Instruments for delivering transfascial sutures, transfascial suture assemblies, and methods of transfascial suturing

Patent metadata

Field	Value
Publication number	US-9439643-B2
Application number	US-201113157155-A
Country	US
Kind code	B2
Filing date	Jun 9, 2011
Priority date	Jun 9, 2010
Publication date	Sep 13, 2016
Grant date	Sep 13, 2016

Abstract

An instrument for delivering a suture transfascially may include a handle, a shaft extending from the handle, and a pair of needles that are moveable to an extended position beyond the end of the shaft. One or more sutures are carried by the instrument and may be delivered transfascially. A transfascial suture assembly includes a suture having a first segment, a second segment, and an intermediate segment therebetween. A force distributing member is locatable at the intermediate segment. Suture retainers may be provided at the end of each suture segment, and may be moveable relative to the suture segment connected therewith. A method of delivering transfascial sutures includes inserting a twin-needle instrument loaded with one or more sutures into an abdominal cavity and deploying, from within the abdominal cavity, the suture carrying needles through a soft tissue repair patch and then through at least part of the abdominal wall.

First claim

What is claimed is:

1. A method of delivering a transfascial suture, the method comprising acts of:
(a) providing a soft tissue repair prosthetic and a suturing instrument in an abdominal cavity of a patient with the soft tissue repair prosthetic located between the suturing instrument and the abdominal wall, the soft tissue repair prosthetic including a first surface facing away from the abdominal wall and a second surface facing toward the abdominal wall, the suturing instrument including a distal end facing the first surface and the suturing instrument not passing through the soft tissue repair prosthetic, the suturing instrument including a suture defined by a pair of suture segments and an intermediate segment extending continuously between and connecting the suture segments, the intermediate segment including a suture force distributing member;
(b) passing, from within the abdominal cavity, each suture segment in a distal direction beyond the distal end of the suturing instrument first through the first surface of the soft tissue repair prosthetic and then through the second surface and at least a part of the abdominal wall; and
(c) positioning the suture force distributing member against the first surface of the soft tissue repair prosthetic to spread forces applied along the intermediate segment.

2. The method of claim 1 , wherein act (c) includes preventing passage of the intermediate segment through the soft tissue repair prosthetic.

3. The method of claim 1 , wherein act (b) includes simultaneously passing the pair of suture segments from the suturing instrument through the soft tissue repair prosthetic and then through the at least a part of the abdominal wall.

4. The method of claim 1 , wherein act (b) includes piercing the soft tissue repair prosthetic and then piercing the at least a part of the abdominal wall.

5. The method of claim 1 , further comprising repeating act (b) in one or more locations about a peripheral segment of the soft tissue repair prosthetic.

6. The method of claim 1 , wherein the soft tissue repair prosthetic is in the form of a patch.

7. The method of claim 1 , further comprising, after act (b), securing the suture segments together outside the abdominal cavity.

8. The method of claim 1 , wherein during act (b) the suture force distributing member is not fixedly secured to a position on the suture.

9. The method of claim 1 , further comprising, before act (b), non-suture fixating the soft tissue repair prosthetic to the abdominal wall.

10. The method of claim 9 , wherein the act of non-suture fixating includes one or more acts of tacking, screw fastening or helicoil fastening the soft tissue repair prosthetic to the abdominal wall.

11. The method of claim 1 , further comprising after act (b), non-suture fixating the soft tissue repair prosthetic to the abdominal wall.

12. The method of claim 11 , wherein the act of non-suture fixating includes one or more acts of tacking, screw fastening or helicoil fastening the soft tissue repair prosthetic to the abdominal wall.

13. The method of claim 1 , wherein act (b) includes an act of passing a pair of suture retainers, each connected to a respective suture segment, from within the abdominal cavity through the soft tissue repair prosthetic and the at least part a of the abdominal wall to outside the abdominal cavity.

14. The method of claim 13 , after act (b), further including an act of reorienting the suture retainers.

15. The method of claim 13 , after act (b), further including an act of adjusting the relative position of at least one of the suture retainers and the respective suture segment.

16. The method of claim 15 , wherein the act of adjusting includes pulling a length of the respective suture segment through the at least one of the suture retainers.

17. The method of claim 15 , wherein the act of adjusting includes moving the at least one of suture retainers along a length of the respective suture segment.

18. The method of claim 1 , wherein act (b) includes passing the pair of suture segments in substantially parallel paths through the at least a part of the abdominal wall.

19. The method of claim 1 , wherein act (b) includes passing the pair of suture segments in diverging paths through the at least a part of the abdominal wall.

20. The method of claim 1 , wherein act (b) includes passing the pair of suture segments through fascia and muscle and further through skin.

21. The method of claim 1 , further comprising, before act (b), the act of inserting a deployment assist device into the abdominal cavity and positioning, with the deployment assist device, the soft tissue repair prosthetic against the abdominal wall.

22. The method of claim 21 , wherein the inserting step includes mounting the soft tissue repair prosthetic to the deployment assist device before inserting the deployment assist device into the abdominal cavity.

23. The method of claim 22 , wherein the deployment assist device is inflatable.

24. The method of claim 1 , wherein act (b) includes associating at least one of the suture segments with a needle and passing the associated needle with the at least one of the suture segments through the soft tissue repair prosthetic and the at least a part of the abdominal wall.

25. The method of claim 24 , wherein a length of the at least on of the suture segments is contained within the associated needle.

26. The method of claim 25 , wherein the length of suture segment plays out of the associated needle as the needle is passing through the soft tissue repair prosthetic and at least part of the abdominal wall.

27. The method of claim 1 , wherein the pair of suture segments each include a free end section and a proximal section, and act (b) includes passing the free end section, before the proximal section, through the soft tissue repair prosthetic.

28. The method of claim 1 , wherein the pair of suture segments each include a free end section and a proximal section, and act (b) includes passing the proximal section before the free end section through the soft tissue repair prosthetic.

29. A method of delivering a transfascial suture, the method comprising acts of:
(a) inserting a suturing instrument into an abdominal cavity, the suturing instrument having a pair of needles and loaded with at least one continuous suture defined by a pair of suture segments, each suture segment connected to a suture retainer, each needle associated with one of the suture retainers, the suturing instrument including a distal end with each needle being extendable beyond the distal end:
(b) advancing each of the needles in a distal direction beyond the distal end of the suturing instrument and in the distal direction outwardly from within the abdominal cavity through at least a part of the abdominal wall, and passing each suture retainer outwardly from within the abdominal cavity through the at least a part of the abdominal wall; and
(c) retracting each of the needles inwardly back through the at least a part of the abdominal wall and into the abdominal cavity to deploy each suture retainer outside the abdominal cavity by separating each suture retainer from the suturing instrument while the suturing instrument is located within the abdominal cavity.

30. The method of claim 29 , wherein act (b) includes advancing each of the needles through a soft tiss

Assignees

• Darois Roger E
• Ziniti Donald E
• Ranucci Kevin J
• Bard Inc C R

Inventors

• Darois Roger E
• Ziniti Donald E
• Ranucci Kevin J

Classifications

• A61B2017/0488

  Instruments for applying suture clamps, clips or locks · CPC title

• A61B2017/0414

  having a suture-receiving opening, e.g. lateral opening · CPC title

• A61B2017/00663

  the implement being a suture · CPC title

• A61B17/0487

  Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks (suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122) · CPC title

• A61B2017/0404

  Buttons · CPC title