Methods and systems for treatment of prolapse

Abstract

Described are implants, tools, and related methods, for use in pelvic surgery to treat conditions such as prolapse, including embodiments of methods that involve a tissue path above the arcus tendineus.

1 - 20 . (canceled) 
     
     
         21 . An insertion tool for placing a pelvic implant, the insertion tool comprising:
 a longitudinally extending shaft having a longitudinal axis,   a handle having a proximal end and a distal end, the distal end attached to a proximal end of the shaft, and   a curved portion at a distal end of the shaft, the curved portion being sized and shaped to be used in a transvaginal procedure to define a tissue path that exits the pelvic floor region in a region of the arcus tendineus, partially extends around an arcus tendineus, and re-enters the pelvic floor, wherein the region of the arcus tendineus comprises a region from 2 centimeters above the arcus tendineus to 2 centimeters below the arcus tendineus and between the ischial spine and a distance 3 centimeters anterior to the ischial spine.   
     
     
         22 . The insertion tool of  claim 21 , wherein the curved portion comprises a radius of curvature in the range of from 0.5 to 1.5 centimeters. 
     
     
         23 . The insertion tool of  claim 21 , wherein the curved portion has a length of from 3 to 5 centimeters. 
     
     
         24 . The insertion tool of  claim 21 , wherein the curved portion is substantially a shape of a partial circle of from 90 to 270 degrees. 
     
     
         25 . The insertion tool of  claim 21 , wherein the curved portion is substantially a shape of a partial circle of from 170 to 190 degrees. 
     
     
         26 . The insertion tool of  claim 21 , wherein the shaft is substantially straight. 
     
     
         27 . The insertion tool of  claim 21 , wherein the longitudinal axis of the shaft is aligned with a longitudinal axis of the handle. 
     
     
         28 . The insertion tool of  claim 21 , wherein the curved distal end is capable of engaging a dilator and pushing the dilator through tissue. 
     
     
         28 . The insertion tool of  claim 28 , wherein the engagement between the curved distal end and dilator is a permanent attachment or a removable engagement. 
     
     
         30 . The insertion tool of  claim 21 , comprising a second insertion tool, the second insertion tool comprising:
 a longitudinally extending shaft having a longitudinal axis,   a handle having a proximal end and a distal end, the distal end attached to a proximal end of the shaft, and   a curved portion at a distal end of the shaft, the being sized and shaped to be used in a transvaginal procedure to define a tissue path that exits the pelvic floor region in a region of the arcus tendineus, partially extends around an arcus tendineus, and re-enters the pelvic floor, wherein the region of the arcus tendineus comprises a region from 2 centimeters above the arcus tendineus to 2 centimeters below the arcus tendineus and between the ischial spine and a distance 3 centimeters anterior to the ischial spine.   
     
     
         31 . The insertion tool of  claim 28  wherein a distal end of the curved portion comprises an anti-rotation feature that prevents relative movement between the curved portion and the dilator. 
     
     
         32 . The insertion tool of  claim 28  wherein a distal end of the curved portion comprises an alignment feature that engages the dilator in a desired alignment. 
     
     
         33 . An insertion tool for placing a pelvic implant, the insertion tool comprising a longitudinal extending shaft having a longitudinal axis,
 a handle having a proximal end and a distal end, the distal end attached to a proximal end of the shaft, and   a curved portion at a distal end of the shaft, the curved portion having a three-dimensional shape and being sized and shaped to be used in a transvaginal procedure to define a tissue path in a region of the arcus tendinous at the level of the ischial spine, and wherein the curved portion extends from the longitudinal axis and extends in two additional directions.   
     
     
         34 . The insertion tool of  claim 21 , wherein the curved portion comprises a radius of curvature in the range of from 0.5 to 1.5 centimeters. 
     
     
         36 . The insertion tool of  claim 21 , wherein the curved portion has a length of from 3 to 5 centimeters. 
     
     
         37 . The insertion tool of  claim 21 , wherein the curved portion is substantially a shape of a partial circle of from 90 to 270 degrees. 
     
     
         38 . The insertion tool of  claim 21 , wherein the curved portion is substantially a shape of a partial circle of from 170 to 190 degrees.