Note: Descriptions are shown in the official language in which they were submitted.
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SURGICAL SUTURING APPARATUS WITH hOADING MECHANISM
BACKGROUND OF THE INVENTION
This application is a division of copending
Canadian Application Serial No. 2,133,377 filed September
30, 1994 .
1. Field of the Invention
This invention relates generally to surgical
instrumentation and, mare particularly, t:o a suturing
apparatus adapted for use in endoscopic or laparoscopic
surgical procedures.
2. Description of the Related Art
Endoscopic or Iaparoscopic procedures are
characterized by the use of an elongated cannula structure
having a relatively small diameter with a proximal and
distal end. The distal end is'passed thraugh the
surrounding tissue into the body cavity wherein the surgical
procedure or examination is to be effected, thus providing a
conduit for the insertion of surgical instrumentation. A
plurality of cannula structures may be used to allow
operation of a variety of instruments simultaneously during
a given procedure. For example, one canrAUla may provide a
conduit for an endoscope for vision and illumination within
the operative cavity while the other cannulas may provide
conduits for control of specialized surgical instruments
designed for performing specific procedural functions.
Many surgical procedures call for placing stitches
through tissue, a procedure traditionally accomplished by
hand. Laparoscopic suturing presents a particularly
challenging task, because it must be accomplished through a
port that typically averages between five and ten
millimeters. One instrument for facilitating laparoscopic
suturing is discussed in British Patent Application no.
2260704, published April 28, 1993.
Although the suturing device described in
application serial no. 2260704 can be used to place
laparoscopic sutures, once the suture is used up, or if a
new needle is required, the suturing device must be manually
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reloaded, which can be very time-consuming. As it is
generally considered desirable t:o place 2 or 3 lines of
stitching when performing an anastomosis to provide
reinforcement, the laparoscopic suturing device as described
in the British application mentioned above requires manual
reloading one or more time. It would be advantageous to
provide a laparoscopic suturing instrument to permit quick
and efficient reloading of a new needle and suture. A
laparoscopic suturing device would also provide an, advantage
if the jaws could be prevented f=rom moving when the needle
is not secured in either jaw, so as to prevent the needle
from accidentally dislodging in the body cavity.
SUMMARY OF TH:E INVENTION
In accordance with one embodiment of the present
invention there is provided loading mechanism for use with a
surgical apparatus having jaws, comprising a body portion
having a top and bottom surfaced a member on the top surface
of the body portion to attach a surgical incision member to
the loading mechanism; a first z-ecess on the top surface of
the body portion into which the jaws may be inserted and
a second recess from which the jaws may be removed.
In a preferred embodiment, a surgical incision
member is provided which comprises an elongated body of
substantially uniform diameter having first and second
pointed ends and a channel in the elongated body between the
pointed ends to receive a surgical suture.
In another preferred embodiment the elongated body
is curved.
In a still further emx>odiment, the elongated body
includes at least one recess.
In a particularly preferred embodiment of the
present invention, the elongated body includes a first
i .~"
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recess between the channel and -the first pointed end and a
second recess between the channel and the second pointed
end.
These together with other features and advantages
which will become subsequently apparent reside in the
details of construction and operation as more fully
hereinafter described and claimE=_d, reference being had to
the accompanying drawings forming a part hereof, wherein
like numerals refer to like parts throughout.
BRIEF DESRIPTION OF THE DRAWINGS
Fig. 1 is a perspecti~ae view of a surgical
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suturing apparatus;
Fig. 2 is an exploded view of the instrument
depicted in Fig. 1;
Fig. 3 is an exploded view of the jaw actuating
mechanism of the instrument depicted in Fig. 1;
Fig. 4 is a plan view showing the instrument
depicted in Fig. 1 with the jaws open and the needle secured
in the upper j aw;
Fig. 5 is a plan view showing the instrument
depicted in Fig. 1 with the jaws closed;
Fig. 6 is a perspective view of an embodiment of a
loading mechanism for i:.he apparatus according to the present
invention;
Fig. 7 is a perspective view of the needle,
surgical thread and anchor used with the apparatus;
Fig. 8 is a plan view of the needle used with the
apparatus;
Fig. 9 shows the loading mechanism of Fig. 6 being
placed into the jaw of the apparatus;
Figs. 10, 12 and l2 show a plan view of the jaws
of the instant invention as they draw the needle and
connected length of suture through tissue;
Fig. 13 is a perspective view of an alternate
embodiment of the loading mechanism used with. the apparatus
of the present invention; and
Fig. 14 is a side view of part of the mechanism
that overrides the lockout mechanism of the instrument
depicted in Fig. 1.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
Referring now to the drawings and in particular to
FIG. 1, there is shown a suturing apparatus in accordance
with one embodiment. The suturing apparatus, generally
indicated by reference numeral 1, has a handle housing 61
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with a two-armed handle 2, an elongated tubular housing or
body portion 3, and two jaws (or jaw elements) 4 and 5.
Handle 2 is used to control the opening and closing of jaws
4 and 5 and may be designed to move in the same plane as
jaws 4 and 5 to provide an ergonomic advantage: Handle 2
may also be rotatably connected to body portion 3 to provide
further ergonomic advantage. This embodiment is
particularly well adapted for use in endoscopic or
laparoscopic procedures as the tubular housing 3 is
preferably dimensioned to be deployable through a tubular
cannula structure, e.g., of 5 mm or l0 mm internal diameter.
Referring to FIG. 2, handles 2 are connected to
rod 7 by a pair of links 33 and 34 and pins 49, 50 and 51.
Center rod 7 is spring biased distally by spring 6. Spring
6 fits around center rod 7 and rests in channel 63 of
housing 61. When the handles 2 are squeezed, center rod 7
moves backward (proximally), causing spring 6 to be
compressed. Referring to FIG. 3, the distal end of center
rod 7 has a pin 8 which rides in a cam slot 9 and 10 in each
of the jaws 4 and 5. Jaws 4 and 5 are pivotally connected
to each other by pin 11 extending through holes 12 and 13
and through holes 53 and 54 of support 52. When center rod
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7 is pulled back, pin 8 is also pulled back in cam slots 9
and l0, ramming jaws 4 and 5 closed.
Referring to FIG. 3, each jaw is adapted to
receive needle 14 (FIG. 7) in recess 15. When jaws 4 and 5
are closed as shown in FIG. 5, the needle 14 sits in the
recess 15 in both jaws. When the jaws are opened, the
needle 14 is retained in one or the other recess 15
depending on which blade 16 or 29 intersects the needle 14
through recess 17 (see FIG. 8). As shown in FIG. 4, blade
16, for example, cooperating with upper jaw element 4 has
been extended into recess 17 to secure needle 14.
Alternatively, blade 29 may intersect needle 14 through
recess 17, securing needle 14 in jaw 5. The movement of
blades 16 and 29 to engage needle 14 will be described in
more detail below.
On either side of the center rod 7, side rods 21
and 22 sit inside tubular housing 3 and are connected at
their proximal ends to a wheel 23 movably housed inside
handle housing 61. The two halves of housing 61 are secured
by pins 30. Wheel 23 has two arms 24 an,d 25 projecting from
either side that allow the operator of the apparatus to turn
wheel 23. To transfer needle 14 from ja.w 4 to jaw 5, the
jaws are closed and wheel 23 is rotated by turning side arm
clockwise so that side rod 21 is pulled back and side rod
25 22 is pushed forward. The side rods 21 and 22 are connected
to blades 16 and 29, respectively. Therefore, when side rod
22 is pushed forward, blade 29 is pushed forward and engages
needle 14 by extending into recess 17 to secure needle 14 in
jaw 5. While blade 29 is in a forward position, blade 16 is
in a retracted position, thus blade 16 does not contact
needle 14, thereby allowing release of the needle from jaw
4. Similarly, side arm 24 may be turned counterclockwise,
sliding side rod 21 and blade 16 forward and side arm 22 and
blade 29 backward, thereby securing needle 14 in jaw 4 and
allowing release from jaw 5. Blades 16 and 29 have notches
and 41, respectively, in their distal ends. These
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notches remain behind (proximal to) recesses 15 in jaws 4
and 5 unless the override mechanism, discussed below, is
activated. When the override mechanism is activated,
notches 40 and 41 align with recesses 15.
Turning now to the lockout mechanism which
prevents jaws 4 and 5 from opening unless blade 16 or 29 has
moved into position to secure needle 14, as shown in FIG. 2,
a pin 28 extends through rod 7 which is housed proximally in
wheel 23. Wheel 23 has notches 26 and 27 and abutment
surface 65 therebetween. When wheel 23 is positioned so
that pin 28 is aligned with the mouth of one of the notches
26, 27, the jaws 4, 5 can be opened because pin 28 has room
to move forward into that notch; when wheel 23 is positioned
so that pin 28 rests against abutment surface 65, jaws 4 and
5 cannot be opened because pin 28 is stopped by abutment
surface 65, i.e., it does not have room to move forward.
In the initial position shown in FIG. 4, the
handles 2 are open, as are jaws 4 and 5. Needle 14 is
retained in jaw 4 by blade 16. In this position, pin 28 is
forward in notch 27. To close jaws 4, 5 and suture body
tissue, handles 2 are squeezed together, causing rod 7 and
associated pin 28 to move rearwardly so that pin 28 is at
the mouth of notch 27. Wheel 23 is then rotated using arms
24 or 25 to pass the needle 14 from jaw 4 to jaw 5 as
described above. The rotation of wheel 23 slides pin 28
along abutment surface 65 to the mouth of notch 26. The
handles can then be released, causing pin 28 to move forward
into notch 26 under the force of spring 6 (discussed above),
consequently moving rod 7 forward to open the jaws.
Therefore, when wheel 23 is positioned so that pin
28 is aligned with notch 26, it causes side rod 22 to be
pushed into a forward position, placing blade 29 in a
forward position so as to intersect needle 14 through recess
17, thereby securing needle 14 in jaw 5. When wheel 23 is
positioned so that pin 28 is aligned with notch 27, it
causes side arm 21 to be pushed into a forward position,
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placing blade 16 in a forward position so that it intersects
needle 14 though recess 17, thereby securing needle 14 in
jaw 4.
If the user attempts to release the handles 2 when
the pin 28 is not aligned with the mouth of either notch,
i.e., when wheel 23 is in position so that pin 28 is resting
against (aligned with) abutment surface 65, pin 28 cannot
slide forward and consequently rod 7 cannot slide forward to
open the jaws 4 and 5. Thus, the locking mechanism of the
present invention prevents jaws 4 and 5 from opening if
needle 14 is not secured in one of the jaws by the
respective blade.
Needle 14 as shown in FIG. 7 is curved, has two
pointed ends 55 and 56 and is connected to a portion of
surgical suture 18 in the center of needle 14. Channel 66
holds an end of the suture. To retain the suture in the
needle, the suture may either be glued into channel 66 or
the needle itself may be crimped. A straight needle as
shown in FIG. 8 may also be utilized, and the suture can be
connected adjacent one of the ends (not shown). A single-
pointed needle could also be alternatively provided (not
shown). The opposite end of suture 18 may also have an
anchor 19 affixed thereto for securing the suture in tissue.
Referring to FIGS. 10, 11 and 12, to operate the
suturing apparatus of the instant invention, the open jaws
4, 5 are positioned around the tissue to be sutured. Note
that needle 14 is shown held securely ira jaw 4 by blade 16.
Handles 2 are squeezed, closing the jaws 4; 5 around the
tissue and piercing it with needle 14, which is held
securely in jaw 4 by blade 16. As needle 14 pierces the
tissue, it is guided into a recess 15 in the opposite jaw 5.
If the jaws are open, pin 28 is positioned forward in notch
26 or 27 as described above, and consequently wheel 23
cannot move until the jaws are closed and pin 28 can then
travel along abutment surface 65. With the jaws closed,
wheel 23 may be moved by turning side arm 25 clockwise,
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thereby sliding blade 16 out of one end of the needle 14 and
simultaneously sliding blade 29 into the other end of the
needle. This clockwise movement slides pin 28 from the
mouth of notch 27 to the mouth of notch 26 as described
above. Thus, by turning side arm 25 (and wheel 23), needle
14 is released from jaw 4 and engaged in jaw 5. The needle
14 will then be positioned in the jaw 5, drawing suture 18
through the tissue. Anchor 19 will rest on the tissue,
thereby securing suture 18 in the tissue. The jaws 4 and 5
are then opened by releasing the handles. If the needle 14
is double-pointed, the instrument is ready to make another
stitch. To do so, the handles 2 are squeezed and the jaws
are again closed. After closing the jaws to make the second
stitch, the needle 14 can be passed back to jaw 4 by
rotating side arm 24 of wheel 23 to slide blade 16 distally
and blade 29 proximally. If the needle has only one point,
the needle must be transferred back to the opposite jaw (by
closing the jaws and rotating wheel 23) before the
instrument is ready to make another stitch.
In order to load the suturing apparatus, jaws 4
and 5 must be opened and still allow needle 14 to be removed
and a replacement needle to be loaded into slot 15. This
cannot be accomplished if either blade 16 or 29 is
intersecting slot 15 in accordance with the securing
mechanism described above. Therefore, a mechanism to
override the lockout mechanism described above is provided,
as shown in FIGS. 2 and 14. U-channel 35 straddles wheel
23. Spring 34 is seated within channel 64 of housing 61 and
is proximal to U-channel 35 and wheel 23. Rod 7 extends
through spring 34, hole 59 in U-channel 35 and wheel 23.
Plungers 36 and 37 each rest in hole 60 on either side of
wheel 23 and each plunger extends through U-channel 35.
Each plunger 36, 37, rests upon a spring washer 46, which
also rests in hole 60 in wheel 23. Plungers 36 and 37 have
a smaller°diameter knobs 38 and 39, respectively, extending
therefrom and through housing 61.
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As shown in FIGs. 2 and 14, housings 61 have
channels 62 in which knobs 38 and 39, respectively, may move
back and forth freely. Plungers 36 and 37, however, rest
against surface 48 in housing 61. When knobs 38 and 39 are
pushed down, spring washers 46 compress, plungers 36 and 37
clear surfaces 48 and ride forward (distally) into recesses
47, propelled by the energy of compressed spring 34.
Therefore, to operate this override mechanism,
side arms 24 and 25 are positioned so that pin 28 is
abutting abutment surface 65 and cannot ride forward into
notches 26 or 27. Knobs 38 and 39 are pushed down, thereby
causing wheel 23 to ride forward into recesses 47 of housing
61. As wheel 23 rides forward, so do pin 28 and rod 7,
thereby allowing jaws 4 and 5 to open.
When wheel 23 is propelled forward as described
above, side rods 21 and 22 and blades 16 and 29 are driven
forward sufficiently so that notches 40 and 41 align with
recess 15 in each jaw. When notches 40 and 41 align with
recess 15, blades 16 and 29 are technically in a forward
position (which allows the jaws to be opened because the
lockout mechanism described above is only actuated if
neither blade is in a forward position). In this position,
however, recesses 15, instead of being intersected by blades
16 and 29, are aligned with notches 40 and 41 so that
recesses 15 are clear all the way through in each jaw,
thereby allowing the old needle 14 to be removed from the
instrument and a new needle 14 to be replaced. Thus, the
lockout mechanism discussed above has been defeated by the
override mechanism, because the jaws 4, 5 are open, and yet
the needle 14 is not secured. After the new needle has been
inserted, side arms 24 and 25 can be pulled proximally,
compressing spring 34 and re-engaging lower knobs 36 and 37
with surface 48, thereby re-arming the lockout mechanism of
this instrument.
Referring to the loading mechanism for replacing
the needle, suture and anchor of the present invention shown
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in FIG. 13, needle 14 is positioned in notch 44 and recesses
42 and 43 of the loading mechanism are configured to receive
jaws 4 and 5. When jaws 4 and 5 are closed, the needle 14
becomes engaged in jaw 4 and the closed jaws are removed
from the loading mechanism by lifting them through recess
49. The body portion of this loading mechanism 45 may be
hollow, thereby holding a package containing suture and
anchor inside it.
FIG. 6 shows another embodiment of a loading
mechanism 33 for replacing the needle, suture and anchor of
the present invention. The loading mechanism consists of
handle 30 and arms 31 and 32 attached thereto via fasteners
57 and 58. Each arm .is adapted to hold either an
anchor/positioning element 19 or a needle 14. The
anchor/positioning element 19 and the needle 14 are
preferably approximately the same diameter so that both arms
31 and 32 may be of similar dimension.
Referring to FIG. 9, each jaw may be adapted to
hold anchor 19 shown in FIG. 6. Recess 20 is one adaptation
suitable to hold the suture anchor. The distance between
the needle's recess 15 and the anchor's recess 20
approximately equals the distance between the needle 14 and
anchor 19 in the loading mechanism to facilitate proper
loading. Suture anchor 19 can be fixedly attached to needle
14 by suture 18. Suture anchor 19 may also help guide and
position needle 14 into recess 15. If anchor 19 is not
properly placed in recess 20, jaws 4 and 5 cannot close. If
anchor 19 is properly placed, however, this placement helps
guide the position of needle 14 into recess 15.
Alternatively, a separate positioning element may be
provided. In yet another embodiment, positioning element 19
is fixedly attached to loading mechanism 33 and is placed
into recess 20 for positioning purposes, but is drawn away
when the loading mechanism 33 is removed from the suturing
apparatus.
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To reload a needle, anchor and suture into the
apparatus, the override mechanism described above would be
activated and the old needle removed. As shown in FTG. 9,
to reload the apparatus utilizing loading mechanism 33,
mechanism 33 is held perpendicular to t~-~e bottom open jaw 5
and the needle 14 and the anchor/positioning element 19 are
placed into their respective recesses (15 and 20) one at a
time. After the needle 14 and anchor/positioning element 19
are placed in their respective recesses, the jaws 4, 5 are
closed, and~.the loading mechanism 33 is pulled away, leaving
the needle 14 and anchor 19 in place.
Regardless of the loading mechanism employed, once
a new needle, suture and anchor are loaded into jaws 4 and
5, the lockout mechanism must then be re-armed, as described
above, by pulling knobs 38 and 39 proximally so that
plungers 36 and 37 re-engage surface 48 of housing 61.
Wheel 23 must then be turned, placing blade 16 or 29 in a
forward position so that it intersects needle 14, thereby
retaining needle 14 when jaws 4 and 5 are opened, allowing
the instrument to pierce another portion of tissue.
The foregoing is considered illustrative only of
the principles of the invention. Further, the invention is
not intended to be limited to the exact construction and
operation shown and described. Accordingly, all suitable
modifications and equivalents fall within the scope of this
invention.
