Devices for minimally invasive pelvic surgery

• US 20040230207A1
• Filed: 02/09/2004
• Published: 11/18/2004
• Est. Priority Date: 02/13/1997
• Status: Active Grant

• Current Assignee: Boston Scientific Scimed, Inc. (Boston Scientific Corporation)
• Original Assignee: Scimed Life Systems Incorporated (Boston Scientific Corporation)
• Inventors: Gellman, Barry N., Brenneman, Rodney, Appell, Rodney, Morin, Armand A., Sauvageau, David, Pintauro, William
• Granted Patent: US 7,413,540 B2
• Time in Patent Office: Days
• US Class Current: 606/148
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• CPC Class Codes: A61B 17/06109 Big needles, either gripped by hand or connectable to a handle
• CPC Class Codes: A61B 17/221 Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions surgical snare instruments A61B17/32056
• CPC Class Codes: A61B 17/32 Surgical cutting instruments A61B18/042 takes precedence; suture cutters A61B17/0467; instruments for ligaturing or cutting A61B17/128; instruments for rupturing the amniotic membrane A61B17/4208; specially adapted knives for eye surgery A61F9/0133
• CPC Class Codes: A61B 17/3415 for introducing tubes or catheters, e.g. gastrostomy tubes, drain catheters A61B17/3417 takes precedence; body piercing catheter guide needles A61M25/06
• CPC Class Codes: A61B 2017/00349 Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue A61B17/06066 takes precedence
• CPC Class Codes: A61B 2017/00805 Treatment of female stress urinary incontinence
• CPC Class Codes: A61B 2017/06052 Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle
• CPC Class Codes: A61B 2017/061 hollow or tubular
• CPC Class Codes: A61B 2017/06104 interconnected at their distal ends, e.g. two hollow needles forming a loop for passing a suture
• CPC Class Codes: A61B 2017/22035 for retrieving or repositioning foreign objects
• CPC Class Codes: A61B 2017/22038 with a guide wire
• CPC Class Codes: A61B 2017/320044 Blunt dissectors
• CPC Class Codes: A61B 90/02 Devices for expanding tissue, e.g. skin tissue implements for holding wounds open, surgical tractors A61B17/02; implantable mammary prosthesis A61F2/12; dilators A61M29/00
• CPC Class Codes: A61F 2/0045 Support slings
• CPC Class Codes: Y10S 128/25 Artificial sphincters and devices for controlling urinary incontinence

Abstract

Devices and methods relating to percutaneous and hiatal approaches for treating urinary incontinence are provided herein. In particular, guide member placement devices, sling application catheters, tissue dissectors/dilators, sling application devices and a sling application system, tissue expanders, grasping devices, and balloon catheters are disclosed herein. Methods for using the preceding devices to stabilize the bladder neck or the urethral floor in order to maintain or improve urinary incontinence are also disclosed.

Claims

1-156. -156. (Cancelled).

157. A method for treating female urinary incontinence comprising,

inserting a shaft having a curved portion percutaneously into a body and through a vaginal wall of a patient;

associating a sling assembly end with an end of the shaft subsequent to the shaft extending through the vaginal wall; and

withdrawing the shaft to place at least a portion of the sling assembly under a urethra of the patient.

158. The method of claim 157, wherein the sling assembly comprises an element for receiving a distal end of the shaft.

159. The method of claim 157 comprising inserting the shaft via an abdomen of the patient.

160. The method of claim 157, wherein the shaft comprises a channel for receiving the sling assembly end.

161. The method of claim 160 comprising locking the sling assembly end in the channel.

162. The method of claim 160 comprising unlocking the sling assembly end from the channel subsequent to withdrawing the shaft.

163. The method of claim 157 comprising disassociating the sling assembly end from the shaft end subsequent to withdrawing the shaft.

164. The method of claim 157, wherein the sling assembly comprises a sling.

165. The method of claim 157, wherein the sling assembly comprises a sling and a pouch enclosing at least partially the sling.

166. The method of claim 165 comprising removing the sling from a pouch subsequent to sling assembly placement.

167. The method of claim 157, wherein the end of the shaft is a distal end.

168. A method for treating female urinary incontinence comprising,

inserting a shaft having a curved portion percutaneously into a body and through a vaginal wall of a patient;

associating a sling assembly end to an end of the shaft subsequent to the shaft extending through the vaginal wall; and

withdrawing the shaft to pull at least a portion of the sling assembly through the vaginal wall to place at least a portion of the sling assembly under a urethra of the patient.

169. The method of claim 168 comprising inserting the shaft via an abdomen of the patient.

170. The method of claim 168 comprising disassociating the sling assembly end with shaft subsequent to withdrawing the shaft.

171. The method of claim 168, wherein the sling assembly comprises a sling.

172. The method of claim 168, wherein the sling assembly comprises a sling and a pouch enclosing at least partially the sling.

173. The method of claim 172 comprising removing the sling from the pouch.

174. A method for treating female urinary incontinence comprising,

inserting first and second shafts, each having a curved portion, percutaneously into a body and through a vaginal wall of a patient;

associating a first end of a sling assembly with the first shaft;

associating a second end of the sling assembly with the second shaft; and

placing at least a portion of the sling assembly under a urethra of the patient.

175. The method of claim 174, wherein the step of inserting comprises inserting the first shaft and then inserting the second shaft.

176. The method of claim 174 comprising inserting at least one of the shafts via the abdomen.

177. The method of claim 174 comprising withdrawing at least one of the first and second shafts to place at least a portion of the sling assembly under a urethra of the patient.

178. The method of claim 174 comprising disassociating the first and second assembly ends from the shafts subsequent to withdrawing the shafts from the body.

179. The method of claim 174, wherein the sling assembly comprises a sling.

180. The method of claim 174, wherein the sling assembly comprises a sling and a pouch for enclosing at least partially the sling.

181. The method of claim 180 comprising removing the sling from the pouch.

182. A method for treating female urinary incontinence comprising,

inserting a shaft having a curved portion percutaneously into a body and through a vaginal wall of a patient;

associating a sling assembly with an end of the shaft; and

withdrawing the shaft to place at least a portion of the sling assembly under the urethra.

183. The method of claim 182, wherein the associating comprises interfitting the sling assembly in a channel located at an end of the shaft.

184. The method of claim 182, wherein the associating comprises releasably interfitting the sling assembly in a channel located at an end of the shaft.

185. The method of claim 182 comprising dissociating the sling assembly from the shaft subsequent to withdrawing the shaft from the body of the patient.

186. The method of claim 182, wherein the sling assembly comprises a sling.

187. The method of claim 182, wherein the sling assembly comprises an elongated extension located at an end of the sling assembly.

188. The method of claim 182, wherein the sling assembly comprises an aperture located at an end of the sling assembly.

189. The method of claim 182, wherein the sling assembly comprises a sling and a pouch for enclosing at least partially the sling.

190. The method of claim 189, wherein the pouch comprises an opening intermediate to first and second ends of the sling assembly.

191. The method of claim 189, wherein the pouch is substantially flat.