Suture needle abstract
A laparo-suture needle and method for use thereof. A medical suturing
instrument employs an outer, hollow shaft having a laterally-disposed,
elongate handle at a proximal end and an elongate, inner shaft disposed
within the outer shaft. The inner shaft has a cutting edge at the
distal end and extends out of the outer shaft at the proximal end,
terminating in a spring-loaded push button. A lateral notch is formed
in the inner shaft proximal of the cutting edge. The spring forces
the inner shaft rearwardly so as to pull the notch within the outer
shaft. By gripping the handle and placing pressure on the push button,
the inner shaft is moved forward so as to expose the notch. A suture
may then be placed in the notch so that the instrument grips the
suture between the outer shaft and the inner shaft when the push
button is released. The instrument is used for suturing muscle at
an incision by gripping the end of a suture, forcing the distal
end of the instrument beneath the epidermis within an incision,
into the fatty tissue and through the muscle adjacent one side of
the incision to force the suture through the muscle.
Suture needle claims
I claim:
1. A method for suturing muscle tissue of a patient at the site
of a wound, comprising the steps of:
(a) attaching a suture to a needle having a distal end and a proximal
end, gripping means adjacent the distal end and operating means
adjacent the proximal end for actuating the gripping means to grip
said suture, said suture being attached to said needle by said gripping
means;
(b) forcing said needle through muscle tissue adjacent a first
side of said wound so as to guide said suture therethrough;
(c) after said suture has been guided through said muscle tissue
in step (b), releasing said suture from said needle using said operating
means;
(d) forcing through muscle tissue adjacent a second side of said
wound a needle having a distal end and a proximal end, gripping
means adjacent the distal end and operating means adjacent the proximal
end for actuating the gripping means to grip said suture;
(e) gripping said suture within the body of the patient using the
needle used in step (d); and
(f) withdrawing the needle used in step (e) from said muscle tissue
adjacent said second side of said wound so as to guide said suture
from within the body of the patient therethrough.
2. The method of claim 1 further comprising the step of withdrawing
said needle used in step (b) from said muscle tissue adjacent said
first side of said wound.
3. The method of claim 1 wherein said needle comprises:
(i) an elongate, hollow first shaft having a proximal end and a
distal end;
(ii) an elongate second shaft having a proximal end and a distal
end disposed inside said first shaft, said second shaft terminating
at the distal end thereof in a sharp point and having a lateral
notch therein disposed a predetermined distance proximally from
said distal end; and
(iii) operating means disposed at the proximal end of said first
shaft for moving said second shaft forward to position said notch
beyond the distal end of said first shaft and for moving said second
shaft backward to position said notch within the distal end of said
first shaft.
4. The method of claim 3 wherein said operating means includes
a spring connected to said first shaft and to said second shaft
so as to apply backward force on said second shaft relative to said
first shaft.
5. The method of claim 4 wherein said operating means includes
actuation means for applying forward force on said second shaft
relative to said first shaft to overcome said backward force and
move said first shaft forward.
6. The method of claim 5 wherein said actuation means comprises
a push attached to the proximal end of said second shaft.
7. The method of claim 6 further comprising a handle attached
adjacent the proximal end of said first shaft.
8. The method of claim 7 wherein said handle comprises an elongate
member extending laterally from said first shaft.
9. The method of claim 8 wherein said elongate member includes
proximally-concave indentations on opposite sides of said first
shaft for receiving first and second fingers, respectively, of the
hand of a user so that the thumb of that hand may be used to depress
said push button.
10. The method of claim 3 wherein said sharp point is formed by
a v-shaped cutting edge extending from a point on one side of said
second shaft to a position proximal therefrom on the opposite side
of said second shaft.
11. The method of claim 10 wherein said notch is formed in said
second shaft a predetermined distance proximally from said cutting
edge and has a predetermined length.
12. The method of claim 11 wherein said operating means includes
a spring connected to said first shaft and to said second shaft
so as to apply backward force on said second shaft relative to said
first shaft, and actuation means for applying forward force on said
second shaft relative to said first shaft to overcome said backward
force and move said first shaft forward sufficiently to expose said
notch.
13. The method of claim 3 further comprising a handle attached
adjacent the proximal end of said first shaft.
14. The method of claim 13 wherein said handle comprises an elongate
member extending laterally from said first shaft.
15. The method of claim 14 wherein said elongate member includes
proximally-concave indentations on opposite sides of said first
shaft for receiving first and second fingers, respectively, of the
hand of a user so that the thumb of that hand may be used to depress
said push button.
16. The method of claim 13 wherein said operating means includes
a spring connected to said first shaft and to said second shaft
so as to apply backward force on said second shaft relative to said
first shaft and a push button attached to the proximal end of said
second shaft.
17. The method of claim 13 wherein said sharp point is formed
by a v-shaped cutting edge extending from a point on one side of
said second shaft to a position proximal therefrom on the opposite
side of said second shaft.
18. The method of claim 3 wherein said operating means includes
a spring connected to said first shaft and to said second shaft
so as to apply backward force on said second shaft relative to said
first shaft and a push button attached to the proximal end of said
second shaft.
19. The method of claim 3 wherein, said first shaft is made of
a flexible material.
20. The method of claim 3 wherein said second shaft is substantially
solid and flexible.
21. The method of claim 1 further comprising, between steps (c)
and (d), the steps of (i) gripping said suture within the body of
the patient using a separate gripping means inserted into the body,
and (ii) withdrawing said needle from said muscle tissue adjacent
said first side of said wound.
22. A method for suturing muscle tissue of a patient at the site
of a wound, comprising the steps of:
(a) attaching a suture to a needle having a distal end and a proximal
end, gripping means adjacent the distal end and operating means
adjacent the proximal end for actuating the gripping means to grip
said suture, said suture being attached to said needle by said gripping
means;
(b) forcing said needle through muscle tissue adjacent a first
side of said wound so as to guide said suture therethrough;
(c) after said suture has been guided through said muscle tissue
in step (b), releasing said suture from said needle using said operating
means;
(d) withdrawing said needle from said muscle tissue adjacent said
first side of said wound after said suture has been released in
step (c);
(e) forcing said needle through muscle tissue adjacent a second
side of said would and gripping said suture within the body of the
patient using said needle; and
(f) withdrawing said needle from said muscle tissue adjacent said
second side of said wound so as to guide said suture from within
the body of the patient therethrough.
23. The method of claim 22 wherein steps (a) through (f) are repeated
until the muscle tissue at the wound is substantially closed, the
portion of the suture guided through the muscle tissue in step (f)
the suture thereafter being guided through the muscle tissue in
step (a).
24. The method of claim 22 wherein said needle comprises:
(i) an elongate, hollow first shaft having a proximal end and a
distal end;
(ii) an elongate second shaft having a proximal end and a distal
end disposed inside said first shaft, said second shaft terminating
at the distal end thereof in a sharp point and having a lateral
notch therein disposed a predetermined distance proximally from
said distal end; and
(iii) operating means disposed at the proximal end of said first
shaft for moving said second shaft forward to position said notch
beyond the distal end of said first shaft and for moving said second
shaft backward to position said notch within the distal end of said
first shaft.
25. A method for suturing muscle tissue of a patient at the site
of a wound, comprising the steps of:
(a) attaching a suture to a needle having a distal end and a proximal
end, gripping means adjacent the distal end and operating means
adjacent the proximal end for actuating the gripping means to grip
said suture, said suture being attached to said needle by said gripping
means;
(b) forcing said needle through muscle tissue adjacent a first
side of said wound so as to guide said suture therethrough;
(c) after said suture has been guided through said muscle tissue
in step (b), releasing said suture from said needle using said operating
means;
(d) gripping said suture within the body of the patient using a
separate gripping means inserted into the body; and
(e) withdrawing said needle from said muscle tissue adjacent said
first side of said wound.
Suture needle description
BACKGROUND OF THE INVENTION
This invention relates to instruments and methods for suturing
tissue, particularly for suturing abdominal (laparo) muscle tissue
and the lining of the abdominal cavity following abdominal, especially
laparoscopic, surgery.
In performing laparoscopic surgery, it is necessary to make an
incision through several layers of tissue. They are the outer layer
of skin, or epidermis, a layer of fat beneath the epidermis, a layer
of abdominal muscle tissue beneath the fat and the lining of the
abdominal cavity, called the peritoneum. Once the procedures within
the abdomen are complete, it is necessary to close the wound resulting
from the incision. This has customarily been done merely by suturing
the incision through the layer of epidermis. Closure of the skin
does not close the muscle or the peritoneum. While the muscle and
peritoneum will eventually heal, it is possible for the intestinal
and fatty contents of the cavity to protrude through the opening
thereby creating a hernia. Closure of the muscle and peritoneum
eliminates such risk.
Therefore, it is desirable first to suture the peritoneum and the
layer of abdominal muscle and thereafter to suture the layer of
epidermis. However, this is difficult to accomplish with a conventional
suture needle, even a curved suture needle, because the incision
in the skin is small. Exposure of the incision in the muscle requires
making the skin incision several times larger, defeating the concept
of minimal invasion. It is difficult to manipulate a standard needle
into the edges of the underlying muscle through the small incision
in the skin and underlying fat tissue.
Accordingly, there is a need for an improved medical instrument
and method for suturing the abdominal muscle tissue and peritoneum
at an incision therethrough.
SUMMARY OF THE INVENTION
The present invention meets the aforementioned need and solves
the aforementioned problems by providing a novel and improved medical
instrument for suturing muscle tissue, particularly the abdominal
muscle tissue together with the peritoneum. It employs an outer,
hollow shaft having a laterally-disposed, elongate handle at a proximal
end and an elongate, inner shaft disposed within the outer shaft.
The inner shaft is solid, but flexible, and has a cutting edge at
a distal end. It extends out of the outer shaft at the proximal
end, terminating in a spring-loaded push button. A lateral notch
is formed in the inner shaft adjacent the cutting edge. Ordinarily,
the spring forces the inner shaft rearwardly so as to pull the notch
within the outer shaft. By gripping the handle and placing pressure
on the push button, the inner shaft is moved forward so as to expose
the notch. A suture may then be placed in the notch so that the
instrument pulls the suture inside the outer shaft and grips the
suture between the outer shaft and the inner shaft when the push
button is released.
The instrument is used by placing a suture into the notch, securing
it by retracting the notch into the outer shaft, and forcing the
needle through the fascia, muscle and peritoneum into the abdominal
cavity. The suture is then grasped by another grasping instrument,
such as grasping forceps, inserted into the abdominal cavity through
another incision, and the suture is released from the notch by extending
the inner shaft so as to move the notch forward out of the sheath.
The instrument is then removed from the wound and reinserted on
the opposite side of the muscle incision in the same way, except
the instrument is empty. The suture previously passed through the
muscle is grasped by the instrument, which is then removed from
the incision, bringing the suture with it.
Therefore, it is a principle object of the present invention to
provide a novel and improved suturing instrument and suturing method.
It is another object of the present invention to provide a suturing
instrument which facilitates suturing the abdominal muscle tissue
and peritoneum at an incision.
It is a further object of the present invention to provide a suturing
instrument which facilitates manipulation of a suture inside the
abdomen of a patient so as to guide the suture through muscle tissue
on one side of an incision, grasp it within the abdomen, and pull
it out through muscle tissue on the other side of the incision.
It is yet another object of the present invention to provide a
method of manipulating a suture through the abdominal muscle, into
the abdominal cavity, without enlarging the associated skin incision
solely for the purpose of manipulating needles to suture the muscle
layers of the incision.
The foregoing and other objects, features and advantages of the
invention will be more readily understood upon consideration of
the following detailed description of the invention, taken in conjunction
with the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 shows a side view of a medical instrument according to the
present invention, in partial section.
FIG. 2 shows a side view of a medical instrument according to the
present invention with an inner shaft thereof forced to its forward
position.
FIG. 3 shows a side view of the tip of an inner shaft of a medical
instrument according to the present invention from a side facing
the cutting edge thereof.
FIG. 4A shows a perspective view of a medical instrument according
to the present invention, and the preferred method for use thereof
to close an abdominal wound according to the present invention.
FIG. 4B shows a perspective view of the abdominal wound of FIG.
4A following use of the medical instrument according to the present
invention to place one loop of a suture at the wound.
DESCRIPTION OF THE PREFERRED EMBODIMENT
Referring first to FIG. 1 a preferred embodiment of a medical
instrument 10 according to the present invention comprises a needle
having a first, elongate, hollow, outer shaft 12 and a second, inner
shaft 14 disposed within the outer shaft 12 the inner shaft 14
having a sharp point 16 disposed at the distal end 18 thereof and
being longitudinally movable within the outer shaft. The outer shaft
serves as a sheath for the inner shaft.
An operating means is provided at the proximal end of the outer
shaft for moving the inner shaft forward and backward. Preferably,
the inner and outer shafts each have cylindrical cross sections,
though it is to be recognized that other shapes could be employed
without departing from the principles of the invention. The operating
means comprises a push button 22 for moving the inner shaft forward
relative to the outer shaft, thereby activating the instrument,
and a spring 24 for returning the inner shaft to a rearward position
once the push button is released. The limit of the rearward position
to which the shaft is returned when the instrument is not activated
is determined by the length of the spring when it is not compressed.
The inner shaft is provided with a lateral notch 26 spaced a distance
d proximally from the sharp point 16 of the inner shaft, the purpose
of moving the inner shaft forward relative to the outer shaft 12
being to expose the notch 26 as shown in FIG. 2. Preferably, the
notch has a rectangular shape of predetermined width w, as shown
in FIGS. 1 and 2. The distance d and the width w of the notch are
chosen so that when the push button is released the notch is drawn
entirely within the outer shaft, or sheath, and when the push button
is fully depressed, the notch is entirely exposed.
In addition, a handle 28 is connected to the distal end of the
outer shaft 12 to enable the user to grip the instrument. The handle
is in the shape of an elongate, rectangular prism disposed symmetrically
about the proximal end of the outer shaft 12. Also, the handle 28
is provided with a pair of proximally concave indentations 30 and
32 respectively, disposed on opposite sides of the shaft 12. That
is, the distal side of the handle is indented in the proximal direction.
These permit the user to place two fingers in the respective concave
indentations and the thumb of the same hand of the user on the end
of the push button 22 to manipulate the instrument. By pressing
down on the thumb, the inner shaft is extended to expose the notch
26 thereby activating the instrument.
Turning to FIG. 3 as well as FIGS. 1 and 2 the sharp point preferably
is formed by a cutting edge 34 extending from the distal tip of
the shaft 14 along one side thereof rearwardly toward the proximal
end of the shaft. The cutting edge may be formed by grinding the
end of the inner shaft 14 to achieve the shape shown in FIGS. 1
2 and 3.
Preferably, the inner shaft 14 is substantially solid clear through
and made of a flexible metal suitable for surgical use. However,
it is to be recognized that the shaft 14 need not be entirely solid,
provided that it has sufficient rigidity and resiliency that it
will flex to fit into position for use, yet return to its original
shape and transmit adequate force from its proximal end to its distal
end to cut and be pushed through the abdominal muscle. The outer
shaft primarily serves as a sheath for the notch 26 and is preferably
made of a suitable flexible material, such as plastic, so as to
deform to allow a suture placed in the notch to be pulled into the
outer shaft by the inner shaft. If the outer shaft material is relatively
thick, as may be the case where plastic is used, the outer shaft
should preferably have a taper 19 at the distal end to facilitate
forcing the instrument through tissue.
It is to be recognized that other materials, a different type of
handle and a different type of operating means for moving the inner
shaft forward and backward may be used without departing from the
principals of the invention.
The method of use of the instrument 10 is illustrated in FIGS.
4A and 4B. In those figures, an incision 36 in the abdomen 38 of
a patient is shown. Along one side 40 of the incision four layers
of tissue can be seen, that is, the epidermis 42 a layer of fat
44 a layer of muscle 46 and the peritoneum 47. The upper edge 48
of the epidermis is shown on the opposite side of the incision,
along with the upper edge 50 and lower edge 51 of the muscle, by
hidden lines.
Referring first to FIG. 4A, in use of the instrument, the distal
end 18 is forced beneath the epidermis 42 into the fatty tissue
44 and through the muscle 46 and peritoneum 47 as shown at 52.
The sharp point 16 starts a cut through the muscle tissue and peritoneum,
which is completed by the cutting edge 34 providing a small opening
adequate for receiving the outer shaft 12. Typically, the user would
place a thumb or other finger on the push button 22 to keep the
inner shaft 14 from being pushed further back into the outer shaft
12.
Referring back to FIGS. 1 and 2 in the first instance the push
button 22 is depressed as shown in FIG. 2. A suture, such as suture
53 shown in FIG. 4A, is then placed in the notch 26. Thereafter,
the push button 22 is released so that the spring 24 draws the inner
shaft backward through the outer shaft 12 until the suture 52 is
pulled back into the outer shaft 14 and gripped between the inner
shaft 14 and the outer shaft 12 as shown in FIG. 4. It is to be
recognized that, in FIG. 4A, the suture is shown gripped inside
the abdomen, as explained hereafter, but that initially the suture
would be gripped outside the abdomen to begin the suturing process.
Once the suture is gripped by the instrument, the instrument is
forced through the muscle tissue 46 as previously explained, at
a starting point for suturing the muscle. In FIG. 4A that starting
point is shown at 54 where the suture 53 runs through the muscle
tissue. Indeed, forcing the instrument 10 through the muscle tissue
46 also guides the suture through the resulting opening.
More specifically, the instrument is used as follows. After placing
a suture 53 into the notch 26 and securing it by retracting the
notch into the outer shaft, the instrument is grasped by the handle
28. The pointed end of the needle is placed through the incision
in the skin and underlying fat, engaging the facial covering of
the muscle on one side of the incision. Sufficient pressure is applied
to force the needle through the fascia, muscle and peritoneum into
the abdominal cavity. The suture 53 is then grasped by another grasping
instrument 55 such as grasping forceps, inserted into the abdominal
cavity through another incision, and the suture is released from
the notch by extending the inner shaft so as to move the notch forward
out of the sheath. The instrument is then removed from the wound,
leaving the suture in place at 54 in FIG. 4A.
Thereafter, the instrument is reinserted on the opposite side of
the muscle incision at 52 in FIG. 4A in the same way, except that
the instrument is empty. The suture previously passed through the
muscle, and now being held by the separate grasping instrument 55
is placed into the notch by the separate grasping instrument 55.
The push button of the instrument is pressed to expose its notch
26 which is manipulated over the suture inside the abdomen, and
the push button is released to grip the suture inside the abdomen,
as shown in FIG. 4A. The instrument is then removed from the incision,
bringing the suture with it. The suture has thereby been placed
through the desired tissues and both ends exit the skin incision
so that the suture is ready to be tied, as shown in FIG. 4B.
It is to be recognized that, while the procedure described above
is the preferred method of using the instrument, variations in these
steps might be used without departing from the principles of the
invention.
The terms and expressions which have been employed in the foregoing
specification are used therein as terms of description and not of
limitation, and there is no intention in the use of such terms and
expressions of excluding equivalents of the features shown and described
or portions thereof, it being recognized that the scope of the invention
is defined and limited only by the claims which follow. |