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    • 专利摘要:
    METHODS AND INSTRUMENTS FOR THE APPLICATION OF SUTURE IN ENDOSCOPIC SURGERY AND ROBOT ASSISTANCE. The present invention relates to a suture application tool that releasably attaches a self-retaining suture in order to allow the application of the self-retaining suture to a surgical site on a patient through an access door. Suture application instruments suitable for manual operation and operation using robot-assisted surgical systems are described. In some embodiments, a suture coil is part of a cartridge that is releasably attached to the suture application tool. The cartridges are, in some embodiments, replaced after the self-retaining suture has been positioned and different cartridges that have different self-retaining sutures are, in some modalities, selected and attached to the suture tool as needed for a procedure.
    公开号:BR112012031606B1
    申请号:R112012031606-0
    申请日:2011-06-10
    公开日:2020-11-10
    发明作者:Rui Avelar；Lev Drubetsky；Alexander Naimagon
    申请人:Ethicon Llc；
    IPC主号:
    专利说明:

    RELATED REFERENCE RELATED APPEARANCES
    [001] This application claims the benefit of provisional application No. U.S. 61 / 354,009, filed on June 11, 2010, hereby incorporated by reference, in its entirety. FIELD OF THE INVENTION
    [002] The present invention relates to systems for packaging, selecting and applying sutures to surgical sites on a patient during surgical procedures including minimally invasive surgical procedures. BACKGROUND OF THE INVENTION
    [003] Minimally invasive surgical procedures (MIS) prevent open invasive surgery, favoring closed or local surgery with less damage to the patient. Minimally invasive surgical procedures typically involve remote manipulation of instruments with indirect observation of the surgical field through an endoscope or similar device, and are performed through a small access door through the skin or through a body cavity or anatomical opening. Minimally invasive medical techniques thus reduce tissue damage during diagnosis or surgical procedures, thereby reducing the patient's recovery time, discomfort and harmful side effects. Minimally invasive medical techniques consequently shorten the average length of hospital stay for a procedure when compared to standard open surgery.
    [004] A form of minimally invasive surgery is endoscopy. Probably the most common form of endoscopy is laparoscopy, which is a minimally invasive inspection and surgery within the abdominal cavity. In standard laparoscopic surgery, a patient's abdomen is insufflated with gas, and cannula sleeves pass through small (approximately 1.3 cm (1Z inch)) incisions to provide access ports for laparoscopic surgical instruments. Laparoscopic surgical instruments generally include an endoscope for viewing the surgical field and specialized surgical instruments that, in some modalities, cross the access doors. Instruments can include staples, tweezers, scissors, staplers and needle holders, for example. Surgical instruments may or may not be similar to those used in conventional (open) surgery; typically the one where the working end of each instrument is separated from its cable by an elongated rod and is sized and configured to fit through the access door. To perform surgical procedures, the surgeon passes the surgical instruments through the access doors to an internal surgical site and manipulates them from outside the abdomen. The surgeon monitors the procedure using a monitor that displays an image of the surgical site taken from the laparoscope. Similar endoscopic techniques are employed, for example, in arthroscopy, thoracoscopy, retroperitoneoscopy, pelviscopy, nephroscopy, cystoscopy, cisternoscopy, synoscopy, hysteroscopy, urethroscopy, craniotomy, and natural orifice surgery (for example, the airways and gastrointestinal tract) .
    [005] There are many disadvantages related to MIS technology that uses manually operated instruments. For example, existing MIS instruments deny the surgeon the flexibility of placing the instrument found in open surgery. The most current laparoscopic instruments have rigid nails, so that it can be difficult to approach the surgical site through the small incision. Additionally, the length and construction of many endoscopic instruments reduces the surgeon's ability to feel forces exerted by the instrument on tissues and organs at the surgical site. The lack of dexterity and sensitivity of endoscopic instruments is an impediment to the expansion of minimally invasive surgery.
    [006] Minimally invasive telesurgery systems were developed to increase the surgeon's dexterity while performing work at an internal surgical site, as well as to allow a surgeon to operate on a patient from a remote location. In a tele-surgery system, the surgeon is provided with an image of the surgical site as in endoscopy. However, instead of manipulating surgical instruments directly, the surgeon performs surgical procedures on the patient by manipulating input devices or master control on a console. The master control and input devices control the movement of surgical instruments using telemanipulators. Depending on the system, telesurgery systems may overcome some, but not all, of the lack of dexterity and sensitivity of endoscopic instruments. Surgical telemanipulator systems are often referred to as robotic or robot-assisted surgery systems.
    [007] Many MIS procedures including MIS tele-surgery procedures employ wound closure devices such as sutures, staples and adhesives to close wounds, repair traumatic defects or damage, join tissues (place several tissues in close proximity, close an anatomical space, fix layers single or multiple tissues, create an anastomosis between two hollow / luminous structures, adhere tissues, fix or fix tissues to their appropriate anatomical location), fix foreign elements to tissues (affix medical implants, devices, prostheses and other functional devices or support), and to reposition tissues in new anatomical sites (repairs, tissue elevations, tissue grafting and related procedures) to name a few examples. Sutures typically consist of a filamentary suture thread attached to a needle with a fine point. Suture threads can be produced from a variety of materials including bioabsorbable materials (ie, decompose completely in the body over time), or non-absorbable materials (permanent; non-degradable). It has been observed that absorbable sutures are particularly useful in situations where suture removal could impair repair or when the natural healing process makes the support provided by the suture material unnecessary after the wound has completed healing; as, for example, when finishing a skin closure without complications. Non-degradable (non-absorbable) sutures are used on wounds where, in some modalities, healing can be expected to take time or where suture material is needed to provide physical support to the wound over long periods of time; such as, for example, deep tissue repairs, high-tension wounds, many orthopedic repairs and some types of surgical anastomoses. In addition, a wide variety of surgical needles are available, and the shape, size of the needle body and the needle tip configuration is typically selected based on the needs of the particular application.
    [008] To use a common suture, the suture needle is moved through the desired tissue on one side of the wound and then through the adjacent side of the wound. The suture is then formed as a "loop" that is completed by tying a knot in the suture to keep the wound closed. Tying the knot takes some time and causes a range of complications, including, but not limited to, (i) expulsion (a condition in which the suture, usually a knot, pushes through the skin after a subcutaneous closure), (ii ) infection (bacteria are often able to settle and grow in the spaces created by the node), (iii) volume / mass (a significant amount of suture material left in a wound is the portion that comprises the node), (iv) slip (the nodes may slip or come loose), and (v) irritation (the nodes serve as a bulky "foreign body" in an injury). The suture ties associated with tying the knot can lead to ischemia (the knots can create tension points that can strangle tissue and limit blood flow to the region) and increase the risk of dehiscence or rupture in the surgical wound. Tying the knot is also laborious and can comprise a significant percentage of the time spent closing a surgical wound. The additional time in the operating procedure is not only bad for the patient (complication rates increase with time spent under anesthesia), but also increases the total cost of the operation (it is estimated that many surgical procedures cost between $ 15 and $ 30 per minute operating time). The time taken to place the suture and the range of complications is exasperated by the lack of dexterity and sensitivity of MIS instruments.
    [009] Self-retaining sutures (including barbed sutures) differ from conventional sutures in that self-retaining sutures have multiple tissue retainers (such as splinters) that anchor the self-retaining suture in the tissue after positioning and resist movement of the suture in a opposite direction to that which the retainers are facing, thus eliminating the need to tie knots to fix adjacent fabrics together (a "knotless" closure). This facilitates and promotes the positioning of self-retaining sutures compared to ordinary sutures. Knotless tissue approach devices that have splinters have been described previously, for example, in U.S. Patent No. 5,374,268, which discloses armed anchors that have splinter-like projections, while suture sets that have barbed side members have been described in US Patent Nos. 5,584,859 and 6,264,675. Sutures that have a plurality of splinters positioned along a larger portion of the suture are described in US Patent No. 5,931,855, which features a unidirectional barbed suture, and in US Patent No. 6,241,747, which features a barbed suture. bidirectional. Methods and apparatus for forming splinters in sutures have been described, for example, in U.S. Patent No. 6,848,152. It is noted that all patents, patent applications and patent publications identified throughout this document are hereby incorporated by reference in their entirety. Self-retaining sutures result in a better approximation of the wound edges, evenly distribute the tension along the length of the wound (reducing areas of tension that can break or lead to ischemia), reduce the volume of the suture material remaining in the wound (by elimination knots) and reduce expulsion (the extrusion of suture material - typically knots) through the skin surface. All of these characteristics are believed to reduce healing, improve cosmesis, and increase wound resistance compared to wound closure systems that use common sutures or staples. In this way, the self-retaining sutures, due to the fact that these sutures prevent the knot tying, allow patients to experience an improved clinical result, and also save time and costs associated with prolonged surgeries and follow-up treatments. SUMMARY OF THE INVENTION
    [0010] The present invention is, in general, directed to surgical instruments for the application of sutures and, in particular, self-retaining sutures to a surgical site in an MIS procedure including robot-assisted MIS procedures. Despite the great amount of advantages of unidirectional and bidirectional self-retaining sutures for MIS and MIS telesurgery, there is still a need to improve the suture design, so that the functionality is enhanced and / or additional functionality is provided. The present invention overcomes the problems and disadvantages of the prior art by providing packages and systems for applying self-retaining sutures to the surgical site. The self-retaining sutures can be installed by endoscopic and / or telesurgical instruments in the surgical site to suture, approach and retain tissue. Self-retaining sutures provide advantages that compensate for the lack of dexterity and sensitivity present in instruments used in MIS and MIS procedures. Thus, the time taken for the procedure is reduced and the clinical result is accentuated.
    [0011] According to one aspect of the present invention, a method of performing MIS procedure on a patient's body cavity includes providing a suture package containing a suture or a self-retaining suture and introducing the package at an operational site in a patient for use during an MIS procedure. The suture or self-holding suture is then manipulated by the MIS instrument to suture, approximate and / or retain the tissue.
    [0012] In some modalities, the suture package is introduced into the cavity with the use of an instrument for the application of a surgical suture. The suture application instrument applies the suture to the cavity under the control of the surgeon and positions the suture so that, in some modalities, it is located by the surgeon and manipulated with the use of MIS instruments.
    [0013] In some embodiments, the suture package is introduced into the cavity with the use of a telesurgical suture application system. The tele-surgical suture application system applies sutures to the cavity using a telemanipulator under the control of the surgeon and positions the suture so that, in some modalities, it is located by the surgeon and manipulated by MIS instruments.
    [0014] In some embodiments, the suture package includes a suture coil and self-retaining suture. The coil releasably holds one or more self-holding sutures and surgical needles in it.
    [0015] In a specific embodiment, a cartridge releasably holds one or more sutures. A cartridge is selected and attached to the suture application system that applies the cartridge and suture to the surgical site. In some embodiments, a variety of different cartridges are available that have different sutures.
    [0016] In a specific embodiment, a cartridge releasably holds one or more sutures. A cartridge is selected and attached to the suture application system that applies the cartridge and suture to the surgical site.
    [0017] In some modalities, different cartridges are available that have different sutures, and the cartridges have characteristics that allow them to be identified and / or selected by an automated application system responsive to instructions from a surgeon.
    [0018] In some embodiments, the suture cartridges endowed with visible, machine-readable markings, codes, labels or the like that are indicative of one or more properties of a suture loaded in the cartridge.
    [0019] Details of one or more modalities are presented in the description below, including the modalities identified in paragraphs 124 to 195. Other characteristics, objects and advantages will be evident from the description, drawings and embodiments. In addition, the descriptions of all patents and patent applications mentioned herein are hereby incorporated by reference in their entirety. BRIEF DESCRIPTION OF THE DRAWINGS
    [0020] The characteristics of the invention, its nature and various advantages will be apparent from the attached drawings and the detailed description below of various modalities.
    [0021] Figure 1A shows a perspective view of a bidirectional self-holding suture according to an embodiment of the present invention.
    [0022] Figure 1B shows an enlarged view of a portion of the bidirectional suture of figure 1A.
    [0023] Figure 1C shows a view of a suture application instrument, according to an embodiment of the present invention.
    [0024] Figure 1D shows an enlarged view of an embodiment of a suture coil that is, in some embodiments, used with the suture application instrument of figure 1C, in accordance with an embodiment of the present invention.
    [0025] Figure 1E shows a sectional view of an individual illustrating the application of a suture using the suture application instrument of figure 1C.
    [0026] Figure 1F shows a view of a surgical site that illustrates the use of the suture application instrument in figure 1C.
    [0027] Figure 1G shows an image of a surgical site provided to a surgeon and illustrating the use of the suture application instrument in figure 1C.
    [0028] Figure 1H includes a portion of the suture of figure 1A that also includes an optional compress.
    [0029] Figure 2A shows a suture application tool suitable for use with a robot-assisted surgery system, according to an embodiment of the present invention; and a surgical manipulator suitable for use with the suture application tool.
    [0030] Figures 2B and 2C show the introduction of a suture application tool by a surgical manipulator, according to an embodiment of the present invention.
    [0031] Figure 2D shows a side view of a suture application tool mounted on a surgical manipulator.
    [0032] Figures 2E and 2F show a surgery system, and a schematic description of it, to control the surgical manipulators and suture application instruments of figures 2A to 2D.
    [0033] Figures 3A and 3B show application of a suture cartridge using an alternative suture application tool, according to an embodiment of the present invention.
    [0034] Figures 3C and 3D show internal and sectional views, respectively, of the suture application tool of figures 3A and 3B.
    [0035] Figures 3E and 3F show different views of a suture cartridge suitable for use with the suture application tool of figures 3A to 3D, according to an embodiment of the present invention.
    [0036] Figures 4A to 4H show suture cartridges, according to the modalities of the present invention.
    [0037] Figures 5A to 5C show a suture cartridge carrier, according to an embodiment of the present invention.
    [0038] Figures 6A-6D show alternative self-retaining suture systems that have an anchor at one end.
    [0039] Figures 6E to 6F show views of a cartridge for retaining yet another of the alternative self-retaining suture systems of Figures 6A to 6D.
    [0040] Figures 6G to 6H show views of a cartridge / bobbin to retain one more of the alternative self-retaining suture systems of figures 6A to 6D. DETAILED DESCRIPTION Definitions
    [0041] Definitions of certain terms that are, in some embodiments, used later in this document include the following.
    [0042] "Self-holding system" refers to a self-holding suture together with devices for positioning the suture in the tissue. Such positioning devices include, but are not limited to, suture needles and other positioning devices as well as ends sufficiently rigid and pointed on the suture itself to penetrate tissue.
    [0043] "Self-holding suture" refers to a suture that comprises elements on the suture filament to engage the tissue without the need for a suture knot or anchor. Self-retaining sutures as described in this document are produced by any suitable method, including, without limitation, injection molding, stamping, cutting, laser, extrusion, and so on. Regarding the cut, thread or polymeric filaments are, in some modalities, manufactured or acquired for the suture body, and the retainers can be subsequently cut over the suture body; the retainers are, in some modalities, hand cut, laser cut, or mechanically cut by machine using blades, cutting discs, grinding discs, and so on. During cutting, both the cutting device and the suture thread are, in some modalities, moved relative to each other, or both are, in some modalities, moved to control the size, shape and depth of cut 210. The methods Particulars for cutting barbs in a filament are described in patent application serial number US 09 / 943,733 entitled "Method of Forming Barbs on a Suture and Apparatus for Performing Same" by Genova et al., and patent application no. US series 10 / 065,280 entitled "Barbed Sutures" by Leung et al. in which both are incorporated by reference.
    [0044] "Tissue retainer" (or simply "retainer") refers to a physical feature of a suture filament that is adapted to mechanically engage the tissue and resist the movement of the suture in at least one axial direction. Just as an example, the fabric retainer or retainers may include hooks, projections, splinters, spears, extensions, protrusions, anchors, protrusions, teeth, shoulders, tips, cogs, fabric hitches, traction devices, roughness of surface, surface irregularities, surface defects, edges, facets and the like. In certain configurations, the tissue retainers are adapted to engage the tissue to resist movement of the suture in a direction beyond the direction in which the suture is positioned on the tissue by the physician, as they are oriented so that they are substantially facing the direction positioning. In some embodiments, the retainers are flat when pulled in the direction of positioning and open or "spread out" when pulled in a direction contrary to the direction of positioning. As the end that penetrates the fabric of each retainer is facing away from the positioning direction when it moves through the fabric during placement, the fabric retainers should not trap or grip the fabric during this phase. Once the self-retaining suture has been positioned, a force exerted in another direction (often substantially opposite the positioning direction) causes the retainers to be displaced from the positioning position (that is, resting substantially along the body of the suture), forces the ends of the retainer to open (or "spread") from the suture body in a way that grabs and penetrates the surrounding tissue, and results in a tissue being trapped between the retainer and the suture body; "anchoring" or fixing the self-retaining suture in place. In certain other modalities, the tissue retainers are, in some modalities, configured to allow movement of the suture in one direction and resist movement of the suture in the other direction without spreading or positioning. In certain other configurations, the tissue retainer is, in some embodiments, configured or combined with other tissue retainers to resist movement of the suture filament in both directions. Typically, a suture that has such retainers is positioned through a device, such as a cannula that prevents contact between the retainers and the tissue until the suture is in the desired location. In some embodiments, the mechanical retainers are replaced and / or augmented with chemical and / or adhesive retainers that engage the tissue through the physical and / or chemical bonding or bonding of the suture to the surrounding tissue.
    [0045] The term "retainer configurations" refers to the configurations of fabric retainers and may include characteristics such as size, shape, flexibility, surface characteristics, etc. They are sometimes also called "splinter configurations".
    [0046] "Retainer distribution" refers to the arrangement of retainers on the surface of a filament and can include variables such as orientation, pattern, pitch, and angle of spiral.
    [0047] The term "bidirectional suture" refers to a self-retaining suture that has retainers oriented in one direction at one end and retainers oriented in the other direction at the other end. A bidirectional suture is typically assembled with a needle at each end of the suture thread. Many bidirectional sutures have a transition segment located between the two orientations of the barb.
    [0048] A "transition segment" refers to a portion without retainer (without splinter) of a bidirectional suture located between a first set of retainers (splinters) oriented in one direction and a second set of retainers (splinters) oriented in one direction. another direction. The transition segment may be around the midpoint of the self-holding suture, or closer to one end of the self-holding suture to form an asymmetric self-holding suture system.
    [0049] The term "suture thread" refers to the filamentary structure component of the suture. The suture thread is, in some embodiments, a monofilament, or comprises multiple filaments as in a braided suture. The suture thread is, in some modalities, produced from any biocompatible material, and is, in some modalities, additionally treated with any suitable biocompatible material, either to enhance resistance, resilience, longevity, or other qualities of the sutures, or to equip the sutures to fulfill additional functions in addition to joining the tissues together, repositioning the tissues, or fixing foreign elements to the tissues.
    [0050] The term "monofilament suture" refers to a suture comprising a monofilament suture.
    [0051] The term "braided suture" refers to a suture comprising a multifilament suture. The filaments in such sutures are typically twisted, twisted, or woven together.
    [0052] "Degradable suture" (also called "biodegradable suture" or "absorbable suture") refers to a suture that, after being introduced into a tissue, is decomposed and absorbed by the body. Typically, the degradation process is at least partially mediated or carried out in a biological system. "Degradation" refers to a chain-splitting process by which a polymeric chain is cleaved into oligomers and monomers. Chain splitting can occur through a variety of mechanisms, including, for example, by chemical reaction (for example, hydrolysis, oxidation / reduction, enzymatic mechanisms or a combination of these) or by a thermal or photolytic process. The degradation of the polymer is, in some embodiments, characterized, for example, using gel permeation chromatography (GPC), which monitors the changes in the molecular weight of the polymer during erosion and degradation. Degradable suture material may include polymers such as polyglycolic acid, copolymers of glycolide and lactide, copolymers of trimethylene carbonate and glycolide with diethylene glycol (eg MAXONTM, Tyco Healthcare Group), terpolymer composed of glycolide, trimethylene carbonate and dioxanone ( e.g. BIOSYNTM [glycolide (60%), trimethylene carbonate (26%) and dioxanone (14%)], Tyco Healthcare Group), glycolide copolymers, caprolactone, trimethylene carbonate and lactide (e.g. CAPROSYNTM, Tyco Healthcare Group). A dissolvable suture can also include partially deacetylated polyvinyl alcohol. Polymers suitable for use in degradable sutures can be linear polymers, branched polymers or multiaxial polymers. Examples of multiaxial polymers used in sutures are described in US patent application publications No. 2002/0161168, 2004/0024169, and 2004/0116620. Sutures produced from degradable suture material lose tensile strength as the material degrades. Degradable sutures can be either in a braided multifilament form or a monofilament form.
    [0053] The term "non-degradable suture" (also called "non-absorbable suture") refers to a suture comprising material that is not degraded by chain splitting, such as chemical reaction processes (eg, hydrolysis, oxidation / reduction, enzymatic mechanisms or a combination of these) or by a thermal or photolytic process. The non-degradable suture material includes polyamide (also known as nylon, such as nylon 6 and nylon 6.6), polyester (eg, polyethylene terephthalate), polyethylene fluoroethylene (eg expanded polytetrafluoroethylene), polyether ester with polybutester (butylene terephthalate block copolymer and polytetra methylene ether glycol), polyurethane, metal alloys, metal (for example, stainless steel wire), polypropylene, polyethylene, silk, and cotton. Sutures produced from non-degradable suture material are suitable for applications in which the suture is intended to remain permanently or is intended to be physically removed from the body.
    [0054] "Suture diameter" refers to the diameter of the suture body. It should be understood that a variety of suture lengths is, in some embodiments, used with the sutures described herein and that, although the term "diameter" is often associated with a circular periphery, it should be understood in the present invention to indicate a dimension in cross section associated with a periphery of any shape. The suture sizing is based on the diameter. The American Pharmacopoeia ("USP") designation of the suture size ranges from 0 to 7 in the largest range and from 1 -0 to 11-0 in the smallest range; in the shortest interval, the higher the value that precedes the hyphenated zero, the smaller the suture diameter. The actual diameter of a suture will depend on the material of the suture, so that, for example, a suture with size 5-0 and produced from collagen will have a diameter of 0.15 mm, while sutures that have the same designation in size from USP, but are produced from a synthetic absorbable material or a non-absorbable material will each have a diameter of 0.1 mm. The selection of the suture size for a specific purpose depends on factors such as the nature of the tissue to be sutured and the importance of cosmetic concerns; although smaller sutures are, in some modalities, more easily manipulated through tight surgical sites and are associated with less healing, the tensile strength of a suture made from a given material tends to reduce with size reduction. It should be understood that the sutures and methods for making the sutures presented herein are suitable for a variety of diameters, including, but not limited to, 7, 6, 5, 4, 3, 2, 1, 0, 1- 0, 2-0, 3-0, 4-0, 5-0, 6-0, 7-0, 8-0, 9-0, 10-0 and 11-0.
    [0055] "Needle fixation" refers to the attachment of a needle to a suture that needs it for its positioning within the tissue, and may include methods such as crimping, pinching, use of adhesives, etc. The suture thread is attached to the suture needle using methods such as crimping, bonding and adhesives. The fixation of sutures and surgical needles is described in US Patent Nos. 3,981,307, 5,084,063, 5,102,418, 5,123,911, 5,500,991, 5,722,991, 6,012,216 and 6,163,948, and in the publication US patent application No. US 2004/0088003). The point of attachment of the suture to the needle is known as a churin.
    [0056] "Needle for suture" refers to the needles used to position the sutures in the fabric, which come in many different shapes, shapes and compositions. There are two main types of needles, traumatic needles and atraumatic needles. Traumatic needles have perforated channels or ends (that is, holes or eyes) and are supplied separately from the suture and the thread is passed in place. Atraumatic needles have no holes and are attached to the suture at the factory by bonding or other methods by which the suture material is inserted into a channel at the blind end of the needle which is then deformed to a final shape that holds the suture and needle together . In this way, atraumatic needles do not require additional time at the site to pass the thread and the end of the suture at the needle attachment site is generally smaller than the needle body. In the traumatic needle, the thread comes out of the needle hole on both sides and the suture often tears the tissues to some extent as it passes through it. Most modern sutures are atraumatic needles that are embedded. Atraumatic needles are, in some modalities, permanently embedded in the suture or are, in some modalities, designed to be removed from the suture with a strong pull. These "pop-offs" are commonly used for interrupted sutures, where each suture is passed only once and then tied. For barbed sutures, which are uninterrupted, these atraumatic needles are preferred.
    [0057] Suture needles can also be classified according to the geometry of the tip or tip of the needle. For example, needles are, in some embodiments, (i) "tapered" when the needle body is round and tapers smoothly to the tip; (ii) "sharp" when the needle body is triangular and has a sharp cutting edge on the inside; (iii) "reverse cutting" when the cutting edge is outside; (iv) "trocar tip" or "tapered cut" when the needle body is round and tapered, but ends at a small triangular cutting tip; (v) "blind" indicates that it is for sewing friable fabrics; (vi) "lateral cut" or "spatulate" when the needle is flat on top and bottom with a cutting edge from the front to one side (these are typically used for eye surgery).
    [0058] Suture needles can also have several shapes, including (i) straight, (ii) semi-curved or "ski", (iii) 1/4 circle, (iv) 3/8 circle, (v) 1 / 2 circle, (vi) 5/8 circle, (v) and compound curve.
    Suture needles are described, for example, in U.S. Patent Nos. 6,322,581 and 6,214,030 (Mani, Inc., Japan); and 5,464,422 (W.L. Gore, Newark, DE, USA); and 5,941,899; 5,425,746; 5,306,288 and 5,156,615 (US Surgical Corp., Norwalk, CT); and 5,312,422 (Linvatec Corp., Largo, FL, USA); and 7,063,716 (Tyco Healthcare, North Haven, CT). Other suture needles are described, for example, in U.S. Patent No. 6,129,741; 5,897,572; 5,676,675; and 5,693,072. The sutures described here are, in some embodiments, positioned with a variety of needle types (including, but not limited to, curved, straight, long, short, micro needles, etc.), needle cutting surfaces (including, but not limited to) not limited to, sharp, tapered surfaces, etc.), and needle fixation techniques (including, but not limited to, perforated, crimped, etc.). In addition, the sutures described herein may include ends sufficiently rigid and sharp to dispense with the need to position the needles completely.
    [0060] The "needle diameter" refers to the diameter of a needle for positioning the suture at the widest point of this needle. Although the term "diameter" is often associated with a circular periphery, it can be understood in the present invention to indicate a cross-sectional dimension associated with a periphery of any shape.
    [0061] "Mounted suture" refers to a suture that has a suture needle in at least one suture positioning end. "End for suture placement" refers to an end of the suture to be positioned in the tissue; one or both ends of the suture are, in some embodiments, ends of suture positioning. The suture positioning end is, in some embodiments, attached to a positioning device such as a suture needle, or is, in some embodiments, sufficiently sharp and rigid to penetrate tissue itself.
    [0062] "Closure of injury" refers to a surgical procedure to close a wound. An injury, especially one in which the skin or other external or internal surface is cut, torn, punctured or otherwise broken is known as an injury. An injury commonly occurs when the integrity of any tissue is compromised (for example, the skin breaks or burns, the muscle tears or the bone breaks). An injury is, in some modalities, caused by an act, such as a perforation, fall or surgical procedure; by an infectious disease; or because of an underlying medical condition. Closing the surgical wound facilitates the biological healing event by joining or bringing the edges of these wounds together where the tissue has been torn, cut or otherwise separated. Closing the surgical wound directly joins or closes the tissue layers, which serves to reduce the volume of new tissue formation necessary to fill the gap between the two edges of the wound. The closure can serve both functional and aesthetic purposes. These purposes include the elimination of dead space by bringing subcutaneous tissues together, reducing the formation of scars by carefully aligning the epidermis, and preventing a depressed scar by precisely eversing the edges of the skin.
    [0063] "Tissue lifting procedure" refers to a surgical procedure to reposition the tissue from a lower height to a higher height (that is, moving the tissue in a direction opposite to the direction of gravity). The retention ligaments of the face support the facial soft tissue in the normal anatomical position. However, with age, the gravitational effects and the loss of tissue volume cause the tissue to migrate downward and the fat descends to the plane between the superficial and deep facial fascia thus making the facial tissue flabby. Facial plastic surgery procedures are designed to lift these flabby tissues and are an example of a more general class of medical procedures known as a tissue lifting procedure. More generally, a tissue elevation procedure reverses the change in appearance resulting from the effects of aging and gravity over time, and other temporal effects that cause the tissue to become flabby, such as genetic effects. It should be noted that the fabric, too, can be repositioned without lifting; in some procedures, the tissues are repositioned laterally (away from the midline), medially (towards the midline) or lower (lowered) in order to restore symmetry (that is, repositioned so that the left and right sides) right of the body "coincide").
    [0064] "Medical device" or "implant" refers to any object placed on the body for the purpose of restoring physiological function, reducing / relieving symptoms associated with a disease, and / or repairing and / or replacing organs and damaged or diseased tissues. Although they are typically composed of biologically compatible synthetic materials (for example, medical grade stainless steel, titanium and other metals or polymers such as polyurethane, silicon, PLA, PLGA and other materials) that are exogenous, some medical devices and implants include materials derived from animals (for example, "xenografts" as whole organs of animals; animal tissues as heart valves; naturally occurring or chemically modified molecules such as collagen, hyaluronic acid, proteins, carbohydrates and others), human donors (for example, "allografts" such as whole organs; tissues such as bone grafts, skin grafts and others), or from the patients themselves (for example, "autografts" such as saphenous vein grafts, skin grafts, tendon / ligament / muscle transplants). Medical devices that can be used in procedures in connection with the present invention include, but are not limited to, orthopedic implants (artificial joints, ligaments and tendons; threads, plates, and other implantable hardware), dental implants, intravascular implants (vascular secondary grafts arterial and venous, hemodialysis access grafts; both autologous and synthetic), skin grafts (autologous, synthetic), tubes, drains, volume forming agents for implantable tissue, pumps, shunts, sealants, surgical networks (for hernia repair networks, tissue molds), fistula treatments, spinal implants (eg, artificial intervertebral discs, spinal fusion devices, etc.) and the like. Suture Application for Minimally Invasive Surgery
    [0065] As discussed above, the present invention features compositions, configurations, methods of manufacture and methods of using self-retaining sutures. The invention overcomes the problems and disadvantages of the prior art by applying self-retaining sutures to the surgical site. Self-retaining sutures can be manipulated by endoscopic surgical instruments and / or assisted by a robot in place to suture, approximate and retain tissue. Several devices have been proposed for applying surgical elements and accessories for use in MIS procedures. The devices are disclosed, for example, in U.S. patent 6,986,780 entitled "Surgical Element Delivery System and Method" by Rudnick et al. and U.S. Patent 7,125,403 entitled "in Vivo Accessories For Minimally Invasive Robotic Surgery" by Julian et al., both of which are incorporated herein by reference in their entirety. Endoscopic Suture Application System
    [0066] A self-retaining suture is, in some modalities, unidirectional, having one or more retainers oriented in one direction along the length of the suture thread; or bidirectional, typically having one or more retainers oriented in one direction along a portion of the wire, followed by one or more retainers oriented in another direction (often opposite) along a different portion of the wire (as described with barbed retainers on US Patent No. 5,931,855 and 6,241,747). Although any number of sequential or intermittent retainer configurations is possible, a common form of bidirectional self-holding suture involves a needle at one end of a suture thread that has barbed ends that protrude "away" from the needle to the point of transition (often the midpoint) of the suture is achieved; at the transition point, the splinter configuration is inverted by about 180 ° (so that the splinters are now facing in the opposite direction) along the remaining length of the suture prior to attachment to a second needle at the opposite end ( with the result that the splinters in that portion of the suture also have the tips pointing "away" from the nearest needle). Projecting "away" from the needle means that the tip of the splinter is further away from the needle and the suture portion that comprises the splinter is, in some embodiments, pushed more easily through the tissue in the direction of the needle than in the opposite direction. In other words, the splinters in both "halves" of a typical two-way self-holding suture have points that point in the middle direction, with a transition segment (without splinters) interposed between them, and with a needle attached to either end.
    [0067] Figure 1A illustrates a self-holding suture system 100. The self-holding suture system 100 comprises needles 110, 112 attached to the self-holding suture 102. Self-holding suture 102 includes a plurality of retainers 130 distributed over the surface of a filament 120. In the entry area section 140 of filament 120 there are no retainers 130. In section 142 of filament 120, there are a plurality of retainers 130 arranged so that the suture can be positioned in the direction of the needle 110, but resist movement in the direction of needle 112. In the transition section 144, there are no retainers 130. The transition section 122 is, in some embodiments, provided with a marker to facilitate the location of the transition section. The transition section 122, as shown, is provided with a visible strip 122 to help identify the transition section. Markers are also, in some embodiments, provided in sections 142, 146 and / or needles 110, 112 to assist in identifying the location of the retainer and guiding a particular portion of the self-retaining suture system 100. In section 146 , there are a plurality of retainers 130 arranged so that the suture can be positioned in the direction of needle 112, but resist movement in the direction of needle 110. Retainers 130 in section 146 are larger than retainers 130 in section 142. The largest retainers are more suitable for gripping fabric that is softer and / or less dense than smaller retainers. In the entry area section 148 of filament 120 there are no retainers 130.
    [0068] A break is shown in each of sections 140, 142, 144, 146 and 148 to indicate that the length of each section is, in some modalities, varied and selected depending on the application for which the suture is intended to be used. For example, the transition section 144 can be located asymmetrically closer to needle 110 or needle 112, if desired. A self-retaining suture that has an asymmetrically located transition section 144 is, in some embodiments, favored by a physician who prefers to use his dominant hand in techniques that require suturing in opposite directions along an injury. The doctor can also start from one end of the wound than from the other and sew the longest portion of the wound with the needle that is located beyond transition section 144. This allows a doctor to use his dominant hand to sew the largest part of the wound with the longest arm of the suture. The longest arm of the suture is that suture section between the transition section and the needle that is located beyond the transition section.
    [0069] Figure 1B illustrates an enlarged view of the self-retaining suture thread 102 in section 142. As shown in figure 1B, a plurality of retainers 130 are distributed over the surface of filament 120. Fixing the self-retaining sutures after positioning in the tissue involves penetrating the ends of the retainer 132 into the surrounding tissue resulting in the tissue being trapped between the retainer 130 and the suture filament body 120. The inner surface 134 of the retainer 130 which is in contact with the tissue that is trapped between the retainer 130 and filament body 120, is referred to herein as the "fabric engaging surface" or "inner retaining surface". As shown in Figure 1B, each retainer 130 has a tip 132 and a tissue retaining surface 134. When the self-retaining suture 102 is moved in the direction of arrow 136, retainers 130 lie flat against the body of filament 120. However , when the self-holding suture thread 102 is moved in the direction of arrow 138, the tip 132 of the retainer 130 engages the filament that surrounds the fabric 120 and causes the retainer 130 to spread from the filament 120 and engage the fabric with the surface engaging the tissue 134 thus preventing movement of the suture in this direction.
    [0070] In alternative modalities, a lock can be applied to a self-retaining suture. Figure 1H depicts a lock 124 located in the transition zone 144 of the self-holding suture system 100. In some embodiments, a lock 124 may carry a marker / code 128 which helps to identify the suture and / or properties thereof. The wick 124 has one or more openings 126 through which the suture 120 can be traversed, as shown. Alternatively, a wick can be connected and / or mechanically attached to suture 120, by, for example, welding, stapling, gluing, fusing. The wick 126 can be used to locate the transition zone, to provide an interruption, so that the wick can be pushed through the fabric only until the wick comes into contact with the fabric, and / or to provide a support for the fabric and organs, to name just a few uses. The wick 126 can take a variety of forms including a wider section that can support the fabric.
    [0071] The ability of the self-holding sutures to anchor and hold tissues in place, even in the absence of tension applied to the suture by a knot, is a characteristic that also provides superiority over common sutures. When closing a wound that is under tension, this advantage manifests itself in several ways: (i) the self-retaining sutures have a multiplicity of retainers that can dissipate the tension along the entire length of the suture (by providing hundreds of "anchor points" ", this produces a superior cosmetic result and reduces the chance that the suture" slips "or passes through) as opposed to sutures interrupted with knots that concentrate tension at different points; (ii) complicated wound geometries can be closed uniformly (circles, arcs, uneven edges) with more precision and accuracy than can be achieved with interrupted sutures; (iii) the self-retaining sutures eliminate the need for a "third hand" that is often necessary to maintain tension through the wound during traditional suturing and knot tying (to prevent "slipping" when tension is momentarily released during tying ); (iv) self-retaining sutures are superior in procedures in which knot tying is technically difficult, such as in deep wounds or laparoscopic / endoscopic procedures; and (v) the self-retaining sutures can be used to approximate and secure the wound before final closure. As a result, self-retaining sutures provide easier handling in anatomically tight or deep locations (such as the pelvis, abdomen and chest) and facilitate the approximation of tissues in laparoscopic / endoscopic and minimally invasive procedures; all without having to hold the knot closed. Greater precision allows self-retaining sutures to be used for more complex closure systems (such as those with unpaired diameters, larger defects or bag sutures) than can be achieved with standard sutures. The superior qualities of the self-retaining suture are particularly beneficial in endoscopic and telesurgical procedures. The self-retaining suture helps to overcome the limitations of dexterity and sensitivity present in endoscopic and tele-surgical instruments.
    [0072] Figure 1C shows an endoscopic suture application instrument 150 for applying a self-retaining suture system 100 to a surgical site on a patient. The suture instrument 150 includes, at the proximal end, a cable 152 connected by an elongated tubular member 154 to a coil 156. The cable 152 allows the positioning and operation of the suture instrument 150 from outside the patient's body. Cable 152 may include one or more actuators 158 which are, in some embodiments, moved relative to each other and / or cable 152 to operate an effector, such as surgical scissors, an application coil etc., located on the application instrument suture.
    [0073] The elongated tubular member connects cable 152 (proximal end) to coil 156 (distal end). The elongated tubular member 154 is a rigid member that is sized to fit through an access door to the patient's body. Preferably, the tubular member 154 is about or less than 12 mm, 8 mm and 5 mm. The elongated tubular member 154 must be large enough to reach the desired surgical site through the access port. For laparoscopic instruments, for example, the elongated tubular member 154 is between 180 mm and 450 mm long and is typically 360 mm long for adults and 280 mm long for pediatric surgery. Typically, the access door will be 12 mm in diameter or less. Preferably, the access door will be 10 mm in diameter or less. In some cases, the access door is, in some embodiments, 8 mm or 5 mm in diameter or less. In general, smaller access doors are preferred to reduce damage to patient tissues, however, the parts must be large enough to allow instruments that have the functionality to perform the desired surgical manipulations to enter. The diameter of the elongated tubular member 154 and the coil 156 will be smaller than the inner diameter of the access door so that the distal portion of the suture instrument is, in some embodiments, introduced through the access door.
    [0074] Figure 1D shows a cartridge 170 that includes a coil 156 and a connector 172. The connector 172 allows the cartridge 170 to be releasably attached to the distal end of the elongated tubular member 154. In some embodiments, an actuator 158 controls securing and releasing cartridge 170. A selection of sterile cartridges 170 is, in some embodiments, provided for a procedure, each supporting a different self-retaining suture. Thus, the suture application instrument 150 can be used by the surgeon or assistant to select and apply multiple self-retaining suture systems 100 during the course of a procedure. In alternative embodiments, the coil 156 is, in some embodiments, permanently fixed to the end of the suture instrument 150. As shown in Figure 1D, the coil 156 can also include one or more needle docks 157 to support the needles 110, 112 of the self-holding suture system 100. Needles 110, 112 are removably attached to needle docks 157. Needles 110, 112 are removed from needle docks 157 to allow positioning of the self-holding suture thread 102. In some embodiments, needles 110, 112 are replaced on needle docks 157 to allow removal of needles 110, 112 and any excess self-retaining suture 102 after positioning the self-retaining suture 102.
    [0075] As also shown in figure 1D, cartridge 170 includes a marker 174. As shown in figure 1D, marker 174 is a QR code. A QR code is a machine-readable matrix code or two-dimensional bar code designed to allow rapid decoding of its content. In particular, QR codes can be quickly recognized and decoded into camera images. The QR code, in some modalities, directly identifies the properties of the suture and, in other cases, identifies the location (URL or other) of properties that identify suture data. The suture properties are then shown with the image of the surgical site provided to the surgeon (see figure 1G). The information shown allows the surgeon to verify that the cartridge is loaded with the desired suture. Although a QR code is shown in Figure 1D, potential markers include, but are not limited to: visible markers in the visible light frequency range; alphanumeric markers, QR code markers, markers invisible to the naked eye, but which can be viewed under conditions of surgical use; recognizable markers in the non-visible radiation frequency range; detectable markers with ultrasound; markers that are machine readable; markers that are readable by humans; bookmarks that are, in some modalities, read remotely; markers that are active markers (including RFID); and markers that are passive markers (including passive RFID). The suture properties that can be associated with the marker include, but are not limited to: length, diameter, material, needles, presence of retainers, absence of retainers, source / mark and / or other fixed properties. In addition to fixed or static properties, a marker can be used to identify dynamic properties. For example, the movement of the cartridge and / or suture through the forces that are applied on the cartridge can cause the marker to move, and such movement can be observed through the tele-surgical system in order to track the location of the change of the cartridge and the suture. Such a movement can be translational movement or rotational movement. With tracking the rotational movement of the bobbin, for example, the amount of suture removed from the bobbin can be traced. The markings placed, additionally, on the suture can be used to identify the place of alteration of the suture and, in addition, for example, of the tension exerted on the suture. Appointments can also be used with a voice-controlled telesurgical system. The surgeon speaks the type of suture desired, and the telesurgical system then carries the cartridge over the end of a tool located on an arm of the telesurgical system for positioning on a patient.
    [0076] Coil 156 is mounted on the distal end of elongated tubular member 154 and is dimensioned so that it can slide through an access door to the patient's body. The coil 156 supports the self-holding suture system 100 thus allowing the self-holding suture system 100 to be applied through an access door to the surgical site on the patient. Figure 1E shows the distal portion of the suture instrument 150 inserted through an access port 160 on a patient 162. The suture instrument 150 is inserted through a cannula 164 into the access port 160. The instrument of suture Suture application 150 is, in some embodiments, slid in and out of cannula 164 as shown by arrow 166. Suture application instrument 150 and cannula 164 can also rotate around access door 160 as shown by arrows 168. Thus, the suture application instrument 150 allows the coil 156 to be applied to a surgical site in the patient 162.
    [0077] Figure 1F shows the application of a self-retaining suture system 100 to a surgical site in a patient. As shown in Figure 1F, an endoscope 180 illuminates the surgical site with one or more light sources 182. The endoscope 180 also generates images of the surgical site through one or more imaging devices 184. The endoscope 180 thus illuminates the site surgical. The dotted circle 186 indicates the field of view that is, in some modalities, transmitted to the surgeon. Note that the suture application instrument 150 has been inserted in order to position a coil 156 of a cartridge 170 in the field of view. The end effectors (scissors, forceps and the like) of one or more surgical endoscopic instruments 190 also appear in the field of view. The surgeon can operate the surgical endoscopic instruments 190 to grasp the needles 110, 112 supported by the coil 156. The surgeon can then operate the surgical endoscopic instruments 190 to position the self-holding suture 102 on the tissue 192. After positioning the wire of self-retaining suture 102, the surgeon can operate surgical endoscopic instruments 190 to replace needle 110, 112 on coil 156 and cut any unused self-retaining suture thread 102. The suture instrument 150 can then be removed the surgical site thus removing the needles and any excess self-retaining suture 102 from the patient's body.
    [0078] Figure 1G shows an example of an image 194 on a screen 196 of the surgical site of figure 1F as displayed to a surgeon. The dotted circle 186 indicates the field of view available from the endoscope (not shown). Note that the suture instrument 150 has been inserted in order to position a coil 156 of a cartridge 170 in the field of view 186. The marker 174 of the cartridge 170 is visible in the image. A computer system associated with screen 196 identifies and translates marker 174. As shown in figure 1G, the suture property information 176 associated with marker 174 is shown to the surgeon in image 194. The information shown allows the surgeon to verify that the cartridge is loaded with the desired suture. The information shown can be static or dynamic information. For example, when identifying the suture, the image display system can also show other suture property information 176 relevant to the suture. For example, the tension captured by endoscopic instruments can be shown as a percentage graph of the maximum assessed tension of the identified suture. Robot-Assisted Suture Application System
    [0079] As described above, minimally invasive telesurgical systems were developed to increase the surgeon's dexterity while working at an internal surgical site, as well as to allow a surgeon to operate on a patient from a remote location. In a telesurgery system, the surgeon is provided with an image of the surgical site on a console. When observing an image of the surgical site on a suitable screen, the surgeon performs the surgical procedures on the patient by manipulating the console's input devices. The input devices control a robot arm that positions and manipulates the surgical instrument. During the surgical procedure, the tele-surgical system can provide mechanical actuation and control of a variety of surgical instruments or instruments that have end effectors, for example, tissue clamps, cauterizers, needle drivers, or the like, that perform various functions to the surgeon, for example, withhold or activate a needle, grab a blood vessel, or dissect tissue, or the like, in response to manipulation of the master control devices. The DAVINCI® Surgical System from Intuitive Surgical, Inc. is an example of a MIS tele-surgical system.
    [0080] In a telesurgical procedure, sutures, including self-retaining suture systems, can, in some modalities, be introduced into the surgical site using the suture application instrument 150 previously described in relation to figures 1C to 1G. The suture application instrument could be operated manually by the surgeon. However, this requires the surgeon to leave the workstation. Alternatively, the suture delivery instrument 150 can be operated manually by a surgical assistant. However, this requires the assistant to insert the suture instrument manually without the visualization provided by the workstation. According to another embodiment of the present invention, a suture application instrument is provided which interfaces with the telesurgery system. The suture application instrument is used to apply the self-retaining suture to the surgical site under the command of the surgeon. Such a suture application instrument advantageously leverages the capabilities of the telesurgery system to precisely apply the self-retaining suture to the surgical site under the control of the surgeon at the workstation and with the use of the visualization capabilities of the telesurgery system. In addition, certain portions of the suture operation are, in some modalities, safely automated to facilitate the application and repeated extraction of sutures to the surgical site after initial configuration under the control of the surgeon. The surgeon controls the suture instrument with one or more console inputs, which may include, for example, a switch, keyboards, motion controllers and / or voice input devices.
    [0081] Figure 2A shows a suture application tool 250 suitable for use with a telesurgery system. The suture tool 250 includes, at the proximal end, a box 252 connected by a tool stem 254 to an end effector including a coil 256. Box 252 can be mounted on interface 246 of a manipulator arm 240 to allow for positioning and operation of the suture application tool 250 from outside the patient's body. Suture application tool 250 includes a coil 256 mounted at the distal end of tool shank 254. Coil 256 supports the self-holding suture system 100 thus allowing the self-holding suture system 100 to be applied via a cannula / guide 264 to the surgical site in the patient. Coil 256 is sized so that it can slide through the cannula / guide 264 into the patient's frame.
    [0082] Tool rod 254 connects box 252 (proximal end) to coil 256 (distal end). The tool shank 254 is a rigid member that is dimensioned to fit, through an access door, to the patient's body. Alternatively, the tool shank can be flexible. The tool shank itself can be controlled by the telesurgical system, so that the tool shank can be "contorted" to a desired location. The tool shank 254 must be long enough to reach the desired surgical site through the access door. The diameter of the tool shank 254 and the coil 256 should be small enough so that the distal portion of the surgical tool 250 is, in some embodiments, introduced through the cannula / guide tool / access port 264 into the patient. The tool shank 254 may contain one or more mechanical connections to transfer movement of the gears 258 in the case, to an end effector at the distal end of the tool shank 254.
    [0083] Figure 2A also shows the portion of a manipulator arm 240 on which a suture application tool 250 is, in some embodiments, mounted. The box 252 of the suture application tool 250 (or other tool) is, in some embodiments, releasably mounted on the interface 246 on the manipulator arm 240. The box 252 includes one or more clips 253 that engage corresponding structures on the interface 246 to retain box 252 to interface 246. Note that interface 246 can be moved up and down on rail 247 to slide a tool in and out of the cannula / guide tool 264. The movement of interface 246 along of rail 247 is performed by a transducer / actuator. The rail 247 is long enough that when the interface 246 is moved to the proximal end of the rail (the end furthest from the patient), a suture application tool 250 mounted on the interface is completely retracted from the cannula / guide tool 264. Thus, a suture application tool 250 is, in some embodiments, fitted into or released from interface 246 when interface 246 is at the proximal end of the rail. The suture application tool 250 can then be inserted through the access port 264 using the transducer / actuator to advance the interface 246 along the rail 247 towards the access port 264.
    [0084] As shown in figure 2A, box 252 of suture tool 250 can include one or more gears 258 to control the movement / operation of portions of suture tool 250. Interface 246 includes a plurality of gears equipped with motor 248 that mesh with the plurality of gears 258 in housing 252 when housing 252 is mounted on interface 246. This allows gears equipped with motor 248 from the interface to be used to rotate tool shank 254 and / or coil 256 and / or operate other mechanical operations of the suture application tool. For example, the suture application tool 250, in some embodiments, includes at its distal end, a claw to hold needles for removal from the patient or a cutter to cut the suture during the procedure; the claw or cutter is, in some embodiments, operated by gears equipped with a motor 248 through the corresponding gears 258 in box 252.
    [0085] Figures 2B and 2C show a suture application tool 250 mounted on a manipulator arm 240. Box 252 is held at interface 246 by one or more clips 253 (not shown). One or more release levers 257 are accessible when box 252 is mounted on interface 248 to release tabs 253 (not shown) when desired. The coil 256 is, in some embodiments, permanently attached to the suture tool 250 or may be part of a cartridge that is, in some embodiments, releasably attached to the suture tool 250. In some embodiments, the bobbin is permanently or fixed releasably at a fixed location of the suture tool 250. The bobbin 256 is fixed (in this example) to the distal end of the suture tool 250. To introduce the bobbin 256 in one place in the individual, interface 246 is first moved to the proximal end of rail 247 (the patient’s farthest end). The box 248 of the suture application tool 250 carrying the coil 256 is then fitted to the interface 246 of the manipulator arm 240, as shown in figure 2B. The interface 246 then advances linearly towards the patient following the path 247. The movement of the interface 246 following the path 247 inserts the coil 256 and the self-holding suture 100 through the cannula / guide tool 264 into the patient, as shown in the figure 2C. The self-retaining suture 100 can then be positioned at the surgical site on the patient by the manipulator arm 240.
    [0086] When coil 256 has been positioned at the surgical site, the self-retaining suture 100 is positioned to be removed from coil 256 by another instrument. In some embodiments, additional needles and sutures are fixed to the bobbin after suture placement. Suture application tool 250 and bobbin 256 (and, optionally, needles and excess suture) are removed from the body by retracting interface 246 to the proximal end of rail 247 (the end furthest from the patient) as shown in figure 2B. If another suture is needed, suture tool 250 is exchanged for another suture tool, or a cartridge that includes coil 256 is removed and replaced with a new cartridge that has a new coil 256.
    [0087] Figure 2D shows a view of the manipulator arm 240 with the distal portion of the suture tool 250 inserted through an incision 260 in a patient 262. The suture tool 250 is inserted through a cannula 264 in the incision 260. Cannula 264 is attached to the manipulator arm 240. The suture application tool 250 is releasably attached to the interface 246 on the manipulator arm 240. The manipulator arm 240 can position the suture application tool 250 and the coil 256 in three dimensions and rotate the suture tool 250 on the insertion axis while restricting movement (prevents lateral displacement) in incision 260. The suture tool 250 is slid in and out of the cannula 264 as shown by the arrow 266. The suture tool 250 and the cannula 264 are adapted to be rotated over the incision 260 as shown by arrows 268, 269. The movements of the suture tool suture application in three or more dimensions to patient 262 is thus under the control of the manipulator arm 240 allowing coil 256 and suture 100 to be applied to a desired position at the operating site and / or in the field of view of the surgeon . [0088] Figures 2E and 2F show an example of a telesurgical system 200 that includes a plurality of manipulator arms 240, one of which can be used to position the suture tool 20 on a patient. Figure 2E shows a perspective view of the telesurgical system while figure 2F shows a functional block diagram of the telesurgical system 200. As shown in figures 2E, 2F, the telesurgical system 200 comprises a manipulator system next to patient 204 and a patient console. surgeon 201. The manipulator system next to patient 204 includes a plurality of manipulator arms 240 mounted on an adjustable support 242. The manipulator arms 240 comprise a plurality of mechanical connections and a plurality of transducers / actuators. Transducers / actuators are, in some modalities, electric motors, for example, stepper motors and / or servo motors. In alternative modes, the actuators are pneumatic, hydraulic, magnetic or other transducers that have the ability to effect movement of the connections in response to the control signals. The position of the connections is monitored using a plurality of sensors 270; for example, linear or rotary optical encoders. The connections are adapted to be moved independently by a plurality of actuators 272; for example, stepper motors and format memory actuators. In some cases, actuators 272 can also be sensors 270; for example, stepper motors act as actuators, position encoders and force sensors.
    [0089] The endoscope, the suture instrument and one or more surgical instruments are coupled to the manipulator arms 240. The number of manipulators next to the patient and instruments used will vary depending on the procedure. A manipulator system next to patient 240, in some modalities, includes two mechanical manipulator arms 240 to operate surgical instruments and a manipulator arm 240 to position the endoscope. A suture application tool is, in this modality, positioned and operated by one of the two manipulator arms 240 to operate surgical instruments. A suture is, in some cases, inserted into the suture application tool 250 and then the suture application tool is exchanged for another surgical tool such as a needle or claw driver. In some systems, a fourth arm is provided. In such systems, the suture application tool is positioned and operated by the fourth manipulator arm. The surgeon can switch between controlling the surgical instruments and controlling the suture tool without having to change the suture tool for a surgical instrument.
    [0090] The surgeon console 201 comprises a display system 212, a control system 214 and a processing system 218. Display system 212 includes a 2D or 3D video screen 213 and one or more from an output system audio, power feedback system, touch screen and other display elements, for example, lights, sound emitters, etc. The display system 212 provides the surgeon 202 with an image of the surgical site and can also provide other information in visual, audible and / or tactile formats. The control system 214 can include one or more of a variety of input devices; for example manually operated controllers 215, joysticks, gloves, keyboards 216, buttons, pedals 217, touch screens, mouse and the like. A microphone can also be provided, so that the surgeon can provide voice commands to the control system. The particular components are elements of both display system 212 and control system 214; for example, manual power feedback controllers and touch screens that both display information and receive input.
    [0091] Surgeon 202 performs a minimally invasive surgery procedure by manipulating control devices from the control system 214. The output from the control system 214 is received by a processing system 218. A function of the processing system 218 is translate the output of the control system 214 into control signals for the operation of the manipulator system with patient 204. The surgeon's console 201 is connected by cable 206 to manipulators with patient 240 and 242. The operation of control devices by the surgeon 204 operates the manipulator system with the patient 204 and the manipulator arms 240 to position and operate surgical instruments and an endoscope attached to the manipulator arms 240. The endoscope produces images of the movement of the surgical instruments and these images of the surgical instruments are transmitted to the system 218. The processing system transforms the image of surgical instruments cos and transmits it (and other information) to the display system 212, so that it can be observed by the surgeon 202.
    [0092] Figures 3A and 3B show an alternative suture tool 350 mounted on a manipulator arm 240. The suture tool has a loading slot 310 for receiving a cartridge 320 including a coil 356. The cartridge 320 is dimensioned and configured to fit, through the loading slot 310, to the tool shank 354 as shown in figure 3A. Suture application tool 350 has a transport mechanism 312 for moving cartridge 320 from loading slot 352 to the distal end of suture application tool 350 where it is accessible through application slot 314 for removing suture 100. In some embodiments, the driven gears 248 of a manipulator arm 240 operate the conveyor mechanism through corresponding gears (not shown) in box 352. The conveyor mechanism 312 is, for example, a screw or the like to move a cartridge linearly through of the 354 tool shank.
    [0093] In order to introduce the coil 356 into a surgical site on a patient, the distal end of the suture application tool 350 is first positioned in the surgical site under the surgeon's control. The cartridge 320 is then loaded into the loading slot 310 of the suture application tool 350. The transport mechanism 312 is then operated to move the cartridge 320 from the loading slot 310 to the application slot 314 at the distal end. suture tool 350 as shown by arrow 317. When cartridge 320 reaches the distal end of suture tool 350, cartridge 320 is exposed sufficiently in application slot 314 so that the suture and needles are exposed to be accessed and removed from cartridge 320 as shown in figure 3B. The self-holding suture 100 is then removed from cartridge 320 by another surgical instrument at the surgical site. In some embodiments, the coil 356 can be rotated in the application slot 314 to remove the suture from the coil. In some embodiments, the additional needles and sutures are re-attached to the cartridge 320 after positioning the self-holding suture 100. The cartridge 320 is then removed from the body by operating the transport mechanism 356 in the opposite direction to retract the cartridge 320 from the application slot 314 for loading slot 310 where cartridge 320 is positioned to be removed and replaced with a new cartridge 320.
    [0094] Advantageously, one or more cartridges 320 are applied through the suture application tool 350 automatically. The automatic application of cartridges is safe because the cartridge 320 remains within the limits of the suture tool 350. Additionally, the suture tool itself does not change position during automatic application of the cartridge (only the cartridge is moved ). Once the suture application tool has been positioned under the surgeon's guidance, there is little or no possibility of inserting or retracting a new cartridge 320 that causes tissue damage at the surgical site. Thus, the presentation and removal of suture cartridges 320 is carried out automatically or by the surgeon's assistant without the need to check the position for application of subsequent cartridge applications.
    [0095] Figure 3C shows a modality of a suture application tool 350 that is adapted to move a cartridge 320 from a proximal end of stem 354 to the distal end of stem 354. Figure 3D shows a section through the stem of tool 354. Figures 3E and 3F show views of an embodiment of a cartridge for use with the suture application tool 350 of figure 3C. Figure 3C shows internal components of the box 352 and the tool stem 354. As shown in figure 3C, the transport mechanism comprises a threaded bar 316 that runs the length of the tool stem 354. The threaded bar 316 is supported at each end by a pad that allows rotation of the threaded bar. A capstan 360 in box 352 is directly connected to a gear in box 352 which is adapted to fit a driven gear from the manipulator arm interface. A transmission mechanism transmits rotation of the capstan 360 to rotation of the threaded bar 316. The transmission mechanism is, in some embodiments, a geared mechanism or may comprise a pulley driven system, as shown in figure 3C. As shown in figure 3C, a loop of the cable 364 is wound around the capstan 360 and the free pulley 364 between the capstan 360 and the free pulley 364, the cable 364 is also wound around a pulley 366 mounted on the threaded bar 316 Thus, when the capstan 360 is rotated by a gear driven from the manipulator arm, the threaded bar is rotated. When a cartridge 320 is inserted into the loading slot 310, a groove 322 in the cartridge 320 engages with the threaded bar 316.
    [0096] When the cartridge 320 is engaged with the threaded bar 316, rotation of the threaded bar 316 results in movement of the cartridge up or down of the tool shank 354 depending on the direction of rotation of the threaded bar 316. The threaded bar 316 can be rotated in one direction to move cartridge 320 from loading slot 310 to application slot 316. Threaded bar 316 can be rotated in the opposite direction to move cartridge 320 from application slot 316 back to loading slot 310 where it can be removed / replaced. Note that, in some embodiments, what is shown as a cartridge in Figure 3C is a carrier that is an integral part of the suture application tool 350. In such embodiments, instead of removing and replacing a cartridge, the sutures are loaded and unloaded from the conveyor to be transported to or from the distal end of the suture tool 350.
    [0097] Figure 3D shows a sectional view through rod 354 along line D — D of figure 3C. The position of a cartridge 320 on the stem is shown by the dashed line. Note that the interior of the groove 322 is pushed against and engaged with the threaded bar 316. Also note that the rod 354 has an internal ridge 318 that also engages the groove 322 to prevent rotation of the cartridge 320.
    [0098] Figures 3E and 3F show a modality of a cartridge 320 suitable for use with the suture application tool 350 of figures 3C and 3D. As shown in figure 3E, cartridge 320 comprises a cylinder several centimeters long and having a slightly smaller diameter than the inner diameter of rod 354. Cartridge 320 has a groove 322 on the rear surface. The groove 322 is dimensioned to fit over the threaded bar 316 and the crest 318 of the suture application tool 350. The groove 322 has surface characteristics 324 to engage the threaded bar 316. The surface characteristics 325 include, for example, threads, ridges or similar contact points that can engage threaded bar 316 to cause linear movement of cartridge 320. Cartridge 320 has an opening 321 in the front surface through which a self-holding suture 100 is loaded into hollow chamber 326. The hollow chamber contains docks needle 328 to releasably secure the needles 110, 112 of the self-holding suture 100. The suture thread 102 is positioned linearly to the hollow chamber 326 passing around pin 329 to hold the self-holding suture 100 in position during transfer. Where a longer suture is required, the self-holding suture 100 is wound with cartridge 320. Cartridge 320 may additionally comprise more needle docks and projections so that cartridge 320 can retain two or more self-holding sutures 100. C. Suture Cartridges for Suture Application Systems
    [0099] Figures 4A to 4G show several suture cartridges suitable for use with MIS suture application instruments, according to the modalities of the present invention. In general, the cartridge should have a diameter smaller than the diameter of the access door, that is, typically, the cartridge should be 10 mm in diameter or less. The length of the cartridge will be determined by the amount of suture to be contained. As a practical matter, the cartridges will preferably be a fraction of the length of the suture tool. Thus, the cartridges are preferably 120 mm or less in length and more preferably 80 mm or less in length. In some circumstances, the cartridges are 10 mm or less in length. The cartridge should have a coupling, opening, groove or similar to attach the cartridge to the suture tool or engage the suture tool drive mechanism. Each of the cartridges and bobbins discussed in this document is adaptable for use with each of the suture application instruments discussed in this document by adding the appropriate fitting characteristics to engage the suture application tool.
    [00100] Figure 4A shows a cartridge 410 that comprises a coil 412 that has a helical groove 414. As shown in figure 4A, the self-holding suture 100 is wound around the coil 412 in the helical groove 414. In preferred embodiments, the The cartridge includes a mechanism to prevent entanglement of the suture or the self-holding suture. For example, with respect to cartridge 410, the retainers in section 142 facing in a given direction are separated from the retainers in section 146 facing in an opposite direction (and that is separated from section 142 by transitional segment 144). The self-holding suture 100 is, in some embodiments, wound sufficiently tightly around the coil 412 whose pluralities of retainer do not overlap each other; for example, needles 110 and 112 at either end of the self-retaining suture 100 are, in some embodiments, removably engaged with needle seating locations 416 and 417, respectively, in order to achieve such tension.
    [00101] Note that the helical groove 414 is deep enough, so that suture 100 does not protrude above the ridges between the turns of groove 414. It should be understood that, in this particular embodiment, that the friction coupling structures can be used to hold suture 100 on bobbin 412 in place in the grooves. Note that suture 100 must be unwound from coil 412 thus requiring coil 412 to be mounted in a way that allows it to rotate or be assembled without obstruction to the unwinding of suture 100 from coil 412. As shown in figure 4A, the cartridge 410 has a central opening 418 for mounting the cartridge on a pin at the end of a suture tool (for example, the suture tool 150 in figure 1C or the suture tool 250 in figure 2A. The opening it is provided with a locking mechanism, so that the pin is releasably retained in the opening 418 while still allowing rotation of the cartridge 410 during removal of the self-holding suture 100.
    [00102] Figure 4B shows a partial sectional view of a variation of cartridge 410 of figure 4A. In the embodiment of figure 4B, coil 412 is provided with a cover 430 that fits over coil 412, retaining suture 100 in groove 414. Suture 100 can be removed by sliding cover 430 out of coil 412 (from increasing or at once). Alternatively, cover 430 is produced from a material that can be divided by the suture while suture 100 is unwound. The cover 430 can, for example, be perforated along the groove 414 so that the suture 100 is adapted to be pushed through the cover 430 while it is unwound from the coil 412. Such cover can also be used with other cartridges described in this document. A cover is useful to protect the suture during application to the surgical site and to retain the suture in the cartridge during application. In some modalities, the cover is removed by the surgeon using another surgical instrument. In other embodiments, the cover is removed through the application of the suture application tool to which the cartridge is attached.
    [00103] As shown in figure 4C, the self-holding suture 100 is wound around the coil 422 in double helical grooves 424. The retainers of section 142 facing in a given direction are spaced from the retainers of section 146 facing in the opposite direction ( and that is separated from section 142 by the transitional segment 144). The self-holding suture 100 is, in some embodiments, wound sufficiently tightly around coil 422 whose pluralities of retainer do not overlap one another. For example, needles 110 and 112 at either end of the self-holding suture 100 are, in some embodiments, removably engaged at needle seating locations 426 and 427 and the transitional segment 144 can be wrapped around pin 423 , respectively, in order to achieve such tension. Note that the helical groove 424 is deep enough that suture 100 does not protrude above the ridges between the turns of grooves 424. It should be understood that, in this particular embodiment, that the friction engagement structures can be used to retain the suture 100 on coil 422 in place in the grooves. Note that suture 100 must be unwound from coil 422 thus requiring coil 422 to be mounted in a way that allows it to rotate or be mounted without obstruction to the unwinding of suture 100 from coil 422. As shown in figure 4A, cartridge 420 it has a central protrusion 428 for mounting the cartridge on the end of a suture tool, for example, the suture tool 150 of figure 1C or the suture tool 250 of figure 2A. The protrusion is provided with a locking mechanism 429 so that the protrusion is releasably retained in a suture tool while still allowing rotation of the cartridge 420 during removal of the self-holding suture 100.
    [00104] Groove 414 or grooves 424 are, in some embodiments, provided with retention characteristics to releasably retain the self-holding suture 100 to handle the self-holding suture 100 while it is unwound from a coil. For example, as shown in the figure, 4D, the groove is shaped so that the adjacent walls of the grooves are approximately parallel and slightly closer than the diameter of suture 100. The walls thus serve to keep suture 100 in the groove even when tension in suture 100 is released. The walls are flexible enough, so that they can be pushed with a slight force to admit and release the suture 100 while it is wound in or out of the bobbin. This helical groove configuration forms what is essentially a continuous helical loop which slightly retains suture 100 on the coil surface. Other groove and loop configurations are used in alternative modalities to hold suture 100 in place. For example, the removable clips are positioned intermittently along the helical groove. Alternatively, a removable adhesive or gel is provided continuously or intermittently along the helical groove to secure suture 100 in the absence of tension. The coils of the various modalities of this document retain the sutures so as not to compress or reposition the retainers. In general, retainers in the suture are assumed. That is, the retainers are outside or away from the suture structure. In a container or cartridge such as a coil, it may be desirable that the retainers remain away from the suture structure and are not compressed close to the suture body. Additionally, it should be understood that some materials such as polymers, whose suture body is constituted, may have a memory. That is, the suture can develop an adjusted shape after being helped in a certain shape for an instant, as it is retained in a container. With a coil, the suture can be adjusted or have a memory of a suture with very small ties. This can be advantageous in a situation where tight radius suturing is desired. With the suture fitted with tight loops, the suture can be manipulated while it is in a bobbin and the tight suture loops help to facilitate sewing the fabric with tight radius points. In addition, with these cartridges, the drug can be coated on the internal surfaces of the cartridges so that, while the suture is removed from the cartridges, drugs coated on the surfaces of the helical grooves, for example, can be removed from the suture for application to the fabric.
    [00105] Cartridges 410 and 420 are preferably 10 mm or less in diameter so that they can fit through a cannula / guide on a patient. The length of cartridges 410, 420 may vary depending on the length of the self-holding suture 100 and the number of groove turns required to retain the self-holding suture 100. For example, if coils 412, 422 are 10 mm in diameter, approximately 30 mm of the suture will be removed with a loop around the coil. Thus, a 70 mm total length suture will require less than three groove turns around the coil. A 140 mm total length suture will require less than five groove turns around the coil. These three to five groove turns can be readily supplied in a 10 mm cartridge in a coil 10 mm or less in length. This allows three to five cartridges 10 mm or less in length to be mounted on the end of a suture tool to
    multiple self-retaining sutures in a surgical site at the same time. As shown in Figure 4E, a suture application tool 450 includes a spindle 452. A plurality of cartridges 454 each retaining a self-holding suture 100 including needles is received over spindle 452. Each cartridge 454 has a central opening 455 that fits over spindle 452. Spindle 452 has, at its distal end, a retract 456 to reliably retain a plurality of cartridges on spindle 452 during use. Additional clips 456 are, in some embodiments, provided along the length of spindle 452 so that a number less than the maximum number of cartridges is, in some embodiments, held securely on spindle 452.
    [00106] Figures 4F and 4G show two partial section views of a 460 suture cartridge suitable for use with MIS suture application instruments, in accordance with the modalities of the present invention. In cartridge 460, the self-holding suture 100 is arranged in a linear configuration. The linear configuration is suitable for shorter sutures that are often used in MIS surgery. For example, in one embodiment, the self-holding suture 100 is, in some embodiments, approximately 70 mm in total length with each of sections 142 and 146 having approximately 35 mm in length. The cartridge 460 would be approximately 40 mm long to accommodate the 70 mm suture in the configuration of figure 4F. In another embodiment, the self-holding suture 100 is, in some embodiments, approximately 140 mm in total length with each of sections 142 and 146 having approximately 70 mm in length. The cartridge 460 would be approximately 80 mm long to accommodate the 140 mm suture in the configuration of figure 4F.
    [00107] As shown in figures 4F and 4G, the cartridge 460 is approximately cylindrical and has a projection 462 at its proximal end to releasably engage a suture tool. The cartridge 460 has an inlet 464 at its distal end to allow access to the interior of the cartridge 460. There are, at the adjacent inlet 464, a plurality of needle docks 466 for releasably retaining a plurality of needles. As shown in figures 4F and 4G, a self-holding suture 100 is contained in cartridge 460 with needles 110 and 112 releasably attached to the entrance 464 by needle docks 466. A longitudinal divider 467 separates sections 142 and 146 from the self-holding suture 100. Section 144 of the self-holding suture 100 passes through a slot 468 in divider 467. When positioned, the self-holding suture 100 can be pulled along / through slot 468 towards entrance 464. Slit 468 is open with the entrance 464 allowing the self-holding suture 100 to be released from cartridge 460.
    [00108] The 460 cartridge can include several different sutures in similar configurations and spaced from each other by dividers or similar. As shown in figure 4H, multiple loops of suture 100 are separated from each other by dividers 472 so that each suture is, in some embodiments, removed individually from a cartridge. The stacked sutures can then be loaded into a 470 suture cartridge. The 470 cartridge has enough needle docks for each of the suture needles. In use, the surgeon can remove a suture and its associated needles at a time without disturbing other sutures 100. Suture Cartridge Loader For Suture Application Systems
    [00109] In some situations, it is desirable, in some modalities, to automate the application, loading and exchange or the suture application cartridges for a suture application tool in a telesurgery system. In one example, in which telesurgery must be performed in a remote location, there is, in some modalities, an assistant with the patient to load cartridges in a suture application system. In another example, it is, in some modalities, more beneficial or reliable to let the surgeon select a suture of choice using the surgeon's console as an interface rather than relying on communication between the surgeon and an assistant with the patient. A suture cartridge carrier holds a plurality of suture cartridges. A selector mechanism allows a surgeon to select a cartridge to be loaded into a suture tool from the cartridges available in the magazine. A cartridge loading / unloading mechanism loads the cartridge over the suture application tool and unloads the cartridge after positioning the suture. This allows the surgeon to choose a suture and position it in the surgical site using the surgeon's console controls without the use of an assistant.
    [00110] Figures 5A-5C show a suture cartridge loader 500 which is adapted to select, load and unload cartridges 520 in a suture application tool 550 mounted on a manipulator arm 540. Box 552 of the cartridge loader Suture 500 is releasably mounted on interface 546 on the manipulator arm 540. The loader 500 is, in this mode, mounted on interface 546 adjacent to a loading slot 522 in the suture application tool 550. Thus, in this mode, the loader 500 is in a fixed position in relation to the suture tool 550. In other embodiments, such as in which a cartridge is loaded at the distal end of a suture tool, the loader 500 is, in some embodiments, mounted on a fixed position in relation to the manipulator arm 540. In such a case, the suture tool retracts to place the distal end of the tool in the loading position and is then av towards the patient.
    [00111] As shown in figures 5A-5C, a support 502 is mounted on the interface 546. The support 502 carries a selector mechanism 504 and a loading / unloading mechanism 506. The loader 500 has an arched shape and has a plurality of loaded wings with spring 508 each adapted to releasably hold a cartridge. The number of wings can be selected based on the needs of the system. The wings 508 are opened towards the inside and outside of the loader. However, a cover 510 substantially covers the charger 500 so that only one wing 508 is exposed at an entrance 512 at any time. The wings can rotate with respect to the cover 510 so that any of the wings 508 is, in some embodiments, adjacent to the inlet 512. The magazine 500 is mounted on the support 502 so that the inlet 512 in the cover 510 is adjacent to the suture 550.
    [00112] The selector mechanism 504 engages the magazine 500 so that it rotates the wings 508 beyond the entry 512 and the suture application tool 550 as shown by the arrow 514 of figures 5A and 5B. The selector mechanism 504 can rotate the wings 508 after the entry 512 for sequential loading of the cartridges 520. Alternatively, since the cartridges 520 are, in some modalities, loaded with different sutures, it is, in some modalities, desirable to allow selectable loading and unloading any of the cartridges. The data related to the sutures are, in some modalities, entered into the system manually by loading the loader, or, more preferably, each cartridge comprises a machine-readable device, such as a bar code or RFID tag, which identifies the loaded suture in the cartridge. The system can thus automatically determine the sutures available in a magazine and the position of the respective cartridges in the magazine by reading each machine-readable device in sequence when the magazine is loaded. The surgeon's console should show data related to the sutures available in cartridges available in the carrier for the surgeon and allow the surgeon to select a suture for use in the procedure. When the surgeon selects a suture, the selector system 504 thus prepares the magazine 500 until the desired cartridge 520 is positioned adjacent to the inlet 512 and the suture application tool 550. The selector system 504 is preferably operated by one or more plus surgeon-controlled transducers / actuators from the surgeon's console. In some embodiments, the selector system 504 can be coupled to a driven gear 248 (see figure 2A) of interface 546.
    [00113] When the desired cartridge 520 is positioned adjacent to the inlet 512 and the suture tool 550, the loading / unloading mechanism 506 is activated to push the cartridge 520 from the spring loaded wing 508 through the inlet 512 and into the loading slot 522 of the suture application tool 550 (see arrow 516 in figure 5C). The suture tool transport mechanism can then be activated to transport the cartridge 520 to the distal end of the suture tool 550 for positioning the suture. After positioning, cartridge 520 is transported back to the loading slot of the suture tool 550. The loading / unloading mechanism 506 is then activated to push cartridge 520 from the loading slot into the spring loaded wing. 508. A new suture can then be selected by the surgeon and the cartridge prepared and loaded automatically in response to the suture selected by the surgeon. The 506 loading / unloading mechanism is operated by one or more transducers / actuators controlled by the surgeon from the surgeon's console. In some embodiments, the loading / unloading mechanism 506 can be coupled to a driven gear 248 (see figure 2A) of interface 546.
    [00114] Note that the totality of the suture application systems described in this document is, in some modalities, used for the application of flat sutures. In addition, suture delivery systems are, in various modalities, used for applying self-retaining sutures in a wide variety of configurations including one-way self-retaining sutures, one-way self-retaining sutures that have an anchor at one end and a needle in the other end; and / or bidirectional self-holding sutures as discussed in this document.
    [00115] Figure 6A illustrates an alternative embodiment of a self-holding suture system 600. The self-holding suture system 600 includes needle 110 and sections 140, 142 and 144 of the self-holding suture system 100 of figure 1A. However, the self-retaining suture system 600 is a one-arm system. As shown in figure 6A, filament 120 ends after section 144 on a fabric anchor 602a. The fabric anchor 602a is a device for engaging the fabric and preventing filament 120 from moving through the fabric in the direction of needle 110. Fabric anchor 602a is formed, in some embodiments, into a single piece with filament 120 or formed separated and subsequently attached to filament 120. As shown in figure 6A, fabric anchor 602a has a bar-shaped body 610a that extends approximately perpendicular to the axis of filament 120. The bar-shaped body 610a is long enough and rigid to prevent movement of the distal end of filament 120 towards needle 110 after the fabric anchor 602a has engaged with a fabric.
    [00116] Figure 6B shows an alternative anchor 602b that could be used in place of the fabric anchor 602a of figure 6A. As shown in figure 6B, the fabric anchor 602b comprises a tapered body 610b. The conical body 610b has a pointed end 612b and features of engagement with the fabric 614b which consist of ribs and / or splinters. The fabric anchor 602b is configured to be pushed into the fabric in order to anchor filament 120 to that fabric and prevent movement of the distal end of filament 120 in the direction of needle 110.
    [00117] Figure 6C shows an alternative fabric anchor 602c that could be used in place of the fabric anchor 602a of figure 6A. As shown in figure 6C, the fabric anchor 602c comprises a loop 610c. Loop 610c is, in this embodiment, formed by bending back to end 612c of filament 120 and gripping end 612c to filament 120 by welding, melting and / or adhesive. Loop 610c is formed in this way from filament material 120. Loop 610c has an opening 614c through which needle 110 can pass in order to create a sliding knot / saddle that can be used to engage the fabric and prevent movement of the end distal from filament 120 towards needle 110.
    [00118] Figure 6D shows an alternative fabric anchor 602d that could be used in place of the fabric anchor 602a of figure 6A. As shown in figure 6D, the fabric anchor 602d comprises a clip-shaped body 610d. Filament 120 passes through an opening in anchor 602d and is secured by a strip 614d. The clamp-shaped body 610d has two pointed ends 612d which can be pushed into the fabric and deformed towards each other to engage the fabric and prevent movement of the distal end of filament 120 in the direction of needle 110.
    [00119] Figures 6E and 6F show exploded and partial section views of a 660 suture cartridge suitable for use with MIS suture application instruments, in accordance with the modalities of the present invention. The cartridge 660 can be used to releasably retain one or more one-way self-retaining sutures 600 with an anchor 602a-d as described in figures 6A-6D. In cartridge 660, one or more self-retaining suture systems 600 are arranged in a linear configuration. The linear configuration is suitable for shorter sutures that are often used in MIS surgery. For example, in one embodiment, the self-retaining suture system 600 is, in some embodiments, approximately 70 mm in total length. The cartridge 660 would be approximately 70 mm long to accommodate the 70 mm suture in the configuration of figure 6E. As shown in figures 6E and 6F, the cartridge 660 is approximately cylindrical and has a protrusion 662 at its proximal end to releasably engage a suture tool. The cartridge 660 has an entry 664 at its distal end to allow access to the interior of the cartridge 660. There is, at the adjacent entry 664, one or more needle docks 667 to releasably retain one or more needles 110. As shown in figure 6F , one or more self-retaining suture systems 600 can be contained in cartridge 660 with needles 110 releasably attached adjacent to entry 664 by needle docks 666. Anchors 602a-d of self-retaining suture systems 600 are positioned in the direction of proximal end of cartridge 660.
    [00120] Multiple self-holding suture systems 600 are, in some embodiments, loaded into a 660 cartridge. As shown in figure 6E, the self-holding suture systems 600 are stacked and loaded through entry 664. Where multiple suture systems self-holding 600 are loaded in a cartridge 600, they can be spaced apart by dividers or similar to avoid tangling. The cartridge 670 of figure 6G and / or dividers 669 have sufficient needle docks 667 for each of the needles 110. As shown in figures 6E and 6F, multiple self-retaining suture systems 600 are separated from each other by dividers 669. Each one of the plurality of self-retaining suture systems 600 can, in some embodiments, be removed individually from a 670 cartridge. Cartridge 660 containing one or more self-retaining suture systems 600 can be mounted on an endoscopic suture application tool as previously described for applying self-retaining suture systems 600 through a door at a desired location on a patient's body. In use, the surgeon can remove a 600 self-retaining suture system and its associated needle 110 and anchor 602a-d without disturbing other 600 self-retaining suture systems.
    [00121] Figure 6G shows a cartridge 670 that includes the coil 656 and a connector 672. The connector 672 allows the cartridge 670 to be releasably attached to the distal end of a tool as an endoscopic tool. Coil 656 includes a spiral groove 658 to releasably retain a unidirectional self-holding suture 600 with an anchor 602a-d as described in figures 6A-6D. As shown in figure 6G, bobbin 656 also includes one or more needle docks 657 to support needle 110 of the self-holding suture system 600. Needle 110 is removably attached to needle dock 657. Needle 110 is removed needle dock 657 to allow positioning of the self-holding suture system 600. In some embodiments, needle 110 is replaced in needle dock 657 to allow removal of needle 110 and any excess self-holding suture after positioning the suture system self-hold 600.
    [00122] Figure 6H shows the cartridge 670 attached to the elongated member 682 of an endoscopic instrument 680 for insertion through a door into a patient's body. A selection of sterile 670 cartridges is, in some embodiments, provided for a procedure, each supporting a different self-retaining suture system 100, 600. In this way, the 680 endoscopic suture application instrument can be used by the surgeon or assistant to select and apply multiple 100, 600 self-retaining suture systems during the course of a procedure. Cable 684 can be manipulated by a surgeon outside a patient's body to apply coil 656 to a desired location on the patient. In some embodiments, an actuator 686 is provided to control the attachment and release of the 670 cartridge. In alternative embodiments, the coil 656 is attached to the end of the 680 suture instrument. Although a 680 hand-held endoscopic instrument is shown, the 670 cartridge it can also be applied using a robot-operated endoscopic tool as shown, for example, in figure 3A.
    [00123] The suture delivery systems of the present invention include, in some embodiments, the systems, dispensers, devices and methods described in paragraphs 124 to 195 below.
    [00124] A suture distributor, comprising:
    [00125] a self-holding suture having an elongated suture body with a first segment having a first plurality of retainers arranged proximally to a first end, and a second segment having a second plurality of retainers arranged proximally to a second end;
    [00126] an elongated rod;
    [00127] a coil coupled to a distal end of the elongated stem, in which the self-holding suture is releasably attached to the coil; and
    [00128] an actuator attached to a proximal end of the elongated nail through which the dispenser is manipulated to introduce the coil and the distal end of the elongated nail through an access door to a surgical site on a patient.
    [00129] The distributor of paragraph 124, where:
    [00130] the self-holding suture comprises a first needle at the first end and a second needle at the second end; and
    [00131] the bobbin comprises a first needle dock for the first needle and a second needle dock for the second needle.
    [00132] The distributor of paragraph 124, where:
    [00133] the coil comprises a plurality of suture confinement regions of the first segment of the retainers of the second segment.
    [00134] The distributor of paragraph 124, where:
    [00135] the coil comprises a plurality of grooves to segregate the retainers of the first segment from the retainers of the second segment.
    [00136] The distributor of paragraph 124, where:
    [00137] the coil is releasably coupled to the distal end of the elongated rod in such a way that the coil is adapted to be replaced by a second coil.
    [00138] The distributor of paragraph 124, which further comprises:
    [00139] a cover positioned on the coil and adapted to protect the self-retaining suture during insertion of the coil and the distal end of the elongated nail through an access door to a surgical site on a patient.
    [00140] The distributor of paragraph 124, which further comprises:
    [00141] the cover positioned on the coil and adapted to protect the self-retaining suture during insertion of the coil and the distal end of the elongated nail through an access door to a surgical site on a patient; and
    [00142] in which the cover opened to access the retaining suture.
    [00143] The distributor of paragraph 124, who additionally comprises:
    [00144] the cover positioned on the coil and adapted to protect the self-retaining suture during insertion of the coil and distal end of the elongated nail through an access door to a surgical site on a patient; and
    [00145] in which the actuator is attached to the cover and can open the cover on a patient to allow access to the self-holding suture.
    [00146] The distributor of paragraph 124, where:
    [00147] the distributor is provided with a machine-readable code to identify a characteristic of the self-retaining suture.
    [00148] The distributor of paragraph 124, where:
    [00149] the coil includes a therapeutic agent to be applied to the self-holding suture.
    [00150] The suture dispenser of paragraph 124, being that:
    [00151] said coil has a helical groove to reliably retain said self-retaining suture.
    [00152] The suture distributor of paragraph 124, being that:
    [00153] said coil has a groove for releasably retaining the self-holding suture.
    [00154] The suture distributor of paragraph 124, being that:
    [00155] said suture includes an elongated channel to retain said self-retaining suture in a free manner.
    [00156] The suture distributor of paragraph 124, being that:
    [00157] said suture dispenser has a linear channel to retain said releasable suture in a releasable manner.
    [00158] The suture dispenser of paragraph 124, being that:
    [00159] first retainers of said first plurality of retainers and second retainers of said second plurality of retainers all project in the same direction along the suture.
    [00160] The suture distributor of paragraph 124, being that:
    [00161] first retainers of said first plurality of retainers protrude in a first direction along said suture, and second retainers of said second plurality of retainers protrude in a second direction along the suture and wherein said first direction is different from the said second direction.
    [00162] The suture dispenser of paragraph 124, being that:
    [00163] said actuator is a cable.
    [00164] The suture dispenser of paragraph 124, being that:
    [00165] said actuator is an assembly that is adapted to mount said suture distributor on a surgical tool aided by a robot.
    [00166] The suture distributor of paragraph 124, being that:
    [00167] said actuator is an assembly that is adapted to mount said suture distributor on at least one of an endoscopic surgical tool and a laparoscopic surgical tool.
    [00168] The suture distributor of paragraph 124, being that:
    [00169] said coil has a diameter of about 12 mm or less.
    [00170] The suture dispenser of paragraph 124, being that:
    [00171] said coil has a diameter of about 8 mm or less.
    [00172] The suture distributor of paragraph 124, being that:
    [00173] said coil has a diameter of about 5 mm or less.
    [00174] The suture distributor of paragraph 124, being that:
    [00175] The suture distributor of the paragraph in which said rod is flexible. 124, of which:
    [00176] The suture dispenser of paragraph 124, being that:
    [00177] The suture dispenser of the paragraph said suture includes the wick. 124, of which:
    [00178] The suture dispenser of paragraph 124, being that:
    [00179] said suture distributor is adapted to be operated by a telesurgical system.
    [00180] The suture dispenser of paragraph 124 in combination with a telesurgical system.
    [00181] The suture dispenser of paragraph 124 in combination with one of an endoscopic surgical tool, a robot-assisted tool and a laparoscopic surgical tool.
    [00182] The suture dispenser of paragraph 124, said dispenser being provided with a machine-readable code to identify a characteristic of said suture, in combination with a telesurgical system with a code reader and a screen, and in which said code reader can read said code and said screen can show a representation of said code.
    [00183] The suture dispenser of paragraph 124, said dispenser having a machine-readable code to identify a characteristic of said suture, in combination with a robot-assisted tool with a code reader and a screen, and wherein said code reader may read said code and said screen may show a representation of said code.
    [00184] The suture dispenser of paragraph 124, said dispenser having a machine-readable code to identify one or both of a static feature and a dynamic feature of said suture, in combination with a telesurgical system with a reader code and a screen, and wherein said code reader can read said code and said screen can show a representation of said code.
    [00185] The suture dispenser of paragraph 124 in combination with a tele-surgical system that can accept voice commands in order to at least one, select the coil and position the suture.
    [00186] The suture dispenser of paragraph 124, said dispenser can accept and apply a plurality of bobbins.
    [00187] The suture dispenser of paragraph 124, said dispenser being a carrier that can accept and apply a plurality of coils.
    [00188] The suture distributor of paragraph 124, and said actuator is an interface that is adapted to be fixed, in a way that can be released to one of a robot-assisted system, a robotic system and a tele-surgical system.
    [00189] A suture dispenser comprising:
    [00190] a self-retaining suture;
    [00191] a coil that is adapted to be releasably attached to a surgical tool; and
    [00192] a channel in said coil that can selectively receive said self-holding suture.
    [00193] The suture distributor of paragraph 158, said channel being helical.
    [00194] The suture distributor of paragraph 158 being that said channel is straight.
    [00195] The suture dispenser of paragraph 158 that includes a cover to cover said coil with the self-holding suture received in a channel of said coil.
    [00196] The suture dispenser of paragraph 158, said coil having a diameter of about 12 mm or less.
    [00197] The suture distributor of paragraph 158, said coil having a diameter of about 8 mm or less.
    [00198] The suture dispenser of paragraph 158, said coil having a diameter of about 5 mm or less.
    [00199] The suture dispenser of paragraph 158, said suture having a wick.
    [00200] The suture dispenser of paragraph 158, said dispenser having a machine-readable code that can identify a characteristic of said suture.
    [00201] The suture dispenser of paragraph 158 wherein said bobbin includes at least one needle dock and said suture includes at least one needle.
    [00202] A suture distributor, comprising:
    [00203] a self-holding suture having an elongated suture body with a first segment having a plurality of retainers arranged proximally to a first end, and a second segment having a plurality of retainers arranged proximally to a second far end;
    [00204] an endoscopic tool comprising an elongated tube;
    [00205] a suture cartridge positioned at a distal end of the elongated tube, in which the self-retaining suture is securely attached to the suture cartridge; and
    [00206] an interface attached to a proximal end of the elongated nail through which the dispenser is manipulated to introduce the coil and the distal end of the elongated nail through an access door to a surgical site on a patient.
    [00207] The distributor of paragraph 168, being that:
    [00208] the self-holding suture comprises a first needle at the first end and a second needle at the second end; and
    [00209] the suture cartridge comprises a first needle dock for the first needle and a second needle dock for the second needle.
    [00210] The distributor of paragraph 168, being that:
    [00211] the suture cartridge comprises a plurality of suture containment regions adapted to segregate the retainers of the first segment from the retainers of the second segment.
    [00212] The distributor of paragraph 168, being that:
    [00213] the suture cartridge is releasably coupled to the suture distributor in such a way that the bobbin is adapted to be replaced by a second bobbin.
    [00214] The dispenser of paragraph 168, which additionally comprises a second self-retaining suture removably attached to a second suture cartridge positioned with the elongated tube.
    [00215] The distributor of paragraph 168, being that:
    [00216] the elongated tube comprises a cover positioned on the coil to protect the self-retaining suture during introduction at the distal end of the elongated tube through an access door to a surgical site on a patient; and
    [00217] in which the cover can be opened on a patient in order to allow access to the self-retaining suture.
    [00218] The dispenser of paragraph 168, which additionally comprises an actuator adapted to move the cartridge out of the distal end of the elongated tube in order to allow access to the self-holding suture.
    [00219] The distributor of paragraph 168, being that:
    [00220] the cartridge is equipped with a machine-readable code adapted to identify a characteristic of the self-retaining suture to show to a surgeon.
    [00221] The distributor of paragraph 168, being that:
    [00222] the cartridge includes a therapeutic agent to apply to the self-retaining suture.
    [00223] The distributor of paragraph 168, being that:
    [00224] the interface is adapted to be fixed, releasably to a surgical robot.
    [00225] A system for suturing a surgical site on a patient with an endoscopic instrument, in which the system comprises:
    [00226] a plurality of cartridges, each loaded with a suture;
    [00227] a selector cartridge that can select a cartridge that has a selected suture; and
    [00228] an actuator cartridge that can move the selected cartridge through the endoscopic instrument and expose the selected cartridge in order to allow access to the self-retaining suture from the inside of a surgical site in a patient.
    [00229] The system of paragraph 178, the system additionally comprising a surgical robot to position the endoscopic instrument and thus position the selected cartridge on a patient.
    [00230] The system of paragraph 178, the selector being responsive to a voice command from a surgeon.
    [00231] The system of paragraph 178, with the cartridge selection comprising:
    [00232] a compartment external to the patient that has a plurality of wings for receiving a plurality of cartridges; and
    [00233] an aligner that can align one of the plurality of wings and one of the plurality of cartridges to a lumen of the endoscopic instrument in order to apply the surgical site to a patient.
    [00234] The distributor of paragraph 124, being that:
    [00235] said coil includes a plurality of suture confinement regions that retain the suture and prevent the retainers from being repositioned.
    [00236] The distributor of paragraph 158, being that:
    [00237] said coil includes a plurality of suture confinement regions that retain the suture and prevent the retainers from being repositioned.
    [00238] The distributor of paragraph 124, being that:
    [00239] said suture acquired a set of memory that included a plurality of loops around the diameter of said coil.
    [00240] The distributor of paragraph 158, being that:
    [00241] said suture acquired a set of memory that included a plurality of loops around the diameter of said coil.
    [00242] The distributor of paragraph 168, being that:
    [00243] said suture acquired a set of memory that included a plurality of loops around the diameter of said coil.
    [00244] The distributor of paragraph 178, being that:
    [00245] said suture acquired a set of memory that included a plurality of loops around the diameter of said coil.
    [00246] The distributor of paragraph 124, being that:
    [00247] said suture acquired a set of memory that included a plurality of loops around the diameter of said coil, whose loops assist in the suturing of a fair radius.
    [00248] The distributor of paragraph 158, being that:
    [00249] said suture acquired a set of memory that includes a plurality of loops around the diameter of said coil, whose loops assist in suturing a tight radius.
    [00250] The distributor of paragraph 168, being that:
    [00251] said suture acquired a set of memory that includes a plurality of loops around the diameter of said coil, whose loops assist in suturing a tight radius.
    [00252] The distributor of paragraph 178, being that:
    [00253] said suture acquired a set of memory that includes a plurality of loops around the diameter of said coil, whose loops assist in suturing a tight radius.
    [00254] A minimally invasive surgical method that comprises:
    [00255] applying a cartridge to a surgical site, the cartridge of which includes a suture with self-retainers and a needle;
    [00256] access the cartridge with an endoscopic tool;
    [00257] use the endoscopic tool to remove the suture from the cartridge;
    [00258] use the endoscopic tool to sew the fabric to the suture.
    [00259] The method of paragraph 192, being that:
    [00260] said application stage includes applying said cartridge with one of an endoscopic tool, a laparoscopic tool, a robot-assisted tool and a surgical tool.
    [00261] The method of paragraph 192, where:
    [00262] said application stage includes restraining the cartridge suture.
    [00263] The method of paragraph 193, where:
    [00264] said application stage includes restraining the cartridge suture.
    [00265] Although the present invention has been shown and described in detail with respect to only a few exemplary embodiments of the invention, it should be understood by those skilled in the art that this is not intended to limit the invention to the specific embodiments presented. Various modifications, omissions, and additions can be made to the presented modalities without deviating substantially from the new teachings and advantages of the invention, particularly, in light of the aforementioned teachings. Consequently, it is intended to cover all modifications, omissions, additions and equivalents, as is, in some modalities, included within the spirit and scope of the invention defined by the following embodiments.
    权利要求:
    Claims (9)
    [0001]
    1. Suture distributor comprising: a self-holding suture (100) having an elongated suture body with a first segment (142) having a first plurality of retainers (130) arranged proximally to a first end, and a second segment (146) which has a second plurality of retainers (130) arranged proximal to a second end; a spool (156, 256, 356, 412, 422), the self-holding suture (100) being loosely attached to the spool (156, 256, 356, 412, 422); characterized by the fact that it still comprises an elongated shank ( 154, 254, 354); the coil (156, 256, 356, 412, 422) coupled to a distal end of the elongated rod (154, 254, 354); and an actuator (158, 272) attached to a proximal end of the elongated rod through which the dispenser introduces the coil and the distal end of the elongated rod (154, 254, 354) through an access door.
    [0002]
    2. Distributor according to claim 1, characterized in that: the self-holding suture (100) comprises a first needle (110) at the first end and a second needle (112) at the second end; and the bobbin comprises a first needle dock (157, 328) for the first needle (110) and a second needle dock (157, 328) for the second needle (112).
    [0003]
    3. Distributor according to claim 1, characterized by the fact that: the coil (156, 256, 356, 412, 422) comprises a plurality of suture containment regions to segregate the retainers (130) of the first segment (142 ) of the retainers (130) of the second segment (146).
    [0004]
    4. Dispenser according to claim 1, characterized by the fact that: the coil (156, 256, 356, 412, 422) is releasably coupled to the distal end of the elongated rod (154, 254, 354) in such a way so that the coil is adapted to be replaced by a second coil.
    [0005]
    5. Distributor, according to claim 1, characterized by the fact that: the distributor is equipped with a machine-readable code to identify a characteristic of the self-holding suture (100).
    [0006]
    6. Suture distributor, according to claim 1, characterized by the fact that: the actuator is an assembly that is adapted to mount the suture distributor on at least one of an endoscopic surgical tool and a laparoscopic surgical tool.
    [0007]
    7. Suture distributor according to claim 1, characterized by the fact that: the coil (156, 256, 356, 412, 422) has a diameter of 12 mm or less.
    [0008]
    8. Suture distributor according to claim 1, characterized by the fact that it is in combination with a telesurgical system.
    [0009]
    9. Suture distributor according to claim 1, characterized by the fact that the distributor can accept and distribute a plurality of coils.
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    同族专利:
    公开号 | 公开日
    US20140039527A1|2014-02-06|
    KR101859360B1|2018-05-21|
    CA2801271C|2018-10-30|
    CA2801271A1|2011-12-15|
    KR20130087496A|2013-08-06|
    AU2011265232A1|2013-01-24|
    EP3155978A2|2017-04-19|
    ES2615229T3|2017-06-06|
    MX337815B|2016-03-18|
    WO2011156733A3|2012-03-29|
    EP2579787B1|2016-11-30|
    AU2011265232B2|2015-01-22|
    CN104873237A|2015-09-02|
    WO2011156733A2|2011-12-15|
    JP2013533762A|2013-08-29|
    RU2568538C2|2015-11-20|
    EP3155978A3|2017-08-09|
    CN103068323B|2015-07-22|
    EP2579787A2|2013-04-17|
    CN103068323A|2013-04-24|
    US9955962B2|2018-05-01|
    EP2579787A4|2015-11-11|
    BR112012031606A2|2016-11-08|
    NZ604320A|2014-07-25|
    CN104873237B|2017-08-08|
    RU2012157810A|2014-07-20|
    JP5897560B2|2016-03-30|
    MX2012014456A|2013-02-07|
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    法律状态:
    2017-07-11| B25A| Requested transfer of rights approved|Owner name: ETHICON ENDO-SURGERY LLC (US) |
    2017-07-18| B25F| Entry of change of name and/or headquarter and transfer of application, patent and certif. of addition of invention: change of name on requirement|Owner name: ETHICON ENDO-SURGERY LLC (US) |
    2017-07-25| B15G| Petition not considered as such [chapter 15.7 patent gazette]|
    2017-08-08| B15G| Petition not considered as such [chapter 15.7 patent gazette]|
    2017-12-12| B25D| Requested change of name of applicant approved|Owner name: ETHICON LLC (US) |
    2018-12-26| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|
    2019-08-13| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|
    2020-03-31| B07A| Application suspended after technical examination (opinion) [chapter 7.1 patent gazette]|
    2020-09-15| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|
    2020-11-10| B16A| Patent or certificate of addition of invention granted [chapter 16.1 patent gazette]|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 10/06/2011, OBSERVADAS AS CONDICOES LEGAIS. |
    优先权:
    申请号 | 申请日 | 专利标题
    US35400910P| true| 2010-06-11|2010-06-11|
    US61/354,009|2010-06-11|
    PCT/US2011/040014|WO2011156733A2|2010-06-11|2011-06-10|Suture delivery tools for endoscopic and robot-assisted surgery and methods|
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