Abstract:
An endoscopic system for winding and inserting a mesh into an abdominal cavity of a patient is provided. The endoscopic system includes an introducer having an elongated shaft extending distally therefrom. The shaft includes a split portion that defines an opening therealong. The split portion is configured to support the mesh within the opening. A furler defining a lumen is engageable with the split portion of the shaft and configured to exert a radial force onto the mesh that is supported by the split portion. Rotation of one of the furler and introducer with respect to the other winds the mesh inside the furler to a diameter smaller than a diameter of the lumen of the furler.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims the benefit of and priority to U.S. Provisional Patent Application No. 61/915,730, filed Dec. 13, 2013, the entire disclosure of which is incorporated by reference herein. 
    
    
     BACKGROUND 
     1. Technical Field 
     The present disclosure relates to an endoscopic system for winding and inserting mesh. More particularly, the present disclosure relates to an endoscopic system including an introducer and furler configured to wind and insert a mesh into an abdominal cavity of a patient. 
     2. Description of Related Art 
     Current mesh application typically requires a scrub nurse or other operating room personal to open, at the operating table, a pre-packaged sterile container containing a mesh, which may have a flat configuration. A surgeon will often remove the mesh from the opened container and mark the mesh with a marker and then roll or wind the mesh (e.g., like a scroll). The wound mesh is inserted into an abdominal cavity of a patient through an access port, e.g., a large diameter port (10 or 12 mm trocar) or through an open port site from which a trocar has been removed. In the latter case, after the mesh is inserted into the abdominal cavity, the trocar may be reinserted into the open port site to reenter the abdominal cavity. This additional step of reinserting the trocar adds time to the surgical procedure and can sometimes be difficult because of tissue plane movement. 
     While the aforementioned method for winding and inserting a mesh into an abdominal cavity of a patient may be satisfactory, a need exists for a simpler and less time-consuming method. 
     SUMMARY 
     As can be appreciated, an endoscopic instrument including an introducer and furler configured to wind (or roll) and insert a mesh into an abdominal cavity may prove useful in the surgical arena. 
     Embodiments of the present disclosure are described in detail with reference to the drawing figures wherein like reference numerals identify similar or identical elements. As used herein, the term “distal” refers to the portion that is being described which is further from a user, while the term “proximal” refers to the portion that is being described which is closer to a user. 
     An aspect of the present disclosure provides an endoscopic system for winding and inserting a mesh into an abdominal cavity of a patient. The endoscopic system includes an introducer having an elongated shaft extending distally therefrom. The shaft includes a split portion that defines an opening therealong. The opening of the split portion may extend to a distal tip of the shaft. The split portion is configured to support the mesh within the opening. A furler defining a lumen is engageable with the split portion of the shaft and configured to exert a radial force onto the mesh that is supported by the split portion. Rotation of one of the furler and introducer with respect to the other winds the mesh inside the furler to a diameter smaller than a diameter of the lumen of the furler. 
     The furler may be movable along the shaft to at least partially cover the mesh when the mesh is positioned within the split portion of the shaft. The furler may have an elongated configuration and a longitudinal slit extending along a length thereof. The longitudinal slit of the furler may be configured to receive the mesh when the mesh is supported on the split portion of the shaft. 
     The furler may include a tapered-down distal end defined by a v-shaped opening. The furler may include a flared proximal end having a conical configuration. The furler may include a medial portion having a tabbed cut-out defined by three side walls and a living hinge. The tabbed cut-out may be depressible to reduce the diameter of the lumen of the furler and apply the radial force to the mesh as the mesh is being wound. 
     The furler may include a pair of tension tabs extending radially from a center of the furler. Alternatively, the furler may include a pair of tension tabs extending tangentially from a center of the furler. 
     The shaft of the introducer may include an articulating portion positioned proximally in relation to the split portion. The endoscopic system may also include a sheath which is movable along the shaft and slidable within the furler. 
     Another aspect of the present disclosure provides a method that utilizes the endoscopic system for inserting a mesh into an abdominal cavity of a patient. The mesh is, initially, positioned through the split portion of the shaft. The furler, is then positioned over the split portion of the shaft to at least partially cover the mesh. Thereafter, one of the furler and shaft is rotated with respect to the other to wind the mesh inside the furler. A radial force is applied to the mesh, by reducing the diameter of the furler, as the mesh is being wound in the furler. 
     The furler including the wound mesh may then be inserted through an access opening in a patient. Further, the shaft may be pushed distally in relation to the access opening to engage a proximal end of the furler with the access opening to position the mesh into the abdominal cavity of a patient and unwind the mesh. 
     Positioning the mesh through the split portion of the shaft may further include positioning the mesh within the opening that extends along the split portion of the shaft. Moreover, prior to positioning the furler over the split portion of the shaft to at least partially cover the mesh, the mesh may be folded over the split portion of the shaft and at least a portion of the folded mesh may be positioned within the longitudinal slit of the furler. Rotating one of the furler and shaft with respect to the other to wind the mesh inside the furler may further include depressing the tabbed cut-out of the furler to apply the radial force to the mesh as the mesh is being wound, thereby facilitating a tight wind of the mesh and preventing unwinding of the mesh. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWING 
       Various embodiments of the present disclosure are described hereinbelow with references to the drawings, wherein: 
         FIG. 1A  is a perspective view of an endoscopic system including an introducer, a furler and a mesh according to an embodiment of the instant disclosure; 
         FIG. 1B  is a perspective view of the endoscopic system shown in  FIG. 1A  with parts separated; 
         FIG. 2  is a perspective view of the introducer shown in  FIGS. 1A and 1B ; 
         FIG. 3A  is a perspective view of the furler shown in  FIGS. 1A and 1B ; 
         FIG. 3B  is a partial, perspective view of a furler according to an alternate embodiment of the instant disclosure; 
         FIG. 4  is an indicated area of detail shown in  FIG. 3A ; 
         FIG. 5  is an indicated area of detail shown in  FIG. 3A ; 
         FIG. 6  is an indicated area of detail shown in  FIG. 3A ; 
         FIGS. 7-11  are perspective views illustrating a method of use of the endoscopic system shown in  FIG. 1A ; 
         FIG. 12  is a perspective view of an endoscopic system including an introducer, a furler and a mesh according to another embodiment of the instant disclosure; 
         FIG. 13  is a perspective view of the furler shown in  FIG. 12 ; 
         FIG. 14  is a perspective view of a furler according to another embodiment of the instant disclosure; and 
         FIGS. 15-18  are perspective views illustrating a method of use of the endoscopic system shown in  FIG. 12 . 
     
    
    
     DETAILED DESCRIPTION 
     Detailed embodiments of the present disclosure are disclosed herein; however, the disclosed embodiments are merely examples of the disclosure, which may be embodied in various forms. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a basis for the claims and as a representative basis for teaching one skilled in the art to variously employ the present disclosure in virtually any appropriately detailed structure. 
     As discussed above, an endoscopic system including an introducer and furler configured to wind (or roll) and insert a mesh into an abdominal cavity of a patient may prove useful in the surgical arena, and such an endoscopic system is described herein. 
       FIGS. 1A and 1B  illustrate an endoscopic system  10  that includes an introducer  12  and a furler  14  which are configured to wind and insert one or more types of mesh  16  into an abdominal cavity of a patient. Suitable meshes include, but are not limited to, mesh that are formed via casting, molding, needle-punching, hooking, weaving, rolling, pressing, bundling, braiding, spinning, piling, knitting, felting, drawing, splicing, cabling, extruding, and/or combinations thereof. In some embodiments, the mesh  16  may further include reactive and/or may be bioabsorbable or non-bioabsorbable. The mesh  16  may have a thickness of from about 0.2 mm to about 5 mm, in embodiments, from about 1 mm to about 3 mm. Strands of the mesh  16  may be spaced apart to form pores of from about 100 microns to about 2000 microns in diameter, in embodiments, from about 200 microns to about 1500 microns, in other embodiments, from about 750 microns to about 1250 microns in diameter. Examples of various meshes include those disclosed in U.S. Pat. Nos. 6,596,002; 6,408,656; 7,021,086; 6,971,252; 6,695,855; 6,451,032; 6,443,964; 6,478,727; 6,391,060; and U.S. Patent Application Publication No. 2007/0032805, the entire disclosures of each of which are incorporated by reference herein. 
     Filaments of the mesh  16  may be monofilament or multi-filament. Where multi-filament constructs are utilized, they may be plaited, braided, weaved, twisted, and the like, or laid parallel to form a unit for further construction into a fabric, textile, patch, mesh, and the like. The distribution of the filaments or strands may be random or oriented. 
     The mesh  16  may include natural or synthetic, bioabsorbable or non-bioabsorbable materials including those listed below. Suitable meshes include a collagen composite mesh such as PARIETEX™ (Tyco Healthcare Group LP, d/b/a Covidien, North Haven, Conn.) may be used. PARIETEX™ Composite mesh is a 3-dimensional polyester weave with a resorbable collagen film bonded on one side. 
     In embodiments, the mesh  16  component may be a substantially flat sheet (as described in the illustrated embodiments). In other embodiments, the mesh  16  may be cylindrical in shape. 
     In embodiments, the mesh  16  may act as a tissue scaffold, thereby providing a means for tissue integration/ingrowth. Such meshes are capable of providing cells with growth and development components. Thus, where a mesh is utilized as a tissue scaffold, it may assist in native tissue regrowth by providing the surrounding tissue with needed nutrients and bioactive agents. In some embodiments, as discussed herein, the mesh  16  itself may include a natural component, such as collagen, gelatin, hyaluronic acid, combinations thereof, and the like, and thus the natural component may be released or otherwise degrade at the site of implantation as the tissue scaffold degrades. 
     Continuing with reference to  FIGS. 1A and 1B , the endoscopic system  10  may include or be utilized with one or more suitable access ports (e.g., trocar or radial sleeve with access openings ranging from about 5 mm to about 15 mm) to access the abdominal cavity of a patient to insert a wound mesh  16 . Alternatively, the endoscopic system  10  can be utilized to insert the wound mesh  16  directly into the abdominal cavity through an incision in a patient. 
       FIG. 2  is a perspective view of the introducer  12 . The introducer  12  includes a generally elongated configuration and has a handle  18 , which may be ergonomically shaped to facilitate grasping and rotation of the introducer  12 . In the illustrated embodiments, for example, a plurality of rib portions  20  are provided along a length of the handle  18  of the introducer  12  to facilitate grasping and rotation of the introducer  12 . 
     Continuing with reference to  FIG. 2 , a shaft  22  extends from the handle  18  of the introducer  12 . In the illustrated embodiments, the shaft  22  includes a first shaft portion  24  that extends distally from a distal end of the handle  18 . The first shaft portion  24  connects to or supports an articulating or flexing portion  26  (shown schematically in  FIG. 2 ) from which a second shaft portion  28  extends distally. The second shaft portion  28  pivotally connects to the articulating or flexing section  26  so that the second shaft portion  28  can be moved to one or more articulated or flexed configurations for positioning the mesh  16  within the abdominal cavity of a patient. In embodiments, the first and second shaft portions  24 ,  28  can be directly coupled to one another and the articulating or flexing portion  26  may be omitted. 
     The first shaft portion  24  has a generally elongated, cylindrical configuration and is configured to support the furler  14 . The first shaft portion  24  has an outer diameter that allows the furler  14  to be moved along the first shaft portion  24  and over the mesh  16 , which mesh  16  will be secured to or hung on the second shaft portion  28  and in a folded configuration, described in detail below. During insertion of the second shaft portion  28  into an access opening to insert the wound mesh  16  into the abdominal cavity, due to the size of the outer diameter of the first shaft portion  24 , the furler  14  is able to move along the first shaft portion  24  to release the mesh  16  from the second shaft portion  28 , also described in detail below. 
     The second shaft portion  28  may take the form of a splined shaft including two tines  30   a ,  30   b  that extend along a length of the second shaft portion  28 . The two tines  30   a ,  30   b  are spaced-apart from one another and define a longitudinal opening  32  therebetween to form a fork or split configuration. The longitudinal opening  32  extends to a distal tip  34  that is configured to receive the mesh  16  so that the mesh  16  can be temporarily secured between the two tines  30   a ,  30   b  of the introducer  12 . 
     In one method of use, once the mesh  16  is inserted between the two tines  30   a ,  30   b  of the introducer  12 , the mesh  16  can be folded over the two tines  30   a ,  30   b  and the furler  14  can be positioned along the two tines  30   a ,  30   b  to cover the mesh  16 , which can then be wound within the furler  14 . Thereafter, the wound mesh  16  can be inserted into the abdominal cavity of a patient where the mesh  16  can be positioned adjacent target tissue with the articulating section  26  and/or released from between the tines  30   a ,  30   b  through the opening  32 . 
     The introducer  12  including the handle  18  and first and second shaft portions  24 ,  28  may be formed from any suitable material, e.g., plastic, metal, ceramic, etc. For example, in embodiments, the handle  18  and first shaft portion  24  may be formed from a relatively rigid plastic and the tines  30   a ,  30   b  of the second shaft portion  28  may be formed from surgical steel. If the articulating portion  26  is provided with the introducer  12 , the articulating portion  26  can be formed from plastic and/or surgical steel. 
     Turning now to  FIGS. 3A and 4-6 , the furler  14  is illustrated and will be described. The furler  14  can be formed from the same materials used to form the introducer  12 . In the illustrated embodiments, the furler  14  may be formed from a relatively rigid plastic or stainless steel. 
     The furler  14  has a generally tubular configuration including proximal and distal ends  36 ,  38 , respectively, and a medial portion  46  extending therebetween. Extending along the medial portion  46  of the furler  14  from the proximal end  36  to the distal end  38  is a longitudinal slot  37 . The longitudinal slot  37  is configured to receive the mesh  16  when the mesh  16  is folded over the tines  30   a ,  30   b  so that the mesh  16  can be inserted into the furler  14  and wound. 
     Referring to  FIG. 4 , the proximal end  36  includes a flared neck portion  40  that tapers outwardly to define an opening or lumen  42 , which extends through the furler  14 . The flared neck portion  40  has a conical configuration and includes a diameter that is greater than a diameter of the medial portion  46  and the distal end  38 . The diameter of the flared neck portion  40  is also greater than a diameter of a proximal end of the access opening. This difference in diameter causes interference between the proximal end of the access opening and the flared neck portion  40  of the furler  14 , which prevents the furler  14  from passing through the access opening as the second shaft portion  28  is being pushed distally therethrough to insert the wound mesh  16  into the abdominal cavity. Accordingly, the force that a user is applying to the introducer  12  after the flared neck portion  40  engages the proximal end of the access opening overcomes the frictional force between the wound mesh  16  and the furler  14  causing the wound mesh  16  to exit the furler  14  into the abdominal cavity of the patient. Additionally, the flared neck portion  40  provides a guide or funnel-like structure to facilitate alignment and insertion of the distal tip  34  of the second shaft portion  28  into the furler  14 . 
     Referring to  FIG. 5 , the distal end  38  of the furler  14  includes a tapered down configuration having a generally v-shaped opening  44 , which facilitates sliding the distal end  38  over the mesh  16  when the mesh  16  is folded over the tines  30   a ,  30   b  of the second shaft portion  28 . The tapered down distal end  38  of the furler  14  also facilitates inserting the distal end  38  of the furler  14  into the access opening. The distal end  38  of the furler  14  may include other configurations not disclosed herein. 
     Referring to  FIG. 6 , the medial portion  46  of the furler  14  includes a tabbed cut-out  48  defined by three side walls  50   a - 50   c  and a living hinge  52 , which allows the tabbed cut-out  48  to be depressed by a user to apply a radial force “F” normal or perpendicular ( FIGS. 6 and 8 ) to the mesh  16  as the mesh  16  is being wound. 
     More particularly, in one embodiment of use, the tabbed cut-out  48  can be depressed and held by the user to effectively decrease the inside diameter of the furler  14  (i.e., to decrease a diameter of the lumen  42 ) to a point where the tabbed cut-out  48  comes into contact with the mesh  16 . As the mesh  16  is being wound, and increasing in diameter within the furler  14 , the tabbed cut-out  48  follows an outside diameter of the mesh  16  such that the application of the radial force “F” to the mesh  16  provides a tight wind of the mesh  16  (and prevents unwinding of the mesh  16 ). The tightly wound mesh  16  can be inserted into the abdominal cavity of the patient through a relatively smaller access opening, e.g., trocar with 5 mm opening, as compared to a wound mesh  16  that has not been more tightly wound due to the use of tabbed cut-out  48 . 
     In embodiments, the tabbed cut-out  48  can be omitted and the furler  14  can be provided with a window  47  ( FIG. 3B ). In one embodiment of use, a user can position their thumb (or one of their fingers) within the window  47  to apply a radial force “F” normal or perpendicular to the mesh  16  as the mesh  16  is being wound to effectively decrease the inside diameter of the furler  14  (i.e., to decrease a diameter of the lumen  42 ) to a point where the user&#39;s thumb comes into contact with the mesh  16 . As the mesh  16  is being wound, and increasing in diameter within the furler  14 , the user&#39;s thumb follows an outside diameter of the mesh  16  such that the application of the radial force “F” to the mesh  16  provides a tight wind of the mesh  16  (and prevents unwinding of the mesh  16 ). The tightly wound mesh  16  can be inserted as described above. 
     Referring to  FIGS. 7-11 , a method of use of the endoscopic system  10  is now described. The components of the endoscopic system  10  may be packaged and shipped (in a sterile environment) separately, or together as a kit. In the latter instance, for example, the kit may include one or more of the aforementioned radial sleeves or trocar, the introducer  12 , the furler  14  and the mesh  16 . Conversely, the kit may be sold without the radial sleeves or trocar. 
     According to one embodiment of use, the furler  14  is, initially, positioned on the first shaft portion  24  towards the handle  18 , with the tines  30   a ,  30   b  exposed (see  FIG. 1A  for example) or extending distally of the furler  14 . The mesh  16  may be placed flat between the tines  30   a ,  30   b , with the tines  30   a ,  30   b  in the center of the mesh  16 . It is noted, the mesh  16  can be provided with a center-line “CL” to facilitate positioning the mesh  16  between the tines  30   a ,  30   b  (see  FIG. 1B  for example). The mesh  16  is then folded in half along the tines  30   a ,  30   b  ( FIG. 7 ). In embodiments, such as when the endoscopic system  10  is sold as a kit, the mesh  16  can be pre-positioned between the tines  30   a ,  30   b  of the second shaft portion  28  and pre-wound within the furler  14 . 
     The furler  14  is then slid distally along the first and second shaft portions  24 ,  28  with the longitudinal slot  57  of the furler  14  aligning with the folded mesh  16  so that the furler  14  covers the tines  30   a ,  30   b  with the two halves of the mesh  16  hanging out of the longitudinal slot  57  thereof ( FIG. 7 ). It is noted that the furler  14  may be positioned completely or partially over the mesh  16  to wind the mesh  16 . 
     In one hand a surgeon holds the furler  14 , and with the other hand rotates the handle  18  of the introducer  12 , thereby rolling or winding the mesh  16  within the furler  14  ( FIG. 8 ). Alternatively, the handle  18  of the introducer  12  can be held while the furler  14  is rotated with respect to the handle  12 . In either instance, the tabbed cut-out  48  can be depressed as the mesh  16  is being wound in the furler  14  to provide a tight wind of the mesh  16 . Desirably, the introducer  12  is rotated in a direction toward the sidewall  50   b  of the tabbed cut-out  48  (see FIG.  6 ) of the furler  14 . Once the mesh  16  is fully wound, the introducer  12  including the furler  14  with the wound mesh  16  is inserted into a trocar  54  ( FIG. 9 ). 
     The furler  14  acts as a sheath which protects the mesh  16  as the mesh  16  is being inserted through the trocar  54 . As the introducer  12  is being inserted into the trocar  54 , the flared neck  40  on the proximal end  36  of the furler  14  contacts the proximal end of the trocar  54  preventing the furler  14  from going past a proximal end of the trocar  54  and completely entering the trocar  54  ( FIG. 10 ). As the surgeon continues to insert the introducer  12  via the handle  18 , the tines  30   a ,  30   b  advance the mesh  16  past the furler  14 /trocar  54  and into the abdominal cavity of the patient, where the mesh  16  naturally unwinds ( FIG. 10 ). At this point the surgeon can use the introducer  12  to roughly position (e.g., via the articulating portion  26  of the introducer  12 ) the mesh  16  for initial tacking, or simply remove the introducer  12 , thereby allowing the mesh  16  to gently drop into the abdominal cavity ( FIG. 11 ). 
     In accordance with the instant disclosure, the endoscopic system  10  allows for tight winding of the mesh  16  so that the mesh  16  can be inserted through trocars or radial sleeves that include relatively small access openings (e.g., 5 mm). As can be appreciated, this allows the surgeon to use smaller access ports, which, in turn, may prevent port site herniation and post-operative pain typically associated with larger port sites. Additionally, the furler  14  protects the mesh  16  from prematurely coming in contact with skin or underlying tissue. 
     From the foregoing and with reference to the various figure drawings, those skilled in the art will appreciate that certain modifications can also be made to the present disclosure without departing from the scope of the same. For example, the flared neck portion  40  of the furler  14  is one of many ways to create a stop that prevents the furler  14  from completely entering the access opening. For example, any number of tube forming operations could be utilized to achieve the same function. In embodiments, a flange (not shown) can be provided along an exterior surface of the furler  14  or a tab that extends radially outward from the furler  14  can also be used to create a stop that prevents the furler  14  from completely entering and/or exiting the access opening. 
     In embodiments, the introducer  12  may be provided with a pin or other suitable device (not explicitly shown) that aligns with the longitudinal slot  37  on the furler  14  to engage the longitudinal slot  37 , thereby preventing the furler  14  from coming off of the introducer  12  upon removal from the access opening. 
     In embodiments, the handle  18  of the introducer  12  can have a trigger or button (not explicitly shown) for automatic deployment/unwrapping of the mesh  16 , or can be powered to dispense/unravel/unwind the mesh  16  intra-abdominally with the push of the button. 
     Referring to  FIG. 12  an endoscopic system  110  in accordance with another embodiment of the present disclosure is illustrated. The endoscopic system  110  is similar to the endoscopic system  10 . Accordingly, only those components and operative features that are unique to the endoscopic system  110  are described herein. 
     The endoscopic system  110  includes a sheath  113  that is positionable along a first and second shaft portions  124 ,  128  of an introducer  112 . 
     The endoscopic system  110  includes a furler  114  that is substantially similar to the furler  14  ( FIG. 13 ). Unlike the furler  14 , however, the furler  114  illustrated in  FIG. 13  is not an “in-line” furler as the furler  14 . In other words, the furler  114  is not configured to remain attached to the introducer  112  when a mesh  116  is being inserted through an access port, e.g., the trocar  54 . Accordingly, the furler  114  need not include the flared neck portion  40 , as this feature (e.g., a flared neck portion  140 ) is provided on the sheath  113  (see  FIG. 12 ). 
     As illustrated in  FIG. 13 , the furler  114  includes a longitudinal slot  137  that is defined by a pair of spaced-apart fins or tension tabs  138   a ,  138   b . The tension tabs  138   a ,  138   b  define the longitudinal slot  137  along a center of the furler  114  which provides a center “lead-in” for the folded mesh  116  into the furler  114  ( FIG. 13 ). Alternatively, at least one of the tension tabs  138   a ,  138   b  extends along a tangent of the furler  114  which provides a tangent “lead-in” for the folded mesh  16  into the furler  114  ( FIG. 14 ). 
     The longitudinal slot  137  is defined by the tension tabs  138   a ,  138   b  and is wider than the longitudinal slot  37  on the furler  14 . This wideness of the longitudinal slot  137  facilitates inserting the folded mesh  116  into the furler  114 , as the mesh  116  is led into the furler  114  from the center of the furler  114  or the tangent along the furler  14  as opposed to the distal end  38  of the furler  14  described above. Moreover, when the tension tabs  138   a ,  138   b  are moved towards one another, the tension tabs  138   a ,  138   b  provide an additional force to the mesh  116 , thereby facilitating an even tighter wind of the mesh  116 . 
     Referring to  FIGS. 15-18 , a method of use of the endoscopic system  110  is now described. The components of the endoscopic system  110  may be packaged and shipped separately, or together as a kit. In the latter instance, for example, the kit may include one or more of the aforementioned radial sleeves or trocar  54 , the introducer  112 , the furler  114 , the sheath  113  and the mesh  116 . 
     The sheath  113  is, initially, positioned on the first shaft portion  124  adjacent a handle  118 , with the tines  130   a ,  130   b  exposed or extending distally of the sheath  113  (see  FIG. 12  for example). The mesh  116  may be placed flat between the tines  130   a ,  130   b , with the tines  130   a ,  130   b  in the center of the mesh  116  ( FIG. 15 ). The mesh  116  is then folded in half along the tines  130   a ,  130   b  and the mesh  116  is then inserted into the longitudinal slot  137  of the furler  114  ( FIG. 16 ), which can include either of the configurations of the tensions tabs  138   a ,  138   b  shown in  FIGS. 13 and 14 . 
     In one hand a surgeon holds the furler  114 , and with the other hand rotates the handle  118  of the introducer  112 , thereby rolling or winding the mesh  116  within the furler  114 . The tabbed cut-out  148  can be depressed (as described above) as the mesh  16  is being wound in the furler  114  to provide a tight wind of the mesh  16 . Alternatively, or in addition thereto, the tension tabs  138   a ,  138   b  can be moved towards one another, which can also facilitate in providing a tight wind of the mesh  116 . Once the mesh  116  is fully wound, the sheath  113  is moved along the first and second shaft portions  124 ,  128  so that the sheath  113  is positioned within the furler  114  and over the tines  130   a ,  130   b  including the wound mesh  116  ( FIG. 17 ). For clarity, the sheath  113  is not explicitly shown positioned within the furler  114 . The introducer  112  including the sheath  113  with the wound mesh  116  is then inserted into the trocar  54 . 
     As the introducer  112  is being inserted into the trocar  54 , the flared neck portion  140  of the sheath  113  prevents the sheath  113  from going past the trocar  54 . As the surgeon continues to insert the introducer  112  via the handle  118 , the tines  130   a ,  130   b  advance the mesh  116  past the sheath  113 /trocar  54  and into the abdominal cavity of the patient, where the mesh  116  naturally unwinds ( FIG. 18 ). At this point the surgeon can use the introducer  112  to roughly position (e.g., via an articulating portion  126  of the introducer  112 ) the mesh  116  for initial tacking, or simply remove the introducer  112 , thereby allowing the mesh  116  to gently drop into the abdominal cavity. 
     As can be appreciated, the same advantages described above with respect to the endoscopic system  10  are attainable with the endoscopic system  110 . 
     While several embodiments of the disclosure have been shown in the drawings, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.