Instrument for assisting in the remote placement of tied surgical knots and trimming of suture away from the knot and method of use

摘要

An instrument (10) is provided having a shaft (12) extending to a distal end (16). The distal end (16) has a distal tip member (40) having a cavity (42, 83), and a passageway (44, 80) extending to the cavity through which a first suture end (48A) of a loop of suture (48) extends from a tissue site to facilitate a user looping a second suture end (48B) around the first suture end (48A) between the distal tip member (40) and the tissue site to form a knot (48C). Advancing of the distal tip member (40) while drawing the first suture end (48A) through the passageway (44, 80) pushes the knot (48C) for placement at the tissue site. The distal tip member (79) of another embodiment provides an additional open-sided passageway (81) through which the second suture end (48B) is passed to assist in forming and pushing a knot at to the tissue site. A more secure knot (50) may be formed by a double loop (49A) and then a single loop (49B) by the second suture end (48B) around the first suture end (48A) and appropriate tensioning of the first and second suture ends when the knot is pushed to the tissue site. The distal end (16) further has two openings (46, 47) through which the two suture ends (48A, 4813) are passed from the placed knot (48C, 50), and a blade (38) in the distal end (16) is positionable to cut the two suture ends near the tissue site to trim the suture away from such knot.