The present invention relates to a medical implement for manipulating sutures. The invention is particularly useful in arthroscopic surgery or other minimally invasive surgery, and is therefore described below with respect to such an application.
In minimally invasive surgery, such as arthroscopic surgery, all operations must be performed through a narrow opening, the size of which limits the size of the instruments used and the free space available to manipulate them. Small-size cutting, grasping, debriding and stitching instruments, capable of operating through small portals, have been developed for this purpose.
Internal suturing is necessary in many arthroscopic procedures, in order to close wounds, repair tissue tears, or to reattach tissue which becomes detached from its normal position. A strand of suture must be applied to the location to be sutured, and the suture must then be passed through a layer of tissue and retrieved from the exit side. In other cases sutures attached to an anchoring element must be captured and passed through tissue.
Many suture passing and stitching devices are available to the arthroscopist. For example, U.S. Pat. No. 5,499,991, U.S. Pat. No. 5,222,977, as well as catalogs of Linvatec-Concept Inc., Arthrex Inc., DePuy Mitek Inc. and others describe and advertise such devices. All these devices are limited either to a part of the functions necessary, or in directions of approach, or in maneuverability in limited space.
An object of the present invention is to provide a medical implement particularly useful in arthroscopic surgery and having advantages in one or more of the above respects.
According to a broad aspect of the present invention, there is provided a medical implement particularly useful in arthroscopic sutures, comprising:
In the preferred embodiment of the invention described below, the implement further comprises a shaft having a proximal end joined to the distal end of the handle, a distal end formed with a pointed tip for piercing tissue, and a passageway from its proximal end to its distal end for receiving the movable shuttle.
According to further features in the described preferred embodiment, the shuttle includes a long flexible wire having a proximal end extending outwardly of the proximal end of the handle, and a distal end formed with a loop defining the suture-receiving-element. The long flexible wire of the shuttle includes two strands formed at its distal end with the loop.
According to still further features in the described preferred embodiment, the handle is further formed with a slot having a longitudinally-extending section extending along one side of the handle and terminating in a transversely-extending section adjacent to the recess in the handle and spaced therefore in the proximal direction; the slot communicating with the internal passageway through the handle to permit side-loading of the shuttle through the handle.
In addition, the transversely-extending section of the slot terminates in a proximally-extending notch effective to center the shuttle with respect to the handle, and therefore also with respect to the recess therein and to overlie the central area of the roller underlying the recess.
As will be described more particularly below, such a medical instrument is particularly useful in arthroscopic surgery wherein all operations must be performed through a narrow opening.
The invention is herein described, by way of example only, with reference to the accompanying drawings, wherein
It is to be understood that the foregoing drawings, and the description below, are provided primarily for purposes of facilitating understanding the conceptual aspects of the invention and possible embodiments thereof, including what is presently considered to be a preferred embodiment. In the interest of clarity and brevity, no attempt is made to provide more details than necessary to enable one skilled in the art, using routine skill and design, to understand and practice the described invention. It is to be further understood that the embodiments described are for purposes of example only, and that the invention is capable of being embodied in other forms and applications than described herein.
The medical implement illustrated in
The long flexible wire 30 constitutes a shuttle for manipulating a suture, as will be disclosed more particularly below. It consists of two twisted strands having a proximal end 31 extending outwardly of the proximal end 11 of handle 10; a distal end twisted at its tip to form a loop 32 for receiving the suture to be passed through the tissue; and an intermediate portion 33 (
As shown particularly in
In addition, the implement further includes a roller 15 rotatably mounted at 15a to the handle so as to underlie the exposed intermediate portion 33 of the long flexible wire 30 received within passageway 13 of the handle. Preferably, the outer surface of roller 15 is knurled or ribbed or is made of an elastomeric material, to enable the user, by pressing the exposed wire portion 33 against the roller, to rotate the roller in either direction in order to move the wire 30, particularly its distal loop 32, outwardly from the elongated shaft 20 to extend the distal loop, or inwardly into the elongated shaft to retract the distal loop. As shown particularly in
It will thus be seen that the proximal side of notch 15c communicates with the portion of internal passageway 13, between the transverse slot section 16b and the distal end of the handle, via an opening 13a at the proximal end of the notch. It will also be seen that the distal side of recess 14 communicates with the portion of passageway 13 between the recess and the distal end of the handle via an opening 13b.
The manner of loading the implement with the long flexible wire 30, and of using the implement for passing sutures through tissue, will now be described, particularly with reference to
Thus, as shown in
The implement is thus loaded (
When the illustrated implement is used for passing a suture through tissue, the implement is inserted through a portal at the surgical site; and the tissue to be sutured is then pierced with the sharp distal tip 22 (
A suture manipulating device may then be used to thread the suture into the loop 32. When this is done, the wire is then retracted into the shaft 20 until the suture is held against the distal end of the shaft. The distal end of shaft 20, with the suture held to it, is then passed through the tissue.
The implement, with the suture held to the distal tip of the shaft 20, may then be passed through the portal to the outside, and the suture freed from the loop for knotting. Alternatively, once the suture is passed through the tissue, the suture may be released from the implement, by releasing the pressure applied against portion 14 of the wire, to remove the implement from the suture, if so convenient to the surgeon.
While the invention has been described with respect to one preferred embodiment, it will be appreciated that this is set forth merely for purposes of example, and that many other variations, modifications and applications of the invention may be made.
This application is a continuation of U.S. patent application Ser. No. 13/201,867 filed on Aug. 17, 2011, which is a National Phase of PCT Patent Application No. PCT/IL2010/000140 having International filing date of Feb. 17, 2010, which claims the benefit of priority of U.S. Provisional Patent Application No. 61/152,980 filed on Feb. 17, 2009. The contents of the above applications are all incorporated by reference as if fully set forth herein in their entirety.
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20160106416 A1 | Apr 2016 | US |
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61152980 | Feb 2009 | US |
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Parent | 13201867 | US | |
Child | 14979616 | US |