Running stitch suturing device

• US 20050154403A1
• Filed: 05/13/2004
• Published: 07/14/2005
• Est. Priority Date: 01/14/2004
• Status: Active Grant

• Current Assignee: LSI Solutions, Inc.
• Original Assignee: LSI Solutions, Inc.
• Inventors: Sauer, Jude S., Bovard, Mark A., Fitzsimmons, Michael W., Guelzow, James W., Hammond, John F.
• Granted Patent: US 7,407,505 B2
• Time in Patent Office: Days
• US Class Current: 606/139
• 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 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• 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 17/0491 Sewing machines for surgery
• 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 2017/00371 Multiple actuation, e.g. pushing of two buttons, or two working tips becoming operational
• CPC Class Codes: A61B 2017/0406 Pledgets
• 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 2017/0474 Knot pushers
• CPC Class Codes: A61B 2017/0496 for tensioning sutures
• CPC Class Codes: B33Y 80/00 Products made by additive manufacturing

Abstract

An instrument and method for suturing wound closures is provided having a handle, shaft and suture engagement mechanism. The instrument provides for multiple placements or “bites” of suture in tissues to enable a wide variety of suturing techniques, including the ability to “run” a suture. The instrument further facilitates suture knot tying. The method of this instrument provides for rapid and effective remote suture placement and knot tying.

Claims

1. A surgical suturing instrument comprising:

a housing having a handle and an actuating member;

an elongated guide member attached to the housing, and having a distal end;

first and second needles extending from the housing through the shaft to the distal end;

a selector for selectively coupling the actuating member to a selected one of the first and second needles

2. The surgical suturing instrument of claim 1 in which the actuating member is pivotally mounted in the housing.

3. The surgical suturing instrument of claim 2 in which the actuating member comprises a pair of pins.

4. The surgical suturing instrument of claim 2 comprising an extension spring attached to the actuating member and the housing biasing the actuating member to a forward position.

5. The surgical suturing instrument of claim 1 in which the actuating member includes first and second grooves receiving the first and second needles.

6. The surgical suturing instrument of claim 1 in which at each of the first and second needles comprises a ball at a proximal end thereof.

7. The surgical suturing instrument of claim 6 comprising a shuttle coupled to the selector and movable between a first position engaging the first needle, and a second position engaging the second needle.

8. The surgical suturing instrument of claim 7 in which the shuttle includes a channel receiving the ball at the proximal end of a selected one of the first and second needles, coupling the selected needle to the actuator so that the actuator drives the selected needle between an extended position and a retracted position.

9. The surgical suturing instrument of claim 1 comprising a suture routing tube extending from the handle through the housing.

10. The surgical suturing instrument of claim 1 in which the longitudinal guide member includes a suture channel and first and second needle tracks.

11. The surgical suturing instrument of claim 1 comprising an adaptor in the housing attached to the longitudinal guide member.

12. The surgical suturing instrument of claim 11 comprising a shaft receiving the longitudinal guide member.

13. The surgical suturing instrument of claim 12 in which the shaft is attached to the adapter by a threaded nut.

14. The surgical suturing instrument of claim 13 comprising a gasket disposed between the shaft and the adapter.

15. The surgical suturing instrument of claim 13 in which the shaft and the adapter comprise mating D-shaped profiles.

16. The surgical suturing instrument of claim 9 in which the gasket comprising a ring sealing to a suture routing tube, and first and second needle holes.

17. The surgical suturing instrument of claim 16 in which the gasket comprises sealing flaps sealing to the first and second needles.

18. The surgical suturing instrument of claim 12 comprising a distal tip attached to the shaft.

19. The surgical suturing instrument of claim 18 in which the distal tip comprises a front section, a jaw opening, and a ferrule latch pocket.

20. The surgical suturing instrument of claim 19 comprising a ferrule latch disposed in the ferrule latch pocket.

21. The surgical suturing instrument of claim 1 comprising an interlock for inhibiting movement of the selector except when the actuating member is in a forward position.

22. The surgical suturing instrument of claim 21 in which the actuating member comprises a selection track, a first advancing track and a second advancing track.

23. The surgical suturing instrument of claim 22 in which the selector comprises a follower pin engaged in the selector track when the actuating member is in a forward position, and in one of the first advancing track or the second advancing track when the actuating member is in an advanced position.

24. The surgical suturing instrument of claim 7 in which the selector comprises an arm pivotally mounted in the housing so that the selector is constrained to move in a back and forth motion.

25. The surgical suturing instrument of claim 24 in which the selector comprises a shuttle actuator coupled to the shuttle.

26. The surgical suturing instrument of claim 25 in which the shuttle comprises a tongue engaging a longitudinal shuttle groove in the shuttle actuator.

27. The surgical suturing instrument of claim 11 in which the adapter comprises first and second rotation cams attached to the first and second needles, and first and second cam followers.

28. The surgical suturing instrument of claim 27 in which the first and second cam followers comprise spring arms mounted to the adapter.

29. The surgical suturing instrument of claim 28 in which the adapter comprises first and second follower holes through which the first and second cam followers extend.

30. The surgical suturing instrument of claim 27 in which the adapter comprises first and second rotation bores receiving the first and second rotation cams.

31. The surgical suturing instrument of claim 27 in which the first and second rotation cams comprise an advancing track and a rotation track.

32. The surgical suturing instrument of claim 31 in which the first and second advancing tracks comprise first and second advancing stops preventing the cam followers from following the advancing tracks in a backward direction.

33. The surgical suturing instrument of claim 31 in which the rotation track extends over 90 degrees.

34. The surgical suturing instrument of claim 31 in which the first and second rotation tracks comprise first and second rotation stops preventing the cam followers from following the rotation tracks in a backward direction.

35. The surgical suturing instrument of claim 20 in which the first and second needles comprise a tissue engaging end having a latch engaging surface.

36. The surgical suturing instrument of claim 35 in which the ferrule latch comprises a ferrule contact edge selectively engaging a ferrule for stripping the ferrule off the needle.

37. The surgical suturing instrument of claim 36 in which the latch engaging surface engages the ferrule latch and moves the ferrule contact edge to a retracted position where it does not engage the ferrule.

38. The surgical suturing instrument of claim 35 in which the first and second needles comprises a non latch engaging surface.

39. The surgical suturing instrument of claim 38 in which the latch engaging surface and the non latch engaging surface are arranged radially around the tissue engaging ends of the first and second needles.

40. The surgical suturing instrument of claim 39 comprising two latch engaging surfaces and two non latch engaging surfaces disposed in an alternating arrangement around the tissue engaging ends of the first and second needles.

41. The surgical suturing instrument of claim 20 in which the ferrule latch comprises a base disposed in the ferrule latch pocket.

42. The surgical suturing instrument of claim 41 in which the ferrule latch comprises a needle engaging portion connected to the base by a resilient spring.

43. The surgical suturing instrument of claim 42 in which the needle engaging portion comprises first and second needle relief grooves.

44. The surgical suturing instrument of claim 42 in which the needle engaging portion comprises a needle ramp.

45. The surgical suturing instrument of claim 42 in which the first and second needles comprise a tissue engaging end having a ferrule latch engaging surface.

46. The surgical suturing instrument of claim 45 in which the ferrule latch comprises a ferrule contact edge selectively engaging a ferrule for stripping the ferrule off the needle.

47. The surgical suturing instrument of claim 46 in which the ferrule latch engaging surface engages the ferrule latch and moves the ferrule contact edge to a retracted position where it does not engage the ferrule.

48. The surgical suturing instrument of claim 45 in which the first and second needles comprises a non ferrule latch engaging surface.

49. The surgical suturing instrument of claim 48 in which the ferrule latch engaging surface and the non ferrule latch engaging surface are arranged radially around the tissue engaging ends of the first and second needles.

50. The surgical suturing instrument of claim 49 comprising two ferrule latch engaging surfaces and two non ferrule latch engaging surfaces disposed in an alternating arrangement around the tissue engaging ends of the first and second needles.

51. The surgical suturing instrument of claim 50 in which the adapter comprises first and second rotation cams attached to the first and second needles, and first and second cam followers.

52. The surgical suturing instrument of claim 51 in which the first and second cam followers comprise spring arms mounted to the adapter.

53. The surgical suturing instrument of claim 52 in which the adapter comprises first and second follower holes through which the first and second cam followers extend.

54. The surgical suturing instrument of claim 51 in which the adapter comprises first and second rotation bores receiving the first and second rotation cams.

55. The surgical suturing instrument of claim 51 in which the first and second rotation cams comprise an advancing track and a rotation track.

56. The surgical suturing instrument of claim 55 in which the first and second advancing tracks comprise first and second advancing stops preventing the cam followers from following the advancing tracks in a backward direction.

57. The surgical suturing instrument of claim 55 in which the rotation track extends over 90 degrees.

58. The surgical suturing instrument of claim 55 in which the first and second rotation tracks comprise first and second rotation stops preventing the cam followers from following the rotation tracks in a backward direction.

59. The surgical suturing instrument of claim 20 in which the distal tip comprises first and second ferrule compartments.

60. The surgical suturing instrument of claim 59 in which the ferrule latch is disposed adjacent the first and second ferrule compartments for selectively retaining first and second ferrules in the first and second ferrule compartments.

61. A surgical suture comprising:

a length of suture material having a first end;

a ferrule attached to the first end of the length of suture;

a protective sleeve covering a portion of the ferrule and a portion of the length of suture to protect the suture end from damage.

62. The surgical suture of claim 61 in which the ferrule comprises a reduced diameter suture-engaging sleeve.

63. The surgical suture of claim 62 in which the protective sleeve covers a portion of the reduced diameter suture-engaging sleeve.

64. A ferrule assembly for attaching to an end of a length of surgical suture comprising:

a generally cylindrical ferrule having a needle receiving opening;

a leader connected to the ferrule.

65. The ferrule assembly of claim 64 in which the leader comprises a semi-rigid material.

66. The ferrule assembly of claim 65 in which the leader comprises stainless steel wire, cable, or monofilament.

67. The ferrule assembly of claim 64 comprising a ball attached to an end of the leader opposite the ferrule.

68. The ferrule assembly of claim 67 comprising a suture having a ball receiving sleeve attached to one end there of.

69. The ferrule assembly of claim 68 in which the ball receiving sleeve is crimped to the suture.

70. The ferrule assembly of claim 68 in which the ball receiving sleeve comprises stainless steel.

71. The ferrule assembly of claim 68 in which the ball is disposed in the ball-receiving sleeve.

72. A method of tying a closed loop of suture having a ferrule end and a free end using a surgical suturing instrument having a jaw comprising the steps of:

a) passing the ferrule end of the suture through a tissue section;

b) passing the ferrule end over the free end above the loop;

c) positioning the free end inside the jaw so that the ferrule end passes under the free end; and

d) drawing the ferrule end through the loop.

73. The method of tying a closed loop of suture of claim 72 comprising repeating steps b, c, and d to form two throws.

74. The method of tying a closed loop of suture of claim 73 comprising pulling the ferrule end of the suture taut, and advancing the two throws towards the tissue.

75. The method of tying a closed loop of suture of claim 74 comprising:

passing the ferrule end over the free end of suture;

passing the ferrule end under the free end of the suture;

passing the ferrule end through the closed loop created by the free end and the ferrule end of the suture to form a throw.

76. The method of tying a closed loop of suture of claim 75 comprising:

pulling the ferrule end of the suture taut, and sliding the throw towards the tissue to create an end point knot.

77. The method of tying a closed loop of suture of claim 76 comprising:

passing the ferrule end of the suture over the free end;

passing the ferrule end of the suture under the free end to form a closed loop;

passing the ferrule end of the suture through the closed loop created by the free end and the ferrule end of the suture to create a throw about the free end.

78. The method of tying a closed loop of suture of claim 77 comprising pulling the free end taut, and advancing the throw towards the end point knot to create a lock knot.

79. The method of tying a closed loop of suture of claim 78 comprising:

passing the ferrule end of the suture over the free end;

passing the ferrule end of the suture under the free end to form a closed loop;

passing the ferrule end of the suture through the closed loop to create a throw.

80. The method of tying a closed loop of suture of claim 79 comprising pulling the ferrule end of the suture taut, and advancing the throw towards the lock knot to form a finishing knot.

81. A surgical suturing instrument comprising:

a housing having a handle and an actuating member;

an elongated guide member attached to the housing and having a distal end;

a reciprocally movable needle extending from the housing through the elongated guide member to the distal end;

an actuator coupled between the actuating member and the needle for successively moving the needle between an extended position and a retracted position, and rotating the needle.

82. A surgical suturing instrument comprising:

a ferrule holding tip adjacent to a tissue receiving gap;

a reciprocally movable needle movable across the tissue receiving gap to engage the ferrule holding tip;

a ferrule stripper movable between a first position in proximity with the needle for stripping a ferrule off the needle and a second position.

83. The surgical suturing instrument of claim 82 in which the ferrule stripper moves between the first and second positions on successive movements of the needle across the gap.

84. The surgical suturing instrument of claim 83 in which the ferrule stripper is responsive to the rotational position of the needle, and including an actuator coupled to the needle for rotating the needle.