Anastomosis method using self-retaining sutures
An anastomosis procedure utilizes a self-retaining suture to secure one vessel to another vessel. One or more self-retaining sutures are deployed around the interface between the vessels. The self-retaining sutures have tissue-grasping surface features which allow passage of the sutures in one direction through tissue, but not in the opposite direction. The self-retaining sutures may be deployed using a needle attached to the end of the sutures. The anastomosis technique may be performed without using knots.
1. A method for creating an anastomosis between a first tubular structure having a first end and a second tubular structure having a second end, the method comprising:
(a) receiving a suture system including a suture having a first suture section having a first pointed end and a second suture section having a second pointed end, a first plurality of barbs projecting from the first suture section, the first plurality of barbs being adapted to permit movement of the first suture section through tissue in the direction of the first pointed end and resist movement in an opposite direction, and a second plurality of barbs projecting from the second suture section, the second plurality of barbs being adapted to permit movement of the second suture section through tissue in the direction of the second pointed end and resist movement in an opposite direction;
(b) deploying the first suture section along a path within at least the first tubular structure adjacent the first end; and
(c) securing the second suture section to at least tissue of the second tubular structure adjacent the second end by deploying the second suture section along a path through at least tissue of the second tubular structure adjacent the second end; and
(d) approximating and joining the first end and second end to create an anastomosis between the first tubular structure and the second tubular structure without forming a loop with the suture (d1) inserting the first pointed end in tissue of the first tubular structure adjacent the first end; (d2) pushing the first pointed end along a curvilinear path through tissue of the first tubular structure adjacent the first end until it projects out of the tissue of the first tubular structure; and (d3) pulling the first pointed end out of the tissue of the first tubular structure and drawing the first suture section through the curvilinear path but leaving a part of the first suture section within the first curvilinear path.
2. The method of claim 1 , wherein step (d) further comprises:
(d4) inserting the first pointed end in tissue of the second tubular structure adjacent the second end;
(d5) pushing the first pointed end along a second curvilinear path through tissue of the second tubular structure adjacent the second end until it projects out of the tissue of the second tubular structure; and
(d6) pulling the first pointed end out of the tissue of the second tubular structure and drawing the first suture section through the second curvilinear path but leaving a part of the first suture section within the second curvilinear path.
3. The method of claim 2 further comprising repeating steps (d1), (d2), (d3), (d4), (d5), and (d6).
4. The method of claim 3 , wherein step (d) comprises deploying the first suture section along a continuous path which repeatedly crosses from tissue of the first tubular structure to tissue of the second tubular structure and back again.
5. The method of claim 1 , comprising repeating steps (a), (b), (c), and (d) with a plurality of suture systems to create an anastomosis.
6. The method of claim 1 , performed endoscopically.
7. The method of claim 1 , wherein step (b) comprises using an insertion device in which the first suture section is initially disposed to deploy the first suture section along a path within at least the first tubular structure adjacent the first end.
8. A method for creating an anastomosis between a first vessel having a first opening and a second vessel having a second opening, the method comprising:
(a) receiving a suture system including a suture having a first suture section having a first pointed end and a second suture section having a second pointed end, a first plurality of projections distributed on the first suture section, the first plurality of projections being adapted to permit movement of the first suture section through tissue in a direction of the first pointed end and resist movement in an opposite direction, and a second plurality of projections distributed on the second suture section, the second plurality of projections being adapted to permit movement of the second suture section through tissue in a direction of the second pointed end and resist movement in an opposite direction;
(b) deploying the first suture section along a path within at least the first vessel adjacent the first opening; and
(c) securing the second suture section to at least tissue of the second vessel adjacent the second opening by deploying the second suture section along a path through at least tissue of the second vessel adjacent the second opening; and
(d) deploying the first suture section along a continuous path which passes alternately through the tissue of the first vessel and the tissue of the second vessel, thereby approximating and joining the first opening and second opening to create an anastomosis between the first vessel and the second vessel without forming a loop with the suture.
9. The method of claim 8 , wherein step (d) comprises:
(d1) inserting the first pointed end in tissue of the first vessel adjacent the first opening;
(d2) pushing the first pointed end along a curvilinear path through tissue of the first vessel adjacent the first opening until it projects out of the tissue of the first vessel; and
(d3) pulling the first pointed end out of the tissue of the first vessel and drawing the first suture section through the curvilinear path but leaving a part of the first suture section within the first curvilinear path.
10. The method of claim 9 , wherein step (d) further comprises:
(d4) inserting the first pointed end in tissue of the second vessel adjacent the second opening;
(d5) pushing the first pointed end along a second curvilinear path through tissue of the second vessel adjacent the second opening until it projects out of the tissue of the second vessel; and
(d6) pulling the first pointed end out of the tissue of the second vessel and drawing the first suture section through the second curvilinear path but leaving a part of the first suture section within the second curvilinear path.
11. The method of claim 8 , further comprising repeating steps (a), (b), (c), and (d) with another suture system.
12. The method of claim 8 , performed endoscopically.
13. The method of claim 8 , wherein step (b) comprises using an insertion device in which the first suture section is initially disposed to deploy the first suture section along a path within at least the first vessel adjacent the first opening.
14. A method for creating a knotless anastomosis between a first vessel having a first opening in a first wall and a second vessel having a second opening in a second wall, the method comprising:
(a) receiving a suture system including a suture having a first suture section having a first pointed end and a second suture section having a second pointed end, a first plurality of projections distributed on the first suture section, the first plurality of projections being adapted to permit movement of the first suture section through tissue in the direction of the first pointed end and resist movement in an opposite direction, and a second plurality of projections distributed on the second suture section, the second plurality of projections being adapted to permit movement of the second suture section through tissue in the direction of the second pointed end and resist movement in an opposite direction;
(b) deploying the first suture section along a path within the first wall of the first vessel adjacent the first opening;
(c) deploying the second suture section along a path within the second wall of the second vessel adjacent the second opening;
(d) approximating and joining the first opening and second opening to create an anastomosis between the first vessel and the second vessel without forming a loop with the suture , (d1) inserting the first pointed end in the first wall adjacent the first opening; (d2) pushing the first pointed end along a curvilinear path through the first wall adjacent the first opening until it projects out of the first wall; and (d3) pulling the first pointed end out of the first wall and drawing the first suture section through the curvilinear path but leaving a part of the first suture section within the first wall.
15. The method of claim 14 , wherein step (d) further comprises:
(d4) inserting the second pointed end in the second wall adjacent the second opening;
(d5) pushing the second pointed end along a curvilinear path through the second wall adjacent the second opening until it projects out of the second wall; and
(d6) pulling the second pointed end out of the second wall and drawing the second suture section through a curvilinear path but leaving a part of the second suture section within the second wall.