Percutaneous and hiatal devices and methods for use in minimally invasive pelvic surgery

• US 6,423,080 B1
• Filed: 02/13/1998
• Issued: 07/23/2002
• Est. Priority Date: 02/13/1997
• Status: Expired due to Term

• Current Assignee: Boston Scientific Scimed (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
• Primary Examiner(s): Recla, Henry J.
• Assistant Examiner(s): Lewis, William W
• Application Number:
  US09/023,965
• Time in Patent Office: 1,621 Days
• Field of Search: 606/1, 606/96, 606/129, 606/130, 606/159, 606/184, 606/185, 606/108, 606/146-149, 606/205-210
• 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 hollow suture needles A61B2017/061
• CPC Class Codes: A61B 2017/061 hollow or tubular suture extending inside a hollow needle A61B2017/06052; hollow sutures A61B2017/06185
• 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 blunt suture needles A61B2017/06085
• 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 continence are also disclosed.

Claims

1. A method of inserting a guide member into a body tissue, comprising the steps of:

percutaneously inserting a shaft of a first guide member placement device;

advancing said shaft of said first guide member placement device through the body tissue to a central point through which the guide member will pass;

percutaneously inserting a shaft of a second guide member placement device;

advancing said shaft of said second guide member placement device through the body tissue to said central point through which the guide member will pass inserting the shafts of the first and second guide member placement devices into a pre-formed opening or pocket in the body tissue;

coupling an engaging member on a distal end of said shaft of said first guide member placement device to an engaging member on a distal end of said shaft of said second guide member placement device such that a lumen in said shaft of said first guide member placement device is in fluid communication with a lumen in said shaft of said second guide member placement device;

passing a guide member through said lumens of said coupled shafts of said first guide member placement device and said second guide member placement device; and

removing said shaft of said first guide member placement device and said shaft of said second guide member placement device from the body, thereby leaving said guide member in the body tissue.

2. The method of claim 1, wherein said first and second shafts are percutaneously inserted through first and second suprapubic incisions.

3. The method of claim 2, wherein said guide member left in body tissue extends between said two suprapubic incisions after removal of the first and second guide member placement devices such that the terminal ends of the guide member are positioned outside of the body.

4. The method of claim 2, wherein said pre-formed openings or pockets are created using a sling application catheter.

5. The method of claim 2, wherein said preformed openings or pockets are created using a hydrodissector.

6. The method of claim 1, wherein said suprapubic incisions are positioned over the pubic tubercles.

7. The method of claim 1, wherein said preformed opening or pocket is in the tissue between the urethra and the upper vaginal wall, such that said guide member is left in said pre-formed opening or pocket.

8. The method of claim 1, wherein said guide member comprises a guide wire.

9. The method of claim 1, wherein said guide-member comprises a suture.

10. The method of claim 1, further comprising the step of attaching a surgical sling to said guide member.

11. The method of claim 10, wherein said surgical sling is attached to said guide member after said first and second member placement devices are removed.

12. The method of claim 2, wherein said preformed openings or pockets are created using an expandable balloon.

13. The method of claim 2, further comprising the step of dissecting from the supra pubic incisions through the rectus fascia.

14. The method of claim 1, further comprising the step of tenting the upper vaginal wall to determine the position of the guide member placement device.

15. The method of claim 1, further comprising the step of viewing the guide member placement devices to ensure proper alignment of said first and second guide member placement devices.

16. The method of claim 1, wherein said positioning step further comprises laproscopically viewing the distal ends of the guide member placement devices prior to said coupling step.