Surgery – Instruments – Suture – ligature – elastic band or clip applier
Reexamination Certificate
1999-12-13
2001-12-18
Jackson, Gary (Department: 3731)
Surgery
Instruments
Suture, ligature, elastic band or clip applier
C606S146000, C606S148000
Reexamination Certificate
active
06331182
ABSTRACT:
BACKGROUND OF THE INVENTION
This invention relates to a method for forming a surgical closure. This invention also relates to a device for use in the method. More specifically, this invention relates to a surgical instrument and an associated method for forming a closure in organic tissues of a patient in a minimally invasive endoscopic operation. The invention is useful in laparoscopic, arthroscopic, thoracoscopic, etc., procedures.
Minimally invasive surgical procedures such as laparoscopy, arthroscopy, thoracoscopy, etc., use endoscopes (laparoscopes, arthroscopes . . .) for enabling visual observation of a surgical site below the patient's skin surface. These minimally invasive operations generally entail the placement of one or more cannulas in the patient's skin. The cannulas penetrate to the surgical site and various instruments are inserted through the cannulas to perform an operation on organic tissues which remain mostly covered by the skin surfaces of the patient.
A continuing problem in such minimally invasive operations is the formation of surgical closures inside the body. The suturing of an incision, the closure of a wound or the ligating of a tube inside the body through endoscopic cannulas is a difficult and tedious task. Various methods have been proposed for simplifying and facilitating the formation of sutures. U.S. Pat. No. 5,037,433, for example, discloses a method for performing a surgical operation on internal body tissues of a patient which comprises the steps of inserting a tubular endoscope member through an aperture in the patient's body, using the endoscope to visually locate the internal body tissues inside the patient's body, and upon locating the surgical site, pushing an elongate flexible rod member in a distal direction through a biopsy channel in the tubular endoscope member to eject a needle disposed in a straightened configuration inside the channel at a distal end of the tubular endoscope member. In this method, the needle has a spring bias construction tending to automatically bend the needle into an arcuate configuration, and the needle further has a proximal end attached to a suture. Upon ejection of the needle from the endoscope biopsy channel, the needle is passed in the arcuate configuration through the internal body tissues. After passing of the needle through the internal body tissues, the suture is closed, whereupon the tubular endoscope member is withdrawn or removed from the patient's body though the introduction aperture.
Other recently proposed methods entail the tying of sutures outside the body and sliding the suture ties down through a cannula to the surgical site inside the patient.
Nevertheless, despite these recent proposals, no method has been generally adopted by surgeons who regularly perform minimally invasive surgical operations.
OBJECTS OF THE INVENTION
An object of the present invention is to provide an instrument and/or an associated method for forming a surgical closure inside a patient through a small opening in the skin surface of the patient.
Another object of the present invention is to provide such an instrument and associated closure method which is easy to use.
A further object of the present invention is to provide such an instrument and associated method which result in a reliable closure.
These and other objects of the present invention will be apparent from the drawings and descriptions herein.
SUMMARY OF THE INVENTION
These objects are attained in a procedure wherein an elongate, at least partially flexible tie member is partially wound about tissues to be closed at a surgical site. Opposite ends of the flexible tie element are entrained by a twisting instrument which has a distal end juxtaposed to the surgical site. The twisting instrument extends out of the patient so that a proximal end of the instrument is manipulable by a surgeon. The surgeon rotates the instrument about a longitudinal axis, thereby twisting the tie member multiple turns about itself.
Where the tie member is a wire, the twisting effectively locks the tie member at the surgical site. The tie member may then be severed by a cutters so that the tissues are closed.
Where the tie member is a suture, the suture may be locked after the twisting operation by placing a clamp or clip on the twisted portion of the suture. The clamp or clip may be a welded clip as disclosed in U.S. Pat. No. 5,383,883, the disclosure of which is hereby incorporated by reference. The locking of the suture may additionally or alternatively be effectuated through the application of glue. A glue gun or ejector may be used to apply a drop of glue to the twisted part of the suture prior to the severing of the suture. Alternatively, the glue may be dried on the suture and subsequently activated by a heating instrument.
In one embodiment of the present invention, the twisting instrument has a pair of pivoting jaws at a distal end. The jaws are provided with a passageway for the tie member. The instrument is inserted into the patient and the jaws opened and subsequently closed about the tissues (e.g., a blood vessel or duct). After the closure of the jaws inside the patient, an end of the tie member is threaded from one jaw to another and gripped by the second jaw. The jaws are then opened and pulled away from the surgical site. The tie member slides out of the first jaw during the opening of the jaws and during the withdrawal of the instrument from the surgical site. Thus, a loop is formed about the tissues to be closed. The instrument is then turned about its longitudinal axis, thereby twisting the tie member between the jaws and the target tissues of the patient. Where the tie member is a wire, the twisting effectively locks the tie member at the surgical site. Where the tie member is a suture, the suture is locked after the twisting operation by an additional procedural step such as placing a clamp or clip and/or gluing. After locking, the tie member is severed by a cutters so that the tissues are closed.
Other types of twisting devices may be used to perform a surgical closure operation in accordance with the present invention. For example, an elongate tube provided at a distal end with a pair of eyelets, or a pair of hooks, may be used for twisting a wire or suture after the wire or suture has been partially wound around tissues to be closed. This winding can be accomplished with elongate forceps-type instruments commonly used in minimally invasive endoscopic operations.
REFERENCES:
patent: 4935027 (1990-06-01), Yoon
patent: 5501690 (1996-03-01), Measamer et al.
patent: 5797927 (1998-08-01), Yoon
patent: 6096051 (2000-08-01), Kortenbach et al.
patent: WO 2000 12013 (1999-08-01), None
Tiefenbrun Jonathan
Wilk Peter J.
Coleman Henry E.
Jackson Gary
Sapone William J.
Sudol R. Neil
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