# Patent

## Title
Surgical suture anchors and deployment device

## Abstract

A suture anchor is provided which includes a hollow member having an outer surface defining an enclosure, the member having a longitudinal axis and a slot through a portion of the outer surface in a direction transverse to the longitudinal axis, the slot providing an opening into the enclosure. The suture anchor further includes a one-way valve positioned within the enclosure at the slot to allow entry of a suture through the slot into the enclosure and to prevent the exit of the suture from the enclosure. A device is provided for deploying the suture anchor. The deployment device includes an elongate hollow member having a suture anchor release zone positioned at the distal end, a launch bar having at least a portion positioned in the release zone. The launch bar is movable within the release zone between a resting position and a launching position and is operatively connected to an actuation member positioned proximally to the elongate member. The hollow elongate member defines a housing for receiving a plurality of suture anchors in tandem.

## Background
FIELD OF THE INVENTION
The invention relates to surgical suture anchors and a tool for deploying them, and more particularly to suture anchors that can be deployed to anchor sutures already in place in tissue.
BACKGROUND
Sutures are used to approximate, or bring together, tissue separated, for example, by some trauma, or wound or during a surgical procedure to close an incision or an organ perforation. Suturing instruments generally include a needle and a trailing length of suture material. In endoscopic procedures, the instruments placed through an instrument channel may include needles and sutures for stitching such a wound, incision or perforation within the patient's body cavity. An exemplary suturing device is shown in U.S. Pat. No. 7,131,978.
In some cases, the leading, or distal end, of the suture material is attached during manufacture to a small anchor, sometimes referred to as a T-tag, to stabilize the tissue and the suture as the surgeon pulls the suture material through tissue. Anchors are commonly utilized to retain sutures in a patient's body. The anchors may be formed of metal, such as stainless steel or titanium, or of a biodegradable material. Several known anchors rely upon mechanical interlocks between the body tissue and the anchor to retain the anchor in place against the influence of forces transmitted through the suture to the anchor. It has previously been suggested to construct anchors in the manner disclosed in U.S. Pat. Nos. 5,405,359; 5,403,348; 5,203,787; 5,046,513; and 5,041,129.
In many cases, however, the suture does not include an anchor and the ends of the suture are tied using conventional suturing and knotting techniques. Only after the wound or incision is sutured, does the practitioner, such as a surgeon, physician, or clinician, determine that a suture anchor is needed. It is not believed that securing sutures with an anchor, after the suture is already in place, has heretofore been done. It is the current thought that the wound or incision would have to be sutured a second time with an anchor/suture combination.
Physicians have often used endoscopes to examine, to biopsy, and to ablate the tissue of patients within lumens such as the esophageous and the bowel or other body cavity and internal patient sites. An endoscope generally includes either a rigid or flexible tube containing one or more optical fiber systems and, for operative uses (human or veterinary), one or more channels for passage of medical instruments. The optical system includes a light delivery system to illuminate the organ or site under inspection and a camera system to transmit the image of the site of interest to the viewer. The light source is normally outside the body and the light is typically directed via optical fiber bundles to the area of interest. A physician performing a therapeutic procedure with the use of an endoscope places a long, flexible instrument through the endoscope's instrument channel and then positions the instrument near the site within the body cavity, lumen or other internal site of interest where a therapeutic procedure is to be performed.
SUMMARY OF THE INVENTION
A suture anchor for securing a section of a suture already in place in a patient's tissue is provided. The suture anchor includes a hollow member having an outer surface defining an enclosure, the hollow member having a longitudinal axis and a slot through a portion of the outer surface in a direction transverse to the longitudinal axis, the slot providing an opening into the enclosure. The suture anchor further includes a one-way valve positioned within the enclosure at the slot to allow entry of a suture through the opening into the enclosure and to prevent the exit of the suture from the enclosure. In one embodiment, the one-way valve is a leaf spring biased toward contact with a surface of the enclosure and positioned such that it spans at least a portion of the opening in a direction parallel to the longitudinal axis of the hollow member.
The slot may be configured such that it forms a straight cut through the hollow member at an angle relative to the longitudinal axis of the hollow member. The cut is preferably configured such that it defines an apex and a pair of end sections. When the hollow member is a cylinder, the cut will appear as an ellipse. However, the hollow member may form a number of different shapes and is not limited to a cylinder.
In another embodiment, the one-way valve may be a resilient wire having a first end attached to a first surface of the enclosure and a second free end biased toward contact with a second surface of the enclosure, wherein the second surface of the enclosure faces and is spaced from the first surface of the enclosure. The second free end in this embodiment is positioned such that it spans the cut of the slot at the apex thereof in a direction parallel to the longitudinal axis of the hollow member.
A device is provided for deploying the suture anchor. The deployment device includes an elongate hollow member having a longitudinal axis, a distal end and a proximal end, a tip of reduced diameter relative to the elongate member at the distal end of the elongate member, a suture anchor release zone in the elongate member positioned adjacent to and proximal to the tip, a launch bar having at least a portion thereof positioned in the release zone, wherein the launch bar is movable within the release zone between a resting position and a launching position and is operatively connected to an actuation member positioned at the proximal end of the elongate member. The hollow elongate member defines a housing for receiving a plurality of suture anchors in tandem along the longitudinal axis of the hollow member, wherein each of the suture anchors is configured for release from the release zone when positioned within the release zone upon movement of the launch bar from the resting position to the launching position.
The release zone is shown in one embodiment herein as configured for holding a single suture anchor therein until the launch bar is moved to the launching position.
In the embodiment shown herein suitable for use with an endoscope, the elongate member is a cylinder dimensioned in cross-section to allow the elongate member to pass through a channel leading to an internal site in a patient. The tip is preferably conical in shape. The release zone is shown in one embodiment to define an opening in the elongate member.
A method for deploying one or more suture anchors is also provided. Further, a method for sterilizing and packaging the deployment device is also provided.



BRIEF DESCRIPTION OF THE DRAWINGS
The novel features of the invention are set forth with particularity in the appended claims. The invention itself, however, both as to organization and methods of operation, together with further objects and advantages thereof, may best be understood by reference to the following description, taken in conjunction with the accompanying drawings in which:
FIG. 1 is a perspective view of a surgical suture anchor and a section of a suture.
FIG. 2 is a section view through the line 2-2 of FIG. 1, showing the suture at the entry of the slot but still outside of the suture anchor.
FIG. 3 is a section view through the line 2-2 of FIG. 1 showing the suture entering the slot in the suture anchor.
FIG. 4 is a section view through the line 2-2 of FIG. 1 showing the suture captured in the suture anchor.
FIG. 5 is a perspective view of a suture anchor being deployed to a section of suture.
FIG. 6 is a view of a suture anchor in the deployment device showing the suture captured in the anchor, as in FIG. 4.
FIG. 7 is a view of the suture anchor being ejected from the deployment device.
FIG. 8 is an alternative view of the ejection of the suture anchor of FIG. 7.
FIG. 9 is a view of the deployment device being withdrawn from the suture and deployed anchor.
FIG. 10 is a view of the deployment device of FIG. 9 being drawn back into the endoscope.
FIG. 11 is a view of a suture anchor engaging a section of suture in tissue following the completion of the anchor deployment procedure.



DETAILED DESCRIPTION
Before the present method and embodiments of an instrument are disclosed and described, it is to be understood that this invention is not limited to the particular process steps and materials disclosed herein as such process steps and materials may vary somewhat. It is also to be understood that the terminology used herein is used for the purpose of describing particular embodiments only and is not intended to be limiting since the scope of the present invention will be limited only by the appended claims.
Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood to one of ordinary skill in the art to which this invention belongs. Although any method, instrument and materials similar or equivalent to those described herein may be used in the practice or testing of the invention, particular embodiments of a method, instrument and materials are now described.
It must be noted that, as used in this specification and the appended claims, the singular forms “a,” “an,” and “the” include plural referents unless the content clearly dictates otherwise.
In describing and claiming the present invention, the following terminology will be used in accordance with the definitions set out below.
As used herein, the term “patient,” used herein, refers to any human or animal on which a suturing procedure may be performed.
As used herein, the term “biocompatible” includes any material that is compatible with the living tissues and system(s) of a patient by not being substantially toxic or injurious and not causing immunological rejection. “Biocompatibility” includes the tendency of a material to be biocompatible.
As used herein, the term “bioabsorbable” includes the ability of a material to be dissolved and/or degraded, and absorbed, by the body.
As used herein, the term “proximal” (or any form thereof), with respect to a component of an instrument, means that portion of the component that is generally nearest the practitioner, physician, or surgeon, or nearest to the end of the instrument handled by the practitioner, physician, or surgeon, when in use; and with respect to a direction of travel of a component of an instrument, means toward the end of the instrument generally nearest the practitioner, physician, or surgeon, or handled by the practitioner, physician, or surgeon, when in use.
As used herein, the term “distal” (or any form thereof), with respect to a component of an instrument, means that portion of the component that is generally farthest from the practitioner, physician, or surgeon, or farthest from the end of the instrument handled by the practitioner, physician, or surgeon, when in use; and with respect to a direction of travel of a component of an instrument, means away from the end of the instrument generally nearest the practitioner, physician, or surgeon, or handled by the practitioner, physician, or surgeon, when in use.
As used herein, the term “transverse” (or any form thereof), with respect to an axis, means extending in a line, plane or direction that is across such axis, i.e., not collinear or parallel therewith. “Transverse” as used herein is not to be limited to “perpendicular
As used herein, the term “longitudinal axis”, with respect to an instrument, means the exact or approximate central axis defined by said instrument along its greater dimension, i.e., along its length, from its distal end to its proximal end, and vice versa, and is not intended to be limited to imply a straight line, wherein, for example, an instrument includes a bend angle as described herein, it is intended that “longitudinal axis” as used herein follows such bend angle.
As used herein, the term “internal site” of a patient means a lumen, body cavity or other location in a patient's body including, without limitation, sites accessible through natural orifices or through incisions.
The present invention has application in conventional endoscopic and open surgical instrumentation, as well as application in robotic-assisted surgery. The embodiments shown illustrate the use of the invention in connection with an endoscope within an internal site of a patient. The invention is useful in a variety of minimally invasive medical procedures, including without limitation medical procedures performed through laparoscopic incisions for access to body cavities and internal organs of the body. The invention also encompasses apparatus and methods employing endoscopic devices in general, including various forms and variations of endoscopes, including without limitation: laparoscopes, gastroscopes, peritoneoscopes, sigmoidoscopes, fiberoptic endoscopes, arthroscopes, amnioscopes, and the like.
Referring to FIGS. 1-4, the embodiment of the suture anchor 10 includes a hollow cylinder 26 which may be open or closed at one or both ends 14, 16 and defines an internal chamber or lumen 12. A slot 20 is cut into the cylinder 26, in a direction transverse to the longitudinal axis 18 of cylinder 26, beginning at an apex 22 and ending at bottom ends 24. To facilitate the smooth entry of a section of suture 44, the slot 20 is preferably cut at an acute or obtuse angle relative to the axis 18, rather than cut perpendicular to the axis 18. In one embodiment, the slot is configured such that it forms a cut through the hollow cylinder 26 at an angle relative to the longitudinal axis 18 of the cylinder 26. The cut of the slot defines an apex 22 and a pair of end sections 24.
A valve 30 is housed in the lumen 12 of anchor 10. In the embodiment shown, the valve may be a leaf spring, formed from a flexible, but resilient wire or band attached at one end 34 to a bottom surface 36 of lumen 12. A free end 32 of valve 30 is biased toward the top surface 38 of lumen 12, forming a one way gate at slot 20 into lumen 12. The leaf spring wire or band bends over itself as shown in FIGS. 2-3 to create the spring-like tension in valve 30.
In use, the anchor 10 would be advanced toward a section of suture 44 stitched into tissue 100. The anchor 10 would be advanced distally. The anchor 10 is passed under the suture 44 with the side of cylinder 26 having the apex 22 of slot 20 facing the suture 44, away from the tissue 100. The suture 44 slides into the open apex end 22 of slot 20, as shown in FIG. 2. As the anchor 10 is advanced against the suture section 44, suture 44 presses against the free end 32 of valve 30 as shown in FIG. 3, pushing it downward into lumen 12 enough to allow suture 44 to slide down slot 20, past the free end 32 of valve 30, to rest at bottom ends 24 of slot 20. When anchor 10 is advanced to the point where suture 44 is past free end 32, free end 32 snaps back to its original position against top surface 38 of lumen 12, closing the “gate” at slot 20 and thereby preventing suture 44 from exiting the slot 20. Anchor 10 is thus attached to the suture 44 between the suture 44 and the tissue 100 to assist in securing the suture 44 to the tissues 100, as shown in FIG. 11.
Referring to FIGS. 5-10, an embodiment of a suture anchor deployment device 50 is shown. In FIG. 5, the deployment device 50 is shown extending from a working channel 62 of an endoscope 60. The deployment device 50 may be used with any suitable known endoscope having at the distal end thereof, a camera and lights 64 to enable the practitioner to see the internal site of the patient, and one or more working channels 62 through which various instruments are typically inserted to allow the practitioner to perform desired procedures at the internal site. The working channel 62 includes a longitudinal axis (not shown), as defined herein.
In one embodiment, deployment device 50 includes a hollow cylinder or tube 52 with an open lumen 54 defining a housing in which a plurality of anchors 10 may be positioned in tandem for deployment to anchor in-place sections of suture 44. Deployment cylinder 52 has a longitudinal axis 58. The anchors 10 line up such that the longitudinal axes 18 of the anchors 10 are co-linear to, or parallel to, the longitudinal axis 58 of the deployment cylinder 52. In the orientation shown in FIGS. 5-10, end 16 of anchor 10 is positioned distally and end 14 is proximal to the suture 44 to be anchored. Those skilled in the art will recognize that the orientation of the anchors 10 may change such that end 14 is positioned distally and end 16 is proximal to the suture 44 to be anchored. The difference in orientation would require different maneuvering from the practitioner to secure the anchor 10 to suture section 44.
At the distal end 70 of cylinder 52 is a cone-shaped tip 56 of reduced diameter relative to the cross-sectional dimension of the elongate member. The tip 56 facilitates passage of the distal end 70 of deployment device 50 under suture section 44. Just behind tip 56 is an opening 72 in cylinder 52 which functions as a release zone for the suture anchors. The opening 72 is about the same length as the length of an anchor 10. The length of opening 72 may be less that the length of cylinder 52 so that the proximal end 16 of anchor 10 is in sufficient contact with cylinder 52 to hold the leading anchor 10 in place until the desired section of suture 44 is captured in slot 20. The overlap between the end 16 of anchor 10 and the cylinder 52 should not, however, interfere with the launch of anchor 10 from the opening 72 at the release zone.
A launch bar 74, as shown in a launching configuration in FIGS. 7-10, runs along the bottom interior surface 80 of the lumen 54 of cylinder 52. The launch bar 74 has a resting position as shown in FIGS. 5 and 6 wherein the launch bar 74 is flat. When the anchor 10 is to be released from deployment device 50, as may be determined by the practitioner based on the image observed due to the optical system and camera 64 communicated through the endoscope, the practitioner moves launch bar 74 from its resting position to its launching position by causing the launch bar 74 to be pushed forward (by actuation, for example, of a push rod or a control operatively connected to a push rod, not shown, which applies a force in the distal direction against the proximal end of launch bar 74), in a distal direction, along cylinder bottom 80. The force in the distal direction causes launch bar 74 to bend at first and second joints 76, 78. The section of launch bar 74 between joint 76 and the distal end of launch bar 74 pops up, with joint 78 forming the apex of a triangle, and thus assuming the launching position.
The anchors 10 may be made of stainless steel, titanium, nitonal (a nickel-titanium shape memory alloy) or any biocompatible material or bioabsorbable material. As used herein, “shape memory” refers to the tendency of a material to return to a preformed shape following deformation.
Deployment device 50 may be made of any suitable biocompatible material. Deployment device 50, and in particular, cylinder 52 thereof is preferably made of a flexible material to allow deployment device 50 to travel through the length of the working channel 62 of an endoscope 60, which in many embodiments, will require flexibility to enter a patient's internal sites, particularly if inserted through a natural orifice. In recent literature, a procedure is advanced in which an endoscope is passed through a natural orifice (mouth, anus, etc.), then through an internal incision in the stomach or colon, for example, to avoid any external incisions or scars.
Referring to the sequence shown in FIGS. 5-11, deployment device 50 is advanced distally through a working channel 62 of endoscope 60. In the orientation shown, an anchor 10 is positioned in the release zone, at opening 72 of the cylinder 52 of deployment device 50 with slot 20 exposed to the suture 44. Tip 56 of deployment device 50 is eased under a section of suture 44. The suture 44 slides up the cone shaped tip 56, onto the exposed surface of anchor 10. Deployment device 50 is advanced to position the apex 22 of slot 20 of anchor 10 under suture 44.
Referring to FIG. 6, the deployment device 50 is pulled back in a proximal direction to slide suture section 44 down slot 20 of anchor 10, past valve 30 as shown in FIGS. 3 and 4. Valve 30 snaps back into the closed position, thereby securely attaching anchor 10 to suture section 44.
To release anchor 10, launch bar 74 is moved from the flat resting position shown in FIG. 6 to the launching position shown in FIGS. 7 and 8. The apex formed by joint 78 of launch bar 74 pushes the distal end 16 of anchor 10 upwardly, out of release zone opening 72. Deployment device 50 is pulled back in the proximal direction into the endoscope 60, moving the rim 66 of tip 56 along the bottom of anchor 10 while the apex 78 of launch bar 74 lifts the proximal end 14 of anchor 10 upwardly and out of the opening 72 at the release zone of cylinder 52.
When the deployment device 50 is completely withdrawn from beneath suture section 44, anchor 10 remains to anchor the suture 44 in position, as shown in FIG. 11, inhibiting the suture 44 from migrating through tissue 100.
As the leading anchor 10 is released or launched from the deployment device 50, the next anchor 10 in line within cylinder 52 advances distally into the opening 72 at the release zone of cylinder 52. Manual or automatic means, such as a spring-like member, or a push bar, may be provided to advance the next anchor to the release zone. The practitioner positions deployment device 50 adjacent the next section of suture 44 that the practitioner wants to secure with an anchor 10 and repeats the procedure until suture 44 is adequately anchored.
The devices disclosed herein can be designed to be disposed of after a single use, or they can be designed to be used multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps of disassembly of the device, followed by cleaning or replacement of particular pieces, and subsequent reassembly. In particular, the device can be disassembled, and any number of the particular pieces or parts of the device can be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular parts, the device can be reassembled for subsequent use either at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure. Those skilled in the art will appreciate that reconditioning of a device can utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. Use of such techniques, and the resulting reconditioned device, are all within the scope of the present invention.
Preferably, the various embodiments of the invention described herein will be processed before patient use. First, a new or used instrument, in this case, deployment device 50 and new anchors 10 are obtained and if necessary cleaned. The deployment device 50 and anchors 10 can then be sterilized by any suitable known sterilization technique. This can be done by any number of ways known to those skilled in the art including beta or gamma radiation, ethylene oxide, steam. In one sterilization technique, the deployment device 50 and anchors 10 are placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and instruments are then placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons. The radiation kills bacteria on the instruments and in the container. The sterilized instruments can then be stored in the sterile container. The sealed container keeps the deployment device and anchors sterile until it is opened in the medical facility.
The deployment device 50 and a plurality of anchors 10 can thus be provided as a sterile kit for use, for example, in a hospital or out patient facility. The kit may also include sutures. Alternatively, a plurality of anchors 10 may be provided in a kit for use with an existing deployment device.
In summary, numerous benefits are apparent which result from employing the concepts of the invention. The foregoing description of one or more embodiments of the invention has been presented for purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise form disclosed. Obvious modifications or variations are possible in light of the above teachings. The embodiments were chosen and described in order to best illustrate the principles of the invention and its practical application to thereby enable one of ordinary skill in the art to best utilize the invention in various embodiments and with various modifications as are suited to the particular use contemplated. It is intended that the scope of the invention be limited only by the claims appended hereto.

## Claims

1. A suture anchor for securing a section of a suture to patient tissue, comprising:
a hollow member having an outer surface defining an enclosure, the member having a longitudinal axis and a slot through a portion of the outer surface in a direction transverse to the longitudinal axis, said slot providing an opening into the enclosure; and,
a one-way valve positioned within said enclosure at said slot to allow entry of a suture through the slot and to prevent the exit of the suture from said enclosure;
wherein the slot is configured such that it forms a cut through said hollow member at an angle relative to the longitudinal axis of the hollow member
wherein said one-way valve is a resilient wire having a first end attached to a first surface within the enclosure and a second free end biased toward and contacting a second surface within the enclosure, said second surface of the enclosure facing and being spaced from the first surface of the enclosure, said second free end being positioned to span the slot at an apex of the slot thereof in a direction parallel to the longitudinal axis of the hollow member.

2. The suture anchor recited in claim 1 wherein said one-way valve is a leaf spring.

3. The suture anchor recited in claim 1 wherein the slot defines the apex and a pair of end sections.

4. The suture anchor recited in claim 1 wherein said hollow member is a cylinder.

5. A method for deploying a suture anchor to a section of suture in tissue not having an associated anchor, the method comprising:
providing a deployment device comprising an elongate hollow member having a longitudinal axis, a distal end and a proximal end, a tip, a suture anchor release zone in said elongate member positioned adjacent and proximal to the tip, a launch bar having at least a portion thereof positioned in said release zone, said launch bar being movable within said release zone between a resting position and a launching position and being operatively connected to an actuation member positioned proximally to the elongate member, said hollow elongate member defining a housing for receiving a plurality of suture anchors in tandem along the longitudinal axis of the hollow member, each said suture anchor being configured for release from said release zone when such suture anchor is positioned within said release zone upon movement of said launch bar from said resting position to said launching position;
providing the plurality of suture anchors in said housing of said hollow elongate member, each said suture anchor comprising a hollow member having an outer surface defining an enclosure therein, the hollow member having a longitudinal axis and a slot through a portion of the outer surface in a direction transverse to the longitudinal axis of the hollow member, said slot providing an opening into the enclosure, and a one-way valve positioned within said enclosure at said slot to allow entry of a suture through the opening into said enclosure and to prevent the exit of the suture from said enclosure, wherein the slot is configured such that it forms a cut through said hollow member at an angle relative to the longitudinal axis of the hollow member; and wherein said one-way valve is a resilient wire having a first end attached to a first surface within the enclosure and a second free end biased towards and contacting a second surface within the enclosure, said second surface of the enclosure facing and being spaced from the first surface of the enclosure, said second free end being positioned to span the slot at an apex of the slot thereof in a direction parallel to the longitudinal axis of the hollow member;
advancing the distal end of the deployment device distally to the patient site;
directing the tip of the deployment device under a section of suture and advancing the deployment device distally under the section of suture until the suture is over the slot and the suture anchor positioned in the release zone of the deployment device;
directing the deployment device to a position that slides the section of suture into the slot of the suture anchor, past the one-way valve to position the section of suture within the enclosure of the suture anchor;
moving the launch bar from the resting position to the launching position;
pushing the suture anchor out of the release zone; and,
moving the deployment device in a proximal direction away from the suture anchor and the section of suture attached thereto.

6. The method recited in claim 5 wherein the step of advancing the deployment device to the patient site comprises inserting the deployment device into the proximal end of a channel leading to the patient site and
advancing the deployment device distally through the channel to the patient site.