Dual insufflation and wound closure devices ans 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 closure device for use in connection with a surgery involving an open wound, comprising:
 a shaft defining an axis and having a shaft distal end and a shaft proximal end, the shaft distal end including a sharp needle tip; and   a deformable snare disposed adjacent to the shaft distal end and configured to engage a suture,   wherein the snare is movable between a retracted position where the snare is substantially housed within the shaft and an exposed position.   
     
     
         2 . The device of  claim 1 , wherein the snare forms a loop that increases in size and curves toward a perpendicular orientation with respect to the axis of the shaft as the snare is moved towards the exposed position. 
     
     
         3 . The device of  claim 1 , wherein the deformable loop in the exposed position is slanted with respect to the axis of the shaft. 
     
     
         4 . The device of  claim 1 , further comprising an actuator mechanism for moving the snare between the retracted position and the exposed position. 
     
     
         5 . The device of  claim 4 , 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 having a rod distal portion coupled to the snare and a rod proximal portion protruding from the housing proximal portion.   
     
     
         6 . The device of  claim 5 , wherein the rod is configured to axially translate more than 1 inch with respect to the housing. 
     
     
         7 . The device of  claim 5 , wherein:
 the exposed position comprises a fully exposed position;   the actuator mechanism further comprises a trigger;   the rod proximal portion is configured to move the snare between the fully exposed position to a partially exposed position; and   the trigger is configured to move the snare between the partially exposed position and the retracted position.   
     
     
         8 . The device of  claim 1 , wherein the snare comprises a plurality of strands. 
     
     
         9 . A closure device for use in connection with a surgery involving an open wound, comprising:
 a shaft defining an axis and having a shaft distal end and a shaft proximal end;   a snare comprising a plurality of strands, the snare being 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 and a fully exposed position where the snare protrudes from the shaft;   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.   
     
     
         10 . The device of  claim 9 , 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. 
     
     
         11 . The device of  claim 9 , wherein the deformable loop in the fully exposed position is slanted with respect to the axis of the shaft assembly. 
     
     
         12 . The device of  claim 9 , 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. 
     
     
         13 . The device of  claim 12 , wherein the rod assembly is configured to translate more than 1 inch axially with respect to the housing. 
     
     
         14 . The device of  claim 12 , wherein:
 the exposed position comprises a fully exposed position;   the rod assembly comprises a rod proximal portion protruding proximally from the housing proximal portion and a rod distal portion coupled to the snare;   the actuator mechanism comprises a slide coupled to the rod assembly, the rod distal portion is configured to move the snare between a fixed partially exposed position and the fully exposed position; and   the slide is configured to move the snare between the fixed partially exposed position and the retracted position.   
     
     
         15 . The device of  claim 9 , wherein the shaft distal end comprises a sharp needle tip. 
     
     
         16 . A closure device for use in connection with a surgery involving an open wound, comprising:
 a shaft defining an axis and having 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 comprising a deformable loop composed of a material having memory characteristics such that the snare forms a pre-formed shape when exposed;   a housing having a sidewall, a housing proximal end and a housing distal end; and   an actuator mechanism comprising a first actuator configured to move the snare between a retracted position and a fixed partially exposed position and a second actuator configured to move the snare between the fixed partially exposed position and a fully exposed position.,   
     
     
         17 . The device of  claim 16 , wherein:
 the first actuator comprises a trigger disposed on the sidewall of the housing; and   the second actuator comprises a slide rod proximally protruding out from the housing proximal end.   
     
     
         18 . The device of  claim 17 , wherein the slide rod is configured to slide more than 1 inch axially with respect to the housing. 
     
     
         19 . The device of  claim 17 , wherein the trigger is configured to lock the snare in the retracted position. 
     
     
         20 . The device of  claim 16 , wherein the shaft distal end comprises a sharp needle tip. 
     
     
         21 . The device of  claim 16 , wherein the deformable loop in the fully exposed position is slanted with respect to the axis of the shaft assembly. 
     
     
         22 . A closure device for use in connection with a surgery involving an open wound, comprising:
 a housing having a housing proximal end and a housing distal end;   a shaft defining an axis and extending distally from the housing, the shaft comprising a shaft distal end;   a snare configured to engage a suture and disposed adjacent to the shaft distal end, the snare comprising a deformable loop composed of a material having memory characteristics such that the snare forms a pre-formed shape when not deformed;   wherein the snare is linearly movable between a retracted position and a fixed partially exposed position that is oblique to the axis, and   wherein the snare is arcuately moveable between the fixed partially exposed position and a fully exposed position.   
     
     
         23 . The device of  claim 22 , further comprising:
 a first actuator configured to move the snare between the retracted position and the fixed partially exposed position; and   a second actuator configured to move the snare between the fixed partially exposed position and the fully exposed position.   
     
     
         24 . The device of  claim 23 , wherein:
 the first actuator comprises a thumb slide; and   the second actuator comprises an extender rod protruding proximally out from the housing.   
     
     
         25 . The device of  claim 22 , wherein:
 the snare in the fixed partially exposed position forms a first elongate loop shape oriented off-axis at an angle less than perpendicular to the axis; and   the snare in the fully exposed position forms a second elongate loop shape wider than the first elongate loop shape, the second elongate loop shape being oriented substantially perpendicular to the axis.   
     
     
         26 . A method for closing a wound open to a body cavity using a single device, comprising:
 engaging a suture with a partially exposed snare protruding sideways from a distal portion of a shaft;   linearly retracting the snare from a partially exposed position to a retracted position to secure the suture;   inserting the shaft with secured suture into the body cavity at a desired first location;   releasing the suture by moving the snare from the retracted position to at least the partially exposed position;   retracting the shaft without the suture;   inserting the shaft into the body cavity at a desired second location spaced apart from the first location;   moving the snare into a fully exposed position that is oriented substantially perpendicular to an axis of the shaft;   securing the suture to the shaft by retracting the snare to the retracted position; and   retracting the shaft from the second location with the secured suture.   
     
     
         27 . The method of  claim 26 , wherein:
 the step of linearly retracting the snare from the partially exposed position to the retracted position to secure the suture comprises moving a thumb slide proximally; and   the step of releasing the suture by moving the snare from the retracted position to at least the partially exposed position comprises moving the thumb slide distally.   
     
     
         28 . The method of  claim 27 , wherein the step of moving the snare into a fully exposed position that is oriented substantially perpendicular to the axis of the shaft comprises distally translating an extender rod distally. 
     
     
         29 . The method of  claim 28 , wherein the step of distally translating the extender rod comprises distally translating the rod more than 1 inch with respect to a housing. 
     
     
         30 . The method of  claim 28 , wherein the step of securing the suture to the shaft by retracting the snare to the retracted position comprises:
 proximally translating the extender rod; and   then proximally moving the thumb slide.