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WO2004049898A2 - Technique de suture - Google Patents

Technique de suture Download PDF

Info

Publication number
WO2004049898A2
WO2004049898A2 PCT/GB2003/005252 GB0305252W WO2004049898A2 WO 2004049898 A2 WO2004049898 A2 WO 2004049898A2 GB 0305252 W GB0305252 W GB 0305252W WO 2004049898 A2 WO2004049898 A2 WO 2004049898A2
Authority
WO
WIPO (PCT)
Prior art keywords
thread
clamp
passageway
jaws
suturing
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/GB2003/005252
Other languages
English (en)
Other versions
WO2004049898A3 (fr
Inventor
John Dalton Griffith
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Griffith Textile Machines Ltd
Original Assignee
Griffith Textile Machines Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Griffith Textile Machines Ltd filed Critical Griffith Textile Machines Ltd
Priority to AU2003294117A priority Critical patent/AU2003294117A1/en
Publication of WO2004049898A2 publication Critical patent/WO2004049898A2/fr
Publication of WO2004049898A3 publication Critical patent/WO2004049898A3/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0487—Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0483—Hand-held instruments for holding sutures
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/062—Needle manipulators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0448—Additional elements on or within the anchor
    • A61B2017/0451—Cams or wedges holding the suture by friction
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0458—Longitudinal through hole, e.g. suture blocked by a distal suture knot
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0487—Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
    • A61B2017/0488—Instruments for applying suture clamps, clips or locks
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06004—Means for attaching suture to needle
    • A61B2017/06028—Means for attaching suture to needle by means of a cylindrical longitudinal blind bore machined at the suture-receiving end of the needle, e.g. opposite to needle tip

Definitions

  • the present invention relates to a suturing method and a suturing implement and suture thread clamp for use in the method.
  • the general aim of the present invention is to provide a suturing method, and a suture assembly and applicator, which facilitates the suturing process in laparoscopic type procedures.
  • a suturing implement adapted to be capable of inserting a suture thread clamp through a cannula and to hold the thread clamp for performing a suturing operation
  • the suture thread clamp including a passageway through which a length of thread may be threaded in one direction, thread gripping means associated with the passageway which acts to permit passage of thread in one direction along the passageway but which acts to prevent passage of thread along the passageway in the opposite direction
  • the suturing implement including an elongate support body having at one end a seat for detachably securing the thread clamp to the support body, the elongate body being in the form of a pair of clamp jaws movable between a jaws closed position whereat the jaws are closely spaced to be able to grip tissue to be sutured therebetween and a jaw open position whereat the jaws are widely spaced to release tissue which may be gripped between the jaws when at the said closed position, said seat being formed on one of said jaws at a location which
  • a method of suturing using the combination defined above including mounting the clamp on the suturing implement, inserting the implement through a cannula in the patient, operating the implement to grip tissue to be sutured in between said jaws and passing a suturing needle, manipulated by a holder separate to the implement, through the gripped tissue and said thread clamp.
  • a suture thread clamp including a clamp body having a passageway through which a length of thread may be threaded and a thread gripping means associated with the passageway which acts to permit passage of tliread in one direction along the passageway but which acts to prevent passage of thread along the passageway in the opposite direction, the thread gripping means including a resiliently deflectable barb which extends across the passageway from one side wall to an opposed side wall of the passageway, the terminal end of the barb being biased into abutment with a clamp face.
  • Figure 1 is a schematic illustration of a suture assembly according to an embodiment of the present invention
  • Figure 2 is a schematic illustration showing the suture assembly of Figure 1 forming a suture
  • Figure 3 is a plan view of a suture thread clamp according to a first embodiment of the present invention.
  • Figure 4 is a sectional view along line IN-IV of Figure 3;
  • Figure 4a is an illustration of the clamp of Figure 4 shown without suture thread in the passageway;
  • Figure 5 is a sectional view similar to Figure 4 showing a thread clamp according to a second embodiment of the present invention.
  • Figure 6 is a side view of a thread clamp according to a third embodiment of the present invention.
  • Figure 7 is a plan view of the thread clamp shown in Figure 6;
  • Figure 8 is a part axial section along an applicator according to an embodiment of the invention.
  • Figure 9 is a section along line IX-IX in Figure 8;
  • Figure 10 is an enlarged side view of the head of the applicator of
  • Figure 11 is a view similar to Figure 10, in part section, showing the applicator in its jaw open condition;
  • Figure 12 is a section along XII-XII in Figure 8;
  • Figure 13 is an end view of the head of the applicator shown in
  • a suture assembly 20 is illustrated in Figure 1 and comprises a length of suture thread 2 which is attached at one end to a thread clamp 3 and is attached at its other end to a suture needle 1.
  • FIG. 2 The principle of operation of the suture assembly 20 is illustrated in Figure 2.
  • the needle 1 has been inserted through adjacent flaps of flesh 4 and then subsequently inserted through the thread clamp 3.
  • the length of thread 2 thereby forms a suture loop 2 ' passing through flaps of flesh 4 and is pulled to tighten the loop 2' and thereby hold the flaps of flesh 4 together in close proximity.
  • the thread 2 after insertion by the needle 1 passes through thread clamp 3 and is held against withdrawal by the clamp 3 and so holds the loop 2 ' in a tight condition.
  • the thread 2 may subsequently be severed at a location S beyond the clamp 3 in order to complete the suture and to detach the needle 1 and remaining thread 2.
  • FIGS 3 and 4 there is illustrated a first embodiment of a thread clamp 310 according to the present invention.
  • the thread clamp 310 includes a main body 10 having a slot 11 passing therethough.
  • the slot 11 defines a passageway through which needle 1 may be passed in a direction shown by arrow A N .
  • a thread gripping means 30 is operably located within the passageway for gripping thread 2 passing through the passageway and preventing its withdrawal in the direction shown by arrow A P .
  • the gripping means 30 is also operable to permit the needle 1 and thread 2 to be moved along the passageway in the direction of arrow A N -
  • the gripping means 30 is in the form of a resiliently deflectable barb 13 having a base portion 14 which is mounted on the main body 10.
  • the base portion 14 is preferably of channel form having a bottom portion 314, an inner leg 114 and an outer leg 214 on which is formed an inwardly directed projection 14' .
  • the body 10 preferably includes a slot 25 formed in the lower edge of side wall 24 of the main body 10 and an outwardly directed projection 26.
  • the barb 13 is preferably formed form a length of resilient material such as a suitable plastics or spring steel.
  • the barb 13 is inclined downwardly relative to side wall 28 of main body 10 and has a head portion 29 which co-operates with the inner face 28a of wall 28 to trap thread 2 therebetween.
  • barb 13 is resiliently biased upwardly such that head portion 29 is urged toward side wall 28 and into abutting engagement with the inner face 28a.
  • the gripping means 30 is a separate component which is fixedly mounted on body 10, it is possible to ensure that the head portion 29 resiliently abuts face 28a under a predetermined pre-load force. This is particularly advantageous as it enables the clamp to positively grip suture threads having a small diameter, i.e. fine threads.
  • the head 29 is urged by the thread 2 closer toward side wall 28 to increase its grip on the thread 2 and thereby prevent its movement. If the thread 2 is pulled in direction A N , the thread 2 urges the head portion 29 further away from the side wall 28 and so permit its movement in direction A N .
  • thread end 12 is moulded integrally with the main body 10 and exits the main body 10 in a direction which is lateral to the direction A N .
  • thread end 12 is also mounted integrally with the main body 10 but exits the main body 10 in a direction parallel to direction A N .
  • the embodiment illustrated in Figure 5 may be modified by creating a plain bore 130 in the main body 10 during the moulding process. This enables thread 2 to be passed through the bore 130. Anchorage of the thread 2 to the body 10 may be achieved by forming a knot 131 in thread end 12 to thereby prevent thread 2 being pulled out of bore 30 in direction As-
  • the main body 10 is provided with a pair of slots 11, 11 ' , each housing thread clamping means 30, 30' respectively.
  • the clamping means 30 ' located in slot 11 ' acts to permit insertion and pulling of thread end 12 in direction Ai but prevent its movement in direction As-
  • a suturing operation using the suture assembly of the invention is preferably performed using a suturing implement or applicator 100 of the invention as exemplified in Figures 8 to 13.
  • the applicator 100 shown in Figures 8 to 13 has a number of functions, such that a suture can be formed using only the applicator 100, a needle holder and scissors.
  • Its first function is to hold the needle, suture thread and clamp 3 during insertion through the cannula; its second function is to hold the clamp 3 while the needle 1 is inserted into the tissue to be sutured using the separate needle holder (of conventional construction) and to also hold the clamp 3 so that the needle 1 can be easily threaded through the clamp 3; and its third function is to act as a tissue clamp which can be used to hold the tissue while suturing.
  • the applicator 100 includes a main body in the form of a tube 58. Slidably connected to the tube 58 is a jaw assembly 150.
  • the jaw assembly 150 includes a lower jaw 50 to which is pivotally attached an upper jaw 51 via a pivot 55.
  • the jaws 50, 51 project axially beyond one end 58 ' of tube 58 and are preferably sized and shaped so as not to extend beyond the radial boundaries of tube 58 when the jaws 50, 51 are in their closed position as shown in Figure 8.
  • a resilient spring 56 is provided for biasing the upper and lower jaws apart to their jaw open position as shown in Figure 10.
  • the lower jaw 50 is fixedly mounted on a push rod 57 which extends longitudinally within the tube 58.
  • a radially extending arm 60 is provided on the push-rod 57.
  • the arm 60 passes through a longitudinally extending slot 62 formed in the tube 58 and is secured to a handle sleeve 61 which is axially slidably received on the tube 58.
  • the axial end of the tube 58, remote from the end from which jaws 50, 51 project, is provided with a thumb holder 64 and the sleeve 61 is provided with a pair of finger holders 63. This enables a surgeon to hold the applicator 100 in one hand and to move the push-rod 57 axially along the tube 58 in either axial direction in a controlled manner.
  • the upper jaw 51 is provided with an inclined cam face 51 ' which cooperates with an opposed cam face 59 ' formed in a tubular insert 59 located within the end 58 ' of tube 58.
  • the cam faces 51, 51 ' co-operate to control movement of jaw 51 about pivot 55 in response to axial movement of the push-rod 57 within tube 58.
  • the jaws 50, 51 may be moved to their jaw open position ( Figure 10) by moving the push-rod 57 to extend jaws 50, 51 further beyond tube 58 and may be moved to their jaw closed position ( Figure 8) by moving the push-rod 57 to retract the jaws 50, 51 into the tube 58.
  • the inner faces of the upper and lower jaws are preferably provided with serrations 170 which enable the jaws to more effectively grip tissue during the suturing process.
  • the jaws 50, 51 preferably are adapted to hold needle 1 during the initial insert of the applicator 100 into the cannula.
  • the upper jaw 51 is preferably provided with an axially extending groove 251 in which the body 10 of the needle 1 may be accommodated.
  • the lower jaw 50 is preferably provided with a recess 250 in which the terminal end 1 E of the needle may be seated.
  • the needle 1 may advantageously have a cylindrical portion 52 to which the suture thread 2 is fixed and a flat portion 53 which has some resilience. This means that in its natural state, it has a deep curvature for suturing (see Figure 10) but it can be stored in the applicator 100 pressed into a shallower curve (see Figure 8) to pass through the cannula. It is held in this position by being pressed between the lower jaw 50 and closed upper jaw 51.
  • the terminal end of lower jaw 51 is provided with a seat 210 in which a thread clamp 3 may be seated during the suturing process.
  • the seat 210 is defined by a pair of opposed resilient tongues 49 which act to resiliently grip a clamp 3 therebetween.
  • the seat 210 is also preferably arranged such that the slots 11 extend in a direction perpendicular to the direction of closing of the jaws. This enables a needle to be easily threaded through the slots 11 when the jaws are in their closed position.
  • a first cannula is needed for the applicator 100
  • a second cannula is needed for the needle holder and scissors
  • a third cannula is required for an endoscope.
  • the applicator 100 is initially inserted into the first cannula in the condition illustrated in Figures 8 to 11, i.e. holding the clamp 3, needle 1 and thread 2.
  • the thread 2 is arranged so that it forms a loop 71 which extends between the needle 1 and clamp 3.
  • the loop 71 is located within the tube 58 in a gap between the push-rod 57 and internal wall of the tube 58.
  • the loop 71 has a lower portion 70 and an upper portion 72.
  • Thread portion 72 extends through the clamp 3 and emerges to define thread portion 74.
  • Thread portion 74 extends longitudinally within the tube 58 to emerge through slot 62 and out of a slot 67 formed in sleeve 61.
  • Arm 60 is preferably provided with a thread clamp in the form of a wedge shaped slot 175 to enable the thread portion 74 to be pulled taut and held under a slight tension.
  • the thread passes through the clamp 3 such that pulling on thread portion 74 can cause the loop 71 to be shortened; however, the slight tension referred to above which is applied to the thread portion 74 is insufficient to draw the thread through clamp 3.
  • the slight tension within the thread portion 74 is sufficient to ensure that the clamp 3 is retained within the seat 210.
  • the jaw 51 With the applicator 100 inserted through the first cannula, the jaw 51 is opened and the needle grasped by the needle holder from the second cannula. The loop of thread 71 is pulled out from the tube 58 and suturing is commenced. During this procedure tissue can be held by jaws 50 and 51.
  • suture thread ends are then cut by inserting scissors through the second cannula, and the needle withdrawn by holding the thread which is attached to it in the jaws.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

Technique de suture reposant sur l'emploi combiné d'un outil de suture et d'une pince à fil. Cette technique consiste à monter la pince (3) sur l'outil de suture, à insérer l'outil de saisie du tissu à suturer entre les mâchoires et à faire passer une aiguille de suture - dont la manipulation est distincte de celle de l'outil - au travers des tissus pincés et de ladite pince à fil.
PCT/GB2003/005252 2002-12-03 2003-12-03 Technique de suture Ceased WO2004049898A2 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU2003294117A AU2003294117A1 (en) 2002-12-03 2003-12-03 Suturing method

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
GB0228134A GB0228134D0 (en) 2002-12-03 2002-12-03 Suturing method
GB0228134.3 2002-12-03

Publications (2)

Publication Number Publication Date
WO2004049898A2 true WO2004049898A2 (fr) 2004-06-17
WO2004049898A3 WO2004049898A3 (fr) 2004-08-12

Family

ID=9948955

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/GB2003/005252 Ceased WO2004049898A2 (fr) 2002-12-03 2003-12-03 Technique de suture

Country Status (3)

Country Link
AU (1) AU2003294117A1 (fr)
GB (1) GB0228134D0 (fr)
WO (1) WO2004049898A2 (fr)

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2013015452A1 (fr) * 2011-07-27 2013-01-31 Olympus Corporation Dispositif de ligature de tissu
KR101452340B1 (ko) * 2011-12-16 2014-10-21 주식회사 삼양바이오팜 수술용 봉합사
CN105725954A (zh) * 2011-05-08 2016-07-06 阿波罗体内手术公司 内窥镜缝合系统
WO2017029853A1 (fr) * 2015-08-20 2017-02-23 オリンパス株式会社 Ensemble de suture, et système de suture

Family Cites Families (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
SU975006A1 (ru) * 1981-03-02 1982-11-23 Проблемная Лаборатория "Вспомогательного Кровообращения" Благовещенского Государственного Медицинского Института Устройство дл фиксации лигатуры
US4611593A (en) * 1984-12-03 1986-09-16 Thomas J. Fogarty Vessel occluding instrument
US5100421A (en) * 1991-02-05 1992-03-31 Cyprus Endosurgical Tools, Inc. Christoudias curved needle suture assembly
US5879371A (en) * 1997-01-09 1999-03-09 Elective Vascular Interventions, Inc. Ferruled loop surgical fasteners, instruments, and methods for minimally invasive vascular and endoscopic surgery
US6015428A (en) * 1997-06-03 2000-01-18 Anthony C. Pagedas Integrally formed suture and suture lock
US6066160A (en) * 1998-11-23 2000-05-23 Quickie Llc Passive knotless suture terminator for use in minimally invasive surgery and to facilitate standard tissue securing

Cited By (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN105725954A (zh) * 2011-05-08 2016-07-06 阿波罗体内手术公司 内窥镜缝合系统
WO2013015452A1 (fr) * 2011-07-27 2013-01-31 Olympus Corporation Dispositif de ligature de tissu
JP2013027472A (ja) * 2011-07-27 2013-02-07 Olympus Corp 組織結紮デバイス
US9414836B2 (en) 2011-07-27 2016-08-16 Olympus Corporation Tissue ligation device
KR101452340B1 (ko) * 2011-12-16 2014-10-21 주식회사 삼양바이오팜 수술용 봉합사
WO2017029853A1 (fr) * 2015-08-20 2017-02-23 オリンパス株式会社 Ensemble de suture, et système de suture
JPWO2017029853A1 (ja) * 2015-08-20 2017-08-17 オリンパス株式会社 縫合体および縫合システム
US10709441B2 (en) 2015-08-20 2020-07-14 Olympus Corporation Suture body and suture system

Also Published As

Publication number Publication date
GB0228134D0 (en) 2003-01-08
AU2003294117A1 (en) 2004-06-23
AU2003294117A8 (en) 2004-06-23
WO2004049898A3 (fr) 2004-08-12

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