Patent Publication Number: US-2022233189-A1

Title: Surgical method and system for performing the same

Description:
FIELD OF THE INVENTION 
     The present invention relates to general field of surgery. More specifically, the present invention is concerned with a surgical method and a system for performing the same. 
     BACKGROUND 
     Some surgical procedures involve insertion of a helicoidal member into tissue, either in the form of an anchor that remains in place at the end of the procedure, or as a needle that is used to insert a suture thread. The helicoidal member is inserted by rotating it about its longitudinal axis. Once the helicoidal member has its tip inserted in the tissue, the rotation advances the helicoidal member in the tissue as the tip moves forward with the rotation. Helicoidal members may be inserted so that their longitudinal axis is perpendicular to a tissue surface to penetrate. In such cases, the forces exerted on the instrument used to insert the anchor help in maintaining the instrument fixed relative to the tissue surface during the procedure. If needed, the instrument may also be fixed relative to the tissue by securing the tip of the instrument to the tissue. 
     In some procedures it would be advantageous to insert the helicoidal member in the tissue with its longitudinal axis parallel to the tissue surface. After insertion, part of each coil making the helicoidal member is then outside of the tissue, adjacent the tissue surface, and the remainder of the helicoidal member is embedded in the tissue. Insertion of the helicoidal member, especially in transcatheter procedures, is difficult to perform as the instrument needs to be kept fixed at a predetermined location, at least for the first few turns of the helicoidal member during insertion. However, the various forces and torques exerted on the helicoidal member and the instrument used for insertion make immobilization of the instrument very difficult. 
     Mitral valve regurgitation (MR) is a functional heart disease under which the valve does not close completely and causes blood to leak back into the left atrium. This condition increases the workload on the heart and, if left untreated, can lead to irreversible heart damage, cardiac arrhythmia and congestive heart failure. Currently, mitral valve repair, as the intervention is called, requires open heart surgery with cardiopulmonary bypass. Under such conditions, the patient is subjected to intra- and post-operative trauma that can result in mortality increase and that can prevent high-risk individuals from undergoing the intervention. Hence the need to develop alternative procedures such as minimally invasive percutaneous interventions, which would greatly reduce the trauma and risks associated with conventional surgery, resulting in an increase of the number of potential candidates for repair, while significantly cutting patient&#39;s recovery times from weeks to days. There have been attempts to perform such surgery with helicoidal anchors inserted at the periphery of the valve, but they have failed, at least in part because of the problem of instrument immobilization described hereinabove. 
     Against this background, there exists a need in the industry to provide novel surgical methods and systems for performing the same in which helicoidal members are inserted in tissues. An object of the present invention is therefore to provide such improved methods and systems. 
     SUMMARY OF THE INVENTION 
     In a first broad aspect, the invention provides a system for performing a surgical procedure in a target biological tissue, the target biological tissue defining a target tissue exposed surface, the system including: a substantially helicoidal member, the helicoidal member defining a helicoidal member longitudinal axis and substantially longitudinally opposed helicoidal member proximal and distal ends; a substantially elongated guide positionable so as to be extending at least partially through the helicoidal member along the helicoidal member longitudinal axis, the guide defining a guide tip and a guide peripheral surface extending substantially longitudinally from the guide tip, the guide peripheral surface having a peripheral surface cooled portion covering at least part of the guide peripheral surface; a cooling subsystem operatively coupled to the guide for selectively cooling the peripheral surface cooled portion to a temperature sufficiently low to cause adhesion between the guide and the target biological tissue; a driver, the helicoidal member being mounted to the driver at the helicoidal member proximal end, the driver being operative for selectively simultaneously rotating the helicoidal member along the helicoidal member longitudinal axis and allowing the helicoidal member to advance along the guide in a distally oriented direction; wherein, in operation, when the cooling subsystem cools the peripheral surface cooled portion and the latter is positioned to abut against the target tissue exposed surface, the peripheral surface cooled portion adheres to the target tissue exposed surface so that the driver can operated to drive the helicoidal member into the target biological tissue by rotating the helicoidal member and advancing the helicoidal member along the guide with the peripheral surface cooled portion remaining fixed relative to the target biological tissue. 
     The invention may also provide a system wherein the helicoidal member is selectively detachable from the driver. 
     The invention may also provide a system wherein the driver includes a driver lock movable between a locked configuration and an unlocked configuration, wherein, in the locked configuration, the helicoidal member is locked to the driver, and, in the unlocked configuration, the helicoidal member is detachable from the driver. 
     The invention may also provide a system wherein the driver includes a substantially helicoidal thread configured and sized for receiving part of the helicoidal member at the helicoidal member proximal end. 
     The invention may also provide a system wherein the helicoidal member is provided with at least one notch substantially longitudinally extending substantially adjacent the helicoidal member proximal end and the driver lock includes a pin insertable in the notch when the helicoidal member is operatively secured to the driver in the helicoidal thread, the pin being selectively removable from the notch, the pin being inserted in the notch in the locked configuration and the pin being removed from the notch in the unlocked configuration. 
     The invention may also provide a system wherein the lock includes a wire secured to the pin and the pin is mounted in a substantially longitudinally extending pin receiving passageway intersecting the helicoidal threads, the pin being removable from the pin receiving passageway by pulling on the wire. The pin may be flexible or rigid. In some embodiments, the pin and wire extend integrrally from each other. 
     The invention may also provide a system wherein the cooling subsystem includes a coolant passageway having a portion thereof substantially adjacent to the peripheral surface cooled portion, the coolant passageway being configured for circulating a coolant therethrough to cool the peripheral surface cooled portion. 
     The invention may also provide a system wherein the cooling subsystem further includes a coolant source in a fluid communication relationship with the coolant passageway for providing cooled coolant thereto. 
     The invention may also provide a system wherein the guide is hollow and the cooling subsystem includes a coolant tube positioned at least partially in the guide, the coolant tube defining at least part of the coolant passageway. 
     The invention may also provide a system wherein the guide is closed at guide tip and the coolant tube is provided with at least one coolant tube outlet located in the guide substantially adjacent the peripheral surface cooled portion, the coolant tube having at least a portion thereof that is spaced apart from the guide so that coolant can be circulated from the coolant tube, through the coolant outlet and between the coolant tube and the guide. 
     The invention may also provide a system further comprising a substantially elongated catheter defining substantially opposed catheter proximal and distal ends and a catheter lumen extending therebetween, the guide being partially provided in the catheter lumen and protruding therefrom at the catheter distal end. 
     The invention may also provide a system further comprising a hook removably mountable to the helicoidal member and a suture thread secured to the hook. 
     The invention may also provide a system wherein the helicoidal member is made of a hollow tube, the suture thread extending through the hollow tube and the hook engaging the hollow tube at the helicoidal member distal end. 
     The invention may also provide a system wherein the driver is further operative for retracting the helicoidal member in a proximally oriented direction and the hook is removable from the helicoidal member when the hook is pulled. 
     The invention may also provide a system wherein the peripheral surface cooled portion is at least partially substantially flat. 
     The invention may also provide a system further comprising an insert mounted to the guide, the insert and guide being longitudinally movable relative to each other. 
     The invention may also provide a system wherein the insert includes a substantially resiliently deformable piece of material provided opposed to the peripheral surface cooled portion. 
     The invention may also provide a system wherein the insert is made of a foam. 
     The invention may also provide a system wherein the insert includes a substantially tubular membrane positioned over the guide peripheral surface, the membrane being provided with apertures in register with the peripheral surface cooled portion. 
     The invention may also provide a system wherein the insert includes a membrane positioned over the guide peripheral surface opposed to the peripheral surface cooled portion so that the peripheral surface cooled portion is free of the membrane. 
     The invention may also provide a system further comprising attachment loops securing the membrane to the guide, the attachment loops extending circumferentially around the guide. 
     The invention may also provide a system wherein the guide defines a pair of substantially longitudinally extending mounting grooves and the insert defines a pair of substantially longitudinally extending mounting rods each mounted in a respective one of the mounting grooves. 
     The invention may also provide a system wherein the helicoidal member is inserted through the insert. 
     The invention may also provide a system wherein the helicoidal member has the same shape before and after insertion in the target biological tissue. 
     The invention may also provide a system wherein the helicoidal member includes a shape memory material, the helicoidal member changing between a helicoidal member first configuration and a helicoidal member second configuration at a transition temperature, the transition temperature being between 20 C and 37 C, but other values are within the scope of the invention. 
     The invention may also provide a system wherein the helicoidal member first and second configurations have different pitches. 
     The invention may also provide a system wherein the helicoidal member has a pitch that varies between the helicoidal member proximal and distal ends. 
     The invention may also provide a system wherein the pitch is larger at the helicoidal member distal end than at the helicoidal member proximal end. 
     In another broad aspect, the invention provides a surgical method using a guide to assist in insertion of a helicoidal member in a target biological tissue, the target biological tissue defining a target tissue exposed surface, the helicoidal member defining a helicoidal member longitudinal axis and substantially longitudinally opposed helicoidal member proximal and distal ends, a helicoidal member passageway extending longitudinally between the helicoidal member proximal and distal ends, the guide being substantially elongated and defining a guide tip, the method including: abutting a substantially longitudinally extending portion of the guide against the target tissue exposed surface with the helicoidal member mounted thereto so that at least a portion of the guide is inserted in the helicoidal member passageway substantially parallel to the helicoidal member longitudinal axis; adhering the substantially longitudinally extending portion of the guide to the target tissue exposed surface with the helicoidal member longitudinal axis substantially parallel to the target tissue exposed surface; and advancing the helicoidal member in the target biological tissue in a substantially helicoidal movement with the guide remaining substantially fixed relative to the target biological tissue. 
     The invention may also provide a method wherein adhering the substantially longitudinally extending portion of the guide to the target tissue exposed surface includes cooling at least part of the guide to a predetermined temperature, the predetermined temperature being low enough to cause cryoadhesion between the substantially longitudinally extending portion of the guide and the target tissue exposed surface. 
     The invention may also provide a method wherein the predetermined temperature is low enough to allow cryoadhesion, but remains high enough and is applied for a duration short enough that substantially no irreversible physiological damages are caused to the target biological tissue. 
     The invention may also provide a method wherein the predetermined temperature is between 0 and −40 C. 
     The invention may also provide a method wherein the guide includes suction apertures in the substantially longitudinally extending portion of the guide and wherein adhering the substantially longitudinally extending portion of the guide to the target tissue exposed surface includes exerting a suction through the suction apertures. 
     The invention may also provide a method wherein the helicoidal member is between the guide tip and the substantially longitudinally extending portion of the guide before adhering the substantially longitudinally extending portion of the guide to the target tissue exposed surface. 
     The invention may also provide a method wherein the substantially longitudinally extending portion of the guide is between the guide tip and helicoidal member before adhering the substantially longitudinally extending portion of the guide to the target tissue exposed surface. 
     The invention may also provide a method wherein the substantially longitudinally extending portion of the guide and the helicoidal member have at least portions thereof substantially in register with each other before adhering the substantially longitudinally extending portion of the guide to the target tissue exposed surface. 
     The invention may also provide a method further comprising detaching the guide from the target tissue exposed surface with the helicoidal member remaining in the target biological tissue and removing the guide from within the helicoidal member passageway. 
     The invention may also provide a method further comprising delivering an insert while advancing the helicoidal member so that when the helicoidal member remains in the target biological tissue, the helicoidal member engages the insert. 
     The invention may also provide a method wherein the insert includes a membrane. 
     The invention may also provide a method wherein the insert includes a resiliently deformable material. 
     The invention may also provide a method further comprising delivering a prosthesis while advancing the helicoidal member so that when the helicoidal member remains in the target biological tissue, the prosthesis is secured to the target biological tissue by the helicoidal member. 
     The invention may also provide a method wherein the prosthesis includes a cardiac valve. 
     The invention may also provide a method wherein the helicoidal member supports a distally provided hook to which a suture thread is secured, the hook being removable from the helicoidal member, the method further comprising using the helicoidal member to insert the suture thread in a helicoidal configuration in the target biological tissue; withdrawing the helicoidal member from the target biological tissue with the hook hooking the target biological tissue so that the hook and suture thread remain in the target biological tissue; and pulling on the suture thread to tighten the suture thread. 
     The invention may also provide a method further comprising positioning the guide at a predetermined location along the target tissue exposed surface before adhering the substantially longitudinally extending portion of the guide to the target tissue exposed surface. 
     The invention may also provide a method further comprising adjusting the shape of the guide before adhering the substantially longitudinally extending portion of the guide to the target tissue exposed surface. 
     The invention may also provide a method further comprising inserting a catheter in a mammal in which the target biological tissue is located so that a catheter distal tip of the catheter is substantially adjacent the target tissue exposed surface; and advancing the guide in the catheter until at least part of the guide protrudes from the guide. 
     The invention may also provide a method wherein the target biological tissue is a valve annulus. 
     The invention may also provide a method comprising implanting at least two of the helicoidal members around the valve annulus and tightening the valve annulus by pulling the at least two helicoidal member towards each other. 
     The invention may also provide a method wherein the method includes implanting the helicoidal member around the valve annulus and tightening the valve annulus by reducing a radius of curvature of the helicoidal member. 
     The invention may also provide a method wherein the valve annulus is a mitral valve annulus. 
     The invention may also provide a method wherein the helicoidal member has the same shape before and after insertion in the target biological tissue. 
     The invention may also provide a method wherein the helicoidal member includes a shape memory material, the helicoidal member changing between a helicoidal member first configuration and a helicoidal member second configuration at a transition temperature, the transition temperature being between 20 C and 37 C. 
     The invention may also provide a method wherein the helicoidal member first and second configurations have different pitches. 
     The invention may also provide a method wherein the helicoidal member has a pitch that varies between the helicoidal member proximal and distal ends. 
     The invention may also provide a method wherein the pitch is larger at the helicoidal member distal end than at the helicoidal member proximal end. 
     The invention may also provide a method wherein the guide is inserted in a deformable sleeve, the sleeve being partially inserted in the suction apertures. 
     In yet another broad aspect, the invention provides a system for performing a surgical procedure in a target biological tissue using a helicoidal member, the helicoidal member defining a helicoidal member longitudinal axis and substantially longitudinally opposed helicoidal member proximal and distal ends, the target biological tissue defining a target tissue exposed surface, the system including: a substantially elongated guide positionable so as to be extending at least partially through the helicoidal member along the helicoidal member longitudinal axis, the guide defining a guide tip and a guide peripheral surface extending substantially longitudinally from the guide tip, the guide peripheral surface having a peripheral surface cooled portion; a cooling subsystem operatively coupled to the guide for selectively cooling the peripheral surface cooled portion to a temperature sufficiently low to cause adhesion between the guide and the target biological tissue; a driver, the helicoidal member being mountable to the driver at the helicoidal member proximal end, the driver being operative for selectively simultaneously rotating the helicoidal member along the helicoidal member longitudinal axis and advancing the helicoidal member along the guide in a distally oriented direction; wherein, in operation, when the cooling subsystem cools the peripheral surface cooled portion and the latter is positioned to abut against the target tissue exposed surface, the peripheral surface cooled portion adheres to the target tissue exposed surface so that the driver can operated to advance the helicoidal member along the guide while driving the helicoidal member into the target biological tissue with the peripheral surface cooled portion remaining fixed relative to the target biological tissue. 
     Advantageously, the present system and method use a guide that can be safely secured to tissue to penetrate so that the helicoidal member can be inserted therein at a predetermined location. The proposed instrument can also be manufactured using known methods and materials at a reasonable cost. 
     The present application claims priority from U.S. Provisional patent applications 62/094,151 filed 19 Dec. 2014 and 62/186,708 filed 30 Jun. 2015 and from PCT patent application PCT/IB2015/059806 filed Dec. 19, 2015, the contents of which is hereby incorporated by reference in its entirety. 
     Other objects, advantages and features of the present invention will become more apparent upon reading of the following non-restrictive description of preferred embodiments thereof, given by way of example only with reference to the accompanying drawings. 
    
    
     
       BRIEF DESCRIPTION FOR DRAWINGS 
       In the appended drawings: 
         FIG. 1 , in a perspective view, illustrates a system in accordance with an embodiment of the present invention; 
         FIG. 2 , in a perspective view, illustrates a helicoidal member part of the system shown in  FIG. 1 ; 
         FIG. 3 , in a perspective view, illustrates an alternative helicoidal member usable in the system shown in  FIG. 1 ; 
         FIG. 4A , in a perspective view, illustrates an alternative guide usable in the system shown in  FIG. 1 ; 
         FIG. 4B , in a transversal cross-sectional view, illustrates the guide shown in  FIG. 4A   
         FIG. 5A , in a perspective view, illustrates another alternative guide usable in the system shown in  FIG. 1 ; 
         FIG. 5B , in a transversal cross-sectional view, illustrates the guide shown in  FIG. 5A ; 
         FIG. 6A , in a perspective view, illustrates yet another alternative guide usable in the system shown in  FIG. 1 ; 
         FIG. 6B , in a transversal cross-sectional view, illustrates the guide shown in  FIG. 6A ; 
         FIG. 7 , in a cut away perspective view, illustrates the guide part of the system shown in  FIG. 1 . 
         FIG. 8 , in a perspective view, illustrates an attachment and an helicoidal member both usable in the system of  FIG. 1 , the helicoidal member being detached from the attachment; 
         FIG. 9A , in a perspective view, illustrates the attachment of  FIG. 8 ; 
         FIG. 9B , in a perspective view, illustrates an alternative attachment; 
         FIG. 9C , in a perspective view, illustrate an alternative helicoidal member usable with the attachment of  FIG. 9B   
         FIG. 10 , in a perspective view, illustrates the attachment and helicoidal member of  FIG. 8  attached to each other; 
         FIG. 11 , in a perspective view, illustrates yet another alternative guide and yet another alternative helicoidal member usable in the system of  FIG. 1 ; 
         FIG. 12 , in a perspective partial view, illustrates the guide and helicoidal member of  FIG. 11 ; 
         FIG. 13 , in a perspective view, illustrates yet another another alternative helicoidal member usable in the system of  FIG. 1 ; 
         FIG. 14 , in a perspective view, illustrates the guide of the system of  FIG. 1  with an insert engaged by the helicoidal member; 
         FIG. 15A , in a side elevation view, illustrates an alternative insert mountable to a guide; 
         FIG. 15B , in a front partial cross-sectional view, illustrates the insert of  FIG. 15A  mounted to a guide; 
         FIG. 16A , in a side elevation view, illustrates an other alternative insert mountable to a guide; 
         FIG. 16B , in a front partial cross-sectional view, illustrates the insert of  FIG. 16A  mounted to a guide; 
         FIG. 17A , in a side elevation view, illustrates yet an other alternative insert mountable to a guide; 
         FIG. 17B , in a front partial cross-sectional view, illustrates the insert of  FIG. 17A  mounted to a guide; 
         FIG. 18A , in a perspective view, illustrates yet another alternative guide usable in a system similar to the system of  FIG. 1 , the present guide using suction to adhere to tissue; 
         FIG. 18B , in a schematic view, illustrate a configuration of suction apertures usable in the guide of  FIG. 18A ; 
         FIG. 18C , in a schematic view, illustrate another configuration of suction apertures usable in the guide of  FIG. 18A ; 
         FIG. 18D , in a schematic view, illustrate yet another configuration of suction apertures usable in the guide of  FIG. 18A ; 
         FIG. 18E , in a schematic transversal cross-sectional view, illustrates yet another alternative guide usable in a system similar to the system of  FIG. 1 ; 
         FIGS. 19A to 19H , in schematic views, illustrate various cross-sectional configuration usable in a guide similar to the guide of  FIG. 18 ; 
         FIG. 20 , in a flowchart, illustrates a method of using the system of  FIG. 1 ; 
         FIGS. 21A to 21C , in schematic views, illustrate successive steps in an annuloplasty procedure performed using the system of  FIG. 1 ; 
         FIGS. 21D to 21F , in schematic views, alternative embodiments of an annuloplasty procedure performed using the system of  FIG. 1 ; 
         FIGS. 22A to 22C , in a schematic top view, illustrate various configurations of helicoidal members usable to perform the annuloplasty procedures shown in  FIGS. 21A to 21F ; 
         FIGS. 23A , in a perspective schematic view, illustrates a prosthesis in the form of a valve leaflet positioned about a valve annulus; 
         FIG. 23B , in a perspective schematic view, illustrates the prosthesis of FIG.  23 A attached to surrounding tissue with the helicoidal member of  FIG. 2 ; 
         FIG. 23C , in a perspective schematic view, illustrates an alternative prosthesis attached to surrounding tissue with the helicoidal member of  FIG. 2 ; 
         FIG. 23D , in a transversal cross-sectional view, illustrates the prosthesis of  FIG. 23A  attached to a guide usable in the system of  FIG. 1 ; 
         FIGS. 23E to 23G , in schematic views, illustrate successive steps in an implantation of a tubular valve performed using a system similar to the system of  FIG. 1 ; 
         FIG. 23H , in a perspective view, illustrates the tubular valve used in the procedure illustrated in  FIGS. 23E to 23G ; 
         FIGS. 24A to 24D , in a schematic side cross-sectional view, illustrate part of the annuloplasty procedure shown in  FIGS. 21A to 21C ; 
         FIG. 24E , in a schematic side cross-sectional view, illustrate an alternative positioning of a guide to perform the annuloplasty procedure shown in  FIGS. 21A to 21C ; 
         FIGS. 25A to 25H , in schematic views, illustrate successive step in a procedure in which the system  10  is used to close a gap between two tissue portions; 
         FIG. 26 , in an exploded view with parts removed, illustrates the system of  FIG. 1 ; and 
         FIG. 27 , in a longitudinal cross-sectional view with parts removed, illustrates the system of  FIG. 1 . 
     
    
    
     DETAILED DESCRIPTION 
     With reference to  FIG. 1 , there is shown a system  10  for performing a surgical procedure in a target biological tissue  12  (shown only schematically in  FIG. 1 ). The target biological tissue  12  defines a target tissue exposed surface  14 . The target tissue exposed surface  14  is either at the surface of a subject on which the surgical procedure is performed, and thus exposed to the environment, or in one of the numerous cavities or vessels present in animals, such as for example and non-limitingly, the interior of the gastro-intestinal system, the blood vessels, cardiac chambers and airways. The target tissue exposed surface  14  may also be at the junction between two adjacent tissues or tissue portions that can move relative to each other at this junction, for example within an incision in a tissue. The target tissue exposed surface  14  is thus any surface that can be accessed to insert something in the bulk of the target biological tissue  12 , and is typically exposed to gases or fluids. 
     The system  10  includes a substantially helicoidal member  16 . As better seen in  FIG. 2 , the helicoidal member  16  defines a helicoidal member longitudinal axis  18  and substantially longitudinally opposed helicoidal member proximal and distal ends  20  and  22 . A helicoidal member passageway  24  extending longitudinally between the helicoidal member proximal and distal ends  20  and  22 . 
     In the present document, the terminology distal and proximal refers to the location relative to an operator (not shown in the drawings) using the system  10 . Distal elements are closer to the target biological tissue  12 , while proximal elements are closer to the operator of the system  10 . This terminology is used to facilitate the description of the system  10  and should not be used to restrict the scope of the present invention. Also, the terminology “substantially” and “about” is used to denote variations in the thus qualified terms that have no significant effect on the principle of operation of the system  10 . These variations may be minor variations in design or variations due to mechanical tolerances in manufacturing and use of the system  10 . These variations are to be seen with the eye of the reader skilled in the art. 
     Returning to  FIG. 1 , the system also includes a substantially elongated guide  26  positionable so as to be extending at least partially through the helicoidal member  16  along the helicoidal member longitudinal axis  18 . Referring to  FIG. 7 , the guide  26  defines a guide tip  28  and a guide peripheral surface  30  extending substantially longitudinally from the guide tip  28 . The guide peripheral surface  30  has a peripheral surface cooled portion  32  covering at least part of the guide peripheral surface  30 . The peripheral surface cooled portion  32  may cover only a small part of the guide peripheral surface  30 , or may include most or all of the guide peripheral surface  30 . 
     Returning to  FIG. 1 , a cooling subsystem  33  is operatively coupled to the guide  26  for selectively cooling the peripheral surface cooled portion  32  to a temperature sufficiently low to cause adhesion between the guide  26  and the target biological tissue  12 . As described in further details hereinbelow, cooling is for example performed using a coolant that is refrigerated and circulated in the guide  26 . In alternative embodiments, the peripheral surface cooled portion  32  is in contact with a Pelletier device that cools the peripheral surface cooled portion  32 . Any other suitable cooling method may also be used to cool the peripheral surface cooled portion  32 , such as for example and non- limitingly, evaporative cooling of a liquid provided in the guide  26 , or by phase change of a material provided in the guide  26  so that it may absorb heat from adjacent tissue. 
     Returning to  FIG. 7 , the helicoidal member  16  is mounted to a driver  34  at the helicoidal member proximal end  20 . The driver  34  is operative for selectively simultaneously rotating the helicoidal member  16  along the helicoidal member longitudinal axis  18  and advancing the helicoidal member  16  along the guide  26  in a distally oriented direction. In some embodiments, the driver  34  is configured so that the helicoidal member  16  is actively advanced while rotated. In other embodiments, the driver  34  is simply free to move longitudinally and is advanced by the helicoidal member  16  as the latter advances in the target biological tissue  12  due to rotation of the helicoidal member  16 . 
     In operation, when the cooling subsystem  33  cools the peripheral surface cooled portion  32  and the latter is positioned to abut against the target tissue exposed surface  14 , the peripheral surface cooled portion  32  adheres to the target tissue exposed surface  14  so that the driver  34  can operated to advance the helicoidal member  16  along the guide  26  while driving the helicoidal member  16  into the target biological tissue  12  with the peripheral surface cooled portion  32  remaining fixed relative to the target biological tissue  12 . 
     More specifically, the guide  26  abuts on the target tissue exposed surface  14  from the side, as opposed from abutting from the guide tip  28 . The helicoidal member longitudinal axis  18  and the target tissue exposed surface  14  are substantially parallel to each other. The peripheral surface cooled portion  32  is from a substantially longitudinally extending portion of the guide  26 . The peripheral surface cooled portion  32  may reach the guide tip  28  or may be spaced apart therefrom longitudinally. Due to its helicoidal shape, rotating the helicoidal member  16  causes the latter advances in the target tissue in a corkscrew-like motion. It was found that, surprisingly, cryoadhesion of the guide  26  provides sufficient adhesion in this configuration to allow driving the helicoidal member  16  into the target biological tissue  12  as described even with the relatively large forces and torques involved in advancing the helicoidal member  16 . 
     The system  10  is particularly useful in surgical procedures that are performed away from the target biological tissue  12 , for example through a laparoscopy, percutaneous or a transcatheter procedure. In this latter case, as see in  FIG. 1 , the system  10  also includes a substantially elongated catheter  36  defining substantially opposed catheter proximal and distal ends  38  and  40  and a catheter lumen  42  (seen in  FIG. 7 ) extending therebetween. The guide  26  protrudes from the catheter lumen  42  at the catheter distal end  40 . However, the present invention may also be used without the catheter  36  when easy access to the target biological tissue  12  exists. 
     The guide  26  is substantially elongated and is typically connected to a guide actuator  44 . The guide actuator  44  extends along the catheter  36  in the catheter lumen  42  to the catheter proximal end  38  and is longitudinally movable therealong. The guide actuator  44  has a rigidity sufficient to be movable substantially longitudinally along the catheter  36  so that the guide  26  protrudes more or less therefrom, but is nevertheless sufficiently flexible to follow the shape of the catheter  36  inside the patient, for example around the vasculature in the case of cardiac interventions. The guide actuator  44  terminates with a guide actuator handle  46  that allows controlling the longitudinal position of the guide  26 . In some embodiments, the guide actuator  44  is substantially tubular with circular transversal cross-section to allow circulation of coolant fluid therethrough, as further described hereinbelow. In some embodiments, the guide actuator  44  and the guide  26  extend integrally from each other. 
     The guide  26  may have any suitable transversal cross-sectional configuration. For example, the guide  26  has a substantially oval transversal cross-sectional configuration, as shown in  FIG. 1 . In other embodiments, as shown for guides  26   a  to  26   c  shown respectively in  FIGS. 4A, 5A and 6A , the guide may have substantially, rectangular, T-shaped or D-shaped, transversal cross-sectional configurations, among other possibilities. These transversal cross-sectional configurations are better illustrated in  FIGS. 4B, 5B and 6B , respectively. In yet another embodiments, shown in  FIGS. 11 to 13 , a guide  26   d  had a substantially circular transversal cross-sectional configurations. For example, D-shaped configuration of guide  26   c  allows a substantially flat peripheral surface cooled portion  32   c , which may contact efficiently substantially flat target tissue exposed surfaces  14 . Also, the T-shaped transversal cross-sectional configuration of the guide  26   b  allows for peripheral surface cooled portion  32   b  having a pair of flat portions  35  spaced apart laterally from each other with a U-shaped portion  37  extending therefrom and therebetween. The U-shaped portion  37  may be inserted in the space between two tissue portions to attach to each other with minimal or no gap therebetween, each of the flat portions  35  abutting against one of the tissue portions. The exact size and cross sectional configuration of the guides  26 ,  26   a ,  26   b ,  26   c  and  26   d  allow control over the depth of insertion of the helicoidal member  16 . 
     In some embodiments, the guide  26  is substantially rigid so that it remains with a substantially constant shape while in use. This shape may be substantially rectilinear or curved, among other possibilities. In other embodiments, the guide  26  is deformable so that its shape can be adjusted (not shown in the drawings). An exemplary deformation is from a linear configuration to an arcuate configuration and is accomplished using mechanical and/ or electrical devices known to those skilled in the art. In these embodiments, the guide  26  may be either entirely deformable, or may have a section thereof that is more deformable than the remainder of the guide  26 . Deformation of the guide  26  may be effected for example by using a tether secured to the guide tip  28  and extending in a distally oriented direction therefrom and returning through the catheter lumen  42 . In other embodiments, the tether is inserted in a separate lumen traversing the guide  26  and guide actuator  44 . The tether and can be pulled onto by the intended user of the system  10  to bend the guide  26 . In other embodiments, one, two or more pairs of laterally opposed cables are secured to the guide tip  28  and extend through the catheter lumen  42  to the catheter proximal end  38 . Pulling on these cables allow bending of the guide  26 , for example using a bending actuator  47 . The guide  26  may also be deformed using any other suitable mechanism. Such mechanisms for remotely adjusting the shape of a member at the end of a catheter are known in the art and are not described in further details herein. 
     In yet other embodiments, when not constrained, the guide  26  achieves a shape suitable for its intended purpose. The guide  26  is however deformable passively to allow for example passage through the catheter  36  as the latter is advanced through a patient&#39;s vasculature. In other words, once deployed adjacent the target biological tissue  12 , the guide  26  achieves the shape required for the specific surgical intervention practiced. However, the guide  26  may deform to allow reaching the target biological tissue, due for examples to curves in the catheter  36 . An example of such a guide  26  may be substantially arc segment shape for use in valve annuloplasty. The guide 26  can be shaped by inserting pre-shaped flexible longitudinal inserts thereinto. 
     Referring to  FIG. 7 , the guide  26  is typically hollow to define a guide cavity  49  thereinto and extends from the guide actuator  44 , which is also hollow typically. The guide cavity  49  is closed at the guide tip  28  by a guide end wall  48 . The guide peripheral surface  30  extends from the guide end wall  48 . The guide  26  is relatively highly thermally conductive at least in the peripheral wall cooled portion  32 . For example, the peripheral wall cooled portion  32  is made of metal or any heat conductive material or combination of heat conductive materials that is in contact with the coolant or that is in contact with any other cooled material. In some embodiments, creating a flexible metallic guide can be made using below type constructions or using a series of metallic rings intertwined by a polymer. 
     The cooling subsystem  33  includes a coolant source  50  (shown in  FIG. 1 ). The coolant source  50  is in a fluid communication relationship with a coolant passageway  52 , seen in  FIG. 7 , for providing cooled coolant thereto. The coolant passageway has a portion thereof substantially adjacent to the peripheral surface cooled portion  32  and in a thermal transfer relationship therewith, The coolant passageway  52  is configured for circulating a coolant therethrough to cool the peripheral surface cooled portion  32 . 
     The coolant source  50  is a conventional device that is used to cool a conventional coolant, such as the those used in cryosurgery. In some embodiments, the temperature to which the coolant is cooled is controlled so that no or only minimal irreversible damages are caused in the target biological tissue  12 . In other embodiments, the target biological tissue  12  may be cooled with some damages without affecting the normal physiology of an organ including the target biological tissue  12 . The coolant source  50  typically also includes a pump to circulate the coolant through the coolant passageway  52 . The coolant can be a liquid or a gas or a change of phase can occur in the guide cavity  49 . 
     In some embodiments, temperature control is made by supplying to the coolant passageway  52  coolant at a predetermined temperature. In other embodiments (not shown in the drawings), the coolant source  50  is operatively coupled to a temperature sensor, such as a thermocouple, at the peripheral surface cooled portion  32  so that the temperature of the latter can be controlled by supplying cooler or warmer coolant to the coolant passageway  52 . 
     In some embodiments, the coolant passageway  52  is formed as follows. A coolant tube  54 , which forms part of the coolant passageway  52 , extends in the guide  26  along a portion thereof. The coolant tube  54  may also extends along the catheter  36  when the latter is provided. The coolant tube  54  is provided with at least one coolant tube outlet  56 , and in some embodiments a series of longitudinally spaced apart coolant tube outlets  56 , located in the guide  26  substantially adjacent the peripheral surface cooled portion  32 . The coolant tube outlets  56  typically extend substantially radially and proximally relative to the peripheral surface cooled portion  32  so as to provide the coolant directly adjacent the peripheral surface cooled portion  32 . The coolant tube  54  has at least a portion thereof that is spaced apart from the guide  26  so that coolant can be circulated from the coolant tube  54 , through the coolant tube outlets  56  and between the coolant tube  54  and the guide  26 . A coolant return passageway  58  is provided for collecting the coolant from the interior of the guide  26  and return it to the coolant source  50  through the catheter  36 . For example, the coolant tube  54  is of an outside diameter that is slightly smaller than an inner diameter of the guide  26  so that when the coolant is forced under pressure in the coolant tube  54 , the coolant can exit the coolant tube through the coolant tube outlets  56  and get to the coolant return passageway  58 . In other cases the coolant tube  54  diameter is much smaller than the inner diameter of the guide  26  to allow for coolant expansion, thus triggering a decrease in temperature. In some embodiments, the coolant tube outlets  56  are substantially adjacent to the peripheral surface cooled portion  32  to provide optimal cooling of the latter. In some examples, the coolant is returned in a dedicated coolant return tube. 
     In alternative embodiments (not shown), the cooling subsystem  33  includes a cooling tube that reaches the interior of the guide  26  and abut against the peripheral surface cooled portion  32 . The cooling tube circulates the coolant in a closed circuit between the guide  26  and the coolant source  50 . 
     In some embodiments, the helicoidal member  16  has the same shape, or substantially the same shape, before and after insertion in the target biological tissue  12 . In other words, the helicoidal member  16  does not deform substantially during insertion. In other embodiments, the helicoidal member  16  includes a shape memory material, for example Nitinol™ and changes between a helicoidal member first configuration and a helicoidal member second configuration at a transition temperature. For example, the transition temperature is between 20 C and 37 C. In some embodiments, the helicoidal member first and second configurations have different pitches. The pitch is defined in the present document as the longitudinal distance covered when advancing along the helicoidal member one full turn about the helicoidal member longitudinal axis  18 . 
     In some embodiments, as seen in  FIG. 1 , the pitch of the helicoidal member  16  is constant along the whole helicoidal member  16 . In other embodiments, the helicoidal member  16   a  has a pitch that varies between the helicoidal member proximal and distal ends  20  and  22 , as seen in  FIG. 3 . In such embodiments, the pitch may be larger at the helicoidal member distal end  22  than at the helicoidal member proximal end  20 . This configuration provides a compression of the target biological tissue  12  as the helicoidal member  16  is advanced thereinto. The helicoidal member distal end  22  sharpness is varied depending on target biological tissue  12  properties. 
     The helicoidal member  16  may be metallic. The helicoidal member  16  may be biodegradable. Also, in some embodiments, the helicoidal member  16  may be provided with small tins on its surface or finishing that increases the friction with surrounding target biological tissue  12 . 
     As seen for example in  FIG. 7 , the driver  34  includes an attachment  60  for holding the helicoidal member  16 , a driver actuator  62  for selectively rotating the driver  34 . The driver actuator  62  terminates typically with a driver handle  64  opposed to the attachment  60 . When the catheter  36  is present, the driver actuator  62  extends thereinto with the driver handle  64  protruding therefrom. For example, the driver actuator  62  includes is a substantially elongated tube through which the guide  26  and part of the guide actuator  44  are inserted. The attachment  60  and guide actuator  62  may extend integrally from each other or be two separate components permanently or reversibly secured to each other. The guide  26 /guide actuator  44  assembly and the driver actuator  62  are longitudinally movable relative to each other. In some embodiments, the driver actuator  62  includes a braided or coiled catheter to allow good torque transfer to the helicoidal member  16 . 
     In some embodiments, as shown in  FIG. 1 , the helicoidal member  16  is permanently secured to the driver  34 , for example by extending integrally therefrom. In other embodiments, as seen in  FIGS. 8 to 10 , the helicoidal member  16  is selectively detachable from the driver  34   a . A specific embodiment of this latter case is further described in the following paragraphs. 
     In this embodiment, the driver  34   a  includes a driver lock  66  movable between a locked configuration (seen in  FIG. 10 ) and an unlocked configuration (seen in  FIG. 8  with the helicoidal member  16  detached from the driver  34   a ). In the locked configuration, the helicoidal member  16  is locked to the driver  34   a . In the unlocked configuration, the helicoidal member  16  is detachable from the driver  34   a.    
     For example, as better seen in  FIG. 9A , the attachment  60   a  defines an attachment passageway  70  opened distally at an attachment passageway distal end  72 . A substantially helicoidal thread  74  extends into the attachment passageway  70  from attachment passageway distal end  72 . The helicoidal thread  74  is configured and sized for receiving part of the helicoidal member  16  or  16   a  (not shown in  FIG. 9A ) at the helicoidal member proximal end  20 . For example, the helicoidal thread  74  has a configuration complementary to that of the helicoidal member  16  or  16   a  at the helicoidal member proximal end  20  to substantially snugly hold the helicoidal member  16  in the attachment passageway  70 . 
     The driver lock  66  can be any suitable lock that can prevent detachment of the helicoidal member  16  from the attachment  60   a . In some embodiments the helicoidal member  16  or  16   a  is provided with at least one notch  76  (better seen in  FIG. 3 ) substantially longitudinally extending substantially adjacent the helicoidal member proximal end  20  and the driver lock includes a pin (or rigid wire)  78  (seen in  FIGS. 8  an  10 ) insertable in the notch  76  when the helicoidal member  16  is operatively secured to the driver  34  in the helicoidal thread  74 . The pin  78  is selectively removable from the notch  76 . Removal of the pin  78  from the notch  76  unlocks the helicoidal member  16 , which can then be removed by rotating the attachment  34   a  and helicoidal member  16  relative to each other. 
     There may be more than one notch  76  provided, all longitudinally aligned along the helicoidal member  16 . For example, the notches  76  are provided at the periphery of the helicoidal member  16  and a substantially rectilinear and substantially longitudinally extending pin receiving passageway  80  may extend in the attachment  60   a , as seen in  FIG. 9A . The pin receiving passageway  80  receives the pin  78  thereinto and intersects the helicoidal thread  74  in register with the position of the notches  76  when the helicoidal member  16  is operatively secured to the attachment  60 . The pin  78  is longitudinally movable along the pin receiving passageway  80 . 
     Removal of the pin  80  from the pin receiving passageway  78  may be performed in any suitable manner. For example, a wire  82  (seen in  FIG. 10 ) is secured to the pin  80  and extends in the catheter  36 . The pin  80  is removable from the pin receiving passageway  78  by pulling on the wire  82 . 
     In another embodiment, as seen in  FIG. 9B , the attachment  60   b  is substantially tubular with circular cross-sectional configuration and defines an attachment passageway  70   b  opened distally through which the guide  26  (not seen in  FIG. 9A ) can pass. A substantially helicoidal thread  74   b  is formed on the outer peripheral surface  75  of the attachment  60   b  and extends from the attachment distal end  72   b . The helicoidal thread  74   b  is configured and sized for receiving part of an alternative helicoidal member  16   c  (seen in  FIG. 9C ) at the helicoidal member proximal end  20 . The helicoidal member  16   c  is similar to the helicoidal member  16 , except that the notches  76  face inwardly. For example, the helicoidal thread  74   b  has a configuration complementary to that of the helicoidal member  16   c  at the helicoidal member proximal end  20  to substantially snugly hold the helicoidal member  16   c . A pin  78  (not shown in  FIG. 9B ) is insertable in a pin receiving passageway  80   b  that intersects the helicoidal thread  74   b  and locks the helicoidal member  16   c  to the attachment  60   b , similarly to the manner in which the helicoidal member  16  is locked to the attachment  60   a.    
       FIGS. 26 and 27  better illustrate various features of the system  10  at the proximal end thereof. In some embodiments, a catheter end piece  128  receives the catheter  36  at the catheter proximal end  38 . The catheter end piece  128  defines an end piece passageway  129  (seen in  FIG. 27 ) that is in prolongation of the catheter lumen  42 . The end piece passageway  129  is threaded internally. The catheter end piece  128  is mountable to a base  130  in any suitable manner. The base  130  defines an end piece mount  132  for removably mounting the catheter end piece  128  thereto. The end piece mount  132  defines a mount aperture  134  extending therethrough in register with the end piece passageway  129 . 
     The driver actuator  62  is substantially tubular and provided with external threads  136  configured for engaging the threads of the end piece passageway  129  and is long enough to protrude from the catheter end piece  128  and end piece mount  132  when inserted in the catheter  36 . Rotating the driver actuator  62  thus advances or retracts the driver actuator  62  along the catheter  36  over the guide actuator  44 . 
     When the system  10  is assembled, the coolant tube  54  is inserted in the guide actuator  44 , which itself is inserted in the driver actuator  62 , which itself is inserted in the catheter  36 . Those components typically have a generally cylindrical configuration and in embodiments in which it is required, are flexible so as to allow bending of the catheter  36  and components contained therein. The coolant source  50  is coupled to the coolant tube  54  and guide actuator  44  through a coupler  140 , which may support the bending actuator  47  when the latter is present. The coupler  140  is typically easily releasable from the coolant tube  54  and the guide actuator  44  through a quick release coupler  142 . This allows easy removal of the driver actuator  62  to insert different helicoidal members  16  during a surgical procedure. The coupler  140  is also configured to suitably convey the coolant returning between the coolant tube  54  and guide actuator  44  to the coolant source  50  and convey the cold coolant coming from the latter to the coolant tube  54 . 
     Referring to  FIG. 11 , in some embodiments a hook  88  is removably mountable to the helicoidal member  16   b . A suture thread  86  is secured to the hook  88 . For example the hook  88  is crimped to the end of the suture thread  86 . In other embodiments (not shown in the drawings), the hook  88  defines a suture eye and a suture thread  86  is attachable to the suture eye. In some embodiments, the helicoidal member  16   b  is made of a hollow tube and the suture thread  86  extends through the helicoidal member  16   b . The hook  88  has a part thereof insertable in the hollow tube at the helicoidal member distal end  22 . For example, a hook attachment  89  part of the hook  88  is configured to be slidably inserted in the helicoidal member  16   b . The hook  88  is typically terminated by a sharp point  90 , as better seen in  FIG. 12 . In other embodiments, the helicoidal member  16   c , seen in  FIG. 13 , defines a helicoidal groove  91  therealong receiving the suture thread  86 . 
     The hook  88  is configured so that the helicoidal member  16   b  may be advanced relatively easily in the target biological tissue  12  with the hook  88  remaining secured to the helicoidal member  16   b . The hook  88  is also configured so that withdrawing the helicoidal member  16   b  from the target biological tissue  12  causes the latter to catch the hook  88  so that the hook  88  is detached from the helicoidal member  16   b  or  16   c  as the target biological tissue  12  pulls on the hook  88 . In these embodiments, the driver  34  is further operative for retracting the helicoidal member  16   b  in a proximally oriented direction. 
     In some embodiments, the system  10  further includes an insert. Four different inserts  92   a ,  92   b ,  92   c  and  92   d  are shown in  FIGS. 14, 15A  and B,  16 A and B and  17 A and B respectively. However, any other suitable insert is usable. The inserts  92   a ,  92   b ,  92   c  and  92   d  are elements that are mountable to the guide  26  and engaged by the helicoidal member  16 . The inserts  92   a ,  92   b ,  92   c  and  92   d  and the guide  26  are longitudinally movable relative to each other. The inserts  92   a ,  92   b ,  92   c  and  92   d  are elements that are delivered along with the helicoidal member  16  so that when the helicoidal member  16  remains in the target biological tissue  12 , the helicoidal member  16  engages the insert  92   a ,  92   b ,  92   c  and  92   d , which is thus attached at the target tissue exposed surface  14  after the helicoidal member  16  has been delivered and detached from the driver  34 . Such inserts  92   a ,  92   b ,  92   c  and  92   d  may be used to secure a prosthesis to the target biological tissue  12  or simply to provide a smoother interface and/or biocompatibility between the helicoidal member  16  an adjacent lumen or cavity. Smoothening is advantageous for example in blood vessels or in the heart as this will reduce turbulence around the helicoidal member  16 . This smooth insert outer line would also promote endothelial cells build up. In other embodiments, the insert  92   a ,  92   b ,  92   c  and  92   d  may be used to deliver a drug or cells at the target biological tissue  12 . The insert  92   a ,  92   b ,  92   c  and  92   d  can then have the drug or cells embedded therein and be permeable to the drug or be bioresorbable. Such inserts  92   a ,  92   b ,  92   c  and  92   d  may facilitate permanent implantation of the helicoidal member  16  in the target biological tissue  12  by promoting healing and/or tissue growth. 
     Referring to  FIG. 14 , the insert  92   a  includes a substantially resiliently deformable piece of material  94   a  provided opposed to the peripheral surface cooled portion  32  and extending along the guide  26 . For example, the insert  92   a  is made of a foam and may have a length that is larger than that of the helicoidal member  16 , as seen in  FIG. 14 , or that is similar or shorter to that of the helicoidal member  16  (not shown in the drawings). The insert  92   a  has a shape that allows snugly fitting to the guide  26  and the helicoidal member  16  is inserted through the insert  92   a . Rotation of the insert  92   a  about the longitudinal axis of the guide  26  is prevented by the non-cylindrical shape of the guide  26 . In some embodiments, the insert  92   a  is slightly compressed when mounted on the guide  26  to further prevent such rotation or the insert  92   a  can be secured to guide  26  with adhesive and is dislodged by force after the helicoidal member  16  penetrates the sleeve insert  92   a . Thus, in some embodiments, the guide  26  with insert  92   a  secured thereto are first positioned, without the helicoidal member  16  engaging the insert  92   a , and then the helicoidal member  16  is advanced, thus engaging the the insert  92   a.    
     In some embodiments, a distally provided tether attachment  95  is provided for attaching a tether  97  to the insert  92   a . In other embodiments, the tether  97  extends integrally from the insert  92   a.    
     Referring to  FIG. 15A , the insert  92   b  includes a substantially tubular membrane  94   b  positioned over the guide peripheral surface  30 . The membrane  94   b  is provided with apertures  96  in register with the peripheral surface cooled portion  32  of the guide  26   e  to allow adhesion. The guide  26   e  is similar to the guide  26 , but includes a substantially flat peripheral surface cooled portion  32  The membrane  94   b  is typically longer than the helicoidal member  16 . In some embodiments, the insert  94   b  is provided with a body  99   b  made of a substantially resiliently deformable material, as seen in  FIG. 15B  that can be engaged by the helicoidal member  16  (not shown in  FIG. 15B ). 
     Another type of insert  92   c  is shown in  FIGS. 16A and 16B . As seen in  FIG. 16B , the guide  26   f  usable with the insert  92   c  defines a pair of substantially longitudinally extending mounting grooves  100 , opposed to the peripheral surface cooled portion  32 . The insert  92   c  defines a pair of substantially longitudinally extending mounting rods  102  each mounted in a respective one of the mounting grooves  100 , thus securing the insert  92   c  to the guide  26   f . The insert  92   c  can be also engaged by the helicoidal member  16 . 
       FIGS. 17A and 17B  illustrate the insert  92   d . As seen in  FIG. 17B , the insert  92   d  includes a membrane  94 d positionable opposed to the peripheral surface cooled portion  32  and through which the helicoidal member  16  (not shown in  FIG. 17B ) can be inserted. The insert  92   d  includes attachment loops  98  securing the membrane  94 d to the guide  26   e , the attachment loops  98  extending circumferentially around the guide  26   e  at longitudinally spaced apart positions therealong. 
       FIG. 18A  illustrates an alternative guide  106 . The guide  106  is similar to the guide  26 , except that adhesion with the target tissue exposed surface  14  is made though suction. As such, in a system including the guide  106 , the cooling subsystem  33  is omitted and the guide  106  is hollow and provided with radially extending suction apertures  108 . The guide  106  may be connected to a conventional suction apparatus  113  so that suction can be selectively exerted through the suction apertures  108 . Such suction adheres the portion of the guide adjacent the suction apertures  108  to any surface adjacent thereto. In other embodiments, a suction apparatus is not provided. Instead, each suction aperture  108  leads to an enclosed deformable cavity. Deforming the cavity to increase its volume then provides suction. 
     The guide  106  and suction apertures  108  can have various configurations. For example, a guide  106   a  including a series of longitudinally spaced apart suction apertures  108   a  having a substantially ellipsoidal shape is shown schematically in  FIG. 18B . A guide  106   b  including a series of longitudinally spaced apart suction apertures  108   a  having a substantially rectangular shape is shown schematically in  FIG. 18B . A guide  106   c  including an array of spaced apart suction apertures  108   c  having a substantially circular shape is shown schematically in  FIG. 18D . 
     The transversal cross-sectional configuration of the guide  106  can also have various shapes. The guide  26  may also be replaced by guides having such transversal configurations.  FIGS. 19A to 19H  illustrate schematically such transversal cross-sectional configurations. The suction surface  109  is the surface of the guide  106  through which the suction apertures  108  extend.  FIG. 19A  illustrates a guide  106   d  having a substantially trapezoidal suction surface  109   d .  FIG. 19B  illustrates a guide  106   e  having a substantially T-shaped suction surface  109   e .  FIG. 19C  illustrates a guide  106   f  having a substantially flat suction surface  109   f , the guide  106   f  having a substantially rectangular transversal cross-sectional configuration.  FIGS. 19D and 19E  illustrate respectively guides  106   g  and  106   h  having a substantially flat suction surfaces  109   g  and  109   h , the guides  106   g  and  106   h  having a transversal cross-sectional configuration corresponding to a portion of a disc.  FIG. 19F  illustrates a guide  106   i  having a substantially arc segment shaped suction surface  109   i , the guide  106   i  having a substantially circular transversal cross-sectional configuration. The guide  106   j  of  FIG. 19  includes two elements. The larger element, with a generally half-moon shaped transversal cross-sectional configuration may be structural and support a smaller element of similar configuration, but flipped so as to define an arc segment shaped suction surface  106   j .  FIG. 19H  illustrates a guide  106   k  having a substantially arc segment shaped and convex suction surface  109   k , the guide  106   k  having a transversal cross-sectional configuration corresponding to a portion of a disc. Other shapes for the guide  106  are also within the scope of the invention. 
       FIG. 18E  illustrates another embodiment of a guide  106   a  using suction to adhere to the tissue exposed surface  14 . The guide  106   a  is hollow and provided with the suction apertures  108 . The guide  106   a  is in communication with a suction apparatus  113  (not shown in  FIG. 18E , as in the guide  106 . A sleeve  111  covers the guide  106   a . The sleeve  111  is deformable and at least partially inserted in the suction apertures  108 . The sleeve  111  may be sealed around the guide  106   a , or only sealed at the edge of each suction aperture  108 . The sleeve  111  prevents biological material from entering the guide  26   g . When the sleeve  111  is completely sealed around the guide  106   a , sterilization of the guide  106   a  is also facilitated. 
     The system  10  is usable in many surgical procedures. For example, the system  10  is usable to maintain in contact two sides of an incision to promote healing of the incision. To that effect, the helicoidal member  16  may be inserted so that it intersects both sides of the incision and is then left in the target biological tissue  12  after being detached from the driver  34 . In other embodiments, the helicoidal member  16   b  is used to thread the suture thread  86  between the two sides of the incision and is then withdrawn with the hook  88  remaining anchored in the target biological tissue  12 . After withdrawal, one can pull on the suture thread to close the incision. In another example, the system  10  is also usable in any procedure in which an anchor similar to the helicoidal member  16  is to be implanted. Such procedures include implantation of the anchor alone in the target biological tissue  12  , or to anchor a prosthesis to the target biological tissue  12  , such as a cardiac valve. The system  10  is for example usable to implant the helicoidal member  16  in an annuloplasty procedure or to implant a replacement cardiac valve. 
     Generally speaking, referring to  FIG. 20 , the invention provides a surgical method  200  using one of the guides  26 ,  26   a ,  26   b ,  26   c ,  26   d ,  26   e  or  26   f  or  106 , or any other suitable guide, to assist in insertion of one of the helicoidal members  16 ,  16   a  or  16   b  in a target biological tissue  12 . For ease of reference and to improve readability, the method  200  will be described with reference to the helicoical member  16  and guide  26  only, with the understanding that other guides, described or not in the present application, and other helicoidal members, described or not in the present application, may be used. The method  200  starts at step  205  and includes step  210  of abutting a substantially longitudinally extending portion of the guide  26  against the target tissue exposed surface  14  with the helicoidal member  16  mounted thereto so that at least a portion of the guide  26  is inserted in the helicoidal member passageway  24  substantially parallel to the helicoidal member longitudinal axis  18 . The method  200  also includes step  215  of adhering the substantially longitudinally extending portion of the guide  26  to the target tissue exposed surface  14  and step  220  of advancing the helicoidal member  16  in the target biological tissue  12  in a substantially helicoidal movement with the guide  26  remaining substantially fixed relative to the target biological tissue  12 . Finally the method  200  also includes in some embodiments step  225  of completing the procedure and ends at step  230 . 
     Step  225  depends on the exact surgical procedure performed. In some embodiments, step  225  includes detaching the helicoidal member  16  from the driver  34  so that the former remains implanted in the target biological tissue  12  and detaching the guide  26  from the target tissue exposed surface  14  with the helicoidal member  16  remaining in the target biological tissue  12 . In some embodiments, step  225  also includes delivering the insert  92   a ,  92   b ,  92   c  or  92   d  while advancing the helicoidal member  16  so that when the helicoidal member  16  remains in the target biological tissue  12 , the insert  92   a ,  92   b ,  92   c  or  92   d  engaging the helicoidal member  16  to be secured to the target biological tissue  12 . 
     In other embodiments, step  225  includes withdrawing the helicoidal member  16   b  from the target biological tissue  12  so that the hook  88  hooks the target biological tissue  12  and the suture thread  86  remains in the target biological tissue  12 . In these embodiments, the helicoidal member  16   b  is used to insert the suture thread  86  in a helicoidal configuration in the target biological tissue  12 . Step  225  may then also include pulling on the suture thread  86  to tighten the suture thread  86 . This action may compress parts of the target biological tissue  12 . This action may also bring together two sides of an incision or other opening in the target biological tissue  12 . 
     Step  210  may include many actions. For example, in the case of transcatheter procedures, step  210  includes positioning the catheter  36  in a conventional manner at a location suitable to perform the transcatheter procedure and then inserting the guide  26  with the helicoidal member  16  positioned at least partially thereonto through the catheter  36  so that the guide  26  is adjacent to the target tissue exposed surface  14 , at a predetermined location. Then, the catheter  36  can be moved to cause contact between the target tissue exposed surface  14  and the guide  26 . This procedure can be guided in a conventional manner, for example through 3D echocardiography and fluoroscopy. In some embodiments, the guide  26  may be provided with a sensor, such as a force sensor or electrical sensor, among other possibilities to detect contact with the target tissue exposed surface  14 . In some embodiments, step  210  also includes adjusting the shape of the guide  26  before adhering the substantially longitudinally extending portion of the guide  26  to the target tissue exposed surface  14 . 
     In some embodiments, the guide  26  is used for cryoadhesion. In this method, adhering the substantially longitudinally extending portion of the guide  26  to the target tissue exposed surface  14  includes cooling at least part of the guide  26  to a predetermined temperature, using the cooling subsystem  33 . The predetermined temperature is low enough to cause cryoadhesion between the substantially longitudinally extending portion of the guide  26 , in this case part of the peripheral surface cooled portion  32 , and the target tissue exposed surface  14 . In some embodiments, the predetermined temperature is low enough to allow cryoadhesion, but remains high enough and is applied for a duration short enough that substantially no irreversible physiological damages are caused to the target biological tissue  12 . In other embodiments, some irreversible physiological damages may be caused to the target biological tissue  12 . For example the predetermined temperature is between 0 and −40° C., or between −20 and −40° C. 
     Depending on the procedure to perform, the helicoidal member  16  may be distally located relative to the longitudinally extending portion of the guide  26 , proximally located relative to the longitudinally extending portion of the guide  26  or at least partially in register with the longitudinally extending portion of the guide  26 . In some embodiments, the helicoidal member  16 ,  16   a  or  16   b  and guide  26  have substantially similar lengths and are substantially in register with each other. 
     In other embodiments, the guide  106  is used and adhering the substantially longitudinally extending portion of the guide  106  to the target tissue exposed surface  14  includes exerting a suction through the suction apertures  108 , thus abutting the suction surface  109  against the target tissue exposed surface  109 . In yet other embodiments, a guide similar to the guide  106  is used to inject through apertures similar to the suction apertures  108  a temporary glue or polymer that adheres with tissues. 
     In some embodiments, the method  200  is performed during an annuloplasty procedure, as illustrated schematically in the sequence of  FIGS. 20A to 20E  and described in further details hereinbelow. In such embodiments, the target biological tissue  12  is a valve annulus  110  and/or tissue adjacent the valve annulus  110 , for example a mitral valve annulus  110 . In a specific embodiment, annuloplasty includes implanting at least two of the helicoidal members  16  around the valve annulus  110  and tightening the valve annulus  110  by pulling the at least two helicoidal members  16  towards each other, As illustrated in  FIGS. 22B and 22C . The helicoidal member  16  then has the same shape before and after insertion in the target tissue. In yet other embodiments, as illustrated in  FIG. 22A , the helicoidal member  16  goes around the whole valve annulus  110  in a closed loop, or partially around the valve annulus  110  in an arc segment shape, and tightening the valve annulus includes reducing a radius of curvature of the helicoidal member  16 . 
     In other embodiments, the helicoidal members  16  do not require pulling as they inherently allow tightening of the valve annulus  110 . In one such embodiment, the helicoidal member  16  includes a shape memory material and changes between a helicoidal member first configuration and a helicoidal member second configuration at a transition temperature, the transition temperature being between 20° C. and 37° C. The helicoidal member first and second configurations have different pitches. In the case of annuloplasty, the helicoidal member second configuration may have a smaller pitch than the helicoidal member first configuration. In another example, the helicoidal member  16   a  is used. The helicoidal member  16   a  has a pitch that varies between the helicoidal member proximal and distal ends  20  and  22 . For example, the pitch is larger at the helicoidal member distal end  22  than at the helicoidal member proximal end  20 . In such embodiments, threading the helicoidal member  16   a  will compress the tissue to tighten the valve annulus. 
     A specific case of the method  200  used for installing an anchor or a suture around the mitral valve annulus  110  and cinching the latter to reduce its size are shown schematically from a top view in  FIGS. 21A to 21C . At first, as shown in  FIG. 21A , the guide  26  is shaped and positioned to match the mitral valve annulus  110  shape and position, corresponding to step  210 . Once in place, as seen in  FIG. 21B , adhesion is activated and the anchor, in the form of the helicoidal member  16 , is advanced over the guide  26  plunging into tissue, corresponding to steps  215  and  220 .  FIG. 21C  illustrates an embodiment in which a wire  112  is pre-attached to the guide  26 . When the guide  26  is removed the wire  112  tethers through the helicoidal member passageway  24 . Once both end of wire  112  are accessible, they are tightened and tension is maintained by a locking clip  115  that is advanced over a loop of the wire  112  passing through the helicoidal member  16 . This effectively shrinks the radius of curvature of the helicoidal member  16  and in consequence the orifice size for the valve. 
     In other embodiments, as seen in  FIGS. 21D and 21E , the wire  112  has a clip  115  at its free extremity that prevents the wire end to go through the helicoidal member  16  (by being too large to enter the helicoidal member passageway  24  thus allowing to cinch the helicoidal member  16  by only pulling on one end of the wire 112 . In some cases to reduce any gaps that can persist between wire  112 , helicoidal member  16  and target biological tissue  12 , a bigger wire diameter is used with an expansion capabilities provided by foam type material. This reduces possible blood damage created by sharp edges and small gaps. In yet another embodiment, as seen in  FIG. 21F , the helicoidal member  16   b  is removed, leaving in place the suture thread  86  and hook  88  running along the path of anchoring. When the suture thread  86  is pulled, the same area reduction as in  FIGS. 21A to 21E  may be achieved, albeit with less parts remaining inside the patient. 
     In other embodimends, the wire that tightens the helicoidal members  16  doesn&#39;t form a loop, so each helicoidal members  16  can be tightened individually, i.e. the wire is attached to the distal end of an insert  92   a  to  92   d , and a pull on the proximal end of the wire with a locking clip will reduce the size of the wire thus reducing the size of the helicoidal member  16 . 
       FIGS. 24A to 24D  illustrate some steps of this process in a different orientation, with the guide  26  viewed head on. In  FIG. 24A , the guide  26  is positioned adjacent to the mitral valve annulus  110 . Then, as shown in  FIG. 24B , the guide  26  is adhered to the mitral valve annulus  110  and the helicoidal member  16  is advanced on the guide  26 , as shown in  FIGS. 24C and 24D .  FIGS. 24A to 24D  illustrate the guide  26  positioned in the atrium. As shown in  FIG. 24E , the guide  26  may also be positioned in the ventricle. 
       FIGS. 23A to 23D  illustrate the attachment of a prosthesis in the form of a valve  114  (shown in  FIG. 23A  for example) or  114   a  (shown in  FIG. 23C  for example) at the valve annulus  110 . The valves  114  and  114   a  are typically secured the the valve annulus  110  while the biological defective valve is left in place. However, in other embodiments, the biological defective valve may be removed before the valve  114  or  114   a  is attached. 
     Referring to  FIG. 23D , the valve  114  includes a valve leaflet  116  secured to a leaflet support  118 . The leaflet support  118  has for example a substantially ellipsoidal transversal cross-sectional configuration and is substantially elongated. The leaflet support  118  may be provided, in some embodiments, with a central wire  120  usable to adjust its shape prior or after implantation. The leaflet support  118  is secured to a guide  26   e  defining a substantially flat valve supporting surface  122 , opposed to the peripheral surface cooled portion  32 . The leaflet support  118  also defines a substantially flat leaflet support attachment surface  124  facing the valve supporting surface  122  and secured thereto in any suitable manner, for example through a relatively weak adhesive or by using a few spaced apart circular wires going around the guide  26   e  (not shown in the drawings), among other possibilities. 
     As shown in  FIG. 23A , the valve  114  is positioned substantially adjacent the valve annulus  110 , for example in the atrium. The guide  26   e  has been omitted from  FIG. 23A  but is usually present. In some embodiments, two guides  26   e  are used to anchor the leaflet support  118  from both ends thereof simultaneously, each with a respective helicoidal member  16 . However, using a single helicoidal member  16  is also within the scope of the invention. Once the valve  114  is suitably positioned, the helicoidal member(s)  16  is (are) advanced over the leaflet support  118  and into the tissue adjacent the valve annulus  110 . The resulting configuration is illustrated schematically in  FIG. 23B . In other embodiments, a tubular valve  114   a , partially shown in  FIG. 23C  is used instead, but the remainder of the process is similar to the process described for valve  114 . 
     More specifically, referring to  FIG. 23E , a pair of guides  26  arcing in opposed directions are positioned adjacent the valve annulus  110 . Then, the tubular valve  114   a  is positioned over the pre-existing valve, and the helicoidal members  16  are each advanced over a respective guide  26  to anchor the valve  114   a  to the adjacent tissue, as seen in  FIG. 23F . Finally, as seen in  FIG. 23G , the guides  26  are removed with the helicoidal members  16  remaining anchored in the patient. The tubular valve  114   a  is better seen in  FIG. 23H . For delivery, the tubular valve  114   a  is rolled to form a generally annular shape and then folded in half with each half secured to a respective guide  26 . When exiting the catheter  36 , the guides  26  deploy, forming the shape shown in the drawings and the valve  114   a  unrolls. 
     In yet another example, placating two pieces of tissue together by means of the system  10  is illustrated schematically in  FIGS. 25A to 25H . In this embodiment, the hook  88  and suture thread  86  are used. The guide  26  is first suitably positioned and adhered to the target biological tissue  12 , in this case between two tissue portions  13 , and the helicoidal member  16   b  is advanced over both tissue portions  13 , as seen in  FIGS. 25A and 25B . Then, the helicoidal member  16   b  is withdrawn leaving in place the suture thread  86 , as see in the sequence of  FIGS. 25C, 25D and 25E . Subsequently, the guide  26  is removed and the continuous suture thread  86  is left in place, as seen in  FIG. 25F . To further reduce and eliminate any distance therebetween and secure both tissue portions  13  to each other, the suture thread  86  is pulled on as illustrated in  FIGS. 25G and 25H . 
     The system  10  is manufactured using materials commonly used in the biomedical industry, such as stainless steel and polymers. 
     Although the present invention has been described hereinabove by way of preferred embodiments thereof, it can be modified, without departing from the spirit and nature of the subject invention as defined in the appended claims.