CONTINUOUS METHOD ANASTOMOSIS USING SELF-RETAINING SUTURES
An anastomosis procedure utilizes a self-retaining suture to secure one vessel to another vessel. A single self-retaining suture is deployed in a continuous pattern around the interface between the vessels. The self-retaining suture has tissue-grasping surface features which allow passage of the suture in one direction through tissue, but not in the opposite direction. The self-retaining suture may be deployed using a needle attached to the end of the suture. The continuous anastomosis technique may be performed without using knots.
1 . A method for joining a first vessel, having a first opening and a first vessel wall, to a second vessel, having a second opening and a second vessel wall, the method comprising:
(a) receiving a self-retaining suture comprising a first portion including a first end and a first plurality of barbs projecting from the first portion, the first plurality of barbs permitting movement of the first portion through tissue in a direction of movement of the first end and preventing movement of the first portion through tissue in an opposite direction, and a second portion including a second end and a second plurality of barbs projecting from the second portion, the second plurality of barbs permitting movement of the second portion through tissue in a direction of movement of the second end and preventing movement of the second portion through tissue in an opposite direction;
(b) inserting the first end of the suture into the first vessel wall at a first entrance point adjacent the first opening;
(c) pushing the first end of the suture through the first vessel wall until the first end of the suture extends out of the first vessel at a first exit point displaced from the first entrance point;
(d) gripping the first end of the suture and drawing the first portion of the suture through the vessel wall until the second portion of the elongate body is at the first insertion point thereby leaving a length of the first portion of the elongate body in the first vessel wall between the first entrance point and the first exit point;
(e) inserting the second end of the suture into a second entrance point in the second vessel wall adjacent the second opening;
(f) pushing the second end of the suture through the second vessel wall until the second end of the suture extends out of the second vessel wall at a second exit point displaced from the second entrance point; and
(g) gripping the second end of the suture and pulling the second end out of the vessel wall while approximating the first opening and the second opening and leaving a length of the second portion of the suture in the second vessel wall between the second insertion point and the second exit point.
2 . The method of claim 1 , wherein:
step (c) comprises pushing the first end of the suture through the first vessel wall until the first end of the suture extends out of the first vessel at a first exit point displaced from the first entrance point and adjacent the first opening; and
step (f) comprises pushing the second end of the suture through the second vessel wall until the second end of the suture extends out of the second vessel wall at a second exit point displaced from the second entrance point and adjacent the second opening.
3 . The method of claim 1 , wherein:
step (c) comprises pushing the first end of the suture along a curvilinear path through the first vessel wall until the first end of the suture extends out of the first vessel at a first exit point displaced from the first entrance point and adjacent the first opening; and
step (f) comprises pushing the second end of the suture on a curvilinear path through the second vessel wall until the second end of the suture extends out of the second vessel wall at a second exit point displaced from the second entrance point and adjacent the second opening.
4 . The method of claim 1 , wherein:
step (c) comprises,
(c1) pushing the first end of the suture through the first vessel wall until the first end of the suture extends out of the first vessel at a first exit point displaced from the first entrance point and adjacent the first opening; and
(c2) pushing the first end of the suture through the second vessel wall until the first end of the suture extends out of the second vessel at a third exit point displaced from the third entrance point and adjacent the second opening; and
step (f) comprises,
(f1) pushing the second end of the suture through the second vessel wall until the second end of the suture extends out of the second vessel wall at a fourth exit point displaced from the fourth entrance point and adjacent the second opening; and
(f2) pushing the second end of the suture through the first vessel wall until the second end of the suture extends out of the first vessel wall at a second exit point displaced from the second entrance point and adjacent the second opening.
5 . The method of claim 1 , further comprising:
(h) repeating steps (c1), (c2), (f1) and (f2) until the first portion of the suture and the second portion of the suture meet at a position around the first and second openings substantially opposite to the first entrance point.
6 . The method of claim 1 , wherein the first end comprises a first needle and the first end comprises a second needle; and wherein the method comprises:
(h) severing the first needle and the second needle from the suture.
7 . The method of claim 1 , performed endoscopically.
8 . A method for joining a first structure having a first tubular wall and a first end, to a second structure having a second tubular wall and a second end to create an anastomosis, the method using a suture including an elongate body, a first end and a second end, and a first plurality of projections distributed on a first portion of the elongate body between the first end of the suture and a second portion of the elongate body, the first plurality of projections oriented to permit movement of the first portion of the elongate body through tissue toward the first end and prevent movement of the first portion of the elongate body through tissue in an opposite direction, the method comprising steps of:
(a) inserting the first end of the suture into a first entrance point in the first tubular wall adjacent the first end of the first structure;
(b) pushing the first end of the suture through the first tubular wall until the first end of the suture extends from a first exit point in the first tubular wall adjacent the first end and spaced from the first entrance point;
(c) gripping the first end of the suture and pulling the first end out of the first tubular wall and drawing the first portion of the elongate body through the first tubular wall until the second portion of the elongate body is adjacent the first entrance point in the first tubular wall, leaving a length of the first portion of the elongate body in the first tubular wall;
(d) inserting the first end of the suture into a second entrance point in the second tubular wall adjacent the second end of the second structure;
(e) pushing the first end of the suture through the second tubular wall until the first end of the suture extends from a second exit point in the second tubular wall adjacent the second end and spaced from the second entrance point; and
(f) gripping the first end of the suture and pulling the first end out of the second tubular wall and drawing the first portion of the elongate body through the second tubular wall, leaving a length of the first portion of the elongate body in the second tubular wall.
9 . The method of claim 8 , further comprising:
(g) securing the second portion of the elongate body to at least one of the first tubular wall and the second tubular wall.
10 . The method of claim 9 , wherein the suture includes a second plurality of projections distributed on the second portion of the elongate body between the second end of the suture and the first portion of the elongate body, the second plurality of projections being oriented to permit movement of the second portion of the elongate body through tissue towards the second end and prevent movement of the second portion of the elongate body through tissue in an opposite direction, and wherein step (g) includes securing the second portion of the elongate body to at least one of the first tubular wall and the second tubular wall by performing the steps:
(g1) inserting the second end of the suture into a third entrance point in the second tubular wall adjacent the second end of the second structure;
(g2) pushing the second end of the suture through the second tubular wall until the second end of the suture extends from a third exit point spaced from the third entrance point and adjacent the second end; and
(g3) gripping the second end of the suture and pulling the second end out of the third exit point and drawing the second portion of the elongate body through the second tubular wall; leaving a length of the second portion of the elongate body in the second tubular wall.
11 . The method of claim 10 , wherein the first end comprises a first needle and the second end comprises a second needle; and wherein the method comprises:
(h) severing the first needle and the second needle from the elongate body.
12 . The method of claim 8 , wherein the first end comprises a first needle and wherein the method comprises:
(g) severing the first needle from the elongate body.
13 . The method of claim 8 , wherein step (b) comprises pushing the first end of the suture along a curvilinear path through the first tubular wall until the first end of the suture extends from a first exit point in the first tubular wall adjacent the first end and spaced from the first entrance point.
14 . The method of claim 8 , wherein the second structure is a gastrointestinal structure.
15 . The method of claim 8 , performed endoscopically.
16 . A method for creating an anastomosis of a first opening in a first tissue and a second opening in a second tissue, the method comprising:
(a) receiving a tissue-closure device including a strand having a first end and a second end, a needle secured to the first end of the strand, a first strand portion adjacent the first end, a second strand portion adjacent the second end, a plurality of projections distributed on the first strand portion, the plurality of projections being configured to permit movement of the first strand portion through tissue in a direction of the needle and grasp tissue in an opposite direction;
(b) using the needle to deploy the first strand portion along a subcutaneous path which passes alternately through the first tissue adjacent the first opening and the second tissue adjacent the second opening by,
(b1) inserting the first needle into an entrance point in a selected tissue;
(b2) pushing the first needle through the tissue until the first needle extends from an exit point in the selected tissue and spaced from the entrance point;
(b3) pulling the first needle out of the selected tissue and drawing the first strand portion through the selected tissue, leaving a length of the first strand portion in the selected tissue; and
(c) approximating at least a portion of the first tissue and the second tissue of the anastomosis.
17 . The method of claim 16 , wherein step (b) comprises using the needle to deploy the first strand portion along a subcutaneous path in a continuous stitch pattern which passes alternately through the first tissue adjacent the first opening and the second tissue adjacent the second opening.
18 . The method of claim 16 , wherein step (b) comprises using the needle to deploy the first strand portion along a sinusoidal subcutaneous path which passes alternately through the first tissue adjacent the first opening and the second tissue adjacent the second opening.
19 . The method of claim 16 , wherein step (b) comprises using the needle to deploy the first strand portion along a helical subcutaneous path which passes alternately through the first tissue adjacent the first opening and the second tissue adjacent the second opening.
20 . The method of claim 16 , further comprising:
(d) securing the second strand portion to tissue adjacent the anastomosis.