Suture threading, stitching and wrapping device for use in open and closed surgical procedures

• US 5,059,201 A
• Filed: 01/22/1991
• Issued: 10/22/1991
• Est. Priority Date: 11/03/1989
• Status: Expired due to Fees

• Current Assignee: Smith & Nephew Incorporated (Smith & Nephew PLC)
• Original Assignee: Stanley E. Asnis
• Inventors: Asnis, Stanley E.
• Primary Examiner(s): Pellegrino, Stephen C.
• Assistant Examiner(s): Jackson, Gary
• Application Number:
  US07/644,677
• Time in Patent Office: 273 Days
• Field of Search: 606/138-140, 606/144, 606/146, 606/148
• US Class Current: 606/144
• CPC Class Codes: A61B 17/04 for suturing wounds; Holders or packages for needles or suture materials suture materials A61L17/00
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 2017/00349 Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue A61B17/06066 takes precedence
• CPC Class Codes: A61B 2017/06042 located close to needle tip

Abstract

A surgical instrument for threading a loop of suture material through a piece of tissue to be stitched or removed as part of a surgical procedure and for wrapping a loop of suture around a piece of tissue. The instrument includes an extractor shaft assembly which is slidably disposed inside an inner tube. The latter is slidably disposed inside an outer tube. The extractor assembly has a pointed front end and a hook directly behind the front end. A tissue clamping bracket is secured to the front end of the outer tube, both of which are sized to fit inside a conventional cannula of the sort used in closed surgeries. The outer tube is secured to a handle assembly which includes a movable member for causing the inner tube to reciprocate inside the outer tube so as to coact with the clamping bracket to clamp a piece of tissue therein. By proper manipulation of the extractor assembly, a suture segment which is secured to the front of the clamping bracket can be captured and pulled through or over a piece of tissue clamped in the bracket and formed into a slip knot stitch which can be closed about the tissue piece.

Claims

1. A suturing device for passing a loop of suture material through a piece of tissue, said suturing device comprising:

(a) clamping means for releasably clamping a piece of tissue, said clamping means comprising;

an outer tube having a first end and a second end;

a bracket including a leg, said bracket being attached to said outer tube so that said leg projects across the longitudinal axis of said outer tube adjacent said first end of said outer tube and spaced from said first end of said outer tube; and

an inner tube having a first end and a second end, said inner tube being slidably disposed within said outer tube so that said first end of said inner tube can be advanced towards and away from said leg, whereby a piece of tissue can be clamped between said leg and said first end of said inner tube when said tissue is disposed between said leg and said first end of said inner tube and said first end of said inner tube is advanced towards said leg;

(b) actuation means coupled to said clamping means for actuating said clamping means from a location spaced from said tissue;

(c) suture support means for positioning and securing a segment of a loop of suture material having two free ends adjacent a first side of a piece of tissue clamped in said clamping means; and

(d) extraction means for (1) piercing an opening in a piece of tissue clamped in said clamping means and (2) engaging said segment adjacent said first side of said piece of tissue and pulling said segment through said opening to a location remote from said piece of tissue so that said loop of suture material passes through said opening from said first side of said piece of tissue through to a second side of said piece of tissue.

2. A device according to claim 1 wherein said clamping means, said suture support means and said extraction means are sized so as to be insertable in a single conventional cannula of the type used in closed surgery.

3. A device according to claim 1 wherein said leg comprises an inside surface that is configured to engage said first side of a piece of tissue clamped in said clamping means, an outside surface, and an aperture extending through said leg from said inside surface to said outside surface, with said aperture being aligned with the longitudinal axis of said inner tube and being sized so as to pass said extraction means therethrough.

4. A device according to claim 3 wherein said suture support means comprises a groove provided in said outside surface of said leg and a clamp secured to said actuation means for securing said two free ends of said loop of suture material so as to secure said loop under tension to said device and thereby retain said segment in said groove.

5. A device according to claim 1 wherein said bracket comprises a bottom wall having first and second shoulders positioned on opposite sides of said bottom wall.

6. A device according to claim 3 wherein said extraction means comprises a shaft slidably disposed in said inner tube, said shaft having a hooked first end for (1) piercing an opening in a piece of tissue clamped in said clamping means and thereafter passing through said aperture in said leg, (2) engaging said segment adjacent said outside surface of said leg, and (3) maintaining engagement with said segment as said shaft is withdrawn from said aperture and said opening in said tissue.

7. A device according to claim 1 wherein said actuation means comprises:

a fixed handle secured to said outer tube;

a movable handle pivotally mounted to said fixed handle, said movable handle having linkage means coupled with said inner tube for transmitting motion from said movable handle to said inner tube so that when said movable handle is pivoted toward and away from said fixed handle, said first end of said inner tube is moved, respectively, toward and away from said leg.

8. A device according to claim 7 wherein said actuation means further comprises locking means for locking said movable handle in a selected, fixed relationship with said fixed handle.

9. A device according to claim 6 wherein said hooked first end of said shaft extends beyond said outside surface of said leg when engaging said segment secured by said suture support means, and further wherein said extraction means comprises travel limit means for limiting the travel of said shaft so that only a selected length of said shaft can extend through said aperture in said leg.

10. A device according to claim 9 wherein said selected length ranges from 0.125 inches to 0.375 inches.

11. A suturing device for passing a loop of suture material around a piece of tissue, said suturing device comprising:

clamping means for releasably clamping a piece of tissue;

actuation means coupled to said clamping means for actuating said clamping means from a location spaced from said tissue;

suture support means for positioning and securing a segment of a loop of suture material adjacent a first side of a piece of tissue clamped in said clamping means; and

extraction means for engaging said segment and pulling said segment over a piece of tissue clamped in said clamping means to a location remote from said piece of tissue so that said loop of suture material passes around said piece of tissue.

12. A method of passing a loop of suture material through a piece of tissue comprising the following steps:

(1) providing a suturing device comprising;

clamping means for releasably clamping a piece of tissue, said clamping means comprising an outer tube having a first end and a second end, a bracket attached to said outer tube and including a leg having an inside surface and an outside surface, wherein said leg includes a groove in its outside surface and has a bore extending through said leg adjacent said groove, said bracket being attached to said outer tube so that said bore is coaxial with said outer tube, and an inner tube slidably disposed within said outer tube, said inner tube having a first end;

actuation means coupled to said inner tube for causing said inner tube to move axially between a forward position wherein said first end of said inner tube is advanced toward said leg, and a rearward position wherein said first end of said inner tube is withdrawn from said leg;

clamp means for securing portions of a length of suture material to said actuation means; and

a shaft slidably disposed in said inner tube and adapted to (1) pierce an opening in a piece of tissue disposed between said first end of said inner tube and said inside surface of said leg and pass through said bore in said leg and (2) engage a segment of a length of suture positioned in said groove and pull said segment through said bore and through the opening formed in a piece of tissue disposed between said first end of said inner tube and said inside surface of said leg to a location remote from said leg and said piece of tissue so that said length of suture material passes through said bore and said piece of tissue, said shaft including a front end having a hook;

(2) positioning a segment of a length of suture material in said groove in said outside surface of said leg, pulling portions of said length of suture material adjacent said segment away from said groove and securing said portions of suture material to said clamp means so that those of said portions between said groove and said clamp means are under tension;

(3) manipulating said suturing device so as to cause a piece of tissue having front and back surfaces to be received between said first end of said outer tube and said inside surface of said leg;

(4) manipulating said actuation means so as to cause said inner tube to move toward said forward position until said first end of said inner tube engages said rear surface of said tissue and said front surface of said tissue engages said inside surface of said leg;

(5) urging said shaft toward and through said piece of tissue and through said bore in said leg until said hook is adjacent said segment of suture material positioned in said groove, whereby said shaft forms an opening in said piece of tissue;

(6) manipulating said shaft so as to captivate said segment of suture material in said hook of said shaft, freeing said portions of suture material from said clamp means, and withdrawing said shaft from said piece of tissue so as to cause said segment of suture material and said portions of said suture adjacent said segment of suture material to pass through said opening in said piece of tissue, past said back surface of said piece of tissue, and into said inner tube; and

(7) operating said actuation means so as to cause said inner tube to move toward said rear position, thereby disengaging said inner tube from said piece of tissue, and manipulating said surgical device so as to disengage said piece of tissue from said bracket.

13. A method of wrapping a loop of suture material around an elongate piece of tissue comprising the following steps:

a) providing a suturing device comprising;

clamping means for releasably clamping a piece of tissue, said clamping means having (1) an outer tube, (2) a bracket attached to one end of said outer tube and including a leg having an inside surface and an outside surface, wherein said leg includes a groove in its outside surface and has a bore extending through said leg which is positioned adjacent said groove, and (3) an inner tube slidably disposed within said outer tube, said inner tube having a first end;

actuation means coupled to said inner tube for causing said inner tube to move axially between a forward position and a rearward position;

clamp means for securing portions of a length of suture material to said actuation means; and

a shaft slidably disposed in said inner tube and adapted to (1) pass through said bore in said leg and (2) engage a segment of a length of suture positioned in said groove and pull said segment through said bore to a location remote from said leg, said shaft including a front end having a hook;

b) positioning a segment of a length of suture material in said groove in said outside surface of said leg, pulling portions of said length of suture material adjacent said segment away from said groove and securing said portions of suture material to said clamp means so that those of said portions between said groove and said clamp means are under tension;

c) manipulating said suturing device so as to cause an elongate piece of tissue having front and back surfaces to be received between said outer tube and said leg;

d) manipulating said actuation means so as to cause said inner tube to move to said forward position and thereby extend above and captivate said piece of tissue between said bracket and said inner tube;

e) urging said shaft toward and through said bore in said leg until said hook is adjacent said segment of suture material positioned in said groove;

f) manipulating said shaft so as to captivate said segment in said hook of said shaft, freeing said portions of suture material from said clamp means, and withdrawing said shaft from said leg so as to cause said segment of suture material and portions of said suture material adjacent said segment of suture material to pass over said piece of tissue, past said back surface of said piece of tissue, and into said inner tube; and

g) operating said actuation means so as to cause said inner tube to move to said rear position, whereby said inner tube does not extend above and captivate said piece of tissue, and manipulating said suturing device so as to disengage said piece of tissue from said suturing device.

14. In a suturing apparatus comprising suture means for positioning a suture relative to a piece of tissue and control means for operating said suture means, said control means being remotely located from said suture means,

the improvements comprising:

a) clamping means for releasably clamping a piece of tissue, said clamping means having (1) an outer tube, (2) a bracket attached to one end of said outer tube and including a leg having an inside surface and an outside surface, wherein said leg includes a groove in its outside surface and has a bore extending through said leg which is positioned adjacent said groove, and (3) an inner tube slidably disposed within said outer tube, said inner tube having a first end;

(b) actuation means coupled to said inner tube for causing said inner tube to move axially between a forward position and a rearward position;

(c) clamp means for securing portions of a length of suture material to said actuation means; and

(d) a shaft slidably disposed in said inner tube and adapted to engage a segment of a length of suture positioned in said groove and pull said segment through said bore to a location remote from said piece of tissue so that said length of suture material is positioned relative to said piece of tissue.

15. A suturing device for passing a loop of suture material through a piece of tissue, said suturing device comprising:

(a) clamping means for releasably clamping a piece of tissue;

(b) actuation means coupled to said clamping means for actuating said clamping means from a location spaced from said tissue;

(c) suture support means for positioning and securing a segment of a loop of suture material having two free ends adjacent a first side of a piece of tissue clamped in said clamping means; and

(d) extraction means for (1) piercing a piece of tissue clamped in said clamping means and engaging said segment at said first side of said piece of tissue, and (2) pulling said segment through said piece of tissue to a location remote from said piece of tissue while said tissue is clamped in said clamping means, so that said loop of suture material passes through said tissue from said first side.

16. A suturing device for passing a loop of suture material through a piece of tissue, said suturing device comprising:

(a) clamping means for releasably clamping a piece of tissue;

(b) actuation means coupled to said clamping means for actuating said clamping means from a location spaced from said tissue;

(c) suture support means for positioning and securing a segment of a loop of suture material having two free ends adjacent a first side of a piece of tissue clamped in said clamping means; and

(d) extraction means for (1) piercing an opening in a piece of tissue clamped in said clamping means, (2) engaging said segment adjacent said first side of said piece of tissue, and (3) pulling said segment through said opening to a location remote from said piece of tissue so that said loop of suture material passes through said opening from said first side of said piece of tissue through to a second side of said piece of tissue, said extraction means being operable independently of said clamping means.

17. A suturing device for passing a loop of suture material through a piece of tissue, said suturing device comprising:

(a) clamping means for releasably clamping a piece of tissue;

(b) actuation means coupled to said clamping means for actuating said clamping means from a location spaced from said tissue;

(c) suture support means for positioning and securing a segment of a loop of suture material having two free ends adjacent a first side of a piece of tissue clamped in said clamping means; and

(d) extraction means for (1) piercing an opening in a piece of tissue clamped in said clamping means, (2) engaging said segment adjacent said first side of said piece of tissue, and (3) pulling said segment through said opening to a location remote from said piece of tissue so that said loop of suture material passes through said opening from said first side of said piece of tissue through to a second side of said piece of tissue, said extraction means and a portion of said clamping means being disposed in telescoping relation with one another.

18. A suturing device for passing a loop of suture material around a piece of tissue, said suturing device comprising:

(a) clamping means for releasably clamping a piece of tissue;

(b) actuation means coupled to said clamping means for actuating said clamping means from a location spaced from said tissue;

(c) suture support means for positioning and securing a segment of a loop of suture material having two free ends adjacent a first side of apiece of tissue clamped in said clamping means so that said suture material also extends below and adjacent to a bottom side of said piece of tissue and so that said two free ends extend adjacent to a second side of said piece of tissue; and

(d) extraction means for (1) engaging said segment of a loop of suture material adjacent said first side of said piece of tissue clamped in said clamping means, and (2) pulling said segment over a top side of said piece of tissue clamped in said clamping means to a location remote from said piece of tissue so that said loop of suture material passes around said piece of tissue.

19. A suturing device for passing a loop of suture material around a piece of tissue, said suturing device comprising:

(a) clamping means for releasably clamping a piece of tissue;

(b) actuation means coupled to said clamping means for actuating said clamping means from a location spaced from said tissue;

(c) suture support means for positioning and securing a segment of a loop of suture material having two free ends adjacent a first side of a piece of tissue clamped in said clamping means so that said suture material also extends below and adjacent to a bottom side of said piece of tissue and so that said two free ends extend adjacent to a second side of said piece of tissue; and

(d) extraction means for (1) engaging said segment of a loop of suture material adjacent said first side of said piece of tissue clamped in said clamping means, and (2) pulling said segment over a top side of said piece of tissue clamped in said clamping means to a location remote from said piece of tissue so that said loop of suture material passes around said piece of tissue, said extraction means being operable independently of said clamping means.

20. A suturing device for passing a loop of suture material around a piece of tissue, said suturing device comprising:

(a) clamping means for releasably clamping a piece of tissue;

(b) actuation means coupled to said clamping means for actuating said clamping means from a location spaced from said tissue;

(c) suture support means for positioning and securing a segment of a loop of suture material having two free ends adjacent a first side of a piece of tissue clamped in said clamping means so that said suture material also extends below and adjacent to a bottom side of said piece of tissue and so that said two free ends extend adjacent to a second side of said piece of tissue; and

(d) extraction means for (1) engaging said segment of a loop of suture material adjacent said first side of said piece of tissue clamped in said clamping means, and (2) pulling said segment over a top side of said piece of tissue clamped in said clamping means to a location remote from said piece of tissue so that said loop of suture material passes around said piece of tissue, said extraction means and a portion of said clamping means being disposed in telescoping relation with one another.