Methods and systems for treatment of prolapse
View Patent ↗Described are implants, tools, and related methods, for use in pelvic surgery to treat conditions such as prolapse, including embodiments of methods that involve a tissue path above the arcus tendineus.
1. A method of supporting posterior vaginal tissue, the method comprising:
providing an implant comprising a tissue support portion and an extension portion extending from the tissue support portion,
creating an incision,
contacting the support portion with posterior vaginal tissue,
producing a tissue path that passes between a position of the tissue support portion and a region of an arcus tendineus, wherein the region of the arcus tendineus comprises a region from 2 centimeters above the arcus tendineus to 2 centimeters below the arcus tendineus and between an ischial spine and a distance 3 centimeters anterior to the ischial spine,
wherein the tissue path passes below the arcus tendineus through an iliococcygeus muscle, wraps around the arcus tendineus to a location above the arcus tendineus, through an obturator internus muscle, and back to a region of the pelvic floor, and
extending the extension portion through the tissue path.
2. The method of claim 1 , comprising treating a condition selected from the group consisting of enterocele, rectocele, apical prolapse, and vault prolapse.
3. The method of claim 1 , wherein the region of the arcus tendineus further includes the region between the arcus tendineus and 1 centimeter above the arcus tendineus, and between the ischial spine and a distance 1 centimeter anterior to the ischial spine.
4. The method of claim 1 , wherein a distal end of the extension portion is sutured to the pelvic floor.
5. The method of claim 1 , wherein the tissue path does not extend to an external incision.
6. The method of claim 1 , wherein the extension portion is passed through an external incision.
7. The method of claim 1 , wherein an incision is a perirectal incision.
8. A pelvic implant assembly comprising an implant and an insertion tool,
the implant comprising
a tissue support portion,
elongate extension portions extending from the tissue support portion, and
a dilator located at a distal end of each elongate extension portion, the dilator comprising a curve having a radius of curvature in the range of from 0.5-1.5 centimeters, a sharp tip at a distal end, and an opening at a proximal end, the opening designed and adapted to fit and removably engage a distal end of the insertion tool.
9. The pelvic implant assembly of claim 8 , wherein the implant is a mesh strip.
10. The pelvic implant assembly of claim 8 , wherein the implant has a length sufficient to extend from a region of an arcus tendineus on a first side of a patient to a region of an arcus tendineus on a second side of the patient.
11. The pelvic implant assembly of claim 8 , wherein the tissue support portion has a width greater than a width of the extension portions.
12. The pelvic implant assembly of claim 8 , wherein the implant includes a removable sheath that can cover one of the extension portions.
13. The pelvic implant assembly of claim 8 , wherein the insertion tool comprises a handle and a longitudinally extending shaft, wherein a proximal end of the extending shaft extends from the handle and a distal end of the extending shaft comprises a radius of curvature.
14. The pelvic implant assembly of claim 13 , wherein the dilator has a radius of curvature that matches the radius of curvature of the insertion tool.
15. The pelvic implant assembly of claim 13 , wherein the insertion tool is configured to push the dilator through tissue.
16. The pelvic implant assembly of claim 8 , wherein the insertion tool comprises a substantially straight shaft.
17. The pelvic implant assembly of claim 8 , wherein the insertion tool comprises a curved distal end, the curved portion comprising a radius of curvature in the range of from 0.5-1.5 centimeters.
18. A pelvic implant assembly comprising an implant and a first and second insertion tools,
the implant comprising
a tissue support portion,
a first elongate extension portion extending from an end of the tissue support portion and a second elongate extension portion extending from an opposite end of the tissue support portion, and
a first dilator located at a distal end of the first extension portion and a second dilator located at a distal end of the second extension portion, each dilator comprising a sharp tip at a distal end and an opening at a proximal end, the opening designed and adapted to engage a distal end of the first and second insertion tools; and wherein
each insertion tool comprises a shaft, a handle, and a curved distal end, the curved distal end comprising a radius of curvature in the range of from 0.5-1.5 centimeters, and the curved distal end being capable of engaging one of the dilators and pushing the dilator through tissue.
19. The pelvic implant assembly of claim 18 comprising a first suture extending along a length of the first extension portion and a second suture extending along a length of the second extension portion.