Surgical suture abstract
A method is provided for snagging a surgical suture wherein a device
is introduced to the interior of the patient's body through a cylindrical
cannula. The device includes a resilient loop which collapses as
it passes through the cannula. The loop is crimped at its end whereby
when a length of suture material is passed through the loop and
the device is withdrawn from the patient through the cannula, the
suture is snagged within the crimped portion so that it does not
escape the loop.
Surgical suture claims
What is claimed is:
1. A method for snagging an end of a surgical suture located within
a patient's body during arthroscopic surgery, comprising the steps
of:
deploying a distal end of a cylindrical cannula adjacent the end
of said suture within said body;
passing a resilient loop through the cannula from a proximal end
thereof towards said distal end of said cannula into said body,
said loop being secured to a distal end of an elongated rod and
having a portion which is crimped at a location opposite to where
the loop is secured to the rod;
inserting the suture end through said loop as the loop extends
beyond the distal end of the cannula within said body; and
withdrawing the rod and the loop from the cannula whereby the end
of the suture is snagged in the crimped portion of the loop and
then is displaced so as to emerge from the proximal end of the cannula.
2. A method as set forth in claim 1 wherein said loop is substantially
elliptical in shape, the width of the loop being greater than the
inner diameter of the cannula whereby the loop is compressed when
it passes through the cannula.
Surgical suture description
BACKGROUND OF THE INVENTION
Advancements in the science of arthroscopic surgery have resulted
in a wide range of instruments being developed facilitating improved
surgical techniques. However, because arthroscopy provides only
limited direct access to the portion of the anatomy being operated
on, problems unique to this type surgery persist. One such problem
is the manipulation of lengths of suture material.
In conventional practice, one end of a strand of suture material
is threaded onto a needle which is carried by a barrel-like device
provided with a plunger. The needle-carrying end of the device is
inserted through an opening in the patient's body to a position
proximate the tissue which is to be sutured. The plunger then is
actuated to force the needle outwardly from the body. As the needle
emerges through the skin, it is grasped by the surgeon and is completely
withdrawn so as to render accessible the said one end of the suture
material. When the procedure is repeated with the other end of the
material, both ends become exposed. The paths of needle travel in
the procedural steps just described are generally parallel to one
another in closely spaced relationship. Consequently, when the tissue
spanning the separated portions of the suture material is cut, the
surgeon can knot the ends drawing the knot tightly onto the tissue
to complete the suture.
The method of suturing just described has several shortcomings,
a principal one being the difficulty in accurately controlling the
path of needle movement when the plunger is actuated. This lack
of control can result in the needle causing neurovascular damage.
Additionally, when the incision is made in the tissue spanning the
separated portions of the suture material, the suture itself can
be severed, thereby requiring the removal of its pieces and the
substitution of another strand of material.
SUMMARY OF THE INVENTION
The shortcomings just described are overcome by the present invention.
More particularly, a cylindrical cannula is deployed in an opening
in the patient, and the distal end of the cannula is accurately
positioned adjacent the tissue to be sutured. A collapsible loop
secured to the end of an elongated handle is moved through the cannula
from outside the body. As the loop emerges from the distal end of
the cannula, the loop expands from its collapsed condition within
the cannula. An end of suture material inserted through another
opening in the patient's body is fed through the expanded loop.
As the loop is withdrawn through the cannula, it snags the suture
material and carries it outside the body. Using a second cannula
and repeating the procedure, the other end of the suture material
is rendered accessible to the surgeon who then can make an incision
in the tissue spanning the two cannulas so that the suture can be
completed when the cannulas are removed.
DETAILED DESCRIPTION OF THE INVENTION
The invention will be described in greater detail with respect
to the accompanying drawings wherein:
FIG. 1 is a side elevational view of a suture-snagging surgical
device capable of carrying out the method of the present invention;
FIG. 2 is an end elevational view thereof;
FIG. 3 is an enlarged side elevational view, partially in section,
of a portion of the device shown in FIG. 1; and
FIG. 4 is a sectional view of a portion of the device shown in
FIG. 1 in operative relationship with a segment of a cylindrical
needle.
Referring to FIGS. 1-3 an elongated rod 10 has secured to one
end thereof a handle 12 of any convenient configuration. Preferably,
rod 10 and handle 12 are formed of stainles steel. An elongated
elliptically-shaped loop 14 is secured to the end of rod 10 opposite
handle 12. Loop 14 preferably is formed of stranded stainless steel,
and at its free end, the loop has a crimped portion 16. As can be
appreciated from FIG. 3 the loop 14 is secured to rod 10 by its
inner end being received and swaged within a cavity at the end of
the rod.
Since loop 14 is formed of thin stranded lengths of wire, it is
resilient whereby it can be compressed and then can return to its
original configuration when the compression forces are released.
In FIG. 4 the loop 14 is illustrated in its compressed state within
an elongated cylindrical cannula 18. A cannula suitable for use
with loop 14 is a conventional spinal needle.
The structure having the capability of carrying out the present
invention having been detailed, the manner in which it is employed
now will be described.
In a typical arthroscopic procedure, three incisions are made to
receive, respectively: an optic system (arthroscope) for allowing
the involved surgical area to be viewed on a television monitor;
the instruments for performing the surgery; and an irrigation device.
When the surgical procedure requires suturing to facilitate the
healing process--as, for example, in mending menisci--it is necessary
to introduce suture material to the area of the tissue involved.
In accordance with the present invention, a pair of cannulas 18
are inserted through the skin in closely spaced relationship. Since
the distal ends of the cannulas can be carefully and accurately
directed to positions adjacent the suturing location, the opportunity
for unnecessary neurovascular damage is reduced. The surgeon then
grasps the surgical device by handle 12 and passes loop 14 through
one of the cannulas 18. During its passage, the loop is compressed
(FIG. 4), but as it leaves the distal end of the cannula, loop 14
expands to the shape shown in FIGS. 1 and 3. The surgeon then inserts
one end of a length of suture material through the incision provided
for receiving the surgical instruments. Utilizing the television
monitor for guidance, the end of the suture material is threaded
through loop 14. The loop then is withdrawn through cannula 18.
As the loop re-enters the distal end of the cannula, the suture
material is snagged within the crimped portion 16 of the loop. This
prevents the material from escaping the loop. When the loop completely
exits the proximal end of cannula, the captured end of the suture
material is removed from the loop. The surgeon then inserts the
device through the second cannula 18 whereupon the procedure just
described is repeated for the other end of the length of suture
material.
Both ends of the suture material now being accessible to the surgeon,
an incision is made between the two cannulas. The suture material
is protected by the cannulas when this occurs. The cannulas then
are removed, the suture material is knotted about the tissue being
repaired, and the loose ends are trimmed to complete the suturing
procedure. |