Method of closing the opening of a hernial sac

• US 4,919,152 A
• Filed: 05/18/1988
• Issued: 04/24/1990
• Est. Priority Date: 03/02/1987
• Status: Expired due to Term

• Current Assignee: Stryker Sales Corporation (Stryker Corporation)
• Original Assignee: Ralph Ger
• Inventors: Ger, Ralph
• Primary Examiner(s): Thaler, Michael H.
• Application Number:
  US07/195,586
• Time in Patent Office: 706 Days
• Field of Search: 128/337, 128/334 R, 128/334 C, 128/335, 128/898
• US Class Current: 128/898
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/295 combined with cutting implements
• CPC Class Codes: A61B 2017/306 holding by means of suction

Abstract

Disclosed is an improved surgical instrument useful in indirect hernia for closing sacs having narrow neck openings. The instrument is formed of a tubular body and has manual drive extending therethrough to actuate a pair of jaws at an end of the tubular body between open and closed positions. The instrument is formed with a conduit and valve which provide suction at the remote end of the instrument in the immediate vicinity of the jaws.

Claims

1. A method for closing the opening of a hernial sac having separated tissue portions in the groin area of a patient by inserting an instrument through an incision in the patient'"'"'s abdominal wall, comprising the steps:

(a) making an incision in the abdominal wall of said patient at a site in the abdomen which site is remote from said opening in said hernial sac in said groin area;

(b) providing an instrument loaded with at least one surgical clip releasable from the instrument, said instrument being slim for entry into said abdominal incision and elongated to reach said opening of said hernial sac from said abdominal incision, said instrument having jaw elements at one end thereof, the other end of said instrument including drive means to operate the jaws reversibly from opened and closed positions;

(c) inserting said instrument, jaw elements first, through said abdominal incision;

(d) maneuvering said one end of the instrument to the site of the opening of said hernial sac;

(e) grasping and approximating the edges of the separated tissue portions of said hernial sac opening; and

(f) joining permanently said approximated edges of the tissue portions by closing said surgical clip carried by said instrument about said approximated edges.

2. A method as claimed in claim 1, comprising the further steps of separating said instrument from said closed surgical clip, and then withdrawing said instrument via said abdominal incision to be outside said abdomen.

3. A method as claimed in claim 1, comprising a further step before step (c) of inserting a cannula through said abdominal incision, step (c) being performed by passing said instrument through said cannula.

4. A method as claimed in claim 1, wherein said instrument has a length not less than 300 millimeters and an outside diameter of about 6.5 millimeters.

5. A method for closing the opening of a hernial sac having separated tissue portions in the groin area of a patient by inserting an instrument through an incision in the patient'"'"'s abdominal wall comprising the steps:

(a) making a small incision in the abdominal wall at a site in the abdomen which site is remote from the opening in said hernial sac in said groin are and through which an instrument is insertable to reach and close the opening of said hernial sac;

(b) providing an instrument loaded with at least one surgical clip releasable from the instrument, said instrument being slim for entry into said small abdominal incision and elongated to reach said opening of said hernial sac from said small abdominal incision, said instrument having jaw elements at one end thereof, the other end of said instrument including drive means to operate the jaws reversibly from opened and closed positions;

(c) inserting said instrument, jaw elements first, through said small abdominal incision;

(d) maneuvering said one end of the instrument to the site of the opening of said hernial sac while said drive means remains at least partially outside of said abdominal incision;

(e) grasping and approximating the edges of the separated tissue portions of said hernial sac opening; and

(f) joining permanently said edges of the tissue portions by closing said surgical clip carried by said instrument about said approximated edges.

6. A method as claimed in claim 5, whereby the said other end of said instrument and said drive means remain outside said abdominal wall when the jaw elements thereof are within the abdomen at the site of the opening of said hernial sac.

7. A method according to claim 5 wherein said small incision in said abdominal wall is maximally 1.25 centimeters in length.

8. A method for closing the opening of a hernial sac having separated tissue portions in the groin area of a patient by inserting an instrument through an incision in the abdominal wall comprising the steps of:

making a small incision through the abdominal wall of the patient at a site in the abdomen which site is remote from the opening in said hernial sac in said groin area of the patient;

inserting an elongate instrument through said abdominal incision;

moving said instrument through said abdominal incision and through the internal body cavity of the patient so that the distal end of said instrument is close to the opening in said hernial sac in said groin area of the patient while remaining on an internal side of said abdominal opening;

gripping, approximating and holding together two pieces of body tissue on opposite sides of said opening in the hernial sac from said internal side of said abdominal opening, the composite step of gripping, approximating and holding being performed remotely from tissue edges with said instrument by manual manipulation at a proximal end thereof; and

joining together said two pieces of body tissue from said internal side of said abdominal opening, said step of joining being performed with said instrument by manual manipulation at a proximal end thereof.

9. A method for closing the opening of a hernial sac having separated tissue portions in the groin area of a patient by inserting an instrument through an incision in the abdominal wall, comprising the steps:

(a) making a small incision of approximately one half inch breadth in the abdominal wall of said patient at a site in the abdomen which site is remote from said opening in said hernial sac in said groin area;

(b) providing an instrument loaded with at least one surgical clip releasable from the instrument, said instrument being slim for entry into said abdominal incision and elongated to reach said opening of said hernial sac from said abdominal incision, said instrument having jaw elements at one end thereof, the other end of said instrument including drive means to operate the jaws reversibly between opened and closed positions;

(c) inserting said instrument, jaw elements first, through said abdominal incision;

(d) maneuvering said one end of the instrument from inside the abdomen to the site of the opening of said hernial sac;

(e) grasping and approximating the edges of the separated tissue portions of said hernial sac opening by partially closing said surgical clip; and

(f) joining permanently said approximated edges of the tissue portions by fully closing said surgical clip carried by said instrument about said approximated edges.

10. A method for closing the opening of a hernial sac having separated tissue portions in the groin area of a patient by inserting an instrument through an incision in the abdominal wall, comprising the steps;

(a) making a small incision of approximately on half inch in the abdominal wall of said patient at a site in said abdomen which site is remote from said opening in said hernial sac in said groin;

(b) providing an instrument loaded with at least one surgical clip releasable from the instrument, said instrument being slim for entry into said abdominal incision and elongated to reach said opening of said hernial sac from said abdominal incision, said instrument having jaw elements at one end thereof, the other end of said instrument including drive means to operate the jaws reversibly between opened and closed positions;

(c) inserting said instrument, jaw elements first, through said abdominal incision;

(d) maneuvering said one end of the instrument to the site of the opening of said hernial sac;

(e) grasping and approximating the edges of the separated tissue portions of said hernial sac opening; and

(f) joining permanently said approximated edges of the tissue portions by closing said surgical clip carried by said instrument about said approximated edges.

11. A method for a hernial repair operation for closing the neck opening of a hernial sac having separated tissue portions in the groin area of a patient, said neck opening defined by spaced apart tissue portions thereof, said method including use of an endoscope, comprising the steps:

(a) creating a puncture wound of approximately one half inch breadth in the abdomen at a site remote from said hernial sac in the groin area,

(b) inserting a canula through said puncture wound,

(c) providing an instrument loaded with at least one surgical clip releasable from the instrument, said instrument being slim with a maximum outside diameter of 6.5 mm and being elongated with length of approximately twelve inches to reach said hernial sac neck opening from said puncture wound, said instrument having a pair of jaws at the end inserted through said canula into said abdomen and drive means at said opposite end for operating said jaws reversibly between open and closed positions,

(d) inserting said instrument with the jaws end first through said canula,

(e) maneuvering said jaws end of the instrument to the site of the opening of said hernial sac,

(f) operating said instrument for grasping and approximating selected portions of said tissue of said hernial sac opening and for joining permanently said approximated portions of said tissue by closing said surgical clip carried by said instrument about said approximated portions,

(g) monitoring said insertion, maneuvering and operation of said instrument by using said endoscope, and

(h) removing said instrument from said abdomen while said closed surgical clip remains joining said approximated portions of tissue of said hernial sac.

12. A method according to claim 11 comprising the further steps, after said instrument is removed from said abdomen, of re-loading said instrument with another clip, and repeating steps (d) through (h).

13. A method according to claim 11 wherein said surgical clip has a pair of legs and a tooth extending from each leg, wherein said step of grasping and approximating selected portions of said tissue, comprises operating said instrument to open said surgical clip carried thereon, causing said teeth of said open clip to engage said selected tissue portions, and operating said instrument to close said surgical clip whose teeth pierce said tissue portions, urge said portions together and permanently join said approximated portions.

14. A method for a hernial repair operation for closing the neck opening of a hernial sac having separated tissue portions in the groin area of a patient, said neck opening defined by spaced apart tissue portions thereof, said method including use of a stapling instrument having a body part that is slim with a maximum outside diameter of 6.5 mm and with a length of at least ten inches, said instrument having a pair of jaws at one end and drive means at said opposite end for operating said jaws reversibly between open and closed positions, said instrument being loaded with at least one surgical clip releasable from the instrument, comprising the steps:

(a) creating a puncture wound of approximately one half inch breadth in the abdomen at a site remote from said hernial sac in the groin area,

(b) inserting a canula through said puncture wound,

(c) inserting said instrument with the jaws end first through said canula,

(d) maneuvering said jaws end of the instrument to the site of the opening of said hernial sac,

(e) operating said instrument for grasping and approximating selected portions of said tissue of said hernial sac opening and for joining permanently said approximated portions of said tissue by closing said surgical clip carried by said instrument about said approximated portions,

(f) monitoring said insertion maneuvering and operation of said instrument by using an endoscope, and

(g) removing said instrument from said abdomen while said closed surgical clip remains joining said approximated portions of tissue of said hernial sac.