U.S. patent application number 13/298862 was filed with the patent office on 2012-03-15 for suture retainer with multiple circumferentially spaced attachment points.
This patent application is currently assigned to Anpa Medical, Inc.. Invention is credited to Jervis James E..
Application Number | 20120065678 13/298862 |
Document ID | / |
Family ID | 36916925 |
Filed Date | 2012-03-15 |
United States Patent
Application |
20120065678 |
Kind Code |
A1 |
James E.; Jervis |
March 15, 2012 |
SUTURE RETAINER WITH MULTIPLE CIRCUMFERENTIALLY SPACED ATTACHMENT
POINTS
Abstract
What is claimed is a suture retainer having a retainer body and
a plurality of suture attachment mechanisms spaced
circumferentially about the retainer body, each adapted to hold a
suture strand at a discrete attachment point. One embodiment has a
wheel portion and a plug portion. The wheel portion has a center
aperture that the plug portion is configured to be insertable in
and to engage with. The plug portion is configured to receive the
non-needle end of a suture strand, securing it in place upon
insertion of the plug into the wheel portion. The plug portion has
a latch member extending therefrom which pushes the moveable arm
into a flexed position during insertion. When the plug portion is
fully inserted, the notch engagement ledge associates with the
latch member and allows the moveable arm to return to a neutral
position and secure the plug portion within the wheel portion.
Inventors: |
James E.; Jervis; (Atherton,
CA) |
Assignee: |
Anpa Medical, Inc.
San Mateo
CA
|
Family ID: |
36916925 |
Appl. No.: |
13/298862 |
Filed: |
November 17, 2011 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11061128 |
Feb 17, 2005 |
8062333 |
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13298862 |
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Current U.S.
Class: |
606/232 |
Current CPC
Class: |
A61B 17/06061 20130101;
A61B 17/0487 20130101 |
Class at
Publication: |
606/232 |
International
Class: |
A61B 17/04 20060101
A61B017/04 |
Claims
1. A suture retainer comprising a retainer body, said retainer body
comprising: a wheel portion comprising, a substantially planar
first plate and a substantially planar second plate, said first
plate and said second plate defining an outer circumference of said
wheel portion, and an upper surface and a lower surface of said
wheel portion; said first plate being spaced from said second plate
at said outer circumference, thereby forming an outward radially
open channel throughout said outer circumference; a plurality of
suture attachment mechanisms spaced circumferentially about said
wheel portion between said first plate and said second plate,
wherein each of said suture attachment mechanisms is adapted to
hold a suture strand at a discrete attachment point; an aperture
extending through, and substantially perpendicular to, said first
plate and said second plate; a circumferential side wall
surrounding said aperture; an arm member extending into said
aperture, said arm member having a free top end, and a secured
lower end; said arm member being movable between a neutral position
wherein said free top end is in a receiving position at least
partially disposed in said aperture, and a flexed position wherein
said free top end is placed in an engaged position, wherein said
engaged position is closer to said side wall than said receiving
position; and said moveable arm member having an engagement ledge;
and a plug portion at least partially insertable into and adapted
to cooperate with said aperture in said wheel portion, said plug
portion comprising, a plug body having an insertion end and a
second end, and a plug perimeter wall extending between said
insertion end and said second end, wherein said plug perimeter wall
defines a latch ledge; wherein said plug portion is configured to
engage said arm member of said wheel portion, causing said arm
member to move into said flexed position, during insertion of said
plug portion into said wheel portion; and wherein said engagement
ledge is configured to interface with said latch ledge to retain
said plug portion at least partially within said wheel portion.
2. The suture retainer according to claim 1 wherein each suture
attachment mechanism comprises a pair of teeth.
3. The suture retainer according to claim 1 wherein each suture
attachment is adapted to releasably hold said suture strand.
4. The suture retainer according to claim 1 wherein said engagement
ledge is located closer to said free top end than to said secured
lower end.
5. The suture retainer according to claim 1 wherein said plug body
is substantially cylindrical.
6. The suture retainer according to claim 1 wherein said insertion
end and said second end of said plug body are substantially
planar.
7. The suture retainer according to claim 6 wherein said insertion
end and said second end of said plug body are substantially
parallel.
8. The suture retainer of claim 1 wherein said plug body further
comprises a groove formed in said second end.
9. The suture retainer of claim 1 wherein said plug body further
comprises a groove formed in said insertion end.
10. The suture retainer of claim 1 wherein said wheel portion
further comprises a suture guide mechanism projecting from at least
one of said first plate and said second plate.
11. The suture retainer of claim 10 wherein said suture guide
mechanism comprises a projection including a hooked portion
radially spaced from the outer circumference of the wheel
portion.
12. The suture retainer of claim 10 wherein said wheel portion
further comprises a suture strand slot disposed in at least one of
said first plate and said second plate, and wherein said slot is
formed in one of said plates and said suture guide mechanism
projects from the other of said plates.
13. The suture retainer of claim 1 wherein said wheel portion
further comprises a suture strand slot disposed in at least one of
said first plate and said second plate.
14. A suture retainer according to claim 1 wherein said plug body
further comprises a slot extending inwardly from said plug
perimeter wall.
15. A suture retainer according to claim 1 wherein said latch
member is a tab member that is flush with said insertion end of
said plug body.
16. A suture retainer according to claim 1 wherein said engagement
ledge is formed by said free top end of said arm member.
17. A suture retainer according to claim 1 wherein said insertion
end and said second end of said plug body lie flush with said upper
surface and said lower surface of said wheel portion, respectively,
when said engagement ledge and said latch ledge are interfaced.
18. A suture retainer according to claim 1 wherein said insertion
end of said latch member is an angled surface angling away from
said plug body side wall and in the direction of said second side
of said plug body.
19. A suture retainer according to claim 1 wherein said engagement
ledge extends laterally from said free top end of said arm member,
away from said circumferential side wall.
20. A suture retainer according to claim 1 wherein said plug
portion is hingedly coupled to said wheel portion.
21. A suture retainer according to claim 20 wherein said plug body
further comprises an attachment surface extending from said second
end, said attachment surface having at least one pin member.
22. A suture retainer according to claim 21 wherein said at least
one pin member is positioned at a location that is on the opposite
side of said plug body from said latch ledge.
23. A suture retainer according to claim 20 wherein said wheel
portion further comprises at least one pair of arms extending
upward from said first plate forming a yoke for receiving said at
least one pin member on said plug body.
Description
RELATED APPLICATIONS
[0001] This application claims the benefit and is a continuation of
co-pending U.S. patent application Ser. No. 11/061,128, entitled
Suture Retainer With Multiple Circumferentially Spaced Attachment
Points And Suture Retention Method, filed on Feb. 17, 2005.
BACKGROUND OF THE INVENTION
[0002] The invention relates generally to suture retainers and
methods of using suture retainers. In particular, the invention
relates to suture retainers that hold a suture strand at a
plurality of circumferentially spaced points about the suture
retainer.
[0003] Sutures are used for a variety of surgical purposes, such as
approximation of tissue and ligation of tissue. Most generally,
when placing sutures, the strand of suture material to be used has
a needle affixed to one end. The needle is passed through the
tissue to be approximated or ligated, forming a stitch. The stitch
is then tensioned appropriately, and the two ends of the suture,
the needle end and the non-needle end, are knotted to retain the
desired tension in the stitch. Sometimes the ends are knotted
together; in other instances they may be stoppered separately,
often with the aid of a clip or other device to form resistance to
passage through tissue. While forming knots in suture during open
surgery is a simple matter, forming knots in suture during
endoscopic surgery can be very difficult.
[0004] Suture retainers may be used in place of suture knots to
prevent passage of a suture end into and through tissue and to
maintain the tension applied to the suture material during the
suturing procedure. Suture clips and other suture retainers are
described in the following publications: U.S. Pat. No. 5,234,449;
U.S. Pat. No. 5,383,905; U.S. Pat. No. 5,391,173; U.S. Pat. No.
5,643,295; U.S. Pat. No. 5,645,553; U.S. Pat. No. 5,735,877; U.S.
Pat. No. 5,845,645; U.S. Pat. No. 5,895,393; U.S. Pat. No.
6,015,428; U.S. Pat. No. 6,066,160; U.S. Pat. No. 6,231,592; and
U.S. Pat. No. 6,432,123.
SUMMARY OF THE INVENTION
[0005] The present invention provides a suture retainer with
multiple circumferentially spaced attachment points. The invention
also provides a suture retainer with a suture guide mechanism
adapted to maintain an angle between a suture strand and a suture
attachment mechanism. While the suture retainer of this invention
can be used in conventional open surgeries or external surgeries,
the invention is particularly useful for endoscopic suturing.
[0006] The suture retainer according to one aspect of the invention
has a retainer body and a plurality of suture attachment mechanisms
spaced circumferentially about the retainer body, each of the
suture attachment mechanisms (such as a pair of teeth) being
adapted to hold a suture strand at a discrete attachment point. In
some embodiments, each suture attachment mechanism is adapted to
releasably hold the suture strand.
[0007] In some embodiments of the invention, the suture retainer
also has a suture guide mechanism, such as a projection from the
retainer body, adapted to maintain an angle between the suture
strand and one of the suture attachment mechanisms. The suture
guide mechanism may be adapted to be a first contact point of the
suture strand with the suture retainer.
[0008] In some embodiments, the suture attachment mechanisms are
needle-end suture attachment mechanisms, with the suture retainer
also including a non-needle-end suture attachment mechanism adapted
to hold a non-needle-end of the suture strand. The non-needle-end
suture attachment mechanism may be disposed radially inward from
each of the needle-end suture attachment mechanisms. Also, in some
embodiments, the retainer body has a first member and a second
member, with at least a portion of the second member being adapted
to be inserted into the first member to form the non-needle-end
suture attachment mechanism, such as a slot in the second member
which interacts with the first member to hold the non-needle-end of
the suture strand. The suture retainer may also have an alignment
mechanism adapted to orient the second member with respect to the
first member. In some embodiments, the suture retainer also has a
movable connection between the first member and the second member,
and in some embodiments the suture retainer has a snap connection
between the first member and the second member. In some
embodiments, a suture guide mechanism may project from the first
and/or second member.
[0009] Another aspect of the invention provides a method of
securing a suture in a suture retainer, including the following
steps: providing a suture retainer having a retainer body and a
plurality of suture attachment mechanisms spaced circumferentially
about the retainer body; and attaching a suture strand to the
retainer body at each of the suture attachment mechanisms. In some
embodiments, each suture attachment mechanism is at least a pair of
teeth, with the method further including the step of inserting the
suture strand between each of the pairs of teeth. The method may
also include the step of releasing the suture strand from the
suture attachment mechanisms after the attaching step and possibly
the step of reattaching the suture strand to the suture attachment
mechanisms after the releasing step.
[0010] In some embodiments the method also includes the step of
contacting the suture strand with a suture guide to maintain an
angle between the suture strand and one of the suture attachment
mechanisms. The contacting step may include the step of contacting
with the suture guide a portion of the suture strand between a
point where the suture strand leaves a tissue surface and a point
where the suture strand contacts a suture attachment mechanism.
[0011] In some embodiments, the attaching step includes the step of
attaching a needle-end of the suture strand to needle-end suture
attachment mechanisms, with the method further including the step
of attaching a non-needle-end of the suture strand to the suture
retainer. The retainer body may include a first member and a second
member, and the step of attaching the non-needle-end of the suture
strand may include the step of inserting at least a portion of the
second member into the first member to hold the non-needle-end of
the suture strand. In embodiments in which the retainer body has a
movable connection between the first member and the second member,
the inserting step may include the step of moving the second member
about the movable connection with respect to the first member and
possibly the step of snapping the first and second members
together.
[0012] Yet another aspect of the invention provides a suturing
method including the steps of: attaching a first end of a suture
strand to a suture retainer; contacting a tissue contact portion of
the suture strand with tissue to be sutured, the tissue contact
portion being disposed between the first end of the suture strand
and a second end of the suture strand; and attaching the second end
of the suture strand to the suture retainer at a plurality of
suture attachment points spaced circumferentially about the suture
retainer. In some embodiments, the step of attaching the second end
of the suture strand includes the step of placing the second end of
the suture strand between a plurality of pairs of teeth, each pair
of teeth being disposed at one of the suture attachment points. The
method may also include the step of detaching the suture strand
from the suture attachment mechanisms after the attaching step and
possibly the step of reattaching the suture strand to the suture
attachment mechanisms after the detaching step.
[0013] In some embodiments, the step of attaching the first end of
the suture strand includes the step of inserting at least a portion
of a first suture retainer body member into a second suture
retainer body member. The attaching step may also include the step
of placing the first end of the suture strand into a slot formed in
the first suture retainer body member. The inserting step may
include the step of aligning the first suture retainer body member
with the second suture retainer body member, such as by rotating
the second body member to align a second suture retainer body
member alignment element with a first suture retainer body member
alignment element.
[0014] Some embodiments of this aspect of the invention include the
step of contacting the second end of the suture strand with a
suture guide to maintain an angle between the suture strand and one
of suture attachment mechanisms, such as by making a first contact
of the second end of the suture strand with the suture
retainer.
INCORPORATION BY REFERENCE
[0015] All publications and patent applications mentioned in this
specification are herein incorporated by reference to the same
extent as if each individual publication or patent application was
specifically and individually indicated to be incorporated by
reference.
BRIEF DESCRIPTION OF THE DRAWINGS
[0016] The novel features of the invention are set forth with
particularity in the appended claims. A better understanding of the
features and advantages of the present invention will be obtained
by reference to the following detailed description that sets forth
illustrative embodiments, in which the principles of the invention
are utilized, and the accompanying drawings of which:
[0017] FIG. 1 is a side elevational view of a suture retainer
according to one embodiment of this invention.
[0018] FIG. 2 is a side elevational view of the suture retainer of
FIG. 1, partially assembled.
[0019] FIG. 3 is a side elevational view of a plug portion of the
suture retainer of FIG. 1.
[0020] FIG. 4 is a top elevational view of the plug portion of the
suture retainer shown in FIG. 3.
[0021] FIG. 5 is a medial cross-sectional view of the wheel portion
of one embodiment of the suture retainer of this invention with a
suture strand laid into the attachment mechanisms.
[0022] FIG. 6 is a side elevational view of the wheel portion of
the suture retainer shown in FIG. 1.
[0023] FIG. 7 is a perspective view of the suture retainer shown in
FIG. 1.
[0024] FIG. 8 shows a suture retainer according to one embodiment
of this invention in use to retain a suture strand.
[0025] FIG. 9 is a top elevational view of a suture attachment
feature that may be used with embodiments of this invention.
[0026] FIG. 10 is a top elevational view of the wheel portion of
yet another embodiment of the suture retainer of this
invention.
[0027] FIG. 11 is a cross-sectional view taken along the line A-A
of FIG. 10.
[0028] FIG. 12 is a side elevational view of the plug portion of
the embodiment of FIG. 10.
[0029] FIG. 13 is a schematic view of an assembled suture retainer
according to the embodiment of FIGS. 10-12 showing a suture in
place.
[0030] FIG. 14 is a top elevational view of the wheel portion of
another embodiment of the suture retainer of this invention.
[0031] FIG. 15 is a cross-sectional view taken along the line A-A
of FIG. 14.
[0032] FIG. 16 is a top elevational view of the plug portion of the
embodiment of FIG. 14.
[0033] FIG. 17 is a cross-sectional view of a suture and a
partially assembled suture retainer according to the embodiment of
FIGS. 14-16, prior to use.
DESCRIPTION OF THE PREFERRED EMBODIMENT
[0034] FIGS. 1-7 show embodiments of a suture retainer 10 with two
principal parts: a wheel portion 12 and a plug portion 14. Wheel
portion 12 has sets of teeth 16 arranged around its circumference.
As shown best in FIG. 7, tooth sets 16 each have a pair of inclined
facing edges 18 and 20 that diverge from the center of wheel
portion 12 toward the outer circumference of wheel portion 12. The
spacing and angle of inclined surfaces 18 and 20 are chosen to
engage the diameter of the suture strand with which the retainer is
intended to be used. In one embodiment, for example, the angle
between the inclined surfaces of each tooth set is about 10.degree.
or less.
[0035] In the embodiments shown in FIGS. 1-7, wheel portion 12 has
three sets of teeth arranged about the circumference of wheel
portion 12 in a manner to produce pull angles of between about
50.degree. and 70.degree. for each tooth set. Pull angle is defined
as the angle formed on the "pull" side of the tooth set between a
suture held by the tooth set and a line normal to a plane formed by
the juxtaposed edges of the teeth. The tooth sets extend radially
from the center of wheel portion 12 or may extend on an angle from
a radius in order to provide the desired pull angle. In other
embodiments, the suture retainer may have one, two or more than
three sets of suture attachment mechanisms, such as the teeth shown
in the embodiments of FIGS. 1-7.
[0036] A pair of plates or flanges 22 and 24 surround and support
the tooth sets. Plates 22 and 24 also aid the surgeon in passing
the needle end of the suture around wheel portion 12 to engage
successive tooth sets. Wheel portion 12 has a central opening 26
and an alignment hole 28. Opening 26 and hole 28 mate with
corresponding portions of plug portion 14 when the suture retainer
is assembled.
[0037] Plug portion has lock arms 30 and 32 extending from a plate
34. Lock arms 30 and 32 have cam surfaces 36 and 38, respectively
that are adapted to bend arms 30 and 32 inward when surfaces 36 and
38 engage the edges of opening 26 in wheel portion 12. A slot 40 is
formed between arms 30 and 32.
[0038] Also extending from plate 34 is a suture guide mechanism
(such as hook 42 in FIG. 1 or tab 50 in FIG. 7) and an alignment
member 44. Alignment member 44 extends into alignment hole 28 when
plug portion 14 is connected to wheel portion 12. This arrangement
sets the position of the suture guide mechanism (e.g., hook 42)
with respect to one of the tooth sets 16 so that hook may serve as
a retainer or guide for a suture strand as it enters a first tooth
set 16, as described below. Other means of aligning the plug and
wheel portions of the suture retainer may be used, of course,
without departing from the invention.
[0039] To use the suture retainer, the non-needle-end of a suture
is inserted into the slot 40, preferably when the suture retainer
is in the partially assembled configuration shown in FIG. 3. Plug
portion 14 is then advanced completely into wheel portion 12, with
alignment member 44 aligned with alignment hole 28. As lock arms 30
and 32 move into opening 26, cam surfaces 36 and 38 engage the
edges of opening 26 to move arms 30 and 32 inward. After cam
surfaces 36 and 38 have completely passed through opening 26, arms
30 and 32 move outwardly so that lock surfaces 46 and 48 formed on
arms 30 and 32, respectively, engage the far side of plate 24 in a
snap connection, as shown in FIGS. 1 and 7, and the suture strand
is gripped firmly, preferably in a controlled clearance space
between the shaft of the plug and the bore of the wheel.
[0040] When thus assembled, the non-needle-end of the suture strand
is held firmly by suture retainer 10. The surgeon can then pass the
needle and needle-end of the suture strand through and/or around
the tissue 2 to be sutured or ligated, pulling suture retainer 10
against the surface of the tissue, as shown in FIG. 8. When the
suture stitch is complete, the surgeon passes the needle-end 6 of
the suture strand 4 around and in engagement with the suture guide
mechanism 42, tensions the stitch, then guides the needle-end of
the suture strand in succession into the three sets of teeth 16,
maintaining the tension in the suture strand as the surgeon
progresses. If the stitch tension and suture retainer grip are
satisfactory, the surgeon then may sever the unused ends of the
suture strand. If, however, the stitch needs to be retensioned to
either increase or decrease tissue approximation or the retainer
grip needs to be adjusted, the surgeon may pull the suture strand
away from the tooth sets, then retension the stitch and reengage
the suture strand with the suture retainer. While the illustrations
show a clockwise wrapping of the suture, other embodiments of the
invention may employ counterclockwise wrapping of the suture around
the retainer.
[0041] The shape and position of hook 42 help retain the suture
strand's orientation and pull angle with respect to the first set
of teeth 16 it encounters. In addition, the curved end of hook 42
helps retain the suture strand in place after the suturing
procedure has been completed. Other shapes and manners of suture
strand guides may be used in place of hook 42, such as tabs, posts,
rings, etc. In addition, the suture strand guide of this invention
may be used with suture retainers having one, two or more than
three suture attachment mechanisms.
[0042] FIG. 9 shows an optional feature for holding the far end of
the needle-end of the suture strand after engagement with the
retainer's sets of teeth. A slot 54 is formed in plate 24 of suture
retainer 10. The end of the suture strand may be placed within slot
54 to provide additional retention of the suture and to maintain
the retention of the suture provided by the last set of teeth
before severing and removing the needle end of the suture. The slot
may be tapered or parallel, as shown, and may be used with any of
the embodiments of this invention. This feature may also be used to
retain one end of a suture strand without regard to whether, or the
manner in which, the other end of the suture strand is
retained.
[0043] Another embodiment of the invention is shown in FIGS. 10-13.
Suture retainer 60 has a wheel portion and a plug portion 64. Like
the previous embodiments, wheel portion 62 has sets of teeth 66
arranged about a circumference of wheel portion 62. A pair of
plates or flanges 68 and 70 surround and support the tooth sets.
Wheel portion 62 also has a central opening 72 with a movable
member 74 formed inside the opening. A suture guide mechanism 76
extends from wheel portion 62.
[0044] Plug portion 64 has a slot 78 and a groove 80. A tab 82
extends from the top surface of plug portion 64. Prior to insertion
(or after partial insertion) of plug 64 into wheel 62 in the
direction shown by the arrow in FIG. 11, the non-needle-end of a
suture strand 86 may be inserted into slot 78 and, if desired,
wrapped around groove 80 and back through slot 78. Plug 64 is then
inserted fully into opening 72 of wheel 62 from the bottom, as
shown in FIG. 11. As it is inserted, the plug's tab 82 pushes the
top of the wheel's movable member 74 radially away from the center
of opening 72. When the plug's tab 82 reaches a space 84 above
movable member 74, movable member 74 moves back toward the center
of opening 72, snapping plug 64 in place within wheel 62. In this
position, the non-needle-end of suture strand 86 is held firmly by
suture retainer 60. The suture thread may be tensioned downward, as
shown in FIG. 13.
[0045] After assembly of the suture retainer, the surgeon may then
use the needle-end of the suture to perform the suturing or
ligation procedure. As in the other embodiments, when the suture
stitch is complete, the surgeon passes the needle-end of the suture
strand around the suture guide 76, then inserts the suture strand
in succession into the sets of teeth 66. Thereafter, the surgeon
may place the needle-end of the suture strand into a slot 88 formed
in plate or flange 68.
[0046] In the embodiment shown in FIGS. 10-13, the top and bottom
edges of plug 64 lie flush with the top and bottom edges of wheel
62. This arrangement is an optional feature of the invention. Also,
it should be understood that other suture attachment mechanisms and
other numbers of suture attachment mechanisms may be used in the
suture retainer of this invention.
[0047] FIGS. 14-17 show yet another embodiment of this invention.
Suture retainer 100 has a wheel portion 102 and a plug portion 104.
Like the previous embodiments, wheel portion 102 has sets of teeth
106 arranged about a circumference of wheel portion 102. A pair of
plates or flanges 108 and 110 surround and support the tooth sets.
Wheel portion 102 also has a central opening 112 with a movable arm
114 formed inside the opening. A suture guide mechanism 116 extends
from wheel portion 112.
[0048] Plug portion 104 has a pair of pins 107 extending from an
upper surface. When the suture retainer is assembled prior to use,
pins 107 are snapped into openings formed by pairs of arms 118
extending upward from the upper surface of flange 108 of wheel 102
to form a hinge to allow rotational movement between plug 104 and
wheel 102. Other forms of movable connection between the plug and
wheel are also covered by this invention.
[0049] FIG. 17 shows the arrangement of plug 104 and wheel 102
prior to use of the suture retainer. A loop 120 formed in the
non-needle-end of a suture strand is passed up through opening 112.
The suture strand may then be wrapped one or more times around plug
104 with the suture strand lying in grooves 122 (and groove 123,
for multiple suture wraps) formed in plug 104. Plug 104 is then
rotated downward about the hinge formed by pins. 107 and arms 118.
As the bottom of plug 104 enters opening 112, an angled surface 124
of plug 104 engages an angled surface formed on the top of a tab
126 of movable arm 114, pushing the top of arm 114 radially
outward. When plug 104 has been completely inserted into wheel 102,
tab 126 moves radially inward into a slot 128 formed in plug 104 to
latch plug 104 in place within wheel 102. The surgeon may then use
the needle-end of the suture to perform the suturing or ligation
procedure. As in the other embodiments, when the suture stitch is
complete, the surgeon passes the needle-end of the suture strand
around the suture guide 116, then inserts the suture strand in
succession into the sets of teeth 106 to hold the suture in
place.
[0050] The use of circumferentially spaced tooth sets provides
multiple suture attachment mechanisms each at desired pull angles.
This arrangement reduces the likelihood of slippage of the suture
strand in the event one of the attachment points fails or provides
less than 100% of the required tensioning force. Other numbers of
tooth sets set at other pull angles may also be used. In addition,
other attachment mechanisms may be used in place of the tooth sets
described above, such as high friction surfaces, hooks, posts,
rings, etc.
[0051] The components of the device described above can be made of
medically suitable metal or plastics, including bio-absorbable
polymers. Example materials include stainless steel, polycarbonate
and polyglycolide.
[0052] While preferred embodiments of the present invention have
been shown and described herein, it will be obvious to those
skilled in the art that such embodiments are provided by way of
example only.
[0053] Numerous variations, changes, and substitutions will now
occur to those skilled in the art without departing from the
invention. It should be understood that various alternatives to the
embodiments of the invention described herein may be employed in
practicing the invention. It is intended that the following claims
define the scope of the invention and that methods and structures
within the scope of these claims and their equivalents be covered
thereby.
* * * * *