Transobturator surgical articles and methods

• US 6,911,003 B2
• Filed: 03/03/2003
• Issued: 06/28/2005
• Est. Priority Date: 03/07/2002
• Status: Expired due to Term

• Current Assignee: ASTORA Women's Health, LLC (Endo International PLC)
• Original Assignee: Ams Research Corporation (Endo International PLC)
• Inventors: Neisz, Johann J., Watschke, Brian P., Anderson, Kimberly A., Mellier, Georges
• Primary Examiner(s): Gilbert, Samuel G.
• Assistant Examiner(s): Veniaminov, Nikita R.
• Application Number:
  US10/377,101
• Publication Number:
  US 20030212305A1
• Time in Patent Office: 848 Days
• Field of Search: 600 29- 37, 128/DIG.25, 128/885, 128897-899, 606/139, 606/148, 606/151, 606/185, 606/141, 606/144, 606/145, 604272-274, 604/263, 623/23.64, 623/23.65, 623/23.66
• US Class Current: 600/30
• 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 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• CPC Class Codes: A61B 17/06066 Needles, e.g. needle tip configurations making needles B21G1/00
• CPC Class Codes: A61B 17/06109 Big needles, either gripped by hand or connectable to a handle
• CPC Class Codes: A61B 17/30 Surgical pincettes without pivotal connectionsfor holding suture needles or materials A61B17/0483; wound clamps A61B17/08 ; hand-held gripping tools without pivotal connections in general B25B9/02
• CPC Class Codes: A61B 17/3211 Surgical scalpels, knives; Accessories therefor
• CPC Class Codes: A61B 2017/00805 Treatment of female stress urinary incontinence
• CPC Class Codes: A61B 2017/00946 malleable
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/06009 having additional means for releasably clamping the suture to the needle, e.g. actuating rod slideable within the needle
• CPC Class Codes: A61B 2017/06076 helically or spirally coiled for sutures A61B2017/06171
• CPC Class Codes: A61B 2017/320056 Tunnelers
• CPC Class Codes: A61B 50/30 Containers specially adapted for packaging, protecting, dispensing, collecting or disposing of surgical or diagnostic appliances or instruments for wound clamps A61B17/10; for ligaturing clips A61B17/122; packages or dispensers for surgical gloves or finger-stalls A61B42/40
• 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: A61F 2002/30708 Means for distinguishing between left-sided and right-sided devices, Sets comprising both left-sided and right-sided prosthetic parts
• CPC Class Codes: A61F 2250/0084 Means for distinguishing between left-sided and right-sided devices; Sets comprising both left-sided and right-sided prosthetic parts
• CPC Class Codes: Y10S 128/25 Artificial sphincters and devices for controlling urinary incontinence

Abstract

Surgical articles, implants and components suitable for a transobturator surgical procedure are described.

Claims

1. A method of treating incontinence in a female patient comprising the steps of:

a. creating a vaginal incision and a pair of pelvic incisions, each of the pair of pelvic incisions substantially aligned with the patient'"'"'s obturator foramen on opposite lateral sides of the vaginal incision and wherein both pelvic incisions lie in a straight line approximately at the level of the patient'"'"'s clitoris;

b. providing an elongate surgical instrument comprising first and second ends and an elongate implant for treating incontinence;

c. passing one of the ends of the instrument between the vaginal incision, through one obturator foramen, and one of the pelvic incisions;

d. associating the implant with the instrument;

e. using the instrument to pass the implant through the tissue between the vaginal incision and the one pelvic incision such that the implant extends between the vaginal incision, through the one obturator foramen, and one of the pelvic incisions;

f. subsequently passing one of the ends of the instrument between the vaginal incision, through the other obturator foramen, and the other pelvic incision; and

g. using the instrument to extend the implant between the vaginal incision, through the other obturator foramen, to the other pelvic incision such that the implant then extends from one pelvic incision to the other pelvic incision, through both obturator foramen and between the patient'"'"'s urethra and vaginal wall.

2. The method of claim 1 wherein the incisions are made with the patient placed in a modified lithotomy position.

3. The method of claim 1 wherein both pelvic incisions lie in a straight line that is superior to the urethral meatus.

4. The method of claim 1 wherein the instrument passes through an obturator foramen membrane adjacent to a medial region of the obturator foramen membrane inferior to a region of the patient'"'"'s obturator foramen containing vascular and nerve structures.

5. The method of claim 1 wherein one end of the instrument passes through an obturator foramen membrane adjacent to the patient'"'"'s lateral margins of each ischiopubic ramus on a horizontal line level with the clitoris.

6. The method of claim 1 wherein the ends of the instrument pass from the vaginal incision through each obturator foramen to each pelvic incision.

7. The method of claim 1 wherein at least one end of the instrument passes from at least one of the pelvic incisions through one of the obturator foramen to the vaginal incision.

8. The method of claim 1 wherein the implant provides support for the patient'"'"'s urethra.

9. The method of claim 1 wherein at least one end of the instrument forms a curve.

10. The method of claim 1 wherein at least one end of the instrument comprises an eyelet to associate the instrument with the implant.

11. The method of claim 1 wherein at least one end of the instrument is associated with the implant using a connector.

12. The method of claim 1 wherein the implant is a sling.

13. The method of claim 1 wherein the implant is a polypropylene sling.

14. The method of claim 1 wherein the implant is a knitted polypropylene sling.