Patent Description:
Often times an important aspect of a surgical procedure is to pass suture through tissue. This could be required to mend a tear or connect two or more pieces of soft tissue. Though this task is common it can be challenging for the surgeon especially in an arthroscopic procedure where visualization is limited.

Many devices have been created to address difficult suturing scenarios but there are still certain procedures and anatomies where the average surgeon still struggles. For example, suturing the labrum at times can prove challenging particularly when the tissue is severely damaged. In such cases decreasing the overall profile of the feature penetrating the tissue and optimizing the working profile of the instrument to improve access to the working site can be critical factors to facilitate suturing.

Within this smaller needle profile, a mechanism must be housed that allows easy passing and retrieving of suture by the doctor in an arthroscopic atmosphere. With many devices currently on the market a very small loop of suture is provided during tissue passing such that the surgeon is challenged to hit the miniscule target and retrieve the suture.

A device is required that easily passes suture through tissue and provides a large amount of suture on the other side of the tissue that will be relatively easy for the surgeon to grab and pull out of the arthroscopic portal. This system must also be relatively simple so that the manufacturing cost can be kept at a reasonable level.

A suture passing device of known type is disclosed in the international patent application <CIT> from which a <CIT> is derived.

Such European application is a document under Art. <NUM>(<NUM>) EPC.

An other suture passing device of known type is disclosed in the patent application <CIT>.

A surgical assembly of known type is disclosed in the patent application <CIT>.

The presently claimed invention is defined by a suture passing device according to claim <NUM>. Further developments of the herein claimed invention are described in the dependent claims.

The following preferred embodiments, in general, are directed to devices and methods for manipulating and passing suture. As will be appreciated, aspects of the suture passing device and its embodiments provide convenience for grasping suture and passing captured suture through tissue. Moreover, aspects disclosed are useful and superior to conventional suture passing devices because the preferred elements provide a reliable and more convenient capture of sutures. In general, preferred devices are disclosed which include a jaw assembly having a suture capturing mechanism that securely pushes and pulls a captured suture. It will be understood that the embodiments disclosed may include different jaw assemblies and suture capturing mechanisms in combination and no one jaw assembly is necessarily operated with any particular suture capturing mechanism disclosed. Thus enumeration in the following does not imply that a jaw assembly with the same number series must be operated by a suture capturing mechanism of the same number series.

Referring now to <FIG>, a first preferred embodiment of a suture passing device or suturing device <NUM> is shown. The device <NUM> preferably comprises a proximal portion <NUM> and a distal portion <NUM>. The proximal portion <NUM> includes a handle <NUM> and an actuating mechanism which may comprise a thumb slide <NUM>. The thumb slide <NUM> communicates with and actuates a jaw assembly <NUM> included in the distal portion <NUM> of the device <NUM>. An actuator (not shown) is coupled to the thumb slide and the jaw assembly <NUM> which is housed in a shaft <NUM>. The shaft <NUM> defines a shaft axis A.

The device <NUM> comprises a distal tip <NUM>. In the preferred embodiment, the distal tip <NUM> comprises a sharp needle tip. While the distal tip <NUM> is shown in a straight configuration for simplicity, it should be expressly understood that this tip can be bent in a number of different curves as required.

In <FIG>, a close-up of the first preferred distal needle tip <NUM> is shown with the jaw assembly <NUM> in a default open configuration when the actuating mechanism <NUM> of <FIG> is moved distally. The distal tip <NUM> may comprise a sharpened distal blade that enhances its ability to puncture tissue. In the first preferred embodiment, the jaw assembly <NUM> preferably comprises a pair of jaw members, or first and second jaw members, <NUM>. In the preferred embodiment, the full length of the first and second jaw members <NUM> can range from <NUM> to <NUM> or longer depending on the amount of spread and reach desired for suture manipulation.

The jaw assembly <NUM> comprises a push-pull suturing capturing mechanism <NUM> preferably formed on the pair of jaw members <NUM>. In the first preferred embodiment, the suture capturing mechanism <NUM> may comprise a series of valleys <NUM> and teeth <NUM> formed on each jaw member <NUM> in a preferably alternating pattern. In the preferred embodiment, the height of the teeth <NUM>, or depth of the valleys <NUM> can range from <NUM> to <NUM> depending on the constraining tube diameter and suture to be manipulated. The number of valleys <NUM> and teeth <NUM> can vary from one to multiple quantities. The number of valleys <NUM> need not match the number of teeth <NUM>. And the configuration on one jaw member <NUM> relative to the other opposite jaw member <NUM> can mesh as shown in the illustrated embodiment, comprise a mirror image (which would not mesh) or interact in a more random manner. Each jaw member <NUM> can also have a different pattern relative to the other jaw member <NUM> such as staggered teeth. As a further example, one jaw member <NUM> may comprise a flat face, i.e. no valleys or teeth, while the opposite jaw member <NUM> comprises valleys and teeth.

In the preferred embodiment, the push-pull suture capturing mechanism <NUM> is configured to both push and pull a captured portion of suture. The suture capturing mechanism <NUM> may accomplish this dual push-pull action by having, for example, teeth <NUM> that affix to and lock on a specific point of suture. That fixed point of suture may be both pulled - e.g., when the jaw assembly <NUM> is retracted into the into hollow shaft <NUM> - and pushed - e.g., when the jaw assembly <NUM> exits out the shaft carrying the affixed point of suture until the jaw members <NUM> diverge from each other so as to release the suture.

In the preferred embodiment, the jaw assembly <NUM> may preferably be composed of a variety of materials including plastic and/or metal. One preferred material may be Nitinol which can be shape-set in the spread-out configuration as shown in <FIG>. In the illustrated embodiment, the jaws may be preconfigured to a default spread-apart configuration shown in <FIG> when at rest and can be brought together as in <FIG> without yielding the material. In the first preferred embodiment, there are no hooks located at the distal ends of the jaws.

In the default open position of the jaw assembly <NUM> as shown in <FIG>, the first and second jaws <NUM> diverge away from the shaft axis A, and thus diverge away from each other <NUM>. When the jaws <NUM> are moved distally to exit the distal tip <NUM>, the jaws <NUM> are biased to this flared-out open configuration where neither jaw <NUM> is parallel to the shaft axis A.

In <FIG>, the jaw assembly <NUM> is being drawn in to a lumen <NUM> defined within the shaft <NUM> when the actuating mechanism <NUM> shown in <FIG> is moved proximally. As shown in <FIG>, an inner wall <NUM> of the shaft <NUM> slowly forces the two jaw members <NUM> together as the jaw assembly <NUM> is retracted into the distal tip <NUM> and further into the shaft <NUM>. The inner wall <NUM> causes the pair of jaw members <NUM> to converge towards each other as the jaw assembly <NUM> is drawn into lumen <NUM>. In <FIG>, the jaw assembly <NUM> is retracted into distal tip <NUM> and moved to a closed configuration when the actuating mechanism is moved further proximally. The inner wall <NUM> is preferably abutting not only one jaw member <NUM>, but both jaw members <NUM> to cause the pair of jaw members <NUM> to converge when retracted into the shaft <NUM>. This is accomplished in part to the default shape of each jaw <NUM> which is preferably biased away (i.e., opposite direction) from the opposing jaw <NUM> as shown in <FIG>.

In the first preferred embodiment where similar geometries are formed on each jaw member <NUM>, this convergence can be likened to two sets of teeth meshing in a zipper-type action when retracted into the shaft <NUM>. In the illustrated embodiment, it should be noted that the jaw members <NUM> are shown coming together on the same plane but it is a common occurrence for jaw members <NUM> to come in to the distal tip <NUM> at slightly different planes especially if suture is also being pulled in. Also, the two jaw members <NUM> not need be symmetrical. For example, one jaw member could be curved as shown and the other jaw member relatively straight.

In the preferred embodiment shown in <FIG>, the device <NUM> comprises a kerf <NUM> that forms a space between the two jaw members <NUM> which can vary from touching to a distance capable of holding a particular suture of a desired size. This gap can be as large as <NUM> and still hold some of the larger suture sizes. For smaller suture sizes this gap will often be closer to a range between <NUM> and <NUM>. In the preferred embodiment, the distal end <NUM> of the jaw assembly <NUM> may be retracted into the shaft <NUM> in a preferred range of <NUM> to <NUM> from the blade tip <NUM>.

<FIG> illustrate operative views of the preferred suturing device <NUM>. <FIG> shows the deployed jaw assembly <NUM> extending distally out from the shaft <NUM> and surrounding a piece of suture <NUM> with a wide capture space, or region <NUM> that is generally shaped as a flared-out funnel or flared-out horn. In this deployed configuration, the jaw members <NUM> are extended distally out of the shaft <NUM> and positioned on opposite sides of the suture <NUM> in their default divergent configuration. The jaw members <NUM> are biased to a diverging configuration when deployed and moved to a converging configuration when retracted into the tube <NUM>. The spread of the distal jaw tips <NUM> will be dependent on what the nearby anatomy of the patient will allow, but the ability to spread between <NUM> and <NUM> will be desired in most instances. In this default diverging configuration shown in <FIG>, the jaw members <NUM> are preferably flared out such that the distance between counterpart portions of the jaw members <NUM> increases starting from the proximal jaw portion <NUM> to the distal jaw portion <NUM>. This flared-out configuration between the jaw members <NUM> creates a wide capture space for receiving a suture to be captured.

In <FIG>, the jaw assembly <NUM> is partially drawn into the shaft <NUM> which pushes the jaw members <NUM> towards each other to capture the suture <NUM>. In particular, the inner wall <NUM> of the shaft <NUM> causes the jaws <NUM> to converge as the jaw assembly <NUM> is retracted into the lumen <NUM>. The suture <NUM> is retracted further in <FIG> which illustrates a closed configuration of the jaw assembly <NUM> wherein the jaws <NUM> abut each other. In this closed position in <FIG>, the suture <NUM> is captured as a fixed point <NUM> of suture <NUM> is locked between the valleys <NUM> and teeth <NUM> of the jaw members <NUM>. In the preferred embodiment, the captured portion of suture <NUM> may be retracted into the lumen <NUM> in a preferred range of <NUM> to <NUM> from the distal tip <NUM>.

In <FIG>, the closed jaw assembly is further retracted into the shaft <NUM> carrying the suture <NUM> further within the distal tip <NUM>. It should be noted that the suture <NUM> can be pulled in a relatively long distance such that when the suture <NUM> is pushed out, a large loop can be formed with the deployed length. This length could be <NUM> to <NUM>, or more. The captured suture portion <NUM> is pushed out by virtue of the suture capturing mechanism (disposed within the shaft in <FIG>) locking onto a fixed point of suture and carrying the affixed point of captured suture in a distal direction. This push dynamic is distinguishable from prior art jaw assemblies that loosely hook onto a suture and thus cannot distally push a fixed point of suture.

<FIG> show a preferred method for passing suture <NUM> with the first preferred embodiment of the suturing device <NUM>. In <FIG>, the suture <NUM> has been loaded in the passer <NUM> as shown in <FIG>. In <FIG>, the sharp distal tip <NUM> is pushed through the tissue <NUM> carrying at least portion of suture <NUM> through the tissue <NUM>.

In the retracted position shown in <FIG>, the jaw assembly <NUM> carries the captured suture portion <NUM> into the shaft <NUM> for a preferred distance in the range of <NUM> to <NUM> measured from the blade tip <NUM> end of the distal tip <NUM>. In the preferred embodiment, the suture capturing mechanism <NUM> locks onto a fixed point <NUM> of suture <NUM> and distally pushes this affixed point <NUM> of suture <NUM> when the jaw assembly <NUM> is translated distally with respect to the shaft <NUM>. Jaw mechanisms configured to lock onto a fixed point of suture may comprise teeth/valley combinations as discussed above, and a variety of gripping or securing jaw combinations as discussed below in reference to <FIG>, except <FIG>.

In <FIG> the jaw assembly <NUM> is deployed out the tip <NUM> so that the jaw members <NUM> push and pull the suture <NUM> out of the tip <NUM> and release a large suture loop <NUM> once the proper spread is achieved between the jaw members <NUM>. This leaves the large loop <NUM> that can easily be grabbed by the passer <NUM> once it has adjusted to a new position as shown in <FIG>. It should be noted that an addition or variation to this method is to pierce the tissue <NUM> with a distal tip <NUM> that is not loaded with suture. The jaw assembly <NUM> can then grab the suture <NUM> on the other side of the tissue <NUM> similar to <FIG>.

<FIG> illustrates details of the preferred jaw assembly <NUM> having a suture capturing mechanism <NUM> that prevents or inhibits captured suture from sliding. For machining purposes there may be a witness kerf <NUM>. This acts to form the pattern of teeth <NUM> and valleys <NUM> between the two jaw members though the two jaws do not necessarily have to nest as shown in the illustrated embodiment. Also, the kerf <NUM> can vary in width over its length to create smaller or larger gaps between the two jaws <NUM>.

In <FIG>, the jaw assembly <NUM> may preferably comprise thinned sections <NUM> with cutouts <NUM> that allow for the pair of jaws <NUM> to bend outwards away from each other bend outwards (as shown in <FIG>) or inwards with minimal imparted stresses as shown in <FIG>. This diverging motion is represented in <FIG> with movement arrows <NUM> indicating that the jaw assembly <NUM> as a whole is more flexible along the plane shown in <FIG>. The thinned sections <NUM> shown in <FIG> also provide greater flexibility for the jaw assembly <NUM> to bend as indicated by the movement arrows <NUM> in <FIG>. The thinned sections <NUM> also allow for twisting of the jaw assembly <NUM> under torsion forces, thereby allowing the jaw assembly <NUM> to pass through non-linear tubes that may be bent in multiple planes. Referring back to <FIG>, the thinned sections <NUM> are preferably located proximal to suture capturing mechanism <NUM> and collectively form a void <NUM> when the suture capturing mechanism is in the closed position as shown. For proper flexibility without imparting yielding stresses, the length and displacement must be taken into account but in general the thickness can preferably range from <NUM> to <NUM>.

And for jaw assemblies <NUM> composed of memory materials such as Nitinol the thinned sections <NUM> allow for shape set in an open position. The proximal relief is a feature that minimizes the stress on the part when the jaw members <NUM> are displaced. In the first preferred embodiment, the jaw members <NUM> preferably comprise distal portions of a unitary jaw structure <NUM>. Thinned sections <NUM> are shown to have uniform cross section along their length but this cross-section area may vary over that length in order to evenly distribute stresses during bending. For instance, the cross-sectional area of the thinned section <NUM> can decrease as it gets closer to the teeth <NUM> in a way to even out stresses during bending.

A <NUM>° view of <FIG> is shown in <FIG>. It is obvious that this aspect is much thinner than that of <FIG> which allows for relative flexure ease as shown with arrows <NUM> while minimizing imparted stresses. Another view of the relative planar thicknesses is shown in <FIG>.

In the following alternative embodiments, elements of similar structure are designated by the same reference numerals followed by at least one lower case letter (e.g., jaw assembly 30b).

<FIG> illustrate alternative embodiments of the jaw assembly, each having a preferred suture capturing mechanism configured to lock onto a point of suture and both push and pull the affixed point of suture.

<FIG> shows an alternative embodiment of the jaw assembly 30b comprising teeth 46b that need not be rectangular but can be curved or round as shown. The teeth can also be triangular or a combination of different shapes as shown in the following embodiments.

<FIG> illustrates a jaw assembly 30c comprising an axial slit <NUM> that makes the jaw ribbon <NUM> more flexible. This allows for the two halves <NUM> of the ribbon <NUM> to move independently while keeping most of the compressive and tensile properties of the ribbon <NUM>. This becomes most important when the ribbon <NUM> is moving through constraining components that have bends in multiple axis.

<FIG> illustrates a jaw assembly 30d having a second suture capture mechanism <NUM> that enables suture to slide once it has been captured. The gentle geometry of the cutout distal curve <NUM> can be positioned such that the suture captured by the jaw assembly 30d will slide within the curve <NUM> when the device pulls on the suture. In the configuration shown, access <NUM> to the kerf 57d is proximal to the distal-most portion <NUM> of the curve <NUM> such that the suture would tend to settle in to the curve <NUM> when the suture is moved distally with respect to the jaw assembly 30d (i.e., when the jaw assembly 30d is retracted proximally). This prevents the suture from getting stuck in the kerf access <NUM>. The cutout distal curve <NUM> thus comprises a hook <NUM> that enables captured suture to slide transversely (i.e., in and out of the page in the view of <FIG>) with respect to the jaw assembly 30d. Thus, the jaw assembly 30d comprises two suture capture mechanisms 44d, <NUM>: namely, a first push-pull suture capturing mechanism 44d that locks onto a fixed point of suture and a second loose suture capturing mechanism <NUM> that captures suture while allowing the capture suture to slide.

In <FIG>, the cutout 70e of the jaw assembly 30e defines a distal cutout curve, or hook, 78e positioned even more distally with respect to the kerf access 84e. In comparison to the jaw assembly 30d shown in <FIG>, the kerf access 84e in <FIG> is positioned more proximally with respect to the hook 78e. The jaw assembly 30e thus comprises a first push-pull suture capturing mechanism 44e that locks onto a fixed point of suture and a second loose suture capturing mechanism 78e that allows captured suture to slide.

In <FIG>, the cutout 70f of the jaw assembly 30f defines two distal cutout curves, or hooks, 78f positioned distally to the kerf access 84f, which enables the captured suture to seat in to either of the hooks 78e and away from the kerf access 84f. The jaw assembly 30f thus comprises a first push-pull suture capturing mechanism 44f that locks onto a fixed point of suture and a second loose suture capturing mechanism 78f having two hooks that allow captured suture to slide.

<FIG> show alternative embodiments of the push-pull suture capturing mechanism having asymmetrical patterns of teeth and valleys, namely, where the pattern on a first jaw is not symmetrical to the pattern on the opposing second jaw. The teeth themselves can have a consistent or varying width and height along the length of the jaws. The number of teeth can also vary from one to more than one.

In <FIG>, the suture capturing mechanism <NUM> may comprise teeth <NUM> on only one jaw <NUM>-<NUM> with the second jaw <NUM>-<NUM> having a relatively flat jaw surface <NUM>.

In <FIG>, the suturing capturing mechanism <NUM> comprises a first jaw <NUM>-<NUM> with a first geometry of teeth <NUM>-<NUM> while a second jaw <NUM>-<NUM> comprises a different second geometry of teeth <NUM>-<NUM>.

In <FIG>, the suturing capturing mechanism 44i comprises different tooth geometries within the same jaw 41i-<NUM>, <NUM>-<NUM>. For example, the first jaw 41i-<NUM> may have both rectangular and triangular teeth 46i-<NUM>. Similarly, the second jaw 41i-<NUM> may itself have differently shaped teeth.

<FIG> illustrate different cross-sectional profiles of preferred ribbons. <FIG> shows a ribbon 74j having a circular profile. <FIG> illustrates a ribbon <NUM> having a rectangular profile, which may comprise a square. <FIG> illustrates a ribbon <NUM> with a triangular profile. <FIG> illustrates a ribbon <NUM> having a hexagonal profile. <FIG> illustrates a ribbon 74n having an oval profile.

<FIG> shows an assembly of two ribbons 74o stacked on top of each other lengthwise. <FIG> shows an assembly of two ribbons 74p stacked on top of each other widthwise.

<FIG> illustrates a preferred jaw assembly 30p where each jaw 41p comprises an alternating pattern of pointy teeth 46p and curved valleys 45p to form a scalloped edge <NUM>. In <FIG>, the two scalloped edges 41p are staggered with respect to each other so as to nest at least slightly when the jaws 41p are closed.

<FIG> illustrates a pair of jaws 41q with symmetrical scalloped edges 80q such that opposing pointy teeth 46q contact each other when the pair of jaws 41q is closed.

<FIG> illustrates a jaw assembly 30r where a first jaw 41r-<NUM> comprises a distal U-shaped hook structure <NUM> that defines a hook 78r located distally to a distal end of the second jaw 41r-<NUM> which comprises a substantially flat surface <NUM>. This illustrated embodiment 30r would allow captured suture to slide.

<FIG> illustrates a jaw assembly <NUM> where a first jaw <NUM>-<NUM> comprises a distal U-shaped hook structure <NUM> that defines a hook <NUM> located distally to a distal end of the second jaw <NUM>-<NUM>. Each jaw <NUM>-<NUM>, <NUM>-<NUM> comprises a scalloped edge <NUM> that is preferably staggered with respect to the opposite edge. The jaw assembly <NUM> thus comprises a first push-pull suture capturing mechanism 44e that locks onto a fixed point of suture and a second loose suture capturing mechanism <NUM> that allows captured suture to slide. In the preferred embodiment of <FIG>, the loose suture capturing mechanism <NUM> is preferably distal to the fixed suture capturing mechanism <NUM>.

In any of the preferred embodiments disclosed herein having a loose suture capturing mechanism, it may be preferable to bring the loosely captured suture into the hollow shaft a preferred distance of <NUM> to <NUM> from a blade tip of the distal tip.

<FIG> illustrates a jaw assembly 30t where each jaw 41t comprises tapered teeth 46t and valleys 45t with curved bases <NUM>. A cutout 70t located proximal to the suture capturing mechanism 44t defines a hook 78t positioned distal to the kerf access 84t. The jaw assembly 30t thus comprises a first push-pull suture capturing mechanism 44t that locks onto a fixed point of suture and a second loose suture capturing mechanism 78t that allows captured suture to slide. In the preferred embodiment of <FIG>, the loose suture capturing mechanism 78t is preferably proximal to the fixed suture capturing mechanism 44t.

<FIG> illustrates a jaw assembly 30u where each jaw 41u comprises tapered teeth 46u and valleys 45u spaced apart from the counterpart teeth 46u and valleys 45u on the opposite jaw 41u so as to form a larger kerf 57u, namely, a greater gap or space between the medial edge of a tooth 46t and the base of the corresponding valley 45u.

<FIG> illustrates a dual-stack jaw assembly 30v that inhibits unwanted jaw movement within the hollow shaft by filling up more of space therein with multiple pairs of jaw members 41v stacked on one another. In this preferred embodiment, two pairs of jaw members 41v along with corresponding ribbons 74v are stacked upon each other so as to form a first jaw member stack <NUM>-<NUM> and a second jaw member stack <NUM>-<NUM>. The first and second jaw member stacks <NUM>-<NUM>, <NUM>-<NUM> diverge from each other in the same manner as unstacked first and second jaw members do as described in the foregoing embodiments. The stacked jaw members in each jaw member stack <NUM>-<NUM>, <NUM>-<NUM> preferably move in unison.

The dual-stack jaw assembly 30v may comprise two pairs of jaw members that are either discrete from each other or integral to each other. If discrete pairs of jaw members are stacked, each pair may be connected, adhered, fused or otherwise coupled to the other pair to form a stack. Alternatively, a dual-stack jaw assembly 30v may comprise the equivalent of a discretely stacked pair of jaws by having a single unitary pair of jaws with a greater thickness in the preferred range of <NUM> to <NUM>. In the preferred embodiment, this inner diameter of the shaft may have a range of <NUM> to <NUM>. In the preferred embodiment, the jaw assembly has a thickness that reduces the gap between the exterior of the jaw assembly and the internal surface of the shaft, which distance is preferably between <NUM> to <NUM>. This stacked jaw assembly 30v inhibits jaw movement within the shaft while maintaining the flexibility for the jaw members to move through the curves of a shaft or tube.

According to the invention, a preferred suture passing device may comprise a dual stack of any of the preferred jaw assemblies disclosed herein.

<FIG> illustrates a jaw assembly 30w having multiple elongate cutouts 70w spaced apart along the jaw assembly axis. In this illustrated embodiment which preferably comprises three cutouts 70w where the length of a particular cutout can be made larger if increased flexibility is required as shown in <FIG>. One or more bridges <NUM> can then be added to manipulate the flexibility of the jaw assembly as shown in <FIG>. The bridges <NUM> can also be strategically placed to prevent the jaws from crossing within the hollow shaft, which is advantageous in curved tubes (see <FIG>).

<FIG> illustrates a jaw assembly 30x having distal elongate cutouts 70x-<NUM> and a proximal elongate cutout 70x-<NUM> with a substantially greater axial length than that of the distal cutout 70x-<NUM>. The distal elongate cutouts 70x-<NUM> collectively form a first void 71x directly proximal to the suture capturing mechanism 44x and having a preferred length of <NUM> to <NUM> including the suture capturing mechanism when the jaw assembly 30x is closed. The proximal elongate cutout 70x-<NUM> comprises a second void 70x-<NUM> with a preferred width in the range of. <NUM> and a preferred length in the range of <NUM> to <NUM>.

<FIG> illustrates a cylindrical jaw assembly 30y having four jaw members 41y that collectively form a cylinder. In particular, the jaw assembly 30y comprises a pair of top jaw members 41y-t and a pair of bottom jaw members 41y-b. With some of these thicker cross-sections such as the circle, the stiffness may become too great for bending around corners so it may be advantageous to make cuts 70y-<NUM> along a first plane and additional cuts 70y-<NUM> along a second plane orthogonal to the first plane as shown in <FIG>.

<FIG> illustrates a jaw assembly 30z having a pair jaw members 41z that collectively form a cylinder. The jaw assembly 30z comprises a planar ribbon 74z with a cutout 70z proximal to the pair of jaws 41z. <FIG> shows cuts made to removal material in the flexible section but leaving the round distal portion full to form a cylinder at the distal end of the jaw assembly 30z. In both cases the extra cut is shown <NUM>° to the original cut but it/they can be at any angle that leaves sufficient material for the jaws' operation.

<FIG> illustrates a jaw assembly 30aa that may be manufactured from a rod as opposed to the ribbon associated with the foregoing embodiments. The jaw assembly 30aa comprises curved valleys 45aa and teeth 46aa. A cutout 70aa defines a hook 86aa located distal to a kerf access 84aa.

In <FIG>, it will be appreciated that forming the jaw assembly 30aa manufactured from a rod provides a more substantial three-dimensional jaw body than the planar jaw assemblies of foregoing embodiments. This provides the jaw assembly 30aa with a jaw height or thickness <NUM> such that top indentations and bottom indentations <NUM>, or grooves, may be formed in an alternating pattern with peaks <NUM>. In this preferred embodiment, the top and bottom indentations <NUM> of a first jaw member 41aa are aligned with those <NUM> on the second jaw member 41aa.

<FIG> illustrates a jaw assembly 30bb manufactured from a rod having tapered teeth 46bb and tapered valleys 45bb shaped to receive the teeth 46bb to form a nesting relationship.

In <FIG>, a second preferred embodiment of a suture passing device 10cc comprises a dual-stack jaw assembly 30cc having two pairs of jaws 41cc-<NUM>, 41cc-<NUM> stacked on top of each other. In this preferred embodiment, a first pair of jaws 41cc-<NUM> is stacked on top of a second pair of jaws 41cc-<NUM> to form a first jaw member stack 141cc-<NUM> that diverges away from a second jaw member stack 141cc-<NUM> in the open configuration. The second pair of jaws 41cc-<NUM> can be a replica of the first pair of jaws 41cc-<NUM>.

<FIG> shows a third preferred embodiment of a suture passing device 10dd having a flattened or planar hollow shaft 32dd to minimize unwanted jaw movement within when housing a planar jaw assembly 30dd with a planar jaw ribbon. It will be appreciated that the cross-sectional ribbon profiles shown in <FIG> may also aid in taking up open space within the tube and minimize unwanted movement of the jaws.

<FIG> shows a fourth preferred embodiment of a suture passing device 10ee having a jaw assembly 30ee where a first side portion <NUM> comprises a single jaw member 41ee-<NUM> and a second side portion <NUM> comprises a pair of stacked jaw members 41ee-<NUM>. It will be appreciated that a jaw assembly 30ee may comprise different and asymmetrical jaw members.

<FIG> illustrates a fifth preferred embodiment of a suture passing device 10ff where each jaw member 41ff comprises a distal spacer <NUM> that prevents unwanted jaw movement within the shaft 32ff. Each jaw member 41ff thus comprises dual distal tips stacked on each other. In a preferred embodiment, the spacers <NUM> may comprise teeth <NUM> and valleys <NUM>. Though the spacers are attached to the distal tip in this illustrated embodiment, they can be attached anywhere along the length of the jaw assembly 30ff to manipulate the movement within the shaft 32ff. Though it is not required that the stacked jaw assemblies be attached the resultant stiffness can be manipulated by strategically attaching the assemblies at various points along the length of the assembly. For example, attaching the assemblies at distal tips as shown in <FIG> and leaving the rest of the construct free would result in a jaw assembly with a stiffer tip. This design methodology can also be advantageous to keep the distal tips pieces from crossing within the tube but allowing the shaft portion of the pieces to move relative to each other and thus be more flexible. The opposite can also be done by welding a portion of the shaft but not the jaw tips such that the shafts will move together but the tips can move relative to each other for more flexibility.

The advantage described in the above paragraph is most evident in curved tubes (see <FIG>) where relative position is important as is flexibility. Though the preferred means of attachment is laser welding there are a variety of methods that can be used to attach the jaw assemblies such as a variety of adhesives.

<FIG> illustrates a sixth preferred embodiment of a suture passing device 10gg where each jaw member 41gg diverges linearly away from each along the distal direction, as opposed to foregoing embodiments where each jaw member increasingly diverges away from each along the distal direction. Each jaw member 41gg preferably comprises a scalloped edge 80gg.

<FIG> illustrates a seventh preferred embodiment of a suture passing device 10hh having a jaw assembly 30hh where each jaw 41hh comprises a first proximal bend <NUM> and a second distal bend <NUM>. The first bend <NUM> of each jaw 41hh is diverging while the second bend <NUM> of each jaw 41hh is converging such that distal jaw portions <NUM> containing the suture capturing mechanism 44hh extend in a substantially parallel manner when the jaw assembly 30hh is in the open configuration as shown in <FIG>.

<FIG> illustrates a curved hollow needle shaft 32ii that may be used with any of the foregoing preferred embodiments of the suture passing needle. The curved shaft 32ii comprises a shaft bend <NUM> proximal to the sharp needle tip 34ii.

In all of the foregoing embodiments where the jaw assembly comprises a proximal ribbon portion, the ribbon may have a thickness in the preferred range of <NUM> to <NUM>, and a width in the preferred range of <NUM> to <NUM>.

In all of the foregoing embodiments where the jaw assembly comprises one or more cutouts, the cutout may have a length in the preferred range of 10mm_to <NUM>, and a width in the preferred range of.

In all of the foregoing embodiments where a preferred jaw assembly is shown in the closed configuration but without an accompanying shaft, it is to be expressly understood that the jaw members are shown closed for illustrative purposes only and that such Figures do not imply that the jaw assembly defaults to a closed configuration without a shaft.

It is to be expressly understood that a preferred suturing passing device according to the invention may comprise a dual stack of any foregoing preferred jaw assemblies having any of the foregoing preferred suture capturing mechanisms and any of the foregoing preferred cutouts.

A preferred method of passing suture <NUM> is also provided and illustrated in <FIG>. The method <NUM> comprises the step <NUM> of diverging a pair of jaw members of a suture passing device from each other by translating a jaw assembly distally with respect to a hollow shaft to cause the outwardly biased jaw members to exit a distal needle tip. This step <NUM> creates a preferably flared-out capture space for receiving a portion of suture. This steps <NUM> also comprises diverging each of the jaw members away from an axis defined by the shaft.

In step <NUM>, the suture passing device is moved to surround a suture with the open jaw members. In step <NUM>, the suture would be disposed within a suture capture space that is defined between the two diverging jaw members and preferably shaped as a funnel.

In step <NUM>, the jaw assembly is retracted with respect to the tube such that the inner wall of the tube causes the jaw members to converge toward each other.

In step <NUM>, the jaw members are moved to a closed configuration so as to capture the suture and lock onto a fixed point of the suture to prevent sliding of the captured suture.

In step <NUM>, the captured suture is retracted into the tube in a preferred range of <NUM> to <NUM> from a blade tip of the shaft.

In step <NUM>, the captured suture is pushed out of the shaft by the jaw members carrying a fixed point of suture to exit the shaft.

In step <NUM>, the suture is released when the jaw members are moved to an open configuration. In the preferred method, the suture is not immediately released as soon as a distal portion of the jaw members exits the shaft. Instead, the suture is preferably retained for a short distance of after the suture capturing mechanism exits the lumen of the shaft.

A preferred method of passing loosely captured suture <NUM> is also provided and illustrated in <FIG>. The method <NUM> comprises the step <NUM> of diverging a pair of jaw members of a suture passing device from each other by translating a jaw assembly distally with respect to a hollow shaft to cause the outwardly biased jaw members to exit a distal needle tip. This step <NUM> creates a preferably flared-out capture space for receiving a portion of suture. This steps <NUM> also comprises diverging each of the jaw members away from an axis defined by the shaft.

In step <NUM>, the jaw members are moved to a closed configuration so as to loosely capture the suture and while allowing the loosely captured suture to slide.

In step <NUM>, the loosely captured suture is retracted into the tube in a preferred range of <NUM> to <NUM> from a blade tip of the shaft.

<FIG> illustrate an eighth preferred embodiment of a suture passing device 10jj having a jaw assembly 30jj where each jaw member 41jj comprises two bends, namely, a first proximal bend 112jj and a second distal bend 114jj. In <FIG>, the first bend 112jj of each jaw 41jj is diverging while the second bend 114jj is converging. Unlike the embodiment of <FIG>, however, the distal jaw portions 116jj containing the suture capturing mechanism 44jj extend not in a parallel manner but in a diverging manner when the jaw assembly 30hh is in the fully open configuration as shown in <FIG>.

Each jaw member 41jj preferably comprises a thinned section 68jj measured from a lateral side of the jaw member to a medial side. The thinned section 68jj comprises a width <NUM> that is less than a width <NUM> of the distal jaw portion 116jj, resulting in a pair of thinned sections 68jj having relatively more flexibility than the distal jaw portions 116jj. The distal jaw portion width <NUM> is measured from a tooth 46jj to a lateral side <NUM> of the distal jaw portion 116jj, namely, the opposite side <NUM> of the teeth 46jj and valleys 45jj. The width <NUM> of the thinned section 68jj is measured from a medial side <NUM> to a corresponding lateral side <NUM> of the thinned section 68jj. In the preferred embodiment, the thinned section width <NUM> may preferably be in the range of <NUM> (<NUM> inch) to <NUM> (<NUM> inch) and the distal jaw portion width <NUM> may preferably be in the range of <NUM> (<NUM> inch) to <NUM> (<NUM> inch). In the preferred embodiment, the distal jaw portion width <NUM> will be greater than the thinned section width <NUM> in the preferred range of <NUM> (<NUM> inch) to <NUM> (<NUM> inch).

The teeth 46jj and valleys 45jj preferably form a first scalloped edge <NUM>-1jj and a second scalloped edge <NUM>-2jj that is offset from the first scalloped edge <NUM>-1jj. The offset relationship between the first scalloped edge <NUM>-1jj and second scalloped edge <NUM>-2jj is more apparent when the jaw assembly is in the closed position.

It will be appreciated that forming each jaw member 41jj with two bends, namely, a proximal diverging bend 112jj and a distal converging bend 114jj, results in the jaw assembly 30jj holding onto the suture more securely when the jaw assembly 30jj is in the closed position and retracted into the lumen 50jj of the shaft 21jj. As shown in <FIG>, a first distal jaw tip <NUM>-1jj and a second distal jaw tip <NUM>-2jj abut each other in the closed position to prevent suture captured therein from escaping the jaw assembly 30jj. In <FIG>, it will be appreciated that the thinned proximal sections 68jj help to form a void 71jj when the jaw members 41jj are in the closed configuration.

<FIG> illustrates a top plan view of the preferred ribbon 74jj of the eighth preferred embodiment that comprises the jaw assembly 30jj. In this preferred embodiment, the jaw assembly 30jj is integrally formed at a distal section <NUM> of the ribbon 74jj. The ribbon 74jj preferably comprises a cutout 70jj with a cutout length <NUM> that is preferably in the range of <NUM> (<NUM> inch) to <NUM> (<NUM> inches). The cutout 70jj is proximal to the jaw assembly 30jj. The reduction in material resulting from the cutout 70jj facilitates a more flexible ribbon 74jj while maintaining sufficient rigidity for purposes of grasping suture or other objects.

In contrast to the preferred embodiment with the dual-bend jaws of <FIG>, <FIG> illustrates a ninth preferred embodiment of a suture passing device 10kk having a jaw assembly 30kk where each jaw member 41kk comprises a single diverging bend 112kk. In the retracted closed position as illustrated in <FIG>, the distal tips <NUM>-1kk, <NUM>-2kk do not abut each other.

<FIG> illustrates a tenth preferred embodiment of a suture passing device <NUM> having a jaw assembly <NUM> with a pair of thinned proximal sections <NUM> that are inwardly or medially formed. Each thinned section <NUM> is proximal to a corresponding distal jaw portion <NUM>. Each thinned section <NUM> comprises a lateral side <NUM> that is inwardly indented with respect to a lateral side <NUM> of the distal jaw portion <NUM>. In the closed position of this preferred embodiment, each thinned proximal section <NUM> is disposed medially and spaced apart from an inner wall <NUM> of the shaft <NUM> so as to form a gap <NUM> therebetween.

In this preferred embodiment, the jaw assembly <NUM> comprises a single diverging bend <NUM> formed at the base of each jaw member <NUM>. Each thinned section <NUM> comprises a width <NUM>, measured from a medial side <NUM> to a corresponding lateral side <NUM>, that is lesser than a width <NUM> of each distal jaw portion <NUM>, measured from a tooth <NUM> to its corresponding lateral side <NUM>. In the preferred embodiment, the thinned section width <NUM> may preferably be in the range of <NUM> (<NUM> inch) to <NUM> (<NUM> inch) and the distal jaw portion width <NUM> may preferably be in the range of <NUM> (<NUM> inch) to <NUM> (<NUM> inch). In the preferred embodiment, the distal jaw portion width <NUM> will be greater than the thinned section width <NUM> in the preferred range of <NUM> (<NUM> inch) to <NUM> (<NUM> inch).

<FIG> illustrates an eleventh preferred embodiment of a suturing passing device <NUM> having a jaw assembly <NUM> with a pair of thinned proximal sections <NUM> that are inwardly or medially formed proximal to a distal jaw portion <NUM>. This eleventh embodiment <NUM> is similar to the tenth embodiment <NUM> shown in <FIG> except that the eleventh embodiment <NUM> comprises a second bend <NUM> formed in each jaw member <NUM>. While the first bend <NUM> is diverging, the second bend <NUM> is converging and distal to the first bend <NUM>. This facilitates a more secure closed position as shown in <FIG> where the distal tips <NUM>-<NUM>, <NUM>-<NUM> of each jaw member <NUM> abut each other in the closed configuration to prevent secured suture from escaping.

Each thinned section <NUM> comprises a lateral side <NUM> that is inwardly indented with respect to a lateral side <NUM> of the distal jaw portion <NUM>. In the closed position of this preferred embodiment, each thinned proximal section <NUM> is disposed medially and spaced apart from an inner wall <NUM> of the shaft <NUM> so as to form a gap <NUM> therebetween.

In this preferred embodiment, each thinned section <NUM> comprises a width <NUM>, measured from a medial side <NUM> to a corresponding lateral side <NUM>, that is lesser than a width <NUM> of each distal jaw portion <NUM>, measured from a tooth <NUM> to its corresponding lateral side <NUM>. In the preferred embodiment, the thinned section width <NUM> may preferably be in the range of <NUM> (<NUM> inch) to <NUM> (<NUM> inch) and the distal jaw portion width <NUM> may preferably be in the range of <NUM> (<NUM> inch) to <NUM> (<NUM> inch). In the preferred embodiment, the distal jaw portion width <NUM> will be greater than the thinned section width <NUM> in the preferred range of <NUM> (<NUM> inch) to <NUM> (<NUM> inch).

In <FIG>, a twelfth preferred embodiment of a suture passing device 10nn is shown having a significantly smaller jaw assembly 30nn. For clarity, the shaft is not shown in <FIG>.

<FIG> illustrates a ribbon 74nn of the twelfth embodiment 10nn with the jaw assembly 30nn in a closed configuration while <FIG> illustrates the jaw assembly 30nn in an open configuration. In the preferred embodiment as shown in <FIG>, each jaw member 41nn comprises a first proximal diverging bend 112nn and a second distal converging bend 114nn. Forming each jaw member 41nn with dual bends 112nn, 114nn facilitates a more secure closed position where the distal jaw tips <NUM>-1nn, <NUM>-2nn abut each other in the closed position as shown in <FIG>.

In <FIG>, a width 122nn of a proximal jaw member section <NUM> is measured from a medial side 130nn to a corresponding lateral side 132nn of the proximal section <NUM>. In the preferred embodiment, the proximal section width <NUM> may preferably be in the range of <NUM> (<NUM> inch) to <NUM> (<NUM> inch) and a distal jaw portion width 124nn may preferably be in the range of <NUM> (<NUM> inch) to <NUM> (<NUM> inch). In this preferred embodiment, the distal jaw portion width 124nn may be substantially equivalent to the thinned section width 122nn.

<FIG> illustrates a thirteen preferred embodiment of a suture passing device 10oo with a significantly smaller jaw assembly 30oo. In this embodiment, each jaw 41oo contains a single diverging bend 112oo.

<FIG> illustrates a fourteenth embodiment of a suture passing device 10pp having a jaw assembly 30pp where each of the pair of jaws 41pp has a thinner distal jaw portion 116pp. For clarity, the shaft is not shown. In particular, each jaw 41pp has a distal jaw portion width 124pp that is lesser than a proximal jaw portion width 122pp. In particular, a proximal jaw section 140pp comprises a width 122pp, measured from a medial side 130pp to a corresponding lateral side 132pp, that is greater than a width 124pp of each distal jaw portion <NUM>, measured from a tooth 146pp to its corresponding lateral side 126pp. In the preferred embodiment, the proximal section width 122pp may preferably be in the range of <NUM> (<NUM> inch) to <NUM> (<NUM> inch) and the distal jaw portion width 124pp may preferably be in the range of <NUM> (<NUM> inch) to <NUM> (<NUM> inch). In the preferred embodiment, the distal jaw portion width 124pp will be lesser than the proximal section width 122pp in the preferred range of <NUM> (<NUM> inch) to <NUM> (<NUM> inch).

<FIG> is a top plan view of a fifteenth embodiment of a suture passing device 10qq in a closed figuration. In <FIG>, a jaw assembly 30qq comprises a first jaw member <NUM>-1qq having a first configuration of teeth <NUM>-1qq, and a second jaw member <NUM>-2qq having a second configuration of teeth <NUM>-2qq. The first configuration of teeth <NUM>-1qq and second configuration of teeth <NUM>-22qq collectively form a suture capturing mechanism 44qq that locks onto a fixed point of suture when the jaw assembly 30qq is in the closed configuration.

In this preferred embodiment 10qq, the configurations of teeth <NUM>-1qq, <NUM>-2qq are axially staggered with respect to each other. In other words, along the axis A as shown in <FIG>, the first configuration of teeth <NUM>-1qq formed on the first jaw member <NUM>-1qq are axially offset with respect to the second configuration of teeth <NUM>-2qq included in the second jaw member <NUM>-2qq such that two configurations of teeth <NUM>-1qq, <NUM>-2qq do not overlap or align with each other when the jaw assembly 30qq is closed. This staggered, non-overlapping relationship between the configurations of teeth on opposite jaw members <NUM>-1qq, <NUM>-2qq uniquely captures a broader range of suture sizes, from smaller sutures with a size of USP2-<NUM> to larger sutures with a size of USP#<NUM>.

Therefore, when the jaw assembly 30qq is in the closed position as shown in <FIG>, the first configuration of teeth <NUM>-1qq are exposed, or visible from a top view, through the valleys <NUM>-<NUM> of the second jaw member <NUM>-2qq. Likewise, the second configuration of teeth <NUM>-2qq are exposed, or visible from a bottom view as shown in <FIG>, through the valleys <NUM>-1qq of the second jaw member <NUM>-1qq. Thus, larger sutures may be captured by the jaw assembly 30qq in a completely closed position without inhibiting the jaw assembly 30qq from closing. At the same time, a smaller sized suture may be secured by the jaw assembly 30qq in the closed position without being loose. The jaw assembly 30qq can secure a broad range of suture sizes while maintaining a low profile when the jaw assembly is in the fully closed position. In the fully closed position, secured suture whether large or small would not be able to freely slide or translate with respect to the jaw assembly 30qq more than <NUM> due to the unique configurations of teeth in this preferred embodiment.

Not only are the configurations of teeth staggered axially, the first configuration of teeth <NUM>-1qq is staggered vertically with respect to the second configuration of teeth <NUM>-2qq. In <FIG>, the first configuration of teeth <NUM>-1qq is disposed along a first planar row <NUM>-<NUM> while the second configuration of teeth <NUM>-2qq is disposed along a second planar row <NUM>-<NUM> that is above and the first planar row <NUM>-<NUM>. The first planar row <NUM>-<NUM> upon which the first configuration of teeth <NUM>-1qq is disposed, preferably does not intersect the second planar row <NUM>-<NUM> upon which the second configuration of teeth <NUM>-2qq is disposed.

This vertical staggering of the teeth configurations <NUM>-1qq, <NUM>-2qq causes each set of teeth to abut a substantially smooth and toothless opposite surface when the jaw assembly 30qq is closed. In the closed jaw position as shown in <FIG>, the second configuration of teeth <NUM>-2qq abuts a substantially smooth and flat medial side surface <NUM>-<NUM> of the first jaw member <NUM>-1qq. As shown more clearly in <FIG>, this planar toothless medial side surface <NUM>-<NUM> extends above the first configuration of teeth <NUM>-1qq along the first planar row <NUM>-<NUM> above. In other words, the first jaw member <NUM>-1qq comprises a first configuration of teeth <NUM>-1qq and a substantially flat and toothless medial side surface <NUM>-<NUM> above the first set of teeth <NUM>-1qq. The second jaw member <NUM>-2qq preferably comprises a second substantially flat and toothless medial surface <NUM>-<NUM> disposed beneath the second set of teeth <NUM>-2qq. In the closed jaw position as shown in <FIG>, the first set of teeth <NUM>-1qq abuts the second planar toothless medial surface <NUM>-<NUM>. When the jaw assembly 30qq is in the closed position, therefore, each configuration of teeth on a particular jaw member abuts a substantially toothless surface on the opposite jaw member.

When the jaw assembly 30qq is in the closed position, the first configuration of teeth <NUM>-1qq in the first jaw member <NUM>-1qq preferably does not mesh with the second figuration of teeth <NUM>-2qq in the second jaw member <NUM>-2qq. As shown in this preferred embodiment, the opposing configurations of teeth preferably avoids contact with each other, or at least avoids meshing with each other. In other words, teeth in one jaw member preferably do not abut or mesh with teeth in the other jaw member when the jaw assembly 30qq is in the closed position.

<FIG> are operative views of the suture passing device 10qq capturing a smaller braided suture <NUM>, such as a USP2-<NUM> sized suture. In this closed position, the staggered teeth between the jaw members <NUM>-1qq, <NUM>-2qq enables the jaw assembly 30qq to maintain a sufficiently low profile <NUM> such that the jaw assembly 30qq may be retracted into the shaft 32qq.

<FIG> are operative views of the suture passing device 10qq capturing a larger braided suture <NUM>, such as a USP#<NUM> sized suture. In this closed position, the staggered teeth between the jaw members <NUM>-1qq, <NUM>-2qq will clamp onto the larger suture <NUM> such that the capture portion of the suture <NUM> may span across two adjacent valleys <NUM>-1qq on each jaw member <NUM>-1qq, <NUM>-2qq. In the closed position, a particular tooth <NUM>-1qq on each jaw member <NUM>-1qq, <NUM>-2qq bites into the larger suture <NUM>. This biting action enables the jaw assembly 30qq to maintain a sufficiently low profile <NUM> in the closed position such that the jaw assembly 30qq may be retracted into the shaft 32qq while retaining a larger suture <NUM>.

At times, captured suture may cause the jaws <NUM>-1qq, <NUM>-2qq to move off-plane with respect to each other as shown in <FIG>. For example, one jaw <NUM>-1qq may be lifted relative to the other jaw <NUM>-2qq as shown in <FIG>. It is also possible that the jaws <NUM>-1qq, <NUM>-2qq may be slightly twisted with respect to each other as shown in <FIG>. Yet, in all these possible lifted or twisted configurations, the jaw assembly 30qq with such off-centered jaws <NUM>-1qq, <NUM>-2qq maintains a sufficiently low profile when capturing smaller or larger suture such that the jaw assembly 30qq may be proximally retracted into a needle shaft.

<FIG> is a top plan view of a sixteenth embodiment of a suture passing device 10rr in a closed figuration. In <FIG>, a jaw assembly 30rr comprises a first jaw member <NUM>-1rr and a second jaw member <NUM>-2rr, each having a gapped configuration of teeth.

As shown more clearly in <FIG>, the first jaw member <NUM>-1rr preferably has a first upper row <NUM>-<NUM> of gapped teeth <NUM>-1rr and a first lower row of <NUM>-<NUM> of gapped teeth <NUM>-1rr. Axial gaps <NUM>-<NUM> are formed between adjacent upper teeth <NUM>-1rr and adjacent lower teeth <NUM>-1rr.

Except for the first distal jaw tip 43rr-<NUM>, the first upper configuration of gapped teeth <NUM>-1rr are axially staggered, or offset, with respect to the first lower configuration gapped teeth <NUM>-1rr in the first jaw member <NUM>-1rr. This axial staggering of teeth between upper and lower rows on the first jaw member <NUM>-1rr is shown in <FIG>, where each lower tooth <NUM>-1rr is preferably disposed beneath an upper gap <NUM>-<NUM>, while each upper tooth <NUM>-1rr is disposed above a lower gap <NUM>-<NUM>.

As shown more clearly in <FIG>, the second jaw member <NUM>-2rr preferably has a second upper row <NUM>-<NUM> of gapped teeth <NUM>-2rr and a second lower row of <NUM>-<NUM> of gapped teeth <NUM>-2rr. A second plurality of axial gaps <NUM>-<NUM> are formed between adjacent upper teeth <NUM>-2rr and adjacent lower teeth <NUM>-2rr. Except for the second distal jaw tip 43rr-<NUM>, the second upper configuration of gapped teeth <NUM>-2rr are axially staggered, or offset, with respect to the second lower configuration gapped teeth <NUM>-2rr. This axial staggering of teeth between upper and lower rows on the second jaw member <NUM>-2rr is shown in <FIG>, where each lower tooth <NUM>-2rr is preferably disposed beneath an upper gap <NUM>-<NUM>, while each upper tooth <NUM>-2rr is disposed above a lower gap <NUM>-<NUM>.

In the preferred embodiment, the length of the axial gaps <NUM>-<NUM>, <NUM>-<NUM> may range from <NUM> (<NUM> inches) to <NUM> (<NUM> inches), although smaller or larger gaps may be formed.

The bottom perspective view of <FIG> and front perspective view of <FIG> show more clearly the first set of lower gaps <NUM>-<NUM> in the first jaw member <NUM>-1rr and the second set of lower gaps <NUM>-<NUM> in the second jaw member <NUM>-2rr. It will be appreciated that within each jaw member <NUM>-1rr, <NUM>-2rr, the upper set of gaps are axially staggered with respect to the lower set of gaps.

In the closed jaw position as shown in <FIG> and <FIG>, each tooth from one jaw nests in a gap of the opposing jaw on the same planar row. For example, in the closed jaw position:.

In this preferred embodiment, the jaw assembly 30rr comprises two planar rows, of jaw configurations. Each row of teeth is preferably staggered with respect to the row of teeth above or underneath on the same jaw member. Each row of teeth is also staggered with respect to the row of teeth on the opposite jaw member located on the same planar row. When the jaw assembly 30rr is in the closed position, no tooth in the first jaw member <NUM>-1rr contacts any teeth in the second jaw member <NUM>-2rr. In other words, teeth in one jaw member do not abut or contact teeth in other jaw member when the jaw assembly 30rr is in the closed position.

Terms such as "top," "bottom," "front," "rear," "above," "below" and the like as used in this disclosure should be understood as referring to an arbitrary frame of reference, rather than to the ordinary gravitational frame of reference. Thus, a top surface, a bottom surface, a front surface, and a rear surface may extend upwardly, downwardly, diagonally, or horizontally in a gravitational frame of reference. Similarly, an item disposed above another item may be located above or below the other item along a vertical, horizontal or diagonal direction; and an item disposed below another item may be located below or above the other item along a vertical, horizontal or diagonal direction. While some features are shown facing away from gravity, it will be understood that features can be rotated or positioned perpendicular to gravity and work to hold, knot, or cut a suture in the same way as shown.

Claim 1:
A suture passing device (10qq), comprising:
a handle;
a shaft (32qq) coupled to the handle, the shaft (32qq) comprising a sharp distal tip (<NUM>) that defines a shaft axis (A), the shaft (32qq) defining a lumen;
a jaw assembly (30qq) housed within the shaft (32qq), the jaw assembly (30qq) comprising a first jaw member (<NUM>-1qq) and a second jaw member (<NUM>-2qq), the first jaw member (<NUM>-1qq) and the second jaw member (<NUM>-2qq) being movable with respect to each other between a closed position and an open position, the jaw assembly (30qq) comprising a suture capturing mechanism (44qq);
an actuating mechanism coupled to the jaw assembly (30qq) and configured to move the jaw assembly (30qq) between the closed position and the open position;
wherein the first jaw member (<NUM>-1qq) and the second jaw member (<NUM>-2qq) are biased away from each towards the open position and moved to the open position when the actuating mechanism moves the jaw assembly (30qq) distally with respect to the shaft (32qq) such that first jaw member (<NUM>-1qq) and the second jaw member (<NUM>-2qq) each diverge from the shaft axis (A) when exiting the shaft (32qq),
wherein the first jaw member (<NUM>-1qq) and the second jaw member (<NUM>-2qq) are moved to the closed position when the actuating mechanism is moved to retract the jaw assembly (30qq) proximally with respect to the shaft (32qq), characterized in that
the suture capturing mechanism (<NUM>-qq) comprises a first configuration of teeth (<NUM>-1qq) included in the first jaw member (<NUM>-1qq) and a second configuration of teeth (<NUM>-2qq) included in the second jaw member (<NUM>-2qq), the second configuration of teeth being axially and vertically staggered with respect to the first configuration of teeth (<NUM>-1qq), wherein, in a closed position, the first and second configurations of teeth do not overlap or align with each other.