U.S. patent application number 10/760634 was filed with the patent office on 2005-02-17 for apparatus and method for placing suture wires into tissue for the approximation and tensioning of tissue.
Invention is credited to Field, Frederic P., Sancoff, Gregory E..
Application Number | 20050038449 10/760634 |
Document ID | / |
Family ID | 30002620 |
Filed Date | 2005-02-17 |
United States Patent
Application |
20050038449 |
Kind Code |
A1 |
Sancoff, Gregory E. ; et
al. |
February 17, 2005 |
Apparatus and method for placing suture wires into tissue for the
approximation and tensioning of tissue
Abstract
A suture placer for placing a length of suture wire through
tissue such that the suture wire is directed into the tissue and
then back out again.
Inventors: |
Sancoff, Gregory E.; (North
Hampton, NH) ; Field, Frederic P.; (North Hampton,
NH) |
Correspondence
Address: |
Mark J. Pandiscio
Pandiscio & Pandiscio
470 Totten Pond Road
Waltham
MA
02154
US
|
Family ID: |
30002620 |
Appl. No.: |
10/760634 |
Filed: |
January 20, 2004 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10760634 |
Jan 20, 2004 |
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09706472 |
Nov 3, 2000 |
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6679895 |
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60163808 |
Nov 5, 1999 |
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Current U.S.
Class: |
606/144 ;
606/148; 606/228 |
Current CPC
Class: |
A61B 17/0467 20130101;
A61B 17/0469 20130101; A61B 17/0482 20130101; A61B 2017/06052
20130101; A61B 2017/0498 20130101; A61B 17/068 20130101 |
Class at
Publication: |
606/144 ;
606/148; 606/228 |
International
Class: |
A61B 017/04; A61B
017/12; A61L 017/00 |
Claims
What is claimed is:
1. Suture placer apparatus for placing a length of suture wire
through tissue whereby the length of suture wire may thereafter be
used to approximate and tension the tissue, said suture placer
apparatus comprising: a shaft having a proximal end and a distal
end, and a lumen extending through said shaft and sized to closely
receive the suture wire for supported passage therethrough, said
lumen exiting said shaft at hole at said distal end of said shaft;
and a deflection die located adjacent to said hole for engagement
by a suture wire passing through said lumen, whereby the trajectory
of the suture wire will be changed by said deflection die.
2. A suture placer apparatus according to claim 1 wherein said
deflection die is substantially planar.
3. A suture placer apparatus according to claim 1 wherein said
deflection die has a radius of curvature.
4. Suture placer apparatus according to claim 1 wherein said shaft
is adapted to pierce tissue so that said hole may be positioned
intermediate the tissue.
5. Suture placer apparatus according to claim 1 wherein said
apparatus further comprises a length of suture wire disposed in
said lumen.
6. A method for approximating and tensioning tissue, comprising:
providing suture placer apparatus comprising: a shaft having a
proximal end and a distal end, and a lumen extending through said
shaft and sized to closely receive the suture wire for supported
passage therethrough, said lumen exiting said shaft at a hole at
said distal end of said shaft; and a deflection die located
adjacent to said hole for engagement by a suture wire passing
through said lumen, whereby the trajectory of the suture wire will
be changed by said deflection die; positioning said suture placer
apparatus so that suture wire exiting said hole will penetrate said
tissue; and advancing a length of suture wire through said lumen so
that the suture wire engages said deflection die and is passed
through said tissue.
Description
REFERENCE TO PENDING PRIOR PATENT APPLICATION
[0001] This patent application claims benefit of pending prior U.S.
Provisional Patent Application Ser. No. 60/163,808, filed Nov. 15,
1999 by Gregory E. Sancoff et al. for DEVICE FOR PLACING SUTURE
WIRES INTO TISSUE FOR APPROXIMATION AND TENSION, which pending
prior patent application is hereby incorporated herein by
reference.
FIELD OF THE INVENTION
[0002] This invention relates to surgical apparatus and methods in
general, and more particularly to apparatus and methods for placing
suture wires into tissue for the surgical approximation and
tensioning of tissue.
BACKGROUND OF THE INVENTION
[0003] There is a growing trend to perform many surgical procedures
using minimally invasive techniques. In such surgery, which is
sometimes referred to as "keyhole surgery", surgical instruments
are inserted into the body through small surface incisions, and
then the instruments are manipulated from outside the body while
the actual surgery is carried out at a remote site inside the
body.
[0004] One of the more common surgical tasks is the placement of
sutures into tissue so as to aid repair. However, conventional
suturing requires a substantial amount of manipulation, i.e., the
needle must be moved safely into position at the surgical site,
then the needle (and trailing suture) must be passed through the
target tissue, then the needle must be safely removed from the
surgical site, and finally the suture must be effectively knotted.
During minimally invasive surgery, this must all be done at a
remote interior surgical site, using a minimum of space. This can
be difficult and time-consuming to do.
[0005] As a result, one object of the present invention is to
provide apparatus for quickly and easily placing suture wires into
tissue for the approximation and tensioning of tissue.
[0006] Another object of the present invention is to provide a
method for quickly and easily placing suture wires into tissue for
the approximation and tensioning of tissue.
SUMMARY OF THE INVENTION
[0007] These and other objects are addressed by the present
invention, which comprises an apparatus and method for placing
suture wire through tissue, e.g., during minimally invasive surgery
or during open surgery where space may be limited. The apparatus is
configured so as to deliver suture wire to the distal end of a
shaft, whereupon the wire is deflected so as to change directions
and pass into, and through, the tissue. As a result of this
construction, the suture wire can be made to follow a path such
that the wire goes into the tissue and then back out again, whereby
a loop of suture wire may be passed through the tissue. This loop
of suture wire may then be used to approximate and/or tension the
tissue.
BRIEF DESCRIPTION OF THE DRAWINGS
[0008] These and other objects and features of the present
invention will be more fully disclosed or rendered obvious by the
following detailed description of the preferred embodiments of the
invention, which is to be considered together with the accompanying
drawings wherein like numbers refer to like parts and further
wherein:
[0009] FIG. 1 is a perspective view of a suture placer formed in
accordance with the present invention;
[0010] FIGS. 2 and 3 are sectional views showing operation of the
suture placer of FIG. 1;
[0011] FIGS. 4 and 5 are enlarged sectional views showing several
different deflection die shapes and the wire shapes that they
create;
[0012] FIG. 6 is an enlarged schematic view showing another
deflection die shape, wherein the deflection die shape also has a
lateral curvature whereby to create a helical wire trajectory;
[0013] FIG. 7 is a sectional view of an alternative form of suture
placer that uses telescopic tubing to advance the suture wire;
[0014] FIG. 8 is a perspective view of another alternative form of
suture placer, wherein the suture placer is adapted to place
multiple sutures in tissue, and includes wire cutting
apparatus;
[0015] FIGS. 9, 10 and 11 are sectional views showing operation of
the suture placer of FIG. 8;
[0016] FIG. 12 is an enlarged side view of the distal end of still
another alternative form of suture placer, wherein the suture
placer is adapted to place suture into tissue from the surface of
the tissue, without the suture placer penetrating the tissue with
its shaft;
[0017] FIG. 13 is a sectional view of the suture placer shown in
FIG. 12;
[0018] FIG. 14 is an end view of the suture placer shown in FIG.
12;
[0019] FIG. 15 is a sectional view like that of FIG. 13, but
showing the suture placer with its cutting bar advanced distally;
and
[0020] FIGS. 16 and 17 show two twisted knot embodiments.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0021] Looking first at FIGS. 1-3, there is shown a suture placer 5
formed in accordance with the present invention. Suture placer 5
generally comprises an elongated shaft 10 and a plunger 15. Shaft
10 has a crosshandle 20 at its proximal end, and contains a lumen
25 that runs from the proximal end of the shaft to a location near
the distal end of the shaft.
[0022] At a location near the distal end of shaft 10, lumen 25
turns at a deflection die 30 and then proceeds out of the shaft
through a side hole 35. Deflection die 30 is designed to turn a
suture wire 40, passing distally down lumen 25, outward and
backward (i.e., proximally). As a result, when the shaft's sharp
distal tip 45 is placed in tissue 50, suture wire 40 travels below
the surface of tissue 50 inside lumen 25 and, when the suture wire
hits deflection die 30, the suture wire is deflected outward,
through side hole 35, and backward up to the surface of tissue
50.
[0023] The shape of deflection die 30 helps determine the manner in
which the suture wire changes direction at the distal end of the
device.
[0024] More particularly, in one form of the invention, deflection
die 30 is substantially planar (see FIGS. 1-3), whereby the
deflection die will act as a simple deflection surface for
redirecting the suture wire.
[0025] Alternatively, and more preferably, deflection die 30 is
formed with a radius of curvature (see FIGS. 4 and 5), whereby the
deflection die will cause suture wire 40 to take on a permanent
set. In general, a sharper radius of curvature at the die surface
causes a tighter wire loop (see FIGS. 4 and 5). The yield strength
of the wire also helps determine the degree of wire curvature. In
general, for a given deflection die and wire diameter, wire that
has a higher yield strength will tend to permanently deform less,
and therefore form a larger loop.
[0026] If deflection die 30 also includes a lateral radius, it will
cause suture wire 40 to adopt a helical trajectory (see FIG. 6). A
helical trajectory can be desirable where the distal end of suture
wire 40 is to be burrowed into tissue 50, or where the suture wire
is to be passed through a side wall of tissue 50, etc.
[0027] Suture wire 40 is contained within lumen 25 of shaft 10 and
is laterally supported as the suture wire is advanced. To this end,
the lumen diameter is preferably formed so as to be slightly larger
than the diameter of the suture wire it is to receive (e.g., the
lumen diameter might be 0.0055-0.0060 inches where the wire
diameter is 0.0050 inches). This slight gap between suture wire 40
and lumen 25 is provided in order to avoid line-to-line contacts
or, even worse, press fits between the suture wire and the lumen
wall which might be encountered with likely manufacturing
tolerances. Such tight fits would cause undue resistance to wire
movement. At the same time, however, too large a gap could allow
the suture wire to buckle, thus causing resistance to forward
motion and also presenting a crumpled appearance along the length
of the wire.
[0028] For smaller diameter wires, the plunger diameter may be too
small to support the pushing load without the plunger buckling in
the area outside of lumen 25 (i.e., in the area above crosshandle
20). Consequently, an alternative arrangement can be used that
provides more support for the plunger. One such arrangement, shown
in FIG. 7, is to make plunger 15 in the form of a tube 55 which
telescopes over another smaller tube 60 which supports the suture
wire in its lumen 25. As long as the smaller tube 60 has a
relatively thin wall, suture wire 40 can be reasonably supported in
the areas where tubes 55 and 60 are not overlapping (i.e., in the
area above crosshandle 20). In this respect it should be
appreciated that the sizes of tubes 55 and 60 have been exaggerated
somewhat in FIG. 7 so as to make the details of construction more
readily apparent.
[0029] It will be appreciated that the suture placer 5 shown in
FIGS. 1-7 is configured to deploy a single length of wire suture
40, whereupon a new length of wire suture 40 must be loaded into
lumen 25. While such a device is quite useful, there are many
surgical settings in which it would be beneficial to have a device
that could place a plurality of wire suture lengths before
reloading. FIGS. 8-11 illustrate one such suture placer 5A.
[0030] More particularly, suture placer 5A is substantially the
same as the suture placer 5 described above, except that it has a
cutting tube 65 on the outside of shaft 10. Cutting tube 65 is
attached to a finger-operated tab 70 which, if moved forward (i.e.,
distally), slides cutting tube 65 downward so that the distal end
of the cutting tube crosses the shaft's side hole 35 and shears off
any suture wire 40 extending out of side hole 35, with a
guillotine-type effect. If desired, the end of cutting tube 65 may
be beveled so as to present a sharp edge to wire 40, whereby to
make cutting easier.
[0031] FIGS. 9-11 show how suture placer 5A may be used to place a
length of wire suture 40 into tissue and then cut that length off
from the remainder of the suture wire still in suture placer 5A.
The first step is to place the sharp tip 45 of shaft 10 into tissue
50 near where it is desired to put the suture, e.g., near a
laceration 75 (FIG. 9). The next step is to advance suture wire 40
by pushing down on plunger 15 until the suture wire emerges from
tissue 50 with sufficient length (FIG. 10). Then suture placer 5A
is withdrawn from tissue 50 while simultaneously advancing suture
wire 40 with plunger 15 so that the suture wire that is already in
tissue 50 will be left in its current position as suture placer 5A
is withdrawn. Finally, cutting tube tab 70 is pushed forward (i.e.,
distally) so as to cause cutting tube 65 to sever suture wire 40,
whereby to disconnect the length of suture wire deployed in tissue
50 from the suture wire remaining in suture placer 5A. The two free
ends of the deployed suture wire can now be twisted together so as
to close laceration 75 and tension the approximation.
[0032] It should also be appreciated that if suture wire 40 is made
of a relatively stiff material, or if suture wire 40 has a
relatively large diameter, the suture wire can have enough rigidity
to pass through tissue in a circular arc on its own, without first
being taken down into the tissue with a penetrating shaft. Again, a
deflection die will govern the radius of the wire trajectory and,
in this case, the depth of penetration of the suture wire into the
tissue before it returns out of the tissue.
[0033] More particularly, FIGS. 12-15 show the distal end of a
suture passer 5B which is adapted to rest on the surface of tissue
50 as it passes a length of suture wire 40 therethrough. Suture
passer 5B comprises a cutting bar 65B which is slidably received
within a lumen 80 in shaft 10. Wire lumen 25 extends through shaft
10 and cutting bar 65B (see FIGS. 13-15). Cutting bar 65B also
includes the deflection die 30 (see FIGS. 13 and 15). Inasmuch as
the cutting bar 65B includes part of the wire lumen 25, when the
cutting bar is displaced forward (i.e., distally) relative to shaft
10, the cutting bar will shear the suture wire against the lumen
wall and cut it off (FIG. 15).
[0034] Once suture wire 40 has been placed through the tissue, the
two free ends of the wire can be twisted together (FIG. 16),
causing the closed loop of suture wire to become smaller, which in
turn draws the tissue closer together. The excess can then be cut
away and the proximal end of the twisted section bent downward,
towards the tissue. Another option is to keep one end of the suture
long after the twisted knot has been formed, so that the long
suture end can be used to pull the tissue in some direction (see
FIG. 17).
[0035] As used herein, the term "suture wire" is intended to mean
any filament-like element consistent with the present invention. By
way of example but not limitation, suture wire may comprise a metal
(e.g., stainless steel, titanium, Nitinol or other shape memory
alloy, etc.) or a plastic (e.g., polypropylene, polyimide, etc.),
or other materials or combinations of materials.
[0036] It should be noted that the suture wire may have a
configuration other than round, e.g., rectangular, square,
elliptical, ribbon-like, etc. In this respect it should also be
appreciated that a ribbon-like wire could provide increased lateral
strength, resulting in more precise guidance as the suture wire
passes through the tissue.
[0037] The present invention permits a wire suture to be placed
into tissue at a remote surgical site, whereby that wire suture can
be used for approximation and tensioning. Wire suture has the added
benefit of acting as its own needle, so that holes larger than the
suture itself need not be created.
* * * * *