Surgical suture abstract
The present invention is directed to a surgical suture instrument
specifically designed for suturing body tissues in enclosed surgical
operations. The instrument includes a casing with a slot or housing
a suture needle. The needle includes a first puncture end and a
second manipulation end. The needle is pivotally positioned on an
axis within the casing, such that the puncture end may be exposed
or retracted as needed. The casing also includes equipment to manipulate
the needle within the casing.
Surgical suture claims
What is claimed is:
1. A surgical suture instrument, which comprises:
a) a shaft;
b) a suture needle having a tapered portion and a base portion,
said base portion extending from the shaft and being generally longitudinally
fixed relative thereto; and
c) means disposed on the shaft for shielding the tapered end portion,
whereby the shielding means and the tapered end portion are relatively
positionable from a first orientation to shield the tapered end
portion to a second orientation to expose the tapered end portion
such that said needle base portion remains generally radially fixed
relative to the shield means during such relative positioning from
said first orientation to said second orientation.
2. A surgical suture instrument according to claim 1 wherein said
needle is curved.
3. A surgical suture instrument according to claim 2 wherein said
needle is C-shaped.
4. A surgical suture instrument according to claim 1 wherein said
needle is pivotable.
5. A surgical suture instrument according to claim 1 wherein said
needle is oriented with said puncture end portion directed toward
said proximal end of said shaft.
6. A surgical suture instrument, comprising:
a) an elongated housing defining an opening;
b) a suture needle connected to said elongated housing and having
a puncture end and a manipulation end, said needle being movable
along an arcuate path from a first position to a second position,
wherein when in the second position the needle is connected to the
elongated housing and the puncture end is directed toward a proximal
end of the elongated housing and is capable of piercing body tissue
in such position;
c) an actuator positioned within the elongated housing and longitudinally
slidable in a distal direction to move the needle along such arcuate
path from said first position to said second position; and
d) means disposed on the housing for shielding the puncture end
whereby the shielding means and the puncture end are relatively
positionable from a first orientation to shield the puncture end
to a second orientation to expose the puncture end such that the
needle manipulation end remains generally radially fixed relative
to the shield means during such relative positioning from said first
orientation to said second orientation.
7. A surgical suture instrument according to claim 6 wherein said
suture needle is pivotably connected to said elongated housing.
8. A surgical suture instrument according to claim 6 wherein said
suture needle includes a suture opening formed at said puncture
9. A surgical suture instrument according to claim 6 further comprising
a finger grip portion extending from said elongated housing adjacent
a proximal end portion thereof.
10. A method of closing trocar puncture wounds, comprising the
a) positioning a surgical suturing instrument at a suture site,
the surgical suturing instrument including a shaft, a suture needle
having a tapered portion and a base portion and an opening for receiving
suture material, said base portion extending from the shaft and
being longitudinally fixed relative thereto;
b) inserting the surgical instrument into the wound to be sutured;
c) retracting the surgical instrument toward the wound opening
to urge the tapered portion of the needle to penetrate the body
tissue such that the needle exits the tissue surrounding the wound
and exposes the opening in the suture needle;
d) inserting a suture material through the opening in the suture
e) reinserting the instrument into the wound opening to be sutured;
f) rotating the instrument approximately 180.degree.;
g) retracting the surgical instrument from the wound to urge the
tapered portion of the needle to penetrate the body tissue such
that the needle exits the tissue surrounding the wound and exposes
the opening in the suture needle;
h) removing the instrument from the wound; and
i) tying off the suture material to form a suture knot.
Surgical suture description
FIELD OF THE INVENTION
The present invention relates generally to surgical instruments.
The present invention is specifically directed to a suture instrument
for suturing tissue at a surgical site having limited dimensions.
DESCRIPTION OF THE PRIOR ART
For purposes of the present specification, the term "surgery"
applies to a medical operation involving an incision to subcutaneous
body tissue. Therefore, the surgical incision includes cutting the
patient's skin, the fascia, i.e., the tough fibrous tissue which
envelopes the body beneath the skin, and/or the peritoneum, i.e.,
the internal layer of thin connective tissue that lines the abdominal
cavity and covers most of the viscera contained therein. As used
herein, the term "patient" is directed toward humans,
but can also include animals.
Surgical procedures can be "open" or "closed."
The term "open" surgery usually describes a surgical procedure
in which the surgeon accesses the surgical site by making a relatively
large incision in the patient's body. For example, laparoscopic
surgery involves use of a laparoscope, an illuminated optical instrument
for examining internal organs. In such surgery, access must be gained
to the desired body cavity. For "open" access, a relatively
large incision is made at the umbilicus, the fascia is visualized,
sutures are placed, and the peritoneum is opened under direct vision
allowing a blunt trocar or port to be placed in the incision site.
The trocar can also be fixed in position by inflatable balloons
or threaded sleeves rather than suture. The trocar has a system
of channels to allow the passage of various tools and carbon dioxide
used to expand the abdominal cavity, i.e., "pneumoperitoneum,"
to provide a working space and to provide a sufficient opening to
view the working space by a laparoscope.
Alternatively, for "closed" access, a small incision
is made and a Verres needle inserted. A Verres needle is a special
needle having a spring-loaded safety tip that is designed to pierce
skin, fat, fascia, and the peritoneum, without causing unwanted
damage to the internal visceral organs. Carbon dioxide can then
be insufflated to provide the protective pneumoperitoneum, which
allows a trocar to be safely inserted. This trocar can be of the
sharp pointed variety, well known to the art, or it may have a safety
spring-loaded shield to protect the viscera.
The surgeon places the laparoscope through the trocar and attaches
it to the camera to display the internal view on a television monitor.
Once a scope is in place, other trocars or ports can be safely inserted
under direct laparoscopic view at different locations to act as
channels for scopes and instruments.
For example, in laparoscopic surgery directed to the gallbladder,
ports, typically 10-11 mm in size, are placed at the umbilicus and
in the epigastric region high in the mid-line just under the rib
cage. Smaller ports (5 mm) are placed as necessary for additional
instruments to accomplish the procedure. For other procedures such
as appendectomies, hysterectomies, gastric, colonic or other surgeries,
several ports, typically 12 mm in size, may be placed at various
At the end of the procedure, the instruments and trocars are removed.
If the umbilical port was placed in "open" fashion, the
surgeon may have adequate room to manipulate the fascia in order
to close the incision with sutures. If, however, the umbilical or
other ports were placed in "closed" fashion, the skin
and fascial incisions are both relatively small. There is no extra
room to manipulate the fascia in order to place a closing suture,
and efforts to do so are often rudimentary at best and often simply
abandoned to the possible detriment of the patient.
SUMMARY OF THE INVENTION
It is therefore an object of the present invention to provide a
surgical suture instrument, which can place a stitch in an incision
in a restricted or "closed" surgical site.
This object is accomplished by the presently claimed invention,
which is a surgical suture device comprising a casing with a slot
for housing a suture needle. The needle has a puncture end and a
manipulation end and is pivotally positioned within the slot such
that the puncture end of the needle may be exposed or retracted
within the casing. The surgical suture instrument also includes
a means to manipulate the needle within the casing. Preferably,
the needle is manipulated by companion manipulation rods, which
are slidably positioned within channels in the casing. The manipulation
rods have finger-activated ends and needle manipulation ends.
The instrument of the present invention simplifies surgical suturing
processes, especially in "closed" situations, by providing
a device for suturing body tissue in areas where the incision opening
The present invention advantageously provides a simple instrument,
which is easy to assemble or disassemble, can be readily sterilized
and comprises few working parts. The instrument can also be conveniently
formed of disposable materials. The casing also advantageously serves
as an obturator to occlude the fascial and skin openings, to retain
pneumoperitoneum and thus maintain direct laparoscopic vision for
safe operation of the instrument. Although the instrument is specifically
designed for laparoscopic surgery, it may also be used for other
surgical procedures, including endoscopic surgical procedures such
as arthroscopy, gastroentroscopy, and laryngobronchoscopy.
BRIEF DESCRIPTION OF THE DRAWINGS
In the drawings:
FIG. 1 is a perspective view of the surgical suture instrument
of the present invention.
FIG. 2 is a side plan view of the surgical suture instrument of
the present invention.
FIG. 2a is a cross-sectional view of the surgical suture instrument
of FIG. 2 taken along lines 2a--2a of FIG. 2.
FIG. 2b is a cross-sectional view of the surgical suture instrument
of FIG. 2 taken along lines 2b--2b of FIG. 2.
FIG. 2c is a cross-sectional view of the surgical suture instrument
of FIG. 2 taken along lines 2c--2c of FIG. 2.
FIG. 2d is a cross-sectional view of the surgical suture instrument
of FIG. 2 taken along lines 2d--2d.
FIG. 3 is a cross-sectional view of the surgical suture instrument
of FIG. 2 taken along lines 3--3 of FIG. 2.
FIG. 4 is a side view of the suture needle of the present invention.
FIG. 4a is a cross-sectional view of the suture needle of FIG.
4 taken along lines 4a--4a.
FIG. 4b is a cross-sectional view of the suture needle of FIG.
4 taken along lines 4b--4b.
FIG. 4c is a cross-sectional view of the suture needle of FIG.
4 taken along lines 4c--4c.
FIG. 5 is a top view of the cap of the instrument of FIG. 1.
FIG. 6 is a partially exploded side view of the surgical suture
instrument of the present invention.
FIG. 7 is a side view of the surgical suture instrument of the
present invention illustrating the needle in retracted position.
FIG. 8 is a side view of a needle manipulation rod of the present
FIG. 8a is a cross-sectional view of the needle manipulation rod
of FIG. 8 taken along lines 8a--8a.
FIG. 8b is a cross-sectional view of the needle manipulation rod
of FIG. 8 taken along lines 8b--8b.
FIG. 9 is a front view of a needle manipulation rod of the present
FIG. 9a is a cross-sectional view of the needle manipulation rod
of FIG. 9 taken along 9a--9a.
DETAILED DESCRIPTION OF THE DRAWINGS
Referring now to the drawings, in which like reference numerals
refer to similar embodiments, reference is initially made to FIG.
1 which illustrates the surgical suture instrument of the present
invention, at reference numeral 10.
The instrument 10 includes a generally tubular-shaped casing 12
of a size and configuration suitable for placement in a body opening.
For purposes of the present invention, the term "body opening"
is intended to include both surgically-manipulated and natural or
non-surgically manipulated openings in a body cavity of a patient.
Aside from its primary purpose as a suture instrument, the tubular
shape of the casing also serves as an obturator to occlude the body
opening. The blockage prevents the escape of any gases and enables
the body opening to retain the pneumoperitoneum and to maintain
direct laparoscopic vision.
The casing 12 can be made of any material known to the art and
suitable for surgical applications. For example, the casing 12 may
be formed of a material designed for re-use, such as stainless steel.
The casing 12 can also be designed for single use and made of disposable
plastics or aluminum.
Referring now to FIG. 2 the casing 12 is preferably formed of
two symmetrical pieces 14 16 which are joined together by pins,
screws or the like, identified at reference numeral 18. In the case
of a disposable surgical instrument 10 the pins 18 may be permanently
positioned such that the pieces 14 16 are not capable of separating.
If a re-usable instrument is contemplated, the pins 18 will preferably
be in the form of screws in order to allow easy separation of the
pieces 14 16 for cleaning, sterilization and repairs.
FIG. 2 illustrates pieces 14 16 in the casing 12 which are formed
to provide a pocket 19 far slidably receiving a surgical needle
22. A second pocket 21 on the opposite side of the casing 12 is
provided to allow complete manipulation of the needle 22 as will
be described in more detail later in the specification.
The casing 12 may also be characterized by a cut-away portion 20
as illustrated on FIG. 7. The cut-away portion 20 is adjacent the
surgical suture needle 22 and is designed to provide a space for
body tissue between the needle 22 and the shaft of the casing 12
in order to give the surgeon some "traction" to expose
a suture opening 23 in the needle.
Cap and Coupler
The casing 12 also preferably includes a collar 24 as illustrated
in FIGS. 1 and 6 for positioning an instrument cap 26 onto the surgical
instrument 10. The collar 24 is designed to releasably mount a connecting
coupler 28 onto the casing 12. The coupler 28 is provided with internal
threads 30 which are designed to cooperate with external threads
32 on the cap 26. The assembling coupler 28 is provided to connect
the cap 26 to the casing 12. The collar 24 is integrated with the
casing 12 to maintain the cap 26 in position on the casing 12. Preferably,
the casing 12 may be provided with a positioning button 25 on the
shaft of the casing 12 above the collar 24 as illustrated in FIG.
6 to coact with a channel 27 illustrated in phantom in FIG. 6
to properly position the cap 26 on the casing 12.
As illustrated in FIG. 1 the cap 26 is preferably provided with
finger grips 26a, 26b to assist the surgeon in manipulating the
instrument 10. The finger grips 26a or 26b may be provided with
a marker 31 e.g., a notice or other marking on one of the finger
grips, to identify the position of the cut-away portion 20 and the
needle 22 when the casing 12 is within a body opening.
Referring now to FIGS. 1 and 3 there is illustrated the suture
needle 22 of the instrument of the present invention. Preferably,
the suture needle 22 is designed for single use and is therefore
disposable. The needle 22 may be made of any material known to the
art for use with surgical needles. Stainless steel is a preferred
material, especially for reusable needles. However, disposable needles
may be made of other surgical steels as tarnishing is not a problem
with disposable needles. The suture needle 22 is also preferably
designed in a bowed configuration, although other configurations,
known to the art for surgical needles, are contemplated. The suture
needle 22 is characterized by a suture opening 23 for positioning
suture material. The suture opening 23 is preferably located near
the puncture end 26 of the surgical needle 22. As illustrated in
FIGS. 4a, 4b and 4c, the width of the needle 22 increases as the
from the puncture end 36 to the needle connection end 38 opposite
the puncture end 36.
The needle connection end 38 is characterized by a notch 40 which
engages with an axle 42 in the casing 12 of the assembled instrument
10 to allow the suture needle 22 to pivotally rotate about the axle
42. As illustrated in the figures, the axle 42 may serve a dual
purpose of providing an axle for the suture needle 22 and providing
an additional pin, e g., pins 18 for securing the pieces 14 and
16 of the casing 12. The suture needle 22 can pivotally rotate such
that the puncture end 36 is exposed, as illustrated in FIGS. 1 and
3 or the puncture end 36 can be retracted within the casing 12
as illustrated in FIG. 7. The pocket 21 in the casing 12 is provided
to allow full mobility to the needle 22. In either the retracted
or extended position, the needle connection end 38 extends into
the pocket 21 as illustrated in FIG. 7 and the rounded surface
44 remains flush with the surface of the casing 12.
The needle connection end 38 is further defined by an internal
edge 43 culminating at surface 44 that is used for rotating the
suture needle 22. As illustrated in FIGS. 3 and 4 the edge 43 is
configured in a substantially straight-line pattern, the purpose
of which will be explained later.
Needle Manipulation Rods
Positioned within the casing 12 are two parallel disposed channels
50 52 which may be of like size and length. The channels 50 52
are designed to retain needle manipulation rods 54 56 which are
illustrated in FIGS. 8 and 9. Referring to FIG. 5 the cap 26 is
likewise provided with two channels 50a, 52a which align with the
channels 50 52 respectively when the cap 26 is placed in position
on the casing 12.
As illustrated in FIG. 1 the needle manipulation rod 54 is defined
by a finger-activated end 58 which extends from the channel 50.
Likewise the needle manipulation rod 56 is defined by a finger-activated
end 60 protruding from channel 52a.
FIGS. 8 and 9 illustrate one of the manipulation rods, i. e., manipulation
rod 54. The manipulation rods 54 56 are further defined by a body
62 which is preferably square. It is within the scope of the present
invention to provide a body 62 of any shape. However a rounded
shape is not desired as it will allow the manipulation rods 54
56 to spin within the channels 50 52.
The lower end of the body 62 is defined by a slotted portion 64.
The slotted portion 64 provides a chamber 66 for receiving the needle
22 when the needle is in the retracted position as illustrated in
FIG. 7. It is within the scope of the present invention to provide
chambers 66 of the same size in each manipulation rod 54 56. Alternatively,
the chamber 66 of the manipulation rod 56 may be shorter as it only
needs to accommodate the needle 22 at the area near the puncture
end 36 while the chamber 66 of the manipulation rod 54 must accommodate
substantially more of the needle 22 when the needle 22 retracts
within the casing 12.
Located at the opposite end of the finger activated ends 58 60
are the needle manipulation ends 67 68 respectively. Needle manipulation
ends 67 68 are designed to coact with the edge 43 of the needle
22 to expose or retract the needle 22 according to the finger manipulations
of the surgeon. In this manner the edge 43 provides a pivoting surface
for the rods 54 56. For example, by fully depressing the finger-activated
end 58 of the manipulation rod 54 and simultaneously releasing the
finger-activated end 60 of the manipulation rod 56 the needle manipulation
end 67 of the manipulation rod 54 will coact with the edge 43 of
the needle 22 moving the needle 22 to the position shown in FIGS.
1 and 3 and causing the needle 22 to be exposed.
Alternatively, by depressing the finger-activated end 60 of the
manipulation rod 56 and releasing the finger-activated end 58 of
the manipulation rod 54 the needle manipulation end 68 of the manipulation
rod 56 will coact with the edge 43 of the needle 22 to retract the
needle 22 into the pocket 19 of the casing 12 and into the slots
66 of the manipulation rods 54 56 as shown in FIG. 7.
Assembly and Disassembly
The instrument 10 is designed to be easily assembled or disassembled.
To assemble the instrument 10 the pieces 14 16 of the casing 12
are position and attached together by means of the pins 18 and the
axle 42. The needle 22 is placed through the pocket 19 and positioned
on the axle 42 as illustrated in FIG. 3. The manipulation rods 54
56 are then placed in the channels 50 52 such that the slots 66
are in proper placement and alignment with respect to the needle.
The coupler 28 is slipped over the casing 12 and placed in alignment
with the collar 24. The cap 26 is fitted over the manipulation rods
54 56 such that the channels 50a, 52a in the cap coact with the
channels 50 52 in the casing 12. The coupler 28 is then threadably
tightened onto the cap. Disassembly fellows the opposite procedure.
Preferred Mode of Use
A preferred method of closing an umbilical incision with the surgical
suture instrument 10 of the present invention will now be described.
Following completion of the operative portion of the surgical procedure,
the umbilical trocar is removed. A finger or blunt trocar may then
be inserted into the incision site to prevent carbon dioxide gas
from leaking out of the abdominal cavity.
When the suture is to be made at the umbilical body opening, the
finger or blunt trocar is removed and the surgical instrument 10
is positioned in the body opening. At this point, the surgeon fully
depresses the finger-activated end 60 of the manipulation rod 56
to retract the needle 22 such that the puncture end 36 is within
the casing 12 as illustrated in FIG. 7. The surgical instrument
10 is then advanced into the body cavity through the body opening.
When the surgeon observes that the needle 22 has passed beyond the
body cavity wall, the surgeon full depresses the finger-activated
end 58 of the manipulation rod 54 to expose the puncture end 36
of the needle 22. The needle 22 is then ready to pierce the tissue
wall. The instrument 10 is then retracted from the body opening.
Retracting the instrument 10 from the body opening enables the puncture
end 36 of the needle to penetrate the surgically-cut body tissue
adjacent the body opening. The surgeon can manipulate the needle
22 by adjustably depressing the finger-activated ends 58 and 60
of the manipulation rods 54 56. At this point, the puncture end
36 of the needle has successfully punctured the tissue.
Gentle retraction of the surgical instrument 10 allows the needle
22 exit the body opening and expose the suture opening 22. At this
point, the body tissue is skewered on the needle 22.
When the suture opening 23 of the needle 22 is exposed at skin
level, a suture is passed through the suture opening 23. Suture
material can be any of a variety of surgical suture thread-like
material known to the art. The instrument 10 is then gently reinserted
in the body opening, with minimal pressure, on the manipulation
rods 54 56 allowing the needle 22 to naturally pull through its
track in the tissue until the surgeon can see the full needle in
the body cavity via the endoscopic camera in the other body opening.
The instrument 10 is then rotated approximately 180.degree.. The
surgeon fully depresses the manipulation rod 54 to expose the needle,
and the instrument 10 is withdrawn from the body opening. As before,
the surgeon can balance the pressure between the manipulation rods
54 56 in order to "sheath the tip" of the needle 22 after
it has passed the body tissue and before it breaks the skin.
When the suture can be seen from outside the body opening, the
thread is grasped and extracted from the suture opening 23 in the
needle. The stitch is placed, but not tied. The instrument 10 is
then ready for re-insertion in the body opening, in order to release
the needle 22 from the tissue. Once the instrument has been reinserted
in the body opening, the needle 22 is then fully sheathed by pressing
the finger-activated end 60 of the manipulation rod 56 and the instrument
is completely and finally removed from the body opening. The suture
is tied to close the body opening.
The instrument 10 allows a safe, secure and expeditious tissue
closure mechanism for small trocar incisions while maintaining adequate
pneumoperitoneum and direct laparoscopic visualization.
It is understood that the invention is not confined to the particular
construction and arrangement herein illustrated and described but
embraces such modified forms thereof as come within the scope of
the following claims. For example, activators, such as rocker switches,
handles and buttons are contemplated to manipulate the needle 22.