GB2389313A

GB2389313A - Suturing apparatus with disposable head

Info

Publication number: GB2389313A
Application number: GB0208401A
Authority: GB
Inventors: Rajen Pathan
Original assignee: Advanced Plastics Technologies Ltd
Current assignee: Advanced Plastics Technologies Ltd
Priority date: 2002-04-12
Filing date: 2002-04-12
Publication date: 2003-12-10
Also published as: GB0208401D0

Abstract

Suturing apparatus including means to propel 9,10 a needle along a closed loop, typically a circular path and arranged so that the needle 11 may be caused to pass through tissue as it travels around the path thereby to suture the tissue. The needle may be arc shaped. The means for propulsion may include rollers 9,10, and/or a belt. The apparatus may be arranged to be insertable into a body cavity through a porthole to facilitate suturing inside the body cavity. The apparatus can be provided in a cartridge that can be removably mounted on a support 1. A suitable support includes an elongate member to facilitate insertion into a body cavity, and a drive means 7 for driving the cartridge.

Description

238931 3

SuturinE Device The present invention relates to suturing apparatus and particularly, although not exclusively, to suturing apparatus suitable for use in endoscopic surgery.

Endoscopic surgery is an attractive technique rapidly growing in popularity. The advantage to the patient is that the surgery to internal organs may be performed without the need for a major opening of the body cavity. The surgery is performed by making a number of small incisions in the skin of the patient, known as "portholes", and using them for the insertion of surgical instruments which are manoeuvred by the surgeon, using an endoscopic camera to view the operation via a monitor.

Whilst operating it is usually necessary to transfix, ligate or stitch blood vessels and/or ducts. At present one way this is achieved is by stitching with a needle manipulated by conventional instruments such as needle holders and forceps. It is necessary to pass the needle through a porthole into the patient's body cavity and to pull the needle out of another porthole.

The procedure has to be repeated several times until the stitching has been secured. This is extremely time consuming.

Another approach where blood vessels are concerned is to use clips, known as ligaclips.

However, a risk with the use of such clips is that they may fall off as a consequence of pulsation in blood flow, the result being major postoperative bleeding.

The present invention has been made in consideration of the abovementioned problems.

According to the present invention there is provided suturing apparatus comprising means to propel a needle along a closed loop path arranged so that the needle may be caused to pass through tissue as it travels around the path thereby to suture the tissue.

As a needle can be made to travel along a closed path it can be passed through tissue and retrieved by the apparatus. Thus if the apparatus is arranged to be insert able into a body cavity

through a porthole it can be used to facilitate suturing inside the body cavity.

Preferably the apparatus enables a needle to be propelled around the path a plurality of times in one direction. Preferably the path is substantially circular. In this case the apparatus may comprise a needle and the needle is preferably arc-shaped and forms more than half the circumference of a circle, preferably at least five eighths of the circumference of a circle.

Preferably the means to propel a needle only extends along part, but not all, and preferably about half, of the path. The means to propel may comprise two or more rollers operative to grip the needle. Alternatively the means to propel could comprise a belt.

Preferably the means to propel a needle is disposed in a slot through which the needle may pass, the slot extending along the part, but not all, and preferably about half of the path. The slot may be substantially semi circular.

Preferably the apparatus is arranged so that a length of suture material attached to a needle does all not have to follow the needle along the paths and does not become entrained with the means for propelling the needle as the needle is propelled along the path.

Preferably the means for propelling the needle is disposed in a cartridge that is removably mountable on a support. The support may comprise an elongate member. The support may comprise a drive means for driving the cartridge. The support may comprise a handle. An elongate support of suitable dimensions enables the cartridge to be inserted into a body cavity through a porthole and once inserted to be manipulated in the cavity.

In order that the invention may be more clearly understood embodiments thereof will now be described, by way of example, with reference to the accompanying drawings in which: Figure I shows a part cut-away view of suturing apparatus without a cartridge fitted; Figure 2 shows a part cutaway view of a cartridge for use with the apparatus of Figure 1, in one operational state;

( 1

Figure 3 shows a similar view of the cartridge of Figure 2 in another operational state; Figure 4 shows a similar view of the cartridge of Figure 2 in use in one operational state; Figure 5 shows a similar view of the cartridge of Figure 2 in use in another operational state; Figure 6 shows a possible modification to part of the cartridge of Figure 2; Figure 7 shows the apparatus of Figure 6 with a needle fitted; and Figure 8 shows the apparatus of Figure 6 with part removed, i Figure 9 shows the part of the apparatus of Figure 6 which is removed in Figure 8.

Referring to Figure I suturing apparatus comprises an elongate tubular member 1. This member I is generally circular in cross section, may be made of plastics material, metal or any other suitable material and may be flexible.

At one end of the tubular mennber I there is fitted a handle 2. The handle 2 comprises two arms extending generally at the right angles to each other to form an "L" shape. The tubular: member I is rotatably received into a first hollow arm of the handle 2 so that the long axis of the tubular member is aligned with the arm.

A spring loaded trigger 3 is pivotally mounted towards the free end of the second arm of the handle and extends into a slot in the first arm. The trigger 3 is urged away from the second arm by the spring loading.

Towards the opposite end of the tubular member 1 part of the tubular member is cut away, so that the member has a generally semicircular crosssection. At the far opposite end of the member I the half section tube is flattened so that the overall cross-section of the member is reduced. This end of the tubular member is adapted to receive a cartridge, to be described further below.

( -4 A rotatable shaft 4 is mounted in and extends through the tubular member 1 and the first arm ofthe handle 2. A portion 5 ofthe part ofthe shaft 4 that extends in the handle 2 is threaded.

A co-operating threaded member 6, like a nut, is mounted on the threaded portion 5 of the shaft, and slidably mounted on the free end of the trigger 3 so that when the trigger is squeezed towards the second arm of the handle 2 the shaft is caused to rotate. At the opposite end of the tubular member I to the handle 2 the shaft is exposed and a cog wheel 7 is fitted to the shaft 4, for rotation with the shaft 4.

Referring to figures 2 and 3 a cartridge for use with the apparatus of figure I comprises a tapered hollow body 8, generally semi-circular in cross-section, for fitment to the end of the tubular member I remote from the handle 2, so that the cartridge tapers towards the free end of the tubular member 1 A flat portion of the cartridge supports three rotatably mounted drive wheels 9, and five associated idler wheels 10. The rotational axes of three of the drive wheels 9 lie at respective corners of a triangle and the axis of the fourth, central, wheel lies along one edge of the triangle so that the fourth wheel is in driving contact with the other three wheels, and so that part of the circumference of each of the other three wheels lies on a first semicircular path.

The axes of rotation of the idler wheels 10 are all substantially evenly spaced around a second semicircular path parallel to and of greater radius than the first semicircular path so that a semicircular path is defined between the drive 9 and idler 10 wheels.

The circumference of all the wheels comprises a resilient friction material, such as rubber The drive wheels 10 may additionally include teeth that mesh with each other. In any event, the central drive wheel includes teeth arranged to mesh with the cog 7 of the tubular member so that when the trigger 3 is squeezed the central drive wheel rotates anticlockwise when viewed from above, as shown. Accordingly the central drive wheel will cause the other drive wheels to rotate in a clockwise direction when the trigger is squeezed, again as shown.

-5 A curved needle I 1 is received between the outer driving 9 and idler 10 wheels, such that when the driving wheels are rotated the needle I I is propelled along a circular path. The needle has a first, sharp, end 12 and a second end 13 to which a length of suture material 14 is attached.

The needle 1 I has a constant radius of curvature along its length and its length is such that it curves through more that 180 degrees so that as the needle 11 is propelled by the drive wheels 9 so that the first end 12 extends out of the cartridge the first end 12 will re-enter the cartridge before the second end leaves. Thus the needle can be made to travel in a closed substantially circular path. Figure 3 shows the needle I 1 with its first end 12 extending out of the cartridge.

The suture material 13 does not necessarily need to follow the path ofthe needle I I between the rollers 9 and 10.

Referring to figures 4 and S the cartridge may be used to suture tissue as follows. First, as shown in Fig 4, the needle I 1 is caused to travel in a substantially circular path out of and back into the cartridge. Whilst out of the cartridge the first end 12 of the needle is caused to pass through tissue to be sutured 14, dragging suture material 13 through the tissue. This process may be repeated as necessary. When a knot is required the needle is caused to pass around the free end of the suture material to form a knot 15, as shown is fig 5.

Figures 6 to 9 show a possible modification to the cartridge of figures 2 to 5. Referring to these figures, with this arrangement both the drive wheels and idler wheels 11 are disposed in blocks of plastic material. The drive wheels are mounted in a block which is substantially semicircular in shape 16 and the idler rollers 10 are mounted in a block 17 which defines a concave substantially semicircular wall. The two blocks 16 and 17 are fitted together so that together they define a substantially semicircular slot 18 along which a needle 1 I may be propelled by the drive wheels 9. Provision of the slot 18 leads to better support of the needle I 1 than the arrangement of the cartridge of figures 2 to S.

( -6 Multiple cartridges may be used with the apparatus sown in Figure 1. The apparatus may be made of materials such that it is economic to dispose of after a single use. An alternative arrangement may be used to drive the drive wheels 9 of the cartridge, for example a motor such as an electric motor.

The apparatus is particularly suited to endoscopic surgery when the tubular member and cartridge are sized so that they can be conveniently inserted into a body cavity through a porthole.

The apparatus can be used expeditiously in most common endoscopic treatments, including abdominal, gynaecologicaL and cardiac surgery. The use of the apparatus in the laparoscopic cholecystectomy procedure is to ligate the cystic artery and the cystic duct, without fear that it will come undone after the operation. Naturally the same device can be used in fundoplication procedure and several other procedures such as appendicectomy and the repair of the large and small intestines. A typical size for the tubular member I is 10-12 mm in diameter and 300 mm in length. The radius of curvature of the needle 11 is typically about Smm. However, with a reduced diameter of tubular member the apparatus could be used in shoulder anthoscopy operations to penetrate trocar's sheath.

Use of the apparatus very significantly reduces the time spent sewing vessels, ducts and tissue during endoscopic surgery, possibly by as much as 90%. A further significant advantage is a reduced risk that the stitch or ligation of an arterial blood vessel will fall off post operatively.

Use of the apparatus is not, of course, limited to endoscopic procedures. It can also be used externally and on robotic arms for robotic surgery. It is particularly suited to use in vascular surgery. The above embodiments are described by way of example only. Many variations are possible without departing from the invention.

Claims

CIi'ls 1. Suturing apparatus comprising means to T,ropcl a nacelle along

a closed loop path an-anOeti so that tlc neecilc may he caused to loss through tissue as it travcis around the path thereby to suture the tissue.

A. Apparatus as claimer) in claim I arranged tat lee insertable into a ht, tly cavity through a p,rtlole to facilitate suturing insiLle the hotly cavity.

3. Apparatus as claimed in any lrecetling claim which en.ibics a nceclle to he propelled arounci the path a plurality t times in onc ctirectio.

4. Apparatus as claineci in any lrececling claim wherein the flat} is substantially circular.

5. Apparatus as claimed in any prcccdin, claim cornprisirl an arc-shal1el ncecilc the neccile Corning Marc than half the circumter-ericc ot a circle (a. Apparatus as clairncL1 in claim:, wherein the nectile tor-ms at Icast live eighths of the circurTferenct of a circle.

7. Apparatus as claiTIecl in any 11reccclinO Clairol wher-cin t.hc ncans k, propel a neetile orily

extends along Iyart ol the path.

8. Alparatu.s as claimed in any prececlinO claim whercil the tneans to propel comprises twit or more rollers operative to grill the net tile.

9 Apparatus as Clairol in any lit claims 1 t, 7 wlcrein the Ricers to prol1cl con'riscs a heft. 1(). Apparatus as clairilerl in any prcecLIin=, clain1 wherein the means to pr'pcl a nccLlle is ciisposecl in a slot through wlich the net tile may]1aSS, the slot extcrtTinO alone part, hut not all, of to path.

I I. Apparatus as claimed in claim I () whcrcir1 the slot is substantially mini circular.

I 0. Apparatus as claimed in any prccedint, claim errand so that a Icrgth ot suture material

l -- attaehekl to a ncelle ctoes all rtOt have to TOllOW the neeLllc along, the patl1.

Ap[?aratus aS elaimecl in any 1?reccLiing claim whciein thc means tor llr> l?elling the neeLtle is flisl?osccl in.1 cartriLlpe that is Tenlovahly I1lctrIltai?le on a SUl?pUtt.

4. pl?aTatus as claimecl in clailll I Inouritckl ort a sull?ort coTIll?risitl an elongate tnen-1her. 15. Al?llaratus as clainleLl in eitller claim 13 or 14 mitintckl ?n a sul?l?or! cL,lnprlilrly À lri\'e rncans tor clriving thc cartridge.

I t3. A?paratus as claimed itI either claitIl 14 <,r 1 vhetein the SUl) I?Ott C()ml?riSCS a harllle. 17. uturing, al?paratus substantially as herein cleScrit?CCI with rcterence to the aecorl1T,anying, drawinL;s.