Abstract:
The present invention is directed to an apparatus and its method of use in delivering surgical tissue connectors into an area of the body and removing the surgical tissue connectors from the body area. Svlore specifically, the present invention is directed to a surgical tissue connector apparatus having at least two tissue connectors connected by a length of cord and a delivery and removal tube. At least one of the tissue connectors has a base with a tapered, beveled or chamfered surface projecting from one end of the base. A hook or other type of tissue connector projects from the opposite side of the base. The hook is positioned on the base where a peripheral side surface of the base shields the hook from unintentionally snagging objects. The base peripheral surface is also dimensioned to slide easily through an interior bore of the tube. This enables the base and the projecting hook to be easily delivered through the tube into an area of the body. The chamfered or tapered surface on the base is positioned to engage with the distal end opening of the tube and direct the base into the center of the tube as the surgical tissue connector is retracted info the tube from the body area in removing the apparatus from the abdominal cavity.

Description:
BACKGROUND OF THE INVENTION 
     Field of the Invention 
     The present invention is directed to an apparatus and its method of use in delivering surgical tissue connectors into an area of the body and removing the surgical tissue connectors from the body area. More specifically, the present invention is directed to a surgical tissue connector apparatus having at least two tissue connectors connected by a length of cord and a delivery and removal tube. At least one of the tissue connectors has a base with a tapered, beveled or chamfered surface projecting from one end of the base. A hook or other type of tissue connector projects from the opposite side of the base. The hook is positioned on the base where a peripheral side surface of the base shields the hook from unintentionally snagging objects. The base peripheral surface is also dimensioned to slide easily through an interior bore of the tube. This enables the base and the projecting hook to be easily delivered through the tube into an area of the body. The chamfered or tapered surface on the base is positioned to engage with the distal end opening of the tube and direct the base into the center of the tube as the surgical tissue connector is retracted into the tube from the body area in removing the apparatus from the abdominal cavity. 
     Description of the Related Art 
     In laparoscopic surgery procedures, it is often necessary to pass surgical tissue connectors though a cannula, trocar, endosope or other similar device that is positioned through an incision in the body to deliver the tissue connectors into an area of the body where the connectors are used in a laparoscopic surgery procedure. A disadvantage associated with the current constructions of surgical tissue connectors and the tubular delivery device used to deliver the connectors into the body and then remove the connectors from the body is that often the connectors will snag or catch a portion of the tubular delivery device being used to deliver or retrieve the connectors. 
     SUMMARY OF THE INVENTION 
     The present invention overcomes the above described disadvantages associated with tissue connectors used in laparoscopic and other surgery procedures by providing an apparatus that facilitates the delivery of a surgical tissue connector through a tubular delivery device and into the body, and the subsequent removal of the surgical tissue connector through the tubular device from the body. 
     The basic construction of the apparatus of the invention includes at least two surgical tissue connectors. Each tissue connector has a base. The base has a side surface that extends around the base, and a distal end surface and proximal end surface at the opposite ends of the side surface. In one embodiment of the tissue connector, the base side surface is a cylindrical surface having a center axis that defines mutually perpendicular axial and radial directions relative to the base. 
     A hook is secured stationary to and projects axially from the base distal end surface. The hook has a shank portion that extends axially from the base distal end surface. The shank portion is substantially parallel with the base center axis but spaced radially from the center axis. The hook also has a bent portion that extends from the shank portion across the base distal end surface and through the center axis to a distal end tip of the hook. The end tip and the shank are radially spaced on opposite sides of the base center axis and the end tip does not project radially beyond the base side surface. Thereby, the base side surface shields the end tip of the hook from snagging or catching with other objects. 
     The base proximal end surface of at least one of the connectors has a chamfered or tapered configuration that tapers as the proximal end surface extends axially away from the base side surface. In one embodiment of the apparatus, the base proximal end surface has a conical configuration. The conical configuration of the base proximal end surface extends axially from the base side surface to an apex that is centered on the base distal end surface. 
     The apparatus also includes a length of cord that extends between the proximal end surfaces of the tissue connectors. In one embodiment of the apparatus, the length of the cord extending between the tissue connectors is flexible and can be adjusted. 
     The apparatus also includes a tissue connector delivery and removal tube. In one embodiment of the apparatus, the tube has a straight length with opposite proximal and distal ends, and a cylindrical interior bore that extends through the length of the tube. The interior bore has an interior diameter dimension that is slightly larger than an exterior diameter dimension of the base cylindrical side surface. This enables the tissue connectors to easily slide through the interior bore of the tube then delivering the tissue connectors through the tube, or removing the tissue connector through the tube. Additionally, the tapered configuration of the base proximal end surface of at least one of the tissue connectors enables that tissue connector to be easily pulled into the tube at the tube distal end. Removing the apparatus by pulling the other tissue connector through the tube distal end and then pulling the cord and the tapered tissue connector into the tube causes the tapered configuration of the base proximal end surface to first enter the end of the tube, whereby the tapered configuration centers the base cylindrical side surface relative to the tube interior bore as the tapered proximal end surface is pulled into the tube interior bore. With the base side surface centered in the tube interior bore, the hook projecting from the base distal end surface is prevented from snagging or catching the distal end of the tube as the tissue connector is pulled into and through the tube. 
     The apparatus also includes a rod having a straight length that is dimensioned to be inserted into the tube proximal end to push the tissue connectors and their connecting cord through the tube interior bore to deliver the tissue connectors and the connecting cord from the tube distal end. 
     When use of the apparatus in the surgical procedure is complete, the apparatus can be easily removed from the body by inserting the tube through a cannula or an incision to position the tube distal end adjacent the connectors and the cord, and then inserting a surgical grasper through the tube and grasping the tissue connector without the tapered end surface. The tissue connector is grasped at its hook. Retracting the grasper back through the tube will move the grasped connector into the tube and then pull the cord into the tube interior bore. As the cord is pulled through the tube bore it pulls the tapered proximal end surfaces of the other tissue connectors into the bore. The tapered proximal end surface of the connector will center the connector and the cylindrical side surface of the connector relative to the interior bore as the connector enters the tube distal end and passes through the interior bore. The cylindrical side surface of the connector prevents the hook extending from the distal end surface of the connector from snagging or catching against the tube distal end as the connector enters into and passes through the tube interior bore. 
     As described above, the apparatus of the invention and its method of use facilitate the delivery of surgical tissue connectors to a surgery site and facilitate the removal of the surgical tissue connectors from the surgery site. 
    
    
     
       DESCRIPTION OF THE DRAWINGS 
       Further features of the apparatus of the invention and its method of use are set forth in the following detailed description of the apparatus and method and are shown in the drawing figures. 
         FIGS. 1 a  and 1 b    show an embodiment of the apparatus comprising a pair of tissue connectors connected by a cord where one of the tissue connectors employs a releasable one-way cord lock that enables adjusting the length of the portion of the cord extending between the pair of tissue connectors. 
         FIGS. 2 a  and 2 b    show further embodiments of the apparatus similar to that of  FIGS. 1 a    and  1   b.    
         FIG. 3  is a perspective view of one of the tissue connectors. 
         FIG. 4  is a plan view of the tissue connector of  FIG. 3 . 
         FIGS. 5 a  and 5 b    illustrate the assembly of the tissue connector of  FIG. 3 . 
         FIG. 6  is a perspective view of a further embodiment of a tissue connector. 
         FIG. 7  is a plan view of the tissue connector of  FIG. 6 . 
         FIGS. 8 a  and 8 b    illustrate the assembly of the tissue connector of  FIG. 6 . 
         FIG. 9  is a perspective view of a further embodiment of a tissue connector. 
         FIG. 10  is a side view of the tissue connector of  FIG. 9 . 
         FIG. 11  is cross-section view of the tissue connector of  FIG. 9 . 
         FIG. 12  is a perspective view of the disassembled component parts of the tissue connector of  FIG. 9 . 
         FIG. 13  is a cross-section view of the delivery and removal tube of the apparatus. 
         FIG. 14  is an end view of the proximal end of the delivery and removal tube. 
         FIG. 15  is a side view of the delivery rod of the apparatus. 
         FIG. 16  is a partial sectioned view of the apparatus illustrating the method of removing a tissue connector of the apparatus from an abdominal cavity using the delivery and removal tube of the apparatus. 
         FIG. 17  is a partial sectioned view of the apparatus further illustrating the method of removing a tissue connector of the apparatus from an abdominal cavity using the delivery and removal tube of the apparatus. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       FIGS. 1A and 1B  show an embodiment of the tissue connector apparatus of the invention that is constructed to facilitate the delivery of the tissue connectors through a cannula or other type of tubular delivery device to a surgical site of a body for use in a laparoscopic surgery or other type of surgical procedure, and facilitate the removal of the tissue connectors of the apparatus following completion of the procedure. As is conventional with laparoscopic apparatus, the component parts of the apparatus are dimensioned to be inserted through an incision or through a cannula, trocar, endoscope or other type of tubular delivery device extending into the body to position the apparatus at a surgery site. All of the component parts of the apparatus to be described are constructed of biocompatible materials. 
     The first embodiment of the apparatus is shown in  FIGS. 1 a  and 1 b   . The embodiment shown is basically comprised of a first tissue connector  12 , a second tissue connector  14  and a length of cord  16  extending between and connecting the two tissue connectors. The cord could be a suture, IV tubing or other equivalent types of cord and could be one piece or several pieces connected together. 
     Details of the construction of the first tissue connector  12  are shown in  FIGS. 3, 4, 5   a  and  5   b . The first tissue connector  12  is comprised of a base  18  and a hook  22 . The base  18  for the most part is a solid single piece of material having a side exterior surface that extends completely around the base. In the embodiment shown in the drawing figures, the side surface  24  is cylindrical. The cylindrical surface  24  has a center axis  26  that defines mutually perpendicular axial and radial directions relative to the base. The base also has a proximal end surface  28  at one axial end of the base and a distal end surface  30  at an opposite axial end of the base. 
     The proximal end surface  28  is chamfered or tapers as it extends axially away from the base side surface  24 . In the embodiment shown, the proximal end surface  28  has a conical configuration with a circular peripheral edge  32  defined by the intersection of the proximal end surface with the cylindrical base side surface  24 . The proximal end surface  28  tapers as it extends axially from the base side surface  24  to an apex end  34  of the proximal end surface. 
     The base distal end surface  30  is substantially flat. The distal end surface  30  has a circular peripheral edge  36  defined by the intersection of the distal end surface with the cylindrical base side surface  24 . 
     A hook hole  38  is formed in the base distal end surface  30 . The hook hole  38  is spaced radially inwardly from the distal end surface peripheral edge  36  and radially from the center axis  26 . The hook hole extends axially into the base a short distance from the distal end surface  30  and does not extend entirely through the base. A center hole  42  is also formed in the base at the center of the base distal end surface  30 . The center hole  42  extends axially through the base and emerges at the apex  34  of the base proximal end surface  28 . The center hole  42  has a slightly larger interior diameter dimension adjacent the base distal end surface  30  than the interior diameter dimension of the hole  42  adjacent the apex  34  of the base proximal end surface  28 . 
     The hook  22  has a straight shank portion  44  extending from a proximal end  46  of the hook. The hook shank portion adjacent the hook proximal end  46  is dimensioned with a cylindrical exterior surface that fits tightly into the hook hole  38  in the base distal end surface  30 . The hook shank portion  34  is secured stationary to the base by laser welding or other equivalent means. The hook  22  is secured to the base distal end surface  32  with the hook shank portion  34  extending axially from the distal end surface  32  substantially parallel with the center axis  26 , but radially spaced from the center axis. The hook shank portion  44  extending from the distal end surface  30  has a square or other similar cross-section configuration to facilitate grasping the hook with a surgical grasper and preventing the hook shank from rotating in the grasper. The shank portion  44  extends axially from the base distal end surface  30  to a bent portion  48  of the hook that extends radially across the distal end surface  30 , through the base center axis  26  and to a distal end tip  52  of the hook. The distal end tip  52  and shank portion  44  of the hook are each radially spaced on opposite sides of the base center axis. The shank portion  44  and end tip  52  are both spaced a radial distance dimension on opposite sides of the center axis  26  that is smaller than the base radius dimension, whereby the hook bent portion and tip do not project radially beyond the cylindrical side surface of the base. Although the hook  22  is shown as the part of the tissue connector  12  that is removably attachable to body tissue, other equivalent devices that do not project radially beyond the side surface of the base could be used. 
     In the embodiment of the apparatus shown in  FIGS. 1 a  and 1 b   , the cord  16  has a flexible length with opposite first  54  and second  56  ends. The cord first end  54  passes through the center hole  42  of the first tissue connector  12  from the proximal end surface  28  to the distal end surface  30 . A knot  58  is tied in the cord first end  54 . A medical grade glue, for example cyanoacrylate is applied to the knot. The cord is pulled from the base proximal end surface  28  to pull the knot  58  into the center hole  42  in the base distal end surface  30 . The knot  56  is too large to pass though the smaller portion of the center hole  42  that emerges from the apex  34  of the proximal end surface  28 . Thereby, the cord first end  54  is secured to the first tissue connector  12  with the cord extending from the base proximal end surface  28  of the tissue connector. 
       FIGS. 6, 7, 8   a  and  8   b  show an alternate embodiment of the first tissue connector where a post  62  of an eyelet ring  64  is inserted through the base center hole  42  from the base proximal end surface  28 . The post  62  is secured to the base by laser welding the end of the post  62  in the center hole at the base distal end surface  32 . The eyelet ring  64  could be secured to the base by other equivalent means. The first end  54  of the cord  16  is then secured to the eyelet  64  by a knot being tied in the cord around the eyelet ring  64  and the knot being secured by a medical grade glue. 
     Details of the construction of the second tissue connector  14  are shown in  FIGS. 9, 10, 11 and 12 . 
     The second tissue connector  14  is also basically comprised of a base  68  and a hook  72  projecting from the base. The base  68  has a side surface  74  that extends completely around the base. The in embodiment shown in the drawing figures the side surface  74  is cylindrical and has a center axis  76  that defines mutually perpendicular axial and radial directions relative to the base  68 . The base  68  also has a proximal end surface  78  at one axial end of the base and a distal end surface  80  at the opposite axial end of the base. 
     The base proximal end surface  78  is chamfered or tapers as it extends axially away from the cylindrical side surface  74 . In the embodiment of the second tissue connector  68  shown, the base proximal end surface  78  has a conical configuration with a circular peripheral edge  82  defined by the intersection of the proximal end surface  78  with the cylindrical base side surface  74 . The proximal end surface  78  tapers as it extends from the cylindrical side surface  74  to an apex  84  on the proximal end surface. A hole  86  passes through the center of the apex  84  of the proximal end surface  78  to an interior bore of the base that is described later. 
     The base distal end surface  80  is substantially flat. The distal end surface  80  has a circular peripheral edge  88  defined by the intersection of the distal end surface  80  and the cylindrical base side surface  74 . 
     A hook hole  92  is formed in the base distal end surface  80 . The hook hole  92  is spaced radially inwardly from the distal end surface peripheral edge  88  and radially from the center axis  76 . The hook hole  92  extends axially into the base a short distance from the distal end surface  80  and does not extend entirely through the base. 
     The hook  72  of the second tissue connector  14  has substantially the same construction as the hook  22  of the first tissue connector  12 . The hook  72  has a straight shank portion  94  extending from a proximal end  96  of the hook. Adjacent the proximal end  96  the hook shank portion has a cylindrical configuration dimensioned to fit tightly into the hook hole  88  on the distal end surface  80 . The hook shank portion  94  is secured to the base distal end surface  80  by laser welding or other equivalent means. The hook shank portion  94  extends axially from the base distal end surface  80  substantially parallel with the base center axis  76  but spaced radially from the center axis. The shank portion  94  extending from the distal end surface  80  has a square or other similar cross-section configuration that facilitates grasping the shank portion with surgical graspers and preventing rotation of the shank portion in the graspers. The hook shank portion  94  extends axially from the base to a bent portion  98  of the hook that extends radially over the base distal end surface  80  and through the base center axis  76 . The hook bent portion  98  extends from the shank portion  94  to a distal end tip  100  of the hook. The hook distal end tip  100  and shank portion  94  are both spaced a radial distance dimension on opposite sides of the center axis  76  that is smaller than the base radius dimension, whereby the hook bent portion and the distal end tip  100  do not project radially beyond the cylindrical side surface  74  of the base. Although the hook  72  is shown as the part of the tissue connector that is removably attachable to body tissue, other equivalent devices that do not project radially beyond the side surface of the base could be used. Additionally, although both tissue connectors  12 ,  14  are described as having chamfered or tapered surfaces  28 ,  78 , it is not necessary that both have tapered surfaces for the intended functioning of the apparatus. 
     Although the first  12  and second  14  tissue connectors have similar constructions as discussed above, the second tissue connector  14  is constructed with a releasable one-way cord lock that enables the length of the portion of the cord  16  extending between the two tissue connectors  12 ,  14  to be adjusted. 
     The second tissue connector base  68  has a tubular configuration with a cylindrical housing wall having the base cylindrical side surface  74  on its exterior, and a hollow interior bore  102  extending through the length of the housing wall interior. 
     A disk shaped cap  104  is secured to a distal end of the base housing wall by laser welding or other equivalent means. The disk-shaped cap  104  defines the distal and surface  80  of the base. 
     A rod or pin  106  is secured to the base  68  in the base interior bore  102 . The rod  106  extends radially across the base interior bore  102  adjacent the proximal end surface  78  of the base. Opposite ends of the rod  106  are secured to the interior surface of the base cylindrical housing. 
     The cord  6  is secured to the second tissue connector  14  inside the base interior bore  102 . The second end  56  of the cord  16  extends through the center hole  86  in the apex of the base proximal end surface  78  and into the hollow interior bore  102  of the base. An intermediate portion of the cord  112  is wrapped around the rod  106  in the base interior, thereby attaching the cord  16  to the second tissue connector  14 . The intermediate portion of the cord  112  is wrapped around the rod  106  by being tied in a knot around the rod. The preferred knot  112  is a Blunter hitch knot. A first portion  114  of the cord length extends from the intermediate portion  112  though the base center hole  86 . The cord first portion  114  extends from the proximal end surface  78  of the base to the cord first end  54  attached to the first tissue connector  12 . A second portion of the cord length  116  extends from the cord intermediate portion  112  through a side hole  118  in the base cylindrical side surface  74  and the proximal end surface  78 . The side hole  118  is provided to separate the cord first portion  114  and the cord second portion  116  to prevent tangling. The side hole  118  also allows for a greater angle that the cord second portion  116  can be pulled from the connector. The second portion of the cord  116  extends from second tissue connector  14  to a second, free end  122  of a cord. 
     The releasable one-way cord lock is comprised of a pair slots  124  that are formed in radially opposite sides of the cylindrical side wall of the base  68 . As seen in the drawing figures, the slots  124  extend axially along a portion of the cylindrical wall of the base  68  and are positioned radially to one side of the base center axis  76 . A lock pin  126  is positioned in the slots  124  and extends from one slot  124  across the interior bore of the base  68  to the other slot. The lock pin  126  slides axially along the slots  124 . 
     An actuator  128  is mounted on the base cylindrical side surface  74  and is connected to the lock pin  126  inside the base. The actuator  128  is formed as cylindrical sleeve that surrounds the base cylindrical side surface  74 . The actuator  128  is mounted on the cylindrical side surface  74  of the base  68  for axially reciprocating movements between first and second positions of the actuator  128  relative to the base  68 . The opposite ends of the lock pin  126  project beyond the slots  124  in the base cylindrical side surface  74  and are secured in opposite sides of the actuator  128 . Moving the actuator  128  to its first position shown in  FIG. 11  causes the lock pin  126  to engage against the cord intermediate portion  112  that is wrapped around the rod  106 . In  FIG. 11 , the pin  126  prevents the knot  112  from rotating counterclockwise around the rod  106  when the knot  112  is in a 3 o&#39;clock position, or to the right of the rod as shown in  FIG. 11  and the cord first portion  114  is pulled. The engagement of the lock pin  126  against the cord intermediate portion or knot  112  locks the cord and prevents the first portion of the cord length  114  from being pulled from the proximal end surface  78  of the second tissue connector  14 . However, in the position of the knot  112  shown in  FIG. 11  the cord second portion  116  can be pulled from the second tissue connector  14  to shorten the length of the cord first portion  114 , but the cord first portion  114  cannot be pulled from the connector. Moving the actuator  128  to its second position causes the lock pin  126  to disengage from the cord intermediate portion or knot  112 . With the pin  126  moved upward, the cord first portion  114  can be pulled to move the knot  112  counterclockwise from the 3 o&#39;clock position to a 6 o&#39;clock position as viewed in  FIG. 11 . This allows the length of the cord first portion  114  extending between the second tissue connector  14  and the first tissue connector  12  to be pulled from the second tissue connector  14  to adjust or increase the length of the cord first portion  114 . With the pin  126  moved upward the cord second portion  116  can also be pulled from the connector. 
     A biasing device  132  urges the lock pin  126  to its first position shown in  FIG. 11 . In the drawing figures the biasing device  132  is coiled spring. Other equivalent types of biasing devices could be employed. 
     The slot  124  and the pin  126  are off center relative to the base cylindrical side surface  74  to facilitate the knot  112  pushing the pin  126  upward against the bias of the spring  132  when the cord second portion  116  is pulled and the knot  112  moves clockwise from the 6 o&#39;clock position to the 3 o&#39;clock position relative to the rod  106 . 
     Tissue connectors having one way cord locks such as that described above are disclosed in the currently pending international patent application No. PCT/US2011/01494 which is assigned to the assignee of this invention and is incorporated herein by reference. 
       FIG. 2 a    shows a further embodiment of the apparatus of the invention comprising the first tissue connector  12  and the second tissue connector  14  connected by the length of cord  16 . However, the first end of the length of cord  16  is connected to the first tissue connector  12  having the eyelet ring  64  that was described earlier. In addition, a second length of cord  134  connects a third tissue connector  136  to the first tissue connector  12 . The construction of the third tissue connector  136  is substantially the same as that of the second tissue connector  14  described earlier. In the embodiment of  FIG. 2A , at least two of the three tissue connectors would require tapered proximal end surfaces in order for the apparatus to function as intending in removing the apparatus from a surgical site as described be low. 
       FIG. 2B  shows a still further embodiment of the apparatus where the tissue connector hook  72  or other equivalent device is not directly connected to the base  68  of the second tissue connector  14 , but is connected by a further length of suture  138 . 
     The apparatus of the invention also comprises a tissue connector deliver and removal tube  142  shown in  FIGS. 13 and 14 , and a delivery rod  144  shown in  FIG. 15 . 
     In one embodiment of the apparatus, the tube  142  has a straight length with opposite proximal  146  and distal  148  ends. An interior bore having a smooth cylindrical interior surface  152  extends through the length of the tube. The cylindrical interior surface  152  has an interior diameter dimension that is just slightly larger than the exterior diameter dimension of the first tissue connector base cylindrical side surface  24  and the second tissue connector base cylindrical side surface  74 . This enables the tissue connectors  12 ,  14  to easily slide through the interior bore of the tube when delivering the tissue connectors through the tube, or removing the tissue connectors through the tube. 
     The delivery rod  144  has a straight length that is dimensioned to be inserted into the tube proximal end  146  to push the tissue connectors  12 ,  14  and the connecting cord  16  through the tube interior bore to deliver the tissue connectors and the connecting cord from the tube distal end  142  and to a surgical site in a body. 
     Additionally, the tapered configuration of the base proximal end surface  28  of the first tissue connector  12  and the tapered configuration of the base proximal end surface  78  of the second tissue connector  14  enables the tissue connectors to be easily pulled into the interior bore of the tube  42  at the tube distal end  148 . However, it is only necessary that one tissue connector  12  have a tapered proximal end surface in a two connector embodiment of the apparatus such as that shown in  FIGS. 1A and 1B . When it is desired to remove the tissue connectors  12 ,  14  from a surgical site in an area of the body, the tube distal end  142  is positioned in the area by inserting the distal end through a cannula or through an incision to position the tube distal end  148  at the surgical site. An instrument, for example a surgical grasper is then inserted through the tube  142  until it emerges from the tube distal end  148 . The surgical grasper then grasps the second tissue connector  14  at the hook  72 . The surgical grasper is then removed through the tube  142  moving the second connector  14  hook first into the tube distal end and pulling the cord into the tube distal end  142 . The cord  16  is then continued to be pulled through the tube until the tapered configuration of the base proximal end surface  28  of the first tissue connector  12  is pulled into the tube distal end  148 . The tapered configuration of the proximal end surface  28  centers the base cylindrical side surface  24  of the first tissue connector  12  relative the tube interior bore as the tapered proximal end surface is pulled into the tube interior bore. With the base cylindrical side surface  24  centered in the interior bore of the tube  142 , the hook  22  projecting from the base distal end surface  30  is prevented from snagging or catching the distal end  148  of the tube  142  as the first tissue connector is pulled into an through the tube. 
     Thus, as described above, the apparatus of the invention and its method of use facilitate the delivery of surgical tissue connectors to a laparoscopic surgical site and facilitate the removal of the surgical connectors from the surgical site. 
     As various modifications could be made in the apparatus herein described and illustrated and its method of use without departing from the scope of the invention, it is intended that all the matter contained in the foregoing description or shown in the accompanying drawings shall be interpreted as illustrative rather than limiting. Thus, the breath and scope of the present invention should not be limited by any of the above described exemplary embodiments, but should be defined only in accordance with the following claims appended hereto and their equivalents.