WO1996025885A1 - Laparoscope permettant de realiser une souture - Google Patents

Laparoscope permettant de realiser une souture Download PDF

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Publication number
WO1996025885A1
WO1996025885A1 PCT/US1995/002242 US9502242W WO9625885A1 WO 1996025885 A1 WO1996025885 A1 WO 1996025885A1 US 9502242 W US9502242 W US 9502242W WO 9625885 A1 WO9625885 A1 WO 9625885A1
Authority
WO
WIPO (PCT)
Prior art keywords
needle
assembly
suturing device
jaw member
jaw
Prior art date
Application number
PCT/US1995/002242
Other languages
English (en)
Inventor
Carl R. Della Badia
Carl J. Costello
Original Assignee
Badiaco, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Badiaco, Inc. filed Critical Badiaco, Inc.
Priority to AU20909/95A priority Critical patent/AU2090995A/en
Priority to PCT/US1995/002242 priority patent/WO1996025885A1/fr
Publication of WO1996025885A1 publication Critical patent/WO1996025885A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2948—Sealing means, e.g. for sealing the interior from fluid entry

Definitions

  • the present invention relates to a surgical suturing instrument, particularly for use, for example, in non-open surgery, and more particularly for use, for example, in laparoscopic surgery. More specifically, the present invention provides a suturing device comprising a jaw assembly having first and second jaw members, wherein said first jaw member is provided with a cupped recess having means for securably retaining a needle such that the needle lies within the cupped recess when the jaw members are in a closed position and can be extended away from the first jaw member when the jaw members are in an open position.
  • the jaw assembly also is utilized to grasp and stabilize tissue between the opposed jaw members. In this manner, the suturing device functions both as a needle holder and as a clamping device. In operation and use, the suturing device of ers superior control over both the needle and the tissue being sutured.
  • Non-open surgeries such as arthroscopic surgery and laparoscopic surgery, recently have become widely practiced surgical procedures. Such procedures have gained rapid popularity and generally are preferable over the traditional open surgery which requires cutting large incisions through the skin, muscles and membranes to open and expose the body cavity, thereby necessitating longer hospitalization stays and prolonged recovery periods.
  • small incisions are made into which tubular conduits, such as cannulae and trocars, are inserted and directed to the site of the operable internal organ or tissue.
  • One or more surgical instruments are introduced through the tubular conduits in order to perform the surgical procedure.
  • T h e laparoscopic procedure generally involves creating small incisions through the navel and through the abdominal wall for viewing and operating on internal areas of the body, such as the uterus, ovaries, gall bladder and appendix.
  • a trocar tube is introduced through the navel incision for receiving a camera, magnifying lens or other fiber optic device for viewing the surgery.
  • One or more additional trocar tubes are introduced through incisions in the abdominal wall such that laparoscopic surgical tools can be inserted through the tube(s) for manipulating, cutting and/or suturing an internal organ or tissue.
  • the surgeon can grasp an organ or tissue with one surgical tool and simultaneously cut or suture with another surgical device.
  • a major drawback to non-open surgery is that it requires exceptional motor coordination to grasp and stabilize an organ or tissue with one surgical tool and performing a cutting or suturing procedure on said organ or tissue with a second surgical device, all while viewing a two dimensional video monitor. This disadvantage is particularly acute in performing a laparoscopic suturing procedure.
  • the suturing needle In laparoscopic suturing, thick tissue, such as uterine tissue, is oftentimes encountered. Consequently, the suturing needle must be of a length sufficient to pass through the tissue being sutured. Typically, the length of these needles is greater than the diameter of the single shaft suturing instruments. As a result, the suturing needle must be inserted lengthwise through a trocar.
  • a straight Semm needle holder having opposing jaws at one end is used in the suturing procedure. This type of needle holder essentially is a clamping device which holds the suturing needle lengthwise between opposing jaws such that it can be introduced through a trocar and guided to the incision site.
  • the tissue to be sutured is grasped by a clamping device which has been previously introduced through a second trocar to the incision site.
  • the suturing needle is repositioned so that the needle is held transversely between the opposed jaws of the conventional needle holder and thereafter is pushed into the first layer of tissue. Oftentimes, the needle does not pass completely through the first layer of tissue and difficulty is encountered in finding the needle in the tissue mass.
  • the needle has to be regrasped by the conventional needle holder and pulled through the layer of tissue. The needle again is released, repositioned and regrasped by the needle holder such that it is ready to be passed through the second layer of tissue.
  • U.S. patent 4,493,323 to Albright et al. and U.S. patent 4,621,640 to Mulhollan et al. are representative of prior art suturing instruments for internal suturing without requiring open surgery and are particularly designed for use in arthroscopic surgery, specifically knee surgery. However, such suturing devices require the needle to be continuously manipulated as it progresses through the tissue layer being sutured. Albright et al.
  • Mulhollan et al. discloses a mechanical needle carrier for carrying, gripping and manipulating a suturing needle within the body, particularly a knee joint. The Mulhollan device is inserted through a cannula or tube wherein the needle is guided to the knee tissue.
  • the needle carrying device is positioned such that the needle end can puncture the tissue and the needle thereafter is released from the carrying device.
  • the entire instrument must be withdrawn from the cannula in order to allow insertion of another instrument which pulls the needle through the conduit so that the suture can be tied and set.
  • Mulhollan renders better manipulative control over the surgical needle, it is incapable of providing control over the tissue in concert with the needle.
  • a suturing thread originating from a spool mechanism positioned at the proximal end of the tubular shaft, is passed through said shaft and extends longitudinally through the hollow needle.
  • the instrument drives the needle through the tissue to be sutured while clamping the tissue between the upper and lower jaws.
  • the Caspari device does not provide a means of releasing the needle from the needle-holding device after its passage through the tissue.
  • the surgeon is restricted to a double-pass type of stitch: upon closing of the jaws and the resultant tissue puncture, the suture is passed through the hollow needle, hooked by the jaw opposing the needle- holding jaw, and then pulled back through the hole made by its first pass through the tissue.
  • the needle is integral with the needle holding device and must be a hollow needle.
  • the Caspari needle holder more easily lends itself to breakage due to its intricate design and many parts. Further, the device more readily can become clogged with blood and debris, thereby rendering it ineffective, and is difficult to clean and maintain.
  • the Caspari instrument is not suitable for and cannot be adapted for use in a laparoscopic procedure where thick layers of tissue require suturing for several reasons. First, the permanently affixed hollow needle is of insufficient length and as such cannot pass through the thick tissue encountered in laparoscopic surgery. Second, the design of the Caspari device would not allow substitution of a longer suturing needle suitable for laparoscopic surgery because such a needle would prevent the jaw assembly from closing, thereby prohibiting the introduction of the instrument into a laparoscopic trocar.
  • a suturing instrument capable of being introduced through a caunula, trocar or similar conduit to the incision site, which provides superior control over both the suturing needle and the tissue to be sutured.
  • a device should provide means whereby a surgeon is afforded with the flexibility of choosing different types of surgical needles, rather than restricting the surgeon to a specific, built-in needle.
  • the device should further provide means for grasping, stabilizing and controlling the tissue being sutured.
  • the suturing device should be capable of securably retaining a surgical device whereby the surgeon is not required to positively grasp the needle (thereby risking loss of needle control) and the device also should be capable of releasing the surgical needle once the needle has pierced the tissue layer.
  • the suturing device should be of a design which is easy to use, inexpensive to manufacture and lends itself to easy cleaning and maintenance.
  • the suturing device of the present invention comprises a tubular elongated shaft having a handle assembly at the proximal end, thereby providing control of said device, and a jaw element at the distal end, said jaw element being fashioned to releasably mount a suturing needle.
  • the jaw element at the distal end of the device not only provides means to retain the needle but also functions as a clamping member for grasping and stabilizing the tissue to be sutured.
  • the device offers superior positioning means of the suturing needle relative to the tissue being sutured.
  • the device may be in the form of a single use instrument with the jaw element being incorporated in a disposable head.
  • the use of the suturing device of the present invention offers a surgeon superior control over both the needle and the tissue to be sutured and the choice of various standard surgical needles.
  • the device enables the surgeon to introduce the device through a laparoscopic trocar, cannula or similar conduit by providing means whereby the suturing needle lies within a cupped recess in the upper jaw when the opposed jaws are closed.
  • the jaws are opened and suturing needle is deployed from the cupped recess into a protracted, suturing position.
  • the open jaw members grasp and stabilize the tissue to be sutured, the needle punctures and passes through the tissue and is then released from suturing device for further suturing manipulations.
  • Figure 1 is an elevational view the suturing device of the present invention.
  • Figure la is an elevational view of an alternate embodiment of the suturing device of the present invention.
  • Figure 2 is an elevational view illustrating the jaw assembly when the jaws are opened and the needle is deployed from the first jaw member.
  • Figure 3 is a detailed elevational view of the jaw assembly and, in a partial cross section, the needle and wheel assembly.
  • Figure 4a is a perspective view of the wheel assembly.
  • Figure 4b is an elevational cross section view of the wheel assembly and an alternate embodiment of the needle mount.
  • Figure 4c is a perspective view of an alternate embodiment of the wheel assembly having a spring element.
  • Figure 5 is an elevational view of an alternative embodiment of the suturing device having a rotating collar.
  • Figure 6 shows an alternative embodiment of the suturing device having the jaw assembly in the form of a disposable head.
  • Figure 7 shows an alternate embodiment of the jaw assembly.
  • Figure 8 shows an alternate embodiment of the jaw assembly.
  • Figure 9 illustrates operation of the suturing device.
  • Figure 10 illustrates operation of the suturing device.
  • the present invention relates to surgical suturing devices, particularly for use, for example, in operations deep within body cavities without requiring open surgery, and more particularly for use, for example, in laparoscopic surgery.
  • the suturing device provides a needle holder which offers a surgeon superior manipulative control over both the needle and the tissue to be sutured.
  • the suturing device 1 hereinafter sometimes referred to as the needle holder, comprises an elongated shaft 2 having a handle assembly 10 at one end and a jaw assembly 20 at the distal end thereof, said handle assembly 10 being connected to said shaft 2.
  • Handle assembly 10 comprises a stationary handle 10a and an actuator handle 10b pivotally mounted to stationary handle 10a on a pivot pin 10c.
  • the stationary handle 10a is rigidly attached to said shaft 2 to ensure manipulative control over the entire suturing device assembly.
  • the suturing device 1 further comprises actuating means connecting the handle assembly to the jaw assembly.
  • the actuating means is in the form of an actuator rod 4 extending longitudinally within the length of said shaft.
  • the actuator rod 4 is pivotally joined to the actuator handle 10b by pivot means 4a, thereby linking the actuator handle 10a to said jaw element 20.
  • the stationary and actuator handle members and the elongated tube terminating at a distal end into the jaw element are structurally similar to conventional grasping microsurgical instruments commonly associated with non-open surgery.
  • the handle assembly 10 provides a grip assembly that may be comfortably held and operated the surgeon.
  • the elongated shaft 2 is shown in Figure 1 as being substantially cylindrical and having substantially equal diameters at both the proximal and distal ends thereof, it is to be understood that the configuration of the shaft can be fashioned in any form.
  • the proximal end of the shaft can be tapered such that it terminates in a diameter slightly larger than the diameter of actuator rod 4.
  • the proximal end of shaft 2 can be fitted with a washer, gasket, o-ring or similar element in order to seal the tubular shaft 2 around said actuator rod 4, thereby preventing air from escaping through the shaft.
  • the suturing device of the present invention further comprises a connecting coupler 3 positioned between and joining the handle assembly 10 and elongated shaft 2.
  • Connectjng coupler 3 comprises a tubular shaft 3a having sealing element 3b at the proximal end thereof in order to seal said shaft 3a about said actuator rod 4.
  • the distal end of the connecting coupler 3 may be securely joined to the elongated shaft 2 by any means known in the art.
  • the connecting coupler 3 may be permanently affixed to shaft 2, such as by soldering, welding and the like.
  • the connecting coupler 3 is joined to said shaft 2 by means of a fitting for securably mating said coupler to said shaft.
  • Such fittings are well known in the art and include, for example, snap-type fittings, screw-type fittings and the like.
  • Stationary handle 10a of the handle assembly is rigidly affixed to said connecting coupler 3 as shown in Figure la.
  • Jaw assembly 20 comprises a first or upper jaw member 21 pivotally connected to a second or lower jaw member 22.
  • second or lower jaw member 22 is stationary, wherein first or upper jaw member 21 is pivotally connected to said lower jaw member by means of hinge element 21a.
  • Actuator rod 4 is pivotally connected at its distal end to the pivotal upper jaw member 21 at actuator pivot pin 21b.
  • the first or upper jaw member 21 is provided with a cupped recess or hollow cavity 23 as shown in Figure 3.
  • a wheel assembly 24 is mounted on a pin axle 25.
  • Wheel assembly 24 is rotatably mounted on said pin axle such that the pin axle is parallel to the longitudinal plane of said jaw and said shaft, as shown in Figures 3, 4a and 4b.
  • Wheel assembly 24 comprises a shoulder stop 24a, a needle mount 26 and optionally a suture chase 26a which may be in the form of a groove or channel on the circumference of said wheel assembly.
  • Needle mount 26 is provided at a peripheral position on said wheel, in order to hold and secure a surgical needle 5.
  • Needle mount 26 may be fashioned in any manner known in the art capable of holding and securing a surgical needle.
  • the needle mount 26 may be a simple aperture designed to provide a tight and firm fit when the end of surgical needle 5 is inserted therein.
  • the needle mount 26 may be in the form of an open notch on the wheel periphery designed so that the needle can be clipped and retained therein.
  • the needle mount 26 further comprises a tube 26b which is positioned and secured within the wheel assembly such that the end of a surgical needle can be inserted and retained therein. The tube may be cut lengthwise in order to enable the suturing thread to be drawn through the suture chase.
  • the wheel assembly is configured such that when the surgical needle is inserted in needle mount 26, rotation of the wheel in one direction will position the needle lengthwise in a plane parallel to the upper jaw, thereby enabling the needle to lie within said cupped recess. Rotation of said wheel in the opposite direction causes the needle to extend away from the pivotal upper jaw member 21 and outside of the cupped recess.
  • a wheel limit 27, in the form of a node or similar protuberance, is provided on the inner surface of upper jaw member 21 such that it extends into said recess 23 in order to restrict the rotation of wheel assembly 24 upon contact with shoulder stop 24a.
  • wheel limit 27 is situated directly above pin axle
  • a spring element 28 may be provided on pin axle 25 and connected to the wheel assembly in order to impose a rotating bias upon said wheel. In this manner, when the jaw members are opened, the spring action causes the wheel to rotate about 90°, thereby biasing the needle 5 in a protracted and deployed position.
  • wheel limit 27 and shoulder stop 24a can be eliminated.
  • a suturing thread 6 is affixed to the surgical needle 5 in a manner known in the surgical arts. After the needle has been securably attached to the needle mount 26, the free end of the suturing thread 6 is drawn through the suture chase 26a, alongside the upper exterior surface of pivotal upper jaw element 21 and the exterior surface of the elongated shaft 2 such that the free end is positioned near the handle assembly 10.
  • the elongated shaft 2 is provided with a longitudinal groove or channel 7 along the upper surface thereof such that the suturing thread 6 may lie within said longitudinal groove.
  • the needle holder of the present invention can be used with a variety of surgical needles, including straight and various curvature needles of different sizes.
  • Stationary lower jaw 22 is provided with a needle notch 22a as shown in Figure 2, which may be in the form of an aperture, slot or similar opening within the distal end of said lower jaw. Said notch 22a enables upper jaw member 21 to close upon the lower jaw member 22 when the needle 5 is deployed. In this manner, as shown in Figure 2, any conventional surgical needle can be inserted in the needle mount
  • First and second jaw members 21 and 22 may be fashioned in any manner to provide suitable clamping means as illustrated in Figures 2, 7 and 8. Either of both of said jaw members may be straight, bent at an angle or hooked. Preferably, the upper jaw member is straight and the lower jaw member is either straight or bent upward as shown in Figures 7 and 8. Additionally, the gripping surfaces of either or both of said jaw members may be smooth or may be knurled to enhance grasping and stabilizing the tissue. Preferably, the first and second jaw members have knurled gripping surfaces.
  • the suturing device of the present invention may be further adapted to provide a means to control and facilitate radial rotation of the jaw element 20.
  • a rotating collar 8 is installed on the elongated shaft 2 and rotatably joined to connecting coupler 3 by means well known in the art.
  • the rotating collar 8 preferably comprises a knurled collar or other suitable means which both joins the proximal end of said shaft to the handle assembly and also radially rotates the shaft with respect to said handle assembly 10.
  • the surgeon can rotate the shaft with the other hand by gripping and rotating said collar in a clockwise or counter ⁇ clockwise direction.
  • the jaw element 20 is rotated at the distal end of the shaft.
  • the laparoscopic needle holder of the present invention can be either a multiple use instrument, as described hereinabove, or in an alternative embodiment, can be a disposable, single use instrument.
  • the suturing device is provided with a joint member 9 located at the distal end of the shaft.
  • Joint member 9 connects the elongated shaft 2 to a disposable jaw element 200, sometimes hereinafter referred to as a disposable head.
  • the joint member comprises a fitting for securably mating the disposable head with the shaft 2.
  • fittings are well known in the art and include snap-type fittings, screw-type fittings and the like.
  • joint member 9 is fashioned to provide a snap-on fitting, wherein the disposable jaw element 200 is pushed axially into the fitting. In this manner, after completion of the suturing operation, the disposable head may by pulled off the shaft and discarded.
  • the suturing device 1 now in the closed position, is introduced into a trocar or similar conduit 30 and guided to the operative site 40 of tissue to be sutured.
  • a clamping device 50 is inserted into a second trocar (not shown) and guided to the operative site near the suturing device of the present invention.
  • the actuator handle 10b is manipulated thereby causing the upper jaw 21 to open away from lower jaw 22.
  • the proximal free end of the suturing thread 6 is pulled taut thereby effecting the surgical needle 5 in needle mount 26 to be rotated about wheel assembly 24 such that the needle is in a fully protracted position, as shown in Figure 9.
  • the tissue 40 to be sutured is positioned between opposed jaw members 21 and 22 and upper jaw member 21 is closed upon lower jaw 22, thereby forcing needle 5 through the tissue 40 and through needle notch 22a, as shown in Figure 10.
  • the sutured tissue remains gripped between the jaws of the device after being pierced by the needle, and remains under the control of the surgeon, thereby facilitating further tissue manipulations.
  • the clamping member 50 thereafter grasps the needle 5, thereby releasing the needle from the needle mount 26 and the needle and suturing thread are pulled through the tissue.
  • the needle holder 1 and clamping device 50 are withdrawn from the trocar, an extracorporeal knot is tied and pushed down the trocar to the sutured site.
  • the needle, held by clamping device 50 may be re-inserted into needle mount 26 of needle holder 1.
  • the needle holder then may be guided to next site to be sutured and a second tissue-piercing procedure can be performed, identical to the first operation.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

Le dispostif chirurgical pour effectuer des sutures de la présente invention a un arbre allongé tubulaire (2) se terminant par un système de mâchoire (20) à l'extrémité distale et par un système de poignée (10) à l'extrémité proximale. Le système de mâchoire comprend un premier élément (21) de mâchoire capable de pivoter par rapport à un second élément (22) de mâchoire. Une tige d'actionnement (4) disposée longitudinalement à l'intérieur dudit arbre est reliée en pivotement par son extrémité distale audit système de mâchoire. Le côté inférieur du premier élément de mâchoire a un creux concave (23) contenant un dispositif (24) à roue. Le dispositif à roue a un support (26) pour une aiguille permettant d'y fixer une aiguille (5) et il est conçu pour que l'aiguille se trouve à l'intérieur du creux concave lorsque les éléments de mâchoire sont en position de fermeture et il peut se mettre dans une position où l'aiguille fait saillie hors du premier élément de mâchoire quand les éléments de mâchoire sont en position d'ouverture.
PCT/US1995/002242 1995-02-23 1995-02-23 Laparoscope permettant de realiser une souture WO1996025885A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
AU20909/95A AU2090995A (en) 1995-02-23 1995-02-23 Laparoscopic suturing device
PCT/US1995/002242 WO1996025885A1 (fr) 1995-02-23 1995-02-23 Laparoscope permettant de realiser une souture

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/US1995/002242 WO1996025885A1 (fr) 1995-02-23 1995-02-23 Laparoscope permettant de realiser une souture

Publications (1)

Publication Number Publication Date
WO1996025885A1 true WO1996025885A1 (fr) 1996-08-29

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US1995/002242 WO1996025885A1 (fr) 1995-02-23 1995-02-23 Laparoscope permettant de realiser une souture

Country Status (2)

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AU (1) AU2090995A (fr)
WO (1) WO1996025885A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2018138722A1 (fr) * 2017-01-24 2018-08-02 Elad Rash Instrument de passage de suture

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3946740A (en) * 1974-10-15 1976-03-30 Bassett John W Suturing device
US5281235A (en) * 1992-02-21 1994-01-25 Habley Medical Technology Corporation Needle manipulator

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3946740A (en) * 1974-10-15 1976-03-30 Bassett John W Suturing device
US5281235A (en) * 1992-02-21 1994-01-25 Habley Medical Technology Corporation Needle manipulator

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2018138722A1 (fr) * 2017-01-24 2018-08-02 Elad Rash Instrument de passage de suture
US11364025B2 (en) 2017-01-24 2022-06-21 Elad Rash Suture passer

Also Published As

Publication number Publication date
AU2090995A (en) 1996-09-11

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