Surgical needle abstract
A surgical needle holder is provided in which the handle members
are arranged in a plane at right angles to associated jaws which
are operated by the handles. A camming arrangement is coupled between
the handles and jaws to convert the movement of the handles in one
plane to movement of the jaws in a second perpendicularly arranged
plane. The needle holder is employed for suturing in surgical procedures
and facilitates placement of the hand of the operator as well as
the application of force in a rotary sense thereby.
Surgical needle claims
What is claimed is:
1. A surgical needle holder comprising first and second handle
members in a first plane, first and second jaw members cooperatively
associated in a second plane to constitute means for grasping and
manipulating a surgical needle, and coupling means coupling said
jaw and handle members so that the jaw members are relatively pivotal
about a first pivot axis which is angularly disposed to a second
pivot axis on which the handle members are relatively pivotal and
so that the jaw members pivot relative to each other in response
to a relative pivoting of said handle members, said jaw members
and handle members being related to each other such that, when said
first plane is vertical, said second plane is at least substantially
horizontal.
2. A surgical needle holder as claimed in claim 1 wherein the first
pivot axis is at least generally perpendicular to and spaced from
the second pivot axis.
3. A surgical needle holder as claimed in claim 2 wherein one of
the handle members include an extension and the jaw members are
supported on the extension of said one handle member.
4. A surgical needle holder as claimed in claim 3 wherein interengaging
means are respectively mounted on said handle members for releasably
locking the handle members and thereby the jaw members in fixed
relative positions.
5. A surgical needle holder as claimed in claim 4 wherein the interengaging
means are relatively planar ratchet members.
6. A surgical needle holder as claimed in claim 3 wherein the jaw
members are provided with intersecting slots in superposed relationship
and said coupling means includes a camming member simultaneously
accommodated in both said slots whereby to effect a pivoting of
said jaw members.
7. A surgical needle holder as claimed in claim 6 wherein said
coupling means includes a rod coupled between said camming member
and the other of said handle members.
8. A surgical needle holder as claimed in claim 7 wherein said
coupling means includes a first pivot coupling said handle members
together and a second pivot on said other handle member and radially
spaced from said first pivot said second pivot coupling said rod
to said other handle member whereby displacement of said other handle
member displaces said rod and thereby said camming member.
9. A surgical needle holder as claimed in claim 8 wherein said
jaw members have relatively flat surfaces adapted to oppose each
other in face-to-face relationship and adapted for relative movement
in directions generally perpendicular to the flat surfaces.
10. A surgical needle holder as claimed in claim 3 wherein one
of said jaw members is monolithic with one of said handle members.
11. A surgical needle holder as claimed in claim 3 comprising a
guide member intervening between said jaw members.
12. A surgical needle holder as claimed in claim 11 wherein the
jaw members are provided with intersecting slots in superposed relationship
and said coupling means includes a camming member simultaneously
accommodated in both said slots whereby to effect a pivoting of
said jaw members; said guide member also being provided with a slot
in which said camming member is guided.
13. A surgical needle holder as claimed in claim 1 wherein one
of said handle members includes a finger ring and the other of said
handle members includes a hooked shaped configuration defining an
open access for the thumb of a user.
14. A method of surgical suturing wherein a curved needle is employed
to sew together the edges of two tissue sections, said method comprising
grasping said needle in a needle holder having jaws arranged to
cooperate along a plane and handles coupled to the jaws and operable
in a plane to open and close said jaws, said method further comprising
arranging said planes at an angle relative to each other whereby
to facilitate grasping said handles in a hand of a suturer and such
that, when the handles are in a vertical plane, the jaws are parallel
to a plane which is at least substantially horizontal.
15. A method as claimed in claim 14 wherein the planes are arranged
perpendicularly of each other.
16. A method as claimed in claim 15 comprising displacing the holder
with a rotary motion to exchange positions of the planes.
17. A method as claimed in claim 16 wherein the plane of the handles
is initially in generally vertical attitude whereby the hand of
the suturer is also initially in generally vertical attitude.
18. A method as claimed in claim 16 comprising driving the needle
along a generally arcuate path through the edges of the tissue sections
by the rotary motion of the holder.
Surgical needle description
FIELD OF INVENTION
This invention relates to surgical instruments and more particularly
to surgical needle holders of the type employed in connection with
surgical suturing techniques. The invention also relates to surgical
methods and, more particularly, to methods for improving hand position
and the application of needle driving forces during suturing steps
in surgical procedures.
BACKGROUND
There are a wider variety of surgical instruments involving the
use of jaws or pincers or the like in which an instrument is provided
with handles or provision is made for the relative movements of
parts of the instrument involved. Some of these instruments are,
by way of example, shown in U.S. Pat. Nos. 2002594; 3585985;
4043343; and 4258716.
In U.S. Pat. No. 2002594 R. H. Wappler et al show an instrument
for electrical surgical treatment of tissue. In this instrument,
a pair of handle members are arranged relative to a pivot with a
pair of jaws being laterally offset relative thereto. As will be
shown, this instrument is distinguishable from the type of instrument
contemplated within the scope of the present invention because the
pivot provided for the jaws is, in essence, arranged in parallel
to the pivot provided for the handle members.
W. Gould shows in U.S. Pat. No. 3585985 a surgical instrument
comprising a first assembly member having a handle portion, a shank
portion and a tip portion all relatively fixed in spatial and structural
relationship to each other. A second handle member is provided which
is hingedly connected to the first assembly member at the juncture
of the handle and shank portions. A shank member is provided which
is hingedly connected to the second handle member which slidably
mates with the shank portion of the first assembly member and a
tip member hingedly connected to the shank member at the end thereof
remote from the handle-shank hinge. It will be noted that in this
instrument, the pivots provided for the handle members are parallel
to the pivot provided for the shank.
In U.S. Pat. No. 4043343 (R. Williams), there is shown a forceps
having a pair of handles, one of which is hinged for reciprocal
movement relative to the other. Extension arms are provided between
the handles. One of the arms is reciprocally slidable along the
other arm. Upper and lower jaw members are furthermore provided,
one of which is hinged for reciprocal movement relative to the other
in response to reciprocal handle movement. In this arrangement,
as in the above arrangement, the various pivots are provided in
relative parallel attitude.
G. Sutherland shows, in U.S. Pat. No. 4258716 a microsurgical
instrument having a handle adapted to be grasped by a surgeon and
operating means being provided on the handle. An instrument body
extends outwardly from the handle and has at its outer end the operative
portion of the instrument which may, for example, be a scissors
or forceps. The arrangement is such that the instrument body can
be freely rotated about the axis of the handle to align the instrument
in the required position with the body being located frictionally
in position when the operating means is actuated. Thus, there is
no firm predetermined position between the handle and instrument
body as is necessary during certain types of procedures.
As will be shown hereinafter, the present invention provides for
a relative arrangement of handles and jaws. Since the conception
of the present invention, I have researched the various prior art
and find that there are non-surgical instruments which provide,
in general, a type of relative placement of parts of the type with
which I am generally concerned. Some of these relationships are
shown in U.S. Pat. Nos. 2679096; 3296697; 3325896; and 3375581.
In these previously granted patents are shown grass shears in which
handles relatively pivotable in one plane are related to cutting
blades which are relatively pivotal in a second plane which is perpendicular
to the first plane. As will become apparent hereinafter, I employ
an arrangement with a camming construction which is different from
anything shown in the above patents while at the same time, I employ
the arrangement of the jaw plane and handle plane for a purpose
and in a manner heretofore unrecognized.
SUMMARY OF INVENTION
It is an object of the invention to provide an improved surgical
instrument and particularly a surgical instrument suitable to constitute
a surgical needle holder of improved characteristics.
As will be shown hereinafter, there is provided in accordance with
the invention a needle holder in which the jaws function in a plane
perpendicular to the plane in which the handle members pivot. By
having the jaws of the apparatus in a perpendicular plane, the related
needle which is grasped is in a position to function while the operator's
hand is in a neutral position. The advantages of this is multifold.
Firstly, the needle is in a position to enter the tissue without
any hand motion. In other words, the hand does not have to be cocked
to an unnatural position. Secondly, the motion required to place
and bury the needle in the tissue being sewn is substantially reduced
due to the starting angle of the needle. Moreover, the needle is
moved by a more natural motion of the hand of the operator doing
the suturing. Thirdly, the needle can be readily removed from the
tissue without cocking the wrist or twisting the needle holder.
In achieving the above and other objects and advantages of the
invention, there is provided a surgical needle holder comprising
first and second handle members and first and second jaw members
cooperatively associated to constitute a means for grasping and
manipulating a surgical needle. A coupling means is provided which
couples the jaw and handle members so that the jaw members are relatively
pivotable about a first pivot axis which is angularly disposed to
a second pivot axis on which the handle members are relatively pivoted
and so that the jaw members pivot relative to each other in response
to a relative pivoting of said handle members.
According to a specific embodiment of the invention, the first
pivot axis is at least generally perpendicular to the second pivot
axis. It is possible, in accordance with the invention, that this
angle be other than perpendicular, although the perpendicular arrangement
constitutes the preferred and most useful embodiment of the invention,
according to the present analysis thereof.
According to a first embodiment of the invention, one of the jaw
members is an extension of and monolithic with one of the handle
members. According to a second embodiment, the jaw members are not
monolithic with the handle members at all. Moreover, enterengaging
means are respectively mounted on the handle members for releasably
locking the handle members together and thereby locking the jaw
members in fixed relative positions. These enterengaging means may
be relatively planar ratchet members or the like.
In accordance with the invention, the jaws members are provided
with intersecting slots which are in superposed relationship. An
intervening guide member may additionally be employed. The coupling
means, as will be seen, includes a camming member simultaneously
accommodated in both of these slots whereby to effect a pivoting
of the jaw members. The coupling means, moreover, includes a rod
coupled between the camming member and the other of the handle members.
This rod translates movement of the handle member to which it is
coupled into movement of the camming member in the aforesaid slots.
Special constructions of the handle members are also envisaged.
In accordance with yet another aspect of the invention, the coupling
means mentioned above includes a first pivot coupling the handle
members together and a second pivot on the other handle member and
radially spaced from the first pivot, said second pivot coupling
said rod to said other handle member whereby displacement of said
other handle member displaces said rod and thereby said camming
member.
The aforesaid construction is related to jaw members which conventionally
have relatively flat surfaces adapted to oppose each other in face-to-face
relationship and which furthermore are adapted for relative movements
in directions generally perpendicular to the flat surfaces.
The invention also relates to a method of surgical suturing pertaining
to the above wherein a curved needle is employed to sew together
the edges of two tissue sections. The method comprises grasping
the needle in a needle holder having jaws arranged, as mentioned
above, such that the jaws are arranged to cooperate along a plane
with handles being coupled to the jaws and operable in a plane to
open and close the aforesaid jaws. In accordance with the invention,
the method comprises arranging the planes at an angle relative to
each other whereby to facilitate grasping said handles in the hand
of a suturer and operating the aforenoted needle.
As has been indicated above, the planes are perferably arranged
to be perpendicular with respect to each other. In association with
the aforegoing. The holder will be displaced with a rotary motion
to exchange positions of the planes.
In accordance with a preferred aspect of the method of the invention
referred to generally hereinabove, the plane of the handles is initially
in generally vertical attitude whereby the hand of the suturer is
also initially in generally vertical attitude. From this arrangement,
the needle is driven in a generally arcuate path through the edges
of the tissue section by rotary motion of the needle holder.
The above and further objects and advantages as well as features
of the invention will be explained in greater detail hereinbelow
with reference to the accompanying drawing.
BRIEF DESCRIPTION OF DRAWING
In the drawing:
FIG. 1 is a side view of a surgical needle holder provided in accordance
with a preferred embodiment of the invention;
FIG. 2 is a top view of the tip or jaw section of the surgical
instrument of FIG. 1;
FIG. 3 is a diagrammatic illustration of the application of the
method of the invention according to one aspect thereof;
FIG. 4 illustrates a variation of the handle portion of the holder
of FIGS. 1-3;
FIG. 5 is a rear view of the structure of FIG. 4; and
FIG. 6 shows a variation of the camming action in FIGS. 1-3.
DETAILED DESCRIPTION
In FIGS. 1 and 2 is shown a surgical instrument 10 having handle
members 12 and 14 having openings 16 and 18 therein for receipt
of respective fingers on the applied hand of the operator in a surgical
procedure. The instrument will be employed to grasp a surgical needle,
as will be shown in greater detail hereinafter. The instrument is
adapted to be grasped by the hand of the suturer which hand is the
hand most normally employed by the user (i.e., the right hand of
a right-handed person).
The handle members 12 and 14 are pivoted together about a pivot
pin indicated at 20. This enables the handle members to partake
in a relative pivotal movement in a plane such as, for example,
the plane of FIG. 1 of the drawing. This movement is indicated by
arrow 22. The movement is reciprocal, i.e. in one instance the members
move relatively towards one another and in another instance the
handle members move relatively away from one another.
The surgical instrument 10 furthermore comprises jaw members 26
and 28. These jaw members meet and cooperate against a pair of facing
surfaces indicated at 30. These surfaces are slightly serrated.
These surfaces are the surfaces which grasp the needle therebetween
for purposes of manipulation as will be shown in greater detail
hereinbelow.
The jaw members are capable of a reciprocal movement about a pivot
32. In other words, the jaw members can move towards and/or away
from one another. They do this in a plane which is perpendicular
to the drawing in FIG. 1 and parallel with the plane of the drawing
as seen in FIG. 2. The jaw members have sections (i.e. sections
34 and 36 which oppose each other and sections 38 and 40 which overlap
each other).
In sections 38 and 40 are provided respective rectilinear slots
42 and 44 which cross each other in the nature of an X. The slots
are superposed relative to one another and include a section 50
in which the slots cooperatively pass entirely through the jaw section.
In section 50 is accommodated a camming member 52 the motion of
which, in a manner to be described hereinafter, affects an opening
and closing of the jaw sections relative to one another. Thus, for
example, the jaw section 28 may be moved to a position indicated
in chain line at 28'.
The cam or camming member 52 is, in effect, an elongated cylindrical
member such as a pin. It is attached to a rod 54 in turn connected
to a pivot pin 56 mounted on the handle member 12. The pivot pin
56 is radially spaced from pivot pin 20 by an amount indicated at
R. The pin 56 is, therefore, displaceable about pin 20 in the direction
indicated by arrow 58. This movement, in turn occasioned by displacement
by handle member 12 relative to handle member 14 in the direction
indicated by arrow 22 effects a displacement of rod 54 as indicated
by arrow 60. This, in turn, effects a displacement of camming member
52 to alter the angular attitude of the slots 42 and 44 to bring
about a relative displacement of the jaw members 28 and 30. Thus,
there will be seen that a relative movement of the handle members
12 and 14 is converted to a relative movement of the jaw members
28 and 30 with the respective relative movements taking place in
planes which are angularly related and preferably perpendicular
with respect to one another.
Utilization of the aforegoing instrument and its characteristic
movements is illustrated in one form thereof in FIG. 3. Therein
are shown the edge portions 70 and 72 of two tissue sections which
are to be sewn together in a suturing procedure which is part of
a surgical operation. The needle is shown at 74. It is a conventional
curved surgical needle having a point indicated at 76. It is preferably
grasped between jaw members 26 and 28 with these members occupying
a horizontal plane. The plane along which the jaw members 26 and
28 cooperate is indicated in vertical attitude at 30.
The handle members 12 and 14 are indicated in FIG. 3 as being in
a vertical plane and operatively displaceable parallel thereto.
The hand of the operator is indicated at H with the thumb indicated
at T. It will thus be seen that the hand of the operator occupies
a vertical position parallel to the plane of handle members 12 and
14 and to the plane in which they are relatively displaceable.
From the above description, it will be appreciated that the hand
of the operator as well as the plane of jaw members 12 and 14 is
perpendicular to that of the members 26 and 28. For purposes of
elucidation the plane of the jaw members 26 and 28 is indicated
at P1 and the plane of the handle members 12 and 14 is indicated
at P2. Thereafter, the hand is rotated in the direction indicated
by arrow 80 to assume the position indicated at H'. This carries
with it the handle members 12 and 14 which move to the positions
indicated at 12' and 14'.
By this motion the surgical needle 74 is driven first through tissue
section 70 and then through tissue section 72 or the edges thereof
in the direction indicated by the dotted line at 82 and therefore
the suturing operation or a portion thereof takes place.
From the above it will be seen that a method of surgical suturing
is provided wherein a curved needle is employed to sew together
the edges of two tissue sections or the like. This method comprises
grasping the needle in a needle holder having jaws arranged to cooperate
along a plane and handles coupled to the jaws and operable in a
plane to open and close these jaws. In accordance with the invention
the method comprises arranging said planes at an angle relative
to each other whereby to facilitate grasping of the handle in the
hand of a suturer. By visualization and reference to FIG. 3 it
can be seen that the initial grasping position is a conventional
position in which the palm or back of the hand is vertical and the
hand is in a natural position uncocked and with no torsional stresses
or other muscular or ligament pressures applied thereto. From this
position, the hand can be readily rotated in a clockwise direction
as visualized with reference to FIG. 3 with the motion being quite
normal and a maximum of pressure being enabled without bringing
any distortional contractions to the hand being employed.
As stated above, the invention is preferably such that the planes
are arranged perpendicularly of each other. The holder is displaced
with a rotary motion as aforesaid to exchange positions of the planes.
In the initial condition, the plane of the handles is preferably
generally of vertical attitude whereby the hand of the suturer is
also, as stated above, initially in generally vertical disposition.
The needle is driven along a generally arcuate plane through the
edges of the tissue sections by the rotary motion of the hand of
the operator and of the holder.
In the construction which has been described above, one of the
jaw members (i.e. jaw member 26) is a continuation of and monolithic
with the handle member 14. Other constructional arrangements are
possible within the scope of the invention if certain advantageous
characteristic features of the invention are to be disregarded.
With reference to FIGS. 4 and 5 it is seen that a variation in
the handle members is contemplated in the scope of the invention.
In FIGS. 4 and 5 are shown handle members 100 and 102. Ratchet members
104 and 106 extend between the handle members for purposes of locking
the same in position in the manner which was discussed hereinabove.
Handle member 102 is seen as including a finger ring support 108
of conventional design. Handle member 100 carries a hooked shaped
configuration 110 having a curved flange 112 which cooperatively
defines an open throat 114 for purposes of providing an open access
for the thumb of the user. Thus, it will be readily appreciated
that the thumb of the user can be readily inserted and withdrawn
from the opening defined by the hooked shaped configuration 110.
It is to be noted that by eliminating the top ring, comfort for
the user is substantially increased. Furthermore, there is no room
for the thumb to get caught in the top ring. Moreover, the palming
of the instrument is facilitated with substantially greater control.
FIG. 6 illustrates a variation in the camming control. In FIG.
6 are shown jaw members 120 and 122. A control rod 124 is seen which
is similar to the control rod noted hereinabove. It controls displacement
of the camming member 126. In this embodiment of the invention,
there is provided an intervening guide member 128 provided with
a slot through which extends the camming member 126. This intervening
guide member 128 may be rigid with one of the handle members. It
is in intervening relationship between portions 130 and 132 of jaw
members 120 and 122. In this embodiment of the invention, no directly
monolithic connection between the jaw members and any one of the
handle members is employed.
There will now be obvious to those skilled in the art, many modifications
and variations of the structure and methods set forth hereinabove.
These modifications and variations will not depart from the scope
of the invention if defined by the following claims.
|