Anastomosis method using self-retaining sutures

• US 8,764,776 B2
• Filed: 08/04/2010
• Issued: 07/01/2014
• Est. Priority Date: 06/29/2001
• Status: Expired due to Fees

• Current Assignee: Ethicon Incorporated (Johnson & Johnson), Ethicon, LLC (Johnson & Johnson)
• Original Assignee: Ethicon Incorporated (Johnson & Johnson)
• Inventors: Leung, Jeffrey C., Megaro, Matthew A., Ruff, Gregory, Kaplan, Andrew
• Primary Examiner(s): McDermott, Corrine M
• Assistant Examiner(s): ORKIN, ALEXANDER J
• Application Number:
  US12/850,362
• Publication Number:
  US 20100298880A1
• Time in Patent Office: 1,427 Days
• Field of Search: 606/139, 606/144, 606/151, 606/228, 606/232, 606/213, 606/215, 606/216, 606/153
• US Class Current: 606/153
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• 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 17/04 for suturing wounds; Holders or packages for needles or suture materials suture materials A61L17/00
• CPC Class Codes: A61B 17/06061 Holders for needles or sutures, e.g. racks, stands hand-held holding instruments A61B17/0483; holders for articles A61B50/20; racks for syringes or for hypodermic or infusion needles A61M5/008
• CPC Class Codes: A61B 17/06166 Sutures suture materials A61L17/00; manufacture of artificial threads D01D; treatment of threads D06M
• CPC Class Codes: A61B 17/062 Needle manipulators
• CPC Class Codes: A61B 17/1114 of the digestive tract, e.g. bowels or oesophagus
• CPC Class Codes: A61B 17/1146 of tendons
• CPC Class Codes: A61B 2017/00575 for closure at remote site, e.g. closing atrial septum defects
• CPC Class Codes: A61B 2017/0061 Implements located only on one side of the opening
• CPC Class Codes: A61B 2017/00632 Occluding a cavity, i.e. closing a blind opening
• CPC Class Codes: A61B 2017/00663 the implement being a suture
• CPC Class Codes: A61B 2017/00792 Plastic surgery
• CPC Class Codes: A61B 2017/06052 Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle hollow suture needles A61B2017/061
• CPC Class Codes: A61B 2017/06057 Double-armed sutures, i.e. sutures having a needle attached to each end
• CPC Class Codes: A61B 2017/06171 helically or spirally coiled for needles A61B2017/06076
• CPC Class Codes: A61B 2017/06176 with protrusions, e.g. barbs
• CPC Class Codes: A61B 2017/1135 End-to-side connections, e.g. T- or Y-connections Y-shaped blood vessel prostheses A61F2002/065

Abstract

An anastomosis procedure utilizes a self-retaining suture to secure one vessel to another vessel. One or more self-retaining sutures are deployed around the interface between the vessels. The self-retaining sutures have tissue-grasping surface features which allow passage of the sutures in one direction through tissue, but not in the opposite direction. The self-retaining sutures may be deployed using a needle attached to the end of the sutures. The anastomosis technique may be performed without using knots.

Claims

1. A method for creating an anastomosis between a first tubular structure having a first end and a second tubular structure having a second end, the method comprising:

(a) receiving a suture system including a suture having a first suture section having a first pointed end and a second suture section having a second pointed end, a first plurality of barbs projecting from the first suture section, the first plurality of barbs being adapted to permit movement of the first suture section through tissue in the direction of the first pointed end and resist movement in an opposite direction, and a second plurality of barbs projecting from the second suture section, the second plurality of barbs being adapted to permit movement of the second suture section through tissue in the direction of the second pointed end and resist movement in an opposite direction;

(b) deploying the first suture section along a path within at least the first tubular structure adjacent the first end; and

(c) securing the second suture section to at least tissue of the second tubular structure adjacent the second end by deploying the second suture section along a path through at least tissue of the second tubular structure adjacent the second end; and

(d) approximating and joining the first end and second end to create an anastomosis between the first tubular structure and the second tubular structure without forming a loop with the suture (d1) inserting the first pointed end in tissue of the first tubular structure adjacent the first end;

(d2) pushing the first pointed end along a curvilinear path through tissue of the first tubular structure adjacent the first end until it projects out of the tissue of the first tubular structure; and

(d3) pulling the first pointed end out of the tissue of the first tubular structure and drawing the first suture section through the curvilinear path but leaving a part of the first suture section within the first curvilinear path.

2. The method of claim 1, wherein step (d) further comprises:

(d4) inserting the first pointed end in tissue of the second tubular structure adjacent the second end;

(d5) pushing the first pointed end along a second curvilinear path through tissue of the second tubular structure adjacent the second end until it projects out of the tissue of the second tubular structure; and

(d6) pulling the first pointed end out of the tissue of the second tubular structure and drawing the first suture section through the second curvilinear path but leaving a part of the first suture section within the second curvilinear path.

3. The method of claim 2 further comprising repeating steps (d1), (d2), (d3), (d4), (d5), and (d6).

4. The method of claim 3, wherein step (d) comprises deploying the first suture section along a continuous path which repeatedly crosses from tissue of the first tubular structure to tissue of the second tubular structure and back again.

5. The method of claim 1, comprising repeating steps (a), (b), (c), and (d) with a plurality of suture systems to create an anastomosis.

6. The method of claim 1, performed endoscopically.

7. The method of claim 1, wherein step (b) comprises using an insertion device in which the first suture section is initially disposed to deploy the first suture section along a path within at least the first tubular structure adjacent the first end.

8. A method for creating an anastomosis between a first vessel having a first opening and a second vessel having a second opening, the method comprising:

(a) receiving a suture system including a suture having a first suture section having a first pointed end and a second suture section having a second pointed end, a first plurality of projections distributed on the first suture section, the first plurality of projections being adapted to permit movement of the first suture section through tissue in a direction of the first pointed end and resist movement in an opposite direction, and a second plurality of projections distributed on the second suture section, the second plurality of projections being adapted to permit movement of the second suture section through tissue in a direction of the second pointed end and resist movement in an opposite direction;

(b) deploying the first suture section along a path within at least the first vessel adjacent the first opening; and

(c) securing the second suture section to at least tissue of the second vessel adjacent the second opening by deploying the second suture section along a path through at least tissue of the second vessel adjacent the second opening; and

(d) deploying the first suture section along a continuous path which passes alternately through the tissue of the first vessel and the tissue of the second vessel, thereby approximating and joining the first opening and second opening to create an anastomosis between the first vessel and the second vessel without forming a loop with the suture.

9. The method of claim 8, wherein step (d) comprises:

(d1) inserting the first pointed end in tissue of the first vessel adjacent the first opening;

(d2) pushing the first pointed end along a curvilinear path through tissue of the first vessel adjacent the first opening until it projects out of the tissue of the first vessel; and

(d3) pulling the first pointed end out of the tissue of the first vessel and drawing the first suture section through the curvilinear path but leaving a part of the first suture section within the first curvilinear path.

10. The method of claim 9, wherein step (d) further comprises:

(d4) inserting the first pointed end in tissue of the second vessel adjacent the second opening;

(d5) pushing the first pointed end along a second curvilinear path through tissue of the second vessel adjacent the second opening until it projects out of the tissue of the second vessel; and

(d6) pulling the first pointed end out of the tissue of the second vessel and drawing the first suture section through the second curvilinear path but leaving a part of the first suture section within the second curvilinear path.

11. The method of claim 8, further comprising repeating steps (a), (b), (c), and (d) with another suture system.

12. The method of claim 8, performed endoscopically.

13. The method of claim 8, wherein step (b) comprises using an insertion device in which the first suture section is initially disposed to deploy the first suture section along a path within at least the first vessel adjacent the first opening.

14. A method for creating a knotless anastomosis between a first vessel having a first opening in a first wall and a second vessel having a second opening in a second wall, the method comprising:

(a) receiving a suture system including a suture having a first suture section having a first pointed end and a second suture section having a second pointed end, a first plurality of projections distributed on the first suture section, the first plurality of projections being adapted to permit movement of the first suture section through tissue in the direction of the first pointed end and resist movement in an opposite direction, and a second plurality of projections distributed on the second suture section, the second plurality of projections being adapted to permit movement of the second suture section through tissue in the direction of the second pointed end and resist movement in an opposite direction;

(b) deploying the first suture section along a path within the first wall of the first vessel adjacent the first opening;

(c) deploying the second suture section along a path within the second wall of the second vessel adjacent the second opening;

(d) approximating and joining the first opening and second opening to create an anastomosis between the first vessel and the second vessel without forming a loop with the suture , (d1) inserting the first pointed end in the first wall adjacent the first opening;

(d2) pushing the first pointed end along a curvilinear path through the first wall adjacent the first opening until it projects out of the first wall; and

(d3) pulling the first pointed end out of the first wall and drawing the first suture section through the curvilinear path but leaving a part of the first suture section within the first wall.

15. The method of claim 14, wherein step (d) further comprises:

(d4) inserting the second pointed end in the second wall adjacent the second opening;

(d5) pushing the second pointed end along a curvilinear path through the second wall adjacent the second opening until it projects out of the second wall; and

(d6) pulling the second pointed end out of the second wall and drawing the second suture section through a curvilinear path but leaving a part of the second suture section within the second wall.