BI-DIRECTIONAL SUTURE PASSER

• US 20110028998A1
• Filed: 01/26/2010
• Published: 02/03/2011
• Est. Priority Date: 01/26/2009
• Status: Active Grant

• Current Assignee: Depuy Synthes Products Incorporated (Johnson & Johnson)
• Original Assignee: Synthes USA LLC (Johnson & Johnson)
• Inventors: Bertagnoli, Rudolf, Singhatat, Wamis, Helfer, Joel, Talbot, James, Larsen, Scott, Banks, David T., Vennard, Daniel, Mata, Vincent, Manos, Jamie, Messerli, Dominique, Overes, Tom, Underhill, Ken, Laurence, Lawton, Adams, Ray, Lehman, Adam
• Granted Patent: US 9,011,466 B2
• Time in Patent Office: Days
• US Class Current: 606/145
• 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 17/06066 Needles, e.g. needle tip configurations making needles B21G1/00
• 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 2017/00477 Coupling A61B2017/0046 takes precedence
• CPC Class Codes: A61B 2017/00867 shape memory effect
• CPC Class Codes: A61B 2017/0496 for tensioning sutures

Abstract

A bi-directional suture passing instrument configured to approach soft tissues perpendicularly, enables safer and more efficient surgical repairs and minimally invasive techniques to be employed, useful in areas such as annulus repair, meniscal repair, shoulder arthroscopy, hernia repair, laproscopic repair, and wound closure.

Claims

1. A bi-directional suture passing instrument configured to approximate soft tissue defects, the suture passing instrument comprising:

a body member defining a needle receiving channel;

a boom arm extending from the body member, the boom arm having a boom arm housing that is spaced from the body member, wherein a tissue-receiving gap is disposed between the boom arm housing and the body member;

a needle reciprocally translatable within the channel of the body member between an advanced position in which a distal end of the needle extends into the boom arm housing, and a retracted position in which the distal end of the needle is retracted from the boom arm housing; and

a shuttling element configured to detachably couple to the needle, and to the boom arm housing,

wherein (i) when the shuttling element is detachably coupled to the needle, rotation of the needle relative to the boom arm housing causes the shuttling element to detachably couple to the boom arm housing, and (ii) when the shuttling element is detachably coupled to the boom arm housing, rotation of the needle relative to the shuttling element causes the needle to detachably couple to the shuttling element.

2. The bi-direction suture passing instrument of claim 1, wherein (i) the needle includes an engagement feature, (ii) the shuttling element includes an engagement feature, and (iii) when the shuttling element is detachably coupled to the boom arm housing, rotation of the needle relative to the shuttling element causes the engagement feature of the needle to engage the engagement feature of the shuttling element to detachably couple the needle to the shuttling element.

3. The bi-directional suture passing instrument of claim 2, wherein (i) the shuttling element includes a locking mechanism, (ii) the boom arm housing includes a locking interface, and (iii) when the shuttling element is detachably coupled to the needle, rotation of the needle relative to the boom arm housing causes the locking mechanism of the shuttling element to engage the locking interface of the boom arm housing to detachably couple the shuttling element to the boom arm housing.

4. The bi-directional suture passing instrument of claim 3, wherein engagement feature of the shuttling element and the locking mechanism of the shuttling element are oppositely oriented threads.

5. The bi-directional suture passing instrument of claim 2, wherein the engagement features of the needle and the shuffling element are threads, and the threads of the needle are configured to engage the threads of the shuffling element.

6. The bi-directional suture passing instrument of claim 5, wherein the threads of the needle extend from an external surface of the needle.

7. The bi-directional suture passing instrument of claim 6, wherein (i) the shuttling element defines a bore, (ii) the threads of the shuttling element extend from an internal surface of the bore, and (iii) the bore is configured to receive the needle.

8. The bi-directional suture passing instrument of claim 7, wherein the bore extends completely through the shuttling element, and the needle is configured to extend through the bore of the shuttling element.

9. The bi-directional suture passing instrument of claim 5, wherein the needle includes a bore, and the threads of the needle extend from an internal surface of the bore.

10. The bi-directional suture passing instrument of claim 9, wherein (i) the threads of the shuttling element extend from an external surface of the shuttling element, and (ii) the bore of the needle is configured to receive the shuffling element.

11. The bi-directional suture passing instrument of claim 3, wherein (i) the locking mechanism of the shuffling element and the locking interface of the boom arm housing are threads, (ii) the threads of the shuffling element extend from an external surface of the shuffling element, (iii) the threads of the boom arm housing extend from an internal surface of a bore that is defined by the boom arm housing, and (iv) the threads of the shuffling element are configured to engage the threads of the boom arm housing.

12. The bi-directional suture passing instrument of claim 3, wherein (i) the engagement feature of the needle includes a wing extending out from a body of the needle, (ii) the shuttling element includes a bore that defines an axial slot configured to receive the wing of the needle, (iii) the axial slot extends into the engagement feature of the shuttling element, (iv) the engagement feature of the shuttling element includes a radial slot, and (v) rotation of the needle causes the wing of the needle to engage the radial slot of the shuttling element to thereby detachably couple the shuttling element to the needle.

13. The bi-directional suture passing instrument of claim 12, wherein (i) the locking mechanism of the shuttling element includes a wing extending out from a body of the shuttling element, (ii) the boom arm housing includes a bore that defines an axial slot configured to receive the wing of the shuttling element, (iii) the axial slot extends into the locking interface of the boom arm housing, (iv) the locking interface of the boom arm housing includes a radial slot, and (v) rotation of the shuttling element causes the wing of the shuttling element to engage the radial slot of the boom arm housing to thereby detachably couple the shuttling element to the boom arm housing.

14. The bi-directional suture passing instrument of claim 1, further comprising a tip actuator coupled to the needle, wherein rotation of the tip actuator causes the needle to rotate.

15. The bi directional suture passing instrument of claim 1, further comprising an actuation member coupled to a proximal end of the needle, wherein translation of the actuation member causes the needle to translate.

16. The bi-directional suture passing instrument of claim 1, wherein either the boom arm housing or the needle include an awl tip.

17. A method of passing a suture through a soft tissue defect, the method comprising:

rotating a needle such that an engagement feature of the needle engages an engagement feature of a shuttling element to thereby detachably couple the shuttling element to the needle;

advancing the needle and the shuttling element into a boom arm housing; and

rotating the shuttling element such that a locking mechanism of the shuttling element engages a locking interface of the boom arm housing to thereby detachably couple the shuttling element to the boom arm housing.

18. The method of claim 17, further comprising:

rotating the needle to disengage the needle from the shuffling element; and

retracting the needle from the boom arm housing while the shuffling element remains coupled to the boom arm housing.

19. The method of claim 18, further comprising:

advancing the needle into the boom arm housing;

rotating the needle such that the engagement feature of the needle reengages the engagement feature of the shuffling element to thereby recouple the shuffling element to the needle;

rotating the shuffling element such that the locking mechanism of the shuffling element disengages the locking interface of the boom arm housing to thereby detach the shuffling element from the boom arm housing; and

retracting the needle and the shuffling element from the boom arm housing and through the soft tissue defect.

20. The method of claim 17, wherein the engagement features of the needle and the shuffling element are threads.

21. The method of claim 20, wherein the threads of the needle extend from an external surface of the needle.

22. The method of claim 21, wherein (i) the shuttling element defines a bore, (ii) the threads of the shuttling element extend from an internal surface of the bore, and (iii) the bore is configured to receive the needle.

23. The method of claim 22, wherein the bore extends completely through the shuffling element, and the needle is configured to extend through the bore of the shuffling element.

24. The method of claim 17, wherein (i) the shuffling element stops rotating when the shuffling element is coupled to the boom arm housing, and (ii) continued rotation of the needle disengages the needle from the shuffling element.

25. The method of claim 17, wherein (i) the shuttling element is rotated in a first direction to couple the shuttling element to the boom arm housing, and (ii) the shuttling element is rotated in a second direction that is opposite to the first direction to uncouple the shuttling element from the boom arm housing.

26. A bi-directional suture passing instrument configured to approximate soft tissue defects, the suture passing instrument comprising:

a body member defining a needle receiving channel;

a boom arm extending from the body member, the boom arm having a boom arm housing that is spaced from the body member such that a tissue-receiving gap is disposed between the boom arm housing and the body member,

a needle reciprocally translatable within the channel of the body member between an advanced position in which a distal end of the needle extends into the boom arm housing, and a retracted position in which the distal end of the needle is retracted from the boom arm housing, the needle including a channel and an engagement feature at least partially disposed within the channel between an extended position and a retracted position; and

a shuttling element configured to carry threading,

wherein (i) the engagement feature detachably couples the shuttling element to the needle in the extended position, and the engagement feature decouples the shuttling element from the needle in the retracted position.

27. The bi-directional suture passing instrument of claim 26, wherein (i) the shuttling element has a bore that is configured to receive the needle.

28. The bi-directional suture passing instrument of claim 26, wherein the engagement feature is a wire stop translatable within the needle channel such that a distal portion of the wire stop engages the shuttling element when the wire stop is in an extended position.

29. The bi-directional suture passing instrument of claim 26, further comprising a wedge translatable within the channel of the needle, the wedge being configured to engage the engagement feature.

30. The bi-directional suture passing instrument of claim 29, wherein (i) the engagement feature is an axial finger defined by the shuttling element, the axial finger having a protrusion that engages the channel of the needle when the finger is in an extended position, and (ii) distal translation of the wedge disengages the axial finger from the channel of the needle.

31. The bi-directional suture passing instrument of claim 30, further comprising a sleeve disposed about the needle, the sleeve being configured to push the shuttling element off of the needle when the axial finger is disengaged from the channel of the needle.

32. The bi-directional suture passing instrument of claim 29, wherein (i) the engagement feature is a ball stop, and (ii) distal translation of the wedge causes the ball stop to extend from the channel and engage the shuttling element.

33. The bi-directional suture passing instrument of claim 32, wherein the ball stop includes a hemispheric top and a triangular bottom.

34. The bi-directional suture passing instrument of claim 29, wherein (i) the engagement feature is a finger stop that extends from a distal wall of the channel, and (ii) distal translation of the wedge causes the finger stop to extend from the channel and engage the shuttling element to thereby detachably couple the shuttling element to the needle.

35. The bi-directional suture passing instrument of claim 34, wherein the finger stop includes an angled surface that is engaged by the wedge.

36. The bi-directional suture passing instrument of claim 29, wherein (i) the engagement feature is a scissor stop comprising two fingers attached at a single pivot point, and (ii) distal translation of the wedge causes the fingers to each rotate about the pivot point thereby enabling a head of each finger to extend from the channel and engage the shuttling element.

37. The bi-directional suture passing instrument of claim 29, wherein (i) the engagement feature is a boot stop rotatable about a single pivot point, and (ii) distal translation of the wedge causes the boot stop to rotate about the pivot point thereby enabling a portion of the boot stop to extend from the channel and engage the shuttling element.

38. The bi-directional suture passing instrument of claim 27, wherein the engagement feature engages a distal end of the shuttling element when the engagement feature is in an extended position.

39. The bi-directional suture passing instrument of claim 27, wherein the bore of the shuttling element defines a recess, and the engagement feature extends into the recess when the engagement feature is actuated.

40. The bi-directional suture passing instrument of claim 27, wherein the boom arm housing includes a locking interface configured to retain the shuttling element within the boom arm housing.

41. The bi-directional suture passing instrument of claim 40, wherein the locking interface includes an elastomer configured to engage the shuttling element when the shuttling element is disposed within the boom arm housing.

42. The bi-directional suture passing instrument of claim 40, wherein (i) the boom arm housing defines a bore, (ii) the locking interface includes a transverse member having a bore, and (iii) the transverse member being configured to bias between a locked position, in which the bore of the transverse member is not aligned with the bore of the boom arm housing, and an unlocked position, in which the bore of the member is aligned with the bore of the boom arm housing.

43. The bi-directional suture passing instrument of claim 40, wherein (i) the locking interface includes a flexible polymeric tube having an internal rope mechanism, and (ii) the rope mechanism is configured to contract to thereby cause the polymeric tube to contract and engage the shuttling element.

44. The bi-directional suture passing instrument of claim 40, wherein (i) the locking interface includes a C-clip having a protrusion extending from an internal surface of the C-clip, and (ii) the C-clip is configured to contract such that the protrusion engages the shuttling element.

45. The bi-directional suture passing instrument of claim 40, wherein (i) the locking interface includes a flexible finger extending from a distal wall of the boom arm housing, and (ii) the finger includes a protrusion that is configured to engage the shuttling element.

46. The bi-directional suture passing instrument of claim 40, wherein (i) the boom arm housing includes a bore configured to receive the shuttling element, and (ii) the locking interface includes a wire translatable within a transverse bore, such that a portion of the wire is capable of extending into the bore of the boom arm housing to thereby engage the shuttling element.

47. The bi-directional suture passing instrument of claim 40, wherein the locking interface engages a proximal end of the shuttling element.

48. The bi-directional suture passing instrument of claim 40, wherein the locking interface is a spring loaded gate.

49. The bi-directional suture passing instrument of claim 40, wherein the shuttling element defines a recess, and the locking interface is configured to engage the recess.

50. The bi-directional suture passing instrument of claim 40, wherein either the boom arm housing or the needle include an awl tip.

51. A method of passing a suture through a soft tissue defect, the method comprising:

advancing an engagement feature through a channel of a needle such that a portion of the engagement feature extends out from the channel to engage a shuttling element to thereby detachably couple the shuttling element to the needle;

advancing the needle and the shuttling element into a boom arm housing;

retracting the engagement feature within the channel of the needle to decouple the shuttling element from the needle; and

retracting the needle while the shuttling element remains in the boom arm housing.

52. The method of claim 51, wherein the engagement feature within the channel of the needle is a wire stop.

53. The method of claim 51, wherein (i) the shuttling element defines a bore, (ii) the bore defines a recess, and (iii) the engagement feature engages the recess to detachably couple the shuttling element to the needle.

54. A bi-directional suture passing instrument configured to approximate soft tissue defects, the suture passing instrument comprising:

a body member having a needle receiving channel;

a boom arm extending from a distal end of the body member, the boom arm having a boom arm housing that is spaced from the body member, wherein a tissue receiving gap is disposed between the boom arm housing and the body member;

a needle reciprocally translatable within the channel of the body member between an advanced position in which a distal end of the needle extends into the boom arm housing, and a retracted position in which the distal end of the needle is retracted from the boom arm housing, the needle having a shaft and a head extending from the shaft;

a sleeve disposed around the shaft of the needle, the sleeve being configured to allow translation of either the sleeve or the needle with respect to the other; and

a shuttling element having a bore, the bore being configured to receive the needle and the sleeve,

wherein (i) translation of either the needle or the sleeve detachably couples the shuttling element to the needle.

55. The bi-directional suture passing instrument of claim 54, wherein (i) the needle head defines slots, and (ii) translation of either the needle or the sleeve causes the head to expand and engage the shuttling element.

56. The bi-directional suture passing instrument of claim 54, wherein (i) the needle head defines an angled surface, (ii) the distal end of the sleeve includes deflectable arms, and (iii) translation of either the needle or the sleeve causes the deflectable arms to ride up the angled surface of the needle head and engage the shuttling element.

57. The bi-directional suture passing instrument of claim 54, wherein (i) the distal end of the shaft is tapered thereby creating an undercut with the needle head, (ii) the sleeve includes a head at its distal end that is configured to engage the undercut, and (iii) retraction of the sleeve disengages the head of the sleeve from the undercut, thereby causing a portion of the head to engage the shuttling element.

58. The bi-directional suture passing instrument of claim 57, wherein the sleeve head includes a protrusion that engages the shuttling element.

59. The bi-directional suture passing instrument of claim 57, wherein the bore of the shuttling element defines a recess, and the sleeve head is configured to extend into the recess.

60. The bi-directional suture passing instrument of claim 54, further comprising an expandable ring disposed around the shaft of the needle between the sleeve and the needle head, wherein translation of either the needle or the sleeve causes the ring to expand and extend into a recess defined by the bore of the shuttling element.

61. The bi-directional suture passing instrument of claim 54, further comprising an expandable cage disposed around the shaft of the needle between the sleeve and the needle head, wherein translation of either the needle or the sleeve causes the cage to expand and extend into a recess defined by the bore of the shuttling element.

62. The bi-directional suture passing instrument of claim 61, wherein the cage includes a protrusion that is configured to extend into the recess of the shuttling element.

63. The bi-directional suture passing instrument of claim 61, wherein the cage includes an expandable portion that is configured to extend into the recess of the shuttling element.

64. A bi-directional suture passing instrument configured to approximate soft tissue defects, the suture passing instrument comprising:

a body member having a needle receiving channel;

a boom arm extending from a distal end of the body member, the boom arm having a boom arm housing that is spaced from the body member, wherein a tissue receiving gap is disposed between the boom arm housing and the body member;

a needle reciprocally translatable within the channel of the body member between an advanced position in which a distal end of the needle extends into the boom arm housing, and a retracted position in which the distal end of the needle is retracted from the boom arm housing, the needle defining an engagement feature on an external surface of the needle; and

a shuttling element having a bore that defines an engagement feature,

wherein (i) the engagement features of the needle and the shuttling element engage each other to thereby detachably couple the shuttling element to the needle, when the needle is received within the bore of the shuttling element.

65. The bi-directional suture passing instrument of claim 64, wherein the engagement feature of the needle is a fin that extends radially outward from the external surface of the needle, and the engagement feature of the shuttling element is a groove that is configured to receive the fin.

66. The bi-directional suture passing instrument of claim 64, wherein the engagement feature of the needle is a rib extending up from the external surface of the needle, and the engagement feature of the shuttling element is a recess that is configured to receive the rib.

67. The bi-directional suture passing instrument of claim 64, wherein (i) the shuttling element further includes a locking mechanism, (ii) the boom arm housing defines a locking interface, (iii) the locking mechanism is a protrusion defining a slot, and (iv) the slot is configured to engage the locking interface of the boom arm housing.

68. The bi-directional suture passing instrument of claim 64, wherein (i) the shuttling element further includes a locking mechanism, (ii) the boom arm housing defines a locking interface, (iii) the locking mechanism is a recess defined by the shuttling element, and (iv) the recess being configured to receive the locking interface defined by the boom arm housing.

73. The method of claim 68, further comprising:

rotating the needle such that a distal end of the needle advances into a bore defined by the proximal end of the shuttling element to thereby recouple the shuttling element to the needle;

69. A bi-directional suture passing instrument configured to approximate soft tissue defects, the suture passing instrument comprising:

a body member having a needle receiving channel;

a boom arm extending from a distal end of the body member, the boom arm having a boom arm housing spaced apart from the body member, wherein a tissue receiving gap is disposed between the boom arm housing and the body member;

a needle reciprocally translatable within the channel of the body member between an advanced position in which a distal end of the needle extends into the boom arm housing, and a retracted position in which the distal end of the needle is retracted from the boom arm housing; and

a strand of suture detachably coupled directly to the needle,

wherein (i) the suture strand is coupleable to the boom arm housing, such that the needle may be retracted while the suture strand remains in the boom arm housing.

70. The bi-directional suture passing instrument of claim 69, wherein the needle includes a cut configured to capture the strand of suture.

71. The bi-directional suture passing instrument of claim 69, wherein the strand of suture defines a loop and is comprised of a shape memory material.

72. A method of passing a suture through a soft tissue defect, the method comprising:

advancing a needle and a shuttling element through a piece of tissue and toward a boom arm housing;

ratcheting a distal end of the shuttling element into a bore defined by the boom arm housing, to thereby couple the shuttling element to the boom arm housing;

rotating the needle to decouple the needle from the shuttling element; and

retracting the needle from the boom arm housing, while the shuttling element remains within the bore of the boom arm housing.