Surgical instrument for forming a knot

• US 5,846,254 A
• Filed: 10/09/1997
• Issued: 12/08/1998
• Est. Priority Date: 04/08/1997
• Status: Expired due to Term

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Inventors: Nobis, Rudolph Henry, Conlon, Sean P., Schulze, Dale R., Qureshi, Saleem Urrehman
• Primary Examiner(s): Buiz, Michael
• Assistant Examiner(s): PHAM, THUY D
• Application Number:
  US08/947,657
• Time in Patent Office: 425 Days
• Field of Search: 606/148, 606/139, 606/228, 289/1.2, 289/12, 289/17, 112/80.03, 112/169
• US Class Current: 606/148
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/0483 Hand-held instruments for holding sutures A61B17/0469 takes precedence; other holders for needles or sutures A61B17/06061; surgical forceps A61B17/28; surgical pincettes A61B17/30
• CPC Class Codes: A61B 17/062 Needle manipulators
• 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 17/12013 for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 2017/0474 Knot pushers
• CPC Class Codes: A61B 2017/0475 using sutures having a slip knot
• CPC Class Codes: A61B 2017/0477 with pre-tied sutures
• CPC Class Codes: A61B 2017/0479 Packages or dispensers for MIS suturing instruments
• CPC Class Codes: A61B 2017/2912 transmission of forces to actuating rod or piston
• CPC Class Codes: A61B 2017/2931 with releasable head
• CPC Class Codes: A61B 2017/3419 Sealing means between cannula and body

Abstract

A surgical instrument for forming a fully tied knot to fasten bodily tissue is disclosed. The instrument has a handle assembly for actuating first and second actuators. The first actuator remotely effects movement of a grasping jaw from an open position to a closed position relative to a suture cartridge contained in a cartridge carrier at the distal end of the instrument. Accordingly, the first actuator is capable of causing the manipulation of bodily tissue or suture filament contained in the suture cartridge. The second actuator is operatively connected to the suture filament in the suture cartridge. A portion of the suture filament is configured into a partially tied knot, and when the second actuator is actuated, it causes the proximal end of the filament to be pulled for converting the partially tied knot into a fully formed knot. Consequently, the instrument is particularly desirable during endoscopic surgery where the bodily tissue and the suture filament need to be manipulated remotely, and the conversion of the partially tied knot into the fully formed knot must also be carried out remotely to fasten the targeted tissue.

Claims

1. A surgical instrument for forming a fully tied knot to fasten bodily tissue during a surgical procedure, said instrument comprising:

a) a suture cartridge at a distal end of said instrument, said cartridge containing a suture filament configured into a partially tied knot at a distal end of said suture filament;

b) a cartridge carrier at the instrument distal end for receiving said suture cartridge;

c) a grasping jaw facing said suture cartridge in said cartridge carrier, said grasping jaw moveable from an open position spaced from said suture cartridge to a closed position adjacent said suture cartridge;

d) a handle assembly spaced from said suture cartridge and located at a proximal end of said instrument, said handle assembly having;

i) a grip for manipulating said instrument,

ii) a first actuator for effecting the movement of the grasping jaw from the open position to the closed position, and

iii) a second actuator operatively connected to a proximal end of said suture filament for pulling the filament proximal end proximally so as to form said fully tied knot from said partially tied knot to fasten the bodily tissue; and

e) a closure tube coupling said cartridge carrier to said handle assembly, said closure tube moveable from a proximal position wherein said grasping jaw is in the open position to a distal position wherein said grasping jaw is in the closed position in response to actuation of said first actuator.

2. The instrument of claim 1 wherein said suture cartridge is loaded into said cartridge carrier when said closure tube is in its proximal position, and said suture cartridge is secured in said cartridge carrier when said closure tube is moved to a middle position between its proximal and distal positions.

3. The instrument of claims 1 further comprising a first biasing element cooperable with said second actuator and the proximal end of said suture filament for preventing said suture filament from breaking when said second actuator is actuated so as to form said fully tied knot.

4. The instrument of claim 3 further comprising a second biasing element cooperable with said first actuator for providing overload protection when said first actuator is actuated so as to move said closure tube from its proximal position to its distal position.

5. The instrument of claim 1 wherein said first actuator is a trigger pivotally mounted on said handle assembly, said first actuator is moveable from a first trigger position spaced from said grip to a second trigger position adjacent said grip, wherein when said first actuator is in its first trigger position, said closure tube is in its proximal position, and when said first actuator is in its second trigger position, said closure tube is in its distal position.

6. The instrument of claim 5 wherein said first actuator is moveable to a third trigger position between said first and second trigger positions, and when said first actuator is in its third trigger position, said closure tube is in its middle position.

7. The instrument of claim 5 wherein said second actuator is a lever pivotally mounted on said handle assembly, and said lever is pivoted from a first lever position to a second lever position so as to pull the filament end proximally for forming said fully tied knot.

8. The instrument of claim 7 wherein said handle assembly of said instrument is adapted for one-handed operation for actuating said trigger and said lever with a single hand when said grip is placed in the palm of a user'"'"'s hand.

9. The instrument of claim 8 wherein said trigger is biased toward its first trigger position, said closure tube is biased toward its proximal position, and said lever is biased toward its first lever position.

10. The instrument of claim 9 further comprising a release button protruding from said handle assembly, said release button cooperable with said closure tube and said trigger, wherein when said release button is depressed inwardly toward said handle assembly, and said trigger is in its second or third trigger positions, said trigger moves to its first trigger position.

11. The instrument of claim 7 wherein said suture cartridge has a hook slot therein, the proximal end of said suture filament traverses said hook slot, and said lever is connected to a pinion housed inside said handle assembly.

12. The instrument of claim 11 further comprising a rack housed inside said handle assembly cooperable with said pinion, and a suture pull rod connected to said rack, said suture pull rod extending from said handle assembly to said cartridge carrier, said suture pull rod having a hook at a distal end thereof extending through said hook slot of said suture cartridge, wherein when said lever is pivoted from said first lever position to said second position, said pinion moves said rack and said suture pull rod connected thereto proximally, and said hook on said suture pull rod pulls the proximal end of said suture filament traversing said hook slot in said suture cartridge proximally so as to form said fully tied knot from said partially tied knot.