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1. (WO1992021291) APPARATUS AND METHOD FOR PERITONEAL RETRACTION
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1. A method of lifting the abdominal wall for peritoneal retraction, said method comprising:
(a) forming a small opening in the abdominal
wall;
(b) inserting a lifting device through the
opening in a contracted state to dispose said device beneath abdominal wall;
(c) extending the lifting device to engage an extensive area of the abdominal wall; and,
(d) lifting the abdominal wall with the device.

2. A method according to Claim 1 wherein:
(a) at least a portion of the lifting device extends externally of the abdominal wall when the device is inserted into the condition
disposed beneath the wall; and,
(b) the abdominal wall is lifted by applying mechanical force to said portion.

3. A method according to Claim 2 wherein:
(a) the device comprises an elongate rod having a distal portion; and,
(b) the device is inserted through the puncture to feed the distal portion beneath the abdominal wall.

4. A method according to Claim 3 wherein the distal portion of the rod terminates in a balloon inflatable to shield tissue against snagging by the rod.

5. A method according to Claim 2 wherein:
(a) the device comprises an elongate rod; and,

(b) the device is expanded beneath the
abdominal wall by extending the rod through the puncture and across the wall.

6. A method according to Claim 5 wherein the rod is elevated to lift the abdominal wall.

7. A method according to Claim 5 wherein rod is bent to lift the abdominal wall.

8. A method according to Claim 5 wherein the rod is formed with a lateral offset and is turned to lift the abdominal wall.

9. A method according to Claim 2 wherein:
(a) the lifting device comprises an elongate
rod having a distal portion with an inflatable balloon secured thereto;
(b) the device is inserted through the opening to dispose the balloon beneath the abdominal wall; and,
(c) the device is extended beneath the wall by inflating the balloon.

10. A method according to Claim 2 wherein:
(a) the device comprises a pair of angle-shaped elements having first legs disposed in generally parallel relationship to each other and second legs extending laterally from the first legs;
(b) the device is inserted through the opening to dispose the second legs beneath the abdominal wall; and,
(c) the device is extended by turning the first legs relative to one another to move the second legs apart.

11. A method according to Claim 10 wherein:
(a) the second legs have inflatable balloons secured thereto; and,
(b) the device is further extended by inflating the balloons.

12. A method according to Claim 1 wherein:
(a) the lifting device includes a light
emitter; and,
(b) the light emitter is energized to
illuminate beneath the lifted abdominal wall.

13. A method according to Claim 1 wherein:
(a) the device comprises an balloon; and,
(b) the abdominal wall is lifted by inflating the balloon.

14. A method according to Claim 13 wherein:
(a) the balloon comprises a pair of balloon elements disposed on opposite ends of a rod;
and,
(b) the device is inserted so as to dispose the rod in generally parallel relationship to the abdominal wall.

15. A method according to Claim 13 wherein the balloon is comprised of a primary annular balloon element having an open central portion with a
secondary balloon element therein inflatable to laterally extend the primary element.

16. A method according to Claim 13 wherein the balloon is comprised of a primary annular balloon element having an open central portion with a membrane extending thereacross to drape over body tissue when the balloon is inflated to lift the abdominal wall.

17. A method according to Claim 13 wherein the balloon is U-shaped.

18. A method according to Claim 17 wherein a
membrane extends across the U-shaped balloon element to drape over body tissue when the balloon is inflated to lift the abdominal wall.

19. A method according to Claim 1 wherein the opening is formed by:
(a) piercing the abdominal wall with a needle having a tubular sheath therearound and
withdrawing the needle while leaving the sheath in place within the puncture formed by the
needle;
(b) extending a guidewire through the sheath and then removing the sheath;
(c) making a small incision in the abdominal wall adjacent the guidewire;

(d) advancing a dilator having a tubular sheath extending thereover over the guidewire and
through the incision; and,
(e) withdrawing the guidewire and dilator while leaving the sheath in place within the incision.

20. A method of removing the gallbladder from an abdominal cavity, said method comprising:
(a) laparoscopically inserting a compression generally inelastic balloon into the abdominal cavity and inflating the balloon to displace the liver and gallbladder for access; and,
(b) laparoscopically gripping the gallbladder externally of the compression balloon and
withdrawing the gallbladder from the body.

21. A method according to Claim 20 wherein the compression balloon is transparent and an endoscope is disposed within the compression balloon to view the gallbladder.

22. A method according to Claim 20 wherein an endoscope is extended through the compression balloon to view the gallbladder.

23. A method according to Claim 20 wherein the" gallbladder is gripped and laparoscopically withdrawn by:
(a) externally gripping the gallbladder;
(b) laparoscopically piercing the gallbladder
with a needle carrying a gripping balloon to
dispose the gripping balloon within the
gallbladder;
(c) inflating the gripping balloon to
internally grip the gallbladder;
(d) manipulating the needle with the
gallbladder engaged; and,
(e) withdrawing the needle with the gallbladder engaged therefrom from the body.

24. A method according to Claim 23 wherein the gallbladder is drained through the needle prior to inflation of the gripping balloon.

25. Apparatus for lifting the abdominal wall for peritoneal retraction, said apparatus comprising:
(a) abdominal wall engaging means insertable
through a small incision in the abdominal wall, said means being expansible beneath the
abdominal wall to engage an extended area of the abdominal wall; and, (b) lifting means impart lifting force to the to the abdominal vail through the engaging
means.
26. Apparatus according to Claim 25 wherein:
(a) the engaging means comprises a primary
balloon fabricated of a generally inelastic flexible material shaped to expand laterally into engagement with an extended area of the
*.
abdominal wall upon inflation; and,
(b) the lifting means selectively forces the balloon against the abdominal vail to impart lifting force thereto.

27. Apparatus according to Claim 26 wherein the balloon is selectively expansible to provide the lifting means.

28. Apparatus according to Claim 27 wherein the balloon is transparent, said apparatus further comprising an endoscope disposed within the balloon.

29. Apparatus according to Claim 27 wherein the balloon includes means to enable an endoscope to be extended fully therethrough.

30. Apparatus according to Claim 26 wherein the lifting means comprises an elongate element secured to the balloon and extensible through a puncture opening in the abdominal wall.

31. Apparatus according to Claim 26 wherein the balloon is toroidal and a membrane extends
thereacross to drape body tissue when the balloon is expanded beneath the abdominal wall.

32. Apparatus according to Claim 26 wherein the balloon is U-shaped and a membrane extends
thereacross to drape body tissue when the balloon is expanded beneath the abdominal wall.

33. Apparatus according to Claim 26 wherein:
(a) the balloon comprises a plurality of
stacked toroidal chambers; and,
(b) the chambers are selectively inflatable to provide said lifting means.

34. Apparatus according to Claim 33 further
comprising a membrane secured to the balloon to extend across the toroidal chambers when the balloon is inflated.

35. Apparatus according to Claim 34 wherein the membrane is apertured to provide access therethrough.

36. Apparatus according to Claim 26 wherein the primary balloon is toroidal, said apparatus further comprising a secondary balloon within the primary balloon, said secondary balloon being inflatable to laterally expand the primary balloon.

37. Apparatus according to Claim 26 wherein:
(a) the balloon comprises a plurality of
stacked U-shaped chambers; and,
(b) the chambers are selectively inflatable to provide said lifting means.

38. Apparatus according to Claim 37 further
comprising a membrane secured to the balloon to extend across the U-shaped chambers when the balloon is inflated.

39. Apparatus according to Claim 38 wherein the membrane is apertured to provide access therethrough.

40. Apparatus according to Claim 24 wherein the lifting means comprises:
(a) an element secured to the abdominal wall engaging means and extensible through --the
abdominal wall when the engaging means is
expanded to engage an extended area of the
abdominal wall;

(b) an arm attachable to said elements; and,
(c) elevation means carrying said arm, said
elevation means being mountable in fixed
relation to the abdominal wall and selectively operable to raise and lower the arm.

41. Apparatus according to Claim 25 wherein the engaging means comprises a pair of angle-shaped elements moveable relative to one another, said elements having first legs disposed in generally parallel relationship and second legs extending laterally from said first legs to fan out upon rotation of said first legs relative to one another.

42. Apparatus according to Claim 41 further
comprising selectively inflatable balloons carried by said second legs.

43. Apparatus according to Claim 25 further
comprising light emitting illumination means carried by said engaging means.

44. Apparatus according to Claim 25 wherein:
(a) the engaging means comprises an elongate rod having an intermediate portion of a length sufficient to extend through and across the
abdominal wall and proximal and distal portions proportioned to extend out of opposite sides of the abdominal wall when the intermediate portion is extended through and across the wall; and,
(b) the lifting means comprises support
elements engagable with the distal and proximal ends of the rod to support the rod in an
elevated condition.

45. Apparatus according to Claim 25 wherein:
(a) the engaging means comprises an elongate rod extensible through and across the abdominal wall; and,
(b) the lifting means comprises an element
extensible through the abdominal for lifting
engagement with the rod.

46. Apparatus according to Claim 25 wherein:
(a) the engaging means comprises an elongate rod having an intermediate portion of a length sufficient to extend through and across the
abdominal wall and proximal and distal portions proportioned to extend out of opposite sides of the abdominal wall when the intermediate portion is extended through and across the wall, said center portion being laterally offset relative to the proximal and distal portions; and.

(b) the lifting means comprises support
elements engagable with the distal and proximal ends to support the rod and means to turn the
rod while so supported.

47. Apparatus according to Claim 25 wherein:
(a) the engaging means comprises an elongate
rod having an intermediate portion of a length
sufficient to extend through and across the
abdominal wall and proximal and distal portions proportioned to extend out of opposite sides of the abdominal wall when the intermediate portion is extended through and across the wall, said intermediate portion being fabricated of a shape memory alloy capable of assuming a laterally
offset position relative to the proximal and
distal portions upon being heated; and,
(b) the lifting means comprises support
elements engagable with the distal and proximal ends of the rod to support the rod in an
elevated condition and a heater to impart heat to the intermediate portion of the rod.

48. Apparatus for withdrawing the gallbladder from an abdominal cavity, said apparatus comprising:
(a) compression balloon means laparoscopically insertable into the abdominal cavity and inflatable to compress the liver and displace the gallbladder for access; and,
(b) gripping means laparoscopically insertable into the abdominal cavity externally of the
compression balloon means to grip and withdraw
the gallbladder from the abdominal cavity.

49. Apparatus according to Claim 48 wherein the balloon means comprises a transparent flexible balloon fabricated of generally inelastic material, said apparatus further comprising:
(a) access means to permit the insertion of an endoscope into the balloon while inflated in the abdominal cavity; and,
(b) an endoscope insertable through the access means and into the balloon to view through the balloon.

50. Apparatus according to Claim 48, further
comprising:
(a) access means to permit an endoscope to be extended through the balloon while inflated in the abdominal cavity; and,
(b) an endoscope extensible through said access means.

51. Apparatus according to Claim 48 wherein the gripping means comprises:
(a) an elongate tubular shaft having a
sharpened distal end for piercing the
gallbladder; and,
(b) a balloon carried by the shaft for
insertion into the gallbladder and expansion
into internal gripping engagement therewith.

52. Apparatus according to Claim 51 further comprising an opening formed in the shaft to enable the contents of the gallbladder to be drawn into the shaft upon entry of the shaft into the gallbladder.

53. Gripping apparatus for removing the gallbladder from an abdominal cavity, said apparatus comprising: (a) an elongate tubular shaft having a
sharpened distal end for piercing the
gallbladder; and,
(b) a balloon carried by the shaft for
insertion into the gallbladder and expansion into internal gripping engagement therewith.

54. Apparatus according to Claim 53 further
comprising an opening formed in the shaft to enable the contents of the gallbladder to be drawn into the shaft upon entry of the shaft into the gallbladder.