fig1 - 6 illustrate how a partially tied surgical knot can be made from a length of suture filament . the partially tied knot thus formed can be used in the practice of the specific embodiment of this invention illustrated in fig2 - 39 . of course , other partially tied knots can be used in the practice of this invention . the suture filament 30 shown in fig1 can be composed of any suture material currently used or hereafter developed . the suture filament may be a monofilament suture or a multifilament , braided suture . the suture filament , regardless of construction , may be non - absorbable or bio - absorbable , depending on the particular application for which the suture is being used to fasten tissue . the length of suture filament 30 has proximal and distal ends , 31 and 32 , respectively . adjacent the proximal end , there is a proximal length 33 of suture filament . correspondingly , adjacent the distal end of the suture filament , there is a distal length 34 of the suture filament . as shown in fig2 a first loop 35 is formed by manipulating the distal length 34 of the suture filament . now looking at fig3 while the proximal length 33 of the suture filament remains fixed , the distal length is manipulated to form a second loop 36 wrapped generally transversely around the first loop 35 . third and fourth loops , 37 and 38 , respectively , are likewise formed about the first loop as depicted in fig4 . the second , third and fourth loops are generally parallel to each other and are oriented generally transversely to the first loop . for purposes of describing this partially tied knot , these loops may be referred to collectively as the &# 34 ; knot loops &# 34 ;. the number of knot loops may vary depending on the particular application for which the knot is used . in the illustrated embodiment , the second , third and fourth loops together form a common loop core 39 which receives the first loop 35 . reviewing fig5 the loosely formed knot is tightened by applying tension on the distal length 34 of the suture filament . in so doing , the second , third and fourth loops tighten down on the first loop , and thus the first loops is securely received in the common loop core . as depicted in fig6 a tissue - fastening loop 40 can be formed by passing the distal end 32 and the distal length 34 of the suture filament through the first loop 35 . to form the knot , the partially tied knot of fig6 is taken , and tension on the proximal length 33 of the suture filament is applied in the proximal direction as indicated by the arrow in fig7 . to facilitate forming the knot , the surgeon ideally holds his fingertips against the proximal side of the knot loops while tension is applied to the proximal length 33 of the suture filament . alternatively , as described in the embodiments below , an instrument can be used to hold the knot loops in place . as tension is applied , the first loop 35 begins to be pulled through the common loop core 39 of the knot . when the first loop has sufficiently diminished in size from that shown in fig6 it snares the distal length 34 of the suture filament . with continuing proximal tension on the proximal length of the suture filament , the first loop and the distal length of filament are pulled through the common loop core 39 . when the first loop and distal length of filament emerge from the fourth loop 38 , an audible &# 34 ; clicking &# 34 ; sound may alert the user that the completed knot has been formed . although the partially tied knot illustrated in fig6 often referred to as a &# 34 ; blood &# 34 ; knot , is the preferred partially tied knot for conversion into the fully formed , non - slip knot which is used in the practice of this invention , other slip knots described in the literature can be used . the key characteristic for the acceptability of other partially tied knots is a common loop core ( exemplified in fig6 as common loop core 39 ) allowing passage of suture filament through the core . see , for example , the encyclopedia of knots and fancy ropework , r . graumont and j . hensel , fourth edition , cornell maritime press . suitable partially tied knots are shown in this book as numbers 102 , 185 , 227 and 349 on pages 71 , 83 , 87 and 102 , respectively . as depicted in fig8 the completed surgical knot is a non - slip knot 41 . the first loop has been eliminated , and a distal loop 42 positioned adjacent to the fourth loop 38 is formed from a portion of the distal length of the suture filament . the tissue loop 40 , which is used to fasten tissue , consequently becomes rigidly fixed and secure . tension applied to the loop 40 due to the tendency of the fastened tissue to expand or pull apart may result beneficially in further tightening of the non - slip knot . referring to fig9 and 10 , there is shown the formation of the partially tied knot depicted in fig1 - 6 , formed about a core tube 43 . the core tube facilitates the placement of the partially tied knot adjacent tissue desired to be fastened , as well as the conversion of the partially tied knot into the completed non - slip knot shown in fig8 . the core tube has proximal and distal ends , 44 and 45 , respectively . a surgical needle 46 is attached to the distal end 32 of the surgical filament . the proximal length 33 of the filament is passed through the core tube . the length of suture filament exceeds the length of the core tube so that the proximal length of the suture filament may extend from the proximal end 44 of the core tube . additionally , a sufficient amount of suture filament represented by its distal length 34 exits the distal end of the core tube so that it is possible to form the partially tied knot about the distal end 45 of the core tube . the first loop 35 and the subsequent knot loops represented by the second , third and fourth loops , 36 , 37 and 38 , are formed about the distal end of the core tube . once formed , tension is applied to the distal length of the filament to tighten the knot loops about the distal end of the core tube . the partially tightened knot formed about the core tube can be loaded into a suture cartridge 47 as illustrated in fig1 . the suture cartridge has an elongated body 48 . it also has top and bottom faces 78 and 79 , respectively . a tube slot 49 for receiving the core tube 43 is embedded in the body of the cartridge between the top and bottom faces . the body also contains a knot recess 50 which has a pair of stripping shoulders 51 . extending from a proximal edge 52 of the tube slot in a proximal direction is a filament slot 53 . correspondingly , extending from a distal edge 54 of the tube slot toward a distal end of the cartridge body is a loop slot 55 . the length of the core tube , designated as l 1 , in fig1 , is less than the length of the tube slot , designated as l 2 in fig1 . when the partially tied knot is formed about the core tube 43 , the knot loops are wrapped about the distal end 45 of the core tube . the free proximal end of the suture filament extends from the proximal end 44 of the core tube . the first loop 35 of the partially tied knot extends from the distal end of the core tube . when the core tube is loaded into the tube slot 49 of the cartridge body between the top and bottom faces , the knot loops sit inside the knot recess and abut the stripping shoulders of the knot recess . a portion of the proximal length 33 of the suture filament rests in the filament slot 53 embedded in the body of the cartridge , and the remaining portion of the proximal length of the suture filament extends from the proximal end of the cartridge body . correspondingly , the first loop 35 of the partially tied knot and the distal end 34 of the surgical filament are received in the loop slot 55 . a substantial portion of the first loop and the distal length of suture filament descend from the bottom face 79 of the cartridge body . in its original position as best illustrated in fig1 , the distal end 45 of the core tube is adjacent the distal edge 54 of the tube slot . since the tube slot 49 has a length greater than that of the core tube 43 , the core tube is capable of sliding proximally toward the proximal edge 52 of the tube slot . in this position , the knot is trapped in recess 50 . the surgeon can then easily manipulate needle 46 and suture filament 34 without danger of prematurely deploying the knot . when the core tube is loaded into the tube slot within the body of the cartridge , a cartridge top 56 can be mounted onto the top face 78 of the cartridge body 48 as shown in fig1 . when the cartridge top is mounted , the core tube 43 is fully enclosed within the cartridge . with the core tube fully enclosed within the suture cartridge , the partially tied knot wrapped about the core tube can be deployed to fasten desired bodily tissue as illustrated in fig1 - 15 . the first step is to position the suture cartridge 47 adjacent bodily tissue 57 desired to be fastened . next , the surgical needle 46 is passed through the tissue , and into and through the first loop 35 to form the tissue loop 40 . the size of the tissue loop is adjusted to provide the appropriate tension on the opposed tissue sections of the bodily tissue 57 desired to be fastened ; once the knot is completed to from the non - slip knot , the tissue loop becomes rigidly fixed and further adjustment is unavailable . when the tissue loop 40 is formed and appropriately sized , proximal tension is applied to the proximal length 33 of the suture filament in the direction of the arrow as depicted in fig1 . the completed knot is formed when sufficient tension is felt or applied to the proximal length 33 . advantageously , when tension is applied to the proximal length 33 of the filament , the first loop is pulled and eventually applies a proximal force against the distal end 45 of the core tube 43 , causing it to slide proximally as shown in fig1 . since the knot loops abut against the stripping shoulders in the knot recess 50 , the knot loops remain stationary even though the core tube slides proximally . when the core tube slides to a position where it is adjacent the proximal edge 52 of the tube slot 49 , the knot loops are stripped from the distal end 45 of the core tube . the knot is then fully formed , and the user can remove the cartridge top 56 , cut the remaining proximal and distal lengths of suture filament , and remove the core tube . alternatively , the proximal and distal lengths of suture filament can be exposed without removing cartridge top 56 by releasing the tension on proximal length 33 and pulling the cartridge proximally , thus allowing a portion of the proximal and distal lengths of suture filament contained in the core tube 43 to extend distally from recess 50 . the suture cartridge 47 is advantageous because it is readily adaptable to conventional open and endoscopic instruments , and thus readily facilitates the formation of the knot . the suture cartridge may be disposable , or it can be used on multiple patients . when used on multiple patients , a plurality of disposable core tubes , including the partially tied knot wrapped about the tube , can be loaded serially into the suture cartridge to provide for the placement of numerous surgical knots to fasten tissue using a single suture cartridge . in another example utilizing the core tube concept , the partially tied knot is wrapped about the core tube to facilitate the conversion of the knot to the completed , non - slip knot to fasten tissue . this similar embodiment is illustrated in fig2 - 23 . the one key difference between what is shown here and that illustrated in fig9 - 15 is that the core tube has a tapered distal end . for convenience , the same numbers have been used to identify component parts in fig2 - 23 as those used in fig9 - 15 . another example of a partially tied surgical knot is illustrated in fig1 - 17 . the knot is made from a suture filament 58 which has a proximal end 59 and a distal end 60 . a surgical needle 61 is attached to the distal end . the distal end of the filament is manipulated to form the knot while the proximal end of the filament is held stationary . a core loop 62 , proximal loop 63 and first loop 64 are initially formed . the proximal loop is at a first end 70 of the knot , and the first loop is at an opposite end 71 of the knot . the core loop is situated between the first and opposite ends of the knot . knot loops , in the preferred embodiment consisting of second , third and fourth loops , 65 , 66 , and 67 , are formed about the proximal loop 63 and the first loop 64 . the knot loops together form a common loop core 68 . the core loop is positioned within the common loop core . when tension is applied to the distal end of the surgical filament while the proximal end of the knot loops is supported , the knot loops are tightened . the knot loops are tightened about the first loop , proximal loop and core loop . when tightened , as shown in fig1 , the first loop , core loop and proximal loop are securely received in the knot loops , and the partially tied knot is formed . referring specifically to fig1 , the core loop 62 has a free proximal end 69 extending from the common loop core 68 toward the first end 70 of the knot . the core loop has a loop end 72 which extends from the common loop core in an opposite direction toward the opposite end 71 of the knot . the loop end 72 of the core loop 62 is disposed inside the first loop 64 . the partially tied knot of fig1 can be converted to a completed non - slip knot when axial tension is applied to the proximal loop in the proximal direction while the proximal end of the knot loops is supported . in a manner similar to the deployment of the knot best illustrated in fig1 - 8 , the knot is converted when the first loop is pulled through the common loop core to form a distal loop . advantageously , when tension is applied on the proximal loop , not only is the first loop pulled through the common loop core , but also the core loop is pulled through as well . this provides an advantage because the core loop creates a sufficient space represented by the common loop core to enhance the ease of passage of the first loop through the common core to form the completed knot . easier passage reduces the amount of tension which is needed to be applied to the proximal loop to form the completed knot , and therefore increases the degree of control of the user when the knot is being deployed . fig1 - 20 illustrate the use of the knot depicted in fig1 to fasten tissue , where the knot is deployed in combination with a stripping tube 73 . when the partially tied knot of fig1 is formed , the proximal loop 63 is passed through the stripping tube . a portion of the proximal loop extends from a proximal end of the stripping tube . the proximal loop is passed through the stripping tube until the knot loops abut against the distal end of the stripping tube . significantly , the stripping tube has a tapered distal end 74 . the core loop and the first loop extend away from the tapered distal end of the tube . the opening at the distal end of the tube is smaller in diameter than the diameter of the knot loops . consequently , when tension is applied on the proximal loop in the proximal direction , the knot loops will not pass into the stripping tube . the conversion of the partially tied knot to the completed knot is performed in a manner substantially similar to that described in connection with the conversion of the previously illustrated knot depicted in fig6 . referring now to fig1 - 20 , the stripping tube 73 is positioned adjacent bodily tissue 75 desired to be fastened . the surgical needle 61 is drawn through the tissue . a tissue loop 76 is formed when the surgical needle and distal end of the filament are fed through the first loop 64 . again , it is important to adjust the size of the tissue loop to provide for appropriate tensioning of the fastened tissue before the knot is fully deployed . when the desired tissue loop is formed , tension on the proximal loop 63 is applied in the proximal direction as indicated by the arrow in fig1 to pull the core loop 62 and the first loop 64 through the common loop core . when the first loop emerges from the fourth knot loop 67 , the distal loop 77 is formed , and the completed , non - slip knot has been created . the preferred embodiment of this invention is detailed in fig2 - 39 . the preferred embodiment is a further refinement of the assembly illustrated in fig1 - 15 which includes the partially tied surgical knot wrapped about a core tube , and subsequently loaded into a suture cartridge . referring initially to fig2 and 25 , the suture cartridge assembly 80 of this invention includes a suture filament 81 with proximal and distal ends , 82 and 83 , respectively , configured into a partially tied surgical knot 84 wrapped about a core tube 85 . the proximal end of the suture filament extends from a proximal end of the core tube , a first loop 86 of the surgical filament extends from a distal end of the core tube , and a surgical needle 87 is attached to the distal end of the surgical filament . the suture cartridge has top and bottom faces , 88 and 89 , respectively , and a slot 90 for receiving the core tube , including the suture filament with its partially tied knot wrapped about the core tube , between the top and bottom faces of the cartridge . the slot contains a knot recess 91 for receiving the partially tied knot of the suture filament , and the partially tied knot abuts a pair of stripping shoulders 92 within the knot recess . when the core tube is loaded into the slot , a portion of the distal end of the suture filament including the surgical needle and the first loop descend from the bottom face of the cartridge . a cartridge top 93 covers the top face of the suture cartridge , and therefore encloses the core tube and a portion of the suture filament . importantly , a grasping jaw 94 is pivotally attached to the suture cartridge at a pivot pin 99a . the grasping jaw faces the cartridge top and is moveable from an open position spaced from the cartridge top to a closed position adjacent the cartridge top . the grasping jaw is biased in its open position . a cartridge housing 95 which includes a suture filament track 96 is also mounted to the proximal end of the suture cartridge . referring now to fig2 - 32 , the details of the suture cartridge and the cartridge housing integrally mounted to the suture cartridge can be seen . the distal end of the cartridge contains a retaining pin 97 for permanently attaching the cartridge top 93 to the top face of the cartridge . the retaining pin is &# 34 ; heat - staked &# 34 ; to attach the cartridge top to the cartridge . also included at the distal end of the cartridge is a locating boss 98 . there is a pin orifice 99 for receiving the pivot pin for pivotally attaching the grasping jaw to the cartridge . a central aperture 100 is contained at the distal end of the cartridge housing to provide an opening for receiving the proximal end of the grasping jaw . also contained within the cartridge housing is a torsion spring slot 101 for receiving a torsion spring 102 ( see fig2 and 33 ) to bias the grasping jaw in its open position . the torsion spring has an upper arm 113 , a torsion loop 114 and a jaw arm 115 . the suture filament track 96 of the cartridge housing includes a ventral channel 103 which merges into a left side suture groove 104 extending proximally to the proximal end of the cartridge housing . at the proximal end of the cartridge housing , a pair of lateral filament slots 105 are displayed . continuing from the lateral filament slots , a right side suture groove 106 is embedded within the cartridge housing . the cartridge housing also contains a hook slot 107 surrounded by a pair of spaced - apart hook tines 108 . referring now to fig3 - 36 , the details of the grasping jaw 94 can be seen . the grasping jaw has an inner serrated surface 109 to facilitate the grasping of tissue , suture filament or the surgical needle . it contains a jaw lug 110 including a jaw orifice 111 for receiving the pivot pin 95 for its pivotal mount relative to the suture cartridge . it also includes a spring arm slot 112 for receiving the torsion spring 102 . the proximal end of the cartridge top has a spring tab 116 . the spring tab biases and maintains core tube 85 distally during assembly and knot deployment . in the preferred embodiment , the suture cartridge assembly is a disposable assembly intended to be discarded after a single patient use . the suture cartridge and the housing are preferably composed of a biocompatible , injection - molded plastic , and the grasping jaw is preferably made from medical grade stainless steel . alternatively , the suture cartridge assembly could be fabricated from a suitable metal in a metal injection molding ( mim ) process , which is a conventional forming technique adaptable for fabricating conventional staple cartridges for surgical staplers and cutters . fig2 and 27 illustrate how the core tube is mounted into the suture cartridge , and how the proximal end of the suture filament is wrapped about the periphery of the cartridge housing within the suture filament track . as the core tube is mounted into the slot in the cartridge , the surgical needle and a portion of the distal end of the suture filament are passed through the slot , and the partially tied surgical knot is positioned into the knot recess where the knot abuts against the stripping shoulders and the first loop descends from the bottom face of the cartridge . the proximal end of the suture filament is passed through the ventral channel of the cartridge housing and is wrapped about the left side suture groove , lateral suture slots and right side suture groove of the suture filament track before emerging at an anchor recess 117 within the cartridge housing . a knot anchor 118 is tied at the proximal end of the suture filament within the anchor recess to place the suture filament in a fixed position within the cartridge housing . also worthy of note in observing fig2 and 27 are the pair of retaining slots 119 at a junction between the cartridge housing and the top face 88 of the suture cartridge for further retaining the cartridge 93 top when it is mounted onto the top face of the suture cartridge . in an especially preferred embodiment of this invention , the loaded suture cartridge assembly of this invention is received within a cartridge carrier 120 of a surgical instrument 121 to further facilitate the deployment of the knot and the grasping of tissue , the surgical needle or the filament . referring specifically to fig3 , the suture cartridge including the cartridge housing is loaded into and received within the cartridge carrier . the cartridge carrier has a pair of containing walls 122 defining a channel 123 for receiving the cartridge assembly . each containing wall has a top edge surface 124 , and a serrated edge surface 125 at its distal end . the surgical instrument which includes the cartridge carrier for receiving the suture cartridge advantageously includes a reciprocating closure tube 126 for urging the jaw to its closed position when the closure tube is reciprocated forwardly , and to its open position when the closure tube is reciprocated rearwardly . such an instrument preferably includes a hook 127 which is received in the hook slot 107 between the pair of hook tines 108 in the cartridge housing . when the hook is retracted , it pulls the proximal end of the suture filament within the suture filament track 96 of the suture cartridge housing , and the knot is deployed in a manner substantially similar to that illustrated in fig1 - 15 . referring now to fig3 - 39 , it can be observed that when the cartridge assembly is loaded into the carrier , the serrated edge surfaces of the containing walls of the cartridge carrier protrude from the cartridge top of the suture cartridge , and mesh with the inner serrated surface of the grasping jaw when the grasping jaw is in its closed position . in so doing , the meshing surfaces facilitate the grasping of tissue 128 ( fig3 ), the surgical filament 81 ( fig3 ) and the surgical needle 87 ( fig3 ). the suture cartridge assembly of this invention therefore facilitates not only the deployment of a fully formed knot from a partially formed knot , but also the manipulation of tissue or the suture filament including the surgical needle which is so important during the surgical procedure to easily place the knot . the different embodiments of this invention are representative of the preferred embodiments of the invention . these embodiments are merely illustrative . the scope of the invention should not be construed to be limited by these embodiments , or any other particular embodiments which may come to mind to those skilled in this art . instead , the reader must refer to the claims which appear below to determine the scope of the invention .
a suture cartridge assembly is disclosed . the assembly has a suture cartridge containing a slot for receiving a suture filament and a cartridge top for covering at least a portion of the filament . a grasping jaw faces the cartridge top , and it is movable from an open position spaced from the cartridge top to a closed position adjacent the cartridge top . the slot in the cartridge for receiving the filament facilitates the formation and placement of surgical knots made from the suture filament , particularly when knots are needed at remote surgical sites such as during minimally invasive surgery . the placement and deployment of the knot is further facilitated because the grasping jaw can grasp the filament or the tissue which is desired to be sutured when the jaw is moved from its open to closed positions . the ability to grasp the filament or tissue enables the surgeon to manipulate the filament or tissue during the procedure for deploying and placing the knot , further facilitating the ease with which the surgeon can deploy and place the knots in a minimally invasive procedure .