Instruments and method for suturing and ligation

• US 5,383,877 A
• Filed: 10/08/1992
• Issued: 01/24/1995
• Est. Priority Date: 05/01/1991
• Status: Expired due to Term

• Current Assignee: Henry C. Clarke
• Original Assignee: Henry C. Clarke
• Inventors: Clarke, Henry C.
• Primary Examiner(s): Pellegrino, Stephen C.
• Assistant Examiner(s): SCHMIDT, JEFFREY
• Application Number:
  US07/958,548
• Time in Patent Office: 838 Days
• Field of Search: 606/139, 606/144, 606/148, 606/205, 606/206, 606/207
• US Class Current: 606/148
• CPC Class Codes: A61B 17/0467 Instruments for cutting sutures surgical cutting instruments A61B17/32
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/0493 Protective devices for suturing, i.e. for protecting the patient's organs or the operator
• CPC Class Codes: A61B 17/06066 Needles, e.g. needle tip configurations making needles B21G1/00
• CPC Class Codes: A61B 17/12013 for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 2017/00353 one mechanical instrument performing multiple functions, e.g. cutting and grasping channel for multiple instruments A61B2017/3445; instrument channel A61B2017/22072; replaceable heads A61B2017/2931; suction A61M1/00
• CPC Class Codes: A61B 2017/0474 Knot pushers
• CPC Class Codes: A61B 2017/0477 with pre-tied sutures
• CPC Class Codes: A61B 2017/0496 for tensioning sutures

Abstract

A laparscopic method and instrument for suturing and ligation of tissue in a body cavity of a patient through trocar tubes inserted into the cavity. First forceps have a needle on the end of a movable jaw to pierce the tissue and pass a surgical thread through it. Second forceps have a movable jaw and a groove through the ends of both jaws and transverse to the pivotal axis of the movable jaw for advancing a loose tie in the surgical thread through a trocar tube and into engagement with the tissue and tensioning or drawing up the tie to close the tissue and produce a secure knot. Preferably, the jaws of both forceps each have therein a groove for guiding the thread to avoid tearing the tissue and blades for cutting the excess thread when the suture is completed.

Claims

1. A method for suture ligating using laparoscopic instruments comprising:

a) inserting at least first and second trocars at spaced locations into the body of a patient,

b) inserting through the first trocar a first laparoscopic forceps having jaws and a needle threaded with a surgical thread with one end or the thread adjacent the needle and with a portion of the thread extending through the first trocar and the other end of the thread being retained exteriorly of the first trocar,

c) inserting through the second trocar a second laparoscopic forceps having jaws with a groove through outer free ends of the jaws extending transverse to the longitude of the second forceps and the pivotal axis of the jaws,

d) manipulating the first forceps to pierce the tissue with the needle and bring a free end of the thread therethrough,

e) manipulating the second forceps and jaws thereof to grasp the thread adjacent the free end and disengage the thread from said needle,

f) manipulating the first forceps to remove the needle from the tissue and then to grasp the thread adjacent its free end within the jaws of the first forceps,

g) withdrawing said first forceps through said first torcar to bring said free end of the thread through and outside of said first trocar,

h) tying the runs of the thread together to provide a loose tie exteriorly of the first trocar,

i) withdrawing the second forceps from the second trocar,

j) manipulating the second forceps with its jaws in their closed position and the runs of the thread adjacent such loose tie being received in such groove to move said loose tie through the first trocar and immediately adjacent the tissue, and

k) manipulating the said second forceps to move its jaws to an open position while maintaining the runs of the suture thread taut to finally tighten the tie into a secure knot to hold the tissue together.

2. The method as claimed in claim 1 further comprising after step (k) cutting the ends of the suture with shear blades secured in the jaws of the second forceps.

3. The method as claimed in claim 1 further comprising after step (k) removing said second forceps from said first trocar.

4. The method as claimed in claim 1 further comprising after step (f) and before step (g) disposing such thread through a guide groove between the jaws of said second forceps and encircling such thread by closing the jaws of said second forceps.

5. The method as claimed in claim 1 further comprising after step (f) and before step (g) disposing such thread through a guide groove between the jaws of said second forceps and encircling such thread by closing the jaws of said second forceps to thereby prevent the thread from tending to pull on and tear the tissue while withdrawing the first forceps through the first trocar to bring such free end of the thread through and outside of the first trocar, and after step (g) and before step (i) opening the jaws of said second forceps and releasing such thread from such guide groove thereof.

6. A method for suture ligating using laparoscopic instruments comprising:

a) inserting at least a first trocar into the body of a patient,

b) inserting through the first trocar a first laparoscopic forceps having jaws and a needle threaded with a surgical thread with one free end of the thread adjacent the needle and with a portion of the thread extending through the first trocar and the other end of the thread being retained exteriorly of the first trocar,

c) manipulating the first forceps to pierce the tissue with the needle and bring the one free end of the thread therethrough,

d) disengaging the thread from the needle,

e) manipulating the first forceps to remove the needle from the tissue and then to grasp the thread adjacent the free end of the thread within the jaws of the first forceps,

f) withdrawing said first forceps through said first trocar to bring such free end of the thread through and outside of said trocar,

g) tying the runs of the thread together to provide a loose tie exteriorly of the first trocar,

h) providing outside the first trocar a second laparoscopic forceps having a pair of jaws at least one of which pivots about an axis transverse to the longitude of the second forceps and with a groove through the outer ends of the jaws and extending at generally a right angle to both said axis and the longitude of the second forceps,

i) manipulating the second forceps with its jaws in their closed position and the runs of the thread adjacent said loose tie being received in said groove to move said loose tie through the first trocar, and

j) manipulating the second forceps to move its jaws to an open position and tensioning the runs of the suture thread to finally tighten said tie to hold the tissue together.

7. The method as claimed in claim 6 further comprising after step (j) cutting the ends of the suture with shear blades secured in the jaws of the second forceps.

8. The method as claimed in claim 6 further comprising after step (j) removing said second forceps from said first trocar.

9. The method as claimed in claim 6 further comprising, inserting a second trocar into the body of the patient at a location spaced from the first trocar, inserting a second forceps through said second trocar, and after step (e) and before step (f) disposing said thread through a guide groove between the jaws of said second forceps and encircling said thread by closing the jaws of said second forceps while performing step (f).

10. The method as claimed in claim 6 further comprising inserting a second trocar into the body of the patient at a location spaced from the first trocar, inserting a second foreceps through said second trocar, and after step (e) and before step (f) disposing said thread through a guide groove between the jaws of said second forceps and encircling said thread by closing the jaws of said second forceps to thereby prevent the thread from tending to pull on and tear the tissue while withdrawing the first forceps through the first trocar to bring said free end of said thread through and outside of the first trocar, and after step (f) and before step (h) opening the jaws of said second forceps and releasing said thread from said guide groove thereof.

11. A laparoscopic forceps for extending through a trocar in the body of a patient and positioning and tensioning a loose tie in a suture thread within the body of a patient and having both runs of the thread passing through the trocar to the exterior thereof for manual engagement by a user of the forceps, the laparoscopic forceps comprising:

a pair of elongated slender links which lie in side by side relationship and are constructed and arranged to be received in the trocar tube,

a pair of jaws adjacent one end of said elongated links and carried by at least one of said links,

at least one of said jaws being pivotally movable to open and closed positions relative to the other jaw about an axis extending transversely to the longitude of the forceps, said jaws being constructed and arranged so that in the closed position they can pass through the trocar tube and into the body of the patient,

means for manually moving said jaws to a closed position and to an open position, and

a groove through the free ends of both jaws and extending at generally a right angle to both the longitude of the forceps and the axis of pivotal movement of said jaws and opening outwardly of the jaws, said groove being constructed and arranged for slidably receiving the runs of the suture thread with a loose tie therein adjacent the free ends of the jaws and with the runs of the thread extending from both ends of such groove generally longitudinally along the elongated links of the forceps and through the trocar tube to the exterior thereof to facilitate tensioning of the tie by opening the jaws while in the body with the thread slidably received in the groove through both of said jaws.

12. The laparoscopic forceps as claimed in claim 11 wherein said jaws have shear blades secured therein inboard from the free ends thereof to provide a suture thread cutting action when the jaws move from the open to the closed position.

13. The laparoscopic forceps as claimed in claim 11 wherein said jaws have at least one suture thread guide groove therein inboard from the free ends thereof and extending axially generally parallel to said axis about which at least said one jaw pivots and constructed and arranged such that when said jaws are closed said suture guide groove provides an opening having a substantially continuous periphery through which the suture thread can be slidably received.

14. The laparoscopic forceps as claimed in claim 13 wherein said jaws have shear blades secured therein inboard from the free ends thereof to provide a suture thread cutting action when the jaws move from the open to the closed position.

15. A laparoscopic forceps for extending through a trocar in the body of a patient and positioning and tensioning a loose tie in a surgical thread within the body of a patient and having both runs of the thread passing through the trocar to the exterior thereof for manual engagement by a user of the forceps, the laparoscopic forceps comprising, at least one elongate slender element constructed and arranged to be received in the trocar tube, a pair of jaws adjacent one end of said elongate element and carried by said elongate element, at least one of said jaws being pivoted to move about an axis extending transversely to the longitude of said elongate element to open and closed positions relative to the other jaw of said pair of jaws, said jaws being constructed and arranged so that in the closed position they will pass through the trocar tube and into the body of the patient, means carried by said elongate element and manually engagable adjacent the end of said elongate element opposite said jaws for moving said jaws to a closed position and to an open position, and a groove through the free end of both jaws and extending at generally a right angle to both the longitude of said elongate element and said axis of pivotal movement of said at least one jaw and opening outwardly of said jaws, and said groove being constructed and arranged for slidably receiving the runs of the surgical thread with a loose tie therein adjacent the free ends of the jaws and with the runs of the thread extending from both ends of said groove generally longitudinally along said elongate element toward the other end of said elongate element and through the trocar tube to the exterior thereof to facilitate tensioning of the tie in the thread by opening said jaws while in the body with the thread slidably received in the groove through both of said jaws.

16. The laparoscopic forceps as claimed in claim 15 which also comprises at least one surgical thread guide groove through at least one of said jaws, inboard from the free ends of said jaws, and extending generally parallel to said axis of pivotal movement of said at least one jaw and constructed and arranged such that when said jaws are closed, said suture guide groove provides an opening having a substantially continuous periphery through which a surgical thread can be slidably received and retained therein and when said jaws are open the surgical thread is released from said guide groove.

17. The laparoscopic forceps as claimed in claim 15 wherein said jaws have shear blades secured therein inboard from the free ends of said jaws to provide a suture thread cutting action when said jaws are moved from the open to the closed position of said jaws.