Refined suspension procedure with implement for treating female stress incontinence
First Claim
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1. A procedure for treating incontinence in a woman, comprising the steps of:
- inserting a urethral trocar into the woman'"'"'s bladder and therethrough to press outward firmly against the woman'"'"'s abdominal wall, so as to be perceptible from the exterior of the woman'"'"'s body;
then, with the exteriorly perceptible trocar as a guide, making a suprapubic incision in the woman'"'"'s abdominal wall and bladder to gain access to a tip of the trocar;
then using the tip of the trocar directly or indirectly to guide a tip of a viewing device through the suprapubic incision and into the woman'"'"'s bladder; and
then installing sutures between the woman'"'"'s rectus fascia and vagina, by means of a needle inserted through the woman'"'"'s abdomen and into the woman'"'"'s vagina;
substantially during the suture-installing step, monitoring the interior of the bladder through the viewing device to avoid placement of sutures in the bladder wall;
whereby the viewing device is remote from the neck of the bladder, where inadvertent placement of sutures is particularly likely; and
substantially during the suture-installing and monitoring steps, maneuvering the trocar or the viewing device, or both, to manipulate tissues of the woman'"'"'s bladder, urethra, or abdominal wall, or combinations of any of these tissues, to facilitate accurate placement of the sutures, particularly avoiding the bladder and urethra.
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Abstract
The incision-free pubovaginal suspension due to Gittes and Loughlin is improved by simultaneous gas obturation and visual monitoring using a suprapubic endoscope, inserted with the aid of a urethral trocar. It is further improved by simultaneous manipulation of the urethra, bladder and other tissues by the trocar, to optimize alignment for the Gittes procedures. The trocar, and procedure for its use, are refinements of the present inventor'"'"'s earlier apparatuses and procedures for suprapubic cystostomy with endoscopy, and for gas obturation.
293 Citations
19 Claims
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1. A procedure for treating incontinence in a woman, comprising the steps of:
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inserting a urethral trocar into the woman'"'"'s bladder and therethrough to press outward firmly against the woman'"'"'s abdominal wall, so as to be perceptible from the exterior of the woman'"'"'s body; then, with the exteriorly perceptible trocar as a guide, making a suprapubic incision in the woman'"'"'s abdominal wall and bladder to gain access to a tip of the trocar; then using the tip of the trocar directly or indirectly to guide a tip of a viewing device through the suprapubic incision and into the woman'"'"'s bladder; and then installing sutures between the woman'"'"'s rectus fascia and vagina, by means of a needle inserted through the woman'"'"'s abdomen and into the woman'"'"'s vagina; substantially during the suture-installing step, monitoring the interior of the bladder through the viewing device to avoid placement of sutures in the bladder wall; whereby the viewing device is remote from the neck of the bladder, where inadvertent placement of sutures is particularly likely; and substantially during the suture-installing and monitoring steps, maneuvering the trocar or the viewing device, or both, to manipulate tissues of the woman'"'"'s bladder, urethra, or abdominal wall, or combinations of any of these tissues, to facilitate accurate placement of the sutures, particularly avoiding the bladder and urethra. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16)
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17. A procedure for treating incontinence in a woman, comprising the steps of:
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inserting a urethral trocar into the woman'"'"'s bladder and therethrough to press outward firmly against the woman'"'"'s abdominal wall, so as to be perceptible from the exterior of the woman'"'"'s body; then, with the exteriorly perceptible trocar as a guide, making a suprapubic incision in the woman'"'"'s abdominal wall and bladder to gain access to a tip of the trocar; providing a catheter that has near its end a balloon; then mating the end of the catheter or an intermediary appliance with the tip of the trocar; and then moving the end of the catheter or appliance, while it is mated with the tip of the trocar, inward through the suprapubic incision and into the woman'"'"'s bladder; then positioning the balloon within the woman'"'"'s bladder; then inflating the balloon to anchor the end of the catheter within the bladder; and after the moving step, inserting the tip of a viewing device through the catheter into the woman'"'"'s bladder; whereby the viewing device is remote from the neck of the bladder, where inadvertent placement of sutures is particularly likely; then installing sutures between the woman'"'"'s rectus fascia and vagina, by means of a needle inserted through the woman'"'"'s abdomen and into the woman'"'"'s vagina; substantially during the suture-installing step, monitoring the interior of the bladder through the viewing device to avoid placement of sutures in the bladder wall; the installing and monitoring steps comprising repetitive performance of this sequence of substeps;
(1) placing a suture, then (2) inflating the bladder with gas through the catheter, viewing device, or trocar, or combinations thereof, to facilitate observation of the bladder wall, then (3) observing the bladder wall to determine whether the suture just placed is visible therein, and then (4) deflating the bladder through the catheter, viewing device, or trocar, or combinations thereof;substantially during the suture-installing and monitoring steps, maneuvering the trocar or the viewing device, or both, to manipulate tissues of the woman'"'"'s bladder, urethra, or abdominal wall, or combinations of any of these tissues, to facilitate accurate placement of the sutures, particularly avoiding the bladder and urethra; and after the suture-installing step, withdrawing the viewing device and leaving the catheter anchored in place by the balloon for drainage of urine from the bladder until the woman recovers from immediate effects of the previous steps. - View Dependent Claims (18, 19)
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Specification