Method of endoscopic suturing
An endoscopic suturing system and method are disclosed as are devices for use with the system and method such as a suture dispenser, a cinch device, and a tissue grasper. In one embodiment the suturing system includes a cap assembly arranged at the distal end portion of an endoscope or guide member, with the cap assembly including a rotatable needle holder. The needle holder is actuated through a transmission element extending outside the endoscope or guide member. A needle capture device may be inserted through a channel of the endoscope or guide member in order to capture a needle held in the needle holder when the needle holder is rotated so that the needle punctures tissue.
1. A method of suturing tissue of a mammal using an endoscopic suturing system, comprising the follow steps:
(a) inserting an endoscope into a body with a suturing device coupled to the endoscope, the endoscope having an instrument channel extending therethrough;
(b) opening a needle arm of the suturing device having a removable needle removably coupled to the needle arm;
(c) drawing tissue at a desired suture site between the needle and a distal end of the endoscope;
(d) closing the needle arm of the suturing device such that the needle axially aligns with the instrument channel of the endoscope;
(e) piercing the tissue with the needle;
(f) recovering the needle within the distal end of the endoscope by using a needle capture device extended through the instrument channel of the endoscope;
(g) opening the needle arm to disengage the needle arm relative to the needle;
(h) closing the needle arm; and
(i) removing the suturing device from the body.
2. A method according to claim 1 , further comprising:
after step (b) and before step (c), engaging a tissue adjacent a desired suture site using a tissue grasper; and
after step (g) and before step (h), releasing the tissue from the tissue grasper.
3. A method according to claim 1 , further comprising:
(j) after step (h) and before step (i), inserting the needle into the needle arm endoscopically using the needle capture device; and
repeating steps (b) through (h) and (j) as needed.
4. A method according to claim 1 , wherein:
the needle arm is rigid.
5. A method according to claim 1 , wherein:
the needle arm is rigid,
the instrument channel opens at a distal end face of the endoscope, and
the needle arm extends through a predefined plane intersecting the distal end face of the endoscope.
6. A method of suturing tissue of a mammal using an endoscopic suturing system, comprising the follow steps:
(a) inserting a guide tube into a body;
(b) inserting a suturing device coupled to an endoscope into the guide tube and inserting the suturing device into the body;
(c) opening a needle holding arm of the suturing device having a removable needle clip;
(d) engaging a tissue adjacent a desired suture site using a tissue grasper;
(e) pushing the needle clip against tissue at a desired suture site;
(f) closing the needle holding arm of the suturing device such that the needle clip pierces the tissue and the needle clip axially aligns with an instrument channel of the endoscope;
(g) grasping the needle clip using a needle capture device extended through the instrument channel of the endoscope;
(h) opening the needle holding arm to remove it from tissue;
(i) releasing the needle clip from the needle capture device;
(j) releasing the tissue from the tissue grasper;
(k) closing the needle holding arm; and
(l) removing the suturing device from the body.
7. A method according to claim 6 , wherein:
the tissue grasper includes a helical coil with a sharp distal tip that is rotated into the tissue to engage the tissue.
8. A method according to claim 7 , wherein:
the suturing device is removed from the body while the needle arm is closed.
9. A method according to claim 6 , wherein:
said engaging tissue includes rotating the tissue grasper relative to the tissue.
10. A method according to claim 6 , further comprising:
after opening the needle arm, releasing the tissue grasper from the tissue.
11. A method according to claim 10 , wherein:
said releasing includes rotating the tissue grasper relative to the tissue.
12. A method according to claim 6 , wherein:
the needle holding arm is rigid.
13. A method of suturing tissue of a mammal using an endoscopic suturing system, comprising the follow steps:
(a) inserting an endoscope into a body with a suturing device coupled to the endoscope, the endoscope having an instrument channel;
(b) rotating open a rigid needle arm of the suturing device having a removable needle with a length of suture fixed thereto;
(c) engaging a tissue adjacent a desired suture site using a tissue grasper;
(d) drawing the engaged tissue into the path of the needle;
(e) rotating the rigid needle arm of the suturing device to cause the needle to pierce the tissue;
(f) engaging the needle with a needle capture device passed through the endoscope;
(g) recovering the needle with the needle capture device within the instrument channel;
(h) rotating open the rigid needle arm;
(i) closing the rigid needle arm; and
(j) removing the suturing device from the body.
14. A method according to claim 13 , wherein:
the tissue grasper includes a helical coil with a sharp distal tip that is rotated into the tissue to engage the tissue.
15. A method according to claim 13 , wherein:
said engaging tissue includes rotating the tissue grasper relative to the tissue.
16. A method according to claim 13 , further comprising:
after opening the needle arm, releasing the tissue grasper from the tissue.
17. A method according to claim 16 , wherein:
said releasing includes rotating the tissue grasper relative to the tissue.
18. A method according to claim 13 , wherein:
the suturing device is removed from the body while the needle arm is closed in a closed position.
19. A method according to claim 13 , wherein:
the instrument channel opens at a distal end face of the endoscope, and
the needle arm rotates in a path extending through a predefined plane intersecting the instrument channel.
20. A method of suturing tissue of a mammal using an endoscopic suturing system, comprising the following steps:
(a) inserting an endoscope into a body with a suturing device coupled at a distal end of the endoscope, the endoscope having an instrument channel that opens at a distal end face of the endoscope, the suturing device having a rigid needle arm and a needle removably coupled thereto, the needle arm rotatable through a predefined plane intersecting the instrument channel of the endoscope;
(b) rotating the needle arm of the suturing device into an open position to define a space between the needle and distal end of the endoscope;
(c) positioning tissue within the space between the needle in the open position and the distal end of the endoscope;
(d) rotating the needle arm into a closed position and toward the distal end of the endoscope in order to pierce the tissue with the needle;
(e) positioning the needle in alignment with the instrument channel of the endoscope;
(f) mechanically engaging the needle with an instrument extending through the instrument channel of the endoscope; and
(g) opening the needle arm to disengage the needle arm relative to the needle.
21. A method according to claim 20 , wherein:
a length of suture is fixed to the needle and extends through an instrument channel of the endoscope.
22. A method according to claim 20 , wherein:
the needle is recovered within the distal end of the endoscope using an instrument that is longitudinally displaceable within and removable from the endoscope.
23. A method according to claim 20 , further comprising:
after step (g), removing the disengaged needle arm from tissue.
24. A method according to claim 20 , further comprising:
after step (g), rotating the needle arm into a closed position, and removing the suturing device from the body with the needle arm in the closed position.