Surgical needle abstract
A surgical needle is attached to a handle which includes a vibrating
device for inducing vibrations in a prescribed frequency range to
the needle. The needle's vibration helps avoid damage to major blood
vessels and nerves when the needle is pushed through subcutaneous
patient tissue. In one form the needle has provision to grip the
end of a suture, so that the suture may be attached after the needle
is pushed through and emerges out of subcutaneous tissue. In a face-lift
operation the needle may be pushed through a path where support
is desired, then the end of a one-way suture can be attached to
the distal end of the needle, after which the one-way suture can
be retracted so that the one-way suture occupies the same path where
the needle was inserted. The suture attachment can be via a hollow
bore through the needle, with suction applied through the handle,
so that the end of the suture can be drawn into the needle from
the needle's distal end, retaining the suture to the needle when
the needle is retracted from the tissue. After such insertion of
a one-way suture, the suture can be tensioned from the distal end
so as to pull and maintain the desired tension in the skin tissue.
Surgical needle claims
1. A surgical needle apparatus for passing through a patient's
tissue while avoiding or minimizing damage to major blood vessels
and nerves, comprising:
a needle with a proximal end and with a sharp distal end, and
a handle attached to the proximal end of the needle, the handle
having means for inducing vibration in the needle, such vibration
being of a frequency which will cause the needle's distal end to
tend to work its way around major blood vessels and nerves without
substantial damage as the distal end is pushed through the patient's
2. The apparatus of claim 1 wherein the needle includes, at one
of its ends, means for engaging a suture end to enable pulling the
suture through the tissue after the needle has been passed through
3. The apparatus of claim 1 wherein the means for inducing vibration
comprises air-responsive vibration means within the handle, and
including a pneumatic line connected to the handle so as to cause
passage of air through the handle and through the vibration means,
thus causing the needle to vibrate.
4. The apparatus of claim 3 wherein the pneumatic line is a suction
5. The apparatus of claim 3 wherein the vibration means comprises
a rotatable wheel, eccentrically weighted, with blades responsive
to air passage so as to cause rotation of the wheel.
6. The apparatus of claim 3 wherein the vibration means comprises
a vibrating flutter valve through which air is directed by the pneumatic
7. The application of claim 1 wherein said vibration caused by
the means for inducing vibration is in a frequency range well below
8. The apparatus of claim 1 wherein said vibration caused by the
means for inducing vibration is in the frequency range of about
20 to 30 hertz.
9. The apparatus of claim 2 wherein the means for engaging a suture
end comprises the needle being hollow and open at its distal end,
and of a diameter enabling the end of a suture to be drawn into
the needle from the distal end, and including a suction line secured
to the handle and means for causing suction from the suction line
to be applied to the proximal end of the hollow needle so as to
draw in the suture end, thereby holding the suture end to the needle.
10. The apparatus of claim 9 wherein the distal end of the hollow
needle is angled, and wherein only a distal portion of the angled
end is sharp, helping reduce damage to blood vessels and nerves
as the needle is inserted through tissue.
11. The apparatus of claim 9 wherein the means for inducing vibration
comprises air-responsive vibration means within the handle, with
said suction line communicating with the vibration means and include
a selectively openable vent in the handle such that, when the vent
is opened, suction from the suction line causes passage of air through
the handle and through the vibration means, thus causing the needle
to vibrate, and such that when the vent is closed, all suction is
drawn through the hollow needle.
Surgical needle description
BACKGROUND OF THE INVENTION
This invention concerns surgical needles and procedures for their
use. In particular the invention relates to a needle which can be
vibrated to aid in passing through tissue and which, in some embodiments,
has provision for attaching to a suture to pull the suture through
tissue as the needle is retracted.
Application Ser. No. 859887 now U.S. Pat. No. 5931855 discloses
a one-way surgical suture and methods for its use. The sutures have
barbs enabling passage through tissue in one direction, but not
the other, so that wounds can be closed by a pair of such one-way
sutures oriented oppositely on opposed sides of a wound and connected
together, or, as the pending application discloses, by a double
armed suture with barbs in opposite directions, both ends implanted
into opposite sides of the wound. The copending application discloses
several methods for use of such one-way sutures. This invention
is concerned with a surgical needle apparatus particularly useful
with such one-way sutures, and also with a cooperating feature which
helps avoid blood vessels and nerves as the needle is pushed through
the patient's tissue.
The following patents have some relevance to the subject matter
of this invention: U.S. Pat. Nos. 4103689 4356823 4493694
4708717 4730635 4886491 5199943 5254082 5380273
5514086 5484398 5549119 5562609 5562610 5645537.
Most of these patents are concerned with medical devices involving
suction, or ultrasonic vibration, or both. The suction is generally
applied to the medical instrument for the purpose of drawing fragments
of tissue out of the body, often after portions of tissue have been
shattered using ultrasonic energy transmitted from the tip of the
Of the above patents, U.S. Pat. No. 5549119 describes a vibrating
tip catheter or guidewire which is vibrated for the purpose of passing
through tortuous anatomical pathways, the vibration being intended
to enhance the ability of the catheter or guidewire to pass through
the narrow pathways or to cross lesions or stenoses. In that patent
the vibrations can be achieved with a microvibrating motor integral
with the catheter or guidewire, the frequency and amplitude of vibration
being adjustable via an external control device. The instrument
seems primarily concerned with movement through a blood vessel,
particularly for angioplasty and atharectomy.
Medical devices of the prior art have not been effective for the
purposes of the present invention, and have not included a surgical
suturing needle which vibrates at a sub-ultrasonic frequency to
aid in passing the needle through tissue, or a surgical needle which
is hollow, with means for gripping the end of a suture.
SUMMARY OF THE INVENTION
In a principal embodiment of the present invention, a surgical
needle is attached at its base end to a hollow handle having provision
for vibrating the needle. This vibration could be via an internal
electric motor, but in a preferred form the vibration is induced
by a suction-operated device served by a suction line connected
to the handle. When the surgical needle, vibrating at a frequency
well below ultrasonic (usually in very low audible range, e.g. a
range of about 20 to 30 per second) is pushed through subcutaneous
patient tissue, the vibratory force permits the needle to be passed
smoothly through the tissue, avoiding damage to major blood vessels
and nerves. In tendon surgery, the needle tends to slide down the
core of the tendon as it follows the longitudinal fibers of the
One type of suction-operated vibration inducer which can be included
in the handle is a wheel with vanes, caused to rotate by the passage
of air via the suction. The wheel has eccentric weighting, so as
to cause vibration, and the handle is vented appropriately to allow
the suction passage of air at sufficient velocity through the vaned
wheel. Another type of vibratory device can be a flutter valve,
such as a rubber duckbill valve which vibrates as air pulses through.
Once the needle, which may be a lengthy needle in the case of a
face-lift operation, has been passed through the desired path and
its sharp end exposed, the needle has provision for attaching to
a suture, to enable the surgeon to pull the suture through the same
path that has been occupied by the needle. The suture attachment
device could be at either end of the needle, but in a specific embodiment
it is at the distal, sharp end of the needle so that the surgeon
can attach a one-way suture with barbs along its length and retract
the needle by its handle, pulling the one-way suture in a reverse
direction along the same path where the needle was inserted.
One arrangement for retaining the suture end to the needle includes
the use of a hollow needle, with suction applied to the needle from
the proximal end, thus enabling the needle to draw the suture end
firmly into the needle to hold the suture for pulling it back through
the tissue. This procedure is particularly useful in face-lifts,
where a one-way suture is drawn back through the tissue in the permitted
direction, then tension can later be applied to the distal end of
the suture to pull and maintain tension in the skin tissue.
In one embodiment of the invention the tubular needle has an angled
distal end, only the tip portion of which is sharpened. This, in
conjunction with the vibration, helps avoid damage to vessels and
nerves. The needle preferably is capable of disconnection from the
handle and replaceable with a new needle.
The invention also encompasses methods for use of the vibrating
needle, with or without the suction feature for retaining suture
ends to the needle. These methods include the implantation and use
of double-armed sutures having barbs extending in opposite directions
on opposed sides of a midpoint of the suture. By one procedure,
the needle of the invention is inserted through a lengthy path of
subcutaneous tissue, from which it emerges at its distal end, an
end of a double-armed suture is drawn into the hollow needle by
suction from the handle, and the needle is retracted out from the
tissue, drawing the one-way suture into the same path, in the direction
permitted by the barbs. Then the procedure is repeated from the
opposite direction to the same distal emerging point, where the
other end of the suture, with the oppositely-directed barbs, is
pulled through tissue in the opposite direction until the suture
is fully implanted. Tension can then be applied to the tissue by
drawing the double-armed suture tight.
It is among the objects of the invention to improve on surgical
techniques, including face-lifts and plastic surgery, by use of
a surgical needle useful in avoiding damage when passed through
subcutaneous tissue and useful particularly for implanting one-way
sutures. These and other objects, advantages and features of the
invention will be apparent from the following description of preferred
embodiments, considered along with the accompanying drawings.
DESCRIPTION OF THE DRAWINGS
FIG. 1 is a side view partially cut away showing one form of a
surgical needle according to the invention, having a handle with
FIG. 2 is a side view showing a tip end of a hollow needle which
preferably forms a part of the invention.
FIG. 3 is a partially cut away perspective view of a vibrating
needle apparatus of the invention, the cut away in the handle revealing
a vibration generator.
FIG. 3A is a cut away view showing an alternative vibration generator
in the handle.
FIG. 4 is a view showing a profile of a patient and demonstrating
schematically one step in a face-lift operation using a surgical
needle according to principles of the invention, in conjunction
with a one-way suture which is illustrated schematically.
FIG. 5 is a view similar to FIG. 4 showing a further step in the
FIG. 6 is another similar view, showing a subsequent step wherein
the one-way suture is pulled into place in subcutaneous tissue.
FIG. 7 is another similar view, showing another step in the face-lift
procedure wherein the needle is again inserted under the skin.
FIG. 8 is a similar view showing another step in the procedure.
FIG. 9 is another similar view showing the patient in profile and
indicating multiple paths where double-armed one-way sutures have
been inserted using the methods and surgical appliance of the invention.
DESCRIPTION OF PREFERRED EMBODIMENTS
FIG. 1 shows a surgical needle apparatus 10 which includes a suturing
needle 12 and a handle or housing 14 secured to the proximal end
16 of the needle. As noted above, the handle preferably has provision
(not shown) for removal and replacement of the needle 12. The figure
also illustrates a suction line 18 connected to a rear connection
port 20 of the handle, and a vent opening 22 which allows air to
pass through the handle, drawn by the suction in the suction line
The handle 14 can be similar in size and shape to a known aspirator
device sometimes referred to by physicians as a "tonsil sucker".
The vent 22 which may be manually switchable between open and
closed, activates a vibration inducing device 24 within the handle,
so as to provide vibration of a desired frequency and amplitude
in the handle, that vibration being transferred to the needle 12.
The vibration is far below ultrasonic, and may be in the frequency
range of about 20 to 30 hertz, although any frequency that will
cause vibrations effective for the purpose of the invention can
be used. The form of vibratory device 24 shown in FIG. 1 is a flutter
valve, normally closed by the relaxed state of the rubbery material
from which it is made, but causing a fluttering vibration when air
rushes through toward the suction line 18. The valve 24 may be configured
as a duckbill valve, with a normally closed slit 26 which opens
under sufficient force of air, then flutters open and closed repeatedly
as air passes through, somewhat like the function of a duck call
or reed instrument. The frequency and amplitude of vibration will
be proportional to negative pressure of suction.
The needle 12 shown in FIG. 1 is a hollow needle, in one specific
embodiment of the invention. Such a hollow needle may be approximately
the size of an 18 gauge hypodermic needle. FIG. 2 shows a distal
end or tip 28 of the needle, revealing a hollow, open interior 30.
It is preferable that the distal end 28 of the hollow needle be
angled or beveled as shown, and the beveled edge 32 in one preferred
form of the invention is sharpened only in the distal region 34
of the tip. The sharpened portion 34 helps the needle pass through
tissue, but the remaining portion 36 of the angled end, being rounded
and not sharp, helps avoid damage as the vibrating needle pushes
its way around blood vessels, nerves and other internal features
where damage should be avoided.
FIG. 3 shows a modified surgical needle apparatus 10a similar to
the needle 10 of FIG. 1 but with a different vibrator. In FIG. 3
the apparatus 10a is shown with a needle 12 similar to the earlier
embodiment, but with a handle or housing 14a which shows an example
of a different type of vibrating device 42. The vibrator 42 comprises
a vaned wheel or turbine-like device 44 mounted for rotation on
a longitudinal shaft 46 secured via a bearing 48 and struts 49
to the housing 14a. The vaned wheel or turbine 44 is eccentrically
weighted so that a wobble-type of vibration is induced and transmitted
into the handle or housing 14a, in turn transferred to the needle
12. Air drawn through a suction line 18 connected at a back end
50 of the housing is drawn at the appropriate velocity, via a vent
door 22 to produce vibration at the desired frequency. The vent
door 22 can be selectively opened for use of the vibrating feature,
or closed for inducing suction through the hollow needle 12.
Other forms of air-operated vibration inducing mechanisms can be
used. For example, a paddle wheel-type vibrator 42a as shown in
FIG. 3A can be mounted in the housing with an axis 46a transverse
to the length of the housing, and with only one edge of the paddle
wheel exposed to the rushing air, via a partial partition 51 so
that air passes tangentially over the paddle wheel blades. Again,
such a wheel 42a has eccentric weighting, as by a weighted blade
or vane 44a, so as to cause the desired vibration in the handle
and hence in the needle 12.
FIG. 4 shows a step in use of the vibrating suction needle device
10 (or 10a) of the invention. In FIG. 4 the surgeon has inserted
the needle 12 under the surface of the skin in a face-lift patient
52. The needle 12 is shown inserted virtually through its whole
length, up to the distal end of the handle 14. The relatively long
needle 12 has been caused to emerge at a small incision 54 which
has been made for this purpose, and the distal end or tip 28 of
the vibrating suction needle now extends out of the skin by the
ear 56 as shown. The drawing shows a barbed suture 58 having barbs
59 extending in two directions: at the first or proximal side of
a suture midpoint 60 the barbs 59 extend back as shown, so that
the suture in this region can be pulled through tissue in a direction
to the right as seen in FIG. 4 while a distal section of the suture
58 at a distal side of the midpoint 60 has barbs 59 which extend
in the opposite direction, permitting passage through tissue only
to the left as would be viewed in FIG. 4. The term "midpoint"
is not intended to mean necessarily the center of the suture's length,
but simply the location at which the barbs 59 change direction.
In a preferred form of the invention, the suture 58 has a smooth
proximal end 62. Preferably there is also a smooth section 62 at
the opposite end of the suture, at the opposite side of the midpoint
60. The smooth section 62 is designed to be drawn into the hollow
needle 12 with suction applied through the needle via the suction
tube 18 and the handle 14. As discussed above, when the suction
is applied and the suture is inserted, the suture material is closely
drawn into the hollow shank of the needle 12 and is firmly retained
therein, to the extent that the handle 14 and needle 12 can be pulled
back to draw the one-way suture, with the barbs 59 through the
tissue up to the extent of the suture's midpoint 60.
The smooth section 62 on the suture is preferred, especially to
allow the diameter of the needle to be as small as possible. An
alternative less preferable is to have the suture with barbs 59
extending to its proximal end 64 without a smooth section. The
suction applied through the needle 12 can still be sufficient to
retain the suture within the needle for drawing through the tissue,
although the inside diameter of the needle may have to be slightly
If desired for further gripping of the suture, the handle or housing
14 can have an appropriate form of engaging clip (not shown) inside
the housing, near its forward end, to grab the end of the suture
when the suture is to be pulled through the patient's tissue. Such
a clip can then be released by an external lever or button (not
shown) after this operation is complete. The preferred gripping
method is strictly by suction through the hollow needle.
As described above, the vibrating suction needle device 10 (or
10a) of the invention induces a vibration in the needle 12 via a
vibrating device in the handle 14. This facilitates the insertion
of the needle 12 through subcutaneous tissue substantially without
damage to blood vessels, nerves, etc., so that when the needle has
been fully inserted to the position shown in FIG. 4 internal damage
to the patient's tissue is minimal. Needles of similar length are
used routinely to infiltrate tissues for operations under local
anaesthesia ("field blocks").
FIG. 5 shows the procedure of FIG. 4 as carried to a further step.
The proximal end of the suture 58 has been inserted into the open
end of the needle 12 and drawn into the length of the needle via
suction. This effects the gripping of the suture to the point that
it can now be pulled through the tissue, to be placed along the
same path which is shown as occupied by the needle 12 in FIG. 5.
FIG. 5 also shows a series of small incisions 66 which may be made
on either side of the patient's ear 56 as proposed additional sites
for placement of the one-way sutures 58. Each of these can be made
just prior to needle insertion. The small incisions are made at
the exit site of the needle tip to permit the suture to drop into
a subcutaneous plane when both ends have been placed.
FIG. 6 shows the procedure at a further stage, at which the needle
12 has been retracted back out of the patient's tissue and is being
released from the suture 58. FIG. 6 reveals that a proximal end
length 62 of the suture has been pulled out from the skin, this
length essentially being the length of the needle, since this proximal
portion of the suture was engaged by suction within the needle as
the needle was retracted. In a preferred embodiment, this proximal
portion 62 is smooth and non-barbed, as discussed above.
At this point the suture has been pulled through the tissue to
the extent that the barbs 59 lie under the skin and reach to or
essentially to the puncture wound 68 where the needle was first
inserted. The suture 58 is selected and appropriately proportioned
such that the midpoint 60 of the suture, at which the barbs reverse
direction, resides at the small incision 54 and under the skin surface.
The surgeon is now ready to undertake placement of the distal end
of the barbed suture 58 into the tissue.
In FIG. 7 the original proximal end portion 62 of the suture has
been severed by the surgeon, leaving an end 70 beneath the patient's
skin. The surgeon may elect to leave this end of the suture long
until the end of the procedure, should final adjustments be needed.
The surgeon has now inserted the needle 12 using vibrating mode,
through the patient's tissue as shown, through a puncture wound
point 72 to the point that the needle tip 28 has emerged from the
tissue at the small midpoint incision 54. Once the vibrating needle
has been so placed, vibration is turned off, by closing the vent
22 in this preferred form of the device, and suction is applied
so as to draw air through the needle 12.
FIG. 8 shows the procedure of feeding the original distal end portion
62 of the suture into the end of the hollow needle 12 at the midpoint
incision 54. Again, this end portion 62 preferably is smooth and
without barbs. The vibrating suction needle device 10 (or 10a) is
set to the mode in which suction draws air through the needle by
closing the vent 22 so that the device readily pulls the portion
62 of the suture into the shank of the needle and retains it there.
Once the suture end portion 62 has been fully drawn into the needle
12 the surgeon is ready to again retract the needle 12 from the
patient's tissue. At this point (which is not shown in FIG. 9) the
smooth portion 62 of the suture is fully ensconced in the needle,
but the barbed portion 74 of the once-distal portion of the suture
is slack and extends outside the patient's tissue, in a loop.
The surgeon retracts the needle 12 thus pulling the barbed portion
74 of the suture into the tissue, to reside in the path occupied
by the needle in its position shown in FIG. 8. Following this, the
needle is removed from the suture, by turning off suction to the
needle to allow its easy retraction.
FIG. 9 shows the suture 58 as fully installed along a first desired
line of support 77 in the face-lift operation, and with the needle
apparatus 10 removed. The once-distal end 62 of the suture extends
out the back of the line 77 from the rear puncture wound 72 as
shown. At this point traction is applied by the surgeon to tension
the one-way suture 58 thus supporting the tissue at the lower portion
of the line of support 77 via the back or upper end of the suture
with its reversed barbs, leading from the midpoint 54 back to the
rear puncture wound 72. However, this traction can be applied later,
after insertion of the desired number of additional one-way sutures
as indicated in dashed lines at 80 80a, 80b, 80c, 80d, 80e, 80f,
80g, 80h and 80i. The implanted tensioned sutures are left in place.
The above described preferred embodiments are intended to illustrate
the principles of the invention, but not to limit its scope. Other
embodiments and variations to this preferred embodiment will be
apparent to those skilled in the art and may be made without departing
from the spirit and scope of the invention as defined in the following