Minimally invasive levator avulsion repair

Abstract

Described are pelvic implants and methods of surgically placing pelvic implants that provide treatment for pelvic floor disorders by support of the levator by creating an incision that allows access to a region of tissue of the pelvic floor and inserting a pelvic implant comprising a tissue support portion delivered by a delivery tool. A pelvic implant for supporting levator tissue comprising: a tissue support portion having a first end and a second; a tissue fastener disposed on the first end of the tissue support portion for fastening it to levator tissue; a guide extension portion disposed on the second end of the tissue support portion; and a support backer member attachable to the guide extension portion to adjust a tension of the tissue support portion and concomitantly the levator tissue.

What is claimed is: 
     
         1 . A method of supporting tissue of the pelvic floor, the method comprising
 creating an incision that allows access to a region of tissue of the pelvic floor,   providing a pelvic implant comprising a tissue support portion;   connecting an end of the pelvic implant to a delivery tool;   passing the implant and an end of the delivery tool through the incision and placing the tissue support portion at the region of pelvic floor tissue; and   placing a support backer member on a portion of the support portion to apply tension to the support portion support the tissue of the pelvic floor.   
     
     
         2 . The method of  claim 1  comprising placing the support portion in a portion of a muscle selected from the group comprising:
 pubococcygeus muscle; 
 iliococcygeus muscle; and 
 coccygeus muscle. 
 
     
     
         3 . The method of  claim 1 , wherein the method is selected from the group comprising:
 a method of treating fecal incontinence;   a method of supporting a perineal body,   a method of perineal body repair;   a method of treating levator avulsion;   a method of treating levator ballooning;   a method of supporting levator ani muscle;   a method of levator ani muscle repair;   a method of tightening or reducing the size of a levator hiatus;   a method of treating vaginal prolapse; and   combinations of one or more of these.   
     
     
         4 . A method according to  claim 1 , wherein the implant further comprises an extension guide portion extending from the tissue support portion, and the support backer member being guided along the extension guide portion to engage the tissue support portion. 
     
     
         5 . A method according to  claim 1 , wherein the implant further comprises a tissue fastener on a portion of the tissue support portion, and the method comprises securing the tissue fastener to tissue of the pelvic region. 
     
     
         6 . A method according to  claim 1 , wherein the step of making an incision comprises making an incision proximate the obturator foramen and passing a portion of the tissue support portion there through to the tissue to be supported. 
     
     
         7 . A method according to  claim 1 , comprising extending a portion of the implant through a tissue path between levator ani muscle and obturator internus muscle and abutting the tissue backer portion against the obturator internus muscle. 
     
     
         8 . A method according to  claim 1 , comprising a portion of the guide portion extending out of the incision in proximate the obturator foramen and guiding the tissue backer along a length of the guide portion and into the incision to abut a muscle of the obturator foramen. 
     
     
         9 . A kit to treat levator defects comprising:
 a tissue support portion having a first end and a second;   a tissue fastener fixedly connected to the first end of the tissue support portion for fastening to levator tissue;   a guide extension portion fixedly connected to the second end of the tissue support portion, the guide extension portion comprising a rod; and   a support backer member movably attachable to the guide extension portion to adjust a tension of the tissue support portion and concomitantly the levator tissue.   
     
     
         10 . A kit according to  claim 9 , further comprising a support backer advancement tool having an engagement portion to engage and advance the support backer member along the guide extension portion. 
     
     
         11 . A pelvic implant according to  claim 9 , wherein the first end of the tissue support portion comprises mesh. 
     
     
         12 . A kit according to  claim 9 , wherein the first end of the tissue support portion comprises mesh. 
     
     
         13 . A kit according to  claim 9 , comprising a carrier, the carrier comprising a rod, the rod comprising a mating feature at an end, wherein the mating feature mates with an end of an extension guide portion. 
     
     
         14 . A kit according to  claim 13 , wherein the carrier carries a plurality of support backer members along the rod. 
     
     
         15 . The implant of  claim 9 , wherein the tissue support portion comprises an elongate mesh, the first end comprises the mesh, the second end comprises the mesh, the tissue fastener is fixedly connected to the mesh at the first end, and the guide extension portion is fixedly connected to the mesh at the second end. 
     
     
         16 . The implant of  claim 9 , wherein the tissue support portion is sized and shaped to contact tissue selected from tissue of levator, coccygeous, rectum, and external anal sphincter. 
     
     
         17 . The kit of  claim 9 , wherein the tissue support portion comprises an elongate mesh, the first end comprises the mesh, the second end comprises the mesh, the tissue fastener is fixedly connected to the mesh at the first end, and the guide extension portion is fixedly connected to the mesh at the second end. 
     
     
         18 . The kit of  claim 9 , wherein the tissue support portion is sized and shaped to contact tissue selected from tissue of levator, coccygeous, rectum, and external anal sphincter. 
     
     
         19 . A pelvic implant for supporting levator tissue, the implant comprising:
 a tissue support portion having a first end and a second;   a tissue fastener disposed on the first end of the tissue support portion for fastening to levator tissue;   a guide extension portion disposed on the second end of the tissue support portion; and   a support backer member attachable to the guide extension portion to adjust a tension of the tissue support portion and concomitantly the levator tissue.