A tube device for forming a fistula is constructed in such a way that the tube device is composed of a metallic guide wire, a small diameter tube to which the guide wire can be inserted in its center, a medium diameter tube covering the outer periphery of the small diameter tube, a medium-large diameter tube covering the outer periphery of the small diameter tube and having an outer diameter larger than the medium diameter tube, a large diameter tube covering the outer periphery of the small diameter tube and having an outer diameter larger than the medium-large diameter tube, a large diameter drainage tube covering the outer periphery of the small diameter tube and having an outer diameter equal to that of the large diameter tube, and an extra large diameter tube covering the outer periphery of the large diameter drainage tube. An outer diameter of each tip portion of the small diameter tube, medium diameter tube, medium-large diameter tube and large diameter tube is gradually reduced towards ends thereof to be taper-shaped. These tubes are exchanged and inserted in the order of their diameters, i.e. from small diameter to large diameter, by means of a guide wire. The extra large diameter tube necessary for the insertion of the endscope can be inserted in a short time with an extreme safety since the tapered surface of the tip portion of the tube applies the pressure to the liver tissue to expand it gradually.

A surgical process for the complete functional inactivation of the Sphincter of Oddi for the purpose of treating accurately diagnosed functional abnormality of the Sphincter of Oddi complex.

A tissue manipulator is provided which is insertable through an endoscopic tube to enable a surgeon to manipulate tissue inside a body cavity. The endoscopic tissue manipulator includes an expandable tissue manipulating frame adapted to expand transversely through a longitudinal slot in a support tube to provide a spatula-shaped platform which can be manipulated by rotation of the support tube about its longitudinal axis to engage and displace large body organs away from a desired surgical site in a body cavity. The frame consists of a plurality of flexible frame members or wires adapted to flex laterally outward through the longitudinal slot in the support tube into a bow-shaped configuration overlapping the other frame members or wires of the spatula-shaped platform. The instrument can be provided with a single tissue manipulating frame or a pair of frames which are expandable through separate longitudinal slots in the support tube to provide a pair of spatula-shaped platforms to engage the tissue. The pair of frames of the dual frame embodiment may be actuated together or independently.

A subcutaneous tunnelling device, a dilator and a method of forming a subcutaneous tunnel are provided. The device includes a trocar having a front end with a point configured for piercing skin, and a dilator which has a front end removably attached to the rear end of the trocar. The dilator is for dilating a section of a subcutaneous tunnel and includes a dilating section having a maximum diameter sized for dilating an interior surface of a subcutaneous tunnel for seating a catheter stabilizing cuff in the subcutaneous tunnel. The method of forming a subcutaneous tunnel includes the steps of inserting a trocar through a first location on a cutaneous surface and moving the trocar through subcutaneous tissue to form a subcutaneous tunnel. The trocar is at least partially removed and a front end of a dilator is attached to the trocar. A section of the tunnel is dilated by moving the dilator partially through the tunnel until the front end of the dilator reaches a first subcutaneous location in the tunnel. The dilator and trocar are at least partially withdrawn from the dilated tunnel section of the subcutaneous tunnel through the first end of the tunnel.

An apparatus for carrying out tracheostomy tube replacement includes the use of a specially constructed obturator having a central longitudinal opening. The central opening of the obturator allows the obturator to pass over a guide tube which has been left in place after removal of the old tracheostomy tube. The obturator also has an atraumatic rounded tip to make passage of the obturator and replacement tracheostomy tube assembly through the stoma and into the tracheal lumen safer and easier, guided by the emplaced guide tube.