Knot tying apparatus having a notched thread cover and method for using same

• US 6,221,084 B1
• Filed: 01/15/1999
• Issued: 04/24/2001
• Est. Priority Date: 01/15/1999
• Status: Expired due to Fees

• Current Assignee: PARE Surgical Incorporated
• Original Assignee: PARE Surgical Incorporated
• Inventors: Fleenor, Richard P.
• Primary Examiner(s): Recla, Henry J.
• Assistant Examiner(s): TRINH, HOA B
• Application Number:
  US09/232,393
• Time in Patent Office: 830 Days
• Field of Search: 606/148, 606/144, 606/139, 606/145, 606/150, 606/151, 606/158, 606/205, 606/206, 606/208, 606/167, 606/170, 606/171, 112/169, 112/80.03, 289/17, 604/104-106
• US Class Current: 606/148
• CPC Class Codes: A61B 17/0467 Instruments for cutting sutures surgical cutting instruments A61B17/32
• 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 17/06066 Needles, e.g. needle tip configurations making needles B21G1/00
• CPC Class Codes: A61B 17/062 Needle manipulators
• 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 2017/0475 using sutures having a slip knot
• CPC Class Codes: A61B 2017/0477 with pre-tied sutures

Abstract

The present invention provides a knot tying apparatus having a notched thread cover and methods for using such a knot tying apparatus for placing knots. The present invention has particular utility in tying and placing knots during laparoscopic surgery. The thread cover includes at least one notch in the distal end which is sized so as to allow a thread such as a suture thread to pass therethrough while preventing a knot in the thread from passing therethrough. Using the notched thread cover which is attached to the distal end of a knot tying apparatus, it is possible to both pull and push on the knot when cinching the knot around the member being tied. Being able to simultaneously push and pull on the knot minimizes the forces exerted against the member being tied, thereby reducing the likelihood that fragile members such as blood vessels and the like are damaged during the tying procedure. The knot tying apparatus includes a knot carrier and a knot slider slidably connected thereto. The thread cover preferably at least partially surrounds a knot carrier and is connected to the distal end of a knot slider.

Claims

1. A thread cover for a knot tying apparatus, said knot tying apparatus being used for placing an at least partially formed knot located between a first end and a second end of a thread, comprising:

(a) a sheath surrounding an inner cavity, said sheath having a proximal end, and a distal end, said inner cavity being sized and shaped to accommodate a thread disposed therein, and wherein said sheath is adapted at said proximal end to be connected to a knot slider, said knot slider acting to displace at least a portion of said thread into said cavity; and

(b) a notch in said distal end of said sheath, wherein the width of said notch is sufficient to allow said thread to slide therethrough while preventing said at least partially formed knot in said thread from sliding therethrough, thereby allowing said at least partially formed knot to be pushed by said thread cover along a portion of said thread.

2. A thread cover according to claim 1, wherein said sheath contains an aperture near said proximal end, and wherein said knot slider includes a protrusion which fits into said aperture.

3. A thread cover according to claim 1, wherein said sheath includes a plurality of notches at said distal end.

4. A thread cover according to claim 3, wherein said sheath includes two notches.

5. A thread cover according to claim 1, wherein said sheath is substantially cylindrical.

6. A thread cover according to claim 5, wherein said sheath includes two notches which are spaced approximately 180 degrees apart.

7. A knot tying apparatus for use in placing a knot near a member, comprising:

(a) a knot carrier;

(b) a knot slider slidably attached to said knot carrier;

(c) a thread having a first end and a second end and an at least partially formed knot located therebetween, a portion of said thread being initially wound around said knot carrier and said first end of said thread being attached to said knot slider; and

(d) a thread cover having a proximal end and a distal end, said thread cover proximal end connected to said knot slider distal end, and said thread cover at least partially surrounding said knot carrier and including a notch in said distal end, wherein the width of said notch is sufficiently wide to allow said thread to slide therethrough while preventing said at least partially formed knot from sliding therethrough, thereby allowing said at least partially formed knot to be pushed along said thread by said thread cover.

8. A knot tying apparatus according to claim 7, further including a needle, said needle being attached to said second end of said thread.

9. A knot tying apparatus according to claim 8, further including a jaws for pulling on said needle or said second end of said thread, said jaws capable of being retracted so as to be at least partially surrounded by said thread cover.

10. A knot tying apparatus according to claim 8, wherein said at least partially formed knot is initially located on said knot carrier at a point distal from said knot slider, whereby sliding said knot slider distally pushes said at least partially formed knot distal to said knot carrier.

11. A knot tying apparatus according to claim 7, wherein said thread cover includes a plurality of notches at said distal end.

12. A knot tying apparatus according to claim 11, wherein said thread cover includes 2 notches.

13. A knot tying apparatus according to claim 7, wherein said thread cover is a substantially cylindrical sheath.

14. A knot tying apparatus according to claim 13, wherein said thread cover includes 2 notches at said distal end, said 2 notches being spaced approximately 180 degrees apart.

15. A knot tying apparatus according to claim 7, wherein said thread cover includes an aperture at said proximal end of said thread cover, and wherein the distal end of said knot slider includes a protrusion which fits into said aperture.

16. A knot tying apparatus for use in placing a knot near a member, comprising:

(a) a knot carrier having a proximal end and a distal end;

(b) a knot slider slidably attached to said knot carrier;

(c) a thread having a first end and a second end and an at least partially formed knot located therebetween, said at least partially formed knot initially located on said knot carrier distal to said knot slider, and wherein said knot slider is a sheath that is attached to said knot carrier at a position proximal to said at least partially formed knot, and wherein said first end of said thread is attached to said knot slider; and

(d) a thread cover having a proximal end and a distal end, said thread cover proximal end being attached to said knot slider, said thread cover at least partially surrounding said knot carrier and being spaced away from said knot carrier sufficiently such that said at least partially formed knot initially resides between said knot carrier and said thread cover, and said thread cover distal end including a notch, wherein the width of said notch is sufficiently wide to allow said thread to slide therethrough while preventing said at least partially formed knot from sliding therethrough, thereby allowing said at least partially formed knot to be pushed along said thread by said thread cover.

17. A knot tying apparatus according to claim 16, wherein said knot slider snugly fits around said knot carrier at a position proximal to said at least partially formed knot, and wherein said thread cover is attached to said knot slider proximal to first end of said thread and extends distally beyond said knot carrier.

18. A knot tying apparatus according to claim 16, further including:

(a) an elongate tube having a proximal end and a distal end, said elongate tube distal end being connected to said knot carrier; and

(b) an actuating tube having a first end and a second end which overlaps said elongate tube, said actuating tube first end abutting said knot pusher proximal end, and said actuating tube second end being located between said knot slider and said elongate tube proximal end.

19. A method of placing and tying a knot using a knot tying apparatus, comprising:

(a) positioning said knot tying apparatus adjacent a member to which an at least partially formed knot is to be applied, said knot tying apparatus including a knot slider and a thread cover, each having a proximal end and a distal end, said thread cover proximal end being connected to said knot slider distal end, and said thread cover distal end having a notch for engaging an at least partially formed knot located between a first and second end of a thread, said notch being sufficiently wide to allow said thread to slide therethrough while preventing said at least partially formed knot in said thread from sliding therethrough;

(b) placing said at least partially formed knot adjacent said member using said knot tying apparatus;

(c) engaging said at least partially formed knot with said notch in said thread cover; and

(d) sliding said at least partially formed knot along a portion of said thread with said thread cover in a first direction.

20. A method according to claim 19, wherein said knot tying apparatus further including a knot carrier, said knot carrier having a proximal end and a distal end, said knot slider being slidably attached to said knot carrier, said knot carrier being at least partially surrounded by said thread cover, and said at least partially formed knot initially being located on said knot carrier.

21. A method according to claim 20, wherein said first end of said thread is attached to said knot slider and said at least partially formed knot is located distal to said knot slider, and wherein said placing step includes sliding said knot slider distally, thereby pushing said at least partially formed knot distal to said knot carrier.

22. A method according to claim 19, wherein said engaging step involves placing said at least partially formed knot in abutting relationship with the exterior of said thread cover and said notch.

23. A method according to claim 19, further including a pulling step, wherein said pulling step involves pulling on said knot tying apparatus in a second direction.

24. A method according to claim 23, wherein said first direction is toward said member and wherein said second direction is away from said member.

25. A method according to claim 23, said knot tying apparatus further including a needle, said needle being attached to said thread second end, and wherein said pulling step includes pulling on said needle.

26. A method according to claim 25, said knot tying apparatus further including a pair of jaws, said jaws being capable of being retracted so as to be at least partially surrounded by said thread cover, and wherein said pulling step involves pulling on said needle with said jaws.

27. A method according to claim 23, wherein said sliding step and said pulling step are performed simultaneously to minimize pulling forces on said member.

28. A method according to claim 26, wherein said sliding step and said pulling step are performed simultaneously to minimize pulling forces on said member.

29. A method for placing and tying a knot using a knot tying apparatus, comprising:

(a) positioning said knot tying apparatus adjacent a member to which an at least partially formed knot is to be applied, said knot tying apparatus including (I) a knot carrier having a proximal end and a distal end, (ii) a knot slider slidably attached to said knot carrier, (iii) a thread having a first end and a second end and an at least partially formed knot located therebetween, said at least partially formed knot initially located on said knot carrier distal to said knot slider, and wherein said knot slider is a sheath that is attached to said knot carrier at a position proximal to said at least partially formed knot, and wherein said first end of said thread is attached to said knot slider, and (iv) a thread cover having a proximal end and a distal end, said thread cover proximal end being attached to said knot slider, said thread cover at least partially surrounding said knot carrier and being spaced away from said knot carrier sufficiently such that said at least partially formed knot initially resides between said knot carrier and said thread cover, and said thread cover distal end including a notch, wherein the width of said notch is sufficiently wide to allow said thread to slide therethrough while preventing said at least partially formed knot from sliding therethrough, thereby allowing said at least partially formed knot to be pushed along said thread by said thread cover;

(b) placing said at least partially formed knot adjacent said member using said knot tying apparatus;

(c) engaging said at least partially formed knot with said notch in said thread cover; and

(d) sliding said at least partially formed knot along a portion of said thread with said thread cover in a first direction.

30. A method according to claim 29, wherein said placing step includes sliding said knot slider distally, thereby pushing said at least partially formed knot distal to said knot carrier.

31. A method according to claim 29, further including a pulling step, wherein said pulling step involves pulling on said knot tying apparatus in a second direction.

32. A method according to claim 31, wherein said first direction is toward said member and wherein said second direction is away from said member.

33. A method according to claim 31, said knot tying apparatus further including a needle attached to said thread second end, and wherein said pulling step includes pulling on said needle.

34. A method according to claim 33, said knot tying apparatus further including a pair of jaws, said jaws being capable of being retracted so as to be at least partially surrounded by said thread cover, and wherein said pulling step involves pulling on said needle with said jaws.

35. A method according to claim 31, wherein said sliding step and said pulling step are performed simultaneously to minimize pulling forces on said member.

36. A method according to claim 34, wherein said sliding step and said pulling step are performed simultaneously to minimize pulling forces on said member.