An introducer cannula for use in crossing pleural layers includes an elongate tubular member and a pleural access liner. The elongate tubular member has a proximal end, a distal end, and a side wall that longitudinally extends between the proximal end and the distal end. The side wall has an outer surface and an inner surface, wherein the inner surface defines a lumen. The pleural access liner is made of a swellable and bioabsorbable material that swells when hydrated. The pleural access liner has a shape of an elongate tube and the pleural access liner has an elongate opening that surrounds an outer surface portion of the outer surface of the elongate tubular member.

In some embodiments, a microsurgical instrument includes a trocar having a rigid, hollow shaft formed with a lumen extending from a proximal end to a distal end of the shaft. The distal end of the shaft may be shaped for tissue penetration. The instrument may further include a composite microcannula slidably engaged with the trocar in the lumen. The microcannula includes a light guide and a flexible hollow tube having an outer diameter less than an inner diameter of the lumen in the trocar. Other embodiments include placing the microcannula in the lumen of the trocar, illuminating the end of the trocar by illuminating the end of the microcannula, advancing the trocar from a selected entry point on an eye into a selected structure in the eye, and extending the illuminated end of the microcannula from the trocar into the selected structure.

A kyphoplasty system includes various instruments which can be selectively used in a surgical theater (e.g., during a surgical operation on a patient) or a surgical training environment. The kyphoplasty system can include one or more of a kyphoplasty apparatus, a prone table mat, a connector system, a bone introducer needle, and a biopsy device. The kyphoplasty system may also include a training system for use in the training environment.

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes inserting an intramural crossing device into the vascular lumen, positioning at least the distal tip of the crossing device in the vascular wall, advancing an orienting device over the crossing device such that an orienting element of the orienting device resides in the vascular wall, inserting a reentry device, and re-entering the true vascular lumen.

An access device places a medical article within a body space of a patient. The device has a needle that includes an elongated body and a needle hub. The device further includes a dilator disposed on and slideable along the elongated body of the needle and a medical article. The medical article is disposed on and slideable along the dilator. A track extends in a proximal direction from the dilator. The needle hub slides along at least a portion of the track between a first position and a second position. The device further includes a locking mechanism operably disposed between the track and the needle hub so as to inhibit further axial movement of the needle in the proximal direction when the needle hub is in the second position.

The present disclosure provides an access system having a maneuverable catheter assembly configured for providing access to and navigating a desired vessel for subsequent treatment thereof. The access system includes an adjustable delivery handle assembly and an access catheter subassembly having a maneuverable access catheter configured to be delivered to desired site (e.g., within duodenum) to assist in treatment of a condition (e.g., drainage of a bile ducts via Endoscopic Ultrasound Guided Biliary Drainage (EUS-BD) techniques). The access catheter includes at least a distal section having an adjustable portion along a length thereof configured to transition to a pre-defined arcuate shape to provide directional control over the distal end of the catheter as it is navigated through a vessel (e.g., bile duct). The handle assembly includes additional elements configured to allow a clinician to maneuver and manipulate the distal end of the access catheter.

This document relates to the apparatus and methods used in the minimally invasive creation of arteriovenous fistula (AVF). In particular, the invention relates to the creation of an AVF using catheters and an alignment methodology that is based upon detection of asymmetric electric fields. The invention finds particular application in vascular access (VA) in the hemodialysis (HD) population.

One embodiment is directed to a geometric adaptor apparatus for assisting with translumenal vascular access, comprising a dilator adaptor member having proximal and distal ends and defining a dilator adaptor lumen therethrough, wherein the dilator adaptor lumen is defined by an inner diameter profile sized to accommodate insertion of one or more portions of a guidewire, and wherein the dilator adaptor is further defined by an outer diameter profile sized to accommodate at least partial insertion of the proximal end of the dilator adaptor into a dilator member lumen formed through a dilator member, the dilator member being coupleable to an introducer catheter member through an introducer member lumen formed through the introducer member.

An introducer for a tracheostomy tube is formed of several articulated sections (24) that can be changed from a relatively flexible state to a more rigid state by tightening a tension member extending along the introducer using an actuator at its machine end. In its flexible state the introducer can be inserted into and removed from the tube. The introducer is put in its more rigid state for use in inserting the tube into a tracheostomy. Alternatively or additionally the introducer could have several gripping rings on its outside towards its patient end and two elongate members that can be slid relative to one another to enlarge the patient end so that the gripping rings engage and grip the inside of the tube, thereby enabling the introducer to pull the tube through the tracheostomy from its patient end.

Shaped liver biopsy sheaths and methods for transfemoral transcaval liver access are disclosed. The present invention provides methods of obtaining a tissue sample from the liver of a patient, the methods comprising inserting a hollow sheath, such as a stiffened sheath with an angled tip, through a femoral vein into a portion of the inferior vena cava (IVC) adjacent to the liver, wherein the sheath's tip is in the intrahepatic IVC and wherein the sheath has a shape that brings the tip of the sheath adjacent to the wall of the IVC at an angle that is optimal to allow penetration of the wall of the IVC by a biopsy needle, and inserting a biopsy needle through the sheath and through the wall of the NC into the liver to obtain a tissue sample from the liver.