JP7007363B2 - Suture delivery device for suturing tissue - Google Patents

Description

Contents of disclosure

[Related application]
This application is a partial continuation of US Patent Application No. 14 / 615,786 claiming the benefit of US Provisional Patent Application No. 61 / 937,089 filed February 7, 2014. This application also claims priority and benefit to US Provisional Patent Application No. 62 / 203,670 filed August 11, 2015, the contents of which are incorporated herein by reference in their entirety.

[Disclosure field]
The present disclosure relates generally to techniques and devices for closing small incisions in the patient's body. For example, the present disclosure relates to systems, devices, and methods for closing laparoscopic port sites that are required after various minimally invasive surgical procedures such as gallbladder resection, appendectomy, or obesity surgery.

〔background〕
Laparoscopic surgery is a type of minimally invasive surgery. It replaces traditional “laparotomy” surgery with the benefits of minimizing postoperative pain, shortening hospital stays and duration of illness, and reducing costs for both hospitals and patients.

For example, more than 7.5 million laparoscopic surgeries are performed worldwide each year in the fields of gallbladder resection, appendectomy, obesity surgery, gynecological surgery, and urology surgery. However, due to the incidence of portsite hernias in laparoscopic surgery, portsite closure is preferred for fasciotomy of 10 mm or larger. Hernia repair can be effectively reduced by closing the port site, with an estimated cost of US $ 6,000-US $ 10,000 per surgery and a recovery period of 3 weeks. The need for surgery is reduced. Approximately 70% of laparoscopic surgery performed has port sites of 10 mm or larger.

To improve these problems, techniques for suturing port sites have been developed. Despite the benefits associated with using suture delivery devices, there are some challenges. The device for closing the port site may rotate, tilt, and slide vertically downward in the wound track or incision during the insertion of the suture needle. As the device rotates, the suture is deployed across the wound at an angle smaller than the ideal 180 ° placement. When the device slides vertically during insertion, devices that use the peritoneum as a reference point for the needle to enter the desired muscle / fascia layer reduce tissue bite in that muscle / fascia layer. That is, if such a device does not engage with the peritoneum by sliding downwards, the point of entry of the needle into the muscle / fascia layer will be lower than the intended position, reducing tissue bite. It is also desirable to provide a device configured to deploy the needle in a reproducible manner to minimize the amount of skill required of the surgeon. Accordingly, the present disclosure is directed to systems and methods for wound closure that provide these and other desirable features.

〔Overview〕
The present disclosure includes a suture delivery device for suturing tissue. In certain embodiments, the delivery device comprises an elongated deploying member. At the distal end of the elongated deploying member, the opposing force member has a retracted configuration that facilitates entry of the opposing force member into the incision and a deployment configuration that resists the opposing force member being pulled out of the incision. It is configured to migrate between and. Towards the proximal end of the elongated deploying member, the compressing member is configured to resist entering the incision. The compressed and opposed force members transition between the compressed and non-compressed configurations. In the compression configuration, the structure can be sandwiched between the compression member and the opposing force member to stabilize the device. The suture catcher, located towards the distal end of the elongated deploying member, has a retracted configuration that facilitates entry of the suture catcher into the incision and a deployment configuration that facilitates catching the suture. It is configured to transition between. The first needle passage is associated with the elongated deploying member and is directed towards the first area of the suture catcher when in the deploying configuration. The second needle passage is also associated with the elongated deploying member and is directed towards the second area of the suture catcher when in the deploying configuration. The first area of the suture catcher when in the unfolded configuration and the second area of the suture catcher when in the unfolded configuration are located on the suture catcher so that they are placed on both sides of the incision. ing. The first and second needle passages can pass through elongated deploying members.

In certain embodiments, the suture catcher may be a catcher element with a V-shaped hole. The suture catcher may also include a strut with a needle exit opening, which strut is hinged to the catcher element. The V-shaped hole can be formed by a bent wire or by a plate with a V-shaped opening fixed to the catcher element. The V-shaped hole may have a constricted area configured to engage the suture material when under tension.

In certain embodiments, the compression member and the opposing force member may automatically transition from an uncompressed configuration to a compressed configuration. The compression member may be positioned along the elongated deploying member and may be distally urged to automatically transition from the uncompressed configuration to the compressed configuration. The compression member can be urged distally by a spring or by a driven gear that engages a groove along an elongated deploying member.

In certain embodiments, access to at least one of the first needle passage and the second needle passage may be restricted when the opposing force member is in the retracted configuration. Access may be restricted by the gate control lever. The facing force member may be operably coupled to the control button, and if the control button may be in a position associated with the facing force member being in the deployed configuration, the control button engages with the gate control lever. It provides access through at least one of a first needle passage and a second needle passage.

In certain embodiments, the facing force member may be operably coupled to the control button, and the locking mechanism may be configured to hold the control button at a position associated with the facing force member being in the deployed configuration. .. The locking mechanism may be located inside the control button and may be engaged when the control button is in a position associated with the facing force member in the deployed configuration and also disengaged when the control button is depressed. Can be done.

In certain embodiments, the suture catcher may include a shield configured to deflect outward and resist penetration by the needle tip.

In certain embodiments, the suture catcher may include a material strip that is secured in proximal and distal locations on the suture catcher and is configured to resist penetration by the needle tip.

In certain embodiments, the elongated deploying member may include a visual indicator configured to signal when the suture delivery device was inserted through a tissue of sufficient thickness. The indicator may be a colored area of an elongated deploying member having a proximal end adjacent to at least one exit of the first needle passage and the second needle passage.

Further features and advantages will be apparent from the following more specific description of preferred embodiments of the present disclosure, as illustrated in the accompanying drawings. In the accompanying drawings, similar reference numerals generally refer to the same part or element throughout the drawing.

[Detailed explanation]
First, it should be understood that the present disclosure is not limited to, but may vary from, specifically exemplified materials, configurations, routines, methods, or structures. Accordingly, some such options, similar to or equivalent to those described herein, can be used in the practices or embodiments of the present disclosure, but suitable materials and methods are provided herein. Describe.

It should also be understood that the terms used herein are for purposes of illustration only, and are not intended to be limiting.

The detailed description described below in connection with the accompanying drawings is intended to be an exemplary embodiment of the present disclosure and is intended to represent only exemplary embodiments in which the present disclosure may be carried out. Not intended. As used throughout this description, the term "exemplary" means "useful as an example, an example, or an example" and is not necessarily preferred or advantageous over other exemplary embodiments. Should not be interpreted. This detailed description includes specific details for the purpose of providing a complete understanding of the exemplary embodiments herein. It will be apparent to those skilled in the art that the exemplary embodiments of the present specification may be practiced without these specific details. In some cases, well-known structures and devices are shown in the form of block diagrams so as not to obscure the novelty of the exemplary embodiments presented herein.

Top, bottom, left, right, top, down, over, above, below, bottom, simply for convenience and clarity. Directional terms such as beneath, rear, back, and front can be used with respect to the accompanying drawings. These and similar directional terms should not be construed as limiting the scope of the present disclosure in any way.

Unless otherwise specified, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure belongs. For example, the term "suturing" includes pulling two surfaces or edges together with a flexible material to close a puncture, opening, or other wound, and the suture is synthetic or A material that can be natural, such as a polymer, gut, metal wire, or other suitable equivalent.

As used herein and in the claims, the singular forms "one (a)", "one (an)", and "the" are unless otherwise explicitly stated in the content. , Includes multiple referents.

In embodiments, a suture delivery device that can be inserted into the same opening used to perform a surgical procedure such as laparoscopic surgery is described. The suture delivery device reduces the likelihood of tilting, rotating, or sliding relative to the opening by compressing the surrounding tissue, thereby stabilizing the device within the opening. Such stability allows the suture delivery device to improve tissue bite by ensuring that the suture is directed to a predetermined tissue area or layer. The suture delivery device can be used to direct one or more suture threading devices that pass through the body of the delivery device, penetrate the port site tissue, and release the suture after penetration. The suture delivery device captures the suture, and once the delivery device is pulled out, the suture end can be pulled back through the opening to secure the suture and close the opening. The embodiments are easy to use, which is important for tissue closure devices, which can be the final stage of long and painful surgical procedures.

A suture delivery device (or "wound closure device", or "trocar wound closure device" (TWC)) generally has two parts: a handle 100 (FIGS. 1A, 1B) and a suture threader (FIGS. 2A-FIG. 1B). 2C) and. 1A and 1B depict two configurations of the handle 100 of the suture delivery device. The configuration of FIG. 1A is used when the device is inserted into the opening. In FIG. 1A, the handle 100 is in an uncompressed configuration. FIG. 1A depicts a handle 100 with a shaft 105, a catcher 110 (including catcher elements 112, 114), a slider 115, a needle passage 150, 155, and a suture outlet slot 160. The shaft 105 is an elongated deploying member with a ridged track 120. The slider 115 is a compression member that can move along the shaft 105 towards the distal end 135 and be secured in place by engaging with the groove 120. An anti-rotation ridge (not shown), along with the groove 120, prevents the slider 115 from rotating with respect to the needle passages 150 and 155 (FIG. 1B). The slider button 125 may be used to engage or disengage the groove 120. The catcher 110, shown closed, may include a tooth 140 that, when unfolded, becomes an opposing force member and can surround and grab the suture. The control button 130, shown to be depressed, moves the control rod 145 (FIG. 1B), which opens (or unfolds) or closes the catcher 110 by moving the stanchions 165, 170. .. With the catcher 110 closed, the distal end 135, catcher 110, and shaft 105 may be inserted into the opening until the catcher 110 penetrates the surgical opening, at which point. , The catcher 110 can be deployed as shown in FIG. 1B.

In FIG. 1B, the handle 100 is in a compressed configuration, the control button 130 is shown to be released, the control rod 145 can be seen, the catcher 110 is deployed, and the slider 115 moves distally. ing. To deploy the catcher 110, release the control button 130, move the control rod 145 proximally (ie, towards the control button 130 or "up" in this drawing), and the stanchions 165, 170 are the catcher 110. To expand. To move the slider 115 proximally or distally, the slider button 125 can be used to disengage the slider 115 from the groove 120 and then move the slider 115. Optionally, the slider 115 can be ratcheted distally along the shaft 105, using the slider button 125 to disengage the slider 115 from the groove 120 and move the slider 115 proximally (FIG. 7). See). In yet another embodiment, the slider 115 may be urged distally along the groove 120 by a spring or a driven gear (see FIGS. 31 and 32).

The configuration of FIG. 1B is capable of compressing tissue between the slider 115 and the catcher 110. For example, the fascia, muscle, and peritoneal layers of the abdominal wall may be compressed between the slider 115 and the catcher 110, with the peritoneum closest to the catcher 110. When deployed as shown, the catcher 110 resists being pulled through the opening in the abdominal wall. Therefore, in this embodiment, the catcher 110 is a facing force member. In other embodiments, the opposing force can be applied by an element that lacks the ability to catch the suture. Similarly, in other embodiments, the ability to catch the suture may be provided by an element lacking the ability to oppose. As discussed in more detail below, the facing force member, such as the catcher 110, may be held in an open deployment configuration by an appropriate locking mechanism (see FIGS. 34A and 34B).

In this configuration, with the tissue compressed between the slider 115 and the catcher 110, the handle 100 is stable with respect to the compressed tissue, reducing the possibility of rotation, sliding, or tilting. Further, with the handle 100 stable, the needle passages 150 and 155 are also stable against the surrounding tissue, which is the tissue to be sutured. This results in optimal placement of the suture and deployment of the suture in a reproducible manner, both of which ensure proper tissue bite and the amount of skill required of the surgeon. Work to minimize.

2A-2C depict embodiments of the suture threading device 200. The suture threader 200 is used to grip the suture end and pass the suture through a needle passage, eg, the needle passage 150, to position the suture so that the suture can be caught by the catcher 110. The suture threader 200 includes a hook 205 at the distal end, a needle tube 210, a shaft 215, a trigger 220, and a needle button 225. The hook 205 is at the distal end of the shaft 215. The needle tube 210 has a point at its distal end and can move with respect to the shaft 215 to cover or uncover the hook 205. The hook 205 is configured to receive the suture 230 (see FIG. 2B) and hold the suture 230 when covered with the needle tube 210 (see FIG. 2C). The hook 205 can have a blunt tip, which is not needed while loading the suture 230. The hook 205 may also have an inclined surface 235, which allows the suture to slide off when the hook 205 is uncovered. In FIG. 2A, the needle button 225 is shown extended (not pressed) and the hook 205 is shown uncovered. When pressed, the needle button 225 can extend the needle tube 210 over the hook 205 to hold the suture. When the trigger 220 is pressed, as a result, the needle tube can uncover the hook 205 and release the suture. The needle tube 210, shaft 215, hook 205, and trigger 220 fit within the needle passage 150, 155, and deliver and release the suture at the desired location to the deployed catcher 110. ,It is configured.

2B and 2C generally depict the loading of the suture threading device 200. The suture threader 200 has two states controlled by the needle button 225 and the trigger 220. In the initial "off" state, the shaft 215 and hook 205 project from the needle tube 210. The hook 205 is used in this configuration to receive the suture 230. That is, the suture 230 may be positioned so as to be gripped by the hook 205. To transition to the "on" state, the user presses the needle button 225, which extends the needle tube 210 to cover the suture 230 and the hook 205. Thus, the shaft 215, hook 205, and needle tube 210 work together to hold or grip the suture 230. To return to the "off" state, the trigger 220 can be triggered by pushing it proximally. The suture 230 can be released by pressing the trigger 220.

FIG. 3 depicts a suture delivery device 300. In FIG. 3, the suture threading device 200 is inserted into the needle passage 150 of the handle 100. In some embodiments, access to the needle passages 150 and 155 is positioned with a control button 130 to prevent the introduction of the suture threading device 200 if the catcher 110 is not fully deployed in its open configuration. (See FIGS. 33A and 33B). The handle 100 is in a compressed configuration, the catcher 100 is unfolded, and the slider 115 is moving distally. The needle button 225 is shown to be pushed down, and the needle tube 210 covers the hook 205 (not shown). The distal tip of the needle tube 210 is near the membrane 302. The film 302 extends between the catcher element 114 and the catcher element 314. Membrane 305 extends between the catcher element 112 and the catcher element 312.

As shown in FIG. 3, the needle passage 150 directs the suture threading device 200 to point to the area between the catcher element 114 and the catcher element 314 of the deployed catcher 110. In this embodiment, the catcher 110 is supplied with the membrane 302 in the area. Membrane 302 is added to improve the ability of the catcher 110 to catch the suture. When the suture threading device 200 is further inserted into the needle passage 150, the sharp tip of the needle tube 210 penetrates the membrane 302 and carries the suture 230 (not shown) with the membrane. Upon further insertion, the trigger 220 touches the opening of the needle passage 150. Upon further insertion, the trigger 220 activates and retracts the needle tube 210, exposing the hook 205 and releasing the suture 230 (not shown). At this point, the suture threader 200 can be removed from the needle passage 150. When the suture threading device 200 is pulled out from the needle passage 150, the suture threading device 200 is also pulled out from the membrane 302. However, the suture 230 released from the hook 205 is held inside the membrane 302. After that, when the catcher 110 is retracted, the membrane 302 is also retracted, and the suture 230 is carried together with the membrane 302 to be gripped by the catcher elements 114 and 314. This is further illustrated with respect to FIGS. 9A and 9B. Alternatively, or in addition, catcher elements such as 112, 114, 312, and / or 314 may be aligned with the needle passages 150, 155, and the suture threading device 200 as described below with reference to the drawings. It can be characterized by a hole configured to receive and hold the suture 230.

4A-4C depict embodiments of the handle 100 that result in automatic suture release. When the two ends of one suture 415 are delivered into the surgical opening and held at the distal end of the suture delivery device, the portion of suture 415 near the proximal end is Form a loop. This loop can become entangled with the device during device recovery. The existing closing device allows the surgeon to manually disengage the suture 415 from the device. In the embodiments of FIGS. 4A-4C, an internal suture relief slot 400 is used that facilitates the automatic release of the suture 415. The suture relief slot 400 connects the needle passages 150 and 155 over their length and provides a slot for the suture 415 to pass through the handle 100 and exit the suture exit slot 160. In FIG. 4A, the suture threader 200 is inserted into the needle passage 155 and extends from the shaft 105 to expose the needle tube 210. The needle tube 210 is shown after penetrating the membrane 305. The suture tip 410 of the suture 415 has also been shown to have passed through the membrane 305, which is accomplished by the tip of the suture threading device 200. The control button 130 is shown to be extended. Thus, the needle tube 210 does not cover the hook 205 and the suture end 410 is released from the suture threader 200 (although the needle tip is not well visible by the membrane 305 in FIG. 4A. ). The needle passage 150 shows the suture 415 after the suture end 405 has passed through the membrane 302 and has been released and the suture threader 200 has been removed. As shown in FIG. 4A, the suture end portions 405 and 410 are both held by the membranes 302 and 305. From the suture end 405, the suture 415 passes through the needle passage 150, exits from it, loops over the handle 100, and enters the needle passage 155 with the suture threading device 200. In FIGS. 4A-4C, the slider 115 is not shown to more clearly illustrate the internal suture relief passage.

In FIG. 4B, the suture threading device 200 is withdrawn from the needle passage 155 and the catcher 110 is retracted to grip the suture end portions 405 and 410. The handle 100 may be removed from the surgical opening in this configuration and pulls the suture ends 405 and 410 with the handle. The suture 415 creates a loop between the needle passage outlet 152 and the catcher 110. The suture 415 also creates a loop between the needle passage outlet 157 and the catcher 110. These loops represent the portion of suture 415 that has passed through the tissue to be sutured. Thus, when the handle 100 is removed from the surgical opening and the suture end 410, 415 is pulled with the handle, the portion of the suture 415 that loops through the tissue is (as shown by the dotted line). The rest of the suture 415 is pulled downward through the suture relief slot 400. In FIG. 4C, the suture thread 415 has completely passed through the suture thread relief slot 400 and exited from the suture thread exit slot 160.

Thus, referring to FIGS. 1-4, embodiments of the handle 100 of the suture delivery device 300 may include needle passage elements such as the needle passages 150 and 155 and suture holding elements such as the catcher 110. The needle passage element may extend from the proximal end to the distal end of the handle 100 and may include an automatic suture release mechanism, eg, a suture relief slot 400. The suture holding element may be located at or near the distal end of the handle 100. The suture delivery device may also have a compression element, eg, a slider 115.

The needle passage element can provide a defined trajectories for a needle (eg, a suture threader 200) inserted through a handle (eg, handle 100), which is proximal. It starts near the end and exits near the distal end. For example, with the handle inserted into the surgical opening, the needle enters the proximal end of the needle passage element (eg, needle passage 150, 155) on the skin and through the needle passage within the device. It can move, exit at the distal end, and penetrate the panniculus (fascia, muscle, and peritoneum, etc.) at a defined position and angle with respect to the handle. The trajectory of the needle may be completely surrounded by a handle between the inlet and the outlet. The needle passage element may be coupled to an automatic suture release mechanism (discussed with reference to FIGS. 4A-4C), whereby the suture loop (or the main portion of the suture, excluding the suture end). ) Is not held at the distal end of the device and can slide out of the needle passage without user intervention when the handle is withdrawn from the surgical opening.

The suture holding element (eg, catcher 110) can include a frame (eg, catcher elements 112, 114, 312, 314) and a suture trapping surface (eg, membranes 302, 305), or just the frame. .. The suture holding element can include features (eg, teeth 140) that improve grip on the suture and / or holes as described below with respect to FIGS. 28-30. The frame of the suture holding element may have multiple struts and may have a variety of shapes (eg, flat, lantern, molly, umbrella, etc.). The frame of the suture holding element can define the area of interest and can also provide an opposing force against the compressive force of the compressive element to sandwich tissue in between. This opposing force may be, for example, against the peritoneum. The suture holding element can also provide support to the optional suture trapping surface during needle insertion. The suture retention element may be inserted through the tissue opening in a low profile or retracted state and deployed in an expanded state after passing through the tissue layer to the intended location, eg, inside the peritoneal cavity. can. The suture trapping surface may be connected to the stanchions of the frame and may be in a folded configuration during insertion of the device and during removal of the device.

The needle carrying the suture (eg, the suture threader 200) is introduced into the needle passage element (eg, the needle passage 150), guided to penetrate the panniculus (eg, past the peritoneum), and into the catcher. It can be inserted (eg, positioned between the catcher elements 112 and 312, or inserted into the membrane 305). The design of the distal tip of the needle allows the suture to be disengaged from the needle (eg, the hook 205 slides off the suture 230 more than a real "hook"). Can have an inclined surface 235). In some embodiments, the needle can be actuated to release the suture from the tip of the needle once the needle has been inserted to the intended position.

In embodiments, the design of the tip of the needle (eg, tilted surface 235) allows the suture to be disengaged from the needle. In certain embodiments of the capture surface (eg, membranes 302, 305), the surface itself may have properties or designs that enhance the capture and retention of the suture 230 by the surface, which needles the suture 230. Helps disengage from.

The device can be withdrawn from a surgical opening (eg, a trocar wound) while the captured suture end is held at the distal end of the device (eg, in a catcher).

In certain embodiments, the membranes 302, 305 are essentially enclosed by the frame of the catcher 110 during insertion and removal of the catcher 110 through the tissue layer. In embodiments, the suture end can be captured within the membranes 302, 305 and held between the struts of the frame of the closed catcher 110. In embodiments where the suture holding element comprises a frame, the suture end may be held by a mechanical clamp between the struts of the closed frame during device recovery.

The suture delivery device may also have a compression element, such as a slider 115, which can move along the shaft of the device to fit various anatomical structures. The compression element may be placed in a position that abuts and sandwiches the tissue against a facing force member (eg, catcher 110). For example, the tissue may be a layer of the abdominal wall, the opposing force member may be positioned in contact with the peritoneum in the abdominal cavity, and the compressive element may be in contact with the surface of the skin. This allows the compression element to stabilize the tissue and adapt to a variety of anatomical structures. In some embodiments, the compression element may be coupled to an opposing force member deployment mechanism, which moves the opposing force member to expand and retract the opposing force member.

5A and 5B show cross sections of an embodiment of a handle 100 with nested needle passages 153 and 158. In FIG. 5A, the handle 100 is in an uncompressed configuration with the slider 115 extending proximally away from the catcher 110. For simplicity, and because the nested needle passages 153 and 158 are similar, only the nested needle passage 153 will be described. The nested needle passage 153 includes a pair of tubes 505 and 510 configured to be nested so that the tubes 510 fit into the tubes 505. In one embodiment (not shown), the tube 505 moves inside the tube 510 and the suture threader avoids hitting the end of the tube 510 when inserted. In FIGS. 5A and 5B, the tube 505 has a non-nested end fixed to the slider 115. The tube 510 has a non-nested end fixed to the shaft 105. This fixed attachment allows for angular motion between the tube and the fixed point. In FIG. 5B, the handle 100 is in a compression configuration with the slider 115 moving distally towards the catcher 110. This movement shortens the length of the nested needle passages 153 and 158 and changes the angle at which they exit the handle 100. Nonetheless, the nested needle passages 153 and 158 are oriented so that the suture threading device 200 points toward the catcher 110. As the slider 115 moves from the uncompressed configuration to the compressed configuration, the nested needle passage 153 quickly passes through the volume within the shaft 105 bounded by the upper limit 520, the lower limit 525, and the needle passage outlet 152. swept out). In this embodiment, the handle 100, the shaft 105, and the slider 115 are configured to allow this movement of the nested needle passages 153 and 158.

In a method using certain embodiments, the handle 100 is initially in an uncompressed receding configuration. In the first step, the handle 100 is inserted into the trocar wound. Proper positioning of the handle 100 can be confirmed through the use of visual indicators as described below with respect to FIG. 37. At the next stage, the control button 130 is pressed to open the catcher 110. In the next step, the handle 100 is pulled against the tissue until the catcher 110 comes into contact with the peritoneum. In the next step, the slider 115 is pushed down to pinch the abdominal wall against the catcher 110. The handle 100 is then stabilized inside the tissue to be sutured. In the next step, one end of the suture 230 is loaded onto the hook 205 and the needle button 225 is pressed. At the next step, the suture threading device 200 is inserted into the needle passage 150, the trigger 220 is activated, and the suture 230 is released. In the next step, the suture threading device 200 is withdrawn from the handle 100. In the next step, a second end (or end of a different suture) of the suture 230 is loaded onto the hook 205 and the previous two suture threading steps are repeated in different needle passages 155. The handle 100 may have been removed and the suture end is removed together with the handle according to the following steps. In the next step, the control button 130 is pressed to capture the suture end with the catcher 110 (the suture end may be held by the optional membranes 302, 305 or hole 3004 shown in FIG. 28. ). In the next step, the handle 100 is removed from the surgical opening and the suture end is brought with the handle. The suture end is then removed from the handle 100 and a knot is tied.

6A-6C depict embodiments of the suture catcher 110 in each of the retracted, partially deployed, and fully deployed configurations. In FIG. 6A, the suture catcher 110 has hinge joints 705, 710, 715, stanchions 165, 170, and catcher elements 112, 114. The joints 705, 710, 715 may be mechanical hinges, living hinges, or a combination thereof. In FIG. 6B, the catcher 110 is extended to a partially deployed state by using a control rod 145 to press the columns 165, 170 against the catcher elements 112, 114. The catcher elements 312 and 314 are similarly developed. In FIG. 6C, the catcher 110 is fully deployed using the control rod 145. FIG. 6C also shows optional membranes 302, 305 attached to catcher elements 112, 114. The control button 130 (FIGS. 1 and 3) is connected to the control rod 145 and can be used to activate the control rod 145.

FIG. 7 depicts a portion of the embodiment of the handle 100 in cross section. In the embodiment of FIG. 7, the slider 115 can easily move toward the distal direction, but not toward the proximal direction, using the ratchet 805 and the rack 810. Thus, the slider 115 can easily move towards the compressed configuration, but not towards the uncompressed configuration. In this embodiment, pressing the slider button 125 releases the ratchet 805, allowing the slider 115 to move proximally. The rack 810 may include a lower limit (not shown) that prevents the slider from moving excessively in the compression direction. In certain embodiments, a friction pad (not shown) is used between the slider 115 and the shaft 105. The shape of the friction pad is designed to adjust pushing friction in two directions.

8A-8G depict embodiments at various stages of deploying sutures. FIG. 8A is a perspective view of the loaded suture threading device 200 inserted into the needle passage 150. In FIG. 8A, the catcher 110 is in a deployed configuration. The needle tube 210 gripping the suture end 405 emerges from the needle passage 150 but has not yet penetrated the membrane 302. In FIG. 8B, the suture threading device 200 is further inserted into the needle passage 150, the needle tube 210 penetrates the membrane 302 (not shown), and the suture end 405 is also carried through the membrane 302. ing. FIG. 8B shows that the needle tube 210 punctures three tissue layers 902, 904, 906. Thus, ultimately, the bite of the suture 230 will include these layers. In FIG. 8C, the suture threader 200 is further inserted into the needle passage 150 to push down the trigger 220, which causes the needle tube 210 to be as described with reference to FIGS. 2A-2C. It is reset to "off" and the suture 230 is released from the suture threader 200. FIG. 8D depicts an enlarged view of the apparatus of FIG. 8C. In FIG. 8D, the needle tube 210 and the suture end 405 penetrate the membrane 302. It can be seen that the suture end 405 is separated from the hook 205 and the needle tube 210. In FIG. 8E, the suture threading device 200 is removed from the needle passage 150. The suture end 405 is retained and is retained by the retentive squeezing properties of the membrane 302. FIG. 8F depicts this process being repeated by suture end 410, needle passage 155, and membrane 305 (not shown). FIG. 8F also depicts the bite of the suture, with the suture ends 405 and 410 each passing through the panniculus 902, 904, 906, respectively. FIG. 8G depicts the handle 100 after the suture threading device 200 has the suture end portions 405 and 410 deployed in the membranes 302 and 305, respectively, and pulled out.

9A and 9B depict the handle 100 at different stages of capturing the suture end. After the suture ends 405, 410 have been deployed over the membranes 302, 305 (as shown in FIG. 8G), the control button 130 is pressed and the control rod 145 is moved distally to close the catcher 110. FIG. 9A depicts the handle 100, approximately in the middle of the process of capturing the suture end. When the control button 130 is pressed down, the membranes 302, 305 fold between the catcher element 114 and the catcher element 314 (FIG. 3) and between the catcher element 112 and the catcher element 312 (FIG. 3), respectively, with them. Carry suture ends 405, 410. FIG. 9B depicts the catcher 110 in a retracted configuration. The control button 130 is completely depressed. In this configuration, the catcher 110 no longer exerts an opposing force on the compressive force of the slider 115, which is still in the compressed position. That is, the catcher 110 does not exhibit a flat surface with respect to the panniculi 902, 904, 906 and can be easily withdrawn. In the fully retracted position, the elements 114, 314 and 112, 312 clamp the suture ends 405, 410, respectively. An optional tooth 140 (see FIGS. 6C, 8D), which may also be between the catcher elements 112, 312 and 114, 314, improves the retention of suture ends 405, 410.

10A and 10B depict an embodiment of a handle 100 that automatically releases the suture after the catcher 110 has fully retracted. In FIG. 10A, the suture 230 is deployed, for example, on layers 902, 904, 906 of the abdominal wall, with suture ends 405, 410 captured on the handle 100 by the catcher 110. The handle 100 is pulled from the surgical opening 1100 and carries suture ends 405, 410 with it so that more sutures 230 reach the surgical opening 1100 through the tissue layers 902, 904, 906. Be pulled. As a result, the loop of the suture thread 230 is contained in the suture thread relief slot 400 (see FIGS. 4A to 4C). In FIG. 10B, by continuing to pull the handle 110, the rest of the suture 230 passes through the suture relief slot 400 and exits the suture exit slot 160.

The method using the embodiment to close the wound begins with the handle of the suture delivery device in an uncompressed retracted configuration and the suture threading device detached from the handle. In step 1, the trocar is removed from the wound with one hand. In step 2, the handle is inserted into the trocar wound with the other hand until the catcher is completely visible on the laparoscopic image. In step 3, the catcher is opened by pressing the control button with one finger under visual guidance using a laparoscopic image. In step 4, hold the handle with one hand and push the slider toward the patient with the other hand until the tissue to be sutured is firmly pinched between the slider and the catcher. Laparoscopic images can be used to show if the catcher is in contact with the peritoneal wall. In step 5, the suture threading device main body is held with one hand, and one end of the suture thread is inserted into the hook of the suture threading device with the other hand. Then press the needle button with your finger to load the suture threader. In step 6, hold the handle with one hand, insert the suture threader into the needle passage with the other hand until the trigger is activated, and release the suture again on the catcher under the visual guidance of the laparoscopic image. (Or deploy). In step 7, steps 5 and 6 are repeated for the other end of the suture and the other needle passage. In step 8, the control button is pressed with one finger to capture the suture end under visual guidance. In step 9, the handle is pulled from the wound with one hand, from which the two suture ends are removed.

FIG. 11 depicts an embodiment of a strut from a suture catcher structure in plan and cross-sectional views as part of an open and closed suture catcher structure. The suture catcher 1105 can include several struts 1110. Each strut 1110 has a proximal connection to the proximal joint 1117 (upper hinge), an upper strut 1120, an intermediate hinge 1125, a lower strut 1130, a distal (or lower) hinge 1135, and a distance to the distal hinge 1135. It may have a position connection unit 1140. These hinges may be living hinges, mechanical hinges, or metal wire / leaf spring hinges. The stanchions may be made of metal (ie stainless steel), plastic (ie polypropylene, polycarbonate, polyurethane, nylon, or polyethylene), or any other suitable material. Multiple struts can be joined together at proximal and distal joints to form a catcher. The control rod 1145 can be coupled to the catcher's distal connection 1140 and extend to the proximal end of the suture delivery device. In one embodiment, the movement of the control rod 1145 drives the vertical movement of the distal connection 1140, resulting in the suture catcher opening (elevating or "deploying" the distal joint) or closing. (Distal joint lowers or "retracts"). In an alternative embodiment, the catcher deployment mechanism can be driven by controlling the proximal connection 1115. In an embodiment, the catcher 1105 serves as an opposing force member against a tissue compressive force when in a deployed configuration.

The length of the lower and upper struts is based on the desired size of the area of interest of the catcher 1105, or based on the desired angle formed between the upper and lower struts, or both. Can be selected. The shape of the stanchion may be rectangular or trapezoidal. The advantage of the trapezoidal shape over the rectangular shape is that the trapezoidal shape provides an additional additional membrane packing space. The outer surface of the stanchion (the surface visible in the retracted configuration) has many possible variants, including flat, flat with curved edges, or curved. Designs with curved surfaces have fewer sharp edges, which can result in a suture delivery device with a more non-traumatic lateral contour. That is, in various embodiments, the strut parts (including protrusions and fitting features) may be flat or curved to form a more rounded outer contour. See, for example, FIG. 13C.

12A and 12B show an embodiment in which the film 1200 is attached to the column 1205. The membrane 1200 may be made of a material such as polyurethane, PVC, polypropylene, or any other flexible material that does not resist excessive puncture or folding. To more securely hold the suture between the struts while the device is pulled out, the catcher closes so that the adjacent struts (or the features that secure the suture, such as teeth) can engage as designed. There must be. If the membranes fold and are packed into an outer shape that does not prevent the catcher frame from closing, the catcher will tend to close properly. However, the catcher's membrane cannot naturally fold or compress in any particular direction or configuration. Further, the space in which the membrane can be compressed is the space surrounded by the struts when the struts contract, and the space is limited. In addition, films of varying thickness and hardness have different folding properties. It has been found that the mounting position of the membrane on the stanchion affects its folding properties. Thus, in embodiments, the catcher stanchions or frames may be designed to guide the membrane and fold inwardly, for example, radially inward towards the control rod 1245 (FIG. 12B), as desired.

The membrane can be attached to the frame stanchions by a variety of methods (eg, adhesive, mechanical attachment, etc.). The membrane mounting position may extend sufficiently to the edge of the strut, or may be mounted recessed from the lateral edge of the strut. The membrane 1200 may be mounted at a position 1210 recessed from the lateral edge as shown in FIGS. 12A and 12B to facilitate complete encapsulation of the membrane by the stanchions when the catcher is closed. The membrane 1200 typically has a minimum curvature and radius. Therefore, by attaching the film 1200 at a position deep from the edge of the column 1205, the film 1200 can be folded inside the space defined by the column, as shown by the crease 1215. This helps prevent the membrane 1200 from congesting between the struts 1205 and reducing the ability of the struts to clamp and secure the suture together.

13A-13D depict further embodiments of attaching the membrane to the stanchions. In FIG. 13A, the stanchion 1300 has a two-part structure, including an outer (or upper) stanchion component 1305 and an inner (or lower) stanchion component 1310, which are combined to sandwich the membrane 1315. The outer strut component may be wider than the inner strut component, and the membrane mounting edge 1320 may be recessed from the edge of the outer strut component 1305. The difference between the width of the outer strut component and the width of the inner strut component provides membrane mounting support by sandwiching the membrane, and the membrane mounting edge 1320 is placed recessed from the edge of the strut 1305 to facilitate folding of the membrane. To. In FIG. 13B, the membrane guide feature 1325 can be used between the stanchions 1305 and the membrane 1315 to help push the membrane inward. The guide feature 1325 may be part of the column 1305, or membrane 1315, or may be a separate accessory. The guide feature portion 1325 may be, for example, a metal rod. The guide feature 1325 projects from the surface of the column to increase or initiate folding of the membrane 1315. Thus, rather than advancing more parallel to the stanchions 1305, the membrane 1315 quickly bends inward to help achieve the intended membrane fold. Protruding features of different shapes and sizes can be used to create different membrane bending patterns as intended.

In FIG. 13C, the outer strut component 1330 has an edge that is slightly curved inward to help the membrane 1315 fold inward and away from the edge of the outer strut when the catcher is closed. Can be. FIG. 13D depicts an embodiment in which a catcher with a two-part strut design is in a closed configuration. The closed catcher 1340 also has an outer strut component 1345, which has a slanted edge 1350 that increases the contact surface between the outer strut components 1345.

In general, the membrane can be attached to the catcher strut or frame using a variety of methods, such as adhesives, mechanical attachment, fusion, injection molding, or any other suitable means.

14A and 14B depict embodiments where the membrane is mechanically attached. In this embodiment, the stanchion 1400 may have a two-part structure with an outer / upper stanchion component 1405 and an inner / lower stanchion component 1410 sandwiching the membrane 1415. Membrane 1415 is preferably flexible and can be secured by mechanical means such as clamps or clasps. In this embodiment, the outer strut component 1405 and the inner strut component 1410 have an interlock feature portion 1420, which is assembled together to secure the membrane 1415. The interlock feature 1420 includes a protruding feature and corresponding holes, which work together to secure the membrane 1415 between the stanchions 1405 and the stanchions 1410. The membrane 1415 is elongated and fits around the protruding feature portion 1420. The position 1430 shows a possible pattern of the feature portion 1420. Alternatively, the membrane 1415 may have a perforated hole corresponding to the feature portion 1420, which is not elongated to fit the feature portion 1420.

15A and 15B depict embodiments where the membrane is mechanically attached. In FIG. 15A, the film 1505 has a hole through which the protruding feature portion 1520 passes. Alternatively, the protruding feature portion 1520 may be designed to penetrate the membrane 1505 during the interlocking process of the strut components. The stanchion may include a plurality of protruding features and matching features to form the desired fixation pattern.

The attachment of the membrane to the stanchions can only be brought about by the mechanical forces generated by the interlock components. Alternatively, an adhesive may be used to provide additional membrane attachment force. In embodiments where the protruding feature is plastic and passes through a hole in the membrane, the protruding feature can be melted or welded to the other strut component to provide interlocking force. In addition, the membrane can also be thermally fused to one or both of the strut components.

Metals have advantages over plastics in terms of creep resistance and function more effectively as tension holding elements. In an alternative to the embodiment of FIG. 15A, the membrane 1505 may spread over the protruding feature portion 1520, and a strut component having a compatible feature portion in the form of a "metal clip" may extend the film 1505 to the protruding feature portion 1520. It is applied to pinch. The metal clip portion can be made by punching or by any other suitable method.

FIG. 15B depicts an addition to the embodiment of FIG. 15A. The conforming feature portion has the form of a slide lock 1525 with a thin metal portion and a slot 1530. The slot 1530 is sized to slide onto the neck of the protruding feature 1520. In this variant, the membrane is perforated to accommodate the protruding features. The slide lock 1525 can be punched or laser cut, or made by any other suitable method.

FIG. 16 depicts an embodiment in which the membrane is mechanically attached by passing the membrane through a strut. Small slits 1605 may be made in the suture catcher stanchions 1610 and the membrane 1615 can pass through these openings. The size, length, and shape of the openings can be optimized to control the attachment of the membrane 1615 to the stanchions 1610. The membrane 1615 can be inserted from the inside of the stanchion 1610 through the first slit 1605, across the outside of the stanchion 1610, and then inserted through the second slit 1605 and reappear inside the stanchion 1610. In addition, adhesives or other methods can be used as ancillary methods to increase the anchoring force between the membrane and the stanchions. The slit 1605 also serves the purpose of guiding or controlling the angle at which the membrane 1615 exits the stanchion 1610. Since the slit 1605 is positioned away from the lateral edge, the film 1615 appears slightly behind the lateral edge and inside the strut. Therefore, since the film 1615 has room to rotate inward in the radial direction and is already guided in that direction by the slit 1605, it is unlikely to prevent the columns from closing.

In an alternative embodiment, the slit 1605 may extend to one end of the stanchion 1605, creating an opening for the membrane 1615 to slide in and be held by the stanchion 1610 (similar to a paper clip). ). The open edge may be on the outer radial edge or on the inner edge, near the shaft of the device.

The membrane extending between the two struts tends to hang down along the unsupported edges. In embodiments, the membrane can hang down, especially if it extends radially beyond the straight line between the ends of the two struts. In such areas, if the membrane does not have sufficient support from the stanchion and is not rigid enough to resist bending away when in contact with a needle or suture threader. There is. This bending may reduce the effective target zone for capturing the suture. This is because the needle can slide past the bent membrane rather than through it. The embodiments are intended to control the extent to which the membrane can sag or bend, often by ameliorating membrane tension.

FIG. 17 depicts an embodiment of a catcher for controlling the extent to which the membrane can hang down or bend. In FIG. 17, film 1705 has a straight edge 1710 along the line between the outer radial edges of two adjacent open struts 1715. Membrane 1705 may be more effective in capturing sutures than a shape in which the membrane material extends beyond the line between the ends of the struts (eg, a membrane with an extended bow-shaped outer edge). The linear membrane 1705 removes the membrane area that is not well supported by the stanchions 1715, thereby reducing the possibility of the membrane 1705 bending when the needle contacts. Thus, the membrane 1705 maximizes the effective suture capture area.

In an alternative embodiment, the membrane may be of any shape or may not be present between the struts if it is not intended to capture the suture, i.e., if the needle passage is not targeted. ..

In embodiments, the edges of the membrane 1705 can be reinforced by a tension element 1720 that improves membrane tension. In one embodiment, the tension element 1720 is a string or other fiber bonded to the edge of the membrane, the end of which is attached to the catcher strut, much like the string around the perimeter of the kite. good. For example, the tension element 1720 may be a Kevlar fiber fused at the edge of the membrane. The fibers may stretch to create tension in the fibrous portions between the ends of the struts, thereby providing support to the outer edges of the membrane. The mechanism for pulling the fibers may be the deployment of catcher struts. An alternative or additional mechanism for pulling the fibers may be to extend the stanchions radially outward after the catcher stanchions have been deployed.

The fibers can be attached to the edges of the membrane in different ways. One method is to glue the fibers to the edges of the membrane. Another method is to fold the edges of the membrane to create pockets for the fibers. Yet another method is to fuse the layers of the membrane with the fibers embedded between the layers.

The tension element may be more flexible than the membrane, and the tension element does not adversely affect the compression of the membrane. In embodiments, the tension element itself may have a default bend that helps the membrane fold. The cross section of the tension element may have any desired shape.

18A and 18B depict embodiments of the handle 1800 of the suture delivery device. In embodiments, suture ends 1805, 1810 may be loaded onto the handle 1800 before the handle 1800 is inserted into the surgical opening. In FIG. 18A, the suture ends 1805, 1810 are loaded into the distal openings 152, 157 of the needle passage 150, 155 on the handle 1800. FIG. 18B depicts a friction method for loading sutures. In FIG. 18B, slots 1815, 1820 are configured to hold the suture end 1805, 1810, for example by press fitting or other wedge-fastening action. In an alternative embodiment, flexible retaining flaps 1825, 1830 are added to further retain the suture end 1805, 1810. The flaps 1825, 1830 may be, for example, rubber or metal, depending on the desired holding force. In addition, the handle 1800 may be loaded with suture ends 1805, 1810 during the factory assembly process.

19A and 19B depict an embodiment in which a suture is loaded using a suture cassette. In FIG. 19A, cassette 1905 has two access ports that store one suture thread 1910 and provide access to suture thread ends 1915, 1920. In FIG. 19B, the handle 1900 has a cassette insertion port 1925, which receives the suture cassette 1905 and deploys the exposed suture ends 1915, 1920, and finally the suture 1910. It is configured to be positioned inside the needle passages 150 and 155 inside the handle 1900 so that it can be loaded into the suture threader during preparation.

In one embodiment, the slider 115 is spring-loaded to compress the tissue to be sutured when the control button 130 is pressed. Therefore, in this embodiment, pressing the control button 130 can cause two actions. First, the catcher 110 can be deployed and second, the slider 115 can be moved distally towards the catcher 110. These actions can be achieved by a spring that is loaded as the slider 115 moves proximally away from the catcher 110. The spring may have a trigger activated by the final stage of the button stroke, the catcher 110 first opens when the control button 130 is pressed, and the trigger is activated when the control button 130 is further pressed any amount. , Release the spring, which causes the slider 115 to be pressed against the skin and the tissue to be pinched between the slider 115 and the catcher 110.

20A-20C depict embodiments in which the wing is a flexible portion of the catcher strut and helps to capture the suture. FIG. 20A depicts struts 912, 914, 916, 918 having portions similar in size and rigidity to struts 112, 114, 312, 314 (FIG. 3). The stanchions 912, 914, 916, 918 have flexible wings 1905, 1910, 1915, 1920. FIG. 20B depicts the flexible wings 1905 and 1910 folded inside the catcher 110 as the catcher 110 retracts. When the catcher 110 is deployed, the wings 1905, 1910, 1915, 1920 extend to their intended positions, and the pairs of wings 912, 916 and 914, 918 spread and overlap, as shown in FIG. 20A. Shows the area of interest of the suture, as can be seen. In this embodiment, the area of interest indicated by a pair of overlapping wings is a plane similar to that shown by membranes 302, 305 (FIG. 3), but with wings 1905, 1910, 1915, 1920. Does not rely on tension to support, so they may be configured to extend beyond the area defined by the columns 912, 914, 916, 918. Wings 1905, 1910, 1915, 1920, like membranes 302, 305, can be punctured to help capture the suture end, or the seams between pairs of wings 1925, Passing the suture threader 200 through 1930 can help capture the suture. Once the suture threader 200 has passed through the seams 1925, 1930 to release and withdraw the suture, the pair of wings 1905, 1915, or 1910, 1920 closes around the deployed suture. , Capture this suture. The captured suture end is then retracted by the pair of wings as the catcher 110 retracts (FIG. 20C) and is more firmly gripped by the pair of struts 912, 916, or 914, 918. Can be done.

21A-21E depict embodiments that allow the catcher membrane to be used multiple times by varying where the catcher membrane is punctured. Generally, each insertion of the needle through the membrane creates and leaves a footprint on the membrane. When the needle is inserted multiple times, the holes made in the membrane can reduce the ability of the membrane to capture and hold the next suture. The embodiment allows the same device to be used multiple times by changing the area through which the suture threading device penetrates with each use. The suture catcher can be rotated so that the area of the membrane intended to penetrate the needle is (sufficiently) different each time. This rotation may be at a large angle or a small angle depending on the number of times the needle is desired to be penetrated and the number of times the needle is repeatedly penetrated. In another embodiment, for example, the suture catcher is randomly rotated to reduce the possibility of the needle repeatedly penetrating the same area.

21A and 21B depict embodiments of a multi-use catcher with a random rotation mechanism. In this embodiment, the catcher stanchions can swivel within a defined distance with respect to the handle shaft. The membrane attached to the stanchion can swivel with the stanchion. In FIG. 21A, a single stanchion 2010 is drawn for clarity, but the following description also applies to the other stanchions of the catcher. The catcher stanchion 2010 freely swivels around an angle 2015 inside the window 2020 of the shaft 2005. The size of the window 2020 can determine how much the catcher stanchion 2010 can rotate. The window 2020 may be provided at the proximal portion (eg, proximal connection 1115 (FIG. 11)) for each strut of the catcher, and each individual strut is free to move inside the window. The connection between the joint and the control rod may be fluid such that the rotation of the proximal joint causes the entire catcher to rotate. The random rotation of the catcher, which is possible in this embodiment, allows the two to rotate. It is less likely that the needle will penetrate the membrane at exactly the same location. FIG. 21B depicts a puncture pattern on the membrane that can result from the rotation of a catcher with a strut as in FIG. 21A. Membrane 2030 may result from the use of a suture threader inside a single needle passage, eg, needle passage 155 (FIG. 3), as the catcher and membrane rotate within an angle of 2015, puncture portion 2030a. , 2030b, 2030c are shown.

FIG. 21C depicts an embodiment of a multi-use catcher having a needle passage with an inner swivel point. The needle passage 2105 may be larger in diameter than the needle or suture threader between the insertion point 2110 and the stenosis 2120 and between the exit point 2115 and the stenosis 2120. The constriction 2120 may be a constriction of the needle passage 2105, or simply a protrusion, somewhere inside the needle passage 2105 that serves as a turning point. Since the needle or suture threader can move radially within the needle passage 2105, the constriction 2120 is a needle or suture threader as depicted by the exemplary suture threader positions 2125, 2130. By moving the proximal end of the suture catcher 2135, it can serve as a swivel point that facilitates the movement of the distal end of the needle or suture threader with respect to the surface of the suture catcher 2135. Positions 2125 and 2130 of the suture threader indicate that, according to this embodiment, the suture threader can exit the needle passage 2105 at various angles with respect to the shaft 2140 and the suture catcher 2135. The changing angle reduces the likelihood that the needle will penetrate the membrane of the suture catcher 2135 at exactly the same location. In certain embodiments, the hand passage 2105 may be in the form of an hourglass. In a further embodiment, the needle passage 2105 does not have to have a constriction 2120, but by making it generally larger in diameter than the needle or suture threader, also the position of the exemplary suture threader 2125, 2130. Is possible.

FIG. 21D depicts a top view of the handle 2200 that results in multiple uses of the catcher membrane. In FIG. 21D, each of the pair 2205a and 2205b, 2210a and 2210b, 2215a and 2215b of the plurality of needle passages targets different areas of the membrane (not shown). Further, the dial feature (not shown) can rotate on the handle 2200 to expose a set of needle passages at a time.

FIG. 21E depicts a cross-sectional view of an embodiment of a plurality of uses using an automatic pen rotation mechanism. The rotation of the suture catcher can ensure that the needle or suture threader penetrates the membrane in unused areas. In this embodiment, an automatic pen rotation mechanism 2300, or variant, can be used to achieve this. The mechanism 2300 includes a feature portion that changes the vertical movement of the control rod 2305 into the rotational movement of the control rod 2305. The control rod 2305 is connected to the distal joint so that the distal joint of the suture catcher rotates as the control rod 2305 rotates, and the proximal joint of the suture catcher allows the suture catcher to rotate. When the control rod 2305 rotates, the suture catcher rotates. The magnitude of the resulting rotation is controlled by the design of the rotation mechanism 2300 and may be arbitrarily small or large. In the variant of this embodiment, the vertical movement of the control rod 2305 causes the proximal joint of the suture catcher to rotate, the connection between the distal joint and the control rod is fluid, and the proximal joint rotates. As a result, the entire suture thread catcher is rotated.

Embodiments may use a suture threading device with a tip designed to receive a suture preloaded in the handle (eg, FIGS. 18A and 18B, for loading the suture into the handle. See relevant text). In such an embodiment, the tip of the suture threader preferably grips the suture end before entering the abdominal tissue; if a catcher is so provided, the tissue to be sutured. And while penetrating the catcher's membrane, the suture end is retained; and the suture end can be deployed.

22A-22D depict various embodiments of a suture threader designed to grip, hold, and deploy sutures. In FIG. 22A, the suture threader 2400 has a fixed tip 2405 with a slot 2410 configured to engage the suture 2415 located at the outlet 2420 of the needle passage 2425. In FIG. 22B, the suture threading device 2430 has a clamp member 2440 inside the suture threading device 2430 for clamping the suture thread 2445 against the fixing member 2450 by receiving the support of the device 2455, for example, the moving shaft. It has an actuated tip 2435 provided. In FIG. 22C, the suture threader 2460 has a gripping tip 2465 with a needle head 2470 actuated by an inner rod 2475 to abut against the needle tube 2485 to grip the suture 2480. 22D depicts the gripping tip of the suture threading device 200 described above with reference to FIGS. 2A and 2B for comparison. This embodiment of the suture threading device may be used to receive a suture preloaded in the handle. Similarly, embodiments of the suture threading device of FIGS. 22A-22C may be loaded with sutures prior to being inserted into the needle passage of the handle. In embodiments, any of the disclosed needle tip embodiments may be configured to work with any of the disclosed needle passages.

In an embodiment of the procedure of deploying a suture loaded on a handle, after the tissue to be sutured has been pinched by the handle (see, eg, FIG. 8B), the suture threading device has the tip loaded into the handle. It is inserted into the needle passage until it reaches the suture. The suture is then loaded into the suture threader. The suture threader is then inserted through the needle passage to deploy the suture end onto the catcher. Depending on the catcher's configuration, the suture end may be deployed by being released within the gripping distance of the catcher strut, or by being inserted into the catcher's membrane and then released. After the suture is released, the suture threader can be inserted into the second needle passage by repeating the above procedure for the second suture that has been removed and loaded into the handle.

23A and 23B depict a cross-sectional view of an embodiment in which the suture threading device is integrated within the handle 2500. In FIG. 23A, the suture threaders 2505 and 2510 are located inside the needle passages 2515 and 2520, respectively, and are used to deploy the suture. The suture threading device 2505, 2510 may be designed to be located inside the needle passage 2515, 2520. When the control button 2540 (or control lever, or control slider) is activated, the suture threaders 2505, 2510 are moved in the needle passages 2515, 2520 to grip the loaded suture and the handle 2500. It can be extended from the shaft 105 to penetrate tissue to be sutured, such as abdominal tissue. The suture threaders 2505, 2510 can then deploy the suture on the catcher 110.

In this embodiment, the suture threaders 2505, 2510 are deployed using rollers and a track 2545 and a control button 2540 to advance the two suture threaders through the needle passages 2515, 2520 to thread the suture. Can be deployed. The roller and track 2545 may include the roller 2550 inside the track 2555 connected to the actuating arm 2560. When pressed, the control button 2540 can move the roller and track 2545 and the actuating arm 2560 towards the distal end 2525 of the handle 2500. The actuating arm 2560 then pushes the suture threading device 2505, 2510 through the needle passages 2515, 2520 to deploy the suture. The rollers and tracks 2545 are configured to move the actuating arm 2560 inward inside the handle 2500 as the arm 2560 moves distally. In FIG. 23B, the control button 2540 is fully depressed and pushes the suture threaders 2505, 2510 to extend past the catcher 110 to open the tip of the suture threader (eg, FIG. 22B-see FIG. 22D) and sutures (not shown) are placed. As the control button 2540 moves, the control button 130 appears, which controls the catcher 110, and possibly the slider 115, as described above. This movement causes the roller 2550 to move inward inside the track 2555 as the actuating arm 2560 follows the contours of the needle passages 2515, 2520. In certain embodiments, the functions of control buttons 130 and 2540 are performed by a single control button.

Embodiments of the suture delivery device can be used to insert and remove a suture threader and to perform methods for capturing, holding, and fixing the suture. In embodiments, the properties of the membrane affect the capture, retention, and fixation of the suture. As described, when a needle or suture threader carrying the suture is inserted into the membrane, the suture can be released and captured by the membrane. When the catcher is then closed, the membrane folds due to the closure of the catcher frame, allowing the suture to be held inside the membrane. The membrane itself can be made of a material that has a high coefficient of friction or has a design that further enhances the suture retention properties of the membrane. Retention properties may be a function of material thickness, or number of material layers, or material surface. Holding properties may be on one or both sides of the holding surface.

In embodiments, the suture may be secured by the strut edge of the catcher. Several methods can be used (separately or in combination) to ensure that the suture is secured to the distal end of the device. A mechanical clamp of suture can be used to hold the suture while the suture delivery device is withdrawn from the surgical opening. The edges of adjacent struts can be used (as a mechanical clamp) to hold the suture firmly. In embodiments where the suture catcher comprises a membrane, the membrane retention force is not sufficient to withstand the force exerted on the suture by the sutured tissue, even though the suture is properly engaged with the membrane. Maybe. Therefore, the adjacent catcher strut can be used as a clamp to secure the suture. Such adjacent struts may be used independently (eg, in a membrane-free catcher embodiment) or in combination with a membrane (eg, in a membrane-containing catcher embodiment). May be good.

24A-24E depict embodiments of catchers with varying lengths of clamp surfaces, number of clamp surfaces, or number of contact points. In FIG. 24A, the strut edges 2605, 2610 of the strut 2620 are tilted to increase the contact surface with the suture 2615. That is, the edges of the catcher frame stanchions are tilted and the sutures are in contact with the struts over the length of the tilted edges. In FIG. 24B, the stanchions 2625, 2630 are configured to make one contact point 2635 with respect to the suture 2615. In FIG. 24C, the stanchion 2640 is sized differently from the stanchion 2650. The suture 2615 is clamped between the surfaces of a pair of differently sized struts 2640, 2650. In FIG. 24D, the strut edges 2655, 2660 are engaged to create an angle on the suture contact surface 2665. This angle may be, for example, 90 °. The catcher strut may also have serrated or corrugated edges along the suture contact edges. The advantage of a design with such an edge is that the direction of the force applied to the suture changes and the normal force increases at points along the suture. In FIG. 24E, the stanchion 2670 is added to the configuration of FIG. 24B to create an additional suture contact point 2637.

In embodiments, in addition to the various strut designs discussed, strut edges are roughened, treated, coated, or otherwise treated to increase friction and suture. The thread fixing performance can be improved. For example, rubber pads or strips, or rubber coatings may be applied to the strut edges.

In an alternative embodiment of the catcher, the suture folds inward to the control rod or to a block located around the control rod that presents a flat surface to the stanchion when the stanchion folds inward. Can be clamped to and from the stanchion. In such an embodiment, both the membrane and the suture can be clamped between the external element (strut) and the internal element (control rod, or block around the control rod). The effectiveness of clamping the suture can be associated with sufficient (or complete) closing of the suture catcher, so the level of closing force applied and the interference caused by the membrane can be associated with the effectiveness of the clamp. May affect.

In various embodiments of the suture catcher, increasing the force to close the strut can increase the holding force on the suture. As a result, the catcher can hold the suture while further forcing the suture delivery device out of the surgical opening.

In embodiments, the suture can be held by the catcher without a capture surface, such as a membrane. In such an embodiment, the catcher stanchions can directly clamp the suture. This clamping action may be, for example, part of retracting the catcher to pull it out of the surgical opening.

25-27 depict further embodiments for delivering and catching sutures. 25A, 25B, and 26 describe an embodiment in which the suture is captured on one side of the surgical opening and the suture is moved to the other side to complete the suture. 25A and 25B, respectively, depict a top view and a perspective view of a clamp device 2700 with clamp arms 2705, 2710 that swivel in directions 2707, 2712, respectively, to capture the suture end 2720. The clamp arm 2705 may be rotated by the inner shaft 2725 and the clamp arm 2710 may be rotated by the outer shaft 2730. The clamp device 2700 can replace, for example, the catcher 110 on the handle 100 of FIGS. 1A and 1B. The clamp device 2700 can be used to capture the suture 2720 and position it on the opposite side of the clamp device 2700 within the surgical opening.

FIG. 26 depicts a perspective view of the capture device 2800, which is supported by a strut 2810 that swivels around the shaft 2815 to place the captured suture 2820 on the opposite side of the capture device 2800. It comprises an area of film 2805. The suture 2820 can be captured by the membrane 2805, as discussed above. The catcher 2800 can also replace, for example, the catcher 110 on the handle 100 of FIGS. 1A and 1B.

One embodiment may include an umbrella-shaped membrane, which is supported by several radial struts and extends 360 ° around the device. Like an umbrella, the membrane may be pulled, making it even easier for the needle to penetrate the membrane material. Also, the friction between the membrane material and the suture may be sufficient to disengage and hold the suture when the suture threader is withdrawn. Alternative embodiments may include multilayer films in which each layer has a different orientation. In such a multilayer, the suture can be disengaged from the suture threader by friction and entanglement in a lattice structure.

The embodiments depicted in FIGS. 25A, 25B and 26 can be used according to the following methods. The needle carrying the suture (or suture threader) is inserted into the needle passage using a handle with either a clamp device 2700 or a capture device 2800, and then a muscle / myocardial layer on one side of the trocar wound. Will be inserted into. The suture threader releases the suture and is withdrawn. In the case of the clamp device 2700, the suture is then captured by the movement of the clamp arms 2705, 2710. In the case of the capture device 2800, the suture penetrates the membrane 2805, which has the material properties or design to disengage the suture from the needle threader and hold the suture. Once the suture is held, the suture is moved by rotating the instrument 2700 or 2800, and the suture 2720 or 2820 is repositioned to the opposite side of the trocar wound. The surgeon can then easily retrieve the suture. This is because the suture is positioned at the target point of the needle (or suture threader) inserted through the other needle passage of the handle and through the tissue to be sutured. Once through the tissue to be sutured, the needle (or suture threader) can capture the repositioned suture under the guidance of a laparoscopic image. The captured suture may have a controlled shape, orientation, and tension that makes it easy for the surgeon to retrieve it. These embodiments eliminate the need for the assistant to assist the surgeon in moving the suture to the point where the suture threader can grip the suture, as in previous embodiments.

FIG. 27 depicts a top view of an embodiment connecting suture ends within a surgical opening. In FIG. 27, the clamp device 2900 has clamp arms 2905, 2910 that swivel in directions 2907, 2912, respectively, to move in an arc and capture the suture end portions 2920, 2922. The clamp arm 2905 may be rotated by the inner shaft 2925 and the clamp arm 2910 may be rotated by the outer shaft 2930 (or rotate only one clamp arm to capture both suture ends). The clamp device 2900 can replace, for example, the catcher 110 on the handle 100 of FIGS. 1A and 1B. Clamping device 2900 can be used to capture suture ends 2920, 2922 and connect them with a link element 2935. The link element 2935 may be a crimp member or a biodegradable member fixed to one of the clamp arms 2905 and 2910. It may be a clamp or a clip. Further, the suture end portions 2920 and 2922 may be connected by using an adhesive or heat. The resulting suture connection must be at least strong enough to withstand the pull of the suture junction through the tissue passage created by the needle or suture threader. Alternatively, the suture connection must be strong enough to result in wound closure.

The clamp device 2900 can be used according to the following method. The vacuum cleaner or clamp arm is initially positioned so as not to interfere with the delivery of the suture. Two suture ends are delivered on both sides of the trocar wound. The clamp arm then rotates to bring the suture end into contact with the link element. The suture end and link element are then pressed together by the clamp arm to connect the suture. The suture delivery device can then be removed.

In this embodiment, one option to terminate the suture comprises delivering the two ends of a single suture. Once the two suture ends are connected, the connected sutures form a loop. The user can cut the suture at the proximal end, outside the trocar wound. The user can then pull on the outer suture end to close the wound and then tie a knot at the end. Alternatively, with the suture delivery device, the user pulls the suture connection through a surgical opening or pulls one side of the suture loop with full force to create the connection by inserting the first needle. It can be taken out from the established tissue passage. The user can then cut the suture joint, close the surgical opening and tie a knot. Another option is to deliver two suture ends from separate sutures into the abdomen. Once the two suture ends are connected, the user can withdraw the device and finish the suture as described above.

In one embodiment, the catcher closure mechanism is slider activated. The suture delivery device may have a slide member that can be positioned in the abdominal cavity so as to abut against an opposing force member (eg, a catcher) to pinch the abdominal wall tissue. Many of the described embodiments are configured in this way. In this embodiment, the slide member may be coupled to a catcher deployment mechanism and the movement of the slide member may be used to control the opening and closing of the catcher. When the slide member moves downward (towards the distal end of the device) with the slide member coupled to the deployment mechanism, the catcher deployment mechanism can be actuated to open the catcher. As the sliding member moves upwards (towards the proximal end of the device), the catcher deployment mechanism can be actuated to close the catcher. The position where the slide member can interact with the catcher deployment mechanism can be designed as desired. In one embodiment, the catcher can be opened when the slide member moves downward by a small distance, and the catcher can be closed when the slide member moves upward by a small distance. For example, moving the slider downwards causes the distal joint to move upwards, which allows the suture catcher to be deployed. Various mechanical options are available to enable this concept.

A method using one embodiment is to insert the suture delivery device through the tissue passage until the distal end is inside the cavity; move the slide member towards the distal end of the device to move the catcher. Open and then sandwich the abdominal wall tissue between the catcher and the slide member; suture until the suture is released and held at the distal end (or until the suture is released and captured by the catcher). Delivering the suture to the suture holding element (catcher) by inserting a suture carrier into the device; moving the slide member towards the proximal end of the device to close the catcher and release the abdominal wall tissue. It may include withdrawing the suture delivery device from the cavity with the suture end held at the distal end of the device.

The methods for automatically deploying sutures are to insert the suture delivery device into the surgical opening; to pinch the wound tissue; to deploy the suture end; and to withdraw the handle. Can include. Pinching the wound tissue may further include pressing a button, causing the catcher to open and causing the slider to press the tissue against the catcher. Deploying the suture end may further include using a separate suture threader or a suture threader integrated with the handle. Pulling out the handle may further include closing the catcher to catch the suture and automatically releasing the suture.

The method of deploying the suture is to load the suture on the handle or load the suture cassette into the handle; remove the trocar with the left hand; make the catcher completely visible from the laparoscopic image. It may include inserting the handle into the trocar wound with the right hand until it becomes; opening the catcher, then pushing down the slider to pinch the tissue under gaze guidance, and releasing the control button with the right hand. Laparoscopic images can be used to show if the catcher is in contact with the peritoneal wall. In one embodiment, the method of deploying this suture is to hold the handle with the left hand; insert the suture threader through the needle passage with the right hand to deploy the suture on the catcher under gaze guidance. And: Repeating this for the other needle passage under gaze guidance is included as an option. In another embodiment, the method of deploying this suture is to hold the handle with the left hand; press the deploy button with the right hand and deploy the suture on the catcher under gaze guidance; The option includes using the thumb of the left hand to press the control button and capturing the suture under gaze guidance; and using the left hand to pull the handle and collect the two suture ends.

FIG. 28 schematically illustrates an embodiment in which the handle 100 comprises a catcher 110 having a stanchion 3000 with a catcher element 3002 with a V-shaped hole 3004. The hole 3004 may be aligned with the corresponding needle passage, such as the needle passage 150 or 155, and the distal tip of the needle tube 210 carrying the suture 230 (not shown in this figure for clarity) is suture threaded. The instrument 200 can be extended through as it is advanced inside the needle passage. The outlet opening 3006 on the stanchion 3000 may allow the needle tube 210 to be further advanced. The V-shaped contour of the hole 3004 may be configured to capture and hold the suture 230. As will be appreciated, the hole 3004 has an increased dimension, which may generally be larger than the diameter of the needle tube 210 or suture 230, and both the needle tube 210 and the suture 230 pass through the opening. Can be easily advanced. The holes 3004 taper from the increased diameter region to a relatively narrow region with dimensions less than the diameter of the suture 230. When tension is applied to the suture 230, the suture is pulled into the narrow area and holds the suture firmly. In one aspect, the increased dimension area may be directed proximally and the narrow area may be directed distally. In addition, the tapered contour of the hole 3004 increases the retention of the suture 230 when more force is applied, further drawing material into the increasingly narrowed area.

As shown in FIG. 28, the contour of the hole 3004 can be formed directly on the material of the catcher element 3002. Alternatively, a separate structure can be anchored to the catcher element to create the desired contour. For example, FIG. 29 depicts a wire 3008 bent to exhibit a V-shaped contour. By fixing the wire 3008 over a larger diameter opening in the catcher element, holes with the aforementioned characteristics can be formed. Similarly, FIG. 30 depicts a plate 3010 with a V-shaped opening 3012 that can be secured to the catcher element 3002. The opening 3012 may be formed in the plate 3010 by electrical discharge machining, punching, or any other suitable technique. For embodiments shown in FIGS. 29 and 30, a V-shaped material that is relatively thinner than the material of the catcher element 3002 is used to more effectively engage the suture 230 by concentrating friction over a small surface area. Hole 3004 can be created. In another aspect, if the hole 3004 is formed directly on the catcher element 3002, the perimeter of the hole may exhibit a thin thickness to achieve similar results. Further, although a single V-shaped hole 3004 is shown in FIG. 28, the opposing catcher element and / or one or more adjacent catcher elements are also characterized by the corresponding V-shaped hole. Can be done. For example, the catcher element 3002 may be aligned with the needle passage 150, while the catcher element 312 may be aligned with the needle passage 155. Therefore, the catcher element 312 may also include a V-shaped hole in some embodiments.

As mentioned above, some embodiments may utilize a configuration in which the slider 115 is distally urged to facilitate tissue compression against the catcher 110 in the open unfolded state. For example, FIG. 31 schematically illustrates a slider 115 positioned relatively distally along a range of motion along the shaft 105 of the handle 100. The compression spring 3020 is coaxially arranged on the pillar 3022. During insertion, the slider 115 is positioned more proximally relative to the shaft 105 and is capable of compressing the spring 3020. In response, the spring 3020 urges the slider 115 distally. In another embodiment, as shown in FIG. 32, the driven gear 3024 (shown in the perspective view) may be rotatably fixed to the slider 115 and engages the teeth in the groove 120. The driven gear 3024 may be configured to urge the slider 115 distally along the groove 120, for example, by springing or by any other suitable method.

In these embodiments, urging the slider 115 distally produces an automatic sandwich function, which is between the insertion of the handle 100 and the resulting result between the slider 115 and the catcher 110. Tissue compression can be facilitated. For example, a handle 100 in which the catcher 110 is in its closed configuration can be inserted through a trocar wound. When the slider 115 abuts on the outer surface of the patient's body, further advancement of the handle 100 causes the slider 115 to move proximally along the shaft 105. In the situation of FIG. 31, this may compress the spring 3020, and in the situation of FIG. 32, the driven gear 3024 may be wound and store energy. When the handle 100 is sufficiently inserted, the catcher 110 is opened and deployed as described above by pushing down the control button 130. Accordingly, when the pressure on the handle 100 is released, the spring 3020 or the driven gear 3024 moves the slider 115 distally towards the catcher 110 so that the slider 115 is manually moved in subsequent movements. Automatically pinch the tissue rather than need it. Recognize that the slider 115 can be urged distally using any suitable mechanism.

In another aspect, FIGS. 33A and 33B show embodiments of the handle 100 configured to limit access through the needle passage when the catcher is not fully deployed in its open configuration. As shown in FIG. 33A, the control button 130 is pushed down so that the catcher 110 is closed. The gate control lever 3030 swivels on the mandrel 3032, and when the actuator 3034 of the control button 130 engages the gate control lever 3030 at the distal end of the mandrel 3032, the distal end 3036 of the gate control lever 3030 enters the needle passage 150. It is deflected radially outwards to a position that blocks access through. Correspondingly, FIG. 33B depicts a handle 100 in which the catcher 110 is opened and unfolded. Here, the control button 130 is released and the actuator 3034 engages the gate control lever 3030 proximal to the mandrel 3032, thereby deflecting the proximal end 3038 of the gate control lever 3030 radially outward. Let me. This then pulls the distal end 3036 radially inward to unblock the needle passage 150.

To help hold the catcher 110 in an open configuration, some embodiments of the handle 100 may use a locking mechanism, which unlocks the control button 130 when not depressed. Keep in. 34A and 34B show an embodiment of the handle 100 in which the lock 3040 is incorporated into the control button 130. The lock 3040 can be coaxially slid inside the control button 130 between the engaged state and the disengaged state, and is fixed to the control rod 145. In the engaged state shown in FIG. 34A, the lock 3040 is positioned relatively proximal within the control button 130 and the ridge 3042 inside the control button 130 is positioned above the leg 3044 of the lock 3040. Accordingly, the legs 3044 may be in a nominal configuration such that the flange 3046 engages the ledge 3048 of the handle 100. This keeps the control rod 145 in a fixed position with respect to the handle 100 and keeps the catcher 110 in its fully open configuration. As is recognized, this locking action helps resist any force generated by pinching the tissue, or any other force along the length axis of the shaft. Without the lock 3040, such a force could cause the control rod 145 to move, which could cause the catcher 110 to begin to close, resulting in a diminished ability to give the tissue a platform. If it is desirable to have the catcher 110 in a closed configuration, such as for insertion or recovery from a trocar wound, the control button as depicted in FIG. 34B (the original position of the control button 130 is shown in fluoroscopy). When the 130 is pushed down, the ridge 3042 engages the leg 3044 and deflects it radially inward, causing the flange 3046 to disengage from the ledge 3048. Once the lock 3040 is disengaged, the control button 130 is free to continue distal movement, advancing the control rod 145 to bring the catcher 110 into its closed configuration.

To improve the risk of damage to organs or other tissues, some embodiments of the handle 100 have been associated with the catcher 110 to limit the suture threading device 200 from moving beyond the desired amount. It may feature additional elements. For example, FIGS. 35A and 35B schematically depict the operation of the shield 3050 fixed to the catcher 110. First, in FIG. 35A, the suture threading device 200 has not advanced sufficiently for the tip of the needle tube 210 to penetrate the catcher 110. Therefore, the shield 3050 is substantially aligned with the stanchion 170 of the catcher 110. As the suture threader 200 advances further, as shown in FIG. 35B, the tip of the needle tube 210 extends beyond the catcher 110, while the shield 3050 deflects outward as the tip advances. It is elastic enough. Despite its elasticity, the material of the shield 3050 resists penetration of the tip of the needle tube 210, reducing the risk of damage to surrounding tissue.

Alternatively, the catcher 110 may have one or more material strips 3052 fixed proximal and distal to where the needle tube 210 extends beyond the catcher 110 as shown in FIGS. 36A and 36B. Accordingly, the strip 3052 can resist penetration of the tip of the needle tube 210 and reduce the risk of tissue damage beyond the catcher 110 as depicted in FIG. 36A. The strip 3052 may be made of a material that is sufficiently elastic and flexible to fit the contours of the catcher 110 closely, including when in a closed configuration as shown in FIG. 36B.

In a further aspect, the handle 100 may be configured to help ensure that the suture threader 200 is able to extend through sufficient tissue when placing the suture 230. For example, the shaft 105 may be marked with a suitable indicator 3060, such as by using contrasting colors, as shown in FIG. Indicator 3060 can be used to represent the correct positioning of the handle 100 from both the external viewing angle as well as the internal viewing angle, such as from a laparoscope. It is desirable to determine that sufficient tissue is sandwiched between the slider 115 and the catcher 110 to allow for reliable placement of the suture 230. By way of example, it is desirable that the suture threader 200 completely penetrates the peritoneum to achieve successful suturing closure. In one embodiment, the indicator 3060 may have a proximal end located substantially adjacent to the exit 3062 of the needle passage 150, 155 and extends distally to a location approximately adjacent to the suture exit slot 160. For example, the indicator 3060 may have a length of about 1.5 cm. The position and length of the indicator 3060 can be adjusted as desired based on the intended application. During use, the handle 100 can be inserted into the trocar wound and advanced until the indicator 3060 is obstructed by tissue. In one aspect, the indicator 3060 is not visible from the outside viewing angle or from within the abdominal cavity when the handle 100 is properly positioned. In some embodiments, the shaft 105 may be further marked with an additional indicator 3064 just above the catcher 110 to indicate that the handle 100 has been advanced to the correct position and is ready to open the catcher 110. ..

Specific exemplary embodiments have been described herein. However, those skilled in the art relating to these embodiments will appreciate that the principles of the present disclosure can be easily extended to other applications with appropriate modifications.

[Implementation mode]
(1) In a suture delivery device for suturing tissue
Elongated deployment member and
An opposed force member arranged toward the distal end of the elongated deploying member, wherein the opposed force member has a retracting configuration that facilitates entry of the opposed force member into the incision and the opposed force. A counter-force member configured to transition between a deployment configuration that resists the member being pulled out of the incision, and a counter-force member.
A compression member arranged toward the proximal end of the elongated deploying member with respect to the opposing force member, the compression member being configured to resist entering the incision and the compression member. And the opposing force member is a compression member that transitions between a compressed configuration and a non-compressed configuration.
A suture catcher disposed towards the distal end of the elongated deploying member, wherein the suture catcher has a retracted configuration that facilitates entry of the suture catcher into the incision and a suture. A suture catcher, which is configured to transition between a deployment configuration that facilitates catching, and
A first needle passage associated with the elongated unfolding member and directed towards a first area of the suture catcher when in the unfolding configuration.
A second needle passage associated with the elongated unfolding member and directed towards a second area of the suture catcher when in the unfolding configuration.
Including
The first area of the suture catcher when in the unfolded configuration and the second area of the suture catcher when in the unfolded configuration are such that they are placed on both sides of the incision. A suture delivery device located on the suture catcher.
(2) In the suture delivery device according to the first embodiment.
The suture catcher is a suture delivery device comprising a catcher element having a V-shaped hole.
(3) In the suture delivery device according to the second embodiment.
The suture catcher further includes a strut with a needle exit opening, the suture delivery device to which the strut is hinged to the catcher element.
(4) In the suture delivery device according to the second embodiment.
The suture delivery device, wherein the V-shaped hole is formed by a bent wire.
(5) In the suture delivery device according to the second embodiment.
The suture delivery device, wherein the V-shaped hole is formed by a plate having a V-shaped opening fixed to the catcher element.

(6) In the suture delivery device according to the second embodiment.
The suture delivery device, wherein the V-shaped hole has a constricted area configured to engage the suture material when under tension.
(7) In the suture delivery device according to the first embodiment.
A suture delivery device in which the compression member and the facing force member automatically shift from the non-compression configuration to the compression configuration.
(8) In the suture delivery device according to the seventh embodiment.
The suture delivery, which can be positioned along the elongated deploying member and is distally urged to automatically transition from the uncompressed configuration to the compressed configuration. Device.
(9) In the suture delivery device according to the eighth embodiment.
The suture delivery device, wherein the compression member is urged toward the distal direction by a spring.
(10) In the suture delivery device according to the eighth embodiment.
The suture delivery device, wherein the compression member is urged toward the distal direction by a driven gear that engages a groove along the elongated deploying member.

(11) In the suture delivery device according to the first embodiment.
A suture delivery device that limits access to at least one of the first needle passage and the second needle passage when the opposing force member is in the retracted configuration.
(12) In the suture delivery device according to the eleventh embodiment.
The suture delivery device, wherein the access is restricted by a gate control lever.
(13) In the suture delivery device according to the twelfth embodiment.
The facing force member is operably connected to the control button, and when the control button is located at a position associated with the facing force member being in the deployed configuration, the control button engages with the gate control lever. Together, a suture delivery device that provides access through at least one of the first needle passage and the second needle passage.
(14) In the suture delivery device according to the first embodiment.
The facing force member is operably connected to the control button and is connected to the control button.
A suture delivery device further comprising a locking mechanism configured to hold the control button at a position associated with the facing force member being in the deployment configuration.
(15) In the suture delivery device according to the 14th embodiment.
The locking mechanism is disposed inside the control button and is engaged when the control button is at the position associated with the facing force member being in the deployment configuration, and the control button is pushed down. A suture delivery device that is disengaged with.

(16) In the suture delivery device according to the first embodiment.
The suture catcher is a suture delivery device further comprising a shield configured to deflect outward and resist penetration by the needle tip.
(17) In the suture delivery device according to the first embodiment.
The suture delivery device further comprising a material strip, wherein the suture catcher is secured in proximal and distal locations on the suture catcher and is configured to resist penetration by the needle tip.
(18) In the suture delivery device according to the first embodiment.
The elongated deploying member further comprises a visual indicator configured to signal when the suture delivery device was inserted through a tissue of sufficient thickness.
(19) In the suture delivery device according to the eighteenth embodiment.
The indicator is a suture delivery device comprising a colored area of the elongated deploying member having a proximal end adjacent to at least one exit of the first needle passage and the second needle passage.
(20) In the suture delivery device according to the first embodiment.
The suture delivery device, wherein the first and second needle passages are joined by a suture outlet slot configured to exit the suture loop from the device.

A side view of an embodiment of the handle of the suture delivery device is drawn. A side view of an embodiment of the handle of the suture delivery device is drawn. A perspective view of an embodiment of a suture threading device is drawn. A perspective view of an embodiment of a suture threading device is drawn. A perspective view of an embodiment of a suture threading device is drawn. A perspective view of an embodiment of a handle of a suture delivery device into which a suture threader is inserted is drawn. An embodiment of a suture delivery device with a suture relief slot is depicted. An embodiment of a suture delivery device with a suture relief slot is depicted. An embodiment of a suture delivery device with a suture relief slot is depicted. A cross-sectional view of an embodiment of a suture delivery device with a nested needle passage is drawn. A cross-sectional view of an embodiment of a suture delivery device with a nested needle passage is drawn. An embodiment of a suture catcher is depicted. An embodiment of a suture catcher is depicted. An embodiment of a suture catcher is depicted. A cross-sectional perspective view of a part of the embodiment of the suture delivery device is drawn. It depicts the steps in the use of the handle of the suture delivery device and the embodiment of the suture threading device. It depicts the steps in the use of the handle of the suture delivery device and the embodiment of the suture threading device. It depicts the steps in the use of the handle of the suture delivery device and the embodiment of the suture threading device. It depicts the steps in the use of the handle of the suture delivery device and the embodiment of the suture threading device. It depicts the steps in the use of the handle of the suture delivery device and the embodiment of the suture threading device. It depicts the steps in the use of the handle of the suture delivery device and the embodiment of the suture threading device. It depicts the steps in the use of the handle of the suture delivery device and the embodiment of the suture threading device. A side view of the stage of retreating the embodiment of the suture catcher is drawn. A side view of the stage of retreating the embodiment of the suture catcher is drawn. An embodiment for automatically releasing the suture is depicted. An embodiment for automatically releasing the suture is depicted. An embodiment of a suture catcher is depicted in cross section. An embodiment in which the membrane is attached to a support is depicted. An embodiment in which the membrane is attached to a support is depicted. An embodiment in which the membrane is attached to a support is depicted. An embodiment in which the membrane is attached to a support is depicted. An embodiment in which the membrane is attached to a support is depicted. An embodiment in which the membrane is attached to a support is depicted. An embodiment in which the membrane is attached to a support is depicted. An embodiment in which the membrane is attached to a support is depicted. An embodiment in which the membrane is attached to a support is depicted. An embodiment in which the membrane is attached to a support is depicted. A perspective view of an embodiment in which the membrane is attached to a support is drawn. An embodiment of managing the sagging of the membrane is depicted. An embodiment of the handle of the suture delivery device is depicted. An embodiment of the handle of the suture delivery device is depicted. An embodiment of the handle of the suture delivery device is depicted. An embodiment of the handle of the suture delivery device is depicted. An embodiment of a suture catcher is depicted. An embodiment of a suture catcher is depicted. An embodiment of a suture catcher is depicted. It depicts an embodiment of a versatile suture catcher. It depicts an embodiment of a versatile suture catcher. It depicts an embodiment of a versatile suture catcher. It depicts an embodiment of a versatile suture catcher. It depicts an embodiment of a versatile suture catcher. An embodiment of the tip of a suture threading device is depicted. An embodiment of the tip of a suture threading device is depicted. An embodiment of the tip of a suture threading device is depicted. An embodiment of the tip of a suture threading device is depicted. An embodiment of a suture delivery device is depicted. An embodiment of a suture delivery device is depicted. An embodiment of a suture catcher is depicted. An embodiment of a suture catcher is depicted. An embodiment of a suture catcher is depicted. An embodiment of a suture catcher is depicted. An embodiment of a suture catcher is depicted. An embodiment of a suture catcher is depicted. An embodiment of a suture catcher is depicted. An embodiment of a suture catcher is depicted. An embodiment of a suture catcher is depicted. It depicts an embodiment of a catcher element with a V-shaped hole. An embodiment of a wire overlay for forming a V-shaped hole is depicted. An embodiment of a plate for forming a V-shaped hole is depicted. An embodiment of a spring-driven slider is depicted. An embodiment of a slider driven by a gear is depicted. An embodiment including an access control unit for a needle passage is depicted. An embodiment including an access control unit for a needle passage is depicted. An embodiment with a locking mechanism for a catcher is depicted. An embodiment with a locking mechanism for a catcher is depicted. It depicts an embodiment with a shield that limits needle penetration. It depicts an embodiment with a shield that limits needle penetration. An embodiment is depicted with a material strip that limits needle penetration. An embodiment is depicted with a material strip that limits needle penetration. It depicts an embodiment with a visual indicator.

Claims (19)

In a suture delivery device for suturing tissue
Elongated deployment member and
A suture catcher located at the distal end of the elongated deploying member, wherein the suture catcher has a retracted configuration that facilitates entry of the suture catcher into the incision and a suture catcher. The suture catcher is configured to transition between a deployment configuration and the suture catcher , which resists the suture catcher being pulled out of the incision in the deployment configuration. ,
A compression member disposed on the elongated deploying member on the proximal side of the suture catcher , wherein the compression member is configured to resist entering the incision. A compression member that moves along the elongated deploying member towards the distal end, thereby transitioning from a compressed configuration to an uncompressed configuration for the suture catcher .
A first needle passage associated with the elongated unfolding member and directed towards a first area of the suture catcher when in the unfolding configuration.
A second needle passage associated with the elongated unfolding member and directed towards a second area of the suture catcher when in the unfolding configuration.
Including
The first area of the suture catcher when in the unfolded configuration and the second area of the suture catcher when in the unfolded configuration are such that they are placed on both sides of the incision. Located on the suture catcher
The suture catcher is a suture delivery device comprising a catcher element having a V-shaped hole . In the suture delivery device according to claim 1 ,
The suture catcher further includes a strut with a needle outlet opening, the suture delivery device to which the strut is hinged to the catcher element. In the suture delivery device according to claim 1 ,
The suture delivery device, wherein the V-shaped hole is formed by a bent wire. In the suture delivery device according to claim 1 ,
The suture delivery device, wherein the V-shaped hole is formed by a plate having a V-shaped opening fixed to the catcher element. In the suture delivery device according to claim 1 ,
The V-shaped hole is a suture delivery device having a region with an increased diameter and a relatively narrow region having a dimension smaller than the diameter of the suture. In the suture delivery device according to claim 1,
A suture delivery device in which the compression member automatically shifts from the non-compressed configuration to the compressed configuration with respect to the suture catcher . In the suture delivery device according to claim 6 ,
The suture delivery, which can be positioned along the elongated deploying member and is distally urged to automatically transition from the uncompressed configuration to the compressed configuration. Device. In the suture delivery device according to claim 7 ,
The suture delivery device, wherein the compression member is urged toward the distal direction by a spring. In the suture delivery device according to claim 7 ,
The suture delivery device, wherein the compression member is urged toward the distal direction by a driven gear that engages a groove along the elongated deploying member. In the suture delivery device according to claim 1,
A suture delivery device that limits access to at least one of the first needle passage and the second needle passage when the suture catcher is in the retracted configuration. In the suture delivery device according to claim 10 ,
The suture delivery device, wherein the access is restricted by a gate control lever. In the suture delivery device according to claim 11 ,
If the suture catcher is operably coupled to a control button and the control button is located at a position associated with the suture catcher being in the unfolded configuration, the control button engages with the gate control lever. Together, a suture delivery device that provides access through at least one of the first needle passage and the second needle passage. In the suture delivery device according to claim 1,
The suture catcher is operably connected to a control button and
The suture delivery device further comprises a locking mechanism configured to hold the control button at a position associated with the suture catcher being in the deployment configuration. In the suture delivery device according to claim 13 ,
The locking mechanism is disposed inside the control button and is engaged when the control button is in the position associated with the suture catcher being in the deployment configuration and the control button is depressed. A suture delivery device that is disengaged with. In the suture delivery device according to claim 1,
The suture catcher is a suture delivery device further comprising a shield configured to deflect outward and resist penetration by the needle tip. In the suture delivery device according to claim 1,
The suture delivery device further comprising a material strip, wherein the suture catcher is secured in proximal and distal locations on the suture catcher and is configured to resist penetration by the needle tip. In the suture delivery device according to claim 1,
The elongated deploying member further comprises a visual indicator configured to signal when the suture delivery device was inserted through a tissue of sufficient thickness. In the suture delivery device according to claim 17 ,
The indicator is a suture delivery device comprising a colored area of the elongated deploying member having a proximal end adjacent to at least one exit of the first needle passage and the second needle passage. In the suture delivery device according to claim 1,
The suture delivery device, wherein the first and second needle passages are joined by a suture outlet slot configured to exit the suture loop from the suture delivery device.

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