Patent Application
20170112481
The present disclosure relates to tissue closure devices, and more particularly to a laparoscopic fascial closure system that includes a template and a sliding suture retrieving needle for use during an intra-abdominal suturing procedure or the suturing of a puncture wound generated by a surgical trocar or other puncturing devices.
Minimally invasive methods for conducting surgery on internal organs, tissues, ligaments and bones use extremely small instruments such as catheters, laparoscopes, and the like. The instruments are introduced using very small incisions, for example on the order of 5 mm to 18 mm in diameter, into which a trocar or other introducing device is placed. The trocars may have a diameter, for example, between 3 mm and 30 mm, with the smaller trocars leaving the opening substantially unchanged. The larger trocars may enlarge the opening. The trocars provide a reliable and fixed opening for introducing and removing various surgical instruments, viewing devices and other instruments used during the surgical procedure.
While the incisions and the trocar opening are quite small by traditional surgical standards, they still require closure after completing the surgical procedure. Surgical closure reduces the possibility of post-surgical infection, post-surgical herniation (for example in abdominal surgeries), subsequent bleeding or other effects. Closure can be accomplished either through manual suturing or suturing instruments used to complete the closure. In either case, suturing is made difficult by the small opening size, for example not only for manipulating the suture but also for visualizing the procedure. Closure is also made more difficult by the need to suture the subcutaneous tissue, for example fascial layers, separate from closure of the overlying skin, and doing so through a very small opening in the skin while also avoiding possible injury or damage to the internal organs during such a procedure.
Conventional closure techniques such as those for closing openings in the abdominal wall pass sutures through the abdominal wall tissue a distance from the original trocar incision. One or more sutures are then tied off to close the subcutaneous layer followed by suitable closure of the skin layer. It has been noted that the distance of the suture location from the original incision opening is important in order to secure a suitable amount of abdominal wall tissue for forming a reliable closure. If the distance is too small, the closure may not be enough to reliably close the opening without later complications.
Tissue closure devices, for example laparoscopic port closure devices, may be introduced into the opening after removal of the trocar device to make easier the suturing of the trocar opening. Various methods and structures may help in closing the opening, but may require a significant number of steps for completing the closure. Some devices may require a significant amount of manual care in suturing the opening and tying off the suture, as well as close visualization for accomplishing the closure. Additionally, some devices have a significant number of components or special devices in order to accomplish the closure, or they may not provide consistent and reliable results even under normal operating circumstances.
This disclosure relates to tissue closure devices, including surgical suturing devices as well as such devices that can be used for intra-abdominal suturing and suturing of puncture wounds generated by surgical trocars and other puncturing devices.
A laparoscopic fascial closure system may provide a suture preloaded on a closure template for insertion into a body cavity that may be used with a suture grasper retriever to easily capture a portion of the suture with the template disposed within the body cavity and then facilitating free movement or sliding of the suture at or within the device tip during retraction of the device from the body cavity.
According to one exemplary embodiment, a tissue closure device includes an elongated body defining a central longitudinal axis and including a proximal end, a distal end, and a lumen extending axially through the elongated body. The tissue closure device further includes an actuator rod at least partially extending through the lumen of the elongated body. A distal portion of the elongated body is pivotally connected to a plurality of wings, which are pivotally connected to a plurality of shields. The plurality of shields are pivotally connected to a distal tip portion of the device, the distal tip portion being attached to a distal end of the actuator rod. The plurality of wings each include an opening to allow passage into a suture retrieval space defined between one each of the plurality of wings and plurality of shields when said wings and shield are extended away from the elongated body in a deployed position of the device.
According to one aspect, the opening is a round or open shape.
According to one aspect, each of the plurality of shields is connected to a corresponding one of the plurality of wings via living hinges.
According to one aspect, the plurality of shields and the plurality of wings are pivotally retractable to be parallel to the elongated body as the actuator rod is moved in a distal direction with respect to the elongated body.
According to one aspect, the plurality of shields and the plurality of wings extend at angles laterally away from the central longitudinal axis as the actuator rod is moved in a proximal direction with respect to the elongated body, in the deployed position.
According to one aspect, the elongated body further includes a plurality of suture runner guides to control a location of a suture loaded onto the device, each suture runner guide disposed at a predetermined position distal to an inner surface of each of the plurality of wings.
According to one aspect, the location aligns the suture in the predetermined position to allow a suture grasper to orthogonally intersect the suture, when said grasper is inserted into the suture retrieval space, after passing through the at least one needle guide lumen.
According to one aspect, the plurality of shields prevent inadvertent needle perforation of organs, vessels, or other tissues in the deployed position.
According to one aspect, a proximal portion of the elongated body includes a suture cleat for stabilizing or holding a suture taut.
According to one exemplary embodiment, a tissue closure system includes a suture grasper, a tissue closure template, the template including an elongated body defining a central longitudinal axis and having a proximal end, a distal end, a lumen extending axially through the elongated body, an actuator rod at least partially extending through the lumen of the elongated body, and at least one needle guide lumen traversing the elongated body at an angle with respect to a central axis of the elongated body. A distal portion of the elongated body is pivotally connected to a plurality of wings, which are pivotally connected to a plurality of shields, and the plurality of wings and the plurality of shields are operable to extend laterally away from the elongated body, in a deployed position, as the actuator rod is moved in a proximal direction with respect to the elongated body. The plurality of wings each include an opening to allow passage into a suture retrieval space defined between the one each of the plurality of wings and plurality of shields when extended away from the elongated body in the deployed position.
According to one aspect, a distal end of the suture grasper is insertable through the at least one needle guide lumen and through the opening of the plurality of wings while the plurality of shields are extended laterally away from the elongated body in the deployed position.
According to one aspect, the plurality of shields, in the deployed position, prevent inadvertent needle perforation of organs, vessels, or other tissues by the suture grasper as the suture grasper is inserted through the opening of the plurality of wings.
According to one aspect, the elongated body further includes a plurality of suture runner guides to control a location of a suture loaded onto the template, each suture runner guide disposed at a predetermined position distal to an inner surface of each of the plurality of wings.
According to one aspect, the location aligns the suture in the predetermined position to allow the suture grasper to orthogonally intersect the suture, when the suture grasper is inserted into the suture retrieval space.
According to one aspect, the suture grasper includes at least one element that can expand laterally to encircle the suture at the predetermined position.
The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate various embodiments consistent with the invention, and, together with the description, serve to explain the principles of the invention.
The invention will now be described with reference to the drawing figures, in which like reference numerals refer to like parts throughout.
Various aspects of a laparoscopic fascial closure system may be illustrated by describing components that are coupled, attached, and/or joined together. As used herein, the terms “coupled”, “attached”, and/or “joined” are used to indicate either a direct connection between two components or, where appropriate, an indirect connection to one another through intervening or intermediate components. In contrast, when a component is referred to as being “directly coupled”, “directly attached”, and/or “directly joined” to another component, there are no intervening elements present.
Relative terms such as “lower” or “bottom” and “upper” or “top” may be used herein to describe one element's relationship to another element illustrated in the drawings. It will be understood that relative terms are intended to encompass different orientations of a laparoscopic fascial closure system or the components thereof in addition to the orientation depicted in the drawings. By way of example, if aspects of a laparoscopic fascial closure system shown in the drawings are turned over, elements described as being on the “bottom” side of the other elements would then be oriented on the “top” side of the other elements. The term “bottom” can therefore encompass both an orientation of “bottom” and “top” depending on the particular orientation of the apparatus.
Closure devices for trocar openings are used as examples of a closure device that can incorporate one or more of the features and derive some of the benefits described herein, and in particular closure devices for abdominal tissue openings. Closure of trocar openings in abdominal walls present particular issues for acceptable results, and closure devices for abdominal openings will be considered in more detail. However, closure devices other than for abdominal wound closures can benefit from one or more of the present inventions.
In accordance with one example of apparatus that can be used for closing a tissue opening, for example a trocar opening in the abdominal wall, and where the apparatus reflects one or more methods that can be used for tissue closure, a fascial closure system 100 includes a closure assembly or closure template 102 and a needle retriever 104. The closure template 102 can be used with the needle retriever 104 as discussed herein, or with other suture introducers or needles, and the needle retriever 104 as discussed herein can be used with other closure devices. However, for purposes of some of the examples, the closure device 102 and the needle assembly 104 will be considered as being used together. Additionally, the present discussion for the application of the closure assembly will be in the context of closure of an abdominal opening, but it should be understood that other tissue closures can be carried out with one or more of the components of the assembly.
In the context of a trocar opening in an abdominal wall, the opening extends through a skin and superficial layer that may include muscle, depending on the location in the abdomen at which the opening is made. The skin and superficial layer will be referred to as the skin layer for simplicity. Underlying the skin layer is a fascial layer having a thin peritoneum. The peritoneum forms the lining of the abdominal cavity outside the internal organs (not shown), and it is through the skin layer, fascial layer and peritoneum that the trocar opening and trocar permit access for an operator to the internal organs. Once the surgery is complete, the trocar opening is closed by closing the fascial layer and peritoneal layer, while taking care to avoid puncturing or injuring any underlying organs. One way to minimize puncturing underlying organs during the closure process is to retract the tissue layers away from the underlying organs and to limit or carefully control the ingress of suture introducers or retrievers beyond the tissue wall (peritoneal layer), for example in the manner described more fully below.
As shown generally in
The closure template 102 also includes an intermediate or middle portion 122, which will be generally considered that portion of the closure body 116 residing within the laparoscopic opening during normal use. The middle portion 122 generally will extend between the outer surface of the skin layer and the peritoneal layer. The middle portion 122 includes at least one element that helps to reliably and repeatably guide a needle retriever toward a predetermined target site without the operator having to substantially adjust or vary the direction of movement of the retriever. In the present examples, as discussed more fully below, the at least one element in the middle portion 122 that helps to reliably and repeatably place a suture introducer or retriever at the predetermined target site is a channel or passageway, for example a trans lateral passageway 127, through the body 116 of the closure device 102. In select aspects, the middle portion 122 may include a plurality of channels or passageways extending through the body 116 of the closure device 102.
Considering the closure template 102 in more detail, the distal portion 120 in the present example includes a plurality of wings 124, which can be planar or curved structures that span an area wider than a suture or grasper needle, up to a width of the closure body 116, 1102, in the embodiments shown in
The wings 124 may be pivotally mounted to respective portions of a mounting structure 126 at the distal end of the closure body 116. The wings 124 may be linked to and operated through a pull rod 130. The pull rod 130 extends upward into and is substantially centered on the central axis of the closure body 116 for longitudinal movement within the body 116. The pull rod 130 and wings 124 are mounted to the body 116 such that upward movement of the pull rod 130 pulls the link arms or expanders upward to move the wings 124 from a collapsed or insertion configuration shown in
In addition to the wings 124 shown in
In addition to the wings 1120, the distal portion of the template 1100 include shields 1122 pivotally connected to the wings 1120. The shield portions 1122 may be connected to the top wings 1120 by living hinges, for example, or by any suitable hinge structure. The shield portions 1122 in turn pivotally connect to a distal tip portion 1124 of the template 1100. The tip portion 1124 may be atraumatically shaped and connected to the actuator rod 1112 such that actuation of the handle 1110 results in the distal tip portion 1124 being retracted toward or extended away from the body 1102. The wings 1120 and the shield portions 1122 are thus controlled by the actuation rod 1112 to extend from a closed position to an expanded or deployed position when the actuation rod 1112 is pulled. The wings 1120 and shield portions 1122 thus form a completely enclosed suture retrieval cavity when the wings 1120 are deployed as shown in
The wings 1120 may be used to locate the peritoneum and allow retraction when expanded. Each wing 1120 may include an opening 1126, which may be round or oval or any suitable shape, that allows passage of the suture grasper 200 into the suture retrieval cavity when the system is deployed. Suture positioning guides and grooves are provided in the wing and may provide a predetermined position of the suture that is designed to release away from the suture when the wings are collapsed and the template is retracted out of the body cavity.
Suture retaining means such as living hinge clamp and the like (not shown) may be integrated and located at the proximal portion of the body that may be used as an alternative design to the cleat described below. Suture clamps temporarily hold the suture in place when loaded in the device and may allow the suture to slide or move when the wings are activated from a collapse to an open position.
Suture positioning guides or grooves 1130 may also be provided along the length of the body in order to load and place a portion of a suture strand at a predetermined position relative to the lateral wing in the open or deployed position. The guides and grooves serve to hide the suture by positioning it below the outer surface of the device when suture is loaded, which may prevent inadvertent suture dislodgement during insertion of device to the patient.
An active or passive clamping or cleating means of holding the suture in place after loading the suture to the device may be used. For example, a suture cleat 1132 may be located toward the proximal portion of the body to hold the suture taut or stabilize the suture when loaded in the device during insertion, wing expansion and suture retrieval. The clamp or cleat 1132 may allow the suture to slide or move when the lateral wings 1120 are opened and/or during suture pick-up and withdrawal using a suture grasper and the like.
The body 1102 may include a keyway on the proximal end of the template that interacts with a key feature on the proximal handle of the suture grasper device 200. The key and keyway could be configured such that the lateral expanding element is generally orthogonal to the suture to be captured held in the template when the key resides in the keyway. The key/keyway feature could act as a stop and limit the penetration distance of the needle. The user could be instructed to bottom out the handle of the retriever directly against the insertion point for the retriever on the template.
The shield portions 1122 are located toward the distal portion of the template. As noted above, the shield portions 1122 may prevent inadvertent needle perforation of organs or vessels or other tissues and may serve as column support for the lateral wings 1120. The shield portions 1122 may comprise at least one hinge connecting the distal shield and the top wing. The hinge configuration may comprise a pin or living hinge or combination thereof. A living hinge may be configured to have constant thickness at predefined length that forms a radius transition between the top wing 1120 and the shield portion 1122. A larger radius transition will bring the (inner surface of) the shield farther away from the top wing when in the open position. This in turn increases the working space where the suture can be positioned and make room for the suture grasper 200 when capturing the suture.
As shown in
As shown in
The side loading suture slot 1130 retains the suture 1180 during insertion and is configured to allow release of the suture during retraction of the suture retriever. A suture runner guide 1140 (see also
As shown in
The suture grasper 200 may be inserted into an insertion point on the proximal portion of the template body 1102 transverse to the centerline of the template through an exit point of the template body 1102 through the soft tissue and across the aperture opening of the top wing in proximity of the suture to allow its capture and retrieval. This retrieval maneuver could then be repeated on the opposite side of the template to facilitate retrieval of the suture there.
The suture grasper 200 may include at least one element 220 that can expand laterally to encircle the suture 1180 and is configured to allow the suture 1180 to slide freely after the suture has been captured. The suture grasper 200 may include a key feature 230 on the proximal handle 240 that interacts with a keyway 1150 on the proximal end of the template, as shown in
The suture grasper 200 may be configured to automatically activate to expand when approaching the suture target and to deactivate or close when retracting the retriever thereby capturing the suture during the retraction maneuver. This would allow a surgeon to engage and remove suture using a blind technique without visualization. The activation/deactivation feature could work in conjunction with the key/keyway arrangement mentioned previously.
The suture 1180 is loaded on the outside perimeter of the device with the wings 1120 in a collapsed state, as shown in
It will be appreciated that the foregoing description provides examples of the disclosed system and technique. However, it is contemplated that other implementations of the disclosure may differ in detail from the foregoing examples. All references to the disclosure or examples thereof are intended to reference the particular example being discussed at that point and are not intended to imply any limitation as to the scope of the disclosure more generally. All language of distinction and disparagement with respect to certain features is intended to indicate a lack of preference for those features, but not to exclude such from the scope of the disclosure entirely unless otherwise indicated.
Recitation of ranges of values herein are merely intended to serve as a shorthand method of referring individually to each separate value falling within the range, unless otherwise indicated herein, and each separate value is incorporated into the specification as if it were individually recited herein. All methods described herein can be performed in any suitable order unless otherwise indicated herein or otherwise clearly contradicted by context.
This patent application is a continuation of U.S. patent application Ser. No. 14/564,331, filed Dec. 9, 2014, which claims priority to U.S. Provisional Patent Application No. 61/913,910, filed Dec. 9, 2013, the disclosures of which are incorporated herein by reference in their entireties.
| Number | Date | Country | |
|---|---|---|---|
| 61913910 | Dec 2013 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 14564331 | Dec 2014 | US |
| Child | 15401173 | US |
