Slotted anchor device

A slotted anchor that secures to a connector as part of an anchor assembly is disclosed. The slotted anchor includes a pair of spaced apart prongs which join together at a slot inception. The prongs are shaped and sized of a configuration and of a rigidity to substantially prevent deflection of the prongs. The prongs include inwardly facing protrusions that are configured to capture and deform the connector between the protrusions and prevent the connector from disengaging from the slotted anchor once engaged.

FIELD OF THE INVENTION

The disclosed embodiments relate generally to medical devices and methods, and more particularly to systems and associated methods for manipulating or retracting tissues and anatomical or other structures within the body of human or animal subjects for the purpose of treating diseases or disorders.

BACKGROUND

There are a wide variety of situations in which it is desirable to lift, compress or otherwise reposition normal or aberrant tissues or anatomical structures (e.g., glands, organs, ligaments, tendons, muscles, tumors, cysts, fat pads, and the like) within the body of a human or animal subject. Such procedures are often carried out for the purpose of treating or palliating the effects of diseases or disorders (e.g., hyperplasic conditions, hypertrophic conditions, neoplasias, prolapses, herniations, stenoses, constrictions, compressions, transpositions, congenital malformations, and the like) and/or for cosmetic purposes (e.g., face lifts, breast lifts, brow lifts, and the like) and/or for research and development purposes (e.g., to create animal models that mimic various pathological conditions). In many of these procedures, surgical incisions are made in the body, and laborious surgical dissection is performed to access and expose the affected tissues or anatomical structures. Thereafter, in some cases, the affected tissues or anatomical structures are removed or excised. In other cases, various natural or man-made materials are used to lift, sling, reposition or compress the affected tissues.

One example of a condition where it is desirable to lift, compress or otherwise remove a pathologically enlarged tissue is Benign Prostatic Hyperplasia (BPH). BPH is one of the most common medical conditions that affects men, especially elderly men. It has been reported that, in the United States, more than half of all men have histopathologic evidence of BPH by age 60 and, by age 85, approximately 9 out of 10 men suffer from the condition. Moreover, the incidence and prevalence of BPH is expected to increase as the average age of the population increases in developed countries.

The prostate gland enlarges throughout a man's life. In some men, the prostatic capsule around the prostate gland may prevent the prostate gland from enlarging further. This causes the inner region of the prostate gland to squeeze the urethra. This pressure on the urethra increases resistance to urine flow through the region of the urethra enclosed by the prostate. Thus, the urinary bladder has to exert more pressure to force urine through the increased resistance of the urethra. Chronic over-exertion causes the muscular walls of the urinary bladder to remodel and become stiffer. This combination of increased urethral resistance to urine flow and stiffness and hypertrophy of urinary bladder walls leads to a variety of lower urinary tract symptoms (LUTS) that may severely reduce the patient's quality of life. These symptoms include weak or intermittent urine flow while urinating, straining when urinating, hesitation before urine flow starts, feeling that the bladder has not emptied completely even after urination, dribbling at the end of urination or leakage afterward, increased frequency of urination particularly at night, urgent need to urinate, and the like.

In addition to patients with BPH, LUTS may also be present in patients with prostate cancer, prostate infections, and chronic use of certain medications (e.g. ephedrine, pseudoephedrine, phenylpropanolamine, antihistamines such as diphenhydramine, chlorpheniramine, and the like) that cause urinary retention especially in men with prostate enlargement.

Although BPH is rarely life threatening, it can lead to numerous clinical conditions including urinary retention, renal insufficiency, recurrent urinary tract infection, incontinence, hematuria, and bladder stones.

In developed countries, a large percentage of the patient population undergoes treatment for BPH symptoms. It has been estimated that by the age of 80 years, approximately 25% of the male population of the United States will have undergone some form of BPH treatment. At present, the available treatment options for BPH include watchful waiting, medications (phytotherapy and prescription medications), surgery and minimally invasive procedures.

For patients who choose the watchful waiting option, no immediate treatment is provided to the patient, but the patient undergoes regular exams to monitor progression of the disease. This is usually done on patients that have minimal symptoms that are not especially bothersome.

Medications for treating BPH symptoms include phytotherapy and prescription medications. In phytotherapy, plant products such as Saw Palmetto, African Pygeum, Serenoa Repens (sago palm) and South African star grass are administered to the patient. Prescription medications are prescribed as first line therapy in patients with symptoms that are interfering with their daily activities. Two main classes of prescription medications are alpha-1 a-adrenergic receptors blockers and 5-alpha-reductase inhibitors. Alpha-1 a-adrenergic receptors blockers block the activity of alpha-1 a-adrenergic receptors that are responsible for causing constriction of smooth muscle cells in the prostate. Thus, blocking the activity of alpha-1 a-adrenergic receptors causes prostatic smooth muscle relaxation. This, in turn, reduces urethral resistance thereby reducing the severity of the symptoms. 5-alpha-reductase inhibitors block the conversion of testosterone to di-hydro-testosterone. Di-hydro-testosterone causes growth of epithelial cells in the prostate gland. Thus, 5-alpha-reductase inhibitors cause regression of epithelial cells in the prostate gland and, hence, reduce the volume of the prostate gland, which in turn reduces the severity of the symptoms.

Surgical procedures for treating BPH symptoms include Transurethal Resection of Prostate (TURP), Transurethral Electrovaporization of Prostate (TVP), Transurethral Incision of the Prostate (TUIP), Laser Prostatectomy and Open Prostatectomy.

Transurethal Resection of Prostate (TURP) is the most commonly practiced surgical procedure implemented for the treatment of BPH. In this procedure, prostatic urethral obstruction is reduced by removing most of the prostatic urethra and a sizeable volume of the surrounding prostate gland. This is carried out under general or spinal anesthesia. In this procedure, a urologist visualizes the urethra by inserting a resectoscope, that houses an optical lens in communication with a video camera, into the urethra such that the distal region of the resectoscope is in the region of the urethra surrounded by the prostate gland. The distal region of the resectoscope consists of an electric cutting loop that can cut prostatic tissue when an electric current is applied to the device. An electric return pad is placed on the patient to close the cutting circuit. The electric cutting loop is used to scrape away tissue from the inside of the prostate gland. The tissue that is scraped away is flushed out of the urinary system using an irrigation fluid. Using a coagulation energy setting, the loop is also used to cauterize transected vessels during the operation.

Another example of a surgical procedure for treating BPH symptoms is Transurethral Electrovaporization of the Prostate (TVP). In this procedure, a part of prostatic tissue squeezing the urethra is desiccated or vaporized. This is carried out under general or spinal anesthesia. In this procedure, a resectoscope is inserted transurethrally such that the distal region of the resectoscope is in the region of the urethra surrounded by the prostate gland. The distal region of the resectoscope consists of a rollerball or a grooved roller electrode. A controlled amount of electric current is passed through the electrode. The surrounding tissue is rapidly heated up and vaporized to create a vaporized space. Thus, the region of the urethra that is blocked by the surrounding prostate gland is opened up.

Another example of a surgical procedure for treating BPH symptoms is Transurethral Incision of the Prostate (TUIP). In this procedure, the resistance to urine flow is reduced by making one or more incisions in the prostate gland in the region where the urethra meets the urinary bladder. This procedure is performed under general or spinal anesthesia. In this procedure, one or more incisions are made in the muscle of the bladder neck, which is the region where the urethra meets the urinary bladder. The incisions are in most cases deep enough to cut the surrounding prostate gland tissue including the prostatic capsule. This releases any compression on the bladder neck and causes the bladder neck to spring apart. The incisions can be made using a resectoscope, laser beam, and the like.

Another example of a surgical procedure for treating BPH symptoms is Laser Prostatectomy. Two common techniques used for Laser Prostatectomy are Visual Laser Ablation of the Prostate (VLAP) and the Holmium Laser Resection/Enucleation of the Prostate (HoLEP). In VLAP, a neodymium: Yttrium-aluminum-gamet (NdYAG) laser is used to ablate tissue by causing coagulation necrosis. The procedure is performed under visual guidance. In HoLEP, a holmium: Yttrium-aluminum-gamet laser is used for direct contact ablation of tissue. Both these techniques are used to remove tissue obstructing the urethral passage to reduce the severity of BPH symptoms.

Another example of a surgical procedure for treating BPH symptoms is Photoselective Vaporization of the Prostate (PVP). In this procedure, laser energy is used to vaporize prostatic tissue to relieve obstruction to urine flow in the urethra. The type of laser used is the Potassium-Titanyl-Phosphate (KTP) laser. The wavelength of this laser is highly absorbed by oxyhemoglobin. This laser vaporizes cellular water and, hence, is used to remove tissue that is obstructing the urethra.

Another example of a surgical procedure for treating BPH symptoms is Open Prostatectomy. In this procedure, the prostate gland is surgically removed by an open surgery. This is done under general anesthesia. The prostate gland is removed through an incision in the lower abdomen or the perineum. The procedure is used mostly in patients that have a large (greater than approximately 100 grams) prostate gland.

Minimally invasive procedures for treating BPH symptoms include Transurethral Microwave Thermotherapy (TUMT), Transurethral Needle Ablation (TUNA), Interstitial Laser Coagulation (ILC), and Prostatic Stents.

In Transurethral Microwave Thermotherapy (TUMT), microwave energy is used to generate heat that destroys hyperplastic prostate tissue. This procedure is performed under local anesthesia. In this procedure, a microwave antenna is inserted in the urethra. A rectal thermosensing unit is inserted into the rectum to measure rectal temperature. Rectal temperature measurements are used to prevent overheating of the anatomical region. The microwave antenna is then used to deliver microwaves to lateral lobes of the prostate gland. The microwaves are absorbed as they pass through prostate tissue. This generates heat which in turn destroys the prostate tissue. The destruction of prostate tissue reduces the degree of squeezing of the urethra by the prostate gland, thus, reducing the severity of BPH symptoms.

Another example of a minimally invasive procedure for treating BPH symptoms is Transurethral Needle Ablation (TUNA). In this procedure, heat-induced coagulation necrosis of prostate tissue regions causes the prostate gland to shrink. It is performed using local anesthetic and intravenous or oral sedation. In this procedure, a delivery catheter is inserted into the urethra. The delivery catheter comprises two radiofrequency needles that emerge at an angle of 90 degrees from the delivery catheter. The two radiofrequency needles are aligned at an angle of 40 degrees to each other so that they penetrate the lateral lobes of the prostate. A radiofrequency current is delivered through the radiofrequency needles to heat the tissue of the lateral lobes to 70-100 degree Celsius at a radiofrequency power of approximately 456 KHz for approximately 4 minutes per lesion. This creates coagulation defects in the lateral lobes. The coagulation defects cause shrinkage of prostatic tissue which in turn reduces the degree of squeezing of the urethra by the prostate gland thus reducing the severity of BPH symptoms.

Another example of a minimally invasive procedure for treating BPH symptoms is Interstitial Laser Coagulation (ILC). In this procedure, laser-induced necrosis of prostate tissue regions causes the prostate gland to shrink. It is performed using regional anesthesia, spinal or epidural anesthesia or local anesthesia (periprostatic block). In this procedure, a cystoscope sheath is inserted into the urethra, and the region of the urethra surrounded by the prostate gland is inspected. A laser fiber is inserted into the urethra. The laser fiber has a sharp distal tip to facilitate the penetration of the laser scope into prostatic tissue. The distal tip of the laser fiber has a distal-diffusing region that distributes laser energy 360° along the terminal 3 mm of the laser fiber. The distal tip is inserted into the middle lobe of the prostate gland, and laser energy is delivered through the distal tip for a desired time. This heats the middle lobe and causes laser-induced necrosis of the tissue around the distal tip. Thereafter, the distal tip is withdrawn from the middle lobe. The same procedure of inserting the distal tip into a lobe and delivering laser energy is repeated with the lateral lobes. This causes tissue necrosis in several regions of the prostate gland which, in turn, causes the prostate gland to shrink. Shrinkage of the prostate gland reduces the degree of squeezing of the urethra by the prostate, thus, reducing the severity of BPH symptoms.

Another example of a minimally invasive procedure for treating BPH symptoms is implanting Prostatic Stents. In this procedure, the region of urethra surrounded by the prostate is mechanically supported to reduce the constriction caused by an enlarged prostate. Prostatic stents are flexible devices that are expanded after their insertion in the urethra. They mechanically support the urethra by pushing the obstructing prostatic tissue away from the urethra. This reduces the constriction of the urethra and improves urine flow past the prostate gland thereby reducing the severity of BPH symptoms.

Although existing treatments provide some relief to the patient from symptoms of BPH, they have disadvantages. Alpha-1 a-adrenergic receptors blockers have side effects such as dizziness, postural hypotension, lightheadedness, asthenia and nasal stuffiness. Retrograde ejaculation can also occur. 5-alpha-reductase inhibitors have minimal side effects, but only have a modest effect on BPH symptoms and the flow rate of urine. In addition, anti-androgens, such as 5-alpha-reductase, require months of therapy before LUTS improvements are observed. Surgical treatments of BPH carry a risk of complications including erectile dysfunction; retrograde ejaculation; urinary incontinence; complications related to anesthesia; damage to the penis or urethra; need for a repeat surgery; and the like. Even TURP, which is the gold standard in treatment of BPH, carries a high risk of complications. Adverse events associated with this procedure are reported to include retrograde ejaculation (65% of patients), post-operative irritation (15%), erectile dysfunction (10%), need for transfusion (8%), bladder neck constriction (7%), infection (6%), significant hematuria (6%), acute urinary retention (5%), need for secondary procedure (5%), and incontinence (3%). Typical recovery from TURP involves several days of inpatient hospital treatment with an indwelling urethral catheter, followed by several weeks in which obstructive symptoms are relieved, but there is pain or discomfort during micturition.

The reduction in the symptom score after minimally invasive procedures is not as large as the reduction in symptom score after TURP. Up to 25% of patients who receive these minimally invasive procedures ultimately undergo a TURP within 2 years. The improvement in the symptom score generally does not occur immediately after the procedure. For example, it takes an average of one month for a patient to notice improvement in symptoms after TUMT and 1.5 months to notice improvement after ILC. In fact, symptoms are typically worse for these therapies that heat or cook tissue, because of the swelling and necrosis that occurs in the initial weeks following the procedures. Prostatic stents often offer more immediate relief from obstruction but are now rarely used because of high adverse effect rates. Stents have the risk of migration from the original implant site (up to 12.5% of patients), encrustation (up to 27.5%), incontinence (up to 3%), and recurrent pain and discomfort. In published studies, these adverse effects necessitated 8% to 47% of stents to be explanted. Overgrowth of tissue through the stent and complex stent geometries has made their removal quite difficult and invasive.

Thus, the most effective current methods of treating BPH carry a high risk of adverse effects. These methods and devices either require general or spinal anesthesia or have potential adverse effects that dictate that the procedures be performed in a surgical operating room, followed by a hospital stay for the patient. The methods of treating BPH that carry a lower risk of adverse effects are also associated with a lower reduction in the symptom score. While several of these procedures can be conducted with local analgesia in an office setting, the patient does not experience immediate relief and, in fact, often experiences worse symptoms for weeks after the procedure until the body begins to heal. Additionally, all device approaches require a urethral catheter placed in the bladder, and in some cases for weeks. In some cases, catheterization is indicated because the therapy actually causes obstruction during a period of time post operatively, and in other cases it is indicated because of post-operative bleeding and potentially occlusive clot formation. While drug therapies are easy to administer, the results are suboptimal, take significant time to take effect, and often entail undesired side effects.

Cosmetic or Reconstructive Tissue Lifting and Repositioning:

Many cosmetic or reconstructive surgical procedures involve lifting, compressing or repositioning of natural tissue, natural tissue or artificial grafts, or aberrant tissue. For example, surgical procedures such as face lifts, brow lifts, neck lifts, tummy tucks, and the like, have become commonplace. In many cases, these procedures are performed by creating incisions through the skin, dissecting to a plane beneath muscles and fascia, freeing the muscles, fascia and overlying skin from underlying structures (e.g., bone or other muscles), lifting or repositioning the freed muscles, fascia and overlying skin, and then attaching the repositioned tissues to underlying or nearby structures (e.g., bone, periostium, or other muscles) to hold the repositioned tissues in their new (e.g., lifted) position. In some cases, excess skin may also be removed during the procedure.

There have been attempts to develop minimally invasive devices and methods for cosmetic lifting and repositioning of tissues. For example, connector suspension lifts have been developed where one end of a standard or modified connector thread is attached to muscle and the other end is anchored to bone, periostium or another structure to lift and reposition the tissues as desired. Some of these connector suspension techniques have been performed through cannulas or needles inserted though relatively small incisions of puncture wounds.

There remains a need for the development of a suture lock or suture anchor that can be used throughout the body The disclosed embodiments address these and other needs.

SUMMARY

Briefly and in general terms, the present disclosure is directed towards a slotted suture anchor which includes a back end that resembles a flattened tube in shape, with a width in lateral cross-section that is greater than its thickness. The slotted suture anchor also includes a pair of spaced apart prongs. The spaced prongs join together at a slot inception. The prongs are shaped and sized of a configuration and of a rigidity to substantially prevent deflection of the prongs. The mechanism of suture attachment and strength of the assembly is a combination of compression of the suture between the stiff slotted prongs of the anchor as well as disruption of the suture surface by the discreet edges of the slotted, flattened-tubular anchor. The discreet edges provide a lower contact surface area between anchor prongs and suture and focuses the compressive forces in focal points that cause the suture to conform around both internal recesses and external faces. In some embodiments, the prongs include inwardly facing protrusions that are configured to capture and deform the suture between the protrusions and prevent the suture from disengaging from the slotted anchor device once engaged.

Various further embodiments of slotted anchors are also contemplated. In each, a pair of rigid prongs are provided so that a grip onto a connector can be achieved without the necessity or significant reliance upon an additional locking member. In particular, various embodiments of slotted structures are disclosed which accordingly provide alternative approaches to inward extending protrusions as well as the slot inception of the device.

Other features and advantages will become apparent from the following detailed description, taken in conjunction with the accompanying drawings, which illustrate by way of example, the features of the various embodiments.

DETAILED DESCRIPTION

Turning now to the figures, which are provided by way of example and not limitation, the disclosed embodiments are illustrated with regard to anchor assemblies configured to be delivered within a patient's body. As stated, the disclosed embodiments can be employed for various medical purposes including but not limited to approximating, retracting, lifting, compressing, supporting or repositioning tissues, organs, anatomical structures, grafts or other material found within a patient's body. Such tissue manipulation is intended to facilitate the treatment of diseases or disorders. Moreover, the disclosed embodiments have applications in cosmetic or reconstruction purposes, or in areas relating to the development or research of medical treatments. Referring now to the drawings, wherein like reference numerals denote like or corresponding components throughout the drawings and, more particularly toFIGS. 1-7, there is shown an embodiment of an anchor assembly.

In such applications, one portion of an anchor assembly is positioned and implanted against a first section of anatomy. A second portion of the anchor assembly is then positioned and implanted adjacent to a second section of anatomy for the purpose of approximating, retracting, lifting, compressing, supporting or repositioning one section of anatomy with respect to the other section of anatomy, as well as for the purpose of approximating, retracting, lifting, compressing, supporting or repositioning one section of anatomy with respect to the other section of anatomy. It is also to be recognized that both a first and second portion of the anchor assembly can be configured to accomplish the desired approximating, retracting, lifting, compressing, supporting or repositioning of anatomy due to tension supplied thereto via a connector assembly (e.g., suture) affixed to the first and second portions of the anchor assembly.

In one embodiment of the anchor assembly, the anchor assembly is configured to include structure that is capable of being implanted within a patient's body. The anchor assembly may also be used in conjunction with a conventional remote viewing device (e.g., an endoscope) so that an interventional site can be observed.

In one embodiment, the anchor assembly can be placed at an intervention site using a delivery tool (See co-pending U.S. application Ser. No. 11/318,240). One specific, non-limiting application of the delivery tool is for the treatment of benign prostatic hyperplasia. In this procedure, an implant is delivered to a prostatic lobe that is obstructing the urethral opening and restricting flow. The implant compresses the lobe, thereby increasing the urethral opening and reducing the fluid obstruction through the prostatic urethra.

Additionally, in one embodiment, the anchor assembly is embodied in a tissue approximation anchor (TAA). The tissue approximation anchor is an implant assembly that includes one tubular member, referred to as the capsular anchor or, more generally, distal anchor70. The distal anchor70is preferably connected by a suture (preferably polyester)78to a slotted, flattened-tubular member (preferably comprised of stainless steel), referred to as the urethral anchor or proximal anchor84. In one specific, non-limiting embodiment, the distal anchor70is comprised of an electro-polished Nitinol (nickel titanium alloy SE508, 50.8% nickel) tube.

The tissue approximation anchor is designed to be useable in an office environment (in contrast to requiring a hospital environment) with a delivery tool. The delivery tool is used through a 19 Fr sheath in one preferred embodiment, while in another embodiment a sheath size of 21F is employed. Additionally, the material selection and construction of the tissue approximation anchor still allows for a subsequent TURP procedure to be performed, if necessary, on the prostate. In this suture-based, tissue approximation technique, a needle delivery mechanism (as described in U.S. application Ser. No. 11/318,246) is used to implant a nitinol distal anchor70and attached suture78. Once the distal anchor70and attached suture78have been deployed, with the needle retracted and the suture78tensioned, the slotted anchor84is pushed by the delivery tool and captures the suture78transverse to the anchor axis. The flattened portion of the anchor84allows the anchor to be held by the tool without rotating so that it will stay oriented properly to ensure the suture enters the space between the prongs. In many of the illustrated embodiments, the seating region in the slotted anchor for the suture is shown in approximately the midpoint of the slotted anchor but it is within the scope of the present invention to locate the seating region closer to one end or the other of the anchor in order to prevent the ends of the prongs of the anchor from digging into tissue after implantation but rather sit more parallel to the tissue, if so desired.

In one embodiment, the nitinol tube is attached to a USP size 0 PET (Poly Ethylene Terephthalate) monofilament suture78by thermally forming the suture to locking features on the anchor70. Referring again to the suture itself, the PET suture is a round monofilament extrusion/pulltrusion composed of a grade 8816 polyethylene terephthalate. Typically, the base material for the suture is annealed at approximately 100 degrees Celsius for approximately 130 minutes in a straight condition. In one non-limiting embodiment, the PET suture78has a diameter of 0.015 inches and a tensile strength greater than or equal to 12.7 pounds.

In one embodiment, the anchor84is a 316L stainless steel flattened tube that is slotted, electro-polished, and passivated. The anchor is depicted in the figures with a flat surface on the top or bottom but it is within the scope of the present invention that only one of the surfaces be flat and that the surface(s) do not have to be true flat but rather could have a slight dip or protrusion on the flattened surfaces. The slotted anchor84includes prongs96that grip and deform the suture78in the seating region98between the spaced prongs96. It is to be recognized that rather than defining mirrored images, in one or more of the embodiments disclosed herein, the seating region can be formed by staggered structure or one prong can have a longer area defining seating structure than an opposing prong to provide an effective engagement for a particular suture or connector design. The prongs96are quite stiff and robust therefore subject to minimal to no deflection. In particular preferred embodiments, the prongs or overall width of the anchor adjacent the seating region98expands, after a connector has been seated in the seating region, less than about 0.002 inches (i.e., less than about five percent), more preferably less than about 0.001 inches (i.e., less than about two and half percent). In particular preferred embodiments, the prongs or overall width of the anchor adjacent the ends of the prongs96expands, after a connector has been seated in the seating region, less than about 0.0065 inches (i.e., less than about seventeen percent), more preferably less than about 0.006 inches (i.e., less than about fifteen percent). Due to its particular configuration, the slotted anchor84also requires less force to deploy onto a suture78. Being relatively stiff, the prongs96of the slotted anchor84are significantly more resistant to bending. The four individual edges/faces (two on each prong96) of the slotted anchor84disrupt the surface of the suture78, both biting into the suture78as well as compressing the suture78between the slotted prongs96, including sometimes melting the suture locally due to the pressure and heat created during deployment of the slotted anchor onto the suture. The reduced area of contact provided by this structure as well as multiple planes of engagement of the anchor slot to the connector strengthens connections and prevents inadvertent separation. Additionally, the narrow width of the slot inception97is substantially smaller than the connector diameter, with the purpose to allow the stiffer prongs to slightly elastically expand over the connector and contribute to anchor retention by means of compression but not intended to receive the connector into this relief slot, which is positioned proximal to the seating portion98. It is beneficial in some circumstances however for the slotted anchor to be pushed far enough on to the connector such that the connector becomes at least partially seated in the slot inception relief slot so that it becomes pinched and/or wedged. In this circumstance, a two-part compression slot is created wherein the short, narrow part of the slot ensures a good mechanical interlock but my compromise the strength of the suture locally and the second wider part is ensures a good mechanical interlock but without any compromise in the strength of the suture. Notably, the outwardly stepped slot width also has a dimension smaller than the connector diameter, and receives the connector with some interference.

In one embodiment, the prongs96are formed from a wide (or flattened) tubular structure. The wider and smoother prongs96of the anchor84assist in preventing the prongs96from irritating and/or damaging tissue, which is more likely to occur with a thinner and pointier leg structure forming piercing structure. Further, in one embodiment, the slot in the anchor84is configured to create registering and aligning surfaces to the delivery tool (not shown). In several embodiments, the two inner surfaces of the prongs96of the slotted anchor84are configured as corresponding inwardly facing U-shapes. In this configuration, the inner surfaces of the prongs96bite into the suture78. In still other embodiments, the two inner surfaces of the prongs96of the slotted anchor84are configured to present a notched geometry. In still other embodiments, the inner surfaces of the prongs are configured with burrs, roughened edges, serrations, etc. to enhance their ability to retain the connector.

In several embodiments, such as for exampleFIGS. 1-7, the slotted anchor84includes a rigid generally tubular or flattened cylindrical back end95, extending from which are a pair of spaced prongs96. Optionally, the anchor assembly may be filled in with a radiopaque material, or other therapeutic agent. Terminal ends of the prongs96may be tapered to receive a section of the suture78. Notably, the prong structure commences at a narrowed slot inception97, which steps outwardly to a wider dimension to thereby define the space between the prongs96. This narrow slot97provides the slotted anchor84with desired structural rigidity to receive the suture78and to facilitate locking engagement with the slotted anchor84. Notably, the space between the prongs96of the slotted anchor84is dimensioned relative to the diameter of the suture78such that is has sufficient gripping force moving toward the seating region98to obviate the need for a securing end unit. Accordingly, in a preferred embodiment, a securing end unit is not needed. Moreover, it is to be recognized that the slot inception97is not intended to receive a connector or suture78but rather it provides the prongs with the slight flexibility to receive the suture78in a manner so that the suture78is positioned as desired within the seating region. Such desired positioning creates a lock between the anchor84and the suture78thereby providing the clinical benefit of preventing loss of tension between members forming an anchor assembly.

As described above, in one embodiment, shaped tube raw stock is used to produce the anchor70and the anchor84using slot/profile cutting. Specifically, in one embodiment the raw stock may be cut by laser, wire-EDM, or stamped from a flat and formed into a shape. In one non-limiting embodiment, the raw stock has a total height ranging from 0.020 inches to 0.025 inches, and has a total width ranging from 0.038 inches to 0.040 inches. Thus, this raw stock is flatter and wider than a purely round tube would be.

The inwardly facing protrusion region99on the prongs96is configured to keep the suture78from “walking” out over time. In one embodiment, the inner surface of the prongs96near the slot inception97is more of an extended landing (i.e., wider seating region98) than a simple U-shaped surface configuration. Various of the contemplated embodiments can include such landings and the landings can assume curved or other shapes. Additionally, the inner surface of the prongs96can have alternative configurations differing from a U-shape. Non-flat inner surfaces tend to facilitate retention of a suture78under tension such as exemplified inFIG. 3Bwhich depicts a suture forming a hourglass shape between opposing surfaces of prongs96. The outer surfaces of the prongs96are contemplated to define an atraumatic structure such as that provided by curved surfaces. In one embodiment, there is a longer root diameter for better seating of the suture78. In such an embodiment, the prongs96have a straight lead-in initially before beginning to taper. In another embodiment (SeeFIGS. 5 and 6), the prongs have a tapered lead-in configuration with additional inward protrusions100. This tapered lead-in configuration with additional inward protrusions100assists with the centering of the suture78into the seating region98and facilitated placement of the anchor onto the suture78.

In one embodiment, a 0.014 inch gap between prongs96provides a structure suitable for use with a 0.015 inch suture78while allowing minimal to no tissue impingement. In another approach, the seating region98of the slot has a 0.008 inch gap while the inwardly protruding region99, which helps prevent a suture78from walking out over time, has a 0.006 inch gap. In still another embodiment, the seating region98of the slot has a 0.009 inch gap, while the inwardly protruding region99, has a 0.007 inch gap. In one embodiment, seating region98is approximately 0.011 inches.

These configurations create a lower resistance interference fit to achieve reliable seating while maintaining strength. It will be appreciated by those skilled in the art, that many variations in the slot parameters are possible for optimizing performance in different situations. Additionally, in some embodiments, the protrusions formed on opposite prongs may be of differing shapes. Such slot parameters include, by way of example only, and not by way of limitation: width, thickness, length, and profile.

One embodiment of an anchor assembly10is depicted inFIGS. 8-10. In its unconstrained configuration, the anchor70includes a tubular (head) portion72which is generally orthogonally oriented to a tail portion74. It is to be noted, however, that while housed in a delivery assembly and prior to deployment at a target area, the anchor70is constrained to define a generally straight configuration, only subsequently assuming the unconstrained (i.e., orthogonally oriented) configuration upon deployment from a delivery device.

The anchor70is laser cut or wire EDM (electrical discharge machined) from a Nitinol base stock that is generally-tubular in shape. The nitinol anchor is shape-set to have a “flipping tail” and is electro-polished. The suture78is then attached to the anchor70. Specifically, in one embodiment, the PET suture78is thermoformed onto locking features in the anchor70. The anchor70may be locally heated to re-flow the suture onto the end of the anchor70and into cutouts on the anchor70. Continuing, in one non-limiting embodiment, the post electro-polished anchor70has a 0.016 inner diameter and a 0.0245 outer diameter.

In one non-limiting embodiment, the tubular portion72of the anchor70includes a plurality of tabs76which can be deformed or deflected to accomplish affixing the anchor70to a suture78. It has been found that three such tabs76, two on one side of the tubular portion72and one on an opposite side, provide a sufficient connecting force. However, the anchor70may be attached to the suture78through any of several known techniques, such as by being attached to the distal end of the tubular portion72.

In another aspect of a non-limiting embodiment, it is contemplated that the anchor70can be laser cut from a tube formed of Nitinol or other appropriate material. A mid-section80of the distal anchor70provides a structural transition from the tubular portion72to the tail portion74. As such, a portion of a side wall is removed in the mid-section area80. A further portion of the side wall is removed to define a connector section82of the tail74which extends from the mid-section80. In one embodiment, this connector section82includes a bend that creates the orthogonally or obliquely oriented configuration. This connector section82acts as a barb or deflected strut to cause rotation of the anchor70relative to the suture78after deployment from a delivery tool (creating a “flipping tail”) and produce the relative unconstrained (orthogonally oriented) angle assumed between the tail74and tubular portion72of the anchor70. The recovered shape of the terminal end portion83of the anchor presents a transverse strut that engages tissue when the suture is tensioned.

Thus, in its implanted form (FIG. 1), the anchor assembly can include an anchor70(e.g., first anchor) whose initial engagement with a suture78is generally coaxial, and an anchor84(e.g., second anchor) with an initial engagement being generally perpendicular with the suture78. The anchor70is “unsheathed” from a needle delivery device (not shown) once positioned for reliable deployment An anchor assembly ejected from a terminal end of a delivery device and implanted across a prostate is shown inFIG. 10.

A number of additional embodiments of the slotted anchor are described. It is to be recognized that the previous and below disclosed structures can be used for many applications. However, each of these disclosed embodiments may include structure accomplishing an engagement with a connector without requiring a secondary locking component. Such a secure engagement can be provided by an interference between anchor structure and the connector resulting in deformation of the connector.

Referring now toFIGS. 11-12, an embodiment of a slotted anchor1184having a flattened tubular shape is shown. In this embodiment, the slotted anchor1184has a width in lateral cross-section that is greater than its thickness, as well as tapered prongs1196that meet at a circular slot inception1197after passing inwardly facing protrusions1199and a seating region1198for the suture78. This embodiment lacks a “relief slot” at the slot inception1197(as shown inFIGS. 5-7), but instead has only the above-described circular seating region1198for receiving the suture78.

FIGS. 13-14illustrate an embodiment of a slotted anchor1384having a flattened tubular shape. In this embodiment, the slotted proximal anchor1384has a width in lateral cross-section that is greater than its thickness. The anchor further includes tapered prongs1396that converge towards a circular seating region1398after passing inwardly facing protrusions1399and before reaching a generally U-shaped, more narrowly dimensioned slot inception1397. This embodiment includes a “relief slot” at the slot inception1397for receiving the suture78. Additionally, the relief slot may reduce stress concentration in the anchor when the suture is seated.

Referring now toFIGS. 15-16, an embodiment of a slotted anchor1584also having a flattened tubular shape is shown. In this embodiment, the slotted anchor1584includes tapered prongs1596that converge towards a seating region1598after passing a plurality of inwardly facing serrated protrusions1599and before the slot inception1597. Here, as the serrated region1599tapers towards the seating region1598, the surfaces forming apices of the serrated region have generally equal dimensions. It is also to be recognized that the serrated region1599can also define or embody a portion of a seating region. The serrated region1599can function to lock into and grasp a connector to thereby result in a firm engagement as well as provide a lower surface area for contacting a suture being placed therethrough. The apices of the serrated region cause more deformation than many of the previously discussed surfaces without abrading the suture78.

Another embodiment of a slotted anchor1784having a flattened tubular shape and a serrated region is shown inFIGS. 17-18. In this embodiment, tapered prongs1796converge towards a seating region1798extending from a slot inception1797after passing a serrated region formed by inwardly facing barbed protrusions1799. The barbed protrusions1799of the serrated region are formed by surfaces of different dimensions, thus forming more of a barbed shape. Such a barbed shape is intended to facilitate sufficient gripping forces on a suture78. A slotted proximal anchor1784with a barbed serrated region preferably is used in conjunction with a tougher type of suture78that is resistant to abrasion.

Referring now toFIGS. 19-21, yet a further embodiment of a slotted anchor1984having a tubular shape is shown. In this embodiment, the slotted proximal anchor1984has tapered prongs1996that converge toward inwardly facing protrusions1999adjacent the seating region1998before reaching the slot inception1997. In combination, the angle formed by the tapered prongs, the protrusion and relatively narrow dimension of the seating region cooperate to create a substantial engagement with a connector. Preferably, the protrusions1999cause moderate deformation of the suture78while minimizing abrasion of the suture.

FIGS. 22-23show an embodiment of a slotted anchor2284having a generally rectangular shape and that has been formed by stamping a flat sheet of metal that is folded over at the leading end of the prongs2296to form two layers (only one layer is shown). In this embodiment, the slotted anchor2284has a width in lateral cross-section that is greater than its thickness. The anchor also includes prongs2296that define a tapered convergence before turning parallel towards inwardly facing barbed protrusions2299, one projecting from each prong. The anchor also includes a seating region2298configured adjacent a barbed slot inception2297. The barbed slot inception2297and barbed protrusions2299cooperate to deform and grasp a suture78. Preferably, these barbed protrusions create more point pressure or “bite” into the suture78and therefore is contemplated to be used in conjunction with a tougher type of suture78that is more resistant to abrasion.

Referring now toFIGS. 24-25, there is shown another embodiment of a slotted anchor2484having a generally rectangular portion that has been formed by folding over a flat sheet (only one layer is shown). In this approach, the slotted proximal anchor2484has a width in lateral cross-section that is greater than its thickness transverse to the axis of the suture78, and prongs2496that begin a tapered convergence before turning parallel towards a seating region2498formed at a circular slot inception2497. This circular slot inception2497creates a compression ring to secure the suture78. This type of compression ring tends to deform the suture78without abrading the suture78(i.e., less “bite” into the suture). This embodiment also has expanded width prongs2496. In this manner, the terminal ends of the prongs2496diverge in a manner such that they span a dimension greater than the width of the rectangular portion. Such structure facilitates receiving the connector and guides it to the seating region2498as the anchor2484is moved into engagement with the suture.

As shown inFIGS. 26-28, and as best seen inFIG. 27, another embodiment of a slotted anchor2684has tapered prongs2696that converge toward inward protrusions2699and a seating region2698before reaching the circular slot inception2697. This anchor2684can be formed by stamping or cutting of flat metal stock to produce an elongated member and then folding the member in half. When folded, the pattern formed into the structure defines the inward protrusions2699, seating region2698, and circular slot inception2697. Otherwise stated, in this embodiment, one side of the anchor2684has inward protrusions2699that are an inverted configuration from the inward protrusions2699on the other side of the anchor2684to form structure well suited to grip a connector. This embodiment has an oblong seating region2698for receiving the suture78. After the elongated member is folded, a unitary body may be produced by tack welding or laser welding the anchor2684together. This type of slotted anchor2684is generally easier to manufacture.

Referring now toFIGS. 29-30, another embodiment of a slotted anchor2984formed from a folded member is shown. In this approach, when folded, the slotted proximal anchor2984has a width in lateral cross-section that is greater than its thickness and oppositely tapered prongs2996that converge toward inward protrusions2999and a seating region2998before reaching the slot inception2997. Additionally, in this embodiment one side of the anchor2984has oppositely tapered prongs2996that are an inverted configuration from the other side of the oppositely tapered prongs2996of the anchor2984. This embodiment has an oblong seating region2998for receiving the suture78.

FIGS. 31-33depict an embodiment of a slotted anchor3184having a slit that extends along its top. This anchor is produced using an alternative forming technique, namely the flat sheet is rolled along its length rather than being folded at its ends as described before. Thus, in cross-section the anchor defines a C-shape (SeeFIG. 33). In this embodiment, the slotted anchor3184again has a width in lateral cross-section that is greater than its thickness and includes tapered prongs3196. The prongs3196converge toward inward protrusions3199and continue to a circular seating region3198before reaching the slot inception3197. Additionally, in this embodiment the prongs3196include inwardly facing protrusions at their terminal ends that increase the stiffness of the prongs3196, as well as reducing possible irritation of the surrounding tissue when implanted. If desired, during manufacturing, the anchor3184can be clamped down to close the slit that extends along its length. As described above, a unitary body may be produced by tack welding or laser welding the anchor2984together in some embodiments.

Referring now toFIGS. 34-36, an embodiment of a slotted anchor3484having a slit extending along the outside wall of one of the prongs3496. Here, a cross-section of the anchor3484defines a U shape (SeeFIG. 36). In this embodiment, the slotted anchor3484has a width in lateral cross-section that is greater than its thickness and tapered prongs3496that converge toward inward protrusions3499and a circular seating region3498. The circular seating region3498is configured adjacent a slot inception3497. Additionally, the prongs3496include inwardly facing protrusions at their terminal ends.

In still another embodiment, a slotted anchor3784that is formed from an S-shaped folded member is depicted inFIGS. 37-38. In this embodiment, the slotted anchor3784includes structure forming tapered prongs3796that converge towards a semi-circular seating region3798formed adjacent the slot inception3797. Additionally, in this embodiment the top half of anchor3784has an inverted configuration from the bottom of the anchor3784to create multiple places capable of intersecting with a suture. In this embodiment, the prongs3196generate three layers for gripping the suture. It is within the scope of the present invention to provide multiple layers of engagement with the suture.

Referring now toFIG. 39, an embodiment of a slotted anchor3984is shown. The slotted anchor3984is quite similar to the slotted anchor84shown inFIG. 4, except that the slotted anchor3984ofFIG. 39is substantially square in cross-section. Additionally, the prongs3996of the slotted anchor3984are significantly shorter than the prongs96of the slotted anchor84shown inFIG. 4. This embodiment includes a “relief slot” at the slot inception3997and a seating region3998.

In another embodiment depicted inFIGS. 40-42, a slotted anchor4084incorporates a slit in its top, and is formed into a substantially square shaped member that is folded over on itself towards its center. This “folded over” region produces a greater surface area that is in contact with the suture78, and thus, creates a larger amount of deformation of the suture78and friction against the suture78. In this embodiment, the slotted anchor4084includes a structure forming tapered prongs4096that converge towards protrusions4099and a seating region4098formed adjacent to the slot inception4097.

In yet another embodiment shown inFIGS. 43-45, a slotted anchor4384incorporates a slit in its top, and has one prong4396with a shorter height than the other prong. In this embodiment, the slotted anchor4384includes structure forming tapered prongs4396that converge towards inward protrusions4399and seating region4398formed adjacent the slot inception4397. This anchor's configuration, which incorporates one prong4396with a shorter height than the other prong, creates multiple places at different heights capable of intersecting with a suture78. In this embodiment, the prongs4396generate less distortion of the suture78, but more friction against the suture.

The disclosed embodiments contemplate both pushing directly on anchor portions of an anchor assembly as well as pushing directly upon the connector of the anchor assembly. Further, an anchor assembly can be delivered and deployed at an interventional site by a deployment device. Consequently, in the context of prostate treatment, the disclosed embodiments accomplish both compressing of the prostate gland and the opening of the prostatic urethra and applying tension between ends of the implant. Moreover, drug delivery is contemplated as a further remedy in BPH and over-active bladder treatment.

Once implanted, the anchor assembly of the disclosed embodiments accomplishes desired tissue approximation, manipulation, compression or retraction, as well as cooperates with the target anatomy to provide an atraumatic support structure. In particular, the shape and contour of the anchor assembly can be configured so that the assembly invaginates within target tissue, such as within natural folds formed in the urethra by the opening of the urethra lumen by the anchor assembly. In fact, in situations where the anchor assembly is properly placed, wispy or pillowy tissue in the area collapses around the anchor structure. Eventually, the natural tissue can grow over the anchor assembly, and new cell growth occurs over time. Such cooperation with target tissue facilitates healing and avoids unwanted side effects such as calcification or infection at the interventional site.

Furthermore, in addition to an intention to cooperate with natural tissue anatomy, the disclosed embodiments also contemplate approaches to accelerate healing or induce scarring. Manners in which healing can be promoted can include employing abrasive materials, textured connectors, biologics and drugs.

It has been observed that placing the anchors at various desired positions within the anatomy can extract the best results. For example, when treating a prostate, one portion of an anchor can be placed within a urethra. It has been found that configuring such anchors so that ten o'clock and two o'clock positions (when looking along the axis of the urethra) are supported or retained, effectively holds the anatomy open and also can facilitate invagination of the anchor portion within natural tissue. This is particularly true in the regions of anatomy near the bladder and the juncture at which the ejaculatory duct connects to the urethra.

Moreover, it is to be recognized that the foregoing procedure is reversible. In one approach, the connection of an anchor assembly can be severed and a proximal (or second) anchor component removed from the patient's body. For example, the physician can simply cut the connector and simultaneously remove the second anchor previously implanted for example, in the patient's urethra. It is to be recognized that various materials are contemplated for manufacturing the disclosed devices. Moreover, one or more components such as distal anchor70, proximal anchor84, suture78, of the one or more anchor assemblies disclosed herein may be designed to be completely or partially biodegradable or bio-fragmentable.

Further, as stated, the systems and methods disclosed herein may be used to treat a variety of pathologies in a variety of tubular structures comprising a cavity or a wall. Examples of such organs include, but are not limited to urethra, bowel, stomach, esophagus, trachea, bronchii, bronchial passageways, veins (e.g. for treating varicose veins or valvular insufficiency), arteries, lymphatic vessels, ureters, bladder, cardiac atria or ventricles, uterus, fallopian tubes, and the like.

Finally, it is to be appreciated that the invention has been described hereabove with reference to certain examples or embodiments, but that various additions, deletions, alterations and modifications may be made to those examples and embodiments without departing from the intended spirit and scope of the disclosed embodiments. For example, any element or attribute of one embodiment or example may be incorporated into or used with another embodiment or example, unless to do so would render the embodiment or example unpatentable or unsuitable for its intended use. Also, for example, where the steps of a method are described or listed in a particular order, the order of such steps may be changed unless to do so would render the method unpatentable or unsuitable for its intended use. All reasonable additions, deletions, modifications and alterations are to be considered equivalents of the described examples and embodiments and are to be included within the scope of the following claims.

The various embodiments described above are provided by way of illustration only and should not be construed to limit the disclosed embodiments. Those skilled in the art will readily recognize various modifications and changes that may be made to the disclosed embodiments without following the example embodiments and applications illustrated and described herein, and without departing from the true spirit and scope of the disclosed embodiments, which is set forth in the following claims.