Devices for minimally invasive pelvic surgery

• US 8,636,641 B2
• Filed: 10/31/2007
• Issued: 01/28/2014
• Est. Priority Date: 02/13/1997
• Status: Active Grant

• Current Assignee: Boston Scientific Scimed (Boston Scientific Corporation)
• Original Assignee: Boston Scientific Scimed (Boston Scientific Corporation)
• Inventors: Gellman, Barry N., Brenneman, Rodney, Sauvageau, David, Pintauro, William, Appell, Rodney, Morin, Armand A.
• Primary Examiner(s): LACYK, JOHN P
• Application Number:
  US11/982,313
• Publication Number:
  US 20080146867A1
• Time in Patent Office: 2,281 Days
• Field of Search: 600 29- 32, 600/37, 128/DIG.25
• US Class Current: 600/29
• 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.

Claims

1. A method for stabilizing a patient'"'"'s pelvic floor, comprising

making a first incision on a left or right side of a patient'"'"'s pelvic area,

making a second incision on a left or right side of a patient'"'"'s pelvic area,

inserting a first shaft into the first incision and advancing the first shaft through body tissue of the patient toward the patient'"'"'s vaginal wall,

penetrating the vaginal wall with the first shaft subsequent to advancing the first shaft through the body tissue,

inserting a second shaft into the second incision and advancing the second shaft through body tissue of the patient toward the patient'"'"'s vaginal wall,

associating the first shaft with a pelvic support sling,

associating the second shaft with the pelvic support sling,

positioning the pelvic support sling within the patient'"'"'s pelvic floor, and

anchoring the pelvic support sling in fascia located in the patient'"'"'s pelvic area.

2. The method of claim 1, comprising anchoring the pelvic support sling in the patient'"'"'s rectus fascia.

3. The method of claim 1, comprising anchoring the pelvic support sling in a ligament.

4. The method of claim 1, comprising anchoring the pelvic support sling in the patient'"'"'s pubic periosteum.

5. The method of claim 1, wherein the body tissue is between the patient'"'"'s urethra and upper vaginal wall.

6. The method of claim 1, comprising penetrating the patient'"'"'s upper vaginal wall.

7. A method for stabilizing a patient'"'"'s pelvic floor, comprising:

making a first incision on a pelvic area of a patient, and advancing a first shaft through the first incision, the first shaft including a pelvic support sling, and a detachable member coupled to the first shaft and the pelvic support sling;

penetrating the vaginal wall with the detachable member of the first shaft such that a portion of the detachable member remains within a pelvic floor area of the patient;

decoupling the detachable member from the first shaft;

making a second incision on the pelvic area of the patient, and advancing a second shaft through the second incision until reaching the pelvic floor area;

coupling the detachable member with the second shaft, and withdrawing the second shaft from the pelvic floor area such that the pelvic support sling is removed from the first shaft and positioned with the pelvic floor area; and

anchoring the pelvic support sling in the pelvic area.

8. The method of claim 7, wherein the detachable member is coupled to the pelvic support sling via a first suture, and the pelvic support sling is coupled to the first shaft via a second suture.

9. The method of claim 8, wherein, when the pelvic support sling is anchored, the first suture extends from the second incision to the pelvic support sling, and the second suture extends from the first incision to the pelvic support sling.

10. The method of claim 7, wherein the vaginal wall is penetrated with the detachable member such that a first portion of the detachable member advances through the vaginal wall and a second portion of the detachable member, disposed within the pelvic floor area, is configured to be coupled to the second shaft.

11. The method of claim 10, wherein the first portion of the detachable member includes a portion of a removable needle, and the method further includes:

securing the removable needle on the vaginal side of the patient; and

removing the removable needle after the second portion of the detachable member is coupled with the second shaft.

12. The method of claim 10, wherein the first portion of the detachable member includes a portion of a needle, and the penetrating the vaginal wall with the detachable member of the first shaft includes:

distally moving a needle tip of the needle, located within the detachable member, to a position extending outside the detachable member.

13. The method of claim 7, wherein the first shaft includes an actuator and an inner shaft, and the decoupling the detachable member from the first shaft includes:

distally moving the inner shaft to contact the detachable member based on an operation of the actuator.

14. The method of claim 13, wherein the operation of the actuator includes pivoting the actuator.

15. The method of claim 7, wherein the pelvic support sling is anchored within an opening between the urethra and the upper vaginal wall of the patient.

16. A method for stabilizing a patient'"'"'s pelvic floor, comprising:

making a first incision on a pelvic area of a patient;

making a second incision on the pelvic area of the patient;

inserting a first shaft into the first incision and advancing the first shaft through body tissue of the patient toward the vaginal wall, the first shaft being associated with a pelvic support sling;

penetrating the vaginal wall with the first shaft;

inserting a second shaft into the second incision and advancing the second shaft through body tissue of the patient toward the patient'"'"'s vaginal wall;

associating the second shaft with the pelvic support sling;

positioning the pelvic support sling within the pelvic floor area of the patient; and

anchoring the pelvic support sling in the pelvic area of the patient.

17. The method of claim 16, comprising:

anchoring the pelvic support sling in the rectus fascia of the patient.

18. The method of claim 16, comprising:

anchoring the pelvic support sling in a ligament.

19. The method of claim 16, comprising:

anchoring the pelvic support sling in the pubic periosteum of the patient.

20. The method of claim 16, wherein the body tissue is between the urethra and upper vaginal wall of the patient.