Devices for minimally invasive pelvic surgery

A method of inserting a guide member into a body tissue, comprising the steps of:

• percutaneously inserting a shaft of a first guide member placement device;
• advancing said shaft of said first guide member placement device through the body tissue to a central point through which the guide member will pass;
• percutaneously inserting a shaft of a second guide member placement device;
• advancing said shaft of said second guide member placement device through the body tissue to said central point through which the guide member will pass;
• coupling an engaging member on a distal end of said shaft of said first guide member placement device to an engaging member on a distal end of said shaft of said second guide member placement device such that a lumen in said shaft of said first guide member placement device is in fluid communication with a lumen in said shaft of said second guide member placement device;
• passing a guide member through said lumens of said coupled shafts of said first guide member placement device and said second guide member placement device;
• and
• removing said shaft of said first guide member placement device and said shaft of said second guide member placement device from the body, thereby leaving said guide member in the body tissue.

A tissue dissector/dilator for creating and dilating an opening or pocket in a body tissue, said tissue dissector/dilator comprising:

• a body;
• a noncompliant shaft attached to said body;
• a dissector carried on said shaft for creating an opening or pocket in said body tissue;
• and
• a dilator carried on said shaft for dilating said opening or pocket in said body tissue.

A tissue dissector/dilator for creating and dilating an opening or pocket in a body tissue, comprising:

• a body;
• a noncompliant shaft attached to said body;
• a dissection means carried on said shaft for dissecting an opening or pocket in a body tissue;
• and
• a dilation means carried on said shaft for dilating the opening or pocket,

A method of creating and dilating an opening or pocket in a body tissue, comprising the steps of:

• percutaneously inserting a noncompliant shaft of a tissue dissector/dilator into said body tissue;
• advancing said shaft through said body tissue;
• extending a dissector from a distal end of said shaft to create a first opening or pocket in said body tissue;
• and
• extending a dilator from said distal end of said shaft and expanding said dilator within said first opening or pocket to dilate said first opening or pocket.

A sling application system comprising:

• a sling application device comprising a first shaft and a second shaft, said first and second shafts having lumens extending therethrough, said lumens having dimensions adapted for receiving a sling introducer therein, said sling application device also comprising an adjuster for incrementally adjusting the distance between said first and second shafts;
• a blunt dissector for dissecting a body tissue without scoring or creasing tissue or bone with which it comes in contact, said blunt dissector comprising a dissector shaft adapted for insertion into said first and second shafts of said sling application device, said dissector shaft having a generally rigid tip at its distal end, wherein said generally rigid tip protrudes from the distal ends of said first and second shafts of said sling application device when said blunt dissector is inserted into said first and second shafts;
• and
• said sling introducer for introducing a sling attached thereto into an opening or pocket in the body tissue without the use of sutures, said sling introducer comprising a sling engager having said sling releasably engaged thereto, said sling engager adapted for advancement through said lumens of said first and second shafts of said sling application device, wherein said sling introducer has a length sufficient to extend between the first and second shafts of said sling application device.

A method for introducing a sling into a body tissue comprising:

• inserting a first blunt dissector into a first shaft of a sling application device;
• percutaneously inserting said first shaft having said first blunt dissector therein;
• advancing said first shaft through the body tissue;
• inserting a second blunt dissector into a second shaft of said sling application device;
• percutaneously inserting said second shaft having said second blunt dissector therein;
• advancing said second shaft through the body tissue;
• decreasing the distance between the distal ends of said first and second shafts;
• advancing a sling introducer having said sling releasably engaged thereto between said first and second shafts of said sling application device;
• releasing said sling from said sling introducer;
• and
• removing said first and second shafts from the body tissue, thereby introducing said sling into the body tissue.

A detachable member sling application device for introducing a sling having sutures attached thereto into an opening or pocket in a body tissue, comprising:

• a housing;
• an introduction shaft connected to said housing, said introduction shaft having a lumen extending therethrough, said lumen adapted to receive said sling having sutures attached thereto;
• and
• a detachable member on the distal end of said introduction shaft, said detachable member being connected to at least one of said sutures attached to said sling.

A method of stabilizing the bladder neck comprising the steps of:

• forming a pocket or opening in said the tissue between the urethra and the upper vaginal wall;
• inserting a sling application device into said pocket or opening;
• introducing a sling into said pocket or opening with said sling application device;
• and
• securing said sling to tissue or bone to stabilize the bladder neck.

A device for expanding an opening or pocket within a body tissue, said device comprising:

• a tube having a lumen extending therethrough;
• an axially movable expandable and collapsible expansion basket attached to said tube for insertion into said opening or pocket within the body tissue and expansion thereof;
• and
• an expansion and collapse control in communication with said expandable and collapsible basket for expanding and collapsing said basket.

A method for holding a pocket in a body tissue in an open position, comprising:

• making a lumen in the body tissue;
• expanding said lumen in the body tissue to create said pocket in said body tissue;
• inserting an expansion device into said pocket;
• and
• expanding an expansion basket on said expansion device in said pocket, thereby holding said pocket in said open position.

A method of introducing a sling into a pocket in a body tissue comprising:

• a) making a lumen in the body tissue;
• b) creating a pocket in said body tissue;
• c) holding said pocket in an open position;
• d) inserting a suture or guide member into said pocket in said body tissue, wherein said suture is on a first side of a urethra;
• e) grasping said suture or guide member;
• f) withdrawing said suture or guide member outside of said body tissue through said lumen;
• g) repeating steps (d) through (f) on a second side of said urethra;
• h) tying the two sutures together;
• and
• i) guiding said sling into said pocket using said sutures.

A method of introducing a sling into an opening in a body tissue comprising:

• a) making a lumen in the body tissue;
• b) creating a pocket in said body tissue;
• c) holding said pocket in an open position;
• d) inserting a suture or guide member into said pocket in said body tissue, wherein said suture is on a first side of a urethra;
• e) grasping said suture or guide member;
• f) withdrawing said suture or guide member outside of said body tissue through said lumen;
• g) repeating steps (d) through (f) on a second side of said urethra;
• h) attaching a sling to the two sutures outside of said body tissue;
• and
• i) introducing the sling through said lumen into said pocket in said body tissue.