Abstract:
A system for managing one or more sutures extending from a surgical portal apparatus during a surgical procedures that incorporates the use of at least one suture includes a surgical portal member configured for insertion into a patient and defining a longitudinal passage for the receipt of the at least one suture and at least a first and a second suture clip. Each suture clip includes a base portion operably connected to a retaining portion by a hinge portion. The base portion and the retaining portion are configured for securing at least one end of a suture therebetween. The at least first and second suture clip each includes at least one visible identifying marking.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
       [0001]    The present application claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/153,461 filed on Feb. 18, 2009, the entire contents of which are incorporated herein by reference. 
     
    
     BACKGROUND 
       [0002]    1. Technical Field 
         [0003]    The present disclosure relates to trocars and other surgical portal apparatus, and more particularly, relates to a suture management system including numbered clips for use with surgical portal apparatus. 
         [0004]    2. Background of Related Art 
         [0005]    Trocars and other surgical portal apparatus are known, as are myriad procedures that may be performed using such assemblies. Many of the minimally invasive procedures performed through access assemblies necessitate or are simplified by the use of one or more sutures passing through the surgical portal apparatus. For example, in certain procedures, such as arthroscopic procedures, it is sometimes necessary to secure soft tissue to a selected bone surface either directly or indirectly via an implant typically called an anchor. Sutures extending into a body cavity through a surgical portal apparatus may be used to, for example, temporarily retain tissue, manipulate tissue, anchor tissue or operate peripheral devices. In an attempt to reduce the number of incision sites required to complete a given surgical procedure, a single surgical portal apparatus may be used to pass one or more sutures into a body cavity, in addition to providing access for one or more devices. A single anchor device may have numerous suture ends extending through the surgical portal apparatus. These sutures may become tangled as each is manipulated or as one or more instruments are inserted and withdrawn from the assembly. Also, a surgeon may confuse the suture ends during the course of a surgery. Tangling or confusion of the suture ends may unnecessarily complicate the procedure and increase time necessary to complete the procedure. 
         [0006]    Therefore, it would be beneficial to have a suture management system for use with a surgical portal apparatus for managing sutures during a surgical procedure such as a laparoscopic or orthopedic procedure. 
       SUMMARY 
       [0007]    A system for managing one or more sutures extending from a surgical portal apparatus during a surgical procedures that incorporates the use of at least one suture is provided. The system includes a surgical portal member configured for insertion into a patient and defining a longitudinal passage for the receipt of the at least one suture and at least a first and a second suture clip. Each suture clip includes a base portion operably connected to a retaining portion by a hinge portion. The base portion and the retaining portion are configured for securing at least one end of a suture therebetween. The at least first and second suture clip each includes at least one visible identifying marking. 
         [0008]    The first and second suture clips may include substantially similar or substantially different visible identifying markings. The visible identifying markings on the at least first and second suture clips may be sequenced numerically and/or alphabetically. The identifying markings may be formed on the base portion and/or the retainer portion. The at least first and second suture clips may be color coded. The first and second suture clips may be selectively removable from the at least one suture. The first and second suture clips may be received on the same or different sutures. 
         [0009]    A method of managing one or more sutures extending from a surgical portal apparatus during a surgical procedures that incorporates the use of at least one suture is provided. The method includes the steps of: 
         [0010]    inserting a surgical portal member into a patient; 
         [0011]    extending at least two sutures through the portal member; 
         [0012]    attaching first and second suture clips to respective first and second sutures extending through the portal member device, the first suture clip having an identifying marker and the second suture clip having an identifying marker different from the first identifying marker; and 
         [0013]    performing a surgical procedure with the first and second sutures as coordinated with the first and second suture clips. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0014]    The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the disclosure and, together with a general description of the disclosure given above, and the detailed description of the embodiment(s) given below, serve to explain the principles of the disclosure, wherein: 
           [0015]      FIG. 1  is a side view of a surgical portal apparatus and a suture management system including a pair of suture clips according to an embodiment of the present disclosure; 
           [0016]      FIG. 2  is a perspective view of the suture clip of  FIG. 1 , in a first or open position; 
           [0017]      FIG. 3  is a perspective view of the suture clip of  FIGS. 1 and 2 , in closed position; 
           [0018]      FIG. 4  is a perspective view of the bottom of the suture clip of  FIGS. 1-3 ; 
           [0019]      FIG. 5  is a cross-sectional side view of the suture clip of  FIGS. 1-4 ; 
           [0020]      FIG. 6  is a side view of a suture clip according to another embodiment of the present disclosure; and 
           [0021]      FIG. 7  is a perspective view of a clip applier for applying the clips of  FIGS. 1-6 . 
       
    
    
     DETAILED DESCRIPTION 
       [0022]    Referring now to the drawings wherein like reference numerals illustrate similar components throughout the several views, with reference initially to  FIG. 1 , there is illustrated a surgical portal apparatus  10  and a suture management system  100  in accordance with the principles of the present disclosure. Surgical portal apparatus  10  is provided as an example only, and should not be read as limiting to the aspects of the present disclosure. Suture management system  100  may be adapted for use with any access assembly capable of receiving one or more sutures. 
         [0023]    Still referring to  FIG. 1 , suture management system  100  includes suture clips  110  for securing, identifying and/or manipulating respective ends of first and second sutures “S 1 ”, “S 2 ”. Although shown including only two suture clips, suture management system  100  may include any number of suture clips. During a procedure, a clinician may find it useful to attach more than one suture clip to a suture. 
         [0024]    With reference now to  FIGS. 2-5 , suture clip  110  comprises a base  111  and retainer  112  which are joined at their edges by flexible hinge  116 . Base  111  includes a pair of upstanding spaced apart prongs  113 ,  114 . Each prong  113 ,  114  includes a shaft portion ( 113   a ,  114   a,  respectively) which extends along the base, and a locking barb ( 113   b,    114   b,  respectively) with a camming surface ( 113   c,    114   c,  respectively). Retainer  112  includes an aperture  115  having edges  115   a.    
         [0025]    Still referring to  FIGS. 2-4 , base  111  further includes identifying markings or labels  117  on one or both of a first and second side  118   a,    118   b  of base  111 . Markings  117  may include numerals, characters, symbols or any other suitable identifying character. Markings  117  may be sequentially numbered for identifying individual sutures “S 1 ”, “S 2 ”, or instead may include the same number, character or symbol for identifying groups of sutures. Markings  117  on suture clips  110  enable a clinician to label and/or organize sutures “S 1 ”, “S 2 ” during a surgical procedure, thereby minimizing suture entanglement and confusion that might otherwise lengthen the procedure. In addition, or alternatively, clips  110  may be of different colors to distinguish clips  110 , and thus, sutures “S 1 ”, “S 2 ” from one another. 
         [0026]    To secure suture clip  110  to suture “S 1 ”, one or more strands of suture “S 1 ” is positioned across prongs  113 ,  114  and retainer  112  is brought down into engagement with prongs  113 ,  114 . As retainer  112  is closed upon base  111 , edges  115   a  of the aperture can engage surfaces  113   c,    114   c,  thereby forcing prongs  113 ,  114  to resiliently bend inward to accommodate aperture  115 . When retainer  112  and prongs  113 ,  114  are fully engaged, prongs  113 ,  114  resiliently snap outward to lock suture clip  110  closed, as shown in  FIGS. 3 and 4 . In this manner, suture “S 1 ” is held in a serpentine fashion. Although shown only receiving two strands of a single suture “S 1 ”, it is envisioned that suture clips  110  may be configured to hold one or more strands and that the multiple strands may be from multiple sutures. 
         [0027]    Referring now to  FIG. 6 , an alternative embodiment of the suture clip according to the present disclosure is shown generally as suture clip  210 . Suture clip  210  includes a base portion  211  and a retainer portion  212  connected by hinge portion  216 . Retainer portion  212  includes an aperture  215  for receiving and engaging locking prongs projecting from base portion  211 . Two spaced apart prongs project perpendicularly from base  211 , prong  214  being shown in  FIG. 6 . Both prongs include a shaft portion and a locking barb, shaft portion  214   a  and locking barb  214   b  being shown in  FIG. 6 . Distal and proximal rounded edges  214   c  facilitate the engagement of the prongs with aperture  215 . Hinge portion  216  includes a thin strip optionally having a laterally extending notch  219  which defines a bending region along which hinge portion  215  bends. Suture clip  210  includes at least one identifying marking  217  formed on either or both of base  211  and retainer  212 . 
         [0028]    Suture clips  110 ,  210  may be secured to a suture manually, or may instead be applied with the assistance of a clip applier. With reference now to  FIG. 7 , an apparatus for applying suture clips  110 ,  210  to one or more sutures “S 1 ”, “S 2 ” is shown generally as clip applier  50 . Briefly, clip applier  50  includes a handle assembly  52 , an elongated body  54  extending from handle assembly  52  and a tool assembly  56  formed on a distal end of elongated body  54 . Handle assembly  52  includes a trigger  53  operably connected to tool assembly  56 . Handle assembly  52  further includes a rotary wheel  55  rotatably connected thereto for rotating elongated body  54 . For a more detailed discussion of clip applier  50  please refer to commonly owned U.S. Pat. No. 5,645,553 to Kolesa et al., the contents of which are hereby incorporated herein in their entirety. 
         [0029]    With reference to  FIGS. 1-5  and  7 , a procedure including the use of suture management system  100  will be described. Initially, surgical portal apparatus  10  or other surgical access assembly is used to access a body cavity “C” in a conventional manner as passed through a portal “p”. During the course of the procedure, as one or more suture “S 1 ”, “S 2 ” are used within body cavity “C” and the ends of sutures “S 1 ”, “S 2 ” extend from surgical portal apparatus  10 , suture clips  110  are attached thereto. Suture clips  110  may be attached to suture “S 1 ” manually, as described above, or may instead be attached using clip applier  50 . Once attached to suture “S 1 ” markings  117  on suture clip  110  may be used to identify suture “S 1 ”. Additionally, suture clip  110  may facilitate manipulation of suture “S 1 ” by providing a means for a clinician to grasp suture “S 1 ”. As sutures “ 51 ”, “S 2 ” are no longer needed, clips  110  may be removed therefrom by deflecting prongs  113 ,  114  toward one another, thereby releasing base  111  from within aperture  115  of retainer  112 . Alternatively, sutures “S 1 ”, “S 2 ” may instead be cut along the length extending between portal apparatus  10  and suture clip  110  to free sutures “S 1 ”, “S 2 ”. 
         [0030]    With reference to  FIG. 8 , a surgical procedure method  200  may include the steps of inserting a surgical portal member into a patient to access an underlying body site  202 ; extending at least two sutures through the portal member  204 , attaching first and second suture clips to respective first and second sutures extending through the portal member device, the first suture clip having an identifying marker and the second suture clip having an identifying marker different from the first identifying marker  206  and performing a surgical procedure with the first and second sutures as coordinated with the first and second suture clips  208 . For example, an arthroscopic procedure may be performed to attach a ligament to bone, tissue tear, repair a meniscus tear, labrum tear or the like and may incorporate the apparatus of  FIG. 7 . The ability to identify the respective sutures associated with the procedure with the suture clips assists the clinician in properly performing the procedure, and also reduces or minimizes time spent in potentially sorting out the sutures, particularly, when a number of sutures are extending from the surgical site. 
         [0031]    Although the illustrative embodiments of the present disclosure have been described herein with reference to the accompanying drawings, it is to be understood that the disclosure is not limited to those precise embodiments, and that various other changes and modifications may be effected therein by one skilled in the art without departing from the scope or spirit of the disclosure.