Apparatus and method for closing puncture wounds

• US 5,391,182 A
• Filed: 08/03/1993
• Issued: 02/21/1995
• Est. Priority Date: 08/03/1993
• Status: Expired due to Term

• Current Assignee: Covidien AG (Medtronic Plc)
• Original Assignee: Origin Medsystems Inc. (Boston Scientific Corporation)
• Inventors: Chin, Albert K.
• Primary Examiner(s): Graysay, Tamara L.
• Assistant Examiner(s): Jackson, Gary
• Application Number:
  US08/100,926
• Time in Patent Office: 567 Days
• Field of Search: 606/144-148, 606/139, 606/224, 606/213, 606/215, 128/898, 128/899, 604/15, 604/52, 604/60, 604/168, 604/288, 604/285
• US Class Current: 606/213
• 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 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/06066 Needles, e.g. needle tip configurations making needles B21G1/00
• CPC Class Codes: A61B 17/06166 Sutures suture materials A61L17/00; manufacture of artificial threads D01D; treatment of threads D06M
• 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 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0454 the anchor being crimped or clamped on the suture
• CPC Class Codes: A61B 2017/0458 Longitudinal through hole, e.g. suture blocked by a distal suture knot
• CPC Class Codes: A61B 2017/0472 Multiple-needled, e.g. double-needled, instruments

Abstract

An apparatus for suturing fascial tissue for deep puncture wounds utilizes a flexible membrane inserted into a body cavity through a trocar sheath positioned in a wound. A suture to be applied to the wound has anchors attached to each of its ends. A pair of suture-carrying needles each carry an end of the suture and its corresponding anchor. The suture-carrying needles are passed through the fascial layer surrounding the wound and are subsequently passed through the flexible membrane. The suture ends and corresponding anchor means are released from the needles. A lifting force is applied to the flexible member via a cord or shaft which extends out of the wound. The anchors are engaged by the flexible membrane as it is withdrawn out of the wound, pulling the ends of the suture out of the wound to close the opening in the fascial tissue.

Claims

1. An apparatus kit for closing a wound comprising:

a suture having at least two ends;

a suture receiving means for insertion through the wound and into a body cavity underlying the wound;

a needle means for carrying the ends of the suture through tissue surrounding the wound and to the suture receiving means;

anchoring means attached to the ends of the suture, for passage through the tissue by the needle means, and for anchoring the suture ends to the suture receiving means while within the body cavity;

withdrawing means for engaging the suture-receiving means inside the body cavity and for withdrawing the suture-receiving means, with the anchoring means and the suture ends attached thereto, through the wound and out of the body cavity.

2. An apparatus kit for closing a wound with a suture having at least two ends, the apparatus comprising:

a suture having at least two ends;

a suture receiver having a flexible membrane capable of being penetrated by a needle, the suture receiver insertable through the wound and into a body cavity underlying the wound and for carrying the ends of the suture out of the wound;

a needle means for carrying the ends of the suture through tissue surrounding the wound and through the flexible membrane of the suture receiver;

anchoring means attached to the ends of the suture, for anchoring the suture ends to the suture receiver while within the body cavity;

withdrawing means for withdrawing the suture receiver with the anchor means and the ends attached thereto, through the wound and out of the body cavity.

3. The apparatus of claim 2 further comprising insertion means for inserting the flexible membrane through the wound and into the body cavity.

4. The apparatus of claim 3 wherein the insertion means comprises:

a first tube capable of being inserted into the wound, the first tube having a first throughbore for receiving the flexible membrane;

a pusher means for insertion into the first throughbore and for pushing the flexible membrane through the first throughbore.

5. The apparatus of claim 4 wherein the pusher means comprises:

a second tube slidably positioned in the first throughbore, the second tube having a proximal end, a distal end and a second throughbore.

6. The apparatus of claim 5 wherein:

the withdrawing means comprises;

a knob removably positioned in the second throughbore at the proximal end of the second tube;

a cord passing through the second throughbore, the cord having a first end attached to the flexible membrane and a second end attached to the knob.

7. The apparatus of claim 3 wherein the withdrawing means and the insertion means comprise a shaft connected to the flexible membrane.

8. The apparatus of claim 7 wherein:

the shaft includes a throughbore, a distal end, a proximal end, and an inflation port connected to the proximal end; and

the flexible membrane further comprises an inflatable portion having an opening connected to the distal end of the shaft such that an inflation medium introduced into the inflation port inflates the inflatable portion.

9. The apparatus of claim 2 wherein:

the needle means comprises;

a hollow needle having a needle throughbore capable of receiving the anchoring means; and

plunger means positioned in the needle throughbore, for ejecting the anchoring means from the needle throughbore after the needle has been passed through the flexible membrane.

10. The apparatus of claim 9 wherein each anchoring means comprises a flexible member, the flexible member having a retracted position wherein the flexible member is capable of being positioned inside the needle throughbore and an expanded position wherein the flexible member is incapable of passing through the flexible membrane.

11. The apparatus of claim 9 wherein each anchoring means comprises a tube having first and second ends and wherein the suture ends are connected to the tubes at a point between the first and second ends.

12. A method of closing a wound with a suture, the method comprising the steps of:

providing a suture receiver and a suture having at least two ends;

inserting the suture receiver into the body cavity through the wound;

passing the ends of the suture through tissue surrounding the wound and into a body cavity;

engaging the suture ends with the suture receiver; and

withdrawing the ends of the suture out of the body cavity and out of the wound by withdrawing the suture receiver with the suture ends engaged thereto out of the body cavity and out of the wound.

13. A method of closing a wound with a suture, the method comprising the steps of:

providing a suture receiver, a suture having at least two ends, and anchors attached to the ends of the suture;

inserting the suture receiver into a body cavity through the wound;

passing the ends of the suture with the anchors thereon through tissue surrounding the wound and into the body cavity;

engaging the anchors with the suture receiver;

withdrawing the ends of the suture out of the body cavity and out of the wound by withdrawing the suture receiver with the anchors engaged thereto out of the body cavity and out of the wound.

14. The method of claim 13 wherein:

the providing step provides a suture receiver having a flexible membrane, anchors each having a first state wherein the anchors are capable of passing through the flexible membrane and a second state wherein the anchors are incapable of passing through the flexible membrane, and further provides at least two needles capable of carrying the anchors in their first state with the ends of the suture attached thereto;

the passing step includes the step of inserting the hollow needles with the anchors and the ends thereon through the tissue surrounding the wound, through the flexible membrane, and into the body cavity; and

the engaging step includes the steps of;

releasing the anchors with the ends thereon from the hollow needles, and

allowing the anchors to adjust from their first state to their second state.

15. The method of claim 14 wherein:

the providing step further provides;

a first tube having a proximal end, a distal end, and a first throughbore,

a second tube having a second throughbore, a proximal end, and a distal end, the second tube slidably positioned in the first throughbore near the proximal end of the first tube, and

a line having a first end attached to the distal end of the second tube and a second end attached to the flexible membrane;

the step of inserting the suture receiver into the body cavity through the wound includes the steps of;

positioning the flexible membrane inside the first throughbore distally from the second tube,

inserting the distal end of the first tube into the wound, and

sliding the second tube in a distal direction within the first throughbore thereby ejecting the flexible membrane through the distal end of the first tube and into the abdominal cavity.

16. The method of claim 15 wherein:

the providing step further provides a cord having a first end and a second end connected to the flexible membrane; and

the withdrawing step includes the step of;

applying a lifting force to the first end, thereby lifting the flexible membrane out of the wound and into the first tube.

17. The method of claim 14 wherein:

the providing step further provides a shaft having a proximal end and a distal end connected to the flexible membrane; and

the step of inserting the suture receiver into the body cavity through the wound includes the steps of;

positioning the flexible membrane over the wound; and

delivering a pushing force to the shaft to push the flexible membrane into the wound.

18. The method of claim 14 wherein:

the providing step further includes a shaft having a proximal end and a distal end connected to the flexible membrane; and

the withdrawing step includes the step of;

applying a lifting force to the proximal end of the shaft, thereby lifting the flexible membrane out of the wound.

19. The method of claim 17 or 18 wherein:

the providing step further provides an inflatable portion connected to the flexible membrane; and

the method further includes the step of inflating the inflatable portion by delivering an inflation medium into the inflatable portion.

20. The method of claim 17 or 18 wherein:

the providing step further provides an inflatable portion connected to the flexible membrane and having an outlet connected to the distal end of the shaft; and

the method further includes the step of inflating the inflatable portion by delivering an inflation medium through the shaft and into the inflatable portion.

21. An apparatus kit for closing a wound with a suture having at least two ends, the apparatus comprising:

a suture having at least two ends;

a suture receiver having an inflatable membrane connected to an inflation port, the suture receiver insertable through the wound and into a body cavity underlying the wound;

a needle means for carrying the ends of the suture through tissue surrounding the wound and to the suture receiver;

anchoring means attached to the ends of the suture, for anchoring the suture ends to the suture receiver while within the body cavity;

withdrawing means for withdrawing the suture receiver with the anchor means and the ends attached thereto through the wound and out of the body cavity.