Device and method for suturing tissue
First Claim
1. A device for suturing a tissue layer having two sides, the device comprising:
- a suture;
an elongate member;
means on the elongate member for releasably retaining at least a portion of the suture in a stationary position on one side of the tissue layer; and
means located at least partially on an opposite side of the tissue layer for retrieving the portion of the suture through the tissue layer whereby the suture is drawn from one side to the opposite side.
3 Assignments
0 Petitions
Accused Products
Abstract
The present invention provides devices and methods for suturing a tissue layer having two sides with a suture by releasably retaining at least a portion of the suture in a stationary position on one side of the tissue layer. The portion of the suture is retrieved through the tissue layer from the opposite side whereby the suture is drawn from one side to the opposite side. Devices and methods for suturing the wall of a tubular graft having two sides is also provided using a suture by releasably retaining at least a portion of the suture on one side of the wall. The portion of the length of suture is retrieved through the wall of the graft to the opposite side of the wall. A graft anastomosis assembly provided herein sutures a tubular graft about an aperture in a tissue wall using a suture, a tissue suturing and graft suturing devices. Fastener types other than sutures are useful with the present invention whereby a first fastener portion is releasably retained in a stationary position on one side of a tissue layer while a second fastener portion is driven through the tissue layer from the opposite side and securely engages the two portions together.
454 Citations
58 Claims
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1. A device for suturing a tissue layer having two sides, the device comprising:
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a suture;
an elongate member;
means on the elongate member for releasably retaining at least a portion of the suture in a stationary position on one side of the tissue layer; and
means located at least partially on an opposite side of the tissue layer for retrieving the portion of the suture through the tissue layer whereby the suture is drawn from one side to the opposite side. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13)
a shaft having a proximal and distal end, the shaft being adapted for advancing through the tissue layer by forming an aperture therein;
at least one needle carried near the distal end of the shaft, the suture secured to the needle; and
means for drawing the needle proximally through the tissue layer, the drawing means being integrally formed with the shaft.
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3. The tissue suturing device of claim 2 wherein the suture is drawn through the aperture and then through the tissue.
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4. The tissue suturing device of claim 2 wherein the suture is releasably secured to the needle.
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5. The tissue suturing device of claim 2 wherein the at least one needle is removably carried near the distal end of the shaft.
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6. The tissue suturing device of claim 1 wherein the retrieving means includes passing the portion of the suture through the tissue layer from the proximal side to a distal side.
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7. The tissue suturing device of claim 1 wherein:
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the retrieving means includes a shaft having a proximal and distal end, the shaft being adapted for advancing partially through the tissue layer to form an aperture, at least one needle carried above the distal end of the shaft sufficient to be positioned on the distal side of the tissue layer, and means for reversibly advancing the needle through the tissue; and
the retaining means includes a foot attached to the distal end of the shaft, the foot being adapted to advance through the aperture to be positioned on the proximal side of the tissue layer, the foot having a suture channel integrally formed therewith to releasably retain at least a portion of the suture therein.
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8. The tissue suturing device of claim 7, wherein the device includes:
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a plurality of needles, each of the needles spaced about the shaft; and
a plurality of sutures, each suture having a first and second suture portion, each first suture portion releasably retained on the foot for engaging the needle and each second suture portion extending toward the proximal end of the shaft.
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9. The tissue suturing device of claim 8, wherein the distal end of the shaft further includes at least one suture lumen adapted to house the second suture portions.
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10. The tissue suturing device of claim 1 wherein the retaining means includes:
a foot being adapted for advancing to the suture site adjacent the tissue layer, the foot having a suture channel integrally formed therewith to releasably retain at least a portion of the suture therein.
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11. The tissue suturing device of claim 1 wherein the tissue layer is a vessel wall.
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12. The tissue suturing device of claim 1 wherein the two sides of the tissue layer are a distal side and proximal side, the retaining means releasably retaining at least a portion of the suture on the distal side of the tissue layer, and the retrieving means retrieving a portion of the suture through the tissue layer to the proximal side.
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13. The tissue suturing device of claim 1 wherein the retrieving means and retaining means are integrally connected.
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14. A device for suturing tissue in the proximity of an aperture in a tissue layer, the device comprising:
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a shaft having a proximal and distal end;
a foot attached to the distal end of the shaft, the foot being adapted for advancing through the aperture;
at least one needle carried above the distal end of the shaft;
at least a portion of a suture releasably retained on the foot in the proximity of the aperture; and
means for reversibly advancing the needle through the tissue to retrieve and draw at least a portion of the suture through the tissue, the advancing means being integrally formed with the shaft. - View Dependent Claims (15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29)
at least two needles carried above the distal end of the shaft; and
the suture is secured to and extends between the pair of needles.
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17. The tissue suturing device of claim 16 wherein the suture is drawn through the tissue on opposite sides of the aperture.
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18. The tissue suturing device of claim 17 wherein the suture is tightened to draw the aperture closed.
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19. The tissue suturing device of claim 14 wherein the advancing means includes drawing the suture through a second tissue layer.
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20. The tissue suturing device of claim 19 wherein the suture is tightened to draw the tissue layer and second tissue layer in contact with one another.
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21. The tissue suturing device of claim 20 wherein the tissue layer defines a vessel wall and the second tissue layer defines a graft.
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22. The tissue suturing device of claim 14 wherein the device includes:
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a plurality of needles carried above the distal end of the shaft;
a plurality of sutures, each suture releasably retained on the foot in the proximity of the aperture; and
the advancing means reversibly advances each needle through the tissue to retrieve and draw at least a portion of each suture through the tissue layer.
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23. The tissue suturing device of claim 22 wherein the advancing means reversibly advances the plurality of needles simultaneously.
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24. The tissue suturing device of claim 22, wherein the shaft further includes a suture lumen adapted to house the plurality of sutures.
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25. The tissue suturing device of claim 14 wherein the tissue layer is a vessel wall.
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26. The tissue suturing device of claim 25 wherein the device includes means for maintaining adequate perfusion through a vessel defined by the vessel wall while the foot extends through the aperture into the vessel, drawing the suture through the vessel wall and securing the suture to the vessel wall in the proximity of the aperture.
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27. The tissue suturing device of claim 26 wherein the maintaining perfusion means includes a passageway through the foot parallel to the direction of perfusion.
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28. The tissue suturing device of claim 26 wherein the maintaining perfusion means includes the foot having a cross-sectional shape and size smaller than the vessel to allow perfusion between the vessel wall and the cross-section of the foot.
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29. The tissue suturing device of claim 25 wherein the device includes means for maintaining hemostasis in the proximity of the aperture while advancing the shaft through the aperture in the vessel wall, drawing the suture through the vessel wall and securing the suture to the vessel wall in the proximity of the aperture.
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30. A device for suturing the wall of a tubular graft having two sides, the device comprising:
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a suture;
an elongate member;
means fixedly secured to the elongate member for releasably retaining at least a portion of the suture on one side of the wall; and
means on the elongate member for retrieving the portion of the length of suture through the wall of the graft to the opposite side of the wall. - View Dependent Claims (31, 32, 33, 34, 35)
a plurality of sutures;
the retrieving means including a plurality of needles that are secured to and are spaced about a needle carrying portion, each of the needles is extendible from the needle carrying portion and an actuator being adapted for extending the needles from the needle carrier and through the wall of the graft to retrieve the sutures.
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33. The graft suturing device of claim 30 wherein the elongate member comprises a shaft and the retrieving means includes:
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the shaft having a needle carrying portion being adapted to be positioned coaxially within the wall of the graft;
a needle being secured to and extendible from the needle carrying portion; and
an actuator for extending the needle from the needle carrying portion through the wall of the graft to engage and retrieve the suture.
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34. The graft suturing device of claim 30 wherein the retrieving means includes:
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a needle carrying portion being adapted to be positioned coaxially along the exterior wall of the graft;
a needle being secured to and extendible from the needle carrying portion; and
a cam being adapted to be positioned coaxially along the needle carrying portion and the exterior wall of the graft, the cam having an actuator for extending the needle inwardly through the wall of the graft, retrieving the suture and withdrawing the suture from the retaining means.
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35. The graft suturing device of claim 30, wherein the retrieving means includes:
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a needle carrying portion being adapted to be positioned coaxially and external the wall of the graft;
a needle being secured to and extendible from the needle carrying portion; and
an actuator for extending the needle from the needle carrying portion through the wall of the graft to engage and retrieve the suture.
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36. A device for suturing a tissue layer having two sides, the device comprising:
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a suture;
means for releasably retaining at least a portion of the suture in a stationary position on one side of the tissue layer, said means including a foot adapted for advancing to the suture site adjacent the tissue layer, the foot having a suture channel integrally formed therewith to releasably retain at least a portion of the suture therein; and
means for retrieving the portion of the suture through the tissue layer from the opposite side whereby the suture is drawn from one side to the opposite side. - View Dependent Claims (37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55)
a shaft coupled to said foot, said shaft having a distal end and a proximal end;
a plurality of needles, each of the needles spaced about the shaft; and
a plurality of sutures, each suture having a first and second suture portion, each first suture portion releasably retained on the foot for engaging the needle and each second suture portion extending toward the proximal end of the shaft.
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38. The tissue suturing device of claim 37 for suturing a tubular graft about an aperture in the tissue layer, wherein the device includes:
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the shaft has a needle carrying portion being adapted to be positioned coaxially within the wall of the graft;
at least one graft needle being secured to and extendible from the needle carrying portion; and
an actuator for extending the graft needle from the needle carrying portion through the wall of the graft to engage and retrieve the graft suture.
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39. The tissue suturing device of claim 37 for suturing a tubular graft about an aperture in the tissue layer, wherein the device includes:
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a needle carrying portion being adapted to be positioned coaxially along an exterior wall of the graft;
at least one graft needle being secured to and extendible from the needle carrying portion; and
a cam being adapted to be positioned coaxially along the needle carrying portion and the exterior wall of the graft, the cam having an actuator for extending the graft needle inwardly through the wall of the graft, and retrieving the suture.
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40. The graft anastomosis assembly of claim 38 to suture a tubular graft about an aperture in said tissue layer, wherein:
the suture having a first suture portion adapted to be engaged by one of said plurality of needles through the tissue layer and a second suture portion adapted to be engaged by the graft needle through the graft, the tissue suturing device being adapted to place the first suture portion proximally from the interior of the tissue wall and through the tissue adjacent the aperture, and the graft suturing needle being adapted to place the second suture portion proximally from the interior of the graft and through a wall of the graft, such that the first and second suture portions form a loop which is tightened to secure a portion of the graft to the tissue wall.
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41. The graft anastomosis assembly of claim 38 wherein said means for reversibly advancing the first suture portion may be drawn through the tissue wall in a proximal direction by reversibly advancing the tissue needle proximally to puncture the tissue adjacent the aperture, engaging the first portion of the suture and drawing one of said plurality of needles with the first suture portion engaged therewith outwardly through the tissue wall to allow the first suture portion to be harvested.
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42. The graft anastomosis assembly of claim 38 wherein the graft suturing needle is secured to the graft needle carrying portion, such that the second suture portion may be placed through the graft wall by advancing the graft needle from the graft needle carrying portion and through the graft wall, engaging the second portion of the suture, and drawing the graft needle with the second suture portion outwardly through the graft wall to allow the second suture portion to be harvested.
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43. The tissue suturing device of claim 37, wherein the distal end of the shaft further includes at least one suture lumen adapted to house the second suture portions.
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44. The tissue suturing device of claim 36 wherein the device is used for suturing a tubular graft about an aperture in tissue layer and the retrieving means are adapted to draw the suture through the aperture and then through the tissue layer.
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45. The tissue suturing device of claim 36 wherein the suture is releasably secured to the needle.
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46. The tissue suturing device of claim 36 wherein the at least one needle is removably carried near the distal end of the shaft.
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47. The tissue suturing device of claim 36 wherein the retrieving means is adapted to pass the portion of the suture through the tissue layer from the proximal side to the distal side.
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48. The tissue suturing device of claim 36 wherein the two sides of the tissue layer are a distal side and proximal side, the retaining means releasably retaining at least a portion of the suture on the distal side of the tissue layer, and the retrieving means retrieving a portion of the suture through the tissue layer to the proximal side.
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49. The tissue suturing device of claim 36 wherein the retrieving means and retaining means are integrally connected.
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50. The tissue suturing device of claim 36 wherein the retrieving means are adapted to draw the suture through a second tissue layer.
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51. The tissue suturing device of claim 50 wherein the suture is of sufficient length to draw the tissue layer and second tissue layer in contact with one another.
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52. The tissue suturing device of claim 36 for suturing a tubular graft about an aperture in tissue layer, wherein the tissue layer comprises a vessel wall and the device includes means for maintaining adequate perfusion through a vessel defined by the vessel wall while the foot extends through the aperture into the vessel, said retrieving means adapted to draw the suture through the vessel wall to secure the suture to the vessel wall in the proximity of the aperture.
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53. The tissue suturing device of claim 52 wherein the maintaining perfusion means includes a passageway through the foot parallel to a direction of perfusion.
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54. The tissue suturing device of claim 52 wherein the maintaining perfusion means includes the foot having a cross-sectional shape and size smaller than the vessel to allow perfusion between the vessel wall and the cross-section of the foot.
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55. The tissue suturing device of claim 36 for suturing a tubular graft about an aperture in tissue layer, wherein the tissue layer comprises a vessel wall and the device includes means for maintaining hemostasis in the proximity of the aperture while advancing the shaft through the aperture in the vessel wall, drawing the suture through the vessel wall and securing the suture to the vessel wall in the proximity of the aperture.
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56. A device for suturing a tissue layer having two sides, the device comprising:
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a suture;
means for releasably retaining at least a portion of the suture in a stationary position on one side of the tissue layer, said means include a shaft having a proximal and distal end, the shaft being adapted for advancing partially through the tissue layer to form an aperture, at least one needle carried above the distal end of the shaft sufficient to be positioned on the distal side of the tissue layer, and means for reversibly advancing the needle through the tissue; and
means for retrieving the portion of the suture through the tissue layer from the opposite side whereby the suture is drawn from one side to the opposite side, said means includes a foot attached to the distal end of the shaft, the foot being adapted to advance through the aperture to be positioned on a proximal side of the tissue layer, the foot having a suture channel integrally formed therewith to releasably retain at least a portion of the suture therein. - View Dependent Claims (57, 58)
a plurality of needles, each of the needles spaced about the shaft; and
a plurality of sutures, each suture having a first and second suture portion, each first suture portion releasably retained on the foot for engaging the needle and each second suture portion extending toward the proximal end of the shaft.
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58. The tissue suturing device of claim 56, wherein the distal end of the shaft further includes at least one suture lumen adapted to house the second suture portions.
Specification