Suturing method and apparatus

Abstract

A suturing apparatus comprises an elongated body, at least one arms movable relative to the elongated body and at least one needle movable relative to the elongated body. The arm releasably holds an end portion of a length of suture. The arm has a sharp end portion adapted to pierce an inner surface of a wall of a biological structure and pass an end portion of the suture through the inner surface. The needle is adapted to pierce the inner surface of such biological structure at a location proximal to the location where the end portion of the suture was inserted. The needle captures an end portion of the suture from the arm and draws the end portion of the suture back through the inner surface. The end of the suture is then drawn out of the biological structure by removing the elongated body.

1 . A method of placing a suture, comprising: 
 positioning a distal portion of an elongated member adjacent a location to be sutured;    deploying at least one arm which releasably holds a portion of a suture;    penetrating tissue with a sharp end portion of the arm;    penetrating tissue with a needle and driving the needle toward said suture portion; and    capturing the suture portion from the arm with the needle and drawing the suture portion through the tissue and toward the elongated body.    
   
   
       2 . The method of  claim 1 , wherein penetrating tissue with a sharp end portion of the arm comprises penetrating an inner wall of a tubular biological structure.  
   
   
       3 . The method of  claim 2 , wherein the tubular biological structure is a fallopian tube.  
   
   
       4 . The method of  claim 2 , wherein the tubular biological structure is a common bile duct.  
   
   
       5 . The method of  claim 2 , wherein the tubular biological structure is an arterial-venous fistula.  
   
   
       6 . The method of  claim 2 , wherein penetrating tissue with a sharp end portion of the arm further comprises positioning the sharp end portion beyond an outer surface of the biological structure.  
   
   
       7 . The method of  claim 1 , comprising deploying two arms which releasably hold end portions of a suture.  
   
   
       8 . The method of  claim 7 , further comprising penetrating tissue with the two arms on opposite sides of an opening.  
   
   
       9 . The method of  claim 8 , wherein the two arms penetrate tissue simultaneously.  
   
   
       10 . The method of  claim 8 , wherein the two arms penetrate tissue sequentially.  
   
   
       11 . The method of  claim 8 , comprising penetrating tissue with two needles and driving each needle toward the end portions of the suture held by each of the arms.  
   
   
       12 . The method of  claim 7 , further comprising penetrating tissue with only one of the two arms.  
   
   
       13 . The method of  claim 12 , comprising penetrating tissue with a first needle and driving the first needle toward the end portion of the suture held by the first arm, and driving a second needle toward the end portion of the suture held by the second arm without driving the second needle through tissue.  
   
   
       14 . The method of  claim 1 , wherein deploying the at least one arm comprises moving the arm from within the elongated member to outside the elongated member.  
   
   
       15 . The method of  claim 11 , wherein deploying the at least one arm comprises moving the end portion of the arm to a location distal to the elongated member.  
   
   
       16 . A method of closing a tubular biological structure from within the tubular biological structure, the method comprising: 
 inserting a distal portion of an elongated member into the tubular biological structure;    deploying a pair of arms, each arm releasably holding an end portion of a suture;    penetrating an inner surface of the tubular biological structure with sharp end portions of the arms such that the arms position the suture portions beyond the inner surface of the tubular biological structure;    penetrating the inner surface of the tubular biological surface with a pair of needles;    capturing the suture portions from the arms with the needles and drawing the suture portions through the tissue and toward the elongated body; and    tying the suture to close the tubular biological structure.    
   
   
       17 . The method of  claim 16 , wherein deploying the pair of arms comprises moving the arms from within the elongated member to outside the elongated member.  
   
   
       18 . The method of  claim 16 , wherein the pair of arms when deployed are parallel to one another.  
   
   
       19 . The method of  claim 16 , wherein the pair of arms when deployed form an acute angle relative to one another.  
   
   
       20 . A method of suspending a biological structure, comprising: 
 positioning a distal portion of an elongated member adjacent the biological structure to be suspended;    positioning a first arm connected to the elongated member on one side of the biological structure, the first arm releasably holding an end portion of a suture;    penetrating tissue of an adjacent biological structure with a sharp end portion of a second arm, the second arm releasably holding an end portion of the suture;    driving a first needle toward the end portion of the suture in the first arm, the first needle moving on an opposite side of the biological structure such that when the first needle engages the first arm, the biological structure is surrounded by the first arm, the first needle and the elongated member;    driving a second needle toward the end portion of the suture in the second arm, wherein the second needle penetrates tissue to engage the second arm;    capturing the suture portions from the arms with the needles and drawing the suture portions with the needles toward the elongated member; and    tying the ends of the suture together to suspend the biological structure to the adjacent biological structure.    
   
   
       21 . The method of  claim 20 , wherein the first arm and the second arm are moveable from a first position within the elongated member to a second position extended from the elongated member.  
   
   
       22 . The method of  claim 20 , wherein positioning the first arm and driving the first needle occurs prior to penetrating tissue with the second arm.  
   
   
       23 . The method of  claim 20 , wherein penetrating tissue with the second arm and driving the second needle occurs prior to positioning the first arm.  
   
   
       24 . A method of blocking the vas deferens to achieve male sterilization, comprising: 
 accessing the vas deferens through the scrotum;    positioning a distal portion of an elongated member adjacent a vas deferens to be blocked;    deploying an arm connected to the elongated member on one side of the vas deferens, the first arm releasably holding an end portion of a suture;    deploying a needle toward the end portion of the suture in the first arm, the needle moving on an opposite side of the vas deferens such that when the needle engages the arm, the vas deferens is surrounded by the arm, the first needle and the elongated member;    capturing the suture portion from the arm with the needle and drawing the suture portion with the needle toward the elongated member;    tying the ends of the suture together to block the vas deferens; and    repeating the procedure on the other vas deferens.