CA2054366A1 - Surgical apparatus for suture insertion - Google Patents
Surgical apparatus for suture insertionInfo
- Publication number
- CA2054366A1 CA2054366A1 CA 2054366 CA2054366A CA2054366A1 CA 2054366 A1 CA2054366 A1 CA 2054366A1 CA 2054366 CA2054366 CA 2054366 CA 2054366 A CA2054366 A CA 2054366A CA 2054366 A1 CA2054366 A1 CA 2054366A1
- Authority
- CA
- Canada
- Prior art keywords
- suture thread
- optical fiber
- tissue
- laser
- laser radiation
- 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.)
- Abandoned
Links
Abstract
Abstract of the disclosure Surgical Apparatus for Suture Insertion The apparatus comprises suture thread; an optical fiber or fibers for transmission of laser radiation along the interior of the suture thread; and a laser source for supply of laser radiation via the optical fiber or fibers to the leading end of the suture thread such that the radiation can penetrate tissue of the patient; in which the leading end of the suture thread can be manipulated. The suture thread is inserted into tissue of a patient by directing laser radiation at the tissue surface so as to form a pilot hole in the tissue followed by the insertion of the suture thread into the pilot hole.
Description
20~43~
Surgical Appa,ratus fo,r Suture Ins~r on FIELD OF THE-INvENTIo--N
The present invention is concerned with an apparatus and method for insertion of suture thread into tissue of a patient.
BACKGROUND OF THE INVENTI,ON
A common procedure in medicine and surgery is the installation of sutures into tissue. For example, in surgery a wound is closed by the use of a suture thread installed by means of a sharp needle attached to the suture thread. Needle passage through tough tissue is often necessary and as such the needle must be rigid and sharply pointed. Even so, the medical operative often experiences difficulty forcing the ne dle through such tissue. The application of force often results in tearing, bleeding and trauma for the patient.
The forceful use of a sharp needle also sometimes results in needle stick injuryto medical personnel. Needle stick injury has been cited as a probable cause for transmission of disease from medical personnel to patient and vice-versa.
The use of lasers is well known in medicine for certain procedures e.g. in surgery, where its use is in the manner of a scalpel or probe to cut or destroy tissue or to cauterise vascular tissue. Optical fiber technology is also well understood in medicine where its use in endoscopy has become routine.
It is an object of the present invention to provide a method and apparatus which can facilitate penetration of suture thread into tissue without the use of a needle by using laser energy to create a pilot hole in the tissue of the patient.
SIJMMARY OF THE INVENTION
According to the present invention there is provided surgical apparatus comprising:
25 a) suture thread;
b) transmission means for transmission of laser radiation along the interior of said suture thread;
c) a laser source for supply of laser radiation via said transmission means to the leading end of said suture thread such that said radiation can penetrate tissue of the patient;
3 0 and d) means for permitting manipulation of said leading end of said suture thread.
205~366 The present invention further comprises a method of insertion of a suture thread into tissue of a patient, which comprises directing laser radiation at the tissue surface so as to form a pilot hole in said tissue followed by the insertion of said suture thread into the pilot hole. The method according to the invention is preferably carried out using 5 apparatus as just described.
The laser source is typically of the YAG (yttrium aluminium garnet) or argon type, which have wavelengths in the near infra-red range or (with appropriate waveguides) of the carbon dioxide type.
The means for transmission of laser radiation is typically an optical fiber or 10 fibers or similar waveguide.
It is preferred that such an optical fiber terminates some distance from the tipof the suture thread in contact with the tissue in order to form a small air gap between the end of the optical fiber and the tissue. This is done to keep the end of the optical fiber clean and clear of tissue and thus avoid overheating of the end of the optical fiber.
It is further preferred that the optical fiber or fibers be contained within the suture and clad with a flexible cladding so as to provide an optical fiber capable of total internal reflection.
It is further preferred that the optical fiber or fibers be sheathed with a supple and flexible sheathing of, for example, polybutyrolactone, or a material known an 20 polybutester (which is commercially available under the trade mark "Novafil") to form a suture thread with the necessary soft and supple handling qualities It is further preferred that the optical fiber within the suture thread be defocused at its terminal point distal from the laser source so as to render the laser beam harmless a short distance in front of the suture thread, for example, by the provision of a 2 5 convex surface at the end of the optical fiber. This is intended to protect medical personnel and patient from accidental exposure to focussed laser energy.
It is further preferred that the sheathing of the suture thread be made stiffer or be stiffened by the application of a relatively more rigid material, for example, polypropylene, over a convenient length of the leading end of suture thread, so as to enable 3 0 the end of the suture thread to be manipulated through the pilot hole formed in the tissue and to protect the said optical fiber from instrument damage during manipulation.
In use, the stiffened end of the suture is applied to the tissue to be penetrated 3 ~ $~
in the usual way. The laser source is activated under the control of the medical operative and the laser energy, which may be in the infra-red band, passes at high intensity through the optical fiber within the suture thread. The laser energy, which may be defocussed by a convex surface (or other similar means) at the end of the optical fiber, and thus causes 5 vaporisation over a relatively small area of tissue a short distance in front of the stiffened end of the suture thread.
The effect is to create a pilot hole in the tissue into which the stiffened end of the suture thread is easily inserted. A secondary effect is the cauterisation of the sides of the pilot hole by the laser leading to reduced bleeding, tearing and trauma.
In a further embodiment, the suture thread may be made one-use disposable by providing a non-disposable section of optical flber or other delivery system from the laser source to a connecting terminal which can be clipped to the operating apron.
The disposable one-use section of the suture thread will be plugged into the connecting terminal before use.
In a further embodiment, normal light of visible frequency may be mixed with the laser infra red light to enable the medical operative to visibly detect the position of the stiffened end of the suture thread near the penetration point, where the stiffened end of the suture thread is about to emerge from the tissue.
In a further variation, visible light entering the stiffened end of the suture 20 thread may be tested for and detected within the laser source. An electronic interlock may be provided to prevent the laser being operated when visible light is detected entering the optical fiber via the stiffened end of the suture thread. The effect is to prevent the laser being operated when the stiffened end of the suture thread is not touching or buried in tissue.
To prevent damage to the optical detection system, the use if a pulsed laser is desirable, with 25 the interlock made inoperative and thus protected whilst the laser pulse is operative. To prove additional safety in operation and enable the medical operative to have feedback, an audible indication of laser use may be provided.
An alternative or additional feedback mechanism may be supplied by the provision of a transparent sheathing (of, for example, polybutyrolactone) to the suture thread 30 through which visible light may be passed from the laser source. The visible light would be pulsed in direct proportion to the laser energy passing through the fiber optic core and thus provide the medical operative with visual feedback of laser strength in use even when viewed 20~366 using peripheral vision.
In a further embodiment of the invention, a pulsed non-laser white light may be inJecte~ into the optical fiber between the pulses of laser radiation. The visible light after travelling down the optical fiber will emerge at the stiffened end of the suture thread and will illuminate the small section of "pilot" hole formed by the previous laser pulse.Reflected light from the surface of the "pilot" hole may travel in the reverse direction through the optical fiber and it may be possible to detect its frequency at the laser source end of the optical fiber. The purpose of this arrangement is to detect the reddish light given by passage of the stiffened end of the suture thread through normal blood-bearing tissue e.g. muscle fiber, and to differentiate in particular white fluid or tissue. This may be of importance in certain procedures involving medical apparatus such as spinal taps where there is a risk of insertion so far into the spine that the spinal cord which is primarily white tissue is damaged. The use of such a sensory arrangement interlocked with the laser source may reduce the risk.
BRIEF DESCRIPTION OF THE DRAWINGS
The forgoing and other objects and features of the present invention will be apparent and more fillly understood from the folowing detailed description of a preferred embodiment of the present invention, in which reference will be made to the accompanying drawings.
Figure l is a schematic representation of an exemplary embodiment of apparatus according to the present invention;
Figure 2a is a longitudinal sectional view of the suture thread used in apparatus according to the invention when passing through tissue; and Figure 2b is a cross-sectional view of the suture thread illustrated in Figure 2a, along plane A-A.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
Referring to Figure 1, there is shown apparatus comprising a laser unit filrthercomprising a power supply la, laser source Ib and coupling optics lc, connected to a non-disposable section of clad optical fiber or delivery system 2. A connecting terminal 3 joins delivery system 2 to a one-use disposable suture thread 4. Suture thread 4 comprises an optical fiber surrounded by a flexible cladding and sheathing, and is plugged into connecting terminal 3 before use. At the leading end of suture thread 4, the sheathing 5 is stiffened to -s-facilitate manipulation of suture thread 4 through tissue.
Referring to Figure 2a, there is shown suture thread 4 comprising an optical fiber 6 along which laser radiation passes from laser unit 1. Defocussed laser radiation 7 emitted by optical fiber 6 can only penetrate through a short distance of tissue 8. Optical 5 fiber 6 is contained within flexible cladding 9 to ensure total internal re~lection within optical fiber 6, cladding 9 itself being further surrounded by sheathing S to provide the required handling properties of suture thread 4. Optical fiber 6 is separated from tissue 8 by an air gap 10 to protect optical fiber 6 from damage during use. As suture thread 4 passes through tissue 8 the sides 11 of the resulting pilot hole are cauterised by defocussed laser radiation 10 7.
Figure 2b shows the suture thread comprising optical fiber 6 surrounded by cladding 9 and sheathing 5.
Surgical Appa,ratus fo,r Suture Ins~r on FIELD OF THE-INvENTIo--N
The present invention is concerned with an apparatus and method for insertion of suture thread into tissue of a patient.
BACKGROUND OF THE INVENTI,ON
A common procedure in medicine and surgery is the installation of sutures into tissue. For example, in surgery a wound is closed by the use of a suture thread installed by means of a sharp needle attached to the suture thread. Needle passage through tough tissue is often necessary and as such the needle must be rigid and sharply pointed. Even so, the medical operative often experiences difficulty forcing the ne dle through such tissue. The application of force often results in tearing, bleeding and trauma for the patient.
The forceful use of a sharp needle also sometimes results in needle stick injuryto medical personnel. Needle stick injury has been cited as a probable cause for transmission of disease from medical personnel to patient and vice-versa.
The use of lasers is well known in medicine for certain procedures e.g. in surgery, where its use is in the manner of a scalpel or probe to cut or destroy tissue or to cauterise vascular tissue. Optical fiber technology is also well understood in medicine where its use in endoscopy has become routine.
It is an object of the present invention to provide a method and apparatus which can facilitate penetration of suture thread into tissue without the use of a needle by using laser energy to create a pilot hole in the tissue of the patient.
SIJMMARY OF THE INVENTION
According to the present invention there is provided surgical apparatus comprising:
25 a) suture thread;
b) transmission means for transmission of laser radiation along the interior of said suture thread;
c) a laser source for supply of laser radiation via said transmission means to the leading end of said suture thread such that said radiation can penetrate tissue of the patient;
3 0 and d) means for permitting manipulation of said leading end of said suture thread.
205~366 The present invention further comprises a method of insertion of a suture thread into tissue of a patient, which comprises directing laser radiation at the tissue surface so as to form a pilot hole in said tissue followed by the insertion of said suture thread into the pilot hole. The method according to the invention is preferably carried out using 5 apparatus as just described.
The laser source is typically of the YAG (yttrium aluminium garnet) or argon type, which have wavelengths in the near infra-red range or (with appropriate waveguides) of the carbon dioxide type.
The means for transmission of laser radiation is typically an optical fiber or 10 fibers or similar waveguide.
It is preferred that such an optical fiber terminates some distance from the tipof the suture thread in contact with the tissue in order to form a small air gap between the end of the optical fiber and the tissue. This is done to keep the end of the optical fiber clean and clear of tissue and thus avoid overheating of the end of the optical fiber.
It is further preferred that the optical fiber or fibers be contained within the suture and clad with a flexible cladding so as to provide an optical fiber capable of total internal reflection.
It is further preferred that the optical fiber or fibers be sheathed with a supple and flexible sheathing of, for example, polybutyrolactone, or a material known an 20 polybutester (which is commercially available under the trade mark "Novafil") to form a suture thread with the necessary soft and supple handling qualities It is further preferred that the optical fiber within the suture thread be defocused at its terminal point distal from the laser source so as to render the laser beam harmless a short distance in front of the suture thread, for example, by the provision of a 2 5 convex surface at the end of the optical fiber. This is intended to protect medical personnel and patient from accidental exposure to focussed laser energy.
It is further preferred that the sheathing of the suture thread be made stiffer or be stiffened by the application of a relatively more rigid material, for example, polypropylene, over a convenient length of the leading end of suture thread, so as to enable 3 0 the end of the suture thread to be manipulated through the pilot hole formed in the tissue and to protect the said optical fiber from instrument damage during manipulation.
In use, the stiffened end of the suture is applied to the tissue to be penetrated 3 ~ $~
in the usual way. The laser source is activated under the control of the medical operative and the laser energy, which may be in the infra-red band, passes at high intensity through the optical fiber within the suture thread. The laser energy, which may be defocussed by a convex surface (or other similar means) at the end of the optical fiber, and thus causes 5 vaporisation over a relatively small area of tissue a short distance in front of the stiffened end of the suture thread.
The effect is to create a pilot hole in the tissue into which the stiffened end of the suture thread is easily inserted. A secondary effect is the cauterisation of the sides of the pilot hole by the laser leading to reduced bleeding, tearing and trauma.
In a further embodiment, the suture thread may be made one-use disposable by providing a non-disposable section of optical flber or other delivery system from the laser source to a connecting terminal which can be clipped to the operating apron.
The disposable one-use section of the suture thread will be plugged into the connecting terminal before use.
In a further embodiment, normal light of visible frequency may be mixed with the laser infra red light to enable the medical operative to visibly detect the position of the stiffened end of the suture thread near the penetration point, where the stiffened end of the suture thread is about to emerge from the tissue.
In a further variation, visible light entering the stiffened end of the suture 20 thread may be tested for and detected within the laser source. An electronic interlock may be provided to prevent the laser being operated when visible light is detected entering the optical fiber via the stiffened end of the suture thread. The effect is to prevent the laser being operated when the stiffened end of the suture thread is not touching or buried in tissue.
To prevent damage to the optical detection system, the use if a pulsed laser is desirable, with 25 the interlock made inoperative and thus protected whilst the laser pulse is operative. To prove additional safety in operation and enable the medical operative to have feedback, an audible indication of laser use may be provided.
An alternative or additional feedback mechanism may be supplied by the provision of a transparent sheathing (of, for example, polybutyrolactone) to the suture thread 30 through which visible light may be passed from the laser source. The visible light would be pulsed in direct proportion to the laser energy passing through the fiber optic core and thus provide the medical operative with visual feedback of laser strength in use even when viewed 20~366 using peripheral vision.
In a further embodiment of the invention, a pulsed non-laser white light may be inJecte~ into the optical fiber between the pulses of laser radiation. The visible light after travelling down the optical fiber will emerge at the stiffened end of the suture thread and will illuminate the small section of "pilot" hole formed by the previous laser pulse.Reflected light from the surface of the "pilot" hole may travel in the reverse direction through the optical fiber and it may be possible to detect its frequency at the laser source end of the optical fiber. The purpose of this arrangement is to detect the reddish light given by passage of the stiffened end of the suture thread through normal blood-bearing tissue e.g. muscle fiber, and to differentiate in particular white fluid or tissue. This may be of importance in certain procedures involving medical apparatus such as spinal taps where there is a risk of insertion so far into the spine that the spinal cord which is primarily white tissue is damaged. The use of such a sensory arrangement interlocked with the laser source may reduce the risk.
BRIEF DESCRIPTION OF THE DRAWINGS
The forgoing and other objects and features of the present invention will be apparent and more fillly understood from the folowing detailed description of a preferred embodiment of the present invention, in which reference will be made to the accompanying drawings.
Figure l is a schematic representation of an exemplary embodiment of apparatus according to the present invention;
Figure 2a is a longitudinal sectional view of the suture thread used in apparatus according to the invention when passing through tissue; and Figure 2b is a cross-sectional view of the suture thread illustrated in Figure 2a, along plane A-A.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
Referring to Figure 1, there is shown apparatus comprising a laser unit filrthercomprising a power supply la, laser source Ib and coupling optics lc, connected to a non-disposable section of clad optical fiber or delivery system 2. A connecting terminal 3 joins delivery system 2 to a one-use disposable suture thread 4. Suture thread 4 comprises an optical fiber surrounded by a flexible cladding and sheathing, and is plugged into connecting terminal 3 before use. At the leading end of suture thread 4, the sheathing 5 is stiffened to -s-facilitate manipulation of suture thread 4 through tissue.
Referring to Figure 2a, there is shown suture thread 4 comprising an optical fiber 6 along which laser radiation passes from laser unit 1. Defocussed laser radiation 7 emitted by optical fiber 6 can only penetrate through a short distance of tissue 8. Optical 5 fiber 6 is contained within flexible cladding 9 to ensure total internal re~lection within optical fiber 6, cladding 9 itself being further surrounded by sheathing S to provide the required handling properties of suture thread 4. Optical fiber 6 is separated from tissue 8 by an air gap 10 to protect optical fiber 6 from damage during use. As suture thread 4 passes through tissue 8 the sides 11 of the resulting pilot hole are cauterised by defocussed laser radiation 10 7.
Figure 2b shows the suture thread comprising optical fiber 6 surrounded by cladding 9 and sheathing 5.
Claims (19)
1. Surgical apparatus comprising:
a) suture thread;
b) means for transmission of laser radiation along the interior of said suture thread;
c) a laser source for supply of said laser radiation via said transmission means to the leading end of said suture thread such that said radiation can penetrate tissue of the patient; and d) means for permitting manipulation of said leading end of said suture thread.
a) suture thread;
b) means for transmission of laser radiation along the interior of said suture thread;
c) a laser source for supply of said laser radiation via said transmission means to the leading end of said suture thread such that said radiation can penetrate tissue of the patient; and d) means for permitting manipulation of said leading end of said suture thread.
2. Apparatus according to claim 1, wherein said laser radiation has a wavelength in the near infra-red range.
3. Apparatus according to claim 1, wherein said means for transmission of laser radiation comprises at least one optical fiber.
4. Apparatus according to claim 3, wherein said at least one optical fiber terminates some distance from the tissue-contacting tip of said suture thread in order to form a small air gap between the end of said optical fiber and said tissue.
5. Apparatus according to claim 3, wherein said at least one optical fiber is contained within said suture thread and clad with a flexible cladding so as to provide an optical fiber capable of total internal reflection.
6. Apparatus according to claim 3, wherein said at least one optical fiber is sheathed with a supple and flexible sheathing.
7. Apparatus according to claim 6, wherein said sheathing comprises polybutyrolactone.
8. Apparatus according to claim 3, wherein said at least one optical fiber within said suture thread is defocused at the terminal point of said fiber distal from said laser source.
9. Apparatus according to claim 1, wherein the sheathing of said suture thread is stiffened by the provision of a relatively more rigid material thereon.
10. Apparatus according to claim 9, wherein said material comprises polypropylene.
11. Apparatus according to claim 3, wherein said apparatus comprises a non-disposable section of optical fiber leading from said laser source to a connecting terminal.
12. Apparatus according to claim 11, wherein said apparatus is provided in use with a one-use section of said suture thread arranged to be plugged into said connecting terminal.
13. Apparatus according to claim 1, wherein said laser radiation source is arranged to mix the laser radiation with light of visible frequency.
14. Apparatus according to claim 1, which is provided with an electronic interlock to prevent said laser being operated when visible light is detected entering said optical fiber via said leading end.
15. Apparatus according to claim 14, wherein said laser radiation source is provided with means for pulsing said radiation.
16. Apparatus according to claim 1, which comprises a feedback mechanism capable of providing an audible indication of laser use.
17. Apparatus according to claim 1, wherein a transparent sheathing is provided on said suture thread through which visible light can be passed from said laser source.
18. A method of insertion of a suture thread into tissue of a patient, which comprises directing laser radiation at the tissue surface so as to form a pilot hole in said tissue followed by the insertion of said suture thread into the pilot hole.
19. A method according to claim 18, which method is carried out using apparatus according to any of claims 1 to 18.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CA 2054366 CA2054366A1 (en) | 1991-10-28 | 1991-10-28 | Surgical apparatus for suture insertion |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CA 2054366 CA2054366A1 (en) | 1991-10-28 | 1991-10-28 | Surgical apparatus for suture insertion |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA2054366A1 true CA2054366A1 (en) | 1993-04-29 |
Family
ID=4148649
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA 2054366 Abandoned CA2054366A1 (en) | 1991-10-28 | 1991-10-28 | Surgical apparatus for suture insertion |
Country Status (1)
| Country | Link |
|---|---|
| CA (1) | CA2054366A1 (en) |
-
1991
- 1991-10-28 CA CA 2054366 patent/CA2054366A1/en not_active Abandoned
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Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| FZDE | Dead |