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 wound closure apparatus for use in connection with a surgery involving a body cavity having an inner wall, comprising:
 a puncture closure device including a shaft and a retractable snare disposed adjacent to a shaft distal end;   a guide configured to direct the puncture closure device into the body cavity, the guide including a radially expandable securing mechanism configured to be secured to the inner wall and a track for receiving the puncture closure device.   
     
     
         2 . The apparatus of  claim 1 , wherein the guide comprises:
 a tubular barrel including an axis, a barrel proximal portion defining an entry, and a barrel distal portion defining an exit; and   a plunger coupled to the securing mechanism and 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.   
     
     
         3 . The apparatus of  claim 1 , wherein:
 the track comprises a first track having a first guide exit; and   the guide comprises a second track having a second guide exit substantially opposite to the first guide exit.   
     
     
         4 . The apparatus of  claim 3 , wherein:
 the first guide exit and the second guide exit are configured to direct the puncture closure device to traverse the inner wall at an equal lateral distance from the guide.   
     
     
         5 . The apparatus of  claim 1 , wherein:
 the guide comprises a distal portion having a sidewall defining a side opening; and   the closure device exits the guide through the side opening.   
     
     
         6 . The apparatus of  claim 1 , wherein:
 the path comprises a first path; and   the guide comprises a second path that is off-axis with respect to the guide axis and non-parallel to the first path, the second path being configured to direct the closure device to exit the guide through a second side opening.   
     
     
         7 . The apparatus of  claim 6 , wherein the guide comprises:
 a barrel having a side entry and a side exit; and   a plunger axially movable with respect to the barrel, the plunger defining a track that is communication with the side entry and side exit when the plunger is in an operative position,   wherein the track, side entry and side exit collectively form the path.   
     
     
         8 . The apparatus of  claim 7 , wherein the radially expandable securing mechanism is moved to an expanded configuration when the plunger is in the operative position. 
     
     
         9 . The apparatus of  claim 1 , wherein the radially expanding securing mechanism comprises a living hinge. 
     
     
         10 . An obturator apparatus for use in connection with a surgery involving penetration through a body wall, comprising:
 a shaft including a sharp needle tip having a needle peak at a distal end;   an obturator comprising a pointed yet blunt distal obturator peak movable between a proximal rest position and a distal operative position distal to the needle peak, the obturator peak being biased to the operative position;   wherein the obturator peak in the rest position is located less than one mm from the sharp needle tip.   
     
     
         11 . The apparatus of  claim 10 , wherein:
 the sharp needle tip comprises a first cutting edge and a second cutting edge, both the first and second cutting edges leading distally to the needle peak;   the obturator comprises a first ramped surface and a second ramped surface, both the first and second ramped surfaces leading distally to the obturator peak,   wherein the first ramped surface is positioned proximally to the first cutting edge and the second ramped surface is positioned proximally to the second cutting edge even where the obturator peak distally traverses the needle peak.   
     
     
         12 . The apparatus of  claim 13 , wherein the first and second ramped surfaces are positioned proximally to the first and second cutting edges, respectively, when the obturator peak distally passes the needle peak up to 5 mm. 
     
     
         13 . The apparatus of  claim 10 , wherein the obturator comprises a generally triangular shape with ramped portions tapering distally to the obturator peak. 
     
     
         14 . An obturator apparatus for use in connection with a surgery involving penetration through a body wall, comprising:
 a shaft including a sharp needle tip at a distal end, the sharp needle tip comprising at least one cutting edge extending distally to a pointed needle peak;   an obturator comprising a pointed yet blunt distal obturator peak movable between a proximal rest position and a distal operative position distal to the needle peak, the obturator tip being biased to the operative position, the obturator comprising at least one ramped surface extending from a base to the obturator peak,   wherein the ramped surface is positioned proximally to the cutting edge when the obturator peak distally traverses the needle peak up to 5 mm.   
     
     
         15 . The apparatus of  claim 14 , wherein:
 the obturator peak is spaced less than 1 mm from the needle peak when the obturator peak is in the rest position.   
     
     
         16 . The apparatus of  claim 14 , wherein the obturator peak defines a tip surface area less than 0.1 square mm. 
     
     
         17 . The apparatus of  claim 14 , wherein the obturator comprises a generally triangular shape with ramped portions tapering distally to the pointed distal tip. 
     
     
         18 . The apparatus of  claim 14 , wherein:
 the at least one cutting edge comprises a first cutting edge;   the sharp needle tip further comprises a second cutting edge extending distally to the needle peak;   the at least one ramped surface comprises a first ramped surface; and   the obturator further comprises a second ramped surface extending distally to the obturator peak.   
     
     
         19 . A method of shielding a sharp needle tip of a surgical instrument after insertion through a body wall, comprising:
 distally biasing an obturator having an obturator body and a obturator peak to an operative position where the obturator peak is distal to a needle peak of the sharp needle tip;   limiting a proximal movement of the obturator with respect to the sharp needle tip such that the obturator peak is never positioned more than 1 mm from the needle peak upon insertion of needle tip through the body wall; and   automatically moving the obturator peak distally past the needle peak upon a drop in resistance from the body.   
     
     
         20 . The method of  claim 19 , wherein the step of automatically moving the obturator peak distally past the needle peak upon the drop in resistance from the body comprises exposing at least one cutting edge of the needle tip while the obturator peak is distal to the needle peak.