Patent Publication Number: US-2007123914-A1

Title: Tissue grasper/suture passer instrument

Description:
TECHNICAL FIELD  
      The field of art to which this invention relates is surgical instruments, in particular, surgical instruments for use in minimally invasive surgical procedures.  
     BACKGROUND OF THE INVENTION  
      Minimally invasive surgical procedures have proven to be of significant benefit to patients. Typically, in a minimally invasive procedure, a surgical site is accessed using a small incision through a patient&#39;s skin and underlying fascia. A conventional trocar cannula may be inserted through the incision to provide a passageway for instruments, scopes, etc. The surgeon may view the operative site remotely or by direct visualization. Many instruments have been developed for minimally invasive surgical procedures including endoscopic and arthroscopic instruments. Arthroscopic instruments that are known and used include, for example, conventional arthroscopic scissors, arthroscopic fastener appliers, and arthroscopic suture passers.  
      Of particular importance in this art are instruments and methods for applying surgical sutures in an arthroscopic procedure. In an open procedure, the surgeon typically holds a surgical needle in a needle grasper and pushes and pulls the surgical needle through tissue around a tissue site and releases and re-grasps the needle each time the needle is exits the tissue that is required to be approximated. This type of open suturing technique is difficult to perform successfully in an arthroscopic procedure because of the limited working space. Specially designed arthroscopic suture devices have been developed to remotely pass sutures through tissue in arthroscopic procedures.  
      Although the arthroscopic suture passers of the prior art are adequate for their intended purpose, there is a constant need in this art for new instruments having advantageous characteristics and features that are easy to use in an arthroscopic surgical procedure.  
     SUMMARY OF THE INVENTION  
      Therefore, it is an object of the present invention to provide novel surgical instruments for arthroscopic surgical instruments that advantageously pass suture in arthroscopic surgical procedures.  
      Accordingly, a novel suture passer instrument is disclosed. The suture passer instrument has a frame having a proximal end and a distal end. The frame has a longitudinal passage. A bottom jaw member is mounted to the distal end of the frame. The bottom jaw member has a top surface and a bottom surface. There is a needle passageway in the bottom jaw member having a distal opening out through the top surface of the bottom jaw and a proximal opening in communication with the longitudinal passage of the frame. A top jaw member is pivotally mounted to the distal end of the frame such that the top jaw member is moveable with respect to the bottom jaw member. The top jaw member having a distal opening for receiving a cartridge member. A handle member is mounted to the proximal end of the frame. The handle member has a cavity. There is a jaw actuation member having a top end and a bottom end, wherein the top end of the jaw actuation member is mounted to the handle member. There is also a needle rod driving trigger member having a top and a bottom, wherein the top of the needle rod driving member is pivotally mounted to the handle member. A jaw actuation rod having a proximal end a distal end is slidably mounted in the passage of the frame. The distal end of the jaw actuation rod operably engages the top jaw member, and the proximal end of the actuation rod is mounted to the jaw actuation member. A needle driving rod is slidably mounted to the frame. The needle driving member has a proximal end mounted to the needle driving trigger and a distal end for engaging a surgical needle mounted in the needle passageway.  
      Yet another aspect of the present invention is a suture passer instrument. The suture passer instrument has a frame having a proximal end and a distal end. The frame has a longitudinal passage. A bottom jaw member is mounted to the distal end of the frame. The bottom jaw member has a top surface and a bottom surface. There is a needle passageway in the bottom jaw member having a distal opening out through the top surface of the bottom jaw and a proximal opening in communication with the longitudinal passage of the frame. A top jaw member is pivotally mounted to the distal end of the frame such that the top jaw member is moveable with respect to the bottom jaw member. The top jaw member having a distal opening for receiving a cartridge member. A handle member is mounted to the proximal end of the frame. The handle member has a cavity. There is a jaw actuation member having a top end and a bottom end, wherein the top end of the jaw actuation member is mounted to the handle member. There is also a needle rod driving trigger member having a top and a bottom, wherein the top of the needle rod driving member is pivotally mounted to the handle member. A jaw actuation rod having a proximal end a distal end is slidably mounted in the passage of the frame. The distal end of the jaw actuation rod operably engages the top jaw member, and the proximal end of the actuation rod is mounted to the jaw actuation member. A needle driving rod is slidably mounted to the frame. The needle driving member has a proximal end mounted to the needle driving trigger and a distal end for engaging a surgical needle mounted in the needle passageway. The instrument has a removable cartridge member mounted in the opening of the top jaw member. The cartridge member has a cavity for receiving and engaging at least part of a surgical needle.  
      Yet another aspect of the present invention is a method of using the above-described suture passer instruments of the present invention in a surgical procedure to pass a surgical needle and attached suture through tissue.  
      These and other aspects and advantages of the present invention will become more apparent from the following description and accompanying drawings. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       FIG. 1  is a perspective view of a grasper and needle passer instrument of the present invention.  
       FIG. 2  is a side view of the tissue grasper and suture passer instrument of  FIG. 1 .  
       FIG. 3A  is a partial cross-sectional view of the proximal end of the instrument of  FIG. 2 .  
       FIG. 3B  is a partial cross-sectional view of the distal end of the instrument of  FIG. 2 .  
       FIG. 4  is a magnified exploded perspective view of the distal end of the tissue and suture passer instrument of the present invention illustrating the upper and lower jaws of the instrument and a needle clip cartridge that is mounted to the upper jaw.  
       FIG. 5  illustrates a surgical needle and suture prior to mounting in the lower jaw of the instrument.  
       FIG. 6  illustrates the distal end of the instrument in an armed configuration with the needle cartridge mounted in the upper jaw and the surgical needle mounted in the lower jaw with the upper jaw open and ready to receive tissue.  
       FIG. 7  illustrates the distal end of the armed instrument in proximity to tissue that will be grasped and sutured.  
       FIG. 8  is a partial side view illustrating the instrument grasping the soft tissue between the jaws, prior to engaging the needle.  
       FIG. 9  is a side view of the instrument illustrating the needle deployed through the tissue, with the distal end of the needle engaged and locked by the cartridge in the top jaw.  
       FIG. 10  is a partial transverse cross-sectional view of the instrument of  FIG. 9 , illustrating the needle engaged in the cartridge.  
       FIG. 11  is a partial longitudinal cross-sectional view of the cartridge of  FIG. 10 , illustrating the needle engaged by the cartridge.  
       FIG. 12  illustrates the upper jaw of the instrument rotated to the raised position with the needle exited from the tissue and the suture passing through the tissue.  
       FIG. 13  illustrates the instrument of  FIG. 12 , wherein the instrument has been pulled back away from the tissue, causing an additional length of the suture to be pulled or passed through the tissue.  
       FIG. 14  is a perspective view of the distal end of the instrument of the present invention after the cartridge has been removed from the upper jaw and the needle has been cut away from the suture.  
       FIG. 15  illustrates the instrument of the present invention inserted into a patient&#39;s shoulder and passing a needle and suture through the patient&#39;s ligament labral complex to effect a Bankart repair procedure  
       FIG. 16  is a top view of an alternate embodiment of a cartridge that can be used with the suture passer instruments of the present invention; the cartridge has an elongated slot for engaging a needle and a proximal opening such that the needle can be moved along the slot into the proximal opening and removed from the cartridge.  
       FIG. 17  is a partial, cross-sectional view of the cartridge of  FIG. 16 , illustrating a needle engaged in the slot.  
       FIG. 18  is a top view of the cartridge of  FIG. 16 , illustrating the distal end of a needle engaged in the slot.  
       FIG. 19  illustrates the cartridge of  FIG. 18  with the needle moved along the slot into the proximal opening.  
       FIG. 20  is a cross-sectional view of the cartridge of  FIG. 19  illustrating the needle in the proximal opening in position to be removed from the cartridge. 
    
    
     DETAILED DESCRIPTION OF THE INVENTION  
      The tissue grasper and suture passer instruments of the present invention are preferably used in minimally invasive arthroscopic surgical procedures. However, these instruments may be use in other types of minimally invasive procedures including endoscopic surgical procedures, laparoscopic surgical procedures, etc. The instruments may also be used in open surgical procedures. The tissue grasper and suture passer instruments may be constructed of conventional, biocompatible materials that are easily cleaned and capable of being sterilized. The materials include but are not limited to surgical stainless steel, nitinol, titanium, polycarbonate and the like, and combinations thereof. The cartridges used in the tissue grasper and needle passer instruments of the present invention are preferably made from conventional biocompatible polymeric materials that are readily sterilizable including but not limited to polyethylene, polycarbonate, ABS and the like. The cartridges may also be made from the previously-mentioned metals, and combinations of metals and polymeric materials.  
      The tissue grasper and suture passer instrument  5  of the present invention is illustrated in  FIGS. 1-3 . The instrument  5  is seen to have a frame member  10  having a proximal end  12 , a distal end  14 , a top  16 , opposed lateral sides  18  and a bottom  20 . Cavity  22  is contained within frame member  10 . Cavity  22  is seen to have distal opening  24 , bottom opening  26  and proximal opening  28 . Openings  24 ,  26  and  28  are seen to be in communication with cavity  22 . A pair of opposed trigger pivot pin openings  21  extend though the top of frame  10  and are in communication with cavity  20 . In addition, a pair of opposed pivot pin openings  29  extend through the bottom of frame  10  and are in communication with cavity  22 . Frame member  10  is also seen to have mounting cavity  30 . Extending back and angulated down from the proximal end  12  of frame member  10  is the handle member  40 . Handle member  40  is seen to have proximal end  41  and distal end  42 . Extending from proximal end  41  is the optional finger ring  44  having opening  45 . Also extending from the handle member  40  is the locking member engagement post  50 . Engagement post  50  is seen to be preferably curved, having a proximal end  52 , a distal rounded free end  54  and a plurality of teeth  56 . The jaw actuation member  60  is seen to have upper end  62  and lower end  64 . Upper end  62  has pivot pin hole  66  extending therethrough. Lower end  64  is seen to have pivot hole  68  extending therethrough. Extending from the lower end  64  of jaw actuation member  60  is the optional finger ring member  70  having opening  72 . Spring retainer cavity  74  is seen to extend into member  60  through the distal side  61 . The jaw actuation member  60  is seen to be pivotally mounted to frame member  10 . More specifically, upper end  62  is seen to be mounted in cavity  22  by pivot pin  78  that extends through openings  21  in frame  10  and opening  68  in jaw actuation member  60 .  
      The locking member  80  is seen to be pivotally mounted to actuation member  60 . The locking member  80  is seen to be an “L” shaped member having a proximal end  82  and a distal end  88 , however the member  80  may have other shapes If desired. Extending from the top surface of the proximal end of member  80  are the teeth  84 . Teeth  84  are engageable with teeth  56  of locking member  50 . Pivot pin mounting hole  86  is seen to extend transversely through member  80 . Mounted to the proximal end  88  of locking member  80  is the disengagement member  90 . Disengagement member  90  is seen to have a generally curved shape with top end  91  bottom end  92 , proximal surface  93  and distal surface  94 . Disengagement member  90  is mounted to actuation member  60  by pivot mounting pin  98  that is inserted through pivot pin mounting hole  86  and pivot pin hole  64 . Helical spring  100  is seen to be mounted in cavity  74  such that the bottom  102  of spring member  100  is in contact with the bottom of cavity  74 , and the top  104  of spring member  100  is in contact with the proximal surface  93  of member  90 , thus exerting a biasing force against member  90 . Also pivotally mounted in cavity  22  of frame  10  is the trigger member  110 . The trigger member  110  is seen to have a bottom end  112 , a top end  114 , a proximal surface  116  and a distal surface  118 . Extending proximally from the top end  114  is the lever member  120 . Lever-member  120  is seen to have second spring retention cavity  122 . Extending through the upper end  114  of trigger member  110  are the slotted opening  125  and the pivot pin opening  127 . The trigger member  110  is seen to be pivotally mounted in cavity  22  of frame  10  by the pivot pin  129  that extends through pivot pin mounting opening openings  29  in frame  10  and pivot pin opening  127  in trigger member  110 . Spring member  130  is seen to have bottom  132  and top  134 . The spring member  130  is mounted in spring retention cavity  122 , and the bottom  132  exerts a biasing force against lever member  110  through lever member  120 .  
      Extending from the distal end  14  of frame  10  is the elongated member  150 . Elongated member  150  is seen to have a proximal end  152 , a distal end  154  and a longitudinal slot  156  therein extending along the length of member  150  and having proximal opening  157  and distal opening  158 . The elongated member  150  is seen to have outer surface  160  and inner surface  162 , as well as top  164  and bottom  166 . The proximal end  152  of elongated member  150  is seen to be mounted in frame  10  in cavity  30 . Although it is preferred that proximal end  152  be fixedly mounted, alternatively, the end  152  may be mounted to provide for rotational movement or longitudinal movement of tubular member  150 . Extending downward from the outer bottom  166  of elongated member  150  are the grommet members  170  having longitudinal passages  172 .  
      Referring also now to FIGS.  3 B and  4 - 15 , seen to be extending from the distal end  154  of elongated member  150  is the lower jaw member  180 . The lower jaw member  180  is seen to have proximal end  182  and distal end  184 , and a pair of opposed sides  188  and  189 , top  186  and bottom  185 . Lower jaw member  180  is seen to have cavity  190  having proximal opening  192  and top opening  194 , both of which are in communication with cavity  190 . Cavity  190  is seen to have distal end  196  adjacent to inner wall  186 . The needle passage opening  187  is contained in wall  186 . Extending transversely through jaw member  180 , and in communication with cavity  190 , are the pivot pin mounting holes  188 . The jaw member  180  is seen to have top grasping surface  200 . Extending up from the surface  200  are the tissue engagement teeth  202  having tips  204 . Surface  200  is seen to have needle opening  206 . Also contained in the lower jaw member  180  is the needle passageway  210  having proximal and distal ends  212  and  214 , respectively. The proximal end  212  of passageway  210  is in communication with opening  187  and the distal end  214  is in communication with opening  206 . Preferably, the passage has an opening  218  extending out through the side  188  of jaw member  180  to facilitate the loading and passage of a needle and suture. The opening  218 , although not preferred, may be located on the bottom  185  of jaw member  180 . Optionally, there are multiple openings  218 . The upper jaw member  230  is seen to be pivotally mounted to lower jaw member  180 . The upper jaw member  230  is seen to have proximal end  232 , distal end  234 , upper surface  236  and bottom surface  238 . Extending down from the bottom surface  238  are the tissue engagement teeth  241  having tips  242 . Extending down and proximally from distal end  232  of the upper jaw member  230  is the camming member  240 . The camming member  240  is seen to have concave curved top camming surface  249 . Contained in surface  249  is the longitudinal retention groove  244 . The pivot hole passage  248  is seen to be contained in the bottom of the camming member  240 . The upper jaw member  230  is mounted in cavity  190  by inserting pivot pin  235  though pivot pin openings  188  and pivot hole passage  248 . The upper jaw  230  is seen to have U-shaped slot  250  having opening  251 . Extending up from the upper surface  236  of jaw member  230  is the cartridge retainer member  255 . Retainer member  255  is seen to have top  256  and distal ramped surface  257 . The member  255  has opposed sides  258  connected by curved ends  259 .  
      Slidably mounted in the passages  172  of grommet member  170  is the needle actuator rod  260 . Rod  260  is seen to be an elongated rod-like member having a proximal end  262  and a distal end  266  having a distal needle engagement nose  268 . Distal end  266  is seen to be optionally necked down and has a smaller diameter than that of rod  260 . The proximal end  262  of rod  260  is seen to pivotally mounted in cavity  22  of frame  10  in slotted opening  125  in trigger member  110 .  
      The jaw actuation rod  280  is seen to have distal end  284  and proximal end  282 . The jaw actuation rod  280  is a rod-like member that is slidably mounted in longitudinal slot  156  of elongated member  150 . The proximal end  282  of actuation rod  282  is pivotally mounted to the top section  62  of jaw actuation member  60  by pin member  281  extending proximally from proximal end  282  and engaged by nub  63  extending up from the top  62  of jaw actuation member  60 . Extending distally from the distal end  284  of actuation rod  280  is the cam member  290  having camming surface  295 . The tongue member  297  is seen to extend out from surface  295 , and to be engaged in retention groove  244  of camming member  240 .  
      The needle cartridge  300  is seen in  FIG. 4 . The cartridge  300  is seen to have member  310  having cavity  315 . Although cavity  315  preferably has a circular cross-section as shown, the cavity  315  my have other geometric cross-sections including but not limited to square, polygonal, rectangular, triangular, oval and the like and combinations thereof. Cartridge  300  is seen to have proximal end  302  and distal end  304 . Member  310  is seen to have top  311 , bottom  312 , and exterior surface  314  and interior surface  316 . Extending into the cavity  315  is the annular engagement tab ring member  318 . Although it is preferred that the tab ring member  318  have an annular configuration, other configurations may be used including tab segments, or other geometric configurations depending on the configuration of the cavity  315 . Mounted to the top  311  of cartridge  300  is the upper flange  320  having top surface  322 , bottom surface  324 , proximal end  326  and distal end  329 . Extending through flange  320  is the needle opening  327  in communication with cavity  315 . Seen to extend through the proximal end  326  of flange  320  is the retainer opening  325 . Bottom flange  330  is seen to be mounted to the bottom  312  of member  310 , and has opening  335  in communication with cavity  315 , as well as proximal end  332  and distal end  334 . The cartridge  300  is mounted to jaw member  230  by sliding the proximal end  326  of flange  320  over the top surface  236  of jaw member  230  such that the member  310  slides into slot  250 , and opening  325  is engaged by retention member  255 , such that the top flange  320  is partially on top of and bottom flange  330  is partially below upper jaw member  230 .  
      The instrument  5  is armed for passing a needle  350  and attached suture  370  through tissue by inserting a needle  350  in needle passageway  210  of jaw member  180 . The needle  350  is seen to have distal end  354  and proximal end  352  extending from the proximal end  352  of needle  350  is the suture  370 . Extending distally from the distal end  354  of needle  350  is the pointed piercing end  356 . Needle  356  is seen to have opposed undercuts  358  to facilitate locking in cavity  315  of cartridge  300 . The needle  350  is mounted in jaw member  180  such that the distal piercing end  354  extends at least partially out of passage  210  and through opening  206  and above grasping surface  200 . The needle  350  is seen to preferably have a curved configuration to conform to the needle passageway  210 , but may also be made of a resilient material such as spring stainless steel or a superelastic shape memory material such as Nitinol, and may have a substantially straight configuration. The cartridge  300  is then mounted to upper jaw  230  by sliding member  310  into slot  250  such that the flanges  320  and  330  are above and below the top and bottom surfaces of jaw member  230 , and such that retainer opening  325  is engaged by retention member  255 , and thereby substantially fixed in place with respect to jaw member  230 .  
      The suture  370  may be mounted to needle  350  in a conventional manner, including swaging the distal end  374  of suture in a drilled hole or channel in the proximal end  352  of needle  350 , threading the suture  370  through an eyelet, etc. Any conventional sutures may be used including non-absorbable sutures made from conventional biocompatible polymers and bio-absorbable sutures made from conventional bio-absorbable and resorbable polymers.  
      When armed, the instrument  5  operates in the following manner. The surgeon grasps the instrument  5  by the handle member  40  and places a thumb within opening  45  of thumb ring  44 . One or more of the other fingers of the hand are placed through opening  72  of finger loop  70 . Tissue  500  is grasped between the upper jaw member  230  and the lower jaw member  180  by pulling back on the actuation member  60  causing the actuation member  60  to pivot about pivot pin  78  causing jaw actuation rod  280  to be displaced distally in the slot  157  of elongated member  150 . This causes the camming member  290  of actuation rod  280  to engage the camming surface  242  of camming member  240 , thereby causing the jaw member  230  to rotate about pivot pin  235  toward lower jaw member  180 . The opposite rotation of the jaw actuation member  60  causes the actuation rod  280  to slide and move proximally causing the top jaw to rotate open. The tissue  600  is engaged by teeth  202  extending from the upper surface  200  of jaw member  180  and the teeth  241  extending downward from the bottom surface  238  of jaw member  230 . The tissue  500  is also partially pierced by the piercing point  356  of needle  350 . The spatial position of jaw  180  relative to jaw  230  is maintained by the locking member  80  and the engagement post  50  which are engaged by the teeth  56  and  84  in a ratcheting manner. The needle  350  and suture  370  are passed through tissue  600  by the surgeon engaging or pulling back on trigger member  110  thereby rotating the trigger member  110  about pivot pin  129 . This is seen to cause the actuation rod  260  to move distally through the passages  172  of grommet members  170 . The needle engagement nose  268  of distal end  266  then engages the distal end  352  of needle  350  pushing it through  210 , and out through opening  206 , through tissue  500  and into passage  315  of member  310  of cartridge  300  and partially out through opening  327  such that the undercuts  358  are engaged by the ring tab member  318 . Next the surgeon opens jaw  230  by first unlocking the jaw  230  by pulling back on disengagement member  90  causing locking member  80  to disengage from engagement post  50 , and then moving finger loop  70  distally to rotate the jaw  230  open. This causes the needle  350  to move completely through tissue  600  and move the suture  370  through tissue  500 . The surgeon then cuts the suture  370  away from needle  350  and cartridge  300 , completing the passage of the suture  370  through the tissue  600 . If desired, the instrument  5  can be re-armed with a new needle  350  and attached suture  370  along with a new cartridge  300  to provide for multiple suture passes.  
      In an alternate embodiment of the cartridge  300  of the present invention is seen in  FIGS. 15-20 . The cartridge  500  is seen to have a member  510  having a cavity  515 . Cavity  515  has an elongated slot section  520  communicating with a proximal circular opening  522 . Opening  522  may have other geometric configurations as well. Tab engagement members  530  are seen to extend into slot section  520  to engage a surgical needle. The tab engagement members  530  are not present in the opening  522 . Cartridge  500  is seen to have proximal end  502  and distal end  504 . Member  510  is seen to have top  511 , bottom  512  and exterior surface  514  and interior surface  516 . Mounted to the top  511  of cartridge  500  is the upper flange  540  having top surface  542 , bottom surface  544 , proximal end  546  and distal end  549 . Extending through upper flange  540  is the needle opening  547  in communication with cavity  515 . Seen to extend through the proximal end  546  of upper flange member  540  is the retainer opening  545 . Bottom flange  550  is seen to be mounted to the bottom  512  of member  510 , and has opening  555  in communication with cavity  515 , as well as proximal end  562 , and distal end  564 . The cartridge  500  is mounted to upper jaw member  230  of instrument  5  by sliding the proximal end  546  of upper flange  540  over the top surface  236  of jaw member  230  such that the member  510  slides into slot  250 , and retainer opening  545  is engaged by retention member  255 , such that top flange  540  is substantially on top of bottom flange  550  is substantially below upper jaw member  230 . In use with instrument  5  to pass a needle and suture through tissue, after surgical needle  350  is engaged in the elongated slot section  520 , the distal end  354  of the needle having the undercuts  358  can be moved or slid in slot section  520  into opening  522  where the undercuts  358  of the needle  350  are disengaged from the engagement tab members  530 . The needle  350  can then be removed from the cavity  522  (without cutting the attached suture) and reloaded into the needle receiving passage of the lower jaw, thereby re-arming the instrument  5  for additional or multiple suture passes using the same needle  350  and suture and cartridge. The cartridge member  500  may be removed from upper jaw  230  prior to removing the suture from cavity  522 , and then remounted in slot  250  to rearm the instruments  5  for additional suture passes.  
      The suture passer instruments of the present invention can be used in a variety of minimally invasive procedures including arthroscopic, endoscopic, laparoscopic and the like. One common arthroscopic procedure that the suture passers of the present repair can be utilized is an arthroscopic Bankart repair. An arthroscopic surgical Bankart repair procedure is disclosed in the following journal article which is incorporated by reference: “Arthroscopic Bankart Repair Using Suture Anchors”, Eugene M. Wolf, M.D., Richard M. Wilk, M.D. and John C. Richmond, M.D.,  Operative Techniques in Orthopaedics , Vol. 1, No. 2 (April), 1999:pp. 184-191.  
      The following example is illustrative of the principles and practice of the present invention, although not limited thereto.  
     EXAMPLE  
      A patient is prepared for arthroscopic rotator cuff shoulder repair surgery in a conventional manner. The patient is anesthetized using conventional anesthesia and anesthesia procedures. The patient is positioned in a conventional manner to perform an arthroscopic Bankart procedure or to repair a torn rotator cuff. Bankart repair restores stability by re-attaching the labrum or capsule directly to the anterior glenoid cavity. Two anterior portal and tow posterior portals are then placed in a conventional manner using a conventional scalpel and conventional cannulas and blunt obturators. A conventional arthroscope is inserted into a cannula and the shoulder is insufflated in a conventional manner with sterile saline to provide the surgeon with a visible field and a view of the surgical site. After examining the site arthroscopically, the instrument of the present invention is armed with a surgical needle and suture and inserted into a cannula and positioned proximate to the surgical site. The detached inferior ligament labral complex is engaged in the jaws of the instrument as seen in  FIG. 15 , and the needle and suture are passed through the tissue such that the needle is engaged in the cavity of the cartridge. The tissue is disengaged from the jaws and the instrument is pulled out through the cannula where the suture is cut away from the needle that is engaged in the cartridge. The procedure is then completed in a conventional manner using conventional suture anchors implanted in the glenoid rim with the suture that has been passed through the labral complex to anchor the tissue to the glenoid rim. The wounds for the portals are then closed in a conventional manner after removal of the cannulas and the procedure is complete.  
      Although this invention has been shown and described with respect to detailed embodiments thereof, it will be understood by those skilled in the art that various changes in form and detail thereof may be made without departing from the spirit and scope of the claimed invention.