Abstract:
A method for passing suture through tissue and a suture passing instrument having a first jaw coupled to an end of an elongated shaft, a second jaw coupled to the first jaw, and formed with a holder for supporting a suture, and a needle slidably disposed within the first jaw, having a hook on a side for releasably capturing a portion of a suture, is provided. The first jaw defines a channel for receiving the needle and a ramp for deflecting the needle transversely of the shaft when advanced to an extended position.

Description:
FIELD OF THE INVENTION 
     The invention relates to suture passing surgical instruments. More specifically, the invention relates to a hand instrument and method for passing suture through tissue. 
     BACKGROUND OF THE INVENTION 
     Arthroscopic surgery often requires a surgeon to attach a length of suture material remotely to an internal body part. For example, a suture is passed through a detached tendon and is then secured to a hole or anchored in a bone. Various instruments have been developed for this purpose, many of them having an elongate configuration and low profile for facilitating use through cannulas in less invasive surgery. These devices have also typically have opposing jaws, which clamp onto either side of the tissue to be sutured. However, the various known mechanisms and configurations for loading the suture, grasping the suture, and threading a suture between the jaws shown in these prior art devices are exceedingly complex. Moreover, due to this complexity and poor design, in general, these devices have a tendency to create tangles in the suture or to simply fail to pass the suture through the tissue as intended. Many of these devices may also require the use of both hands to operate the instrument. 
     What is desired, therefore, is a suture passing device having a low profile that can accommodate many thicknesses of tissue, is easy to load with a suture and utilizes a mechanism that is easy and reliable for threading the suture through tissue. 
     SUMMARY OF THE INVENTION 
     Accordingly, it is an object of the present invention to provide a suture passing instrument that is of simple configuration so that a suture may be loaded into the instrument with relative ease. It is a further object of the present invention to provide a suture passing instrument having wide opening jaws so that it may be used with a range of tissue thickness. It is a further object of the invention to provide a suture passing instrument which prevents tangling of the suture and only threads one loop of suture through the tissue as desired. A further object of the invention is to provide a suture passing instrument which may be operated with one hand. 
     These and other objectives are achieved by providing a suture passing instrument comprising a first jaw coupled to an end of an elongated shaft, a second jaw coupled to the first jaw, and formed with a holder for supporting a suture, and a needle slidably disposed within the first jaw, the needle having a hook on a side for releasably capturing a portion of a suture. The first jaw defines a channel for receiving the needle and a ramp for deflecting the needle transversely of the shaft when advanced to an extended position. In some embodiments, the first jaw is stationary and the second jaw is movable and may be pivotally coupled to the first jaw. The needle may be made from a malleable material and may have a sharp distal tip for piercing tissue. An opening may also be formed in the second jaw that provides a clearance for a tip portion of the needle to pass when it is advanced to its extended position. 
     In some embodiments, the opening and the holder may be aligned such that a suture received in the holder extends across the opening. In further embodiments, the holder supports the suture on an inner surface of the movable jaw facing the stationary jaw. The holder may comprise at least one slot formed on an edge of the movable jaw which, in further embodiments, may comprise a first slot formed on a distal edge of the movable jaw and a second slot formed on an adjacent edge of the movable jaw. The second slot may be T-shaped. In further embodiments, a plurality of needles may be slidably disposed within the first jaw. In yet further embodiments, the elongated shaft may be semi-rigid or hinged. 
     Other objects of the present invention are achieved by provision of a suture passing instrument comprising a stationary jaw coupled to an elongated shaft, a malleable needle slidably disposed within the stationary jaw, the needle having a distal tip and a hook on an edge for releasably capturing a portion of a suture, a movable jaw pivotally coupled to the stationary jaw, and formed with a holder for supporting a suture and an opening that provides a clearance through which a tip portion of the needle passes when in its extended position, a first actuating member coupled to the movable jaw for moving it between a closed position alongside the stationary jaw and an open position spaced therefrom, and a second actuating member coupled to said needle for moving the needle between a recessed position and an extended position wherein the distal tip of the needle is deflected by the ramp and extends out of the stationary jaw transversely of the shaft such that the needle tip enters the opening in the movable jaw and the needle hook captures a portion of the suture supported in the holder. The stationary jaw may define an internal channel for receiving the needle and a distal ramp. 
     Other objects of the present invention are achieved by provision of a method of passing suture comprising the steps of providing a suture passing instrument having a first jaw coupled to an elongated shaft, a second jaw coupled to the first jaw, and formed with a holder for supporting a suture, and a needle slidably disposed within the first jaw, the needle having a hook on a side for capturing a portion of a suture; loading a suture into the holder of said second jaw; grasping tissue between said first jaw and second jaw; and passing suture through said tissue by advancing said needle to its extended position, capturing a portion of the suture supported in the holder with the hook, and returning the needle to a recessed position so that a loop of the suture portion captured by the needle is drawn through the tissue. The first jaw may define a channel for receiving the needle and a distal ramp for deflecting the needle transversely of the shaft when advanced to an extended position. 
     In some embodiments, the step of grasping tissue between the first jaw and second jaw further includes actuating a first actuating member displaced within the shaft and coupled to the second jaw such that the second jaw pivots toward the first jaw to grasp tissue therebetween. In further embodiments, the step of advancing the needle further includes actuating a second actuating member displaced within the shaft and coupled to the needle such that the distal tip of the needle is advanced proximally, is deflected by the ramp and extends out of the first jaw transversely of the shaft. The step of advancing the needle may include advancing the needle through tissue. In still further embodiments, the step of advancing the needle includes advancing the needle such that the needle tip enters the opening in the second jaw. 
     Other objects of the invention and its particular features and advantages will become more apparent from consideration of the following drawings and accompanying detailed description. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a perspective view of one embodiment of the suture passing instrument of the present invention. 
         FIG. 2  is a top view of one embodiment of the suture passing instrument of the present invention. 
         FIG. 3  is a sectional side view of one embodiment of the suture passing instrument of the present invention, taken along line B. 
         FIG. 4  is a side view of one embodiment of the suture passing instrument of the present invention. 
         FIG. 5  is a perspective view of the jaw portion of one embodiment of the suture passing instrument of the present invention. 
         FIG. 6  is a perspective view of the jaw portion of one embodiment of the suture passing instrument of the present invention. 
         FIG. 7  is a perspective view of the jaw portion of one embodiment of the suture passing instrument of the present invention. 
         FIG. 8  is a perspective view of the jaw portion of one embodiment of the suture passing instrument of the present invention. 
         FIG. 9  is a perspective view of the jaw portion of one embodiment of the suture passing instrument of the present invention. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     One embodiment of the suture passing instrument  10  of the present invention is shown in  FIG. 1 . Suture passing instrument  10  includes a shaft  12  connecting a proximally disposed handle portion  14  to a distally disposed jaw portion  16 . Shaft  12  may be semi-rigid or hinged along its length so that it can be bent or angled once the suture passing instrument  10  is inserted in a trocar (not shown). This allows a user to adjust the jaw portion  16  at different angles to reach the desired area. Jaw portion  16  includes an upper jaw  18  pivotally connected to a stationary lower jaw  20 , which may be formed integral with the shaft  12 . Alternatively, upper jaw  18  may be pivotally connected directly to the shaft  12 . The distal end  22  of lower jaw  20  is provided as a curved portion  24 . 
     As shown in  FIGS. 2 and 3 , upper jaw  18  includes a holder  26 , which comprises at least one slot, for supporting a suture (not shown). In the present embodiment, the holder  26  comprises a first slot  28  formed on the distal edge  30  of the upper jaw  18  and a second slot  32  formed on an adjacent edge  34 . Second slot  32  may be provided in the shape of a “T”, having bar  36 , which aids in supporting the suture within the holder. An opening  38  is also provided on second slot  32 , the utility of which will be described below. Preferably, bar  36  and the first slot  28  both lie along an axis A. More preferably, bar  36 , first slot  28 , and opening  38  all lie along axis A. Axis A may, but need not, be the same as axis B, which bisects shaft  12 . The inner surface  39  of upper jaw  18  may also be provided with a plurality of ridges  40  to aid in gripping tissue between the jaws. 
     Suture passing instrument  10  also comprises a needle  42 . Preferably, needle  42  is flexible and may be composed of spring stainless steel or nitinol. Depicted in  FIG. 7 , needle  42  is provided with a sharp tip  90  for piercing tissue and a hook  92  on an edge for capturing a suture, as will be described below. Needle  42  is disposed within an internal channel  44  which runs the length of shaft  12  and continues into the lower jaw  20 . Corresponding to the curved portion  24  of lower jaw  20 , internal channel  44  is provided with a ramp  46 , the utility of which will be explained below. In additional embodiments, multiple needles may be disposed within internal channel  44 , or individually within multiple channels. Accordingly, upper jaw  18  would be provided with multiple holders for supporting a suture so that multiple suture loops could be passed at one time. 
     Handle portion  14  comprises a trigger arm  48  and a stationary arm  50 , both terminating in finger grips  52 ,  54 , and a spring loaded push button  56 . Spring  58  biases push button  56  in an inactive position. As shown in  FIG. 3 , a first actuator  60  is coupled at a proximal end  62  to trigger arm  48  and at a distal end  64  to upper jaw  18 . When trigger arm  48  is moved in the direction of arrow A (shown in  FIG. 4 ), upper jaw  18  pivots around pivot point  66  in the direction of arrow B from an open position  68  to a closed position  70 . This allows for a user to grasp an object, namely tissue, between the jaws  18 ,  20  by squeezing trigger arm  48 . Moreover, the ample clearance provided when upper jaw  18  is in the open position  68  allows a user to grasp tissue of many thicknesses. 
     A second actuator  72  is coupled at a proximal end  74  to push button  56  and at a distal end  76  to needle  42 . Depressing push button  56  in the direction of arrow C, distally advances needle  42  from a recessed position  78  (shown in  FIG. 3 ) to an extended position  80  (shown in  FIG. 4 ), where it extends out of outlet  82  to channel  44 . Ramp  46  deflects needle  42  so that it exits channel  44  transverse of the shaft  12 . As shown in  FIG. 3 , outlet  82  is vertically aligned with opening  38  when upper jaw  18  is in its closed position  70 . Thus, when needle  42  is in its extended position, it extends into opening  38 . Both first  60  and second  72  actuators are disposed within internal channel  44 . 
     Notably, a user can grasp the instrument and actuate trigger arm  52  with the fingers of one hand through finger loops  52 ,  54 , leaving the thumb free to actuate push button  56  so that only one hand is necessary to operate the instrument. This leaves the user&#39;s other hand free to manipulate the suture threaded in the tissue or to perform other tasks. 
     In operation, a suture  84  is first loaded into holder  26  by sliding it into first  28  and second  32  slots, as shown in  FIG. 5 , so that a portion  86  of suture  84  lies across the inner surface  39  of upper jaw  18 . As noted above, bar  36 , first slot  28 , and opening  38  preferably lie along a single axis A so that suture portion  86  lies squarely across opening  38 . Jaws  18 ,  20  are then placed on either side of tissue  88  intended to be sutured. Upper jaw  18  is moved into a closed position  70 , as shown in  FIG. 6 , clamping the tissue  88  between the lower and upper jaws. 
     Needle  42  is advanced to its extended position  80 , piercing tissue  88  as it passes through outlet  82  and into opening  34 , passing by suture portion  86  (shown in  FIG. 7 ). When push button  56  is released, needle  42  then withdraws back through opening  38  and hook  92  catches suture portion  86 . As shown in  FIG. 8 , as needle  42  continues to recede in a proximal direction, suture portion  86  is threaded through tissue  88  forming a suture loop  94 . The suture portion  86  is held by the hook  92  against the distal end  22  of lower jaw  20  as the user opens the jaws  18 ,  20  to release the tissue  88 . The trailing ends of suture  84  are then released from holder  26  and the suture loop  94  is released by advancing needle  42  until the suture can clear the hook  92  ( FIG. 9 ). If desired, the user may pull one side of the suture loop  94  through the tissue  88  so that one end of the suture lies on either side of the tissue. 
     Notably, the length and configuration of the needle  42  is such that it only passes into opening  34  far enough to capture suture portion  86 . If needle  42  were allowed to advance such that all of hook  92  extended through opening  34 , it would be more likely to capture another portion of suture  84  in addition to suture portion  86 . This would cause the suture  84  to become tangled and or for more than one suture portion to be passed through the tissue, which is undesirable. 
     It should be understood that the foregoing is illustrative and not limiting, and that obvious modifications may be made by those skilled in the art without departing from the spirit of the invention. Accordingly, reference should be made primarily to the accompanying claims, rather than the foregoing specification, to determine the scope of the invention.