Surgical suture abstract
A surgical suture clamp is provided with two clamp jaws positioned
movably one in relation to the other in a forceps-like manner. It
is formed as an endoscopable suture clamp to be inserted into the
body through a trocar and provided with a leading tube, in the vicinity
of the inner tube end of which, to be lead into the body, at least
one clamp jaw is positioned to be pivotably driven in relation to
the second clamp jaw. A drive is arranged in the portion of the
outer tube end remaining outside the body and is coupled by way
of a transmission with the at least one pivotably driven clamp jaw.
Surgical suture claims
What is claimed is:
1. A surgical suture clamp, in particular a purse string suture
clamp for applying a purse string suture during the performance
of gastric, intestinal and pulmonary operations, comprising two
clamp jaws (3 4) movably positioned one in relation to the other
in a forceps-like manner, wherein the suture clamp is structured
as an endoscopable suture clamp, to be lead into the body via a
trocar, with a leading-in tube (1), in the vicinity of an inner
tube end (2) of which, to be lead into the body, at least one clamp
jaw (3) is positioned to be pivotably driven in relation to the
second clamp jaw (4), wherein a drive means (22) is arranged in
the vicinity of an outer tube end (15) remaining outside the body
and is coupled, by way of a transmission (31 34), with the at least
one pivotably driven clamp jaw (3 4) for the opening and the closing
of the suture clamp, wherein in a closed position the clamp jaws
(3 4) in their longitudinal direction (L) extend at a small acute
angle (W) to the longitudinal axis (A) of the leading-in tube (1),
and wherein the clamp jaws (34) each comprise a needle passage
(14) extending in the longitudinal direction (L) of the clamp jaws
(34).
2. A suture clamp according to claim 1 wherein the drive and the
transmission are formed as a spindle drive with a spindle wheel
(22) arrested longitudinally axially in relation to a tube axis
(A) and positioned coaxially rotatably thereto and a push bar (34)
arrested in the direction of rotation and longitudinally axially
displaceable in the leading-in tube (1), which push bar (34), with
an external thread (32) at its outer end, is in engagement with
an internal thread (30) of the spindle wheel (22) and which, with
its inner end (35), is coupled for articulation with the at least
one pivotably positioned clamp jaw (3 4).
3. A suture clamp according to claim 2 wherein the clamp jaws
(3 4) are each formed as an arm of double-armed clamp levers (5
6), which are positioned at the inner tube end (2) pivotably about
an axis (10), and wherein the operating arms (39 40) of the clamp
levers (5 6) are connected by way of articulated lever bars (36
37) for articulation with the inner end (35) of the push bar (34).
4. A suture clamp according to claim 3 wherein a forked bearing
head (9) with fork legs (7 8) is provided at the inner tube end
(2), the clamp levers (5 6) being positioned pivotably about a
common axis (10) between the fork legs (7 8).
5. A suture clamp according to claim 4 wherein at least with the
clamp jaws (3 4) closed, the inner end (35) of the push bar (34)
and the articulated lever bars (36 37) are arranged between the
fork legs (7 8) of the forked bearing head (9).
6. A suture clamp according to claim 1 wherein the clamp jaws
(3 4) in their longitudinal direction (L) extend at a small acute
angle (W) to the longitudinal axis (A) of the leading-in tube (1).
7. A suture clamp according to claim 1 wherein a substantially
cylindrical handle member (16) is arranged at the outer tube end
(15).
8. A suture clamp according to claim 7 wherein a spindle wheel
(22) is pivotably supported on the handle member (16) and is longitudinally
axially arrested by means of projections (26) on the spindle wheel
(22) engaging with an annular circumferential groove (24) on the
handle member (16).
9. A suture clamp according to claim 2 wherein for arrest of rotation,
the push bar (34) is provided with a radially projecting elevation
(43), which engages with an oblong hole (44) extending parallel
to the longitudinal axis (A) of the leading-in tube (1).
10. A surgical suture clamp, in particular a purse string suture
clamp for applying a purse string suture during the performance
of gastric, intestinal and pulmonary operations, comprising two
clamp jaws (3 4) movably positioned one in relation to the other
in a forceps-like manner, wherein the suture clamp is structured
as an endoscopable suture clamp, to be lead into the body via a
trocar, with a leading-in tube (1), in the vicinity of an inner
tube end (2) of which, to be lead into the body, at least one clamp
jaw (3) is positioned to be pivotably driven in relation to the
second clamp jaw (4), wherein a spindle wheel (22) is pivotably
supported on a handle member (16), said handle member being arranged
at the outer tube end (15), and said spindle wheel being longitudinally
axially arrested by means of projections (26) on the spindle wheel
(22) engaging with an annular circumferential groove (24) on the
handle member (16), said spindle wheel being coupled by way of a
transmission (31 34) to at least one pivotably driven clamp jaw
(3 4) for the opening and closing of the suture clamp, wherein
in a closed position the clamp jaws (3 4) in their longitudinal
direction (L) extend at a small acute angle (W) to the longitudinal
axis (A) of the leading-in tube (1), and wherein the clamp jaws
(34) each comprise a needle passage (14) extending in the longitudinal
direction (L) of the clamp jaws (34).
11. A surgical suture clamp, in particular a purse string suture
clamp for applying a purse string suture during the performance
of gastric, intestinal and pulmonary operations, comprising two
clamp jaws (3 4) movably positioned one in relation to the other
in a forceps-like manner, wherein the suture clamp is structured
as an endoscopable suture clamp, to be lead into the body via a
trocar, with a leading-in tube (1), in the vicinity of an inner
tube end (2) of which, to be lead into the body, at least one clamp
jaw (3) is positioned to be pivotably driven in relation to the
second clamp jaw (4), wherein a spindle drive with a spindle wheel
(22) arrested longitudinally axially in relation to a robe axis
(A) and positioned coaxially rotatably thereto and a push bar (34)
arrested in the direction of rotation and longitudinally axially
displaceable in the leading-in tube (1), said push bar having a
radially projecting elevation (43), which engages with an oblong
hole (44) extending parallel to the longitudinal axis (A) of the
leading-in tube (1) which push bar (34), with an external thread
(32) at its outer end, is in engagement with an internal thread
(30) of the spindle wheel (22) and which, with its inner end (35),
is coupled for articulation with the at least one pivotably positioned
clamp jaw (3 4) for the opening and the closing of the suture clamp,
wherein in a closed position the clamp jaws (3 4) in their longitudinal
direction (L) extend at a small acute angle (W) to the longitudinal
axis (A) of the leading-in tube (1), and wherein the clamp jaws
(34) each comprise a needle passage (14) extending in the longitudinal
direction (L) of the clamp jaws (34).
Surgical suture description
BACKGROUND OF THE INVENTION
1. Field of the Invention
The invention relates to a surgical suture clamp, in particular
a purse string suture clamp for applying a purse string suture during
the performance of gastric, intestinal and pulmonary operations
or the like, with two clamping jaws movably positioned one in relation
to the other in a forceps-like manner.
2. Background Art
A conventional, comparatively long surgical cut into the abdominal
wall has so far been necessary to apply a purse string suture with
the aid of the suture clamp mentioned at the outset for instance
for closing the colon during the performance of certain intestinal
operations such as partial intestinal removal. Because of the scissors-like
configuration of the suture clamp there has so far been no possibility
to apply such a suture in so-called endoscopic surgery where the
necessary observation instruments such as endoscopes and surgical
instruments are inserted via trocars which pierce the abdominal
wall. In this regard certain operations requiring for instance a
purse string suture to be applied are not feasible with the means
of endoscopic surgery.
SUMMARY OF THE INVENTION
Proceeding from these problems it is accordingly the object of
the invention to specify a surgical suture clamp and in particular
a purse string suture clamp of the generic kind which is suitable
for the purposes of endoscopic surgery.
This object is attained by the features wherein the suture clamp
is structured as an endoscopable suture clamp, to be lead into the
body via a trocar, with a leading-in tube, in the vicinity of an
inner tube end of which, to be lead into the body, at least one
clamp jaw is positioned to be pivotably driven in relation to the
second clamp jaw, and wherein a drive means is arranged in the vicinity
of an outer tube end remaining ouside the body and is coupled, by
way of a transmission, with the at least one pivotably driven clamp
jaw for the opening and the closing of the suture clamp. Accordingly,
the suture clamp is structured as an endoscopable suture clamp,
to be lead into the body via a trocar, with a leading-in tube, in
the vicinity of the inner tube end of which, to be lead into the
body, at least one clamp jaw is positioned to be pivotably driven
in relation to the second clamp jaw. Further, a drive is arranged
in the vicinity of the outer tube end remaining ouside the body
and is coupled, by way of a transmission, with the at least one
pivotably driven clamp jaw.
By reason of this configuration it is possible to use the suture
clamp for the purposes of endoscopic surgery, it being understood
that the tube as well as in particular the clamp jaws provided at
the inner tube end are arranged and dimensioned, at least in their
closed position, such that these parts fit through the inside opening
of the trocar, the latter thus serving as a sluice provided in the
abdominal wall for the suture clamp.
In keeping with a preferred embodiment the clamp jaws of the endoscopic
suture clamp are arranged in their longitudinal direction at a small
acute angle to the longitudinal axis of the leading-in tube. This
inclination helps to achieve that a needle passage formed in the
clamp jaws is readily accessible from both ends of the clamp jaws.
On the other hand, the clamp jaws, when closed, remain within the
contours of the leading-in tube referred to the latter's longitudinal
axis, so that the suture clamp can be pushed through the inside
opening of the trocar even with its clamp jaws inclined.
Further features, details and advantages of the invention will
become apparent from the sub-claims and the ensuing description
of an example of embodiment of the subject matter of the invention
taken in conjunction with the attached figures.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a lateral view of a purse string suture clamp according
to the invention,
FIG. 2 is a lateral view of the clamp seen from the direction of
the arrow II of FIG. 1 with the clamp jaws closed, and
FIG. 3 is a lateral view, partially cut along the section line
III--III of FIG. 1 of the clamp from the direction of the arrow
II with the clamp jaws opened.
DESCRIPTION OF THE PREFERRED EMBODIMENT
An endoscopic purse string suture clamp according to the invention,
as illustrated in FIGS. 1 to 3 has a leading-in tube 1 as its main
component, which is pilotable into the body via a trocar (not shown)
in the abdominal wall of the patient. In the vicinity of the inner
tube end insertable into the body, two clamp jaws 3 4 are positioned
to be pivotably driven, each clamp jaw 3 4 being formed as an arm
of a double-armed clamp lever 7 8. The latter are positioned between
the fork legs 7 8 of a forked bearing head 9 secured to the inner
tube end 2 to be pivotable by means of a common pivot axis 10.
The clamp faces 11 12 facing each other, of the clamp jaws 3
4 are structured undulatorily as usual, the elevations 13 on the
clamp faces 11 12 being passed through by a needle passage 14 extending
in the longitudinal direction L of the clamp jaws 3 4 and shown
in dashed lines in FIGS. 1 and 2. In the closed position of the
clamp, a thread is passed through these needle passages 14 unidirectionally
with the aid of needles for applying a purse string suture.
In their closed position (FIGS. 1 2) the two clamp jaws 3 4 extend
in their longitudinal direction L at a small acute angle W to the
longitudinal axis A of the leading-in tube. This angle W is approximately
10.degree. and is dimensioned such that the clamp jaws 3 4 in their
closed position (FIG. 1 2) are within the circular contour of the
leading-in tube referred to a direction of view of the clamp jaws
3 4 extending in parallel to the longitudinal axis A of the tube
1. As a result of this inclination the orifices of the needle passage
14 are comfortably accessible, which is of special advantage when
needles are entered into the needle passage 14 with the aid of an
endoscopic manipulator.
A substantially cylindrical handle member 16 is coaxially screwed
on to the external tube end 15 remaining outside the body, of the
leading-in tube 1 by means of a screw connection 17 the handle
member 16 having a continuous inner bore 19 extending coaxially
with the tube orifice 18. An annular shoulder 21 likewise extending
coaxially, on which a spindle wheel 22 is arranged rotatably with
its cylindrical internal opening 23 is provided at the front end
20 facing away from the leading-in tube 1 of the handle member
16. A circumferential groove 24 with which headless screws 25 engage
as projections, is further provided on the circumference of the
annular shoulder 21. These headless screws are screwed through corresponding
threaded bores 26 in the annular collar 27 around the cylindrical
internal opening 23 of the spindle wheel 22 and arrest the latter
in the longitudinal axial direction of the leading-in tube 1. A
sliding ring 28 from brass is inserted between the front side of
the annular collar 27 and the handle member 16.
With its blind-hole bore 29 which, proceeding from the internal
opening 23 is arranged coaxially to the longitudinal axis A of
the leading-in tube 1 and has an internal thread 30 the spindle
wheel 22 forms, together with a threaded bolt 31 in the inner bore
19 of the handle member 16 a spindle drive for the clamp jaws 3
4. To this end the external thread 32 of the threaded bolt 31 is
in engagement with the internal thread 30 in the spindle wheel 22.
At its end 33 facing away from the spindle wheel 22 the threaded
bolt 31 is further connected with a push bar 34 leading to the forked
bearing head 9 where it ends within the two fork legs 7 8. Two
articulated lever bars 36 37 are articulated with their ends on
this corresponding end 35 of the push bar 34 by means of a common
articulated axle 38. The two other ends of the articulated lever
bars 36 37 are connected with the two operating arms 39 40 of
the clamp levers 5 6 for articulation by way of articulated axles
41 42. By reason of the above described construction the threaded
bolt 31 together with the push bar 34 and the two articulated lever
bars 36 37 form a transmission for transmitting the rotary actuation
originating from the spindle wheel 22 to the two clamp levers 5
6. In this case, the unit of the threaded bolt 31 and the push bar
34 is further arrested in the direction of rotation. For the purpose
of this arrest of rotation the threaded bolt 31 is provided on its
outside with a radially projecting elevation in the form of a screw
head 43 of a screw radially screwed into the threaded bolt, which
screw head 43 engages with an oblong hole 44 extending parallel
to the longitudinal axis A of the leading-in tube 1 in the latter.
The opening and closing of the clamp jaws 3 4 is made as follows:
Starting from the closed position, shown in FIGS. 1 and 2 of the
two clamp jaws 3 4 in which the articulated lever bars 36 37
and the operating arms 39 40 lie within the two fork legs 7 8
of the forked bearing head 9 the spindle wheel 22 is actuated to
rotate. Due to the arrest of rotation of the threaded bolt 31 and
the push rod 34 the rotary movement of the spindle wheel 22 is
translated in the way of a spindle drive into a pushing movement
of the threaded bolt 31 and the push rod 34 in the direction towards
the inner tube end 2 of the leading-in tube 1. As a result of this
pushing and of the approach of the articulated axle 38 towards the
pivot axis 10 of the two clamp levers 5 6 the two articulated
lever bars 36 37 move apart outwards and consequently, spread open
the two operating arms 39 40 of the clamp levers 5 6 (FIG. 3).
The clamp jaws 3 4 are thus moved into their opened position.
For closing the clamp jaws 3 4 the spindle wheel 22 is actuated
in the opposite direction of rotation, whereby the threaded bolt
31 is displaced with the push bar 34 in the opposite direction coaxially
to the longitudinal axis A, thus causing the two clamp levers 5
6 to be retracted by way of the articulated lever bars 36 37. |