WO2014018344A1

WO2014018344A1 - Grasper/needle guide tool

Info

Publication number: WO2014018344A1
Application number: PCT/US2013/050923
Authority: WO
Inventors: Bernard Joseph Bourque; Michael C. Ferragamo; Konsei Shino
Original assignee: Smith & Nephew, Inc.
Priority date: 2012-07-23
Filing date: 2013-07-17
Publication date: 2014-01-30

Abstract

According to one configuration, a medical instrument comprises a proximal end and a distal end. A shaft portion of the medical instrument extends between the proximal end and the distal end. The shaft portion includes a tubular guide through which an item such as a needle is passed. The medical instrument can further include a grasper disposed at the distal end of the shaft. During a surgical operation, the grasper facilitates grasping of tissue so that it does not move. The tubular guide facilitates passage of the needle through the grasped tissue.

Description

Inventors: Bernard J. Bourque, Michael Charles Ferragamo,

and Konsei Shino Attorney Docket No.: SNI13-57(PT-4017-WO-PCT)PCT

GRASPER/NEEDLE GUIDE TOOL

RELATED APPLICATIONS

This application is related to and claims the benefit of earlier filed United States

Provisional Patent Application Serial Number 61/674,404 entitled "MENISCUS

NEEDLE GRASPER," (Attorney Docket No. PT-4017-US-PSP), filed on July 23, 2012, the entire teachings of which are incorporated herein by this reference. BACKGROUND

As shown in FIG. 1, conventional tools include a tubular guide 110-1 to direct a needle to a desired location within a patient during a respective operation. For handling purposes, one end of the tubular guide 110-1 includes a disk 120-1. The disk 120-1 at proximal end 150-1 of tubular guide 110-1 includes an opening, enabling a respective surgeon to insert a needle into tubular guide 110-1. The tubular guide 110-1 directs the need disposed therein towards distal end 150-2 of tubular guide 110-1.

As mentioned, the distal end 150-2 of the tubular guide 110-1 can be disposed in a patient to guide a respective needle to an appropriate surgical location. The tubular guide 110-1 is passive to the extent that the respective surgeon must grasp the needle and push it through the tubular guide 110-1. This may be difficult and awkward.

Tubular guide 110-2 is similar in many respects to tubular guide 110-1. For example, proximal end 151-1 of tubular guide 110-2 also includes a disk 151-1 facilitating handling of tubular guide 110-2. However, as shown, tubular guide 100-2 includes a bend at distal end 151-2. In certain instances, the bend at distal end 151-2 can be useful to steer a needle around an obstacle to an appropriate surgical location. Use of tubular guide 110-2 also may be difficult and awkward to use in a surgical setting.

BRIEF DESCRIPTION

Embodiments herein include novel cannulated guide tools for use in various applications.

For example, a first example embodiment includes a medical instrument. The medical instrument comprises a proximal end and a distal end. A shaft portion of the medical instrument extends between the proximal end and the distal end. The shaft portion includes a tubular guide through which an item such as a needle is passed. The medical instrument can further include a grasper disposed at the distal end of the shaft. During a surgical operation, the grasper facilitates grasping of an object such as tissue. The tubular guide facilitates passage of the needle through the grasped tissue.

This first example embodiment can be implemented along with any of one or more of the following limitations below (or other limitations as discussed herein) to produce yet further embodiments:

In one embodiment, the grasper at the distal end of the shaft portion includes a first jaw and a second jaw to grab a target object such as tissue.

In accordance with further embodiments, a handle is disposed at the proximal end of the medical instrument; a setting of the handle controls a positioning of the first jaw with respect to the second jaw of the grasper.

The handle can be configured to include a locking mechanism to lock the position of the first jaw with respect to the second jaw. The locking mechanism can include a release. Activation of the release unlocks the first jaw with respect to the second jaw.

In accordance with yet further embodiments, the medical instrument can include linkage extending between the handle and the grasper portion, the linkage controls an angular orientation of the first jaw with respect to the second jaw. In one embodiment, the first jaw is substantially fixed with respect to the shaft portion. The second jaw is movable with respect to the first jaw. The angular orientation of the second jaw with respect to the first jaw varies depending on the setting of the handle.

In accordance with another embodiment, the tubular guide extends along the shaft portion of the medical instrument from the proximal end to the distal end. The tubular guide includes a first opening at the proximal end and a second opening at the distal end. The openings facilitate passage of an item such as a needle into, along, and out of the tubular guide.

As mentioned, the item passed through the tubular guide of the medical instrument can be a needle. In one embodiment, the needle is free to move through the tubular guide from the proximal end to the distal end.

The medical instrument can further include a needle advancing mechanism. In one embodiment, the needle advancing mechanism controls movement of a respective needle through the tubular guide from the proximal end to the distal end of the shaft portion. A tip of the needle protrudes out an opening of the tubular guide at the distal end of the shaft portion.

In accordance with further embodiments, the needle advancing mechanism can be configured to slidably move along an axis of the shaft portion, the needle advancing mechanism exerts a gripping force on the needle to move the needle through the tubular guide when the needle advancing mechanism is moved (by a respective surgeon) in a forward direction (potentially against a spring and corresponding spring force) towards the distal end of the medical instrument. If desired, the needle advancing mechanism can be configured to discontinue exertion of the gripping or pinching force on the needle when a user of the medical instrument discontinues applying a force to the needle advancing mechanism. In one embodiment, during release of the needle advancing mechanism, the compressed spring moves the needle advancing mechanism in a reverse direction towards the proximal end (or away from the distal end) of the medical instrument to an original position. Repeated forwarding and release of the needle advancing mechanism causes the needle to move forward through the tubular guide.

A second example embodiment as discussed herein includes a method. The method can include controlling a grasper at a distal end of a medical instrument to grasp tissue; and forwarding a needle through a tubular guide of the medical instrument to the tissue.

The second example embodiment can be implemented along with any of one or more of the following limitations (or other limitations as discussed herein) to produce yet further embodiments below:

For example, in one embodiment, the method further comprises controlling a needle advancing mechanism on the medical instrument to push a tip of the needle out the distal end of the medical instrument and through an object such as tissue.

In accordance with another embodiment, a respective strand is attached to an end of the needle opposite the tip. The method can further include: pulling the needle and the respective strand through the tissue.

In accordance with further embodiments, the grasper can include multiple jaws such as a first jaw and a second jaw.

Controlling the grasper can include: operating a handle disposed on a proximal end of the medical instrument, an angle of the second jaw with respect to the first jaw varies depending on a setting of the handle.

The method can further include locking the first jaw with respect to the second jaw.

In one non-limiting example embodiment, the first jaw can be substantially fixed and substantially parallel with respect to an axis of the tubular guide or shaft portion. The second jaw can be movable with respect to the first jaw, the angular orientation of the second jaw with respect to the first jaw varying depending on the setting of the handle. In accordance with further embodiments, the method can include sliding a needle advancing mechanism along the tubular guide. The needle advancing mechanism can be advanced via application of a force from a finger of an operator.

When pushed by a respective user, the needle advancing mechanism can be configured to exert a gripping or pinching force on the needle to force the needle to move through the tubular guide in a direction towards and potentially through the tissue.

The method can further include: discontinuing exertion of the gripping force on the needle when a respective spring moves the needle advancing mechanism in a direction towards a proximal end of the medical instrument. Accordingly, the user can repeatedly press the needle advancing mechanism to advance the needle though the tubular guide to a surgical site.

In one embodiment, the needle is a first needle. The method can further comprise: controlling a needle advancing mechanism on the medical instrument to advance the first needle and push a tip of the first needle through a tubular guide of the medical instrument out the distal end and through the tissue. Advancement of the first needle creates a first perforation through the tissue. The method can further include pulling the first needle through the first perforation, a first end of a strand attached to a tail end of the first needle, the tail end of the first needle disposed opposite the tip of the first needle.

Additionally, the method can further comprise: inserting a tip of a second needle into the tubular guide of the medical instrument, a second end of the strand attached to a tail end of the second needle, the tail end of the second needle disposed opposite the tip of the second needle; controlling the needle advancing mechanism on the medical instrument to advance the second needle and push a tip of the second needle out the distal end of the medical instrument and through the tissue, the second needle creating a second perforation through the tissue, the second perforation disparately located with respect to the first perforation; and pulling the second needle through the second perforation.

In accordance with yet further embodiments, a method as discussed herein can further comprise: detaching the first needle from the strand; detaching the second needle from the strand; and tying the strand to pull the first perforation and the second perforation in a direction towards each other.

These and other more specific embodiments are disclosed in more detail below. As discussed herein, techniques herein are well suited for surgical applications.

However, it should be noted that embodiments herein are not limited to use in such applications and that the techniques discussed herein are well suited for other applications as well.

Additionally, note that although each of the different features, techniques, configurations, etc., herein may be discussed in different places of this disclosure, it is intended, where suitable, that each of the concepts can optionally be executed

independently of each other or in combination with each other. Accordingly, the one or more present inventions as described herein can be embodied and viewed in many different ways.

Also, note that this preliminary discussion of embodiments herein purposefully does not specify every embodiment and/or incrementally novel aspect of the present disclosure or claimed invention(s). Instead, this brief description only presents general embodiments and corresponding points of novelty over conventional techniques. For additional summary and details and/or possible perspectives (permutations) of the invention(s), the reader is directed to the Detailed Description section and corresponding figures of the present disclosure as further discussed below.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other objects, features, and advantages of the invention will be apparent from the following more particular description of preferred embodiments herein, as illustrated in the accompanying drawings in which like reference characters refer to the same parts throughout the different views. The drawings are not necessarily to scale, with emphasis instead being placed upon illustrating the embodiments, principles, concepts, etc. FIG. 1 is an example image of hand tools according to conventional techniques. FIG. 2 is an example side view diagram of a hand tool according to embodiments herein.

FIG. 3 is an example cross-sectional side view diagram of a medical instrument according to embodiments herein.

FIG. 4 is an example cross-sectional side view diagram of a grasper according to embodiments herein.

FIG. 5 is an example cross-sectional side view diagram of a medical instrument and corresponding open jaws according to embodiments herein.

FIG. 6 is an example cross-sectional side view diagram of a medical instrument and corresponding closed jaws according to embodiments herein.

FIG. 7 is an example diagram illustrating insertion of a needle at a proximal end of a handheld medical instrument according to embodiments herein.

FIG. 8 is an example diagram illustrating advancement of a needle through a tubular guide of the handheld medical instrument according to embodiments herein.

FIG. 9 is an example diagram illustrating grasping of tissue and advancement of a needle through the tissue using the handheld medical instrument according to

embodiments herein.

FIG. 10 is an example diagram illustrating dispensing of a first needle of a needle pair according to embodiments herein.

FIG. 11 is an example diagram illustrating dispensing of a second needle of a needle pair according to embodiments herein.

FIG. 12 is an example diagram illustrating creation of a suture according to embodiments herein.

FIG. 13 is a flowchart illustrating an example method of using a handheld medical instrument according to embodiments herein.

FIG. 14 is a flowchart illustrating an example method of using a handheld medical instrument according to embodiments herein. FIG. 15 is a flowchart illustrating an example method of using a handheld medical instrument according to embodiments herein.

DETAILED DESCRIPTION

More specifically, FIG. 2 is an example side view diagram of a hand tool according to embodiments herein.

As shown, medical instrument 200 includes a proximal end 210-1 and a distal end 210-2. A shaft portion 225 of the handheld medical instrument 200 extends between the proximal end 210-1 and the distal end 210-2.

In one embodiment, the shaft portion 225 includes a tubular guide 230 in which to guide an object such as a needle along axis 250 of tubular guide 230 to a surgical site. The tubular guide 230 and other portions of the medical instrument 200 can be made from metal such as stainless steel, plastic, etc.

In one embodiment, the tubular guide 230 includes a respective opening at the proximal end 210-1 to receive an item such as a needle inputted by a surgeon along axis 250. The tubular guide 230 of medical instrument 200 includes a respective opening at the distal end 210-2 to deliver the needle to a surgical site along axis 250.

As shown, the medical instrument 200 further includes a grasper 220 disposed at the distal end 210-2 of the shaft portion 225.

In general, the handle 260 of medical instrument 200 controls a state of the grasper 220. As its name suggests, grasper 220 enables the operator (e.g., user, surgeon, etc.) to grasp an object such as tissue, bone, cartilage, etc., in a respective surgical site. As its name suggests, needle advancing mechanism 240 can be used to control movement of the needle through the tubular guide 230 to the distal end 210-2 of the medical instrument 200 and through tissue.

In accordance with one embodiment, the grasper 220 disposed at the distal end of the shaft portion includes a first jaw 320-1 and a second jaw 320-2. The position of handle 260 (such as a scissors type handle or any other suitable type of control mechanism) disposed at the proximal end 210-1 of the medical instrument 200 controls movement and/or a positioning or orientation of the first jaw 320-1 with respect to the second jaw 320-2 of the grasper 220.

More specifically, by way of a non-limiting example, lever 261-2 of handle 260 can be substantially fixed with respect to the shaft portion 225. Lever 260-1 of handle 260 can pivot about point 370. Squeezing lever 261-1 towards lever 261-2 causes the second jaw 320-2 to close with respect to the first jaw 261-1. This provides gripping action.

Conversely, movement of lever 261-1 away from lever 261-2 causes the second jaw 320-2 to open with respect to the first jaw 261-1.

As previously discussed, the operator of medical instrument 200 can insert a needle 330 into the opening 355.

In one embodiment, the needle 330 is free to move through the tubular guide 230 from the proximal end 210-1 to the distal end 210-2 of the medical instrument 200. In other words, a user can push needle 330 to advance needle 330 though the tubular guide 230. After the user advances the tip of needle 330 through the tubular guide 230, the user can pull the needle 330 through out of the distal end 210-1 of tubular guide 230.

In certain instances, invalid data desired, the needle advancing mechanism 355 may restrict free movement of the needle 330 through the tubular guide 230. For example, the needle advancing mechanism 240 can be configured to enable forward movement of the needle 330 to the distal end 210-2 but restrict movement of the needle 330 in a backward direction towards the proximal end 210-1.

If desired, the needle advancing mechanism 240 can include a release mechanism activated by the operator to enable backward movement of the needle out the proximal end 210-1.

FIG. 4 is an example cross-sectional side view diagram of a grasper according to embodiments herein. As shown by way of a non-limiting example, in one embodiment, the first jaw 320-1 can be substantially fixed with respect to the shaft portion 225. The second jaw 320-2 can be movable with respect to the first jaw 320-1.

An angle 430 (e.g., angular orientation) of the second jaw 320-2 with respect to the first jaw 320-1 varies depending on the setting of the handle 260 as previously discussed.

More specifically, movement of lever 261-1 towards the lever 261-2 causes the linkage 365 to slide toward the distal end 210-2 of the medical instrument 200 and close the second jaw 320-2 with respect to the first jaw 320-1.

Conversely, movement of lever 261-1 away from the lever 261-2 causes the linkage 365 to move toward the proximal end 210-1 of the medical instrument 200 and open the second jaw 320-2 with respect to the first jaw 320-1.

Accordingly, the linkage 365 extending between the handle 240 and the grasper 220 controls an angular orientation of the first jaw 320-1 with respect to the second jaw 320-2.

In accordance with alternative embodiments, note that both the first jaw 320-1 and the second jaw 320-2 can be movable with respect to the shaft portion 225 as opposed to the second jaw 320-2 only being movable with respect to the shaft portion 225.

As mentioned, as the needle 330 is moved forward through the tubular guide 230, the tip of needle 330 exits the tubular guide 230 at the distal end 210-2 of the medical instrument 200. The grasper 220 can be used to grasp an object such as tissue. Gripping of tissue using grasper 220 makes it easier to move the tip of needle 330 into and through a desired surgical location.

In one embodiment, the linkage 365 is substantially parallel to axis 250. The offset 410 of the needle 330 with respect to the grasper 220 is between 0.1 and 10 millimeters, although the offset 410 can be any suitable value outside of this range as well. In certain instances, it may be desirable that the distal end 210-2 of the medical instrument 200 is narrow to be less intrusive to a patient. Thus, a smaller magnitude of offset 410 may be desired.

As shown, the handle 260 of the medical instrument 200 can include a locking mechanism 520 (such as a lever that pivots around point 512) to lock the position of the first jaw 320-1 with respect to the second jaw 320-2.

For example, spring 530 applies a force to locking mechanism 520 in direction 540 pushing teeth 550 against stopper 560. As a result of the user squeezing the handle 260, an appropriate tooth is pushed against the stopper 560 and the locking mechanism 520 prevents lever 261-1 from moving away from lever 261-2 (closing the grasper 220) at distal end 210-2.

Referring now to FIG. 6, the locking mechanism 520 can be released to unlock the position of the first jaw 320-1 with respect to the second jaw 320-2. As an example, to open the grasper 220, the user can apply a force (such as using an appropriate finger) in direction 620 to overcome force exerted by spring 530. In such an instance, the teeth 550 no longer engage with stopper 560. The lever 261-1 can then be moved away from lever 261-2, opening jaws of grasper 220.

If desired, note that the levers 261 of handle 260 can be spring-loaded such that the jaws 320 automatically open upon activation of the release function as discussed above.

FIG. 7 is an example diagram illustrating insertion of a needle at a proximal end of the medical instrument according to embodiments herein. The needle advancing mechanism 240 enables the user to push the needle 330 into opening 335 at proximal end 210-1 to insert the needle 330 into tubular guide 230. Thereafter, the user applies a force to lever 840 to advance the needle advancing mechanism 240 (and needle 330) along shaft towards distal end 210-2.

FIG. 8 is an example diagram illustrating advancement of a needle through a tubular guide of the handheld medical instrument according to embodiments herein. As previously discussed, the needle advancing mechanism 240 can be used to control movement of a respective needle 330 through the tubular guide 230 from the proximal end 210-1 to the distal end 210-2 of the shaft portion 225.

When pushed far enough, a tip of the needle 330 protrudes out an opening of the tubular guide 230 at the distal end 210-2 of the shaft portion 225.

In one non-limiting example embodiment, the needle advancing mechanism 240 slidably moves along an axis 250 of the shaft portion 225. As mentioned, the needle advancing mechanism 240 slides forward via a user applying a respective force to lever 840 towards distal end 210-2.

The needle advancing mechanism 240 can be configured to exert a gripping or clamping force on the needle 330 to move the needle 330 through the tubular guide 230 when the needle advancing mechanism 240 is moved in a forward direction towards the distal end 210-2 of the medical instrument. More specifically, in one non-limiting example embodiment, needle advancing mechanism 240 lever 840 pressed by the operator. Pressing lever 840 causes clamp 820 to pinch the needle 330 as shown. The forward force applied to the lever 840 transfers to the needle 330, advancing the needle 330 forward through the tubular guide 230.

The slidable needle advancing mechanism 240 can include spring 850 that is configured to push the needle advancing mechanism 240 away from the distal end 210-2 after the user discontinues pressing the lever 840. In such an instance, after release, the needle advancing mechanism 240 discontinues exertion of the gripping force (via clamp 820 or pincher) on the needle 330. The compressed spring 850 in the needle advancing mechanism 240 moves the needle advancing mechanism 240 in a reverse direction away from the distal end 210-2. Although the needle advancing mechanism 240 reverts back to an original position after release, the needle 330 does not move backwards towards proximal end 210-1. Accordingly, to advance the needle 330 through the tubular guide 230, the user repeatedly pushes the lever 840 forward and releases lever 840 of needle advancing mechanism 240. FIG. 9 is an example diagram illustrating grasping of tissue and advancement of a needle through the tissue using the handheld medical instrument according to

embodiments herein.

As shown, a surgical site 900 can include tissue 920 (such as a meniscus or other suitable object). The tissue can include damage such as a tear 940. As previously discussed, use of the medical instrument 200 can include grasping the tissue 920 as shown via grasper 220. The user inserts a respective needle 330 into the medical instrument 220 and advances the tip of needle 330 through the tissue 920.

More specifically, in a manner as previously discussed, the user initially inserts and advances needle 331-1 (tip first) through tubular guide 230 to a respective surgical location. A tail end of the needle 331-1 is connected to strand 1010 (flexible material such as thread, string, suture thread, etc.). As shown, the other end of strand 1010 is connected to the tail end of needle 331-2.

FIG. 11 is an example diagram illustrating dispensing of a second needle of a needle pair through the handheld medical instrument according to embodiments herein.

Subsequent to advancing the needle 331-1 through the tubular guide 230, the user inserts the tip of the needle 331-2 and corresponding body of needle 331-2 into tubular guide 230. In a similar manner as previously discussed, the user advances the needle 331-2 to the appropriate surgical location. The second needle 331-2 can be inserted through a different surgical location than the first needle 331-1.

Note that after advancing needle 331-1 through the tubular guide 230, a portion of the strand 1010 resides in the tubular guide 230 when the second needle 331-2 is inserted into the tubular guide 230. Thus, both the needle 331-2 and the portion of the strand reside in the tubular guide 230 at the same time.

FIG. 12 is an example diagram illustrating creation of a surgical suture according to embodiments herein. As previously discussed, the user operates the medical instrument 200 to insert needle 331-1 and needle 331-2 through the tissue 920. Each needle perforates a different location of the tissue 920. In one embodiment, the user pulls both needles 331-1 and 331-2 through the tissue 920 and uses the strand 1010 to create a stitch and sew the tissue 920 together in a similar manner as sutures 1020 holds tissue 920 as shown. As an example, the strand 1010 is cut to remove needles 331. The remaining portion of strand 1010 is ten tied off to create a surgical suture, holding body tissue together.

FIG. 13 is a flowchart 1300 illustrating an example method of using a medical instrument according to embodiments herein. Note that the order of steps is shown by way of non-limiting example only and that the steps can be performed in any suitable order.

In step 1310, a user controls grasper 220 disposed at a distal end 210-2 of medical instrument 200 to grasp tissue such as tissue 920.

In step 1320, the user forwards a needle 330 through a tubular guide 230 of the medical instrument 200 to the tissue such as tissue 920.

FIG. 14 is a flowchart 1400 illustrating an example method of utilizing a handheld medical instrument according to embodiments herein. Note that the order of steps is shown by way of non-limiting example only and that the steps can be performed in any suitable order.

In step 1410, a user operates the medical instrument 200 to control a grasper 220 at a distal end 210-2 of a medical instrument 200 to grasp tissue 920.

In sub-step 1420, the user operates a handle 260 disposed on a proximal end 210-1 of the medical instrument 200. An angle of the second jaw 320-2 with respect to the first jaw 320-1 varies depending on a setting of the handle 260.

In sub-step 1430, the user operates the medical instrument 200 to lock the first jaw 320-1 with respect to the second jaw 320-2. As discussed below, the closed jaws 320 of the grasper 220 hold the tissue 920 in place as the needle is inserted through the tissue 920. In step 1440, a user operates the medical instrument 200 to forward a needle 330 through a tubular guide 230 of the medical instrument 200 to a desired location of the tissue 920.

In sub-step 1450, the user operates the medical instrument 200 to slide a needle advancing mechanism 240 along the tubular guide 230. In such an instance, the needle advancing mechanism 240 exerts a gripping force on the needle 330 to move the needle 330 through the tubular guide 230 in a direction towards the tissue 920. The needle advancing mechanism 240 discontinues exertion of the gripping force on the needle 330 when a respective spring 850 moves the needle advancing mechanism 240 in a direction away from the distal end 210-2 such as towards a proximal end 210-1 of the medical instrument 200. The needle 330 passes through the tissue as mentioned.

In step 1460, the user operating the medical instrument 200 pulls the needle 330 and the respective strand 1010 (trailing behind the strand 1010) through the tissue.

FIG. 15 is a flowchart 1500 illustrating example steps of a user utilizing a hand tool according to embodiments herein. Note that the order of steps is shown by way of non-limiting example only and that the steps can be performed in any suitable order.

In step 1510, a user (e.g., a surgeon, operator, etc.) controls a needle advancing mechanism 240 on the medical instrument 200 to advance a first needle 331-1 and push a tip (e.g., sharp point) of the first needle 331-1 along and through a tubular guide 230 of the medical instrument 200 out the distal end 210-2 and through respective tissue. The passage of the first needle 331-1 through tissue 920 creates a first perforation through the tissue 920.

In step 1520, the user pulls the first needle 331-1 through the first perforation. As previously discussed, a first end of a strand 1010 is attached to a tail end of the first needle 331-1. The tail end of the first needle 331-1 is disposed opposite the tip (e.g., sharp point) of the first needle 331-1.

In step 1530, the user inserts a tip of a second needle 331-2 into the tubular guide 230 of the medical instrument 200. As previously discussed, a second end of the strand 1010 attaches to a tail end of the second needle 331-2. The tail end of the second needle 331-2 is disposed opposite the tip (e.g., sharp point) of the second needle 331-2.

In step 1540, the user controls the needle advancing mechanism 240 on the medical instrument 240 to advance the second needle 331-2 and push a tip of the second needle 331-2 out the distal end 210-2 of the medical instrument 200 and through the tissue 920. In one embodiment, the second needle 331-2 creates a second perforation through the tissue 920. As mentioned, the location of the second perforation can be disparately located with respect to the first perforation in the tissue 920.

In step 1550, the user pulls the second needle 331-2 through the second perforation.

In step 1560, the user detaches the first needle 331-1 from the strand 1010.

In step 1570, the user detaches the second needle 331-2 from the strand 1010.

In step 1580, the user ties a remaining portion of ends of the strand 1010 together to create a surgical stitch or suture that pulls the first perforation and the second perforation in a direction towards each other, repairing a surgical site such as a tear in respective tissue (such as a meniscus).

Note again that techniques herein are well suited for use in surgical applications. However, it should be noted that embodiments herein are not limited to use in such applications and that the techniques discussed herein are well suited for other applications as well.

While this invention has been particularly shown and described with references to preferred embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the spirit and scope of the present application as defined by the appended claims. Such variations are intended to be covered by the scope of this present application. As such, the foregoing description of embodiments of the present application is not intended to be limiting. Rather, any limitations to the invention are presented in the following claims.

Claims

is claimed is:

A medical instrument comprising:

a proximal end;

a distal end;

a shaft portion extending between the proximal end and the distal end, the shaft portion including a tubular guide; and

a grasper disposed at the distal end of the shaft.

The medical instrument of claim 1, wherein the grasper at the distal end of the shaft portion includes a first jaw and a second jaw.

The medical instrument of claim 2 further comprising:

a handle disposed at the proximal end of the medical instrument, a setting of the handle controlling a position of the first jaw with respect to the second jaw of the grasper.

The medical instrument of claim 2 or 3, wherein the tubular guide extends along the shaft portion from the proximal end to the distal end, the tubular guide including a first opening at the proximal end and a second opening at the distal end.

The medical instrument of claim 1, 2, 3, or 4 further comprising:

a needle, the needle free to move through the tubular guide from the proximal end to the distal end.

6. The medical instrument of claim 3, wherein the handle includes a locking

mechanism to lock the position of the first jaw with respect to the second jaw.

7. The medical instrument as in claim 6, wherein the locking mechanism includes a release to unlock the position of the first jaw with respect to the second jaw.

8. The medical instrument as in claim 3 further comprising:

linkage extending between the handle and the grasper portion, the linkage controlling an angular orientation of the first jaw with respect to the second jaw.

9. The medical instrument as in claim 3, 6, 7 or 8, wherein the first jaw is

substantially fixed with respect to the shaft portion; and

wherein the second jaw is movable with respect to the first jaw, the angular orientation of the second jaw with respect to the first jaw varying depending on the setting of the handle.

10. The medical instrument of claim 1, 2, 3, 4, 5, 6, 7, 8, or 9 further comprising:

a needle advancing mechanism, the needle advancing mechanism controlling movement of a respective needle through the tubular guide from the proximal end to the distal end of the shaft portion; and

wherein a tip of the needle protrudes out an opening of the tubular guide at the distal end of the shaft portion.

11. The medical instrument of claim 10, wherein the needle advancing mechanism slidably moves along an axis of the shaft portion, the needle advancing mechanism exerting a gripping force on the needle to move the needle through the tubular guide when the needle advancing mechanism is moved in a forward direction towards the distal end of the medical instrument.

12. The medical instrument as in claim 11, wherein the needle advancing mechanism includes a spring; and wherein the needle advancing mechanism discontinues exertion of the gripping force on the needle when a user of the medical instrument discontinues applying a force to the needle advancing mechanism and a corresponding decompression of the spring moves the needle advancing mechanism in a reverse direction towards the proximal end of the medical instrument.

A method comprising:

controlling a grasper at a distal end of a medical instrument to grasp tissue; and

forwarding a needle through a tubular guide of the medical instrument to the tissue.

The method as in claim 13 further comprising:

controlling a needle advancing mechanism on the medical instrument to push a tip of the needle out the distal end of the medical instrument and through the tissue.

The method as in claim 13, wherein a respective strand is attached to an end of the needle opposite the tip, the method further comprising:

pulling the needle and the respective strand through the tissue.

The method as in claim 13, 14, or 16, wherein the grasper includes a first jaw and a second jaw; and

wherein controlling the grasper includes operating a handle disposed on a proximal end of the medical instrument, an angle of the second jaw with respect to the first jaw varying depending on a setting of the handle.

17. The method as in claim 16 further comprising:

locking the first jaw with respect to the second jaw. The method as in claim 14, 15, 16, or 17, wherein the first jaw is substantially fixed and substantially parallel with respect to an axis of the tubular guide; and wherein the second jaw is movable with respect to the first jaw, the angular orientation of the second jaw with respect to the first jaw varying depending on the setting of the handle.

The method as in claim 13, 14, 15, 16, 17, or 18 further comprising:

sliding a needle advancing mechanism along the tubular guide, the needle advancing mechanism exerting a gripping force on the needle to move the needle through the tubular guide in a direction towards the tissue.

20. The method as in claim 19 further comprising:

discontinuing exertion of the gripping force on the needle when a respective spring moves the needle advancing mechanism in a direction towards a proximal end of the medical instrument.

21. The method as in claim 13, 14, 15, 16, 17, or 18, wherein the needle is a first needle, the method further comprising:

controlling a needle advancing mechanism on the medical instrument to advance the first needle and push a tip of the first needle through a tubular guide of the medical instrument out the distal end and through the tissue, the first needle creating a first perforation through the tissue; and

pulling the first needle through the first perforation, a first end of a strand attached to a tail end of the first needle, the tail end of the first needle disposed opposite the tip of the first needle.

22. The method as in claim 21 further comprising: inserting a tip of a second needle into the tubular guide of the medical instrument, a second end of the strand attached to a tail end of the second needle, the tail end of the second needle disposed opposite the tip of the second needle; controlling the needle advancing mechanism on the medical instrument to advance the second needle and push a tip of the second needle out the distal end of the medical instrument and through the tissue, the second needle creating a second perforation through the tissue, the second perforation disparately located with respect to the first perforation; and

pulling the second needle through the second perforation.

The method as in claim 22 further comprising:

detaching the first needle from the strand;

detaching the second needle from the strand; and

tying the strand to pull the first perforation and the second perforation in a direction towards each other.