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 surgical guide apparatus for use in connection with a surgery involving a body cavity having an inner wall, comprising
 a barrel including an axis, a barrel proximal portion defining an entry, and a barrel distal portion defining an exit;   a plunger axially movable with respect to the barrel, the plunger defining at least one track that is in communication with both the entry and the exit when the plunger is in an operative position;   a radially expandable securing mechanism disposed adjacent to the barrel distal portion and configured to be secured to the inner wall of the body cavity.   
     
     
         2 . The apparatus of  claim 1 , wherein the securing mechanism comprises a first living hinge and a second living hinge. 
     
     
         3 . The apparatus of  claim 1 , wherein:
 the plunger is coupled to the securing mechanism;   the plunger causes the securing mechanism to is move between a slender configuration and an expanded configuration when the plunger is axially translated with respect to the barrel.   
     
     
         4 . The apparatus of  claim 3 , wherein:
 the plunger causes the securing mechanism to move to the slender configuration when the plunger is manually pushed with respect to the barrel; and   the plunger causes the securing mechanism to move to the expanded configuration when the plunger is released.   
     
     
         5 . The apparatus of  claim 3 , wherein:
 the plunger is spring-biased with respect to the barrel to cause the securing mechanism to comprise the expanded configuration when the plunger is not manually engaged.   
     
     
         6 . The apparatus of  claim 1 , wherein:
 the entry is positioned on a first barrel surface and exit is positioned on a substantially opposite second barrel surface; and   the track is non-parallel to the axis and is open to both a track entry formed on a first plunger surface and a track exit formed on a substantially opposite second plunger surface.   
     
     
         7 . The apparatus of  claim 1 , wherein:
 the entry comprises a first entry;   the exit comprises a first exit;   the track comprises a first track;   the barrel comprises a second entry formed in the barrel proximal portion and a second exit formed in the barrel distal portion; and   the plunger comprises a second track that is communication with both the second entry and the second exit when the plunge is in the operative position.   
     
     
         8 . The apparatus of  claim 7 , wherein:
 the second entry is substantially opposite to the first entry; and   the second exit is substantially opposite to the first exit.   
     
     
         9 . The apparatus of  claim 1 , further comprising an axial wing disposed along a portion of the barrel distal to the entry. 
     
     
         10 . The apparatus of  claim 1 , further comprising:
 a cap coupled to the plunger and the securing mechanism; and   a stop disposed at the barrel distal portion to limit proximal movement of the cap with respect to the barrel   
     
     
         11 . A surgical guide apparatus for use in connection with a surgery involving a body cavity having an inner wall, comprising:
 a barrel including an axis, a barrel proximal portion defining an entry formed on a first barrel surface, and a barrel distal portion defining an exit formed on a second barrel surface substantially opposite to the first barrel surface;   a plunger axially movable with respect to the barrel and biased to a proximal position with respect to the barrel, the plunger defining at least one track that is in communication with both the entry and the exit when the plunger is in an operative position;   a radially expandable securing mechanism coupled to the plunger and disposed adjacent to the barrel distal portion, the securing mechanism being movable between a slender configuration when the plunger is retracted proximally with respect to the barrel and an expanded configuration when the plunger is pushed distally with respect to the barrel.   
     
     
         12 . The apparatus of  claim 11 , wherein the securing mechanism comprises a first living hinge and a second living hinge. 
     
     
         13 . The apparatus of  claim 11 , wherein the track is oblique to the axis and is open to both a track entry formed on a first plunger surface and a track exit formed on a substantially opposite second plunger surface. 
     
     
         14 . The apparatus of  claim 11 , wherein:
 the entry comprises a first entry;   the exit comprises a first exit;   the track comprises a first track;   the barrel comprises a second entry formed in the barrel proximal portion and a second exit formed in the barrel distal portion; and   the plunger comprises a second track that is communication with both the second entry and the second exit when the plunge is in the operative position.   
     
     
         15 . The apparatus of  claim 14 , wherein:
 the second entry is substantially opposite to the first entry;   the second exit is substantially opposite to the first exit; and   the second track intersects the first track.   
     
     
         16 . The apparatus of  claim 11 , further comprising an axial wing disposed along a portion of the barrel distal to the entry. 
     
     
         17 . The apparatus of  claim 11 , further comprising:
 a cap coupled to the plunger and the securing mechanism; and   a stop disposed at the barrel distal portion to limit proximal movement of the cap with respect to the barrel.   
     
     
         18 . A surgical guide apparatus for use in connection with a surgery involving a body cavity having an inner wall, comprising:
 a barrel including an axis, a barrel proximal portion defining a first entry and a second entry, and a barrel distal portion defining a first exit and a second exit;   a plunger axially movable with respect to the barrel, the plunger defining a first track that is in communication with both the first entry and the first exit when the plunger is in an operative position, the plunger defining a second track that is in communication with both the second entry and the second exit when the plunger is in the operative position;   a radially expandable securing mechanism coupled to the plunger and disposed adjacent to the barrel distal portion, the securing mechanism being movable between a slender configuration when the plunger is retracted proximally with respect to the barrel and an expanded configuration when the plunger is pushed distally with respect to the barrel.   
     
     
         19 . The apparatus of  claim 18 , wherein the securing mechanism comprises a first living hinge and a second living hinge. 
     
     
         20 . The apparatus of  claim 18 , wherein the first track defines a first track axis and the second track defines a second track axis that is different than the first track axis. 
     
     
         21 . The apparatus of  claim 20 , wherein the first track intersects the second track. 
     
     
         22 . The apparatus of  claim 18 , further comprising:
 a first axial wing disposed adjacent to the first exit; and   a second axial wing disposed adjacent to the second exit.   
     
     
         23 . The apparatus of  claim 18 , further comprising:
 a cap coupled to the plunger and the securing mechanism; and   a stop disposed at the barrel distal portion to limit proximal movement of the cap with respect to the barrel.   
     
     
         24 . A surgical guide apparatus for use in connection with a surgery involving a body cavity having an inner wall, comprising
 a barrel including an axis, a barrel proximal portion defining an entry, and a barrel distal portion defining an exit;   a plunger axially movable with respect to the barrel, the plunger defining at least one off-axis track that is in communication with both the entry and the exit when the plunger is in an operative position; and   a wing disposed adjacent to the exit.   
     
     
         25 . The apparatus of  claim 24 , further comprising a radially expandable securing mechanism disposed adjacent to the barrel distal portion and configured to be secured to the inner wall of the body cavity. 
     
     
         26 . The apparatus of  claim 25 , wherein the securing mechanism comprises a first living hinge and a second living hinge. 
     
     
         27 . The apparatus of  claim 25 , wherein:
 the plunger is coupled to the securing mechanism;   the plunger causes the securing mechanism to is move between a slender configuration and an expanded configuration when the plunger is axially translated with respect to the barrel.   
     
     
         28 . The apparatus of  claim 25 , wherein:
 the plunger causes the securing mechanism to comprise the slender configuration when the plunger is a non-operative position; and   the plunger causes the securing mechanism to comprise the expanded configuration when the plunger is an operative position.