Dual insufflation and wound closure devices and methods

Abstract

A dual functioning instrument set, comprising a needle and guide, has not only the capabilities to enter and insufflate the abdominal cavity but also the ability of a suture passer to carry and retrieve suture for closure of the incision sites at the end of the procedure. The needle contains a deployable snare that is used to pass and retrieve suture. The guide is used to repeatedly locate the needle relative to the inner abdominal wall allowing for consistent placement of sutures. For insufflation purposes, obturator tips having different distal structures are provided for shielding the sharp needle tip after insertion through a body wall.

1 . A dual insufflation and closure device for use in connection with a surgery involving an open wound, comprising:
 a shaft assembly defining a lumen extending along an axis between a shaft distal end and a shaft proximal end, the lumen configured to be in fluid communication with a source of pressurized fluid; and   a puncture closure mechanism configured to engage a suture.   
     
     
         2 . The device of  claim 1 , wherein the puncture closure mechanism comprises a snare disposed adjacent to the shaft distal end, the snare being movable between a retracted position where the snare is substantially disposed within the shaft assembly and an exposed position where the snare protrudes from the shaft assembly. 
     
     
         3 . The device of  claim 2 , wherein the snare comprises a deformable loop composed of a material having memory characteristics such that the snare forms a pre-formed shape when exposed. 
     
     
         4 . The device of  claim 3 , wherein the deformable loop in the exposed position is slanted with respect to the axis of the shaft. 
     
     
         5 . The device of  claim 3 , wherein the deformable loop forms an opening substantially perpendicular with respect to the axis of the shaft. 
     
     
         6 . The device of  claim 2 , further comprising an actuator mechanism for moving the snare between the retracted position and the exposed position. 
     
     
         7 . The device of  claim 6 , further comprising:
 a housing disposed adjacent to the shaft proximal end, the housing having a housing proximal portion and a housing distal portion, and   wherein the actuator mechanism comprises a rod assembly coupled to the snare, the rod including a rod proximal portion protruding from the housing proximal portion, the rod assembly being configured to axially translate more than 1 inch with respect to the housing.   
     
     
         8 . The device of  claim 7 , wherein the actuator mechanism comprises a trigger configured to lock the snare in the retracted position. 
     
     
         9 . The device of  claim 2 , wherein the shaft assembly comprises:
 an outer shaft having a sharp needle distal tip; and   an inner shaft comprising the lumen and housing the snare.   
     
     
         10 . The device of  claim 9 , further comprising a distally biased obturator tip to shield the needle distal tip when the obturator tip encounters a drop in resistance. 
     
     
         11 . A dual insufflation and closure device for use in connection with a surgery involving an open wound, comprising:
 a shaft assembly defining a lumen along an axis between a shaft distal end and a shaft proximal end;   a snare configured to engage a suture and disposed adjacent to the shaft distal end, the snare being movable between a retracted position where the snare is substantially disposed within the shaft assembly and a fully exposed position where the snare protrudes from the shaft assembly;   a housing having a housing proximal portion and a housing distal portion; and   an actuator mechanism for moving the snare between the retracted position and the fully exposed position.   
     
     
         12 . The device of  claim 11 , wherein the snare comprises a deformable loop composed of a material having memory characteristics such that the snare forms a pre-formed shape when exposed. 
     
     
         13 . The device of  claim 11 , wherein the deformable loop in the fully exposed position is off-axis. 
     
     
         14 . The device of  claim 11 , wherein the actuator mechanism comprises a rod assembly coupled to the snare and configured to slide axially with respect to the housing between a proximal retracted configuration and a distal exposed configuration. 
     
     
         15 . The device of  claim 14 , wherein the rod is configured to slide more than 1 inch axially with respect to the housing. 
     
     
         16 . The device of  claim 11 , further comprising a lock mechanism configured to secure the snare in the retracted position. 
     
     
         17 . The device of  claim 11 , wherein the shaft assembly comprises a sharp needle distal tip. 
     
     
         18 . The device of  claim 17 , further comprising a distally biased obturator tip to shield the needle distal tip when the obturator tip encounters a drop in resistance. 
     
     
         19 . The device of  claim 11 , wherein the actuator mechanism moves the snare between the retracted position, a fixed partially exposed position and the fully exposed potion. 
     
     
         20 . A method for insufflating a body cavity and engaging a suture to close a wound open to the body cavity using a single device, comprising:
 insufflating the body cavity with a shaft defining an insufflation channel along an axis between a shaft distal end and a shaft proximal end;   securing a suture with a snare disposed adjacent to the shaft distal end;   inserting the shaft with the secured suture into the body cavity at a desired first location;   releasing the suture by moving the snare to an exposed position;   removing the shaft from the first location;   inserting the shaft into the body cavity at a desired second location spaced apart from the first location;   capturing the suture with the snare;   securing the suture to the shaft by retracting the snare; and   removing the shaft from the second location with the secured suture to complete a stitch loop.   
     
     
         21 . The method of  claim 20 , wherein the step of releasing the suture by moving the snare to the exposed position comprises moving the snare to a fixed partially exposed position. 
     
     
         22 . The method of  claim 21 , wherein the step of capturing the suture with the snare comprises moving the snare to a fully exposed position. 
     
     
         23 . The method of  claim 20 , wherein:
 the step of releasing the suture by moving the snare to the exposed position comprises moving an actuator mechanism in a distal direction with respect to a housing coupled to the actuator; and   the step of capturing the suture with the snare comprises moving the actuator in a proximal direction with respect to the housing.   
     
     
         24 . The method of  claim 20 , wherein:
 the step of inserting the shaft with the secured suture into the body cavity at the desired first location further comprises inserting a needle distal tip of the shaft through a body wall and shielding the needle distal tip of the shaft upon exiting the body wall; and   the step of inserting the shaft with the secured suture into the body cavity at the desired second location spaced apart from the first location further comprises inserting the needle distal tip of the shaft through the body wall and shielding the needle distal tip of the shaft upon exiting the body wall.