US20120116153A1 - Apparatus and method for intra-abdominally moving a first internal organ to a position away from a second internal organ and then holding the first internal organ in the position without manual input - Google Patents

Abstract

An apparatus including a flexible length of cord and three tissue connectors positioned at the opposite ends of the cord and at an intermediate position of the cord is designed to be laparoscopically inserted through the abdominal wall and into the abdominal cavity, and used to move a first internal organ to a position away from a second internal organ where the apparatus holds the first internal organ in the position without further manual input, thereby providing surgical access to the second internal organ.

Description

BACKGROUND OF THE INVENTION
• 1. Field of the Invention
• The present invention is directed to an apparatus and its method of use in intra-abdominally moving a first internal organ to a position away from a second internal organ where the apparatus holds the first internal organ in the position without further manual input. More specifically, the present invention is directed to an apparatus that is inserted through the abdominal wall and into the abdominal cavity, and the method of using the apparatus in the abdominal cavity to move a human liver to a position away from a human stomach where the apparatus holds the liver in the position without further manual input, thereby providing surgical access to the stomach.
• 2. Description of the Related Art
• In laparoscopic surgical procedures, it is often necessary to make incisions through the abdominal wall for the sole purpose of providing access to the abdominal cavity for surgical graspers or other similar types of retracting instruments that are used to move one internal organ to a position away from a second internal organ to gain surgical access to the second internal organ. The incisions made for the surgical graspers or similar retracting instruments are in addition to the incisions made in the abdominal wall for the surgical instruments used in performing the surgical procedure on the second organ.
• Furthermore, it is often necessary that an additional surgeon or surgical assistant be present solely for the purpose of manipulating the surgical graspers or other similar retracting instruments in moving the first internal organ to a position away from the second internal organ, and then manually holding the first internal organ in the position during the surgical procedure performed on the second internal organ.
• The need for the additional surgical personnel to manipulate and hold the surgical graspers or other similar retracting instruments during the surgical procedure increases the costs of surgery. In addition, the additional incisions in the abdominal wall required for the surgical graspers or other similar retracting instruments often results in additional discomfort to the patient following surgery and additional scarring.
• What is needed to overcome these disadvantages associated with the above-described type of laparoscopic surgical procedure is an apparatus that can be operated to intra-abdominally move a first internal organ to a position away from a second internal organ and then hold the first internal organ in the position without requiring additional manual input other than that provided by the surgeon and without requiring additional abdominal incisions other than those required for the surgery.
SUMMARY OF THE INVENTION
• The present invention overcomes the above-described shortcomings of laparoscopic surgical procedures by providing an apparatus that can be inserted into the abdominal cavity through the same incision to be used in a laparoscopic surgery procedure, and the method of using the apparatus to move or retract a first internal organ, for example the liver, away from a second internal organ, for example the stomach, and then hold the first internal organ in the retracted position providing surgical access to the second Internal organ without requiring further manual input.
• The apparatus Is constructed of component parts that are often used in laparoscopic as well as other types of surgical procedures. The component parts will be described herein using their common understood names and their functions, without going into details of the particular constructions of the component parts.
• The basic construction of the apparatus of the invention includes a length of cord. The cord could be comprised of a first cord segment having a flexible length with opposite first and second ends, and a second cord segment having a flexible length with opposite first and second ends. The cord segments could be provided by lengths of suture, lengths of tubing such as IV tubing, lengths of umbilical tape or elastic strips, or other equivalent cord constructions. The first and second cord segments could be separate cord segments that are attached together, or could be two cord segments of a single continuous length of cord.
• First, second, and third separate tissue connectors are attached to the first and second cord segments. The tissue connectors can be any type of known tissue connector that can be manually manipulated to connect to body tissue, and then manually manipulated to be removed from the body tissue without leaving any significant damage to the body tissue. In addition, the tissue connectors can be biocompatible tissue connectors that are designed to be left in the abdominal cavity after the surgery. Some examples of such tissue connectors include suture needles, “T” bars, graspers, barbed needles, hooks, clasps, rivet assemblies, or any other equivalent type of connector. The first and third tissue connectors are attached to the opposite ends of the first cord segment and the second and third tissue connectors are attached to the opposite ends of the second cord segment. This positions the first and second tissue connectors at the opposite ends of the combined lengths of the first and second cord segments, and positions the third tissue connector at an intermediate position of the combined lengths of the first and second cord segments.
• In the use of the apparatus according to the method of the invention, the apparatus is first manually passed through the abdominal wall, for example through an incision or a cannula in the abdominal wall, and is positioned in the abdominal cavity in the area of the first and second internal organs. The third tissue connector is then manually connected to tissue adjacent the first internal organ. This positions the ends of the first and second cord segments connected to the third tissue connector between the first and second internal organs and on an opposite side of the first internal organ from the abdominal wall. The first tissue connector attached to the opposite end of the first cord segment from the third tissue connector is manually moved causing the length of the first cord segment to move and engage across the first internal organ and to move the first internal organ toward the position away from the second internal organ. The first tissue connector is then manually connected to the abdominal wall.
• The second tissue connector attached to the opposite end of the second cord segment from the third tissue connector is then manually moved causing the second cord segment to move and engage across the first internal organ and move the first internal organ toward the position away from the second internal organ. The second tissue connector is then manually connected to the abdominal wall.
• In the above matter, the first and second cord segments engaging across the first internal organ hold the first internal organ at the position away from the second internal organ without further manual input. This provides surgical access to the second internal organ.
• In a further embodiment of the apparatus of the invention, the apparatus is comprised of a cord having a continuous flexible length with opposite first and second ends. A needle is attached to one end of the length of cord and a knot is formed in the opposite end of the length of cord.
• According to the method of use of this embodiment of the apparatus, the apparatus is first positioned inside the abdominal cavity in the same manner as the previously-described embodiment. The knotted end of the length of cord is then connected to tissue adjacent the first internal organ by first passing the needle through the tissue and then manually pulling the length of cord through the tissue. This attaches the knotted end of the cord to the tissue between the first and second internal organs.
• The needle is then passed through the inter-abdominal wall and manually moved back into the abdominal cavity, causing a first segment of the length of cord to engage across the first internal organ and move the first internal organ toward the position away from the second internal organ.
• The needle is then again inserted through the inter-abdominal wall at a location spaced from the first insertion of the needle through the inter-abdominal wall, and the needle and length of cord are pulled manually into the abdominal cavity.
• The needle and the end of the length of cord attached to the needle are then passed through the knot formed at the opposite end of the length of cord and pulled tight, causing a second segment of the length of cord to engage across and move the first internal organ toward the position away from a second internal organ. A knot is then tied between the opposite ends of the length of cord and the portion of the cord extending from the knot to the needle is cut and removed with the needle from the abdominal cavity. The length of cord left in the abdominal cavity forms a triangular loop with first and second cord segments that engage across and hold the first internal organ in the position away from the second internal organ without manual input. In this manner, surgical access is provided to the second internal organ without manual input.
• As described above, the apparatus of the invention and its method of use enable intra-abdominally moving a first internal organ to a position away from a second internal organ where the apparatus holds the first internal organ in the position without manual input.
DESCRIPTION OF THE DRAWING FIGURES
• Further features of the apparatus of the invention and Its method of use are set forth in the following detailed description of the apparatus and method and are shown in the drawing figures.
• FIG. 1 is a plan view of one embodiment of the apparatus of the invention.
• FIG. 2 is a plan view of a further embodiment of the apparatus of the invention.
• FIG. 3 is a plan view of a still further embodiment of the apparatus of the invention.
• FIG. 4 is a representation of the apparatus ofFIG. 1 being inserted into the abdominal cavity.
• FIG. 5 is a representation of the apparatus ofFIG. 1 being used according to the method of the invention.
• FIG. 6 is a representation of the apparatus ofFIG. 2 in use according to the method of the invention.
• FIG. 7 is a representation of the apparatus ofFIG. 3 in use according to the method of the invention.
• FIGS. 8A-8E represent the insertion of one embodiment of the apparatus into the abdominal cavity and one method of use of the apparatus.
• FIGS. 9A-9E represent the insertion of a further embodiment of the apparatus into the abdominal cavity and the method of using the apparatus.
• FIGS. 10A and 10B represent the insertion of a further embodiment of the apparatus into the abdominal cavity and the method of using the apparatus.
• FIGS. 11A and 11B represent a further embodiment of the apparatus and its method of use.
• FIGS. 12A and 12B represent a further embodiment of the apparatus and its method of use.
• FIGS. 13A and 13B represent a further embodiment of the apparatus and its method of use.
• FIGS. 14A-14C represent a further embodiment of the apparatus and its method of use.
• FIGS. 15A and 15B represent a further embodiment of the apparatus and its method of use.
• FIGS. 16A and 16B represent a further embodiment of the apparatus and its method of use.
• FIG. 17 represents a further embodiment of the apparatus and its method of use.
• FIGS. 18A and 18B represent a further embodiment of the apparatus and its method of use.
• FIGS. 19A and 19B represent a further embodiment of the apparatus and its method of use.
• FIGS. 20A and 20B represent a further embodiment of the apparatus and its method of use.
• FIGS. 21A and 21B represent a further embodiment of the apparatus and its method of use.
• FIGS. 22A and 22B represent a further embodiment of the apparatus and its method of use.
• FIG. 23 represents a further embodiment of the apparatus and its method of use.
• FIGS. 24A-24C represent component parts of a further embodiment of the apparatus.
• FIG. 25 represents a component part of a further embodiment of the apparatus.
• FIG. 26 represents a component part of a further embodiment of the apparatus.
• FIG. 27 represents a further embodiment of the apparatus.
• FIG. 28 represents a further embodiment of the apparatus.
• FIG. 29 represents a further embodiment of the apparatus.
• FIG. 30 represents a further embodiment of the apparatus.
• FIG. 31 represents a further embodiment of the apparatus.
• FIG. 32 represents a further embodiment of the apparatus.
• FIG. 33 represents a component part of an embodiment of the apparatus.
• FIG. 34 represents a component part of an embodiment of the apparatus.
• FIG. 35 represents a component part of an embodiment of the apparatus.
• FIG. 36 represents a component part of an embodiment of the apparatus.
• FIG. 37 represents a component part of an embodiment of the apparatus.
• FIG. 38 represents a component part of an embodiment of the apparatus.
• FIGS. 39A-39C represent component parts of an embodiment of the apparatus.
• FIGS. 40A and 40B represent component parts of an embodiment of the apparatus.
• FIG. 41 represents a component part of an embodiment of the apparatus.
• FIG. 42 represents a component part of an embodiment of the apparatus.
• FIG. 43 represents a component part of an embodiment of the apparatus.
• FIGS. 44A and 44B represent component parts of an embodiment of the apparatus.
• FIGS. 45A-45E represent component parts of an embodiment of the apparatus.
• FIGS. 46A-46E represent component parts of an embodiment of the apparatus and its method of use.
• FIGS. 47A-47D represent component parts of an embodiment of the apparatus and its method of use.
• FIGS. 48A-48D represent component parts of an embodiment of the apparatus and its method of use.
• FIGS. 49A and 49B represent component parts of an embodiment of the apparatus and its method of use.
• FIGS. 50A and 50B represent component parts of an embodiment of the apparatus and its method of use.
• FIGS. 51A-51E represent a method of positioning an embodiment of the apparatus in an abdominal insertion device.
• FIGS. 52A and 52B represent embodiments of the apparatus and an insertion device and the method of mounting the apparatus on the insertion device.
• FIG. 53 represents embodiments of the apparatus and an insertion device and a method of mounting the apparatus on the insertion device.
• FIG. 54 represents embodiments of the apparatus and an insertion device and a method of mounting the apparatus in the insertion device.
• FIGS. 55A-55C represent an embodiment of the apparatus and a method of using the apparatus.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
• FIG. 1 shows oneembodiment12 of the apparatus for intra-abdominally moving a first internal organ to a position away from a second internal organ and then holding the first internal organ in the position without manual input. As stated earlier, theapparatus12 is constructed of component parts that are often used in laparoscopic instruments and procedures as well as other types of surgical instruments and procedures. Because such component parts are known, the component parts that make up theapparatus12 of the invention will be described herein using their common understood names and functions, without going into the details of the particular constructions of the component parts. As is conventional with laparoscopic apparatus, the component parts of the apparatus are dimensioned to be inserted through an incision in the abdominal wall or through a cannula extending through the abdominal wall to position the apparatus in the abdominal cavity.
• The basic construction of theapparatus12 of the invention includes a length of cord. In the example ofFIG. 1 the cord length is 10 inches, but the size of theapparatus12 could change depending on the size of the patient in which the apparatus is used. In the embodiment shown inFIG. 1, the cord is comprised of afirst cord segment14 having a flexible length with opposite first16 and second18 ends, and asecond cord segment22 having a flexible length with opposite first24 and second26 ends.
• Thecord segments14,22 could be provided by lengths of suture, lengths of tubing such as IV tubing, lengths of umbilical tape or elastic strips, or other equivalent cord constructions. The tubing or tape configurations of the cord segments have the advantage of being less likely to dig into or cut into the first internal organ in use of the apparatus to be described. The first14 and second22 cord segments could be separate cord segments that are attached directly together, or separate cord segments that are attached by way of afurther cord segment28 or some other component part of the apparatus, or two cord segments of a single continuous length of cord such as the twocord segments14a,22ashown inFIG. 2.
• First32, second34, and third36 separate tissue connectors are attached to the first14 and second22 cord segments. Thetissue connectors32,34,36 can be any type of known tissue connector that can be manually manipulated to connect to body tissue, and then manually manipulated to be removed from the body tissue without leaving any significant damage to the body tissue. In addition, thetissue connectors32,34,36 could be biocompatible tissue connectors that are designed to be left in the abdominal cavity after the surgical procedure is completed. Some examples of tissue connectors include suture needles, “T” bars, surgical graspers, barbed needles, hooks, clasps, rivet assemblies, or any other equivalent type of connector. In the apparatus of the invention, it is not necessary that all threetissue connectors32,34,36 be the same type of tissue connector. Because various different types of tissue connectors may be employed with theapparatus12 of the invention, the threetissue connectors32,34,36 of theapparatus12 are represented schematically in the drawing figures. The first32 and third36 tissue connectors are attached to the opposite ends of thefirst cord segment14. Thethird tissue connector36 is also attached to one end of thesecond cord segment22, with thesecond tissue connector34 being connected to the opposite end of thesecond cord segment22. This positions the first32 and second34 tissue connectors at the opposite ends of the combined lengths of the first14 and second22 cord segments, and positions thethird tissue connector36 at an intermediate position of the combined length of the first14 and second22 cord segments. InFIG. 1, the first32 and second34 tissue connectors are shown connected to the respectivefirst end16 of thefirst cord segment14 and thefirst end24 of thesecond cord segment22 through the intermediary ofadditional cord segments38,40. Thethird tissue connector36 is shown connected to thesecond end18 of thefirst cord segment14 and thesecond end26 of thesecond cord segment22 through the intermediary of afurther cord segment28.FIG. 2 shows theapparatus12 with the first32 and second34 tissue connectors connected directly to the respectivefirst end16 of thefirst cord segment14 and thefirst end24 of thesecond cord segment22.FIG. 2 also shows thethird tissue connector36 connected directly to the second ends18,26 of thefirst cord segment14 and thesecond cord segment22.
• FIGS. 4 and 5 illustrate an example of the use of theapparatus12 ofFIG. 1 according to the method of the invention. In use, theapparatus12 is first manually passed through theabdominal wall42, for example through an incision or acannula44 in theabdominal wall42, and is positioned in theabdominal cavity46 in the area of the first48 and second50 internal organs. InFIG. 4, the firstinternal organ48 represented is the human liver, and the secondinternal organ50 represented is the human stomach.
• Thethird tissue connector36 of the apparatus is then manually connected totissue52 adjacent the firstinternal organ48 and between the first48 and second50 internal organs. In the example shown inFIG. 4, thetissue52 is the crus of the diaphragm. Connection of thethird tissue connector36 to thetissue52 positions the second ends18,26 of the first14 and second22 cord segments connected to thethird tissue connector32 between the first48 and second50 internal organs and on an opposite side of the firstInternal organ48 from theabdominal wall42.
• Thefirst tissue connector32 attached to theopposite end16 of thefirst cord segment14 from thethird tissue connector36 is then manually moved causing the length of thefirst cord segment14 to move and engage across the firstinternal organ48. Continued movement of thefirst tissue connector32 causes thefirst cord segment14 engaging across the firstinternal organ48 to move the first internal organ toward a position away from the secondinternal organ50. Thefirst tissue connector32 is then manually connected to the innerabdominal wall42.
• Thesecond tissue connector34 attached to theopposite end24 of thesecond cord segment22 from thethird tissue connector36 is then manually moved causing thesecond cord segment22 to move and engage across the firstinternal organ48. Continued movement of thesecond tissue connector34 causes thesecond cord segment22 engaging across the firstinternal organ48 to move the firstinternal organ48 toward the position away from the secondinternal organ50. Thesecond tissue connector34 is then manually connected to the innerabdominal wall42.
• With theapparatus12 connected between thetissue52 and the innerabdominal wall42 in the manner discussed above, thefirst cord segment14 and thesecond cord segment22 engage across the firstinternal organ48 and hold the firstinternal organ48 at the position away from the secondinternal organ50 without further manual input. This provides surgical access to the secondinternal organ50. Without requiring manual holding or restraining of the firstinternal organ48 in the position away from the secondinternal organ50.
• FIG. 6 is a representation of the apparatus ofFIG. 2 that has been connected between thetissue52 and the innerabdominal wall42 according to the same method as the apparatus ofFIG. 1 described above.
• In a further embodiment of the apparatus of the invention shown inFIG. 3, theapparatus54 is comprised of asingle cord56 having a continuous flexible length with opposite first58 and second60 ends. A tissue connector in the form of aneedle62 is attached to thefirst end58 of the length ofcord56. At the oppositesecond end60 of the length ofcord56, the cord is formed in aknot64.
• The method of using the embodiment of theapparatus54 shown inFIG. 3 is illustrated inFIG. 7. Theapparatus54 Is first positioned Inside the abdominal cavity in the same manner as the previously described embodiments. The knottedend64 of the length of cord is then connected to thetissue52 adjacent the firstinternal organ48 by first passing theneedle62 through thetissue52 and then manually pulling theneedle62 and the attached length ofcord56 through thetissue52. This attaches the knottedsecond end64 of the length ofcord58 to thetissue52 between the first48 and second50 internal organs.
• Theneedle62 is then passed through theinter-abdominal wall42 and theneedle62 and the attached length ofcord56 are pulled from theinsertion site72 back into theabdominal cavity46. This causes afirst segment74 of thecord length56 to move into engagement with and across the firstinternal organ48. The engagement of thefirst cord segment74 with the firstinternal organ48 moves the firstinternal organ48 toward the position away from the secondinternal organ50.
• Theneedle62 is then again inserted through theinter-abdominal wall42 at asecond insertion location76 spaced from thefirst insertion location72. Theneedle62 and the attached length ofcord56 are pulled manually through thesecond insertion76 into theabdominal cavity46 until an intermediate section ofcord78 extends between the twoinsertion sites72,76.
• Theneedle62 and the attached length ofcord56 are then passed through theknot64 formed at the opposite end of the length ofcord56 and are pulled tight. This causes asecond cord segment82 of the length ofcord56 to engage across and move the firstinternal organ48 toward the position away from the secondinternal organ50. The length ofcord56 Is pulled tight and a knot is tied between the opposite ends of the cord at theknot64 on the cordsecond end60. The portion of the length ofcord54 extending from theknot64 to theneedle62 is then cut and removed from the abdominal cavity. The length ofcord54 left in the abdominal cavity forms a triangular loop with the first56 and second82 cord segments extending across the firstinternal organ48 and holding the first internal organ in the position away from the secondinternal organ50 without manual input. In this manner, surgical access is provided to the secondinternal organ50 without manually holding the firstinternal organ48 in its retracted position.
• FIGS. 8A-8E represent one method of inserting the apparatus of the invention into the abdominal cavity and the method of using the apparatus. The embodiment of theapparatus12 shown in these drawing figures has a pair of keith needles80,82 as the first and second tissue connectors, and abar84 as the third tissue connector. Theapparatus12 is first positioned inside aninsertion device86 in the form of a hollow narrow tube. Theinsertion device86 is then inserted through a trocar orcannula44 that has been positioned in theabdominal wall42 in a conventional manner. Once inside theabdominal cavity46, theapparatus12 is removed from the interior of theinsertion device86 and the insertion device is removed from the abdominal cavity through thecannula44. The “T”bar84 or the third tissue connector is then passed through thebody tissue52, i.e., the right diaphragm crus as described earlier. Once the “T”bar84 is passed through thetissue52, it is rotated to its substantially 90 degree position relative to its pathway through thetissue52 as shown inFIG. 8C. Theapparatus12 is then pulled from the keith needles80,82. As represented inFIG. 8D, the keith needles80,82 are then passed through theabdominal wall42 and the apparatus is pulled tight against the firstinternal organ48, i.e., the liver. Theneedles80,82 are then pulled at the exterior of theabdominal wall42, causing the apparatus to move the firstinternal organ48 away from the second internal organ, i.e., the stomach. A pair of tension clasps88,90 are attached to the respective first14 and second22 cord segments of the apparatus on the exterior of theabdominal wall42 to hold the apparatus in its position across the firstinternal organ48 in theabdominal cavity46.
• FIGS. 9A-9E represent a method of using an embodiment of theapparatus12 that is similar to that shown inFIGS. 8A-8E and described above. In this example, theapparatus12 also employs the “T”bar84 as its third tissue connector. However, there is no needle provided on thefirst cord segment14 and there is no needle provided on thesecond cord segment22. In this embodiment of theapparatus12, thefirst cord segment14 is a length of suture having afree end92 opposite the “T”bar84 and thesecond cord segment22 is a length of suture also having afree end94 opposite the “T”bar84. Theapparatus12 is shown inFIG. 9A as being positioned in theabdominal cavity46 using theinsertion device86 in the same manner described earlier with reference to the method ofFIGS. 8A-8E. Theapparatus12 ofFIG. 9A is also initially used according to the same method ofFIGS. 8A-8E in that the “T”bar84 is passed through thebody tissue52 and is positioned substantially 90 degrees relative to the pathway through the tissue. A pair of GraNee needles98,98 are then passed through theabdominal wall42. One of the GraNee needles96 grabs the suturefree end92 of thefirst cord segment14 and theother GraNee needle98 grabs the suturefree end94 of thesecond cord segment22. The GraNee needles96,98 are then withdrawn through theabdominal wall42 pulling the suture free ends92,94 through the abdominal wall. The suture free ends92,94 are then secured to the abdominal wall using a pair ofclamps88,90 as was done in the previously-described embodiment ofFIGS. 8A-8E.
• FIGS. 10A and 10B are a representation of the method of the invention practiced using an ENDO STITCH® device marketed by United States Surgical Corporation.FIG. 10A represents the distal end of theENDO STITCH®102 being inserted through thecannula44 in theabdominal wall42 to a position adjacent thediaphragm crus52. As is conventional, the pair ofjaws104,108 at the ENDO STITCH®distal end102 hold aneedle108 and a length ofsuture110. TheENDO STITCH®102 is manually actuated to pass theneedle108 through thetissue52 of the crus from oneJaw104 of the ENDO STITCH® to theopposite jaw106 of the ENDO STITCH®. The length ofsuture110 is then removed from theabdominal cavity46 through thecannula44 and is pulled tight, causing the length ofsuture110 to move and hold the first interal organ away from the second internal organ in substantially the same manner as described earlier.
• FIGS. 11A and 11B represent a further embodiment of theapparatus12 and its method of use. The embodiment of theapparatus12 shown inFIGS. 11A and 11B and its method of use are substantially the same as that of earlier-described embodiments, except that the “T” bar of the previously-described embodiments is replaced by a “J”hook locking clasp112.FIG. 11A shows the lockingclasp112 in its open position prior to the hook portion of the clasp being passed through thetissue52 of the diaphragm crus.FIG. 11B shows the lockingclasp112 after the hook of the clasp has been passed through thetissue52 and the clasp has been locked. The method of further using the apparatus to move and hold an internal organ is substantially the same as that of earlier-described embodiments.
• FIGS. 12A and 12B show a further embodiment of theapparatus12 and its method of use. The construction of the embodiment of theapparatus12 shown inFIGS. 12A and 12B is substantially the same as earlier described embodiments, except that the “T” bar or locking clasp is replaced by abarbed needle114. The method of using the embodiment of the apparatus shown inFIGS. 12A and 12B is substantially the same as that of earlier described embodiments, except that thebarbed needle114 is passed through thetissue52 of the diaphragm crus until the barb of the needle emerges from the tissue as shown inFIG. 12B. This secures the apparatus to thetissue52. Further use of the apparatus to move and hold an internal organ is substantially the same as that of earlier-described embodiments.
• FIGS. 13A and 13B show a further embodiment of theapparatus12 of the invention that is substantially the same as that as earlier-described embodiments except that the third tissue connector or “T” bar is replaced by a resilient biasedclasp116. In the method of using the apparatus ofFIGS. 13A and 13B, theopposite arms118,120 of theclasp116 are compressed to open thejaws122,124 of the clasp as shown inFIG. 13A. Thejaws122,124 are then positioned around thetissue52 of the diaphragm crus and are allowed to close, thereby securing theclasp116 to thetissue52. The subsequent method of using the apparatus shown inFIGS. 13A and 13B is substantially the same as that of previously-described embodiments of the apparatus.
• FIG. 14A-14C show a further embodiment of theapparatus12 that is substantially the same as that of previously-described embodiments except that the third tissue connector is a two-piece rivet assembly. The assembly is comprised of apin126 having anenlarged point128 and acap130 having acircular center opening132. In the method of using the apparatus ofFIGS. 14A-C, thepin126 is first inserted through thetissue52 of the diaphragm crus until thepoint128 projects from the opposite side of the tissue. Thepoint128 is then inserted through the center opening132 of thecap130, thereby securing thepin126 and thecap130 to thetissue152. The subsequent steps of using the apparatus ofFIGS. 14A-14C is substantially the same as that of earlier-described embodiments of the apparatus.
• FIGS. 15A and 15B show a further embodiment of theapparatus12 that has substantially the same construction of earlier-described embodiments of the apparatus except for the first and second tissue connectors being a pair of “J” shaped hooks134,136. In the method of using the embodiment of the apparatus shown inFIGS. 15A and 15B, thefirst cord segment14 and thesecond cord segment22 are secured to the innerabdominal wall42 by passing thehooks134,136 through the tissue of the inner abdominal wall. Apart from this, the method of using the apparatus shown inFIGS. 15A and 15B is substantially the same as that of earlier-described embodiments of the apparatus.
• FIGS. 16A and 16B represent a further embodiment of the apparatus and its method of use that are substantially the same as that of previously-described embodiments, except for the first and second tissue connectors being a pair of “J” hook locking clasps138,140. In the method of using the apparatus ofFIGS. 16A and 16B, the hook portions of the locking clasps138,140 are passed through the tissue of the innerabdominal wall42 and then are locked closed. This secures thefirst cord segment14 and thesecond cord segment22 to the inner abdominal wall. Apart from this, the method of using the apparatus of the invention shown inFIGS. 16A and 16B is substantially the same as that of earlier-described embodiments of the apparatus.
• FIGS. 17 shows a representation of an embodiment of the apparatus where the first and second tissue connectors are provided as a pair of resilient,biased clasps142,144 that have substantially the same construction of the earlier-describedclasp116. Theclasps142,144 are secured to the innerabdominal wall42 by first opening the clasps and positioning tissue of the inner abdominal wall between the open jaws of the clasps, and then allowing the jaws of the clasps to close over the tissue. This secures thefirst cord segment14 and thesecond cord segment22 to the inner abdominal wall. Apart from this, the method of using the apparatus represented inFIG. 17 is substantially the same as that as earlier-described embodiments of the apparatus.
• FIGS. 18A and 18B show an embodiment of the apparatus and its method of use that is substantially the same as that ofFIG. 7. The embodiment ofFIGS. 18A and 18B differs from that of theFIG. 7 embodiment in that the free ends146,148 of the length ofsuture150 are tied in a knot completing the triangular loop configuration of the length ofsuture150 at a location that is displaced from the portion of thesuture150 passed through thetissue52 of the diaphragm crus. Apart from this, the method of using the apparatus of the invention shown inFIGS. 18A and 18B is substantially the same as that of the embodiment of the apparatus shown inFIG. 7.
• FIGS. 19A and 19B show a further embodiment of the apparatus and its method of use. The apparatus shown in these drawing figures is comprised of a length ofcord152 with acircular pledget154 secured at one end of the cord and a needle, for example akeith needle156, secured to the opposite end of the cord. Thecord152 could be a length of suture or other similar material. In the method of using the apparatus shown inFIGS. 19A and 19B, theneedle156 is first passed through theabdominal wall42 and Into theabdominal cavity46. Theneedle156 is then passed through thetissue52 of the diaphragm crus. Theneedle156 is then again passed through theabdominal wall42 to the exterior of the abdomen and is pulled tight. This results in the length ofcord152 engaging against and moving the first internal organ away from the second internal organ in substantially the same manner as previously-described embodiments. The tight length ofcord152 is then secured in place by aclasp158 attached to the length ofcord152 against the exterior of theabdominal wall42.
• FIGS. 20A and 20B show a representation of a further embodiment of the apparatus and its method of use. InFIG. 20A, the apparatus is shown comprised of a length ofcord160 having acircular pledget162 at one end and a needle, for example akeith needle164, at the opposite end. The apparatus also includes a second shorter length ofcord166 with a “T”bar168 at one end and aloop170 formed in the opposite end. In the embodiment, thecords160,166 may be suture or other similar materials. The method of using the apparatus is represented inFIG. 20B. The “T”bar168 is first secured to thetissue52 of the diaphragm crus. Theneedle164 is then passed through the tissue of the innerabdominal wall42, through theloop170 and then through theabdominal wall42 to the exterior of the abdomen. Pulling theneedle164 on the exterior of the abdomen pulls thecord160 tight across the internal organ to move and hold the internal organ in substantially the same manner as that of previously-described embodiments of the apparatus.
• FIGS. 21A and 21B show a further embodiment of the apparatus that is substantially the same as that of the embodiment ofFIGS. 20A and 20B, except that theneedle164 is removed from the end of the length ofcord160, leaving afree end172 of the cord. The method of using this embodiment of the apparatus is substantially the same as that of the previously-described embodiment except for the step of passing the cordfree end172 through theabdominal wall32. A GraNee needle (not shown) may be used to perform this step of the method.
• FIGS. 22A and 22B show a further embodiment of the apparatus that is substantially the same as that of the previously-described embodiment, except that it is comprised of only the length ofcord160 having thecircular pledget162 at one end and afree end172 of the cord at the opposite end. In the method of using this embodiment of the apparatus, the suturefree end172 is first passed through the innerabdominal wall42, then through thetissue52 of the diaphragm crus, and then through and out of theabdominal wall42. As in the previously-described embodiment, the suturefree end172 can be passed through the tissue of theabdominal wall42 and thecrus52 using a GraNee needle or other similar instrument. The length ofcord160 is pulled tight to move and hold the first internal organ relative to the second internal organ in substantially the same manner as previously-described method embodiments of the apparatus.
• FIG. 23 shows a further embodiment of the apparatus that is substantially the same as that of earlier-described embodiments except for the first and second tissue connectors being “J” hook locking clasps174,176 that incorporate one-way clutch mechanisms. The ends of thecord segments14,22 can be pulled through the clutch mechanisms of theclasps174,176 in one direction, but are prevented by the clutch mechanisms from being pulled through theclasps174,176 in the opposite directions.
• FIG. 24A-24C show representations of a “J” hook locking clasp such as that shown inFIG. 23, with a one-way clutch mechanism. The one-way clutch mechanism is comprised of arotatable pulley178 and a “V” shapedgroove180 positioned adjacent thepulley178. An end portion of thecord182 is threaded through the “V” shapedgroove180 and then around thepulley178. When the end of thecord182 extending from thepulley178 is pulled tight, the relative positions of thepulley178 and thegroove180 cause the portion of thecord182 to wedge and become locked in the bottom of thegroove180.
• FIG. 25 shows a further representation of the embodiment of the apparatus employing a “J”hook locking clasp184 with a one-way clutch mechanism. The one-way clutch mechanism is comprised of a pair of pivotingcams186,188 having opposingratchet tooth surfaces190,192. A portion of theapparatus cord194 is threaded between the opposed tooth surfaces. The portion ofcord194 can be pulled through the spacing between the camratchet tooth surfaces190,192 in one direction, for example to the left inFIG. 25, but thecams186,188 pivot toward each other and theirratchet tooth surfaces190,192 clamp thecord portion194 between the surfaces when the cord portion is pulled in the opposite direction, for example to the right as shown InFIG. 25.
• FIG. 26 shows a representation of a further embodiment of the “J”hook clasp196 having a one-way clutch mechanism. In this embodiment, the one-way clutch mechanism is comprised of atoothed wheel198 that engages with the cord portion20 pulled through theclaps196. Thetooth wheel198 also has asmaller ratchet wheel202 at its center. Theratchet wheel202 engages against aresilient pawl204. Theratchet wheel202 andresilient pawl204 function in the conventional manner allowing thetoothed wheel198 to rotate in one direction when thecord portion200 is pulled through the clutch mechanism, for example to the right as shown inFIG. 26, but prevent the rotation of thetoothed wheel198 and the movement of thecord portion200 when the cord portion is pulled in the opposite direction, for example to the left as shown inFIG. 26.
• FIGS. 27-32 show several different representations of the possible constructions of thecord segments14,22,38 of the apparatus of the invention. InFIGS. 27-32 the first and second tissue connectors are represented by needles, for example keith needles80,82. The third tissue connector is represented by a “T”bar84. It should be understood that these are only examples of only three tissue connectors that could possibly be used with the apparatus of the invention, and that other forms of tissue connectors, for example the types described herein could be used as the three tissue connectors on the apparatus.
• FIG. 27 shows the first14, second22 and third38 cord segments as being constructed of suture material.
• FIG. 28 shows the first14 and second22 cord segments being part of a single length of surgical tape or strap, and thethird cord segment38 being constructed of suture.
• FIG. 29 shows the first14 and second22 cord segments being constructed of lengths of suture inserted through lengths of surgical tubing. Thethird cord segment38 is constructed of suture.
• FIG. 30 shows the apparatus as having first14 and second22 cord segments constructed of combinations of surgical tape and suture connected end to end. Thethird cord segment38 is constructed of suture material.
• FIG. 31 shows the apparatus being constructed of first14 and second22 cord segments formed from a single length of suture material inserted through a single length of surgical tubing. Thethird cord segment38 is constructed of suture material.
• FIG. 32 shows the apparatus as having the first14 and second22 cord segments constructed of a single continuous length of surgical tape having lengths of suture at opposite ends. Thethird cord segment38 is constructed of suture material.
• FIGS. 33-45 show examples of some of the various different types of tissue connectors that could be used as any one of thetissues connectors32,34,36 of the apparatus. These are only some of the possible types of tissue connectors, and the connectors shown inFIGS. 33-45 should not be interpreted as limiting the apparatus to the particular tissue connectors shown.
• FIG. 33 shows a “T”bar84 as one example of any one of the threetissue connectors32,34,36.
• FIG. 34 shows abarbed needle114 as any one of the threetissue connectors32,34,36.
• FIG. 35 shows the two-piece rivet pin126 andcap130 connector that can be used as any one of the threetissue connectors32,34,36.
• FIG. 36 shows the “J”hook locking clasp112 that can be used as any one of the threetissue connectors32,34,36.
• FIG. 37 shows the resilient,biased clasp116 that could be used as any one of the threetissue connectors32,34,36.
• FIG. 38 shows a cross-section of an embodiment of a “J” hook locking clasp. The embodiment shown is comprised of acylindrical housing206 that contains the “J”hook208 and acoil spring210 that biases the “J”hook208 to its closed position.
• FIGS. 39A-39C show a variation of the “J” hook locking clasp ofFIG. 38 where thecoil spring210 is replaced by aspiral band spring212.FIG. 39B shows the spiral andspring212 in its extended configuration, andFIG. 39C shows the spring in its compressed configuration.
• FIGS. 40A and 40B show a tissue connector clasp that is comprised of a pair ofresilient jaws214,216 that project from one end of ahollow housing218, and apin220 connected to the jaws that projects from the opposite end of the housing. Aspring22 contained in thehousing218 biases thepin220 and thejaws214,216 to the left as shown inFIG. 40A. This causes the resilient jaws to move to their open position shown inFIG. 40A. Pulling thepin220 to the right against the bias of thespring222 causes the housing to slide against the opposite sides of thejaws214,216 and move the jaws to their closed position.
• FIG. 41 shows a side view of the resilient biasedclasp116 described earlier. Compressing theopposite arms118,120 of theclasp116 causes thejaws122,124 to separate. Releasing the compression force causes thejaws122,124 to move together under the bias of the resilience of theclasp116.
• FIG. 42 shows an embodiment of a clasp comprised of afirst jaw224 andfirst arm226 connected by apivot connection228 to asecond jaw230 andsecond arm232. Anoblong cam234 on atoothed cam wheel236 is positioned between the pair ofarms226,232. Atoothed actuator wheel238 meshes with thetoothed cam wheel236. Rotation of theactuator wheel238 will cause rotation of thecam wheel236 and thecam238. Rotation of thecam234 to its position shown inFIG. 42 pushes the pair ofarms226,232 away from each other which In turn causes the pair ofjaws224,230 to move toward each other. Rotation of thecam234 90 degrees or one-quarter turn from its position shown inFIG. 2 will cause thejaws242,230 to move away from each other.
• FIG. 43 shows an embodiment of a clasp comprised of afirst jaw240 andfirst arm242 connected by apivot connection244 to asecond jaw246 andsecond arm248. Aspring250 is positioned between the pair ofarms240,248 and biases the arms away from each other. This in turn biases thefirst jaw242 andsecond jaw246 toward each other. Thejaws242,246 are opened by applying a compression force to the opposite sides of thefirst arm240 andsecond arm248 that compresses thespring250.
• FIGS. 44A-44B show a side-sectioned view of a construction of the rivet assembly described earlier. As seen in the drawing figures, thepin head128 is slightly larger in diameter than thecap hole132. When thepin126 is attached to thecap130, there is a fixed gap or maximum distance between acircular head252 of thepin126 and thecap130.
• FIGS. 45A-45E show a further embodiment of a rivet assembly. In this assembly, therivet pin254 hasseveral notches256 along its length between thepin head258 and thepin point260. Therivet cap262 is similar in construction to that of the previously-described embodiment with a center opening orhole264 extending through the cap. However, thecap262 is also formed with atransverse slot266 that intersects thecenter hole264 and aparallel slot268 that extends into thecap262 parallel to thecenter hole264 and intersects thetransverse slot266. Alocking tab270 with apin hole272 and aspring hole274 is inserted in thetransverse slot266 for sliding movement therein. Aresilient wire spring276 is inserted downwardly into theparallel slot268 and through thetab pin hole272. Inserting therivet pin254 into thecap center hole264 and through thetab pin hole272 causes the pin to slide the tab to the left as shown inFIG. 45A against the bias of thewire spring276. As apin notch256 passes through thetab hole272, the bias of thespring276 causes thetab270 to move to the right and into thenotch256. This locks thepin254 in place relative to thecap262. With thepin254 having a number of notches, and in the example ofFIG. 45A having three notches, the position of thepin head258 relative to thecap262 can be adjusted between three positions. This provides an adjustable gap or an adjustable distance between thepin head258 and thecap262.
• FIGS. 46A-46E represent a further embodiment of the apparatus of the invention. This embodiment is comprised of a length ofcord278 having aneedle280 at one end and aloop282 formed at the opposite end. Acircular pledget284 is provided on the length of cord,278 toward the loop end of the cord. The apparatus also includes a locking collar having a hollowcylindrical housing286 that contains a tubular one-way suture lock288. Thesuture lock288 is basically cylindrical but is formed with aresilient tab290 that projects toward the center of the cylindrical configuration of the suture lock.FIG. 46E shows a cross-section representation of the collarcylindrical housing286 containing the one-way suture lock288 and a portion of the length ofcord278 extending through the collar. The method of using this embodiment of the apparatus is shown inFIG. 46C. In use in theabdominal cavity46, theneedle280 is first passed through thetissue52 in the area of the diaphragm crus, and then is passed a first time through the innerabdominal wall42. Theneedle280 is then moved across the innerabdominal wall42 and is again passed a second time through the inner abdominal wall. The needle is then inserted through theloop282 and is pulled tight. This causes the length ofcord278 to form a triangular loop in the abdominal cavity that moves the first Internal organ away from the second internal organ and holds the first internal organ in the displaced position in the same manner as previously-described methods of using the apparatus of the invention. Theneedle280 is then passed through the collarcylindrical housing286 and thehousing286 is moved tight against thecord loop282. Thecord loop282 is smaller than thehousing286 so that the housing cannot pass through theloop282. As the length ofcord278 is pulled through thecollar housing286, thelocking tab290 engages against the side of thecord278 as shown inFIG. 46E. This allows thecord278 to move through thecollar housing286 in the direction to the right shown inFIG. 46E, but prevents movement of the cord to the left as shown in the figure. In this manner, the apparatus ofFIGS. 46A-46E holds the length of cord tight in its triangular loop configuration.
• FIGS. 47A and 47B show a further embodiment of the apparatus of the invention and its method of use. The apparatus is comprised of a length ofcord294 having apledget296 secured at one end and aneedle298 secured at the opposite end. The apparatus also includes a one-way locking mechanism300 having a pair ofchannels302,304 through the mechanism dimensioned to receive the length ofcord294. One of thechannels302 allows the length ofcord294 to move through the channel in one direction, but prevents the opposite direction of movement. Theother channel304 allows the length ofcord294 to move through the channel in one direction, but also prevents the opposite direction of movement of thecord294. As represented inFIG. 47A, the method of using the apparatus first involves theneedle298 passing through the inner abdominal wall until thepledget296 is positioned up against the wall. Theneedle298 then passes through thetissue52 in the area of the diaphragm crus. Theneedle298 is then inserted through thefirst channel302 of the one-way locking mechanism300. Theneedle298 is then against passed through the inner abdominal wall at a location spaced from the first insertion site and is then passed through thesecond channel304 of the one-way locking mechanism300. Theneedle298 with the length ofcord294 are then pulled tight and thelocking mechanism300 is moved up against the inner abdominal wall at the second needle insertion site. This causes the length ofcord294 to move the first internal organ and hold the first internal organ in its moved position away from the second internal organ in a similar manner to that of earlier-described embodiments.
• FIGS. 47C and 47D show the interior of one embodiment of the one-way locking mechanism300. Themechanism300 includes a housingfirst half306 and asecond half308 that are connected together by aliving hinge310. The open position of the locking mechanism is shown inFIG. 47D. The interior of the twohalves306,308 of the locking mechanism are formed withgrooves312,314 that form the twochannels302,304 through the locking mechanism when the twohalves306,308 of the locking mechanism are pivoted about theliving hinge310 and snapped together. A “U” shapedspring member316 is positioned in the firstlocking mechanism half306. Thespring member316 has a pair ofarms318,320 that project from opposite sides of the spring member. Eacharm318,320 in turn has aresilient locking tab322,324 that projects outwardly at an angle from itsrespective arm318,320. Theresilient tabs322,324 are positioned to engage in sliding engagement along portions of thecord294 that pass through thechannels302,304. As shown inFIG. 47D, the onetab322 will allow thecord294 to slide across the tab in a direction from right to left as shown in the drawing figure, but will prevent the reverse sliding movement of the cord. Theother tab324 will allow sliding movement of thecord294 across thetab324 in a left to right direction as shown inFIG. 47D, but will prevent the reverse movement of the length ofcord294.
• FIGS. 48A-48D show a variant embodiment of the one-way locking mechanism300. As shown inFIG. 48A, the length of cord is passed through thelocking mechanism328 in much the same manner as the earlier-describedlocking mechanism300. However, thesecond channel330 of thelocking mechanism328 ofFIG. 48A has ablock332 with ahole334 positioned along the channel. Aninclined tooth336 is positioned in theblock hole334. The portion of thecord length338 that extends through thelocking mechanism channel330 also extends through theblock hole334. Aspring340 in thelocking mechanism328 biases theblock332 and thetooth336 toward the portion ofcord338 extending through thelocking mechanism channel330. Due to the inclination of thetooth336, with thespring340 biasing thetooth336 into engagement with thecord portion338, thecord portion338 can slide over thetooth336 as it is moved in a left to right direction as shown inFIG. 48C, but is prevented from moving in the opposite direction. Pressing theblock332 into thelocking mechanism328 against the bias of thespring340 disengages thetooth336 from thecord portion338 and permits the cord portion to move in either direction through thelocking mechanism328.
• FIGS. 49A and 49B show a further embodiment of a cord locking mechanism344 that is similar to that ofFIG. 48A. A cross-section of achannel346 extending through the locking mechanism344 is shown inFIG. 49A. Thechannel346 is formed with pairs ofridges348,350 on opposite sides of the channel. Awave form spring352 is positioned in thechannel346. Thespring352 hasgrooves354 formed through peaks formed in the wave form spring. The portion of the cord356 passing through thelocking mechanism channel346 also passes through thegrooves354 in thewave form spring352. Abutton hole358 is provided
• In the top of the cord locking mechanism344 and arelease button360 is positioned in the hole. When therelease button360 is pressed in thehole358, it engages with thewave form spring352 and compresses the spring to the position shown inFIG. 49A. In this position of thespring352 the cord356 is free to move in opposite directions through the locking mechanism344. When thebutton360 is released, thespring352 moves upwardly from its position shown inFIG. 49A and portions of thespring362 engage with the cord portion356 extending through thelock mechanism channel346 and hold the cord portion against theridges348 at the top of thechannel346. This locks the cord portion356 in the locking mechanism344.
• FIGS. 50A and 50B show a further embodiment of a one-way cord locking mechanism. The mechanism includes ahousing364 having ahole366 extending through the housing that is defined by a cone-shapedinterior surface368. A pair oflock members370,372 are positioned in thehousing hole366. Each of thelock members370,372 haveexterior surfaces374,376 that when the locking members are positioned together, define a truncated cone shape that fits within the cone-shapedinterior surface368 of thehousing364. The opposing Interior surfaces378,380 of thelock members370,372 are formed with mating peaks and valleys. As shown inFIG. 50B, aspring382 biases the twolock members370,372 into the cone-shapedinterior surface368 of thehousing364, thereby causing the lock member interior surfaces378,380 to move toward each other. A portion of acord length384 extending through the opposinginterior surfaces378,380 of thelock members370,372 is prevented from moving in the upward direction as shown inFIG. 50B due to the bias of thespring382. However, when thecord portion384 is moved in the opposite downward direction as shown inFIG. 50B, the movement of thecord portion384 causes thelock members370,372 to compress thespring382. This allows the lock member interior surfaces378,380 to move away from each other and release the portion of thecord384 for movement through the lock mechanism.
• FIGS. 51A-51E show one method of inserting the apparatus of the invention Into thetubular insertion device86 described earlier. As shown in these drawing figures, a length ofsuture386 is looped around the apparatus and is then pulled through the interior of theinsertion device86. The first14 and second22 cord segments are folded flat against each other and theadditional cord segment38 is folded over parallel with thefirst cord segment14 andsecond cord segment22. The apparatus is then pulled by thesuture loop386 into the interior of theinsertion device86 to the position shown inFIG. 51E.
• FIGS. 52A and 52B show a further embodiment of aninsertion device390. Theinsertion device390 has the configuration of an elongate narrow rod with a pair ofopposed grooves392,394 extending up one side of the rod from adistal end396 of the rod. Athird groove398 is formed in a side of the rod toward a proximal end of the rod. Thethird groove398 is positioned between the opposed pair ofgrooves392,394. According to the method of using theinsertion device390, thefirst cord segment14 andsecond cord segment22 of theapparatus12 are positioned in the opposed pair ofgrooves392,394 that extend from the insertion devicedistal end396. Theadditional cord segment38 of theapparatus12 is positioned in thethird groove398 in the side of the rod. With the cords of the apparatus held in these grooves, theinsertion device390 is then inserted through acannula44 to insert theapparatus12 into the abdominal cavity.
• FIG. 53 shows a representation of a further embodiment of theinsertion device402 that is similar In construction to the previously-described embodiment of theinsertion device390. Theinsertion device402 ofFIG. 54 is also comprised of a pair ofopposed grooves404,406 that receive the first14 and second22 cord segments of theapparatus12, and athird groove408 that receives theadditional cord segment38 of the apparatus.
• FIG. 54 shows a still further embodiment of aninsertion device410. Theinsertion device410 has a rod-shaped length with a hollow distal end. The rod distal end is comprised of afirst half412 and asecond half414 that are connected together by a livinghinge assembly416. According to the method of using theinsertion device410 ofFIG. 54, theapparatus12 is positioned in the interior of thefirst half412 with thefirst cord segment14 andsecond cord segment22 extending parallel to each other, and thethird cord segment38 folded over thefirst cord segment14 andsecond cord segment22. Thesecond half414 of the insertion device is then folded over thehinge assembly416 and snapped closed to prepare theinsertion device410 for insertion of theapparatus12.
• FIGS. 55A-55C show amesh apparatus420 that is designed to be used as a part of the apparatus of the invention. Themesh apparatus420 is basically comprised of a generally rectangular or trapezoidal-shaped panel ofsurgical mesh422 with a pair of axially alignedtubes424 at one side and a pair of axially alignedtubes426 at the opposite side. As shown inFIG. 55B, themesh apparatus420 can be rolled up around the pairs oftubes424,426 to reduce the size of the apparatus for Insertion through a cannula and into the abdominal cavity.FIG. 55C shows themesh apparatus420 positioned in theabdominal cavity46 and held in place against the firstinternal organ48 by one of the previously-described embodiments of the apparatus. It should be understood that any of the previously-described embodiments of the apparatus may be employed according to the method of the invention to hold thesurgical mesh420 in its position as shown inFIG. 55C.
• As various modifications could be made in the constructions of the apparatus and the methods herein described and illustrated without departing from the scope of the invention, it is intended that all matter contained in the foregoing description or shown in the accompanying drawings shall be interpreted as illustrative rather than limiting. Thus, the breadth and scope of the present invention should not be limited by any of the above-described exemplary embodiments, but should be defined only in accordance with the following claims appended hereto and their equivalents.

Claims (36)

1. An apparatus for intra-abdominally moving a first internal organ to a position away from a second internal organ and then holding the first internal organ in the position without manual input, the apparatus comprising:

a cord having a flexible length with opposite first and second ends;

a first tissue connector at the cord first end;

a second tissue connector at the cord second end; and

a third tissue connector at an intermediate position of the cord between the cord first and second ends;

the first, second and third tissue connectors each being intra-abdominally connectable to intra-abdominal tissue to position the cord in engagement with the first internal organ whereby the cord moves the first internal organ to the position away from the second internal organ and the cord holds the first internal organ in the displaced position.

2. The apparatus ofclaim 1, comprising:

the first, second and third tissue connectors each being removably connectable to intra-abdominal tissue.

3. The apparatus ofclaim 1, further comprising:

the cord being a single continuous cord that extends between the first and second tissue connectors.

4. The apparatus ofclaim 1, further comprising:

the cord being comprised of a plurality of distinct cord segments connected end to end.

5. The apparatus ofclaim 1, further comprising:

the cord having a configuration of a strip.

6. The apparatus ofclaim 1, further comprising:

the first and second tissue connectors being needles.

7. The apparatus ofclaim 1, further comprising:

the tissue connector being a “T” bar.

8. The apparatus ofclaim 1, further comprising:

the cord being elastic.

9. The apparatus ofclaim 1, further comprising:

the cord being branchless.

10. The apparatus ofclaim 1, further comprising:

the first tissue connector being attached to the cord first end, the second tissue connector being attached to the cord second end, and the third tissue connector being attached to the cord at the intermediate position of the cord.

11. An apparatus for intra-abdominally moving a first internal organ to a position away from a second internal organ and then holding the first internal organ at the position without manual input, the apparatus comprising:

a first cord segment having a flexible length with opposite ends;

a second cord segment having a flexible length with opposite ends;

a first tissue connector;

a second tissue connector;

a third tissue connector;

the first and third tissue connectors being attached to the opposite ends of the first cord segment and the second and third tissue connectors being attached to the opposite ends of the second cord segment.

12. The apparatus ofclaim 11, further comprising:

the first, second and third tissue connectors being removably connectable to intra-abdominal tissue.

13. The apparatus ofclaim 11, further comprising:

the first and second cord segments being continuous cord segments with an end of the first cord segment being attached to an end of the second cord segment.

14. The apparatus ofclaim 11, further comprising:

the first and second cord segments each having a configuration of a strip.

15. The apparatus ofclaim 11, further comprising:

the first and second tissue connectors being needles.

16. The apparatus ofclaim 11, further comprising:

the third tissue connector being a “T” bar.

17. The apparatus ofclaim 11, further comprising:

the first and second cord segments being elastic.

18. The apparatus ofclaim 11, further comprising:

the first and second cord segments each being branchless.

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