Method and apparatus for applying a knot to a suture

• US 20070010829A1
• Filed: 06/19/2006
• Published: 01/11/2007
• Est. Priority Date: 06/20/2005
• Status: Active Grant

• Current Assignee: Scarab Technology Services, LLC
• Original Assignee: Nobles Medical Technologies, Inc (Medtronic Plc)
• Inventors: Decker, Steven, Nobles, Anthony, Ratering, Egbert
• Granted Patent: US 8,197,497 B2
• Time in Patent Office: Days
• US Class Current: 606/148
• 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 17/0485 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 17/0487 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 2017/045 snug fit within the anchor
• 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 2017/0488 Instruments for applying suture clamps, clips or locks

Abstract

A knot placement device allows a physician to apply a knot for securing two or more suture ends extending from an incision in a vessel or organ of a patient relative to each other in order to seal an opening in the vessel or organ. The knot placement device has a handle and an elongate shaft and a push rod slidably inserted in said shaft. A knot is disposed in the distal end of the shaft. An actuator on the handle may be depressed to distally advance said push rod relative to said shaft and thereby distally advance said knot. The knot may include a knot body having an inner cavity and a plug sized to fit securely within the inner cavity. In use, the plug may be inserted into the inner cavity of the knot body to fixedly hold two or more suture ends between the knot body and the plug.

Claims

1. A method for securing two suture portions extending from an opening in the body, comprising:

positioning said two suture portions within a knot body;

advancing said knot body to a location near tissue adjacent the opening; and

moving a plug into said knot body to fixedly secure said suture portions between said knot body and said plug.

2. The method of claim 1, further comprising applying tension to said suture portions while advancing the knot body.

3. The method of claim 1, wherein the suture portions extend from two tissue portions adjacent an incision of a wound site.

4. The method of claim 1, wherein the suture portions are positioned initially within the knot body, and the plug is inserted into the knot body.

5. The method of claim 1, wherein the suture portions are positioned initially within the plug, and the knot body is advanced over the plug.

6. The method of claim 1, wherein positioning said two suture portions within a knot body comprises:

inserting a threader, having proximal and distal ends and a hole in the distal end, through said knot body;

threading said two suture portions through the hole in said threader; and

proximally retracting said threader through said knot body.

7. The method of claim 1, further comprising cutting the suture portions proximal to a proximal end of the knot body.

8. The method of claim 1, wherein the knot body and plug are slidably disposed within a knot placement device, and further comprising advancing the knot placement device to the opening.

9. The method of claim 8, wherein advancing the knot body comprises activating the knot placement device to distally advance the knot body.

10. The method of claim 9, wherein moving the plug comprises activating the knot placement device to distally advance the plug into the knot body.

11. The method of claim 8, further comprising cutting the suture portions proximal to a proximal end of the knot body, wherein said cutting comprises distally advancing a cutting surface of said knot placement device.

12. The method of claim 8, further comprising:

ejecting the knot body from the knot placement device; and

withdrawing the knot placement device.

13. A knot placement device comprising:

an elongate shaft with proximal and distal ends and a lumen extending therethrough;

a knot positioned in the distal end of the elongate shaft within the lumen;

a push rod having proximal and distal ends slidably disposed in the lumen of said elongate shaft; and

an actuator configured to distally advance said push rod relative to said elongate shaft to distally engage the knot.

14. The device of claim 13, wherein depression of the actuator distally advances said push rod.

15. The device of claim 13, wherein the actuator comprises a locking mechanism configured to lock the position of the push rod.

16. The device of claim 13, further comprising an intermediate tube having distal and proximal ends concentrically and slidably disposed between said shaft and said push rod, the proximal end of said intermediate tube extending through the proximal end of said elongate shaft into said handle.

17. The device of claim 16, wherein partial depression of the actuator distally advances said push rod and additional depression of the actuator distally advances said intermediate tube.

18. The device of claim 16, wherein the distal end of the intermediate tube comprises a cutting member.

19. The device of claim 16, wherein said shaft comprises a keyway and wherein said intermediate tube comprises a key configured to be inserted in said keyway.

20. The device of claim 13, wherein the knot comprises a knot body and a plug, the plug being positioned in the lumen of the shaft proximal of the knot body, wherein distal advancement of the push rod pushes the plug distally into the knot body and ejects the knot from the shaft.

21. The device of claim 13, wherein the knot is configured to receive at least one suture portion therein, and wherein distal advancement of the push rod secures the suture portion relative to the knot and ejects the knot from the lumen of the shaft.

22. The device of claim 13, wherein the shaft further comprises a side hole proximal to the distal end.

23. A knot placement device comprising:

a handle;

an elongate shaft with proximal and distal ends and a lumen extending therethrough, the proximal end of said shaft coupled to said handle, the elongate shaft further comprising a side hole near its distal end;

an intermediate tube, having proximal and distal ends and a lumen extending therethrough, slidably disposed in the lumen of said elongate shaft, the proximal end of said intermediate tube extending through the proximal end of said elongate shaft into said handle, the intermediate tube further comprising a cutting surface;

a push rod having proximal and distal ends slidably disposed in the lumen of said intermediate tube, the proximal end of said push rod extending through the proximal end of said intermediate tube into said handle;

an actuator located on said handle, said actuator configured to distally advance said push rod and said intermediate tube relative to said elongate shaft; and

a knot comprising a knot body and a plug positioned in the lumen of the elongate shaft at the distal end thereof;

wherein at least one of the knot body and the plug is configured to receive at least one suture portion extending into the lumen of the elongate shaft at the distal end, the at least one suture portion exiting the shaft through the side hole;

wherein distal advancement of the push rod moves the plug relatively into the knot body to secure the at least one suture portion, and further distal advancement of the push rod causes the cutting surface of the intermediate tube to sever the at least one suture portion and eject the knot from the lumen of the shaft.

24. The knot placement device of claim 23, wherein the plug is positioned proximally of the knot body within the lumen of the shaft, such that distal advancement of the push rod pushes the plug into the knot body.

25. A knot for fixedly securing portions of a suture, comprising:

a knot body having distal and proximal ends, a distal opening and a proximal opening, and an inner cavity extending therethrough; and

a plug having proximal and distal ends, wherein the plug is operably sized to be received into the inner cavity of the knot body through the proximal opening;

wherein the knot body and plug are sized and configured to receive and fixedly secure the suture portions therebetween.

26. The knot of claim 25, wherein at least a portion of said plug forms a friction fit with at least a portion of said inner cavity.

27. The knot of claim 25, wherein the plug is tapered from proximal to distal end.

28. The knot of claim 25, wherein the inner cavity of the knot body is tapered from proximal to distal end.

29. The knot of claim 25, wherein the distal opening of the knot body has a smaller diameter than a cross sectional diameter of the distal end of the plug.

30. The knot of claim 25, wherein the inner cavity comprises one or more protrusions located on a side wall of the inner cavity.

31. The knot of claim 25, wherein the knot body further comprises one or more holes extending from said inner cavity through a side wall of said tubular member.

32. The knot of claim 31, wherein the inner cavity further comprises one or more holes located on an opposing side wall of the inner cavity.

33. The knot of claim 25, wherein the plug further comprises one or more holes located on a side wall of the plug and extending through a section of the plug.

34. The knot of claim 25, wherein the plug further comprises a slit extending longitudinally from said distal end of said plug.

35. The knot of claim 25, wherein the knot body further comprises an atraumatic tip.