Device and method for applying large-diameter ligating loop

• US 5,489,288 A
• Filed: 04/04/1994
• Issued: 02/06/1996
• Est. Priority Date: 10/09/1992
• Status: Expired due to Fees

• Current Assignee: Dacomed Corp. (Imagyn Medical Technologies, Inc.)
• Original Assignee: Advanced Surgical, Inc. (Imagyn Medical Technologies, Inc.)
• Inventors: Buelna, Terry
• Primary Examiner(s): Graysay, Tamara L.
• Application Number:
  US08/223,261
• Time in Patent Office: 673 Days
• Field of Search: 606/113, 606/139, 606/144, 606/145, 606/146, 606/148, 606/228, 606/108
• US Class Current: 606/144
• CPC Class Codes: A61B 17/12013 for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 2017/0474 Knot pushers
• CPC Class Codes: A61B 2017/0477 with pre-tied sutures
• CPC Class Codes: A61B 2017/2911 rings
• CPC Class Codes: A61B 2017/2943 Toothed members, e.g. rack and pinion

Abstract

A suture applying device comprises an elongate shaft having a length of suture therein. A pre-tied loop suture is held at the distal end of the shaft with a free end of the suture being attached within a handle secured to the proximal end of the shaft. In a first embodiment, a pulley and puller assembly is provided for closing the pre-tied suture loop, where the pulley permits a greater length of suture to be taken in than is traveled by the puller. In a second embodiment, a pair of opposed jaws are slidably mounted within the handle for selectively engaging and gripping the free end of the suture. In this way, an arbitrarily large length of suture may be taken in by pulling on the free end of the suture in successive strokes. The device further includes a sheath slidably disposed on the shaft for protecting the suture during introduction. The sheath automatically retracts when the device is introduced through a trocar sleeve or cannula, thereby exposing the suture loop.

Claims

1. A system for applying a suture loop through a cannula having a central lumen, said system comprising:

a suture loop applier including a handle connected to a shaft, a length of suture loop having a free end and a loop at another end, wherein the loop extends from a distal end of the shaft; and

a sheath slidably mounted on the shaft to move between an extended position wherein the suture loop is covered and a retracted position wherein the suture loop is uncovered.

2. A system as in claim 1, wherein a distal end of the sheath is configured to engage with a proximal end of the cannula, whereby engagement of the distal end of the sheath with the proximal end of the cannula will cause the sheath to slide proximally on the shaft allowing the suture to advance entirely through the lumen uncovered by the sheath.

3. A system as in claim 2, wherein the sheath has an outer diameter that is greater than an inner diameter of the central lumen of the cannula, so that the distal end of the sheath is engagable with the proximal end of the cannula.

4. A system as in claim 1, further comprising a protrusion at a proximal end of the sheath for engagement with a proximal end of the cannula, whereby the suture is advancable through the lumen while covered by the sheath until the protrusion engages the cannula to retract the sheath.

5. A system as in claim 4, further comprising a restriction at the proximal end of the cannula for engagement with the protrusion of the sheath.

6. A system as in claim 1, wherein a distal end of the sheath is configured to engage with a distal end of the cannula, whereby the suture is allowed to advance through the lumen covered by the sheath until engagement of the distal end of the sheath with the distal end of the cannula.

7. A system as in claim 6, further comprising a restriction at the distal end of the cannula for engagement with the sheath.

8. A system as in claim 1, wherein a distal end of the sheath is configured to engage the cannula at a midpoint between a proximal and a distal end thereof, whereby the suture is covered by the sheath during a portion of the sheath'"'"'s advancement through the cannula lumen.

9. A system as in claim 8, further comprising a restriction at the midpoint of the cannula for engagement with the sheath.

10. A system as in claim 1, wherein the sheath is scored along an axial line to facilitate splitting as the handle is advanced therethrough.

11. A system as in claim 1, wherein the sheath is axially compressible.

12. A system as in claim 11, wherein the sheath is constructed of a braided or woven mesh material, whereby the sheath will compress upon contact with the handle.

13. A system as in claim 11, wherein the sheath is a tube having a convoluted wall.

14. A system for applying a suture loop through a cannula having a central lumen, said system comprising:

a suture loop applier including a handle connected to a shaft, a length of suture loop having a free end and a loop at another end, wherein the loop is held at a distal end of the shaft;

a sheath slidably mounted on the distal end of the shaft, said sheath covering the suture loop, said sheath having an outer diameter greater than an inner diameter of the central lumen of the cannula whereby the sheath is prevented from entering the proximal end of the central lumen of the cannula;

said shaft having an outer diameter less than the inner diameter of the cannula such that the shaft may be extended through the cannula while the sheath is prevented from entering the central lumen of the cannula, thereby causing the sheath to slide proximally on the shaft to expose the suture loop through a distal end of the cannula.

15. A method for applying a suture loop into a body cavity, said method comprising:

introducing a cannula having a central lumen into the body cavity;

introducing a suture loop protected by a sheath into the cannula;

engaging the cannula with the sheath so that the sheath is held stationary relative to the cannula; and

advancing the suture loop through the lumen and into the body cavity.

16. A method as in claim 15, wherein the step of introducing the cannula includes introducing the cannula with an internal stylet, the method further comprising removing the stylet prior to introducing the suture loop and the sheath into the cannula.

17. A method as in claim 15, further comprising a step of placing the loop around a body structure in the body cavity and tightening the loop around the structure after the advancing step.

18. A method as in claim 15, wherein the engaging step includes engaging a proximal end of the cannula with a distal end of the sheath, and the advancing step includes advancing the suture entirely through the lumen without the sheath.

19. A method as in claim 15, wherein the engaging step includes engaging a distal end of the cannula with a distal end of the sheath so that the suture is covered by the sheath as it advances through the lumen.

20. A method as in claim 15, wherein the engaging step includes engaging a proximal end of the cannula with a proximal end of the sheath, and the advancing step includes advancing the suture through the lumen covered by the sheath until a protrusion engages the cannula to retract the sheath.

21. A method as in claim 15, wherein the engaging step includes engaging the cannula at a midpoint between the proximal and distal ends thereof with a distal end of the sheath, so that the suture is covered by the sheath during at least part of the advancing step.

22. A method for applying a suture loop into a body cavity, said method comprising:

introducing a cannula into a patient;

providing a suture applier including a shaft, a length of suture having a free end and a pre-formed loop, a handle connected to a proximal end of said shaft, and a sheath on the distal end of the shaft protecting the preformed loop;

introducing the suture applier and the sheath into the cannula; and

exposing the suture loop through the distal end of the cannula.

23. A method as in claim 22, wherein the step of introducing the cannula includes introducing the cannula with an internal stylet, the method further comprising a step of removing the stylet prior to introducing the suture applier and the sheath into the cannula.

24. A method as in claim 22, further comprising the steps of engaging a proximal end of the cannula with a distal end of the sheath and advancing the suture entirely through the lumen without the sheath.

25. A method as in claim 22, further comprising the steps of engaging a distal end of the cannula with a distal end of the sheath and advancing the suture so that the suture is covered by the sheath as it advances through the lumen.

26. A method as in claim 22, further comprising the steps of engaging a proximal end of the cannula with a proximal end of the sheath and advancing the suture through the lumen covered by the sheath until a protrusion engages the cannula to retract the sheath.

27. A method as in claim 22, further comprising the steps of engaging the cannula at a midpoint between the proximal and distal ends thereof with it distal end of the sheath and advancing the suture so that the suture is covered by the sheath during a portion of the sheath'"'"'s advancement through the cannula lumen.

28. A method as in claim 22, further comprising a step of separating the sheath along an axial score as the handle contacts the sheath and is advanced therethrough.

29. A method as in claim 22, further comprising a step of axially compressing the sheath as the handle contacts the sheath and is further advanced.

30. A method for applying a suture loop into a body cavity, said method comprising:

introducing a cannula having a central lumen into a patient;

providing a suture applier including a shaft, a length of suture having a free end and a pre-formed loop, a handle connected to a proximal end of said shaft, and a sheath on the distal end of the shaft protecting the preformed loop, the sheath having an outer diameter greater than an inner diameter of the central lumen of the cannula, the shaft having an outer diameter less than the inner diameter of the central lumen of the cannula;

introducing the suture applier and the sheath into the cannula thereby retracting the sheath along the shaft and exposing the suture loop through the distal end of the cannula.

31. Apparatus for applying and tightening a suture loop, said apparatus comprising:

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

a length of suture having a free end and a loop at another end, wherein the loop is held at the distal end of the shaft and the free end of the suture extends through the hollow shaft to the proximal end;

a handle assembly comprising a housing having a protected interior attached to the proximal end of the shaft, said handle assembly including a slidably mounted actuator, said actuator comprising a puller; and

a pulley on the puller positioned entirely within the protected interior, wherein the free end of the suture travels around the pulley and is secured to the handle, said pulley coupling the puller to the free end of the suture so that the free end is drawn proximally by the puller at a faster rate than the puller, whereby drawing proximally on the puller will tighten the suture loop.

32. Apparatus for applying and tightening a suture loop, said apparatus comprising:

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

a length of suture having a free end and a loop at another end, wherein the loop is held at the distal end of the shaft and the free end of the suture extends through the hollow shaft to the proximal end;

a handle assembly comprising a housing having a protected interior attached to the proximal end of the shaft, said handle assembly including a slidably mounted actuator, said actuator comprising a pusher; and

a pulley rotatably mounted in the interior of the housing having a small gear wheel and a large uptake wheel attached to the free end of the suture, wherein the pusher includes a gear face which mates with the gear wheel, said pulley coupling the pusher to the free end of the suture so that the free end is drawn proximally by the pusher at a faster rate than the pusher, whereby drawing proximally on the pusher will tighten the suture loop.

33. Apparatus for applying and tightening a pre-tied suture loop, said apparatus comprising:

a shaft having proximal and distal ends;

a length of suture having a free end and a knotted loop at the other end, wherein said knotted loop is held on the distal end of the shaft; and

a handle assembly attached to the proximal end of the shaft and having means for selectively engaging and proximally translating the free end of the suture, whereby the free end may be successively engaged and drawn proximally to close the knotted loop.

34. Apparatus as in claim 33, wherein the shaft is a tube having a lumen which receives the free end of the suture, wherein the loop is held on an open distal port of the lumen.

35. Apparatus as in claim 33, wherein the loop has a diameter which is larger than a size which can be drawn closed around an object in a single stroke of the engaging means.

36. Apparatus as in claim 33, wherein the means for selectively engaging and translating the free end of the suture comprises a pair of opposed jaws, wherein each jaw has an attached finger retainer and the handle includes a thumb retainer, whereby the apparatus can be manipulated using the thumb and two fingers of a single hand.

37. Apparatus as in claim 36, wherein the opposed jaws are spring-biased away from each other.

38. Apparatus as in claim 37, wherein the opposed jaws define opposed gripping surfaces which firmly grip the suture when the jaws are closed together.