Surgery – Instruments – Tweezers
Reexamination Certificate
1999-11-08
2001-09-04
Reip, David O. (Department: 3731)
Surgery
Instruments
Tweezers
C606S205000, C606S207000
Reexamination Certificate
active
06283984
ABSTRACT:
BACKGROUND
1. Technical Field
The present disclosure concerns a device for drawing together opposite sides of an incised dura, and more particularly, to dural closing forceps for use in closing the dura after a durotomy.
2. Background of the Related Art
The dura is a tough protective membranous covering surrounding the central nervous system including the spinal cord and related nerve bundles. Surgery involving the dissection of the dura, a durotomy, is often required when operating on the brain or spine. A durotomy allows the surgeon to approach particular nerve structures for definitive dissection.
The central nervous system including the spinal cord and related nerve bundles are all constantly bathed in cerebrospinal fluid (CSF) all of which are encased by the dura. The CSF is constantly under pressure within the dura, this CSF pressure increases with certain disorders of the nervous system or by an erect posture of the head. The CSF is manufactured from circulating arterial blood passing through specialized filtration glands deep within brain cavities. The CSF then leaves the cavities and flows downward over the spinal structures by motion of the spine and pulsation of blood vessels. The CSF then flows back into the brain cavities where it is reabsorbed back into the body's circulatory system.
After the dura has been incised and the surgical procedure on the underlying nerve structures is performed, the dura must be closed to prevent any further escape of CSF. If the CSF leaks are not halted, the patient may have severe, persistent, disabling headaches. In some cases the durotomy may permit bacterial invasion resulting in life threatening meningitis. Water tight closure or sealing of durotomies is therefore an important aspect of neurosurgical practice.
Upon leakage of the CSF, nerve filaments or fragments of other, softer covering membranes are frequently flushed out and protrude beyond the margins of the durotomy. These filaments or fragments must be replaced and retained inside the dura as it is closed by the surgeon. Closing or sealing the dura after a durotomy requires retaining the filaments or fragments within the dura and holding the dural margins tightly together, aspirating the escaping fluid and obscuring blood while keeping the nerves and fragments from being caught into the closing seal and applying the sutures or clips. Optical magnification, often by a surgical microscope, is generally needed in order to complete the tedious procedure. It is quite clear that surgeons must possess considerable skill to effect a water tight closure of certain complex durotomies. Fortunately, once the dura is well closed, the margins are quickly sealed over with blood clots and-new tissue growth begins in a matter of hours permanently closing the durotomy in a matter of days.
Closing the dura can be quite difficult. It is usually performed using very small needles and sutures and specialized, fine-tipped grasping instruments. These instruments are necessary to hold together the incised or torn margins of the durotomy while the curved needle is passed through the two opposing dural margins or edges. The needle tracts or holes frequently create additional puncture sites through which CSF may leak or even squirt out. To make matters even more complex, the dura is protected by being surrounded with bony coverings such as the skull or the neural arches of the spine. Therefore, in order to operate on the brain or spine, bone material must be removed from the surgical site.
Closing the durotomy site also requires the removal of additional bone material, the extent of which relates generally to the space required to pass the curved needle through the incised dural margins. The margins which are torn or ragged result in excessive bleeding inside and around the dura thereby bringing blood into the surgical field and partially obscuring the durotomy surgical site.
A simplification of the durotomy closure procedure has been provided by United States Surgical Corporation (USSC) with small “C” shaped clips made from surgically implantable grade titanium. These clips are dispensed from a miniature surgical instrument called a clip applier also made by USSC. The clips do not perforate the dura but rather, hold the dural margins tightly together to halt the leak and promote dura regrowth. This instrument has been adapted from the larger clip appliers also made by USSC which are widely used in blood vessel surgery. The dural closure clips are generally available in sizes of 1.4 mm, 2 mm and 3 mm (outside diameters). Simple holding forceps are also provided by USSC to hold the durotomy margins together while the clips are being applied. An additional instrument is provided for opening and removing the clips.
Notwithstanding the ease of use of the dural clip applier and the holding forceps, suitable closure of the dural margins prior to applying the clips can still be a difficult task. The embodiments of the present disclosure solve these and other associated problems and provides a simple and easily applied instrument to draw together the dural margins while retaining the necessary nerve filaments and fragments inside the dura as it is closed by the surgeon.
SUMMARY
The present disclosure is directed to surgical forceps for use in closing a dural incision. The forceps include a pair of extension members cantilevered at a proximal end thereof and a central member disposed between the extension members, wherein the extension members and the central members are coupled together at the proximal end. The central member includes a foot glide transverse to a longitudinal axis thereof and positioned distally of the extension members, wherein the foot glide includes an intradural supporting surface for maintaining intradural tissue within a dura during a dural closing procedure. The foot glide further includes a rear portion and a front portion, wherein the front portion has a length greater than a length of the rear portion. The extension members include teeth for grasping tissue, wherein the teeth are disposed along a distal end of each extension member. The central member and each extension member includes a finger pad area. Each extension member is dimensioned and configured to move relative to the central member wherein movement of each extension member toward the central member results in a gripping force between the central member and each extension member at a distal end thereof.
Also disclosed is surgical forceps for joining tissue on opposed sides of an incision. The forceps include a pair of extension members, wherein each extension member includes tissue engaging projections at a distal end thereof and are dimensioned and adapted to engage tissue on respective opposed sides of the incision. A central member is disposed between the extension members and defines a longitudinal axis, wherein the extension members are coupled to the central member at the proximal end thereof. The central member includes a foot glide disposed at a distal end of the central member, wherein the foot glide defines a retaining surface dimensioned to retain tissue within the incision and is positioned distally of the extension members. The foot glide further includes a rear portion and a front portion, wherein the front portion has a length greater than a length of the rear portion. The extension members are adapted for movement relative to the central member whereby movement of the extension members toward the central member causes the tissue engaging projections to engage and draw the tissue on the opposed sides of the incision toward each other in a general approximated relation. The central member also includes opposed longitudinal support surfaces, wherein in the approximated relation of the tissue, the tissue is held between the tissue engaging projections of the extension members and the respective longitudinal support surfaces of the central member. The tissue securing projections further include at least one tooth projection for grasping tissue. The extension members and the central member each include a
Reip David O.
Tegementa, LLC
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