Patent Document

TECHNICAL FIELD 
   This invention relates to suture passing surgical instruments, and more particularly, to a surgical instrument and method for single-handedly passing suture through tissue. 
   BACKGROUND 
   Suture is passed through tissue many ways including, for example, cannulated needles and instruments and needle passing instruments, which in general, require the use of multiple portal entry points in order to transfer the suture through tissue or require the use of additional instruments or devices to facilitate the passage of suture. As described in U.S. Pat. No. 5,935,149, it is known to place the suture at a desired site to be sutured by passing a needle attached to the suture from a first member of a suture passing forceps to a second member of the forceps. The suture is secured at the site by passing the needle through a suture receiving passage in an outer member of a suture securing device to position a portion of the suture therein and inserting an inner member of the suture securing device into the passage to secure the portion of the suture between the inner and outer members. The needle is passed through the passage by threading the needle through a suture threader disposed in the passage and pulling the threader from the passage. The suture threader has one end terminating in the needled suture and an opposite end terminating in a suture receiving loop. 
   SUMMARY 
   In one general aspect of the invention, a surgical instrument includes first and second members configured to receive tissue therebetween. The first member is adapted to receive suture, the second member is coupled to the first member, and a grasper is coupled to the second member for engaging the suture received by the first member. 
   Embodiments of this aspect of the invention may include one or more of the following features. The grasper is coupled to the second member for movement between a retracted position and a suture engaging position. The second member defines a slot for receiving suture from the first member, and the grasper is configured to trap suture within the slot. The first member is configured to move relative to the second member between an open position and a closed, tissue piercing position. The second member defines a passageway for receiving a portion of the first member. The second member defines a slot for receiving suture from the first member. The slot opens into the passageway. 
   The first member includes a needle for piercing tissue. The needle defines an eyelet for receiving suture. The eyelet includes a hole. Alternatively, the eyelet includes two holes. In another alternative, the eyelet includes a cutout. 
   The surgical instrument also includes a handle that controls movement of the first member. The handle includes an articulating handle and a stationary handle. 
   The second member includes a passageway that receives a portion of the first member. The second member includes at least one suture slot that is disposed in a lengthwise side of the passageway. Also, the at least one suture slot opens to the passageway. 
   The first member includes a jaw and a needle arm extending from a distal end of the surgical instrument. The needle arm is adapted to receive suture. The jaw defines a passageway that receives a portion of the needle arm. The second member defines a passageway that receives a second portion of the needle arm. The second member defines at least one suture slot that is disposed in a lengthwise side of the passageway and opens to the passageway. The suture grasper engages the suture and holds the suture in the at least one suture slot. 
   The grasper is disposed on a portion of the second member. The grasper includes a hook. Alternatively, the grasper includes a wedge. In another alternative, the grasper includes a set of jaws. In another alternative, the grasper includes a U-shaped cup. 
   The surgical instrument includes a trigger that controls the grasper. The trigger is a paddle. Alternatively, the trigger is a lever. In another alternative, the trigger is a button. The surgical instrument also includes a grasper guide that is disposed on a portion of the second member. The trigger moves the grasper distally under the grasper guide to engage the suture. 
   A portion of the first member is serrated. A portion of the second member is serrated. 
   In another general aspect of the invention, a method of passing suture includes loading suture into a first member of a suture passing surgical instrument, stabilizing tissue between the first member and a second member of the surgical instrument, passing suture through tissue via the first member of the surgical instrument, holding the passed suture via a suture grasper of the surgical instrument, and removing the first member from the tissue. 
   Embodiments of this aspect of the invention may include one or more of the following features. After loading suture, the surgical instrument is passed through a cannula. The method also includes removing the surgical instrument from the surgical site. 
   Loading suture includes loading suture from a side of the surgical instrument. Loading suture further includes loading suture from the side of the surgical instrument on which the suture grasper is located. 
   The method includes stabilizing tissue and passing suture through tissue simultaneously. 
   The method includes passing suture multiple times. Passing suture multiple times includes loading suture into the first member of the suture passing surgical instrument, and passing suture through tissue via the first member of the suture passing instrument. 
   Conventional instruments and methods for passing suture generally require multiple portal entry points and/or supplemental instruments to facilitate passage of suture. The surgical instrument of this invention overcomes these difficulties. In particular, the instrument and method provide a surgeon with the ability to single-handedly pass suture through tissue. As a result, only one portal and one instrument are required. 
   The details of one or more implementations are set forth in the accompanying drawings and the description below. Other features and objects will be apparent from the description and drawings, and from the claims. 

   
     DESCRIPTION OF DRAWINGS 
       FIG. 1  is a partial cross-sectional view of an exemplary suture passing surgical instrument. 
       FIG. 2  is a partial cross-sectional view of a distal portion of the surgical instrument of  FIG. 1  in which an articulating jaw is closed. 
       FIG. 3A  is a side view and  FIG. 3B  is a perspective view of a push/pull rod for the articulating jaw of the surgical instrument of  FIG. 1 . 
       FIG. 3C  is a top view of an elongated shaft of the surgical instrument of  FIG. 1 . 
       FIG. 3D  is a partial cross-sectional view of a proximal portion of the surgical instrument of  FIG. 1 . 
       FIG. 4A  is a top view of a distal portion of the surgical instrument of  FIG. 1  showing a suture grasper capturing the suture and  FIG. 4B  is a perspective view of the distal portion of the surgical instrument of  FIG. 1  showing the eyelet of the needle in line with the suture slots of the passageway. 
       FIG. 5A  is an exemplary tip of a suture capture device of the suture grasper and  FIG. 5B  is an exemplary arm of the suture capture device of the suture grasper of the surgical instrument of  FIG. 1 . 
       FIG. 6A  is a partial cutaway top view of a trigger portion for the suture grasper shown in an open position and  FIG. 6B  is a partial cutaway top view of the trigger portion for the suture grasper shown in a closed position. 
       FIGS. 7A–7H  illustrate use of the surgical instrument of  FIG. 1 . 
       FIGS. 8A–8H  illustrate alternative configurations of a suture eyelet of a needle of the surgical instrument of  FIG. 1 . 
       FIG. 9  shows a suture threaded through the suture eyelet of the needle of the surgical instrument of  FIG. 1 . 
       FIG. 10  shows a suture attached to an exemplary soft tissue attachment device. 
       FIG. 11  is a detailed side view of an articulating jaw of the surgical instrument of  FIG. 1  showing serrations. 
       FIG. 12  is a detailed side view of a tissue platform of the surgical instrument of  FIG. 1  showing serrations. 
       FIG. 13A  is a side view of an alternate implementation of the suture grasper. 
       FIG. 13B  is a detailed view of the suture capture device of the suture grasper of  FIG. 13A . 
       FIG. 13C  is a top view of an alternate implementation of the tissue platform provided with the suture grasper of  FIG. 13A . 
       FIGS. 14A–14H  are top views of alternative implementations of the suture capture device of the suture grasper. 
       FIG. 15A  is a side view of the alternative implementation of the trigger. 
       FIG. 15B  is an exploded view of the trigger and a locking mechanism of  FIG. 15A . 
       FIG. 15C  is a side view of another alternative implementation of the trigger. 
       FIG. 15D  is a detailed view of a locking mechanism of the trigger of  FIG. 15C . 
       FIGS. 16A–16E  are top views of alternative implementations of push/pull rods of the suture grasper. 
       FIG. 17A  is a side view of an alternate implementation of the suture passing surgical instrument. 
       FIG. 17B  is a perspective view of the push-pull rod of the cross-sectional view of a proximal portion of the surgical instrument of  FIG. 17A . 
       FIG. 17C  is a detailed cross-sectional view of a proximal portion of the surgical instrument of  FIG. 17A . 
       FIG. 17D  is a perspective view of a needle arm of the surgical instrument of  FIG. 17A . 
       FIG. 17E  is a partial cross-sectional view of a distal portion of the surgical instrument of  FIG. 17A . 
       FIG. 17F  is a perspective view of a first jaw of the surgical instrument of  FIG. 17A . 
       FIG. 17G  is a perspective view of a second jaw of the surgical instrument of  FIG. 17A . 
       FIG. 17H  is a view of the suture grasper push rod that can be used in the surgical instrument of  FIG. 17A . 
       FIGS. 18A–18E  illustrate use of the surgical instrument of  FIG. 17 . 
   

   Like reference symbols in the various drawings indicate like elements. 
   DETAILED DESCRIPTION 
   Referring to  FIG. 1 , a single-handed suture passing surgical instrument  100  passes suture  101  through tissue and holds the passed suture such that the instrument can be rethreaded to pass suture through tissue multiple times. An operator actuates a handle  190  to close an articulating jaw  110  through which suture is threaded to pass the suture through tissue, and thereafter actuates a trigger portion  150  to advance a suture grasper  130  along a tissue platform  120  to engage the suture with the suture grasper  130 . The jaw  110  is then opened and the instrument  100  removed with the suture remaining in the tissue and held by the suture grasper  130 . The instrument  100  can be rethreaded and reinserted to the surgical site to pass suture multiple times, for instance, as with a Mason-Allen Stitch. 
   Suture passing surgical instrument  100  includes an elongated shaft  140  with a distal portion  105  and a proximal portion  145 . Located at the proximal portion  145  of the elongated shaft  140  are handle  190  and trigger portion  150 . Located at the distal end  105  are articulating jaw  110 , tissue platform  120 , and suture grasper  130 . 
   The articulating jaw  110  is pivotally attached to the tissue platform  120 , and movement of the articulating jaw  110  is controlled by the handle  190 . In use, distal portion  105  is positioned such that when jaw  110  is closed, tissue is held between an upper surface of the articulating jaw  110  and a lower surface of the tissue platform  120 . The handle  190  includes an articulating handle  191  and a stationary handle  192 . As the articulating handle  191  is moved away from and towards the stationary handle  192 , the articulating jaw  110  is opened and then closed, respectively. The articulating handle  191  is attached to a push/pull rod  128 , which moves along a groove  140 A in the elongated shaft  140 . The rod  128  is attached to the articulating jaw  110  by a pivot hinge assembly  165 , described further below. 
   The suture grasper  130  is controlled by the trigger portion  150  and is located on the tissue platform  120 . Tissue platform  120  is the distal portion of shaft  140 . Generally, the suture grasper  130  is designed to advance forward and hold the suture. The trigger portion  150  includes a trigger mechanism  139  and a rod  138  (see  FIG. 5B ). The trigger mechanism  139  is attached to the rod  138 , which runs along the elongated shaft  140 , to control movement of the suture grasper  130 . 
   Referring to  FIG. 2 , the articulating jaw  110  is attached at its proximal end  119  to the tissue platform  120  by the pivot hinge assembly  165 . The pivot hinge assembly  165  includes two pins  166 ,  168  and a hinge connector  167 . The hinge connector  167  is part of the jaw  110  and is attached to the tissue platform  120  by the pin  166  such that the articulating jaw  110  pivots about the pin  166  as the jaw  110  articulates. The rod  128  is attached to the hinge connector  167  by the pin  168  such that forward and backward motion of the rod  128  causes the jaw  110  to pivot about the pin  166 . 
   Referring to  FIGS. 3A–3D , the push/pull rod  128  includes two tabs  128 A,  128 B at its proximal end  129 B. Rod  128  is an elongated square-shaped shaft. At its distal end  129 A, rod  128  slopes away from its axis. Rod  128  includes this slope in order to articulate the jaw  110  in relation to the action of the handle  190 . 
   The rod  128  reciprocates within groove  140 A in the instrument shaft  140  as the articulating handle  191  is moved away from and then towards the stationary handle  192  to open and close the articulating jaw  110 . The instrument shaft  140  also includes a limiting groove  140 B in which tab  128 A is located. The axial movement of tab  128 A in limiting groove  140 B limits movement of the rod  128  in the axial direction because axial movement of tab  128 A within the groove  140 B is constrained by the proximal and distal sides of groove  140 B. The articulating handle  191  defines a handle slot  140 C in which tab  128 B is located providing coupling between the rod  128  and the articulating handle  191  such that as the handle  191  is moved, the rod  128  moves to actuate jaw  110 . 
   Referring again to  FIG. 2 , the articulating jaw  110  includes a needle  115 . Generally, the needle  115  is sickle-shaped with a sharp point  113  and is formed of hardened stainless steel or similar material. The needle  115  is formed integral to the articulating jaw  110  and extends from the articulating jaw  110  toward the tissue platform  120 . Needle  115  includes a suture eyelet  111  disposed proximate to the tip  113  of the needle  115 . The needle  115  is sized such that when the articulating jaw  110  is closed, the instrument can fit within a predetermined sized cannula. Thus, the length of the needle  115  varies with different sized cannulas. 
   Referring to  FIGS. 4A and 4B , the tissue platform  120  has an U-shaped end  122 C defining a passageway  122 . The passageway  122  includes two suture slots  121 X,  121 Y. The suture slots  121 X,  121 Y are positioned such that when the needle passes through passageway  122 , the needle eyelet  111  is aligned with the slots when the portion of the needle defining the eyelet is within the passageway  122  to consistently place the suture  101  that is threaded through the eyelet in the suture slots  121 X,  121 Y (see  FIG. 4B ). The suture rests in one of the suture slots  121 X,  121 Y after the needle  115  has passed through the tissue. The slots  121 X,  121 Y are provided in each of the lengthwise sides  122 A,  122 B of the passageway  122 . Suture grasper  130  acts to move the suture away from the needle  115  and holds the suture, for example, in slot  121 X against surface  121 A. Additionally, as the suture grasper  130  holds the suture against the wall  121   a  of the suture slot  121 , the suture grasper  130  also closes the opening in side  122 A to capture the suture in the suture slot  121 X, as explained in more detail below. 
   Referring to  FIGS. 1 ,  2 ,  5 A, and  5 B, the suture grasper  130  is located on the tissue platform  120  and is attached to rod  138 . The suture grasper  130  includes a suture capture device  132  in the form of an arm  133  with an U-shaped tip  134 . The suture grasper  130  is shown to one side of the passageway  122  (the left side as viewed in  FIG. 4A ). However, the suture grasper  130  can be located on either side, e.g., right or left, of the passageway  122 . To minimize possible damage to the suture, the suture is threaded through the eyelet  111  from the same side on which the suture grasper  130  is located. Rod  138  is formed as a pair of parallel rods  138 A,  138 B that terminate at their proximal end at a spring plate  137 A. 
   The suture grasper  130  is activated by the trigger portion  150  to capture and hold the suture. The arm  133  of the suture capture device  132  of the suture grasper  130  advances forward to hold the suture in the U-shaped tip  134  against the distal wall  121 A of suture slot  121 X ( FIG. 4A ). The tissue platform  120  includes a grasper guide  170  under which the suture grasper  130  moves. The grasper guide  170 , for example, is formed like a bridge such that as the suture grasper  130  moves forward to hold the suture in suture slot  121 X, the suture grasper  130  follows a direct path towards the distal end  105  of the instrument  100 . 
   The tip  113  of the needle  115  on the articulating jaw  110  passes through the passageway  122  when the articulating jaw  110  is closed. The passageway  122  is slightly wider than the needle  115 . The needle  115  pivots about pin  166  along an arc  110   a  (see  FIG. 2 ). The needle  115  is shaped with an arch, which corresponds to the radius of the arc  110   a . Thus, when the needle  115  extends through the passageway  122 , it arches over the suture grasper  130 . The arch of the needle  115  limits possible tearing of the tissue as the needle passes through the tissue. 
   Referring to  FIGS. 6A and 6B , the trigger portion  150  for moving the suture grasper  130  includes the trigger mechanism  139 , for example, shaped like a paddle, and the push/pull rod  138 . The trigger mechanism  139  rotates about an axis X. The trigger mechanism  139  is attached to the push/pull rod  138  that ends in the U-shaped suture capture device  132 . The trigger portion  150  also includes a rigid pin  139 A that follows a J-shaped groove  139 B in the trigger mechanism  139  and a spring  137 . 
   In its resting position, the suture grasper  130  is in an open, locked position with pin  139 A located in the hook side  139 B 1  of the J-shaped groove  139 B, as shown in  FIG. 6A . To create the forward movement of the suture grasper  130  necessary to capture the suture, the trigger mechanism  139  is rotated counter-clockwise (looking from the proximal end  190  down the shaft  140 ) to move the pin  139 A from the hook side  139 B 1  of the J-shaped groove  139 B to the long side  139 B 2  of the J-groove  139 B, as shown in  FIG. 6B . The movement of the pin  139 A within the groove  139 B forces the push/pull rod  138  forward and the trigger mechanism  139  proximally and then distally against the spring  137 . The forward movement of the suture grasper  130  is created as the spring  137  moves forward against a spring plate  137 A and back against a spring brake or spring plate  137 B. To return the suture grasper  130  to its resting position, the trigger mechanism  139 A is rotated clockwise, e.g., moved from the long side  139 B 2  of the J-shaped groove  139 B back to the hook side  139 B 1  of the J-shaped groove  139 B. 
   Referring to  FIGS. 7A–7K , an operator uses the suture passing surgical instrument as follows. As shown in  FIGS. 7A  (top view) and  7 B (side view), an operator opens the articulating jaw  110 , i.e., articulating the jaw  110  away from tissue platform  120 , by moving handle  190  and loads suture into the suture eyelet  111  of the needle  115 . As shown in  FIG. 7C  (top view), the operator moves handle  190  to close articulating jaw  110  to hold the suture in the eyelet  111 . 
   Then, as shown in  FIG. 7D  (side view), the operator passes the instrument  100  down a cannula to the surgical site. As seen in  FIG. 7E  (side view), after placing the instrument  100  in the surgical site, the operator moves handle  190  to open articulating jaw  110  to place the needle  115  under the targeted tissue. As shown in  FIGS. 7F  (side view) and  7 G (top view), the operator moves handle  190  to close articulated jaw  110  to capture the targeted tissue between the jaw  110  and the tissue platform  120 . The needle  115  on the articulating jaw  110  pierces the tissue as the tissue is grasped between the tissue platform  120  and the articulating jaw  110 , carrying the suture through the tissue. 
   Next, as shown in  FIGS. 7H  (side view) and  71  (top view), the operator moves trigger portion  150  to advance suture grasper  130  forward to hold suture in the suture slot  121 Y. As shown in  FIGS. 7J  (side view) and  7 K (top view), the suture passed through the tissue is trapped on the proximal side of the tissue. 
   As shown in  FIGS. 7L  (side view) and  7 M (top view), the operator moves handle  190  to open articulating jaw  110  to release the tissue. As the jaw  110  is opened, the suture grasper  130  holds the suture against wall  121 A of suture slot  121 X. As the operator begins to withdraw the instrument  100  from the surgical site, the free end of the suture slides out of eyelet  111  of needle  115 . As shown in  FIGS. 7N  (side view) and  7 O (top view), the free end  101 A of the suture  101  (the end that was threaded through the eyelet  111 ) remains above the tissue platform  120 . The other end of the suture is located in suture slot  121 X and passes through the tissue. The operator moves handle  190  to close jaw  110  to withdraw instrument  100  through the cannula (not shown). The instrument may be rethreaded and reinserted through the cannula to the surgical site in order to pass suture multiple times. For instance, where most tendon tissue are fibrous bundles, a repair that can be less prone to tearing along the fibrous bundle structure can be possible when the suture is secured perpendicular to the bundle cord with multiple passes of the suture. By passing suture through a different tissue bundle, the suture/tendon interface can be improved. 
   Numerous alternative implementations or configurations of elements of the surgical instrument are possible. For instance, referring to  FIGS. 8A–8H , the suture eyelet disposed proximate to the tip of the needle can have a variety of shapes and/or orientations. For example,  FIG. 8A  shows a rounded hole  211  as the suture eyelet, whereas  FIG. 8B  shows an oval or oblong hole  311  as the suture eyelet. In an alternative implementation, there can be more than one hole  411 , as shown in  FIG. 8C . Or, the suture eyelet can be a cutout in the side of the needle proximate to the tip. For example,  FIGS. 8D and 8E  show cutouts  511 ,  611  that extend into the needle, toward the jaw  110 . Alternatively,  FIG. 8F  shows a cutout  711  disposed below the tip  713  of the needle  715  that extends in both toward the tip  713  and toward the jaw  110 . Or, the eyelet can be located on the rounded side of the needle, as shown in  FIGS. 8G and 8H  (e.g., cutouts  811 ,  911 ). 
   The various positions and shapes of the suture eyelets affect a surgeon&#39;s ability to load/unload suture, to penetrate tissue, and to minimize procedure length. For instance, the suture may be threaded through the rounded hole or closed eyelet type of suture eyelets, as shown, for example, in  FIG. 9 . While loading suture requires a bit more skill, the closed eyelet type of suture needle penetrates tissue more easily and accurately. Additionally, for example, the double eyelet needle shown in  FIG. 8C  may be used to pass two sutures simultaneously to form a mattress stitch with one pass and hence, reduce surgical time. With the cutout-type of suture eyelet, the suture is easier to load/unload, but tissue is more difficult to penetrate. Regardless of type or orientation of suture eyelet, suture is loaded on the same side that the suture grasper is located. 
   The various embodiments discussed can include “free” suture or suture attached to a soft tissue attachment device. As shown in  FIG. 9 , the “free” suture (suture not attached to an external device) is threaded through the suture eyelet  111  of the needle  115 . The ability to use “free” suture with the suture passing surgical instrument provides a surgeon with the flexibility to use intricate weaving (suture) patterns without the demand of visualizing each suture transfer. Alternatively, referring to  FIG. 10 , suture is attached to a soft tissue attachment device, e.g., an anchor, prior to being threaded through the suture eyelet  111 . 
   Referring to  FIG. 11 , the surface  117  of the horizontal portion of the articulating jaw  110  (the surface facing the tissue platform  120 ) includes serrations  124  (see also  FIG. 2 ). The serrations  124 , for example, are “V” shaped and provide an increased surface area against which to hold the tissue. The shape, number, and length of the serrations  124  can, for instance, vary. The serrations  124  can be, for example, grooves, ribs, or ridges. Alternatively, the surface  117  is smooth, i.e., without serrations, as shown in  FIGS. 8A–8H . 
   Referring to  FIG. 12 , the surface  127  of the tissue platform  120  (the surface that faces the articulating jaw  110 ) includes serrations  123  (see also  FIG. 2 ). The serrations  123  of the tissue platform  120  are, for instance, V-shaped and provide a larger surface against which to hold the tissue after the needle  115  has penetrated the tissue. The shape, number and length of the serrations  123  can vary. For example, the serrations  123  can be grooves, ribs, or ridges. A surgeon may want to move the tissue after it has been grabbed to ensure that the tissue will reach the attachment site. Or, if the detached tissue creates adhesions to other tissue surfaces, by pulling on the held tissue, the surgeon can determine if it is necessary to release or cut those adhesions free. 
   Referring to  FIGS. 13A–13C , an alternative implementation of the suture grasper  230  includes a suture capture device  232  having two opposing jaws  233 ,  234  that, when advanced forward, flex outward to open around the suture and then spring shut to enclose the suture between the two jaws  233 ,  234 . The suture grasper  230  is moved forward by activation of a push-pull rod  238  by an alternative implementation of the trigger mechanism  339 , a thumb push plate. The opposing jaws  233 ,  234  of the suture grasper  230  initially contact an expansion pin  280 , which causes the jaws  233 ,  234  to open. The jaws  233 ,  234  of the suture capture device  232  include a plurality of grasping teeth  233   a ,  234   a  on their facing surfaces for holding the suture. The suture grasper  230  continues to move forward until the expansion pin  280  enters the expansion pin release slot  285 , at which point the opposing jaws  233 ,  234  of the grasper  230  close on the suture. 
   A grasper guide  270  provides directional guidance for the suture grasper  230  as the grasper moves forward along shaft  140  to capture the suture from the needle (not shown). The grasper guide  270  is a raised structure, e.g., a bridge, under which the suture grasper  230  moves. In this implementation of the guide  270 , the expansion pin  280  is located between the grasper guide  270  and the tissue platform  120 . 
   Other implementations or configurations of a suture capture device include, for example, a hook or pick that advances forward or moves backward, pushes the suture away from the needle, and captures the suture. For example, the hook may be a forward-moving hook  332 , as shown in  FIG. 14A ; a backward-moving hook  432 ,  632 , as shown in  FIGS. 14B and 14D ; a forward-moving wedge  532 ,  732 , as shown in  FIGS. 14C and 14E ; or a forward- or backward-moving hook  1032 , as shown in  FIG. 14H . Alternatively, as shown in  FIGS. 14F and 14G , the cup-shape of the suture capture device can have sides of different lengths ( FIG. 14F )  832  or a flat base of the cup ( FIG. 14G )  932 . As illustrated, for example, in  FIGS. 14D–14H , the suture capture device alternatives are shown located on the left side of the tissue platform. However, the suture capture device can be located on the right side of the tissue platform, for example, as in  FIGS. 14A–14C , if the suture were loaded from a different direction. 
   Referring to  FIGS. 15A and 15B , in an alternate implementation, the trigger portion  250  includes a trigger mechanism  239 , which is a hinged lever  239  attached to a push-pull rod  238  that ends in, e.g., one of the suture capture devices of  FIGS. 14A–14H . A locking mechanism  236 , such as a spring or ratchet-type lock is used to hold the suture capture device, e.g., suture pick or hook, in a retracted position and to retain the suture capture device in a suture holding position. After the needle  115  has passed through the tissue, the lever  239  is pulled towards the handle  190  by the surgeon&#39;s finger. This action advances the push/pull rod  238  forward. The suture capture device then captures the suture from the needle and holds it in the suture slot. When the surgeon releases lever  239 , the locking mechanism acts to hold the suture capture device in its suture holding position. To release the suture, the lever  239  is actuated again to advance the push/pull rod  238  and release the suture. 
   Referring to  FIGS. 15C and 15D , in another alternative implementation, the trigger portion  350  includes a trigger mechanism  339  in the form of a button  339 , and a push rod  338 . The thumb-operated button  339  activates the push rod  338 , which moves the suture grasper  130  in a forward direction to capture the suture with the suture capture device, e.g., suture capture device  232 , after the articulating jaw  110  is closed and the suture needle  115  has penetrated the tissue. The button  339  is attached to the push rod  338  and the push rod  338  runs through a single or a series of rings  335  that direct the suture grasper  130  forward to grasp the suture. The articulating jaw  110  is then opened and removed from the tissue. 
   A locking mechanism  336  for the suture grasper  130  is provided to secure the suture grasper  130  in position once the suture grasper  130  has been activated to hold the suture in the suture slot  121 . The locking mechanism can be a spring type mechanism that holds the suture capture device in a retracted position and retains the suture capture device in a suture holding position. Alternatively, as shown, the locking mechanism includes a plurality of teeth  336 A that mate with a latch  336 B, for example, within ring  335  (see  FIG. 15D ) or on the instrument handle  190  (not shown), in order to lock the suture grasper  130  in place. To release, the locking mechanism  336 , button  339  is pushed away from the handle  190  to separate teeth  336 A and latch  336 B. 
   Referring to  FIGS. 16A–16E , other implementations of the push/pull rod of the suture grasper include, for example, a dual split rod configuration  438  or a single rod configuration  538 ,  638 ,  738 ,  838 . In the single rod configurations, the rod can have locking teeth  736 ,  836 , as shown, for example, in  FIGS. 16D and 16E . In each implementation, the rod is attached at its proximal end to a thumb-plate, for example, the button  339  of  FIG. 15B  or an articulating lever, for example, lever  239  of  FIG. 15A . 
   Referring to  FIGS. 17A–17H , an alternate implementation of a suture passing surgical instrument  1700  includes an elongated shaft  1740  with a distal portion  1705  and a proximal portion  1745 . At the proximal end of the elongated shaft, there is a handle  1790 , a control arm  1712 , and a trigger portion  1750 . At the distal end, there is a set of jaws  1718 ,  1720 , a suture grasper  1730 , and a moveable needle arm  1710 . 
   The jaw  1718  is controlled by the handle  1790  and attached to the elongated shaft  1740  by a pivot hinge assembly  1765 , as described above in relation to articulating jaw  110 . 
   The needle arm  1710  is attached to a push/pull rod  1712 A and includes a needle  1715  at its distal end. The push/pull rod  1712 A runs along the elongated shaft  1740  and is actuated by a lever  1712  attached to the handle  1790 . The surgeon activates the lever  1712  with his finger to move the needle arm  1710  forward and backward. 
   The suture grasper  1730  is controlled by the trigger portion  1750  and disposed on jaw  1720 , which is similar to the tissue platform  120  described above. The trigger portion  1750  includes a trigger mechanism  1739 , e.g., a thumb-operated button, and a rod  1738 . The thumb-operated button  1739  is attached to the rod  1738 , which runs along the elongated shaft  1740  to control the movement of the suture grasper  1730 , as described above. 
   The trigger portion  1750  permits the surgeon to control when the surgeon captures the suture from the needle  1715 , after the needle  1715  and the suture have been passed through the tissue and are exposed above the jaw  1720 . As described above, the surgeon activates the button  1739  with his thumb to move the suture grasper  1730  forward to grasp the suture. The trigger portion may have similar alternatives and variations as previously described. 
   Referring to  FIG. 17B , the push/pull rod  1728  includes two tabs  1728 A,  1728 B at its proximal end and moves along a groove  1740 A of the instrument shaft  1740 , as described above. 
   Referring to  FIGS. 17C and 17D , the needle  1715  on the needle arm  1710  is shaped like a tapered rectangle that ends in a sharp tip  1713 . The needle  1715  is formed of nitinol, hardened stainless steel, or similar materials. The needle  1715  optionally is formed integral to the needle arm  1710  or separately and then rigidly attached (i.e., welded or mounted) to the needle arm  1710 . 
   The needle  1715  initially extends from the needle arm  1710 , which is parallel to the pair of jaws  1718 ,  1720 , and has a suture eyelet  1711  disposed therein. Needle arm  1710  is attached to push/pull rod  1712 A at pivot  1710 A. The suture eyelet  1711  is disposed proximate to the tip  1713  of the needle  1715 . As described above, the suture eyelet  1711  can, for example, open to the front or side of the needle and have various alternative shapes. 
   An operator moves the needle arm  1710  to articulate away from the set of jaws  1718 ,  1720  in order for suture to be threaded onto the needle  1715 . A “free” suture (not attached to anything) or suture attached to a soft tissue attachment device, e.g., an anchor is threaded through the suture eyelet  1711  of the needle  1715 . The ability to use “free” suture with the suture passing surgical instrument provides a surgeon with the flexibility to use intricate weaving (suture) patterns without the demand of visualizing each suture transfer. 
   After suture is threaded through the needle  1715 , an operator moves lever  1712  to return the needle arm  1710  parallel to the set of jaws  1718 ,  1720 . Movement of the push/pull rod  1712 A distally causes the needle arm  1710  to move distally until tip  1713  of needle  1715  contacts deflector  1718 A of jaw  1718 . Contact with deflector  1718 A by needle  1715  causes needle  1715  to pivot towards jaw  1720  about pivot  1715 A such that needle  1715  passes through passageway  1722 B of jaw  1718  and passageway  1722 A of jaw  1720 . 
   Referring to  FIG. 17E , the surface  1729  of the jaw  1720  (the surface that faces the jaw  1718 ) and the surface  1717  of the horizontal portion of the jaw  1718  (the surface facing the jaw  1720 ) can be smooth and/or serrated. The serrations  1723 ,  1724 , respectively, can vary in shape, number, and length, as described above. 
   Referring to  FIGS. 17F and 17G , the set of jaws  1718 ,  1720  (shown in these figures without grooves for clarity) includes passageways  1722 A,  1722 B through which the needle  1715  of the needle arm  1710  passes. Each passageway  1722 A,  1722 B is slightly wider than the needle  1715 . 
   The passageway  1722 A of the jaw  1720  includes two suture slots or grooves  1721 X,  1721 Y in which the suture rests after the needle  1715  has passed through the tissue. In this implementation, the grooves  1721 X,  1721 Y are provided in each lengthwise side  1722 A 1 ,  1722 A 2  of the passageway  1722 A. The suture capture device  1732  moves the suture away from the needle  1715  and holds the suture for example in the suture slot  1721 X against surface  1721 A as described above. 
   Jaw  1718  includes passageway  1722 B, which is defined by a central rectangular cutout. The Jaw  1718  can have similar grooves, as described above in relation to jaw  1720 . 
   Jaw  1720  includes a U-shaped end  1720 A defining passageway  1722 A. A grasper guide  1770 , as described above, is located on the jaw  1720 . 
   Referring to  FIGS. 17A and 17H , suture grasper  1730  is disposed on jaw  1720  and has similar alternatives as those described above. 
   Referring to  FIGS. 18A–18E , an operator uses the suture passing surgical instrument  1700  of  FIG. 17A  as follows. In the position of instrument  1700  as shown in  FIG. 18A , the operator has moved lever  1712  to move moveable needle arm  1710  of the suture passing surgical instrument  1700  away from the set of jaws  1718 ,  1720  to load suture through eyelet  1711 . Then, the operator moves lever  1712  to return needle arm  1710  parallel to the set of jaws  1718 ,  1720 , as shown in  FIGS. 18B and 18D . 
   The operator moves lever  1712  to move moveable needle arm  1710  distally toward the deflector  1718 A of jaw  1718 . Upon contacting deflector  1718 A, moveable needle arm  1710  pivots about pivot  1715 A toward jaw  1720  and pierces the tissue held by the jaws  1718 ,  1720  through passageway  1722 A,  1722 B, as shown in  FIGS. 18C and 18E . 
   The operator moves lever  1712  moveable needle arm  1710  distally toward the deflector  1718 A of jaw  1718 . Upon contacting deflector  1718 A, moveable needle arm  1710  pivots about pivot  1715 A toward jaw  1720  and pierces the tissue held by the jaws  1718 ,  1720  through passageway  1722 A,  1722 B. 
   Next, the operator activates trigger portion  1750  to advance suture grasper  1730  distally to hold the suture in suture slot  1721 X. The operator moves lever  1712  to move needle arm  1710  back out of the set of jaws  1718 ,  1720 . The needle  1715  moves out of the tissue through passageway  1722 A,  1722 B. The operator then moves the lever  1712  to return the needle arm  1710  parallel to the set of jaws  1718 ,  1720 . 
   The operator moves handle  1790  to open the set of jaws  1718 ,  1720  to release the tissue and then the operator moves handle  1790  to close the jaws  1718 ,  1720 . The free end of the suture remains above the jaw  1720 . The other end of the suture is located in the suture slot  1721 X and through the tissue. The operator removes instrument  1700  from the surgical site. The instrument may be rethreaded and reinserted through the cannula to the surgical site in order to pass suture multiple times. 
   A number of implementations have been described. Nevertheless, it will be understood that various modifications may be made without departing from the spirit and scope. For example, the tissue platform may include one suture slot or the needle may pass through tissue to either side of the articulating jaw or set of jaws. Alternatively, the passageway may be offset to accommodate orientation of the needle or suture eyelet. The suture capture device may be or may include a latch or a cutout. The trigger portion may include a button or other mechanism to activate movement of the suture grasper. The needle may be formed separately from the jaw and then rigidly attached, e.g., welded or mounted to the jaw. The eyelet of the needle may open to the front of the needle or to the inside of the needle. 
   Additionally, the instrument can be used in many surgical environments, including, for example, open, mini-open, and endoscopic, and with visualization, limited visualization, or no visualization of the suture grasper. Also, other devices for attaching tissue to bone or tissue to tissue will work with the device and can be carried into the operative site and attached or secured by the device. The type of material used, i.e., material construction, braided or monofilament or combinations of construction and material type, synthetic, natural, permanent or reabsorbable, can vary, and a variety of material diameters are possible. Loose or highly mobile tissue can be translocated as desired by the surgeon. Also, the same suture strand can be passed through tissue multiple times and in various directions. Accordingly, other implementations are within the scope of the following claims.

Technology Category: a