Transobturator surgical articles and methods

Abstract

A surgical instrument for treating incontinence includes a handle portion elongate along a handle axis and a needle portion connected to the handle portion. The needle portion has a spacer portion along the handle axis, and has a distal end. The needle portion includes a substantially helical portion that is a variable spiral portion, extending from the straight spacer portion. The variable spiral portion is sized and shaped to extend from an incision substantially adjacent the patient's obturator foramen through the obturator foramen along a path in a region between the superior pubic ramus and the inferior pubic ramus. The needle portion has a structure near the distal end that associates the instrument with an implantable material configured to treat incontinence.

1 . A surgical instrument for treating incontinence, the instrument comprising:
 a handle portion elongate along a handle axis and defining a midplane; and   a needle portion connected to said handle portion, having a spacer portion along the handle axis, and having a distal end, the needle portion having a substantially helical portion extending from the spacer portion, wherein said variable spiral portion is sized and shaped to extend from an incision substantially adjacent a patient's obturator foramen through the obturator foramen along a path in a region between the superior pubic ramus and the inferior pubic ramus   wherein the needle portion has a structure near the distal end that associates the instrument with an implantable material configured to treat incontinence.   
     
     
         2 . The instrument of  claim 1 , wherein the needle portion comprises a variable spiral portion having a tissue clearance depth of greater than about 1.5 inches and less than 2.5 inches. 
     
     
         3 . The instrument of  claim 1 , wherein the needle portion comprises a variable spiral portion having a maximum width of greater than about 1.25 inches and less than about three inches. 
     
     
         4 . The instrument of  claim 1 , wherein the structure comprises an eyelet. 
     
     
         5 . The instrument of  claim 1 , wherein the distal end of the needle portion includes a distal tip situated substantially near an extension of the mid plane that is spaced from the handle portion. 
     
     
         6 . The instrument of  claim 1 , wherein the needle portion includes a substantially circular cross-sectional shape with a diameter less than about 4 mm. 
     
     
         7 - 11 . (canceled) 
     
     
         12 . The instrument of  claim 1 , wherein the needle comprises a distal end having a securement surface to enable a snap fit of the instrument to another surgical component used to treat the incontinence, wherein the snap fit provides a secure attachment between the instrument and the other surgical component. 
     
     
         13 . The instrument of  claim 12 , wherein the other surgical component comprises a dilator of a sling assembly configured to treat incontinence. 
     
     
         14 . The instrument of  claim 13 , wherein the instrument and the dilator have complementary engagement surfaces to resist separation of the instrument from the dilator upon being snap fit together. 
     
     
         15 - 17 . (canceled) 
     
     
         18 . A surgical assembly for treating incontinence comprising:
 a surgical instrument having a handle portion defining a midplane;   a needle portion connected to said handle portion, said needle portion having a distal end and having a first portion that is sized and shaped to extend between an incision substantially adjacent an obturator foramen of a patient through the obturator foramen along a path in a region between the superior pubic ramus and the inferior pubic ramus;   an implantable synthetic material; and   the needle portion having structure near the distal end to associate the surgical instrument with the implantable synthetic material.   
     
     
         19 . The surgical assembly of  claim 18 , further comprising a dilator wherein the dilator has an overall length of less than about 0.7 inches. 
     
     
         20 . (canceled) 
     
     
         21 . The surgical assembly of  claim 18 , further comprising a dilator with an engagement surface to connect the dilator to the surgical instrument, the dilator operatively associate with the implantable synthetic material, wherein the structure of the needle portion near the distal end that associates the surgical instrument with the implantable synthetic material includes a surface complementary with the engagement surface of the dilator. 
     
     
         22 . The surgical assembly of  claim 18 , wherein the needle portion is sized and shaped for a predetermined side of the patient, and the handle portion includes indicia indicating the predetermined side of the patient. 
     
     
         23 - 28 . (canceled) 
     
     
         29 . A surgical instrument for treating incontinence, comprising:
 a handle portion defining a midplane, and   a needle extending from the handle, the needle sized and shaped to either: (a) initially extend through an incision substantially adjacent an obturator foramen of a patient and then through the obturator foramen along a path in a region between the superior pubic ramus and the inferior pubic ramus; or (b) initially extend through a region between the superior pubic ramus and the inferior pubic ramus and then through an incision substantially adjacent an obturator foramen of a patient.   
     
     
         30 . (canceled) 
     
     
         31 . (canceled) 
     
     
         32 . The surgical instrument of  claim 29 , wherein the handle comprises
 a proximal end and a distal end, the distal end connected to the needle,   two opposing sides extending between the proximal end and the distal end and being located to intersect the midplane,   two opposing elongate surfaces extending between the two opposing sides, each having a length and a width, and   a thumb surface at the distal end of a first elongate surface.   
     
     
         33 . The surgical instrument of  claim 32 , wherein the thumb surface comprises an indentation. 
     
     
         34 . The surgical instrument of  claim 33 , comprising a finger area at a distal end of a second elongate surface, the finger area comprising an indentation. 
     
     
         35 . The surgical instrument of  claim 1 , wherein the handle comprises
 a proximal end and a distal end, the distal end connected to the needle,   two opposing sides extending between the proximal end and the distal end and being located to intersect the midplane,   two opposing elongate surfaces extending between the two opposing sides, each having a length and a width, and   a thumb surface at the distal end of a first elongate surfaces.   
     
     
         36 . The surgical instrument of  claim 35 , wherein the thumb surface comprises an indentation. 
     
     
         37 . The surgical instrument of  claim 36 , comprising a finger area at a distal end of a second elongate surface, the finger area comprising an indentation.