Abstract:
A surgical tack applier comprising a handle assembly, an inner tube, a plurality of fasteners and a solution is disclosed. The handle assembly includes an actuator associated therewith. The inner tube extends distally from the handle assembly and defines a longitudinal axis. The inner tube is rotatable about the longitudinal axis. The plurality of fasteners are disposed at least partially within the inner tube and are selectively ejectable therefrom. The solution is disposed within the inner tube and is dispensable through a distal opening of the inner tube.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a Divisional of U.S. patent application Ser. No. 13/835,223 filed Mar. 15, 2013, the disclosure of the above-identified application is hereby incorporated by reference in its entirety. 
     
    
     BACKGROUND 
       [0002]    1. Technical Field 
         [0003]    The present disclosure relates to a surgical instrument for dispensing tacks and a solution. More particularly, the present disclosure relates to a tacker instrument for use in applying surgical fasteners through a prosthetic mesh and into tissue and for dispensing a solution adjacent at least some of the tacks. 
         [0004]    2. Background of Related Art 
         [0005]    Various surgical procedures require instruments capable of applying fasteners to tissue to form tissue connections or to secure objects to tissue. For example, during hernia repair procedures it is often desirable to fasten a mesh to body tissue. In certain hernias, such as direct or indirect inguinal hernias, a part of the intestine protrudes through a defect in the abdominal wall to form a hernial sac. The defect may be repaired using an open surgery procedure in which a relatively large incision is made and the hernia is closed off outside the abdominal wall by suturing. The mesh is attached with sutures over the opening to provide reinforcement. 
         [0006]    Less invasive surgical procedures are currently available to repair a hernia. For example, in laparoscopic procedures, the hernia repair surgery is performed through a small incision in the abdomen while in endoscopic procedures, the hernia repair surgery is performed through narrow endoscopic tubes or cannulas inserted through small incisions in the body. Laparoscopic and endoscopic procedures generally require the use of long and narrow surgical instruments capable of reaching deep within the body and configured to seal with the incision or tube they are inserted through. Additionally, the instruments must be capable of being actuated remotely, that is, from outside the body. 
         [0007]    Currently, endoscopic techniques for hernia repair utilize fasteners, such as, surgical staples or clips, to secure the mesh to the tissue to provide reinforcement in the repair and structure for encouraging tissue regrowth. The staples or clips are compressed against the tissue and mesh to secure the two together. 
         [0008]    One other type of fastener suited for use in affixing mesh to tissue, during procedures such as hernia repair, is a coil fastener having a helically coiled body portion terminating in a tissue penetrating tip or a hollow screw type fastener having an external thread. Unique instruments have been developed to rotate these fasteners into tissue. Examples of some of these types of surgical fasteners and surgical instruments are disclosed in U.S. Pat. Nos. 5,258,000 and 5,830,221, the contents of which are incorporated by reference herein. 
         [0009]    In hernia repair surgery, e.g., ingunal or ventral hernia repair, adhesion may occur between the tissue and the fastener. Accordingly, the present disclosure relates to a solution, e.g., a collagen-based paste, that can be applied from the same tube where the fasteners are ejected from, to or adjacent at least some of the ejected fasteners to help minimize adhesion between the fastener and the tissue. 
       SUMMARY 
       [0010]    The present disclosure relates to a surgical tack applier comprising a handle assembly, an inner tube, a plurality of fasteners and a solution. The handle assembly includes an actuator associated therewith. The inner tube extends distally from the handle assembly and defines a longitudinal axis. The inner tube is rotatable about the longitudinal axis. The plurality of fasteners are disposed at least partially within the inner tube and are selectively ejectable therefrom. The solution is disposed within the inner tube and is dispensable through a distal opening of the inner tube. 
         [0011]    In disclosed embodiments, the solution is configured to minimize adhesion between a patient&#39;s tissue and the plurality of fasteners. 
         [0012]    In disclosed embodiments, the solution is selected from the group consisting of a paste, a collagen-based paste, and porcine dermal collagen. Here, it is disclosed that the solution is stored completely within the inner tube. It is further disclosed that the solution is disposed proximally of each of the plurality of fasteners. It is further disclosed that the solution is disposed in contact with each of the plurality of fasteners. It is further disclosed that the entirety of the solution is disposed within the inner tube and proximally of a proximal-most fastener. Here, it is disclosed that the solution is disposed within an ampoule, and wherein the ampoule is disposed completely within the inner tube. 
         [0013]    In disclosed that the solution is stored within a plurality of pouches. It is further disclosed that each of the plurality of pouches may be disposed on a portion of an individual anchor. 
         [0014]    The present disclosure also relates to a method of applying fasteners to tissue. The method comprises the step of providing a surgical tack applier. The surgical tack applier comprises a handle assembly including an actuator associated therewith, an inner tube extending distally from the handle assembly, defining a longitudinal axis, and being rotatable about the longitudinal axis, a plurality of fasteners disposed at least partially within the inner tube, and a solution disposed within the inner tube. The method also comprises the steps of selectively ejecting at least one of the plurality of fasteners from a distal opening of the inner tube, and dispensing the solution from within the inner tube through the distal opening of the inner tube. 
         [0015]    In disclosed embodiments of the method, the solution is selected from the group consisting of a paste, a collagen-based paste and a porcine dermal collagen. Here, it is disclosed that the solution is disposed in a plurality of pouches, and the method further comprises the step of rupturing at least one pouch. It is further disclosed that the entirety of the solution is disposed in an ampoule disposed proximally of a proximal-most anchor, and the method further comprises the step of rupturing the ampoule. It is further disclosed that the step of dispensing the solution from within the inner tube is performed after all of the anchors have been ejected from the inner tube. It is further disclosed that the step of dispensing the solution from within the inner tube is performed while at least one anchor is within the inner tube. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0016]    Embodiments of the present disclosure are described herein with reference to the accompanying drawings, wherein: 
           [0017]      FIG. 1  is a perspective view of a surgical tacker instrument in accordance with embodiments of the present disclosure; 
           [0018]      FIG. 2  is a perspective, assembly view of the surgical tacker instrument shown in  FIG. 1 ; 
           [0019]      FIG. 2 a    is an enlarged view of the area of detail indicated in  FIG. 2 ; 
           [0020]      FIG. 3  is a perspective, assembly view of an anchor retaining/advancing assembly of the surgical tacker instrument of  FIG. 1 ; 
           [0021]      FIG. 4  is an enlarged view of the area of detail indicated in  FIG. 3 ; 
           [0022]      FIG. 5  is a cross-sectional view of a portion of the anchor retaining/advancing assembly taken along line  5 - 5  in  FIG. 1 ; 
           [0023]      FIG. 6  is a cross-sectional view of a portion of the anchor retaining/advancing assembly taken along line  6 - 6  in  FIG. 1 ; 
           [0024]      FIG. 7  is an in-situ view of the surgical tacker instrument of the present disclosure applying anchors to mesh and tissue; 
           [0025]      FIG. 8  is an enlarged view of the area of detail indicated in  FIG. 7  and further includes a partial cut-away view of a distal portion of the anchor retaining/advancing assembly; 
           [0026]      FIG. 9  is a perspective, assembly view of another surgical tacker instrument in accordance with the present disclosure; 
           [0027]      FIGS. 10-14  illustrate various features of the surgical tacker instrument of  FIG. 9 ; 
           [0028]      FIGS. 15-18  illustrate various views of an anchor for use in the surgical tacker instrument of  FIGS. 1 and 9 ; 
           [0029]      FIG. 18A  illustrates an anchor including a solution disposed adjacent a distal surface of a head section; and 
           [0030]      FIGS. 19-21  illustrate various embodiments of the surgical tacker instrument of  FIGS. 1 and 9  including a solution therein. 
       
    
    
     DETAILED DESCRIPTION OF EMBODIMENTS 
       [0031]    Embodiments of the presently disclosed surgical systems, apparatuses and/or devices are described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views. As used herein the term “distal” refers to portions of the system, apparatus and/or device, or component thereof, that are farther from the user, while the term “proximal” refers to portions of the system, apparatus and/or device, or component thereof, that are closer to the user. 
         [0032]    Referring to  FIG. 1 , a tacking instrument or tacker  200 , for use in installing surgical fasteners in tissue is disclosed. Tacker  200  generally includes a handle assembly  210  and an anchor retaining/advancing assembly  230  extending from handle assembly  210  and configured to store and selectively release or fire a plurality of fasteners or anchors  100  therefrom. 
         [0033]    As shown in  FIGS. 1, 2 and 7 , handle assembly  210  includes a handle housing  212  pivotably supporting a trigger  214 . With specific reference to  FIG. 2 , trigger  214  defines a gear rack  214   a  formed thereon for operative engagement with a pinion gear  216  rotatably supported in handle housing  212 . In disclosed embodiments, gear rack  214   a  and pinion gear  216  are dimensioned such that one complete squeeze of trigger  214  results in one complete revolution of pinion gear  216 . As shown in  FIG. 2 a   , pinion gear  216  includes an arm  216   a  extending radially therefrom and a cam or ramp  216   b  extending from arm  216   a.  Cam  216   b  includes a front end  216   c  having a height and tail end  216   d  tapering into arm  216   a.    
         [0034]    Handle assembly  210  further includes a bevel gear  218  operatively engaged with pinion gear  216 . Bevel gear  218  defines an arcuate slot  218   a  formed therein for selectively receiving and engaging cam  216   b  of pinion gear  216 . Slot  218   a  includes a front end wall  218   b  configured to engage front end  216   c  of cam  216   b  of pinion gear  216 . 
         [0035]    In use, as pinion gear  216  is rotated, upon the squeezing or actuation of trigger  214 , front end  216   c  of cam  216   b  of pinion gear  216  engages front end wall  218   a  of slot  218   b  of bevel gear  218  resulting in concomitant rotation of bevel gear  218 . Upon the completion of the actuation of trigger  214  and release thereof, pinion gear  216  rotates in an opposite direction and rear end  216   d  of cam  216   b  thereof cams out of slot  218   b  of bevel gear  218  and along a surface thereof. In disclosed embodiments, pinion gear  216  makes a complete revolution until front end  216   c  of cam  216   b  of pinion gear  216  re-engages or clears front end wall  218   a  of slot  218   b  of bevel gear  218 . As such, cam  216   b  of pinion gear  216  re-enters slot  218   b  of bevel gear  218 . Bevel gear  218  is maintained from rotating in an opposite direction, upon the opposite direction rotation of pinion gear  216 , due to a coefficient of static friction between bevel gear  218  and a surface of handle housing  212  or an axis upon which bevel gear  218  is supported which will tend to maintain bevel gear  218  stationary. 
         [0036]    With reference to  FIGS. 2 and 3 , handle assembly  210  further includes a pinion-bevel gear  220  having gear teeth  220   a  operatively engaged with gear teeth  218   c  formed on front end wall  218   a  of bevel gear  218 . Pinion-bevel gear  220  is pinned to a proximal end of an inner tube  238  of anchor retaining/advancing assembly  230 . 
         [0037]    In use, as described above, upon squeezing of trigger  214 , rotation of gear rack  214   a  causes pinion gear  216  to rotate. Rotation of pinion gear  216  results in rotation of bevel gear  218  and, in turn, rotation of pinion-bevel gear  220  and rotation of anchor retaining/advancing assembly  230 . 
         [0038]    Referring now to  FIGS. 3-6 , anchor retaining/advancing assembly  230  includes an outer tube  232  secured to and extending from handle housing  212 , a stiffener tube  234  concentrically disposed within outer tube  232 , a spiral or coil  236  fixedly disposed within stiffener tube  234  at a location proximate a distal end thereof, and an inner tube  238  rotatably disposed within coil  236 . 
         [0039]    Inner tube  238  includes a proximal end portion  240  and a distal end portion  242 . Proximal end portion  240  of inner tube  238  extends into handle housing  212  and is secured to pinion-bevel gear  220  by a pin  222 . Distal end portion  242  of inner tube  238  is slotted, defining a pair of tines  242   a  and a pair of channels  242   b.  Distal end portion  242  of inner tube  238  is capable of accepting a plurality of anchors  100  within inner tube  238 . In particular, and with additional reference to  FIG. 4 , anchors  100  are loaded into anchor retaining/advancing assembly  230  such that the pair of opposing threaded sections  112   a,    112   b  of anchors  100  extend through channels  242   b  of distal end portion  242  of inner tube  238  and are slidably disposed within the groove of coil  236 , and the pair of tines  242   a  of distal end portion  242  of inner tube  238  are disposed within the pair of slotted sections  116  of anchors  100 . It is envisioned that each anchor  100  is loaded into anchor retaining/advancing assembly  230  such that adjacent anchors  100  are not in contact with one another so as to not damage distal tips  136  thereof. 
         [0040]    In operation, as inner tube  238  is rotated about its longitudinal axis, with respect to coil  236 , the pair of tines  242   a  of inner tube  238  transmits the rotation to anchors  100  and advances anchors  100  distally due to head threads  114   a,    114   b  of anchors  100  engaging with coil  236 . 
         [0041]    It is envisioned that coil  236  includes twenty-four threads per inch, and the overall length of each anchor  100  is between about 0.1 inches and about 0.3 inches (e.g., approximately equal to 0.203 inches). In such an embodiment, five full turns of inner tube  238  results in anchor  100  being advanced the approximate length of anchor (e.g., 0.203 inches). 
         [0042]    Reference may be made to U.S. Provisional Patent Application No. 61/776,811, filed on Mar. 12, 2013, the entire contents of which are incorporated herein by reference, for a further detailed discussion of the construction and operation of tacker  200 . 
         [0043]    Reference may also be made to U.S. Provisional Patent Application No. 61/783,559, filed on Mar. 14, 2013, the entire contents of which are incorporated herein by reference, for a further detailed discussion of the construction and operation of a tacker which is configured and adapted for articulation and which may incorporate some of the principles of the present disclosure. 
         [0044]    Turning now to  FIGS. 9-14 , a second embodiment of a tacker  1200  is shown. Tacker  1200  is substantially identical to tacker  200  and thus will only be described further herein to the extent necessary to identify differences in construction and/or operation. 
         [0045]    As seen in  FIGS. 9-14 , tacker  1200  is provided with a ratchet mechanism  1260  which is configured to inhibit or prevent inner tube  1238  from backing-out after an anchor  100  has been at least partially driven into tissue. Ratchet mechanism  1260  includes a series of ratchet teeth  1218   e  formed on a rear end wall  1218   d  of a bevel gear  1218  (see  FIG. 10 ). Further details of a ratchet mechanism are disclosed in commonly-owned U.S. patent application Ser. No. 10/123,490, the entire contents of which being hereby incorporated by reference herein. 
         [0046]    With specific reference to  FIG. 13 , ratchet mechanism  1260  further includes a spring clip  1262  secured within handle assembly  1210 . Spring clip  1262  includes a resilient finger  1262   a  configured for engagement with ratchet teeth  1218   e  formed on rear end wall  1218   d  of bevel gear  1218 . 
         [0047]    As shown in  FIG. 11 , each ratchet tooth  1218   e  includes a shallow angled side  1218   e   1  and a steep angled side  1218   e   2 . In this manner, resilient finger  1262   a  of spring clip  1262  engages with ratchet teeth  1218   e  in such a manner that as bevel gear  1218  is rotated in a first direction resilient finger  1262   a  cams over shallow angled side  1218   e   1  of ratchet teeth  1218   e.  Also, if bevel gear  1218  is rotated in a second direction (opposite to the first direction), resilient finger  1262   a  stops against steep angled side  1218   e   2  of ratchet teeth  1218   e  thereby preventing or inhibiting bevel gear  1218  from rotating in the second direction. As such, any reverse rotation or “backing-out” of anchor  100  or inner tube  1238  (tending to cause bevel gear  1218  to rotate in the second direction), during a driving or firing stroke, is inhibited or prevented. 
         [0048]    Referring now to  FIGS. 9 and 14 , tacker  1200  includes a plug  1264  disposed within inner tube  1238 . In disclosed embodiments, plug  1264  is fabricated from a polymeric thermoplastic material (Monsanto Santoprene 271-87, available from Monsanto, Inc.) and dimensioned to create a fluid-tight seal within inner tube  1238 . In this manner, escape or leakage of insufflations gas (and/or solution  2000 , as discussed below) through inner tube  1238  is inhibited or prevented. 
         [0049]    With reference to  FIGS. 15-18 , anchor  100  of the present disclosure, which is usable with tacker  200  and  1200 , is shown. Anchor  100  includes a head section  110 , a mesh retention section  120 , and a threaded tissue-snaring section  130 . Head section  110  includes a pair of opposing threaded sections  112   a,    112   b  having respective head threads  114   a,    114   b,  and a pair of opposing open or slotted sections  116   a,    116   b.  A distal surface of head section  110  is formed onto or integral with a proximal end of mesh retention section  120 . 
         [0050]    Mesh retention section  120  of anchor  100  extends from and between a distal end of head section  110  and a proximal end of tissue-snaring section  130 . Mesh retention section  120  functions to lock, anchor or otherwise retain a surgical mesh “M” on to anchor  100  when anchor  100  is screwed into the mesh to a depth past a proximal-most segment  138  of tissue-snaring thread  132 . This is achieved because there is no thread located in mesh retention section  120  that would allow the mesh “M” to be unscrewed from anchor  100 . 
         [0051]    In the illustrated embodiments, mesh retention section  120  is generally cylindrical or conical in shape with a dimension transverse to its longitudinal axis that is smaller than the transverse dimension of head  110  and the transverse dimension of proximal-most segment  138  of tissue-snaring thread  138 . 
         [0052]    Threaded tissue-snaring section  130  of anchor  100  includes helical threads  132  formed onto a tapered truncated body section  134 . A distal point or tip  136  defines the terminus of the distal most tissue-snaring thread  132 . 
         [0053]    As shown in  FIG. 18 , body section  134  of tissue-snaring section  130  is tapered, i.e., becoming smaller toward the distal end of threaded tissue-snaring section  130 , and terminates, or truncates, distally prior to reaching an apex. Body section  134  includes a concave taper such that, for a given length, a minimum diameter body section  134  is defined upon truncation thereof which is approximately less than 0.01 inches, for example. 
         [0054]    Anchor  100  includes a transverse dimension “D” ( FIG. 18 ), of a distal-most thread in the threaded tissue-snaring section  130  which, in disclosed embodiments, is as large as design constraints will allow or approximately greater than 0.040 inches. It is envisioned that a small truncated body diameter and a large value of “D” minimizes tissue indentation. The tissue-snaring threads  132  terminate at distal tip  136 , which is distal of the truncation point of body section  134 . This geometry allows for ease of mesh penetration and minimizes indentation of the mesh into soft tissue as compared to a non-truncated body with tapered threads. 
         [0055]    For a given force applied to a surgical mesh “M” by the surgeon, exerting a distal force on an applier  200 , the larger the dimension “D,” the less the pressure to cause indentation of an underlying tissue and surgical mesh “M.” 
         [0056]    Additionally, and with reference to  FIGS. 18A-21 , tackers  200  and  1200  of the present disclosure are usable with a solution  2000 . While solution  2000  is at least usable with tackers  200  and  1200 , only its use with tacker  200  is described herein. Solution  2000  may be a paste-like solution, a collagen-based solution, or a collagen paste solution, for example. For instance, solution  2000  may include porcine dermal collagen, which is sold by under the trade name Permacol™. Here, solution  2000  may be an injectable Permacol™ or a Permacol™ paste with a viscosity tailored to the desired application. It is envisioned that Permacol™ sheets or other collagen sheets are cryomilled and prepared into suspensions by mixing the cryomilled power with water and/or saline. Here, the mixing concentration will determine the viscosity of the solution. 
         [0057]    Solution  2000  is positioned within inner tube  238  and is dispensible from distal end  242  of inner tube  238 , as discussed below. It is envisioned that solution  2000  is formulated to help reduce or prevent adhesion between the surgical mesh “M” and/or anchor  100  and a patient&#39;s tissue. 
         [0058]    With specific reference to the embodiment illustrated in  FIG. 19 , the entirety of solution  2000  is disposed within an ampoule  2100 . Ampoule  2100  is disposed within inner tube  238  and proximally of the proximal-most anchor  100 . It is envisioned that ampoule  2100  includes at least one threaded portion  2110  on at least a portion of its perimeter. In the illustrated embodiment, ampoule  2100  includes two threaded portions  2110 : one adjacent its proximal and one adjacent its distal end, but it is envisioned that ampoule  2100  includes more or fewer threaded portions  2110  disposed at any suitable location on or near ampoule  2100 . Further, threaded portions  2110  may include any suitable number of threads and may be of any suitable length. As shown, threaded portion  2110  of ampoule  2100  engages coil  236 , such that the rotation of bevel gear  220  (and, thus inner tube  238 ) to cause ejection of anchors  100  also causes ampoule  2100  to advance distally. 
         [0059]    In this embodiment, a user initially ejects all anchors  100  from inner tube  238  (e.g., through mesh “M” and into tissue). Continued actuation of tacker  200  advances ampoule  2100  such that solution  2000  therein is able to be dispensed from distal end  242  of inner tube  238  onto/adjacent head section  110  of each anchor  100 , for instance. It is envisioned that a distal tip  2120  of ampoule  2100  is frangible. Here, once distal tip  2120  is accessible (e.g., extends distally from inner tube  238 ), a user may rupture ampoule  2100  by causing distal tip  2120  to contact/depress against anchor  100 , mesh “M,” or tissue, for example, to cause solution  2000  from within ampoule  2100  to ooze/flow from ampoule  2100 . The user can then position distal end  242  of inner tube  238  adjacent each anchor  100 , individually, such that solution  2000  oozes/flows onto at least a portion of each anchor  100 , for instance. 
         [0060]    With specific reference to the embodiment illustrated in  FIG. 20 , solution  2000  is disposed proximally-adjacent, and in contact with, a proximal-facing surface  111  of head section  110  of anchor  100 . Here, solution  2000  is mechanically engaged with, adhered to, or otherwise disposed on head section  110  of anchor  100  and is distally advanced along with anchor  100 . In this embodiment, solution  2000  is either in direct contact with head section  110 , or solution  2000  is enclosed in a puncturable impermeable or semi-permeable pouch, sac or membrane  250 . It is envisioned that the viscosity of the solution  2000  that is used helps determine whether solution  2000  is in direct contact with head section  110  (solution  2000  has a relatively low viscosity) or whether solution  2000  is enclosed in a pouch  250  (solution  2000  has a relatively high viscosity). 
         [0061]    When used in this embodiment, each anchor  100  is ejected from tacker  200  having its own pouch  250  of solution  2000  associated therewith, such that mesh retention section  120 , and threaded tissue-snaring section  130  extend at least partially through mesh “M” and into tissue. In the embodiment where solution  2000  is in direct contact with head section  110 , it is envisioned that solution  2000  flows/oozes at least partially around head section  110  substantially immediately after firing of anchor  100 . 
         [0062]    In the embodiment where solution  2000  is enclosed in a pouch  250 , pouch  250  (including solution  2000  therein) remains on head section  110  of anchor  100  after anchor  100  is positioned in relation to mesh “M” and the patient. Subsequently, the user of tacker  200  may then use the distal end of anchor retaining/advancing assembly  230  to puncture pouch  250  to cause solution  2000  to be released adjacent anchor  100 . Here, it is envisioned that the distal end of anchor retaining/advancing assembly  230  includes a suitable shape (e.g., a point-like) tip  243  ( FIG. 20 ), or knurling, to facilitate puncturing of pouch  250 . In this embodiment, it is envisioned that the user punctures each pouch  250  directly after its associated anchor  100  is emplaced through mesh “M” and into tissue. Alternatively, all anchors  100  can be ejected from inner tube  238  prior to pouches  250  being punctured. Any combination of these methods is also envisioned by the present disclosure. 
         [0063]    Additionally, and with reference to  FIG. 18A , it is envisioned for solution  2000  to be disposed on the distal surface of head section  110  of anchor  100 . In such an embodiment, when solution  2000  is within a pouch  252  disposed on the distal surface of head section  110 , it is envisioned that pouch automatically ruptures when anchor  100  is applied through mesh “M.”That is, the distal surface of head section  110  compresses pouch  252  against the mesh “M,” which results in pouch  252  rupturing, and the solution  2000  flowing/oozing from pouch  252  and around the periphery of head section  110  of anchor  100 . 
         [0064]    Referring to  FIG. 21 , another embodiment of tacker  200  is shown. Here, tacker  200  includes a plurality of anchors  100  within inner tuber  238 , and also includes solution  2000  filling at least part of the remainder of the volume of inner tube  238 . That is, in this embodiment, solution  2000  fills the voids between each anchor  100 , proximally of the proximal-most anchor  100 , distally of the distal-most anchor  100  and/or between each adjacent anchor  100 . Here, when a user actuates handle assembly  120  to eject anchors  100 , solution  2000  is automatically dispensed as well. It is envisioned that solution  2000  and anchors  100  are positioned within inner tube  238  during assembly of tacker  200 . For example, inner tuber  238  may be injected with a first dosage of solution  2000 , loaded with a first anchor  100 , injected with a second dosage of solution  2000 , followed by a second anchor  100 , etc. 
         [0065]    Additionally, methods using the disclosed tacker  200 ,  1200  including solution  2000 , are also envisioned and part of the present disclosure. 
         [0066]    While the present disclosure relates to anchors  100  and solution  2000  used with a manually-actuatable tacker  200 ,  1200 , it is envisioned that anchors  100  and/or solution  2000  are usable with a powered tacker instrument, such as that described in U.S. Pat. No. 7,931,660 to Aranyi, et al., the entire contents of which being hereby incorporated by reference herein. 
         [0067]    It will be understood that various modifications may be made to the embodiments disclosed herein. For example, the disclosed tacker devices may be configured so that the anchor retaining/advancing assembly is removable, and or disposable, from the associated handle assembly. 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.