to a surgical site 26, comprising: a base 10; and a plurality of cannulas 14 connected to said base 10; wherein each said cannula 14 includes an access-port 3, is provided. Also, the invention for transfixing a plurality of cannulas 14 through a tissue 25 for providing a plurality of entry-ports 33 to a surgical site 26, comprising: a sleeve 9 including a base 10; said sleeve 9 including a plurality of cannulas 14 connected to said base 10; a mandrel 1 including a handle 7; and said mandrel 1 including a plurality of piercing tips 2 connected to said handle 7; wherein said mandrel 1 detachably engage said sleeve 9 forming a single punch assembly; wherein said cannula 14 includes an access-port 3 to a surgical site 26, is provided.

In a method of forming an access route to the bile duct, a needle is introduced into a duodenum, and the introduced needle is pierced into an oral side projection of a duodenal papilla, which is located at an oral position than an opening of the duodenal papilla. The tip of the pierced needle is made to reach the inside of the bile duct to form a tunnel communicating the duodenum and the bile duct, and a treatment device is inserted into the formed tunnel.

A tissue retractor comprising an outer ring, an inner ring, and a flexible, metal sheath extending therebetween is described. Embodiments of the inner ring comprise a flat or wedge-shaped conformation useful for insertion between muscle layers. Other embodiments of the inner ring include variable diameter inner rings, where the diameter can be adjusted as required and optionally locked into place, and reshapeable inner rings that permit a user to conform the inner ring to the anatomy of the patient when placing the inner ring.