Methods and apparatus for grasping and cinching tissue anchors

• US 20050251210A1
• Filed: 01/14/2005
• Published: 11/10/2005
• Est. Priority Date: 05/07/2004
• Status: Active Grant

• Current Assignee: USGI Medical, Inc.
• Original Assignee: USGI Medical, Inc.
• Inventors: Saadat, Vahid, Ewers, Richard C., Lam, Cang C., Westra, Hendrik S.
• Granted Patent: US 7,390,329 B2
• Time in Patent Office: Days
• US Class Current: 606/232
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• 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 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• 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 17/22031 Gripping instruments, e.g. forceps, for removing or smashing calculi A61B17/221 takes precedence
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/00349 Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue A61B17/06066 takes precedence
• CPC Class Codes: A61B 2017/00407 Ratchet means
• CPC Class Codes: A61B 2017/00827 Treatment of gastro-esophageal reflux
• CPC Class Codes: A61B 2017/00867 shape memory effect for prostheses A61F2210/0014
• CPC Class Codes: A61B 2017/0406 Pledgets
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0419 H-fasteners
• CPC Class Codes: A61B 2017/0443 the shaft being resilient and having a coiled or helical shape in the released state
• CPC Class Codes: A61B 2017/0445 cannulated, e.g. with a longitudinal through-hole for passage of an instrument
• CPC Class Codes: A61B 2017/0446 Means for attaching and blocking the suture in the suture anchor
• CPC Class Codes: A61B 2017/045 snug fit within the anchor
• CPC Class Codes: A61B 2017/0451 Cams or wedges holding the suture by friction
• CPC Class Codes: A61B 2017/0454 : the anchor being crimped or clamped on the suture
• CPC Class Codes: A61B 2017/0456 : Surface features on the anchor, e.g. ribs increasing friction between the suture and the anchor
• CPC Class Codes: A61B 2017/0458 : Longitudinal through hole, e.g. suture blocked by a distal suture knot
• CPC Class Codes: A61B 2017/0459 : Multiple holes in the anchor through which the suture extends and locking the suture when tension is applied
• CPC Class Codes: A61B 2017/0461 : with features cooperating with special features on the suture, e.g. protrusions on the suture
• CPC Class Codes: A61B 2017/0464 : for soft tissue
• CPC Class Codes: A61B 2017/0474 : Knot pushers
• CPC Class Codes: A61B 2017/0475 : using sutures having a slip knot
• CPC Class Codes: A61B 2017/0477 : with pre-tied sutures
• CPC Class Codes: A61B 2017/0488 : Instruments for applying suture clamps, clips or locks for applying suture anchors A61B2017/0409; for applying wound clamps A61B17/10; for applying ligaturing clamps or clips A61B17/128
• CPC Class Codes: A61B 2017/0496 : for tensioning sutures
• CPC Class Codes: A61B 2017/06028 : by means of a cylindrical longitudinal blind bore machined at the suture-receiving end of the needle, e.g. opposite to needle tip
• CPC Class Codes: A61B 2017/06052 : Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle hollow suture needles A61B2017/061
• CPC Class Codes: A61B 2017/06076 : helically or spirally coiled for sutures A61B2017/06171
• CPC Class Codes: A61B 2017/06171 : helically or spirally coiled for needles A61B2017/06076
• CPC Class Codes: A61B 2017/06176 : with protrusions, e.g. barbs
• CPC Class Codes: A61B 2017/0649 : Coils or spirals
• CPC Class Codes: A61B 2090/061 : for measuring dimensions, e.g. length

Abstract

Methods and apparatus for controlled grasping and cinching or locking of a tissue anchor are provided. In one variation, a tube is provided having a lumen and a resilient member that obstructs the lumen. A grasper may be advanced coaxially through the lumen, such that it reversibly displaces the resilient member and extends beyond the lumen'"'"'s outlet to engage an element of the tissue anchor. The grasper then may be retracted within the tube, such that the resilient member again obstructs the lumen of the tube. Continued retraction of the grasper may act to cinch the anchor, for example, via interaction between the anchor and the obstructing resilient member. During cinching, a cinching mechanism of the anchor optionally may be positioned at least partially within the tube to enhance lateral stability. Furthermore, feedback indicative of a degree of cinching or locking may be provided during cinching.

Claims

1. An apparatus for securing a tissue anchor, the apparatus comprising:

a tubular member defining a lumen therethrough with a distal outlet; and

at least one resilient member that at least partially obstructs the lumen proximal of the distal outlet such that a distal compartment within the tube is defined between the at least one obstructing resilient member and the distal outlet, wherein the obstructing resilient member is adapted to be reversibly displaced from the lumen when displaced by a grasper.

2. The apparatus of claim 1, further comprising a grasper configured for coaxial advancement through the lumen, wherein the grasper is configured to extend beyond the distal outlet of the lumen to grasp the tissue anchor or a portion thereof.

3. The apparatus of claim 1, wherein the tubular member is rigid.

4. The apparatus of claim 1, wherein the tubular member is flexible along at least a portion of its length.

5. The apparatus of claim 1, wherein the apparatus is configured to cinch the tissue anchor with the at least one resilient member.

6. The apparatus of claim 1, further comprising a cinching mechanism adapted to cinch the tissue anchor when the anchor is urged against the at least one resilient member.

7. The apparatus of claim 6, wherein the distal compartment within the tubular member is adapted to at least partially receive the cinching mechanism therein during cinching of the tissue anchor such that the cinching mechanism is laterally stabilized relative to the tubular member.

8. The apparatus of claim 1, wherein the tubular member defines at least one slot in communication with the lumen and wherein the at least one resilient member is disposed within the at least one slot to at least partially obstruct the lumen.

9. The apparatus of claim 1, wherein the distal outlet defines an atraumatic inner circumferential edge.

10. The apparatus of claim 1, further comprising a feedback element configured to indicate a degree of anchor cinching.

11. The apparatus of claim 10, wherein the feedback element comprises a spring element.

12. The apparatus of claim 10, further comprising a longitudinally translatable marker positioned along the tubular member for visually indicating a degree of anchor cinching.

13. The apparatus of claim 1, wherein the apparatus comprises three obstructing resilient members positioned uniformly and circumferentially within the tubular member.

14. The apparatus of claim 1, wherein the at least one obstructing resilient member projects radially from the lumen when displaced.

15. A method for grasping and cinching a tissue anchor, the method comprising:

deploying at least one tissue anchor and a cinching mechanism into or against a region of tissue to be secured;

advancing a grasper through a lumen of a tubular member having at least one resilient member that obstructs the lumen such that the grasper reversibly displaces the at least one resilient member from the lumen;

grasping an element of the tissue anchor with the grasper; and

retracting the grasper and the tissue anchor element within the lumen of the tubular member such that the at least one resilient member re-obstructs the lumen and the cinching mechanism is laterally stabilized at least partially within the tubular member and abutted against the obstructing resilient member.

16. The method of claim 15, further comprising cinching the anchor by retracting the tissue anchor element while the cinching mechanism abuts against the at least one resilient member.

17. The method of claim 15, wherein deploying at least one tissue anchor comprises deploying into or against gastrointestinal tissue.

18. The method of claim 15, wherein grasping an element of the tissue anchor comprises grasping a suture attached to or passing through the tissue anchor.

19. The method of claim 15, further comprising locking the tissue anchor in a deployed configuration via the cinching mechanism.

20. The method of claim 15, wherein retracting the grasper comprises drawing the cinching mechanism at least partially through a distal opening of the lumen such that the cinching mechanism is abutted against the obstructing resilient member.

21. The method of claim 15, further comprising monitoring a cinching force while retracting the grasper via a feedback mechanism positioned proximally of the at least one resilient member.

22. The method of claim 21, further comprising recording a maximum degree of cinching force exerted.

23. The method of claim 21, wherein monitoring a cinching force comprises compressing a spring element when retracting the grasper such that the spring feeds a restoring force back through the tubular member.

24. A system for controlled cinching of a tissue anchor, the system comprising:

a grasper adapted to engage the tissue anchor or a suture depending from the tissue anchor;

a cinching assembly defining a lumen for passage of the grasper therethrough and to cinch the engaged tissue anchor or suture against a portion of the cinching assembly; and

a force feedback mechanism configured to indicate a degree of anchor cinching force.

25. The system of claim 24, wherein the force feedback mechanism comprises a compression spring configured to apply a restoring force during anchor cinching.

26. The system of claim 24, wherein the force feedback mechanism comprises a longitudinally translatable marking element configured to record a maximum degree of exerted anchor cinching force.

27. The system of claim 24, wherein the cinching assembly comprises:

a tubular member having a lumen with a distal outlet such that the grasper is able to be advanced coaxially through the lumen, wherein a distal portion of the tubular member defines a compartment for laterally stabilizing a cinching mechanism relative to the tubular member; and

at least one resilient member that at least partially obstructs the lumen and is adapted to be reversibly displaced by the grasper when the grasper is passed beyond the distal outlet of the lumen.