US20120016409A1 - Systems and methods for facilitating closure of bodily openings - Google Patents

Abstract

The present embodiments provide a system for facilitating closure of a bodily opening. In one embodiment, the system comprises an anchor having a deployed state dimensioned for engaging tissue surrounding the opening, a first tether coupled to the anchor and extending proximally therefrom, and a graft member comprising a first bore disposed therein. The anchor may comprise a width that is larger than a width of the opening such that the anchor is disposed securely within or distal to the opening. The first tether is dimensioned to be disposed through the first bore in the graft member, such that the graft member is advanced distally over the first tether. The graft member then may be secured to the anchor. Various anchor designs are provided along with a supporting framework that may be coupled to the graft member.

Description

PRIORITY CLAIM
• This invention claims the benefit of priority of U.S. Provisional Application Ser. No. 61/343,435, entitled “Hernia Repair Device, Deployment Device And Technique For The Repair Of Hernias,” filed Apr. 29, 2010, as well as U.S. Provisional Application Ser. No. 61/379,243, entitled “Systems and Methods for Facilitating Closure of Bodily Openings,” filed Sep. 1, 2010, both of which are hereby incorporated by reference in their entireties.
BACKGROUND
• The present embodiments relate generally to medical devices, and more particularly, to systems and methods for closure of bodily openings.
• Perforations in tissue or bodily walls may be formed intentionally or unintentionally. For example, an unintentional abdominal hernia may be formed in the abdominal wall due to heavy lifting, coughing, strain imposed during a bowel movement or urination, fluid in the abdominal cavity, or other reasons. Intentional perforations may be formed, for example, during surgical procedures such as translumenal procedures. In a translumenal procedure, one or more instruments, such as an endoscope, may be inserted through a visceral wall, such as the stomach wall. During a translumenal procedure, a closure instrument may be used to close the perforation in the visceral wall. Depending on the structure comprising the perforation, it may be difficult to adequately close the perforation and prevent leakage of bodily fluids.
• Attempts to seal perforations have been attempted by coupling a graft member to tissue. For example, during hernia repair, a graft material such as a mesh or patch may be disposed to cover the perforation. The graft material may completely overlap with the perforation, and the edges of the graft material may at least partially overlap with tissue surrounding the perforation. The graft material then may be secured to the surrounding tissue in an attempt to effectively cover and seal the perforation.
• In order to secure the graft material to the surrounding tissue, sutures commonly are manually threaded through the full thickness of the surrounding tissue. In the case of an abdominal hernia, the sutures may be threaded through the thickness of the abdominal wall, then tied down and knotted. However, such manual suturing techniques may be time consuming and/or difficult to perform.
• There is also a hernia repair method commonly referred to as a “mesh plug” or “plug and patch” repair technique, in which a surgeon uses a mesh plug to fill the perforation. Potential advantages include fewer sutures and less tissue dissection. However, a mesh plug alone may not effectively cover the entire area of the perforation, or alternatively, the mesh plug may shrink, become loose, or poke into the bladder or intestines.
SUMMARY
• The present embodiments provide a system for facilitating closure of a bodily opening. In one embodiment, the system comprises an anchor having a deployed state dimensioned for engaging tissue surrounding the opening, a first tether coupled to the anchor and extending proximally therefrom, and a graft member comprising a first bore disposed therein. The anchor may comprise a width that is larger than a width of the opening such that the anchor is disposed securely within or distal to the opening. The first tether is dimensioned to be disposed through the first bore in the graft member, such that the graft member can be advanced distally over the first tether. The graft member then may be secured to the anchor.
• In one embodiment, the anchor comprises a plug of material including a plurality of filaments. The plug of material may comprise a diamond shape in a pre-deployment state, and a deployed state having an increased width relative to the pre-deployment state. In an alternative embodiment, the anchor comprises a plurality of deployable members that are biased radially outward in the deployed state.
• In other embodiments, the system may further comprise a supporting framework coupled to the graft member, wherein the supporting framework comprises a plurality of deployable members. The supporting framework may comprise a plurality of eyelets, and the graft member may be sutured to the supporting framework around at least one of the eyelets.
• The system may comprise a second tether coupled to the anchor, where the first tether is disposed through the first bore in the graft member and the second tether is disposed through a second bore in the graft member. The graft member may be advanced over the first and second tethers toward the anchor, and the first and second tethers are tied together to secure the graft member to the anchor.
• Advantageously, an enhanced anchor and graft member attachment may be achieved to better treat the opening. For example, the anchor is capable of expanding to securely engage the opening. Additionally, the expanded anchor is secured to the graft member in a manner that may reduce the rate of migration of the anchor.
• Other systems, methods, features and advantages of the invention will be, or will become, apparent to one with skill in the art upon examination of the following figures and detailed description. It is intended that all such additional systems, methods, features and advantages be within the scope of the invention, and be encompassed by the following claims.
BRIEF DESCRIPTION OF THE DRAWINGS
• The invention can be better understood with reference to the following drawings and description. The components in the figures are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the invention. Moreover, in the figures, like referenced numerals designate corresponding parts throughout the different views.
• FIGS. 1-5 are side-sectional views illustrating exemplary method steps that may be used to facilitate closure of an opening using a system according to a first embodiment comprising an anchor and a graft member.
• FIG. 6 is an elevated perspective view of an alternative anchor.
• FIG. 7 is a top view illustrating use of the alternative anchor ofFIG. 6.
• FIG. 8 is top view of a further alternative anchor.
• FIG. 9 is a top view illustrating use of the alternative anchor ofFIG. 8.
• FIG. 10 is bottom view of a graft member and a supporting framework.
• FIG. 11 is a top view illustrating use of the graft member and the supporting framework ofFIG. 10.
• FIGS. 12-13 illustrate an alternative anchor in two different states.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
• In the present application, the term “proximal” refers to a direction that is generally towards a physician during a medical procedure, while the term “distal” refers to a direction that is generally towards a target site within a patent's anatomy during a medical procedure. Thus, “proximal” and “distal” portions of a device or bodily region may depend on the point of entry for the procedure (e.g., percutaneously versus laparoscopically or endoscopically).
• Referring now toFIGS. 1-5, systems and methods are described for facilitating closure of a bodily opening according to a first embodiment. The system comprises ananchor20, which has pre-deployment and deployed states. In the pre-deployment state, theanchor20 comprises a generally diamond shape having aproximal region22, adistal region24, andside regions26 and28, and further comprising a height h and a width w, as shown inFIG. 1. In this example, theanchor20 may be formed of a plug of material, such as a plurality offilaments21 that are woven together in a manner that allows compression of the filaments with respect to each other when a sufficient force is applied. In one embodiment, in the pre-deployment state the height h between the proximal anddistal regions22 and24 may be about the same or greater than the width w between theside regions26 and28. Preferably, the width w of theanchor20 in the pre-deployment state is greater than a width w_oof anopening75 formed intissue74. As will be explained further below, by oversizing the width w of theanchor20 relative to the width w_oof theopening75, theanchor20 may be frictionally held in place within theopening75. Moreover, the width w of theanchor20 may be further increased in the deployed state using anactuator40, as explained further inFIG. 3 below, to further enhance the frictional engagement with thetissue74 surrounding theopening75.
• Theanchor20 can be fashioned from absorbable and non-absorbable mesh or biologic implant with or without spars of absorbable or non-absorbable material to help it retain its shape and anchorage. The mesh can be shaped like an umbrella or diamond. The deployed expanded shape can be maintained with suture material or a locking mechanism or through the inherent shape and orientation of the spars. In addition, theanchor20 can be fashioned out of absorbable or non-absorbable spars or a metallic material (e.g., nitinol, stainless steel etc.) shaped as an umbrella, diamond or any shape that expands in diameter after deployment which can be deformed and compressed when placed into the deployment instrument and will then return to its expanded shape after deployment in the defect. In addition, legs of theanchor20 can have small hooks or tines at the ends to catch on the surrounding tissue. The anchor can be made in multiple sizes for different depth and/or diameter defects.
• The system further comprises afirst tether30 coupled to theanchor20 and extending proximally therefrom, as shown inFIGS. 1-5. Thefirst tether30 is sized to be disposed through afirst bore81 in agraft member80, thereby enabling distal advancement of thegraft member80 over thefirst tether30 towards theanchor20 after theanchor20 has been deployed within theopening75, as explained further inFIGS. 4-5 below. Optionally, asecond tether32 similarly may be coupled to theanchor20, and disposed through asecond bore82 in thegraft member80. After distal advancement of thegraft member80 over the first andsecond tethers30 and32 toward theanchor20, the first andsecond tethers30 and32 may be tied, thereby securing thegraft member80 in place relative to theanchor20, as explained further inFIG. 5 below. In one example, the first andsecond tethers30 and32 each comprise monofilament sutures, though they can comprise single fibers or woven fibers, may be biodegradable, and have other suitable characteristics to perform the functions herein.
• Optionally, the system may comprise anactuator40 for laterally expanding theanchor20 between the pre-deployment and the deployed states. In one example, theactuator40 comprises asuture42 having a distal region comprising aloop member44, which may extend around thedistal region24 of theanchor20 as shown inFIG. 1. Theloop member44 is coupled to a tensioningmember46 that is disposed adjacent to theproximal region22 of theanchor20. In use, the tensioningmember46 may be advanced distally over thesuture42 to reduce the overall diameter of theloop member44, thereby moving theproximal region22 towards thedistal region24 to reduce the height h, while increasing the width w between theside regions26 and28, as explained further inFIG. 3 below.
• In the example shown, theopening75 is a hernia located in thetissue74 of the abdominal wall. While treatment of a hernia is shown for illustrative purposes, it will be apparent that the systems described herein may be used in a wide range of medical procedures, including but not limited to any exemplary procedures described herein.
• The initial stages of the hernia repair may be performed using various techniques, for example, an open technique, a laraposcopic technique, an endoscopic technique, or a percutaneous technique. In an open technique, an incision may be made in the abdominal wall and the hernia may be repaired using generally known principles.
• In a laparoscopic technique, two or three smaller incisions may be made to access the hernia site. A laparoscope may be inserted into one incision, and surgical instruments may be inserted into the other incision(s) and the hernia may be repaired in a similar fashion as the open procedure.
• In an endoscopic technique, an endoscope is used instead of the laparoscopic devices, and no visible incisions may be made on the skin of the patient. In particular, the endoscope may be advanced through a bodily lumen such as the alimentary canal, with an access hole being created through the alimentary canal, to obtain peritoneal access to the hernia. One or more components, such as an insertion tool, may be advanced through a working lumen of the endoscope. The distal end of the insertion tool may be viewed via optical elements of the endoscope, which may comprise fiber optic components for illuminating and capturing an image distal to the endoscope.
• The percutaneous approach is similar to the laparoscopic approach, however, in the percutaneous approach an insertion tool may be advanced directly through a patient's abdominal skin. In particular, with the components loaded, the insertion tool is advanced directly through the abdominal skin, through the tissue, and may be advanced just distal to the opening and into the peritoneum. In order to optimally visualize the insertion tool, a laparoscopic viewing device may be positioned in the peritoneum, or an endoscope may be translumenally advanced in proximity to the target site, as noted above. Alternatively, the insertion tool and markers disposed thereon may be viewed using fluoroscopy of other suitable techniques.
• After gaining access to theopening75 using any of the above-referenced techniques, aninsertion tool70, such as a catheter or a needle, may be used to delivery one or more of the components of the system. If a needle is used, it may be an endoscopic ultrasound (EUS) or echogenic needle, such as the EchoTip® Ultrasound Needle, or the EchoTip® Ultra Endoscopic Ultrasound Needle, both manufactured by Cook Endoscopy of Winston-Salem, N.C.
• Theanchor20 is disposed within a lumen of theinsertion tool70, as illustrated in the dasheddelivery state20′ of the anchor, shown inFIG. 1. The anchor may be advanced within the lumen of theinsertion tool70, e.g., using a stylet, and then is ejected from a distal end of theinsertion tool70. Theanchor20 assumes its pre-deployment state, as shown inFIG. 1. At this time, the first andsecond tethers30 and32, along with thesuture42 of theactuator40, each extend proximally through the lumen of theinsertion tool70 for manipulation by a physician.
• Referring toFIG. 2, theanchor20 is advanced distally by a suitable device, such as a pusher tube, insertion tool, forceps or other grasping instrument. Theanchor20 is positioned within theopening75, as shown inFIG. 2. Advantageously, theanchor20 is diamond-shaped in the pre-deployment state, such that thedistal region24 is tapered to facilitate entry into theopening75. Since the width w of theanchor20 preferably is greater than the width w_oof theopening75 in the pre-deployment state, a force may be applied, e.g., using the pusher tube, insertion tool, forceps or other grasping instrument, to urge theanchor20 in place so that at least theside regions26 and28 securely engage thetissue74 surrounding theopening75, as shown inFIG. 2. Alternatively, theanchor20 may be deployed distal to theopening75, in which case the anchor can assume a diameter larger than theopening75 and provide anchoring functionality just distal to thetissue74 with the same method steps otherwise being performed as shown herein.
• Referring toFIG. 3, in a next step theactuator40 is actuated to laterally expand theanchor20, thereby further securing theanchor20 within theopening75 and/or distal to theopening75. In particular, the tensioningmember46 is advanced distally over thesuture42 to reduce the overall diameter of theloop member44, thereby moving theproximal region22 towards thedistal region24 to reduce the height h, while increasing the width w between theside regions26 and28 of theanchor20 to enhance a secure fit between theside regions26 and28 of theanchor20 and thetissue74 surrounding theopening75. An increased width w of theanchor20 in the deployed state ofFIG. 3 may provide an increased frictional engagement with tissue disposed within theopening75.
• Preferably, the tensioningmember46 comprises a one-way movement feature, such as a cinching or ratcheting mechanism, to prevent proximal movement of the tensioningmember46 relative to theanchor20 after deployment. Alternatively, the tensioningmember46 may comprise a rubber disc or beaded member, which may frictionally engage an exterior surface of thesuture42, but may be advanced distally over thesuture40 with a suitable external force. After actuating theactuator40, thesuture42 may be cut by a suitable device, such as laparoscopic scissors, leaving theanchor40 in place as shown inFIG. 3.
• Referring toFIGS. 4-5, in a next step thegraft member80 may be advanced distally over the first andsecond tethers30 and32 towards theanchor20. Properties ofsuitable graft members80 are described in detail below. Thegraft member80 comprises first andsecond bores81 and82, as noted above, which are sized to permit advancement of thegraft member80 over the first andsecond tethers30 and32, respectively.
• In use, proximal ends of the first andsecond tethers30 and32 are disposed through the first andsecond bores81 and82 of thegraft member80 outside of the patient, and thegraft member80 is advanced distally relative to the first andsecond tethers30 and32. Thegraft member80 may be delivered through theinsertion tool70, as depicted by the dashed lines of agraft member80′ in the delivery state inFIG. 4. Alternatively, thegraft member80 may be delivered directly through a trocar, e.g., a 5 mm trocar. When ejected from theinsertion tool70 or the trocar, thegraft member80 then is positioned in place relative to thetissue74 using a suitable grasping device, or a pusher tube or theinsertion tool70 itself, such that thegraft member80 is adjacent to thetissue74 and covering theopening75, as shown inFIG. 4.
• In a next step, a suture tying device may be used to tie the first andsecond tethers30 and32 together in a manner that secures thegraft member80 adjacent to thetissue74 and theanchor20. By way of example, and without limitation, one suitable suture tying device is disclosed in U.S. patent application Ser. No. 12/125,525, filed May 22, 2008, the disclosure of which is hereby incorporated by reference in its entirety. Another suitable suture tying device is disclosed in U.S. patent application Ser. No. 12/191,001, filed Aug. 13, 2008, the disclosure of which is hereby incorporated by reference in its entirety. Upon completion of the tying procedure, the first andsecond tethers30 and32 may be cut by a suitable device, such as laparoscopic scissors, leaving theanchor40 and thegraft member80 in place as shown inFIG. 5.
• Advantageously, using theanchor20, the first andsecond tethers30 and32, and thegraft member80 in combination, along with the techniques described, an enhanced anchor and graft member attachment may be achieved to comprehensively treat theopening75. In this example, theanchor20 is capable of expanding to fill theopening75, potentially resulting in better tissue ingrowth and lower rates of recurrence. Moreover, theanchor20 is secured within theopening75 in an expanded, secure manner that may reduce anchor migration. Further, the coupling of theanchor20 to thegraft member80 provides an enhanced seal relative to a plug alone, and the secure attachment of theanchor20 to thegraft member80 may further reduce the rate of migration of theanchor20.
• Thegraft member80 may comprise any suitable material for covering theopening75 and substantially or entirely inhibiting the protrusion of abdominal matter. In one embodiment, thegraft member80 may comprise small intestinal submucosa (SIS), such as BIODESIGN® SURGISIS® Tissue Graft, available from Cook Biotech, Inc., West Lafayette, Ind., which provides smart tissue remodeling through its three-dimensional extracellular matrix (ECM) that is colonized by host tissue cells and blood vessels, and provides a scaffold for connective and epithelial tissue growth and differentiation along with the ECM components. Thegraft member80 may be lyophilized, or may comprise a vacuum pressed graft that is not lyophilized. In one example, thegraft member80 would be a one to four layer lyophilized soft tissue graft made from any number of tissue engineered products. Reconstituted or naturally-derived collagenous materials can be used, and such materials that are at least bioresorbable will provide an advantage, with materials that are bioremodelable and promote cellular invasion and ingrowth providing particular advantage. Suitable bioremodelable materials can be provided by collagenous ECMs possessing biotropic properties, including in certain forms angiogenic collagenous extracellular matrix materials. For example, suitable collagenous materials include ECMs such as submucosa, renal capsule membrane, dermal collagen, dura mater, pericardium, fascia lata, serosa, peritoneum or basement membrane layers, including liver basement membrane. Suitable submucosa materials for these purposes include, for instance, intestinal submucosa, including small intestinal submucosa, stomach submucosa, urinary bladder submucosa, and uterine submucosa. Thegraft member80 may also comprise a composite of a biomaterial and a biodegradeable polymer. Additional details may be found in U.S. Pat. No. 6,206,931 to Cook et al., the disclosure of which is incorporated herein by reference in its entirety.
• Referring now toFIGS. 6-7, analternative anchor120 is shown and described. Theanchor120 comprises a plurality of deployable members122a-122d, each having aproximal end123 and adistal end124. One ormore barbs155 may be provided on one or multiple deployable members122a-122d, and in the example ofFIG. 6, asingle barb155 is formed near the distal ends123 of each deployable member122a-122d. The plurality of deployable members122a-122dextend distally from a retainingmember130. One or more tethers, such as first andsecond tethers30 and32 ofFIGS. 1-5, may be coupled to theanchor120, e.g., directly around the retainingmember130 or attached to aneyelet134 at the proximal end of theanchor120.
• In addition to the expanded deployed state shown inFIG. 6, theanchor120 comprises a delivery state in which theanchor120 may be delivered through asuitable insertion tool170, such as a catheter or needle, as described above. As noted above, in the delivery state the plurality of deployable members122a-122dare generally parallel to one another, with the distal ends124 being closer together and facing distally within theinsertion tool170.
• In a preferred embodiment, each of the plurality of deployable members122a-122dtheanchor20 comprises a shape-memory material, such as a nickel-titanium alloy (nitinol). If a shape-memory material such as nitinol is employed, the plurality of deployable members122a-122dmay be manufactured such that they can assume the preconfigured expanded state shown inFIG. 6 upon application of a certain cold or hot medium. More specifically, a shape-memory material may undergo a substantially reversible phase transformation that allows it to “remember” and return to a previous shape or configuration. For example, in the case of nitinol, a transformation between an austenitic phase and a martensitic phase may occur by cooling and/or heating (shape memory effect) or by isothermally applying and/or removing stress (superelastic effect). Austenite is characteristically the stronger phase and martensite is the more easily deformable phase.
• In an example of the shape-memory effect, a nickel-titanium alloy having an initial configuration in the austenitic phase may be cooled below a transformation temperature (M_f) to the martensitic phase and then deformed to a second configuration. Upon heating to another transformation temperature (A_f), the material may spontaneously return to its initial, predetermined configuration, as shown inFIG. 6. Generally, the memory effect is one-way, which means that the spontaneous change from one configuration to another occurs only upon heating. However, it is possible to obtain a two-way shape memory effect, in which a shape memory material spontaneously changes shape upon cooling as well as upon heating.
• Alternatively, the plurality of deployable members122a-122dmay be made from other metals and alloys that are biased, such that they may be restrained prior to deployment, but are inclined to return to their relaxed, expanded configuration upon deployment. Solely by way of example, the plurality of deployable members122a-122dmay comprise other materials such as stainless steel, cobalt-chrome alloys, amorphous metals, tantalum, platinum, gold and titanium, or may be made from non-metallic materials, such as thermoplastics and other polymers.
• Theanchor120 is disposed within alumen172 of theinsertion tool170 in the delivery state, i.e., with the plurality of deployable members122a-122dbeing generally parallel to one another. In the delivery state, the distal ends124 of each of the plurality of deployable members122a-122dare positioned proximal to the distal end of theinsertion tool170. In the delivery state, the plurality of deployable members122a-122dare generally parallel to one another, with the distal ends124 being closer together. Moreover, the distal ends124 of theanchor120 preferably face distally within theinsertion tool170 in the delivery state.
• In use, theinsertion tool170 is positioned such that its distal end is within theopening75. In this embodiment, the distal tip of theinsertion tool170 must be inserted within theopening75 to properly deploy the self-expandinganchor120 therein. Optionally, theinsertion tool170 may comprise a flexible distal tip feature, such as a spring coil that may be flexed by retracting a stylet coupled to it, to maneuver the distal tip of theinsertion tool170 into an angle suitable for insertion into theopening75.
• After positioning of theinsertion tool170, theanchor120 and theinsertion tool170 are translated relative to one another to eject theanchor120 from theinsertion tool170. A suitable device, such as a stylet, torque cable or spring coil, may be disposed for longitudinal movement within thelumen172 of theinsertion tool170 to permit translation of theanchor120 relative to theinsertion tool170. Optionally, the retainingmember130 may comprise anotch132 or other feature for engaging the stylet, torque cable or spring coil within thelumen172 prior to ejection of theanchor120.
• Upon ejection from theinsertion tool170, the plurality of deployable members122a-122dassume the expanded deployed shape, in which each deployable member122a-122dengages thetissue74 surrounding theopening75, as shown inFIG. 7. The plurality of deployable members122a-122dare oversized relative to theopening75 to ensure a secure engagement with thetissue74. In particular, an overall width of theanchor120 in the expanded state, measured as the longitudinal distance between thedistal end124 of thedeployable member122aand thedistal end124 of the opposingdeployable member122c, is greater than the width w_oof theopening75. Moreover, thebarbs155 on each of the deployable members122a-122dmay promote a secure attachment to thetissue74.
• With theanchor120 deployed securely within theopening75, in a next step thegraft member80 is advanced distally over the first andsecond tethers30 and32 towards theanchor120, as generally described above inFIGS. 4-5. A suture tying device may be used to tie the first andsecond tethers30 and32 together in a manner that holds thegraft member80 adjacent to thetissue74 and theanchor120, as explained above. Upon completion of the tying procedure, the first andsecond tethers30 and32 may be cut off, leaving theanchor120 and thegraft member80 in place. Notably, in the embodiment ofFIGS. 6-7, theanchor120 does not plug theentire opening75, but rather is intended to provide a secure anchor into thetissue74 that may be used in conjunction with thegraft member80. Since the deployable members122a-122dare oversized relative to theopening75, anchor migration may be reduced.
• Referring now toFIGS. 8-9, a furtheralternative anchor220 is shown and described. Theanchor220 comprises a plurality of deployable members222a-222d, each having aproximal end223 and adistal end224. Theanchor220 may be formed of asingle wire221, or a plurality of wires, that are bent in the configuration shown inFIG. 8, whereby the plurality of deployable members222a-222dextend distally from acentral portion230. Notably, each of the distal ends224 of the plurality of deployable members222a-222dcomprises generally curved apices. Further, each of the distal ends224 of the plurality of deployable members222a-222dmay comprise anoverlap region225 where the wire crosses over itself, as shown inFIG. 8. One or more tethers, such as first andsecond tethers30 and32 ofFIGS. 1-5, may be coupled to theanchor220, preferably tied around thecentral portion230 of thewire221.
• In addition to the expanded deployed state shown inFIG. 8, theanchor220 comprises a delivery state in which theanchor220 may be delivered through theinsertion tool170 described inFIG. 6 above. In the delivery state, the plurality of deployable members222a-222dare generally parallel to one another, with the distal ends224 being closer together. Moreover, the distal ends224 of theanchor220 preferably face distally within theinsertion tool170 in the delivery state. In a preferred embodiment, each of the plurality of deployable members222a-222dof theanchor220 comprises a shape-memory material, such as a nickel-titanium alloy (nitinol), or alternatively other metals and alloys that are biased, such that they may be restrained prior to deployment, but are inclined to return to their relaxed, expanded configuration upon deployment.
• In use, theinsertion tool170 is positioned such that its distal end is within theopening75, as described above. Theanchor220 is disposed within thelumen172 of theinsertion tool170 in the delivery state, with the plurality of deployable members222a-222dbeing generally parallel to one another, and the distal ends224 of each of the plurality of deployable members222a-222dproximal to the distal end of theinsertion tool170. Then, theinsertion tool170 and theanchor220 are translated relative to one another to eject theanchor220 from the insertion tool.
• Upon ejection from theinsertion tool170, the plurality of deployable members222a-222dassume the expanded deployed shape, in which each deployable member222a-222dengages thetissue74 surrounding theopening75, as shown inFIG. 9. The plurality of deployable members222a-222dare oversized relative to theopening75 to ensure a secure engagement with thetissue74. In particular, an overall width of theanchor220 in the expanded state, measured as the longitudinal distance between thedistal end224 of thedeployable member222aand thedistal end224 of the opposingdeployable member222c, is greater than the width w_oof theopening75.
• With theanchor220 deployed securely within theopening75, in a next step thegraft member80 is advanced distally over the first andsecond tethers30 and32 towards theanchor220, as generally described above inFIGS. 4-5 andFIGS. 5-6 above, and a suture tying device may be used to tie the first andsecond tethers30 and32 together in a manner that holds thegraft member80 adjacent to thetissue74 and theanchor220. Like the embodiment ofFIGS. 6-7, theanchor220 does not plug theentire opening75, but rather is intended to provide a secure anchor into thetissue74 that may be used in conjunction with thegraft member80.
• Referring now toFIGS. 10-11, a supportingframework350, which may be coupled to thegraft member80, is shown and described. The supportingframework350 comprises a plurality of deployable members352a-352d, each having a proximal end with first andsecond segments353aand353b, and adistal end354. The supportingframework350 may be formed of asingle wire351, or a plurality of wires, that are bent in the configuration shown inFIG. 10, whereby the plurality of deployable members352a-352dextend distally from acentral portion365. Notably, each of the distal ends354 comprises aneyelet357, which may be formed where thewire351 loops over itself. Additionally, aneyelet363 may be formed in a region where thedeployable member352atransitions into thedeployable member352d, as shown inFIG. 10. Thegraft member80 is coupled to the supportingframework350 usingsutures359, which preferably are looped around each of theeyelets357 of the deployable members352a-352d, as well as theeyelet363.
• In addition to the expanded deployed state shown inFIG. 10, the supportingframework350 comprises a delivery state, in which the supportingframework350 may be delivered through theinsertion tool170 as described above, or alternatively, directly though a trocar. In the delivery state, the plurality of deployable members352a-352dare generally parallel to one another. In a preferred embodiment, each of the plurality of deployable members352a-352dcomprises a shape-memory material, such as a nickel-titanium alloy (nitinol), or alternatively other metals and alloys that are biased, such that they may be restrained prior to deployment, but are inclined to return to their relaxed, expanded configuration upon deployment, as described above.
• In use, one of theanchors20,120 or220 is positioned and deployed securely within theopening75, as described in detail above. The first andsecond tethers32 and34 extend away from the anchor that is deployed within theopening75. Thegraft member80 comprises first andsecond bores381 and382, which permit advancement of thegraft member80 over the first andsecond tethers30 and32, as described above.
• Thegraft member80 is advanced over the first andsecond tethers30 and32 with each of the plurality of deployable members352a-352dof the supportingframework350 in the compressed delivery state. The plurality of deployable members352a-352dare generally parallel to one another, preferably with the distal ends354 of each of the plurality of deployable members352a-352dfacing proximally. Then, the selectedanchor20,120 or220 is ejected from the insertion tool, allowing the plurality of deployable members352a-352dto assume the expanded deployed shape, as shown inFIG. 11. The plurality of deployable members352a-352dare sized such that an overall width of the supportingframework350 in the expanded state, measured as the longitudinal distance between thedistal end354 of thedeployable member352aand thedistal end354 of the opposingdeployable member352c, is about 2-4 times greater than the diameter of theopening75, thereby ensuring that thegraft member80 sufficiently covers theopening75. After deployment and positioning of thegraft member80, a suture tying device may be used to tie the first andsecond tethers30 and32 together in a manner that holds thegraft member80 adjacent to thetissue74 and the selectedanchor20,120 or220.
• Referring now toFIGS. 12-13, analternative anchor420 is shown and described. Theanchor420 comprises a plurality of deployable members422a-422d, each having aproximal end423 and adistal end424. The distal ends424 of the plurality of deployable members422a-422dmay be joined at abase428. One or more tethers, such as first andsecond tethers30 and32 ofFIGS. 1-5 (illustrated as onetether430 inFIG. 12) may be coupled to theanchor420, e.g., attached to thebase428 and extending proximally therefrom.
• Theanchor420 comprises a delivery state in which theanchor420 may be delivered through a suitable insertion tool, as generally described above with regard to the embodiment ofFIGS. 6-7. Theanchor420, when deployed from the insertion tool, may assume the configuration shown inFIG. 12. In a next step, an expansion member, such asexemplary balloon450, may be used to radially expand the plurality of deployable members422a-422dinto engagement withtissue74 surrounding theopening75. The plurality of deployable members422a-422dthen assume an expanded deployed state as shown inFIG. 13, where the plurality of deployable members422a-422dsecurely engage tissue.Barbs455 may be provided near each of the proximal ends423, as shown inFIGS. 12-13, to promote a secure attachment. In subsequent steps, with theanchor420 deployed securely within theopening75, thegraft member80 above is advanced distally over the tethers towards theanchor420, as generally described above with regard to the method ofFIGS. 4-5 andFIGS. 6-7.
• In any of the above-referenced embodiments, the anchors and/or supporting frameworks may comprise a bioresorbable material, such as L-lactide/caprolactone copolymers-PLC 8516 (85/15 L-Lactide/caprolactone) as well as PLC 7015 (70/30 L-Lactide/caprolactone), which are supplied by Purac Biomaterials, Gorinchem, Netherlands. Other potential bioresorbable polymers include PLGA, PLA, PGA, PLLA, and the like. Alternatively, the anchors and supporting frameworks may comprise non-resorbable materials, including but not limited to materials disclosed herein. Similarly, thegraft member80 may comprise a material that can be integrated with the surrounding tissue. In further alternatives, thegraft member80 may comprise an adhesion barrier to facilitate coupling to tissue. In a further embodiment, a magnetic arrangement may be used, with one magnet coupled to thegraft member80 and an opposing magnet coupled to the anchor to hold thegraft member80 and the anchor in proximity to each other.
• Moreover, as noted above with regard to theanchor20, any of the anchors described herein may be deployed distal to theopening75, in which case the anchors can assume a diameter larger than theopening75 and provide anchoring functionality just distal to thetissue74 with the same method steps otherwise being performed as shown herein. Alternatively, an anchor may be disposed at least partially within theopening75 and simultaneously at least partially distal to theopening75 in any of the embodiments shown.
• While the exemplary embodiments herein have illustrated the use of one or more systems for covering anopening75 formed in the abdominal wall, the systems disclosed herein may be useful in many other procedures. Solely by way of example, the systems may be used to treat perforations in a visceral wall, such as the stomach wall. Further, thesystems20 may be used to secure a graft member to tissue for reconstructing local tissue, and the like.
• While various embodiments of the invention have been described, the invention is not to be restricted except in light of the attached claims and their equivalents. Moreover, the advantages described herein are not necessarily the only advantages of the invention and it is not necessarily expected that every embodiment of the invention will achieve all of the advantages described.

Claims (20)

1. A system for facilitating closure of a bodily opening, the system comprising:

an anchor having a deployed state dimensioned for engaging tissue surrounding the opening;

a first tether coupled to the anchor and extending proximally from the anchor; and

a graft member comprising a first bore disposed therein,

wherein the first tether is dimensioned to be disposed through the first bore in the graft member such that the graft member is advanced distally over the first tether after deployment of the anchor within or distal to the opening.

2. The system ofclaim 1 wherein the anchor comprises a width that is larger than a width of the opening to frictionally engage the anchor within the opening.

3. The system ofclaim 1 wherein the anchor comprises a plug of material including a plurality of filaments.

4. The system ofclaim 1 wherein the anchor comprises a plug of material comprising a pre-deployment state having a diamond shape.

5. The system ofclaim 4 further comprising an actuator coupled to the plug of material, wherein the actuator moves the plug of material from the pre-deployment state to the deployed state, and wherein actuator comprises a loop member configured to reduce a height of the plug of material while increasing a width of the plug of material in the deployed state.

6. The system ofclaim 1 wherein the anchor comprises a plurality of deployable members that are biased radially outward in the deployed state.

7. The system ofclaim 6 where the anchor comprises a width in the deployed state, defined by a distance between distal ends of opposing deployable members, wherein the width of the anchor in the deployed state is greater than a width of the opening.

8. The system ofclaim 1 further comprising a supporting framework coupled to the graft member, wherein the supporting framework comprises a plurality of deployable members.

9. The system ofclaim 8 wherein the supporting framework comprises a plurality of eyelets, wherein the graft member is sutured to the supporting framework around at least one of the eyelets.

10. The system ofclaim 1 further comprising a second tether coupled to the anchor, wherein the first tether is disposed through the first bore in the graft member and the second tether is disposed through a second bore in the graft member, wherein the graft member is advanced over the first and second tethers, and the first and second tethers are tied together.

11. A method for facilitating closure of a bodily opening, the method comprising:

providing an anchor and a first tether coupled to the anchor, the first tether extending proximally away from the anchor;

deploying the anchor into engagement with tissue surrounding the opening;

advancing a graft member comprising a first bore distally over the first tether, with the first tether being disposed through the first bore;

positioning the graft member at a desired location relative to the tissue and covering the opening; and

securing the engagement of the graft member to the anchor.

12. The method ofclaim 11 wherein the anchor comprises a plug of material including a plurality of filaments, the method further comprising actuating an actuator to move the plug of material from a pre-deployment state to a deployed state, wherein the actuator reduces a height of the plug of material while increasing a width of the plug of material in the deployed state relative to the pre-deployment state.

13. The method ofclaim 11 wherein the anchor comprises a plurality of deployable members that are biased radially outward in the deployed state.

14. The method ofclaim 11 further comprising providing a supporting framework coupled to the graft member, wherein the supporting framework comprises a plurality of deployable members.

15. The method ofclaim 14 wherein the supporting framework comprises a plurality of eyelets, the method further comprising suturing the graft member to the supporting framework around at least one of the eyelets.

16. The method ofclaim 11 further comprising:

providing a second tether coupled to the anchor;

disposing the first tether the first bore in the graft member and disposing the second tether through a second bore in the graft member;

advancing the graft member over the first and second tethers; and

tying the first and second tethers together to secure the graft member to the anchor.

17. A system for facilitating closure of a bodily opening, the system comprising:

an anchor having a deployed state, wherein the anchor comprises a width in the deployed state that is greater than a width of the opening to securely engage tissue surrounding the opening;

a graft member; and

a first tether coupled to the anchor and extending proximally from the anchor, the first tether configured for guiding the graft member towards the anchor when the anchor is in the deployed state, and further configured for securing the graft member to the anchor.

18. The system ofclaim 17 wherein the anchor comprises a plug of material including a plurality of filaments, wherein the plug of material comprises a diamond shape in a pre-deployment state.

19. The system ofclaim 17 wherein the anchor comprises a plurality of deployable members that are biased radially outward in the deployed state, wherein the width of the anchor in the deployed state is defined by a distance between distal ends of opposing deployable members.

20. The system ofclaim 17 further comprising a second tether coupled to the anchor, wherein the graft member comprises first and second bores, where the first tether is disposed through the first bore in the graft member and the second tether is disposed through the second bore in the graft member, where the graft member is advanced over the first and second tethers, and the first and second tethers are tied together.

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