Method of advancing a suture through tissue

• US 5,544,664 A
• Filed: 05/16/1994
• Issued: 08/13/1996
• Est. Priority Date: 12/03/1991
• Status: Expired due to Term

• Current Assignee: Boston Scientific Scimed (Boston Scientific Corporation)
• Original Assignee: Boston Scientific Technology Incorporated (Boston Scientific Corporation)
• Inventors: Benderev, Theodore V., Legome, Mark J., Naves, Neil H.
• Primary Examiner(s): Sykes, Angela D.
• Assistant Examiner(s): GILBERT, SAMUEL G
• Application Number:
  US08/243,690
• Time in Patent Office: 820 Days
• Field of Search: 128/898, 606/60, 606/76, 606/77, 606/78, 606/139, 606/144, 606/145, 606/147-148, 606/150, 606/222, 606/223, 606/224-227, 606/80, 606/96-98
• US Class Current: 128/898
• 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 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• 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 17/06109 Big needles, either gripped by hand or connectable to a handle
• CPC Class Codes: A61B 17/062 Needle manipulators
• CPC Class Codes: A61B 17/0644 penetrating the tissue, deformable to closed position
• CPC Class Codes: A61B 17/10 for applying or removing wound clamps, e.g. containing only one clamp or staple A61B17/076 takes precedence; containing multiple wound clamps A61B17/068; Wound clamp magazines containers, packaging elements or packages specially adapted for particular articles or with special means for dispensing contents B65D83/00, B65D85/00
• CPC Class Codes: A61B 17/1739 specially adapted for particular parts of the body
• CPC Class Codes: A61B 17/1796 for holes for sutures or flexible wires
• CPC Class Codes: A61B 17/42 Gynaecological or obstetrical instruments or methods ligaturing clamps or clips for the umbilical cord A61B17/122; curettage A61B17/320708; dilators A61M29/00
• 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 2017/00805 Treatment of female stress urinary incontinence
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening lateral eyelet for attaching suture to needle A61B2017/06019
• CPC Class Codes: A61B 2017/0458 Longitudinal through hole, e.g. suture blocked by a distal suture knot
• CPC Class Codes: A61B 2017/0461 with features cooperating with special features on the suture, e.g. protrusions on the suture
• CPC Class Codes: A61B 2017/0462 One way system, i.e. also tensioning the suture
• CPC Class Codes: A61B 2017/0464 for soft tissue
• CPC Class Codes: A61B 2017/0472 Multiple-needled, e.g. double-needled, instruments
• CPC Class Codes: A61B 2017/0496 : for tensioning sutures
• CPC Class Codes: A61B 46/30 : for surgery through the lower body openings, e.g. urology, gynaecology

Abstract

The surgical treatment of stress urinary incontinence is disclosed. The disclosed methods include: 1) a technique of probe passage to avoid injuring the bladder and to provide a more accurate and reproducible capture of the pubocervical fascia lateral to the bladder neck and urethra, 2) anchor fixation of the suspending sutures to the pubic bone to decrease the risk of suture pull through from above and to decrease post-operative pain and 3) a simple and reproducible technique to set a limited tension of the suspending sutures. A description of these methods and results of procedures with some of these methods are disclosed. Novel drill guides, suture passers, suture tensioners, and various related tools and devices for use in the surgical method are also disclosed.

Claims

1. A method of advancing a suture through tissue, comprising the steps of:

positioning a suture on one side of the tissue;

providing a suture passer having an elongate probe for penetrating tissue and a releasable suture engagement structure on a distal portion thereof, the suture engagement structure being adapted to engage the suture at a point spaced apart from an end of the suture;

advancing the suture passer distally through the tissue towards the suture;

grasping the suture at the point spaced apart from the end of the suture within the suture engaging structure by activating the suture engagement structure to lock the suture in the suture engaging structure; and

thereafter

withdrawing the suture passer proximally to draw the suture through the tissue.

2. A method of advancing a suture through tissue as in claim 1, further comprising the step of advancing the suture passer distally through the tissue to advance the suture distally therethrough.

3. A method of advancing a suture through tissue, comprising the steps of:

positioning a suture on one side of the tissue;

providing a suture passer having a handle, an elongate tubular guide extending in a distal direction from the handle, an elongate pointed probe axially movably disposed within the tubular guide, and movable from a first position with respect to the guide to a second axially displaced position with respect to the guide, and a suture engaging structure on at least one of the guide and the probe;

advancing the suture passer distally through the tissue towards the suture;

positioning the suture within the suture engaging structure while the probe is in the first position;

displacing the probe from the first position to the second position to secure the suture within the suture engaging structure; and

thereafter

withdrawing the suture passer proximally to draw the suture through the tissue.

4. A method of advancing a suture through tissue as in claim 3, wherein said positioning the suture step comprises positioning a portion of the suture spaced apart from an end of the suture.

5. A method of advancing a suture through tissue as in claim 4, wherein said positioning the suture step comprises manually pressing a portion of the suture against a side of the tubular guide and sliding the suture along the guide until the suture into the suture engaging structure.

6. A method of advancing a suture through tissue as in claim 3, wherein said positioning the suture step comprises positioning the suture within a recess on the probe.

7. A method of advancing a suture through tissue as in claim 6, wherein said positioning the suture step comprises advancing the suture radially inwardly through an opening on the tubular guide and into a recess on the probe, and thereafter axially displacing the recess on the probe from the opening on the tubular guide.

8. A method of advancing a suture through tissue, comprising the steps of:

providing a suture passer having a handle, a tubular guide extending in a distal direction from the handle, and a pointed probe axially movably disposed within the tubular guide;

advancing the probe in a distal direction through tissue;

positioning the suture within the suture engagement structure on the suture passer;

axially displacing the probe with respect to the guide to lock the suture within the suture structure; and

proximally withdrawing the suture passer to draw the suture through the tissue.