CA2248090A1 - Suture spring device applicator - Google Patents
Suture spring device applicator Download PDFInfo
- Publication number
- CA2248090A1 CA2248090A1 CA002248090A CA2248090A CA2248090A1 CA 2248090 A1 CA2248090 A1 CA 2248090A1 CA 002248090 A CA002248090 A CA 002248090A CA 2248090 A CA2248090 A CA 2248090A CA 2248090 A1 CA2248090 A1 CA 2248090A1
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- CA
- Canada
- Prior art keywords
- guide
- spring device
- suture
- applicator
- suture spring
- 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.)
- Abandoned
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/08—Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound
- A61B17/083—Clips, e.g. resilient
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
- A61B17/1285—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
- A61B17/06066—Needles, e.g. needle tip configurations
- A61B2017/06076—Needles, e.g. needle tip configurations helically or spirally coiled
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
- A61B17/06166—Sutures
- A61B2017/06171—Sutures helically or spirally coiled
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B2017/0649—Coils or spirals
Abstract
A suture spring device applicator (20) includes a storage portion (32) configured to hold one or more suture spring devices (38) in a substantially relaxed, contracted state and a guide (36) disposed distally of the storage portion to receive a suture spring device in an elastically deformed, expanded state for positioning in or in relation to anatomical tissue. A pusher (26) is used to bias the suture spring device distally so that, when the guide is rotated and moved proximally relative to the suture spring device, the device will be loaded into the guide in the elastically deformed, expanded state. The guide is then positioned in or in relation to anatomical tissue and is retracted or moved proximally relative to the suture spring device which is held in place by the force of the pusher. When the guide is removed, the suture spring device is no longer restrained and can move from the elastically deformed, expanded state toward the substantially relaxed, contracted state to apply a predetermined force to compress the anatomical tissue. The applicator preferably includes a central channel (159) through which instruments, such as tissue penetrating instruments and tissue grasping instruments can be inserted prior to or during operative procedure.
Description
WO g7/32527 PCr/US97102979 Suture Spring Device Applicator BACKGROUND OF THE INVENTION
Field of the Invention:
The ~reaont invention relates to surgical devices and proc6.1ures and, more particularly, to a suture spring device s~rpli~or, that is, an apparatus for applying at least one suture sprin~ device, for example a suture spring device of the type ~;r~:lQssd in my co pending U.S. Patent A~plication Serial No. 08/610,951, e"litled ~Suture Spring Device,~ the discl~s~ ~e of which is inco(purdled herein by refe~nce.
Disu~ssion of the Prior Art:
Suturir~ of bodily tissue is a Ume cor~uming part of most sur~ical procedures including both open surgery and ellJoscopic or minimally invasive surgery. By W O 97~2S27 PCTrUS97~2g79 "open" surgery is meant sur~ery wherein the sur~eon gains ~ss to the surgical site via a relatively large inc;sion and by ~ndosoopic surgery is meant sur~ery wherein the sur~eon gains access to the surgical site via one or more portals through which e(-d-~s are introd~qcl to view the sur~ical site and through which variousins~s are intro~luc~cl to the surgical site. There are many co")mo., endoscopic surgical procedlJres including al 11 .r~,tcopy, laparoscopy (pclvi500py), ~astr~, Itn~5COp~ and lar~"~obrt,r,choscGp~, for e~,ople.
In the past suturing was ac~ plished with the use of a sharp suture needle attached to the end of a length of suture material. Depending on the size of the~re needle and the type of sur~ery bein~ pe. rOlllle~l~ the suture needle was either ~,~sped manually or with a needle holding instrument and moved to cause a sharp tip of the needle to pe"el~ale and pass through andtOllliCal tissue. When the sharp tip of the needle e",ergeJ from the tissue the body of the needle was rela~ ed so that the distal end of the body adjacent the tip could be ~ras~d to pull the needle and the suture l-.al~lial dtlach6d to the needle throu~h the tissue. Once the suture material was pulled throu~h the tissue, the sur~eon tied a knot in the suture ",ale, ial and ad~usted the lensi~ l on the suture material to aco~ Gddte the particular tissue bein~ sutured and to oontrol app,o~",~tion, oa~ icn, dt~l;lnllellt or other conditions of the tissue. However, the ~n~cess of tissue ~, .etration and l~notlin~ of the suture material can be time consuming and tedious work, particularly when pel F~ll l-le~l in co ~n~tiGI ~ with microsur~ery and en~os~ic surgery, and can unduly prolong the duration d sur~ery and U ,e~ror~ the period in which the patient is under an~.U ,esia.
Nevertheless, e~ esc~ic sur~ery is pr~fe.~ ed over open sur~ery due to the ~reatly red~ wl trauma and wound healing time for the patient and due to concGn,ita, It cost ~v;"~s associated with shorter hospital stays and p~ F~ ming surgery in non~os~i~PI
or out-patient sùrgery sites.
Accordin~ly, there has been much effort spent to dev~lop techniques for facilitatin~ the suturin~ normally pe-~"-,ed by use of a suture needle and a length of suture ",d~rial. One technique, eAe",~lified by U.S. Patent Nos. 3,545,4~4 to W O 97132S27 ~n~97~2~79 Green and 4,595,007 to Mericle, employs elon~.Jt~J wire sutures f~l,.,ed of ductile materials that are bent into coiled shapes by a curved tip of a suturin~ instrument.
The wire sutures can be bent around tubular structures or throu~h anatomical tissue and will tend to remain in the bent condition to hold the tissue to~U .er, however, once bent, the wire sutures will not co""~ress the tubular strudures or tissue so that ~ it is n~a~y to ~o,u.-~te the tubular structures or tissue prior to or concurrently with bendin~ of the sutures.
The use of staplin~ insln~ts has also been prs~>osed, as exe"lpli~,ed by U.S.
Patent Nos. 4,979,954 to Gwatll.l-ey et al, 5,465,894 to Clark et al, 5,465,895 to Knodel et al, 5,465,896 to Atlen et al, 5,467,991 to Tsuruta et al, 5,480,089 to Blewen and 5,486,187 to S~lc; however, stapli,-g instruments typically include sepal-~te staple driving and staple forming or anvil pol lions for positioning on orposite sides of the tissue to be sbpled. This requires access to both sides of the tissue andin~ses the size of the instruments and the portals throu~h which the instrumentsare pACsacl in en~hs~pic procedures. Some slaplin5a instruments do not have a separate anvil portion and are thus capable of a~",ly;ng staples from one side of the tissue; however, the staples must still be fo.ll.~l of a ductile n,atelial and bentto a finsl shape by such instruments requiring relatively complex ~-.eoha--;sl,-s which i ~ the cost of such instruments. Ano~r disadvanta~c of st~pl ng instruments is that the staples have sharp, tissue p~ ~ti, ~ tips which remain in the tissue after the staples have been bent into their final shape.
Other techniques that have been proposed include elecl,ical e4a~ ion, .~l~nical dovicas such as dips and clamps, and Issers; ~)o~avor, no a.temative l~, .ique has yet been well AC ~pted by sur~eons to produce the results obtainedby suturin~ and tyin~. Thus, there is a ~reat need for suturing techniques us~ful in G.- '_.~piC sur~ery that permit s~.,geons to suture anatomical tissue in a time efficient, consistent and pr~is~ .naaner.
W O 97~2S27 PCTnUS97~2979 SUMMARY OF THE INvFl~lTloN
Aecordingly, it is a primary ob~ct of the ~ Yl invention to over~",e the above-~,~nlion~l disadvanta,aes of the prior art and to provide an ap,var~t.Js and " ,eU ,oJ
for applyin~ a suture sprin~ device in or in relation to anatomieal tissue.
Another ob~ct of the pr~nl invention is to use an applicator to position a suture sprin~ device in or in relation to around ~lo--lieal tissue in an ~Iq6tically d~fo",~
expanded state and to allow the suture sprin~ device to move toward a relaxed eo,~t~a~t~ state to cG-n~,,ess a~p,oAi",ate o~e fasten or control other eonditions of the ~ t~-~ical tissue.
A further object of the pr~s~. It invention is to apply a plurality of suture spring devices to analo,-lical tissue using a suture sprin~ deviee applicator without havin~
to remove the applicator from the body for reloadin~.
Some of the adva-ha~s of the pres~nt inve.ltion over the prior art are that ~oc~J-Jres such as suturin~ dtil~ and fastenin~ of a..dtu.-licsl tissue can be p~ F.n.l~cl in less time with fewer instruments and with ~reater consiste. .c~ that the suture sprin~ device applicator permits suture sprin~ devices to be applied from one side of the a.~tcl.lical tissue without the need of having to ~sition or r~sitioo instrurnents on an opposite side of the tissue that the suture sprin~ device appliGnter can apply suture spring devices made of bicabsG-bable and non-bioabso.L.dl)le materials that the suture sprin~ device applicator can be ~-lartecl for use in a~.Jos~pic and non cn-Joscopic pr~ceclures snd that a plurality of suture springdevices can be carried by the suture sprin~ device ~r plic~'or to permit suture spring devices to be appJied at multiple bcatiùns within ~e body without the need of having to withdraw the ~ppliG~'er from the body for reloading.
The pr~3e. ~t invention is ~3G. ,c~ally cl)ar~cteri~ed in an applicator for applying a suture sprin~ device in reldtion to anatûmical tissue including a slur~ye portion confi~ured to hold at least one suture spring dsvice in a s~l,s~3.nt;ally rela~e~l cG-It~auleJ state a guide ~i5pose-J distally of the sloraye portion and including a hollow tubular body configured to ,e,cei~fe therein a suture spring device in an W O g7132~27 PCTnUS97~2979 elqstic~'ly d~f~ ded state for positionin~ in or in relation to ~nstomical tissue, and a pusher movable in relation to the guide to control the ,~s-tion of a suture spring device relative to the guide. An e~ndar is preferably ~14posed between the st~ra~e portion and the guide to el-~tically e~and the suture sprin~device as it is moved distally from the ~t~ a po lion to the ~uide. The e~ander can be fomled separately or inte~rally with the ~uide and can be a tubular e~te. ~sion of the ~uide or a solid surface with a ~roove extendin~ from the stora~e portion to communicate with an openin~ in the guide. For example, the e~.~ander could define a conical sur~ace of i- ~~eas;n~ diameter in a distal dire~lion with the groove defining a h~lical path around the conical surFac~ between the ~toraye po, t;GI I and the guide so that a suture spring device advanced alon~ the groove will be axially andlor radially ex~dnded. The pusher is p~efer~l,ly movable in relalion to the guide to~ ~e a suture spring device and can be made to lock in a retracted position behind the suture spring device so that as the guide is moved ~JIw(illldlly relative to the suture spring device, the device will be advanced distally or loaded into the guide.
The pusher is prdfe~ly biased to move distally so that, when the pusher is unlocked, it will continue to en~a~e the suture sprin~ device as the guide is moved distally to be posilioned in or in r~lalion to anato.YIical tissue. The pusher holds the suture spring device sul~tantially slatia~-~ as the guide is moved ~ uAilllally relative to the tissue or removed, thereby albwing the suture spring device to move from the ela~:i~'ly ~l~f~.ne-J, e~nd~ state toward the relaxed, c~-ltract~J state in or in relation to the tissue in order to apply a prddete. ,.lined c~...pressi~e force U .ereto. In one embodiment, the pusher int~lucles a tubular body with inwardly biased fingers at a distal end for engagin~ the suture spring device. In an~lther ei-lbodi...e,lt, the pusher includes a flexible rod or finger slidingly movable throu~h the hollow, tubular body of the guide.
Yet ,.--oU.er aspect of the pre~enl invention is ~onerally cl~aracteri~ed in an applicator fw apply;n~ a suture device in or in relation to al ldtGmical tissue including a slora~a pG- tiun configured to hold at least one suture device, a guide clisposed s W O 97n2s27 PCTnUS97J0297g distally of the slora~a portion and ineludin~ a hollow, tubular body of coiled eonfi~uration with a ~rl~Ai~lal openin~ to reo~ivc a suture device ll-e,rain, and a pushe~r movable in relation to the guide to eontrol the po~ition of the suture device in relation to the ~uide. The pusher ean be made to loek in a ret~;ta~l positionbehind 8 suture deviee so that, if the guide is retraeted, the suture deviee will be advaneed distally or loaded into the ~uide. The pusher is pr~,feratJly biased to move distally so that, when it is unlocl(ed, the pusher will eontinue to e, ~ G the suture deviee as the ~uide is moved .'is'-'ly to be po~itio.~-J in or in relalion to anatonlieal tissue. The pusher will hold the suture deviee s~ s'~-utially sl~liona, y so that, when the ~uide is removed, the suture deviee will remain in or in ~elalion to the anato,.lieal tissue and be allc~wed to move from the ~anded state toward the ~ontra~ed state.A furU~er aspeet of the presenl invention is ~e,.erally chara~e.i~ad in an applieator for a~,ply;n~ a suture sprin~ deviee in or in relation to anaton~ieal tissue ineludin~ a housing, an outer tubular ,~e"lber havin~ a proAi,l,al end mounted by the housin~ and terminatin~ distally at a distal end, an inner ~el~ber movably d;s~osecl in the outer tubular l..e..~r and ineludin~ a slora~e ~.lion eonfi~ured to hold at least one suture sprin~ device in a svhst~ntially r~ ecl cont-~d state and a ~uide ~; ,pos6J distally of the 8tw~e portion to recciv~ a suture sprin~ device in an el~ically delomNd, e~J state, a pusher movably ~ os~J in the outer tubular ",e7,ober to en~aye a suture spring device so that the poEitio" of the suture spring device relative to the inner ",e,.~ber can be cont~lled, and a drive .,.ecl)a..i;,.~
coupled with the inner .-~-~6er to move the inner ~-~l~r relative to the outer tubular me..lber when ope~te~J. The applicator can also include a locb,n~ ")ecl~anism selectively o. .ya~eable with the pusher to lock the pusher in a r~t~a~led positiv. .
where a distal end ~f the pusher e"ga~es a suture spring device in the ~lorage portion of the applicator so that, when the inner ",e"~ber is moved pru)~i" ,ally relative to the pusher, the suture spring device will be advanced distally into the guide. The inner ~~ ber can be rotale-l as it is retl~oted, for e,.a,npl~s using splines fo, ."ed on a drive shafl of the drive ",~hanlsr". If provided with splines, the drive shaft is wo g7132S27 rcrluss7/02s7s rotated as it is advanced to facilitate positioning of the guide and suture spring device .~ ,osed therein in or in reldti~n to anatomical tissue. The pusher is unlocked or rel3f ss~ when the inner ~"6"~er is moved distally and is prefera~lybiased distally to hold the suture sprin~ device s~ nlially station.l, ~ in relation to the anatomical Ussue as the ~uide is retracted or moved ,c.,o,o."all~ so that the suture sprin~ device will move from the elastically Wormed, e~unded state toward the relaxed, contracted state to apply a pleJetell~li,led c~""~ss.ve force to the tissue.
Still another aspect of the pr~-ent invention is ~e"erYIlly ~I,ara~l6ri~ed in a method of applyin~ a suture sprin~ device in relation to anat~"lical tissue including the stsps of storin~ the suture spring device in a s~ s~ tially rela~ad, conlracte~l state, elaslioally deforrning the suture spring device from the re'~Yed, cont~a.~ted stats to an e'~ ic-~"y Wormed, e~nded stats, loadin~ the suture sprin~ device into a guide in the elastically Wom~ed, ~and~J state, positionin~ ths suture spring device ,elati~ to anatornical tissue in the elastically deformsd, eA~anJeJ state using the guide, and re",o~/;.~ the guide to allow the suture spring devioe to move resiliently from the elastically d~fol~l~ed, a~anJed state toward the r~'~Y.~l, c~ntra~,1eJ state to apply a pr~dete.",ineJ co""~ressive force to the tissue. The loading step can, for example, include holding the suture spring device in a s~ s~ ~-nially s~aliGna~ ~silion and moving the guide relative to the suture spring devics, in which case the guids can be rotated andlor moved proximally relative to the suture sprin~ device. Simibrly, the guide can be removed from the suture spring device by holding the suture spring device s~ lPntially slationd"r and moving the guids relativs to the suhne sprin~ dsvice, for example by roldti,.~ and/or moving the guide p~u~"~aJly relative to ths suture spring device. In both cases, the suture spring device can be held in a s~ s~anlially slalivnafy posilio,- by positioning a pusher behind the suturs spring devics and either IGckin~ the pusher in place or biasi, ~a the pusher ~ tr'ly relstive to the guide.
Other objects and adv~n~3s of the p~3enl invention will become app~renl from the following des~iptiûn of the pref2~red er.l~di."ents taken in conjunction with the WO 97132S27 PCTlUS97tO2Y79 ac~""~n~ drawin~s, wherein like parts in each of the sever~l flgures are identified by the same reference numerals.
BRIEF ~ESCRIPTION OF TI~F DRAWINGS
Fi~. 1 is a broken side view, partly in se~tiG~I, of a suture spring device awlicator acoordin~ to ths present inv~. Ition.
Fi~. 2 is an exploded side view, partly in sectior., of an inner m6~ r for the suture spring device applicator according to the ~,r~seot in~ntiGn.
Fi~. 3 is a front view, in elevation, of the inner ~--e.-lber of Fig. 2.
Fi~. 4 is a side view, in broken lon~itudinal elevation, of a pusher for the suture sprin~ device applicator according to the present invention.
Fi~. 5 is a front view, in elevation, of the pusher shown in Fi~. 4 Fi~. 6 is an enlar~ed pc.specti~e view of a pusher locl~in~ ,..eehan;sn~ for thesuture sprin~ device applicator accordin~ to the p(G5ent invention.
Fi~s. 7 and 8 are side views, in broken lon~itudinal elevation, illustl ati, .~ Ioadin~
of a suture sprin~ device into the ~uide of an applicator according to the pr~se. ,~
invention.
Fi~. 9 is an enlar~eJ tf~")enta- ~ side view, partly in section, of a suture spring device disl~oseJ within a guide.
Fi~. 10 is a ~Jy~ lta~y side view, partly in s~Aion, illuatratill~ uper~tion of the l~;ing l.~cllal,is", of Fig. 6.
Fi~s. 11 - 13 are side views, in broken longitudinal elevation, illuslratin~ use of the applicator to position a suture spring dsvice in relation to analo"lical tissue.
Fig. 14 is an eYrlc~le~ per~peu e view illuslratil.y a modification of the inner.~..~Ler and pusher accordin~ to the present invention.
Fi~. 15 is a flay -~ n~" side view, in elevation, illusl(aliny a further m~,~lealiûn of the inner ,.,e,.l~er according to the present invention.
Fi~. 16 is a ~..~nt~y side view, partly in s~tion, of the .nodified inner "~.lber of Fig. 15 showing a modified pusher for use therewith.
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WO 97132S27 PCTIUS97/029'J9 Fi~. 17 is a fr~.n~y p~AiYe view of the pro,.i".al end of the ~uide shown in Figs. 15 and 16.
Fi~. 18 is a broken side view, in elevation, of a tissue p~netr~tin~ instrument for use with the spplicator according to the p(esenl inve.-lion.
Figs. 19 and 20 are enlarged ha~...enta,y po~s~_ti-/e views of l--~ified tissue penet,dtin~ tips for the instrument shown in Fi~. 18.
Fi~. 21 is a ha~ ~y side view in elevation of a tissue grasping instrument for use with the a~ ator accordin~ to the ~,rese, It invention.
Fi~. 22 is a broken side vicw, partly in se~ion, illus~atin~ a modified ap pli~tor according to the pr~sent invention.
Fig. 23 is an enlar~ed, hd~...enta"~ side view, partly in section, of the distal end of the applicator shc~wn in Fi~. 22.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
The applicator of the ~t,so~t invention is desc~ ibed h~reiadner as an apparal.ls for apply;. na suture sprin~ devices of coiled configuration such as those desc iL,ed in my afore"~e~nio~d co pendin~ U.S. Patent ~p~ ion Serial No. 08/610,951, e.~tiUed ~Suture Sprin~ Device~; it will be appreci~'eJ, however, that the ~ppli~tor can be used to 8pply a wide variety of suture devices, including sutur~ devices of coiled and non-coiled configuration which are e'~sticrlly or pl~~ti~11y J~on.,able or which rigidly maintain a predale..,lined shape when applied.
A suture sprin~ device awlicator 20 a rording to the p.~s~n~ invention, as shownin F4 1, includes an outer tubular ~~-enlber 22 extending distally from a housing 24, a middle tubular "Rj.nber ~ pusher 26 .~i~ed wi~in ~ outer tubular n.ember, and an elon~a~e inner n.~ ber 28 r~c~3ived within the middle tubular menlber and coupled with a drive m6.~;1 Rnism 30 in the housing.
As best seen in Fi~. 2, inner ,~ er 28 includes an elongate st~rage pGI lion 32,a fr~stocG.i-cal e~anJer 34 at the distal end of the slo~ge portion and a hollow, W O 97~2~27 PCTnUS97/02979 tubular guide 36 of coiled cor~l~uration extendin~ distally from the expander. Storage liGn 32 is shown as an elon~ate, hollow cylinder with an extemally lh~ade~
"al end 37 snd an outer diameter of pred~temlined di-l~nsion so that a pluralityof centrally apertured suture devices, for example suture sprin~ devices 38, may be iv0d U ~6r~) in an une~, relsxed or con~ aeteJ state in end-to-end series fashion as shown. For pul~osas of illu~tr~ation, each of the suture devices is shown as a centrally apertured suture sprin~ device of coiled confi~uration includin~ an elastic, wire-like body defining a series of connect6cl coils or rin~s 40 of ~enerally circular confi~uration, the rings bsing of like diall~ter and extendin~ een ,u-oxi,.~al and distal ends of the elastic body concent- ic with a longitudinal axis of the device. A knob or handle 42 in the form of a ball is ean ied on an outer peri~l .eral, convex ed~e or surface of the body of the suture sprin~ device near the proxi",al end and exl~s radially or laterally outward relative to the longitudinal axis of the device.
The body of the suture spring device is formed of an elastic or resilient material, that is, a ~-~al6rial able to recover its G-i~inal shape or position after having been defo,..-e~. Any medically S~cceptA~ le b.aa~-L,dble or non~io~hsG,bable elastic material can be used for the body of the device including, but not limited to, titanium, nicl~l ti'rnium alloys, stainless steel and plqstics such as nylon. Further details of suturc spring device 38 are set forth in my above-r~fer~nced c~pending U.S. Patent Application Serial No. 08/610,951 and several embodiments of suit~hle suture spring devices are dis~losed therein.
FnJstoconical expander 34 dQr" ,es an annular step or shoulder 44 at the distal end of st~rase po, lion 32 and a sl ~l,slPnlially conical surface 46 ex~eudi, ~y from the shoulder to ~uide 36. A groove 48 in the conical surface def,nes a helical path around the e~"Jer extending from shoulder 44 at the distal end of the alorage portion to ~uide 36. As best seen in Figs. 2 and 3, the hollow, cylind~ical ~lora~e portion and frustoconical ~r coo~ate to define a central pessa.~e or ~ ,an.)el 50 along a iongitudinal axis of the inner "~"lber to permit l~s~e of surgical instruments, andto"lical tissue and various types of fluids ll-eretl"uugh.
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W O 97/32527 PCTnUSg7~29n Guide 36 inçll~es a tubular body 50 of coiled configuration defining a series ofc~ ,. ~ted rin6~s or coils 52 of ~nerally circular configuration brminatin~ at a sharp, tissue pen~ til ~~ tip 54 at the distal end of the ~uide. Rings 52 of the ~uide have a predetermined radius of curvature and a predetermined axial ~. ~ r~between which are ~reater than the diameter and axial spa~n~ behNeen rings 40 of the suture spring device in the un~nd~l, ~ ad state. Rings 52 of the guide are also hollow to define a lumen therethrough in communication with groove 48 in the e~ar,cJer. A slot 56 ~ J alon~ an outer ~oriph~r~l, convex ed~e of the guide body communicates between an outer surface of the guide and the lumen and is of sufficient ske to n~ive and hold the body of a suture spring device while preferably being V-sl ~ped in transverse cross section and some~at narrower in width than the diameter of the suture sprin~ device body to allow knob 42 of the suture spring device to slide along the slot while preventin~ the body of the device from slipping U ~r~hluugh. The guide can be made of any suitable medically ~c~pt~ble Illalel ial, such as stainless steel, so long as it is cor~lgured to have a sliffuess suitable for maintaining the suture sprin~ device in an elastically ~fo,l-,ed, eA~,andecl stab.
The helical path de~ned by groove 48 sround the eA~ ar,cler commlJ"i~ates with the open p.u,~i..~l end of ~uide 36 to f~oilit~te loading of a suture spring device into the guide. Rec~lse the e~a,.Jer is frl,s~?nically shap~d, the dia-"ater of the helical path ir,cre~es in the dire~io" of the guide so that a suture spring device advanced along the ~roove will be receivcd by the guide in an elaslically defo,l"ed, radially e~nded state. Alten~t;,~ely, or in addition to i"~asing the dia,neter of the helical path about the e~ ander, the axial spaci"~, of the helical path may be gradually increaseJ in the distal direction so that the suture spring device will be axially expa"J.,d as it is advanced along tne ~roove into the guide.
Referrin~ a~ain to Fi~. 1, housing 24 includes lon~itudinally s~l front and rearwaîls 58 and 60 of rounded configuration, a top wall 62 in configuration parallel to a longi'tudinal axis of the outer tubular n~er, and a bottom wall 64 having a concave W O 97~2S27 PCTnUS97~297g portion 66 curvin~ d~ from the front wall to con,~e~l with a handle 68 or ented 0~ slnntially per~,er dicular to the lor~itudinal axis of the outer tubular " ~" l~er.
Out~r tubular ~-,e-,l~er 22 is open at both ends and extends from an openi ,~ inthe housin~ front wall 58 to terminate distally at a blunt distal end 70. It will be app-~ated, however, that distal end 70 of outer tubular ...e.,~ar 22 can be t~pered or chamfered as desired or have any other suitable distal cor~ uration dep4. ~a, ll upon the ~Jwe to be ~ f~rn.e~. Preferably, the outer tubular ",e.,lber is made of a s~l,sl~-ltially cylinJ~ical len~th of a sl~ ntially ri~id r"aterial such as a medically ~c~pt~ble plastic or metal ~-,aterial. The outer tubular me,.lber and housin~ can be of inte~ral on~-picce construction ~s shown or can be fon"ed s~bly and joined lo~eU,ar by any suitable l.-eU.od includin~ but not limited to U ,. ~Jed en~a~--~nl, ~JI ~sive bonding or friction fit.
Pusher 26 includes a tubular body 72 telescopically ntted within the outer tubular ..,o~nber 22. The tubular body of the pusher terminates PI~A;IIIaIIY at a transverse flan~e 74 ~i ~os~ within housing 24 b~t~ oen front and rear walls 58 and 60 of the housin~; and, as best seen in Figs. 4 and 5, a distal end of tubular body 72 is split lon~itudinally to form a plurality of fin~ers or flaps 76 which are ..o-.,-ally biased radially inward as shown to enSta~e the ~A.,--al end of a suture sprin~ device as will be des~ iL~J in ~reater detail below. Fingers 76 are generally b~apeLoidal in shape with taper~ sides 78 and a flat distal end 80. When biased lo~etl ~er as shown in Fig. 4, distal ends of the fingers coope d~e to defne a generdll)/ circular abutment surface of ~,redete.,.-ined clia-neter havin~ a dil--ensio.. to abut knob 42 of a suture spring device while ,ec~ coils 40 of an adjacent"~o,u,.~lly SpA~ suture spring device therein. A post 82 ~ l6nJs upwardly from flange 74 of the pusher through a slot 84 f~n.led in the top wall of housin~ 24 parallel to the longitudinal axis of the instrument and brminates at a knob or handle 86 ~ os~ e,~te" ,ally of the housing.
Pusher 26 can be fon,-ed of any medically Ac~4~t~ 1e metal or plastic material having sufficient elastic ~-,e.--o~y to bias the fi")~ars into the normally closed configuration as shown. A bias ,~"lber 88 is held in co""~ressio-- beh~een nange W 097~2S27 PCTnUS97~2979 74 of tho pusher and an inner wall 90 of the housin~ to bias the pusher distallyt~d an ~1 pOSitiOI~ where post 82 of the pusher abuts the disbl end of slot 84 in the housin~ and didal end 80 of the pusher is disposed adjacent the distal end o~ outor tubular ,~ml~r ~. Bias ...~")l~er 88 is shown as a helical coil sprin~ but can include various other types of sp.i"~s as well as other types of bias J~vices ~ includin~ co,~"~s~ien spr;"~s bnsion spri"~s, torsion sprin~s pan s~ri-~s leaf sp. in~s rubber, plastic or ",~. ~ls for example.
Drive ..~n:~-, 30 includes a drive shaft 92 oa~led with a tri~er 94 via a rack 96 snd pinon 98. Drive shaft 92 includes a distsl p~ lion 100 with spli. ,es 102 and a ~ i"~l portion 104 carryin~ the rack. Distal pol liGn 100 is inte" .ally th, e~cJ6.J at 106 to couple with the ~.nal end 37 of inner ~ Ler 28 and is of ~- oater di.-,-~ter than slor~ge pGI liGn 32 to define an snnular step or shoulder 108 at the pr~xi.nal end of the slu~e portion. A rotator 110 with an inten ~ally U-reacle.l pAS,S.i3j)e 1 t2 U ~ ~U u~u~h is mounted at the distal end of a tubular support ..,e,-lber 1 t 4 ~;5pos~1 within pusher 26 and secured to inner wall 90 to U .,~I~ ,ec~i~e the splined, distal pGlliGIl of driv~ shaft 92. ~r~Ai"~al portion 104 of the drive shaft is of smaller diameter than distal portion 1 00 so that a radial step or shoulder 116 is f~ ."~J at the int~iu n U .e~, and the rack 96 is disposed L.e~osn the shoulder and a flange 118 ~n~Ai~dlly sp5"~i.1 from thc shouldcr and Gl iented transverse or pe~endicular to a lon~itudinal aAis of the drive shaft.
Rack 96 is ~ene, ~ lly U-sl ape~l in transverse cross-secliG, ~ with axially spac~
teeth 126 def~ alon~ a bottom su~cs of the rack and a slot extending downward, lookin4 at Fi~. 1, from an upper surface of the rack. The rack fits under the drive shaft between shoulder 116 and flange 118 with clearance to permit ir..lependenlotational movelT~nt of the drive shaft within the slot which is at the same timesufflciently narrow to assure that upstandin~ legs of the rack on opposite sides of the shaft will abut the shoulder and flan~e to permit a~dal movo~-.ent to be ka,~sn.itled between the rack and the shaft.
wo s~r~ls~7 PCT/US9'7/02979 Trigger 94 is ph~ohlly mounted on a pin 120 secured to a wall or walls of the housing and is generally trian~ular in shape with a cut-out or openin~ 122 f~,..eJ
therethrough to ac~chln~ate one or more fin~ers of the user if desir~. Looking at Fi~. 1, pinion 98 is ~is~o~ co- ~cer,b ic with pin t 20 at the upper end of trig~er 94.
The pinion is generally circular with a plurality of circumferentially s~oacl teeth 124 and a ~Jian.~tar to cause the teeth to mesh with teeth 126 of the rack. A torsion spring 128 is ~I sl~o~d around pin 120 and con~cted between pinion 98 and housing 24 to bias the tri~ger in a doc~urise direclion, lookin~ at Fi~. 1. A sprin~-lo=~ud button 130 is carried at a lower, pro~i...al end of the tri~er and is radially aligned with a circular openin~ 132 in the handle 68 to lock the tri~ger within the handle in a manually releasable manner when the tti~er is dQpr~ss~d or moved counter-cloc~wise lookin~ at Fi~. 1.
As best seen in Fi~. 6 a locking n,ecl,anis--, 134 for locl~in~ pusher 26 in a retracted position and releasin~ the pusher to be moved distally by the bias ..-en~ber 88 upon depression of tri~ger 94 indudes a latch or locl~in~ spring 136 made of a strip of resilient material formed to have a s~ ~b~"~n:i,lly flat base 138 secured to the botborn wall 64 of the housin~ and a bend 140 joining the distal end of the base with an upwardiy an~led arm 142 s~l from the base. Arm 142 carries or forms a latch 144 havin~ a disbl an~led latchin~ sur~ace 146 joining a p,o,~ al latchin~ surface 148 ~ osqd snb~l~ntially lran~erse to the lon~itudinal axis of the instrument and s~ tially parallel to the pusher flan~e 74. Arm 142 has an extension 150 positio.~J p,~J,u~ally of latch 148 and a releasin~ r-~e~ er 152 pivotally mounted on a pin 154 secured to an upper surface of the er~tdllSiOn. R~ in~ n,e,.ll~er 152 extends frorn pivot pin 154 in a prox;.-~l direction to be disposed between teeth 124 of pinion 98. A torsion spring (not shown) is coiled around pin 154 and fixed toreleasin~ ~.e,-~ber 152 to bias the releasing r.n5"~ber cloclcwise, l~ .ing at Fi~. 6 sud~ that the reieasing .ne..lber is biased toward extension 150.
Referring again to Fig. 2, a plural~ty of suture spring devices 38 are received and loaded onto st~na~e portion 32 of the inner i"e"~ber. A cylindrical abutment r"enll~er W 0 97~2S27 P~n~97~979 156 is baded onto s~3,ae portion 32 behind ffle last of the suture sprin~ devices 38.
Member 156 is oentrally apertured so that it can slide along sll ra~a po-liG-) 132. A
~n~r~ssiQn spring 158 is coiled around storaye portion 32 and is held in c~."xess~n bet~ sen abutment ",ernl,er 156 and the annular step or shoulder 108 defined by the drive shaft at the pro,.in-al end of the stora~e ~lio-- when the ~ exter"ally tl"ea~J ~o<i.nal p~lion 37 of the inner .ne"lber is lhreaJ~ into the tl "e~J~J disbl p~ tiOI~ 106 of drive shaft 92. It will be appl ec~ l that spring 158 biases the abutment m~ l,er 156 and, thus, suture spring dGvio~s 38 distaHy until a distalmost suture sprin~ device abuts the shoulder 44 f~.m~l by the frl~stoconical ~r 34 at ~e distal end of ~lora~a portion 32. Drive shafl 92 J~f,nes a central ~q~ or ~)arb ,el 159 alon~ a lon~itudinal axis of the shaft which is communicated with central cl.annel ~0 of inner ,..enlber 28 when the con,~"ents are coupled, thereby establishin~ a continuous central ~,an,.al through the length of the a~>lic- '~r for I~A5SP~ of additional instruments, tissue and/or fluids. The central .~;1.6--r,el is communicated with a tubular ..~ml~r 160 having a distal end 162 telescopically re~ i.~ the drive shaft within housing 24 and a ~ruxi".al end 164~s,~ed externally of the housing to define a valve 166, such as a stop cock valve, and a coupling 168, for ~ ple a Luer finin~ 5pos~1 ~;ùJci, l~ally of the valve.
As best soQn in Fbs. 1 and 9, an electrical conn~1or 169 is mounted on the top wall 62 of the housing and co.~"e~ted via wires 171 ~nth electrically conductive~.~n~ of the applicatorfor pe~""in~ ebctrosurgical ~,~Jures such as unipolar or bipolar elect~ical cQa~u~ion, for example usin~ guide 36 as a conductive ebment It ~nll be app~iated, h~wever, that the position of electrical connector 169 c,,~s t~ handle 68 is merely G,~c~."~la"~ of the many various loc~ions at which an el~ ical connector can be positio,~. Also, inner surfaces of any of the tubular i"e.nb~r~, such as inner, middle and outer tubular "~"l~ers 2~, 26 and 22, can be electrically insulated to permit ~ ~c~e of electrosur~ical instruments ll ,ereU~rough as a b~ r *rB
W 0 97132S27 rCTnUS97/02979 In use, applicator 20 is p-~fo~ly supplied in the rest conditio-. shown in ~ig. 1 with tri~er 94 pro~udin~ distally from handle 68 in an unlocked p~ sition. Pinion 98 at the end of tri~er 94 en~a~es a distal end of rack 96 which is biased pr~xi..,ally toward a rG~a~eJ ,~sition by the clock~ ota~iGr~l bias of the to~5-0n sprin~
actin~ on the pinhn. Rack 96 en~d~s flan~e 118 to bias drive shaft 92 and inner ,n~..~bar 28 to a retracted ~osition where guide 36 is disposed within outer tubular n~"~L,er 22 to pr~t~l the sharp tip of the guide. Pusher 26 is unlocked in the rest condition and biased distally toward an extended position where knob 86 abuts a distal end of slot 84 and fir~ets 76 at the distal end of the pusher en~a~e the ~uide.
Flan~e 74 at the p~ximal end of the pusher is ~-~t~lly spAce~l from latch 144 oflocking ~-~J ~nism 134 when the pusher is in the G~lu~ded position. As n-e.ltioned preYiously, suture sprin~ Je~ s 38 are held on the storaç,~e po.lion of inner .ne "ber 28 in an u-.c~--~d, relaxed state. Cc,--.~r~s6i~n sprin~ 158 pushes abutment member 156 forward in a distal direction into abuttin~ relation the ~,ro.<i..~almost suture spring device which, in tum, is pushed d;sl~lly into the next suture sprin~
device until the distalmost suture spring device abuts shoulder 44 at the distal end of storage po. lion 32.
A suture sprin~ d~vice 38 is loaded into ~uide 36 by l~in~ pusher 26 in a retracted position where fingers 76 ~ s~a knob 42 of the suture sprin~ device and retractin~ inner n-e--lber 28 ~fo.~i...ally relative to the suture spring device while maintainin~ the pusher in the locked ~ o sition. Refen i. .~ to Fi~. 7, inner .~ L er 28 is moved to an e~t~fi.bd ,~sition by dep~ssin~ tri~ger 94 into handle 68 to cause pinion 98 to rotate co~"~cl~Nise about pin 120, loch:n~ at ~is. 7, U.ereb~ forcing rack 96 to move in a distaî direction. Rack 96 pushes against shoulder 116 of the drive shaft, for~ the drive shaft to move distally throu~h block 110 which rotates the shaft in a clockwise direction looking distally. Inner "~."~r 28 is also moved distally to an e~t~. .J6J po5ilio-) where ~uide 36 is ~ cl distally of outcr tubular , ber 22. When tri~er 94 is completely Jepresse~ as shown, button 130 in the tri~er will be ali~ned with opening 132 in the handle and will thus be able to spring *rB
WO 97t32S27 PCr/US97102979 outwardly of the trig~er into the opening to lock the trig~er in the depr~.ssed condition. Pusher 26 is then retracted to en~a~ a suture spring device 38 by pullin~
handle 86 raarwardly or in a ~ ~l direction against the distal bias of bias ...e.,lber 88 to force flan8e 74 a~ainst arm 146 of the lochi..~ ~-.eCI.3nian.. Arm 146 is pushed downwardly by nan~e 74 as handle 86 is drawn back, allowin~ the flange to slide ~ over latch 144. When flange 74 is d;~owd p~)~ ~lly of the latch, arm 142 will spring upwardly pOsnionin~ ~ro)~imal latchir~ surface 148 in front of the flange.
Wnen handle 86 is released, bias ..~n~bar 88 will bias flan~e 74 distally into cont~t with the pro)~i...al latchin~ surface which prevents the flan~e from moving further distally. As the handb is drawn back, fingers 76 at the distal end of the pusher slide along the periphe-y of inr~r ~--anlber 28 and over the suture spring device 38 until they are l,ositioned i.-,--~di~tely behind knob 42 of the distalmosl suture spring device. Since fi"~ers 76 are biased radially inward, distal ends of the r,. .~ers will abut the knob and prevent the knob from movinQ p. ~"ci.nally past the finyGrs.
Referring now to Fig. 8, pusher 26 is maintained in a locked position with fingers 76 enga~ing knob 42 at the ~..~l end of suture spring device 38, and button 130 is ~rass~ to perrnit trig~er g4 to be moved in a clockv~isa directio.. about pin 120 under the influence of torsion spring 128. ~ l~ise moven,6, It of the tri~ger ~nses pinion 98 to move in a clocl~Nise direction thereby forcing rack 96 to move p~i--,ally toward the .~t~acl~d, ~sition. r, o~i"~al movement of rack 96 c~ ~ses drive shan 92 to move pr~"~in,ally throu~h blo~ 110 which rotates the shaft in a colJn~erclG~nN~se directlon lookin~ distally. Inner ~ er 28 ~acls with drive shaft 92 and is rotaled in the same direction. Suture spring device 38 is ~,~v~uted from moving ~,-o-(i-..ally by pusher 26 and will thus be ~~ceivoiJ in and e~a,~d along the groove 48 in ther and be loaded or fed into guide 36 as shown in Fig. 9. In the loaded position shc~wn, suture spring device 38 is held in an eln~ti~lly defo,..~ed, e3~ancJed state within guide 36, and knob 42 at the p~i,..al end of the suture spring device is aligned with and made to slide alon~ slot 56 in the guide.
WO 97/32S27 PCTAUS97~2979 With suture sprin~ device 38 loaded within ~uide 36 as shown in Fi~s. 8 and 9 applicator 20 can be used to suture and/or li~ate ~natomicsl tissue within the body as described in my afo.~.,-,ntion6J co~n-Ji..~ U.S. Patent Arplic~tion Serial No.
08Jff10,951 entitled ~Suture Sprin~ Device~. For p~J",oses of illustration suturing of layered tissue structures T, and T2 will be Je~ il~l it being u"Jerstoocl thst the applicator can be used in a similar fashion to suture other types of tissue and/or to li~ate tissue within the body usin~ a suture sprin~ device.
Ref~., ing still to Fi~. 8 distal end 70 of outer tubular ...e..l~er 22 is positioned adjacent the tissue to be u~d while tri~er 94 is dopr~sad. As shown in Fi~. 11 depression of tri~er 94 into handle 68 ~ ~s~s pinion 98 to rotate in a countef~ wise direction about pin 120. Rack 96 is moved distally by count~rolocl~4isa rolation of the pinion causin~ drive shafl 92 to be moved distally throu~h block 110 and rotated in a clockwise direction lookiny ~ t~ly alon~ the lon~itudinal axis of the applicator. Co~.nler~ vise rot~tion of pinion 98 also ~ ses teeth 124 of the pinion to press dow-~ ~.dly against rcla-~ing mem~er 152 at the pf~,.i-"al end of Gxtension 150 as shown in Fi~. 1û causing arm 142 of the locking "~1~ -;~.. to be moved downwardly toward base 138. Down~rd movement of arm 142 cP~ ~ses latch 144 to move away from nange 74 of pusher 26 allowing the pusher to be moved in the distal direction under the influence of bias ",e,nber 88.
hner ,-~-lber 28 moves distally and is rotated with drive shaft 92 causing sharp tip 54 of the guide to penetrate into the pro~in~al tissue structure T,. As inner ~-.e"~ber 28 is moved further distally and lotaled, ~uide 36 will penet,ate through analo",ical stnJc~res T, s~nd T2 like a o~lhscr~w thereby ~st-~lishing a helical path through the structures as shown in Fi~. 11. Pusher 26 is biased distally under the influence of bias ~--e..ll~r 88 and will thus maintain co-ltact with knob 42 at the pro~i...al end of WO g7132S27 ~ ,7102g7g suture sprin~ device 3B to assure retention of the device within the guide as itpenetrates into the tissue.
Peneb~tion is oompleb when tri~er 94 is fully Je,~eJ within I ~a. ~Jle 68 and button 130 is en~a~ed within openin9 132 of the handle. Guide 36 holds suture sprino device 38 in the elastically Juf~)eJ, expanded state for positioning in or in relation to the ~nat~ r.lical tissue and is removed from the suture sprin~ device by pressin~ button 132 into openin~ 130 to allow the tri~er to be moved in the clockwise dir~t;on under the force of torsion spring 128 as shown in Fig. 12. Astri~er 94 moves dockwise about pin 120, rack 96 is moved proximally once more, causing drive shaft 9Q to be moved p~Ai~l~ally through rotator block 110 and f~tatecl in a countercloc~wise direction lookin~ disblly alon~ the longitudinal axis of the appliG-~'or. rr~Ai-,-al movement of suture spring device 38 is prevented by ~,~. ~t of fin~e. ~ 76 with the knob 42 at the pr~il"al end of the suture springdevice. Guide 36 is thus ulltl-r.-~ or r~...oJed from suture sprin~ device 38 with knob 42 sliding along slot 56 in the guide to permit the guide to move pr~"ci,--ally rebtive to the suture spring device. As the ~uide is removed, rings 40 of the suture sprin~ device move from the el~ llc~ y ~fo- "~ed, GApan~d condition toward theirori~inal relaxed, c~lt~ J condition. When guide 36 is removed e"tir~ly from suture spring device 38, as shown in Fi~. 13, rin~s 40 of the suture spring device will en~a~e tissue structures T, and ~ d;~osed between the coils and exert a predeterrnined axially COIll~aS5 JC force to app(oxi,nale the tissue structures. ît will be apprec ~ted that suture spring devices 38 remainin~ in applicator 20 are biased distally by con~essien sprin~ 28 and are thus r~sitioned for loading and use in the ",J~nu J~ il~J above without the need of havin~ to remove the appli~ ~r from the body for reloadin~.
While the npplTc~tor accordin~ to the pr~se.~t invontion has been desc~ibeJ as applyin~ a particular suture sprin~ device, it will be appr~ that the arplic~r cz~n be adapted to apply a vanety of dmerent types of suture sprin~ devices. In Fi~.
14, for exalr~le, a modified ~uide 36' and pusher 26' are shown for applyin~ one or more suture sprin~ devices 38 similar to the suture sprin~ davic6s previously J~ iL~J but wi~out knobs. Each suture spring devioe 38 incluclss an elastic bodyof coiled confi~uration definin~ a plurality of rin~s or coils 40 extending between plw.Y~al and distal ends 39 and 41 of the device. F~ --al and distal ends 39 and41 are bent at an an~le relative to the coils and extend in axially o~ost-J dire-lions alon~ a longitudinal axis of the device. Tubular ~uide 36 is similar to the ~uide previously d~s~il~ but does not include a slot. A pruA---~I end 44 of the ~uide is bent at an angle relative to rin~s or coils 52 of the ~uide to extend alon~ abn~itudinal axis of the ~uide and to be axially ali~ned with the disbl end 41 of the suture spring device 38 . Rin~s 52 of the ~uide are of in~easin~ diameter in a distal direction so that the ~uide will function to elaslically deform the suture sprin~ device as it is loaded into the ~uide tl-er~y obviatin~ the need for a separat3 e~nder.Pusher 26 ir~' ~~~s an elastic rod or fin~er 76 extendin~ distally from a peripl~e.dl edge of tubular body 72~ in axial ali~- ~..-e. ~t with pr~ximal end 39~ of suture sprin~
device 38'. The hr~r 76' has a cor~l~uration to fit co ~ro.--~ably within and to move or slide along the ~uide. In use, finger 76' of pusher 26' is ali~ned with and made to abut l~r~Ai,.-al end 39' of suture sprin~ device 38' in order to move the suture sprin~ device in the distal di-~i~ relative to ~uide 36'. ff more than one suture sprirlg device 38~ is ~ os~J within the appli~tor, the suture sprin~ devices can be IO ~d~d in end-to-end series fashion as indicated in Fi~. 14 by the p- usel .ce of the second suture sprin~ device which can be ;-~S6- ted ~tw~n the distalmost suture sprin~ device and the pusher. The distalmost suture spring device is loaded into the ~uide in the ~).anner des~ i~d above, for example by usin~ the pusher to hold the suture sprin~ device in place while the ~uide is relr~teJ. As the suture spring device is lo~led, finger 76' will enter the P~A;~al end 44' of the guide and be elastically deformed within the guide in order to maintain co,~tact with the proAi...al end 39' of the suture spring device. A~ the suture sprin~ device 38' is advanceddistally throu~h ~uide 36', it will be elastically d~for,.,ed by the coils of the guide and will be held in the elastically Ju~o. ---ed, e~and~J sbte as the ~uide is positie, .~1 in -or in relation to anatomical tissue. Once the ~uide i8 positionel, the suture sprin~
device is held in a sub~blly ~lat~y position in relation to anatomical tissue bythe fin~r d the pusher while the guide is remoYed by slidin~ along the fin~er of the pusher in a pr~)~i."al direc~n.
Ano~er modification of the applicator according to the ~nt invention, shown in Figs. 15 -17, in~ s~ an inner me.n~r 28~ havin~ a hollow stora~e ~GI tion 32~of cylindrical confi~uration, a hollow, tubular ~uide 36~ of coiled configuration with a ~r~mal pGIliGn 171~ extendin~ into the intc.ior of the stora~e portion and a pusher 26~ similar to that shown in Fi~. 14, havin~ a hollow, tubular body 72 ly r~ceiYod within ~tDra~e portion 32~ and an elastic rod or fin~er 76~
extending distally from a peripl .6~al ed~e of the tubular body to be axially ali~ned with an open P~J~;"~I end 173~ of the ~uide. As best seen in Fi~. 17, ,~roxi",alon 171~ inolu~s a first tubular extension 175~ extendin~ radially inward from ahrst bend 177~ in the proximalmost coil to a se~,d bend 179~ conn~ti..~ the first tubular extension wtth a seco(~ tubular extension 181 n ~isF!osed alon~ the interior of slora~e pG,lion 32~ in axial ali~an",ent with fin~er 76~. The second tubular ex~ension terminates proximally at open prOAimal end 173~. Stora~e pG.Iion 32n is received tc'es~opically within the lon~itudinal ~ s~e Je~,ne.l by rin~s 52~ of the ~uide and can be connecbd thereto in any suitable ,--a. .. er includin~, but not limited to, ~Jhe5;VG bondin~ and friction fit. An openin~ 183~ is f~""~l in an outer po.ipl.aral, convex surface of the ~uide ~ cenl bend 51 u and is confi~ured to ive the distal end 41 u of a suture sprin~ devioe, for example suture sprin~ device 38n, carried on an outer surface of the cylindrical ~to~a pGI tion. A plurality of ~re sprin~ davic~s 38U are shown, each bein~ similar to suture sprin~ device 38 but without knobs or handles. The suture sprin~ JEvioas are preferably biased distally relative to the ~uide so that, when the ~uide is r~tated relative to the distalmost suture sprin~ device as de~ iL~J above, the device will be loaded into the ~uide. Pusher 26~ is movable throu~h the tubular body of the guide to control movement of the suture sprin~ device relative to the ~uide once the device is within W O 97~2S27 PCT~USg7~2g7g the ~uide; and, it will be appreaated that the fin~er of the pusher can be used to nt udbsequent suture ~prin~ devices 38~ frorn bein~ loaded into the guide by blocking opening 183~ when advanced distally beyond the opening to push the suture sprin~ device already loaded within the guide. However, under cortain circun)sl~nc~s it may be desi,~le to have more than one suture spring device disposed within a ~uide, in which case o Ih~l ~ently loaded suture sprin~ devioes will be disposed between the pusher and the distalmost suture sprin~ device, forexample in the additional rin~s 52~ at the p~,-i-,~l end of the guide, and the additional devices can be used to push the distalmost device in relation to the ~uide.
Fi~s. 18 and 19 show a pen~tin~ instrument 174 which can be asse.~.bled as part d the applicator 20 or inse, l~l throu~h the central ~;1 ,an"al of the applicator by the user durin~ an o~,eralive ~ce.Jure. The instrument 174 inc'udes an elon~ate,tubulsr body 176 havin~ an outer diamebr of predetermined dil..ensio" to fit within the oentral ~ ~1 of the applicator and a len~th to protrude distally beyond the tip 54 of the ~uide when fully inserted. Body 176 <Jef~nes a lumen 187 which e).ler,d,.
from a con~r~ntiG"al couplin~ 180, such as a Luer fittin~ at a proxi",al end of the body to a sharp tissue pen~trdtin~ tip 182 at a distal end of the body. A valve 184 for example a stop~srll; valve is ~J;sroseJ near the couplin~ at the proxi" al end o~
the body and communicated wffl the lumen to control p~~~a of instruments, fluidsandlor tissue throu~h the lumen. An electrical conneclor 186 protrudes ,endicularly from the body of the ,oe"~alin~ instrument throu~h an ele.b ically insulative layer 188 which is fGIllled about the p4ri~1,e,~ of the body and made to e~end all or substantially all of the len~th of the instrument to fA~.il '~te use of the tip of the instrument for electrosur~ical procedures. It will be a~re~ated that instrument 174 can also be used to pe~bate and ~issecl anatomical tissue to pc.for", i,.i~aati.~ and aspiratin~ fu-l~tions and to administer medica",en~s to the Gpordli~e site.
A modification of the penJ~tin~ instrument is shown in Fig. 20 wherein the modified penetrating instrument 174' inç~des an alon~ate solid body 176' W O 97~2S27 ~ 97~2979 terminatin~ at a sharp, ti~ue ~- le~t;nU tip 182' which can, for example, be used to pene~ate and dissect anatomical tissue as well as for electrosur~ical ~r~Jures.
Another instrument usable with the applicator 20 accordin~ to the pr~ t invention, as shown in Fi~ 21, ir~ ules an elon~ate body 192 terminatin~ distally in a pair of arms 1~4. Each arm o~n~nd~ distally from the body to a bend 196 connectin~ the aml with a tissue en~a~in~ tip or pincer 198 ~ ;GnteJ substantially perpendicular or transverse to the arm. A~ms 194 are an~ularly -spsc~d from one another in ~PI ~3~J relation and are normally biased apart as shown with a ~ap or spac;nU between the arms in~er sin~ in a distal di(eution. Tips 198 extend toward one a~U ~ from the arms in op~,osed relation and can have any confi~uration useful for graspin~ tissue and medical devices. The grasping inslrument 190 is p,~erably formed of an elastic l-~t,_.ial so that arms 194 and tips 196 can be straiJhten6J to pass thru ~e central d ~ I of the applicator, for example by advan~ng a tubular e (not shown) distally relativ~ to the arms and ;. ~. tin~ th~ sleeve throu~h lhe nth the arrns ~;sp~ therein. Wnen the distal end of the sleeve protrudes beyond the ~uide, the sleeve is r~a~teJ to allow arms 194 to spreacl apart as ~wn. Arms 194 can be drawn tG~U ,er to ~rasp a-,alG"lical tissue and/or devices disposed be~en the arms by advancin~ a sleeve distally relative to the arms and/or by movin~ ffle instrument pr~,,u,,-ally relative to the ~uide. The graspin~ instmment can be f~.~d with more than two arms, for example to ~rab weakened po. lior,s ofa~tomical tissue. Body 192 of ffie tissue ~raspin~ instrument 190 can be of hollow, c~ylindrical conf~uration as shown or have any other solid or hollow configuration as desired. H hollaw, the body of the instrument can be used to allow pAssa~e of tissue or fluids 11 ~U ~h or to acoor""~hle other instruments, such as the ~ ali, ~~
instruments d~ d above.
Another "~ f;~tion of the applicator accordin~ to the p,esont inven~ion, shown in Fi~. 22 at 20"', is similar to appl;~t~ 20 but is shown without a prole~ti~,e outer tubular ,-,o.l~lLer. The rnodified applicator inrludes a housing 24"', a first pusher 26a"' of tubular configuration ~xtendir~ distally from the housin~, and the elongate W 0 97m 527 rCTnUS97~2979 inner .-.e..~or 28"' ~03iYed within the first pusher and coupled with a drive mechani~m 30"' in the housin~, and a c3cond pusher 26b"' ~coivad within the inner .~.k~- and ooupled with a handle 8S"'. Inner ~-~-~r 28"' inrl~les a hollowtubular sto~e portion 32"' of c~lindrical confi~uration extendir~ between a transverse proximal nan~o 200"' dispo~od within housin~ 24"' and a ~uide 36"' ~imilar to ~uide 36~ but with fewer rin~ 52"' to acc~.h~GJate a sin~le suture sprin~
device. An outwardly probudir~ peo, post or pin 202"' extends po",o~)dicularly from a ~--~1 end of stora~e po-lion 32"' adjacent flange 200"'. Housin~ 24"~
int~ ss a pr~xi---al cylindrical portion 204"' whidl is internally U--~deJ, ~rooved or splined at 206"' to n3c~ re pin 202"' of the ;.tora~a "~e,.ll~r, and a distalcylindrical pG.ti~ 208"' of smaller diameter than the ,,r~A,---al poftien which is e~ernally tth~J~I at 210"' and which terminates dlstally at an outwardly protrudin~
transverse flan~e 212"'. Tlans~arse pr~Ai."al flange 200"' of st~ e pG-lion 32"'i8freely rotatably l~i~r~d wffllin a circular or ring-like collar 214" ', and a generally U ~h,~ handle 68"' is co..nect~,~l between the collar and a forward wall 216~ ofhousin~ p~lion 204"' to bias the inner m~7"lt~er PrOA;IIIallY relative to the housin~.
Handle 68"' aAt~nds throu~h a slot 220"' f~"~ in the bottom wall of housin~
pG.tion 204"' parallel to a longitudinal axis of the inner ...e..~ber to con.)acl with collar 214"' and is prereraLly f~r,.,eJ as an inte~ral one-piece unit from an elastic material, such as sprin~ steel, but can be made of other ,..dhrials and/or be made af separate, pivotally ~ted pieces which are biased apart. A pair of finger loops 218a"' and 218b"' of ~enerally circular corhl~uration are pr~erably provided on opposite sides of the handle to ac~..-- odat~ one or more r.. .~..r~ of the user and to permit expansive forces to be applied to the handle if required. A lock 222"' islhreaJedl~ mounted on the top of housing portion 204"' and is manually rotatablethrou~h the housin~ to be ~ posGtl ~xi.,.ally of collar 214"' when the collar is in an ~dend~d po~ition adjacent forward wall 216"'. The lock prevents prOAilllal movement of the inner ...e.-~ber, thereby holdin~ the ~uide at the distal end of the inner r...".lber in an ext~n.J~cl rcsition as will described further below.
W O 97~2527 rcTnusg7~2979 A plurality of suture spring ~wic~, for example suture s~ri- ~s gsvicas 38"', are received on ~tora~ ber 32" ' in a relaxed, u. ~and_J ~tate and are biased didally in the direction of ~uide 36"' by a sprin~ 158"' held in cc"--~ession between a ~e or shoulder 224"' on an inte, ..~liate secli~ ~ of storage ",~.lber 32" ' and an abutment ~ er 156"' slldably disposed behind the suture sprin~ 35.
Sutwe sprin~ devices 38"' are similar to suture spring ~e~;Ce5 38~ in that they do not carry a knob or handle, but differ in that they are shown with only two rin~s.
When biased didally, distal end 41 "' of the distalmost suture sprin~ device will be lon~itudinally or axially aligned with opening 183"' in the guide.
Outer, tubular pusher 26a"' e~derds from a cylin~ical hub 226"' at a pr~Ai.,~l end to a plurality of inwardly biased fin~ers 76a"' at a distal end. ~Ith pusher 26a~"
in the rJt,~ Yition shown, at least one of the fin~ers will extend throu~h the space between sutwe spring ~ioas to conla~,1 storage portion 32"' i").ne~ ely ~nt or behind the pr~,.i,..al end 39"' of the distalmost suture sprin~ device.
Cylindrical hub 226"' terminates pr~Ai".ally in an inwardly protrudin~ transverse flange 228"' which is internally th~l to couple with the extemally ll ,reaJeJ distal housin~ portion 208"'. Hub 226" ' is rotatable about housin~ ~GIlion 208" ' to move pusher 26a"' distally relative to the housing while at the same time rotat;n~ the pusher, and thus the distalmost suture sprin~ device, about a lon~itudinal axis of the housino. When pusher 26a"' is in an Gxl~nded position or cGndition, inwardly probudin~ flan~e 228"' of the hub will abut out~lvardly protrudin~ flan~e 212"' of the housin~ to prevent further distal movement of the pusher. The threaded length ofhousin~ pG. tion 208"' and of hub ~6"' can be varied to obtain a desired position for the distal end of the pusher in the extended r ~ition. For example, the distal end of the pusher can be made to protrude distally beyond the ~uide when ~,.ler ~d if it is desirable to protect the tip of the guide, for example when passio~ the appli~ t.or throu~h an ou~Joscopic sleeve or portal with inte".al c6..ponen~s that can be dur~a~d by the sharp tip of the ~uide. A sprir~ 230"' can be held in o~",pression behNeen flan~es 212"' and 228"' if desired to bias the hub ~Jro,~i-.-dlly relative to the W O 971~2~7 PCTnUSg7~2979 housin~ in order to reduce play in the hub and to p~VG.~t the hub from bein~
inad~e. t~ltly rotated.
The second, inner pusher 26b" ' incl~ ~des a hollow, tubular body 72" ' extendin~
1~n a ~o~ -al nange 74b"' disposed in housin~ ~ti~ 204"' to a flexible rod or fin~er 76b"' mounted on a ~ l ~- al ed~e at the distal end of the tubular body in axial ali~ t with the open pro;~(i--~l end 173"' of ~uide 36"'. P~Ai---al flan~e74b"' is ~i~d within a hollow rin~ or collar 232"' which is c~n--ected to one le~
of an elastic, U-sh~reJ handle 86" ' similar to handle 68" '. Handle 86" ' eAtends upwardly, lookin~ at Fb. ~, from collar 232~ through a slot 234"~ in the upper wall of the housin~ and tums downwardly to conne ~ with housin~ po tion 204"' to biastt e collar, and thus the pusher, pluAill~ally relative to the housin~ toward a retr~ct~i position where a distal end of fin~er 76b"' is 81i~hUy prOAimally sp~eed from PrOA;~al end 173"' of ~uide 36"'. The handle includes a lockinu ~"e,.~ber 236"' which extends longitudinally behleen legs of the handle and ~sss throu~h an opening 238"' in the pr~ in~al leg. The locl;in~ ".~filber is biased upwardly, lookin~ at Fig.
22, and has teeth 240"' on an upper surface ll .er_~ that en~a~a an upper ed~e of the openin~ 238"' to lock the handle in any position and stab of con)pr~ssion orexpansion. A handle extension 242"' extends down~rdly, looking at Fi~. 2 2, fro m collar 232"' through a slot 2 4 4 " ' in the bottom wall of the housing to brminate at a semi4ircular finger loop 2 4 6 "' havin~ a conc~ve portion axially aligned with and facin~ finger loops 218a"' and 218b"' of handle 68"'.
It will be app~e~iated that since st~a~e portion 32"' and pusher 2 6 b " ' d;s p o s ecl therein are hollow, a central ~,annal is def~n~ through the ~pplic~'or, for example to be communicated with a tubular ..-e.,lL,er 160"' having a distal end 1 6 2 " ' di~osad in the hollow, tubular body of pusher 26b"' and a pn~i."al end 1 6 4 " '~;s~sed ext~n.ally of the housing to mount with a coupling 168"', such as a Luerfittin~.
To load a suture sprin~ devioe 38"' into ~uide 36"', the suture sprin~ device is advanoed distally relative to the ~uide and rotated in a clocl~vise Ji,~c~ion, looking WO 971~S~7 rcrluss7l02s7s distally, by ~raspin~ hub 226"' at the ~UAil~al end of outer pusher 26a"' and byrotatin~ the hub in the cloc~ise direction. Hub 226"' moves distally as it is rotated, causin~ pusher 26a"' and fin~ers 76a"' at the distal end of the pusher to rotate and move distally as well. As Ille-~tiGned above, in the retracted position, at least one fin~er 76a"' is ~;~posed adjacent to or behind proAi.l,al end 39"' of the distalmost ~re sprin~ device 38"' so that as ~e hub is rotated, the fin~er adjacent the sutwe sprin~ device will bear a~ainst ~e proAimal end of the device to advance the device distally toward ~uide 36"' while at the same time n,tatin~ the device. As suturespring device 38"' is advanced, distal end 41 "' of the device will l~co...e ali~ned with opening 183"' in the ~uide and will pass throu~h the openin~ into the interior of the ~uide as shown in Fig. 23. Finger 76a"' will continue to push suture sprin~
device 38"' into the ~uide until preAi~lR3l snd 39"' of the device ~ssas throu~hopenin~ 183"', after which the outer pusher will no lon~er en~a~a the device.
Guide 36"' can then be positioned in or in relation to anatomical tissue or, if the suture sprir~ device 38"' is proximally sp~ceJ from the distal end of the guide, the suture spring device can be advanced futher distally within the ~uide to be ~I sposed aJjac~nl the distal end.
To position guide 36"' in or in relation to anat~.."ical tissue, distal tip 54" ' of the ~uide is moved to a po~;tion adjacent the anato-,lical tissue and handle 68"' s~îee~sd or cG~Ilp~essecî to move collar 214"', and thus flange 200"' of the inner ...~albar, distally relative to housing 24"', thereby drivin~ pin 202"' on the inner .,~,~er along ll.reads or ~rooves 206"' f~.l.~1 in the housin~ to rotate and move the inner ..~..~ar distally relative to the tissue. Guide 36"' is mounted at the distal end of inner ,.~..~er 28"' and is thus rnoved with the inner ~--e,-~bsr to be ~ ~ sitioned in or in l~le~ion to the anatomical tissue with the suture spring devics d:sposed therein in an elastically deformed, expanded state as des~ il~d above. If the suture spring device is ~Ai..,ally ~J from the distal end of the guide, inner ",ember 28"' can be locked in place relative to the anat~-lical tissue by deploying lockin~
mo..lbar 222"' in the housing to form a pn"~ al abutment surface behind collar W O 97132S27 PCTnUSg7~g7g 214"' d the handle. hner pusher 26b"' may then be operated to move finger 76b"~
distally into open ~---al end 173"' of the guide and along rings 52 ' of the guide to ~ ~e the ~ end of the suture spring devioe and to push the device furtherdistally within the ~uide. Pusher 26b"' is advanced by sq~ or co-.,pr~ssinghandle ~6 or drawin~ handle 246" toward finger loop 21 8b of handle 68" . In either case, oollar 232 " i8 moved distally relative to the housin~ to move flange 74 ", and thus pwher 26b", distally relative to the inner ,-,em~r and the housin~.
Teeth 240"' have distal faces o, i~.~t~l s~ ~h~'qntially pe",e. Idicular to a longitudinal axis of the n~plio~tor and pro~i--,al faces disposed at an an~le relative to thebn~itudinal axis in order to permit distal movement or co"",ressio.. of handles 86 and 246 " while preventin~ p, wd,, ~I movement lhereo~. Pusher 26b can thus be held in an extended position j"ll-~ ely ~ ~ut the ~ruximal end of suture sprin~
device 38 ' by locl~i.~ ,-~--~ber 236 ".
To apply the suture spring device to the a.,dto"lical tissue guide 36" is retracted while maintaining the suture sprin~ device in a substantially stationary position in or in ralation to the anatomical tissue. Ratr~ctio-, of ~uide 36"' is a~,.plished by releasin~ lockin~ "~,ber 222"' to albw the U~l~d handle 68 to sp~in~ apart lh~ y drawing collar 214"' and inner ".ember 28" proximally while at the same time r~tati,~ the inner ",e..~ber to allow ~uide 36" to be unthreaded from the suture sprin~ device. As Jer~ iL~J previously ret.a~lion of ~uide 36" oPu~s suture sprin~ device 38 ' to no lon~er be oonstrained and allowsthe suture sprin~ device to contuJ~A from the e'~~ y deformed e~a~ l~ed state toward a r~ ed co.lt~acted state to exert a cGIllpr~ssivo foroe on the analo"lical tissue.
From the above it will be appre~ated ttlat the applicator accor~ to the present invGntio., can be used to position a sutwe sprin~ device in or in relatioo to anatomical tissue in an elastically de~d, ~nJ~ state so that the suture sprin~
device may then be allowed to move towd a relaxed cout ~t~l state to col~press approxi".~le occh~de fasten or secure the ~natomical tissue. The appli~-or W O 97~2S27 PCTnUS97~2979 p~eferably incl~ ~s a st~ portion for holdin~ at least one suture spring device in a substantially relaxed, co.~bdcted state, a ~uide dis~loseJ distally of the stora~e portion to r~3~g a suture spring device in an elastically Wormed, a~and~d state for positioning in or in relation to ~at~ ical tissue, and a pusher for enga~in~ the suture sprin~ device to perrnit relative movement between the ~uide and the suture sprin~ device. The ~uide can have a U~sue penetratin~ tip as shown, a blunt tip or the disbl end of the sutur~ device can be used as a tissue penetratin~ tip either alor~ or in combination with the distal end of the ~uide.
The ~uide can be used to, ~ ~'ion any type of suture device in or in relation toanatomical Ussue by cr~ali. ,~ a path in or in relation to the tissue which the suture ctevice will c~ ~y when the ~uide is removed. Hence, in aJ~I~fiu- ~ to apptyin~ suture devices havin~ an elastic body of coiled confi~uration, where by ~elastic~ is meant havin~ an ability to recover an ori~inal shape or ~ ~ition after havin~ been d~, ~-~d and by ~coiled~ is meant definin~ a sin~le ooil or rin~, a po. lion of a coil or rin~ or a series of connecled 00il8 or rings, the - ppli~e'or can be used to apply rigid suture clevices havin~ substantially the same shape and size as the guide, len~U.s of hl~-~t~y suture material as well as suture dG~ices ~-~J of shape mel~lG~ alloys,such as nitinol, soft materials which can be l.u~ ~Je. ~~ by application of energy once applied, or ductile materials, where by ~ductile~ is meant having a le~ n3enc~r, once bent, to remain in the bent condition. The guide can also be used like a probe to p~bate and dissect anatomical Uswe and to wpply energy to tissue or devices as re~uired; and, w,hen the guide is used as a probe, instruments such as the graspin~
instrument shown in Fig. 21 can be used to brin~ the tissue or device to the probe.
The ~uide can be made of any suitable medically ~cco~t~le material, such as stainless steeJ, so bn~ as it is configured to have a stifh .~ss suitable for maintaining a suture sprin~ device in an e~KleJ state for positionin~ in or in f~latioo to anatomical tissue. The ~uide preferably inc~s a tubular body of coiled configuration as shown but can also be of straight or angular configuration as desired. Ulhen the ~uide of the applicator is of coiled configuration, the coils can be WO g7132527 PCr/US97/02g79 circular, elliptical, poly~nal or have any othor curved or angular confi~uration and, when a ~uide has more than one coil, adjacent coils can be of bhe same size and shape or Ji~renl ske and shape dependin~ on the type of ~r~lure to be ~f~..~. The tubular body of bhe guide can have any confi~uration in ba..s~erse cross-section indudin~, but not limited to, circular, elliptical, pol~onal and open confi~urations. A150, ~e shape of bhe lumen in trL.~./~se cross wction can be dillerent than the *lape of ~e outer surface of the ~uide in b~s~erse cross Se~tiQn so that, for example, the outer surface may be circular and the inner surface poly~onal or vice versa. Dependin~ upon the ~-~. ~ner in which the ~uture device is moved relative to the ~uide, the ~uide can be fo, ~--ed with or without a slot. When k..nei with a slot, the slot will preferably extend from a pro;~i...al end of the guide to a distal end of the guide and will communicate between an exterior surface of the guide and an interior lumen. The slot can have ta~r~J or V-s~a"eJ sides to a~----~Jab a ball-shaped knob as shown, or the size of the slot can be strai~ht.Furth~-.~, alU~h the slot is shaNn on the outer, convex side of the ~uide, it can be formed on the inner, concave side or anywhere inbetween or the slot can be made to spiral around the coiled body of the ~uide. The guide can be co, ¢ ic with a longitudinal axis of the inner ,~-e--lber or offset ll~r~hom.
If an elastic suture sprin~ device is to be applied, an a~a. ~ ier can be positiGn6J
between the sl~age portion and the guide to elastically e~a--J the suture sprin~device in an axial and/or radial direction as it is adva,~ distally toward the ~uide.
The a~a, .J~r can be a solid surface with a ~roove or a tubular e)~1e, ~sion of the ~uide with or without a slot.
Although the pusher i8 shown and cle~;~d herein as includin~ one or more fin~;e. a mounted on a tubular body, it will be appr~iabd that the pusher can have any configurstion to on~a~e a suture device including, but not limited to, tubular oonfigur~ions with fingers biased radially inward at a distal end of the tubular body, tubular oor~igurations with rod like hn~ers confi~ured to slide within a hollow, tubular ~uide and configurations where ~e body of the pusher is not of tubular configuration.
.
W O 97~2~27 r~-lrJ~n2g7g The pusher can be disposed alon~ an exterior or interior of the inner ~ ber or a~liGII of the pusher can be d,s~sed alon~ the exterior and anoU.ar p~.li~.
di~J alon~ the ir~br of the ir~r ..~.~ . While the pusher is shown as bein~
biased, it will be appreciated that any type of force can be used to move the ~uture sprino device relative to the ~uide includir~, but not limited to, mechanical forces provided by sp, in~s, .--a~. ~GtiC forces and/or hydraulic or pneumatic forces.
The pusher can also be made to rotate to~- -.her with or i- ,clepend-J. nly of the suture sp~in~ device ~~ desired.
The inner ,-~.-1~ and drive ~ft preferably coop4-~te to define a central ~;1 ~u~el ttuou~h the applicator throu9h which instruments, such as penetrators and ~raspers can be passed durin~ an op~ative proc~Jure. Sove~al instruments or implements which can be ~i t~ou~h such a central d ~nnal are di~ losecl in my co~ndin~ application Serial No. 081376,186, e/ltiUeJ~Multifi nctiGnal InstrumentW~h Int~le Operating Units For re.f~"lin~ Cndos~pic P,~ures,~ the ~lisclosJre of which is incG,~ora~ed herein by r~r~nce. The central c;l.annel can also be used for irri~ation and aspiration as well as for administerin~ medicame,nts and fluids to the operd~ e site.
~ he handle and drive ..~l~nism sh~rwn and des_,il~J herein are exe.,.plc,.y of the types of handles and driw ..~;I.anisms suitable for p6,fc..~lin~ ~he function of ",ovin~ the inner ",~"lber and w the suture sprin~ device relative to one another, accordin~ly, the handle and drive "~i.sm can have any configuration to produce robtional andJor linear movement of the inner .,~,.~er and/or the suture spring device, including, but not limibd to, confi~urations employin~ a pair of pivoted le~s with fin~er loops, one fixed and one pivoteJ le~ with fin~er loops, or resilient U-~ .,~I~L~r:s con,~_teJ between outer and inner ..,e",lber~ of the arplic~'~r or between the inner ~e~ er and the pusher. Moreover, the handle can have any cri~nlalion ~GIat;~e to the lon~itudinal axis of the applicator includin~, for example, o ~ ntially b ~"s~erse o, ienlations where the handle e~tend~ transYersely from a L~tIGIII of the housin~ or sul,s'~-ltially lon~itudinal Grient~tions where the handle W O 971~L5~7 P~ v~1~2979 extends bn~itudinally 1~orn a rear wall d the housin~ and is operated like a sc"ssor~, or r~tatable conf~ where the handbs can be rnoved between tr_. .s~0rse and lon~itudinal orientations as desired. While a rack and pinion has been shown formovin~ the inner ,-~-~er linearly alon~ a lon~itudinal axis of the applicator, it will be appreciated that any type of for~e can be used to move the inner ~~ er includin~, but not lirnited to, ..-eol ~anical forces pn,~ickd by rods, pulleys or sp i. ~~s, ~l~a~ ie~tic forces and/or hydraulic or pneurnatic for~s.
The ~n~ As d the applic~tor can be made of any &uibble rnedical ~rade rnaterials to permit derilization for r~use orfor sin~le patient use. The Co...po~Kat~
can be made of multiple parts of various configu.~tions and materials to reduce cost.
The housir~ can have various valves and/or seals to control fluid flow and the pas~,~o of instruments therethrough, such as the stop~k valve shown at the ~rOAillldl end of the applicator, and conventional locl~ I.~d-ani .-.s can be used to hold the tri~er within the handle in the fully de~ EJ position or at any other position relative to the handle. In addition, the outer tubular ,.~ber can be provided with scale l.~hi.~ on an exterior sufaoe to assist the user in determinin~ dislances within the body.
It will also be appreciated that . ~tali~, of the ~uide can be combined with linear on by use of suitable ç,~ea, in~, and that the guide or any other oc."ponent of the F~ppli~or can be configured to rotate in a clockwise or coLnleroloc~ isa direction when bein~ a~v~c~l distally along the longitudinal axis of the ap~,licator dependin~ upon the configuration of the ~uide or c~npol~enl. Also, the applicator housin~ can be adapted to allow re---o~al of the inner .--e-.ll.ar frorn a pr~Ai,..al end of the housin~ to permit reloading of the inner ",ehl~er without removin~ the applicator from the o~rati~re site. The applicator can also be mGdifi~d to simply rotate the ~uide without linear lran~l~tion or, conversely, to linearly translate the ~uide without lot~tiG-., both modific~tiuns requirin~ manual opor~tiG"s to be .~J in order to p~ition the suture device in or in relation to anatu"lical tissue.
Once ~e suture device is positioned in or with res~l to the tissue, the retum of the suture device taward the rest position, can be ~r~hanccd, Jependent upon the material from which thc suture device is constructed, by bmperature ~ ~a. ~~,,e and/or by the appl caUon of electricity, Ibht or o~er ener~y to alter the c;har~,~ri-~ti.,s of the material.
The features of the various embodiments described above can be combined in any "u~mer desired ~ ~t upon the G~ ati~ ~al requin...~ents of the ~ cJure to be ~rf~,n.-ed and the complexi~ of the particular desi~n.
Inasmuch as the pr~~ant invention is ~ject to many variations, mod~fications and ehan~es in detail, it is intended that all subject matter di6c:ussed above or shown in the aca~mpaorin~ drawin~s be inter~,reted as illustrative only and not be taken in a limitin~ sense.
Field of the Invention:
The ~reaont invention relates to surgical devices and proc6.1ures and, more particularly, to a suture spring device s~rpli~or, that is, an apparatus for applying at least one suture sprin~ device, for example a suture spring device of the type ~;r~:lQssd in my co pending U.S. Patent A~plication Serial No. 08/610,951, e"litled ~Suture Spring Device,~ the discl~s~ ~e of which is inco(purdled herein by refe~nce.
Disu~ssion of the Prior Art:
Suturir~ of bodily tissue is a Ume cor~uming part of most sur~ical procedures including both open surgery and ellJoscopic or minimally invasive surgery. By W O 97~2S27 PCTrUS97~2g79 "open" surgery is meant sur~ery wherein the sur~eon gains ~ss to the surgical site via a relatively large inc;sion and by ~ndosoopic surgery is meant sur~ery wherein the sur~eon gains access to the surgical site via one or more portals through which e(-d-~s are introd~qcl to view the sur~ical site and through which variousins~s are intro~luc~cl to the surgical site. There are many co")mo., endoscopic surgical procedlJres including al 11 .r~,tcopy, laparoscopy (pclvi500py), ~astr~, Itn~5COp~ and lar~"~obrt,r,choscGp~, for e~,ople.
In the past suturing was ac~ plished with the use of a sharp suture needle attached to the end of a length of suture material. Depending on the size of the~re needle and the type of sur~ery bein~ pe. rOlllle~l~ the suture needle was either ~,~sped manually or with a needle holding instrument and moved to cause a sharp tip of the needle to pe"el~ale and pass through andtOllliCal tissue. When the sharp tip of the needle e",ergeJ from the tissue the body of the needle was rela~ ed so that the distal end of the body adjacent the tip could be ~ras~d to pull the needle and the suture l-.al~lial dtlach6d to the needle throu~h the tissue. Once the suture material was pulled throu~h the tissue, the sur~eon tied a knot in the suture ",ale, ial and ad~usted the lensi~ l on the suture material to aco~ Gddte the particular tissue bein~ sutured and to oontrol app,o~",~tion, oa~ icn, dt~l;lnllellt or other conditions of the tissue. However, the ~n~cess of tissue ~, .etration and l~notlin~ of the suture material can be time consuming and tedious work, particularly when pel F~ll l-le~l in co ~n~tiGI ~ with microsur~ery and en~os~ic surgery, and can unduly prolong the duration d sur~ery and U ,e~ror~ the period in which the patient is under an~.U ,esia.
Nevertheless, e~ esc~ic sur~ery is pr~fe.~ ed over open sur~ery due to the ~reatly red~ wl trauma and wound healing time for the patient and due to concGn,ita, It cost ~v;"~s associated with shorter hospital stays and p~ F~ ming surgery in non~os~i~PI
or out-patient sùrgery sites.
Accordin~ly, there has been much effort spent to dev~lop techniques for facilitatin~ the suturin~ normally pe-~"-,ed by use of a suture needle and a length of suture ",d~rial. One technique, eAe",~lified by U.S. Patent Nos. 3,545,4~4 to W O 97132S27 ~n~97~2~79 Green and 4,595,007 to Mericle, employs elon~.Jt~J wire sutures f~l,.,ed of ductile materials that are bent into coiled shapes by a curved tip of a suturin~ instrument.
The wire sutures can be bent around tubular structures or throu~h anatomical tissue and will tend to remain in the bent condition to hold the tissue to~U .er, however, once bent, the wire sutures will not co""~ress the tubular strudures or tissue so that ~ it is n~a~y to ~o,u.-~te the tubular structures or tissue prior to or concurrently with bendin~ of the sutures.
The use of staplin~ insln~ts has also been prs~>osed, as exe"lpli~,ed by U.S.
Patent Nos. 4,979,954 to Gwatll.l-ey et al, 5,465,894 to Clark et al, 5,465,895 to Knodel et al, 5,465,896 to Atlen et al, 5,467,991 to Tsuruta et al, 5,480,089 to Blewen and 5,486,187 to S~lc; however, stapli,-g instruments typically include sepal-~te staple driving and staple forming or anvil pol lions for positioning on orposite sides of the tissue to be sbpled. This requires access to both sides of the tissue andin~ses the size of the instruments and the portals throu~h which the instrumentsare pACsacl in en~hs~pic procedures. Some slaplin5a instruments do not have a separate anvil portion and are thus capable of a~",ly;ng staples from one side of the tissue; however, the staples must still be fo.ll.~l of a ductile n,atelial and bentto a finsl shape by such instruments requiring relatively complex ~-.eoha--;sl,-s which i ~ the cost of such instruments. Ano~r disadvanta~c of st~pl ng instruments is that the staples have sharp, tissue p~ ~ti, ~ tips which remain in the tissue after the staples have been bent into their final shape.
Other techniques that have been proposed include elecl,ical e4a~ ion, .~l~nical dovicas such as dips and clamps, and Issers; ~)o~avor, no a.temative l~, .ique has yet been well AC ~pted by sur~eons to produce the results obtainedby suturin~ and tyin~. Thus, there is a ~reat need for suturing techniques us~ful in G.- '_.~piC sur~ery that permit s~.,geons to suture anatomical tissue in a time efficient, consistent and pr~is~ .naaner.
W O 97~2S27 PCTnUS97~2979 SUMMARY OF THE INvFl~lTloN
Aecordingly, it is a primary ob~ct of the ~ Yl invention to over~",e the above-~,~nlion~l disadvanta,aes of the prior art and to provide an ap,var~t.Js and " ,eU ,oJ
for applyin~ a suture sprin~ device in or in relation to anatomieal tissue.
Another ob~ct of the pr~nl invention is to use an applicator to position a suture sprin~ device in or in relation to around ~lo--lieal tissue in an ~Iq6tically d~fo",~
expanded state and to allow the suture sprin~ device to move toward a relaxed eo,~t~a~t~ state to cG-n~,,ess a~p,oAi",ate o~e fasten or control other eonditions of the ~ t~-~ical tissue.
A further object of the pr~s~. It invention is to apply a plurality of suture spring devices to analo,-lical tissue using a suture sprin~ deviee applicator without havin~
to remove the applicator from the body for reloadin~.
Some of the adva-ha~s of the pres~nt inve.ltion over the prior art are that ~oc~J-Jres such as suturin~ dtil~ and fastenin~ of a..dtu.-licsl tissue can be p~ F.n.l~cl in less time with fewer instruments and with ~reater consiste. .c~ that the suture sprin~ device applicator permits suture sprin~ devices to be applied from one side of the a.~tcl.lical tissue without the need of having to ~sition or r~sitioo instrurnents on an opposite side of the tissue that the suture sprin~ device appliGnter can apply suture spring devices made of bicabsG-bable and non-bioabso.L.dl)le materials that the suture sprin~ device applicator can be ~-lartecl for use in a~.Jos~pic and non cn-Joscopic pr~ceclures snd that a plurality of suture springdevices can be carried by the suture sprin~ device ~r plic~'or to permit suture spring devices to be appJied at multiple bcatiùns within ~e body without the need of having to withdraw the ~ppliG~'er from the body for reloading.
The pr~3e. ~t invention is ~3G. ,c~ally cl)ar~cteri~ed in an applicator for applying a suture sprin~ device in reldtion to anatûmical tissue including a slur~ye portion confi~ured to hold at least one suture spring dsvice in a s~l,s~3.nt;ally rela~e~l cG-It~auleJ state a guide ~i5pose-J distally of the sloraye portion and including a hollow tubular body configured to ,e,cei~fe therein a suture spring device in an W O g7132~27 PCTnUS97~2979 elqstic~'ly d~f~ ded state for positionin~ in or in relation to ~nstomical tissue, and a pusher movable in relation to the guide to control the ,~s-tion of a suture spring device relative to the guide. An e~ndar is preferably ~14posed between the st~ra~e portion and the guide to el-~tically e~and the suture sprin~device as it is moved distally from the ~t~ a po lion to the ~uide. The e~ander can be fomled separately or inte~rally with the ~uide and can be a tubular e~te. ~sion of the ~uide or a solid surface with a ~roove extendin~ from the stora~e portion to communicate with an openin~ in the guide. For example, the e~.~ander could define a conical sur~ace of i- ~~eas;n~ diameter in a distal dire~lion with the groove defining a h~lical path around the conical surFac~ between the ~toraye po, t;GI I and the guide so that a suture spring device advanced alon~ the groove will be axially andlor radially ex~dnded. The pusher is p~efer~l,ly movable in relalion to the guide to~ ~e a suture spring device and can be made to lock in a retracted position behind the suture spring device so that as the guide is moved ~JIw(illldlly relative to the suture spring device, the device will be advanced distally or loaded into the guide.
The pusher is prdfe~ly biased to move distally so that, when the pusher is unlocked, it will continue to en~a~e the suture sprin~ device as the guide is moved distally to be posilioned in or in r~lalion to anato.YIical tissue. The pusher holds the suture spring device sul~tantially slatia~-~ as the guide is moved ~ uAilllally relative to the tissue or removed, thereby albwing the suture spring device to move from the ela~:i~'ly ~l~f~.ne-J, e~nd~ state toward the relaxed, c~-ltract~J state in or in relation to the tissue in order to apply a prddete. ,.lined c~...pressi~e force U .ereto. In one embodiment, the pusher int~lucles a tubular body with inwardly biased fingers at a distal end for engagin~ the suture spring device. In an~lther ei-lbodi...e,lt, the pusher includes a flexible rod or finger slidingly movable throu~h the hollow, tubular body of the guide.
Yet ,.--oU.er aspect of the pre~enl invention is ~onerally cl~aracteri~ed in an applicator fw apply;n~ a suture device in or in relation to al ldtGmical tissue including a slora~a pG- tiun configured to hold at least one suture device, a guide clisposed s W O 97n2s27 PCTnUS97J0297g distally of the slora~a portion and ineludin~ a hollow, tubular body of coiled eonfi~uration with a ~rl~Ai~lal openin~ to reo~ivc a suture device ll-e,rain, and a pushe~r movable in relation to the guide to eontrol the po~ition of the suture device in relation to the ~uide. The pusher ean be made to loek in a ret~;ta~l positionbehind 8 suture deviee so that, if the guide is retraeted, the suture deviee will be advaneed distally or loaded into the ~uide. The pusher is pr~,feratJly biased to move distally so that, when it is unlocl(ed, the pusher will eontinue to e, ~ G the suture deviee as the ~uide is moved .'is'-'ly to be po~itio.~-J in or in relalion to anatonlieal tissue. The pusher will hold the suture deviee s~ s'~-utially sl~liona, y so that, when the ~uide is removed, the suture deviee will remain in or in ~elalion to the anato,.lieal tissue and be allc~wed to move from the ~anded state toward the ~ontra~ed state.A furU~er aspeet of the presenl invention is ~e,.erally chara~e.i~ad in an applieator for a~,ply;n~ a suture sprin~ deviee in or in relation to anaton~ieal tissue ineludin~ a housing, an outer tubular ,~e"lber havin~ a proAi,l,al end mounted by the housin~ and terminatin~ distally at a distal end, an inner ~el~ber movably d;s~osecl in the outer tubular l..e..~r and ineludin~ a slora~e ~.lion eonfi~ured to hold at least one suture sprin~ device in a svhst~ntially r~ ecl cont-~d state and a ~uide ~; ,pos6J distally of the 8tw~e portion to recciv~ a suture sprin~ device in an el~ically delomNd, e~J state, a pusher movably ~ os~J in the outer tubular ",e7,ober to en~aye a suture spring device so that the poEitio" of the suture spring device relative to the inner ",e,.~ber can be cont~lled, and a drive .,.ecl)a..i;,.~
coupled with the inner .-~-~6er to move the inner ~-~l~r relative to the outer tubular me..lber when ope~te~J. The applicator can also include a locb,n~ ")ecl~anism selectively o. .ya~eable with the pusher to lock the pusher in a r~t~a~led positiv. .
where a distal end ~f the pusher e"ga~es a suture spring device in the ~lorage portion of the applicator so that, when the inner ",e"~ber is moved pru)~i" ,ally relative to the pusher, the suture spring device will be advanced distally into the guide. The inner ~~ ber can be rotale-l as it is retl~oted, for e,.a,npl~s using splines fo, ."ed on a drive shafl of the drive ",~hanlsr". If provided with splines, the drive shaft is wo g7132S27 rcrluss7/02s7s rotated as it is advanced to facilitate positioning of the guide and suture spring device .~ ,osed therein in or in reldti~n to anatomical tissue. The pusher is unlocked or rel3f ss~ when the inner ~"6"~er is moved distally and is prefera~lybiased distally to hold the suture sprin~ device s~ nlially station.l, ~ in relation to the anatomical Ussue as the ~uide is retracted or moved ,c.,o,o."all~ so that the suture sprin~ device will move from the elastically Wormed, e~unded state toward the relaxed, contracted state to apply a pleJetell~li,led c~""~ss.ve force to the tissue.
Still another aspect of the pr~-ent invention is ~e"erYIlly ~I,ara~l6ri~ed in a method of applyin~ a suture sprin~ device in relation to anat~"lical tissue including the stsps of storin~ the suture spring device in a s~ s~ tially rela~ad, conlracte~l state, elaslioally deforrning the suture spring device from the re'~Yed, cont~a.~ted stats to an e'~ ic-~"y Wormed, e~nded stats, loadin~ the suture sprin~ device into a guide in the elastically Wom~ed, ~and~J state, positionin~ ths suture spring device ,elati~ to anatornical tissue in the elastically deformsd, eA~anJeJ state using the guide, and re",o~/;.~ the guide to allow the suture spring devioe to move resiliently from the elastically d~fol~l~ed, a~anJed state toward the r~'~Y.~l, c~ntra~,1eJ state to apply a pr~dete.",ineJ co""~ressive force to the tissue. The loading step can, for example, include holding the suture spring device in a s~ s~ ~-nially s~aliGna~ ~silion and moving the guide relative to the suture spring devics, in which case the guids can be rotated andlor moved proximally relative to the suture sprin~ device. Simibrly, the guide can be removed from the suture spring device by holding the suture spring device s~ lPntially slationd"r and moving the guids relativs to the suhne sprin~ dsvice, for example by roldti,.~ and/or moving the guide p~u~"~aJly relative to ths suture spring device. In both cases, the suture spring device can be held in a s~ s~anlially slalivnafy posilio,- by positioning a pusher behind the suturs spring devics and either IGckin~ the pusher in place or biasi, ~a the pusher ~ tr'ly relstive to the guide.
Other objects and adv~n~3s of the p~3enl invention will become app~renl from the following des~iptiûn of the pref2~red er.l~di."ents taken in conjunction with the WO 97132S27 PCTlUS97tO2Y79 ac~""~n~ drawin~s, wherein like parts in each of the sever~l flgures are identified by the same reference numerals.
BRIEF ~ESCRIPTION OF TI~F DRAWINGS
Fi~. 1 is a broken side view, partly in se~tiG~I, of a suture spring device awlicator acoordin~ to ths present inv~. Ition.
Fi~. 2 is an exploded side view, partly in sectior., of an inner m6~ r for the suture spring device applicator according to the ~,r~seot in~ntiGn.
Fi~. 3 is a front view, in elevation, of the inner ~--e.-lber of Fig. 2.
Fi~. 4 is a side view, in broken lon~itudinal elevation, of a pusher for the suture sprin~ device applicator according to the present invention.
Fi~. 5 is a front view, in elevation, of the pusher shown in Fi~. 4 Fi~. 6 is an enlar~ed pc.specti~e view of a pusher locl~in~ ,..eehan;sn~ for thesuture sprin~ device applicator accordin~ to the p(G5ent invention.
Fi~s. 7 and 8 are side views, in broken lon~itudinal elevation, illustl ati, .~ Ioadin~
of a suture sprin~ device into the ~uide of an applicator according to the pr~se. ,~
invention.
Fi~. 9 is an enlar~eJ tf~")enta- ~ side view, partly in section, of a suture spring device disl~oseJ within a guide.
Fi~. 10 is a ~Jy~ lta~y side view, partly in s~Aion, illuatratill~ uper~tion of the l~;ing l.~cllal,is", of Fig. 6.
Fi~s. 11 - 13 are side views, in broken longitudinal elevation, illuslratin~ use of the applicator to position a suture spring dsvice in relation to analo"lical tissue.
Fig. 14 is an eYrlc~le~ per~peu e view illuslratil.y a modification of the inner.~..~Ler and pusher accordin~ to the present invention.
Fi~. 15 is a flay -~ n~" side view, in elevation, illusl(aliny a further m~,~lealiûn of the inner ,.,e,.l~er according to the present invention.
Fi~. 16 is a ~..~nt~y side view, partly in s~tion, of the .nodified inner "~.lber of Fig. 15 showing a modified pusher for use therewith.
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WO 97132S27 PCTIUS97/029'J9 Fi~. 17 is a fr~.n~y p~AiYe view of the pro,.i".al end of the ~uide shown in Figs. 15 and 16.
Fi~. 18 is a broken side view, in elevation, of a tissue p~netr~tin~ instrument for use with the spplicator according to the p(esenl inve.-lion.
Figs. 19 and 20 are enlarged ha~...enta,y po~s~_ti-/e views of l--~ified tissue penet,dtin~ tips for the instrument shown in Fi~. 18.
Fi~. 21 is a ha~ ~y side view in elevation of a tissue grasping instrument for use with the a~ ator accordin~ to the ~,rese, It invention.
Fi~. 22 is a broken side vicw, partly in se~ion, illus~atin~ a modified ap pli~tor according to the pr~sent invention.
Fig. 23 is an enlar~ed, hd~...enta"~ side view, partly in section, of the distal end of the applicator shc~wn in Fi~. 22.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
The applicator of the ~t,so~t invention is desc~ ibed h~reiadner as an apparal.ls for apply;. na suture sprin~ devices of coiled configuration such as those desc iL,ed in my afore"~e~nio~d co pendin~ U.S. Patent ~p~ ion Serial No. 08/610,951, e.~tiUed ~Suture Sprin~ Device~; it will be appreci~'eJ, however, that the ~ppli~tor can be used to 8pply a wide variety of suture devices, including sutur~ devices of coiled and non-coiled configuration which are e'~sticrlly or pl~~ti~11y J~on.,able or which rigidly maintain a predale..,lined shape when applied.
A suture sprin~ device awlicator 20 a rording to the p.~s~n~ invention, as shownin F4 1, includes an outer tubular ~~-enlber 22 extending distally from a housing 24, a middle tubular "Rj.nber ~ pusher 26 .~i~ed wi~in ~ outer tubular n.ember, and an elon~a~e inner n.~ ber 28 r~c~3ived within the middle tubular menlber and coupled with a drive m6.~;1 Rnism 30 in the housing.
As best seen in Fi~. 2, inner ,~ er 28 includes an elongate st~rage pGI lion 32,a fr~stocG.i-cal e~anJer 34 at the distal end of the slo~ge portion and a hollow, W O 97~2~27 PCTnUS97/02979 tubular guide 36 of coiled cor~l~uration extendin~ distally from the expander. Storage liGn 32 is shown as an elon~ate, hollow cylinder with an extemally lh~ade~
"al end 37 snd an outer diameter of pred~temlined di-l~nsion so that a pluralityof centrally apertured suture devices, for example suture sprin~ devices 38, may be iv0d U ~6r~) in an une~, relsxed or con~ aeteJ state in end-to-end series fashion as shown. For pul~osas of illu~tr~ation, each of the suture devices is shown as a centrally apertured suture sprin~ device of coiled confi~uration includin~ an elastic, wire-like body defining a series of connect6cl coils or rin~s 40 of ~enerally circular confi~uration, the rings bsing of like diall~ter and extendin~ een ,u-oxi,.~al and distal ends of the elastic body concent- ic with a longitudinal axis of the device. A knob or handle 42 in the form of a ball is ean ied on an outer peri~l .eral, convex ed~e or surface of the body of the suture sprin~ device near the proxi",al end and exl~s radially or laterally outward relative to the longitudinal axis of the device.
The body of the suture spring device is formed of an elastic or resilient material, that is, a ~-~al6rial able to recover its G-i~inal shape or position after having been defo,..-e~. Any medically S~cceptA~ le b.aa~-L,dble or non~io~hsG,bable elastic material can be used for the body of the device including, but not limited to, titanium, nicl~l ti'rnium alloys, stainless steel and plqstics such as nylon. Further details of suturc spring device 38 are set forth in my above-r~fer~nced c~pending U.S. Patent Application Serial No. 08/610,951 and several embodiments of suit~hle suture spring devices are dis~losed therein.
FnJstoconical expander 34 dQr" ,es an annular step or shoulder 44 at the distal end of st~rase po, lion 32 and a sl ~l,slPnlially conical surface 46 ex~eudi, ~y from the shoulder to ~uide 36. A groove 48 in the conical surface def,nes a helical path around the e~"Jer extending from shoulder 44 at the distal end of the alorage portion to ~uide 36. As best seen in Figs. 2 and 3, the hollow, cylind~ical ~lora~e portion and frustoconical ~r coo~ate to define a central pessa.~e or ~ ,an.)el 50 along a iongitudinal axis of the inner "~"lber to permit l~s~e of surgical instruments, andto"lical tissue and various types of fluids ll-eretl"uugh.
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W O 97/32527 PCTnUSg7~29n Guide 36 inçll~es a tubular body 50 of coiled configuration defining a series ofc~ ,. ~ted rin6~s or coils 52 of ~nerally circular configuration brminatin~ at a sharp, tissue pen~ til ~~ tip 54 at the distal end of the ~uide. Rings 52 of the ~uide have a predetermined radius of curvature and a predetermined axial ~. ~ r~between which are ~reater than the diameter and axial spa~n~ behNeen rings 40 of the suture spring device in the un~nd~l, ~ ad state. Rings 52 of the guide are also hollow to define a lumen therethrough in communication with groove 48 in the e~ar,cJer. A slot 56 ~ J alon~ an outer ~oriph~r~l, convex ed~e of the guide body communicates between an outer surface of the guide and the lumen and is of sufficient ske to n~ive and hold the body of a suture spring device while preferably being V-sl ~ped in transverse cross section and some~at narrower in width than the diameter of the suture sprin~ device body to allow knob 42 of the suture spring device to slide along the slot while preventin~ the body of the device from slipping U ~r~hluugh. The guide can be made of any suitable medically ~c~pt~ble Illalel ial, such as stainless steel, so long as it is cor~lgured to have a sliffuess suitable for maintaining the suture sprin~ device in an elastically ~fo,l-,ed, eA~,andecl stab.
The helical path de~ned by groove 48 sround the eA~ ar,cler commlJ"i~ates with the open p.u,~i..~l end of ~uide 36 to f~oilit~te loading of a suture spring device into the guide. Rec~lse the e~a,.Jer is frl,s~?nically shap~d, the dia-"ater of the helical path ir,cre~es in the dire~io" of the guide so that a suture spring device advanced along the ~roove will be receivcd by the guide in an elaslically defo,l"ed, radially e~nded state. Alten~t;,~ely, or in addition to i"~asing the dia,neter of the helical path about the e~ ander, the axial spaci"~, of the helical path may be gradually increaseJ in the distal direction so that the suture spring device will be axially expa"J.,d as it is advanced along tne ~roove into the guide.
Referrin~ a~ain to Fi~. 1, housing 24 includes lon~itudinally s~l front and rearwaîls 58 and 60 of rounded configuration, a top wall 62 in configuration parallel to a longi'tudinal axis of the outer tubular n~er, and a bottom wall 64 having a concave W O 97~2S27 PCTnUS97~297g portion 66 curvin~ d~ from the front wall to con,~e~l with a handle 68 or ented 0~ slnntially per~,er dicular to the lor~itudinal axis of the outer tubular " ~" l~er.
Out~r tubular ~-,e-,l~er 22 is open at both ends and extends from an openi ,~ inthe housin~ front wall 58 to terminate distally at a blunt distal end 70. It will be app-~ated, however, that distal end 70 of outer tubular ...e.,~ar 22 can be t~pered or chamfered as desired or have any other suitable distal cor~ uration dep4. ~a, ll upon the ~Jwe to be ~ f~rn.e~. Preferably, the outer tubular ",e.,lber is made of a s~l,sl~-ltially cylinJ~ical len~th of a sl~ ntially ri~id r"aterial such as a medically ~c~pt~ble plastic or metal ~-,aterial. The outer tubular me,.lber and housin~ can be of inte~ral on~-picce construction ~s shown or can be fon"ed s~bly and joined lo~eU,ar by any suitable l.-eU.od includin~ but not limited to U ,. ~Jed en~a~--~nl, ~JI ~sive bonding or friction fit.
Pusher 26 includes a tubular body 72 telescopically ntted within the outer tubular ..,o~nber 22. The tubular body of the pusher terminates PI~A;IIIaIIY at a transverse flan~e 74 ~i ~os~ within housing 24 b~t~ oen front and rear walls 58 and 60 of the housin~; and, as best seen in Figs. 4 and 5, a distal end of tubular body 72 is split lon~itudinally to form a plurality of fin~ers or flaps 76 which are ..o-.,-ally biased radially inward as shown to enSta~e the ~A.,--al end of a suture sprin~ device as will be des~ iL~J in ~reater detail below. Fingers 76 are generally b~apeLoidal in shape with taper~ sides 78 and a flat distal end 80. When biased lo~etl ~er as shown in Fig. 4, distal ends of the fingers coope d~e to defne a generdll)/ circular abutment surface of ~,redete.,.-ined clia-neter havin~ a dil--ensio.. to abut knob 42 of a suture spring device while ,ec~ coils 40 of an adjacent"~o,u,.~lly SpA~ suture spring device therein. A post 82 ~ l6nJs upwardly from flange 74 of the pusher through a slot 84 f~n.led in the top wall of housin~ 24 parallel to the longitudinal axis of the instrument and brminates at a knob or handle 86 ~ os~ e,~te" ,ally of the housing.
Pusher 26 can be fon,-ed of any medically Ac~4~t~ 1e metal or plastic material having sufficient elastic ~-,e.--o~y to bias the fi")~ars into the normally closed configuration as shown. A bias ,~"lber 88 is held in co""~ressio-- beh~een nange W 097~2S27 PCTnUS97~2979 74 of tho pusher and an inner wall 90 of the housin~ to bias the pusher distallyt~d an ~1 pOSitiOI~ where post 82 of the pusher abuts the disbl end of slot 84 in the housin~ and didal end 80 of the pusher is disposed adjacent the distal end o~ outor tubular ,~ml~r ~. Bias ...~")l~er 88 is shown as a helical coil sprin~ but can include various other types of sp.i"~s as well as other types of bias J~vices ~ includin~ co,~"~s~ien spr;"~s bnsion spri"~s, torsion sprin~s pan s~ri-~s leaf sp. in~s rubber, plastic or ",~. ~ls for example.
Drive ..~n:~-, 30 includes a drive shaft 92 oa~led with a tri~er 94 via a rack 96 snd pinon 98. Drive shaft 92 includes a distsl p~ lion 100 with spli. ,es 102 and a ~ i"~l portion 104 carryin~ the rack. Distal pol liGn 100 is inte" .ally th, e~cJ6.J at 106 to couple with the ~.nal end 37 of inner ~ Ler 28 and is of ~- oater di.-,-~ter than slor~ge pGI liGn 32 to define an snnular step or shoulder 108 at the pr~xi.nal end of the slu~e portion. A rotator 110 with an inten ~ally U-reacle.l pAS,S.i3j)e 1 t2 U ~ ~U u~u~h is mounted at the distal end of a tubular support ..,e,-lber 1 t 4 ~;5pos~1 within pusher 26 and secured to inner wall 90 to U .,~I~ ,ec~i~e the splined, distal pGlliGIl of driv~ shaft 92. ~r~Ai"~al portion 104 of the drive shaft is of smaller diameter than distal portion 1 00 so that a radial step or shoulder 116 is f~ ."~J at the int~iu n U .e~, and the rack 96 is disposed L.e~osn the shoulder and a flange 118 ~n~Ai~dlly sp5"~i.1 from thc shouldcr and Gl iented transverse or pe~endicular to a lon~itudinal aAis of the drive shaft.
Rack 96 is ~ene, ~ lly U-sl ape~l in transverse cross-secliG, ~ with axially spac~
teeth 126 def~ alon~ a bottom su~cs of the rack and a slot extending downward, lookin4 at Fi~. 1, from an upper surface of the rack. The rack fits under the drive shaft between shoulder 116 and flange 118 with clearance to permit ir..lependenlotational movelT~nt of the drive shaft within the slot which is at the same timesufflciently narrow to assure that upstandin~ legs of the rack on opposite sides of the shaft will abut the shoulder and flan~e to permit a~dal movo~-.ent to be ka,~sn.itled between the rack and the shaft.
wo s~r~ls~7 PCT/US9'7/02979 Trigger 94 is ph~ohlly mounted on a pin 120 secured to a wall or walls of the housing and is generally trian~ular in shape with a cut-out or openin~ 122 f~,..eJ
therethrough to ac~chln~ate one or more fin~ers of the user if desir~. Looking at Fi~. 1, pinion 98 is ~is~o~ co- ~cer,b ic with pin t 20 at the upper end of trig~er 94.
The pinion is generally circular with a plurality of circumferentially s~oacl teeth 124 and a ~Jian.~tar to cause the teeth to mesh with teeth 126 of the rack. A torsion spring 128 is ~I sl~o~d around pin 120 and con~cted between pinion 98 and housing 24 to bias the tri~ger in a doc~urise direclion, lookin~ at Fi~. 1. A sprin~-lo=~ud button 130 is carried at a lower, pro~i...al end of the tri~er and is radially aligned with a circular openin~ 132 in the handle 68 to lock the tri~ger within the handle in a manually releasable manner when the tti~er is dQpr~ss~d or moved counter-cloc~wise lookin~ at Fi~. 1.
As best seen in Fi~. 6 a locking n,ecl,anis--, 134 for locl~in~ pusher 26 in a retracted position and releasin~ the pusher to be moved distally by the bias ..-en~ber 88 upon depression of tri~ger 94 indudes a latch or locl~in~ spring 136 made of a strip of resilient material formed to have a s~ ~b~"~n:i,lly flat base 138 secured to the botborn wall 64 of the housin~ and a bend 140 joining the distal end of the base with an upwardiy an~led arm 142 s~l from the base. Arm 142 carries or forms a latch 144 havin~ a disbl an~led latchin~ sur~ace 146 joining a p,o,~ al latchin~ surface 148 ~ osqd snb~l~ntially lran~erse to the lon~itudinal axis of the instrument and s~ tially parallel to the pusher flan~e 74. Arm 142 has an extension 150 positio.~J p,~J,u~ally of latch 148 and a releasin~ r-~e~ er 152 pivotally mounted on a pin 154 secured to an upper surface of the er~tdllSiOn. R~ in~ n,e,.ll~er 152 extends frorn pivot pin 154 in a prox;.-~l direction to be disposed between teeth 124 of pinion 98. A torsion spring (not shown) is coiled around pin 154 and fixed toreleasin~ ~.e,-~ber 152 to bias the releasing r.n5"~ber cloclcwise, l~ .ing at Fi~. 6 sud~ that the reieasing .ne..lber is biased toward extension 150.
Referring again to Fig. 2, a plural~ty of suture spring devices 38 are received and loaded onto st~na~e portion 32 of the inner i"e"~ber. A cylindrical abutment r"enll~er W 0 97~2S27 P~n~97~979 156 is baded onto s~3,ae portion 32 behind ffle last of the suture sprin~ devices 38.
Member 156 is oentrally apertured so that it can slide along sll ra~a po-liG-) 132. A
~n~r~ssiQn spring 158 is coiled around storaye portion 32 and is held in c~."xess~n bet~ sen abutment ",ernl,er 156 and the annular step or shoulder 108 defined by the drive shaft at the pro,.in-al end of the stora~e ~lio-- when the ~ exter"ally tl"ea~J ~o<i.nal p~lion 37 of the inner .ne"lber is lhreaJ~ into the tl "e~J~J disbl p~ tiOI~ 106 of drive shaft 92. It will be appl ec~ l that spring 158 biases the abutment m~ l,er 156 and, thus, suture spring dGvio~s 38 distaHy until a distalmost suture sprin~ device abuts the shoulder 44 f~.m~l by the frl~stoconical ~r 34 at ~e distal end of ~lora~a portion 32. Drive shafl 92 J~f,nes a central ~q~ or ~)arb ,el 159 alon~ a lon~itudinal axis of the shaft which is communicated with central cl.annel ~0 of inner ,..enlber 28 when the con,~"ents are coupled, thereby establishin~ a continuous central ~,an,.al through the length of the a~>lic- '~r for I~A5SP~ of additional instruments, tissue and/or fluids. The central .~;1.6--r,el is communicated with a tubular ..~ml~r 160 having a distal end 162 telescopically re~ i.~ the drive shaft within housing 24 and a ~ruxi".al end 164~s,~ed externally of the housing to define a valve 166, such as a stop cock valve, and a coupling 168, for ~ ple a Luer finin~ 5pos~1 ~;ùJci, l~ally of the valve.
As best soQn in Fbs. 1 and 9, an electrical conn~1or 169 is mounted on the top wall 62 of the housing and co.~"e~ted via wires 171 ~nth electrically conductive~.~n~ of the applicatorfor pe~""in~ ebctrosurgical ~,~Jures such as unipolar or bipolar elect~ical cQa~u~ion, for example usin~ guide 36 as a conductive ebment It ~nll be app~iated, h~wever, that the position of electrical connector 169 c,,~s t~ handle 68 is merely G,~c~."~la"~ of the many various loc~ions at which an el~ ical connector can be positio,~. Also, inner surfaces of any of the tubular i"e.nb~r~, such as inner, middle and outer tubular "~"l~ers 2~, 26 and 22, can be electrically insulated to permit ~ ~c~e of electrosur~ical instruments ll ,ereU~rough as a b~ r *rB
W 0 97132S27 rCTnUS97/02979 In use, applicator 20 is p-~fo~ly supplied in the rest conditio-. shown in ~ig. 1 with tri~er 94 pro~udin~ distally from handle 68 in an unlocked p~ sition. Pinion 98 at the end of tri~er 94 en~a~es a distal end of rack 96 which is biased pr~xi..,ally toward a rG~a~eJ ,~sition by the clock~ ota~iGr~l bias of the to~5-0n sprin~
actin~ on the pinhn. Rack 96 en~d~s flan~e 118 to bias drive shaft 92 and inner ,n~..~bar 28 to a retracted ~osition where guide 36 is disposed within outer tubular n~"~L,er 22 to pr~t~l the sharp tip of the guide. Pusher 26 is unlocked in the rest condition and biased distally toward an extended position where knob 86 abuts a distal end of slot 84 and fir~ets 76 at the distal end of the pusher en~a~e the ~uide.
Flan~e 74 at the p~ximal end of the pusher is ~-~t~lly spAce~l from latch 144 oflocking ~-~J ~nism 134 when the pusher is in the G~lu~ded position. As n-e.ltioned preYiously, suture sprin~ Je~ s 38 are held on the storaç,~e po.lion of inner .ne "ber 28 in an u-.c~--~d, relaxed state. Cc,--.~r~s6i~n sprin~ 158 pushes abutment member 156 forward in a distal direction into abuttin~ relation the ~,ro.<i..~almost suture spring device which, in tum, is pushed d;sl~lly into the next suture sprin~
device until the distalmost suture spring device abuts shoulder 44 at the distal end of storage po. lion 32.
A suture sprin~ d~vice 38 is loaded into ~uide 36 by l~in~ pusher 26 in a retracted position where fingers 76 ~ s~a knob 42 of the suture sprin~ device and retractin~ inner n-e--lber 28 ~fo.~i...ally relative to the suture spring device while maintainin~ the pusher in the locked ~ o sition. Refen i. .~ to Fi~. 7, inner .~ L er 28 is moved to an e~t~fi.bd ,~sition by dep~ssin~ tri~ger 94 into handle 68 to cause pinion 98 to rotate co~"~cl~Nise about pin 120, loch:n~ at ~is. 7, U.ereb~ forcing rack 96 to move in a distaî direction. Rack 96 pushes against shoulder 116 of the drive shaft, for~ the drive shaft to move distally throu~h block 110 which rotates the shaft in a clockwise direction looking distally. Inner "~."~r 28 is also moved distally to an e~t~. .J6J po5ilio-) where ~uide 36 is ~ cl distally of outcr tubular , ber 22. When tri~er 94 is completely Jepresse~ as shown, button 130 in the tri~er will be ali~ned with opening 132 in the handle and will thus be able to spring *rB
WO 97t32S27 PCr/US97102979 outwardly of the trig~er into the opening to lock the trig~er in the depr~.ssed condition. Pusher 26 is then retracted to en~a~ a suture spring device 38 by pullin~
handle 86 raarwardly or in a ~ ~l direction against the distal bias of bias ...e.,lber 88 to force flan8e 74 a~ainst arm 146 of the lochi..~ ~-.eCI.3nian.. Arm 146 is pushed downwardly by nan~e 74 as handle 86 is drawn back, allowin~ the flange to slide ~ over latch 144. When flange 74 is d;~owd p~)~ ~lly of the latch, arm 142 will spring upwardly pOsnionin~ ~ro)~imal latchir~ surface 148 in front of the flange.
Wnen handle 86 is released, bias ..~n~bar 88 will bias flan~e 74 distally into cont~t with the pro)~i...al latchin~ surface which prevents the flan~e from moving further distally. As the handb is drawn back, fingers 76 at the distal end of the pusher slide along the periphe-y of inr~r ~--anlber 28 and over the suture spring device 38 until they are l,ositioned i.-,--~di~tely behind knob 42 of the distalmosl suture spring device. Since fi"~ers 76 are biased radially inward, distal ends of the r,. .~ers will abut the knob and prevent the knob from movinQ p. ~"ci.nally past the finyGrs.
Referring now to Fig. 8, pusher 26 is maintained in a locked position with fingers 76 enga~ing knob 42 at the ~..~l end of suture spring device 38, and button 130 is ~rass~ to perrnit trig~er g4 to be moved in a clockv~isa directio.. about pin 120 under the influence of torsion spring 128. ~ l~ise moven,6, It of the tri~ger ~nses pinion 98 to move in a clocl~Nise direction thereby forcing rack 96 to move p~i--,ally toward the .~t~acl~d, ~sition. r, o~i"~al movement of rack 96 c~ ~ses drive shan 92 to move pr~"~in,ally throu~h blo~ 110 which rotates the shaft in a colJn~erclG~nN~se directlon lookin~ distally. Inner ~ er 28 ~acls with drive shaft 92 and is rotaled in the same direction. Suture spring device 38 is ~,~v~uted from moving ~,-o-(i-..ally by pusher 26 and will thus be ~~ceivoiJ in and e~a,~d along the groove 48 in ther and be loaded or fed into guide 36 as shown in Fig. 9. In the loaded position shc~wn, suture spring device 38 is held in an eln~ti~lly defo,..~ed, e3~ancJed state within guide 36, and knob 42 at the p~i,..al end of the suture spring device is aligned with and made to slide alon~ slot 56 in the guide.
WO 97/32S27 PCTAUS97~2979 With suture sprin~ device 38 loaded within ~uide 36 as shown in Fi~s. 8 and 9 applicator 20 can be used to suture and/or li~ate ~natomicsl tissue within the body as described in my afo.~.,-,ntion6J co~n-Ji..~ U.S. Patent Arplic~tion Serial No.
08Jff10,951 entitled ~Suture Sprin~ Device~. For p~J",oses of illustration suturing of layered tissue structures T, and T2 will be Je~ il~l it being u"Jerstoocl thst the applicator can be used in a similar fashion to suture other types of tissue and/or to li~ate tissue within the body usin~ a suture sprin~ device.
Ref~., ing still to Fi~. 8 distal end 70 of outer tubular ...e..l~er 22 is positioned adjacent the tissue to be u~d while tri~er 94 is dopr~sad. As shown in Fi~. 11 depression of tri~er 94 into handle 68 ~ ~s~s pinion 98 to rotate in a countef~ wise direction about pin 120. Rack 96 is moved distally by count~rolocl~4isa rolation of the pinion causin~ drive shafl 92 to be moved distally throu~h block 110 and rotated in a clockwise direction lookiny ~ t~ly alon~ the lon~itudinal axis of the applicator. Co~.nler~ vise rot~tion of pinion 98 also ~ ses teeth 124 of the pinion to press dow-~ ~.dly against rcla-~ing mem~er 152 at the pf~,.i-"al end of Gxtension 150 as shown in Fi~. 1û causing arm 142 of the locking "~1~ -;~.. to be moved downwardly toward base 138. Down~rd movement of arm 142 cP~ ~ses latch 144 to move away from nange 74 of pusher 26 allowing the pusher to be moved in the distal direction under the influence of bias ",e,nber 88.
hner ,-~-lber 28 moves distally and is rotated with drive shaft 92 causing sharp tip 54 of the guide to penetrate into the pro~in~al tissue structure T,. As inner ~-.e"~ber 28 is moved further distally and lotaled, ~uide 36 will penet,ate through analo",ical stnJc~res T, s~nd T2 like a o~lhscr~w thereby ~st-~lishing a helical path through the structures as shown in Fi~. 11. Pusher 26 is biased distally under the influence of bias ~--e..ll~r 88 and will thus maintain co-ltact with knob 42 at the pro~i...al end of WO g7132S27 ~ ,7102g7g suture sprin~ device 3B to assure retention of the device within the guide as itpenetrates into the tissue.
Peneb~tion is oompleb when tri~er 94 is fully Je,~eJ within I ~a. ~Jle 68 and button 130 is en~a~ed within openin9 132 of the handle. Guide 36 holds suture sprino device 38 in the elastically Juf~)eJ, expanded state for positioning in or in relation to the ~nat~ r.lical tissue and is removed from the suture sprin~ device by pressin~ button 132 into openin~ 130 to allow the tri~er to be moved in the clockwise dir~t;on under the force of torsion spring 128 as shown in Fig. 12. Astri~er 94 moves dockwise about pin 120, rack 96 is moved proximally once more, causing drive shaft 9Q to be moved p~Ai~l~ally through rotator block 110 and f~tatecl in a countercloc~wise direction lookin~ disblly alon~ the longitudinal axis of the appliG-~'or. rr~Ai-,-al movement of suture spring device 38 is prevented by ~,~. ~t of fin~e. ~ 76 with the knob 42 at the pr~il"al end of the suture springdevice. Guide 36 is thus ulltl-r.-~ or r~...oJed from suture sprin~ device 38 with knob 42 sliding along slot 56 in the guide to permit the guide to move pr~"ci,--ally rebtive to the suture spring device. As the ~uide is removed, rings 40 of the suture sprin~ device move from the el~ llc~ y ~fo- "~ed, GApan~d condition toward theirori~inal relaxed, c~lt~ J condition. When guide 36 is removed e"tir~ly from suture spring device 38, as shown in Fi~. 13, rin~s 40 of the suture spring device will en~a~e tissue structures T, and ~ d;~osed between the coils and exert a predeterrnined axially COIll~aS5 JC force to app(oxi,nale the tissue structures. ît will be apprec ~ted that suture spring devices 38 remainin~ in applicator 20 are biased distally by con~essien sprin~ 28 and are thus r~sitioned for loading and use in the ",J~nu J~ il~J above without the need of havin~ to remove the appli~ ~r from the body for reloadin~.
While the npplTc~tor accordin~ to the pr~se.~t invontion has been desc~ibeJ as applyin~ a particular suture sprin~ device, it will be appr~ that the arplic~r cz~n be adapted to apply a vanety of dmerent types of suture sprin~ devices. In Fi~.
14, for exalr~le, a modified ~uide 36' and pusher 26' are shown for applyin~ one or more suture sprin~ devices 38 similar to the suture sprin~ davic6s previously J~ iL~J but wi~out knobs. Each suture spring devioe 38 incluclss an elastic bodyof coiled confi~uration definin~ a plurality of rin~s or coils 40 extending between plw.Y~al and distal ends 39 and 41 of the device. F~ --al and distal ends 39 and41 are bent at an an~le relative to the coils and extend in axially o~ost-J dire-lions alon~ a longitudinal axis of the device. Tubular ~uide 36 is similar to the ~uide previously d~s~il~ but does not include a slot. A pruA---~I end 44 of the ~uide is bent at an angle relative to rin~s or coils 52 of the ~uide to extend alon~ abn~itudinal axis of the ~uide and to be axially ali~ned with the disbl end 41 of the suture spring device 38 . Rin~s 52 of the ~uide are of in~easin~ diameter in a distal direction so that the ~uide will function to elaslically deform the suture sprin~ device as it is loaded into the ~uide tl-er~y obviatin~ the need for a separat3 e~nder.Pusher 26 ir~' ~~~s an elastic rod or fin~er 76 extendin~ distally from a peripl~e.dl edge of tubular body 72~ in axial ali~- ~..-e. ~t with pr~ximal end 39~ of suture sprin~
device 38'. The hr~r 76' has a cor~l~uration to fit co ~ro.--~ably within and to move or slide along the ~uide. In use, finger 76' of pusher 26' is ali~ned with and made to abut l~r~Ai,.-al end 39' of suture sprin~ device 38' in order to move the suture sprin~ device in the distal di-~i~ relative to ~uide 36'. ff more than one suture sprirlg device 38~ is ~ os~J within the appli~tor, the suture sprin~ devices can be IO ~d~d in end-to-end series fashion as indicated in Fi~. 14 by the p- usel .ce of the second suture sprin~ device which can be ;-~S6- ted ~tw~n the distalmost suture sprin~ device and the pusher. The distalmost suture spring device is loaded into the ~uide in the ~).anner des~ i~d above, for example by usin~ the pusher to hold the suture sprin~ device in place while the ~uide is relr~teJ. As the suture spring device is lo~led, finger 76' will enter the P~A;~al end 44' of the guide and be elastically deformed within the guide in order to maintain co,~tact with the proAi...al end 39' of the suture spring device. A~ the suture sprin~ device 38' is advanceddistally throu~h ~uide 36', it will be elastically d~for,.,ed by the coils of the guide and will be held in the elastically Ju~o. ---ed, e~and~J sbte as the ~uide is positie, .~1 in -or in relation to anatomical tissue. Once the ~uide i8 positionel, the suture sprin~
device is held in a sub~blly ~lat~y position in relation to anatomical tissue bythe fin~r d the pusher while the guide is remoYed by slidin~ along the fin~er of the pusher in a pr~)~i."al direc~n.
Ano~er modification of the applicator according to the ~nt invention, shown in Figs. 15 -17, in~ s~ an inner me.n~r 28~ havin~ a hollow stora~e ~GI tion 32~of cylindrical confi~uration, a hollow, tubular ~uide 36~ of coiled configuration with a ~r~mal pGIliGn 171~ extendin~ into the intc.ior of the stora~e portion and a pusher 26~ similar to that shown in Fi~. 14, havin~ a hollow, tubular body 72 ly r~ceiYod within ~tDra~e portion 32~ and an elastic rod or fin~er 76~
extending distally from a peripl .6~al ed~e of the tubular body to be axially ali~ned with an open P~J~;"~I end 173~ of the ~uide. As best seen in Fi~. 17, ,~roxi",alon 171~ inolu~s a first tubular extension 175~ extendin~ radially inward from ahrst bend 177~ in the proximalmost coil to a se~,d bend 179~ conn~ti..~ the first tubular extension wtth a seco(~ tubular extension 181 n ~isF!osed alon~ the interior of slora~e pG,lion 32~ in axial ali~an",ent with fin~er 76~. The second tubular ex~ension terminates proximally at open prOAimal end 173~. Stora~e pG.Iion 32n is received tc'es~opically within the lon~itudinal ~ s~e Je~,ne.l by rin~s 52~ of the ~uide and can be connecbd thereto in any suitable ,--a. .. er includin~, but not limited to, ~Jhe5;VG bondin~ and friction fit. An openin~ 183~ is f~""~l in an outer po.ipl.aral, convex surface of the ~uide ~ cenl bend 51 u and is confi~ured to ive the distal end 41 u of a suture sprin~ devioe, for example suture sprin~ device 38n, carried on an outer surface of the cylindrical ~to~a pGI tion. A plurality of ~re sprin~ davic~s 38U are shown, each bein~ similar to suture sprin~ device 38 but without knobs or handles. The suture sprin~ JEvioas are preferably biased distally relative to the ~uide so that, when the ~uide is r~tated relative to the distalmost suture sprin~ device as de~ iL~J above, the device will be loaded into the ~uide. Pusher 26~ is movable throu~h the tubular body of the guide to control movement of the suture sprin~ device relative to the ~uide once the device is within W O 97~2S27 PCT~USg7~2g7g the ~uide; and, it will be appreaated that the fin~er of the pusher can be used to nt udbsequent suture ~prin~ devices 38~ frorn bein~ loaded into the guide by blocking opening 183~ when advanced distally beyond the opening to push the suture sprin~ device already loaded within the guide. However, under cortain circun)sl~nc~s it may be desi,~le to have more than one suture spring device disposed within a ~uide, in which case o Ih~l ~ently loaded suture sprin~ devioes will be disposed between the pusher and the distalmost suture sprin~ device, forexample in the additional rin~s 52~ at the p~,-i-,~l end of the guide, and the additional devices can be used to push the distalmost device in relation to the ~uide.
Fi~s. 18 and 19 show a pen~tin~ instrument 174 which can be asse.~.bled as part d the applicator 20 or inse, l~l throu~h the central ~;1 ,an"al of the applicator by the user durin~ an o~,eralive ~ce.Jure. The instrument 174 inc'udes an elon~ate,tubulsr body 176 havin~ an outer diamebr of predetermined dil..ensio" to fit within the oentral ~ ~1 of the applicator and a len~th to protrude distally beyond the tip 54 of the ~uide when fully inserted. Body 176 <Jef~nes a lumen 187 which e).ler,d,.
from a con~r~ntiG"al couplin~ 180, such as a Luer fittin~ at a proxi",al end of the body to a sharp tissue pen~trdtin~ tip 182 at a distal end of the body. A valve 184 for example a stop~srll; valve is ~J;sroseJ near the couplin~ at the proxi" al end o~
the body and communicated wffl the lumen to control p~~~a of instruments, fluidsandlor tissue throu~h the lumen. An electrical conneclor 186 protrudes ,endicularly from the body of the ,oe"~alin~ instrument throu~h an ele.b ically insulative layer 188 which is fGIllled about the p4ri~1,e,~ of the body and made to e~end all or substantially all of the len~th of the instrument to fA~.il '~te use of the tip of the instrument for electrosur~ical procedures. It will be a~re~ated that instrument 174 can also be used to pe~bate and ~issecl anatomical tissue to pc.for", i,.i~aati.~ and aspiratin~ fu-l~tions and to administer medica",en~s to the Gpordli~e site.
A modification of the penJ~tin~ instrument is shown in Fig. 20 wherein the modified penetrating instrument 174' inç~des an alon~ate solid body 176' W O 97~2S27 ~ 97~2979 terminatin~ at a sharp, ti~ue ~- le~t;nU tip 182' which can, for example, be used to pene~ate and dissect anatomical tissue as well as for electrosur~ical ~r~Jures.
Another instrument usable with the applicator 20 accordin~ to the pr~ t invention, as shown in Fi~ 21, ir~ ules an elon~ate body 192 terminatin~ distally in a pair of arms 1~4. Each arm o~n~nd~ distally from the body to a bend 196 connectin~ the aml with a tissue en~a~in~ tip or pincer 198 ~ ;GnteJ substantially perpendicular or transverse to the arm. A~ms 194 are an~ularly -spsc~d from one another in ~PI ~3~J relation and are normally biased apart as shown with a ~ap or spac;nU between the arms in~er sin~ in a distal di(eution. Tips 198 extend toward one a~U ~ from the arms in op~,osed relation and can have any confi~uration useful for graspin~ tissue and medical devices. The grasping inslrument 190 is p,~erably formed of an elastic l-~t,_.ial so that arms 194 and tips 196 can be straiJhten6J to pass thru ~e central d ~ I of the applicator, for example by advan~ng a tubular e (not shown) distally relativ~ to the arms and ;. ~. tin~ th~ sleeve throu~h lhe nth the arrns ~;sp~ therein. Wnen the distal end of the sleeve protrudes beyond the ~uide, the sleeve is r~a~teJ to allow arms 194 to spreacl apart as ~wn. Arms 194 can be drawn tG~U ,er to ~rasp a-,alG"lical tissue and/or devices disposed be~en the arms by advancin~ a sleeve distally relative to the arms and/or by movin~ ffle instrument pr~,,u,,-ally relative to the ~uide. The graspin~ instmment can be f~.~d with more than two arms, for example to ~rab weakened po. lior,s ofa~tomical tissue. Body 192 of ffie tissue ~raspin~ instrument 190 can be of hollow, c~ylindrical conf~uration as shown or have any other solid or hollow configuration as desired. H hollaw, the body of the instrument can be used to allow pAssa~e of tissue or fluids 11 ~U ~h or to acoor""~hle other instruments, such as the ~ ali, ~~
instruments d~ d above.
Another "~ f;~tion of the applicator accordin~ to the p,esont inven~ion, shown in Fi~. 22 at 20"', is similar to appl;~t~ 20 but is shown without a prole~ti~,e outer tubular ,-,o.l~lLer. The rnodified applicator inrludes a housing 24"', a first pusher 26a"' of tubular configuration ~xtendir~ distally from the housin~, and the elongate W 0 97m 527 rCTnUS97~2979 inner .-.e..~or 28"' ~03iYed within the first pusher and coupled with a drive mechani~m 30"' in the housin~, and a c3cond pusher 26b"' ~coivad within the inner .~.k~- and ooupled with a handle 8S"'. Inner ~-~-~r 28"' inrl~les a hollowtubular sto~e portion 32"' of c~lindrical confi~uration extendir~ between a transverse proximal nan~o 200"' dispo~od within housin~ 24"' and a ~uide 36"' ~imilar to ~uide 36~ but with fewer rin~ 52"' to acc~.h~GJate a sin~le suture sprin~
device. An outwardly probudir~ peo, post or pin 202"' extends po",o~)dicularly from a ~--~1 end of stora~e po-lion 32"' adjacent flange 200"'. Housin~ 24"~
int~ ss a pr~xi---al cylindrical portion 204"' whidl is internally U--~deJ, ~rooved or splined at 206"' to n3c~ re pin 202"' of the ;.tora~a "~e,.ll~r, and a distalcylindrical pG.ti~ 208"' of smaller diameter than the ,,r~A,---al poftien which is e~ernally tth~J~I at 210"' and which terminates dlstally at an outwardly protrudin~
transverse flan~e 212"'. Tlans~arse pr~Ai."al flange 200"' of st~ e pG-lion 32"'i8freely rotatably l~i~r~d wffllin a circular or ring-like collar 214" ', and a generally U ~h,~ handle 68"' is co..nect~,~l between the collar and a forward wall 216~ ofhousin~ p~lion 204"' to bias the inner m~7"lt~er PrOA;IIIallY relative to the housin~.
Handle 68"' aAt~nds throu~h a slot 220"' f~"~ in the bottom wall of housin~
pG.tion 204"' parallel to a longitudinal axis of the inner ...e..~ber to con.)acl with collar 214"' and is prereraLly f~r,.,eJ as an inte~ral one-piece unit from an elastic material, such as sprin~ steel, but can be made of other ,..dhrials and/or be made af separate, pivotally ~ted pieces which are biased apart. A pair of finger loops 218a"' and 218b"' of ~enerally circular corhl~uration are pr~erably provided on opposite sides of the handle to ac~..-- odat~ one or more r.. .~..r~ of the user and to permit expansive forces to be applied to the handle if required. A lock 222"' islhreaJedl~ mounted on the top of housing portion 204"' and is manually rotatablethrou~h the housin~ to be ~ posGtl ~xi.,.ally of collar 214"' when the collar is in an ~dend~d po~ition adjacent forward wall 216"'. The lock prevents prOAilllal movement of the inner ...e.-~ber, thereby holdin~ the ~uide at the distal end of the inner r...".lber in an ext~n.J~cl rcsition as will described further below.
W O 97~2527 rcTnusg7~2979 A plurality of suture spring ~wic~, for example suture s~ri- ~s gsvicas 38"', are received on ~tora~ ber 32" ' in a relaxed, u. ~and_J ~tate and are biased didally in the direction of ~uide 36"' by a sprin~ 158"' held in cc"--~ession between a ~e or shoulder 224"' on an inte, ..~liate secli~ ~ of storage ",~.lber 32" ' and an abutment ~ er 156"' slldably disposed behind the suture sprin~ 35.
Sutwe sprin~ devices 38"' are similar to suture spring ~e~;Ce5 38~ in that they do not carry a knob or handle, but differ in that they are shown with only two rin~s.
When biased didally, distal end 41 "' of the distalmost suture sprin~ device will be lon~itudinally or axially aligned with opening 183"' in the guide.
Outer, tubular pusher 26a"' e~derds from a cylin~ical hub 226"' at a pr~Ai.,~l end to a plurality of inwardly biased fin~ers 76a"' at a distal end. ~Ith pusher 26a~"
in the rJt,~ Yition shown, at least one of the fin~ers will extend throu~h the space between sutwe spring ~ioas to conla~,1 storage portion 32"' i").ne~ ely ~nt or behind the pr~,.i,..al end 39"' of the distalmost suture sprin~ device.
Cylindrical hub 226"' terminates pr~Ai".ally in an inwardly protrudin~ transverse flange 228"' which is internally th~l to couple with the extemally ll ,reaJeJ distal housin~ portion 208"'. Hub 226" ' is rotatable about housin~ ~GIlion 208" ' to move pusher 26a"' distally relative to the housing while at the same time rotat;n~ the pusher, and thus the distalmost suture sprin~ device, about a lon~itudinal axis of the housino. When pusher 26a"' is in an Gxl~nded position or cGndition, inwardly probudin~ flan~e 228"' of the hub will abut out~lvardly protrudin~ flan~e 212"' of the housin~ to prevent further distal movement of the pusher. The threaded length ofhousin~ pG. tion 208"' and of hub ~6"' can be varied to obtain a desired position for the distal end of the pusher in the extended r ~ition. For example, the distal end of the pusher can be made to protrude distally beyond the ~uide when ~,.ler ~d if it is desirable to protect the tip of the guide, for example when passio~ the appli~ t.or throu~h an ou~Joscopic sleeve or portal with inte".al c6..ponen~s that can be dur~a~d by the sharp tip of the ~uide. A sprir~ 230"' can be held in o~",pression behNeen flan~es 212"' and 228"' if desired to bias the hub ~Jro,~i-.-dlly relative to the W O 971~2~7 PCTnUSg7~2979 housin~ in order to reduce play in the hub and to p~VG.~t the hub from bein~
inad~e. t~ltly rotated.
The second, inner pusher 26b" ' incl~ ~des a hollow, tubular body 72" ' extendin~
1~n a ~o~ -al nange 74b"' disposed in housin~ ~ti~ 204"' to a flexible rod or fin~er 76b"' mounted on a ~ l ~- al ed~e at the distal end of the tubular body in axial ali~ t with the open pro;~(i--~l end 173"' of ~uide 36"'. P~Ai---al flan~e74b"' is ~i~d within a hollow rin~ or collar 232"' which is c~n--ected to one le~
of an elastic, U-sh~reJ handle 86" ' similar to handle 68" '. Handle 86" ' eAtends upwardly, lookin~ at Fb. ~, from collar 232~ through a slot 234"~ in the upper wall of the housin~ and tums downwardly to conne ~ with housin~ po tion 204"' to biastt e collar, and thus the pusher, pluAill~ally relative to the housin~ toward a retr~ct~i position where a distal end of fin~er 76b"' is 81i~hUy prOAimally sp~eed from PrOA;~al end 173"' of ~uide 36"'. The handle includes a lockinu ~"e,.~ber 236"' which extends longitudinally behleen legs of the handle and ~sss throu~h an opening 238"' in the pr~ in~al leg. The locl;in~ ".~filber is biased upwardly, lookin~ at Fig.
22, and has teeth 240"' on an upper surface ll .er_~ that en~a~a an upper ed~e of the openin~ 238"' to lock the handle in any position and stab of con)pr~ssion orexpansion. A handle extension 242"' extends down~rdly, looking at Fi~. 2 2, fro m collar 232"' through a slot 2 4 4 " ' in the bottom wall of the housing to brminate at a semi4ircular finger loop 2 4 6 "' havin~ a conc~ve portion axially aligned with and facin~ finger loops 218a"' and 218b"' of handle 68"'.
It will be app~e~iated that since st~a~e portion 32"' and pusher 2 6 b " ' d;s p o s ecl therein are hollow, a central ~,annal is def~n~ through the ~pplic~'or, for example to be communicated with a tubular ..-e.,lL,er 160"' having a distal end 1 6 2 " ' di~osad in the hollow, tubular body of pusher 26b"' and a pn~i."al end 1 6 4 " '~;s~sed ext~n.ally of the housing to mount with a coupling 168"', such as a Luerfittin~.
To load a suture sprin~ devioe 38"' into ~uide 36"', the suture sprin~ device is advanoed distally relative to the ~uide and rotated in a clocl~vise Ji,~c~ion, looking WO 971~S~7 rcrluss7l02s7s distally, by ~raspin~ hub 226"' at the ~UAil~al end of outer pusher 26a"' and byrotatin~ the hub in the cloc~ise direction. Hub 226"' moves distally as it is rotated, causin~ pusher 26a"' and fin~ers 76a"' at the distal end of the pusher to rotate and move distally as well. As Ille-~tiGned above, in the retracted position, at least one fin~er 76a"' is ~;~posed adjacent to or behind proAi.l,al end 39"' of the distalmost ~re sprin~ device 38"' so that as ~e hub is rotated, the fin~er adjacent the sutwe sprin~ device will bear a~ainst ~e proAimal end of the device to advance the device distally toward ~uide 36"' while at the same time n,tatin~ the device. As suturespring device 38"' is advanced, distal end 41 "' of the device will l~co...e ali~ned with opening 183"' in the ~uide and will pass throu~h the openin~ into the interior of the ~uide as shown in Fig. 23. Finger 76a"' will continue to push suture sprin~
device 38"' into the ~uide until preAi~lR3l snd 39"' of the device ~ssas throu~hopenin~ 183"', after which the outer pusher will no lon~er en~a~a the device.
Guide 36"' can then be positioned in or in relation to anatomical tissue or, if the suture sprir~ device 38"' is proximally sp~ceJ from the distal end of the guide, the suture spring device can be advanced futher distally within the ~uide to be ~I sposed aJjac~nl the distal end.
To position guide 36"' in or in relation to anat~.."ical tissue, distal tip 54" ' of the ~uide is moved to a po~;tion adjacent the anato-,lical tissue and handle 68"' s~îee~sd or cG~Ilp~essecî to move collar 214"', and thus flange 200"' of the inner ...~albar, distally relative to housing 24"', thereby drivin~ pin 202"' on the inner .,~,~er along ll.reads or ~rooves 206"' f~.l.~1 in the housin~ to rotate and move the inner ..~..~ar distally relative to the tissue. Guide 36"' is mounted at the distal end of inner ,.~..~er 28"' and is thus rnoved with the inner ~--e,-~bsr to be ~ ~ sitioned in or in l~le~ion to the anatomical tissue with the suture spring devics d:sposed therein in an elastically deformed, expanded state as des~ il~d above. If the suture spring device is ~Ai..,ally ~J from the distal end of the guide, inner ",ember 28"' can be locked in place relative to the anat~-lical tissue by deploying lockin~
mo..lbar 222"' in the housing to form a pn"~ al abutment surface behind collar W O 97132S27 PCTnUSg7~g7g 214"' d the handle. hner pusher 26b"' may then be operated to move finger 76b"~
distally into open ~---al end 173"' of the guide and along rings 52 ' of the guide to ~ ~e the ~ end of the suture spring devioe and to push the device furtherdistally within the ~uide. Pusher 26b"' is advanced by sq~ or co-.,pr~ssinghandle ~6 or drawin~ handle 246" toward finger loop 21 8b of handle 68" . In either case, oollar 232 " i8 moved distally relative to the housin~ to move flange 74 ", and thus pwher 26b", distally relative to the inner ,-,em~r and the housin~.
Teeth 240"' have distal faces o, i~.~t~l s~ ~h~'qntially pe",e. Idicular to a longitudinal axis of the n~plio~tor and pro~i--,al faces disposed at an an~le relative to thebn~itudinal axis in order to permit distal movement or co"",ressio.. of handles 86 and 246 " while preventin~ p, wd,, ~I movement lhereo~. Pusher 26b can thus be held in an extended position j"ll-~ ely ~ ~ut the ~ruximal end of suture sprin~
device 38 ' by locl~i.~ ,-~--~ber 236 ".
To apply the suture spring device to the a.,dto"lical tissue guide 36" is retracted while maintaining the suture sprin~ device in a substantially stationary position in or in ralation to the anatomical tissue. Ratr~ctio-, of ~uide 36"' is a~,.plished by releasin~ lockin~ "~,ber 222"' to albw the U~l~d handle 68 to sp~in~ apart lh~ y drawing collar 214"' and inner ".ember 28" proximally while at the same time r~tati,~ the inner ",e..~ber to allow ~uide 36" to be unthreaded from the suture sprin~ device. As Jer~ iL~J previously ret.a~lion of ~uide 36" oPu~s suture sprin~ device 38 ' to no lon~er be oonstrained and allowsthe suture sprin~ device to contuJ~A from the e'~~ y deformed e~a~ l~ed state toward a r~ ed co.lt~acted state to exert a cGIllpr~ssivo foroe on the analo"lical tissue.
From the above it will be appre~ated ttlat the applicator accor~ to the present invGntio., can be used to position a sutwe sprin~ device in or in relatioo to anatomical tissue in an elastically de~d, ~nJ~ state so that the suture sprin~
device may then be allowed to move towd a relaxed cout ~t~l state to col~press approxi".~le occh~de fasten or secure the ~natomical tissue. The appli~-or W O 97~2S27 PCTnUS97~2979 p~eferably incl~ ~s a st~ portion for holdin~ at least one suture spring device in a substantially relaxed, co.~bdcted state, a ~uide dis~loseJ distally of the stora~e portion to r~3~g a suture spring device in an elastically Wormed, a~and~d state for positioning in or in relation to ~at~ ical tissue, and a pusher for enga~in~ the suture sprin~ device to perrnit relative movement between the ~uide and the suture sprin~ device. The ~uide can have a U~sue penetratin~ tip as shown, a blunt tip or the disbl end of the sutur~ device can be used as a tissue penetratin~ tip either alor~ or in combination with the distal end of the ~uide.
The ~uide can be used to, ~ ~'ion any type of suture device in or in relation toanatomical Ussue by cr~ali. ,~ a path in or in relation to the tissue which the suture ctevice will c~ ~y when the ~uide is removed. Hence, in aJ~I~fiu- ~ to apptyin~ suture devices havin~ an elastic body of coiled confi~uration, where by ~elastic~ is meant havin~ an ability to recover an ori~inal shape or ~ ~ition after havin~ been d~, ~-~d and by ~coiled~ is meant definin~ a sin~le ooil or rin~, a po. lion of a coil or rin~ or a series of connecled 00il8 or rings, the - ppli~e'or can be used to apply rigid suture clevices havin~ substantially the same shape and size as the guide, len~U.s of hl~-~t~y suture material as well as suture dG~ices ~-~J of shape mel~lG~ alloys,such as nitinol, soft materials which can be l.u~ ~Je. ~~ by application of energy once applied, or ductile materials, where by ~ductile~ is meant having a le~ n3enc~r, once bent, to remain in the bent condition. The guide can also be used like a probe to p~bate and dissect anatomical Uswe and to wpply energy to tissue or devices as re~uired; and, w,hen the guide is used as a probe, instruments such as the graspin~
instrument shown in Fig. 21 can be used to brin~ the tissue or device to the probe.
The ~uide can be made of any suitable medically ~cco~t~le material, such as stainless steeJ, so bn~ as it is configured to have a stifh .~ss suitable for maintaining a suture sprin~ device in an e~KleJ state for positionin~ in or in f~latioo to anatomical tissue. The ~uide preferably inc~s a tubular body of coiled configuration as shown but can also be of straight or angular configuration as desired. Ulhen the ~uide of the applicator is of coiled configuration, the coils can be WO g7132527 PCr/US97/02g79 circular, elliptical, poly~nal or have any othor curved or angular confi~uration and, when a ~uide has more than one coil, adjacent coils can be of bhe same size and shape or Ji~renl ske and shape dependin~ on the type of ~r~lure to be ~f~..~. The tubular body of bhe guide can have any confi~uration in ba..s~erse cross-section indudin~, but not limited to, circular, elliptical, pol~onal and open confi~urations. A150, ~e shape of bhe lumen in trL.~./~se cross wction can be dillerent than the *lape of ~e outer surface of the ~uide in b~s~erse cross Se~tiQn so that, for example, the outer surface may be circular and the inner surface poly~onal or vice versa. Dependin~ upon the ~-~. ~ner in which the ~uture device is moved relative to the ~uide, the ~uide can be fo, ~--ed with or without a slot. When k..nei with a slot, the slot will preferably extend from a pro;~i...al end of the guide to a distal end of the guide and will communicate between an exterior surface of the guide and an interior lumen. The slot can have ta~r~J or V-s~a"eJ sides to a~----~Jab a ball-shaped knob as shown, or the size of the slot can be strai~ht.Furth~-.~, alU~h the slot is shaNn on the outer, convex side of the ~uide, it can be formed on the inner, concave side or anywhere inbetween or the slot can be made to spiral around the coiled body of the ~uide. The guide can be co, ¢ ic with a longitudinal axis of the inner ,~-e--lber or offset ll~r~hom.
If an elastic suture sprin~ device is to be applied, an a~a. ~ ier can be positiGn6J
between the sl~age portion and the guide to elastically e~a--J the suture sprin~device in an axial and/or radial direction as it is adva,~ distally toward the ~uide.
The a~a, .J~r can be a solid surface with a ~roove or a tubular e)~1e, ~sion of the ~uide with or without a slot.
Although the pusher i8 shown and cle~;~d herein as includin~ one or more fin~;e. a mounted on a tubular body, it will be appr~iabd that the pusher can have any configurstion to on~a~e a suture device including, but not limited to, tubular oonfigur~ions with fingers biased radially inward at a distal end of the tubular body, tubular oor~igurations with rod like hn~ers confi~ured to slide within a hollow, tubular ~uide and configurations where ~e body of the pusher is not of tubular configuration.
.
W O 97~2~27 r~-lrJ~n2g7g The pusher can be disposed alon~ an exterior or interior of the inner ~ ber or a~liGII of the pusher can be d,s~sed alon~ the exterior and anoU.ar p~.li~.
di~J alon~ the ir~br of the ir~r ..~.~ . While the pusher is shown as bein~
biased, it will be appreciated that any type of force can be used to move the ~uture sprino device relative to the ~uide includir~, but not limited to, mechanical forces provided by sp, in~s, .--a~. ~GtiC forces and/or hydraulic or pneumatic forces.
The pusher can also be made to rotate to~- -.her with or i- ,clepend-J. nly of the suture sp~in~ device ~~ desired.
The inner ,-~.-1~ and drive ~ft preferably coop4-~te to define a central ~;1 ~u~el ttuou~h the applicator throu9h which instruments, such as penetrators and ~raspers can be passed durin~ an op~ative proc~Jure. Sove~al instruments or implements which can be ~i t~ou~h such a central d ~nnal are di~ losecl in my co~ndin~ application Serial No. 081376,186, e/ltiUeJ~Multifi nctiGnal InstrumentW~h Int~le Operating Units For re.f~"lin~ Cndos~pic P,~ures,~ the ~lisclosJre of which is incG,~ora~ed herein by r~r~nce. The central c;l.annel can also be used for irri~ation and aspiration as well as for administerin~ medicame,nts and fluids to the operd~ e site.
~ he handle and drive ..~l~nism sh~rwn and des_,il~J herein are exe.,.plc,.y of the types of handles and driw ..~;I.anisms suitable for p6,fc..~lin~ ~he function of ",ovin~ the inner ",~"lber and w the suture sprin~ device relative to one another, accordin~ly, the handle and drive "~i.sm can have any configuration to produce robtional andJor linear movement of the inner .,~,.~er and/or the suture spring device, including, but not limibd to, confi~urations employin~ a pair of pivoted le~s with fin~er loops, one fixed and one pivoteJ le~ with fin~er loops, or resilient U-~ .,~I~L~r:s con,~_teJ between outer and inner ..,e",lber~ of the arplic~'~r or between the inner ~e~ er and the pusher. Moreover, the handle can have any cri~nlalion ~GIat;~e to the lon~itudinal axis of the applicator includin~, for example, o ~ ntially b ~"s~erse o, ienlations where the handle e~tend~ transYersely from a L~tIGIII of the housin~ or sul,s'~-ltially lon~itudinal Grient~tions where the handle W O 971~L5~7 P~ v~1~2979 extends bn~itudinally 1~orn a rear wall d the housin~ and is operated like a sc"ssor~, or r~tatable conf~ where the handbs can be rnoved between tr_. .s~0rse and lon~itudinal orientations as desired. While a rack and pinion has been shown formovin~ the inner ,-~-~er linearly alon~ a lon~itudinal axis of the applicator, it will be appreciated that any type of for~e can be used to move the inner ~~ er includin~, but not lirnited to, ..-eol ~anical forces pn,~ickd by rods, pulleys or sp i. ~~s, ~l~a~ ie~tic forces and/or hydraulic or pneurnatic for~s.
The ~n~ As d the applic~tor can be made of any &uibble rnedical ~rade rnaterials to permit derilization for r~use orfor sin~le patient use. The Co...po~Kat~
can be made of multiple parts of various configu.~tions and materials to reduce cost.
The housir~ can have various valves and/or seals to control fluid flow and the pas~,~o of instruments therethrough, such as the stop~k valve shown at the ~rOAillldl end of the applicator, and conventional locl~ I.~d-ani .-.s can be used to hold the tri~er within the handle in the fully de~ EJ position or at any other position relative to the handle. In addition, the outer tubular ,.~ber can be provided with scale l.~hi.~ on an exterior sufaoe to assist the user in determinin~ dislances within the body.
It will also be appreciated that . ~tali~, of the ~uide can be combined with linear on by use of suitable ç,~ea, in~, and that the guide or any other oc."ponent of the F~ppli~or can be configured to rotate in a clockwise or coLnleroloc~ isa direction when bein~ a~v~c~l distally along the longitudinal axis of the ap~,licator dependin~ upon the configuration of the ~uide or c~npol~enl. Also, the applicator housin~ can be adapted to allow re---o~al of the inner .--e-.ll.ar frorn a pr~Ai,..al end of the housin~ to permit reloading of the inner ",ehl~er without removin~ the applicator from the o~rati~re site. The applicator can also be mGdifi~d to simply rotate the ~uide without linear lran~l~tion or, conversely, to linearly translate the ~uide without lot~tiG-., both modific~tiuns requirin~ manual opor~tiG"s to be .~J in order to p~ition the suture device in or in relation to anatu"lical tissue.
Once ~e suture device is positioned in or with res~l to the tissue, the retum of the suture device taward the rest position, can be ~r~hanccd, Jependent upon the material from which thc suture device is constructed, by bmperature ~ ~a. ~~,,e and/or by the appl caUon of electricity, Ibht or o~er ener~y to alter the c;har~,~ri-~ti.,s of the material.
The features of the various embodiments described above can be combined in any "u~mer desired ~ ~t upon the G~ ati~ ~al requin...~ents of the ~ cJure to be ~rf~,n.-ed and the complexi~ of the particular desi~n.
Inasmuch as the pr~~ant invention is ~ject to many variations, mod~fications and ehan~es in detail, it is intended that all subject matter di6c:ussed above or shown in the aca~mpaorin~ drawin~s be inter~,reted as illustrative only and not be taken in a limitin~ sense.
Claims (38)
1. An applicator for applying a suture spring device in or in relation to anatomical tissue, said applicator comprising a storage portion configured to hold at least one suture spring device in a substantially relaxed, contracted state;
a guide disposed distally of said storage portion and including a hollow, tubular body configured to receive therein a suture spring device in an elastically deformed, expanded state for positioning in or in relation to the anatomical tissue; and a pusher movable in relation to said guide to control the position of the suturespring device relative to said guide.
a guide disposed distally of said storage portion and including a hollow, tubular body configured to receive therein a suture spring device in an elastically deformed, expanded state for positioning in or in relation to the anatomical tissue; and a pusher movable in relation to said guide to control the position of the suturespring device relative to said guide.
2. An applicator as recited in claim 1 and further comprising an expander disposed between said storage portion and said guide to elastically expand the suture spring device as it is moved distally from said storage portion relative to said guide.
3. An applicator as recited in claim 2 wherein said expander includes a solid surface with a groove leading from said storage portion to said guide.
4. An applicator as recited in claim 3 wherein said expander defines a conical surface of increasing diameter in a distal direction and said groove defines a helical path around said conical surface between said storage portion and said guide.
5. An applicator as recited in claim 4 wherein a distal end of said groove communicates with an opening in said guide so that a suture spring device will be loaded into said guide as the device advances distally along said groove.
6. An applicator as recited in claim 1 and further comprising bias means for biasing said pusher distally relative to said guide.
7. An applicator as recited in claim 1 wherein said pusher includes a distal portion slidingly movable through said tubular body of said guide to push a suture spring device distally therein.
8. An applicator as recited in claim 7 wherein said distal portion of said pusher includes a finger formed of a flexible material.
9. An applicator as recited in claim 1 wherein said tubular body of said guide includes a slot communicating between interior and exterior surfaces of said tubular body so that, if the suture spring device includes a knob, the knob can extend laterally through said slot when the suture spring device is disposed within said guide.
10. An applicator as recited in claim 9 wherein a distal end of said pusher includes inwardly biased fingers.
11. An applicator as recited in claim 6 and further comprising a locking mechanism engageable with said pusher to lock said pusher in a retracted position engaging a suture spring device.
12. An applicator as recited in claim 1 wherein an opening is formed in an outer, convex surface of said guide distally of said proximal end of said guide to receive a suture spring device therethrough.
13. An applicator as recited in claim 12 wherein said pusher includes a distal portion movable within said guide to block said opening when advancing a suture spring device through said guide.
14. An applicator as recited in claim 1 and further comprising a drive mechanism coupled with said guide to move said guide relative to a suture springdevice engaged by said pusher.
15. An applicator as recited in claim 14 wherein said drive mechanism is operable to move said guide linearly along a longitudinal axis of said guide.
16. An applicator as recited in claim 15 wherein said drive mechanism includes a rotator coupled with said guide to rotate said guide about said longitudinal axis as said guide is moved linearly.
17. An applicator as recited in claim 1 wherein said storage portion, said expander and said guide cooperate to define a central channel through said applicator.
18. An applicator as recited in claim 1 wherein said guide includes an elongate tubular body of coiled configuration.
19. An applicator as recited in claim 1 wherein said tubular body of said guide terminates distally at a tissue penetrating tip.
20. An applicator for applying a suture device in or in relation to anatomical tissue, said applicator comprising a storage portion configured to hold at least one suture device;
a guide disposed distally of said storage portion and including a hollow, tubular body of coiled configuration with an opening to receive therein a suture device; and a pusher movable in relation to said guide to control the position of a suture device relative to said guide.
a guide disposed distally of said storage portion and including a hollow, tubular body of coiled configuration with an opening to receive therein a suture device; and a pusher movable in relation to said guide to control the position of a suture device relative to said guide.
21. An applicator as recited in claim 20 and further comprising a drive mechanism coupled with said guide to move said guide relative to the anatomical tissue.
22. An applicator for applying a suture spring device in or in relation to anatomical tissue, said applicator comprising a housing;
an outer tubular member having a proximal end mounted by said housing and terminating distally at a distal end;
an inner member movably disposed in said outer tubular member and including a storage portion configured to hold a suture spring device in a substantially relaxed, contracted state and a guide disposed distally of said storage portion to receive the suture spring device in an elastically deformed, expanded state;
a pusher movably disposed in said outer tubular member to engage the suture spring device so that the position of the suture spring device relative to said guide can be controlled; and a drive mechanism coupled with said inner member to move the inner member relative to said outer tubular member when operated.
an outer tubular member having a proximal end mounted by said housing and terminating distally at a distal end;
an inner member movably disposed in said outer tubular member and including a storage portion configured to hold a suture spring device in a substantially relaxed, contracted state and a guide disposed distally of said storage portion to receive the suture spring device in an elastically deformed, expanded state;
a pusher movably disposed in said outer tubular member to engage the suture spring device so that the position of the suture spring device relative to said guide can be controlled; and a drive mechanism coupled with said inner member to move the inner member relative to said outer tubular member when operated.
23. An applicator as recited in claim 22 wherein said pusher includes a tubular body telescopically received within said outer tubular member and said inner member is received within said tubular body of said pusher.
24. An applicator as recited in claim 23 wherein said inner member is movable between a retracted position where a distal end of said guide is disposed proximally of the distal end of the outer tubular member and an extended position where said distal end of said guide protrudes distally from said outer member.
25. An applicator as recited in claim 24 wherein said pusher is movable distally from a retracted position where a distal end of said pusher engages a suture spring device held by said storage portion when said inner member is in said extended position.
26. An applicator as recited in claim 25 end further comprising a locking mechanism which engages said pusher in said retracted position to prevent distalmovement of said pusher so that, when said inner member is moved from said extended position to said retracted position, a suture spring device engaged by said pusher will be loaded into said guide.
27. An applicator as recited in claim 26 and further comprising bias means for biasing said pusher distally relative to said outer tubular member so that said pusher will maintain engagement with a suture spring device loaded in said guide as said guide is moved from said retracted position to said extended position in or in relation to anatomical tissue, said pusher holding the suture spring device substantially stationary in relation to the anatomical tissue when said guide is moved from said extended position back to said retracted position.
28. An applicator as recited in claim 25 and further comprising a handle mounted on said pusher to permit manual movement of said pusher from said extended position to said retracted position.
29. An applicator as recited in claim 22 and further comprising an expander of frustoconical configuration disposed between said storage portion and said guide.
30. An applicator as recited in claim 29 wherein a helical groove is formed in said frustoconical expander to communicate with an opening in said guide.
31. A method of applying a suture spring device comprising the steps of storing the suture spring device in a substantially relaxed, contracted state;
elastically deforming the suture spring device from the relaxed, contracted state to an elastically deformed, expanded state;
holding the suture spring device in the elastically deformed, expanded state within a guide;
positioning the suture spring device in relation to anatomical tissue in the elastically deformed, expanded state using the guide; and removing the guide to allow the suture spring device to move resiliently from the elastically deformed, expanded state toward the relaxed, contracted state to apply a predetermined compressive force to the anatomical tissue.
elastically deforming the suture spring device from the relaxed, contracted state to an elastically deformed, expanded state;
holding the suture spring device in the elastically deformed, expanded state within a guide;
positioning the suture spring device in relation to anatomical tissue in the elastically deformed, expanded state using the guide; and removing the guide to allow the suture spring device to move resiliently from the elastically deformed, expanded state toward the relaxed, contracted state to apply a predetermined compressive force to the anatomical tissue.
32. A method of applying a suture spring device as recited in claim 31 wherein said step of holding the suture spring device includes holding the suture spring device substantially stationary and moving the guide relative to the suture spring device to load the device into the guide.
33. A method of applying a suture spring device as recited in claim 32 wherein said step of moving the guide includes moving the guide in a proximal direction relative to the suture spring device.
34. A method of applying a suture spring device as recited in claim 33 wherein said step of moving the guide further includes rotating the guide relative to the suture spring device.
35. A method of applying a suture spring device as recited in claim 31 wherein said step of removing the guide includes holding the suture spring device substantially stationary and moving the guide relative to the suture spring device.
36. A method of applying a suture spring device as recited in claim 35 wherein said step of moving the guide relative to the suture spring device includes moving the guide in a proximal direction relative to the suture spring device.
37. A method of applying a suture spring device as recited in claim 36 wherein said step of moving the guide further includes rotating the guide relative to the suture spring device.
38. A method of applying a suture spring device as recited in claim 37 wherein said step of holding the suture spring device stationary includes positioning a pusher behind the suture spring device to resist movement of the device.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US08/610,735 US5782844A (en) | 1996-03-05 | 1996-03-05 | Suture spring device applicator |
US610,735 | 1996-03-05 |
Publications (1)
Publication Number | Publication Date |
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CA2248090A1 true CA2248090A1 (en) | 1997-09-12 |
Family
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Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CA002248090A Abandoned CA2248090A1 (en) | 1996-03-05 | 1997-03-05 | Suture spring device applicator |
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US (1) | US5782844A (en) |
EP (1) | EP0955903A1 (en) |
AU (1) | AU2137697A (en) |
CA (1) | CA2248090A1 (en) |
WO (1) | WO1997032527A1 (en) |
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-
1997
- 1997-03-05 AU AU21376/97A patent/AU2137697A/en not_active Abandoned
- 1997-03-05 CA CA002248090A patent/CA2248090A1/en not_active Abandoned
- 1997-03-05 WO PCT/US1997/002979 patent/WO1997032527A1/en not_active Application Discontinuation
- 1997-03-05 EP EP97906772A patent/EP0955903A1/en not_active Withdrawn
Also Published As
Publication number | Publication date |
---|---|
AU2137697A (en) | 1997-09-22 |
WO1997032527A1 (en) | 1997-09-12 |
US5782844A (en) | 1998-07-21 |
EP0955903A4 (en) | 1999-11-17 |
EP0955903A1 (en) | 1999-11-17 |
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Legal Events
Date | Code | Title | Description |
---|---|---|---|
FZDE | Discontinued |