U.S. patent number 3,871,379 [Application Number 05/378,582] was granted by the patent office on 1975-03-18 for laparoscopy instruments and method for suturing and ligation.
Invention is credited to Henry C. N. Clarke.
United States Patent |
3,871,379 |
Clarke |
March 18, 1975 |
Laparoscopy instruments and method for suturing and ligation
Abstract
An improved combined laparoscopic needle and forceps comprising
an elongated parallelogram type of linkage suitable for insertion
through a trocar and having first and second ends, a needle, means
for mounting said needle on said first end for movement from a
position in substantial alignment with said linkage, which permits
it to pass through a trocar, to a position transverse to said
linkage, handle means on said second end of said linkage for
actuating said linkage to effect movement of said needle, and a
forceps construction including jaw means mounted proximate said
first end of said needle linkage and being formed from a portion of
said linkage and a portion of the holder of the needle. An improved
combined laparoscopic forceps, suture guide and cutter comprising
an elongated parallelogram type of linkage which is sufficiently
slender for passage through a trocar and having first and second
ends, jaw means on said first end, and handle means on said second
end for actuating said linkage to move said jaws, groove means
associated with said jaws for receiving a suture to thus act as a
suture guide, and cutter means mounted on said jaws for cutting a
suture. An improved laparoscopic ligator comprising an elongated
stem having first and second ends, a handle at said first end and
suture guiding means at said second end, said suture guiding means
being of substantially the same cross sectional dimension as said
elongated stem for guiding a suture through a trocar. An improved
method of performing a surgical operation by laparoscopy comprising
the steps of inserting at least first and second trocars through
the body of a patient at spaced locations, inserting a first
instrument comprising the above described combined laparoscopic
needle and forceps through said first trocar, inserting a second
instrument comprising the above described laparoscopic forceps,
suture guide and cutter through said second trocar, manipulating
said first and second instruments in cooperating relationship with
each other in a predetermined area to the central portion of a
suture in position, withdrawing one of said instruments to bring
the end of the suture outside of the patient's body, tying a knot
in the suture outside of the body, and bringing the knot into the
desired position by means of said laparoscopic ligator.
Inventors: |
Clarke; Henry C. N. (Buffalo,
NY) |
Family
ID: |
26870936 |
Appl.
No.: |
05/378,582 |
Filed: |
July 12, 1973 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
|
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175163 |
Aug 26, 1971 |
3763860 |
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Current U.S.
Class: |
606/148 |
Current CPC
Class: |
A61B
17/0469 (20130101); A61B 17/29 (20130101); A61B
10/00 (20130101); A61B 2017/0474 (20130101) |
Current International
Class: |
A61B
17/28 (20060101); A61B 10/00 (20060101); A61B
17/04 (20060101); A61b 017/12 () |
Field of
Search: |
;128/326 ;132/91 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Primary Examiner: Medbery; Aldrich F.
Parent Case Text
This is a division of application Ser. No. 175,163, filed Aug. 26,
1971, and now U.S. Pat. No. 3,763,860
Claims
What is claimed is:
1. A ligator comprising an elongated stem and suture guiding means
at one end of said stem, said suture guiding means being of
substantially the same cross sectional dimension as said stem and
comprising a pair of spaced arms convexly outwardly curved about an
axis extending transversely of said stem and converging toward each
other at their tip ends remote from said stem and jointly with the
end of said stem defining a generally circular opening for guiding
a suture, said tip ends of said arms being spaced from each other
to provide a suture entrance to said opening, and means for gently
and firmly holding said suture comprising a blunt end on said stem
opposite from said entrance, said end being convexly rounded to
provide complimentarially grooved recessed portions at the bases of
said arms on opposite sides of said stem between said arms.
Description
The present invention relates to improved laparoscopy instruments
for suturing and ligation and to an improved method of
laparoscopy.
By way of background, recently there has been an increasing use of
laparoscopy in pelvic surgery. The most common uses of laparoscopy
are for diagnosis of pelvic disease and tubal electrocoagulation
and cutting. Among the operations performed with a great degree of
safety and less morbidity for the patient than by laparotomy are:
biopsy and electrocoagulation; lysis of adhesions with
electrocoagulation; fertility studies by intrauterine dye
injection; ovarian follicle aspiration; biopsy of the ovary;
extended post coital aspiration tests; tuboplasty by opening the
fimbriated ends of closed tubes; cul-de-sac aspiration; ovarian
cyst aspiration; electrocoagulation of bleeding points such as
bleeding corpus luteum or bleeding secondary to instrumentation;
electrocoagulation of endometriosis; electrocoagulation of tumor
implants; biopsies in general; and excision of small tumors with
electrocoagulation.
In certain of the foregoing procedures difficulty has been
encountered when blood vessels are cut and hemostatis cannot be
maintained by electrocoagulation. This bleeding has been an
especially troublesome problem in tubal electrocoagulation and
cutting. When bleeding difficulties have been encountered,
laparotomy has become necessary because of the past inability to
suture and ligate with laparoscopic procedures.
It is accordingly one important object of the present invention to
provide an improved series of instruments which increase the
ability to suture and ligate in laparoscopy. A related object of
the present invention is to provide a combined laparoscopic needle
and forceps. Another related object of the present invention is to
provide a combined laparoscopic tissue forceps, suture guide and
cutter. A further related object of the present invention is to
provide an improved laparoscopic ligator.
Another object of the present invention is to provide a new and
improved surgical method of laparoscopy. Other objects and
attendant advantages of the present invention will readily be
perceived hereafter.
The improved combined laparoscopic needle and forceps of the
present invention comprises an elongated linkage portion having
first and second ends, a needle, means for mounting said needle on
said first end for movement from a position in substantial
alignment with said linkage, which permits it to pass through a
trocar, to a position transverse to said linkage, means on said
second end of said linkage for actuating said linkage to effect
said movement of said needle, and a forceps construction including
jaw means mounted proximate said first end of said linkage.
The improved combined laparoscopic forceps, suture guide and cutter
comprises an elongated linkage having first and second ends, jaw
means mounted on said first end and handle means on said second end
for actuating said linkage to move said jaws, groove means
associated with said jaws for receiving a suture to thus act as a
suture guide, and cutter means mounted on said jaws for cutting a
suture.
The improved laparoscopic ligator of the present invention
comprises an elongated stem having first and second ends, a handle
at said first end, and suture guiding means at said second end,
said suture guiding means being of substantially the same cross
sectional dimension as said elongated stem for guiding a suture
through a trocar.
The improved method of performing a surgical operation by
laparoscopy, in its broadest aspect, comprises the steps of
inserting at least first and second trocars through the body at
spaced locations, inserting a first instrument through said first
trocar, inserting a second instrument through said second trocar
and manipulating said first and second instruments in cooperating
relationship with each other in a predetermined area to perform
said operation.
The various aspects of the present invention will be more fully
understood when the following portions of the specification are
read in conjunction with the accompanying drawings wherein:
FIG. 1 is a side elevational view of a trocar of the type suitable
for use in a laparoscopy;
FIG. 2 is a fragmentary cross sectional view thereof taken
substantially along line 2--2 of FIG. 1;
FIG. 3 is a side elevational view of a combined laparoscopic tissue
forceps, suture guide, and suture cutter;
FIG. 4 is an enlarged fragmentary top plan view thereof taken
substantially in the direction of arrows 4--4 of FIG. 3;
FIG. 5 is a fragmentary longitudinal sectional view thereof taken
substantially along line 5--5 of FIG. 4 and showing the suture
guide and cutter associated with the jaws;
FIG. 6 is an enlarged fragmentary longitudinal sectional view of
the rear portion thereof taken substantially along line 6--6 of
FIG. 9 and showing the linkage associated with the handles;
FIG. 7 is a cross sectional view thereof taken substantially along
line 7--7 of FIG. 5 and showing the suture cutter structure;
FIG. 8 is a cross sectional view thereof taken substantially along
line 8--8 of FIG. 5 and showing the jaw mounting linkage;
FIG. 8A is an enlarged cross sectional view thereof taken
substantially along line 8A--8A of FIG. 3 and showing details of
the spring structure for biasing the links together;
FIG. 9 is a fragmentary cross sectional view thereof taken
substantially along line 9--9 of FIG. 6 and showing the linkage
associated with the handles;
FIG. 10 is a side elevational view of a combined laparoscopic
needle and forceps;
FIG. 11 is an enlarged fragmentary top plan view thereof taken
substantially in the direction of arrows 11--11 of FIG. 10;
FIG. 12 is a fragmentary longitudinal sectional view thereof taken
substantially along line 12--12 of FIG. 11 and showing the linkage
for moving the needle and the jaws;
FIG. 13 is a fragmentary view similar to FIG. 12 but showing the
forcep jaws open;
FIG. 14 is a cross sectional view thereof taken substantially along
line 14--14 of FIG. 12;
FIG. 15 is an enlarged fragmentary longitudinal sectional view
thereof taken substantially along line 15--15 of FIG. 16 and
showing the linkage associated with the handles;
FIG. 16 is a fragmentary cross sectional view thereof taken
substantially along line 16--16 of FIG. 15;
FIG. 17 is a side elevational view of a laparoscopic ligator with
an open ended circular tip;
FIG. 18 is a fragmentary enlarged view of the ligator of FIG. 17
with the handle portion of the ligator illustrated in section;
FIG. 19 is a fragmentary cross sectional view thereof taken
substantially along line 19--19 of FIG. 18 and showing the tip of
the ligator in greater detail;
FIG. 20 is a fragmentary perspective view showing the first step of
s surgical operation wherein a tissue tube is clamped by the
forceps and the needle is brought into the clamped area;
FIG. 21 is a view showing the needle deflected around the tube with
the forceps released from the tube and grasping the end of the
suture;
FIG. 22 is a fragmentary perspective view showing the suture being
held in the suture guide portion of the forceps with the forceps
associated with the needle pulling the suture;
FIG. 23 is a fragmentary perspective view showing the ligator
pushing the suture knot toward the tube; and
FIG. 24 is a fragmentary perspective view showing the cutter
portion of the forceps severing the suture after tying has been
completed.
By way of introduction, the laparoscopy which is performed with the
instruments of the present invention consists of the steps of
inserting first and second sheathed trocars approximately 4
centimeters above the lower third of the inguinal ligament on each
side of the patient. A third trocar is inserted through the naval
for receiving an endoscope. A tissue forceps is inserted through
the first trocar to hold the tissue which is to be sutured-ligated.
Through the second trocar, the laparoscopic needle threaded with
suture is introduced and brought into the area of the tissue
forceps. Thereafter the instruments are manipulated as will be
described hereafter after their structure has been described.
The trocars which are used are shown in FIGS. 1 and 2. In assembled
condition the trocar includes a stem 11 having a pointed end 12 at
one end and a head 13 at the other end. A sheath 14 is located on
stem 11 and mounts an enlarged portion 15 which includes a
diaphragm member 16 mounted thereon. As is well understood by those
skilled in the art, the assembled stem and sheath are inserted
through the skin and thereafter stem 11 is withdrawn leaving sheath
14 in place. The laparoscopic instruments are inserted through tube
14 and a seal is maintained with them by means of diaphragm 16, to
prevent the escape of gas which has been pumped into the abdominal
cavity to separate the abdominal wall from body organs. This
sealing is effected in the manner shown in FIG. 2 by having the
circular diaphragm 16 engage the instrument.
The combined laparoscopic tissue forceps, suture guide and cutter
17 is shown in FIGS. 3-9. Basically, it includes a pair of
elongated slender links 18 and 19 which lie in side-by-side
relationship and are attached at one end to each other by means of
cross link 20 which is pivotally mounted on pin 21 secured to the
bifurcated end 22 of link 18, and is also pivotally mounted on pin
23 on bifurcated end 24 of link 19. The opposite ends of links 18
and 19 are secured to each other by cross link 25 which has the end
thereof pivotally mounted on pin 26 attached to opposite side
portions 26' of link 19 and an adjacent portion pivotally mounted
on pin 27 mounted on bifurcated end 18' of line 18, as can be seen
from FIGS. 6 and 9. Link 25 is essentially an extension of handle
28 having finger receiving opening 29 therein. Located proximate
handle 28 is handle 30 which is an extension of link 18 and has
finger receiving opening 31 therein.
Links 18, 19, 20 and 25 essentially define a parallelogram type of
linkage so that when handle portions 28 and 30 are spread apart
from the position shown in FIG. 3 link 19 will move essentially in
the direction of arrow 32 relative to link 18 which moves
essentially in the direction of arrow 33 relative to link 19. The
foregoing action will cause link 20 to pivot in a clockwise
direction as viewed in FIG. 5 about pin 21 which in turn will cause
jaw 34 which is formed integrally with link 20 to pivot in a
clockwise direction about pin 21 to thereby move away from jaw 35
which is an extension of link 18 and formed integrally therewith.
It will be appreciated that jaws 34 and 35, when closed, can be
inserted through trocar sheath 14 and links 18 and 19, in all
positions thereof, can be moved relative to sheath 14, as is
required during surgery. A spring structure 19' (FIGS. 3 and 8A)
biases links 18 and 19 together to maintain jaws 34 and 35 biased
to a closed position. Spring 19' includes a longitudinally
extending strip 20' from which U-shaped portions 21', 22' and 23'
extend, with portions 21' and 23' embracing link 19 and portion 22'
embracing link 18. A plastic sheath, not shown, can be used to
cover spring 19' so that it will not snag in the trocar.
The combined laparoscopic tissue forceps, suture guide and cutter
17 performs a plurality of functions. First of all, jaws 34 and 35
have serrations 34' and 35' on their opposing surfaces to provide a
good grip on either the tissue or the suture which is to be held.
In addition jaws 34 and 35 have opposing grooves 36 and 37,
respectively, in their opposing surfaces intermediate the ends of
the serrated portions 34' and 35'. When the jaws are closed grooves
36 and 37 provide an opening or hole 38 having a continuous
periphery. As will become more apparent hereafter, a suture can be
received in opening 38 and guided therethrough during a suturing
operation. In addition, jaws 34 and 35 have shear blades 39 and 40,
respectively, secured thereon to provide a suture cutting action as
will also become more apparent hereafter. Because of the fact that
the combinated laparoscopic forceps, suture guide and cutter
performs a plurality of functions, it is not necessary to insert a
plurality of individual instruments through a particular trocar
sheath because the same instruments can be maintained in position
therein to perform a plurality of functions, as desired, thereby
lessening the number of times that entry need be made through the
trocar.
The combined laparoscopic needle and forceps 41 of the present
invention, shown in FIGS. 10-16, includes a pair of elongated
slender links 42 and 43 which are maintained in side-by-side
relationship by cross links which provide a parallelogram type of
linkage. More specifically, cross link 44 is pivotally connected to
link 42 by pin 45, to link 43 by pin 46. Pin 45 is secured to the
bifurcated end portion of link 42, and pin 46 is secured to
opposite sides 47' of link 43. The lower end of link 44 lies within
depression 47 in link 43. Needle holder portion 48, which supports
needle 49 at its outer end, is formed integrally as an extension of
link 44. The ends of links 42 and 43 which are remote from needle
49 are fastened together by link 50 which is pivotally mounted on
pin 51 carried by opposite side portions 51' of link 42 and on pin
52 mounted on bifurcated end 52' of link 43. Link 50 is an
extension of and integral with handle 53 having finger-receiving
opening 54 at the end thereof. Handle 55 having finger-receiving
opening 56 at the end thereof is integral with and an extension of
link 43.
By suitable manipulation of handles 53 and 55 link 42 can be caused
to move in the direction of arrow 57 (FIG. 13) relative to link 43
which moves in the direction of arrow 58 relative to link 42. This
will cause link 44 and needle holder 48 to pivot from the position
shown in FIG. 12 to the position shown in FIG. 13. A detent tab 59
is rigidly attached at portion 60 to handle 53, and handle 55
slides across tab 59 in frictional engagement therewith. Thus when
handles 53 and 55 are released, the needle holder 48 will remain in
the position in which it was last placed until the handles are
again manipulated. Because needle 49 can move from a position shown
in FIG. 12 to the position shown in FIG. 13, it can be moved
essentially through a right angle after it is placed in position
within the body, as will become more apparent hereafter. It will be
appreciated that because of the slender nature of links 42 and 43,
and further because needle 49 is in substantially longitudinal
alignment therewith, the needle can be inserted through the trocar
and thereafter be moved to any desired position therein, as
required.
It is also to be noted that a pair of opposing jaws 61 and 62 are
provided. Jaw 61 is located on one side of needle holder 48 and jaw
62 is located at the end of link 43 (FIG. 13). It can thus be seen
that the combined laparoscopic needle and forceps can be used to
provide both a sewing action and a clamping action as required to
obviate the necessity of using two separate instruments, thereby
lessening the number of times that entry and withdrawal of
instruments need be made through the trocar.
The laparoscopic ligator 63 of the present invention, shown in
FIGS. 17-19, includes an elongated stem 64 having an enlarged end
65 which is embedded in handle 66. The opposite end of ligator 63
is formed into a pair of curved integral arms 67 separated by slot
68. The end of stem 64 between the arms is formed or recessed into
complimentarilly grooved portions 69. The suture is received in
opening 70 for ligating, as will be described in greater detail
hereafter.
The laparoscopy is performed by the above described instruments in
the following manner. Firstly, as noted above, two sheathed trocars
14 are inserted approximately 4 centimeters above the lower third
of the inguinal ligaments on each side of the patient, in the event
the operation is for the purpose of tying off the Fallopian tubes.
A third trocar is inserted through the naval for the purpose of
receiving an endoscope. Through one lateral trocar sheath, the
tissue forceps 17 is inserted and the tissue to be suture ligated,
namely, the tube 71, is clamped and held between jaws 34 and 35.
Through the other lateral trocar sheath the laparoscopic needle 41
is introduced. This needle prior to insertion is threaded with
suture 72 which is held on needle 49 by being wedged into a crotch
formed between the needle proper and protuberance 73 thereon. After
the needle is brought to the proper position, such as shown in FIG.
21, and while the tube is still clamped as shown in FIG. 20,
handles 53 and 55 are manipulated to move needle 49 from its
in-line position to a lateral position where it extends
transversely to links 42 and 43, this lateral position being
illustrated in FIG. 21. After the needle has been so flexed, the
tissue 74 is pierced to bring the suture 72 through the tissue.
Thereafter handles 28 and 30 of the tissue forceps are manipulated
so as to cause jaws 34 and 35 to release tube 71 and to grasp the
end 75 of suture 72, as shown in FIG. 21, and disengage it from
needle 49 which is then withdrawn from tissue 74. Next, the suture
72 is carried around tube 71 by forceps 17 and end 75 of suture 72
is clamped between the jaws 61 and 62 of laparoscopic forceps 41.
The opening 38 formed between the jaws of forceps 17 may be closed
around suture 72, as shown in FIG. 22, to provide a guide for
suture 72 to prevent suture-pull on delicate tissue as needle 49 is
being withdrawn through trocar 14 to bring the free end 75 of
suture 72 outside of the body. The diaphragm 16 at the end of
trocar 14 prevents the escape of gas from the inflated abdominal
cavity and externally of this diaphragm free end 75 of the suture
is tied with end 76 thereof to provide a first tie. This tie is
then introduced by ligator 63 through sheath 14 (FIG. 23), with the
tie being held in groove 70 of the ligator. This tie is carried
down to the central portion 77 of the suture to close off tube 71.
Thereafter second and third ties may be formed at ends 75 and 76
and brought down into position with ligator 63 in the same manner
as just described. A surgical knot has been found to be most
convenient to provide the type of tie at 78 which is desired.
Thereafter the shear blades 39 and 40 which are located on forceps
17 are used to cut the free ends of suture 72 to complete the tying
operation.
It will be appreciated that because each of the instruments 17 and
41 performs a plurality of functions, there is no necessity to keep
reinserting different instruments through the trocars to effect the
various functions which are required. Furthermore, because the
links which form the main central body portions of the instruments
are extremely slender and do not spread apart appreciably when the
instruments are manipulated, they can be conveniently inserted and
removed through the trocars and manipulated while therein as
required.
* * * * *