专利摘要:
The knot pusher and suture cutters for use in arthroscopy, for example in knee arthroscopy, can be operated with a single command to lock the suture within the distal end of the knee. the device and cut the suture once the node has been pushed to the appropriate location. The apparatus may include a safety lock preventing deployment of the cutting device until the safety lock (eg cutting device release) has been released.
公开号:FR3050924A1
申请号:FR1753894
申请日:2017-05-03
公开日:2017-11-10
发明作者:William R George；Michael J Hendricksen；Chad R Yolland；Michael Murillo
申请人:Ceterix Orthopaedics Inc；
IPC主号:

专利说明:

NODE PUSHER AND SUTURE CUTTING DEVICE FOR
ARTHROSCOPY
Field
The present invention relates to suture techniques, devices and methods, and in particular knot pusher and suture trimming apparatus, and a method for using them during surgery, such as arthroscopy.
Context
Tissue suturing during surgical procedures is time-consuming and can be particularly problematic for accessing areas of the body and regions that have limited space, such as areas partially surrounded or covered by bone. For many surgical procedures, it is necessary to perform a large opening in the human body to expose the area requiring surgical repair. However, in many cases, access to the tissue in this manner is undesirable, increasing the recovery time and exposing the patient to a higher risk of infection.
Sutures have been developed to help access and treat internal areas of the body, and generally to assist a physician in repairing the tissue. Although many of these devices are available for endoscopic, arthroscopic and / or percutaneous use, these devices suffer from a variety of problems, including the limited ability to navigate and be operated in the narrow confines of the body, the risk injury to adjacent structures, problems in controlling the position and / or condition of the tissue before, during and after suturing, as well as problems related to the reliable operation of the suture passer.
In addition, when performing the surgery, such as arthroscopy, the establishment of the suture knot can be an important but difficult step. In addition, after knotting the knots in the sutures, the surgeons usually cut off the excess sutures so that only the necessary amount of suture remains at the repair site. However, such node placement and node cutting typically requires the use of two separate tools, further complicating the surgical process. Even when a device can include the function of cutting and pushing the suture / knot, it would be useful for a device to be operated with one hand or one finger (eg, one inch) to engage the suture. and then cut the suture. Finally, it would be beneficial for a knot / suture pusher device to include security (eg, a safety lock) to prevent inadvertent activation of the cutter, which can prematurely cut a suture.
Devices are described herein for pushing a suture knot and cutting the suture that can treat the problems and needs identified above. Summary of Description
In general, surgical suture pusher and suture cutter apparatuses and methods for their use are described herein for positioning a knot and cutting the suture. These devices (which include devices for pushing the node / cutting the suture, and a system comprising such devices) typically include a control which is configured to open a portion of the distal end of the apparatus for loading a suture laterally to the level of the distal tip region; this same command (or a different command) may be configured to cause a cutting device to cut a predetermined length of suture relative to a pushed node. Any of the devices described herein may include security (e.g., security release, cutter release, cutter security, etc.) that can be normally engaged to prevent the device from being tampered with. cutting to cut a suture in the distal end of the device, but can be selectively released to allow the cutting device to cut a suture. Safety can be positioned with the control on the handle of the device, so that a user can operate the control to open / load the device and to cut the suture with one finger (eg, thumb) and can set take / release the safety with another finger (other fingers). Safety can be released, allowing cutting by the cutter, pressing safety and simultaneously activating the control to drive the cutter to cut the suture. Any of these devices may also include a latch, a stop, or other feature (such as a locking tab) that prevents the suture from falling off the distal end of the device, even when the force is applied against the device. loading part of the device (for example, an internal mandrel or an inner member that can be moved to allow loading of the suture) by a knot or other structure. Any of these devices, and particularly those with a lock or other feature that prevents the suture from falling even when applying force against the suture loading region, may also include an thumb ring. at the proximal end that can be used by a surgeon to manipulate and position the device.
For example, any of the node and suture pusher surgical apparatus described herein may include: a handle; an elongate holding tube secured to the handle, an elongate holding tube including a lateral slot opening from a distal end of the holding tube and configured to allow passage of the suture; an inner member (also referred to herein as an internal mandrel) within the holding tube, wherein the inner member is axially movable relative to the holding tube and configured, when positioned distally, to capture the suture between the inner member and the holding tube; a tubular cutter around the holding tube, the cutting device being configured to be axially movable with respect to the holding tube for cutting an end of the suture when extended distally; a control on the handle configured to control the axial movement of the inner member and the axial movement of the cutter; and a cutting device release configured to prevent axial movement of the cutting device unless the release of the cutting device is disengaged.
The elongated holding tube is generally a cannula that includes an opening (cut region, slot, etc.) positioned laterally in the surface of the cannula body which is continuous with the distal tip of the device to allow access to at least one part of the suture in the cannula body. Any of the apparatuses may therefore include an elongated holding tube having an open side slot forming a generally J-shaped opening through the distal end of the holding tube and configured to allow passage of a suture. In some embodiments, the slit or lateral opening is L-shaped rather than J-shaped or some other forms having an axially extending (distal to proximal) slot region and radial extension (e.g. the base of the "L" or "J"); this region may also be connected to a shorter proximal to distal region that does not extend completely to the distal tip. The slot can have any suitable width and length. In general, the slit is wide enough to accommodate a suture even of large diameter. In addition, the slot extends completely through the elongated holding tube. The walls of the slot may be rounded or smoothed to prevent accidental cutting of the suture. The wall of the slot can be selectively smoothed in some areas but not in others (for example, allowing cutting in some areas). The axial length of the region from the open slot to the distal end of the elongate holding tube may determine the length of the residual suture after it has been cut (eg, the distance from the knot to the cut end suture). This distance can be generally minimal (for example less than 5 mm), but of sufficient length to prevent the knot from coming out of the suture or being unraveled. For example, in some embodiments, the distance (for example the height of the J or L forming the J-shaped or L-shaped slot) is between about 5 mm and 0.2 mm, between about 5 mm and about 0.5 mm, between about 3 mm and about 1 mm, about 1.5 mm, about 2 mm, about 2.5 mm, etc. Any of the apparatuses described herein may include an inner member that includes a recessed region at the distal end extending longitudinally to form an opening between the inner member and an inner wall of the elongated holding tube. This inner member is configured to be biased to be held in the "rest" state distally. In general, the inner member may correspond to the inner diameter of the elongated holding tube, however, at least the distal region may comprise a region that has a smaller outer diameter and is therefore spaced apart (forming a cavity, a notch, an opening , spacing, etc.) relative to the elongated holding tube when the apparatus is at rest; when a suture is loaded into the elongated holding tube and the inner member is at rest, distally extended, the suture may be retained within the tip of the apparatus in the cavity / channel / opening formed by the inner wall of the elongate holding tube and the notched region of the inner member and specifically the portion of the inner member which has the smaller outer diameter (OD), such as a notched region.
In some embodiments, as shown in FIGS. 1A-2D, the inner member may be held stationary in rotation relative to the elongate holding tube. For example, the inner member may be positioned so that the region forming the notch with the elongated holding tube is radially offset from the long (distal to proximal) portion of the lateral opening through the elongated holding tube, but aligned with the short leg of the opening, for example, the radial extension (for example, the base of the "L" or "J" in the slot) and / or this region can also be connected to a proximal region distal shorter of the slit. The proximal portion of the suture may protrude from the node pusher / suture cutter, while the distal portion of the suture protrudes from the distally oriented opening in the apparatus. In use, a user can hold or pull the proximal end of the stretched suture so that the suture can be placed in the longitudinal opening (e.g., the "J" shaped slot) in the holding tube extended with a device held entirely in the other hand of the user, once coupled to the suture, the device can be advanced distally (or pulled proximally) to push a suture; the same hand can be used to clear the safety and cut the suture held in the distal end of the device by operating the sole control of the device.
In any of the variants of the apparatuses described, the control may be a slider which is configured to be actuated with a single finger to control the movement of the inner member (e.g., sliding and / or rotation) and to control the axial movement of the cutting device. For example, sliding the control (slider) proximally (again to the user's hand) against a biasing or biasing force can "open" the lateral slit so that a suture can be captured therein . Release of the slider or movement of the slider back distally may restore the inner member (the inner plunger member, etc.) closing part of the side slit and may lock a suture to the interior of the cavity formed by the inner member and the inner diameter of a portion of the elongate holding tube.
The control includes, can be a button, a wheel, a dial or a slider. In general, the slider can be configured to be actuated with a single finger and to control the axial movement of the inner member when the slider is actuated in a first direction and to control the axial movement of the cutter when the slider is actuated in a second direction.
As mentioned, the inner member may be urged against proximal sliding and the cutter may be urged against distal sliding. In any of the apparatuses described herein, the neutral position for the device may be configured with the lateral opening at least partially closed by the distally extended inner member, while the cutting device is retracted proximally. Any of the apparatus variants described herein may include safety, such as cutting device release. Safety may be referred to as a safety, a safety release of a cutting device, a release of a cutting device or the like. The cutter release may generally include a button, slider, wheel, latch, or any other manual control that may be activated by a user's hand. The cutting device release may be, for example, a button. The cutting device release can be positioned on the handle. For example, the cutter release may be positioned on a surface opposite to the control. In general, the cutter release can be configured so that it engages the cutter ("tubular cutter") and / or the control (eg, the slider) on the handle to prevent advancing distally, the cutting device for cutting a suture held in the distal end of the device. In some embodiments, the cutting device release may be in a rail or cursor path and / or prevent the control and / or the cutting device from advancing distally until the cutting device release. is released by manually activating, for example by pushing, sliding, switching, etc. the release of cutting device. For example, the cutter release may be biased to engage the control to prevent the cutter from advancing distally until the cutter release is engaged.
Any suitable cutting device may be used, including the tubular cutter which is positioned on or at least partially on the elongated holding tube (and / or the inner member). The cutting device may comprise a distally oriented cutting face for cutting through the region of the suture extending out of the opening from the apparatus, such as the region of the last slot through the tube elongated holding member which overlaps the smaller diameter region of the inner member. For example, the tubular cutter may include a distally oriented, tapered edge that is configured to cut the suture. A progressively narrowed edge that tapers downwardly in an annular cut ring may be preferred because it allows the suture to be cut at any angle or orientation of the suture relative to the elongate body of the suture. device (for example, the distal end of the device).
For example, any of the knot pusher and suture cutters may include: a handle; an elongate holding tube attached to the handle, the elongated holding tube comprising an open side slot forming a generally J-shaped opening through the distal end of the holding tube and configured to allow passage of the suture; an inner member within the holding tube and axially movable relative to the holding tube, the inner member being configured, when positioned distally, to capture the suture between the inner member and the holding tube; maintenance; a tubular cutting device extending around the holding tube, the cutting device being configured to be axially movable relative to the holding tube for cutting one end of the suture; a slider on the handle and configured to be actuated with a single finger and to control the axial movement of the inner member when the slider is actuated in a first direction and to control the axial movement of the cutting device when the slider is actuated in a second direction; and a cutting device release configured to prevent axial movement of the cutting device unless the cutting device release is engaged; wherein the inner member is biased against proximal sliding and the cutter is urged against distal sliding. Any of the surgical node and suture pusher apparatus may include: a handle; an elongate holding tube secured to the handle, the elongated holding tube comprising an open side slot forming a generally J-shaped opening through the distal end of the holding tube and configured to allow passage of a suture; an inner member within the holding tube and axially movable relative to the holding tube, the inner member being configured, when positioned distally, to capture the suture between the inner member and the holding tube; holding, wherein the inner member comprises a recessed region at the distal end extending longitudinally to form an opening between the inner member and an inner wall of the elongate holding tube; a tubular cutter extending around the holding tube, the cutting device being configured to be axially movable with respect to the holding tube for cutting an end of the suture, wherein the tubular cutter comprises a progressively narrowed edge distally oriented; a slider on the handle and configured to be actuated with a single finger and to control the axial movement of the inner member when the slider is actuated in a first direction and to control the axial movement of the cutting device when the slider is actuated in a second direction; and a cutter release button on the handle opposite the slider, and configured to prevent axial movement of the cutter unless the cutter release is engaged, wherein the inner member is biased against the proximal sliding and the cutting device is biased against the distal sliding.
Also disclosed herein are methods for using an apparatus to push a knot and cut a suture, as described herein. In general, these methods include the steps of coupling the suture to the distal end of the apparatus, pushing the knot distally, and releasing the cutting device release (safety) and cutting the suture. In some variants, all these steps can be performed with one hand, using only two fingers (or two digital controls); a first command, for example a thumb, for loading the suture into the distal end of the device by opening and closing a side slot, and to activate the cutter to cut a loaded suture into the distal end; a second command, for example at the index, to disengage the cutting device safety (cutting device release).
For example, a method for pushing a suture knot with a knot pusher and suture cutting surgical apparatus may include the steps of: sliding a control on a handle of the apparatus proximally to retract an inner member proximally; placing a suture in a lateral opening of the elongate holding tube of the apparatus so that the suture extends from the distal end of the apparatus and also from the lateral opening; advancing the inner member distally within the elongated holding tube to secure the suture between the inner member and the elongated holding tube; push a knot on the suture by advancing the apparatus distally on the suture; engaging a cutter release on the handle to allow the tubular cutter outside the elongated holding tube to be advanced distally; sliding the control on the handle of the apparatus distally to advance the tubular cutter after engagement of the cutting device release; and cutting the suture using a beveled edge oriented distally of the tubular cutter. Some of these steps may be omitted, and additional steps added.
In any of the described devices, the step of sliding the control on the handle of the apparatus proximally to retract the inner member proximally may include sliding the control proximally with a single finger, wherein the command includes a cursor. Sliding the control on the handle of the apparatus proximally to retract the inner member proximally may include sliding the control proximally against a biasing force operating to hold the inner member distally positioned. . The placement step may include hooking the suture into a generally J-shaped or L-shaped opening (side slot) through the distal end of the holding tube. Advancing the inner member distally may include releasing the control to allow the inner member to move distally. Advancing the inner member distally may include slidably disengaging the control to advance the inner member distally. In general, the engagement of the cutting device release may include thrusting on the cutting device release with an index finger of one hand while an inch of the hand operates the control on the handle. The croaking of the control on the handle of the apparatus distally may include sliding a slider with a thumb while simultaneously pushing the release of cutting device with a finger. Any of the methods described herein may include loading a length of suture into the distal end of the device (e.g., the L-shaped or J-shaped side slit) so that the suture length extends at one end, distal to the device (e.g., where the push node may be positioned) and at the tip end, laterally of the slot ; the lateral outlet allows the device to be cut by the sliding cutter. Any of these methods may include loading the suture length into the device by first moving the inner member (inner mandrel) to expose a continuous opening relative to the distal end and along the lateral slit and then loading the suture length into the open side slot so that one end of the suture extends distally and a second end extends laterally. In some embodiments, the inner member (mandrel) is displaced by axially sliding the inner member / mandrel proximally or distally. In some embodiments, the inner member (mandrel) is moved by rotating the inner member / mandrel so that a notch on the side of the inner member / mandrel is aligned with the side slot at the end. distal of the device. In any of these variants, the method may also include locking or securing the inner member (mandrel) in position after loading, so that it can not be accidentally moved (axially slid and / or driven in rotation) and allows the suture to escape through the distal end of the device. For example, the apparatus may include a latch (e.g., locking tab, as described below) that engages the inner mandrel and prevents it from axially slid when engaged; the latch (locking tab) can be released / bypassed by the user (eg, the surgeon) by manipulating a control, such as a latch release or control to actuate the inner member / mandrel, allowing the latch element / mandrel to be axially displaced and / or rotated. In addition, any of these methods may include one or more steps for engaging the device through a proximal thumb ring. For example, a physician may engage the device by placing his thumb in the thumb ring and manipulating the device to push a knot along the suture. Other fingers, as mentioned above, can be used to manipulate loading / unloading (e.g., the inner member) and cutting.
In some examples hereof, there are surgical knot pusher and suture cut apparatus comprising: a handle; an elongate holding tube secured to the handle, the elongate holding tube including a lateral slot opening from a distal end of the holding tube and configured to allow passage of a suture; an inner mandrel within the holding tube, the inner mandrel having a notch extending proximally from a distal end of the inner mandrel along a lateral region of the inner mandrel, wherein the inner mandrel is axially movable relative to the holding tube and is configured to capture the suture between the inner mandrel and the holding tube when the inner mandrel is distally extended; a tubular cutter around the holding tube, the cutting device being configured to be axially movable with respect to the holding tube for cutting an end of the suture when the tubular cutter is distally extended; a control on the handle configured to control axial movement of the inner mandrel and axial movement of the cutter; a locking tab coupled to the inner mandrel and configured to prevent axial movement of the inner mandrel until the locking tab is released; and a cutting device release configured to prevent axial movement of the cutting device unless the cutting device release is released. Any of these devices may also include a thumb ring at the proximal end of the device as described above. The elongate holding tube may include an open side slot forming a generally L-shaped or J-shaped opening through the distal end of the holding tube which is configured to allow passage of a suture. The notch of the inner mandrel (inner member) may include a recessed region at the distal end extending longitudinally to form an opening between the inner mandrel and an inner wall of the elongate holding tube. A mandrel may be any elongated member (eg, a shaft, tube, shaft, column, etc.) that can be moved to allow loading of the suture length. The distal end of the mandrel (or in some variations, the distal end of the holding tube) is typically configured to provide a surface against which a node can be pushed.
As mentioned above, and shown in more detail below, the control for moving the cutter and / or the inner member / mandrel may be a slider that is configured to be actuated with a single finger. For example, the slider can control axial movement of the inner chuck and control the axial movement of the cutter. In some embodiments, the control may include a slider configured to be actuated with a single finger and control the axial movement of the inner chuck when the slider is actuated in a first direction and to control the axial movement of the slitter when the slider is actuated. in a second direction.
In general, the cutting device can be biased (for example by including a biasing or spring element) which provides a force to urge the cutter proximally; to operate the cutting device, the user can push against the bias to cut a suture extending laterally from the apparatus. Similarly, in some embodiments, the inner member / mandrel may be biased (for example, including a biasing or spring member) that pushes and holds the inner member distally; when loading the device with a suture, the inner member can be slid proximally by applying the force against this bias. For example, an apparatus may include a first biasing force opposed to proximal movement of the inner mandrel in the holding tube and a second biasing force to oppose distal movement of the tubular cutter. relative to the holding tube. In addition to (or in certain variations, instead of) the bias, one or more locks may be included to prevent the cutting device and / or the inner member / mandrel from moving until the lock is released. .
For example, any of these variants may include a cutter release that releases a locking member holding the cutter in place proximally of the distal end of the elongate holding tube. The cutting device release can be a button. Release of a cutting device can cause the latch (which may be a latch, hook, clamp, or the like, for example now holding the cutter proximally) to disengage when activated, allowing the cutting device to be moved distally. In some embodiments, the cutter release is positioned on the handle on a surface opposite the control. The cutting device release may be biased to engage the control to prevent distal advancement of the cutting device until release of the cutting device is released.
In variants in which the inner member / mandrel is axially movable (slidable) to open the side slot on the distal end of the elongated holding tube, a locking tab may be configured to be released by operation of the ordered. In some embodiments, the locking tongue is a strip of material (for example a rigid material) which is connected to the inner member and to another part of the device (for example the handle) to hold it relative to the holding tube. elongate. This may prevent the inner member from sliding proximally when the knot is pushed or pulled against the distal end of the inner member / mandrel, which may otherwise disengage the inner member and allow the suture to fall out of the internal member / mandrel. apparatus. For example, a locking tab may be configured to be released by deflecting the remote locking tab of the internal mandrel with the application of a threshold force.
In some examples, a surgical knot pusher and suture cutter apparatus includes: a handle; an elongate holding tube secured to the handle, the elongate holding tube comprising an open side slot forming a generally L-shaped or J-shaped opening through the distal end of the holding tube and configured to allow passage of a suture; an internal mandrel within the holding tube in which the inner mandrel is axially movable relative to the holding tube, the inner mandrel being configured to capture the suture between the inner mandrel and the holding tube when the inner mandrel is positioned distally; a tubular cutter around the holding tube, the cutting device being configured to be axially movable relative to the holding tube for cutting one end of the suture; a slider on the handle and configured to be actuated with a single finger and to control the axial movement of the internal mandrel when the slider is operated in a first direction and to control the axial movement of the cutter when the slider is operated within one second direction ; a locking tab coupled to the inner mandrel and configured to prevent axial movement of the inner mandrel until the locking tab is released; and a cutting device release configured to prevent axial movement of the cutting device unless release of cutting device is released; wherein the inner mandrel is biased against proximal sliding and the cutter is urged against distal sliding.
Apparatuses are also described wherein the inner member (e.g., mandrel) is a rotatable member that includes a notch or other cut-out region extending along a side portion of the distal end of the inner member. . By rotating this inner member, the lateral slot in the elongated housing can be aligned with the notch in the inner member so that a suture can be changed in the side slot and extend distally from the distal end of the apparatus and laterally from the proximal end of the apparatus.
For example, surgical knot pusher and suture cutting apparatus are described herein which comprise: a handle; an elongate holding tube secured to the handle, the elongate holding tube including a lateral slot opening from a distal end of the holding tube and configured to allow passage of a suture; an inner mandrel within the holding tube, the inner mandrel having a notch extending proximally from a distal end of the inner mandrel along a lateral region of the inner mandrel, wherein the inner mandrel is rotatable relative to the holding tube and is configured to capture the suture between the inner mandrel and the holding tube when the notch rotates away from the side slot opening; a tubular cutter around the holding tube, the tubular cutter being configured to be axially movable relative to the holding tube for cutting an end of the suture when extended distally; a first command on the handle configured to control axial movement of the cutter; and an internal mandrel drive on the handle configured to rotate the inner mandrel relative to the holding tube. These devices may also include a stop configured to prevent axial movement of the inner mandrel within the holding tube. For example, the proximal end of the apparatus may include a collar or other region that engages a lip preventing it from being displaced axially (distally and proximally) into the elongated holding tube; the lip and the collar region form a variant of a stop.
As mentioned above, any of these variants may include a thumb ring at the proximal end of the device that may be used by a surgeon or other medical personnel (user) using the device to manipulate / maintain the device. The control may include a slider configured to be actuated with a single finger to control axial movement of the cutter. Any of these devices may also include a biasing application force to oppose distal movement of the tubular cutter relative to the holding tube. Any of these devices may also include a cutting device release configured to prevent axial movement of the cutting device unless the cutting device release is released.
In some embodiments of the apparatus, the inner mandrel is rotated so that the notch is rotated remotely from the side slot opening. For example, the load control (by rotating the inner member / mandrel) can be actuated against the biased position in which the distal end is "closed". The biasing may be a mechanical biasing member and may automatically return the inner member to a predetermined position with the notch which rotates away from the side slot. In some embodiments, the inner member may be biased so that the notch is aligned with the side slot (in an "open" configuration).
For example, a surgical knot pusher and suture cutter apparatus may include: a handle; an elongate holding tube secured to the handle, the elongate holding tube including a lateral slot opening from a distal end of the holding tube and configured to allow passage of a suture; an inner mandrel within the holding tube, the inner mandrel having a notch region extending proximally from a distal end of the inner mandrel along a lateral region of the inner mandrel, wherein the inner mandrel is rotatable relative to the holding tube but is axially fixed relative to the holding tube, wherein the inner mandrel is configured to capture the suture between the inner mandrel and the holding tube when the notch rotates. distance from the lateral slot opening; a tubular cutter around the holding tube, the tubular cutter being configured to be axially movable relative to the holding tube for cutting an end of the suture when extended distally; a first command on the handle configured to control axial movement of the cutter; an internal mandrel drive on the handle configured to rotate the inner mandrel relative to the holding tube; and a thumb ring at the proximal end of the device.
Brief description of the drawings
Figs. 1A to 1C show a knot pusher and suture cut apparatus in front perspective views, in bottom and side perspective, respectively.
Figures 2A and 2B are closeups of the distal end of the apparatus of Figures 1A-C.
Figures 2C and 2D show alternative variations of the distal end (including the cutter tube) of an apparatus such as that shown in Figures 1A-C.
Figure 3A shows a close-up of the distal end of the apparatus of Figures 1A-1C where the inner member has been retracted proximally.
Figure 3B shows the movement of the actuator on the handle to retract the inner member.
Figure 4 shows the loading of a suture in the apparatus of Figures 1A-1C.
Figures 5A and 5B show the placement of the apparatus of Figures 1A-1C against a suture node.
Fig. 6A shows the movement of the actuator of the apparatus of Figs. 1A-1C distally to activate the cutting device.
Figure 6B shows a close-up of the distal end as the cutter is moved proximally to remove the tail from the suture.
Figs. 7A and 7B show top and side perspective views, respectively of another variant of a knot pusher and cutter apparatus similar to the variant shown in Fig. 6A above.
Figs. 8A-8E illustrate the operation of the distal end of the apparatus of Figs. 7A-7B. In Fig. 8A, the inner member (mandrel) is in the idle configuration, biased with the inner member distally extended. In Figure 8B, the inner member is retracted proximally against the biasing force, so that the distal end is in a loading position. In Figure 8C, a suture is loaded into the distal end in which the inner member is retracted proximally. In Figure 8D, the inner member is released and distally extended, securing the suture within the distal tip of the apparatus. In Fig. 8E, the cutting device is distally extended so that the pointed (beveled) distal end cuts the suture held in the side slot (L-shaped or J-shaped).
Fig. 9A shows the device of Figs. 7A-8D with the lower cover removed so that the locking tab can be represented.
Figure 9B shows an enlarged view of the framed region B in Figure 9A.
Fig. 9C is an enlarged view of the framed region of the locking tab shown in Fig. 9B.
Figs. 10A to 10D show side, top, side and bottom perspective views respectively of another variant of a knot / cut pusher apparatus in which the inner member (mandrel) rotates and can be locked axially in a fixed position relative to the holding tube.
Figs. 11A-11F illustrate the operation of the apparatus shown in Figs. 10A-10D. In Fig. 11A, the apparatus is shown in a neutral position with the inner member having a notch (a distal whistle end region in this example) which is rotated away from the side slot formed in the elongated holding tube. The device can be locked in this position. Fig. 11B illustrates the rotation of the inner member / mandrel, for example by activating a rotation control, so that the notch region is open to the side slot in the elongated holding tube, as shown in Figure 11C. Figure 11D illustrates the loading of a suture length, near a node, into the side slot once the inner member / mandrel rotates to align with the side slot. Figures 11E and 11F illustrate the return of the inner member / mandrel in the closed and locked position.
Figs. 12A to 12C show distal end variants of the inner members that may be used with any of the apparatuses described herein. Fig. 12A shows an inner mandrel having a notch region formed in a lateral side of the member (shown as a whistle region); this internal element is represented in the device of FIGS. 7A to 8E. In Fig. 12B, the distal end of the inner member is similar to the rotational inner member shown in Figs. 10A-11F. Fig. 12B shows an inner member similar to the variant shown in Fig. 12, but with the cut-off region (notch) that extends along most of the length of the inner member, rather than just the region of distal end.
Figs. 13A to 13D illustrate the operation of another exemplary apparatus having a rotatable inner member. In Fig. 13A, the inner member is shown in a closed configuration so that the notch on the side of the inner member is not aligned with the side slot in the elongated holding tube. In Fig. 13a, the inner member (which in this example is a tube having a lateral cut-out region or slot) rotates to align with the slot in the elongate holding tube. Figure 13C illustrates the loading of a suture length into the distal end of the apparatus. Figure 13D illustrates the locking of the suture length in the distal end of the device by rotating the inner member again (or allowing the inner membrane to rotate in the opposite direction) in the closed position.
Fig. 14A shows an example of an apparatus such as that shown in Figs. 10A-11F, including control for rotating the inner member.
Figs. 14B and 14C illustrate the operation of the apparatus shown in Fig. 14A.
Figures 15A and 15B illustrate thumb rings that can be included as the proximal end of any of the devices described herein.
Figure 16A shows another variation of a knot pusher and suture cutter apparatus (similar to that shown in Figure 1A) in a perspective front view, with the inner chuck in a relaxed (configuration).
Figure 16B shows the apparatus of Figure 16A with the inner mandrel rotated by actuating a control on the handle of the device so that a suture can be loaded into the distal end.
Fig. 16C shows the apparatus of Fig. 16A actuated by pushing a cutter control on the handle to actuate cutting of the suture held in the distal end of the device.
Fig. 17A shows a top view of the node push and suture cutter apparatus of Fig. 16A.
Figs. 17B and 17C show left and right side views, respectively, of the node push and suture cut apparatus of Fig. 17A.
Figures 18A and 18B show top and perspective views from above respectively of the distal end of a knot pusher such as that shown in Figure 17A with the mandrel rotated to allow loading and unloading of a suture (for example a knotted suture) in the distal end.
Figures 18C and 18D show side and side perspective views, respectively of the distal end of the node pusher and the suture cutter shown in Figures 18A and 18B.
Figs. 18E and 18F show bottom and bottom side views respectively of the distal end of the node pusher and the suture cutter shown in Figs. 18A and 18B.
Figs. 19A and 19B are top and top perspective views, respectively, of the distal end of a knot pusher such as that shown in Fig. 17A with the chuck rotated to prevent loading and unloading. a suture (eg knotted suture) in the distal end.
Figures 19C and 19D show side and side perspective views, respectively of the distal end of the node pusher and the suture cutter shown in Figures 19A and 19B.
Figs. 19E and 19F show bottom and bottom side views, respectively, of the distal end node pusher and the suture cutter shown in Figs. 19A and 19B. The apparatus may be configured so that the mandrel is biased to remain in that position unless it is moved by a command on the handle to turn away from a suture at the distal end, as shown.
Figs. 20A and 20B illustrate the operation of a knot pusher and cutter apparatus as described herein. In this example, a suture was loaded into the distal end region, as described above, with reference to Figs. 18A-18F by rotating the mandrel (e.g. mandrel control on the handle) to form a mandrel. opening and releasing the mandrel and / or rotating it back to lock the suture within the distal end, as shown in Fig. 20A. after which, the cutting / cutting device control on the proximal handle can be actuated to drive the outer cutting cannula distally and to cut the knotted suture, as shown in Fig. 20B.
detailed description
Node pusher and suture cutters are described herein in combination for manipulating (eg, pushing) a pre-knot node in a suture at a desired location and then for cutting the excess suture near the node. The apparatuses described herein may include a handle attached to an external holding tube (or pushing member). The handle may include a thumb ring at the proximal end to hold the device. The outer support tube typically extends around an inner shaft (also referred to as an inner member or inner mandrel). The distal ends of the outer holding tube and the inner member may generally be configured to engage a suture in a region extending laterally (proximal to distally) from the inner member and the outer holding tube, so that the distal end of the device can be used to push a pre-knot node, which typically has a diameter greater than the diameter of an opening distally oriented between the holding tube and the inner member, along the suture by advancing the device distally. A cutting device (cutting element) may extend around the outer tube and may be axially displaced to cut the proximal end of the suture extending from a lateral opening in the apparatus. The cutting device may be referred to as a tubular cutter. A control or actuator on the handle (e.g., a slider, a wheel, etc.) can be actuated to move the inner member (e.g., an inner mandrel) relative to the outer holding tube, exposing a side slot in the outer holding tube and a notch in the inner member, and allowing access to a region between the inner member and the outer holding tube for loading the suture through the side slot. Once loaded, the outer slot can be closed by moving the inner member. For example, the inner member can be moved by sliding axially (eg, pulling proximally) relative to the outer holding tube and / or rotating inside the outer holding tube.
A second command (eg, trigger, slider, etc.) that is connected to the actuator can provide a safety release (cutter release) to prevent undesired distal movement of the actuator and / or the actuator. cutting device and thus prevent undesired cutting of the suture.
In any of these variants, the inner member may be locked in position when not actuated to prevent the suture from disengaging from the distal end of the apparatus. For example, in rotation variants, the inner member may be configured to rotate in the elongate axis, but not proximally slide, and may include a latch to prevent axial sliding. In some embodiments, the rotational movement can also be prevented by a latch (e.g., a spindle, pliers, etc.) which keeps the inner member in fixed rotation relative to the outer support tube. The lock of the inner member (inner mandrel) can be released by the same command to allow the user to rotate the inner member to load the device. Similarly, devices in which the inner member is configured to slide axially and allow access of the suture for loading into the outer holding tube through the side slot may include a lock that prevents the element internal slide except when the lock is released. For example, the control to actuate the movement of the inner member may disengage the lock, which may also be referred to as an inner member lock or a lock member, and may be configured as a pin, a lock tab , pliers, etc. Any of the apparatuses described herein may be sized for use with surgical sutures placed in a knee, and may further be sized for arthroscopic use. For example, the outer diameter of the inner member (except for the lateral notch region, for example in some variations, a narrower region forming the laterally extending space, for holding the suture together with the inner wall of the tube external holding), may be between about 0.5 and 4 mm (for example about 2 mm). The inner diameter of the cutting device can be between about 1 mm and about 5 mm (for example 2.75 mm). The lengthened length of the holding tube can be from about 6 to about 20 cm, for example from about 10 cm to about 11 cm.
Figures 1A-1C illustrate a variant of an apparatus described herein. In this example, the suture is loaded into the distal end, so that a knot on the suture is distal to the distal end and a proximal region of the suture extends laterally from the lateral slit in the distal end. the external holding tube. In this example, the inner member is an axially slidable inner mandrel and includes a notch region on a lateral side of the inner member; when loaded, a length of the suture may be maintained in this channel between the inner member and the outer holding tube.
For example, with reference to Figs. 1A to 2D, a node and suture pusher surgical apparatus 100 includes a handle 101 and an elongated surgical mechanism 103 extending therefrom. The surgical mechanism 103 includes an inner member 109 within a biasing member (elongate holding member) 107 which is disposed within a cutting member 105. The elongate holding member (pushing) 107 can be fixedly attached to the handle 101 while the inner member 109 and the cutting element 105 can be independently axially movable relative to the holding / pushing member 107 and the handle 101. In one any of these variants described herein, the cutting element 105 and the elongated holding member 107 may be hollow while the inner member 109 is full; in some embodiments (shown below), the inner member may be hollow or partially hollow (eg near the distal end). In addition, the cutting element 105, 105 'can extend coaxially at least partially around the holding member (thrust element) 107 which extends coaxially around the inner member 109. The holding member 107 may also be referred to as a push member (or a push / hold or hold / push member) because it can hold the suture and push the suture knot. The holding / pushing member 107 may comprise an elongate cutaway portion 113 (extending laterally) in its configured wall to form, together with the inner diameter of the elongate holding tube wall, a passage or channel 155 extending longitudinally for the passage of a suture. For example, as shown in Figs. 2A and 2B, the elongate cutout portion may comprise a circumferentially extending portion approximately about half the circumference of the thrust member 107 connected to a substantially extending portion. axial, extending towards the distal end 117 of the device 100. In addition, the inner member 109 may comprise a notch 115 extending substantially along the length of the cut portion 113, 113 'when the distal edges of the the inner member 109 and the thrust member 107 are aligned. The cut-out portion 113, 113 'may be L-shaped or J-shaped, as mentioned above. The leg portion of the notch (eg forming the base of the L or J) may be of any suitable length, and may extend transversely of the lateral portion of the notch (e.g. an angle between about +45 and -45 degrees). The cutting element 105, 105 'may comprise a cutting edge around all or part of the distal edge of the cutting device. For example, the distal edge 121 of the cutter 105 (as shown in Figs. 2A-2B) may be progressively narrowed to a point (forming a circumferential cutting edge) in section. As mentioned above, the cutting element 105 may be positioned around the thrust member 109 and the inner member 107.
In addition, the handle 101 may include a control (e.g. slider, actuator, etc.) 111 configured to retract the inner member 109 and / or actuate the cutter (cutter) 105. The handle 101 may also include a control (eg, trigger, slider, knob, etc.) 110 as part of the safety or release of cutting device, which is configured to prevent distal movement of the actuator 111 and or the cutting device 105 until the trigger is compressed. The safety (cutting device release) can be attached to the actuator 111 and / or the cutting device 105. Using a single actuator 111 to move the inner member for suture loading and to operate the cutting device to cut the suture, the handle 101 may advantageously still be maintained and / or held in position throughout the surgery without requiring rotation or repositioning of the surgeon's hand relative to the handle. Similarly, the security can be operated by the same hand. The surgeon can operate both mechanisms and hold the handle with one hand. In addition, security 110 may advantageously prevent actuation of the cutting mechanism until it is desired, thereby preventing inadvertent cutting of the suture during use.
In the rest position of the device 100 shown in FIGS. 1A-1C, 2A-2B, the cutting element 105, 105 'can be positioned proximally with respect to the cut portion 113, 113' and the notch 115 while the distal ends of the pusher member 107 and the inner member 117 may be substantially aligned. In some embodiments, to prevent accidental unloading of a suture when held within the loading region.
Figures 2A to 2B and 2C to 2D illustrate alternative variations of the cutting element (tubular cutter) 105, 105 '. In Figs. 2A-2B, the cutting element extends around the holding / pushing tube 107 and the inner member 109 and has a progressively narrowed cutting edge 121 all around the distal end of the cutting element. chopped off. In Figs. 2C-2D, the cutting element is bevelled on the overlapping region on the window of the cut-out region in which the tail of the suture resides, but not on the portion of the cut-out region 113 'which extends laterally. (in the distal to proximal direction). In Figs. 2A-2B, the cut-out region 113 is approximately L-shaped and includes a lateral slot opening from the distal end 117 of the hold / push tube 107 and is configured to allow a suture to be loaded into the an elongate proximal distal portion which is connected to the distal end 117. The section of the cut region 113 which is transverse to the distal axis proximal to the apparatus (the "base" of the L-shape or J) forms a window from which the tail of a suture, once held in the apparatus extends, as illustrated below. This window is formed by the notched portion (smaller diameter portion) of the inner member 109 and the cut portion of the holding / pushing member 107. In Figures 2C to 2D, the transverse portion of the cutout region 113 ', forming a window from which the suture tail can extend, returns in the distal direction of the apparatus.
With reference to FIGS. 3A and 3B, to use the device 100, the control / actuator 111 can be pulled proximally by a surgeon to retract the inner member 109. By retracting the inner member, the lateral slot (FIG. cut portion) 113 'can be exposed, thereby opening the lumen of the outer holding tube 119 within the pusher member (outer holding tube) 107. Referring to Fig. 4, a suture 221 having a knot pre-tied slide 222 on the latter can then be loaded or threaded centrally in the access channel formed by moving the inner member of the side slot 113 'in the outer holding tube. As shown in Figs. 5A and 5B, the inner member 109 can then be distally displaced (i.e., via the release of the actuator 111) to lock the suture within the slot. 119. While maintaining the proximal end of the suture (for example, using a thumb ring, not shown in FIGS. 5A and 5B), the device 100 can then be slid distally on the suture 221 until the distal end of the device strikes a pre-knot node 222. After reaching the node 222, the device 100 may be further distally biased when the proximal end of the suture 221 is held thereby pushing the node 222 distally until the node reaches the desired location, such as a repair site, and can be secured (eg, straped).
As shown in Figs. 5B and 6A-6B, when the node 222 has been fully advanced to the repair site, the trigger 110 may be squeezed by the surgeon to release the security (and / or engage the security release) thus allowing the slider actuator 111 to be distally displaced by the surgeon. This distal movement moves the cutting element 109 distally, which can be cut from the end of the tail of the suture 221. After use, the residual length of the tail of the suture 221 can be very small, for example between about 0.5 mm and about 3 mm, between about 1 mm and about 2 mm, about 1.5 mm etc. the length of the tail may be determined by the location in the lateral slot into which the suture exits, such as a fork or cul-de-sac region of the J-shaped or L-shaped lateral slot. the distance from the exit region (to the most distal region that is offset from the long tab of the notch) may be chosen to determine the length of the tail (e.g., less than 4 mm, less than 3 mm, less than 2 mm, less than 1,5 mm, less than 1 mm, less than 0,5 mm, etc.)
Advantageously, the device described herein can provide a single arthroscopic instrument that allows a surgeon, after forming a pre-knotted node on the outside of the body, to push the pre-knotted node through the arthroscopic portal downward. repair site and cut the excess suture tail after pushing the pre-knotted knot.
The knot pusher and the suture cutter may be used with any suitable type of suture or material, including any suitable size, length and / or diameter of suture. Examples of suture materials may include: surgical grade sutures such as catgut (plain, chromic), silk, polyglycolic acid, polylactic acid, polydioxanone, nylon, polypropylene, etc.
A pre-knot node may refer to one or more nodes formed in a suture length. The pre-knotted node may be formed exclusively with a suture material, or it may include one or more additional materials, and / or it may modify the suture material, or it may be formed with materials not intended for sutures ( such as metals, alloys, etc.). The pre-knotted knot may be loose or taut and may be movable along a portion of the length of a suture. The knot body of the pre-knot node may be formed of the same material as the suture on which the pre-knotted knot is positioned, or it may be formed of a different material. The knot body can also be tight. In some embodiments, the node body is formed at the end of the length of the suture from the end of the suture material. In some embodiments, the knot body of the pre-knotted suture may include one or more loops that may be strapped, clamped, and / or closed to terminate the knot.
Another example of a knot pusher and suture cut apparatus is shown in Figs. 7A-9C. This example also includes an internal member slidable as described above for Figs. 1A through 6B. In addition, the variant shown in Figs. 7A-9C includes a locking mechanism which prevents movement of the inner member during node pushing, preventing inadvertent release of the suture from the device.
Certain variants of the node push and suture cutter (KPSC) devices may allow unintentional unloading of the suture of the device while advancing the nodes in the tissue (e.g. in a knee joint). For example, an apparatus such as that shown in Figs. 1A to 1B may include biasing to urge the inner mandrel distally, such as a compression spring. However, this compression spring can still allow a compressive force on the distally oriented end of the inner member (e.g. as applied by the suture node) so that the inner mandrel is moved slightly proximally. , and the suture slides through the lateral slot (groove) in the outer holding tube. The force vector applied to the KPSC against the suture may include a component in the proximal direction of the long axis of the device.
Thus, in the variant shown in Figs. 7A-7B, the apparatus 900 includes an inner member (inner mandrel) which is slidable in the long axis (distally and proximally) and has a lateral notched region. The device also includes an external holding tube that includes a side slot (which may be J-shaped, L-shaped, or the like). As described above, the distal end of the device may be loaded with a length of suture by sliding the inner member proximally (e.g., using the control 711 on the handle 901). The inner member may be biased (for example by a spring) so that it is at rest in a distal position. In addition, the inner member may be locked by the locking member (not visible in Figs. 7A-7B) to prevent it from slipping distally against the bias and potentially to release a suture held within the channel formed between the notched region of the inner member and the inner diameter of the outer holding tube. The latch may be configured such that it can be disengaged by activating a release command or applying a sufficiently large force (greater than a threshold lock force) on the sliding control 911 of the inner member or both.
Figs. 9A to 9C illustrate an example of a locking member that can be used to prevent inadvertent sliding of the inner member and suture drop. In Fig. 9A, for example, the bottom of the apparatus shown in Figs. 7A and 7B is removed, showing the locking mechanism (configured as a locking tab) 909.
The locking tab 909 in this example is a sheet metal portion which is secured (e.g., screwed 922) to the upper housing of the handle. The proximal end of the locking tab includes a hole 925 surrounding a boss feature 930 on the inner member support. The inner member support is rigidly attached to the inner mandrel (inner member). The bias 933 for the inner member (compression spring) is positioned near the locking member, and pushes the inner member distally. If a compressive force is applied to the mandrel, for example, by a knot at the distal end of the mandrel, the mandrel and the fixed mandrel holder move proximally until the boss characteristic 930 on the mandrel support reaches the end of the slot 925 of the locking tab in which it is located, limiting the axial movement of the inner member. Restricting the axial movement of the mandrel in this manner prevents the suture from prematurely discharging the distal end of the apparatus.
In operation, the locking tab can stop proximal movement of the mandrel unless it is intentionally disengaged. For example, the locking element may be disengaged when the user actuates the cursor. In Fig. 9C, a sharp corner feature 935 on the slider may push against a bend in the locking tongue. When the user retracts the control (for example slider 711) in preparation for loading the suture into the device, the locking member can bend (for example by deflecting or hinging) upwards, until that the stop slot 925 is no longer around the boss feature 930 on the mandrel support. The slider is now free to push the mandrel support, and the mandrel proximally and compress the compression spring 933, by pulling the inner mandrel proximally and opening the channel into the distal end to allow loading of the suture .
In FIGS. 9A-9C, other elements of the apparatus are also visible, including the cutter lock 910 and the bias (compression spring 944).
Figs. 8A to 8F illustrate the operation of the apparatus shown in Figs. 7 to 7B and 9A to 9C. In this example, the distal end of the apparatus is shown, including the outer holding tube 907 and the inner member (inner mandrel 909). In Fig. 8A, the inner member 909 is shown at rest, biased distally by the compression spring so that the distal end of the inner membrane is level (or approximately level) with the distal end of the 907. The inner member may be locked by the locking mechanism (locking tab, not visible in Figure 8A). To load a suture, the inner member may first axially slide proximally, as shown in FIG. 8B. In this example, the control on the handle can first be moved to first disengage the locking tab, and after it has been disengaged, to slide the inner member proximally. Alternatively, a separate control may be used to disengage the locking mechanism, for example a knob which deflects the locking mechanism so that it does not attach to the inner member (for example by releasing a boss, as described in Figs. 9A-9C, above).
As shown in FIGS. 8C and 8D, the suture 921 can then be loaded through the lateral slot into the inner chamber of the outer holding tube, and the inner member released (for example by releasing the control) to return in a distal position, with the suture trapped in a channel 955, between the inner chamber and the outer holding tube, as shown in Figure 8D. The device can then be used to push the node 922 distally; once positioned, the external cutter 905 can be actuated (e.g. by releasing the latch and actuating the suture control) to cut the proximal length 928 of the suture from the region immediately adjacent to the node 922, as illustrated in Figures 8D and 8E.
Another variation of a knot pusher and suture cut apparatus is shown in Figs. 10A-11F. In this example, the inner member (mandrel) rotates relative to the outer holding member, allowing the loading of a length of suture into the distal end of the device. In this variant, the handle 1001 includes an inner member control 1051 that rotates the inner member and a separate control 1011 that controls the cutter; a separate latch for the cutter (not shown) may also be included as described above. In some embodiments, the inner member control and the cutter control may be part of the same control, as described above (where sliding in one direction rotates the inner member for loading, and sliding in the other direction drives the cutting device for cutting). In the variant shown in Figs. 10A-10D, the proximal end of the device also includes a thumb ring 1080 which can be used to hold and manipulate the apparatus.
This alternative may provide another mechanism that prevents the inadvertent release of the suture from the distal end of the device. In this example, the mandrel can be rotated while being held in the distal position. A notched region on the inner member (mandrel) provides sufficient space to load a suture, as shown in Figs. 11A-11F. In this example, the notched region of the mandrel is flat on the mandrel, which creates enough space for a suture between the inner wall of the outer holding tube, but not enough for the node to pass through this channel, as shown in Figure 11E. If the mandrel rotates 180 degrees, the space to accommodate the suture is adjacent to the slot on the cutter guide, as shown.
For example, in Fig. 11A, the home position represents the inner member 1009 rotated with the notched (cut) region 1013 opposite to the side slot through the outer housing tube 1007. The inner member is rotatable 1090 (eg, by operating the control 1051 on the handle of the device), as shown in Fig. 11B, until the notch is aligned with the side slot, as shown in Fig. 11C. After that, a length of suture 1121 can be inserted into the notch, and the released inner member returns to the closed (or actively closed) position, so that it moves away from the side slot into the outer housing tube, as shown in FIGS. 11E and 11F. As mentioned above, the rotatable inner element can also be biased into the "closed" position (eg driven in rotation away from the side slot and / or can be locked in this closed position, preventing accidental rotation, for example by using a locking mechanism such as a spindle, pliers, locking element or the like.
Another variation of a knot pusher and suture cut apparatus is shown in Figs. 14A-14C. This example, similar to that shown in Figs. 10A to 11F, also includes a rotatable inner member. Figs. 14B and 14C illustrate the operation of the rotation control 1455 of the inner member. This variant of a command is represented as a cursor, and the sliding of the cursor causes the rotation of the inner element. In this example, a separate control (slider 1411) may be connected to the slitter tube to facilitate movement of the slitter tube distally along the axis of the devices. Control 1455 of the inner member may cause rotation of the inner member as it moves side-by-side, as shown. The side-by-side movement can be translated by a rack gear inside the handle. The rack can interact with a pinion gear attached to the mandrel. By moving the control of the inner member side by side, the user can switch the angular orientation of the mandrel between a loadable configuration (see Fig. 13B) and a loaded configuration (see Fig. 13D). The device can also include features (eg on the handle) to determine the axial position of the mandrel, which further reduces the possibilities of premature discharge, and allow to change the angular position. Figs. 13A to 13D illustrate the loading of the apparatus of Figs. 14A to 14C with a suture, starting with an initial rest configuration as shown in Fig. 13A, rotating the inner member to expose the channel to the Inside the outer housing tube and the inner element (Figure 13B), placing the suture inside the canal through the lateral slot (Figure 13C) and locking the suture length inside the distal end by rotating the inner member away from the side slot (Figure 13D). The inner member of Figs. 14A-13D is a tube having a distal notched end withdrawing a portion of the tube wall, as shown in Figs. 13B and 13C, wherein the inner member slot is visible through the lateral slot.
In any of the variants of the devices described above, the apparatus may include an inner member which is elongated and mounts within the outer housing tube. In some embodiments, the inner member / inner mandrel is an elongate cylindrical member. The cylinder may be solid or hollow, and may have a generally circular, oval, rectangular, triangular or other cross section. At least the distal end of the inner member may include a cut or notch region; in some embodiments, most of the length of the inner member may comprise a notch region. For example, the inner member may be a split cylinder. In some embodiments, the notch region may be a compound notch, wherein the first notch region extends from the distal end to the proximal end, and a second notch region intersecting at an angle the first notch region, begins near the distal end. A compound notch may allow a guide or surface for the suture that can help direct the suture, out of the side slot into a particular location.
For example, Figs. 12A through 12C illustrate variations of the internal elements that may be used in any of the variants described herein. In Fig. 12A, the inner member is a cylinder having a generally round profile with the distal end cut to provide a cut-away region 1205. This variant of the inner member is shown in Figs. 7A-9C. Fig. 12B is another example of an inner member / mandrel in which a distal compound notch is used; the cut-off region forms a first notch region 1205 'and a second notch region 1209. This alternative is used in FIGS. 10A-11F. Fig. 12C is another variation of an inner member in which the mandrel is scored over most of the length of the inner member, so that the inner member comprises a substantially flat side 1211.
As mentioned above, any of the apparatuses described herein may include a proximal thumb ring, as shown in Figs. 10A-10D. Figures 15A and 15B illustrate other variants of thumb rings. When a surgeon uses a thumb ring, it often turns between several angular orientations. Since the apparatuses described above are configured to prevent premature unloading of the suture from the distal end of the device, even at angular orientations in which the suture is aligned with the cutting device guide slot and the Force is applied by the knot to drive the inner member away from the side slot, a thumb ring can be used. Thus, a thumb ring can be added to the device, because there is little risk of premature discharge of the suture. The exemplary thumb bushings in Figs. 15A and 15B do not show other handle features that may be included, including any of those shown above in Figs. 1A to 1B, 7A to 7B, and 10A to 10D.
Figs. 16A to 16C and 17A to 17C illustrate another variation of a knot pusher and cutter apparatus as described above. In this example, the handle comprises a first control 1601 (for example a cutter control) and a second control 1603 (for example a mandrel drive or an internal mandrel drive). These controls can be on the same side (for example the upper side) of the handle. In this example, both commands are cursors; they may alternatively or additionally be dials, buttons, wheels, wheels or the like. Fig. 16B illustrates the operation of the mandrel drive (shown by the arrow) to cause rotation of the inner mandrel (represented by the curved boom); alternatively or additionally, the control can move the inner mandrel proximally.
As mentioned, in any of the variations described herein, the apparatus may be configured such that rotation and / or axial movement of the inner mandrel is biased so that the mandrel is held in a configuration preventing suture to enter or exit the distal end of the device. A solicitation may be a spring or other solicitation element. In addition, the cutting device can be biased by a second spring or other biasing element to hold it proximally until the force is applied by the cutter drive to push it distally to cut the suture as shown above.
Figs. 18A to 18F illustrate another variation of a distal end region of a knot pusher and suture cutter apparatus similar to that illustrated above. In this example, the elongate holding tube 1805 is attached to the handle (not shown), and the elongated holding tube 1805 includes a side slot opening 1810 from a distal end of the sustainably extending holding tube. proximal. The lateral slot extends into a somewhat P-shaped opening unlike the J and L-shaped openings described above. The distal end opening of the lateral slot region is radially offset (e.g., between 30 and 90 degrees) from the most proximal tip of the opening, which may assist in positioning the suture during loading and the cup. The side slot region is configured to allow passage of a suture when the inner mandrel 1807 departs therefrom, as shown in Figs. 18A-18F. The lateral opening (slit) curves around a central elongated axis of the elongated holding tube forming the opening 1810.
Figs. 19A-19F illustrate the same views as Figs. 18A-18F but with the inner mandrel 1907 rotated so that at least a portion of the inner mandrel 1907 overlaps the side opening 1810. This configuration may be the requested configuration (Preset) of the inner mandrel, and can maintain the suture length in the distal end of the device, as described above.
Figs. 20A and 20B illustrate the operation of the distal end configuration shown in Figs. 18A-19F, similar to the devices already described above, wherein the cutter control on the handle (not visible in Fig. 20A ) is actuated against a biasing force (eg a spring) to drive the cutter distally to cut the suture, as shown in Figure 20B.
Thus, for example, a knot pusher and suture cut apparatus may include: a handle; an elongate holding tube secured to the handle, the elongated holding tube including a lateral slot opening from a distal end of the holding tube and configured to allow passage of a suture, the lateral opening curving around a central elongate axis of the elongated holding tube; an inner mandrel within the holding tube, the inner mandrel having a lateral notch extending proximally from a distal end of the inner mandrel, wherein the inner mandrel is axially or rotatively movable relative to to the holding tube and is configured to capture the suture between the notch of the inner mandrel and the holding tube; a tubular cutter around the holding tube, the cutting device being configured to be axially movable with respect to the holding tube for cutting an end of the suture when the tubular cutter is distally extended; a cutter control on the handle configured to control axial movement of the cutter; and a chuck control on the handle, configured to control the rotational position of the inner chuck within the elongate holding tube, wherein the chuck control is biased so that the inner chuck blocks at least a portion of the lateral slot until the chuck control is actuated.
A surgical knot pusher and suture cutter apparatus may include: a handle; an elongate holding tube secured to the handle, the elongate holding tube including a side slot open through the distal end of the holding tube and configured to allow passage of a suture, the side slot extending from a distal end of the elongated tube and curving around a central elongate axis of the elongated holding tube as it extends proximally downwardly from the elongate holding tube; an inner mandrel within the holding tube, the inner mandrel having a lateral notch extending proximally from a distal end of the inner mandrel, wherein the inner mandrel is rotatable relative to the inner mandrel; holding, the inner mandrel being configured to capture the suture between the inner mandrel and the holding tube when the inner mandrel is held in a first rotational position; a tubular cutting device extending around the holding tube, the cutting device being configured to be axially movable relative to the holding tube for cutting one end of the suture; a chuck control being configured as a slider on the handle and configured to be actuated with a single finger and to control rotation of the inner chuck; a cutter control on the handle configured to control axial movement of the cutter; a first bias configured to maintain the inner mandrel in the first rotational position until the mandrel drive is actuated against the bias to rotate the mandrel drive; a second bias configured to oppose distal movement until the force is applied to the cutter drive to slid the cutter distally.
Alternatively or additionally, a surgical knot pusher and suture cutter apparatus may comprise: a handle; an elongated holding tube attached to the handle, the elongated holding tube comprising a lateral slot opening & from a distal end of the holding tube and configured to allow passage of a suture; an inner mandrel within the holding tube, the inner mandrel having a notch extending proximally from a distal end of the inner mandrel along a lateral region of the inner mandrel, wherein the inner mandrel is axially movable or rotatable relative to the holding tube, wherein the inner mandrel is configured to capture the suture between the inner mandrel and the holding tube when the notch is rotated away from the slot opening lateral; a tubular cutter around the holding tube, the tubular cutter being configured to be axially movable relative to the holding tube for cutting an end of the suture when extended distally; a first command on the handle configured to control axial movement of the cutter; a chuck control on the handle configured to rotate the inner chuck relative to the holding tube or to axially slide the inner chuck proximally relative to the holding tube; and a thumb ring at the proximal end of the device.
Where a feature or feature is referred to herein as "on" another feature or element, it may be directly on the other feature or feature or features and / or intermediate elements may also be present. In contrast, when a characteristic or element is designated as being "directly on" another characteristic or element, there are no features or intermediate elements present. It should be understood that when a feature or element is designated as "connected", "fixed" or "coupled" to another characteristic or element, it (it) may be directly connected, attached or coupled to the other characteristics or element or features or intermediate elements may be present. In contrast, when a feature or element is designated as "directly connected", "directly attached" or directly coupled "to another feature or element, there is no features or intermediate elements present. Although described or illustrated with respect to one embodiment, the features and elements thus described or shown can be applied to the other embodiments. Those skilled in the art will also appreciate that references to a structure or feature that is disposed "adjacent" to another feature may have portions that overlap or are below the adjacent feature.
The terminology used herein is intended to describe particular embodiments and is not intended to limit the invention. For example, as used herein, the singular forms "one", "one" and "the", "the" are intended to also include plural forms, unless otherwise clearly indicated in the context. It is further understood that the terms "includes" and / or "including", when used in this specification, specify the presence of the features, steps, operations, elements and / or components mentioned, but do not exclude presence or addition of one or more other characteristics, steps, operations, elements, components and / or their groups. As used herein, the term "and / or" includes any and all combinations of the one or more related listed items and may be abbreviated to "/".
Spatial terms, such as "under", "below", "below", "above", "above", and the like, can be used here to aid description in describing a relationship. an element or feature with respect to another (other) element (s) or other (other) characteristic (s), as illustrated in the figures. It should be understood that the space terms are intended to encompass different orientations of the device for use or operation in addition to the orientation illustrated in the figures. For example, if a device in the figures is inverted, the elements described as being "under" or "below" other elements or features could be oriented "above" other elements or features. Thus, the exemplary term "sub" can encompass both an orientation above and under. Alternatively, the device may be oriented (rotated 90 degrees or in other orientations) and the space descriptions used here interpreted accordingly. Similarly, the terms "up", "down", "vertical", "horizontal" and the like are used here for explanatory purposes only, unless otherwise indicated.
Although the terms "first" and "second" may be used herein to describe different features / elements (including steps), these features / elements should not be limited by these terms unless otherwise specified. These terms can be used to distinguish one characteristic / element from another characteristic / element. Thus, a first feature / element discussed below may be called a second feature, and similarly, a second characteristic / element. discussed below may be referred to as a first feature without departing from the teachings of the present invention.
Throughout the present description and the following claims, unless otherwise indicated, the term "understand" and variants such as "includes" and "comprising" means that different components may be used together in processes and articles (e.g. compositions and apparatus comprising the device and methods). For example, the term "comprising" should be understood as implying the inclusion of any element or step mentioned but not the exclusion of any other element or step.
As used herein in the description and claims, including, as used in the examples, unless otherwise indicated, all numbers may be read as if they were preceded by the term "about" or "approximately", even if the term does not appear expressly. The term "approximately" or "approximately" may be used in describing the magnitude and / or position to indicate that the value and / or position being described is within a reasonable expected range of values and / or positions . For example, a numeric value may have a value that is +/- 0.1% of the value (or range of values) mentioned, +/- 1% of the value (or range of values) mentioned, +/- 2 % of the value (or range of values) mentioned, +/- 5% of the value (or range of values) mentioned, +/- 10% of the value (or range of values) mentioned, etc. Any of the numerical values given herein should also be understood to comprise about or approximately the value unless otherwise indicated. For example, if the value "10" is disclosed, then "about 10" is also disclosed. Any of the digital ranges presented here are intended to include all the sub-ranges included here. It should also be understood that when a value is disclosed, "less than or equal" to the value, "greater than or equal" to the value and the possible ranges between the values are also disclosed, as will be understood by those skilled in the art. For example, if the value "X" is disclosed, "less than or equal to X" and "greater than or equal to X" (for example, when X is a numerical value) are also disclosed. It should be understood that throughout the application, the data is transmitted in a number of different formats, and that this data represents the end and start terminals, and the ranges for any one of the data terminal combinations. . For example, if a particular data terminal "10" and a particular data terminal "15" are disclosed, it should be understood that greater than, greater than or equal to, less than, less than or equal to, and equal to 10 and 15 are considered between 10 and 15. It should be understood that each unit between two particular units is also disclosed. For example, if 10 and 15 are disclosed, then 11, 12, 13 and 14 are also disclosed.
Although various illustrative embodiments are described above, any of a number of changes may be made to various embodiments without departing from the scope of the invention as described by the revendications. For example, the order in which the various process steps described are carried out can often be modified in alternative embodiments, and in other alternative embodiments, one or more process steps may be all made to be skipped. Optional features of the various device and system embodiments may be included in some embodiments and not in others. Therefore, the foregoing description is offered primarily as an example and should not be construed as limiting the scope of the invention as set forth in the claims.
The examples and illustrations included herein represent, by way of illustration and not limitation, specific embodiments in which the subject can be realized, as mentioned, other embodiments can be used and derived from them, so that structural and logical replacements and changes can be made without departing from the scope of this specification. Such embodiments of the subject of the invention may be designated individually or collectively by the term "invention" simply for convenience and without wishing to voluntarily limit the scope of the present application to a single invention or inventive concept, if one disclose more than one. Thus, although specific embodiments have been illustrated and described herein, any arrangement calculated to achieve the same purpose may be replaced by the specific embodiments shown. This description is intended to cover any and all adaptations or variations of the various embodiments. Combinations of the above embodiments and other embodiments not specifically described herein will become more apparent to those skilled in the art upon consideration of the above description.

权利要求:
Claims (12)
[1" id="c-fr-0001]
A knuckle pusher and suture cut apparatus, the apparatus comprising: a handle; an elongate holding tube secured to the handle, the elongate holding tube including a lateral slot opening through the elongated holding tube and extending proximally from a distal end of the holding tube, wherein the lateral opening curves around a central elongated axis of the elongate holding tube so that the most proximal end of the lateral slot opening is radially offset by a value of between 30 and 90 degrees from the lateral slot opening at the distal end of the holding tube, further wherein the side slot opening is configured to allow passage of a suture; an inner mandrel within the holding tube, the inner mandrel having a lateral notch extending proximally from a distal end of the inner mandrel, wherein the inner mandrel is axially or rotatively movable relative to the inner mandrel; to the holding tube, and is configured to capture the suture between the notch of the inner mandrel and the holding tube; a tubular cutter around the holding tube, the cutting device being configured to be axially movable with respect to the holding tube for cutting a suture end when the tubular cutter is distally extended; a cutter control on the handle configured to control the axial movement of the cutter i and a chuck control on the handle, configured to control the rotational position of the inner mandrel within the elongate holding tube, in wherein the mandrel drive is biased so that the inner mandrel blocks the side slot opening at the distal end of the holding tube until the mandrel drive is actuated.
[2" id="c-fr-0002]
The apparatus of claim 1, further comprising a thumb ring at the proximal end of the device.
[3" id="c-fr-0003]
Apparatus according to claim 1, wherein the inner mandrel comprises a notch.
[4" id="c-fr-0004]
An apparatus according to claim 3, wherein the notch includes a region extending longitudinally from the distal end of the inner mandrel to form an opening between the inner mandrel and an inner wall of the elongate holding tube.
[5" id="c-fr-0005]
Apparatus according to claim 1, wherein the cutting device control comprises a slider configured to be actuated with a single finger to control the axial movement of the cutting device.
[6" id="c-fr-0006]
Apparatus according to claim 1, wherein the chuck control comprises a slider configured to be actuated with a single finger and for controlling the rotational position of the inner chuck.
[7" id="c-fr-0007]
An apparatus according to claim 1, further comprising a biasing spring applying the biasing force opposed to a rotational movement of the inner mandrel within the holding tube to maintain the inner mandrel so that the inner mandrel blocks the inner mandrel. lateral slot opening at the distal end of the holding tube.
[8" id="c-fr-0008]
Apparatus according to claim 1, further comprising a cutter release button.
[9" id="c-fr-0009]
An apparatus according to claim 8, wherein the cutting device release is biased to engage the control to prevent distal advancement of the cutting device until the cutting device release is released.
[10" id="c-fr-0010]
The apparatus of claim 1, wherein the tubular cutter comprises a progressively narrowed edge oriented distally.
[11" id="c-fr-0011]
Apparatus according to claim 1, further comprising a locking tab.
[12" id="c-fr-0012]
The apparatus of claim 1, further comprising a stop configured to prevent axial movement of the interned mandrel within the holding tube.

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法律状态:
2018-03-15| PLFP| Fee payment|Year of fee payment: 2 |

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2019-02-15| PLSC| Search report ready|Effective date: 20190215 |

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2020-03-26| PLFP| Fee payment|Year of fee payment: 4 |

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2021-03-25| PLFP| Fee payment|Year of fee payment: 5 |

优先权:

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申请号 | 申请日 | 专利标题

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US201361881319P| true| 2013-09-23|2013-09-23|

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US15/145,627|US10143464B2|2013-09-23|2016-05-03|Arthroscopic knot pusher and suture cutter|

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