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WO1991006247A1 - Dispositif pour enfiler et effectuer des points de suture, et pour envelopper des tissus - Google Patents

Dispositif pour enfiler et effectuer des points de suture, et pour envelopper des tissus Download PDF

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Publication number
WO1991006247A1
WO1991006247A1 PCT/US1990/006504 US9006504W WO9106247A1 WO 1991006247 A1 WO1991006247 A1 WO 1991006247A1 US 9006504 W US9006504 W US 9006504W WO 9106247 A1 WO9106247 A1 WO 9106247A1
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WO
WIPO (PCT)
Prior art keywords
tissue
piece
inner tube
segment
suture
Prior art date
Application number
PCT/US1990/006504
Other languages
English (en)
Inventor
Stanley E. Asnis
Original Assignee
Asnis Stanley E
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Asnis Stanley E filed Critical Asnis Stanley E
Publication of WO1991006247A1 publication Critical patent/WO1991006247A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00349—Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue

Definitions

  • This invention relates generally to surgical instruments, and more particularly to surgical punches, forceps, and suture threading, stitching and wrapping instruments.
  • Surgical punches and forceps are well known in the art, as illustrated by the surgical punch and surgical forceps disclosed in U.S. Patent No. 4,712,545 issued to G. Honkanen. Such instruments are frequently used in arthroscopic and other surgeries to cut and clamp, respectively, body tissue.
  • cartilage or other tissue is clamped, cut, shaved or otherwise formed using special surgical tools which are sized so as to allow the tools to extend into an interior surgical site (i.e., the interior of a joint) from a point outside the body through an opening-lining tube or cannula.
  • a saline wash is pumped into the surgical site through an inlet cannula and out of the surgical site through an outlet cannula.
  • one of the objects of the present invention is to provide a surgical suture threading, stitching and wrapping device for use in open and closed surgeries for (1) threading a loop of suture material through a piece of tissue which is to be removed during a subsequent severing operation, or (2) placing a suture stitch in a piece of material or stitching together several pieces of tissue, or (3) wrapping a piece of suture material around a soft tissue structure such as ligaments, tubes or ducts.
  • Another object of the invention is to provide a surgical suture threading, stitching and wrapping device which is sized so as to be able to extend through a conventional cannula used in closed surgeries (e.g. arthroscopy) and which is operable from a location adjacent the outside opening of the cannula or soft tissue portal.
  • Yet another object of the present invention is to provide a surgical suture threading, stitching and wrapping device having a novel clamp assembly for clamping a piece of tissue while suture material is simultaneously being threaded through the piece of tissue.
  • Still another object of the present invention is to provide a surgical suture threading, stitching and wrapping device having a novel threading assembly for threading a loop of suture material through a piece of tissue and forming a slip knot stitch which can be closed about the tissue piece.
  • a novel tool having a clamping assembly for clamping a piece of tissue and a threading assembly for threading a loop of suture material through or around the clamped piece of tissue.
  • the clamping assembly comprises an outer tube, an inner tube disposed for slidable movement inside the outer tube, a U-shaped bracket attached to the outer tube at one end thereof, and an actuating assembly for moving the inner tube toward and away from the U-shaped bracket.
  • the U-shaped bracket is constructed so that a piece of tissue to be threaded, stitched or wrapped can be received between the legs of the bracket.
  • the threading assembly comprises a pointed shaft slidably disposed in the inner tube.
  • the pointed shaft has a hook at its pointed end for engaging a length of suture.
  • An aperture is provided in the leg of the U-shaped bracket against which the piece of tissue is clamped for receiving the pointed shaft, and a groove is provided in the outer surface of this bracket leg for receiving a segment of a loop of suture.
  • a loop of suture is secured in the groove in the front leg of the U-shaped bracket so as to extend rearward from the groove. Then the tool is inserted through the cannula to the surgical site, and the tool is positioned so that the target tissue is inserted in the U-shaped bracket. Then the inner tube is driven forward so as to clamp the piece of tissue between the front end of the inner tube and the front leg of the U-shaped bracket.
  • a loop of suture is threaded through the clamped piece of tissue by (1) forcing the pointed shaft through the clamped tissue material and through the aperture in the bracket leg, whereby the shaft's hook may engage the suture, and (2) then pulling the engaged suture through the aperture and the hole in the tissue formed by the shaft.
  • a loop of suture is secured in the groove in the bracket so as to extend rearward from the groove.
  • the tool is inserted through the cannula to the surgical site, and the tool is positioned so that the target tissue is positioned on the base of the U-shaped bracket.
  • the inner tube is driven forward toward the front leg of the U-shaped bracket so as to clamp the piece of tissue between the base of the U-shaped bracket and the bottom side of the front end of the inner tube.
  • the pointed shaft is (1) moved forward inside the inner tube so as to pass over the clamped tissue piece and through the aperture in the bracket, whereby the shaft's hook engages the suture, and (2) the engaged suture is pulled back over the tissue piece with the result that the loop of suture is wrapped around the tissue piece.
  • Fig. 1 is a side elevation view of the suture stitching, threading and wrapping device of the present invention, partially in cross section, with portions of the device being shown in phantom;
  • Fig. 2 is a front elevation view of the tissue-clamping bracket
  • Fig. 3 is a side elevation view of the inner tube
  • Fig. 4 is a plan view of the inner tube illustrated in Fig. 3;
  • Fig. 5 is a front elevation view of the tube illustrated in Figs. 3 and 4;
  • Fig. 6 is a side elevation of the suture extractor
  • Fig. 7 is a plan view of the front portion of the extractor illustrated in Fig. 6;
  • Fig. 8 is a cross-sectional view of the actuating assembly taken along line 8-8 in Fig. 1;
  • Fig. 9 is cross-sectional view of the actuating assembly taken along line 9-9 in Fig. 1;
  • Fig. 10 is a schematic side elevation of the present invention, with a loop of suture material secured around the bracket;
  • Fig. 11 is similar to Fig. 10, except that a piece of tissue is disposed in the clamping bracket and the inner tube has been moved forward so as to clamp the tissue in the bracket;
  • Fig. 12 is similar to Fig. 11, except that the hook end of the extractor has been urged through the clamped tissue;
  • Fig. 13 is similar to Fig. 12, except that the hook end of the extractor has been pulled through the tissue and into the inner tube bringing with it the loop of suture material secured around the bracket;
  • Fig. 14 is similar to Fig. 13, except that the outer clamping member has been moved rearward so that it does not engage the tissue;
  • Fig. 15 is similar to Fig. 14, except that the tissue-clamping bracket has been disengaged from the tissue;
  • Fig. 16 is similar to Fig. 11, except that an elongate tiss piece having a circular cross section is clamped between the bottom of the bracket and the bottom of the inner tube;
  • Fig. 17 is similar to Fig. 16, except that the extractor has been urged over the clamped piece of tissue;
  • Fig. 18 is similar to Fig. 17, except that the hook end of the extractor of suture has been pulled over the piece of tissue and into the inner tube bringing with it the loop of suture material secured around the bracket.
  • the suture threading, stitching and wrapping device 20 of the present invention comprises an outer tube assembly 22, an inner tube assembly 100, an extractor assembly 200, and a housing and inner tube actuation assembly 300.
  • the various elements of device 20 are preferably made from a corrosion-resistant material, such as stainless steel.
  • Outer tube assembly 22 comprises a hollow tube 24 and a clamping bracket 26 secured to the distal end of the tube.
  • the diameter of tube 24 and the cross-sectional dimensions of bracket 26 are selected so that the elements may be readily inserted into a conventional cannula of the type used in arthroscopy or other closed surgeries.
  • the length of tube 24 is selected so that the latter may extend from a position inside the joint being operated on to a position outside the opening of the cannula in which the device 20 is inserted. This length of tube 24 is also advantageous in open surgeries when the tissue piece to be threaded, stitched or wrapped is deeply recessed.
  • clamping bracket 26 when viewed in side elevation as in Fig. 1, has a substantially U-shaped configuration. Bracket 26 has a front wall 28, a bottom wall 30 and a rear wall 32. Clamping bracket 26 is attached to the distal end of outer tube 24 via its rear wall 32. The latter includes a bore 34 (Fig. 2) extending therethrough. Bore 34 is sized to receive inner tube 102 with a sliding fit, as described hereinafter.
  • Front wall 28 is preferably inclined forwardly slightly relative to rear wall 32, i.e., away from actuation assembly 300, and is substantially coaxially aligned with tube 24.
  • a circular hole 36 (Fig. 2) is provided in front wall 28 extending entirely therethrough. Hole 36 is coaxially aligned with bore 34 in rear wall 32 and is sized to receive extractor shaft 202 with a sliding fit, as described hereinafter.
  • a vertically-extending slot 38 is provided in front wall 28 intersecting hole 36.
  • a horizontally-extending groove 40 is provided in front surface 42 of front wall 28. Grove 40 extends across the center of hole 36 and is sized to receive a length of suture of the type used in surgery.
  • Front wall 28 has an inside surface 44 (Fig. 1) opposite front surface 42.
  • the width X (see Fig. 2) of front wall 28 and the front portion 30a (see Fig. 13) of bottom wall 30 is less than the width Y (see Fig. 2) of the rear por ion 30b (see Fig. 13) of bottom wall 30.
  • a shoulder 46 is formed at the junction of the front and rear portions of bottom wall 30.
  • this shoulder in inclined forwardly toward front wall 28 so as to subtend an angle ranging from 45° to 70° with respect to the bottom surface of bottom wall 30.
  • inner tube assembly 100 comprises tube 102 and pivot assembly 104.
  • Tube 102 is sized to slide freely inside outer tube 24. The length of tube 102 is selected so that when the latter is received in outer tube 24, the front end 106 of tube 102 will project forwardly of rear wall 32 of bracket 26 a selected distance when the actuating assembly 300 is properly manipulated, as described hereinafter. When tube 102 is in this forwardly projecting position, bottom wall 30 of bracket 26 is spaced somewhat from the bottom of tube 102. Front end 106 is preferably inclined forwardly slightly an amount corresponding to the inclination of front wall 28.
  • bracket inside surface 44 and tube front end 106 extend substantially in parallel with one another when inner tube assembly 100 is pivotally mounted to actuating assembly 300, as described hereinafter.
  • a V-shaped notch 108 (Fig. 4) is provided in the top surface of tube 102 intersecting front end 106.
  • Pivot assembly 104 comprises a rectangular block 110 secured to the bottom surface of tube 102 at the back end thereof. As best seen in Fig. 5, the thickness of block 110 is about equal to the outside diameter of tube 102. Pivot assembly 104 includes a bottom projection 112 having a circularly curved outer pivot surface 114 of selected radius of curvature. The thickness of projection 112 is substantially identical to the thickness of block 110. As such, the side surfaces of block 110 and projection 112 are coextensive, which side surfaces are identified at 116 and 118 in Fig. 5. The side surfaces 116 and 118 of block 110 and projection 112 are substantially planar and extend in parallel with one another. Referring next to Figs.
  • extractor assembly 200 comprises a shaft 202 that is sized to slide freely inside inner tube 102.
  • Shaft 202 has a pointed front end 204.
  • a slot 206 is provided in the top surface of shaft 202 directly behind front end 204. Slot 206 extends transversely to the longitudinal axis of the shaft and is angled forwardly toward the front of shaft 202. Slot 206 is sized to accept a length of conventional suture of the type used in surgery.
  • Extractor assembly 200 includes a knurled knob 208 for facilitating manipulation of shaft 202.
  • Knob 208 is attached to projection 210, and the latter has a bore 212 in which the back end of shaft 202 is releasably secured by suitable means, e.g. a set screw.
  • Projection 210 includes a curved contact surface 214 for engaging actuating assembly 300 so as to limit the travel of shaft 202 and maintain the rotational orientation of shaft 202, as described hereinafter.
  • the length of shaft 202 is selected and projection 210 is provided so that only a selected length of shaft 202, typically front end 204, will extend through and past the front surface of bracket front wall 28. Preferably, this selected distance ranges from about 0.125 to 0.375 inches.
  • actuating assembly 300 comprises a fixed scissors-type handle 302, a movable scissors-type handle 304 pivotally mounted to the fixed handle, and a locking member 306 for locking the movable handle in a selected position relative to the fixed handle.
  • Handles 302 and 304 are constructed to extend away from one another in V-shaped configuration when fully open, and to extend substantially in parallel with one another when fully closed.
  • Fixed handle 302 includes an upper portion 308 to which the back end of outer tube 102 is attached.
  • a cavity 310 (Fig. 8) is provided in upper portion 308.
  • Upper portion 308 comprises a first opening (not shown) through which inner tube assembly 100 can be inserted into cavity 310 and a second opening 311 (Fig. 9) through which top end 312 of movable handle 304 can be inserted into cavity 310.
  • Upper portion 308 also includes parallel sidewalls 314 and 316 (Fig. 8) which enclose cavity 310. Sidewalls 314 and 316 are spaced apart a distance sufficient to accommodate inner tube pivot portion 104 therebetween with a close sliding fit.
  • a pivot bore 318 (Fig. 8) is provided in sidewall 314.
  • Upper portion 308 includes a curved contact surface 320 (Fig. 1) having a curvature that corresponds to the curvature of curved surface 214 of projection 210.
  • Upper portion 308 includes a clamp 322 (Fig. 1) .
  • the latter is attached via a center stud (not shown) to the top surface 324 of upper portion 308 so that a small space is provided between the top surface and the bottom of the clamp.
  • This space is of sufficient dimension to permit a conventional suture to be wrapped around the clamp stud and to be secured to clamp 322 by friction engagement between the bottom of the clamp and the top surface 324 of upper portion 308.
  • a serrated surface 326 (Fig. 1) is provided on the rear surface of fixed handle 302.
  • Top end 312 of movable handle 304 comprises a pivot bore 330 (Fig. 8) having a diameter that is somewhat greater than the diameter of pivot bore 318 in sidewall 314 of upper portion 308. As illustrated in Figs. 1 and 8, the top end 312 of fixed handle 304 is disposed in cavity 310 so that bore 330 is coaxially aligned with bore 318.
  • Actuating assembly 300 includes a cylindrical pivot stud 332 for pivotally mounting fixed handle 302 to movable handle 304. Stud 332 is mounted in bore 330. The diameter of stud 332 is selected so that the latter makes a close sliding fit in bore 330. Stud 332 includes a reduced diameter circular portion 334 that is sized to make a close sliding fit in bore 318. Stud 332 includes a cavity 336 in which one end of coil spring 338 is disposed. The opposite end of spring 338 contacts the inner surface of sidewall 316 of upper portion 308. Spring 338 forces stud 332 into contact with sidewall 314 and stud portion 334 into bore 318.
  • Top end 312 of movable handle 304 includes a curved pocket 340 (Fig. 1) sized for receiving curved projection 112 (Fig. 3) of inner tube assembly 100.
  • the configuration of pocket 340 is selected to permit projection 112 to pivot freely therein, as described hereinafter, about an axis extending substantially normal to sidewalls 314 and 316 of upper portion 308.
  • Movable handle 304 includes an upstanding ridge 342 (Fig. 1) which extends along the length of the handle. Movable handle 304 also includes a front surface 344 (Fig. 1) that extends along the length thereof.
  • locking member 306 surrounds and is disposed for slidable movement along handles 302 and 304.
  • Member 306 is of hollow construction and includes a pair of identical sidewalls 350 and 351 (Fig. 9), a front section 352, and a rear wall 353 (Fig. 9) .
  • Front section 352 includes a C-shaped finger-grip depression 354 sized to accept a finger of the user of the present tool.
  • Front section 352 also has an interior opening 355 that accommodates ridge 342 of fixed handle 304 and an interior slot 356 that accommodates movable handle 302.
  • Front section 352 further includes one or more biasing assemblies 368 (Fig. 1) for preventing the front section from binding as it slides along movable handle 304.
  • the assembly 368 preferably comprises an anti-friction pad 370 and a compression spring 372, both of which are disposed in a bore provided in the front section 352.
  • the compression spring 372 forces the anti-friction pad 370 into engagement with the front surface 344 of movable handle 304.
  • Rear wall 353 is formed with a right angle corner edge 358 (Fig. 1) for engaging the serrations 326 on fixed handle 302.
  • movable handle 304 is pivotally mounted to fixed handle 302 via stud 332.
  • Curved projection 112 of inner tube assembly 100 is positioned in pocket 340 of top end 312 of movable handle 304.
  • Extractor shaft 202 is disposed inside inner tube 102 and is positioned so that its curved contact surface 214 is spaced a selected distance from the curved contact surface 320 of fixed handle 302.
  • the length of shaft 202 is selected so that when the latter is in this position, itr pointed front end 204 does not project forwardly of rear wall 32 of bracket 26.
  • Lock member 306 surrounds handles 302 and 304 and is positioned near the upper ends of the handles adjacent pivot stud 332. The handles 302 and 304 are spaced apart from one another as far as locking member 306 will permit, i.e., they are in the "undamped" position.
  • the length of inner tube 102, the configuration of top end 312 of movable handle 304, and the placement of pocket 340 in top end 312 are selected so that when the handles 302 and 304 are in the undamped positioned, front end 106 of inner tube 102 does not project forwardly of rear wall 32 of bracket 26.
  • a loop of suture 400 is sec ired to the instrument by positioning a mid-length segment 402 of the loop in -
  • the loop 400 is then tensioned and the loop is secured to clamp 322, so as to maintain tension on the loop, by forcing the loop between the bottom of the clamp and top surface 324 of upper portion 308.
  • the loop 400 is wrapped around the clamp 322 several times so as to increase the length of suture clamped thereto, which in turn ensures the loop will remain securely attached to the clamp.
  • Additional tension is then applied to loop 400 by moving the portion of the loop immediately rearward of the mid-length section 402 of the loop so that it engages (1) shoulder 46 and (2) the outermost edges of the bottom surface of the rear portion 30b of bottom wall 30, as illustrated in Fig. 10.
  • the loop is supported below the interior U-shaped surface of clamping bracket 26.
  • a piece of tissue can be easily inserted into the bracket and moved into contact with the top surface of bottom wall 30 without interfering with the loop. If the loop 400 is not moved to pass around shoulder 46, then insertion of tissue into bracket 26 also involves manipulating the bracket relative to the tissue so as to cause the latter to force the front portion of loop 400 downwardly toward the top surface of bottom wall 30.
  • the outer tube assembly 22 is inserted into a skin portal or a cannula (not shown) extending into the closed surgical site.
  • a piece of tissue 404 e.g. a piece of meniscal tissue
  • the user of the instrument manipulates the latter so as to position a piece of tissue 404 (e.g. a piece of meniscal tissue) which is to be threaded or stitched between walls 28 and 32 of bracket 26 and in contact with bottom wall 30 of bracket 26, as illustrated in Fig. 11.
  • the device For open surgery, the device is inserted into the surgical site and is manipulated, typically based on direct observation, until the piece of tissue 404 is received between walls 28 and 32 of bracket 26 and is in contact with bottom wall 30 of bracket 26, as illustrated in Fig. 11.
  • tissue piece 404 is positioned in this manner, loop of suture 400 extends rearwardly from groove 40 beneath tissue piece 404.
  • movable handle 304 is squeezed toward fixed handle 302 causing the former to pivot about stud 332.
  • This pivotal motion drives pocket 340 of top end 312 forward toward bracket 26.
  • pocket 340 moves forward, it carries projection 112 disposed therein forward.
  • the latter pivots inside pocket 340, about an axis that extends normal to sidewalls 314 and 316, with the curved surface 114 of projection 112 sliding along the curved surface of pocket 340.
  • projection 112 is attached via block 110 to inner tube 102.
  • inner tube 102 is driven forward.
  • the length of inner tube 102 is selected so that when handle 304 is moved a selected distance toward handle 302, which distance will vary with the thickness of tissue piece 404, front end 106 of inner tube 102 is driven against tissue piece 404.
  • tissue piece 404 is forced against inside surface 44 of bracket leg 28 so as to clamp the tissue piece between bracket front wall 28 and tube 102. This clamping action is illustrated in Fig. 11.
  • locking member 306 is slid down handles 302 and 304 until the latter are wedged within the locking member.
  • handles 302 and 304 extend away from one another in V-shaped configuration when fully open and extend substantially in parallel to one another when fully closed. As such, the handles provide a V-shaped wedge which the locking member frictionally engages when moved into frictional contact with the handles. The position where this contact occurs will, of course, vary with the thickness of the tissue piece 404 clamped in bracket 26.
  • Serrated surface 326 is provided on movable handle 302 for ensuring locking member 306 remains frictionally engaged with the handles 302 and 304.
  • extractor assembly 200 is urged forward within inner tube 102 toward the clamped tissue piece 404 until curved contact surface 214 of extractor assembly 200 engages curved contact surface 320 of upper portion 308.
  • this forward movement is achieved by pressing forward on extractor knob 208.
  • extractor assembly 200 is pressed forward, its pointed end 204 will pass through bore 34 in bracket rear wall 32, through tissue piece 404 and through bore 36 in bracket front wall 28, as illustrated in Fig. 12.
  • the length of extractor shaft 202 is selected and projection 210 is provided so that only a front portion of the latter, measuring about 0.125 to 0.375 inch in length, extends beyond front surface 42 of bracket front wall 28.
  • Curved contact surface 214 of extractor assembly 200 and curved contact surface 320 of upper portion 308 are configured to ensure that extractor assembly 200 assumes a predetermined rotational alignment when surface 214 engages surface 320.
  • slot 206 of shaft 202 is on top of the shaft.
  • the suture loop is undamped from clamp 322 and is preferably held under tension by the user of the instrument to ensure segment 402 of the suture loop remains disposed within groove 40.
  • Extractor assembly 200 is then caused to move rearwardly in the inner tube 102 by pulling rearwardly on extractor knob 208.
  • suture segment 402 may be captured in slot 206 when shaft 202 first pierces through tissue piece 404.
  • pointed end 204 passes back through tissue piece 404 and into inner tube 102. Because suture segment 402 is captured in slot 206, as extractor shaft 202 is moved rearwardly, segment 402 is drawn through the tissue piece 404 and into inner tube 102. During this rearward movement of the extractor assembly 200, the user of the present instrument will pay out the suture loop 400 to permit the latter to be drawn into inner tube 102.
  • captured loop segment 402 is pulled away from tissue piece 404 thereby causing suture 400 to be drawn further through the tissue piece.
  • the portion of suture 400 being drawn through the tissue may be passed through the loop of suture formed at the knotted end of suture 400 so as to form a slip knot stitch. A point is reached during the extraction of instrument 20 where the slip knot stitch will be drawn closed around tissue piece 404.
  • the extractor assembly 02 is urged forward so that slot 206 projects out of the front end of outer tube 102.
  • Mid-length section 402 of suture 400 is then removed from slot 206 and is anchored outside the surgical site. No further steps are required using device 20 when tissue piece 404 is to be cut away and removed. Such removal is typically effected by severing tissue piece 404 by known methods and then pulling on the suture loop 400 threaded through the tissue piece whereby the latter is removed from the surgical site.
  • the mr iscus is to be manipulated to facilitate cutting or cherwise treating the meniscus
  • the suture 400 captivated in the ring will move laterally as will the tissue piece which is anchored to the end of the suture by the slip knot.
  • the tissue piece may be moved to a position where the cutting or other treatment of the tissue is facilitated.
  • one half of suture loop 400 is pulled through the opening in the tissue piece 404 so that a single length of suture extends throughout the opening. Then, the entire suture threading procedure described above and illustrated in Figs. 10-15 is repeated at another location on tissue piece 400 or on another tissue piece using a portion of the single length of suture.
  • a loop of suture will extend through the opening formed at another location in tissue piece 400 or in the second tissue piece.
  • One end of this loop is then pulled through this opening with the result that one end of the length of suture extends through the opening in tissue piece 400, an intermediate portion of the suture extends between this latter opening and the opening formed at the other location in piece 404 or in the second tissue piece, and the other end of the -23-
  • suture extends through the opening in the other location in piece 404 or in the second tissue piece.
  • the two openings in tissue piece 404, or the opening in tissue piece 404 and the opening in the second tissue piece, as the case may be, are then stitched together by knotting the two ends of the suture adjacent the openings in the tissue.
  • a loop of suture 400 is secured to the front bracket, positioned under shoulder 46, and clamped off on the device.
  • Tool 20 is then inserted into the cannula and maneuvered so that tissue piece 405 is positioned to contact bottom wall 30 of bracket 26, and to extend perpendicularly to the axis of inner tube 102, as illustrated in Figs. 16-18.
  • inner tube 102 is further selected so that when movable handle 304 is moved to extend substantially in parallel with fixed handle 302, front end 106 will nearly contact inner surface 44 of bracket leg 28, i.e., front end 106 will be spaced about 0.03 inches from surface 44. In this position, tissue piece 405 is secured between bottom wall 30 of bracket 26 and the bottom surface of the front portion of inner tube 102, as illustrated in Fig. 16.
  • extractor assembly 200 is urged forwardly in inner tube 102 on top of tissue piece 405 and through bore 36 in bracket front wall 28, as illustrated in Fig. 17. Then, after freeing suture 400 from clamp 322, extractor assembly 200 is withdrawn, capturing suture segment 402 in the process, as illustrated in Fig. 18. Then inner tube 102 is moved rearwardly to release the clamping force on tissue piece 405, and the device is manipulated to free the tissue piece from the tool. Device 20 is then removed from the surgical site, with segment 402 captivated in extractor 200 being simultaneously removed. At this point, the knotted end of suture 400 can be used to form a slip knot around the piece of tissue 405. The mid-length segment 402 is then detached from extractor slot 206 and is typically anchored outside of the surgical site. The slip knot can be tightened or the ligament manipulated using a shaft having a small ring attached to the end thereof, as described above.
  • suture threading, stitching and wrapping device of the present invention possesses several advantages over known open and closed surgical tissue clamping, punching and suture threading, stitching and wrapping devices.
  • the present invention is a single instrument, designed for use in open or closed surgery, for threading a loop of suture through or around a tissue piece.
  • a single instrument designed for use in open or closed surgery, for threading a loop of suture through or around a tissue piece.
  • several known surgical instruments must be employed to perform this threading function.
  • the present invention is designed to permit a user to quickly and easily anchor a tissue piece to be removed during a surgical procedure with a loop of suture, before severing the tissue piece, so as to reduce significantly the possibility that the tissue piece will escape from the surgical site and lodge elsewhere in the joint undergoing surgery.
  • the present invention permits suture threading, stitching, and wrapping of tissue located in an area of the surgical site where access is limited. For instance, where a piece of tissue to be threaded is spaced from a bone a distance insufficient to permit a conventional suture needle to be passed through the tissue, the device of the present invention can be advantageously employed to achieve such suture threading.
  • the present invention provides an instrument for threading a loop of suture through or around a piece of tissue, wherein the tissue-receiving portion of the instrument (i.e., the clamping bracket 26) has a fixed configuration and does not need to change its configuration or expand in size in order to receive the tissue which is to be affixed to the suture.
  • the tissue-receiving portion of the instrument i.e., the clamping bracket 26
  • the present invention provides an instrument for threading a loop of suture through or around a piece of tissue, wherein the suture-manipulating shaft or needle 202 moves along a controlled and largely shielded pathway, so that the needle's location can always be carefully regulated by the surgeon and the surrounding tissue safeguarded.

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Abstract

Un instrument chirurgical sert à enfiler une boucle de matériau de suture (400) à travers un morceau de tissu (404) à suturer ou à enlever lors d'une opération chirurgicale et à entourer un morceau de tissu avec une boucle de matériau de suture (402). L'instrument comprend un ensemble à tige d'extraction qui glisse à l'intérieur d'un tube interne qui, à son tour, glisse à l'extérieur d'un tube externe (24). L'ensemble d'extraction est pourvu d'une extrémité frontale en pointe (202), un crochet étant agencé directement derrière l'extrémité frontale. Une patte (26) de serrage du tissu est assujettie à l'extrémité frontale du tube externe, les deux étant de dimensions telles qu'ils pénètrent à l'intérieur d'une canule classique du type utilisé en chirurgie interne. Le tube externe est assujetti à une poignée (300) qui comprend un organe mobile qui entraîne un mouvement alternatif du tube interne à l'intérieur du tube externe, pour qu'il coopère avec la patte de serrage afin de serrer un morceau de tissu à saisir par celle-ci. En manipulant de manière appropriée l'ensemble d'extraction, on peut capturer un segment de suture fixé à la partie antérieure de la patte de serrage et le tirer à travers ou par-dessus un morceau de tissu serré dans la patte de serrage, puis former un n÷ud coulant que l'on peut serrer autour du morceau de tissu.
PCT/US1990/006504 1989-11-03 1990-11-02 Dispositif pour enfiler et effectuer des points de suture, et pour envelopper des tissus WO1991006247A1 (fr)

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US43213889A 1989-11-03 1989-11-03
US432,138 1989-11-03
US54404290A 1990-06-26 1990-06-26
US544,042 1990-06-26

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WO1991006247A1 true WO1991006247A1 (fr) 1991-05-16

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Cited By (26)

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EP0669102A1 (fr) * 1994-02-24 1995-08-30 LaserSurge, Inc. Instrument chirurgical de suture
US5562686A (en) * 1995-04-19 1996-10-08 United States Surgical Corporation Apparaus and method for suturing body tissue
US5591180A (en) * 1995-04-19 1997-01-07 United States Surgical Corporation Surgical suturing apparatus
US6551330B1 (en) * 2000-09-21 2003-04-22 Opus Medical, Inc. Linear suturing apparatus and methods
EP1306056A1 (fr) * 2001-10-23 2003-05-02 Arthrex, Inc. Appareil chirurgical pour réaliser des sutures de tissus
US7118583B2 (en) 2001-10-23 2006-10-10 Arthrex, Inc. Meniscal suturing instrument and method
US7556640B2 (en) 2001-02-12 2009-07-07 Arthrocare Corporation Bone anchor device having toggle member for attaching connective tissues to bone
US7615061B2 (en) 2006-02-28 2009-11-10 Arthrocare Corporation Bone anchor suture-loading system, method and apparatus
US7637926B2 (en) 2002-02-04 2009-12-29 Arthrocare Corporation Method and apparatus for attaching connective tissues to bone using a knotless suture anchoring device
US7879048B2 (en) 2002-06-26 2011-02-01 Arthrocare Corporation Suture capture device
CN104039252A (zh) * 2011-07-08 2014-09-10 史密夫和内修有限公司 整形外科器械
US8834495B2 (en) 2008-06-30 2014-09-16 Arthrocare Corporation Independent suture tensioning and snaring apparatus
US9023083B2 (en) 2012-01-27 2015-05-05 Arthrocare Corporation Method for soft tissue repair with free floating suture locking member
US9034014B2 (en) 2012-01-27 2015-05-19 Arthrocare Corporation Free floating wedge suture anchor for soft tissue repair
US9186133B2 (en) 2001-12-06 2015-11-17 Arthrocare Corporation Bone anchor insertion device
US9198649B2 (en) 2012-01-27 2015-12-01 Arthrocare Corporation Rotating locking member suture anchor and method for soft tissue repair
US9211118B2 (en) 2009-11-16 2015-12-15 Arthrocare Corporation Suture passer
US9226742B2 (en) 2012-01-27 2016-01-05 Arthrocare Corporation Restricted wedge suture anchor and method for soft tissue repair
US9364210B2 (en) 2012-01-27 2016-06-14 Arthrocare Corporation Biased wedge suture anchor and method for soft tissue repair
US9636101B2 (en) 2011-09-01 2017-05-02 Arthrocare Corporation Bone anchor having an integrated stress isolator
US9662105B2 (en) 2011-07-08 2017-05-30 Smith & Nephew, Inc. Suture passer and method
EP3089676A4 (fr) * 2013-12-31 2017-07-26 Children's Medical Center Corporation Appareil et procédés de réalisation de points de suture
US9855028B2 (en) 2012-04-06 2018-01-02 Arthrocare Corporation Multi-suture knotless anchor for attaching tissue to bone and related method
US9955963B2 (en) 2011-07-08 2018-05-01 Smith & Nephew, Inc. Soft tissue repair
US10265062B2 (en) 2012-02-07 2019-04-23 Arthrocare Corporation Surgical instrument for manipulating and passing suture
US10335138B2 (en) 2011-07-08 2019-07-02 Smith & Nephew, Inc. Suture passer and method

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US2457379A (en) * 1945-09-28 1948-12-28 Vern J Kallenbach Incision needle
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US4935027A (en) * 1989-08-21 1990-06-19 Inbae Yoon Surgical suture instrument with remotely controllable suture material advancement

Cited By (30)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0669102A1 (fr) * 1994-02-24 1995-08-30 LaserSurge, Inc. Instrument chirurgical de suture
US5562686A (en) * 1995-04-19 1996-10-08 United States Surgical Corporation Apparaus and method for suturing body tissue
US5591180A (en) * 1995-04-19 1997-01-07 United States Surgical Corporation Surgical suturing apparatus
US7544199B2 (en) 2000-09-21 2009-06-09 Arthrocare Corporation Linear suturing apparatus and methods
US6551330B1 (en) * 2000-09-21 2003-04-22 Opus Medical, Inc. Linear suturing apparatus and methods
US7556640B2 (en) 2001-02-12 2009-07-07 Arthrocare Corporation Bone anchor device having toggle member for attaching connective tissues to bone
EP1306056A1 (fr) * 2001-10-23 2003-05-02 Arthrex, Inc. Appareil chirurgical pour réaliser des sutures de tissus
US7118583B2 (en) 2001-10-23 2006-10-10 Arthrex, Inc. Meniscal suturing instrument and method
US9186133B2 (en) 2001-12-06 2015-11-17 Arthrocare Corporation Bone anchor insertion device
US7637926B2 (en) 2002-02-04 2009-12-29 Arthrocare Corporation Method and apparatus for attaching connective tissues to bone using a knotless suture anchoring device
US7879048B2 (en) 2002-06-26 2011-02-01 Arthrocare Corporation Suture capture device
US7615061B2 (en) 2006-02-28 2009-11-10 Arthrocare Corporation Bone anchor suture-loading system, method and apparatus
US8834495B2 (en) 2008-06-30 2014-09-16 Arthrocare Corporation Independent suture tensioning and snaring apparatus
US9211118B2 (en) 2009-11-16 2015-12-15 Arthrocare Corporation Suture passer
US9662105B2 (en) 2011-07-08 2017-05-30 Smith & Nephew, Inc. Suture passer and method
US9955963B2 (en) 2011-07-08 2018-05-01 Smith & Nephew, Inc. Soft tissue repair
US11006947B2 (en) 2011-07-08 2021-05-18 Smith & Nephew, Inc. Suture passer and method
CN104039252B (zh) * 2011-07-08 2019-10-15 史密夫和内修有限公司 整形外科器械
US10342529B2 (en) 2011-07-08 2019-07-09 Smith & Nephew, Inc. Osteotomy guide and method
US10335138B2 (en) 2011-07-08 2019-07-02 Smith & Nephew, Inc. Suture passer and method
CN104039252A (zh) * 2011-07-08 2014-09-10 史密夫和内修有限公司 整形外科器械
US9636101B2 (en) 2011-09-01 2017-05-02 Arthrocare Corporation Bone anchor having an integrated stress isolator
US9034014B2 (en) 2012-01-27 2015-05-19 Arthrocare Corporation Free floating wedge suture anchor for soft tissue repair
US9364210B2 (en) 2012-01-27 2016-06-14 Arthrocare Corporation Biased wedge suture anchor and method for soft tissue repair
US9226742B2 (en) 2012-01-27 2016-01-05 Arthrocare Corporation Restricted wedge suture anchor and method for soft tissue repair
US9023083B2 (en) 2012-01-27 2015-05-05 Arthrocare Corporation Method for soft tissue repair with free floating suture locking member
US9198649B2 (en) 2012-01-27 2015-12-01 Arthrocare Corporation Rotating locking member suture anchor and method for soft tissue repair
US10265062B2 (en) 2012-02-07 2019-04-23 Arthrocare Corporation Surgical instrument for manipulating and passing suture
US9855028B2 (en) 2012-04-06 2018-01-02 Arthrocare Corporation Multi-suture knotless anchor for attaching tissue to bone and related method
EP3089676A4 (fr) * 2013-12-31 2017-07-26 Children's Medical Center Corporation Appareil et procédés de réalisation de points de suture

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