A surgical sheath for use in endoscopic trans-nasal or intra-ocular surgery is made of a braid material. The sheath may be manufactured by placing a length of braided tube material over a mandrel. The braid material is conformed to the shape of the mandrel and is then heat set. An atraumatic end may be made by folding or rolling one or both ends of the sheath. A coating may also optionally be applied to the braid material. The sheath reduces collateral trauma to the tissues in the surgical pathway.

An improved method and device are provided for forming and/or maintaining a percutaneous access pathway. The device generally comprises an access pathway and attachment device. The provided assembly substantially reduces the possibility of iatrogenic infection while accessing and/or re-accessing a body space.

An access device for accessing an intervertebral disc having an outer shield comprising an access shield with a larger diameter (˜16-30 mm) that reaches from the skin down to the facet line, with an inner shield having a second smaller diameter (˜5-12 mm) extending past the access shield and reaches down to the disc level. This combines the benefits of the direct visual microsurgical/mini open approaches and the percutaneous, “ultra-MIS” techniques.

Apparatus described herein includes a tube, shaped to define a tube lumen and including a distal portion that has a plurality of articulated sections. The apparatus further includes a ribbon that passes longitudinally through the tube lumen and is connected to a distalmost one of the articulated sections, and a control handle disposed at a proximal end of the tube, the control handle being configured to flex the distal portion of the tube by pulling the ribbon. Other embodiments are also described.

A system for performing minimally invasive procedures in a body lumen of a patient including a flexible catheter having a first lumen configured and dimensioned to receive an endoscope therethrough and a second lumen configured and dimensioned to receive a first flexible tube therethrough. The first flexible tube is movable through the second lumen and has a distal portion including a first curve extending in a first direction with respect to the longitudinal axis and a second curve extending in a second different direction with respect to the longitudinal axis. A retractor system is positioned at a distal portion of the catheter and is movable from a non-expanded insertion position to an expanded position forming an expanded cage to form a larger working space. The distal portion of the first flexible tube is movable within the expanded cage.

Apparatus for placement in an incision of a natural body opening comprises a retractor having a sleeve (655, 656, 657) and a guard device comprising overlapping petals (662) depending from a mounting ring (661). The guard device is movable by the retractor from an insertion configuration to a deployed configuration as the retractor sleeve is moved to the retracting configuration.

An example assembly for use with a vacuum system and an esophageal positioning device esophageal positioning device includes an introducer, in which the esophageal positioning device includes a first segment and a second segment. The second segment is pivotally connected to the first segment. A gap portion of an outer tube of the introducer is defined along a longitudinal axis between a tube tip of the introducer and the distal end of the second segment of the esophageal positioning device when the esophageal positioning device is disposed within the introducer. The gap portion defines one or more radial vacuum holes.

Method and system for treating a patient using an inflatable device. A removal device may be used to remove the inflatable device from the body. The removal device can have at least one manually-actuatable member and at least two opposing jaws at a distal end. At least one of the at least two jaws can be movable by actuation of the at least one manually-actuatable member. At least one of the at least two jaws can have a puncturing member.

In laparoscopic surgery, small (5-12 mm diameter) incisions are made in an abdominal wall through which instruments dissect and remove specimens that may be several centimeters in diameter. Removal of a sample typically requires either enlarging these incisions or morcellating the sample to pass through sub-centimeter ports. A laparoscopic device permits extraction of the sample to be removed in a female using a vagina, which has sufficient elasticity to accommodate removal of large specimens. A posterior portion of the vagina communicates to an abdomen through a few tissue layers, and is distant from vital anatomic structures. Utilizing the vagina is optimal due to its ease of access to the abdomen and repair, minimal scarring and post-operative pain, and faster recovery following surgery. A deployable collection bag is housed in a sheath, which is deployed into the vagina or an abdominal cavity to extract a large (multiple-centimeter) specimen(s) through the vagina. An optional insufflation system and an inflatable balloon to maintain a pneumoperiotoneum may be used to reduce a number of laparoscopic ports required.

An apparatus comprising: a sheath comprising a plurality of openings at a distal end; an elongate first needle extendible perpendicularly from said sheath through one of said plurality of openings; and an assembly comprising at least two second needles arranged in a predetermined pattern relative to said first needle, and extendible perpendicularly from said sheath, wherein, when extended from said distal end of said sheath: (i) each of said second needles extends a different length from said distal end of said sheath, (ii) at least a distal portion of each of said second needles is resiliently biased to extend laterally outwardly in relation to said first needle, and (iii) a lateral spread region defined by said distal portions of all of said second needles is determined based, at least in part, on a distance of said extending from said distal end of said sheath.