Method of suturing a trocar path incision

Patent metadata

Field	Value
Publication number	US-11389192-B2
Application number	US-201715637778-A
Country	US
Kind code	B2
Filing date	Jun 29, 2017
Priority date	Jun 29, 2017
Publication date	Jul 19, 2022
Grant date	Jul 19, 2022

Abstract

A method of suturing a trocar path incision in a tissue of a patient with an obturator includes inserting the obturator through the tissue such that a shaft of the obturator extends through a tissue opening about the trocar path incision and a distal tip of the obturator is positioned within a cavity of the patient. The method also includes directing the suture via a suturing feature with the obturator inserted through the tissue in order to direct the suture relative to the tissue. Furthermore, the method includes closing the tissue opening about the trocar path incision with the suture.

First claim

We claim:

1. A method of suturing a trocar path incision in a tissue of a patient with a cannula assembly and an obturator, wherein the obturator includes a proximal head, a distal tip configured to penetrate tissue of a patient, a shaft extending along a longitudinal axis from the proximal head to the distal tip and received within a working channel of the cannula assembly, and a suturing feature configured to receive a suture including a suture thread, the method comprising:
(a) inserting the obturator and the cannula assembly through the tissue such that the shaft extends through a tissue opening about the trocar path incision and the distal tip is positioned within a cavity of the patient;
(b) inserting a thread end portion of the suture thread with a needle through a channel of the cannula assembly, into the tissue, and to the suturing feature such that insertion is obliquely oriented relative to the longitudinal axis of the shaft and the needle with the suture thread thereon simultaneously extends from the channel to the suturing feature;
(c) directing the suture thread via the suturing feature with the obturator inserted through the tissue in order to direct the suture thread relative to the tissue;
(d) rotating the suture feature about the longitudinal axis of the shaft thereby transitioning the suturing feature from a first deployed position toward a second deployed position;
(e) removing the thread end portion of the suture thread from the tissue such that the removal is obliquely oriented relative to the longitudinal axis of the shaft; and
(f) closing the tissue opening about the trocar path incision with the suture.

2. The method of claim 1 , wherein the suturing feature of the obturator includes a catch arm selectively moveable from a retracted position to the first deployed position and the second deployed position and configured to releasably capture the suture thread of the suture from the needle, the method further comprising:
(a) extending the catch arm radially outwardly to the first deployed position;
(b) inserting the thread end portion of the suture thread into the tissue with the needle;
(c) releasably capturing the thread end portion of the suture thread with the catch arm;
(d) rotating the catch arm to the second deployed position with the thread end portion of the suture thread releasably captured thereto;
(e) releasing the thread end portion of the suture thread from the catch arm; and
(f) withdrawing the thread end portion of the suture thread from the patient to thereby suture the tissue opening.

3. The method of claim 2 , wherein rotating the catch arm further includes rotating the obturator relative to the cannula assembly.

4. The method of claim 1 , further comprising:
(a) manipulating the needle from a catch position toward a release position;
(b) urging the suture thread of the suture with a cam surface of the needle from a catch portion of a suture notch; and
(c) releasing the suture thread from the catch portion of the suture notch.

5. The method of claim 1 , wherein a surgical access device includes a tissue retractor including a flexible body, a plurality of surgical instrument channels arranged in a central portion of the tissue retractor, a needle entrance port, and a needle exit port arranged distally of the needle entrance port, the needle entrance port and the needle exit port defining a needle channel extending distally through the surgical access device and obliquely relative to the longitudinal axis of the shaft thereof, the method comprising:
(a) guiding a surgical instrument with at least one surgical instrument channel distally through the surgical access device; and
(b) guiding the needle through the surgical access device and adjacent to the tissue to facilitate closure of the tissue opening.

6. The method of claim 1 , wherein directing the suture thread via the suturing feature further includes directing the suture thread via the suturing feature with the obturator inserted through the tissue in order to direct the suture thread relative to the tissue while the cannula assembly is releasably secured to the obturator.

7. The method of claim 1 , further comprising piercing the tissue with the distal tip of the obturator thereby forming a tissue opening in the tissue.

8. A method of suturing a trocar path incision in a tissue of a patient with an obturator and a needle, wherein the obturator includes a proximal head including a distal tip configured to penetrate tissue of a patient, a shaft extending from the proximal head to the distal tip and the shaft is configured to be received within a working channel of a cannula assembly, and a suturing feature configured to receive a suture, the method comprising:
(a) piercing the tissue with the distal tip of the obturator thereby forming a tissue opening in the tissue;
(b) inserting the obturator through the tissue such that the shaft extends through a tissue opening about the trocar path incision and the distal tip is positioned within a cavity of the patient;
(c) inserting a thread end portion of the suture through a first portion of the tissue with the needle;
(d) directing the suture via the suturing feature with the obturator inserted through the tissue in order to direct the suture distally through the tissue;
(e) removing the needle and the thread end portion of the suture proximally through another portion of the tissue with the needle, wherein the needle remains in contact with the thread end portion during the removal of the thread end portion from the tissue; and
(f) knotting the suture to close the tissue opening about the trocar path incision.

9. A method of suturing a trocar path incision in a tissue of a patient with an obturator, wherein the obturator includes a proximal head, a distal tip configured to penetrate tissue of a patient, a shaft extending from the proximal head to the distal tip and received within a working channel of a cannula assembly, and a catch arm configured to receive a suture including a suture thread, the method comprising:
(a) inserting the obturator through the tissue such that the shaft extends through a tissue opening about the trocar path incision and the distal tip is positioned within a cavity of the patient;
(b) moving the suture thread with a needle into the catch arm while the obturator is releasably secured to the cannula assembly;
(c) manipulating the needle from a catch position toward a release position to release the suture thread;
(d) directing the suture thread via the catch arm with the obturator inserted through the tissue in order to direct the suture thread relative to the tissue;
(e) manipulating the needle from the release position to the catch position to grasp the suture thread and remove the suture thread from the catch arm, wherein the needle maintains contact with the suture thread while the suture thread is removed from the catch arm; and
(f) closing the tissue opening about the trocar path incision with the suture.

Assignees

• Ethicon Llc
• Cilag Gmbh Int

Inventors

• Shelton Iv Frederick E
• Bakos Gregory J
• Christopher Layne D
• Gettinger Rebecca J
• Harris Jason L
• Hess Christopher J
• Huang Zhifan F
• Hunt John V
• Jacobs Michael
• Jadhav Anil R
• Jast John A
• Kwee Nichole Y
• Larson Kevin A
• Lee James G
• Martin David T
• Morgan Jerome R
• Murray Michael A
• Parihar Shailendra K
• Posada Sol
• Raghavan Devanathan
• Schings Brian D
• Schleitweiler Patrick M
• Seipelt Nicholas
• Tellmann Melinda
• Widenhouse Tamara S Vetro

Classifications

• A61B17/3421 Primary

  Cannulas · CPC title

• A61B17/0057

  Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect (sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009) · CPC title

• A61B17/0469

  Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery · CPC title

• A61B2017/06042

  located close to needle tip · CPC title

• A61B2017/3445

  used as instrument channel for multiple instruments · CPC title