Apparatus for laparoscopic repair of inguinal hernia in children , neonates and adults

Inventors: Bahar Ashjaei Affiliation:

MD. Assistant professor

Department of surgery

Faculty of medicine

Tehran University of Medical Science.

Keshavarz Blvd, Gharib St, Pediatric Center of Excellence, Tehran, Iran

FIELD OF THE INVENTION:

This invention is related to the field of surgery especially pediatric surgery and laparoscopic surgery. The present invention concerns the field of surgical techniques for hernia repair in any sites of the human and animal bodies especially for inguinal and femoral canals. This is more special to repair of inguinal canal hernia in children , infants and neonates. The present invention relates to surgical device and more particularly to an apparatus, method and system for the simultaneously employment and fixation of a surgical mesh inside of a patient's body.

BACKGROUND OF THE INVENTION:

Hernia is a defect or hole in the abdominal wall which allows protruding the intraperitoneal components outside the peritoneal cavity. This defect is located in the inguinal canal more than the other sites of the peritoneal cavity. Patients feel discomfort of protruding the intraperitoneal organs from this defect.

Traditionally, sutures were utilized to repair hernia and close hernia sac in children and adults. In order to suture the hernia sac in inguinal or femoral hernia some surgeons open the inguinal or femoral canal by scalpel. In minimally invasive surgery or laparoscopic surgery the inguinal canal is not opened by scalpel, but for applying laparoscopic devices we need some openings more than one in the patient's body. These openings are named as ports and they are three to six in laparoscopic methods. If we insert all of the devices through one opening we need a large port that reduces the benefits of minimally invasive or laparoscopic surgery. Furthermore the process of suturing requires special skill to perform, particularly time-consuming, when it is done through a small port. Inguinal hernia is bilateral in many patients this problem increases the openings or ports in minimally invasive or

laparoscopic surgery. By increasing the opening numbers or ports in the patient's body the cosmetic results are reduced and the feeling of pain is increased therefore the need for analgesic drugs also will be increased.

One important problem in laparoscopic hernia repair in adults is

difficulties in spreading the mesh in the abdominal cavity. The U.S. patent No. 5,383,477( 1995 ) can help surgeons to spread the mesh inside the body, but it has not any effect on fixing the mesh .This patent is directed to an applicator for placing and holding a patch of surgical mesh over a hernia defect, but another instrument is needed for affixing this patch. On the other hand this device and procedure need more than one port for inserting the laparoscopic hernia repair instruments. (1)

The U.S. patent No. 5,263,969 ( 1993 ) is a tool for inserting a mesh prosthesis into the retroperitoneal space in the laparoscopic repair of inguinal and femoral hernia , but it is not for intraperitoneal space therefore it needs some other instruments for retroperitoneal dissection for inserting and fixing the surgical mesh. (2)

The U.S. patent No. 5,366,479 ( 1994 ) is an apparatus and surgical staple for attaching a surgical mesh to body tissue in laparoscopic hernia repair, but it is not for inserting and spreading the surgical mesh over the hernia defect and we need more ports for inserting more other instruments for the

procedure. (3) The PCT patent No. PCT/US2010/002648 (2010) and WIPO patent No WO 2011/043795 Al (2011) is an apparatus for deployment of a surgical mesh inside the patient's body but it can't affix or staple the surgical mesh and we need more other ports for inserting the other instruments for this purpose. (4)

The U.S. patent No. 5,370,650 (1994) is an apparatus for positioning surgical implants adjacent to body tissue. It can't fix or staple the surgical mesh and we need more other ports for inserting the other instruments in the abdominal wall for this purpose. (5)

The U.S. patent No. 8,097,008 B2 (2012) is an apparatus which is provided for the laparoscopic deployment and positioning of surgical materials, such as mesh. In one embodiment of this patent includes an attaching mechanism at the end of the arm to secure the repair material to an abdominal wall.

(6) Examples of attaching mechanisms include surgical staplers, adhesive dispenser and/or heating element. In this device the attaching mechanism is not designed and mentioned as a possible mechanism. Furthermore we need an additional port for inserting the fiber optic rod for display images from inside the body. In our device the spreading, inserting, stapling and

disengaging mechanisms are designed simultaneously. Furthermore the fiber optic rod for visualization the surgical field (internal inguinal ring) is designed in the body of the device. In our mesh and device the site of fixation is inside the inguinal canal by two strings which are equipped with two parts of a staple therefore it can acts as an apparatus for single port repair of inguinal hernia specially in children with indirect inguinal hernia.

We need only one small opening in patient's body for repairing the inguinal or femoral hernia even in bilateral hernias by using this device and method. This mesh is inserted, without any need to suture. The insertion technique is very easy and doesn't need special skill. This method is very fast and it is not time consuming like in suturing techniques. Furthermore we can enter the abdominal cavity from a small opening which is made in the

umbilicus and repair even bilateral inguinal hernia from the same one opening. We don't need any more opening to watch the surgical field because the cold light conductor and the lens (fiber optic rod) are attached in the body of the said device. The process of repairing is just one shoot in inguinal hernia, left or right. We need one shoot for the left side inguinal hernia repairing and one other shoot for the right side inguinal hernia repairing. All the surgical instruments which are needed for laparoscopic hernia repair are designed in the body of this apparatus. These components are mesh inserting and

spreading part (it is named as mesh holder part or mesh positioner part), stapling part (it is named as inner blade and outer blade) and visual field producer (is named as cold light conductor and lens or fiber optic rod).

In open techniques, the sutures can damage the vascular components of cord also vas deferens damage is possible. In the minimally invasive

techniques vascular or vas deferens damages are in lower rate in comparison with open techniques, but can occur.

By using the said device and mesh, vascular and vas deferens damage can be impossible because of suture less technique. We need one staple for fixing the said mesh which is designed in it and the position of the staple is far from the important elements like vas and vessels, therefore this method is safer than the other mentioned methods and patents.

Another new method for laparoscopic hernia repair in children is laparoscopic hernia repair with endoneedle. This procedure has some advantages comparable to those with open surgery like the shorter time of operation, more easear than the other methods and reproductive system remains intact. By using our device the procedure can be performed more easily than the enoneedle procedure and the time of operation is shorter than the endoneedle operation and the reproductive system will be intact.

Furthermore our device is designed for single port operation but the

endoneedle technique is not a single port technique. (7)

Another method for laparoscopic hernia repair in children is hook method. This method is a time consuming method and it needs more skill to perform in comparison to our method. Furthermore our device is designed for single port operation but the hook technique is not a single port technique. (8)

Needlescopic aproach to inguinal hernia repair is another laparoscopic inguinal hernia repair in method in children. This method is a time consuming method too and it needs more skill to perform in comparison to our method. Furthermore our device is designed for single port operation but the hook technique is not a single port technique. (9)

Trans umbilical endoscopic surgery TUES is another method for laparoscopic inguinal hernia repair in children. This method is safe, effective and cosmetic reliable but is a time consuming method too and it needs more skill to perform in comparison to our method. Furthermore in TUES method two trocar is inserted through two incisions in the paraumbilicus area but our device is designed for single port operation but the hook technique is not a single port technique. (10) & (11)

Laparoscopic resection of hernia sac without suture is another method for laparoscopic hernia repair in children. This method is a time consuming method too and it needs more skill to perform in comparison to our method. Furthermore our device is designed for single port operation but the hook technique is not a single port technique. (12)

SUMMARY OF THE INVENTION:

Inguinal hernia is a current disease in children and adults. In this disease there is a defect or a weakness in the abdominal wall of the patient. We close this defect or strengthen the weakness by some different methods. In traditional methods the abdominal wall is opened and the defect is closed by sutures and in adults we can use the mesh for this purpose.

In laparoscopic method we make some separate holes in the abdominal wall and insert our instruments in the peritoneal cavity to do the operation. After inserting the instruments in the peritoneal cavity, the defect is closed by suturing the peritoneum in the site of defect. If we use the single port laparoscopic method to repair the inguinal canal defect or close the hole, this opening should be sutured or the mesh should be fixed by using sutures and staples, too.

In all the above mentioned methods, the process of suturing or stapling is time consuming and needs numerous skills to do the method of surgery that is selected.

This invention consists of some segments that can enter the peritoneal cavity from a single opening that is made in or under the umbilicus.

Therefore this device is designed for single port laparoscopic hernia repair, especially in children. The device can hold a mesh that is attached to a staple to its end by two strings or two cord-like segments. The light and the lens (fiber optic rod) are attached to the same device and the peritoneal cavity and inguinal ring can be seen at the same time by the said device

simultaneously. The device can press the staple and fix it by applying just one pressure. The mesh holder segment of the device can open and the said mesh will exit from it and will be fixed over the defect or inguinal internal ring. We can use the same umbilical opening to repair the other side inguinal hernia. Therefore bilateral inguinal hernia can be repaired just by making one opening in the umbilicus or under it. This method and device for inguinal hernia repair is more time saving rather than all existing traditional and laparoscopic methods, furthermore we don't need numerous skills to do this method in comparison with the other existing methods.

One embodiment disclosed here is related to a device for laparoscopic hernia repair in children and neonates and indirect inguinal hernia in adults.

This device is made for the placement of a mesh in the inguinal canal to repair indirect inguinal hernia. The said mesh consists of several parts that will be explained. One part is a discoid or circle shaped part that is made of PVDF or other materials like that. This part of mesh can become crumpled to be placed into the mesh holder segment of the device. The others parts of the said mesh are two strings or two cord-like segments that are made of a non reactive material to the body like silicon and other similar materials. One of these cord-like parts is attached to the central part of the mesh in one end and has a hollow circle at the other end. This hollow circular part has the same material as the cord-like part that is attached to it. Another part of the said mesh is another string or cord-like segment that is made of a non reactive material to the human body such as silicon and other similar materials. This cord-like part is attached to the central part of the mesh lateral to the first cord-like segment in one end and is attached to a metal or rigid segment in another end. This metal segment works as a staple. This metal part doesn't have any reaction to the body of patient and is made of three parts. One part is like a disk and the other two parts are like two nails that are attached to the center of that metal discoid part. The cord-like part of the mesh that has a hollow circle at one end will be placed to the inguinal canal from the same end. Another cord-like part that is attached to the metal staple will be placed in the peritoneal cavity in front of the recent cord-like part that can be fixed to it by closing two blades of the mesh holder segment of the apparatus.

This laparoscopic device can enter to the peritoneal cavity from one hole that is made in the umbilicus and every side inguinal hernia, left or right; can be repaired from the same hole in the umbilicus.

The said laparoscopic apparatus consists of three main parts. 1- The first part is a handle that works as a driver part. This part is held outside of the patient's body in the surgeon's hand.2- The second part is a hollow cylinder shaped part that conducts the movement to the third part. 3- The third part that works as a mesh holder part. This third part can deliver and insert the mesh through the inguinal canal. Moreover the third part can fix the mesh in the inguinal canal and over the internal ring of inguinal canal by stapling the staple that is placed in the mesh.

The third part of the laparoscopic device, which is named mesh holder part is made of different parts that we will explain them. This mesh holder part can be separated and fused to the cylinder by twisting with a nut which is prepared at its proximal end. One nut is prepared in proximal end in the mesh holder part and a screw is prepared at the distal end of the cylinder part.

The mesh holder part consists of two main parts. One part is like a half of a hollow cone, named as inner semi cone. This inner semi cone is attached to a hollow semi cylinder part and this recent part has a round concavity at the end to keep the hollow ring part of the said mesh. The outer part is like a half of a hollow cone, which is named outer semi cone. This outer semi con is attached to a hollow semi cylinder part and this recent part has a round concavity at the end to keep the metal part of the said staple. A hinge is prepared in both lateral sides of proximal end of the outer semi cone, which joins the outer semi cone to the inner semi cone. BRIEF DESCRIPTION OF THE FIGURES:

FIG 1 : Whole view of the laparoscopic apparatus.

A: Front view of the laparoscopic apparatus.

B: the upper view of A.

C: the detailed view of (g&f) part in A.

D: detailed view of (circular sign) (^) in E.

E: the 3 dimensional view of A.

FIG 2: the hollow cylinder part of the instrument that connects the driver handle part to the hollow cone-shaped mesh holder part.

A: Cylinder part of the instrument.

B: front view of A.

C: the left view of E.

E: detailed view of the(T) part in the A.

F: the 3 dimensional view of the A.

FIG 3: Inner hollow semi cone of the mesh holder part.

A: the front view of B.

B: the left view of inner hollow semi cone of the mesh holder part

C: the upper view of B.

D: the detailed view of part (circular sign) (^) in E.

E: the 3 dimensional view of B. FIG 4: Detailed view of the instrument.

A: the front view of the instrument.

FIG 5: The lever bar.

A: front view of the lever bar.

C: upper view of the A.

D: detailed view of the part (circular sign) (^) in the E. E: 3 dimensional view of A.

B: the right view of the A.

FIG 6: digitate part of the driving handle.

A: Front view of the digitate part of the driving handle.

B: lateral view of A.

C: upper view of A.

D: 3 dimensional view of A.

FIG 7: Housing cover

A: front view of housing cover or part (e) in FIG 4.

B: left view of A.

C: upper view of A. D: 3 dimensional view of A.

FIG 8: Outer hollow semi cone part.

A: left view of the outer hollow semi cone part.

B: front view of A.

C: upper view of A.

D: 3 dimensional view of A.

FIG 9: Mesh and mesh holder part.

A: the said mesh inside the mesh holder part

B: a schematic view of the said mesh.

C: front view of the said mesh when it is in the mesh holder and is crumpled. D: a schematic view of the said mesh when it is crumpled.

E: 3 dimensional view of the said mesh when it is crumpled.

F: Staples parts of the said mesh which is shown as circular sign E in FIG 9.

DETAILED DESCRIPTION OF THE INVENTION: (Figures)

Unless defined otherwise, all technical and scientific terms used herein have the same meanings as commonly understood by one of ordinary skill in the art to which this invention belongs. All publications and patents specifically mentioned herein are incorporated by reference in their entirety for all purposes including describing and disclosing the chemicals, instruments, statistical analysis and methodologies which are reported in the publications which might be used in connection with the invention. All references cited in this specification are to be taken as indicative of the level of skill in the art. Nothing herein is to be construed as an admission that the invention is not entitled to antedate such disclosure by virtue of prior invention

FIG 1 : Whole view of the laparoscopic apparatus.

A: Front view of the laparoscopic apparatus. This is a laparoscopic

apparatus to repair inguinal hernia. This apparatus is made for holding a mesh and placing the mesh in the inguinal canal and upon inguinal internal ring and fixing the mesh in this position by stapling one staple that is

prepared in the said mesh. This apparatus has three main parts. One part is a hollow cone shaped part that is made of two hollow semi cone pieces. This hollow cone shaped part is named mesh holder part. The other part is a handle that will be held in surgeon's hand which can open and close the two hollow semi cone parts and can fix the staple just by one shoot. This recent part is named the driver handle part. The third part is a hollow slenderer part that is placed between the mesh holder part and the driver handle part that connects them together. Part (a) is a part of the driver handle which starts and performs the process of shooting. Part (b) is the hollow cylinder part which connects the driver handle to the hollow cone shaped mesh holder part and conducts the process of shooting from (a) to (f&g). Part (c) Is a spring that can be compressed and decompressed by moving part (d). Part (d) Part is a pressure button which is marked as part (g) of (A) of FIG 5. Can compress and decompress the spring and perform the process of shooting and conduct the stapling. Part (e) is the housing cover of the driver handle that is marked in FIG 4 (A) as part (e) of device. Part (f) is the outer hollow semi cone shaped part that will be placed outside the inguinal canal from its narrow tip which can help the fixation process of the mesh over the internal ring of inguinal canal. Part (g) is the internal hollow semi cone part of the mesh holder which will be placed against part (f) and inside the inguinal canal this part fixes the staple of the mesh through the process of shooting.

B: This is the upper view of A.

C: This is the detailed view of (f&g) part in A. This part is the mesh holder hollow cone-shaped part that can place the mesh on the internal ring of the inguinal canal that performs the stapling process and fixing the mesh over the inguinal internal ring. This part can be attached or detached to the hollow cylinder part by screwing. This screwing action is required to place the mesh into the mesh holder part. (loading action)

D: This is a detailed view of circle sign in (E). This part can do the screwing action of the mesh holder part. This action can attach or detach the mesh holder part to the hollow cylinder part and we can place the mesh inside the mesh holder part when it is detached from the hollow cylinder part.

E: This is the 3 dimensional view of A.

FIG 2: the hollow cylinder part of the instrument that connects the driver handle part to the hollow cone-shaped mesh holder part.

A: This is the hollow cylinder part of the instrument that connects the driver handle part to the hollow cone-shaped mesh holder part. One lever bar is prepared in this hollow cylinder part which conducts the shooting process from pressure button to the mesh holder part. This lever bar is shown as a spotted line inside the hollow cylinder part in (B). The part (a) is the holding part which connects the driver handle to the hollow cylinder part. Part (b) is a beam which connects the lever bar in the hollow cylinder part to the driver handle and conducts the shooting process to the mesh holder part. Part (1) is hollow cylinder part which enfolds the lever bar. Two parts are prepared outside this cylinder part. One part is a lens which creates the visual field of inspection of intra peritoneal cavity. Another part is a cold light conductor which conducts the light from the light source to the peritoneum. These two recent parts can be as fiber optic rod in plural situation. Part (1) is a notch or chamber through which a beam is prepared that can move through it. Part (d) is the cold light conductor which conducts the cold light from light source to the peritoneal cavity. Part (e) is the lens which creates the visual field for surgeon to watch the operation field. Parts (d&e) can be as a single part (fiber optic rod). Circle sign in (A) which is named circle (B) in (A) is the same as (E) which can screw and fix the hollow cylinder part to the mesh holder part.

B: This is a front view of (A). Circle sign in this view which is named (A) can fix the hollow cylinder part at its position. C: This is the left view of E.

D: Detailed view of circle sign in (B). Parts (f), (g), (h), (i) are grooves or sluts which hold the holding part in its position.

E: This is the detailed view of the circle sign or circle (B) in the (A). Part (j) is the cold light conductor which conducts the cold light from light source to the peritoneal cavity. Part (k) is the lens which creates the visual field for the surgeon to watch the operation field. The two parts (j), (k) can be juxtaposed and attached together or can be separated from each other and with some space between them.

F: This is the 3 dimensional view of the (A). Part (j) is the cold light conductor which conducts the cold light from light source to the peritoneal cavity. Part (k) is the lens which creates the visual field for the surgeon to watch the operation field. The two parts (j), (k) can be juxtaposed and attached together or can be separated from each other and with some space between them. Parts (j, k) can be in collection as a fiber optic rod.

FIG 3: Inner hollow semi cone of the mesh holder part.

A: This is the front view of inner hollow semi cone of the mesh holder part.

B: This is the left view of inner hollow semi cone of the mesh holder part. Parts (a & h) are nut which can be attached to the body of the apparatus or the hollow cylinder part. Part (b) is the body of the inner semi cone which is hollow. Part (c) is the inner hollow semi cylinder shaped part which is attached to the inner hollow semi cone part and the inner string part of the mesh can be placed in it. Part (d) is a depression or notch which the hollow circle or ring part of the inner string of the said mesh can be Placed in it and the process of stapling will be completed by the movement of the tip of the outer hollow semi cone. Part (e) is the tip of the inner hollow semi cylinder part of the mesh holder which is an arch shaped for easy movements and being safe with no sharp edges. Part (f) is a prominence part which is prepared in the hollow semi cone part to create an opening in it to hinge or join the two hollow semi cone parts. Part (g) is an opening which is prepared in part (f) to hinge or join the two hollow semi cone parts.

C: This is the upper view of (B).

D: This is the detailed view of circle sign in (E).

E: This is the 3 dimensional view of (B).

FIG 4: Detailed view of the instrument.

A: This is the front view of the instrument. Part (a) is a part of the driver handle which starts and performs the process of shooting. Part (b) is the hollow cylinder which connects the driver handle to the mesh holder part. Part (h) is one spring which can create the potential ability of shooting. Part (d) is the lever bar which conducts the force of shooting from the driver handle to the mesh holder part. Part (e) is a housing cover. Part (f) is the inner hollow semi cone-shaped part of the mesh holder part. This part will be placed inside the inguinal canal partially from its narrow end before shooting process. Part (g) is the outer hollow semi cone-shaped part of the mesh holder which will be placed outside the inguinal canal. Parts (f), (g) can perform the process of stapling and fixing the mesh over the inguinal internal ring. Circle sign (A) is the screw part of the body or cylinder which can join the cylinder to the mesh holder by screwing. Circle sign(C) is the mesh holder part which can be attached or detached to the cylinder part by a nut which is prepared in it.

B: This is the screw part of the body or cylinder which can join the cylinder to the mesh holder by screwing. This part can attach and detach the mesh holder part to the body or hollow slender which is required for placing the mesh into the mesh holder part.

C: This is the detailed view of circle sign (C) in the (A). This part is a hollow cone-shaped part which is made of two hollow semi cone shaped parts. These two semi cone shaped parts can perform the process of placing the mesh, stapling the mesh and fixing the mesh.

D: This is a 3 dimensional view of the (A).

FIG 5: The lever bar.

A: This is a front view of the lever bar. Part (g) is the pressure button which triggers the shooting process. Part (f) is the lever bar which conducts the shooting process to the mesh holder part.

B: This is the right view of the (A). Part (h) is the outer part of a T slut rail which is prepared to protect the collection of (A) from sliding during its movements.

C: This is an upper view of the (A). Part (a) is the tip of the said ratchet performing the main movements and positions of the ratchet specially the locking process. Part (b) is the tip of the lever bar which is connected to the mesh holder part. Part (c) is the tip of the body of the ratchet which has an arch for the free movement of the lever bar. Part (d) is a ratchet which can place the lever bar in locking and shooting process. These positions can be more than two for some purposes, for example the semi-opened position which is between the locking and shooting position. This semi-opened position is suitable to enter the mesh holder part to the peritoneum from an opening which is made inside the umbilicus.

D: This is a detailed view of the circle sign in the (E).This is the collection of parts (a), (c), (d) in (C).

E: This is a 3 dimensional view of (A). Part (e) is the inner part of a T slut rail which is prepared to protect the collection of (A) from sliding during its movements.

FIG 6: digitate part of the driving handle.

A: This is the digitate part of the driving handle. Part (a) is a circle to be held by the surgeon's fingers. Part (b) is releaser. Part (c) is a channel for the placement of the beam of lever bar in it. Part (d) is a hollow body space. Part (e) is a rail which T slut rail can slide on it. Part (f) is a cover fixer guide which guides the cover housing fixation. Part (g) is a cover fixer to fix the housing cover.

Part (h) is a stopper which works to stop the stapling process. Part (i) is a hollow space.

B: This is a lateral view of (A).

C: This is an upper view of (A). Part (j) is a cavity for placing the housing cover and part (k) is a cavity for placing the lever bar.

D: This is a 3 dimensional view of (A).

FIG 7: Housing cover

A: This is the front view of housing cover.

Part (a) is a square-shaped channel which a prominent part of part (a) in (A) of FIG 4 be placed inside it. Part (b) is oblique edge of inner surface in housing cover. Part (c) is a rail which the lever bar can slide in it. Part (d) is a benchmark to fix the sliding level. B: This is the left view of (A). Part (e) is the fixing body which part (a) of (A) in FIG 4 or fixing guide can be placed inside it.

C: This is the upper view of (A).

D: This is the 3 dimensional view of (A).

FIG 8: Outer hollow semi cone part.

A: This is the left view of the outer hollow semi cone part. Part (a) is the position to place the beam or the other end of lever bar in it. Part (b) is the outer hollow semi cone part which the mesh can be placed inside it. Part (c) is the inner part of the outer hollow semi cone part and the said mesh is shown by spotted line. Part (d) is a depression or notch which the staple part of the said mesh can be placed inside it. Part (e) is the tip of the outer hollow semi cylinder part of the outer hollow semi cone which is arch shaped for easy movement and being safe with no sharp edge. Part (f) is a hollow semi cylinder shaped part which is attached to the outer hollow semi cone part and the outer string part of the mesh can be placed in it. Part (g) is an arch to join or hinge and perform easy movement of the join. Part (h) is a hollow circle for hinging tow semi cones together. Part (i) is a prominence part which the end of the lever bar or beam can be placed over it.

B: This is the front view of (A).

C: This is the upper view of (A).

D: This is the 3 dimensional view of (A).

FIG 9: Mesh and mesh holder part.

A: This view shows the said mesh inside the mesh holder part. Part (a) is the ring-shaped part of the mesh which can be fixed to the internal aspect of posterior wall of the inguinal canal by one staple. Part (b) is the inner string part of the said mesh which is attached to the ring-shaped part. Part (c) is the inner hollow semi cylinder part of the mesh holder which can embrace the string part of the said mesh. Part (d) is discoid part of the staple. Parts (e) are two needle-shaped parts of staple. Part (f) is outer hollow semi cylinder part of outer semi cone part of the mesh holder. Part (g) is the said mesh which is placed inside the mesh holder. Part (h) is the hollow semi cone of mesh holder. Part (I) is the position for the placement of the beam of lever bar. Part (j) is the outer hollow semi cone. Part (k) is the opening to join the two hollow semi cone of mesh holder.

B: This is a schematic view of the said mesh.

C: This is a front view of the said mesh when it is in the mesh holder and is crumpled.

D: This is a schematic view of the said mesh when it is crumpled.

E: This is the 3 dimensional view of the said mesh when it is crumpled. Part (f) is the discoid part of the said mesh when it is crumpled. Part (g) is the central part of the mesh which the two strings are attached.

F: Staples parts of the said mesh which is shown as circular sign in E in FIG 9. Part (a) is the discoid part of the said staple. Part (b) is the outer string part of the said mesh which the staple is attached to it. Part (c) is the two Needle-shaped parts of the staple. Part (e) is the inner string part of the said mesh which the ring part of the mesh is attached to it. Part (d) is the ring part of the said mesh,