Percutaneous suturing apparatus and method

#The present invention relates to a method and apparatus for placing sutures in tissue, and more particularly to a method and device for arthroscopic repair of a torn rotator cuff.

#Suturing of body tissues is a time consuming aspect of most surgical procedures. Many surgical procedures are currently being performed where it is necessary to make a large opening to expose an area of the body which requires surgical repair. There are instruments that are becoming increasingly available that allow the viewing of certain areas of the body through a small incision without exposing the entire body cavity. These viewing instruments, called endoscopes, can be used in conjunction with specialized surgical instrumentation to detect, diagnose, and repair areas of the body that were previously only able to be repaired using traditional “open” surgery.

#In the past, there have been many attempts to simplify the surgeons's task of driving a needle-carrying suture through body tissues to approximate, ligate and fixate them. Many prior disclosures, such as described in U.S. Pat. No. 919,138 to Drake et al, employ a hollow needle driven through the tissue with the suture material passing through the hollow center lumen of the needle. The needle is withdrawn, leaving the suture material in place, and the suture is tied, completing the approximation. A limitation of these types of devices is that they are particularly adapted for use in open surgical procedures, involving a large incision, where there is room for the surgeon to manipulate the instrument.

#FIG. 1 is a schematic view illustrating a percutaneous suturing device constructed in accordance with the principles of the present invention, in a first operational position relative to a shoulder joint which is to be repaired;

#FIG. 2 is a schematic view similar to FIG. 1, illustrating the inventive suturing device after the needles of the device have penetrated the skin of the patient;

#FIG. 3 is a schematic view similar to FIGS. 1 and 2, showing the needles of the inventive suturing device after they have penetrated the soft tissue to be repaired and engaged the suturing material;

#The present invention relates to a method and apparatus for the arthroscopic repair of torn tissue and bone at a surgical repair site using a device, which is a combination tissue grasper and suture placement device. Although the present invention is described primarily in conjunction with the repair of a tom rotator cuff, the apparatus and method could also be used in arthroscopic repair at other sites, such as the knee, elbow, or hip, for example, as well as in conjunction with other surgical techniques, such as traditional open or mini-open surgical procedures.

#Referring now to FIG. 1, there is shown a representative shoulder 11, including a torn rotator cuff 13, and a humeral head 15. As is common with rotator cuff injuries, in the illustrated example the torn rotator cuff 13 has pulled away from the head 15 of the humerus. A method of repair for such an injury which is a significant improvement over prior art approaches is discussed in co-pending U.S. patent application Ser. No. 09/876,488, entitled Method and Apparatus for Attaching Connective Tissues to Bone Using a Knotless Suture Anchoring Device, filed on Jun. 7, 2001, commonly assigned herewith, and expressly incorporated herein by reference.

#According to the present invention, the objective is the same as in the '488 patent application, that being to re-attach the soft tissue (tendon) 13 to the humeral head 15, using a bone anchor to which has been secured suturing material which has also been sutured to the tendon 13. To accomplish this objective, a percutaneous suturing instrument 17 is placed in close proximity to the repair site, as shown in FIG. 1. The suturing instrument 17 comprises a clamping portion 19 and a needle portion 21. In a preferred embodiment, the instrument 17 further comprises a base portion 23. The clamping portion 19 extends axially in a distal direction from the base portion 23, along a longitudinal axis 25, and the needle portion 21 extends transversely from the base portion. The needle portion 21 includes a curved portion 27 for re-orienting the needle portion 21 so that it is substantially parallel to the clamping portion at a spaced distance therefrom, as shown in FIG. 1. Portions 19, 21, and 23 of the instrument 17 may be constructed of known relatively rigid structural materials suitable for medical instruments, such as plastic or metal, depending upon durability and cost parameters.