U.S. patent application number 10/529567 was filed with the patent office on 2006-02-16 for surgical suturing apparatus with measurement structure.
This patent application is currently assigned to TYCO HEALTHCARE GROUP LP. Invention is credited to Kevin Clair, Michael Primavera.
Application Number | 20060036232 10/529567 |
Document ID | / |
Family ID | 32093806 |
Filed Date | 2006-02-16 |
United States Patent
Application |
20060036232 |
Kind Code |
A1 |
Primavera; Michael ; et
al. |
February 16, 2006 |
Surgical suturing apparatus with measurement structure
Abstract
There is disclosed suture manipulating instrumentation having
measuring structure to determine the length of suture during a
given point in a surgery. The instrument is preferably a surgical
suturing instrument capable of manipulating a suture carrying
needle at the distal end. The measuring structure in the form of a
scale is provided on the suturing instrument at a location remote
from the distal end. The length of suture can easily be determined
with the use of the scale at any point during a surgery. There is
also disclosed a kit for providing the suture measuring structure
on other suture manipulating instruments, as well as, methods of
using suture manipulating instrumentation having the disclosed
measuring structure.
Inventors: |
Primavera; Michael;
(MILFORD, CT) ; Clair; Kevin; (Easton,
CT) |
Correspondence
Address: |
Paul R Audet;US Surgical a divison of
Tyco Healthcare Group
150 Glover Avenue
Norwalk
CT
06856
US
|
Assignee: |
TYCO HEALTHCARE GROUP LP
|
Family ID: |
32093806 |
Appl. No.: |
10/529567 |
Filed: |
October 6, 2003 |
PCT Filed: |
October 6, 2003 |
PCT NO: |
PCT/US03/31640 |
371 Date: |
March 28, 2005 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
60416058 |
Oct 4, 2002 |
|
|
|
Current U.S.
Class: |
604/411 |
Current CPC
Class: |
A61B 2017/06047
20130101; A61B 2017/0609 20130101; A61B 17/0469 20130101; A61B
2017/2901 20130101; A61B 2090/061 20160201; A61B 17/29
20130101 |
Class at
Publication: |
604/411 |
International
Class: |
A61M 5/32 20060101
A61M005/32 |
Claims
1. A surgical instrument for manipulating a needle and suture
comprising: an elongate member having a distal end configured to
manipulate a needle and suture; a scale on at least a part of the
elongate member and extending from the distal end, the scale having
at least one graduation; and a predetermined point on the elongate
member, wherein the scale indicates the distance from the
predetermined point to the at least one graduation.
2. The surgical instrument as recited in claim 1, wherein the
elongate member includes at least one jaw and the predetermined
point is disposed on the jaw.
3. The surgical instrument as recited in claim 2, wherein the at
least one jaw has a recess configured to retain a needle carrying a
suture and the predetermined point is located on the needle.
4. The surgical instrument as recited in claim 2, wherein the at
least one jaw has a recess configured to retain a needle carrying a
suture and the predetermined point is located at a point of
connection between the suture and the needle.
5. The surgical instrument as recited in claim 4, wherein the point
of connection is at one end of the needle.
6. The surgical instrument as recited in claim 4, wherein the point
of connection is located between the ends of the needle.
7. The surgical instrument as recited in claim 2, wherein the at
least one jaw is movable relative to the elongate member, wherein
the distance from the predetermined point and the scale is
calibrated with the at least one movable jaw in a predetermined
position.
8. The surgical instrument as recited in claim 7, wherein elongate
member includes two movable jaws.
9. The surgical instrument as recited in claim 8, wherein the two
movable jaws are configured to pass a needle carrying a suture
therebetween.
10. The surgical instrument as recited in claim 1, wherein the
scale includes a plurality of graduations.
11. The surgical instrument as recited in claim 1, wherein the
scale is provided on a material affixed to the elongate member.
12. The surgical instrument as recited in claim 11, wherein the
scale is located on shrink wrap affixed to the elongate member.
13. The surgical instrument as recited in claim 11, wherein the
scale is located on at least one longitudinally extending strip of
material.
14. The surgical instrument as recited in claim 11, wherein the
scale is etched into the elongate member.
15. The surgical instrument as recited in claim 1, wherein the at
least one graduation indicates the distance in centimeters.
16. The surgical instrument as recited in claim 1, wherein the at
least on jaw is configured for grasping a needle carrying a
suture.
17. A kit to assist manipulation of a suture with an elongate
instrument comprising: a scale configured to be attached to the
distal end of a suture manipulating instrument; and a template to
calibrate the position of the scale relative to a predetermined
point on the distal end of the instrument.
18. The kit as recited in claim 17, wherein the scale is provided
on a shrink wrap material.
19. A method of manipulating a suture comprising: providing an
elongate suture manipulating instrument configured to hold a first
end of a suture at a predetermined point on a distal end of the
instrument and a scale having at least one graduation provided on
the instrument at a location remote from the distal end; grasping a
second end of the suture with a separate device; and drawing the
suture along the instrument adjacent the scale so that a second end
of the suture is adjacent the at least one graduation on the scale
to measure the length of suture.
20. The method as recited in claim 19, wherein the step of drawing
is performed while the suture is being passed through tissue.
21. The method as recited in claim 19, wherein the step of drawing
is performed after the suture is passed through tissue.
22. In a surgical suturing apparatus including an elongate member
having a proximal end and a distal end and a longitudinal axis; a
pair of jaws at the distal end, at least one of the pair of jaws
being movable, the pair of jaws each having a recess for receiving
a suture carrying needle; needle retaining structure in each jaw of
the pair of jaws, the needle retaining structure extending from the
respective jaw toward the proximal end; and a handle at the
proximal end including structure for alternately advancing and
retracting the needle retaining structure the improvement
comprising; a scale defined on the elongate member, the scale
extending along the longitudinal axis of the elongate member and
having graduations for measuring the length of the suture.
Description
CROSS REFERENCE TO RELATED APPLICATION
[0001] The present disclosure claims priority to U.S. provisional
application Ser. No. 60/416,058, filed Oct. 4, 2002, entitled
Surgical Suturing Apparatus With Measurement Structure, the entire
disclosure of which is incorporated by reference herein.
BACKGROUND
[0002] 1. Technical Field
[0003] The present disclosure relates generally to surgical
instrumentation and, more particularly, to surgical instrumentation
having measuring apparatus for use in endoscopic or laparoscopic
surgical procedures.
[0004] 2. Description of Related Art
[0005] Endoscopic procedures are typically performed through an
elongated cannula structure having a relatively small diameter with
a proximal and distal end. In laparoscopic surgery an incision is
made in the abdominal wall and the distal end of the cannula is
passed through the tissue into the body cavity wherein the surgical
procedure or examination is to be effected, thus providing a
conduit for the insertion of surgical instrumentation. A plurality
of cannula structures may be used to allow operation of a variety
of instruments simultaneously during a given procedure. For
example, one cannula may provide a conduit for an endoscope for
vision and illumination within the operative cavity while the other
cannulas may provide conduits for control of specialized surgical
instruments designed for performing specific procedural
functions.
[0006] Many surgical procedures call for suturing tissue, a
procedure traditionally accomplished by hand, or by passing a
needle between forceps. Laparoscopic suturing presents a
particularly challenging task, because it must be accomplished
using instrumentation extended through a port that typically has an
internal diameter that averages between five and twelve
millimeters. Instruments for facilitating laparoscopic suturing are
disclosed in U.S. Pat. No. 5,478,344, issued Dec. 26, 1995, to
Stone et al., which is incorporated herein in its entirety by
reference. The Stone et al. patent discloses in certain
embodiments, a surgical suturing apparatus capable of passing
control of a surgical needle, having a length of suture attached
thereto, back and forth between its jaws to repeatedly pass the
surgical needle and suture through tissue to suture tissue. In
addition, it discloses methods of using the apparatus to suture
tissue.
[0007] Other laparoscopic suturing instruments are also available
in the marketplace. For example, U.S. Pat. No. 5,690,653, issued
Nov. 25, 1997, to Richardson et al. discloses in certain
embodiments a suturing device that includes an elongated tubular
shaft having a needle disposed at the distal end. The needle is
attached to a suture and is passed between one or more relatively
movable jaws, as well as a method of using the device.
[0008] However, while the above-mentioned devices are valuable for
laparoscopic suturing, none of the above-mentioned devices includes
structure or discloses a method that facilitates measurement of the
length of suture material while the device is in the body cavity.
Therefore, a need exists for a suturing apparatus that maintains
the advantages of laparoscopic suturing and incorporates a suture
material measurement structure.
SUMMARY
[0009] Various measuring structures are provided for use with a
number of different laparoscopic surgical instruments. The
measuring structures are disposed on the apparatus for determining
the length of a suture or determining the amount of suture material
remaining when using the apparatus. Preferably, the measuring
structure is an integral part of the laparoscopic instrument and is
disposed at the distal end of the instrument for accurate
measurement of the suture. Alternatively, by measuring structure is
included in a kit that can be used with a number of different
laparoscopic instruments. In either embodiment, the measuring
structure has a number of graduations showing the selected units of
measure. Further still, the measuring structure can be positioned
such that the graduations are only visible from one vantage point.
However, in a preferred embodiment, the measuring structure will be
disposed so that it covers the outer perimeter of the surgical
instrument substantially in its entirety. In this embodiment, the
graduations of the measuring structure will be visible to the
surgeon from most any vantage point enabling the surgeon to obtain
a measurement without undue manipulation of the laparoscopic
instrument.
[0010] Specifically a surgical instrument for manipulating a suture
is disclosed including an elongate member having a distal end
configured to manipulate a suture and a scale on at least a part of
the elongate member and adjacent the distal end. The scale has at
least one graduation and preferably a plurality of graduations to
measure suture lengths. A predetermined point is identified on the
elongate member such that the scale indicates the distance from the
predetermined point to the at least one graduation. Preferably, the
elongate member includes at least one jaw and the predetermined
point is disposed on the the jaw. The jaw is configured to retain a
needle carrying a suture and, alternatively, the predetermined
point is located on the needle.
[0011] The surgical instrument is preferably a suturing apparatus
and predetermined point is located at the point of connection
between the suture and the needle. The point of connection can be
at one end of the needle, but preferably is located between the
ends of the needle, especially with a double pointed needle.
[0012] The surgical instrument has at least one jaw is movable
relative to the elongate member such that the distance from the
predetermined point and the scale is calibrated with the at least
movable jaw in a predetermined position. In a preferred embodiment
of the surgical instrument the elongate member includes two movable
jaws which are configured to repeatedly pass control of a needle
carrying a suture therebetween and through tissue to form
stitches.
[0013] The scale is provided to measure the remaining amount of
suture after suturing and includes a plurality of graduations.
Preferably, the scale is provided on a material affixed to the
elongate member such as a shrink wrap affixed to the elongate
member. Alternatively, the scale can be located on at least one
longitudinally extending strip of material or etched into the
elongate member. Preferably, the graduations indicate the distance
in centimeters.
[0014] There is also disclosed a kit to assist manipulation of a
suture with an elongate instrument including a scale configured to
be attached to the distal end of a suture manipulating instrument
and a template to calibrate the position of the scale relative the
predetermined point on the distal end of the instrument.
Preferably, the scale is provided on a shrink wrap material.
[0015] There is further disclosed a method of manipulating a suture
by providing an elongate suture manipulating instrument configured
to hold a first end of a suture at a predetermined point on a
distal end of the instrument and a scale having at least one
graduation provided on the instrument at a location remote from the
distal end. During surgery a second end of the suture is grasped
with a separate device and drawn along the instrument adjacent the
scale so that a second end of the suture is adjacent the
graduations on the scale to measure the length of suture. The
drawing of the suture can be performed while the suture is being
passed through tissue or after the suture is passed through
tissue.
[0016] These together with other advantages will become apparent
from the details of construction and operation as more fully
hereinafter described.
BRIEF DESCRIPTION OF THE DRAWINGS
[0017] Various embodiments are disclosed herein with reference to
the drawings wherein;
[0018] FIG. 1 is a perspective view of the distal end of a surgical
suturing apparatus in accordance with an embodiment of the present
disclosure, showing a measuring structure;
[0019] FIG. 2 is a side plan view, partially shown in section, of
the suturing apparatus in accordance with the embodiment of FIG.
1;
[0020] FIG. 3 is a exploded perspective view of the distal end of a
surgical suturing apparatus in accordance with the embodiments of
FIGS. 1 and 2;
[0021] FIG. 4 is a side view of the distal end of the suturing
apparatus in accordance with the embodiment of FIGS. 1-3, showing a
grasping instrument holding the suture along the measuring
structure;
[0022] FIG. 5 is a plan view of a measuring structure in accordance
with the embodiment of FIGS. 1-4;
[0023] FIG. 6 is a side view of the distal end of the suturing
apparatus in accordance with the embodiment of FIGS. 1-5,
illustrating the measuring structure measuring a length of suture
material;
[0024] FIG. 7 is a side view of the distal end of the tubular
housing in accordance with the embodiment of FIG. 1-6, illustrating
the measuring structure measuring a different length of suture
material;
[0025] FIG. 8 is a perspective view of the distal end of a surgical
suturing apparatus in accordance with a further embodiment of the
present disclosure;
[0026] FIG. 9 is a perspective view of the distal end of a surgical
apparatus in accordance with another embodiment of the present
disclosure; and
[0027] FIG. 10 is a perspective view of a surgical grasping
instrument in accordance with another embodiment of the present
disclosure.
DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS
[0028] The embodiments disclosed herein below relate to surgical
instruments for manipulating a suture and having measuring
structure to measure a length of suture at any time during a
surgery.
[0029] FIGS. 1-7, show an embodiment of a suturing apparatus in
accordance with an embodiment of the present disclosure. Suturing
apparatus, generally indicated by reference numeral 10, has an
elongated tubular housing or body portion 12, and two movable jaws
(or jaw elements) 14 and 16. A needle 18 is releasably retained in
one of jaws 14 and 16 at the distal end of suturing apparatus 10.
Suturing apparatus 10 is configured to pass needle 18 back and
forth between jaws 14 and 16. A length of suture 20 is connected to
needle 18 such that passing needle 18 back and forth between tissue
passes suture 20 through the tissue to form stitches. A measuring
structure 90 is disposed on the distal portion of tubular housing
12 to measure the length of suture 20. As is conventional, the term
"distal" refers to that direction further from the user while the
term "proximal" refers to that direction closer to the user.
[0030] Referring to FIGS. 2 and 3, there is shown suturing
apparatus 10 in greater detail. Suturing apparatus 10 is described
in certain embodiments of U.S. Pat. No. 5,690,653, the disclosure
of which is hereby incorporated by reference herein. Suturing
apparatus 10 has a handle housing 30 with a two-armed handle 2,
elongated tubular housing 12, and two jaws 14 and 16. Handle 2 is
used to control the opening and closing of jaws 14 and 16. Handles
2 are connected to a rod 7 by a pair of links 33 and 34 and pins
49,50 and 51. Center rod 7 is spring biased distally by spring 6.
Spring 6 fits around center rod 7 and rests in a channel of housing
30. When the handles 2 are squeezed, center rod 7 moves backward
(proximally), causing spring 6 to be compressed. Referring to FIG.
3., the distal end of center rod 7 has a pin 8 which rides in a cam
slots 9 and 41 in each of the jaws 14 and 16. Jaws 14 and 16 are
pivotally connected to each other by pin 11 extending through holes
43 and 13 and through holes 53 and 54 of support 52. When center
rod 7 is pulled proximally through actuation of the handles 2, pin
8 is also pulled proximally in cam slots 9 and 41, camming jaws 14
and 16 closed.
[0031] Each jaw 14 and 16 is adapted to receive needle 18 in recess
15. When jaws 14 and 16 are closed needle 18 sits in recesses 15 in
both jaws 14 and 16. When jaws 14 and 16 are opened, needle 18 is
retained in one or the other recesses 15 depending on which blade
31 or 29 intersects needle 18 through recess 15. Blade 31
cooperating with upper jaw 14 extends into recess 15 to secure
needle 18. Alternatively, blade 29 may intersect needle 18 through
recess 15, securing needle 18 in jaw 16. The movement of blades 31
and 29 to engage needle 18 will now be described.
[0032] On either side of center rod 7 are side rods 21 and 22 which
sit inside tubular housing 12 and are connected at their proximal
ends to a wheel 23 movably housed inside handle housing 30. Wheel
23 has two arms 24 and 25 projecting from either side that allow
the operator of the apparatus to turn wheel 23. To transfer needle
18 from jaw 14 to jaw 16, the jaws are closed and wheel 23 is
rotated by turning side arm 25 clockwise so that side rod 21 is
pulled proximally and side rod 22 is pushed distally. Side rods 21
and 22 are connected to blades 31 and 29, respectively. Therefore,
when side rod 22 is pushed distally, blade 29 is pushed distallly
and engages needle 18 by extending into recess 15 to secure needle
18 in jaw 16. While blade 29 is in a distal position, blade 31 is
in a retracted or proximal position, as each blade is connected to
wheel 23 through a respective rod. Thus blade 31 does not contact
needle 18, thereby allowing release of the needle 18 from jaw 14.
Similarly, side arm 24 may be turned counterclockwise, sliding side
rod 21 and blade 31 distally and side arm 25 and blade 29
proximally, thereby securing needle in jaw 14 and allowing release
of needle 18 from jaw 16.
[0033] Referring to FIGS. 1 and 4-7 measuring structure 90 has a
scale 100 preferably disposed along a portion of tubular housing 12
such that scale 100 is adjacent to the distal end and extends
longitudinally along tubular housing 12. Scale 100 has a
longitudinal axis 101 that extends in the same direction as the
longitudinal axis of body portion 120. A plurality of graduations
110 are disposed on scale 100 and are uniformly spaced apart along
longitudinal axis 101 of scale 100. Graduations 110 indicate the
distance from a predetermined point on the distal end of suturing
apparatus 10. Preferably, the predetermined point is the point of
connection between suture 20 and needle 18 to give an accurate
measurement of the remaining usable length of suture 20. Since at
least one of jaws 14 and 16 are movable, scale 100 must be
calibrated with the jaw holding needle 18 in a predetermined
position. This predetermined position may be fully open, fully
closed or some predetermined position in between. Otherwise,
movement of the jaw holding needle 18 will affect the measurement
reading.
[0034] Graduations 110 may be marked with Arabic numerals, Roman
numerals, Greek letters, or other suitable symbols of indicia.
Preferably, graduations 110 are marked with Arabic numerals so that
the units of measure are readily ascertainable. Although
graduations 110 are shown in centimeters, the actual units of
measure may be changed to suit the user's needs without departing
from the scope of the disclosure (e.g. inches, millimeters,
decimeters, etc.).
[0035] As shown in FIGS. 1 and 4, graduations 110 on scale 100
generally in the same viewing plane as needle 18. Placing needle 18
and graduations 110 in the same viewing plane allows the surgeon
using suturing apparatus 10 to observe scale 100, needle 18 and a
suture 20 simultaneously. However, during endoscopic surgery, the
surgeon's field of view is limited by the endoscope, and suture 20
may not lie in the field of view of the endoscope. It is preferred
that graduations 110 be visible to the surgeon regardless of the
physical orientation of the surgical instrument. Therefore, the
lateral dimensions of scale 100 and graduations 110 are such that
graduations 110 cover a large enough area on tubular housing 12 so
that graduations 110 are visible to the surgeon regardless of the
orientation of the surgical instrument. Scale 100 and graduations
110 may cover the full perimeter of body portion 12 or only a part
thereof.
[0036] Extending scale 100 and graduations 110 along a greater
portion of the surface of regular housing 12 does not alter the
accuracy of the instrument since graduations 110 are still
uniformly spaced apart, but allows graduations 110 to be visible in
more than one plane of view. For example, graduations 110 may
encompass approximately up to 90 degrees of the surface of tubular
housing 12 as shown in FIG. 1. In addition, more than one scale may
be disposed on a surgical instrument such as disposing a number of
scales around the surface of tubular housing 12. When a number of
scales are disposed in this fashion, the scales may be contiguous
or may be transversely spaced apart. Preferably, graduations 110
will extend circumferentially about tubular housing 12 up to and
including 360 degrees of the surface.
[0037] Scale 100 and graduations 110 are shown in the figures as
being disposed on tubular surgical instruments for illustrative
purposes only. It is within the scope of this disclosure for scale
100 and graduations 110 to be disposed on instruments that have
regular or irregular polygonal shapes. With instruments that have
regular or irregular polygonal shapes, graduations 110 may be
disposed on one or more surfaces of the polygon, alternating
surfaces of the polygon or all surfaces of the polygon depending on
the particular instrument and its application.
[0038] A more detailed view of scale 100 with graduations 110 is
shown in FIG. 5. Although scale 100 is shown having a range of 5-20
units, preferably centimeters, other units and ranges are entirely
within the scope of the present disclosure. The selected range of
scale 100 and units of graduations 110 are determined by the user's
requirements. In the present example of 5-20 centimeters, scale 100
has an accuracy of .+-.0.6 centimeters. In this figure, the scale
100 uses one (1) unit graduations commencing with the numeral five
(5). It is within the scope of the disclosure that scale 100 could
be designed to include graduations 110 representing less than one
(1) unit (i.e. 1/2 unit) or units greater than one (1) unit (e.g.
11/2, 2, or 5). The number of units represented by each graduation
110 is not limited to what is disclosed here, but is to be
determined by the ultimate application of the scale 100. In
addition, graduations 110 are illustrated in centimeters, the
actual units of measure may be changed to suit the user's needs
without departing from the scope of the disclosure (e.g. inches,
millimeters, decimeters, etc.).
[0039] FIGS. 6 and 7 depict the distal end of tubular housing 12 of
suturing apparatus 10. Scale 100 is disposed adjacent and posterior
to the jaw support 52. In FIG. 6, scale 100 shows that
approximately twenty (20) centimeters of suture 20 are attached to
needle 18. It should be noted that the figure is not to scale as it
appears that the distance from the predetermined point to the first
graduation is greater than 5 cm and that while suture 20 appears
loose in FIGS. 6 and 7, in actuality suture 20 would be slightly
tensioned or straightened as shown in FIG. 2 to give an accurate
reading. Furthermore, it is necessary that suture 20 be drawn along
a direct line from its point of connection with needle 18 to give
an accurate measurement. Care should be taken that suture 20 not
get caught on, or bend around the distal most ends 15 and 17 of
jaws 14 and 16, respectively, as this would give an incorrect
measurement indicating a smaller amount of suture 20 left than is
actually the case.
[0040] FIG. 7 illustrates the situation in which one or more
stitches have been sewn leaving approximately ten (10) centimeters
of suture 20 available for use. The accuracy of scale 100 is
.+-.0.6 graduations, or in the present example .+-.0.6 centimeters.
The ability of the surgeon to discern the remaining length of
suture 20 easily and readily enables the surgeon to predict the
number of sutures that can be safely sewn before it is necessary to
remove suturing apparatus 10 for reloading.
[0041] Although suturing apparatus 10 will be periodically removed
for reloading, the addition of attached scale 100 permits the
surgeon to minimize the number of reloading operations that must be
performed due to guess work involved in determining the amount of
suture 20 remaining. This enables the surgeon to minimize the time
of the procedure and optimize the quantity of suture material used.
Scale 100 is envisioned to be incorporated into the structure of
tubular housing 12 during the manufacturing process wherein
graduations 110 would be etched, embossed or otherwise permanently
part of tubular housing 12.
[0042] Alternately, scale 100 and graduations 110 could be supplied
as part of a kit to allow the surgeon to select the units of
measurement and the length of scale 100. Furthermore, supplying
scale 100 in kit form allows existing owners of suturing apparatus
10 to take full advantage of this disclosure without the need to
purchase new suturing apparatus 10. For example, the kit could
include several scales 100 having different ranges of graduations,
different units of measurement, or numerous combinations of the
preceding depending on the demands of the marketplace. In one
embodiment, each scale 100 that is supplied as part of a kit would
has an adhesive backing for attachment to tubular housing 12 and
that this adhesive backing would securely attach scale 100 to
tubular housing 12 to alleviate any concerns about scale 100
becoming dislodged in the cavity during the endoscopic
procedure.
[0043] The preferred method for attaching scale 100 is to place
scale 100 on heat shrinkable tubing. During preparation for
surgery, the heat shrinkable tubing would be placed over the distal
end of the surgical instrument and moved towards the proximal end
along the longitudinal axis of the instrument. Once the heat
shrinkable tubing is properly positioned, a flameless heat source
is applied uniformly to the heat shrinkable tubing. Once the heat
shrinkable tubing has shrunk to its designed size, and conformed to
the shape of the surgical instrument, the heat source is removed
leaving the surgical instrument with a measuring apparatus properly
positioned for use. Further still, the kit may include an assembly
template or other calibration device to ensure that scale 100 is
disposed along tubular housing 12 with the proper orientation and
proper longitudinal positioning from the predetermined point. The
tubular housing 12 and heat shrinkable tubing may include reference
marks that are aligned by placing the heat shrinkable tubing on
tubular housing 12. This is essential so that each suturing
apparatus 10 will produce the same accurate measurements and ensure
highly repeatable results for the surgeon.
[0044] Referring now to FIG. 4, the use of suturing apparatus 10
including scale 100 to suture tissue and measure the remaining
amount of suture 20 will now be described. As noted above, scale
100 is disposed along the longitudinal axis of tubular housing 12
and posterior to jaws 14, 16 with suture 20 extending from a
predetermined point which is preferably the connection point with
needle 18. During laparoscopic suturing, the surgeon closes jaws
14, 16 about the tissue, forcing needle 18 and suture 20 to pierce
the tissue and passes control of the needle 20 between jaws 14 and
16. Next, the surgeon then takes a grasping tool 150 and grabs the
distal end of suture 20 with grasping tool 150. Using grasping tool
150, the surgeon holds suture 20 taut against the surface of scale
100 thereby allowing the surgeon to measure the length of suture
20. By holding suture 20 taut against scale 100, the surgeon is
able to read the remaining length of suture 20 accurately. Again,
care should be taken to ensure that suture 20 extends in a
generally straight line from the predetermined point to scale 100
and does not become wrapped around the distal most ends of the jaws
which would cause an inaccurate reading.
[0045] It should be noted that by measuring the remaining usable
length of suture after a stitch, the surgeon can estimate the
number of stitches that can be performed before having to reload a
new needle and suture to a fairly certain degree of accuracy. This
asset is not limited to endoscopic uses of measuring structure on
suture manipulating instruments, but rather, may also find useful
application in open surgery.
[0046] Alternatively, the surgeon may pass needle 18 through the
tissue and move suturing apparatus 10 adjacent the tissue and then
take the measurement. As noted above, the measurement is taken with
suture 20 extending from a predetermined point and with at least
one of jaws 14 and 16 in a predetermined position corresponding to
the calibration of scale 100 on suturing apparatus 10.
[0047] Turning to FIG. 8, the distal end of a surgical suturing
apparatus in accordance with a further embodiment is illustrated.
This particular surgical instrument 210 includes a tubular housing
212 with only one movable or pivotably hinged jaw 216 disposed at
the distal end of tubular housing 212. A needle 218 is removaby
receivable by an aperture in jaw 216. A suture 220 is attached to
the end of needle 218, which establishes the predetermined point
for the measuring structure of this apparatus, and the remaining
length of suture 220 is disposed along the longitudinal axis of
tubular housing 212. Scale 100 is disposed near the distal end of
tubular housing 212 and preferably covers the entire outer
perimeter of tubular housing 212 so that graduations 110 are
visible to the surgeon regardless of the orientation surgical
suturing apparatus 210. Scale 100 is calibrated to read accurately
with jaw 216 in the predetermined position, i.e., fully open, fully
closed or some predetermined position in between.
[0048] In FIG. 9, a surgical suturing apparatus in accordance with
yet another embodiment is illustrated. As in previous embodiments,
the surgical suturing apparatus 310 has a scale 100 disposed near
the distal end of a tubular housing 312. A suture 320 extends from
the most distal end of tubular housing 312 with a needle 318 at the
distal end of suture 320. Needle 318 and suture 320 are attached to
a cartridge carrier 322 that is removably attached to tubular
housing 312. It is preferred that scale 100 and graduations 110 are
disposed such that graduations 110 encompass the entire outer
perimeter of tubular housing 312 of surgical suturing apparatus
310.
[0049] Referring to FIG. 10, a surgical instrument in accordance
with a further embodiment is shown. Similar to previous
instruments, surgical instrument 510 is particularly arranged for
laparoscopic or other minimally invasive surgery and it includes an
elongate tubular housing 512. Surgical instrument 510 has a
grasping tool 514 at the distal end of tubular housing 512. This
instrument permits the surgeon to grasp a suture 520 and determine
the length of the unused portion. Once again, scale 100 is disposed
along the distal end of tubular housing 512 just posterior to
grasping tool 514. Having scale 100 disposed in this location
permits the surgeon to determine the length of suture 520
accurately by moving suture 520 with grasping tool 514 along the
side of tubular housing 512 to measure the length of suture 520. It
is preferred that scale 100 and graduations 110 cover the outer
perimeter of tubular housing 512 so that the surgeon can view
graduations 110 without having to reposition surgical instrument
510. The surgical instrument 510 may be used to manipulate a needle
and suture or may be used in conjunction with a suturing
apparatus.
[0050] It will be understood that various modifications may be made
to the embodiments disclosed herein. For example, the unit may be
color coded to indicate the range and units of measurement. When
supplied as part of a kit, it is fully compatible with other
laparoscopic surgical instruments such as scissors, knot-tying
tools, and other tools. Further still, other methods for disposing
measuring structures on surgical instruments such as
shrink-wrapping may be employed. Therefore, the above description
should not be construed as limiting, but merely as exemplifications
of preferred embodiments. Those skilled in the art will envision
other modifications within the scope and spirit of the claims
appended hereto.
[0051] The foregoing is considered illustrative only of the
principles of the measuring apparatus. Further, this is not
intended to be limited to the exact structure, construction and
operation shown and described.
* * * * *