Apparatus and method for intra-abdominally moving a first internal organ to a position away from a second internal organ and then holding the first internal organ in the position without manual input

Abstract

An apparatus including a flexible length of cord and three tissue connectors positioned at the opposite ends of the cord and at an intermediate position of the cord is designed to be laparoscopically inserted through the abdominal wall and into the abdominal cavity, and used to move a first internal organ to a position away from a second internal organ where the apparatus holds the first internal organ in the position without further manual input, thereby providing surgical access to the second internal organ.

1 . A surgical tissue connector apparatus for intra-abdominally moving a first internal organ to a position away from a second internal organ and then holding the first internal organ in the position without manual input, the apparatus comprising:
 a first tissue connector that is intra-abdominally connectable to body tissue and is intra-abdominally removable from the body tissue without leaving any significant damage to the body tissue;   a second tissue connector that is intra-abdominally connectable to body tissue and is intra-abdominally removable from the body tissue without leaving any significant damage to the body tissue;   a flexible cord having a length with opposite first and second ends, the cord being connected to the first tissue connector and the second tissue connector with a portion of the cord length extending between the first tissue connector and the second tissue connector, the portion of the cord length extending between the first tissue connector and the second tissue connector being intra-abdominally adjustable to selectively move the first and second tissue connectors toward each other and allow the first and second tissue connectors to move away from each other; and,   the apparatus being constructed for removal of the apparatus from an abdominal cavity after intra-abdominal use of the apparatus.   
     
     
         2 . The apparatus of  claim 1 , comprising:
 the portion of the cord being selectively adjustable while the first and second tissue connectors are connected to body tissue.   
     
     
         3 . The apparatus of  claim 1 , further comprising:
 the portion of the cord being selectively adjustable while the first and second tissue connectors are connected to body tissue on opposite sides of an abdominal cavity.   
     
     
         4 . The apparatus of  claim 1 , further comprising:
 the apparatus being dimensioned for endoscopic insertion into an abdominal cavity for use of the apparatus in moving the first internal organ to the position away from the second internal organ and temporarily holding the first internal organ in the position and removal from the abdominal cavity after use.   
     
     
         5 . The apparatus of  claim 1 , further comprising:
 the portion of the cord extending between the first tissue connector and the second tissue connector being a percentage of the cord length, and the percentage of the cord length extending between the first tissue connector and the second tissue connector being intra-abdominally adjustable to increase the percentage of the cord length extending between the first tissue connector and the second tissue connector and to decrease the percentage of the cord length extending between the first tissue connector and the second tissue connector.   
     
     
         6 . The apparatus of  claim 5 , further comprising:
 the first tissue connector being intra-abdominally connectable to an abdominal wall inside an abdominal cavity and the second tissue connector being intra-abdominally connectable to body tissue on an opposite side of the abdominal cavity from the abdominal wall with the percentage of the cord length extending between the first and second tissue connectors extending across a first internal organ in the abdominal cavity whereby adjustably decreasing the percentage of the cord extending between the first and second tissue connectors results in decreasing a length of a portion of the cord extending between the first and second tissue connectors and thereby causes the portion of the cord to engage across the first internal organ and move the first internal organ to the position away from a second internal organ.   
     
     
         7 . The apparatus of  claim 6 , further comprising:
 the second tissue connector being intra-abdominally connectable to body tissue adjacent the first internal organ.   
     
     
         8 . The apparatus of  claim 6 , further comprising:
 the second tissue connector being, intra-abdominally connectable to body tissue of the first internal organ.   
     
     
         9 . The apparatus of  claim 5 , further comprising:
 a third tissue connector that is intra-abdominally connectable to body tissue, the third tissue connector being mounted on the percentage of the cord length extending between the first and second tissue connectors for sliding movement of the third tissue connector along the percentage of the cord length.   
     
     
         10 . The apparatus of  claim 5 , further comprising:
 an intermediate portion of the cord length being attached to the first tissue connector, a first portion of the cord length extending from the cord intermediate portion to the cord first end, and the percentage of the cord length extending between the first tissue connector and the second tissue connector being a second portion of the cord length that extends from the cord intermediate portion to the cord second end and the second tissue connector, whereby pulling the cord first portion from the first tissue connector to increase a length of the cord first portion extending from the cord intermediate portion results in decreasing the percentage of the cord length extending between the first and second tissue connectors and decreasing the length of the cord second portion.   
     
     
         11 . The apparatus of  claim 10 , further comprising:
 a releasable one-way lock attached to the first tissue connector, the lock being moveable between first and second positions of the lock relative to the cord intermediate portion where in the lock first position the lock is operative to allow the cord first portion to be pulled from the cord intermediate portion to thereby increase the length of the cord first portion while decreasing the length of the cord second portion and prevents the cord second portion from being pulled from the cord intermediate portion, and in the lock second position the lock is operative to allow the cord second portion to be pulled from the cord intermediate portion to thereby increase the length of the cord second portion while decreasing the length of the cord first portion.   
     
     
         12 . The apparatus of  claim 11 , further comprising:
 in the lock second position, the lock allows the cord first portion to be pulled from the cord intermediate portion to thereby increase the length of the cord first portion while decreasing the length of the cord second portion.   
     
     
         13 . The apparatus of  claim 11 , further comprising:
 a base attached to the first tissue connector;   a rod on the base;   the intermediate portion of the cord being attached to the base by being wrapped around the rod with the first portion of the cord extending from the base to the cord first end and the second portion of the cord extending from the base to the cord second end and the second tissue connector; and,   the releasable one-way lock being mounted on the base for movement of the lock between first and second positions of the lock on the base where in the lock first position the lock engages with the cord intermediate portion and in the lock second position the lock is disengaged from the cord intermediate portion.   
     
     
         14 . The apparatus of  claim 13 , further comprising:
 a biasing device on the base urging the lock toward the lock first position relative to the base.   
     
     
         15 . The apparatus of  claim 13 , further comprising:
 an actuator mounted on the base for movement of the actuator between first and second positions of the actuator relative to the base;   the actuator being operatively connected to the lock to cause the lock to move to the first and second positions of the lock in response to the actuator being moved to the respective first and second positions of the actuator, and the actuator being positioned on the base where the actuator is accessible to be grasped.   
     
     
         16 . The apparatus of  claim 13 , further comprising:
 the base having a tubular housing wall with a hollow interior bore extending through the housing wall between the base first and second ends; and   the lock being mounted inside the tubular housing wall for reciprocating movement through the interior bore between the lock first and second positions.   
     
     
         17 . The apparatus of  claim 13 , further comprising:
 the cord intermediate portion being wrapped around the rod in a Munter hitch knot.   
     
     
         18 . A surgical tissue connector apparatus for intra-abdominally moving a first internal organ to a position away from a second internal organ and then holding the first internal organ in the position without manual input, the apparatus comprising:
 a base having a length with opposite first and second ends;   a tissue connector on the base, the tissue connector extending from the base first end to a device on the tissue connector that is operable to connect the tissue connector to body tissue;   a rod on the base;   a flexible cord having a length with opposite first and second ends, an intermediate portion of the cord length being tied in a Munter hitch knot around the rod, a first portion of the cord extending from the Munter hitch knot on a first side of the rod and from the base second end to the first end of the cord and a second portion of the cord extending from the Munter hitch knot on a second side of the rod opposite the first side of the rod and from the base second end to the second end of the cord, the Munter hitch knot being movable on the rod between the first and second sides of the rod where when the Munter hitch knot is positioned on the first side of the rod the cord first portion can be pulled from the Munter hitch knot and thereby increase the length of the cord first portion and decrease the length of the cord second portion while the cord second portion cannot be pulled from the Winter hitch knot to increase the length of the cord second portion, and when the Munter hitch knot is positioned on the second side of the rod, the cord second portion can be pulled from the Munter hitch knot and thereby increase the length of the cord second portion and decrease the length of the cord first portion while the cord first portion cannot be pulled from the Munter hitch knot to increase the length of the cord first portion; and   a releasable one-way lock mounted on the base for movement of the lock between first and second positions of the lock relative to the base where in the first position the lock keeps the Munter hitch knot on the first side of the rod and prevents the Munter hitch knot from moving from the first side of the rod to the second side of the rod and thereby allows the cord first portion to be pulled from the Munter hitch knot to increase the length of the cord first portion while preventing the cord second portion from being pulled from the Munter hitch knot to increase the length of the cord second portion, and in the second position the lock allows the Munter hitch knot to move from the first side of the rod to the second side of the rod and thereby allows the cord second portion to be pulled from the Munter hitch knot to increase the length of the cord second portion while decreasing the length of the cord first portion   
     
     
         19 . The apparatus of  claim 18 , further comprising:
 in the lock second position the lock allows the Munter hitch knot to move from the first side of the rod to the second side of the rod and allows the Munter hitch knot to move from the second side of the rod to the first side of the rod.   
     
     
         20 . The apparatus of  claim 18 , further comprising:
 in the first position of the lock the lock engages against the Munter hitch knot when the Munter hitch knot is on the first side of the rod and in the second position of the lock the lock disengages from the Munter hitch knot.   
     
     
         21 . The apparatus of  claim 18 , further comprising:
 a biasing device on the base urging the lock toward the first position of the lock relative to the base.   
     
     
         22 . The apparatus of  claim 18 , further comprising:
 an actuator mounted on the base for movement of the actuator between first and second positions of the actuator relative to the base, the actuator being operatively connected to the lock to cause the lock to move between the first and second positions of the lock in response to the actuator being moved between the respective first and second positions of the actuator, and the actuator being positioned on the base where the actuator can be grasped.   
     
     
         23 . The apparatus of  claim 18 , further comprising:
 an additional tissue connector on the cord second end.   
     
     
         24 . The apparatus of  claim 18 , further comprising:
 the base having a cylindrical housing wall with a hollow interior bore extending through the housing wall, the housing wall having a center axis that defines mutually perpendicular axial and radial directions relative to the housing wall, and the releasable one-way lock being mounted on the housing wall inside the interior bore for axially reciprocating movements of the lock relative to the housing wall.   
     
     
         25 . A method of intra-abdominally moving a first internal organ to a position away from a second internal organ and then holding the first internal organ at the position without manual input, the method comprising:
 providing a cord having a flexible length with opposite first and second ends;   inserting the cord through an abdominal wall and into an abdominal cavity containing the first and second organs;   connecting a first part of the cord to body tissue on an opposite side of the abdominal cavity from the abdominal wall;   connecting a second part of the cord to the abdominal wall with the cord extending across the first internal organ;   moving the first internal organ to the position away from the second internal organ;   disconnecting the first part of the cord from the body tissue to which it is connected;   disconnecting the second part of the cord from the body tissue to which it is connected; and,   removing the cord from the abdominal cavity.   
     
     
         26 . The method of  claim 25 , further comprising:
 moving the first internal organ to the position away from the second internal organ by decreasing a length of the cord extending across the first internal organ and thereby causing the decreasing length of the cord to engage across the first internal organ and move the first internal organ to the position away from the second internal organ.   
     
     
         27 . The method of  claim 25 , further comprising:
 connecting the first part of the cord to body tissue adjacent the first internal organ.   
     
     
         28 . The method of  claim 25 , further comprising:
 connecting the first part of the cord to body tissue on the first organ.   
     
     
         29 . The method of  claim 25 , further comprising:
 the second part of the cord connected to the abdominal wall being an intermediate portion of the cord length with a first portion of the cord length extending from the cord intermediate portion to the cord first end and a second portion of the cord extending from the cord intermediate portion to the cord second end, the second portion of the cord extending from the cord intermediate portion across the first internal organ to the cord second end; and   shortening a length of the cord second portion and thereby causing the cord second portion to push against and move the first internal organ to the position away from the second internal organ and then hold the first internal organ at the position without manual input.   
     
     
         30 . The method of  claim 29 , further comprising:
 shortening the length of the cord second portion by exerting a pulling force on the cord first portion causing a length of the cord first portion to increase and in response causing the length of the cord second portion to decrease.   
     
     
         31 . The method of  claim 29 , further comprising:
 providing a tissue connector apparatus having a base with a tissue connector extending from the base and having a releasable one-way lock on the base with the cord intermediate portion extending through the one-way lock on the base, the lock being moveable between first and second positions of the lock relative to the base where in the lock first position the lock engages with the cord intermediate portion and allows the cord first portion to be pulled from the base to thereby increase the length of the cord first portion while decreasing the length of the cord second portion while the lock prevents the cord second portion from being pulled from the base, and in the lock second position, the lock disengages from the cord intermediate portion and allows the cord second portion to be pulled from the base to thereby increase the length of the cord second portion while decreasing the length of the cord first portion.