Source: https://patents.justia.com/patent/20190357906
Timestamp: 2020-04-02 20:16:44
Document Index: 377436319

Matched Legal Cases: ['Application No. 61', 'Application No. 61', 'Application No. 61', 'Application No. 61', 'Application No. 61', 'Application No. 61', 'Application No. 61']

US Patent Application for DEVICES, SYSTEMS, AND METHODS FOR WOUND CLOSURE Patent Application (Application #20190357906 issued November 28, 2019) - Justia Patents Search
Justia Patents US Patent Application for DEVICES, SYSTEMS, AND METHODS FOR WOUND CLOSURE Patent Application (Application #20190357906)
A suture grasper for retrieving a suture from an internal surgical site includes an inner shaft defining a tissue-penetrating tip, an intermediate shaft disposed about the inner shaft, and an outer shaft disposed about the intermediate shaft. The intermediate shaft defines a plurality of spring fingers movable between a spread position, wherein the spring fingers extend radially outwardly from the inner shaft, and a compressed position, wherein the spring fingers are approximated about the inner shaft. The outer shaft is selectively translatable relative to the inner shaft and the intermediate shaft for moving the spring fingers between the spread position and the compressed position.
This application is a continuation application of U.S. patent application Ser. No. 14/337,415, filed on Jul. 22, 2014, which claims the benefit of, and priority to, U.S. Provisional Patent Application No. 61/861,732, filed on Aug. 2, 2013; U.S. Provisional Patent Application No. 61/882,742, filed on Sep. 26, 2013; U.S. Provisional Patent Application No. 61/882,745, filed on Sep. 26, 2013; U.S. Provisional Patent Application No. 61/882,750, filed on Sep. 26, 2013; U.S. Provisional Patent Application No. 61/882,754, filed on Sep. 26, 2013; U.S. Provisional Patent Application No. 61/882,758, filed on Sep. 26, 2013; and U.S. Provisional Patent Application No. 61/882,759, filed on Sep. 26, 2013.
This application is related to U.S. patent application Ser. No. 14/337,391, filed on Jul. 12, 2011, now U.S. Pat. No. 9,681,868; U.S. patent application Ser. No. 14/337,465, filed on Jul. 22, 2014, now U.S. Pat. No. 9,861,364; U.S. patent application Ser. No. 14/337,322, filed on Jul. 22, 2014, now U.S. Pat. No. 9,675,342; U.S. patent application Ser. No. 14/337,491, filed on Jul. 22, 2014, now U.S. Pat. No. 9,848,879; and U.S. patent application Ser. No. 14/337,800, filed on Jul. 22, 2014, now U.S. Pat. No. 10,070,851.
In accordance with the present disclosure, a suture grasper for retrieving a suture from an internal surgical site is provided. The suture grasper includes an inner shaft having a tissue-penetrating tip, an intermediate shaft disposed about the inner shaft, and an outer shaft disposed about the intermediate shaft. The intermediate shaft defines a plurality of spring fingers movable between a spread position, wherein the spring fingers extend radially outwardly from the inner shaft, and a compressed position, wherein the spring fingers are approximated about the inner shaft. The outer shaft is selectively translatable relative to the inner shaft and the intermediate shaft for moving the spring fingers from the spread position to the compressed position.
In embodiments, the intermediate shaft is translatable relative to the inner shaft and the outer shaft between a first proximal position, wherein free ends of the spring fingers are positioned proximally of a distal region of the inner shaft, and a first distal position, wherein the free ends of the spring fingers extend to the distal region of the inner shaft.
In embodiments, the outer shaft is translatable relative to the intermediate shaft and the inner shaft between a second proximal position, wherein a free end of the outer shaft is spaced-apart from the distal region of the inner shaft, a second distal position, wherein the free end of the outer shaft is positioned in the distal region of the inner shaft, and an intermediate position disposed between the second proximal and distal positions.
In embodiments, the suture grasper is transitionable to a first state, wherein the intermediate shaft is disposed in the first proximal position and the outer shaft is disposed in the intermediate position. In the first state, the suture grasper defines a low-profile configuration with the tissue-penetrating tip of the inner shaft exposed to facilitate penetration through tissue.
In embodiments, the suture grasper is transitionable to a second state, wherein the intermediate shaft is disposed in the first proximal position and the outer shaft is disposed in the second proximal position.
In embodiments, the suture grasper is transitionable to a third state, wherein the intermediate shaft is disposed in the first distal position and the outer shaft is disposed in the second proximal position, to facilitate positioning of a portion of a suture between the inner shaft and the spring fingers.
In embodiments, the suture grasper is transitionable to a fourth state, wherein the intermediate shaft is disposed in the first distal position and the outer shaft is disposed in the second distal position, to facilitate grasping a portion of a suture between the inner shaft and the spring fingers.
A suture passer for depositing ends of a suture within an internal surgical site is provided in accordance with the present disclosure and includes a handle portion defining a longitudinal passageway having first and second chambers. An elongated body extends distally from the handle portion and defines a longitudinal lumen communicating with the longitudinal passageway. A plunger including an actuator, a shaft, and a selector is provided. The actuator extends proximally from the handle portion. The shaft extends distally through the longitudinal passageway into the longitudinal lumen. The selector is mounted about the shaft within the longitudinal passageway, is confined to translation within the first chamber of the longitudinal passageway when the plunger is disposed in a first rotational orientation relative to the handle portion. The selector is permitted to translate within and between the first and second chambers of the longitudinal passageway in the second rotational orientation relative to the handle portion.
In embodiments, a suture member including a suture and first and second retention members coupled to respective first and second ends of the suture is provided. The first and second retention members are positioned within the longitudinal lumen of the elongated body in longitudinal alignment with one another.
In embodiments, when the selector is disposed in the first rotational orientation, the plunger is translatable from a proximal position to an intermediate position to eject the first retention member.
In embodiments, when the selector is disposed in the second rotational orientation, the plunger is further translatable from the intermediate position to a distal position to eject the second retention member. In the first rotational orientation, the plunger is inhibited from translating into the second chamber thereby inhibiting ejection of the second retention member.
In embodiments, the first chamber of the longitudinal passageway defines a first minimum width and the second chamber of the longitudinal passageway defines a second minimum width smaller than the first minimum width.
In embodiments, the selector defines a first width greater than the second minimum width of the second chamber but smaller than the first minimum width of the first chamber. The selector further defines a second width less than the first and second minimum widths of the first and second chambers, respectively.
In embodiments, the elongated body defines a tissue-penetrating distal tip.
In embodiments, a biasing member is disposed between the selector and a shoulder defined between the first and second chambers of the longitudinal passageway. The biasing member is configured to bias the plunger proximally.
A suture passer for depositing and/or retrieving ends of a suture from within an internal surgical site is provided in accordance with the present disclosure. The suture passer includes a handle portion defining a longitudinal passageway, an elongated body extending distally from the handle portion, a plunger, and a suture member. The elongated body defines a distal tip, a longitudinal lumen communicating with the longitudinal passageway, and at least one engagement feature positioned towards the distal tip of the elongated body. The plunger includes an actuator and a shaft. The actuator extends proximally from the handle portion. The shaft extends distally through the longitudinal passageway into the longitudinal lumen. The plunger is selectively translatable between a proximal position, wherein a distal end of the shaft is disposed within the longitudinal lumen of the elongated body, and a distal position, wherein the distal end of the shaft extends distally from the distal tip of the elongated body. The suture member includes a suture and a retention member. The retention member is engaged to an end of the suture and defines at least one complementary engagement feature configured to engage the at least one engagement feature of the elongated body to releasably engage the retention member about the distal tip of the elongated body. Translation of the plunger from the proximal position to the distal position urges the distal end of the shaft into the retention member to disengage the retention member from about the distal tip of the elongated body.
In embodiments, one of the at least one engagement feature and the at least one complementary engagement feature is a recess and the other of the at least one engagement feature and the at least one complementary engagement feature is a tab.
In embodiments, the retention member defines a pocket configured to receive the distal tip of the elongated body when engaged about the distal tip of the elongated body.
Turning to FIGS. 1-2B, a wound closure device provided in accordance with the present disclosure is shown generally as wound closure device 100. Wound closure device 100 includes an elongated shaft 110 defining proximal and distal regions 111a, 111b, respectively, and a longitudinal axis “X-X.” A plunger 120 is slidably received within shaft 110 and extends longitudinally through shaft 110. A pair of selectively deployable arms 130, 140 is operably coupled to both shaft 110 and plunger 120 at distal region 111b of shaft 110. A suture 150 is operably coupled to wound closure device 100 and includes a intermediate portion 152 extending proximally from plunger 120 and shaft 110, a body portion 154 extending distally through plunger 120 and shaft 110, and first and second ends 156, 158 retained via first and second deployable arms 130, 140, respectively. First and second ends 156, 158 of suture 150 may defined a looped configuration formed via a cinch-knot, or any other suitable looped or other non-looped configuration. A pair of routing members 116, 117 is positioned in distal region 111b of shaft 110 and configured to route first and second ends 156, 158 of suture 150 from plunger 120, about routing members 116, 117, to the respective first and second arms 130, 140.
Shaft 110 is configured for insertion through an opening in tissue, e.g., wound, incision, or a naturally occurring orifice, such that distal region 111b of shaft 110 extends through the opening into an internal body cavity of the patient to allow for deployment of arms 130, 140 within the internal body cavity, while proximal region 111a of shaft 110 remains externally positioned relative to the opening to facilitate manipulation and/or actuation of wound closure device 100. Shaft 110 defines a longitudinal bore 112 extending therethrough. Bore 112 is configured to slidably receive plunger 120. Shaft 110 also includes first and second opposed cut-outs 113, 114 defined within the exterior surface of shaft 110 towards distal region 111b thereof for at least partially receiving arms 130, 140, respectively, when arms 130, 140 are disposed in the retracted position (FIG. 2A). As can be appreciated, such a feature reduces the maximum radial dimension of shaft 110 when arms 130, 140 are disposed in the retracted position (FIG. 2A) to facilitate insertion and removal of shaft 110 through the opening in tissue.
Arms 130, 140 are pivotably coupled to shaft 110 via pivot pins 131, 141 and are disposed in distal region 111b of shaft 110. Pivoting ends 132, 142 of arms 130, 140 each define a pinion member 133, 143 including a plurality of radially-disposed gear teeth 134, 144. Arms 130, 140 extend from pivoting ends 132, 142 to free ends 135, 145, respectively. Suture-retaining voids 136, 146 are defined within arms 130, 140 proximate free ends 135, 145, respectively. First and second ends 156, 158 of suture 150 may be releasably retained on arms 130, 140 adjacent to or within suture-retaining voids 136, 146 via adhesives, friction-fitting within slots defined about suture-retaining voids 136, 146 (see FIG. 13, for example), or in any other suitable fashion such as via any of the configurations detailed hereinbelow. Suture-retaining voids 136, 146, as will be described in greater detail hereinbelow, are configured for receiving needles 316, 318 (FIG. 4), respectively, to facilitate retrieval of first and second ends 156, 158 of suture 150 from arms 130, 140, and proximal withdrawal of first and second ends 156, 158 of suture 150 through tissue adjacent the opening in tissue.
Plunger 120, as mentioned above, is slidably received within shaft 110. More specifically, plunger 120 has an elongated rod 122 that is slidably received within longitudinal bore 112 defined through shaft 110. Rod 122 extends proximally from bore 112 of shaft 110 to an actuator member 124 disposed at the proximal end of rod 122. Actuator member 124 is configured to facilitate actuation of plunger 120. A gear rack 126 is disposed at the distal portion of rod 122. Gear rack 126 defines first and second linear gear-tooth segments 127a, 127b positioned adjacent respective first and second arms 130, 140 in meshed engagement with radially-disposed gear teeth 134, 144 of pinion members 133, 143 of arms 130, 140, respectively, such that distal translation of rod 122 through bore 112 and relative to arms 130, 140 effects rotation of arms 130, 140 relative to shaft 112 from the deployed position (FIG. 2B) to the retracted position (FIG. 2A), and such that proximal translation of rod 122 through bore 112 and relative to arms 130, 140 effects rotation of arms 130, 140 relative to shaft 112 from the retracted position (FIG. 2A) to the deployed position (FIG. 2B). Plunger 120 may be biased towards a proximal position such that arms 130, 140, in turn, are biased towards the deployed position (FIG. 2B), similarly as described below with respect to wound closure device 400 (FIGS. 10A-10B). Other biased configurations, or no biasing of arms 130, 140, are also contemplated.
Referring to FIGS. 5A-5C, when it is desired to close the opening in tissue, wound closure device 100 is inserted into through access device 200 with arms 130, 140 disposed in the retracted position, as shown in FIG. 5A. More specifically, prior to insertion, actuator member 124 of plunger 120 is depressed relative to shaft 110 to in order to rotate arms 130, 140 from the deployed position to the retracted position. Thus, with wound closure device 100 disposed in the retracted condition, wound closure device 100 may be inserted through access device 200 such that distal region 111b of shaft 110 of wound closure device 100 extends distally from access device 200 into the internal surgical site, while proximal region 111a of shaft 110 remains proximally of access device 200 and external to tissue. Once wound closure device 100 has been inserted through access device 200, actuator member 124 may be returned proximally relative to shaft 110 (or released, in embodiments where arms 130, 140 are biased towards the deployed position) to return arms 130, 140 to the deployed position, as shown in FIG. 5B. Thereafter, access device 200 may be withdrawn from the opening in tissue about wound closure device 100 (see FIG. 5C). More specifically, as the portion of wound closure device 100 disposed within and extending proximally from access device 200 defines a substantially uniform radial dimension, withdrawal of access device 200 about wound closure device 100 can be readily effected.
With additional reference to FIG. 8B, with ends 156, 158 of suture 150 cinched or held about needles 316, 318, needles 316, 318 may be retracted by translating base member 312 proximally relative to sleeve 320 until distal ends 317, 319 (FIG. 5E) of needles 316, 318 are retracted into needle lumens 334, 335 of sleeve 320. Retraction of needles 316, 318 catches first and second ends 156, 158 of suture 150 with respective distal ends 317, 319 (FIG. 5E) of needles 316, 318 such that first and second ends 156, 158 of suture 150 are pulled proximally through tissue and into needle lumens 334, 335 of sleeve 320. As can be appreciated, with suture 150 routed above distal region 111b of shaft 110 via routing members 116, 117, the above-detailed proximal movement of ends 156, 158 of suture 150 pulls intermediate portion 152 of suture 150 distally through wound closure device 100 and the opening in tissue (see FIG. 8C).
Referring to FIGS. 11A-13, another wound closure device provided in accordance with the present disclosure is shown designated as wound closure device 500. With reference to FIGS. 11A and 11B, wound closure device 500 includes an elongated tubular member 502, an elongated shaft 510 extending longitudinally through tubular member 502, a plunger 520 slidably received within shaft 510 and extending longitudinally through shaft 510, an actuator sleeve 530 slidably disposed about an annularly recessed proximal region 503a of elongated tubular member 502, and an end cap 540 disposed at the distal end of shaft 510 that includes four (4) selectively deployable arms 542. Similar to wound closure device 400 (FIGS. 10A and 10B), a suture 550 is operably coupled to wound closure device 500 such that an intermediate portion 552 extends proximally from plunger 520 and shaft 510, and a body portion (not shown) extends distally through plunger 520 and shaft 510. However, rather than providing two ends as with respect to wound closure device 400 (FIGS. 10A-10B), suture 550 defines four (4) ends 555, 556, 557, 558 (FIG. 12), e.g., via adjoining, knotting, braiding, etc. multiple sutures (or providing two or more separate sutures), each of which is retained via one of the deployable arms 542. Unless specifically contradicted hereinbelow, wound closure device 500 may incorporate any of the features of wound closure devices 100, 400 (FIGS. 1 and 10A-10B, respectively), detailed above, and vice versa.
Continuing with reference to FIGS. 11A-11B, a needle assembly is integrally provided with wound closure device 500. The needle assembly includes an actuator sleeve 530 slidably mounted about annularly recessed proximal region 503a of elongated tubular member 502 between a distal body portion 503b thereof and a proximal collar 503c thereof. The needle assembly further includes four (4) suture-retrieving needles 562 coupled to actuator sleeve 530 and slidably received within needle lumens 504 to move in conjunction with actuator sleeve 530. Each needle 562 defines a hooked or “J”-shaped distal end 563, although other configurations are also contemplated. Actuator sleeve 530 is slidable about annularly recessed proximal region 503 and relative to elongated tubular member 502 from a proximal position, corresponding to a storage position of needles 562, wherein needles 562 are fully disposed within lumens 504 (FIG. 11A), and a distal position, corresponding to an extended position of needles 562, wherein each needle 562 extends radially outwardly and distally from one of the openings 506 towards one of the arms 542 (FIG. 11B). Actuator sleeve 530 defines a low-profile configuration relative to distal body portion 503b of elongated tubular member 502 to facilitate removal of surgical access device 200 (FIG. 3) about wound closure device 500, similarly as detailed above. Wound closure device 500 may further include a handle (not shown) fixedly engaged to elongated tubular member 502 to facilitate sliding of actuator sleeve 530 relative to elongated tubular member 502 between the proximal and distal positions, e.g., via grasping both the handle and actuator sleeve 530 and sliding actuator sleeve 530 relative to the handle, and/or facilitating depression of actuator 522 relative to elongated tubular member 502, e.g., via grasping both the handle and actuator 522 and depressing actuator 522 relative to the handle. Alternatively or additionally, actuator sleeve 530 may be configured to rotate, e.g., 90 degrees, about elongated tubular member 502 between a locked position, wherein actuator sleeve 530 is fixed relative to elongated tubular member 502, e.g., to facilitate actuation of actuator 522, and an unlocked position, wherein actuator sleeve 530 is slidable about elongated tubular member 502, e.g., to permit actuation of actuator sleeve 530.
Once wound closure device 500 has been inserted and access device 200 (FIG. 3) removed, actuator 522 may be released, allowing arms 542 to return under bias, to the deployed position. Alternatively, access device 200 (FIG. 3) may be removed after deployment of arms 542. With arms 542 deployed, wound closure device 500 may be manipulated such that the desired portion of tissue to be sutured is positioned between openings 506 defined within elongated tubular member 502 and arms 542. Next, actuator sleeve 530 is slid distally about annularly recessed proximal region 503a of elongated tubular member 502, e.g., via grasping actuator sleeve 530 and elongated tubular member 502 (or a handle (not shown) affixed thereto) and translating actuator sleeve 530 distally relative to elongated tubular member 502 to move needles 562 from the storage position, wherein needles 562 are fully disposed within lumens 504 (FIG. 11A), to the extended position, wherein needles 562 extend through tissue into a respective one of the suture-retaining voids 543 of arms 542 (see FIG. 13).
Once needles 562 have been advanced through tissue and into suture-retaining voids 543, the user may grasp intermediate portion 552 of suture 550 (FIGS. 11A and 11B) and translate suture 550 proximally with sufficient urging such that ends 555, 556, 557, 558 of suture 550 are disengaged from annular slots 545 and are cinched or otherwise held against needles 562. Once ends 555, 556, 557, 558 of suture 550 are cinched or held about needles 562, needles 562 may be retracted via proximal sliding of actuator sleeve 530 about annularly recessed proximal region 503a of elongated tubular member 502. As actuator sleeve 530 is slid proximally relative to elongated body 502, needles 562 are likewise translates proximally relative to elongated body 502 to catch ends 555, 556, 557, 558 of suture 550 with hooked distal ends 563 of needles 562. Needles 562 may then be retracted further proximally, e.g., via further proximal sliding of actuator sleeve 530, through tissue and into needle lumens 504 of elongated tubular member 502 to likewise pull ends 555, 556, 557, 558 of suture 550 through tissue and into needle lumens 504. Thereafter, arms 542, may be returned to the retracted position and wound closure device 400 may be withdrawn from the opening in tissue, leaving suture 550 positioned in a “U”-shaped configuration, similarly as detailed above with respect to wound closure device 100 (FIGS. 1-9), thus facilitating the tying off of ends 555, 556, 557, 558 of suture 550 to close the opening in tissue.
Referring to FIGS. 15A-18B, and initially to FIGS. 15A-15B, another wound closure device provide in accordance with the present disclosure is shown generally as wound closure device 600. As detailed below, wound closure device 600 is configured for use with collar 700, suture grasper 800, cartridge 900 (FIGS. 16-18B), and/or any other suitable components such as any of those detailed herein. Wound closure device 600 includes an elongated shaft 610 defining proximal and distal regions 611a, 611b. A slider 612 is slidably received within the bifurcated proximal region 611a of shaft 110 and an end cap 614 is disposed at distal region 611b of shaft 610. Shaft 610 further includes a set of indentations 616 longitudinally arranged on either side thereof (only one of which is shown), and a plurality of angled needle lumens 617 extending therethrough, the importance of each of which will be detailed below.
Wound closure device 600 further includes a sleeve 618 disposed about elongated shaft 610 and extending from proximal region 611a to distal region 611b thereof. Sleeve 618 may be formed from first and second sleeve sections 619a, 619b configured to engage one another about shaft 610, e.g., via snap-fit engagement or other suitable releasable engagement. Alternatively, sleeve 618 may be integrally formed and/or permanently disposed about shaft 610 in any suitable fashion. Each sleeve section 619a, 619b is symmetrical relative to the other and includes a proximal portion that is operably positioned relative to slider 612, and a distal portion that is pivotably engaged to end cap 614 of shaft 610, e.g., via a post-recess engagement or other suitable pivotable engagement. Each sleeve section 619a, 619b defines a deployable arm 630, 640 proximate its distal portion. Each arm 630, 640 includes first and second spaced-apart living hinges 632, 634 and 642, 644, respectively, that permit arms 630, 640 to transition between a retracted position (FIG. 15A), corresponding to a proximal position of slider 612, wherein arms 630, 640 extend along and in generally parallel orientation relative to shaft 610 to facilitate insertion and removal of wound closure device 600, and a deployed position (FIG. 15B), corresponding to a distal position of slider 612, wherein slider 612 urges the proximal portion of sleeve 618 distally relative to the fixed distal end thereof to flex living hinges 632, 634 and 642, 644 such that arms 630, 640 extend outwardly from shaft 610 to facilitate retrieval of a portion of suture retained therein, as will be detailed below. Intermediate segments 636, 646 of arms 630, 640, which extend between the respective living hinges 632, 634 and 642, 644, each define a guide slit 638, 648 configured to guide a needle or other suture grasper towards the portion of suture retained on the respective arm 630, 640, as will be detailed below. Living hinges 632, 634 and 642, 644 may be configured such that arms 630, 640 are biased towards the retracted position, the deployed position, or define a bi-stable configuration. Arms 630, 640 may be configured to retain a portion of suture therein, similarly as detailed with respect to any of the other configurations herein, or may be configured for use in conjunction with a cartridge 900 (FIGS. 16-17) that retains the portion of the suture, as will be detailed below.
Each sleeve section 619a, 619b of sleeve 618 of wound closure device 600 further includes first and second elongated openings 622, 624. When sleeve 618 is engaged about shaft 610, the first opening 622 of each sleeve section 619a, 619b is aligned with one of the angled needle lumens 617 extending through shaft 610 to permit insertion of a needle or other suture grasper through shaft 610 and sleeve 618, tissue, and into one of the arms 630, 640. The second elongated opening 624 of each sleeve section 619a, 619b exposes indentations 616 of shaft 610 to allow for ratcheting of collar 700 thereabout, as detailed below.
Referring to FIGS. 21-22, another wound closure device provided in accordance with the present disclosure is shown generally as wound closure device 1100. Wound closure device 1100 includes an elongated shaft 1110 defining proximal and distal regions 1111a, 1111b, respectively, a plunger 1120 slidably received within shaft 1110 and extending longitudinally through shaft 1110, and a pair of selectively deployable arms 1130, 1140 operably coupled to shaft 1110 and plunger 1120 at respective distal regions 1111b, 1121 of shaft 1110 and plunger 1120.
Shaft 1110 is configured for insertion through a wound or other opening in tissue and defines a longitudinal bore 1112 extending therethrough that is configured to slidably receive plunger 1120. First and second arms 1130, 1140 are coupled to distal region 111b of shaft 1110 on opposite sides thereof via living hinges 1132, 1142. Shaft 1110 further defines a plurality of angled needle lumens 1114 configured to direct a needle inserted therethrough to a corresponding arm 1130, 1140. Although only two needle lumens 1114 are shown, it is contemplated that a plurality of pairs of angled needle lumens 1114 be provided at different longitudinal positions along shaft 1110 for use with various tissue thicknesses and/or tissue layer structures.
Plunger 1120 includes a distal region 1121 that extends distally beyond distal region 111b of shaft 1110. The proximal region (not shown) of plunger 1120 may include an actuator (not shown) for selectively translating plunger 1120 through and relative to bore 1112 of shaft 1110, similarly as detailed above with respect to wound closure device 100 (FIG. 1). First and second arms 1130, 1140 are coupled to distal region 1121 of plunger 1120 via a pivot pin 1122, although separate pivot pins and/or other pivotable engagement structures, e.g., living hinges, are also contemplated.
Cartridges 1298 each includes a base 1299a and legs 1299b engaged to base 1299a on either end thereof. Legs 1299b are configured for releasable receipt within engagement slots 1284 defined within second segments 1282 of arms 1280 of wound closure device 1200″, as will be detailed below. Bases 1299a are configured to retain retention members 1295 thereon, e.g., via adhesives, releasable clips, etc., and further define openings 1299c within the retention-member supporting surface thereof, the importance of which will be detailed below.
Wound closure device 1200″ is similar to wound closure device 1200 (FIG. 23) and further includes a slot 1284 defined within the second segment 1282 of each arm 1280. Each slot 1284 is configured to releasably receive a retention member 1295 retaining an end 1292 of a suture 1290. More specifically, slots 1284 are shaped complementary to legs 1299b, e.g., defining “T”-shaped configurations, such that legs 1299b may be engaged with slots 1284 via transversely sliding cartridges 1298 relative to arms 1280, as shown in FIG. 31. In preparation for use, with wound closure device 1200 disposed in the deployed configuration (FIG. 30), cartridges 1298 may be engaged within arms 1280 as noted above and such that intermediate portion 1294 of suture extends about the distal end of wound closure device 1200″. Thereafter, wound closure device 1200″ may be moved to the retracted condition to facilitate insertion through the opening in tissue.
Continuing with reference to FIGS. 30-32, in use, once wound closure device 1200″ has been inserted through the opening in tissue and transitioned to the deployed condition, suture grasper 1270, lead by hooked distal end 1272 may be inserted through wound closure device 1200″, tissue, and into one of the arms 1280. More specifically, hooked distal end 1272 of suture grasper 1270 is urged into one of the arms 1280 and through one of openings 1297 in web 1296 of retention member 1295 and opening 1299c in base 1299a of cartridge 1298. Once inserted to this position, suture grasper 1270 may be retracted such that the hooked distal end 1272 hooks or grasps at least a portion of the retention member 1295 of suture 1290, disengages the retention member 1295 from cartridge 1298 and retracts the retention member 1295 of suture 1290 proximally through tissue. The process may then be repeated with respect to the other arm member 1280, ultimately allowing suture 1290 to be tied off in a configuration similar to that shown in FIG. 9. For subsequent use, the spent cartridges 1298 are removed from arms 1280 and wound closure device 1200″ is loaded with a new suture 1290, similarly as detailed above.
Wound closure device 2100 includes an elongated shaft 2110, a proximal arm 2120 pivotably coupled to elongated shaft 2110 at the proximal end 2111a of elongated shaft 2110, and a distal arm 2130 pivotably coupled to elongated shaft 2110 at the distal end 2111b of elongated shaft 2110. Proximal and distal arms 2120, 2130 are coupled to one another via one or more linkages 2140, e.g., cables, such that pivoting of proximal arm 2120 relative to elongated shaft 2110 in a first direction effects corresponding pivoting of distal arm 2130 relative to elongated shaft 2110 in an opposite direction (see FIGS. 38 and 39). Proximal arm 2120 remains external of tissue during use, thus functioning as an actuator that enables the user to selectively pivot distal arm 2130, which is internally-disposed, to a desired position. Distal arm 2130 includes first and second opposed surfaces 2132, 2134, respectively. As can be appreciated, depending on the direction of pivoting of distal arm 2130, first surface 2132 may be proximally-facing (as shown in FIGS. 38, 39, and 41), or second surface 2134 may be proximally-facing (when distal arm 2130 is pivoted in the opposite direction). Elongated shaft 2110 is configured for insertion through the opening in tissue.
A suture 2600 configured for use with wound closure device 2500 includes a body 2610 routed through outer shaft 2510, a first end 2620 releasably looped about the free end of first spring arm 2530, and a second end 2630 releasably looped about the free end of second spring arm 2540. Thus, with plunger 2520 disposed in the deployed position, suture grasper 2300 may be utilized to sequentially retrieve first and second ends 2620, 2630 of suture, such that suture 2600 may ultimately be tied off in a configuration similar to that shown in FIG. 9.
19. A wound closure device, comprising:
an elongated shaft configured for insertion through an opening in tissue;
a pair of arms pivotably coupled to a distal region of the shaft;
a collar slidably positioned about the shaft and including: a body defining a longitudinal bore having the elongated shaft received therein; and an annular rim disposed at a distal end portion of the body, the annular rim having a distally-facing tissue-stop surface, wherein the collar is configured to move toward the pair of arms to capture tissue between the tissue-stop surface of the collar and the pair of arms.
20. The wound closure device according to claim 19, wherein the pair of arms is configured to move between a retracted position and a deployed position, in which the pair of arms extend outwardly from the shaft.
21. The wound closure device according to claim 20, wherein each arm of the pair of arms includes:
a first segment movably coupled to the distal region of the shaft; and
a second segment having a first end movably coupled to the first segment.
22. The wound closure device according to claim 21, wherein the first segment of each arm of the pair of arms is parallel with the annular rim when the pair of arms is in the deployed position.
23. The wound closure device according to claim 22, wherein the first segment of each arm of the pair of arms is perpendicular relative to the annular rim when the pair of arms is in the retracted position.
24. The wound closure device according to claim 21, further comprising a plunger extending longitudinally through the shaft, the second segment of each arm of the pair of arms having a second end movably coupled to a distal region of the plunger, wherein the plunger is configured to move between a proximal position, in which the pair of arms is in the deployed position, and a distal position, in which the pair of arms is in the retracted position.
25. The wound closure device according to claim 20, wherein the pair of arms assumes a generally triangular configuration when in the deployed position.
26. The wound closure device according to claim 19, wherein the collar further includes a ratchet tab movably coupled to the body and having a tooth configured to engage the shaft to selectively fix the collar in a longitudinal position on the shaft.
27. The wound closure device according to claim 26, wherein the shaft has a plurality of teeth disposed along a length of the shaft, the tooth of the ratchet tab configured to engage at least one tooth of the plurality of teeth.
28. The wound closure device according to claim 26, wherein the tooth of the ratchet tab extends into the longitudinal bore of the collar.
29. A wound closure device, comprising:
first and second arms movably coupled to a distal region of the shaft; and
a collar including: a body slidably disposed about the shaft; and a lock member movably coupled to the body and having a protruding portion, wherein the lock member is configured to move relative to the body between an unlocked position, in which the protruding portion is disengaged from the shaft, and a locked position, in which the protruding portion is engaged with the shaft.
30. The wound closure device according to claim 29, wherein the lock member is rotationally coupled to the body.
31. The wound closure device according to claim 29, wherein the collar defines a longitudinal bore therethrough, the protruding portion of the lock member extending into the longitudinal bore when the lock member is in the locked position.
32. The wound closure device according to claim 29, further comprising a plunger extending longitudinally through a longitudinal bore defined through the shaft, the first and second arms pivotably coupled to a distal region of the plunger and configured to move between a retracted position and a deployed position in response to longitudinal movement of the plunger.
33. A wound closure device, comprising:
an elongated shaft defining a longitudinal bore;
a plunger slidably received in the longitudinal bore;
first and second arms movably coupled to a distal region of the shaft and a distal region of the plunger, wherein movement of the plunger is configured to move the first and second arms relative to the shaft; and
a collar slidably positioned about the shaft and configured to move toward the pair of arms to secure tissue between the collar and the first and second arms.
34. The wound closure device according to claim 33, wherein the collar is configured to selectively lock with the shaft at a plurality of axial positions along the shaft.
35. The wound closure device according to claim 34, wherein the collar includes:
a body disposed about the shaft; and
a ratchet tab movably coupled to the body and having a tooth configured to engage the shaft to selectively fix the collar in one of the plurality of axial positions along the shaft.
36. The wound closure device according to claim 35, wherein the shaft has a plurality of teeth arranged along a length of the shaft, the tooth of the ratchet tab configured to engage a space defined between adjacent teeth of the plurality of teeth.
37. The wound closure device according to claim 34, wherein the collar includes:
a lock member movably coupled to the body and having a protruding portion, the lock member being configured to move relative to the body between an unlocked position, in which the protruding portion is disengaged from the shaft, and a locked position, in which the protruding portion is engaged with the shaft.
38. The wound closure device according to claim 33, wherein the collar includes:
a body defining a longitudinal bore having the elongated shaft received therein; and
an annular rim extending radially outward from the body, the collar being configured to move toward the first and second arms to retain tissue between the annular rim and the first and second arms.
Inventors: Scott J. Prior (Shelton, CT), Jaroslaw T. Malkowski (Trumbull, CT), Justin Williams (Southbury, CT), Christopher W. Kaswer (Avon, CT), Eric Taylor (Southington, CT)
Application Number: 16/535,587
International Classification: A61B 17/08 (20060101); A61B 17/06 (20060101); A61B 17/04 (20060101); A61B 17/00 (20060101);