U.S. patent application number 11/649194 was filed with the patent office on 2007-05-31 for tissue grasper/suture passer instrument.
Invention is credited to Jose E. Lizardi, Daniel A. Perkins.
Application Number | 20070123914 11/649194 |
Document ID | / |
Family ID | 33477039 |
Filed Date | 2007-05-31 |
United States Patent
Application |
20070123914 |
Kind Code |
A1 |
Lizardi; Jose E. ; et
al. |
May 31, 2007 |
Tissue grasper/suture passer instrument
Abstract
A needle passer instrument for use in minimally invasive
surgical procedures, including arthroscopy. The instrument has
upper and lower jaws for engaging tissue and a handle. A removable
needle engaging cartridge is mounted to the upper jaw. A surgical
needle with attached suture is mounted in a needle passage in the
lower jaw. A needle actuation rod engages the surgical needle and
pushes the needle through tissue contained between the jaws. The
needle is engaged by the cartridge, and the needle may be cut away
from the suture.
Inventors: |
Lizardi; Jose E.; (Franklin,
MA) ; Perkins; Daniel A.; (Hyde Park, UT) |
Correspondence
Address: |
PHILIP S. JOHNSON;JOHNSON & JOHNSON
ONE JOHNSON & JOHNSON PLAZA
NEW BRUNSWICK
NJ
08933-7003
US
|
Family ID: |
33477039 |
Appl. No.: |
11/649194 |
Filed: |
January 3, 2007 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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10601479 |
Jun 23, 2003 |
7166116 |
|
|
11649194 |
Jan 3, 2007 |
|
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Current U.S.
Class: |
606/144 |
Current CPC
Class: |
A61B 2017/2946 20130101;
A61B 17/0469 20130101; A61B 17/0625 20130101; A61B 2017/2926
20130101 |
Class at
Publication: |
606/144 |
International
Class: |
A61B 17/04 20060101
A61B017/04 |
Claims
1. A suture passer instrument, comprising: a frame having a
proximal end and a distal end, said frame having a longitudinal
passage; a bottom jaw member mounted to the distal end of the
frame, the bottom jaw having a passage for receiving a surgical
needle; a top jaw member pivotally mounted to the distal end of the
frame such that the top jaw member is moveable with respect to the
bottom jaw member, said top jaw member having a distal opening for
receiving a cartridge member; a handle member mounted to the
proximal end of the frame, the handle member having a cavity; a jaw
actuation member having a top end and a bottom end, wherein the top
end of the jaw actuation member is mounted to the handle member; a
needle rod driving trigger member having a top and a bottom,
wherein the top of the needle rod driving member is pivotally
mounted to the handle member; a jaw actuation rod having a proximal
end a distal end, wherein the jaw actuation rod is slidably mounted
in the passage of the frame and wherein the proximal end of the jaw
actuation rod engages the top jaw member, and the proximal end of
the actuation rod is mounted to the jaw actuation member; a needle
driving rod slidably mounted to the frame, wherein the needle
driving member has a proximal end mounted to the needle driving
trigger and a distal end for engaging a needle; and, a needle
passage in the lower jaw having a distal opening out through the
top of the lower jaw and a proximal opening in communication with
the longitudinal passage of the frame.
2. The instrument of claim 1 additionally comprising a cartridge
member mounted to the top jaw.
3. The instrument of claim 2, wherein the cartridge comprises an
opening for receiving at least part of a surgical needle.
4. The instrument of claim 2 wherein the cartridge comprises: a
member having a top, a bottom and a cavity extending therethough; a
top flange mounted to the cartridge having an opening in
communication with the cavity; a bottom flange mounted to the
bottom of the member having an opening in communication with the
cavity; and, at least one needle engagement tab member extending
into the cavity.
5. The instrument of claim 1 additionally comprising a surgical
needle mounted in the needle passage of the bottom jaw.
6. The instrument of claim 1 additionally containing an opening in
the bottom jaw in communication with the needle passage.
7. A suture passer instrument, comprising: a frame having a
proximal end and a distal end, said frame having a longitudinal
passage; a bottom jaw member mounted to the distal end of the
frame, the bottom jaw having a passage for receiving a surgical
needle; a top jaw member pivotally mounted to the distal end of the
frame such that the top jaw member is moveable with respect to the
bottom jaw member, said top jaw member having a distal opening for
receiving a cartridge member; a handle member mounted to the
proximal end of the frame, the handle member having a cavity; a jaw
actuation member having a top end and a bottom end, wherein the top
end of the jaw actuation member is mounted to the handle member; a
needle rod driving trigger member having a top and a bottom,
wherein the top of the needle rod driving member is pivotally
mounted to the handle member; a jaw actuation rod having a proximal
end a distal end, wherein the jaw actuation rod is slidably mounted
in the passage of the frame and wherein the proximal end of the jaw
actuation rod engages the top jaw member, and the proximal end of
the actuation rod is mounted to the jaw actuation member; a needle
driving rod slidably mounted to the frame, wherein the needle
driving member has a proximal end mounted to the needle driving
trigger and a distal end for engaging a needle; a needle passage in
the lower jaw having a distal opening out through the top of the
lower jaw and a proximal opening in communication with the
longitudinal passage of the frame; and, a cartridge member
removably mounted to the top jaw, said cartridge comprising an
opening for receiving at least part of a surgical needle.
8. The instrument of claim 7 wherein the cartridge comprises: a
member having a top, a bottom and a cavity extending therethough; a
top flange mounted to the cartridge having an opening in
communication with the cavity; a bottom flange mounted to the
bottom of the member having an opening in communication with the
cavity; and, at least one needle engagement tab member extending
into the cavity.
9. The instrument of claim 7 additionally comprising a surgical
needle mounted in the needle passage of the bottom jaw.
10. The instrument of claim 7 additionally containing an opening in
the bottom jaw in communication with the needle passage.
11. A method of passing suture through tissue, the method
comprising: I. providing a suture passer instrument, said
instrument comprising: a frame having a proximal end and a distal
end, said frame having a longitudinal passage; a bottom jaw member
mounted to the distal end of the frame, the bottom jaw having a
passage for receiving a surgical needle; a top jaw member pivotally
mounted to the distal end of the frame such that the top jaw member
is moveable with respect to the bottom jaw member, said top jaw
member having a distal opening for receiving a cartridge member; a
handle member mounted to the proximal end of the frame, the handle
member having a cavity; a jaw actuation member having a top end and
a bottom end, wherein the top end of the jaw actuation member is
mounted to the handle member; a needle rod driving trigger member
having a top and a bottom, wherein the top of the needle rod
driving member is pivotally mounted to the handle member; a jaw
actuation rod having a proximal end a distal end, wherein the jaw
actuation rod is slidably mounted in the passage of the frame and
wherein the proximal end of the jaw actuation rod engages the top
jaw member, and the proximal end of the actuation rod is mounted to
the jaw actuation member; a needle driving rod slidably mounted to
the frame, wherein the needle driving member has a proximal end
mounted to the needle driving trigger and a distal end for engaging
a needle; and, a needle passage in the lower jaw having a distal
opening out through the top of the lower jaw and a proximal opening
in communication with the longitudinal passage of the frame; II.
providing a cartridge member, said cartridge member comprising: a
member having a top, a bottom and a cavity extending therethough; a
top flange mounted to the cartridge having an opening in
communication with the cavity; a bottom flange mounted to the
bottom of the member having an opening in communication with the
cavity; and, at least one needle engagement tab member extending
into the cavity; III. providing a surgical needle having a distal
piercing point and a proximal suture mounting end, said needle
having a suture mounted to the suture mounting end; IV. mounting
the cartridge member to the top jaw member; V. mounting the
surgical needle in the needle passage of the bottom jaw member; VI.
engaging tissue between the top jaw member and the bottom jaw
member; and, VII moving the surgical needle and attached suture
through the tissue by engaging the needle with the needle driving
rod such that the needle is engaged in the cavity of the cartridge
member.
12. The method of claim 11 additionally comprising the steps of
opening the jaws with respect to each other, moving the instrument
away from the tissue, and cutting the engaged needle from the
cartridge member.
13. The instrument of claim 4 wherein the cavity comprises a distal
slot and a proximal opening, and wherein the tab member extends
into the slot but does not extend into the proximal opening.
14. The instrument of claim 8 wherein the cavity comprises a distal
slot and a proximal opening, and wherein the tab member extends
into the slot but does not extend into the proximal opening.
Description
TECHNICAL FIELD
[0001] The field of art to which this invention relates is surgical
instruments, in particular, surgical instruments for use in
minimally invasive surgical procedures.
BACKGROUND OF THE INVENTION
[0002] Minimally invasive surgical procedures have proven to be of
significant benefit to patients. Typically, in a minimally invasive
procedure, a surgical site is accessed using a small incision
through a patient's skin and underlying fascia. A conventional
trocar cannula may be inserted through the incision to provide a
passageway for instruments, scopes, etc. The surgeon may view the
operative site remotely or by direct visualization. Many
instruments have been developed for minimally invasive surgical
procedures including endoscopic and arthroscopic instruments.
Arthroscopic instruments that are known and used include, for
example, conventional arthroscopic scissors, arthroscopic fastener
appliers, and arthroscopic suture passers.
[0003] Of particular importance in this art are instruments and
methods for applying surgical sutures in an arthroscopic procedure.
In an open procedure, the surgeon typically holds a surgical needle
in a needle grasper and pushes and pulls the surgical needle
through tissue around a tissue site and releases and re-grasps the
needle each time the needle is exits the tissue that is required to
be approximated. This type of open suturing technique is difficult
to perform successfully in an arthroscopic procedure because of the
limited working space. Specially designed arthroscopic suture
devices have been developed to remotely pass sutures through tissue
in arthroscopic procedures.
[0004] Although the arthroscopic suture passers of the prior art
are adequate for their intended purpose, there is a constant need
in this art for new instruments having advantageous characteristics
and features that are easy to use in an arthroscopic surgical
procedure.
SUMMARY OF THE INVENTION
[0005] Therefore, it is an object of the present invention to
provide novel surgical instruments for arthroscopic surgical
instruments that advantageously pass suture in arthroscopic
surgical procedures.
[0006] Accordingly, a novel suture passer instrument is disclosed.
The suture passer instrument has a frame having a proximal end and
a distal end. The frame has a longitudinal passage. A bottom jaw
member is mounted to the distal end of the frame. The bottom jaw
member has a top surface and a bottom surface. There is a needle
passageway in the bottom jaw member having a distal opening out
through the top surface of the bottom jaw and a proximal opening in
communication with the longitudinal passage of the frame. A top jaw
member is pivotally mounted to the distal end of the frame such
that the top jaw member is moveable with respect to the bottom jaw
member. The top jaw member having a distal opening for receiving a
cartridge member. A handle member is mounted to the proximal end of
the frame. The handle member has a cavity. There is a jaw actuation
member having a top end and a bottom end, wherein the top end of
the jaw actuation member is mounted to the handle member. There is
also a needle rod driving trigger member having a top and a bottom,
wherein the top of the needle rod driving member is pivotally
mounted to the handle member. A jaw actuation rod having a proximal
end a distal end is slidably mounted in the passage of the frame.
The distal end of the jaw actuation rod operably engages the top
jaw member, and the proximal end of the actuation rod is mounted to
the jaw actuation member. A needle driving rod is slidably mounted
to the frame. The needle driving member has a proximal end mounted
to the needle driving trigger and a distal end for engaging a
surgical needle mounted in the needle passageway.
[0007] Yet another aspect of the present invention is a suture
passer instrument. The suture passer instrument has a frame having
a proximal end and a distal end. The frame has a longitudinal
passage. A bottom jaw member is mounted to the distal end of the
frame. The bottom jaw member has a top surface and a bottom
surface. There is a needle passageway in the bottom jaw member
having a distal opening out through the top surface of the bottom
jaw and a proximal opening in communication with the longitudinal
passage of the frame. A top jaw member is pivotally mounted to the
distal end of the frame such that the top jaw member is moveable
with respect to the bottom jaw member. The top jaw member having a
distal opening for receiving a cartridge member. A handle member is
mounted to the proximal end of the frame. The handle member has a
cavity. There is a jaw actuation member having a top end and a
bottom end, wherein the top end of the jaw actuation member is
mounted to the handle member. There is also a needle rod driving
trigger member having a top and a bottom, wherein the top of the
needle rod driving member is pivotally mounted to the handle
member. A jaw actuation rod having a proximal end a distal end is
slidably mounted in the passage of the frame. The distal end of the
jaw actuation rod operably engages the top jaw member, and the
proximal end of the actuation rod is mounted to the jaw actuation
member. A needle driving rod is slidably mounted to the frame. The
needle driving member has a proximal end mounted to the needle
driving trigger and a distal end for engaging a surgical needle
mounted in the needle passageway. The instrument has a removable
cartridge member mounted in the opening of the top jaw member. The
cartridge member has a cavity for receiving and engaging at least
part of a surgical needle.
[0008] Yet another aspect of the present invention is a method of
using the above-described suture passer instruments of the present
invention in a surgical procedure to pass a surgical needle and
attached suture through tissue.
[0009] These and other aspects and advantages of the present
invention will become more apparent from the following description
and accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
[0010] FIG. 1 is a perspective view of a grasper and needle passer
instrument of the present invention.
[0011] FIG. 2 is a side view of the tissue grasper and suture
passer instrument of FIG. 1.
[0012] FIG. 3A is a partial cross-sectional view of the proximal
end of the instrument of FIG. 2.
[0013] FIG. 3B is a partial cross-sectional view of the distal end
of the instrument of FIG. 2.
[0014] FIG. 4 is a magnified exploded perspective view of the
distal end of the tissue and suture passer instrument of the
present invention illustrating the upper and lower jaws of the
instrument and a needle clip cartridge that is mounted to the upper
jaw.
[0015] FIG. 5 illustrates a surgical needle and suture prior to
mounting in the lower jaw of the instrument.
[0016] FIG. 6 illustrates the distal end of the instrument in an
armed configuration with the needle cartridge mounted in the upper
jaw and the surgical needle mounted in the lower jaw with the upper
jaw open and ready to receive tissue.
[0017] FIG. 7 illustrates the distal end of the armed instrument in
proximity to tissue that will be grasped and sutured.
[0018] FIG. 8 is a partial side view illustrating the instrument
grasping the soft tissue between the jaws, prior to engaging the
needle.
[0019] FIG. 9 is a side view of the instrument illustrating the
needle deployed through the tissue, with the distal end of the
needle engaged and locked by the cartridge in the top jaw.
[0020] FIG. 10 is a partial transverse cross-sectional view of the
instrument of FIG. 9, illustrating the needle engaged in the
cartridge.
[0021] FIG. 11 is a partial longitudinal cross-sectional view of
the cartridge of FIG. 10, illustrating the needle engaged by the
cartridge.
[0022] FIG. 12 illustrates the upper jaw of the instrument rotated
to the raised position with the needle exited from the tissue and
the suture passing through the tissue.
[0023] FIG. 13 illustrates the instrument of FIG. 12, wherein the
instrument has been pulled back away from the tissue, causing an
additional length of the suture to be pulled or passed through the
tissue.
[0024] FIG. 14 is a perspective view of the distal end of the
instrument of the present invention after the cartridge has been
removed from the upper jaw and the needle has been cut away from
the suture.
[0025] FIG. 15 illustrates the instrument of the present invention
inserted into a patient's shoulder and passing a needle and suture
through the patient's ligament labral complex to effect a Bankart
repair procedure
[0026] FIG. 16 is a top view of an alternate embodiment of a
cartridge that can be used with the suture passer instruments of
the present invention; the cartridge has an elongated slot for
engaging a needle and a proximal opening such that the needle can
be moved along the slot into the proximal opening and removed from
the cartridge.
[0027] FIG. 17 is a partial, cross-sectional view of the cartridge
of FIG. 16, illustrating a needle engaged in the slot.
[0028] FIG. 18 is a top view of the cartridge of FIG. 16,
illustrating the distal end of a needle engaged in the slot.
[0029] FIG. 19 illustrates the cartridge of FIG. 18 with the needle
moved along the slot into the proximal opening.
[0030] FIG. 20 is a cross-sectional view of the cartridge of FIG.
19 illustrating the needle in the proximal opening in position to
be removed from the cartridge.
DETAILED DESCRIPTION OF THE INVENTION
[0031] The tissue grasper and suture passer instruments of the
present invention are preferably used in minimally invasive
arthroscopic surgical procedures. However, these instruments may be
use in other types of minimally invasive procedures including
endoscopic surgical procedures, laparoscopic surgical procedures,
etc. The instruments may also be used in open surgical procedures.
The tissue grasper and suture passer instruments may be constructed
of conventional, biocompatible materials that are easily cleaned
and capable of being sterilized. The materials include but are not
limited to surgical stainless steel, nitinol, titanium,
polycarbonate and the like, and combinations thereof. The
cartridges used in the tissue grasper and needle passer instruments
of the present invention are preferably made from conventional
biocompatible polymeric materials that are readily sterilizable
including but not limited to polyethylene, polycarbonate, ABS and
the like. The cartridges may also be made from the
previously-mentioned metals, and combinations of metals and
polymeric materials.
[0032] The tissue grasper and suture passer instrument 5 of the
present invention is illustrated in FIGS. 1-3. The instrument 5 is
seen to have a frame member 10 having a proximal end 12, a distal
end 14, a top 16, opposed lateral sides 18 and a bottom 20. Cavity
22 is contained within frame member 10. Cavity 22 is seen to have
distal opening 24, bottom opening 26 and proximal opening 28.
Openings 24, 26 and 28 are seen to be in communication with cavity
22. A pair of opposed trigger pivot pin openings 21 extend though
the top of frame 10 and are in communication with cavity 20. In
addition, a pair of opposed pivot pin openings 29 extend through
the bottom of frame 10 and are in communication with cavity 22.
Frame member 10 is also seen to have mounting cavity 30. Extending
back and angulated down from the proximal end 12 of frame member 10
is the handle member 40. Handle member 40 is seen to have proximal
end 41 and distal end 42. Extending from proximal end 41 is the
optional finger ring 44 having opening 45. Also extending from the
handle member 40 is the locking member engagement post 50.
Engagement post 50 is seen to be preferably curved, having a
proximal end 52, a distal rounded free end 54 and a plurality of
teeth 56. The jaw actuation member 60 is seen to have upper end 62
and lower end 64. Upper end 62 has pivot pin hole 66 extending
therethrough. Lower end 64 is seen to have pivot hole 68 extending
therethrough. Extending from the lower end 64 of jaw actuation
member 60 is the optional finger ring member 70 having opening 72.
Spring retainer cavity 74 is seen to extend into member 60 through
the distal side 61. The jaw actuation member 60 is seen to be
pivotally mounted to frame member 10. More specifically, upper end
62 is seen to be mounted in cavity 22 by pivot pin 78 that extends
through openings 21 in frame 10 and opening 68 in jaw actuation
member 60.
[0033] The locking member 80 is seen to be pivotally mounted to
actuation member 60. The locking member 80 is seen to be an "L"
shaped member having a proximal end 82 and a distal end 88, however
the member 80 may have other shapes If desired. Extending from the
top surface of the proximal end of member 80 are the teeth 84.
Teeth 84 are engageable with teeth 56 of locking member 50. Pivot
pin mounting hole 86 is seen to extend transversely through member
80. Mounted to the proximal end 88 of locking member 80 is the
disengagement member 90. Disengagement member 90 is seen to have a
generally curved shape with top end 91 bottom end 92, proximal
surface 93 and distal surface 94. Disengagement member 90 is
mounted to actuation member 60 by pivot mounting pin 98 that is
inserted through pivot pin mounting hole 86 and pivot pin hole 64.
Helical spring 100 is seen to be mounted in cavity 74 such that the
bottom 102 of spring member 100 is in contact with the bottom of
cavity 74, and the top 104 of spring member 100 is in contact with
the proximal surface 93 of member 90, thus exerting a biasing force
against member 90. Also pivotally mounted in cavity 22 of frame 10
is the trigger member 110. The trigger member 110 is seen to have a
bottom end 112, a top end 114, a proximal surface 116 and a distal
surface 118. Extending proximally from the top end 114 is the lever
member 120. Lever-member 120 is seen to have second spring
retention cavity 122. Extending through the upper end 114 of
trigger member 110 are the slotted opening 125 and the pivot pin
opening 127. The trigger member 110 is seen to be pivotally mounted
in cavity 22 of frame 10 by the pivot pin 129 that extends through
pivot pin mounting opening openings 29 in frame 10 and pivot pin
opening 127 in trigger member 110. Spring member 130 is seen to
have bottom 132 and top 134. The spring member 130 is mounted in
spring retention cavity 122, and the bottom 132 exerts a biasing
force against lever member 110 through lever member 120.
[0034] Extending from the distal end 14 of frame 10 is the
elongated member 150. Elongated member 150 is seen to have a
proximal end 152, a distal end 154 and a longitudinal slot 156
therein extending along the length of member 150 and having
proximal opening 157 and distal opening 158. The elongated member
150 is seen to have outer surface 160 and inner surface 162, as
well as top 164 and bottom 166. The proximal end 152 of elongated
member 150 is seen to be mounted in frame 10 in cavity 30. Although
it is preferred that proximal end 152 be fixedly mounted,
alternatively, the end 152 may be mounted to provide for rotational
movement or longitudinal movement of tubular member 150. Extending
downward from the outer bottom 166 of elongated member 150 are the
grommet members 170 having longitudinal passages 172.
[0035] Referring also now to FIGS. 3B and 4-15, seen to be
extending from the distal end 154 of elongated member 150 is the
lower jaw member 180. The lower jaw member 180 is seen to have
proximal end 182 and distal end 184, and a pair of opposed sides
188 and 189, top 186 and bottom 185. Lower jaw member 180 is seen
to have cavity 190 having proximal opening 192 and top opening 194,
both of which are in communication with cavity 190. Cavity 190 is
seen to have distal end 196 adjacent to inner wall 186. The needle
passage opening 187 is contained in wall 186. Extending
transversely through jaw member 180, and in communication with
cavity 190, are the pivot pin mounting holes 188. The jaw member
180 is seen to have top grasping surface 200. Extending up from the
surface 200 are the tissue engagement teeth 202 having tips 204.
Surface 200 is seen to have needle opening 206. Also contained in
the lower jaw member 180 is the needle passageway 210 having
proximal and distal ends 212 and 214, respectively. The proximal
end 212 of passageway 210 is in communication with opening 187 and
the distal end 214 is in communication with opening 206.
Preferably, the passage has an opening 218 extending out through
the side 188 of jaw member 180 to facilitate the loading and
passage of a needle and suture. The opening 218, although not
preferred, may be located on the bottom 185 of jaw member 180.
Optionally, there are multiple openings 218. The upper jaw member
230 is seen to be pivotally mounted to lower jaw member 180. The
upper jaw member 230 is seen to have proximal end 232, distal end
234, upper surface 236 and bottom surface 238. Extending down from
the bottom surface 238 are the tissue engagement teeth 241 having
tips 242. Extending down and proximally from distal end 232 of the
upper jaw member 230 is the camming member 240. The camming member
240 is seen to have concave curved top camming surface 249.
Contained in surface 249 is the longitudinal retention groove 244.
The pivot hole passage 248 is seen to be contained in the bottom of
the camming member 240. The upper jaw member 230 is mounted in
cavity 190 by inserting pivot pin 235 though pivot pin openings 188
and pivot hole passage 248. The upper jaw 230 is seen to have
U-shaped slot 250 having opening 251. Extending up from the upper
surface 236 of jaw member 230 is the cartridge retainer member 255.
Retainer member 255 is seen to have top 256 and distal ramped
surface 257. The member 255 has opposed sides 258 connected by
curved ends 259.
[0036] Slidably mounted in the passages 172 of grommet member 170
is the needle actuator rod 260. Rod 260 is seen to be an elongated
rod-like member having a proximal end 262 and a distal end 266
having a distal needle engagement nose 268. Distal end 266 is seen
to be optionally necked down and has a smaller diameter than that
of rod 260. The proximal end 262 of rod 260 is seen to pivotally
mounted in cavity 22 of frame 10 in slotted opening 125 in trigger
member 110.
[0037] The jaw actuation rod 280 is seen to have distal end 284 and
proximal end 282. The jaw actuation rod 280 is a rod-like member
that is slidably mounted in longitudinal slot 156 of elongated
member 150. The proximal end 282 of actuation rod 282 is pivotally
mounted to the top section 62 of jaw actuation member 60 by pin
member 281 extending proximally from proximal end 282 and engaged
by nub 63 extending up from the top 62 of jaw actuation member 60.
Extending distally from the distal end 284 of actuation rod 280 is
the cam member 290 having camming surface 295. The tongue member
297 is seen to extend out from surface 295, and to be engaged in
retention groove 244 of camming member 240.
[0038] The needle cartridge 300 is seen in FIG. 4. The cartridge
300 is seen to have member 310 having cavity 315. Although cavity
315 preferably has a circular cross-section as shown, the cavity
315 my have other geometric cross-sections including but not
limited to square, polygonal, rectangular, triangular, oval and the
like and combinations thereof. Cartridge 300 is seen to have
proximal end 302 and distal end 304. Member 310 is seen to have top
311, bottom 312, and exterior surface 314 and interior surface 316.
Extending into the cavity 315 is the annular engagement tab ring
member 318. Although it is preferred that the tab ring member 318
have an annular configuration, other configurations may be used
including tab segments, or other geometric configurations depending
on the configuration of the cavity 315. Mounted to the top 311 of
cartridge 300 is the upper flange 320 having top surface 322,
bottom surface 324, proximal end 326 and distal end 329. Extending
through flange 320 is the needle opening 327 in communication with
cavity 315. Seen to extend through the proximal end 326 of flange
320 is the retainer opening 325. Bottom flange 330 is seen to be
mounted to the bottom 312 of member 310, and has opening 335 in
communication with cavity 315, as well as proximal end 332 and
distal end 334. The cartridge 300 is mounted to jaw member 230 by
sliding the proximal end 326 of flange 320 over the top surface 236
of jaw member 230 such that the member 310 slides into slot 250,
and opening 325 is engaged by retention member 255, such that the
top flange 320 is partially on top of and bottom flange 330 is
partially below upper jaw member 230.
[0039] The instrument 5 is armed for passing a needle 350 and
attached suture 370 through tissue by inserting a needle 350 in
needle passageway 210 of jaw member 180. The needle 350 is seen to
have distal end 354 and proximal end 352 extending from the
proximal end 352 of needle 350 is the suture 370. Extending
distally from the distal end 354 of needle 350 is the pointed
piercing end 356. Needle 356 is seen to have opposed undercuts 358
to facilitate locking in cavity 315 of cartridge 300. The needle
350 is mounted in jaw member 180 such that the distal piercing end
354 extends at least partially out of passage 210 and through
opening 206 and above grasping surface 200. The needle 350 is seen
to preferably have a curved configuration to conform to the needle
passageway 210, but may also be made of a resilient material such
as spring stainless steel or a superelastic shape memory material
such as Nitinol, and may have a substantially straight
configuration. The cartridge 300 is then mounted to upper jaw 230
by sliding member 310 into slot 250 such that the flanges 320 and
330 are above and below the top and bottom surfaces of jaw member
230, and such that retainer opening 325 is engaged by retention
member 255, and thereby substantially fixed in place with respect
to jaw member 230.
[0040] The suture 370 may be mounted to needle 350 in a
conventional manner, including swaging the distal end 374 of suture
in a drilled hole or channel in the proximal end 352 of needle 350,
threading the suture 370 through an eyelet, etc. Any conventional
sutures may be used including non-absorbable sutures made from
conventional biocompatible polymers and bio-absorbable sutures made
from conventional bio-absorbable and resorbable polymers.
[0041] When armed, the instrument 5 operates in the following
manner. The surgeon grasps the instrument 5 by the handle member 40
and places a thumb within opening 45 of thumb ring 44. One or more
of the other fingers of the hand are placed through opening 72 of
finger loop 70. Tissue 500 is grasped between the upper jaw member
230 and the lower jaw member 180 by pulling back on the actuation
member 60 causing the actuation member 60 to pivot about pivot pin
78 causing jaw actuation rod 280 to be displaced distally in the
slot 157 of elongated member 150. This causes the camming member
290 of actuation rod 280 to engage the camming surface 242 of
camming member 240, thereby causing the jaw member 230 to rotate
about pivot pin 235 toward lower jaw member 180. The opposite
rotation of the jaw actuation member 60 causes the actuation rod
280 to slide and move proximally causing the top jaw to rotate
open. The tissue 600 is engaged by teeth 202 extending from the
upper surface 200 of jaw member 180 and the teeth 241 extending
downward from the bottom surface 238 of jaw member 230. The tissue
500 is also partially pierced by the piercing point 356 of needle
350. The spatial position of jaw 180 relative to jaw 230 is
maintained by the locking member 80 and the engagement post 50
which are engaged by the teeth 56 and 84 in a ratcheting manner.
The needle 350 and suture 370 are passed through tissue 600 by the
surgeon engaging or pulling back on trigger member 110 thereby
rotating the trigger member 110 about pivot pin 129. This is seen
to cause the actuation rod 260 to move distally through the
passages 172 of grommet members 170. The needle engagement nose 268
of distal end 266 then engages the distal end 352 of needle 350
pushing it through 210, and out through opening 206, through tissue
500 and into passage 315 of member 310 of cartridge 300 and
partially out through opening 327 such that the undercuts 358 are
engaged by the ring tab member 318. Next the surgeon opens jaw 230
by first unlocking the jaw 230 by pulling back on disengagement
member 90 causing locking member 80 to disengage from engagement
post 50, and then moving finger loop 70 distally to rotate the jaw
230 open. This causes the needle 350 to move completely through
tissue 600 and move the suture 370 through tissue 500. The surgeon
then cuts the suture 370 away from needle 350 and cartridge 300,
completing the passage of the suture 370 through the tissue 600. If
desired, the instrument 5 can be re-armed with a new needle 350 and
attached suture 370 along with a new cartridge 300 to provide for
multiple suture passes.
[0042] In an alternate embodiment of the cartridge 300 of the
present invention is seen in FIGS. 15-20. The cartridge 500 is seen
to have a member 510 having a cavity 515. Cavity 515 has an
elongated slot section 520 communicating with a proximal circular
opening 522. Opening 522 may have other geometric configurations as
well. Tab engagement members 530 are seen to extend into slot
section 520 to engage a surgical needle. The tab engagement members
530 are not present in the opening 522. Cartridge 500 is seen to
have proximal end 502 and distal end 504. Member 510 is seen to
have top 511, bottom 512 and exterior surface 514 and interior
surface 516. Mounted to the top 511 of cartridge 500 is the upper
flange 540 having top surface 542, bottom surface 544, proximal end
546 and distal end 549. Extending through upper flange 540 is the
needle opening 547 in communication with cavity 515. Seen to extend
through the proximal end 546 of upper flange member 540 is the
retainer opening 545. Bottom flange 550 is seen to be mounted to
the bottom 512 of member 510, and has opening 555 in communication
with cavity 515, as well as proximal end 562, and distal end 564.
The cartridge 500 is mounted to upper jaw member 230 of instrument
5 by sliding the proximal end 546 of upper flange 540 over the top
surface 236 of jaw member 230 such that the member 510 slides into
slot 250, and retainer opening 545 is engaged by retention member
255, such that top flange 540 is substantially on top of bottom
flange 550 is substantially below upper jaw member 230. In use with
instrument 5 to pass a needle and suture through tissue, after
surgical needle 350 is engaged in the elongated slot section 520,
the distal end 354 of the needle having the undercuts 358 can be
moved or slid in slot section 520 into opening 522 where the
undercuts 358 of the needle 350 are disengaged from the engagement
tab members 530. The needle 350 can then be removed from the cavity
522 (without cutting the attached suture) and reloaded into the
needle receiving passage of the lower jaw, thereby re-arming the
instrument 5 for additional or multiple suture passes using the
same needle 350 and suture and cartridge. The cartridge member 500
may be removed from upper jaw 230 prior to removing the suture from
cavity 522, and then remounted in slot 250 to rearm the instruments
5 for additional suture passes.
[0043] The suture passer instruments of the present invention can
be used in a variety of minimally invasive procedures including
arthroscopic, endoscopic, laparoscopic and the like. One common
arthroscopic procedure that the suture passers of the present
repair can be utilized is an arthroscopic Bankart repair. An
arthroscopic surgical Bankart repair procedure is disclosed in the
following journal article which is incorporated by reference:
"Arthroscopic Bankart Repair Using Suture Anchors", Eugene M. Wolf,
M.D., Richard M. Wilk, M.D. and John C. Richmond, M.D., Operative
Techniques in Orthopaedics, Vol. 1, No. 2 (April), 1999:pp.
184-191.
[0044] The following example is illustrative of the principles and
practice of the present invention, although not limited
thereto.
EXAMPLE
[0045] A patient is prepared for arthroscopic rotator cuff shoulder
repair surgery in a conventional manner. The patient is
anesthetized using conventional anesthesia and anesthesia
procedures. The patient is positioned in a conventional manner to
perform an arthroscopic Bankart procedure or to repair a torn
rotator cuff. Bankart repair restores stability by re-attaching the
labrum or capsule directly to the anterior glenoid cavity. Two
anterior portal and tow posterior portals are then placed in a
conventional manner using a conventional scalpel and conventional
cannulas and blunt obturators. A conventional arthroscope is
inserted into a cannula and the shoulder is insufflated in a
conventional manner with sterile saline to provide the surgeon with
a visible field and a view of the surgical site. After examining
the site arthroscopically, the instrument of the present invention
is armed with a surgical needle and suture and inserted into a
cannula and positioned proximate to the surgical site. The detached
inferior ligament labral complex is engaged in the jaws of the
instrument as seen in FIG. 15, and the needle and suture are passed
through the tissue such that the needle is engaged in the cavity of
the cartridge. The tissue is disengaged from the jaws and the
instrument is pulled out through the cannula where the suture is
cut away from the needle that is engaged in the cartridge. The
procedure is then completed in a conventional manner using
conventional suture anchors implanted in the glenoid rim with the
suture that has been passed through the labral complex to anchor
the tissue to the glenoid rim. The wounds for the portals are then
closed in a conventional manner after removal of the cannulas and
the procedure is complete.
[0046] Although this invention has been shown and described with
respect to detailed embodiments thereof, it will be understood by
those skilled in the art that various changes in form and detail
thereof may be made without departing from the spirit and scope of
the claimed invention.
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