Vascular hole closure

• US 6,368,334 B1
• Filed: 03/12/1998
• Issued: 04/09/2002
• Est. Priority Date: 10/21/1996
• Status: Expired due to Fees

• Current Assignee: LSI Solutions, Inc.
• Original Assignee: Lasersurge, Inc.
• Inventors: Sauer, Jude S.
• Primary Examiner(s): Shoap, Allan N.
• Assistant Examiner(s): NGO, LIEN M
• Application Number:
  US09/041,207
• Time in Patent Office: 1,489 Days
• Field of Search: 606/139, 606/144, 606/148, 606/233, 606/158, 606/213, 606/222-228
• US Class Current: 606/139
• CPC Class Codes: A61B 17/0057 Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 2017/00637 for sealing trocar wounds through abdominal wall
• CPC Class Codes: A61B 2017/00663 the implement being a suture
• CPC Class Codes: A61B 2017/0472 Multiple-needled, e.g. double-needled, instruments

Abstract

A method and apparatus for closing a punctured blood vessel is described. The method includes providing a suturing instrument adapted to apply at least one suture to at least a portion of a blood vessel in order to close a puncture wound therein. In a preferred embodiment, the suture is secured by crimping a sleeve member over the free ends of the suture.

Claims

1. A surgical apparatus for closing a wound characterized by a given circumference comprising:

a body portion;

an elongate body assembly having a longitudinal axis and extending from the body portion;

a tongue member extending from a distal end of the elongate body assembly;

a sleeve holder on a distal portion of the tongue member and separated from a proximal portion of the tongue member by a gap;

the tongue member having a perimeter at a cross section of the sleeve holder, and at a cross section of the gap, approximately equal to the given circumference of the wound for holding the wound substantially fully open in the gap;

a face opposing the sleeve holder across the gap, the tongue member having a cross sectional perimeter at the face larger than the circumference of the wound to stop further insertion of the instrument into the wound; and

,

a needle slidable from a position in the body assembly, through an opening in the face, across the gap to the sleeve holder.

2. The surgical apparatus of claim 1 wherein a cross-sectional perimeter at the face is greater than the cross sectional perimeter at the sleeve holder and in the gap.

3. The surgical apparatus of claim 1 comprising first and second levers pivotally secured to said body portion.

4. The surgical apparatus of claim 3 comprising first and second elongate needles positioned at least partially within the elongate body assembly, said first needle being longitudinally movable by said first lever and said second needle being longitudinally movable by said second lever.

5. The surgical apparatus of claim 4 in which the first lever has a flat surface, and wherein the first elongate needle is reciprocally movable in a plane perpendicular to the flat surface of the first lever when the first lever is in a closed position.

6. The surgical apparatus of claim 4 in which the second lever has a flat surface, and wherein the second elongate needle is reciprocally movable in a plane perpendicular to the flat surface of the second lever when the second lever is in a closed position.

8. The surgical apparatus of claim 4 wherein the first and second levers are mounted to a distal end of the body portion.

9. The surgical apparatus of claim 1 comprising first and second sleeves disposed within the sleeve holder, said first and second sleeves being joined by a length of suture material.

10. The surgical apparatus of claim 9 comprising a suture tube for receiving the suture material.

11. The surgical apparatus of claim 1 comprising a guide wire tube disposed through said body portion and said elongate body assembly, a distal end of the guide wire tube being disposed adjacent the distal opening of said tongue member.

12. The surgical apparatus of claim 11 wherein the guide wire tube has an opening spaced proximal of a distal end thereof.

7. A surgical apparatus for closing a wound characterized by a given circumference comprising:

a body portion;

an elongate body assembly having a longitudinal axis and extending from the body portion;

a tongue member extending from a distal end of the elongate body assembly;

a sleeve holder on a distal portion of the tongue member and separated from a proximal portion of the tongue member by a gap;

a face opposing the sleeve holder across the gap;

first and second levers pivotally secured to said body portion;

first and second elongate needles positioned at least partially within the elongate body assembly slidable from a position in the body assembly, through an opening in the face, across the gap to the sleeve holder, said first needle being longitudinally movable by said first lever and said second needle being longitudinally movable by said first lever and said second needle being longitudinally movable by said second lever, in which the first lever is a first color to indicate its connection with the first needle and the second lever is a second color, different from the first color, to indicate its connection with the second needle.

13. A combination crimper and cutter for securing a suture with a sleeve comprising:

an elongated body;

a tubular member extending from the body, and having an axial bore in a distal end thereof for receiving a sleeve in an axial orientation;

a jaw assembly within the tubular member adjacent to the bore, the jaw assembly having a crimping member for engaging and crimping a sleeve, and a cutting blade for cutting a suture extending from a sleeve;

an actuator within the tubular member, engaging the jaw assembly for sequentially actuating the crimping member for crimping a sleeve, and then actuating the cutting blade for cutting a suture.

14. The combination crimper and cutter of claim 13 comprising a lever pivotably mounted to the elongated body for axially moving the actuator.

15. The combination crimper and cutter of claim 13 wherein the jaw assembly comprises a movable jaw and a stationary jaw, wherein the actuator has a camming face which moves the movable jaw towards the stationary jaw.

16. The combination crimper and cutter of claim 15 wherein the movable jaw comprises the cutting blade.

17. The combination crimper and cutter of claim 15 wherein the movable jaw comprises a pair of arms at a distal end thereof for positioning a suture securing member.

18. The combination crimper and cutter of claim 17 wherein the movable jaw comprises the cutting blade, the cutting blade positioned proximal the pair of arms.

19. A single use kit for closing an opening in a vessel comprising:

a surgical apparatus for suturing the opening comprising;

a body portion;

an elongate body assembly having a longitudinal axis and extending from the body portion;

a tongue member extending from a distal end of the elongate body assembly;

a sleeve holder on a distal portion of the tongue member and separated from a proximal portion of the tongue member by a gap;

the tongue member having a perimeter at a cross section of the sleeve holder, and at a cross section of the gap, approximately equal to the given circumference of the wound for holding the wound substantially fully open in the gap;

a face opposing the sleeve holder across the gap, the tongue member having a cross sectional perimeter at the face larger than the circumference of the wound to stop further insertion of the instrument into the wound; and

a needle slidable from a position in the body assembly, through an opening to the face, across the gap to the sleeve holder, and

a combination crimper and cutter for securing a suture and cutting its ends.

20. The single use kit of claim 19 wherein the combination crimper and cutter comprises:

an elongated body;

a tubular member extending from the elongated body, and having an axial bore in a distal end thereof for receiving a sleeve in an axial orientation;

a jaw assembly within the tubular member adjacent to the bore, the jaw assembly having a crimping member for engaging and crimping a sleeve, and a cutting blade for cutting a suture extending from a sleeve;

an actuator within the tubular member, engaging the jaw assembly for sequentially actuating the crimping member for crimping a sleeve, and then actuating the cutting blade for cutting a suture.

21. A single use kit for closing an opening in a vessel comprising:

a surgical apparatus for suturing the opening; and

,

a combination crimper and cutter for securing a suture and cutting its ends, the combination crimper and cutter comprising;

an elongated body;

a tubular member extending from the body, and having an axial bore in a distal end thereof for receiving a sleeve in an axial orientation;

a jaw assembly within the tubular member adjacent to the bore, the jaw assembly having a crimping member for engaging and crimping a sleeve, and a cutting blade for cutting a suture extending from a sleeve;

an actuator within the tubular member, engaging the jaw assembly for sequentially actuating the crimping member for crimping a sleeve, and then actuating the cutting blade for cutting a suture.

22. A single use kit for closing an opening in a vessel comprising:

a surgical apparatus for suturing the opening comprising a combination crimper and cutter for securing a suture and cutting its ends;

a cannula and an obturator assembly, the obturator assembly having

a first longitudinal bore for receiving a guide wire; and

a second longitudinal bore having an aspiration port through a side of the second longitudinal bore.

23. A method of closing an opening in a vessel comprising:

threading an obturator and a cannula over a guide wire;

locating the guide wire in the opening, with a distal portion thereof extending into the vessel a substantial distance from the opening;

sliding the obturator and cannula along the guide wire until the obturator extends into the vessel, and a distal end of the cannula is disposed just outside the opening;

removing the obturator;

sliding a sewing instrument inside the cannula, along the guide wire to position a sewing end of the sewing instrument within the opening;

passing a first end of a suture through the vessel adjacent one side of the opening;

passing a second end of the suture through the vessel at an opposite side of the opening;

withdrawing the sewing instrument and guide wire from the cannula, leaving behind a suture across the puncture wound and within the cannula;

inserting a crimping/cutting instrument through the cannula, over the suture to a top of the wound site;

closing the wound opening by tightening the suture;

securing the suture with the crimping/cutting instrument; and

withdrawing the crimping/cutting instrument, cut suture ends, and the cannula.

24. The method of claim 23 further comprising the step of rotating the sewing instrument in the opening, prior to the step of passing a second end of the suture through the vessel and subsequent the step of passing a first end of a suture through the vessel.