Surgery – Instruments – Suture – ligature – elastic band or clip applier
Reexamination Certificate
1999-10-25
2001-08-07
Jackson, Gary (Department: 3731)
Surgery
Instruments
Suture, ligature, elastic band or clip applier
C606S207000, C606S208000
Reexamination Certificate
active
06270508
ABSTRACT:
The present invention relates generally to the field of surgical instruments. In particular, it relates to an end effector of a surgical instrument for use in endoscopic surgical procedures.
BACKGROUND OF THE INVENTION
Endoscopy is a minimally invasive surgical procedure and includes, among other procedures, laparoscopy, thoracoscopy, and arthroscopy. Endoscopic procedures involve viewing the interior of the body using an illuminated optical instrument, referred to as an endoscope. The endoscope and other surgical instruments for operating on tissue inside the body enter the body through ports placed in small incisions in the skin.
Endoscopic procedures are typically conducted using specialized surgical instruments that have been adapted to perform general surgical procedures endoscopically. Endoscopic surgical instrument end effectors often take the form of a scissors, dissectors, or scissoring jaws, attached to the distal end of a rigid shaft. A handle attached to the proximal end of the shaft has a mechanism for operating the end effector. An operating linkage inside the shaft connects the handle to the end effector. The handle may also have a second mechanism for rotating the shaft and end effector.
Suturing is the preferred method of tissue approximation in endoscopic procedures. Suture needles are typically curvilinear in shape to facilitate stitching. One end of a suture needle is sharpened, and suture thread is attached to the other end of the needle. Because of restrictions on space and on instrument orientation, suture placement and tying of the suture thread involve difficult and awkward movements, making the process of suturing both lengthy and tedious. Surgical needle holders and needle drivers designed for endoscopic procedures generally have taken the form of an elongated tool designed to hold the suture needle rigidly and immovably in the surgical instrument. These holders and drivers enable the surgeon to hold and push the needle through tissue, but do not give the surgeon good needle mobility.
While the holders or drivers are typically comprised of a pair of jaws, they can take other forms, such as a gripper and anvil. A needle is typically grasped by the jaws midway between the tip of the needle and its tail. When a needle is first grasped in the jaws of a traditional needle holder, the needle may curve in any direction, whether upward, downward, distally, or proximally. In practice, the surgeon uses a second instrument, such as a forceps, a dissector, or another needle holder, to grasp and help orient the needle before suturing. This practice can be awkward and slow, and can also result in errors.
As surgeons become more proficient in conducting minimally invasive surgery, they are attempting to conduct more difficult and complex procedures laparoscopically. These newer procedures often require accurate suture placement. Present laparoscopic needle holders hold the needle firmly, but do not allow the operator to reorient the needle easily. In open surgery, where access is not restricted, this is not a problem. However, where access becomes restricted, such as in endoscopic procedures, needle re-orientation by the needle holder becomes more important.
SUMMARY OF THE INVENTION
In general, an end effector in accordance with the present invention includes a needle roller attached to a handle portion of a surgical instrument by an elongated tubular barrel. A handle on the handle portion may provide for holding the instrument and may also provide natural and precise control for grasping, rotating, and rolling a needle. The tubular barrel may be rotatably connected to the handle, and the needle roller may be disposed at the distal end of the tubular barrel. The handle may be configured to give full independence between the actions of rolling the needle, gripping the needle, and rotating the needle about the axis of the tubular barrel. Two linkage members may be disposed along the inner length of the tubular barrel and connect the end effector pieces with controls in the handle. In one embodiment, the end effector is plier-like and includes two jaws. The first jaw is pivotably attached to a pin affixed to the distal end of the tubular barrel. The first jaw is also coupled to the distal end of the first linkage member so that axial motion of the first linkage member causes the jaw to pivot open or closed.
In operation, the needle is grasped between the two jaws by pivoting the first jaw toward the second jaw. The first jaw is pivoted by pulling the first linkage member in a proximal direction. The first linkage member is coupled, at its proximal end, to a control actuator, in the form of a thumb trigger lever, mounted on the handle. When the thumb trigger lever is squeezed toward the handle, the first linkage member slides proximally inside the tubular barrel and thereby closes the first jaw. A trigger lock may also be provided to lock the thumb trigger lever to the handle and thus allow the surgeon to grasp and lock the jaws onto a needle.
The second jaw is a sliding jaw and is attached to the distal end of the second linkage member. The second jaw slides axially along with the second linkage member. Such axial motion of the second jaw causes a needle held between the jaws to roll. The second linkage member may be moved by operating a fingerwheel, a fingerloop, or a fingertrigger, in the handle, to which the second linkage member may be operably connected. The fingerwheel, when rotated by the surgeon's index finger, or the fingerloop or fingertrigger, when pushed or pulled by the surgeon's index finger, thus translates the second jaw.
The handle assembly may also take the form of a servomotor-powered set of actuators. Servomotors may be coupled to the tubular barrel and to each of the linkage members. The servomotors may be mounted transversely to the longitudinal axis of the tubular barrel or may be mounted parallel to the rotational axis of the tubular barrel.
The jaw surfaces may be coated with a high friction or abrasive surface to better hold the needle. The coating serves both to permit the jaws to grip the outside of the needle to facilitate rolling of the needle, and also to hold the needle securely in place to permit the surgeon to push the needle without it sliding in the jaws.
Suturing may also be aided by axial rotation of both jaws, i.e., rotation about the longitudinal axis of the tubular barrel. The tubular barrel is rotatably attached to the handle but is restrained from moving axially. Rotation is accomplished by, for example, applying rotational force with the index finger to a rotation knob attached to the tubular barrel, or by operating a servomotor coupled to the tubular barrel. Because the first jaw pivots on a pin that is attached to the tubular barrel and the second jaw extends from the tubular barrel, both jaws rotate when the tubular barrel rotates.
The jaws may also be provided with opposing internal pockets on their faces. Flat jaws often cause excess stress on a curvilinear needle because they force the portion of the needle that is between the jaws to straighten. In a disclosed embodiment, small recesses, or pockets, are formed on the interior surfaces of the jaws. A needle is allowed to curve slightly into these pockets and therefore undergoes less overall stress than if there were no pockets.
A device in accordance with the present invention can be capable of positioning a needle within the limited space provided by an endoscopic procedure. The device may also provide a simple, robust mechanism for achieving the needle-rolling function. The device may be reusable utilizing standard sterilization means, such as steam, gas, or soaking. The device is simple, yet it may provide precise and intuitive one-handled controls for changing the direction of curve of a needle, for rotating the needle, and for rigidly grasping the needle.
In one embodiment, a surgical instrument used in laparoscopy is provided, comprising a tubular member having a proximal end and a distal end, a first end effector piece pivotably mounted to the tubular
Klieman Charles H.
Needleman David
Stiggelbout John M.
Fish & Richardson P.C. P.A.
Jackson Gary
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