Surgical purse string suturing instrument and method
First Claim
1. A method of placing a purse string suture in a section of tubular tissue inside a body cavity of a patient without fully opening the patient, said method comprising the steps of:
- inserting a cannula into the body cavity;
inserting, through the cannula, an instrument comprising a pair of relatively movable jaws hinged together at one end for pivotal movement about a first axis, each jaw having a row of spaced apart, uniform-size teeth, each tooth having a base and a crest, the two rows being opposed and offset with respect to each other so that the rows of teeth mesh when the jaws are closed, the crest of each tooth having a channel therein running parallel to the direction of the row, all of the channels in each row being aligned so as to define at their bases a substantially straight needle passageway through all of the teeth in the rows, the instrument being inserted through the cannula with the pair of jaws being closed;
articulating the pair of jaws about a second pivot axis transverse to the first pivot axis;
actuating the first and second jaws to pivot about the first axis to an open position;
positioning the first and second jaws adjacent and transverse to the section of tubular tissue;
actuating the first and second jaws to pivot about the first axis to clamp around the tissue and bend the clamped tissue into a wavelike configuration with a two-wall thickness of the tissue overlying the crest of each tooth, the tissue being forced deep enough into the spaces between the teeth that a first wall thickness of tissue, but not the second wall thickness thereof, protrudes into the needle passageway;
sliding a suturing cartridge having two needles attached to opposite ends of a length of bioabsorbable thread and loaded into a needle cartridge through a pathway in one of the jaws;
forcing the two needles completely through the needle passageways and the tissue, one needle for each passageway, thereby creating an encircling series of stitches in the wall of the tubular tissue; and
detaching the needles from the thread and removing the needles from the body, thereby leaving a purse string suture in the tubular tissue, ready to be drawn snug and tied.
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Accused Products
Abstract
A purse string suturing instrument is provided for quickly and effectively forming a purse string suture in tubular tissue through relatively small cannulas placed in the body. The instrument includes a pair of elongated jaws, each having a row of spaced-apart uniform-size teeth. The jaws are hinged together at one end to clamp the tubular tissue therebetween. The two rows of teeth are offset with respect to each other so that they mesh when the jaws are closed. The jaws are inserted through a cannula and positioned to close around the tissue to be sutured. The rows of teeth then bend the tissue between them into a wavelike configuration. A pair of needles, the ends of each being connected to a single length of suture, is then inserted through passageways provided through the teeth. An encircling series of stitches are thus formed in the wall of the tubular tissue to create a purse string suture. The needles and the suturing instrument are then withdrawn through the cannula. The tubular tissue can be snugly fitted over an anastomosis ring or the like by drawing and tying the purse string suture.
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Citations
16 Claims
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1. A method of placing a purse string suture in a section of tubular tissue inside a body cavity of a patient without fully opening the patient, said method comprising the steps of:
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inserting a cannula into the body cavity; inserting, through the cannula, an instrument comprising a pair of relatively movable jaws hinged together at one end for pivotal movement about a first axis, each jaw having a row of spaced apart, uniform-size teeth, each tooth having a base and a crest, the two rows being opposed and offset with respect to each other so that the rows of teeth mesh when the jaws are closed, the crest of each tooth having a channel therein running parallel to the direction of the row, all of the channels in each row being aligned so as to define at their bases a substantially straight needle passageway through all of the teeth in the rows, the instrument being inserted through the cannula with the pair of jaws being closed; articulating the pair of jaws about a second pivot axis transverse to the first pivot axis; actuating the first and second jaws to pivot about the first axis to an open position; positioning the first and second jaws adjacent and transverse to the section of tubular tissue; actuating the first and second jaws to pivot about the first axis to clamp around the tissue and bend the clamped tissue into a wavelike configuration with a two-wall thickness of the tissue overlying the crest of each tooth, the tissue being forced deep enough into the spaces between the teeth that a first wall thickness of tissue, but not the second wall thickness thereof, protrudes into the needle passageway; sliding a suturing cartridge having two needles attached to opposite ends of a length of bioabsorbable thread and loaded into a needle cartridge through a pathway in one of the jaws; forcing the two needles completely through the needle passageways and the tissue, one needle for each passageway, thereby creating an encircling series of stitches in the wall of the tubular tissue; and detaching the needles from the thread and removing the needles from the body, thereby leaving a purse string suture in the tubular tissue, ready to be drawn snug and tied.
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2. A surgical suturing instrument for placing a purse string suture in a tubular tissue, said instrument comprising:
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a pair of relatively movable jaws for clamping the tubular tissue therebetween, a first jaw of said pair of jaws being pivotable with respect to a second jaw about a first pivot axis, each jaw having a row of spaced-apart, uniform-size teeth; actuating means for actuating said pair of jaws between an open position for receiving the tubular tissue and a clamping position where the row of teeth of said first jaw meshes with the row of teeth of said second jaw, said actuating means including a toggle linkage having a rigid lever pivotally connected to one of said jaws about a second pivot axis parallel to the first pivot axis, a link pivotally connected to said lever and a driving rod pivotally connected to said link; and articulating means, positioned to contact one of said jaws, for pivoting said pair of jaws about a third pivot axis transverse to the first pivot axis, wherein each tooth includes a base and a crest, the two rows being opposed and offset with respect to each other in the clamping position so that the rows of teeth mesh when the jaws are closed, thereby bending the tubular tissue between the rows of teeth into a wavelike configuration with a two-wall thickness of the tissue overlying the crest of each tooth, and wherein the crest of each tooth includes a channel therein running parallel to the direction of the row, all of the channels in each row being aligned so as to define at their bases a substantially straight passageway for the transit of a thread-pulling needle through all of the teeth in the row, the base of each channel being sufficiently close to the base of the tooth that a needle forced through the passageway when said jaws are clamped across the tissue can run through only the wall of the wave of tissue contacting and overlying the crest of each tooth without penetrating the next adjacent wall of the tissue. - View Dependent Claims (3, 4, 5, 6, 7, 8, 9)
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10. A surgical suturing instrument for placing a purse string suture in a tubular tissue, said instrument comprising:
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a pair of relatively movable jaws for clamping the tubular tissue therebetween, a first jaw of said pair of jaws being pivotable with respect to a second jaw about a first pivot axis, each jaw having a row of spaced-apart, uniform-size teeth; actuating means for actuating said pair of jaws between an open position for receiving the tubular tissue and a clamping position where the row of teeth of said first jaw meshes with the row of teeth of said second jaw, said actuating means including a toggle linkage having a rigid lever pivotally connected to one of said jaws about a second pivot axis parallel to the first pivot axis, a link pivotally connected to said lever and a driving rod pivotally connected to said link; and articulating means, positioned to contact one of said jaws, for pivoting said pair of jaws about a third pivot axis transverse to the first pivot axis, wherein said articulating means includes a camming rod slidably disposed to engage one of said jaws and pivot said pair of jaws about the third pivot axis. - View Dependent Claims (11, 12, 13)
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14. A surgical suturing instrument for placing a purse string suture in a tubular tissue, said instrument comprising:
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a pair of relatively movable jaws for clamping the tubular tissue therebetween, a first jaw of said pair of jaws being pivotable with respect to a second jaw about a first pivot axis, each jaw having a row of spaced-apart, uniform-size teeth; actuating means for actuating said pair of jaws between an open position for receiving the tubular tissue and a clamping position where the row of teeth of said first jaw meshes with the row of teeth of said second jaw, said actuating means including a toggle linkage having a rigid lever pivotally connected to one of said jaws about a second pivot axis parallel to the first pivot axis, a link pivotally connected to said lever and a driving rod pivotally connected to said link; articulating means, positioned to contact one of said jaws, for pivoting said pair of jaws about a third pivot axis transverse to the first pivot axis; and a first universal pin connecting said link with said lever and a second universal pin connecting said link with said driving rod, said first and second universal pins allowing said link to rotate about its longitudinal axis and relative to said lever and said driving rod.
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15. A medical device, comprising:
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a pair of jaws; hinge means for linking said jaws together for relative pivoted movement about a first pivot axis between an open position and a closed position; actuating means including a rigid lever, having first and second ends, connected to one said jaw for pivoted movement therewith;
an articulated link connected to said second end of said lever; and
a driving rod, mounted for reciprocal movement between advanced and withdrawn positions, connected to said link;
wherein the interconnection of said driving rod and said one jaw through said lever and said link causes said jaws to move to the closed position when said driving rod is moved to the advanced position and to move to the open position when said driving rod is moved to the withdrawn position; anda first universal pin connecting said link with said first end of said lever and a second universal pin connecting said link with said driving rod, said first and second universal pins allowing said link to rotate about its longitudinal axis and relative to said lever and said driving rod. - View Dependent Claims (16)
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Specification