Implant for hernia repair

A pneumatic seal for laparoscopic surgery, comprising:

• a patient adhesion side positionable against a patient's insufflated abdomen to hold the seal onto the patient;
• a puncture membrane opposed to the patient adhesion side;
• and
• a sealant chamber containing sealant and disposed under the puncture membrane, wherein a piercing instrument can be advanced through the puncture membrane and sealant and into the patient's insufflated abdomen with the sealant sealing around the piercing instrument to impede leakage of insufflation gas from inside the patient's abdomen along the piercing instrument to external of the patient.

Method for laparoscopic implantation of a hernia repair implant having fixation straps with respective ends, comprising:

• laying the implant or a pattern thereof on a patient's abdomen;
• indicating on the patient's abdomen a strap end retrieval piercing location for at least some respective strap ends;
• advancing the implant into the patient's insufflated abdomen through a trocar;
• unfolding the implant inside the patient;
• and
• using the piercing locations indicated on the patient's abdomen, retrieving straps up into the patient's tissue by advancing a snaring instrument into the patient through a piercing location, snaring the end of the strap, and pulling the strap outwardly.

Method for laparoscopic implantation of a hernia repair implant having fixation straps with respective ends, comprising:

• advancing the implant into the patient's insufflated abdomen through a trocar;
• unfolding the implant inside the patient;
• retrieving a strap up into the patient's tissue by advancing a snaring instrument into the patient along a path that is not parallel to an anterior-posterior dimension defined by the patient's body;
• snaring the end of the strap using the snaring instrument;
• pulling the strap outwardly along the path such that the strap is disposed in the patient in an orientation that is not parallel to the anterior-posterior dimension;
• and
• disengaging the instrument from the strap such that at least a segment of the strap remains implanted in the patient in the orientation that is not parallel to the anterior-posterior dimension.

Snaring instrument for snaring a strap of a hernia repair implant disposed in a patient's abdomen, comprising:

• elongated tube assembly defining a distal end segment;
• a magnet disposed on the distal segment to attract a magnet on the strap;
• and
• a grasping member on the distal end segment movable to grasp and then hold the strap.

Snaring instrument for snaring a strap of a hernia repair implant disposed in a patient's abdomen, then partially retracting the strap and transecting the strap to reside in patient tissue, comprising:

• elongated tube assembly defining a distal end segment terminating in an open distal end;
• hypotube slidably disposed in the assembly;
• loop connected to a loop line disposed in the hypotube, the loop being disposed on a distal end of the hypotube such that pushing the hypotube distally in the assembly pushes the loop out of the open distal end and pulling on the loop line cinches the loop against the distal end of the hypotube to shrink the loop;
• cutter formed with a cutting edge, the cutter being positioned inside the tube assembly at or near the distal end to transect, using the cutting edge, a strap cinched by the loop and retracted into the tube assembly by the loop line.

Method for laparoscopic placement of a hernia repair implant, comprising:

• advancing a hollow tunneling catheter through a patient's skin into an insufflated abdomen of a patient to form a path;
• advancing an illumination catheter through the tunneling catheter, the illumination catheter having a light source thereon to illuminate the insufflated abdomen from inside the patient to provide a visible indication from outside the patient, the illumination catheter being advanced between a fat layer and a muscle layer but not through the muscle layer to a muscle layer piercing location under visualization of light from the light source propagating through the skin;
• removing the illumination catheter from the tunneling catheter and advancing a snare catheter through the tunneling catheter to the piercing location, the snare catheter having a puncturing distal segment pushable out of an open distal end of the tunneling catheter to assume a curved configuration under material bias;
• and
• advancing the puncturing distal segment through the muscle layer into the insufflated abdomen to establish a retrieval path through which a portion of the implant can be retrieved.

Method for laparoscopic advancement of a hernia repair implant into a patient, comprising;

• insufflating the abdomen of the patient;
• establishing laparoscopic access into the abdomen through a trocar assembly;
• using a grasper, pushing a center portion of the implant into an open proximal funnel removably housing a flexible hollow sheath, the center portion of the implant thus being pushed into the sheath inside the funnel;
• continuing to push the implant further into the sheath, causing the implant to fold inwardly on itself as it enters the sheath;
• and
• removing the sheath from the funnel and advancing the sheath into the trocar assembly.

Snaring instrument for snaring a strap of a hernia repair implant disposed in a patient's abdomen, comprising:

• elongated tube assembly defining a distal end segment terminating at an open distal end;
• curved snare member extending out of the distal end of the assembly;
• and
• cord attached to the snare member at or near a distal end of the snare member, the cord extending through the assembly to a proximal end segment of the assembly;
• wherein
• the snare member and cord are movable between a closed configuration, in which the snare member and cord are proximate to each other and have substantially the same degree of curvature, and an open configuration, in which the snare member and cord are distanced from each other to establish a gap to allow a strap to pass therethrough.

Method for laparoscopic advancement of a hernia repair implant into a patient, comprising;

• insufflating the abdomen of the patient;
• establishing laparoscopic access into the abdomen through a trocar assembly;
• using a cord, initially pulling a center portion of the implant into an open proximal funnel;
• continuing to pull the implant further into the funnel, causing the implant to fold inwardly on itself as it enters the funnel;
• and
• advancing the funnel with the implant into the trocar assembly.