CA1192466A - Extractor for surgical staples - Google Patents
Extractor for surgical staplesInfo
- Publication number
- CA1192466A CA1192466A CA000419508A CA419508A CA1192466A CA 1192466 A CA1192466 A CA 1192466A CA 000419508 A CA000419508 A CA 000419508A CA 419508 A CA419508 A CA 419508A CA 1192466 A CA1192466 A CA 1192466A
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- Prior art keywords
- extractor
- blade
- anvil
- handle
- legs
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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Abstract
EXTRACTOR FOR SURGICAL STAPLES
ABSTRACT OF THE INVENTION
A manually actuated surgical staple extractor comprising upper and lower handles pivotally joined together and swingable between open and closed positions.
The upper handle terminates at its forward end in a pair of thin, flat, laterally extending stops separated by a blade-receiving slot. The forwardmost portions of the stops lie an an obtuse angle to the upper handle and are joined together by a thin, coplanar, forwardly projecting, U-shaped anvil. The lower handle terminates in a thin blade. When the handles are in their open positions, the blade is located in the above noted slot with its lower edge above the anvil. When the handles are shifted toward each other to their closed positions, the blade pivots downwardly so that it passes through the U-shaped anvil to a position therebelow. The blade and the anvil are so configured that, as the blade passes through the anvil, there is clearance therebetween to either side of the blade, the clearance being at least equal to the diameter of the crown portion of the staple.
ABSTRACT OF THE INVENTION
A manually actuated surgical staple extractor comprising upper and lower handles pivotally joined together and swingable between open and closed positions.
The upper handle terminates at its forward end in a pair of thin, flat, laterally extending stops separated by a blade-receiving slot. The forwardmost portions of the stops lie an an obtuse angle to the upper handle and are joined together by a thin, coplanar, forwardly projecting, U-shaped anvil. The lower handle terminates in a thin blade. When the handles are in their open positions, the blade is located in the above noted slot with its lower edge above the anvil. When the handles are shifted toward each other to their closed positions, the blade pivots downwardly so that it passes through the U-shaped anvil to a position therebelow. The blade and the anvil are so configured that, as the blade passes through the anvil, there is clearance therebetween to either side of the blade, the clearance being at least equal to the diameter of the crown portion of the staple.
Description
~YTRACTOR FOR SURGICAL STAPLES
ROBERT G. ROTHFUSS
DAVID K. KUHL
TECHNICAL FIELD
The invention relates to an extractor for surgical staples, and more particularly to a manually operated e~tractor capable of removing surgical staples with greater ~ase and less trauma to the patient.
BAC~ROUND ART
In recent years surgeons hav~ turned more and more to the use of surgical staples, rather than convsntional thread sutures, for closing wounds or incisions in the s'~in or ~ascia o~ a patient. This is true, in part, because the stapling operation is a simpler procedure in many instances. More importantly, however, is the fact that the ~tapling procPdure is very much faster than conver.tional thread suturing. Thus, particularly in those instances where a large number o sutures is r~quired, the length of time for the suturing procedure and the length of ti~e the patient must be maintained under anesthesia are greatly reduced wh~n surgical staples are used.
U.S. Patents 3,643,851; 3,717,294; alld 3,837,555 illustrate typical surgical staples. A staple of t~e type shown in these patents initially has an elongated crown terminating in downwardly depending leg portions. The free ends of the downwardly dependi.ng leg portions are provided with downwardly and outwardly sloping cuts, forming points. During the forming and implanting of such a staple in the skin or fascia of a patient by a surgical stapling instrument, end portions of the elongated crown are bent downwardly. This results in a staple with a narrower crown and L-shaped legs, the pointed ends of w~ich are opposed, and the L-shaped legs being em~edded in the patient's skin or fascia.
Another type of surgical staple is taught in U.S.
4,014,4~2. This 3taple initially comprises a central crot~ por~ion terminating Rt either end in portion~ sloplno upwardly and ou~wardly, these upwardly and outwardly sloping portions, in turn, terminating in S downwardly and ou~wardly sloping portions. The last mentioned portions are provided with cut s~rfaces forming points. The cut sur~aces ~nitially lie in a position substsntially perpendicular to the staple crown and the skin or ascia of the patient to be joined. During forming and implanting of this type of staple, the upwardly and outwardly sloping portions of the staple, at their ~uncture with the crown, are ben~ downwardly to form a staple having a crown and L-shaped legs, the points of which are opposed.
Either type of surgical staple described above can be removed from the skin or fascia of the patient by bending the st~ple crown into a U-shaped configuration. This will cause the L-shaped legs o the formed staple to shift upwardly and outwardly so that they may be lifted from the patient's skin or fascia.
Prior art workers having developed manual extractors for bending the crown of surgical staples and lif~ing the staple from the patient's skin. In its typical form, a prior art extractor comprises a pliers-like tool having irst and second handle me~ns pivoted togather and formed of sheet metal. The first handle means termina~es in a pair of an~ils in parallel-spaced relationship. The anvil~ are provided at their rearward ends with notches so that, when the anvils are slipped ~mder the crown portion of a surgical staple, the crown will be received in ~he notches.
The second handle of the extractor generally is provided with a relatively thick, two-ply, blade-like forward end substantially as long or longer than the an~ils. l~hen the handle elements of the extractor are in ~heir open position, this blade lies above the anvils and ~he notches therein. As the handle elements are shiXted to their closed positions, the bladP element passes between the anvils and the notches therein making the above described U-shaped bend in the staple crown loca~ed in the notches.
In the use o an extra~tor of this type, ~he anvils (when slipped beneath the crown of a staple) will rub against traumatized areas of the ski~, causing pain to the patient. Since the blade portion of the ex~ractor is as long or longer than the anvils, it partially obscures the anvils, making their proper insertion under t~e s~aple crown and locatlon of the staple crown in the anvil notches more dif~icult. Furthermore, when the extractor anvils are parallel throughout their length, t~e operator may inadvertently slip only one anvil under the cro~n of the staple to be extracted. Under these circumstances, the staple will not properly open and if the operator pulls the extraceor upwardly the patient will undergo severe pain.
When such a prior art extractor is actuated to bend the crown of a surgical staple, clearance between the blade and the anvils is such that the crown tends to make the anvils spread apart, further irritating the traumatized 2S s~in. As a further consequence, the legs of the U-shaped bend in the staple crown are generally non-parallel, with the result that the staple legs themselves are not ~ully opened. In addition, such extractors are generally constructed in such a way that the first handle element can inadvertently become "flipped" (or pivoted through more than 180) with respect to the second handle element, thus rendering the extractor useless until its handle elements sre returned to their proper orientation.
Frequently, such prior art extractors are provided w~th means to bias the handle elements to their open position.
Thi~ biasing means c~n become dislocated, tending to jam the extractor.
U.S. Patent 4,026,520 te~ches a manually operated surgical,staple extractor of pliers-like form and having first and second handle element~ pivo~ally joined together near their forward ends. ~hese handle elements are manually shiftable between open and closed positions and may be biased to their open position. The biasing means is so configured that it canno~ become dislocated and ~am the extractor. Furthermore, means are provided to prevent one handle ~rom becoming 1l ~lipped" with respect to the other.
The first handle element of the extractor of U.S.
~ Patent 4,02~ 520 is bifurcated at its forward end, the bifurcations terminating in p~ir of elongated anvils in parallel-spaced relationship with the forward ends of these anvils angled toward each other so that the frontmost tips thereof are contivuous or nearly so. At the rearward ends, the anvils are provided with aligned no~ches to receive the crown of a staple. The bifurcations of the first handle element provide a steep upwardly and rearwardly sloping surface adjacent each o~
the anvil notches to assist in and ensure the location of the staple crown in the notche~.
~5 A thin blade means is located between the bifur~ations of the first handle element and is operatively connected to the forward end of the second handle element. The blade means has a nose portion shorter than the anvils and a lower edge adapted to produce a U-shaped bend in the crown of a staple located in the anvil notches. The blade nose portion is shitable by the second handle element between a first position (when the handle elements are in their open positi.on) wherein the lower edge of the nose lies above the anvils and the notches therein, and a second position (when the handle elements are in their closed position) wherein the nose lies batween the anvils with the lower edge of the nose located below the anvils.
The anvils are so spaced from each other and the nose of the blade means ls suficiently thin ~hat clearance is provided between the nose and each anvil subst~ntially equal to the diameter o~ the cro~n portion of the surgical staple being extracted. As a result, the anvils do not tend to spread during an extracting procedure and the surgical staple legs are fully opened.
U.S. Patent 4,026,520 teaches two embodimen~s of the extractor. In one embodiment, the blade comprises an integral one-piece part of the second handle element. In th~ other embodiment, the blade is a separate element pivotally mounted between the bifurcations of the first handle element and operatively connected to the forward end of the second handle element.
~ hile the extractor of U.S. Patent 4,026,520 represents a considerable advance in ~he art, it still is characterized by certain deficiencles. First o all, the a~vil portions are of considerable thickness, causing trauma when slipped beneath the crown of a surgical staple, especially when the staple is embedded.
Furthermore, as is true of other prior art extractors, the extractor of U.S. Patent 4,026,520 has a tendency to bend a surgical staple in more than one plane during the extracting procedure, again increasing the trauma experienced by the patient.
The extractor of the present invention is intended to overcome the problems encountered with prior art extractors and to constitute an improvement thereover.
Its construction is simple and inexpensive so th~t, whil~
it may be ~snllf~ctured as a reusable and resterilizable tool, it lends itself well to being produced in the form of a single-use, disposable tool. The extractor is characterized by a one-piece, horizontal anvil, slightly pointed at its forwardmost end and oE minimal thickness to greatly reduce the trauma in placing the anvil under the staple crown. The anvil is provided with means for positive and exact positioning oE the staple crown to prevent slipping while reforming and extracting a staple. The reforming of the surgical staple is accomplished subs-tantially in a single plane and the configuration of the anvil, together with the provision of a thin blade, makes it possible to achieve paral-lel staple legs during the reforming and extracting process.
This enables the legs to be lifted from the skin or fascia of the patient with minimal discomfort. The handle portions may be provided with scissors-like, finger-engaging loops designed to lend the extractor stability during the extracting procedure. The handles may be provided with stops giving the surgeon a positive tactile feedback when the staple is properly reformed, and insuring that each s-taple is identically reformed.
A method of attaching the looped handles to the instrument is taught. Preferably, spring means are provided to bias the handles to their open positions, the spring being so mounted that it cannot be dislocated, and thus cannot jam the extractor.
The combination of the blade of the lower handle and the slotted forward end of the upper handle prevent -the possibility of one handle becoming "flipped" with respect to the other.
A plastic insert may take up the slack between the handle elements at the point at which they are pivoted together, lend-ing a firm and positive scissoring action to the instrument.
Finally, while the instrument could be made of materials such ~, . .~, -7- ~
that it could be reused and resG~Lili2ed,i-t can be manufac-tured quite inexpensively, lerlc~ing i-tself well to being a single-use, disposable instrument. The instrument also lends itself well to appropriate presterile packaging.
DISCLOSURE OF T~IE INVENTION
According to the invention there is provided a man-ually actuated extractor for a surgical staple of the type having, when implanted in the skin of a patient, an exposed crown and opposed L-~shaped skin-engaging legs. The extractor comprises an upper handle and a lower handle, each having a forward and a rearward end. The handles are pivotally joined together near their forward ends and are manually shiftable between open and closed positions. The upper handle terminates at its forward end in a pair of thin, flat, laterally extending stops with a slot located therebetween. The laterally extending stops have coplanar forward portions lying at an obtuse angle to the upper handle. There is provided a thin, U-shaped anvil comprising a base portion and substantially parallel legs, with each of the legs extending to and joining the forward portion of one of the laterally extending stops. The legs are located to either side of the slot. The anvil is substantially coplanar with the forward portions of the laterally ex-tending stops.
The lower handle terminates at its Eorward end in a thin blade that is shiftable by the lower handle such that when the handles are shifted from the open to the closed position, the blade shifts from a normal position extending throu~h the slot and lying above the anvil downwardly through the U-shaped anvil to -8~ 2~
a s-taple reforming position therebelow. There i~ a clearance be-tween the blade and each oE -the anvil legs at least equ~l to the maximum cross sectional dimension o~ the staple crown, whereby when the anvil is slipped beneath -the crown of a staple foîmed and implanted in the s]cin of a patientr with the staple contacted by the forward portions of the laterally extending stops, and the handles are shifted to their closed position shifting the blade -to its staple reforming posi-tion, the crown of the staple will be reEormed into a U-shape causing the L-shaped legs to shift upwardly and outwardly enabling them to belifted by the extractor from the skin of the patient.
BRIEF DESCRIPTION OF THE DRAWINGS
Figure 1 is a bottom view of the extrac-tor of the present invention.
Figure 2 is a side elevational view oE the extractor of Figure 1.
Figure 3 is a fragmentary side elevational view, partly in cross-section.
Figure 4 is a fragmentary enlarged view (partly in cross-sec-tion) of the forward end of the instr~lment as seen in Figure 3.
Figure 5 is a cross-sectional view taken along section line 5-5 of Figure 4.
Figure 6 is a cross-sectional view similar to Figure 5, but illustrating an anvil without aligned notches.
Figure 7 is a fragmentary perspective view of the forward end of the extractor.
Figure 8 is a fragmentary view illustrating a surgical .~
--8a~ 46~
staple implan-ted in a patient's skin and closing a wound therein.
~ igure 9 i.s a fragmentary view, similar to Figure 8, but illustrating -the surgical staple having been extrac-ted.
Figure 10 is a perspective view illustrating an extracted surgical staple which has been reEormed in more than one plane.
Figure 11 is a perspective view, similar to Figure 10, but illustrating a surgical staple having been reformed in 4~Ç~
a single plane.
DE~AILED DESCRIPTION OF THE INVENTION
Th~ extractor of the present invention is bes~
illustrated in Fig~res 1 and 2 and is generally indicated at 1 therein. The extractor 1 has an upper handle generally indicated at 2 and a lower handle generally indicated at 3. Handles 2 and 3 are pivotally ~oined together near their forward ends by pivot p~n 4.
Upper handle 2 has a first metallic part 5 and a second plastic part 6. The major portion of the metallic part 5 is of inverted U-shaped configuration having a base 7 and downwardly depending leg portions 8 and 9 (see also Figure 3 and 7). ~ear the forward end of the metallic por~ion 5 of upper handle 2, a pair of coaxial perforations are formed in the 12gs 8 and 9. The perforation in leg 9 is shown at 10 in Figure 7. These perforations are adapted to accommodate pivot pin 4.
The rearward end of leg 8 of metallic portion 5 has a rearward ex~ension 11 formed thereon (see Figure 3). As is most clearly shown in Figure 3, the extension 11 is inset at 12 from leg 8 so as to lie in a plane parallel to, but between the planes of legs 8 and 9. ~he purpose - of extension 11 will be evident hereinafter.
The plastic portion 6 of upper handle 2 comprises a shank 13 constituting essentially a continuation of the metallic upper handle portion 5. The shank 13 terminates in a scissors-like loop 14, engagable by the thumb of the operator. At the juncture of shank 13 and loop 14, the plastic upper handle portion 6 has an integral, downwardly depending stop 15, provided with an abutment sur~ace 15a.
The purpose of stop 15 and abutment surface 15a will be des~-ribed hereinafter.
The shank 13 of plastic upper handle portion 6 has an elongated, longitudinally extending cavity 16 formed therein (see Fig. 3). The cavity 16 and the metallic upper handle portion e~tension 11 are so sized and configured that the e~tension 11 is just nicely received in cavity 16, preferably with a friction fit. It will be noted from Figure 3 tha-t both extension 11 and cavity 16 are longitudinally tapered. To assure that extension 11 remains firmly within cavity 16, the extension may be provided with a small pointed tang 17 ormed and slightly offset from the ex~ension 113 itself. The tang 17 engages the inside surface of cavity 16 and precludes detachment of upper handle plastic portion 6 from upper handle me~allic portion 5.
Reference is again made to Figures 1 and 7 in particular. From these figures it will be evident that the forwardmost end of the metallic portion S of upper handle 2 terminates in a pair o~ lat2rally extending stops 18 and 19, separated from each ot'ner by a slot 20. The laterally extending stops 18 and 19 constitute integral one-piece parts o the metallic portion 5 of upper handle
ROBERT G. ROTHFUSS
DAVID K. KUHL
TECHNICAL FIELD
The invention relates to an extractor for surgical staples, and more particularly to a manually operated e~tractor capable of removing surgical staples with greater ~ase and less trauma to the patient.
BAC~ROUND ART
In recent years surgeons hav~ turned more and more to the use of surgical staples, rather than convsntional thread sutures, for closing wounds or incisions in the s'~in or ~ascia o~ a patient. This is true, in part, because the stapling operation is a simpler procedure in many instances. More importantly, however, is the fact that the ~tapling procPdure is very much faster than conver.tional thread suturing. Thus, particularly in those instances where a large number o sutures is r~quired, the length of time for the suturing procedure and the length of ti~e the patient must be maintained under anesthesia are greatly reduced wh~n surgical staples are used.
U.S. Patents 3,643,851; 3,717,294; alld 3,837,555 illustrate typical surgical staples. A staple of t~e type shown in these patents initially has an elongated crown terminating in downwardly depending leg portions. The free ends of the downwardly dependi.ng leg portions are provided with downwardly and outwardly sloping cuts, forming points. During the forming and implanting of such a staple in the skin or fascia of a patient by a surgical stapling instrument, end portions of the elongated crown are bent downwardly. This results in a staple with a narrower crown and L-shaped legs, the pointed ends of w~ich are opposed, and the L-shaped legs being em~edded in the patient's skin or fascia.
Another type of surgical staple is taught in U.S.
4,014,4~2. This 3taple initially comprises a central crot~ por~ion terminating Rt either end in portion~ sloplno upwardly and ou~wardly, these upwardly and outwardly sloping portions, in turn, terminating in S downwardly and ou~wardly sloping portions. The last mentioned portions are provided with cut s~rfaces forming points. The cut sur~aces ~nitially lie in a position substsntially perpendicular to the staple crown and the skin or ascia of the patient to be joined. During forming and implanting of this type of staple, the upwardly and outwardly sloping portions of the staple, at their ~uncture with the crown, are ben~ downwardly to form a staple having a crown and L-shaped legs, the points of which are opposed.
Either type of surgical staple described above can be removed from the skin or fascia of the patient by bending the st~ple crown into a U-shaped configuration. This will cause the L-shaped legs o the formed staple to shift upwardly and outwardly so that they may be lifted from the patient's skin or fascia.
Prior art workers having developed manual extractors for bending the crown of surgical staples and lif~ing the staple from the patient's skin. In its typical form, a prior art extractor comprises a pliers-like tool having irst and second handle me~ns pivoted togather and formed of sheet metal. The first handle means termina~es in a pair of an~ils in parallel-spaced relationship. The anvil~ are provided at their rearward ends with notches so that, when the anvils are slipped ~mder the crown portion of a surgical staple, the crown will be received in ~he notches.
The second handle of the extractor generally is provided with a relatively thick, two-ply, blade-like forward end substantially as long or longer than the an~ils. l~hen the handle elements of the extractor are in ~heir open position, this blade lies above the anvils and ~he notches therein. As the handle elements are shiXted to their closed positions, the bladP element passes between the anvils and the notches therein making the above described U-shaped bend in the staple crown loca~ed in the notches.
In the use o an extra~tor of this type, ~he anvils (when slipped beneath the crown of a staple) will rub against traumatized areas of the ski~, causing pain to the patient. Since the blade portion of the ex~ractor is as long or longer than the anvils, it partially obscures the anvils, making their proper insertion under t~e s~aple crown and locatlon of the staple crown in the anvil notches more dif~icult. Furthermore, when the extractor anvils are parallel throughout their length, t~e operator may inadvertently slip only one anvil under the cro~n of the staple to be extracted. Under these circumstances, the staple will not properly open and if the operator pulls the extraceor upwardly the patient will undergo severe pain.
When such a prior art extractor is actuated to bend the crown of a surgical staple, clearance between the blade and the anvils is such that the crown tends to make the anvils spread apart, further irritating the traumatized 2S s~in. As a further consequence, the legs of the U-shaped bend in the staple crown are generally non-parallel, with the result that the staple legs themselves are not ~ully opened. In addition, such extractors are generally constructed in such a way that the first handle element can inadvertently become "flipped" (or pivoted through more than 180) with respect to the second handle element, thus rendering the extractor useless until its handle elements sre returned to their proper orientation.
Frequently, such prior art extractors are provided w~th means to bias the handle elements to their open position.
Thi~ biasing means c~n become dislocated, tending to jam the extractor.
U.S. Patent 4,026,520 te~ches a manually operated surgical,staple extractor of pliers-like form and having first and second handle element~ pivo~ally joined together near their forward ends. ~hese handle elements are manually shiftable between open and closed positions and may be biased to their open position. The biasing means is so configured that it canno~ become dislocated and ~am the extractor. Furthermore, means are provided to prevent one handle ~rom becoming 1l ~lipped" with respect to the other.
The first handle element of the extractor of U.S.
~ Patent 4,02~ 520 is bifurcated at its forward end, the bifurcations terminating in p~ir of elongated anvils in parallel-spaced relationship with the forward ends of these anvils angled toward each other so that the frontmost tips thereof are contivuous or nearly so. At the rearward ends, the anvils are provided with aligned no~ches to receive the crown of a staple. The bifurcations of the first handle element provide a steep upwardly and rearwardly sloping surface adjacent each o~
the anvil notches to assist in and ensure the location of the staple crown in the notche~.
~5 A thin blade means is located between the bifur~ations of the first handle element and is operatively connected to the forward end of the second handle element. The blade means has a nose portion shorter than the anvils and a lower edge adapted to produce a U-shaped bend in the crown of a staple located in the anvil notches. The blade nose portion is shitable by the second handle element between a first position (when the handle elements are in their open positi.on) wherein the lower edge of the nose lies above the anvils and the notches therein, and a second position (when the handle elements are in their closed position) wherein the nose lies batween the anvils with the lower edge of the nose located below the anvils.
The anvils are so spaced from each other and the nose of the blade means ls suficiently thin ~hat clearance is provided between the nose and each anvil subst~ntially equal to the diameter o~ the cro~n portion of the surgical staple being extracted. As a result, the anvils do not tend to spread during an extracting procedure and the surgical staple legs are fully opened.
U.S. Patent 4,026,520 teaches two embodimen~s of the extractor. In one embodiment, the blade comprises an integral one-piece part of the second handle element. In th~ other embodiment, the blade is a separate element pivotally mounted between the bifurcations of the first handle element and operatively connected to the forward end of the second handle element.
~ hile the extractor of U.S. Patent 4,026,520 represents a considerable advance in ~he art, it still is characterized by certain deficiencles. First o all, the a~vil portions are of considerable thickness, causing trauma when slipped beneath the crown of a surgical staple, especially when the staple is embedded.
Furthermore, as is true of other prior art extractors, the extractor of U.S. Patent 4,026,520 has a tendency to bend a surgical staple in more than one plane during the extracting procedure, again increasing the trauma experienced by the patient.
The extractor of the present invention is intended to overcome the problems encountered with prior art extractors and to constitute an improvement thereover.
Its construction is simple and inexpensive so th~t, whil~
it may be ~snllf~ctured as a reusable and resterilizable tool, it lends itself well to being produced in the form of a single-use, disposable tool. The extractor is characterized by a one-piece, horizontal anvil, slightly pointed at its forwardmost end and oE minimal thickness to greatly reduce the trauma in placing the anvil under the staple crown. The anvil is provided with means for positive and exact positioning oE the staple crown to prevent slipping while reforming and extracting a staple. The reforming of the surgical staple is accomplished subs-tantially in a single plane and the configuration of the anvil, together with the provision of a thin blade, makes it possible to achieve paral-lel staple legs during the reforming and extracting process.
This enables the legs to be lifted from the skin or fascia of the patient with minimal discomfort. The handle portions may be provided with scissors-like, finger-engaging loops designed to lend the extractor stability during the extracting procedure. The handles may be provided with stops giving the surgeon a positive tactile feedback when the staple is properly reformed, and insuring that each s-taple is identically reformed.
A method of attaching the looped handles to the instrument is taught. Preferably, spring means are provided to bias the handles to their open positions, the spring being so mounted that it cannot be dislocated, and thus cannot jam the extractor.
The combination of the blade of the lower handle and the slotted forward end of the upper handle prevent -the possibility of one handle becoming "flipped" with respect to the other.
A plastic insert may take up the slack between the handle elements at the point at which they are pivoted together, lend-ing a firm and positive scissoring action to the instrument.
Finally, while the instrument could be made of materials such ~, . .~, -7- ~
that it could be reused and resG~Lili2ed,i-t can be manufac-tured quite inexpensively, lerlc~ing i-tself well to being a single-use, disposable instrument. The instrument also lends itself well to appropriate presterile packaging.
DISCLOSURE OF T~IE INVENTION
According to the invention there is provided a man-ually actuated extractor for a surgical staple of the type having, when implanted in the skin of a patient, an exposed crown and opposed L-~shaped skin-engaging legs. The extractor comprises an upper handle and a lower handle, each having a forward and a rearward end. The handles are pivotally joined together near their forward ends and are manually shiftable between open and closed positions. The upper handle terminates at its forward end in a pair of thin, flat, laterally extending stops with a slot located therebetween. The laterally extending stops have coplanar forward portions lying at an obtuse angle to the upper handle. There is provided a thin, U-shaped anvil comprising a base portion and substantially parallel legs, with each of the legs extending to and joining the forward portion of one of the laterally extending stops. The legs are located to either side of the slot. The anvil is substantially coplanar with the forward portions of the laterally ex-tending stops.
The lower handle terminates at its Eorward end in a thin blade that is shiftable by the lower handle such that when the handles are shifted from the open to the closed position, the blade shifts from a normal position extending throu~h the slot and lying above the anvil downwardly through the U-shaped anvil to -8~ 2~
a s-taple reforming position therebelow. There i~ a clearance be-tween the blade and each oE -the anvil legs at least equ~l to the maximum cross sectional dimension o~ the staple crown, whereby when the anvil is slipped beneath -the crown of a staple foîmed and implanted in the s]cin of a patientr with the staple contacted by the forward portions of the laterally extending stops, and the handles are shifted to their closed position shifting the blade -to its staple reforming posi-tion, the crown of the staple will be reEormed into a U-shape causing the L-shaped legs to shift upwardly and outwardly enabling them to belifted by the extractor from the skin of the patient.
BRIEF DESCRIPTION OF THE DRAWINGS
Figure 1 is a bottom view of the extrac-tor of the present invention.
Figure 2 is a side elevational view oE the extractor of Figure 1.
Figure 3 is a fragmentary side elevational view, partly in cross-section.
Figure 4 is a fragmentary enlarged view (partly in cross-sec-tion) of the forward end of the instr~lment as seen in Figure 3.
Figure 5 is a cross-sectional view taken along section line 5-5 of Figure 4.
Figure 6 is a cross-sectional view similar to Figure 5, but illustrating an anvil without aligned notches.
Figure 7 is a fragmentary perspective view of the forward end of the extractor.
Figure 8 is a fragmentary view illustrating a surgical .~
--8a~ 46~
staple implan-ted in a patient's skin and closing a wound therein.
~ igure 9 i.s a fragmentary view, similar to Figure 8, but illustrating -the surgical staple having been extrac-ted.
Figure 10 is a perspective view illustrating an extracted surgical staple which has been reEormed in more than one plane.
Figure 11 is a perspective view, similar to Figure 10, but illustrating a surgical staple having been reformed in 4~Ç~
a single plane.
DE~AILED DESCRIPTION OF THE INVENTION
Th~ extractor of the present invention is bes~
illustrated in Fig~res 1 and 2 and is generally indicated at 1 therein. The extractor 1 has an upper handle generally indicated at 2 and a lower handle generally indicated at 3. Handles 2 and 3 are pivotally ~oined together near their forward ends by pivot p~n 4.
Upper handle 2 has a first metallic part 5 and a second plastic part 6. The major portion of the metallic part 5 is of inverted U-shaped configuration having a base 7 and downwardly depending leg portions 8 and 9 (see also Figure 3 and 7). ~ear the forward end of the metallic por~ion 5 of upper handle 2, a pair of coaxial perforations are formed in the 12gs 8 and 9. The perforation in leg 9 is shown at 10 in Figure 7. These perforations are adapted to accommodate pivot pin 4.
The rearward end of leg 8 of metallic portion 5 has a rearward ex~ension 11 formed thereon (see Figure 3). As is most clearly shown in Figure 3, the extension 11 is inset at 12 from leg 8 so as to lie in a plane parallel to, but between the planes of legs 8 and 9. ~he purpose - of extension 11 will be evident hereinafter.
The plastic portion 6 of upper handle 2 comprises a shank 13 constituting essentially a continuation of the metallic upper handle portion 5. The shank 13 terminates in a scissors-like loop 14, engagable by the thumb of the operator. At the juncture of shank 13 and loop 14, the plastic upper handle portion 6 has an integral, downwardly depending stop 15, provided with an abutment sur~ace 15a.
The purpose of stop 15 and abutment surface 15a will be des~-ribed hereinafter.
The shank 13 of plastic upper handle portion 6 has an elongated, longitudinally extending cavity 16 formed therein (see Fig. 3). The cavity 16 and the metallic upper handle portion e~tension 11 are so sized and configured that the e~tension 11 is just nicely received in cavity 16, preferably with a friction fit. It will be noted from Figure 3 tha-t both extension 11 and cavity 16 are longitudinally tapered. To assure that extension 11 remains firmly within cavity 16, the extension may be provided with a small pointed tang 17 ormed and slightly offset from the ex~ension 113 itself. The tang 17 engages the inside surface of cavity 16 and precludes detachment of upper handle plastic portion 6 from upper handle me~allic portion 5.
Reference is again made to Figures 1 and 7 in particular. From these figures it will be evident that the forwardmost end of the metallic portion S of upper handle 2 terminates in a pair o~ lat2rally extending stops 18 and 19, separated from each ot'ner by a slot 20. The laterally extending stops 18 and 19 constitute integral one-piece parts o the metallic portion 5 of upper handle
2, extending from the base 7 thereof.
Laterally extending stops 18 and 19 have forwardmost portions l~a and l9a, respectively, which are coplanar and lie at an angle to the main portions of lateral stops 18 and 19. The main portions oE lateral stops 18 and 19 are coplanar with respect to each other and with respect to the base 7 of upper handle metallic portion 5. The angle between the main portions of stops 18 and 19 and their forwardmost portions 18a and l9a is an obtuse angle.
While this angle may be varied, an angle of about 12~ has been found suitable for ease of use by the operator.
A U-shaped anvil 21 extends forwardly from lateral stop portions 18a and l9a and constitutes an integral, one-piece part thereof. The U-shaped anvil 21 has a somewhat pointed base portion 21a and leg portions 22 and 23.
Lower handle 3 comprises a metallic portion 24 and a ~2~
plastic portion 25. The main part of metallic portion 24 is of U-shaped con~iguration ha~ing a base 26 and laterally extending legs 27 and 28 (see Figure 4).
The forward end of the lower handle me~allic portion 24 is adapted to be received between the legs 8 and 9 o metallic upper handle portion 5 ~th the base 25 of lower handle metallic portion 24 lying adjacent and parallel to leg 8 of upper metallic handle portion 5.
The orward end o~ base 26 of lower handle metallic portion ~4 terminates in a blade 29. Blade 29 is an integral, one-piece part of base 260 As can most clearly be seen in Figures 1 and 4, blade 29 is slightly offse~ as at 30 so as to lie in a plane parallel to but inset from the plane of base 26 of lower handle metallic portion 24.
This also ensures that blade 29 will be centered with respect to slot 20 separating laterally extending stops 18 and 19 (see Figure 7). The blade 29 has an upper edge 29a and a lower edge 29b.
Near its juncture with the base 26 of lower handle metallic portion 24, the blade 29 has a perforation (not shown) ormed therein to accommodate pivot pin 4. In this way, upper handle 2 and lower handle 3 are pivotally joined together.
At its rearward end, the base portion 26 of the lower handle metallic portion 24 terminates in an extension 31 similar to the extension 11 of upper handle 2. Ihe extension 31 constitutes an integral one-piece part of base 26 and is offset therefrom as at 32 so as to lie in a plane parallel to but slightly inset from that of base 26. The extension 31 may have an offset, pointed tine formed therein, as at 33.
The plastic portion 25 of lower handle 3 is similar to the upper handle plastic portion 6 and comprises an elongated shank 34 which substantially constitutes a continuation of lower handle metallic portion 24. The 2~
shank 34 terminates at its rearward end in a scissor-like loop 35, ~imilar to loop 14 and adapted to be engaged by a finger o~ the opera~or. At the juncture of shank 34 and loop 35 there is an integral upwardly extending stop 36 on the plast~c handle portion 25, having an abutment surface 36a adapted to cooperate wi~h abutment suraca 15a o upper handle plas~ic por~ion 6. As will be evident hereinafter, stops 15 and 3~, when their surfaces 15a and 36a abut, determine the closed position of upper handle 2 and lower handle 3. In all of Figures 1, 2~ 3 and 4, upp2r handle 2 and lower handle 3 are shown in their open positions. .~s can most clearly be discerned from Figure 4, the open position of the handles is determined by the abutment of upper edge 29a o~ blade 29 against the end 20a lS o~ slot 20.
To attach the plastic portion 25 of lower handle 3 to the lower handle metallic portion 24, it is only necessary to insert extension 31 into the elongated, longitudinally extending cavity 37 formed in shank 34. Again, cavity 37 is so si~ed and configured as to just nicely receive extension 31, preferably with a frictional fit.
Detachment of plastic portion 25 from extension 31 is precluded by tine 33. It will be understood that the attachment of plastic portions 6 and 25 to their respective extensions 11 and 31 could be accomplished in any other suitable manner, as for example, by insert molding.
In order to take up any play between upper handle 2 and lower handle 3 at the point of their pivoted connection, an insert 38 is used. The insert 38 is most clearly seen in Figures 3 and 4. Insert 38 comprises an elongated member just nicely received between the legs 27 and 28 of the lower handle metallic portion 24. At its rearward end, insert 38 is provided with a short tab 39 extending into the cavity 37 of plastic lower handle portion 25~ At ~%~
its forward end, insert 38 has a rounded nose portion 40 containing a perforation 41. The per-Eoration 41 accommodates pivot pin 4 and the rounded nose por~ion 40 serves as a sort of washer for pivot pin 4. Preferably, insert 38 is made of the same plastic material ~s are plastic handle portions 6 and 25. It will be noted from Figure 1 that pivot pin 4 may take the form of a rivet.
While not required, it is preferable that means be provided to urge or bias upper handle 2 and lower handle 3 to their open posi~ions. Such a me~ns is ~ost clearly shown in Figuxe 3 in the form o a leaf spring generally indica~ed a~ 42. Lea~ spring 42 is substantially V-shaped, having a first leg 42a located between legs 8 and 9 of upper handle metallic portion 5 and bearing against the inside surface of the base 7 thereof. Leaf spring 42 has a second leg 42b which extends along the outside of leg 27 of lower handle metallic portion. The free end of leg 42b is bent downwardly as at 42c and extends between the lower handle metallic portion 24 and the lower handle plastic portion 25.
~ hile not required, it is preferred that t'ne anvil 21 be provided with a pair of aligned notches. Such notches are most clearly shown in Figure 7 at 43 and 44, formed in the anvil legs 22 and 23, respectively, adjacent their juncture with laterally extending stop por~ions 18a and l9a. The aligned notches 43 snd 44 are adapted to receive the crown of an implanted staple. Preferably, the upper inside edges of notches 43 and 44 are rounded, as at 45 and 46 (see Figure 5) for reasons ~ich will be evident hereinaf~er.
Figure 6 is substantially identical to Figure 5, but illustrates an anvil 21b having a base portion 21c and legs 22a and 23a. The anvil 21b differs from anvil 21 of Figure 5 only in ~hat its legs 22a and 23a are not provided with aligned notches. In this event, the upper ., ~9~
1~
inside edges o~ legs 22a and 23a are preerably rounded as at 45a and 46a, respectivQly, again for reasons which will be evident hereina~ter.
The metallic parts o-f the extractor 1 arP made from any app~opriate metal (such a.~ stainless steel) which is non-corrosive and sterilizable by any one or more o~ the standard methods. Similarly, the plastic parts are molded of non-toxic plastic material sterilizable by any one or more of the standard methods.
The extractor 1 having been described in detail, its operation can now be set forth. First, however, attention is turned to Figure 8. In Figure 8, tha sk~n of a patient is illustrated at 47, having a wound 48 ~ormed therein.
The wound is maintained in closed condition by a fully formed and implanted staple, generally indicated at 49.
Such staples, together with the surgical stapling instruments by which they are fo~med and implanted, and the method by which they are formed and implanted, are all w~ll known in the art. The formed and implanted staple 49 20 comprises a horizontal crown portion 50 terminating in L-shaped opposed legs 51 and 52, the .free ends of w'nich are pointed. As is well known to one skilled in the art, the vertical portions o~ legs 51 and 52, as seen in Figure 8, originally constituted parts of crown portion 50 and were coextensive therewith.
To remove the surgical staple 49 from the skin 47 of the patient, it is only necessary to bend or reform the crown portion 50 into a U-shape, as shown at 50a in Figure 9. This makes the vertical portions of L-shaped legs 51 30 and 52 (as viewed in Figure 8) become horizontal (as viewed in Figure 9). This, in turn, r~.sults in the horizontal portions of legs 51 and 52 (as viewed in Figure 8) becoming vertical (as viewed in Figure 9). ~nen the surgical staple 49 is properly re~ormed during the extracting process, the vertical portions o~ legs 51 and 246~
52 should be substan~ially parallel so that ~hey can be lited ~ro~ the skin 47 oE the patient with a minimum of discomfort to the patient.
In the use of the extractor 1, the extractor is caused S to approach the formed and implanted surgical staple 49 w~h i~s upper handle 2 and lower handle 3 in their open positions, as shown in ~iguxes 1 through 4. The operator, having 'nis thumb extending through loop 14 of handle 2 and a finger (such as the middle inger o~ the hand) extending through loop 35 of lower handle 3, simply maintains upper ~nd lower handles 2 and 3 in their open positions. On the other hand, when a biasing means such as leaf spring 42 is used, the spring 42 may be employed to maintain or assist in maintaining handles 2 and 3 in their open positions.
With handles 2 and 3 in their open positions, it will be noted rom the Figures that the lower edge 29b of blade 29 lies above anvil 21 and laterally extending stop portions 18a and 19a. This enables the anvil 21 to be inserted beneath the crown 50 of the ormed and implanted staple 49 (see Figure 8) until the vertical portions of legs 51 and 52 contact the forwardmost edges of laterally extending stop portions 18a and 19a. At this stage, the crown 50 of surgical staple 49 will be located in the alignsd anvil notches 43 and 44~ i s~ch notches are present.
The fact that the base portion 21a of anvil 21 is somewhat pointed, and the fact that the anvil is thin (having a thickness equal to the gauge 6f the metal from which the upper handle metallic portion 5 is made), will greatly facilitate the slipping of the anvil 21 under the staple crown 50 with a minimum o~ discom~ort to the patient, especially when the staple is embedded with crown 50 contacting skin 47. The orward por~ions 18a and l9a of laterally extending stops 18 and 19 will prevent the placing of anvil 21 too ar under staple crown 50. When 24~;
notches 43 and 44 are provided in the anvil legs 22 and 23, they will be quite shallow and wiLl tend to hold the staple crown in exact position, preventing slipping of anvil 21 with respect to s~aple crown 50 during ~he s~aple reorming procedure.
At this point, upper and lower handles 2 and 3 are squeezed together, causing lower handle 3 to approach upper handle 2 until the surface 36a of its stop 36 contacts the surface 15a o stop 15 of the upper handle 2.
When upper and lower handles 2 and 3 are in their clos~d positions, the blade 29 will pass through slot 20 and anvil ~1 to the position shown in broken lines at 29c in Figure 3. This causes the crown 50 of formed and implanted surgical staple 49 to be bent in~o a U-shape as at 50a in Figure 9. The act that the anvil legs 22 and 23 are rounded in notches 43 and 44 as at 45 and 46 in Figure 5 (or ro~nded as at 45a and 46a in the absence of notches 43 and 44, as in Figure ~), will help facilitate the initial part of this crown bending procedure. ~he fact that blade 29 is only one thickness of sheet metal allows or a sharper crimp in staple crown 50, making it possible to achie~e parallelism between the end portions of legs 51 and 52, as shown in Figure 9, even with staples of maximum crown size. As is most clearly shown in Figura 1, there is clesrance to either side of blade 29 and the adjacent anvil legs 22 and 23. Th.is clearance is at least equal to and preferably slightly grea~er than the diameter of the cro~n 50 of sur~ical staple 49. This ensures that surgical staples are reformed precisely the same time-a~ter time.
When t'ne upper handle 2 and lower handle 3 are closed, the surgical staple 49 will achieve the configuratiQn shown in Figure 9. During the reforming of the surgical staple, the L-shaped legs 51 and 52 will begin ~o pull ou~
of skin 47. ~hen the free ends of the legs 51 and 52 are substantially parallel, the legs can be fully extracted from skin 47 with a minimum of discomort to the patient.
The surgical staple of Figure 9 is illustrated in perspective in both Figure 10 and Figure 11 and like parts have been given like index numerals. The illustration o Figure 10 difers from that of Figure 11 in that during the reforming step~ the ~urvical staple 49 of Figure 10 ~as been bent in more than one plane, so that the hori~ontal portion~ of legs 51 ~nd 52 (as viewed in Figure 10) are not substantially coaxial. In Fig~re 11, however, the reformed staple has been bent in one plane only and the horizontal portions of legs 51 and 52 (as viewed in Figure 11) are indeed substantially coaxial. A surglcal staple, when reformed in one plane as shown in Figure 11, offers far less discomfort to the patient during the extracting procedure. The forward portions 18a and 19a of laterally extending stops 18 and 19 aid in reforming the surgical staple 49 in one plane.
l~hen the surgical staple 49 has been ex~racted from the skin 47, it can be dislodged from an~il 21 and blade 29 simply by causing upper handle 2 and lower handle 3 to return to their open positions. This will r~le~se the reformed and extracted surgical staple.
The provision of loops 14 and 35 on upper handle 2 and lower handle 3, respectively, tend to lend stability to the extractor and make its manipulation easier~S~ops 15 and 36 give the surgeon a positive tactile fe~d_back when the staple has been properly reformed. These stops also ensure that each staple will be identically re~ormed.
Finally, it will be evident that the extraceor of the present invention can be manufactured inexpensively, and lends itsel well to being manufactured as a single-use, disposable tool.
It will be understood by one skilled in the art that in the foregoing description and in the claims which follow, 2~
terms such as "upper", "lower", "vertical", and ~'horizontal", a~e used for purposes of clarity of descrip~ion, in conjunction with th~o Figures. I'he operator may, oE course, hold the extractor in any appropriate orientation during the extractin~ process.
Modifications may be made in the invention without departing ~rom the spirit of ito
Laterally extending stops 18 and 19 have forwardmost portions l~a and l9a, respectively, which are coplanar and lie at an angle to the main portions of lateral stops 18 and 19. The main portions oE lateral stops 18 and 19 are coplanar with respect to each other and with respect to the base 7 of upper handle metallic portion 5. The angle between the main portions of stops 18 and 19 and their forwardmost portions 18a and l9a is an obtuse angle.
While this angle may be varied, an angle of about 12~ has been found suitable for ease of use by the operator.
A U-shaped anvil 21 extends forwardly from lateral stop portions 18a and l9a and constitutes an integral, one-piece part thereof. The U-shaped anvil 21 has a somewhat pointed base portion 21a and leg portions 22 and 23.
Lower handle 3 comprises a metallic portion 24 and a ~2~
plastic portion 25. The main part of metallic portion 24 is of U-shaped con~iguration ha~ing a base 26 and laterally extending legs 27 and 28 (see Figure 4).
The forward end of the lower handle me~allic portion 24 is adapted to be received between the legs 8 and 9 o metallic upper handle portion 5 ~th the base 25 of lower handle metallic portion 24 lying adjacent and parallel to leg 8 of upper metallic handle portion 5.
The orward end o~ base 26 of lower handle metallic portion ~4 terminates in a blade 29. Blade 29 is an integral, one-piece part of base 260 As can most clearly be seen in Figures 1 and 4, blade 29 is slightly offse~ as at 30 so as to lie in a plane parallel to but inset from the plane of base 26 of lower handle metallic portion 24.
This also ensures that blade 29 will be centered with respect to slot 20 separating laterally extending stops 18 and 19 (see Figure 7). The blade 29 has an upper edge 29a and a lower edge 29b.
Near its juncture with the base 26 of lower handle metallic portion 24, the blade 29 has a perforation (not shown) ormed therein to accommodate pivot pin 4. In this way, upper handle 2 and lower handle 3 are pivotally joined together.
At its rearward end, the base portion 26 of the lower handle metallic portion 24 terminates in an extension 31 similar to the extension 11 of upper handle 2. Ihe extension 31 constitutes an integral one-piece part of base 26 and is offset therefrom as at 32 so as to lie in a plane parallel to but slightly inset from that of base 26. The extension 31 may have an offset, pointed tine formed therein, as at 33.
The plastic portion 25 of lower handle 3 is similar to the upper handle plastic portion 6 and comprises an elongated shank 34 which substantially constitutes a continuation of lower handle metallic portion 24. The 2~
shank 34 terminates at its rearward end in a scissor-like loop 35, ~imilar to loop 14 and adapted to be engaged by a finger o~ the opera~or. At the juncture of shank 34 and loop 35 there is an integral upwardly extending stop 36 on the plast~c handle portion 25, having an abutment surface 36a adapted to cooperate wi~h abutment suraca 15a o upper handle plas~ic por~ion 6. As will be evident hereinafter, stops 15 and 3~, when their surfaces 15a and 36a abut, determine the closed position of upper handle 2 and lower handle 3. In all of Figures 1, 2~ 3 and 4, upp2r handle 2 and lower handle 3 are shown in their open positions. .~s can most clearly be discerned from Figure 4, the open position of the handles is determined by the abutment of upper edge 29a o~ blade 29 against the end 20a lS o~ slot 20.
To attach the plastic portion 25 of lower handle 3 to the lower handle metallic portion 24, it is only necessary to insert extension 31 into the elongated, longitudinally extending cavity 37 formed in shank 34. Again, cavity 37 is so si~ed and configured as to just nicely receive extension 31, preferably with a frictional fit.
Detachment of plastic portion 25 from extension 31 is precluded by tine 33. It will be understood that the attachment of plastic portions 6 and 25 to their respective extensions 11 and 31 could be accomplished in any other suitable manner, as for example, by insert molding.
In order to take up any play between upper handle 2 and lower handle 3 at the point of their pivoted connection, an insert 38 is used. The insert 38 is most clearly seen in Figures 3 and 4. Insert 38 comprises an elongated member just nicely received between the legs 27 and 28 of the lower handle metallic portion 24. At its rearward end, insert 38 is provided with a short tab 39 extending into the cavity 37 of plastic lower handle portion 25~ At ~%~
its forward end, insert 38 has a rounded nose portion 40 containing a perforation 41. The per-Eoration 41 accommodates pivot pin 4 and the rounded nose por~ion 40 serves as a sort of washer for pivot pin 4. Preferably, insert 38 is made of the same plastic material ~s are plastic handle portions 6 and 25. It will be noted from Figure 1 that pivot pin 4 may take the form of a rivet.
While not required, it is preferable that means be provided to urge or bias upper handle 2 and lower handle 3 to their open posi~ions. Such a me~ns is ~ost clearly shown in Figuxe 3 in the form o a leaf spring generally indica~ed a~ 42. Lea~ spring 42 is substantially V-shaped, having a first leg 42a located between legs 8 and 9 of upper handle metallic portion 5 and bearing against the inside surface of the base 7 thereof. Leaf spring 42 has a second leg 42b which extends along the outside of leg 27 of lower handle metallic portion. The free end of leg 42b is bent downwardly as at 42c and extends between the lower handle metallic portion 24 and the lower handle plastic portion 25.
~ hile not required, it is preferred that t'ne anvil 21 be provided with a pair of aligned notches. Such notches are most clearly shown in Figure 7 at 43 and 44, formed in the anvil legs 22 and 23, respectively, adjacent their juncture with laterally extending stop por~ions 18a and l9a. The aligned notches 43 snd 44 are adapted to receive the crown of an implanted staple. Preferably, the upper inside edges of notches 43 and 44 are rounded, as at 45 and 46 (see Figure 5) for reasons ~ich will be evident hereinaf~er.
Figure 6 is substantially identical to Figure 5, but illustrates an anvil 21b having a base portion 21c and legs 22a and 23a. The anvil 21b differs from anvil 21 of Figure 5 only in ~hat its legs 22a and 23a are not provided with aligned notches. In this event, the upper ., ~9~
1~
inside edges o~ legs 22a and 23a are preerably rounded as at 45a and 46a, respectivQly, again for reasons which will be evident hereina~ter.
The metallic parts o-f the extractor 1 arP made from any app~opriate metal (such a.~ stainless steel) which is non-corrosive and sterilizable by any one or more o~ the standard methods. Similarly, the plastic parts are molded of non-toxic plastic material sterilizable by any one or more of the standard methods.
The extractor 1 having been described in detail, its operation can now be set forth. First, however, attention is turned to Figure 8. In Figure 8, tha sk~n of a patient is illustrated at 47, having a wound 48 ~ormed therein.
The wound is maintained in closed condition by a fully formed and implanted staple, generally indicated at 49.
Such staples, together with the surgical stapling instruments by which they are fo~med and implanted, and the method by which they are formed and implanted, are all w~ll known in the art. The formed and implanted staple 49 20 comprises a horizontal crown portion 50 terminating in L-shaped opposed legs 51 and 52, the .free ends of w'nich are pointed. As is well known to one skilled in the art, the vertical portions o~ legs 51 and 52, as seen in Figure 8, originally constituted parts of crown portion 50 and were coextensive therewith.
To remove the surgical staple 49 from the skin 47 of the patient, it is only necessary to bend or reform the crown portion 50 into a U-shape, as shown at 50a in Figure 9. This makes the vertical portions of L-shaped legs 51 30 and 52 (as viewed in Figure 8) become horizontal (as viewed in Figure 9). This, in turn, r~.sults in the horizontal portions of legs 51 and 52 (as viewed in Figure 8) becoming vertical (as viewed in Figure 9). ~nen the surgical staple 49 is properly re~ormed during the extracting process, the vertical portions o~ legs 51 and 246~
52 should be substan~ially parallel so that ~hey can be lited ~ro~ the skin 47 oE the patient with a minimum of discomfort to the patient.
In the use of the extractor 1, the extractor is caused S to approach the formed and implanted surgical staple 49 w~h i~s upper handle 2 and lower handle 3 in their open positions, as shown in ~iguxes 1 through 4. The operator, having 'nis thumb extending through loop 14 of handle 2 and a finger (such as the middle inger o~ the hand) extending through loop 35 of lower handle 3, simply maintains upper ~nd lower handles 2 and 3 in their open positions. On the other hand, when a biasing means such as leaf spring 42 is used, the spring 42 may be employed to maintain or assist in maintaining handles 2 and 3 in their open positions.
With handles 2 and 3 in their open positions, it will be noted rom the Figures that the lower edge 29b of blade 29 lies above anvil 21 and laterally extending stop portions 18a and 19a. This enables the anvil 21 to be inserted beneath the crown 50 of the ormed and implanted staple 49 (see Figure 8) until the vertical portions of legs 51 and 52 contact the forwardmost edges of laterally extending stop portions 18a and 19a. At this stage, the crown 50 of surgical staple 49 will be located in the alignsd anvil notches 43 and 44~ i s~ch notches are present.
The fact that the base portion 21a of anvil 21 is somewhat pointed, and the fact that the anvil is thin (having a thickness equal to the gauge 6f the metal from which the upper handle metallic portion 5 is made), will greatly facilitate the slipping of the anvil 21 under the staple crown 50 with a minimum o~ discom~ort to the patient, especially when the staple is embedded with crown 50 contacting skin 47. The orward por~ions 18a and l9a of laterally extending stops 18 and 19 will prevent the placing of anvil 21 too ar under staple crown 50. When 24~;
notches 43 and 44 are provided in the anvil legs 22 and 23, they will be quite shallow and wiLl tend to hold the staple crown in exact position, preventing slipping of anvil 21 with respect to s~aple crown 50 during ~he s~aple reorming procedure.
At this point, upper and lower handles 2 and 3 are squeezed together, causing lower handle 3 to approach upper handle 2 until the surface 36a of its stop 36 contacts the surface 15a o stop 15 of the upper handle 2.
When upper and lower handles 2 and 3 are in their clos~d positions, the blade 29 will pass through slot 20 and anvil ~1 to the position shown in broken lines at 29c in Figure 3. This causes the crown 50 of formed and implanted surgical staple 49 to be bent in~o a U-shape as at 50a in Figure 9. The act that the anvil legs 22 and 23 are rounded in notches 43 and 44 as at 45 and 46 in Figure 5 (or ro~nded as at 45a and 46a in the absence of notches 43 and 44, as in Figure ~), will help facilitate the initial part of this crown bending procedure. ~he fact that blade 29 is only one thickness of sheet metal allows or a sharper crimp in staple crown 50, making it possible to achie~e parallelism between the end portions of legs 51 and 52, as shown in Figure 9, even with staples of maximum crown size. As is most clearly shown in Figura 1, there is clesrance to either side of blade 29 and the adjacent anvil legs 22 and 23. Th.is clearance is at least equal to and preferably slightly grea~er than the diameter of the cro~n 50 of sur~ical staple 49. This ensures that surgical staples are reformed precisely the same time-a~ter time.
When t'ne upper handle 2 and lower handle 3 are closed, the surgical staple 49 will achieve the configuratiQn shown in Figure 9. During the reforming of the surgical staple, the L-shaped legs 51 and 52 will begin ~o pull ou~
of skin 47. ~hen the free ends of the legs 51 and 52 are substantially parallel, the legs can be fully extracted from skin 47 with a minimum of discomort to the patient.
The surgical staple of Figure 9 is illustrated in perspective in both Figure 10 and Figure 11 and like parts have been given like index numerals. The illustration o Figure 10 difers from that of Figure 11 in that during the reforming step~ the ~urvical staple 49 of Figure 10 ~as been bent in more than one plane, so that the hori~ontal portion~ of legs 51 ~nd 52 (as viewed in Figure 10) are not substantially coaxial. In Fig~re 11, however, the reformed staple has been bent in one plane only and the horizontal portions of legs 51 and 52 (as viewed in Figure 11) are indeed substantially coaxial. A surglcal staple, when reformed in one plane as shown in Figure 11, offers far less discomfort to the patient during the extracting procedure. The forward portions 18a and 19a of laterally extending stops 18 and 19 aid in reforming the surgical staple 49 in one plane.
l~hen the surgical staple 49 has been ex~racted from the skin 47, it can be dislodged from an~il 21 and blade 29 simply by causing upper handle 2 and lower handle 3 to return to their open positions. This will r~le~se the reformed and extracted surgical staple.
The provision of loops 14 and 35 on upper handle 2 and lower handle 3, respectively, tend to lend stability to the extractor and make its manipulation easier~S~ops 15 and 36 give the surgeon a positive tactile fe~d_back when the staple has been properly reformed. These stops also ensure that each staple will be identically re~ormed.
Finally, it will be evident that the extraceor of the present invention can be manufactured inexpensively, and lends itsel well to being manufactured as a single-use, disposable tool.
It will be understood by one skilled in the art that in the foregoing description and in the claims which follow, 2~
terms such as "upper", "lower", "vertical", and ~'horizontal", a~e used for purposes of clarity of descrip~ion, in conjunction with th~o Figures. I'he operator may, oE course, hold the extractor in any appropriate orientation during the extractin~ process.
Modifications may be made in the invention without departing ~rom the spirit of ito
Claims (16)
1. A manually actuated extractor for a surgical staple of the type having, when implanted in the skin of a patient, an exposed crown and opposed L-shaped skin-engaging legs, said extractor comprising an upper handle and a lower handle each having a forward and a rearward end, said handles being pivotally joined together near their forward ends and being manually shiftable between open and closed positions, said upper handle terminating at its forward end in a pair of thin, flat, laterally extending stops with a slot located therebetween, said laterally extending stops having coplanar forward portions lying at an obtuse angle to said upper handle, a thin, U-shaped anvil comprising a base portion and substantially parallel legs, with each of said legs extending to and joining said forward portion of one of said laterally extending stops, said legs being located to either side of said slot, said anvil being substantially coplanar with said forward portions of said laterally extending stops, said lower handle terminating at its forward end in a thin blade, said blade being shiftable by said lower handle such that when said handles are shifted from said open to said closed position, said blade shifts from a normal position extending through said slot and lying above said anvil downwardly through said U-shaped anvil to a staple reforming position therebelow, there being clearance between said blade and each of said anvil legs at least equal to the maximum cross sectional dimension of said staple crown, whereby when said anvil is slipped beneath the crown of a staple formed and implanted in the skin of a patient with said staple contacted by said forward portions of said laterally extending stops, and said handles are shifted to their closed position shifting said blade to its staple reforming position, said crown of said staple will be reformed into a U-shape causing said L-shaped legs to shift upwardly and outwardly enabling them to be lifted by said extractor from the skin of the patient.
2. The extractor claimed in claim 1 wherein each of said handles terminates at its rearward end in a scissors-like loop.
3. The extractor claimed in claim 1 wherein said anvil base portion is V-shaped.
4. The extractor claimed in claim 1 wherein said upper handle has a downwardly depending upper stop terminating in an abutment surface and said lower handle has an upwardly extending lower stop terminating in an abutment surface, said stops being so positioned on their respective upper and lower handles as to have their abutment surfaces in contact with each other when said handles are in said closed position to determine said closed position and to determine said staple reforming position of said blade.
5. The extractor claimed in claim 1 wherein said slot has an upper end contactable by said blade to determine said open position of said handles and said normal position of said blade.
6. The extractor claimed in claim 1 including means to bias said handles to said open position and said blade to said normal position.
7. The extractor claimed in claim 1 including a pair of shallow aligned notches, each notch located at the juncture of one of said anvil legs and the forward portion of one of said laterally extending stops from which it extends, said aligned notches being configured to receive said crown of said implanted surgical staple when said anvil is slipped therebeneath.
8. The extractor claimed in claim 1 wherein the upper opposed edges of said anvil legs adjacent said laterally extending stop forward portions are rounded.
9. The extractor claimed in claim 1 wherein said upper handle comprises a forward metallic portion and a rearward plastic portion, said upper handle forward metallic portion terminating at its forward end in said laterally extending stops and said anvil, said upper handle plastic portion comprising an elongated shank affixed at its forward end to the rearward end of said upper handle metallic portion and constituting a continuation thereof, said upper handle plastic portion terminating at its rearward end in a loop engagable by the thumb of an operator of said extractor, said lower handle comprising a forward metallic portion and a rearward plastic portion, said lower handle metallic portion terminating at its forward end in said blade, said lower handle plastic portion comprising an elongated shank affixed at its forward end to the rearward end of said lower handle metallic portion and constituting a continuation thereof, said lower handle plastic portion terminating at its rearward end in a loop engagable by the finger of an operator of said extractor.
10. The extractor claimed in claim 9 wherein said upper handle metallic portion has an inverted U-shaped cross section comprising a base and a pair of downwardly depending legs, said laterally extending stops and said anvil extending forwardly of said upper handle metallic portion base and being an integral, one-piece part thereof, one of said legs of said upper handle metallic portion having an extension extending rearwardly of said upper handle metallic portion, said shank of said upper handle plastic portion having a longitudinal cavity receiving said extension and means to maintain said extension therein, said lower handle metallic portion having a U-shaped cross section comprising a base and a pair of laterally extending legs, said blade extending forwardly of said lower handle metallic portion base and comprising an integral, one-piece part thereof, said last mentioned base terminating at its rearward end in an extension, said shank of said lower handle plastic portion having a longitudinal cavity receiving said last mentioned extension and means to maintain said last mentioned extension therein, said forward end of said lower handle metallic portion being located between said legs of said upper handle metallic portion near said forward end thereof, said blade and said upper handle metallic portion having coaxial perforations therein, a rivet mounted in said coaxial perforations to pivotally join said upper and lower handles together, and a plastic insert located between the legs of said lower handle metallic portion and surrounding said rivet.
11. The extractor claimed in claim 10 wherein said upper handle plastic portion has a downwardly depending upper stop located at the juncture of said shank and loop thereof, said upper stop terminating in an abutment surface, said lower handle plastic portion having an upwardly extending lower stop located at the juncture of said shank and loop thereof, said lower stop terminating in an abutment surface, said stops having their abutment surfaces in contact with each other when said handles are in their closed position to determine said close position and said staple reforming position of said blade.
12. The extractor claimed in claim 11 wherein said slot has an upper end contactable by said blade to determine said open position of said handles and said normal position of said blade.
13. The extractor claimed in claim 12 wherein said anvil base portion is V-shaped.
14. The extractor claimed in claim 12 including means to bias said handles to said open position and said blade to said normal position.
15. The extractor claimed in claim 14 including a pair of shallow aligned notches, each notch located at the juncture of one of said anvil legs and the forward portion of one of said laterally extending stops from which it extends, said aligned notches being configured to receive said crown of said implanted surgical staple when said anvil is slipped therebeneath.
16. The extractor claimed in claim 14 wherein the upper opposed edges of said anvil legs adjacent said laterally extending stop forward portions are rounded.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US36710082A | 1982-04-14 | 1982-04-14 | |
| US367,100 | 1982-04-14 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA1192466A true CA1192466A (en) | 1985-08-27 |
Family
ID=23445933
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA000419508A Expired CA1192466A (en) | 1982-04-14 | 1983-01-14 | Extractor for surgical staples |
Country Status (1)
| Country | Link |
|---|---|
| CA (1) | CA1192466A (en) |
-
1983
- 1983-01-14 CA CA000419508A patent/CA1192466A/en not_active Expired
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| MKEC | Expiry (correction) | ||
| MKEX | Expiry |