CA2525275A1 - Single intubation, multi-stitch endoscopic suturing system - Google Patents

Single intubation, multi-stitch endoscopic suturing system Download PDF

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Publication number
CA2525275A1
CA2525275A1 CA002525275A CA2525275A CA2525275A1 CA 2525275 A1 CA2525275 A1 CA 2525275A1 CA 002525275 A CA002525275 A CA 002525275A CA 2525275 A CA2525275 A CA 2525275A CA 2525275 A1 CA2525275 A1 CA 2525275A1
Authority
CA
Canada
Prior art keywords
needle
suture
tissue
suture tag
tag
Prior art date
Legal status (The legal status 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 status listed.)
Granted
Application number
CA002525275A
Other languages
French (fr)
Other versions
CA2525275C (en
Inventor
Richard A. Gambale
Peter J. Lukin
Paul C. Dicesare
Christopher A. Battles
Jeffrey P. Radziunas
Danial P. Ferreira
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CR Bard Inc
Original Assignee
Individual
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Filing date
Publication date
Application filed by Individual filed Critical Individual
Publication of CA2525275A1 publication Critical patent/CA2525275A1/en
Application granted granted Critical
Publication of CA2525275C publication Critical patent/CA2525275C/en
Expired - Fee Related legal-status Critical Current
Anticipated expiration legal-status Critical

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets 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, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0467—Instruments for cutting sutures
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0487—Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00743—Type of operation; Specification of treatment sites
    • A61B2017/00818—Treatment of the gastro-intestinal system
    • A61B2017/00827—Treatment of gastro-esophageal reflux
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0448—Additional elements on or within the anchor
    • A61B2017/045—Additional elements on or within the anchor snug fit within the anchor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0464—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors for soft tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets 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
    • A61B2017/047—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery 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

Abstract

Provided is an encloscopic suturing system for joining internal body tissues in a variety of procedures. The system comprises a suturing capsule (100)releasably mountable to the distal end (14) of an endoscope (10) and capable of forming multiple stitches in tissue at a plurality of locations without requiring withdrawal of the capsule (100) from the patient between stitches. Also enclosed is a suture lock (120) to secure the placed stitch that is delivered by a device introduced through the working channel of the indwelling endoscope (10). Suitable control handles (16) for the suturing capsule (100) and for the suture lock delivery device (500) positioned at the proximal end (12) of the endoscope (10) are provided to facilitate operation by the user.

Claims (15)

1. An endoscopic tissue suturing device comprising:
a suturing capsule having a tissue suction chamber, needle track and a suture tag catch, wherein the suture tag catch is positioned distal to the tissue suction chamber, a needle slidable in the needle track and along a pathway that passes through the tissue suction chamber, a suture tag lock on an exterior surface of the needle, and a suture tag capturable on the exterior surface of the needle by the suture tag lock and that is releasable from the needle into the suture tag catch when the suture tag lock is released.
2. An endoscopic tissue suturing device as defined in claim 1 wherein the suture tag lock changes its position relative to the exterior surface of the needle to create a locking surface that engages the suture tag to prevent distal sliding movement of the tag relative to the needle.
3. An endoscopic tissue suturing device as defined in claim 2 wherein the exterior surface of the needle is shaped to engage the suture tag lock when the lock is moved longitudinally relative to the needle to form the locking surface.
4. An endoscopic tissue suturing device as defined in claim 3 wherein the suture lock comprises at least two locking splines that are spread open as they slide over an enlarged surface of the needle to create the locking surface that holds the suture tag from longitudinal movement.
5. An endoscopic tissue suture device as defined in claim 1 wherein the suture tag catch comprises two resilient arms bound together at one end of their ends in a Y-configuration each with a prong-shaped free end having an inwardly projecting edge configured to engage a surface of the suture tag.
6. An endoscopic tissue suturing device as defined in claim 5 wherein the suture capsule further comprises a cavity which is configured to closely fit around the surface of the suture tag while permitting movement of the resilient arms of the suture tag catch.
7. An endoscopic tissue suturing device as defined in claim 1 wherein the suture tag is annular and slides over an exterior surface of the needle.
8. An endoscopic tissue suturing device as defined in claim 7 wherein the tag has proximal and distal ends and is tapered at least at its distal end to present a low profile as the needle is advanced distally through tissue.
9. An endoscopic tissue suturing device as defined in claim 4 wherein the needle is solid and has a spear-shaped distal end with straight tapered barrel surfaces extending from the proximal and distal directions meeting at a central increased diameter section to define an enlarged shape.
10. An endoscopic tissue suturing device as defined in claim 1 further comprising a control handle releasably securable to a proximal end of an endoscope and having at least one longitudinal control member joined to a shaft extending through a working channel of an endoscope to control the longitudinal movement of the needle.
11. An endoscopic tissue suturing device as defined in claim 10 wherein the handle further comprises a control mechanism for actuating the suture tag lock during a portion of a stroke of the longitudinal control member that operates the needle.
12. An endoscopic tissue suturing device as defined in claim 11 wherein the longitudinal control member of the handle includes an around-the-world pawl and track mechanism oriented to cause movement of a suture tag lock control shaft during only a portion of the longitudinal stroke of the control mechanism that operates the needle.
13. An endoscopic tissue suturing device as defined in claim 10 wherein the control handle further includes a vacuum control switch including an interlock feature that prevents longitudinal movement of the handle control members until a pre-established vacuum pressure to the suction chamber of the capsule is achieved.
14. ~A single intubation multiple stitch endoscopic suturing system comprising:
a suturing capsule releasably securable to a distal end of an endoscope and having a needle slidable in a needle track;
a suction chamber for receiving tissue;
a suture tag joined to a suture and slidable over the needle;
a selectively releasable suture tag lock on the needle;
a suture tag catch distal to the suction chamber and configured to frictionally engage the suture tag;
a suturing capsule control handle releasably securable to a proximal end of an endoscope and comprising at least one longitudinal control member attached to one end of a control shaft having at its other end a connection to the needle so that longitudinal movement of the control member results in corresponding movement of the needle;
a suture lock comprising a plug frictionally engageable within a ring to capture a suture therebetween;
a suture lock delivery device comprising a shaft having distal and proximal ends and having a sufficiently small diameter to be slidably receivable through a working channel of an endoscope and sufficient length to extend at least the length of the endoscope;
a suture lock carrier at its distal end comprising a cage defined by a plurality of arms longitudinally arranged and hinged at their proximal ends;
a suture cutter slidable on the cage;
a suture lock delivery device control handle comprising a longitudinal slide for actuating a pusher extending through the shaft to push the plug into the ring and advance the cage distally relative to the sleeve to open the fingers and release the assembled ring and plug.
15. ~A method of suturing a plurality of tissue folds, comprising:
providing:
a suturing capsule having a tissue suction chamber, needle track and a suture tag catch, where the suture tag catch is positioned distal to the tissue suction chamber;

a needle slidable in the needle track and along a pathway that passes through the tissue suction chamber, a suture tag lock on an exterior surface of the needle, a suture tag releasably secured to and about the needle by the suture tag lock and that is releasable from the needle into the suture tag catch when the suture tag lock is released; and a suture attached to the suture tag;
suctioning a tissue fold into the tissue suction chamber;
advancing the needle, suture tag and suture into and through the tissue fold;
capturing the suture tag in the suture tag catch;
releasing the suture tag from the needle;
retracting the needle through and out of the tissue fold;
releasing the tissue fold from the tissue suction chamber;
advancing the needle to the suture tag catch and into the suture tag;
capturing the suture tag on the needle;
releasing the suture tag from the suture tag catch;
retracting the needle and attached suture tag to a position proximal to the tissue suction chamber;
advancing the suturing capsule to another area of tissue;
suctioning a tissue fold into the tissue suction chamber;
advancing the needle, suture tag and suture into and through the tissue fold;
capturing the suture tag in the suture tag catch;
releasing the suture tag from the needle;
retracting the needle through and out of the tissue fold;
releasing the tissue fold from the tissue suction chamber; and securing the ends of the suture with a suture clip;
thereby suturing the tissue folds.
CA2525275A 2003-05-16 2004-05-17 Single intubation, multi-stitch endoscopic suturing system Expired - Fee Related CA2525275C (en)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
US47124803P 2003-05-16 2003-05-16
US60/471,248 2003-05-16
PCT/US2004/015670 WO2004103189A1 (en) 2003-05-16 2004-05-17 Single intubation, multi-stitch endoscopic suturing system

Publications (2)

Publication Number Publication Date
CA2525275A1 true CA2525275A1 (en) 2004-12-02
CA2525275C CA2525275C (en) 2012-02-07

Family

ID=33476821

Family Applications (1)

Application Number Title Priority Date Filing Date
CA2525275A Expired - Fee Related CA2525275C (en) 2003-05-16 2004-05-17 Single intubation, multi-stitch endoscopic suturing system

Country Status (11)

Country Link
US (1) US8075573B2 (en)
EP (1) EP1631201B1 (en)
JP (2) JP4565218B2 (en)
CN (1) CN1822794B (en)
AU (1) AU2004240645B2 (en)
BR (1) BRPI0410376B1 (en)
CA (1) CA2525275C (en)
ES (1) ES2705604T3 (en)
MX (1) MXPA05012303A (en)
NO (1) NO339143B1 (en)
WO (1) WO2004103189A1 (en)

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AU2004240645A1 (en) 2004-12-02
EP1631201B1 (en) 2018-11-07

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