US20230320724A1 - Steerable suture retriever - Google Patents
Steerable suture retriever Download PDFInfo
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- US20230320724A1 US20230320724A1 US18/185,010 US202318185010A US2023320724A1 US 20230320724 A1 US20230320724 A1 US 20230320724A1 US 202318185010 A US202318185010 A US 202318185010A US 2023320724 A1 US2023320724 A1 US 2023320724A1
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Classifications
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Definitions
- Suturing techniques and instruments facilitate the suturing of tissue during endoscopic and open surgical procedures.
- endoscopic encompasses arthroscopy, laparoscopy, hysteroscopy, etc.
- endoscopic surgery involves surgical procedures that are performed on a patient's through small openings as opposed to conventional open surgery through large incisions.
- the access to a surgical site in an endoscopic procedure relies on one or more portals created in the patient's body or through one or more cannulas inserted into the patient's body through small incisions.
- the use of sutures in endoscopic procedures relies on remote retrieval of the suture when it is passed through, tied to, and/or anchored in tissue of the surgical site.
- a suture snare is used with suture passers to retrieve the suture within the joint space during endoscopic surgery. Due to the limited space within the joint, deployment of the snare is often challenging. There remains a need for a minimally invasive surgical instrument that can retrieve or pass a suture or similar surgical item, where the device can allow for steerability as well ease of manipulation to grasp or release a suture used in a surgical procedure.
- the present disclosure includes a surgical instrument for manipulating a component within a patient.
- the devices and methods described herein can manipulate by positioning or retrieving the component.
- Such components include, but are not limited to, sutures, anchors, clips, staples, or any surgical component used in a medical procedure.
- the devices and method described herein can be used in any open surgical procedure or any procedure performed via arthroscopic, endoscopic, thorascopic or similar means.
- an instrument includes a shaft having a far portion, a near portion, and an arcuate shaft segment located between the far portion and the near portion such that a far end of the shaft extends radially away from an axis of the near portion; a lumen extending through the shaft and exiting at the far portion; a handle fixed relative to the near portion of the shaft, such that rotation of the handle causes rotation of the shaft; a suture carrying element comprising a main segment, a capture portion at a distal end, and an arcuate element segment proximal between the capture portion and the main segment, such that in an unconstrained configuration the capturing portion extends radially away from an axis of the main segment, the suture carrying element being elastically deformable into a constrained configuration when located within the lumen; and an actuator housed in the handle and coupled to the main segment of the suture carrying element, the actuator being moveable relative to an axis of the handle simultaneously in a rotational direction and in an axial direction, such
- the arcuate segment is configured such that when moved with the opening at the far portion the arcuate segment deflects to cause the capturing portion to move through an arc such that rotation of the suture carrying element can reposition the capturing portion within an increased distance without moving the far portion of the shaft.
- the arcuate segment can also be configured to cause the capturing portion to re-enter the opening at the far portion in a single position relative to the opening.
- the actuator is positioned within the handle and is moveable relative to the axis of the handle simultaneously in the rotational direction and in the axial direction while the handle remains stationary.
- a variation of the instrument can further include a torque shaft extending in the lumen and coupling the main segment to the actuator, wherein a torsional stiffness of the torque shaft is greater than a torsional stiffness of the main segment such that the torque shaft transfers rotation to the main segment.
- the torque shaft comprises a stainless steel hypodermic tubing.
- the torque shaft can comprise a reinforcement member coupled to a portion of the main segment to form a reinforced segment, such a torsional stiffness of the reinforced segment is greater than a torsional stiffness of a remainder of the main segment such that the torque shaft transfers rotation to the remainder of the main segment.
- Variations of the device include a capturing portion that extends in a u-shaped profile having a first leg and a second leg with an opening therebetween, the first leg being continuous with the arcuate element segment.
- an arc of the arcuate element segment is greater than 90 degrees such an apex of the arcuate element segment is positioned distally of the first leg, such that when a suture is located against the apex, distal movement of the suture capturing element urges the suture into the u-shaped profile.
- Variations of the surgical instrument include a shaft that is rigid or malleable. Alternate variations include a rigid shaft with a malleable section.
- Variations of the instrument include a capture portion that comprises a u-shape having a first leg connected to the arcuate element segment, a second leg having a free end and a u-segment between the first leg and the second leg, where the u-segment forms a seat for the suture.
- the capture portion is angled 45 degrees relative to an axis of the main segment.
- Surgical instruments of the present disclosure can optionally include a sharp tip located at the distal end, which allows the distal end of the rigid shaft to penetrate through soft tissue when advanced therethrough.
- the handle of the instrument further comprises a window opening and where the actuator is accessible through the window opening.
- the actuator is recessed within the window opening.
- the suture carrying element can comprise a superelastic alloy.
- the capture portion can include an opening disposed proximal to the distal end including a distal concave surface facing proximally for retaining the suture within the opening as the instrument is drawn proximally.
- the capture portion comprises a pivotably operable jaw.
- the capture portion comprises a v-shape having an apex and an open end, where the apex is distal to the open end.
- the present disclosure also includes methods for manipulating a suture passed through a tissue region.
- one such method includes positioning a shaft adjacent to the tissue region using a handle, where the shaft is affixed to the handle such that rotation and axial movement of the handle produces rotation and axial movement of the shaft, the shaft having an arcuate segment proximate to a sharp distal tip; passing a distal opening of the shaft through the tissue region and advancing the shaft through the tissue region using the handle; manipulating an actuator in the handle to advance a suture carrying element through a lumen of the shaft, where the suture carrying element a main segment, a capture portion at a distal end, and an arcuate element segment proximal between the capture portion and the main segment, such that in an unconstrained configuration the capturing portion extends radially away from an axis of the main segment, the suture carrying element being elastically deformable into a constrained configuration when located within the lumen; simultaneously rotating the handle while rotating and axially moving the actuator to engage the suture with
- proximally moving the actuator relative to the handle to retract the capturing portion and the suture within the shaft causes the arcuate element segment to deform when withdrawn into the distal opening of the shaft causing the capturing portion to move towards an axis of the distal end of the shaft without deforming the capturing portion.
- the present disclosure also includes a medical device comprising: a handle portion having a cylindrical bore; an actuator having a cylindrical periphery that forms a slidable fit with the cylindrical bore; a shaft fixed relative to the handle portion; a torque shaft fixed to the actuator, where rotation and/or axial movement of the actuator causes rotational and/or axial movement of the torque shaft; a fixed component secured to a distal end of the shaft; and an actuatable component coupled to both the fixed component and the torque shaft, where movement of the actuator causes movement of the actuatable component relative to the fixed component.
- FIG. 1 A illustrates a variation of a surgical instrument for manipulating or retrieving an item such as a suture.
- FIG. 1 B illustrates a magnified view of the section 1 B from FIG. 1 A .
- FIG. 2 A illustrates another magnified view of a shaft of an instrument to better illustrate movement of a carrying element within a lumen of the shaft.
- FIGS. 2 B and 2 C illustrate a device with a torque shaft or reinforced carrying element.
- FIGS. 3 A to 3 H illustrate examples of carrying elements extending distally from a lumen or opening in a distal of a shaft of an instrument as described herein.
- FIG. 4 provides an illustrated example of positioning a shaft of an instrument through tissue.
- FIGS. 5 A to 5 F illustrate an example of manipulating a variation of a surgical instrument of the present disclosure to secure a suture 20 .
- FIGS. 6 A to 6 D illustrate some additional variations of carrying elements with various types of capturing portions at an end of the shaft.
- FIGS. 7 A and 7 B show alternative shaft configurations of variations of the instrument described herein.
- FIG. 8 illustrates a cross sectional view of a handle with a cylindrical actuator floating within the actuator.
- FIG. 1 A illustrates a variation of a surgical instrument 100 for manipulating an item (not shown in FIG. 1 A ) during a medical procedure.
- the item being manipulated is depicted as a suture and one variation of the surgical instrument comprises a suture retriever/manipulator.
- variations of the surgical instrument are not limited to sutures.
- the instrument can be used to manipulate or retrieve implants, fabric (such as gauze or sheets), threads, wires, etc.
- a variation of the instrument 100 includes a shaft 102 coupled to a handle 120 .
- the shaft 120 can include a near portion 104 (e.g., a section of the shaft 102 that is adjacent the handle 120 ) and a far portion 106 (e.g., a section of the shaft 102 that is towards a distal end 108 of the shaft 102 ).
- the far portion 106 includes an arcuate or angled segment 114 that causes a far end 112 of the shaft 102 to extend at an angle or radially away from an axis 116 of the shaft 102 .
- Variations of devices described herein can include shafts 102 with angled segments 114 that produce an angle greater than 0 degrees to 90 degrees. However, the disclosure includes any angle as well as straight shafts.
- the angled segment 114 can also be located at the near portion 104 of the shaft 102 .
- the medical apparatus 100 illustrated in FIG. 1 A also shows a near portion 104 separated from a far portion 106 by a tapered transition section 110 .
- Alternative variations of the device do not require the different sections of the shaft 102 to be different diameters or different configurations. However, varying diameters of the shaft 102 can provide benefits depending upon the main intended procedure of the device. For example, in the variation illustrated in FIG. 1 A , a shaft 102 with a larger diameter at the near portion 104 provided for increased column strength when manipulating the instrument 100 via the handle 120 . The smaller diameter far portion 106 of the shaft 102 reduces a force required to advance through tissue.
- a device 100 according to the present disclosure includes various portions (e.g., 104 , 106 ) having different cross-sectional profiles than the circular profiles shown.
- FIG. 1 B illustrates a magnified view of the section 1 B from FIG. 1 A .
- FIG. 1 B shows a lumen 108 that extends through the shaft 102 , exiting at the far end 112 .
- Variations of the device 102 can include a shaft lumen 102 that extends into the handle 120 .
- the lumen can exit from other portions of the shaft not just the far end 112 .
- alternate variations of the device 100 include one or more lumens that exit through multiple portions of the device and/or shaft.
- the shaft 102 can include a main lumen 108 that accommodates a carrying element 140 , which as described below, can be advanced, retracted, and/or rotated using controls coupled to the handle 120 .
- the carrying element 140 is referred to herein as a suture carrying element 140 , however, the carrying element 140 can be used to manipulate and/or retrieve a number of surgical items as described above.
- FIG. 1 B also illustrates the far end 112 as having a sharp tip that can penetrate tissue. Alternate variations of the instrument 100 do not require a sharp tip. Instead, the tip can be rounded or blunted to dissect tissue.
- FIG. 1 B also illustrates a variation of a capture portion 144 being configured in a U-shape with a first leg 156 adjacent to the arcuate segment 152 of the carrying element 140 and a second leg 158 being open to permit positioning of a suture (or other component) adjacent to a seat 155 of the capturing portion.
- the devices described herein can include capturing portions of various shapes as well as actuatable arms or graspers.
- FIG. 1 A also shows a handle 120 located adjacent to the near section 104 of the shaft 102 .
- Variations of the instrument 100 include handles 120 that are affixed to or relative to the shaft 102 such that rotation of the handle 120 causes rotation of the shaft 102 .
- the handle 120 also includes an actuator 130 that is coupled to the carrying element 140 and allows for movement of the carrying element 140 relative to the shaft 102 .
- the actuator 120 can allow for rotational and/or axial movement of the carrying element 140 relative to the shaft.
- the handle 120 includes a body 120 with a window 124 that exposes the actuator 130 . This configuration allows for rotation of the handle 120 without any features of the actuator 130 that protrude from the handle body 122 .
- a portion of the actuator 130 can protrude from the handle body 122 .
- the actuator 130 can include features, such as the recessed pockets 132 , that ease positioning of an operators fingers while the operator's hand is able to grasp the remaining portion of the handle body 122 . This allows control of the handle 120 and simultaneous adjustment of the actuator 130 using a single hand.
- the recessed features 132 of the actuator can extend around a circumference of the actuator 130 .
- FIG. 1 A further shows an optional feature of the handle 120 where a proximal opening 126 for a lumen that is in fluid communication with the shaft lumen 108 . This allows for flushing of the shaft 102 or advancement of a suture through the device.
- FIG. 2 A illustrates another magnified view of a shaft 102 of an instrument to better illustrate movement of the carrying element 140 within the lumen 108 of the shaft 102 .
- the capturing element 142 can comprise a main segment 142 that is elastically deformable such that it can navigate any bend or arcuate segment 114 of the shaft 102 without retaining the deformation.
- the main segment 142 and/or entire capturing element 140 is fabricated from a super elastic alloy or a flexible material (e.g., alloy, polymer, or similar material).
- the carrying element 140 is coupled to the actuator (not shown) along a portion of a proximal end of the main segment 142 , wherein rotation of the actuator causes the capturing element 140 to rotate.
- axial movement of the actuator (or other component) along an axis of the handle will cause axial movement 146 of the capturing element 140 about an axis 148 of the main segment 142 .
- Rotation of the actuator also causes the capturing element 140 to rotate about the axis 148 causing a capture portion 144 to rotate in a pattern up to a 360 degree pattern 150 .
- FIG. 2 B illustrates an actuator 130 coupled to a carrying element 140 via a torque shaft 180 .
- the torque shaft 180 provides a connection between the carrying element 140 and actuator 130 but also provides a torsional strength or stiffness that allows the actuator 130 to transfer a consistent rotation to the carrying element 140 in addition to providing an axial translation (in those variations requiring both rotation and axial movement). In those previous devices without a torque shaft the wire used to secure the suture twists and binds if over-rotated.
- the torque shaft 180 of the present disclosure can extend the distance of the shaft 102 with the carrying element 140 connected to a distal end of the torque shaft 180 .
- the torque shaft 180 can also provide provides rigidity and linear structure to the device.
- a carrying element 140 can be directly coupled to the actuator 130 but forms a torque shaft 180 using a reinforcement member (e.g., sheath, coating, tube, etc.) over a portion of the main segment 142 of the carrying element 140 .
- a reinforcement member e.g., sheath, coating, tube, etc.
- the reinforcement allows the actuator 130 to transfer rotation to the capture portion 144 while minimizing binding and torque/torsion loading of the capture portion 144 .
- FIG. 2 C illustrates a magnified view of a variation of a carrying element 140 and torsion shaft 180 .
- the torsion shaft 180 can comprise a hypotube (e.g., stainless steel) that includes a passage 180 , where the main segment 142 is loaded within the passage 180 at a distal end of the torsion shaft 180 .
- Variations of the device can include a torsion shaft 180 (or reinforcement) that does not enter the articulated segment 114 of the shaft.
- the torsion shaft 180 (or reinforcement) can extend at least partially into or beyond the articulated segment 114 .
- FIGS. 3 A to 3 H illustrate an example of a carrying element 140 extending distally from a lumen or opening 108 in a distal end 112 of a shaft 102 of an instrument as described herein.
- a main segment 142 of the carrying element 140 can be axially advanced in a direction 146 relative to the shaft 102 .
- the carrying element 140 can be positioned entirely within the shaft 102 and advanced distally from the opening 108 as needed.
- the carrying element 140 includes a capturing portion 144 that is typically at a distal end. In the illustrated variation shown in FIG. 3 A , the capturing portion 144 extends away from an axis 148 of the main segment 142 .
- the capturing portion 144 is positioned approximately 90 degrees from the axis 148 of the main segment 142 .
- variations of devices can include a capturing element with an angular spacing that ranges between 0 and 180 degrees relative to the axis 148 to extend in a radial direction from the axis 148 of the main segment.
- the angle can be measured from either leg of the capture portion 144 .
- the carrying element 140 can include one or more arcuate sections/segments 152 between the capturing portion 144 and the main segment 142 .
- FIG. 3 B illustrates a configuration where the carrying element 144 has been withdrawn proximally towards the shaft 102 such that the main segment (not pictured) is within the shaft 102 and the arcuate segment 152 engages a side of the distal end 112 .
- the capturing portion 144 will move in an arc 154 and into alignment with the lumen 108 of the shaft 102 .
- Movement of the capturing portion 144 in an arc pattern 154 is desirable to prevent the suture (or other item being carried) from engaging a side of the wall of the distal end 112 .
- This arc pattern 154 movement is primarily made possible by the large radiused arcuate segment 152 .
- FIGS. 3 C and 3 D illustrate additional variations of the capturing element 140 to illustrate the features of an arc angle of the arcuate segment 152 of the capturing element 140 .
- the arc angle can be measured starting from the location where the arcuate segment 152 deviates from an axis of the main segment 142 to location where the arcuate segment 152 becomes parallel to or meets a leg of the capturing portion 144 .
- the sweep angle 160 of the arcuate segment 152 is approximately 90 degrees.
- the arc angle 160 is greater than 90 degrees. It is believed that an arc angle greater than 90 degrees coupled with a large radius arc segment 152 improves the ability of the device to retrieve a suture or similar structure within an opening of the shaft.
- the combination of arc angle and large radius arc segment provides an increased range for an operator to maneuver the carrying element from the location where it passes through tissue to a location where a suture (or other medical item) is located.
- FIG. 3 E illustrates a variation of the carrying element 140 that includes an arc angle greater than 90 degrees where the carrying element 140 is retracted in a proximal direction 146 to within the shaft 102 .
- the capturing portion 144 continues to move in an arc 154 (relative to FIG. 3 B ) as the arcuate segment 152 engages a wall of the distal end 112 when withdrawn into the shaft 102 .
- FIG. 3 F illustrates a state of the instrument when the arcuate segment 152 is within the shaft 102 .
- the capture portion 144 can enter the shaft in alignment with the opening/lumen 108 .
- FIG. 3 E illustrates a variation of the carrying element 140 that includes an arc angle greater than 90 degrees where the carrying element 140 is retracted in a proximal direction 146 to within the shaft 102 .
- the capturing portion 144 continues to move in an arc 154 (relative to FIG. 3 B ) as the arcuate segment 152 engages
- 3 G shows the carrying element 140 as it retracts into the shaft until the carrying element 140 and capture portion 144 are fully within the shaft 102 .
- retracting the carrying element 140 causes the arcuate element segment 152 to deform against the distal end such that the capturing portion 144 sweeps to move towards alignment with an axis of the opening 108 (as shown in FIGS. 3 F and 3 G ) without deforming during movement outside of the shaft 102 .
- the capturing portion 144 can deform as it enters the shaft lumen 108 , which compresses the suture (or component). This configuration allows for a suture to be retained within or against the capturing portion 144 as it is repositioned outside of the shaft and prepared for withdrawal into the shaft.
- the ability to move axially while simultaneously rotating allows for increased positioning of the capturing portion 144 during positioning of the carrying element 140 when trying to secure the suture (or other medical component) as well as allows for the capture portion 144 to be rotated when a suture (or other medical component) is secured therein. In the latter case, rotation of a suture (or other element) secured within the capture portion 144 can cause the suture to wrap about the carrying element 140 , which further assists in manipulation of the suture.
- the distal end 112 of the shaft 102 comprises a tapered or beveled end at the opening 108 .
- the tapered opening 108 as well as the shape and angle of the arcuate segment 108 of the carrying element 140 allows the capture portion 144 to slightly deform such that it enters the opening 108 in a consistent manner regardless of the position of the carrying capture portion 144 when extended.
- variations of the device rely on a torque shaft that is connected to the actuator. Therefore, the relatively short length of the capture portion 144 and main segment that is not reinforced allows the main segment to flex as it re-enters the shaft 108 .
- the arcuate segment provides an advantage in being configured such that when moved with the opening at the far portion the arcuate segment 152 deflects to cause movement of the capturing portion 144 through an arc 154 . This allows the capturing portion to move through a range of positions such that rotation of the suture carrying element can reposition the capturing portion within an increased distance to reach a suture without having to move the far portion of the shaft. Another benefit is that in variations of the device, the arcuate segment is configured to cause the capturing portion to re-enter the opening at the far portion in a single position relative to the opening. This means that regardless of the orientation of the capturing portion 144 (e.g., if it is rotated 180 degrees from that shown in FIG. 3 E , the capturing portion will orient as shown in FIGS. 3 E and 3 F when retracted within the shaft 102 .
- FIG. 4 provides an illustrated example of positioning a shaft 102 of an instrument according to the present disclosure.
- FIG. 4 shows a section of tissue 2 having a first surface 4 and a second surface 6 .
- the instruments described herein are especially useful in applications where a suture 20 extends from a first surface 4 to a second surface 6 through an opening 8 and must be withdrawn back through the tissue 2 from the second surface 6 .
- the medical practitioner only has visual access to the second surface 6 while manipulating the instrument from the first surface 4 .
- FIG. 4 illustrates the suture 20 as having a loop configuration.
- other configurations e.g., a knot, hook, attached needle, etc.
- the illustrated suture 20 is shown to be a ribbon type configuration.
- the present disclosure includes sutures (or other medical components) of multiple shapes, sizes, and cross sections.
- FIG. 4 illustrates a situation where a medical practitioner advances the shaft 102 through an opening 10 in the tissue 2 where the shaft 102 includes a distal end 112 with a sharp tip.
- alternate variations of the device include blunted, atraumatic, or otherwise rounded ends.
- the opening 108 might be mis-aligned with the suture 20 .
- FIGS. 5 A to 5 F illustrate an example of manipulating a variation of a surgical instrument 100 of the present disclosure to secure a suture 20 .
- the devices disclosed herein can position, retrieve, or otherwise manipulate a suture or other surgical component.
- FIG. 5 A illustrates a state immediately after the shaft 102 is advanced through tissue 2 .
- the shaft 102 and handle 120 are not drawn to scale.
- the handle 120 can be rotated in either direction 134 to produce a corresponding rotation 134 of the shaft 102 .
- the medical practitioner will be able to manipulate the handle 120 while visually observing the distal end 112 of the shaft 102 .
- the shaft 102 can be made sufficiently radiopaque (or have radiopaque markers) such that it is observable under x-ray or a CT scan.
- the device can be made to be visible under alternate non-invasive imaging (e.g., visible under ultrasound imaging, etc.).
- the medical practitioner can position the far/distal end 112 of the shaft 102 such that the opening/lumen 108 is placed sufficiently close to the suture 20 .
- the arcuate segment 114 of the shaft 102 can further increase the ability to position the opening 108 of the shaft 102 away from the tissue opening 10 by axial movement of the entire shaft 102 as well as rotation of the handle 120 .
- the device 100 provides the medical practitioner with the ability to reposition the distal end 112 using a single hand.
- FIG. 5 B illustrates a configuration where the carrying element 140 advances in an axial direction 146 upon a corresponding axial movement 146 of the actuator 130 coupled to the handle 120 .
- some variations of the instrument 100 allow for simultaneous rotation 150 of the actuator, which produces corresponding rotation 150 of the carrying element 140 .
- the handle 120 can be rotated 134 and/or axially moved 136 to produce corresponding rotation 134 and/or axial movement 136 of the shaft 102 .
- the manipulation of the handle 120 and actuator 130 are used to position the capturing element 144 adjacent to the suture 20 .
- FIG. 5 C illustrates the carrying element 140 as being advanced into a loop of the suture 20 .
- the suture 20 will include a knot, needle, hook, etc. that is used to engage the capture portion 144 .
- FIG. 5 D shows the capture portion 144 of the carrying element 140 advancing beyond the suture 20 .
- the capturing portion 144 as well as the remaining portion of the carrying element 140 can be fabricated to be elastically deformable to assist in navigating to and securing the suture 20 .
- FIG. 5 E illustrates the situation where either the device 100 and/or the carrying element 140 is withdrawn relative to the suture 20 to secure the suture 20 within the capturing portion 144 .
- FIG. 5 F shows further withdrawal of the carrying element (not illustrated in FIG. 5 F ) into the opening 108 of the shaft 102 to partially draw the suture 20 within the shaft 10 such that retrieval of the device 100 causes the suture 20 to be pulled through the shaft opening 10 and through the tissue 2 .
- a suture 20 can be initially advanced through the tissue 2 using an instrument (i.e., a placement instrument).
- the suture can either extend outside of the placement instrument or extend within a shaft of the placement instrument.
- a second device i.e., a retrieval instrument
- a benefit of this dual instrument procedure is that both devices can be manipulated using either hand of the medical practitioner.
- FIGS. 6 A to 6 D illustrate some additional variations of carrying elements 140 with various types of capturing portions 144 at an end of the shaft 102 .
- FIG. 6 A illustrates a capture portion 144 that has a v-shape where the open legs of the v-shape are proximal to an apex of the v-shape.
- FIG. 6 B illustrates an actuatable capture portion 155 having a jaw structure joined at a hinge 162 .
- the jaw structure can be operated using one or more pull wires 164 that extends to a proximal end of the device and/or to a handle of the device.
- FIGS. 6 C and 6 D illustrate a carrying element 150 having a capturing portion configured in a coil structure 166 .
- the coil 166 can be flexible such that a suture becomes secured within the turns of the coil 166 .
- the turns of the coil 166 can be in contact or can be separated by a gap.
- FIGS. 7 A and 7 B illustrate additional variations of devices 100 as described herein.
- FIG. 7 A illustrates an actuator 130 within a handle 120 , where the handle 120 is coupled to a shaft 102 where the far portion 106 of the shaft 102 is straight.
- FIG. 6 B illustrates a shaft 102 coupled to a handle 120 where the near portion 104 and far portion 106 of the shaft are the same or similar diameters (e.g., the shaft 102 can comprise a single tubular member).
- FIG. 8 illustrates another aspect of variations of devices 100 under the present disclosure.
- the handle body 120 comprises a bore 128 that accommodates a free-floating sliding fit with an actuator 130 .
- the actuator 130 is shown to be a substantially solid cylindrical piece, it can comprise any structure that has an effective cylindrical profile such as a varying surface comprising peaks and grooves where the peaks effectively form a cylindrical circumference that forms a sliding fit with the bore 128 of the handle 120 .
- variations of the device 100 include a body 120 that is non-cylindrical on an outer surface but comprises a bore 128 that is sized to allow a sliding fit with the actuator 130 .
- the body 120 comprises a cylindrical surface, which allows for a medical practitioner to grasp the body 100 with a palm of their hand and use their fingers to aid in manipulation of the body 100 while the thumb can be used to provide axial movement 146 of the actuator and/or rotational movement 150 of the actuator to drive a torque shaft 180 relative to a shaft 102 that is affixed to the body 120 .
- a handle configuration can be used for the carrying element 140 as described herein.
- this handle configuration can be used in a number of other medical devices used in arthroscopic, thorascopic, and/or endoscopic procedures.
- FIG. 8 also shows the device 100 as having a tensioning component 170 having a tensioning surface 172 that can adjust a force required to move the actuator 130 within the bore 128 .
- the tensioning component 170 and surface 172 can comprise a spring loaded ball-bearing that applies an adjustable force on a portion of the handle 130 .
- the invention includes combinations of aspects of the variations of the devices described herein as well as the combination of the variations themselves.
- any optional feature of the inventive variations may be set forth and claimed independently, or in combination with any one or more of the features described herein. Accordingly, the invention contemplates combinations of various aspects of the embodiments or combinations of the embodiments themselves, where possible.
- Reference to a singular item includes the possibility that there are plural of the same items present. More specifically, as used herein and in the appended claims, the singular forms “a,” “and,” “said,” and “the” include plural references unless the context clearly dictates otherwise.
Abstract
A positioning and retrieval device manipulated by carrying element coupled to an handle and driven by an actuator that allows for axial movement and rotational movement of a capturing portion on the carrying element.
Description
- This application is a continuation of U.S. patent application Ser. No. 16/846,127 filed on Apr. 10, 2020, which is a continuation of U.S. patent application Ser. No. 16/533,413 filed on Aug. 6, 2019 (U.S. Pat. No. 10,667,805 issued Jun. 2, 2020), which claims the benefit of priority to U.S. Provisional Application No. 62/849,568 filed on May 17, 2019, the contents of which are incorporated herein by reference in their entireties.
- Suturing techniques and instruments facilitate the suturing of tissue during endoscopic and open surgical procedures. The term “endoscopic” encompasses arthroscopy, laparoscopy, hysteroscopy, etc., and endoscopic surgery involves surgical procedures that are performed on a patient's through small openings as opposed to conventional open surgery through large incisions. The access to a surgical site in an endoscopic procedure relies on one or more portals created in the patient's body or through one or more cannulas inserted into the patient's body through small incisions. The use of sutures in endoscopic procedures relies on remote retrieval of the suture when it is passed through, tied to, and/or anchored in tissue of the surgical site.
- Various instruments and techniques exist and are used for surgical repairs requiring the passing of sutures back through tissue. For example, a suture snare is used with suture passers to retrieve the suture within the joint space during endoscopic surgery. Due to the limited space within the joint, deployment of the snare is often challenging. There remains a need for a minimally invasive surgical instrument that can retrieve or pass a suture or similar surgical item, where the device can allow for steerability as well ease of manipulation to grasp or release a suture used in a surgical procedure.
- The illustrations and variations described herein are meant to provide examples of the methods and devices of the invention. It is contemplated that combinations of aspects of specific embodiments or combinations of the specific embodiments themselves are within the scope of this disclosure.
- The present disclosure includes a surgical instrument for manipulating a component within a patient. The devices and methods described herein can manipulate by positioning or retrieving the component. Such components include, but are not limited to, sutures, anchors, clips, staples, or any surgical component used in a medical procedure. The devices and method described herein can be used in any open surgical procedure or any procedure performed via arthroscopic, endoscopic, thorascopic or similar means.
- In one example, an instrument according to the present disclosure includes a shaft having a far portion, a near portion, and an arcuate shaft segment located between the far portion and the near portion such that a far end of the shaft extends radially away from an axis of the near portion; a lumen extending through the shaft and exiting at the far portion; a handle fixed relative to the near portion of the shaft, such that rotation of the handle causes rotation of the shaft; a suture carrying element comprising a main segment, a capture portion at a distal end, and an arcuate element segment proximal between the capture portion and the main segment, such that in an unconstrained configuration the capturing portion extends radially away from an axis of the main segment, the suture carrying element being elastically deformable into a constrained configuration when located within the lumen; and an actuator housed in the handle and coupled to the main segment of the suture carrying element, the actuator being moveable relative to an axis of the handle simultaneously in a rotational direction and in an axial direction, such that the suture carrying element can be simultaneously rotated and advanced relative to the shaft using the actuator.
- In one variation of the surgical instrument of
claim 1, the arcuate segment is configured such that when moved with the opening at the far portion the arcuate segment deflects to cause the capturing portion to move through an arc such that rotation of the suture carrying element can reposition the capturing portion within an increased distance without moving the far portion of the shaft. The arcuate segment can also be configured to cause the capturing portion to re-enter the opening at the far portion in a single position relative to the opening. - In another variation, the actuator is positioned within the handle and is moveable relative to the axis of the handle simultaneously in the rotational direction and in the axial direction while the handle remains stationary.
- A variation of the instrument can further include a torque shaft extending in the lumen and coupling the main segment to the actuator, wherein a torsional stiffness of the torque shaft is greater than a torsional stiffness of the main segment such that the torque shaft transfers rotation to the main segment.
- In one variation the torque shaft comprises a stainless steel hypodermic tubing. Alternatively, or in combination, the torque shaft can comprise a reinforcement member coupled to a portion of the main segment to form a reinforced segment, such a torsional stiffness of the reinforced segment is greater than a torsional stiffness of a remainder of the main segment such that the torque shaft transfers rotation to the remainder of the main segment.
- Variations of the device include a capturing portion that extends in a u-shaped profile having a first leg and a second leg with an opening therebetween, the first leg being continuous with the arcuate element segment.
- In an additional variation, an arc of the arcuate element segment is greater than 90 degrees such an apex of the arcuate element segment is positioned distally of the first leg, such that when a suture is located against the apex, distal movement of the suture capturing element urges the suture into the u-shaped profile.
- Variations of the surgical instrument include a shaft that is rigid or malleable. Alternate variations include a rigid shaft with a malleable section.
- Variations of the instrument include a capture portion that comprises a u-shape having a first leg connected to the arcuate element segment, a second leg having a free end and a u-segment between the first leg and the second leg, where the u-segment forms a seat for the suture. In additional variations, the capture portion is angled 45 degrees relative to an axis of the main segment.
- Surgical instruments of the present disclosure can optionally include a sharp tip located at the distal end, which allows the distal end of the rigid shaft to penetrate through soft tissue when advanced therethrough.
- In variations of the device, the handle of the instrument further comprises a window opening and where the actuator is accessible through the window opening. In certain variations, the actuator is recessed within the window opening.
- The suture carrying element can comprise a superelastic alloy. The capture portion can include an opening disposed proximal to the distal end including a distal concave surface facing proximally for retaining the suture within the opening as the instrument is drawn proximally. In some variations, the capture portion comprises a pivotably operable jaw. Alternatively, the capture portion comprises a v-shape having an apex and an open end, where the apex is distal to the open end.
- The present disclosure also includes methods for manipulating a suture passed through a tissue region. For example, one such method includes positioning a shaft adjacent to the tissue region using a handle, where the shaft is affixed to the handle such that rotation and axial movement of the handle produces rotation and axial movement of the shaft, the shaft having an arcuate segment proximate to a sharp distal tip; passing a distal opening of the shaft through the tissue region and advancing the shaft through the tissue region using the handle; manipulating an actuator in the handle to advance a suture carrying element through a lumen of the shaft, where the suture carrying element a main segment, a capture portion at a distal end, and an arcuate element segment proximal between the capture portion and the main segment, such that in an unconstrained configuration the capturing portion extends radially away from an axis of the main segment, the suture carrying element being elastically deformable into a constrained configuration when located within the lumen; simultaneously rotating the handle while rotating and axially moving the actuator to engage the suture with the capturing portion; proximally moving the actuator relative to the handle to retract the capturing portion and the suture within the shaft; and retrieving the shaft through the tissue region to pull the suture through the tissue region.
- In one variation of the method, proximally moving the actuator relative to the handle to retract the capturing portion and the suture within the shaft causes the arcuate element segment to deform when withdrawn into the distal opening of the shaft causing the capturing portion to move towards an axis of the distal end of the shaft without deforming the capturing portion.
- The present disclosure also includes a medical device comprising: a handle portion having a cylindrical bore; an actuator having a cylindrical periphery that forms a slidable fit with the cylindrical bore; a shaft fixed relative to the handle portion; a torque shaft fixed to the actuator, where rotation and/or axial movement of the actuator causes rotational and/or axial movement of the torque shaft; a fixed component secured to a distal end of the shaft; and an actuatable component coupled to both the fixed component and the torque shaft, where movement of the actuator causes movement of the actuatable component relative to the fixed component.
- Each of the following figures diagrammatically illustrates aspects of the invention. Variation of the invention from the aspects shown in the figures is contemplated.
-
FIG. 1A illustrates a variation of a surgical instrument for manipulating or retrieving an item such as a suture. -
FIG. 1B illustrates a magnified view of thesection 1B fromFIG. 1A . -
FIG. 2A illustrates another magnified view of a shaft of an instrument to better illustrate movement of a carrying element within a lumen of the shaft. -
FIGS. 2B and 2C illustrate a device with a torque shaft or reinforced carrying element. -
FIGS. 3A to 3H illustrate examples of carrying elements extending distally from a lumen or opening in a distal of a shaft of an instrument as described herein. -
FIG. 4 provides an illustrated example of positioning a shaft of an instrument through tissue. -
FIGS. 5A to 5F illustrate an example of manipulating a variation of a surgical instrument of the present disclosure to secure asuture 20. -
FIGS. 6A to 6D illustrate some additional variations of carrying elements with various types of capturing portions at an end of the shaft. -
FIGS. 7A and 7B show alternative shaft configurations of variations of the instrument described herein. -
FIG. 8 illustrates a cross sectional view of a handle with a cylindrical actuator floating within the actuator. - It is understood that the examples below discuss uses in minimally invasive arthroscopic procedures. However, unless specifically noted, variations of the device and method are not limited to use in arthroscopic procedures. Instead, the invention may have applicability in various parts of the body under any minimally invasive or invasive procedure. Moreover, the invention may be used in any procedure where the benefits of the method and/or device are desired.
-
FIG. 1A illustrates a variation of asurgical instrument 100 for manipulating an item (not shown inFIG. 1A ) during a medical procedure. For the sake of illustration, the item being manipulated is depicted as a suture and one variation of the surgical instrument comprises a suture retriever/manipulator. However, variations of the surgical instrument are not limited to sutures. For example, the instrument can be used to manipulate or retrieve implants, fabric (such as gauze or sheets), threads, wires, etc. As shown inFIG. 1A , a variation of theinstrument 100 includes ashaft 102 coupled to ahandle 120. Theshaft 120 can include a near portion 104 (e.g., a section of theshaft 102 that is adjacent the handle 120) and a far portion 106 (e.g., a section of theshaft 102 that is towards adistal end 108 of the shaft 102). In the illustrated variation of theinstrument 100, thefar portion 106 includes an arcuate orangled segment 114 that causes afar end 112 of theshaft 102 to extend at an angle or radially away from anaxis 116 of theshaft 102. Variations of devices described herein can includeshafts 102 withangled segments 114 that produce an angle greater than 0 degrees to 90 degrees. However, the disclosure includes any angle as well as straight shafts. Moreover, in alternate variations theangled segment 114 can also be located at thenear portion 104 of theshaft 102. - The
medical apparatus 100 illustrated inFIG. 1A also shows anear portion 104 separated from afar portion 106 by a taperedtransition section 110. Alternative variations of the device do not require the different sections of theshaft 102 to be different diameters or different configurations. However, varying diameters of theshaft 102 can provide benefits depending upon the main intended procedure of the device. For example, in the variation illustrated inFIG. 1A , ashaft 102 with a larger diameter at thenear portion 104 provided for increased column strength when manipulating theinstrument 100 via thehandle 120. The smaller diameterfar portion 106 of theshaft 102 reduces a force required to advance through tissue. In alternate variations, adevice 100 according to the present disclosure includes various portions (e.g., 104, 106) having different cross-sectional profiles than the circular profiles shown. -
FIG. 1B illustrates a magnified view of thesection 1B fromFIG. 1A .FIG. 1B shows alumen 108 that extends through theshaft 102, exiting at thefar end 112. Variations of thedevice 102 can include ashaft lumen 102 that extends into thehandle 120. In alternate variations of the device, the lumen can exit from other portions of the shaft not just thefar end 112. Moreover, alternate variations of thedevice 100 include one or more lumens that exit through multiple portions of the device and/or shaft. In any case, theshaft 102 can include amain lumen 108 that accommodates a carryingelement 140, which as described below, can be advanced, retracted, and/or rotated using controls coupled to thehandle 120. The carryingelement 140 is referred to herein as asuture carrying element 140, however, the carryingelement 140 can be used to manipulate and/or retrieve a number of surgical items as described above.FIG. 1B also illustrates thefar end 112 as having a sharp tip that can penetrate tissue. Alternate variations of theinstrument 100 do not require a sharp tip. Instead, the tip can be rounded or blunted to dissect tissue. -
FIG. 1B also illustrates a variation of acapture portion 144 being configured in a U-shape with afirst leg 156 adjacent to thearcuate segment 152 of the carryingelement 140 and asecond leg 158 being open to permit positioning of a suture (or other component) adjacent to aseat 155 of the capturing portion. As noted herein, and shown below, the devices described herein can include capturing portions of various shapes as well as actuatable arms or graspers. -
FIG. 1A also shows ahandle 120 located adjacent to thenear section 104 of theshaft 102. Variations of theinstrument 100 includehandles 120 that are affixed to or relative to theshaft 102 such that rotation of thehandle 120 causes rotation of theshaft 102. Thehandle 120 also includes anactuator 130 that is coupled to the carryingelement 140 and allows for movement of the carryingelement 140 relative to theshaft 102. In the illustrated variation, as also discussed below, theactuator 120 can allow for rotational and/or axial movement of the carryingelement 140 relative to the shaft. In this variation of theinstrument 100, thehandle 120 includes abody 120 with awindow 124 that exposes theactuator 130. This configuration allows for rotation of thehandle 120 without any features of theactuator 130 that protrude from thehandle body 122. In alternate variations, a portion of theactuator 130 can protrude from thehandle body 122. Theactuator 130 can include features, such as the recessedpockets 132, that ease positioning of an operators fingers while the operator's hand is able to grasp the remaining portion of thehandle body 122. This allows control of thehandle 120 and simultaneous adjustment of theactuator 130 using a single hand. Although not illustrated, the recessed features 132 of the actuator can extend around a circumference of theactuator 130. -
FIG. 1A further shows an optional feature of thehandle 120 where a proximal opening 126 for a lumen that is in fluid communication with theshaft lumen 108. This allows for flushing of theshaft 102 or advancement of a suture through the device. -
FIG. 2A illustrates another magnified view of ashaft 102 of an instrument to better illustrate movement of the carryingelement 140 within thelumen 108 of theshaft 102. The capturingelement 142 can comprise amain segment 142 that is elastically deformable such that it can navigate any bend orarcuate segment 114 of theshaft 102 without retaining the deformation. In certain variations, themain segment 142 and/orentire capturing element 140 is fabricated from a super elastic alloy or a flexible material (e.g., alloy, polymer, or similar material). The carryingelement 140 is coupled to the actuator (not shown) along a portion of a proximal end of themain segment 142, wherein rotation of the actuator causes the capturingelement 140 to rotate. Furthermore, axial movement of the actuator (or other component) along an axis of the handle (not shown) will causeaxial movement 146 of the capturingelement 140 about anaxis 148 of themain segment 142. Rotation of the actuator also causes the capturingelement 140 to rotate about theaxis 148 causing acapture portion 144 to rotate in a pattern up to a 360degree pattern 150. -
FIG. 2B illustrates anactuator 130 coupled to a carryingelement 140 via atorque shaft 180. Thetorque shaft 180 provides a connection between the carryingelement 140 andactuator 130 but also provides a torsional strength or stiffness that allows theactuator 130 to transfer a consistent rotation to the carryingelement 140 in addition to providing an axial translation (in those variations requiring both rotation and axial movement). In those previous devices without a torque shaft the wire used to secure the suture twists and binds if over-rotated. Thetorque shaft 180 of the present disclosure can extend the distance of theshaft 102 with the carryingelement 140 connected to a distal end of thetorque shaft 180. Thetorque shaft 180 can also provide provides rigidity and linear structure to the device. In alternate variations, a carryingelement 140 can be directly coupled to theactuator 130 but forms atorque shaft 180 using a reinforcement member (e.g., sheath, coating, tube, etc.) over a portion of themain segment 142 of the carryingelement 140. In such a case, similar to the torque shaft, the reinforcement allows theactuator 130 to transfer rotation to thecapture portion 144 while minimizing binding and torque/torsion loading of thecapture portion 144. -
FIG. 2C illustrates a magnified view of a variation of a carryingelement 140 andtorsion shaft 180. As illustrated, thetorsion shaft 180 can comprise a hypotube (e.g., stainless steel) that includes apassage 180, where themain segment 142 is loaded within thepassage 180 at a distal end of thetorsion shaft 180. Variations of the device can include a torsion shaft 180 (or reinforcement) that does not enter the articulatedsegment 114 of the shaft. Alternatively, the torsion shaft 180 (or reinforcement) can extend at least partially into or beyond the articulatedsegment 114. -
FIGS. 3A to 3H illustrate an example of a carryingelement 140 extending distally from a lumen oropening 108 in adistal end 112 of ashaft 102 of an instrument as described herein. As noted above, amain segment 142 of the carryingelement 140 can be axially advanced in adirection 146 relative to theshaft 102. In variations of thedevice 100, the carryingelement 140 can be positioned entirely within theshaft 102 and advanced distally from theopening 108 as needed. The carryingelement 140 includes a capturingportion 144 that is typically at a distal end. In the illustrated variation shown inFIG. 3A , the capturingportion 144 extends away from anaxis 148 of themain segment 142. As discussed below, providing the capturingportion 144 at a distance from theaxis 148 of the main segment increases the ability of an operator to reposition the carryingelement 140 andcapture section 144 through a range of positions adjacent to thedistal end 112 of theshaft 102. In the illustrated variation ofFIG. 3A , the capturingportion 144 is positioned approximately 90 degrees from theaxis 148 of themain segment 142. However, variations of devices can include a capturing element with an angular spacing that ranges between 0 and 180 degrees relative to theaxis 148 to extend in a radial direction from theaxis 148 of the main segment. For convenience, the angle can be measured from either leg of thecapture portion 144. In order to position thecapture portion 144 at an angle to themain segment axis 148, the carryingelement 140 can include one or more arcuate sections/segments 152 between the capturingportion 144 and themain segment 142. -
FIG. 3B illustrates a configuration where the carryingelement 144 has been withdrawn proximally towards theshaft 102 such that the main segment (not pictured) is within theshaft 102 and thearcuate segment 152 engages a side of thedistal end 112. Continued withdrawal of the carryingelement 140 in theproximal direction 146 will cause the capturingportion 144 to move in anarc 154 and into alignment with thelumen 108 of theshaft 102. Movement of the capturingportion 144 in anarc pattern 154 is desirable to prevent the suture (or other item being carried) from engaging a side of the wall of thedistal end 112. Thisarc pattern 154 movement is primarily made possible by the large radiusedarcuate segment 152. -
FIGS. 3C and 3D illustrate additional variations of the capturingelement 140 to illustrate the features of an arc angle of thearcuate segment 152 of the capturingelement 140. The arc angle can be measured starting from the location where thearcuate segment 152 deviates from an axis of themain segment 142 to location where thearcuate segment 152 becomes parallel to or meets a leg of the capturingportion 144. InFIG. 3C , thesweep angle 160 of thearcuate segment 152 is approximately 90 degrees. InFIG. 3D , thearc angle 160 is greater than 90 degrees. It is believed that an arc angle greater than 90 degrees coupled with a largeradius arc segment 152 improves the ability of the device to retrieve a suture or similar structure within an opening of the shaft. The combination of arc angle and large radius arc segment (coupled with the repositioning of the shaft) provides an increased range for an operator to maneuver the carrying element from the location where it passes through tissue to a location where a suture (or other medical item) is located. -
FIG. 3E illustrates a variation of the carryingelement 140 that includes an arc angle greater than 90 degrees where the carryingelement 140 is retracted in aproximal direction 146 to within theshaft 102. As shown, the capturingportion 144 continues to move in an arc 154 (relative toFIG. 3B ) as thearcuate segment 152 engages a wall of thedistal end 112 when withdrawn into theshaft 102.FIG. 3F illustrates a state of the instrument when thearcuate segment 152 is within theshaft 102. As shown, because the arc angle is greater than 90 degrees, thecapture portion 144 can enter the shaft in alignment with the opening/lumen 108.FIG. 3G shows the carryingelement 140 as it retracts into the shaft until the carryingelement 140 andcapture portion 144 are fully within theshaft 102. As shown, retracting the carryingelement 140 causes thearcuate element segment 152 to deform against the distal end such that the capturingportion 144 sweeps to move towards alignment with an axis of the opening 108 (as shown inFIGS. 3F and 3G ) without deforming during movement outside of theshaft 102. In certain variations, the capturing portion 144 (either entirely or a portion thereof) can deform as it enters theshaft lumen 108, which compresses the suture (or component). This configuration allows for a suture to be retained within or against the capturingportion 144 as it is repositioned outside of the shaft and prepared for withdrawal into the shaft. - It should be noted that variations of the instruments described herein include the ability to retract the carrying element 140 (as shown in
FIGS. 3A to 3B and 3D to 3H ) while simultaneously rotating (as demonstrated inFIG. 2A ). - The ability to move axially while simultaneously rotating allows for increased positioning of the capturing
portion 144 during positioning of the carryingelement 140 when trying to secure the suture (or other medical component) as well as allows for thecapture portion 144 to be rotated when a suture (or other medical component) is secured therein. In the latter case, rotation of a suture (or other element) secured within thecapture portion 144 can cause the suture to wrap about the carryingelement 140, which further assists in manipulation of the suture. - Another feature of the present device is that the
distal end 112 of theshaft 102 comprises a tapered or beveled end at theopening 108. In such variations, thetapered opening 108 as well as the shape and angle of thearcuate segment 108 of the carryingelement 140 allows thecapture portion 144 to slightly deform such that it enters theopening 108 in a consistent manner regardless of the position of the carryingcapture portion 144 when extended. As noted above, variations of the device rely on a torque shaft that is connected to the actuator. Therefore, the relatively short length of thecapture portion 144 and main segment that is not reinforced allows the main segment to flex as it re-enters theshaft 108. - In variations of the device, the arcuate segment provides an advantage in being configured such that when moved with the opening at the far portion the
arcuate segment 152 deflects to cause movement of the capturingportion 144 through anarc 154. This allows the capturing portion to move through a range of positions such that rotation of the suture carrying element can reposition the capturing portion within an increased distance to reach a suture without having to move the far portion of the shaft. Another benefit is that in variations of the device, the arcuate segment is configured to cause the capturing portion to re-enter the opening at the far portion in a single position relative to the opening. This means that regardless of the orientation of the capturing portion 144 (e.g., if it is rotated 180 degrees from that shown inFIG. 3E , the capturing portion will orient as shown inFIGS. 3E and 3F when retracted within theshaft 102. -
FIG. 4 provides an illustrated example of positioning ashaft 102 of an instrument according to the present disclosure. For purposes of illustrationFIG. 4 shows a section oftissue 2 having afirst surface 4 and a second surface 6. The instruments described herein are especially useful in applications where asuture 20 extends from afirst surface 4 to a second surface 6 through an opening 8 and must be withdrawn back through thetissue 2 from the second surface 6. In some cases, the medical practitioner only has visual access to the second surface 6 while manipulating the instrument from thefirst surface 4.FIG. 4 illustrates thesuture 20 as having a loop configuration. However, other configurations (e.g., a knot, hook, attached needle, etc.) are considered to be within the scope of this disclosure. Furthermore, the illustratedsuture 20 is shown to be a ribbon type configuration. However, the present disclosure includes sutures (or other medical components) of multiple shapes, sizes, and cross sections. -
FIG. 4 illustrates a situation where a medical practitioner advances theshaft 102 through anopening 10 in thetissue 2 where theshaft 102 includes adistal end 112 with a sharp tip. However, alternate variations of the device include blunted, atraumatic, or otherwise rounded ends. In the initial advancement of theshaft 102, theopening 108 might be mis-aligned with thesuture 20. -
FIGS. 5A to 5F illustrate an example of manipulating a variation of asurgical instrument 100 of the present disclosure to secure asuture 20. As noted herein, the devices disclosed herein can position, retrieve, or otherwise manipulate a suture or other surgical component.FIG. 5A illustrates a state immediately after theshaft 102 is advanced throughtissue 2. For purposes of illustration, theshaft 102 and handle 120 are not drawn to scale. - As shown in
FIG. 5A , once theshaft 102 of thedevice 100 is positioned throughtissue 2, thehandle 120 can be rotated in eitherdirection 134 to produce acorresponding rotation 134 of theshaft 102. In most cases, the medical practitioner will be able to manipulate thehandle 120 while visually observing thedistal end 112 of theshaft 102. In alternate variations, theshaft 102 can be made sufficiently radiopaque (or have radiopaque markers) such that it is observable under x-ray or a CT scan. Alternatively, the device can be made to be visible under alternate non-invasive imaging (e.g., visible under ultrasound imaging, etc.). Regardless, the medical practitioner can position the far/distal end 112 of theshaft 102 such that the opening/lumen 108 is placed sufficiently close to thesuture 20. Thearcuate segment 114 of theshaft 102 can further increase the ability to position theopening 108 of theshaft 102 away from thetissue opening 10 by axial movement of theentire shaft 102 as well as rotation of thehandle 120. Clearly, thedevice 100 provides the medical practitioner with the ability to reposition thedistal end 112 using a single hand. -
FIG. 5B illustrates a configuration where the carryingelement 140 advances in anaxial direction 146 upon a correspondingaxial movement 146 of theactuator 130 coupled to thehandle 120. As noted above, some variations of theinstrument 100 allow forsimultaneous rotation 150 of the actuator, which producescorresponding rotation 150 of the carryingelement 140. In addition, thehandle 120 can be rotated 134 and/or axially moved 136 to producecorresponding rotation 134 and/oraxial movement 136 of theshaft 102. In those procedures where theinstrument 100 is used to retrieve asuture 120, the manipulation of thehandle 120 andactuator 130 are used to position the capturingelement 144 adjacent to thesuture 20. -
FIG. 5C illustrates the carryingelement 140 as being advanced into a loop of thesuture 20. As noted above, in alternate variations thesuture 20 will include a knot, needle, hook, etc. that is used to engage thecapture portion 144.FIG. 5D shows thecapture portion 144 of the carryingelement 140 advancing beyond thesuture 20. As noted herein, the capturingportion 144 as well as the remaining portion of the carryingelement 140 can be fabricated to be elastically deformable to assist in navigating to and securing thesuture 20. -
FIG. 5E illustrates the situation where either thedevice 100 and/or the carryingelement 140 is withdrawn relative to thesuture 20 to secure thesuture 20 within the capturingportion 144.FIG. 5F shows further withdrawal of the carrying element (not illustrated inFIG. 5F ) into theopening 108 of theshaft 102 to partially draw thesuture 20 within theshaft 10 such that retrieval of thedevice 100 causes thesuture 20 to be pulled through theshaft opening 10 and through thetissue 2. - Although not illustrated, a
suture 20 can be initially advanced through thetissue 2 using an instrument (i.e., a placement instrument). In such a situation, the suture can either extend outside of the placement instrument or extend within a shaft of the placement instrument. A second device (i.e., a retrieval instrument) can be used to secure a portion of the suture thereto. This allows the retrieval instrument to be withdrawn back through tissue. A benefit of this dual instrument procedure is that both devices can be manipulated using either hand of the medical practitioner. -
FIGS. 6A to 6D illustrate some additional variations of carryingelements 140 with various types of capturingportions 144 at an end of theshaft 102.FIG. 6A illustrates acapture portion 144 that has a v-shape where the open legs of the v-shape are proximal to an apex of the v-shape.FIG. 6B illustrates anactuatable capture portion 155 having a jaw structure joined at ahinge 162. The jaw structure can be operated using one ormore pull wires 164 that extends to a proximal end of the device and/or to a handle of the device.FIGS. 6C and 6D illustrate a carryingelement 150 having a capturing portion configured in acoil structure 166. In such a case, thecoil 166 can be flexible such that a suture becomes secured within the turns of thecoil 166. Although not illustrated, the turns of thecoil 166 can be in contact or can be separated by a gap. -
FIGS. 7A and 7B illustrate additional variations ofdevices 100 as described herein. For example,FIG. 7A illustrates anactuator 130 within ahandle 120, where thehandle 120 is coupled to ashaft 102 where thefar portion 106 of theshaft 102 is straight.FIG. 6B illustrates ashaft 102 coupled to ahandle 120 where thenear portion 104 andfar portion 106 of the shaft are the same or similar diameters (e.g., theshaft 102 can comprise a single tubular member). -
FIG. 8 illustrates another aspect of variations ofdevices 100 under the present disclosure. As shown, another feature of thedevice 100 is that thehandle body 120 comprises abore 128 that accommodates a free-floating sliding fit with anactuator 130. Although theactuator 130 is shown to be a substantially solid cylindrical piece, it can comprise any structure that has an effective cylindrical profile such as a varying surface comprising peaks and grooves where the peaks effectively form a cylindrical circumference that forms a sliding fit with thebore 128 of thehandle 120. Moreover, variations of thedevice 100 include abody 120 that is non-cylindrical on an outer surface but comprises abore 128 that is sized to allow a sliding fit with theactuator 130. In the illustrated variation, thebody 120 comprises a cylindrical surface, which allows for a medical practitioner to grasp thebody 100 with a palm of their hand and use their fingers to aid in manipulation of thebody 100 while the thumb can be used to provideaxial movement 146 of the actuator and/orrotational movement 150 of the actuator to drive atorque shaft 180 relative to ashaft 102 that is affixed to thebody 120. Such a handle configuration can be used for the carryingelement 140 as described herein. Moreover, this handle configuration can be used in a number of other medical devices used in arthroscopic, thorascopic, and/or endoscopic procedures. -
FIG. 8 also shows thedevice 100 as having atensioning component 170 having atensioning surface 172 that can adjust a force required to move theactuator 130 within thebore 128. For example, thetensioning component 170 andsurface 172 can comprise a spring loaded ball-bearing that applies an adjustable force on a portion of thehandle 130. - As for other details of the present invention, materials and manufacturing techniques may be employed as within the level of those with skill in the relevant art. The same may hold true with respect to method-based aspects of the invention in terms of additional acts that are commonly or logically employed. In addition, though the invention has been described in reference to several examples, optionally incorporating various features, the invention is not to be limited to that which is described or indicated as contemplated with respect to each variation of the invention.
- Various changes may be made to the invention described. For example, the invention includes combinations of aspects of the variations of the devices described herein as well as the combination of the variations themselves. Also, any optional feature of the inventive variations may be set forth and claimed independently, or in combination with any one or more of the features described herein. Accordingly, the invention contemplates combinations of various aspects of the embodiments or combinations of the embodiments themselves, where possible. Reference to a singular item, includes the possibility that there are plural of the same items present. More specifically, as used herein and in the appended claims, the singular forms “a,” “and,” “said,” and “the” include plural references unless the context clearly dictates otherwise.
- It is important to note that where possible, aspects of the various described embodiments, or the embodiments themselves can be combined. Where such combinations are intended to be within the scope of this disclosure.
Claims (1)
1. A surgical instrument for manipulating a suture, the surgical instrument comprising:
a shaft having a far portion and a near portion;
a lumen extending through the shaft to an opening at the far portion;
a handle at the near portion of the shaft;
a suture carrying element comprising a main segment having an arcuate element segment and a capture portion at a distal end, the capture portion having a first leg adjacent to the arcuate element segment, a seat connecting the first leg to a second leg, the seat having an arc shape such that the second leg extends back towards the arcuate element segment, where a free end of the second leg is opposite to the seat and forms an opening between the first leg and the second leg that opens towards the arcuate element segment, the opening configured to receive the suture;
wherein when the arcuate element segment is advanced out of the shaft the capture portion extends radially away from an axis of the main segment, the suture carrying element being elastically deformable when withdrawn within the lumen, and movement of the arcuate element segment within the opening deforms the arcuate element segment causing movement of the capture portion through an arc profile independently of the shaft, where a shape of the capture portion does not change during movement through the arc profile; and
an actuator housed in the handle and coupled to the main segment of the suture carrying element, the actuator being moveable relative to an axis of the handle in a rotational direction and in an axial direction, such that the suture carrying element can rotate and advance either independently or simultaneously relative to the shaft with movement of the actuator.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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US18/185,010 US20230320724A1 (en) | 2019-05-17 | 2023-03-16 | Steerable suture retriever |
Applications Claiming Priority (4)
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US201962849568P | 2019-05-17 | 2019-05-17 | |
US16/533,413 US10667805B1 (en) | 2019-05-17 | 2019-08-06 | Steerable suture retriever |
US16/846,127 US11701106B2 (en) | 2019-05-17 | 2020-04-10 | Steerable suture retriever |
US18/185,010 US20230320724A1 (en) | 2019-05-17 | 2023-03-16 | Steerable suture retriever |
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US16/846,127 Continuation US11701106B2 (en) | 2019-05-17 | 2020-04-10 | Steerable suture retriever |
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US20230320724A1 true US20230320724A1 (en) | 2023-10-12 |
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US16/846,127 Active 2040-09-07 US11701106B2 (en) | 2019-05-17 | 2020-04-10 | Steerable suture retriever |
US18/185,010 Pending US20230320724A1 (en) | 2019-05-17 | 2023-03-16 | Steerable suture retriever |
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US16/846,127 Active 2040-09-07 US11701106B2 (en) | 2019-05-17 | 2020-04-10 | Steerable suture retriever |
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EP (1) | EP3968868A4 (en) |
WO (1) | WO2020236531A1 (en) |
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EP3817668A1 (en) * | 2018-07-05 | 2021-05-12 | Smith & Nephew, Inc. | Suture passing device and methods of use thereof |
US10667805B1 (en) | 2019-05-17 | 2020-06-02 | Composite Surgical, LLC | Steerable suture retriever |
US10973512B1 (en) | 2020-05-14 | 2021-04-13 | Composite Surgical, LLC | Steerable suture retriever |
US11154295B1 (en) | 2020-05-14 | 2021-10-26 | Composite Surgical, LLC | Steerable suture retriever |
US11553921B2 (en) * | 2020-07-15 | 2023-01-17 | Covidien Lp | Surgical stapling device with flexible shaft |
US20240016490A1 (en) * | 2020-10-28 | 2024-01-18 | Smith & Nephew, Inc. | Surgical instrument for manipulating and passing suture |
WO2022246007A1 (en) * | 2021-05-18 | 2022-11-24 | Neuronoff, Inc. | System and methods for minimally invasive removal of implanted devices |
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2019
- 2019-08-06 US US16/533,413 patent/US10667805B1/en active Active
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2020
- 2020-04-10 US US16/846,127 patent/US11701106B2/en active Active
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EP3968868A4 (en) | 2023-06-28 |
US20200360013A1 (en) | 2020-11-19 |
US10667805B1 (en) | 2020-06-02 |
WO2020236531A1 (en) | 2020-11-26 |
US11701106B2 (en) | 2023-07-18 |
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