ENDOSCOPIC STITCHING DEVICES

• US 20090312773A1
• Filed: 06/10/2009
• Published: 12/17/2009
• Est. Priority Date: 06/13/2008
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Covidien LP (Medtronic Plc)
• Inventors: Cabrera, Ramiro, Richard, Paul D., Menn, Dmitri, Wingardner, Thomas, Creston, Brian J., Fowler, David N.
• Granted Patent: US 8,628,545 B2
• Time in Patent Office: Days
• US Class Current: 606/144
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/0491 Sewing machines for surgery
• CPC Class Codes: A61B 17/0625 the needle being specially adapted to interact with the manipulator, e.g. being ridged to snap fit in a hole of the manipulator A61B17/06109 takes precedence
• CPC Class Codes: A61B 17/2909 Handles
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/00323 Cables or rods
• CPC Class Codes: A61B 2017/00389 Button or wheel for performing multiple functions, e.g. rotation of shaft and end effector
• CPC Class Codes: A61B 2017/06047 located at the middle of the needle
• CPC Class Codes: A61B 2017/0609 having sharp tips at both ends, e.g. shuttle needle alternately retained and released by first and second facing jaws of a suturing instrument
• CPC Class Codes: A61B 2017/2903 transferring rotary motion
• CPC Class Codes: A61B 2017/2905 flexible
• CPC Class Codes: A61B 2017/2912 transmission of forces to actuating rod or piston
• CPC Class Codes: A61B 2017/2913 cams or guiding means
• CPC Class Codes: A61B 2017/2923 Toothed members, e.g. rack and pinion
• CPC Class Codes: A61B 2017/2929 with a head rotatable about the longitudinal axis of the shaft

Abstract

The present disclosure relates to devices, systems and methods for endoscopic suturing or stitching through an access tube or the like. An endoscopic stitching device is provided and includes a handle assembly; an elongate shaft supported by and extending from the handle assembly; and an end effector supported on a distal end of the elongate shaft. The end effector includes a neck assembly configured and adapted for articulation in one direction between a substantially linear configuration and an off-axis configuration, and a pair of juxtaposed jaws pivotally associated with one another. Each jaw defines a suture needle receiving recess formed in a tissue contacting surface thereof.

Claims

1. An endoscopic stitching device, comprising:

a handle assembly;

an elongate shaft supported by and extending from the handle assembly; and

an end effector supported on a distal end of the elongate shaft, the end effector including a neck assembly configured and adapted for articulation in one direction between a substantially linear configuration and an off-axis configuration, and a pair of juxtaposed jaws pivotally associated with one another, wherein each jaw defines a suture needle receiving recess formed in a tissue contacting surface thereof.

2. The endoscopic stitching device according to claim 1, wherein the jaws are rotatably supported on the end effector for selective rotation about a longitudinal axis thereof when the end effector is in the substantially linear configuration and in the articulated configuration.

3. The endoscopic stitching device according to claim 1, wherein the handle assembly supports a rotation assembly configured to transmit an actuation from the handle assembly through the elongate shaft to effectuate rotation of the jaws.

4. The endoscopic stitching device according to claim 3, wherein the rotation assembly includes a knob rotatably supported on a housing of the handle assembly and operatively connected to a center drive rod assembly, wherein the center drive rod assembly includes a distal end extending through the elongate shaft and connected to the jaws.

5. The endoscopic stitching device according to claim 4, wherein at least a portion of the center drive rod assembly is flexible.

6. The endoscopic stitching device according to claim 1, further comprising a center drive rod assembly translatably supported therein, the center drive rod assembly including a proximal end operatively connected to at least one handle of the handle assembly and a distal end extending through the elongate shaft and operatively connected to the jaws, wherein axial translation of the center drive rod assembly results in opening and closing of the jaws.

7. The endoscopic stitching device according to claim 6, wherein axial rotation of the center drive rod assembly results in rotation of the jaws about a longitudinal axis thereof.

8. The endoscopic stitching device according to claim 7, further comprising a rotation assembly supported on a housing of the handle assembly and operatively connected to the center drive rod assembly, wherein actuation of the rotation assembly results in concomitant rotation of the center drive rod assembly and the jaws.

9. The endoscopic stitching device according to claim 8, wherein at least a portion of a length of the center drive rod assembly is flexible, wherein the flexible portion of the center drive rod assembly will flex upon an articulation of the end effector and enable rotation of the jaws when the end effector is in an articulated condition.

10. The endoscopic stitching device according to claim 1, wherein the end effector further includes a pair of axially translatable needle engaging blades slidably supported, one each, in a respective jaw, each blade having a first position wherein a portion of the blade engages a suture needle when a suture needle is present in suture needle receiving recess formed in the tissue contacting surface of the jaw, and a second position wherein the blade does not engage the suture needle.

11. The endoscopic stitching device according to claim 10, wherein a proximal end of each blade is rotatably supported on a respective barrel of a concentric barrel pair, wherein the blades rotated about the barrels upon a rotation of the jaws.

12. The endoscopic stitching device according to claim 10, wherein a suture needle is loadable into the suture needle receiving recess defined in the jaw when the respective blade is in the second position.

13. The endoscopic stitching device according to claim 10, further comprising a loading/unloading assembly supported on the handle assembly and connected to each blade, wherein the loading/unloading assembly is movable between a first position in which the blades are in the first position and a second position in which the blades are in the second position.

14. The endoscopic stitching device according to claim 13, wherein the loading/unloading assembly is actuatable in a first direction to move a first blade to the first position and a second blade to the second position, and a second direction to move the first blade in the second direction and the second blade in the first direction.

15. The endoscopic stitching device according to claim 1, further comprising an articulation assembly supported on the handle assembly and actuatable to articulate the end effector, wherein actuation of the articulation assembly results in articulation of the end effector between the linear configuration and the off-axis configuration.

16. The endoscopic stitching device according to claim 15, wherein the articulation assembly includes an articulation cam supported on a housing of the handle assembly and includes first and second cam disks having opposing respective first and second camming channels defined therein, a first pin operably associated with the first camming channel and a first slider configured to longitudinally translate with respect to the housing, and a second pin operably associated with the second camming channel and a second slider configured to longitudinally translate with respect to the housing, the first and second slider secured with respective proximal ends of first and second articulation cables, the distal ends being secured at a location distal of the neck assembly, and wherein the articulation cables are disposed on opposed sides of a center drive rod assembly.

17. The endoscopic stitching device according to claim 16, wherein the first and second camming channels are configured to provide equidistant linear motion directly proportional to the angular rotation of the first and second cam disks.

18. The endoscopic stitching device according to claim 17, wherein the first and second camming channels have a shape substantially similar to a logarithmic spiral.

19. The endoscopic stitching device according to claim 16, wherein each articulation cable remains substantially taut upon translation thereof.

20. The endoscopic stitching device according to claim 16, wherein the first and second cam disks are monolithically formed.

21. The endoscopic stitching device according to claim 16, wherein a torsion spring operably couples the first and second cam disks.

22. The endoscopic stitching device according to claim 15, wherein the articulation assembly includes an articulation knob supported on a housing of the handle assembly, an articulation sleeve operatively connected to the articulation knob and including a pair of oppositely pitched outer helical threads, an articulation collar threadably connected to each helical thread and configured to permit axial translation and prevent rotation thereof, and an articulation cable secured to each articulation collar, wherein each articulation cable includes a first end secured to the respective articulation collar and a second end secured at a location distal of the neck assembly, and wherein the articulation cables are disposed on opposed sides of a center drive rod assembly.

23. The endoscopic stitching device according to claim 22, wherein each articulation cable is operably associated with a seal having first and second lumens extending therethrough, and wherein at least one lumen is configured to receive at least one articulation cable in substantial sealing relationship therewith.

24. The endoscopic stitching device according to claim 23, wherein at least one of the first and second lumens has an arched section.

25. The endoscopic stitching device according to claim 23, wherein at least one of the first and second lumens is repositionable through a plurality of positions including a first position and a second position in response to longitudinal translation of at least one articulation cable therethrough.

26. The endoscopic stitching device according to claim 25, wherein at least one lumen is biased towards at least one of the first or second positions.

27. The endoscopic stitching device according to claim 22, wherein rotation of the articulation knob results in rotation of the articulation sleeve and concomitant axial translation of the articulation collars, wherein axial translation of the articulation collars results in articulation of the end effector.

28. The endoscopic stitching device according to claim 27, wherein rotation of the articulation sleeve in a first direction results in relative axial separation of the articulation collars to articulate the end effector in a first direction, and rotation of the articulation sleeve in a second direction results in relative axial separation of the articulation collars to articulate the end effector in a second direction.

29. The endoscopic stitching device according to claim 1, wherein the neck assembly includes a plurality of links in pivotable contact with one another, wherein each link includes a knuckle formed on a first side thereof and a clevis formed on a second side thereof, wherein the knuckle of a first link is operatively connected to a clevis of an adjacent link.

30. The endoscopic stitching device according to claim 29, wherein the knuckles and devises are configured to enable unidirectional articulation of the neck assembly.

31. The endoscopic stitching device according to claim 29, wherein the knuckles and devises are configured to at least partially overlap one another when the neck assembly is in either the substantially linear configuration or the off-axis configuration.

32. The endoscopic stitching device according to claim 1, wherein the handle assembly includes a pair of handles and a center drive rod connected at a first end to the handles and at a second end to the pair of jaws, wherein actuation of the handles results in axial translation of the center drive rod and concomitant opening and closing of the jaws.

33. An endoscopic stitching device, comprising:

a handle assembly including a housing;

an elongate shaft supported by and extending from the housing;

an end effector supported on a distal end of the elongate shaft, the end effector including a neck assembly configured and adapted for articulation in one direction between a substantially linear configuration and an off-axis configuration, and a pair of juxtaposed jaws pivotally associated with one another, wherein each jaw defines a suture needle receiving recess formed in a tissue contacting surface thereof, and wherein the jaws are rotatably supported on the end effector for selective rotation about a longitudinal axis thereof when the end effector is in the substantially linear configuration and in the articulated configuration;

an articulation assembly supported on the housing and actuatable to articulate the end effector, wherein actuation of the articulation assembly results in articulation of the end effector between the linear configuration and the off-axis configuration; and

a rotation assembly supported on the housing, the rotation assembly being configured to transmit an actuation from the handle assembly through the elongate shaft to effectuate rotation of the jaws.

34. The endoscopic stitching device according to claim 33, wherein the articulation assembly includes an articulation cam supported on a housing of the handle assembly and includes first and second cam disks having opposing respective first and second camming channels defined therein, a first pin operably associated with the first camming channel and a first slider configured to longitudinally translate with respect to the housing, and a second pin operably associated with the second camming channel and a second slider configured to longitudinally translate with respect to the housing, the first and second slider secured with respective proximal ends of first and second articulation cables, the distal ends being secured at a location distal of the neck assembly, and wherein the articulation cables are disposed on opposed sides of a center drive rod assembly.

35. The endoscopic stitching device according to claim 34, wherein the first and second camming channels are configured to provide equidistant linear motion directly proportional to the angular rotation of the first and second cam disks.

36. The endoscopic stitching device according to claim 35, wherein the first and second camming channels have a shape substantially similar to a logarithmic spiral.

37. The endoscopic stitching device according to claim 34, wherein each articulation cable remains substantially taut upon translation thereof.

38. The endoscopic stitching device according to claim 34, wherein the first and second cam disks are monolithically formed.

39. The endoscopic stitching device according to claim 34, wherein a torsion spring operably couples the first and second cam disks.

40. The endoscopic stitching device according to claim 33, wherein the rotation assembly includes a knob rotatably supported on the housing and operatively connected to a center drive rod assembly, wherein the center drive rod assembly includes a distal end extending through the elongate shaft and connected to the jaws.

41. The endoscopic stitching device according to claim 40, wherein the rotation assembly includes a beveled gear assembly operatively associated with the knob.

42. The endoscopic stitching device according to claim 41, wherein the beveled gear assembly is configured to translate the center drive rod assembly for opening and closing the jaws.

43. The endoscopic stitching device according to claim 41, wherein the beveled gear assembly is configured to translate rotational energy to the center drive rod assembly in accordance with at least one of the following ratios 1:

1, more than 1;

1, or less than 1;

1.

44. The endoscopic stitching device according to claim 41, wherein the beveled gear assembly includes a sun gear disposed in mechanical cooperation with the knob and operatively associated with first and second beveled gears, the first and second beveled gears being operatively associated with each other.

45. The endoscopic stitching device according to claim 44, wherein the beveled gear assembly further includes a first beveled gear mount disposed in mechanical cooperation with the first beveled gear and the knob.

46. The endoscopic stitching device according to claim 44, wherein the second beveled gear is disposed in mechanical cooperation with the center drive rod assembly.

47. The endoscopic stitching device according to claim 40, wherein at least a portion of the center drive rod assembly extending through the neck assembly is flexible.

48. The endoscopic stitching device according to claim 33, further comprising a center drive rod assembly at least translatably supported in the housing, the elongate shaft and the end effector, and at least rotatably supported in the elongate shaft and the end effector, the center drive rod assembly including a proximal end operatively connected to at least one handle of the handle assembly and a distal end extending through the elongate shaft and operatively connected to the jaws, wherein axial translation of the center drive rod assembly results in opening and closing of the jaws.

49. The endoscopic stitching device according to claim 48, wherein axial rotation of at least a distal portion of the center drive rod assembly results in rotation of the jaws about a longitudinal axis thereof.

50. The endoscopic stitching device according to claim 33, wherein the end effector further includes a pair of axially translatable needle engaging blades slidably supported, one each, in a respective jaw, each blade having a first position wherein a portion of the blade engages a suture needle when a suture needle is present in suture needle receiving recess formed in the tissue contacting surface of the jaw, and a second position wherein the blade does not engage the suture needle.

51. The endoscopic stitching device according to claim 50, wherein a proximal end of each blade is rotatably supported on a respective barrel of a concentric barrel pair, wherein the blades rotated about the barrels upon a rotation of the jaws.

52. The endoscopic stitching device according to claim 50, wherein a suture needle is loadable into the suture needle receiving recess defined in the jaw when the respective blade is in the second position.

53. The endoscopic stitching device according to claim 50, further comprising a loading/unloading assembly supported on the handle assembly and connected to each blade, wherein the loading/unloading assembly is movable between a first position in which the blades are in the first position and a second position in which the blades are in the second position.

54. The endoscopic stitching device according to claim 53, wherein the loading/unloading assembly is actuatable in a first direction to move a first blade to the first position and a second blade to the second position, and a second direction to move the first blade in the second direction and the second blade in the first direction.

55. The endoscopic stitching device according to claim 33, wherein the articulation assembly includes an articulation knob supported on the housing of the handle assembly, an articulation sleeve operatively connected to the articulation knob and including a pair of oppositely pitched outer helical threads, an articulation collar threadably connected to each helical thread and configured to permit axial translation and prevent rotation thereof, and an articulation cable secured to each articulation collar, wherein each articulation cable includes a first end secured to the respective articulation collar and a second end secured at a location distal of the neck assembly, and wherein the articulation cables are disposed on opposed sides of a center drive rod assembly.

56. The endoscopic stitching device according to claim 55, wherein each articulation cable is operably associated with a seal having first and second lumens extending therethrough, and wherein at least one lumen is configured to receive at least one articulation cable in substantial sealing relationship therewith.

57. The endoscopic stitching device according to claim 56, wherein at least one of the first and second lumens has an arched section.

58. The endoscopic stitching device according to claim 56, wherein at least one of the first and second lumens is repositionable through a plurality of positions including a first position and a second position in response to longitudinal translation of at least one articulation cable therethrough.

59. The endoscopic stitching device according to claim 58, wherein at least one lumen is biased towards at least one of the first or second positions.

60. The endoscopic stitching device according to claim 55, wherein rotation of the articulation knob results in rotation of the articulation sleeve and concomitant axial translation of the articulation collars, wherein axial translation of the articulation collars results in articulation of the end effector.

61. The endoscopic stitching device according to claim 60, wherein rotation of the articulation sleeve in a first direction results in relative axial separation of the articulation collars to articulate the end effector in a first direction, and rotation of the articulation sleeve in a second direction results in relative axial separation of the articulation collars to articulate the end effector in a second direction.

62. The endoscopic stitching device according to claim 33, wherein the neck assembly includes a plurality of links in pivotable contact with one another, wherein each link includes a knuckle formed on a first side thereof and a clevis formed on a second side thereof, wherein the knuckle of a first link is operatively connected to a clevis of an adjacent link.

63. The endoscopic stitching device according to claim 62, wherein the knuckles and devises are configured to enable uni-directional articulation of the neck assembly.

64. The endoscopic stitching device according to claim 62, wherein the knuckles and devises are configured to at least partially overlap one another when the neck assembly is in either the substantially linear configuration or the off-axis configuration.

65. The endoscopic stitching device according to claim 62, wherein the handle assembly includes:

a pair of handles supported on the housing; and

a center drive rod connected at a first end to the handles and at a second end to the pair of jaws, wherein actuation of the handles results in axial translation of the center drive rod and concomitant opening and closing of the jaws.