Apparatus and methods for advancing surgical knots

Claim 2

A knot pusher comprising: a shaft having a proximal end and a distal end and an axis therebetween, the shaft having a side opening disposed proximally of the distal end; a fitting on the distal end of the shaft, said fitting having a slot extending from the side opening to the distal end of the fitting, the slot at a different radial position than a portion of the opening; a member having a proximal end and a distal end mounted on the shaft to move axially between a first position and a second position, the member in the first position radially blocking the slot while leaving an open passage from the distal end of the fitting to the portion of the side opening, the slot providing a radial opening to the open passage when the member is in the second position.

Claim 3

A knot pusher as claimed in claim 1, wherein the member is biased toward the first position.

Claim 4

A knot pusher as claimed in claim 1, wherein the shaft comprises a tube and the member comprises a rod disposed within the tube, the rod having an axial notch defining an axially oriented wall which blocks the slot when the member is in the first position, the rod being axially slidable without rotation relative to the tube between the first position and the second position.

Claim 5

A knot pusher comprising: a tubular shaft having a proximal end and a distal end and an axis therebetween, the shaft having a side opening proximal of the distal end; a fitting on the distal end of the shaft, said fitting having a radial slot in communication with the side opening so that the slot and the side opening are adapted to radially receive a length of suture; a member having a proximal end and a distal end mounted on the shaft to slide axially between a first position that closes the slot, the slot and member adapted to radially capture the length of suture and allow the captured length of suture to slide axially when the member is in the first position, and a second position that opens the slot to allow the length of suture to enter and leave the slot radially; and a handle actuator assembly disposed at the proximal end of the shaft for moving the member between said first position and said second position with one hand; wherein the distal end of the shaft, the fitting, and the distal end of the member are insertable into the patient body through an introduction sheath while the member remains in the first position; wherein the member is a rod slidably received in a lumen of the shaft, wherein a distal end of the rod is shaped to close a portion of the slot when the rod is in a first axial position and to open the portion of the slot when the rod is in a second axial position, the rod angularly aligned with the slot throughout movement between the first and second positions.

Claim 6

A knot pusher comprising: a tubular shaft having a proximal end and a distal end and an axis therebetween, the shaft having a side opening proximal of the distal end; a fitting on the distal end of the shaft, said fitting having a radial slot in communication with the side opening so that the slot and the side opening are adapted to radially receive a length of suture; a member having a proximal end and a distal end mounted on the shaft to slide axially between a first position that closes the slot, the slot and member adapted to radially capture the length of suture and allow the captured length of suture to slide axially when the member is in the first position, and a second position that opens the slot to allow the length of suture to enter and leave the slot radially; and a handle actuator assembly disposed at the proximal end of the shaft for moving the member between said first position and said second position with one hand; wherein the distal end of the shaft, the fitting, and the distal end of the member are insertable into the patient body through an introduction sheath while the member remains in the first position; wherein the member is a rod slidably received in a lumen of the shaft, wherein a distal end of the rod is shaped to close a portion of the slot when the rod is in a first axial position and to open the portion of the slot when the rod is in a second axial position, the rod angularly aligned with the slot throughout movement between the first and second positions.

Claim 7

A knot pusher as in claim 4, wherein the shaft has a length in the range from 5 cm to 40 cm and a diameter less than 10 mm.

Claim 8

A knot pusher as in claim 5, wherein the fitting is cylindrical having a length in the range from 3 mm to 10 mm and a diameter in the range from 2 mm to 10 mm.

Claim 9

A knot pusher as in claim 4, wherein the fitting is formed in the shaft as an integral component.

Claim 10

A knot pusher as in claim 4, wherein the radial slot is flared open over at least a radially outward portion thereof to facilitate capture of suture in the slot.

Claim 11

A knot pusher as in claim 4, wherein the handle actuator assembly comprises a finger grip attached at the proximal end of the rod member, a thumb depressor attached at the proximal end of the shaft, and a spring maintained under compression between the finger grip and the thumb depressor, wherein depression of the thumb depressor toward the finger grip opens the radially outward portion of the slot.

Claim 12

A knot pusher as in claim 4, wherein the handle actuator assembly comprises a tubular handle casing having an open interior or chamber and an axial slot attached to the proximal end of the shaft, a slider slidably received within the open interior chamber, a thumb knob attached to the slider and extending through the slot, and a spring maintained under compression between the slider and the handle casing to distally urge the slider, wherein proximal retraction of the thumb knob relative to the handle casing opens the radially outward portion of the slot.

Claim 13

A knot pusher as in claim 4, wherein the handle actuator assembly comprises a first knob attached to the proximal end of the shaft and a second knob attached to the rod, wherein relative rotation of the first and second knobs opens and closes the slot.

Claim 14

A knot pusher as in claim 4, further comprising an anchor adjacent to the handle, the anchor permitting temporary attachment of the length of suture.

Claim 15

An improved knot pusher of the type including a shaft having a proximal end and a distal end, wherein the distal end engages and advances a slidable knot formed on a free suture end, wherein the improvement comprises means at the distal end of the shaft for selectively capturing and releasing the suture end, the selective capturing and releasing means being biased toward a first position wherein the suture is captured so that the suture will not be inadvertently lost as the knot is advanced, the selective capturing and releasing means adapted to allow the captured suture to slide through the selective capturing and releasing means to advance the knot along the suture, and a handle actuator assembly at the proximal end of the shaft for actuating the selective capturing and releasing means, the handle allowing one-handed extracorporal actuation of the selective capturing and releasing means and one-handed manipulation of the knot pusher relative to the suture to advance the knot.

Claim 16

An improved knot pusher of the type including a shaft having a proximal end and a distal end, wherein the distal end engages and advances a slidable knot formed on a free suture end, wherein the improvement comprises means at the distal end of the shaft for selectively capturing and releasing the suture end, the selective capturing and releasing means being biased toward a first position wherein the suture is captured so that the suture will not be inadvertently lost as the knot is advanced, the selective capturing and releasing means adapted to allow the captured suture to slide through the selective capturing and releasing means to advance the knot along the suture, and a handle actuator assembly at the proximal end of the shaft for actuating the selective capturing and releasing means, the handle allowing one-handed extracorporal actuation of the selective capturing and releasing means and one-handed manipulation of the knot pusher relative to the suture to advance the knot.

Claim 17

An improved knot pusher as in claim 13, wherein the selective capturing and releasing means comprises a member which is mounted to axially translate within the shaft to move between the first position wherein the suture is captured and a second position wherein the suture is released.

Claim 18

An improved knot pusher as in claim 9, further comprising an anchor adjacent to the handle, the anchor adapted for temporary attachment of the length of suture.

Claim 19

An improved knot pusher of the type including a shaft having a proximal end and a distal end, wherein the distal end engages and advances a slidable knot formed on a free suture end, wherein the improvement comprises means at the distal end of the shaft for selectively capturing and releasing the suture end, the selective capturing and releasing means being biased toward a first position wherein the suture is captured so that the suture will not be inadvertently lost as the knot is advanced, and a handle actuator assembly at the proximal end of the shaft for actuating the selective capturing and releasing means, the handle allowing one-handed extracorporal actuation of the selective capturing and releasing means and one-handed manipulation of the knot pusher relative to the suture to advance the knot, wherein the selective capturing and releasing means comprises a member which is rotatably mounted within the shaft to move between a first position wherein the suture is captured and a second position wherein the suture is released.

Claim 20

An improved knot pusher of the type including a shaft having a proximal end and a distal end, wherein the distal end engages and advances a slidable knot formed on a free suture end, wherein the improvement comprises means at the distal end of the shaft for selectively capturing and releasing the suture end, the selective capturing and releasing means being biased toward a first position wherein the suture is captured so that the suture will not be inadvertently lost as the knot is advanced, and a handle actuator assembly at the proximal end of the shaft for actuating the selective capturing and releasing means, the handle allowing one-handed extracorporal actuation of the selective capturing and releasing means and one-handed manipulation of the knot pusher relative to the suture to advance the knot, wherein the selective capturing and releasing means comprises a member which is rotatably mounted within the shaft to move between a first position wherein the suture is captured and a second position wherein the suture is released.

Claim 23

A method as in claim 17, wherein the advancing step comprises advancing the distal end through a tissue tract toward suture anchored in a blood vessel wall.

Claim 24

A method as in claim 18, wherein the advancing step comprises advancing the distal end over the free end of suture while said free end extends outward through a sheath disposed in the tissue tract.

Claim 25

A method as in claim 17, wherein the advancing step comprises advancing a square knot.

Claim 26

A method as in claim 17, wherein tensioning said one free end comprises grasping the free end in one hand.

Claim 27

A method as in claim 17, further comprising tying and advancing additional knot throws over the first knot which had been advanced.

Claim 28

A method as in claim 17, further comprising temporarily attaching said one of said two free ends to the shaft.