Abstract:
A suturing device, and methods for suturing various sizes of apertures in tissues, are presented. The suturing device has a body with at least one or more adjustable arms that are coupled with catch targets. The arms are coupled with needle guides such that movements of the arms orient the needle guides to direct the needles towards the catch targets. The catch targets are coupled with sutures, such that when the needles reach the targets, they capture and pull the sutures back to the body. By changing the angles at which the arms extend from the body, the catch targets are moved closer to, or farther from, the body, and the suture device is readily configured to suture various sizes of apertures.

Description:
This application claims priority to U.S. Provisional Patent Application No. 62/267,836 filed Dec. 15, 2015 which is incorporated by reference herein in its entirety. 
    
    
     FIELD OF THE INVENTION 
     The field of the invention is systems and method for suturing various sizes of apertures. 
     BACKGROUND 
     The background description includes information that may be useful in understanding the present invention. It is not an admission that any of the information provided herein is prior art or relevant to the presently claimed invention, or that any publication specifically or implicitly referenced is prior art. 
     Health practitioners frequently use sutures to close various openings such as cuts, punctures, and incisions in various places in the human body. Depending on types and sizes of tissues to be sutured, and their locations, various different types of needles, suture threads, and suture devices can be used in the suturing process. Also, the size of the wound or apertures that can be sutured by a suturing device is often limited by a size or a radius of a needle, or the distance from the needle to the needle capture device. Thus, most of currently available suturing device are directed to a specific size of wounds or apertures, and are unsuitable for suturing a range of different sizes of wounds or apertures. 
     There are suturing devices that can adapt to different sizes of wounds or apertures by deploying needles at different distances from the body of the device. For example, U.S. Pat. No. 5,374,275 to Bradley discloses a suturing device having a needle platform, which enables the physician/operator/user to use hinged connectors to deploy a needle by desired incremental distances from the body of the device. Similarly, U.S. Pat. No. 7,449,024 to Stafford discloses a suture device having split, movable arms, wherein each of the arms is coupled with one needle. Stafford&#39;s arms are independently movable at different angles. For another example, U.S. Pat. No. 8,709,020 to Nobles discloses a suture device having suture clasp members, which can be hinged in different angles. For yet another example, U.S. Pat. No. 5,507,757 to Sauer discloses a trocar wound closure device having laterally deployable needle holders. The number of retractable needle holders can be increased to make them suitable for closing large trocar wounds. 
     Yet, none of prior arts allows the needles moving in different angles toward a target which retains suture threads, so-called “throw and catch” suturing. 
     All publications identified herein are incorporated by reference to the same extent as if each individual publication or patent application were specifically and individually indicated to be incorporated by reference. Where a definition or use of a term in an incorporated reference is inconsistent or contrary to the definition of that term provided herein, the definition of that term provided herein applies and the definition of that term in the reference does not apply. 
     Thus, there is still a need for improved systems and methods for suturing various sizes of apertures. 
     SUMMARY OF THE INVENTION 
     The inventive subject matter provides systems and methods for suturing various sizes of apertures. 
     One aspect of the invention includes an adjustable suturing device for suturing various sizes of apertures. The device includes a body having an arm, and a catch target disposed in the arm such that movement of the arm moves the target away from the body. The arm is coupled to a needle guide such that the movement of the first arm orients the needle guide to direct the needle towards the catch target. 
     Another aspect of the invention includes methods of suturing various sizes of apertures. The methods include a step of providing a suture device having a body, one or more arms, and both a catch target and a needle guide coupled to each of the arms. The methods further include a step of moving an arm way from the body of the device at a desired angle, such that movement of the arm moves the target away from the body, and orients the needle guide to direct the needle towards the catch target. 
     Various objects, features, aspects and advantages of the inventive subject matter will become more apparent from the following detailed description of preferred embodiments, along with the accompanying drawing figures in which like numerals represent like components. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1A  illustrates a perspective view of an embodiment of the distal portion of suturing device in a partially closed configuration. 
         FIG. 1B  illustrates a perspective view of the distal portion of suturing device of  FIG. 1A  in a partially open configuration. 
         FIG. 1C  illustrates a perspective view of the distal portion of suturing device of  FIGS. 1A and 1B  in a more open configuration. 
         FIG. 2  illustrates a side view of the distal portion of suturing device of  FIGS. 1A-C  in a fully closed configuration. 
         FIG. 3  illustrates another perspective view of the distal portion of suturing device of  FIGS. 1A-C  in an open configuration. 
         FIG. 4  illustrates a schematic view of a controlling mechanism of the distal portion of suturing device of  FIGS. 1A-C . 
         FIG. 5  illustrates a perspective underside view of another embodiment of the distal portion of suturing device in an open configuration. 
     
    
    
     DETAILED DESCRIPTION 
     The inventive subject matter provides suturing devices, especially for suturing various sizes of apertures in tissues, and methods of suturing the apertures using the suturing devices. 
     The following discussion provides many example embodiments of the inventive subject matter. Although each embodiment represents a single combination of inventive elements, the inventive subject matter is considered to include all possible combinations of the disclosed elements. Thus if one embodiment comprises elements A, B, and C, and a second embodiment comprises elements B and D, then the inventive subject matter is also considered to include other remaining combinations of A, B, C, or D, even if not explicitly disclosed. 
     In some embodiments, the numbers expressing quantities or ranges, used to describe and claim certain embodiments of the invention are to be understood as being modified in some instances by the term “about.” Accordingly, in some embodiments, the numerical parameters set forth in the written description and attached claims are approximations that can vary depending upon the desired properties sought to be obtained by a particular embodiment. In some embodiments, the numerical parameters should be construed in light of the number of reported significant digits and by applying ordinary rounding techniques. Notwithstanding that the numerical ranges and parameters setting forth the broad scope of some embodiments of the invention are approximations, the numerical values set forth in the specific examples are reported as precisely as practicable. The numerical values presented in some embodiments of the invention may contain certain errors necessarily resulting from the standard deviation found in their respective testing measurements. Unless the context dictates the contrary, all ranges set forth herein should be interpreted as being inclusive of their endpoints and open-ended ranges should be interpreted to include only commercially practical values. Similarly, all lists of values should be considered as inclusive of intermediate values unless the context indicates the contrary. 
     As used in the description herein and throughout the claims that follow, the meaning of “a,” “an,” and “the” includes plural reference unless the context clearly dictates otherwise. Also, as used in the description herein, the meaning of “in” includes “in” and “on” unless the context clearly dictates otherwise. 
     All methods described herein can be performed in any suitable order unless otherwise indicated herein or otherwise clearly contradicted by context. The use of any and all examples, or exemplary language (e.g., “such as”) provided with respect to certain embodiments herein is intended merely to better illuminate the invention and does not pose a limitation on the scope of the invention otherwise claimed. No language in the specification should be construed as indicating any non-claimed element essential to the practice of the invention. 
     Groupings of alternative elements or embodiments of the invention disclosed herein are not to be construed as limitations. Each group member can be referred to and claimed individually or in any combination with other members of the group or other elements found herein. One or more members of a group can be included in, or deleted from, a group for reasons of convenience and/or patentability. When any such inclusion or deletion occurs, the specification is herein deemed to contain the group as modified thus fulfilling the written description of all Markush groups used in the appended claims. 
     One aspect of the inventive subject matter includes a suturing device, especially a suturing device that is configurable to suture various sizes of apertures. The suturing device has a body that includes a lumen within which are disposed arm control elements and needles. The body is coupled with at least one arm, preferably two or more arms, each of which is coupled to a catch target. In a preferred embodiment, the arm is coupled with a needle guide. 
     For purposes of the present application, the term “needle” means both a length of metal or other material intended to pass through a tissue, along with an extension portion that can be used to direct translational or other motion of the working end of the needle. Thus, as used herein, a needle would typically be longer than the lumen of a catheter or trocar in which the needle is to be utilized. The length of needles can vary depending on the use of the suture device. For endoscopic suturing via vascular structures, it is preferred that lengths of needles are at least 10 cm, preferably at least 20 cm, and in at least some embodiments, more preferably at least 30 cm. 
       FIGS. 1A-C  illustrate an embodiment of a distal portion of suturing device  100  in a partially closed configuration  FIG. 1A , in a partially open configuration  FIG. 1B , and in a more open configuration  FIG. 1C , respectively.  FIG. 2  illustrates the distal portion of suturing device  100  of  FIGS. 1A-C  in a closed configuration. The distal portion of suturing device  100  has a body  105  with a lumen  120 . As depicted in  FIGS. 1A-C  and  2 , the body  105  can have a cylindrical shape. But these figures should be interpreted to indicate a body having any shape suitable for inserting into a body cavity, vascular or other structure. For example, the body can be in a cuboid shape, a triangular prism shape, a corn shape, a pyramid shape, or a prism shape. 
     Body  105  can comprise any suitable material or materials. For example, the body  105  can be made of one or more of plastic materials (e.g., polypropylene, polyethylene, nylon, PVC or PTFE), metal materials (e.g., aluminum, copper, platinum, metal alloys, etc.), silicon, or glass fiber. In some embodiments, the body  105  can be in biocompatible material. 
     When the distal portion of suturing device  100  is in a closed configuration as shown in  FIG. 2 , the arms  130   a ,  130   b  are substantially co-planar with a plane running longitudinally through the body  105 . The body  105  is pivotally (hingeably) coupled with one or more arms  130   a ,  130   b , by one or more pivots, such that the arms  130   a ,  130   b  can pivot laterally away from the body  105 . It is contemplated that such lateral pivoting can occur by at least 45 degrees, preferably at least 90 degrees, and more preferably by at least 135 degrees. 
     In some embodiments where the body  105  is coupled with two arms  130   a ,  130   b , the two arms  130   a ,  130   b  are preferably disposed to be deployed in opposite directions. In other embodiments where the body  105  is coupled with more than two arms, the arms are preferably arrayed evenly about the perimeter of the body  105 . For example, if there are three arms coupled with the body  105 , the three arms are preferably located in every 120 degree about the body in a circle. For other example, if there are four arms coupled with the body  105  and the body is in a cuboid shape, each of the four arms can be located in four different faces of the cuboid. 
     In a preferred embodiment, the arms  130   a ,  130   b  are coupled with one or more second arms  135   a ,  135   b  having proximal ends and distal ends. The proximal ends of the second arms  135   a ,  135   b  are coupled with the arm&#39;s distal ends by one or more pivots such that the second arms  135   a ,  135   b  can laterally moveable from the body  105  and from the arms  130   a ,  130   b . It is contemplated that the second arms  135   a ,  135   b  can laterally moveable from the arm  130   a ,  130   b  at least 15 degrees, preferably at least 30 degrees, more preferably at least 45 degrees, and most preferably at least 90 degrees. 
     The second arms  135   a ,  135   b  includes a catch target  140   a ,  140   b  at their distal ends. The catch targets  140   a ,  140   b  position sutures  155   a ,  155   b , respectively, so that needles  150   a ,  150   b  can approach the corresponding catch targets  140   a ,  140   b  and grab the sutures  155   a ,  155   b . The catch targets can have any suitable shape(s) for grabbing or coupling with the sutures  155   a ,  155   b . For example, the catch target can be in a clip shape, a curved pin shape, a hook shape, a loop shape. 
     Needles  150   a ,  150   b  are coupled with needle guides  190   a ,  190   b , which direct the needles  150   a ,  150   b  towards the catch targets  140   a ,  140   b . In a preferred embodiment, needle guides  190   a ,  190   b  are coupled with arms  130   a ,  130   b , respectively, so that the movements of the needle guides  190   a ,  190   b  coordinate with movement of the arms  130   a ,  130   b . For example, both the needle guides  190   a ,  190   b  and the arms  130   a ,  130   b  can be coupled using a common pole or stem (not shown) in the lumen  120  of the distal portion of suturing device  100 . In another example, the needle guides  190   a ,  190  can be directly attached to lower portions of the arms  130   a ,  130   b , respectively. 
     In  FIGS. 1A-C , Lateral movements of the arms  130   a ,  130   b  and the second arms  135   a ,  135   b  are controlled by movements of control wires  180   a ,  180   b ,  185   a ,  185   b , respectively. For example, control wire  180   a  is coupled with arm  130   a . When the control wire  180   a  is pushed (away from the physician/operator/user), arm  130   a  is moved laterally relative to the body  105 . In other example, control wire  185   a  is coupled with the second arm  135   a . When the control wire  185   a  is pushed, the arm  135   a  is moved laterally relative to both the body  105  and arm  130   a . In a preferred embodiment, movement of each control wire is independent from movement of other control wires, and the movement of each arm or second arm is independent from other arms or second arms. 
     In some embodiments, once the control wires  180   a ,  180   b ,  185   a ,  185   b  moves the arms  130   a ,  130   b , or the second arms  135   a ,  135   b , the positions of at least one of those arms  130   a ,  130   b ,  135   a ,  135   b , can be locked. For example, the control wires  180   a ,  180   b ,  185   a ,  185   b  can be held at one or more holders placed in the lumen  120  of the suturing device  100 . 
       FIG. 3  shows another perspective view of the distal portion of suturing device  100  of  FIGS. 1A-C  and  FIG. 2 , in a substantially open configuration. As shown in  FIG. 3 , the control wires  180   a ,  180   b ,  185   a ,  185   b  separately enter lumen  120  of the distal portion of suturing device  100  via separate openings  175   a ,  175   b ,  177   a ,  177   b . Separation of the control wires  180   a ,  180   b ,  185   a ,  185   b  allows for their independent operations without disturbing other control wires, so that angles of each arms  130   a ,  130   b , or second arms  135   a ,  135   b  can be independently controlled. Preferably, needles  150   a ,  150   b  separately enter the lumen  120  via separate openings  170   a ,  170   b . In some embodiments, the body  105  includes an additional opening  171  for a guide wire (not shown). 
     Because the catch targets  140   a ,  140   b  are coupled with the second arms  135   a ,  135   b  and then the arms  130   a ,  130   b , lateral movement of the arms  130   a ,  130   b  and/or the second arms  135   a ,  135   b  away from the body  105  will automatically move the catch targets  140   a ,  140   b  away from the body  105 . As the catch targets  140   a ,  140   b  are moved away in different angles, the corresponding needles  150   a ,  150   b  must also be reoriented to catch the sutures  155   a ,  155   b  coupled to the catch targets  140   a ,  140   b . In preferred embodiments, this is accomplished by pivoting the needle guides  190   a ,  190   b  along with corresponding pivoting of the  130   a ,  130   b.    
       FIG. 4  shows an embodiment in which the needle guides  190   a ,  190   b  directly attached to the arms  130   a ,  130   b , respectively. Thus, when the control wires  180   a ,  180   b  laterally move the arms  130   a ,  130   b  relative to the body  105 , the needle guides  190   a ,  190   b  are oriented along corresponding directions and angles with the arms  130   a ,  130   b.    
     In some embodiments, it is contemplated that the needle guides  190   a ,  190   b  are not operated by direct attachment to the arms  130   a ,  130   b , but are operated indirectly through coupling to the control wires  180   a ,  180   b . In these embodiments, the needle guides  190   a ,  190   b  can be attached to wing-like structures (not shown) that resemble the arms  130   a ,  130   b , which are then attached to the control wires  180   a ,  180   b . Movements of the wing-like structures are controlled by the control wires  180   a ,  180   b , concurrently with movement of the arms  130   a ,  130   b.    
       FIG. 5  shows another embodiment of a distal portion of a suturing device  200 , here displayed in a substantially open configuration. In this embodiment, the suturing device  200  includes four arms  230   a ,  230   b ,  230   c ,  230   d , which are pivotally (hingeably) coupled with the body  205  of the suturing device  200 . The distal portion of suturing device  200  further includes four second arms  235   a ,  235   b ,  235   c ,  235   d , which are pivotally (hingeably) coupled with four arms  230   a ,  230   b ,  230   c ,  230   d , respectively. In a preferred embodiment, the four arms  230   a ,  230   b ,  230   c ,  230   d  are radially arrayed about the body  205  of the suturing device  200  in circle. 
     Each of the arms  230   a ,  230   b ,  230   c ,  230   d  and each of the second arms  235   a ,  235   b ,  235   c ,  235   d  are controlled by control wires that are coupled with each of the arms  230   a ,  230   b ,  230   c ,  230   d  or each of the second arms  235   a ,  235   b ,  235   c ,  235   d  via separate openings  275   a ,  275   b ,  275   c ,  275   d  or  277   a ,  277   b ,  277   c ,  277   d . The body  205  of the suturing device  200  also has needle openings  270   a ,  270   b ,  270   c ,  270   d , through which each of the needles (not shown) passes, so that the needles can be directed toward catch targets  290   a ,  290   b ,  290   c ,  290   d  on the second arms  235   a ,  235   b ,  235   c ,  235   d , respectively. Optionally, the body  205  of the suturing device  200  can have another opening  271  for a guide wire (not shown). 
     Another aspect of the invention includes methods of suturing various sizes of apertures in tissues, using the suture devices described in  FIGS. 1-5 . The methods generally include a step of providing a suture devices having at least one arm that is coupled with a catch target and a needle guide. As used herein, a step of providing includes a step of supplying, selling, or placing the device. 
     In a further step, a user can move the arm(s) using linear movements of the control wire(s) (e.g., pushing distally or pulling proximally), which move the target(s) away from or closer to the body, which thereby orients the needle guide(s) to direct the needle(s) towards the catch target(s). By automatically reorienting the direction of movement of the needle(s) along with reorientation of the arms, a physician/operator/user can suture multiple different sizes of apertures by moving the arm or arms of the suture device, without worrying about having the needle(s) properly reach the catch targets disposed on the arms. 
     Once the needle(s) are directed toward the corresponding catch target(s), the methods further include steps of moving the needle(s) toward the catch target(s), catching the suture(s), and moving the needle(s) with the suture(s) away from the catch target(s). 
     It should be apparent to those skilled in the art that many more modifications besides those already described are possible without departing from the inventive concepts herein. The inventive subject matter, therefore, is not to be restricted except in the spirit of the appended claims. Moreover, in interpreting both the specification and the claims, all terms should be interpreted in the broadest possible manner consistent with the context. In particular, the terms “comprises” and “comprising” should be interpreted as referring to elements, components, or steps in a non-exclusive manner, indicating that the referenced elements, components, or steps may be present, or utilized, or combined with other elements, components, or steps that are not expressly referenced. Where the specification claims refers to at least one of something selected from the group consisting of A, B, C . . . and N, the text should be interpreted as requiring only one element from the group, not A plus N, or B plus N, etc.