US20080039894A1 - Devices, systems and methods for retracting, lifting, compressing, supporting or repositioning tissues or anatomical structures - Google Patents

Abstract

Devices, systems and methods for retracting, lifting, compressing, supporting or repositioning tissues, organs, anatomical structures, grafts or other structures within the body of human or animal subjects for the purpose of treating a diseases or disorders and/or for cosmetic or reconstructive purposes and/or for research and development purposes or other purposes.

Description

RELATED APPLICATIONS
• This application is a continuation-in-part of copending U.S. patent application Ser. No. 11/134,870 entitled Devices, Systems and Methods for Treating Benign Prostatic Hyperplasia and Other Conditions, filed on May 20, 2005, the entire disclosure of which is expressly incorporated herein by reference.
FIELD OF THE INVENTION
• The present invention relates generally to medical devices and methods, and more particularly to systems and methods for retracting, lifting, compressing, supporting or repositioning tissues, organs, anatomical structures, grafts or other structures within the body of human or animal subjects for the purpose of treating a diseases or disorders and/or for cosmetic or reconstructive purposes and/or for research and development purposes or other purposes.
BACKGROUND OF THE INVENTION
• There are a wide variety of situations in which it is desirable to lift, compress or otherwise reposition normal or aberrant tissues or anatomical structures (e.g., organs, ligaments, tendons, muscles, tumors, cysts, fat pads, etc.) within the body of a human or animal subject. Such procedures are often carried out for the purpose of treating or palliating the effects of diseases or disorders (e.g., hyperplasic conditions, hypertrophic conditions, neoplasias, prolapses, herniations, stenoses, constrictions, compressions, transpositions, congenital malformations, etc.) and/or for cosmetic purposes (e.g., face lifts, breast lifts, brow lifts, etc.) and/or for research and development purposes (e.g., to create animal models that mimic various pathological conditions). In many of these procedures, surgical incisions are made in the body and laborious surgical dissection is performed to access and expose the affected tissues or anatomical structures. Thereafter, in some cases, the affected tissues or anatomical structures are removed or excised. In other cases, various natural or man made materials are used to lift, sling, reposition or compress the affected tissues.
• Benign Prostatic Hyperplasia (BPH)
• One example of a condition where it is desirable to lift, compress or otherwise remove a pathologically enlarged tissue is Benign Prostatic Hyperplasia (BPH). BPH is one of the most common medical conditions that affect men, especially elderly men. It has been reported that, in the United Sates, more than half of all men have histopathologic evidence of BPH byage 60 and, by age 85, approximately 9 out of 10 men suffer from the condition. Moreover, the incidence and prevalence of BPH are expected to increase as the average age of the population in developed countries increases.
• The prostate gland enlarges throughout a man's life. In some men, the prostatic capsule around the prostate gland may prevent the prostate gland from enlarging further. This causes the inner region of the prostate gland to squeeze the urethra. This pressure on the urethra increases resistance to urine flow through the region of the urethra enclosed by the prostate. Thus the urinary bladder has to exert more pressure to force urine through the increased resistance of the urethra. Chronic over-exertion causes the muscular walls of the urinary bladder to remodel and become stiffer. This combination of increased urethral resistance to urine flow and stiffness and hypertrophy of urinary bladder walls leads to a variety of lower urinary tract symptoms (LUTS) that may severely reduce the patient's quality of life. These symptoms include weak or intermittent urine flow while urinating, straining when urinating, hesitation before urine flow starts, feeling that the bladder has not emptied completely even after urination, dribbling at the end of urination or leakage afterward, increased frequency of urination particularly at night, urgent need to urinate etc.
• In addition to patients with BPH, LUTS may also be present in patients with prostate cancer, prostate infections, and chronic use of certain medications (e.g. ephedrine, pseudoephedrine, phenylpropanolamine, antihistamines such as diphenhydramine, chlorpheniramine etc.) that cause urinary retention especially in men with prostate enlargement.
• Although BPH is rarely life threatening, it can lead to numerous clinical conditions including urinary retention, renal insufficiency, recurrent urinary tract infection, incontinence, hematuria, and bladder stones.
• In developed countries, a large percentage of the patient population undergoes treatment for BPH symptoms. It has been estimated that by the age of 80 years, approximately 25% of the male population of the United States will have undergone some form of BPH treatment. At present, the available treatment options for BPH include watchful waiting, medications (phytotherapy and prescription medications), surgery and minimally invasive procedures.
• For patients who choose the watchful waiting option, no immediate treatment is provided to the patient, but the patient undergoes regular exams to monitor progression of the disease. This is usually done on patients that have minimal symptoms that are not especially bothersome.
• Medications for treating BPH symptoms include phytotherapy and prescription medications. In phytotherapy, plant products such as Saw Palmetto, African Pygeum, Serenoa Repens (sago palm) and South African star grass are administered to the patient. Prescription medications are prescribed as first line therapy in patients with symptoms that are interfering with their daily activities. Two main classes of prescription medications are alpha-1a-adrenergic receptors blockers and 5-alpha-reductase inhibitors. Alpha-1a-adrenergic receptors blockers block that activity of alpha-1a-adrenergic receptors that are responsible for causing constriction of smooth muscle cells in the prostate. Thus, blocking the activity of alpha-1a-adrenergic receptors causes prostatic smooth muscle relaxation. This in turn reduces urethral resistance thereby reducing the severity of the symptoms. 5-alpha-reductase inhibitors block the conversion of testosterone to dihydrotestosterone. Dihydrotestosterone causes growth of epithelial cells in the prostate gland. Thus 5-alpha-reductase inhibitors cause regression of epithelial cells in the prostate gland and hence reduce the volume of the prostate gland which in turn reduces the severity of the symptoms.
• Surgical procedures for treating BPH symptoms include Transurethral Resection of Prostate (TURP), Transurethral Electrovaporization of Prostate (TVP), Transurethral Incision of the Prostate (TUIP), Laser Prostatectomy and Open Prostatectomy.
• Transurethral Resection of Prostate (TURP) is the most commonly practiced surgical procedure implemented for the treatment of BPH. In this procedure, prostatic urethral obstruction is reduced by removing most of the prostatic urethra and a sizeable volume of the surrounding prostate gland. This is carried out under general or spinal anesthesia. In this procedure, a urologist visualizes the urethra by inserting a resectoscope, that houses an optical lens in communication with a video camera, into the urethra such that the distal region of the resectoscope is in the region of the urethra surrounded by the prostate gland. The distal region of the resectoscope consists of an electric cutting loop that can cut prostatic tissue when an electric current is applied to the device. An electric return pad is placed on the patient to close the cutting circuit. The electric cutting loop is used to scrape away tissue from the inside of the prostate gland. The tissue that is scraped away is flushed out of the urinary system using an irrigation fluid. Using a coagulation energy setting, the loop is also used to cauterize transected vessels during the operation.
• Another example of a surgical procedure for treating BPH symptoms is Transurethral Electrovaporization of the Prostate (TVP). In this procedure, a part of prostatic tissue squeezing the urethra is desiccated or vaporized. This is carried out under general or spinal anesthesia. In this procedure, a resectoscope is inserted transurethrally such that the distal region of the resectoscope is in the region of the urethra surrounded by the prostate gland. The distal region of the resectoscope consists of a rollerball or a grooved roller electrode. A controlled amount of electric current is passed through the electrode. The surrounding tissue is rapidly heated up and vaporized to create a vaporized space. Thus the region of urethra that is blocked by the surrounding prostate gland is opened up.
• Another example of a surgical procedure for treating BPH symptoms is Transurethral Incision of the Prostate (TUIP). In this procedure, the resistance to urine flow is reduced by making one or more incisions in the prostrate gland in the region where the urethra meets the urinary bladder. This procedure is performed under general or spinal anesthesia. In this procedure, one or more incisions are made in the muscle of the bladder neck, which is the region where the urethra meets the urinary bladder. The incisions are in most cases are deep enough to cut the surrounding prostate gland tissue including the prostatic capsule. This releases any compression on the bladder neck and causes the bladder neck to spring apart. The incisions can be made using a resectoscope, laser beam etc.
• Another example of a surgical procedure for treating BPH symptoms is Laser Prostatectomy. Two common techniques used for Laser Prostatectomy are Visual Laser Ablation of the Prostate (VLAP) and the Holmium Laser Resection/Enucleation of the Prostate (HoLEP). In VLAP, a neodymium:yttrium-aluminum-garnet (Nd:YAG) laser is used to ablate tissue by causing coagulation necrosis. The procedure is performed under visual guidance. In HoLEP, a holmium: Yttrium-aluminum-garnet laser is used for direct contact ablation of tissue. Both these techniques are used to remove tissue obstructing the urethral passage to reduce the severity of BPH symptoms.
• Another example of a surgical procedure for treating BPH symptoms is Photoselective Vaporization of the Prostate (PVP). In this procedure, laser energy is used to vaporize prostatic tissue to relieve obstruction to urine flow in the urethra. The type of laser used is the Potassium-Titanyl-Phosphate (KTP) laser. The wavelength of this laser is highly absorbed by oxyhemoglobin. This laser vaporizes cellular water and hence is used to remove tissue that is obstructing the urethra.
• Another example of a surgical procedure for treating BPH symptoms is Open Prostatectomy. In this procedure, the prostate gland is surgically removed by an open surgery. This is done under general anesthesia. The prostate gland is removed through an incision in the lower abdomen or the perineum. The procedure is used mostly in patients that have a large (greater than approximately 100 grams) prostate gland.
• Minimally invasive procedures for treating BPH symptoms include Transurethral Microwave Thermotherapy (TUMT), Transurethral Needle Ablation (TUNA), Interstitial Laser Coagulation (ILC), and Prostatic Stents.
• In Transurethral Microwave Thermotherapy (TUMT), microwave energy is used to generate heat that destroys hyperplastic prostate tissue. This procedure is performed under local anesthesia. In this procedure, a microwave antenna is inserted in the urethra. A rectal thermosensing unit is inserted into the rectum to measure rectal temperature. Rectal temperature measurements are used to prevent overheating of the anatomical region. The microwave antenna is then used to deliver microwaves to lateral lobes of the prostate gland. The microwaves are absorbed as they pass through prostate tissue. This generates heat which in turn destroys the prostate tissue. The destruction of prostate tissue reduces the degree of squeezing of the urethra by the prostate gland thus reducing the severity of BPH symptoms.
• Another example of a minimally invasive procedure for treating BPH symptoms is Transurethral Needle Ablation (TUNA). In this procedure, heat induced coagulation necrosis of prostate tissue regions causes the prostate gland to shrink. It is performed using local anesthetic and intravenous or oral sedation. In this procedure, a delivery catheter is inserted into the urethra. The delivery catheter comprises two radiofrequency needles that emerge at an angle of 90 degrees from the delivery catheter. The two radiofrequency needles are aligned at an angle of 40 degrees to each other so that they penetrate the lateral lobes of the prostate. A radiofrequency current is delivered through the radiofrequency needles to heat the tissue of the lateral lobes to 70-100 degree Celsius at a radiofrequency power of approximately 456 KHz for approximately 4 minutes per lesion. This creates coagulation defects in the lateral lobes. The coagulation defects cause shrinkage of prostatic tissue which in turn reduces the degree of squeezing of the urethra by the prostate gland thus reducing the severity of BPH symptoms.
• Another example of a minimally invasive procedure for treating BPH symptoms is Interstitial Laser Coagulation (ILC). In this procedure, laser induced necrosis of prostate tissue regions causes the prostate gland to shrink. It is performed using regional anesthesia, spinal or epidural anesthesia or local anesthesia (periprostatic block). In this procedure, a cystoscope sheath is inserted into the urethra and the region of the urethra surrounded by the prostate gland is inspected. A laser fiber is inserted into the urethra. The laser fiber has a sharp distal tip to facilitate the penetration of the laser scope into prostatic tissue. The distal tip of the laser fiber has a distal-diffusing region that distributeslaser energy 360° along the terminal 3 mm of the laser fiber. The distal tip is inserted into the middle lobe of the prostate gland and laser energy is delivered through the distal tip for a desired time. This heats the middle lobe and causes laser induced necrosis of the tissue around the distal tip. Thereafter, the distal tip is withdrawn from the middle lobe. The same procedure of inserting the distal tip into a lobe and delivering laser energy is repeated with the lateral lobes. This causes tissue necrosis in several regions of the prostate gland which in turn causes the prostate gland to shrink. Shrinkage of the prostate gland reduces the degree of squeezing of the urethra by the prostate thus reducing the severity of BPH symptoms.
• Another example of a minimally invasive procedure for treating BPH symptoms is implanting Prostatic Stents. In this procedure, the region of urethra surrounded by the prostate is mechanically supported to reduce the constriction caused by an enlarged prostate. Prostatic stents are flexible devices that are expanded after their insertion in the urethra. They mechanically support the urethra by pushing the obstructing prostatic tissue away from the urethra. This reduces the constriction of the urethra and improves urine flow past the prostate gland thereby reducing the severity of BPH symptoms.
• Although existing treatments provide some relief to the patient from symptoms of BPH, they have disadvantages. Alpha-1a-adrenergic receptors blockers have side effects such as dizziness, postural hypotension, lightheadedness, asthenia and nasal stuffiness. Retrograde ejaculation can also occur. 5-alpha-reductase inhibitors have minimal side effects, but only a modest effect on BPH symptoms and the flow rate of urine. In addition, anti-androgens, such as 5-alpha-reductase, require months of therapy before LUTS improvements are observed. Surgical treatments of BPH carry a risk of complications including erectile dysfunction; retrograde ejaculation; urinary incontinence; complications related to anesthesia; damage to the penis or urethra, need for a repeat surgery etc. Even TURP, which is the gold standard in treatment of BPH, carries a high risk of complications. Adverse events associated with this procedure are reported to include retrograde ejaculation (65% of patients), post-operative irritation (15%), erectile dysfunction (10%), need for transfusion (8%), bladder neck constriction (7%), infection (6%), significant hematuria (6%), acute urinary retention (5%), need for secondary procedure (5%), and incontinence (3%) Typical recovery from TURP involves several days of inpatient hospital treatment with an indwelling urethral catheter, followed by several weeks in which obstructive symptoms are relieved but there is pain or discomfort during micturition.
• The reduction in the symptom score after minimally invasive procedures is not as large as the reduction in symptom score after TURP. Up to 25% of patients who receive these minimally invasive procedures ultimately undergo a TURP within 2 years. The improvement in the symptom score generally does not occur immediately after the procedure. For example, it takes an average of one month for a patient to notice improvement in symptoms after TUMT and 1.5 months to notice improvement after ILC. In fact, symptoms are typically worse for these therapies that heat or cook tissue, because of the swelling and necrosis that occurs in the initial weeks following the procedures. Prostatic stents often offer more immediate relief from obstruction but are now rarely used because of high adverse effect rates. Stents have the risk of migration from the original implant site (up to 12.5% of patients), encrustation (up to 27.5%), incontinence (up to 3%), and recurrent pain and discomfort. In published studies, these adverse effects necessitated 8% to 47% of stents to be explanted. Overgrowth of tissue through the stent and complex stent geometries have made their removal quite difficult and invasive.
• Thus the most effective current methods of treating BPH carry a high risk of adverse effects. These methods and devices either require general or spinal anesthesia or have potential adverse effects that dictate that the procedures be performed in a surgical operating room, followed by a hospital stay for the patient. The methods of treating BPH that carry a lower risk of adverse effects are also associated with a lower reduction in the symptom score. While several of these procedures can be conducted with local analgesia in an office setting, the patient does not experience immediate relief and in fact often experiences worse symptoms for weeks after the procedure until the body begins to heal. Additionally all device approaches require a urethral catheter placed in the bladder, in some cases for weeks. In some cases catheterization is indicated because the therapy actually causes obstruction during a period of time post operatively, and in other cases it is indicated because of post-operative bleeding and potentially occlusive clot formation. While drug therapies are easy to administer, the results are suboptimal, take significant time to take effect, and often entail undesired side effects.
• Urinary Incontinence (UI)
• Many women experience loss of bladder control following childbirth or in old age. This condition is broadly referred to as urinary incontinence (UI). The severity of UI varies and, in severe cases, the disorder can be totally debilitating, keeping the patient largely homebound. It is usually associated with a cystocele, which results from sagging of the neck of the urinary bladder into or even outside the vagina
• The treatments for UI include behavioral therapy, muscle strengthening exercises (e.g., Kegel exercises), drug therapy, electrical stimulation of the pelvic nerves, use of intravaginal devices and surgery.
• In severe cases of UI, surgery is generally the best treatment option. In general, the surgical procedures used to treat UI attempt to lift and support the bladder so that the bladder and urethra are returned to their normal positions within the pelvic cavity. The two most common ways of performing these surgeries is through incisions formed in the abdominal wall or though the wall of the vagina.
• A number of different surgical procedures have been used to treat UI. The names for these procedures include the Birch Procedure, Marshall-Marchetti Operation, MMK, Pubo-Vaginal Sling, Trans-Vaginal Tape Procedure, Urethral Suspension, Vesicourethral Suspension. These procedures generally fall into two categories, namely a) retropubic suspension procedures and b) sling procedures.
• In retropubic suspension procedures, an incision is typically made in the abdominal wall a few inches below the navel and a network of sutures are placed to support the bladder neck. The sutures are anchored to the pubic bone and to other structures within the pelvis, essentially forming a cradle which supports the urinary bladder.
• In sling procedures, an incision is typically made in the wall of the vagina and a sling is crafted of either natural tissue or synthetic (man-made) material to support the bladder neck. Both ends of the sling may be attached to the pubic bone or tied in front of the abdomen just above the pubic bone. In some sling procedures a synthetic tape is used to form the sling and the ends of the synthetic tape are not tied but rather pulled up above the pubic bone.
• The surgeries used to treat UI are generally associated with significant discomfort as the incisions heal and may require a Foley or supra-pubic urinary catheter to remain in place for at least several days following the surgery. Thus, there exists a need in the art for the development of minimally invasive (e.g., non-incisional) procedures for the treatment of UI with less postoperative discomfort and less requirement for post-surgical urinary catheterization.
• Cosmetic or Reconstructive Tissue Lifting and Repositioning
• Many cosmetic or reconstructive surgical procedures involve lifting, compressing or repositioning of natural tissue, natural tissue or artificial grafts or aberrant tissue. For example, surgical procedures such as face lifts, brow lifts, neck lifts, tummy tucks, etc. have become commonplace. In many cases, these procedures are performed by creating incisions through the skin, dissecting to a plane beneath muscles and fascia, freeing the muscles, fascia and overlying skin from underlying structures (e.g., bone or other muscles), lifting or repositioning the freed muscles, fascia and overlying skin and then attaching the repositioned tissues to underlying or nearby structures (e.g., bone, periostium, other muscles) to hold the repositioned tissues in their new (e.g., lifted) position. In some cases excess skin may also be removed during the procedure.
• There have been attempts to develop minimally invasive devices and methods for cosmetic lifting and repositioning of tissues. For example, suture suspension lifts have been developed where one end of a standard or modified suture thread is attached to muscle and the other end is anchored to bone, periostium or another structure to lift and reposition the tissues as desired. Some of these suture suspension techniques have been performed through cannulas or needles inserted though relatively small incisions of puncture wounds.
• For example, barbed threads known as Aptos threads may be inserted through a hollow trocar and used to lift tissues of the face in a procedure that is performed commercially under the name Featherlift™ (KMI, Inc. 2550 West Rowland Anaheim, Calif. 92804).
• Another barbed thread that is useable for minimally invasive cosmetic lifting procedures is marketed under the name Contour Threads™ (Surgical Specialties Corporation, 100 Dennis Drive Reading, Pa. 19606).
• There remains a need for the development of new devices and methods that may be used for various procedures where it is desired to lift, compress, support or reposition tissues or organs within the body with less intraoperative trauma, less post-operative discomfort and/or shorter recovery times.
SUMMARY OF THE INVENTION
• The present invention provides systems and methods for retracting, lifting, compressing, supporting or repositioning an organ or tissue within the body of a human or animal subject. In these systems and methods a first anchoring member (e.g., a distal anchor) is positioned at a first location, a second anchoring member (e.g., a proximal anchor) is positioned at a second location and a connector (e.g., an elongate connector, tensioning member, filament, strand, thread, suture thread, string, wire, semi-rigid member, flexible member, elastic member, non-elastic member, resilient member, plastically deformable member, etc.) extends between the first and second anchoring members with a sufficient distance or tension to bring about the desired retracting, lifting, compressing, supporting or repositioning of the organ or tissue. In some applications of the invention, the invention may be used to facilitate volitional or non-volitional flow of a body fluid through a body lumen, modify the size or shape of a body lumen or cavity, treat prostate enlargement, treat urinary incontinence, support or maintain positioning of a tissue, organ or graft, perform a cosmetic lifting or repositioning procedure, form anastomotic connections, and/or treat various other disorders where a natural or pathologic tissue or organ is pressing on or interfering with an adjacent anatomical structure. Also, the invention has a myriad of other potential surgical, therapeutic, cosmetic or reconstructive applications, such as where a tissue, organ, graft or other material requires retracting, lifting, repositioning, compression or support.
• Further in accordance with the invention, in some embodiments, a first (e.g., distal) anchor having the connector attached thereto is implanted at a first location within the subject's body. A second anchor (e.g., proximal) is then advanced over the connector to a second location where it is affixed to the connector such that the connector is under tension and thereby retracts, lifts, compresses, supports or repositions said organ or tissue. Any excess or residual portion of the connector may then be cut and removed. This embodiment of the invention may be used, for example, to treat enlargement of the prostate gland. When used to treat enlargement of the prostate gland, a first introducer may be inserted into the subject's urethra and a penetrator (e.g., a needle) may be advanced from the first introducer, through the wall of the urethra and into or through the prostate (e.g., at an extracapsular location outside of the prostate's connective tissue capsule, at an intracapsular location within the prostate capsule or at a sub-capsular location within the paryenchyma of the prostate). The first anchor (with the connector attached thereto) is then deployed from the penetrator such that it becomes implanted at the desired first location. The penetrator may be retracted into the first introducer and the first introducer may be removed from the subject's urethra, leaving the connector trailing from the implanted first anchor, through the penetration tract created by the penetrator and into (or all the way out of) the subject's urethra. A second introducer bearing the second anchor may then be advanced over the trailing portion of the connector to a second location where it is affixed to the connector to compress prostate tissue between the first and second anchors or otherwise reposition the prostate tissue so as to decrease compression of the urethra, thereby allowing normal or improved micturition while avoiding substantial resection or cutting of the urethral wall or prostate gland. In some applications, multiple sets of tissue anchors may be placed at different locations to reposition the lobes of the prostate. In other cases, more than two anchors may be attached to a single connector such that more than two anchoring locations are established on that connector.
• Still further in accordance with the invention, there are provided introducer-delivery devices useable to install the tissue retracting, lifting, compressing, supporting or repositioning systems of the foregoing character. In some embodiments, device for delivering the first (e.g., distal) anchor may comprise an elongate shaft that is insertable into a lumen or cavity of the subject's body and a penetrator (e.g., a needle) that is advanceable from the elongate shaft such that the penetrator penetrates into or through tissue. After the penetrator has been advanced, the first (e.g., distal) anchor is deployed from the penetrator such that it becomes implanted at the desired first location within the subject's body. A handpiece may be provided on the proximal end of the elongate shaft. Such handpiece may incorporate one or more actuators (e.g., triggers or other controls) for a) advancing/retracting the penetrator and b) deploying the first (e.g., distal) anchor from the penetrator. In some embodiments, a delivery device for delivering the second (e.g., proximal) anchor may comprise an elongate shaft with a mechanism that holds the second (e.g., proximal) anchor. After the free end of the connector has been inserted into the passageway of the second anchor, the elongate shaft bearing the second anchor is advanced into the body lumen or cavity such that the second (e.g., proximal) anchor tracks over the connector and becomes cinched up to the desired second position. Then the second anchor is affixed to the connector at such second position and released from the elongate shaft. Any residual or protruding connector may be cut and the elongate shaft may then be removed from the body lumen or cavity, leaving the first (e.g., distal) anchor, connector and second (e.g., proximal) anchor in place. A handpiece may be provided on the proximal end of this elongate member. Such handpiece may incorporate one or more actuators (e.g., triggers or other controls) for a) affixing (e.g., locking) the second anchor into the connector, b) releasing the second anchor from the elongate shaft and c) optionally cutting away any residual portion of the connector.
• Still further aspects and elements of the invention will become apparent to those of skill in the art upon reading of the detailed description and examples set forth herebelow.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1A shows a coronal section through the lower abdomen of a male human suffering from BPH showing a hypertrophied prostate gland.
• FIG. 1B shows a coronal section through the lower abdomen of a male human suffering from BPH showing a hypertrophied prostate gland treated with an embodiment of the device of the present invention.
• FIG. 1C shows a side view of an embodiment of the retractor shown inFIG. 1B.
• FIGS. 1D through 1J show the various steps of a method of treating a prostate gland by the retractor shown inFIG. 1C.
• FIG. 2A shows a sectional view through the embodiment of a distal anchor shown inFIG. 1C.
• FIG. 2B shows a first embodiment of a flat pattern that can be used to design the distal anchor ofFIG. 2A.
• FIG. 2C shows a second embodiment of a flat pattern that can be used to design the distal anchor ofFIG. 2A.
• FIG. 2D shows a longitudinal sectional view through an embodiment of a distal anchor that is attached to a connector by a crimped loop.
• FIG. 2E shows a longitudinal sectional view through an embodiment of a distal anchor that is attached to a connector by multiple crimped loops.
• FIG. 2F shows a perspective view through an embodiment of a distal anchor that is attached to a connector by a buckle.
• FIG. 2G shows a side view of the embodiment of a distal anchor ofFIG. 2F that is attached to a connector under tension.
• FIG. 2H shows a perspective view of an embodiment of a distal anchor that is attached to a connector by a knot.
• FIG. 2I shows a longitudinal sectional view through an embodiment of a distal anchor that is attached to a connector by an adhesive.
• FIG. 3A shows a side view of a first embodiment of a distal anchor delivery device.
• FIG. 3B shows the distal anchor delivery device ofFIG. 3A with a portion of the distal region removed.
• FIG. 3C shows an enlarged view of thedistal region3C ofFIG. 3B.
• FIGS. 3D through 3K show various steps of a method of deploying a distal anchor in the anatomy by the distal anchor delivery device ofFIG. 3A.
• FIG. 3L shows a side view of a second embodiment of a distal anchor delivery device.
• FIGS. 3M through 3T show steps of an embodiment of a method for deploying the anchor ofFIG. 3L in an anatomical region.
• FIG. 3U shows a first side view of the distal tip of an embodiment of a needle that can be used to introduce one or more of the distal anchors disclosed herein.
• FIG. 3V shows a second side view of the distal tip of the embodiment of the needle shown inFIG. 3U.
• FIG. 3W shows a longitudinal section through the distal tip of a distal anchor delivery device comprising a bushing to guide the trajectory of a needle through the distal anchor delivery device.
• FIG. 3X shows a longitudinal section through the distal tip of a distal anchor delivery device comprising a distal crimp or dimple to guide the trajectory of a needle through the distal anchor delivery device.
• FIG. 3Y shows a perspective view of the distal tip of a distal anchor delivery device comprising a bent, curved or angled needle introducing lumen.
• FIG. 3Z shows a perspective view of an embodiment of a first elongate part that is used to construct the distal end of the embodiment of the distal anchor delivery device ofFIG. 3Y.
• FIG. 3A′ shows a perspective view of an embodiment of a second elongate part that is used to construct the distal end of the embodiment of the distal anchor delivery device ofFIG. 3Y.
• FIGS. 4A and 4B show longitudinal sections through a first embodiment of a proximal anchor showing the steps of an embodiment of a method of attaching the proximal anchor to a connector.
• FIG. 4C shows a first embodiment of a flat pattern that can be used to design the proximal anchor ofFIG. 4A.
• FIGS. 4D and 4E show longitudinal sections through a second embodiment of a proximal anchor showing the steps of an embodiment of a method of attaching the proximal anchor to a connector.
• FIGS. 4F and 4G show longitudinal sections through a third embodiment of a proximal anchor showing the steps of an embodiment of a method of attaching the proximal anchor to a connector.
• FIG. 4H shows an embodiment of a flat pattern that can be used to design the proximal anchor ofFIGS. 4F and 4G.
• FIGS. 4I and 4J show longitudinal sections through a fourth embodiment of a proximal anchor showing the steps of an embodiment of a method of attaching the proximal anchor to a connector.
• FIGS. 4K and 4L show longitudinal sections through a proximal anchor showing the steps of an embodiment of a method of anchoring a connector to a proximal anchor by an elongate wedging device comprising multiple branches or bristles.
• FIGS. 4M and 4N show longitudinal sections through an embodiment of a proximal anchor showing the steps of an embodiment of a method of anchoring a connector to a proximal anchor by a lock pin pulled by a flexible pull shaft.
• FIGS. 4O and 4P show longitudinal sections through an embodiment of a proximal anchor showing the steps of an embodiment of a method of anchoring a connector to the proximal anchor by a hollow wedging element.
• FIGS. 4Q and 4R show an embodiment of a method of using a compression cutter for cutting the excess length of a connector and a wedging element.
• FIGS. 4S and 4T show longitudinal sections through a first embodiment of a proximal anchor comprising a crimping zone showing the steps of an embodiment of a method of anchoring a connector to the proximal anchor.
• FIGS. 4U and 4V show longitudinal sections through a second embodiment of a proximal anchor comprising a crimping zone showing the steps of an embodiment of a method of anchoring a connector to the proximal anchor.
• FIGS. 4W and 4X show a third embodiment of a proximal anchor comprising multiple crimping zones showing the steps of an embodiment of a method of anchoring a connector to the proximal anchor.
• FIG. 4Y shows a side view of an embodiment of a proximal anchor comprising a tapering outer surface.
• FIGS.4Z through4AB show side views of the embodiment of the proximal anchor ofFIG. 4Y showing the steps of an embodiment of a method of anchoring a connector to the proximal anchor by an anchoring ring.
• FIG. 4AC shows a cross sectional view of an embodiment of the cutting ring of FIGS.4M and4AB.
• FIG. 4AD shows a side view of a first embodiment of a proximal anchor made of a thermal shape memory alloy.
• FIG. 4AE shows a cross section of the proximal anchor ofFIG. 4AD through the line4AE-4AE when the shape memory material of the proximal anchor is in the martensite phase.
• FIG. 4AE′ shows a cross section of the proximal anchor ofFIG. 4AD through the line4AE-4AE when the shape memory material of the proximal anchor is in the programmed shape.
• FIG. 4AF shows a cross section of the proximal anchor ofFIG. 4AD through the line4AF-4AF when the shape memory material of the proximal anchor is in the martensite phase.
• FIG. 4AF′ shows a cross section of the proximal anchor ofFIG. 4AD through the line4AF-4AF when the shape memory material of the proximal anchor is in the programmed shape.
• FIG. 4AG shows a side view of a second embodiment of a proximal anchor made of a thermal shape memory alloy.
• FIG. 4AH shows a cross section of the proximal anchor ofFIG. 4AG through the line4AH-4AH when the shape memory material of the proximal anchor is in the martensite phase.
• FIG. 4AH′ shows a cross section of the proximal anchor ofFIG. 4AG through the line4AH-4AH when the shape memory material of the proximal anchor is in the programmed shape.
• FIGS.4AI and4AJ show longitudinal sections of an embodiment of a proximal anchor showing the steps of an embodiment of a method of anchoring a looped or folded region of the connector to the proximal anchor.
• FIG. 4AK shows a side view of an embodiment of a proximal anchor made of a suitable elastic or super elastic or shape memory material comprising one or more inwardly opening flaps.
• FIG. 4AL shows a longitudinal section through the embodiment of the proximal anchor ofFIG. 4AK.
• FIG. 5A shows a side view of a first embodiment of a proximal anchor delivery device comprising one or more finger activated triggers.
• FIGS. 5B through 5D show longitudinal sections through the distal tip of the proximal anchor delivery device ofFIG. 5A showing the steps of a method of deploying a proximal anchor in the anatomy.
• FIG. 5E shows a side view of a proximal anchor similar to the proximal anchor inFIGS. 5B-5D having a undeployed lock pin partially inserted into the proximal anchor.
• FIGS. 5F through 5H show longitudinal sections through the proximal anchor and the lock pin ofFIG. 5E showing the steps of a method of attaching the proximal anchor to a connector using the lock pin.
• FIG. 5I shows a side view of an embodiment of a lock pin that can be used to lock a connector to a proximal anchor as shown in the method ofFIGS. 5B-5D.
• FIG. 5J shows another side view of the lock pin of connector shown inFIG. 5I.
• FIG. 5K shows an isometric view of an embodiment of an actuator that can be used to drive a lock pin into a proximal anchor.
• FIG. 5L shows a side view of the embodiment of the actuator shown inFIG. 5K.
• FIG. 5M shows a longitudinal section through the actuator ofFIG. 5L.
• FIG. 5N shows a side view of a second embodiment of a proximal anchor delivery device.
• FIGS. 5O through 5S show the steps of an embodiment of a method of deploying an anchor in an anatomical region using the proximal anchor delivery device ofFIG. 5N.
• FIG. 5T shows the distal end of an embodiment of a proximal anchor delivery device comprising an anchor tube with a bent, curved or angled distal end.
• FIG. 5U shows the step of deploying a proximal anchor in an anatomical region by the proximal anchor delivery device ofFIG. 5T.
• FIG. 5V shows a cystoscopic view of a region of canine urethra enclosed by the prostate gland that has been treated by a procedure similar to the procedure shown inFIGS. 1D through 1J.
• FIG. 6A shows a side view of an embodiment of a distal anchor delivery device.
• FIG. 6B shows an enlarged view of the distal region of the distal anchor delivery device ofFIG. 6A showing the step of deploying a distal anchor by the distal anchor delivery device.
• FIG. 6C shows a side view of an embodiment of a proximal anchor delivery device.
• FIG. 6D shows an enlarged view of the distal region of the proximal anchor delivery device ofFIG. 6C.
• FIG. 6E shows the distal region of an embodiment of a proximal anchor delivery device comprising a curved penetrating distal tip.
• FIG. 6F shows an embodiment of a retractor comprising a proximal anchor buried within an anatomical tissue by the proximal anchor delivery device ofFIG. 6E.
• FIG. 6G shows the distal region of an embodiment of a proximal anchor delivery device comprising a straight penetrating distal tip.
• FIG. 6H shows an embodiment of a retractor comprising a proximal anchor buried within an anatomical tissue by the proximal anchor delivery device ofFIG. 6G.
• FIG. 6I shows a section through the distal tip of a first embodiment of a combined device that can deliver a distal anchor connected to a proximal anchor by a connector.
• FIG. 6J shows a side view of a second embodiment of a combined device that can deliver a distal anchor and a proximal anchor connected to each other by a connector.
• FIG. 6K shows another view of the embodiment of the combined device shown inFIG. 6J that can deliver a distal anchor and a proximal anchor connected to each other by a connector.
• FIGS. 6L through 6Q show the steps of a method of compressing an anatomical tissue by a combined device that delivers a proximal anchor and a distal anchor in the anatomy.
• FIGS. 6R through 6W show the distal region of an embodiment of a combined device showing the steps of a method of delivering a retractor comprising a proximal anchor and a distal anchor, wherein the distal anchor is delivered through the proximal anchor.
• FIGS. 7A through 7H show a longitudinal section of a tubular organ showing the steps of a method of reducing the cross sectional area of the lumen of the tubular organ.
• FIG. 7I shows a schematic diagram of a tubular organ showing the configuration of the tubular organ before performing the method shown inFIGS. 7A through 7H.
• FIG. 7J shows a schematic diagram of the tubular organ ofFIG. 7I showing a possible configuration obtained after performing the method shown inFIGS. 7A through 7H.
• FIG. 7K shows an embodiment of a distal anchor delivery device comprising a helical needle.
• FIGS. 7L through 7N show a cross section of a tubular organ showing the steps of a method of reducing the cross sectional area of the lumen of the tubular organ by creating one or more folds or pleats in the walls of the tubular organ along the circumference of the lumen.
• FIG. 7O shows a cross section of a tubular organ showing a first embodiment of a method of compressing a tissue adjacent to a tubular organ to cause one or more regions of the tissue to displace the walls of the tubular organ thereby reducing the cross sectional area of the lumen of the tubular organ.
• FIG. 7P shows a cross section of a tubular organ showing a second embodiment of a method of compressing a tissue adjacent to a tubular organ to cause one or more regions of the tissue to displace the walls of the tubular organ thereby reducing the cross sectional area of the lumen of the tubular organ.
• FIGS. 7Q through 7V show longitudinal sections of a tubular organ showing the steps of a method of reducing the cross sectional area of the lumen of the tubular organ by creating one or more folds or bulges in the walls of the tubular organ along the axis of the tubular organ.
• FIGS. 7W through 7Y shows cross sections of a tubular organ showing the steps of a first embodiment of a method of reducing the cross sectional area of the lumen of the tubular organ by implanting a device that pinches the walls of the tubular organ to create a recess.
• FIGS.7Z through7AD show cross sections of a tubular organ showing the steps of a second embodiment of a method of reducing the cross sectional area of the lumen of the tubular organ by implanting a device that pinches the walls of the tubular organ to create a recess.
• FIG. 7AE shows a cross section of a tubular organ showing the steps of a first embodiment of a method of reducing the cross sectional area of the lumen of the tubular organ by implanting devices that pinch the walls of the tubular organ to create two recesses.
• FIG. 7AF shows a cross section of a tubular organ showing a step of a second embodiment of a method of reducing the cross sectional area of the lumen of the tubular organ by implanting devices that pinch the walls of the tubular organ to create two recesses.
• FIG. 7AG shows a cross section of a tubular organ showing a method of reducing the cross sectional area of the lumen of the tubular organ by creating a recess in the walls of the tubular organ and reinforcing the recessed region.
• FIG. 8A shows an anchoring system implanted in a stomach to reduce the volume of the stomach to treat obesity.
• FIG. 8B shows a cross sectional view of a stomach before implanting an anchoring system to reduce the volume of the stomach.
• FIG. 8C shows a cross sectional view of the stomach ofFIG. 8B after implanting an anchoring system to reduce the volume of the stomach.
• FIG. 8D shows a section through wound edges closed by an anchoring system in a first configuration.
• FIG. 8E shows a section through wound edges closed by an anchoring system in a second configuration.
• FIG. 8F shows an anchoring device used to reconnect torn tissues of the musculoskeletal system.
• FIG. 8G shows a sagittal section through the head of a patient suffering from sleep apnea.
• FIG. 8H shows a sagittal section through the head of a patient suffering from sleep apnea who has been treated with two anchoring devices that displace the obstructing portions of the soft palate SP and the tongue To.
• FIG. 8I shows an anchoring system that is implanted to lift loose skin in the face of a human.
• FIG. 8J shows a view of a human face showing facial regions that may be treated by a method similar to the method shown inFIG. 8I to improve the cosmetic appearance of the human.
• FIG. 8K shows a sagittal section through the lower abdomen of a human female showing an embodiment of a method of treating female urinary incontinence by a sling attached to the anatomy by anchoring devices.
• FIG. 8L shows a cross section of a normal urethra UT.
• FIG. 8M shows a cross section of the urethra UT in a human female suffering from stress urinary incontinence.
• FIG. 8N shows a cross section of the urethra UT in a human female suffering from stress urinary incontinence where the urethra UT has been supported with a sling.
• FIG. 8O shows a section through the lower abdomen of a human female suffering from stress urinary incontinence where the urethra UT has been supported with a sling.
• FIG. 8P shows a section through the lower abdomen showing an embodiment of a colposuspension procedure wherein one or more regions of the vaginal wall of a patient suffering from incontinence are suspended to the Cooper's ligament by one or more anchoring devices.
• FIG. 8Q shows an anchoring device used to attach a seal to a puncture site on a blood vessel BV to seal the puncture site.
• FIG. 8R shows a view of the pectoral region of a human female.
• FIG. 8S shows the pectoral region of a human female wherein mastopexy has been performed on one or more regions of the breasts using the anchoring devices disclosed herein.
DETAILED DESCRIPTION
• The following detailed description and the accompanying drawings are intended to describe some, but not necessarily all, examples or embodiments encompassed by the present invention.
• A number of the drawings in this patent application show anatomical structures of the male reproductive and/or urinary system. In general, these anatomical structures are labeled with the following reference letters:

  	Urethra	UT
  	Urinary Bladder	UB
  	Prostate Gland	PG
  	Target Tissue	TT
  	Urethral Wall	UW
  	Ligament	Li
  	Bone	Bo
  	Pubic Bone	PB
  	Soft Palate	SP
  	Tongue	To
  	Rectum	R
  	Vagina	V
  	Blood Vessel	BV

• FIG. 1A shows a coronal section (i.e., a section cut approximately in the plane of the coronal suture or parallel to it) through the lower abdomen of a male human suffering from BPH showing a hypertrophied prostate gland. As depicted inFIG. 1A, the urinary bladder UB is a hollow muscular organ that temporarily stores urine. It is situated behind the pubic bone PB. The lower region of the urinary bladder has a narrow muscular opening called the bladder neck which opens into a soft, flexible, tubular organ called the urethra UT. The muscles around the bladder neck are called the internal urethral sphincter. The internal urethral sphincter is normally contracted to prevent urine leakage. The urinary bladder gradually fills with urine until full capacity is reached, at which point the sphincters relax. This causes the bladder neck to open, thereby releasing the urine stored in the urinary bladder into the urethra. The urethra conducts urine from the urinary bladder to the exterior of the body. The urethra begins at the bladder neck and terminates at the end of the penis. The prostate gland PG is located around the urethra at the union of the urethra and the urinary bladder. InFIG. 1A, the prostate gland is hypertrophied (enlarged). This causes the prostate gland to press on a region of the urethra. This in turn creates an undesired obstruction to the flow of urine through the urethra.
• FIG. 1B shows a coronal section through the lower abdomen of a male human suffering from BPH showing a hypertrophied prostate gland treated with an embodiment of the device of the present invention. It has been discovered that the enlarged prostate gland is compressible and can be retracted so as to relieve the pressure from the urethra. In accordance with one embodiment of the present invention, a retractor device can be placed through the prostate gland in order to relieve the pressure on the urethra. InFIG. 1B, aretractor10 is implanted in the prostate gland.Retractor10 comprises adistal anchor12 and aproximal anchor14.Distal anchor12 and aproximal anchor14 are connected by aconnector16. The radial distance from the urethra todistal anchor12 is greater than the radial distance from the urethra toproximal anchor14. The distance or tension between the anchors is sufficient to compress, displace or change the orientation of an anatomical region betweendistal anchor12 andproximal anchor14. Theconnector16 can be inelastic so as to maintain a constant force or distance between the proximal and distal anchors or be elastic so as to attempt to draw the proximal and distal anchors closer together. In the embodiment shown inFIG. 1B,distal anchor12 is located on the outer surface of the capsule of prostate gland CP and acts as a capsular anchor. Alternatively,distal anchor12 may be embedded inside the tissue of prostate gland PG or in the surrounding structures around the prostate such as periosteum of the pelvic bones, within the bones themselves, pelvic fascia, coopers ligament, muscles traversing the pelvis or bladder wall. Also, in the embodiment shown inFIG. 1B,proximal anchor14 is located on the inner wall of urethra UT and acts as a urethral anchor. Alternatively,proximal anchor14 may be embedded inside the tissue of prostate gland PG or surrounding structures as outlined above.Distal anchor12 andproximal anchor14 are implanted in the anatomy such that a desired distance or tension is created inconnector16. This causesdistal anchor12 andproximal anchor14 to retract or compress a region of prostate gland PG to relieve the obstruction shown inFIG. 1A. InFIG. 1B, tworetractors10 are implanted in prostate gland PG. Eachretractor10 is implanted in a lateral lobe (side lobe) of prostate gland PG. The various methods and devices disclosed herein may be used to treat a single lobe or multiple lobes of the prostate gland or other anatomical structures. Similarly, two or more devices disclosed herein may be used to treat a single anatomical structure. For example, a lateral lobe of prostate gland PG may be treated using tworetractors10. One or more retractors may be deployed at particular angles to the axis of the urethra to target one or more lateral lobes and/or middle lobe of the prostate gland. In one embodiment,retractor10 is deployed between the 1 o'clock and 3 o'clock position relative to the axis of the urethra to target the left lateral lobe of the prostate gland. In another embodiment,retractor10 is deployed between the 9 o'clock and 11 o'clock position relative to the axis of the urethra to target the right lateral lobe of the prostate gland. In another embodiment,retractor10 is deployed between the 4 o'clock and 8 o'clock position relative to the axis of the urethra to target the middle lobe of the prostate gland.
• FIG. 1C shows a side view of one embodiment of the retractor shown inFIG. 1B.FIG. 1C showsretractor10 comprisingdistal anchor12 andproximal anchor14.Distal anchor12 andproximal anchor14 are connected byconnector16. In the embodiment shown inFIG. 1C,distal anchor12 comprises atube18 having a lumen.Tube18 can be made of suitable elastic or non-elastic materials including, but not limited to metals, polymers, etc. Typical examples of such materials include, but are not limited to stainless steel 304, stainless steel 316, nickel-Titanium alloys, titanium, Pebax, Polyimide, braided Polyimide, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK, PTFE, PFA, FEP, EPTFE, shape memory polymers, such as polyesterurethane, polyetherurethane, polyetherpolyesters, polyetherpolyamines or combinations of oligo e-caprolactore diol and oligo p-dioxanone diol polymers, etc.Connector16 is attached totube18. In one embodiment,connector16 is aUSP size 0 polypropylene monofilament suture. In the embodiment shown inFIG. 1C, a distal region ofconnector16 is located in the lumen oftube18 such that the distal tip ofconnector16 emerges out of one end of the lumen oftube18. The distal tip ofconnector16 is enlarged, such that the diameter of the enlarged distal tip ofconnector16 is greater than the inner diameter oftube18. In one embodiment, the diameter ofconnector16 is 0.014 inches and the diameter of the enlarged distal tip ofconnector16 is 0.025 inches. In one embodiment, the enlarged distal tip ofconnector16 is created by controlled melting of the distal tip ofconnector16. This attachesconnector16 totube18.Tube18 may comprise one or more additional attachment mechanisms to attach a distal region ofconnector16 totube18. In one embodiment, the distal region ofconnector16 is attached totube18 by a suitable biocompatible adhesive. In the embodiment shown inFIG. 1C, the distal region ofconnector16 is attached totube18 by one or more inwardly openingflaps20 that are cut in the material oftube18.Flaps20grip connector16 and thus prevent the relative motion ofconnector16 andtube18. The angle between one offlaps20 andconnector16 may range from 1 degree to 90 degrees.Tube18 further comprises alongitudinal slot22.Longitudinal slot22 extends from one end to roughly the mid section oftube18.Connector16 emerges out of thislongitudinal slot22. Thus, whenconnector16 is pulled in the proximal direction,distal anchor12 assumes a T-shape that helps to anchordistal anchor12 to an anatomical structure.Distal anchor12 may comprise a sharp edge to help penetratedistal anchor12 through the anatomy. In a preferred embodiment,distal anchor12 is constructed by laser cutting an electropolished nickel-titanium alloy (e.g., nitinol) tube made of 50.8% nickel-49.2% titanium. In the preferred embodiment, the outer diameter oftube18 is 0.026 inches, the inner diameter oftube18 is 0.015 inches, the length oftube18 is 0.315 inches and the length oflongitudinal slot22 is 0.170 inches.
• In the embodiment shown inFIG. 1C,proximal anchor14 comprises atube24 comprising a lumen.Tube24 can be made of suitable elastic or non-elastic materials including, but not limited to metals, polymers, etc. Typical examples of such materials include, but are not limited to stainless steel 304, stainless steel 316, nickel-Titanium alloys, titanium, Pebax, Polyimide, braided Polyimide, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK, PTFE, PFA, FEP, ePTFE, such as polyesterurethane, polyetherurethane, polyetherpolyesters, polyetherpolyamines or combinations of oligo e-caprolactone diol and oligo p-dioxanone diol polymers, etc. An outwardly openingflap26 is cut through the material oftube24.Flap26 is folded on the outer surface oftube18 as shown inFIG. 1C. This creates an opening to the lumen oftube24 that is lined by the atraumatic edge of the foldedflap26.Connector16 enterstube24 through this opening to the lumen oftube24.Proximal anchor14 further comprises an attachment mechanism to attachconnector16 totube24.Connector16 can be made of suitable elastic or non-elastic materials including, but not limited to metals, polymers, etc. Typical examples of such materials include, but are not limited to stainless steel 304, stainless steel 316, nickel-Titanium alloys, suture materials, titanium, silicone, nylon, polyamide, polyglycolic acid, polypropylene, Pebax, PTFE, ePTFE, silk, gut, or any other braided or mono-filament material. In a preferred embodiment,tube24 has a length of 0.236 inches and an outer diameter of 0.027 inches and an inner diameter of 0.020 inches. The length of opening to the lumen oftube24 is approximately 0.055 inches. In the preferred embodiment, the attachment mechanism comprises a lock pin that frictionally attachesconnector16 totube24. The lock pin andtube24 are made of stainless steel 316L. In the preferred embodiment,tube24 is laser cut and then electropolished. Lock pin is constructed using EDM (electrical discharge machining) and then passivated.
• FIGS. 1D through 1J show the various steps of a method of treating a prostate gland by the retractor shown inFIG. 1C. Similar methods may be also used to deploy retractor or compression devices in other anatomical structures. In the step shown inFIG. 1D, asheath28 such as a standard resectoscope sheath is introduced into the urethra (trans-urethrally).Sheath28 is advanced through urethra UT such that the distal end ofsheath28 is positioned near a region of urethra UT that is obstructed by a hypertrophied prostate gland PG. Distalanchor delivery device30 is introduced throughsheath28. Distalanchor delivery device30 can be placed in thesheath28 after the distal end ofsheath28 is positioned near the region of the urethra UT that is obstructed or the distalanchor delivery device30 can be pre-loaded in thesheath28 before positioning of thesheath28. Distalanchor delivery device30 is advanced throughsheath28 such that the distal end of distalanchor delivery device30 emerges out of the distal end ofsheath28. Distalanchor delivery device30 is oriented such that a working channel opening of distalanchor delivery device30 points towards a lateral lobe of prostate gland PG.
• In the step shown inFIG. 1E, aneedle32 is introduced through distalanchor delivery device30.Needle32 can be placed in distal anchor delivery device after the distalanchor delivery device30 is advanced throughsheath28 or theneedle32 can be pre-loaded in the distalanchor delivery device30. In one embodiment,needle32 is a 20 gauge needle.Needle32 is advanced through distalanchor delivery device30 such that it emerges through the working channel opening.Needle32 is further advanced such that it penetrates through the tissue of prostate gland PG and the distal end ofneedle32 emerges out of the capsule of prostate gland CP.
• In the step shown inFIG. 1F,distal anchor12 connected toconnector16 is advanced throughneedle32.Distal anchor12 can be pre-loaded inneedle32 or can be loaded inneedle32 afterneedle32 has been advanced through distalanchor delivery device30.Distal anchor12 is advanced throughneedle32 such that it emerges out of the distal end ofneedle32.
• In the step shown inFIG. 1G,needle32 is removed from distalanchor delivery device30 by pullingneedle32 in the proximal direction.
• In the step shown inFIG. 1H, distalanchor delivery device30 is removed fromsheath28 by pulling distalanchor delivery device30 in the proximal direction. Also,connector16 is pulled to orientdistal anchor12 perpendicularly toconnector16.
• In the step shown inFIG. 1I,connector16 is passed throughproximal anchor14 located on a proximalanchor delivery device34. Proximalanchor delivery device34 is advanced throughsheath28 such that the distal end of proximalanchor delivery device34 emerges out of the distal end ofsheath28. A desired tension is introduced inconnector16 such thatdistal anchor12 is pulled byconnector16 with a desired force. Alternatively, the proximal anchor can be visualized through an endoscope or under fluoroscopy and advanced along the connector until the desired retraction of the tissue is achieved.
• In the step shown inFIG. 1J,connector16 is attached toproximal anchor14.Proximal anchor14 is also released from proximalanchor delivery device34, thus deployingproximal anchor14 in the anatomy. Proximalanchor delivery device34 andsheath28 are removed form the anatomy.Retractor10 comprisingdistal anchor12,proximal anchor14 andconnector16 is used to retract, lift, support, reposition or compress a region of prostate gland PG located betweendistal anchor12 andproximal anchor14. This method may be used to retract, lift, support, reposition or compress multiple regions or lobes of the prostate gland PG. In the method shown inFIGS. 1D through 1J,distal anchor12 is deployed on the outer surface of the capsule of prostate gland CP. Thus,distal anchor12 acts as a capsular anchor. Alternatively,distal anchor12 may be deployed inside the tissue of prostate gland PG or beyond the prostate as outlined previously. Similarly, in the method shown inFIGS. 1D through 1J,proximal anchor14 is deployed on the inner wall of urethra UT and acts as a urethral anchor. Alternatively,proximal anchor14 may be deployed inside the tissue of prostate gland PG.
• FIG. 2A shows a sectional view through the embodiment of a distal anchor shown inFIG. 1C. In the embodiment shown inFIG. 2A,distal anchor12 comprisestube18 comprising a lumen.Tube18 is attached to aconnector16. In the embodiment shown inFIG. 2A, a distal region ofconnector16 is located in the lumen oftube18 such that the distal tip ofconnector16 emerges out of one end of the lumen oftube18.Distal anchor12 and/orconnector16 comprise one or more attachment mechanisms to attachdistal anchor12 toconnector16. In the embodiment shown inFIG. 2A, the attachment mechanism comprises an enlarged distal tip ofconnector16. In one embodiment, the enlarged distal tip is created by controlled melting of the distal tip ofconnector16. The enlarged distal tip anchorsconnector16 totube18. In another embodiment, the attachment mechanism comprises a suitable biocompatible adhesive that attaches the distal region ofconnector16 totube18. Other examples of attachment mechanisms include, but are not limited to one or more knots onconnector16, one or more turnbuckles onconnector16, crimped regions ofdistal anchor12, additional crimping elements that crimp onto the outer surface ofconnector16, or crimping elements that fit inside the tube, etc.Tube18 further compriseslongitudinal slot22. Longitudinal slot extends from one end to roughly the mid section oftube18.Connector16 emerges out of thislongitudinal slot22. Thus, whenconnector16 is pulled in the proximal direction,distal anchor12 assumes a T-shape that helps to anchordistal anchor12 to an anatomical structure.Distal anchor12 may comprise a sharp edge to help penetratedistal anchor12 through the anatomy. In one embodiment,distal anchor12 comprises a nickel-titanium alloy (e.g., nitinol) tube andconnector16 comprises a polypropylene suture.
• In one embodiment of a method of manufacturingdistal anchor12, a tube is laser cut with a radially aligned laser. The geometry of the laser cut pattern is specified using a flat pattern drawing which is mapped onto the outside circumference of the tube.FIG. 2B shows a first embodiment of a flat pattern that can be used to manufacture adistal anchor12 ofFIG. 2A. InFIG. 2B,flat pattern36 comprises a rectangular region. The length of the rectangular region represents the length of the tube. The width of the rectangular region OC represents the outer circumference of the tube. In one embodiment, the length of the rectangular region is 0.315+/−0.005 inches and the width of the rectangular region is 0.088+/−0.001 inches.Flat pattern36 further comprises aU-shaped slot38 cut at the proximal end offlat pattern36 as shown inFIG. 2B. The width ofslot38 is 0404+/−0.002 inches. The length of the straight region ofslot38 is 0.174+/−0.005 inches. The distal end ofslot38 comprises a semi-circular region as shown inFIG. 2B. The proximal end ofslot38 comprises rounded edges with a radius of 0.2+/−0.005 inches. The distal region offlat pattern36 may comprise one or moresemicircular notches40 that create inwardly opening flaps20. In the embodiment shown inFIG. 2B,flat pattern36 comprises threenotches40. In this embodiment, the width ofnotches40 is 0.010+/−0.001 inches. The length of the straight region ofnotches40 is 0.010+/−0.001 inches. The distal end ofnotches40 comprises a semi-circular region as shown inFIG. 2B. Asuitable connector16 is passed through the lumen of the nickel-titanium alloy (e.g., nitinol) tube.Connector16 is attached to the distal end of the nickel-titanium alloy (e.g., nitinol) tube. Inwardly openingflaps20 are crimped onto the outer surface ofconnector16. This crimping produces additional anchoring sites on the nickel-titanium alloy (e.g., nitinol) tube to anchorconnector16 to the nickel-titanium alloy (e.g., nitinol) tube. The nickel-titanium alloy (e.g., nitinol) tube then acts asdistal anchor12. A region ofconnector16 emerges out of distal anchor throughslot38. The diameter ofslot38 may be designed to allow the edges ofslot38 to accurately contact the outer surface ofconnector16.
• FIG. 2C shows a second embodiment of a flat pattern that can be used to designdistal anchor12 ofFIG. 2A. InFIG. 2C,flat pattern42 comprises a rectangular region. In one embodiment, the length of the rectangular region is 0.354+/−0.005 inches and the width of the rectangular region OC is 0.88+/−0.001 inches.Flat pattern42 further comprises a W-shapedslot44 cut at the proximal end offlat pattern42 as shown inFIG. 2C. The distal end ofslot44 comprises two semi-circular regions as shown inFIG. 2C. In the embodiment shown inFIG. 2C, the radius of the semicircular regions is approximately 0.0015 inches. The length ofslot44 measured along the length offlat pattern42 from the proximal end offlat pattern42 to the proximal edges of the semicircular regions is 0.174+/−0.005 inches.Slot44 encloses acentral folding tab46. In the embodiment shown inFIG. 2C,folding tab46 comprises a straight proximal region and a tapering distal region. The length of the straight proximal region offolding tab46 is 0.11+/−0.010 inches. The length of the tapering distal region offolding tab46 is 0.040+/−0.005 inches. The proximal end ofslot44 has rounded edges with a radius of 0.020+/−0.005 inches. The distal region offlat pattern42 may comprise one or moresemicircular notches40. In the embodiment shown inFIG. 2C,flat pattern42 comprises threenotches40 that create inwardly opening flaps20. In this embodiment, the width ofnotches40 is 0.010+/−0.001X inches. The length of the straight region ofnotches40 is 0.010+/−0.001 inches. The distal end ofnotches40 comprises a semi-circular region as shown inFIG. 2C. Asuitable connector16 is passed through the lumen of the nickel-titanium alloy (e.g., nitinol) tube.Connector16 is attached to the distal end of the nickel-titanium alloy (e.g., nitinol) tube. Inwardly openingflaps20 are crimped onto the outer surface ofconnector16. This crimping produces additional anchoring sites on the nickel-titanium alloy (e.g., nitinol) tube to anchorconnector16 to the nickel-titanium alloy (e.g., nitinol) tube. The nickel-titanium alloy (e.g., nitinol) tube then acts asdistal anchor12. A region ofconnector16 emerges out of distal anchor throughslot44. To prevent or reduce the scraping ofconnector16 by the distal edge ofslot44, a blunt edge is created at the distal edge ofslot44. This blunt edge is created by folding or bendingfolding tab46 along the length ofdistal anchor12. Several alternate designs of the blunt edge may be created using a variety of lengths offolding tab46 and/or a variety of methods of folding or bending.
• In the example shown inFIG. 2A,distal anchor12 is attached toconnector16 by an attachment mechanism comprising an enlarged distal tip ofconnector16. Several alternate or complementary attachment mechanisms are illustrated inFIGS. 2D-2J.
• FIG. 2D shows a longitudinal sectional view through an embodiment of a distal anchor that is attached to a connector by a crimped loop. InFIG. 2D, the distal end ofconnector16 is looped. This looped distal end ofconnector16 is inserted intodistal anchor12.Distal anchor12 is crimped to attach the looped distal end ofconnector16 todistal anchor12.
• FIG. 2E shows a longitudinal sectional view through an embodiment of a distal anchor that is attached to a connector by multiple crimped loops. InFIG. 2E, the distal end ofconnector16 is folded multiple times to obtain multiple loops. These multiple loops ofconnector16 are inserted intodistal anchor12.Distal anchor12 is crimped to attach the multiple loops ofconnector16 todistal anchor12.
• FIG. 2F shows a perspective view through an embodiment of a distal anchor that is attached to a connector by a buckle. InFIG. 2F, the distal end ofconnector16 is passed throughdistal anchor12. The distal end ofconnector16 is passed through abuckle47 and is looped. The distal end ofconnector16 is inserted back intodistal anchor12. The distal end ofconnector16 may be attached todistal anchor12 by one or more mechanisms disclosed herein. In the embodiment shown inFIG. 2F, the distal end ofconnector16 is attached todistal anchor12 by a suitable biocompatible adhesive.Distal anchor12 may be crimped to attachconnector16 todistal anchor12.
• FIG. 2G shows a side view of the embodiment of a distal anchor ofFIG. 2F that is attached to a connector under tension.Buckle47 prevents the looped distal end ofconnector16 from unraveling withindistal anchor12.
• FIG. 2H shows a perspective view of an embodiment of a distal anchor that is attached to a connector by a knot. InFIG. 2H, the distal end ofconnector16 is passed throughdistal anchor12. The distal end ofconnector16 is knotted. This knot attaches the distal end ofconnector16 todistal anchor12.
• FIG. 2I shows a longitudinal sectional view through an embodiment of a distal anchor that is attached to a connector by an adhesive. InFIG. 2I, the distal end ofconnector16 is passed throughdistal anchor12. This distal end ofconnector16 is attached todistal anchor12 by a suitable biocompatible adhesive. Examples of biocompatible adhesives that can be used to attachconnector16 toproximal anchor12 include, but are not limited to epoxies, cyanoacrylates and thermoplasitics. The inner surface ofdistal anchor12 may be roughened or may be provided with one or more projections or depressions to increase the strength of the attachment betweenconnector16 toproximal anchor12.
• The various distal anchors disclosed herein may be delivered by one or more distal anchor delivery devices. Such distal anchor delivery devices may be introduced in the body of a human or animal through a variety of access routes. For example, the prostate gland of a patient with BPH may be treated by a distal anchor delivery device introduced trans-urethrally.
• FIG. 3A shows a side view of a first embodiment of a distalanchor delivery device30. Distalanchor delivery device30 comprises an elongateendoscope introducing tube48. Theendoscope introducing tube48 may range in length from 8 inches to 13 inches. In one embodiment,endoscope introducing tube48 is made of stainless steel. The proximal end ofendoscope introducing tube48 may comprise anendoscope hub50 to lock an endoscope toendoscope introducing tube48. In the text the endoscope is used to mean any telescope, camera or optical system that provides visualization. In one embodiment, the endoscope is a 4 mm endoscope. A region ofendoscope introducing tube48 is attached to adistal handle assembly52. In one embodiment,distal handle assembly52 is made of anodized aluminum, stainless steel and nickel-plated brass components. The components may be fastened to each other by soldering, braising, welding or stainless steel fasteners. In the embodiment shown inFIG. 3A,distal handle assembly52 comprises adistal attachment54 that enclosesendoscope introducing tube48.Distal attachment54 is further attached to adistal handle56. A region ofendoscope introducing tube48 proximal todistal handle assembly52 passes through aproximal handle assembly58. In one embodiment,proximal handle assembly58 is made of machined acetal resin engineering plastic (e.g., Delrin®, E.I. du Pont de Nemours and Company, Wilmington, Del.), polytetrafluoroethylene (PTFE), and nickel-plated brass components. The components may be fastened to each other by stainless steel fasteners.Proximal handle assembly58 can slide over the outer surface ofendoscope introducing tube48. In the embodiment shown inFIG. 3A, distalanchor delivery device30 further comprises one or more guide rails60. The distal ends ofguide rails60 are attached to a proximal surface ofdistal attachment54.Guide rails60 pass throughproximal handle assembly58 such thatproximal handle assembly58 can slide over the outer surface of guide rails60.Guide rails60 help to stabilize the orientation ofproximal handle assembly58 relative todistal handle assembly52 during the relative motion ofproximal handle assembly58 relative todistal handle assembly52. Distalanchor delivery device30 further comprises an elongateneedle introducing tube62.Needle introducing tube62 is attached to endoscope introducingtube48 as shown inFIG. 3A. In one embodiment,needle introducing tube62 is made of stainless steel.Needle introducing tube62 passes throughdistal handle assembly52 and is attached to a region ofdistal handle assembly52. The distal tip ofneedle introducing tube62 may comprise a curved region. The curved distal tip ofneedle introducing tube62 is used to direct the exit trajectory of anelongate needle32 that slides throughneedle introducing tube62. In one embodiment,needle32 is made of nickel-titanium allow (e.g., nickel-titanium alloy (e.g., nitinol)) and comprises a ground beveled tip. The proximal end ofneedle32 is attached toproximal handle assembly58. Thus a user can moveneedle32 throughneedle introducing tube62 by movingproximal handle assembly58 alongendoscope introducing tube48. Distalanchor delivery device30 may comprise a needle stop to control the maximum movement ofproximal handle assembly58 alongendoscope introducing tube48. This in turn controls the maximum depth of penetration ofneedle32 into a tissue.Needle32 comprises a lumen through which a distal anchor deploying system is introduced in the anatomy. The distal anchor deploying system is used to deploydistal anchor12 in the anatomy. The distal anchor deploying system comprises apusher64 that pushesdistal anchor12 out ofneedle32 and into the anatomy. In one embodiment,pusher64 is made of nickel-titanium alloy (e.g., nitinol). In the embodiment shown inFIG. 3A, the proximal end ofpusher64 is attached to atrigger66 that is attached to aproximal handpiece68 of theproximal handle assembly58.Trigger66 is attached toproximal handpiece68 by apivot70. Thus, a user can movepusher64 relative toneedle32 by movingtrigger66.Proximal handle assembly58 further comprises asafety system72 that prevents unwanted motion oftrigger66. In the embodiment shown inFIG. 3A,safety system72 comprises a lock pin that locks trigger66 toproximal handpiece68. In one embodiment, the components of the safety system are made of stainless steel.
• In one embodiment, distalanchor delivery device30 is sized to be introduced through a 25F cystoscope sheath. The length of distalanchor delivery device30 within the sheath ranges from 6 to 10 inches. In this embodiment,endoscope introducing tube48 andendoscope hub50 are designed to fit a 4 mm telescope. In this embodiment, the outer diameter ofendoscope introducing tube48 ranges from 0.174 to 0.200 inches and the inner diameter ofendoscope introducing tube48 ranges from 0.160 to 0.180 inches. In this embodiment, the outer diameter ofneedle introducing tube62 ranges from 0.059 to 0.83 inches and the inner diameter ofneedle introducing tube62 ranges from 0.041 to 0.072 inches. In this embodiment, the outer diameter ofneedle32 ranges from 0.034 to 0.043 inches and the inner diameter ofneedle32 ranges from 0.027 to 0.035 inches. In this embodiment, the outer diameter ofpusher64 ranges from 0.020 to 0.026 inches and the inner diameter ofpusher64 ranges from 0.014 to 0.019 inches. In this embodiment, the radius of the curved distal tip ofneedle introducing tube62 ranges from 0.25 to 0.50 inches. In this embodiment, the maximum distance through whichproximal handle assembly58 can slide over the outer surface ofendoscope introducing tube48 ranges from 1 to 2 inches. In this embodiment, the maximum distance through whichpusher64 travels relative toneedle32 ranges from 0.2 to 0.8 inches. In a preferred embodiment, distalanchor delivery device30 is sized to be introduced through a 25F cystoscope sheath. The length of distalanchor delivery device30 within the sheath is 9.5 inches. In this preferred embodiment,endoscope introducing tube48 andendoscope hub50 are designed to fit a 4 mm telescope. In this preferred embodiment, the outer diameter ofendoscope introducing tube48 is 0.18 inches and the inner diameter ofendoscope introducing tube48 is 0.16 inches. In this preferred embodiment, the outer diameter ofneedle introducing tube62 is 0.083 inches and the inner diameter ofneedle introducing tube62 is 0.072 inches. In this preferred embodiment, the outer diameter ofneedle32 is 0.037 inches and the inner diameter ofneedle32 is 0.030 inches. In this preferred embodiment, the outer diameter ofpusher64 is 0.025 inches and the inner diameter ofpusher64 is 0.020 inches. In this preferred embodiment, the radius of the curved distal tip ofneedle introducing tube62 is 0.3 inches. In this preferred embodiment, the maximum distance through whichproximal handle assembly58 can slide over the outer surface ofendoscope introducing tube48 is 1.7 inches. In this preferred embodiment, the maximum distance through whichpusher64 travels relative toneedle32 is 0.4 inches.
• FIG. 3B shows the distal anchor delivery device ofFIG. 3A with a portion of the distal region removed.
• FIG. 3C shows an enlarged view of thedistal region3C ofFIG. 3B.FIG. 3C shows the distal end of distalanchor delivery device30 comprising elongateendoscope introducing tube48 andneedle introducing tube62.
• FIGS. 3D through 3K show various steps of a method of deployingdistal anchor12 in the anatomy by distalanchor delivery device30 ofFIG. 3A. For the description below regardingFIGS. 3D through 3K, the procedure is described as if applied to prostate gland although other anatomical regions could be used. InFIG. 3D, anelongate sheath28 is introduced in the urethra. In one embodiment,sheath28 is a 25F cystoscope resectoscope sheath. The position ofsheath28 is adjusted such that the distal tip ofsheath28 is close to the region of the urethra enclosed by the prostate gland. InFIG. 3E, distalanchor delivery device30 is introduced throughsheath28 into the urethra. This step may performed under endoscopic visualization by anendoscope74 inserted in theendoscope introducing tube48 of distalanchor delivery device30. Distalanchor delivery device30 may be rotated to orient the distal tip ofneedle introducing tube62 in a desired orientation with respect to an anatomical organ such as the prostate gland. InFIG. 3F,proximal handle assembly58 is moved in the distal direction overendoscope introducing tube48 relative todistal handle assembly52. This in turn causes needle32 to advance throughneedle introducing tube62. The distal tip ofneedle32 emerges out of the distal tip ofneedle introducing tube62.Needle32 penetrates through one or more anatomical regions. In one method embodiment, the distal tip ofneedle32 emerges out of the capsule of the prostate gland and enters the surrounding pelvic space. In one method embodiment, the dimensions of the prostate gland are measured. This information is then used to determine the distance through which needle32 is advanced throughneedle introducing tube62. InFIG. 3G,safety system72 is released. This step unlockstrigger66 fromproximal handpiece68. InFIG. 3H, trigger66 is lifted. This causespusher64 to advance in the distal direction throughneedle32. This in turn causesdistal anchor12 to emerge out through the distal end ofneedle32 and into the anatomy. In one method embodiment,distal anchor12 emerges out ofneedle32 and enters the surrounding pelvic space. InFIG. 3I,connector16 is pulled in the proximal direction. This causesdistal anchor12 to orient itself perpendicularly toconnector16. InFIG. 3J,needle32 is removed from the anatomy by pullingproximal handle assembly58 in the proximal direction overendoscope introducing tube48. InFIG. 3K, distalanchor delivery device30 is removed from the anatomy.
• FIG. 3L shows a side view of a second embodiment of a distalanchor delivery device30. Distalanchor delivery device30 comprises anendoscope introducing tube48. The proximal end ofendoscope introducing tube48 may comprise anendoscope hub50 to lock anendoscope74 to endoscope introducingtube48.Endoscope introducing tube48 encloses a lumen through whichendoscope74 may be introduced into the anatomy. Distalanchor delivery device30 comprises aneedle introducing tube62.Endoscope74 is introduced throughendoscope introducing tube48 such that the distal end ofneedle introducing tube62 is located near the distal end ofendoscope74.Needle introducing tube62 is used to introduce aneedle32 into the anatomy. The distal end ofneedle introducing tube62 may comprise a curved, bent or tapered region to introduceneedle32 into the anatomy at an angle to the axis ofendoscope74.Needle introducing tube62 is attached to endoscope introducingtube48 by acoupling element76. Distalanchor delivery device30 may be introduced into the anatomy through a suitable sheath. Such as sheath may comprise a flushing or aspiration port. The flushing or aspiration port may be in fluid communication with the lumen of the sheath to allow a user to introduce fluids into or remove fluids from an anatomical region.
• FIGS. 3M through 3T show perspective views of distalanchor delivery device30 ofFIG. 3L showing the steps of an embodiment of a method of deploying an anchor in an anatomical region. Distalanchor delivery device30 comprisesendoscope introducing tube48 that encloses a lumen. Anendoscope74 is located in the lumen ofendoscope introducing tube48. In the step shown inFIG. 3M, distalanchor delivery device30 is introduced in an anatomical region such as the urethra through anelongate sheath28. Distalanchor delivery device30 may be rotated to orient the distal tip ofneedle introducing tube62 in a desired orientation. Aneedle32 is introduced throughneedle introducing tube62. In the step shown inFIG. 3N,needle32 is advanced throughneedle introducing tube62 such that the distal end ofneedle32 emerges out of the distal end ofneedle introducing tube62 and enters an anatomical region. In one method embodiment,needle32 is advanced such that the distal end ofneedle32 penetrates through the prostate gland and enters the surrounding pelvic space. In this embodiment, the dimensions of the prostate gland may be measured. This information may then be used to determine the distance through which distal end ofneedle32 penetrates through the prostate gland. In the step shown inFIG. 3O,distal anchor12 attached toconnector16 is introduced intoneedle32.Distal anchor12 is pushed in the distal direction throughneedle32 bypusher64. In the step shown inFIG. 3P,distal anchor12 is further pushed in the distal direction throughneedle32 bypusher64 such thatdistal anchor12 emerges out of the distal end ofneedle32. In the step shown inFIG. 3Q,connector16 is pulled in the proximal direction. This causesdistal anchor12 to orient itself perpendicularly toconnector16. In the step shown inFIG. 3R,needle32 andpusher64 are pulled along the proximal direction. This step reintroduces the distal tip ofneedle32 intoneedle introducing tube62. In the step shown inFIG. 3S,pusher64 andneedle32 are pulled further along the proximal direction such thatpusher64 andneedle32 are removed from distalanchor delivery device30. In the step shown inFIG. 3T, distalanchor delivery device30 is pulled along the proximal direction to remove distalanchor delivery device30 from the anatomy.
• FIG. 3U shows a first side view of the distal tip of an embodiment of a needle that can be used to introduce one or more of the distal anchors disclosed herein.FIG. 3U shows aneedle32 comprising a sharp distal tip.Needle32 may be made of suitable biocompatible materials including, but not limited to nickel-titanium alloy (e.g., nitinol), stainless steel, etc.Needle32 may comprise one or more curved, bent or angled regions. The outer diameter ofneedle32 may range from 0.034 inches to 0.043 inches.Needle32 encloses a lumen such that the inner diameter ofneedle32 ranges from 0.027 niches to 0.035 inches. In a preferred embodiment, the outer diameter ofneedle32 is approximately 0.0372 inches and the inner diameter is approximately 0.0295 inches. The length ofneedle32 may range from 10 to 15 inches. In a preferred embodiment, length ofneedle32 is 13+/−0.2 inches. In the embodiment shown inFIG. 3U, the distal tip ofneedle32 has afirst bevel78 and asecond bevel80. In a preferred embodiment, the angle betweenfirst bevel78 and the axis ofneedle32 is 17 degrees. In this embodiment, the distance along the axis ofneedle32 from the proximal end offirst bevel78 to the distal end ofneedle32 is approximately 0.12 inches.Second bevel80 is curved as shown inFIG. 3U. In the embodiment shown inFIG. 3U, the distance along the axis ofneedle32 from the proximal end ofsecond bevel80 to the distal end ofneedle32 is approximately 0.07 inches.
• FIG. 3V shows a second side view of the distal tip of the embodiment of the needle shown inFIG. 3U.FIG. 3V shows a side view ofneedle32 showingfirst bevel78 andsecond bevel80.
• In an alternate embodiment, the outer diameter ofneedle32 is 0.050+/−0.008 inches.Needle32 encloses a lumen such that the inner diameter ofneedle32 is 0.038+/−0.008 inches. The length ofneedle32 is 12+/−4 inches. The angle betweenfirst bevel78 and the axis ofneedle32 may range from 20 to 24 degrees.
• The distal tip of distalanchor delivery device30 may comprise one or more guiding mechanisms to accurately guide the trajectory ofneedle32 asneedle32 emerges from the distal tip of distalanchor delivery device30. Such guiding mechanisms may also be used to prevent or reduce the scraping of the inner surface of distalanchor delivery device30 by the sharp distal end ofneedle32. For example,FIG. 3W shows a longitudinal section through the distal tip of distalanchor delivery device30 comprising abushing82 to guide the trajectory ofneedle32 through distalanchor delivery device30.Bushing82 may be made of suitable biocompatible materials including, but not limited to biocompatible metals such as stainless steel, nickel-titanium alloy (e.g., nickel-titanium alloy (e.g., nitinol)), and/or polymers; etc. In the example shown inFIG. 3W, bushing82 is made of a curved cylindrical member.Bushing82 lines the inner surface of distalanchor delivery device30. In one embodiment, bushing82 is attached to the inner surface of distalanchor delivery device30 by a suitable adhesive. The distal end ofbushing82 is located proximal to the distal tip of distalanchor delivery device30 as shown. This enables the distal sharp tip ofneedle32 to emerge from the distal tip of distalanchor delivery device30 without substantially scraping the inner surface of distalanchor delivery device30.
• FIG. 3X shows a longitudinal section through the distal tip of distalanchor delivery device30 comprising adistal crimp84 or dimple to guide the trajectory ofneedle32 through distalanchor delivery device30.Distal crimp84 may be by crimping or dimpling the distal region of distalanchor delivery device30 such that a region ofdistal crimp84 extends into the lumen of distalanchor delivery device30.Distal crimp84 is located proximal to the distal tip of distalanchor delivery device30 as shown.Distal crimp84 acts as a ramp forneedle32. Thusneedle32 emerges from the distal tip of distalanchor delivery device30 without substantially scraping the inner surface of distalanchor delivery device30. Distalanchor delivery device30 may comprise one or moredistal crimps84 or dimples.
• The distal tip of distalanchor delivery device30 may comprise a bent, curved or angled tip. Such a bent, curved, or angled tip may be designed to introduce one or more devices such asneedle32 into the anatomy at an angle to the axis of distalanchor delivery device30. In an alternate embodiment, the distal tip of distalanchor delivery device30 comprises one or more bent, curved or angled lumens. For example,FIG. 3Y shows a perspective view of the distal tip of distalanchor delivery device30 comprising a bent, curved or angledneedle introducing lumen86.Needle introducing lumen86 may be used to introduce aneedle32 or other devices into the anatomy. In the embodiment shown inFIG. 3Y,needle introducing lumen86 comprises a straight proximal region and a bent, curved or angled distal region. The distal most region ofneedle introducing lumen86 may be oriented to the longitudinal axis of distalanchor delivery device30 at an angle ranging from 30 degrees to 70 degrees. In the embodiment shown inFIG. 3Y, distalanchor delivery device30 further comprises a bent, curved or angledendoscope introducing lumen88.Endoscope introducing lumen88 may be used to introduce anendoscope74 or other devices into the anatomy. In the embodiment shown inFIG. 3Y,endoscope introducing lumen88 comprises a straight proximal region and a bent, curved or angled distal region. The distal most region ofendoscope introducing lumen88 may be oriented to the longitudinal axis of distalanchor delivery device30 at an angle. Thus, bothneedle32 andendoscope74 may be introduced into the anatomy at desired angles through distalanchor delivery device30.
• In one embodiment,needle introducing lumen86 may be made by drilling a lumen through the distal region of distalanchor delivery device30. In another embodiment,needle introducing lumen86 is made of two grooved elongate parts that are attached to each other such that the two grooved elongate parts encloseneedle introducing lumen86. For example, the embodiment of the distal tip of distalanchor delivery device30 shown inFIG. 3Y is made of two elongate parts: a firstelongate part90 and a secondelongate part92.FIG. 3Y′ shows a perspective view of an embodiment of a firstelongate part90 that is used to construct the distal end of an embodiment of distalanchor delivery device30. Firstelongate part90 comprises afirst groove94.First groove94 has a D-shaped cross section. The diameter of the semi-circular region offirst groove94 is approximately 0.045+/−0.005 inches. Firstelongate part90 further comprises asecond groove96.Second groove96 also has a D-shaped cross section. The diameter of the semi-circular region ofsecond groove96 is approximately 0.172+/−0.010 inches.FIG. 3Z shows a perspective view of an embodiment of a secondelongate part92 that is used to construct the distal end of an embodiment of distalanchor delivery device30. Secondelongate part92 comprises athird groove98.Third groove98 has a D-shaped cross section. Firstelongate part90 and secondelongate part92 are attached to each other such thatsecond groove96 andthird groove98 formendoscope introducing lumen88. Also, when firstelongate part90 and secondelongate part92 are attached to each other,first groove94 and an outer surface of secondelongate part92 form a D-shapedneedle introducing lumen86.
• FIGS. 4A and 4B show longitudinal sections through a first embodiment of a proximal anchor showing the steps of an embodiment of a method of attaching the proximal anchor to a connector. In the embodiment shown inFIG. 4A,proximal anchor14 comprises a hollow tube. The hollow tube comprises aconnector opening100 located roughly midway between the ends of the tube. In the embodiment shown inFIG. 4A,connector opening100 is made by cutting outwardly openingflap26 in the material of the tube. Outwardly openingflap26 is folded as shown inFIG. 4A to create a blunt edge toconnector opening100.Proximal anchor14 further comprises alocking tab102. Lockingtab102 is made by cutting a flap in the material ofproximal anchor14 and bending the flap into the lumen ofproximal anchor14 as shown.Connector16 entersproximal anchor14 throughconnector opening100.Connector16 emerges out ofproximal anchor14 through the distal end ofproximal anchor14.Connector16 can be attached toproximal anchor14 by alock pin104.Lock pin104 comprises an elongate body with a tapering distal tip.Lock pin104 comprises alocking slot106. Lockingslot106 is designed such thatlocking tab102 fits into lockingslot106. This temporarily lockslock pin104 toproximal anchor14 as shown inFIG. 4A. InFIG. 4B,lock pin104 is pushed in the distal direction by a user. This releases lockingtab102 from lockingslot106. This in turn releases lockpin104 fromproximal anchor14.Lock pin104 then moves in the distal direction. The tapering distal tip oflock pin104 then wedges firmly betweenconnector16 andproximal anchor14. This attachesconnector16 toproximal anchor14.Lock pin104 andproximal anchor14 may comprise further mechanisms to prevent relative motion between lock pin andproximal anchor14 afterconnector16 is attached toproximal anchor14.
• One or more edges ofconnector opening100 may be smoothened. In one method embodiment, the edges are smoothened by applying a coating. In another method embodiment, the edges are smoothened by polishing. In another embodiment, the edges are smoothened by folding the material aroundconnector opening100.
• In one embodiment of a method of manufacturingproximal anchor104, a tube is laser cut with a radially aligned laser. The geometry of the laser cut pattern is specified using a flat pattern drawing which is mapped onto the outside circumference of the tube.FIG. 4C shows a first embodiment of a flat pattern that can be used to manufactureproximal anchor14 ofFIG. 4A. The length of the rectangular region represents the length of the tube. The width of the rectangular region OC represents the outer circumference of the tube. InFIG. 4C, thirdflat pattern108 comprises a rectangular region. In one embodiment, the length of the rectangular region is 0.236+/−0.005 inches and the width of the rectangular region OC is 0.088+/−0.002 inches. Thirdflat pattern108 further comprises aU-shaped slot110 cut at the proximal end of thirdflat pattern108 as shown inFIG. 4C. The largest width ofslot110 is 0.028+/−0.001 inches. The total length ofslot110 is 0.050+/−0.002 inches. The proximal end ofslot110 encloses a rectangular region as shown inFIG. 4C. The rectangular region is folded to create outwardly openingflap26. The distal end ofslot110 comprises rounded edges with a radius of approximately 0.014 inches. The distal region of thirdflat pattern108 comprises a secondU-shaped slot112 as shown inFIG. 4C. In one embodiment of a method of manufacturingproximal anchor14, a nickel-titanium alloy (e.g., nickel-titanium alloy (e.g., nitinol)) or stainless steel tube is cut according to thirdflat pattern108. The rectangular region ofslot110 is bent outwards to create outwardly openingflap26. The region enclosed by secondU-shaped slot112 is bent inwards to create lockingtab102.
• FIGS. 4D and 4E show longitudinal sections through a second embodiment of a proximal anchor showing the steps of an embodiment of a method of attaching the proximal anchor to a connector. In the embodiment shown inFIG. 4D,proximal anchor14 comprises a hollow tube. The hollow tube comprises aconnector opening100 located roughly midway between the ends of the tube. In the embodiment shown inFIG. 4D,connector opening100 is made by cutting outwardly openingflap26 in the material of the tube. Outwardly openingflap26 is folded as shown inFIG. 4D to create a blunt edge toconnector opening100.Connector16 entersproximal anchor14 throughconnector opening100.Connector16 emerges out ofproximal anchor14 through afirst shearing opening114 ofproximal anchor14.Connector16 can be attached toproximal anchor14 by alock pin104.Lock pin104 comprises an elongate body with a tapering proximal tip.Proximal anchor14 further comprises a securing mechanism to preventlock pin104 from separating fromproximal anchor14. In the embodiment shown inFIG. 4D, the securing mechanism comprises a lockingcrimp103. Lockingcrimp103 is made by crimping a region of the wall ofproximal anchor14. Lockingcrimp103 preventslock pin104 from accidentally emerging from the distal end ofproximal anchor14. In the embodiment shown inFIG. 4D, proximal anchor further comprises a second securing mechanism. The second securing mechanism comprises alocking tab102. Lockingtab102 fits into alocking slot106 present onlock pin104. This temporarily lockslock pin104 toproximal anchor14 as shown inFIG. 4D.Lock pin104 further comprises adistal locking notch118 that is located distal to lockingslot106.Connector16 is attached toproximal anchor14 by pulling anactuator120 located on a proximalanchor delivery device34.Actuator120 comprises a distal bent region as shown inFIG. 4D. The distal bent region ofactuator120 pulls the distal end oflock pin104 in the proximal direction.Actuator120 further comprises asecond shearing opening122, such thatconnector16 passes throughsecond shearing opening122. Proximal anchor is prevented from moving in the proximal direction by aholder124 located on a proximalanchor delivery device34.
• InFIG. 4E, a user pullsactuator120 in the proximal direction.Actuator120 in turn pullslock pin104 in the proximal direction. This releases lockingtab102 from lockingslot106. This in turn releases lockpin104 fromproximal anchor14.Lock pin104 then moves in the proximal direction. The tapering proximal tip oflock pin104 then wedges firmly betweenconnector16 andproximal anchor14. This attachesconnector16 toproximal anchor14. Also, lockingtab102 locks intodistal locking notch118 thereby further securinglock pin104 toproximal anchor14. The movement oflock pin104 in the proximal direction also shearsconnector16 betweenfirst shearing opening114 andsecond shearing opening122. This cutsconnector16 thereby releasingproximal anchor14 from proximalanchor delivery device34.
• Connector16 may enter or exitproximal anchor14 through one or more connector openings. The walls of such openings may comprise one or more bent tabs. Such bent tabs may be bent inwards into the proximal anchor and may be used towedge lock pin104 toconnector16. For example,FIGS. 4F and 4G show longitudinal sections through a third embodiment of a proximal anchor showing the steps of an embodiment of a method of attaching the proximal anchor to a connector. In the embodiment shown inFIG. 4F,proximal anchor14 comprises a hollow tube. The hollow tube comprises aconnector opening100 located roughly midway between the ends of the tube. In the embodiment shown inFIG. 4F,connector opening100 is made by cutting an H-shaped slot in the material of the tube. The H-shaped slot creates an outwardly openingflap26. Outwardly openingflap26 is folded as shown inFIG. 4F to create a blunt edge toconnector opening100. The H-shaped slot also creates an inwardly openingwedging tab126 as shown inFIG. 4F.Proximal anchor14 further comprises alocking tab102. Lockingtab102 is made by cutting a flap in the material ofproximal anchor14 and bending the flap into the lumen ofproximal anchor14 as shown.Connector16 entersproximal anchor14 throughconnector opening100.Connector16 emerges out ofproximal anchor14 through an end ofproximal anchor14.Connector16 can be attached toproximal anchor14 by alock pin104.Lock pin104 comprises an elongate body with a tapering tip.Lock pin104 comprises alocking slot106. Lockingslot106 is designed such thatlocking tab102 fits into lockingslot106. This temporarily lockslock pin104 toproximal anchor14 as shown inFIG. 4F. InFIG. 4G,lock pin104 is moved by a user. This releases lockingtab102 from lockingslot106. This in turn releases lockpin104 fromproximal anchor14.Lock pin104 then moves withinproximal anchor14 such that the tapering tip oflock pin104 wedges firmly betweenconnector16 andproximal anchor14. Further, wedgingtab126 gets wedged betweenlock pin104 andconnector16. This attachesconnector16 toproximal anchor14.Lock pin104 andproximal anchor14 may comprise mechanisms to prevent relative motion betweenlock pin104 andproximal anchor14 afterconnector16 is attached toproximal anchor14.
• In one embodiment of a method of manufacturing proximal anchors ofFIGS. 4F and 4G, a tube is laser cut with a radially aligned laser. The geometry of the laser cut pattern is specified using a flat pattern drawing which is mapped onto the outside circumference of the tube.FIG. 4H shows an embodiment of a flat pattern that can be used to designproximal anchor14 ofFIGS. 4F and 4G. InFIG. 4H, fourthflat pattern128 comprises a rectangular region. In one embodiment, the length of the rectangular region is 0.236+/−0.005 inches and the width of the rectangular region OC is 0.088+/−0.002 inches. The proximal region of fourthflat pattern128 comprises aU-shaped slot112 as shown inFIG. 4H. Fourthflat pattern128 further comprises an H-shapedslot130 as shown inFIG. 4H. The largest width ofslot110 is 0.028+/−0.001 inches. The total length ofslot110 is 0.050+/−0.002 inches. In one embodiment of a method of manufacturingproximal anchor14 ofFIGS. 4F and 4G, a nickel-titanium alloy (e.g., nickel-titanium alloy (e.g., nitinol)) or stainless steel tube is cut according to fourthflat pattern128. The proximal rectangular region created by H-shapedslot130 is bent outwards to create outwardly openingflap26. The distal rectangular region created by H-shapedslot130 is bent inwards to create wedgingtab126. The region created byU-shaped slot112 is bent inwards to create lockingtab102.
• FIGS. 4I and 4J show longitudinal sections through a fourth embodiment of a proximal anchor showing the steps of an embodiment of a method of attaching the proximal anchor to a connector.Proximal anchor14 comprises a hollow tube. The tube comprises a proximal opening and a distal opening.Proximal anchor14 further comprisesmultiple connector openings198.Connector16 is introduced through oneconnector opening100 and is weaved through themultiple connector openings198 as shown inFIGS. 4I and 4J. The edges ofconnector openings198 may be coated or polished to facilitate smooth movement ofproximal anchor14 overconnector16.Proximal anchor14 further compriseslock pin104 located in the lumen ofproximal anchor14.Proximal anchor14 may comprise one or more restricting elements to restrict the movement oflock pin104 withinproximal anchor14. In the embodiment shown inFIGS. 4I and 4J,proximal anchor14 comprises twocrimps132 that act as restricting elements.Crimps132 preventlock pin104 from escaping from the lumen ofproximal anchor14. In the step shown inFIG. 4I,proximal anchor14 is advanced overconnector16 to positionproximal anchor14 in a desired location. In the step shown inFIG. 4J,lock pin104 is advanced throughproximal anchor14.Lock pin104 wedges betweenconnector16 andproximal anchor14. This locksconnector16 toproximal anchor14. The excess length ofconnector16 may be cut or trimmed.
• Several embodiments oflock pin104 may be used to lockconnector16 toproximal anchor14. Such lock pins104 may comprise one or more tapered regions that wedge betweenconnector16 and a region ofproximal anchor14. In addition, several alternate embodiments of wedging elements may be used to attachconnector16 to a region ofproximal anchor14. For example,FIGS. 4K and 4L show longitudinal sections through a proximal anchor showing the steps of an embodiment of a method of anchoring a connector to a proximal anchor by an elongate wedging device comprising multiple branches or bristles. In the embodiment shown inFIG. 4K,proximal anchor14 comprises aconnector opening100 through which aconnector16 passes. Anelongate wedging element134 also passes throughproximal anchor14 such that one end of wedgingelement134 can be pulled by a user. The embodiment of wedgingelement134 shown inFIG. 4K comprises anelongate wedging shaft136. One or more branches or bristles138 are connected to wedgingshaft136. In one embodiment, wedgingshaft136 and bristles138 are made of suitable polymeric materials. Examples of such polymeric materials include, but are not limited to polyester, polyimide, PEEK, polyurethane, etc. In one embodiment, one ormore bristles138 are connected to each other to form a web. The movement ofproximal anchor14 is restricted by astopper140. In the step shown inFIG. 4K,proximal anchor14 is advanced overconnector16 to positionproximal anchor14 in a desired location. In the step shown inFIG. 4L, a user pulls wedgingelement134. This causes a region of wedgingelement134 comprising one ormore bristles138 to wedge betweenproximal anchor14 andconnector16. This inturn locks connector16 toproximal anchor14. The excess length ofconnector16 and/or wedgingelement134 may be cut or trimmed.
• The various wedging elements, lock pins, etc. disclosed herein may be deployed using one or more flexible pull shafts. For example,FIGS. 4M and 4N show longitudinal sections through an embodiment of a proximal anchor showing the steps of an embodiment of a method of anchoring a connector to a proximal anchor by a lock pin pulled by a flexible pull shaft. InFIG. 4M,proximal anchor14 comprises a hollow elongate body comprising aconnector opening100 through which aconnector16 passes.Proximal anchor14 encloses anelongate lock pin104 comprising a tapering proximal end. A user can pulllock pin104 in the proximal direction by pulling an elongate flexible pull shaft142. Flexible pull shaft142 is detachably attached to lockpin104. The movement ofproximal anchor14 is restricted by astopper140. In the step shown inFIG. 4M,proximal anchor14 is advanced overconnector16 to positionproximal anchor14 in a desired location. In the step shown inFIG. 4N, flexible pull shaft142 is pulled in the proximal direction by a user. This pullslock pin104 in the proximal direction.Lock pin104 wedges betweenconnector16 andproximal anchor14. This locksconnector16 toproximal anchor14. Flexible pull shaft142 is detached fromlock pin104. In one embodiment, the attachment between flexible pull shaft142 andlock pin104 is designed to break at a pre-defined high force. In this embodiment, after the step of lockingconnector16 toproximal anchor14, flexible pull shaft142 is pulled in the proximal direction at the pre-defined high force. This detaches flexible pull shaft142 fromlock pin104. In another embodiment, the attachment between flexible pull shaft142 andlock pin104 is electrolytically detachable. In this embodiment, after the step of lockingconnector16 toproximal anchor14, an electric current is passed through the attachment between flexible pull shaft142 andlock pin104. This electrolytically dissolves the attachment between flexible pull shaft142 andlock pin104. This in turn detaches flexible pull shaft142 fromlock pin104.
• FIGS. 4O and 4P show longitudinal sections through an embodiment of a proximal anchor showing the steps of an embodiment of a method of anchoring a connector to the proximal anchor by a hollow wedging element. InFIG. 4O,proximal anchor14 comprises a hollow elongate body comprising aconnector opening100 through which aconnector16 passes.Proximal anchor14 encloses an elongatehollow wedging element144 comprising a tapering distal end. Hollow wedgingelement144 is made of suitable high tensile strength materials such thathollow wedging element144 can be pushed overconnector16. Examples of such materials include, but are not limited to high stiffness polyimide, or PEEK, etc. The movement ofproximal anchor14 is restricted by astopper140. In the step shown inFIG. 4O,proximal anchor14 is advanced overconnector16 to positionproximal anchor14 in a desired location. Hollow wedgingelement144 is advanced overconnector16 while pullingconnector16 in the proximal direction. This causeshollow wedging element144 to wedge betweenconnector16 andproximal anchor14 as shown inFIG. 4P. This in turn attachesproximal anchor14 toconnector16. In one embodiment, the lumen ofhollow wedging element144 is lined with one or more barbs or projections. The one or more barbs or projections allow motion ofconnector16 through the lumen ofhollow wedging element144 in one direction and prevent or substantially resist motion ofconnector16 through the lumen ofhollow wedging element144 in the opposite direction. In an alternate embodiment, wedgingelement144 may be non-coaxial withconnector16. In another alternate embodiment, wedgingelement144 may be pulled in a proximal direction in order to wedge wedgingelement144 betweenconnector16 andproximal anchor14.
• The excess lengths ofconnector16 and/or wedging elements may be cut or trimmed using a variety of mechanisms. For example,FIGS. 4Q and 4R show an embodiment of a method of using a compression cutter for cutting the excess length ofconnector16 and a wedging element. In the step shown inFIG. 4Q, aconnector16 is attached toproximal anchor14 byhollow wedging element144. This may be done by the steps shown inFIGS. 4O-4P. Acompression cutter146 is advanced over hollow wedgingelement144.Compression cutter146 comprises two or more distal cutting edges. The outer surface of the distal cutting edges comprises an enlarged region as shown inFIG. 4Q. The enlarged region increases the radial profile ofcompression cutter146 near the distal cutting edges. A compressingshaft148 is advanced overcompression cutter146. In the step shown inFIG. 4R, compressingshaft148 is advanced over the distal end ofcompression cutter146. This exerts a radially inward force on the distal cutting edges. This in turn compresses the distal cutting edges causing them to cut the region ofconnector16 andhollow wedging element144 enclosed by the distal cutting edges. Thus excess lengths ofconnector16 andhollow wedging element144 are removed fromproximal anchor14.
• FIGS. 4S and 4T show longitudinal sections through a first embodiment of a proximal anchor comprising a crimping zone showing the steps of an embodiment of a method of anchoring a connector to the proximal anchor. InFIG. 4S,proximal anchor14 comprises a hollow elongate body comprising aconnector opening100. Aconnector16 entersproximal anchor14 throughconnector opening100.Connector16 exitsproximal anchor14 through one end ofproximal anchor14. The proximal end ofproximal anchor14 comprises a crimpingzone150. Crimpingzone150 can be crimped by a suitable radial compressive force. Crimpingzone150 is enclosed by an elongate crimpingdevice152 as shown inFIG. 4S. The distal end of crimpingdevice152 may be used to maintain the position ofproximal anchor14. The distal end of crimpingdevice152 is compressed by a compressingshaft148. In the step shown inFIG. 4S,proximal anchor14 is advanced overconnector16 to positionproximal anchor14 in a desired location. In the step shown inFIG. 4T, compressingshaft148 is advanced over crimpingdevice152 in the distal direction tillcompression shaft148 passes over the enlarged distal end of crimpingdevice152. This exerts a radially compressive force on the distal end of crimpingdevice152. Crimpingdevice152 in turn exerts a compressive force on crimpingzone150. This force compresses crimpingzone150 causing it to crimp overconnector16. This in turn causesproximal anchor14 to attach toconnector16. The excess length ofconnector16 may be cut or trimmed using a variety of cutting or trimming mechanisms.
• FIGS. 4U and 4V show longitudinal sections through a second embodiment of a proximal anchor comprising a crimping zone showing the steps of an embodiment of a method of anchoring a connector to the proximal anchor.Proximal anchor14 comprises a hollow elongate body comprising aconnector opening100. Aconnector16 entersproximal anchor14 throughconnector opening100.Connector16 exitsproximal anchor14 through one end ofproximal anchor14. The proximal end ofproximal anchor14 can be crimped by a suitable radial compressive force. The proximal end ofproximal anchor14 is enclosed by an elongate crimpingshaft154 as shown inFIG. 4U. Crimpingshaft154 encloses a lumen. The distal end of the lumen of crimpingshaft154 is tapered as shown inFIG. 4U, such that the diameter of the lumen gradually decreases till a certain distance along the proximal direction.Connector16 passes through the lumen of crimpingshaft154 as shown inFIG. 4U. The distal end of crimpingshaft154 and a region of proximalanchor delivery device34 may be used to maintain the position ofproximal anchor14. In the step shown inFIG. 4U,proximal anchor14 is advanced overconnector16 to positionproximal anchor14 in a desired location. In the step shown inFIG. 4V, crimpingshaft154 is advanced in the distal direction. The proximal end ofproximal anchor14 is forced into the lumen of crimpingshaft154. The tapering lumen of crimpingshaft154 exerts a radially compressive force on the proximal end ofproximal anchor14. This force compresses the proximal end ofproximal anchor14 causing it to crimp overconnector16. This in turn causesproximal anchor14 to attach toconnector16. The excess length ofconnector16 may be cut or trimmed using a variety of cutting or trimming mechanisms.
• Compression shaft148 and crimpingshaft154 may be connected to a trigger mechanism to allow a user to controllably movecompression shaft148 and crimpingshaft154.
• FIGS. 4W and 4X show a third embodiment of a proximal anchor comprising multiple crimping zones showing the steps of an embodiment of a method of anchoring a connector to the proximal anchor. InFIG. 4W,proximal anchor14 comprises a hollow elongate body comprising a connector opening. Aconnector16 entersproximal anchor14 through the connector opening.Connector16 exitsproximal anchor14 through one end ofproximal anchor14.Proximal anchor14 comprises multiple crimpingzones150. Crimpingzones150 can be crimped by a suitable radial compressive force. In the embodiment of proximal anchor shown inFIG. 4W,proximal anchor14 comprises three crimpingzones150. The crimpingzones150 are created in the material ofproximal anchor14 by creating U-shaped laser cuts. Each U-shaped cut encloses a flap that acts as a crimpingzone150. In the embodiment shown inFIG. 4W, the U-shaped laser cuts are aligned circumferentially. In an alternate embodiment, the U-shaped laser cuts are aligned along the axis ofproximal anchor14. The region ofproximal anchor14 comprising crimpingzones150 is enclosed by an elongate crimpingdevice152 as shown inFIG. 4W. The lumen of crimpingdevice152 may comprise one or more projections that coincide with crimpingzones150. The distal end of crimpingdevice152 comprises a tapering region as shown inFIG. 4W such that the outer diameter of crimpingdevice152 increases along the distal direction. The distal end of crimpingdevice152 is compressed by a compressingshaft148. In the step shown inFIG. 4W,proximal anchor14 is advanced overconnector16 to positionproximal anchor14 in a desired location. In the step shown inFIG. 4X, compressingshaft148 is advanced over crimpingdevice152 in the distal direction tillcompression shaft148 passes over the tapering distal end of crimpingdevice152. This exerts a radially compressive force on the distal end of crimpingdevice152. Crimpingdevice152 in turn exerts a compressive force on crimpingzones150. This force compresses crimpingzones150 causing them to crimp overconnector16. This in turn causesproximal anchor14 to attach toconnector16. The excess length ofconnector16 may be cut or trimmed using a variety of cutting or trimming mechanisms.
• FIG. 4Y shows a side view of an embodiment of a proximal anchor comprising a tapering outer surface. In the embodiment shown inFIG. 4Y,proximal anchor14 comprises an elongate tapering body with effective diameter “d” at one end smaller than effective diameter “D” at the other end.Proximal anchor14 further comprises an external groove or slot156 on the outer surface of the elongate tapering body. Examples of suitable biocompatible materials that may be used to constructproximal anchor14 include, but are not limited to metals e.g. nickel-titanium alloy (e.g., nickel-titanium alloy (e.g., nitinol)), stainless steel, titanium, polymers (e.g. polyester, polyimide, PEEK, polyurethane, etc.
• FIGS.4Z through4AB show side views of the embodiment of the proximal anchor ofFIG. 4Y showing the steps of an embodiment of a method of anchoring a connector to the proximal anchor by an anchoring ring. In the step shown inFIG. 4Z,proximal anchor14 is positioned at a desired location in the anatomy along aconnector16 such that a portion ofconnector16 passes throughslot156. Ananchoring ring158 is advanced overproximal anchor14. Examples of suitable biocompatible materials that may be used to construct anchoringring158 include, but are not limited to metals e.g. nickel-titanium alloy (e.g., nitinol), stainless steel, titanium, etc.; polymers e.g. polyester, polyimide, PEEK, polyurethane, etc. Anchoringring158 is advanced overproximal anchor14 by a suitable pushing device. In one embodiment, the pushing device is a hollow, elongate pushing rod. As anchoringring158 is advanced overproximal anchor14, the diameter of the region ofproximal anchor14 enclosed by anchoringring158 increases. After anchoringring158 is advanced to a certain distance alongproximal anchor14, anchoringring158 firmly grips the outer surface ofproximal anchor14. This causes a region ofconnector16 to be compressed between a region of anchoringring158 and a region ofproximal anchor14. This in turn causesproximal anchor14 to attach toconnector16. The excess length ofconnector16 may be cut or trimmed using a variety of cutting or trimming mechanisms. In one embodiment of a method of cutting or trimmingconnector16, acutting ring160 is advanced overproximal anchor14 as shown inFIG. 4AA. Examples of suitable biocompatible materials that may be used to construct cuttingring160 include, but are not limited to metals e.g. nickel-titanium alloy (e.g., nitinol), stainless steel, titanium, etc.; polymers e.g. polyester, polyimide, PEEK, polyurethane, etc. Cuttingring160 comprises a circular body that is attached to acutting blade162. As cuttingring160 is advanced overproximal anchor14, the diameter of the region ofproximal anchor14 enclosed by cuttingring160 increases. After cuttingring160 is advanced to a certain distance alongproximal anchor14, cuttingblade162 comes into contact with a region ofconnector16. Cuttingring160 is advanced further to cutconnector16 by cuttingblade162 as shown inFIG. 4AB.
• FIG. 4AC shows a cross sectional view of an embodiment of the cutting ring of FIGS.4AA and4AB. In the embodiment shown inFIG. 4AC, cuttingring160 comprises a circular body that is attached to acutting blade162 that projects radially inwards.
• FIG. 4AD shows a side view of a first embodiment of a proximal anchor made of a thermal shape memory alloy. InFIG. 4AD,proximal anchor14 comprises a hollow elongate body made of a suitable shape memory material. Examples of such shape memory materials include, but are not limited to nickel-titanium alloys (nickel-titanium alloy (e.g., nitinol)), copper-aluminum-nickel alloys, copper-zinc-aluminum alloys, iron-manganese-silicon alloys, etc. In the embodiment shown inFIG. 4AD,proximal anchor14 is made of nickel-titanium alloy (e.g., nitinol).Proximal anchor14 encloses a lumen. One end ofproximal anchor14 may be plugged by alumen plug164. In the embodiment shown inFIG. 4AD,proximal anchor14 also comprises a longitudinal slit. The longitudinal slit creates a fluid communication between the lumen ofproximal anchor14 and the exterior ofproximal anchor14.Proximal anchor14 comprises aconnector opening100. Aconnector16 entersproximal anchor14 throughconnector opening100.Connector16 exitsproximal anchor14 through one end ofproximal anchor14. A user can control the diameter of the lumen ofproximal anchor14 by changing the temperature ofproximal anchor14. In one embodiment of a method of anchoringproximal anchor14 toconnector16,proximal anchor14 is introduced in the anatomy in the martensite phase of the shape memory material ofproximal anchor14. The diameter of the lumen ofproximal anchor14 in the martensite state is sufficiently large to allowproximal anchor14 to be advanced overconnector16. The martensite phase may be achieved for example, by coolingproximal anchor14 and introducing the cooledproximal anchor14 in the anatomy. Afterproximal anchor14 warms up to the body temperature, the shape memory material recovers a programmed shape and becomes super-elastic. In the programmed shape, the diameter of the lumen ofproximal anchor14 is sufficiently small to allowproximal anchor14 to attach toconnector16. The excess length ofconnector16 may be cut or trimmed using a variety of cutting or trimming mechanisms. In one method embodiment, the temperature ofproximal anchor14 is maintained or changed by controlling the temperature of a liquid such as saline that is brought into contact withproximal anchor14 by a user. In one embodiment, the lumen ofproximal anchor14 is lined with one or more barbs or projections. The one or more barbs or projections allow motion ofconnector16 through the lumen ofproximal anchor14 in one direction and prevent or substantially resist motion ofconnector16 through the lumen ofproximal anchor14 in the opposite direction.
• FIG. 4AE shows a cross section of the proximal anchor ofFIG. 4AD through the line4AE-4AE when the shape memory material of the proximal anchor is in the martensite phase. InFIG. 4AE, the diameter of the lumen ofproximal anchor14 is larger than the outer diameter ofproximal anchor14. This allows a user to advanceproximal anchor14 overconnector16.FIG. 4AE′ shows a cross section of the proximal anchor ofFIG. 4AD through the line4AE-4AE when the shape memory material of the proximal anchor is in the programmed shape. InFIG. 4AE′, the diameter of the lumen ofproximal anchor14 is smaller than the outer diameter ofproximal anchor14. This causes a region ofproximal anchor14 to compress a region ofconnector16. This in turn causesproximal anchor14 to attach toconnector16.
• FIG. 4AF shows a cross section of the proximal anchor ofFIG. 4AD through the line4AF-4AF when the shape memory material of the proximal anchor is in the martensite phase. InFIG. 4AF, the diameter of the lumen ofproximal anchor14 is larger than the outer diameter oflumen plug164.FIG. 4AF′ shows a cross section of the proximal anchor ofFIG. 4AD through the line4AF-4AF when the shape memory material of the proximal anchor is in the programmed shape. InFIG. 4AF′, the diameter of the lumen ofproximal anchor14 is smaller than the outer diameter oflumen plug164. This causeslumen plug164 to substantially plug one end of the lumen ofproximal anchor14.
• FIG. 4AG shows a side view of a second embodiment of a proximal anchor made of a thermal shape memory alloy. InFIG. 4AG,proximal anchor14 comprises a hollow elongate body made of a suitable shape memory material. Examples of such shape memory materials include, but are not limited to nickel-titanium alloys (nickel-titanium alloy (e.g., nitinol)), copper-aluminum-nickel alloys, copper-zinc-aluminum alloys, iron-manganese-silicon alloys, etc. In the embodiment shown inFIG. 4AG,proximal anchor14 is made of nickel-titanium alloy (e.g., nitinol).Proximal anchor14 encloses a lumen. One end ofproximal anchor14 may be plugged. In the embodiment shown inFIG. 4AG,proximal anchor14 comprises two or moreshape memory arms166.Proximal anchor14 comprises aconnector opening100. Aconnector16 entersproximal anchor14 throughconnector opening100.Connector16 exitsproximal anchor14 through the region enclosed byshape memory arms166. A user can control the size of the region enclosed byshape memory arms166 by changing the temperature ofproximal anchor14. In one embodiment of a method of anchoringproximal anchor14 toconnector16,proximal anchor14 is introduced in the anatomy in the martensite phase of the shape memory material ofshape memory arms166. The size of the region enclosed byshape memory arms166 in the martensite state is sufficiently large to allowproximal anchor14 to be advanced overconnector16. The martensite phase may be achieved for example, by coolingproximal anchor14 and introducing the cooledproximal anchor14 in the anatomy. Afterproximal anchor14 warms up to the body temperature, the shape memory material recovers a programmed shape and becomes super-elastic. In the programmed shape, the size of the region enclosed byshape memory arms166 is sufficiently small to causeshape memory arms166 to compress a region ofconnector16. This causesproximal anchor14 to attach toconnector16. The excess length ofconnector16 may be cut or trimmed using a variety of cutting or trimming mechanisms. In one method embodiment, the temperature ofproximal anchor14 is maintained or changed by controlling the temperature of a liquid such as saline that is brought into contact withproximal anchor14 by a user. In one embodiment, the lumen ofproximal anchor14 is lined with one or more barbs or projections. The one or more barbs or projections allow motion ofconnector16 through the lumen ofproximal anchor14 in one direction and prevent or substantially resist motion ofconnector16 through the lumen ofproximal anchor14 in the opposite direction.
• FIG. 4AH shows a cross section of the proximal anchor ofFIG. 4AG through the line4AH-4AH when the shape memory material of the proximal anchor is in the martensite phase. InFIG. 4AH, the size of the region enclosed byshape memory arms166 is larger than the outer diameter ofproximal anchor14. This allows a user to advanceproximal anchor14 overconnector16.FIG. 4AH′ shows a cross section of the proximal anchor ofFIG. 4AG through the line4AH-4AH when the shape memory material of the proximal anchor is in the programmed shape. InFIG. 4AH′, the size of the region enclosed byshape memory arms166 is smaller than the outer diameter ofproximal anchor14. This causes the region enclosed byshape memory arms166 to compress a region ofconnector16. This in turn causesproximal anchor14 to attach toconnector16.
• FIGS.4AI and4AJ show longitudinal sections of an embodiment of a proximal anchor showing the steps of an embodiment of a method of anchoring a looped or folded region of the connector to the proximal anchor.Proximal anchor14 comprises a hollow elongate body. Apull wire168 passes through the hollowproximal anchor14. Pullwire168 loops aroundconnector16 and reentersproximal anchor14 as shown inFIG. 4AI. Thus, the loop ofpull wire168 pullsconnector16 towardsproximal anchor14. InFIG. 4AI, the loop ofpull wire168 is advanced overconnector16. This causesproximal anchor14 to be advanced overconnector16.Proximal anchor14 is advanced to positionproximal anchor14 in a desired location. In the step shown inFIG. 4V, pullwire168 is pulled by a user. This pulls a loop ofconnector16 insideproximal anchor14. The loop ofconnector16 pulled insideproximal anchor14 wedges inside the lumen ofproximal anchor14. This in turn causesconnector16 to attach toproximal anchor14. The excess length ofconnector16 and/or pullwire168 may be cut or trimmed using a variety of cutting or trimming mechanisms.
• FIG. 4AK shows a side view of an embodiment of a proximal anchor made of a suitable elastic or super elastic or shape memory material comprising one or more inwardly opening flaps. InFIG. 4AK,proximal anchor14 comprises a hollow tubular body. The hollow tubular body is made of a suitable elastic or super elastic or shape memory material. Examples of such materials include, but are not limited to metals such as nickel-titanium alloy (e.g., nitinol), stainless steel, titanium, etc. and polymers such as shape memory polymers, etc. The tubular body comprises one or more inwardly opening flaps20. In the embodiment shown inFIG. 4AK, inwardly openingflaps20 are oriented along the axis ofproximal anchor14. Inwardly openingflaps20 allow the motion of aconnector16 that passes throughproximal anchor14 along the direction of orientation of inwardly opening flaps20. Also, inwardly openingflaps20 prevent the motion ofconnector16 that passes throughproximal anchor14 along the direction opposite to the direction of orientation of inwardly opening flaps20. This enablesproximal anchor14 to be advanced overconnector16 along one direction. In one embodiment,proximal anchor14 is made of an elastic or super elastic material. In this embodiment,proximal anchor14 is introduced in the anatomy by slidingproximal anchor14 overconnector16 in the direction of orientation of inwardly opening flaps106.Proximal anchor14 is advanced overconnector16 tillproximal anchor14 is located in a desired location. Inwarldy opening flaps106 prevent the motion ofproximal anchor106connector16 in the direction opposite to the direction of orientation of inwardly opening flaps106. In another embodiment,proximal anchor14 is made of a shape memory material such as nickel-titanium alloy (e.g., nitinol). In this embodiment,proximal anchor14 is introduced in the anatomy in the martensite phase of nickel-titanium alloy (e.g., nitinol). In this state, inwardly openingflaps20 are aligned substantially parallel to the surface ofproximal anchor14. This allowsproximal anchor14 to be advanced overconnector16. The martensite phase may be achieved, for example, by coolingproximal anchor14 and introducing the cooledproximal anchor14 in the anatomy. Afterproximal anchor14 warms up to the body temperature, the nickel-titanium alloy (e.g., nitinol) recovers a programmed shape and becomes super-elastic. In the programmed shape, inwardly openingflaps20 are bent inwards into the lumen ofproximal anchor14. This attachesproximal anchor14 toconnector16.
• FIG. 4AL shows a longitudinal section through the embodiment of the proximal anchor ofFIG. 4AK. Proximal anchor14 comprises a hollow tubular body comprising one or more inwardly opening flaps20. Inwardly openingflaps20 prevent the motion ofconnector16 along the direction opposite to the direction of orientation of inwardly opening flaps20.
• In an alternate embodiment,proximal anchor14 is attached toconnector16 using a biocompatible adhesive. The biocompatible adhesive may be introduced by a suitable proximalanchor delivery device34 that comprises an adhesive injecting tube. In one embodiment of a method of attachingproximal anchor14 toconnector16,proximal anchor14 is positioned at a desired location relative toconnector16. A suitable biocompatible adhesive is introduced such that the adhesive attachesproximal anchor14 to a location onconnector16. In one embodiment, the adhesive is introduced through a lumen inactuator120.
• FIG. 5A shows a side view of a first embodiment of a proximal anchor delivery device comprising one or more finger activated triggers. The embodiment of proximalanchor delivery device34 shown inFIG. 5A comprises anelongate endoscope channel170.Elongate endoscope channel170 may be made of suitable biocompatible materials. Examples of such materials include, but not limited to polymers e.g. polyester, polyimide, PEEK, polyurethane, polysulfone, polyetherimides, polycarbonate, and may be filled with glass or reinforcing fiber, etc; metals e.g. stainless steel, titanium, etc. In one embodiment,endoscope channel170 is made of 316 stainless steel. The proximal end ofendoscope channel170 comprises anendoscope adapter hub172.Endoscope adapter hub172 allows a user to introduce an endoscope through the proximal end ofendoscope channel170. The proximal region ofendoscope channel170 is attached to ahandle174. Proximalanchor delivery device34 further comprises anelongate anchor tube176.Anchor tube176 may be made of suitable biocompatible materials. Examples of such materials include, but not limited to polymers e.g. polyester, polyimide, PEEK, polyurethane, polysulfone, polyetherimides, polycarbonate, and may be filled with glass or reinforcing fiber, etc. metals e.g. stainless steel, titanium, nickel-titanium alloy (e.g., nitinol), etc. In one embodiment,anchor tube176 is made of 316 stainless steel. The distal end ofanchor tube176 may comprise a blunt or atraumatic tip.Anchor tube176 is attached toendoscope channel170 such thatanchor tube176 is substantially parallel toendoscope channel170 as shown inFIG. 5A.Anchor tube176 comprises a lumen that enclosesproximal anchor14.Proximal anchor14 is deployed in the anatomy through the distal region ofanchor tube176. The distal region ofanchor tube176 may comprise a bent, curved or angled region. Proximalanchor delivery device34 is used to attach aproximal anchor14 to a desired location on aconnector16. A suitable tension may be introduced intoconnector16 before the step of attachingproximal anchor14 toconnector16. In order to introduce this desired tension, proximalanchor delivery device34 further comprises a tensioning mechanism. In the embodiment shown inFIG. 5A, the tensioning mechanism comprises a pulling mechanism. The pulling mechanism pullsconnector16 between a slidingrack178 and asuture trap180.Suture trap180 is hinged to slidingrack178 as shown inFIG. 5A. Slidingrack178 moves on a slidingslot182 located onhandle174. In one embodiment, various components of the pulling mechanism are constructed from stainless steel 304 and nickel-titanium alloy (e.g., nitinol). The step of moving slidingrack178 on slidingslot182 is performed by pulling afirst trigger184 attached to handle174. Handle174 may comprise afirst trigger safety186 to prevent unwanted movement offirst trigger184. After a desired tension has been created inconnector16,proximal anchor14 may be deployed in the anatomy by asecond trigger188. In the embodiment shown inFIG. 5A,second trigger188 comprises an elongate lever. One end of the elongate lever is hinged to handle174. The other end of elongate lever is pivotally attached to anactuator block190.Actuator block190 slides over the outer surface ofendoscope channel170.Actuator block190 is connected to an elongate actuator. The movement of the elongateactuator cuts connector16 and also attachesproximal anchor14 toconnector16. Handle174 may comprise asecond trigger safety192 to prevent unwanted movement ofsecond trigger188.
• In the embodiment shown inFIG. 5A, a portion ofconnector16 passes throughanchor tube176. In an alternate embodiment, proximalanchor delivery device34 further comprises an elongate suture tube. The suture tube is attached to the outer surface ofendoscope channel170. The distal end of the suture tube is attached to anchortube176 around secondanchor tube opening196 such thatconnector16 emerges out of secondanchor tube opening196 and passes through the suture tube.Connector16 emerges out of the proximal end of the suture tube and further passes through the tensioning mechanism.
• In one embodiment, proximalanchor delivery device34 is sized to be introduced through a 25F cystoscope sheath. The length of proximalanchor delivery device34 within the sheath ranges from 6 to 14 inches. In this embodiment,endoscope channel170 andendoscope adapter hub172 are designed to fit a 4 mm telescope. In this embodiment, the outer diameter ofendoscope channel170 ranges from 0.174 to 0.200 inches and the inner diameter ofendoscope channel170 ranges from 0.160 to 0.180 inches. In this embodiment, the outer diameter ofanchor tube176 ranges from 0.050 to 0.072 inches and the inner diameter ofanchor tube176 ranges from 0.030 to 0.063 inches. In this embodiment, the maximum distance through which the actuator travels ranges from 0.060 to 0.300 inches. In a preferred embodiment, proximalanchor delivery device34 is sized to be introduced through a 25F cystoscope sheath. The length of proximalanchor delivery device34 within the sheath ranges from is approximately 10 inches. In this preferred embodiment,endoscope channel170 andendoscope adapter hub172 are designed to fit a Storz 4 mm telescope. In this preferred embodiment, the outer diameter ofendoscope channel170 is approximately 0.180 inches and the inner diameter ofendoscope channel170 is approximately 0.160 inches. In this preferred embodiment, the outer diameter ofanchor tube176 is approximately 0.059 inches and the inner diameter ofanchor tube176 is approximately 0.046 inches. In this preferred embodiment, the maximum distance through which the actuator travels is approximately 0.240 inches.
• FIGS. 5B through 5D show longitudinal sections through the distal tip of the proximal anchor delivery device ofFIG. 5A showing the steps of a method of deploying a proximal anchor in the anatomy. In the step shown inFIG. 5B,proximal anchor14 is enclosed in the distal region ofanchor tube176. In the embodiment shown inFIG. 5B,anchor tube176 comprises a firstanchor tube opening194 and a secondanchor tube opening196.Connector16 entersanchor tube176 through firstanchor tube opening194.Connector16 passes throughproximal anchor14 and emerges out ofanchor tube176 through secondanchor tube opening196. In the embodiment shown inFIG. 5B,proximal anchor14 comprises a hollow tube.Proximal anchor14 comprises a lockingcrimp103. The hollow tube further comprises aconnector opening100 located roughly midway between the ends of the tube. One edge ofconnector opening100 is lined with an outwardly openingflap26. Outwardly openingflap26 is folded as shown inFIG. 5B to create a blunt edge toconnector opening100. The opposite edge of connector opening comprises asecond locking tab198.Second locking tab198 is made by cutting a flap in the material ofproximal anchor14 and bending the flap into the lumen ofproximal anchor14 as shown.Connector16 is locked toproximal anchor14 by driving alock pin104 intoproximal anchor14. InFIG. 5B,lock pin104 is partially inserted intoproximal anchor14 such that the length of the combination oflock pin104 andproximal anchor14 is more than the length of firstanchor tube opening194. This prevents unwanted separation ofproximal anchor14 fromanchor tube176 through secondanchor tube opening196. In the embodiment shown inFIG. 5B,lock pin104 comprises alocking slot106. Lockingslot106 allowslock pin104 to lock toproximal anchor14 by lockingcrimp103.Lock pin104 further comprises asecond locking slot200. In one embodiment, the distance from lockingslot106 tosecond locking slot200 along the length oflock pin104 is the same as the distance fromsecond locking tab198 to lockingcrimp103 along the length ofproximal anchor14. In another embodiment, the distance from lockingslot106 tosecond locking slot200 along the length oflock pin104 is slightly more than the distance fromsecond locking tab198 to lockingcrimp103 along the length ofproximal anchor14. In a preferred embodiment,proximal anchor14 andlock pin104 are made of stainless steel 316L. In the preferred embodiment,tube24 is laser cut and then electropolished.Lock pin104 is constructed using EDM (electrical discharge machining) and then passivated. The geometries ofproximal anchor14,connector16 andlock pin104 enablelock pin104 to lockconnector16 toproximal anchor14. In a preferred embodiment, the length ofproximal anchor14 is 0.236 inches, the outer diameter ofproximal anchor14 is 0.027 inches, the inner diameter ofproximal anchor14 is 0.020 inches, the length oflock pin104 is 0.236 inches and the outer diameter oflock pin104 is 0.019 inches.
• In the embodiment shown inFIG. 5B,lock pin104 is driven intoproximal anchor14 by anactuator120. In the embodiment shown inFIG. 5B,actuator120 comprises a bent distal tip. The bent distal tip forms a distal edge that is in contact with the distal end oflock pin104.Actuator120 further comprises anactuator opening202. The distal edge ofactuator opening202 may be sharpened.Actuator opening202 is located near secondanchor tube opening196 such thatconnector16 passes through bothactuator opening202 and secondanchor tube opening196. In the step shown inFIG. 5B, a desired tension is created inconnector16.
• In the step shown inFIG. 5C,actuator120 is pulled in the proximal direction by a user. This causes the bent distal tip ofactuator120 to drivelock pin104 towardsproximal anchor14. This in turncauses locking crimp103 to unlock from lockingslot106.Lock pin104 then moves in the proximal direction till lockingcrimp103 locks intosecond locking slot200 andsecond locking tab198 locks into lockingslot106. This causeslock pin104 to lock toproximal anchor14. In this configuration, lock pin is inserted intoproximal anchor14 such that the length of the combination oflock pin104 andproximal anchor14 is smaller than the length of firstanchor tube opening194. The movement oflock pin104 along the proximal direction further causes the proximal tapering end oflock pin104 to wedge betweenproximal anchor14 andconnector16. Thus,proximal anchor14 is locked toconnector16. Further, pullingactuator120 in the proximal direction causesconnector16 to get sheared between the edges ofactuator opening202 and secondanchor tube opening196. This cutsconnector16.
• In the step shown inFIG. 5D,proximal anchor14 is pulled by the tension inconnector16. Since the length of the combination oflock pin104 andproximal anchor14 is less than the length of firstanchor tube opening194,proximal anchor14 emerges out ofanchor tube176 through firstanchor tube opening194. Thus,proximal anchor14 is deployed in the anatomy.
• FIG. 5E shows a side view of a proximal anchor similar to the proximal anchor inFIGS. 5B-5D having an undeployed lock pin partially inserted into the proximal anchor.
• FIGS. 5F through 5H show longitudinal sections through the proximal anchor and the lock pin ofFIG. 5E showing the steps of a method of attaching the proximal anchor to a connector using the lock pin. InFIG. 5E,proximal anchor14 comprises lockingtab102 andsecond locking tab198.Lock pin104 comprises lockingslot106 andsecond locking slot200. InFIG. 5E, lockingtab102 ofproximal anchor14 locks into lockingslot106 onlock pin104. Thus lockpin104 is temporarily locked toproximal anchor14 in an undeployed configuration. In the step shown inFIG. 5G,connector16 is passed throughproximal anchor14. In the embodiment shown inFIG. 5G,connector16 entersproximal anchor14 throughconnector opening100 and exitsproximal anchor14 through the proximal end ofproximal anchor14. In the step shown inFIG. 5H,lock pin104 is moved by a user along the proximal direction intoproximal anchor14.Lock pin104 is moved until lockingtab102 locks intosecond locking slot200 andsecond locking tab198 locks into lockingslot106. This causeslock pin104 to lock toproximal anchor14. Also, the proximal tapering end oflock pin104 wedges betweenproximal anchor14 andconnector16. Thus,proximal anchor14 is attached toconnector16. The excess length ofconnector16 may be cut or trimmed.
• Several embodiments oflock pin104 may be used to lockconnector16 toproximal anchor14.FIG. 5I shows a side view of an embodiment of a lock pin that can be used to lockconnector16 toproximal anchor14 as shown in the method ofFIGS. 5B-5D. In the embodiment shown inFIG. 5I,lock pin104 is made from a cylinder of suitable biocompatible material. Examples of such biocompatible materials include, but are not limited to metals e.g. nickel-titanium alloy (e.g., nitinol), stainless steel, titanium, etc. or polymers e.g. EXAMPLES, etc.Lock pin104 comprises alocking slot106. Lockingslot106 allowslock pin104 to lock tolocking tab102 ofproximal anchor14.Lock pin104 further comprises asecond locking slot200 distal to lockingslot106.Lock pin104 further comprises a tapering region proximal to lockingslot106. The tapering region acts as a wedge between the internal surface ofproximal anchor14 andconnector16, thereby lockingconnector16 toproximal anchor14. In one embodiment, the total length oflock pin104 is about 0.236 inches. In this embodiment,lock pin104 is made from a cylinder of stainless steel 316L of a diameter about 0.019 inches. In this embodiment, the length from the proximal tip oflock pin104 to the proximal edge of lockingslot106 is about 0.122 inches. In this embodiment, the length from the proximal tip oflock pin104 to the proximal edge ofsecond locking slot200 is about 0.206 inches. In one embodiment of a method for manufacturinglock pin104,lock pin104 is made by laser cutting a cylinder of a suitable biocompatible material.
• FIG. 5J shows another side view of the lock pin of connector shown inFIG. 5I.
• Several embodiments ofactuator120 may be used to drivelock pin104 intoproximal anchor14 to lockconnector16 toproximal anchor14.FIG. 5K shows an isometric view of an embodiment of anactuator120 that can be used to drivelock pin104 intoproximal anchor14. In the embodiment shown inFIG. 5K,actuator120 comprises an elongate cylindrical or flattenedpull rod203. The proximal region ofpull rod203 is enlarged as shown inFIG. 5K. The distal region ofactuator120 comprises two projections: aproximal projection204 and adistal projection206.Proximal projection204 anddistal projection206 are used to temporarily holdproximal anchor14 between them. The region ofactuator120 betweenproximal projection204 and adistal projection206 comprisesactuator opening202.
• FIG. 5L shows a side view of the embodiment of the actuator shown inFIG. 5K.FIG. 5L showsactuator120 comprisingproximal projection204 anddistal projection206. The region ofactuator120 betweenproximal anchor14 and adistal projection206 comprisesactuator opening202.
• FIG. 5M shows a longitudinal section through the actuator ofFIG. 5L. The distal edge ofactuator opening202 is sharpened to form anactuator cutting edge208. In the embodiment shown inFIG. 5M, the angle betweenactuator cutting edge208 and the longitudinal axis ofactuator120 is about 45 degrees. In one embodiment, the total length ofactuator120 is 14 inches. The distance between the proximal edge ofdistal projection206 and the distalmost region ofproximal projection204 is about 0.373 inches. In this embodiment, the length from the distal end of the enlarged proximal region ofpull rod203 to the distal end ofactuator120 is about 1.49 inches.
• FIG. 5N shows a side view of a second embodiment of a proximalanchor delivery device34. Proximalanchor delivery device34 comprises anendoscope introducing tube48. The proximal end ofendoscope introducing tube48 may comprise anendoscope hub50 to lock anendoscope74 to endoscope introducingtube48.Endoscope introducing tube48 encloses a lumen through which asuitable endoscope74 may be introduced into the anatomy. Proximalanchor delivery device34 comprises ananchor tube176. The distal end of theanchor tube176 comprises firstanchor tube opening194 and secondanchor tube opening196 such as shown inFIG. 5B. The lumen ofanchor tube176 encloses aproximal anchor14 held by anactuator120.Actuator120 is used to deployproximal anchor14 out of the distal region ofanchor tube176 and into the anatomy by a method similar to the method shown inFIGS. 5B-5D. Deployment ofproximal anchor14 in the anatomy is visualized by anendoscope74 that is introduced throughendoscope introducing tube48 such that the distal end ofanchor tube176 is located near the distal end ofendoscope74. The distal end ofanchor tube176 may comprise a curved, bent or tapered region.Anchor tube176 is attached to endoscope introducingtube48 by acoupling element76. Proximalanchor delivery device34 may be introduced into the anatomy through a suitable sheath. Such as sheath may comprise a flushing or aspiration port. The flushing or aspiration port may be in fluid communication with the lumen of the sheath to allow a user to introduce fluids into or remove fluids from an anatomical region.
• The embodiment of proximalanchor delivery device34 shown inFIG. 5N may be used to introduce aproximal anchor14 over aconnector16 into the anatomy.Proximal anchor14 is attached toconnector16 and the excess length of connector is trimmed. For example,FIGS. 5O through 5S show the steps of an embodiment of a method of deploying an anchor in an anatomical region using proximalanchor delivery device34 ofFIG. 5N. In the step shown inFIG. 5O, adistal anchor12 attached to aconnector16 has been anchored in the anatomy. In one method embodiment,distal anchor12 is anchored transurethrally near the prostate gland capsule by the method shown inFIGS. 3M through 3T. In this embodiment,distal anchor12 is anchored by one or more devices inserted through asheath28 inserted in the urethra. After performing this step, the one or more devices are removed leavingsheath28 in the urethra.
• In the step shown inFIG. 5P,connector16 is inserted into an opening in the distal region ofanchor tube176.Connector16 is passed throughproximal anchor14 enclosed byanchor tube176.Connector16 is removed from the proximal region ofanchor tube176. Proximalanchor delivery device34 is inserted insheath28 overconnector16 such that the distal end ofanchor tube176 emerges out of the distal end ofsheath28.
• In the step shown inFIG. 5Q,proximal anchor14 is attached toconnector16. Also, the excess length ofconnector16 is trimmed. This may be done for example, by a mechanism similar to the mechanism shown inFIGS. 5B through 5D. Thus,proximal anchor14 is released fromanchor tube168 and is deployed in the anatomy as shown inFIG. 5Q. In one method embodiment,proximal anchor14 is deployed in the region of the urethra enclosed by the prostate gland.
• In the step shown inFIG. 5R, proximalanchor delivery device34 andendoscope74 are removed fromsheath28.
• In the step shown inFIG. 5S,sheath28 is removed from the anatomy leaving behindproximal anchor14 anddistal anchor12 connected byconnector16.
• The distal ends of the various proximalanchor delivery devices34 may be bent, curved, angled, or shaped to deliver aproximal anchor14 at an angle to the axis of proximalanchor delivery device34. For example,FIG. 5T shows the distal end of an embodiment of a proximal anchor delivery device comprising an anchor tube with a bent, curved or angled distal end. Proximalanchor delivery device34 inFIG. 5T is introduced in the anatomy through asheath28. Proximalanchor delivery device34 comprisesanchor tube176 with a bent, curved or angled distal end. The bent, curved or angled distal end ofanchor tube176 enables a user to deploy aproximal anchor14 in the anatomy at an angle to the axis of proximalanchor delivery device34.
• FIG. 5U shows the step of deploying a proximal anchor in an anatomical region by the proximal anchor delivery device ofFIG. 5T. In the step shown inFIG. 5U,proximal anchor14 is being deployed in the anatomy at an angle to the axis of proximalanchor delivery device34.
• The various mechanisms of deploying proximal or distal anchor disclosed herein may be used to design various embodiments of proximal and distal anchor delivery devices. For example, mechanisms of deploying a distal anchor similar to the mechanism shown inFIGS. 3D through 3K may be used to design several embodiments of distal anchor deploying devices. Similarly, mechanisms of deploying a proximal anchor similar to the mechanism shown inFIGS. 5B through 5D may be used to design several embodiments of proximal anchor deploying devices.
• Pre-Clinical Testing:
• Pre-clinical testing of an embodiment of a method of compressing a region of the prostate gland was done to evaluate the safety aspects of the method. The devices shown inFIGS. 3A and 5A were used to deploy theretractor10 shown inFIG. 1C in the prostate gland of the dogs. Six mongrel dogs of 27 to 35 kg underwent a transurethral procedure for luminal restoration of the urethral region enclosed by the prostate gland. In each animal asingle retractor10 was deployed. All procedures were successful with no adverse events. The total procedure time from thetime sheath28 was introduced transurethrally until the time thesheath28 was removed ranged from 27 to 55 minutes. All the animals were followed up cystoscopically. Typical acute results are shown inFIG. 5V.FIG. 5V shows a cystoscopic view of a region of canine urethra enclosed by the prostate gland that has been treated by a procedure similar to the procedure shown inFIGS. 1D through 1J.FIG. 5V shows aproximal anchor14 of aretractor10 shown inFIG. 1C.Retractor10 is used to compress a region of the prostate gland.
• FIG. 6A shows a side view of an embodiment of a distal anchor delivery device. In the embodiment shown inFIG. 6A, distalanchor delivery device30 comprises an elongate puncturing element e.g. aneedle32 that comprises a lumen. The proximal end ofneedle32 is connected to ahandle174. In the embodiment shown inFIG. 6A, handle174 comprises a curved handpiece that can be gripped by a user with one hand. Anelongate pusher64 slides through the lumen ofneedle32. The proximal end ofpusher64 may be enlarged to allow the user to pushpusher64 with the other hand. Whenpusher64 is pushed by the user, adistal anchor12 attached to aconnector16 is pushed out of the distal end ofneedle32.
• FIG. 6B shows an enlarged view of the distal region of the distal anchor delivery device ofFIG. 6A showing the step of deploying a distal anchor by the distal anchor delivery device. In one method embodiment of deploying adistal anchor12, distalanchor delivery device30 is pushed into the anatomy until the distal tip ofneedle32 is in a desired location.Pusher64 is pushed by a user. This causes the distal tip ofpusher64 to push adistal anchor12 attached to aconnector16 out of the distal end ofneedle32. Distalanchor delivery device30 is removed from the anatomy by sliding distalanchor delivery device30 overconnector16. A desired tension may be generated inconnector16 and aproximal anchor14 attached toconnector16 to hold and/or compress an anatomical region betweenproximal anchor14 anddistal anchor12.
• FIG. 6C shows a side view of an embodiment of a proximal anchor delivery device. The embodiment of proximalanchor delivery device34 shown inFIG. 6C may be used to generate a desired tension inconnector16 and attach aproximal anchor14 toconnector16 after the step shown inFIG. 6B. In the embodiment shown inFIG. 6C, proximalanchor delivery device34 comprises anelongate anchor tube176 that comprises a lumen. In the embodiment shown, the distal tip ofanchor tube176 comprises a bent, curved or angled region. The proximal end ofanchor tube176 is connected to ahandle174. In the embodiment shown inFIG. 6C, handle174 comprises a curved handpiece that can be gripped by a user with one hand. Anelongate actuator120 slides through the lumen ofanchor tube176. The proximal end ofactuator120 may be enlarged to allow the user to pull actuator120 with the other hand. When actuator120 is pulled by the user, aproximal anchor14 is attached to aconnector16. Also, whenactuator120 is pulled by the user, the excess length ofconnector16 may be cut or trimmed by a mechanism similar to the mechanism shown inFIGS. 5B through 5D.
• FIG. 6D shows an enlarged view of the distal region of the proximal anchor delivery device ofFIG. 6C. In one embodiment of a method of deploying aproximal anchor14, proximalanchor delivery device34 ofFIG. 6C is inserted in the anatomy overconnector16. This is done such thatconnector16 passes through aproximal anchor14 located inanchor tube176. Proximalanchor delivery device34 is advanced in the anatomy until the distal tip ofanchor tube176 is in a desired location.Connector16 is pulled by a user to introduce a desired tension inconnector16.Actuator120 is pulled by a user. This attachesproximal anchor14 toconnector16 by a mechanism similar to the mechanism shown inFIGS. 5B through 5D. Also, the excess length ofconnector16 may be cut or trimmed by a mechanism similar to the mechanism shown inFIGS. 5B through 5D. Distalanchor delivery device30 is removed from the anatomy. This step leaves behindproximal anchor14 anddistal anchor12 connected to each other byconnector16.
• The anchor delivery devices disclosed herein may be used to bury an anchor within an anatomical tissue. For example,FIG. 6E shows the distal region of an embodiment of a proximal anchor delivery device comprising a curved penetrating distal tip. In the embodiment shown inFIG. 6E, proximalanchor delivery device34 comprises ananchor tube176 with a curved penetrating distal tip. The penetrating distal tip is used to penetrate an anatomical tissue. Aproximal anchor14 is deployed within the anatomical tissue, thereby buryingproximal anchor14 within the anatomical tissue.
• FIG. 6F shows an embodiment of a retractor comprising a proximal anchor buried within an anatomical tissue by the proximal anchor delivery device ofFIG. 6E. In one method embodiment, adistal anchor12 attached to aconnector16 is deployed in the anatomy. Proximalanchor delivery device34 is inserted in the anatomy overconnector16. This is done such thatconnector16 passes through aproximal anchor14 located inanchor tube176. Proximalanchor delivery device34 is advanced in the anatomy such that the curved distal tip ofanchor tube176 tangentially penetrates a wall of an anatomical tissue. Proximalanchor delivery device34 is advanced until the curved distal tip ofanchor tube176 is in a desired location.Connector16 is pulled by a user to introduce a desired tension inconnector16.Proximal anchor14 is attached toconnector16. This may be done by a mechanism on proximalanchor delivery device34 similar to the mechanism shown inFIGS. 5B through 5D. Also, the excess length ofconnector16 may be cut or trimmed. This may be done by a mechanism on proximalanchor delivery device34 similar to the mechanism shown inFIGS. 5B through 5D. Distalanchor delivery device30 is removed from the anatomy. This step leaves behindproximal anchor14 buried within the anatomical tissue connected todistal anchor12 byconnector16.
• FIG. 6G shows the distal region of an embodiment of a proximal anchor delivery device comprising a straight penetrating distal tip. In the embodiment shown inFIG. 6G, proximalanchor delivery device34 comprises ananchor tube176 with a straight penetrating distal tip. The penetrating tip is used to penetrate an anatomical tissue. Aproximal anchor14 is deployed within the anatomical tissue, thereby buryingproximal anchor14 within the anatomical tissue.
• FIG. 6H shows an embodiment of a retractor comprising a proximal anchor buried within an anatomical tissue by the proximal anchor delivery device ofFIG. 6G. In one method embodiment, adistal anchor12 attached to aconnector16 is deployed in the anatomy. Proximalanchor delivery device34 is inserted in the anatomy overconnector16. This is done such thatconnector16 passes through aproximal anchor14 located inanchor tube176. Proximalanchor delivery device34 is advanced in the anatomy such that the straight distal tip ofanchor tube176 penetrates a wall of an anatomical tissue roughly perpendicular to the wall of an anatomical tissue. Proximalanchor delivery device34 is advanced until the straight distal tip ofanchor tube176 is in a desired location.Connector16 is pulled by a user to introduce a desired tension inconnector16.Proximal anchor14 is attached toconnector16. This may be done by a mechanism on proximalanchor delivery device34 similar to the mechanism shown inFIGS. 5B through 5D. Also, the excess length ofconnector16 may be cut or trimmed. This may be done by a mechanism on proximalanchor delivery device34 similar to the mechanism shown inFIGS. 5B through 5D. Distalanchor delivery device30 is removed from the anatomy. This step leaves behindproximal anchor14 buried within the anatomical tissue connected todistal anchor12 byconnector16. The tension inconnector16 may causeproximal anchor14 to flip and orient perpendicularly toconnector16.
• Various embodiments of distalanchor delivery device30 and various embodiments of proximalanchor delivery device34 may be combined into a single device that delivers bothdistal anchor12 andproximal anchor14. For example,FIG. 6I shows a section through the distal tip of a first embodiment of a combined device that can deliver a distal anchor connected to a proximal anchor by a connector. InFIG. 6I, a combineddevice210 is introduced in the anatomy through anelongate sheath28. The distal tip of combineddevice210 comprises an arrangement to hold aproximal anchor14.Proximal anchor14 may be controllably delivered from combineddevice210 by a user into the anatomy by a releasing mechanism.Proximal anchor14 is connected to aconnector16.Connector16 is further connected to adistal anchor12.Distal anchor12 is attached to a distal region ofcombined device210 by an arrangement to holddistal anchor12.Distal anchor12 may be controllably delivered from combineddevice210 by the user into the anatomy by a releasing mechanism. The step of deliveringproximal anchor14 and/or the step of deliveringdistal anchor12 may be visualized by anendoscope74.
• FIG. 6J shows a side view of a second embodiment of a combined device that can deliver a distal anchor and a proximal anchor connected to each other by a connector. InFIG. 6J, combineddevice210 comprises anelongate anchor tube176 through whichproximal anchor14 anddistal anchor12 are delivered.Combined device210 further comprises an arrangement for introducing anendoscope74. The step of deliveringproximal anchor14 and/or the step of deliveringdistal anchor12 may be visualized byendoscope74.Combined device210 further comprises ahandle174 to enable a user to hold combineddevice210.Proximal anchor14 anddistal anchor12 are delivered in the anatomy by moving ananchor delivery trigger216 connected to handle174. In a distal anchor delivery mode,anchor delivery trigger216 is used to deliverdistal anchor12. In a proximal anchor delivery mode,anchor delivery trigger216 is used to deliverproximal anchor14. In one embodiment, movement ofanchor delivery trigger216 causes movement of a needle in the distal anchor delivery mode. Adistal anchor12 is delivered through the needle in the anatomy. In one embodiment, movement ofanchor delivery trigger216 locks aproximal anchor14connector106. Also, movement ofanchor delivery trigger216 cuts excess length of aconnector16 attached toproximal anchor14. This deliversproximal anchor14 in the anatomy.Anchor delivery trigger216 is switched between distal anchor delivery mode and proximal anchor delivery mode by amode selecting switch218.
• FIG. 6K shows a side view of a third embodiment of a combined device that can deliver a distal anchor and a proximal anchor connected to each other by a connector. In this embodiment, combineddevice210 further comprises a deflectinglever212 that can be used to controllably bend or deflect the distal region ofcombined device210.
• In one method embodiment, a combined device is used to deliver a first anchor to a region distal to a tissue and deliver a second anchor to a region proximal to the tissue. In another method embodiment, a combined device is used to deliver a first anchor to a region proximal to a tissue and deliver a second anchor to a region distal to the tissue. For example,FIGS. 6L through 6Q show the steps of a method of compressing an anatomical tissue by a combined device that deliversproximal anchor14 anddistal anchor12 in the anatomy. In the step shown inFIG. 6L, a combineddevice210 is introduced in the anatomy.Combined device210 comprises a sharp distal end to penetrate anatomical tissue.Combined device210 is advanced through the anatomy until the distal tip of combineddevice210 is located in a desired location proximal to a tissue.Distal anchor12 is delivered by combineddevice210 to the desired location proximal to a tissue. In the step shown inFIG. 6M, combineddevice210 is advanced such that the sharp distal tip of combineddevice210 penetrates through the tissue.Combined device210 is advanced through the tissue until the distal tip of combineddevice210 is located in a desired location distal to the tissue. In the step shown inFIG. 6N, aproximal anchor14 is delivered by combineddevice210 to the desired location distal to the tissue.Proximal anchor14 is connected todistal anchor12 by aconnector16 that is attached todistal anchor12 and passes throughproximal anchor14.Proximal anchor14 comprises a unidirectional mechanism to allow the motion ofconnector16 throughproximal anchor14 only in one direction. The unidirectional mechanism prevents the motion ofconnector16 throughproximal anchor14 in the opposite direction. In the step shown inFIG. 6O, combineddevice210 is pulled in the proximal direction to partially withdraw combineddevice210 from the tissue. In the step shown inFIG. 6P,connector16 is pulled with a sufficient force to moveconnector16 throughproximal anchor14. This step pullsdistal anchor12 towardsproximal anchor14 thereby compressing the tissue betweenproximal anchor14 anddistal anchor12. In the step shown inFIG. 6Q,connector16 is cut. This step may be performed by a cutting mechanism in combineddevice210 or by a separate cutter device disclosed elsewhere in this patent application or in the documents incorporated herein by reference. Afterconnector16 is cut, the unidirectional mechanism onproximal anchor14 prevents motion ofconnector16 throughproximal anchor14. This in turn maintains the tension inconnector16 betweenproximal anchor14 anddistal anchor12.
• FIGS. 6R through 6W show the distal region of an embodiment of a combined device showing the steps of a method of delivering a retractor comprising a proximal anchor and a distal anchor, wherein the distal anchor is delivered through the proximal anchor. In the step shown inFIG. 6R, a combineddevice210 is introduced in the anatomy. In one method embodiment, combineddevice210 is inserted trans-urethrally into the region of the urethra enclosed by the prostate gland. In other alternate method embodiments, combineddevice210 may be introduced into anatomical regions including, but not limited to large intestines, stomach, esophagus, trachea, a bronchus, bronchial passageways, veins, arteries, lymph vessels, a ureter, bladder, cardiac atria or ventricles, etc. In the embodiment shown inFIG. 6R, the distal region ofcombined device210 encloses anelongate actuator120. A surface ofactuator120 can be used to drive alock pin104 into aproximal anchor14. The movement ofproximal anchor14 along the proximal direction is restricted by astopper140. Aneedle32 passes throughproximal anchor14. In the embodiment shown inFIG. 6R,needle32 entersproximal anchor14 through the proximal end ofproximal anchor14.Needle32 exitsproximal anchor14 through a side opening inproximal anchor14. In the step shown inFIG. 6S,needle32 is advanced throughproximal anchor14 such that the distal tip ofneedle32 exits combineddevice210.Needle32 is advanced further such thatneedle32 penetrates through a target tissue TT. In the step shown inFIG. 6T, adistal anchor12 is delivered throughneedle32.Distal anchor12 is connected to aconnector16 that passes throughneedle32. In the step shown inFIG. 6U,needle32 is withdrawn from combineddevice210. This step leaves behinddistal anchor12 connected toconnector16.Connector16 is pulled in the proximal direction. This step orientsdistal anchor12 perpendicular toconnector16. Also, this step causes a region of the target tissue to be compressed betweencombined device210 anddistal anchor12. In the step shown inFIG. 6V,actuator120 is pulled in the proximal direction by a user. This causes actuator120 to drivelock pin104 intoproximal anchor14.Lock pin104 compresses a region ofconnector16 between a surface ofproximal anchor14 andlock pin104. This locksproximal anchor14 toconnector16.Combined device210 may further comprise a mechanism to cut or trim the excess length ofconnector16. In one embodiment, the mechanism is similar to the cutting mechanism shown inFIGS. 5B-5D. In the step shown inFIG. 6W, combineddevice210 is withdrawn from the anatomy. This step leaves behindretractor10 comprisingdistal anchor12 connected toproximal anchor14 byconnector16.
• The various devices and methods disclosed herein or modifications thereof may be used to retract, lift, support, reposition or compress a region of a tubular anatomical organ such as the urethra. Such methods may also be used, for example, to reduce the cross sectional area of the lumen of a tubular anatomical organ. For example, the various devices and methods disclosed herein or modifications thereof may be used to reduce the cross sectional area of the lumen of the urethra to treat incontinence, especially urinary stress incontinence. This may be done by various devices that may be introduced in the urethra through a variety of approaches. Some examples of such approaches include, but are not limited to transurethral approach, transvaginal approach, transperineal approach, etc.
• FIGS. 7A through 7H show a longitudinal section of a tubular organ showing the steps of a method of reducing the cross sectional area of the lumen of the tubular organ. In the step shown inFIG. 7A, an elongate distalanchor delivery device30 is introduced in the tubular organ such as the urethra. In one particular embodiment, distalanchor delivery device30 is introduced transurethrally into the urethra. Aneedle32 is introduced through distalanchor delivery device30. The distal region ofneedle32 may comprise a curved region.Needle32 may exit distalanchor delivery device30 at an exit angle ranging from 0 degrees to 180 degrees to the axis of distalanchor delivery device30.Needle32 is advanced through the tubular organ such thatneedle32 penetrates through a wall of the tubular organ. In the step shown inFIG. 7B, distalanchor delivery device30 is rotated. This causesneedle32 to pull the tissue surrounding the wall of the tubular organ along the direction of rotation of distalanchor delivery device30. In the step shown inFIG. 7C, distalanchor delivery device30 is rotated further. This causes a region of the tissue surrounding the tubular organ to fold around the tubular organ as shown inFIG. 7C. In the step shown inFIG. 7D, adistal anchor12 is delivered in the anatomy throughneedle32. In the step shown inFIG. 7E,needle32 is withdrawn from the anatomy through distalanchor delivery device30. As shown inFIG. 7E,distal anchor12 is attached to anelongate connector16 that passes through distalanchor delivery device30. In the step shown inFIG. 7F, distalanchor delivery device30 is removed from the tubular organ overconnector16. An elongate proximalanchor delivery device34 is introduced in the tubular organ overconnector16. This is done such thatconnector16 passes through aproximal anchor14 located on proximalanchor delivery device34. Proximalanchor delivery device34 is advanced through the tubular organ such that the distal tip of proximalanchor delivery device34 is located near the site whereneedle32 punctured the wall of the tubular organ. In the step shown inFIG. 7G,connector16 is pulled by a user to introduce a desired tension inconnector16. In the step shown inFIG. 7H,proximal anchor14 is attached toconnector16. This may be done by a mechanism on proximalanchor delivery device34 similar to the mechanism shown inFIGS. 5B through 5D. Also, the excess length ofconnector16 may be cut or trimmed. This may be done by a mechanism on proximalanchor delivery device34 similar to the mechanism shown inFIGS. 5B through 5D. Distalanchor delivery device30 is removed from the anatomy. This step leaves behindproximal anchor14 connected todistal anchor12 byconnector16. The tension inconnector16 causes the tissue betweenproximal anchor14 anddistal anchor12 to fold as shown inFIG. 7H. This in turn reduces the cross sectional area of the lumen of the tubular organ.
• FIG. 7I shows a schematic diagram of a tubular organ showing the configuration of the tubular organ before performing the method shown inFIGS. 7A through 7H. Examples of tubular organs that may be treated by the method shown inFIGS. 7A through 7H include, but are not limited to urethra, bowel, stomach, esophagus, trachea, bronchii, bronchial passageways, veins, arteries, lymphatic vessels, ureters, bladder, cardiac atria or ventricles, uterus, fallopian tubes, etc.FIG. 7J shows a schematic diagram of the tubular organ ofFIG. 7I showing a possible configuration obtained after performing the method shown inFIGS. 7A through 7H. InFIG. 7J, the tension inconnector16 causes the tissue betweenproximal anchor14 anddistal anchor12 to twist. This in turn reduces the cross sectional area of the lumen of the tubular organ.
• The method shown inFIGS. 7A through 7H may also be performed using a distal anchor delivery device comprising a helical needle. For example,FIG. 7K shows an embodiment of a distalanchor delivery device30 comprising ahelical needle32. In one method embodiment, distalanchor delivery device30 is inserted into a tubular organ.Helical needle32 is advanced through distalanchor delivery device30 such that the distal region onneedle32 emerges out of distalanchor delivery device30.Needle32 emerges out of distalanchor delivery device30 and penetrates the wall of the tubular organ. In one embodiment, the tubular organ is the urethra UT comprising a urethral wall UW. The helical shape ofneedle32 causes at least a portion ofhelical needle32 to curve around the lumen of the tubular organ. Also, the helical shape ofneedle32 causes the distal tip ofneedle32 to be axially spaced apart from the site whereneedle32 penetrates into the wall of the tubular organ. Adistal anchor12 may be delivered into the anatomy from the distal tip ofneedle32. Thus,distal anchor12 may be delivered at a location that is axially spaced apart from the penetration site ofneedle32. Aproximal anchor14 may be attached toconnector16 by a method similar to the method shown inFIGS. 7F-7H.
• FIGS. 7L through 7N show a cross section of a tubular organ showing the steps of a method of reducing the cross sectional area of the lumen of the tubular organ by creating one or more folds or pleats in the walls of the tubular organ along the circumference of the lumen.FIG. 7L shows a cross section of a tubular organ. Examples of tubular organs that may be treated by the method shown inFIGS. 7L through 7N include, but are not limited to urethra UT, bowel, stomach, esophagus, trachea, bronchii, bronchial passageways, veins, arteries, lymphatic vessels, ureters, bladder, cardiac atria or ventricles, uterus, fallopian tubes, etc. In the step shown inFIG. 7M, an anchor delivery device comprising acurved needle32 is introduced in the lumen of the tubular organ.Needle32 is advanced through the anchor delivery device such that the distal tip ofneedle32 penetrates the wall of the tubular organ.Distal anchor12 is advanced throughneedle32 and is delivered through the distal tip ofneedle32 into the surrounding tissue. A desired tension is created inconnector16 attached todistal anchor12. Aproximal anchor14 is attached to a desired location onconnector16 to compress the tissue betweenproximal anchor14 anddistal anchor12 as shown inFIG. 7N. This compression creates one or more folds or pleats in the walls of the tubular organ as shown inFIG. 7N. This in turn reduces the cross sectional area of the lumen of the tubular organ. In one embodiment, distalanchor delivery device30 comprising acurved needle32 is introduced trans-urethrally in the urethra of a patient suffering from urinary incontinence.Distal anchor12 is deployed in the tissue surrounding the urethra by distalanchor delivery device30. Distalanchor delivery device30 is removed from the urethra. Proximalanchor delivery device34 is introduced trans-urethrally in the urethra overconnector16.Proximal anchor14 is attached toconnector16 by proximalanchor delivery device34 such thatproximal anchor14 is located in the lumen of the urethra. Throughout this document wherever an anchor is said to be placed within a body lumen, it is to be understood that such anchor could be positioned within the lumen itself or at some sub-luminal or peri-luminal location, unless specified otherwise. A suitable tension inconnector16 causesproximal anchor14 anddistal anchor12 to compress the tissue between them. This compression creates one or more folds or pleats in the walls of the urethra as shown inFIG. 7N. The one or more folds or pleats are preferably created in the region of the urethra adjacent to a urinary sphincter. This enables the urinary sphincter to close more efficiently. This in turn reduces the undesired leakage of urine through the urethra of the patient, thereby reducing the severity of incontinence.
• FIG. 7O shows a cross section of a tubular organ showing a first embodiment of a method of compressing a tissue adjacent to a tubular organ to cause one or more regions of the tissue to displace the walls of the tubular organ thereby reducing the cross sectional area of the lumen of the tubular organ. InFIG. 7O, the urethra is used as an example of a tubular organ that may be treated using the method. Other examples of tubular organs that may be treated by the method shown inFIG. 7O include, but are not limited to bowel, stomach, esophagus, trachea, bronchii, bronchial passageways, veins, arteries, lymphatic vessels, ureters, bladder, cardiac atria or ventricles, uterus, fallopian tubes, etc. In the method shown inFIG. 7O,proximal anchor14 is located in a lumen of the tubular organ.Proximal anchor14 is connected to one end of aconnector16 that is under a desired tension. The other end ofconnector16 is connected to adistal anchor12.Distal anchor12 is implanted outside the lumen of the tubular organ. In one embodiment,distal anchor12 is implanted within a tissue located adjacent to the tubular organ. In another embodiment,distal anchor12 is implanted beyond a tissue located adjacent to the tubular organ. The tension inconnector16 causesproximal anchor14 anddistal anchor12 to compress a region of the tissue located adjacent to the tubular organ. This causes one or more regions of the tissue located adjacent to the tubular organ to bulge and displace one or more regions of the wall of the tubular organ. This in turn reduces the cross sectional area of the lumen of the tubular organ.
• FIG. 7P shows a cross section of a tubular organ showing a second embodiment of a method of compressing a tissue adjacent to a tubular organ to cause one or more regions of the tissue to displace the walls of the tubular organ thereby reducing the cross sectional area of the lumen of the tubular organ. InFIG. 7P, the urethra is used as an example of a tubular organ that may be treated using the method. Other examples of tubular organs that may be treated by the method shown inFIG. 7P include, but are not limited to bowel, stomach, esophagus, trachea, bronchii, bronchial passageways, veins, arteries, lymphatic vessels, ureters, bladder, cardiac atria or ventricles, uterus, fallopian tubes, etc. In the method shown inFIG. 7P,proximal anchor14 is located on one side of a tissue located adjacent to the tubular organ.Proximal anchor14 is connected to one end of aconnector16 that is under a desired tension. The other end ofconnector16 is connected to adistal anchor12.Distal anchor12 is implanted on the opposite side of the tissue located adjacent to the tubular organ. The tension inconnector16 causesproximal anchor14 anddistal anchor12 to compress a region of the tissue. This in turn causes one or more regions of the tissue located adjacent to the tubular organ to bulge and displace one or more regions of the wall of the tubular organ as shown inFIG. 7P. This in turn reduces the cross sectional area of the lumen of the tubular organ.
• FIGS. 7Q through 7V show longitudinal sections of a tubular organ showing the steps of a method of reducing the cross sectional area of the lumen of the tubular organ by creating one or more folds or bulges in the walls of the tubular organ along the axis of the tubular organ. In the step shown inFIG. 7Q, a distalanchor delivery device30 is introduced in a tubular organ. InFIGS. 7Q-7V, the urethra is used as an example of a tubular organ that may be treated using the method. Other examples of tubular organs that may be treated by the method shown inFIGS. 7Q to7V include, but are not limited to bowel, stomach, esophagus, trachea, bronchii, bronchial passageways, veins, arteries, lymphatic vessels, ureters, bladder, cardiac atria or ventricles, uterus, fallopian tubes, etc. Distalanchor delivery device30 comprises a bendable distal tip. The bendable distal tip can be controllably bent by a user. Distalanchor delivery device30 is advanced through the tubular organ and positioned in a desired location. In the step shown inFIG. 7R, the distal tip of distalanchor delivery device30 is controllably bent by the user. In the step shown inFIG. 7S, aneedle32 is advanced through distalanchor delivery device30.Needle32 emerges out of distalanchor delivery device30 at an angle to the axis of distalanchor delivery device30 as shown inFIG. 7S.Needle32 is advanced such that it penetrates through a region of the wall of the tubular organ at a penetration site.Needle32 is further advanced such that it reenters the lumen of the tubular organ. This step may be visualized by an endoscope located in the lumen of the tubular organ. In the step shown inFIG. 7T, adistal anchor12 is deployed through the distal tip ofneedle32. Distalanchor delivery device30 is withdrawn from the tubular organ leavingdistal anchor12 connected to aconnector16. In the step shown inFIG. 7U, a proximalanchor delivery device34 is advanced overconnector16. Proximalanchor delivery device34 is advanced until the distal region of proximalanchor delivery device34 is adjacent to the penetration site ofneedle32.Connector16 is pulled to create a desired tension inconnector16.Proximal anchor14 is attached toconnector16 in the lumen of the tubular organ. The tension inconnector16 causesproximal anchor14 anddistal anchor12 to compress the region of the wall of the tubular organ located betweenproximal anchor14 anddistal anchor12. This in turn causes one or more regions of the wall of the tubular organ to fold or bulge into the lumen of the tubular organ as shown inFIG. 7V. This in turn creates one or more folds or bulges in the walls of the tubular organ along the axis of the tubular organ. The one or more folds or bulges reduce the cross sectional area of the lumen of the tubular organ. This method can be repeated to compress multiple regions of the wall of the tubular organ to create multiple bulges in the wall of the tubular organ. In one method embodiment, the one or more folds or bulges are preferably created in the region of the urethra adjacent to a urinary sphincter of a patient suffering from incontinence. This enables the urinary sphincter to close more efficiently. This in turn reduces the undesired leakage of urine through the urethra of the patient, thereby reducing the severity of incontinence.
• FIGS. 7W through 7Y shows cross sections of a tubular organ showing the steps of a first embodiment of a method of reducing the cross sectional area of the lumen of the tubular organ by implanting a device that pinches the walls of the tubular organ to create a recess. InFIGS. 7W-7Y, the urethra is used as an example of a tubular organ that may be treated using this method. Other examples of tubular organs that may be treated by the method shown inFIGS. 7W-7Y include, but are not limited to urethra, blood vessels, bowel, stomach, esophagus, trachea, bronchii, bronchial passageways, veins, arteries, lymphatic vessels, ureters, bladder, cardiac atria or ventricles, uterus, fallopian tubes, etc. A distal anchor delivery device is introduced in the anatomy. The distal anchor delivery device is used to penetrate through the lumen of a tubular organ and deploy adistal anchor12 in the walls of the tubular organ or in the surrounding anatomy as shown inFIG. 7W.Distal anchor12 is connected to aconnector16 that passes through the lumen of the tubular organ. In the step shown inFIG. 7X, aproximal anchor14 is advanced overconnector16.Proximal anchor14 is advanced overconnector16 such thatproximal anchor14 is proximal to the lumen of the tubular organ.Proximal anchor14 may be located in the walls of the tubular organ or in the surrounding anatomy.Connector16 is pulled to create a desired tension inconnector16. The tension inconnector16 causesproximal anchor14 anddistal anchor12 to pinch a region of the tubular organ located between them. This in turn creates a recess or fold in the wall of the tubular organ as shown inFIG. 7Y.Proximal anchor14 is attached toconnector16 in the lumen of the tubular organ. The excess length ofconnector16 may be cut or trimmed. The recess or fold in the wall of the tubular organ reduces the cross sectional area of the lumen of the tubular organ. The steps shown inFIGS. 7W-7Y may be repeated to create multiple recesses or folds in the walls of the tubular organ. Such a method may be used to treat a variety of diseases including, but not limited to incontinence, emphysema, obesity, vaginal prolapse, aneurysms, diverticuli, etc.
• FIGS.7Z through7AD show cross sections of a tubular organ showing the steps of a second embodiment of a method of reducing the cross sectional area of the lumen of the tubular organ by implanting a device that pinches the walls of the tubular organ to create a recess. In FIGS.7Z-7AD, the urethra is used as an example of a tubular organ that may be treated using this method. Other examples of organs that may be treated by the method shown in FIGS.7Z-7AD include, but are not limited to bowel, stomach, esophagus, trachea, bronchii, bronchial passageways, veins, arteries, lymphatic vessels, ureters, bladder, cardiac atria or ventricles, uterus, fallopian tubes, etc. A distal anchor delivery device is introduced in the anatomy. The distal anchor delivery device may be introduced, for example, transluminally through the lumen of the tubular organ. The distal anchor delivery device is used to penetrate through a wall of the tubular organ. The distal anchor delivery device is used to deploy adistal anchor12 in the wall of the tubular organ or in the surrounding anatomy as shown inFIG. 7Z.Distal anchor12 is connected to aconnector16 that passes through the lumen of the tubular organ. Similarly, in the step shown inFIG. 7AA, a seconddistal anchor12 is deployed in the wall of the tubular organ or in the surrounding anatomy. The seconddistal anchor12 is also connected to asecond connector16 that passes through the lumen of the tubular organ. In the step shown inFIG. 7AB, a connectingdevice214 is introduced in the lumen of the tubular organ over the twoconnectors106.Connecting device214 may be introduced, for example, transluminally through the lumen of the tubular organ. The twoconnectors106 are pulled to create a desired tension in the twoconnectors106. The tensions in the twoconnectors106 cause the twodistal anchors102 to pinch a region of the tubular organ located between them. This in turn creates a recess or fold in the wall of the tubular organ as shown inFIG. 7AC. A desired region of the first connector is connected to a desired region of thesecond connector16 by connectingdevice214. This connection is created in the lumen of the tubular organ as shown inFIG. 7AD. The excess length ofconnectors106 may be cut or trimmed. The recess or fold in the wall of the tubular organ reduces the cross sectional area of the lumen of the tubular organ. The steps shown in FIGS.7Z-7AD may be repeated to create multiple recesses or folds in the walls of the tubular organ. Such a method may be used to treat a variety of diseases including, but not limited to incontinence, emphysema, obesity, vaginal prolapse, aneurysms, diverticuli, etc.
• The methods and devices disclosed herein may be used to create multiple folds, bulges or recesses in the walls of a tubular organ to reduce the cross sectional area of the lumen of the tubular organ. For example,FIG. 7AE shows a cross section of a tubular organ showing a first embodiment of a method of reducing the cross sectional area of the lumen of the tubular organ by implanting devices that pinch the walls of the tubular organ to create two recesses. InFIG. 7AE, a first anchoring system comprising aproximal anchor14 and adistal anchor12 connected by aconnector16 is deployed as shown. The tension inconnector16 causesdistal anchor12 andproximal anchor14 to pinch a region of the tubular organ located between them. This in turn creates a first recess or fold in the wall of the tubular organ as shown.Proximal anchor14,distal anchor12 andconnector16 may be deployed in the anatomy, for example, by the method shown inFIGS. 7W-7Y. Alternatively,proximal anchor14,distal anchor12 andconnector16 may be deployed in the anatomy by the method shown in FIGS.7Z-7AD. A second anchoring system comprising aproximal anchor14 and adistal anchor12 connected by aconnector16 is also deployed as shown. The second anchoring system creates a second recess or fold in the wall of the tubular organ as shown. In the embodiment shown inFIG. 7AE, the second recess or fold is created at a location that is roughly diametrically opposite to the first recess or fold.
• FIG. 7AF shows a cross section of a tubular organ showing a second embodiment of a method of reducing the cross sectional area of the lumen of the tubular organ by implanting devices that pinch the walls of the tubular organ to create two recesses. InFIG. 7AF, a first anchoring system comprising aproximal anchor14 and adistal anchor12 connected by aconnector16 is deployed as shown. The tension inconnector16 causesdistal anchor12 andproximal anchor14 to pinch a region of the tubular organ located between them. This in turn creates a first recess or fold in the wall of the tubular organ as shown.Proximal anchor14,distal anchor12 andconnector16 may be deployed in the anatomy, for example, by the method shown inFIGS. 7W-7Y. Alternatively,proximal anchor14,distal anchor12 andconnector16 may be deployed in the anatomy by the method shown in FIGS.7Z-7AD. A second anchoring system comprising aproximal anchor14 and adistal anchor12 connected by aconnector16 is also deployed as shown. The second anchoring system creates a second recess or fold in the wall of the tubular organ as shown. In the embodiment shown inFIG. 7AF, the second recess or fold is created at a location that is not diametrically opposite to the first recess or fold.
• The methods and devices disclosed herein may be used to reinforce a fold, bulge or recess in the walls of a tubular organ to further reduce the cross sectional area of the lumen of the tubular organ. For example,FIG. 7AG shows a cross section of a tubular organ showing a method of reducing the cross sectional area of the lumen of the tubular organ by creating a recess in the walls of the tubular organ and reinforcing the recessed region. InFIG. 7AG, a first anchoring system comprising aproximal anchor14 and adistal anchor12 connected by aconnector16 is deployed in a tubular organ. The tension inconnector16 causesdistal anchor12 andproximal anchor14 to pinch a region of the tubular organ located between them. This in turn creates a recess or fold in the wall of the tubular organ as shown.Proximal anchor14,distal anchor12 andconnector16 may be deployed in the anatomy, for example, by the method shown inFIGS. 7W-7Y. Alternatively,proximal anchor14,distal anchor12 andconnector16 may be deployed in the anatomy by the method shown in FIGS.7Z-7AD. A second anchoring system comprising aproximal anchor14 and adistal anchor12 connected by aconnector16 is also deployed as shown. The second anchoring system is deployed in the recess or fold created by the first anchoring system in the wall of the tubular organ. The second anchoring system reinforces the recess or fold created by the first anchoring system. The second anchoring system may also increase the size of the recess or fold created by the first anchoring system. This in turn may further reduce the cross sectional area of the lumen of the tubular organ. It should also be understood that variations in the procedure may be usable to subtly alter the shape of the lumen of the tubular organ or may be usable to remove deformities or pockets in the lumen, for example, closing or compressing diverticuli or aneurysmic morphologies.
• The various devices and methods disclosed herein may be used to prevent or treat a variety of diseases or disorders of a variety of anatomical systems. Examples of such anatomical systems include, but are not limited to the musculoskeletal system, the gastrointestinal system, the urinary system, etc. For example,FIG. 8A shows an anchoring system implanted in a stomach to reduce the volume of the stomach to treat obesity. The anchoring system comprises aproximal anchor14 connected to adistal anchor12 by aconnector16.Proximal anchor14 is located on the outer surface or within the wall of the stomach of an obese patient. Similarly,distal anchor12 is located on the outer surface or within the wall of the stomach of the obese patient.Connector16 passes through the lumen of the stomach. The tension inconnector16 causesproximal anchor14 anddistal anchor12 to compress a region of stomach located between them. This in turn reduces the volume of the stomach. This in turn restricts the volume of intake of food by the patient, thereby causing weight loss.
• FIG. 8B shows a cross sectional view of a stomach before implanting an anchoring system to reduce the volume of the stomach.FIG. 8C shows a cross sectional view of the stomach ofFIG. 8B after implanting an anchoring system to reduce the volume of the stomach. InFIG. 8C, the volume of the stomach is reduced by implanting an anchoring system. The anchoring system comprises aproximal anchor14 connected to adistal anchor12 by aconnector16.
• The various devices and methods disclosed herein may be used to close or repair wounds. For example,FIG. 8D shows a section through wound edges closed by an anchoring system in a first configuration. InFIG. 8D, a wound comprising two wound edges is closed by an anchoring system comprising aproximal anchor14 connected to adistal anchor12 by aconnector16. The tension inconnector16 causesproximal anchor14 anddistal anchor12 to compress the wound edges. This in turn brings the wound edges close to each other, thereby closing the wound. In the embodiment shown inFIG. 8D, the wound edges are closed in a side-to-side configuration. The anchoring system shown inFIG. 8D may be deployed, for example, by distalanchor delivery device30 and proximalanchor delivery device34 ofFIGS. 6A and 6C respectively.Connector16 may be fully or partially biodegradable or bioabsorbable.
• FIG. 8E shows a section through wound edges closed by an anchoring system in a second configuration. InFIG. 8E, a wound comprising two wound edges is closed by an anchoring system comprising aproximal anchor14 connected to adistal anchor12 by aconnector16. The tension inconnector16 causesproximal anchor14 anddistal anchor12 to compress the wound edges. This in turn brings the wound edges close to each other, thereby closing the wound. In the embodiment shown inFIG. 8D, the wound edges are closed in an end-to-end configuration. The anchoring system shown inFIG. 8D may be deployed, for example, by distalanchor delivery device30 and proximalanchor delivery device34 ofFIGS. 6A and 6C respectively. Distalanchor delivery device30 may comprise a curved distal tip.Connector16 may be fully or partially biodegradable or bioabsorbable.
• FIG. 8F shows an anchoring device used to reconnect torn tissues of the musculoskeletal system. InFIG. 8F, an anchoring system is used to reconnect a torn ligament Li. In the normal anatomy, one piece of the ligament Li is connected to bone Bo, and the other piece of ligament Li is connected to a muscle. The anchoring system comprises aproximal anchor14 connected to adistal anchor12 by aconnector16. The tension inconnector16 causesproximal anchor14 anddistal anchor12 to compress the ends of the two pieces of ligament Li. This in turn brings the two pieces of ligament Li close to each other, thereby joining the torn ligament Li as shown inFIG. 8F. Similarly, other torn tissues of the musculoskeletal system such as torn muscles may be reconnected by an anchoring system.
• FIG. 8G shows a sagittal section through the head of a patient suffering from sleep apnea. InFIG. 8G, the soft palate SP of the patient is blocking the flow of air from the nostrils to the lungs. Also, inFIG. 8G, the tongue TO of the patient is obstructing the fluid path from the mouth to the pharynx. Thus, the patient is unable to breathe normally.
• FIG. 8H shows a sagittal section through the head of a patient suffering from sleep apnea who has been treated with two anchoring devices that displace the obstructing portions of the soft palate SP and the tongue To. InFIG. 8H, an anchoring system comprising aproximal anchor14 connected to adistal anchor12 by aconnector16 is implanted in the posterior region of the soft palate SP. The tension inconnector16 causesproximal anchor14 anddistal anchor12 to compress a region of the soft palate SP. This in turn displaces the obstructing region of the soft palate SP as shown. Thus, the flow of air from the nostrils to the lungs is not blocked by the soft palate SP. In addition, or alternatively, a region of the tongue TO may also be displaced by an anchoring system. InFIG. 8F, the anchoring system comprises aproximal anchor14 connected to adistal anchor12 by aconnector16. The tension inconnector16 causesproximal anchor14 anddistal anchor12 to compress a posterior region of the tongue TO. This in turn displaces the obstructing region of the tongue TO as shown. Thus, the fluid path from the mouth to the lungs is not blocked by the tongue TO. Multiple anchoring systems may be used to displace obstructing regions of the soft palate SP and/or obstructing regions of the tongue TO.
• The devices and systems disclosed herein may be used for a variety of cosmetic procedures. For example,FIG. 8I shows an anchoring system that is implanted to lift loose skin in the face of a human. Such an anchoring system may be used, for example, to lift wrinkled skin to smoothen wrinkles. InFIG. 8I, an anchoring system comprising aproximal anchor14 connected to adistal anchor12 by aconnector16 is implanted in the tissues of the face as shown. In the embodiment shown inFIG. 8I, distal anchor is implanted behind an ear of the patient.Proximal anchor14 is implanted in a region of the cheek of the patient having wrinkled facial skin. The tension inconnector16 causesproximal anchor14 anddistal anchor12 to displace the region of the cheek having wrinkled facial skin. This in turn stretches the wrinkled facial skin to improve the cosmetic appearance of the human. Similar methods may be used to lift sagging facial skin to improve the cosmetic appearance of a human.
• Various regions of the face may be treated by methods similar to the method shown inFIG. 8J. For example,FIG. 8J shows a view of a human face showing facial regions that may be treated by a method similar to the method shown inFIG. 8I to improve the cosmetic appearance of the human. One example of a facial region that can be treated by a method similar to the method shown inFIG. 8I is the eyebrow zone. Aproximal anchor14 may be implanted in the region EB and adistal anchor12 may be implanted in a region EB′.Proximal anchor14 is connected todistal anchor12 by aconnector16 that passes through the line joining region EB to region EB′. In an alternate embodiment,proximal anchor14 may be implanted in the region EB′ and adistal anchor12 may be implanted in a region EB. Another example of a facial region that can be treated by a method similar to the method shown inFIG. 8I is the temporal zone. Aproximal anchor14 may be implanted in the region TE and adistal anchor12 may be implanted in a region TE′.Proximal anchor14 is connected todistal anchor12 by aconnector16 that passes through the line joining region TE to region TE′. In an alternate embodiment,proximal anchor14 may be implanted in the region TE′ and adistal anchor12 may be implanted in a region TE. Another example of a facial region that can be treated by a method similar to the method shown inFIG. 8I is the malar zone. Aproximal anchor14 may be implanted in the region MA and adistal anchor12 may be implanted in a region MA′.Proximal anchor14 is connected todistal anchor12 by aconnector16 that passes through the line joining region MA to region MA′. In an alternate embodiment,proximal anchor14 may be implanted in the region MA′ and adistal anchor12 may be implanted in a region MA. Another example of a facial region that can be treated by a method similar to the method shown inFIG. 8I is the mandibular zone. Aproximal anchor14 may be implanted in the region MD and adistal anchor12 may be implanted in a region MD′.Proximal anchor14 is connected todistal anchor12 by aconnector16 that passes through the line joining region MD to region MD′. In an alternate embodiment,proximal anchor14 may be implanted in the region MD′ and adistal anchor12 may be implanted in a region MD. Another example of a facial region that can be treated by a method similar to the method shown inFIG. 8I is the neckerchief zone. Aproximal anchor14 may be implanted in the region NK and adistal anchor12 may be implanted in a region NK′.Proximal anchor14 is connected todistal anchor12 by aconnector16 that passes through the line joining region NK to region NK′. In an alternate embodiment,proximal anchor14 may be implanted in the region NK′ and adistal anchor12 may be implanted in a region NK. The facial regions shown inFIG. 8J may be treated, for example, to improve the cosmetic appearance of a human with wrinkled or sagging facial skin.
• FIG. 8K shows a sagittal section through the lower abdomen of a human female showing an embodiment of a method of treating female urinary incontinence by a sling attached to the anatomy by anchoring devices.FIG. 8K shows the lower abdomen of a human female showing the urinary bladder UB, uterus U and rectum R. The method shown inFIG. 8K is especially suited to treat stress incontinence caused due to physical changes because of pregnancy, childbirth, menopause, etc. The physical changes prevent the urethral sphincter from closing tightly. This in turn causes urine to leak during moments of physical stress. The method shown inFIG. 8K is similar to the Tension-Free Vaginal Tape (TVT) Procedure. In the method shown inFIG. 8K, asling220 is inserted around the urethra UT.Sling220 may be inserted around the urethra UT by a retropubic or transvaginal approach.Sling220 is made of suitable biocompatible materials. Examples of such materials include, autologous graft tissue such as muscles, ligaments, tendons, etc.; animal graft tissue from animals such as pigs, etc.; synthetic biodegradable or non-biodegradable polymers, etc. The two ends ofsling220 are anchored to surrounding anatomical regions such as the pubic bone, periostial membrane of the pubic bone, Cooper's ligament, abdominal wall, lateral pelvic wall, outer bladder wall, pelvic fascia by anchoring devices. In the embodiment shown inFIG. 8K, the two ends ofsling220 are attached to the surrounding anatomical structures by two anchoring devices. Each anchoring device comprises aproximal anchor14 and adistal anchor12 connected toproximal anchor14 by a connector.Connector16 passes through an end ofsling220 such thatproximal anchor14 is anchored in the material ofsling220.Distal anchor12 anchors into the surrounding anatomical structures, thereby attaching the end ofsling220 to the surrounding anatomical structures.Sling220 supports the urethra UT and partially compresses the urethra UT.Sling220 cause a sufficient compression of the urethra UT to enable urethral sphincter to close tightly. It should be noted that the intent of these procedures is not in all cases to create compression on the urethra but in other situations is used to support surrounding structures or prevent the movement of certain structures under certain conditions, such as in the case of hypermobility. In this circumstance, the devices would normally be “tension-free” and would only be brought into tension when there is movement of the tissue with respect to the anchor/tensioning-member assembly.
• FIG. 8L shows a cross section of a normal urethra UT.FIG. 8M shows a cross section of the urethra UT in a human female suffering from stress urinary incontinence. InFIG. 8M, the urethra UT has reduced support from surrounding anatomical structures. This prevents the urethral sphincter from closing tightly causing incontinence.FIG. 8N shows a cross section of the urethra UT in a human female suffering from stress urinary incontinence where the urethra UT has been supported with a sling. InFIG. 8N,sling220 supports the urethra UT and partially compresses the urethra UT.Sling220 causes a sufficient compression of the urethra UT to enable urethral sphincter to close tightly. This in turn reduces the severity of the incontinence.
• FIG. 8O shows a coronal section through the lower abdomen of a human female suffering from stress urinary incontinence. Two anchoring devices have been implanted in order to tether together separate tissue planes. The tethering of these planes reduces their relative movement; thus reducing hypermobility. Each anchoring device comprises aproximal anchor14 and adistal anchor12 connected toproximal anchor14 by a connector that passes through separate tissue planes. Tissue planes supports the urethra UT and may partially compresses the urethra UT. With this supportive tissue plane now fixed in place, forces which would otherwise have caused the involuntary descent of the bladder resulting in incontinence are now apposed.
• One or more anchoring or tensioning devices disclosed herein may be used to anchor a first anatomical region to a second anatomical region. For example, one or more anchoring or tensioning devices disclosed herein may be used to perform various embodiments or modifications of colposuspension procedures. In the standard colposuspension procedure (Burch colposuspension) a surgeon sutures a region of the vaginal wall to the Cooper's ligament. This is performed by placing two non-absorbable sutures on each side of the urethra, partially through the segment of the vaginal wall located under the junction where the bladder joins the urethra. The two sutures on each side (four total) are then attached to the Cooper's ligament. A key difficulty in performing this procedure is the step of tying a knot, especially when the procedure is performed laparoscopically. The need to synch and tie sutures sequentially through a laparoscope is very time consuming using standard techniques and it is often difficult to achieve the desired suture tension. For example,FIG. 8P shows a section through the lower abdomen showing an embodiment of a colposuspension procedure wherein one or more regions of the vaginal wall of a patient suffering from incontinence are suspended to the Cooper's ligament by one or more anchoring devices. In the embodiment shown inFIG. 8P, one or moredistal anchors102 are deployed in a desired region of the Cooper's ligament by a device introduced through the vagina V. The one or moredistal anchors102 may be deployed through a needle that emerges through the device introduced through the vagina and penetrate through the vaginal wall to reach the desired location. The one or moredistal anchors102 are deployed on each side of the urethra as shown inFIG. 8P. Eachdistal anchor12 is connected to aconnector16. Aproximal anchor106 is attached to a desired region of eachconnector16 located in the vagina. Eachproximal anchor14 anchors one end of eachconnector16 to the vaginal wall. The tension inconnector16 causes the vaginal wall to be suspended by Cooper's ligament. The suspension of the vaginal wall to the Cooper's ligament reduces the severity of the incontinence. The abovementioned method may be visualized by a laparoscope inserted in the pelvic area.
• In an alternate embodiment, the devices for deployingproximal anchor14 and/ordistal anchor12 are inserted laparoscopically into the pelvic area. A laparoscope may be used to visualize the instruments. In one embodiment, the laparoscope is introduced through the navel. The devices for deployingproximal anchor14 and/ordistal anchor12 are introduced through two other incisions in the lower abdomen.
• One or more devices or methods disclosed herein may be used to attach a plugging element to a tubular organ to seal an opening or a puncture site of the tubular organ. For example,FIG. 8Q shows an anchoring device used to attach a seal to a puncture site on a blood vessel BV to seal the puncture site. InFIG. 8Q, the puncture site on the blood vessel is plugged by aseal222.Seal222 is made of suitable biocompatible materials. Examples of such materials include, but are not limited to collagen, gelfoam, other bioabsorbable polymer matrices, etc.Seal222 is attached to the puncture site by an anchoring device that passes throughseal222. The anchoring device comprises adistal anchor12, aproximal anchor14 and aconnector16 that connectsdistal anchor12 toproximal anchor14.Distal anchor12 is located in the lumen of the blood vessel.Proximal anchor14 is located outside the blood vessel, such thatconnector16 passes through the puncture site. A sufficient tension is created inconnector16 such thatdistal anchor12 andproximal anchor14 compress the edges of the puncture site to seal222. This in turn securely attachesseal222 to the edges of the puncture site, thereby sealing the puncture site.
• One or more anchoring or tensioning devices disclosed herein may be used to suspend a first anatomical region to a second anatomical region. For example, one or more anchoring or tensioning devices disclosed herein may be used to suspend a breast region to an anatomical region superior anatomical region such as a muscle, subcutaneous fatty tissue, a ligament, etc. This may be used to achieve cosmetic modification of the breasts. In a particular embodiment, a subcutaneous fatty tissue of a breast is suspended to an anatomical region superior to the fatty tissue such as a muscle, a subcutaneous fatty tissue, a ligament, etc. In another particular embodiment, a breast tissue is suspended to an anatomical region superior to the breast tissue such as a muscle, a subcutaneous fatty tissue, a ligament, etc. The anchor delivery devices may be introduced in the anatomy through a cannula. Alternatively the anchor delivery device may comprise a sharp distal tip to penetrate through tissue. For example,FIG. 8R shows a view of the pectoral region of a human female. A region of a breast may be suspended to an anatomical region superior to the region of the breast using the anchoring devices disclosed herein. This may be used, for example, for cosmetic mastopexy. The anchoring devices may be deployed such that the connectors of the anchoring devices pass through the dashed lines shown inFIG. 8R.FIG. 8S shows the pectoral region of a human female wherein mastopexy has been performed on one or more regions of the breasts using the anchoring devices disclosed herein.
• Any of the anchors disclosed herein may be made of suitable elastic or non-elastic biocompatible materials. Examples of such materials include, but are not limited to metals such as stainless steel 304, stainless steel 316, nickel-Titanium alloys, titanium, etc. and polymers such as Pebax, Polyimide, braided Polyimide, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK, PTFE, PFA, FEP, EPTFE, shape memory polymers, etc.
• Connector16 described herein may be made from several biocompatible materials. For example,connector16 may be made from synthetic fibers e.g. various grades of Nylon, polyethylene, polypropylene, polyester, Aramid, shape memory polymers, etc.; metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; natural fibers e.g. cotton, silk etc.; rubber materials e.g. various grades of silicone rubber, etc. In a particular embodiment, connector is made of elastic suture materials.Connector16 may comprise one or more serrations or notches. The serrations or notches may be aligned in a particular direction to allow relatively easy movement of an outer body alongconnector16 in one direction and offer significant resistance to movement of the outer body along theconnector16 in the opposite direction.Connector16 may comprise a single filament or multiple filaments of one or more materials. For example,connector16 may comprise a composite braided structure in a plastic/metal or plastic/plastic configuration to reduce profile and increase strength. Such composite materials could have preset levels of elasticity.Connector16 may be coated with a coating. Examples of such coatings include, but are not limited to lubricious coatings, antibiotic coatings, etc.
• One or more of the devices disclosed herein may comprise a variety of markers. In one embodiment, the markers are visual markers located on the surface of the one or more devices. Such markers may enable a user to determine the absolute of relative location of the one or more devices visually or by an instrument such as a cystoscope. In another embodiment the markers may be radiographic markers. Similarly, one or more of the devices disclosed herein may comprise a variety of electromagnetic or ultrasonic or MRI or multimodality markers.
• A suitable urinary catheter may be inserted into the urethra for a desired period of time after completion of one or more of the procedures described herein. The urinary catheter may be used, for example, if the patient is at risk of bleeding or acute urethral obstruction.
• The one or more anchoring devices disclosed herein may be designed to allow a user to reverse the anatomical changes caused by the anchoring devices if needed. In one method embodiment the anatomical changes may be reversed by cuttingconnector16 nearproximal anchor14. In another method embodiment the anatomical changes may be reversed by cuttingconnector16 neardistal anchor12.
• One or more components such asdistal anchor12,proximal anchor14,connector16, etc. of the one or more anchoring devices disclosed herein may be designed to be completely or partially biodegradable or biofragmentable.
• The devices and methods disclosed herein may be used to treat a variety of pathologies in a variety of tubular organs or organs comprising a cavity or a wall. Examples of such organs include, but are not limited to urethra, bowel, stomach, esophagus, trachea, bronchii, bronchial passageways, veins (e.g. for treating varicose veins or valvular insufficiency), arteries, lymphatic vessels, ureters, bladder, cardiac atria or ventricles, uterus, fallopian tubes, etc.
• It is to be appreciated that the invention has been described hereabove with reference to certain examples or embodiments of the invention but that various additions, deletions, alterations and modifications may be made to those examples and embodiments without departing from the intended spirit and scope of the invention. For example, any element or attribute of one embodiment or example may be incorporated into or used with another embodiment or example, unless to do so would render the embodiment or example unpatentable or unsuitable for its intended use. Also, for example, where the steps of a method are described or listed in a particular order, the order of such steps may be changed unless to do so would render the method unpatentable or unsuitable for its intended use. All reasonable additions, deletions, modifications and alterations are to be considered equivalents of the described examples and embodiments and are to be included within the scope of the following claims.

Claims (14)

1-63. (canceled)

64. A device useable to anchor an elongate member to tissue of a human or animal subject, said anchor device comprising:

an anchor body having a hollow passage through which the filament may pass; and

a locking member that is initially positioned in a non-locked position that allows the anchor body to advance over the filament and a locked position where the locking member engages the filament thereby holding the anchor body at a substantially fixed position on the filament.

65. A device according toclaim 64 wherein the elongate member is selected from the group consisting of. connector members, filaments, strands, threads, suture threads, string, wires, semi-rigid members, flexible members, elastic members, non-elastic members, resilient members and plastically deformable members.

66. A device according toclaim 64 wherein the locking member comprises a locking pin.

67. A device according toclaim 64 wherein the locking member comprises a wedging element that wedges between the filament and the anchor body.

68. A device according toclaim 67 wherein the wedging element comprises an elongate shaft having branches or bristles extending therefrom.

69. A device according toclaim 64 wherein the second body anchor body further comprises a locking member engagement surface that engages the locking member after it has been advanced to its locked position, thereby holding the locking member in its locked position.

70. A device according toclaim 64 wherein the locking member engagement surface comprises a tab that extends into the hollow channel and wherein a notch is formed in the locking member such that when the locking member is advanced to its locked position the tab will seat in the notch, thereby holding the locking member in its locked position.

71. A system comprising a device according toclaim 64 in combination with an introducer that is insertable into the body and useable to advance the anchor body over the filament to a desired position on the filament and the then move the locking member from its non-locked position to its locked position, thereby locking the anchor body on the filament at the desired location.

72. A system according toclaim 71 wherein the introducer further comprises a cutter for cutting the filament at a site proximal to the anchor body after the anchor body has been advanced to the desired location.

73. A system according toclaim 71 further comprising a handpiece on the proximal end of the introducer, said handpiece comprising a first actuator for advancing the anchor body over the filament and a second actuator for moving the locking member from its non-locked position to its locked position.

74. A system according toclaim 72 further comprising a handpiece on the proximal end of the introducer, said handpiece comprising a first actuator for advancing the anchor body over the filament, a second actuator for moving the locking member from its non-locked position to its locked position and a third actuator for cutting the filament.

75. A device according toclaim 64 wherein the anchor body comprises an elongate member having an open proximal end, a side aperture and wherein the hollow passage extends at least from the open proximal end to the side aperture such that an end of the filament may be inserted into the side aperture and the anchor body may then be advanced over the filament such that the filament trails out of the open proximal end of the second anchor as the second anchor is advanced over the filament.

76-137. (canceled)

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