Apparatus and method for repairing vaginal reconstruction

Abstract

Described are pelvic implants for treating vaginal prolapse, systems including the described pelvic implants, and methods of using the described implants and systems.

1 . An implantable device useful for treating vaginal prolapse including a paravaginal defect, the device comprising a mesh support portion and multiple mesh extension portions, the support portion being capable of supporting a bladder, each extension portion being capable of extending to tissue of an obturator foramen while the support portion supports the bladder. 
   
   
       2 . The device of  claim 1  comprising exactly four extension portions. 
   
   
       3 . The device of  claim 2  wherein each portion has a length dimension in the range from 4 to 6 centimeters. 
   
   
       4 . The device of  claim 1  wherein the support portion is circular or rectangular with rounded anterior and posterior ends. 
   
   
       5 . A system for treating vaginal prolapse comprising two implants, each implant comprising: a mesh support portion and two mesh extension portions, wherein for each implant the support portion is capable of contacting vaginal sulcus tissue while the two extension portions extend to tissue of an obturator foramen. 
   
   
       6 . The system of  claim 5  wherein the implant comprises a mesh strip, the support portion has a length of from 4 to 6 centimeters, the total length of the mesh strip is from 15 to 20 centimeters, and the mesh strip is of substantially uniform width in the range from 0.5 to 1.3 centimeters. 
   
   
       7 . The system of  claim 5  comprising one or multiple helical needles. 
   
   
       8 . The system of  claim 5  wherein the implant comprises two sutures, one suture connected at each opposing end of the implant. 
   
   
       9 . The system of  claim 5  wherein the implant comprises one or multiple sutures connected along a length of the implant. 
   
   
       10 . The system of  claim 5  wherein the implant comprises a sheath that covers the support portion and at least portions of the extension portions. 
   
   
       11 . A method of treating cystocele related to a lateral vaginal defect, the method comprising
 providing an implant according to  claim 1 ,   making an upper vaginal midline incision,   passing the implant through the vaginal incision,   placing the mesh support portion in a position superior to vaginal tissue, to support a bladder,   making a superior left external incision at an inner thigh adjacent to a left obturator foramen,   preparing a tissue path between the superior left external incision and the lateral vaginal tissue on a left side of the vagina,   passing an extension portion through the tissue path between the superior left external incision and the lateral vaginal tissue on the left side of the vagina,   making an inferior left external incision at an inner thigh adjacent to a left obturator foramen,   preparing a tissue path between the inferior left external incision and the lateral vaginal tissue on a left side of the vagina,   passing an extension portion through the tissue path between the inferior left external incision and the lateral vaginal tissue on the left side of the vagina,   making a superior right external incision at an inner thigh adjacent to a right obturator foramen,   preparing a tissue path between the superior right external incision and the lateral vaginal tissue on a right side of the vagina,   passing an extension portion through the tissue path between the superior right external incision and the lateral vaginal tissue on the right side of the vagina,   making an inferior right external incision at an inner thigh adjacent to a right obturator foramen,   preparing a tissue path between the inferior right external incision and the lateral vaginal tissue on a right side of the vagina, and   passing an extension portion through the tissue path between the inferior right external incision and the lateral vaginal tissue on the right side of the vagina.   
   
   
       12 . The method of  claim 11  comprising attaching the support portion to pubocervical fascia and positioning the support portion below a bladder and proximal to an arcus tendineus. 
   
   
       13 . The method of  claim 11  comprising:
 placing an anterior segment or edge of the support portion approximately below a bladder neck, and   placing a posterior segment or edge of the support portion approximately 1.5 centimeters proximal to an ischial spine.   
   
   
       14 . A method of treating cystocele, including treating a lateral vaginal defect, the method comprising
 providing a system according to  claim 5 ,   making an upper vaginal midline incision,   passing a first implant through the vaginal incision,   placing a mesh support portion of the first implant in contact with lateral vaginal tissue on a left side of the vagina   making a superior left external incision at an inner thigh adjacent to a left obturator foramen,   preparing a tissue path between the superior left external incision and the lateral vaginal tissue on a left side of the vagina,   passing a first extension portion of the first implant through the tissue path between the superior left external incision and the lateral vaginal tissue on the left side of the vagina,   making an inferior left external incision at an inner thigh adjacent to a left obturator foramen,   preparing a tissue path between the inferior left external incision and the lateral vaginal tissue on a left side of the vagina,   passing a second extension portion of the first implant through the tissue path between the inferior left external incision and the lateral vaginal tissue on the left side of the vagina,   passing a second implant through the vaginal incision,   placing a mesh support portion of the second implant in contact with lateral vaginal tissue on a right side of the vagina,   making a superior right external incision at an inner thigh adjacent to a right obturator foramen,   preparing a tissue path between the superior right external incision and the lateral vaginal tissue on a right side of the vagina,   passing a first extension portion of the second implant through the tissue path between the superior right external incision and the lateral vaginal tissue on the right side of the vagina,   making an inferior right external incision at an inner thigh adjacent to a right obturator foramen,   preparing a tissue path between the inferior right external incision and the lateral vaginal tissue on a right side of the vagina, and   passing a second extension portion of the second implant through the tissue path between the inferior right external incision and the lateral vaginal tissue on the right side of the vagina.