Systems, devices, and methods for minimally invasive pelvic surgery

• US 7,614,999 B2
• Filed: 07/28/2006
• Issued: 11/10/2009
• Est. Priority Date: 02/13/1997
• Status: Expired due to Term

• Current Assignee: Boston Scientific Scimed (Boston Scientific Corporation)
• Original Assignee: Boston Scientific Scimed (Boston Scientific Corporation)
• Inventors: Gellman, Barry N., Brenneman, Rodney, Sauvageau, David J., Appell, Rodney, Pintauro, William, Morin, Armand
• Primary Examiner(s): Lacyk; John P
• Application Number:
  US11/495,971
• Publication Number:
  US 20070021686A1
• Time in Patent Office: 1,201 Days
• Field of Search: 600 29- 32, 600/37, 128/DIG.25
• US Class Current: 600/30
• 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

The invention, in various embodiments, provides systems, devices, and methods for treating urinary incontinence.

The invention also provides a driver and methods for advancing needles, cannulas, and other medical devices through the pubic bone. The driver may be used in connection with a driver frame assembly for proper positioning and stabilization of the driver, and with other devices for creating a cavity in the urethral floor and for positioning medical devices therein. The invention also provides simple connections for attaching a suture to a device within the cavity in the urethral floor or in the vagina, and also for attaching sutures to the pubic bone.

Claims

1. A method for delivering a supportive sling for treating urinary incontinence to an anatomical site in the body of a female patient comprising:

a) inserting a distal end of a first guide into the body of the patient by way of the abdomen on one side of the body;

b) penetrating the vaginal cavity of the patient with the distal end of the first guide;

c) associating a sling assembly, comprising a supportive sling, with the distal end of the first guide;

d) repeating steps a-c with a second guide on the contra-lateral side of the body of the patient; and

e) delivering the supportive sling to an anatomical site in the body of the patient.

2. The method of claim 1, wherein at least one of the guides is a needle, catheter, or solid rod, the method further comprising passing of said needle, catheter or solid rod through the tissues of the patient by way of the abdomen.

3. The method of claim 1, wherein at least one of the guides has a sharpened distal end, the method further comprising penetrating the vaginal cavity of the patient with said sharpened distal end.

4. The method of claim 1, wherein at least one of the guides is stiff, the method further comprising passing said stiff guild through the tissues of the patient by way of the abdomen.

5. The method of claim 1, further comprising at least one of the guides piercing the tissues of the patient.

6. The method of claim 1, comprising penetrating bone by at least one of the guides.

7. The method of claim 1, further comprising at least partially enclosing the sling inside a pouch, wherein the sling assembly includes the pouch that at least partially encloses the sling.

8. The method of claim 7, wherein step c) comprises associating the pouch with the distal end of the first guide.

9. The method of claim 7, wherein the pouch is flexible, the method further comprising flexing the pouch.

10. The method of claim 7, wherein the pouch has a flat shape, the method further comprising delivering the sling to the anatomical site in a flat orientation.

11. The method of claim 7, further comprising exposing the sling wherein the pouch includes through apertures exposing the sling.

12. The method of claim 1, further comprising only partially enclosing the sling inside a pouch, wherein the sling assembly includes the pouch that only partially encloses the sling.

13. The method of claim 1, further comprising completely enclosing the sling inside a pouch, wherein the sling assembly includes the pouch that completely encloses the sling.

14. The method of claim 7, further comprising releasing the sling from the pouch.

15. The method of claim 1, further comprising attaching the sling to the patient via a suture, wherein the sling includes one or more of said sutures extending bilaterally therefrom.

16. The method of claim 1, comprising tensioning the sling assembly.

17. The method of claim 1, wherein the anatomical site is adjacent or below the urethra or bladder neck of the patient.

18. A method for delivering a supportive sling for treating urinary incontinence to an anatomical site in the body of a female patient comprising:

a) inserting a distal end of a first guide into the body of the patient by way of the abdomen on one side of the body;

b) penetrating the vaginal cavity of the patient with the distal end of the first guide;

c) repeating steps a-b with a second guide on the contra-lateral side of the body of the patient;

d) associating a sling assembly, comprising a supportive sling, with the distal ends of the first and second guides; and

e) delivering the supportive sling to an anatomical site in the body of the patient.