Abstract:
A hernia repair method includes the step of identifying a hernia defect in a patient, the hernia defect having a size, a location, and a shape. The method involves positioning a dispensing instrument laparoscopically into the patient adjacent the hernia defect. According to one step, the method includes dispensing one or more light pipes from the dispensing instrument at predetermined locations. The method also involves advancing the one or more light pipes through the patient&#39;s skin. Another step includes coupling a light source to the one or more light pipes. The method also involves generating a pattern of light that indicates one or more of the size, the location, and the shape of the hernia defect. One step includes positioning a surgical patch adjacent the hernia defect in accordance with the pattern of light.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
     The present application claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/641,974, filed on May 3, 2012, the entire contents of which are incorporated herein by reference. 
    
    
     BACKGROUND 
     1. Technical Field 
     The present disclosure relates to hernia repair methods. More particularly, the present disclosure relates to methods for positioning a surgical patch to a tissue site of a hernia using light. 
     2. Description of Related Art 
     A hernia is a protrusion of a tissue, structure, or part of an organ through injured muscle tissue or an injured membrane by which the tissue, structure, or organ is normally contained. Some examples of hernias include: abdominal hernias, diaphragmatic hernias and hiatal hernias (for example, para-esophageal hernia of the stomach), pelvic hernias, for example, obturator hernia, anal hernias, hernias of the nucleus pulposus of the intervertebral discs, intracranial hernias, and Spigelian hernias. 
     Hernias may be surgically repaired, and are principally repaired by pushing back, or “reducing”, the herniated tissue, and then reinforcing the defect in injured muscle tissue (an operation called herniorrhaphy). Modern muscle reinforcement techniques involve placement of a surgical patch, such as a surgical mesh, near the injured tissue or defect to support the defect. The surgical patch is either placed over the defect (anterior repair) or under the defect (posterior repair). 
     A variety of different fixation devices are used to anchor the surgical patch to the tissue. For example, a needled suture may be passed through or around the tissue near the defect to hold the surgical patch in a position which spans the injured tissue. In other examples, staples, tacks, clips and pins are also known to be passed through or around the tissue near the defect to anchor the surgical patch in a position which spans the injured tissue. 
     When applying a surgical patch during minimally invasive surgery, it is imperative that the surgeon know the precise location, size and shape of the hernia defect in order to properly place the surgical patch. However, since the bounds of the hernia defect are generally internal, visibility is often limited and placement of the surgical patch can be cumbersome. Thus, a continuing need still exits to provide a means for facilitating the effectiveness of the placement of surgical patches used to surgically repair hernias. 
     SUMMARY 
     Accordingly, a hernia repair method includes the step of identifying a hernia defect in a patient, the hernia defect having a size, a location, and a shape. The method involves positioning a dispensing instrument laparoscopically into the patient adjacent the hernia defect. 
     According to one step, the method includes dispensing one or more light pipes from the dispensing instrument at predetermined locations. The light pipes may be fiber optic. The method may include the step of positioning the dispensing instrument adjacent a corner or an extreme of the hernia defect prior to dispensing the one or more light pipes. 
     The method also involves advancing the one or more light pipes through the patient&#39;s skin. The method may further include piercing the patient&#39;s skin with that one or more light pipes. The method may further comprise the step of advancing the one or more light pipes to a position immediately adjacent the hernia defect after advancing the one or more light pipes through the patient&#39;s skin. 
     The method may include the step of bundling a plurality of light pipes. Another step includes coupling a light source to the one or more light pipes. The method also involves generating a pattern of light that indicates one or more of the size, the location, and the shape of the hernia defect. The method further includes the step of forming an outline of the hernia defect, in vivo, with the pattern of light being formed from the positioning of the plurality of light pipes at the predetermined locations. 
     One step includes positioning a surgical patch adjacent the hernia defect in accordance with the pattern of light. According to one step, the method involves generating a pattern of light that can be visualized, ex vivo, through the surgical patch when the surgical patch is positioned over the hernia defect in vivo. According to one step, the method involves removing the one or more light pipes from the patient after positioning the surgical patch adjacent the hernia defect. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The above and other aspects, features, and advantages of the present disclosure will become more apparent in light of the following detailed description when taken in conjunction with the accompanying drawings in which: 
         FIG. 1  is a cross-sectional view illustrating a tear in an abdominal wall; 
         FIG. 2  is a cross-sectional view illustrating a ventral hernia; 
         FIG. 3  is a perspective view of a hernia repair system in accordance with the present disclosure; 
         FIGS. 4-8  are progressive views illustrating a deployment of a light pipe of the hernia repair system of  FIG. 3  into tissue; 
         FIG. 9  is perspective view of a plurality of light pipes disposed in tissue after being deployed from the hernia repair system of  FIG. 3 ; 
         FIG. 10  is a perspective view of another embodiment of a hernia repair system deploying a plurality of light pipes in tissue in accordance with the present disclosure; and 
         FIGS. 11-13  are progressive views illustrating a surgical patch being positioned adjacent a hernia defect with the aid of a plurality of light pipes in accordance with the present disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     The present disclosure relates to methods for surgeries such as transluminal and/or endoluminal placement of a surgical patch at a surgical site. As used herein the term “surgical patch” is used to refer to any type of patch for use in surgical procedures, such as, for example, meshes that can be attached to the abdominal wall. Although described herein with reference to a hernia surgical patch, the methods of the disclosure may be used in any surgical repair. 
     In the drawings and in the description that follows, the term “proximal,” as is traditional, will refer to an end of a device that is closer to the user, while the term “distal” will refer to the end of the device that is farther from the user. 
     Referring now in specific detail to the drawings, in which like numbers identify similar or identical elements,  FIG. 1  illustrates a hernia that may involve a defect  30  such as a tear in the abdominal wall  40 . The abdominal wall  40  is defined by an external side  40   a  and an internal side  40   b . A surface tissue  42 , which covers the external side  40   a  of abdominal wall  40 , may or may not be immediately affected by this defect  30 . An internal organ  44  located below the internal side  40   b  of the abdominal wall  40  may not protrude until some form of exertion or use of the muscle located at the abdominal wall  40  forces the internal organ  44  into the defect  30 . Depending on the size and location of the defect  30 , exertion may not be needed to cause the organ to protrude. As shown in  FIG. 2 , a hernia occurs when an internal organ  44  protrudes into the defect  30  of abdominal wall  40 . Oftentimes the protrusion creates a bulge  46  in the surface tissue  42 . 
     As depicted in  FIG. 3 , a hernia repair system  100  includes an access port  110 , a dispensing instrument  120 , and one or more light pipes  130 . 
     The access port  110  includes a seal assembly  112  at a proximal end and cannula  114  at a distal end. The seal assembly  112  accommodates the dispensing instrument  120  in a substantially sealed relationship. The seal assembly  112  includes an insufflation valve  116  to selectively permit the passage of insufflation fluids therethrough to create a working space in an underlying tissue site. 
     The dispensing instrument  120  includes an actuation assembly  122  at a proximal end and a shaft  124  at a distal end. The shaft  124  extends from the actuation assembly  122 . The shaft  124  defines a lumen  126  therethrough to accommodate the one or more light pipes  130 . The shaft  124  is movable via the actuation assembly  122  to dispense the one or more light pipes  130  at predetermined locations within a patient. In particular, as illustrated in  FIG. 3 , the distal end of the shaft  124  may be rotatable, pivotable, and/or articulable to orient the distal end of the shaft  124  in a particular orientation relative to the hernia defect  30 . 
     Each light pipe  130  includes a distal tip  132 , which may be sharpened to pierce tissue, and an elongated member  134 . The elongated member  134  may define a lumen  136  therethrough to permit the passage of light therethrough when coupled to a light source  150  (see  FIG. 11 ). Alternatively, the elongated member  134  may include any suitable electrical and/or mechanical and/or chemical components configured to emit light from the distal end of the elongated member  134  (e.g., like a flashlight). The elongated member  134  may be rigid or flexible. The light pipes  130  may be fiber optic. 
     In use, a hernia defect  30  is identified in a patient. As can be appreciated, each hernia defect  30  has a particular size, location, and shape and therefore proper placement of a surgical patch  160  during minimally invasive surgery is facilitated when a practitioner can ascertain the size, location, and shape from an ex vivo location. Thus, in order to be able to perceive the hernia defect  30  from an ex vivo location, the practitioner inserts the access port  110 , namely the cannula  114  into tissue adjacent the hernia defect  30  (see  FIG. 4 ). With continued reference to  FIGS. 4-5 , the underlying tissue site “TS” may be insufflated when the insufflation valve  116  is coupled to an insufflation source  118  to create a working space. In this respect, the practitioner may then laparoscopically advance the dispensing instrument  120  into the patient adjacent the hernia defect  30  to facilitate placement of one or more light pipes  30  in position about the hernia defect  30 , which is best depicted in  FIG. 5 . As depicted in  FIG. 10 , any number of access ports  110  and/or dispensing instruments  120  may be used to position the one or more light pipes  130  in tissue. In some modes of operation, the practitioner may even directly laparoscopically advance the one or more light pipes  30  through the access port  110  or directly laparoscopically advance the one or more light pipes  30  through an incision (without the access port  110 ) by virtue of the sharpened distal tip  132 , where appropriate. 
     Turning now to  FIGS. 6-9 , one or more light pipes  130  may then be dispensed from the dispensing instrument  120  at predetermined locations about the hernia defect  30  to create a pattern about the defect  30  that is commensurate with the size, location, orientation and/or shape of the defect  30 . For example, the dispensing instrument  120  may be positioned adjacent one or more corners and/or extremes of the hernia defect  30  prior to dispensing the one or more light pipes  130  to generate the pattern. The one or more light pipes  130  can then be dispensed with sufficient force to pierce and advance through the patient&#39;s skin, e.g. surface tissue  42 . The one or more light pipes  130  may include sharpened tips  132  to further facilitate the penetration of the patient&#39;s skin. After the ends, e.g., the sharpened tips  132  are positioned so that they extend externally, the one or more light pipes  130  may be advanced to a position immediately adjacent the hernia defect  30  or the abdominal wall  40 . In this respect, the one or more light pipes  130  may be pulled proximally through the pierced skin until they are positioned snug against the hernia defect  30  or the abdominal wall  40 , depending upon the desired position. 
     Once in the snug position, the one or more light pipes  130  are most suitably configured in the pattern. The pattern may extend along the defect  30  and/or along an area immediately adjacent the defect  30 . The pattern may have any suitable geometry, size, etc. for facilitating the placement of a surgical patch  160  adjacent the defect  30 . 
     As illustrated in  FIGS. 11-13 , when the one or more light pipes  130  are coupled to a light source  150  or are otherwise adapted to emit light (e.g., selectively via a switch coupled to the one or more light pipes or autonomously by fluorescent chemicals or the like), one or more points of light are formed about the defect  30  corresponding to the pattern to indicate the size, location, orientation and/or shape of the defect  30 . 
     With reference to  FIG. 11 , when there is a plurality of light pipes  130 , the plurality may be bundled together via a bundling member  140 . The light source  150  may then be coupled to the one or more light pipes  130 , either individually, collectively, or by groups of light pipes  130 . The bundling member  140  may include a light source  150 . As depicted in  FIG. 12 , the light source  150  generates the pattern of light “P” via points of light P1, P2, P3, P4, P5, P6, etc. that indicate the size, the location, the orientation and/or the shape of the hernia defect  30 . In this regard, the light emitted from the light source  150  will form an outline of the hernia defect  30 , in vivo, so as to be viewable ex vivo so that the surgical patch  160  may be positioned adjacent the hernia defect  30  with any suitable instrument  200  (e.g., a grasper) in accordance with the outline/pattern of light. As can be appreciated, when the surgical patch  160  is positioned in vivo over the hernia defect  30 , the generated pattern of light can be visualized, ex vivo, through the surgical patch  110  and the tissue. After the surgical patch  160  is placed in a desired position adjacent the hernia defect  30 , the surgical patch  160  may be secured to the defect  30  by any suitable means (e.g., glue, tack, staple, suture, etc.) and the one or more light pipes  130  may then be removed from the patient either individually, collectively, or by groups of light pipes  130  (see  FIG. 13 ). 
     The presently disclosed surgical patch may be any type of patch for use in surgical repair and suitable for use in situ. The surgical patch may be any suitable shape (i.e., circular, noncircular, etc.) and may include one or more layers. The surgical patch may be made of multiple fibers, or may be made of a single fiber. The fibers may be a monofilament or multi-filament. 
     The fibers forming the presently disclosed patch may be made from a natural material or a synthetic material. The fibers may be biodegradable or non-biodegradable. Any combination of natural, synthetic, bioadegradable and non-biodegradable materials may be used to form the fibers. The term “biodegradable” as used herein is defined to include both bioabsorbable and bioresorbable materials. By biodegradable, it is meant that the materials decompose, or lose structural integrity under body conditions (e.g. enzymatic degradation or hydrolysis) or are broken down (physically or chemically) under physiologic conditions in the body such that the degradation products are excretable or absorbable by the body. 
     The surgical patch of the present disclosure may be formed using any method suitable to forming patch structures, including but not limited to knitting, weaving, non-woven techniques, and the like. Suitable techniques for making the surgical patch are within the purview of those skilled in the art. 
     The surgical patch may be any shape or size suitable for covering the herniated area and securing the patch to surrounding tissue. The surgical patch may be preformed to a certain size, such as, for example, a 9 cm diameter round patch or 50 cm×50 cm square patch. In embodiments, the surgical patch may be cut to a particular size and shape as needed. 
     In addition, the surgical patch of the present disclosure may be rolled, folded, or otherwise oriented so that the surgical patch forms a shape more suitable for placement adjacent a hernia defect. 
     While several embodiments of the disclosure have been shown in the drawings, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.