Suturing aid

Details Suturing aid Suturing aid

1999-05-03

2001-10-02

Recla, Henry J. (Department: 3731)

Surgery

Instruments

Suture, ligature, elastic band or clip applier

Reexamination Certificate

active

06296648

ABSTRACT:

The present invention relates to a suturing aid for closing minilaparotomies from minimal-invasive surgical operations.
Minimal-invasive surgery has become widely accepted in recent times. Especially laparoscopic operations are almost exclusively carried out by minimal-invasive surgery techniques, due to their outstanding advantages for both, patient and surgeon.
In the case of this operating technique guide sleeves, also known as trocar sleeves, which accommodate a pointed mandrel, also known as trocar mandrel, are introduced, for example, into the abdominal cavity through the abdominal wall. After the trocar mandrel has been pulled off, it is then possible to insert endoscopes and surgical instruments through the sleeve into the operating area. In complicated operations, more than one trocars can be introduced at different points. The surgeon can then perform the operation under visual control, in the abdominal cavity that has been opened only through small punctures.
Upon completion of the operation, the instruments and, thereafter, the trocar sleeve are removed. The remaining wounds, known as minilaparotomies, are small, but penetrate the entire abdominal wall, i.e. the skin, the hypodermis and the muscular coat, the muscles and the peritoneum.
Initially, one used to let the minilaparotomies remaining with that operation technique unclosed, but this led to the formation of hernia, sometimes combined with visceral or enteric encarceration, comparable with inguinal hernia, umbilical hernia or postoperative hernia. One therefore developed instruments with the aid of which minilaparotomies can be closed.
An instrument for closing trocar wounds is known from U.S. Pat. No. 5,474,568.
This instrument comprises a long shaft that carries a scissors-like handle on its proximal end. In the area of the distal end, there are provided needles that carry a thread and that are bent to an approximately semicircular shape and can be swung out laterally. The long thin shaft is pushed through the trocar wound, with the needles in the retracted position in which they do not radially project beyond the contour of the shaft. Once introduced into the body, the needles are extended laterally and penetrate into the abdominal wall from its bottom surface, pulling the thread with them, until the point of the curved needle reaches and engages the shaft body. During the returning motion, the curved needle body as such is detached from the engaged point, and the thread held by it. The device is then pulled off, and the thread is knotted.
Thus, this instrument works as a true suturing device.
It is a disadvantage of that device that the surgeon does not know the moment when the shaft or its distal area has just penetrated the entire abdominal wall, but has not yet entered any other organs located below the abdominal wall. one must realize in this connection that once the trocar sleeve has been pulled off, it is no longer possible to visually observe and control the suturing process in the body.
A similar suturing device, comprising curved needles or needle holders that can be swung out laterally, is known from U.S. Pat. No. 5,364,408.
DE-C-4 210 724 describes a surgical actuating device having an elongated shaft portion from which spreading elements can be laterally extended in a plane vertical to the shaft axis. The motion of the spreading elements, that can be extended in a radial plane, is effected by rotation of a shaft extending through the shaft portion. According to one embodiment it is provided to arrange on the outer points of the spreading elements upright needles capable of penetrating through the abdominal wall. This device again works as a suturing device and provides the risk that surrounding organs may get damaged by the radial movement in a radial plane.
An organ manipulator known from DE-A-4 021 153 comprises a spreading body consisting of a multi-joint lever system with articulated arms that are pivotally connected one with the other, for being moved between an elongated position, in which it can be introduced into the body cavity, and an expanded position, where the arms form together a triangular flat shape. This organ manipulator serves exclusively the purpose to expose organs inside a body cavity.
So, to this day, the problem of closing minilaparotomies has not been technically solved in a satisfactory way.
Due to the small incision in the skin, with a diameter in the range of approximately 10 to 15 mm, and the thickness of the abdominal walls, which is in the range of several centimeters, the operator has poor control of all layers of the abdominal wall that have to be closed. Closing the layers of an abdominal wall, without visual inspection, with the aid of thread and needle or special clips, is very risky and would be irresponsible because of the existing risk of damage.
Now, it is the object of the present invention to provide an auxiliary device for closing minilaparotomies that makes it easier for the surgeon to apply a suture and that prevents damage during the closing of minilaparotomies.
The invention solves this object by a suturing aid having a shaft whose distal end is provided with at least one plane support, that can be swung out laterally, and an actuating element for swinging out the support, whereby the support can be moved between a working position in which it is folded up towards the proximal end, a working position in which it is folded out laterally, and a working position in which it is folded down towards the distal end.
The term “plane support” as used in the context of the present invention is meant to describe any two-dimensional structure either resembling a plate, or in the form of a plate, or in the form of a grid or grate, which ultimately can be applied flat against the bottom face of an abdominal wall. The term “plane” includes slightly curved surfaces or waved surfaces.
The term “support” not only means that something, for example the suturing device as such, can be placed upon that surface, but also means that the support can be placed against a part of a body.
The term “swinging out laterally” as used in the context of the present invention means that the support can be moved in outward direction, or folded out laterally, with respect to the longitudinal axis of the shaft.
The term “working position in which it is folded up towards the proximal end” is meant to describe a position of the support in which the free outer end of the support is closer to the proximal end than its axis of rotation, viewed from the distal end towards the proximal end along the shaft axis.
The term “working position in which it is folded out laterally” is meant to describe a position of the support in which its plane forms an angle of approximately 90° with the shaft axis.
The term “working position in which it is folded down towards the distal end” is meant to describe a tilted position in which the support has been pivoted by more than 90° relative to the working position mentioned first, being folded up towards the proximal end, i.e. in which its outer end, viewed from the distal towards the proximal end, is positioned below its axis of rotation.
Due to this arrangement, it is now possible to fold the support up into a position in which it closely rests against the shaft, so that the shaft and support assembly can be introduced through the minilaparotomy in a way similar to the point of an arrow. As long as the support remains inside the wound channel, that leads through the abdominal wall, it cannot be swung out laterally, which can be recognized by the surgeon simply by the fact that the actuating element, which serves to swing out the support, cannot be moved.
When the support has penetrated for example the abdominal wall, the uppermost folded up end of the support is the last element of the support to leave the wound channel. Once this position has been reached, the support can be swung out relative to the shaft from the bottom face of the abdominal wall towards the interior of the body. This safely prevents, on the one hand, any parts of the body from being cau

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