Endoscopic Suture Cinch System
A suture cinch, cinch applicator, and cinch loader for loading the cinch into the cinch applicator are provided and permit re-use of the applicator with multiple cinches during an endoscopic procedure. The applicator can be loaded with a first cinch, apply the first cinch onto a portion of suture to fix the portion of suture relative to anatomical tissue, reloaded with a second cinch optionally using the loader, and subsequently used to apply the second cinch to fix another portion of suture to fix the other portion of suture relative to anatomical tissue. The cinch is a tubular member through which the suture can be advanced when the cinch is loaded within the applicator. The cinch defines multiple ribs and cutter defined in a wall thereof. Operation of the applicator deforms the ribs inward to retain the cinch on the suture, and displaces the cutter to sever the suture.
1 . A cinch applicator for applying a tubular suture cinch to suture, the cinch having a distal first portion defining a lateral suture entry opening, and a proximal second portion defining a lateral suture exit opening, an internal suture pathway between the entry and exit openings, and a deformable structure between the entry and exit openings, the cinch applicator comprising:
a) an elongate first tubular member having proximal and distal ends and defining a longitudinal axis therebetween;
b) a housing adapted to receive the cinch, said housing having a proximal end and a distal end, said proximal end coupled to said first tubular member, and said housing defining,
i) a relatively longitudinally extending distal hood for extending about the second side of the cinch and open to provide access to the entry opening of the cinch such that suture may be advanced into the entry opening,
ii) a socket relatively proximal to said hood, said socket having a taper that tapers in a distal-to-proximal direction, and
iii) a window defined in said housing adjacent a proximal end of the socket, said window opening into said socket for alignment with the exit opening of the cinch when the cinch is loaded within said housing and adapted for passage of suture out thereof;
c) a shaft extending through said tubular member, said shaft having a proximal end and a distal end;
d) a force applying member at said distal end of the shaft, said force applying member adapted for contacting and deforming the deformable structure of the cinch when the cinch is loaded in said socket; and
e) a proximal handle operable to move said shaft relative to said housing.
2 . A cinch applicator according to claim 1 , wherein:
said taper of said socket is defined by a first wall extending proximally from said hood and oriented obliquely relatively to said longitudinal axis of said tubular member and an opposing axial wall oriented parallel to said longitudinal axis.
3 . A cinch applicator according to claim 1 , wherein:
said first wall and said axial wall are preferably angled at approximately 9°-11° relative to each other.
4 . A cinch applicator according to claim 2 , wherein:
said axial wall is located in space to allow said force applying member to be displaced along said longitudinal axis as said force applying member is contacting and deforming the deformable structure of the cinch.
5 . A cinch applicator according to claim 4 , wherein:
said force applying member is a spherical bead.
6 . A cinch applicator according to claim 4 , wherein:
said tubular member is flexible, said shaft is flexible, and each of said tubular member and shaft are sufficiently flexible to be bent through 180°.
7 . A cinch applicator according to claim 4 , wherein:
said housing has a maximum length of 25 mm and a maximum outer diameter of 2.6 mm.
8 . A cinch applicator according to claim 1 , further comprising:
a cutter displaceable relative to said window of said housing, said cutter adapted to cut suture extending through said window.
9 . A cinch applicator according to claim 8 , wherein:
said cutter is located external said housing.
10 . A cinch applicator for applying a deformable suture cinch to suture, the applicator comprising:
a) an elongate first tubular member having proximal and distal ends and defining a longitudinal axis therebetween;
b) a housing adapted to receive the suture cinch, said housing having a proximal end and a distal end, said proximal end coupled to said first tubular member, and said housing defining,
i) a relatively longitudinally extending distal hood for extending about a first circumferential portion of the cinch and open to provide access to a suture entry opening provided in a rotationally displaced second circumferential portion of the cinch,
ii) a socket relatively proximal to said hood, said socket having a taper that tapers in a distal-to-proximal direction, and
iii) a window defined in said housing adjacent a proximal end of the socket, said window opening into said socket;
c) a shaft extending through said tubular member, said shaft having a proximal end and a distal end;
d) a force applying member at said distal end of the shaft, said force applying member adapted for contacting and deforming the cinch loaded in said socket; and
e) a proximal handle operable to longitudinally displace said shaft and the force applying member relative to said housing.