BR112019026962B1 - SUTURE HOLDER - Google Patents

Abstract

SUTURE GRIP INSTRUMENT. The present invention relates to a suture passer that includes a longitudinally extending needle and is configured to be manipulated between a capture position and a release position and a first suture notch and a second suture notch. The first and second suture notches respectively extend through the needle with a first capture notch and a second capture notch. Each of the first and second suture notches is configured to receive a suture thread therein and releasably capture the suture thread radially inwardly as the needle is manipulated toward the capture direction.

Description

BACKGROUND OF THE INVENTION

[001] Surgical procedures may require a physician to gain access to a cavity or other desirable surgical site within a patient's body. To perform this surgical procedure, an incision can be made through the patient's tissue into the cavity. Some conventional surgical procedures may apply a knife, such as a scalpel, to the tissue for the incision, while some less invasive surgical procedures, such as laparoscopic and endoscopic surgical procedures, may access the cavity through a trocar set. Trocar assemblies generally include a trocar obturator received within a trocar cannula. In use, the physician guides the trocar obturator and cannula through the tissue to access the desired surgical site cavity. Once accessed, the physician removes the trocar obturator from the trocar cannula so that the trocar cannula can be used to introduce surgical instruments into the cavity for treatment.

[002] Merely exemplary trocar sets, their components, and other varieties of wound closure devices are provided for in US patent 7,981,092, entitled "Vibratory Trocar", granted on July 19, 2011; US Patent No. 8,226,553, entitled "Access Device with Insert", granted July 24, 2012; US Patent No. No. 8,251,900, titled “Surgical Access Devices and Methods Providing Seal Movement in Predefined Paths” granted August 28, 2012; US Patent No. 8,579,807, entitled "Absorbing Fluids in a Surgical Access Device", granted November 12, 2013; US Patent No. 8,568,362, entitled "Surgical Access Device with Sorbents", granted October 29, 2013; US Patent No. 8,636,686, entitled "Surgical Access Device", granted January 28, 2014; US Patent No. 8,690,831, entitled "Gas Jet Fluid Removal in a Trocar", granted April 8, 2014; US Patent Publication No. 2008/0200950, entitled "Surgical Hook" published August 21, 2008; US Patent Publication No. 2015/0038793, entitled "Devices, Systems, and Methods for Providing Surgical Access and Facilitating Closure of Surgical Access Openings" published February 5, 2015; US Patent Publication No. 2015/0038994, entitled "Devices, Systems, and Methods for Providing Surgical Access and Facilitating Closure of Surgical Access Openings" published February 5, 2015; and US Patent Publication No. 2015/0094741, entitled "Wound Closure Device including Mesh Barrier", published April 2, 2015. The description of each of the US patents and US patent publications cited above is incorporated herein by way of reference.

[003] Surgical instruments having such trocars may have a distal end actuator for engaging tissue through the trocar cannula in various ways to achieve a diagnostic or therapeutic effect (e.g., endocutter, gripper, cutter, stapler, clipper, access device, drug/gene therapy delivery device, and device for applying energy through the use of ultrasonic vibration, RF, laser, etc.). Endoscopic and laparoscopic surgical instruments may include a drive shaft between the end actuator and a handle portion, which is manipulated by the clinician. Such a drive shaft may enable insertion to a desired depth and rotation about the longitudinal axis of the drive shaft, thereby facilitating positioning of the end actuator from the patient cavity. Positioning of an end effector may be further facilitated by the inclusion of one or more joints or articulation features, allowing the end effector to be selectively articulated or otherwise deflected relative to the longitudinal axis of the drive shaft.

[004] Although various types of surgical instruments, including trocar sets and end actuators and other associated components have been produced and used, it is believed that no one before the inventor (or inventors) has produced or used the invention described in the embodiments attached.

BRIEF DESCRIPTION OF THE DRAWINGS

[005] The attached drawings, which are incorporated into this specification and which constitute part thereof, illustrate embodiments of the invention and, together with the general description provided above and the detailed description of the embodiments provided below, serve to explain the principles of present invention.

[006] Figure 1 shows a perspective view of an exemplary trocar assembly;

[007] Figure 2 represents a partially exploded side elevation view of the trocar assembly of Figure 1 with a trocar housing, a trocar cannula, and an obturator;

[008] Figure 3A represents a side sectional view of a patient's tissue with the trocar assembly of Figure 1 being manipulated by a physician through the tissue;

[009] Figure 3B shows a side sectional view of the tissue and the trocar assembly of Figure 3A, with the trocar assembly of Figure 1 inserted through the tissue and received within a patient cavity;

[0010] Figure 3C represents a side sectional view of the tissue and the trocar assembly of Figure 3A, with the obturator removed from the trocar cannula to access the cavity through a working channel through the trocar cannula and the catheter compartment. trocar;

[0011] Figure 3D represents a side sectional view of the tissue and the trocar assembly of Figure 3C, with the trocar compartment and the trocar cannula being removed from the patient's cavity and tissue;

[0012] Figure 4A represents another side sectional view of the tissue shown in Figures 3A-3D after removal of the trocar assembly of Figure 1, with an opening through the tissue and a suture thread being introduced into a portion of the tissue to suture the opening closed;

[0013] Figure 4B shows a cross-sectional side view of the tissue of Figure 4A, with the suture thread being inserted through another portion of the tissue and pulled through the tissue;

[0014] Figure 4C shows a sectional side view of the tissue of Figure 4A, with the suture tightened and tied to at least partially close the opening;

[0015] Figure 4D shows a side sectional view of the tissue from Figure 4A, with the additional suture to further close the opening;

[0016] Figure 5 represents a perspective view of an exemplary suture passer having a first needle head;

[0017] Figure 6 represents a partially exploded side elevation view of the suture passer of Figure 5;

[0018] Figure 7A shows a cross-sectional side view of the suture passer of Figure 5 taken along a center line with the needle in a retracted position and the traction member in an expanded state;

[0019] Figure 7B shows the cross-sectional side view of the suture passer similar to Figure 7A, but with the needle in an extended position and the traction member in a compressed state;

[0020] Figure 8 is a side elevational view of the first needle head of the suture passer of Figure 5;

[0021] Figure 9 represents a side elevation view of a second needle head;

[0022] Figure 10 represents a side elevation view of a third needle head of the suture passer of Figure 5;

[0023] Figure 11 shows a view of the distal end of the needle head of Figure 10;

[0024] Figure 12 represents a cross-sectional side view of another example of a suture passer with a rotating driver and a fourth needle head;

[0025] Figure 13A shows an enlarged cross-sectional side view of the needle head 12 along a center line with the needle head in a retracted position;

[0026] Figure 13B represents an enlarged cross-sectional side view of the needle head similar to Figure 13A, but with the needle head in an extended position;

[0027] Figure 13C represents a side view in enlarged side section of the needle head similar to Figure 13B, but with the needle head in a third position;

[0028] Figure 14A represents an enlarged side elevation view of the needle head of Figure 13A with the needle head in the retracted position and holding a suture within a suture notch;

[0029] Figure 14B represents an enlarged side elevation view of the needle head of Figure 13B with the needle head in the extended position and securing the suture within the suture notch;

[0030] Figure 14C represents an enlarged side elevation view of the needle head of Figure 13C with the needle head returned to the retracted position and releasing the suture thread from within the suture notch;

[0031] Figure 15A represents an enlarged side elevation view of the needle head of Figure 13A with the needle head in the retracted position and holding the suture within another suture notch;

[0032] Figure 15B is an enlarged side elevational view of the needle head of Figure 13B with the needle head in the extended position and releasing the suture thread from within the other suture notch; and

[0033] Figure 15C represents an enlarged side elevation view of the needle head of Figure 13C with the needle head back in the retracted position and securing the suture within the other suture notch.

[0034] In no way are the drawings intended to be limiting and it is contemplated that various embodiments of the invention may be carried out in a variety of other forms, including those not necessarily represented in the drawings. The attached drawings incorporated and forming part of the specification illustrate various aspects of the present invention and, together with the description, serve to explain the principles of the invention. It should be understood, however, that this invention is not specifically limited to the arrangements shown.

DETAILED DESCRIPTION

[0035] The following description of specific examples of the invention should not be used to limit the scope of the present invention. Other examples, characteristics, aspects, embodiments and advantages of the invention will be apparent to those skilled in the art from the following description, which is, by way of illustration, one of the best modes contemplated for carrying out the invention. As will be understood, the invention may have other different and obvious aspects, all without departing from the invention. Consequently, drawings and descriptions should be considered illustrative and not restrictive in nature.

I. Exemplary surgical access device

[0036] Figures 1 and 2 represent an example of a surgical access device in the form of a first exemplary trocar assembly 10 that includes a trocar cannula 12 and a trocar obturator 14. The trocar obturator 14 is received so removable within the trocar cannula 12 through a trocar housing 16 of the trocar cannula 12. As shown in Figure 1, with the trocar obturator 14 positioned within the trocar cannula 12, a physician inserts the trocar assembly 12 through of tissue 17 (see Figure 3A) of a patient at a desirable surgical site to access a cavity 18 (see Figure 3A) within the patient. By way of example only, such a trocar assembly 10 may be inserted into a patient's abdomen, between two of the patient's ribs, or elsewhere. A tip 20 of the trocar obturator 14 projects distally from the trocar cannula 12 to pierce the tissue 17 (see Figure 3A) to introduce a distal end portion of the trocar cannula 12 into the cavity 18 (see Figure 3B). . The physician proximally withdraws the trocar obturator 14 from the trocar cannula 12 so that the cavity 18 (see Figure 3C) within the patient is in communication with a surgical environment via the trocar cannula 12. The physician can then introduce a fluid , as a gas, through the trocar cannula 12 to inflate the cavity 18 (see Figure 3A) and/or an end actuator of a surgical instrument through the trocar cannula 12 to engage the tissue 17 to obtain a diagnostic or therapeutic.

[0037] It should be understood that terms such as "proximal" and "distal" are used in the present invention with reference to a doctor holding the trocar gripping compartment 16. In this way, the tip 20 is in a distal position in relation to the compartment of trocar 16 more proximally. It will be further understood that, for convenience and clarity, spatial terms such as "vertical" and "horizontal" are used in the present invention in connection with the drawings. However, surgical instruments are used in many orientations and positions, and such terms are not intended to be limiting and absolute. Additionally, in some cases, components are referred to interchangeably with and without the term "assembly", for example, a trocar and a trocar assembly. There is no specific intent that the terms refer to different components. Similarly, terms such as "instrument" and "device" can be used interchangeably.

A. Exemplary trocar set with cannula and obturator

[0038] The trocar assembly 10 of Figures 1 and 2 12 includes a cannula extending distally from the trocar housing 16. In the present example, the trocar housing 16 has a generally cylindrical shape with a proximal removable cap 22 over a distal housing chamber (not shown). The cap 22 is selectively attachable to and removable from the housing chamber (not shown). The trocar housing 16 includes a sidewall 24 that extends circumferentially about a central longitudinal axis 26 through the trocar assembly 10 and thus along the trocar cannula 12. The trocar housing 16 further includes a central lumen 27 that extends from a proximal end housing opening 28 to a distal end housing opening not shown. As shown, the cap 22 selectively engages the side wall of the housing 24 via distal coupling elements (not shown) and further includes proximal coupling elements, such as slots (not shown), configured to removably connect to a pair of tabs 32, respectively, extending distally from a portion of the obturator 14. However, it will be recognized that alternative structures and devices may also be removably connected to the cap 22 during use.

[0039] The cannula 12 extends distally from the trocar housing 16, and is also generally defined by a cannula side wall 33 that extends circumferentially around the central longitudinal axis 26. The cannula side wall 33 extends distally to a beveled end 34 so that the cannula side wall 33 and beveled end 34 are configured to be inserted through tissue 17 (see Figure 3A) as discussed below in greater detail to access cavity 18 (see Figure 3A). For this purpose, cannula 12 generally has a smaller diameter than the trocar compartment 16, which is configured to remain external to the tissue 17 (see Figure 3C). Furthermore, the cannula 12 defines an internal lumen 35 with a proximal cannula end opening (not shown) and a distal cannula end opening 36 extending through the beveled end 34. In the present example, the cannula end opening 36 extends through the beveled end 34. distal compartment (not shown) of the trocar compartment 16 fluidly connects to the opening of the proximal end of the cannula not shown such that the central lumen 27 of the trocar compartment 16 and the inner lumen 35 of the cannula 12 define a working channel 38. The working channel 38 thus extends from the opening of the proximal end of the compartment 28 to the opening of the distal end of the cannula 36 and is configured to receive one or more surgical instruments therethrough to access the cavity 18 .

[0040] Additionally, an insufflation port 40 is operatively connected to the trocar housing 16 to control the flow of an insufflation fluid, such as carbon dioxide, through a portion of the cannula 12 and into the cavity 18. More particularly, the insufflation port 40 includes a regulating valve 42 and a regulating valve lever 44, which may work together to enable and/or prevent the passage of a fluid into the tubing (not shown) through the trocar housing. 16 and into the trocar cannula 12. The compartment 16 and the trocar cannula 12, respectively, have proximal and distal seal assemblies (not shown) positioned within the central lumen 27 and the inner lumen 35 of the working channel 38. In the present example, the proximal seal assembly is an instrument seal (not shown), while the distal seal assembly (not shown) is a zero-closure seal, such as a duckbill seal (not shown). The instrument seal (not shown) is retained with the cap 22 and configured to seal fluidly against a surgical instrument extending through the working channel 38. In contrast, the duckbill seal (not shown) is configured to form a seal in the working channel 38 when no instrument is disposed therethrough so as to inhibit leakage of inflation fluid during use. Of course, it will be understood that alternative seal assemblies can be positioned within the working channel 38 to inhibit such leakage of inflation fluid.

[0041] As briefly discussed above, the obturator 14 is used in conjunction with the cannula 12 to insert the trocar assembly 10 into the patient. The obturator 14 of the present example includes a cable head 46 with a cylindrical drive shaft 48 extending distally therefrom to the tip 20, which is generally configured to pierce tissue 17 (see Figure 3A), as per described below in more detail. The handle head 46 is configured to be wielded by the physician during use and includes selectively movable tabs 32 that extend distally to detachably connect with the trocar housing 16 for selective fixation. The drive shaft 48 is received through the working channel 38 so that the tip 20 extends distally from the beveled end 34. Logically, the obturator 14 can be selectively removed from the cannula 12 and the trocar compartment 16 to release the 38 working channel for use. Although the present example of a trocar assembly 10 has an obturator 14, it will be understood that the cannula 12 may be inserted, in some examples, without the obturator 14 or may alternatively be configured to assist with insertion without the use of an obturator 14.

B. Exemplary method for accessing a cavity within a patient

[0042] Figures 3A to 3D 18 illustrate access to the cavity 17 through the tissue with the trocar assembly 10 discussed above. The fabric 17 of the present example has, more particularly, superficial layers relatively outward and deep layers relatively inward. The superficial layers generally include an outer layer of skin 52 and an inner layer of fat 54; while the deeper layers include layers of fascia 56, which are fibrous and flexible with relatively higher tensile strength than the superficial layers. As shown in Figure 3A, with the obturator 14 received within the cannula 12 and connected to the trocar housing 16, the physician manipulates the trocar assembly 10 to propel the tip 20 of the obturator 14 against the skin 52 and inward toward the cavity. 18 while rotating the trocar assembly 10 back and forth. Arrow 49 and arrow 50 indicate, respectively, this inward movement. Continuous inward thrust of the trocar assembly 10 further directs the tip 20 and beveled end 34 of the cannula 12 through the layers of fat 54 and fascia 56 and into the cavity 18, as shown in Figure 3B. The physician then disconnects the obturator 14 from the trocar housing 16 and withdraws the obturator 14 from the cannula 12 to establish access from the outside of the tissue 17 into the cavity 18 through the working channel 38 as shown in Figure 3C to obtain a diagnostic or therapeutic effect with another surgical instrument (not shown). Once the diagnostic or therapeutic effect is complete, the physician withdraws the cannula 12 and the trocar housing 16 outward to remove the tissue 17, as shown in Figure 3D.

[0043] As shown in Figure 4A, removal of the cannula 12 from the tissue 17 generally results in an opening of the tissue 58, which may also be called a tissue port or tissue wound, which is closed by the physician to encourage regeneration. of tissue 17. While some tissue openings may close sufficiently when tissue 17 comes together, other openings, such as tissue opening 58, are closed by suturing with a suture thread 60. In an example shown in Figures 4A to 4D, the suture thread 60 is detachably coupled with a needle 62 to guide the suture thread 62 through tissue 17 as the clinician manipulates 62 the needle. More particularly, as shown in Figure 4B, the practitioner guides the needle 62 downward through the fascia 56 on one side of the tissue opening 58 and then upward through the fascia 56 on the other side of the tissue opening 58 as the needle 62 releases the tissue 17. Notably, the practitioner threads the needle 62 through the fascia 56 along a desirable distance from the tissue opening 58 in order to provide relatively close proximity to the tissue opening 58; but also a sufficient distance to provide a broad fascia 56 for anchoring the suture 60 therein. As shown in Figure 4C, the suture thread 60 from the respective sides of the tissue opening 58 are brought together and pulled to pull the tissue 17 in a manner similar to at least partially closing the tissue opening 58. The physician then gives a knot the suture thread 60 to secure the tissue 17 together and sufficiently close the tissue opening 58 with a formed suture 64, as shown in Figure 4D. Additional sutures 64 may be placed along the tissue 17 to further close the opening of the tissue 58 and encourage healing of the tissue 17.

[0044] Although the above-described suturing technique shown in Figures 4A to 4D is an exemplary procedure for closing tissue opening 58 with suture thread 60 after use of the trocar set 10 (see Figure 1), other procedures and Exemplary devices can alternatively be used to close such tissue openings. By way of example, US Patent Application No. 15/088,723, entitled "Surgical Access Devices with Integrated Wound Closure Features" filed on April 1, 2016, which is incorporated herein by reference in its entirety, describes a set of trocar and an alternative suturing technique. For this purpose, alternative trocar sets and suturing techniques may be used in any combination as desired by the physician.

11. Exemplary suture passer

[0045] Grasping the suture thread 60 to manipulate the suture thread 60 to close the tissue opening 58 may be difficult in some cases, particularly given the limited access 58 within the tissue opening and the relatively small size of the suture thread 60. Therefore, it may be beneficial to use a suture passer, such as a suture passer 100 as shown in Figure 5, which is configured to grip and release the suture thread 60 to facilitate closure of the tissue opening 58 after removal. of the trocar assembly 10. For example, after the suture thread 60 has been inserted through the fascia 56 on one side of the tissue opening 58, the suture passer 100 captures the suture thread 60 to facilitate selective redirection and repositioning of the suture 60 upward toward the fascia 56 on the other side of the tissue opening 58, as discussed below in more detail.

[0046] The following description provides several examples of a suture passer 100 with multiple needle heads 132, 232, 332, 432 in Figures 5 to 15C configured to capture and securely hold the suture thread 60 within a patient. Each needle head 132, 232, 332, 432 is configured to permit capture and release of the suture thread 60. Additionally, the suture passer 100 also includes various actuation mechanisms for covering and uncovering the needle heads 132, 232 , 332, 432 in use. The suture passer 100 and needle heads 132, 232, 332, 432 described below can be used with any of the various trocar assemblies 10 described above and in any of the various procedures described in the various references described herein. Although the following examples are provided in the context of the trocar assembly 10 described above, the teachings below can be readily incorporated into any other surgical access devices and instruments. Other suitable ways in which the suture passer described below 100 may be used will be apparent to those skilled in the art in view of the teachings of the present invention.

A. Exemplary suture passer with traction member

[0047] As shown in Figures 5 and 6, an exemplary suture passer 100 includes an outer sheath 110 and an inner needle. The inner needle 130 is substantially enclosed within the outer sheath 110 such that the longitudinal length of the inner needle 130 extends into an orifice 112 of the outer sheath 110. The inner needle 130 comprises a first needle head 132, a shaft longitudinal drive shaft 140 and a driver 142. The longitudinal drive shaft 140 has a longitudinal length that separates the needle head 132, positioned at a distal end of the longitudinal drive shaft 140, from the driver 142, positioned at an opposite proximal end of the longitudinal drive shaft 140. The needle head 132 of the inner needle 130 comprises a proximal notch 133 and a distal notch 136. The outer sheath 110 comprises an orifice 112, a housing 114, a radial wall 115 (see Figure 8) with a distal opening 116 (see Figure 7A), and a proximal opening 118 (see Figure 7A). Orifice 112 has a longitudinal length that separates the distal opening 116 (see Figure 7A) from the housing 114 and the proximal opening 118 (see Figure 7A). The openings 116, 118 (see Figure 7A) are in communication with the orifice 112 and in axial alignment with the longitudinal length of the orifice 112. The inner needle 130 inserts into the outer sheath 110 by directing the needle head 132 into the proximal opening 118 and sliding advancement 130 of the internal needle 112 through the orifice. As further seen in Figure 6, the inner needle 130 further comprises a latch 144 configured to engage a pulling member 120 of the outer sheath 110 and contained within the housing 114.

[0048] As a purely illustrative example, the internal needle 130 is formed from a hardened stainless steel while the features molded into the internal needle 130, particularly the driver 142 and the lock 144, are formed from plastic, such as polycarbonate. Notches 133, 136 are machined into inner needle 130 in the present example, but may alternatively be molded with inner needle 130, such as by injection molding. In another example, the inner needle 130 may be formed from a plastic material and coated metal to provide additional surface hardness similar to stainless steel with a flexural strength similar to aluminum. The inner needle 130 has a diameter smaller than a diameter of the outer sheath 110 so that the inner needle 130 is slidably received within the outer sheath 110. For example, the inner needle 130 has a diameter in the range of approximately 2 mm to approximately 3 mm and the outer sheath 110 has a correspondingly larger diameter with ample clearance, configured to receive a size 2 suture thread 60 in accordance with the United States Pharmacopeia (U.S.P.) designation. Furthermore, the outer sheath 110 is formed from seamless stainless steel tubing. As will be evident to those skilled in the art, the outer sheath 110 and the inner needle 130 may be formed from various other suitable materials that will maintain durability when inserted into a patient's cavity.

[0049] Figures 7A-7B show the suture passer 100 changing, respectively, from a retracted position to an extended position when a physician exerts a distal force on the driver 142. In particular, Figure 7A illustrates the suture passer 100 in the initial retracted position where the inner needle 130 is slidably inserted into the hole 112 of the outer sheath 110. Due to the natural expanded state of the traction member 120 being captured in compression, the suture passer 100 generally remains in the retracted position unless be manipulated toward the extended position by the clinician. While in the retracted position, the needle head 132 of the inner needle 130 is substantially contained within the orifice 112 in the distal opening 116. Furthermore, the proximal notch 133 and the distal notch 136 are entirely covered within the orifice 112 by the outer sheath 110 in the retracted position, and the actuator 142 is fully extended with respect to the proximal opening 118. With the suture passer 100 in the retracted position, the potential for the notches 133, 136 to contact the tissue opening 58 or another portion of the body of the patient in use is reduced since the notches 133, 136 remain covered within the outer sheath 110. The traction member 120 within the housing 114 is similarly in a fully extended state and securely engaged with the latch 144 of the inner needle 130. The latch 144 is configured to movably secure the inner needle 130 to the outer sheath 110 so that the inner needle 130 has limited translational movement so that it does not slide distally out of the outer sheath 110 from the distal opening 116.

[0050] In the present example, the physician holds the suture passer 100 in the compartment 114 to selectively position the needle head 132 in a position adjacent to the suture thread 60 (see Figure 4A) within a patient cavity. When the practitioner exerts a certain force on the actuator 142 to overcome the resilient pull created by the traction member 120, the internal needle 130 slides slidably within the orifice 112 in the distal direction, as seen in Figure 7B. The traction member 120 compresses to a compressed state while the suture passer 100 is in the extended position and the driver 142 is held in a distal position toward the housing 114. As a purely illustrative example, the traction member 120 has a rate spring rates in the range of approximately 2.3 pounds/inch to approximately 2.8 pounds/inch, although other spring rates configured to provide relatively smooth translation of the inner needle 130 within the outer sheath 110 may similarly be used. With the suture passer 100 in the extended position, the needle head 132 of the inner needle 130 extends distally through the distal opening 116 so that the notches 133, 136 extend beyond the hole 112 of the outer sheath 110. In this case, the inner needle 130 and the notches 133, 136 are configured to be physically maneuvered within the tissue opening 58 to capture and subsequently release the suture 60 (see Figure 4A).

[0051] Figure 8 shows the needle head 132 of the inner needle 130 exposed beyond the hole 112 of the outer sheath 110 when the suture passer 100 is in the extended position. In addition to the notches 133, 136, the needle head 132 further comprises a domed pointer 131 geometrically configured to provide the inner needle 130 with a gentle, low-force impact when the inner needle 130 is inserted into the fabric opening 58 (see Figure 4A). . With this blunt tip, the domed pointer (131) is configured to inhibit inadvertent tissue damage during insertion of the suture passer 100 into the patient.

[0052] The proximal notch 133 extends through the inner needle 130 and comprises a proximal capture recess 134 and a release cam surface 135. The proximal capture recess 134 has a hook-shaped surface 139 and is configured to receiving and holding the suture 60 (see Figure 4A) radially inward toward the inner needle 130 when the inner needle 130 is selectively maneuvered to capture the suture 60 see Figure 4A. The proximal surface of the release cam 135 is positioned between the proximal capture recess 134 and an outer radial surface 141 of the inner needle 130. The proximal surface of the release cam 135 extends proximally and radially outwardly from the dome-shaped surface. hook 139 of the proximal capture recess 134 until it is flush with the outer radial surface 141 of the internal needle 130. The proximal surface of the release cam 135 is configured to force the suture 60 see Figure 4A radially outward from the capture 134 to thereby remove the suture 60 see Figure 4A from the proximal notch 133 when the internal needle 130 is selectively maneuvered to release the suture 60 (see Figure 4A).

[0053] Similarly, the distal notch 136 extends through the internal needle 130 and comprises a distal capture recess 137 and a distal release cam surface 138. The distal capture recess 137 has a hook-shaped surface 139 and is configured to receive and hold the suture 60 (see Figure 4A) radially inward toward the inner needle 130 when the inner needle 130 is selectively maneuvered in a capture direction to capture the suture 60 (see Figure 4A ). The distal surface of the release cam 138 is positioned between the distal capture recess 137 and an outer radial surface 141 of the inner needle 130. The distal surface of the release cam 138 extends distally and radially outwardly from the dome-shaped surface. hook 139 of the distal capture recess 137 until it is flush with the outer radial surface 141 of the inner needle 130. The distal surface of the release cam 138 is configured to force the suture 60 (see Figure 4A) radially outward from the distal capture recess 137 to thereby remove the suture thread 60 (see Figure 4A) from the distal notch 136 when the internal needle 130 is selectively maneuvered into a release position to release the suture thread 60 (see Figure 4A).

[0054] As can be seen better in Figure 8, the notches 133, 136 are positioned along the internal needle 130 in different angular positions around a longitudinal geometric axis 129 so that the proximal notch 133 is angularly positioned on the internal needle 130 opposite the distal notch 136. Notwithstanding the relative positioning of the notches 133, 136 with respect to each other along the inner needle 130, the capture recesses 134, 137 are oriented distally on the inner needle 130 relative to the surfaces of the cam. release 135, 138, respectively. Although not shown, it should be understood that the proximal notch 133 and/or the distal notch 136 may be oriented along the inner needle 130 in a position opposite to that shown in Figure 8. In this case, the capture recesses 134, 137 are oriented proximally on the inner needle 130 relative to the release cam surfaces 135, 138, respectively.

[0055] Figure 9 depicts a second needle head 232 of an internal needle 230. The needle head 232 comprises first side notches 233, 236, second side notches 243, 246, and a domed pointer 231. As the domed pointer 131 (see Figure 7A), the domed pointer 231 is geometrically configured to provide the inner needle 230 with a gentle, low-force impact when the inner needle 230 is inserted into the fabric opening 58 (see Figure 4A) to reduce the probability of tissue damage upon insertion of suture passer 100 into the patient. The first side notches 233, 236 extend through the inner needle 230 and are positioned angularly opposite the second side notches 243, 246 about a longitudinal axis 229 of the inner needle 230. Like the notches 133, 136 (see FIG. 7A) of the inner needle 130 (see Figure 7A), the first side notches 233, 236 and the second side notches 243, 246 respectively include capture recesses 234, 237, 244, 247 and release cam surfaces 235 , 238, 245, 248 configured to act in a manner similar to that described above with respect to the capture recesses 134, 137 (see Figure 7A) and the release cam surfaces 135, 138 (see Figure 7A).

[0056] Figures 10 to 11 illustrate a third needle head 332 of an internal needle 330. In the present example, the needle head 332 comprises a plurality of notches 333 along the internal needle 330 and a domed pointer 331. The plurality of notches 333 are angularly positioned along the needle head 332 about a longitudinal geometric axis 329 of the inner needle 330 in a helical arrangement, as indicated by reference numeral 334. Although six notches 333 are shown, it will be apparent to those skilled in the art. technique that a greater or lesser number of notches 333 can be positioned along the needle head 332.

B. Exemplary suture passer with rotation member

[0057] Figure 12 depicts another exemplary suture passer 400 comprising an outer sheath 410 and an inner needle 430 with a fourth needle head 432. The inner needle 430 is substantially enclosed within the outer sheath 410 so that the length longitudinal drive of the inner needle 430 extends into a hole 412 of the outer sheath 410. The inner needle 430 comprises a needle head 432, a longitudinal drive shaft 440, and a driver 442. The longitudinal drive shaft 440 has a longitudinal length which separates the needle head 432, positioned at a distal end of the longitudinal drive shaft 440, from the driver 442, positioned at an opposite proximal end of the longitudinal drive shaft 440. The driver 442 includes a button 446, an external threaded portion 443 , and an engagement mechanism 445. The longitudinal drive shaft 440 further includes an engagement coupling 441 configured to movably secure the internal needle 430 to the driver 442 by mating with the corresponding engagement mechanism 445 of the driver 442.

[0058] The needle head 432 of the inner needle 430 has an upper notch 433 and a lower notch 436 positioned angularly opposed to each other along the inner needle 430. The upper notch 433 comprises a curved upper surface 434 and an upper surface hook-shaped 435. The upper surfaces 434, 435 are positioned longitudinally opposite each other so that the upper surfaces 434, 435 face each other along the inner needle 430. The curved upper surface 434 is positioned distally relative to the hook-shaped upper surface 435. As will be described in more detail below, the curved upper surface 434 is configured to direct the suture 60 (see Figure 14A) toward an upper surface of the release cam 455 ( see Figure 13A) so that the curved upper surface 434 pushes the suture 60 (see Figure 14A) out of the upper notch 433, while the hook-shaped upper surface 435 is configured to capture and hold the suture 60 (see Figure 14A) against an upper capture recess 454 (see Figure 13A). Similarly, the lower notch 436 comprises a hook-shaped lower surface 437 and a curved lower surface 438. The lower surfaces 437, 438 are positioned longitudinally opposite each other so that the lower surfaces 437, 438 face one another. to the other along the inner needle 430. The hook-shaped lower surface 437 is positioned distal to the curved lower surface 438. As will be described in more detail below, the curved lower surface 438 is configured to direct the suture 60 (see Figure 15A) toward a lower surface of the release cam 458 (see Figure 13A) so that the curved lower surface 438 pushes the suture 60 (see Figure 15A) out of the lower notch 436, while the hook-shaped lower surface 437 is configured to capture and hold the suture 60 (see Figure 15A) against a lower capture recess 457 (see Figure 13A). Although not shown, it is to be understood that the needle head 432 may comprise more or fewer notches 433, 436 along the inner needle 430 than that shown.

[0059] The outer sheath 410 comprises an orifice 412, a housing 414, a radial wall 415, and a distal end 416. The Distal end 416 is angled with a cutting edge configured to pierce tissue 17. The orifice 412 is a length longitudinal separating the distal end 416 from the compartment 414, which is positioned at a proximal end thereof. The inner needle 430 is configured to translate slidingly in the orifice 412 of the outer sheath 410 through rotation of the driver 442. In other words, the inner needle 430 and the driver 442 are translatably coupled to the engagement mechanism 445, but decoupled. rotatably so that rotation and translation of the driver 442 will translate only the inner needle 430 without rotating the inner needle 430. For this purpose, the housing 414 includes an inner threaded portion 420 and a slot 422 to allow the inner needle 430 slides slidingly into hole 412.

[0060] The internal threaded portion 420 is configured to engage the external threaded portion 443 of the driver 442 so that clockwise rotation of the driver 442, when viewed from the proximal end, translates the internal needle 430 in a distal direction. In contrast, a counter-rotation of the driver 442 counterclockwise, when viewed from the proximal end, translates the internal needle 430 in a proximal direction. As further seen in Figure 12, the slot 422 extends into the housing 414 and has a longitudinal length parallel to a longitudinal axis 429 of the inner needle 430. The inner needle 430 further comprises a latch 444 that projects laterally from the drive shaft 440 along a portion of the inner needle 430 contained within the housing 414. The latch 444 is configured to engage the slot 422, which is configured to inhibit rotation of the inner needle 430 as well as restrict longitudinal translation 430 of the needle. internal to the longitudinal length of the slit 422.

[0061] As can best be seen in Figures 13A to 13C, the outer sheath 410 additionally includes an upper opening 453 and a lower opening 456 proximal to the end 416. The openings 453, 456 are configured to provide communication between a radial surface In particular, the upper opening 453 is positioned along of the outer sheath 410 to correspond to the upper notch 433 in the needle head 432 and the lower opening 456 is positioned along the outer sheath 410 to correspond to the lower notch 436. The openings 453, 456 extend through the outer sheath 410 and comprise recesses of capture recesses 454, 457 release cam surfaces 455, 458. Capture recesses 454, 457 have a hook-shaped surface 459 and are configured to receive and secure suture 60 (see Figure 14A) radially inwardly in toward the outer sheath 410 when the suture passer 400 is selectively manipulated in a capture direction to capture the suture thread 60.

[0062] The release cam surfaces 455, 458 are positioned, respectively, between the capture recesses 454, 457 and the outer radial surface 451 of the outer sheath 410. The release cam surfaces 455, 458 extend distally and radially outward from the hook-shaped surfaces 459 of the capture recesses 454, 457 until they become flush with the outer radial surface 451 of the outer sheath 410. The release cam surfaces 455, 458 are configured to drive the suture 60 radially outwardly from the capture recesses 454, 457 to thereby remove the suture thread 60 from the notches 433, 436 when the suture passer 400 is selectively maneuvered in a release direction to release the suture thread 60.

[0063] The upper opening 453 is positioned along the outer sheath 410 angularly opposite the lower opening 456 about a longitudinal axis 429 of the outer sheath 410. The upper capture recess 454 is oriented distally over the outer sheath 410 in relative to the upper surface of the release cam 455 so that the lower capture recess 454 is positioned proximal to the distal end 416 and the upper surface of the release cam 455 is positioned distal to the distal end 416. Conversely, the lower capture recess 457 is oriented proximally on the outer sheath 410 relative to the lower surface of the release cam 458 such that the lower capture recess 457 is positioned distal to the distal end 416 and the lower surface of the release cam 458 is positioned proximally to the distal end 416.

[0064] In the present example, suture passer 400 shifts into a series of positions when a clinician rotates driver 442. In particular, rotation of driver 442 slidably advances inner needle 430 into orifice 412 through threaded engagement of inner threaded portion 420 and outer threaded portion 443 to the point where latch 444 meets the confined confines of slot 422. As seen in Figure 13A, driver 442 is rotated until notches 433, 436 are substantially aligned with openings 453, 456. Figure 13B shows inner needle 430 in a distally translated position with notches 433, 436 not substantially aligned with openings 453, 456 but substantially covered by the orifice 412 in a position proximal to the distal end 416. Finally, as seen in Figure 13C, the driver 442 is oppositely rotated until the inner needle 430 is in a proximally translated position with the notches 433, 436 not substantially aligned with the openings 453, 456 but substantially covered by the orifice 412 in a position distal to the distal end 416.

[0065] Figures 14A to 14C illustrate the suture passer 400 that captures and releases the suture 60 within the upper opening 453 and the upper notch 433. In particular, Figure 14A depicts the notches 433, 436 substantially aligned with the openings 453, 456 (in the position previously illustrated in Figure 13A) and the suture 60 releasably secured in the upper capture recess 454 of the upper opening 453. Upon rotation of the driver 442, the internal needle 430 is translated distally within the opening 412 of the outer sheath 410, thereby causing the notches 433, 436 to translate distally. In this example, as seen in Figure 14B, the hook-shaped upper surface 435 of the upper notch 433 securely captures the suture thread 60 against the upper capturing recess 454, thereby preventing the suture thread 60 from sliding out of the reach of the suture threader 400. The physician can then selectively maneuver the suture threader 400, with the suture thread 60 securely attached, to a preferred position for placement. Upon rotation of the actuator 442 in a direction opposite to that depicted in Figure 14B, the upper notch 433 translates proximally and simultaneously releases the suture thread 60 from the upper capture recess 454, as seen in Figure 14C. As the upper notch 433 translates proximally, the curved upper surface 434 directs the suture 60 proximally along the upper surface of the release cam 455 until the suture 60 is freely released from the upper opening 453.

[0066] As seen in Figures 15A to 15C, the suture passer 400 can similarly capture and release the suture 60 within the lower opening 456 and the lower notch 436. However, due to the opposite orientation of the lower opening 456 , and particularly of the lower capture recess 457 and the lower surface of the release cam 458, identical rotations of the driver 442 may generate different interactions between the suture passer 400 and the suture thread 60. For example, upon rotation of the driver 442 in a direction like that depicted in Figure 14B, lower curved surface 438 serves to release the suture thread 60 from the lower capture recess 457, as seen in Figure 15B. In this way, identical rotation of the driver 442 generates an opposite interaction between the suture 60 and the upper notch 433 or the lower notch 436. In this case, the curved lower surface 438 directs the suture 60 distally along the lower surface. of the release cam 458 until the suture 60 is freely released from the lower opening 456. Furthermore, by rotating the actuator 442 in the direction depicted in Figure 14C, wherein the lower notch 436 translates in the proximal direction, the hook-shaped 437 of the upper surface securely 60 Captures suture against capture 457 upper recess, as seen in Figure 15C.

III. Example combinations

[0067] The following examples refer to various non-exhaustive ways in which the teachings of the present invention can be combined or applied. The following examples are not intended to restrict coverage of any embodiments that may be presented at any time in this application or in subsequent filings of this application. No waiver of rights is intended. The following examples are provided for illustrative purposes only. It is contemplated that the various teachings of the present invention may be arranged and applied in various other ways. It is also contemplated that some variations may omit certain features mentioned in the examples below. Therefore, none of the aspects or features mentioned below should be considered to be of critical importance unless otherwise explicitly indicated at a later date, by the inventors or a successor in interest to the inventors. If any embodiments are presented in the present application or in subsequent filings relating to this application that include additional features other than those mentioned below, it should not be assumed that such additional features were added for any reason related to patentability.

Example 1

[0068] A suture passer comprising: (a) a longitudinally extending needle configured to be manipulated between a capture position and a release position; (b) a first suture notch extending through the needle, wherein the first suture notch includes a first capture recess configured to receive a suture therein and releasably capture the suture radially inwardly as the needle is manipulated toward a capture direction; and (c) a second suture notch extending through the needle, wherein the second suture notch includes a second capture recess configured to receive the suture radially inwardly and releasably capture the suture radially inwardly as the needle is manipulated toward a capture direction.

Example 2

[0069] The suture passer of example 1, wherein the first suture notch additionally includes a first release cam surface configured to force the suture radially outwardly from the first capture notch when the needle is manipulated in towards a release direction.

Example 3

[0070] The suture passer of example 2, wherein the needle additionally includes an outer radial surface and the first release cam surface projects between the first capture recess and the outer radial surface of the needle.

Example 4

[0071] The suture passer of example 3, wherein the first lower recess defines a hook-shaped surface within the first suture notch, wherein the first release cam surface extends continuously from the hook-shaped surface to the radial surface external to the needle.

Example 5

[0072] The suture passer of example 4, wherein the first release cam surface extends distally and radially outwardly from the hooked surface to the outer radial surface of the needle.

Example 6

[0073] The suture passer of any one or more of examples 1 to 5, which further comprises a sheath having a longitudinal hole extending therethrough, wherein the longitudinal hole slidably receives the needle so that the needle is configured to move distally within the longitudinal hole relative to the sheath from a retracted position to an extended position.

Example 7

[0074] The suture passer of example 6, wherein the sheath includes a radial wall extending distally to a distal end of the sheath, wherein the radial wall includes a first opening in communication with the longitudinal orifice, and wherein the The first opening is configured to align longitudinally with the first suture notch and thereby expose the first suture notch to capture the suture thread through the first opening.

Example 8

[0075] The suture passer of example 7, in which the distal end of the sheath is configured to pierce a tissue.

Example 9

[0076] The suture passer of any one or more of examples 1 to 8, further comprising a driver operatively connected to the needle and configured to selectively translate the needle longitudinally from the retracted position to the extended position.

Example 10

[0077] The suture passer of example 9, wherein the driver is further configured to selectively rotate the needle from the retracted position to the extended position.

Example 11

[0078] The suture passer of example 9 or 10, wherein the driver further includes a resilient member configured to pull the needle toward the retracted position.

Example 12

[0079] The suture passer of any one or more of Examples 1 to 11, wherein the second suture notch includes a second release cam surface configured to force the suture radially outwardly from the second capture notch when the needle is manipulated toward the direction of release, wherein the needle extends along a longitudinal geometric axis, and wherein the first suture notch is positioned angularly in position to the second suture notch around the axis longitudinal geometric.

Example 13

[0080] The suture passer of example 12, which further comprises a third suture notch extending through the needle, wherein the third suture notch includes a third capture recess configured to receive the suture therein and capture from releasably the suture radially inward as the needle is manipulated toward the capture direction.

Example 14

[0081] The suture passer of example 13, wherein the third suture notch includes a third release cam surface configured to force the suture thread radially outward from the third capture notch when the needle is manipulated toward the release direction, wherein the needle extends along a longitudinal axis, and wherein the first, second, and third suture notches are positioned longitudinally and angularly about the longitudinal axis in a helical arrangement.

Example 15

[0082] The suture passer of any one or more of examples 1 to 14, wherein the distal end of the needle has a convex end extending distally therefrom.

Example 16

[0083] A suture passer comprising: (a) a needle that extends longitudinally along a longitudinal geometric axis and is configured to be manipulated between a capture position and a release position; (b) a first suture notch extending through the needle in a first position about the longitudinal geometric axis, wherein the first suture notch includes: (i) a first capture portion configured to receive a suture in its interior and releasably capture the suture as the needle is manipulated toward the capture direction, and (ii) a first release portion configured to force the suture from the first capture portion as the needle is manipulated toward the release direction; and (c) a second suture notch extending through the needle at a second position about the longitudinal geometric axis, wherein the second suture notch includes: (i) a second capture portion configured to receive a suture thread within it and releasably capture the suture as the needle is manipulated toward the capture direction, and (ii) a second release portion configured to force the suture away from the second capture portion as it is the needle is manipulated toward the release direction, wherein the first position of the first suture notch is different from the second position of the second suture notch;

Example 17

[0084] The suture passer of example 16, in which the first suture notch is positioned angularly opposite the second suture notch around the longitudinal geometric axis.

Example 18

[0085] The suture passer of any one or more of Examples 16 to 17, further comprising a third suture notch extending through the needle at a third position about the longitudinal geometric axis, wherein the third suture notch includes : (i) a third capture portion configured to receive a suture therein and releasably capture the suture as the needle is manipulated toward the capture direction, and (ii) a third portion of release configured to force the suture of the third capture portion as the needle is manipulated toward the release direction, wherein the third position of the third suture notch is different from the first and second positions of the first and second suture notches, respectively.

Example 19

[0086] The suture passer of example 18, wherein the first, second and third suture notches are positioned longitudinally and angularly in the first, second, and third positions around the longitudinal geometric axis in a helical arrangement.

Example 20

[0087] A method of securing a suture on a patient with a suture passer having a needle and a suture notch extending through the needle, wherein the suture notch includes a capture portion and a suture portion. release, wherein the capture portion is configured to receive the suture and releasably capture the suture, and wherein the release portion is configured to force the capture thread from the capture portion, wherein The method comprises: (a) manipulating the needle from a capture position toward a release position; (b) forcing the suture with the cam surface from the capture portion of the suture notch; and (c) releasing the suture from the capture portion of the suture notch.

IV. General considerations

[0088] It should be understood that any one or more of the teachings, expressions, modalities, examples, etc. described herein may be combined with any one or more of the other teachings, expressions, modalities, examples, etc. which are described in the present invention. The teachings, expressions, modalities, examples, etc. described above should therefore not be seen as isolated from each other. Various suitable ways in which the teachings of the present invention may be combined will become readily apparent to those skilled in the art in view of the teachings of the present invention. These modifications and variations are intended to be included in the scope of the attached embodiments.

[0089] It should be understood that any patent, publication or other disclosure material which, in whole or in part, is said to be incorporated herein by reference, is incorporated herein only to the extent that the incorporated material does not enter into in conflict with the definitions, statements or other disclosure materials presented in this release. Accordingly, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated into the present invention by reference. Any material, or portion thereof, that is incorporated herein by reference but which conflicts with existing definitions, statements, or other promotional materials set forth herein is incorporated herein only to the extent that there is no conflict between the incorporated material and existing promotional material.

[0090] Versions of the devices described above may have application in conventional medical treatments and procedures conducted by a medical professional, as well as application in robotic-assisted medical treatments and procedures. By way of example only, various teachings of the present invention can be readily incorporated into a robotic surgical system such as the DAVINCI™ system from Intuitive Surgical, Inc., of Sunnyvale, California, USA. Similarly, those skilled in the art will recognize that various teachings set forth herein can be readily combined with various teachings of: US Patent No. 5,792,135, entitled "Articulated Surgical Instrument For Performing Minimally Invasive Surgery With Enhanced Dexterity and Sensitivity", issued in August 11, 1998, the disclosure of which is incorporated herein by reference; US Patent No. 5,817,084, entitled "Remote Center Positioning Device with Flexible Drive", issued October 6, 1998, the disclosure of which is incorporated herein by reference; US Patent No. 5,878,193, entitled "Automated Endoscope System for Optimal Positioning", issued March 2, 1999, the disclosure of which is incorporated herein by reference; US Patent No. 6,231,565, entitled "Robotic Arm DLUS for Performing Surgical Tasks", issued May 15, 2001, the disclosure of which is incorporated herein by reference; US Patent No. 6,783,524, entitled "Robotic Surgical Tool with Ultrasound Cauterizing and Cutting Instrument", issued August 31, 2004, the disclosure of which is incorporated herein by reference; US Patent No. 6,364,888, entitled "Alignment of Master and Slave in a Minimally Invasive Surgical Apparatus", issued April 2, 2002, the disclosure of which is incorporated herein by reference; US Patent No. 7,524,320, entitled "Mechanical Actuator Interface System for Robotic Surgical Tools", issued April 28, 2009, the disclosure of which is incorporated herein by reference; US Patent No. 7,691,098, entitled "Platform Link Wrist Mechanism", issued April 6, 2010, the disclosure of which is incorporated herein by reference; US Patent No. 7,806,891, entitled "Repositioning and Reorientation of Master/Slave relationship in Minimally Invasive Telesurgery", granted October 5, 2010, the disclosure of which is incorporated herein by reference; US Patent No. 8,844,789, entitled "Automated End Effector Component Reloading System for Use with a Robotic System", issued September 30, 2014, the disclosure of which is incorporated herein by reference; in US Patent No. 8,820,605, entitled "Robotically-Controlled Surgical Instruments", granted September 2, 2014, the disclosure of which is incorporated herein by reference; US Patent No. 8,616,431, entitled "Shiftable Drive Interface for Robotically-Controlled Surgical Tool", issued December 31, 2013, the disclosure of which is incorporated herein by reference; US Patent No. 8,573,461, entitled "Surgical Stapling Instruments with Cam-Driven Staple Deployment Arrangements", issued November 5, 2013, the disclosure of which is incorporated herein by reference; US Patent No. 8,602,288, entitled "Robotically-Controlled Motorized Surgical End Effector System with Rotary Actuated Closure Systems Having Variable Actuation Speeds", issued December 10, 2013, the disclosure of which is incorporated herein by reference; US Patent No. 9,301,759, entitled "Robotically-Controlled Surgical Instrument with Selectively Articulatable End Effector", issued April 5, 2016, the disclosure of which is incorporated herein by reference; US Patent No. 8,783,541, entitled "Robotically-Controlled Surgical End Effector System", issued July 22, 2014, the disclosure of which is incorporated herein by reference; US Patent No. 8,479,969, entitled "Drive Interface for Operably Coupling a Manipulatable Surgical Tool to a Robot," granted July 9, 2013; US patent publication No. 8,800,838, entitled "Robotically-Controlled Cable-Based Surgical End Effectors", granted on June 12, 2014, the disclosure of which is incorporated herein by reference; and/or US Patent No. 8,573,465, entitled "Robotically-Controlled Surgical End Effector System with Rotary Actuated Closure Systems", issued November 5, 2013, the disclosure of which is incorporated herein by reference.

[0091] The teachings set forth in the present invention may be further combined with various teachings from any one or more of the following: U.S. Application No. [Ref. of Attorney END8137USNP], entitled "Needle Guide Instrument with Traverse Suture Capture Feature," filed on the same date as the present application, the disclosure of which is incorporated into the present invention by way of reference. U.S. Application No. [Ref. of Attorney END8139USNP], incorporated by reference above; U.S. Application No. [Ref. of Attorney END8140USNP], incorporated by reference above; U.S. Application No. [Ref. of Attorney END8141USNP], entitled "Suture Passing Instrument with Puncture Site Identification Feature" filed on the same date as this application, the disclosure of which is incorporated into the present invention by reference. U.S. Application No. [Ref. of Attorney END8142USNP], entitled "Exchange Obturator with Transverse Needle Ports" filed on the same date as the present application, the disclosure of which is incorporated into the present invention by way of reference. U.S. Application No. [Ref. of Attorney END8143USNP], entitled "Surgical Port with Wound Closure Channels," filed on the same date as the present application, the disclosure of which is incorporated into the present invention by reference. U.S. Application No. [Ref. of Attorney END8144USNP], entitled "Trocar Obturator with Detachable Rotary Tissue Fastener" filed on the same date as the present application, the disclosure of which is incorporated into the present invention by way of reference. U.S. Application No. [Ref. of Attorney END8153USNP], entitled "Method of Suturing a Trocar Patch Incision", filed on the same date as the present application, the disclosure of which is incorporated into the present invention by way of reference. and/or other patents and patent application publications incorporated herein by reference above.

[0092] Versions of the devices described above may be designed to be discarded after a single use, or may be designed to be used multiple times. Versions may, in either or both cases, be refurbished for reuse after at least one use. Reconditioning may include any combination of the steps of disassembling the device, followed by cleaning or replacing specific parts, and subsequent reassembly. In particular, some versions of the device may be disassembled and any number of parts or parts of the device may be selectively replaced or removed in any combination. By cleaning and/or exchanging specific parts, some versions of the device can be reassembled for subsequent use, either in a reconditioning facility or by a user immediately prior to a surgical procedure. Those skilled in the art will understand that reconditioning a device can use a variety of disassembly, cleaning/exchange and reassembly techniques. The use of these techniques, as well as the resulting refurbished device, are all within the scope of this application.

[0093] Just as an example, the versions described here can be sterilized before and/or after a procedure. In one sterilization technique, the device is placed in a closed, sealed container, such as a plastic or TYVEK bag. The container and device can then be placed in a radiation field, such as gamma radiation, x-rays, or high-energy electrons, which can penetrate the container. Radiation can kill bacteria on the device and container. The sterilized device can then be stored in a sterile container for later use. The device may also be sterilized using any other known technique, including, but not limited to, beta or gamma radiation, ethylene oxide, or water vapor.

[0094] Having shown and described various embodiments of the present invention, other adaptations of the methods and systems described herein can be carried out through suitable modifications by a person skilled in the art without departing from the scope of the present invention. Several of these possible modifications have been mentioned, and others will be apparent to those skilled in the art. For example, the examples, embodiments, geometries, materials, dimensions, proportions, steps and the like discussed above are illustrative and are not mandatory. Accordingly, the scope of the present invention should be considered in terms of the following embodiments, and it should be understood that it is not limited to the structural and functional details shown and described in the specification and drawings.

Claims (12)

1. Suture passer (100, 400), comprising: (a) a needle (62, 130, 230, 330, 430) extending longitudinally and configured to be manipulated between a capture position and a release position; (b) a first suture notch (133, 433) extending through the needle, wherein the first suture notch includes a first capture notch (134) configured to receive a suture therein and releasably capture the suture radially inward as the needle is manipulated toward a capture direction; and (c) a second suture notch (136, 436) extending through the needle, wherein the second suture notch includes a second capture recess (137) configured to receive the suture therein and releasably capture the suture radially inward as the needle is manipulated toward the capture direction; (d) a sheath (110, 410) having a longitudinal hole (112, 412) extending therethrough, characterized in that the longitudinal hole receives the needle in a sliding manner so that the needle is configured to move distally within the longitudinal hole relative to the sheath from a retracted position to an extended position; wherein the sheath further includes an upper opening (453) and a lower opening (456) proximal to an end (416) of the distal sheath, wherein the openings are configured to provide communication between an outer radial surface (451) of the sheath and the hole (412) so that the openings expose the needle head (432) when the needle is slidably inserted into the longitudinal hole (412); and wherein the upper opening is positioned along the sheath (410) to correspond to the first suture notch (433) in the needle head and wherein the lower opening (456) is positioned along the sheath (410) to correspond to the second suture notch (436). 2. The suture passer of claim 1, wherein the openings extend through the sheath and comprise capture recesses (454, 457) and release cam surfaces (455, 458). 3. Suture passer according to claim 2, characterized by the fact that the capture recesses have a hook-shaped surface (459) and are configured to receive and retain suture radially inwardly towards the sheath ( 410) when the suture passer is selectively maneuvered in a capture direction to capture the suture. 4. Suture passer according to any one of claims 1 to 3, characterized in that the first suture notch includes a first release cam surface (135) configured to urge the suture radially outwardly from the first capture recess as the needle is manipulated toward a release direction. 5. Suture passer according to claim 4, characterized by the fact that the needle further includes an external radial surface (141, 451) and the first surface of the release cam projects between the first capture recess and the surface outer radial of the needle. 6. Suture pass according to claim 5, characterized by the fact that the first capture recess defines a hook-shaped surface (139) within the first suture notch, wherein the first release cam surface extends continuously from the hook-shaped surface to the outer radial surface of the needle. 7. The suture passer of claim 6, wherein the first release cam surface extends distally and radially outwardly from the hook-shaped surface to the outer radial surface of the needle. 8. Suture passer according to any one of claims 1 to 7, characterized in that the distal sheath end is configured to pierce a tissue. 9. Suture passer according to any one of claims 1 to 8, characterized in that it further comprises an actuator (142, 442) operatively connected to the needle and configured to selectively translate the needle longitudinally from the retracted position to the extended position ; optionally wherein the driver further includes a resilient member (120) configured to bias the needle toward the retracted position. 10. Suture passer according to any one of claims 1 to 9, characterized in that the second suture notch includes a second release cam surface (138) configured to urge the suture radially outwardly from the second capture recess as the needle is manipulated toward the release direction, wherein the needle extends along a longitudinal axis, and wherein the first suture notch is positioned angularly opposite the second suture notch around of the longitudinal geometric axis. 11. Suture passer according to claim 10, characterized by the fact that it further comprises a third suture notch extending through the needle, wherein the third suture notch includes a third capture recess configured to receive the suture thread. suture therein and releasably capture the suture thread radially inward as the needle is manipulated toward the capture direction; optionally wherein the third suture notch includes a third release cam surface configured to urge the suture radially outward from the third capture notch when the needle is manipulated toward the release direction, wherein the needle extends to the along a longitudinal geometric axis, and wherein first, second and third suture notches are positioned longitudinally and angularly about the longitudinal geometric axis in a helical arrangement. 12. Suture passer according to any one of claims 1 to 11, characterized in that the distal needle end has a convex end extending distally therefrom.