U.S. patent application number 15/450206 was filed with the patent office on 2017-06-22 for suture passing devices and methods.
The applicant listed for this patent is Scott Heneveld. Invention is credited to Scott Heneveld.
Application Number | 20170172565 15/450206 |
Document ID | / |
Family ID | 46798535 |
Filed Date | 2017-06-22 |
United States Patent
Application |
20170172565 |
Kind Code |
A1 |
Heneveld; Scott |
June 22, 2017 |
Suture Passing Devices and Methods
Abstract
A suture passing device includes a notchless tubular needle
having a preformed curved shape. One or more cleats are disposed
within the needle to help secure suture engaged by the sharp distal
tip of the needle and to prevent further bifurcation of the suture.
The deformable needle is housed in a channel of a lower jaw having
a curved guidepath that approximates the curved geometry of the
preformed needle, thereby facilitating the consistent return of the
needle to its preformed shape each time the needle exits the
channel. A dual needle suture passing device is also provided
having a second notchless needle to enable a mattress stitch.
Methods of loading a suture onto a notchless needle in a suture
passer are also provided.
Inventors: |
Heneveld; Scott; (Whitmore,
CA) |
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Applicant: |
Name |
City |
State |
Country |
Type |
Heneveld; Scott |
Whitmore |
CA |
US |
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|
Family ID: |
46798535 |
Appl. No.: |
15/450206 |
Filed: |
March 6, 2017 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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14120243 |
May 8, 2014 |
9610075 |
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15450206 |
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PCT/US2012/027782 |
Mar 5, 2012 |
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14120243 |
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61464578 |
Mar 7, 2011 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 2017/0608 20130101;
A61B 2017/06095 20130101; A61B 17/0483 20130101; A61B 17/0482
20130101; A61B 2017/061 20130101; A61B 17/06004 20130101; A61B
17/0469 20130101; A61B 2017/06052 20130101; A61B 2017/00867
20130101; A61B 2017/0472 20130101; A61B 17/06066 20130101; A61B
2017/06042 20130101; A61B 2017/00367 20130101 |
International
Class: |
A61B 17/04 20060101
A61B017/04; A61B 17/06 20060101 A61B017/06 |
Claims
1. A suture passing device, comprising: a suture, a deformable
needle comprising; a notchless needle shaft member having a tissue
piercing end distal to an elongate shaped section, the shaped
section having a curvilinear shape, the shaped section being
elastically deformable into a strained state and upon release to an
unstrained state assumes the curvilinear shape, the needle shaft
member comprising a sharp distal tip configured to engage the
suture; at least one cleat member inhibiting bifurcation of the
suture engaged by the sharp distal tip of the needle; a first jaw
defining an axis and including a channel housing the notchless
needle when retracted; and a second jaw movable with respect to the
first jaw for holding tissue to be sutured.
2. The device of claim 1, wherein the notchless needle shaft member
is tubular.
3. The device of claim 1, wherein: the non-straight needle geometry
comprises a first curved shape; the channel comprises a curved
channel geometry approximating the first curved shape.
4. The device of claim 1, wherein the second jaw defines an
aperture through which suture may be passed, the device further
comprising: a pawl coupled to the second jaw, the pawl defining a
window and being movable with respect to the second jaw such that
the window is movable between a first position in which the window
substantially overlaps the aperture and a second position in which
the window does not substantially overlap the aperture, thereby
causing suture to be pinched between window and aperture.
5. The device of claim 1, wherein the notchless needle comprises a
first notchless needle, the device further comprising: a second
notchless needle disposed adjacent to the first notchless
needle.
6. The device of claim 5, further comprising: an actuator
operatively coupled to each of the first and second notchless
needles; and a toggle mechanism to switch the actuator between the
first and second notchless needles.
7. A suture passing device, comprising: a deformable notchless
needle having a memory shape comprising a curved needle geometry
when fully exposed, the needle comprising a tube defining a distal
opening; a cleat disposed within the needle and configured to
protrude out from the distal opening; a first jaw defining an axis
and including a channel having a curved channel geometry that
approximates the needle geometry, the channel housing the
deformable needle when retracted and providing an exit of the
deformable needle to facilitate the needle returning to its memory
shape upon exit; and a second jaw defining an aperture through
which suture may be passed, the second jaw being movable with
respect to the first jaw for holding tissue to be sutured.
8. The device of claim 7, wherein the cleat comprises a first
cleat, the device further comprising a second cleat disposed within
the needle and configured to protrude out from the distal
opening.
9. The device of claim 7, further comprising: a pawl coupled to the
second jaw, the pawl defining a window and being movable with
respect to the second jaw such that the window is movable between a
first position in which the window substantially overlaps the
aperture and a second position in which the window does not
substantially overlap the aperture, thereby causing suture to be
pinched between window and aperture.
10. The device of claim 7, wherein the second jaw is configured to
pivot with respect to the first jaw so as to remain substantially
parallel to the first jaw when the second jaw is moved away from
the first jaw.
11. The device of claim 7, wherein the notchless needle comprises a
first notchless needle, the device further comprising: a second
notchless needle disposed adjacent to the first notchless needle.
Description
RELATED APPLICATIONS
[0001] This application relates to, claims priority from, and
incorporates herein by reference, as if fully set forth, U.S.
Provisional Patent Application Ser. No. 61/464,578 filed on Mar. 7,
2011 and entitled "METHOD AND APPARATUS FOR PASSING SUTURE THROUGH
SOFT TISSUE."
BACKGROUND OF THE INVENTION
[0002] 1. Field of the Invention
[0003] The present invention relates to system, methods, and
apparatus for enhancing the advancement and retention of suture
through tissue.
[0004] 2. Description of Prior Art and Related Information
[0005] Suturing apparatus in the past have had an elongate shaft
and a low profile distal clamping mechanism to facilitate their use
through cannulas in less invasive surgery. These devices have
typically included opposing jaws which clamp onto the tissue to be
sutured. The end segment of the suture is pre-positioned and
secured at the distal end of one jaw member. Beyond the clamping
motion, the mechanism for passing a suture between the jaws and
through the tissue incorporates a bendable flat needle. The
bendable needle advances distally within the jaw member, bringing
it in contact with a segment of the suture. The needle has a notch
which engages and secures the suture to carry it forward. This
distal advancement of the bendable needle also results in the
leading end of the needle to approach and engage a ramp in the jaw
member, deflecting the bendable needle in a direction toward the
opposing jaw. The bending of the needle requires a high force and
results in excess strain on the notched needle component. Fracture
and failure of the bendable needle is a concern. Additionally,
capturing suture reliably after being passed through the tissue is
also a feature not currently offered by the existing technologies.
The ability to throw a horizontal mattress stitch with the desired
stitch width without having to remove and reload the instrument is
currently an unmet need. Another area of improvement is the need to
clamp onto thick tissue and reliably pass suture.
SUMMARY OF THE INVENTION
[0006] In accordance with the present invention, structures and
associated methods are disclosed which address these needs and
overcome the deficiencies of the prior art. The following
description includes an example of the methods and devices within
the scope of this disclosure. It is also contemplated that
combinations of aspects of various embodiments as well as the
combination of the various embodiments themselves is within the
scope of this disclosure.
[0007] In one aspect, a suturing device, or apparatus, comprises of
a distal tip and jaw, movable with respect to each other, a
bendable, tubular needle housed in distal tip and adapted to carry
a suture, and a suture receiver disposed on the opposing jaw. The
device includes a suture driving assembly for positioning a suture
in a tissue section, the assembly comprising at least one needle
assembly having a tissue piercing end distal to an elongate shaped
section, the elongate shaped section having a curvilinear shape,
the elongate shaped section being elastically deformable when
restrained into a strained state and upon release assumes the
curvilinear shape, the suture coupled to the needle assembly; a
shaft having a tip with a tissue engaging surface at a distal end,
at least one constraining channel and a pivoting jaw with at least
one retrieving channel, each of which having an opening at the
tissue engaging surface; such that when the elongate shaped section
of the needle assembly is in the restraining portion, the elongate
shaped section is deformed into the strained state and when the
elongate shaped section advances through the guide segment portion,
the elongate shaped section assumes the curvilinear shape, upon
continued advancement the elongated shaped section exits through
the opening of constraining channel in the curvilinear shape; a
suture retriever assembly located in the pivoting jaw.
[0008] The needle assembly as well as the number of needle
assemblies can vary depending upon the type of suture stitch
required. For example, the device can include a single needle
assembly having a single shaped section or multiple shaped
sections. In alternate variations, the assembly comprises two or
more needle assemblies; the needle assemblies as well as the shaped
portions used in any particular suture driving mechanism need not
have the same shape. Instead, a single suture driving assembly can
use needle assemblies of differing shapes at the same time;
however, the spacing and relation of the constraining channel and
the retrieval channel shall be adjusted to accommodate a particular
shape and configuration of a particular needle assembly.
[0009] The suture devices and methods described herein can include
a needle assembly comprising a needle lumen extending through at
least the tissue piercing end and where the suture is removably
positioned on the distal end of the needle; in another variation, a
single suture can be affixed at both ends to a pair of needle
assemblies where the needle assemblies comprise two shaped sections
with each having a tissue piercing end.
[0010] Sutures used in the present devices and methods can be front
loaded into a needle assembly; as a result, a suture retriever
assembly can remove the suture from the needle assembly via a front
portion of the needle assembly; in one example, the suture
retriever assembly comprises at least one pawl member that reduces
an opening of the retrieving channel to less than a size of the
needle assembly and suture, where the pawl member in a first
position allows the needle assembly and suture to move in a first
direction and prohibits suture movement in a second direction.
[0011] The devices described herein can be combined with various
other medical implements to aid in the suturing of tissue.
[0012] In another variation, a suture driving assembly for placing
suture in a tissue section can include a first needle assembly
having a tissue piercing end distal and being elastically
deformable when restrained into a strained state and upon release
assumes the curvilinear shape; a suture exterior to the needle
assembly and having at least one end front-loaded onto the distal
end of a needle of a first tissue piercing portion of the first
needle assembly; a cleat is supported in the needle lumen and
extends from the distal end of the needle lumen to engage the
suture, thus preventing the bifurcation of the suture from sliding
down the shaft of the needle; a shaft having a tissue engaging
surface at a distal end, at least one constraining channel, and a
pivoting jaw with at least one retrieving channel, each of which
having an opening at the tissue engaging surface; where the
constraining channel extends through the shaft tip and comprises at
least a restraining portion having a profile to maintain the needle
assembly into the strained state and a guide segment portion
adjacent to the constraining channel opening and having a profile
to release needle assembly into the curvilinear shape when advanced
there through and upon continued advancement the needle assembly
exits the opening of the constraining channel in the curvilinear
shape; a suture retriever assembly located in the needle retrieving
channel and comprising a pawl mechanism, where the pawl mechanism
interferes with the front loaded suture and needle assembly when
advanced therein, where rearward movement of the front loaded
suture and needle assembly causes the pawl to engage the suture to
retain the suture within the needle retrieving channel.
[0013] In another variation, the method may further include
advancing a plurality of needle assembly pairs, where each needle
assembly pair is coupled to an end of a suture and where each
needle assembly advances from a respective constraining channel
into a respective guide segment, where the guide segment permits
the shaped section of the respective needle assembly located
therein to revert to the curvilinear shape prior to leaving the
respective guide segment and enter the wall of the organ; and where
the plurality of needle assemblies move through the curvilinear
shape so that the tissue piercing distal end of each needle
assembly pair re-enter the main body at a respective retrieving
channel.
[0014] As described above, the method optionally includes the use
of front-loaded sutures. Such sutures allow for securing the suture
in the retrieving channel by advancing the needle assembly and
suture against a pawl mechanism such that the pawl mechanism
compresses the suture to retain the suture while allowing the
needle assembly to be withdrawn back into the constraining
channel
[0015] In certain variations, the suture driving assembly can be
used to drive a needle without any suture. In such a case, the
needle may be left within the tissue (to be removed later, to be
absorbed by the native tissue, or for permanent placement.)
Accordingly, needle driving assemblies having the same or similar
structures disclosed herein are within the scope of this
disclosure.
BRIEF DESCRIPTION OF THE DRAWINGS
[0016] Further features and advantages will become apparent from
the following and more particular description of the preferred
embodiments of the invention, as illustrated in the accompanying
drawings, and in which like referenced characters generally refer
to the same parts or elements throughout the views, arid in
which:
[0017] FIGS. 1A-C. show side views of a preferred embodiment of a
suture passing device in various stages of deployment.
[0018] FIG. 2A. is a side view of a preferred notchless tubular
needle having a preformed memory shape.
[0019] FIG. 2B. is a side view of a preformed tubular needle in a
sheathed, constrained state.
[0020] FIG. 3A. is a side view of the preferred device's tip and
suture prior to loading.
[0021] FIG. 3B. is a perspective view of the tip with slot formed
in a lower jaw.
[0022] FIG. 3C. is a perspective view of the tip, tubular needle,
and suture.
[0023] FIG. 4A. is a perspective view of the tip, tubular needle,
cleat, and suture.
[0024] FIG. 4B. is a perspective view of the device's tubular
needle and prong cleat.
[0025] FIG. 4C. is a perspective view of the device's prong
cleat.
[0026] FIG. 5A. is a perspective view of the device's tubular
needle and lateral post cleat.
[0027] FIG. 5B. is a perspective view of the device's lateral post
cleat.
[0028] FIG. 5C. is a perspective view of the device's tip, tubular
needle, cleat, and suture.
[0029] FIG. 6A. is a partial side view of the tubular needle
extended to carry the suture through the aperture of the jaw and
pawl.
[0030] FIG. 6B. is a perspective view of the tubular needle
extended to carry the suture through the aperture of the jaw and
pawl.
[0031] FIG. 6C. is a perspective view of the suture captured by the
pawl.
[0032] FIG. 6D. is a side view of the suture captured by the
pawl.
[0033] FIG. 7A. is a perspective view of a preferred embodiment
having two tubular needles and jaw.
[0034] FIG. 7B. is a perspective view of the left tubular needle
extended in the jaw.
[0035] FIG. 7C. is a side view of the device's hand grip, toggle
switch and needle assemblies.
[0036] FIG. 7D. is a perspective view of the right tubular needle
extended in the jaw.
[0037] FIG. 8A. is a side view of tip with slot and floating pivot
in the collapsed state.
[0038] FIG. 8B. is a perspective view mechanism for the floating
pivot.
[0039] FIG. 8C. is a side view of tip with slot and floating pivot
in the expanded state.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
[0040] Before describing the present invention in detail, it is to
be understood that this invention is not limited to particularly
exemplified apparatus, systems, structures or methods as such may,
of course, vary. Thus, although a number of apparatus, systems and
methods similar or equivalent to those described herein can be used
in the practice of the present invention, the preferred apparatus,
systems, structures and methods are described herein,
[0041] It is also to be understood that the terminology used herein
is for the purpose of describing particular embodiments of the
invention only and is not intended to be limiting.
[0042] Unless defined otherwise, all technical arid scientific
terms used herein have the same meaning as commonly understood by
one having ordinary skill in the art to which the invention
pertains.
[0043] Further, all publications, patents and patent applications
cited herein, whether supra or infra, are hereby incorporated by
reference in their entirety.
[0044] As used in this specification and the appended claims, the
singular forms "a, "an" and "the" include plural referents unless
the content clearly dictates otherwise. Thus, for example,
reference to "an active" includes two or more such actives and the
like.
[0045] Further, ranges can be expressed herein as from "about" one
particular value, and/or to "about" another particular value. When
such a range is expressed, another embodiment includes from the one
particular value and/or to the other particular value. Similarly,
when values are expressed as approximations, by use of the
antecedent "about," it will be understood that the particular value
forms another embodiment. It will be further understood that the
endpoints of each of the ranges are significant both in relation to
the other endpoint, and independently of the other endpoint.
[0046] It is also understood that there are a number of values
disclosed herein, and that each value is also herein disclosed as
"approximately" that particular value in addition to the value
itself. For example, if the value "10" is disclosed, then
"approximately 10" is also disclosed. It is also understood that
when a value is disclosed that "less than or equal to" the value,
"greater than or equal to the value" and possible ranges between
values are also disclosed, as appropriately understood by the
skilled artisan. For example, if the value "10" is disclosed then
"less than or equal to 10", as well as "greater than or equal to
10" is also disclosed.
[0047] In the following detailed description, reference is made to
various specific embodiments in which the invention may be
practiced. These embodiments are described with sufficient detail
to enable those skilled in the art to practice the invention, and
it is to be understood that other embodiments may be employed, and
that structural and logical changes may be made without departing
from the spirit or scope of the present invention.
[0048] The present invention relates generally to systems and
methods for the driving of a needle or suture through or into body
tissue (typically, the needle will be affixed to a suture that
remains in the tissue) using a cannula, introducer or other
minimally invasive means. The methods and devices described herein
can be used in any number of medical procedures, including but not
limited to, approximating tissue (e.g., bring separated tissue
together), ligating tissue (e.g., encircling or tying off), and
fixating of tissue (attaching tissue to another structure or
different tissue).
[0049] The term "endoscopy" encompasses arthroscopy, laparoscopy,
hysteroscopy, among others, and endoscopic surgery involves the
performance of surgical procedures within a patient's body through
small openings as opposed to conventional open surgery through
large incisions.
[0050] Both open and endoscopic surgical procedures often require
sutures to ligate, join or otherwise treat tissue. Generally,
suture needles with attached suture strands are grasped either
manually or by forceps and passed through the desired work site so
a knot can be tied. While the procedures are fairly uncomplicated
in open surgery where most suture sites are readily accessible, in
endoscopic procedures, where access to the work site is not readily
available, the surgeon must use auxiliary devices to be able to
grasp the suture strands and pass them through desired tissue.
[0051] Referring now to the images where like elements are
represented by like reference numerals. FIG. 1A illustrates a
suture passing device, or instrument, of the present invention
having an elongated tubular body 10, a hand grip 20, a tip 30, a
jaw 40, an actuator 50 and a needle assembly 60. With actuator 50,
a surgeon may seize and maintain tissue by movement of jaw 40
against tip 30 as shown in FIG. 1B. Using actuator 50, a surgeon
may also deploy needle assembly 60 with tubular needle 70 carrying
a suture 71 through tissue, as described below.
[0052] FIG. 2A Shows a preferred notchless tubular needle 70 in its
natural state. As used throughout the specification, "notchless"
shall refer to the absence of notches, slots, eyelets, or other
such transverse openings for receiving suture as typically formed
in needles of prior art suture passers.
[0053] The distal end of the needle 80 is formed in a non-straight
geometry. FIG. 2B. shows a tubular needle 70 with the formed end 80
sheathed in a constraining channel 91. The channel for the needle
also includes a curvilinear portion 90, or guidepath, that
approximates the same geometry curve as the distal end of the
tubular needle 80, thereby facilitating the consistent return of
the needle 70 its preformed curved shape each time the needle 70
exits the channel. The constrained state tubular needle 70
contained in the needle assembly 60 is loaded into the handle end
of the tubular body 10 and advanced through a track in the tubular
body 10.
[0054] FIG. 1A. illustrates a hand grip 20 and actuator 50 that
provide articulation of jaw 40 relative to tip 30. The actuator 50
may be coupled to a return spring that biases the actuator 50 in
the open position as seen in FIG. 1A. A surgeon may rotate actuator
50 approximately five to ten degrees, and preferably seven degrees,
toward hand grip 20 to close jaw 40, as seen in FIG. 1B. A surgeon
may then rotate actuator 50 approximately an additional thirty to
forty degrees, and preferably thirty four degrees, towards hand
grip 20 to activate tubular needle 70, extending it to its natural
state 80, seen in FIG. 1C. The initial additional actuator rotation
could require a significant resistance from a spring in the handle
mechanism. This significant resistance on the actuator 50 acts as
an indicator for the operator to know the tubular needle 70 is
beginning to be deployed. Releasing the actuator 50 to its resting,
open position returns tubular needle 70 to its constrained state 90
and then disengages jaw 40 to the open position.
[0055] In FIG. 3A. a loop of suture 71 is loaded into distal end of
tip 30 with slot 31, seen in FIG. 3B. The slot 31 allows spring
action for gripping the loop of suture 71 when the loop of suture
is pulled into the tip 30. In one embodiment, shown in FIG. 3C.,
tubular needle 70 pierces the loop of suture 71 and creates a
bifurcation 72 in the suture. When additional force is applied to
the suture, the bifurcation 72 will advance along the shaft of the
needle. To prevent the bifurcation 70 from advancing along the
shaft of the needle, a prong cleat 73, illustrated in FIG. 4A. is
positioned to pierce the loop of suture 71 loop in second location.
The pierce of the prong cleat may partially engage the thickness of
the suture or create a second bifurcation 74 in the suture. The
prong cleat 72 is a wire rod or tube housed within the lumen of the
tubular needle with a sharp distal tip 73, shown in FIG. 4C, that
slightly extends from the lumen of the tubular needle 70, as seen
in FIG. 4B. The two piercing objects at different locations in the
suture act in conjunction to stabilize the suture from advancing
along the shaft of the needle.
[0056] In another embodiment, shown in FIG. 3C., tubular needle 70
pierces the loop of suture 71 and creates a bifurcation 72 in the
suture. When additional force is applied to the suture, the
bifurcation 72 will advance along the shaft of the needle. To
prevent the bifurcation 72 from advancing along the shaft of the
needle, a lateral post cleat 75, illustrated in FIG. 4A. is
positioned to engage the bifurcated section of the suture, FIG. 5C.
The body of the lateral post cleat 75 is housed inside the lumen of
the tubular needle 70. Tension on the loop of suture 71 pulls the
bifurcated legs of the suture against the lateral post 76,
preventing the suture from sliding down the shaft of the
needle.
[0057] FIG. 6B. shows an aperture 41 in jaw 40 that tubular needle
70 and suture 71 pass through, as seen in FIG. 6A. A retractable
pawl 42 is sideably positioned on jaw 40. Retractable pawl 42
includes a window 43 that aligns with aperture 41 when extended
forward in the open position. With tubular needle 70 and suture 71
deployed within aperture 41 by rotation of the actuator 50, the
retractable pawl is then actuated to a reward position. The
mechanism to actuate reward motion of the retractable pawl 42 may
include a spring bias to provide a relatively constant load of the
retractable pawl 42 against the deployed tubular needle 70 and
suture 71. Upon release of the actuator 50, a spring in the
actuator mechanism returns the tubular needle 70 to the
constraining channel 90. The spring bias of the retractable pawl 42
allows the tubular needle to return, yet maintains a grip on the
suture 71 and pulls it in a reward movement to become captured in
between the proximal edge 44 of the aperture 41 in the jaw 40 and
distal edge of pawl window 43, as is shown in FIG. 6C and 6D.
Complete release of the actuator 50 disengages the jaw 40 to the
open position, thus completing the passage of suture through the
tissue.
[0058] In some variations, the suture passing device may be
composed to have two or more tubular needles 70. In one embodiment,
the suture passing device can throw more than one segment of suture
through tissue simultaneously. The segments of suture being passed
by multiple tubular needles may be attached to form a continuous
loop of suture, thus enabling the formation of a desired suture
pattern, i.e. horizontal mattress stitch. FIG. 7A. shows a left
tubular needle 74 and a right tubular needle 75 after being
simultaneously released to their natural states 80. In another
embodiment, the device may throw two or more tubular needles 70
through tissue sequentially. The segments of suture being passed by
multiple tubular needles may be attached to form a continuous loop
of suture, thus enabling the formation of a desired suture pattern,
i.e. horizontal mattress stitch. The handle mechanism could be
configured to deploy the left needle assembly 64 and right needle
assembly 65 independently. FIG. 7C shows the handle mechanism with
a switch 61 to toggle and engage one needle assembly at a time in
the drive track 60. Suture could be loaded to the tips of both
needle assemblies (as described above) before entering the device
down the cannula. With the switch 61 toggled to engage the left
needle assembly 64, the jaw could be actuated to grasp a desired
location of tissue and the left tubular needle 74 deployed to pass
suture and capture suture in a first tissue location. FIG. 7B.
shows a left tubular needle 74 released to its natural state 80
(suture is not shown in image). Fully releasing the actuator 50
returns the left tubular needle 74 to its constrained state 90 and
disengages jaw 40. The suture passing instrument may then be
repositioned to a second desired tissue location. A surgeon could
then select right needle assembly 65 by toggling the needle track
60 on the instrument's body 10, as seen in FIG. 7C. With the switch
61 toggled to engage the right needle assembly 65, the jaw could be
actuated to grasp a second desired location of tissue and the right
tubular needle 75 deployed to pass suture and capture suture in a
second tissue location. FIG. 7D. shows a right tubular needle 75
released to its natural state 80 (suture is not shown in image). .
Fully releasing the actuator 50 returns the right tubular needle 75
to its constrained state 90 and disengages jaw 40 from tissue. The
suture passing instrument may then be removed from the cannula to
expose the two ends of the suture.
[0059] In yet another embodiment, the device described above
includes floating a pivot mechanism as shown in FIGS. 8A-C to
facilitate a lower profile when the jaws are separated. The jaw 40
includes a pivot interface 36 with linkage 35. At the opposite end
of linkage 35 is another pivot interface 37 that joins linkage 35
and drive rod 38. The tip 30 includes a slot 31 in which a pin 39
slides within. The pin 39 is fixed to jaw 40. Axial movement of
drive rod 38 in relation to the tip 30 causes jaw 40 to rotate
about pin 39 in relationship to the tip 30. A leaf spring 45 exerts
a load against the pin 39 in a direction to bias the pin against
the lower end of slot 31, thus resulting in the jaw 40 in a
collapsed state as shown in FIG. 8A. The gap 90 between the inner
surfaces of the tip 30 and jaw 40 is minimized. The collapsed state
is advantageous for providing a minimum profile for advancing the
device through a cannula. The leaf spring segment 45 may be an
integral part of the pawl 42. When the tip 30 and jaw 40 are
positioned unto tissue, advancement of the drive rod 38 causes the
jaw 40 to rotate about pin 39 to clamp onto the tissue. The
resisting force of the tissue to compression between tip 30 and the
jaw 40 causes a force on the inner surface of the jaw 40. If the
force on the inner surface of the jaw 40 exceeds the force of the
leaf spring 45 to hold the pin 39 against the lower end of slot 31,
the pin will ride up the slot 31, and effectively increase the gap
90 between the inner surfaces of tip and the jaw 40, as shown in
FIG. 8C. To increase the gap 90 at the axillia acts to distribute
the clamp force along the length of the jaw 40. The distribution of
clamp force enables the distal end of jaw 40 to achieve a position
in closer proximity to tip 30.
[0060] The above description and drawings illustrate preferred
embodiments which achieve the objects, features and advantages of
the present invention. It is not intended that the present
invention be limited to the illustrated embodiments. Any
modification of the present invention which comes within the spirit
and scope of the following claims should be considered part of the
present invention.
[0061] Many alterations and modifications may be made by those
having ordinary skill in the art without departing from the spirit
and scope of the invention. Therefore, it must be understood that
the illustrated embodiments have been set forth only for the
purposes of examples and that they should not be taken as limiting
the invention as defined by the following claims. For example,
notwithstanding the fact that the elements of a claim are set forth
below in a certain combination, it must be expressly understood
that the invention includes other combinations of fewer, more or
different ones of the disclosed elements. The words used in this
specification to describe the invention and its various embodiments
are to be understood not only in the sense of their commonly
defined meanings, but to include by special definition in this
specification the generic structure, material or acts of which they
represent a single species.
[0062] The definitions of the words or elements of the following
claims are, therefore, defined in this specification to not only
include the combination of elements which are literally set forth.
In this sense it is therefore contemplated that an equivalent
substitution of two or more elements may be made for any one of the
elements in the claims below or that a single element may be
substituted for two or more elements in a claim. Although elements
may be described above as acting in certain combinations and even
initially claimed as such, it is to be expressly understood that
one or more elements from a claimed combination can in some cases
be excised from the combination and that the claimed combination
may be directed to a subcombination or variation of a
subcombination.
[0063] Insubstantial changes from the claimed subject matter as
viewed by a person with ordinary skill in the art, now known or
later devised, are expressly contemplated as being equivalently
within the scope of the claims. Therefore, obvious substitutions
now or later known to one with ordinary skill in the art are
defined to be within the scope of the defined elements. The claims
are thus to be understood to include what is specifically
illustrated and described above, what is conceptually equivalent,
what can be obviously substituted and also what incorporates the
essential idea of the invention.
* * * * *