SEWING MACHINE

Abstract: A sewing machine for forming stitches in a substrate (16, 116), for example in forming stitches in tissue during surgery, comprises a needle (6; 106; 20, 30) for passing thread (9,109,24) into the substrate from one side thereof at a first location and for withdrawing the thread from the substrate at a second location spaced from the first location. The needle is removably operable solely from the said one side of the substrate. A stapling machine is also disclosed operating on similar principles for similar purposes.

Description: This invention relates to sewing machines. The invention has particular application to sewing required in surgical procedures, and, more particularly, relates to sewing machines which can be used inside the body of a patient without the need to make an external incision in the patient, the machine being controlled externally of the patient, for example by endoscopic means. For convenience such a machine is referred to below as an endoscopic sewing machine, and the ensuing description relates largely to endoscopic sewing machines. It is to be understood, however, that sewing machines according to the present invention could be used in other applications. GB-A-2050448 describes a sewing machine for forming stitches in a substrate, comprising means defining a slot open towards the substrate for receiving the substrate therein, thread carrying means for passing a thread into the substrate in the slot from one side of the substrate at a first location and for withdrawing the thread from the substrate on the same side at a second location spaced from the first location, the said means being remotely operable solely from the said one side of the substrate, According to the present invention there is provided a sewing machine of the type just referred to, characterized in that it comprises means for drawing a U-shaped double layer of the substrate into the slot by suction. The machines according to the present invention open up the possibility of performing a wide range of internal surgical procedures without having to make an external incision in the patient. Potential medical uses of such machines could include the oversewing of bleeding or perforated ulcers, the oversewing of bleeding varices, the narrowing of lax internal anatomical sphincters or organs, the closure of internal holes or fistulae, the assistance in the removal of normal or abnormal tissue, and the attachment of materials or objects to the walls of tissue (for example for attaching gastric tubes for feeding purposes to the wall of the stomach, or for attaching X-ray opaque markers to mark the site of, say, a cancer, or for attaching a piece of material containing a drug to permit localised internal treatment). Figures 1 a , 1 b and 1 c show a first embodiment of a sewing machine according to the present invention, in three successive stages of operation; Figure 2 shows, by way of example, one stitch pattern which can be formed by the machine of Figures 1 a to 1 c ; Figures 3 a and 3 b are underplan and side elevational views respectively showing a second embodiment of a sewing machine; and Figures 4 a to 4 h show diagrammatically the second embodiment of sewing machine in successive stages of operation, each Figure comprising two longitudinal sections through mutually perpendicular planes, in order to enable the operation of the machine to be more easily visualised in three dimensions, one of the longitudinal sections in each Figure being taken along the section line indicated in the other. The embodiment shown in Figures 1 a to 1 c comprises a block 1 preferably formed of a transparent material, such as perspex. A slot 2 is formed in the block 1, the slot extending from the front to the back of the block, i.e. in a direction perpendicular to the plane of the paper. The block also has two longitudinal channels 3 and 4 formed therein. The channel 3 receives a needle 5 which is longitudinally slidable in the channel 3 under the control of a control wire 6. The needle 5 has a head portion 7 in which is formed an eye 8, and a thread 9 to be used in sewing is passed through the eye 8. The channels 3 and 4 are continuous with corresponding channels 17 and 18 formed in a two-channel endoscope tube 19. The block 1 also has a compartment 10 formed therein, distal to the slot 2. A shoe 11 is mounted in the compartment 10. The rear portion 13 of the shoe 11 is resilient and serves to bias the shoe in an anti-clockwise direction into the position shown in Figure 1 a . A hook 14 is mounted on the shoe 11 by means of a pin 12 for pivotal movement on the pin 12. The hook 14 is approximately in the shape of a V, and a control wire 15, which passes down the channels 4 and 18, is attached to the hook 14 adjacent the vertex of the V. A source of suction (not shown) is connected to the proximal end of channel 18 for a purpose which will be described below. Turning now to the operation of the machine, the initial position is shown in Figure 1 a , with the machine positioned above a layer of tissue 16 in which it is desired to form stitches. Suction is then applied to the slot 2 to suck into the slot a U-shaped double layer of tissue, as can be seen in Figure 1 b . The depth of the slot 2 controls the amount of tissue which is sucked in. The needle 5 is then forced forwards through the double layer of tissue, as is also shown in Figure 1 b . The needle carries with it the loop of thread 9. The tip of the needle strikes the shoe 11 which is thereby caused to pivot downwardly against the biassing force of the shoe portion 13. The control wire 15 is then pulled rightwardly to cause the hook 14 to pivot and thereby catch the loop of thread carried by the eye 8 of the needle 5. This can also be seen in Figure 1 b . It should be mentioned at this point that the side of the head portion 7 of the needle has a groove (not shown) formed therein to allow the hook 14 to pass between the head portion 7 and the thread carried thereby. As shown in Figure 1 c the needle is then withdrawn leaving the loop of thread held between the hook 14 and the shoe 11. The suction applied to the slot 2 is then released and the double layer of tissue leaves the slot. This is also shown in Figure 1 c , from which it can be seen that the effect of the steps described above is to pass a loop of thread from one side of the tissue through the tissue at a first location and back out of the tissue on the same side at a second location from the first location. As will be appreciated, this has been done without requiring access to the opposite side of the tissue which one would expect to be inaccessible under normal circumstances. The machine is then moved to the site of the next stitch, suction is re-applied and the needle passes through a double layer of tissue at a different point. It is possible to form a variety of different stitches using the machine, but one example is shown diagrammatically in Figure 2. This stitch pattern is formed by moving the machine between successive stitches in a direction perpendicular to the plane of the paper in the drawings of Figure 1 a to 1 c . Figure 2 is a view taken looking down on the upper surface of the tissue shown in Figures 1 a to 1 c , and it will be seen that each of the loops formed by the hook 14 and the shoe 11 passes through the preceding such loop. How this is achieved can be understood by imagining the effect of moving the needle forwardly from the position shown in Figure 1 c , with suction re-applied to the slot 2 to suck the tissue into the slot. It will be appreciated that the forward end of the needle will pass through the loop of thread caught between the hook 14 and the shoe 11, carrying a new loop of thread with it. It should be mentioned that to assist this process a small groove can be formed in the upper surface of the shoe, up which the tip of the needle can slide. This enables the needle to pass under the loop of thread already caught between the hook and shoe, without the risk that the needle may simply push the existing loop further up the surface of the shoe. Once the needle has placed the second loop through the first loop the hook 14 is pivoted to allow the first loop to be cast off by pulling on the tail of the thread. The hook 14 is then pivoted downwardly again, so that when the needle is withdrawn the second loop of thead is caught thereby. As already mentioned, the body 1 is preferably made of a transparent material, so as to make it easier for the operator to see, and hence control, the operation of the machine. The control mechanisms can pass down the channel of an existing endoscope, or the machine can be used independently with a small supervising endoscope passed in parallel with the control channel of the machine. The embodiment shown in Figures 3 a and 3 b is modular in construction, and comprises modules A to G joined face to face and held in position by suitable means, for example, a pair of longitudinally extending bolts passing through aligned bores in the individual modules. In the embodiment illustrated the modules B and D are formed of a transparent material and the remaining modules are not, but others of the modules may be transparent, and indeed it is preferable for some purposes that at least the module A should be transparent. The module A is the main body portion, and defines longitudinal channels 103 and 104, corresponding to the channels 3 and 4 shown in Figure 1. The channel 103 receives a needle 105, which is longitudinally slidable therein under the control of a control wire 106. The needle 106 has a head portion in which is formed an eye 108 and a thread to be used in sewing is passed through the eye. The channels 103 and 104 are continuous with corresponding channels 117 and 118 formed in a two-channel endoscope tube, the rest of the endoscope being omitted for simplicity in Figures 3 a and 3 b . The module B has a slot 102 formed therein, which, as viewed in underplan view, extends across the central region of the module B and which, as viewed in elevation, extends from the top of the module to a location falling just short of the bottom. The module B is separated by module C, which constitutes a spacer disc and which has an aperture 150 therein through which the needle 105 can pass, from the module D. Module D has a compartment 110 therein which is aligned with slot 102 in module B. Modules E and F retain a pin 112 on which a U-shaped member 111 is pivotally mounted. The arms of the member 111 each carry a respective resilient wire 151. As can be seen in Figure 3a, the wires converge towards one another at their tips as viewed in underplan, and, as can be seen in Figure 3 b , the tip portions of the wires are bent upwardly and one of the wires is longer than the other and thus extends further upwards than does the other. A control wire 115, which passes down the channels 118 and 104 is attached to an arm 152 which is, in turn, rigidly connected to the U-shaped member 111. The module G provides a curved or bevelled front end to the device, so as to increase the ease with which it can be introduced into a patient. A source of suction (not shown) is connected to the proximal end of the channel 118 for a purpose which will be described in more detail below and which is basically similar to that for which the source of suction is used in the embodiment of Figure 1. The operation of the device of Figures 3 a and 3 b will now be described with reference to Figures 4 a to 4 h . It should be noted that these figures are diagrammatic in character. In each case module G has been omitted, and the modular construction of the remaining portion of the device has not been shown in detail. The initial position is shown in Figure 4 a with the machine positioned above a layer of tissue 116 in which it is desired to form stitches. Suction is then applied to the slot 102 via the channel 104 to suck into the slot a double layer of tissue, as can be seen in Figure 4 b . The depth and width of the slot 102 controls the amount of tissue which is sucked in. The modular design of this embodiment makes it possible to vary the amount of tissue sucked in, and hence vary the size of the stitches, simply by removing module B and replacing it by a module having a different thickness of depth of slot. The needle 105 is then forced forwards through the double layer of tissue, as shown in Figure 4 c . The needle carries with it a loop of a thread 109. The needle passes behind the upwardly extending tip portions of both of the wires 151, as viewed in Figure 4 c . The control wire 115 is then pushed leftwards, as shown in Figure 4 c , to cause the U-shaped member 111 to pivot anti-clockwise and thus to cause the outer ends of the wires 151 to pass upwardly on the same side of the needle and through the loop of thread carried by the eye of the needle 105, that is to say, the wires pass between the needle and one of the runs of the thread to catch the same. The needle 105 is then withdrawn rightwards whilst the U-shaped member is rotated fully anti-clockwise carrying the thread upwards into the compartment 110. This is shown in Figure 4 d . This last action forms the thread into a large diameter loop. This results from the fact that the wires 151 diverge from one another as considered in a direction running leftwardly from their tips. The suction applied to the slot 102 is then released and the double layer of tissue, with the thread 109 passing through it, leaves the slot. This is also shown in Figure 4 d . The machine is then moved with respect to the tissue in any direction to the right of a plane drawn perpendicular to the plane of the paper and passing through the machine. Thus, the machine could be moved rightwardly in a direction parallel to its length, or at any angle less than 90° with respect to the aforesaid direction. The step shown in Figure 4 e is then carried out, that is to say, suction is re-applied and the needle caused to pass through a double layer of tissue at a different point to that where the needle passed through the tissue in step 4 c . As can be seen in Figure 4 e , the forward end of the needle passes through the loop of thread already held by the U-shaped member 111, carrying a second loop of thread with it. Once the needle has placed this second loop through the first loop, the U-shaped member is pivoted clockwise, as shown in Figure 4 f . The wires 151, being resilient, are forced apart by the needle and thus pass one on either side of the needle as the U-shaped member 111 travels to the position shown in Figure 4 f , in which it is below the needle. In so doing the wires 151 drop the first loop onto the second loop. The member 111 is then pivoted anti-clockwise, as shown in Figure 4 g , so as to catch the second loop carried by the eye of the needle. This is shown in Figure 4 g . Both wires 151 at this stage lie against the needle 102 and between the needle 102 and the adjacent portion of the thread 109. As shown in Figure 4 h , the needle 102 is then withdrawn rightwardly and the member 112 is pivoted further in an anti-clockwise direction, carrying the second loop upwards with it. As also shown in Figure 4 h , the suction is then released to allow the tissue to leave the slot 102. The above procedure is repeated as many times as are necessary in order to produce the desired number of stitches. Various modifications may be made to the embodiments described above. One of these is that the machine can be provided with a plurality of slots 2 into each of which a double layer of tissue may be sucked. A single needle can then pass through each of these double layers of tissue, thus making a plurality of stitches in a single operation. Also, it should be understood that the stitch forming part of the machine could be modified to correspond to that of any one of a number of conventional sewing machines. For example, the stitching mechanism could be one which uses two threads, rather than one as in the illustrated embodiments. As mentioned above, the module A is preferably transparent. This is to make it easier for the operator to see, and hence control the operation of the machine. Visibility may further be improved, both in the embodiment of Figures 3 and 4 and in the embodiment of figure 1, by positioning a mirror in the slot 102 (or slot 2) at 45° to the longitudinal axis of the machine. By way of example this is shown diagrammatically as 153 in Figure 3b. This enables the user to see the double layer of tissue sucked into the slot 2. A still further improvement can be achieved by extending the endoscope optics right up to the slot 102 (or 2).

Claims: A sewing machine for forming stitches in a substrate (16, 116), comprising means defining a slot (2, 102) open towards the substrate (16, 116) for receiving the substrate therein, thread carrying means (5, 105) for passing a thread (9, 109) into the substrate in the slot from one side of the substrate at a first location and for withdrawing the thread from the substrate on the same side at a second location spaced from the first location, the said means being remotely operable solely from the said one side of the substrate, characterized in that it comprises means (18, 118) for drawing a U-shaped double layer of the substrate into the slot (2, 102) by suction. A machine according to claim 1, wherein the thread-carrying means (5, 105) is arranged for movement from a retracted position to an extended position, in which movement it carries a loop of thread into and through the said double layer and further comprising means (11, 14; 111) for catching the said loop after it has been passed through the said double layer and holding the said loop while the thread-carrying means (5, 105) is withdrawn to the retracted position. A machine according to claim 2, wherein the catching means (11, 14; 111) is movable from a catching position to a position in which the loop caught is positioned so that subsequent movement of the thread-carrying means (5, 105) from said retracted position to said extended position carries a further loop of thread through the previously caught loop. A machine according to any preceding claim, comprising a channel (18, 118) communicating with said slot for supplying the suction thereto to effect the said drawing in of the double layer. A machine according to claim 4, as dependent on claim 2 or 3, comprising a block (1) having distal and proximal ends, the block (1) defining a compartment (10, 110) adjacent the distal end housing the catching means (11, 14; 111), said slot (2, 102) being defined in the block on the proximal side of the compartment, said suction-supplying channel (18, 118) being defined in the block on the proximal side of the slot, a further channel (17, 117) being defined on the proximal side of the slot and communicating with the slot, said thread-carrying means (5, 105) being slidably received therein for movement between said retracted position, in which the thread-carrying meals is substantially wholly within said further channel, and said extended position, in which the thread-carrying means extends across said slot (2, 102) into said compartment (10, 110). A machine according to claim 5, wherein control means (15, 115) for controlling the catching means extend through the suction-supplying channel (18, 118) and across said slot (2, 102) into said compartment (10, 110) to connect with the catching means (11, 14; 111). A machine according to claim 6, wherein said control means (15, 115) comprises a flexible wire, and wherein the machine further comprises a further flexible wire (6, 106) for moving the thread-carrying means (5, 105) between the retracted and extended positions. A machine according to claim 6 or 7, wherein the catching means comprises a shoe (11) resiliently mounted in the compartment for pivotal movement about an axis transverse to the length of the block (1), and a hook (14) pivotally mounted at one end on the shoe and movable by said control means (15) between a position in which the other end thereof is in contact with the shoe and a position in which there is no such contact. A machine according to claim 6 or 7, wherein the catching means comprises a pair of arms defining a U, the U-shaped member (111) being mounted in the compartment for pivotal movement about an axis transverse to the length of the block and a pair of resilient members (151) each extending from a respective one of said arms, the resilient members converging towards one another adjacent the outward ends thereof, the U-shapad member (111) being movable by said control means (115) between an outward position in which, when the thread-carrying means (105) is in its extended position both resilient members (151) are closely adjacent the thread-carrying means on the same side thereof, and an inward position in which the resilient members are located inwardly of the thread-carrying means. A machine according to any of claims 5 to 9, wherein the block is formed of a plurality of disconnectible modules (A-G) located face to face, one of said modules being a module (B) defining said slot. A machine according to any of claims 5 to 10, wherein proximally of the slot the block is transparent. A machine according to any of claims 5 to 11, further comprising a mirror (153) located in the said slot and angled with respect to a line extending between the proximal and distal ends of the block. A machine according to any preceding claim, mounted on an end of an endoscope.

Inventors: MILLS, TIMOTHY NOEL, SWAIN, CHRISTOPHER PAUL
Applicants: UNIVERSITY COLLEGE LONDON
Application year: 1985
Main classification: A61B17
IPC codes: A61B19, A61B1, A61B17