KR102504401B1 - Suture delivery device for suturing tissue - Google Patents

Abstract

A system for delivering sutures to close a surgical opening is provided. The elongate deployable member may have a retracted counterforce member at its distal end. The counterforce member can be inserted into the surgical opening and deployed so as not to come out of the opening. A compression member may slide under the elongate member to compress tissue to be sutured against the force member. A suture passer loaded with a suture end may pass through a needle tube within the elongate member, emerge from the elongate member, penetrate the tissue to be sutured, and then place the suture end into the suture catcher. The suture passer may be retracted leaving a suture end. The suture catcher is retracted to retain the suture end, and the device - elongate member, retracted suture catcher and retained suture end may exit the surgical opening. Sealing can then be completed.

Description

Suture delivery device for suturing tissue

related application

This application is a continuation-in-part of US Patent Application Serial No. 14/615,786, which claims the benefit of US Provisional Application Serial No. 61/937,089, filed on February 7, 2014. This application also claims the priority and benefit of U.S. Provisional Application No. 62/203,670, filed on August 11, 2015, the contents of each of which are incorporated by reference in their entirety.

field of invention

The present invention relates generally to techniques and devices for closing small incisions in the body of a patient. For example, the present invention relates to systems, devices, and methods for closure of laparoscopic port sites that must follow various minimally invasive surgical procedures, such as cholecystectomy, appendectomy, or bariatric surgery.

Laparoscopic surgery is a type of minimally invasive surgery. It is an alternative to traditional “open” surgery and offers the advantages of minimizing postoperative pain, reducing hospital stay and disability, and reducing costs for both hospital and patient.

For example, more than 7.5 million laparoscopic surgeries are performed worldwide each year in fields such as cholecystectomy, appendectomy, bariatric surgery, gynecological surgery, and urological surgery. However, because of the incidence of port-site hernias for laparoscopic surgery, port-site closure is preferred for fascial incisions greater than 10 mm. Port-site closure effectively reduces hernia rates, reducing the need for hernia surgery, which costs between $6,000 and $10,000 per operation and has a three-week recovery period. Approximately 70% of performed laparoscopic procedures have a port-site greater than 10 mm.

In order to improve this problem, a technique for suturing the port site has been developed. Despite the advantages associated with the use of suture delivery devices, many challenges exist. The port site closure device can rotate, tilt, and slide vertically downward in a wound track or incision while inserting a suture needle. As the device rotates, the sutures will develop less than the ideal 180 degrees across the wound. If the device slides vertically during insertion, the desired tissue bite of the muscle/fascia layer is reduced for devices that use the peritoneum as a reference point for needle insertion in the muscle/fascia layer. That is, if such a device does not engage the peritoneum due to downward sliding, the needle entry point into the muscle/fascia layer is lower than the intended location and reduces tissue bite. It is also desirable to provide a device configured to position the needle in a reproducible manner to minimize the amount of skill required from the operator.

Accordingly, the present invention is directed to wound closure systems and methods that provide these and other desirable properties.

The present disclosure includes a suture delivery device for suturing tissue. In one embodiment, the delivery device includes an elongate deployable member. Towards the distal end of the elongate deployable member, the counterforce member is configured to transition between a retracted configuration that facilitates entry of the counterforce member into the incision and a deployment configuration that resists extracting the counterforce member from the incision. Towards the proximal end of the elongated deployable member, the compression member is configured to resist entry into the incision. The compression member and counterforce member are transitioned between compression and non-compression configurations. In a compression configuration, tissue may be interposed between the compression member and the counterforce member to stabilize the device. A suture catcher disposed towards the distal end of the elongate deployable member is configured to transition between a retracted configuration that facilitates entry of the suture catcher into an incision and a deployment configuration that facilitates suture capture. A first needle track is associated with the elongate deployable member and is oriented towards the first area of the suture catcher when in a deploy configuration. The second needle track is also associated with the elongate deployable member and is oriented towards the second area of the suture catcher when in the deploy configuration. A first region of the suture catcher in a deployed configuration and a second region of the suture catcher in a deployed configuration are positioned on the suture catcher such that they can be disposed on opposite sides of the incision. The first and second needle tracks can pass through the elongate deployable member.

In one embodiment, the suture catcher may be a catcher element having a V-shaped opening. The suture catcher may also include a strut having a needle exit opening, the strut being hinged to the catcher element. The V-shaped opening may be formed by a bent wire or a plate having a V-shaped opening fixed to the catcher element. The V-shaped opening may have a narrowed area configured to engage the suture material when under tension.

In one embodiment, the compression member and counterforce member may automatically transition from a non-compression configuration to a compression configuration. A compression member can be positioned along the elongate deployable member and biased in a distal direction to automatically transition from a non-compressed configuration to a compressed configuration. The compression member may be biased in a distal direction by a spring or a driven gear engaging a track along an elongated deployable member.

In one embodiment, access to at least one of the first needle track and the second needle track may be restricted when the counterforce member is in the retracted configuration. Access can be restricted by a gate control lever. The counterforce member is operatively coupled to the control button such that when the control button is in a position associated with the counterforce member in a deployed configuration, the control button provides access through at least one of the first needle track and the second needle track. To do so, it is combined with the gate control lever.

In one embodiment, the counterforce member may be operatively coupled to a control button and the locking mechanism may be configured to retain the control button in a position associated with the counterforce member in a deployed configuration. A locking mechanism is disposed within the control button so that it can be engaged when the control button is in a position associated with the counterforce member in a deployed configuration, and can be disengaged when the control button is depressed.

In one embodiment, the suture catcher may include a shield configured to deflect outwardly while resisting penetration by a needle tip.

In one embodiment, the suture catcher may include a strip of material secured in proximal and distal locations on the suture catcher and configured to resist penetration by a needle tip.

In one embodiment, the elongate deployment member may include a visual indicator configured to signal when the suture delivery device is inserted through tissue of sufficient thickness. The indicator may be a colored region of an elongate deployable member having a proximal end adjacent an exit of at least one of the first needle track and the second needle track.

Additional features and advantages will become apparent from the following detailed description of preferred embodiments of the present application, as shown in the accompanying drawings, in which like reference numbers generally refer to like parts or elements throughout the drawings.
1A and 1B are side views of one embodiment of a suture delivery device handle.
2A-2C are perspective views of an embodiment of a suture passer.
3 is a perspective view of one embodiment of a suture delivery device handle with a suture passer inserted therein.
4A-4C depict one embodiment of a suture delivery device having a suture exit slot.
5A and 5B show cross-sections of one embodiment of a suture delivery device having a telescoping needle track.
6A-6C show one embodiment of a suture catcher.
7 is a cross-sectional perspective view of one embodiment of a suture delivery device.
8A-8G illustrate steps in use of one embodiment of a suture delivery device handle and suture passer.
9A and 9B are side views of retracting one embodiment of a suture catcher.
10A and 10B show one embodiment for automatically releasing a suture.
11 shows one embodiment of a suture catcher in cross section.
12a and 12b show an embodiment of attaching a membrane to a strut;
13A-13D show an embodiment of attaching a membrane to a strut.
14a and 14b show an embodiment for attaching a membrane to a strut;
15a and 15b show an embodiment for attaching a membrane to a strut;
16 is a perspective view of an embodiment for attaching a membrane to a strut.
17 shows an embodiment for managing membrane sagging.
18A and 18B show one embodiment of a suture delivery device handle.
19A and 19B show one embodiment of a suture delivery device handle.
20A-20C depict one embodiment of a suture catcher.
21A-21E show an embodiment of a multipurpose suture catcher;
22A-22D show an embodiment of a suture passer tip;
23A and 23B show one embodiment of a suture delivery device.
24A-24E show an embodiment of a suture catcher;
25A and 25B show one embodiment of a suture catcher.
26 shows one embodiment of a suture catcher.
27 shows one embodiment of a suture catcher.
28 shows one embodiment of a catcher element with a V-shaped opening.
29 shows one embodiment of a wire overlay to form a V-shaped opening.
30 shows one embodiment of a plate for forming a V-shaped opening.
31 shows one embodiment of a spring driven slider.
32 shows one embodiment of a gear driven slider.
33A and 33B show one embodiment with access control of the needle track.
34a and 34b show one embodiment with a locking mechanism for the catcher;
35A and 35B show one embodiment with a shield to limit needle penetration.
36A and 36B show one embodiment having a strip of material that restricts needle penetration;
37 shows an embodiment with visual indicators.

Initially, it should be understood that this disclosure is not limited to the variety of particular illustrated materials, architectures, routines, methods, or structures. Thus, although many options similar or equivalent to those described herein may be used in the practice or examples of the present disclosure, the preferred materials and methods are described herein.

It should be understood that the terminology used herein is merely for describing specific embodiments of the present disclosure and is not intended to limit the present invention.

The detailed description set forth below in connection with the accompanying drawings is intended as a description of exemplary embodiments of the present disclosure and is not intended to represent only exemplary embodiments in which the present disclosure may be practiced. The term "exemplary" as used throughout this description means "means of example, illustration, or description," and should not necessarily be construed as preferred or advantageous over other exemplary embodiments. The detailed description includes specific details for the purpose of providing a thorough understanding of the exemplary embodiments of the disclosure. It will be apparent to those skilled in the art that the exemplary embodiments herein may be practiced without these specific details. In some instances, well-known structures and devices are shown in block diagram form in order to avoid obscuring the novelty of the exemplary embodiments presented herein.

For convenience and purposes of clarity, directional terms such as top, bottom, left, right, up, down, above, above, below, below, back, back, and front may be used with respect to the accompanying drawings. These and similar directional terms should not be construed as limiting the scope of this invention in any way.

Unless defined otherwise, 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 pertains. For example, the term "suturing" includes drawing two surfaces or edges together with a flexible material to seal a perforation, opening, or other wound, the suture being a material that may be a synthetic or natural polymer; It may be, for example, a polymer, lining, metal wire or other suitable equivalent.

As used in the specification and claims, the singular forms "a", "an" and the definite article "the" include plural referents unless the content clearly dictates otherwise.

Embodiments describe a suture delivery device that can be inserted into the same opening used to perform surgical procedures such as laparoscopic surgery. The suture delivery device stabilizes the device within the opening by compressing the surrounding tissue thereby reducing the possibility of tilting, rotating or sliding with respect to the opening. Thus, the stabilized, suture delivery device can enhance tissue bite by reliably guiding the suture to a predetermined tissue area or layer. The suture delivery device may be used to orient one or more suture passers that pass through the body of the delivery device to penetrate the port-site tissue and release the suture after penetration. The suture delivery device captures the suture, and upon retracting the delivery device, the suture end is pulled back through the opening such that the suture is secured and the opening is closed. The embodiment is easy to use, and is important for a tissue closure device that can be the final step in a long and tedious surgical procedure.

The suture delivery device (or “wound closure device” or “trocar wound closure device” (TWC)) generally consists of two parts: a handle 100 ( FIGS. 1A , 1B ) and a suture passer ( FIGS. 2A-2C ). have 1A and 1B show two configurations of an embodiment of a suture delivery device handle 100 . The configuration of Figure 1A is used when the device is inserted into the opening. In FIG. 1A, handle 100 is in a non-compressed configuration. 1A shows a handle 100 having a shaft 105, a catcher 110 (including catcher elements 112, 114), a slider 115, needle tracks 150, 155, and a suture exit slot 160. shows The shaft 105 is an elongate deployment member equipped with a ridge-like track 120. The slider 115 is a compression member that can be moved along the shaft 105 toward the distal end 135 and locked into position in engagement with the track 120 . An anti-rotation bump, not shown, along with the track 120 prevents the slider 115 from rotating relative to the needle tracks 150 and 155 (FIG. 1B). Slider button 125 can be used to engage or uncouple tracks 120 . The catcher 110 shown in a closed state is a counterforce member when deployed, and may include a toothed body 140 capable of wrapping and gripping the suture. The control button 130, shown in a depressed state, moves the control rod 145 (FIG. 1B) which opens (or deploys) or closes the catcher 110 by moving the struts 165, 170. With the catcher 110 closed, the distal end 135, catcher 110, and shaft 105 are surgically opened until the catcher 110 passes through an opening that can be deployed as shown in FIG. 1B. can be inserted into the

In FIG. 1B , handle 100 is in a compressed configuration with control button 130 released, control rod 145 visible, catcher 110 deployed, and slider 115 moved distally. To deploy the catcher 110, the control button 130 is released to move the control rod 145 in a proximal direction (i.e., towards the control button 130, or “up” in this view) to force the strut 165, 170 causes the catcher 110 to deploy. To move the slider 115 proximally or distally, the slider button 125 is used to separate the slider 115 from the track 120 and then the slider 115 can be moved. Optionally, slider 115 may be ratcheted distally along shaft 105 by slider button 125 used to disengage slider 115 from track 120 and move slider 115 proximally. can (see FIG. 7). In another embodiment, slider 115 may be biased distally along track 120 by a spring or driven gear (see FIGS. 31 and 32 ).

The configuration of FIG. 1B may compress tissue between slider 115 and catcher 110 . For example, the fascia, muscle and peritoneal layers of the abdominal wall may be compressed between slider 115 and catcher 110 with the peritoneum closest to catcher 110 . As shown in a deployed state, catcher 110 resists being pulled through an opening in the abdominal wall. Thus, in this embodiment, the catcher 110 is a counterforce member. In another embodiment, the opposing force may be applied by an element that lacks suture capture capability. Similarly, in other embodiments, suture capture capability may be provided by an element that lacks an opposing capability. As discussed below, counterforce members such as catcher 110 may be held in an open deployed configuration by a suitable locking mechanism (see Figs. 34A and 34B).

In this configuration, with tissue compressed between the slider 115 and the catcher 110, the handle 100 is stable against the compressed tissue, reducing the possibility of rotation, sliding or tilting. Additionally, with the handle 100 stabilized, the needle tracks 150, 155 are also stabilized against the surrounding tissue, which is the tissue to be sutured. This optimally places the suture and deploys the suture in a reproducible manner, both ensuring proper tissue bite and minimizing the amount of skill required from the operator.

2A-2C show an embodiment of a suture passer 200 . The suture passer 200 grips the suture end and places the suture through a needle track (eg, needle track 150 ) so that it can be captured by the catcher 110 . The suture passer 200 includes a hook 205 at a distal end, a needle tube 210 , a shaft 215 , a trigger 220 and a needle button 225 . Hook 205 is at the distal end of shaft 215 . The needle tube 210 has a distal end attachment and is movable relative to the shaft 215 to cover or not cover the hook 205 . Hook 205 is configured to receive suture 230 (see FIG. 2B ) and retain suture 230 when covered by needle tube 210 (see FIG. 2C ). The hook 205 may have a blunt tip and does not require attachment during loading of the suture 230 . The hook 205 may have a ramp 235 that allows the suture to slide when the hook 205 is not covered. In FIG. 2A , needle button 225 is shown extended (undepressed) and hook 205 is shown uncovered. Needle button 225 may extend needle tube 210 over hook 205 to retain the suture when depressed. The trigger 220 may result in the needle tube not covering the hook 205 to release the suture when depressed. The needle tube 210, shaft 215, hook 205 and trigger 220 fit within the needle tracks 150, 155 and are configured to deliver and release the suture at a desired location relative to the deployed catcher 110. .

2B and 2C show locking of suture passer 200 in general. Suture passer 200 has two states controlled by needle button 225 and trigger 220 . In the initial "off" state, shaft 215 and hook 205 protrude from needle tube 210 . Hook 205 is used to receive suture 230 in this configuration. That is, the suture 230 may be disposed to be gripped by the hook 205 . To transition to the “on” state, the user presses needle button 225, which causes needle tube 210 to extend to cover suture 230 and hook 205. Thus, the shaft 215 , the hook 205 , and the needle tube 210 cooperate to hold or grip the suture 230 . To return to the “off” state, the trigger 220 can be actuated by pressing in the proximal direction. Depressing trigger 220 may thereby release suture 230 .

3 shows a suture delivery device 300 . In FIG. 3 , suture passer 200 is inserted into needle track 150 of handle 100 . In some embodiments, access to the needle tracks 150, 155 is controlled by a control button to prevent introduction of the suture passer 200 if the catcher 110 is not fully deployed in an open configuration (see FIGS. 33A and 33B). 130) can be predicted based on the positioning. The handle 100 is in a compressed configuration with the catcher 100 deployed and the slider 115 moved distally. Needle button 225 is shown pressed into needle tube 210 covering hook 205 (not shown). The distal tip of needle tube 210 is near membrane 302 . Membrane 302 extends between catcher elements 114 and 314 . A membrane 305 extends between catcher elements 112 and 312 .

As shown in FIG. 3 , needle track 150 orients suture passer 200 in a direction pointing to the area between catcher elements 114 and 314 of deployed catcher 110 . In this embodiment, the catcher 110 is provided with a membrane 302 in its area. Membrane 302 is added to enhance the ability of catcher 110 to capture sutures. When the suture passer 200 is further inserted into the needle track 150 , the pointed attachment of the needle tube 210 penetrates the membrane 302 and carries a suture (not shown). Further insertion will cause the trigger 220 to contact the opening of the needle track 150 . Another insertion causes trigger 220 to actuate and needle tube 210 to retract, exposing hook 205 and releasing suture 230 (not shown). At this point, suture passer 200 may be withdrawn from needle track 150 . Retracting suture passer 200 from needle track 150 will also retrieve it from membrane 302 . However, the suture 230 released from the hook 205 remains within the membrane 302 . When catcher 110 is then retracted, membrane 302 is also retracted, allowing suture 230 to be gripped by catcher elements 114, 314. This is further explained with reference to FIGS. 9A and 9B. Optionally or additionally, a catcher element, such as 112, 114, 312 and/or 314, accommodates needle tracks 150, 155 and suture passer 200 and suture threads as described below with respect to the figures below. 230 may be aligned with the shape opening configured to hold.

4A-4C show an embodiment of a handle 100 that provides automatic suture release. When the two ends of single 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 forms a loop. During device retraction, the loop may engage the device. Existing closure devices allow an operator to manually remove suture 415 from the device. The embodiment of FIGS. 4A-4C uses internal suture exit slot 400 to facilitate automatic release of suture 415 . Suture exit slot 400 connects needle tracks 150 and 155 through its length, providing a slot for suture 415 to pass through handle 100 and out of suture exit slot 160 . In FIG. 4A , suture passer 200 is inserted into needle track 155 and extends from shaft 105 to expose needle tube 210 . Needle tube 210 is shown after perforated membrane 305 . Suture tip 410 of suture 415 is shown passing through membrane 305 and carried by the tip of suture passer 200 . Control button 130 is shown extending. Thus, the needle tube 210 does not cover the hook 205 and the suture end 410 is released from the suture passer 200 (the needle tip is opaque in FIG. 4A by the membrane 305). Needle track 150 shows suture 415 after suture end 405 has passed through membrane 302, is released, and suture passer 200 is withdrawn. As shown in FIG. 4A , both suture ends 405 and 410 are held by membranes 302 and 305 . From suture end 405, suture 415 passes through and exits needle track 150, loops over handle 100, is entrained with suture passer 200, and needle track ( 155) to enter. 4A-4C, the slider 115 is not shown to more clearly illustrate the internal suture prolapse path.

In FIG. 4B , suture passer 200 is withdrawn from needle track 155 and catcher 110 is retracted to grip suture ends 405 and 410 . The handle 100 is withdrawn from the surgical opening in this configuration, pulling the suture end 405 by the handle. Suture 415 makes a loop between needle track exit 152 and catcher 110 . Suture 415 also loops between needle track exit 157 and catcher 110 . These loops represent portions of suture 415 that have passed through the tissue to be sutured. Thus, when the handle 100 is removed from the surgical opening and pulls the suture ends 410, 415, the section of suture 415 looped through the tissue passes through the suture escape slot 400 and the remnant of the suture 415. will pull In FIG. 4C , suture 415 passes completely through suture exit slot 400 and through suture exit slot 160 .

Thus, with reference to FIGS. 1-4 , an embodiment of handle 100 of suture delivery device 300 includes needle track elements, such as needle tracks 150 and 155 and suture retention elements, such as catcher 110 . can include The needle track element may extend from the proximal end of the handle 100 toward the distal end and may include an automatic suture release mechanism, such as a suture escape slot 400 . The suture retention element may be disposed at or near the distal end of handle 100 . The suture delivery device may also have compression elements, such as slider 115, for example.

The needle track element may provide a defined trajectory for an inserted needle (eg, suture passer 200) through a handle (eg, handle 100) that begins near the proximal end and exits near the distal end. For example, with a handle inserted into a surgical opening, the needle enters the proximal end of a needle track element (e.g., needle tracks 150, 155) above the skin, travels through the needle track within the device, and passes through the distal end. It emerges and penetrates tissue layers (eg, fascia, muscle, and peritoneum) at a defined location and angle with respect to the handle. The needle trajectory can be completely enclosed by the handle between the inlet and outlet. The needle track element is coupled with an automatic suture release mechanism (described with reference to FIGS. 4A-4C ) so that the suture loop (or the major section of the suture excluding the suture end) is not retained at the distal end of the device and the handle is surgically When retrieved from the opening, it can slide without user intervention from the needle track.

A suture retention element (eg, catcher 110) may include a frame (eg, catcher elements 112, 114, 312, 314) and a suture capture surface(s) (eg, membranes 302, 305) or a frame. may contain only The suture retention element may have features that enhance grip on the suture (eg, teeth 140 ) and/or the openings described below with respect to FIGS. 28-30 . The suture retaining element frame may have a plurality of struts and may have a variety of shapes (eg flat, lantern, molly, umbrella, etc.). The suture retaining element frame may define the target area and provide a counter force to the compressive force of the compression element to interpose tissue therebetween. This counterforce can be against the peritoneum, for example. The suture retention element may also provide support to an optional suture capture surface during needle insertion. The suture retaining element may be inserted through a tissue opening in a low profile or retracted state and deployed in its expanded state after passing through a layer of tissue to an intended location, which may be, for example, in an abdominal cavity. The suture capture surface may be coupled to the struts of the frame and may be in a folded configuration during device insertion as well as during device retrieval.

A needle carrying a suture (eg, suture passer 200) may be introduced into a needle track element (eg, needle track 150) and guided to penetrate through a layer of tissue (eg, past the peritoneum), and catcher It can be inserted into (eg, positioned between catcher elements 112 and 312 or inserted into membrane 305 ). The design of the distal tip of the needle may allow the suture to separate from the needle (e.g., the hook 205 may have a ramp 235 that allows the suture 230 to slide, rather than a natural “hook”). . In some embodiments, the needle may be triggered to release the suture from its tip when inserted into the intended location.

In embodiments, a needle tip design (eg ramp 235 ) may allow the suture to separate from the needle. In embodiments having a capture surface (e.g., membranes 302, 305), the surface itself has properties or designs that enhance the capture and retention of suture 230 by the surface that assists in separating suture 230 from the needle. can have

The device may be retrieved from a surgical opening (eg trocar wound) while maintaining the captured suture end at the distal end of the device (eg catcher).

In one embodiment, the membranes 302 and 305 are essentially encapsulated by the frame of the catcher 110 during insertion and withdrawal of the catcher 110 through the tissue layer. In an embodiment, the suture ends may be captured by the membranes 302 and 305 as well as retained between the struts of the closure catcher 110 frame. In embodiments where the suture retaining element includes a frame, the suture ends may be retained during device retrieval by mechanical clamping between struts of the closure frame.

The suture delivery device may also have a compression element, such as slider 115, that is movable along the device shaft to accommodate various anatomy. The compression element may be positioned across the tissue relative to the counterforce member (eg, catcher 110 ). For example, the tissue can be a layer of the abdominal wall, the counterforce member can be positioned intraperitoneally against the peritoneum, and the compression element can face the surface of the skin. Thus, the compression element stabilizes the tissue while adapting to various anatomical structures. In some embodiments, the compression element is coupled to the counterforce member deployment mechanism such that movement of the compression element causes the counterforce member to deploy and retract.

5A and 5B show a cross-section of an embodiment of a handle 100 having retractable needle tracks 153 and 158 . In FIG. 5A , handle 100 is of an uncompressed configuration with slider 115 extending proximally away from catcher 110 . For simplicity, only the retractable needle track 153 will be described since the retractable needle tracks 153 and 158 are similar. Retractable needle track 153 includes a pair of tubes 505 and 510 configured to fold tube 510 into tube 505 . In an embodiment (not shown), tube 505 may be moved within tube 510 to avoid hitting the end of tube 510 when the suture passer is inserted (not shown). 5A and 5B, the tube 505 is secured to the slider 115 at its non-retractable end. Tube 510 is secured to shaft 105 at its non-collapsible end. Fixed attachments allow angular motion between the tube and a fixed point. In FIG. 5B , handle 100 is in a compressed configuration with slider 115 moved distally toward catcher 110 . With this motion, the retractable needle tracks 153 and 158 shorten in length and change the angle at which they exit the handle 100. Yet, retractable needle tracks 153 and 158 are oriented to direct suture passer 200 toward catcher 110 . Upon movement of the slider 115 from a non-compressed configuration to a compressed configuration, the retractable needle track 153 expands the volume within the shaft 105 bounded by the upper limit 520, the lower limit 525 and the needle track outlet 152. erase In this embodiment, the handle 100, shaft 105 and slider 115 are configured to allow this movement of the retractable needle tracks 153 and 158.

In a method using one embodiment, handle 100 is initially in a non-compressed and retracted configuration. In a first step, the handle 100 is inserted into the trocar wound. Proper positioning of the handle 100 can be verified through the use of a visual indicator as described below with respect to FIG. 37 . In the next step, control button 130 is pressed to open catcher 110 . In a next step, handle 100 is pulled toward tissue until catcher 110 contacts the peritoneum. In the next step, the slider 115 is pressed downward to interpose the abdominal wall against the catcher 110 . The handle 100 is stabilized within 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. In a next step, suture passer 200 is inserted into needle track 150 and trigger 220 is activated to release suture 230 . In a next step, suture passer 200 is retrieved from handle 100 . In the next step, the second end of suture 230 (or the end of a different suture) is loaded onto hook 205 and the previous two suture passing steps are repeated with another needle track 155 . The handle 100 may be retrieved along with the suture end according to the following steps. In the next step, control button 130 presses catcher 110 (the suture end may be held by any of the membranes 302, 305 or aperture 3004 shown in FIG. 28) to capture the suture end. do. In a next step, the handle 100 is withdrawn from the surgical opening to bring the suture end. The suture ends are then removed from the handle 100 and knotted.

6A-6C show embodiments of the suture catcher 110 in retracted, partially deployed, and fully deployed configurations, respectively. In FIG. 6A , suture catcher 110 has hinge joints 705 , 710 , 715 , struts 165 , 170 and catcher elements 112 , 114 . Joints 705, 710, 715 can be mechanical or living hinges or a combination. In FIG. 6B , catcher 110 has been expanded to a partially deployed state by pressing struts 165 and 170 towards catcher elements 112 and 114 using control rod 145 . Catcher elements 312 and 314 are similarly deployed. In FIG. 6C , catcher 110 is fully deployed using control rod 145 . 6C also shows selectable elements 302 and 305 attached to catcher elements 112 and 114 . Control button 130 ( FIGS. 1 and 3 ) may be connected to control rod 145 and may be used to actuate control rod 145 .

7 shows a cross section of one embodiment of handle 100 . In the embodiment of FIG. 7 , the slider 115 can be easily moved in a distal direction rather than a proximal direction using a ratchet 805 and rack 810 . Thus, the slider 115 can easily move to a compressed configuration rather than a non-compressed configuration. In this embodiment, pressing the slider button 125 releases the ratchet 805 allowing the slider 115 to move proximally. Rack 810 may include a lower limit (not shown) that prevents the slider from moving too far in the compression direction. In one embodiment, a friction pad (not shown) is used between slider 115 and shaft 105 . The shape of the friction pad is designed to adjust the pressing friction force in two directions.

8A-8G illustrate embodiments of various stages of deploying a suture. 8A is a perspective view of the loaded suture passer 200 inserted into the needle track 150. In FIG. 8A , the catcher 110 is in a deployed configuration. Needle tube 210 gripping suture end 405 has exited needle track 150 but has not yet penetrated membrane 302 . In FIG. 8B , suture passer 200 is further inserted into needle track 150 such that needle tube 210 penetrates membrane 302 (not shown) and passes suture end 405 through membrane 302 as well. get drunk In FIG. 8B , needle tube 210 is shown passing through three tissue layers 902 , 904 , 906 . Thus, eventually the bite of suture 230 will include these layers. In FIG. 8C, suture passer 200 is further inserted into needle track 150, causing trigger 220 to be depressed, which, as described with reference to FIGS. reset to “off” and release the suture 230 from the suture passer 200. Figure 8d shows the closure of the device from Figure 8c. In FIG. 8D , needle tube 210 and suture end 405 have penetrated membrane 302 . Suture end 405 is shown without hook 205 and needle tube 210 . In FIG. 8E , suture passer 200 has been withdrawn from needle track 150 . Sealed end 405 was retained by the retaining squeeze properties of membrane 302 . 8F shows the process repeated with suture end 410, needle track 155 and membrane 305 (not shown). 8F also shows a bite of suture having suture ends 405 and 410 passing through tissue layers 902, 904 and 906, respectively. 8G shows handle 100 after suture passer 200 has deployed and retracted suture ends 405, 410 into membranes 302, 305.

9A and 9B show the handle 100 in different stages of capturing the suture end. After the suture ends 405, 410 have been deployed on the membranes 302, 305 (as in FIG. 8G), the control button 130 is depressed to move the control rod 145 distally to the catcher 110. to close 9A shows handle 100 approximately midway through the process of capturing the suture ends. As control button 130 is depressed, membranes 302 and 305 are folded between catcher elements 114 and 314 (FIG. 3) and 112 and 312 (FIG. 3), respectively, together with the suture ends ( 405, 410). 9B shows the catcher 110 in a retracted configuration. Control button 130 is fully depressed. In this configuration, the catcher 110 no longer provides a force counteracting the compressive force of the slider 115, which is still in the compressed position. That is, the catcher 110 no longer provides a flat surface for tissue layers 902, 904, 906 and can be easily retrieved. In the fully retracted position, elements 114, 314 and 112, 312 engage respective suture ends 405, 410. Optional teeth 140 (see FIGS. 6C and 8D ) that may be between catcher elements 112, 312 and 114, 314 improve retention on suture ends 405, 410.

10A and 10B show an embodiment of handle 100 that automatically releases the suture after catcher 110 is fully retracted. In FIG. 10A , suture 230 has been deployed, for example on layers 902 , 904 , 906 of the abdominal wall with suture ends 405 , 410 captured by catcher 110 on handle 100 . Handle 100 is pulled out of surgical open 100, carrying suture ends 405, 410 with the handle and more suture 230 into surgical open 1100 and tissue layers 902, 904, 906). This causes the loop of the suture 230 to enter the suture escape slot 400 (see FIGS. 4A to 4C). In FIG. 10B , continuing to pull the handle 110 causes the remaining suture 230 to pass through the suture exit slot 400 and the suture exit slot 160 .

A method using an embodiment to close a wound begins with a suture delivery device handle in a non-compressive and retractable configuration and a suture passer separated from the handle. In Step 1, remove the trocar from the wound with one hand. In step 2, the other hand inserts the handle into the trocar wound until the catcher is fully visible on the laparoscopic image. In step 3, one finger presses the control button to open the catcher under visual guidance using the laparoscopic image. In step 4, while holding the handle with one hand, push the slider toward the patient with the other hand until the tissue to be sutured is firmly interposed between the slider and the catcher. Laparoscopic images can be used to show that the catcher is making contact with the peritoneal wall. In step 5, one hand holds the suture passer body, and the other hand inserts one end of the suture into the hook of the suture passer. The finger then presses the needle button to load the suture passer. In step 6, one hand holds the handle and the other hand inserts the suture passer through the needle track until the trigger is actuated, releasing (or deploying) the suture back onto the catcher under the visual guidance of the laparoscopic images. Repeat steps 5 and 6 with the other end of the suture at step 7 and the other needle track. In step 8, press the control button with one finger to capture the suture under visual guidance. In step 9, pull the handle from the wound with one hand and retrieve the two suture ends from the wound.

11 shows 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. Suture catcher 1005 can accommodate multiple struts 1110 . Each strut 1110 has a proximal connection 1115 to a proximal joint 1117 (upper hinge), an upper strut 1120, an intermediate hinge 1125, a lower strut 1130, a distal (or lower) hinge 1135 ), and distal connection 1140 to distal hinge 1135. The hinge may be a living hinge, a mechanical hinge or a metal wire/leaf spring hinge. The struts may be made of metal (ie stainless steel), plastic (ie polypropylene, polycarbonate, polyurethane, nylon or polyethylene) or any other suitable material. Multiple struts may be connected at the proximal and distal joints to form a catcher. The control rod 1145 may be connected to the distal connection 1140 of the catcher and extend to the proximal end of the suture delivery device. In one embodiment, motion of the control rod 1145 drives up and down motion of the distal connector 1140 to open (up or "extend" the distal joint) or close (down or "retract" the distal joint) suture catcher. ) induces In an alternative embodiment, the catcher deployment mechanism may be actuated by controlling the proximal linkage 1115 . In an embodiment, when in a deployed configuration, catcher 1105 acts as a counter force member to tissue compressive forces.

The length of the lower and upper struts may be selected based on the desired size of the target area of the catcher 1105 or based on the desired angle formed between the upper and lower struts or both. The shape of the strut may be rectangular or trapezoidal. An advantage of the trapezoidal shape over the rectangular shape is that it provides additional membrane packing space. The outer surface of the strut (the surface seen in the retracted configuration) is available in several variations, including flat and planar surfaces with curved edges. A design with a curved surface may have fewer sharp edges, resulting in a suture delivery device with a more trauma-free external profile. That is, in various embodiments, strut components (including raised and mating features) may be flat or may be curved to create a more rounded outer profile (see FIG. 13C ).

12A and 12B show an embodiment of attaching membrane 1200 to strut 1205 . Membrane 1200 may be made of polyurethane, PVC, polypropylene, or other flexible material that does not resist being perforated or overly folded. To more securely hold the suture between the struts during device retrieval, the catcher must be closed to allow adjacent struts (or features for securing the suture, such as teeth) to engage in a designed manner. Proper closure of the catcher is much more likely if the membrane is folded and packed into a profile that does not interfere with the closure of the catcher frame. However, the catcher membrane may not naturally be folded or packed in a particular orientation or configuration. Also, the space in which the membrane can be packed is a space surrounded by the struts when the struts are retracted, and the space is limited. Moreover, membranes with various thicknesses and stiffnesses have different folding behaviors. The location of attachment of the membrane to the strut was found to affect the folding behavior. Thus, in an embodiment, the catcher's strut or frame may be designed to guide the membrane so that it can be folded in a desired manner, for example radially inward towards the control rod 1245 (FIG. 12B).

The membrane may be bonded to the frame struts by various methods (eg adhesives, mechanical attachments, etc.). The membrane attachment location may extend completely to the edge of the strut or may be attached at a location recessed from the side edge of the strut. To facilitate complete encapsulation of the membrane by the strut when the catcher is closed, the membrane 1200 may be attached at a recessed location 1210 from the lateral edge as shown in FIGS. 12A and 12B . Membrane 1200 typically has a minimum curvature and radius. Thus, attachment of the membrane 1200 recessed from the edge of the strut 1205 allows the membrane 1200 to be folded within the space defined by the strut, as shown by fold 1215 . This helps prevent the membrane 1200 from clustering between the struts 1205 and reducing the ability to fasten and secure the sutures together.

13a to 13d show a further embodiment for attaching a membrane to a strut. In FIG. 13A , the strut 1300 has a two-piece structure comprising an outer (or upper) strut component 1305 and an inner (or lower) strut component 1310 that intersects a membrane 1315 . The outer strut component can be wider than the inner strut component and the membrane attachment edge 1320 can be recessed from the edge of the outer component 1305 . The difference between the outer and inner strut component widths provides membrane attachment support by interposing the membrane and facilitates membrane folding by allowing membrane attachment edge 1320 to be recessed from the edge of strut 1305 . In FIG. 13B , a membrane guide feature 1325 may be used between strut 1305 and membrane 1315 to assist in pressing the membrane inward. Guide feature 1325 may be part of strut 1305 or membrane 1315 or may be a separate additional component. Guide feature 1325 can be, for example, a metal rod. Guide feature 1325 protrudes from the surface of the strut to increase or initiate folding of membrane 1315 . Thus, instead of taking a more parallel path with the struts 1305, the membrane 1315 immediately bends inward to help achieve the intended membrane folding. Protruding features of various shapes and sizes may be used to create different membrane bending patterns as desired.

In FIG. 13C , the outer strut component 1330 may have an edge that curves slightly inward to help facilitate folding of the membrane 1315 inward and away from the outer strut edge when the catcher is closed. 13D shows an embodiment of a catcher with a two-piece strut design in a closed configuration. Closure catcher 1340 also has outer strut components 1345 with angled edges 1350 that increase the contact surface between outer strut components 1345 .

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

14A and 14B show an embodiment for mechanically attaching a membrane. In this embodiment, the strut 1400 may have a two-piece structure with an outer/top strut component 1405 and an inner/lower strut component 1410 with a membrane 1415 interposed therebetween. Membrane 1415 is preferably flexible and can be secured by mechanical means such as clamping or fasteners. In this embodiment, outer strut component 1405 and inner strut component 1410 have interlocking features 1420 assembled together to secure membrane 1415 . Interlocking features 1420 include cooperating holes that cooperate to secure membrane 1415 between protruding features and struts 1405 and 1410 . Membrane 1415 is elongated and adapts around protruding feature 1420 . Positions 1430 indicate possible patterns of features 1420 . Alternatively, membrane 1415 may have a punched hole corresponding to feature 1420 such that membrane 1415 is not elongated to accommodate feature 1420 .

15A and 15B show an embodiment for mechanically attaching a membrane. In FIG. 15A , the membrane 1505 has a hole allowing the protruding feature 1520 to pass through. Alternatively, protruding features 1520 may be designed to puncture through membrane 1505 during the strut component interlocking process. The strut may receive a plurality of protruding and mating features to form a desired protruding pattern.

Attachment of the membrane to the struts can only be provided by mechanical forces generated by interlocking components. Alternatively, an adhesive may be used to provide additional membrane adhesion. In embodiments where the protruding features are plastic and penetrate holes in the membrane, the protruding features may be melted or welded to other strut components to provide interlocking force. Additionally, the membrane may also be thermally welded to one or both of the strut components.

Metals have an advantage over plastics in resisting creep and function more effectively as tension retaining elements. As an alternative to the embodiment of FIG. 15A , the membrane 1505 can stretch over the protruding feature 1520 while the strut component with a matching feature in the form of a “metal clip” can extend the membrane 1505 over the protruding feature. It can be applied to intervene section 1520. The metal clip portion may be formed by stamping or other suitable method.

Fig. 15b shows an addition to the embodiment of Fig. 15a. The mating feature has a slide locking portion 1525 in the form of a thin metal piece, i.e., a slot 1530. Slot 1530 is sized to slide onto the neck of the protruding feature. In this variant, the membrane has punched holes to accommodate the protruding features. The slide locking portion 1525 may be stamped, laser cut, or fabricated by any other suitable method.

16 shows an embodiment for mechanically attaching a membrane through a strut. Small slits 1605 can be created in the suture catcher struts 1610 and the membrane 1615 can be threaded through these openings. The size, length and geometry of the opening may be optimized to control the attachment of membrane 1615 to strut 1610. The membrane 1615 can be inserted through the first slit 1605 from the inside side of the strut 1610, across the outside side of the strut 1610, and the second to reappear on the inside side of the strut 1610. It can be inserted through slit 1605. Additionally, adhesives or other methods may be used as an adjunct method to increase the membrane-strut anchorage. Slit 1605 also serves the purpose of guiding or controlling the angle at which membrane 1615 exits strut 1610 . Since the slit 1605 is located away from the lateral edge, the membrane 1615 appearing on the inside of the strut is recessed at some distance from the lateral edge. Thus, membrane 1615 has room to rotate radially inward and does not interfere with strut closure since it is already guided in that direction by slits 1605 .

In an alternative embodiment, a slit 1605 may extend into one end of the strut 1605 and create an opening for the membrane 1615 to be slid and held by the strut 1610 (similar to a paper clip). there is. The open edge may be at an outer radial edge or a proximal inner edge of the device shaft.

A membrane stretched between two struts tends to sag along the unsupported edge. In an embodiment, the membrane may sag particularly where it extends radially beyond a straight line between the two strut ends. In this section, the membrane does not have sufficient support from the struts and may not be strong enough to resist bending when contacted by a needle or suture passer. This bending may reduce the effective target area for suture capture as the needle may slide past the bending membrane without penetrating. Embodiments relate to improving membrane tension to manage the degree of membrane sagging or bending.

17 shows an embodiment of a catcher for managing the degree to which a membrane can sag or bend. In FIG. 17 , membrane 1705 has a straight edge 1710 that follows a line between the outer radial edges of two adjacent open struts 1715 . The membrane 1705 may be more effective at capturing sutures than a shape in which the membrane material extends beyond the line between the strut ends (eg, a membrane with an arc-shaped outer edge extending). The straight membrane 1705 eliminates areas of the membrane that are not well supported by the struts 1715, thereby reducing the likelihood of bending the membrane 1705 upon needle contact. 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 for which suture capture is not intended, i.e., no needle tracks are directed.

In an embodiment, the edge of the membrane 1705 may be reinforced with a tension member 1720 to improve membrane expansion. In one embodiment, the tensile element 1720 may be a string or other fiber coupled to the edge of the membrane, the end of which is attached to the catcher strut much like a string around the perimeter of a kite. For example, tensile element 1720 can be fused Kevlar fibers at the edges of the membrane. The fibers can be stretched to create tension in the portion of the fiber between the strut ends, thereby providing support to the outer edge of the membrane. The mechanism for tensioning the fibers may be the development of a capture strut. An alternative or additional mechanism for tensioning the fibers may be to cause the struts to extend radially outward after the catcher struts are deployed.

Fibers can be bonded to the membrane edge by different methods. One method is to adhere the fibers to the membrane edge. Another method is to fold the membrane edges to create pockets to accommodate the fibers. Another method is to fuse the membrane layers together with fibers sandwiched between the layers.

The tensile element may be more flexible than the membrane so that the tensile element does not adversely affect the membrane packing. In an embodiment, the tension member itself may have a default bend to help fold the membrane. The cross section of the tensile element can be of any desired shape.

18A and 18B show one embodiment of a suture delivery device handle 1800. In an embodiment, suture ends 1805 and 1810 may be loaded onto handle 1800 before handle 1800 is inserted and inserted into the surgical opening. In FIG. 18A , suture ends 1805 and 1810 have been loaded onto handle 1800 at distal openings 152 and 157 of needle tracks 150 and 155 . 18B shows a friction method for loading sutures. In FIG. 18B , slots 1815 and 1820 are configured to retain suture ends 1805 and 1810 by, for example, a press fit or other wedging action. In an alternative embodiment, flexible retention flaps 1825 and 1830 are added to further retain the suture ends 1805 and 1810. Flaps 1825 and 1830 may be rubber or metal, for example, depending on the desired holding force. Additionally, handle 1800 may have suture ends 1805 and 1810 loaded during the factory assembly process.

19A and 19B show an embodiment of loading sutures using a suture cassette. In FIG. 19A , cassette 1905 stores one suture 1910 and has two access ports providing access to suture ends 1915 and 1920 . In FIG. 19B , handle 1900 is exposed within needle tracks 150, 155 inside handle 1900 for final loading into a suture passer in preparation for receiving a suture cassette 1905 and deploying suture 1910. and a cassette insertion port 1925 configured to place suture ends 1915 and 1920 therein.

In one embodiment, the slider 115 is spring-loaded to compress the tissue to be sutured when the control button 130 is depressed. Thus, in an embodiment, pressing the control button 130 can cause two actions. First, the catcher 110 can be deployed, and second, the slider 115 can be forced to move distally towards the catcher 110 . This action may be accomplished with a spring loaded as the slider 115 moves proximally away from the catcher 110 . The spring may have a trigger actuated by the last stage of the button stroke to open the catcher 110 first by pressing the control button 130, and when the control button 130 is depressed by any other amount, the trigger is actuated. to release the spring, and then press the slider 115 toward the skin, interposing tissue between the slider 115 and the catcher 110.

20A-20C show an embodiment in which the wing is a flexible section of the catcher strut and helps capture the suture. 20A shows struts 912, 914, 916, 918 having sections with similar dimensions and stiffness to struts 112, 114, 312, 314 (FIG. 3). Struts 912, 914, 916, and 918 have flexible wings 1905, 1910, 1915, and 1920. 20B shows the flexible wings 1905 and 1910 being folded within the catcher 110 when retracted. When catcher 110 is deployed, wings 1905, 1910, 1915, and 1920 open to their intended positions, and pairs of wings 912, 916 and 914, 918 open and overlap to form a suture as shown in FIG. 20A. presents a target area for In an embodiment, the target area presented by the pair of overlapping vanes is a plane similar to that presented by membranes 302 and 305 (FIG. 3), but still references 1905, 1910, 1915, 1920 do not rely on tension for support. and, accordingly, they may be configured to extend beyond the area defined by the struts 912, 914, 916, and 918. Wings 1905, 1910, 1915, 1920 may be pierced similarly to membranes 302, 305 to help capture the suture ends or they may help suture passer 200 break seams 1925, 1930 between pairs of wings. Passing it through can assist in capturing the suture. Once the suture passer 200 passes through the seam 1925, 1930 to release and retrieve the suture, the pair of wings 1905, 1915 or 1910, 1920 close and capture the deployed suture. The captured suture end may be pulled by the pair of wings as catcher 110 is retracted (FIG. 20C) and gripped more firmly by pair of struts 912, 916 or 914, 918.

21A-21E show an embodiment that allows multiple uses of the catcher membrane by changing the position through which the catcher membrane is pierced. Typically, each time a needle is inserted through the membrane, a footprint is created on the membrane. With multiple needle insertions, holes created in the membrane can reduce the ability of the membrane to capture and retain subsequent sutures. Embodiments provide for multiple uses of the same device by varying the area through which the suture passer is pierced according to each use. The suture catcher can be rotated so that the intended membrane area for needle penetration is (sufficiently) different each time. The rotation can be a large angle or a small angle depending on the intended number of needle penetrations and repeated needle penetrations allowed. Other embodiments reduce the likelihood of needle penetration in the same area repeatedly, for example, by providing random rotation of the suture catcher.

21A and 21B show one embodiment of a multipurpose catcher with a random rotation mechanism. In this embodiment, the strut of the catcher can be pivoted within a prescribed distance relative to the handle shaft. Membrane attached to the struts can pivot with them. 21A, a single strut 2010 is clearly shown, but the following description applies to the other struts of the catcher. Catcher strut 2010 is free to pivot about angle 2015 within window 2020 of shaft 2005 . The size of the window 2020 may define how much the catcher strut 2010 can rotate. A window 2020 may be provided at the proximal portion of each strut of the catcher (e.g., proximal connector 1115 (FIG. 11)) to allow each individual strut to move freely within the window. The connection between the distal joint and the control rod can be floated such that rotation of the proximal joint can cause rotation of the entire catcher. The random rotation of the catchers allowed in this embodiment reduces the probability that two needles will penetrate the membrane exactly at the same location. FIG. 21B shows a perforation pattern on the membrane that may result from rotation of the strut-equipped catcher as in FIG. 21A. In FIG. 21B , membrane 2025 may result from the use of a suture passer within a single needle track, eg, needle track 155 ( FIG. 3 ), as the catcher and membrane are rotated within an angle 2015 . Perforations 2030a, 2030b and 2030c are shown.

21C shows an embodiment of a multipurpose catcher having a needle track with internal pivot points. The needle track 2105 may have a larger diameter than the needle or suture passer between the insertion point 2110 and the narrow portion 2120 and between the exit point 2115 and the narrow portion 2120. The narrow portion 2120 may be a narrow portion or simply a bump in the needle track 2105 at some location within the needle track 2105 that serves as a turning point. While the needle or suture passer can move radially within the needle track 2105, the constriction 2120 moves the proximal end of the needle or suture passer, as illustrated by exemplary suture passer locations 2125 and 2130. By doing so, it can act as a pivot point that facilitates moving the distal end of the needle or suture passer relative to the surface of the suture passer 2135 . Suture passer positions 2125 and 2130 indicate that the suture passer may exit needle track 2105 at various angles relative to shaft 2140 and suture catcher 2135 , depending on the embodiment. The changing angle reduces the probability that the needle will penetrate the membrane on suture 2135 exactly in the same location. In one embodiment, needle track 2105 may be shaped like an hourglass. In a further embodiment, the needle track 2105 may not have a narrow portion 2120, but still allow exemplary suture passer locations 2125 and 2130 since it is generally larger in diameter than a needle or suture passer.

21D shows a top view of a handle 2200 that provides multiple uses for the catcher membrane. In FIG. 21D , multiple needle track pairs 2205a and 2205b, 2210a and 2210b, and 2215a and 2215b each target a different respective area of the membrane (not shown). A dial feature (not shown) can also rotate the upper end of the handle 2200 to expose one set of needle tracks at a time.

21E shows a cross-section of a multiple use embodiment using an automatic pen rotation mechanism. Rotation of the suture catcher may ensure that the needle or suture passer penetrates the membrane at an unused location of the membrane. In this embodiment, an automatic pen rotation mechanism 2300 or variations may be used to accomplish this. Mechanism 2300 contains features that transfer up-and-down motion of control rod 2305 to rotational motion of control rod 2305. The control rod 2305 is connected to the distal joint of the suture catcher so that rotation of the control rod 2305 causes rotation of the distal joint, and the proximal joint of the suture catcher permits rotational motion of the suture catcher, thereby controlling the control rod 2305. Rotation will result in rotation of the suture catcher. The magnitude of the resulting rotation is controlled according to the design of the rotation mechanism 2300 and can be arbitrarily small or large. In a variation of this embodiment, the up and down motion of the control rod 2305 causes rotational motion of the proximal joint of the suture catcher, the connection between the distal joint and the control rod floats, and the proximal joint causes rotation of the entire suture catcher. do.

Embodiments may use a suture passer with a tip designed to receive suture pre-loaded onto the handle (eg, see FIGS. 18A and 18B and text relating to loading suture onto the handle). In this embodiment, the tip of the suture passer is preferably: capable of gripping the suture end prior to entering abdominal tissue; holding the suture end while penetrating the tissue to be sutured and the catcher membrane when the catcher is so mounted; Deploy the suture end.

22A-22D show different embodiments of suture passers designed to grip, hold, and deploy sutures. In FIG. 22A , suture passer 2400 has a fixed tip 2405 having a slot 2410 configured to engage suture 2415 located at outlet 2420 of needle track 2425 . In FIG. 22B , suture passer 2430 is a clamping member for clamping suture 2445 to stationary member 2450 upon propulsion of device 2455, for example, a drive axle inside suture passer 2430. It has actuation tip 2435 with 2440. In FIG. 22C , suture passer 2460 has a gripping tip 2465 with needle head 2470 actuated by internal rod 2475 to grip suture 2480 towards needle tube 2485. 22D shows the gripping tip of the suture passer 200 described above with reference to FIGS. 2A and 2B for comparison. This embodiment of the suture passer can also be used to receive preloaded sutures on the handle. Similarly, the embodiment of the suture passer of FIGS. 22A-22C may be loaded with suture prior to insertion into the needle track of the handle. In an embodiment, any needle tip embodiment disclosed may be configured to cooperate with any of the disclosed needle tracks.

In one embodiment of the procedure for deploying a suture loaded onto the handle, after tissue to be sutured is interposed by the handle (eg, see FIG. 8B ), the suture passer operates until the tip reaches the suture loaded on the handle. It is inserted into and through the needle track. The suture is then loaded onto the suture passer. The suture passer is then inserted through the needle track to deploy the suture end onto the catcher. Depending on the catcher configuration, the suture end can be deployed by being released within the gripping distance of the catcher strut, or it can be inserted into the catcher membrane and deployed and then released. After the suture is released, the suture passer can be retrieved and inserted into the second needle track while repeating the process with the second suture loaded on the handle.

23A and 23B show cross-sections of embodiments in which a suture passer is integrated into handle 2500. 23A, suture passers 2505 and 2510 are located within needle tracks 2515 and 2520, respectively, and are used to develop sutures. Suture passers 2505 and 2510 may be designed to reside within needle tracks 2515 and 2520 . The actuation button 2540 (or control lever or control slider), when actuated, moves the suture passers 2505 and 2510 through the needle tracks 2515 and 2520, grips the loaded suture and handles the shaft 105 of the handle 2500. ) and penetrate the tissue to be sutured, for example abdominal tissue. The suture passers 2505 and 2510 may then deploy the suture onto the catcher 110 .

In this embodiment, to develop sutures, suture passers 2505 and 2510 are deployed using rollers and tracks 2545 and control buttons 2540 to advance two suture passers through needle tracks 2515 and 2520. can make it Roller and track 2545 can include roller 2550 in track 2555 coupled to actuation arm 2560 . Control button 2540, when depressed, may cause roller and track 2545 and actuation arm 2560 to move toward distal end 2525 of handle 2500. Actuation arm 2560 forces suture passers 2505 and 2510 through needle tracks 2515 and 2520 to develop sutures. Roller and track 2545 are configured to allow actuation arm 2560 to move inwardly of handle 2500 as arm 2560 moves distally. In FIG. 23B , control button 2540 is fully depressed, allowing suture passers 2505 and 2510 to extend past catcher 110, open suture passer tips (eg, see FIGS. 22B-22D ), and deposit sutures. (not shown). Movement of control button 2540 represents control button 130 controlling catcher 110 and possibly slider 115 as previously described. Movement also caused roller 2550 to move inwardly within track 2555 in response to actuation arm 2560 following the contours of needle tracks 2515 and 2520 . In one embodiment, the functions of control buttons 130 and 2540 are performed by a single control button.

Embodiments of a suture delivery device may be used to implement methods for inserting and retrieving a suture passer, capturing, holding, and securing a suture. In embodiments, membrane properties affect suture capture, retention, and fixation. As described, when a needle or suture passer carrying a suture is inserted through the membrane, the suture may be released and captured by the membrane. When the catcher is closed, the membrane can be folded into the catcher frame closure to retain the suture within the membrane. The membrane itself may be made of a material with a high coefficient of friction or may further have a design that increases the suture retention properties of the membrane. Retention properties can be a function of material thickness, or number of material layers or material surface. The retaining feature may be on one or both sides of the retaining surface.

In an embodiment, the suture may be secured by the catcher strut edge. A number of methods (individually or in combination) can be used to ensure that the suture is secured to the distal end of the device. Mechanical clamping of the suture may be used to retain the suture during withdrawal of the suture delivery device from the surgical opening. The edge of the adjacent strut can be used to secure the suture (as a mechanical clamp). In embodiments where the suture catcher is fitted to the membrane, the membrane holding force may not be sufficient to withstand the force applied by the suture to the sutured tissue, even when the suture is properly engaged with the membrane. Thus, the adjacent catcher strut may be used as a clamp to secure the suture. These adjacent struts may be used independently (eg, in catcher embodiments that do not include a membrane) or may be used in combination with a membrane (eg, in catcher embodiments that include a membrane).

24A-24E show an embodiment of a catcher that varies the length of the clamping surface, or the number of clamping surfaces or the number of contact points. In FIG. 24A , strut edges 2605 and 2610 of strut 2620 are angled to increase the contact surface with suture 2615 . That is, the edge of the catcher frame strut is slanted, and the suture contacts the strut for the length of the slanted edge of the strap. In FIG. 24B , struts 2625 and 2630 are configured to create a single point of contact 2635 towards suture 2615 . In FIG. 24C , suture 2640 has a different size than strut 2650 . Suture 2615 is clamped between the surfaces of a pair of differently sized struts 2640, 2650. In FIG. 24D , strut edges 2655 and 2660 are joined to create an angle at seam contact surface 2665 . The angle may be 90°, for example. The catcher strut may also have a sawtooth or wavy edge along the suture contact edge. The advantage of this edged design is that the direction of the force applied to the suture is changed, increasing the normal force at points along the suture. In FIG. 24E, struts 2670 are added to the configuration of FIG. 24B to create additional seam contact points 2637.

In embodiments, in addition to the various strut designs just discussed, the strut edges may be roughened, treated, coated or otherwise treated to increase friction and improve suture anchoring performance. For example, a rubber pad or strip or rubber coating may be applied to the strut edge.

In an alternative embodiment of the catcher, a suture may be clamped between the inwardly folding catcher struts against the control rods or against blocks disposed around the control rods that provide a flat surface to the struts when the struts are folded inwardly. In this embodiment, the membrane and suture may be clamped between an outer element (strut) and an inner element (control rod or block around the control rod). The effectiveness of suture clamping can be linked to sufficient (or complete) closure of the suture catcher, the level of closure force applied and the interference caused by the membrane can affect the clamping effect.

In various embodiments of the suture catcher, increasing the strut closing force may increase the retention force on the suture. As a result, the catcher may hold the suture during more forcible extraction of the suture delivery device from the surgical opening.

In embodiments, a suture may be retained by a catcher without a capture surface, eg, a membrane. In this embodiment, the struts of the catcher may directly clamp the suture. The clamping action can be part of the catcher that can be retracted to be extracted from a surgical opening, for example.

25-27 show additional embodiments of delivering and capturing sutures. 25A, 25B and 26 show an embodiment of capturing a suture on one side of a surgical opening and moving the suture to the other side to complete the suture. 25A and 25B show a top and perspective view of a clamping device 2700 with clamping arms 2705 and 2710 pivoting in directions 2707 and 2712, respectively, to capture suture end 2720. Clamping arm 2705 can be rotated by internal shaft 2725 and clamping arm 2710 can be rotated by external shaft 2730. The clamping device 2700 can replace the catcher 110 on the handle 100 of FIGS. 1A and 1B, for example. Clamping device 2700 can be used to capture and place suture 2720 on the opposite side of clamping device 2700 within the surgical opening.

26 shows a capture device with a large area membrane 2805 supported by a strut 2810 pivoting about a shaft 2815 to deposit a captured suture 2820 on the opposite side of the capture device 2800. A perspective view of 2800 is shown. Suture 2820 is supported by membrane 2805 as previously described. Catching device 2800 may replace catcher 110 on handle 100 of FIGS. 1A and 1B .

One embodiment may include an umbrella-shaped membrane, which is supported by several radially extending struts and spans 360 degrees around the device. Like an umbrella, the membrane can easily penetrate the membrane material when the membrane is in tension. Also, the friction between the membrane material and the suture may be sufficient to separate and retain the suture when the suture passer is withdrawn. Alternative embodiments may include multi-layer membranes in which each layer has a different orientation. In such a multi-layer membrane, the suture can separate from the suture passer due to both friction and becoming entangled in the lattice structure.

The embodiments shown in FIGS. 25A, 25B and 26 can be used according to the following method. The needle carrying the suture (or suture passer) is inserted into the needle track and then inserted into the muscle/fascia layer on one side of the trocar wound using a handle equipped with either a clamping device (2700) or a capture device (2800). . The suture passer releases the suture and retreats. In the clamping device 2700, the suture is captured by movement of the clamping arms 2705 and 2710. For the capture device 2800, the suture passed through a membrane 2805 having material properties or design to keep the suture separate from the needle passer. Once the suture is held, the suture can be moved by rotating the device 2700 or 2800 to reposition the suture 2720 or 2820 to the opposite side of the trocar wound. The surgeon can then easily withdraw the suture as the suture is positioned at the target point of the inserted needle (or suture passer) through the other needle track on the handle and through the tissue to be sutured. Once through the tissue to be sutured, the needle (or suture passer) can be guided in the laparoscopic image to capture the repositioned suture. The captured suture may have a controlled shape, orientation and tension that facilitates the surgeon to withdraw it. Like the previous embodiments, these embodiments eliminate the need for an assistant to assist the surgeon in moving the suture into a position where it can grip the suture with the suture passer.

27 shows a plan view of an embodiment for connecting a suture end within a surgical opening. In FIG. 27 , clamping device 2900 has clamping arms 2905 and 2910 that pivot in directions 2907 and 2912 , respectively, to erase through an arc and capture suture ends 2920 and 2922 . Clamping arm 2905 can be rotated by internal shaft 2925 and clamping arm 2910 can be rotated by external shaft 2930 (alternatively, such that only one clamping arm captures both suture ends). rotated). The clamping device 2900 can replace the catcher 110 on the handle 100 of FIGS. 1A and 1B, for example. Clamping device 2900 can be used to capture suture ends 2920 and 2922 and connect them by link element 2935. Link element 2935 may be a crimp or biodegradable member attached to one of clamping arms 2905, 2910. It may also be a clamp or clip. Also, the suture ends 2920 and 2922 may be connected using adhesive or heat. The resulting suture connection must be at least strong enough to keep pulling the suture joint through the tissue track created by the needle or suture passer. Alternately, the suture connection must be strong enough to serve to close the wound.

The clamping device 2900 may be used according to the following method. The sweeper or clamp arm is initially positioned so as not to impede suture delivery. The two suture ends are passed on opposite sides of the trocar wound. The clamp arm is then rotated 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 may then be withdrawn.

In this embodiment, one option for finishing the suture involves passing two ends of one suture. When the two suture ends are connected, the connected suture becomes a loop. The user may cut the suture at the outer-proximal end of the trocar wound. The user can then pull the outer suture end to close the wound and then knot the end. Alternatively, the user may pull the suture link through the surgical opening or pull one side of the suture loop with the suture delivery device to exit the link through the tissue track created by the initial needle insertion. The user can then cut the suture joint, close the surgical opening, and tie a knot. Another option is to pass two suture ends to the abdomen, each from a separate suture. Once the two suture ends are connected, the user can withdraw the device and finalize the suture as described above.

In one embodiment, the catcher closure mechanism is slider actuated. The suture delivery device may have a sliding member that may be positioned to sandwich abdominal wall tissue within the abdominal cavity against a counterforce member (eg, a catcher). Many of the described embodiments are configured in this way. In this embodiment, the slide member is coupled to the catcher deployment mechanism so that movement of the slide member can be used to control opening and closing of the catcher. With the slide member engaged to the deployment mechanism, as the slide member moves downward (toward the distal end of the device), the catcher deployment mechanism may be actuated to open the catcher. When the slide member moves upward (toward the proximal end of the device), the catcher deployment mechanism can be actuated to close the catcher. The position where the slide member interacts with the catcher deployment mechanism can be designed as desired. In one embodiment, the catcher can open when the slide member moves a small distance downward, while the catcher can close when the slide member moves a small distance upward. For example, moving the slider downward may move the distal joint upward to deploy the suture catcher. A variety of instrumentation options can be used to implement this concept.

A method using an embodiment may include: inserting a suture delivery device through a tissue track until the distal end is within the cavity; moving the sliding member toward the distal end of the device to open the catcher and then interposing abdominal wall tissue between the catcher and the sliding member; delivering the suture to the suture retaining element (catcher) by inserting a suture-carrying needle into the device until the suture is released and held at the distal end (or until the suture is released and captured by the catcher); moving the sliding member toward the proximal end of the device to close the catcher and release the abdominal wall tissue; and retrieving the suture delivery device from the cavity having the suture end held at the distal end of the device.

A method for automatically deploying a suture includes: inserting a suture delivery device into a surgical opening; intercalating the scar tissue; deploying the suture end and retrieving the handle. Interposing the scar tissue may further include: pressing a button to cause the catcher to open and the slider to compress the tissue against the catcher. Deploying the suture end may further include: using an independent suture passer or using a suture passer integrated with the handle. Retrieving the handle may further include closing the catcher to capture the suture and automatically releasing the suture.

The method for deploying a suture includes: loading a suture onto a handle or loading a suture cassette into a handle; removing the trocar with the left hand; inserting the handle with the right hand into the trocar wound until the catcher is fully visible in the laparoscopic image; releasing the control button to open the catcher with the right hand and then pressing the slider downward to interpose the tissue under visual guidance. Laparoscopic images can be used to show that the catcher is making contact with the peritoneal wall. In one embodiment, the method for selectively deploying a suture includes: holding a handle with the left hand; inserting the suture passer through the needle track with the right hand to deploy the suture on the catcher under visual guidance; and repeating it with other needle tracks under visual guidance. In another embodiment, the method for selectively deploying a suture includes: using the left hand to hold a handle; pressing the deploy button to deploy the suture onto the catcher under visual guidance using the right hand; using the left thumb to press the control button to capture the suture under visual guidance; and pulling the handle using the left hand and harvesting the two suture ends.

28 schematically illustrates an embodiment in which the handle 100 includes a catcher 110 with a strut 3000 with a catcher element 3002 with a V-shaped aperture 3004. Aperture 3004 is aligned with a corresponding needle track, such as needle track 150 or 155, such that the distal tip of needle tube 210 carrying suture 230 as suture passer 200 advances within the needle track (not shown in this figure) may be extended for clarity. Exit opening 3006 on strut 3000 may allow further advancement of needle tube 210 . The V-shaped profile of aperture 3004 may be configured to capture and retain suture 230 . As can be seen, aperture 3004 can be larger than the diameter of either needle tube 210 or suture 230 so that both can be easily advanced through the aperture. Aperture 3004 tapers from an increased diameter region to a relatively narrow region having dimensions smaller than the diameter of suture 230 . When tension is applied to suture 230, it is pulled into the narrowed area and held securely. In one aspect, the increased dimension area can be oriented in a proximal direction and the narrowed area can be oriented in a distal direction. Also, the tapered profile of aperture 3004 results in increased retention of suture 230 as more force is applied to draw more material into the narrower region.

As shown in FIG. 28 , the profile of aperture 3004 can be formed directly into the material of catcher element 3002 . Alternatively, a separate structure can be secured to the catcher element to create the desired profile. For example, FIG. 29 shows wire 3008 bent to exhibit a V-shaped profile. By securing the wire 3008 over the larger diameter opening of the catcher element, an opening having the characteristics described above can be formed. Similarly, FIG. 30 shows a plate 3010 having a V-shaped opening 3012 that can be secured to a catcher element 3002 . Openings 3012 may be formed in plate 3010 by electrical discharge machining, stamping, or any other suitable technique. 29 and 30, using a material that is relatively thinner than the material of catcher element 3002 more effectively engages suture 230 by concentrating friction over a reduced surface area V A mold opening 3004 can be created. In another aspect, when the aperture 3004 is formed directly in the catcher element 3002, the peripheral portion of the aperture exhibits a reduced thickness to achieve a similar result. Also, while one V-shaped aperture 3004 is shown in FIG. 28 , an opposing catcher element and/or one or more adjacent catcher elements may also feature a corresponding V-shaped aperture. For example, catcher element 3002 can be aligned with needle track 150 and catcher element 312 can be aligned with needle track 155 . As such, catcher element 312 may include a V-shaped opening in some embodiments.

As noted above, some embodiments may employ a configuration in which the slider 115 is biased in a distal direction to facilitate compressing tissue against the catcher 110 in its open deployed state. For example, FIG. 31 schematically shows the slider 115 positioned relatively distally along the range of travel along the shaft 105 of the handle 100 . Compression spring 3020 is coaxially disposed above post 3022 . During insertion, slider 115 may be positioned relatively more proximally along shaft 105, compression spring 3020. Correspondingly, spring 3020 biases slider 115 in a distal direction. In another example shown in FIG. 32 , driven gear 3024 (shown in dashed lines) is rotatably fixed to slider 115 and engages teeth in track 120 . The driven gear 3024 may be configured to bias the slider 115 distally along the track 120 in a spring loaded or any other suitable manner.

In this embodiment, the distal bias of slider 115 creates an automatic interposition function that can facilitate insertion of handle 100 and consequent compression of tissue between slider 115 and catcher 110 . For example, handle 100 with catcher 110 in a closed configuration can be inserted through a trocar wound. When the slider 115 abuts the outer surface of the patient's body, further advancement of the handle 100 causes the slider 115 to move along the shaft 105 in a proximal direction. Referring to FIG. 31 , this compresses spring 3020 and referring to FIG. 32 , it may wind up driven gear 3024 storing energy. After the handle 100 is fully inserted, pressing the control button 130 causes the catcher 110 to open and deploy as described above. Correspondingly, when the pressure on the handle 100 is released, the spring 3020 or driven gear 3024 causes the slider 115 to move distally towards the catcher 110 so that the slider 115 is freed from subsequent actuation. Allows tissue to intervene automatically without requiring manual movement. It should be understood that any suitable mechanism may be used to bias the slider 115 in the distal direction.

In another aspect, FIGS. 33A and 33B show an embodiment of a handle 100 configured to limit access through the needle track when the catcher is not fully deployed in its open configuration. As shown in FIG. 33A, the control button 130 is pressed to close the catcher 110. When the actuator 3034 of the control button 130 engages the gate control lever 3030 in the distal direction of the axle 3032, the distal end 3036 of the gate control lever 3030 moves through the needle track 150. Gate control lever 3030 is pivoted on axle 3020 to bias radially outward into a position that blocks access. Correspondingly, FIG. 33B shows handle 100 with catcher 110 open and deployed. Here, the control button 130 is released and the actuator 3034 engages the gate control lever 3030 proximal to the axle 3032 thereby biasing the proximal end 3038 of the gate control lever 3030 radially outward. let it In turn, this causes the distal end 3036 to retract radially inward to unblock the needle track 150.

To assist in holding catcher 110 in an open configuration, some embodiments of handle 100 may use a locking mechanism that holds control button 130 in a released position when not depressed. 34a and 34b show an embodiment of the handle 100 having a locking portion 3040 integrated into the control button 130 . The locking portion 3040 can slide coaxially within the control button 130 between engaged and disengaged states and is secured to the control rod 145 . In the engaged state shown in FIG. 34A , locking portion 3040 is positioned relatively proximal within control button 130 such that ridge 3042 within control button 130 is over leg 3044 of locking portion 3040 . are placed Correspondingly, leg 3044 is allowed to assume a nominal configuration such that flange 3046 engages ledge 3048 of handle 100 . This holds the control rod 145 in a fixed position relative to the handle 100, allowing the catcher 110 to remain in a fully open configuration. As can be seen, this locking action assists in bearing any forces created via tissue or other forces along the longitudinal axis of the shaft. Without locking portion 3040, this force could cause movement of control rod 145, which could begin to close catcher 110, and consequently reduce its ability to provide a platform for tissue. When trying to position the catcher 110 in a closed configuration, such as insertion or withdrawal from the trocar winding, the control button 130 as shown in FIG. Pressing on causes flange 3046 to engage and deflect radially inwardly with leg 3044 to disengage from ledge 3048. Once locking portion 3040 is disengaged, control button 130 is free to move distally, advancing control rod 145 to position catcher 110 in a closed configuration.

To assist with the risk of damage to organs or other tissues, some embodiments of handle 100 may include additional element(s) associated with catcher 110 to limit movement of suture passer 200 beyond a desired amount. can be characterized. For example, FIGS. 35A and 35B schematically illustrate the operation of the shield 3050 secured to the catcher 110 . First, in FIG. 35A , suture passer 200 has not advanced enough to allow the tip of needle tube 210 to penetrate catcher 110 . Thus, shield 3050 is generally aligned with strut 170 of catcher 110 . As the suture passer 200 is advanced further, as shown in FIG. 35B , the tip of the needle tube 210 extends beyond the catcher 110, but the shield 3050 deflects outward as the tip advances. flexible enough to be Despite being resilient, the material of shield 3050 resists penetration of the tip of needle tube 210, reducing the risk of injury to surrounding tissue.

Alternatively, catcher 110 may include one or more strips of material 3052 secured proximal and distal to the location where needle tube 210 extends beyond catcher 110, as shown in FIGS. 36A and 36B. can have Correspondingly, strip 3052 may resist penetration of the tip of needle tube 210 to reduce the risk of injury to tissue beyond catcher 110, as shown in FIG. 36A. Strip 3052 may be formed of a material that is sufficiently resilient and flexible to closely conform to the profile of catcher 110, including when in a closed configuration as shown in FIG. 36B.

In another aspect, handle 100 may be configured to ensure that suture passer 200 can extend through sufficient tissue when deploying suture 230 . For example, the shaft 105 may be marked with a suitable indicator 3060 as shown in FIG. 37, for example through the use of contrasting colors. Indicator 3060 can be used to indicate the exact position of handle 100 from an external viewing angle as well as an internal viewing angle, such as a laparoscope. It is desirable to determine that sufficient tissue is interposed between slider 115 and catcher 110 to allow secure placement of suture 230 . As an example, it is preferred that the suture passer 200 fully penetrate the peritoneum to achieve successful suture closure. In one embodiment, indicator 3060 may extend distally to a position approximately adjacent suture exit slot 160 with its proximal end positioned approximately adjacent exit 3062 of needle tracks 150, 155. For example, indicator 3060 may have a length of about 1.5 cm. The position and length of indicator 3060 can be adjusted as desired based on the intended application. In use, handle 100 may be inserted into a trocar wound and advanced until indicator 3060 is obscured by tissue. In one aspect, the indicator 3060 is not visible within the external viewing angle or abdominal cavity when the handle 100 is properly positioned. In some embodiments, to indicate that the handle 100 has been advanced to the correct position and the catcher 110 is ready to open, the shaft 105 may be further indicated with an additional indicator 3064 directly above the catcher 110. can

Certain exemplary embodiments are described herein. However, those skilled in the art pertaining to this embodiment will appreciate that the principles of this disclosure can be readily extended with suitable modifications for other applications.

Claims (20)

A suture delivery device for suturing tissue, comprising:
an elongated deployable member;
a suture catcher disposed toward the distal end of the elongate deployable member, the suture catcher being configured to transition between a retracted configuration that facilitates entry of the suture catcher into an incision and a deployment configuration that facilitates suture capture; , the suture catcher has a plurality of struts rotatably coupled to the distal end of the elongate deployment member by hinge joints and a plurality of catcher elements coupled to the struts by hinge joints, the struts at least one of the suture catcher includes a needle exit opening and at least one of the catcher elements has a V-shaped opening configured to retain the suture when the suture catcher is in an open deployment configuration;
a compression member disposed toward the proximal end of the elongated deployable member relative to the suture catcher, the compression member configured to resist entry into the incision, the compression member and the suture catcher between a compressed configuration and a non-compressed configuration. Transitioned at, the compression member;
a first needle track associated with the elongate deployment member and oriented towards a first area of the suture catcher when in the deployment configuration; and
a second needle track associated with the elongate deployable member and oriented towards a second region of the suture catcher in the deploy configuration, the first region of the suture catcher in the deploy configuration and the second region of the suture catcher in the deploy configuration. The suture delivery device for suturing tissue comprising a second needle track positioned on the suture catcher so that the second area of the suture catcher can be disposed on opposite sides of an incision. delete delete According to claim 1,
The suture delivery device for suturing tissue, wherein the V-shaped opening is formed by a bent wire. According to claim 1,
wherein the V-shaped opening is formed by a plate having a V-shaped opening secured to the catcher element. According to claim 1,
wherein the V-shaped opening has a narrowed area configured to engage the suture when under tension. According to claim 1,
wherein the compression member and the suture catcher automatically transition from the non-compression configuration to the compression configuration. According to claim 7,
wherein the compression member is positionable along the elongate deployable member and biased in a distal direction to automatically transition from the uncompressed configuration to the compressed configuration. According to claim 8,
wherein the compression member is biased toward the distal direction by a spring. According to claim 8,
wherein the compression member is biased toward the distal direction by a driven gear engaged with a track along the elongated deployable member. According to claim 1,
wherein access to at least one of the first needle track and the second needle track is restricted when the suture catcher is in the retracted configuration. According to claim 11,
wherein the access is limited by a gate control lever. According to claim 12,
The suture catcher is operatively coupled to a control button such that when the control button is in a position associated with the suture catcher in the deployed configuration, the control button controls at least one of the first needle track and the second needle track. A suture delivery device for suturing tissue that engages the gate control lever to provide access therethrough. According to claim 1,
the suture catcher is operatively coupled to the control button;
wherein the suture delivery device further comprises a locking mechanism configured to retain the control button in a position associated with the suture catcher in the deployed configuration. 15. The method of claim 14,
wherein the locking mechanism is disposed within the control button, the locking mechanism is engaged when the control button is in a position associated with the suture catcher in the deployed configuration, and the locking mechanism is disengaged when the control button is depressed. A suture delivery device for suturing tissue. According to claim 1,
wherein the suture catcher further comprises a shield configured to deflect outwardly while resisting penetration by a needle tip. According to claim 1,
wherein the suture catcher further comprises strips of material secured in proximal and distal positions on the suture catcher and configured to resist penetration by a needle tip. According to claim 1,
wherein the elongate deployable member further comprises a visual indicator configured to signal when the suture delivery device has been inserted through tissue of sufficient thickness. According to claim 18,
wherein the indicator comprises a colored region of the elongate deployable member having a proximal end adjacent an exit of at least one of the first needle track and the second needle track. According to claim 1,
wherein the first needle track and the second needle track are joined by a suture exit slot configured to allow a suture loop to exit the device.

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