Surgery – Instruments – Suture – ligature – elastic band or clip applier
Patent
1996-11-29
1998-05-26
Jackson, Gary
Surgery
Instruments
Suture, ligature, elastic band or clip applier
606167, 606170, A61B 1704
Patent
active
057557306
DESCRIPTION:
BRIEF SUMMARY
This invention relates to a device for use in cutting threads. It is particularly for use in cutting threads during surgery, and, more particularly, in surgery carried out using an endoscope. A primary intended field of application of the invention is in surgery carried out using a flexible endoscope, though it is applicable also to surgery where a rigid endoscope is used.
In conventional surgery, the threads used, for example, in forming sutures, are normally cut using scissors. However, this option may not be open to someone carrying out surgery down a flexible endoscope. In such surgery the surgical tools used are located at the distal end of the endoscope, and must normally be manipulated by control means extending down a channel in the endoscope. Manipulating conventional scissors in this way is at least difficult, and may be impossible. It is also known to use a guillotine, but no satisfactory guillotine is believed currently to exist for endoscopic use.
According to the present invention there is provided a device for use in cutting a surgical thread, which comprises a cutting member having at least one aperture extending therethrough of a size sufficient to permit the surgical thread to slide therethrough, the aperture having a thread-cutting edge, and means for enabling the cutting member to be located at the distal end of an endoscope.
An embodiment of the invention will now be described in more detail, with reference to FIGS. 1 to 4 of the accompanying drawings, which show successive stages in the use of the embodiment.
FIG. 1, like the other drawings, is diagrammatic, and shows the distal end portion of an endoscope 1 having a biopsy channel 2 through which a thread cutter according to the present invention can pass. In practice, of course, the endoscope would have other features, for example a viewing channel, but these are not shown and are assumed to be conventional.
The thread cutter according to the present invention comprises a cutting member 3 mounted on the distal end of a flexible wire 4. By way of example, the wire 4 can be a 1 mm wire made of steel of a surgically acceptable type. In an alternative embodiment, the wire 4 may be replaced by a Bowden cable. The proximal end of the wire is fixed in a mounting member 5, which is of a suitable size and shape to be grasped by the surgeon during use of the thread cutter. The wire 4 is surrounded by a plastics tube 6 which is not connected either to the cutting member 3 or the mounting member 5, and in which the wire 4 is freely slidable. The tube 6 is preferably made of polytetrafluoroethylene, or other material having a low coefficient of friction, and is intended to enable the cutting member and its wire to be readily passed down the channel 2, and withdrawn therefrom. It must be kept in mind that, in practice, the endoscope 1, when in position in a patient, will have a number of bends in it, and care therefore needs to be taken to ensure that the cutting member and its wire can move freely along the channel 2, despite the presence of these bends.
The cutting member 3 is provided with two apertures 7 which extend from the front face 8 to the side wall 9. The cutting member 3 is preferably cylindrical in shape, and the apertures 7 are preferably circular in cross-section. The apertures must be of such a size that a surgical thread can slide therethrough, and it has been found convenient to use apertures having a diameter of 0.6 mm. Where the apertures emerge through the side wall 9 the circular cross-section of the apertures will give rise to an opening which is elliptical in shape. The curved distal portion of each elliptical opening provides an arcuately curved cutting edge for cutting the thread, as will be explained further below.
The drawings show an example of the use of the cutting device of the present invention, in which the surgeon has inserted a surgical thread 10 through a U-shaped piece of a patient's tissue 11 and has tied a knot 12 therein. The procedure used to do this has left the two thread tails 13 extending through a pa
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Gong Feng
Mills Timothy N.
Swain Paul
Bookstein Arthur Z.
Jackson Gary
Perullo John F.
University College London
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