Bladder neck suspension method
First Claim
1. A method of laparoscopically suspending a bladder neck, comprising the steps ofpositioning a knot tying device over a suture passer,grasping an end of a suture with the suture passer,inserting the suture passer and suture into the retropubic space,making a first pass with the suture passer through Cooper'"'"'s ligament, the periurethral tissue and the anterior vaginal wall into the vagina,releasing the suture in the vagina,withdrawing the suture passer out of the vagina through the anterior vaginal wall and periurethral tissue, and out of Cooper'"'"'s ligament into the retropubic space,making a second pass with the suture passer around Cooper'"'"'s ligament through the periurethral tissue and the anterior vaginal wall into the vagina at a position spaced away from the first pass of the suture passer through the anterior vaginal wall into the vagina to achieve a bite with the suture of the anterior vaginal wall,regrasping the released suture in the vagina,withdrawing the suture passer and suture from the vagina into the retropubic space,inserting the knot tying device into the retropubic space adjacent Cooper'"'"'s ligament,retracting the suture passer and suture into the knot tying device, andtying a knot in the suture.
1 Assignment
0 Petitions
Accused Products
Abstract
A laparoscopic bladder neck suture suspension procedure that anchors a suture in Cooper'"'"'s ligament and, transvaginally, in the anterior vaginal wall to provide upper and lower suspension points and, then, ties and tensions a knot intracorporeally within the retropubic space between the upper and lower suspension points. The laparoscopic bladder neck suture suspension procedure utilizes a surgical instrument that combines a knot tying device mounted over a suture passing device. The suture passer may incorporate a grasper at its tip for purposes of passing a suture through body tissue as desired. The knot tying device is used to suture intracorporeally under tension using sliding knots such that the tension can be increased incrementally as the surgeon tests the elevation of the bladder neck by feel.
184 Citations
19 Claims
-
1. A method of laparoscopically suspending a bladder neck, comprising the steps of
positioning a knot tying device over a suture passer, grasping an end of a suture with the suture passer, inserting the suture passer and suture into the retropubic space, making a first pass with the suture passer through Cooper'"'"'s ligament, the periurethral tissue and the anterior vaginal wall into the vagina, releasing the suture in the vagina, withdrawing the suture passer out of the vagina through the anterior vaginal wall and periurethral tissue, and out of Cooper'"'"'s ligament into the retropubic space, making a second pass with the suture passer around Cooper'"'"'s ligament through the periurethral tissue and the anterior vaginal wall into the vagina at a position spaced away from the first pass of the suture passer through the anterior vaginal wall into the vagina to achieve a bite with the suture of the anterior vaginal wall, regrasping the released suture in the vagina, withdrawing the suture passer and suture from the vagina into the retropubic space, inserting the knot tying device into the retropubic space adjacent Cooper'"'"'s ligament, retracting the suture passer and suture into the knot tying device, and tying a knot in the suture.
-
7. A method of laparoscopically suspending a bladder neck, comprising the steps of
inserting a suture passer through a knot tying device, grasping an end of a suture with a suture passer, inserting the suture passer and suture into the retropubic space, making a first pass with the suture passer and suture through Cooper'"'"'s ligament, releasing the suture from the suture passer once the suture passer and suture have passed through Cooper'"'"'s ligament, retracting the suture passer back through Cooper'"'"'s ligament, passing the suture passer around Cooper'"'"'s ligament, regrasping the suture with the suture passer on the other side of Cooper'"'"'s ligament, continuing the first pass of the suture passer and suture through the periurethral tissue and the anterior vaginal wall into the vagina, releasing the suture in the vagina, withdrawing the suture passer out of the vagina and through the anterior vaginal wall and periurethral tissue into the retropubic space, making a second pass with the suture passer around Cooper'"'"'s ligament through the periurethral tissue and the anterior vaginal wall into the vagina at a position spaced away from the first pass of the suture passer through the anterior vaginal wall into the vagina to achieve a bite with the suture of the anterior vaginal wall, regrasping the released suture in the vagina, withdrawing the suture passer and suture from the vagina into the retropubic space, inserting the knot tying device into the retropubic space adjacent Cooper'"'"'s ligament, retracting the suture passer suture into the knot tying device, and tying a knot in the suture.
-
12. A method of laparoscopically suspending a bladder neck, comprising the steps of
positioning a knot tying device over a suture passer, the knot tying device including a suture mounted thereon, passing the suture passer through Cooper'"'"'s ligament while the suture passer grasps the suture, passing the suture passer through the periurethral tissue and anterior vaginal wall while the suture passer grasps the suture, creating a bite of the anterior vaginal wall with the suture, and retracting the suture passer into the knot tying device while the suture passer grasps the suture.
-
14. A method of laparoscopically suspending a bladder neck, comprising the steps of
inserting a suture passer through a knot tying device, the knot tying device including a suture mounted thereon, passing the suture passer through Cooper'"'"'s ligament while grasping the suture with the suture passer, making a first pass with the suture passer through the periurethral tissue and anterior vaginal wall while grasping the suture with the suture passer, making a second pass with the suture passer through the periurethral tissue and anterior vaginal wall while grasping the suture with the suture passer, at a position spaced away from the first pass of the suture passer through the anterior vaginal wall to achieve a bite of the anterior vaginal wall with the suture, and retracting the suture passer into the knot tying device while the suture passer grasps the suture.
Specification