AU2016101793A4 - Laparoscopic grasping and cutting instruments - Google Patents

Abstract

LAPAROSCOPIC GRASPING AND CUTTING INSTRUMENTS The disclosure herein provides laparoscopic grasping and cutting instruments. A medical instrument comprises: a grasping portion to grasp the tissue; and a sharp section to act as scissors to cut sutures. In some embodiments, the instrument further comprises: a short tooth in a first jaw that sits on a corresponding hole or depression in a second jaw; a flat portion on both jaws, with shallow matting or grooves on both jaws to enable a suture strand to be grasped, and not slip, when traction is applied to tighten a knot that has been formed; and a hollow portion or a small groove to hold a needle and also to be used as a knot-pusher to tighten a knot formed by extra-corporeal knot-tying techniques. 8294233 1 (GHMatters) P104243.AU 0o0 C) C)

Description

1 2016101793 13 Oct 2016

LAPAROSCOPIC GRASPING AND CUTTING INSTRUMENTS

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims the benefit of U.S. Provisional Application No. 62/241,034, titled SUTURE PARTNER, filed on October 13, 2015, which is hereby incorporated by reference in its entirety.

BACKGROUND

Field [0002] This disclosure relates to a surgical tool that is intended to simplify surgical procedures in general, and the task of laparoscopic suturing in particular.

Description [0003] Laparoscopic surgery has seen the numbers and types of procedures that are performed by the laparoscopic route increasing exponentially. Yet a factor limiting individuals’ ability to expand the range of procedures they can perform is invariably the lack of suturing skills. Accordingly, there is a need for laparoscopic instruments that make it easier for a surgeon to learn and perform laparoscopic procedures, such as laparoscopic suturing.

SUMMARY

[0004] The disclosure herein provides improved laparoscopic grasping and cutting instruments. According to some embodiments, a medical instrument comprises: a grasping portion to grasp the tissue; and a sharp section to act as scissors to cut sutures. In some embodiments, the medical instrument further comprises: a first jaw and a second jaw; a flat portion on both jaws, with shallow matting or grooves on both jaws to enable a suture strand to be grasped, and not slip, when traction is applied to tighten a knot that has been formed; and a hollow portion or a small groove to hold a needle and also to be used as a knot-pusher to tighten a knot formed by extra-corporeal knot-tying techniques. In some embodiments, the medical instrument is configured in working lengths and diameters suitable for laparoscopic surgery, mini-laparoscopic surgery, robotic-assisted laparoscopic surgery, and bariatric surgery. In some embodiments, bipolar electrical energy is provided to the two jaws or unipolar electrical energy is provided to one jaw. In some embodiments, one jaw is configured to move backwards and forwards on a horizontal plane in a motion similar to hand-sawing. In some embodiments, the first jaw includes a short tooth that sits on a corresponding hole or depression in the second jaw.

8294233.1 (GHMatters) P104243.AU 2 2016101793 13 Oct 2016 [0005] For purposes of this summary, certain aspects, advantages, and novel features of the invention are described herein. It is to be understood that not necessarily all such advantages may be achieved in accordance with any particular embodiment of the invention. Thus, for example, those skilled in the art will recognize that the invention may be embodied or carried out in a manner that achieves one advantage or group of advantages as taught herein without necessarily achieving other advantages as may be taught or suggested herein.

BRIEF DESCRIPTION OF THE DRAWINGS

[0006] The foregoing and other features, aspects, and advantages of the present disclosure are described in detail below with reference to the drawings of various embodiments, which are intended to illustrate and not to limit the disclosure. The drawings comprise the following figures in which: [0007] Fig. 1 illustrates one embodiment of an end portion of a laparoscopic tool or instrument described herein, such as is described below.

[0008] Fig. 2 and Fig. 3 illustrate other embodiments of laparoscopic instruments, with the instrument’s full size visible.

[0009] Fig. 4, Fig. 5, Fig. 6, Fig. 7, and Fig. 8 further illustrate an embodiment of a laparoscopic instrument, providing a more detailed view of the instrument’s jaws.

[0010] Figs. 9A and 9B further illustrates an embodiment of a laparoscopic instrument, providing a more detailed view of an embodiment of the instrument’s jaws.

DETAILED DESCRIPTION

[0011] Although several embodiments, examples, and illustrations are disclosed below, it will be understood by those of ordinary skill in the art that the inventions described herein extend beyond the specifically disclosed embodiments, examples, and illustrations and includes other uses of the inventions and obvious modifications and equivalents thereof. Embodiments of the inventions are described with reference to the accompanying figures, wherein like numerals refer to like elements throughout. The terminology used in the description presented herein is not intended to be interpreted in any limited or restrictive manner simply because it is being used in conjunction with a detailed description of certain specific embodiments of the inventions. In addition, embodiments of the inventions can comprise several novel features and no single feature is solely responsible for its desirable attributes or is essential to practising the inventions herein described.

8294233_1 (GHMatters) P104243.AU 3 2016101793 13 Oct 2016 [0012] Laparoscopic surgery has seen the numbers and types of procedures that are performed by the laparoscopic route increasing exponentially. Yet a factor limiting individuals’ ability to expand the range of procedures they can perform is invariably the lack of suturing skills.

[0013] Each surgeon attempts to improve their suturing skills by attending laparoscopic workshops, which incorporate suturing workshops. Preceptors regularly say to their attendees: "if you can't suture, you should not be operating". The first day or two at each workshop is usually devoted to laparoscopic suturing. “Tips” and “tricks” are passed on from preceptor to attendee on how to ligate vessels, pedicles and repair organ should these unfortunate complications occur during laparoscopic surgery.

[0014] A suture needle comprises a tip, a body and an end. It is to the end of the needle that the suture is attached. Sutures are typically attached by being inserted into a hole at the end of the needle, and the needle is then crimped to hold the suture securely. The action of securing a needle is to drive the needle all the way through the pedicle, then cut it free from the suture, and finally tie the two loose suture ends together to form a knot. In the case of laparoscopic surgery, the needle (which is now loose) then has to be extracted after the suture knot has been tied.

[0015] In one example process of laparoscopic suturing, a laparoscopic needle holder holding the needle is passed through a laparoscopic port and the needle is then driven through the tissue; in this case, for the purpose of description, the vaginal cuff. The needle with the particular strand of suture required is passed through both sides of the vaginal cuff. A grasper, passed from another laparoscopic port, usually from the opposite side, then pulls the needle out from the tissue. The needle is then re-driven through another portion of the cuff until the whole cuff opening is sutured. One grasper is removed and scissors are introduced to cut the needle free of the suture. The scissors are removed and the graspers reintroduced. The surgeon then forms a knot by holding one end of the suture with one grasper and wrapping it around the other grasper. The second grasper then catches the free suture end and pulls to tighten the knot. Finally, the graspers are removed and the scissors reintroduced to cut the suture ends shorter. The scissors are then removed.

[0016] The example laparoscopic suturing process described above can be complicated and difficult to learn and perform. Various embodiments of laparoscopic instruments disclosed herein can simplify the laparoscopic suturing process and make the process easier to learn and perform. The term “suture partner” is used herein in describing various embodiments of laparoscopic instruments, and this term may not always be used to

8294233_1 (GHMallers) P104243.AU 4 2016101793 13 Oct 2016 refer to the same embodiment of a laparoscopic instrument. In some embodiments, the term suture partner is used interchangeably with the terms laparoscopic tool, laparoscopic instrument, surgical tool, surgical instrument, laparoscopic grasper, laparoscopic scissors, surgical grasper, surgical scissors, combined laparoscopic grasper and scissors, combined surgical grasper and scissors, and/or the like.

[0017] In some embodiments, a laparoscopic instrument 100 (alternatively referred to as a medical instrument, surgical tool, suture partner, and/or the like) can include at least one jaw 102, and preferably a pair of jaws 102. The jaws 102 can include a grasping portion or end 104, a sharp section 106, and a tip 108. The jaw can extend from the tip 108 to a base 112. The jaw 102 can pivot about a pivot point 110 positioned at the base 112. The tip 108 can include a tooth 252 and/or a plurality of teeth 252. The tip 108 can include a recess or depression 254 to receive the tooth or plurality of teeth 252. In some embodiments, the tip 108 is blunt or rounded. The jaw 102 can include a flat portion 116. The grasping portion 104 or the flat portion 116 can include matting or grooves 114, 114A, 120, 120A. The jaws 102 can be connected to a shaft 150 and/or an insert 154. The insert 154 can be configured to be positioned within an outer sheath 152 to form the shaft 150. The shaft 150 can be connected to a handle 200. The handle 200 can include and/or be connected to a rotation or locking mechanism 202.

[0018] One advantage of various embodiments of the suture partner 100 disclosed herein is that they can perform all (or in some embodiments, some) the tasks of the opposite hand (i.e., the hand that is not driving the needle) during suturing. The suture partner is designed in some embodiments to provide one, more, or all of the following functions during suturing: • Grasp tissue; • Receive a needle; • Hold the suture to pull it through the knot; and/or • Cut the suture ends after the knot is tied.

[0019] To perform these functions, some embodiments of the suture partner comprise, at least, two jaws 102 incorporating: • A grasping portion 104 to grasp the tissue; • A sharp section 106 to act as scissors to cut sutures.

[0020] In some embodiments, these features are provided sequentially along the length of the suture partner jaws 102 (i.e. in a linear configuration). The order in which they are listed above commences at a tip 108 and finishes at a pivot point 110 at a base 112 of the jaws.

8294233_1 (GHMatters) P104243.AU 5 2016101793 13 Oct 2016

In other embodiments, the features may be positioned or configured differently. With reference to Fig. 1, in some embodiments, the scissors portion is no more than 10 millimeters in length. In other embodiments, the length of the scissors portion and the grasper portion can be longer or shorter. In some embodiments the length of the scissors portion is approximately the same as the length of the grasper portion. In other embodiments, the length of the scissors portion is longer or shorter than the length of the grasper portion.

[0021] The suture partner in some embodiments also comprises a handle 200 (of any type; e.g., pistol grip or squeeze/release grip). The suture partner also comprises, in some embodiments, at least, a shaft 150 culminating in jaws containing the features described above. Some embodiments may, alternatively, comprise both an outer sheath 152 and an inner insert 154 that culminates in the jaws.

[0022] Some embodiments of the suture partner, desirably comprise one or more of the following features that help to achieve the stated benefits: • In some embodiments, (e.g., Figs. 9A and 9B), the front tip 108 of one jaw comprising a short tooth 252 perpendicular to the flat surface of the jaw. This tooth sits into a corresponding hole or depression 254 in an opposite jaw, enabling a good grasp of tissue when the jaws are closed. This ensures the tissue does not slip out of the jaws’ grip when put under tension. • In some embodiments, the front tip 108 of one or more jaws is a blunt tip or is rounded. The blunt tip can desirably grasp fragile tissue, such as a bladder or bowel. • Behind the front tip 108, a flat portion 116 on the jaw, with shallow matting or grooves 114, 114A, 120, 120A on both jaws to enable a suture strand to be grasped, and not slip, when traction is applied to tighten a knot that has been formed. • Further along, a hollow portion or a small groove 118 to hold the needle and also to be used as a knot-pusher to tighten a knot formed by extra-corporeal knot-tying techniques; • Finally, a short scissors portion 106 on both jaws to cut the suture or knot.

[0023] In some embodiments, it is desirable for the shaft 150 or inner insert 154 of the suture partner to have a rotation mechanism 202 so that the grasper and scissors portions can be presented at different angles to provide greater manoeuvrability. For example, a knob or dial (as shown in Fig. 2) could be used to rotate the shaft through 360° (or, in some embodiments, less than 360°) so as to alter the axis of the grasper’s opening and closing, enabling the suture partner to grasp tissue that is presented at different angles. In this and other embodiments, a mechanism could be provided to lock the grasper jaws in position when

8294233_1 (GHMatters) P104243.AU 6 2016101793 13 Oct 2016 they are fully closed, thus securely holding tissue. The surgeon would not need to apply continued pressure on the handle 200 to keep the jaws closed and would instead have to manually unlock the jaws (e.g., by pressing a button) before opening them, which can be safer.

[0024] Some embodiments provide a range of features for laparoscopic suturing that could only otherwise be provided by the use of several different instruments consecutively. During laparoscopic surgery, changing between two instruments is a time-consuming process involving the surgeon removing the first instrument through the laparoscopic port, passing it to a nurse or technician to be replaced on the instrument trolley, choosing and identifying the new instrument required (in most cases, verbally), receiving the new instrument from the nurse or technician (assuming the nurse or technician has correctly identified the instrument that is the request), and finally introducing it into the body through the laparoscopic port. The embodiments of the present disclosure therefore simplifies and shortens laparoscopic suturing procedures by providing all the most necessary functions in one instrument; i.e., grasping tissue under traction without slipping, grasping and holding suture material without slipping, helping to form a knot and then cutting the knot.

[0025] In some embodiments, the outer diameter of the suture partner could vary, for example, from larger instruments to typical laparoscopic sizes between 5mm and 10mm, to mini-laparoscopic sizes of 2mm-3mm, or any other desirable variation. The length of the instrument, which is determined by the length of its shaft or by the length of its outer sheath and inner insert, would, in some embodiments, be a standard laparoscopic length of approximately 35cm. However, the suture partner could be provided in any length desired. In some embodiments, such as robotic-assisted laparoscopic surgery, a longer length may be desired.

[0026] The advent of robotic-assisted laparoscopic surgery has necessitated a change in the placement of laparoscopic ports to higher positions on the anterior abdominal wall. Whereas laparoscopic ports would typically be placed below the line of the umbilicus, robotic ports are placed in line with, or above, the umbilicus.

[0027] In robotic-assisted laparoscopic surgery, the robot console is wheeled in and placed on the left side of the patient. The boom that holds the laparoscopic holders is then extended over the patient. Usually there is a camera port and up to 3 or 4 other ports, because the robot has 3 or 4 arms (depending on the model). Long robotic instruments are attached to panels which move the instruments in response to inputs from the surgeon, who operates the robot from a control station that is away from the operating table. A surgical assistant stands on the right side of the patient, taking care not to be in the way of the moving robotic handles and boom. The assistant operates a port through which suction, additional graspers, scissors and

8294233_1 (GHMatters) P104243.AU 7 2016101793 13 Oct 2016 needles can be introduced, used and removed to assist the robotic surgeon. In particular, the assistant must introduce the needles that the primary surgeon will then manoeuvre using the robotic arms. The assistant’s port is placed much higher than the robotic ports to avoid instruments clashing during the procedure and to avoid the boom and handles striking the assistant.

[0028] Some embodiments of the suture partner 100 can be adapted for use to aid robotic-assisted laparoscopic surgery. These embodiments of the suture partner 100 can, for example, provide a longer working length than the conventional laparoscopic version. Typically, a laparoscopic length would be in the region of 35cm, while a robotic length would in many cases desirably be in the region of 45cm to account for the higher port placement. This longer length would also be suitable in bariatric surgery, where the larger girth of the patient demands a longer working length of laparoscopic instrument.

[0029] The robotic assistant’s main task during laparoscopic suturing is to cut and remove suture ends and used needles. Usually, the assistant would use separate graspers and scissors for these tasks. Each insertion requires careful checking to ensure the path of the instrument is clear of vital organs, for which purpose the telescope must be retracted to provide visualisation. This leads to a further loss of continuity in the flow of the operation, in addition to the existing delays, consequent upon instrument changeover, that were described earlier. Delays are particularly undesirable in robotic cases where the patient is in a steep “head down” position. Prolonged anaesthesia is similarly undesirable in bariatric patients with a high body mass index. Thus the suture partner, providing at least a dual function in one embodiment, lowers the chances of instruments clashing with each other during the procedure and reduces the frequency of instrument changes required.

[0030] In addition to the suture partner configurations described above, other embodiments may comprise various additional designs and features.

[0031] In one embodiment, bipolar tissue sealing or monopolar function can be provided to make both suture partner jaws 102 active and conductive. In this and other embodiments, the suture partner could incorporate a bipolar grasper with a sealing and a cutting component. The sealing component would be provided by the use of bipolar coagulation energy and/or the like, while grooves 120, 114 in the grasper jaws and/or the like would provide compression to blood vessels in the pedicle grasped by the suture partner. The cutting function could be provided by bipolar energy or instead continue to be performed using manual, “cold” scissors.

8294233.1 (GHMatters) P104243.AU 8 2016101793 13 Oct 2016 [0032] Alternatively, in some embodiments, the suture partner 100 could function as a unipolar dissector or cutter. For example, one jaw 102 would be active, and the other jaw a straight piece of non-conductive insulated material upon which the first jaw, when closed, will rest. A typical use would be in laparoscopic subtotal hysterectomy, where the lower segment of the cervix is transected to leave the cervix in situ. After the instrument is inserted through the laparoscopic port, the active unipolar jaw would be opened so that the insulated jaw is placed under the cervix. When the cervix is transected by closing the active jaw, this placement of the insulated jaw would keep the bowel away from the energy and the cutting action. Both jaws can be of variable length, with outer diameters to fit the port they are required to be passed through. In various embodiments, some feasible shapes for the active jaw could vary from a sharp needle to a knife blade, with or without serrations.

[0033] In another embodiment, the suture partner could provide a manual or motorised dissector by having the active jaw move backwards and forwards on a horizontal plane in a motion similar to hand-sawing. This embodiment could be manually hand-operated, or operated by battery or an external battery source. When used in this embodiment, the instrument could achieve the cutting effect without it being necessary for the active jaw to have monopolar electrical activity.

[0034] While the suture partner 100 has been disclosed primarily in the context of a laparoscopic surgical instrument, it could readily be used in other arenas. These arenas include other forms of surgery, for example abdominal, as well as other industries. As such, the suture partner invention should be considered to comprise such adaptations, including of size and strength, as would be necessary for these manners of use.

[0035] Conditional language, such as, among others, “can,” “could,” “might,” or “may,” unless specifically stated otherwise, or otherwise understood within the context as used, is generally intended to convey that certain embodiments include, while other embodiments do not include, certain features, elements and/or steps. Thus, such conditional language is not generally intended to imply that features, elements and/or steps are in any way required for one or more embodiments or that one or more embodiments necessarily include logic for deciding, with or without user input or prompting, whether these features, elements and/or steps are included or are to be performed in any particular embodiment. The headings used herein are for the convenience of the reader only and are not meant to limit the scope of the inventions or claims.

[0036] Although these inventions have been disclosed in the context of certain embodiments and examples, it will be understood by those skilled in the art that the present

8294233_1 (GHMatters) P104243.AU 9 2016101793 13 Oct 2016 inventions extend beyond the specifically disclosed embodiments to other alternative embodiments and/or uses of the inventions and obvious modifications and equivalents thereof. Additionally, the skilled artisan will recognise that any of the above-described methods can be carried out using any appropriate apparatus. Further, the disclosure herein of any particular feature, aspect, method, property, characteristic, quality, attribute, element, or the like in connection with an embodiment can be used in all other embodiments set forth herein. For all of the embodiments described herein the steps of the methods need not be performed sequentially. Thus, it is intended that the scope of the present inventions herein disclosed should not be limited by the particular disclosed embodiments described above.

[0037] In the claims which follow and in the preceding description of the invention, except where the context requires otherwise due to express language or necessary implication, the word “comprise” or variations such as “comprises” or “comprising” is used in an inclusive sense, i.e. to specify the presence of the stated features but not to preclude the presence or addition of further features in various embodiments of the invention.

[0038] It is to be understood that, if any prior art publication is referred to herein, such reference does not constitute an admission that the publication forms a part of the common general knowledge in the art, in Australia or any other country.

8294233J (GHMatters) P104243.AU

Claims (6)

1. What is claimed is:

   1. A medical instrument comprising: a grasping portion to grasp the tissue; and a sharp section to act as scissors to cut sutures.
2. 2. The medical instrument of Claim 1, further comprising: a first jaw and a second jaw; a flat portion on both jaws, with shallow matting or grooves on both jaws to enable a suture strand to be grasped, and not slip, when traction is applied to tighten a knot that has been formed; and a hollow portion or a small groove to hold a needle and also to be used as a knot-pusher to tighten a knot formed by extra-corporeal knot-tying techniques.
3. 3. The medical instrument of Claim 1, configured in working lengths and diameters suitable for laparoscopic surgery, mini-laparoscopic surgery, robotic-assisted laparoscopic surgery, and bariatric surgery.
4. 4. The medical instrument of Claim 1, wherein bipolar electrical energy is provided to the two jaws or unipolar electrical energy is provided to one jaw.
5. 5. The medical instrument of Claim 1, where one jaw is configured to move backwards and forwards on a horizontal plane in a motion similar to hand-sawing.
6. 6. The medical instrument of Claim 1, wherein the first jaw includes a short tooth that sits on a corresponding hole or depression in the second jaw.