The present disclosure relates to surgical access and closure of surgical access openings and, more particularly, to devices, systems, and methods that provide access to an internal surgical site through an opening in tissue and facilitate the closure of the opening in tissue.
Puncture wounds (i.e., wounds that pierce through tissue) may result from trauma or may be intentionally created in order to provide a surgical access opening for accessing an internal surgical site of a patient during surgical procedures. During endoscopic surgical procedures, for example, a trocar device is utilized to puncture the peritoneum to provide access by way of a cannula through the abdominal wall. Generally, a trocar and/or cannula is placed through the abdominal wall for introduction of surgical instrumentation which is necessary to carry out one or more surgical tasks. The surgeon may introduce a surgical instrument such as a forceps, scissors, clip applier, stapler, biopsy device, or any other suitable surgical instrument as necessary to complete a particular surgical task or tasks. Once the task(s) is complete, it is necessary to close the opening.
A continuing need exists in the surgical arts for improved tools and methods for safely closing puncture openings in a body wall of a patient.
The present disclosure provides devices, systems, and methods that facilitate accessing an internal surgical site through an opening in tissue, performing one or more minimally-invasive surgical tasks within the internal surgical site, and closing the opening in tissue once the surgical task(s) is complete. In particular, in accordance with aspects of the present disclosure, a suture passer is provided. The suture passer includes a handle assembly, a shaft extending distally from the handle assembly, a first jaw member coupled to a distal end portion of the shaft, a second jaw member pivotable relative to the first jaw member between open and closed configurations, and an overstroke assembly. The overstroke assembly includes a proximal actuator rod operably coupled to the handle assembly, a distal actuator rod axially movable relative to the shaft and operably coupled to the second jaw member, and a biasing member interposed between the proximal and distal actuator rods. Advancement of the proximal actuator rod in response to an actuation of the handle assembly advances the biasing member and the distal actuator rod. The biasing member is configured to compress to allow for independent movement of the proximal actuator rod relative to the distal actuator rod in response to an obstruction of the second jaw member.
In aspects, the overstroke assembly may further include a sleeve disposed within the shaft and longitudinally movable relative to the shaft. The sleeve may be disposed about the proximal and distal actuator rods and may house the biasing member.
In aspects, the sleeve may define a longitudinally-extending slot, and the proximal actuator rod may have a pin slidably received in the slot.
In aspects, when the second jaw member is prevented from opening by an obstruction, an actuation of the handle assembly may distally move the pin from a proximal position within the slot to a distal position within the slot.
In aspects, the proximal actuator rod may be configured to move relative to the sleeve and the distal actuator rod during the distal movement of the pin toward the distal position.
In aspects, the pin may be configured to proximally move the sleeve and the distal actuator rod to move the second jaw member toward the closed configuration in response to an actuation of the handle assembly.
In aspects, the distal actuator rod may be fixed within the sleeve, and the proximal actuator rod may be slip-fit within the sleeve.
In aspects, the second jaw member may have a proximal end portion pivotably coupled to the distal actuator rod.
In aspects, the first jaw member may have a distal tip configured to pierce tissue.
In aspects, the second jaw member may be nested with the first jaw member in the closed configuration.
In aspects, the first jaw member may define a recessed portion configured to receive the second jaw member when the second jaw member is in the closed configuration.
In aspects, each of the first and second jaw members may have a suture-contacting surface defining a transverse notch therein. The transverse notches of the first and second jaw members may be configured to cooperatively enclose a suture therein.
In another aspect of the present disclosure, a suture passer includes a handle assembly, a shaft extending distally from the handle assembly, and an end effector assembly. The end effector assembly includes a first jaw member coupled to a distal end portion of the shaft and a second jaw member pivotable relative to the first jaw member between open and closed configurations. The suture passer further includes a proximal actuator rod, a distal actuator rod, and a biasing member interposed between the proximal and distal actuator rods. The proximal actuator rod is operably coupled to a trigger of the handle assembly, such that a first actuation of the trigger proximally moves the proximal actuator rod. The distal actuator rod is slidably disposed within the shaft and operably coupled to the second jaw member. The proximal actuator rod is configured to distally move the distal actuator rod via the biasing member in response to a second actuation of the handle assembly. The biasing member is configured to compress between the proximal and distal actuator rods upon the proximal actuator rod exerting a distally-oriented, threshold force on the biasing member.
In aspects, the distal actuator rod may be pivotably coupled to the second jaw member via a pivot pin configured to receive a distally-oriented force from the distal actuator rod. The distally-oriented, threshold force imparted on the biasing member may be lower than a threshold force required to damage the pivot pin.
In aspects, when the second jaw member is prevented from opening by an obstruction, the second actuation of the trigger may distally move the proximal actuator rod relative to the distal actuator rod to compress the biasing member therebetween.
In aspects, the suture passer may further include a sleeve disposed within the shaft and longitudinally movable relative to the shaft. The sleeve may be disposed about the proximal and distal actuator rods and may house the biasing member.
In aspects, the sleeve may define a longitudinally-extending slot, and the proximal actuator rod may have a pin slidably received in the slot.
In aspects, when the second jaw member is prevented from opening by an obstruction, the second actuation of the trigger may distally move the pin from a proximal position within the slot to a distal position within the slot.
In aspects, the proximal actuator rod may be configured to move relative to the sleeve and the distal actuator rod during the distal movement of the pin toward the distal position.
In aspects, the pin may be configured to proximally move the sleeve and the distal actuator rod to move the second jaw member toward the closed configuration in response to the first actuation of the trigger.
In aspects, the distal actuator rod may be fixed within the sleeve, and the proximal actuator rod may be slip-fit within the sleeve.
In yet another aspect of the present disclosure, a method of depositing a portion of a suture into an internal surgical site and/or retrieving a portion of suture from within an internal surgical site is provided. The method includes advancing a suture passer into a surgical site while first and second jaw members of the suture passer are in a closed configuration; and actuating a handle assembly of the suture passer. Actuating the handle assembly one of: distally moves a proximal actuator rod toward a distal actuator rod; or distally moves the proximal actuator rod, the biasing member, and the distal actuator rod together. Distal movement of the proximal actuator rod toward the distal actuator rod compresses a biasing member between the proximal actuator rod and the distal actuator. The proximal actuator rod is operably coupled to the handle assembly and the distal actuator rod is operably coupled to the second jaw member. Distal movement of the proximal actuator rod, the biasing member, and the distal actuator rod together pivots the second jaw member relative to the first jaw member to transition the first and second jaw members to the open configuration for one of depositing a portion of suture into the internal surgical site or retrieving a portion of the suture from the internal surgical site.
In some methods, the biasing member may be compressed between the proximal and distal actuator rods when the second jaw member is in a constrained state as the handle assembly is being actuated.
In some methods, the proximal actuator rod, the biasing member, and the distal actuator rod may distally move together when the second jaw member is in an unconstrained state as the handle assembly is being actuated.
In aspects, the method may further include returning the suture passer to the closed condition; and withdrawing the suture passer from the internal surgical site.
Any of the above aspects, to the extent consistent, may be utilized with any or all of the other aspects detailed herein.
As used herein, the terms parallel and perpendicular are understood to include relative configurations that are substantially parallel and substantially perpendicular up to about + or −10 degrees from true parallel and true perpendicular.
Various aspects and features of the present disclosure are described hereinbelow with references to the drawings, wherein:
As detailed below and illustrated in the figures, the present disclosure provides devices, systems, and methods that facilitate accessing an internal surgical site through an opening in tissue, performing one or more minimally-invasive surgical tasks within the internal surgical site, and closing the opening in tissue once the surgical task(s) is complete. In the accompanying figures and in the description that follows, in which like reference numerals identify similar or identical elements, the term “proximal” will refer to the end of the device or portion thereof which is closest to the clinician during use, while the term “distal” will refer to the end or portion which is farthest from the clinician during use, as is traditional.
The present disclosure provides a suture passer having an overstroke assembly that prevents damage to an end effector assembly of the suture passer when the end effector assembly is in a constrained state. The end effector assembly of the suture passer has a first jaw member, and a second jaw member movable relative to the first jaw member between an open configuration, and a closed configuration, in which the jaw members grasp a suture therebetween. In some instances, the second jaw member of the suture passer may be prevented from opening due to an obstruction present in the surgical site (e.g., a surgical instrument, hard tissue, or the like). In these instances, when a clinician actuates a handle assembly of the suture passer in an attempt to open the second jaw member, one or more internal components of the suture passer are vulnerable to damage if the clinician continues to apply an actuating force. The overstroke assembly of the present disclosure includes a proximal actuator rod operably coupled to the handle assembly, a distal actuator rod operably coupled to the second jaw member, and a biasing member disposed between the proximal and distal actuator rods. The biasing member compresses between the proximal and distal actuator rods during an overstroke by the clinician to prevent the distal actuator rod from damaging a pivot member that couples the second jaw member with the distal actuator rod.
With reference to
With reference to
The elongated portion 102 of the cannula 100 has a pair of opposed slots 106 extending through an annular side wall of the elongated tubular member 102a, thus providing lateral access to and from the longitudinal passageway 105 to and from the exterior of the elongated tubular member 102a. The opposed slots 106 may be positioned along the length of the elongated tubular member 102a at any suitable position, e.g., closer to or further from the base member 102b of the elongated portion 102 of the cannula 100. For some procedures, it has been found to be desirable that, once the cannula 100 is positioned within the opening in tissue, the slots 106 are located on the elongated tubular member 102a at a position distal of the skin and fatty layers of tissue and adjacent to the fascia and muscle layers of tissue. This is desirable because the fascia and muscle layers are better suited to receive and retain a suture for closing the opening in tissue. Thus, a cannula 100 having the slots 106 positioned to achieve this function may be selected. However, other configurations are also contemplated.
For a more detailed description of embodiments of cannulas for use in the surgical assembly 10 of the present disclosure, reference may be made to U.S. Pat. No. 9,700,303, filed Jul. 29, 2014, the entire contents of which being incorporated by reference herein.
With reference to
The guide member 200 generally includes a guide housing 210 disposed in mechanical cooperation with an elongated guide shaft 220. The guide member 200 further includes a pair of guide lumens 216a, 216b extending therethrough. The guide housing 210 defines a proximally-facing portion 211 including a pair of recesses 212 that facilitate grasping and manipulation of the guide member 200 and a pair of apertures 214a, 214b that communicate with the proximal ends of respective lumens 216a, 216b extending through the guide member 200. The guide housing 210 further includes threading 217 defined on a distally-facing portion 215 thereof that is configured to engage complementary threading 129 (
The elongated guide shaft 220 of the guide member 200 extends distally from the guide housing 210 and is configured for insertion through the passageway 105 (
For a more detailed description of embodiments of a guide member for use in the surgical assembly 10 of the present disclosure, reference may be made to U.S. Pat. No. 9,700,303, filed Jul. 29, 2014, the entire contents of which having been incorporated by reference above.
With reference to
The shaft 310 of the suture passer 300 may be flexible to permit insertion through any of the lumens 216a, 216b of the guide member 200. Alternatively, the shaft 310 may have a rigid, curved configuration having a radius of curvature equal to that of the lumens 216a, 216b of the guide member 200 for use therewith, or may have a rigid, linear configuration. The shaft 310 has a proximal end portion 310a fixed to the fixed handle portion 304 of the handle assembly 302. The shaft 310 serves as a barrier to inhibit contact between the internal components of the suture passer 300 and surgical instrumentation (not shown) and/or tissue through which the suture passer 300 is inserted, thus inhibiting rubbing or catching of the internal components of the suture passer 300 upon the surgical instrumentation (not shown) and/or tissue during actuation of the suture passer 300.
The end effector assembly 320 of the suture passer 300 has a first jaw member 322 fixed to the distal end portion 310b of the shaft 310, and a second jaw member 324 coupled to the first jaw member 322 and configured to pivot relative to the first jaw member 322 between a closed configuration, as shown in
The proximal end portion 322a of the first jaw member 322 and the proximal end portion 324a of the second jaw member 324 have a pivot pin 326 extending transversely therethrough to pivotably couple the second jaw member 324 to the first jaw member 322. In alternate embodiments, rather than being pivotably coupled to the first jaw member 322, the second jaw member 324 may be directly pivotably coupled to the distal end portion 310b of the shaft 310. The proximal end portion 324a of the second jaw member 324 may be set at an obtuse angle from the remainder of the second jaw member 324.
The first and second jaw members 322, 324 each have a planar suture-contacting surface 334a, 334b opposing one another when the first and second jaw members 322, 324 are in the closed configuration. Each of the suture-contacting surfaces 334a, 334b defines a notch 336a, 336b therein that extends across the respective first and second jaw members 322, 324. The notches 336a, 336b of the first and second jaw members 322, 324 are configured to cooperatively define a channel 338 (
With reference to
The distal actuator rod 344 of the overstroke assembly 340 is disposed within the distal end portion 310b of the shaft 310 and is longitudinally movable therein. The distal actuator rod 344 has a proximal end portion 344a in abutting engagement with a distal end portion 346b of the biasing member 346, and a distal end portion 344b. The distal end portion 344b of the distal actuator rod 344 has a connector 350 set at an obtuse angle from the remainder of the distal actuator rod 344. The connector 350 rotationally couples the proximal end portion 324a of the second jaw member 324 to the distal actuator rod 344 via the actuation pin 313. As will be described, under normal operating conditions, distal movement of the distal actuator rod 344 transitions the second jaw member 324 toward the open configuration using the actuation pin 313 of the second jaw member 324.
The overstroke assembly 340 may further include an outer sleeve 354 disposed within the shaft 310 and longitudinally movable therein. The sleeve 354 houses the biasing member 346 and has a proximal end portion 354a disposed about the distal end portion 342b of the proximal actuator rod 342, and a distal end portion 354b disposed about the proximal end portion 344a of the distal actuator rod 344. The proximal actuator rod 342 is slip fit within the sleeve 354, such that the proximal actuator rod 342 is movable relative to the sleeve 354, whereas the distal actuator rod 344 is press-fit within the sleeve 354, such that the sleeve 354 and the distal actuator rod 344 translate within the shaft 310 together during actuation of the suture passer 300.
The sleeve 354 defines a pair of opposed longitudinally-extending slots 356 in the proximal end portion 354a thereof. The pin 348 of the proximal actuator rod 342 extends through the slots 356 of the sleeve 354 to permit translation of the proximal actuator rod 342 relative to the sleeve 354 between a proximal position, in which the pin 348 is engaged with a proximal limit 356a of the slots 356, and a distal position, in which the pin 348 is engaged with a distal limit 356b of the slots 356. With the pin 348 disposed in the proximal position, a retraction of the proximal actuator rod 342 results in a retraction of the sleeve 354, and, in turn, the distal actuator rod 344 and the biasing member 346, to close the second jaw member 324. With the pin 348 disposed in the proximal position and when the second jaw member 324 is in the constrained state, advancement of the proximal actuator rod 342 translates the pin 348 from the proximal position toward the distal position within the slots 356 of the sleeve 354, thereby compressing the biasing member 346 between the proximal actuator rod 342 and the distal actuator rod 344. In contrast, with the pin 348 disposed in the proximal position and when the second jaw member 324 is in an unconstrained state, advancement of the proximal actuator rod 342 urges the biasing member 346 with a sufficient amount of force (without compressing the biasing member 346) to advance the biasing member 346, the distal actuator rod 344, and the sleeve 354 as an integral unit, thereby opening the second jaw member 324.
In operation, as shown in
With the second jaw member 324 in the closed configuration (
In some instances, an attempt to transition the end effector assembly 320 to the open configuration via the second actuation of the handle assembly 302 fails due to the second jaw member 324 being constrained from opening due to an obstruction “O” (
The suture passer 300 may be configured for selective disassembly (and be made of sterilizable reusable and/or disposable components) to facilitate cleaning and/or replacement of disposable components.
Any suitable suture or sutures may be utilized in conjunction with the above. In particular, the suture(s) may be provided in any suitable form and/or include any suitable feature(s) to facilitate insertion through and depositing the suture within the internal surgical site on one side of the opening in tissue, and retrieval and withdrawal of the portion of suture from the other side of the opening in tissue. Such a configuration establishes a “U”-shaped suture extending through tissue on either side of the opening and across the opening on the internal side of tissue. This configuration enables tying off of the externally-disposed free ends of the suture and provides sufficient holding strength to permit healing and resist re-opening of the sutured tissue.
From the foregoing and with reference to the various figure drawings, those skilled in the art will appreciate that certain modifications can also be made to the present disclosure without departing from the scope of the same. While several embodiments of the disclosure have been shown in the drawings, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.
This application claims the benefit of and priority to U.S. Provisional Patent Application No. 62/661,861 filed Apr. 24, 2018, the entire disclosure of which is incorporated by reference herein.
Number | Name | Date | Kind |
---|---|---|---|
987173 | Sale | Mar 1911 | A |
2212013 | Devareaux | Aug 1940 | A |
4655219 | Petruzzi | Apr 1987 | A |
5364410 | Failla et al. | Nov 1994 | A |
5431666 | Sauer et al. | Jul 1995 | A |
5496335 | Thomason | Mar 1996 | A |
5499997 | Sharpe et al. | Mar 1996 | A |
5507755 | Gresl et al. | Apr 1996 | A |
5522846 | Bonutti | Jun 1996 | A |
5540704 | Gordon et al. | Jul 1996 | A |
5562688 | Riza | Oct 1996 | A |
5613974 | Andreas et al. | Mar 1997 | A |
5653716 | Malo et al. | Aug 1997 | A |
5674230 | Tovey | Oct 1997 | A |
5700273 | Buelna et al. | Dec 1997 | A |
5716369 | Riza | Feb 1998 | A |
5741278 | Stevens | Apr 1998 | A |
5772672 | Toy et al. | Jun 1998 | A |
5814065 | Diaz | Sep 1998 | A |
5817108 | Poncet | Oct 1998 | A |
5817111 | Riza | Oct 1998 | A |
5836955 | Buelna et al. | Nov 1998 | A |
5860990 | Nobles et al. | Jan 1999 | A |
5899911 | Carter | May 1999 | A |
5938668 | Scirica et al. | Aug 1999 | A |
5954734 | Thomason et al. | Sep 1999 | A |
5993474 | Ouchi | Nov 1999 | A |
6022360 | Reimels et al. | Feb 2000 | A |
6042601 | Smith | Mar 2000 | A |
6099550 | Yoon | Aug 2000 | A |
6110185 | Barra et al. | Aug 2000 | A |
6117144 | Nobles et al. | Sep 2000 | A |
6183485 | Thomason et al. | Feb 2001 | B1 |
6270508 | Klieman | Aug 2001 | B1 |
6641592 | Sauer et al. | Nov 2003 | B1 |
6743242 | Guo | Jun 2004 | B2 |
7842049 | Voss | Nov 2010 | B2 |
7875043 | Ashby et al. | Jan 2011 | B1 |
8109943 | Boraiah et al. | Feb 2012 | B2 |
8172801 | Adams | May 2012 | B2 |
9700303 | Prior et al. | Jul 2017 | B2 |
20030220658 | Hatch | Nov 2003 | A1 |
20040068273 | Fariss et al. | Apr 2004 | A1 |
20040087978 | Velez et al. | May 2004 | A1 |
20050212221 | Smith et al. | Sep 2005 | A1 |
20050228405 | Maruyama et al. | Oct 2005 | A1 |
20060135991 | Kawaura et al. | Jun 2006 | A1 |
20060142784 | Kontos | Jun 2006 | A1 |
20070250112 | Ravikumar et al. | Oct 2007 | A1 |
20070270885 | Weinert | Nov 2007 | A1 |
20100012152 | Hansen | Jan 2010 | A1 |
20100016870 | Campbell | Jan 2010 | A1 |
20100179572 | Voss et al. | Jul 2010 | A1 |
20100262166 | Boraiah et al. | Oct 2010 | A1 |
20110082475 | Smith | Apr 2011 | A1 |
20110112557 | Beeley | May 2011 | A1 |
20110237901 | Duke et al. | Sep 2011 | A1 |
20110245850 | van der Burg et al. | Oct 2011 | A1 |
20110288563 | Gianotti et al. | Nov 2011 | A1 |
20120029532 | Hodgkinson et al. | Feb 2012 | A1 |
20120035623 | Bagaoisan et al. | Feb 2012 | A1 |
20120116422 | Triplett | May 2012 | A1 |
20120123448 | Flom et al. | May 2012 | A1 |
20120143221 | Weisel et al. | Jun 2012 | A1 |
20130006277 | Stafford | Jan 2013 | A1 |
20130079597 | Auerbach et al. | Mar 2013 | A1 |
20130165956 | Sheds et al. | Jun 2013 | A1 |
20150157317 | Bagaoisan et al. | Jun 2015 | A1 |
Number | Date | Country |
---|---|---|
2412317 | Feb 2012 | EP |
9502998 | Feb 1995 | WO |
2011128392 | Oct 2011 | WO |
2012093094 | Jul 2012 | WO |
2013105993 | Jul 2013 | WO |
2017059587 | Apr 2017 | WO |
2017075752 | May 2017 | WO |
Entry |
---|
International Search Report from corresponding PCT/US2014/048892 dated Nov. 25, 2014. |
International Search Report from corresponding PCT/US2014/048919 dated Nov. 7, 2014. |
International Search Report from corresponding PCT/US2014/048907 dated Nov. 12, 2014. |
Extended European Search Report corresponding to counterpart Int'l Appln. No. EP 14 83 1785.2, dated Mar. 17, 2017. |
Extended European Search Report corresponding to counterpart Int'l Appln. No. EP 14 83 2198.7 dated Apr. 18, 2017. |
European Search Report dated Sep. 20, 2019, corresponding to counterpart European Application No. 19170620.9; 7 pages. |
Number | Date | Country | |
---|---|---|---|
20190321028 A1 | Oct 2019 | US |
Number | Date | Country | |
---|---|---|---|
62661861 | Apr 2018 | US |