MAGNETIC SUTURE OR INSTRUMENT
Technical Field
[001] This disclosure relates to devices and procedures for surgery, such as for surgery involving suturing.
Summary
[002 ] According to the invention, a suture can include one or more magnetic elements as part of the suture (e.g., located at or towards the tip or physical end of the suture), which can facilitate the retrieval and manipulation of the suture during surgery, such as during an endoscopic surgery.
[003 ] The details of one or more implementations are set forth in the
accompanying drawings and the description below. Other features will be apparent from the description and drawings, and from the claims.
[ 004] hi its broadest sense the present invention provides a suture comprising a magnetic element.
[005] Suitably, the magnetic element comprises a coil, a wire or strand, a j acket, a mesh, a cylinder, a flexible, rigid, or semi-blunt needle tip.
[006] Suitably, the magnetic element is a magnet; suitably a permanent magnet or an electromagnet. Preferably, the magnetic element comprises a ferromagnetic material. Alternatively, the magnetic element comprises a ceramic or ferrite magnet comprising a composite of powdered iron oxide and barium/strontium carbonate ceramic.
In further alterative embodiments, the magnetic element comprises resin or binder, and a magnetic powder, such that the magnetic element is flexible. Preferably, the resin or binder is a flexible resin or binder.
[007] Alternatively, the magnetic element is formed from a material that is attracted to magnetic material. Suitably, the magnetic element comprises iron or an iron alloy, such as stainless steel, cobalt or nickel.
[008 ] Suitably, the magnetic element is attached to the suture with an adhesive, by swaging or crimping, or the magnetic element is woven or braided with the suture.
[ 009] Suitably, the magnetic element is removably attached to the suture.
Preferably, the magnet element comprises a clip.
[0010] Suitably, the magnetic element is disposable.
[0011] The invention may also comprise a surgical anchor featuring a suture as described above.
[ 0012 ] The invention also includes a surgical instrument for grasping and/or manipulating suture, wherein the instrument comprises a magnetic element. Preferably, the suture comprises a first magnetic element and the surgical instrument comprises a second magnetic element.
[ 0013 ] Optionally, the second magnet element is removably attachable to the surgical instrument. Preferably, the second magnet element comprises a clip. Suitably, the second magnet element is an electromagnet.
[0014] Suitably, the surgical instrument is a suture retriever, suture grasper, suture passer, suture passer, knot pusher or knot cutter.
[ 0015 ] The invention also includes a suturing system comprising a suture and a surgical instrument as described above. [ 0016] In addition, the invention further includes a method for suturing comprising the steps of grasping or manipulating a suture comprising a first magnetic element with a surgical instrument comprising a second magnetic element, wherein a force of attraction exerted by the magnetic elements on one another is used to locate and control the suture. Suitably, the method also includes the step of passing at least a portion of the suture and the first magnetic element through tissue, and wherein the step of grasping or manipulating the suture using the surgical instrument comprises grasping or manipulating the suture using the surgical instrument after the suture and the first magnetic element are passed through the tissue.
[0017] The magnetic element comprises a magnetic strand attached to a tip of the suture and extending distally from the suture, the method further comprising the steps of: passing a tip of a needle through tissue, wherein the needle is hollow with a hole at or near the tip and; passing the magnetic strand through the hollow needle and the hole such that the magnetic strand emerges from the hole before the suture; grasping the magnetic strand using the instrument, wherein grasping includes placing the second magnetic element near the magnetic strand to pull the magnetic strand into contact with the instrument by magnetic attraction between the second magnetic; element and the magnetic strand; and pulling the magnetic strand through the tissue such that the suture is also pulled through the tissue.
[ 0018] The method may include a step of removing the first magnetic element from the suture. Description of the Drawings
[0019 ] FIG. 1 A is a schematic of an example of a suture anchor attached to a suture with a magnetic element at the tip.
[0020] FIG. IB is a schematic of an example of a suture anchor attached to multiple sutures, each having a magnetic strand.
[0021] FIG. 1 C is a schematic of an example of a suture anchor attached to multiple sutures, each having a rectangular or cylindrically-shaped magnetic element at the tip.
[0022 ] FIG. ID is a schematic of an example of an implementation of a suture anchor attached to multiple sutures, each having a pointed magnetic element at the tip.
[0023 ] FIG. 2A is a schematic of an example of a suture with a magnetic coil.
[0024] FIG. 2B is a schematic of an example of a suture with magnetic rings.
[ 0025 ] FIG. 2C is a schematic of an example of a suture with a magnetic jacket.
[ 0026] FIG. 2D is a schematic of an example of a suture with a flexible, magnetic needle tip.
[0027 ] FIG. 2E is a schematic of an example of a suture with a magnetic needle tip and a magnetic material attached at an end of the suture directly below the magnetic needle tip.
[0028] FIG. 2F is a schematic of an example of a suture with a semi-blunt magnetic needle tip.
E 0029 ] FIG. 2G is a schematic of an example o f a suture with a rigid magnetic needle tip.
[0030] FIG. 3 is a schematic of an example of a suture anchor with a suture, clip, and wire. [ 0031] FIG. 4 is a schematic of an example of a suture grasper having rotatable prongs.
[0032 ] FIGS. 5 A and 5B are schematics showing an example of a suture passing instrument.
[ 0033 ] FIGS. 6A-6D are schematics showing an example of the suture passing instrument of FIGS. 5 A and 5B in use.
Detailed Description
[0034 ] Surgical procedures, such as soft tissue repair, often involve passing a suture through tissue, for example, to attach soft tissue to bone, to attach soft tissue to soft tissue, or to close a fissure in soft tissue. For endoscopic surgeries, such as arthroscopic repair procedures, the suture is manipulated intracorporeally using an instrument that is passed into the body through a cannula.
[0035 ] According to the invention, a suture for use in a surgical procedure, such as an endoscopic procedure, includes one or more magnetic elements as part of the suture (e.g., located at or towards the tip or physical end of the suture). Likewise, an instrument used to manipulate the suture may include one or more corresponding magnetic elements to attract the magnetic element of the suture to the magnetic element of the instrument.
[0036] The inclusion of the magnetic elements can facilitate the grasping, retrieval and manipulation of the suture during an endoscopic procedure, such as an arthroscopic repair procedure, or other surgical procedures. For example, magnetic attraction between the magnetic element of the suture and the magnetic element of the instrument may pull the suture into contact with or close proximity to the portion of the instrument used to manipulate and grab the suture. This may facilitate the manipulation of the suture during a procedure, such as an endoscopic procedure, by reducing the need for precise hand manipulation and placement of mechanical devices during the surgery.
[0037 ] In the implementations described in this disclosure, the magnetic element may be formed, in whole or in part, from a material that produces its own magnetic field (e.g., a magnet) or a material that, even though it does not produce a magnetic field itself, is non-neglibly affected by a magnetic field (e.g., iron or martensitic stainless steel). Also, in the implementations described in this disclosure, the magnetic elements of the suture and/or the instrument can be permanently magnetized (e.g., permanent magnets that include ferromagnetic materials, such as cobalt, iron, or nickel) or temporarily magnetized (e.g., electromagnets). The magnetic element may also be flexible, being a composite of a suitable flexible resin or binder and a metallic powder, or maybe a suitable ceramic material. The metallic powder may also be a magnetic powder.
[0038 ] Referring to FIG. IA, a suturing system IOOA includes an anchor 104 having suture 102 coupled to the anchor 104 at a portion 102a of the suture 102, a shaft 101 coupled to the anchor 104, and a handle 106 coupled to the shaft 101. The suture 102 passes through one or more apertures in the anchor 104 (not shown) which are generally perpendicular to the longitundinal axis of the anchor 104. One or more ends 102b of the suture 102 are wrapped around one or more tabs 106a, 106b of the handle 106. For example, in one implementation, a first end of the suture is wrapped around a first tab 106a of the handle 106 and a second end of the suture is wrapped around a second tab 106b of the handle 106, while a middle portion of the suture 102 is coupled to the anchor 104. A magnetic element 107 is permanently coupled to each end of the suture 102, for example, using an adhesive. Alternatively, a swaged needle may be used to connect the suture and add a magnetic element. . The magnetic element 107 may also be coupled to the suture 102 by press fitting, crimping, or swaging onto the suture 102. The suture can be configured on the needle by looping through the proximal portion of an eyelet and swaged at the distal portion of the magnetic element. The compressed distal swag needle will prevent the magnetic element from becoming loose in the joint.
[0039] The suture 102 and suture anchor 104 are made of a biocompatible material that is safe for patients. For example, the suture 102 may be formed from threaded strands of non-metal material, including, but not limited to, polymer material or other biocompatible non-metal material. The sutures may be absorbable or nonabsorbable. The anchor can be formed from metal, including, but not limited to titanium, or non-metal material, such as a polymer material. Other biocompatible metal and non- metal material can also be used. The magnetic element(s) 107 is formed, for example, from biocompatible stainless steel having magnetic qualities or coated medical grade metal material coated with nickel, copper, or other biocompatible coatings. Other biocompatible metal material may be used to make the magnetic element(s) 107.
[0040] The suture anchor 110 can be attached to a body part, such as a bone, using, for instance, the handle 106 and shaft 101, and the suture 102 can be inserted through tissue. A surgeon then uses an instrument to manipulate the suture 102 and, for instance, to form a knot in the suture 102 to affix the tissue to the bone. The knot may be formed manually, as just described, or the suture may have a pre-formed knot, such as a slip knot.
[ 0041] When an instrument with a corresponding magnetic element is used to grasp and manipulate the suture 102, the magnetic element of the instrument can attract the magnetic element 107 attached to the suture 102. This attraction pulls the suture 102 into contact with, or close proximity to, the portion of the instrument used to grasp and manipulate the suture 102. For example, when a grasper employing a pair of closeable jaws with an attached magnetic element is used to manipulate the suture 102, the magnetic element 107 attached to the suture 102 maybe pulled into the jaws, which are then closed around the magnetic element 107 or an end 102b of the suture 102.
[0042 ] Once the procedure is complete, the portion of the suture 102 with the magnetic element can be removed, for example, by cutting the suture 102 below, or proximally of, the magnetic element 107 (but above, or distally of, the place where the knot is formed in the suture 102 if a knot is formed). In particular, the magnetic element
107 can be removed when the magnetic material is not biocompatible.
[ 0043 ] Referring to FIG. IB, another suturing system IOOB includes multiple sutures 102 attached to the suture anchor 104. Each suture 102 is attached to the anchor 104 at a portion 102a of the suture. In addition, each suture 102 has a magnetic element
108 attached at one or more ends 102b of the suture. The magnetic element 108 is, for instance, permanently attached to the end 102b of the suture 102, for example, using a permanent swaged on stainless steel connector or other means as noted above. The magnetic element 108 includes a strand 108b of magnetic material and a cylindrical or other shaped piece 108a of magnetic material that attaches the strand 108b to the suture 102. The piece 108a of magnetic material may be located at the end of the strandlO8b with the strand 108b coupled to the suture via means, such as an adhesive, rather than the piece 108a. Also, a second piece, in addition to piece 108a, maybe coupled, for example by swaging, to the end of the strand 108b.
[0044 ] The magnetic element 108 with the strands 108b may be particularly useful as a shuttle for the suture 102. For instance, some suture passers include a hollow needle with a hole at the tip that is passed through tissue. Suture is then advanced out of the hollow needle and grasped by an instrument to manipulate the suture. The magnetic strand 108b can be oriented to pass through the hollow needle first, and can then be grasped with an instrument that has a corresponding magnetic element that attracts the strand 108b. The magnetic strand 108b is pulled through the tissue such that the suture is also pulled through the tissue, A knot can then be formed in a suture, or between sutures, to affix the tissue to another body part, such as bone (to which the anchor is affixed).
[0045] Once the procedure is complete, the portion of the suture 102 with the magnetic element 108 can be removed, for example, by cutting the suture 102 below the magnetic piece 108a (but, if a knot is formed, above the place where the knot is formed in the suture 102).
[0046] Referring to FIG. 1 C, another suturing system 10OC includes multiple sutures 102 attached to a suture anchor 104. Each suture 102 is attached to the anchor 104 at a portion 102a of the suture 102. In addition, each suture 102 includes a rectangular or cylindrically shaped magnetic element 110 attached to one or more ends 102b of the suture. The magnetic element 110 is, for instance, permanently attached to the second end 102b of the suture, for example, using an adhesive. Alternatively, a swaged connector or other means noted above may be used to connect the suture and add a magnetic element.
[ 0047 ] The suture anchor 104 can be attached to a body part, such as a bone, while the suture 102 is inserted through tissue. A surgeon then grasps and/or manipulates the suture 102 and/or magnetic element 110 using an instrument that has a corresponding magnetic element that attracts the magnetic element 110 and, for instance, forms a knot in the suture 102, or between sutures, to affix the tissue to the bone. The knot may be formed manually or the suture may have a pre-formed knot, such as a slip knot.
[0048 ] Once the procedure is complete, the portion of the suture 102 with the magnetic element 110 can be removed, for example, by cutting the second end 102b of the suture 102 below, or proximally to, the magnetic element 110 (but above, or distally from, the place where the knot is formed in the suture 102 if a knot is formed).
[0049 ] Referring to FIG. ID, multiple sutures 102 are attached to a suture anchor
104, hi particular, each suture 102 is attached to the anchor 104 at a first end 102a of the suture, hi addition, each suture 102 includes a pointed magnetic element 112 attached to a second end 102b of the suture. The magnetic element 112 is, for instance, permanently attached to the second end 102b of the suture, for example, using an adhesive.
Alternatively, a swaged connector or other means noted above may be used to connect the suture and add a magnetic element. A pointed magnetic element 112 may be useful for facilitating piercing of the tissue.
[0050] The suture anchor 104 can be attached to a body part, such as a bone, while the suture 102 is inserted through tissue. A surgeon then grasps and/or manipulates the suture 102 and/or magnetic element 112 using an instrument that has a corresponding magnetic element that attracts the magnetic element 112 and, for instance, forms a knot in the suture 102, or between sutures, to affix the tissue to the bone. The knot maybe formed manually or the suture may have a pre-formed knot, such as a slip knot.
[0051] Once the procedure is complete, the portion of the suture 102 with the magnetic element 112 can be removed, for example, by cutting the suture 102 below the magnetic element 112 (but above the place where the knot is formed in the suture 102 if a knot is formed). [0052 ] The sutures described in the implementations shown in FIGS 1 A- 1 D may be used with an anchor as shown, or alternatively may be used with another implement, such as a needle/passing pin, or alone.
[0053] FIGS.2A-2E illustrate other implementations of sutures with magnetic elements. These sutures and magnetic elements can be used with an anchor in place of, or in addition to, the sutures and magnetic elements shown in FIGS. 1A-1D.
Alternatively, or additionally, these sutures and magnetic elements can be used with other implements, or can be used alone.
[ 0054] Referring to FIG. 2 A, a magnetic element may be formed from a magnetic wire 207 wrapped in a coil around or braided inside the suture 205. The magnetic element in the form of a wire 207 can be coiled around, or braided within, a portion of the suture (e.g., at one end or a middle portion) or the magnetic wire 207 can be coiled around, or braided within, the entire length of the suture. In an alternative
implementation, the magnetic element 227 is a magnetic mesh placed or formed around the suture 205, e.g., at one end, at a middle portion of the suture, or along the entire length of the suture.
[0055] Referring to FIG. 2B, rather than using a magnetic element in the form of a coil of magnetic wire, individual rings 227 of magnetic wire may be wrapped around the suture 205 at individual points along the suture 205. The rings 227 can extend along a portion of the suture (e.g., at one end or a middle portion) or the rings can extend the entire length of the suture. Using individual rings may allow the suture to remain more flexible compared to a swaged on needle 205.
[0056] Referring to FIG. 2C, a magnetic element in the form of a jacket 237 is wrapped around the suture 205. The magnetic jacket 237 can extend along a portion of the suture (e.g., at one end or a middle portion) or the magnetic jacket 237 can extend the entire length of the suture. In addition, the magnetic jacket 237 can be fixed to the suture, or the magnetic jacket 237 can slide relative to the length of the suture 205. For example, the magnetic jacket 237 can extend the length of the suture 205, and be configured to slide relative to the length of the suture 205 such that the magnetic jacket 237 can be removed from the suture 205 after the repair procedure has been completed by sliding the magnetic jacket 237 off the suture 205.
[0057 ] The magnetic j acket 237 can cover only a portion of the suture 205 near the anchor to facilitate manipulation of the suture 205 near the anchor. Similarly, the magnetic jacket 237 can cover only a portion of the suture 205 at the end distal from the anchor to facilitate manipulation of the suture 205 at that end. If the magnetic jacket 237 extends the entire length of the suture, the magnetic jacket 237 can facilitate the manipulation of both ends of the suture. Also, more than one jacket can be used, for instance, with one at each end of the suture to facilitate the manipulation of the two ends of the suture. The jacket can be coated with a medical grade coating, as mentioned above.
[0058] Providing a magnetic j acket 237 that is removable may be advantageous for procedures that use the suture 205 with an anchor, and involve manipulation of suture 205 near the anchor, particularly when the magnetic jacket 237 is made from a material that is not biocompatible. In such procedures, the portion of the suture 205 near the anchor needs to remain in the body. Thus, using a non-removable, non-biocompatible magnetic element near the anchor is not suitable. However, since the magnetic jacket 237 can be removed, the magnetic jacket 237 may facilitate manipulation of the suture near the anchor when an instrument with a corresponding magnetic element is used. Once the procedure is completed, the magnetic jacket 237 can be removed by sliding the magnetic jacket 237 off the suture 205.
[ 0059] Referring to FIG. 2D, a suture 205 includes a flexible, magnetic element in the form of a needle tip 247 at an end point of the suture 205. The needle tip 247 is flexible to bend and contour through tissue as the repair procedure is being conducted with the suture 205. At least a portion of the needle is magnetic. The needle tip 247 can be made of a flexible material, such as biocompatible rubber or plastic, and at least a portion iscoated with a magnetic material or powder. In some implementations, the needle tip 247 can have a flexible, non-magnetic top portion and a rigid magnetic bottom portion. In other implementations, magnetic material may be placed within a center section of a flexible, non-metallic tip. The magnetic needle tip 247 may be removed from the suture 205 after the repair procedure has been completed.
[0060] Referring to FIG. 2E, a suture 257 includes a magnetic element in the form of a needle tip 257 attached to the suture 257 and a magnetic material 258 attached at an end of the suture 205 directly below the needle tip 257. The magnetic material 257 can be, for example, a coil of magnetic wire, such as that shown in FIG. 2 A, one or more magnetic wire rings, such as those shown in FIG. 2B, or a magnetic jacket, such as that shown in FIG. 2D. The magnetic needle tip 257 can be a flexible needle tip, such as the one shown in FIG. 2D, a semi-blunt needle tip, such as the one shown in FIG. 2F, or a rigid needle tip, such as the one shown in FIG. 2G.
[0061] The magnetic element 258 can provide a larger surface area (than j ust the magnetic tip 257) for grasping the suture 205 with an instrument that has a corresponding magnetic element. The magnetic needle tip 257 and magnetic ring 258 may be removed from the suture 205 after the repair procedure has been completed. [ 0062 ] Referring to FIG. 2F, the suture 205 includes a semi-blunt magnetic needle tip 267 attached to an end of the suture 205. The implementation 267 of FIG. 2F maybe similar to the implementation of FIG. 2E, however, a semi-blunt magnetic tip 267 may be useful in some implementations, to reduce possible harm to users.
[0063 ] Referring to FIG. 2G, the suture 205 includes a rigid magnetic needle tip 277 attached at an end of the suture 205. The rigid magnetic needle tip 277 may be hollow and have a magnetic shell. The magnetic needle tip 277 may be removed from the suture 205 after the repair procedure has been completed.
[0064] Referring to FIG. 3 A, a magnetic element 350 is designed as a retrofit for sutures that do not include a magnetic element. Magnetic element 350 includes a clip 340 and a strand 360 of magnetic material, similar to the implementation shown in FIG. IB. A first end of the suture 325 is attached to an anchor 310 and the clip 340 is clipped onto a second end of the suture 325, with the strand 360 of magnetic material extending distally from the second end of the suture 325. By using the clip 340, the magnetic element 350 can be attached to sutures that do not include a magnetic element formed as part of the sutures. Alternatively, the magnetic element can be a suitable metal or magnetic material having a hole or groove through or within which a suture may be placed, prior to a compression force being applied to the metal or magnetic material to crimp it to the suture. An instrument with a corresponding magnetic element can then be used to grasp and manipulate the suture 325 with magnetic element 350 during surgery. The magnetic forces between the strand 360 and the instrument can facilitate the grasping and manipulation of the suture. The wire 360 and clip 340 may be removed from the suture 205 after the repair procedure has been completed, for example, by cutting the suture 325 below the clip 340 or by unclipping the clip 340. A particular advantage of the retrofit magnetic element is that can be used to selectively tag one or more sutures when multiple sutures will be present at the surgical site. As a result this may help to identify certain sutures where they must be manipulated in a particular order, or particular manner.
[ 0065 ] While a magnetic strand 360 is shown with a clip 340, any form of magnetic element described in this disclosure may be equipped with a clip to retrofit the magnetic element to a suture that does not include a magnetic element already formed as part of the suture.
[0066] Referring to FIG. 4, a suture grasper 405 can be used with any of the magnetic sutures described in this disclosure (or other magnetic sutures). The grasper 405 includes a scissor like handle 445 coupled to a shaft 435 that terminates with a magnetic tip 455. Rotatable prongs 415 are located around the shaft 435 at the end of the shaft 435 with the magnetic tip that can be disposable or reusable 455. The suture grasper 405 also includes a finger roller mechanism 425 that can be used to rotate the rotatable prongs to grab suture 415.
[ 0067] During use, the magnetic tip 455 on the shaft 435 attracts the magnetic portion of the suture. Once the magnetic portion of the suture is stuck to the magnetic tip 455, the surgeon rotates the prongs 415 using the finger roller 425 so that the prongs line up and clasp the suture to the grasper 4O5.The suture, or a portion of the suture, can then be removed from the body by withdrawing the grasper 405. Rather than the scissor-like handle, the grasper may have another type of mechanism that would operate the prongs, such as an in-line handle having an actuator.
[0068] Referring to FIGS. 5 A and 5B, a suture passing instrument 10 may be used with any of the magnetic sutures described in this disclosure. The suture passing instrument is also described in U.S. Patent Application 2005/0288690, which is incorporated herein by reference in its entirety.
[0069] Suture passing instrument includes a handle 12, an elongated housing 14, and a distal jaw assembly 16. Jaw assembly 16 includes a first member in the form of a moveable jaw 20 and a second member in the form of a stationary jaw 18. The moveable jaw 20 is pivotable relative to the stationary jaw 18. Handle 12 includes a stationary lever in the form of a thumb loop 22 and a moveable lever in the form of a finger loop 24 that is movable relative to thumb loop 22 to open and close jaw 20. Handle 12 includes a needle actuating assembly 26 with a linked thumb needle driver 28 and a finger trigger 30. A needle 32 is slidably received within housing 14 and attached to needle driver 28. The needle 32 is used to pass a suture through tissue.
[0070 ] Needle 32 has a flexible distal portion 181 with a pointed distal end 180, an edge 196, and a suture receiving slot 182 extending proximally from edge 196 for receiving a suture thread. Lower jaw 18 includes a body portion 195 and a ramp portion 197 that together define a passageway 198 for receiving needle 32. When needle driver 28 is moved in the direction of arrow C and/or trigger 30 is moved in the direction of arrow D, needle 32 is advanced distally through passageway 198 in the direction of arrow C. Body portion 195 and ramp portion 197 deflect distal portion 181 of needle 32 out of passageway 198 and toward the jaw 20 so that needle 32 can pass suture through tissue.
[0071] Jaw 20 includes a cut-out 210 and a slot 212 leading to cut out 210 that form a hook-shaped distal end 214 on jaw 20. Needle 32 freely passes through hook shaped distal end 214 when needle is advanced from jaw 18 to pass suture through tissue. After the suture is passed through the tissue, needle 32 is retracted into jaw 18, leaving the suture in the tissue. The passed suture can be further manipulated by hook-shaped distal end 214, e.g., by placing hook shaped distal end 214 through a loop in the suture and pulling the suture away from the tissue. The hook shaped distal end 214 includes a magnetic element that attracts the magnetic element of the suture to a portion of the hook shaped distal end. This can facilitate the manipulation of the suture.
[00721 FIGS . 6 A-6D show schematics of an example o f the use of the suture passing instrument 10. Referring to FIG. 6A, in use, e.g., in attaching a soft tissue 300 to bone 223, after placing a suture anchor 220 and attached suture 222 with a magnetic element(e.g., any of the magnetic sutures described in this disclosure), into bone 223 in a joint, e.g., the shoulder joint, through a cannula 224, e.g., a 5.5 mm cannula, with the suture 222 extending from the anchor 220 through the cannula 224 to the outside of the joint, the suture 222 is loaded into instrument 10. To load the suture 222, with jaw 20 open, the operator moves needle driver 28 in the direction of arrow A to align suture slots 190, 182. The operator then loops suture 222 over jaw 18 and passes a free end portion of suture 222 through slot 190 into slot 182. The movement of needle driver 28 in the direction of arrow A creates a slight bend in needle 32, biasing needle distally, such that when needle driver 28 is released, the needle 32 and needle driver 28 automatically return to their rest position, corresponding to the position of the needle. Ramp portion 197 prevents needle 32 from traveling distally beyond the rest position when needle driver 28 is released. The operator then closes jaw 20 by moving finger loop 24 in the direction of arrow B, and advances instrument 10 through the cannula to the surgical site. The operator then opens jaw 20 and manipulates instrument 10 such that tissue 300 to be reattached to the bone is positioned between jaws 18 and 20. The operator then closes jaw 20 to grasp tissue 300 (FIG. 6B). [ 0073 ] Referring to FIG. 6C, with tissue 300 secured between jaws 18, 20, the operator advances needle 32 through tissue 300, either by pushing on needle driver 28 or pulling on trigger 30. Referring to FIG. 6D, the operator then reverses the movement of needle driver 28 or trigger 30 to retract needle 32 to its rest position, leaving a loop 228 of suture 222 extending through tissue 300. The operator opens jaw 20 releasing tissue 300, and places the hook 214 with the magnetic element near a magnetic portion 228 of suture 222, which draws the suture to the hook 214 and captures the suture. To complete the procedure, the operator closes jaw 20, pulls instrument 10 with captured suture 222 through cannula 224, and ties off the suture 222 to re-approximate tissue 300 to bone.
[0074] As an alternative, rather than including a magnetic element on hook portion 214, a separate grasping instrument can be used. An example of such an instrument includes jaws similar to instrument 10, with one or both of the jaws having a magnetic element. The magnetic element of the jaw(s) attracts the magnetic portion 228 of the suture 222 during use to draw the suture 222 into the jaws. The jaws are then closed to grasp the suture and used to manipulate the suture, for example, to draw the suture out of cannula224 or to tie the suture.
[0075] In an alternative version of the instrument 10, the needle is hollow 32 rather than including a slot 182 that carries the suture. A hole is located at the tip of the needle and provides access to the hollow portion of the needle 32. hi such an
implementation, once the needle 32 is passed through the tissue 300, the suture is advanced through the hollow portion of the needle 32 and out of the hole at the tip of the needle. At least a portion of the suture that is passed through the hole includes a magnetic element so that the hook 214 with a corresponding magnetic element (or, alternatively, another grasper with a magnetic element) can be used to grasp and manipulate the suture.
[0076 ] Certain features that are described in this specification in the context of separate implementations can also be implemented in combination in a single
implementation. Conversely, various features that are described in the context of a single implementation can also be implemented in multiple implementations separately or in any suitable subcombination. Moreover, although features may be described above as acting in certain combinations and even initially claimed as such, one or more features from a claimed combination can in some cases be excised from the combination, and the claimed combination may be directed to a subcombination or variation of a subcombination.
[0077] The suturing system can include other components. The order of the suturing procedures for various implementations can vary. A number of implementations have been described. Nevertheless, it will be understood that various modifications may be made.
[0078] For example, in some implementations and surgical procedures, the suture can be manipulated primarily from magnetic forces. In other implementations, there can be additional mechanical assistance, or suctioning, to draw the suture to the instrument. Other implementations may include spheres, rings, and/or granules of magnetic material that are mechanically or chemically bonded to the suture.
[0079 ] Also, while the implementations shown involve a magnetic material external to the suture, some implementations use a magnetic material internal to the suture. For instance, suture can be braided around a wire made, for example, of magnetic stainless steel. The magnetic material can extend along a portion or the whole length of the suture. In such implementations, the suture may or may not also have external magnetic material at one or both tips. As an example, in one implementation, suture is braided around a magnetic wire and a magnetic needle tip (such as needle tip 247, 267, or 277) is attached to an end of the suture such that the magnetic wire extends along the suture starting from the needle tip. The wire can extend along a portion of the suture or the entire length.
[0080] Accordingly, various modifications and implementations are within the scope of the following claims.