Medical instrument to place a pursestring suture, open a hole and pass a guidewire

Abstract

A therapeutic instrument for the ergonomic, effective and safe opening and closing of targeted remote tissue sites; includes a pistol grip style handle with a hand activated lever for needle deployment and, optionally, with features to control tissue cutting and guide wire installation; also incorporates a specialized elongated rigid or flexible instrument shaft, which enables vacuum assisted holding of tissue at a uniquely contoured distal tip, where placement of a suture in a purse string configures occurs along with, if desired, tissue cutting and guide wire passage.

1 . A tissue suturing instrument comprising:
 a handle having an operating lever on the handle;   an elongated body extending from the handle to a distal end;   a tip at a distal end of the elongated body;   a tissue receiving region in the tip;   first and second retractable needles coupled to the operating lever and selectively extending across the tissue receiving region and retracting;   a cutter arranged generally parallel to the tissue receiving region; and   a suture having first and second ends disposed at the distal end of the tissue receiving region, the first and second ends engaging the first and second retractable needles when the needles are extended across the tissue receiving region, and being carried proximally across the regions by the needles when the needles are retracted.   
   
   
       2 . A method of gathering and placing a suture in tissue comprising:
 attracting a section of tissue to a pleat forming surface;   placing a suture through the folds of a pleat of tissue while attracted to the surface.   
   
   
       3 . The method of  claim 2  in which the attracting step comprises attracting the tissue to the surface with suction. 
   
   
       4 . The method of  claim 3  in which the step of placing a suture through the folds comprising advancing a needle through the folds, capturing an end of a length of suture with the needle, and drawing the suture back through the folds. 
   
   
       5 . The method of  claim 2  further comprising cutting an opening in the section of tissue. 
   
   
       6 . The method of  claim 5  in which cutting the opening comprises cutting the opening adjacent to the suture. 
   
   
       7 . The method of  claim 6  comprising passing a guide wire through the opening. 
   
   
       8 . The method of placing a suture in a section of tissue of  claim 2  comprising:
 positioning the pleat forming surface adjacent to the tissue;   attracting the tissue to the surface to form a pleat in the tissue;   extending a pair of needles through the pleat;   engaging first and second ends of a length of suture distally of the pleat;   retracting the pair of needles proximally through the pleat;   carrying first and second ends of a length of suture proximally through the pleat; and   securing the suture proximally of the pleat to form the pursestring suture.   
   
   
       9 . The method of  claim 8  in which the attracting step comprises attracting the tissue to the surface with suction. 
   
   
       10 . The method of  claim 8  further comprising cutting an opening in the section of tissue. 
   
   
       11 . The method of  claim 10  in which cutting the opening comprises cutting an opening between the pair of needles. 
   
   
       12 . The method of  claim 11  in which the cutting step is performed between the extending step and the retracting step. 
   
   
       13 . The method of  claim 10  comprising advancing a guide wire through the opening. 
   
   
       14 . A method of making an incision, guiding an instrument through the incision withdrawing the instrument, and closing the incision comprising:
 inserting a cutting and suturing instrument through an organ structure naturally communicating with an existing external orifice;   substantially simultaneously placing a purse string suture in a wall of the existing organ structure and cutting an opening in the wall;   placing a guide wire through the opening with the cutting and suturing instrument;   withdrawing the cutting and suturing instrument leaving the guide wire in place;   inserting a second instrument through the organ structure and the opening and performing a procedure outside the organ structure;   withdrawing the second instrument; and   closing the opening with the previously placed purse string suture