Surgical Instrument for Endoscopic Suturing of Deep Subcutaneous Tissue

A surgical instrument comprising:

• (a) elongate insert means having first and second ends, for insertion of the first end into an incision or access opening of the skin between an outer surface thereof and STFFM that is inwardly of the outer skin surface to a location remote from the opening of the skin and with the second end of the insert means being located and operable outside the incision or access opening of the skin;
• (b) means on the first end of the insert means for engaging remote STFFM inwardly of the skin outer surface and for securing the remote STFFM to the first end of the insert, wherein the engaging and securing means includes means for suturing the remote STFFM to the first end of the insert, inwardly of the outer surface of the skin, wherein the engaging and securing means includes a suturing needle carried by the insert for entering the remote STFFM with a suture in a path of travel, and with a suture securing device separate from the needle and the suture being carried by the insert for engaging the suture after the suture passes through the STFFM, for securing the sutured remote STFFM to the first end of the insert upon actuation of the securing device from the second end of the insert, outside the incision or access opening in the skin;
• (c) whereby withdrawal of the insert through the incision or access opening of the skin withdraws the remote engaged and secured STFFM toward the opening in the skin;
• wherein the suture securing device comprises a hook means on the instrument for hooking the suture from outside the incision or access opening in the skin;
• including a cavity at the first end of the insert, wherein the engaging means includes partial vacuum engaging means delivering partial vacuum to the cavity at the first end of the insert, for sealingly engaging the remote STFFM in a partial vacuum seal in the cavity at the first end of the insert, wherein said path of travel of the needle is outside said cavity.

An instrument for endoscopically, surgically engaging and grasping STFFM of a patient internally remote from a skin access opening and moving the engaged and grasped STFFM relative to the opening, comprising:

• (a) an elongate insert having first and second ends for insertion of the first end through an incision or access opening in the STFFM of a patient to a location inside the skin of a patient that is remote from the incision or access opening, leaving the second end of the insert outside the incision or access opening;
• (b) means including a cavity at the first end of the insert, and partial vacuum delivery means applied via said insert, for delivering a partial vacuum to the cavity for engaging the STFFM in secured contact with said cavity at said first end of said insert internally of the outer surface of the skin and remote from the incision or access opening, with a partial vacuum delivery line provided to the instrument from the second end of the insert;
• (c) a suturing needle having first and second ends, carried by said insert and carrying a suture therewith;
• (d) means associated with said second end of said insert for actuating said first end of said needle for and moving the needle in a path of travel toward and piercing the engaged STFFM of (b) above and passing the suture through the STFFM while the STFFM is in partial vacuum-drawn contact with said cavity;
• (e) means carried by the insert, cooperating with said first end of said needle for engaging and maintaining the suture through the portion of the engaged STFFM after withdrawal of the first end of the needle from the portion of the engaged STFFM;
• (f) means carried by the second end of the insert for engaging the second end of the needle and withdrawing the first end of the needle from the portion of the engaged STFFM;
• (g) whereby movement of the first end of the insert relative to the incision or access opening will cause the portion of the engaged STFFM internally of the outer surface of the skin to be correspondingly moved with the first end of the insert;
• wherein the cavity includes an opening facing toward the portion of the STFFM to be engaged, and wherein the path of travel of the needle is outside the opening of the cavity.