SUTURING INSTRUMENT AND METHOD FOR PASSING MULTIPLE SUTURES

• US 20100121352A1
• Filed: 11/06/2009
• Published: 05/13/2010
• Est. Priority Date: 11/07/2008
• Status: Active Grant

• Current Assignee: Arthrex Incorporated
• Original Assignee: Arthrex Incorporated
• Inventors: Decker, Jonathan I., Powell, Jacob L., Weber, Robert M., Dooney, Thomas JR., Murray, R. Pepper
• Granted Patent: US 8,460,318 B2
• Time in Patent Office: Days
• US Class Current: 606/144
• 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 17/062 Needle manipulators
• 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 2017/06019 by means of a suture-receiving lateral eyelet machined in the needle
• CPC Class Codes: A61B 2017/06042 located close to needle tip
• CPC Class Codes: A61B 2017/2837 with a locking ratchet
• CPC Class Codes: A61B 2017/2912 transmission of forces to actuating rod or piston
• CPC Class Codes: A61B 2017/2925 Pistol grips
• CPC Class Codes: A61B 2017/2926 Details of heads or jaws

Abstract

Apparatus and methods for passing multiple sutures in tissue repair and/or other mini-open procedures. The apparatus includes a pair of jaws mounted on a distal end of a shaft, a hand assembly mounted on a proximal end of the shaft, and a needle mounted on the hand assembly and passing through a cannulation of the shaft. The pair of jaws includes a lower jaw and an upper jaw, the lower jaw being provided with a slot configured to sequentially engage multiple sutures inserted into the instrument. The handle assembly has a cam mechanism and a finger lever with a ratchet and a releaser with a hook, the handle assembly being designed to move the needle from a first position to a second position, and to thereby sequentially capture, in the needle, each of the multiple sutures inserted in the instrument, for subsequent passing through tissue.

Claims

1. A suture passing instrument comprising:

an elongate body having a distal end, a proximal end, and a cannulation configured to receive a needle;

a first jaw member integral to the distal end of the elongate body, the first jaw member having a securing mechanism to secure a plurality of flexible strands, and a passage for receiving the needle;

a second jaw member mounted to the distal end of the elongate body and pivotally connected to the first jaw member such that the second jaw member is movable with respect to the first jaw member; and

a handle assembly configured to move the needle from a first position to a second position and to sequentially engage each of the plurality of flexible strands with the needle.

2. The suture passing instrument of claim 1, wherein the securing mechanism is a slot, a wedge, or a groove.

3. The suture passing instrument of claim 2, wherein the securing mechanism is a V-shaped groove.

4. The suture passing instrument of claim 1, wherein the needle is provided with a slot to securely engage each of the plurality of flexible strands.

5. The suture passing instrument of claim 1, wherein the first jaw member further comprises an opening at its distal end to allow the needle to pass therethrough.

6. The suture passing instrument of claim 1, wherein the elongate body is a shaft.

7. The suture passing instrument of claim 1, wherein the second jaw member is curve-shaped in a humpback configuration with a given radius of curvature.

8. The suture passing instrument of claim 1, wherein the handle assembly further comprises a handle with a proximal end and a distal end, a ratchet-like mechanism comprising a finger lever with a ratchet and a releaser with a hook, the finger lever and the releaser being pivotally connected to the distal end of the handle, and a cam mechanism.

9. The suture passing instrument of claim 8, wherein the cam mechanism is connected to the proximal end and the distal end of the handle, and wherein the cam mechanism includes an opening with a first end a second end so that, when the first end of the opening is in contact with the distal end of the handle, the distal end and the proximal end of the handle are at a maximum distance apart from each other, and when the second end of the opening is in contact with the distal end of the handle, the distal end and the proximal end of the handle are pushed toward each other.

10. The suture passing instrument of claim 8, wherein the proximal and distal ends of the handle are linkably connected and tension between the proximal and distal ends of the handle is maintained using springs.

11. A method of passing suture through tissue, the method comprising the steps of:

providing a suture passing instrument comprising;

a shaft having a distal end and a proximal end;

a first jaw provided with an opening configured to receive a needle;

a second jaw mounted to the distal end of the shaft and pivotally connected to the first jaw such that the second jaw is movable with respect to the first jaw; and

a handle assembly;

positioning a first suture strand and a second suture strand within the first jaw so that the first suture strand is offset to the second suture strand with respect to a most distal tip of the first jaw; and

advancing the needle to sequentially pass the first and second suture strands through tissue.

12. The method of claim 11, wherein the first suture strand is positioned laterally to the second suture strand with respect to a longitudinal axis of the shaft.

13. The method of claim 11, wherein the first suture strand is positioned distally to the second suture strand relative to the handle assembly.

14. The method of claim 11, further comprising the step of sequentially securing the first and second suture strand within a securing mechanism of the first jaw.

15. The method of claim 14, wherein the securing mechanism is a slot, a wedge, or a groove.

16. The method of claim 11, further comprising the steps of:

sliding the needle through a cannulation in a proximal end of the shaft such that a distal end of the needle is on the distal end of the shaft;

loading the first suture strand into securing mechanism of the first jaw;

loading the second suture strand into the securing mechanism of the first jaw, so that the second suture strand is located distally and laterally to the first suture strand with respect to the most distal end of the first jaw; and

closing the first and second jaws and advancing the suture passing instrument in the vicinity of tissue to be sutured.

17. A method of suturing tissue at a surgical site, comprising:

providing a suture passing instrument comprising;

a shaft having a distal end and a proximal end;

a lower jaw integral to the distal end of the shaft and configured to receive a needle, the lower jaw being provided with a groove to secure at least one flexible strand thereon;

an upper jaw mounted to the distal end of the shaft and pivotally connected to the lower jaw such that the upper jaw is movable with respect to the lower jaw member; and

a handle assembly comprising a handle, a ratchet-like mechanism including a finger lever with a ratchet and a releaser with a hook, and a cam mechanism;

mounting the needle in the suture passing instrument by sliding the needle through a cannulation in the proximal end of the shaft such that a distal end of the needle is on the distal end of the shaft;

loading a first flexible strand into the groove of the lower jaw;

loading a second flexible strand into the groove of the lower jaw, so that the second flexible strand is located distally to the first flexible strand with respect to a most distal end of the lower jaw; and

closing the lower and upper jaws and advancing the suture passing instrument in the vicinity of tissue to be sutured.

18. The method of claim 17 further comprising the step of sequentially and independently passing the first and second flexible strands through tissue.

19. The method of claim 17, wherein the step of loading the second flexible strand into the groove of the lower jaw is conducted without removing the instrument out of the surgical site.

20. The method of claim 17, further comprising the steps of

opening the upper jaw by moving the finger lever subsequent to disengaging the ratchet and the hook, and grasping a desired bit of tissue using the upper and lower jaws;

closing the upper and lower jaws by using the finger lever;

capturing the first flexible strand with the needle;

advancing the first flexible strand through the tissue;

retracting the needle;

capturing the second flexible strand with the needle;

advancing the second flexible strand through the tissue; and

retracting the needle.

21. The method of claim 20, wherein the steps of advancing the first and second flexible strands through tissue further comprises advancing the needle by pushing proximal and distal members of the handle toward each other until the needle exits the opening on the lower jaw and advances toward the upper jaw.

22. The method of claim 17, wherein at least one of the first and second flexible strands is a suture comprising a plurality of high strength fibers.

23. The method of claim 17, wherein the surgical site is a rotator cuff.

24. The method of claim 17, wherein the needle is a bendable needle.

25. The method of claim 17, wherein the needle is a nitinol needle.

26. A method of suturing, comprising: