WO2015050896A1

WO2015050896A1 - Nerve coupler

Info

Publication number: WO2015050896A1
Application number: PCT/US2014/058448
Authority: WO
Inventors: Lloyd P. Champagne; Jozef Zoldos
Original assignee: Exsomed Holding Company Llc
Priority date: 2013-10-02
Filing date: 2014-09-30
Publication date: 2015-04-09

Abstract

Devices suitable for coupling a separated nerve and methods of using the devices are disclosed. Such a device may include a first arm, a second arm, and at least one connecting element. The connecting element is used to initially grasp a nerve and to couple nerve sheaths of ends of the severed nerve together.

Description

Attorney Docket No.: 63488.00816

NERVE COUPLER PCT APPLICATION

INVENTORS:

Lloyd Champagne and Jozef Zoldos

NERVE COUPLER

Field of the Disclosure

[0001] The present disclosure generally relates to medical devices. More particularly, the disclosure relates to medical devices suitable for attaching separated nerve ends together and to methods of using same.

Background of the Disclosure

[0002] Nerve lacerations, such as lacerations of nerves within a hand, are often treated using microsurgical techniques. Such coaptation techniques generally includes direct repair of the lacerated nerves using a surgical microscope, forceps, and fine sutures. The forceps are used to hold sheaths (epineurium) of the respective ends of the lacerated nerves together, while a surgeon sutures the nerve sheath together.

[0003] The nerve sizes generally range from about 0.5 mm to about 12 mm in diameter. Thus, manually applying sutures through the nerve sheaths can be relatively difficult. In addition, although typical microsurgical techniques work relatively well to couple lacerated nerves, pulling the nerve sheaths together and applying sutures through the sheath requires multiple, sequential steps by a surgeon, which can be relatively time consuming.

[0004] Various devices for ligation of transected vessels have been developed.

However, such devices are generally not suitable for microsurgery or treatment of nerves. In addition, such devices generally require use of both hands, which may be undesirable when performing microsurgery or nerve treatment. Accordingly, improved medical devices for and methods of attaching separated nerve ends are desired.

Summary of the Disclosure

[0005] Various embodiments of the disclosure relate to a device for coupling separated nerve ends together. While the ways in which the various embodiments of the disclosure address the drawbacks of the prior art devices and methods for treating nerve lacerations are discussed in greater detail below, in general, the devices in accordance with exemplary embodiments of this disclosure are relatively easy to use, and can be held and used with one hand, allowing shorter procedure times to repair damaged nerves.

[0006] In accordance with exemplary embodiments of the disclosure, a hand-held device for attaching nerve ends together includes a first arm having a first arm first end and a first arm second end, a second arm having a second arm first end and a second arm second end, a connecting element attached to the first arm, wherein the first arm first end and the second arm first end are joined together, and wherein the first arm second end and the second arm second end are initially spaced apart. In accordance with various aspects of these embodiments, the connecting element is used to initially grab and approximate a nerve, pierce through nerve sheaths of lacerated nerve ends of the nerve, and couple the respective nerve sheaths together. The device can be operated by, for example, holding the device between an index finger and a thumb of a hand. In these cases, the connecting element can be made of, for example, biodegradable material. In accordance with further aspects of these embodiments, the connecting element is rotatably and detachably coupled to the first arm, such that a user can couple lacerated nerve ends by causing the connecting element to rotate (e.g., by moving the first arm relative to the second arm) and detach from the first arm. In accordance with yet further aspects of these embodiments, the device includes an actuator that may be activated using a finger or thumb. The actuator engages the connecting element to cause the connecting element to rotate and detach from the device. The actuator may be activated by pulling the actuator away from the connecting element or by pushing the actuator toward the connecting element— e.g., by sliding the actuator along a slot formed along an axis of the first arm. In accordance with yet further aspects of these embodiments, the device includes a crimping mechanism to apply a pressure on the connecting element to cause ends of the connecting element to bend, so as to hold the nerve sheaths in place. For example, the connecting element may be initially substantially c-shaped or substantially u- shape prior to use, and before, during, or after the connecting element passes through the nerve sheath, the crimping mechanism causes ends of the connecting element to, for example, come together or towards the body of the connecting element or to otherwise cause the sheaths of the nerve ends to stay together. The first arm may include a slot for detachably receiving the connecting element. In accordance with further aspects, the second arm second end comprises a curvature, which terminates in a point. In accordance with other aspects the second arm second end terminates with a blunt end, which can include a surface that facilitates capture and retention of a nerve sheath. In accordance with yet further aspects of these embodiments, the first arm and the second arm form a forceps. The device, including various components thereof can be formed of any suitable materials, such as stainless steel (e.g., high-grade carbon steel), plastic, and any combination of suitable materials. For example, the first arm and the second arm can be formed of steel, and the connecting element(s) can be formed of suitable biodegradable materials. In accordance with further aspects, the connecting element can be in the form of a clip, a staple, or other suitable configuration. Further, the connecting element may include one or multiple prongs, such as 2, 3, 4, or more prongs, and/or the device may include multiple connecting elements. Multiple connecting elements can be pre-loaded or a single connecting element can be loaded onto the device at one time. When multiple connecting elements are loaded onto the device, any suitable number of elements may be loaded. In accordance with yet additional aspects of these embodiments, the connecting element is initially attached to both the first and the second arm. In these cases, the connecting element may be substantially u-shaped.

[0007] In accordance with additional embodiments of the disclosure, a microsurgical device includes a first arm, a second arm coupled to the first arm, a first connecting element, and a second connecting element, wherein the first connecting element is detachably attached to the first arm and the second connecting element is detachably attached to the second arm, and wherein the first connecting element and the second connecting element engage (e.g., attached to each other) to cause the connecting elements to couple separated nerve sheaths together. The first arm, second arm, actuator, and connecting elements may include any of the materials and/or configurations described herein.

[0008] In accordance with yet further exemplary embodiments of this disclosure, a microsurgical device includes a first arm, a second arm having a first end coupled to a first end of the first arm and a second end; and a biodegradable connecting element coupled to a second end of the first arm. The device and components thereof can include any suitable combination of materials and configurations of actuators, connecting elements, and arms as described herein.

Brief Description of the Drawings

[0001] A more complete understanding of exemplary embodiments of the present disclosure may be derived by referring to the detailed description and claims when considered in connection with the following illustrative figures.

[0009] FIG. 1 illustrates a microsurgical device for attaching separated nerve ends together in accordance with exemplary embodiments of the disclosure.

[0010] FIG. 2 illustrates another exemplary microsurgical device for attaching separated nerve ends together in accordance with additional exemplary embodiments of the disclosure.

[001 1] FIG. 3 illustrates yet another exemplary microsurgical device for attaching separated nerve ends together in accordance with exemplary embodiments of the disclosure. [0012] FIG. 4 illustrates a two-prong connecting element in accordance with exemplary embodiments of the disclosure.

[0013] FIG. 5 illustrates a three-prong connecting element in accordance with exemplary embodiments of the disclosure.

[0014] FIG. 6 illustrates a four-prong connecting element in accordance with exemplary embodiments of the disclosure.

[0015] FIG. 7 illustrates yet another exemplary microsurgical device for attaching separated nerve ends together in accordance with exemplary embodiments of the disclosure.

[0016] FIG. 8 illustrates another exemplary microsurgical device for attaching separated nerve ends together in accordance with additional embodiments of the disclosure.

[0017] FIG. 9 illustrates an exemplary microsurgical device for attaching separated nerve ends together in accordance with yet further exemplary embodiments of the disclosure.

[0018] FIG. 10 illustrates yet another exemplary microsurgical device for attaching separated nerve ends together in accordance with exemplary embodiments of the disclosure.

Detailed Description of Exemplary Embodiments

[0019] The description of exemplary embodiments of the present invention provided below is merely exemplary and is intended for purposes of illustration only; the following description is not intended to limit the scope of the invention disclosed herein. Moreover, recitation of multiple embodiments having stated features is not intended to exclude other embodiments having additional features or other embodiments incorporating different combinations of the stated features.

[0020] The present disclosure describes microsurgical devices that are suitable for use in connecting separated nerve ends. As described in more detail below, various exemplary devices can be held in and used with only one hand (e.g., held between a thumb and an index finger), allowing precise control of the devices during treatment.

[0021] FIG. 1 illustrates a microsurgical device 100 for treating a separated nerve in accordance with exemplary embodiments of the disclosure. Device 100 includes a first arm 102, a second arm 104, a first connecting element 106, and a second connecting element 108.

[0022] Device 100 can be used to perform microsurgery to repair separated or lacerated nerve ends 1 10, 1 12 (neurorrhaphy). Device 100 is advantageous over other instruments used to perform microsurgery on nerve ends, because device allows a user or surgeon to precisely perform the treatment using only one hand. [0023] In use, device 100 can be used to couple nerve ends 110, 112 together by causing connecting elements to grasp nerve sheath 1 14, 1 16 of a lacerated nerve and approximate the nerve, to pierce through nerve sheaths 1 14, 1 16 and to couple nerve sheaths 114, 116 together. For example, during use, connecting elements 106, 108 can come together, couple together, and detach from arms 102, 104 to couple sheaths 1 14, 1 16 together. Alternatively, each connecting elements 106, 108 can engage both sheaths 1 14, 116 and bend or crimp, such that each connecting element binds sheaths 114, 1 16 together and each connecting element disengages from respective arms 102, 104.

[0024] Arms 102, 104 can be formed of any suitable material. By way of examples, arms 102, 104 can be formed of stainless steel (e.g., high-grade carbon steel), plastic, or other material. In the illustrated example, arm 102 includes a first arm first end 1 18, and a first arm second end 120, and second arm 104 includes a second arm first end 122 and a second arm second end 124. First arm first end 1 18 and second arm first end 122 are coupled together and first arm second end 120 and second arm second end 124 are initially space apart. First arm 102 and second arm 104 may comprise or resemble forceps. Although not illustrated, device 100 can include a locking mechanism to maintain a desired space between ends 120, 124 and/or to maintain ends 120, 124 in a closed position.

[0025] Connecting elements 106, 108 can be formed of biodegradable material, such as biodegradable polymers (e.g., polyglycolic acid (PGA) and/or poly L-lactic acid (PLLA)), such that the connecting elements slowing dissolve within a body, such that removal surgery is not required, and connecting elements 106, 108 can include drug-eluting material. As discussed in more detail below connecting elements 106, 108 can be formed in a variety of configurations. For example, connecting elements 106, 108 can include a first end 126 and a second end 128 that form an opening there between. In accordance with exemplary aspects of exemplary connecting elements, connecting elements 106, 108 are configured to deform during use so as to couple sheaths 114, 1 16 together.

[0026] FIG. 2 illustrates another microsurgical device 200 for attaching nerve ends together in accordance with addition embodiments of the disclosure. Device 200 includes a first arm 202, a second arm 204, wherein first arm 202 includes a first end (not illustrated), which is the same or similar to first arm first end 1 18 of device 100, and a second end 206, and second arm 204 includes a first end (not illustrated), which is the same or similar to second arm first end 122 of device 100, and a second end 208, a connecting element 210, and an actuator 214. Similar to device 100, the first arm 202 first end and the second arm 204 first end of device 200 can be joined together. [0027] First arm second end 206 includes a slot or recess 212 to receive connecting element 210. In general, slot 212 is configured to receive and hold connecting element 210 during initial engagement with a nerve sheath and to allow detachment of connecting element 210 during or after coupling of two nerve sheaths (e.g., sheaths 114, 1 16). Slot 212 may be open, as illustrated, or closed.

[0028] In the illustrated example, first arm 202 includes a slot 216 to receive a portion

218 of actuator 214. Slot 216 may be a continuation of slot 212 or a separate slot. During use, portion 218 of actuator 214 moves along slot 216 toward connecting element 210 (e.g., by pushing down on a lever 226) to cause connecting element to rotate in the direction of the arrow to thereby engage nerve sheaths. Once the nerve sheaths are engaged, connecting element 210 can be pinch or crimped (e.g., by engaging with second arm second end 208) to couple the nerve sheaths. First arm second end 206 additionally includes region 220 to guide connecting element 210 as connecting element 210 rotates and is inserted through the sheaths.

[0029] Second arm second end includes a curved region 222 (e.g., substantially c- shaped). Region 222 can be configured to grasp and hold nerve sheaths during a procedure and/or to bend or crimp connecting element 210. In the illustrated example, region 222 includes an end 224 terminating in a pointed (e.g., conical) tip.

[0030] Connecting element 210 can includes any suitable connecting element, such as the connecting elements described herein. By way of example, connecting element is c- shaped and formed of biodegradable material.

[0031] FIG. 3 illustrated another hand-held device 300 for attaching nerve ends together in accordance with additional embodiments of the disclosure. Device 300 is similar to device 200, except device 300 includes an actuator 302, rather than actuator 214, and a connecting element 312 is configured, such that a portion 314 of connecting element 312 initially resides within a slot 316 of a first arm 304, such that as actuator 302 is engaged, a driver 318 of actuator 302 causes connecting element 312 to move through slot 316 toward a second arm 306. As connecting element 312 moves toward second arm 306, connecting element 312 engages nerve sheaths to thereby couple the sheaths. By way of example, as connecting element 312 engages the sheaths and continues relative movement toward second arm 306, second arm 306 causes connecting element to bend— e.g., crimp— to form a link between the sheaths. Second ends 308, 310 of first arm 304 and second arm 306 may be the same or similar as second ends 206, 208, illustrated in FIG. 2 or may include alternative configurations, such as those illustrated in FIG. 3. In the illustrated example, ends 308, 310 include regions defined by respective first radii to define inner edges 320, 322 and outer edges 324, 326. The radii may be the same or different for various combinations of edges.

[0032] Turning now to FIGS. 4-6 exemplary connecting elements 400, 500, and 600 are illustrated. Connecting elements 400, 500, and 600 can be formed of any suitable material, such as the connecting element materials described herein.

[0033] Connecting element 400 includes a first prong 402 and a second prong 404.

As illustrated, first prong 402 and second prong 404 are joined at region 406. First prong 402 and second prong 404 each terminate with a pointed notch 424 to facilitate capture and retention of nerve sheath tissue. Prongs 402, 408 can be flat, rounded or tubular.

[0034] First prong 402 includes a first section 412, a second section 414, and a third second 416. Second section 414 can be angled at about 60 to about 120 or about 70 to about 110 degrees relative to first section 412 and third section 416 can be angled at about 70 to about 130 or 90 to about 120 degrees relative to second section 414. Similarly second prong 404 includes a first section 418, a second section 420, and a third second 422. Second section 420 can be angled at about 60 to about 120 or about 70 to about 1 10 degrees relative to first section 418 and third section 422 can be angled at about 70 to about 130 or 90 to about 120 degrees relative to second section 420.

[0035] Connecting element 500 includes three prongs 502, 504, 506, connected at a region 508. Prongs 502-506 can be the same or similar to prong 402, 404 that include multiple angled sections. In the illustrated example, prong 504 is interposed between prongs 502 and 506.

[0036] Connecting element 600 includes four prongs 602, 604, 606, and 608, which may be the same or similar to prongs 402, 404 and/or prongs 502-506. Prongs 602-608 are coupled at a region 610. In the illustrated example, prong 604 is interposed between prongs 602, 606 and prong 606 is interposed between prongs 604, 608.

[0037] Turning now to FIG. 7, another microsurgical, hand-held device 700 for attaching nerve ends together is illustrated. Device 700 includes a first arm 702, a second arm 704, and connecting element 706.

[0038] Arm 702 includes a first end (not illustrated, which may be the same or similar to first end 1 18) and a second end 708 that includes a slot 710 to receive and detachably retain connecting element 706. Arm 704 includes a first end (not illustrated, which may be the same or similar to first end 122) and a second end 712. Arm 704 may be the same or similar to arm 302, illustrate in FIG. 2. [0039] During operation of device 700, connecting element 706 rotates and bends upon itself to couple nerve endings, such as sheaths 114, 116.

[0040] FIG. 8 illustrates yet another exemplary hand-held device 800 for attaching nerve ends together in accordance with exemplary embodiments of the disclosure. Device 800 includes a first arm 802, a second arm 804, and a connecting element 806.

[0041] Arms 802, 804 may be coupled at first ends of arms 802, 804 (not illustrated) in a manner similar to the coupled of arms 102, 104, illustrated in FIG. 1. Arms 802, 804 can be tapered, as illustrated in FIG. 8, such that second ends 808, 810 of arms 802, 804 are smaller in size (e.g., smaller width and/or length) than the first ends of arms 802, 804.

[0042] In the illustrated example, connecting element 806 is substantially u-shaped and includes sections 812-826. Section 814 can be angled at about 90 to about 150 or about 100 to about 140 degrees relative to section 812. Section 816 can be angled at about 1 10 to about 170 or about 120 to about 160 degrees relative to section 814. Section 818 can be angled at about 70 to about 120 or about 80 to about 1 15 degrees relative to section 816. Sections 820-826 can similarly form angles relative to each section, such that sections 812- 818 are mirror images of sections 820-826. Sections 818 and 826 terminate at pointed tips 828, 830.

[0043] FIG. 9 illustrates another microsurgical device 900 including a first arm 902, a second arm 904, and a connecting element 906. In the illustrated example, arm 902 includes a recess or slot to detachably engage connecting element 906. Arm 904 includes a blunt end 908 to crimp or otherwise mend connecting element to couple nerve sheaths together. An end 910 of arm 902 may be pointed, as illustrated, to facilitate capture and retention of nerve sheaths during a procedure.

[0044] FIG. 10 illustrates yet another microsurgical device 1000 suitable for connecting nerve sheaths in accordance with exemplary embodiments of the disclosure.

Device 1000 includes a first arm 1002, a second arm 1004 coupled to first arm 1002 about a pivot 1006, and a connecting element 1008. Ends 1010 and 1012 may be the same or similar to second ends of devices described herein (e.g., devices 100, 200, 300, and 700-900).

Device 1000 also includes a locking mechanism 1014 to hold ends 1010, 1012 together or at a predetermined distance from each other. Device 1000 also includes ends 1016, 1018 that include openings 1020, 1022 for an operators thumb and/or finger(s) to pass there through.

Some specific examples of the invention are described below: 1. A hand-held device for attaching nerve ends together, the device comprising:

a first arm having a first arm first end and a first arm second end;

a second arm having a second arm first end and a second arm second end; and a connecting element attached to the first arm,

wherein the first arm first end and the second arm first end are joined together, and wherein the first arm second end and the second arm second end are initially spaced apart.

2. The hand-held device for attaching nerve ends together of example 1, wherein the connecting element comprises biodegradable material.

3. The hand-held device for attaching nerve ends together of any of examples 1 or 2, wherein the connecting element is detachably coupled to a pivot point on the first arm. 4. The hand-held device for attaching nerve ends together of any of examples 1-3, wherein movement of the second arm relative to the first arm causes the connecting element to rotate and detach from the first arm.

5. The hand-held device for attaching nerve ends together of any of examples 1-4, further comprising an actuator.

6. The hand-held device for attaching nerve ends together of example 5, wherein the actuator engages with the connecting element to detach the connecting element from the first arm.

7. The hand-held device for attaching nerve ends together of example 6, wherein the first arm includes a slot and a portion of the actuator moves within the slot to cause the connecting element to detach from the first arm. 8. The hand-held device for attaching nerve ends together of example 7, wherein the portion of the slot is along an axis of the first arm and the actuator moves along the axis to detach the connecting element. 9. The hand-held device for attaching nerve ends together of any of examples 5-8, wherein the actuator comprises a lever coupled to the portion.

10. The hand-held device for attaching nerve ends together of example 9, wherein the actuator further comprises a pivot and the connecting element disengages by moving the lever away from the connecting element.

11. The hand-held device for attaching nerve ends together of example 9, wherein the connecting element disengages by moving the lever toward the connecting element.

12. The hand-held device for attaching nerve ends together of any of examples 1-1 1, wherein the second arm second end comprises a crimping mechanism to crimp the connecting element.

13. The hand-held device for attaching nerve ends together of any of examples 1-12, wherein the connecting element is c-shaped.

14. The hand-held device for attaching nerve ends together of any of examples 1-13, wherein the first arm second end includes a slot for detachably receiving the connecting element.

15. The hand-held device for attaching nerve ends together of any of examples 1-14, wherein the second arm second end comprises a curved end.

16. The hand-held device for attaching nerve ends together of any of examples 1-15, wherein the second arm second end comprises a pointed tip.

17. The hand-held device for attaching nerve ends together of any of examples 1-16, wherein the first arm second end comprises a pointed tip.

18. The hand-held device for attaching nerve ends together of any of examples 1-17, wherein the first arm and the second arm comprise a forceps. 19. The hand-held device for attaching nerve ends together of any of examples 1-18, wherein the device is operable using a single hand.

20. The hand-held device for attaching nerve ends together of any of examples 1-19, wherein the device comprises high-grade carbon steel.

21. The hand-held device for attaching nerve ends together of any of examples 1-19, wherein the device comprises plastic. 22. The hand-held device for attaching nerve ends together of any of examples 1-21, wherein the device further comprises a locking mechanism to couple the first arm and the second arm at a fixed distance.

23. The hand-held device for attaching nerve ends together of any of examples 1 -22, wherein the connecting element comprises a clip.

24. The hand-held device for attaching nerve ends together of any of examples 1-22, wherein the connecting element comprises a staple. 25. The hand-held device for attaching nerve ends together of any of examples 1-23, wherein the connecting element is a single-prong connecting element.

26. The hand-held device for attaching nerve ends together of any of examples 1-23, wherein the connecting element is a multi-prong connecting element.

27. The hand-held device for attaching nerve ends together of example 26, wherein the connecting element is a two-prong connecting element.

28. The hand-held device for attaching nerve ends together of example 26, wherein the connecting element is a three-prong connecting element.

29. The hand-held device for attaching nerve ends together of example 26, wherein the connecting element is a four-prong connecting element. 30. The hand-held device for attaching nerve ends together of any of examples 1-29, wherein the device includes a plurality of connecting elements.

31. The hand-held device for attaching nerve ends together of any of examples 1 -2, wherein the connecting element is interposed between the first arm and the second arm.

32. The hand-held device for attaching nerve ends together of example 31, wherein the connecting element is u-shaped. 33. The hand-held device for attaching nerve ends together of any of examples 1-32, wherein the connecting element comprises a first end comprising a first tip and a second end comprising a second tip.

34. The hand-held device for attaching nerve ends together of example 32, wherein the connecting element comprises multiple prongs.

35. The hand-held device for attaching nerve ends together of example 34, wherein the connecting element comprises two prongs. 36. The hand-held device for attaching nerve ends together of example 34, wherein the connecting element comprises three prongs.

37. The hand-held device for attaching nerve ends together of example 34, wherein the connecting element comprises greater than three prongs.

38. The hand-held device for attaching nerve ends together of example 37, wherein the connecting element comprises four prongs.

39. The hand-held device for attaching nerve ends together of any of examples 31-38, wherein the device comprises a plurality of connecting elements.

40. The hand-held device for attaching nerve ends together of any of examples 31-39, wherein the connecting element comprises a clip. 41. The hand-held device for attaching nerve ends together of any of examples 31-40, wherein the connecting element comprises a staple.

42. A microsurgical device comprising:

a first arm;

a second arm coupled to the first arm;

a first connecting element; and

a second connecting element,

wherein the first connecting element is detachably attached to the first arm and the second connecting element is detachably attached to the second arm, and wherein the first connecting element and the second connecting element engage and couple separated nerve sheaths together.

43. The microsurgical device of example 43, wherein the connecting element comprises biodegradable material.

44. The microsurgical device of any of examples 43-44, wherein first the connecting element is detachably coupled to a pivot point on the first arm.

45. The microsurgical device of any of examples 43-44, wherein the second connecting element is detachably coupled to a pivot point on the second arm.

46. The microsurgical device of any of examples 43-45, wherein movement of the second arm relative to the first arm causes at least one of the first connecting element and the second connecting element to rotate and detach from the device.

47. The microsurgical device of any of examples 43-46, further comprising an actuator.

48. The microsurgical device of example 47, wherein the actuator engages with at least one of the first connecting element and the second connecting element to detach the at least one of the first connecting element and the second connecting element from the device. 49. The microsurgical device of example 48, wherein the first arm includes a slot and a portion of the actuator moves within the slot to cause the connecting element to detach from the first arm. 50. The microsurgical device of example 48, wherein the portion of the slot is along an axis of the first arm and the actuator moves along the axis to detach the connecting element.

51. The microsurgical device of any of examples 43-50, wherein the actuator comprises a lever coupled to the portion.

52. The microsurgical device of example 51 wherein the actuator further comprises a pivot and the connecting element disengages by moving the lever away from the connecting element. 53. The microsurgical device of example 51 , wherein the connecting element disengages by moving the lever toward the connecting element.

54. The microsurgical device of any of examples 43-53, wherein the connecting element is c-shaped.

55. The microsurgical device of any of examples 43-54, wherein the first arm second end includes a slot for detachably receiving the first connecting element.

56. The microsurgical device of any of examples 43-55, wherein the second arm second end includes a slot for detachably receiving the second connecting element.

57. The microsurgical device of any of examples 43-56, wherein the first arm second end comprises a tapered end. 58. The microsurgical device of any of examples 43-56, wherein the second arm second end comprises a tapered end.

59. The microsurgical device of any of examples 43-58, wherein the first arm and the second arm comprise a forceps. 60. The microsurgical device of any of examples 43-59, wherein the device is operable using a single hand. 61. The microsurgical device of any of examples 43-60, wherein the device comprises high-grade carbon steel.

62. The microsurgical device of any of examples 43-60, wherein the device comprises plastic.

63. The microsurgical device of any of examples 43-62, wherein the device further comprises a locking mechanism to couple the first arm and the second arm at a fixed distance. 64. The microsurgical device of any of examples 43-63, wherein the connecting element comprises a clip.

65. The microsurgical device of any of examples 43-63, wherein the connecting element comprises a staple.

66. The microsurgical device of any of examples 43-65, wherein the connecting element is a single-prong connecting element.

67. The microsurgical device of any of examples 43-66, wherein the connecting element is a multi-prong connecting element.

68. The microsurgical device of any of examples 43-67, wherein the connecting element is a two-prong connecting element. 69. The microsurgical device of examples 68, wherein the connecting element is a three- prong connecting element.

70. The microsurgical device of examples 69, wherein the connecting element is a four- prong connecting element. 71. The microsurgical device of any of examples 43-70, wherein the device includes a plurality of connecting elements. 72. The microsurgical device of any of examples 43-71 , wherein the one or both of the first and second connecting elements is u-shaped.

73. The microsurgical device of any of examples 43-72, wherein the first connecting element comprises a first end comprising a first tip and a second end comprising a second tip.

74. A hand-held device for attaching nerve ends together comprising:

a first arm;

a second arm having a first end coupled to a first end of the first arm and a second end; and

a biodegradable connecting element coupled to a second end of the first arm.

75. The hand-held device for attaching nerve ends together of example 74, wherein the connecting element is detachably coupled to a pivot point on the first arm. 76. The hand-held device for attaching nerve ends together of any of examples 74-75, wherein movement of the second arm relative to the first arm causes the connecting element to rotate and detach from the first arm.

77. The hand-held device for attaching nerve ends together of any of examples 74-76, further comprising an actuator.

78. The hand-held device for attaching nerve ends together of example 77, wherein the actuator engages with the connecting element to detach the connecting element from the first arm.

79. The hand-held device for attaching nerve ends together of example 78, wherein the first arm includes a slot and a portion of the actuator moves within the slot to cause the connecting element to detach from the first arm. 80. The hand-held device for attaching nerve ends together of example 79, wherein the portion of the slot is along an axis of the first arm and the actuator moves along the axis to detach the connecting element. 81. The hand-held device for attaching nerve ends together of any of examples 77-80, wherein the actuator comprises a lever attached to the portion.

82. The hand-held device for attaching nerve ends together of example 81, wherein the actuator further comprises a pivot and the connecting element disengages by moving the lever away from the connecting element.

83. The hand-held device for attaching nerve ends together of example 81, wherein the connecting element disengages by moving the lever toward the connecting element. 84. The hand-held device for attaching nerve ends together of any of examples 74-83, wherein the second arm second end comprises a crimping mechanism to crimp the connecting element.

85. The hand-held device for attaching nerve ends together of any of examples 74-84, wherein the connecting element is c-shaped.

86. The hand-held device for attaching nerve ends together of any of examples 74-85, wherein the first arm second end includes a slot for detachably receiving the connecting element.

87. The hand-held device for attaching nerve ends together of any of examples 74-86, wherein the second arm second end comprises a curved end.

88. The hand-held device for attaching nerve ends together of any of examples 74-87, wherein the second arm second end comprises a pointed tip.

89. The hand-held device for attaching nerve ends together of any of examples 74-88, wherein the first arm second end comprises a pointed tip. 90. The hand-held device for attaching nerve ends together of any of examples 74-89, wherein the first arm and the second arm comprise a forceps.

91. The hand-held device for attaching nerve ends together of any of examples 74-90, wherein the device is operable using a single hand.

92. The hand-held device for attaching nerve ends together of any of examples 74-91 , wherein the device comprises high-grade carbon steel. 93. The hand-held device for attaching nerve ends together of any of examples 74-91, wherein the device comprises plastic.

94. The hand-held device for attaching nerve ends together of any of examples 74-93, wherein the device further comprises a locking mechanism to couple the first arm and the second arm at a fixed distance.

95. The hand-held device for attaching nerve ends together of any of examples 74-94, wherein the connecting element comprises a clip. 96. The hand-held device for attaching nerve ends together of any of examples 74-94, wherein the connecting element comprises a staple.

97. The hand-held device for attaching nerve ends together of any of examples 74-96, wherein the connecting element is a single-prong connecting element.

98. The hand-held device for attaching nerve ends together of any of examples 74-97, wherein the connecting element is a multi-prong connecting element.

99. The hand-held device for attaching nerve ends together of example 98, wherein the connecting element is a two-prong connecting element.

100. The hand-held device for attaching nerve ends together of example 98, wherein the connecting element is a three-prong connecting element. 101. The hand-held device for attaching nerve ends together of example 98, wherein the connecting element is a four-prong connecting element.

102. The hand-held device for attaching nerve ends together of any of examples 74-101, wherein the device includes a plurality of connecting elements.

103. The hand-held device for attaching nerve ends together of example 74, wherein the connecting element is interposed between the first arm and the second arm. 104. The hand-held device for attaching nerve ends together of example 103, wherein the connecting element is u-shaped.

105. The hand-held device for attaching nerve ends together of any of examples 74-104, wherein the connecting element comprises a first end comprising a first tip and a second end comprising a second tip.

106. The hand-held device for attaching nerve ends together of example 105, wherein the connecting element comprises multiple prongs. 107. The hand-held device for attaching nerve ends together of example 105, wherein the connecting element comprises two prongs.

108. The hand-held device for attaching nerve ends together of example 105, wherein the connecting element comprises three prongs.

109. The hand-held device for attaching nerve ends together of example 105, wherein the connecting element comprises greater than three prongs.

[0045] The present invention has been described above with reference to a number of exemplary embodiments and examples. It should be appreciated that the particular embodiments shown and described herein are illustrative of the preferred embodiments of the invention and its best mode, and are not intended to limit the scope of the invention as set forth in the claims. It will be recognized that changes and modifications may be made to the embodiments described herein without departing from the scope of the present invention. These and other changes or modifications are intended to be included within the scope of the present invention, as expressed in the following claims and the legal equivalents thereof.

Claims

What is claimed is:

1. A hand-held device for attaching nerve ends together, the device comprising:

a first arm having a first arm first end and a first arm second end;

2. The hand-held device for attaching nerve ends together of claim 1, wherein the connecting element comprises biodegradable material.

3. The hand-held device for attaching nerve ends together of any of claims 1 or 2, wherein the connecting element is detachably coupled to a pivot point on the first arm.

4. The hand-held device for attaching nerve ends together of any of claims 1-2, wherein movement of the second arm relative to the first arm causes the connecting element to rotate and detach from the first arm.

5. The hand-held device for attaching nerve ends together of any of claims 1-2, further comprising an actuator.

6. The hand-held device for attaching nerve ends together of claim 5, wherein the actuator engages with the connecting element to detach the connecting element from the first arm.

7. The hand-held device for attaching nerve ends together of claim 6, wherein the first arm includes a slot and a portion of the actuator moves within the slot to cause the connecting element to detach from the first arm.

8. The hand-held device for attaching nerve ends together of claim 7, wherein the portion of the slot is along an axis of the first arm and the actuator moves along the axis to detach the connecting element.

9. The hand-held device for attaching nerve ends together of claim 8, wherein the actuator comprises a lever coupled to the portion.

10. The hand-held device for attaching nerve ends together of claim 9, wherein the actuator further comprises a pivot and the connecting element disengages by moving the lever away from the connecting element.

11. The hand-held device for attaching nerve ends together of claim 9, wherein the connecting element disengages by moving the lever toward the connecting element.

12. The hand-held device for attaching nerve ends together of any of claims 1-2, wherein the second arm second end comprises a crimping mechanism to crimp the connecting element.

13. The hand-held device for attaching nerve ends together of any of claims 1-2, wherein the connecting element is c-shaped.

14. The hand-held device for attaching nerve ends together of any of claims 1-2, wherein the first arm second end includes a slot for detachably receiving the connecting element.

15. The hand-held device for attaching nerve ends together of any of claims 1-2, wherein the second arm second end comprises a curved end.

16. The hand-held device for attaching nerve ends together of any of claims 1-2, wherein the second arm second end comprises a pointed tip.

17. The hand-held device for attaching nerve ends together of any of claims 1-2, wherein the first arm second end comprises a pointed tip.

18. The hand-held device for attaching nerve ends together of any of claims 1-2, wherein the first arm and the second arm comprise a forceps.

19. The hand-held device for attaching nerve ends together of any of claims 1-2, wherein the device is operable using a single hand.

20. The hand-held device for attaching nerve ends together of any of claims 1-2, wherein the device comprises high-grade carbon steel.

21. The hand-held device for attaching nerve ends together of any of claims 1 -2, wherein the device comprises plastic.

22. The hand-held device for attaching nerve ends together of any of claims 1-2, wherein the device further comprises a locking mechanism to couple the first arm and the second arm at a fixed distance.

23. The hand-held device for attaching nerve ends together of any of claims 1-2, wherein the connecting element comprises a clip.

24. The hand-held device for attaching nerve ends together of any of claims 1-2, wherein the connecting element comprises a staple.

25. The hand-held device for attaching nerve ends together of any of claims 1-2, wherein the connecting element is a single-prong connecting element.

26. The hand-held device for attaching nerve ends together of any of claims 1-2, wherein the connecting element is a multi-prong connecting element.

27. The hand-held device for attaching nerve ends together of claim 26, wherein the connecting element is a two-prong connecting element.

28. The hand-held device for attaching nerve ends together of claim 26, wherein the connecting element is a three-prong connecting element.

29. The hand-held device for attaching nerve ends together of claim 26, wherein the connecting element is a four-prong connecting element.

30. The hand-held device for attaching nerve ends together of any of claims 1-2, wherein the connecting element is interposed between the first arm and the second arm.

31. The hand-held device for attaching nerve ends together of claim 30, wherein the connecting element is u-shaped.

32. The hand-held device for attaching nerve ends together of claim 31, wherein the connecting element comprises multiple prongs.

33. A microsurgical device comprising:

a first arm;

a second arm coupled to the first arm;

a first connecting element; and a second connecting element,

34. The microsurgical device of claim 33, wherein the connecting element comprises biodegradable material.

35. The microsurgical device of any of claims 33-34, wherein first the connecting element is detachably coupled to a pivot point on the first arm.

36. The microsurgical device of any of claims 33-34, wherein the second connecting element is detachably coupled to a pivot point on the second arm.

37. The microsurgical device of any of claims 33-34, wherein movement of the second arm relative to the first arm causes at least one of the first connecting element and the second connecting element to rotate and detach from the device.

38. The microsurgical device of any of claims 33-34, further comprising an actuator.

39. The microsurgical device of claim 38, wherein the actuator engages with at least one of the first connecting element and the second connecting element to detach the at least one of the first connecting element and the second connecting element from the device.

40. The microsurgical device of claim 39, wherein the first arm includes a slot and a portion of the actuator moves within the slot to cause the connecting element to detach from the first arm.

41. The microsurgical device of claim 38, wherein the portion of the slot is along an axis of the first arm and the actuator moves along the axis to detach the connecting element.

42. The microsurgical device of any of claims 33-34, wherein the actuator comprises a lever coupled to the portion.

43. The microsurgical device of claim 42 wherein the actuator further comprises a pivot and the connecting element disengages by moving the lever away from the connecting element.

44. The microsurgical device of claim 42, wherein the connecting element disengages by moving the lever toward the connecting element.

45. The microsurgical device of any of claims 33-34 or 43-44, wherein the connecting element is c-shaped.

46. The microsurgical device of any of claims 33-34 or 43-44, wherein the first arm second end includes a slot for detachably receiving the first connecting element.

47. The microsurgical device of any of claims 33-34 or 43-44, wherein the second arm second end includes a slot for detachably receiving the second connecting element.

48. The microsurgical device of any of claims 33-34 or 43-44, wherein the first arm second end comprises a tapered end.

49. The microsurgical device of any of claims 33-34 or 43-44, wherein the second arm second end comprises a tapered end.

50. The microsurgical device of any of claims 33-34 or 43-44, wherein the first arm and the second arm comprise a forceps.

51. The microsurgical device of any of claims 33-34 or 43-44, wherein the device is operable using a single hand.

52. The microsurgical device of any of claims 33-34 or 43-44, wherein the device comprises high-grade carbon steel.

53. The microsurgical device of any of claims 33-34 or 43-44, wherein the device comprises plastic.

54. The microsurgical device of any of claims 33-34 or 43-44, wherein the device further comprises a locking mechanism to couple the first arm and the second arm at a fixed distance.

55. The microsurgical device of any of claims 33-34 or 43-44, wherein the connecting element comprises a clip.

56. The microsurgical device of any of claims 33-34 or 43-44, wherein the connecting element comprises a staple.

57. The microsurgical device of any of claims 33-34 or 43-44, wherein the connecting element is a single-prong connecting element.

58. The microsurgical device of any of claims 33-34 or 43-44, wherein the connecting element is a multi-prong connecting element.