Note : Les descriptions sont présentées dans la langue officielle dans laquelle elles ont été soumises.
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SUTURING APPARATUS AND METHOD
BACKGROUND OF THE INVENTION
1. Field of the Invention
The invention relates generally to suturing devices and methods.
2. Description of Prior Art and Related Information
Suturing apparatus in the past have been required to have an elongate
configuration and a low profile facilitating their use through cannulas in
less invasive
surgery. These devices have typically included opposing jaws which clamp on to
the
tissue to be sutured. Beyond this simple clamping motion, typically
facilitated by scissor
handles, the mechanism for threading a suture between the jaws and through the
tissues have been exceedingly complex.
This complexity has derived primarily from the fact that the elongated, low
profile
configuration calls for an operating force that can be transmitted through an
elongate
tube. This force along the axis of the instrument must then be converted into
a force
extending generally perpendicular to the axis between the jaws. No simple
structure has
been devised to accommodate this transition. Furthermore, loading a suture
onto a
mechanism has also been complicated due to the complexity of the suturing
mechanisms.
SUMMARY OF THE INVENTION
A suturing apparatus is disclosed that comprises a first jaw and a second jaw
movable with respect to each other. A bendable needle is carried by the first
jaw and
adapted to carry a suture. The needle is movable between a first position
wherein the
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needle is substantially housed within the jaw and a second position wherein a
distal
portion of the needle protrudes from the first jaw. The apparatus further
comprises
means for securing the suture in place prior to being carried by the bendable
needle,
and a suture receiver spaced apart from the first jaw and configured to
disengage the
suture carried by the bendable needle.
The securing means may comprise a cantilevered spring included in a distal
portion of the first jaw, a groove defined in a distal portion of the first
jaw, a flap, or an
elastomeric pad. The first jaw defines an axis and further comprises a
transition block
adapted to guide the bendable needle in a direction substantially
perpendicular to the
axis.
Also disclosed is a suturing apparatus for passing suture through tissue,
comprising: a bendable needle that may have a generally flat, narrow and
elongate
configuration, a distal needle tip, and a transverse open- sided needle notch
located at or
near the needle tip; a first jaw defining an axis and having an axial channel
for carrying the
bendable needle, an axial through-slot that extends transversely through the
jaw from top
to bottom, runs axially along the first jaw at or near a distal end of the
first jaw, and is in
communication with the axial channel, and a transverse ingress defined by an
opening
that is located at an edge of the first jaw, extends through the first jaw
from top to
bottom, and is in communication with the axial through-slot; the bendable
needle
reciprocally movable between a proximal position where the bendable needle is
in a first
substantially straight configuration with the needle tip and needle notch
resting inside the
first jaw and a distal position where the bendable needle is in a second
curved
configuration with the needle tip and needle notch protruding from the first
jaw, the
needle notch aligning with the first jaw's transverse ingress when the
bendable needle is
moved to a particular location for transversely loading suture held across the
first jaw
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into the needle notch and the first jaw's axial through-slot via the
transverse ingress, and
for temporarily capturing the suture within the needle notch with the suture
extending
above and below the first jaw's axial through slot and axially movable within
the first
jaw's axial through-slot; a second jaw movable with respect to the first jaw
for holding
tissue to be sutured between the first and second jaws; and an actuator that
reciprocally
moves the bendable needle between the proximal position and the distal
position, the
needle tip, needle notch, and temporarily captured suture moving axially
forward within
the first jaw's axial through-slot and through the tissue held between the
first and second
jaws when the bendable needle is moved to the distal position where the needle
tip,
needle notch, and temporarily captured suture are located beyond a distal side
of the
tissue with the suture in the needle notch forming a suture loop, the suture
loop being
released from the needle notch and remaining on the distal side of the tissue
when the
bendable needle is moved back to the proximal position. The actuator
preferably
comprises a thumb lever. The first jaw defines an axis and further comprises
an axial
slot in communication with the ingress. The ingress may comprise a lateral
opening,
and the needle slot may comprise a lateral slot.
A suture retrieving apparatus is also disclosed. The suture retrieving
apparatus
comprises a first jaw and a second jaw movable with respect to each other, a
suture
receiver spaced apart from the first jaw, the suture receiver being adapted to
releasably
retain a suture, and a bendable needle carried by the first jaw. The bendable
needle is
movable between a proximal position and a distal position. The bendable needle
has a
distal needle portion adapted to engage with the suture when the bendable
needle is in
the distal position. The distal needle portion comprises a hook. The second
jaw may
comprise the suture receiver.
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A method is also disclosed for suturing a tissue. The method comprises the
steps of clamping a piece of tissue to be sutured, securing a suture in place
for
engagement with a bendable needle, engaging a suture with a bendable needle,
carrying the suture toward a receiver with the bendable needle, retaining the
suture with
the receiver, and retracting the bendable needle to release the suture.
The step of clamping a tissue to be sutured comprises the step of capturing
the
piece of tissue with a first jaw and a second jaw. The method further
comprises the step
of advancing the bendable needle in an axial direction.
The step of carrying the suture toward a receiver with the bendable needle
comprises the step of bending the bendable needle, and moving at least a
portion of the
bendable needle in a transverse direction.
Also disclosed is a method for loading a suture onto a suturing apparatus. The
method comprises the steps of housing a needle with a needle slot in a first
jaw, biasing
the needle in a distal direction with respect the first jaw so that the needle
slot is not
aligned with an ingress of the first jaw, aligning the needle slot with the
ingress,
disposing a suture through the ingress into the needle slot, and releasing the
biased
needle such that the needle engages the suture and carries the suture
distally.
The step of aligning the needle slot with the ingress may comprise the step of
moving the needle either proximally or distally. The step of moving the needle
proximally comprises moving the needle proximally with a finger slide. The
step of
disposing a suture through the ingress into the needle slot comprises looping
the suture
about the ingress.
Also disclosed is a suturing apparatus that comprises a pair of jaws. A
bendable
needle may be housed in one of the jaws may be adapted to carry a suture
toward a
suture receiver disposed adjacent to the opposite jaw. A transition block can
curve the
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needle and direct it in a direction generally not parallel to an axis of the
carrying jaw.
The needle may also be configured to retrieve a suture. A retaining mechanism
may
hold a suture in place to be engaged by the needle. The jaw housing the needle
may
include a lateral opening through which the suture may be inserted. The needle
may
5 also include a lateral notch which may be aligned with lateral opening to
receive the
suture. An actuator may be coupled to the needle to enable the user to move
the needle
proximally to align the notch with the lateral slot.
In one aspect there is provided a method for loading a suture onto a suturing
apparatus, comprising the steps of: housing a bendable needle having a
transverse
open-sided needle notch within a first jaw defining an axis and having an
axial channel
for carrying the bendable needle, an axial through-slot that extends
transversely through
the jaw from top to bottom, runs axially along the first jaw at or near a
distal end of the
first jaw, and is in communication with the axial channel, and a transverse
ingress
defined by an opening that is located at an edge of the first jaw, extends
through the first
jaw from top to bottom, and is in communication with the axial through-slot;
biasing the
needle to a first position within the axial channel of the first jaw so that
the needle notch
is located proximally or distally of and not aligned with the transverse
ingress of the first
jaw; aligning the needle notch with the transverse ingress of the first jaw by
moving the
needle within the axial channel, against the bias; disposing a suture through
the
transverse ingress into he needle notch; and releasing the biased needle such
that the
needle returns to the first position and the needle notch engages the suture.
Reference may now be made to the following drawings wherein like elements are
referenced by like numerals.
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BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a side elevation view of a first preferred embodiment of a suturing
apparatus according to the invention;
FIG. 2 is a close-up view of the first preferred suturing apparatus showing a
bendable needle substantially housed within a lower jaw;
FIG. 3 is a close-up view of the first preferred suturing apparatus showing
the
bendable needle piercing a piece of tissue;
FIG. 4 is a close-up view of the first preferred suturing apparatus removed
from
the piece of tissue;
FIG. 5A is a perspective view of a jaw of the first preferred suturing
apparatus
housing the bendable needle;
FIG. 5B is a perspective view of the jaw of FIG. 5A showing the bendable
needle
advanced to a distal, piercing position;
FIG. 6 is a front end view of the first preferred suturing apparatus;
FIG. 7A is an operative view illustrating a preferred suture receiver
intercepting
the suture carried by the needle;
FIG. 7B is a perspective view of the preferred suture receiver of FIG. 7A
retaining
the suture after the needle is retracted;
FIG. 8A is an operative view of a further preferred suture receiver;
FIG. 8B is an operative of the preferred suture receiver of FIG. 8A retaining
the
suture after the needle is retracted;
FIG. 9 is a front end view of a second preferred embodiment of a suture
apparatus comprising a suture retrieving device;
FIG. 10A is an operative view of the preferred suturing retrieving device of
FIG.
9;
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FIG. 10B is an operative view of the preferred suturing retrieving device
showing
a retrieving needle engaging a suture;
FIG. 10C is an operative view of the preferred suturing retrieving device
showing
the needle retrieving the suture;
FIG. 11 is a front end view of a third preferred suturing apparatus wherein a
bendable needle is carried by an upper jaw;
FIG. 12 is a front end view of a fourth preferred suture retrieving apparatus
wherein a bendable needle is carried by an upper jaw;
FIG. 13 is a perspective view of a fifth preferred suturing apparatus
including a
securing mechanism;
FIG. 14 is a front end view of the fifth suturing apparatus;
FIG. 15 is a side elevation view of the fifth suturing apparatus;
FIG. 16 is a close-up, perspective view of a suturing jaw incorporating the
securing mechanism;
FIG. 17 is a top plan view of a tip of the suturing jaw of FIG. 16;
FIG. 18 is a perspective view of a suturing jaw incorporating an alternative
securing mechanism;
FIG. 19 is a close-up perspective of a suturing jaw incorporating a further
alternative securing mechanism;
FIG. 20 is a perspective view of the suturing jaw of FIG. 19;
FIG. 21 is a partially removed side elevation view of a sixth preferred
suturing
apparatus;
FIG. 22 is a top plan view of a needle carrying jaw of the sixth preferred
suturing
apparatus;
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FIG. 23 is a perspective view of the needle carrying jaw of FIG. 22 with a
bendable needle shown overlaid for clarity;
FIG. 24 is a perspective view of the needle carrying jaw with the bendable
needle
shown overlaid in an aligned position;
FIG. 25 is a perspective view of a handle assembly for the sixth preferred
suturing apparatus including a preferred needle actuator, and
FIG. 26 is a perspective view of the sixth preferred suturing apparatus being
loaded with a suture;
FIG. 27 is perspective view of the sixth preferred suturing apparatus with the
suture loaded;
FIG. 28 is an elevation view of a preferred bendable needle according to the
invention;
FIG. 29 is a partially exploded, perspective view of a preferred suture
receiving
mechanism;
FIG. 30 is a perspective view of the preferred suture receiving mechanism of
FIG. 29;
FIG. 31 is a perspective view of a jaw comprising a single barb; and
FIG. 32 is a perspective view of a jaw comprising a pair of barbs.
The invention and its various embodiments can now be better understood by
turning to the following detailed description wherein illustrated embodiments
are
described. It is to be expressly understood that the illustrated embodiments
are set forth
as examples and not by way of limitations on the invention as ultimately
defined in the
claims.
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DETAILED DESCRIPTION
A first preferred embodiment of a suturing apparatus is illustrated in Figure
1 and
designated generally by the reference numeral 10. The apparatus 10 is
illustrated to
have an elongate configuration with a proximal end 12 and a distal end 14. A
handle
assembly 16 is disposed at the proximal end 12 and includes scissor handles 18
and 21
as well as an actuator 23. A pair of opposing jaws 25 and 27 are disposed at
the distal
end and are coupled to the handle assembly 16 through an elongate shaft or
tube 29. In
one embodiment, the upper jaw 25 is pivotal with respect to the lower jaw 27
as
illustrated in Figure 2.
In the illustrated embodiment the lower jaw 27 includes a needle 32 of
particular
interest to the present invention. In this case, the needle 32 has a generally
flat, narrow
and elongate configuration. The needle 32 is bendable so that it can be moved
generally with an axial force and can be bent on a curve, for example, 90 to
move
generally perpendicular to the axis and toward the opposing upper jaw 25. It
is to be
expressly understood that the needle 32 can be bent at any angle and advanced
in any
direction away from the axis. The actuator 23, which preferably comprises a
thumb
rocker or slide, is coupled to the needle 32. The actuator 23 enables a user
to advance
the needle 32 distally to a protruding, operative position and proximally to a
retracted,
inoperative position.
Threading this needle 32 with a suture 34 enables the needle to be deployed
through the tissue and to carry with it the suture 34 to be threaded. The
opposing jaw 25
may include an optional receiver which is adapted to remove the suture from
the needle
32 as the needle 32 is withdrawn back into the lower jaw 27. At this point,
the suture
extends through the tissue and into the upper jaw. Removal of the jaws from
the tissue,
as illustrated in Figure 4 permits withdrawal of the apparatus 10 leaving the
suture in
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place for tying or further manipulation. A suture receiver is optional since
the tissue itself
may frequently serve as a receiver for the suture once the needle is
refracted.
In this embodiment, the lower jaw is illustrated in Figure 5A to include an
elongate configuration and a channel 36 adapted to receive the needle 32. The
needle
5 is bent at the distal end of this jaw 27 and up through a transition
block 38 which aides in
curving the needle 32 and directing it toward a suture receiver. Though the
illustrated
embodiment shows the transition block 38 curving the needle 32 perpendicularly
with
respect to the axis of the lower jaw 27, the transition block 38 may be
configured to
curve and direct the needle 32 at any particular angle or direction that is
generally
10 unparallel to the axis of the lower jaw 27. Figure 5A shows the needle
retracted and
Figure 5B shows the needle 32 deployed and provided with a slot 40 to carry
the suture
34 to the opposing jaw 25. This configuration is further illustrated in the
radial cross-
section view of Figure 6.
In the upper jaw 25, a suture receiver 41 is provided to remove the suture 34
from the needle 32. A metal or elastomeric flap, or paddle, 43 is provided to
engage the
needle 32 and threaded suture 34 as illustrated in Figure 7A. This flap 43
forces the
suture 34 from the needle slot 40 as the needle 32 is withdrawn as illustrated
in Figure 7.
In a similar embodiment, the needle 32 and threaded suture 34 is forced
through
an elastomeric pad 45 which similar engages the suture 34 and removes it from
the
needle slot 40 as the needle 32 is withdrawn as illustrated in Figure 8B.
A second preferred embodiment of a suturing apparatus is illustrated in Figure
9
which is a cross-section view similar to Figure 6, but showing a needle 32
which
functions as a retriever rather than a carrier. In this embodiment, the suture
34 is initially
carried by the upper jaw 25. A needle slot 42 in this case extends distally
from the side
of the needle 32. When this needle 32 and slot 42 are extended, as illustrated
in Figure
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10A, the slot 42 engages the suture 34 in the upper jaw 25. As the needle 32
is
withdrawn, the suture is retrieved in the needle slot 42 and carried back
through the
tissue. The final step in this process is the same as previously discussed
with reference
to Figure 4.
It will be apparent that this apparatus 10 could also operate with the needle
32
carried by the upper jaw 25. Such a feature is shown in a third preferred
embodiment
illustrated in the cross-sectional view of Figure 11 where the needle 32
functions as a
suture carrier. In particular, a suture slot 40 defined in the needle 32
comprises an
opening 50 that is located distally to an end 52 such that the slot 40 faces
the receiver,
or lower jaw 27. A suture 34 is thus carried by the needle 32 toward the
opposing, lower
jaw 27.
In Figure 12, a fourth preferred embodiment of a suturing apparatus comprises
a
suture retrieving device wherein the needle 32 is carried by the upper jaw 25.
In this
case, the needle 32 functions as a retriever of the suture 34. The needle 32
defines a
slot 42 with an opening 54 that is located proximally to an end 56 such that
the slot 42
faces away from the opposing, lower jaw 27. In the illustrated embodiment, a
distal
portion of the needle 32 is thus preferably shaped as a hook.
A fifth preferred embodiment of a suturing apparatus is illustrated in Figure
13
and designated generally by the reference numeral 110. In Figures 13-15, the
apparatus 110 includes an elongate configuration with a proximal end 112 and a
distal
end 114. A handle assembly (not shown) is disposed at the proximal end 112 and
may
include scissor handles which are operatively coupled to a pair of opposing
suturing jaws
116 and 118 at the distal end 114. An elongate shaft or tube 121 couples the
jaws 116,
118 to the handle assembly. In one embodiment, the upper jaw 116 is pivotal
with
respect to the lower jaw 118 as illustrated in Figure 13-15.
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In the illustrated embodiment, the lower jaw 118 includes a retaining
mechanism
123 of particular interest to the present invention. The apparatus 110 may
include a
handle assembly, a bendable needle 125 housed in one of the jaws 116, 118, and
a
suture receiver included in the other of the jaws 116, 118 as described above.
Since the
retaining mechanism 123 serves to securely hold a suture 127 while easily
permitting its
release when engaged by the needle 125, the mechanism 123 is preferably
included in
the jaw that houses the needle 125. For example, if the needle 125 is housed
in the
upper jaw 116, then the retaining mechanism 123 would also be included in the
upper
jaw 116.
A first preferred securing mechanism 123 comprises a spring 129 formed at a
distal tip 132 of the jaw 118. The spring 129 includes a cantilever portion
134 bent back
on itself. A wedge, or groove,136 is defined between the cantilever portion
134 and an
opposite wall 138 as shown more clearly in Figures 16 and 17. In the
illustrated
embodiment of Figures 13-16, the securing mechanism 123 is formed integrally
with the
jaw 118. To assemble the suture 127, a first end 141 is held beneath the jaw
118 and
the other end 143 above the jaw 118. The ends 141, 143 may be pulled in a
proximal
direction such that the suture 127 is wedged into the groove 136. When
disposed in the
groove 136, the cantilever portion 134 biases the suture 127 against the
opposite wall
138, thus pinching the suture 127 securely in place for engagement by the
needle 125.
The biasing force of the spring 129 is configured such that the suture 127 is
both
held securely absent engagement by the needle 125, and yet is permitted to be
easily
released upon engagement. It is to be expressly understood, therefore, that
the spring
129 may comprise a variety of mechanisms capable of abutting, or pinching, the
suture
127 against an opposing surface while permitting its release upon engagement
with a
needle. The groove 136 is preferably aligned with or disposed adjacent to a
needle exit
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port 145 such that when the ends 141, 143 are tugged proximally, a portion 147
of the
suture 127 lies along the path of the transversely extending needle 125.
In Figure 18, a second preferred retaining mechanism 123a may include a spring
mechanism 129a formed separately from the jaw 118a. The spring mechanism 129a
includes an anchor 149 configured to fit within a slot 152 defined in the jaw
118a.
In Figures 19 and 20, a third preferred retaining mechanism 123b comprises a
zigzag groove 154 that becomes increasingly narrow as it extends proximally.
The
zigzag pattern in combination with the proximal tapering facilitates a tight
fit when the
suture 127 is drawn proximally. In particular, the proximally tapered
configuration of the
groove 154 pinches the suture in place as it drawn proximally while the zigzag
pattern
prevents the suture 127 from being distally disengaged from the jaw 118b.
A sixth embodiment of a suturing apparatus is shown in Figures 21-27 and
designated generally by the reference numeral 210. The apparatus 210 comprises
a
first jaw 220 and a second jaw 222 that are pivotal with respect to each
other. In Figures
21-23, the first jaw 220 is configured to house a bendable needle 224. This
needle
carrying jaw 220 may comprise either the lower or upper jaw of the apparatus
210. The
bendable needle 224 is substantially disposed in a channel 226 within the
first jaw 220
when the needle 224 is in a non-operative, or non-piercing, position.
In Figure 22, the first jaw 220 defines an opening, or ingress 228, that is in
communication with an axial slot 231. The ingress 228 is preferably provided
with a
relatively wide mouth 233 is open to one of the sides of the first jaw 220.
This preferably
lateral ingress 228 tapers as it approaches the axial slot 231.
In Figure 23, the needle 224 of particular interest to the invention is shown
out of
position, overlaying the first jaw 220 for clarity. When assembled, the needle
224 would
reside in the channel 226 as discussed above. The needle 224 comprises a
lateral slot,
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or notch 235. An edge defining the notch 235 is preferably radiused, or
smoothed, such
it would not cut a suture. The needle 224 comprises a distal crescent portion
237 and
an adjacent proximal crescent portion 239. The crescent portions 237, 239
collectively
provide flexibility spread out over a greater length of the needle 224 such
that all
stresses do not collect at the notch 235 when the needle 224 is bent. The
notch 235 is
preferably disposed between the crescent portions 237, 239.
In a rest state, the needle 224 may be biased to any rest position with
respect to
the ingress 228. For example, the rest position may comprise the notch 235
being
disposed distally to the ingress 228, as shown in Figure 23, or proximally to
the ingress
to 228. To load a suture, the needle 224 is moved to a loading position
whereby the notch
235 is aligned with the ingress 228 as shown in Figure 24. If the needle 224
is biased
such that the notch 235 is distal to the ingress 228, alignment is reached by
moving the
needle 224 in a proximal direction with respect to the first jaw 220.
Accordingly, if the
needle 224 were biased such that the notch 235 is proximal to the ingress 228,
alignment is reached by moving the needle 224 in a distal direction with
respect to the
first jaw 220. Figure 25 illustrates a preferred handle assembly 243 of the
suturing
apparatus 210. In Figure 25, a manually operable actuator 244 is coupled to
the needle
to enable movement, both proximally and distally, thereof. In the illustrated
embodiment,
the actuator 244 preferably comprises a thumb lever, or rocker, that may be
cocked
backward by a user's thumb, thereby moving the needle proximally to align the
notch
with the ingress, and moved forward, thereby advancing the needle distally.
Figure 26 illustrates a suture 246 being loaded onto the apparatus 210. The
suture 246 is formed into a loop and threaded into the ingress 228. With the
suture 246
held slightly taut across the first jaw 220, the suture 246 has entered the
ingress 228 and
is now disposed in the notch of the needle. The finger slide, shown in Figure
25, may
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now be released, thereby distally biasing the needle with the captured suture
246 to the
resting position as shown in Figure 27. It will be appreciated that the axial
slot 231 of the
first jaw 220 allows the captured suture 246 to travel freely as it is carried
by the needle
224.
5 A transition block 248 is provided at a distal portion of the first jaw
220 and may
be integral with or separate from the jaw 220. The transition block 248 may be
adapted
to curve the needle and direct it at any desired angle, shown in the
illustrated
embodiment as generally perpendicular to the axis of the first jaw 220.
In Figures 26 and 27, the second jaw 222 comprises a distal hook 251 that
10 defines an aperture 253 with a side opening 255. When the jaws 220, 222
are clamped
on a piece of tissue, the aperture 253 is configured to enable the needle to
pass through
after piercing the tissue. As the needle 224 is retracted the tissue acts as a
suture
receiver by holding on to the suture 246 while the needle 224 is withdrawn.
This leaves
a loop or free line of suture 246 on the side of the tissue in contact with
the jaw 222. The
15 hook 251 can then be placed in the loop and pulled. Alternatively, the
two jaws 220, 222
can be grasped on the free line of suture and pulled through the tissue. In
Figure 25, a
stationary finger support 257 serves as a counterforce plate for the actuator
244.
In Figure 28, the preferred bendable needle 224 comprises a distal portion
that
facilitates a smooth piercing of tissue by preventing the tissue from being
snagged or
caught by any part of the needle 224. The needle 224 comprises a notch side
259 and
an opposite, crescent side 262. In particular, the needle 224 comprises a
straight, notch-
side edge 264 located proximally to the notch 235. The needle 224 also defines
a
needle axis "A" that extends generally parallel to the notch-side edge 259.
As the needle 224 pierces a tissue, the tissue will travel along a notch-side
ramp
266 that leads to a distal ledge 268 disposed distally of the notch 235. It
will be
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appreciated that the distal ledge 268 is spaced a transverse distance "B" from
the axis
"A" while a proximal ledge 271 is spaced a transverse distance "C" from the
axis "A." In
the preferred embodiment, distance "B" is greater than distance "C" such that
the distal
ledge 268 pushes the pierced tissue outward to thereby avoid getting caught in
the notch
235. As the tissue travels over the notch 235, a generally rounded bump 273
prevents
any tissue from getting snagged.
On the opposite, crescent side 262, the crescents 237, 239 distribute the
stresses more evenly across the needle 224 when the needle 224 is bent, such
that the
stresses are minimized near the notch 235. The opening to the notch 235 is
directed
distally such that the suture is forced into the needle during deployment
through the
tissue and so that the suture releases easily as the needle is retracted.
A further preferred embodiment of a suture receiver 280 is illustrated in
Figures
29 and 30. The receiver 280 may, for example, be carried by a jaw opposite to
the jaw
housing a needle. The suture receiver 280 comprises a pair of flaps, or
paddles, 282
disposed in a receiver housing 284. The paddles 282 are preferably configured
to abut
one another at a pinch point 286, as shown in Figure 30, to permit a needle to
travel
therebetween while retaining a carried suture when the needle is retracted. As
discussed above, employment of a suture receiver is optional as the pierced
tissue itself
may often times serve as a suture receiver. In particular, after a needle
carrying a suture
has pierced the piece of tissue, the pierced tissue often times sufficiently
retains the
suture in the form of a loop as the needle is retracted.
In Figure 31, a first preferred embodiment of a hook, or barb 291, is formed
at the
distal end of a jaw, preferably the second jaw opposite to the first jaw
housing the
bendable needle. The barb 291 is configured to hook a looped suture that is
retained,
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for example, by the tissue itself after the bendable has been retracted. In
Figure 32, a
distal end of a jaw may alternatively be formed with a pair of barbs 293.
In all embodiments, it is to be expressly understood that a disposable needle
may be employed. It will be appreciated, therefore, that a system or kit is
provided
wherein the suturing apparatus (excluding the needle) may be re-used while the
disposable needles are replaced.
Many alterations and modifications may be made by those having ordinary skill
in
the art. Therefore, it must be understood that the illustrated embodiments
have been set
forth only for the purposes of examples. It must be expressly understood that
other
combinations of fewer, more or different ones of the disclosed elements are
possible.
The words used in this specification to describe the invention and its various
embodiments are to be understood not only in the sense of their commonly
defined
meanings, but to include by special definition in this specification the
generic structure,
material or acts of which they represent a single species.
The definitions of the words or elements of the following claims are,
therefore,
defined in this specification to not only include the combination of elements
which are
literally set forth. In this sense it is therefore contemplated that an
equivalent
substitution of two or more elements may be made for any one of the elements
in the
claims below or that a single element may be substituted for two or more
elements.
Although elements may be described above as acting in certain combinations, it
is to be
expressly understood that one or more elements from a combination can in some
cases
be excised from the combination and that the combination may be directed to a
subcombination or variation of a subcombination.
Insubstantial changes from the claimed subject matter as viewed by a person
with ordinary skill in the art, now known or later devised, are expressly
contemplated.
CA 02725641 2012-11-30
18
Therefore, obvious substitutions now or later known to one with ordinary skill
in the art
are defined to be within the scope of the defined elements.
