Device and method for the percutaneous suturing of a vascular puncture site

• US 5,417,699 A
• Filed: 12/10/1992
• Issued: 05/23/1995
• Est. Priority Date: 12/10/1992
• Status: Expired due to Term

• Current Assignee: Abbott Laboratories Incorporated
• Original Assignee: Perclose Incorporated (Abbott Laboratories Incorporated)
• Inventors: Vetter, James W., Gross, T. Daniel, Hinohara, Tomoaki, Klein, Enrique J.
• Primary Examiner(s): Pellegrino, Stephen C.
• Assistant Examiner(s): SCHMIDT, JEFFREY
• Application Number:
  US07/989,611
• Time in Patent Office: 894 Days
• Field of Search: 606/139, 606/144, 606/145, 606/147, 606/148, 606/157, 606/158, 606/184, 606/187, 606/222, 606/223, 112/169, 112/80.03, 604/168, 604/900
• US Class Current: 606/144
• 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 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• CPC Class Codes: A61B 17/06066 Needles, e.g. needle tip configurations making needles B21G1/00
• CPC Class Codes: A61B 17/0625 the needle being specially adapted to interact with the manipulator, e.g. being ridged to snap fit in a hole of the manipulator A61B17/06109 takes precedence
• CPC Class Codes: A61B 2017/00004 (bio)absorbable, (bio)resorbable, resorptive for implantable prostheses A61F2210/0004
• CPC Class Codes: A61B 2017/00637 for sealing trocar wounds through abdominal wall
• CPC Class Codes: A61B 2017/00641 for closing fistulae, e.g. anorectal fistulae
• CPC Class Codes: A61B 2017/00663 the implement being a suture
• CPC Class Codes: A61B 2017/00867 shape memory effect for prostheses A61F2210/0014
• CPC Class Codes: A61B 2017/0458 Longitudinal through hole, e.g. suture blocked by a distal suture knot
• CPC Class Codes: A61B 2017/0464 for soft tissue
• CPC Class Codes: A61B 2017/047 having at least one proximally pointing needle located at the distal end of the instrument, e.g. for suturing trocar puncture wounds starting from inside the body J-shaped suture needles A61B2017/0608
• CPC Class Codes: A61B 2017/0472 Multiple-needled, e.g. double-needled, instruments
• CPC Class Codes: A61B 2017/0474 Knot pushers
• CPC Class Codes: A61B 2017/06057 Double-armed sutures, i.e. sutures having a needle attached to each end
• CPC Class Codes: A61F 2002/30092 using shape memory or superelastic materials, e.g. nitinol
• CPC Class Codes: A61F 2210/0019 operated at only one temperature whilst inside or touching the human body, e.g. constrained in a non-operative shape during surgery, another temperature only occurring before the operation
• CPC Class Codes: Y10S 604/90 Telltale showing entry of blood into body inserted conduit

Abstract

A suture applying device comprises a shaft which carries a pair of needles near its distal end. The needles are joined by a length of suture, and the shaft is used to both introduce the needles into a lumen of a body structure and to push the needles back through tissue on either side of the puncture site. After the needles have passed through the tissue, they are captured on the shaft and drawn outward through the tract, leaving a loop of suture behind to close the puncture site near the body lumen. The suture can then be tied and the knot pushed back through the tract to complete the closure. Alternatively, a locking fastener formed of a resorbable material can be placed into the penetration over the sutures and the sutures tied over the fastener.

Claims

1. A method for suturing a puncture site, said method comprising:

introducing a shaft inwardly through the puncture site located at the distal end of a tissue tract;

positioning a pair of needles having a length of suture therebetween carried by the shaft so that they engage tissue on opposite sides of the puncture site;

drawing the shaft outwardly through the puncture site to simultaneously push free ends of the needles through the tissue;

guiding the needles through the tissue, into the tissue tract, and outward so that the free ends of the needles emerge through the tissue tract while proximal ends of the needles remain on the shaft;

pulling the free ends of the needle to remove the needles from the shaft;

withdrawing the shaft and the needles from the puncture site and tract to expose free ends of the suture; and

securing free ends of the suture to close the puncture site.

2. A method as in claim 1, wherein the step of positioning includes positioning the pair of needles on opposite sides of a percutaneous penetration to a blood vessel lumen.

3. A method as in claim 2, wherein introducing the shaft comprises introducing the shaft to the blood vessel lumen through an introducer sheath.

4. A method as in claim 1, wherein the tips of the needles are pulled manually.

5. A method as in claim 1, wherein securing the free ends of the suture comprises tying said free ends into a knot.

6. A method as in claim 1, wherein securing the free ends of the suture comprises introducing a fastener over the free ends of the suture.

7. A method for suturing a puncture site in a blood vessel wall, said method comprising:

introducing a shaft inwardly through a tissue tract to the puncture site;

positioning a pair of needles carried by the shaft so that they engage the blood vessel wall on opposite sides of the puncture site;

drawing the shaft outwardly through the tissue tract to simultaneously push free ends of the needles through the blood vessel wall and into the tissue tract;

pulling the free ends of the needle to remove the needles from the shaft after said free ends of the needles emerge from the tissue tract;

withdrawing the shaft and the needles from the tissue tract to expose free ends of the suture; and

securing free ends of the suture to close the puncture site.

8. A method as in claim 7, wherein introducing the shaft comprises introducing the shaft to the blood vessel lumen through an introducer sheath.

9. A method as in claim 7, wherein the tips of the needles are pulled manually.

10. A method as in claim 7, wherein securing the free ends of the suture comprises tying said free ends into a knot.

11. A method as in claim 10, wherein securing the free ends of the suture comprises introducing a fastener over the free ends of the suture.

12. A suturing device comprising:

a guide body having a proximal end and a distal end;

a shaft having a proximal end and a distal end, said shaft being slidably mounted in the guide body;

a pair of needles removably carried near the distal end of the shaft, wherein each needle includes a shank and a sharpened tip with the shank carried on the shaft and the tip disposed toward the proximal end of the shaft;

a length of suture secured to and extending between the needles;

means on the guide body for receiving the needles and passing said needle to the proximal end of the guide body as said needles are drawn proximally by said shaft; and

means near the distal end of the guide body for guiding the needles through tissue and to the needle receiving means as said needles are drawn proximally by said shaft.

13. A suturing device as in claim 12, wherein the shaft and the needles are flexible and at least as long as the guide body.

14. A suturing device as in claim 13, wherein the means for guiding the needles comprises a guide tip fixed at the distal end of the guide body and having guide channels for receiving the flexible needles.

15. A suturing device as in claim 14, further comprising a flexible sheath attached to and extending distally from the guide tip, wherein said sheath receives the flexible needles and shaft prior to the needles and shaft being drawn proximally into the guide body.

16. A suturing device as in claim 13, wherein the means for receiving comprises axial lumens formed in the guide body which receive the needles as the shaft is drawn proximally.

17. A suturing device as in claim 16, wherein the shaft is slidably received in an axial lumen of the guide body.

18. A suturing device as in claim 12, wherein the needles each have arcuate ends near the tips.

19. A suturing device comprising:

a flexible shaft having a proximal end and a distal end;

a pair of needles removably carried near the distal end of the shaft, wherein each needle includes a shank carried near the distal end of the shaft and a sharpened tip disposed toward the proximal end of the shaft;

a length of suture extending between and secured near the tips of needles; and

a guide body having a proximal end, a distal end, means for slidably receiving the flexible shaft, means fixed near the distal end of the guide body for guiding the needles as the shaft is drawn proximally relative to the guide body, and means proximal of the guiding means on the guide body for receiving the needles and passing the needles to the proximal end of the guide body as the shaft is drawn proximally relative to the guide body;

whereby the flexible shaft may be introduced through a tissue tract and puncture site, advanced so that the sharpened needle tips pass beyond said puncture site, and the shaft then drawn proximally relative to the guide body so that the needles pass proximally through the tissue on either side of the puncture site.

20. A suturing device as in claim 19, wherein the guide body is a tubular structure having a central lumen which receives the flexible shaft and wherein the needle receiving means comprises two transversely offset axial lumens for receiving the pair of needles, respectively.

21. A suturing device as in claim 20, wherein the tubular structure has an additional lumen which permits the detection of blood when the distal end of the guide body enters a blood vessel.

22. A suturing device as in claim 20, further comprising a flexible sheath attached to and extending distally from the distal end of the guide body, wherein said sheath receives the shaft and needles prior to the shaft being drawn proximally and the needles drawn into the guide body.

23. A suturing device as in claim 22, wherein the flexible sheath includes at least one axial side lumen for receiving suture.

24. A suturing device as in claim 20, wherein the guide body has a guide tip at its distal end, wherein the guide tip includes channels which receive the distal ends of the needles and which direct the needles toward the transversely offset lumens as the shaft is drawn proximally.

25. A suturing device as in claim 19, wherein the needles are carried in a support holster near the distal end of the shaft, and wherein the support holster extends distally of the distal end of the guide body by at least 5 cm prior to the shaft being drawn proximally.

26. A suturing device as in claim 19, wherein the guide body is a tubular structure having a central lumen which receives the flexible shaft and two transversely offset axial lumens for receiving the pair of needles, respectively.

27. A suturing device as in claim 26, further comprising a flexible sheath attached to and extending distally from the distal end of the guide body, wherein said sheath receives the shaft and needles prior to the shaft being drawn proximally and the needles drawn into the guide body.

28. A suturing device as in claim 27, wherein the flexible sheath includes at least one axial side lumen for receiving suture.

29. A suturing device as in claim 26, wherein the guide body has a guide tip at its distal end, wherein the guide tip includes channels which receive the distal ends of the needles and which direct the needles toward the transversely offset lumens as the shaft is drawn proximally.

30. A suturing device as in claim 19, wherein the needles are carried in a support holster near the distal end of the shaft, and wherein the support holster extends distally of the distal end of the guide body by at least 5 cm prior to the shaft being drawn proximally.

31. A suturing device comprising:

a flexible shaft having a proximal end and a distal end;

a pair of needles removably carried near the distal end of the shaft, wherein each needle includes a shank carried near the distal end of the shaft and a sharpened tip disposed toward the proximal end of the shaft;

a length of suture extending between and secured near the tips of needles;

a guide body having a proximal end, a distal end, means for slidably receiving the flexible shaft, and means for guiding the needles as the shaft is drawn proximally relative to the guide body; and

a flexible sheath attached to and extending distally from the distal end of the guide body, wherein said sheath receives the shaft and needles prior to the shaft being drawn proximally and the needles drawn into the guide body;

whereby the flexible shaft may be introduced through a tissue tract and puncture site, advanced so that the sharpened needle tips pass beyond said puncture site, and the shaft then drawn proximally relative to the guide body so that the needles pass proximally through the tissue on either side of the puncture site.

32. A suturing device as in claim 31, wherein the guide body is a tubular structure having a central lumen which receives the flexible shaft and two transversely offset axial lumens for receiving the pair of needles, respectively.

33. A suturing device as in claim 32, wherein the tubular structure has an additional lumen which permits the detection of blood when the distal end of the guide body enters a blood vessel.

34. A suturing device as in claim 31, wherein the flexible sheath includes at lest one axial side lumen for receiving suture.

35. A suturing device as in claim 31, wherein the guide body has a guide tip at its distal end, wherein the guide tip includes channels which receive the distal ends of the needles and which direct the needles toward the transversely offset lumens as the shaft is drawn proximally.

36. A suturing device as in claim 31, wherein the needles are carried in a support holster near the distal end of the shaft, and wherein the support holster extends distally of the distal end of the guide body by at least 5 cm prior to the shaft being drawn proximally.

37. A suturing device comprising:

a flexible shaft having a proximal end, a distal end, and two transversely offset axial lumens;

a pair of needles removably carried near the distal end of the shaft, wherein each needle includes a shank carried near the distal end of the shaft and a sharpened tip disposed toward the proximal end of the shaft;

a length of suture extending between and secured near the tips of needles; and

a guide body having a proximal end, a distal end, means for slidably receiving the flexible shaft, means for guiding the needles as the shaft is drawn proximally relative to the guide body, and a guide tip at its distal end, wherein the guide tip includes channels which receive the distal ends of the needles and which direct the needles toward the transversely offset lumens as the shaft is drawn proximally;

whereby the flexible shaft may be introduced through a tissue tract and puncture site, advanced so that the sharpened needle tips pass beyond said puncture site, and the shaft then drawn proximally relative to the guide body so that the needles pass proximally through the tissue on either side of the puncture site.

38. A suturing device as in claim 37, wherein the guide body is a tubular structure having a central lumen between the two transversely offset axial lumens.

39. A suturing device as in claim 38, wherein the tubular structure has an additional lumen which permits the detection of blood when the distal end of the guide body enters a blood vessel.

40. A suturing device as in claim 37, further comprising a flexible sheath attached to and extending distally from the distal end of the guide body, wherein said sheath receives the shaft and needles prior to the shaft being drawn proximally and the needles drawn into the guide body.

41. A suturing device as in claim 40, wherein the flexible sheath includes at least one axial side lumen for receiving suture.

42. A suturing device as in claim 37, wherein the needles are carried in a support holster near the distal end of the shaft, and wherein the support holster extends distally of the distal end of the guide body by at least 5 cm prior to the shaft being drawn proximally.

43. A suturing device comprising:

a flexible shaft having a proximal end and a distal end;

a pair of needles removably carried near the distal end of the shaft, wherein each needle includes a shank carried near the distal end of the shaft and a sharpened tip disposed toward the proximal end of the shaft;

a length of suture extending between and secured near the tips of needles; and

a guide body having a proximal end, a distal end, means for slidably receiving the flexible shaft, means for guiding the needles as the shaft is drawn proximally relative to the guide body and a lumen which permits the detection of blood when the distal end of the guide body enters a blood vessel;

whereby the flexible shaft may be introduced through a tissue tract and puncture site, advanced so that the sharpened needle tips pass beyond said puncture site, and the shaft then drawn proximally relative to the guide body so that the needles pass proximally through the tissue on either side of the puncture site.