WO1990003766A1 - Surgical instrument prosthesis and method of utilisation of such - Google Patents

Surgical instrument prosthesis and method of utilisation of such Download PDF

Info

Publication number
WO1990003766A1
WO1990003766A1 PCT/AU1989/000432 AU8900432W WO9003766A1 WO 1990003766 A1 WO1990003766 A1 WO 1990003766A1 AU 8900432 W AU8900432 W AU 8900432W WO 9003766 A1 WO9003766 A1 WO 9003766A1
Authority
WO
WIPO (PCT)
Prior art keywords
shaft
filamentary
surgical instrument
wall
needle
Prior art date
Application number
PCT/AU1989/000432
Other languages
French (fr)
Inventor
Peter Emanuel Petros
Original Assignee
Peter Emanuel Petros
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Peter Emanuel Petros filed Critical Peter Emanuel Petros
Priority to EP89911232A priority Critical patent/EP0437481B1/en
Priority to BR898907704A priority patent/BR8907704A/en
Priority to DE68921762T priority patent/DE68921762T2/en
Publication of WO1990003766A1 publication Critical patent/WO1990003766A1/en

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/42—Gynaecological or obstetrical instruments or methods
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06066—Needles, e.g. needle tip configurations
    • A61B17/06109—Big needles, either gripped by hand or connectable to a handle
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00743—Type of operation; Specification of treatment sites
    • A61B2017/00805—Treatment of female stress urinary incontinence
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06004—Means for attaching suture to needle
    • A61B2017/06019—Means for attaching suture to needle by means of a suture-receiving lateral eyelet machined in the needle
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/0004—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse
    • A61F2/0031—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse for constricting the lumen; Support slings for the urethra
    • A61F2/0036—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse for constricting the lumen; Support slings for the urethra implantable
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10S128/00—Surgery
    • Y10S128/25—Artificial sphincters and devices for controlling urinary incontinence

Definitions

  • THIS INVENTION relates to a surgical instrument for use in the treating of female incontinence and to a method of treating such incontinence.
  • the invention resides in an instrument for the application of a filamentary element to the body for the purpose of treating female incontinence
  • a tubular shaft having'a handle at one end and curved at its other end to the approximate of the general profile of the pubis between the vagina and the anterior surface of theabdomen, a needle element slidably receivable in other end of the shaft and adapted at one end to receive a filamentary element and having an enlarged profiled portion at its other end whereby when the needle element is received in the shaft the other end of the needle element defines a convergent surface at the other end of the shaft and the one end of the needle element is exposed at the one end of the shaft.
  • the invention resides in a method of treating female incontinence comprising looping a filamentary element between the wall of the vagina and the rectus abdominis sheath in the anterior wall of the abdomen whereby it passes to each side of the urethra , tightening the loop to bring the vaginal wall and the urethra into the correct spatial relationship to the pubis allowing the development of scar tissue between the vaginal wall and the anterior wall of the abdomen pubic symphysis and removing the filamentary element.
  • Fig. 1 is a schematic sagital section illustrating the circumstance which the urethro vesical junction wall is in a state of prolapse;
  • Figs. 2 , 3 and 4 are sagital sections illustrating the stages entry of the embodiment into the body
  • Fig. 5 is a side elevation of the embodiment
  • Fig. 6 is a side elevation of the embodiment with the needle element removed
  • Fig. 7 is an isometric view of an alternative form of the embodiment.
  • Fig. 8 is an isometric view of the form of the embodiment of Fig. 7 with the needle removed.
  • the embodiment is directed to a surgical tool for the treatment of female incontinence whereby as a result of the deterioration of the tissue or ligaments interconnecting the pubis with the vaginal wall. Such a condition can level to a loss of control of emissions from the urethra.
  • the embodiment relates to an apparatus ⁇ whereby the vaginal wall and urethra can be brought into a proper spatial relation with the pubis in order to restore continence.
  • the embodiment comprises a surgical tool two forms of which are shown at Figs. 5 and 6 and 7 and 8 which comprise a tubular shaft 11 having a handle 12 at one end and curved at its other end to a configuration approximately corresponding to the general curvature of the pubis between the vaginal wall and the anterior surface of the abdomen.
  • the handle 12 may comprise a central radial arm 12a which is in the plane of curvature of the shaft to provide a positioning guide.
  • the handle further comprises a pair of opposed arms 12b equally angularly offset from the central radial arm 12a.
  • the opposed arms 12b provide facility for applying some leverage which may be required in using the instrument.
  • the tubular shaft accommodates a needle element 13 which is provided at one end with an eye 14 for receipt of a filamentary element (not shown) .
  • the other end of the needle element is formed with an enlarged conically shaped head portion 15 which is receivable at the other end of the shaft 11 to close the other end of the shaft and define a convergent substantially conical surface to facilitate penetration of the instrument through the body cavity.
  • an incision is made in the vaginal wall 16 in the region of the urethro vesical junction.
  • the other end of the instrument, having the needle element 13 therein, is passed through the incision made in the vaginal wail 16 and is passed through the body cavity around the pubis 17 until it contacts the muscle tissue 18 at the anterior wall of the abdomen.
  • An incision is then made into the body wall at the point of contact of the other end of the instrument to allow passage of the instrument through the muscle tissue.
  • a filamentary element 19 which takes the form of a tape is then applied through the eye of the needle element 13 and the needle element is withdrawn from the shaft such that the filamentary element 19 is pulled through the shaft.
  • the shaft is then removed from the body while the filamentary element is stationary.
  • a second incision is made into the vaginal wall 16 to the other side of the urethra 20.
  • the surgical instrument having the needle element in place in the shaft is then inserted into the second incision and again the shaft 11 is passed through the body cavity until it contacts the muscle tissue 18 at the interior wall of the abdomen at a position spaced from the first incision in the muscle wall at which time a second incision is made in the anterior wall of the abdomen through which the other end of the surgical instrument is passed.
  • the needle element is then removed from the shaft while the shaft is held in position and the end of the filamentary element which is in place in the body is then engaged through the eye of the needle element.
  • the needle is then reinserted into the shaf such that the filamentary element 19 is carried to the one end of the shaft where it is disconnected from the needle element 13.
  • the needle element is then removed from the shaft 11.
  • the shaft is then removed from the body while the filamentary element remains stationary. As a result the filamentary element is then looped around the muscle tissue 18 of the abdomen to either side of the urethra 20 with the ends extending into the vagina.
  • the filamentary element is left in place for a sufficient period of time for a scar tissue to develop around the filamentary element which provides a ligament like interconnection between the vaginal wall and the muscle tissue at the anterior surface of the abdomen. After satisfactory development of such tissue the ends of the filamentary element are disconnected and the . filamentary element is removed from the body per vaginam.

Abstract

A method of treating female incontinence comprising looping a filamentary element (19) between the wall of the vagina (16) and the rectus abdominis sheath in the anterior wall of the abdomen whereby it passes to each side of the urethra (20) into the correct spatial relationship to the pubis (17), allowing the development of scar tissue between the vaginal wall (16) and the rectus abdominis sheath and removing the filamentary element (19). A surgical instrument for use with the method comprises a surgical instrument for the application of a filamentary element (19) into the body for the purpose of treating female incontinence said instrument comprising a tubular shaft (11) having a handle (12) at one end and carried toward its other end a flexible needle element (13) slidably receivable in the shaft (11) and adapted at one end to receive a filamentary element (19) and having an enlarged profiled portion (15) at its other end whereby when the needle element (13) is received in the shaft (11) the other end of the needle element (13) defines a convergent surface of the other end of the shaft (11) and the one end of the needle element (13) is exposed at the one end of the shaft (11). A corrective tissue prosthesis for use with the method, comprising an elongate flexible filamentary element (19) to which tissue will not attach itself.

Description

"Surgical Instrument Prosthesis and Method of Utilisation of Such"
THIS INVENTION relates to a surgical instrument for use in the treating of female incontinence and to a method of treating such incontinence.
In one form the invention resides in an instrument for the application of a filamentary element to the body for the purpose of treating female incontinence comprising a tubular shaft having'a handle at one end and curved at its other end to the approximate of the general profile of the pubis between the vagina and the anterior surface of theabdomen, a needle element slidably receivable in other end of the shaft and adapted at one end to receive a filamentary element and having an enlarged profiled portion at its other end whereby when the needle element is received in the shaft the other end of the needle element defines a convergent surface at the other end of the shaft and the one end of the needle element is exposed at the one end of the shaft.
In another form the invention resides in a method of treating female incontinence comprising looping a filamentary element between the wall of the vagina and the rectus abdominis sheath in the anterior wall of the abdomen whereby it passes to each side of the urethra, tightening the loop to bring the vaginal wall and the urethra into the correct spatial relationship to the pubis allowing the development of scar tissue between the vaginal wall and the anterior wall of the abdomen pubic symphysis and removing the filamentary element.
The invention will be more fully understood in the light of the particular embodiment of the invention described below. The description is made with reference to the accompanying drawings of which:- Fig. 1 is a schematic sagital section illustrating the circumstance which the urethro vesical junction wall is in a state of prolapse;
Figs. 2 , 3 and 4 are sagital sections illustrating the stages entry of the embodiment into the body;
Fig. 5 is a side elevation of the embodiment;
Fig. 6 is a side elevation of the embodiment with the needle element removed;
Fig. 7 is an isometric view of an alternative form of the embodiment; and
Fig. 8 is an isometric view of the form of the embodiment of Fig. 7 with the needle removed.
The embodiment is directed to a surgical tool for the treatment of female incontinence whereby as a result of the deterioration of the tissue or ligaments interconnecting the pubis with the vaginal wall. Such a condition can level to a loss of control of emissions from the urethra. The embodiment relates to an apparatus^ whereby the vaginal wall and urethra can be brought into a proper spatial relation with the pubis in order to restore continence. The embodiment comprises a surgical tool two forms of which are shown at Figs. 5 and 6 and 7 and 8 which comprise a tubular shaft 11 having a handle 12 at one end and curved at its other end to a configuration approximately corresponding to the general curvature of the pubis between the vaginal wall and the anterior surface of the abdomen. As shown at Figs. 7 and 8 which are directed to an alternative form of the invention the handle 12 may comprise a central radial arm 12a which is in the plane of curvature of the shaft to provide a positioning guide. The handle further comprises a pair of opposed arms 12b equally angularly offset from the central radial arm 12a. The opposed arms 12b provide facility for applying some leverage which may be required in using the instrument. The tubular shaft accommodates a needle element 13 which is provided at one end with an eye 14 for receipt of a filamentary element (not shown) . The other end of the needle element is formed with an enlarged conically shaped head portion 15 which is receivable at the other end of the shaft 11 to close the other end of the shaft and define a convergent substantially conical surface to facilitate penetration of the instrument through the body cavity.
In using the instrument and as shown at Figs. 2 , 3 and 4 an incision is made in the vaginal wall 16 in the region of the urethro vesical junction. The other end of the instrument, having the needle element 13 therein, is passed through the incision made in the vaginal wail 16 and is passed through the body cavity around the pubis 17 until it contacts the muscle tissue 18 at the anterior wall of the abdomen. An incision is then made into the body wall at the point of contact of the other end of the instrument to allow passage of the instrument through the muscle tissue. A filamentary element 19 which takes the form of a tape is then applied through the eye of the needle element 13 and the needle element is withdrawn from the shaft such that the filamentary element 19 is pulled through the shaft. With the filamentary element 19 in place the shaft is then removed from the body while the filamentary element is stationary. A second incision is made into the vaginal wall 16 to the other side of the urethra 20. The surgical instrument having the needle element in place in the shaft is then inserted into the second incision and again the shaft 11 is passed through the body cavity until it contacts the muscle tissue 18 at the interior wall of the abdomen at a position spaced from the first incision in the muscle wall at which time a second incision is made in the anterior wall of the abdomen through which the other end of the surgical instrument is passed. The needle element is then removed from the shaft while the shaft is held in position and the end of the filamentary element which is in place in the body is then engaged through the eye of the needle element. The needle is then reinserted into the shaf such that the filamentary element 19 is carried to the one end of the shaft where it is disconnected from the needle element 13. The needle element is then removed from the shaft 11. The shaft is then removed from the body while the filamentary element remains stationary. As a result the filamentary element is then looped around the muscle tissue 18 of the abdomen to either side of the urethra 20 with the ends extending into the vagina.
The filamentary element is left in place for a sufficient period of time for a scar tissue to develop around the filamentary element which provides a ligament like interconnection between the vaginal wall and the muscle tissue at the anterior surface of the abdomen. After satisfactory development of such tissue the ends of the filamentary element are disconnected and the . filamentary element is removed from the body per vaginam.

Claims

THE CLAIMS defining the invention are as follows:-
1. A surgical instrument for the application of a filamentary element into the body for the purpose of treating female incontinence said instrument comprising a tubular shaft having a handle at one end and carried toward its other end a flexible needle element slidably receivable in the shaft and adopted at one end to receive a filamentary element and having an enlarged profiled portion at its other end whereby when the needle element is received in the shaft the other end of the needle element defubes a convergent surface of the other end of the shaft and the one end of the needle element is exposed at the one end of the shaft.
2. A surgical instrument as claimed at claim 1 wherein the curvature of the shaft approximates the general profile of the pubis between the vagina and the anterior surface, of the abdomen.
3. A surgical instrument substantially as herein described.
4. A corrective tissue prosthesis comprising a flexible elongate element of a filamentary nature to which tissue will not attach itself.
5. A corrective tissue prosthesis substantially as herein described.
6. A method of treating female incontinence comprising looping a filamentary element between the wall of the vagina and the rectus abdominis sheath in the anterior wall of the abdomen whereby it passes to each side of the urethra into the correct spatial relationship to the pubis, allowing the development of scar tissue between the vaginal wall and the rectus abdominis sheath and removing the filamentary element.
7. A method substantially as herein described.
PCT/AU1989/000432 1988-10-04 1989-10-04 Surgical instrument prosthesis and method of utilisation of such WO1990003766A1 (en)

Priority Applications (3)

Application Number Priority Date Filing Date Title
EP89911232A EP0437481B1 (en) 1988-10-04 1989-10-04 Surgical instrument prosthesis
BR898907704A BR8907704A (en) 1988-10-04 1989-10-04 SURGICAL INSTRUMENT PROSTHESIS AND METHOD FOR ITS USE
DE68921762T DE68921762T2 (en) 1988-10-04 1989-10-04 SURGICAL INSTRUMENT, PROSTHESIS.

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
AUPJ075688 1988-10-04
AUPJ0756 1988-10-04

Publications (1)

Publication Number Publication Date
WO1990003766A1 true WO1990003766A1 (en) 1990-04-19

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/AU1989/000432 WO1990003766A1 (en) 1988-10-04 1989-10-04 Surgical instrument prosthesis and method of utilisation of such

Country Status (6)

Country Link
US (1) US5112344A (en)
EP (1) EP0437481B1 (en)
AT (1) ATE119758T1 (en)
BR (1) BR8907704A (en)
DE (1) DE68921762T2 (en)
WO (1) WO1990003766A1 (en)

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EP0437481A1 (en) 1991-07-24
DE68921762T2 (en) 1995-08-03
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US5112344A (en) 1992-05-12
ATE119758T1 (en) 1995-04-15
DE68921762D1 (en) 1995-04-20
EP0437481B1 (en) 1995-03-15
EP0437481A4 (en) 1991-08-21

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