Abstract:
An intra-abdominally adjustable organ positioning system. The system includes a cord for lifting an organ, such as the liver, during endoscopic surgery, tissue connectors, and an adjustable locking mechanism which allows tightening and loosening of the cord.

Description:
[0001]    This application is a continuation of U.S. application Ser. No. 14/547,076, filed Nov. 18, 2014, pending, which is a continuation of U.S. application Ser. No. 13/538,075, filed Jun. 29, 2012, now U.S. Pat. No. 8,888,679, which is a continuation of U.S. application Ser. No. 13/203,396 filed Nov. 11, 2011, now U.S. Pat. No. 8,251,889, which is a national stage application of International Application PCT/US2010/025425 filed Feb. 25, 2010, which in turn claims priority to U.S. Provisional Application 61/155,409, filed Feb. 25, 2009. Priority is also claimed through U.S. application Ser. No. 14/547,076, pending, filed Nov. 18, 2014, which is also a continuation of U.S. application Ser. No. 13/325,575, filed Dec. 14, 2011, abandoned, which is also a continuation of U.S. application Ser. No. 13/203,396 filed Nov. 11, 2011, now U.S. Pat. No. 8,251,889, which is a national stage application of International Application PCT/US2010/025425 filed Feb. 25, 2010, which in turn claims priority to U.S. Provisional Application 61/155,409, filed Feb. 25, 2009. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The present invention is directed to an apparatus and its method of use in intra-abdominally moving a first internal organ to a position away from a second internal organ where the apparatus holds the first internal organ in the position without further manual input. More specifically, the present invention is directed to an apparatus that is inserted through the abdominal wall and into the abdominal cavity, and the method of using the apparatus in the abdominal cavity to move a human liver to a position away from a human stomach where the apparatus holds the liver in the position without further manual input, thereby providing surgical access to the stomach. 
       DESCRIPTION OF THE RELATED ART 
       [0003]    In laparoscopic surgical procedures, it is often necessary to make incisions through the abdominal wall for the sole purpose of providing access to the abdominal cavity for surgical graspers or other similar types of retracting instruments that are used to move one internal organ to a position away from a second internal organ to gain surgical access to the second internal organ. The incisions made for the surgical graspers or similar retracting instruments are in addition to the incisions made in the abdominal wall for the surgical instruments used in performing the surgical procedure on the second organ. 
         [0004]    Furthermore, it is often necessary that an additional surgeon or surgical assistant be present solely for the purpose of manipulating the surgical graspers or other similar retracting instruments in moving the first internal organ to a position away from the second internal organ, and then manually holding the first internal organ in the position during the surgical procedure performed on the second internal organ. 
         [0005]    The need for the additional surgical personnel to manipulate and hold the surgical graspers or other similar retracting instruments during the surgical procedure increases the costs of surgery. In addition, the additional incisions in the abdominal wall required for the surgical graspers or other similar retracting instruments often results in additional discomfort to the patient following surgery and additional scarring. 
         [0006]    What is needed to overcome these disadvantages associated with the above-described type of laparoscopic surgical procedure is an apparatus that can be operated to intra-abdominally move a first internal organ to a position away from a second internal organ and then hold the first internal organ in the position without requiring additional manual input other than that provided by the surgeon and without requiring additional abdominal incisions other than those required for the surgery. 
       SUMMARY OF THE INVENTION 
       [0007]    The present invention overcomes the above-described shortcomings of laparoscopic surgical procedures by providing an apparatus that can be inserted into the abdominal cavity through the same incision to be used in a laparoscopic surgery procedure, and the method of using the apparatus to move or retract a first internal organ, for example the liver, away from a second internal organ, for example the stomach, and then hold the first internal organ in the retracted position providing surgical access to the second internal organ without requiring further manual input. 
         [0008]    The apparatus is constructed of component parts that are often used in laparoscopic as well as other types of surgical procedures. The component parts will be described herein using their common understood names and their functions, without going into details of the particular constructions of the component parts. 
         [0009]    The basic construction of the apparatus of the invention includes a length of cord. The cord could be comprised of a first cord segment having a flexible length with opposite first and second ends, and a second cord segment having a flexible length with opposite first and second ends. The cord segments could be provided by lengths of suture, lengths of tubing such as IV tubing, lengths of umbilical tape or elastic strips, or other equivalent cord constructions. The first and second cord segments could be separate cord segments that are attached together, or could be two cord segments of a single continuous length of cord. 
         [0010]    First, second, and third separate tissue connectors are attached to the first and second cord segments. The tissue connectors can be any type of known tissue connector that can be manually manipulated to connect to body tissue, and then manually manipulated to be removed from the body tissue without leaving any significant damage to the body tissue. In addition, the tissue connectors can be biocompatible tissue connectors that are designed to be left in the abdominal cavity after the surgery. Some examples of such tissue connectors include suture needles, “T” bars, graspers, barbed needles, hooks, clasps, rivet assemblies, or any other equivalent type of connector. The first and third tissue connectors are attached to the opposite ends of the first cord segment and the second and third tissue connectors are attached to the opposite ends of the second cord segment. This positions the first and second tissue connectors at the opposite ends of the combined lengths of the first and second cord segments, and positions the third tissue connector at an intermediate position of the combined lengths of the first and second cord segments. 
         [0011]    In the use of the apparatus according to the method of the invention, the apparatus is first manually passed through the abdominal wall, for example through an incision or a cannula in the abdominal wall, and is positioned in the abdominal cavity in the area of the first and second internal organs. The third tissue connector is then manually connected to tissue adjacent the first internal organ. This positions the ends of the first and second cord segments connected to the third tissue connector between the first and second internal organs and on an opposite side of the first internal organ from the abdominal wall. The first tissue connector attached to the opposite end of the first cord segment from the third tissue connector is manually moved causing the length of the first cord segment to move and engage across the first internal organ and to move the first internal organ toward the position away from the second internal organ. The first tissue connector is then manually connected to the abdominal wall. 
         [0012]    The second tissue connector attached to the opposite end of the second cord segment from the third tissue connector is then manually moved causing the second cord segment to move and engage across the first internal organ and move the first internal organ toward the position away from the second internal organ. The second tissue connector is then manually connected to the abdominal wall. 
         [0013]    In the above matter, the first and second cord segments engaging across the first internal organ hold the first internal organ at the position away from the second internal organ without further manual input. This provides surgical access to the second internal organ. 
         [0014]    In a further embodiment of the apparatus of the invention, the apparatus is comprised of a cord having a continuous flexible length with opposite first and second ends. A needle is attached to one end of the length of cord and a knot is formed in the opposite end of the length of cord. 
         [0015]    According to the method of use of this embodiment of the apparatus, the apparatus is first positioned inside the abdominal cavity in the same manner as the previously-described embodiment. The knotted end of the length of cord is then connected to tissue adjacent the first internal organ by first passing the needle through the tissue and then manually pulling the length of cord through the tissue. This attaches the knotted end of the cord to the tissue between the first and second internal organs. 
         [0016]    The needle is then passed through the inter-abdominal wall and manually moved back into the abdominal cavity, causing a first segment of the length of cord to engage across the first internal organ and move the first internal organ toward the position away from the second internal organ. 
         [0017]    The needle is then again inserted through the inter-abdominal wall at a location spaced from the first insertion of the needle through the inter-abdominal wall, and the needle and length of cord are pulled manually into the abdominal cavity. 
         [0018]    The needle and the end of the length of cord attached to the needle are then passed through the knot formed at the opposite end of the length of cord and pulled tight, causing a second segment of the length of cord to engage across and move the first internal organ toward the position away from a second internal organ. A knot is then tied between the opposite ends of the length of cord and the portion of the cord extending from the knot to the needle is cut and removed with the needle from the abdominal cavity. The length of cord left in the abdominal cavity forms a triangular loop with first and second cord segments that engage across and hold the first internal organ in the position away from the second internal organ without manual input. In this manner, surgical access is provided to the second internal organ without manual input. 
         [0019]    As described above, the apparatus of the invention and its method of use enable intra-abdominally moving a first internal organ to a position away from a second internal organ where the apparatus holds the first internal organ in the position without manual input. 
     
    
     
       DESCRIPTION OF THE DRAWING FIGURES 
         [0020]    Further features of the apparatus of the invention and its method of use are set forth in the following detailed description of the apparatus and method and are shown in the drawing Figures. 
           [0021]      FIG. 1  is a plan view of one embodiment of the apparatus of the invention. 
           [0022]      FIG. 2  is a plan view of a further embodiment of the apparatus of the invention. 
           [0023]      FIG. 3  is a plan view of a still further embodiment of the apparatus of the invention. 
           [0024]      FIG. 4  is a representation of the apparatus of  FIG. 1  being inserted into the abdominal cavity. 
           [0025]      FIG. 5  is a representation of the apparatus of  FIG. 1  being used according to the method of the invention. 
           [0026]      FIG. 6  is a representation of the apparatus  FIG. 2  in use according to the method of the invention. 
           [0027]      FIG. 7  is a representation of the apparatus of  FIG. 3  in use according to the method of the invention. 
           [0028]      FIGS. 8A-8E  represent the insertion of one embodiment of the apparatus into the abdominal cavity and one method of use of the apparatus. 
           [0029]      FIGS. 9A-9E  represent the insertion of a further embodiment of the apparatus into the abdominal cavity and the method of using the apparatus. 
           [0030]      FIGS. 10A and 10B  represent the insertion of a further embodiment of the apparatus into the abdominal cavity and the method of using the apparatus. 
           [0031]      FIGS. 11A and 11B  represent a further embodiment of the apparatus and its method of use. 
           [0032]      FIGS. 12A and 12B  represent a further embodiment of the apparatus and its method of use. 
           [0033]      FIGS. 13A and 13B  represent a further embodiment of the apparatus and its method of use. 
           [0034]      FIGS. 14A-14C  represent a further embodiment of the apparatus and its method of use. 
           [0035]      FIGS. 15A and 15B  represent a further embodiment of the apparatus and its method of use. 
           [0036]      FIGS. 16A and 16B  represent a further embodiment of the apparatus and its method of use. 
           [0037]      FIG. 17  represents a further embodiment of the apparatus and its method of use. 
           [0038]      FIGS. 18A and 18B  represent a further embodiment of the apparatus and its method of use. 
           [0039]      FIGS. 19A and 19B  represent a further embodiment of the apparatus and its method of use. 
           [0040]      FIGS. 20A and 20B  represent a further embodiment of the apparatus and its method of use. 
           [0041]      FIGS. 21A and 21B  represent a further embodiment of the apparatus and its method of use. 
           [0042]      FIGS. 22A and 22B  represent a further embodiment of the apparatus and its method of use. 
           [0043]      FIG. 23  represents a further embodiment of the apparatus and its method of use. 
           [0044]      FIGS. 24A-24C  represent component parts of a further embodiment of the apparatus. 
           [0045]      FIG. 25  represents a component part of a further embodiment of the apparatus. 
           [0046]      FIG. 26  represents a component part of a further embodiment of the apparatus. 
           [0047]      FIG. 27  represents a further embodiment of the apparatus 
           [0048]      FIG. 28  represents a further embodiment of the apparatus. 
           [0049]      FIG. 29  represents a further embodiment of the apparatus. 
           [0050]      FIG. 30  represents a further embodiment of the apparatus. 
           [0051]      FIG. 31  represents a further embodiment of the apparatus. 
           [0052]      FIG. 32  represents a further embodiment of the apparatus. 
           [0053]      FIG. 33  represents a component part of an embodiment of the apparatus. 
           [0054]      FIG. 34  represents a component part of an embodiment of the apparatus. 
           [0055]      FIG. 35  represents a component part of an embodiment of the apparatus. 
           [0056]      FIG. 36  represents a component part of an embodiment of the apparatus. 
           [0057]      FIG. 37  represents a component part of an embodiment of the apparatus. 
           [0058]      FIG. 38  represents a component part of an embodiment of the apparatus. 
           [0059]      FIGS. 39A-39C  represent component parts of an embodiment of the apparatus. 
           [0060]      FIGS. 40A and 40B  represent component parts of an embodiment of the apparatus. 
           [0061]      FIG. 41  represents a component part of an embodiment of the apparatus. 
           [0062]      FIG. 42  represents a component part of an embodiment of the apparatus. 
           [0063]      FIG. 43  represents a component part of an embodiment of the apparatus. 
           [0064]      FIGS. 44A and 44B  represent component parts of an embodiment of the apparatus. 
           [0065]      FIGS. 45A-45E  represent component parts of an embodiment of the apparatus. 
           [0066]      FIGS. 46A-46E  represent component parts of an embodiment of the apparatus and its method of use. 
           [0067]      FIGS. 47A-47D  represent component parts of an embodiment of the apparatus and its method of use. 
           [0068]      FIGS. 48A-48D  represent component parts of an embodiment of the apparatus and its method of use. 
           [0069]      FIGS. 49A and 49B  represent component parts of an embodiment of the apparatus and its method of use. 
           [0070]      FIGS. 50A and 50B  represent component parts of an embodiment of the apparatus and its method of use. 
           [0071]      FIGS. 51A-51E  represent a method of positioning an embodiment of the apparatus in an abdominal insertion device. 
           [0072]      FIGS. 52A and 52B  represent embodiments of the apparatus and an insertion device and the method of mounting the apparatus on the insertion device. 
           [0073]      FIG. 53  represents embodiments of the apparatus and an insertion device and a method of mounting the apparatus on the insertion device. 
           [0074]      FIG. 54  represents embodiments of the apparatus and an insertion device and a method of mounting the apparatus in the insertion device. 
           [0075]      FIGS. 55A-55C  represent an embodiment of the apparatus and a method of using the apparatus. 
       
    
    
     DETAILED DESCRIPTION 
       [0076]      FIG. 1  shows one embodiment  12  of the apparatus for intra-abdominal moving a first internal organ to a position away from a second internal organ and then holding the first internal organ in the position without manual input. As stated earlier, the apparatus  12  is constructed of component parts that are often used in laparoscopic instruments and procedures as well as other types of surgical instruments and procedures. Because such component parts are known, the component parts that make up the apparatus  12  of the invention will be described herein using their common understood names and functions, without going into the details of the particular constructions of the component parts. As is conventional with laparoscopic apparatus, the component parts of the apparatus are dimensioned to be inserted through an incision in the abdominal wall or through a cannula extending through the abdominal wall to position the apparatus in the abdominal cavity. 
         [0077]    The basic construction of the apparatus  12  of the invention includes a length of cord. In the example of  FIG. 1  the cord length is 10 inches, but the size of the apparatus  12  could change depending on the size of the patient in which the apparatus is used. In the embodiment shown in  FIG. 1 , the cord is comprised of a first cord segment  14  having a flexible length with opposite first  16  and second  18  ends, and a second cord segment  22  having a flexible length with opposite first  24  and second  26  ends. 
         [0078]    The cord segments  14 ,  22  could be provided by lengths of suture, lengths of tubing such as IV tubing, lengths of umbilical tape or elastic strips, or other equivalent cord constructions. The tubing or tape configurations of the cord segments have the advantage of being less likely to dig into or cut into the first internal organ in use of the apparatus to be described. The first  14  and second  22  cord segments could be separate cord segments that are attached directly together, or separate cord segments that are attached by way of a further cord segment  28  or some other component part of the apparatus, or two cord segments of a single continuous length of cord such as the two cord segments  14   a ,  22   a  shown in  FIG. 2 . 
         [0079]    First  32 , second  34 , and third  36  separate tissue connectors are attached to the first  14  and second  22  cord segments. The tissue connectors  32 ,  34 ,  36  can be any type of known tissue connector that can be manually manipulated to connect to body tissue, and then manually manipulated to be removed from the body tissue without leaving any significant damage to the body tissue. In addition, the tissue connectors  32 ,  34 ,  36  could be biocompatible tissue connectors that are designed to be left in the abdominal cavity after the surgical procedure is completed. Some examples of tissue connectors include suture needles, “T” bars, surgical graspers, barbed needles, hooks, clasps, rivet assemblies, or any other equivalent type of connector. In the apparatus of the invention, it is not necessary that all three tissue connectors  32 ,  34 ,  36  be the same type of tissue connector. Because various different types of tissue connectors may be employed with the apparatus  12  of the invention, the three tissue connectors  32 ,  34 ,  36  of the apparatus  12  are represented schematically in the drawing Figures. The first  32  and third  36  tissue connectors are attached to the opposite ends of the first cord segment  14 . The third tissue connector  36  is also attached to one end of the second cord segment  22 , with the second tissue connector  34  being connected to the opposite end of the second cord segment  22 . This positions the first  32  and second  34  tissue connectors at the opposite ends of the combined lengths of the first  14  and second  22  cord segments, and positions the third tissue connector  30  at an intermediate position of the combined length of the first  14  and second  22  cord segments. In  FIG. 1 , the first  32  and second  34  tissue connectors are shown connected to the respective first end  16  of the first cord segment  14  and the first end  24  of the second cord segment  22  through the intermediary of additional cord segments  38 ,  40 . The third tissue connector  36  is shown connected to the second end  18  of the first cord segment  14  and the second end  26  of the second cord segment  22  through the intermediary of a further cord segment  28 .  FIG. 2  shows the apparatus  12  with the first  32  and second  34  tissue connectors connected directly to the respective first end  16  of the first cord segment  14  and the first end  24  of the second cord segment  22 ,  FIG. 2  also shows the third tissue connector  36  connected directly to the second ends  18 ,  26  of the first cord segment  14  and the second cord segment  22 . 
         [0080]      FIGS. 4 and 5  illustrate an example of the use of the apparatus  12  of  FIG. 1  according to the method of the invention. In use, the apparatus  12  is first manually passed through the abdominal wall  42 , for example through an incision or a cannula  44  in the abdominal wall  42 , and is positioned in the abdominal cavity  46  in the area of the first  48  and second  50  internal organs. In  FIG. 4 , the first internal organ  48  represented is the human liver, and the second internal organ  50  represented is the human stomach. 
         [0081]    The third tissue connector  36  of the apparatus is then manually connected to tissue  52  adjacent the first internal organ  48  and between the first  48  and second  50  internal organs. In the example shown in  FIG. 4 , the tissue  52  is the crus of the diaphragm. Connection of the third tissue connector  36  to the tissue  52  positions the second ends  18 ,  26  of the first  14  and second  22  cord segments connected to the third tissue connector  32  between the first  48  and second  50  internal organs and on an opposite side of the first internal organ  48  from the abdominal wall  42 . 
         [0082]    The first tissue connector  32  attached to the opposite end  16  of the first cord segment  14  from the third tissue connector  36  is then manually moved causing the length of the first cord segment  14  to move and engage across the first internal organ  48 . Continued movement of the first tissue connector  32  causes the first cord segment  14  engaging across the first internal organ  48  to move the first internal organ toward a position away from the second internal organ  50 . The first tissue connector  32  is then manually connected to the inner abdominal wall  42 . 
         [0083]    The second tissue connector  34  attached to the opposite end  24  of the second cord segment  22  from the third tissue connector  36  is then manually moved causing the second cord segment  22  to move and engage across the first internal organ  48 . Continued movement of the second tissue connector  34  causes the second cord segment  22  engaging across the first internal organ  48  to move the first internal organ  48  toward the position away from the second internal organ  50 . The second tissue connector  34  is then manually connected to the inner abdominal wall  42 . 
         [0084]    With the apparatus  12  connected between the tissue  52  and the inner abdominal wall  42  in the manner discussed above, the first cord segment  14  and the second cord segment  22  engage across the first internal organ  48  and hold the first internal organ  48  at the position away from the second internal organ  50  without further manual input. This provides surgical access to the second internal organ  50 . Without requiring manual holding or restraining of the first internal organ  48  in the position away from the second internal organ  50 . 
         [0085]      FIG. 6  is a representation of the apparatus of  FIG. 2  that has been connected between the tissue  52  and the inner abdominal wall  42  according to the same method as the apparatus of  FIG. 1  described above. 
         [0086]    In a further embodiment of the apparatus of the invention shown in  FIG. 3 , the apparatus  54  is comprised of a single cord  56  having a continuous flexible length with opposite first  58  and second  60  ends. A tissue connector in the form of a needle  62  is attached to the first end  58  of the length of cord  56 . At the opposite second end  60  of the length of cord  56 , the cord is formed in a knot  64 . 
         [0087]    The method of using the embodiment of the apparatus  54  shown in  FIG. 3  is illustrated in  FIG. 7 . The apparatus  54  is first positioned inside the abdominal cavity in the same manner as the previously described embodiments. The knotted end  64  of the length of cord is then connected to the tissue  52  adjacent the first internal organ  48  by first passing the needle  62  through the tissue  52  and then manually pulling the needle  62  and the attached length of cord  56  through the tissue  52 . This attaches the knotted second end  64  of the length of cord  56  to the tissue  52  between the first  48  and second  50  internal organs. 
         [0088]    The needle  62  is then passed through the inter-abdominal wall  42  and the needle  62  and the attached length of cord  56  are pulled from the insertion site  72  back into the abdominal cavity  46 . This causes a first segment  74  of the cord length  56  to move into engagement with and across the first internal organ  48 . The engagement of the first cord segment  74  with the first internal organ  48  moves the first internal organ  48  toward the position away from the second internal organ  50 . 
         [0089]    The needle  62  is then again inserted through the inter-abdominal wall  42  at a second insertion location  76  spaced from the first insertion location  72 . The needle  62  and the attached length of cord  56  are pulled manually through the second insertion  76  into the abdominal cavity  46  until an intermediate section of cord  78  extends between the two insertion sites  72 ,  76 . 
         [0090]    The needle  62  and the attached length of cord  66  are then passed through the knot  64  formed at the opposite end of the length of cord  56  and are pulled tight. This causes a second cord segment  82  of the length of cord  56  to engage across and move the first internal organ  48  toward the position away from the second internal organ  50 . The length of cord  56  is pulled tight and a knot is tied between the opposite ends of the cord at the knot  64  on the cord second end  60 . The portion of the length of cord  54  extending from the knot  64  to the needle  62  is then cut and removed from the abdominal cavity. The length of cord  54  left in the abdominal cavity forms a triangular loop with the first  56  and second  82  cord segments extending across the first internal organ  48  and holding the first internal organ in the position away from the second internal organ  50  without manual input. In this manner, surgical access is provided to the second internal organ  50  without manually holding the first internal organ  48  in its retracted position. 
         [0091]      FIGS. 8A-8E  represent one method of inserting the apparatus of the invention into the abdominal cavity and the method of using the apparatus. The embodiment of the apparatus  12  shown in these drawing Figures has a pair of keith needles  80 ,  82  as the first and second tissue connectors, and a “T” bar  84  as the third tissue connector. The apparatus  12  is first positioned inside an insertion device  86  in the form of a hollow narrow tube. The insertion device  86  is then inserted through a trocar or cannula  44  that has been positioned in the abdominal wall  42  in a conventional manner. Once inside the abdominal cavity  46 , the apparatus  12  is removed from the interior of the insertion device  86  and the insertion device is removed from the abdominal cavity through the cannula  44 . The “T” bar  84  or the third tissue connector is then passed through the body tissue  52 , i.e., the right diaphragm crus as described earlier. Once the “T” bar  84  is passed through the tissue  52 , it is rotated to its substantially 90 degree position relative to its pathway through the tissue  52  as shown in  FIG. 8C . The apparatus  12  is then pulled from the keith needles  80 ,  82 . As represented in  FIG. 80 , the keith needles  80 ,  82  are then passed through the abdominal wall  42  and the apparatus is pulled tight against the first internal organ  48 , i.e., the liver. The needles  80 ,  82  are then pulled at the exterior of the abdominal wall  42 , causing the apparatus to move the first internal organ  48  away from the second internal organ, i.e., the stomach. A pair of tension clasps  88 ,  90  are attached to the respective first  14  and second  22  cord segments of the apparatus on the exterior of the abdominal wall  42  to hold the apparatus in its position across the first internal organ  48  in the abdominal cavity  46 . 
         [0092]      FIGS. 9A-9E  represent a method of using an embodiment of the apparatus  12  that is similar to that shown in  FIGS. 8A-8E  and described above. In this example, the apparatus  12  also employs the “T” bar  84  as its third tissue connector. However, there is no needle provided on the first cord segment  14  and there is no needle provided on the second cord segment  22 . In this embodiment of the apparatus  12 , the first cord segment  14  is a length of suture having a free end  92  opposite the “T” bar  84  and the second cord segment  22  is a length of suture also having a free end  94  opposite the “T” bar  84 . The apparatus  12  is shown in  FIG. 9A  as being positioned in the abdominal cavity  46  using the insertion device  86  in the same manner described earlier with reference to the method of  FIGS. 8A-8E . The apparatus  12  of  FIG. 9A  is also initially used according to the same method of  FIGS. 8A-8E  in that the “T” bar  84  is passed through the body tissue  52  and is positioned substantially 90 degrees relative to the pathway through the tissue. A pair of GraNee needles  96 ,  98  are then passed through the abdominal wall  42 . One of the GraNee needles  96  grabs the suture free end  92  of the first cord segment  14  and the other GraNee needle  98  grabs the suture free end  94  of the second cord segment  22 . The GraNee needles  96 ,  98  are then withdrawn through the abdominal wall  42  pulling the suture free ends  92 ,  94  through the abdominal wall. The suture free ends  92 ,  94  are then secured to the abdominal wall using a pair of clamps  88 ,  90  as was done in the previously-described embodiment of  FIGS. 8A-8E . 
         [0093]      FIGS. 10A and 10B  are a representation of the method of the invention practiced using an ENDO STITCH® device marketed by United States Surgical Corporation.  FIG. 10A  represents the distal end of the ENDO STITCH®  102  being inserted through the cannula  44  in the abdominal wall  42  to a position adjacent the diaphragm crus  52 . As is conventional, the pair of jaws  104 ,  106  at the ENDO STITCH® distal end  102  hold a needle  108  and a length of suture  110 . The ENDO STITCH®  102  is manually actuated to pass the needle  108  through the tissue  52  of the crus from one jaw  104  of the ENDO STITCH® to the opposite jaw  106  of the ENDO STITCH®. The length of suture  110  is then removed from the abdominal cavity  46  through the cannula  44  and is pulled tight, causing the length of suture  110  to move and hold the first internal organ away from the second internal organ in substantially the same manner as described earlier. 
         [0094]      FIGS. 11A and 11B  represent a further embodiment of the apparatus  12  and its method of use. The embodiment of the apparatus  12  shown in  FIGS. 11A and 118  and its method of use are substantially the same as that of earlier-described embodiments, except that the “T” bar of the previously-described embodiments is replaced by a “J” hook locking clasp  112 .  FIG. 11A  shows the locking clasp  112  in its open position prior to the hook portion of the clasp being passed through the tissue  52  of the diaphragm crus.  FIG. 116  shows the locking clasp  112  after the hook of the clasp has been passed through the tissue  52  and the clasp has been locked. The method of further using the apparatus to move and hold an internal organ is substantially the same as that of earlier-described embodiments. 
         [0095]      FIGS. 12A and 126  show a further embodiment of the apparatus  12  and its method of use. The construction of the embodiment of the apparatus  12  shown in  FIGS. 12A and 126  is substantially the same as earlier described embodiments, except that the “T” bar or locking clasp is replaced by a barbed needle  114 . The method of using the embodiment of the apparatus shown in  FIGS. 12A and 126  is substantially the same as that of earlier described embodiments, except that the barbed needle  114  is passed through the tissue  52  of the diaphragm crus until the barb of the needle emerges from the tissue as shown in  FIG. 12B . This secures the apparatus to the tissue  52 . Further use of the apparatus to move and hold an internal organ is substantially the same as that of earlier-described embodiments. 
         [0096]      FIGS. 13A and 13B  show a further embodiment of the apparatus  12  of the invention that is substantially the same as that as earlier-described embodiments except that the third tissue connector or “T” bar is replaced by a resilient biased clasp  116 . In the method of using the apparatus of  FIGS. 13A and 13B , the opposite arms  118 ,  120  of the clasp  116  are compressed to open the jaws  122 ,  124  of the clasp as shown in  FIG. 13A . The jaws  122 ,  124  are then positioned around the tissue  52  of the diaphragm crus and are allowed to close, thereby securing the clasp  116  to the tissue  52 . The subsequent method of using the apparatus shown in  FIGS. 13A and 13B  is substantially the same as that of previously-described embodiments of the apparatus. 
         [0097]      FIG. 14A-14C  show a further embodiment of the apparatus  12  that is substantially the same as that of previously-described embodiments except that the third tissue connector is a two-piece rivet assembly. The assembly is comprised of a pin  126  having an enlarged point  128  and a cap  130  having a circular center opening  132 . In the method of using the apparatus of  FIGS. 14A-C , the pin  126  is first inserted through the tissue  52  of the diaphragm crus until the point  128  projects from the opposite side of the tissue. The point  128  is then inserted through the center opening  132  of the cap  130 , thereby securing the pin  126  and the cap  130  to the tissue  152 . The subsequent steps of using the apparatus of  FIGS. 14A-14C  is substantially the same as that of earlier-described embodiments of the apparatus. 
         [0098]      FIGS. 15A and 15B  show a further embodiment of the apparatus  12  that has substantially the same construction of earlier-described embodiments of the apparatus except for the first and second tissue connectors being a pair of “J” shaped hooks  134 ,  136 . In the method of using the embodiment of the apparatus shown in  FIGS. 15A and 15B , the first cord segment  14  and the second cord segment  22  are secured to the inner abdominal wall  42  by passing the hooks  134 ,  136  through the tissue of the inner abdominal wall. Apart from this, the method of using the apparatus shown in  FIGS. 15A and 15B  is substantially the same as that of earlier-described embodiments of the apparatus. 
         [0099]      FIGS. 16A and 16B  represent a further embodiment of the apparatus and its method of use that are substantially the same as that of previously-described embodiments, except for the first and second tissue connectors being a pair of “J” hook locking clasps  138 ,  140 . In the method of using the apparatus of  FIGS. 16A and 166 , the hook portions of the locking clasps  138 ,  140  are passed through the tissue of the inner abdominal wall  42  and then are locked closed. This secures the first cord segment  14  and the second cord segment  22  to the inner abdominal wall. Apart from this, the method of using the apparatus of the invention shown in  FIGS. 16A and 16B  is substantially the same as that of earlier-described embodiments of the apparatus. 
         [0100]      FIG. 17  shows a representation of an embodiment of the apparatus where the first and second tissue connectors are provided as a pair of resilient, biased clasps  142 ,  144  that have substantially the same construction of the earlier-described clasp  116 . The clasps  142 ,  144  are secured to the inner abdominal wall  42  by first opening the clasps and positioning tissue of the inner abdominal wall between the open jaws of the clasps, and then allowing the jaws of the clasps to close over the tissue. This secures the first cord segment  14  and the second cord segment  22  to the inner abdominal wall. Apart from this, the method of using the apparatus represented in  FIG. 17  is substantially the same as that as earlier-described embodiments of the apparatus. 
         [0101]      FIGS. 18A and 18B  show an embodiment of the apparatus and its method of use that is substantially the same as that of  FIG. 7 . The embodiment of  FIGS. 18A and 18B  differs from that of the  FIG. 7  embodiment in that the free ends  146 ,  148  of the length of suture  150  are tied in a knot completing the triangular loop configuration of the length of suture  150  at a location that is displaced from the portion of the suture  150  passed through the tissue  52  of the diaphragm crus. Apart from this, the method of using the apparatus of the invention shown in  FIGS. 18A and 18B  is substantially the same as that of the embodiment of the apparatus shown in  FIG. 7 . 
         [0102]      FIGS. 19A and 19B  show a further embodiment of the apparatus and its method of use. The apparatus shown in these drawing Figures is comprised of a length of cord  152  with a circular pledget  154  secured at one end of the cord and a needle, for example a keith needle  156 , secured to the opposite end of the cord. The cord  152  could be a length of suture or other similar material. In the method of using the apparatus shown in  FIGS. 19A and 19B  the needle  156  is first passed through the abdominal wall  42  and into the abdominal cavity  46 . The needle  156  is then passed through the tissue  52  of the diaphragm crus. The needle  156  is then again passed through the abdominal wall  42  to the exterior of the abdomen and is pulled tight. This results in the length of cord  152  engaging against and moving the first internal organ away from the second internal organ in substantially the same manner as previously-described embodiments. The tight length of cord  152  is then secured in place by a clasp  158  attached to the length of cord  152  against the exterior of the abdominal wall  42 . 
         [0103]      FIGS. 20A and 20B  show a representation of a further embodiment of the apparatus and its method of use. In  FIG. 20A , the apparatus is shown comprised of a length of cord  160  having a circular pledget  162  at one end and a needle, for example a keith needle  164 , at the opposite end. The apparatus also includes a second shorter length of cord  166  with a “T” bar  168  at one end and a loop  170  formed in the opposite end. In the embodiment, the cords  160 ,  166  may be suture or other similar materials. The method of using the apparatus is represented in  FIG. 20B . The “T” bar  168  is first secured to the tissue  52  of the diaphragm crus. The needle  164  is then passed through the tissue of the inner abdominal wall  42 , through the loop  170  and then through the abdominal wall  42  to the exterior of the abdomen. Pulling the needle  164  on the exterior of the abdomen pulls the cord  160  tight across the internal organ to move and hold the internal organ in substantially the same manner as that of previously-described embodiments of the apparatus. 
         [0104]      FIGS. 21A and 21B  show a further embodiment of the apparatus that is substantially the same as that of the embodiment of  FIGS. 20A and 20B , except that the needle  164  is removed from the end of the length of cord  160 , leaving a free end  172  of the cord. The method of using this embodiment of the apparatus is substantially the same as that of the previously-described embodiment except for the step of passing the cord free end  172  through the abdominal wall  32 . A GraNee needle (not shown) may be used to perform this step of the method. 
         [0105]      FIGS. 22A and 22B  show a further embodiment of the apparatus that is substantially the same as that of the previously-described embodiment, except that it is comprised of only the length of cord  160  having the circular pledget  162  at one end and a free end  172  of the cord at the opposite end. In the method of using this embodiment of the apparatus, the suture free end  172  is first passed through the inner abdominal wall  42 , then through the tissue  52  of the diaphragm crus, and then through and out of the abdominal wall  42 . As in the previously-described embodiment, the suture free end  172  can be passed through the tissue of the abdominal wall  42  and the crus  52  using a GraNee needle or other similar instrument. The length of cord  160  is pulled tight to move and hold the first internal organ relative to the second internal organ in substantially the same manner as previously-described method embodiments of the apparatus. 
         [0106]      FIG. 23  shows a further embodiment of the apparatus that is substantially the same as that of earlier-described embodiments except for the first and second tissue connectors being “J” hook locking clasps  174 ,  176  that incorporate one-way clutch mechanisms. The ends of the cord segments  14 ,  22  can be pulled through the clutch mechanisms of the clasps  174 ,  176  in one direction, but are prevented by the clutch mechanisms from being pulled through the clasps  174 ,  176  in the opposite directions. 
         [0107]      FIG. 24A-24C  show representations of a “J” hook locking clasp such as that shown in  FIG. 23 , with a one-way clutch mechanism. The one-way clutch mechanism is comprised of a rotatable pulley  178  and a “V” shaped groove  180  positioned adjacent the pulley  178 . An end portion of the cord  182  is threaded through the “V” shaped groove  180  and then around the pulley  178 . When the end of the cord  182  extending from the pulley  178  is pulled tight, the relative positions of the pulley  178  and the groove  180  cause the portion of the cord  182  to wedge and become locked in the bottom of the groove  180 . 
         [0108]      FIG. 25  shows a further representation of the embodiment of the apparatus employing a “J” hook locking clasp  184  with a one-way clutch mechanism. The one-way clutch mechanism is comprised of a pair of pivoting cams  186 ,  188  having opposing ratchet tooth surfaces  190 ,  192 . A portion of the apparatus cord  194  is threaded between the opposed tooth surfaces. The portion of cord  194  can be pulled through the spacing between the cam ratchet tooth surfaces  190 ,  192  in one direction, for example to the left in  FIG. 25 , but the cams  186 ,  188  pivot toward each other and their ratchet tooth surfaces  190 ,  192  clamp the cord portion  194  between the surfaces when the cord portion is pulled in the opposite direction, for example to the right as shown in  FIG. 25 . 
         [0109]      FIG. 26  shows a representation of a further embodiment of the “J” hook clasp  196  having a one-way clutch mechanism. In this embodiment, the one-way clutch mechanism is comprised of a toothed wheel  198  that engages with the cord portion  20  pulled through the claps  196 . The tooth wheel  198  also has a smaller ratchet wheel  202  at its center. The ratchet wheel  202  engages against a resilient pawl  204 . The ratchet wheel  202  and resilient pawl  204  function in the conventional manner allowing the toothed wheel  198  to rotate in one direction when the cord portion  200  is pulled through the clutch mechanism, for example to the right as shown in  FIG. 26 , but prevent the rotation of the toothed wheel  198  and the movement of the cord portion  200  when the cord portion is pulled in the opposite direction, for example to the left as shown in  FIG. 26 . 
         [0110]      FIGS. 27-32  show several different representations of the possible constructions of the cord segments  14 ,  22 ,  38  of the apparatus of the invention. In  FIGS. 27-32  the first and second tissue connectors are represented by needles, for example keith needles  80 ,  82 . The third tissue connector is represented by a “T” bar  84 . It should be understood that these are only examples of only three tissue connectors that could possibly be used with the apparatus of the invention, and that other forms of tissue connectors, for example the types described herein could be used as the three tissue connectors on the apparatus. 
         [0111]      FIG. 27  shows the first  14 , second  22  and third  38  cord segments as being constructed of suture material. 
         [0112]      FIG. 28  shows the first  14  and second  22  cord segments being part of a single length of surgical tape or strap, and the third cord segment  38  being constructed of suture. 
         [0113]      FIG. 29  shows the first  14  and second  22  cord segments being constructed of lengths of suture inserted through lengths of surgical tubing. The third cord segment  38  is constructed of suture. 
         [0114]      FIG. 30  shows the apparatus as having first  14  and second  22  cord segments constructed of combinations of surgical tape and suture connected end to end. The third cord segment  38  is constructed of suture material. 
         [0115]      FIG. 31  shows the apparatus being constructed of first  14  and second  22  cord segments formed from a single length of suture material inserted through a single length of surgical tubing. The third cord segment  38  is constructed of suture material. 
         [0116]      FIG. 32  shows the apparatus as having the first  14  and second  22  cord segments constructed of a single continuous length of surgical tape having lengths of suture at opposite ends. The third cord segment  38  is constructed of suture material. 
         [0117]      FIGS. 33-45  show examples of some of the various different types of tissue connectors that could be used as any one of the tissues connectors  32 ,  34 ,  36  of the apparatus. These are only some of the possible types of tissue connectors, and the connectors shown in  FIGS. 33-45  should not be interpreted as limiting the apparatus to the particular tissue connectors shown. 
         [0118]      FIG. 33  shows a “T” bar  84  as one example of any one of the three tissue connectors  32 ,  34 ,  36 . 
         [0119]      FIG. 34  shows a barbed needle  114  as any one of the three tissue connectors  32 ,  34 ,  36 . 
         [0120]      FIG. 35  shows the two-piece rivet pin  126  and cap  30  connector that can be used as any one of the three tissue connectors  32 ,  34 ,  36 . 
         [0121]      FIG. 36  shows the “J” hook locking clasp  112  that can be used as any one of the three tissue connectors  32 ,  34 ,  36 . 
         [0122]      FIG. 37  shows the resilient, biased clasp  116  that could be used as any one of the three tissue connectors  32 ,  34 ,  36 . 
         [0123]      FIG. 38  shows a cross-section of an embodiment of a “J” hook locking clasp. The embodiment shown is comprised of a cylindrical housing  206  that contains the “J” hook  208  and a coil spring  210  that biases the “J” hook  208  to its closed position. 
         [0124]      FIGS. 39A-39C  show a variation of the “J” hook locking clasp of  FIG. 38  where the coil spring  210  is replaced by a spiral band spring  212 .  FIG. 39B  shows the spiral and spring  212  in its extended configuration, and  FIG. 39C  shows the spring in its compressed configuration. 
         [0125]      FIGS. 40A and 40B  show a tissue connector clasp that is comprised of a pair of resilient jaws  214 ,  216  that project from one end of a hollow housing  218 , and a pin  220  connected to the jaws that projects from the opposite end of the housing. A spring  22  contained in the housing  218  biases the pin  220  and the jaws  214 ,  216  to the left as shown in  FIG. 40A . This causes the resilient jaws to move to their open position shown in  FIG. 40A . Pulling the pin  220  to the right against the bias of the spring  222  causes the housing to slide against the opposite sides of the jaws  214 ,  216  and move the jaws to their closed position. 
         [0126]      FIG. 41  shows a side view of the resilient biased clasp  116  described earlier. Compressing the opposite arms  118 ,  120  of the clasp  116  causes the jaws  122 ,  124  to separate. Releasing the compression force causes the jaws  122 ,  124  to move together under the bias of the resilience of the clasp  116 . 
         [0127]      FIG. 42  shows an embodiment of a clasp comprised of a first jaw  224  and first arm  226  connected by a pivot connection  228  to a second jaw  230  and second arm  232 . An oblong cam  234  on a toothed cam wheel  236  is positioned between the pair of arms  226 ,  232 . A toothed actuator wheel  238  meshes with the toothed cam wheel  236 . Rotation of the actuator wheel  238  will cause rotation of the cam wheel  236  and the cam  238 . Rotation of the cam  234  to its position shown in  FIG. 42  pushes the pair of arms  226 ,  232  away from each other which in turn causes the pair of jaws  224 ,  230  to move toward each other. Rotation of the cam  234  90 degrees or one-quarter turn from its position shown in  FIG. 2  will cause the jaws  242 ,  230  to move away from each other. 
         [0128]      FIG. 43  shows an embodiment of a clasp comprised of a first jaw  240  and first arm  242  connected by a pivot connection  244  to a second jaw  246  and second arm  248 . A spring  250  is positioned between the pair of arms  240 ,  248  and biases the arms away from each other. This in turn biases the first jaw  242  and second jaw  246  toward each other. The jaws  242 ,  246  are opened by applying a compression force to the opposite sides of the first arm  240  and second arm  248  that compresses the spring  250 . 
         [0129]      FIGS. 44A-44B  show a side-sectioned view of a construction of the rivet assembly described earlier. As seen in the drawing Figures, the pin head  128  is slightly larger in diameter than the cap hole  132 . When the pin  126  is attached to the cap  130 , there is a fixed gap or maximum distance between a circular head  252  of the pin  126  and the cap  130 . 
         [0130]      FIGS. 45A-45E  show a further embodiment of a rivet assembly. In this assembly, the rivet pin  254  has several notches  256  along its length between the pin head  258  and the pin point  260 . The rivet cap  262  is similar in construction to that of the previously-described embodiment with a center opening or hole  264  extending through the cap. However, the cap  262  is also formed with a transverse slot  266  that intersects the center hole  264  and a parallel slot  268  that extends into the cap  262  parallel to the center hole  264  and intersects the transverse slot  266 . A locking tab  270  with a pin hole  272  and a spring hole  274  is inserted in the transverse slot  266  for sliding movement therein. A resilient wire spring  276  is inserted downwardly into the parallel slot  268  and through the tab pin hole  272 . Inserting the rivet pin  254  into the cap center hole  264  and through the tab pin hole  272  causes the pin to slide the tab to the left as shown in  FIG. 45A  against the bias of the wire spring  276 . As a pin notch  256  passes through the tab hole  272 , the bias of the spring  276  causes the tab  270  to move to the right and into the notch  256 . This locks the pin  254  in place relative to the cap  262 . With the pin  254  having a number of notches, and in the example of  FIG. 45A  having three notches, the position of the pin head  258  relative to the cap  262  can be adjusted between three positions. This provides an adjustable gap or an adjustable distance between the pin head  258  and the cap  262 . 
         [0131]      FIGS. 46A-46E  represent a further embodiment of the apparatus of the invention. This embodiment is comprised of a length of cord  278  having a needle  280  at one end and a loop  282  formed at the opposite end. A circular pledget  284  is provided on the length of cord  278  toward the loop end of the cord. The apparatus also includes a locking collar having a hollow cylindrical housing  286  that contains a tubular one-way suture lock  288 . The suture lock  288  is basically cylindrical but is formed with a resilient tab  290  that projects toward the center of the cylindrical configuration of the suture lock.  FIG. 46E  shows a cross-section representation of the collar cylindrical housing  286  containing the one-way suture lock  288  and a portion of the length of cord  278  extending through the collar. The method of using this embodiment of the apparatus is shown in  FIG. 46C . In use in the abdominal cavity  46 , the needle  280  is first passed through the tissue  52  in the area of the diaphragm crus, and then is passed a first time through the inner abdominal wall  42 . The needle  280  is then moved across the inner abdominal wall  42  and is again passed a second time through the inner abdominal wall. The needle is then inserted through the loop  282  and is pulled tight. This causes the length of cord  278  to form a triangular loop in the abdominal cavity that moves the first internal organ away from the second internal organ and holds the first internal organ in the displaced position in the same manner as previously-described methods of using the apparatus of the invention. The needle  280  is then passed through the collar cylindrical housing  286  and the housing  286  is moved tight against the cord loop  282 . The cord loop  282  is smaller than the housing  286  so that the housing cannot pass through the loop  282 . As the length of cord  278  is pulled through the collar housing  286 , the locking tab  290  engages against the side of the cord  278  as shown in  FIG. 46E . This allows the cord  278  to move through the collar housing  286  in the direction to the right shown in  FIG. 46E , but prevents movement of the cord to the left as shown in the Figure. In this manner, the apparatus of  FIGS. 46A-46E  holds the length of cord tight in its triangular loop configuration. 
         [0132]      FIGS. 47A and 47B  show a further embodiment of the apparatus of the invention and its method of use. The apparatus is comprised of a length of cord  294  having a pledget  296  secured at one end and a needle  298  secured at the opposite end. The apparatus also includes a one-way locking mechanism  300  having a pair of channels  302 ,  304  through the mechanism dimensioned to receive the length of cord  294 . One of the channels  302  allows the length of cord  294  to move through the channel in one direction, but prevents the opposite direction of movement. The other channel  304  allows the length of cord  294  to move through the channel in one direction, but also prevents the opposite direction of movement of the cord  294 . As represented in  FIG. 47A , the method of using the apparatus first involves the needle  298  passing through the inner abdominal wall until the pledget  296  is positioned up against the wall. The needle  298  then passes through the tissue  52  in the area of the diaphragm crus. The needle  298  is then inserted through the first channel  302  of the one-way locking mechanism  300 . The needle  298  is then against passed through the inner abdominal wall at a location spaced from the first insertion site and is then passed through the second channel  304  of the one-way locking mechanism  300 . The needle  298  with the length of cord  294  are then pulled tight and the locking mechanism  300  is moved up against the inner abdominal wall at the second needle insertion site. This causes the length of cord  294  to move the first internal organ and hold the first internal organ in its moved position away from the second internal organ in a similar manner to that of earlier-described embodiments. 
         [0133]      FIGS. 47C and 47D  show the interior of one embodiment of the one-way locking mechanism  300 . The mechanism  300  includes a housing first half  306  and a second half  308  that are connected together by a living hinge  310 . The open position of the locking mechanism is shown in.  FIG. 47D . The interior of the two halves  306 ,  308  of the locking mechanism are formed with grooves  312 ,  314  that form the two channels  302 ,  304  through the locking mechanism when the two halves  306 ,  308  of the locking mechanism are pivoted about the living hinge  310  and snapped together. A “U” shaped spring member  316  is positioned in the first locking mechanism half  306 . The spring member  316  has a pair of arms  318 ,  320  that project from opposite sides of the spring member. Each arm  318 ,  320  in turn has a resilient locking tab  322 ,  324  that projects outwardly at an angle from its respective arm  318 ,  320 . The resilient tabs  322 ,  324  are positioned to engage in sliding engagement along portions of the cord  294  that pass through the channels  302 ,  304 . As shown in  FIG. 47D , the one tab  322  will allow the cord  294  to slide across the tab in a direction from right to left as shown in the drawing Figure, but will prevent the reverse sliding movement of the cord. The other tab  324  will allow sliding movement of the cord  294  across the tab  324  in a left to right direction as shown in  FIG. 47D , but will prevent the reverse movement of the length of cord  294 . 
         [0134]      FIGS. 48A-48D  show a variant embodiment of the one-way locking mechanism  300 . As shown in  FIG. 48A , the length of cord is passed through the locking mechanism  328  in much the same manner as the earlier-described locking mechanism  300 . However, the second channel  330  of the locking mechanism  328  of  FIG. 48A  has a block  332  with a hole  334  positioned along the channel. An inclined tooth  336  is positioned in the block hole  334 . The portion of the cord length  338  that extends through the locking mechanism channel  330  also extends through the block hole  334 . A spring  340  in the locking mechanism  328  biases the block  332  and the tooth  336  toward the portion of cord  338  extending through the locking mechanism channel  330 . Due to the inclination of the tooth  336 , with the spring  340  biasing the tooth  336  into engagement with the cord portion  338 , the cord portion  338  can slide over the tooth  338  as it is moved in a left to right direction as shown in  FIG. 48C , but is prevented from moving in the opposite direction. Pressing the block  332  into the locking mechanism  328  against the bias of the spring  340  disengages the tooth  336  from the cord portion  338  and permits the cord portion to move in either direction through the locking mechanism  328 . 
         [0135]      FIGS. 49A and 49B  show a further embodiment of a cord locking mechanism  344  that is similar to that of  FIG. 48A . A cross-section of a channel  346  extending through the locking mechanism  344  is shown in  FIG. 49A . The channel  346  is formed with pairs of ridges  348 ,  350  on opposite sides of the channel. A wave form spring  352  is positioned in the channel  346 . The spring  352  has grooves  354  formed through peaks formed in the wave form spring. The portion of the cord  356  passing through the locking mechanism channel  346  also passes through the grooves  354  in the wave form spring  352 . A button hole  358  is provided in the top of the cord locking mechanism  344  and a release button  360  is positioned in the hole. When the release button  360  is pressed in the hole  358 , it engages with the wave form spring  352  and compresses the spring to the position shown in  FIG. 49A . In this position of the spring  352  the cord  356  is free to move in opposite directions through the locking mechanism  344 . When the button  360  is released, the spring  352  moves upwardly from its position shown in  FIG. 49A  and portions of the spring  362  engage with the cord portion  356  extending through the lock mechanism channel  346  and hold the cord portion against the ridges  348  at the top of the channel  346 . This locks the cord portion  356  in the locking mechanism  344 . 
         [0136]      FIGS. 50A and 50B  show a further embodiment of a one-way cord locking mechanism. The mechanism includes a housing  364  having a hole  366  extending through the housing that is defined by a cone-shaped interior surface  368 . A pair of lock members  370 ,  372  are positioned in the housing hole  366 . Each of the lock members  370 ,  372  have exterior surfaces  374 ,  376  that when the locking members are positioned together, define a truncated cone shape that fits within the cone-shaped interior surface  368  of the housing  364 . The opposing interior surfaces  378 ,  380  of the lock members  370 ,  372  are formed with mating peaks and valleys. As shown in  FIG. 50B , a spring  382  biases the two lock members  370 ,  372  into the cone-shaped interior surface  368  of the housing  364 , thereby causing the lock member interior surfaces  378 ,  380  to move toward each other. A portion of a cord length  384  extending through the opposing interior surfaces  378 ,  380  of the lock members  370 ,  372  is prevented from moving in the upward direction as shown in  FIG. 50B  due to the bias of the spring  382 . However, when the cord portion  384  is moved in the opposite downward direction as shown in  FIG. 50B , the movement of the cord portion  384  causes the lock members  370 ,  372  to compress the spring  382 . This allows the lock member interior surfaces  378 ,  380  to move away from each other and release the portion of the cord  384  for movement through the lock mechanism. 
         [0137]      FIGS. 51A-51E  show one method of inserting the apparatus of the invention into the tubular insertion device  86  described earlier. As shown in these drawing Figures, a length of suture  386  is looped around the apparatus and is then pulled through the interior of the insertion device  86 . The first  14  and second  22  cord segments are folded flat against each other and the additional cord segment  38  is folded over parallel with the first cord segment  14  and second cord segment  22 . The apparatus is then pulled by the suture loop  386  into the interior of the insertion device  86  to the position shown in  FIG. 51E . 
         [0138]      FIGS. 52A and 52B  show a further embodiment of an insertion device  390 . The insertion device  390  has the configuration of an elongate narrow rod with a pair of opposed grooves  392 ,  394  extending up one side of the rod from a distal end  396  of the rod. A third groove  398  is formed in a side of the rod toward a proximal end of the rod. The third groove  398  is positioned between the opposed pair of grooves  392 ,  394 . According to the method of using the insertion device  390 , the first cord segment  14  and second cord segment  22  of the apparatus  12  are positioned in the opposed pair of grooves  392 ,  394  that extend from the insertion device distal end  396 . The additional cord segment  38  of the apparatus  12  is positioned in the third groove  398  in the side of the rod. With the cords of the apparatus held in these grooves, the insertion device  390  is then inserted through a cannula  44  to insert the apparatus  12  into the abdominal cavity. 
         [0139]      FIG. 53  shows a representation of a further embodiment of the insertion device  402  that is similar in construction to the previously-described embodiment of the insertion device  390 . The insertion device  402  of  FIG. 54  is also comprised of a pair of opposed grooves  404 ,  406  that receive the first  14  and second  22  cord segments of the apparatus  12 , and a third groove  408  that receives the additional cord segment  38  of the apparatus. 
         [0140]      FIG. 54  shows a still further embodiment of an insertion device  410 . The insertion device  410  has a rod-shaped length with a hollow distal end. The rod distal end is comprised of a first half  412  and a second half  414  that are connected together by a living hinge assembly  416 . According to the method of using the insertion device  410  of  FIG. 54 , the apparatus  12  is positioned in the interior of the first half  412  with the first cord segment  14  and second cord segment  22  extending parallel to each other, and the third cord segment  38  folded aver the first cord segment  14  and second cord segment  22 . The second half  414  of the insertion device is then folded over the hinge assembly  416  and snapped closed to prepare the insertion device  410  for insertion of the apparatus  12 . 
         [0141]      FIGS. 55A-55C  show a mesh apparatus  420  that is designed to be used as a part of the apparatus of the invention. The mesh apparatus  420  is basically comprised of a generally rectangular or trapezoidal-shaped panel of surgical mesh  422  with a pair of axially aligned tubes  424  at one side and a pair of axially aligned tubes  426  at the opposite side. As shown in  FIG. 55B , the mesh apparatus  420  can be rolled up around the pairs of tubes  424 ,  426  to reduce the size of the apparatus for insertion through a cannula and into the abdominal cavity.  FIG. 55C  shows the mesh apparatus  420  positioned in the abdominal cavity  46  and held in place against the first internal organ  48  by one of the previously-described embodiments of the apparatus. It should be understood that any of the previously-described embodiments of the apparatus may be employed according to the method of the invention to hold the surgical mesh  420  in its position as shown in  FIG. 55C . 
         [0142]    As various modifications could be made in the constructions of the apparatus and the methods herein described and illustrated without departing from the scope of the invention, it is intended that all matter contained in the foregoing description or shown in the accompanying drawings shall be interpreted as illustrative rather than limiting. Thus, the breadth and scope of the present invention should not be limited by any of the above-described exemplary embodiments, but should be defined only in accordance with the following claims appended hereto and their equivalents.