US 20050038449 A1
A suture placer for placing a length of suture wire through tissue such that the suture wire is directed into the tissue and then back out again.
1. Suture placer apparatus for placing a length of suture wire through tissue whereby the length of suture wire may thereafter be used to approximate and tension the tissue, said suture placer apparatus comprising:
a shaft having a proximal end and a distal end, and a lumen extending through said shaft and sized to closely receive the suture wire for supported passage therethrough, said lumen exiting said shaft at hole at said distal end of said shaft; and
a deflection die located adjacent to said hole for engagement by a suture wire passing through said lumen, whereby the trajectory of the suture wire will be changed by said deflection die.
2. A suture placer apparatus according to
3. A suture placer apparatus according to
4. Suture placer apparatus according to
5. Suture placer apparatus according to
6. A method for approximating and tensioning tissue, comprising:
providing suture placer apparatus comprising:
a shaft having a proximal end and a distal end, and a lumen extending through said shaft and sized to closely receive the suture wire for supported passage therethrough, said lumen exiting said shaft at a hole at said distal end of said shaft; and
a deflection die located adjacent to said hole for engagement by a suture wire passing through said lumen, whereby the trajectory of the suture wire will be changed by said deflection die;
positioning said suture placer apparatus so that suture wire exiting said hole will penetrate said tissue; and
advancing a length of suture wire through said lumen so that the suture wire engages said deflection die and is passed through said tissue.
This patent application claims benefit of pending prior U.S. Provisional Patent Application Ser. No. 60/163,808, filed Nov. 15, 1999 by Gregory E. Sancoff et al. for DEVICE FOR PLACING SUTURE WIRES INTO TISSUE FOR APPROXIMATION AND TENSION, which pending prior patent application is hereby incorporated herein by reference.
This invention relates to surgical apparatus and methods in general, and more particularly to apparatus and methods for placing suture wires into tissue for the surgical approximation and tensioning of tissue.
There is a growing trend to perform many surgical procedures using minimally invasive techniques. In such surgery, which is sometimes referred to as “keyhole surgery”, surgical instruments are inserted into the body through small surface incisions, and then the instruments are manipulated from outside the body while the actual surgery is carried out at a remote site inside the body.
One of the more common surgical tasks is the placement of sutures into tissue so as to aid repair. However, conventional suturing requires a substantial amount of manipulation, i.e., the needle must be moved safely into position at the surgical site, then the needle (and trailing suture) must be passed through the target tissue, then the needle must be safely removed from the surgical site, and finally the suture must be effectively knotted. During minimally invasive surgery, this must all be done at a remote interior surgical site, using a minimum of space. This can be difficult and time-consuming to do.
As a result, one object of the present invention is to provide apparatus for quickly and easily placing suture wires into tissue for the approximation and tensioning of tissue.
Another object of the present invention is to provide a method for quickly and easily placing suture wires into tissue for the approximation and tensioning of tissue.
These and other objects are addressed by the present invention, which comprises an apparatus and method for placing suture wire through tissue, e.g., during minimally invasive surgery or during open surgery where space may be limited. The apparatus is configured so as to deliver suture wire to the distal end of a shaft, whereupon the wire is deflected so as to change directions and pass into, and through, the tissue. As a result of this construction, the suture wire can be made to follow a path such that the wire goes into the tissue and then back out again, whereby a loop of suture wire may be passed through the tissue. This loop of suture wire may then be used to approximate and/or tension the tissue.
These and other objects and features of the present invention will be more fully disclosed or rendered obvious by the following detailed description of the preferred embodiments of the invention, which is to be considered together with the accompanying drawings wherein like numbers refer to like parts and further wherein:
Looking first at
At a location near the distal end of shaft 10, lumen 25 turns at a deflection die 30 and then proceeds out of the shaft through a side hole 35. Deflection die 30 is designed to turn a suture wire 40, passing distally down lumen 25, outward and backward (i.e., proximally). As a result, when the shaft's sharp distal tip 45 is placed in tissue 50, suture wire 40 travels below the surface of tissue 50 inside lumen 25 and, when the suture wire hits deflection die 30, the suture wire is deflected outward, through side hole 35, and backward up to the surface of tissue 50.
The shape of deflection die 30 helps determine the manner in which the suture wire changes direction at the distal end of the device.
More particularly, in one form of the invention, deflection die 30 is substantially planar (see
Alternatively, and more preferably, deflection die 30 is formed with a radius of curvature (see
If deflection die 30 also includes a lateral radius, it will cause suture wire 40 to adopt a helical trajectory (see
Suture wire 40 is contained within lumen 25 of shaft 10 and is laterally supported as the suture wire is advanced. To this end, the lumen diameter is preferably formed so as to be slightly larger than the diameter of the suture wire it is to receive (e.g., the lumen diameter might be 0.0055-0.0060 inches where the wire diameter is 0.0050 inches). This slight gap between suture wire 40 and lumen 25 is provided in order to avoid line-to-line contacts or, even worse, press fits between the suture wire and the lumen wall which might be encountered with likely manufacturing tolerances. Such tight fits would cause undue resistance to wire movement. At the same time, however, too large a gap could allow the suture wire to buckle, thus causing resistance to forward motion and also presenting a crumpled appearance along the length of the wire.
For smaller diameter wires, the plunger diameter may be too small to support the pushing load without the plunger buckling in the area outside of lumen 25 (i.e., in the area above crosshandle 20). Consequently, an alternative arrangement can be used that provides more support for the plunger. One such arrangement, shown in
It will be appreciated that the suture placer 5 shown in
More particularly, suture placer 5A is substantially the same as the suture placer 5 described above, except that it has a cutting tube 65 on the outside of shaft 10. Cutting tube 65 is attached to a finger-operated tab 70 which, if moved forward (i.e., distally), slides cutting tube 65 downward so that the distal end of the cutting tube crosses the shaft's side hole 35 and shears off any suture wire 40 extending out of side hole 35, with a guillotine-type effect. If desired, the end of cutting tube 65 may be beveled so as to present a sharp edge to wire 40, whereby to make cutting easier.
It should also be appreciated that if suture wire 40 is made of a relatively stiff material, or if suture wire 40 has a relatively large diameter, the suture wire can have enough rigidity to pass through tissue in a circular arc on its own, without first being taken down into the tissue with a penetrating shaft. Again, a deflection die will govern the radius of the wire trajectory and, in this case, the depth of penetration of the suture wire into the tissue before it returns out of the tissue.
Once suture wire 40 has been placed through the tissue, the two free ends of the wire can be twisted together (
As used herein, the term “suture wire” is intended to mean any filament-like element consistent with the present invention. By way of example but not limitation, suture wire may comprise a metal (e.g., stainless steel, titanium, Nitinol or other shape memory alloy, etc.) or a plastic (e.g., polypropylene, polyimide, etc.), or other materials or combinations of materials.
It should be noted that the suture wire may have a configuration other than round, e.g., rectangular, square, elliptical, ribbon-like, etc. In this respect it should also be appreciated that a ribbon-like wire could provide increased lateral strength, resulting in more precise guidance as the suture wire passes through the tissue.
The present invention permits a wire suture to be placed into tissue at a remote surgical site, whereby that wire suture can be used for approximation and tensioning. Wire suture has the added benefit of acting as its own needle, so that holes larger than the suture itself need not be created.