Pinned retainer surgical fasteners, instruments and methods for minimally invasive vascular and endoscopic surgery

A method for attaching soft tissues located in the abdominal cavity, chest or retroperitoneal space and for attaching a graft to an artery in these areas with a surgical fastener comprising,

• providing an instrument having an elongated shaft with a distal end portion for applying a surgical fastener,
• providing only one needle to a needle holder member and at least one retainer to a retainer holder member at the distal end of the instrument,
• incising a patient's tissues to create at least one opening into the patient's abdominal cavity, chest or retroperitoneal space,
• inserting the distal end of the shaft of the instrument through the opening so that the distal end is disposed in the patient,
• passing the shaft of the needle through a portion of one tissue, graft or artery and through a second tissue, artery or graft, and
• actuating a closing assembly associated with the retainer holder member to place the retainer on the needle and form a surgical fastener.

A surgical fastening system, comprising:

• a needle consisting of a base and a body member, said base comprising an upper surface, a lower surface, and further comprising at least two substantially planar surfaces extending in substantially same direction, said body member having a first end affixed to said base, and a second end opposite said first end, said second end being capable of passing through tissues, or tissue and graft;
• a retainer comprising a plate comprising resilient material, said plate having an aperture adapted to engage said shaft and having means for securing the retainer at a selectable position on the shaft of the needle without substantially deforming said shaft, said retainer further having a surface that cooperates with the upper surface of the base of the needle to contact and secure between those surface portions of materials together wherein at least one of the portions is tissue;
• and
• an instrument having a portion adapted to be slideably received by the at least two substantial planar surfaces of the base of the needle so that the needle may be manipulated to skewer materials without rotation.

A surgical retainer system for fastening together tissues, or tissue and graft, comprising:

• a retainer including an aperture;
• and an instrument, including:
• a shaft having a proximal and distal end,
• a needle removably affixed to said distal end,
• first means in said distal end for articulating said needle to skewer a first tissue or graft, align the first tissue or graft to a desired position with respect to a second tissue or graft, and skewer the second tissue or graft in the desired position with respect to the first tissue or graft, and
• second means for holding said retainer, said second means capable of moving between a first position where said second means and said retainer are retracted proximally into said shaft to provide a clear line of sight of a surgeon to the first means and needle, and a second position where said second means is capable of positioning said retainer over said needle.

A surgical retainer system for fastening together tissues, or tissue and graft, comprising:

• a needle including a base, a shaft affixed to said base, said shaft having a retainer-engaging portion, and an end capable of passing through the tissue, or tissue and graft;
• and
• a retainer including an aperture for allowing said retainer to fit over said needle onto said retainer-engaging portion;
• wherein said retainer includes a metallic base, and an elastomeric cap affixed to said base.

A surgical instrument for fastening together tissues, or tissue and graft, together, comprising:

• a shaft including a distal end and a proximal end opposite said distal end;
• a needle holder in said distal end for holding a needle;
• first means in said distal end for articulating said needle holder to allow said needle to skewer the tissues, or tissue and graft, and to align the tissues, or tissue and graft with respect to each other;
• a retainer holder in said distal end for holding a retainer;
• second means in said distal end for moving said retainer holder between a first position where said retainer holder is retracted proximally to provide a clear line of sight of a surgeon to the needle holder and first means, and a second position where said retainer holder is capable of locating a retainer over a needle held by said needle holder;
• and
• controls located remote from said distal end for controlling operation of said first means and said second means.

A method of fastening together tissues, or tissue and graft, in a surgical procedure, comprising the steps of:

• (a) skewering the tissues, or tissue and graft, onto a needle having a base in a minimally invasive procedure;
• (b) positioning a retainer over the needle in a minimally invasive procedure to fasten the tissues, or tissue and graft together between the needle base and retainer;
• and
• (c) providing a clear line of sight for a surgeon to the needle during said step (a) by positioning the retainer out of the line of sight.