CA2234379C - Suture cartridge assembly for a surgical knot - Google Patents

Suture cartridge assembly for a surgical knot Download PDF

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Publication number
CA2234379C
CA2234379C CA002234379A CA2234379A CA2234379C CA 2234379 C CA2234379 C CA 2234379C CA 002234379 A CA002234379 A CA 002234379A CA 2234379 A CA2234379 A CA 2234379A CA 2234379 C CA2234379 C CA 2234379C
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CA
Canada
Prior art keywords
knot
suture
loop
tube
core tube
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
Application number
CA002234379A
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French (fr)
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CA2234379A1 (en
Inventor
Dale R. Schulze
Troy A. Mcmillen
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Ethicon Endo Surgery Inc
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Ethicon Endo Surgery Inc
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Publication date
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Publication of CA2234379A1 publication Critical patent/CA2234379A1/en
Application granted granted Critical
Publication of CA2234379C publication Critical patent/CA2234379C/en
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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12009Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
    • A61B17/12013Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot for use in minimally invasive surgery, e.g. endoscopic surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0483Hand-held instruments for holding sutures
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/062Needle manipulators
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/062Needle manipulators
    • A61B17/0625Needle manipulators the needle being specially adapted to interact with the manipulator, e.g. being ridged to snap fit in a hole of the manipulator
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A61B2017/0474Knot pushers
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A61B2017/0475Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery using sutures having a slip knot
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A61B2017/0477Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery with pre-tied sutures
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A61B2017/0479Packages or dispensers for MIS suturing instruments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2931Details of heads or jaws with releasable head

Abstract

A Suture cartridge assembly is disclosed. The cartridge assembly has a partially tied surgical knot formed from a suture filament for facilitating the fastening of body tissue. It also has a core tube to which the partially tied knot is secured.
Further, the assembly has a suture cartridge which contains a tube slot for receiving the core tube. The assembly makes it easier to convert the partially tied surgical knot into a non-slip knot to securely and consistently fasten tissue. It is simple in construction, and it is readily adaptable to inclusion on various surgical instruments.
When a first partially tied surgical knot is converted to a completed knot, the completed knot and its core tube can be removed from the cartridge, and a second partially tied knot secured about a new core tube can be received into the suture cartridge to enable multiple knot placements.

Description

SUTURE CARTRIDGE ASSEMBLY FOR A SURGICAL KNOT
Background of the Invention This invention relates to an assembly for facilitating the placement of a surgical knot made from a suture filament. In particular, the invention relates to such an as,~embly which is particularly adapted for deployment of the knot during minimally inwasive surgical procedures where access to the surgical site is limited.
A mainstay of surgical practice has been and will continue to be the formation and placement of surgical knots from suture filament to fasten tissue during an operative procedure. Numerous surgical knots have been developed over an 15 appreciable period of time, ~ and the art of forming and tying knots for surgical applications is a critical skill which a surgeon must possess to perform an operation safely and efficiently. Accordingly, the art is extensively developed. See, for example, Tissue Approximation in Endoscopic Surgery, Alfred G~schieri, Zoltan Szabo, Tunes Mirror International Publishers, 1995, which describes numerous 20 surgical knots made from suture filament to facilitate the approximation of tissue during surgery.
The art of surgical knots is also well represented in the patent literature.
U.S.
Patent 2,012,776 discloses a surgical instrument for facilitating the placement of 25 various forms of slip knots made from surgical filament. The inventor named on the '?76 patent, H. A. Roeder, developed the "Roeder Knot" which is a surgical knot which is frequently used in practice today. More recently, U.S. Patent No.
5,573,286 di.~loses a surgical knot of suture strand particularly adapted for orthopedic applications. The preferred embodiment described in the '286 patent is directed to 30 tying the knot to a bone.
El'dD-417 Early on, it was recognized that the deployment and placement of surgical kIIOtS within a remotely accessible surgical site could be difficult, cumbersome and often unreliable. 'Accordingly, instrumentation was developed to facilitate the placement of knots in remote locations. Cleverly, a pre-tied knotted loop of suture was often used to reduce the number of steps required to form the tightened knot. For eaample, U.S. Patent Nos. 2,566,625 and 3,090,386 describe surgical devices which are adapted to support a pre-tied knotted loop of suture for suturing or ligating tissue, particularly during procedures where the tissue desired to be manipulated is difficult to access.
More recently, instrumentation has been developed for facilitating the placement of knots particularly during minimally invasive surgical procedures.
In particular, U.S. Patent No. 5,320,629 discloses the formation of a pre-tied knotted loop of suture, and the placement of the pre-tied knotted loop on'a surgical device for facilitating the tightening of the loop to approximate tissue during endoscopic surgical pi~oc~dures. German Patent No. 912619 also discloses a device similar to that disclosed in the '629 patent.
Although the art of surgical knots is well developed, and surgical devices for facilitating the placement of tightened knots from a pre-tied knotted loop of suture have also been developed for application at remote surgical sites, there are problems which still need to be addressed. In pacrticular, in those surgical procedures where access to the site is limited, for example during minimally invasive procedures such as endoscopic surgical procedures, the knots can be difficult to deploy.
Frequently, the Imots which can be deployed are routinely slip knots having poor knot security. If knot security is poor, then the approximated tissue may not be held for a sufficient period of time to promote adequate wound healing. Additionally, during minimally invasive procedures, the pre-tied knotted loops of suture which have been described in the prior art devices can be difficult to efficiently tighten for final deployment.
E:ND-417 Therefore, in minimally invasive surgical proced<rres where access to the surgical site is limited, what is needed is an assembly for facilitating the formation of a surgical knot. The assembly should be relatively simple in construction and should be compatible with a partially tied surgical knot . The assembly should facilitate the 5 conversion of the partially tied knot into a fully formed knot which can provide a consistently strong knot security each time the laiot is placed to enable even an unexperienced surgeon to confidently and efficiently place a secure suture Irnot.
~~ddidonally, it would be desirable if it were possible to easily retrofit the assembly onto various surgical instruments, partianlarly endosaopic instruments, for ease of use 10 o~f the assembly to place surgical knots. Finally, it would be helpful if it were possible t~~ reload the assembly with a second partially tied knot following deployment of the first knot so that the assembly can be used to place multiple knots.
Summary of the Invention The invention is a suture cartridge assembly. The assembly comprises a suture fiilament which is formed into a partially tied surgical lrnar, a core tube and a suture cartridge.
20 The suture filament has proximal and distal ends. The filament is formed into a partially tied surgical knot for facilitating the fastening of bodily tissue. The knot has a first loop formed between the proximal and distal ends of the suture filament.
The knot also has a plurality of knot loops formed about the first loop so as to form a common loop core.

The partially tied knot is secured to the core tube, and the suture cartridge a~ntains a tube slot for receiving the core tube.
The incorporation of a suture cartridge containing a slot to receive the partially 30 tied knot secured about the core tube significantly facilitates the formation of a E,ND-417 completed non-slip knot from the partially tied knot. The suture cartridge and core tiube are easy to make because each requires few component parts. The partially tied knot can be readily secured to the core tube, and the suture carnidge can readily receive the core tube. Therefore, the component parts of the assembly of this 5 invention are not only easy to construct, but also easy to assemble together. The assembly can facilitate converting the partially tied knot into a fully formed knot because the assembly can be retrofitted onto various surgical instruments, including endoscopic instruments used in minimally invasive surgery. Further, because of the siimple construction of the assembly and the ease with which the components of the 10 assembly can be assembled, it is straightforward to reload the assembly with a second partially tied knot following deployment of a first knot and removal of the first knot from the cartridge. When used in this manner, the assembly can be retrofitted onto various surgical instruments to facilitate the placement of multiple knots in multiple s<ugical procedures.
The suture cartridge assembly of this invention can be used in any surgical procedure where it is necessary or desirable to place surgical knots for fastening bodily tissue. Therefore, the suture carrridge assembly will find uses in a whole host of applications, including conventional open surgical procedures as well as minimally invasive procedures where access to the surgical site is limited.
Brief Description of the Drawings Figures 1-6 are perspective views illustrating the sequence of steps for forming a partially tied knot from a length of suture filament.
Figures 7-8 are perspective views of a preferred embodiment of the invention illustrating the steps to convert the partially tied Irnot depicted in Figure 6 into a non-sli,p surgical knot.
EI~ID-417 -$-Figures 9-10 are perspective views illustrating the formation of the partially tied knot of Figure 6, which includes a surgical needle attached to the suture filament, about a core tube. ' $ Figure 11 is an exploded perspective view of another preferred embodiment of the invention illustrating the partially tied knot of Figure 6 formed about the core tube depicted in Figures 9-10, in combination with a suture cartridge.
Figure 12 is a perspective view in assembly of the combination depicted in Figure 11, where the suture cartridge has a cartridge top.
Figure 13 is a section view of the assembly depicted in Figure 12 taken along lane 13-13 of that Figure.
1$ Figures 14-1$ are section views of the assembly depicted in Figure 13, including a fragmentary section of tissue, illustrating the use of the partially tied knot to~ fasten tissue and the steps necessary to form the completed n~-slip surgical knot to securely fasten the tissue.
20 Figures 16 and 17 are perspective views of yet another preferred embodiment of the invention depicting the formation of a different partially tied surgical knot from a length of suture filament.
Figure 18 is a perspective view of the partially tied knot depicted in Figure 25 foamed about a stripping tube.
Figures 19-20 are side elevation views illustrating the use of the assembly depicted in Figure 18 to form a completed, non-slip surgical knot to fasten tissue.
ErJD-417 Figures 21-23 illustrate the use of the partially tied knot depicted in Figure formed about a tapered core tube to fasten tissue when the partially tied knot is oonverted to a completed, non-slip surgical knot.
H~rief Description of the Preferred Embodiments Figures 1-6 illustrate how a partially tied surgical lrnot can be made from a length of suture filament. The partially tied knot thus formed can be used in the p~cactice of the various embodiments of this invention.
The suture filament 30 shown in Figure 1 can be composed of any suture.
material currently used or hereafter developed. The suture filament may be a m.onofilament suture or a multifilament, braided suture. The suture filament, regardless of construction, may be non-absorbable or bio-absorbable, defending on the 15 particular application for which the suture is being used to fasten tissue.
The length of suture filament 30 has proximal and distal ends, 31 and 32, respectively. Adjacent the proximal end, there is a proximal length 33 of suture filament. Correspondingly, adjacent the distal end of the suture filament, there is a 20 di;~tal length 34 of the suwre fiiament.
As shown in Figure 2, a first loop 35 is formed by manipulating the distal length 34 of the suture filament. Now looking at Figure 3, while the proximal length 33 of the suture filament remains fixed, the distal length is manipulated to form a 25 se~~ond loop 36 wrapped generally transversely around the first loop 35.
Third and fairth loops, 37 and 38, respectively, are likewise formed about the first loop as dqpicted in Figure 4. The second, third and fourth loops are generally parallel to each other and are oriented generally transversely to the first loop. For purposes of describing this invention, these loops may be referred to collectively as the "knot 30 loops". The number of knot loops may vary depending on the particular application _7_ for which the knot is used. In the illustrated embodiment, the second, third and fourth hops together form a common loop core 39 which deceives the first loop 35.
Reviewing Figure 5, the loosely formed knot is tightened by applying tension 5 on the distal length 34 of the suture filament. In so doing, the second, third and fourth laps tighten down on the first loop, and thus the first loops is securely received in the common loop core.
As depicted in Figure 6, a tissue-fastening loop 40 can be formed by passing the distal end 32 and the distal length 34 of the suture filament through the first loop 35.
To form the knot represented by a first embodiment of this invention, the partially tied knot of Figure 6 is taken, and tension on the proximal length 32 of the suture filament is applied in the proximal direction as indicated by the arrow in Figure 7. To facilitate forming the knot, the surgeon ideally holds his fingertips against the pn~ximal side of the knot loops while tension is allied to the proximal length 32 of the: suture filament. Alternatively, as described in the embodiments below, an instrument can be used to hold the knot loops in place. As tension is applied, the first loop 35 begins to be pulled through the common loop core 39 of the knot. When the fir,~t loop has sufficiently diminished in size from that shown in Figure 6, it snares the distal length 34 of the suture filament. With continuing proximal tension on the proximal length of the suture filament, the first loop and the distal length of filament are: pulled through the common loop core 39. When the first loop and distal length of fil<~nent emerge from the fourth loop 38, an audible "clicking" sound will alert the user that the completed knot has been formed.
Although the partially tied knot illustrated in Figure 6, often referred to as a "bland" knot, is the preferred partially tied knot for conversion into the fully formed, non-slip knot of this invention, other slip knots described in the literature can be used.
ErfD-417 -g-The key characteristic for the acceptability of other partially tied knots is a common lcbp core (exemplified in Figure 6 as common loop core 39) allowing passage of s«ture filament through the core. See, for example, The Encyclopedia of Knots and Fancy Ropework, R. Graumont and J. Hensel, Fourth Edition, Comell Maritime Press. Suitable partially tied knots are shown in this book as numbers 102, 185, 227 and 349 on pages 71, 83, 87 and 102, respectively.
As depicted in Figure 8, the completed surgical lmot of this invention is a non-slip knot 41. The first loop has been eliminated, and a distal loop 42 positioned adjacent to the fourth loop 38 is formed from a portion of the distal length of the suture filament. The tissue loop 40, which is used to fasten tissue, consequently bExomes rigidly fixed and secure. Tension applied to the loop 40 due to the tendency of the fastened tissue to expand or pull apart may result beneficially in further tilt~tening of flte non-slip knot.
Referring to Figures 9 and 10, there is shown the formation of the partially tied knot depicted in Figures 1-6, formed about a core tube 43. The core tube facilitates the placement of the partially tied knot adjacent tissue desired to be fastened, as~ well as the conversion of the partially tied knot into the completed non-slip laiot shown in Figure 8. The core tube has proximal and distal ends, 44 and 45, respectively. A surgical needle 46 is attached to the distal end 32 of the surgical filament. The proximal length 33 of the filament is passed through the core tube. The length of suture filament exceeds the length of the core tube so that the proximal length of the suture filament may extend from the proximal end 44 of the core tube.
25 Additionally, a sufficient amount of suture filament represented by its distal length 34 e~c:its the distal end of the core tube so that it is possible to form the partially tied lrnot about the distal end 45 of the core tube. The first loop 35 and the subsequent lrnot loops represented by the second, third and fourth loops, 36, 37 and 38, are formed abbot the distal end of the core tube. Once formed, tension is applied to the distal length of the filament to tighten the knot loops about the distal end of the core tube.
E1~1D-417 In another embodiment of the invention, the partially tightened knot formed about the core tube can be loaded into a suture cartridge 47 as illustrated in Figure 11.
The suture cartridge~has an elongated body 48. A tube slot 49 for receiving the core tube 43 is embedded in the body of the cartridge. The body also contains a knot 5 recess 50 which has a pair of stripping shoulders 51. Extending from a proximal edge 5~: of the tube slot in a proximal direction is a filament slot 53.
Correspondingly, extending from a distal edge 54 of the tube slot toward a distal end of the camidge body is a loop slot 55. The length of the core tube, designated as Ll in Figure 11, is le;~s than the length of the ri~be slot, designated as L2 in Figure 11.
When the partially tied knot is formed atrout the core tube 43, the knot loops are wrapped about the distal end 45 of the core tube. The free proximal end of the suture filament extends from the proximal end 44 of the core tube. The first loop 35 of the partially tied knot extends from the distal end of the core tube. When the core 15 tulbe is loaded into the tube slot 49 of the caroridge body, the knot loops sit inside the knot recess and abut the stripping shoulders of the knot nxess. A portion of tt~
proximal length 33 of the suture filament rests in the filament slot 53 embedded in the body of the cartridge, and the remaining portion of the proximal length of the suture filament extends from the proximal end of the cartridge body. Correspondingly, the 20 first loop 35 of the partially tied lrnot and the distal end 34 of the surgical filament are ra3eived in the loop slot 55. A substantial portion of the first loop and the distal length of suture filament extend outside of the carnidge body. In its original position as best illustrated in Figure 13, the distal end 45 of the core tube is adjacent the distal edge 54 of the tube slot. Since the tube slot 49 has a length greater than that of the core tube 25 43, the core tube is capable of sliding proximally toward the proximal edge 52 of the tube slot. In this position, the knot is trapped in recess 50. The surgeon can then easily manipulate needle 46 and suture filament 34 without danger of prematurely deploying the knot.
EP~1D-417 When the core tube is loaded into the tube slot within the tbdy of the cartridge, a cartridge top 56 can be mounted onto the cartridge body 48 as shown in Figure 12. When the cartridge top is mounted, the core tube 43 is fully enclosed within the cartridge.

With the core tube fully enclosed within the suture cartridge, the partially tied knot wrapped about the core tube can be ~ployed to fasten desired bodily tissue as illustrated in Figures 14-15. The first step is to position the suture cartridge 47 adjacent bodily tissue 57 desired to be fastened. Neat, the surgical needle 46 is passed 10 through the tissue, and into and through the first loop 35 to form the tissue loop 40.
The size of the tissue loop is adjusted to provide the appropriate tension on the opposed tissue sections of the bodily tissaie 57 desired to be fastened; once the knot is completed to from the non-slip knot, the tissue loop becomes rigidly fixed and further adjustment is unavailable. When the tissue loop 40 is formed and appropriately sized, 15 prt~ximal tension is applied to the proximal length 33 of the suture filament in the direction of the arrow as depicted in Figure 15. The completed knot is formed when sufficient tension is felt or applied to the proximal length 33.
Advantageously, when tension is applied to the proximal length 33 of the 20 filiunent, the first loop is pulled and eventually applies a proximal force against the distal end 45 of the core tube 43, causing it to slide proximally as shown in Figure 15.
Sirxx the knot loops abut against the stripping shoulders in the knot recess 50, the knot loops remain stationary even though the core tube slides proximally. When the core tutre slides to a position where it is adjacent the proximal edge 52 of the tube slot 49, 25 the: knot loops are stripped from the distal end 45 of the core tube. The knot is then fully formed, and the user can remove the cartridge top 56, cut the remaining proximal and distal lengths of suture filament, and remove the core tube.
Ahternatively, the proximal and distal lengths of suture filament can be exposed without removing cartridge top 56 by releasing the tension on proximal length 33 and 30 pulling the cartridge proximally, thus allowing a portion of the proximal and distal lengths of suture filament contained in the core tube 43 to extend distally from recess 50.
The suture cartridge 47 is advantageous because it is readily adaptable to 5 ctmventional open and endoscc>pic instruments, and thus readily facilitates the formation of the lrnot. The suture cartridge may be disposable, or it can be used on multiple patients. When used on multiple patients, a plurality of disposable core tubes, including the partially tied lrnot wrapped about the tube, can be loaded serially into the suture cartridge to provide for the placement of numerous surgical lrnots to fasten 10 tiaue using a single suture cartridge.
In another embodiment of the invention, the partially tied knot is wrapped about the core tube to facilitate the conversion of the lrnot to the completed, non-slip knot to fasten tissue. This similar embodiment is illustrated in Figures 21-23. The 15 octe key difference between what is shown here and that illustratied in Figures 9-15 is that the core tube has a tapered distal end. For cxmvenience, the same numbers have bExrn used to identify component parts in Figures 21-23 as those used in Figures 9-15.
In yet another embodiment of this invention, a partially tied surgical knot is 20 illustrated in Figures 16-17. The knot is made from a suture filament 58 which has a proximal end 59 and a distal end 60. A surgical needle 61 is attached to the distal .
end. The distal end of the filament is manipulated to form the knot while the proximal end of the filament is held stationary. A core loop 62, proximal loop 63 and first loop 64 are initially formed. The proximal loop is at a first end 70 of the Irnot, and the first 25 loop is at an opposite end 71 of the knot. The core loop is situated between the first arid opposite ends of the knot. Knot loops, in the preferred embodiment consisting of second, third and fourth loops, 65, 66, and 67, are formed about the proximal loop 63 arid the first loop 64. The knot loops together form a common loop core 68.
The core loop is positioned within the common loop core. When tension is applied to the 30 distal end of the surgical filament while the proximal end of the knot loops is E:I~ID-417 supported, the laiot loops are tightened. The lrnot loops are tightened about the first loop, proximal loop and core loop. When tightened, as shown in Figure 17, the first loop, core loop and proximal loop are sewreiy received in the lrnot loops, and the partially tied lrnot is formed.

Referring specifically to Figure 17, the core loop 62 has a free proximal end 69 extending from the common loop core 68 toward the first end 70 of the irnot. The core loop has a loop end 72 which extends from the common loop core in an opposite direction toward the opposite end 71 of the lrnot. The loop end 72 of the core loop 62 10 is disposed inside the first loop 64.
The partially tied loiot of Figure 17 can be converted to a completed non-slip laiot when axial tension is applied to the proximal loop in the proximal direction while the proximal end of the lrnot loops is supported. In a manner similar to the 15 deployment of the lrnot best illustrated in Figures 1-8, the lrnot is converted when the first loop is pulled through the common loop core to form a distal loop.
Advantageously, when tension is applied on the proximal loop, not only is the first loop pulled through the common loop core, but also the core loop is pulled through as well. This provides an advantage because the core loop creates a sufficient space 20 represented by the common loop core to enhance the ease of passage of the first loop through the common core to form the completed lrnot. Easier passage reduces the arnount of tension which is need to be applied to the proximal loop to form the ccimpleted lrnot, and therefore increases the degree of control of the user when the lmot is being d~loyed.

Figures 18-20 illustrate the use of the lrnot depicted in Figure 17 to fasten tissue, where the lrnot is deployed in combination with a stripping tube 73.
When the p~~rdally ded lrnot of Figure 17 is formed, the proximal loop 63 is passed through the stiripping tube. A portion of the proximal loop extends from a proximal end of the 30 soripping tube. The proximal loop is passed through the stripping tube until the lrnot Ell~ID-417 loops abut against the distal end of the stripping tube. Significantly, the stripping tube h:~s a tapered distal end 74. The core loop and the first loop extend away from the tapered distal end of the tube. The opening at the distal end of the tube is smaller in diameter than the diameter of the knot loops. Consequently, when tension is applied 5 on the proximal loop in the proximal direction, the knot loops will not pass into the stripping tube.
The conversion of the partially tied knot to the completed knot is performed in a manner substantially similar to that described in the previous embodiments.

Referring now to Figures 19-20, the stripping tube 73 is positioned adjacent t~odily tissue 75 desired to be fastened. The surgical needle 61 is drawn through the tissue. A tissue loop 76 is formed when the surgical needle and distal end of the filament are fed through the first loop 64. Again, it is important to adjust the size of 15 tt~e tissue loop to provide for appropriate tensioning of the fastened tissue before the knot is fully deployed. When the desired tissue loop is formed, tension on the proximal loop 63 is applied in the proximal direction as indicated by the arrow in Figure 19 to pull the core loop 62 and the first loop 64 through the common loop acre. When the first loop emerges from the fourth knot loop 67, the distal loop 77 is 20 formed, and die completed, non-slip knot has been created.
The different embodiments of this invention are representative of the preferred embodiments of the invention. These embodiments are merely illustrative. The scope of the invention should not be consaued to be limited by these embodiments, or any 25 other particular embodiments which may come to mind to those skilled in this art.
b~stead, the reader must refer to the claims which appear below to determine the scope of the invention.
I:;ND-417

Claims (10)

1. A suture cartridge assembly comprising:
a) a suture filament having proximal and distal ends, said filament being formed into a partially tied surgical knot for facilitating the fastening of bodily tissue, said knot having a first loop formed between the proximal and distal ends of said suture filament, and a plurality of knot loops formed about said first loop so as to form a common loop core;
b) a core tube wherein said partially tied knot is secured to said tube; and c) a suture cartridge containing a tube slot for receiving said core tube, said tube slot having a proximal edge and a distal edge, and said suture cartridge containing a knot recess for receiving said knot loops, said knot recess embedded in said tube slot between the proximal and distal edges of said tube slot.
2. The suture cartridge assembly of Claim 1 further comprising a surgical needle attached to the distal end of said suture filament.
3. The suture cartridge assembly of Claim 1 wherein said suture filament is initially passed through said core tube, and said partially tied surgical knot is then formed about said tube wherein the proximal end of said suture filament extends from a proximal end of said core tube, said first loop extends from a distal end of said core tube, and said knot loops are wrapped around said core tube.
4. The suture cartridge assembly of Claim 3 wherein said suture cartridge contains a knot recess for receiving said knot loops.
5. The suture cartridge assembly of Claim 4 wherein said suture cartridge contains a loop slot for receiving a portion of said first loop, and a filament slot for receiving a portion of the proximal end of said suture filament.
6. The suture cartridge assembly of Claim 5 wherein said first loop extends from a distal end of said suture cartridge, and the proximal end of said suture filament extends from a proximal end of said suture cartridge.
7. The suture cartridge assembly of Claim 6 wherein said core tube has a tube length, said tube slot of said suture cartridge has a slot length, and said slot length is greater than said tube length.
8. The suture cartridge assembly of Claim 7 wherein said knot recess has a pair of stripping shoulders, and said knot loops abut said shoulders.
9. The suture cartridge assembly of Claim 8 wherein when axial tension is applied on the proximal end of said suture filament so as to pull said first loop through said core tube, said core tube slides proximally in said tube slot while said knot loops remain stationary abutting said stripping shoulders, and said knot loops are stripped from said core tube.
10. The suture cartridge assembly of Claim 9 wherein said suture cartridge hays a cartridge top, and when said core tube is loaded into said tube slot, and said cartridge top is mounted onto said suture cartridge, said core tube is fully enclosed in said suture cartridge.
CA002234379A 1997-04-08 1998-04-06 Suture cartridge assembly for a surgical knot Expired - Lifetime CA2234379C (en)

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US08/841,962 US5749898A (en) 1997-04-08 1997-04-08 Suture cartridge assembly for a surgical knot
US08/841,962 1997-04-08

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CA2234379A1 (en) 1998-10-08
DE69818737D1 (en) 2003-11-13
DE69818737T2 (en) 2004-09-23
US5749898A (en) 1998-05-12
EP0870470B1 (en) 2003-10-08
AU6069198A (en) 1998-10-15
ES2209064T3 (en) 2004-06-16
AU726290B2 (en) 2000-11-02
JPH1142235A (en) 1999-02-16
EP0870470A1 (en) 1998-10-14

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