Apparatuses and methods for formation and use of a slipknot as a surgical suture knot

• US 5,217,470 A
• Filed: 04/29/1991
• Issued: 06/08/1993
• Est. Priority Date: 04/29/1991
• Status: Expired due to Fees

• Current Assignee: Peter V. Weston
• Original Assignee: Peter V. Weston
• Inventors: Weston, Peter V.
• Primary Examiner(s): Pellegrino, Stephen C.
• Assistant Examiner(s): SCHMIDT, JEFFREY
• Application Number:
  US07/693,943
• Time in Patent Office: 771 Days
• Field of Search: 289/15, 289/13, 289/12, 289/2, 289/1.5, 289/17, 289/18, 66/1 A, 66/4, 606/224, 606/139, 606/145, 606/144, 606/148, 606/228
• US Class Current: 606/148
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/12013 for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 2017/0474 Knot pushers
• CPC Class Codes: A61B 2017/0477 with pre-tied sutures

Abstract

Disclosed is a novel use of the capstan knot as a suture knot in surgical procedures along with a simplified method for such knot'"'"'s formation, an apparatus for forming a protoknot of the capstan knot, and a pre-formed suture system which provides a capstan knot protoknot mounted on a knot tightener having a channel passing therethrough. The protoknot, once formed, is transformed into a completed capstan knot by straight-line passage of the standing part of the filament, to which a surgical needle is initially attached, through a defined path through the protoknot after passage of the filament through the patient'"'"'s tissue.

Claims

1. An apparatus for forming a capstan knot from a filament comprising:

a sliding pin plate having a moving pin attached thereto and extending therefrom;

a pin plate having a plurality of stationary pins extending therefrom; and

a middle plate with a plurality of pin holes and a slot passing therethrough for respectively receiving said stationary pins and said moving pin therethrough, said stationary pins and said moving pin when extending through said middle plate together defining a first filament path on a middle plate interior face of said middle plate for threading said filament, said middle plate interior face having a first ridge, a first ridge receiving recess, and a elongate channel formed thereon, said first ridge and said first ridge receiving recess serving to orient said filament when threaded to traverse said first path whereby passing an end of said filament along said elongate channel completes formation of said capstan knot.

2. An apparatus for forming a knot from a filament comprising:

a plate having a plate interior face with a plurality of guide pins extending above said plate interior face, said guide pins for defining in first and second dimensions a first filament path on said plate interior face for a filament to traverse substantially in a first plane;

said plate interior face further includes for defining said first filament path in a third dimension, first positioning means for diverting a first portion of said filament in a first direction substantially perpendicular to said first plane and second positioning means for diverting a second portion of said filament from said first plane generally in a second direction, substantially opposite said first direction;

said plate interior face further exhibiting indicia which defines a second filament path by following which second filament path a needle segment of said filament threaded to traverse said first filament path completes formation of said knot.

3. The invention of claim 2 wherein said plate exhibits a moving guide pin slot, and wherein said apparatus further comprises:

a sliding pin plate having a moving guide pin extending therefrom which moving guide pin constitutes one of said guide pins when aid sliding pin plate and said plate are facially juxtaposed for said moving guide pin to extend through said moving guide pin slot, which moving guide pin, by extending through said plate, extends above said plate interior face; and

a pin plate having a plurality of stationary guide pins extending therefrom, said stationary guide pins constituting all of said guide pins, except said moving guide pins, which extend above said plate interior face, said stationary guide pins extending through correspondingly positioned guide pin holes in said plate;

and further wherein said moving guide pin slot permits said moving guide pin to extend therethrough in a first heading and to move in a second heading, perpendicular to said first heading, for moving between first and second moving guide pin positions relative to said interior face of said plate;

said first moving guide pin position being to facilitate threading said filament about said first filament path, and movement from said first moving guide pin position to said second moving guide pin position being for configuring said filament relative to said indicia for the formation of said capstan knot upon passage of said needle segment along said second filament path, said filament having first been threaded about said first filament path.

4. The invention of claim 3 wherein said positioning means comprise a plurality of first ridges and first recesses on said plate interior face for raising and lowering portions of said filament relative to said first plane.

5. The invention of claim 3 wherein said pin plate and said sliding pin plate are removable from said plate whereby said stationary guide pins and said moving guide pin may be withdrawn from said guide pin holes and said slot in said plate.

6. The invention of claim 2 wherein said positioning means comprise a plurality of first ridges and first recesses on said plate interior face for raising and lowering portions of said filament relative to said first plane.

7. The invention of claim 6 further comprising a top plate having a top plate interior face with a plurality of second ridges and second recesses, said second ridges and said second recesses being situated relative to each other on said top plate interior face whereby said first ridges may extend into said second recesses and said first recesses may receive said second ridges when said top plate interior face and said plate interior face are juxtaposed.

8. A method for forming a capstan knot comprising the steps of:

selecting a filament with a needle segment;

selecting an apparatus comprising;

a middle plate having a middle plate interior face with a plurality of guide pins extending above said middle plate interior face, said guide pins defining a first filament path on said traverse substantially in a first plane, said middle plate interior face further having positioning means for positioning said filament in directions substantially perpendicular to said first plane;

said middle plate interior face further exhibiting indicia which defines a second filament path by following which second filament path the needle segment of said filament threaded to traverse said first filament path completes formation of said capstan knot;

threading said filament so as to traverse said first filament path; and

passing said needle segment of said filament along said second filament path.

9. The invention of claim 8 wherein said apparatus further comprises:

a sliding pin plate having a moving guide pin attached thereto and extending therefrom which moving guide pin constitutes one of said guide pins which, by extending through a moving guide pin slot in said middle plate, extends above said middle plate interior face when said plate and said sliding pin plate are facially juxtaposed; and

a pin plate having a plurality of stationary guide pins extending therefrom, said stationary guide pins constituting all of said guide pins, except said moving guide pin, which extend above said middle plate interior face, said stationary guide pins extending through correspondingly positioned guide pin holes in said middle plate;

and further wherein said moving guide pin slot permits said moving guide pin to extend therethrough in a first heading and to move in a second heading, perpendicular to said first heading, for moving between first and second moving guide pin positions relative to said interior face of said plate;

said first moving guide pin position being to facilitate threading said filament about said first filament path, and movement from said first moving guide pin position to said second moving guide pin position being for configuring said filament relative to said indicia for the formation of said capstan knot upon passage of said needle segment along said second filament path, said filament having first been threaded about said first filament path.

10. The method of claim 9 wherein said positioning means comprise a plurality of first ridges and first recesses on said middle plate interior face for raising and lowering said filament relative to said first plane.

11. The invention of claim 10 wherein said apparatus further comprises a top plate having a top plate interior face with a plurality of second ridges and second recesses, said second ridges and said second recesses being situated relative to each other on said top plate interior face whereby said first ridges may extend into said second recesses and said first recesses may receive said second ridges when said top plate interior face and said middle plate interior face are juxtaposed.

12. The invention of claim 9 wherein said pin plate and said sliding pin plate are removable from said middle plate whereby said stationary guide pins and said moving guide pin may be withdrawn from said guide pin holes and said slot in said middle plate.

13. A method for forming a capstan knot comprising the steps of:

selecting a tubular member and a filament, said tubular member having a first and a second tube end;

with the long axis of said tubular member situated in a fixed reference orientation in a first plane (such as a vertical orientation relative to an individual forming said knot), doubling a length of said filament adjacent to said tubular member and on a first side of said tubular member (such as a side of said tubular member opposite from said individual) such that a first filament bight is formed at a first bight point situated on said first side of said tubular member and separated from said tubular member in substantially a first lateral direction from said tubular member, said first lateral direction being orthogonal to said fixed reference orientation (such as to the right of said tubular member from said individual'"'"'s perspective) with a first terminal length of said filament and a second needle length of said filament extending from said first filament bight beyond and perpendicular to said tubular member in a second lateral direction orthogonal to said fixed reference orientation and substantially opposite said first lateral direction (such as behind said tubular member and toward the left thereof from said individual'"'"'s perspective), said needle length and said terminal length lying substantially in a single second plane parallel with said first plane of said fixed reference orientation, said terminal segment lying closer to said first tube end than said needle segment and being separated from said needle segment by approximately one inch;

grasping a loop segment point a loop segment of said needle segment, said loop segment point lying substantially on said first side of and in said second lateral direction from said tubular member and twisting said loop segment approximately 180°

(such as in a clockwise direction from said individual'"'"'s perspective) so as to form a second filament bight which second filament bight delineates a first length of said needle segment from a second length of said needle segment, said first length of said needle segment being closer to said first filament bight than said second length of said needle segment, said twist being made whereby said second length of said needle segment intersects said first length of said needle segment such that, if such intersection were immediately adjacent to and contacting said tubular member on said first side of said tubular member, said first length of said needle segment would contact said tubular member and separate said second length of said needle segment from said tubular member;

moving said second filament bight substantially in said first lateral direction and across a second side of said tubular member, said second side being opposite said first side, so as to partially encircle said tubular member;

moving said second filament light in a third direction from said second side toward said first side of said tubular member and without further substantially twisting said loop segment, passing said second filament bight through a space the perimeter of which space is jointly defined by said first filament bight and said tubular member;

moving said second filament light in a fourth direction, substantially opposite from said third direction, from said first side of said tubular member toward said second side of said tubular member, passing said second filament bight around a section of said first filament bight closest said first tube end, and over said first tube end; and

passing said needle segment of said filament through said tubular member moving from said second tube end to said first tube end.