Patent Publication Number: US-9848866-B2

Title: System for implanting an implantable penile prosthetic

Description:
SUMMARY 
     One aspect provides a system for implanting an implantable penile prosthetic. The system includes a tool and a suture connected to a needle. The tool includes a tube extending between a handle portion and a distal end, and a bore formed in the tube. The bore forms a first opening at the distal end of the tube and a second opening located proximal of the distal end of the tube. A suture slide communicates with the bore and has a curved surface formed between an exterior surface of the tube and the bore of the tube. A first suture is attached to a proximal portion of a needle, with the needle inserted in the bore. A pointed distal end of the needle is closer to the first opening than to the second opening of the tube, and a segment of the first suture is inserted in the bore and alongside the needle. The first suture is in contact with the suture slide, and a proximal portion of the first suture extends out of the bore at the suture slide. The suture slide is located distal of the proximal portion of the needle that is retained in the bore. The system is configured such that tension applied to the first suture ejects the pointed distal end of the needle out of the distal end of the tube. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings are included to provide a further understanding of embodiments and are incorporated into and a part of this specification. The drawings illustrate embodiments and together with the description serve to explain principles of embodiments. Other embodiments and many of the intended advantages of embodiments will be readily appreciated as they become better understood by reference to the following detailed description. The elements of the drawings are not necessarily to scale relative to each other. Like reference numerals designate corresponding similar parts. 
         FIG. 1  is a perspective view of one embodiment of a system for implanting an implantable penile prosthetic including a needle and a tool. 
         FIG. 2  is a side cross-sectional view of one embodiment of the tool illustrated in  FIG. 1 . 
         FIG. 3  is a top cross-sectional of the tool illustrated in  FIG. 2 . 
         FIG. 4  is a perspective view of the system illustrated in  FIG. 1  with the needle and a segment of suture inserted into the tool. 
         FIG. 5  is a cross-sectional view of the system illustrated in  FIG. 4  during implantation of a penile prosthetic. 
         FIG. 6  is a cross-sectional view of the system illustrated in  FIG. 5  with the needle ejected out of the bore of the tool. 
         FIG. 7  is a side cross-sectional view of one embodiment of a system for implanting an implantable penile prosthetic. 
         FIG. 8  is a cross-sectional view of one embodiment of a system with two sutures useful for implanting an implantable penile prosthetic. 
         FIG. 9  is a cross-sectional view of the system illustrated in  FIG. 8  including a first suture coupled between a penile prosthetic and a needle and a second suture extending away from the needle. 
         FIG. 10  is a cross-sectional view of the system illustrated in  FIG. 9  with tension applied to the first suture to eject needle out of the bore of the tool and the second suture located in the bore of the tool. 
         FIG. 11  is a cross-sectional view of the system illustrated in  FIG. 10  with the first suture and the prosthetic removed from the tool and the second suture employed to retract the needle back into the tool. 
         FIG. 12  is a perspective view of one embodiment of a system for implanting an implantable penile prosthetic. 
         FIG. 13  is a cross-sectional view of the tool of the system illustrated in  FIG. 12 . 
         FIG. 14  is a perspective view of the system illustrated in  FIG. 12  with a needle inserted into the tool and prepared for implantation of an implantable penile prosthetic. 
         FIG. 15  is a perspective view of one embodiment of a system for implanting an implantable penile prosthetic including a needle and a tool. 
     
    
    
     DETAILED DESCRIPTION 
     In the following detailed description, reference is made to the accompanying drawings. The drawings form a part of this specification and illustrate exemplary embodiments for practicing the invention. Directional terminology, such as “top,” “bottom,” “front,” “back,” “leading,” “trailing,” etc., is used with reference to the orientation of the Figure(s) being described. Because components of embodiments can be positioned in a number of orientations, the directional terminology is used for purposes of illustration and is in no way limiting. It is to be understood that other embodiments may be utilized and structural or logical changes may be made without departing from the scope of the invention. The detailed description describes examples for practicing the invention and is not to be read to limit the scope of the invention. The scope of the invention is defined by the attached claims. 
     Embodiments, and features of the various exemplary embodiments described in this application, may be combined with each other (“mixed and matched”), unless specifically noted otherwise. 
     End means endmost. Relative to an observer, for example a surgeon, a distal end is the furthest endmost location of a distal portion of a thing being described, whereas a proximal end is the nearest endmost location of a proximal portion of the thing being described. The portion next to or adjacent to an end is an end portion. 
     An implanted penile prosthetic has proven useful in treating erectile dysfunction in men. One acceptable implantable penile prosthetic includes two inflatable cylinders implanted in the penis, a pump implanted in the scrotum or other internal space of the body, and a liquid holding reservoir implanted in the abdomen or other internal space of the body. 
     In an implantation procedure, the penis of the patient is incised in a corporotomy to expose a pair of corpora cavernosa that are aligned axially in a side-by-side orientation within the penis. A cutting implement, such as a curved Mayo scissors, is employed to penetrate the fascia of the penis and form an opening accessing each corpora cavernosum. Subsequently, each corpora cavernosum is dilated (opened) with an appropriate dilation tool to form a recess that is sized to receive one of the two cylinders of the penile prosthetic. Thereafter, a tool (referred to by surgical practitioners as a “Furlow” introducer) is inserted into each dilated corpora cavernosum to measure a length of the penis distally and proximally to determine a desired length of the cylinders to be implanted. A cylinder of the appropriately selected length is secured to a suture, and the suture is secured to a needle (sometimes called a “Keith” needle). The Keith needle is attached to the Furlow introducer. The Keith needle could possibly fall out of the Furlow introducer, so the surgical staff handles the tool with care. The surgeon steadies the Furlow introducer with one hand and pushes a plunger (or obturator) of the Furlow introducer with the other hand. Pushing the plunger pushes the needle from of the introducer, through tissue of the penis, and out the glans penis. The exposed portion of the needle is handled by the surgeon, removed from the suture, and discarded. The remaining suture is subsequently employed to tow the cylinder into place within the dilated corpora cavernosum. 
     The above-described procedure has proven effective when implanting penile prostheses. However, surgeons would appreciate having fewer parts to handle during the procedure. In addition, surgeons and those handling the Keith needle would possibly welcome a tool for implanting a penile prosthetic that reduces or eliminates exposure to the sharp end of the Keith needle. 
     Embodiments provide a tool for measuring a length of the penis distally (forward toward the glans) and proximally (rearward toward the crus) to determine a suitable length for the implantable prosthetics. 
     Embodiments provide a tool having fewer components than a Furlow introducer. The tool disclosed below omits the plunger employed with the Furlow introducer, yet it retains the function of the Furlow plunger by providing a capability to eject a needle from the tool through the glans penis. 
     Embodiments provide a tool with fewer components than the Furlow introducer, and yet the tool provides additional functionality over the Furlow introducer. Specifically, the tool has tow sutures attached between a needle and a prosthetic that operate to eject the needle forward through tissue and a separate second suture attached to the needle that operates to retrieve the needle backward into a bore of the tool. Retraction of the needle into the bore of the tool could potentially reduce exposure of the staff to the sharp end of the Keith needle. 
     Embodiments provide a tool with a first opening (a longitudinal bore) in a distal end and a second opening formed through a wall of the tool to communicate with the bore, where the second opening provides an exit point from the tool for a second suture attached to the needle, where the second suture is employed to retrieve the needle backward into the bore of the tool. 
     Embodiments provide a needle and a portion of a suture inserted into a bore of a tool. Locating a segment of the suture alongside the needle and distal of a proximal end of the needle advantageously stabilizes the needle before, during, and after the needle is ejected out of the bore. In addition, packing some of the suture alongside the needle within the bore of the tool reduces or eliminates the possibility of the needle undesirably falling away from the tool. Needles that fall out of the tool can become non-sterile if the needle leaves the sterile field and can possibly lead to an increased risk of undesired needle sticks. 
     Embodiments provide a needle having two eyelets, one toward a proximal end and one toward a distal end of the needle. The two eyelets advantageously stabilize the needle as it is moved longitudinally out of the tool. 
     Embodiments provide a suture slide formed in a tool proximal (behind) the distal (forward) end of the tool and in front of (distal) a second eyelet formed in the proximal end portion of the needle. 
     Embodiments provide a suture slide formed as an opening in a wall of a tool somewhere between the proximal end and the distal end of the tool, which provides the advantage of reducing the drag of the suture as it is pulled out of the tool to advance the needle longitudinally out of the tool. 
     Locating a segment of the suture alongside an entire length of the needle from a proximal end to a distal end of the needle advantageously ensures that the needle remains inserted in the bore during the surgical procedure until the surgeon ejects the needle out of the bore of the tool. Placing the suture alongside the needle and extending the suture out of the opening in the distal end of the tube advantageously ensures that the needle is directed in a linear and controlled fashion out of the tool. 
       FIG. 1  is a perspective view of one embodiment of a system  20  for implanting an implantable penile prosthetic. The system  20  includes a tool  22  and a suture  24  attached to a needle  26 , with the suture  24  looped through a penile prosthetic  28 . 
     The tool  22  includes a bore  30  formed in a tube  32 , where the tube  32  is sized for insertion into a dilated corpora cavernosum of the penis. 
     The suture  24  is passed through an eyelet  40  formed in a proximal end portion of the needle  26  and looped through an eyelet  42  formed in the penile prosthetic  28 . In one embodiment, the suture  24  is provided as a single strand  44  including one portion  46  of the single strand  44  passed through the eyelet  42  of the penile prosthetic  28  and two portions  46 ,  48  of the single strand  44  both and passed through the eyelet  40  of the suture  26 . The two portions  46 ,  48  of the single strand  44  and the needle  26  are inserted into the bore  30 . The suture  24  is employed as described below to eject the needle  26  out of the bore  30 , through the glans penis, and to subsequently tow the penile prosthetic  28  into the dilated corpora cavernosum. The suture  24  is pulled out of and away from the penile prosthetic  28  after insertion into the corpora cavernosum. 
       FIG. 2  is a side or lateral cross-sectional view taken top-to-bottom through the tool  22 . The tube  32  extends between a handle portion  50  on one end and a distal end  52 . The bore  30  is formed in the tube  32  and extends between a first opening  54  at the distal end  52  and a second opening  56  that is located proximal of the distal end  52  of the tube  32 . The tube  32  is provided with a suture slide  60  that is configured to allow the suture  24  ( FIG. 1 ) to be pulled out of the bore  30  of the tool  22 . 
     In one embodiment, the suture slide  60  is monolithically integrated as a part of a wall of the tube  32 , which provides the advantage of a smooth instrument for insertion into a dilated corpora cavernosum. 
     Suitable tubes for the tool  22  are described below and include various embodiments of suture slides. 
     In one embodiment, the suture slide  60  is located at the distal end  52  of the tube  32  and includes a curved surface  62  formed between an exterior surface  64  of the tube  32  and the bore  30 . In the embodiment of  FIG. 2 , the tube  32  has a tube wall  65  extending continuously between the handle portion  50  and the distal end  52 , where the tube  32  is characterized by an absence of a slot or other opening formed in the tube wall  65 . As noted in  FIG. 1 , the two portions  46 ,  48  of the suture  24  are inserted into the bore  30  along with the needle  26 . The bore  30  can become crowded by the two portions  46 ,  48  of the suture  24  and the needle  26 . One advantage of forming the tube  32  to have an absence of a slot or opening formed into the tube wall  65  is to ensure that the suture  24  and the needle  26  inserted in the bore  30  are both captured securely in a manner that resists their falling out of the bore  30  during a surgical procedure. One advantage of the curved surface  62  of the suture slide  60  is to provide reduced resistance to the suture  24  as the suture  24  and the needle  26  are ejected out of the crowded bore  30  of the tube  32 . 
     The tube  32  is sized for insertion into one of the two corpora cavernosa of the penis. A suitable diameter for the tube  32  is in a range from 0.5-3.0 centimeters, and preferably the diameter of the tube  32  is in a range from about 0.7-2 centimeters. A suitable inside diameter for the bore  30  is in a range from 0.5 mm-4.0 mm, and preferably the inside diameter of the bore  30  is in a range from about 1 mm-3 mm. In one embodiment, one or more marks  66  is/are formed in the exterior surface  64  of the tube. One advantage of the mark  66  is to provide an indication of a measured distance away from the distal end  52  of the tube  32 , which is useful when measuring the depth of the corpora cavernosum. In one embodiment, a series of the marks  66  are provided to measure distances (e.g., 12 cm, 14 cm, 16 cm, etc.) away from the distal end  52  of the tube  32 . 
     The handle portion  50  of the tool  22  allows the surgeon to control the tube  32  while maintaining access to the corpora cavernosa. In one embodiment, the handle portion  50  is funnel-shaped with the second opening  56  located at the bottom of the funnel-shape. Other suitable shapes for the handle portion  50  are also acceptable, including handles with a finger grooves, a T-shaped handle, or an L-shaped handle. 
     The tool  22  is suitably fabricated from plastic or metal. With additional reference to  FIG. 1 , it is beneficial to provide the suture  24  and the needle  26  pre-loaded into the tool  22  for each predetermined length (12 cm, 14 cm, 16 cm, etc.) of penile prosthetic. With this in mind, it is beneficial to provide the tool  22  in a disposable (plastic or metal) format. Reusable, for example stainless steel, tools  22  are also acceptable. 
       FIG. 3  is a cross-sectional view and  FIG. 4  is a perspective view of the system  20  assembled as it would be supplied in a kit of parts for implantation of the penile prosthetic  28  into a penis. The two portions  46 ,  48  of the suture  24  are looped through the eyelet  40  formed in the proximal end portion of the needle  26 . The needle  26  is inserted in the bore  30  with a pointed distal end  70  of the needle  26  closer to the first opening  54  than it is to the second opening  56 . The portions  46 ,  48  of the suture  24  are also inserted within the bore  30  and are placed alongside (parallel to) the needle  26 . The eyelet  40  part of the needle  26  is behind (or rearward or proximal) to the suture slide  60  where the suture  24  exits the bore  30 . In one embodiment, the needle  26  and the portions  46 ,  48  are packed into the bore  30  in a friction-fit manner that prevents the needle  26  from falling out of the bore  30  under the weight of gravity. One advantage of packing some of the suture  24  alongside the needle  26  within the bore  30  is that the possibility of the needle  26  undesirably falling out of the bore  30  is reduced or eliminated. 
       FIG. 4  illustrates the system  20  as assembled. The system  20  uses the suture slide  60  as a pulley to transfer the rearward, proximal force applied to the free end  72  of the suture  24  into movement of the needle  26  out of the bore  30  in the distal direction. The system  20  operates to trade force (applied to the free ends  72 ) for distance (movement of the needle  26  in the distal direction) in a manner similar to the operation of a pulley. The tool  22  is configured to allow the needle  26  to exit the bore  30  only when a sufficient force is applied to the suture  24  to pull the needle  26  out of the tool  22 . 
     The system  20  is characterized by an absence of a plunger or obturator device inserted into the second opening  56  of the bore  30 . Two advantages of omitting a plunger from the system  20  is a reduction in the number of parts and ease of use for the surgeon. 
     The suture  24  extends out of the first opening  54 , contacts the suture slide  60 , and extends to a pair of free ends  72 . The suture  24  is tensioned when a force is applied to pull the free ends  72  of the suture  24  away from the distal end  52  of the tool  22 , which causes a portion of the suture  24  to move over the suture slide  60 . The tension in the suture  24  and the movement of the suture  24  on the suture slide  60  pulls the proximal end portion of the needle  26  forward in a distal direction. The pulling force applied to the needle  26  by the suture  24  ejects the needle  26  in the distal direction out of the bore  30  of the tool  22 . The suture slide  60  is provided to reduce the resistance of the suture  24  as it exits from the bore  30  of the tool  22 . 
       FIG. 5  and  FIG. 6  are schematic cross-sectional views of the system  20  employed to implant a penile prosthetic  28  into a penis P. 
     The penis P is reclined against the torso and incised to expose the corpora cavernosa (C 1  and C 2 ). 
     The groin area  100  of the patient is shaved, cleaned and suitably prepped with a surgical solution prior to draping with a sterile drape as directed by the healthcare provider&#39;s procedures. A retraction device, such as those available from Lone Star Medical Products of Stafford, Tex., is placed around the penis P if so desired by the surgeon to establish the surgical field. A catheter  103  is inserted into the urethra U from the distal end  104  of the penis P. Thereafter, the surgeon forms an incision to access the corpora cavernosa C 1  and C 2  of the penis. 
     Suitable examples of incisions include either an infrapubic incision or a transverse scrotal incision. The infrapubic incision is initiated between the umbilicus and the penis (i.e., above the penis), whereas the transverse scrotal incision is made across an upper portion of the patient&#39;s scrotum Sc. 
     As an example of the transverse scrotal approach, the surgeon forms a 2-3 cm transverse incision through the subcutaneous tissue of the median raphe of the upper scrotum Sc and dissects down through the Darto&#39;s fascia and Buck&#39;s fascia to expose the tunicae albuginea of the penis P. Thereafter, each corpora cavernosum C 1  and C 2  is exposed in a corporotomy where a small (approximately 1.5 cm) incision is formed to allow the surgeon to access and subsequently dilate the corpora cavernosa C 1  and C 2 . 
     The surgeon typically will insert a blunt-ended scissors or other elongated tool to separate a portion of the spongiosum material to open a pathway for dilation and measurement of the corpora cavernosum C 1 , C 2 . After suitable dilation, the surgeon measures the length of the corpora cavernosa to determine the suitable size for the penile prosthetic  28 . In one approach, the surgeon ensures that the appropriately sized penile prosthetic  28  has been selected by inserting the tool  22  into the corpora cavernosa C 1  or C 2  and using the marks  66  to measure the proximal and distal length of each corpora cavernosum C 1  and C 2 . For example, the tool  22  is inserted into one of the corpora cavernosa C 1  or C 2  forward in the distal penis toward the glans penis, the distal measurement is recorded by reading one of the marks  66 , and the tool  22  is inserted into the same corpora cavernosa C 1  or C 2  rearward in the proximal penis toward the crus of the penis to record the proximal length of the corpora by reading one of the marks  66 . The distal and proximal measurements would typically be made in reference to a “stay stitch” temporarily placed in the incision. The sum of the distal and the proximal measurements represent the length of that corpora cavernosum, and this information is compared to the selected size of the penile prosthetic  28 . This procedure is repeated for the other of the corpora cavernosa C 1  or C 2  to ensure the appropriately sized penile prosthetic  28  has been selected for the companion corpora. 
       FIG. 5  illustrates the penis P prepped for surgery and the system  20  prepared for implantation of the penile prosthetic  28  into the corpora cavernosum C 2 . The needle  26  is retained within the bore  30  with the pointed distal end  70  of the needle rearward (proximal) of the first opening  54 . A portion of the suture  24  is disposed alongside the needle  26  and extends to a location that is distal of both the proximal end and the pointed distal end  70  of the needle  26 . 
       FIG. 6  is a schematic view of the tool  22  inserted into the corpora cavernosum C 2 . The free ends  72  of the suture  24  are outside of the penis P and available to the surgeon. The penile prosthetic  28  is outside of the penis P, attached to the suture  24 . The surgeon, through experience, applies sufficient tension to the free ends  72  of the suture  24  to eject the needle  26  forward out of the glans penis. The proximal, rearward force applied to the free ends  72  of the suture  24  is transferred in a pulley-like fashion to drive the needle  26  is a distal direction. The surgeon employs a forceps or other tool to grasp the needle  26 . The needle  26  is held stationary outside of the penis P as the tool  22  is removed from corpora cavernosum C 2 . Thereafter, the needle  26  is snipped from the suture  24 , and the remaining suture  24  is employed to tow the penile prosthetic  28  distally into the corpora cavernosum C 2  up to the glans penis. The suture  24  is removed from the prosthetic  28 . 
     The proximal end of the penile prosthetic  28  is suitably implanted proximately into the crus penis. 
     A second penile prosthetic is implanted in the corpora cavernosum C 1  following the steps described above for implantation of the penile prosthetic  28  the corpora cavernosum C 2 . 
       FIG. 7  is a cross-sectional view of one embodiment of a system  120  configured for implanting an implantable penile prosthetic  128  into a penis. The system  120  includes a tool  122  and a suture  124  engaged between a needle  126  and the penile prosthetic  128 . 
     The tool  122  includes an annular tube extending between a handle portion (not illustrated in  FIG. 7  since the handle portion is similar to the handle portion illustrated in  FIG. 2 ) and a distal end  130  that is provided with a first opening  132 . One embodiment of the tool  122  includes a suture slide  140  that is located proximal (behind) the distal end  130  of the tool  122  and in front of (distal) the second eyelet  152  formed in the proximal end portion of the needle  126 . In one embodiment, the suture slide  140  is provided as an opening  141  formed in a tube wall  143  of the tool  122  and includes a first surface  142  and a second surface  144 . The suture  124  located between the prosthetic  128  and the needle  126  slides along the first surface  142 , and the suture  124  between the needle  126  and the free ends  146  slides along the second surface  144 . In one embodiment, at least the second surface  144  is provided with a curved surface that reduces resistance of the suture  124  as it is pulled out of the tool  122 . In one embodiment, each of the first surface  142  and the second surface  144  is provided as a curved surface. 
     Locating the suture slide  140  between the proximal end (rear end) of the needle  126  and the distal end  130  of the tool  122  configures the system such that tension T applied to the free ends  146  of the suture  124  will eject the needle  126  in a distal direction through the meatus of the penis. Advantages of providing the suture slide  140  as an opening  141  formed in the tube wall  143  include a neatly designed system that is pleasant to use and reducing or eliminating binding of the suture  124  when tension T is applied to the suture  124  to eject the needle  126  out of the first opening  132 . As noted above, the bore of the tool  122  can become crowded after inserting both the suture and the needle into the bore. Providing the suture slide  140  as a separate opening formed in the wall  143  of the tool  122  advantageously reduces the binding of the suture  124  as it exits the tool  122 . 
     In one embodiment, the needle  126  includes a first eyelet  150  and a second eyelet  152 . At least the second eyelet  152  is located on a proximal end portion of the needle  126 . The suture  124  is threaded through the eyelet of the penile prosthetic  128 , extends over the first surface  142  of the suture slide  140 , engages the needle  126  through the first eyelet  150 , extends alongside the needle  126  to the second eyelet  152 , exits the second eyelet  152 , extends around the second surface  144  of the suture slide  140 , and terminates in the free ends  146 . One advantage of employing two eyelets  150 ,  152  is to reduce the pitch (up-and-down movement) and the yaw (side-to-side movement) of the needle  126  as it exits the first opening  132 . 
     The needle  126  and the suture  124  are inserted in the bore of the tool  122  and combine to occupy a volume of space. One advantage of locating the suture slide  140  between the proximal end portion of the needle  126  and the distal end  130  of the tool  122  is to provide clearance for the suture  124  entering and exiting the tool  122 . The clearance ensures that the needle  126  is controlled as it is ejected as a result of the tension applied to the free ends  146  of the suture  124 . 
       FIG. 8 - FIG. 11  are cross-sectional views of one embodiment of a system  200  configured for implanting an implantable penile prosthetic. 
       FIG. 8  is a cross-sectional view of a tool  206  of the system  200 . The system  200  includes a needle  202  that is insertable into a bore  204  of the tool  206 , a first suture  208  engaged between the needle  202  and a penile prosthetic  210 , and a second suture  212  connected to the needle  202 . 
     The needle  202  includes a pointed distal end  214  and a proximal end portion  216 . The first suture  208  is engaged with the proximal end portion  216  of the needle  202  and the second suture  212  extends from a distal end  218  of the needle  202 . 
     The tool  206  extends between a distal end  220  and a proximal end  222 . A first opening  230  is formed in the distal end  220 , and a second opening  240  is formed in the proximal end portion of the tool  206 . 
       FIG. 9  is a cross-sectional view of the needle  202  placed within the bore  204  of the tool  206 . The first suture  208  is attached to the proximal end portion  216  of the needle  202 , extends alongside the needle  202 , and exits the first opening  230  formed in the distal end  220  of the tool  206 . In one embodiment, a suture slide  250  is formed as a curved wall located at the distal end  220  of the tool  206 . The first suture  208  extends from the needle  202  over the suture slide  250 . The second suture  212  is attached to the proximal end  218  of the needle  202 , extends along the bore  204  of the tool  206 , and exits the tool  206  through the second opening  240 . One alternative embodiment includes forming the suture slide  250  as an opening in a wall of the tool  206  as in  FIG. 7 , with the alternative suture slide located proximal or behind the distal end  220  of the tool  206 . 
       FIG. 10  illustrates tension applied to the first suture  208  to pull the proximal end portion  216  of the needle  202  in a distal direction, which ejects the needle  202  out of the first opening  230 . The second suture  212  is attached to the proximal end  218  of the needle  202  and moves within the bore  204 . The needle  202  is movable in a distal direction in response to tension applied to the first suture  208 , which operates to push the needle  202  out of the first opening  230  of the tool  206  through the meatus of the penis (see  FIG. 7 ). The surgeon tows the penile prosthetic  210  into one of the corpora cavernosum by pulling on the first suture  208 . The first suture  208  is subsequently severed and pulled away from the needle  202  and discarded. The needle  202  remains attached to the second suture  212 . 
       FIG. 11  is a cross-sectional view illustrating the second suture  212  employed to retract the needle  202  back into the bore  204  of the tool  206 . Tension is applied to the second suture  212  to pull the needle  202  backwards in a proximal direction, which returns the needle  202  back into the bore  204  of the tool  206 . The needle  202  is now stowed inside the tool  206 . The tool  206  and the needle  202  are removed from the corpora cavernosum and discarded. 
       FIG. 12 ,  FIG. 13 , and  FIG. 14  illustrate embodiments of a system  300  for implanting an implantable penile prosthetic  310  having a suture slide  350  that is not located at the distal end of a tool  306 . With reference to  FIG. 9 , the multiple strands of suture attached to the needle and to the implant can begin to accumulate near the distal end of the tool. Locating the suture between the proximal end portion of the needle inserted in the bore and the distal end of the bore provides clearance for the suture strand, which advantageously provides relief between the system  300  and the tissue. 
       FIG. 12  is a perspective view of the system  300 . The system  300  includes a needle  302  insertable into a bore  304  of a tool  306 , a first suture  308  secured between a proximal end portion  309  of the needle  302  and the penile prosthetic  310 , and a second suture  312  connected to the needle  302 . When the system  300  is assembled, the needle  302  and the sutures  308 ,  312  are located in the bore  304  of the tool  306 . 
     The tool  306  extends between a distal end  320  and a proximal end  322  that typically includes a handle or other control device. A first opening  330  is provided at the distal end  320 , and a second opening  340  is formed through a wall of the tool  306  to communicate with the bore  304 . The proximal end  322  of the tool  306  provides a handle that is useful when manipulating the tool  306  to implant the penile prosthetic  310 . In one embodiment, a suture slide  350  is formed through the wall of the tool  306  to communicate with the bore  304 . The suture slide  350  is formed in a distal end portion of the tool  306  and extends forward to the distal end  320  of the tool  306 . 
       FIG. 13  is a cross-sectional view of the system  300  prior to assembly, and  FIG. 14  is a perspective view of the system  300  after assembly. 
     The suture slide  350  is formed a distance D behind the distal end  320  of the tool  306 . In one embodiment, the suture slide  350  is formed by a complex curvature including a first curved surface  360  extending from an exterior  362  of the tool  306  and a second curved surface  364  extending from the first curved surface  360  to the bore  304 . In one embodiment, a radius of curvature of the first surface  360  is different from the radius of curvature for the second surface  364 . In one embodiment, a radius of curvature for the first surface  360  is smaller than (less than) a radius of curvature for the second surface  364 . One advantage of providing the suture slide  350  with a complex curvature is to reduce the drag of the suture along the slide as the suture is tensioned to position/implant the penile prosthetic  310  in the penis. 
       FIG. 14  illustrates the system  300  assembled with the needle  302  placed into the bore  304 , with the first suture  308  extending out of the suture slide  350  and the second suture  312  extending out of the second opening  340 . The first suture  308  is disposed alongside of the needle  302  and exits the suture slide  350 . The suture slide  350  is in front of (distal) a proximal end of the needle  302  and behind (proximal) the distal end  320  of the tool  306 . The suture slide  350  is structured to allow the first suture  308  to exit the bore  304  generally along the second surface  364  prior to curving in a direction that directs the suture  308  towards the proximal end  322  of the tool  306 . 
     In one embodiment, the suture slide  350  is located between the proximal portion of the needle  302  and the distal end  320  of the bore  304 , with the suture slide  350  provided as an opening or a slot formed in a wall of the tubular tool  306 . In one embodiment, the suture slide  350  is located midway between the proximal portion of the needle  302  and the distal end  320  of the bore  304 . Locating the suture slide  350  between the proximal portion of the needle  302  and the distal end  320  of the bore  304  had the advantage of combining a level of frictional engagement to retain the suture/needle within the bore and a level of an ease of extraction when ejecting the needle out of the bore. 
     The first suture  308  is connected to the needle  302  and the penile prosthetic  310 . Pulling on, or applying tension to the first suture  308  pulls the needle  302  out of the first opening  330  of the tool  306 . This maneuver allows the needle  302  to be ejected from the bore  304  through the meatus of the penis. The surgeon separates the first suture  308  from the needle  302 , and employs the first suture  308  to subsequently tow the penile prosthetic  310  into the corpora cavernosum. 
     The second suture  312  extends away from the needle  302  and exits the second opening  340  formed in the tool  306 . The surgeon pulls on the second suture  312  to return the needle  302  back into the bore  304  of the tool  306 , where the needle  302  is safely retained within the tool  306 . The second opening  340  is located near where the surgeon would place his or her hands when manipulating the tool  306 , and this positions the second suture  312  for convenient manipulation/retraction of the needle  302  back into the tool  306 . 
     One advantage of locating the suture slide  350  behind (proximal) from the distal end  320  of the tool  306  is to ensure improved traction or control of the first suture  308  as the needle  302  is ejected from the bore  304 . 
     One advantage of locating the second opening  340  between the distal end  320  and the proximal end  322  of the tool  306  is to locate the second suture  312  in a natural location for the surgeon to access and manipulate. The second suture  312  is essentially out of the way during implantation procedure for the penile prosthetic  310 , and is easily accessed for retracting the needle  302  back in the bore  304 . 
     In one embodiment, the system  300  is assembled as illustrated in  FIG. 14  during the manufacturing process, packaged with instructions on its use, and inventoried for shipment to end users as a ready to use system. 
       FIG. 15  is a perspective view of one embodiment of a system  400  including the penile prosthetic  28  associated with the needle  26 . The system  400  includes a tool  402  having a tube  404  extending to a distal end  406 , with a bore  408  formed in the tube  404 . As described above, the needle  26  and some of the suture  24  are inserted into the bore  408  for delivery of the prosthetic  28  into the corpora cavernosum. A suture slide  410  is located at the distal end  406  of the tube  404  to facilitate dispensing the suture  24  out of the bore  408 . In one embodiment, the suture slide  410  is a rotatable conveyance bar attached to the tube  404  and operates to convey the suture  14  out of the bore  408  during implantation of the prosthetic  28 , similar to the procedures described above for other embodiments of the tools. 
     The suture slide  410  operates in a pulley-like manner to transfer the force applied to the suture  24  into forward motion of the needle  26 . In one embodiment, the suture slide  410  is a cylinder  412  that is attached to the tube  404  by an axel  414 , which allows the cylinder  412  to rotate on its axis as the suture  24  is pulled out of the bore  408 . Clearance between the tool  402  and the tissue can be limited when the tube  404  is inserted into the dilated corpora cavernosum, and the reduced clearance can impart a high level of drag onto the suture  24  as the suture  24  is pulled to deploy the needle  26 . The rotation of the cylinder  412  advantageously contributes to reducing the friction of the suture  24  as it is withdrawn from the bore  408  during implantation of the prosthetic  28 . 
     The surgeon will find it useful to locate or identify the position of the suture slide  410  when the tool  402  is inserted into the corpora cavernosum, which would ordinarily block the view of the suture slide  410 . In one embodiment, a guide  420  is formed in an exterior surface of the tube  404 , where the guide  420  is co-located with (aligned longitudinally with) the suture slide  410  to provide a visual indicator of the location of the suture slide  410 . The guide  420  is suitably provided as a visual marking, such as a colored line, or a physical marking such as a flat surface formed in the tube  404 . The surgeon is able to view that portion of the tube  404  that extends out of the corpora cavernosum (see  FIG. 6 ) to see the guide  420 , which identifies the location of the suture slide  410 . The suture  24  is pulled along the side of the tool  402  where the suture slide  410  is located. 
     A single suture slide  410  is illustrated in  FIG. 15 , although it is acceptable to provide the distal end  406  of the tool  402  with multiple rotating suture slides placed side-by-side around the bore  408 . Several small suture slides, similar to suture slide  410 , may be attached around a perimeter of the bore  408  to provide the entire perimeter of the bore  408  with a rotating suture slide. Alternatively, two or three or more suture slides may be placed around the bore  408 . 
     Although specific embodiments have been illustrated and described, it will be appreciated by those of ordinary skill in the art that a variety of alternate and equivalent implementations may be substituted for the specific embodiments shown and described without departing from the scope of the present invention. This application is intended to cover any adaptations or variations of the kind of medical devices described above. Therefore, it is intended that this invention be limited only by the claims and their equivalents.