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US20140257026A1 - Adjustable implants and methods of implanting the same - Google Patents

Adjustable implants and methods of implanting the same Download PDF

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Publication number
US20140257026A1
US20140257026A1 US14/195,599 US201414195599A US2014257026A1 US 20140257026 A1 US20140257026 A1 US 20140257026A1 US 201414195599 A US201414195599 A US 201414195599A US 2014257026 A1 US2014257026 A1 US 2014257026A1
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US
United States
Prior art keywords
tissue anchor
anchor
tissue
medical device
patient
Prior art date
Legal status (The legal status 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 status listed.)
Abandoned
Application number
US14/195,599
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English (en)
Inventor
Ronald Ciulla
James M. Goddard
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Boston Scientific Scimed Inc
Original Assignee
Scimed Life Systems Inc
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 Scimed Life Systems Inc filed Critical Scimed Life Systems Inc
Priority to US14/195,599 priority Critical patent/US20140257026A1/en
Priority to PCT/US2014/020383 priority patent/WO2014138104A2/fr
Assigned to BOSTON SCIENTIFIC SCIMED, INC. reassignment BOSTON SCIENTIFIC SCIMED, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: CIULLA, Ronald, GODDARD, James M.
Publication of US20140257026A1 publication Critical patent/US20140257026A1/en
Priority to US15/842,156 priority patent/US10603030B2/en
Abandoned legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • 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
    • A61F2/0045—Support slings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0412—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors having anchoring barbs or pins extending outwardly from suture anchor body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0414—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors having a suture-receiving opening, e.g. lateral opening
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0417—T-fasteners
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/044—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors with a threaded shaft, e.g. screws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0448—Additional elements on or within the anchor
    • A61B2017/045—Additional elements on or within the anchor snug fit within the anchor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0448—Additional elements on or within the anchor
    • A61B2017/0453—Additional elements on or within the anchor threaded elements, e.g. set screws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0464—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors for soft tissue

Definitions

  • This disclosure relates generally to medical devices and more particularly to implants configured to provide support within a body of a patient and methods for securing such implants with the body of the patient.
  • a variety of medical procedures are performed to provide support to portions of a body of a patient. For example, some medical procedures are performed to treat various female pelvic dysfunctions, including procedures to treat urinary incontinence, and correcting various prolapse conditions such as uterine prolapse, cystoceles, rectoceles, and vaginal vault prolapse. Additionally, some medical procedures are performed to treat various male pelvic dysfunctions, such as urinary incontinence.
  • a cystocele occurs when the bladder bulges into the vagina
  • a rectocele occurs when the rectum bulges into the vagina
  • a hysterocele occurs when the uterus descends into the vagina.
  • An enterocele small bowel prolapse
  • Implants can be delivered to a pelvic region through one or more vaginal incisions, and/or through exterior incisions in the patient.
  • Existing implants differ in many ways including size, shape, material, number and location of straps, and in the method in which they are delivered and placed within a pelvic region. Additionally, depending on the particular condition to be treated and the implant used, pelvic floor repair can require various fixation locations within a pelvic region. For example, an implant can be secured using a number of anchors disposed at various fixation points.
  • a medical device in one embodiment, includes a tissue anchor has a first portion and a second portion.
  • the tissue anchor is configured to be placed within bodily tissue of a patient.
  • the first portion of the tissue anchor includes an extension member configured to engage the bodily tissue to help retain the tissue anchor within the bodily tissue.
  • the first portion having an inner surface and defining a cavity.
  • the second portion of the tissue anchor has a helical ridge.
  • the helical ridge is configured to engage the inner surface of the first portion of the tissue anchor to movably couple the second portion of the tissue anchor to the first portion of the tissue anchor.
  • the medical device is a medical device that includes a size or a length that can be adjusted.
  • a medical device in another embodiment, includes an elongate member, a shaft member, and an actuator.
  • the elongate member has a proximal end portion and a distal end portion.
  • the elongate member defines a cavity.
  • the shaft member is at least partially disposed within the cavity of the elongate member.
  • the shaft member is configured to rotate with respect to the elongate member.
  • the actuator is operatively coupled to the shaft member and is configured to cause the shaft member to rotate with respect to the elongate member.
  • the medical device is a medical device that includes a size or a length that can be adjusted.
  • a method of placing a medical device within a body of a patient includes inserting a tissue anchor into the body of the patient, the tissue anchor having a first portion and second portion; and rotating the second portion of the tissue anchor with respect to the first portion of the tissue anchor.
  • FIG. 1 is a schematic illustration of a medical device according to an embodiment of the invention.
  • FIG. 2 is a top view of a medical device according to an embodiment of the invention.
  • FIG. 3 is a perspective view of an anchor of the medical device of FIG. 2 .
  • FIG. 4 is a side view of the anchor of FIG. 3 .
  • FIG. 5 is a perspective view of a first portion of the anchor of FIG. 3 .
  • FIG. 6 is a perspective view of the second portion of the anchor of FIG. 3 .
  • FIG. 7 is a top view of an implant according to an embodiment of the invention.
  • FIG. 8 is a side view of an insertion tool of the medical device of FIG. 2 .
  • FIG. 9 is a cross-sectional view of the insertion tool taken along line 9 - 9 of FIG. 8 .
  • FIG. 10 is a distal end view of the insertion tool of FIG. 8
  • FIG. 11 is a proximal end view of the insertion tool of FIG. 8 .
  • FIG. 12 is a top view of an implant according to an embodiment of the invention.
  • FIG. 13 is a side view of an anchor of the implant of FIG. 12 .
  • FIG. 14 is a schematic view of an implant disposed within a body of a patient.
  • FIG. 15 is a flow chart of a method according to an embodiment of the invention.
  • the implants are pelvic implants (e.g., posterior support implants, anterior support implants, total pelvic floor repair implants) and the delivery and placement of such implants within a pelvic region (also referred to herein as “pelvis”) of a patient.
  • An implant can be placed into the pelvic space of a patient and secured at any of several locations within the pelvic space to treat many different pelvic floor dysfunctions.
  • an implant can be secured to a sacrospinous ligament or a ureterosacral ligament for uterine preservation (e.g., if a prolapsed uterus is otherwise healthy, a hysterectomy is not preformed and the uterus is re-suspended with an implant), or for posterior support.
  • an implant can be secured to pubo-urethral tissue or an obturator muscle (e.g., internus or externus) or membrane (each also referred to herein as “obturator”) to treat, for example, incontinence.
  • an implant can be secured to a sacrospinous ligament or an arcus tendineus fascia pelvis (i.e., white line) (also referred to herein as “arcus tendineus”) for paravaginal repairs including, for example, cystoceles, rectoceles and enteroceles.
  • An implant can also be secured to various combinations of such locations.
  • a single implant or multiple implants can be used in a single procedure. In some applications, when multiple implants are used, support can be provided in desired areas and improved control of the direction of stretch or support of the implant can be achieved.
  • Various delivery devices, delivery aids, and methods are also described for delivering and securing an implant assembly within the patient. The implants and procedures described herein may be used in a female patient or a male patient.
  • An implant according to an embodiment of the invention can be implanted, for example, through a vaginal incision, in a retro-pubic direction (behind the pubic bone), in a pre-pubic direction (in front of the pubic bone).
  • an implant can be placed in the direction of other anatomical structures or tissues as desired.
  • a procedure to deploy a pelvic implant can include vaginal incisions, such as an anterior vaginal incision and/or an anterior vaginal incision.
  • a procedure may include an exterior incision.
  • implants can be delivered to various parts of the body of the patient using a variety of different method and delivery devices.
  • the implants and methods disclosed herein include pelvic floor implants, but the implants may be configured to be placed and methods may be used to place such implants in any portion of the body of the patient.
  • An implant can be delivered to a pelvic region of a patient using a variety of different delivery devices, only some examples of which are described herein.
  • FIG. 1 is a schematic illustration of a medical device or system 100 .
  • the medical device 100 includes an implant 110 and an insertion tool 150 .
  • the implant 110 has a support member 120 .
  • the support member 120 includes a first end portion 122 coupled to a first mesh carrier or anchor 130 and a second end portion 124 coupled to a second mesh carrier or anchor 140 .
  • the implant 110 is configured to be placed within a body of a patient to provide support to a portion of the body of the patient.
  • the support member 120 of the implant 110 is configured to be placed proximate or adjacent a bladder of a patient to provide support to the bladder of the patient.
  • the support member 120 of the implant is configured to support the urethera or bladder neck of a patient.
  • the support member 120 of the implant 110 is configured to be placed adjacent another portion of the body to provide support to another portion of the body.
  • the support member includes end portions 122 and 124 .
  • the implant 110 also includes mesh carriers or anchors 130 and 140 coupled to end portions 122 and 124 of the support member 120 .
  • the anchors 130 and 140 are directly coupled to the end portions 122 and 124 of the support member 120 .
  • a tether or suture is coupled between the end portions 122 and 124 and the anchors 130 and 140 .
  • Any known mechanism may be used to couple the anchors 130 and 140 to the support member 120 .
  • an adhesive may be used to couple the anchors 130 and 140 to the support member 120 .
  • the anchors 130 and 140 may surround and be frictionally coupled to the support member 120 .
  • the anchors 130 and 140 are configured to be disposed in bodily tissue and provide a support for implant 110 . Specifically, once disposed within bodily tissue, the anchors 130 and 140 are configured to help retain the implant 110 in place within a body of a patient. In some embodiments, the anchors 130 and 140 are configured to be disposed within pelvic tissue of a patient. In other embodiments, the anchors 130 and 140 are configured to be disposed in other bodily tissue, such as muscle tissue.
  • the anchors 130 and 140 include barbs or projections that are configured to help secure the anchors 130 and 140 in place within the bodily tissue. In some embodiments, the anchors 130 and 140 do not include any sort of structure for securing the anchors in place within the body of the patient.
  • the anchor 130 includes a first portion 132 and a second portion 134 .
  • the first end portion 122 of the support member 120 is coupled to the second portion 134 of the anchor 130 .
  • the second portion 134 of the anchor 130 is configured to move with respect to the first portion 132 of the anchor 130 .
  • the second portion 134 of the anchor 130 is configured to selectively move with respect to the first portion 132 of the anchor 130 .
  • the second portion 134 can be moved with respect to the first portion 132 of the anchor 130 to a desired location and then locked or fixed with respect to the first portion 132 of the anchor 130 (to no longer move with respect to the first portion 132 of the anchor 130 ).
  • the second portion 134 of the anchor 130 is configured to rotate with respect to the first portion 132 of the anchor 130 .
  • the second portion 134 of the anchor 130 moves with respect to the first portion 132 of the anchor 130 is a screw type manner.
  • the second portion of the anchor is configured to be selectively coupled to the first portion of the anchor via a different mechanism.
  • the second portion may be configured to be frictionally fit or coupled to the first portion.
  • tapered surfaces or clamping mechanisms may be used to selectively or movably couple the second portion of the anchor to the first portion of the anchor.
  • the anchor 130 may be disposed within the body of the patient.
  • the anchor may be placed within in bodily tissue such that a barb or other projection of the anchor 130 (such as a barb or other projection disposed on or extending from the first portion 132 of the anchor 130 ) engages body tissue to couple the anchor 130 to the bodily tissue.
  • the tension or location of the implant 110 may then be adjusted by moving the second portion 134 with respect to the first portion 132 of the anchor 130 .
  • the anchor 140 is a two part anchor (similar to anchor 130 ). In other embodiments, the anchor 140 is a one part anchor (or an anchor that does not include any portions that are configured to move with respect to each other).
  • the insertion tool 150 of the medical device 100 is configured to place the implant 110 into the body of the patient.
  • the insertion tool 150 is configured to engage the implant 110 and guide the implant into position within the body of the patient.
  • the insertion tool 150 is configured to engage the second portion 134 of the anchor 130 to deliver or guide the anchor 130 into place within the body of the patient.
  • the insertion tool 150 is configured to cause the second portion 134 of the anchor 130 to move with respect to the first portion 132 of the anchor 130 .
  • the insertion tool 150 may be used to place the second anchor 140 into the body of the patient.
  • a vaginal incision may be made and the implant 110 may be placed into the body of the patient through the vaginal incision.
  • the insertion tool 150 may be used to guide the implant 110 into the vaginal incision and to the appropriate location within the body of the patient.
  • the implant 110 is inserted into the body of the patient through a different bodily incision and the anchors 130 and 140 are placed using a different type of insertion tool.
  • the implant 110 may be formed of any biocompatible material.
  • the support member 120 is formed of a mesh material.
  • the support member 120 may be formed of Advantage® mesh or the PolyformTM synthetic mesh, both as sold by Boston Scientific Corporation.
  • in the support member 120 may be formed of a polymer material.
  • the material of the support member 120 allows for tissue in-growth to secure the implant 100 to the bodily tissue of the patient.
  • the mesh weight can be approximately between 15 g/cm 2 to 35 g/cm 2 (e.g., 20 g/cm 2 , 25 g/cm 2 , 30 g/cm 2 ). In other embodiments, the mesh weight can be greater than 35 g/cm 2 .
  • the support member 120 includes tangs to help retain the implant in place within the body of the patient.
  • the tang or tangs are configured to engage the bodily tissue surrounding the support member 120 help retain the implant 100 in place within the body of the patient.
  • the terms “tanged” or “tangs” as used herein mean roughened or jagged edges or areas, such as can result from cutting a woven or knit mesh material.
  • the anchors 130 and 140 may be formed of any biocompatible material.
  • the anchors 130 and 140 are formed of polypropylene or a bio-absorbable material.
  • FIG. 2 illustrates a medical device or system 200 according to an embodiment.
  • the medical device 200 includes an implant 210 and an insertion tool 250 .
  • the implant 210 has a support member 220 .
  • the support member 220 includes a first end portion 222 coupled to a first mesh carrier or anchor 230 and a second end portion 224 coupled to a second mesh carrier or anchor 240 .
  • the implant 210 is configured to be placed within a body of a patient to provide support to a portion of the body of the patient.
  • the support member 220 of the implant 210 is configured to be placed proximate or adjacent a bladder of a patient to provide support to the bladder of the patient.
  • the support member 220 of the implant is configured to support the urethera or bladder neck of a patient.
  • the support member 220 of the implant 210 is configured to be placed adjacent another portion of the body to provide support to another portion of the body.
  • the support member includes end portions 222 and 224 .
  • the implant 210 also includes mesh carriers or anchors 230 and 240 .
  • Anchor 230 is coupled to end portion 222 and anchor 240 is coupled to the end portion 224 .
  • the anchors 230 and 240 are directly coupled to the end portions 222 and 224 of the support member 220 .
  • a tether or suture 235 is coupled between the end portions 222 and the anchors 230 .
  • the tether or suture 235 is looped or threaded through the support member 220 and is looped around and tied to the anchor 230 .
  • Any other known mechanisms may be used to couple the anchors 230 and 240 to the support member 220 .
  • an adhesive may be used to couple the anchors 230 and 240 to the support member 220 .
  • the end portions 222 and 224 may surround and be frictionally coupled to the anchors 230 and 240 .
  • the anchor 230 and 240 are configured to be disposed in bodily tissue and provide a support for implant 210 . Specifically, once disposed within bodily tissue, the anchors 230 and 240 are configured to help retain the implant 210 in place within a body of a patient. In some embodiments, the anchors 230 and 240 are configured to be disposed within pelvic tissue of a patient. In other embodiments, the anchors 230 and 240 are configured to be disposed in other bodily tissue, such as muscle tissue.
  • the anchor 230 includes a barb or projection 231 disposed on or projecting from the first portion of the anchor 232 .
  • the anchor 240 includes also includes a barb or projection 241 projecting from the anchor 240 .
  • the anchors 230 and 240 do not include any barbs or projections for securing the anchors 230 and 240 in place within the body of the patient.
  • the anchor 230 includes a first portion 232 and a second portion 234 .
  • FIG. 3 is a perspective view of the anchor 230 .
  • FIG. 4 is a side view of the anchor 230 .
  • FIG. 5 is a perspective view of the first portion 232 of the anchor 230 .
  • FIG. 6 is a perspective view of the second portion 234 of the anchor 230 .
  • the first end portion 222 of the support member 220 is coupled to the second portion 234 of the anchor 230 (as described above).
  • the second portion 234 of the anchor 230 is configured to move with respect to the first portion 232 of the anchor 230 .
  • the second portion 234 of the anchor 230 moves with respect to the first portion 232 of the anchor 230 as a screw moves.
  • the second portion 234 of the anchor 230 includes a ridge (a helical ridge) 237 .
  • the first portion 232 of the anchor 230 defines a lumen 239 .
  • the lumen 239 is configured to receive the first portion 232 of the anchor 230 and has a sidewall that defines a groove (a helical groove) 238 .
  • the helical groove 238 is configured to receive the helical ridge 237 of the second portion 234 of the anchor 230 .
  • the helical groove 238 and the helical ridge 237 interact to selectively move the second portion 234 of the anchor 230 with respect to the first portion 232 of the anchor 230 .
  • the second portion 234 of the anchor 230 may be rotated with respect to the first portion 232 of the anchor 230 to move the second portion 234 longitudinally with respect to the first portion 232 of the anchor 230 .
  • a proximal end 241 of the second portion 234 of the anchor 230 defines a recess or slot 243 .
  • the recess 243 is configured to receive a portion of the delivery tool 250 to allow for the coupling or engaging of the delivery tool 250 with the anchor 230 and to allow for the rotation of the second portion 234 of the anchor 230 with respect to the first portion 232 of the anchor 230 .
  • the recess 243 is star or “t” shaped. In other embodiments, the recess 243 has a different shape.
  • the anchor 230 may be disposed within the body of the patient.
  • the anchor may be placed within in bodily tissue such that the barb or projection 231 of the anchor 230 engages body tissue to couple the anchor 230 to the bodily tissue.
  • the tension of the implant 210 (or the location of the support member 220 ) may then be adjusted by moving the second portion 234 with respect to the first portion 232 of the anchor 230 .
  • the second anchor 240 is a one part anchor (or an anchor that does not include any portions that are configured to move with respect to each other). In other embodiments, the second anchor 240 is a two part anchor and is structurally and functionally similar to the first anchor 230 .
  • the implant 210 may be formed of any biocompatible material.
  • the support member 220 is formed of a mesh material.
  • the support member 220 may be formed of Advantage® mesh or the PolyformTM synthetic mesh, both as sold by Boston Scientific Corporation.
  • in the support member 220 may be formed of a polymer material.
  • the material of the support member 220 allows for tissue in-growth to secure the implant 200 to the bodily tissue of the patient.
  • the support member 220 includes tangs to help retain the implant in place within the body of the patient.
  • the tang or tangs are configured to engage the bodily tissue surrounding the support member 220 help retain the implant 200 in place within the body of the patient.
  • the terms “tanged” or “tangs” as used herein mean roughened or jagged edges or areas, such as can result from cutting a woven or knit mesh material.
  • FIG. 7 is a top view of an implant 310 according to another embodiment.
  • the implant 320 includes tangs or projections 348 that extend from the support member 320 of the implant (such as the rough or jagged edges of a cut mesh material).
  • the tangs 348 are configured to engage bodily tissue when the implant 310 is disposed within the body to help retain the implant 310 in place within the body of the patient.
  • the support member 320 of the implant 310 includes a tapered end portion 322 .
  • the tapered end portion 322 is directly coupled to the anchor 330 .
  • the anchor 330 extends through a portion of the tapered end portion 322 to couple the anchor 330 to the tapered end portion 322 .
  • the tapered end portion 322 is coupled to the anchor 330 via another mechanism, such an adhesive or other mechanism.
  • the insertion tool 250 of the medical device 200 is configured to place the implant 210 into the body of the patient.
  • the insertion tool 250 is configured to engage the implant 210 and guide the implant into position within the body of the patient.
  • FIG. 8 is a side view of the insertion tool 250 .
  • FIG. 9 is a cross-sectional view of the insertion tool 250 taken along line 9 - 9 of FIG. 8 .
  • FIG. 10 is an end view of a distal tip of the insertion tool 250 .
  • FIG. 11 is an end view of the proximal end of the insertion tool 250 .
  • the insertion tool 250 is configured to engage the second portion 234 of the anchor 230 to deliver or guide the anchor 230 into place within the body of the patient.
  • the insertion tool 250 is configured to cause the second portion 234 of the anchor 230 to move with respect to the first portion 232 of the anchor 230 .
  • the insertion tool 250 may be used to place the second anchor 240 into the body of the patient.
  • the insertion tool 250 includes a handle portion 252 and a needle portion 254 .
  • the needle portion 254 has a tubular member 256 and a shaft or stylet 258 .
  • the tubular member 256 is coupled to the handle portion 252 .
  • the stylet 258 extends through a cavity or lumen defined by the tubular member 256 .
  • the stylet 258 has a proximal portion 261 that is disposed within the handle portion 252 and a distal portion 263 that disposed distally of the tubular member 256 .
  • the needle portion 254 is sized and shaped to allow a user to position the implant 210 within the body of the patient.
  • the needle portion 254 includes a slight curvature.
  • the needle portion 254 includes a larger curvature.
  • the needle portion 254 is linear or substantially linear.
  • the stylet 258 is configured to rotate along a longitudinal axis with respect to the tubular member 256 and the handle portion 252 .
  • the stylet 258 is operatively coupled to an actuation member 259 that is disposed within a window or opening 257 defined by the handle portion 252 of the insertion tool 250 .
  • a user my grasp the handle portion 252 of the insertion tool 250 and move or rotate the actuation member 259 to rotate the stylet 258 with respect to the tubular member 256 .
  • the actuation member 259 is disposed below the outer surface of the handle portion 252 of the insertion member 250 .
  • a user inserts a finger or a portion of a finger into the opening defined by the handle portion 252 of the insertion tool 250 to access and move the actuation member 259 with respect to the handle portion 252 . In some embodiments, this helps prevent unintentional movement of the actuation member 259 .
  • the actuation member 259 , or a portion of the actuation member 259 extends above an outer surface of the handle portion 252 .
  • the distal tip 263 of the insertion tool 250 is configured to engage the anchors 230 and 240 to place or push the anchors 230 and 240 into place within the body of the patient.
  • the distal tip 263 is “t” or star shaped.
  • the distal tip 263 is configured to mate with and engage the recess 243 of the anchor 230 .
  • the distal tip 263 is sized and shaped to frictionally couple (or operatively couple) within the recess 243 of the anchor 230 .
  • the user of the insertion tool 250 may rotate the actuation member 259 to rotate the stylet 258 and cause the second portion 234 of the anchor 230 to rotate with respect to the first portion 232 of the anchor 230 .
  • the second portion 234 of the anchor 230 rotates with respect to the first portion 232 of the anchor 230
  • the second portion 234 of the anchor 230 will move longitudinally with respect to the first portion 232 of the anchor 230 .
  • a vaginal incision may be made and the implant 210 may be placed into the body of the patient through the vaginal incision.
  • the insertion tool 250 may be used to guide the implant 210 into the vaginal incision and to the appropriate location within the body of the patient.
  • the insertion tool 250 may be used to insert and place the anchor 240 through the vaginal incision and into place within the body of the patient.
  • the insertion tool 250 may then be engaged with the anchor (by inserting the tip of the insertion tool 250 into the recess of the anchor 230 ) and used to insert and place the anchor 230 through the vaginal incision and into place with the body of the patient.
  • the support member may be placed below are proximate the portion of the body to be supported (such as a bladder or a urethera of a patient).
  • the insertion tool 250 can be used to move the second portion 234 of the anchor 230 with respect to the first portion 232 of the anchor 230 .
  • actuation member 259 may be rotated or moved by the user to move the second portion 234 of the anchor 230 with respect to the first portion of the anchor 230 (as described in detail above).
  • FIG. 12 is a top view of an implant 410 according to an embodiment.
  • the implant 410 has a support member 420 .
  • the support member 420 includes a first end portion 422 coupled to a first mesh carrier or anchor 430 and a second end portion 424 coupled to a second mesh carrier or anchor 440 .
  • the first end portion 422 is coupled to the first anchor 430 via a suture or tether 435 .
  • One end of the suture or tether 435 is coupled to the first end portion 422 of the implant 420 .
  • Any coupling method may be used to couple the end portion 436 of the suture or tether 435 to the first end portion 422 of the implant 420 .
  • the suture or tether 435 may be tied or looped through a portion of the first end portion 422 .
  • an adhesive may be used to couple the suture or tether 435 to the first end portion 422 .
  • the suture or tether 435 extends through an opening 449 defined by the anchor 430 .
  • FIG. 13 is a side view of the anchor 430 .
  • the opening 449 defines an axis that is offset from the longitudinal axis (or disposed at an angle with respect to the longitudinal axis) of the anchor 430 .
  • the axis of the opening or lumen 449 is disposed orthogonally or perpendicularly to the longitudinal axis of the anchor 430 .
  • the anchor 430 includes a first portion 432 and a second portion 434 .
  • the second portion 434 of the anchor 430 is configured to move with respect to the first portion 432 of the anchor 430 .
  • the second portion 434 of the anchor 430 moves with respect to the first portion 432 of the anchor 430 as a screw moves.
  • the second portion 434 of the anchor 430 includes a ridge (a helical ridge) 437 .
  • the first portion 432 of the anchor 430 defines a lumen 439 .
  • the lumen 439 is configured to receive the first portion 432 of the anchor 430 and has a sidewall that defines a groove (a helical groove).
  • the helical groove is configured to receive the helical ridge 437 of the second portion 434 of the anchor 430 .
  • the helical groove and the helical ridge 237 interact to selectively move the second portion 434 of the anchor 430 with respect to the first portion 432 of the anchor 430 .
  • the second portion 434 of the anchor 430 may be rotated with respect to the first portion 432 of the anchor 430 to move the second portion 434 longitudinally with respect to the first portion 432 of the anchor 430 .
  • a proximal end 441 of the second portion 434 of the anchor 430 defines a recess or slot.
  • the recess is configured to receive a portion of a delivery tool (such as delivery tool 250 ) to allow for the coupling or engaging of the delivery tool with the anchor 430 and to allow for the rotation of the second portion 434 of the anchor 430 with respect to the first portion 432 of the anchor 430 .
  • the suture 435 extends through the opening 449 defined by the anchor 430 .
  • the opening 449 is defined by the first portion 432 of the anchor 430 .
  • the suture 435 extends through the opening 449 and may move within the opening. Accordingly, the length of the implant between the anchors 430 and 440 may be adjusted by pulling the suture 435 through the opening 449 to a different location.
  • the second portion 434 of the anchor 430 may be moved to a second position (toward the first portion 432 of the anchor 430 ) to lock the suture 435 in place with respect to the anchor 430 .
  • the second portion 434 of the anchor 430 moves towards the first portion 432 of the anchor 430 to trap or frictionally engage or couple the suture 435 in place within the opening 449 .
  • the anchor 440 may be placed within the body of the patient.
  • Anchor 430 may then be placed with the second portion 434 of the anchor 430 in its first position.
  • the implant 420 may be positioned under a bodily portion to be supported (such as the bladder or bladder neck).
  • the suture 435 may then be pulled or adjusted to move the suture 435 within the opening 449 of the anchor 440 and set the tension of the implant 410 and/or the length of the implant 410 between the anchors 430 and 440 .
  • the second portion 434 of the anchor 430 may be moved towards the first portion 432 of the anchor 430 to frictionally couple the suture 435 to the anchor 430 .
  • the suture 435 has a length sufficient to extend through the opening 449 and out of the body of the patient when the anchor 430 is placed within the body of the patient.
  • the suture 435 has a length to extend from a vaginal incision of the patient when the anchor 430 is disposed within the body of the patient.
  • FIG. 14 illustrates the implant 210 disposed within a pelvic region of a female patient.
  • the support member 220 is disposed adjacent a portion of a bladder B of the patient and the anchors 230 and 240 are disposed in pelvic tissue.
  • FIG. 15 is a flow chart of a method 500 according to an embodiment.
  • the method includes at 510 inserting a tissue anchor into a body of a patient.
  • the tissue anchor includes a first portion and a second portion that is configured to move with respect to the first portion.
  • the second portion of the tissue anchor is adjusted with respect to the first portion of the tissue anchor.
  • the second portion of the tissue anchor is rotated with respect to the first portion of the tissue anchor.
  • the rotation of the second portion of the tissue anchor with respect to the first portion of the tissue anchor includes engaging a shaft or a stylet with the second portion of the tissue anchor.
  • the shaft or stylet is engaged with the second portion of the tissue anchor by inserting a tip or end portion of the shaft or stylet into a recess or slot defined by the second portion of the tissue anchor.
  • the method 500 includes inserting a second tissue anchor into the body of the patient.
  • a sling or support member extends from the first tissue anchor to the second tissue anchor.
  • a medical device in some embodiments, includes a tissue anchor having a first portion and a second portion.
  • the tissue anchor is configured to be placed within bodily tissue of a patient.
  • the first portion of the tissue anchor includes an extension member configured to engage the bodily tissue to help retain the tissue anchor within the bodily tissue.
  • the first portion has an inner surface and defining a cavity.
  • the second portion of the tissue anchor has a helical ridge. The helical ridge is configured to engage the inner surface of the first portion of the tissue anchor to movably couple the second portion of the tissue anchor to the first portion of the tissue anchor.
  • the extension member is a barb member.
  • the inner surface of the first portion defines a helical groove.
  • the helical ridge of the second portion of the tissue anchor is configured to engage the helical groove of the inner surface of the second portion of the tissue anchor.
  • the medical device includes an implant coupled to the tissue anchor.
  • the tissue anchor is a first tissue anchor and the device further includes an implant having a first end portion and a second end portion opposite the first end portion.
  • the first end portion is coupled to the first tissue anchor.
  • the second end portion is coupled to a second tissue anchor.
  • the second portion of the tissue anchor is configured to rotate with respect to first portion of the tissue anchor.
  • the second portion of the tissue anchor includes an engagement portion configured to engage an insertion device.
  • the second portion of the tissue anchor includes a slot configured to engage an insertion device.
  • the first portion of the tissue anchor defines a longitudinal axis.
  • the first portion of the tissue anchor defines a lumen defining a longitudinal axis.
  • the longitudinal axis of the first portion of the tissue anchor is offset from the longitudinal axis of the lumen.
  • the first portion of the tissue anchor defines a longitudinal axis.
  • the first portion of the tissue anchor defines a lumen defines a longitudinal axis.
  • the longitudinal axis of the first portion of the tissue anchor is disposed at an angle with respect to the longitudinal axis of the lumen.
  • a medical device in some embodiments, includes an elongate member having a proximal end portion and a distal end portion, a shaft member, and an actuator.
  • the elongate member defines a cavity.
  • the shaft member is at least partially disposed within the cavity of the elongate member.
  • the shaft member is configured to rotate with respect to the elongate member.
  • the actuator is operatively coupled to the shaft member and configured to cause the shaft member to rotate with respect to the elongate member.
  • a portion of the shaft member extends from the distal end portion of the elongate member. In some embodiments, a portion of the shaft member extends from the distal end portion of the elongate member and a portion of the actuator extends from a sidewall of the proximal end portion. In some embodiments, the actuator is configured to rotate with respect to the elongate member. In some embodiments, the actuator is configured to rotate with respect to the elongate member and at least a portion of the actuator extends from a sidewall of the proximal end portion. In some embodiments, the shaft member includes a tip that is configured to engage a tissue anchor.
  • a method of placing a medical device within a body of a patient includes inserting a tissue anchor into the body of the patient, the tissue anchor having a first portion and second portion; and adjusting the second portion of the tissue anchor with respect to the first portion of the tissue anchor.
  • the adjusting is a rotating and the rotating the second portion of the tissue anchor with respect to the first portion of the tissue anchor includes engaging the second portion of the tissue anchor with an insertion device that includes a shaft that is rotatably disposed within a cavity of an elongate member.
  • the rotating the second portion of the tissue anchor with respect to the first portion of the tissue anchor includes engaging a projection of a shaft of an insertion device with a slot defined by the second portion of the tissue anchor.
  • the tissue anchor is a first tissue anchor and the method further includes inserting a second tissue anchor into the body of the patient, the second tissue anchor being coupled to a sling member.

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US14/195,599 2013-03-08 2014-03-03 Adjustable implants and methods of implanting the same Abandoned US20140257026A1 (en)

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PCT/US2014/020383 WO2014138104A2 (fr) 2013-03-08 2014-03-04 Implants réglables et leurs procédés d'implantation
US15/842,156 US10603030B2 (en) 2013-03-08 2017-12-14 Adjustable implants and methods of implanting the same

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
ITUA20163503A1 (it) * 2016-05-17 2017-11-17 Herniamesh S R L Dispositivo utilizzabile nel trattamento chirurgico di disfunzioni uroginecologiche.
US10603030B2 (en) 2013-03-08 2020-03-31 Boston Scientific Scimed, Inc. Adjustable implants and methods of implanting the same

Families Citing this family (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7758594B2 (en) 2005-05-20 2010-07-20 Neotract, Inc. Devices, systems and methods for treating benign prostatic hyperplasia and other conditions
US9504461B2 (en) 2005-05-20 2016-11-29 Neotract, Inc. Anchor delivery system
US10195014B2 (en) 2005-05-20 2019-02-05 Neotract, Inc. Devices, systems and methods for treating benign prostatic hyperplasia and other conditions
US10130353B2 (en) 2012-06-29 2018-11-20 Neotract, Inc. Flexible system for delivering an anchor
EP3727171B1 (fr) 2017-12-23 2023-06-07 Teleflex Life Sciences Limited Appareil de mise en prise de tissu extensible
WO2020096827A1 (fr) 2018-11-07 2020-05-14 Neotract, Inc. Système d'administration d'un marqueur de repère
WO2021168057A1 (fr) 2020-02-21 2021-08-26 Neotract, Inc. Appareil pour empêcher un problème de déploiement de dispositif
JP7296522B2 (ja) 2020-08-03 2023-06-22 テレフレックス ライフ サイエンシズ リミテッド 医学的介入のためのハンドルカートリッジシステム

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6149653A (en) * 1997-09-05 2000-11-21 Deslauriers; Richard J. Self-retaining anchor track and method of making and using same
US20060265042A1 (en) * 2005-05-20 2006-11-23 Exploramed Nc2, Inc. Devices, systems and methods for retracting, lifting, compressing, supporting or repositioning tissues or anatomical structures
US20070021649A1 (en) * 2005-07-25 2007-01-25 Boston Scientific Scimed, Inc Elastic sling system and related methods
US20090112270A1 (en) * 2007-10-25 2009-04-30 Smith & Nephew, Inc. Anchor Assembly
US20100191045A1 (en) * 2009-01-05 2010-07-29 Caldera Medical,Inc. Implants And Procedures For Supporting Anatomical Structures For Treating Conditions Such As Pelvic Organ Prolapse
US20100197998A1 (en) * 2006-10-18 2010-08-05 Coloplast A/S Implant for the treatment of incontinence and method of using the same

Family Cites Families (13)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0596829B1 (fr) * 1992-11-02 2000-11-22 Sulzer Orthopädie AG Ancrage pour ligament synthétique
US6162234A (en) * 1993-03-23 2000-12-19 Freedland; Yosef Adjustable button cinch anchor orthopedic fastener
US6019762A (en) * 1998-04-30 2000-02-01 Orthodyne, Inc. Adjustable length orthopedic fixation device
US20070005068A1 (en) * 2005-02-07 2007-01-04 Sklar Joseph H Knotless suture anchor
US7931660B2 (en) * 2007-05-10 2011-04-26 Tyco Healthcare Group Lp Powered tacker instrument
US8454654B2 (en) * 2007-12-13 2013-06-04 Smith & Nephew, Inc. Anchoring system
US20100106254A1 (en) * 2008-10-23 2010-04-29 Delsignore Jeanne L Surgical implantable stabilizer sling for basal joint arthroplasty
US20100262185A1 (en) * 2009-04-10 2010-10-14 Suspension Orthopaedic Solutions, Llc Method and apparatus for aperture fixation by securing flexible material with a knotless fixation device
EP2429411B1 (fr) * 2009-05-12 2017-03-08 The Foundry, LLC Dispositifs de traitement d'un tissu musculo-squelettique malade ou lésé
BR112012010998A2 (pt) * 2009-11-10 2016-04-12 Smith & Nephew Inc conjunto de ancoragem de sutura com travamento
WO2011059995A2 (fr) * 2009-11-10 2011-05-19 Smith & Nephew, Inc. Dispositifs de réparation de tissus
US9402615B2 (en) * 2010-08-05 2016-08-02 Boston Scientific Scimed, Inc. Adjustable implants and methods of implanting the same
US20140257026A1 (en) 2013-03-08 2014-09-11 Boston Scientific Scimed, Inc. Adjustable implants and methods of implanting the same

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6149653A (en) * 1997-09-05 2000-11-21 Deslauriers; Richard J. Self-retaining anchor track and method of making and using same
US20060265042A1 (en) * 2005-05-20 2006-11-23 Exploramed Nc2, Inc. Devices, systems and methods for retracting, lifting, compressing, supporting or repositioning tissues or anatomical structures
US20070021649A1 (en) * 2005-07-25 2007-01-25 Boston Scientific Scimed, Inc Elastic sling system and related methods
US20100197998A1 (en) * 2006-10-18 2010-08-05 Coloplast A/S Implant for the treatment of incontinence and method of using the same
US20090112270A1 (en) * 2007-10-25 2009-04-30 Smith & Nephew, Inc. Anchor Assembly
US20100191045A1 (en) * 2009-01-05 2010-07-29 Caldera Medical,Inc. Implants And Procedures For Supporting Anatomical Structures For Treating Conditions Such As Pelvic Organ Prolapse

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US10603030B2 (en) 2013-03-08 2020-03-31 Boston Scientific Scimed, Inc. Adjustable implants and methods of implanting the same
ITUA20163503A1 (it) * 2016-05-17 2017-11-17 Herniamesh S R L Dispositivo utilizzabile nel trattamento chirurgico di disfunzioni uroginecologiche.
WO2017199152A1 (fr) * 2016-05-17 2017-11-23 Herniamesh S.R.L. Dispositif pour utilisation dans le traitement chirurgical de troubles uro-gynécologiques

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US10603030B2 (en) 2020-03-31
WO2014138104A2 (fr) 2014-09-12
WO2014138104A3 (fr) 2014-11-13

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