Methods and instruments for closing laparoscopic trocar puncture wounds

• US 20050043746A1
• Filed: 08/21/2003
• Published: 02/24/2005
• Est. Priority Date: 08/21/2003
• Status: Active Grant

• Current Assignee: Anthony D. Costabile, Stanley B. Pollak
• Original Assignee: Anthony D. Costabile, Stanley B. Pollak
• Inventors: Pollak, Stanley B., Costabile, Anthony D.
• Granted Patent: US 7,320,693 B2
• Time in Patent Office: Days
• US Class Current: 606/144
• CPC Class Codes: A61B 17/0057 Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009
• CPC Class Codes: A61B 17/0467 Instruments for cutting sutures surgical cutting instruments A61B17/32
• CPC Class Codes: A61B 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• CPC Class Codes: A61B 17/0485 Devices or means, e.g. loops, for capturing the suture thread and threading it through an opening of a suturing instrument or needle eyelet
• CPC Class Codes: A61B 17/0625 the needle being specially adapted to interact with the manipulator, e.g. being ridged to snap fit in a hole of the manipulator A61B17/06109 takes precedence
• CPC Class Codes: A61B 2017/00637 for sealing trocar wounds through abdominal wall
• CPC Class Codes: A61B 2017/00663 the implement being a suture
• CPC Class Codes: A61B 2017/0496 for tensioning sutures
• CPC Class Codes: A61B 2017/061 hollow or tubular suture extending inside a hollow needle A61B2017/06052; hollow sutures A61B2017/06185

Abstract

An instrument for applying a suture to a trocar wound includes an obturator coupled to a central shaft and a coaxially disposed skin pressure plate. The obturator and skin pressure plate are movable relative to each other, and function together to position the tissue and needles relative to each other. The skin pressure plate is provided with two spaced apart needle guides. A pair of hollow needles, held in the guides of the pressure plate are coupled to a needle mounting plate which is movable over the central shaft. One of the needles is provided with a suture control mechanism for moving a suture through the needle and the other needle is provided with a snare control mechanism for moving a snare through the needle.

Claims

1. An apparatus for applying a suture to a wound, comprising:

a) a central shaft having a proximal end and a distal end;

b) an obturator coupled to the distal end of said shaft;

c) a pair of hollow needles slidably coupled to said central shaft, each of said needles having a sharp end and being movable from a first position where said sharp ends are distant from said obturator to a second position where said sharp ends are close to said obturator;

d) a suture control mechanism coupled to one of said needles for delivering suture material through the sharp end of the needle; and

e) a snare control mechanism coupled to the other of said needles for delivering a snare through the sharp end of the needle.

2. An apparatus according to claim 1, further comprising:

f) a skin pressure plate mounted on said shaft and movable relative to said obturator.

3. An apparatus according to claim 2, further comprising:

g) a needle mounting plate secured to said skin pressure plate having a threaded split collar coaxially disposed on said central shaft; and

h) a rotatable locking nut, wherein

said rotatable locking nut is threadably received on said split collar of said needle mounting plate and, upon tightening, locks said needle mounting plate and, in turn, said skin pressure plate to said central shaft.

4. An apparatus according to claim 1, wherein:

said obturator has a bulbous distal end and a pair of fascia stretching fins.

5. An apparatus according to claim 4, wherein:

said fascia stretching fins taper proximally.

6. An apparatus according to claim 4, wherein:

said fascia stretching fins terminate in a fascia supporting shelf.

7. An apparatus according to claim 2, wherein:

said skin pressure plate has a pair of skin stretching fins.

8. An apparatus according to claim 7, wherein:

said fins taper distally.

9. An apparatus according to claim 7, wherein:

the sharp ends of said needles pass through said fins.

10. A method for applying a suture to a trocar wound, said method comprising:

a) inserting an obturator into the wound so that the wound is stretched;

b) inserting a pair of hollow needles on opposite sides of the obturator;

c) passing a snare through one of the needles;

d) passing a suture through the other needle;

e) capturing the suture with the snare; and

f) withdrawing the needles with the suture and the snare.

11. The method according to claim 10, further comprising:

g) prior to inserting the needles, placing a pressure plate on top of the wound, the pressure plate having skin stretching means for stretching the skin in a direction different to the direction stretched by the obturator.

12. The method according to claim 11, wherein:

the pressure plate and the obturator stretch the skin in mutually orthogonal directions.

13. The method according to claim 11, wherein:

the stretching of the skin allows the needles to penetrate the fascia and peritoneum of the abdominal wall.

14. The method according to claim 11, further comprising:

h) removing the pressure plate; and

l) removing the obturator.

17. An apparatus according to claim 14, wherein:

said obturator has a bulbous distal end and a pair of fascia stretching fins.

18. An apparatus according to claim 17, wherein:

said fascia stretching fins taper proximally.

19. An apparatus according to claim 17, wherein:

said fascia stretching fins terminate in a fascia supporting shelf.

15. An apparatus for applying a suture to a wound, comprising:

a) an obturator;

b) a pair of hollow needles, each of said needles having a sharp end and being movable from a first position where said sharp ends are distant from said obturator to a second position where said sharp ends are close to said obturator;

c) a suture control mechanism coupled to one of said needles for delivering suture material through the sharp end of the needle; and

d) a snare control mechanism coupled to the other of said needles for delivering a snare through the sharp end of the needle.

16. An apparatus according to claim 15, further comprising:

e) a skin pressure plate movable relative to said obturator.

20. An apparatus according to claim 16, wherein:

said skin pressure plate has a pair of skin stretching fins.

21. An apparatus according to claim 20, wherein:

said fins taper distally.

22. An apparatus according to claim 20, wherein:

the sharp ends of said needles pass through said fins.