Abstract:
A puncture apparatus is disclosed, which can include an insertion portion that is insertable into a living body, the insertion portion including an urethral insertion portion and a vaginal insertion portion, the urethral insertion portion and the vaginal insertion portion each having at least two sensors; a puncture needle that punctures living body tissues near the insertion portion in a state in which the insertion portion is inserted into the living body, the puncture needle having at least one sensor on a distal portion of the puncture needle; and a monitor configured to receive information relating to a positional relationship between a distal portion of the puncture needle and the insertion portion.

Description:
CROSS-REFERENCES TO RELATED APPLICATIONS 
       [0001]    This application claims priority to U.S. Provisional Patent Application No. 62/192,211 filed on Jul. 14, 2015, the entire content of which is incorporated herein by reference. 
     
    
     TECHNICAL FIELD 
       [0002]    The present disclosure relates to a puncture apparatus, and more particularly to a sensor arrangement on an insertion instrument and a monitor configured to receive information relating to a positional relationship between a distal portion of a puncture needle and the insertion instrument, and wherein the insertion instrument includes a vaginal insertion portion (or vaginal stabilizer) and a urethral insertion portion (or urethral stabilizer). 
       BACKGROUND DISCUSSION 
       [0003]    In a patient suffering from urinary incontinence, for example, stress urinary incontinence, urine leakage (involuntary urination) occurs due to an abnormal pressure exerted during a normal exercise or by, for example, laughing, coughing, or sneezing. This can be attributable, for example, to loosening of a pelvic floor muscle, which is a muscle for supporting a urethra, caused by childbirth. 
         [0004]    For treatment of urinary incontinence, surgical therapy can be effective. For example, a tape-shaped implant called a “sling” can be placed indwelling in the body to support the urethra (for example, U.S. Pat. No. 6,911,003). In order to put a sling indwelling in the body, an operator incises a vagina with a surgical knife, dissects a biological tissue (living body tissue) between the urethra and the vagina, and provides communication between the exfoliated biological tissue site and an exterior through an obturator foramen by using a puncture needle. Then, in such a state, the sling is placed indwelling in the body. 
         [0005]    If a vaginal wall is incised, however, there can be a fear that the sling might be exposed to an inside of the vagina via a wound caused by the incision. There can also be a fear that complications might occur which can be caused by an infection via the wound. In addition, since the vaginal wall is incised, an invasiveness of the procedure can be rather great and patient burden can be relatively heavy. In addition, there can be a fear that the urethra or the like can be damaged by a surgical knife in the course of the procedure by the operator, and there can be a fear that the operator himself might damage his fingertip by the surgical knife. 
         [0006]    Further, when an implant is placed indwelling in a living body, there may arise a case, depending on a length of the implant, where part of the implant can located near the living body surface, such that the patient may experience pain. 
       SUMMARY 
       [0007]    A puncture apparatus is disclosed which can relatively alleviate the burden exerted on a patient when an implant is placed indwelling in the living body. 
         [0008]    A puncture apparatus is disclosed comprising: an insertion portion that is insertable into a living body, the insertion portion including an urethral insertion portion and a vaginal insertion portion, the urethral insertion portion and the vaginal insertion portion each having at least two sensors; a puncture needle that punctures living body tissues near the insertion portion in a state in which the insertion portion is inserted into the living body, the puncture needle having at least one sensor on a distal portion of the puncture needle; and a monitor configured to receive information relating to a positional relationship between a distal portion of the puncture needle and the insertion portion. 
         [0009]    A method is disclosed of preventing a region of a living body from being punctured, comprising: inserting an insertion portion into a living body, the insertion portion comprising at least one of a urethral insertion portion that is inserted into a urethra and a vaginal insertion portion that is inserted into a vagina, the urethral insertion portion and the vaginal insertion portion each having at least two sensors; inserting a puncture needle that punctures living body tissues near the insertion portion in a state in which the insertion portion is inserted into the living body; detecting a positional relationship between a distal portion of the puncture needle and the insertion portion; and informing an operator of the positional relationship between the distal portion of the puncture needle and the insertion portion using a monitor. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0010]      FIG. 1  is a perspective view showing a puncture apparatus to be used at a time of placing indwelling in a living body an implant according to an exemplary embodiment of the present disclosure. 
           [0011]      FIG. 2  is another perspective view showing a puncture apparatus to be used at a time of placing indwelling in a living body an implant according to an exemplary embodiment of the present disclosure. 
           [0012]      FIG. 3  is a perspective view showing a puncture apparatus to be used at a time of placing indwelling in a living body an implant according to an exemplary embodiment of the present disclosure. 
           [0013]      FIG. 4  is a perspective view showing a puncture apparatus to be used at a time of placing indwelling in a living body an implant according to an exemplary embodiment of the present disclosure. 
           [0014]      FIG. 5  is a perspective view showing a puncture apparatus to be used at a time of placing indwelling in a living body an implant according to an exemplary embodiment of the present disclosure. 
           [0015]      FIG. 6  is a perspective view of a sensor arrangement, which includes a vaginal insertion portion, a urethral insertion portion, and a needle tip in accordance with an exemplary embodiment. 
           [0016]      FIG. 7  is a front view of a monitor in accordance with an exemplary embodiment. 
           [0017]      FIG. 8  is an example of the sensor arrangement showing on the monitor that the needle tip is too high. 
           [0018]      FIG. 9  is an example of the sensor arrangement showing on the monitor that the needle tip is on a predefined needle pass. 
           [0019]      FIG. 10  is a diagram explaining a step of the procedure when the puncture apparatus illustrated in  FIGS. 1-9  showing the use of a needle stopper in accordance with an exemplary embodiment. 
           [0020]      FIG. 11  is a diagram explaining a step of the procedure when the puncture apparatus illustrated in  FIGS. 1-9  showing the use of a needle stopper in accordance with an exemplary embodiment. 
           [0021]      FIG. 12  is a diagram explaining a step of the procedure when the puncture apparatus illustrated in  FIGS. 1-9  showing the use of a needle stopper in accordance with an exemplary embodiment. 
           [0022]      FIG. 13  is a diagram explaining a step of the procedure when the puncture apparatus illustrated in  FIGS. 1-9  showing the use of a needle stopper in accordance with an exemplary embodiment. 
           [0023]      FIG. 14  is a diagram explaining a step of the procedure when the puncture apparatus illustrated in  FIGS. 1-9  showing the use of a needle stopper in accordance with an exemplary embodiment. 
           [0024]      FIG. 15  is a diagram explaining a step of the procedure when the puncture apparatus illustrated in  FIGS. 1-9  showing the use of a needle stopper in accordance with an exemplary embodiment. 
           [0025]      FIG. 16  is a diagram explaining a step of the procedure when the puncture apparatus illustrated in  FIGS. 1-9  showing the use of a needle stopper in accordance with an exemplary embodiment. 
           [0026]      FIG. 17  is a diagram explaining a step of the procedure when the puncture apparatus illustrated in  FIGS. 1-9  showing the use of a needle stopper in accordance with an exemplary embodiment. 
           [0027]      FIG. 18  is a diagram explaining a step of the procedure when the puncture apparatus illustrated in  FIGS. 1-9  showing the use of a needle stopper in accordance with an exemplary embodiment. 
       
    
    
     DETAILED DESCRIPTION 
       [0028]      FIGS. 1-5  are views showing a puncture apparatus  1  to be used at a time of placing indwelling in a living body an implant (not shown) according to exemplary embodiments of the present disclosure. 
         [0029]    In accordance with an exemplary embodiment, a puncture apparatus  1  as shown in  FIGS. 1-5  is an apparatus to be used for treatment of female urinary incontinence, for example, to be used in a process in which a biological tissue-supporting implant for treatment of urinary incontinence is embedded (implanted) into a living body as described in U.S. Patent Publication Nos. 2015/0080644 and 2015/0073465, which are incorporated herein by reference in their entirety. 
         [0030]    The puncture apparatus  1  can include a frame (support unit)  2 , a puncture member  3 , a urethral insertion member  4 , a vaginal insertion member  5 , and an operating member  7 . In the puncture apparatus  1 , the urethral insertion member  4  and the vaginal insertion member  5  constitute an insertion instrument  6 . The operating member  7  is a member operating the puncture member  3 . 
         [0031]    Such an operating member  7 , as shown in  FIGS. 1 to 5 , can include an insertion portion  71 , which is a portion to be inserted in the puncture member  3 , and can function as a stylet that supports the puncture member  3  from the inside. With the insertion portion  71  inserted in the puncture member  3 , the puncture member  3  is connected to the operating member  7 , whereby it is enabled to operate the puncture member  3  by the operating member  7 . Such an insertion portion  71  is in an arcuate shape corresponding to the shape of the puncture member  3 . A center angle of the insertion portion  71  is set in conformity with a center angle of the puncture member  3 . In accordance with an exemplary embodiment, a distal portion of the insertion portion  71  can be tapered off. The presence of the tapered distal portion can enable relatively smooth fitting of the puncture member  3  over the insertion portion  71  (smooth insertion of the insertion portion  71  into the puncture member  3 ). 
         [0032]    In accordance with an exemplary embodiment, the insertion portion  71  can be circular in cross-sectional shape. Alternatively, the insertion portion  71  may be flat-shaped in cross section. The flat shape is not limited. Examples of the flat shape applicable here can include not only ellipses but also rounded-cornered rhombuses, rounded-cornered rectangles (flat shapes), and spindle-like shapes enlarged (enlarged in diameter) at a central portion as compared with both end portions of the insertion portion being flat-shaped in cross section. 
         [0033]    In accordance with an exemplary embodiment, such an operating member  7  can be configured to be higher than the puncture member  3  in rigidity. The material constituting the operating member  7  is not limited. Examples of the material applicable here can include various metallic materials such as stainless steels, aluminum, aluminum alloys, titanium, and titanium alloys. 
         [0034]    The puncture member  3  is a member puncturing a living body. Such a puncture member  3  can include, for example, an elongate sheath (medical tube) (not shown), and a needle body provided at a distal end of the sheath as described in U.S. Patent Publication Nos. 2015/0080644, which is incorporated herein by reference in its entirety. For example, the sheath main body (not shown) can be configured by use of an elongate tube, which is open at a distal end and a proximal end of the elongate tube. Such a sheath main body can have an internal space in which an implant main body can be inserted. In addition, the sheath main body can be in an arcuate curved shape, and can have a flat cross-sectional shape. 
         [0035]    In accordance with an exemplary embodiment, for example, the puncture member  3  passes through the living body from one groin to the other groin. A sheath for introducing the sling into the living body can be connected at the distal end of the puncture member  3  which is protruded out of the living body. The sheath can be placed into the living body by moving in the opposite direction to the direction of introducing the puncture member  3 . 
         [0036]    The frame  2  turnably holds the operating member  7  on which the puncture member  3  is mounted. In addition, the frame  2  detachably fixes the insertion instrument  6 . The frame  2  has a function of determining a puncture route for the needle body  35  at the time of puncturing of a biological tissue by the puncture member  3 . For example, the frame  2  can determine a positional relationship between the puncture member  3 , the urethral insertion member  4 , and the vaginal insertion member  5  in such a manner that when a biological tissue is punctured by the puncture member  3 , the needle body (or puncture needle)  35  can pass between the urethral insertion member  4  and the vaginal insertion member  5  without colliding against or striking any of the insertion members  4  and  5 . 
         [0037]    As shown in  FIGS. 1-5 , the frame  2  can include a bearing portion  21 , a guide portion (holding portion)  22  guiding the puncture member  3 , an interlock portion  23  interlocking the bearing portion  21  and the guide portion  22  to each other, and a fixing portion  24  to which the insertion instrument  6  is fixed. 
         [0038]    The bearing portion  21  can be located on the proximal end in the puncture apparatus  1 . The guide portion  22  can be located on the distal end in the puncture apparatus  1 , and is disposed opposite to the bearing portion  21 . As shown in  FIGS. 1-5 , the guide portion  22  is formed with a roughly C-shaped guide groove (not shown) accommodating the puncture member  3  and guiding the puncture member  3 . 
         [0039]    When a rotating operation is applied to the operating member  7  as shown in  FIGS. 2-5 , the puncture member  3  gradually protrudes from the guide portion  22 , and, the needle body  35  enters into the guide portion  22  via a proximal end opening. In accordance with an exemplary embodiment, the puncture apparatus  1  can include a stop plate (or needle stopper)  700 , which can be used to control the movement of the operating member  7  and the puncture member  3  during use. In accordance with an exemplary embodiment, the stop plate  700  helps prevent the needle body  35  from piercing the puncture target (or site) as shown in  FIGS. 2 and 3 . Once the stop plate  700  is rotated upward as shown in  FIGS. 1, 4, and 5 , the operating member  7  and the puncture member  3  can continue forward into and through the puncture target (or site), which is positioned between the vaginal insertion member (or vaginal stabilizer)  51  and the urethral insertion member (or urethral stabilizer)  41 . As shown in  FIGS. 1-5 , the stop plate  700  can be rotatably attached to the frame  2  in the path of the operating member  7  on which the puncture member  3  is mounted. The apparatus  1  can also include an adjustment knob  710  ( FIGS. 1-5 and 15 ). The adjustment knob  710  allows the operator to adjust the position of the fixing portion  24  in an up and down and forward and backward direction relative to bearing portion  21 , the guide portion  22 , and the interlock portion  23 . Thus, by adjusting the relative position of the fixing portion  24  to the bearing portion  21 , the guide portion  22 , and the interlock portion  23 , the position of the urethral insertion member  4  and vaginal insertion member  5  relative to the puncture member  3  can be changed and adjusted as needed. 
         [0040]    The interlock portion  23  can interlock the shaft portion  21  and the guide portion  22  to each other. In addition, the interlock portion  23  can be in the shape of a bar. The interlock portion  23  can also function as a grasping portion, allowing an operator to use the puncture apparatus  1  while grasping the interlock portion  23 . 
         [0041]    As shown in  FIGS. 1-5 , the insertion instrument  6 , which can include a urethral insertion member (second insertion portion)  41  to be inserted into a urethra, a vaginal insertion member (first insertion portion)  51  to be inserted into a vagina, and a support portion  60  supporting the urethral insertion portion  41  and the vaginal insertion portion  51 . As disclosed above, the insertion instrument  6  can be composed essentially of the urethral insertion member  4  and the vaginal insertion member  5 . The urethral insertion member  4  can have the urethral insertion portion  41 , and the vaginal insertion member  5  can have the vaginal insertion portion  51 . 
         [0042]    In addition, the support portion  60  can include a support portion  40 , which is possessed by the urethral insertion member  4  and supports the urethral insertion portion  41 , and a support portion  50 , which is possessed by the vaginal insertion member  5  and supports the vaginal insertion portion  51 . In the insertion instrument  6 , the urethral insertion member  4  and the vaginal insertion member  5  can be freely detachable by way of the support portions  40  and  50 , respectively. The urethral insertion member  4  and the vaginal insertion member  5  will be sequentially described below. 
         [0043]    As shown in  FIGS. 1-5 , the urethral insertion member  4  can include the elongated urethral insertion portion  41  whose portion ranging from a distal end to an intermediate portion of insertion portion  41  is to be inserted into a urethra, and the support portion  40 , which supports the urethral insertion portion  41 . In the following, for convenience of description as shown in  FIG. 3 , that portion of the urethral insertion member  4  which is located inside the urethra (inclusive of a bladder) in the mounted state will be referred to also as “insertion portion  411 ” whereas that portion of the urethral insertion member  4  which is exposed via a urethra orifice to the outside of the body in the mounted state and which ranges to the support portion  40  will be referred to also as “non-insertion portion  412 .” 
         [0044]    The vaginal insertion member  5  can include the elongated vaginal insertion member (first insertion portion)  51  whose portion from a distal end to an intermediate portion of insertion portion  51  is inserted into a vagina, and the support portion  50  supporting the vaginal insertion portion  51 . In the following, for convenience of description as shown in  FIG. 3 , that portion which is located in the vagina in the mounted state will be referred to also as the “insertion portion  511 ,” and that portion which is exposed via a vaginal orifice to the outside of the body in the mounted state and which ranges to the support portion  50  will be referred to also as “non-insertion portion  512 .” 
         [0045]    The vaginal insertion portion  51  can be elongated. In accordance with an exemplary embodiment, the vaginal insertion portion  51  is spaced from the urethral insertion portion  41  on the distal end. In accordance with an exemplary embodiment, the insertion portion  511  can be parallel or inclined relative to the insertion portion  411 . In the mounted state, for example, the puncture apparatus  1  can be held stably onto the patient, and burden on the patient is mitigated. The inclination angle of the vaginal insertion portion  511  relative to the urethral insertion portion  411  is not limited, for example, the inclination angle can be about 0 to 45 degrees, and more preferably about 0 to 30 degrees, or alternatively, most preferably about 0 degrees as shown in  FIGS. 1-5 . 
         [0046]      FIG. 6  is a perspective view of a sensor arrangement  600 , which includes a pair of sensors  620 ,  622  on the vaginal insertion portion  51 , a pair of sensors  610 ,  612  on the urethral insertion portion  41 , and a magnet  630  on the needle tip  36  of the needle body  35 . In accordance with an exemplary embodiment, the urethral insertion portion  41  can include a pair of sensor  610 ,  612 , which can be positioned on proximal side and a distal side of the plurality of suction holes  44  at an intermediate portion of the urethral insertion portion. As shown in  FIG. 6 , the plurality of suction holes  44  can be laid out over the whole range in the circumferential direction of the urethral insertion portion  41 . Each of the suction holes  44  can be connected to a suction port  45  provided at a proximal portion of the urethral insertion portion  41 , via the inside of the urethral insertion portion  41 . The pair of sensors  610 ,  612  can be a pair of magnetic sensors, for example, a pair of hall sensors, which are transducers that can vary their output voltage in response to a magnetic field. 
         [0047]    In addition, the vaginal insertion portion  51  can also include a pair of sensors,  620 ,  622 , which are preferably positioned within or on an upper surface the vaginal insertion portion  51  and immediately below the pair of sensors  610 ,  612  on the urethral insertion portion  41 . The pair of sensors  620 ,  622  can be a pair of magnetic sensors, for example, a pair of hall sensors, which are transducers that can vary their output voltage in response to a magnetic field. The needle tip  36  can include a magnet  630 , which passes through the four sensors  610 ,  612 ,  620 ,  622  during puncturing of the target site (or target tissue). 
         [0048]      FIG. 7  is a front view of a monitor  800  in accordance with an exemplary embodiment. As shown in  FIG. 7 , the monitor  800  can include a plurality of lights  810 , which can include, for example, red  802 , yellow  804 , and green  806  lights. The monitor  800 , for example, can include a single green light  806 , which is surrounded by a four pairs of red lights  802  and a pair of yellow lights  804 . In accordance with an exemplary embodiment, the pair of yellow lights  804  is located just above the single green light. Each of the pairs of red light  802  extend outward from the green light  806  at the twelve, 3, 6, and 9 o&#39;clock positions, respectively. In addition, to assist the operator with directions during use, the monitor can include terminology  820  such as “up”, “down”, “head”, and “foot”. The monitor  800  can also include an ON and OFF switch or button  830 . In accordance with an exemplary embodiment, the monitor  800  can be attached to a computer having a processor and Operating System (OS) and/or the monitor  800  includes a processor and Operating System (OS). 
         [0049]      FIG. 8  is an example of the sensor arrangement  600  showing on the monitor  800  that the needle tip  36  is too high. For example, as shown in  FIG. 8 , if the needle tip  36  is too high, for example, too close to the urethral insertion portion  41 , the two red lights  802  at the 12 o&#39;clock position on the monitor  800  will be illuminated. If the needle tip  36  is too low, for example, to close to the vaginal insertion portion  51 , the two red lights  802  at the 6 o&#39;clock position on the monitor  800  will be illuminated. If the needle tip  36  is too close to the head of the patient, the two red lights  802  at the 3 o&#39;clock position on the monitor  800  will be illuminated. If the needle tip  36  is too close to the foot of the patient, the two red lights  802  at the 9 o&#39;clock position on the monitor  800  will be illuminated. 
         [0050]      FIG. 9  is an example of the sensor arrangement  600  showing on the monitor that the needle tip is on a predefined needle pass. As shown in  FIG. 9 , if the needle tip  36  is on the correct or predetermined path, the green light  806  and/or two yellow lights  804  immediately above the green light  806  will be illuminated. 
         [0051]    Next, one example, of the use of the puncture apparatus  1  will be described with reference to  FIGS. 10-18 . Here, the description will describe the procedure showing the use of a stop plate (or needle stopper)  700  in use with a sensor arrangement  600  in accordance with an exemplary embodiment. In accordance with an exemplary embodiment, the stop plate  700  can be composed of at least a first part or section  702 , and a second part of section  704 , which are configured to overlap each other. ( FIGS. 1 and 2 ). The first and second parts  702 ,  704  can move independently of each other, which allow the operator the ability to change the rotational distance of the operating member  7  based on which part or section  702 ,  704  of the stop plate  700  is used to stop the rotational movement of the operating member  7 . 
         [0052]    As set forth above, when a rotational operation is applied to the operating member  7  as shown in  FIGS. 2-5 , the puncture member  3  gradually protrudes from the guide portion  22 , and, the needle body  35  enters into the guide portion  22  via a proximal end opening. In accordance with an exemplary embodiment, the puncture apparatus  1  can include a stop plate (or needle stopper)  700 , which can be used to control the movement of the puncture member  3  during use. In accordance with an exemplary embodiment, the stop plate  700  prevents the needle body  35  from piercing the puncture target (puncture site) until the stop plate  700  rotates upward as shown in  FIGS. 1, 4, and 5 , which allows the puncture member  3  to continue forward into and through the puncture target (puncture site). 
         [0053]    As shown in  FIGS. 10 and 11 , the puncture apparatus  1  is prepared for use and the stop plate  700  is rotated downward. The rotation of the stop plate  700  downward can help prevent the needle body  35  from piercing the puncture target until the stop plate  700  is rotated upward as disclosed herein. 
         [0054]    As disclosed in U.S. Patent Publication Nos. 2015/0080644 and 2015/0073465, which are incorporated herein by reference in their entirety, the patient is prepared for the puncture apparatus  1  is set to the use state. For example, the puncture apparatus  1  is set to a state in which the puncture apparatus is put on the body surface. In addition, the puncture apparatus  1  is set to a state in which the urethral insertion portion  41  is inserted into a urethra (not shown) and the vaginal insertion portion  51  is inserted into a vagina (not shown). The balloon (not shown) is inserted into the bladder in the deflated state and a balloon inflation device such as a syringe not illustrated is connected to the port. Then, a working fluid supplied from the balloon inflation device is sent to the inside of the balloon via the lumen to inflate the balloon. Due to this, the inflated balloon catches on the bladder neck and thereby the position of the urethral-insertion portion relative to the bladder and the urethra can be fixed. 
         [0055]    Next, as illustrated in  FIGS. 12 and 13 , the needle body  35  in the assembled state is inserted into a through-hole (not shown), the needle body  35  can be thrust directly, and the rotary movement operation of the puncture needle can be carried out. In accordance with an exemplary embodiment, as the needle body  35  is thrust into the through-hole, the needle tip  36  stops before puncturing the puncture target via the stop plate  700 . 
         [0056]    In addition, as shown in  FIG. 14 , the magnet  630  on the needle tip  36  in combination with the sensors  610 ,  612 ,  620 ,  622  ( FIG. 6 ) on the urethral insertion portion  41  and the vaginal insertion portion  51  provides a signal to the monitor  800 , which can provide the operator with an indication of the relative position of the needle tip  36  to the urethral insertion portion  41  and the vaginal insertion portion  51 . 
         [0057]    If needed, as shown in  FIGS. 15 and 16 , the relative position of the needle tip  36  to the urethral insertion portion  41  and the vaginal insertion portion  51  can be adjusted using the adjustment knob  710 . 
         [0058]    Once the relative position of the needle tip  36  has been confirmed to pass through the target site, the stop plate  700  can be raised, and the needle tip  36  can continue through the target site as shown in  FIGS. 17 and 18 . 
         [0059]    In addition, while the case where the puncture apparatus  1  is applied to an implant for treatment of female urinary incontinence has been described in the above exemplary embodiments, this is not restrictive of the use of the implant. 
         [0060]    Examples of which the present disclosure is applicable can include pelvic floor diseases inclusive of excretory disorders (urinary urgency, frequent urination, urinary incontinence, fecal incontinence, urinary retention, dysuria, etc.), pelvic organ prolapse, vesicovaginal fistula, urethrovaginal fistula, and pelvic pain, which would be attendant on weakening of the group of pelvic floor muscles. The pelvic organ prolapse include such diseases as cystocele, enterocele, rectocele, and hysterocele, or such diseases as anterior vaginal prolapse, posterior vaginal prolapse, vaginal apical prolapse, and vaginal vault prolapse, which are denominations based on classification of the vaginal wall part being prolapsed. 
         [0061]    In addition, examples of overactive tissue can include the bladder, vagina, uterus, and bowels. Examples of lessactive tissue can include bones, muscles, fascias, and ligaments. For example, in relation to the pelvic floor diseases, examples of the lessactive tissue include obturator fascia, coccygeus fascia, cardinal ligament, uterosacral ligament, and sacrospinous ligament. 
         [0062]    Examples of the procedure for interlocking an overactive tissue in the pelvic floor disorder with the lessactive tissue, can include a retropubic sling surgery, a transobturator sling surgery (Transobturator Sling Surgery, Transobturator Tape; TOT), a tension-free vaginal mesh (Tension-free Vaginal Mesh; TVM) surgery, a uterosacral ligament suspension (Uterosacral Ligament Suspension; USLS) surgery, an iliococcygeus fascia fixation surgery, and a coccygeus fascia fixation surgery. 
         [0063]    The detailed description above describes a puncture apparatus. The disclosure is not limited, however, to the precise exemplary embodiments and variations described. Various changes, modifications and equivalents can effected by one skilled in the art without departing from the spirit and scope of the disclosure as defined in the accompanying claims. It is expressly intended that all such changes, modifications and equivalents which fall within the scope of the claims are embraced by the claims.