Devices and method for handling a plurality of suture elements during a suturing procedure

[0002] This invention relates to handling, or managing, a plurality of suture elements during a surgical procedure.

[0003] During many different surgical procedures it is required to join, or secure, patient tissue together. One way often employed by surgeons, or medical assistants, or the like, to secure patient tissue together, is by using suture elements in a suturing procedure. During such a suturing procedure, suture elements are typically located, or placed, at a surgical site on a patient body and opposed portions of the suture elements are then tied to form sutures, or stitches, at the surgical site so as to secure the patient tissue together. Traditionally, such suturing procedures have been performed by using suture carrying needles to locate one or more suture elements through tissue, pulling the suture elements through the tissue to bring the tissue together and then tying opposed portions of the suture elements together to secure the tissue together.

[0004] Multi-suture deployment devices have been proposed by means of which a plurality of suture elements can be located, or placed, at a surgical site on a patient body generally at the same time. When such a plurality of suture elements have been located at the surgical site in this fashion, opposed portions of the suture elements are typically extended from the surgical site and then opposed portions of each suture element are typically tied together to secure the tissue together at the surgical site.

[0005] It has been found that managing opposed portions of a plurality of suture elements after having been located on the patient body can be rather tedious. In particular, if appropriate care is not taken, the opposed portions of the suture elements can become mixed up, or twisted, so that identifying which portion of a suture element corresponds with which opposed portion of the same suture element becomes a rather arduous task. Furthermore, after the suture elements have been located on the patient body, the opposed portions of the suture elements are typically positioned to extend from the patient body while being carried on suture holders of the multi-suture deployment device. In such a case, the suture elements can be laterally spaced quite close to one another, making manual pick-up of individual suture element portions, so as to tie them together, for example, rather difficult. Naturally, should the opposed portions of the suture elements become mixed up, or should the opposed portions be spaced laterally relatively close together making manual pick up difficult, the suturing procedure can be complicated and can take longer than it would otherwise.

[0006] It would be advantageous to provide a device and method whereby the handling of multiple suture elements, during a suturing procedure comprising the placement of a plurality of suture elements on a patient body, generally at the same time, before tying opposed portions of each suture element together, could be made easier at least to reduce the problems set forth above.

[0007] Accordingly, the invention provides a device and method of handling a plurality of suture elements after having been located at a surgical site on a patient body, so as to inhibit opposed portions of the suture elements from becoming mixed up during a suturing procedure and to increase a lateral spacing between the suture elements.

[0008] In accordance with one aspect of the invention, there is provided a suture handling device. The suture handling device comprises a body and a plurality of passages defined on the body. Each passage has a mouth and an opposed end. The passages are arranged to diverge outwardly relative to one another in a direction away from the mouths and toward their opposed ends, such that when the suture handling device is advanced laterally over a plurality of spaced apart suture elements so that the suture elements enter the mouths and pass along the passages toward the opposed ends, the suture elements become spaced further apart.

[0009] By passing the suture handling device laterally over a plurality of spaced apart suture elements and advancing the suture handling device such that the suture elements travel along the passages, a lateral spacing between the suture elements can be increased. By increasing the lateral spacing in this fashion, manual pick up of opposed portions of the suture elements so as to tie them together can be made easier.

[0010] The suture handling device may comprise an engaging formation arranged to engage the suture elements when at the ends of the passages.

[0011] The engaging formation may comprise a slide on the body. The slide may be displaceable laterally relative to the passages between an engaging condition, in which the slide protrudes into the passages to engage the suture elements in the passages, and a disengaging condition, in which the slide is clear of the passages to be disengaged from the suture elements.

[0012] Accordingly, after the suture elements have passed along the passages so as to increase their lateral spacing, the suture elements can be held captive on the device by means of the engaging formation. Individual suture element portions can then be removed from the device so as to tie them together, while the rest of the suture element portions remain engaged in the passages on the device, thereby inhibiting the suture element portions from becoming mixed up.

[0013] In accordance with another aspect of the invention, there is provided a method of handling a plurality of suture elements. The method comprises locating a plurality of suture elements on a patient body, positioning the suture elements in a suture handling device and causing the suture handling device to displace the suture elements laterally away from one another to increase a lateral spacing between the suture elements.

[0014] Positioning the suture elements in the suture handling device may comprise passing the suture elements laterally through mouths of passages defined on the suture handling device. The passages can typically diverge laterally away from one another in a direction away from the mouths, so that, causing the suture handling device to displace the suture elements laterally away from one another to increase a lateral spacing between the suture elements comprises advancing the suture elements along the passages such that the suture handling device causes the suture elements to displace laterally away from one another as the suture elements are advanced along the passages.

[0015] The method may further comprise positioning opposed portions of a suture element in each passage of the suture handling device and selectively removing the opposed portions of the suture elements from the suture handling device and tying them together to form a plurality of sutures on the patient body.

[0016] Locating the plurality of suture elements on the patient body may comprise locating the suture elements through patient tissue such that opposed portions of each suture element extend from the patient tissue.

[0017] Locating the plurality of suture elements through patient tissue may comprise actuating a multi-suture deployment device to locate the plurality of suture elements through the patient tissue and withdrawing the multi-suture deployment device from the patient tissue while opposed portions of each suture element is carried on the multi-suture deployment device so that the opposed portions of the suture elements extend from the patient tissue.

[0018] Passing the suture handling device laterally across the suture elements may comprise positioning both opposed portions of each suture element in a separate one of the passages of the suture handling device. The method may further comprise selectively removing the opposed portions of each suture element from the suture handling device and tying the opposed portions together.

[0019] The invention will now be described, by way of example, with reference to the accompanying diagrammatic drawings, in which:

[0020] FIG. 1 shows a schematic three-dimensional view of part of a suture handling device in accordance with the invention, a cover of the suture handling device having been removed;

[0021] FIG. 2 shows a schematic plan view of the suture handling device of FIG. 1, an engaging formation on the suture handling device being in an engaging condition;

[0022] FIG. 3 shows a schematic plan view corresponding to FIG. 2, the engaging formation being in a disengaging condition;

[0023] FIG. 4A shows a schematic three-dimensional view of a plurality of suture elements having been located at a surgical site on a patient body by means of a multi-suture deployment device;

[0024] FIG. 4B shows a schematic three-dimensional view of a plurality of suture elements having been located at another surgical site on a patient body by means of a multi-suture deployment device;

[0025] FIG. 5 shows a schematic three-dimensional view of the suture handling device of FIGS. 1 to 3 being advanced laterally over a plurality of spaced apart suture elements so that the suture elements enter mouths and pass along passages defined by the suture handling device toward opposed ends of the passages so that the suture elements become spaced further apart; and

[0026] FIG. 6 shows a schematic three-dimensional view corresponding to FIG. 5, after the suture elements have passed along the passages and have been spaced further apart by the suture handling device.

[0027] Referring to FIG. 1 of the drawings, part of a suture handling device in accordance with the invention is generally indicated by reference numeral 10. In FIG. 1, a cover of the device 10 has been removed to show the operation of an engaging formation of the device 10, as will be described in greater detail hereinbelow.

[0028] The device 10 comprises a body generally indicated by reference numeral 12. The body 12 typically includes the cover, which is not shown in FIG. 1. The device 10 further comprises a plurality of passages 14 defined on the body 12. Each passage 14 has a mouth 16 and an opposed end 18, as can best be seen with reference to FIGS. 2 and 3 of the drawings. The passages 14 are arranged to diverge outwardly relative to one another in a direction away from the mouths 16, as indicated at 20.

[0029] The mouths 16 of the passages 14 are typically adjacent one another at an end 22 of the body 12. A guide formation, generally indicated by reference numeral 24 at the end 22 of the body 12 for guiding suture elements laterally into the mouths 16 of the passages 14 is typically provide. The guide formation 24 typically comprises opposed edges, or surfaces, 26, 26 which taper, or converge, toward the mouths 16 so as to assist in guiding suture elements into the mouths 16. The passages 14 typically define portions 14.1 which extend generally parallel relative to one another generally at the ends 18 opposed from the mouths 16.

[0030] The device 10 further comprises an engaging formation, generally indicated by reference numeral 30, arranged to engage the suture elements in the passages 14 when the suture elements are generally at the ends 18, or within the generally parallel portions 14.1. The engaging formation 30 typically comprises a slide 32 on the body 12 for selectively providing interference in the passages 14 to enable suture elements to be held captive in the passages 14. The slide 32 is displaceable laterally relative to the passages 14, as indicated by arrow 34 in FIG. 1, and between an engaging condition, in which the slide 32 protrudes into the passages 14 to engage the suture elements in the passages 14, as can be seen with reference to FIG. 2, and a disengaging condition, in which the slide 32 is clear of the passages 14 to be disengaged from the suture elements, as can best be seen with reference to FIG. 3 of the drawings. To this end, the slide 32 comprises a plurality of slots 32.1. When in a disengaging condition, as indicated in FIG. 3, the slots 32.1 are in register with the ends 18 of the passages 14. When in an engaging condition, the slide 32 is laterally displaced such that the slots 32.1 are offset relative to the ends 18 of the passages 14 so as to capture suture element portions within the slots 14.

[0031] The slide 32 is typically biased into its engaging condition, as indicated in FIG. 2. To this end, the slide 32 comprises a resilient biasing member 32.2, such as a leaf spring formation, for resiliently urging the slide 32 away from a wall 12.1 of the body 12 and into its engaging condition. A manually operable actuator, such as a lever arm 40, operatively associated with the slide 32, is provided so as to enable the slide 32 to be displaced into its disengaging condition in response to actuating the actuator 40 manually. To this end, the slide 32 typically comprises a protrusion 32.3 which abuts against the actuator 40. Accordingly, when the actuator 40 is displaced toward the body 12, as indicated by arrow 42 in FIG. 3 of the drawings, the slide 32 is displaced laterally relative to the body 12 against the bias of the biasing member 32.2. Advantageously, the device 10 can be provided with a locking arrangement for locking the slide 32 in its engaging condition so as to inhibit accidental displacement of the slide 32 and release of suture elements when engaged thereby. Edges of the slots 14, at least in the region where the slide 32 passes into the slots 14, can be lined with an appropriate material, such as a soft elastomeric material, or the like, to enhance gripping of the suture elements when engaged by the slide 32 in the slots 14 thereby to improve retention of the suture elements when engaged in the slots 14. In addition, or instead, edges of the slide 32 at the slots 32.1 can be lined with an appropriate material, such as a soft elastomeric material, or the like, to enhance gripping of the suture elements when engaged by the slide 32 in the slots 14 thereby to improve retention of the suture elements when engaged in the slots 14. Instead of the slide 32, the slots 14 can be dimensioned, or provided with resilient formations, such that the suture elements are frictionally engaged in the slots automatically when the suture elements are passed into the slots 14.

[0032] In FIGS. 2 and 3, the cover of the device 10 is generally indicated by reference numeral 44. The body 12 is typically formed from of synthetic plastics material. Lugs and corresponding holes 46 are provided on the cover 44 and the rest of the body 12 for securing the cover 44 on the rest of the body 12 in an appropriate manner, such as by means of a press fit, a suitable adhesive, or the like.

[0033] Referring to FIG. 4A, a plurality of suture elements 50 are shown as having been located at a surgical site on a patient body. By way of example, the suture elements 50 have been located relative to an incision 52 in a wall of a vessel 54 on the patient body. The suture elements 50 are shown as having been located at the incision by means of a multi-suture deployment device. After location of the suture elements 50 relative to the incision 52 by the multi-suture deployment device, suture holders 56, 56 on which the suture elements are carried are typically extended from the surgical site as shown. It will be seen that opposed portions 50.1 of each suture element 50 are positioned adjacent each other while carried on the holders 56, 56 as indicated at 50.2.

[0034] Referring now to FIG. 4B, a plurality of suture elements have been located on a patient body so as to perform a side-to-side anastomosis procedure, for example. As in the case shown in FIG. 4A, a plurality of suture elements 50 have been located relative to two incisions 52 of two vessels 58, 60 which are to be sutured together to perform the side-to-side anastomosis, so that blood flowing in one of the vessels 58, 60 can be passed into the other of the vessels 58, 60.

[0035] Referring now to FIG. 5 of the drawings, after the suture elements 50 have been located on the patient body, as shown in FIGS. 4A and 4B, the device 10 can advantageously be used to facilitate the handling of the suture element portions 50.1 so as to inhibit them from becoming mixed up and to displace the suture elements laterally further apart from one another so as to assist in manual pick up of the suture element portions so as to tie them together. Initially, the device 10 is passed laterally over the suture elements 50 so that the opposed portions 50.1 of each suture element 50 enter the mouths 16 of the passages 14 so as to be positioned in one of the passages 14, as indicated by arrow 70. The converging surfaces 26, 26 assist in guiding the suture elements 50 into the mouths 16. After entering the mouths 16, the device 10 is further advanced laterally over the suture elements 50 to cause the suture elements to pass along the passages 14 so as to become spaced laterally further apart as they pass along the diverging portions of the passages 14.

[0036] A spacing between the mouths 16 of the slots 14 typically corresponds to a spacing between adjacent suture elements on the needle holders 56, 56 to enable the suture elements to be readily passed into the mouths 16 of the slots. Accordingly, the device 10 can be arranged to be compatible with a specific suture holder of a specific multi-suture deployment device and can be supplied together with such a multi-suture deployment device.

[0037] As the device is advanced over the suture elements, the actuator 40 is typically depressed, as indicated by arrow 42, so that the slide 32 is in a disengaging condition to permit the suture elements to pass into and along the parallel portions 14.1 of the passages 14 toward the ends 18. As can best be seen in FIG. 6, and after the suture elements are positioned in the portions 14.1 of the passages 14 at the ends 18, the actuator 40 is typically released, as indicated by arrow 72 in FIG. 5, to permit the urging member 32.2 to urge the slide 32 into its engaging condition so as to engage the suture elements in the passages 14 at the ends 18, thereby releasably to hold the suture elements captive in the passages 14. Conveniently, the device 10 can be provided with a pocket, or the like, so as to enable the holders 56, 56 to be deposited into the pocket after the sutures have been engaged by the device 10, thereby to inhibit the holders 56, 56 from dangling loosely from the device 10.

[0038] After the suture element portions 50.1 are engaged on the device 10 in this fashion, opposed portions of each suture element 50 can selectively be removed, or picked up, from the device 10 manually, while the other portions 50.1 remain engaged on the device 10, so that the picked up portions 50.1 can be tied together to form a suture, or stitch, at the surgical site. To remove the portions selectively from the device 10 in this fashion, the portions 50.1 are typically slid along the passages 14 toward the mouths 16 while the slide 32 is in an engaging condition. After the suture elements are engaged on the device 10, the opposed ends at 50.2 of the suture elements 50 can be disengaged from the suture holders 56, 56, or, instead, the ends at 50.2 can be removed from the holders 56, 56 as the portions 50.1 are selectively removed from the device 10.

[0039] Conveniently, the device 10 can be mounted on the end of an arm. An opposed end of the arm can be provided with an appropriate mount for mounting the arm on a support normally held at a stationary position relative to the patient body during the suturing procedure. The arm can be bendable to vary the position of the device 10 relative to the support and the patient while the mount is mounted on thc support. The arm and mount can be similar to the arm and mount as illustrated in Applicant's co-pending patent application Ser. No. 09 608,832, filed on Jun. 30, 2000 and entitled “Surgical Support Clamp”; the full disclosure of which is incorporated herein by reference. Instead, the device 10 can be provided with an attachment formation for releasably attaching it to an appropriate object during a suturing procedure. For example, the device 10 could be provided with a surface lined with an appropriate adhesive, a spring clip or clamp, a screw clamp, or the like, to enable the device 10 to be releasably attached to an appropriate support, such as, a table, a surgical drape, or the like.

[0040] Although an embodiment of the invention has been described in detail above for purposes of clarity and understanding, it will be appreciated that the invention has been described with reference to the above embodiment by way of example only, and that modifications or changes can be made without detracting from the essence of the invention. For example, the suture handling device of the invention could be in the form of a bulldog type clamp having opposed jaws, one of the jaws having diverging slots so that when the sutures are positioned in the slots and the bulldog-type clamp is closed, the sutures are advanced along the diverging slots so as to be spread further apart. Instead of the slide 32, appropriate interference in the slots 14 can be provided by manually snapping a slotted arm into an engaging condition. Devices similar to the devices 10 could be provided which permit separation of the suture elements relative to each other when engaged in the slots. For example, lines of weakness can be provided so that the device can be snapped into several pieces, each carrying a suture element pair so that each pair can be separately loaded into a knot tying device, or the like. Accordingly, the scope of the invention is defined by the appended claims with due regard to equivalents of the claimed elements or features.