Surgery – Instruments – Sutureless closure
Reexamination Certificate
2002-10-11
2004-06-15
Milano, Michael J. (Department: 3731)
Surgery
Instruments
Sutureless closure
C606S151000, C606S153000, C606S215000
Reexamination Certificate
active
06749622
ABSTRACT:
BACKGROUND OF THE INVENTION
1. Field of the Invention
This invention relates to methods and apparatus for closing apertures in human and animal tissue and to methods and apparatus for inserting apparatus into such tissue to perform such closure functions.
2. Description of the Prior Art
During certain types of vascular surgery, catheters are inserted through an incision in the skin and underlying tissue to access the femoral artery in the patient's leg. The catheter is then inserted through the access opening made in the wall of the femoral artery and guided through the artery to the desired site to perform surgical procedures such as angioplasty or plaque removal. After the surgical procedure is completed and the catheter is removed from the patient, the access hole must be closed. This is quite difficult not only because of the high blood flow from the artery, but also because there are many layers of tissue that must be penetrated to reach the femoral artery.
Several approaches have used to close femoral access holes. Typically, manual compression by hand over the puncture site can be augmented by a sandbag or weight until the blood coagulates. With this approach it can take up to six hours for the vessel hole to close and for the patient to be able to ambulate. This increases time for the surgical procedure as well as overall cost of the procedure since the hospital staff must physically hold pressure and the patient's discharge is delayed because of the inability to ambulate. This is not an efficient use of either the patient's or staff's time. After some procedures, to close the vessel puncture site a clamp is attached to the operating table and the patient's leg; The clamp applies pressure to the vessel opening. The patient must be monitored to ensure the blood is coagulating, requiring additional time of the hospital staff and increasing cost of the procedure.
To avoid the foregoing disadvantages of manual pressure approaches, suturing devices have been developed. One such suturing device, referred to as “The Closer” and sold by Perclose, advances needles adjacent the vessel wall opening and pulls suture material outwardly through the wall adjacent the opening. The surgeon then ties a knot in the suture, closing the opening. One difficulty with this procedure involves the number of steps required by the surgeon to deploy the needles, capture the suture, withdraw the suture, and tie the knot, and cut the suture. Moreover, the surgeon cannot easily visualize the suture because of the depth of the femoral artery (relative to the skin) and essentially ties the suture knot blindly or blindly slips a pre-fabricated knot into position. Additionally, the ability to tie the knot varies among surgeons; therefore success and accuracy of the hole closure can be dependent on the skill of the surgeon. Yet another disadvantage of this suturing instrument is that the vessel opening is widened for insertion of the instrument, thus creating a bigger opening to close in the case of failure to deliver the closure system.
It would therefore be advantageous to provide an instrument which quickly and accurately closes holes in vessel walls. Such instrument would advantageously avoid the aforementioned time and expense of manual pressure, simplify the steps required to close the opening, and avoid widening of the opening.
SUMMARY OF THE INVENTION
The present invention overcomes the disadvantages and deficiencies of the prior art by, in one of its aspects, providing clip apparatus for closing a lumen aperture, particularly a vascular aperture, resulting from insertion of a surgical implement subsequent to completion of an invasive therapeutic procedure and withdrawal of the implement from the aperture where the apparatus includes an elongated strand comprising a central portion together with extremity portions extending from the central portion. The apparatus further involves tips of the extremity portions remote from the central portion being shaped to retain aperture peripheral tissue encountered thereby with the extremity portions having memory characteristics seeking to cause the extremity portions to curl towards and over one another about the central portion when the strand is in an unconstrained disposition, free of externally applied stress. Preferably, the apparatus is deployed in a two stage operation whereby the clip apparatus is initially deployed partially from a delivery apparatus with tips of the extremity portion contacting and the penetrating the interior surface of tissue of the vessel and acts to draw the aperture closed. In a second step the apparatus is fully dispensed from the delivery portion; tips of extremity portion of the apparatus do not penetrate the vessel tissue in the region about the aperture to be closed but act to draw the subcutaneous fascia on top of the outside aspect of the aperture. The two stage deployment of the closure apparatus results in a ratchet-type action by the deployment apparatus thereby providing extreme tactile sensitivity for the physician or other health professional handling the apparatus with resulting high sensitivity to the location of the apparatus and greater safety for the patient than otherwise possible.
In another of its aspects, this invention provides clip apparatus for closing a aperture, particularly a vascular aperture resulting from insertion of a surgical implement, into subsequent to completion of an invasive therapeutic procedure and withdrawal of the implement from the resulting aperture. In this aspect of the invention, the apparatus includes a plurality of elongated strands with each strand including a central portion and extremity portions extending from the central portion. Tips of the extremity portions remote from the central portion are shaped to retain aperture peripheral tissue encountered thereby. The extremity portions have memory characteristics seeking to cause the extremity portions to curl towards and about the central portion when the strand is in an unconstrained disposition, free of externally applied stress.
The clip apparatus may further include a band circumferentially enveloping the strands proximate the longitudinal midpoints of the strands for retaining the strand midpoints in close proximity to one another as the tip portions curl towards and about the midpoints. The band is preferably bonded to the strands.
The clip apparatus may further include a longitudinally elongated member extending from the central portions of grouped strands substantially in the longitudinal direction with respect thereto for facilitating gripping and guiding the strand portions of the clip member. The longitudinally elongated member is preferably rigid relative to the strand members.
In yet another of its aspects this invention provides a clip formed from a one piece integral strand, serving to close a lumen aperture such as a vascular aperture resulting from the insertion of a surgical instrument, where the clip includes an elongated strand of ribbon-like configuration having a central portion and extremity portions extending in opposite directions from the central portion. The central portion assumes a linear configuration and the extremity portions extending from the central portion assume configurations in which first parts of the extremity portions proximate the central portion curve towards one another and towards the central portion and second parts of the extremity portions relatively more remote from the central portion curve away from one another and from the central portion to position arcuate tips of the extremity portion sufficiently skew to the central portion that tissue around the periphery of the aperture which is punctured by the extremity portions is retained between the tip portions as the clip relaxes.
In yet another of its aspects this invention provides apparatus for closing an aperture such as a vascular aperture resulting from insertion of a surgical instrument into where the apparatus includes a telescoping tubular housing and clip apparatus resident within the housin
Maurer Christopher W.
McGuckin, Jr. James F.
Peters Walter H.
Davis D. Jacob
Gershon Neil D.
Milano Michael J.
Rex Medical, L.P.
LandOfFree
Vascular closure does not yet have a rating. At this time, there are no reviews or comments for this patent.
If you have personal experience with Vascular closure, we encourage you to share that experience with our LandOfFree.com community. Your opinion is very important and Vascular closure will most certainly appreciate the feedback.
Profile ID: LFUS-PAI-O-3343592