WO2020257894A1

WO2020257894A1 - Free scar cardiovascular cannula and method

Info

Publication number: WO2020257894A1
Application number: PCT/BR2020/050149
Authority: WO
Inventors: Luiz LANAT PEDREIRA DE CERQUEIRA FILHO
Original assignee: Lanat Pedreira De Cerqueira Filho Luiz
Priority date: 2019-06-27
Filing date: 2020-05-02
Publication date: 2020-12-30
Also published as: BR112021026224A2

Abstract

An invention provides a cardiovascular cannula for extracorporeal circulation that the insertion into a surgical site heals by first intention and leaves no visible scars on the tissue, and a method for use. The invention including:a holder, a plurality of ducts including a first end and a second end, the first end connected to the holder, wherein the holder and the plurality of ducts includes a blood passageway, is provided. The invention including: a holder adapted to connect to an extracorporeal circulation apparatus, a plurality of ducts connected to the holder, and an internal connection adapted to connect the plurality of ducts within the circulatory system of a patient, is provided. The invention includes other embodiments and a method for extracorporeal circulation without visible tissue scarring.

Description

FREE SCAR CARDIOVASCULAR CANNULA AND METHOD

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims of an invention which was disclosed in provisional application number US US62/726,279 filed 2018-09-02, entitled“NoScarCardiacCamiula and method" The benefit under 35 USC § 1 19(e) of the United States provisional application is hereby claimed, and the afore mentioned application is hereby incorporated herein by reference.

DESCRIPTION

FIELD OF INVENTION

[0001] The invention is in the field of medical devices and pertain, particularly, to a cardiovascular cannula for perform an extracorporeal circulation through a plurality of access passageways in a tissue to a surgical site.

BACKGROUND

[0002] In the art of cardiovascular cannula for perform extracorporeal circulation, many- different types of cardiovascular cannula have been developed. One problem with the traditional cardiovascular cannula is to have a single cannula with thick outer diameter that damages the tissue. Another limitation of the current cardiovascular cannula is the need for an incision in the tissue generally with the use of a scalpel blade for the passage of a large caliber cannula. Another limitation of the current cardiovascular cannula is that the tissue incisions required for the passage of the trocar usually result in scars. Another limitation of the current cardiovascular cannula is to provide a single access passageway to the surgical site.

[0003] Current cardiovascular cannula for performing an extracorporeal circulation such as: open heart surgery-, robot-assisted cardiac surgery, minimal invasive cardiac surgeries, among other, cause scars. These scars are not desired because, they alter tire aesthetics of the body. The possibility of performing extracorporeal circulation without a scar is a grate evolution in surgery' . [0004] Therefore, what is clearly needed is a cardiovascular cannula for extracorporeal circulation that the insertion into a surgical site heals by first intention and leaves no visible scars on the tissue, and a method for use that solves the problems mentioned above.

SUMMARY OF THE INVENTION

[0005 ] In one embodiment of the invention, a cardiovascular cannula assembly for insertion into a surgical site through a plurality of perforations in the tissue, including: a holder, a plurality of ducts including a first end and a second end, the first end connected to the holder, wherein the holder and the plurality of ducts includes a blood passageway, is provided.

[0006] Also, in other embodiment, the second end is adapted to connect within a patient's circulatory system .

[0007] Also, in other embodiment, the holder is adapted to connect to an extracorporeal circulation apparatus.

[0008] Also, in other embodiment, the holder is modular and includes an external connection, the external connection including a proximal end and a distal end, the proximal end adapted to connect to an extracorporeal circulation apparatus, and the distal end is adapted to detachably connect to the holder,

[0009] Also, in other embodiment, the plurality of ducts is adapted for insertion through a trocar set containing a plurality of perforations.

[0010] Also, in other embodiment, the cardiovascular cannula assembly further comprising an internal connection, said internal connection including a proximal portion and a distal portion, wherein said distal portion is adapted to connect to the patient's circulatory'· system, wherein said proximal portion is adapted to connect to said second end.

[0011] Also, in other embodiment, at least one of the plurality of ducts further comprises a sharp tip in the second end to insert in the tissue.

[0012] Also, in other embodiment, the ducts are thin enough to not cause scar.

[0013] Also, in other embodiment, the cardiovascular cannula assembly further comprising a mandrel, and the mandrel, including, a plurality of piercing tips connected to a handler, wherein the mandrel detachably engages the cardiac cannula forming a single inserting trocar set.

[0014] Also, in other embodiment, at least one of the plurality of ducts comprises the second end adapted to dilate an insertion hole in a tissue to prevent scarring. [0015] Also, in other embodiment, at least one part is made in a transparent material.

[00161 Also, in other embodiment, at least one of the plurality of ducts is adapted to connect a surgical device within the surgical site.

[0017] Also, in other embodiment, the plurality of cannula comprises means for keeping the blood passage open through the cannula.

[0018] Also, in another embodiment, the cardiovascular cannula assembly further comprising a protector guide.

[0019] Also, in other embodiment, at least one of the plurality of ducts, further comprises a fastening system in the tissue.

[0020] Also, in other embodiment, the cardiovascular cannula assembly further comprising at least one modular part adapted to connect the other modular part.

[0021 ] Also, in other embodiment, at least one of the plurality of piercing tips comprises a retractable protection system.

[0022] Also, in other embodiment, at least one of the plurality of ducts is adapted to connect to an internal connection in the surgical site.

[0023] Also, in another embodiment, the holder is adapted to connect to a surgical device.

[0024] Also, in another embodiment, the cardiovascular cannula assembly, further comprising an external connection to connect to said holder an extracorporeal circulation apparatus. Also, in another embodiment, the cardiovascular cannula assembly, further comprising an internal connection.

[0025] In another embodiment, the cardiovascular cannula assembly for extracorporeal circulation by a plurality of perforations in a tissue, comprising: a holder; a plurality of ducts connected to said holder; and an internal connection, is provided.

[0026] Also, in another embodiment, the internal connection is adapted to be inserted in the surgical site through a conventional trocar.

[0027] Also, in another embodiment, the internal connection includes means to fix the vascular tissue.

[0028] Also, in another embodiment, further comprising a mandrel, and the mandrel including a plurality of piercing tips connected to a handler, wherein the mandrel detachably engages the cannula, forming a single punch trocar set. Also, in another embodiment, further comprising an external connection.

[0029] A method, including, inserting a plurality of ducts of a cardiovascular cannula assembly through a plurality of perforations; connecting an internal connection to said cardiovascular cannula assembly; connecting said cardiovascular cannula to an extracorporeal circulation apparatus, is provided.

[0030] Also, the method, further including, removing the cardiovascular cannula assembly of a patient's circulator}_' system, is provided.

[0031 ] Also, the method, further including, removing the second cardiovascular cannula assembly, is provided.

BRIEF DESCRIPTION OF TOE DRAWINGS

[0032] FIG. 1 is site cross sectional view of the cardiovascular cannula assembly for insertion into the surgical site 26 through the plurality of perforations 44 in the tissue 25, according to one embodiment of the invention.

[0033] FIG.2 is a cross sectional view of the cardiovascular cannula assembly for insertion into the surgical site 26 through the plurality of perforations 44 in the tissue 25, according to another embodiment of the invention.

[0034] FIG.3 is a perspective view of the cardiovascular cannula assembly for insertion into the surgical site 26 through the plurality of perforations 44 in the tissue 25, according to another embodiment of the invention.

[0035] FIG.4 is a cross sectional view⁷ of trocar ser 42 adapted to provide a plurality of perforations 44 in the tissue 25 for insertion of the cardiovascular cannula assembly into the surgical site 26, according to another embodiment of the invention.

[0036] FIG. 5 is a perspective view of another embodiment of the invention including the internal connection 33.

[0037] FIG. 6 is a perspective view of the external connection 36 connect to the holder 10 and including the internal connection 33, according to another embodiment of the invention [0038] FIG. 7 is a perspective view' of the functional cardiovascular cannula assembly, according to one embodiment of the invention.

[0039] FIG. 8 is a lateral view of the second end 14B including piercing sharp tip 32, according to another embodiment of the invention.

[0040] FIG. 9 a perspective view of tire external connection 36 according to other embodiment of the invention. [0041] FIG. 10 is a perspective view of the invention including the mandrel 1, according to another embodiment of the invention.

[0042] FIG. 11 is a perspective view of the middle part 9 including ten ducts 14 and the holder 10, according to other embodiment of the invention.

[0043] FIG. 12 is a perspective view of the internal connection 33 according to another embodiment of the invention.

[0044] FIG.13 is a perspective view' of the internal connection 33, the distal portion 33B connection is lateral according to another embodiment of the invention

[0045] FIG.14 is a perspective view of the internal connection 33 including the plurality of ducts 14 C according to another embodiment of the invention.

[0046] FIG. 15 is a side view' of the internal connection 33, including: the ring 40, the spring 41, and the markings 39, according to another embodiment of the invention.

[0047] FIG.16 is a side view of another embodiment of the present invention for venous use.

[0048] FIG.17 is a sectional view of the middle part 9 adapted to perforate and transfix the tissue 25, according to another embodiment of the invention.

[0049] FIG. 18 is a perspective view of the mandrel 1 and the middle part 9 according to another embodiment of the invention.

[0050] FIG.19 is a perspective view of the trocar set 42, according to another embodiment of the invention.

[0051] FIG. 20- 21 are top views of some embodiments of the invention showing: some holder 10 shape, some position of the blood passageways 3 in the holder 10, and some distribution of the blood passageways 3 in the holder 10.

[0052] FIG. 22 and F1G.23 are top views of some embodiments of the invention adapted for insertion of the intercostal space.

[0053] FIG. 24 is a cross-sectional view⁷ of the mandrel 1 wherein two piercing tips 2 comprise the retractable 4 protection system, according to another embodiment invention, [0054] FIG.25 is a cross-sectional view, wherein the plurality of ducts 14 comprise the fastening system 47 in the tissue 25, the figure in detail is an ampliation of the second end 14B end of the plurality of ducts 14, according to another embodiment of the invention.

[0055] FIG. 26 is a perspective view of another embodiment of the invention, the invention is modular, including the module 23 and the block 2.2.

[0056] FIG. 27 is a perspective view⁷ of another embodiment of the invention, the invention is modular, the mandrel 1 is engaged in the middle part 9. [0057] FIG. 28 is a top view of the module 23 according to another embodiment of the invention.

[0058] FIG. 29 is a top view of other embodiment of the block 22, according to another embodiment of the invention.

[0059] FIG.30 is a top view of other embodiment of the invention including two connected modules 23.

[0060] FIG. 31 is a top view of another embodiment of the invention, including three blocksV)

[0061] FIG. 32 is a perspective view of another embodiment of the invention, the six modules 23 are connected in a suitable way to insertion the intercostal space, it is made to accompanying the shape of the ribs in the chest.

[0062] FIG. 33 is a perspective view of another embodiment of the invention in a modular configuration for pro viding seven blood passageways 3 through tissue 25 to the surgical site 26.

[0063] FIG. 34 is a perspective view of another embodiment of the invention, the modular parts are disconnected.

[0064] FIG.35 is a perspective view of another embodiment of the invention, including: seven female-links 16 to connect four male-links 17 and seven female-connectors 19 to connect four male -connectors 18.

[0065] FIG.36 is a perspective view of another embodiment of the invention in a modular configuration.

[0066] FIG. 37 is a perspective view of another embodiment of the invention, in a modular configuration including four connection sides.

[0067] FIG. 38 is a perspective view of another embodiment of the invention, including the protector guide 8.

[0068] FIG.40 is a cross-sectional view of other embodiment of the invention, including the method of punching the trocar set 42 including two ducts 14 in the tissue 25 to insert in the surgical site 26, according to another embodiment of the invention.

[0069] FIG. 41 is a cross-sectional view of middle part 9 providing two blood passageways through the tissue 25, according to another embodiment of the invention.

[0070] FIG. 42 is a cross-sectional view' of the middle part 9 that is adapted to connect to at least one internal connection 33 in the surgical site 26 and adapted to connect to the external connection 36 outside the tissue 25, according to another embodiment of the invention. [0071] FIG. 43 is sectional view of the cardiovascular cannula assembly for extracorporeal circulation by a plurality of perforations 44 through the tissue 25 according to another embodiment of the invention.

[0072] FIG. 44 is a cross sectional view of the plurality of ducts 14 comprises the fastening system 4, according to another embodiment of the invention.

[0073] FIG. 45 is a cross sectional view of the cardiovascular cannula assembly for insertion into the surgical site 26 through the plurality of perforations 44 in tissue 25, according to another embodiment of the invention.

[0074] FIG. 46 is a cross sectional view of the cardiovascular cannula assembly for extracorporeal circulation by the plurality of perforations 44 through the tissue 25 according to another embodiment of the invention.

[0075] FIG. 47 is a cross sectional view of the cardiovascular cannula assembly for extracorporeal circulation by the plurality of perforations 44 through the tissue 25 according to another embodiment of the invention.

[0076] FIG.48 is a side view of another modular embodiment of the invention.

[0077] FIG. 49 It is a lateral view of the mandrel 1 with handle 7 modular, and the middle part 9 with the plurality of modular holders 10, according to another embodiment of the invention.

[0078] FIG.50 is a lateral view of the middle part 9 with the plurality- of modular holders 10 and the plurality of distal end 36, according to another embodiment of the invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0079] The inventor provides a cardiovascular cannula for extracorporeal circulation that the insertion into a surgical site heals by first intention and leaves no visible scars on the tissue, and a method for use.

[0080] Also, the inventor provides a cardiovascular cannula for providing a plurality of access passageways through a tissue into a surgical site, and a method for use.

[0081] The invention is described in enabling detail in the following examples, which may represent more than one embodiment of the invention, together with the accompanying drawings in which like numerals represent similar components. Additionally, the structures described herein can be embodied as integrated components or as separate components. [0082] FIG. l is a cross sectional view of the cardiovascular cannula assembly for insertion into a surgical site 26 through the plurality of a perforations 44 in a tissue 25, according to one embodiment of the invention.

[0083] In another characteristic of this embodiment, a holder 10; the plurality of a ducts 14 including a first end 14 A and a second end 14 B, the first end 14 A connected to the holder 10; wherein the holder 10 and the ducts 14 including a blood passageway 3.

[0084] FIG.2 is a cross sectional view of the cardiovascular cannula assembly for the insertion into the surgical site 26 through the plurality of perforations 44 in the tissue 25, according to another embodiment of the invention.

[0085] This embodiment includes the holder 10; the plurality of ducts 14 including the first end 14A and the second end 14B, the first end 14A connected to the holder 10; wherein the holder 10 and the ducts 14 include the blood passageway 3.

[0086] In another characteristic of this embodiment, the second end 14 B is adapted to connect within a patient’s circulator_}' system 26B.

[0087] In another characteristic of this embodiment, the holder 10 is adapted to connect to an extracorporeal circulation apparatus 35 hose. In another characteristic of this embodiment, the holder 10 includes a fit 10A to connect to the extracorporeal circulation apparatus 35 hose. In another characteristic of this embodiment, the arrow' show's the direction that the extracorporeal circulation apparatus 35 hose connects to a proximal end 36A.

[0088] FIG.3 is a perspective view of the cardiovascular cannula assembly for insertion into the surgical site 26 through the plurality of perforations 44 in the tissue 25, according to ano ther embodiment of the invention.

100891 Tins embodiment includes the holder 10; the plurality of ducts 14 including the first end 14 A and the second end 14 B, the first end 14 A connected to the holder 10; wherein the holder 10 and the ducts 14 including the blood passageway 3.

[0090] In another characteristic of this embodiment, the holder 10 is modular, including an external connection 36. In another characteristic of this embodiment, the external connection 36 includes the proximal end 36A and a distal end 36B.

10091 1 In another characteristic of this embodiment, the holder 10 is modular, including the external connection 36, the external connection 36, including the proximal end 36 A and the distal end 36B. The proximal end 36 A is adapted to connect to the extracorporeal circulation apparatus 35, and the distal end 36B is adapted to detachably connect to the holder 10. [0092] In another characteristic of this embodiment, a middle part 9 includes the holder 10 and the plurality of ducts 14. In another characteristic of tins embodiment, the distal end 36B is adapted to detachably connect to the holder 10. In another characteristic of this embodiment, the distal end 36B is adapted to detachably connect to the middle part 9 in a sealing manner to avoid the escape of blood and die entrance of air in the extracorporeal circulation circuit. In another characteristic of this embodiment, the proximal end 36A is designed to connect to the extracorporeal circulation apparatus 35 hose.

[0093] In another characteristic of this embodiment, the plurality of ducts 14 are adapted to transfix the tissue 25, reach the surgical site 26, transfix a cardiovascular tissue 25 B and reach the patients circulatory system 26B.

[0094] FIG.4 is a cross sectional view of a trocar set 42, adapted to provide a plurality of perforations 44 in the tissue 25 for the insertion of the cardiovascular cannula assembly into the surgical site 26, according to another embodiment of the invention.

[0095] In another characteristic of this embodiment, the plurality of ducts 14 is adapted for insertion through the trocar set 42 containing three tubings 46. In another characteristic of tins embodiment, the plurality of ducts 14 is adapted to cause minimal trauma to the tissue 25 in order to prevent scars. Another characteristic of this embodiment is that the trocar set 42 provides three perforations 44, for the insertion of the ducts 14 in the surgical site 26. In another characteristic of this embodiment, the trocar set 42 is adapted to cause minimum trauma in the tissue 25 in order to prevent scars.

[0096] FIG. 5 is a perspective view of another embodiment of the invention, including the internal connections 33.

[0097] This embodiment, includes an internal connection 33, which includes a proximal portion 33A and a distal portion 33B, wherein the distal portion 33B is adapted to connect to the patient's circulatory system 26B, wherein the proximal portion 33A is adapted to detachably connect to the second end 14 B; wherein the internal connection 33 accesses the surgical site by another access route.

[0098] In another characteristic of this embodiment, the internal connection 33 accesses the surgical site 26 by another access route, such as, for example, a conventional trocar or a surgical incision, but is not limited to them.

[0099] In another characteristic of this embodiment, the external connection 36 is adapted to detachably connect the holder 10, and the internal connection 33 is adapted to detachably connect the plurality of ducts 14 to form the single cardiovascular cannula assembly. [0100] In another characteristic of this embodiment, the external connection 36 is disconnected from the holder 10, and the plurality of ducts 14 is disconnected from the proximal portion 33 A of the internal connection 33

[0101] In another characteristic of this embodiment, the distal end 36B is adapted to connect disconnectable to the holder 10. In another characteristic of this embodiment, the connection of the distal end 36B in the holder 10 is of a sealant form so that there is no blood leakage and air intake in the blood flow. In another characteristic of this embodiment, a ring 40 limits the perforations 44 of the distal portion 33B to the patient’s circulator}' system 26B. In another characteristic of this embodiment, the proximal end 36A is designed to connect to the extracorporeal circulation apparatus 35 hose. In another characteristic of this embodiment, the middle part 9 includes the holder 10 and the plurality of ducts 14. In some embodiments, the middle part 9 is the trocar set 42 including a sharp tip 32. In some embodiments the middle part 9 is the trocar set 42 and has a mandrel 1 including the piercing tip 2 to insert in the tissue 25. In some embodiments the middle part 9 is made to be inserted through the perforations 44 of the trocar set 42. In another characteristic of this embodiment, tire trocar set 42 includes the plurality of a tubes 46. In another characteristic of this embodiment, the number of ducts 14 required to maintain adequate blood flow for the extracorporeal circulation apparatus 35 and the various embodiments depends on the size of the plurality of ducts 14, the length of the plurality of ducts 14, the diameter of the plurality of ducts 14 and the volume of blood required. In some embodiments, the number of plurality of ducts 14 may be altered during the procedure to match the necessary_' blood flow to the patient^' s circulatory system 26B. In some embodiments, the number of plurality of ducts 14 is adapted to be altered during the procedure to match the blood flow necessary for the patient's circulatory system 26B by adding or reducing the number of ducts 14 used for the passage of blood.

[0102] FIG. 6 is a perspective view of the external connection 36 connected to die holder 10 and including the internal connection 33, according to another embodiment of the invention.

[0103] In another characteristic of this embodiment, the holder 10 is made of one material and the external connection 36 is made of another material.

[0104] In this embodiment, the internal connection 33 includes the proximal portion 33A and the distal portion 33B, wherein the distal portion 33B is adapted to connect to the patient's circulatory system 26B, wherein the proximal portion 33A is adapted to connect to the second end 14 B: wherein the internal connection 33 accesses the surgical site by another access route. The internal connection 33 accesses the surgical site by another access route, such as, for example, a conventional trocar or a surgical incision, but is not limited to them.

[0105] In another characteristic of this embodiment, the proximal end 36A is adapted to connect to the extracorporeal circulation apparatus 35 hose.

[0106] In another characteristic of this embodiment, the arrow points the direction in which the internal connection 33 connects to the plurality of ducts 14. In some embodiments, the middle part 9 and the external connection 36 are a single piece. In some embodiments there are no external connection 36, the extracorporeal circulation apparatus 35 hose is adapted to connect directly to the holder 10.

[0107] FIG. 7 is a perspective view of the functional cardiovascular cannula assembly, according to one embodiment of the invention.

[0108] In another characteristic of this embodiment, the invention is modular, the external connection 36 is connected to the middle part 9, and the middle part 9 is connected to the internal connection 33, forming the cardiovascular cannula assembly. In another characteristic of this embodiment, the middle part 9 includes the bolder 10 and the plurality of ducts 14. In another characteristic of this embodiment, the external connection 36 is adapted to detachably connect to the holder 10 of the middle part 9, and the internal connection 33 is adapted to detachably connect the plurality of ducts 14 to form the single cardiovascular cannula assembly. In another characteri tic of this embodiment, the distal end 36B is detachably connected to the holder 10 of the middle part 9. In another characteristic of this embodiment, the connection of the distal end 36B in the holder 10 has a sealing shape so that there is no leakage of blood and inflow of air into the extracorporeal circulation blood flow. In another characteristic of this embodiment, the proximal end 36A is designed to connect to the extracorporeal circulation apparatus 35 hose.

[0109] FIG. 8 is a lateral view of the second end 14B, including the sharp tip 32 piercing, according to another embodiment of the invention.

[0110] In another characteristic of this embodiment, the plurality of ducts 14 are adapted to cause minimal trauma to the tissue 25 in order to prevent scarring.

[0111] In another characteristic of this embodiment, at least one of the plurality of ducts 14 further includes a sharp tip 32 in the second end 14B to insert in the tissue 25.

[0112] In one characteristic of some embodiments, the ducts 14 have sharp tip 32 to puncture de tissue 25. In other characteristic of this embodiment, the second end 14B is adapted to connect to the internal connection 33. In other characteristic of this embodiment, the ducts 14 are adapted to leave no scar on the skin. In other characteristic of this embodiment, the sharp tip 32 is adapted to cause minimal trauma to the tissue 25 in order to not leave any scars in the tissue 25. In other characteristic of tins embodiment, the sharp tip 32 easily penetrates the tissue 25 and causes no scars. In other characteristic of this embodiment, the smaller the external diameter of the ducts 14, lower is the risk of scarring by perforation.

[0113] FIG. 9 is a perspective view of tire external connection 36, according to other embodiment of the invention.

[01 14] In this embodiment, the external connection 36 has the distal end 36B and the proximal end 36A. In another characteristic of this embodiment, the proximal end 36A is designed to connect to the extracorporeal circulation apparatus 35 hose. In another characteristic of this embodiment, the distal 32B is designed to fit the sealing into the holder 10. In another characteristic of this embodiment, the external connection 36 has a side connection 34. In another characteristic of this embodiment, the screw a cap 37 is connected to the side connections 34. In another characteristic of this embodiment, the side connections 34 is an access to the blood flow for delivering medications, measure blood pressure and collecting blood but is not limited to them.

[0115] FIG. 10 is a perspective view of the invention including the mandrel 1 , according to another embodiment of the invention.

[0116] In another characteristic of this embodiment, the mandrel 1 includes the plurality of a piercing tips 2 connected to a handier 7, wherein the mandrel 1 detachably engages the cardiac cannula forming the single inserting trocar set 42.

[0117] In another characteristic of this embodiment, it contains: the mandrel I, and the mandrel including the plurality of piercing tips 2 connected to the handler 7, wherein the mandrel 1 detachably engages the middle part 9, forming a single set. This embodiment provides four blood passageways 3 through the tissue 25 to the surgical site 26

[0118] In another characteristic of this embodiment, the holder 10 is adapted to connect to the external connection 36. In another characteristic of this embodiment, the plurality of ducts 14 is adapted to connect to the internal connection 33.

[0119] In another characteristic of this embodiment, the surgeon uses the invention in a single punch assembly to puncture the tissue 25, the trocar set 42 transfixes the tissue 25 at four different points until each plurality of ducts 14 reaches the surgical site 26. In another characteristic of this embodiment, each piercing tips 2 is solid and has a bezel 6 shaped tip to facilitate the insertion in the tissue 25. In another characteristic of this embodiment, each duct 14 has four blood passageways 3 and the four piercing tips 2 that are engaged in the four blood passageways 3.

[0120] In another characteristic of this embodiment, longitudinally sliding the mandrel 1 relative to the middle part 9 fully detaches the mandrel 1 of the middle part 9. In another characteristic of this embodiment, after the tissue 25 has been transfixed, the surgeon remo v es the mandrel 1 from the middle part 9 In another characteristic of this embodiment, the middle part 9 remains in the tissue 25 during surgery, so that each ducts 14 of the plurality of ducts 14 has an independent blood passageway 3 through the tissue 25 to the surgical site 26, where surgery will be performed. In another characteristic of this embodiment, each duct 14 of the plurality of ducts 14 has the blood passageway 3.

[0121] In another characteristic of this embodiment, the plurality of ducts 14 is adapted to cause minimal trauma to the tissue 25, in order to prevent scar formation in the tissue 25. In another characteristic of this embodiment, the plurality of ducts 14 has an outer diameter which is adapted to prevent scar formation in the tissue 25. In another characteristic of this embodiment, the outer diameter is thin enough to cause minimal trauma to the tissue 25, in order to avoid scars at tire insertion site. In another characteristic of this embodiment, the piercing tips 2 have the bezel 6 sharp to, easily, penetrate the tissue 25 and not cause scars. In another characteristic of this embodiment, the smaller the external diameter of the cannula ducts 14, the lower is the risk of scars by perforation.

[0122] In another characteristic of this embodiment, it is widely known that the use of needles to deliver medication, including syringes, leaves no scar on the tissue 25. In another characteristic of this embodiment, the thin needle causes small damage to the tissue 25, that regenerates by first intention without leaving a scar. In another characteristic of this embodiment, it works substantially comparable to a plurality of needles, inserting different points of the tissue 25 at the same time. In another characteristic of this embodiment, instead of incising the tissue 25 to insert into the surgical site 26, a conventional single thick trocar, which requires a large incision in the tissue 25, the tissue 25 is punctured by this embodiment of the invention, which has the plurality of piercing tips 2 Each covered by the plurality of ducts 14; each piercing tip 2 of the trocar assembly 42 pierces the tissue 25 and transfixes the tissue 25 until it reaches the surgical site 26. In another characteristic of this embodiment, tire tissue 25 insertion of the ducts 14 with the piercing tips 2 is engaged to function, substantially, similar to the insertion of an injection needle of a syringe. Also, this embodiment functions, substantially, similar to the insertion of a vein insertion catheter that does not cause scar. [0123] In another characteristic of this embodiment, at least, one of the plurality of ducts 14 comprises the second end 14B adapted to dilate an insertion hole in the tissue 25 to prevent scars

[0124] In another characteristic of this embodiment, the four plurality of ducts 14 comprises, in tire distal end, a dilator 11 adapted to dilate an insertion hole in the tissue 25 In another characteristic of this embodiment, at the distal end 36B of each plurality of ducts 14, there is the conical shaped dilator 1 1, which dilates the insertion hole made by the piercing tips 2 in the tissue 25. In another characteristic of this embodiment, this allows the punch into the tissue 25 with the plurality of ducts 14 with an outer diameter greater than the insertion hole made by the piercing tip 2 without causing scars. In another characteristic of this embodiment, the trocar assembly performs four insertions on the tissue 25. Each insertion includes a small diameter that leaves no scar on the tissue 25. After the trocar set 42 is removed from the tissue 25, the dilatated punching orifice retracts, remaining on the tissue 25 only small insertions, which do not cause scars and do not need to be treated, including suture.

[0125] In another characteristic of this embodiment, at least, one part is made of a transparent material.

[0126] In another characteristic of this embodiment, the trocar set 42 is made of a transparent material that allows a view' of what is in its internal parts during the video surgery.

[0127] In another characteristic of this embodiment, the middle part 9 has a faucet 12 for collecting blood and ministering medications by the blood passageways 3 of the plurality of ducts 14. In another characteristic of this embodiment, the faucet 12 controls the inlet and outlet of blood from the surgical site 26, the faucet 12 communicates with at least one blood passageways 3 of the four plurality of ducts 14 and allows to inflate liquids in and blood out of tire patient’s circulator) system 26B, in accordance with another embodiment of the invention.

[0128] In another characteristic of some embodiments of the invention, the mandrel 1 comprises two piercing tips 2; in some embodiments of the invention, the mandrel 1 comprises three piercing tips 2; n some embodiments of the invention, the mandrel 1 comprises four piercing tips 2; m some embodiments of the invention, the mandrel 1 comprises five piercing tips 2; in some embodiments of the invention, the mandrel 1 comprises six piercing tips 2; in some embodiments of the invention, the mandrel 1 comprises seven piercing tips 2; in some embodiments of the invention, the mandrel 1 comprises eight piercing tips 2; in some embodiments of the invention, tire mandrel 1 comprises nine piercing tips 2; in some embodiments of the invention, the mandrel 1 comprises ten piercing tips 2; in some embodiments of the invention, the mandrel 1 comprises eleven piercing tips 2; in some embodiments of the invention, the mandrel 1 comprises twelve piercing tips 2; in some embodiments of the invention, the mandrel 1 comprises thirteen piercing tips 2; In some embodiments of the invention, the mandrel 1 comprises fourteen piercing tips 2, but the number of piercing tips 2 is not limited to them.

[0129] In some embodiments, the invention comprises two ducts 14; in some embodiments, the invention comprises three ducts 14; in some embodiments, the invention comprises four ducts 14; in some embodiments, the invention comprises five ducts 14; in some embodiments, the invention comprises six ducts 14; in some embodiments, the invention comprises seven ducts 14; in some embodiments, the invention comprises eight ducts 14; in some embodiments, the invention comprises nine ducts 14; in some embodiments, the invention comprises ten ducts 14; in some embodiments, the invention comprises eleven ducts 14; m some embodiments, the invention comprises twelve ducts 14; in some embodiments, the invention comprises thirteen ducts 14; in some embodiments, the invention comprises fourteen ducts 14, but the number of ducts 14 are not limited to them.

[0130] FIG. 11 is a perspective view of the middle part 9 including ten ducts 14 and the holder 10, according to other embodiments of the invention.

[0131] In another characteristic of this embodiment, the ten ducts 14 are arranged in two lines of five duets 14 in a formation suitable for transfixing the tissue 25 in the intercostal space. In another characteristic of this embodiment, the holder 10 of the middle part 9 is designed to fit sealing to the distal end 36B of the external connection 36, the plurality of ducts 14 is designed to fit, quickly and securely, in the distal portion 33B. In some embodiments, the plurality of ducts 14 are made to pass through the trocar set 42, including the plurality of blood passageways 3. In some embodiments, the plurality of ducts 14 are made to pass through the plurality of blood passageways 3 in the tissue 25. In some embodiments, the middle part 9 is made to be inserted through the trocar set 42 including the plurality of ducts 14. In some embodiments, the middle part 9 is the trocar set 42 and it is made to, directly, insert the tissue 25. In some embodiments, the middle part 9 is the trocar set 42 and has the mandrel 1 to insert the tissue 25.

[0132] FIG. 12 is a perspective view of the internal connection 33, according to another embodiment of the invention. [01331 In another characteristic of this embodiment, the internal connection 33 is designed to be inserted into the surgical site 26 from within the conventional trocar, within a surgical incision, but it is not limited to them. In another characteristic of this embodiment, the internal connection 33 is made to function in the surgical site 26.

[0134] In another characteristic of this embodiment, the proximal portion 33 A of the internal connection 33 is adapted to connect to the second end 14B inside the surgical site 26.

[0135] In another characteristic of this embodiment, at least, one of the plurality of ducts 14 is adapted to connect a surgical device within the surgical site 26.

[0136] In some embodiments, the invention has an adapter 38 (it is not on the drawing) to connect the plurality of ducts 14 to the internal connection 33. In some embodiments, the proximal portion 33A of the internal connection 33 is adapted to connect to the adapter 38 inside the surgical site. In some embodiments, the adapter 38 is adapted to connect to the plurality of ducts 14 and the internal connection 33 is connected to the adapter 38.

[0137] In another characteristic of this embodiment, the internal connection 33 may be made in various shapes, sizes and models. In another characteristic of this embodiment, the distal portion 33B is adapted to be inserted into the patient’s circulatory' system 2.6B. In another characteristic of this embodiment, the distal portion 33B is adapted to be inserted into the patient’s circulatory system 26B, for example: heart cavity, aorta, vena cava, but are not limited to them.

[0138] FIG.13 is a perspective view of the internal connection 33, where the distal portion 33B connection is lateral, according to another embodiment of the invention

[0139] In another characteristic of this embodiment, the distal portion 33B is adapted to connect sideways to a fitting 30 (not shown) of the ducts 14.

[0140] In another characteristic of this embodiment, the side portion of the distal portion 33B is adapted to connect to the second end 14B of the plurality of ducts 14. In another characteristic of this embodiment, it is adapted to pass, easily, through a conventional trocar.

[0141] In another characteristic of this embodiment, the proximal portion 33A is designed to fit quickly and sealing on the plurality of ducts 14 B, according to another embodiment of the invention.

[0142] FIG.14 is a perspective view of the internal connection 33, including the plurality of tubes 43, according to another embodiment of the invention.

[0143] In another characteristic of this embodiment, the internal connection 33 are the tubes 43 that includes a sleeve 45 including the plurality of tubes 43. In another characteristic of this embodiment, the plurality of tubes 43 includes the plurality of blood passageways 3 to the patient^’s circulatory system 26B. In another characteristic of this embodiment, the internal connection 33 is adapted to insert the cardiovascular tissue 25 B at a plurality of sites, so as to connect an extracorporeal circulation blood flow 35 A to the patient’s circulatory system 26B. In another characteristic of this embodiment, the patient’s circulatory system 26B is the surgical site 26 existing within an organ having blood flow, such as, for example: inside the aorta artery, inside the vena cava, inside the heart, but is not limited to them. In another characteristic of this embodiment, this embodiment is adapted to pass through a conventional trocar.

[0144] FIG. 15 is a side view of the internal connection 33, including: the ring 40, a spring 41, and a markings 39, according to another embodiment of the invention.

[0145] . In another characteristic of this embodiment, the ring 40 is movable on the internal connection 33 and serves as a stop for the internal connection 33 inlet in the patient’s circulatory system 26B. The markings 39 serves as a measure for how much of the internal connections 33 enters the patient’s circulatory system 26B

[0146] In another characteristic of this embodiment, the plurality of cannulas comprises means for keeping the blood passage open through the cannula.

[0147] In another characteristic of this embodiment, the invention comprises means for maintaining open the passage of blood, the spring 41 keeps the blood passageways 3 always open for the blood flow. In some embodiments, there are metal rings, throat, but is not limited to them.

[0148] FIG.16 is a side view of another embodiment of the present invention for venous use.

[0149] In another characteristic of this embodiment, the distal end 36B is disconnected from the holder 10, the plurality of ducts 14 is disconnected from the proximal portion 33A In another characteristic of tins embodiment, the internal connection 33 is disengaged from the middle part 9 which is disconnected from the external connection 36. In another characteristic of this embodiment, the internal connection 33 is longer and adapted for insertion into the conventional trocar. In another characteristic of this embodiment, the internal connection 33 is adapted to be positioned within the patient’s circulatory system 26 B, as for example, the vena cava, but is not limited to them. In another characteristic of this embodiment, the markings 39 serve as a measure for how much of the internal connection 33 enters the patient’s circulatory system 26B. In another characteristic of this embodiment, the invention comprises means for maintaining open the passage of blood, the spring 41 keeps the blood passageways 3 always open for the blood flow.

[0150] FIG.17 is a sectional view of the middle part 9 adapted to perforate and transfix the tissue 25, according to another embodiment of the invention.

[0151 ] In another characteristic of this embodiment, the embodiment provides three blood passageways 3 through the tissue 25 to the surgical site 26. In another characteristic of this embodiment, the middle part 9 is the trocar set 42 including: the holder 10, and three plurality of ducts 14 connected to the holder 10.

[0152] In another characteristic of this embodiment, this embodiment is adapted to cause minimal trauma to the tissue 25 in order to prevent scars.

[0153] In another characteristic of this embodiment, the plurality of ducts 14 are adapted to cause minimal trauma to the tissue 25, in order to prevent scars. The plurality of ducts 14 has an outer diameter which is adapted to prevent scar formation m the tissue 25. In another characteristic of this embodiment, the outer diameter is thin enough to cause minimal trauma to the tissue 25 in order to avoid scars. In another characteristic of this embodiment, the three ducts 14 have the distal sharp tip 32 to, easily, penetrate the tissue 25 and not cause scars. Another characteristic of this embodiment is that it does not need the mandrel 1 to puncture the tissue 25, the plurality of ducts 14 are inserted directly in the tissue 25. In another characteristic of this embodiment, the holder 10 includes a socket 31. In another characteristic of this embodiment, it has no mandrel 1.

[0154] In some embodiments, the invention includes the mandrel 1, including the handle 7 and the mandrel I including the plurality of piercing tips 2, connected to the handle 7, wherein the mandrel 1 detachably engages the trocar set 42 forming a single punch assembly. In some embodiments, the plurality of ducts 14 has no sharp tip 32. In another characteristic of this embodiment, the plurality of ducts 14 comprises a fastening system 47 in the cardiovascular tissue 25 B. In another characteristic of this embodiment, the plurality of ducts 14 has a balloon 20 as the fastening system 47 to fix the plurality of ducts 14 in the cardiovascular tissue 25 B.

[0155] FIG. 18 is a perspective view of the mandrel 1 and the middle part. 9 according to ano ther embodiment of the invention.

[0156] In another characteristic of this embodiment, there are six ducts 14 that provide six blood passageways 3 through the tissue 25 to the surgical site 26.

[0157] In another characteristic of this embodiment, the arrow shows the direction in which the mandrel 1 slides, longitudinally, to fit the middle part 9 perfectly to form single trocar set 42 insertion assembly. In another characteristic of this embodiment, each piercing tips 2 is solid and has the bezel 6 shaped tip that facilitates the tissue 25 insertion.

[0158] in another characteristic of this embodiment, after the insertion in tissue 25, the mandrel I is completely detachable from the middle part 9, and the middle part 9 remains in the tissue 25 during surgery, so that each duct 14 has the blood passageway 3 to the surgical site 26. In another characteristic of this embodiment, the faucet 12 controls the passage of liquid through the blood passageways 3 to the patient’s circulatory system 26B, in accordance with another embodiment of the invention. In some embodiments the invention is disposable. In some embodiments the invention is permanent.

[0159] FIG.19 is a perspective view of the trocar set 42, according to another embodiment of the invention.

[0160] In another characteristic of this embodiment, the embodiment comprises the middle part 9 including the holder 10, and the middle part 9 including seven ducts 14 connected to the holder 10, the mandrel 1 including the handle 7; and the mandrel 1 including seven piercing tips 2 connected to the handle 7; wherein the mandrel 1 detachably engages the middle part 9 forming a single punch assembly. In another characteristic of this embodiment, it has no valve 13.

[0161] FIG. 20- 21 are top views of some embodiments of the invention showing: some holder 10 shape, some positions of the blood passageways 3 in the holder 10, and some distributions of the blood passageways 3 in the holder 10.

[0162] FIG. 22 and FIG.23 are top views of some embodiments of the invention adapted for the insertion of the intercostal space

[01631 In another characteristic of this embodiment, the position of the blood passageways 3 is not limited to them, the number of the blood passageways is not limited to them. In some embodiments, the transversal shape of the blood passageways 3 is circular, in some embodiments, the transversal shape of the blood passageways 3 is elliptical; in some embodiments, the transversal shape of the blood passageways 3 is square, but the shapes of the blood passageways 3 are not limited to them. In another characteristic of this embodiment, the shape of the holder 10 is not limited to them.

[0164] FIG. 24 is a cross-sectional view of the mandrel l, wherein two piercing tips 2 comprise a retractable 4 protection system, according to another embodiment invention, [0165] In another characteristic of this embodiment, the mandrel 1 has two piercing tips 2. In another characteristic of this embodiment, the retractable 4 slides longitudinally into a lumen 28 of the piercing tip 2. In another characteristic of tins embodiment, a spring 5 is seen in two positions: shrank position 5 A, including the retractable 4 fully in the lumen 28 of the piercing tip 2, and in the extended position 5B, with the retractable 4 in the distal extremity out of the lumen 28 of the piercing tip 2. Prior to puncturing the tissue 25, the retractable 4 distal end is out of the lumen 28 of the piercing tip 2 with its distal extremity externalizing out of the piercing tip 2 and the spring 5B is in an extended position. In the position 5B, the bezel 6 is protected by the retractable 4. In another characteristic of this embodiment, when the surgeon pushes the piercing tip 2 to insert the tissue 25, the retractable 4 is pushed by the tissue 25 and slides longitudinally into the piercing tip 2, and the retractable 4 compresses the spring 5 to position 5A. In another characteristic of this embodiment, when the tissue 25 has been transfixed, the spring 5 returns to the position 5B and, longitudinally, pushes the retractable 4 out of the lumen 28 of the piercing tip 2, in accordance with another embodiment of the invention. In some embodiments, the piercing tip 2 has the bezel 6 tip to insert the tissue 25. In another characteristic of this embodiment, the bezel 6 angulation is not limited to them . In another characteristic of this embodiment, the bezel 6 shape is not limited to them. In another characteristic of this embodiment, the bezel 6 shape of edging is not limited to them. In some embodiments, the piercing tip 2 is solid in some embodiments, the piercing tip 2 has the lumen 28.

[0166] FIG.25 is a cross-sectional view, wherein the plurality of ducts 14 comprises the fastening system 47 in the tissue 25. The figure in detail is an ampliation of tire second end I4B of die plurality of ducts 14, according to another embodiment of the invention.

[0167] In another characteristic of this embodiment, the middle part 9 includes two plurality of ducts 14. They are examples of the fastening systems 47: the grooves 15, the balloon 20, but it is not limited to them. In another characteristic of this embodiment, the grooves 15 comprise the fastening system 47 and assist in fixing the middle part 9 in the tissue 25, preventing the plurality of ducts 14, when punched in the tissue 25, to slide longitudinally in the tissue 25 during surgery. In another characteristic of this embodiment, the balloon 20 comprises the fastening system 47, the balloon 20 passes deflated through the tissue 25 and it is inflated after the plurality_' of ducts 14 transfixes the tissue 25. The balloons 20 are inflated by a pipe that passes along the duct 14 but is not limited to that.

[0168 In another characteristic of this embodiment, the invention comprises means for maintaining open the passage of blood through the blood passageways 3. In another characteristic of this embodiment, the plurality of ducts 14 comprises a coil 21 , which keeps open the blood passageways 3 of the plurality of ducts 14. If the plurality of ducts 14 is flexed or folded, the coil 21 maintains pervious the blood passageways 3. In another characteristic of this embodiment, the dilator 11 is part of the plurality of ducts 14, it is a tapering area thereof, and serves to dilate the insertion hole made by the piercing tip 2. In another characteristic of this embodiment, the faucet 12 may be opened or closed to provide perforations 44 through the blood passageways 3 of liquid or blood into the surgical site 26. In another characteristic of this embodiment, the valve 13 prevents liquids from returning from the blood passageways 3, out of tire middle part 9, in accordance with another embodiment of the invention.

[0169] FIG. 26 is a perspective view- of another embodiment of the invention, the invention is modular, including the module 23 and a block 22.

[0170] In another characteristic of this embodiment, the invention includes a module 23, the module 23 includes six sides. In another characteristic of this embodiment, the module 23 has male-female connections to connect to other modules 23, to form the handle 7; the engagement is longitudinally slidable. Also, in another characteristic of this embodiment, the invention including the block 22 and the block 2.2 includes six sides. In another characteristic of this embodiment, the block 22 has male-female connections to connect to other blocks 22 to form the holder 10. In another characteristic of this embodiment, the engagement is longitudinally slidable. In another characteristic of this embodiment, the mandrel 1 is disengaged from the middle part 9, m accordance with another embodiment of the invention. In some embodiments, the handle 7 will be formed by the connection of at least two modules 23, and the holder 10 will be formed by the connection of at least two blocks 22.

[0171] FIG. 27 is a perspective view- of another embodiment of the invention, the invention is modular, the mandrel 1 is engaged in the middle part 9.

[0172] In another characteristic of this embodiment, the engagement is longitudinally slidable by the six sides. In another characteristic of this embodiment, the invention is modular and includes the module 23 and the block 22, the mandrel 1 is perfectly engaged in the middle part 9, forming a single punch assembly. In another characteristic of this embodiment, the module 23 connects perfectly to the block 22, the module 23 is made to connect other modules 23. In another characteristic of this embodiment, the block 22 is made to connect other blocks 22, in accordance with another embodiment of the invention.

[0173] FIG. 28 is a top view of the module 23 according to another embodiment of the invention.

[0174] In another characteristic of this embodiment, tire module 23 includes six sides: three sides including a female-link 16, and the oilier three sides including a male-link 17. [0175] In another characteristic of this embodiment, each the male-link 17 is shaped to engage the female-link 16 of another module 23. In another characteristic of this embodiment, the engagement is longitudinally slidable, the female-link 16 is constructed to fit longitudinally slidable in the male-link 17 of another module 23, the male-link 17 is constructed to fit longitudinally slidable in the female-link 16 of another module 23, in accordance with another embodiment of the invention.

[0176] FIG. 29 is a top view of other embodiments of the block 22, according to other embodiments of the invention

[0177] In another characteristic of this embodiment, the block 22 includes six sides: three sides including a female -connectors 19, three sides including a male-connectors 18.

[0178] In another characteristic of this embodiment, each male-connector 18 is shaped to engage the female-connectors 19 of another block 22. In another characteristic of this embodiment, the engagement is longitudinally slidable, the male -connector 18 is constructed to fit, longitudinally slidable, in the female-connector 19 of another block 22, the female- connector 19 is constructed to fit, longitudinally slidable, in the male-connector 18 of another modular block 22, in accordance with another embodiment of the invention.

[0179] FIG.30 is a top view of two connected modules 23, according to another embodiment of the invention.

[0180] In another characteristic of this embodiment, the handle 7 is modular and formed by the joint of two or more modules 23, engaged in one another in a longitudinal sliding manner by male-female connector. In another characteristic of this embodiment, the female- link 16 is slidably engaged in the male-link 17 of another module 23, forming the handle 7, including two modules 23. In some embodiments, the handle 7 is formed by the connection of the plurality of modules 23, but the number of modules 23 is not limited to them. In another characteristic of this embodiment, the forms of engagement of the modules 23 are not limited to them, in accordance with another embodiment of the invention.

[0181] FIG. 31 is a top view of another embodiment of the invention, including three blocks 22.

[0182] In another characteristic of this embodiment, the holder 10 is modular and formed by the connection of three blocks 22 connected in a longitudinal sliding manner. In another characteristic of this embodiment, the middle part 9 is made by the connection of three blocks 22 [0183] FIG. 32 is a perspective view of another embodiment of the invention, the six modules 23 are connected in a suitable way to puncture the intercostal space, it is made to accompany the shape of the ribs in the chest.

[0384] In another characteristic of this embodiment, the trocar set 42 is modular and includes six connected modules 23 and six connected blocks 22. In another characteristic of this embodiment, the mandrel 1 is perfectly engaged in tire middle part 9, the modules 23 engages perfectly into the blocks 22. In another characteristic of this embodiment, the mandrel 1 is formed by six modules 23 connected modu!arly and sliding longitudinally, the middle part 9 is formed by six blocks 22 connected longitudinally and slidably engaged. In another characteristic of this embodiment, the mandrel 1 detachably engages the middle part 9, forming a single punch assembly, in accordance with another embodiment of the invention.

[0185] FIG. 33 is a perspective view* of another embodiment of the invention in a modular configuration for providing seven blood passageways 3 through tissue 25 to the surgical site 26.

[01861 In another characteristic of this embodiment, tire mandrel 1 is modular and perfectly engaged into the modular middle part 9, forming a single punch assembly. In another characteristic of this embodiment, the mandrel 1 is modular and includes the handle 7, winch is connected to seven piercing tips 2, and the middle part 9 is modular and includes the holder, which 10 connected to seven ducts 14. In another characteristic of this embodiment, the mandrel 1 is adapted to be completely detachable from the middle part 9, by sliding the mandrel 1 longitudinally relative to the middle part 9. In another characteristic of this embodiment, the handle 7 is modular and has seven female-links 16 (not seen) connected in seven modules 23. In another characteristic of tins embodiment, each module 23 has the piercing tip 2. In another characteristic of this embodiment, the middle part 9 is modular and has the holder 10 including seven female -connectors 19 (not seen), seven blocks 22 are embedded in the female-connectors 19. In another characteristic of this embodiment, block 22 has the plurality of ducts 14, according to another embodiment of the invention.

[0187] FIG. 34 is a perspective view- of another embodiment of the invention, the modular parts are disconnected.

[0188] In another characteristic of this embodiment, the embodiment contains: the handle 7, including seven female-links 16, and the holder 10, including seven female-connectors 19. In another characteristic of this embodiment, male-link 17 connects the female-link 16 in longitudinal sliding movement. In another characteristic of this embodiment, the surgeon chooses the number of piercing tips 2 that will be engaged in the handle 7. In another characteristic of this embodiment, the middle part 9 has the holder 10 including seven female-connectors 19, each one of the ducts 14 has the male-connector 18 that connects to the female-connector 19. In another characteristic of this embodiment, the surgeon chooses the number of ducts 14 to fit into the holder 10, in accordance with another embodiment of the invention. In some embodiments, the shape, the size and the types of the modular parts are different.

[0189] FIG.35 is a perspective view of another embodiment of the invention. The embodiment includes: seven female-links 16 to connect four male-links 17 and seven female-connectors 19 to connect four male-connectors 18.

[0190] In another characteristic of this embodiment, the surgeon chooses which of the seven female-links 16 connect the four male-links 17 and which of the seven female- connectors 19 connects the four male-connectors 18. In another characteristic of this embodiment, the modular parts are disconnected. In another characteristic of this embodiment, the mandrel 1 has the handle 7 including seven female-links 16, four of the male-links 17 of the piercing tips 2 are aligned for connect in the female -links 16 in a longitudinal sliding movement in another characteristic of this embodiment, the middle part 9 has the holder 10, including seven female-connectors 19, four of the male-connectors 18 of the ducts 14 are aligned to fit in the female-connectors 19 in a longitudinal sliding movement, m accordance with another embodiment of the invention.

[0191] FIG.36 is a perspective view of another embodiment of the invention in a modular configuration.

[0192] in another characteristic of tins embodiment, the handle 7 has four sides, two of them including male-links 17 and the other two including female-links 16. In another characteristic of this embodiment, the holder 10 also has four sides, two of them including male-connectors 18 and the other two including female-connectors 19. In another characteristic of this embodiment, the modular parts connect substantially similar to the "Lego Toy" male-to-female connectors.

[0193] FIG. 37 is a perspective view of another embodiment of the invention, in a modular configuration including four connection sides.

[0194] In another characteristic of this embodiment, the mandrel 1 has the handle 7 modular formed by the connection of two modules 23 and the middle part 9 has the holder 10 modular formed by the connecting of two blocks 22. In another characteristic of this embodiment, the mandrel i is perfectly engaged in the middle part 9, the mandrel 1 has the handle 7 modular formed by the connection of two modules 23, one module 23 is connected side by side to another module 23, four male-links 17 of the module 23 are connected to four female-links 16 of the other module 23 In another characteristic of this embodiment, module 23 has four connection sides, each side has four connectors, two of them including four male-links 17 the other two sides including four female-links 16. In another characteristic of this embodiment, module 23 includes the piercing tip 2, in accordance with another embodiment of the invention.

[0195] In another characteristic of this embodiment, the middle part 9 has the holder 10 modular formed by the connection of two blocks 22, which are connected side by side to another block 22 In another characteristic of this embodiment, block 22 has four connection sides. In another characteristic of this embodiment, four male -connectors 18 of one block 22 are connected to four female-connectors 19 of the other block 22. In a cross-section view, each of the block 22 has four sides, each side including four connectors, two of them including four male-connectors 18 and the other two sides including four female-connectors 19. In another characteristic of this embodiment, block 22 has the ducts 14. In another characteristic of this embodiment, the mandrel 1, detachably engages the middle part 9, forming a single punch assembly, according to another embodiment of the invention.

[0196] FIG. 38 is a perspective view of another embodiment of the invention, including a protector guide 8.

[0197] In another characteristic of tins embodiment, the protector guide 8 is on the plurality of ducts 14. in another characteristic of this em bodiment, the protector guide 8 is movable over the plurality of ducts 14 and is adapted to be moved from the holder IQ to the distal end of the plurality of ducts 14. When positioned in the distal position of the plurality of ducts 14, it protects the dilator 11 and protects the bezel 6 of the piercing tip 2. In another characteristic of this embodiment, there is a beater 27 at the distal end of the plurality of ducts 14, which prevents the protector guide 8 of coming out of the plurality of ducts 14. In another characteristic of this embodiment, the protector guide 8 has a protective function, so the bezel 6 does not injure something inadvertently and has a hole 2.4 to correctly direct the penetration of the plurality of ducts 14 into the tissue 25. In another characteristic of this embodiment, the two-headed arrow indicates the movement of the protector guide 8 on the plurality of ducts 14, according to another embodiment of the invention. In another characteristic of this embodiment, the protector guide 8 has the hole 2.4 for the passage of the plurality of ducts 14. [0198] FIG. 39, FIG. 40, FIG. 41, FIG.42 and FIG. 43 are cross-sectional views of some embodiments of the invention, including the method of providing a plurality of blood passageways 3 through tissue 25 to the surgical site 26. In another characteristic of this embodiment, the method of providing the plurality of blood passageways 3 through tissue 25 to the surgical site 26, includes: (a) piercing the plurality of ducts 14 in the tissue 25 to insert in the surgical site 26: (b) using, at least, one blood passageway 3 to pass blood of an extracorporeal circulation; and (c) removing the ducts 14 of the tissue 25, is provided. In another characteristic of this embodiment, the methods further include: (d) detach the mandrel 1 within the middle part 9; (e) connecting the external connection 36 to at least one duct 14; (f) inserting, at least, one of the distal ends 36B in the patient's circulation system 26B; (g) inserting, at least, one duct 14 in the patient's circulation system 26B. In another characteristic of this embodiment, the acts or operations of the methods or processes can be performed in any suitable sequence and are not necessarily limited to any disclosed sequence.

[0199] A method for extracorporeal circulation includes: inserting a plurality of ducts of a cardiovascular cannula into a surgical site through a plurality of perforations in the tissue, connecting the cardiovascular cannula to a patient's circulator_} system, connecting the cardiovascular cannula to an extracorporeal circulation apparatus, inserting a second cardiovascular cannula into a surgical site, connecting the second cardiovascular cannula to a patient's circulator_}' system, connecting the second cardiovascular cannula to an extracorporeal circulation apparatus, perform an extracorporeal circulation.

[0200] The method further includes, connecting an internal connection to the cardiovascular cannula.

[0201] The method further includes, removing the cardiovascular cannula of a patient's circulatory system and removing the second cardiovascular cannula of a patient's circulatory system, is provided.

[0202] FIG. 39, FIG. 40, FIG. 41, FIG.42 and FIG. 43 are described in more detail below, according to some embodiments of the invention.

[0203] FIG. 39 is a cross-sectional view of the protector guide 8, positioned at the distal end of the plurality of ducts 14, according to another embodiment of the invention,

[0204] In another characteristic of this embodiment, the method of punching the trocar set 42 includes two ducts 14 in the tissue 25 to insert in the surgical site 26

[0205] In another characteristic of this embodiment, the bezel 6 and the dilator 1 1 are protected inside the hole 24. In another characteristic of this embodiment, the beater 27 prevents tire protector guide 8 from coming out of the plurality of ducts 14. In another characteristic of this embodiment, the mandrel 1 and die middle part 9 form a single punch assembly to puncture the tissue 25, providing the plurality of blood passageways 3 through the tissue 25 to the surgical site 26, according to another embodiment of the invention.

[0206] In another characteristic of this embodiment, the protector guide 8 has the hole 24 through which die plurality of ducts 14 pass. In another characteristic of tins embodiment, the protector guide 8 has two functions: driving the piercing tips 2 during the tissue 25 insertion and protecting the bezel 6 so as not to, inadvertently, injure something. Punching the trocar set 42 including two ducts 14 in the tissue 25 to perforate 44 the surgical site 26. In another characteristic of this embodiment, for the insertion of the trocar set 42 in the tissue 25, the surgeon abuts a face 29 of the protector guide 8 to the tissue 25 and pushes the trocar set 42 against the tissue 25. In another characteristic of this embodiment, the holes 24 of the protector guide 8 drive the piercing tips 2 that perforate the tissue 25 in a driveway, according to another embodiment of the invention.

[0207] FIG.40 is a cross-sectional view of other embodiments of the invention, including tire method of punching the trocar set 42 including two ducts 14 m the tissue 25 to insert in the surgical site 26, according to another embodiment of the invention.

[0208] In another characteristic of this embodiment, the mandrel 1 and the middle part 9 form a single punch assembly which has been inserted in the tissue 25. In another characteristic of this embodiment, the plurality of ducts 14 passes through the protector guide 8 through the hole 24, traverses the tissue 25 and reaches the surgical site 26. In another characteristic of this embodiment, the dilator i 1 dilates the hole made by the piercing tip 2, allowing the passage of the plurality of ducts 14. In another characteristic of this embodiment, the hole 24 is positioned in the proximal end 36A of the plurality of ducts 14 near the bolder 10. In another characteristic of this embodiment, the mandrel 1 has not yet been detached from the middle part 9, the piercing tip 2 is inside the plurality of ducts 14 and the bezel 6 is inside the surgical site 26. In another characteristic of this embodiment, to use the blood passageways, the surgeon detaches the mandrel within the middle part 9 by longitudinal traction .

[0209] FIG. 41 is a cross-sectional view of middle part 9, providing two blood passageways through the tissue 25, according to another embodiment of the invention,

[0210] In another characteristic of this embodiment, the mandrel 1 has been detached from the middle part 9 by longitudinal traction. In another characteristic of this embodiment, the middle part 9 is positioned in the tissue 25 and is now the blood passageway 3 through tissue 25 of the video instrument to the surgical site 26. In another characteristic of this embodiment, the plurality of ducts 14 of the middle part 9 is transfixing the tissue 25. In another characteristic of this embodiment, the ducts 14 were inserted into the surgical site

26 through two perforations 44 in the tissue 25. In another characteristic of this embodiment, the valves 13 prevent gas or liquid from flowing out of the surgical site 26. In another characteristic of this embodiment, the faucet 12 allows the inflation of gas or liquid into the surgical site 26. The fastening system 47 includes grooves 15, secures the plurality of ducts 14 in the tissue 25 and prevents the plurality of ducts 14 from sliding on the tissue 25. In another characteristic of this embodiment, the blood passageways 3 allow the installation of the extracorporeal circulation without scarring. In another characteristic of this embodiment, removing the plurality of ducts 14 from the tissue 25, after the surgery, the trocar set 42 is removed from the tissue 25 by longitudinal traction, according to another embodiment of the invention.

[0211] FIG. 42 is a cross-sectional view of the middle part 9 that is adapted to connect to at least one internal connection 33 in the surgical site 26 and is adapted to connect to the external connection 36 outside the tissue 25, according to another embodiment of the invention.

[0212] Wherein, at least, one of the plurality of ducts 14 is adapted to connect to the internal connection 33 in the surgical site 26.

[0213] In the detail, there is a drawing showing the distal end of the plurality of ducts 14, according to one embodiment of the invention. In another characteristic of this embodiment, the trocar set 42 provides three blood passageways through the tissue 25 into the surgical site 26. In another characteristic of this embodiment, the trocar assembly 42 includes: the middle part 9 including the holder 10 and three plurality of ducts 14 connected to the holder 10. In another characteristic of this embodiment, the three plurality of ducts 14 are adapted to cause minimal trauma to the tissue 25 in order to prevent scarring, the plurality of ducts 14 are thin enough to cause minimal trauma to the tissue 25. Also, the three plurality' of ducts 14 further include the sharp tip 32 distal to insert in the tissue 25, avoiding scarring the tissue 25. In another characteristic of this embodiment, the holder 10 includes the socket 31 to connect to the external connection 36. In another characteristic of this embodiment, the plurality of ducts 14 includes the beater 27 and the fitting 30, according to another embodiment of the invention.

[0214] In another characteristic of this embodiment, the holder 10 is adapted to connect to a surgical device. In another characteristic of this embodiment, at least one surgical de vice may be connected to the socket 31, but it is not limited to them. In another characteristic of tins embodiment, there are some devices that may be connected to the holder 10: the extracorporeal hose 35, a suction appliance, a cannula, a video camera, guide, introduction guide, a surgical instrument, a measurement instrument, an electronic appliance, a surgical robot, an adapter, a cable, a pneumatic appliance, but it is not limited to them. In some embodiments, a device is connected the middle part 9 in a detachable way. In some embodiments, the connection of the device to the holder 10 is in a sealant way. In some embodiments, the connection of the device to the holder 10 is in a non-sealant way. In some embodiments, the connection of the device to the holder 10 is in a removable way. In some embodiments, the connection of the device to the holder 10 is in a non-removable way, but it is not limited to them. In some embodiments, the connection of the device to the holder 10 is made by friction. In some embodiments, the connection of the device to the holder 10 is made by electrical connection. In some embodiments, the connection of the device to the holder 10 is made by mechanical connections, but the type of connection is not limited to them. In some embodiments, there is a mechanism in the middle part 9 for releasing or connecting the device in the holder 10, for example: a button or a lever, according to another embodiment of the invention.

[0215] In another characteristic of this embodiment, the plurali ty of ducts 14 are adapted to connect the internal connection 33 inside the surgical site. In some embodiments, the plurality of ducts 14 includes the beater 27, which both serves to prevent the protector guide 8 from slipping out of the plurality of duets 14 and to connect the internal connection 33 in the surgical si te 26 to the plurality of ducts 14 In some embodiments, the fiting 30 connects the internal connection 33 in the surgical site 26 to the plurality of ducts 14. In some examples, at least one of the plurality of ducts 14 is adapted to connect at least one internal connection 33 in the surgical site 26. In some embodiments, the connection of the internal connection 33 in the surgical site 26 to the plurality of ducts 14 is made by friction. In some embodiments, the connection of the internal connection 33 in the surgical site 26 to the plurality of ducts 14 is m ade by electrical connection, in some embodiments, the connection of the internal connection 33 in the surgical site 26 to the plurality of ducts 14 is made by mechanical connection, but the type of connection is not limited to them. In some embodiments, the internal connection 33 in the surgical site 26 that connects the distal end of the plurality of duets 14 are: a hose, a cannula, an electronic appliance, a mechanical appliance, but it is not limited to them. In some embodiments, there is a mechanism in the middle part 9 for releasing or connecting the internal connection 33 m the surgical site 26 to the plurality of ducts 14, for example: a button or a lever. In some embodiments, the fixation is not limited to single plurality of ducts 14. In some embodiments, the internal connection 33 is connected to, at least, one of the plurality of ducts 14 in the surgical site 26after the trocar set 42 is inserted in the tissue 25, according to another embodiment of the invention.

[0216] In another characteristic of this embodiment, after the surgery, the trocar set 42 is removed from the tissue 25, the surgeon pulls the middle part 9 out of the tissue 25, according to another embodiment of the invention.

[0217] FIG. 43 is sectional view of the cardiovascular cannula assembly for extracorporeal circulation by a plurality of perforations 44 through the tissue 25, according to another embodiment of the invention.

[0218] In another characteristic of this embodiment, the embodiment includes: the holder 10 to connect to the extracoiporeal circulation apparatus 35 hose; the plurality of ducts 14 connected to the holder 10 to allow blood flow through the plurality of blood passageways 3 through the tissue 25; and the internal connection 33 for connecting the blood flow from the plurality of ducts 14 to the blood flow of the cardiovascular tissue 25 B

[0219] In another characteristic of this embodiment, the holder 10 is adapted to connect to the extracorporeal circulation apparatus 35 hose. In another characteristic of this embodiment, the guide 8 is adapted to slide over the plurality of ducts 14 In another characteristic of this embodiment, the beater 27 prevents die guidewire from exiting the ducts 14. In another characteristic of this embodiment, the beating 27 may be a flattening in the duct 14, the shape of the beater 27 is not limited to them. In another characteristic of this embodiment, the plurality of ducts 14 is adapted to transfix the tissue 25 and to connect the internal connection 33 into the surgical site 26. in another characteristic of this embodiment, the distal portion 33B of die internal connection 33 is configured to connect to the plurality of ducts 14. In another characteristic of this embodiment, the distal portion 33B is configured to be introduced into the patient’s circulatory system 26B. In detail, the distal end of the plurality of ducts 14 with the sharp tip 32 is seen.

[0220] FIG. 44 is a cross sectional view of the plurality of ducts 14 that comprises the fastening system 4, according to another embodiment of the invention.

[0221] In another characteristic of this embodiment, die embodiment is in the patient’s circulatory system 26B with balloons 20 which are blown up by ducts 14 which run parallel to the plurality of ducts 14 for external inflation of the balloons 20. In another characteristic of this embodiment, the plurality of second ends 14B are adapted to connect in the proximal portion 33 A. In another characteristic of this embodiment, die distal portion 33B has the plurality of tubes 43 for piercing the cardiovascular tissue 25 B to perforate 44 the patient’s circulatory system 26B. In another characteristic of tins embodiment, each plurality of tubes 43 has the fixation system with the proximal balloons 20B inside the patient’s circulatory system 26. Some embodiments have another balloon 20 positioned outside the cardiovascular tissue 25 B.

[0222] FIG. 45 is a cross sectional view of the cardiovascular cannula assembly for insertion into the surgical site 26 through the plurality of perforations 44 in tissue 25, according to another embodiment of the invention.

[0223] In another characteristic of this embodiment, the embodiment includes the holder 10 to connect to the extracorporeal circulation apparatus 35 hose; the plurality of ducts 14 connected to the holder 10 to allow blood flow through the plurality of blood passageways 3 through the tissue 25. In another characteristic of this embodiment, the external connection 36 connects to the extracorporeal circulation apparatus 35 hose in a detachable manner. In another characteristic of this embodiment, the external connection 36 is adapted to detachably connect the socket 31 . In another characteristic of this embodiment, the holder 10 connects to the external connection 36 in a sealing and detachable manner, to prevent blood leakage and air to input in the blood passageways 3. In another characteristic of this embodiment, the plurality of ducts 14 are adapted to connect to the connection 36 or to the patient’s circulatory system 26B.

[0224] FIG. 46 is a cross sectional view of the cardiovascular cannula assembly for extracorporeal circulation by the plurality of perforations 44 through the tissue 25 according to another embodiment of the invention.

[0225] In another characteristic of this embodiment, the embodiment includes: the holder 10 to connect to the extracorporeal circulation apparatus 35 hose and the plurality of ducts 14 connected to the holder 10 to allow blood flow through the plurality of blood passageways 3. In another characteristic of this embodiment, tire plurality of ducts 14 is connected to the proximal portion 33 A of the internal connection 33. In another characteristic of this embodiment, the distal portion of the internal connection 33 is connected to the patient’s circulatory system 26B through the vascular tissue 25 B. In another characteristic of this embodiment, a proximal balloon 20A serves as a stop for the distal portion 33B inlet in the patient’s circulatory system 26B. In another characteristic of this embodiment, the distal portion 33B has a second balloon 20B inside the patient’s circulatory system 26B. in some embodiments, there is no second balloon 20B. In some embodiments, there is no proximal balloon 20A. In some embodiments, there is no balloon 20. [0226] FIG. 47 is a cross sectional view of the cardiovascular cannula assembly for extracorporeal circulation by the plurality of perforations 44 through the tissue 25, according to another embodiment of the invention.

[0227] This embodiment includes: the holder 10 to connect to the extracorporeal circulation apparatus 35 hose; the plurality of ducts 14 connected to the holder 10 to allow' blood flow through the plurality of blood passageways 3 to the patient’s circulatory system 26B, through the tissue 25 and through the vascular tissue 25 B. In another characteristic of this embodiment, the plurality of ducts 14 is made of flexible material. In another characteristic of this embodiment, the holder 10 connects to the extracorporeal circulation apparatus 35 hose in a detachable manner. In another characteristic of this embodiment, the holder 10 connects to the extracorporeal circulation apparatus 35 hose in a sealing manner, to prevent blood leakage and air to input in the blood passageways 3. In another characteristic of this embodiment, the plurality of ducts 14 is adapted to connect to the patient’s circulatory system 26B. In another characteristic of this embodiment, the plurality of ducts 14 have the fastening system 47 in vascular tissue 25, there is a distal balloon 25B within the patient’s circulatory system 26B and another proximal balloon 20A outside the vascular tissue 25 B. In another characteristic of this embodiment, the proximal balloon 20A and the second balloon 20B is inflated and deflated externally by ducts 14. In another characteristic of this embodiment, the balloon 20 and each second balloon 20B is connected to the tube passing through the wall of the ducts 14 and is externalized in the holder 10.

[0228] FIG.48 is a side view of another modular embodiment of the invention.

[0229] In another characteristic of this embodiment, the plurality of ducts 14 is made of flexible material. In another characteristic of this embodiment, the plurality of ducts 14 is made to be positioned, one at a time, at the patient’s circulatory system 26B, with the aid of the mandrel 1 . In another characteristic of this embodiment, the balloons 20 are inflating through ducts 14 which pass into the wall of the plurality' of ducts 14. In another characteristic of this embodiment, the second balloon 20 B is adapted to be positioned at the patient’s circulatory system 26B, the proximal balloon 20A is adapted to be positioned externally of the cardiovascular tissue 25 B. The blocks 22 are adapted to be joined together outside the surgical site. In another characteristic of this embodiment, the holder 10 is adapted to connect to the external connection 36. In some embodiments, the external connection 36 is modular, there is one external connection 36 for each block 22. In some embodiments, each block 22 is adapted to connect to the external connection 36 in a separate way. The arrows show the direction in which the modular parts connect. In another characteristic of this embodiment, each proximal balloon 20 A and each second balloon 20B is inflated and deflated externally by ducts 14. In another characteristic of this embodiment, each proximal balloon 20A and each second balloon 20B is connected to the tube passing through the wall of the ducts 14 and is externalized in the holder 10.

[0230] FIG. 49 It is a lateral view of the mandrel 1 with the handle 7 modular and the middle part 9 with the plurality of modular holders 10, according to another embodiment of the invention.

[0231] In another characteristic of this embodiment, the protector guide 8 maintains the plurality of the middle part 9 together. In another characteristic of this embodiment, middle

9 part is adapted to he able to connect and disconnect to the protector guide 8. In another characteristic of this embodiment, modular middle part 9 is adapted to be removed and replaced. In another characteristic of this embodiment, the middle parts 9 are interconnectable. In another characteristic of this embodiment, there are four modular 7 handle. In another characteristic of this embodiment, the protector guide 8B keeps the piercing tips together. In another characteristic of this embodiment, the protector guide 8B is adapted to connect disconnectedly to the middle part 9.

[0232] FIG.50 is a lateral view of the middle part 9 with the plurality of modular holders

10 and the plurality of distal ends 36, according to another embodiment of the invention. In another characteristic of this embodiment, the four distal ends 36B are ready to be inserted in the four holders 10. In another characteristic of this embodiment, the extracorporeal circulation apparatus 35 hose is ready to be connected in the proximal end 36A. The second end 14B is within the surgical site 26. The arrows show the direction of connection.

[0233] it will be apparent to one skilled in the art that the invention may be provided including some or all the mentioned features and components without departing from the spirit and scope of the invention. For purposes of comparing some embodiments, certain aspects and advantages of these embodiments are described. Not necessarily all such aspects or advantages are achieved by any particular embodiment. Thus, for example, some embodiments can be carried out in a manner that achieves or optimizes one advantage or group of advantages as described, herein without necessarily achieving other aspects or advantages as can also be described or suggested herein. It will also be apparent to the skilled artisan that the embodiments described above are specific examples of a broader invention which may have greater scope than any of the singular descriptions taught. There may be many alterations made in the descriptions without departing from the spirit scope of the invention. Although, certain preferred embodiments and examples are disclosed, inventive subject matter extends beyond the specifically disclosed embodiments to other alternative embodiments and/or uses, and to modifications and equivalents thereof. Thus, the scope of the claims appended hereto is not limited by any of the particular embodiments described. For example, in any method or process disclosed herein, the acts or operations of the method or process can be performed in any suitable sequence and they are not necessarily limited to any particular disclosed sequence. Some operations can be described as multiple discrete operations in turn, in a manner that can be helpful in understanding certain embodiments, however, the order of description should not be construed to imply that these operations arc order dependent.

Claims

claim:

1. A cardiovascular cannula assembly for insertion into a surgical site through a plurality of perforations in the tissue, comprising: a holder ; a plurality of ducts including a first end and a second end, said first end connected to said holder ; wherein said holder and said plurality of ducts include blood passageway.

1.1. The cardiovascular cannula of claim 1, wherein said second end is adapted to connect within a patient's circulatory system.

1.2. The cardiovascular cannula of claim 1, wherein said holder is adapted to connect to an extracorporeal circulation apparatus.

1.3. The cardiovascular cannula of claim 1, wherein said holder is modular and includes an external connection, said external connection including a proximal end and a distal end, said proximal end adapted to connect to an extracorporeal circulation apparatus, and said distal end is adapted to detachably connect to said holder.

1.4. The cardiovascular cannula of claim 1, wherein said plurality of ducts is made to be inserted through a trocar containing a plurality of perforations.

1.5. The cardiovascular cannula of claim 1 , further comprising an internal connection, said internal connection including a proximal portion and a distal portion, wherein said distal portion is adapted to connect to the patient's circulatory system, wherein said proximal portion is adapted to connect to said second end.

1.6. The cardiovascular cannula of claim 1, wherein at least one of said plurality of ducts further comprises a sharp tip.

1.7. The cardiovascular cannula of claim 1, said ducts are thin enough to not cause scar.

1.8. The cardiovascular cannula of claim 1 , further comprising a mandrel, and said mandrel including a plurality of piercing tips connected to a handler, wherein said mandrel detachably engages said cardiovascular cannula forming a single inserting trocar set.

1.9. The cardiovascular cannula of claim 1, wherein at least one of said plurality of ducts is adapted to dilate an insertion hole in a tissue to prevent scar.

1.10. The cardiovascular cannula of claim 1, wherein at least one part is made in a transparent material.

1.11. The cardiovascular cannula of claim 1, wherein at least one of said plurality of ducts is adapted to connect a surgical device within said surgical site.

1.12. The cardiovascular cannula of claim 1, wherein said plurality of cannula comprises means for keeping said blood passage open through said cannula.

1.13. The cardiovascular cannula of claim 1, further comprising a protector guide. 1.14. The cardiovascular cannula of claim 1, wherein at least one of said plurality of ducts comprises a fastening system in said tissue.

1.15. The cardiovascular cannula of claim 1, further comprising at least one modular part adapted to connect other the modular part.

1.16. The cardiovascular cannula of claim 1, wherein at least one of said plurality of piercing tips comprises a retractable protection system.

1.17. The cardiovascular cannula of claim 1, wherein at least one of said plurality of ducts is made to connect to an internal connection in the surgical site.

1.18. The cardiovascular cannula of claim 1, wherein said holder is adapted to connect to a surgical device.

1.19. The cardiovascular cannula of claim 2, further comprising an external connection to connect to said holder an extracorporeal circulation apparatus.

1.20. The cardiovascular cannula of claim 1, further comprising an internal connection made to connect said plurality of ducts to the patient's circulatory system.

2. A cardiovascular cannula assembly for extracorporeal circulation by a plurality of perforations in a tissue, comprising: a holder; a plurality of ducts connected to said holder; and an internal connection.

2.1. The cardiovascular cannula of claim 2, wherein said internal connection is made to be inserted in said surgical site through a conventional trocar.

2.2. The cardiovascular cannula of claim 2, wherein said connection includes means to fix to said vascular tissue.

2.3. The cardiovascular cannula of claim 2, further comprising a mandrel, and said mandrel including a plurality of piercing tips connected to a handler, wherein said mandrel detachably engages said cannula forming a single punch trocar set.

2.4. The cardiovascular cannula of claim 2, further comprising an external connection.

3. A method, including:

a) inserting a plurality of ducts of a cardiovascular cannula assembly through a plurality of perforations;

b) connecting an internal connection to said cardiovascular cannula assembly ;

c) connecting said cardiovascular cannula to an extracorporeal circulation apparatus.