Suture Passing Instrumentation and Methods of Use Thereof

Abstract

The instant disclosure is directed to methods and devices for passing suture bi-directionally using a hybrid approach. Embodiments of a method described herein include steps of advancing a suture at least partially through tissue; and retrieving the suture; wherein one of the steps of advancing and retrieving comprises manipulating the suture directly, and wherein the other step of advancing and retrieving comprises manipulating a suture trap to which the suture is coupled. Embodiments of a device that may be used to practice the method embodiments include a bi-directional suture passer having a proximal portion for holding a portion of a suture therein; a distal tip coupled to the proximal portion and defining a tissue receiving gap there-between; a reciprocally moveable suture passing member housed within the proximal portion for translating the suture portion between the proximal portion and the distal tip; and a knot carrier for indirectly coupling a knot to the device.

We claim: 
     
         1 . A knot carrier for indirectly coupling a knot to a medical device, the knot carrier comprising:
 a knot carrier body configured to slidably engage with a portion of a medical device; and   an obstructing member projecting from a proximal portion of the knot carrier body, the obstructing member having a first configuration for preventing a knot from being deployed from the knot carrier and a second configuration for allowing the knot to be deployed from the knot carrier.   
     
     
         2 . The knot carrier of  claim 1 , wherein the obstructing member is resilient and is biased in an inward direction. 
     
     
         3 . The knot carrier of  claim 1 , wherein the knot carrier body is tapered towards a distal end thereof for facilitating deployment of the knot from the knot carrier. 
     
     
         4 . The knot carrier of  claim 1 , further comprising a retaining element for providing resistance to movement of a segment of a suture strand secured by the retaining element. 
     
     
         5 . The knot carrier of  claim 4 , wherein the retaining element secures the segment of the suture strand via friction. 
     
     
         6 . A suture passer for passing a suture through a region of tissue, comprising: a proximal portion for holding a portion of suture therein;
 a distal tip coupled to the proximal portion and defining a tissue receiving gap there-between; a suture trap detachably coupled to the distal tip;   a reciprocally moveable suture passing member held within the proximal portion for translating the suture portion between the proximal portion and the suture trap; and   a trigger for causing reciprocal movement of the suture passing member;   wherein upon a first actuation of the trigger the suture passing member is configured to advance distally to a first predetermined position for placing the suture portion into engagement with the suture trap; and   wherein upon a second actuation of the trigger the suture passing member is configured to advance distally to a second predetermined position for engaging the suture trap,   further comprising the knot carrier of  claim 1 .   
     
     
         7 . A medical device for controlled deployment of a pre-tied knot, the medical device comprising:
 a handle body;   an elongate member extending from the handle body;   a knot carrier comprising a knot carrier body configured to slidably engage with the elongate member and an obstructing member projecting from a proximal portion of the knot carrier body, the obstructing member having a first configuration for preventing a knot from being deployed from the knot carrier and a second configuration for allowing the knot to be deployed from the knot carrier.   and   a pre-tied knot disposed about the knot carrier.   
     
     
         8 . A suture passer for passing a suture through a region of tissue, comprising: a proximal portion for holding a portion of suture therein;
 a distal tip coupled to the proximal portion and defining a tissue receiving gap there-between; a suture trap detachably coupled to the distal tip;   a reciprocally moveable suture passing member held within the proximal portion for translating the suture portion between the proximal portion and the suture trap; and   a trigger for causing reciprocal movement of the suture passing member;   wherein upon a first actuation of the trigger the suture passing member is configured to advance distally to a first predetermined position for placing the suture portion into engagement with the suture trap; and   wherein upon a second actuation of the trigger the suture passing member is configured to advance distally to a second predetermined position for engaging the suture trap, further comprising a shaft at the proximal portion of the suture passer and a partially pre-tied knot disposed about the shaft.   
     
     
         9 . The suture passer of  claim 8 , wherein the partially pre-tied knot comprises a plurality of suture loops formed around a surface of the shaft. 
     
     
         10 . The suture passer of  claim 9 , wherein the partially pre-tied knot comprises a plurality of suture loops formed around a knot carrier, the knot carrier being slidably engaged with the shaft, the knot carrier comprising a knot carrier body and an obstructing member projecting from a proximal portion of the knot carrier body, the obstructing member having a first configuration for preventing a knot from being deployed from the knot carrier and a second configuration for allowing the knot to be deployed from the knot carrier. 
     
     
         11 . The suture passer of  claim 10 , further comprising a retaining element coupled, directly or indirectly, to the shaft, for providing resistance to movement of a segment of a suture strand secured by the retaining element. 
     
     
         12 . The suture passer of  claim 11 , wherein the retaining element limits motion of a suture strand segment relative to another portion of the suture strand during at least a part of a knot deployment procedure. 
     
     
         13 . The suture passer of  claim 11 , wherein the retaining element is located directly on the shaft. 
     
     
         14 . The suture passer of  claim 10 , wherein the obstructing member of the knot carrier is sized and configured to transition from the first configuration to the second configuration when the knot carrier is positioned about a tissue receiving gap defined by the suture passer, whereby the obstructing member bends inwardly towards the tissue receiving gap. 
     
     
         15 . The suture passer of  claim 11 , wherein the retaining element is configured to retain a suture strand segment against an application of tension on the suture strand segment and to release the suture strand segment when the tension on the suture strand segment exceeds a pre-determined amount. 
     
     
         16 . The suture passer of  claim 10 , wherein the knot carrier is coupled to the shaft via a releasable coupling. 
     
     
         17 . The suture passer of  claim 16 , further comprising a means for preventing the knot carrier from sliding along the shaft until a predetermined force is applied to the releasable coupling. 
     
     
         18 . The use of a suture passer as claimed in  claim 7  for treating a defect in an intervertebral disc.