Instrument for closing, by subcutaneous suturing, an orifice made in the abdominal wall of a patient

• US 6,939,357 B2
• Filed: 05/01/2002
• Issued: 09/06/2005
• Est. Priority Date: 05/04/2001
• Status: Expired due to Fees

• Current Assignee: Francis Navarro, Jacques Domergue
• Original Assignee: Francis Navarro, Jacques Domergue
• Inventors: Navarro, Francis, Domergue, Jacques
• Primary Examiner(s): Jackson, Gary
• Application Number:
  US10/137,203
• Publication Number:
  US 20030028201A1
• Time in Patent Office: 1,224 Days
• Field of Search: 606/144, 606/145, 606/213
• US Class Current: 606/145
• CPC Class Codes: A61B 17/0057 Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• CPC Class Codes: A61B 2017/00637 for sealing trocar wounds through abdominal wall
• CPC Class Codes: A61B 2017/00663 the implement being a suture
• CPC Class Codes: A61B 2017/047 having at least one proximally pointing needle located at the distal end of the instrument, e.g. for suturing trocar puncture wounds starting from inside the body J-shaped suture needles A61B2017/0608
• CPC Class Codes: A61B 2017/0472 Multiple-needled, e.g. double-needled, instruments

Abstract

An instrument for closing, by subcutaneous suturing, an orifice made in the abdominal wall of a patient. The instrument has a piston rod (5) whose end acts on a flexible support strip (8) for needles (7), thus causing them to emerge at an exterior of the lower part (4) of a cannula (3) of the instrument underneath the abdominal wall (2), so that the needle can then penetrate into a thick part of this wall. Also, a method for suturing of orifices after a surgical operation by laparoscopy.

Claims

1. An instrument for closing, by subcutaneous suturing, an orifice (1) made in the abdominal wall (2) of a patient for passage of a trocar that has been used for a surgical operation by laparoscopy, characterized in that it comprises a cylindrical rigid cannula (3), one end part (4) of which can be introduced into the orifice (1);

a piston (5) extending coaxially in the cannula (3) and being operable externally by an operator;

two needles (7) movably attached to the diametrically opposite ends of a support member (8;

26), which itself is supported in the end part (4) of the cannula (3) and which can occupy, under the action of the piston (5), a collapsed position in which the needles (7) are drawn back into the end part (4) of the cannula and an extended position after introduction of the cannula (3) into the orifice (1), in which case the needles (7) project completely out of the cannula underneath the abdominal wall (2) by passing through respectively two longitudinal slots (10) of the lateral wall of the cannula (3), and are inclined relative to the longitudinal axis of the cannula (3) on both sides thereof and are directed toward one another;

a means (15) for extracting the needles (7), which is mounted slidingly in the cannula (3), concentrically with the piston (5), and which can be maneuvered by the operator so that it can be displaced from a low position in the end part (4) of the cannula (3) to a high position in the upper end part thereof in such a way that, during this displacement, it simultaneously catches the two needles (7), which were introduced beforehand into the abdominal wall (2) and which penetrate obliquely toward one another in the orifice (1) and the cannula (3) through longitudinal slots (10), and extracts them from the support member (8;

26) in order to guide them into the cannula (3), at the same time pulling a suture thread (25) into the abdominal wall (2) and the cannula (3), the thread (25) having its ends integral respectively with the two needles (7) and defining a loop (25a), which is situated outside the cannula and which passes through the orifice (1) to the outside of the abdominal wall (2), the ends of the thread (25) then being accessible, so that they can be grasped and cut by the operator after complete retraction of the cannula (3) from the orifice (1), in order to close the said orifice by tying a knot with the two strands of the thread (25).

2. An instrument according to claim 1, characterized in that the piston is a central rigid rod (5), which is guided slidingly in the extraction means (15) and whose lower end is connected to the support member (8;

26) of the needles (7) and whose upper end part (5a) passes through an upper transverse sealing wall (13) of the cannula (3), the rod (5) capable of being retained axially in the cannula (3) by a manually releasable locking means (11) in such a way as to exert on the support member (8;

26) an axial force for retracting the needles (7) into the cannula (3) to permit introduction thereof into the orifice (1), after which the operator can release the locking means (11) to displace the rod (5) in a direction that causes extension of the support member (8;

26) and emergence of the needles (7) from the cannula (3).

3. An instrument according to claim 2, characterized in that the extraction means (15) comprises a sliding cylindrical upper part (16) in the cannula (3), a cylindrical lower end part (17) of smaller diameter, in which there is slidingly mounted the lower end part (5b) of the rod (5), and an intermediate linking part constituted in particular by two oblique walls (18b), which converge toward the lower end part (17) and each of which comprises a longitudinal slot (19) that permits, when the extraction means (15) is in low position, passage of the corresponding needle (7) to its emerged position, in which it projects out of the cannula (3), each slot (19) being terminated above the lower part (17) of the extraction means (15) by two V-shaped rims (19a), in which the hook-shaped end (7a) of the needle (7) can be caught during the displacement of the extraction means (15) toward the upper part of the cannula (3).

4. An instrument according to claim 3, characterized in that the extraction means (15) comprises two diametrically opposite external gripping tabs (20), which are integral with the upper part (16) of this means and project radially through respectively two longitudinal slots (21) situated in the lateral wall of the cannula (3) at positions above the slots (10) for passage of the needles (7), and in that a precompressed spring (22) is mounted between the extraction means (15) and the cannula (3) to return the extraction means (15) to its low position.

5. An instrument according to claim 2, wherein the support member comprises a flexible strip (8) having ends carrying the two needles (7), said instrument comprising means for maintaining the strip in the lower end part (4) of the cannula (3) such that it is perpendicular to a longitudinal middle plane thereof, said means for maintaining comprising two pairs of support pins (9) which are parallel to the strip (8), disposed on both sides of the transverse central plane of the strip (8) symmetrically with respect thereto, and integral with the body of the cannula (3) and perpendicular to its longitudinal central plane, the two pins (9) of each pair being disposed on each side of the strip (8) in immediate proximity thereto so as to allow modification, by bending, of a radius of curvature of the strip (8) by sliding the strip between the support pins (9) under the action of the piston rod (5), the piston rod having a lower end that is integral with a geometric center of the strip (8) so that the piston rod can displace the geometric center of the strip toward the top or toward the bottom of the cannula (3) to cause, the needles (7) to emerge from or to be drawn back into the cannula (3).

6. An instrument according to claim 5, wherein the locking means comprises two diametrically opposite lugs (11), which are integral with the upper end part (5a) of the rod (5) and project radially therefrom, and which are braced underneath or on top of the transverse sealing wall (13) of the cannula (3), the wall (13) being provided with an oblong hole (12), which is defined on both sides of the central orifice for passage of the rod (5) and which permits passage of the two lugs (11) therethrough by rotation of the upper end part (5a) of the rod (5) relative to a lower end part (5b) to release the rod (5) and displace it axially in the cannula (3).

7. An instrument according to claim 2, wherein the support member comprises two support arms (26) mounted pivotally on a common central pin (27) integral with the body of the cannula (3) in the lower end part (4) thereof and extending perpendicular to a longitudinal central plane of the cannula, the two support arms (26) comprising opposite ends carrying the needles (7), and wherein the piston (5) causes simultaneous pivoting of the two support arms (26) when the piston is displaced downward or upward which in turn causes the needles (7) to emerge from or to be drawn back into the cannula (3) by the intermediary of two rocker arms (29), said rocker arms being linked to one another at a lower end of the piston rod (5) by a joint pin (30) integral with the piston and parallel to the central pin (27) of the support arms (26), said rocker arms also being linked at opposite ends in articulated manner respectively to the two support arms (26), in the vicinity of the needles (7).

8. An instrument according to claim 1, wherein the needles (7) are curved and situated respectively in two planes which are parallel to a longitudinal central plane of the cannula (3) and are disposed on both sides of the longitudinal central plane of the cannula at equal distances therefrom so as to allow the needles (7) to occupy a drawn-in position in which they cross in the end part (4) of the cannula (3).

9. An instrument according to claim 8, wherein the two planes containing the two needles (7) are situated on both sides of the piston rod (5).

10. An instrument according to claim 1, wherein the needles (7) comprise hook-shaped ends (7a) and are mounted movably via ends of the needles at positions opposite to the hook-shaped ends (7a) respectively in two bases (14), said bases being integral with the ends of the support member (8;

26), each of the bases (14) being inclined relative to a corresponding end support plane of the support member to facilitate extraction of the needles (7) during upward movement of the extraction means (15) in the cannula (3).

11. An instrument according to claim 1, wherein the cannula is displaceable by pulling such that, when the needles (7) are in a position in which they have emerged from the cannula (3), the needles (7) can be made to penetrate into the abdominal wall (2), and wherein the piston (5) is operable in a direction that allows the needles (7) to be retracted toward the cannula (3) and the ends thereof to penetrate into the orifice (1) and into the cannula (3) through the two longitudinal slots (10) thereof.

12. A method for closing, by subcutaneous suturing, an orifice (1) made in the abdominal wall (2) of a patient for passage of a trocar that has been used for a surgical operation by laparoscopy, the method comprising:

(a) providing the instrument of claim 1 and providing the needles with respective ends of a suture thread;

(b) introducing the cannula (3) into the orifice (1) immediately after extraction of the trocar while the abdomen is still inflated by a gas;

(c) displacing the piston (5) relative to the cannula (3) in a direction that makes it possible to act on the support member (8;

26) of the needles (7) in such a way that the needles emerge through the slots (10) of the lateral wall of the cannula (3) underneath the abdominal wall (2);

(d) exerting a pulling movement on the cannula (3) to introduce the needles (7) into a thick part of the abdominal wall (2);

(e) displacing the piston (5) in the cannula (3) once again in opposite direction to cause the needles (7) to pass through a thick part of the abdominal wall (2) and to be drawn back into the cannula (3) through slots (10;

19) of the extraction means (15);

(f) displacing the extraction means (15) relative to the cannula (3) at an upper part thereof in such a way that the extraction means (15) catch respective of the needles (7) to retract them from the support member (8;

26) and introduce them into the cannula (3);

(g) operating the piston (5) once again in a direction that makes it possible to retract the support member (8;

26) without the needles (7) into the cannula (3); and

(h) withdrawing the cannula (3) from the orifice (1) to enable grasping of the ends of the suture thread (15) and to complete closing of the orifice (1).

13. The method according to claim 12, wherein the support member comprises a flexible strip (8), and the method comprises displacing the piston (5) upward relative to the cannula (3), so that the needles (7) emerge from the cannula (3), and displacing the piston toward the bottom of the cannula so that the needles (7) are drawn partly back into the cannula (3) and so that ultimately the strip (8) is drawn completely back into the cannula (3) before retraction of the cannula from the orifice (1).

14. The method according to claim 12, wherein the support member comprises two articulated arms (26), and the method comprises displacing the piston (5) downward relative to the cannula (3) so that the needles (7) emerge from the cannula, and displacing the piston toward the top of the cannula, so that the needles (7) are drawn partly back into the cannula and so that ultimately the arms (26) are drawn completely back into the cannula (3) before retraction of the cannula from the orifice (1).

15. The method according to claim 12, wherein after retraction of the cannula (3) from the orifice (1), the method further comprises pulling on free ends of the thread (15) to tighten its loop (15a) underneath the abdominal wall (2) and to ensure that the orifice (1) can then be closed by knotting cut ends of the thread (25).