Abstract
The present invention includes a suture adapted to be anchored into tissue, the suture comprising a length of an elongate flexible suture material and a plurality of barbed anchor articles slidingly disposed along a length of the suture material. The invention also includes a suture placement device designed to insert the anchors of the suture articles into opposing tissue surfaces and associated methods for approximating and/or affixing opposed tissue surfaces in surgical procedures and the like.
Claims
1. A suture or suture-like material adapted to be anchored into tissue, the suture comprising: a. a length of an elongate suture material; and b. a plurality of barbed anchor articles slidingly disposed along said length of an elongate suture material and shaped so as to resist the withdrawal from tissue once placed into tissue as said length of suture material is moved with respect to said drawn through said plurality of barbed anchor articles once placed into tissue.
2. A suture according to claim 1 wherein each of said plurality of barbed anchor articles comprise barbs of sufficient number and length so as to resist the withdrawal once placed into tissue.
3. A suture according to claim 1 wherein each of said plurality of barbed anchor articles comprise barbs numbering from 2 to 10.
4. A suture according to claim 1 wherein each of said plurality of barbed anchor articles comprises an aperture adapted to allow said length of an elongate suture to slidingly pass therethrough.
5. A suture according to claim 4 wherein each of said barbed anchor articles comprise barbs numbering at least 3.
6. A suture according to claim 1 wherein each of said barbed anchor articles has a perimeter and a geometric center, and a slot extending from said perimeter toward said geometric center thereof, said slot of sufficient width to accommodate the sliding engagement of said length of said elongate suture material passing therethrough, once said barbed anchor article is placed into tissue.
7. A suture according to claim 6 wherein each of said barbed anchor articles comprise barbs numbering at least 2.
8. A suture according to claim 7 wherein each of said barbed anchor articles comprise at least 2 barbs on a first side thereof and said slot on a second side thereof.
9. (canceled)
10. A suture according to claim 1 wherein said plurality of barbed anchor articles comprise a resorbable material.
11. (canceled)
12. A device for inserting a suture material adapted to be anchored into opposed tissue surfaces, and to approximate said opposed tissue surfaces, said device comprising: a. a containment portion adapted to contain and dispense a length of an elongate suture material, said length of an elongate suture material having a plurality of barbed anchor articles slidingly disposed along said length of an elongate suture material, and shaped so as to resist the withdrawal from tissue once placed into tissue as said length of suture material is moved with respect to said drawn through said plurality of barbed anchor articles once placed into tissue; and b. an insertion portion adapted to insert at least one of said plurality of barbed anchors in a series into each of said opposed tissue surfaces.
13. A device according to claim 12 additionally comprising means to draw said suture material so that it is drawn through said plurality of barbed anchor articles once placed into tissue, so as to approximate said opposed tissue surfaces.
14. A device according to claim 12 wherein each of said plurality of barbed anchor articles comprise barbs of sufficient number and length so as to resist the withdrawal once placed into tissue.
15. A device according to claim 12 wherein each of said plurality of barbed anchor articles comprise barbs numbering from 2 to 10.
16. A device according to claim 12 wherein each of said plurality of barbed anchor articles comprises an aperture adapted to allow said length of an elongate suture to slidingly pass.
17. A device according to claim 16 wherein each of said barbed anchor articles comprise barbs numbering at least 3.
18. A device according to claim 1 wherein each of said barbed anchor articles has a perimeter and a geometric center, and a slot extending from said perimeter toward said geometric center, said slot of sufficient width to accommodate the sliding engagement of said length of said elongate suture
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0076] FIG. 1 contains top perspective, plan and lower perspective views of an apertured barbed anchor article that may be used in accordance with one embodiment of the invention.
[0077] FIG. 2 contains several profile views of non-limiting shape and designs of an apertured or slotted barbed anchor article as an alternative to the barbed anchor article of FIG. 1, in accordance with one embodiment of the invention.
[0078] FIG. 3 contains two perspective views of a device for inserting a suture material, in accordance with one embodiment of the invention.
[0079] FIG. 4 contains lateral views of a “diamond barrel” knotted suture material in both expanded and collapsed states, in accordance with one embodiment of the invention.
[0080] FIG. 5 is a lateral view of a “diamond barrel” knotted suture material in a collapsed state, in accordance with one embodiment of the invention.
[0081] FIG. 6 contains lateral elevation and top perspective views of suture insertion device, in accordance with one embodiment of the invention.
[0082] FIG. 7 contains top perspective views of two different insertion portions of suture insertion device, in accordance with one embodiment of the invention.
[0083] FIG. 8 contains lateral elevation view of a suture insertion device, in accordance with one embodiment of the invention.
[0084] FIG. 9 is a photograph of a suture insertion device and two test blocks shown beside a length of suture material, in accordance with one embodiment of the invention.
[0085] FIG. 10 contains lateral rear perspective view of a suture insertion device, in accordance with one embodiment of the invention.
[0086] FIG. 11 contains two sectioned elevational views of a suture insertion device, in accordance with one embodiment of the invention.
[0087] FIG. 12 contains two sectioned elevational views of a suture insertion device, in accordance with one embodiment of the invention.
[0088] FIG. 13 is a detailed rear perspective view of a suture insertion device, in accordance with one embodiment of the invention.
[0089] FIG. 14 is a lateral view of a “diamond barrel” knotted suture material in a collapsed state and a bow-tie-shaped knot, in accordance with one embodiment of the invention.
[0090] FIG. 15 is a photograph showing a lateral view of a rounded knotted suture material, in accordance with one embodiment of the invention.
[0091] FIG. 16 is a lateral view of a suture insertion device, in accordance with one embodiment of the invention.
[0092] FIG. 17 is a detailed lateral view of a suture insertion device, in accordance with one embodiment of the invention.
[0093] FIG. 18 is a detailed front perspective view of a suture insertion device, in accordance with one embodiment of the invention.
[0094] FIG. 19 is a second detailed front perspective view of a suture insertion device, in accordance with one embodiment of the invention.
[0095] FIG. 20 is another detailed front perspective view of a suture insertion device, in accordance with one embodiment of the invention.
[0096] FIG. 21 is a partial lateral view of a suture insertion device, in accordance with one embodiment of the invention.
[0097] FIG. 22 is a perspective view of a magazine for a suture insertion device, in accordance with one embodiment of the invention.
[0098] FIG. 23 is a perspective view of a magazine for a suture insertion device, in accordance with one embodiment of the invention.
[0099] FIG. 24 is a sectioned perspective view of a magazine for a suture insertion device, in accordance with one embodiment of the invention.
[0100] FIG. 25 is a sectioned lateral view of a schematic tissue having opposed tissue portions having surfaces to be approximated, and showing two barbs placed within the respective tissue portions, in accordance with one embodiment of the invention,
[0101] FIG. 26 is a sectioned lateral view of a schematic tissue having opposed tissue portions having surface relatively approximated, and showing two barbs placed within the respective tissue portions, in accordance with one embodiment of the invention,
[0102] FIG. 27 is a sectioned lateral view of a schematic tissue having opposed tissue portions having surface further approximated, and showing two barbs placed within the respective tissue portions, in accordance with one embodiment of the invention.
[0103] FIG. 28 is a rear perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated, in accordance with one embodiment of the invention.
[0104] FIG. 29 is a detailed lateral view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated, in accordance with one embodiment of the invention.
[0105] FIG. 30 is a detailed lateral view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and inserting a barb, in accordance with one embodiment of the invention.
[0106] FIG. 31 is a detailed lateral view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and further inserting a barb, in accordance with one embodiment of the invention.
[0107] FIG. 32 is a detailed rear perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and inserting a barb, in accordance with one embodiment of the invention.
[0108] FIG. 33 is a detailed rear perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and inserting a barb, in accordance with one embodiment of the invention.
[0109] FIG. 34 is a detailed rear perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and further inserting a barb, in accordance with one embodiment of the invention.
[0110] FIG. 35 is a detailed rear perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and further inserting a barb, in accordance with one embodiment of the invention.
[0111] FIG. 36 is a detailed rear perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and having inserted a barb, in accordance with one embodiment of the invention.
[0112] FIG. 37 is a detailed rear perspective view of a suture insertion device shown in position withdrawn from in between opposed tissue portions having surfaces to be approximated and having inserted a barb, in accordance with one embodiment of the invention.
[0113] FIG. 38 is a detailed rear perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and inserting a second a barb, in accordance with one embodiment of the invention.
[0114] FIG. 39 is a detailed rear perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and having inserted a second barb, in accordance with one embodiment of the invention.
[0115] FIG. 40 is a detailed rear perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and having inserted a second barb, in accordance with one embodiment of the invention.
[0116] FIG. 41 is a sectioned lateral view of a schematic tissue having opposed tissue portions having surface further approximated, and showing two barbs placed within the respective tissue portions, in accordance with one embodiment of the invention,
[0117] FIG. 42 is a detailed rear perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and having inserted a second barb, in accordance with one embodiment of the invention.
[0118] FIG. 43 is a detailed lateral perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and inserting a second of two barbs, in accordance with one embodiment of the invention.
[0119] FIG. 44 is a detailed lateral perspective view of a suture insertion device shown in position withdrawn from in between opposed tissue portions having surfaces to be approximated and having inserted two barbs, in accordance with one embodiment of the invention.
[0120] FIG. 45 is a detailed lateral perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and inserting a first of two barbs, in accordance with one embodiment of the invention.
[0121] FIG. 46 is a detailed lateral perspective view of a suture insertion device shown in position withdrawn from in between opposed tissue portions having surfaces to be approximated and having inserted a first of two barbs, in accordance with one embodiment of the invention.
[0122] FIG. 47 is a detailed rear perspective view of a suture insertion device shown in position withdrawn from in between opposed tissue portions having surfaces to be approximated and having inserted two barbs, in accordance with one embodiment of the invention.
[0123] FIG. 48 is a detailed front perspective view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0124] FIG. 49 is a detailed front perspective view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0125] FIG. 50 is a detailed opposite front perspective view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0126] FIG. 51 is a detailed lateral view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0127] FIG. 52 is a detailed lateral view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0128] FIG. 53 is a detailed front perspective view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0129] FIG. 54 is a detailed front perspective view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0130] FIG. 55 is a detailed front perspective view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0131] FIG. 56 is a detailed front perspective view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0132] FIG. 57 is a detailed front perspective view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0133] FIG. 58 is a detailed lateral front perspective view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0134] FIG. 59 is a detailed lateral front perspective view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0135] FIG. 60 is a detailed lateral perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and inserting a first of two barbs, in accordance with one embodiment of the invention.
[0136] FIG. 61 is a detailed rear perspective view of a suture insertion device shown in position withdrawn from in between opposed tissue portions having surfaces to be approximated and having inserted a barb engaged with a length of suture, in accordance with one embodiment of the invention.
[0137] FIG. 62 is a detailed rear perspective view of a suture insertion device shown in position in between opposed tissue portions having surfaces to be approximated and inserting a second barb engaged with a length of suture, in accordance with one embodiment of the invention.
[0138] FIG. 63 is a detailed lateral perspective view of a suture insertion device shown in position withdrawn from in between opposed tissue portions having surfaces to be approximated and having inserted a second barb engaged with a length of suture, in accordance with one embodiment of the invention.
[0139] FIG. 64 is a sectioned lateral view of a schematic tissue having opposed tissue portions having surfaces to be approximated, and showing two barbs placed within the respective tissue portions and engaged with a length of suture, in accordance with one embodiment of the invention.
[0140] FIG. 65 is a sectioned lateral view of a schematic tissue having opposed tissue portions having surfaces approximated by action of the two barbs placed within the respective tissue portions and engaged with a length of suture, in accordance with one embodiment of the invention.
[0141] FIG. 66 is a sectioned lateral view of a schematic tissue having opposed tissue portions having surfaces further approximated by action of the two barbs placed within the respective tissue portions and engaged with a length of suture, in accordance with one embodiment of the invention.
[0142] FIG. 67 is a sectioned lateral view of a schematic tissue having opposed tissue portions having surfaces further approximated by action of the two apertured barbs placed within the respective tissue portions and engaged with a length of suture, the suture having been knotted to secure the approximated tissues together, in accordance with one embodiment of the invention.
[0143] FIG. 68 is a detailed front perspective view of a suture insertion device shown in position approaching opposed tissue portions having surfaces to be approximated and having already inserted a first slotted barb engaged with a length of suture, in accordance with one embodiment of the invention.
[0144] FIG. 69 is a detailed front perspective view of a suture insertion device shown in position approaching opposed tissue portions having surfaces to be approximated with a second slotted barb engaged with the length of suture, in accordance with one embodiment of the invention.
[0145] FIG. 70 is a sectioned perspective view of a schematic tissue having opposed tissue portions having surfaces to be approximated by action of a plurality of slotted barbs placed within the respective opposed tissue portions and collectively engaged with a length of suture, in accordance with one embodiment of the invention.
[0146] FIG. 71 is a sectioned perspective view of a schematic tissue having opposed tissue portions having surfaces to be approximated by action of a plurality of slotted barbs placed within the respective opposed tissue portions and shown without the engaged length of suture, in accordance with one embodiment of the invention.
[0147] FIG. 72 is a sectioned perspective view of a schematic tissue having opposed tissue portions having surfaces that have been approximated by action of a plurality of slotted barbs placed within the respective opposed tissue portions and collectively engaged with a length of suture that is drawn to bring about the approximation, in accordance with one embodiment of the invention.
[0148] FIG. 73 is a detailed front lateral view of a suture insertion device shown in position approaching opposed tissue portions having surfaces to be approximated and having already inserted a first apertured barb engaged with a length of suture, in accordance with one embodiment of the invention.
[0149] FIG. 74 is a detailed lateral perspective view of a suture insertion device shown in position withdrawn from in between opposed tissue portions having surfaces to be approximated and having inserted a first and second apertured barb engaged with respective lengths of suture, in accordance with another embodiment of the invention.
[0150] FIG. 75 is a sectioned perspective view of a schematic tissue having opposed tissue portions having surfaces to be approximated by action of a pair of apertured barbs placed within the respective opposed tissue portions and shown engaged with respective lengths of suture, in accordance with one embodiment of the invention.
[0151] FIG. 76 is a sectioned perspective view of a schematic tissue having opposed tissue portions having surfaces having been approximated by action of a pair of apertured barbs placed within the respective opposed tissue portions and shown engaged with respective lengths of suture drawn together to bring about the approximation, in accordance with one embodiment of the invention.
[0152] FIG. 77 contains a lateral perspective view of a device shown inserting a suture material with apertured barbs, in accordance with one embodiment of the invention.
[0153] FIG. 78 is a table summarizing the characteristics of several tissue approximation methods.
[0154] FIG. 79 contains a lateral perspective view of a device shown alongside a suture material with a series of two apertured barbs and showing two foam pieces simulating tissue portions, in accordance with one embodiment of the invention.
[0155] FIG. 80 contains a lateral perspective view of a device shown with a cartridge adapted to insert a suture material with a series of apertured barbs, in accordance with one embodiment of the invention.
[0156] FIG. 81 contains two lateral perspective views of a device shown with a cartridge adapted to insert a suture material with a series of apertured barbs and showing the fully retracted and anchor pick-up position of the reciprocating actuator, in accordance with one embodiment of the invention.
[0157] FIG. 82 contains two lateral perspective views of a device shown with a cartridge adapted to insert a suture material with a series of apertured barbs, showing the anchor insertion and retracted position of the reciprocating actuator, in accordance with one embodiment of the invention.
[0158] FIG. 83 contains a rear lateral perspective view of a device shown with a cartridge adapted to insert a suture material with a series of apertured barbs, in accordance with one embodiment of the invention.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0159] FIG. 1 contains top perspective, plan and lower perspective views of an apertured barbed anchor article that may be used in accordance with one embodiment of the invention, the former show with a light of suture material slidingly engaged in its central aperture; and showing a photograph thereof against a ruler as an indicator of general size (which may be generally on the order of from about 1/16 to ¼ inch, or greater, depending upon utilitarian application).
[0160] FIG. 2 contains several profile views of non-limiting shape and designs of an apertured or slotted barbed anchor article as an alternative to the barbed anchor article of FIG. 1, and that may be used in accordance with other embodiments of the invention. The slots are typically deep enough to contain the entire diameter of the suture material, though other slot design may be used.
[0161] FIG. 3 contains two perspective views of a device for inserting a suture material adapted to be anchored into tissue or through tissue surfaces having a reciprocating slide to insert in a series apertured or slotted barbed anchor articles disposed along the length of a suture material, in accordance with one embodiment of the invention.
[0162] FIG. 4 contains lateral views of a “diamond barrel” knotted suture material in both expanded and collapsed states; and showing a photograph thereof against a ruler as an indicator of general size (which may be generally on the order of from about ¼ inch to ¾inch, or greater, depending upon utilitarian application. This view shows that knots featuring relatively rigid windings such as a “diamond barrel” knot may be used to provide a knot that can be expanded by drawing upon the extending suture material to cause the knot to change from a relatively barrel shape to a diamond shape, in accordance with one embodiment of the invention.
[0163] FIG. 5 is a lateral view of a “diamond barrel” knotted suture material in a collapsed state and disposed along the length of a suture material that is provided with small barbs that may allow the folded knot to be inserted into or through tissue, while resisting sliding along the length of the suture material to permit the second a subsequent knots to be inserted into tissue while permitting the suture material to be drawn through the inserted knots to cause the engaged tissue or tissue surfaces to be gathered, approximated or attached, in accordance with one embodiment of the invention.
[0164] FIG. 6 contains lateral elevation and top perspective views of suture insertion device with an insertion portion releasably engaging a bow-tie-shaped knot in preparation for tissue insertion, in accordance with one embodiment of the invention.
[0165] FIG. 7 contains top perspective views of two different insertion portions of suture insertion device adapted to releasably engage a barbed anchor or knot winding as described herein, in preparation for tissue insertion, in accordance with one embodiment of the invention.
[0166] FIG. 8 contains lateral elevation view of a suture insertion device with an insertion portion having released inserted barbed anchors into tissue.
[0167] FIG. 9 is a photograph of a suture insertion device and two test blocks shown beside a length of suture material bearing two bow-tie-shaped knots, showing generally the scale of same, in accordance with one embodiment of the invention.
[0168] FIG. 10 contains lateral rear perspective view of a suture insertion device with a retracted insertion portion controlled by a slide button, and showing the position of a magazine of barbed anchors with a trailing length of suture material, in accordance with one embodiment of the invention.
[0169] FIG. 11 contains two sectioned elevational views of a suture insertion device with a retracted insertion portion controlled by a slide button, and showing the position of a barbed anchor dispensed from a magazine of barbed anchors, and showing the direction of deployment by the insertion portion in the second figure in the series, in accordance with one embodiment of the invention.
[0170] FIG. 12 contains two sectioned elevational views of a suture insertion device with an extended insertion portion being controlled by the slide button, and showing the position of a barbed anchor as it is being deployed in series from a magazine of barbed anchors, and showing the direction of deployment by the insertion portion in the second figure in the series, with the trailing length of suture material implied, in accordance with one embodiment of the invention.
[0171] FIG. 13 is a detailed rear perspective view of a suture insertion device with an extended insertion portion being controlled by the slide button in the retracted position, and showing the position of a barbed anchors and spool of suture material contained within a magazine, ready for sequential deployment by the insertion portion, in accordance with one embodiment of the invention.
[0172] FIG. 14 is a lateral view of a “diamond barrel” knotted suture material in a collapsed state and a bow-tie-shaped knot, each at the end of a length of a suture material; and showing a photograph thereof against a ruler as an indicator of general size (which may be generally on the order of from about ¼ inch to ¾ inch, or greater, depending upon utilitarian application), in accordance with one embodiment of the invention.
[0173] FIG. 15 is a photograph showing a lateral view of a rounded knotted suture material and engaged with a suture device insertion portion, in accordance with one embodiment of the invention.
[0174] FIG. 16 is a lateral view of a suture insertion device, in accordance with one embodiment of the invention.
[0175] FIG. 17 is a detailed lateral view of a suture insertion device, in accordance with one embodiment of the invention.
[0176] FIG. 18 is a detailed front perspective view of a suture insertion device, in accordance with one embodiment of the invention.
[0177] FIG. 19 is a second detailed front perspective view of a suture insertion device, in accordance with one embodiment of the invention.
[0178] FIG. 20 is another detailed front perspective view of a suture insertion device, in accordance with one embodiment of the invention.
[0179] FIG. 21 is a partial lateral view of a suture insertion device, in accordance with one embodiment of the invention.
[0180] FIG. 22 is a perspective view of a magazine for a suture insertion device, in accordance with one embodiment of the invention.
[0181] FIG. 23 is a perspective view of a magazine for a suture insertion device, in accordance with one embodiment of the invention.
[0182] FIG. 24 is a sectioned perspective view of a magazine for a suture insertion device, in accordance with one embodiment of the invention.
[0183] FIG. 25 is a sectioned lateral view of a schematic tissue having opposed tissue portions having surfaces to be approximated, and showing two barbs placed within the respective tissue portions, in accordance with one embodiment of the invention,
[0184] FIG. 26 is a sectioned lateral view of a schematic tissue having opposed tissue portions having surface relatively approximated, and showing two barbs placed within the respective tissue portions, in accordance with one embodiment of the invention,
[0185] FIG. 27 is a sectioned lateral view of a schematic tissue having opposed tissue portions having surface further approximated, and showing two barbs placed within the respective tissue portions, in accordance with one embodiment of the invention.
[0186] FIG. 28 is a rear perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated, in accordance with one embodiment of the invention.
[0187] FIG. 29 is a detailed lateral view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated, in accordance with one embodiment of the invention.
[0188] FIG. 30 is a detailed lateral view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and inserting a barb, in accordance with one embodiment of the invention.
[0189] FIG. 31 is a detailed lateral view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and further inserting a barb, in accordance with one embodiment of the invention.
[0190] FIG. 32 is a detailed rear perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and inserting a barb, in accordance with one embodiment of the invention.
[0191] FIG. 33 is a detailed rear perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and inserting a barb, in accordance with one embodiment of the invention.
[0192] FIG. 34 is a detailed rear perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and further inserting a barb, in accordance with one embodiment of the invention.
[0193] FIG. 35 is a detailed rear perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and further inserting a barb, in accordance with one embodiment of the invention.
[0194] FIG. 36 is a detailed rear perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and having inserted a barb, in accordance with one embodiment of the invention.
[0195] FIG. 37 is a detailed rear perspective view of a suture insertion device shown in position withdrawn from in between opposed tissue portions having surfaces to be approximated and having inserted a barb, in accordance with one embodiment of the invention.
[0196] FIG. 38 is a detailed rear perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and inserting a second a barb, in accordance with one embodiment of the invention.
[0197] FIG. 39 is a detailed rear perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and having inserted a second barb, in accordance with one embodiment of the invention.
[0198] FIG. 40 is a detailed rear perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and having inserted a second barb, in accordance with one embodiment of the invention.
[0199] FIG. 41 is a sectioned lateral view of a schematic tissue having opposed tissue portions having surface further approximated, and showing two barbs placed within the respective tissue portions, in accordance with one embodiment of the invention,
[0200] FIG. 42 is a detailed rear perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and having inserted a second barb, in accordance with one embodiment of the invention.
[0201] FIG. 43 is a detailed lateral perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and inserting a second of two barbs, in accordance with one embodiment of the invention.
[0202] FIG. 44 is a detailed lateral perspective view of a suture insertion device shown in position withdrawn from in between opposed tissue portions having surfaces to be approximated and having inserted two barbs, in accordance with one embodiment of the invention.
[0203] FIG. 45 is a detailed lateral perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and inserting a first of two barbs, in accordance with one embodiment of the invention.
[0204] FIG. 46 is a detailed lateral perspective view of a suture insertion device shown in position withdrawn from in between opposed tissue portions having surfaces to be approximated and having inserted a first of two barbs, in accordance with one embodiment of the invention.
[0205] FIG. 47 is a detailed rear perspective view of a suture insertion device shown in position withdrawn from in between opposed tissue portions having surfaces to be approximated and having inserted two barbs, in accordance with one embodiment of the invention.
[0206] FIG. 48 is a detailed front perspective view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0207] FIG. 49 is a detailed front perspective view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0208] FIG. 50 is a detailed opposite front perspective view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0209] FIG. 51 is a detailed lateral view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0210] FIG. 52 is a detailed lateral view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0211] FIG. 53 is a detailed front perspective view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0212] FIG. 54 is a detailed front perspective view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0213] FIG. 55 is a detailed front perspective view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0214] FIG. 56 is a detailed front perspective view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0215] FIG. 57 is a detailed front perspective view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0216] FIG. 58 is a detailed lateral front perspective view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0217] FIG. 59 is a detailed lateral front perspective view of a suture insertion device showing a magazine in place, in accordance with one embodiment of the invention.
[0218] FIG. 60 is a detailed lateral perspective view of a suture insertion device shown in position inserted in between opposed tissue portions having surfaces to be approximated and inserting a first of two barbs, in accordance with one embodiment of the invention.
[0219] FIG. 61 is a detailed rear perspective view of a suture insertion device shown in position withdrawn from in between opposed tissue portions having surfaces to be approximated and having inserted a barb engaged with a length of suture, in accordance with one embodiment of the invention.
[0220] FIG. 62 is a detailed rear perspective view of a suture insertion device shown in position in between opposed tissue portions having surfaces to be approximated and inserting a second barb engaged with a length of suture, in accordance with one embodiment of the invention.
[0221] FIG. 63 is a detailed lateral perspective view of a suture insertion device shown in position withdrawn from in between opposed tissue portions having surfaces to be approximated and having inserted a second barb engaged with a length of suture, in accordance with one embodiment of the invention.
[0222] FIG. 64 is a sectioned lateral view of a schematic tissue having opposed tissue portions having surfaces to be approximated and showing two barbs placed within the respective tissue portions and engaged with a length of suture, in accordance with one embodiment of the invention.
[0223] FIG. 65 is a sectioned lateral view of a schematic tissue having opposed tissue portions having surfaces approximated by action of the two barbs placed within the respective tissue portions and engaged with a length of suture, in accordance with one embodiment of the invention.
[0224] FIG. 66 is a sectioned lateral view of a schematic tissue having opposed tissue portions having surfaces further approximated by action of the two barbs placed within the respective tissue portions and engaged with a length of suture, in accordance with one embodiment of the invention.
[0225] FIG. 67 is a sectioned lateral view of a schematic tissue having opposed tissue portions having surfaces further approximated by action of the two apertured barbs placed within the respective tissue portions and engaged with a length of suture, the suture having been knotted to secure the approximated tissues together, in accordance with one embodiment of the invention.
[0226] FIG. 68 is a detailed front perspective view of a suture insertion device shown in position approaching opposed tissue portions having surfaces to be approximated and having already inserted a first slotted barb engaged with a length of suture, in accordance with one embodiment of the invention.
[0227] FIG. 69 is a detailed front perspective view of a suture insertion device shown in position approaching opposed tissue portions having surfaces to be approximated with a second slotted barb engaged with the length of suture, in accordance with one embodiment of the invention.
[0228] FIG. 70 is a sectioned perspective view of a schematic tissue having opposed tissue portions having surfaces to be approximated by action of a plurality of slotted barbs placed within the respective opposed tissue portions and collectively engaged with a length of suture, in accordance with one embodiment of the invention.
[0229] FIG. 71 is a sectioned perspective view of a schematic tissue having opposed tissue portions having surfaces to be approximated by action of a plurality of slotted barbs placed within the respective opposed tissue portions and shown without the engaged length of suture, in accordance with one embodiment of the invention.
[0230] FIG. 72 is a sectioned perspective view of a schematic tissue having opposed tissue portions having surfaces that have been approximated by action of a plurality of slotted barbs placed within the respective opposed tissue portions and collectively engaged with a length of suture that is drawn to bring about the approximation, in accordance with one embodiment of the invention.
[0231] FIG. 73 is a detailed front lateral view of a suture insertion device shown in position approaching opposed tissue portions having surfaces to be approximated and having already inserted a first apertured barb engaged with a length of suture, in accordance with one embodiment of the invention.
[0232] FIG. 74 is a detailed lateral perspective view of a suture insertion device shown in position withdrawn from in between opposed tissue portions having surfaces to be approximated and having inserted a first and second apertured barb engaged with respective lengths of suture, in accordance with another embodiment of the invention.
[0233] FIG. 75 is a sectioned perspective view of a schematic tissue having opposed tissue portions having surfaces to be approximated by action of a pair of apertured barbs placed within the respective opposed tissue portions and shown engaged with respective lengths of suture, in accordance with one embodiment of the invention.
[0234] FIG. 76 is a sectioned perspective view of a schematic tissue having opposed tissue portions having surfaces having been approximated by action of a pair of apertured barbs placed within the respective opposed tissue portions and shown engaged with respective lengths of suture drawn together to bring about the approximation, in accordance with one embodiment of the invention.
[0235] FIG. 77 contains a lateral perspective view of a device shown inserting a suture material with apertured barbs, in accordance with one embodiment of the invention.
[0236] FIG. 78 is a table summarizing the characteristics of several tissue approximation methods.
[0237] FIG. 79 contains a lateral perspective view of a device shown alongside a suture material with a series of two apertured barbs and showing two foam pieces simulating tissue portions, in accordance with one embodiment of the invention.
[0238] FIG. 80 contains a lateral perspective view of a device shown with a cartridge adapted to insert a suture material with a series of apertured barbs, in accordance with one embodiment of the invention.
[0239] FIG. 81 contains two lateral perspective views of a device shown with a cartridge adapted to insert a suture material with a series of apertured barbs and showing the fully retracted and anchor pick-up position of the reciprocating actuator, in accordance with one embodiment of the invention.
[0240] FIG. 82 contains two lateral perspective views of a device shown with a cartridge adapted to insert a suture material with a series of apertured barbs, showing the anchor insertion and retracted position of the reciprocating actuator, in accordance with one embodiment of the invention.
[0241] FIG. 83 contains a rear lateral perspective view of a device shown with a cartridge adapted to insert a suture material with a series of apertured barbs, in accordance with one embodiment of the invention.
[0242] It will be appreciated that the handle, insertion portion, the anchor delivery portion, and the anchors may be produced from any material appropriate to the intended use whether sterile or non-sterile (i.e., for uses other than surgery or treatment, such as taxidermy or post-mortem use), and with due regard to disposability where desired. For instance, the handle, insertion portion, and the anchor delivery portion may be produced from metal, such as medical grade aluminum, while the handle portion may be produced from metal or plastics commonly used in medical devices, typically disposable ones.
[0243] The suture articles, suture placement devices and suture placement and tissue approximation methods of the present invention may be applied to any surgical procedure that may include, benefit from or require tissue approximation or securance, including without limitation procedures prone to seromas including various forms of plastic surgery, large tumor resections, and procedures involving repositioning of major organs. The most common types of surgery that result in seromas include breast procedures, abdominoplasty, body contouring and hernia repair. Other procedures where the present inventions may be advantageously applied include those where tissue approximation is required following the use of a trocar, such as procedures involving trocar placement through the abdomen during laparoscopic surgery. Still other procedures may be those involving tissue approximation associated with securing grafts and implants. In addition to the closure of dead space internally, there also exists a need for rapid and accurate closure of skin and dermis more superficially. The ability to prevent dehiscence of surgical incisions frequently relies upon meticulous repair of the dermal and subcuticular layer, which are the source of strength in surgical closure sites. Running dermal sutures are quicker in their application, but as failure can occur through either suture rupture or knot failure, the entire suture can ultimately fail as a result of an issue at a single point, resulting in dehiscence of the incision and operative site. Interrupted sutures are more accurate, stronger, and allow for independent control of tension at each individual suture location. This is however much more time consuming, which is amplified as the surgical incision length increases. There exists a need to be able to apply independent and accurate suture placement in rapid fashion within the dermis and/or subcuticular plane to facilitate quicker and more reliable wound closure.
[0244] The tissues that may be approximated through use of the subject suture articles, suture placement devices, and suture placement and tissue approximation methods may include tissues of any type having two or more generally opposed or adjacent portions that may be advantageously drawn together to a desired position.
[0245] It will be appreciated that the present invention may be applied to other fields for the tissue approximation, adjoining and fixture, such as in veterinary medicine, or providing embalming or taxidermy services, and the like.
[0246] FIGS. 16-21: Actuators [0247] a. Possible mechanisms to actuate the anchor delivery (pusher) may include but are not limited to: [0248] i. Finger Trigger (FIGS. 16-20) [0249] ii. Slider (FIG. 21)
[0250] FIGS. 22-24: Magazine [0251] a. Dispenses multiple anchors in sequence [0252] b. Intended to enable the multi-shot variation of he device that delivers separate suture articles in sequence [0253] c. May also enable a chain of multiple anchors on a single suture line
[0254] FIGS. 25-47: Approach Angles [0255] a. Anchor positions in the tissue (FIGS. 25-27) [0256] b. Angles of approach for the insertion device and anchor placement in the tissue [0257] i. Oblique (FIGS. 28-37) [0258] ii. Direct (FIGS. 38-47)
[0259] FIGS. 48-59: Insertion Needle Configurations [0260] a. Possible insertion needle configurations may include but are not limited to: [0261] i. Sectioned Half Cannula (FIGS. 48-52) [0262] ii. Slotted Needle (FIGS. 53-59)
[0263] FIGS. 60-67: Workflow: Arrows with Hole [0264] a. Workflow for a suture article comprising two arrows with holes in their centers, through which the suture is threaded. [0265] b. Sequence of anchor delivery [0266] c. Tissue approximation resulting from managing tension of the suture tails [0267] d. Final securing of the suture tails by knotting or cinching, or other means
[0268] FIGS: 68-72: Workflow: Arrows with Slot [0269] a. Workflow for a suture article comprising two arrows with slots in their bodies, through which the suture is threaded. [0270] b. The images go on to show tissue approximation resulting from managing tension of the suture tails as well as final securement of the suture tails by knotting or cinching, or other. [0271] c. Note that the anchor devices can pick up the suture during the actual insertion into the tissue from some sort of continuous suture feed device, referred to above as a spool. This may involve a single arrow catching the suture with tail being cut after placement. The proximal portion of the suture remaining in the device could then be used with the next arrow dispensed from the magazine, and so on. Similarly, two arrows may catch section of the suture in succession, or a chain of many arrows configured as a continuous chain stitch may be run on a single suture with tails being cut as desired. Thus is there great flexibility regarding the number of anchors to be strung on each successive length of suture, with minimal disruption to the operator.
[0272] FIGS. 73-76: Workflow: Single Arrow with Hole [0273] a. Shows one end of the suture attached directly to the anchor so that each tail come independently from an anchor. [0274] b. Similarly, a single knot can be placed with a single tail, as a “blind knot”
