Endoscopic Suture Cinch System With Replaceable Cinch

A cinch applicator for applying a tubular suture cinch to suture, the cinch having a distal first portion defining a lateral suture entry opening, and a proximal second portion defining a lateral suture exit opening, an internal suture pathway between the entry and exit openings, and a deformable structure between the entry and exit openings, the cinch applicator comprising:

• a) an elongate first tubular member having proximal and distal ends and defining a longitudinal axis therebetween;
• b) a housing adapted to receive the cinch, said housing having a proximal end and a distal end, said proximal end coupled to said first tubular member, and said housing defining,
• i) a relatively longitudinally extending distal hood for extending about the second side of the cinch and open to provide access to the entry opening of the cinch such that suture may be advanced into the entry opening,
• ii) a socket relatively proximal to said hood, said socket having a taper that tapers in a distal-to-proximal direction, and
• iii) a window defined in said housing adjacent a proximal end of the socket, said window opening into said socket for alignment with the exit opening of the cinch when the cinch is loaded within said housing and adapted for passage of suture out thereof;
• c) a shaft extending through said tubular member, said shaft having a proximal end and a distal end;
• d) a force applying member at said distal end of the shaft, said force applying member adapted for contacting and deforming the deformable structure of the cinch when the cinch is loaded in said socket;
• and
• e) a proximal handle operable to move said shaft relative to said housing.

A cinch applicator for applying a deformable suture cinch to suture, the applicator comprising:

• a) an elongate first tubular member having proximal and distal ends and defining a longitudinal axis therebetween;
• b) a housing adapted to receive the suture cinch, said housing having a proximal end and a distal end, said proximal end coupled to said first tubular member, and said housing defining,
• i) a relatively longitudinally extending distal hood for extending about a first circumferential portion of the cinch and open to provide access to a suture entry opening provided in a rotationally displaced second circumferential portion of the cinch,
• ii) a socket relatively proximal to said hood, said socket having a taper that tapers in a distal-to-proximal direction, and
• iii) a window defined in said housing adjacent a proximal end of the socket, said window opening into said socket;
• c) a shaft extending through said tubular member, said shaft having a proximal end and a distal end;
• d) a force applying member at said distal end of the shaft, said force applying member adapted for contacting and deforming the cinch loaded in said socket;
• and
• e) a proximal handle operable to longitudinally displace said shaft and the force applying member relative to said housing.

A system of a cinch applicator and cinch for securing suture relative to tissue, comprising:

• a) a suture cinch consisting essentially of a tubular element having a distal first portion defining a lateral suture entry opening, and a proximal second portion defining a lateral suture exit opening, an internal suture pathway between the entry and exit openings, and a deformable structure between the entry and exit openings that when deformed impinges on said suture pathway;
• and
• b) a cinch applicator, comprising,
• i) an elongate first tubular member having proximal and distal ends and defining a longitudinal axis therebetween,
• ii) a cinch housing receiving said cinch, said housing having a proximal end and a distal end, said proximal end coupled to said first tubular member, and said cinch housing defining,
• A) a relatively longitudinally extending distal hood extending peripherally about a portion of said first portion of said cinch and sufficiently open to allow access to said entry opening such that suture may be advanced into said entry opening,
• B) a socket relatively proximal to said hood, said socket having a taper that tapers in a distal-to-proximal direction, said socket receiving said second portion of said cinch,
• C) a window defined in said housing adjacent a proximal end of the socket, said window opening into said socket and aligned with said exit opening of said cinch,
• wherein suture may be advanced into said entry opening through said suture pathway, out of said exit opening and out of said window, and
• iii) a shaft extending through said tubular member, said shaft having a proximal end and a distal end,
• iv) a force applying member at said distal end of the shaft, said force applying member adapted for contacting and deforming the deformable structure of the cinch loaded in said socket, and
• v) a proximal handle operable to move said shaft relative to said housing,
• wherein when said handle is operated to cause retraction of said force applying member relative to said cinch loaded in said housing, said deformable structure of said cinch is plastically deformed into said pathway to cause said cinch to be secured on suture extending within said pathway.

A cinch loader for loading a suture cinch into a cinch applicator that secures the cinch onto a length of suture, the cinch applicator having a longitudinal axis and a distal end provided with a cinch housing into which the cinch is to be loaded, the housing defining a distal portion with a non-circular cross-sectional shape transverse to the longitudinal axis, said cinch loader comprising:

• a body having a throughbore defining a longitudinal axis, and a suture guide slot,
• said throughbore having a first portion, a second portion, and a central portion between said first and second portions,
• said central portion having a smaller diameter than said first portion, and said second portion having a shape and size corresponding to the distal end of the cinch housing of the applicator,
• said guide slot extending into an exterior surface of said body and leading into said second portion of said throughbore;
• a cinch pusher longitudinally displaceable within said central portion of said throughbore, said cinch pusher having first and second ends, said first end having a tip with a first portion adapted to engage the cinch under tension and a second portion adapted to engage the cinch under compression, said cinch pusher prevented from rotational displacement within said throughbore;
• and
• a button attached to said second end of said cinch pusher, said button extending out of said body and longitudinally displaceable within said first portion of said throughbore, wherein movement of said button toward said central portion of said throughbore is limited by a shoulder of said throughbore at a transition between said first and central portions of said throughbore.

A method of applying a suture cinch to a length of suture, wherein a first portion of the suture is inserted in tissue and a second portion of the suture is free of the tissue, comprising:

• a) providing a cinch applicator loaded with a cinch, wherein said cinch applicator has
• i) an elongate first tubular member having proximal and distal ends and defining a longitudinal axis therebetween,
• ii) a cinch housing having a proximal end and a distal end, said proximal end coupled to said first tubular member, and defining,
• A) a relatively longitudinally extending distal hood,
• B) a socket relatively proximal to said hood, said socket having a taper that tapers in a distal-to-proximal direction,
• C) a window defined in said housing adjacent a proximal end of the socket, and
• wherein said cinch consists of a tubular element having a first portion received against said hood, a second portion received in said socket and defining a longitudinal axis, an entry opening in said first portion accessible through said hood, an exit opening in said second portion in alignment with said window, an internal suture pathway defined between said entry and exit openings, and at least one deformable structure defined in said tubular element extending transverse to said longitudinal axis of said tubular element and about a portion of a periphery of said tubular element, and a seat defined in said periphery between said entry opening and said at least one deformable structure,
• iii) a shaft extending through said tubular member, said shaft having a proximal end and a distal end,
• iv) a force applying member at said distal end of the shaft, and
• v) a proximal handle operable to move said shaft relative to said housing;
• b) inserting said second portion of suture through said entry opening, said pathway, and said exit opening of said cinch, and out of said window of said housing;
• c) first operating said applicator to retract said force applying member across at least one of said deformable structures such that said at least one deformable structure is plastically deformed inward into said pathway and against said suture with sufficient force to secure said cinch to said suture;
• d) second operating said applicator to sever a portion of the suture secured by the cinch from another portion of the suture extending out of said window of said housing.

A method of applying a cinch to a length of suture, comprising:

• a) providing a tubular suture cinch having an interior portion with a suture pathway extending along an axis, and a portion of the suture pathway is bounded by a plurality of plastically deformable ribs extending transverse to the axis;
• b) positioning the suture within the suture pathway;
• and
• c) deforming the ribs inward into the suture pathway so that the ribs clamp onto the suture and retain the cinch relative to the suture.