WO2016111683A1 - Dispositif chirurgical et son procédé d'utilisation - Google Patents

Dispositif chirurgical et son procédé d'utilisation Download PDF

Info

Publication number
WO2016111683A1
WO2016111683A1 PCT/US2015/010460 US2015010460W WO2016111683A1 WO 2016111683 A1 WO2016111683 A1 WO 2016111683A1 US 2015010460 W US2015010460 W US 2015010460W WO 2016111683 A1 WO2016111683 A1 WO 2016111683A1
Authority
WO
WIPO (PCT)
Prior art keywords
surgical device
suture
teeth
jaws
rows
Prior art date
Application number
PCT/US2015/010460
Other languages
English (en)
Inventor
Graham Smith
Original Assignee
Smith & Nephew, 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 Smith & Nephew, Inc. filed Critical Smith & Nephew, Inc.
Priority to PCT/US2015/010460 priority Critical patent/WO2016111683A1/fr
Publication of WO2016111683A1 publication Critical patent/WO2016111683A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0483—Hand-held instruments for holding sutures
    • 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
    • A61B17/2812—Surgical forceps with a single pivotal connection
    • A61B17/282—Jaws
    • A61B2017/2825—Inserts of different material in jaws
    • 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
    • A61B17/2812—Surgical forceps with a single pivotal connection
    • A61B17/282—Jaws
    • A61B2017/2829—Jaws with a removable cover
    • 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

Definitions

  • Arthroscopic surgery is a minimally-invasive surgical procedure during which an interior portion of the human body, such as a knee or shoulder joint, is examined or operated on using an arthroscope.
  • the arthroscope is a type of endoscope or miniature camera that is passed through a cannula which is inserted into the joint through a small incision in the skin to enable a surgeon to view the joint and/or perform a surgical operation without fully opening the joint.
  • the surgical device for grasping both tissue and a suture during arthroscopic surgery.
  • the surgical device includes jaws having retrograde teeth preventing tissue from slipping out of the jaws. When closed, the distal end of the jaws form a suture passage allowing a suture to slide therethrough so that its ends can be retrieved through a cannula and a knot can be tied in the suture.
  • the surgical device has an elongate member including a proximal end terminating at a proximal terminus and a distal end terminating at a distal terminus, and a longitudinal axis extending between the proximal end and the distal end; a frame fixedly mounted at the proximal terminus of the elongate member; first and second jaws disposed at a distal terminus of the elongate member, the first jaw movable relative to the second jaw between an open position and closed position; a suture passage defined at a distal end of the first and second jaws in the closed position, the suture passage being transverse to the longitudinal axis of the surgical device and being sized to enable a suture to slide through the suture passage with the first and second jaws in the closed position; and a plurality of rows of teeth, each extending from opposing surfaces of the first and second jaws, the plurality of rows of teeth positioned between the suture passage and proximal end of the first and second jaw
  • the first jaw may be hingedly attached to the distal end of the elongate member.
  • the surgical device may further include a jaw actuation member pivotally mounted to the frame and the elongate member may include a jaw actuation rod having a proximal and a distal end, the distal end of the jaw actuation rod engaging the first jaw, and the proximal end of the jaw actuation rod mounted to the jaw actuation member.
  • the plurality of rows of teeth may be formed from a material selected from any one of silicon rubber, vinyl or plastic and/or a material having a durometer selected within the range between about 40 to about 50.
  • monofilament suture and an inner diameter of the suture passage may be about 1.0 mm to about 2.0 mm.
  • Examples of the methods described herein may include (a) providing a surgical device according to any preceding claim in an area adjacent soft tissue to be repaired, a suture having been passed through the soft tissue; (b) retaining a portion of the soft tissue between the first jaw and second jaws; (c) moving the retained soft tissue to a desired position and releasing the soft tissue from the first and second jaws; (d) grasping the suture within the suture passage of the surgical device; and (e) pulling the suture away from the soft tissue with the surgical device.
  • the method may further include, prior to step (a), providing an arthroscope in the area adjacent to the soft tissue to be repaired, attaching the plurality of rows of teeth to the opposing surfaces of the first and second jaws, and/or passing the suture through the soft tissue to be repaired with another surgical device different from the surgical device.
  • the method may also include, after step (e), removing the plurality of rows of teeth from the opposing surfaces of the first and second jaws and, after removing the plurality of rows of teeth from the opposing surfaces of the first and second jaws, disposing of the plurality of rows of teeth.
  • the method may also include, after step (e), sliding the suture through the suture passage while tying a knot in the suture.
  • kits including the surgical device, at least one other surgical device different from the first surgical device, and/or at least one other plurality of rows of teeth.
  • the at least one other surgical device may be a suture relay and/or a suture passer.
  • FIG.1b is a detailed illustration of the jaw actuation rod of the surgical device of FIG. 1a.
  • FIG.2a is a detailed illustration of an example of the suture grasper in a closed position
  • FIG.2b is a detailed illustration of an example of the suture grasper in an open position
  • FIG.3a is a detailed illustration of an example of the suture grasper while grasping a suture
  • FIGs.4a-c illustrate examples of the disposable elements of the surgical device
  • FIGs.5a-b illustrate examples of the method of using the surgical device.
  • FIG.2a illustrates an example of the grasping member 40 of FIG.1 in a closed position.
  • the lower jaw 44 of the grasping member 40 extends from the distal end 32 of the elongate member 30.
  • the lower jaw 44 has a proximal end 46, a distal end 48 and an upper surface 50.
  • the upper jaw 42 is shown as hingedly attached to the distal end 32 of the elongate member 30.
  • the upper jaw 42 has a proximal end 52, a distal end 54 and a lower surface 56.
  • the plurality of rows of teeth 60a can be formed from silicone rubbers or other suitable materials, such as vinyl or plastic, having a durometer within the range between about 40 to about 50.
  • the distance between the proximal end 46 and the distal end 48 may be about 9.0 mm to about 14.0 mm.
  • a lower jaw stop 70 is spaced from the most distal row of teeth at the distal end 48 of the lower jaw 44.
  • a plurality of rows downwardly extending teeth 60b having tips 62b and comprising the same materials as upwardly extending teeth 60a extends between the proximal end 52 and the distal end 54 and removably attached to the lower surface 56.
  • An upper jaw stop 72 is spaced from the most distal row of teeth 60b at the distal end 54 of the upper jaw 42. It can be seen in FIG.2b that the height of the both the lower and upper jaw stops 70, 72 are greater than the height of the tips 62a,b as measured from the lower and upper surfaces 50, 56. Additionally, both the lower and upper jaw stops 70, 72 are spaced at greater distance from the most distal row of teeth 60a,b than the distance between each rows of teeth 60a,b.
  • a passage is formed for a suture to be grasped without damage to the suture (see, e.g. Fig.3a), while also allowing the suture to slide through the passage when, for example, a knot is tied in the suture.
  • FIG.2c is a detailed view of the upward extending rows of teeth 60a.
  • Each of the upwardly extending rows of teeth 60a are in retrograde form with a tissue surface 66 sloping distally from the tip 62a towards the lower surface 50.
  • the height Y of each tip may be about 0.3 mm to about 0.5 mm.
  • the upwardly extending rows of teeth 60a are shown as spaced equidistant from each other, other variations in spacing are possible.
  • a mirror configuration may exist for the downwardly extending rows of teeth 60b, or the downwardly extending rows of teeth 60b may be offset from the upwardly extending rows of teeth by any distance.
  • suture 80 loaded in a suture pass 82 created between the most distal rows of teeth 60a,b and the jaw stops 70, 72 when the grasping member 40 is in a closed position.
  • the inner surface of suture pass 82 has a substantially circular shape with a diameter than can be about 1.0 mm to about 2.0 mm, and which is selected to accommodate a #2 monofilament suture, without causing damage thereto. Additionally, the size of suture pass 82 is selected to allow the suture 80 to remain slidable through the suture pass 82 during surgical repair and when tying a knot in the suture after the repair is completed.
  • the tips 62a,b are vertically aligned when the grasping member 40 is closed.
  • the grasping member 40 is shown grasping tissue 100 during a surgical repair. Because the rows of teeth 60a,b are slightly deformable, the tissue can be grasped and pulled in a distal direction without damage to the tissue 100.
  • FIGs.4a-b the disposable elements of the grasping member 40 are illustrated.
  • a disposable set of teeth 60a are shown attached to a jaw inserter 90 prior to being attached to the lower jaw 44.
  • An opening 92 in the lower jaw 44 is configured to receive a jaw mountable portion (shown in FIGs.4c-d) which can be formed integrally with and comprised of the same material as the teeth 60a.
  • the opening 92 may be serrated about its edges or have some other suitable configuration.
  • FIG.4b shows the teeth 60a as mounted to the lower jaw 44.
  • FIG.4c illustrates a disposable set of teeth 60b attached to the jaw inserter 90 prior to being attached to the upper jaw 42.
  • An opening 94 in the upper jaw 42 is configured to receive jaw mountable portion 96 of the teeth 60b.
  • FIG.4d shows the teeth 60b as mounted to the upper jaw 42.
  • the jaw mountable portion 96 could be formed separately from the teeth 60a,b and attachable thereto, and comprised of a different material than the teeth 60a,b. In this case, the teeth 60a,b would still be disposable, while the jaw mountable portion 96 could be used repeatedly with other disposable teeth 60a,b and capable of sterilization.
  • the surgical device 10 is inserted through a cannula 200 and then the cannula 200 is inserted through an incision in a patient’s skin (not shown) to the repair site.
  • the distal end of the surgical device 10 comprising the grasping member 40 is inserted through the cannula under direct visualization of an endoscope (not shown) from a separate cannula that has been previously inserted.
  • the grasping member 40 is inserted until the upper and lower jaws 42, 44 reach, for example, torn rotator cuff tissue 100 through which a suture 80 has been passed.
  • the tissue 100 is then introduced into the space between the upper jaw and the lower jaw (as shown in FIG.3b).
  • the soft tissue 100 is immobilized between the upper and lower jaws 42, 44 and can be moved into a desired position and released.
  • the suture 80 can then grasped by the suture pass 82 and a free end removed through the cannula, as shown in FIG.5b.
  • an arthroscopic knot can be tied in the suture.
  • a kit may be provided that includes an example of the surgical device 10 described herein, one or more disposable teeth 60a,b including a jaw mountable portion 96, a jaw inserter 90, and one or more other surgical devices (for example, a suture relay or a suture passer).
  • one or more disposable teeth 60a,b including a jaw mountable portion 96, a jaw inserter 90, and one or more other surgical devices (for example, a suture relay or a suture passer).

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

Abstract

L'invention concerne un dispositif chirurgical permettant de saisir à la fois un tissu et une suture au cours d'une chirurgie arthroscopique. Le dispositif chirurgical comprend des mâchoires dotées de dents rétrogrades empêchant le tissu de glisser en dehors des mâchoires. Lorsque les mâchoires sont fermées, l'extrémité distale de celles-ci forme un passage pour suture qui permet à une suture de glisser dans celui-ci de sorte que ses extrémités peuvent être extraites par une canule et qu'un noeud peut être fait dans la suture.
PCT/US2015/010460 2015-01-07 2015-01-07 Dispositif chirurgical et son procédé d'utilisation WO2016111683A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/US2015/010460 WO2016111683A1 (fr) 2015-01-07 2015-01-07 Dispositif chirurgical et son procédé d'utilisation

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/US2015/010460 WO2016111683A1 (fr) 2015-01-07 2015-01-07 Dispositif chirurgical et son procédé d'utilisation

Publications (1)

Publication Number Publication Date
WO2016111683A1 true WO2016111683A1 (fr) 2016-07-14

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ID=52446430

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2015/010460 WO2016111683A1 (fr) 2015-01-07 2015-01-07 Dispositif chirurgical et son procédé d'utilisation

Country Status (1)

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WO (1) WO2016111683A1 (fr)

Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3871379A (en) * 1971-08-26 1975-03-18 Henry C N Clarke Laparoscopy instruments and method for suturing and ligation
US5865835A (en) * 1993-07-21 1999-02-02 Lolagne; Fritz Forceps
US6146391A (en) * 1998-07-31 2000-11-14 Transneuronix, Inc. Laparoscopic forceps
US20050240219A1 (en) * 2004-04-22 2005-10-27 Henry Kahle Peripheral vascular occlusion devices
US20070016249A1 (en) * 2005-07-14 2007-01-18 Reznik Alan M Suture device
US20070156172A1 (en) * 2006-01-03 2007-07-05 Alfredo Alvarado Multipurpose knot pusher
US20090131976A1 (en) * 2007-11-16 2009-05-21 Microline Pentax Inc. Fenestrated super atraumatic grasper apparatus
US20130046336A1 (en) * 2011-08-15 2013-02-21 Intuitive Surgical Operations, Inc. Medical instrument with flexible jaw mechanism

Patent Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3871379A (en) * 1971-08-26 1975-03-18 Henry C N Clarke Laparoscopy instruments and method for suturing and ligation
US5865835A (en) * 1993-07-21 1999-02-02 Lolagne; Fritz Forceps
US6146391A (en) * 1998-07-31 2000-11-14 Transneuronix, Inc. Laparoscopic forceps
US20050240219A1 (en) * 2004-04-22 2005-10-27 Henry Kahle Peripheral vascular occlusion devices
US20070016249A1 (en) * 2005-07-14 2007-01-18 Reznik Alan M Suture device
US20070156172A1 (en) * 2006-01-03 2007-07-05 Alfredo Alvarado Multipurpose knot pusher
US20090131976A1 (en) * 2007-11-16 2009-05-21 Microline Pentax Inc. Fenestrated super atraumatic grasper apparatus
US20130046336A1 (en) * 2011-08-15 2013-02-21 Intuitive Surgical Operations, Inc. Medical instrument with flexible jaw mechanism

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