U.S. patent application number 13/401148 was filed with the patent office on 2012-09-13 for flexible suturing instrument.
This patent application is currently assigned to BOSTON SCIENTIFIC SCIMED, INC.. Invention is credited to TY FAIRNENY.
Application Number | 20120232567 13/401148 |
Document ID | / |
Family ID | 45774347 |
Filed Date | 2012-09-13 |
United States Patent
Application |
20120232567 |
Kind Code |
A1 |
FAIRNENY; TY |
September 13, 2012 |
FLEXIBLE SUTURING INSTRUMENT
Abstract
A suturing instrument includes a handle, an elongate shaft, and
a suturing head. One or more pull wires extend from the handle into
the elongate shaft for controllably deflecting a deflectable
portion of the elongate shaft in one or more directions and/or
planes for improved maneuverability within the body of a patient
during an endoscopic or laparoscopic surgical procedure and for
changing the positioning of the suturing head.
Inventors: |
FAIRNENY; TY; (Hopkinton,
MA) |
Assignee: |
BOSTON SCIENTIFIC SCIMED,
INC.
MAPLE GROVE
MN
|
Family ID: |
45774347 |
Appl. No.: |
13/401148 |
Filed: |
February 21, 2012 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
61451366 |
Mar 10, 2011 |
|
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|
Current U.S.
Class: |
606/147 |
Current CPC
Class: |
A61B 17/0482 20130101;
A61B 17/0469 20130101; A61B 2017/2927 20130101; A61B 17/0625
20130101; A61B 2017/00314 20130101; A61B 2017/00323 20130101 |
Class at
Publication: |
606/147 |
International
Class: |
A61B 17/062 20060101
A61B017/062 |
Claims
1. A suturing instrument, comprising a handle; an elongate shaft
extending from the handle, at least a portion of the elongate shaft
being flexible; one or more pull wires extending from the handle
into the flexible portion of the elongate shaft for deflecting the
flexible portion of elongate shaft; and a suturing head extending
from a distal end of the elongate shaft, the suturing head
comprising a needle carrier channel, a needle carrier configured to
releasably hold a needle, and a needle catch, the needle carrier
being movably disposed within the needle carrier channel.
2. The suturing instrument of claim 1 wherein the needle carrier
moves along the needle carrier channel out of the suturing head
into an extended position, and back into the suturing head into a
retracted position.
3. The suturing instrument of claim 2 further comprising a needle
deployment system at least partially disposed within the elongate
shaft and coupled to needle carrier for moving the needle carrier
between the extended position and the retracted position.
4. The suturing instrument of claim 3 wherein the needle deployment
system moves the needle carrier out of the suturing head in a
semi-circular path towards the needle catch such that the needle
held by the needle carrier is released from the needle carrier and
retained in the needle catch.
5. The suturing instrument of claim 3 wherein the handle includes
an actuating mechanism coupled to the needle deployment system for
actuating the needle deployment system.
6. The suturing instrument of claim 1 wherein the handle includes a
control system coupled to the one or more pull wires for
controlling deflection of the flexible portion of the elongate
shaft.
7. The suturing instrument of claim 6 wherein the control system
includes a rotatable cam coupled to the one or more pull wires.
8. The suturing instrument of claim 6 wherein the control system
includes one or more knobs, hubs or levers attached to the one or
more pull wires.
9. The suturing instrument of claim 1 wherein the elongate shaft is
capable of being deflected into multiple different planes relative
to a longitudinal axis of the elongate shaft.
10. The suturing instrument of claim 1 wherein the elongate shaft
comprises a flexible coil.
11. The suturing instrument of claim 10 wherein the flexible coil
comprises a Bowden coil.
12. The suturing instrument of claim 10 wherein the elongate shaft
further includes an outer sleeve disposed on the outside of the
flexible coil to provide a smooth exterior surface.
13. The suturing instrument of claim 1 wherein at least a portion
of the elongate shaft includes an articulation structure.
14. The suturing instrument of claim 13 wherein the flexible
portion of the elongate shaft includes an articulation
structure.
15. The suturing instrument of claim 13 wherein the articulation
structure comprises a series of stacked links disposed adjacent to
one another and movable with respect to each other, each link
including a front face tapered to a pair of pivot points and a rear
face defining a wedge shaped recess for receiving the pivot points
of the adjacent link, and wherein said one or more pull-wires are
configured for providing tension to the articulation structure and
holding the adjacent links together.
16. The suturing instrument of claim 13 wherein the articulation
structure comprises: a first articulation section, the first
articulation section includes a first series of stacked links
disposed adjacent to one another and movable with respect to each
other, each link including a front face tapered to a pair of pivot
points and a rear face defining a wedge shaped recess for receiving
the pivot points of the adjacent link; a second articulation
section, the second articulation section includes a second series
of stacked links disposed adjacent to one another and movable with
respect to each other, each link including a front face tapered to
a pair of pivot points and a rear face defining a wedge shaped
recess for receiving the pivot points of the adjacent link, the
wedge shaped recesses of the first articulation section radially
offset from the wedge shaped recesses of the second articulation
section; wherein said one or more pull wires are configured for
providing tension to the articulation structure and holding the
adjacent links together.
17. The suturing instrument of claim 13 wherein said articulation
structure comprises: a number of ring links, each having an inner
circumference and an outer circumference, each ring link including:
two concave recesses with openings that face radially outward from
the outer circumference of the ring link that are positioned on
opposite sides of the outer circumference of the ring link; and two
concave recesses with openings that face radially inward from the
inner circumference of the ring link that are positioned on
opposite sides of the inner circumference of the ring link and are
oriented at 90 degrees to the two concave recesses positioned on
opposite sides of the outer circumference of the ring link; and a
plurality of spring segments that are secured within the concave
recesses on the outer circumferences and inner circumferences of
the ring links to join adjacent ring links together and that are
bendable in the articulating joint; wherein the concave recesses on
the outer circumference of a given ring link are aligned with the
concave recesses on the inner circumference of an adjacent ring
link in the articulating joint.
18. The suturing instrument of claim 17 wherein the spring segments
define apertures adapted to receive the one or more pull wires
therethrough.
19. A suturing instrument, comprising a handle including a control
system; an elongate shaft extending from the handle, the elongate
shaft including a distal portion, at least a portion of the
elongate shaft being flexible; one or more pull wires extending
from the handle into the distal portion of the elongate shaft, the
one or more pull wires coupled to the control system to allow
active control of the flexible portion of the elongate shaft; and a
suturing head extending from a distal end of the distal portion of
the elongate shaft, the suturing head comprising a needle carrier
channel, a needle carrier configured to releasably hold a needle,
and a needle catch, the needle carrier being movably disposed
within the needle carrier channel.
20. A suturing instrument, comprising a handle; an elongate shaft
extending from the handle, the elongate shaft including a distal
portion, at least a portion of the shaft being flexible and
including an articulation structure; one or more pull wires
extending from the handle into the distal portion of the elongate
shaft for deflecting the articulated portion of elongate shaft; and
a suturing head extending from a distal end of the distal portion
of the elongate shaft, the suturing head comprising a needle
carrier channel, a needle carrier configured to releasably hold a
needle, and a needle catch, the needle carrier being movably
disposed within the needle carrier channel.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims the benefit of and priority to U.S.
Provisional Application No. 61/451,366, filed on Mar. 10, 2011, the
contents of which are incorporated herein by reference in its
entirety.
TECHNICAL FIELD
[0002] The invention generally relates to suturing instruments and
methods for placing sutures. The suturing instruments of the
invention can be used to access difficult-to-reach treatment areas
within the body of a patient.
BACKGROUND INFORMATION
[0003] Suturing body tissue is a time consuming aspect of many
surgical procedures. For many surgical procedures, it is necessary
to make a large opening in the human body to expose the area that
requires surgical repair. There are instruments available, such as
endoscopes, that allow viewing of certain areas of the human body
through a small puncture wound without exposing the entire body
cavity. Endoscopes can be used in conjunction with specialized
surgical instruments to detect, diagnose, and repair areas of the
body that previously required open surgery to access.
[0004] Some surgical instruments used in endoscopic procedures are
limited by the manner in which they access the areas of the human
body in need of repair. In particular, the instruments may not be
able to access tissue or organs located deep within the body or
that are in some way obstructed. Also, many of the instruments are
limited by the way they grasp tissue, apply a suture, or recapture
a needle and suture. Furthermore, many of the instruments are
complicated and expensive to produce due to the numerous parts
and/or subassemblies required to make them function properly.
[0005] Suturing instruments, and more specifically suturing
instruments used in endoscopic procedures, are generally rigid and
do not provide the operator a range of motion to access
difficult-to-reach parts of the anatomical region requiring
sutures. Accordingly, multiple instruments of various
configurations and sizes typically are used to access all of the
necessary tissue areas. These limitations of known suturing
instruments complicate the endoscopic procedure for the surgeon by
requiring the insertion and removal of multiple instruments from a
surgical site as the target suturing area changes during the course
of the surgical procedure.
SUMMARY OF THE INVENTION
[0006] The invention generally relates to suturing instruments with
improved maneuverability, efficiency and functionality for use
during a surgical procedure, such as an endoscopic or laparoscopic
procedure. More particularly, the invention is directed to a
suturing instrument including a flexible elongate shaft that can be
actively deflected. The deflection can be controlled by the user of
the instrument (e.g., a surgeon) for improved maneuverability and
functionality during a surgical procedure.
[0007] In one aspect, the invention relates to a suturing
instrument. The suturing instrument includes a handle. An elongate
shaft extends from the handle. At least a portion of the elongate
shaft is flexible. One or more pull wires extend from the handle
into the flexible portion of the elongate shaft for deflecting the
flexible portion of the elongate shaft. The suturing instrument
further includes a suturing head that extends from a distal end of
the elongate shaft. The suturing head includes a needle carrier
channel, a needle carrier having a lumen configured to releasably
hold/receive the non-penetrating end of a needle, and a needle
catch. The needle carrier is movably disposed within the needle
carrier channel.
[0008] In certain embodiments, a proximal, a middle, and/or a
distal portion of the elongate shaft is flexible. In other
embodiments, the elongate shaft is flexible along the entire length
of the shaft.
[0009] Generally, the needle carrier in the suturing head is
movably disposed within the needle carrier channel such that it is
capable of moving along the needle carrier channel out of the
suturing head into an extended position, and back into the suturing
head into a retracted position.
[0010] The suturing instruments of the invention can further
include a needle deployment system at least partially disposed
within the elongate shaft. The needle deployment system is coupled
to the needle carrier and moves the needle carrier between the
extended position and the retracted position. In certain
embodiments, the needle deployment system is configured to move the
needle carrier out of the suturing head in a semi-circular path
towards the needle catch such that the needle held by the needle
carrier is released from the needle carrier and retained in the
needle catch.
[0011] The needle deployment system includes a proximal and a
distal end. The distal end of the needle deployment system is
coupled to the needle carrier, whereas the proximal end of the
needle deployment system is coupled to an actuating mechanism for
actuating the needle deployment system. The actuating mechanism is
disposed within or on the handle portion of the suturing
instrument.
[0012] The handle portion of the suturing instruments of the
invention can further include a control system coupled to the one
or more pull wires for controlling deflection of the flexible
portion of the elongate shaft. The control system can include a
rotatable cam coupled to the one or more pull wires. Alternatively,
the control system can include one or more knobs, hubs or levers
attached to the one or more pull wires.
[0013] Preferably, at least a portion of the elongate shaft the
suturing instruments of the invention is capable of being deflected
into multiple different planes relative to a longitudinal axis of
the elongate shaft. For example, at least a distal portion of the
elongate shaft is capable of being deflected into a plurality of
different directions/planes relative to a longitudinal axis of the
elongate shaft. Alternatively, the elongate shaft is capable of
being simultaneously deflected into multiple different planes along
the entire length of the shaft. Deflection of the elongate shaft is
actively controlled by a user (e.g., a surgeon) using the one or
more pull wires that extend from the handle into a distal portion
of the elongate shaft.
[0014] In certain embodiments, at least a portion of the elongate
shaft includes a flexible coil, such as a Bowden coil. For example,
a proximal, a middle and/or a distal portion of the elongate shaft
can include a flexible coil. In an alternative embodiment, the
flexible coil can extend along the entire length of the elongate
shaft. The elongate shaft can further include an outer sleeve
disposed on the outside of the flexible coil to provide the
instrument with a smooth exterior surface. Deflection of the
flexible coil portion of the elongate shaft can be actively
controlled by a user (e.g., a surgeon) using the one or more pull
wires that extend from the handle into a distal portion of the
elongate shaft.
[0015] In alternative embodiments, at least a portion of the
elongate shaft includes an articulation structure. Preferably, a
flexible portion of the elongate shaft includes an articulation
structure. For example, a proximal, a middle, and/or a distal
portion of the elongate shaft can include an articulation
structure. Alternatively, the articulation structure can extend
along the entire length of the elongate shaft. Deflection of the
articulated portion of the elongate shaft can be actively
controlled by a user (e.g., a surgeon) using the one or more pull
wires that extend from the handle into a distal portion of the
elongate shaft.
[0016] In one embodiment, the articulation structure can include a
series of stacked links disposed adjacent to one another and
movable with respect to each other. Each link includes a front face
tapered to a pair of pivot points and a rear face defining a wedge
shaped recess for receiving the pivot points of the adjacent link.
The one or more pull-wires are configured to provide tension to the
articulation structure and hold the adjacent links together.
[0017] In another embodiment, the articulation structure includes a
first articulation section, the first articulation section and a
second articulation section. The first articulation section
includes a first series of stacked links disposed adjacent to one
another and movable with respect to each other, each link including
a front face tapered to a pair of pivot points and a rear face
defining a wedge shaped recess for receiving the pivot points of
the adjacent link. The second articulation section includes a
second series of stacked links disposed adjacent to one another and
movable with respect to each other, each link including a front
face tapered to a pair of pivot points and a rear face defining a
wedge shaped recess for receiving the pivot points of the adjacent
link, the wedge shaped recesses of the first articulation section
radially offset from the wedge shaped recesses of the second
articulation section. The one or more pull wires provide tension to
the articulation structure and hold the adjacent links
together.
[0018] In yet another embodiment, the articulation structure
includes a number of ring links, each having an inner circumference
and an outer circumference. Each ring link includes: two concave
recesses with openings that face radially outward from the outer
circumference of the ring link that are positioned on opposite
sides of the outer circumference of the ring link; two concave
recesses with openings that face radially inward from the inner
circumference of the ring link that are positioned on opposite
sides of the inner circumference of the ring link and are oriented
at 90 degrees to the two concave recesses positioned on opposite
sides of the outer circumference of the ring link; and a plurality
of spring segments that are secured within the concave recesses on
the outer circumferences and inner circumferences of the ring links
to join adjacent ring links together and that are bendable in the
articulating joint. The concave recesses on the outer circumference
of a given ring link are aligned with the concave recesses on the
inner circumference of an adjacent ring link in the articulating
joint. The spring segments define apertures for receiving the one
or more pull wires.
[0019] In a second aspect, the invention relates to a suturing
instrument having a handle that includes a control system. An
elongate shaft extends from the handle. The elongate shaft includes
a distal portion. At least a portion of the elongate shaft is
flexible. One or more pull wires extend from the handle into the
distal portion of the elongate shaft and are coupled to the control
system to a user (e.g., a surgeon) to actively control the flexible
portion of the elongate shaft. In this second aspect, the suturing
instrument further includes a suturing head that extends from a
distal end of the distal portion of the elongate shaft. The
suturing head includes a needle carrier channel, a need carrier
that is configured to releasably receive/hold the non-penetrating
tip of a needle, and a needle catch. The needle carrier is movably
disposed within the needle carrier channel.
[0020] In a third aspect, the invention relates to a suturing
instrument that includes a handle. An elongate shaft extends from
the handle. The elongate shaft includes a distal portion. At least
a portion of the elongate shaft is flexible. In this third aspect,
at least a portion of the elongate shaft further includes an
articulation structure. One or more pull wires extend from the
handle into the distal portion of the elongate shaft. The one or
more pull wires are used to control deflection of the articulated
portion of the elongate shaft. In this third aspect, the suturing
instrument further includes a suturing head that extends from a
distal end of the distal portion of the elongate shaft. The
suturing head includes a needle carrier channel, a need carrier
that is configured to releasably receive/hold the non-penetrating
tip of a needle, and a needle catch. The needle carrier is movably
disposed within the needle carrier channel.
[0021] The embodiments described herein are illustrative only and
not intended to be limiting. Instruments or other devices similar
or equivalent to those described herein can be used in the practice
or testing of the present invention.
BRIEF DESCRIPTION OF THE DRAWINGS
[0022] In the drawings, like structures are referred to by like
numerals throughout the several views. Note that the illustrations
in the figures are representative only, and are not drawn to scale,
the emphasis having instead been generally placed upon illustrating
the principles of the invention and the disclosed embodiments. In
the following description, various embodiments of the present
invention are described with reference to the following
drawings.
[0023] FIG. 1A depicts the general structure of a suturing
instrument according to the invention; FIG. 1B is a view of the
suturing instrument depicted in FIG. lA that shows the elongate
shaft and the suturing head deflected off of a longitudinal axis
extending along the suturing instrument.
[0024] FIG. 2 illustrates a suturing head for use in a suturing
instrument according to the invention.
[0025] FIG. 3 depicts an example of a needle for use in a suturing
instrument of the invention.
[0026] FIG. 4 depicts an example of a needle catch for use in a
suturing instrument according to the invention.
[0027] FIG. 5 depicts an example of a handle coupled to an elongate
shaft of a suturing instrument according to the invention, and
shows an example of an actuating mechanism that is disposed within
the handle and coupled to a needle deployment system that is
partially disposed within the elongate shaft.
[0028] FIG. 6 is a cross-sectional view of a distal portion of a
suturing instrument according to the invention depicting a needle
deployment system coupled to a needle carrier disposed within a
suturing head.
[0029] FIGS. 7A-7G depicts a suturing instrument having a flexible
distal portion, and the multiple different directions and/or planes
in which the distal portion can be bent or deflected.
[0030] FIG. 8 is an exploded view a handle of a suturing instrument
according to the invention, depicting the components of a control
system disposed within the handle.
[0031] FIG. 9 is an expanded view of a portion of the control
system depicted in FIG. 8.
[0032] FIG. 10 depicts an alternative embodiment of a handle
including a control system for use in a suturing instrument
according to the invention.
[0033] FIG. 11 depicts an alternate orientation of the handle
depicted in FIG. 10.
[0034] FIG. 12 is a cross-sectional view of the handle depicted in
FIG. 10, illustrating the components of a control system disposed
within the handle.
[0035] FIG. 13A is an alternate view of the handle depicted in FIG.
12; FIG. 13B is an expanded view of a portion of FIG. 12.
[0036] FIG. 14 depicts a link used to form an articulation
structure in accordance with an embodiment of the present
invention.
[0037] FIG. 15 depicts a schematic rendering of an articulation
structure formed by stacking a series of the links shown in FIG.
14.
[0038] FIG. 16 depicts an enlarged portion of the articulation
structure shown in FIG. 15.
[0039] FIG. 17 depicts a schematic rendering of the articulation
structure shown in FIG. 15 bent in an upward direction.
[0040] FIGS. 18A-18C illustrate alternative embodiments of an
articulation structure formed of a number of stacked discs in
accordance with another embodiment of the present invention.
DESCRIPTION
[0041] Embodiments of the invention are described below. It is,
however, expressly noted that the invention is not limited to these
embodiments, but rather the intention is that variations,
modifications and equivalents that are apparent to a person skilled
in the art are also included.
[0042] Suturing instruments having a shapeable elongate shaft, an
elongate shaft with a preformed bend and/or a passively deflectable
suturing head, have been described in U.S. Patent Application
Publication Nos. 2004/0181243, 2006/0041263, and 2008/0109015. The
present invention provides suturing instruments having flexible
elongate shafts that can be controllably deflected by a user (e.g.,
a surgeon) in a plurality of directions and/or planes, with
improved precision and maneuverability over previous designs. The
suturing instruments provide a minimally invasive tool that is
useful in endoscopic or laparoscopic procedures, particularly in
intra-abdominal, intra-vaginal, and rectal and procedures, which
typically involve difficult-to-reach areas within a body.
[0043] A flexible suturing instrument according to the invention is
used, for example, to access areas within a human body to ligate,
fixate, or approximate tissue. The suturing instrument generally
throws one or more stitches intracorporeally. FIG. 1A depicts the
general structure of a suturing instrument 100 according to an
illustrative embodiment of the invention. As shown in FIG. 1A,
suturing instrument 100 generally includes a handle 1, an elongate
shaft 2 extending from the handle 1 and including a distal portion
2a, and a suturing head 3 extending from a distal end 2b of the
distal portion 2a the elongate shaft 2. At least a portion of the
elongate shaft is adapted to be flexible such that it can be
deflected in one or more directions and/or planes relative to a
longitudinal axis extending along the elongate shaft. For example,
the distal portion 2a of the elongate shaft 2 is adapted to be
flexible such that it can be deflected off of a longitudinal axis A
extending along the suturing instrument (FIG. 1B). Alternatively,
the entire length of the elongate shaft 2 is adapted to be flexible
such that portions of the shaft can be deflected in one or more
directions and/or planes relative to the longitudinal axis A
extending along the suturing instrument.
[0044] One or more cables or pull wires extend from the handle 1
into the distal portion 2a of the elongate shaft 2 and are
configured for actively controlling deflection of the flexible
portion of elongate shaft 2 relative to a longitudinal axis
extending along the length of the elongate shaft 2. The one or more
cables or pull wires can extend from the handle 1, within the
elongate shaft 2, and into the distal portion 2a. Alternatively,
the one or more cables or pull wires can extend from handle, along
the outside of elongate shaft 2, and into the distal portion 2a. In
certain embodiments, the one or more pull wires terminate in the
distal portion of the shaft, but the wires can terminate elsewhere
such as in the suturing head 3.
[0045] In certain embodiments, at least a portion of elongate shaft
2 includes a flexible coil, such as a Bowden coil. For example, the
distal portion 2a of the elongate shaft can include a flexible
coil. Alternatively, the entire length of the elongate shaft 2 can
include a flexible coil. The flexible coil can be passively and/or
actively bent into one or more shapes. For example, the flexible
coil can passively conform to the shape of a bodily passage during
insertion into the passageway. The flexible coil instead can be
actively bent into a shape by a user's hand(s) prior to insertion
into a bodily passage or cavity, such that the shaft 2 retains that
shape during use. The flexible coil will be stiffer in embodiments
where physical manipulation of the coiled portion of the shaft 2
result in that portion of the shaft 2 retaining its modified shape
(such as an "S" shape). The stiffer the flexible coil, the harder
it is to bend, but the more it will resist changing from its bent
shape. The one or more pull wires extending from the handle 1 into
the distal portion 2a of the elongate shaft instead can be used to
actively control deflection of the flexible coil portion of the
shaft 2.
[0046] In alternative embodiments, at least a portion of the
elongate shaft 2 includes an articulation structure that forms an
articulated portion of the shaft 2 and allows the articulated
portion to be controllably deflected by the one or more pull wires
extending from the handle 1. For example, the distal portion 2a of
the elongate shaft can be articulated and thus controllably
deflected in one or more planes relative to the longitudinal axis
of the elongate shaft 2 using the one or more pull wires extending
from the handle 1 to the distal portion 2a of the shaft 2.
Alternatively, the entire length of the elongate shaft 2 can
include an articulation structure that enables the entire length of
the elongate shaft 2 to be actively and controllably deflected in
one or more planes relative to the longitudinal axis of the
elongate shaft 2 using the one or more pull wires. Examples of
articulation structures suitable for use with the suturing
instruments of the invention are described in detail below.
[0047] A flexible outer sleeve can be placed over the flexible coil
portion and/or the articulated portion of the elongate shaft to
provide a smooth exterior surface. The outer sleeve can be made
from soft, thin polyurethane, LLDPE, silicon, pellethane,
polyurethane, or other approved biocompatible materials such as
polyethylene, polypropylene or polyvinyl alcohol. Additionally, the
outer sleeve can be coated with a hydrophilic, lubricious coating
such as HYDROPASS.TM. hydrophilic coating available from Boston
Scientific Corporation, of Natick, Mass., and described in U.S.
Pat. Nos. 5,702,754 and 6,048,620, which are herein incorporated by
reference in their entireties. Additionally, the outer sleeve can
be coated with a drug agent to treat internal body tissues.
[0048] Turning now to the suturing head components of the suturing
instruments of the invention, an exemplary embodiment of the
suturing head 3 is depicted in FIG. 2. As shown in FIG. 2, suturing
head 3 defines an opening or needle exit port 4 through which a
needle carrier 5 advances a needle 6 that is releasably held within
needle carrier 5. Suturing head 3 includes a curved portion 7,
needle carrier 5, and a needle catch 8. The curved portion 7
defines a needle carrier channel 9, which ends at needle exit port
4. The curved portion 7 also defines an opening 10 for receiving
tissue. Needle carrier 5 is movably disposed within needle carrier
channel 9 in the curved portion 7 such that needle carrier 5 is
capable of moving out of the suturing head into an extended
position, and back into the suturing head into a retracted
position. A distal portion 11 of the needle carrier 5 defines a
lumen 12 dimensioned for holding/receiving the non-penetrating end
of the needle 6. Preferably, the needle carrier 5 is configured to
move out of suturing head 3 in a semi-circular path towards needle
catch 8, such that needle 6 is released from needle carrier 5 and
retained in needle catch 8. However, it should be noted that the
exact structure and operation of the suturing head 3 can vary based
on the type of head used.
[0049] Referring now to FIG. 3, the needle 6 includes a tissue
penetrating tip 13 and a shaft 14 coupled to the tip 13, thereby
forming shoulder 15. The shaft 14 is coupled to a suture 16. The
needle 6 is inserted into lumen 12 of needle carrier 5 and held by
a slight friction fit. Referring now to FIG. 4, needle catch 8
includes one or more openings 17 defined by successive ribs 18.
Needle catch 8 receives tip 13 of needle 6 (coupled to suture 16)
through opening 17, the ribs 18 deflect slightly to allow needle 6
to pass through. After the formed shoulder 15 of needle 6 has
passed ribs 18, the ribs 18 spring back to their original position
defining the openings 17 and needle 6 remains captured in needle
catch 8. It should be noted that the needle 6 and needle catch 8
shown are merely one possible type and other designs may be
selected.
[0050] Suturing instrument 100 further includes a needle deployment
system that is disposed in at least a portion of the elongate shaft
2 and coupled to needle carrier 5 for moving the needle carrier 5
between the extended and retracted positions. Various
configurations and components of needle deployment systems suitable
for use in the suturing instruments of the invention are described
in U.S. Pat. No. 5,713,910 to Gordon et al., U.S. Pat. No.
5,578,044 to Gordon et al., U.S. Pat. No. 5,575,800 to Gordon, U.S.
Pat. No. 5,540,704 to Gordon et al., U.S. Pat. No. 5,458,609 to
Gordon et al., and U.S. Pat. No. 5,364,408 to Gordon, all of which
are incorporated herein by reference in their entireties. In an
exemplary embodiment, the needle deployment system extends
longitudinally through the elongate member 2 to the suturing head 3
where a distal portion 19 of the needle deployment system is
coupled to needle carrier 5 within the suturing head 3 (FIG.
6).
[0051] The handle component 1 of suturing instrument 100 can
include an actuating mechanism 110 that is disposed within the
handle 1 and coupled to a proximal portion of the needle deployment
system for actuating the needle deployment system. In the
illustrative embodiment depicted in FIG. 5, the actuating mechanism
110 includes an actuator button 117 and a shaft 116 (together 112).
The actuating mechanism 110 is coupled to a bearing 118, a hole
121, a button end 119, and a wireform 103. The bearing 118 rides
along a surface 105 that is formed by the inside of the elongate
shaft 2. The wireform 103 is inserted into the hole 121, coupling
it to the actuator button 117. A spring 115 encircles the wireform
103, abuts the button end 119, and is compressed between the button
end 119 and a spring washer 113.
[0052] The distal portion 19 of the needle deployment system
depicted in FIG. 5 includes the spring washer 113, a center tube
107, a pusher wire 111, and a guidance sleeve 109. The spring
washer 113 is seated upon the center tube 107. The center tube 107
is housed by the surface 105 and is constrained in the distal
portion 106 of the suturing instrument 100. The pusher wire 111 is
attached to the wireform 103 by means of a weld, a crimp, a
coupling, adhesive, or other means, and is slideably disposed
within the guidance sleeve 109, the sleeve 109 being disposed
within a surface 123 formed by the inside diameter of the center
tube 107. In one embodiment, the pusher wire 111 is constructed of
a shape memory material, for example, a nickel titanium alloy such
as Nitinol.TM.. Preferably, the shape memory material is chosen for
its combination of properties that allow for bendability and high
column strength when constrained.
[0053] Referring now to the illustrative embodiment depicted in
FIG. 6, the distal portion of the suturing instrument 100 depicted
in FIGS. 1 and 5 includes the distal portion 2a of the elongate
shaft 2 and a distal portion of the needle deployment system 19
coupled to the needle carrier within suturing head 3. The distal
portion of the needle deployment system depicted in FIG. 6 includes
the pusher wire 111, a backstop washer 156, a pocket 160 that
includes a back wall 162, a coupling 150, a track 152, a downstop
washer 158, a pocket 164 that includes a wall 166, and a carrier
wire 154. The pusher wire 111 of the needle deployment system is
attached by welding or other means to the coupling 150, which is
slideably disposed within the track 152. The coupling 150 is
attached to the carrier wire 154, which by virtue of its attachment
to the coupling 150 is also slideably disposed within the track
152. The carrier wire 154 is mechanically coupled to the extendable
needle carrier 5 by means of a weld, a coupling, adhesives, or
other means. The coupling 150 abuts the backstop washer 156 that is
slideably disposed about the pusher wire 111 and is contained
within the pocket 160 that includes the back wall 162, against
which the backstop washer 156 rests. The track 152 terminates
distally in the pocket 164 that includes the wall 166. The downstop
washer 158 is slideably disposed about the carrier wire 154 and
constrained within the pocket 164.
[0054] Referring again to the handle component of the suturing
instruments of the invention, handle 1 of the suturing instrument
100 can further include a control system coupled to the one or more
pull wires for actively controlling deflection of the flexible
portion of the elongate shaft. Various configurations of handles
that include a control system coupled to one or more pull wires for
controllably deflecting an elongate shaft of an endoscopic medical
device, or a portion thereof, are described in U.S. Patent
Application Publication No. 2008/0300462 and 2010/0121147, the
contents of which are incorporated herein by reference in their
entireties.
[0055] One illustrative embodiment of a handle configuration that
includes a control system and is suitable for use in the suturing
instruments of the invention is depicted in FIG. 8 and FIG. 9. As
shown in FIGS. 8 and 9, the handle 1 includes a control system 22
to actively control the deflection of the distal portion 2a of the
elongate shaft 2. In the illustrated embodiment, the control system
22 comprises two activation hubs (rotatable cams) 24, 26, and four
pull wires 28, 30, 32, 34. Each activation hub 24, 26 is connected
to two of the pull wires and allows the user (e.g., a surgeon) to
manipulate the distal portion 2a of the elongate shaft 2 in one
plane of deflection. Additional activation hubs and/or pull wires
could be included in the control system 22 depending on how many
planes of deflection are desired. The pull wires 28, 30, 32, 34 are
made from stainless steel, polymer filaments, or other metals and
alloys such as, for example, Nitinol.TM..
[0056] The first activation hub 24 is movably attached to the right
side of the handle 20 from the perspective of the user and includes
a floating cam 36 and a cam stop 38. The proximal ends of pull
wires 30 and 34 are connected to the floating cam 36. When the user
rotates the first activation hub 24 in a clockwise direction, as
indicated by line A on FIG. 9, tension is applied to pull wire 34,
and tension is released from pull wire 30, thereby deflecting the
distal portion 2a of the elongate shaft 2 to the left. Conversely,
when the user rotates the first activation hub 24 in the opposite,
counter-clockwise direction, tension is applied to pull wire 30 and
tension is released from pull wire 34, thereby deflecting the
distal portion 2a to the right.
[0057] The user can achieve up and down deflection of the distal
portion 2a of elongate shaft 2 by rotating the second activation
hub 26 in a similar manner. The second activation hub 26 is movably
attached to the left side of the handle 1 from the perspective of
the user and includes a floating cam 40 and a cam stop (not shown).
The proximal ends of pull wires 28 and 32 are connected to floating
cam 40. When the user rotates the second activation hub 26 in a
clockwise direction as indicated by line B on FIG. 9, tension is
applied to pull wire 28, and tension is released from pull wire 32,
thereby deflecting the distal portion 2a in an upward direction.
Conversely, when the user rotates the second activation hub 26 in
the opposite, counter-clockwise direction, tension is applied to
pull wire 32 and tension is released from pull wire 28, thereby
deflecting the distal portion 2a in a downward direction. The
control system 22 could comprise additional components or
alternative means for achieving defection of the distal portion 2a
of the elongate shaft 2.
[0058] The handle/control system can be used to deflect the
flexible portion of the elongate shaft in one or more directions
and/or planes relative to a longitudinal axis extending along the
shaft. The control system can also be used to simultaneously
deflect two or more portions of the elongate shaft in different
planes relative to the longitudinal axis. For example, the control
system can be used to deflect the distal portion 2a of the elongate
shaft 2 into two or more different planes relative to the
longitudinal axis, as shown in FIGS. 7A-7G.
[0059] Another illustrative embodiment of a handle configuration
that includes a control system and is suitable for use in the
suturing instruments of the invention is shown in FIGS. 10-13. In
FIG. 10, the handle 1 includes an elongate housing 312, which
includes a proximal end portion 314 and a distal end portion 316
and control system 310 disposed within the elongate housing 312.
The elongate housing 312 further includes a first grip portion 318
and a second grip portion 320 different than the first grip
portion. Each of the first grip portion 318 and second grip portion
320 is adapted to be held or grasped by a hand of a user. The
elongate housing 312 (and control system 310) is couplable to the
elongate shaft 2.
[0060] The elongate housing 312 is adapted to be in a first
orientation when the first grip portion 318 is operatively held by
the hand of the user. For example, as illustrated in FIG. 11, when
the user holds the elongate housing 312 of the steering mechanism
310 by the first grip portion 318, the elongate housing is in a
substantially horizontal orientation. The user (e.g., a surgeon)
can operate the steering button 322 with a single finger of the
hand holding the first grip portion 318.
[0061] As shown in FIG. 12 and FIG. 13, control system 310 includes
the steering button 322, a first cam 330, a second cam 350, and
first, second, third, and fourth wires 332, 334, 352, 354.
[0062] The first cam 330 moves in response to movement of the
steering button 322. The first cam 330 is adapted to move the
flexible portion of the elongate shaft 2 along the first plane when
the first cam moves in response to movement of the steering button
322. As illustrated in FIG. 12, the first cam 330 is at least
partially disposed in the cavity 324 of the elongate housing 312.
The first cam 330 is coupled to the elongate housing 312 by a frame
336. The frame 336 is coupled to an inner surface of the elongate
housing 312 defining the cavity 324. In the embodiment illustrated
in FIG. 12 and FIG. 13, the frame 336 includes a first supporting
arm 342, a second supporting arm 344, and a central arm 346. The
first supporting arm 342 and second supporting arm 344 are each
coupled to the elongate housing 312. The central arm 346 extends
between and is coupled to the first and second supporting arms 342,
344.
[0063] In the embodiment illustrated in FIG. 13A, the central arm
346 defines an opening or pocket adapted to receive a portion of
the first cam 330. The first cam 330 is coupled to the central arm
346. The first cam 330 can be coupled to the central arm 346 by any
known coupling mechanism, including, but not limited to, a pin or
other mechanical fastener.
[0064] The first cam 330 is movable with respect to the frame 336.
The first cam 330 is movable between at least a first position
(illustrated in FIG. 12), a second position different than the
first position, and optionally a third position different from the
first and second positions.
[0065] The first cam 330 is coupled to the steering button 322. In
some embodiments, as illustrated in FIG. 12 and FIG. 13, the first
cam 330 is fixedly coupled to the stem 326 of the steering button
322.
[0066] The first cam 330 is coupled to each of the first wire 332
and the second wire 334. As illustrated in FIG. 12 and FIG. 13, the
first and second wires 332, 334 are coupled to the first cam 330 at
spaced locations. The first wire 332 can be coupled to the first
cam 330 proximate to the steering button 322. In the embodiment
illustrated in FIG. 12, the second wire 334 is coupled to a portion
of the first cam 330 different than the portion of the cam coupled
to the first wire 332. The first wire 332 and the second wire 334
are each adapted to move in response to movement of the first cam
330. Additionally, the first and second wires 332, 334 are each
coupled to the elongate member 302 of the suturing instrument 100.
Thus, movement of the first and second wires 332, 334 moves the
elongate shaft 2.
[0067] Referring again to FIG. 12, as the steering button 322 is
moved in its first direction along a first axis (as indicated by
arrow A.sub.1), the first cam 330 correspondingly moves to a second
position different than its first position. As the first cam 330
moves towards its second position, the first cam moves (or pulls
on) the first wire 332. The first wire 332 moves the flexible
portion of the elongate shaft 2 in its first direction along the
first plane (e.g., "up").
[0068] To return the elongate shaft 2 to its starting position (or
the linear or relaxed position), the steering button 322 is moved
in its second direction until the first cam 330 is moved (or
returned) to its first position. In some embodiments, at least one
of the steering button 322 and the first cam 330 is biased towards
a first (or starting) position.
[0069] The handle/control systems depicted in FIGS. 8-13 are
provided for illustrative purposes only and are not intended to be
limiting. The handle/control system component of the suturing
instruments of the invention may also include levers, knobs,
robotics, a joystick, or other control features, all of which would
be known to those knowledgeable about medical devices
[0070] Now referring back to the elongate shaft 2, in certain
embodiments, at least a portion of the elongate shaft 2 includes an
articulation structure that provides flexibility to the articulated
portion of the elongate shaft. For example, the distal portion 2a
of the elongate shaft 2 can include an articulation structure.
Alternatively, the entire elongate shaft 2 can include an
articulation structure. The articulation structure can be used in
conjunction with a flexible coil to provide a suturing instrument
having increased flexibility and controlled maneuverability. The
articulation structure can also be used as the sole means of
providing flexibility to at least a portion of the elongate shaft.
The articulation structure is coupled to the one or more pull wires
for controllably deflecting the flexible and/or articulated portion
of the elongate shaft 2. Various articulation structures that are
suitable for use in the suturing devices of the invention are
described in U.S. Pat. No. 7,591,783 and U.S. Patent Application
Publication No. 2008/0287741, each of which is incorporated herein
by reference in its entirety.
[0071] One embodiment of an articulation structure 200 according to
the present invention is made of a series of stacked links 212 that
are positioned adjacent to one another, defining an inner lumen 214
and movable with respect to each other. Referring now to FIG. 14, a
link 212 according to one embodiment of the present invention
includes a front face 216 and a rear face 218. Each link may be
deep drawn, rolled and welded, stamped, injection molded, or
otherwise formed of stainless-steel or other biocompatible material
that allows the link 212 to be rigid while having a thin wall
profile in order to maximize the size of the inner lumen 214.
[0072] The front face 216 of the link 212 includes a pair of
oppositely arranged engagement surfaces that bisect the link 212
and define a pair of pivot points 220 that engage the corresponding
rear face 218 of an adjacent link 212. The pivot points 220 are
rounded over forming substantially cylindrical surfaces that serve
as bearings. The front face 216 of the link 212 further includes
two tapered sections 222 that are angled proximally away from the
pivot point 220. The two tapered sections 222 are oriented at an
angle of A.degree. with respect to the longitudinal axis 224 of the
link 212. The terms proximal and distal require a point of
reference. In this application, the point of reference is the
perspective of the user. Therefore, the term proximal will always
refer to an area closest to the user, whereas distal will always
refer to an area away from the user.
[0073] Similarly, the rear face 218 of the link 212 includes two
sloped sections 226 that are angled distally away from a relatively
flat surface 228 of the rear face 218 forming a wedge shaped recess
230 with a vertex 232 for receiving the pivot points 220 of the
adjacent link 212. As with the tapered sections 222 at the front
face 216 of the link, the sloped sections 226 of the rear face 218
are oriented at an angle of B.degree. with respect to the
longitudinal axis 224. Additionally, the vertex 232 is rounded to
form a substantially cylindrical surface to engage the rounded over
surface of the pivot points 220.
[0074] A plurality of wire channels 234, 236, 238, 240, are
integrally formed in the link 212 itself or otherwise disposed on
the inner surface 242 of the link 212. The wire channels are
radially spaced at predetermined distances around the circumference
of the link 212. As shown in FIG. 14, channels 236 and 240 are
positioned at the pivot points 220, while channels 234 and 238 are
rotated 90.degree. with respect to channels 236 and 240.
[0075] Referring now to FIGS. 15-17, the articulation structure 200
is created by stacking a number of links 212a, 212b, 212c, etc.,
such that that the pivot points 220 of each link 212 are aligned
with the vertex 232 of the adjacent link 212. Locking pull-wires
246 and 250 disposed in wire channels 236 and 240 provide tension
to hold adjacent links 212a, 212b, 212c, etc., together while the
one or more pull-wires designated in FIGS. 15-17 as 244 and 248 are
components of the control system for bending the articulation
structure in the desired direction.
[0076] Pull wires 244 and 248 can be coupled to the control system
disposed within or on handle, such as the control system 22
illustrated in FIGS. 8 and 9.
[0077] The proximal ends of pull-wires 244 and 248 can be connected
to the rotatable cam in the control system 22 and the distal ends
of the pull-wires 244 and 248 are connected to the distal end 254
of the articulation structure 200 (FIG. 16). As shown in FIG. 17,
when the user rotates the rotatable cam in control system 22 in the
clockwise direction as indicated by line C on, tension is applied
to pull-wire 244, and tension is released from pull-wire 248,
thereby deflecting the distal end 254 of the articulation structure
in an upward direction. Conversely, when the user rotates the
control cam 252 in a counter-clockwise direction, tension is
applied to pull-wire 248 and released from pull-wire 244, thereby
deflecting the distal end 254 in a downward direction.
[0078] The deflection capability of the articulation structure 200
is a function of the difference between angles A and B and the
number of links N, which can be represented by the formula:
deflection angle=(A-B)/2.times.(N-1). For example, in the
embodiment shown in FIG. 15, if angle A is 140.degree., angle B is
100.degree., and there are 11 links including the first and last
link the deflection would be 200.degree.. The radius of deflection
is a function of the angle difference and the length of the link
(i.e., shorter links will produce a smaller bend radius).
[0079] Other illustrative embodiments of an articulation structure
1000 for use in the suturing devices of the invention are depicted
in FIGS. 18A-18C. Referring now to FIG. 18A, the articulation
structure 1000 is made of a series of stacked rings 1002a, 1002b,
1002c, etc. Each ring is preferably formed of a deep-drawn steel or
other metal that allows the ring to be stiff while having a thin
wall profile in order to maximize the size of the inner lumen.
Positioned at equal intervals around the outer circumference of the
ring are inwardly extending concave recesses 1004 that receive
short spring sections 1006 that are used to join adjacent rings
together. Two springs on opposite sides of a ring 1002 are used to
join adjacent rings together. For example, if three rings 1002a,
1002b, and 1002c are aligned, the rings 1002a and 1002b are joined
together with spring segments located at 0.degree. and 180.degree.
on the rings, while ring 1002b is joined to ring 1002c with
orthogonally aligned spring segments located at 90.degree. and
270.degree. around the rings. A gap is formed between adjacent
rings so that the pair of springs forms a flexible joint that can
bend in directions that are the away from the longitudinal axis of
the articulation structure but has limited ability to compress the
articulation structure in the direction of the longitudinal axis of
the articulation structure. Each spring 1006 is secured within the
concave recess 1004 of the ring 1002 using an adhesive, crimping,
welding, or with other securing mechanism.
[0080] In the embodiment depicted in FIG. 18A, one or more pull
wires pass through the center of the spring segments and/or on the
outer circumference of the articulation structure. The one or more
pull wires are coupled to a control system disposed within or on
handle 1 (e.g., the control system 22 depicted in FIGS. 8 and 9, or
control system 310 depicted in FIGS. 10-13). As such, the
articulation structure can be controllably deflected by the pull
wires coupled to the control system.
[0081] FIG. 18B illustrates an alternative embodiment of the
articulation structure shown in FIG. 18A. In this embodiment, the
articulation structure comprises a number of deep drawn or
otherwise formed metal rings 1008a, 1008b, 1008c that are joined
together with springs that are located on the inner circumference
of each ring. Each ring is connected to an adjacent ring with a
pair of spring segments located on opposite sides of the ring. The
springs 1010 are secured to the inner circumference of the rings
1008 with an adhesive or by welding, or using other securing means.
In the embodiment shown in FIG. 18B, the one or more pull wires are
routed through the spring segments and are more closely positioned
to the longitudinal axis of the articulation structure. Being
closer to the longitudinal axis may require more force on a pull
wire to bend the articulation structure in a desired direction.
[0082] FIG. 18C shows another embodiment of an articulation joint
that is similar to the articulation joint shown in FIG. 18B.
However, in this embodiment, the articulation joint is comprised of
a number of rings 1022a, 1022b, 1022c having oppositely arranged
concave recesses 1024 and convex recesses that allow a spring 1015
having alternate tightly and loosely wound segments to pass on the
outside of one ring and on the inside of an adjacent ring in an
alternating fashion. The oppositely arranged convex and concave
recesses allow a spring to be secured to the ring with an adhesive,
welding, or other bonding mechanism.
[0083] Although the discs of the articulation structures described
herein are generally circular in shape, it will be appreciated that
other shapes could be used.
[0084] The embodiments of flexible and/or articulated suturing
instruments described herein are provided for illustrative purposes
only and are not intended to be limited. Additional deflection
sections and/or pull-wires could be included in the elongate shaft
of the suturing instrument and/or the control system, depending on
how many planes of deflection are desired.
[0085] The suturing instrument's component materials should be
biocompatible. For example, the handle 1, the elongate shaft 2, and
portions of the suturing head 3 and needle deployment system, or
portions thereof, may be fabricated from extruded, molded, or
machined plastic material(s), such as polypropylene, polycarbonate,
or glass-filled polycarbonate. Other components, for example the
needle 6, may be made of stainless steel. Preferably, the
pull-wires are made from stainless steel, polymer filaments, strong
textile or synthetic material such as Kevlar.RTM. or nylon, or
other metals and alloys such as, for example, Nitinol.TM., which is
a nickel-titanium alloy. Other suitable materials will be apparent
to those skilled in the art. The material(s) used to form the
suture should be biocompatible. The surgeon will select the length,
diameter, and characteristics of the suture to suit a particular
application. Additionally, the mechanical components and operation
are similar in nature to those disclosed in U.S. Pat. Nos.
5,364,408, 5,575,800, 6,048,351, and 6,346,111, and commonly owned
U.S. application Ser. No. 10/210,984 (published as U.S. Patent
Application Publication No. 2004/0034372), each of which is
incorporated by reference herein in its entirety.
[0086] Certain embodiments according to the invention have been
disclosed. These embodiments are illustrative of, and not limiting
on, the invention. Other embodiments, as well as various
modifications and combinations of the disclosed embodiments, are
possible and within the scope of the disclosure.
* * * * *