JP4137249B2 - Surgical instrument for forming a knot - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an assembly for facilitating the placement of surgical knots made of sutures. More particularly, the present invention relates to such an assembly that is particularly suitable for knot forming and placement during surgery with minimal intrusion such that access to the target site is limited.
[0002]
[Prior art]
As a main technique of the surgical operation, there is a technique in which a surgical knot made of a suture thread is formed during the operation, and the knot is placed in the body and the tissue is sutured. A number of surgical knots have been developed over time. The technique of forming a knot and sewing tissue is an important technique that a surgeon must acquire in order to perform surgery safely and efficiently. Therefore, such technology has been widely developed. For example, “Tissue Approximation in Endoscopic Surgery”, by Alfred Cuschieri and Zoltan Szabo, Times Mirror International Publishers (published in 1995), A number of surgical knots are described that consist of sutures to simplify the suturing.
[0003]
Many surgical knot techniques are also disclosed in the patent literature. U.S. Pat. No. 2,012,776 discloses a surgical instrument for simplifying the placement of various forms of slip knots made of sutures. H. A. Roeder, the inventor of this US Pat. No. 2,012,776, has developed a surgical knot called “Roeder Knot” which is still frequently used in surgery. More recently, US Pat. No. 5,573,286 discloses a surgical knot comprising a suture thread that is particularly useful in the field of orthopedics. In the preferred embodiment described in this US Pat. No. 5,573,286, a knot is applied to the bone.
[0004]
Traditionally, it has been considered difficult to form and place surgical knots within surgical sites accessible by remote control, which is cumbersome and often unreliable. To that end, instruments have been developed to simplify the knot placement by remote control. A preferred method is often to use a preformed knot loop of suture to reduce the number of steps required to form a tightly knotted knot. For example, U.S. Pat. Nos. 2,566,625 and 3,090,386 describe preformed knots made of sutures for suturing or tying tissue, particularly in the operation of difficult-to-access tissue. A surgical device suitable for supporting a loop is described.
[0005]
More recently, instruments have been developed that simplify the placement of knots during surgery, especially with minimal invasion. Specifically, in US Pat. No. 5,320,629, when an incised tissue is sutured in an endoscopic surgical operation, a knot loop made of a suture is formed in advance, and the knot loop is used as a surgical device. A method is disclosed that simplifies tightening of the knot loop by arranging. DE 912619 also discloses a device similar to that disclosed in US Pat. No. 5,320,629.
[0006]
[Problems to be solved by the invention]
Thus, surgical knot technology is well developed, and surgery to easily form tight knots from pre-formed knot loops of sutures for remote site surgery Equipment has also been developed, but there are still issues to be considered. Specifically, it is a knot that is formed and placed in a surgical operation with limited access to a target site, for example, during a minimally invasive procedure such as endoscopic surgery. Is always a slippery knot with poor safety. If the knot is not safe, the sutured tissue may not be retained for a period of time sufficient to heal the wound. In addition, during a surgical procedure with minimal invasion, the preformed knot loops of sutures described with respect to prior art devices are difficult to tighten efficiently for final knot formation. is there.
[0007]
Therefore, what is needed is an assembly to facilitate the formation of a surgical knot in a minimally invasive surgical procedure with limited access to a target site. This assembly should be relatively simple in construction and should be compatible with a partially tied (incomplete) surgical knot. This assembly also provides consistently strong knot safety each time the knot is placed, ensuring that even a less skilled surgeon can reliably and efficiently secure a suture knot from the suture. There is a need to facilitate the conversion from a partially tied (incomplete) knot to a fully knot so that it can be placed. In addition, in order to facilitate the use of this assembly for placement of surgical knots, the assembly can be easily adapted (retrofit) to various surgical instruments, particularly to endoscopic instruments. Would be desirable. In addition, if the assembly can be used to place a plurality of knots, the second partially tied knot can be reloaded into the assembly after forming and placing the first knot. Will be useful.
[0008]
Further, what is needed is a device that allows a suture cartridge assembly to be easily loaded into a surgical instrument. Specifically, what develops the current state of the surgical field is that a surgeon places a suture cartridge on a surgical instrument for forming and placing (ie, deploying) a surgical knot from a suture contained in a suture cartridge assembly. An apparatus for assisting in loading the assembly and for facilitating reloading of the second suture cartridge assembly after the depleted first suture cartridge assembly is removed from the surgical instrument. Will. Such a device is designed to eliminate the need for the user to handle the needle when the needle is attached to the suture and for shipping and storage of the suture cartridge when used with other packaging materials. It would be advantageous if it was designed to be a suitable container.
[0009]
Further, if a surgical instrument is provided that can easily form a complete knot by remote control (especially during endoscopic surgery where access to the body cavity is very limited), Would be desirable. In particular, remote control of internal tissue, sutures or needles (whatever is desired) to fully tie them from partially tied knots (ie, imperfect knots) It would be desirable to provide a surgical instrument having a handle assembly along with actuating means (actuators) to facilitate knot formation. More specifically, what is needed is a first actuating means for controlling remote manipulation of tissue, sutures or needles in the body for the formation of a perfect knot; A handle assembly having second actuating means for controlling and controlling remote operation.
[0010]
[Means for Solving the Problems]
The present invention relates to a surgical instrument for forming a knot in a completely tied state at the time of surgery to suture a body tissue. The surgical instrument includes a suture cartridge, a cartridge carrier, a gripping jaw, a handle assembly, and a closure tube.
[0011]
The surgical instrument suture cartridge is located at the distal end of the surgical instrument. The suture cartridge contains a suture having a partially tied knot formed at the distal end.
[0012]
The surgical instrument cartridge carrier is also located at the distal end of the surgical instrument. The cartridge carrier receives the suture cartridge.
[0013]
The grasping jaw of the surgical instrument faces the suture cartridge in the cartridge carrier. The gripping jaws are movable from an open position away from the suture cartridge to a closed position adjacent to the suture cartridge.
[0014]
The surgical instrument handle assembly is spaced from the suture cartridge. The handle assembly is located at the proximal end of the surgical instrument. The handle assembly has a grip for operating the surgical instrument. The handle assembly also has first actuating means for causing the gripping jaws to move from the open position to the closed position. In addition, the handle assembly also has second actuation means operatively connected to the proximal end of the suture. When the second actuating means is actuated, the proximal end of the suture is pulled in the proximal direction to form a fully tied knot from the partially tied knot to form body tissue. Is sutured.
[0015]
The closure tube of the surgical instrument connects the cartridge carrier to the handle assembly. The closure tube is movable from a proximal position to a distal position in response to actuation of the first actuation means. When the closure tube is in its proximal position, the gripping jaws of the surgical instrument are in its open position. Conversely, when the closure tube is in its distal position, the gripping jaw is in its closed position.
[0016]
It is important to note that the first and second actuation means of the surgical instrument handle assembly each allow the user to open and close a grasping jaw for grasping body tissue or suture. And allowing the sutures to be pulled functionally to form a fully knotted knot. The surgical instrument of the present invention can perform these two highly desirable functions, so that even if direct access to the subject's body structure is very constrained, it can be partially connected by an endoscope. This makes it easier to form and place a knot in a fully connected state from a knot in the connected state. The first actuating means moves the gripping jaws so that the body tissue or the suture can be appropriately operated for proper arrangement of the knot. Upon completion of this initial operation, the second actuating means is then activated to convert the partially tied knot into the desired fully tied knot for suturing the body tissue of interest. can do.
[0017]
The surgical instrument of the present invention can be used in any surgery where it is necessary or desirable to form a fully knotted knot and suture the body tissue. In a broad sense, the surgical instrument of the present invention can be used not only for endoscopic surgery but also for open surgery. However, the surgical instrument of the present invention is particularly suitable for endoscopic applications where direct access to the target tissue is very limited.
[0018]
DETAILED DESCRIPTION OF THE INVENTION
1-6 illustrate how a partially tied surgical knot can be formed from a length of suture. The imperfect surgical knot formed in this way can be used to implement the various embodiments of the invention described below. Of course, other incomplete surgical knots can also be used.
[0019]
The suture 30 shown in FIG. 1 may be composed of any suture material currently in use or that may be developed in the future. Examples of the suture include a single suture or a multiple suture knitted with three or more yarns. The suture depends on a specific tissue suture example in which the suture is used, but may be made of a material having no absorbability, more specifically, no biological absorbency, regardless of the configuration of the suture.
[0020]
The length of suture 30 has a proximal end 31 and a distal end 32. Further, it has a proximal portion 33 adjacent to the proximal end 31. Similarly, there is a distal portion 34 adjacent to the distal end 32.
[0021]
As shown in FIG. 2, the first loop 35 is formed by manipulating the distal portion 34 of the suture 30. Referring to FIG. 3, the proximal portion 33 of the suture 30 is fixed, and the distal portion 34 is manipulated to wrap around the first loop 35 substantially across the first loop 35. A second loop 36 is formed. Similarly, as shown in FIG. 4, a third loop 37 and a fourth loop 38 are formed around the first loop 35. The second, third, and fourth loops 36, 37, and 38 are substantially parallel to each other and oriented so as to substantially cross the first loop 35. In order to simplify the description of the partially tied surgical knot, these second, third and fourth loops 36, 37, 38 may be collectively referred to as "knot loops". The number of knot loops may vary depending on the specific application for which the knot is used. In the illustrated embodiment, the second, third and fourth loops 36, 37, 38 form a common loop core 39 that holds the first loop 35.
[0022]
Referring to FIG. 5, the loosely formed knot is tightened tightly by applying tension to the distal portion 34 of the suture 30. In that case, the second, third and fourth loops 36 to 38 are tightened in contact with the first loop 35, so that the first loop 35 is safely held in the common loop core 39.
[0023]
As shown in FIG. 6, tissue suture loop 40 is formed by passing distal end 32 and distal portion 34 of suture 30 through first loop 35.
[0024]
To form the surgical knot, the knot tied in the incomplete state of FIG. 6 is formed and then tension is applied to the proximal portion 33 of the suture 30 along the proximal direction indicated by the arrow in FIG. . In order to facilitate the formation of this surgical knot, the surgeon preferably applies tension to the proximal portion 33 of the suture 30 while holding the proximal side of the knot loop with the fingertip. Alternatively, an instrument for holding the knot loop in place can be used, as described in the embodiments below. As tension is applied, the first loop 35 begins to be drawn into the common loop core 39 of the knot. Then, the size of the loop of the first loop 35 is sufficiently reduced from the state shown in FIG. 6, and the distal portion 34 of the suture 30 is captured by the reduced loop. When a proximal tension is further continuously applied to the proximal portion 33 of the suture 30, the first loop 35 of the suture 30 and the distal portion 34 captured by the first loop 35 become common loop core 39. Drawn into. When this first loop 35 and distal portion of the suture 30 emerges outward from the fourth loop 38, a audible sound is produced by the user's ear, which causes the user to see a complete surgical knot. You can know that was formed.
[0025]
The incomplete knot illustrated in FIG. 6, sometimes referred to as a “blood” knot, is suitable for conversion to a non-slip surgical knot that is knotted into a complete state for use in the practice of this invention. However, other slip knots described in the aforementioned literature can also be used. A key characteristic for applying the present invention to a knot tied to another incomplete state is the formation of a common loop core (common loop core 39 in the example of FIG. 6) through which the suture passes. See, for example, “The Encyclopedia of Knots and Fancy Ropewark, Fourth Edition, Cornell Maritime Press by R. Graumont & J. Hensel” as a knot tied to another incomplete state. Appropriate examples of knots in the state partially linked as works No. 102, No. 185, No. 227 and No. 349 on pages 71, 83, 87 and 102 of this book are shown. It is shown.
[0026]
The perfect surgical knot is a non-slip knot 41 as shown in FIG. The first loop 35 disappears, forming a distal loop 42 adjacent to the fourth loop 38 that is part of the distal portion 34 of the suture. As a result, the tissue suture loop 40 used for tissue stitching is firmly and safely fixed. It should be noted that since the sutured tissue is expanded or pulled away from each other, an advantageous result is obtained in that tension is applied to the loop 40 and the non-slip knot 41 is further tightened.
[0027]
FIGS. 9 and 10 show an example in which the partially tied knot shown in FIGS. 1 to 6 is formed around the core tube 43. By using the core tube 43, the knot in the partially tied state can be easily converted into the complete non-slip knot shown in FIG. 8 as well as the partially tied knot. The tied knot can be easily placed adjacent to the sutured tissue. The core tube 43 has a proximal end 44 and a distal end 45. A surgical needle 46 is attached to the distal end 32 of the suture 30. The proximal portion 33 of the suture 30 penetrates through the core tube 43. The length of the suture 30 is longer than the length of the core tube 43, and the proximal portion 33 of the suture 30 extends outward from the proximal end 44 of the core tube 43. In addition, since a sufficiently long portion (distal portion 34) of the suture thread 30 extends outward from the distal end 45 of the core tube 43, the suture 30 is partially tied around the distal end 45 of the core tube 43. Can form a knot. Specifically, a first loop 35 and subsequent knot loops (second, third and fourth loops 36, 37, 38) are formed around the distal end 45 of the core tube 43. Once the knot loop is formed, tension is applied to the distal portion 34 of the suture 30 to tighten the knot loop around the distal end 45 of the core tube 43.
[0028]
A knot that is partially clamped around the core tube 43 in an incomplete state can be loaded into the suture cartridge 47 illustrated in FIG. The suture cartridge 47 has an elongated body 48. The suture cartridge 47 also has a top surface 78 and a bottom surface 79. A tube slot 49 for receiving the core tube 43 is provided in the main body 48 of the cartridge 47 between the upper surface 78 and the bottom surface 79. The main body includes a knot recess 50 having a pair of detachable shoulders 51. Extending proximally from the proximal end 52 of the tube slot 49 is a suture slot 53. Similarly, extending from the distal end 54 of the tube slot 49 toward the distal end of the cartridge body 48 is a loop slot 55. In FIG. 11, L₁ The length of the core tube 43 indicated by₂ Is shorter than the length of the tube slot 49 shown in FIG.
[0029]
When a partially tied knot is formed around the core tube 43, the knot loop is wrapped around the distal end 45 of the core tube 43 and the free proximal portion 33 of the suture is the core tube. The first loop 35 of the knot that extends outwardly from the proximal end 44 of the part 43 and extends partially extends outwardly from the distal end 45 of the core tube 43. When such a core tube 43 is loaded into the tube slot 49 of the cartridge body between the top surface 78 and the bottom surface 79, the knot loop is placed in the knot recess 50 and abuts against the detaching shoulder 51 of the knot recess 50. . A portion of the proximal portion 33 of the suture 30 is placed in a suture slot 53 provided in the cartridge body 48, and the remaining portion of the proximal portion 33 of the suture 30 is the proximal end 52 of the cartridge body 48. Extend outward from. Similarly, the first loop 35 of the partially tied knot and the distal end 32 of the suture 30 are received in the loop slot 55. Most of the first loop 35 and the distal portion 34 of the suture 30 are lowered from the bottom surface 79 of the cartridge body 48. In the basic position best illustrated in FIG. 13, the distal end 45 of the core tube 43 is adjacent to the distal end 54 of the tube slot 49. Since the tube slot 49 is longer than the core tube 43, the core tube 43 can slide proximally toward the proximal end 52 of the tube slot 49. In this basic position, the knot is confined in the recess 50. Thus, the surgeon can easily manipulate the needle 46 and the distal portion 34 of the suture 30 without the risk of accidentally tightening the knot early.
[0030]
When the core tube 43 is loaded into the tube slot 49 in the cartridge main body 48, the cartridge top plate 56 is mounted on the upper surface 78 of the cartridge main body 48 as shown in FIG. 12. When the cartridge top plate 56 is attached, the core tube 43 is sufficiently sealed in the cartridge 47.
[0031]
When the core tube 43 is sufficiently sealed in the suture cartridge 47, a partially tied knot wrapped around the core tube 43 is predetermined as illustrated in FIGS. Used to suture the body tissue. As a first step, a suture cartridge 47 is placed adjacent to the body tissue 57 to be sutured. Subsequently, the surgical needle 46 penetrates through the tissue and passes through the first loop 35 to form the tissue suture loop 40. The size of the tissue suture loop 40 is adjusted so that an appropriate tension is applied to the mutually opposing portions of the body tissue 57 to be sutured. Once the knot is fully tightened to form a non-slip knot, the tissue suture loop 40 is firmly secured and no further adjustment is possible. After the tissue suture loop 40 is sized appropriately, proximal tension is applied to the proximal portion 33 of the suture 30 in the direction indicated by the arrow in FIG. Sufficient tension is applied to the proximal portion 33 to form a perfect knot as described below.
[0032]
That is, advantageously, when tension is applied to the proximal portion 33 of the suture 30, the first loop 35 is pulled so that a proximal force is exerted against the distal end 45 of the core tube 43. And the core tube 43 slides proximally as shown in FIG. Since the knot loop is in contact with the detachable shoulder 51 in the knot recess 50, it remains fixed even if the core tube 43 slides in the proximal direction. As the core tube 43 slides to a position adjacent to the proximal end 52 of the tube slot 49, the knot loop is detached from the distal end 45 of the core tube 43. As a result, the knot is completely formed, and the user removes the cartridge top plate 56, cuts the remaining proximal portion 33 and distal portion 34 of the suture 30, and removes the core tube 43. Alternatively, the tension applied to the proximal portion 33 is released, and the cartridge 47 is pulled in the proximal direction, so that a portion of the proximal portion 33 and the distal portion 34 of the suture 30 contained in the core tube 43 The distal portion 33 and the distal portion 34 of the suture 30 can be exposed from the cartridge 47 without removing the cartridge top plate 56.
[0033]
The suture cartridge 47 can be easily applied to conventional open surgical instruments and endoscopic examination instruments, and has an advantage that a surgical knot can be easily formed. The suture cartridge 47 may be disposable or used for some patients. When used in some patients, a number of surgical knots for suturing tissue are simply loaded by sequentially loading a suture cartridge with a plurality of disposable core tubes wrapped around a partially tied knot. A single suture cartridge can be used.
[0034]
In another example using this core tube concept, a partially tied knot is wrapped around the core tube to facilitate conversion to a fully non-slip knot for suturing tissue. To. This similar embodiment is shown in FIGS. One feature of this embodiment that differs from the embodiment illustrated in FIGS. 9-15 is that the core tube has a beveled distal end. For the sake of simplicity, in FIGS. 21 to 23, parts similar to those shown in FIGS. 9 to 15 are denoted by the same reference numerals.
[0035]
Another example of a knot in a partially tied state is shown in FIGS. The knot consists of a suture 58 having a proximal end 59 and a distal end 60. A surgical needle 61 is attached to the distal end 60. By manipulating the distal end 60 of the suture while keeping the proximal end 59 of the suture fixed, the knot is formed. The core loop 62, the proximal loop 63, and the first loop 64 are formed first. Proximal loop 63 is at the first end 70 of the knot and first loop 64 is at the opposite end 71 of the knot. The core loop 62 is located between their first end and the opposite end. In this preferred embodiment, a knot loop composed of second, third and fourth loops 65, 66 and 67 is formed around the proximal loop 63 and the first loop 64. These knot loops form a common loop core 68. The core loop 62 is located in the common loop core 68. When tension is applied to the distal end 60 of the suture while holding the proximal end of the knot loop, the knot loop is tightened. More specifically, the knot loop is clamped around the first loop 64, the proximal loop 63 and the core loop 62. When the knot loop is tightened, as shown in FIG. 17, the first loop 64, the core loop 62, and the proximal loop 63 are safely held in the knot loop to form a partially knotted knot. Is done.
[0036]
As particularly shown in FIG. 17, the core loop 62 has a free proximal end 59 that extends from the common loop core 68 toward the first end 70 of the knot. The core loop 62 also has a loop end 72 that extends in an opposite direction from the common loop core 68 toward the opposite end 71 of the knot. The loop end 72 of the core loop 62 is disposed in the first loop 64.
[0037]
The partially knotted knot shown in FIG. 17 is completed by applying axial tension proximally to the proximal loop 63 while holding the proximal end 59 of the knot loop. Can be converted into a non-slip knot. The knot can be converted by drawing the first loop into the common loop core 68 to form a distal loop in a manner similar to that preferably illustrated in FIGS. Conveniently, when tension is applied to the proximal loop 63, not only is the first loop 64 drawn into the common loop core 68, but the core loop 62 is also drawn into the common loop core 68. This has the advantage that the core loop 62 forms sufficient space in the common loop core 68 to facilitate the first loop 64 penetrating through the common loop core 68 to form a complete knot. In this way, the first loop 64 easily penetrates the common loop core 68 so that the amount of tension applied to the proximal loop 63 to form a perfect knot can be reduced, and thus User controllability when forming a knot can be improved.
[0038]
FIGS. 18 to 20 show examples in which the detachment tube (core tube) 73 is used to convert the partially knotted knot shown in FIG. 17 into a complete knot for suturing tissue. FIG. When the partially tied knot shown in FIG. 17 is formed, the proximal loop 63 is passed through the detachment tube 73. A portion of the proximal loop 63 extends outward from the proximal end of the detachment tube 73. The proximal loop 63 is passed through the detachment tube 73 until the knot loop abuts the distal end 74 of the detachment tube 73. The important point here is that the detachment tube 73 has a beveled (ie, tapered) distal end 74. A core loop 62 and a first loop 64 extend outwardly from the inclined distal end 74 of the tube 73. The opening at the distal end 74 of the detachment tube 73 is smaller than the diameter of the knot loop. As a result, even if tension is applied to the proximal loop 63 in the proximal direction, the knot loop does not pass through the detachment tube 73.
[0039]
The conversion from a partially tied knot to a fully knot is performed in a manner substantially similar to that previously described in connection with the knot transformation shown in FIG.
[0040]
As shown in FIGS. 19 and 20, the detachment tube 73 is disposed adjacent to the body tissue 75 to be sutured. A surgical needle 61 is passed through the tissue 75. The surgical needle 61 and the distal end 60 of the suture 30 are guided into the first loop 64 to form a tissue suture loop 76. Again, it is important to adjust the size of the tissue suture loop 76 so that the appropriate tension is applied to the suture tissue before the knot is fully formed. Once the predetermined tissue suture loop 76 is formed, tension is applied to the proximal loop 63 in the proximal direction indicated by the arrow in FIG. 19, and the core loop 62 and the first loop 64 are drawn into the common loop core. The first loop 64 then emerges from the fourth knot loop 67 to form a distal loop 77, forming a complete non-slip knot.
[0041]
A preferred embodiment of a suture cartridge assembly that can be used in the practice of the present invention is shown in FIGS. This preferred embodiment is a further improvement of the assembly shown in FIGS. 11-15, comprising a partially tied knot wrapped around a core tube and subsequently loaded into a suture cartridge.
[0042]
Referring first to FIGS. 24 and 25, a preferred suture cartridge 80 is formed into a knot 84 having a proximal end 82 and a distal end 83 and wrapped around a core tube 85 and partially tied. A suture 81 is provided. The proximal end 82 of the suture 81 extends from the proximal end of the core tube 85, the first loop 86 of suture extends from the distal end of the core tube 85, and the surgical needle 87 is connected to the suture 81. Is attached to the distal end 83.
[0043]
The suture cartridge 80 has an upper surface 88, a lower surface 89, and a slot 90 for receiving the core tube 85, and a suture 81 having a knot 84 in a partially tied state wound around the core tube 85. The cartridge is provided between an upper surface 88 and a lower surface 89. The slot 90 includes a knot recess 91 for receiving a partially tied knot 84 of suture, and the partially tied knot 84 is a pair of detachable shoulders 92 within the knot recessed 91. Abut. When the core tube 85 is loaded into the slot 90, a portion of the distal end 83 of the suture 81 having the surgical needle 87 and the first loop 86 is lowered from the lower surface 89 of the cartridge. The cartridge top plate 93 covers the top surface 88 of the suture cartridge, thereby confining a portion of the core tube 85 and the suture 81.
[0044]
It is important that the gripping jaw 94 is pivotally attached to the suture cartridge 80 with a pivot pin (or pivot pin) 95. The gripping jaw 94 faces the cartridge top plate 93 and can move from an open position away from the cartridge top plate 93 to a closed position adjacent to the cartridge top plate 93. The gripping jaw 94 is biased to the open position. A cartridge housing 95 having a suture track 96 is also attached to the proximal end of the suture cartridge 80.
[0045]
Referring now to FIGS. 28-32, details of the suture cartridge 80 and the cartridge housing 95 integrally attached to the suture cartridge can be seen. The distal end of the suture cartridge 80 includes a retaining pin 97 for permanently attaching the cartridge top plate 93 to the upper surface 88 of the suture cartridge. The holding pin 97 is “heat-staked” to attach the cartridge top plate 93 to the suture cartridge 80. A stereotactic boss 98 is also provided at the distal end of the suture cartridge 80. A pin orifice 99 is provided to accommodate a pivot pin 95 that pivotally attaches the gripping jaw 94 to the suture cartridge 80. The pivot pin 95 received through the pin orifice 99 also serves to fix the cartridge housing 95 to the suture cartridge 80. A central aperture 100 is provided at the distal end of the cartridge housing 95 and provides an opening for receiving the proximal end of the gripping jaw 94. Also provided in the cartridge housing 95 is a torsion spring slot 101 for accommodating a torsion spring 102 (see FIGS. 24 and 33) for biasing the gripping jaw 94 to its open position. The torsion spring 102 has an upper arm 113, a torsion loop 114, and a jaw arm 115.
[0046]
The suture track 96 of the cartridge housing 95 has an abdominal channel 103 that joins a left suture groove 104 that extends proximally to the proximal end of the cartridge housing 95. There is a pair of lateral suture slots 105 at the proximal end of the cartridge housing 95. Continuing from the lateral suture slot 105, a right suture groove 106 is embedded in the cartridge housing 95. The cartridge housing 95 also includes a hook slot 107 surrounded by a pair of spaced hook teeth 108.
[0047]
Referring now to FIGS. 34 through 36, details of the gripping jaws 94 are shown. The gripping jaw 94 has a serrated inner surface 109 to facilitate gripping tissue, sutures or surgical needles. The gripping jaw 94 includes a jaw lug (protrusion) 110, and the jaw lug 110 includes a jaw orifice 111 that accommodates a pivot pin 95 for pivotal mounting of the gripping jaw 94 to the suture cartridge 80. The gripping jaw 94 also has a spring arm slot 112 for receiving the torsion spring 102. The proximal end of the cartridge top plate 93 is provided with a spring tab 116. The spring tab 116 biases and holds the core tube 85 during assembly and knot formation.
[0048]
In a preferred embodiment, the suture cartridge assembly is a disposable assembly that is discarded after use by a single patient. The suture cartridge 80 and cartridge housing 95 are preferably made of biocompatible injection molded plastic, and the gripping jaws 94 are preferably made of medical grade stainless steel. Alternatively, the suture cartridge assembly could be manufactured from a suitable metal by a metal injection molding (MIM) process. This metal injection molding (MIM) process is a conventional manufacturing technique adapted to manufacture conventional staple cartridges for surgical staplers and cutters.
[0049]
FIGS. 26 and 27 illustrate how the core tube 85 is attached to the suture cartridge 80 and how the proximal end 82 of the suture is wrapped around the cartridge housing 95 within the suture track 96. FIG. When the core tube 85 is loaded into the slot 90 of the suture cartridge 80, the surgical needle 87 and a portion of the distal end 83 of the suture are passed through the slot 90, and the knot 84 in a partially tied state is connected to the knot recess 91. To place. In the knot recess 91, the knot 84 in a partially tied state comes into contact with the detaching shoulder 92, and the first loop 86 is lowered from the lower surface 89 of the cartridge. The proximal end 82 of the suture is passed through the abdominal channel 103 of the cartridge housing 95 and into the anchor recess 117 in the cartridge housing 95 until it exits the left suture groove 104, the lateral suture slot 105 and the right suture. Wind around the groove 106. The proximal end 82 of the suture 81 is tied within the anchor recess 117 to form the knot anchor 118, and the suture 81 is placed in a fixed position within the cartridge housing 95. It is noteworthy when viewing FIGS. 26 and 27 that, when the cartridge top plate 93 is attached to the upper surface 88 of the suture cartridge, the cartridge top plate 93 is further held to hold the cartridge top plate 93 and the upper surface of the suture cartridge. A pair of retaining slots 119 at the junction between the two.
[0050]
In a particularly preferred embodiment, a loaded suture cartridge assembly that can be used in the practice of the present invention is housed within the cartridge carrier 120 of the surgical instrument 121 to form the knot and the tissue, surgical needle or suture. It makes it easier to grip the yarn. With particular reference to FIG. 33, a suture cartridge 80 having a cartridge housing 95 is loaded and contained within the cartridge carrier 120. The cartridge carrier 120 has a pair of receiving walls 122 that form a channel 123 for receiving the cartridge assembly. Each of the receiving walls 122 has an upper edge surface 124 and a serrated edge surface 125 at its distal end. A surgical instrument having a cartridge carrier 120 for receiving a suture cartridge 80 urges the gripping jaw 94 to its closed position when the closure tube 126 moves forward and when the closure moves backwards. It is advantageous to have a reciprocating closure tube 126 for biasing the gripping jaw 94 to its open position. Such a surgical instrument preferably includes a hook 127 that is received in a hook slot 107 between a pair of hook teeth 108 of the cartridge housing 95. When the hook 127 is retracted, the hook 127 pulls the proximal end of the suture in the suture track 96 of the suture cartridge housing and forms a knot in a manner similar to that shown in FIGS. To do.
[0051]
Reference is now made to FIGS. As can be seen, when the cartridge assembly is loaded into the carrier 120, the serrated edge surface 125 of the cartridge carrier receiving wall 122 protrudes from the cartridge top plate 93 of the suture cartridge and the gripping jaw 94 is in its closed position. Meshes with the serrated inner surface 109 of the jaw. In doing so, these mating surfaces 125, 109 facilitate grasping of the tissue 128 (FIG. 37), suture 81 (FIG. 38), and surgical needle 87 (FIG. 39). Thus, the suture cartridge assembly of the present invention not only facilitates the formation and placement of a partially knot to a complete knot, but also facilitates the placement of tissue or knots during surgery. It also facilitates the operation of sutures with surgical needles, which are important for this.
[0052]
FIGS. 40 to 49 show a loading assist device that can be used in cooperation with a preferred surgical instrument of the present invention, and a suture cartridge housed in the loading assist device. Shows how it is loaded.
[0053]
First, referring to FIGS. 40 to 42, details of the auxiliary loading device 130 can be seen. The loading assist device 130 includes a rigid and transparent cartridge case 131 that is used when a suture cartridge is loaded into a surgical instrument cartridge carrier and the surgical instrument cartridge assembly is removed from the transparent case. It is easy to handle and allows the contents in the case to be easily observed. The case 131 includes a base 132 and an upper lid 133 that faces the base 132. A top cover 133 is removably attached to the base 132. The upper lid 133 includes a distal pin 134 and a proximal pin 135, and the distal pin 134 and the proximal pin 135 are received by the corresponding distal boss 136 and proximal boss 137 of the base 132 of the case 131, respectively. In order to further fix the upper lid 133 to the base 132, the lower boss 138 of the base 132 receives a corresponding low-level pin (not shown) extending from the upper lid 133, and the case support rib 139 also extends from the upper lid 133. Friction engagement with.
[0054]
A cavity between the base 132 of the cartridge case 131 and the upper lid 133 forms a cartridge storage space 140. The cartridge storage space 140 includes a proximal retainer 141, a distal retainer 142 remote from the proximal retainer, and a jaw retaining ledge 143 between the proximal retainer and the distal retainer. The cartridge storage space 140 receives and fixes the suture cartridge in the cartridge case 131 of the loading assist device.
[0055]
The base 132 and the top lid 133 of the cartridge case 131 are also carrier ports for allowing insertion and withdrawal of the cartridge carrier of the surgical instrument to form and position the suture from the suture contained in the suture cartridge during the surgical procedure. 144 is also formed. The internal carrier channel 145 provides a passage between the carrier port 144 and the cartridge storage space 140 until the surgical instrument cartridge assembly is inserted through the carrier port 144 until it enters the cartridge storage space 140 for loading the cartridge into the carrier. It can pass through its internal carrier channel 145. The carrier channel 145 is bounded by a base support ledge 146 extending from the base 132 and a cover support rib 147 extending from the top cover 133 in a mutually opposed relationship with the base support ledge. It has been. An inlet ramp 148 is also provided to further facilitate insertion and withdrawal of the cartridge carrier of the surgical instrument. The inlet ramp 148 extends from the carrier port 144 to the carrier channel 145.
[0056]
The base 132 of the cartridge case 131 includes a pad 149 on which the suture thread of the suture cartridge is disposed. The top lid 133 has a suture retainer 150 for holding the suture of the suture cartridge in a fixed position on the pad 149 when the top lid 133 is fixed to the base 132. Similarly, the upper lid 133 also has a needle retainer 151 for holding a surgical needle attached to the suture of the suture cartridge on the pad 149 when the upper lid 133 is disposed at the base 132 of the cartridge case.
[0057]
The cartridge storage space 140 in the cartridge case 131 of the loading assist device 130 receives the suture cartridge 152. The suture cartridge 152 houses a suture 153 formed in a partially tied knot with a first loop 154 and a surgical needle 155 attached to the distal end of the suture. The suture cartridge 152 has a cartridge top plate 156 and a gripping jaw 157 facing the cartridge top plate. The gripping jaw 157 can be pivotally moved from an open position away from the cartridge top plate 156 to a closed position adjacent to the cartridge top plate 156 by a pivot pin 158. This gripping jaw 94 is normally biased to its open position.
[0058]
The first loop 154 and the suture thread 153 are held in the outer surface of the base portion 132 as shown in FIG. Because of this limitation, the first loop 154 and the suture 153 are not tangled or pinched when the suture cartridge 152 is loaded into the cartridge carrier.
[0059]
A suture cartridge suitable for practicing the present invention is an assembly as shown in FIGS. The suture cartridge 152 is positioned such that the proximal end of the suture cartridge is seated on the proximal retainer 141. The distal end of the suture cartridge is seated on the distal retainer 142 and the gripping jaw 157 is held against the jaw holding ledge 143. In order to securely secure the suture cartridge 152 to the cartridge storage space 140, the spacing between the distal retainer 142 and the jaw retaining ledge 143 is such that the gripping jaw 157 is oriented between its open and closed positions. It is an interval. In this way, the biasing action of the gripping jaws 157 against the jaw holding ledge 143 helps to securely place the suture cartridge 152 in the cartridge storage space 140. It is also worth noting that the suture cartridge 152 in the cartridge storage space 140 is inclined downward from the cartridge proximal end to the cartridge distal end. The suture cartridge assembly as shown in FIG. 42 may be packaged and sterilized using conventional techniques such as gamma irradiation or ethylene oxide exposure.
[0060]
The surgical instrument 159 of the present invention is for loading the suture cartridge 152 from the cartridge case 131 into the instrument 159 and subsequently forming (ie, deploying) a knot from the suture contained within the suture cartridge 152. In addition, it can be used in cooperation with the loading assist device 130. The surgical instrument 159 can be used as a conventional open surgical instrument or an endoscopic surgical instrument suitable for minimally invasive surgery, but is preferably an endoscopic surgical instrument. The surgical instrument 159 has a cartridge carrier 160 that can be inserted into the carrier port 144 of the cartridge case 131 and pulled out from the carrier port 144 and can be passed through the carrier channel 145 to the cartridge storage space 140. It is advantageous. Of course, the cartridge carrier 160 must also be configured to receive the suture cartridge 152 from the cartridge storage space 140. The surgical instrument 159 may have a closure tube 161 that is movable from a retracted position to an extended position (ie, advanced position) to open and close the gripping jaws 157 relative to the cartridge top plate 156 of the suture cartridge. preferable.
[0061]
Referring now to FIGS. 43 through 49, there is shown a sequence of steps for loading the suture cartridge 152 in the cartridge storage space 140 of the cartridge case 131 of the loading assist device into the cartridge carrier 160 of the surgical instrument 159. Yes. In FIG. 43, the cartridge carrier 160 is oriented so that it can be inserted into the carrier port 144 and pass through the carrier channel 145. In FIG. 44, the cartridge carrier 160 has already been inserted into the carrier port 144 and is passed through the carrier channel 145 in the loading direction illustrated by the arrow until it contacts the suture cartridge in the cartridge storage space 140 of the cartridge case. As a result of the tilted orientation of the suture cartridge 152, the cartridge carrier 160 contacts the suture cartridge 152 at an intermediate point between the proximal and distal ends of the suture cartridge 152. Referring now to FIG. 45, the cartridge carrier 160 moves in the distal direction, expelling the suture cartridge 152 from the distal retainer 142 and proximal retainer 141 in the cartridge storage space 140. With the distal movement of the cartridge carrier 160 in the cartridge storage space 140, the suture cartridge 152 is expelled from the distal retainer 142 and the proximal retainer 141, so that the cartridge carrier 160 of the surgical instrument 159 is sutured. A cartridge 152 is received. As the suture cartridge 152 is loaded into the cartridge carrier 160 as the cartridge carrier 160 moves distally, the closure tube 161 of the surgical instrument 159 is maintained in its retracted position. Since the pressure applied to the suture 153 and the surgical needle 155 seated on the pad 149 from the suture retainer 150 and the needle retainer 151 of the upper lid 133 is slight, what prevents the suture and the needle from moving during the loading operation is limited. It is also worth noting that there is no. In FIG. 46, once the suture cartridge 152 is loaded into the cartridge carrier 160 of the surgical instrument 159, the closure tube 161 of the surgical instrument 159 moves from its retracted position to its advanced position, thus removing the suture cartridge 152 from the surgical instrument. Fix to the cartridge carrier 160 of the instrument 159.
[0062]
With particular reference to FIGS. 47 to 49, the cartridge carrier 160 after loading the surgical instrument 159 is removed from the cartridge case 131 of the loading assist device. The cartridge carrier 160 is removed by simply pulling out the cartridge carrier 160 from the cartridge storage space 140, the carrier channel 145, and the carrier port 144 of the cartridge case 131 in the extraction direction indicated by an arrow in FIG.
[0063]
A small gap (between the base support ledge 146 and the cover support rib 147 that bounds the carrier channel 145 in the cartridge case 131 so that the suture 153 and the surgical needle 155 can freely pass out of the cartridge case 131. Advantageously, there is a gap (see FIG. 41 to see the gap). Similarly, the suture 153 and the surgical needle 155 seated on the pad 149 in the base 132 of the cartridge case can be easily passed through the cartridge case 131 so that the suture 153 and the surgical needle 155 can easily pass out of the cartridge case 131. The pressure applied is advantageously minimal.
[0064]
Once the surgical instrument 159 has been used to form and place the knot from the suture contained in the suture cartridge 152 loaded in the cartridge carrier 160 of the surgical instrument 159, the surgeon or operating room assistant may have used the The cartridge can be removed and discarded. If it is necessary to form and place an additional surgical knot, the surgeon or operating room assistant can easily load the second suture cartridge into the cartridge carrier 160 of the surgical instrument 159. You only need to procure another auxiliary device.
[0065]
50 to 60 show a surgical instrument 121 which is a preferred embodiment of the present invention. Referring first to FIG. 51, the handle assembly 300 of the surgical instrument 121 includes a grip 192 having a proximal end 193 and a distal end 194;As the first actuating meansTrigger 180;As second actuating meansThe lever 220 includes a left release button 240, a right release button 238 (see FIG. 50), and a trigger latch 281 on each side of the grip 192. A closure tube 126 is attached to the proximal end 193 of the grip 192, and the closure tube 126 isAs the first actuating meansControlled by the operation of the trigger 180, sliding in the longitudinal direction within the grip 192 is restricted. With the function of the closure tube 126, loading and unloading of the suture cartridge assembly 80 (see FIG. 24) according to the steps shown in FIGS. 43 to 49, and a gripping jaw 94 as shown in FIGS. Can be opened and closed.As second actuating meansWhen the lever 220 is actuated, a knot in a partially connected state is formed and arranged by pulling the proximal portion 33 of the suture in the axial direction as shown in FIGS. As shown in FIG. 8, a knot in a completely connected state is generated. The left release button 240 and the right release button 238 can be simultaneously operated to open the trigger 180 for loading and unloading the suture cartridge assembly 80. The trigger latch 281 holds the trigger 180 against the grip 192 after the trigger 180 is fully activated, and then releases the trigger 180 from the grip 192 after the trigger 180 is fully activated.
[0066]
FIGS. 51 to 56 show a sequence of expected operations of the surgical instrument 121, which will be described next. Referring again to FIG. 51, the surgical instrument 121 is positioned to accommodate the suture cartridge assembly prior to initial use. As can be seen from FIG. 52 associated with FIG. 51, the cartridge carrier 120 is empty and the distal end of the closure tube 126 is near the middle between the farthest position and the most recent position of the cartridge carrier 120 (hereinafter referred to as the “intermediate position”). Called). FIG. 53 shows the surgical instrument 121 in a loading / sampling configuration. The left release button 240 and the right release button 238 are pressed simultaneously, causing the trigger 180 to rebound to the open position shown, and then the closure tube 126 is retracted proximally. The suture cartridge assembly 80 is easy to place in the cartridge carrier 120, and the sequence shown in FIGS. 54, the trigger 180 is actuated to an intermediate position as shown and the closure tube 126 has moved distally to the intermediate position as shown in FIG. At this time, the suture cartridge assembly 80 is captured in the cartridge carrier 120, and the surgical instrument 121 containing the cartridge is pulled out from the loading assist device 130. The next step in the use of the surgical instrument 121 is to introduce the distal end of the surgical instrument into a body cavity as shown in FIG. 55 and the grasping jaw 94 is inserted through the endoscope cannula 298. Since the grasping jaws need to be in their closed position, the surgeon's assistant will pull the trigger 180 and trigger 180 against the grip 192 before removing the instrument 121 from the loading aid 130 and handing it to the surgeon. Until it is latched and held there by the trigger latch 281. This loading sequence is shown in FIGS. Once the surgeon introduces the distal portion of the surgical instrument 121 into the body cavity through the endoscopic cannula 298, full actuation of the trigger 180 releases the trigger from the grip 192 and then the closure tube 126 in the proximal direction. And the gripping jaw 94 is opened. At this time, the surgical instrument 121 can be used for grasping and operating the tissue 128 (see FIG. 37), the suture 81 (see FIG. 38) or the surgical needle 87 (see FIG. 39). FIG. 56 is a view showing the surgical instrument 121 when a knot is formed and arranged for suturing the tissue 128. The lever 220 is actuated in a downward arc by the surgeon's thumb or finger until it reaches the internal stop and places the knot. The operation of the lever 220 is stopped at any point along the arc and the lever 220 maintains its position. This configuration allows the surgeon to manipulate and inspect the suture and the tissue to which it is secured in order to properly pull the suture and place the knot. Once lever 220 is fully actuated and the surgeon's thumb or another finger is lifted from the lever, lever 220 returns to its starting position by spring force. Surgical instrument 121 is then withdrawn from the body cavity with or without trigger 180 in the closed position, ready for loading with a new second suture cartridge assembly.
[0067]
FIG. 50 is an exploded perspective view of the components of the handle assembly 300 along with the closure tube 126. The outer shell of the grip 192 consists of a left grip cover 190 and a right grip cover 200, both preferably made from a rigid medical grade plastic such as polycarbonate. These covers have a plurality of bosses and ribs to support and align the components therein. The trigger 180 and the lever 220 are supported between the left grip cover 190 and the right grip cover 200 and move as described above. Pinion 210, rack 270, and closure tube 260 may be made from metal, but are preferably made from various injection molded rigid medical grade plastics. The following components of the handle assembly 300 are: base anchor 280, trigger latch spring 282, leaf spring pawl 284, lever spring 290, tube spring 230, tube latch 234, coupler spring 242, rack spring 250, washer 252, retaining ring. 254 and suture pull rod 246 may be made from plastic, but are preferably made from a metal such as stainless steel.
[0068]
With further reference to FIG. 50 and now also referring to FIG. 57, the components of the handle assembly 300 are visible and are in an operative configuration corresponding to FIGS. The trigger 180 is in the middle position and is supported by a pivot boss 184 protruding from the right grip cover 200. The trigger fork 182 includes a left push arm 262 and a right push arm 263 of the closure coupler (closure connecting means) 260 attached to the closure pipe 126 by a flange 171 (see FIG. 50) inserted into the coupler recess 264 (see FIG. 50). Are supported. The coupler spring 242 is compressed between the flange 171 and the proximal end of the coupler recess 264 such that the longitudinal force transmitted from the coupler is limited by the spring constant of the coupler spring. This ensures that the surgeon does not apply excessive force to the gripping jaw 157 by the distal end of the closure tube 126 when attempting to grip tissue or another object that does not completely close the gripping jaw 157. It is. The series of components described above are biased proximally by a tube spring 230 captured and partially compressed at the proximal end of the closure tube 126. This tube spring 230 pushes the inner wall of the proximal end 193 of the grip. Closure coupler 260 is held in a longitudinal intermediate position by tube latch 234, which are connected by three coupler posts 261 that are pushed into three holes 235 of tube latch 234. The tube latch 234 engages with the right latch rib 198 with the tube latch right end 232 protruding from the right grip cover 200, and similarly the tube latch left end 233 is engaged with a mirror image-related left latch rib (not shown) on the left grip cover 190. The springs are open in the lateral direction so that they match. The right release button 238 and the left release button 240 are located on the tube latch right end 232 and the tube latch left end 233, respectively. The right release button 238 and the left release button 240 are connected to the “pigeon shape” button anchor 239 in a “wishbone” manner, and the button anchor 239 extends from the right grip cover 200 and the left grip cover 190, respectively. 195 and a mirrored left button retainer (not shown).
[0069]
With further reference to FIG. 57, the lever 220 is shown in its starting position and is supported by a lever pivot boss 222 protruding from the right grip cover 200. Further, the plurality of pinion small gear teeth 213 of the pinion 210 supported by the pinion pivot boss 212 protruding from the right grip cover 200 mesh with the plurality of lever gear teeth 224. The plurality of rack gear teeth 272 of the rack 270 whose longitudinal movement is restricted between the grip cover ribs 218 protruding from the left and right grip covers 190 and 200 mesh with the plurality of large pinion gear teeth 216. The lever spring 290 is captured at the proximal end 274 of the rack 270 and exerts an initial separating force between the rack spring chamber proximal end 277 and the two base ribs 295 and 294 protruding from the left and right grip covers 190 and 200. In order to make it partly compressed. These base ribs 295 and 294 are “C-shaped” and extend to the central axis of the handle assembly 300. The base ribs 295, 294 together form a hole to provide clearance at the distal end 274 of the rack 270 to allow longitudinal movement in the proximal direction of the rack 270. The pre-loaded force of the lever spring 290 biases the rack 270 distally and is transmitted to the lever 220 through the drive element described above, thus urging the lever 220 to remain in its starting position.
[0070]
Referring now to FIG. 58, the handle assembly 300 is illustrated in an operative configuration corresponding to FIG. 53 when the surgical instrument is loaded or unloaded with the suture cartridge assembly 80. Due to the looseness of the closure coupler 260, the trigger 180 is fully swung away from the longitudinal axis of the handle assembly 300. This arrangement of the handle is obtained by the surgeon or his surgeon's assistant using the thumb and the opposing finger to simultaneously squeeze the left and right release buttons 240, 238, which compresses the tube latch 234 and The tube latch 234 moves away from the left and right latch ribs 198,199. This causes the tube spring 230 to exert a proximal force on the end of the closure coupler 260. This immediately causes the closure coupler 260, the tube latch 234, and the closure tube 126 to move proximally, thereby completely opening the trigger 180. The opening of the trigger 180 is limited by the trigger fork 182 hitting the trigger stops 188 of the left and right grip covers 190 and 200. In order for the trigger 180 to open, the user does not need to hold the trigger 180 while pressing the release buttons 238 and 240. Specifically, this configuration is intended to make the retraction of the closure tube 126 a deliberate process while being a one-handed operation. This is because it is undesirable to unexpectedly open the suture cartridge assembly 80 into the body cavity.
[0071]
When the spent or “fired” suture cartridge assembly 80 is withdrawn from the cartridge carrier 120 and a new suture cartridge assembly is loaded according to the steps shown in FIGS. The handle 180 is fully retracted to re-engage the tube latch 234 with the left and right latch ribs 199, 198 and the closure tube 126 is repositioned to a position where the suture cartridge assembly 80 is captured by the cartridge assembly 120. The assembly 300 is set in a “preparation for forming and arranging” mode as shown in FIG. When this is complete, the surgeon can either keep the trigger 180 in this position when the lever 220 is actuated, or the trigger 180 can be fully closed and latched against the grip 192, or triggered somewhere between the above positions. Whether to hold 180 can be selected.
[0072]
In FIG. 60, the lever 220 is fully actuated while the trigger 180 is partially squeezed, but the trigger hook 186 is still insufficient to be latched by the trigger latch spring 282. . When lever 220 is moved downward as shown, rack 270 moves longitudinally proximally and compresses lever spring 290 by the series of gear interactions described above. Since the rack spring 250 housed in the rack spring chamber 276 is also moving in the proximal direction, the rack spring 250 is close to the washer 252 that abuts the retaining ring 254 attached to the suture pull rod 246. A longitudinal force is transmitted in the lateral direction. The suture pull rod 246 is attached to a hook 127 (FIG. 33) that engages the suture proximal end 82. Thus, as the suture pull rod 246 moves proximally, the knot is formed and arranged in a manner similar to that shown in FIGS. Thus, the total force transmitted from the rack 270 to the suture pulling rod 246 is determined by the spring constant of the rack spring 250 and the distance that the rack spring 250 is compressed between the rack spring chamber distal end 276 and the washer 252. The rack spring 250 acts as force limiting means in that it is equal to the sum of the product plus the preloaded force of the rack spring 250. The configuration of this force limiting means of the present invention helps to prevent excessive tensioning of the suture (if this occurs, the suture will break before the knot is fully formed and placed). However, all the above forces are transmitted only when the resistance of the suture pull rod 246 is equal to or exceeds the preloaded force of the rack spring 250. This resistance varies primarily with the tension and angle of the helping 83 tension exerted by the surgeon during tissue sutures. This resistance is maximized when the knot is converted into a non-slip knot as shown in FIGS. This prevents the spring from collapsing to its close contact height (when this occurs, the surgeon will apply excessive force to the lever 220 to break the suture proximal portion 33). It is important that the rack spring 250 be sized and preloaded to transmit a longitudinal force sufficient to effect knot conversion. The rack spring 250 should not be dimensioned or preloaded with the force required to further compress it by a length close to or exceeding the tensile strength of the suture. This is because in this case, it is impossible to prevent the suture from being broken by using the above-described force limiting configuration. Even during the transmission of the force described above, the cartridge carrier 120 is grounded with respect to the grip 192 and does not move by being attached to the base anchor 280 inserted in the recess 281 of the inner wall of the right grip cover 200 (see FIG. 50).
[0073]
With further reference to FIG. 60, it can be seen that the rack 270 has a “T-shaped” leaf spring pawl 284 attached to the rack 270. When the lever 220 is actuated, the lateral arm of the leaf spring pawl 284 engages a plurality of teeth 206 (see FIG. 50) formed on the inner surfaces of the left and right grip covers 190, 200, The rack 270 can maintain its longitudinal position at a number of discontinuous points between the start and stop positions of the lever. Before the leaf spring pawl 284 moves beyond the end of the formed tooth 206 so that the leaf spring pawl 284 moves away from the formed tooth 206 and returns to the position where the lever 220 returns to its starting position, the lever 220 Must be fully operational. At this time, the surgeon must release the lever 220 so that the force of the lever spring 290 causes the rack 270 to move distally and return the lever 220 to its starting position. This lever retention configuration is well known for use with other surgical devices such as skin staplers.
[0074]
It will be appreciated that the handle assembly described above is of a preferred embodiment and that other grip shapes and in-assembly mechanisms are possible to achieve the intended function. For example, the handle assembly may have a “pistol grip” (pistol grip), or may have openings in the grip and trigger for insertion of the thumb and the opposing finger. In addition, the distal end portion of the surgical instrument can rotate about its longitudinal axis while the handle assembly remains stationary (a locking mechanism may be provided for this rotation). The surgical instrument described above may be disposable or reusable by the use of a single patient, depending on the material selection and assembly method, or a combination of the two.
[0075]
Although various embodiments of the present invention are representative embodiments of the present invention, these embodiments are merely examples. The scope of the present invention should not be construed as being limited by these embodiments or by any other specific embodiments that may occur to those skilled in the art, but should be construed according to the claims.
[0076]
The specific embodiments of the present invention are as follows.
  (А) In a surgical instrument for suturing body tissue by forming a fully tied knot during surgery,
a) a suture cartridge at the distal end of the instrument containing a suture having a partially tied knot formed at the distal end;
b) a cartridge carrier at the distal end of the instrument for receiving the suture cartridge;
c) a gripping jaw facing the suture cartridge in the cartridge carrier that is movable from an open position away from the suture cartridge to a closed position adjacent to the suture cartridge;
d) i) a grip for operating the instrument,
ii) first actuating means for causing the gripping jaws to move from the open position to the closed position; and
iii) pulling the proximal end of the suture proximally so that a fully tied knot is formed from the partially tied knot and the body tissue is sutured; A handle assembly located at the proximal end of the instrument and spaced from the suture cartridge, having second actuation means operatively connected to the proximal end of the suture;
e) The cartridge carrier movable in response to actuation of the first actuating means from a proximal position where the gripping jaw is in its open position to a distal position in which the gripping jaw is in its closed position And a closure tube connecting the handle assembly to the handle assembly.
  (1) The suture cartridge is loaded into the cartridge carrier when the closure tube is in its proximal position and when the closure tube is moved to an intermediate position between its proximal and distal positions. Fixed in the cartridge carrierEmbodiment (A)The instrument described in 1.
  (2) The second actuating means and the suture proximal end to prevent the suture from breaking when the second actuating means is actuated to form a fully knotted knot. Further comprising a first biasing element capable of cooperating withEmbodiment (A)The instrument described in 1.
  (3) a second capable of cooperating with the first actuating means to protect against overload when the second actuating means is actuated to move the closure tube from its proximal position to a distal position; The instrument of embodiment (2), further comprising a biasing element.
  (4) the first actuating means is a trigger pivotally attached to the handle assembly, and is movable from a first trigger position away from the grip to a second trigger position adjacent to the grip; The closure tube is in its proximal position when the first actuating means is in its first trigger position and is in its distal position when the second actuating means is in its second trigger positionEmbodiment (A)The instrument described in 1.
  (5) The first actuating means is movable to a third trigger position between the first trigger position and the second trigger position, and the closure tube is located when the first actuating means is at the third trigger position. The device according to embodiment (4), wherein is in its intermediate position.
[0077]
(6) The second actuating means is a lever pivotally attached to the handle assembly, and the lever is a first lever so as to form a knot in a fully tied state by pulling the suture end. The instrument of embodiment (4), wherein the instrument is pivoted from a position to a second lever position.
(7) The instrument according to embodiment (6), wherein the handle assembly of the instrument is suitable for one-handed operation to actuate the trigger and the lever when the grip is placed in the palm of a user.
(8) Embodiment in which the trigger is biased toward the first trigger position, the closure tube is biased toward the proximal position, and the lever is biased toward the first lever position. The instrument as described in (7).
(9) further comprising a release button protruding from the handle assembly, the release button being operable with the closure tube and the trigger, wherein the release button is pushed inward toward the handle assembly and the trigger is The instrument of embodiment (8), wherein when in the second or third trigger position, the trigger moves to the first trigger position.
(10) The suture cartridge has a hook slot therein, a proximal end of the suture traverses the hook slot, and the lever is connected to a pinion provided in the handle assembly. The instrument as described in (6).
[0078]
(11) A rack provided in the handle assembly and capable of cooperating with the pinion, and a suture pulling rod connected to the rack are further provided, and the suture pulling rod is connected to the cartridge carrier from the handle assembly. The suture pulling rod has a hook extending at a distal end thereof through the hook slot of the suture cartridge, and the pinion has the lever from the first lever position to the second lever. Moving the rack and a suture pull rod connected to the rack in a proximal direction when pivoted to a position, wherein the hook of the suture pull rod is fully tied from the partially tied knot Before traversing the hook slot in the suture cartridge to form a knot Instrument of Claim pulling the proximal end of the suture in a proximal direction (10).
[0079]
【The invention's effect】
As described above, according to the suture cartridge assembly of the present invention, the user opens or closes the grasping jaws by the first operating means of the handle assembly of the surgical instrument, and the body tissue or the suture thread. And the second actuating means can pull the suture functionally to form a fully tied knot from a partially tied knot. Even when direct access to the anatomy of the surgical object is very limited, the endoscope can form and place a fully tied knot from a partially tied knot Can be done easily.
The surgical instrument of the present invention can be used in any surgical procedure where it is necessary or desirable to form a fully-knotted knot and suture the body tissue. It is particularly suitable for endoscopic surgery where direct access to the is very limited.
[Brief description of the drawings]
FIG. 1 is a perspective view illustrating a series of steps for forming a knot in a partially tied state from a length of suture.
FIG. 2 is a perspective view illustrating a series of steps for forming a knot in a partially tied state from a certain length of suture.
FIG. 3 is a perspective view illustrating a series of steps for forming a knot in a partially tied state from a certain length of suture.
FIG. 4 is a perspective view illustrating a series of steps for forming a knot in a partially tied state from a length of suture.
FIG. 5 is a perspective view illustrating a series of steps for forming a knot in a state of being partially tied from a certain length of suture.
FIG. 6 is a perspective view illustrating a series of steps for forming a knot in a state of being partially tied from a certain length of suture.
7 is a perspective view of the process of converting the partially tied knot shown in FIG. 6 to a non-slip surgical knot.
8 is a perspective view of the process of converting the partially tied knot shown in FIG. 6 into a non-slip surgical knot.
9 is a perspective view showing an example in which the partially tied knot shown in FIG. 6 including a surgical needle attached to a suture is formed around a core tube. FIG.
10 is a perspective view showing an example in which the partially tied knot shown in FIG. 6 including a surgical needle attached to a suture is formed around a core tube. FIG.
11 is an exploded perspective view illustrating a suture cartridge with the partially tied knot shown in FIG. 6 formed around the core tube shown in FIGS. 9 and 10. FIG.
12 is a perspective view showing an assembly of the suture cartridge shown in FIG. 11 with a cartridge top plate attached thereto. FIG.
13 is a cross-sectional view of the assembly taken along line 13-13 of FIG.
FIG. 14 includes a partial cross-section of tissue showing the process of forming a complete surgical knot to securely suture the tissue from a partially tied knot for suturing the tissue. It is sectional drawing of the assembly shown in FIG.
FIG. 15 includes a partial cross-section of tissue showing the process of forming a full surgical knot to securely suture the tissue from a partially tied knot for suturing the tissue. It is sectional drawing of the assembly shown in FIG.
FIG. 16 is a perspective view showing the formation of another partially tied knot from a length of suture.
FIG. 17 is a perspective view showing the formation of another partially tied knot from a length of suture.
18 is a perspective view of the knot in the partially tied state shown in FIG. 17 formed around the desorption tube.
FIG. 19 is a side view illustrating an example of forming a complete non-slip surgical knot for suturing tissue using the assembly shown in FIG. 18;
20 is a side view illustrating an example of forming a complete non-slip surgical knot for suturing tissue using the assembly shown in FIG. 18. FIG.
21 illustrates an example of forming a complete non-slip surgical knot for suturing tissue from the partially tied knot shown in FIG. 6 formed around a tilted core tube. FIG.
22 illustrates an example of forming a complete non-slip surgical knot for suturing tissue from the partially tied knot shown in FIG. 6 formed around a tilted core tube. FIG.
FIG. 23 illustrates an example of forming a complete non-slip surgical knot for suturing tissue from the partially tied knot shown in FIG. 6 formed around a tilted core tube. FIG.
FIG. 24 is a perspective view of a preferred suture cartridge assembly.
FIG. 25 is an exploded perspective view showing the partially tied knot of the preferred suture cartridge assembly, wrapped around the core tube and separated from the suture cartridge assembly.
26 is an exploded perspective view showing the initial steps of assembling the suture cartridge assembly of FIGS. 24 and 25, with a surgical needle attached to the distal end of the suture being loaded into the cartridge slot of the suture cartridge. FIG. is there.
FIG. 27 is a perspective view showing the next step following loading of the core tube into the cartridge slot, where the proximal end of the suture is secured to the cartridge housing attached to the suture cartridge.
FIG. 28 is a plan view of the preferred suture cartridge assembly of FIG. 24 having a cartridge housing.
29 is a left side view of the cartridge of FIG. 28. FIG.
30 is a bottom view of the cartridge of FIG. 28. FIG.
31 is a right side view of the cartridge of FIG. 28. FIG.
32 is a rear or proximal end view of the cartridge of FIG. 28. FIG.
33 is an exploded perspective view showing the arrangement of the suture cartridge after loading in FIG. 24 on the cartridge carrier.
34 is a bottom view of the gripping jaws of the suture cartridge assembly of FIG. 24. FIG.
35 is a right side view of the gripping jaw of FIG. 34. FIG.
36 is a proximal end view of the gripping jaw of FIG. 35. FIG.
FIG. 37 is a perspective view of the suture cartridge assembly of FIG. 24 attached to a cartridge carrier and used in conjunction with a surgical instrument closure tube to grasp tissue.
FIG. 38 is a perspective view similar to FIG. 37 using a suture cartridge assembly to grip a portion of the suture.
FIG. 39 is a perspective view similar to the view of FIG. 37 using a suture cartridge assembly to grasp a surgical needle.
FIG. 40 is a perspective view of a preferred loading assist device in cooperation with a suture cartridge of a preferred surgical instrument of the present invention.
41 is a proximal end view of the loading assist device of FIG. 40. FIG.
42 is an exploded view of the loading assist device of FIG. 40 showing the containment of the suture cartridge within the cartridge case.
FIG. 43 is an internal side view of the cartridge case base showing the arrangement of the suture cartridge with the suture and surgical needle within the cartridge case base. The cartridge case upper cover for the loading assist device is indicated by a virtual line. The preferred surgical instrument cartridge carrier of the present invention is shown in a pre-loading relationship with a loading aid.
44 is an internal side view of the loading assist device of FIG. 40 when the cartridge carrier of the preferred surgical instrument of the present invention contacts the suture cartridge within the cartridge case. FIG.
45 is an internal side view of the loading assist device of FIG. 40 showing the suture cartridge seated on the cartridge carrier of the preferred surgical instrument of the present invention. FIG.
46 shows the interior of the loading assist device of FIG. 40 showing the suture cartridge assembly secured to the cartridge carrier when the closure tube of the preferred surgical instrument of the present invention moves forward to cover a portion of the suture cartridge. It is a side view.
47 is an internal side view of the loading assist device of FIG. 40 showing a partial retraction of the cartridge carrier after loading.
48 is an internal side view of the loading assist device of FIG. 40 showing further retraction of the cartridge carrier after loading.
49 is an internal side view of the loading assist device of FIG. 40 showing separation of the cartridge carrier after loading.
FIG. 50 is an exploded perspective view of the components of the handle assembly for the preferred surgical instrument of the present invention.
FIG. 51 is a perspective view of a preferred surgical instrument of the present invention when in a packaging and shipping configuration and not loaded with a suture cartridge assembly.
52 is an enlarged perspective view of a distal portion of the surgical instrument of FIG. 51. FIG.
53 is a perspective view of the surgical instrument of FIG. 51 in an arrangement for receiving a suture cartridge assembly. FIG.
54 is a perspective view of the surgical instrument of FIG. 51 in an arrangement when the distal portion is loaded with a suture cartridge assembly. FIG.
55 is a side view of the surgical instrument of FIG. 51 showing a state of being introduced into the body into the endoscope opening.
56 is a side view of the surgical instrument of FIG. 51 after the lever has been actuated and the knot has been formed and placed in body tissue.
57 is an internal side view of the handle assembly of the surgical instrument of FIG. 51 in the arrangement shown in both FIGS. 51 and 54. FIG.
58 is an internal side view of the handle assembly of the surgical instrument of FIG. 51 in the loading / withdrawing arrangement shown in FIG. 53. FIG.
59 is an internal side view of the handle assembly of the surgical instrument of FIG. 51 in the arrangement shown in FIG. 55. FIG.
60 is an internal side view of the handle assembly of the surgical instrument of FIG. 51 in the arrangement shown in FIG. 56. FIG.

Claims (10)

In a surgical instrument (121) for suturing body tissue by forming a fully tied knot during surgery,
a) a suture cartridge (80) disposed at a distal end of the instrument (121), comprising:
The suture cartridge (80) contains a suture (81),
The suture (81) has a knot in a partially tied state at the distal end (83) of the suture (81) .
A suture cartridge;
b) the order to accommodate the suture cartridge (80), and said cartridge carrier at the distal end of the instrument (121) (120),
c) a gripping jaw (94) attached to the suture cartridge (80),
The gripping jaw (94) faces the upper surface of the suture cartridge (80) housed in the cartridge carrier (120), and
It is movable from an open position away from said suture cartridge (80) to a closed position adjacent said suture cartridge (80),
A gripping jaw;
d) a handle assembly (300) positioned at the proximal end of the instrument (121) away from the suture cartridge (80),
The handle assembly (300)
i) a grip for operating the instrument (121) (192),
ii) a first actuating means for moving the gripping jaws (94) to said closed position from the open position (180), and,
iii) second actuating means (220) operatively connected to the proximal end (82) of the suture (81),
The second actuation means (220) can pull the proximal end (82) of the suture proximally;
Pulling the proximal end of the suture proximally to form a fully tied knot from the partially tied knot to suture body tissue ;
Second actuating means,
A handle assembly,
e) a closure tube (126) connecting the cartridge carrier (120) to the handle assembly (300),
The closure tube (126) is movable from a proximal position to a distal position in response to actuation of the first actuation means (180) ;
When the closure tube (126) is in the proximal position, the gripping jaw (94) is in the open position ;
When the closure tube (126) is in the distal position, the gripping jaw (94) is in the closed position;
A closure tube,
With a surgical instrument.   The surgical instrument according to claim 1, wherein
  The suture cartridge (80) can be received in the cartridge carrier (120) when the closure tube (126) is in the proximal position;
  When the closure tube (126) is moved to an intermediate position between the proximal and distal positions, the suture cartridge (80) is secured within the cartridge carrier (120); Surgical instruments.   The surgical instrument according to claim 1 or 2,
  When the second actuating means (220) is actuated to form the fully tied knot, the first biasing element (250) breaks the suture (81). To prevent
  A first biasing element (250) cooperating with a second actuation means (220) and the proximal end (82) of the suture (81);
  Further comprising
  Surgical instruments.   The surgical instrument according to claim 3, wherein
  When the first actuating means (180) is actuated to move the closure tube (126) from the proximal position to the distal position, the second biasing element (242) To give protection
  A second biasing element (242) capable of cooperating with the first actuating means (180);
  Further comprising
  Surgical instruments.   The surgical instrument according to any one of claims 1 to 4, wherein
  The first actuating means (180) is a trigger (180) pivotably attached to the handle assembly (300);
  The first actuating means (180) is movable from a first trigger position remote from the grip (192) to a second trigger position close to the grip (192);
  When the first actuating means (180) is in the first trigger position, the closure tube (126) is in the proximal position;
  Said 1 When the actuation means (180) is located in the second trigger position, the closure tube (126) is in the distal position;
  Surgical instruments.   The surgical instrument according to claim 5, wherein
  The first actuating means (180) is movable to a third trigger position between the first trigger position and the second trigger position;
  When the first actuating means (180) is located in the third trigger position, the closure tube (126) is in an intermediate position between the proximal position and the distal position;
  Surgical instruments.   The surgical instrument according to claim 5 or 6,
  The second actuating means (220) is a lever (220) pivotably attached to the handle assembly (300);
  From the first lever position to the second lever position, the lever (220) pulls the proximal end of the suture (81) proximally to form the fully tied knot. Swirled,
  Surgical instruments.   The surgical instrument according to claim 7, wherein
  When the grip (192) is placed on the palm of a user, the handle assembly (300 of the surgical instrument) can be operated with one hand to actuate the trigger (180) and the lever (220). ) Is configured,
  Surgical instruments.   The surgical instrument according to claim 7 or 8,
  The trigger (180) is the first 1 Biased to the trigger position,
  The closure tube (126) is biased to the proximal position;
  The lever (220) 1 Biased to the lever position,
  Surgical instruments.   The surgical instrument according to any one of claims 6 to 9,
  Release buttons (238, 240) protruding from the handle assembly (300);
  Further comprising
  The release buttons (238, 240) can cooperate with the closure tube (126) and the trigger (180);
  When the trigger (180) is in the second trigger position or the third trigger position and the release button (238, 240) is pushed inward toward the handle assembly (300), the trigger (180) moves to the first trigger position;
  Surgical instruments.

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