Percutaneous suturing apparatus and method

Abstract

A suturing instrument and methods for placing stitches in soft tissues combines the functions of both independently grasping the tissue and passing sutures through the tissue to form a mattress stitch therein. The endoscopic suturing instrument comprises a clamping portion having a longitudinal axis, which is adapted for percutaneous entry into an operative site. The clamping portion further comprises a plurality of jaw members that are movable relative to one another between a closed position wherein the jaw members are disposed in close proximity to one another and an open position wherein the jaw members are spaced apart. A needle portion is disposed at an angle relative to the longitudinal axis, and is adapted for percutaneous entry into said operative site. The needle portion comprises a needle, and preferably a pair of needles, for passage through a portion of soft tissue disposed between the jaw members of the clamping portion.

What is claimed is:  
     
         1 . A suturing device for use endoscopically, comprising: 
 a clamping portion having a longitudinal axis, which is adapted for percutaneous entry into an operative site and which comprises a plurality of jaw members that are movable relative to one another between a closed position wherein the jaw members are disposed in close proximity to one another and an open position wherein the jaw members are spaced apart; and    a needle portion disposed at an angle relative to said longitudinal axis, which is adapted for percutaneous entry into said operative site;    said needle portion comprising a needle for passage through a portion of soft tissue disposed between the jaw members of said clamping portion.    
     
     
         2 . The suturing device as recited in  claim 1 , and further comprising suturing material disposed in one of said jaw members, said needle being adapted for engaging said suturing material at said operative site.  
     
     
         3 . The suturing device as recited in  claim 2 , wherein said needle comprises a distal end which is configured for engaging said suturing material.  
     
     
         4 . The suturing device as recited in  claim 3 , wherein said distal end is hooked for gaffing said suturing material.  
     
     
         5 . The suturing device as recited in  claim 2 , wherein the suturing material disposed in the one jaw member comprises a suture loop.  
     
     
         6 . The suturing device as recited in  claim 5 , wherein there are two suture loops disposed on opposing sides of said one jaw member.  
     
     
         7 . The suturing device as recited in  claim 5 , and further comprising a second needle, each of said needles engaging a respective one of said two suture loops.  
     
     
         8 . The suturing device as recited in  claim 1 , wherein said angle is between about 30 and about 90 degrees.  
     
     
         9 . The suturing device as recited in  claim 1 , wherein said clamping portion and said needle portion enter the operative site through different percutaneous locations.  
     
     
         10 . The suturing device as recited in  claim 1 , wherein said needle portion includes a needle guide having a needle guide channel for guiding said needle to the operative site.  
     
     
         11 . The suturing device as recited in  claim 10 , wherein the needle guide is telescopically fixed to the needle portion to adjust for different patient dimensions.  
     
     
         12 . A suturing device for use endoscopically, comprising: 
 a clamping portion having a longitudinal axis, which is adapted for percutaneous entry into an operative site and which comprises a plurality of jaw members that are movable relative to one another between a closed position wherein the jaw members are disposed in close proximity to one another and an open position wherein the jaw members are spaced apart;    one of said jaw members comprising first and second slots on opposing sides thereof, wherein a first looped end of a length of suturing material is disposed in said first slot and a second looped end of a length of suturing material is disposed in said second slot.    
     
     
         13 . The suturing device as recited in  claim 12 , and further comprising a needle portion having first and second needles adapted for engagement with said first and second looped ends, respectively.  
     
     
         14 . The suturing device as recited in  claim 13 , wherein said first and second needles are disposed at an angle relative to said longitudinal axis.  
     
     
         15 . The suturing device as recited in  claim 14 , wherein said angle is between about 30 degrees and about 90 degrees.  
     
     
         16 . A suturing device for use endoscopically, comprising: 
 a tissue retaining portion having a longitudinal axis, which is adapted for percutaneous entry into an operative site through a cannula; and    a suture engagement portion spaced from said tissue retaining portion, which is adapted for percutaneous entry into said operative site through a location spaced from said cannula.    
     
     
         17 . The suturing device as recited in  claim 16 , wherein said tissue retaining portion comprises a clamping portion having means for retaining soft tissue which is to be attached to bone within said operative site.  
     
     
         18 . The suturing device as recited in  claim 17 , wherein said retaining means comprises first and second jaw members which are movable relative to one another between a closed position wherein the jaw members are disposed in close proximity to one another and an open position wherein the jaw members are spaced apart.  
     
     
         19 . A method of placing sutures in tissue, using a suturing device which comprises a clamping portion having a longitudinal axis and a needle portion spaced from said clamping portion, the method comprising: 
 inserting a distal end of said clamping portion percutaneously into an operative site until a distal working end thereof is adjacent to tissue which is to be repaired; engaging said tissue with said distal working end;    inserting a distal end of said needle portion percutaneously into the operative site, so that at least one needle of said needle portion extends through said engaged tissue and through a suture loop disposed on a distal side of said engaged tissue; and    withdrawing said at least one needle proximally to thereby pull said suture loop proximally through said engaged tissue to form a stitch through said tissue.