METHODS FOR PASSING MULTIPLE SUTURES THROUGH TISSUE

• US 20140188136A1
• Filed: 12/31/2012
• Published: 07/03/2014
• Est. Priority Date: 12/31/2012
• Status: Active Grant

• Current Assignee: Medos International Sarl (Johnson & Johnson)
• Original Assignee: Depuy Mitek LLC (Johnson & Johnson)
• Inventors: Cournoyer, John R., Tang, Howard
• Granted Patent: US 9,271,722 B2
• Time in Patent Office: Days
• US Class Current: 606/144
• 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 17/0483 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 17/0485 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 17/0491 Sewing machines for surgery
• 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 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 2017/06042 located close to needle tip
• CPC Class Codes: A61B 2017/06095 pliable

Abstract

Methods for passing multiple sutures through tissue are provided herein. In particular, the methods described herein allow multiple sutures to be passed through tissue without removing a suture passing instrument from a patient'"'"'s body. In one embodiment, a method for passing a suture through tissue is provided that includes loading first and second suture limbs into a suture passing instrument, positioning the instrument within a patient'"'"'s body, actuating the instrument to pass a portion of the first suture limb through the tissue, pulling the first suture limb through the tissue, pulling the second suture limb to reload the suture passing instrument without removing the instrument from the patient'"'"'s body, actuating the instrument a second time to pass a portion of the second suture limb through the tissue, and pulling the second suture limb through the tissue.

Claims

1. A method of passing a suture through tissue, comprising:

loading a first suture limb into a retaining mechanism disposed at a distal end of a suture passing instrument such that the first suture limb extends on a first side of the instrument;

loading a second suture limb into the retaining mechanism of the suture passing instrument such that the second suture limb extends on the first side of the instrument;

positioning first and second jaws of the suture passing instrument to grasp tissue within a patient'"'"'s body;

deploying a needle from the suture passing instrument such that the needle extends through the tissue grasped between the first and second jaws of the instrument, the needle carrying a portion of at least the first suture limb through the tissue such that the first and second suture limbs extend from a first tissue surface and at least a first suture loop is formed on a second tissue surface opposite the first tissue surface;

pulling the first suture loop to draw the first suture limb through the tissue;

pulling the second suture limb toward a proximal end of the suture passing instrument to draw the second suture limb into a proximal end of the retaining mechanism without removing the suture passing instrument from the patient'"'"'s body;

deploying the needle from the suture passing instrument a second time to carry a portion of the second suture limb through the tissue such that the second suture limb extends from the first tissue surface and a second suture loop is formed on the second tissue surface; and

pulling the second suture loop to draw the second suture limb through the tissue.

2. The method recited in claim 1, wherein the second suture limb extends farther from the suture passing instrument than the first suture limb.

3. The method recited in claim 1, wherein the first suture limb extends from the suture passing instrument by about 10-20 mm.

4. The method recited in claim 1, wherein the second suture limb extends from the suture passing instrument by about 250 mm.

5. The method recited in claim 1, wherein positioning the first and second jaws of the suture passing instrument comprises inserting the instrument into a patient'"'"'s body, opening the jaws to receive tissue therebetween, and closing the jaws to grasp the tissue.

6. The method recited in claim 5, wherein the instrument is inserted into the patient'"'"'s body through a cannula.

7. The method recited in claim 1, further comprising retracting the needle following deployment such that the needle retracts into the suture passing instrument without moving the first or second suture limbs.

8. The method recited in claim 1, further comprising, prior to pulling the first suture loop, determining which of two suture loops is the first suture loop by pulling the second suture limb toward a proximal end of the suture passing instrument to reduce the size of a second suture loop formed on the second tissue surface.

9. The method recited in claim 1, further comprising at least partially opening the first and second jaws prior to pulling the second suture limb toward a proximal end of the instrument to permit easier movement of the second suture limb with respect to the retaining mechanism.

10. The method recited in claim 1, further comprising repositioning the suture passing instrument without removing the instrument from the patient'"'"'s body before deploying the needle a second time such that the second suture limb is passed through tissue at a different location than the first suture limb.

11. The method recited in claim 10, wherein repositioning the suture passing instrument comprises opening the first and second jaws to release the tissue grasped therebetween, moving the instrument to receive a different portion of tissue between the first and second jaws, and closing the first and second jaws to grasp the different portion of tissue therebetween.

12. The method recited in claim 1, wherein the suture passing instrument is not repositioned between the first and second deployments of the needle such that both the first and second suture limbs extend through a single hole formed in the tissue.

13. The method recited in claim 1, further comprising attaching the second suture limb to a tensioning device coupled to the suture passing instrument at a location proximal to the retaining mechanism, the tensioning device being configured to pull the second suture limb toward a proximal end of the instrument.

14. The method recited in claim 1, further comprising attaching the first and second suture limbs to a bone anchor.

15. The method recited in claim 1, wherein the first and second suture limbs are opposite ends of a single suture strand.

16. The method recited in claim 1, wherein the first and second suture limbs are ends of separate suture strands, the method further comprising repeating the steps recited in claim 1 using the opposite ends of the separate suture strands as the first and second suture limbs.

20. The method recited in claim 17, wherein the first and second suture limbs are ends of separate suture strands, the method further comprising removing the instrument from the patient'"'"'s body and repeating the steps recited in claim 16 using the opposite ends of the separate suture strands as the first and second suture limbs.

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

loading first and second suture limbs into a retaining mechanism of a suture passing instrument such that the first and second suture limbs extend from a first side of the instrument;

inserting the suture passing instrument into the body of a patient;

positioning first and second jaws of the suture passing instrument to grasp tissue therebetween;

actuating the suture passing instrument to pass a portion of at least the first suture limb through the tissue grasped between the first and second jaws such that the first and second suture limbs extend from a first tissue surface and at least a first suture loop is formed on a second, opposite tissue surface;

pulling the first suture loop to draw the first suture limb through the tissue;

pulling the second suture limb toward a proximal end of the suture passing instrument to draw the second suture limb into a proximal end of the retaining mechanism without removing the suture passing instrument from the patient'"'"'s body;

actuating the suture passing instrument a second time to pass a portion of the second suture limb through the tissue grasped between the first and second jaws such that the second suture limb extends from the first tissue surface and a second suture loop is formed on the second tissue surface; and

pulling on the second suture loop to draw the second suture limb through the tissue.

18. The method recited in claim 17, further comprising, prior to pulling the first suture loop, determining which of two suture loops is the first suture loop by pulling the second suture limb toward a proximal end of the suture passing instrument to reduce the size of a second suture loop formed on the second tissue surface.

19. The method recited in claim 17, further comprising repositioning the suture passing instrument without removing the instrument from the patient'"'"'s body before actuating the instrument a second time such that the second suture limb is passed through tissue at a different location than the first suture limb.

21. A method for repairing a tear in tissue, comprising:

loading a first suture limb into a retaining mechanism disposed at a distal end of a suture passing instrument, the first suture limb having a free end and an opposite end anchored to bone within a patient'"'"'s body;

loading a second suture limb into the retaining mechanism of the suture passing instrument, the second suture limb having a free end and an opposite end anchored to bone within a patient'"'"'s body;

positioning first and second jaws of the suture passing instrument to grasp tissue within the patient'"'"'s body;

actuating the suture passing instrument to pass a portion of the first suture limb through the tissue grasped between the first and second jaws such that a first suture loop is formed on a surface of the tissue;

pulling the first suture loop to draw the free end of the first suture limb through the tissue;

pulling the free end of the second suture limb toward a proximal end of the suture passing instrument to draw the second suture limb into a proximal end of the retaining mechanism without removing the suture passing instrument from the patient'"'"'s body;

actuating the suture passing instrument a second time to pass a portion of the second suture limb through the tissue grasped between the first and second jaws such that a second suture loop is formed on the surface of the tissue;

pulling on the second suture loop to draw the free end of the second suture limb through the tissue; and

anchoring the free ends of the first and second suture limbs to bone to secure the tissue with respect to the bone.

22. The method of claim 21, wherein anchoring the free ends of the first and second suture limbs to bone comprises securing the free end of the first suture limb to a first bone anchor and the free end of the second suture limb to a second bone anchor.

23. The method of claim 21, further comprising repositioning the suture passing instrument prior to actuating the suture passing instrument a second time.