Device and Methods for Suturing Tissue

Abstract

Systems for suturing a tissue layer having two sides with a suture be releasably retaining at least a portion of the suture in a stationary position on one side of the tissue layer. The portion of the suture is retrieved through the tissue layer from the opposite side whereby the suture is drawn from one side to the opposite side. Systems for suturing the wall of a tubular graft having two sides is also provided using a suture by releasably retaining at least a portion of the suture on one side of the wall. the portion of the length of suture is retrieved through the wall of the graft to the opposite side of the wall.

1 . A device for closing an opening in tissue, the device comprising:
 an elongated body having a proximal end and a distal end, a flexible sheath extending from the distal end of the elongated body and carrying a length of suture, with a cuff molded on an end of the length of suture, to close the opening in the tissue, the length of suture being deployable to penetrate the tissue wall, the elongated body being advanceable toward the opening along a guidewire to position the length of suture substantially adjacent the opening, and further comprising at least one needle advanceable through tissue surrounding the opening to deploy the length of suture through the tissue wall, the cuff having an inner space adapted to receive a tip of one needle of the at least one needle following advancement of the at least one needle through the tissue.   
   
   
       2 . The device of  claim 1 , wherein the flexible sheath has a distal end, wherein the flexible sheath defines a guidewire entry port at or near the flexible sheath distal end, and wherein the flexible sheath defines a guidewire exit port situated along the flexible sheath at a location proximal to the guidewire entry port. 
   
   
       3 . The device of  claim 1 , wherein the flexible sheath is sized to maintain hemostasis at the opening when the flexible sheath is positioned through the opening. 
   
   
       4 . The device of  claim 1 , wherein the elongated body has a proximal end and a distal end, and further comprising a flexible sheath extending from the distal end of the elongated body, the flexible sheath defining a suture storage lumen. 
   
   
       5 . The device of  claim 1 , wherein the needle has a barbed end for insertion through the cuff to attach the needle to the length of suture to deploy the suture through the tissue wall. 
   
   
       6 . A device for closing an opening in tissue, the device comprising:
 a shaft having a proximal end and a distal end;   a foot near the distal end of the shaft;   a length of suture having an end and a cuff molded on the end of the suture, the cuff being releasably retained in the foot; and   at least one needle arranged on the device to be advanceable through the tissue surrounding the opening, the needle having a barbed end for insertion through the cuff to attach the needle to the suture to draw the suture through the tissue, the cuff having an inner space adapted to receive a tip of one needle of the at least one needle following advancement of the at least one needle through the tissue.   
   
   
       7 . The device of  claim 6 , wherein the cuff is molded as one piece from the suture material. 
   
   
       8 . The device of  claim 6 , wherein the cuff is a ring and the length of suture is attached in a perpendicular manner to one side of the ring. 
   
   
       9 . The device of  claim 6 , further comprising a flexible sheath extending from the distal end of the shaft, the flexible sheath defining a guidewire lumen. 
   
   
       10 . The device of  claim 9 , wherein the sheath defines a suture storage lumen. 
   
   
       11 . A method for closing an opening in tissue, the method comprising:
 advancing an elongated body, the elongated body having a proximal end, a distal end, at least one needle, and a flexible sheath extending from the distal end of the elongated body and carrying a length of suture with a cuff molded on an end of the length of suture, along a guidewire to position the length of suture substantially adjacent the opening,   advancing the at least one needle through tissue surrounding the opening; and   deploying the length of suture through the tissue wall, the cuff having an inner space adapted to receive a tip of one needle of the at least one needle following advancement of the at least one needle through the tissue through the opening.   
   
   
       12 . The method of  claim 11 , further comprising partially withdrawing the elongated body leaving a portion of the flexible sheath in the opening to maintain hemostasis. 
   
   
       13 . The method of  claim 11 , further comprising advancing a needle through the tissue adjacent the opening to attach the needle to a length of suture. 
   
   
       14 . The method of  claim 13 , further comprising advancing a barbed end of the needle through the cuff. 
   
   
       15 . The method of  claim 11 , wherein the flexible sheath defines a guidewire lumen, and the method further comprises positioning a guidewire through the opening and loading the guidewire into the guidewire lumen to advance the flexible sheath through the opening. 
   
   
       16 . A method for closing an opening in tissue, the method comprising:
 providing a suturing device having a shaft, the shaft having a distal end;   advancing at least a portion the shaft through the opening;   positioning a length of suture on a distal side of the tissue, the suture having an end and a molded cuff on the end of the suture;   advancing a needle through the tissue adjacent the opening and through the cuff to attach the needle to the length of suture; and   withdrawing the needle and the suture through the tissue.   
   
   
       17 . The method of  claim 16 , further comprising providing a flexible sheath on the distal end of the shaft. 
   
   
       18 . The method of  claim 17 , further comprising partially withdrawing the suturing device leaving a portion of the flexible sheath in the opening to maintain hemostasis. 
   
   
       19 . The method of  claim 17 , wherein the flexible sheath defines a guidewire lumen, and the method further comprises positioning a guidewire through the opening and loading the guidewire into the guidewire lumen to advance the suturing device through the opening. 
   
   
       20 . The method of  claim 16 , further comprising tying a knot in the suture to close the opening. 
   
   
       21 . A method for closing an opening in tissue, the method comprising:
 inserting a guidewire through the opening in the tissue;   providing a closing device adapted to penetrate the tissue and permit closing of the opening carrying an implant with a cuff molded on an end of the implant;   using the guidewire to guide a portion of the closing device to a position substantially adjacent the opening; and   penetrating the tissue to at least partially close the opening.   
   
   
       22 . The method of  claim 21 , wherein penetrating the tissue to at least partially close the opening includes deploying the implant. 
   
   
       23 . The method of  claim 22 , wherein the implant is a length of suture. 
   
   
       24 . The method of  claim 22 , further comprising providing a needle on the closing device and penetrating the tissue wall with the needle to advance the implant into the tissue wall. 
   
   
       25 . The method of  claim 24 , further comprising:
 positioning a portion of the suture on a distal side of the tissue, the molded cuff releasably retained on the closing device;   advancing the needle through the tissue adjacent the opening and through the cuff to attach the needle to the length of suture; and   withdrawing the needle and the suture through the tissue.