SURGICAL SUTURING DEVICE, METHOD AND TOOLS USED THEREWITH

• US 20160106417A1
• Filed: 12/22/2015
• Published: 04/21/2016
• Est. Priority Date: 07/26/2007
• Status: Active Grant

• Current Assignee: Alpha Scientific Corporation
• Original Assignee: Alpha Scientific Corporation
• Inventors: LEVINE, David E., LEVINE, Daniel S., LEVINE, Marshall S., COHEN, Neal B.
• Granted Patent: US 10,064,617 B2
• Time in Patent Office: Days
• US Class Current: 1/1
• 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 17/0485 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 2017/00792 Plastic surgery
• CPC Class Codes: A61B 2017/0496 for tensioning sutures
• CPC Class Codes: A61B 2017/06052 Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle hollow suture needles A61B2017/061
• CPC Class Codes: A61B 2017/06176 with protrusions, e.g. barbs

Abstract

An apparatus for remotely and subcutaneously positioning a tethering strand in tissue includes a housing, an actuator coupled with the housing for longitudinal reciprocation relative to the housing, and a nested pair of needles including a first needle coupled with the housing and a second needle coupled with the actuator. One of the needles has a sharpened tip and another one of the needles has a blunted tip. The first needle has a first length and the second needle has a second length, and the first length and the second length are selected so that advancement of the second needle using the actuator causes the sharpened tip to project beyond the blunted tip, and so that retraction of the second needle using the actuator causes the blunted tip to project beyond the sharpened tip.

Claims

1. An apparatus for remotely and subcutaneously positioning a tethering strand in tissue, wherein the apparatus comprises a housing, an actuator coupled with the housing for longitudinal reciprocation relative to the housing, and a nested pair of needles including a first needle coupled with the housing and a second needle coupled with the actuator, wherein one of the needles has a sharpened tip and another one of the needles has a blunted tip, wherein the first needle has a first length and the second needle has a second length, and wherein the first length and the second length are selected so that advancement of the second needle using the actuator causes the sharpened tip to project beyond the blunted tip, and so that retraction of the second needle using the actuator causes the blunted tip to project beyond the sharpened tip.

2. The apparatus of claim 1 wherein the sharpened tip is associated with an outer needle of the nested pair of needles and the blunted tip is associated with an inner needle of the nested pair of needles.

3. The apparatus of claim 1 wherein the actuator is biased relative to the housing so that the blunted tip is normally biased to project beyond the sharpened tip.

4. The apparatus of claim 3 wherein the housing further includes a spring extending between portions of the housing and portions of the actuator for normally biasing the blunted tip to project beyond the sharpened tip.

5. The apparatus of claim 1 wherein one of the needles is an outer needle of the nested pair of needles, and wherein the tethering strand is coupled with the outer needle.

6. The apparatus of claim 5 wherein the tethering strand is coupled with the outer needle by a sleeve engaging the outer needle and receiving the tethering strand between the sleeve and the outer needle.

7. The apparatus of claim 1 wherein one of the needles is an inner needle of the nested pair of needles, and wherein the tethering strand is coupled with the inner needle.

8. The apparatus of claim 7 wherein the tethering strand is threaded through a hollow inner needle.

9. A method for remotely and subcutaneously positioning a tethering strand in tissue using a nested pair of needles coupled with a housing and an actuator coupled with the housing for longitudinal reciprocation relative to the housing, and wherein a first needle has a blunted tip and a second needle has a Sharpened tip, comprising the steps of:

advancing the second needle relative to the first needle using the actuator so that the sharpened tip projects beyond the blunted tip;

inserting the nested pair of needles through a surface at a first location, and making a first puncture at the first location;

retracting the second needle using the actuator so that the blunted tip projects beyond the sharpened tip;

passing the nested pair of needles through the first puncture and beneath the surface, to a second location spaced from the first location;

advancing the second needle relative to the first needle using the actuator so that the sharpened tip projects beyond the blunted tip; and

inserting the nested pair of needles through the surface at the second location and exiting from beneath the surface, making a second puncture at the second location.

10. The method of claim 9 wherein the first puncture is coupled with an anchoring point located beneath the surface.

11. The method of claim 9 which further includes the steps of inserting a first tether into the first puncture, passing the first tether beneath the surface, and passing the first tether from the second puncture.

12. The method of claim 11 which further includes the steps of inserting a second tether into the first puncture, passing the second tether beneath the surface, and passing the second tether from a third puncture spaced from the first puncture and the second puncture.

13. The method of claim 11 wherein the first tether and the second tether are inserted into the first puncture using an apparatus having at least one tether positioning member, and wherein the method further includes the step of inserting the second tether into the first puncture without removing the tether positioning member from the first puncture.

14. The method of claim 9 which further includes the step of normally biasing the nested pair of needles so that the blunted tip projects beyond the sharpened tip.

15. The method of claim 9 which further includes the steps of forming an anchoring point adjacent to the first location, coupling a tether with the anchoring point using the nested pair of needles, attaching a suture to the tether, and drawing the tether and the suture through the anchoring point, for securing a tissue-engaging sling formed with the suture.

16. The method of claim 15 which further includes the step of forming the anchoring point at a zygomatic arch.

17. The method of claim 16 which further includes the step of forming a supporting rung associated with the zygomatic arch.

18. The method of claim 17 wherein the rung is formed by engaging periosteum or ligament portions associated with the zygomatic arch.

19. The method of claim 17 wherein the rung is formed by puncturing tissue associated with the zygomatic arch, for receiving first portions of the sling, and by extending second portions of the sling over the zygomatic arch.

20. The method of claim 17 wherein the rung is formed by puncturing first tissue portions associated with the zygomatic arch, for receiving first portions of the sling, and by puncturing second tissue portions associated with the zygomatic arch spaced from the first portions, for receiving second portions of the sling.

21. The method of claim 15 which further includes the step of tensioning the sling against the anchoring point.

22. The method of claim 21 which further includes the steps of positioning a correction line between a first end of the suture and a second end of the suture, forming a temporary knot in the suture with the first end and the second end, and loosening the temporary knot using the correction line.

23. The method of claim 9 which further includes remote positioning of a suture beneath the surface, wherein the remote positioning of the suture further includes the steps of:

inserting an elongate member associated with and extending from body portions of a suture-positioning fixture into the second puncture, wherein a distal end of the elongate member includes an opening for engaging portions of the suture, wherein the fixture includes a guide associated with and extending from the body portions of the fixture, and wherein the guide is spaced from the elongate member and includes an aligning key;

aligning the suture with a longitudinal axis extending through the opening of the elongate member by engaging the guide of the fixture, and passing the suture along the axis of the opening, through a first accessing puncture for entering beneath the surface, through the opening of the elongate member, and through a second accessing puncture for exiting from beneath the surface.

24. The method of claim 23 which further includes the steps of coupling a first end of a first tether to the elongate member which receives the suture, and applying tension to a second end of the first tether opposite to the first end, drawing the elongate member into the second puncture.

25. The method of claim 24 wherein the drawing step guides the elongate member through a channel extending between the second puncture and the first puncture.

26. The method of claim 23 which further includes the steps of inserting a second elongate member associated with and extending from the body portions of the fixture into a third puncture spaced from the first puncture and the second puncture, aligning the suture with the longitudinal axis extending through the openings of the elongate members.

27. The method of claim 26 which further includes the steps of coupling a first end of a second tether to the second elongate member, and applying tension to a second end of the second tether opposite to the first end, drawing the elongate member into the third puncture.

28. The method of claim 27 wherein the drawing step guides the elongate member through a channel extending between the third puncture and the first puncture.