Surgical needle abstract
A combined surgical needle holder and scissors to be used in suturing
procedures. The instrument includes a pair of arms which are pivotally
connected together at a location intermediate their ends. A flat
clamping jaw is associated with each arm and is spaced from a first
end of the arm. As the arms are pivoted, the jaws are brought into
clamping relation to clamp a surgical needle. A scissors blade is
formed on each arm and is located between the clamping jaw and the
distal end of the arm. The scissor blades are constructed to be
moved into overlapping cutting relation when the distal ends of
the arms are moved toward each other.
Surgical needle claims
I claim:
1. A surgical instrument, comprising a pair of elongated arms,
each arm having a first end and a second end, pivot means for pivoting
the arms together at a location intermediate said first and second
ends, whereby said first ends are movable between a closed position
where said ends are in proximate relation to each other and an open
position where said first ends are spaced apart, a generally flat
clamping jaw surface disposed on each arm and spaced from the first
end of said arm, said clamping jaw surfaces being disposed in flatwise
contiguous relation when said first ends are in the closed position,
and a scissor blade disposed on each arm and located between the
corresponding clamping surface and said first end, said blades being
constructed and arranged to be in overlapping cutting relation when
said first ends are in the closed position.
2. The instrument of claim 1 and including a shoulder disposed
between each clamping surface and the corresponding blade.
3. The instrument of claim 2 wherein each shoulder is disposed
normal to the longitudinal dimension of the arm.
4. The instrument of claim 1 wherein a portion of at least one
of the arms located between the scissor blade and the corresponding
clamping surface is undercut to provide a visual transition zone.
5. The instrument of claim 1 and including locking means interconnecting
the arms for locking the first ends in the closed position.
6. The instrument of claim 5 wherein said locking means comprises
a projection on each arm and extending laterally from said arm toward
the opposite arm, and a plurality of serrations on each arm, said
serrations being disposed to be in engaging relation when said first
ends are in the closed position to thereby lock the arms together.
7. The instrument of claim 1 wherein said first ends are blunt.
8. A surgical instrument, comprising a pair of elongated arms,
each arm having a first end and a second end, pivot means for pivoting
the arms together at a location intermediate said first and second
ends, whereby said first ends are movable between a closed position
where said first ends are in proximate relation to each other and
an open position where said first ends are spaced apart, a generally
flat clamping surface disposed on each arm and spaced from the first
end of said arm, said clamping surfaces being constructed and arranged
to be in flatwise contiguous relation when said first ends are in
the closed position to thereby clamp an object therebetween, and
a scissor blade disposed on each arm and located between the corresponding
clamping surface and said first end, each scissor blade disposed
generally normal to the corresponding clamping surface, at least
one of said blades extending laterally beyond the corresponding
clamping surface to overlap the other blade when said first ends
are in the closed position, a portion of at least one of said arms
between the scissor blade and the corresponding clamping surface
being undercut to provide a visual transition zone.
9. The instrument of claim 8 wherein the end of each clamping
surface facing the corresponding scissor blade terminates in a shoulder
disposed normal to the longitudinal dimension of the arm.
10. A surgical instrument, comprising a pair of elongated arms,
each arm having a first end and a second end, pivot means for pivoting
the arms together at a location intermediate said first and second
ends, whereby said first ends are movable between a closed position
where said first ends are in proximate relation to each other and
an open position where said first ends are spaced apart, a generally
flat clamping surface disposed on each arm and spaced longitudinally
from the first end of said arm, said clamping surfaces being constructed
and arranged to be in a flat-wise contiguous relation when said
first ends are in the closed position to thereby clamp an object
therebetween, and a scissor blade disposed on each arm and located
between the corresponding clamping surface and said first end, each
scissor blade disposed generally normal to the corresponding clamping
surface and at least one of said scissor blades extending laterally
beyond the corresponding clamping surface to overlap the other scissor
blade when said first ends are in the closed position.
Surgical needle description
BACKGROUND OF THE INVENTION
In a typical suturing procedure, the suture needle is manipulated
through either the skin or underlying tissue of a laceration, by
use of a surgical needle holder. With the needle secured in the
jaws of the needle holder, the needle holder serves to guide the
needle, causing the needle to pierce the skin adjacent the laceration,
so that the edges of the laceration may be drawn together by the
suturing thread which is bonded to the needle. In this manner, the
thread serves to close the laceration and the thread is then tied
by a surgeon's knot. With interrupted suturing, the suture thread
is cut after each suture, so that the sutures are physically separate
from one another.
Suturing of simple lacerations, particularly lacerations of the
face and hands, comprise a substantial proportion of patients seen
in emergency departments, urgent care centers and family practitioner's
offices. Lacerations of this type usually require one or two layers
of sutures for adequate repair, and the typical laceration usually
has a length of 0.5 to 5.0 cm.
The physician suturing a simple laceration works without an assistant,
and accordingly, the suturing procedure is tedious, redundant, and
time-consuming. By contrast, in the operating room setting, an assistant
will pass instruments, cut sutures in rhythm with their placement,
retract wound edges, and perform other small, but time-consuming
tasks.
In the usual sequence of suturing a simple laceration, the curved
needle is clamped by the needle holder held in one hand by the surgeon,
and the needle with thread attached is passed through both wound
edges. The needle, after passing through the wound edges is then
grasped either with the surgeon's fingers or a forceps and held
in the opposite hand. The needle holder is then used to tie the
surgeon's knot, and the suture is then cut. In the normal procedure,
it is necessary for the surgeon to place the needle holder on the
instrument tray and pick up the scissors in order to cut the suture.
After cutting the suture, the scissors are placed back on the tray
and the needle holder again picked up and the suturing process repeated.
A simple cm laceration often requires a number of sutures, and if
the wound is deep, it may also include the placement of buried absorbable
sutures prior to placement of the skin sutures. Thus, even when
suturing minor lacerations, multiple picking up and putting down
of instruments is required. This not only is time consuming, but
creates a measure of distraction for the surgeon from the performance
of the surgical process.
As a further problem, the continual picking up and putting down
of instruments on the surgical tray presents opportunities for possible
injury to the surgeon due to accidental cuts or needle sticks. This
is of major importance in accidental transmission of certain blood-borne
diseases.
In an attempt to avoid the sequences of instrument transfers, it
has been proposed to utilize an instrument which combines both a
needle holder and scissors, such as shown in U.S. Pat. No. 2315326.
In the instrument as disclosed in that patent, a pair of opposing
clamping jaw surfaces are provided at the distal end of each arm
of the instrument and working surfaces shaped as a pair of blades
are located between the clamping jaws and the pivot axis of the
arms.
A combined needle holder and scissors of that type has certain
drawbacks. As the scissor blades are located inwardly from the distal
end of the arms of the instrument, it obscures the surgeon's view
of cutting. As a further disadvantage, the scissors can only be
used for cutting the suture thread and cannot normally be used for
trimming tissue and debriding small bits of a wound. In addition,
with the scissors located inwardly of the clamping jaws, no scissor
points or tips define the scissors, so that it is difficult for
the surgeon to precisely locate the scissor blades.
It has also been proposed in the past to design a combined needle
holder and scissors with a third arm, as shown in U.S. Pat. 4452246.
In this construction, the third arm contains a scissors blade which
operates against the outer edge of the needle holder to provide
a cutting function. However, instruments of this type, incorporating
a third arm, are more costly to produce and are more cumbersome
and difficult to manipulate.
SUMMARY OF THE INVENTION
The invention is directed to an improved surgical instrument, and
more particularly to a combined surgical needle holder and scissors.
The instrument includes a pair of arms which are pivotally connected
together intermediate their length so that the arms are in an X-shaped
configuration. A generally flat clamping jaw surface is located
on each arm and spaced from the distal end of the arm. As the distal
ends of the arms are pivoted toward each other, the clamping jaw
surfaces will be moved to a clamping position to clamp a suture
needle.
The portion of each arm located between the clamping jaw surface
and the distal end is formed with a scissors blade, and as the distal
ends are pivoted toward each other, the blades move into an overlapping
cutting relation, so that they can be used to cut the suture thread.
In the preferred form of the invention, a small transition zone
separates the scissor blades from the clamping jaw surfaces and
the transition zone provides a visual separation between the scissors
and clamping jaws, which minimizes the possibility of the scissors
accidentally grasping and severing the thread while tying a knot
with the instrument.
In addition, the scissors are blunt tipped to avoid accidentally
slashing the patient during suturing.
Incorporating the scissors with the needle holder in one instrument
eliminates the sequence of instrument transfer which has been necessary
in the past when utilizing separate needle holders and scissors.
As the transfer or exchange of instruments is minimized, the likelihood
of dropping instruments on the floor, spilling solutions on the
surgical tray, or surgeon injuries due to accidental contact with
sharp instruments on the tray are substantially reduced.
Positioning the scissors at the distal tip of the instrument enables
the scissors to be used for other operations in addition to cutting
of the suture thread, as for example, trimming minor amounts of
tissue, enlarging the fenestration of a paper drape, and the like.
As the scissors are located at the tip of the instrument, an unobstructed
view is obtained during the cutting operation and permits use in
trimming deeper sutures which can be accomplished only with great
difficulty when using a combination needle holder and scissors in
which the needle clamping surfaces are located at the distal end
of the instrument.
Other objects and advantages will appear in the course of the following
description.
DESCRIPTION OF THE DRAWINGS
The drawings illustrate the best mode presently contemplated of
carrying out the invention.
In the drawings:
FIG. 1 is a plan view of the surgical instrument of the invention;
FIG. 2 is a fragmentary perspective view of the distal end portion
of the instrument with the distal ends being shown in an open position;
FIG. 3 is a fragmentary perspective view of the distal end of the
instrument, with the instrument being inverted with respect to FIG.
2;
FIG. 4 is a view similar to FIG. 3 showing the distal ends of the
arms of the instrument in a closed position;
FIG. 5 is a fragmentary plan view of the distal end of one of the
arms;
FIG. 6 is a fragmentary plan view of the distal end of the other
of the arms; and
FIG. 7 is a section taken along line 7--7 of FIG. 4.
DESCRIPTION OF THE ILLUSTRATED EMBODIMENT
The drawings illustrate a surgical instrument and in particular
an improved combination surgical needle holder and scissors.
The instrument includes a pair of elongated arms 1 and 2 and arm
1 is provided with an elongated slot 3 which receives the arm 2.
Arms 1 and 2 are pivotally connected together at a pivot 4 so that
the distal ends of the arms can be pivoted between an open position,
as shown in FIG. 2 and a closed position as shown in FIG. 4.
Arm 1 is provided with a flat, clamping surface 5 which is spaced
inwardly from the distal end of the arm. Similarly, arm 2 is formed
with a flat clamping surface 6 also spaced from the distal end of
the arm. When the distal ends of the arms are moved to the closed
position, as seen in FIG. 4 the clamping surfaces 5 and 6 will
be brought into contiguous flatwise relation to thereby clamp a
needle between the surfaces.
Surfaces 5 and 6 are preferably roughened to provide more effective
clamping of the needle and, as shown in the drawings, the roughened
surface can be achieved by serrations or grooves.
A scissor surface 7 is formed on arm 1 between the clamping surface
5 and the distal end of the arm. Scissor surface 7 is disposed perpendicular
or normal to clamping surface 5 as shown in FIG. 3.
Arm 2 is also formed with a scissor surface 8 that is located normal
to clamping surface 6 and when the distal ends of the arms are
pivoted to the closed position, the scissor surfaces 7 and 8 will
be in an overlapping cutting position, so that they can be used
to sever the suture thread.
To provide the overlapping relation between the scissor surfaces
7 8 surface 7 is provided with an extension 9 which is in overlapping
relation with surface 8 when the distal ends of the arms are pivoted
to the closed position. While the drawings shown the extension 9
being formed on only one of the scissor blade surfaces, it is contemplated
that extensions could be formed on both of the scissor blade surfaces.
The outer extremity of clamping surface 5 is bordered by a shoulder
10 and similarly, the outer extremity of clamping surface 6 is bordered
by a shoulder 11. Shoulders 10 and 11 are located normal to the
longitudinal dimensions of the respective arm.
As seen in FIG. 6 a transition zone 12 is located between the
blade surface 7 and the clamping surface 5. Transition zone 12 comprises
a groove or undercut and provides a visual separation between the
scissors and the clamping jaws to enable the surgeon to more precisely
utilize the clamping and scissor functions.
The end of each arm 1 and 2 is provided with a standard finger
loop 15 and to lock the arms in the clamping position, projections
16 extend laterally from each arm, and the projections are formed
with parallel serrations or grooves 17. When the ends of the arms
containing finger loops 15 are brought together, the serrations
17 on the projections 16 will move into engaging relation to thereby
hold or lock the arms in the clamping position.
In the preferred form of the invention, the scissor blade surfaces
7 and 8 extend about 30% to 40% of the combined length of the blade
surfaces and the clamping surfaces (length A in FIG. 6). Thus, the
short length of the scissors will not obscure the surgeon's view
when using the clamping jaws to clamp the needle and maneuver the
needle through the skin or tissue.
The distal ends or tips 18 and 19 of arms 1 and 2 are rounded or
blunt to prevent accidentally cutting or slashing the patient during
suturing.
The transition zone 12 provides a visual separation between the
scissors and needle holder which minimizes the possibility of the
scissors accidentally grasping and severing the thread while tying
a knot with the instrument.
As the scissors blades 7 and 8 are located at the tip of the instrument,
there is no obstruction to the surgeon's view while cutting the
suture thread. Positioning the scissor blades at the tip of the
instrument also enables the scissors to be used in trimming deeper
sutures and further permits routine sharpening of the blades 7 and
8.
As the scissors and needle holder are combined in a single instrument,
fewer exchanges of instruments are required during the suturing
procedure, which lessens the likelihood of dropping the instruments
and minimizes possible injury to the surgeon due to accidental contact
with sharp objects on the surgical tray during transfer of the instruments.
Various modes of carrying out the invention are contemplated as
being within the scope of the following claims particularly pointing
out and distinctly claiming the subject matter which is regarded
as the invention. |