referring now to the exemplary embodiment shown in fig1 through 12 , an implant system 100 comprises a handle assembly 130 and a cartridge assembly 160 that can be coupled to or separated from handle assembly 130 . handle assembly 130 comprises a right casing 132 and a left casing 134 , a counter tension arm 136 , a cam gear 138 , a handle 131 , and an actuator 140 . in the embodiment shown , actuator 140 comprises a trigger 141 and an actuator arm 146 . in other embodiments , actuator 140 may comprise different configurations , such as including a cam surface , a lever , switch , or other actuating mechanism . in the exemplary embodiment shown , actuator 140 also comprises a pivot point 145 and a gear 148 , handle assembly 130 further comprises a plurality of screws 142 and pins 144 to couple right casing 132 to left casing 134 . right casing 132 and left casing 134 can be coupled with glue , ultrasonic welding or other commonly practiced methods . cartridge assembly 160 comprises a housing 162 and a cartridge arm 164 . a cartridge lock 147 can be positioned to retain cartridge assembly 160 to handle assembly 130 or to release cartridge assembly 160 from handle assembly 130 . as shown in the views of fig4 - 8 , cartridge assembly 160 comprises an actuator rod 165 with a ram 163 . as actuator 140 is actuated ( i . e . pulled toward handle 131 ), actuator 140 pivots around pivot point 145 , and gear 148 engages cam gear 138 . in addition , actuator arm 146 moves toward ram 163 . as shown in fig7 , when actuator 140 is pulled a sufficient amount , actuator arm 146 engages ram 163 and moves actuator rod 165 within cartridge arm 164 of cartridge assembly 160 . in the exemplary embodiment shown in fig4 - 8 , cam gear 138 has an eccentric cam surface 139 that engages counter tension arm 136 . eccentric cam surface 139 has an effective diameter that is variable for a portion of cam surface 139 and constant for a portion of cam surface 139 . in this exemplary embodiment , the effective diameter is the distance from the center of cam gear 138 to the portion of cam surface 139 engaging counter tension arm 136 . as cam gear 138 rotates ( while actuator 140 is being pulled ), cam surface 139 initially causes counter tension arm 136 to move towards cartridge arm 164 . at a certain point in the actuation of actuator 140 ( just past the location shown in fig7 ), the effective diameter of cam surface 139 reaches a maximum value . as the actuation of actuator 140 is continued , counter tension arm 136 is moved to the position shown in fig8 . in this manner , counter tension arm 136 moves toward cartridge arm 164 , and can provide backing support for tissue located between counter tension arm and cartridge arm 164 . in addition to the movement of counter tension arm 136 , the actuation of actuator 140 also causes actuator arm 146 to move towards ram 163 . as explained above , when actuator arm 146 reaches the position shown in fig7 , it engages ram 163 and causes actuator rod 165 to slide within cartridge assembly 160 . as shown in fig9 and 10 , cartridge assembly 160 comprises housing 162 , cartridge arm 164 , ram 163 , actuator rod 165 , a cartridge 166 holding a plurality of implants 167 , a guide 168 , a support member 161 and a biasing member 169 . actuator rod 165 comprises a distal end 173 that engages guide 168 during operation . biasing member 169 exerts a force against ram 163 and biases ram 163 and actuator rod 165 towards the proximal end of cartridge assembly 160 ( i . e . the end distal from guide 168 ). as previously described , actuator 140 can be actuated so that actuator arm 146 contacts ram 163 . continued actuation of actuator 140 can cause actuator arm 146 to overcome the force exerted by biasing member 169 , so that ram 163 and actuator rod 165 are moved towards guide 168 . in the exemplary embodiment shown , guide 168 comprises a curved surface 178 that receives distal end 173 as actuator rod 165 is actuated during operation . as actuator rod 165 moves toward guide 168 , distal end 173 engages curved surface 178 and is directed towards an implant 167 . distal end 173 can thereby displace an implant 167 from cartridge 166 ( as shown in fig1 ). during use , cartridge 166 can be located proximal to a tissue ( not shown ) into which implant 167 will be implanted . distal end 173 can exert a sufficient force on implant 167 to cause implant 167 to penetrate the tissue . though the guide 168 is shown to translate the distal end 173 ninety degrees , it should be noted that this translation can be any direction between 0 ° and 180 °. in the exemplary embodiment shown , implant 167 is therefore ejected or discharged at an angle of approximately ninety degrees to cartridge arm 164 . in other embodiments , implant 167 may be discharged at an angle to cartridge arm 164 that is greater than or less than ninety degrees . in one exemplary embodiment , implant 167 may be discharged at an angle to cartridge arm 164 that is approximately 45 degrees . referring now to the exemplary embodiment of fig1 , a perspective view of the underneath side of cartridge assembly 160 shows one orientation of housing 162 , cartridge arm 164 , actuator rod 165 , cartridge 166 , implants 167 and guide 168 . in the exemplary embodiment shown , distal end 173 is narrower than the remaining portions of actuator rod 165 and enters cartridge 166 . in other exemplary embodiments , distal end 173 may have a different configuration than that shown in fig1 . for example distal end 173 may not be narrower than the remaining portions of actuator rod 165 . implants 167 extend from cartridge 166 in a manner so that distal end 173 can discharge the implant 167 that is proximal to guide 168 . in certain embodiments , a biasing member 186 biases implants 167 towards guide 168 . when one implant 167 is discharged , distal end 173 is retracted back into the cartridge assembly 160 , and the remaining implants 167 move towards guide 168 . a subsequent actuation of actuator 140 will then discharge an additional implant 167 . as shown in fig1 , distal end 173 may comprise any of several different configurations . for example , distal end 173 may be a ribbon or strip of constant width as shown in end 173 a , or distal end 173 may comprise a varying width as shown in end 173 b . distal end 173 may also comprise a varying thickness as shown in an end 173 c . distal end 173 may also have a cut - out ( or cut - outs ) as shown in 173 d or tabs as shown in 173 e . distal end 173 may be made of any suitable material . examples of such materials comprise plastic and / or metal , including superelastic materials such as nickel titanium , commonly referred to as nitinol ®. it is understood by one skilled in the art that other embodiments of distal end 173 may comprise combinations of the features disclosed , or additional features . referring now to fig1 - 25 , various exemplary embodiments of implants are illustrated . as shown in fig1 - 16 , implant 167 a comprises a post 121 , a transverse section 122 , a barb 123 , and a pointed tip 124 . pointed tip 124 reduces the amount of force needed to insert implant 167 a into tissue ( not shown ), and barb 123 assists in holding implant 167 a in the desired location . transverse section 122 holds the tissue in place and also reduces the likelihood that implant 167 a will be accidentally pushed through the tissue into which it is inserted . implant 167 b shown in fig1 is similar to implant 167 a , but comprises a tip 125 with a straight edge rather than a point . implant 167 c is also similar , but comprises a tip 126 with a single beveled point rather than the multiple bevel point shown in fig1 . implant 167 d shown in fig1 comprises a barb 127 that is perpendicular to the primary axis ( not shown ) of the implant . implant 167 e of fig2 comprises multiple transverse sections 128 , while implant 167 f shown in fig2 also comprises multiple barbs 129 . fig2 shows implant 167 g with a round cross - section instead of the rectangular or square cross - section shown in previous embodiments . fig2 shows an implant with an elliptical barb 111 . fig2 illustrates an implant 167 i with a disc - shaped transverse member 112 , while fig2 illustrates an implant 167 j with a rib 113 rather than a transverse member . in certain embodiments implant 167 may be approximately four to six millimeters long , two to three millimeters wide , and approximately 0 . 4 to 0 . 7 millimeters thick . more specifically , implant 167 may be 4 . 5 to 5 . 5 millimeters long , 2 . 3 to 2 . 7 millimeters wide , and 0 . 5 to 0 . 6 millimeters thick . in a specific exemplary embodiment , implant 167 is approximately 5 millimeters long , 2 . 5 millimeters wide , and 0 . 55 millimeters thick . in certain exemplary embodiments , implant 167 comprises an absorbable copolymer comprising approximately 60 to 80 percent polyactide and approximately 20 to 40 percent polyglycolide . more specifically , implant 167 may comprise an absorbable copolymer comprising approximately 65 to 75 percent polyactide and approximately 25 to 35 percent polyglycolide . in a specific exemplary embodiment , implant 67 comprises an absorbable copolymer comprising approximately 70 percent polyactide and approximately 30 percent polyglycolide . in still other specific embodiments , implant 67 comprises an absorbable copolymer comprising approximately 90 percent polyactide and approximately 10 percent polyglycolide . in other embodiments , implants 167 may be non - absorbable . referring now to fig2 and 27 , implant system 100 is shown in an exemplary method of use during a nasal septum reconstruction . as shown in fig2 , implant system 100 is positioned proximal to a patient &# 39 ; s nose 200 . in this embodiment , implant system 100 is positioned so that cartridge arm 164 is proximal to a nasal cavity 210 and counter tension arm 136 is proximal to a nasal cavity 220 . referring now to fig2 , implant system 100 is then positioned so that cartridge arm 164 is inserted into nasal cavity 210 and counter tension arm 136 is inserted into nasal cavity 220 . implant system 100 is inserted the desired amount so that the distal ends of cartridge arm 164 and counter tension arm 136 are located proximal to a target location where it is desired to place an implant 167 into a mucoperichondrial flap formed in the patient &# 39 ; s septum ( not visible in fig2 and 27 ). when implant system 100 is positioned at the desired location , an operator stabilizes implant system 100 and actuates ( i . e . pulls back on ) actuator 140 . as described in the discussion of the preceding figures , the actuation of actuator 140 causes counter tension arm 136 to move towards cartridge arm 164 . counter tension arm 136 can therefore provide backing support to the tissue into which the implant 167 will be inserted . the actuation of actuator 140 also causes distal end 173 of actuator rod 165 to force an implant 167 from cartridge 166 . in the embodiment shown in fig2 and 27 , counter tension arm 136 supports tissue on one side of the patient &# 39 ; s septum , while an implant 167 is inserted into a mucoperichondrial flap on the opposite side of the patient &# 39 ; s septum . in certain exemplary embodiments , initial implants 167 are placed anteriorly and superiorly within nasal cavity 210 as compared to subsequent implants 167 . in certain embodiments , implants 167 are placed within approximately two centimeters of each other . in other embodiments , implants 167 are placed within approximately 1 . 5 centimeters of each other , and in still other embodiments , implants 167 are placed within approximately one centimeter of each other . in certain embodiments , implants 167 may be placed in both nasal cavities 210 and 220 , while in other embodiments implants 167 may be placed in either nasal cavity 210 or nasal cavity 220 . after the operator has placed implants in the bilayered mucosal flaps , the operator may visualize both nasal cavity 210 and 220 to assure adequate approximation and sufficient penetration of all staples through the flaps . after the tissue is appropriately approximated and all flaps are secured , the operator may dispose of cartridge 166 and any remaining implants 167 . however , the remaining components of implant system 100 may be sterilized reused for future procedures . referring now to fig2 and 29 , front and side views are shown of one embodiment of an implant 1 . implant 1 can be configured for use in conjunction with previously - described embodiments . as shown , a base portion of implant 1 is engaged with a ribbon 2 . in certain embodiments , ribbon 2 is equivalent to distal end 173 of actuator rod 165 of the embodiment described in fig1 - 12 . in this embodiment , implant 1 comprises a t - shaped portion 3 which can act as a support against a tissue surface ( not shown ) when implant 1 is installed . in the embodiment shown , stem 6 couples t - shaped portion 3 to a barb 55 which has a point 4 created by the intersection of two faces 5 and 7 . in exemplary embodiments , faces 5 and 7 do not need to be symmetrical or of the same length . as shown , the included angle 56 between faces 5 and 7 is slightly modified ( as compared , for example , to embodiments shown in fig1 and 19 ) by configuring face 7 so that it is angled toward a center axis ( not shown ) of stem 6 . by angling face 7 towards face 5 , the intersection of faces 5 and 7 at point 4 is closer to the center axis of stem 6 , which can provide for more stable tissue piercing during use . certain embodiments may also comprise a face 12 as shown in fig2 to further assist in piercing tissue during use . as shown in fig2 , a capture surface 8 provides an area that can assist in keeping the back side of pierced tissue in approximation with t - shaped portion 3 . in the embodiment shown , capture surface 8 is extends from only on one side of the stem 6 , but in other embodiments , it could also extend beyond both sides of stem 6 . during use , the embodiment shown in fig2 and 29 can be installed similar to other previously - described embodiments . for example , ribbon 2 can be pushed in the direction shown arrow 11 . ribbon 2 comprises a top portion 9 that can be pushed against the a bottom portion 10 of implant 1 . the action of ribbon 2 against bottom portion 10 of implant 1 can assist pushing point 4 and barb 55 of implant 1 through the desired tissue ( s ). the tissue can then be captured between the t - shaped portion 3 and the capture surface 8 . implant 1 and ribbon 2 , as with other embodiments presented in this document , can be made of metal or plastic , and in particular embodiments , biodegradable plastic . the ribbon 2 , as with other embodiments presented in this document , can be made of metal or plastic and superelastic materials such as nickel titanium , commonly referred to as nitinol ®. fig3 - 32 present an embodiment which comprises a second ( or guide ) ribbon 15 configured to create an initial hole in the tissue ( not shown ) and to give implant 1 stability during deployment . this system consists of the implant 1 being pushed from its bottom by a first ribbon 13 . second ribbon 15 has been placed against the first ribbon 13 and implant 1 . the two ribbons 13 and 15 can be seen more clearly in fig3 . the first ribbon 13 has a top surface 19 for pushing against the implant . the second ribbon 15 has a narrowed section or extension 21 with a point at the tip 20 . the action of this design can be best seen in fig3 . the first ribbon 13 pushes against the implant 1 at the base of t - shaped portion 18 . in this exemplary embodiment , the tapered end or point 20 of the second ribbon 15 is shown above the implant tip 4 in order to create a leading hole in the tissue for easier deployment . in other embodiments , point 20 can be even with the implant tip 4 or slightly below . with extension 21 in place , the implant 1 is restricted from moving in that direction during installation . during installation , a tissue that implant 1 is being inserted through will exert reactionary forces on chamfer 12 as implant 1 passes through the tissue . these forces will to help direct implant 1 in a direction indicated by arrow 17 as implant 1 is pushed through the tissue . such a configuration can create a more stable deployment of implant 1 by effectively holding implant 1 in place against extension 21 . another exemplary embodiment is shown in fig3 and 34 . in this embodiment , however , implant 24 is hollow or cannulated and a ribbon 28 is placed in an aperture 27 extending through implant 24 . in the embodiment shown , ribbon 28 has a leading point 23 and implant 24 has a t - shaped portion 26 and a tissue - capturing head 25 . extra bevels 29 can be added if desired to improve staple insertion through tissue . in alternate embodiments , a second ribbon can be used to push on a base portion of implant 24 during installation . yet another exemplary embodiment of a cannulated implant 30 is shown in fig3 and 36 . in this embodiment , implant 30 comprises a stem , a head portion 31 with a chamfer 37 , and a base with a t - shaped portion 32 . the configuration of this embodiment can provide for a more simplified manufacturing process . for example , if implant 30 is made via an injection molding process , core pins of a mold ( not shown ) may be used create the cavities 34 , 35 , and 38 which can be coupled to create one passage 33 . passage 33 can be configured to accept a narrowed portion or extension of a ribbon , similar to aperture 27 in previously - described embodiments . a chamfer 36 may also be included to assist a ribbon extension in properly loading into the channel 33 in case the alignment is off slightly . another exemplary embodiment is shown in fig3 , 38 and 39 . in this embodiment , implant 40 comprises a stem , a head portion 44 and a base with a t - shaped portion 43 . instead of a single extension being placed in the middle of implant 40 , two extensions 41 are used on either side of the center axis of implant 40 . extensions 41 may have leading points 42 and extend from a top portion 45 of a single ribbon 39 . the embodiment shown may also provide simplify manufacturing processes ( if , for example , implant 40 is manufactured by injection molding or machining ) since the slots 46 and 47 are open to the sides . still another exemplary embodiment is shown in fig4 and 41 . in this embodiment , implant 48 comprises a stem 49 , a head portion 51 and a base with a t - shaped portion 50 . in the embodiment shown , head portion 51 comprises a pair of barbs 54 and an asymmetric point 53 that is closer to one barb 54 ( i . e . the left barb 54 as shown in fig4 ) than the other barb 54 . the barb 54 that is closer to asymmetric point 53 also comprises a slot 52 that can accommodate a ribbon with a point ( not shown ) during deployment . in certain embodiments , asymmetric point 53 which can allow head portion 51 to blend with the ribbon more easily during deployment . fig4 a - 46 present an embodiment which comprises a first ( or push ) ribbon 311 and a second ( or guide ) ribbon 310 . second ribbon 310 is configured to create an initial hole in the tissue ( not shown ) and to give an implant 301 stability during deployment . in fig4 implant 301 comprises a stem or shaft 303 with a barb 302 on one side and a t - shaped section or crossbar 304 on the other side . this embodiment comprises a tapered end or point 305 proximal to barb 302 . point 305 can be used to help guide the implant 301 through tissue . barb 302 comprises a capture surface or overhang 306 and a barb recess or trough 309 . in this embodiment , crossbar 304 comprises two capture surfaces or faces 307 and a crossbar recess or trough 308 . during installation and use , point 305 goes through the tissue until it emerges from the other side . the tissue is then held between the overhang 306 and the faces 307 with the aid of the shaft 303 . in the top view of the staple in fig4 , barb trough 309 and the crossbar trough 308 are more evident . the same is true for fig4 , which is the bottom view of implant 301 . in fig4 and 46 implant 301 is shown in approximation to first ribbon 311 and second ribbon 310 as is the case when deploying implant 301 . second ribbon 310 has a narrowed section or extension 312 on the distal end with a tapered end or point 313 that initial pierces the tissue creating a leading hole for implant 301 to more easily pass through the tissue . first ribbon 311 has a flat edge 314 on the distal end that pushes against a lower surface 317 of the crossbar 304 in order to push the staple through the tissue . implant 301 is stabilized during the deployment phase in part by the first ribbon 311 and second ribbon 310 . extension 312 of first ribbon 310 engages crossbar trough 308 to keep the implant 301 from moving side to side ( e . g . towards or away from the plane of the paper in fig4 ). extension 312 also fits into or engages barb trough 309 to restrict movement in one direction . implant 301 is also constrained from rotating in one direction 315 by the rigidity of the implant 312 , whereas implant 312 is constrained in the opposite direction 316 by a channel in the implant system ( not shown in fig4 - 46 , but shown as channel 57 in fig4 ). first ribbon 311 comprises an engagement surface 314 that engages lower surface 317 during installation . in this embodiment , engagement surface 314 is a flat edge at one end of first ribbon 311 . the engagement of these engagement surface 314 and lower surface 317 also tends to keep implant 301 in a stable , straight position during installation . a more detailed set of drawings describing the deployment method of exemplary embodiments is shown in fig4 to 51 . in fig4 the system at rest consists of a channel 57 enclosing a curved first ribbon 59 ( shown in solid black heavier line weight ) and a curved second ribbon 58 . in certain embodiments , first ribbon 59 is similar to distal end 173 of actuator rod 165 in the embodiment described in fig1 - 12 . in addition to the components described in fig1 - 12 , the system shown in fig4 - 51 comprises second ribbon 58 , which can further assist in placing an implant into a desired tissue location , as described in more detail below . also shown in the figures are several implants 60 lined up ready for deployment . in the embodiments shown , channel 57 is resting against a layer of tissue 61 . in fig4 , an actuator ( not shown ) has been partially actuated and ribbons 58 and 59 are beginning to deploy such that the distal end 62 of first ribbon 59 is in contact with a first implant 60 . as shown in fig4 , when actuation of the actuator continues , the ribbons 58 and 59 are further deployed , with second ribbon 58 creating a hole in the tissue 61 and the first ribbon 59 beginning to push implant 60 through that hole . in fig5 , the actuator has been fully actuated and first and second ribbons 58 and 59 are fully deployed . implant 60 is now in its installed position with the base portion and head portion on opposite sides of tissue 61 . although not visible in the cross - section views of fig4 - 51 , implant 60 may comprise a t - shaped base portion on one side of tissue 61 and a barb or tissue - capturing head section on the opposite side of tissue 61 ( when implant 60 is in its final installed location ). as shown in fig5 , first and second ribbons 59 and 58 have been retracted to their original position in fig5 leaving the implant 60 within the tissue 61 . implant 60 may comprise any of the disclosed embodiments ( as well as variations thereof ). while exemplary embodiments are described herein , it will be understood that various modifications to the method and apparatus can be made without departing from the scope of the present invention . for example , different configurations of implants may be used . in specific embodiments , an implant may have an l - shaped portion rather than a t - shaped portion near its base . furthermore , certain embodiments may not comprise implants in a cartridge arrangement . in addition , the implants may be used in procedures other than septoplasty . for example , any area where tissue approximation is necessary in an enclosed space such as peritoneal , urethral , bladder , gi tract , esophageal repair , or joint repair . furthermore , the sequential recitation of steps in any claim is not a requirement that the steps be performed in any particular order , unless otherwise so stated .
a system and method for inserting an implant into soft tissue . the system may include an elongate arm having an implant at a first end of the elongate arm and an actuator at a second end of the elongate arm . the implants may be contained in a cartridge assembly . methods of inserting an implant may be used during nasal septum reconstruction .