Surgical needle abstract
A surgical needle for use in narrow, deep incisions in the abdominal
wall opening into the abdominal cavity. The needle can be used to
suture laparoscopic incisions and to suture an artery, ligament
and the like which is reached through the incision. The needle has
an elongated shaft with a proximally directed hook at its distal
end. At its proximal end, there is a handle or indicia for indicating
the direction of the hook. The hook is pointed and has an eye adjacent
its point through which a suture can be threaded. The hook is of
a size and shape that it can be inserted through the incision and
manipulated from the opening of the shaft to place the suture "through
and through" a selected portion of the abdominal wall from
the base of the incision.
Surgical needle claims
What is claimed:
1. A surgical needle having an elongated substantially straight
shaft with a proximal end and a distal end,
said shaft having a proximally directed U-shaped hook at its distal
end, said hook being of a size and shape that the hook passes through
a narrow incision in an abdominal wall opening at its base into
an abdominal cavity, said hook having a first leg attached to the
distal end of the shaft and a second leg terminating in a point
with an eye adjacent the point for receipt of a suture, said second
leg is parallel to the shaft at the point and having a length such
that the ratio of the length of the leg to the width of the hook
is equal to or greater than 2.5 in a point with an eye adjacent
the point for receipt of a suture whereby the second leg of the
hook has a length such that the point can be inserted from the base
of the incision through a selected portion of the abdominal wall
surrounding the incision sufficiently far to expose the eye from
the opening of the incision, and
said shaft having a means at its proximal end for indicating the
location of the point whereby the needle can be manipulated from
the opening of the incision to place the suture through and through
the abdominal wall.
2. The needle of claim 1 wherein the hook is in the same plane
as the shaft.
3. The needle of claim 2 wherein the axis of the eye is in the
same plane as the shaft.
4. The needle of claim 2 wherein a bell is mounted on the shaft
for selectively capping the hook.
5. The needle of claim 2 wherein the means for indicating the location
of the point is a handle in the same plane as the shaft.
6. The needle of claim 2 wherein the means for indicating the location
of the point is a marking on a weight attached to the shaft.
7. A surgical needle having an elongated substantially straight
shaft with a proximal end and a distal end,
said shaft having a proximally directed U-shaped hook in the plane
of the shaft at its distal end, said hook being of a size and shape
that the hook passes through a narrow incision in an abdominal wall
opening at its base into an abdominal cavity, said hook having a
first leg attached to the distal end of the shaft and a second leg
terminating in a point with an eye adjacent the point for receipt
of a suture, said second leg is parallel to the shaft at the point
and having a length such that the ratio of the length of the leg
to the width of the hook is equal to or greater than 2.5 whereby
the second leg of the hook has a length such that the point can
be inserted from the base of the incision through a selected portion
of the abdominal wall surrounding the incision sufficiently far
to expose the eye from the opening of the incision, and
said shaft having a means at its proximal end for indicating the
location of the point whereby the needle can be manipulated from
the opening of the incision to place the suture through and through
the abdominal wall.
8. The needle of claim 7 wherein the hook has a maximum width about
4 mm to 24 mm.
9. The needle of claim 8 wherein the shaft is from about 10 cm
to 40 cm long.
10. The needle of claim 9 wherein the hook is from about 1 cm to
10 cm long.
11. A surgical needle having an elongated substantially straight
shaft with a proximal end and a distal end,
said shaft having a proximally directed U-shaped hook at its distal
end, said hook being of a size and shape that the hook passes through
a narrow incision in an abdominal wall opening at its base into
an abdominal cavity, said hook having a first leg attached to the
distal end of the shaft and a second leg terminating in a point
with an eye adjacent the point for receipt of a suture, said second
leg is curved inwardly towards the shaft at the point and having
a length such that the ratio of the length of the leg to the width
of the hook is equal to or greater than 2.5 whereby the second leg
of the hook has a length such that the point can be inserted from
the base of the incision through a selected portion of the abdominal
wall surrounding the incision sufficiently far to expose the eye
from the opening of the incision, and
said shaft having a means at its proximal end for indicating the
location of the point whereby the needle can be manipulated from
the opening of the incision to place the suture through and through
the abdominal wall.
12. The needle of claim 11 wherein the hook is in the same plane
as the shaft.
13. The needle of claim 12 wherein the axis of the eye is in the
same plane as the shaft.
14. The needle of claim 12 wherein the means for indicating the
location of the point is a handle in the same plane as the shaft.
15. The needle of claim 12 wherein the means for indicating the
location of the point is a marking on a weight attached to the shaft.
Surgical needle description
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention relates to a surgical needle for closing
laparoscopic incisions to prevent the development of hernias. The
device may also be used for suturing an artery, ligament and the
like which is reached through a laparoscopic incision and for other
surgical procedures which require suturing of deep but narrow wounds.
2. Brief Description of the Prior Art
Surgical procedures such as laparoscopy have created a need for
a surgical needle capable of closing a small, deep incision through
multiple layers of tissues. At first, laparoscopic incisions tended
to be small and did not require closure. Larger incisions are now
common to accommodate larger instruments and removal of tissue specimens.
As reported by Kadar N., Reich H., Liu C. Y., Manko G. F. and Gimpelson
R. J. in an article entitled "Incisional hernias following
major laparoscopic gynecological procedures" accepted for publication
in the American Journal of Obstetrics and Gynecology, the incidence
of incisional hernia is greatly increased when a 10 mm or larger
trocar is used at an extra-umbilical site. When the incision is
10 mm or larger, the authors believe that the underlying fascia
should be closed and that even the peritoneum may require closure
at a 12 mm and larger site.
There are straight needles for closing a laparoscopic incision
that have a suture attached to the end of the needle opposite the
point and straight needles with a suture attached adjacent the point.
Both types of straight needles must be worked inside the patient
and require the use of graspers. For example, when a suture is attached
opposite the point, the needle is inserted down into the abdominal
wall on one side of an incision and then with much difficulty manipulated
with laparoscopic graspers at the base of the incision and inserted
up through the abdominal wall on the other side of the incision.
Straight needles with an eye adjacent the end are inserted through
the abdominal wall on one side of the incision. The suture is then
unthreaded from the needle and rethreaded into the eye of the needle
inserted on the other side of the incision. Laparoscopic graspers
in the abdominal cavity are used for this difficult and time consuming
procedure.
Curved needles are also used for closing a laparoscopic incision.
They can be worked outside the patient but they require the use
of a needle holder. The suture is usually attached to the end of
the curved needle opposite the point and it is nearly impossible
to determine just where the point is going. Great damage can result
from accidentally penetrating tissues.
SUMMARY OF THE INVENTION
In view of the above, it is an object of the present invention
to provide a curved surgical needle for closing laparoscopic incisions
that allows a surgeon to accurately locate the point. It is another
object to provide a needle that can be worked without a needle holder
or laparoscopic grasper from the outside to place a "through
and through" suture in the abdominal wall. It is also an object
to provide a needle which can be used to suture an artery or ligament
reached from a narrow incision where suturing is otherwise difficult.
Other objects and features of the invention will be in part apparent
and in part pointed out hereinafter.
In accordance with the invention, a surgical needle is provided
with an elongated shaft having a proximal end and a distal end.
The shaft has a hook at its distal end that is adapted in size and
shape to be passed through a narrow incision in an abdominal wall.
The hook terminates in a point with an eve adjacent the point for
receipt of a suture. The hook is of a length that when it is inserted
in a selected portion of the abdominal wall surrounding the incision
starting at the base of the incision, the point sticks through the
wall sufficiently far to expose the eye from the opening of the
incision. The shaft has a means at its proximal end for indicating
the location of the point so that working from the outside the needle
can be manipulated at the base of the incision to accurately place
the suture through and through the abdominal wall. Still working
from the outside, a knot can then be tied in the suture bringing
together that part of the abdominal wall between the "through
and through" stitches.
The invention summarized above comprises the constructions hereinafter
described, the scope of the invention being indicated by the subjoined
claims.
BRIEF DESCRIPTION OF THE DRAWINGS
In the accompanying drawings, in which several of various possible
embodiments of the invention are illustrated, corresponding reference
characters refer to corresponding parts throughout the several views
of the drawings in which:
FIG. 1A is a side elevation of a surgical needle in accordance
with the present invention;
FIG. 1B is a front elevation of the needle shown in FIG. 1A;
FIG. 1C is a side elevation of a surgical needle variant of that
shown in FIG. 1A.
FIG. 2A is a side elevation of a second surgical needle in accordance
with the present invention;
FIG. 2B is a front elevation of the needle shown in FIG. 2A;
FIGS. 3A-3I are simplified (e.g., interleaved layers of subcutaneous
fat and muscle are omitted) diagrammatic successive views in section
showing closure of a laparoscopic incision with the surgical needle
shown in FIGS. 1A-1B.
DETAILED DESCRIPTION OF THE INVENTION
Referring to the drawings more particularly by reference characters
and starting with FIGS. 1A-1B, reference numeral 10 refers to a
surgical needle in accordance with the present invention. Needle
10 is especially designed for use in closing a narrow incision 12
in an abdominal wall 14. As shown in FIGS. 3A-3I, abdominal wall
14 includes layers of skin 16 fascia 18 and peritoneum 20 and incision
12 opens into an abdominal cavity 22.
Needle 10 has an elongated shaft 24 with a proximal end 26 and
a distal end 28 U-shaped. Distal end 28 has a proximally directed
hook 30. Hook 30 has a first leg attached to the distal end of the
shaft and a second leg terminating in a sharpened point 32 with
an eye 34 adjacent the point through which a suture 36 is threaded.
Suture 36 may be permanent or absorbable and made of nylon or of
any other suture material known in the art. Hook 30 is preferably
in the same plane as shaft 24 and may be open (e.g., generally "U"
shaped with the second leg parallel to the shaft at the point) as
shown in FIGS. 1A-1B or partially closed (e.g., generally "C"
shaped) with the second leg curved inwardly towards the shaft at
the point as shown in FIGS. 2A-2B. For use as described hereinafter,
the axis of eye 34 is also preferably in the same plane as shaft
24 (as shown in FIGS. 1A-1B and 3A-3I) but it may be otherwise oriented
(as shown in FIGS. 2A-2B and so forth). The body of needle 10 and
point 32 may be circular in cross section or of some other shape.
Hook 30 has a width and shape such that it passes through incision
12. Hook 30 has a length such that point 32 can be inserted from
the base of the incision through a selected portion of abdominal
wall 14 sufficiently far to expose eye 34 from the opening of the
incision. The exact width and length of hook 30 will vary with the
width and depth of the incision and the tissue type and will also
vary with the size of the patient and the amount of fat at the site
of the wound.
Needle 10 is especially designed for use in suturing laparoscopic
incisions made with a trocar having a diameter larger than 5 mm.
The maximum width of hook 30 is preferably about 1 mm smaller than
the width of the incision such that when the incision is made with
a trocar having a diameter from about 5 mm to about 25 mm, the maximum
width of hook 30 is preferably from about 4 mm to about 24 mm, respectively.
The length of hook 30 will also vary with the nature of the incision
and whether point 32 is inserted through skin 16 and/or peritoneum
20 in addition to fascia 18. In most instances satisfactory results
are obtained when hook 30 is from about 1 cm to 10 cm long and the
ratio of the length of the leg to the width of the hook is equal
to or greater than 2.5. For example, at the lower end of the range,
when hook 30 is 4 mm wide and the second leg is 1 cm long, the ratio
is 2.5 whereas when the hook is 24 mm wide and the second leg is
10 cm long, the ratio is 4.17. Even higher ratios are possible when
hook 30 is less than 24 mm wide.
Shaft 24 preferably is from about 10 cm to 40 cm long. Depth markings
38 may be provided along shaft 24 with a double line at the level
of hook 30 and single lines at centimeter intervals.
A means 40 for indicating the location of point 32 is provided
on proximal end 26 of shaft 24. As shown in FIGS. 1A-1B and 3A-3I,
means 40 comprise a handle 42. Handle 42 is preferably in the same
plane as shaft 24 and the axis of eye 34 and may be formed, for
example, by bending proximal end 26 of the shaft. As shown in full
lines in FIG. 1A, handle 42 may be formed on the same side of shaft
24 as hook 30 (dotted lines) or on the opposite side (full lines).
A bell 44 may be provided on shaft 24 for capping hook 30. As shown
in FIGS. 1A-1B and 3G-3H, bell 44 is reciprocated along shaft 24
for this purpose.
A second illustrative surgical needle 10' in accordance with the
present invention is shown in FIGS. 2A-2B. In this embodiment, means
40 take the form of indicia 46 on one or more weights 48 attached
to proximal end 26 of shaft 24 and the axis of eye 34 is perpendicular
to the plane of shaft 24. In this form, the words "right"
and "left" serve as suitable indicia 46 on the side edges
of weight 48. If eye 34 were in the plane of shaft 24 (a variation
on what is shown in FIGS. 2A-2B), then "front" on weight
48 opposite hook 30 would be a suitable indicia.
The needles of the present invention may be made from any material
suitable for use in surgical needles, including stainless steel
wire, and may have a diameter from about 0.5 mm to about 3 mm depending
on the stiffness of the wire. The needles may be manufactured to
conform with the above described characteristics by any of the techniques
well known in the art of needle manufacturing. One method for manufacturing
the needles is to first straighten a length of wire from a coil.
The straightened wire may be cut to the desired length. One end
of the wire is ground by standard techniques to form point 32. Adjacent
point 32 the needle is drilled to provide an eye 34 for attaching
suture 36. Eye 34 may be circular, oval, C-shaped and so forth.
The wire is then bent to form hook 30 of the desired size and shape
at distal end 28 of shaft 24. Direction indicating means 40 are
then attached (or formed as by bending) at proximal end 26 of shaft
24.
In use needle 10 (or 10' and so forth) functions as a needle, suture
holder and grasper all in one easy-to-use instrument. It uncomplicates
closure of laparoscopic incisions and minimizes the risk of incisional
hernia formation. It can also be used to ligate an artery (e.g.,
one accidentally severed on trocar insertion) and, in general, to
accurately place a "through and through" suture in a narrow,
deep incision.
The following examples illustrate use of the invention.
EXAMPLE 1
A nick or small incision is made in skin 16 of abdominal wall 14
to minimize resistance to entry of a trocar. The trocar punches
through skin 16 fascia 18 and peritoneum 20 forming laparoscopic
incision 12 through which a cannula is inserted and abdominal cavity
22 is accessed.
After a laparoscopic procedure is completed, the cannula is withdrawn.
If the cannula is 10 mm or larger, laparoscopic incision 12 should
be closed to prevent possible development of hernias. As shown in
FIGS. 3A-3I, this can be accomplished with surgical needle 10.
With reference to FIG. 3A, a length of suture 36 is threaded through
eye 34. The ends of suture 36 are dressed together and are held
as with a first finger 50 pressing against skin 16 on one side of
incision 12 while hook 30 is passed through incision 12.
Referring to FIG. 3B, point 32 is inserted through peritoneum 20
and fascia 18 (if it is desired to suture the peritoneum also) and
exits just below skin 16. During this operation, handle 42 removes
any uncertainty as to the location of point 32 and depth markings
38 may also be of guidance. With reference to FIG. 3C and working
from the front or back of eye 34 one of the ends of suture 36 is
pulled through the hole made by point 32 and held as with a second
finger 52 pressing against skin 16 on an opposite side of incision
12.
As shown in FIG. 3D, needle 10 is then withdrawn from the hole
and inserted into peritoneum 20 and fascia 18 on the opposite side
of incision 12. In FIG. 3E, point 32 is shown coming through fascia
18.
With reference to FIG. 3F, the other end of suture 36 is unthreaded
from eye 34 and pulled through the second hole made by point 32.
This is accomplished by pulling the suture from the same side of
eye 34 as in step 3C (i.e., either from the front or back). If the
axis of eye 34 is perpendicular to the plane of hook 30 as in needle
10', the operation of unthreading eye 34 is accomplished by working
the suture in steps 3C and 3F from either the right or from the
left.
Continuing to FIG. 3G, bell 44 (if present) may be reciprocated
down shaft 24 and used to cap hook 30. When point 32 is angled towards
shaft 24 as shown in FIGS. 2A-2B and in other instances, step 3G
may be eliminated.
Hook 30 is then pulled out of incision 12 as shown in FIG. 3H.
If hook 30 is not capped with bell 44 care must be taken not to
hook suture 36 which passes "through and through" on both
sides of incision 12.
With reference to FIG. 3I, the ends of suture 36 are released from
fingers 50 52 and then tied into a knot 54. As shown, knot 54 is
within the incision site and the laparoscopic incision closed. Additional
sutures can be placed in the same manner. Skin 16 is then approximated
over the deep stitch(es) at 56 to complete the closure.
It will be understood that the ends of the suture may be otherwise
immobilized during the steps shown in FIGS. 3A-3H as for example
by having an assistant hold the ends.
EXAMPLE 2
Ligating an artery to control hemorrhage
Occasionally, a trocar cuts an artery in abdominal wall 14 (such
as an inferior epigastric artery) when laparoscopic incision 12
is made and sometimes it is necessary to ligate the vessel to control
hemorrhage. Device 10 is threaded with a suture as described in
Example 1 and hook 30 passed through incision 12. Hook 30 can then
be used to place a "through and through" suture around
the artery working from the base of incision 12. For this purpose,
hook 30 must be long enough to pass through skin 16 and expose eye
34. Once the ends of the suture have been brought through the abdominal
wall, the ends are tied into a knot with sufficient pressure to
ligate the spurting vessel. If there is time, skin 16 may be nicked
such that the knot is subcutaneous for cosmetic reasons.
In view of the above, it will be seen that the several objects
of the invention are achieved and other advantageous results attained.
As various changes could be made in the above constructions without
departing from the scope of the invention, it is intended that all
matter contained in the above description or shown in the accompanying
drawings shall be interpreted as illustrative and not in a limiting
sense. |