Abstract:
A method for grasping and holding tissue employs an apparatus including flexible sheet having walls that define adjoining top and bottom chambers which move together as a unitary part during use. The top and bottom walls of the flexible sheet conform to tissue and have corresponding first and second sets of holes. The method supplies suction to the top chamber and the first set of holes via the first fluid path to engage and hold tissue adjacent the top wall by suction forces applied through the first set of holes, and also supplies suction to the bottom chamber and the second set of holes via the second fluid path to engage and hold tissue adjacent the bottom wall by suction forces applied through the second set of holes.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a divisional application of U.S. application Ser. No. 12/484,287, filed on Jun. 15, 2009, which will issue as U.S. Pat. No. 8,206,295, herein incorporated by reference in its entirety. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    1. Field of the Invention 
         [0003]    This invention relates to surgical instruments used to grasp, move and hold tissue during surgery. 
         [0004]    2. State of the Art 
         [0005]    As shown in  FIG. 1 , the human digestive system includes a biliary tract (gall bladder and bile ducts) that carries and stores bile that contains substances that allow fats to be emulsified. Bile also stimulates the secretion of an enzyme concerned with the breakdown of fats. Bile is secreted by the liver and stored in the gallbladder until needed. The gallbladder is a small pear-shaped organ. When fat is eaten, the gallbladder is stimulated to contract and bile stored in the gallbladder flows down the cystic duct, into the common bile duct and to the small intestine. As well as acting as a storage vessel, the gallbladder concentrates the bile within it by removing water through its wall. 
         [0006]    The most common disorder of the biliary tract is gallstones. Why and how gallstones form is not fully understood, but it is thought that in some cases an abnormality in function causes the gallbladder to remove an excessive amount of water from the bile so that some of its constituents can no longer remain in solution. Gallstones occur very frequently in developed countries and may be associated with eating a diet that is high in fat and refined carbohydrates and low in fiber. Gallstones can give rise to various problems, including cholecystitis (inflammation of the gallbladder), choledocholithiasis (gallstones in the common bile duct), cholangitis (infection of the bile ducts), pancreatitis, and gallstone ileus (obstruction of the intestines by a gallstone). Other disorders of the biliary tract include biliary sludge and dysmotility (poor physiological function). Treatment of such disorders can involve laparoscopic gallbladder removal (laparoscopic cholecystectomy). 
         [0007]    Laparoscopic cholecystectomy requires one or more small incisions in the abdomen to allow the insertion of laparoscopic surgical instruments and a small video camera into the abdominal cavity. After the initial incision(s), the abdominal cavity is inflated with gas (typically carbon dioxide) and the camera is positioned in the abdominal cavity. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. The surgeon watches the video monitor and performs the operation by manipulating laparoscopic surgical instruments that extend into the abdominal cavity. 
         [0008]    Typically, laparoscopic cholecystectomy is carried out by lifting the left lobe of the liver by manipulation of hook retractor to identify and clear Calot&#39;s Triangle (the area bound by the liver, cystic duct, and common hepatic duct). With the liver being held by the hook retractor, the gallbladder is grasped by non-crushing grasping mechanical forceps (e.g., Rotweiler forceps) and lifted up and away from the liver bed. With the liver held by the hook retractor and the gallbladder held by the forceps, the cystic duct is dissected free from the overlying tissue and the cystic duct and then clipped and cut. The cystic artery in then dissected, clipped and cut. The gallbladder is separated from the liver bed typically by a spatula-shaped instrument. The spatula design is ideal for conforming to the gallbladder bed and bluntly dissecting the gallbladder from the liver. Care is taken to not enter the gallbladder to prevent spillage of infected bile or gallstones. Any bleeding points seen on the liver bed are cauterized. With a small length of gallbladder remaining on the liver bed, the gallbladder is retracted towards the abdominal wall by the mechanical forceps to allow for visualization of the liver bed. The gallbladder is then completely removed from the liver bed and placed in a tissue retrieval bag (e.g., Endo-bag). The bag is closed and then removed from the abdominal cavity. Fluid irrigation and suction in the vicinity of the liver is performed typically until the fluid being returned is clear. All instruments are removed from the abdominal cavity, pressure is applied to the outside of the abdominal wall to express as much of the pneumoperitoneum (insufflation gas) as possible, and the incision site(s) are sutured closed. 
         [0009]    As part of the laparoscopic cholecystectomy, the handle of the hook retractor that is used to lift and hold the liver remains in the working field of the surgeon(s) external to the abdomen and can interfere with hand movement of the surgeon(s) in this space. Moreover, to hold the liver in place, the hook retractor requires manual fixation by a surgeon (or mechanical fixation by a support structure disposed outside the abdominal cavity) that holds the retractor in place, thus increasing the complexity of the procedure. 
         [0010]    Similar problems arise when using retractors and other instruments to manipulate other organs and tissue during laparoscopic and non-laparoscopic surgeries involving the abdominal cavity, such as surgeries involving the small intestine, large intestine, stomach, spleen, liver, pancreas, kidneys, and adrenal glands. 
         [0011]    Moreover, similar problems arise when using retractors and other instruments to manipulate other organs and tissue during laparoscopic and non-laparoscopic surgeries involving the thoracic cavity or pelvic cavity, such as surgeries involving the heart, thoracic aorta, the pulmonary artery and all its branches, the superior and inferior vena cava, the pulmonary veins, the trachea, the bronchi and lungs, the esophagus, the endocrine glands, the thoracic duct, the reproductive organs, the urinary bladder, and the rectum. 
         [0012]    Laparoscopic surgery as used herein means any surgery that involves one or more small incisions into a body cavity that allow for the insertion of laparoscopic surgical instruments and a small video camera into the body cavity. After the initial incision(s), the body cavity can be inflated with gas (typically carbon dioxide) and the camera is positioned in the body cavity. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. The surgeon watches the video monitor and performs the operation by manipulating laparoscopic surgical instruments that extend into the body cavity. Laparoscopic surgery includes natural orifice translumenal endoscopic surgery (commonly referred to as “NOTES”) where operations are performed with an endoscope passed through a natural orifice (mouth, urethra, anus, etc.) then through an internal incision into the stomach, vagina, bladder or colon into the desired body cavity (e.g., abdomen). NOTES is advantageous because it avoids external incisions and scarring associated therewith. Laparoscopic surgery also includes single port access (SPA) surgery, which is also known as single incision laparoscopic surgery (SILSTM) or one port umbilical surgery (OPUS) or natural orifice transumbilical surgery (NOTUS). SPA is a minimally invasive surgical procedure in which the surgeon operates almost exclusively through a single entry point, typically the patient&#39;s umbilicus. 
         [0013]    Thus, there is a need for improved devices that can effectively grasp, retract and hold body organs and tissue during surgical procedures with minimal risk in rupturing and/or otherwise damaging such tissue. 
       SUMMARY OF THE INVENTION 
       [0014]    It is therefore an object of the invention to provide a surgical assembly for lifting and manipulating tissue which reduces interference in the working field of the surgeon(s) adjacent the patient as compared to presently used systems. 
         [0015]    It is another object of the invention to provide such a surgical assembly which effective grasps and holds tissue with minimal trauma to the tissue being grasped. 
         [0016]    It is yet another object of the invention to provide such a surgical assembly which is simple and inexpensive relative to presently used systems. 
         [0017]    It is a further object of the invention to such a surgical assembly which is suitable for minimally invasive laparoscopic surgery. 
         [0018]    It is still another object of the invention to provide such a surgical assembly which a reduced number of parts that is simple and effective to use. 
         [0019]    In accord with these objects, which will be discussed in detail below, a surgical assembly according to the invention broadly includes a flexible shell that defines a flexible sheet-like structure with a major top wall opposite a major bottom wall. The top wall is impermeable to air flow therethrough and has a first set of holes that allow for air flow therethrough. The bottom wall is impermeable to air flow therethrough and has a second set of holes that allow for air flow therethrough. A first fluid path supplies a source of suction to the first set of holes in a manner that is independent to suction supplied the second set of holes. A second fluid path supplies a source of suction to the second set of holes in a manner that is independent to suction supplied to the first set of holes. The supply of suction to the first set of holes is used to engage and hold tissue adjacent the top wall by suction forces applied through the first set of holes. The supply of suction to the second set of holes is used to engage and hold tissue adjacent the bottom wall by suction forces applied through the second set of holes. The tissue that is engaged adjacent the top wall is sealably disposed about the first set of holes, and tissue that is engaged adjacent the bottom wall is sealably disposed about the second set of holes. 
         [0020]    In the preferred embodiment, the flexible shell includes walls that define internal top and bottom chambers that are disposed opposite one another. The top chamber is bounded by the top wall, and the bottom chamber is bounded by the bottom wall. The first fluid path is fluidly coupled to the top chamber, and the second fluid path is fluidly coupled to the bottom chamber. The top chamber preferably includes a first diffusion member that disperses vacuum flow across the first set of holes of the top wall, and the bottom chamber preferably includes a second diffusion member that disperses vacuum flow across the second set of holes of the bottom wall. The first and second diffusion members can also function to enhance structural integrity of the respective chamber and helps prevent the respective chamber from buckling or collapsing under vacuum loads applied thereto when engaging tissue. 
         [0021]    The surgical assembly of the invention advantageously provides for lifting, manipulating and holding tissue without the need for manual fixation by a surgeon (or mechanical fixation by an external support structure disposed adjacent the patient). It also operates to reduce interference in the working field of the surgeon(s) adjacent the patient. It also provides effective tissue grasping with minimal tissue damage. It also accomplishes the objects of the invention with a minimum number of parts and may be used to replace expensive laparoscopic tissue grasping and manipulation instruments. 
         [0022]    Additional objects and advantages of the invention will become apparent to those skilled in the art upon reference to the detailed description taken in conjunction with the provided figures. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0023]      FIG. 1  is an illustration showing anatomic details of the abdominal cavity of the human body. 
           [0024]      FIG. 2A  is a cross-sectional schematic view of an exemplary embodiment of a tissue grasper in accordance with the present invention. 
           [0025]      FIG. 2B  is a perspective view of the tissue grasper of  FIG. 2A . 
           [0026]      FIG. 2C  is a pictorial illustration of a configuration of the tissue grasper of  FIGS. 2A and 2B  providing deployment from a cannula suitable for laparoscopic surgical applications. 
           [0027]      FIG. 3A  is a cross-sectional schematic view of an alternate embodiment of a tissue grasper in accordance with the present invention. 
           [0028]      FIG. 3B  is a perspective view of the tissue grasper of  FIG. 3A . 
           [0029]      FIG. 3C  is a schematic view of a surgical instrument employing the tissue grasper of  FIGS. 3A and 3B . 
           [0030]      FIGS. 4A-4D  are pictorial illustrations that depict the use of the tissue grasper of  FIGS. 3A-3B  for grasping and holding a gallbladder during a surgical operation of the abdominal cavity, such as a cholecystectomy. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0031]    Turning now to  FIGS. 2A-2C , a surgical apparatus  10  in accordance with the present invention is provided for engaging and holding tissue during a surgical procedure. The apparatus  10  includes a flexible shell or skin  11  that defines a flexible sheet-like structure with internal top and bottom chambers  12 A,  12 B that are disposed opposite one another as best shown in  FIG. 2A . A first flexible tube  14 A is fluidly coupled to the top chamber  12 A. A second flexible tube  14 B is fluidly coupled to the bottom chamber  12 B. The first tube  14 A is fluidly coupled to a vacuum line (not shown) in a manner that provides for supply of suction (negative air pressure) to the first chamber  12 A independent from the supply provided to the second chamber  12 B. The second tube  14 B is fluidly coupled to the same vacuum line (or another vacuum line) in a manner that provides for supply of suction (negative air pressure) to the second chamber  12 B that is independent from the supply provided to the first chamber  12 A. The tubes  14 A and  14 B can be joined or held together if desired. The tubes  14 A,  14 B can also be realized a multi-lumen conduit. The conduit(s) that realize the tubes  14 A,  14 B are preferably flexible in nature such that they can be moved in the working field of the surgeon(s) adjacent the patient in order to minimize obtrusiveness of the conduits from the hand movements of the surgeon(s). The walls of the top and bottom chambers  12 A,  12 B are realized from a flexible material that is generally impermeable to air flow therethrough, which is necessary to generate a pressure differential between the respective chambers and the ambient environment for suction purposes as described herein. In the preferred embodiment, the walls of the top and bottom chambers is realized from a medical-grade sealing elastomer, such as butyl and nitrile rubbers, silicones, perfluorocarbons (e.g., PTFE), polyurethanes, vinyls, as well as other medical-grade sealing elastomeric materials. Such sealing elastomers allow for conformance of the shell  12  to the tissue to allow for proper sealing therebetween, and also minimize any risk of puncture and other damage to the tissue that it contacts. 
         [0032]    As shown in  FIG. 2B , the major top wall  15  of the top chamber  12 A has a pattern of holes  17  that allow for air flow into the top chamber  12 A upon supply of suction to the top chamber  12 A. Similarly, the major bottom wall  19  of the bottom chamber  12 B has a pattern of holes  21  that allow for air flow into the bottom chamber  12 B upon supply of suction to the bottom chamber  12 B. 
         [0033]    The top chamber  12 A includes a diffusion member  23 A (such as a layer of open cell foam) that disperses the vacuum flow across the pattern of holes  17  on the top wall  15 . The diffusion member  23 A also enhances the structural integrity of the top chamber  12 A and helps prevent the top chamber  12 A from buckling or collapsing under the vacuum load applied thereto. The bottom chamber  12 B includes a diffusion member  23 B (such as a layer of open cell foam) that disperses the vacuum flow across the pattern of holes  21  on the bottom wall  19 . The diffusion member  23 B also enhances the structural integrity of the bottom chamber  12 B and helps prevent the bottom chamber  12 B from buckling or collapsing under the vacuum load applied thereto. 
         [0034]    In an alternative embodiment, the diffusion member  23 A can be substituted by (or enhanced with the addition of) a supportive skeletal network that enhances structural integrity of the top chamber  12 A and prevents the top chamber  12 A from buckling or collapsing under vacuum loads applied thereto. Similarly, the diffusion member  23 B can be substituted by (or enhanced with the addition of) a supportive skeletal network that enhances structural integrity of the bottom chamber  12 B and prevents the bottom chamber  12 B from buckling or collapsing under vacuum loads applied thereto. Such supportive skeletal networks can be realized by a wire or plastic mesh or other suitable support structure. 
         [0035]    One or more tabs  25  (one shown) extend from the shell  11 . The tab(s)  25  is grabbed by a grasping device, such as a laparoscopic forceps instrument, to position and move the shell  11  during use as desired. 
         [0036]    It is contemplated that the color of the major top wall  15  of the top chamber  12 A can be distinct relative to the color of the major bottom wall  19  of the bottom chamber  12 B to allow for easy identification of the orientation of the shell  11  and proper control of negative air pressure to the respective chambers. 
         [0037]    During use, the supply of suction to the bottom chamber  12 B operates to engage and hold tissue adjacent the bottom wall  19  of the bottom chamber  12 B by negative air pressure within the top chamber  12 B ( FIG. 4B ). Such negative air pressure induces suction that extends through the holes  21  to retain and hold the tissue adjacent the bottom wall  19 . Independently, the supply of suction to the top chamber  12 A is used to engage and hold tissue adjacent the top wall  15  of the top chamber  12 A by negative air pressure within the top chamber  12 A. Such negative air pressure induces suction that extends through the holes  17  to retain and hold the tissue adjacent the top wall  15 . Tissue that is engaged adjacent the bottom wall  19  is sealably disposed about the pattern of holes  21  in the bottom wall  19  with the pattern of holes  21  covering an area that is smaller than the area of tissue sealably disposed thereabout. Tissue that is engaged adjacent the top wall  15  is sealably disposed about the pattern of holes  17  in the top wall  15  with the pattern of holes  17  covering an area that is smaller than the area of tissue sealably disposed thereabout. Tissue that is engaged adjacent the top wall  15  is released from the top wall  15  by venting the first fluid path  14 A, which removes the suction forces that are applied to the tissue through the holes  17  in the top wall  15 . Tissue that is engaged adjacent the bottom wall  19  is released from the bottom wall  19  by venting the second fluid path  14 B, which removes the suction forces that are applied to the tissue through the holes  21  in the bottom wall  19 . 
         [0038]    As shown in  FIG. 2C , the flexible shell  11  can be rolled-up on itself and housed at the distal end of a flexible or rigid cannula  27 . In the preferred embodiment, the cannula  27  has an outer diameter preferably in a range of 5-10 mm for insertion through a common laparoscopic port. With the distal end of the cannula  27  positioned inside a body cavity (e.g., an abdominal cavity during laparoscopic surgery therein), the flexible shell  11  (together with the tab  25 ) can be deployed from the distal end of the cannula  27  and into the body cavity, where it is unrolled for use in engaging and holding tissue inside the body cavity ( FIGS. 4A-4D ). 
         [0039]    Turning now to  FIGS. 3A-3C , an alternate embodiment of a surgical apparatus  10 ′ in accordance with the present invention is provided for engaging and holding tissue during a surgical procedure. The apparatus  10 ′ includes a flexible shell or skin  11 ′ that defines a flexible sheet-like structure with internal top and bottom chambers  12 A,  12 B similar to the embodiment of  FIGS. 2A-2C . A first flexible tube  14 A is fluidly coupled to the top chamber  12 A. A second flexible tube  14 B is fluidly coupled to the bottom chamber  12 B. The first tube  14 A is fluidly coupled to a vacuum line (not shown) in a manner that provides for supply of suction (negative air pressure) to the first chamber  12 A independent from the supply provided to the second chamber  12 B. The second tube  14 B is fluidly coupled to the same vacuum line (or another vacuum line) in a manner that provides for supply of suction (negative air pressure) to the second chamber  12 B that is independent from the supply provided to the first chamber  12 A. The walls of the top and bottom chambers  12 A,  12 B are realized from a flexible material that is generally impermeable to air flow therethrough, which is necessary to generate a pressure differential between the respective chambers and the ambient environment for suction purposes as described herein. In the preferred embodiment, the walls of the top and bottom chambers is realized from a medical-grade sealing elastomer, such as butyl and nitrile rubbers, silicones, perfluorocarbons (e.g., PTFE), polyurethanes, vinyls, as well as other medical-grade sealing elastomeric materials. Such sealing elastomers allow for conformance of the shell  12  to the tissue to allow for proper sealing therebetween, and also minimize any risk of puncture and other damage to the tissue that it contacts. 
         [0040]    As shown in  FIG. 3B , the major top wall  15  of the top chamber  12 A has a pattern of holes  17  that allow for air flow into the top chamber  12 A upon supply of suction to the top chamber  12 A. Similarly, the major bottom wall  19  of the bottom chamber  12 B has a pattern of holes  21  that allow for air flow into the bottom chamber  12 B upon supply of suction to the bottom chamber  12 B. 
         [0041]    The top chamber  12 A includes a diffusion member  23 A (such as a layer of open cell foam) that disperses the vacuum flow across the pattern of holes  17  on the top wall  15 . The diffusion member  23 A also enhances the structural integrity of the top chamber  12 A and helps prevent the top chamber  12 A from buckling or collapsing under the vacuum load applied thereto. The diffusion member  23 A can also aid in preventing tissue from being sucked through the holes  17  and any tissue damage that can result therefrom. The bottom chamber  12 B includes a diffusion member  23 B (such as a layer of open cell foam) that disperses the vacuum flow across the pattern of holes  21  on the bottom wall  19 . The diffusion member  23 B also enhances the structural integrity of the bottom chamber  12 B and helps prevent the bottom chamber  12 B from buckling or collapsing under the vacuum load applied thereto. The diffusion member  23 B can also aid in preventing tissue from being sucked through the holes  21  and any tissue damage that can result therefrom. 
         [0042]    In an alternative embodiment, the diffusion member  23 A can be substituted by (or enhanced with the addition of) a supportive skeletal network that enhances structural integrity of the top chamber  12 A and prevents the top chamber  12 A from buckling or collapsing under vacuum loads applied thereto. Similarly, the diffusion member  23 B can be substituted by (or enhanced with the addition of) a supportive skeletal network that enhances structural integrity of the bottom chamber  12 B and prevents the bottom chamber  12 B from buckling or collapsing under vacuum loads applied thereto. Such supportive skeletal networks can be realized by a wire or plastic mesh or other suitable support structure. 
         [0043]    As best shown in  FIG. 3C , a support member  29  is coupled to the shell  11 ′ for positioning and moving the shell  11 ′ as desired. In the preferred embodiment, the support member  29  is a cannula that houses the first and second fluid paths  14 A,  14 B therein. It is contemplated that the fluid paths  14 A,  14 B can be tubes that extend through the interior space of the support cannula  29 . Alternatively, the fluid paths  14 A,  14 B can be realized by fluid passageways that are integrally formed (for example, by molding) as part of the support cannula  29 . It is also contemplated that the fluid paths  14 A,  14 B can be defined by tubing supported on the exterior of the support member  29 . The mechanical coupling between the support member  29  and the shell  11 ′ can be realized by a coupling adapter (not shown) or other suitable mechanisms. The coupling can be bendable or otherwise moveable about one more axes to allow for flexible orientation of the shell  11 ′ relative to the support member  29 . The support member  29  can be bendable, hinged, shortened, a two-piece unit with detachable connectors or other configuration that minimizes obtrusiveness of the support member  29  in the working field of the surgeon(s) adjacent the patient. 
         [0044]    It is contemplated that the color of the major top wall  15  of the top chamber  12 A can be distinct relative to the color of the major bottom wall  19  of the bottom chamber  12 B to allow for easy identification of the orientation of the shell  11 ′ and proper control of negative air pressure to the respective chambers. 
         [0045]    During use, the supply of suction to the bottom chamber  12 B operates to engage and hold tissue adjacent the bottom wall  19  of the bottom chamber  12 B by negative air pressure within the top chamber  12 B ( FIG. 4B ). Such negative air pressure induces suction that extends through the holes  21  to retain and hold the tissue adjacent the bottom wall  19 . Independently, the supply of suction to the top chamber  12 A is used to engage and hold tissue adjacent the top wall  15  of the top chamber  12 A by negative air pressure within the top chamber  12 A. Such negative air pressure induces suction that extends through the holes  17  to retain and hold the tissue adjacent the top wall  15 . Tissue that is engaged adjacent the bottom wall  19  is sealably disposed about the pattern of holes  21  in the bottom wall  19  with the pattern of holes  21  covering an area that is smaller than the area of tissue sealably disposed thereabout. Tissue that is engaged adjacent the top wall  15  is sealably disposed about the pattern of holes  17  in the top wall  15  with the pattern of holes  17  covering an area that is smaller than the area of tissue sealably disposed thereabout. Tissue that is engaged adjacent the top wall  15  is released from the top wall  15  by venting the first fluid path  14 A, which removes the suction forces that are applied to the tissue through the holes  17  in the top wall  15 . Tissue that is engaged adjacent the bottom wall  19  is released from the bottom wall  19  by venting the second fluid path  14 B, which removes the suction forces that are applied to the tissue through the holes  21  in the bottom wall  19 . 
         [0046]    In the preferred embodiment, the proximal portion of the support member  29  is used as a handle to allow the operator to guide and position the distal end of the support member  29  and the flexible shell  11 ′ secured thereto. The proximal portion of the support member  29  also includes first and second valves  31 A,  31 B as shown in  FIG. 3C . The first valve  31 A is fluidly coupled to the first fluid path  14 A. During use, it is connected to a vacuum line (not shown) and is operated to control the supply of suction to the first fluid path  14 A for engaging and holding tissue adjacent the top wall  15  of flexible shell  11 ′. The second valve  31 B is fluidly coupled to the second fluid path  14 B. During use, it is connected between to a vacuum line (not shown) and is operated to control the supply of suction to the second fluid path  14 B for engaging and holding tissue adjacent the bottom wall  19  of flexible shell  11 ′. The first valve  31 A is also operable to vent the first fluid path  14 A to release tissue engaged and held by suction forces adjacent the top wall  15  of shell  11 ′, and the second valve  31 B is also operable to vent the second fluid path  14 B to release tissue engaged and held by suction forces adjacent the bottom wall  19  of shell  11 ′. 
         [0047]    Similar to the configuration shown in  FIG. 2C , the flexible shell  11 ′ can be rolled-up on itself and housed at the distal end of overtube  27 ′. In the preferred embodiment, the overtube  27 ′ has an outer diameter preferably in a range of 5-10 mm for insertion through a common laparoscopic port. With the distal end of the cannula overtube  27 ′ positioned inside a body cavity (e.g., an abdominal cavity during laparoscopic surgery therein), the flexible shell  11 ′ can be deployed from the distal end of the overtube  27 ′ (by moving the overtube  27 ′ proximally to a position shown in FIG.  3 C) and positioned in the body cavity, where it is unrolled for use in engaging and holding tissue inside the body cavity ( FIGS. 4A-4D ). 
         [0048]    In use, a practitioner will select the apparatus  10 ′ and deploy it within a body cavity, for example an abdominal cavity during laparoscopic gallbladder surgery as illustrated in  FIGS. 4A-4D . For laparoscopic applications, the shell  11 ′ can be initially deployed in the body cavity in a rolled-up configuration ( FIG. 2C ) and then unrolled inside the body cavity for use therein. The shell  11 ′ is then positioned with the bottom wall  19  near or adjacent tissue to be engaged and held, such as the left lobe  52 A of the liver for lifting the liver to access the gallbladder  51  adjacent the right lobe  52 B of the liver as shown. Suction is supplied via the second fluid path  14 B to produce negative air pressure that engages and holds the left liver lobe  52 A adjacent the bottom wall  19  of the shell  11 ′. The shell  11 ′ and left liver lobe  52 A secured thereto by suction can then be moved. For example, it can be moved upward as shown in  FIG. 4C  until the top wall  15  of the shell  11 ′ is adjacent or near the abdominal wall  53 . Simultaneous to the application of suction that secures the left liver lobe  52 A adjacent the bottom wall  19 , suction is supplied via the first fluid path  14 A to produce negative air pressure that engages and holds the abdominal wall  53  adjacent the top wall  15  of the shell  11 ′ (with the left liver lobe  52 A secured thereto by suction) as shown in  FIG. 4D . In this manner, the shell  11 ′ is used to retract the left liver lobe  42 A towards the abdominal wall and secure it to the abdominal wall to allow for visualization of the liver bed. The gallbladder  51  can then be completely removed from the liver bed (if not done so already). The shell  11 ′ and left liver lobe  52 A secured thereto can be released from the abdominal wall  53  by venting the first fluid path  14 A. And the left liver lobe  52 A can be released from the bottom wall  19  of the shell  11 ′ by venting the second fluid path  14 B. Such operations can be used to release the left liver lobe from the shell  11 ′ as desired. Similar operations can be carried out using the shell  11  of the embodiment of  FIGS. 2A-2C . 
         [0049]    Note that suction can be supplied by both the first and second fluid paths  14 A,  14 B together to grasp and hold tissue adjacent the top and bottom walls of the shell  11 , or alone (singularly or alternatingly). For example, suction forces can be constantly supplied by one of the first and second fluid paths, while suction forces are applied and released by the other fluid path as needed. 
         [0050]    Similar operations can be performed for grasping and holding organs and tissue during laparoscopic and non-laparoscopic surgeries involving the abdominal cavity (e.g., surgeries involving the small intestine, large intestine, stomach, spleen, liver, pancreas, kidneys, and adrenal glands). Examples of such surgeries include laparoscopic lap-band and other bariatric surgeries, laparoscopic NISSEN fundoplication, and laparoscopic colon surgery. 
         [0051]    Moreover, similar operations can be performed for grasping and holding organs and tissue during laparoscopic and non-laparoscopic surgeries involving the thoracic cavity (e.g., surgeries involving the heart, thoracic aorta, the pulmonary artery and all its branches, the superior and inferior vena cava, the pulmonary veins, the trachea, the bronchi and lungs, the esophagus, the endocrine glands, and the thoracic duct), and for grasping and holding organs and tissue during surgeries involving the pelvic cavity (e.g., surgeries involving the reproductive organs, urinary bladder, and rectum). 
         [0052]    It is also contemplated that the flexible shell can employ one ore more stabilizing members that aid in maintaining structural integrity of the flexible shell under suction loading during use. For example, stabilizing members suitable for laparoscopic applications are described in U.S. Pat. No. 5,245,987; U.S. Pat. No. 5,271,385; U.S. Pat. No. 5,199,419; U.S. Pat. No. 5,195,506; and U.S. Pat. No. 5,195,505; which are herein incorporated by reference in their entireties. 
         [0053]    Advantageously, the surgical assembly of the invention provides for lifting, manipulating and holding tissue without the need for manual fixation by a surgeon (or mechanical fixation by an external support structure disposed adjacent the patient). It also operates to reduce interference in the working field of the surgeon(s) adjacent the patient. It also provides effective tissue grasping with minimal tissue damage. It also accomplishes the objects of the invention with a minimum number of parts and may be used to replace expensive laparoscopic tissue grasping and manipulation instruments. 
         [0054]    There have been described and illustrated herein several embodiments of a surgical assembly for grasping and holding tissue and methods for the use thereof. While particular embodiments of the invention have been described, it is not intended that the invention be limited thereto, as it is intended that the invention be as broad in scope as the art will allow and that the specification be read likewise. Thus, while particular materials for making the assembly have been disclosed, it will be appreciated that other materials may be used as well, and while exemplary diameters for the surgical instruments have been disclosed, other diameters can be utilized. In addition, while particular valving elements and fixation systems have been disclosed for controlling suction and positioning of the assembly, it will be understood that other mechanisms can be used. Moreover, while particular configurations of surgical instruments have been disclosed, it will be appreciated that other configurations could be used as well. It will therefore be appreciated by those skilled in the art that yet other modifications could be made to the provided invention without deviating from its spirit and scope as claimed.