US2182390A - Surgical device - Google Patents

Surgical device Download PDF

Info

Publication number
US2182390A
US2182390A US12039237A US2182390A US 2182390 A US2182390 A US 2182390A US 12039237 A US12039237 A US 12039237A US 2182390 A US2182390 A US 2182390A
Authority
US
Grant status
Grant
Patent type
Prior art keywords
member
guide
instrument
means
slide
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.)
Expired - Lifetime
Application number
Inventor
William F Reardon
Original Assignee
William F Reardon
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Grant date

Links

Images

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/24Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the mouth, i.e. stomatoscopes, e.g. with tongue depressors; Instruments for opening or keeping open the mouth
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00147Holding or positioning arrangements

Description

Dec. 5', E939. w. F. REARDON 2,182,390

SURGICAL DEVICE Filed Jan. 13, 1937 Patented Dec. 5, 1939 Unit" stares r'ATE r OFFICE SURGICAL DEVICE William F. Reardon, West Hartford, Conn.

Application January 13, 1937, Serial No. 120,392

7 10 Claims. .(Cl. 128-6) My invention relates to surgical devices. It has among its objects to provide an improved surgical device, and also to provide such an improved device especially adapted to use 5, when examining, operating on, or treating, the area in back of the nose and above the palate. A further object of my invention is to provide an improved device whereby this area, which it has heretofore been impossible to examine save by contact with the finger, may be made visible and illuminated, and made readily accessible to needed instruments or the like, all while work-, ing through the patients open mouth. A still further object of my invention is to provide such an improved device in which both the illuminating means and the instrument may be disposed in a variety of different positions, in such manner as markedly to extend their possible range of use, while also expediting and markedly facili- ZO-tating the work of the surgeon. Other objects of my invention are to provide such an improved device having improved angularly adjustable means for moving and holding the palate out of the way while permitting the light and instrument to have access to the space above and in back of the palate, and also to provide improved light and instrument supporting and guiding means adapted to enable the light and instrument to be readily adjusted angularly or 30 longitudinally as desired and moved through and in rear of said palate holding means. Still other objects of my invention are to provide such an improved device which may be inverted and then placed in the mouth in such position as to be 35 adapted to use when working on the throat in the region of the larynx, and also to provide such a device wherein in all uses thereof and when obtaining the above advantages and while the device is'as'sociated with a gag adapted to open 4 the patients mouth through engagement with the teeth, it is possible to minimize the amount of equipment necessarily inserted in the mouth the disposition of the illuminating and operating 55, me'ans-relative to the various organs;

Fig. 2 is a detail section on line 22 of Fig ure 1;

Fig. 3 is a detail view partially in section' showing the connecting means for the palate or epiglottis holding ring;

Fig. 4 is a detail View similar to Figure l but showing the device thereof merely inverted to permit it to be used in throat work;

Fig. 5 is a view similar to Figure 4 but showing a modified detachable form of construction also adapted for use in both areas, the same in this view'being shown as applied to throat work, and

Fig. 6 is a detail view of a further modified form of invertible construction.

Referring first to the form of my invention shown in Figures: 1 to 3, it will be noted that'the same is shown as carried upon a' well known form of -mouth opening gag including tooth engaging elements I, 2 insertable between the patients teeth and relatively adjustable to openthe patients mouth. Herein, these elements are adjustable by moving the member I longitudinally relative to a usual slide 3 which is connected by a usual swinging bail t (the shape of which is shown in dotted lines in Fig. 1) with the upper" member 2, the member i being adjustable as de-' sired relative to the member 2 and slide 3 by means of usual operating ratchet mechanism 5. Further, my improved device is carried in an improved manner'by the movable element of this gag structure and is of an'improved adjustable construction and adapted to carry an electric light, generally indicated at L, and any selected instrument, generally indicated at I, and to permit the illumination of and work in the area, generally indicated at A, in rear of the patients nose andabove the palate, all'as will more fully hereinafter appear.

In my improved construction, the tooth engaging member projects laterally a substantial distance beyond a carrying portion 6, herein disposed at right angles thereto, in such manner as to provide ample room for the patients lip. Fur ther, the portion 6 is provided on its upper end,

above the member i, with an extension I and.

the latter carries a lug 8 transversely apertured as at 9 and extending in the opposite direction from the member I from the opposite side of the the upper end of the mg in suchmanner that this member III may move freely about the screw Y I3 on a transverse axis without striking the extension I. As shown, the member III is also provided on its top with lateral guides I4 on its opposite edges which provide between the same a guideway open at the top and adapted to readjacent the handle I6, an elongated light and instrument guide structure I8 having its bottom suitably fixed to the upper surface of the member l5. Here also it will be noted that suitable means are provided for holding the member I in any desired position of adjustmentin the member'ifl,

these means in the illustrative structure shown in Figure 1 including a spring plate I9 adapted to be inserted'beneath the slide I5, and which, through frictional action, tends to hold the guide I5 in any of its'several positions of adjustment.

Referring more particularly to the light and instrument guide structure I 8, it will be noted that the same comprises a plurality of elongated parallel guiding sleeves 2|], 2| and 22, each of which is in the form of a tube having a longitudinally extending opening in its periphery. Two of these members 20 and 2| are herein oppositely disposed, back to back, with their openings at the outer sides thereof as shown, and their bottoms connected as by soldering or brazing, to the top of the slide I5, while the member 22 has its opening in the top and is centrally supported on and fixed to the tops ofthe members 20, 2| between the tops thereof. Further, it will be noted that each of these members 20, 2| and 22 is of substantial length, as shown in Figure 1 and that the inside diameter of each of these members is the same. that with the member 22 fixedto the members 20 and 2| and these latter members 20, 2| fixed to the slide 5, an elongated guideway and support is provided in which various desired arrangements of lighting means and instruments may be carried in the different members 20, 2| and 22.

For example, I have shown herein a light L having a cylindrical body 23 adapted to be slidably and rotatably received in any of these sleeves 20, 2| and 22 and also having a usual eye piece 24 'and'electrical connection 25 on one end andalight 26 on the other extremity, this light L being one similar to those used in examinations of the bladder and being adapted to permit lateral vision after the manner of a periscope. Further, I have shown an instrument I .having a like cylindrical body 21 and herein, for example, a cutting instrument carrying a usual blade 28 on its inner end operative in the usual manner from the opposite end of the instrument, the cylindrical body 21 herein being disposed in and similarly rotatable and reciprocable in any sleeve. Thus, it will be evident that with the sleeves 20, 2|, 22 disposed as described, and the bodies 23, 21 of the'light L and instrument I of the same diameter, the light and instrument may be arranged in any of several different positions in the severalv sleeves, i. e., in the arrangement best adapted to meet the circumstances. Further, it will be evident that in any position, both the light L and the instrument I may be'moved longitudinally or rotated in their sleeves as desired in Thus, it will be evident order to bring them into a more advantageous position. v

Cooperating with both the light L and the instrument I is the improved ring I'I carried on the inner end of the slide I5. Herein this ring is ofa substantially greater area than the meme ber I8 including the several sleeves, the ring extending upward and slightly outwardly relatively tothe lower edges of the openings in the sleeves 20 and, 2| and then around and substantially above the top .of the sleeve 22. Thus, ample space is provided for the insertion of the light or instrument through the ring, while still enabling the upper end of the latter to engage and pull backuthe palate, herein indicated at P. Accordingly, as shown in Figure 1, the light from the lamp 26 may 'illumine the whole area A in back of, the nose, while also enabling any laterally protruding part 28 of the instrument 21 to be used as desired in this space A in rear of the ring II.

Here attention is also directed to the fact that, While the ring I! may be permanently connected to the front end of the guide I5, it is "also preferably suitably removably connected thereto. Herein, for example, I provide a longitudinal passage 29 inthefront end of the slide l5 and a'communicating enlargement 30 in rear of this passage, and also provide longitudinally extending spring portions 3| on the base of the ring II, and lateral extensions 32 on these portions 3| which are adapted to catch over the end walls of the enlargement 30 and thereby hold the ring I? securely in position. Further, it will be un-, derstood that in practice the ring I! may be of varying size and conformation to meet different circumstances, while still continuing to perform its functions of 'pulling the palate forward andpermitting access through the ring to the space A inbackofthe palate.

In the use of my improved construction, the patients mouthds opened in the usual manner by insertingthe tips of the members I and 2 between the teeth and operating the ratchet mechanism 5 of the gag. After the patients mouth has been opened to the desired degree, themember Ill israised from the inoperative dotted line with. the light L thereon, is then inserted longitudinally in the member II]. The member Ill being carried on the swivelfl3, it will also be evident that by manipulation of the handle I6, both the angle and longitudinal position of the slide I5 and the light L may be varied as desired, in

such manner as readily to permit the ring I! to be located below and in back of the palate. Thereupon, the angle and longitudinal position of the parts may be similarly readily-changed to raise the ring II, and the lattermayalso be pulled forward as desired, in such manner as to pullthe palate forward, allwhile permitting the light and anyinstrument subsequently required to be inserted 'throughthe ring and below the palate into the space between the ring and the back wall of thev throat. Thus, it will be evident that the en-r tire areaA may be examined and treated or operated on'with facility as necessary, thelconstruction being such that the light and mam;

ment maybe changed from one sleeve to an; other, while another instrument mayof coursealso be substituted, or two maybe made available atthe same time whenever desired. Attention is further directed to-the fact that, while holding the guide lE by means of the handle I5,; the surgeon is enabled to eifect adjustments angularityor longitudinal l position, while his other hand is free to manipulate the light or instrument as necessary, all while he looks through v the eye-piece 24. Obviously, also, when the desired work has been done, the entire apparatus may be quickly removed, as by either first withdrawing the instrument and light and then depressing the inner end of the guide It to depress the ring ill and permit withdrawal of the latter, or by merely depressing the guide l so that the ring clears the palate and then bodily withdrawing the guide l5 with the light and instrument thereon; the member then dropping back outside the mouth into the dotted line position shown in Figure 1 and the whole gag then also being removable in a usual manner.

As a result of the use of my improved construction, it is made possible for the first time, so far as I am advised, to illumine, and to treat or operate upon the area in back of the nose and above the palate while this area is illumined, and accordingly to obtain results heretofore unobtainable. Further, with my improved construction, it is possible to utilize various instruments and technique in this new area such as have, in general, heretofore only been usable in kidney and bladder work. Attention is further directed to the fact that, if desired, as shown in Figure 4, the device illustrated in Figure 1 may, without change, be inverted and placed in the mouth with the member 2 in engagement with the lower teeth and the member I in engagement with the upper teeth and used for work in the throat. In this position of the device, it will be evident that the member lil will be a pendent member and the guide It and ring ll will depend therefrom; all while continuing to enable the described adjustment of the guide Has to angularity and longitudinal position and the desired longitudinal and rotary adjustment of the light L and any instrument I in the sleeves 2t, 2|, 22. Thus, it is possible to use the ring H as a holding means for the epiglottis, generally indicated at E, and to use the light and the instruments in the same general manner heretofore described, in the area B adjacent or below the epiglottis. In this connection, it will, of course, also be understood that with the ring ll removable as described, various other forms of ring may be readily substituted for that shown, including rings of different sizes and disposed at different angles to the member l5, as adapted to meet different conditions.

In Figure 5, I have illustrated a modified construction which may be used if desired. In this construction, the members and 6 and lug 'l are as previously described, but it will be noted that I have modified the member 2 and the construction at the upper end of the member 4 which constitutes the support for the member 2. More particularly, the member 2 is provided with an outwardly extending lug 33 connected by a vertical screw 36 to a lug of the member 4 to permit the member 4 to swivel relative to the upper end 35 of the screw 34. Further, it will be observed that an additional outwardly extending lug 35 is provided on the outer extremity of the lug 33 and below the latter, and that the slide guide I0 is pivotally connected to this lug 36 by a swivel screw 3'! at right angles to the screw 34. Thus, obviously, it is possible to mount the member Ill on the lug 1 as heretofore described in connection with Figure 1, or, if desired, remove it from the lug and mount it on the lug 36 and thereby support it for work in the throat, as

previously described in connection with Figure 4.

Attention here is also directed to the fact that, in lieu of the spring holding means l9 previously described, I have herein shown a laterally disposed adjustable set screw 31' carried in the side of the member Ill and adapted to engage the side edge of the member l5 and thereby hold the latter in any desired position of longitudinal adjustment relative to the member iii.

In Figure 6, a further modified construction is shown. Therein, it will be noted that both the members I and 2 are of modified form and that the member I is arranged in a new location on the member 5 relative to the pivot for the member l 0. More particularly, note that instead of the lug for member It being above the member l, a lug 38 is provided on the member 8 which is so disposed that the top of the member 9 and the top of the lug 33 are disposed in the same plane while the member H3 is pivoted on this lug 38 by a screw 39. Thus, the topof the member l may abut directly against the bottom of the member 2, as distinguished from being necessarily spaced therefrom. Further, it will be noted that both the members I and 2 are provided with adjacent flat faces, and that the mem ber 2 is provided with a thin inclined end 40, while the member l is also provided with a like thin, herein shorter, inclined end ll. Such a construction, in addition to enabling the two members I and 2 to be brought closer together than in the forms heretofore described, also enables the ends it, ll of the same, which have to be inserted between the teeth, to be thinner than possible in previous constructions, all in such manner as markedly to facilitate the process of inserting the device between the patients teeth in difilcult cases. In connection with this form of my invention, it will also be understood that the structure can be inverted, as described in connection with Figure 4, for throat work. Here and in connection with all forms of the members I and 2, as shown, it will of course also be under-. stood that if desired the surface engaged by the patients teeth may include a suitable rubber or fiber insert, or be leaded, in a customary manner, in order to prevent injury to the teeth as a result of the use of the gag.

My improved construction is particularly useful in cases of deafness, wherein it is frequently important to be able to examine or treat, or to be able to operate upon, the area in back of the nose and above the palate. However, it will be evident that it may be used to advantage in the treatment of various other ailments in this area or in the throat. to the fact that it is thus usable in both areas without requiring any additional mechanism, the form shown in Figures 1 and 6 being simply inverted and inserted without any change whatever, in the general manner shown in Figure 4, while the form shown in Figure 5 requires only the transposition of the member ll] which can be quickly and readily efiected. Here, it will also be understood that under certain conditions when working in the throat, the ring IT on the slide l5 may also be inverted without inverting the slide or changing the position of the guide l0. Further, under these conditions, the light L and instrument I then of course not passing through the ring, no aperture need be provided therein. These and other advantages of my improvements will, however, be clearly apparent to those skilled in the art.

While I have in this application specifically described three forms which my invention may Attention further is directed departing from its spirit or the scope of the appended claims.

What I claim as new and desire to secureby Letters Patent is: a

1. In a surgical device, a support having a guide, a slide mounted in said guide carrying on its front end laterally extending organ engaging and positioning means having an aperture therein, instrument guiding means on said slide, and an instrument movable in said guiding means transversely of said laterally extending means and through the aperture therein.

2. In a surgical device, a support having a guide, a slide mounted in said guide carrying on its front end laterally extending organ engaging and positioning means having an aperture therein, instrument guiding means on said slide in rear of said aperture having a plurality of guideways, and a plurality of instrument and light carrying slide means selectively usuable in said guideways and slidable therein transversely of said laterally extending means and through the aperture therein. 1

3. In a surgical device, supporting means including a supporting element, a guide pivoted on said element, a slide carried by said guide having a laterally extending apertured organ positioning member on its front end and rearwardly located guiding means, and cooperating means having a portion adjustable in said guiding means and a front end portion projectible longitudinally through the laterally extending aperture in said positioning means.

4. In a surgical device, supporting means including a supporting element, a guide pivoted on said element, a slide in said guide, laterally extending organ positioning means on the front end of said slide having an aperture extending laterally of said slide, and light and instrument guiding means carried by said slide in rear of said positioning means for directing a light and instrument through the laterally extending aperture in said positioningmeans.

5. In a surgical device, jaw opening mechanism including relatively movable elements, a guide pivotally mounted on one of said elements, and a slide carried by said guide having on its front end apertured organ positioning means and also having cooperating guiding means in rear of the aperture in said positioning means.

6. In asurgical device, jaw opening mechanism including relatively movable elements, a guide pivotally mounted on one of said elements, and a slide carried by said guide having on its front end apertured organ positioning means and also having cooperating guiding means in rear of the aperture in said positioning means, and comprising a plurality of guides for selectively receiving lighting means and instruments projectible through said aperture.

7. In a surgical device, jaw opening mechanism including a frame having a fixed tooth engaging element thereon and a cooperating tooth engaging element movable relative to said fixed element, a slide receiving guide movable with said movable element, a slide mounted in said guide having laterally extended apertured organ engaging and positioning means, and an instrument carrying slide mounted in said guide in position to have an instrument carried thereby projected through said aperture, said guide having parallel guideways directing said slides for longitudinal movement relative to each other.

8. In a surgical device, jaw opening mechanism including fixed upper and movable lower tooth engaging elements and means for adjusting the lower element relative to the other, a slide receiving pivoted guide adjustable with said movable element, means for at will pivoting said guide in operative position on said fixed element, a slide on said guide having apertured organ engaging and positioning means through which instruments may be inserted, and-a plurality of guides for selectively receiving lighting means and instruments projectible through said aperture.

9. In a surgical device, jaw opening mechanism including relatively movable elements, and a guide pivotally mounted on an axis fixed relative to one of said elements and adapted to receive a slide and permit insertion and angulation of the latter in a patients mouth, said guide being pivotedon a transverse axis in rear of and below the upper surface of said element and said elements being engageable in their closed position and having oppositely disposed thinends insertable together between the patients teeth while said elements are thus engaged. 10. A surgical device comprising jaw opening mechanism, an apertured organ positioning means slidable thereon in a patients mouth, means for enabling angulation of said positioning means, light and instrument guiding means carried on said positioning means in rear of the aperture therein, and lighting and operating means adjustably carried by said guiding means and projectible through said aperture. WILLIAM F. REARDON.

US2182390A 1937-01-13 1937-01-13 Surgical device Expired - Lifetime US2182390A (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
US2182390A US2182390A (en) 1937-01-13 1937-01-13 Surgical device

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
US2182390A US2182390A (en) 1937-01-13 1937-01-13 Surgical device

Publications (1)

Publication Number Publication Date
US2182390A true US2182390A (en) 1939-12-05

Family

ID=22389973

Family Applications (1)

Application Number Title Priority Date Filing Date
US2182390A Expired - Lifetime US2182390A (en) 1937-01-13 1937-01-13 Surgical device

Country Status (1)

Country Link
US (1) US2182390A (en)

Cited By (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4111529A (en) * 1974-08-14 1978-09-05 Olympus Optical Co., Ltd. Optical system for an endoscope
US4151837A (en) * 1977-02-28 1979-05-01 Millard D Ralph Jr Mouth gag with universal adjustability to the alveolar arch
US4592344A (en) * 1980-07-25 1986-06-03 Scheer Peter M Combination illuminator and lip and cheek expander
US4793327A (en) * 1986-01-21 1988-12-27 Frankel Alfred R Device for opening a patient's airway during automatic intubation of the trachea
US4991566A (en) * 1989-04-25 1991-02-12 David H. Shulman Articulating mouth-prop device for use in the diagnosis and/or treatment of patients suffering from trismus or other medical or dental problems or for other purposes
US5158096A (en) * 1991-04-16 1992-10-27 The Regents Of The University Of California Orthopedic measurement device and methodology to quantitatively and simultaneously measure distance and force during a passive stretching of the mandible
US6413231B1 (en) 1999-10-06 2002-07-02 Dynasplint Systems, Inc. Device to assist in therapy of patient who has limited jaw opening
US20060275353A1 (en) * 2002-05-31 2006-12-07 Nicholas V. Perricone Stable topical drug delivery compositions
US20080319270A1 (en) * 2004-11-18 2008-12-25 Lior Rosenberg Safe Mouth Gag
US7881770B2 (en) * 2000-03-01 2011-02-01 Medtronic Navigation, Inc. Multiple cannula image guided tool for image guided procedures
US20140316206A1 (en) * 2010-07-30 2014-10-23 Nilesh R. Vasan Disposable, self-contained laryngoscope and method of using same

Cited By (13)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4111529A (en) * 1974-08-14 1978-09-05 Olympus Optical Co., Ltd. Optical system for an endoscope
US4151837A (en) * 1977-02-28 1979-05-01 Millard D Ralph Jr Mouth gag with universal adjustability to the alveolar arch
US4592344A (en) * 1980-07-25 1986-06-03 Scheer Peter M Combination illuminator and lip and cheek expander
US4793327A (en) * 1986-01-21 1988-12-27 Frankel Alfred R Device for opening a patient's airway during automatic intubation of the trachea
US4991566A (en) * 1989-04-25 1991-02-12 David H. Shulman Articulating mouth-prop device for use in the diagnosis and/or treatment of patients suffering from trismus or other medical or dental problems or for other purposes
US5158096A (en) * 1991-04-16 1992-10-27 The Regents Of The University Of California Orthopedic measurement device and methodology to quantitatively and simultaneously measure distance and force during a passive stretching of the mandible
US6413231B1 (en) 1999-10-06 2002-07-02 Dynasplint Systems, Inc. Device to assist in therapy of patient who has limited jaw opening
US7881770B2 (en) * 2000-03-01 2011-02-01 Medtronic Navigation, Inc. Multiple cannula image guided tool for image guided procedures
US20060275353A1 (en) * 2002-05-31 2006-12-07 Nicholas V. Perricone Stable topical drug delivery compositions
US20080319270A1 (en) * 2004-11-18 2008-12-25 Lior Rosenberg Safe Mouth Gag
US7887483B2 (en) * 2004-11-18 2011-02-15 4-Med Ltd. Safe mouth gag
US20140316206A1 (en) * 2010-07-30 2014-10-23 Nilesh R. Vasan Disposable, self-contained laryngoscope and method of using same
US9289114B2 (en) * 2010-07-30 2016-03-22 Nilesh R. Vasan Disposable, self-contained laryngoscope and method of using same

Similar Documents

Publication Publication Date Title
US3586424A (en) Monocular indirect ophthalmoscope
US3044461A (en) Procto-sigmoidoscope
US4905670A (en) Apparatus for cervical videoscopy
US4500134A (en) Dental treatment chair assembly
US6432045B2 (en) Urethra surgical device
US3897775A (en) Endoscope with facile bending operation
US3677262A (en) Surgical instrument illuminating endotracheal tube inserter
US3195536A (en) Illuminated appliances
US4306547A (en) Rigid fiberoptic laryngoscope
US3789829A (en) Vaginal radium applicator
US4037589A (en) Ocular surgical system
US6048308A (en) Vaginal speculum
US2024982A (en) Surgical instrument
Lau et al. History of endoscopic and laparoscopic surgery
US2482971A (en) Self-illuminated transparent proctoscope
US2621651A (en) Instrument for dilating and examining the esophagus
US4913132A (en) Myringotomy instrument
US2767705A (en) Sigmoidoscope with suction attachment for immobilizing adjacent tissue
US3744481A (en) Medical examining method and means
US4690132A (en) Endoscope particularly useful as an anoscope
US5179938A (en) Apparatus for endoscopic examination of body cavity using chemiluminescent light source
US4022208A (en) Gynecologic instrument
US4215678A (en) Endoscope
US4759348A (en) Endoscope assembly and surgical instrument for use therewith
US5813978A (en) Method and apparatus for direct access endoscopic surgery