Maritsa tissue approximator and method of using the same

This invention comprises an instrument for peritoneal approximation following the application of mesh in a laparoscopic herniorrhaphy or for approximating any tissues that could physically reach each other during the performance of any laparoscopic procedure. The Maritsa Tissue Approximator comprises an elongated cylinder which is divided into two elongated compartments by a central plate which extends outwardly from the bottom of the cylinder. The head of the instrument comprises the outwardly extending fixed plate and two independently controlled jaws which close separately over the fixed central plate. The jaws are pivotally mounted onto a lateral extension of the center plate by pin-means about which they rotate thus opening or closing over the fixed central plate. The rotation about the pin is caused by a control wire which extends through a compartment of the cylinder and is affixed to a pivotal member at the other end of the instrument. The two jaws are each controlled by operation of a separate pivotal member which is resiliently backed against the handle and moved in conjunction with the pressure applied thereto, thus opening or closing the jaws on the opposite end of the instrument to expeditiously move a tissue flap into approximation with the opposite flap to facilitate stapling of the incision.

BACKGROUND OF THE INVENTION 
In the performance of a laparoscopic herniorrhaphy, a linear incision is 
made on a peritoneum from a first point to a second point. Proximal and 
distal peritoneal flaps are then developed. The hernia repair is done and 
to complete the laparoscopic part of the procedure, the proximal and 
distal peritoneal flaps have to be approximated. The present invention 
permits this approximation to be done readily and efficiently. 
In the prior art, where the proximal and distal peritoneal flaps have to be 
approximated, the more mobile distal flap is generally held with a grasper 
and pulled to a corresponding point on the less mobile proximal flap. A 
staple gun is then used to staple a fixed point on the distal end held by 
the grasper to a loose point on the proximal flap. This procedure is 
cumbersome and can be time consuming. It is not unusual for the loose 
point of the proximal flap to be pushed away by the stapler before the 
staple is fired and miss it altogether or hold a minimal amount of tissue 
at a point on the proximal peritoneal flap. 
The present invention permits approximating any tissues that can physically 
reach each other during the performance of a laaroscopic procedure. With 
the flaps held together by the present invention, the suturing or stapling 
of the flaps is greatly facilitated. An approximator with two independent 
jaws is used to grasp both flaps against a central protruding plate and 
hold the tissue for stapling or suturing. 
SUMMARY OF THE INVENTION 
This invention, known as the Maritsa Tissue Approximator, relates to 
laparoscopic surgery and in particular to an apparatus and method employed 
in laparoscopic herniorrhaphy, wherein the laparoscopic tissue is 
approximated by the apparatus. The Maritsa Tissue Approximator comprises a 
cylinder having a central diametrical plate dividing the cylinder into two 
compartments. The control end of the approximator includes a handle and 
two independently operated triggers with a control wire coupled to each 
trigger. The head of the approximator includes a pair of independently 
operated jaws that close over the protruding central plate. The pivotal 
jaws are each connected by a control wire to one of the triggers. This 
allows each jaw to open and close independently of each other over the 
fixed plate. 
In operation, the separated edges of a tissue can be approximated one at a 
time bringing them together in preparation for suturing and/or stapling 
them to each other. Specifically, a distal peritoneal flap is engaged 
between a first jaw and the fixed plate by closing the jaw over the fixed 
plate with the tissue therebetween. The head of the instrument is then 
moved to the proximal flap with the jaw closed, the second jaw is then 
opened and grasps the proximal flap, thus approximating and holding the 
two flaps together for suturing or stapling. The held tissue may be moved 
to the left held tissue may be moved to the left or the right pulling the 
proximal and distal flaps together for stapling with ease. 
Accordingly, it is an object of this invention to provide a new and 
improved apparatus for approximating tissue in laparoscopic surgery. 
An other object of this invention is to provide a new and improved 
approximator for approximating tissue in laparscopic surgery so that the 
tissue may be readily and expeditiously sutured or stapled after an 
operation. 
A further object of this invention is to provide a new and improved 
approximator which includes independently operated jaws Which grasp the 
tissue flaps against a central plate to approximate them for suturing or 
stapling. 
A more specific object of this invention is to provide a new and improved 
instrument for peritoneal approximation for following the application of 
mesh in a laparscopic herniorrhaphy which comprises an instrument, which 
is able to grasp the proximal and distal flaps of tissue and hold them 
together to facilitate suturing or stapling.

DETAILED DESCRIPTION OF THE INVENTION 
Referring now to the drawings the Maritsa Laparoscopic Tissue Approximator 
10 is used particularly in laparoscopic herniorrhaphies, wherein a linear 
incision FIG. 2a, is made on peritoneum tissue from point 11 to point 12. 
Proximal 13 and distal 14 flaps are then developed, see FIG. 2b. After the 
hernia repair is accomplished and to complete the laparoscopic part of the 
procedure following the application of mesh (not shown), the proximal and 
distal peritoneal flaps 13 and 14 have to be approximated. This is 
accomplished by using the unique approximator 10 to grasp the distal flap 
14, as shown in FIG. 2c and bring the flaps 13 and 14 together to 
facilitate suturing or stapling, see FIGS. 4a-c. FIGS. 3a to 3e show in 
greater detail the grasping of the flaps 13 and 14 by the approximator 10. 
The Maritsa Laparoscopic Tissue Approximator 10 is shown in FIG. 1 and 
includes an elongated cylinder 15 having a handle 16, at one end and an 
aperture 17, at the other end or head 18. The hollow cylinder 15, is 
divided into two compartments 19a and 19b, by a central plate 20, which 
extends diametrically across the cylinder and outwardly from the base 
aperture 17 for a predetermined distance. A pair of jaws 21a and b are 
mounted to the cylinder 15 and coupled at their upper ends 22a and b, to 
control wires 23a and b respectively, which extend through the 
compartments 19a and b in the cylinder to reach the respective triggers 
24a and b. The triggers 24a and b are each pivotally mounted to the 
cylinder 15 at pins 25a and b respectively and extend outwardly with a 
downwardly curving lower surface 26a and b. The upper surface 27a and b of 
the triggers 24a and b is resiliently mounted against the lower surface 28 
of the handle 16 by the leaf springs 29a and b. 
The jaws 21a, 21b each comprise a curved outer surface 31a, 31b and a flat 
inner surface 32a, 32b. The jaws 21a, 21b pivot about pins 33a, 33b 
respectively when the corresponding trigger 24a or 24b is pressed. The 
triggers 24a and 24b are pivotally connected to the cylinder 15 by pins 
25a and 25b and to control wires 23a and 23b by pins 35a and 35b 
respectively. The jaws 21a and 21b operate independently as the 
corresponding trigger 24a or 24b is pressed to engage or disengage with 
the protruding central plate 20 in the manner indicated by the arrows. The 
jaws 21a, 21b are connecting to the control wires 23a, 23b by pins 34a, 
34b. 
FIG. 2a discloses an incision from point 11 to point 12 exposing the tissue 
flaps 13 and 14. FIG. 2b depicts the distal flap moved backwardly from the 
incision. Point A' of the distal flap 14 is engaged by the Maritsa Tissue 
Approximator and moved towards point A the proximal flap 13. To accomplish 
this operation the trigger 24a or 24b is released, causing the jaw 24a or 
24b to close over the distal tissue flap 14 and lock it against the center 
plate 20. The other trigger 24a or 24b is then released, causing the other 
jaw 24a or 24b to close, engaging the tissue of the proximal flap 13 
between the jaw 24a or 24b and the central plate 20. The application of 
the stapling and or suture is now easy and expeditious as shown in FIGS. 
4a, b, and c which show the flaps 13 and 14a held together by the 
approximator 10 in FIG. 4a, the suturing partially complete in FIG. 4b and 
the completed job in FIG. 4c. 
The problems with approximating the two flaps 13 and 14 are thereby 
eliminated. Presently, a stapler is used to staple a loose point A to a 
fixed point A in a cumbersome and time consuming sequence. It is not 
unusual for the loose point A of the proximal flap to be pushed away by 
the stapler before the staple is fired and miss it altogether or hold a 
minimal amount of tissue at point A of the proximal peritoneal flap 13. 
FIG. 6b discloses and alternate embodiment to the invention wherein the 
central plate 40 has protruding teeth 41 on both sides and the jaws 44a, 
44b have concave inner portions 42 to engage the teeth. This facilitates 
positive engagement with the flaps 13 and 14. FIG. 6a shows schematically 
the operation of the jaws 21a, 2 1b in the preferred embodiment. 
While the above invention has been illustrated in conjunction with the 
drawings, it is possible that other embodiments utilizing the teachings of 
this invention may be devised and yet will fall within the spirit and 
scope of this invention. This invention covers all likely alternative 
embodiments.