Apparatus and method for laparoscopic urethopexy

• US 5,697,931 A
• Filed: 06/14/1995
• Issued: 12/16/1997
• Est. Priority Date: 06/14/1995
• Status: Expired due to Fees

• Current Assignee: Dexterity Surgical, Inc. (Wave Sync Corp.)
• Original Assignee: Incont, LLC
• Inventors: Thompson, Ronald J.
• Primary Examiner(s): Buiz, Michael
• Assistant Examiner(s): LEONARDO, MARK
• Application Number:
  US08/490,281
• Time in Patent Office: 916 Days
• Field of Search: 606/72, 606/75, 606/113, 606/139, 606/144, 606/219, 606/220, 606/232, 600/30, 128/898, 128/DIG. 23, 128/DIG. 25
• US Class Current: 606/916
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• 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 17/0485 Devices or means, e.g. loops, for capturing the suture thread and threading it through an opening of a suturing instrument or needle eyelet
• CPC Class Codes: A61B 17/06109 Big needles, either gripped by hand or connectable to a handle
• CPC Class Codes: A61B 2017/00805 Treatment of female stress urinary incontinence
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0412 having anchoring barbs or pins extending outwardly from suture anchor body
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening lateral eyelet for attaching suture to needle A61B2017/06019
• CPC Class Codes: A61B 2017/0437 the barbs being resilient or spring-like
• CPC Class Codes: A61F 2/0031 for constricting the lumen; Support slings for the urethra
• CPC Class Codes: A61F 2/005 with pressure applied to urethra by an element placed in the vagina

Abstract

A surgical method for performing laparoscopic urethropexy on a patient is provided. This surgical method comprises the steps of dissecting at least a portion of the space of Retzius in the patient, laparoscopically creating a bore in the pubic bone adjacent the space of Retzius, providing at least one anchor having at least one suture extending therefrom, laparoscopically inserting the anchor in the bore such that the anchor is thereby secured in the bore, and securing the suture to the periurethral tissue adjacent to the urethra to thereby elevate the urethra to the desired angle. The suture is secured to the periurethral tissue by pulling the suture through the periurethral fascia and vaginal mucosa into the vagina, and tying the suture within the vagina. A drill tamper tool for laparoscopically creating the bore in the pubic bone is also provided, along with an anchor-insertion tool, a loaded anchor-insertion tool, and a surgical kit comprising the drill tamper tool and the anchor-insertion tool.

Claims

1. A surgical method for performing laparoscopic urethropexy on a patient, comprising the steps of:

(a) dissecting at least a portion of the space of Retzius in the patient;

(b) laparoscopically creating a bore in the pubic bone adjacent the space of Retzius;

(c) providing at least one anchor, said anchor having at least one suture extending therefrom;

(d) laparoscopically inserting an anchor in said bore such that said anchor is thereby secured in said bore; and

(e) securing said suture to the periurethral tissue adjacent to the urethra to thereby elevate the urethra to the desired angle.

2. The surgical method of claim 1, wherein said suture is secured to the periurethral tissue by pulling said suture through the periurethral fascia and vaginal mucosa into the vagina, and tying said suture within the vagina.

3. The surgical method of claim 2, wherein:

a pair of bores are created in the pubic bone, with one of said bores on either side of the pubic symphysis above the periurethral fascia;

a pair of anchors are provided, each of said anchors having a suture extending therefrom;

one of said pair of anchors is inserted into each of said bores; and

one of said sutures is pulled through the periurethral fascia and vaginal mucosa adjacent either side of the urethra into the vagina; and

each of said sutures is tied within the vagina, such that one of said sutures will provide an upward force on the periurethral tissue positioned on either side of the urethra, thereby elevating the urethra to the desired angle.

4. The surgical method of claim 1, wherein said bore creation step comprises:

(a) inserting a laparoscope into the patient to provide access to and vision of the space of Retzius;

(b) creating a crater in the pubic bone at the desired location for said bore, said crater being sufficiently deep to provide access to the cancellous bone;

(c) providing a drill tamper tool, said drill tamper tool having a boring tip, said boring tip having a distal end; and

(d) inserting said boring tip of said drill tamper tool through the laparoscopic channel;

(e) urging the distal end of said boring tip into said crater to create said bore in the cancellous bone beneath said crater.

5. The surgical method of claim 4, wherein the distal end of said boring tip is sufficiently sharp to enable said tip to create said bore in the cancellous bone by means of hand force, while being insufficiently sharp to inadvertently pierce soft tissue or organs during the bore creation step.

6. The surgical method of claim 4, wherein said drill tamper tool comprises an elongate rigid member having:

(a) said boring tip;

(b) a collar having a diameter greater than that of said boring tip;

(c) a cylindrical guide portion having first and second ends, said guide portion having a diameter greater than said tip and slightly less than the operative channel of said laparoscope; and

(d) a handle attached to said second end of said guide portion;

wherein said collar is positioned between said tip and said guide portion such that said first end of said guide portion is nearer said collar than said second end, and wherein said bore is created by inserting said distal end of the boring tip into said crater, and rotatingly urging said boring tip into said crater by means of said handle.

7. The surgical method of claim 6, wherein said collar acts as a stop during said bore creation step such that the length of said bore is approximately equivalent to the length of said boring tip.

8. The surgical method of claim 7, wherein said drill tamper tool further comprises an intermediate portion having a diameter greater than that of said boring tip, said intermediate portion attached to said boring tip at said collar, wherein said collar comprises the end of said intermediate portion positioned adjacent said boring tip.

9. The surgical method of claim 1, wherein said anchor insertion step comprises:

(a) providing an anchor-insertion tool having said anchor loaded thereon, said anchor-insertion tool comprising an elongate member having;

an anchor-receiving tip at one end, and

a handle at the opposite end;

wherein said anchor is loaded on said tip;

(b) inserting said anchor into said bore by urging said anchor-receiving tip, with said anchor loaded thereon, toward said bore; and

(c) pulling said anchor-insertion tool away from said bore, thereby releasing said anchor from said anchor-receiving tip.

10. The surgical method of claim 9, wherein:

said anchor-insertion tool further comprises an elastic band extending about its circumference;

said suture is positioned between said elastic band and said anchor-insertion tool so that said suture is securely held against said insertion tool by said elastic band; and

during said step of pulling said insertion tool away from said bore, said suture is permitted to slide between said elastic band and said insertion tool so that said suture is tensioned between said anchor and said insertion tool.

11. The surgical method of claim 9, wherein:

after said pulling step said suture extends between said anchor and said insertion tool; and

said suture securing step comprises;

(a) providing a suture retriever, said retriever having a tip;

(b) inserting said tip of said suture retriever into the vagina, through the vaginal mucosa and periurethral fascia adjacent the urethra, towards said suture;

(c) snaring said tensioned suture with said suture retriever;

(d) pulling said snared suture into the vagina by means of said suture retriever; and

(e) tying said suture within the vagina.

12. The surgical method of claim 9, wherein said at least one suture has first and second tails extending from said anchor, wherein both of said tails extend between said insertion tool and said anchor after said pulling step, and wherein said suture securing step comprises:

(a) providing a suture retriever, said retriever having a pointed tip;

(b) inserting said tip of said suture retriever into the vagina, through the vaginal mucosa and periurethral fascia adjacent the urethra, into the space of Retzius;

(c) snaring said first tail of said at least one suture with said suture retriever;

(d) pulling said snared first tail into the vagina by means of said suture retriever;

(e) repeating steps (b)-(d) for the second tail of said at least one suture, wherein said snared second tail is pulled into the vagina a predetermined distance from the first tail; and

(f) tying said first and second suture tails to each other within the vagina in order to elevate the urethra to the desired angle.

13. The method of claim 12, further comprising the steps of:

(a) laparoscopically creating a second bore in the pubic bone, such that one of said bores is positioned on either side of the pubic symphysis above the periurethral fascia;

(b) providing a second anchor having a second suture extending therefrom, said second suture having first and second tails;

(c) laparoscopically inserting said second anchor in said second bore using said insertion tool such that said second anchor is thereby secured in said second bore;

(d) inserting said tip of said suture retriever into the vagina, through the vaginal mucosa and periurethral fascia adjacent the urethra, into the space of Retzius;

(e) snaring said first tail of said second suture with said suture retriever;

(f) pulling said snared first tail into the vagina by means of said suture retriever;

(g) repeating steps (d)-(f) for the second tail of said second suture, wherein said snared second tail is pulled into the vagina a predetermined distance from the first tail; and

(h) tying said first and second tails of said second suture to each other within the vagina in order to elevate the urethra to the desired angle;

wherein said first and second tails of said at least one suture are pulled into the vagina on one side of the urethra, and wherein said first and second tails of said second suture are pulled into the vagina on the opposite side of the urethra, such that after tying one of said sutures will apply an upward force on the periurethral tissue positioned on either side of the urethra, thereby elevating the urethra to the desire angle.

14. The surgical method of claim 10, wherein said anchor-insertion tool further comprises a depression extending about the circumference of said anchor-insertion tool, and wherein said elastic band is positioned within said depression.

15. The surgical method of claim 9, wherein:

said anchor-insertion tool further comprises a cylindrical intermediate portion having a distal end adjacent said anchor-receiving tip, said intermediate portion having a diameter greater than the diameter of said anchor-receiving tip;

the diameter of said anchor-receiving tip is approximately equivalent to the diameter of said anchor; and

the combined length of said anchor and said anchor-receiving tip is approximately equivalent to the depth of said bore;

such that during the step of inserting said anchor into said bore, said distal end of said intermediate portion of the anchor-insertion tool acts as a stop, thereby ensuring that the anchor is inserted into said bore to the maximum possible depth.

40. The surgical method of claim 1, wherein said bore creation step comprises:

(a) creating a crater in the pubic bone at the desired location for said bore;

(b) providing a drill tamper tool, said drill tamper tool having a boring tip, said boring tip having a distal end; and

(c) urging the distal end of said boring tip into said crater to create said bore in the cancellous bone beneath said crater.

41. The method of claim 40, wherein said crater is created by means of a laser.

42. The method of claim 7, wherein said collar is tapered.

16. A drill tamper tool for laparoscopically creating a bore in the cancellous portion of the pubic bone of a patient during a urethropexy procedure, said tool comprising an elongate, rigid member having:

(a) a boring tip, said boring tip having a distal end which is sufficiently sharp to enable said tip to create said bore in cancellous bone by means of hand force;

(b) a cylindrical guide portion having first and second ends, said guide portion having a diameter greater than said tip, and insertable in the operative channel of a laparoscope;

(c) a collar having a diameter greater than that of said boring tip, said collar positioned between said tip and said guide portion such that said first end of said guide portion is nearer said collar than said second end, and such that said collar prevents said boring tip from penetrating the pubic bone beyond a predetermined depth; and

(d) a handle attached to said second end of said guide portion;

wherein the total length of said tool is such that said tool may be readily employed laparoscopically to create a bore in the pubic bone of a patient during a laparoscopic urethropexy procedure by inserting said distal end of the boring tip into a crater previously created in said pubic bone, said crater being sufficiently deep to provide access to the cancellous bone, and rotatingly urging said boring tip into said crater by means of said handle in order to create said bore, said bore having a length corresponding to the length of said boring tip.

17. The drill tamper tool of claim 16, wherein said boring tip has a conical cross section, and flat sides which taper from said distal end of the boring tip to a cylindrical rear portion of the boring tip, wherein the tool may be employed to create a bore having a diameter which corresponds to the diameter of said rear portion.

18. The drill tamper tool of claim 16, wherein said boring tip has a length of between about 1 and about 3 centimeters.

19. The drill tamper tool of claim 18, further comprising an intermediate portion having a diameter greater than that of said boring tip, said intermediate portion positioned between said collar and said guide portion, wherein said intermediate portion has a length of between about 2 and about 6 centimeters.

20. The drill tamper tool of claim 18, wherein said guide portion has a length of at least about 50 centimeters.

21. An anchor-insertion tool for laparoscopically inserting and securing an anchor having a suture extending therefrom within a bore created in the pubic bone of a patient during a urethropexy procedure, said anchor-insertion tool comprising an elongate member having:

(a) an anchor-receiving tip, said tip capable of holding an anchor thereon;

(b) a cylindrical guide portion having first and second ends, said guide portion having a diameter greater than said tip and insertable in the operative channel of a laparoscope; and

(e) a handle attached to said second end of said guide portion;

wherein said guide portion is positioned between said handle and said tip, and wherein the total length of said anchor-insertion tool is such that said tool may be employed laparoscopically to insert said anchor into a bore in the pubic bone of a patient during a laparoscopic urethropexy procedure.

22. The anchor-insertion tool of claim 21, further comprising at least one depression extending about the circumference of said guide portions, said depression sized so as to accommodate an elastic band for holding said suture between said elastic band and said tool.

23. The anchor-insertion tool of claim 22, further comprising at least one groove extending from said tip and at least partially along the length of said tool.

24. The anchor-insertion tool of claim 22, further comprising a second depression extending about the circumference of said tool, said second depression sized so as to accommodate an elastic band for holding said suture between said elastic band and said tool, wherein both of said depressions extend about said cylindrical guide portion.

25. The anchor insertion tool of claim 22, further comprising an intermediate portion positioned between said tip and said guide portion, wherein said anchor-receiving tip has a pair of guide tabs extending from either side of the end of said tip opposite said intermediate portion, said guide tabs matingly receivable in corresponding grooves on an anchor to thereby hold an anchor on said anchor-receiving tip.

26. The anchor-insertion tool of claim 21, wherein said guide portion has a length of at least about 50 centimeters.

27. A loaded anchor-insertion tool comprising, in combination, an anchor-insertion tool, an anchor having a suture extending therefrom, and at least one elastic band, wherein said anchor-insertion tool comprises an elongate member having:

(a) an anchor-receiving tip;

(b) a handle; and

(c) a cylindrical guide portion positioned between said tip and said handle;

wherein the total length of said anchor-insertion tool is such that said tool may be employed laparoscopically to secure said anchor to the pubic bone of a patient during a laparoscopic urethropexy procedure, wherein said anchor is positioned on said anchor-receiving tip, wherein said elastic band is positioned about said guide portion, and wherein said suture extends along at least a portion of the length of said anchor-insertion tool and is slidably held between said elastic band and said guide portion such that after said anchor has been secured in a patient'"'"'s body, said anchor-insertion tool may be pulled away from said anchor with said suture sliding between said elastic band and said guide portion.

28. The loaded anchor-insertion tool of claim 27, further comprising:

a depression extending about the circumference of said cylindrical guide portion;

wherein said elastic band is positioned in said depression.

29. The loaded anchor-insertion tool of claim 27, wherein:

(a) said anchor comprises;

a cylindrical body having a conical end;

at least two flexible barbs curving outwardly away from said body;

a cylindrical end portion extending away from said body at an end of said body opposite to said conical end, said end portion having a diameter smaller than said body;

a pair of grooves extending along a portion of the length of said body from said cylindrical end; and

an aperture extending through a portion of said cylindrical end and a portion of said body; and

(b) said anchor-insertion tool has;

a pair of guide tabs extending from either side of the end of said tip;

a cylindrical slot extending through a portion of said tip; and

a pair of tapered grooves extending along opposite sides of said tip and at least partially along the length of said intermediate portion;

wherein said guide tabs are matingly received in said grooves on said anchor to thereby hold the anchor on said anchor-receiving tip, wherein said suture extends through said aperture on said anchor, and wherein said suture is positioned within said pair of tapered grooves on said anchor-insertion tool.

43. The loaded anchor-insertion tool of claim 28, further comprising a second elastic band and a second depression extending about said guide portion, wherein said second elastic band is positioned in said second depression and said suture is slidably held between said second elastic band and said guide portion.

30. A surgical kit for laparoscopically inserting an anchor into the pubic bone of a patient during an urethropexy procedure, said kit comprising an anchor-insertion tool for inserting an anchor into a bore in the pubic bone of a patient, and a drill tamper tool for creating said bore in the pubic bone for receiving said anchor, said drill tamper tool comprising an elongate, rigid member having:

(a) a boring tip, said boring tip having a distal end which is sufficiently sharp to enable said tip to create said bore in cancellous bone by means of hand force;

(b) a cylindrical guide portion having first and second ends, said guide portion having a diameter greater than said tip, and insertable in the operative channel of a laparoscope;

(c) a collar having a diameter greater than that of said boring tip, said collar positioned between said tip and said guide portion such that said first end of said guide portion is nearer said collar than said second end, and such that said collar prevents said boring tip from penetrating the pubic bone beyond a predetermined depth; and

(d) a handle attached to said second end of said guide portion;

wherein the total length of said drill tamper tool is such that said tool may be readily employed laparoscopically in order to create a bore in the pubic bone of a patient during a laparoscopic urethropexy procedure by inserting said distal end of the boring tip into a crater previously created in said pubic bone, said crater being sufficiently deep to provide access to the cancellous bone, and rotatingly urging said boring tip into said crater by means of said handle in order to create said bore, said bore having a length corresponding to the length of said boring tip.

44. The surgical kit of claim 30, further comprising a surgical template positionable within the vagina of a patient for guiding a portion of a suture extending from an anchor secured to the pubic bone of a patient into the patient'"'"'s vagina.

46. The surgical kit of claim 30, further comprising a suture retrieval tool for vaginally retrieving a portion of a suture extending from an anchor secured to the pubic bone of a patient, said retrieval tool having a retrieving end and a handle.

31. A surgical kit for laparoscopically inserting an anchor into the pubic bone of a patient during an urethropexy procedure, said kit comprising a drill tamper tool for creating a bore in the pubic bone, and an anchor-insertion tool for inserting an anchor into said bore, said anchor-insertion tool comprising an elongate member having:

(a) an anchor-receiving tip, said tip capable of holding an anchor thereon;

(b) a cylindrical guide portion having first and second ends, said guide portion having a diameter greater than said tip and insertable in the operative channel of a laparoscope; and

(e) a handle attached to said second end of said guide portion;

wherein said guide portion is positioned between said handle and said tip, and wherein the total length of said anchor-insertion tool is such that said tool may be employed laparoscopically in order to insert said anchor into a bore in the pubic bone of a patient during a laparoscopic urethropexy procedure.

45. The surgical kit of claim 31, further comprising a surgical template positionable within the vagina of a patient for guiding a portion of a suture extending from an anchor secured to the pubic bone of a patient into the patient'"'"'s vagina.

47. The surgical kit of claim 31, further comprising a suture retrieval tool for vaginally retrieving a portion of a suture extending from an anchor secured to the pubic bone of a patient, said retrieval tool having a retrieving end and a handle.

32. A surgical method for performing laparoscopic urethropexy on a patient, comprising the steps of:

(a) providing at least one anchor and at least one suture;

(b) laparoscopically securing said anchor to the pubic bone of said patient;

(c) securing said suture between said anchor and the periurethral tissue adjacent the urethra, thereby elevating the urethra to the desired angle.

33. The method of claim 32, further comprising the step of dissecting at least a portion of the space of Retzius prior to the step of securing said anchor, and wherein said anchor is secured to the pubic bone adjacent the space of Retzius.

34. The method of claim 32, further comprising the step of laparoscopically creating a bore in the pubic bone, and said step of securing said anchor to the pubic bone comprises laparoscopically inserting said anchor into said bore such that the anchor is secured within the bore.

35. The method of claim 32, wherein said anchor is provided with said suture extending therefrom, and said step of securing said suture between said anchor and the periurethral tissue comprises the steps of pulling said suture through the periurethral fascia and vaginal mucosa into the vagina, and tying said suture within the vagina.

36. The method of claim 33, wherein:

a pair of anchors are provided, each of said anchors having a suture extending therefrom;

each anchor is secured to the pubic bone adjacent the space of Retzius; and

each of said sutures is secured to the periurethral tissue adjacent to the urethra by pulling said suture through the periurethral fascia and vaginal mucosa into the vagina, and tying said suture within the vagina.

37. The method of claim 35, wherein said step of pulling said suture through the periurethral fascia and vaginal mucosa into the vagina comprises the steps of:

(a) providing a suture retriever, said retriever having a tip;

(b) inserting said tip of said suture retriever into the vagina, through the vaginal mucosa and periurethral fascia adjacent the urethra into the patient;

(c) grasping said suture with said retriever;

(d) pulling said tip of said retriever back into the vagina, thereby pulling said suture into the vagina.

38. The method of claim 35, further comprising the steps of:

(a) providing a suture template, said template having at least one guide aperture; and

(b) positioning said template within the vagina of the patient, such that said aperture is alignably positioned against the vaginal mucosa adjacent the urethra;

and wherein said suture is pulled through said guide aperture of said template.

39. The method of claim 35, wherein said suture has first and second tails, each tail is pulled through the periurethral fascia and vaginal mucosa into the vagina such that said first tail is located a predetermined distance from said second tail, and wherein said tying step comprises tying said first tail to said second tail.

48. The surgical method of claim 32, wherein said step of securing said anchor to the pubic bone comprises:

(a) providing an anchor-insertion tool comprising an elongate member having an anchor-receiving tip at one end and a handle at the opposite end wherein said anchor is positioned on said tip with said suture extending from said anchor;

(b) inserting a laparoscope into the patient to provide access to said pubic bone;

(c) inserting the tip of said insertion tool into the operative channel of said laparoscope;

(d) inserting said anchor into a bore in said pubic bone by urging said tip of the insertion tool towards said bore, thereby securing said anchor within said pubic bone; and

(e) pulling said insertion tool away from said bore and said anchor by means of said handle.

49. The surgical method of claim 48, wherein after said step of pulling said insertion tool away from said bore and said anchor, said suture extends between said anchor and said insertion tool.

50. The surgical method of claim 49, wherein said suture is slidably secured to said insertion tool.

51. The surgical method of claim 50, wherein at least one elastic band extends around said insertion tool, and wherein said suture is slidably secured to said insertion tool by positioning said suture between said elastic band and said insertion tool.

52. The surgical method of claim 51, wherein said anchor-insertion tool further comprises a cylindrical guide portion positioned between said tip and said handle, said guide portion having at least one depression extending about its circumference, and wherein said elastic band is positioned within said depression.

53. The surgical method of claim 52, wherein said anchor-insertion tool further comprises a second depression extending about the circumference of said guide portion, wherein a second elastic band is positioned within said second depression, and said suture if further slidably secured between said second elastic band and said insertion tool.

54. The surgical method of claim 51, wherein said elastic band provides tension in said suture during said step of pulling said insertion tool away from said bore, such that said tension pulls outwardly on said anchor thereby further securing said anchor within said bore.

55. The method of claim 34, wherein said step of creating a bore in the pubic bone comprises:

(a) providing a drill tamper tool comprising a rigid, elongate member having a boring tip at one end and a handle at the opposite end, said boring tip having a distal end;

(b) inserting a laparoscope into the patient to provide access to said pubic bone;

(c) creating a crater in the pubic bone at the desired location for said bore;

(d) inserting the boring tip of said drill tamper tool into the operative channel of said laparoscope;

(e) urging said boring tip into said crater to create said bore in the cancellous bone beneath said crater.

56. The surgical method of claim 55, wherein said drill tamper tool has a tapered collar adjacent said boring tip, wherein said collar acts as a stop during said step of urging said boring tip into said crater, thereby ensuring that the length of said bore corresponds approximately to the length of said boring tip.

57. A surgical method for laparoscopically creating a bore in the pubic bone of a patient, comprising the steps of:

(a) inserting a laparoscope into the patient to provide access to and vision of the space of Retzius;

(b) creating a crater in the pubic bone at the desired location for said bore;

(c) providing a drill tamper tool, said tool having a boring tip, said boring tip having a distal end;

(d) inserting said boring tip through the operative channel of the laparoscope; and

(e) urging the distal end of said boring tip into the crater to create said bore.

58. The method of claim 57, wherein said crater is created with a laser.

59. The method of claim 57, wherein said drill tamper tool comprises an elongate rigid member having:

(a) said boring tip;

(b) a collar having a diameter greater than that of said boring tip;

(c) a cylindrical guide portion having first and second ends, said guide portion having a diameter greater than said tip and slightly less than the operative channel of said laparoscope; and

(d) a handle attached to said second end of said guide portion;

wherein said collar is positioned between said tip and said guide portion such that said first end of said guide portion is nearer said collar than said second end, and wherein said boring tip is rotatingly urged into said crater by means of said handle in order to create said bore.

60. The method of claim 59, wherein said collar acts as a stop such that the length of said bore is approximately equivalent to the length of said boring tip.