Sliding suture anchor

• US 20030191497A1
• Filed: 04/05/2002
• Published: 10/09/2003
• Est. Priority Date: 04/05/2002
• Status: Active Grant

• Current Assignee: Cook Medical Technologies, LLC (Cook Group Incorporated)
• Original Assignee: Cook Incorporated (Cook Group Incorporated)
• Inventors: Cope, Constantin
• Granted Patent: US 6,699,263 B2
• Time in Patent Office: Days
• US Class Current: 606/215
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/0467 Instruments for cutting sutures surgical cutting instruments A61B17/32
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/0483 Hand-held instruments for holding sutures A61B17/0469 takes precedence; other holders for needles or sutures A61B17/06061; surgical forceps A61B17/28; surgical pincettes A61B17/30
• CPC Class Codes: A61B 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0454 the anchor being crimped or clamped on the suture
• CPC Class Codes: A61B 2017/0464 for soft tissue
• CPC Class Codes: A61B 2017/0496 for tensioning sutures
• CPC Class Codes: A61B 2017/061 hollow or tubular
• CPC Class Codes: A61D 1/00 Surgical instruments for veterinary use

Abstract

A method and the apparatus for anastomosing two hollow viscera that can be performed percutaneously or through the patients mouth. The apparatus includes an anchor assembly including a stationary T-bar anchor secured to the distal end of a suture and a sliding anchor that is attached to the suture proximal to the stationary T-bar anchor. The sliding anchor is held in place on the suture but can be slid along the suture when pressure is applied to it. The anchor assembly is inserted through the abdominal wall, into the stomach, and then through the stomach into the jejunum. The stationary anchor is then released into the jejunum and the sliding anchor is released in the stomach. A pusher is then used to push or slide the sliding anchor distally until the tissue between the stationary and sliding anchors are in close contact. After the anchor has been placed, the suture can be severed at the sliding anchor.

Claims

1. A method for forming an anastomosis between first and second adjacent hollow viscera, comprising the steps of:

(a) selecting the area where the anastomosis is to be formed;

(b) providing a tract from outside of the body, to the interior of the first hollow viscus and through the adjacent walls of the first and second hollow viscera in the area where the anastomosis is to be formed;

(c) providing an anchor assembly comprising a suture having a stationary anchor secured to its distal end and a sliding anchor slidably attached to the suture proximal to the stationary anchor;

H

(d) attaching said sliding anchor to said suture such that it does not move relative to the suture unless a force is applied to the sliding anchor in a direction longitudinally along the suture;

(e) positioning the anchor assembly, through said tract, in the area where the anastomosis is to be formed;

(f) depositing said stationary anchor in said second hollow viscus;

(g) depositing said sliding anchor in said first hollow viscus;

(h) placing the anchor by applying a force to said sliding anchor through said track to position said sliding anchor against the wall of said first hollow viscus with the adjacent walls of the viscera held flush together between the stationary and sliding anchors;

(i) providing a tract from outside of the body, through which the anastomosis is to be formed, to the area where the anastomosis is to be formed and adjacent to where the walls of the viscera have been anchored together;

(j) piercing the adjacent walls of the hollow viscera in the area where the anastomosis is to be formed and adjacent to where the anchor was placed;

(k) dilating the aperture formed by piercing the adjacent walls of the hollow viscera to form the anastomosis of the size desired.

2. The method for forming an anastomosis as set forth in claim 1 wherein:

(I) repeating steps (a) through (h) to place multiple anchors in the area where the anastomosis is to be formed.

3. The method for forming an anastomosis as set forth in claim 1 wherein said sliding anchor is created by:

providing a length of coil spring and a cylindrical-shaped mandrel that can be received within the coil spring; and

passing the suture through adjacent coils of the coil spring such that the suture wraps around a coil and is engaged between the coil that it wraps around and the coils on opposite sides of the coil that it wraps around;

providing a mandrel of a size that can be inserted in the length of coil spring;

inserting the mandrel in the coil spring such that the mandrel is in engagement with the portion of the suture that is wrapped around the coil spring.

4. The method for forming an anastomosis as set forth in claims 1 or 2 or 3 wherein the method further includes the step of:

(m) severing the portion of the suture that is distal of the placed anchor.

5. The method for forming an anastomosis as set forth in claims 1 or 2 or 3 wherein the method further includes the step of:

(n) placing a stent in the dilated aperture formed in the adjacent walls of the hollow viscera.

6. The method for forming an anastomosis as set forth in claims 1 or 2 or 3 wherein the force applied to said sliding anchor to position said sliding anchor against the wall of said first hollow viscus is in the range of 250-500 grams.

7. The method for forming an anastomosis as set forth in claims 1 or 2 or 3 wherein the following additional steps are performed:

(o) providing stationary and sliding anchors that have elongated shapes;

(p) securing said sutures to the elongated stationary anchor at a mid-portion of the elongated stationary anchor; and

(q) attaching said suture to the elongated sliding anchor at a mid-portion of the elongated sliding anchor.

8. The method for forming an anchor between first and second adjacent hollow viscera, comprising the steps of:

(a) selecting the area where the anchor is to be formed;

(b) providing a tract from outside of the body, to the interior of the first hollow viscus and through the adjacent walls of the first and second hollow viscera in the area where the anchor is to formed;

(c) providing an anchor assembly comprising a suture having a stationary anchor secured to its distal end and a sliding anchor slidably attached to the suture proximal to the stationary anchor;

(d) attaching said sliding anchor to said suture such that it does not move relative to the suture unless a force is applied to the sliding anchor in a direction longitudinally along the suture

(e) positioning the anchor assemble, through said tract, to the area where the anchor is to be formed;

(f) depositing said stationary anchor in said second hollow viscus;

(g) depositing said sliding anchor is said first hollow viscus;

(h) placing the anchor by applying a force to said sliding anchor, through said track, to position said sliding anchor against the wall of said first hollow viscus with the adjacent walls of the viscera held flush together between the stationary and sliding anchors.

9. The method for forming an anchor between first and second adjacent hollow viscera, comprising the steps of as set forth in claim 8 wherein said sliding anchor is created by:

providing a length of coil spring and a cylindrical-shaped mandrel that can be received within the coil spring; and

passing the suture through adjacent coils of the coil spring such that the suture wraps around a coil and is engaged between the coil that it wraps around and the coils on opposite sides of the coil that it wraps around;

providing a mandrel of a size that can be inserted in the length of coil spring;

inserting the mandrel in the coil spring such that the mandrel is in engagement with the portion of the suture that is wrapped around the coil spring.

10. The method for forming an anchor as set forth in claims 8 or 9 wherein the method further includes the step of:

(n) severing the portion of the suture that is distal of the placed anchor.

11. The method for forming an anchor as set forth in claims 8 or 9 wherein the force applied to said sliding anchor to position said sliding anchor against the wall of said first hollow viscus is in the range of 250-500 grams.

12. The method for forming an anchor as set forth in claims 8 or 9 wherein the following additional steps are performed:

(o) providing stationary and sliding anchors that have elongated shapes;

(p) securing said sutures to the elongated stationary anchor at a mid-portion of the elongated stationary anchor; and

(q) attaching said suture to the elongated sliding anchor at a mid-portion of the elongated sliding anchor.

13. A device for percutaneously placing an anchor between the walls of a first and second adjacent hollow viscera, comprising:

a tract that extends percutaneously from outside of the body, to the interior of the first hollow viscus and through the adjacent walls of the first and second hollow viscera in the area where the anchor is to be placed;

an anchor assembly, comprising a suture having a stationary anchor secured to its distal end and a sliding anchor slidably attached to the suture proximal to the stationary anchor;

the attachment of said sliding anchor to said suture being such that the sliding anchor will not move relative to the suture unless a force is applied to the sliding anchor in a direction longitudinally along the suture;

said stationary and sliding anchors being dimensioned to be received sequentially in said tract such that they can be slid through the tract to the area where the anchor is to be placed with the stationary anchor leading and the sliding anchor following;

a force applying mechanism that can extend through said track to the area where the anchor is to be placed at which it can engage the sliding anchor and apply a force thereto to slide the sliding anchor longitudinally along the suture.

said sliding anchor being attached to said suture such that it does not move relative to the suture unless a force is applied to the sliding anchor in a direction longitudinally along the suture.

14. A device for percutaneously placing an anchor between the walls of a first and second adjacent hollow viscera, as set forth in claim 13 further comprising:

the attachment of said sliding anchor to said suture being such that the sliding anchor will not move relative to the suture unless a force in the range of 250-500 grams applied to the sliding anchor in a direction longitudinally along the suture;

15. A device for percutaneously placing an anchor between the walls of a first and second adjacent hollow viscera, as set forth in claims 13 or 14 further comprising:

said sliding anchor comprising a length of coil spring and a cylindrical-shaped mandrel that can be received within the coil spring; and

the attachment of the coil spring to the suture is accomplished by passing the suture through adjacent coils of the coil spring such that the suture wraps around a coil and is engaged between the coil that it wraps around and the coils on opposite sides of the coil that it wraps around, and the mandrel is within the coil spring in engagement with the portion of the suture that is wrapped around the coil spring.

16. A device for percutaneously placing an anchor between the walls of a first and second adjacent hollow viscera, as set forth in claims 13 or 14 and further comprising:

a suture severing mechanism having a sharp distal edge that can be advanced through the catheter to the area where the anchor is to be placed to sever the suture at the sliding anchor after the anchor has been placed.

17. A device for percutaneously placing an anchor between the walls of a first and second adjacent hollow viscera, as set forth in claims 13 or 14 and further comprising:

said stationary and sliding anchors that have elongated shapes;

said suture secured to the elongated stationary anchor at a mid-portion of the elongated stationary anchor; and

said suture secured to the elongated sliding anchor at a mid-portion of the elongated sliding anchor.

18. A device for percutaneously placing an anchor between the walls of a first and second adjacent hollow viscera, as set forth in claims 15 and further comprising:

said length of coil spring having an outside diameter of about 0.038 inch and said cylindrical-shaped mandrel having a diameter of about 0.018 inches.

19. A device for percutaneously placing an anchor between the walls of a first and second adjacent hollow viscera, as set forth in claims 16 and further comprising:

said length of coil spring having an outside diameter of about 0.038 inch and said cylindrical-shaped mandrel having a diameter of about 0.018 inches.

20. A device for percutaneously placing an anchor between the walls of a first and second adjacent hollow viscera, as set forth in claims 17 and further comprising:

said length of coil spring having an outside diameter of about 0.038 inch and said cylindrical-shaped mandrel having a diameter of about 0.018 inches.