Methods for using self-retaining sutures in endoscopic procedures

• US 8,777,988 B2
• Filed: 08/04/2010
• Issued: 07/15/2014
• 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:
  US12/850,263
• Publication Number:
  US 20100298639A1
• Time in Patent Office: 1,441 Days
• Field of Search: 606/144, 606/228, 606/232
• US Class Current: 606/228
• 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

Endoscopic methods utilize self-retaining sutures to approximate tissue in a cavity of a subject. An endoscopic instrument is provided containing the self-retaining suture. The endoscopic instrument may be provided in combination with an endoscope and/or an endoscopic manipulator. The endoscopic instrument is passed through a cavity wall into a cavity of a patient. The self-retaining suture is deployed, using the endoscopic instrument, into a first tissue portion and a second tissue portion within the cavity. The self-retaining suture may be deployed endoscopically in patterns which include, purse string stitch, alpha stitch, linear stitching, curvilinear stitching, continuous helical stitch, and continuous sinusoidal stitch.

Claims

1. An endoscopic method for closing an opening in a tissue, the opening having a first side and a second side, the method comprising:

(a) receiving a wound-closure device including a suture having a first suture section and a second suture section, a first needle secured to the first suture section, where the first suture section comprises a first plurality of cuttings present in the first suture section, each cutting providing for a cut portion on the first suture section, each cut portion being a projection, the suture comprising 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 needle and resist movement in an opposite direction by grasping tissue which surrounds the first suture section;

(b) inserting the wound-closure device through an opening in a body into a cavity within the body;

(c) manipulating the tissue within the cavity with an endoscopic instrument;

(d) deploying the first suture section along a curvilinear path within at least the first side of the opening by a method comprising (d1) inserting the first needle in tissue of the first side;

(d2) pushing the first needle along a curvilinear path through tissue of the first side until it projects out of the tissue of the first side; and

(d3) pulling the first needle out of the tissue of the first side and drawing the first suture section through the curvilinear path but leaving a part of the first suture section within the first curvilinear path;

(d4) inserting the first needle in tissue of the second side;

(d5) pushing the first needle along a second curvilinear path through tissue of the second side until it projects out of the tissue of the second side; and

(d6) pulling the first needle out of the tissue of the second side 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, and repeating steps (d1), (d2), (d3), (d4), (d5), and (d6) to provide a continuous sinusoidal path and not a spiraling path of suture placement in the tissue which repeatedly crosses the opening;

(e) securing the second suture section to at least the second side of the opening;

(f) approximating the first side and the second side of the opening and thereby securing the first side to the second side and closing the opening.

2. The endoscopic method of claim 1, wherein the opening is an opening of a sac communicating with a gastrointestinal tract.

3. The endoscopic method of claim 2, wherein the sac is a Zenker'"'"'s Diverticulum.

4. The endoscopic method of claim 2, further comprising:

(g) using an endoscopic grasping tool to manipulate the sac prior to closing the opening.

5. The endoscopic method of claim 2, further comprising:

(g) using an endoscopic tool to excise tissue of the sac after closing the opening.

6. The endoscopic method of claim 1, wherein:

step (a) comprises receiving a wound-closure device including a suture having a first suture section and a second suture section, a first needle secured to the first suture section and 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 needle and resist movement in an opposite direction, a second needle secured to the second suture section 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 needle and resist movement in an opposite direction; and

step (e) comprises securing the second suture section to at least the second side of the opening by deploying the second suture section along a curvilinear path through at least the second side.

7. The endoscopic method of claim 6, wherein step (e) comprises securing the second suture section to tissue by deploying the second suture section along a continuous sinusoidal path which repeatedly crosses the opening from the second side to the first side of the wound and then back from the first side to the second side.

8. The endoscopic method of claim 1, further comprising imaging the first side and second side of the opening with an endoscope.

9. The endoscopic method of claim 1, wherein the opening is an incision.

10. A method for securing a first tissue to a second tissue within an internal cavity of a patient, the method comprising steps of:

(a) receiving a first endoscopic tool which contains a suture system, the suture system having a first portion of suture and a second portion of suture, the first portion comprising a first end and a first plurality of cuttings present in the first portion, each cutting providing for a cut portion on the first portion, each cut portion being a tissue-griping element, the first portion comprising a plurality of tissue-gripping elements permitting movement of the first portion through tissue in a direction of movement of the first end and preventing movement in an opposite direction by grasping tissue which surrounds the first portion;

(b) receiving a second endoscopic tool which includes a tissue grasper at a distal end;

(c) inserting a distal end of the first endoscopic tool through an opening into a cavity within the patient;

(d) inserting the distal end of the second endoscopic tool through an opening into a cavity within the patient;

(e) manipulating the first tissue with the tissue grasper of the second endoscopic tool;

(f) operating the first endoscopic tool within the cavity to insert the first portion of suture in the first tissue portion by a method comprising (f1) inserting the first end in the first tissue;

(f2) pushing the first end along a curvilinear path through the first tissue until it projects out of the first tissue;

(f3) pulling the first end out of the first tissue and drawing the first portion of suture through the curvilinear path but leaving a part of the first portion of suture within the first curvilinear path;

(f4) inserting the first end in the second;

(f5) pushing the first end along a second curvilinear path through second tissue until it projects out of the second tissue; and

(f6) pulling the first end out of the second tissue and drawing the first portion of suture through the second curvilinear path but leaving a part of the first portion of suture within the second curvilinear path, and repeating steps (f1), (f2), (f3), (f4), (f5), and (f6) to provide a continuous sinusoidal path and not a spiraling path of suture placement in the tissue;

(g) operating the endoscopic tool within the cavity to secure the second portion of suture to the second tissue; and

(h) approximating the first tissue and the second tissue.

11. A method for securing a first tissue of a patient to a second tissue, the method comprising steps of:

(a) receiving an endoscopic tool which contains a suture system, the suture system having a first portion comprising a first end and a first plurality of cuttings present in the first suture section, each cutting providing for a cut portion on the first suture section, each cut portion being a tissue-grasping element, the first suture portion comprising a plurality of tissue-gripping elements permitting movement of the first portion through tissue in a direction of movement of the first end and preventing movement of the first portion through tissue in an opposite direction by grasping tissue that surrounds the first portion, and a second portion comprising a second end and a second plurality of cuttings present in the second suture section, each cutting providing for a cut portion on the second suture section, each cut portion being a tissue-grasping element, the second suture portion comprising a plurality of tissue gripping elements permitting movement of the second portion through tissue in a direction of movement of the second end and preventing movement of the second portion through tissue in an opposite direction by grasping tissue that surrounds the second portion;

(b) inserting a leading end of the endoscopic tool through an opening into a cavity within the patient;

(c) operating the endoscopic tool within the cavity to insert the first portion of suture in the first tissue portion such that the first plurality of tissue-gripping elements engage the first tissue by a method comprising (c1) inserting the first end in the first tissue;

(c2) pushing the first end along a curvilinear path through the first tissue until it projects out of the first tissue;

(c3) pulling the first end out of the first tissue and drawing the first portion of suture through the curvilinear path but leaving a part of the first portion of suture within the first curvilinear path;

(c4) inserting the first end in the second;

(c5) pushing the first end along a second curvilinear path through second tissue until it projects out of the second tissue; and

(c6) pulling the first end out of the second tissue and drawing the first portion of suture through the second curvilinear path but leaving a part of the first portion of suture within the second curvilinear path, and repeating steps (c1), (c2), (c3), (c4), (c5), and (c6) to provide a continuous sinusoidal path and not a spiraling path of suture placement in the tissue;

(d) operating the endoscopic tool within the cavity to insert the second portion of suture in the second tissue portion such that the second plurality of tissue-gripping elements engage the second tissue; and

(e) approximating the first tissue and the second tissue.