MEDICAL SYSTEMS, DEVICES AND METHODS FOR SUTURING PERFORATIONS

• US 20100280530A1
• Filed: 04/29/2010
• Published: 11/04/2010
• Est. Priority Date: 05/01/2009
• Status: Active Grant

• Current Assignee: Cook Medical Technologies, LLC (Cook Group Incorporated)
• Original Assignee: Wilson-Cook Medical Incorporated (Cook Group Incorporated)
• Inventors: HASHIBA, KIYOSHI
• Granted Patent: US 9,089,262 B2
• Time in Patent Office: Days
• US Class Current: 606/144
• CPC Class Codes: A61B 1/0008 characterised by distal tip features
• CPC Class Codes: A61B 1/018 for receiving instruments
• 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 17/0469 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 17/0487 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 17/0625 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 2017/00296 mounted on an endoscope
• CPC Class Codes: A61B 2017/00663 the implement being a suture
• CPC Class Codes: A61B 2090/0811 for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument

Abstract

Medical systems, devices and methods are disclosed for suturing a perforation in tissue, that may be employed endoscopically and/or laparoscopically, and that offer simple, reliable and controllable placement of sutures around a perforation for complete closure thereof.

Claims

1. A medical system for suturing a perforation in tissue, the medical system comprising:

an endoscope having a working channel;

an endcap fitted to a distal end of the endoscope;

an elongated side tube defining a side channel, the side tube connected to the endcap;

a needle having a shaft and a needle tip detachably connected to a distal end of the shaft, the needle sized to be translated through the side channel;

a suture attached to the needle tip; and

a retrieval device sized to be translated through the working channel of the endoscope.

2. The medical system of claim 1, wherein the needle is operable to a deployed configuration, the needle tip being laterally spaced from the side tube in the deployed configuration.

3. The medical system of claim 2, wherein the distal end of the needle shaft bends along a curved path in the deployed configuration.

4. The medical system of claim 2, wherein the distal end of the needle shaft is retroflexed in the deployed configuration.

5. The medical system of claim 2, wherein the distal end of the needle shaft is formed of a resilient material and is biased to the deployed configuration.

6. The medical system of claim 2, the endoscope defining a central axis, and wherein the needle tip and retrieval device are radially aligned relative to the central axis in the deployed configuration.

7. The medical system of claim 6, wherein the distal end of the needle shaft has a curvature such that the needle tip faces proximally in the deployed configuration.

8. The medical system of claim 2, wherein the retrieval device includes a resilient sleeve having teeth, the sleeve defining an interior passageway sized to receive the needle tip.

9. The medical system of claim 8, wherein the needle tip defines a gripping surface, and wherein the teeth are sized and structured to engage the gripping surface.

10. A medical device for use with an endoscope to suture a perforation in tissue, the medical device comprising:

an endcap defining an interior space sized to receive a distal end of the endoscope;

an elongated side tube defining a side channel, the side tube connected to the endcap;

a needle having a shaft and a needle tip detachably connected to a distal end of the shaft, the needle sized to be translated through the side channel, the needle being operable to a deployed configuration, the needle tip being laterally spaced from the side tube in the deployed configuration;

a suture attached to the needle tip; and

a retrieval device sized to be translated through a working channel of the endoscope for retrieval of the suture and needle tip.

11. The medical device of claim 10, wherein the interior space is sized to provide selective frictional engagement between the endcap and the endoscope.

12. The medical device of claim 10, wherein a distal portion of the endcap includes a slot circumferentially aligned with the side tube.

13. The medical device of claim 10, wherein a distal portion of the endcap includes a flange extending radially to define a tissue support surface.

14. The medical device of claim 13, wherein the flange is positioned proximate the needle when the needle is in the deployed configuration.

15. The medical device of claim 10, wherein the needle is operable to a delivery configuration, the needle tip being aligned with the side tube in the delivery configuration.

16. A method for suturing a perforation in tissue, the method comprising the steps of:

providing an endoscope having a working channel;

providing a medical device comprising an endcap, a size tube, a needle, a suture and a retrieval device, the endcap sized to be fitted to a distal end of the endoscope;

the side tube connected to the endcap and being elongated to define a side channel, the needle having a shaft and a needle tip detachably connected to a distal end of the shaft, the needle sized to be translated through the side channel, the suture attached to the needle tip, and the retrieval device sized to be translated through the working channel of the endoscope, the needle being operable between a delivery configuration and a deployed configuration, the needle tip moving laterally between the delivery and deployed configurations;

fitting the endcap to a distal end of the endoscope;

introducing the endoscope and medical device to a position proximate the tissue;

operating the needle from the delivery configuration to the deployed configuration such that the needle passes through the tissue;

operating the retrieval device to engage the needle tip; and

detaching the needle tip from the shaft.

17. The method of claim 16, further comprising the step of retracting the retrieval device to withdraw the suture through the working channel of the endoscope.

18. The method of claim 16, wherein the step of introducing the endoscope and medical device includes positioning the side tube proximate the perforation in the tissue.

19. The method of claim 16, wherein the step of operating the needle includes passing the needle through the tissue in a retrograde manner.

20. The method of claim 16, wherein the step of operating the needle includes passing the needle through the perforation and then passing the needle through the tissue.

21. The method of claim 16, wherein the step of detaching the needle tip includes pulling the needle in a proximal direction to assist in detaching the needle tip from the shaft.