Hydrodynamic Suture Passer

Abstract

A hydrodynamic suturing instrument, comprising an elongated cannulated suturing needle having a distal end configured to carry a suture through tissue and a proximal end adapted to connect to a syringe barrel and a lumen extending form said proximal end to an opening at the distal end for having a size for the passage of a suture, the opening at the distal end configured to receive a suture extending from the lumen along an outer surface of the needle wherein a sharp point extends forward of the suture. A companion instrument includes forceps having a distal end with jaws and a proximal end with a cannula extending from the proximal end to the distal end for passage of the needle, and the jaws having an opening enabling passage of the needle through tissue grasped in the jaws.

1 - 20 . (canceled) 
   
   
       21 . A method for suturing comprising the steps of:
 (a) providing an elongated needle having a distal end and a proximal end and a lumen extending from said proximal end to said distal end having sufficient size for cannula of a predetermined size suture, said distal end having a tip configured for cannula with a suture through a tissue;   (b) providing a suction device detachably connected to said needle proximal end;   (c) selecting and introducing a length of suture into at least said needle; and   (d) moving liquid into or out of said suction device to move a length of said suture into or out of said suction device, respectively, by hydrodynamic force.   
   
   
       22 . A method of suturing according to  claim 21 , wherein moving said length of said suture out of said suction device comprises moving said length of said suture out of a chamber in communication with said needle, wherein at least a portion of said suture is disposed in said chamber prior to motion. 
   
   
       23 . A method of suturing according to  claim 21 , wherein said introducing a length of suture into at least said needle and said moving said suture into said suction device comprises:
 inserting an end of said suture into said distal end of said needle;   submerging said distal end of said needle with said suture in a liquid; and   drawing said length of suture and a quantity of said liquid into said needle with said suction device.   
   
   
       24 . A method of suturing according to  claim 23  further comprising:
 passing said distal end of said needle with said suture through a tissue to be sutured; and   expelling said length of suture from said distal end of said needle by hydrodynamic force from a quantity of said liquid in said suction device.   
   
   
       25 . A method of suturing according to  claim 21 , further comprising providing a suction device and a suture loaded therein. 
   
   
       26 . A method of suturing according to  claim 25 , further comprising providing liquid in a chamber in said suction device with said suture. 
   
   
       27 . A method of suturing according to  claim 25  further comprising:
 submerging said distal end of said needle with said suture in a liquid; and   drawing the liquid into said suction device to surround said length of suture with liquid.   
   
   
       28 . A method of suturing according to  claim 26  further comprising:
 passing said distal end of said needle with said suture through a tissue to be sutured; and   expelling said length of suture from said distal end of said needle by hydrodynamic force from a quantity of said liquid in said suction device.   
   
   
       29 . A method of suturing according to  claim 21 , further comprising:
 (a) providing an elongated tubular member having a distal end and proximal end and a cannula extending from said proximal end to said distal end, first and second jaws on said distal end of said elongated tubular member in opposed relation, one of said first and second jaws being moveable relative to the other and having an opening therethrough, the other of said first and second jaws including an open end of said cannula oriented toward said opening, and means at said proximal end for moving said moveable jaw between open and closed positions;   (b) providing said elongated needle in a length sufficient length to extend said distal end of said elongated needle through said cannula past said open end and through said opening in said one of said jaws;   (c) grasping a tissue to be sutured between said first and second jaws; and   (d) extending said distal end said elongated needle through said cannula past said open end through said tissue and through said opening in said one of said jaws.   
   
   
       30 . A method of suturing according to  claim 29 , further comprising:
 providing said cannula with an oval configuration and orienting said needle in a direction to exit said opening in said one of said jaws, wherein said needle has a curved configuration at said distal end.   
   
   
       31 . A method of suturing according to  claim 21 , further comprising providing a loop adjacent to a distal end of said suture and, following expulsion of said suture from said needle, using said loop to enclose and manipulate another suture. 
   
   
       32 . A method of suturing according to  claim 31 , wherein said loop is formed in said suture by forming an axial opening substantially along a diameter of said suture. 
   
   
       33 - 40 . (canceled) 
   
   
       41 . A method for suturing, comprising:
 providing an elongated needle having a distal end and a proximal end and a lumen extending therebetween, said lumen dimensioned to receive a suture, said distal end configured to pass through a tissue with at least a portion of said suture in said lumen;   introducing a length of said suture into at least a portion of said lumen through said distal end;   providing a first hydrodynamic force to said length of said suture so as to further draw in said suture into said lumen;   passing said distal end of said elongated needle through said tissue; and   providing a second hydrodynamic force to said suture in said lumen so as to expel said length of said suture from said lumen through said distal end.   
   
   
       42 . The method of  claim 41 , wherein said providing of said first and second hydrodynamic forces comprises providing drawing and expelling motions, respectively, of a syringe in communication with said proximal end of said elongated needle. 
   
   
       43 . The method of  claim 41 , wherein said introducing of said length of said suture comprises introducing an end of said suture into said lumen through said distal end. 
   
   
       44 . The method of  claim 43 , wherein further drawing in of said suture by said first hydrodynamic force results in at least a portion of said suture to remain outside of said lumen. 
   
   
       45 . The method of  claim 44 , wherein said passing of said distal end of said elongated needle through said tissue results in a portion of said suture about said distal end of said elongated needle being passed through said tissue. 
   
   
       46 . A method for manipulating a suture, comprising:
 securing a first end of a suture to a bone;   introducing a second end of said suture into a needle that defines a lumen extending between proximal and distal ends of said needle, said second end of said suture entering said lumen from outside of said needle through said distal end;   drawing a length of said suture into said lumen by drawing liquid into said lumen;   passing said distal end of said needle through a tissue so as to pass a portion of said suture about said distal end of said needle; and   expelling at least a portion of said length of said suture in said lumen by expelling at least a portion of said liquid in said lumen.