Needle extractor

A needle extractor is provided for removing elongated surgical needles from within a patient body which comprises a ratchet activated rod member insertable through a cannula and having a hole for grasping and pulling the needle. The cannula is provided with a slim abutting ring to prevent movement of the cannula tip during the extraction process.

BACKGROUND OF THE INVENTION 
1. Field of the Invention 
This invention relates to surgical instruments and more particularly to a 
device of grasping and extracting a needle used for placing sutures within 
a body of tissue or cartilage such as the body of a human being or of an 
animal. 
2. Description of the Prior Art 
Many surgical procedures are currently being performed where it is 
necessary to make a large opening to expose the area of, for instance, a 
human body that requires surgical repair. This is true even though there 
are instruments available which allow the viewing of certain areas which 
have limited accessibility. For example, arthroscopes are available to 
permit viewing of a human knee joint through a puncture wound without 
exposing the entire joint of the knee by cutting through the skin in that 
area. 
These viewing instruments can be used to detect, among other things, 
surgically repairable tears within the cartilage of the knee. Shaving 
instruments exist which allow parts of the damaged cartilage to be shaved 
off and removed from the knee joint through a cannula or tube without 
requiring that the knee be opened. However, prior to this time it has been 
necessary to open the knee to sew the tear in the cartilage. 
When an area of the body is cut into to expose an interior portion thereof, 
that process involves some morbidity which increases as more muscle 
layers, ligaments and other tissues are cut and separated. This morbidity, 
or time and discomfort associated with recovery and chance of 
complications, would be greatly reduced if the required surgery were 
performed without making a large incision, cutting and separating various 
tissues, and exposing a large portion of the interior of the body. 
A device has been provided to introduce one or two needles carrying suture 
material into a relatively inaccessible location percutaneously through a 
cannula by using one or two 25 cm. long needles to pass entirely through 
the knee joint. Although such an approach may work in some cases, there 
are neurovascular structures directly behind the menisci in the knee joint 
which could be jeopardized by the passage of the needles through that 
area. 
SUMMARY OF THE INVENTION 
The invention provides for a device and method of performing surgical 
repair requiring stitches on areas of the interior of the body having 
limited access through a cannula. This is done percutaneously, or through 
a puncture wound in the skin, without requiring a large incision for 
exposing the interior of the body. The device of the present invention 
comprises a needle extractor which is small enough to be inserted through 
a cannula, yet sturdy enough to grasp, bend and extract an elongated 
surgical needle previously inserted through the joint tissue. The device 
is operable to grasp the needle, bend it so it can be extracted through 
the cannula, and complete the extraction process in a smooth, yet forceful 
manner. Also, the needle carrier has the ability to grasp the needle very 
securely during passage through the cannula. 
The procedure for using the device embodying the principles of the 
invention begins with introducing a tube into the knee or other area to be 
worked on by means of a fitted cannula that is rounded on the tip to avoid 
injury to neurovascular and other structures. Unique about this particular 
tube is that it has a ring that can be moved down adjacent to the skin of 
the patient and fixed in that position. By using the ring, a ratchet 
mechanism has something to push against so that the tip of the tube does 
not move relative to the needle location within the knee joint as the 
needle is pulled around an angle out through the tube. 
The surgical needle is grasped by manipulating a rod portion of the needle 
extractor such that the needle passed through a hole in the rod. The 
ratchet mechanism withdraws the rod causing the needle to be bent around 
the end of the tube and pulled out through the tube and gradually out of 
the joint. The ratchet allows for the pulling to occur under control and 
slowly. 
One or two needles can be carried through the tube in the fashion described 
with one ratchet mechanism. If a single needle is passed, then the 
trailing end of the suture material is caught within the knee by a suture 
manipulator, pulled until there is slack, and then passed into the 
postero-medial compartment through the intercondylar notch. A grasping 
instrument can then be introduced through the tube posterial-medially, and 
the suture caught and pulled out so that both ends of the suture are out 
through the tube posterial-medially. 
Thus, the present invention provides the advantage of being able to make 
repairs requiring stitches within the interior of a body in a relatively 
inaccessible area through a puncture wound without making a large incision 
and allowing for extraction of the surgical needle without jeopardizing 
the neurovascular or other structures adjacent the area being stitched.

DESCRIPTION OF THE PREFERRED EMBODIMENTS 
Although the principles of the present invention are applicable to any 
device suitable in surgical procedures whether performed on humans or 
animals, a particular utility is effected in human knee surgery where the 
problems of surgery are particularly acute. Accordingly, as an 
illustrative exemplification of our invention in FIG. 1 there is shown a 
human knee joint generally at 10 which provides an environment in which 
the present invention is especially useful. Within the knee joint 10 there 
is shown the femur bone 12, the tibia bone 14, the patella or knee cap 16 
and the medial meniscus 18 and lateral meniscus 20. The menisci 18, 20 are 
cartilage structures in contact with both the femur 12 and tibia 14. As 
seen in FIG. 2, the menisci are crescent shaped with a central opening 
area. Certain injuries to the knee cause tears to the menisci such as that 
shown in 22 in FIG. 2. 
Arthroscopes are available which have a light and optics probe, as shown at 
24, which can be inserted through a puncture wound for viewing the 
interior portion of the knee joint 10 through a viewing lens or screen 
shown schematically at 26 (FIG. 2). The arthroscope permits the physician 
or surgeon to see the tear 22 without surgically opening the knee to 
expose that portion of the joint. 
A hollow cannula or tube 28 can be inserted through the skin around the 
knee joint to a position proximate to the tear 22 in the miniscus 18. 
Various instruments can be inserted through this cannula 28 to perform 
various surgical tasks. The present invention provides for an instrument 
which can be inserted through this cannula 28 to grasp and extract one or 
more needles that have set a stitch in the meniscus so that the tear 22 
can be sewn shut to assist in the healing process without opening the knee 
to expose this portion of the knee joint. Such a procedure is greatly 
advantageous over previous methods of knee surgery in that healing time is 
drastically reduced to days instead of weeks. Additionally, grasping and 
extracting the needle through a cannula, which has been placed in an area 
avoiding tissue and other structures which may be injured, is greatly 
beneficial over passing the needles all the way through the knee joint for 
extraction. 
A needle extractor 30 is shown in each of the figures and is comprised of a 
rod member 32 having a head portion 34 at one end and a perpendicularly 
arranged handle member 36 at an opposite end. The rod 32 has an outer 
diameter sufficiently lesser than the inner diameter of the cannula bore 
to afford a clearance to allow it to move loosely in the cannula 28. A 
typical rod diameter would be about 5 mm. 
The head portion 34 of the rod 32 has a rounded end 38 and has a 
rectangular cross section. The head portion 34 has a pair of opposed flat 
faces 40, 42 (FIG. 5) with a hole 44 passing therethrough. The hole 44 is 
sized to accomodate a surgical needle 46 in a loose fit. 
The shank of the rod 32 contains a plurality of equally spaced grooves 48 
extending a significant portion of the length of the rod 32. The grooves 
48 may be provided with an angled wall 50 in the form of a truncated cone 
with the base end disposed toward the head portion 34 of the rod 32. 
Selectively movably securable to the cannula is a ring member 52 comprising 
a bushing 54 having an interior passage 56 adapted to loosely engage the 
cannula 28 and an outer ring member 58 secured to the bushing 54 by a 
friction fit. Securing means 60 such as a set screw passes radially 
through the outer ring member 58 and the bushing 54 to engage the outer 
wall of the cannula 28 to prevent rotational or axial movement of the ring 
member 52 relative to the cannula 28. The ring member 52 can be 
selectively positioned at any desirable point along the length of the 
cannula 28. 
Secured to an end of the cannula 28 is a ratchet mechanism 62 comprising a 
crank member 64, a lever member 66 and a ratchet dog member 68. A strap or 
bracket member 70 is secured to the cannula 28 and has a pair of ears 72 
extending outwardly from the cannula 28. A portion of the crank member 64 
is positioned between the ears 72 and is held in position by a pivot pin 
74 extending through the ears 72 and the crank member 64. A short arm 
portion 76 of the crank member 64 extends axially relative to the cannula 
28 and terminates in a rounded end 78. An elongated arm member 80 of the 
crank member 64 extends radially outwardly from the cannula 28 in a gently 
curving manner in the axial direction. 
The lever member 66 has an enlarged first end 82 with a central opening 84 
therethrough to receive the rounded end 78 of the arm 76. A second pivot 
pin 86 extends through the enlarged end 82 and the rounded end 78 to hold 
the lever member 66 and crank member 64 in a relatively fixed, yet 
pivotable relationship. The length of the arm 76 is sufficient to hold the 
enlarged end 82 of the lever member 66 beyond an end 88 of the cannula 28. 
The enlarged end 82 terminates in a tooth type projection 90 having a 
pointed end with a lateral expanse. The lever member 66 has a radially 
outwardly extending arm portion 92 extending outwardly from the enlarged 
end 82 substantially parallel to the elongated arm 80 of the crank member 
64 but having a gentle curve in an axial direction away from the curve of 
the crank arm 80. 
A leaf type spring 94 is secured adjacent a first end 96 to the crank arm 
80 by an appropriate fastening means 98 and at adjacent a second end 100 
to the lever arm 92 by an appropriate fastening means 102. The lever 
member 66 is pivotable about pivot pin 86 relative to the crank member 64, 
however, the spring member 94 biases the two arms apart. 
The ratchet dog member 68 is secured to the cannula 28 radially opposite 
the crank member 64 and lever member 66 and comprises a spring mounted dog 
member having a tooth like projection 104 projecting beyond the end 88 of 
the cannula 28 in a radially inwardly direction. A spring member 106 
continuously urges the tooth projection 104 in a radially inwardly 
direction. 
The dog 68 is pivotally secured to the bracket 70 by means of a pivot pin 
108 extending through a portion of the dog near an end opposite the tooth 
104 and which also extends through a projecting portion 110 of the bracket 
70. The spring 106 wraps around the pivot pin 108 and has forwardly 
extending leg portions which are secured to the pivoting dog member 68 and 
the cannula 28 by appropriate fastening means 112. 
A thumb button 114 is provided on the pivotable dog 68 extending upwardly 
from a top surface thereof which can be used to manually rotate the dog 68 
about the pivot pin to move the tooth portion 104 outwardly. 
In operation, the cannula 28 is inserted percutaneously into the knee joint 
so that the forward end 116 projects into a posterior compartment 118 of 
the knee which can be distended by the introduction of fluid into that 
compartment. This compartment can be visualized by means of the 
arthoscopic probe 24 as described in the paper entitled "Swedish 
Arthroscopic System" by James S. Mulhollan printed in Orthopedic Clinics 
of North America, April, 1982. 
When the cannula 28 is in place, the ring member 52 is moved along the 
cannula until it is abutted against the exterior portion of the knee 
joint, in firm contact with the patient's skin. The set screw 60 is then 
tightened to ensure that the ring member 52 will remain stationary with 
respect to the cannula. The rod 32 is inserted into the cannula by 
squeezing together the two arms 92 and 80 and pushing on the thumb button 
114 so that the two opposed teeth portions of the ratchet mechanisms 62 
are moved radially outwardly to provide sufficient clearance to allow 
passage of the rod through the cannula. The rod member 32 is inserted 
until the head portion 34 projects beyond the end 116 of the cannula 
sufficient to allow the hole 44 to be exposed. 
The surgical needle has its tip 120 now passed through the tear 22 in the 
miniscus 20 and is positioned in the compartment 118 into which the 
cannula 28 extends. The rod 32 is manipulated so that the tip 120 of the 
needle 46 passes through the opening 44 in the head portion 34 a 
sufficient distance as is seen in FIG. 5. With the needle 46 thus grasped 
by the rod 32, the thumb button 114 and the arms 80, 92 are released so 
that they are captured in a groove 48 in the rod. 
The arms 80, 92 are then slowly manually squeezed together and released as 
seen in FIG. 4 to provide a ratchet-type drive for withdrawing the rod 32 
from the cannula 28. The dog member 68 prevents reverse movement of the 
rod and the pivoting action of the crank 64 allows the tooth portion 90 of 
the lever 66 to disengage from one channel and be inserted into the next 
channel. As the withdrawal of the rod 32 occurs, the needle 46 is bent 
around the end 116 of the cannula, as seen in FIG. 6 and is thus withdrawn 
through the cannula a sufficient amount to allow for further withdrawal of 
the rod and captured needle by means of the handle 36 on the end of the 
rod. 
It has been found that the movable ring member 52 is required to give the 
ratchet mechanism 62 something to push against so that the tip of the 
cannula 28 does not move relative to the needle location within the joint 
as the needle is pulled around an angle out through the cannula. Direct 
manual pulling force is too violent, the ratchet mechanism allows the 
withdrawal of the needle to occur under control and slowly. 
In some presently available surgical systems, a double needle is used in 
which the suture material extends between the two needles. If such a 
system is utilized, a rod head 34A as shown in FIG. 8 can be utilized 
which has two holes 44A passing therethrough to allow for the grasping of 
both needles at the same time. In all other respects, the construction of 
this alternate embodiment is identical to that described above. 
When two needles are utilized, when they are withdrawn from the cannula, 
the suture material will extend through the tear in the tissue in two 
places and both ends of the suture material will be excessible to allow 
for tying of knots as described in our copending patent application Ser. 
No. 551,038. When a single needle is utilized, a suture manipulator, 
comprising a small rod with a hook on the end, captures the loose end of 
the suture material and carries it to the back of the knee into the 
compartment 118 where it can be grasped by a currently available 
instrument and withdrawn through the cannula so that both loose ends of 
the suture material will be excessible for the physician to tie and set 
knots. 
Thus, it is seen that there is provided by the present invention a needle 
extractor device which can be used to grasp and extract surgical needles 
from a relatively inaccessible location without causing the needles to 
pass entirely through other tissue which may be damaged by the passage of 
the needles during an operation. 
As is apparent from the foregoing specification, the invention is 
susceptible of being embodied with various alterations and modifications 
which may differ particularly from those that have been described in the 
preceeding specification and description. It should be understood that we 
wish to embody within the scope of the patent warranted hereon all such 
modifications as reasonably and properly come within the scope of our 
contribution to the art.