Deep suturer

Abstract: The present invention provides a deep suturer suitable for suturing a deep portion and a narrow portion which are difficult to be applied by a normal direct hand operation such as transoral operation. The suturer comprises an end needle-holding portion (B) for holding a suture needle, a holder portion (A) for operating said end needle-holding portion (B) and a connection portion (C) for operatively connecting said end needle-holding portion (B) and said holder portion (A), wherein said end needle-holding portion (B) is provided with a disk head (4) which is rotated integral with a needle-holding portion (5), said holder portion (A) is provided with a handle (2), and said connection portion (C) is provided with a rod (7) having one end connected to said handle (2) through a connecting mechanism (18) and the other end connected to said disk head (4) through a link (20), said rod (7) being axially slidably inserted by means of a spring force.

Description: This invention relates to a deep suturer suitable for suturing a deep portion and a narrow portion which are difficult to be applied by a normal direct hand operation such as transoral operation. A needle holder presently used for suturation has the construction in which a suture needle is held in a direction at right angles to the long axis of the needle holder. Accordingly, suturation is difficult in the field of operation for deep and narrow parts. Some constructions have been proposed in order to solve this problem. However, none of them have yet been commercialized. For example, Fig. 8 and Fig. 9 show conventional deep suturers described in IKIGAKU, Vol. 58, No. 12, p. 531-532 (1988) and Japanese Utility Model Publication No. 62-32006, respectively. First, the structure and operation of the suturer shown in Fig. 8 will be described. This suturer comprises a head portion B2 for holding a suture needle, a neck portion C2 for rotating the head portion B2 and a body portion A2 for operating the head portion B2 and the neck portion C2. These are operated by a shaft and a gear. First, by turning an operating knob 31, holding portions 36a and 36b for sandwiching the needle therebetween are opened and closed. Next, gears 40a and 40b are rotated in the same direction by engagement of a gear 41, and a pedestal bevel gear 42 on which the holding portions 36a and 36b are integrally mounted is rotated to left and right by rotating the gear 40a or 40b. The change gear 40a is slidably moved axially along a left shaft 39a into engagement with an auxiliary gear 43 meshed with the center gear 41 and changed into a gear train meshed with the right gear 40b through the auxiliary gear 43 and the center gear 41 whereby the rotational direction of the shafts 39a and 39b is reversed to give the pedestal bevel gear 42 a longitudinal rotation. Accordingly, holding and releasing of the needle are effected by turning the operating knob 31 and, next, the gear train in which the gears 40a, 40b, 41 and 43 are meshed is changed whereby lateral rotation and longitudinal bending drive of the holding portions for suturation are rendered free. Next, a further conventional suturer shown in Figs. 9(a), 9(b) and 9(c) will be described in structure. This suturer comprises an end needle-holding portion B1 on which a suture needle is mounted, a holding portion A1 having a holder 48 and an intermediate portion C1 for connecting both B1 and A1 at opposite ends thereof. Figs. 9(b) and 9(c) show the structure of the end needle holding portion B1. A suture needle 44 is held so as to be sandwiched between a needle receiver 45 and a slide plate 47 which is slidably moved by a spring plate 46. The needle receiver 45 is integrally mounted on a pulley 50 rotatated by a handle 48 of the holding portion A1 through wires 49a and 49b and the slide plate 47 is connected to a small handle 52 through a wire 51. First, by the operation of the handle 48, the suture needle is rotated for suturation through the wires 49a and 49b and the pulley 50 and, by the operation of the small handle 52, the slide plate 47 is slidably moved through the wire 51 against the spring plate 46 to hold and release the suture needle. There are a number of problems associated with the prior art suturers. First, in the conventional example shown in Fig. 8, the drive portion is composed of a number of gears and shafts and therefore there gives rise to a problem that the whole device increases in dimension and the device cannot be inserted into a narrow portion for operation. Even if it is inserted, suturing operation is difficult. Further, in the Fig. 9 example, interlocking between the near-by operation and the rotation of the suture needle is deviated due to the slip occurring between the wire and the pulley or the sag of the wire, resulting in a difficulty of adjustment of the handle operation. In addition, it is not possible to give the suture needle a sufficient piercing force with respect to hard tissue for the same reason as mentioned above. Another problem is that since the rotational angle of the suture needle is small, about 90°, the depth of the tissue to be sutured becomes shallow, bringing forth a practical limitation. This invention has been accomplished in order to solve the problems as noted above. An object of the present invention is to provide a suturer which is provided with a slip-free tight connection means between the rotation of the end needle-holding portion and the near-by operation and can give a sufficient piercing force and which can effect the operation for holding and releasing the needle even by the left hand alone or by the right hand simultaneously with the handle and the knob (in case of a left-handed person, the matter is reversed). In the suturer according to the present invention, as shown in claim 1, a rod for connecting a disk head and a handle or knob through a connecting mechanism is provided on a connection portion in order that the disk head integral with a needle holding portion of an end needle-holding portion is rotated by a handle or knob which is a part of a near-by holder portion. The range of the rotational angle of the disk head is made wide as in 90° to 180°. As shown in claim 2, a small diameter rod for connecting a needle holding portion and the holder portion through a connecting mechanism is provided in order to hold and release a suture needle of the needle-holding portion. Conveniently, as shown in claim 4, a projection is provided to support a rear end of a suture needle when the latter is held on the holding portion. As shown in claim 5, a needle groove for locking the suture needle is inclined between the center line of a needle receiver and the perpendicular direction of the center line. With the arrangement as described above, according to the suturer of the present invention in claim 1, the rotational operation of the needle holding portion is effected by the handle or knob through the rod and therefore rotation without a slip and with smooth and without unevenness is obtained. The features of the subsidiary claims have the following advantages. The small diameter rod of claim 2 is inserted into the groove of the rod and received into the pipe and therefore the connection portion is compact. The projection of claim 4 is provided to receive and support the tail portion of the needle whereby a sufficient piercing force is obtained to render possible suturation even with respect to hard tissue. The mounting angle of the suture needle as defined in claim 5 is outwardly inclined and therefore the extreme end of the needle is directed outwardly and curved inwardly whereby suturation at a deep portion can be easily accomplished. In the accompanying drawings: Fig. 1(a) is a side view showing a first embodiment of this invention and Fig. 1(b) is a top view of an end needle holding portion of Fig. 1(a); Fig. 2 is a top view of the end needle holding portion of Fig. 1; Fig. 3 is a sectional view taken on line III-III of Fig. 2; Fig.4 is a sectional view taken on line IV-IV of Fig. 3; Fig. 5(a) is a side view showing a second embodiment of this invention; Fig. 5(b) is a top view of an end needle holding portion of Fig. 5 (a); Fig. 6 is a top view of the end needle holding portion of Fig. 5; Fig. 7 is a sectional view taken on line VII-VII of Fig. 6; Fig. 8 is a perspective view showing a conventional example; Fig. 9(a) is a side view showing a further conventional example; Fig. 9 (b) is a side view of an end needle holding portion of Fig. 9 (a); and Fig. 9(c) is a top view of Fig. 9(b). In the drawings, A denotes a near-by holder portion, B denotes an end needle holding portion, C denotes a connection portion, 2 denotes a handle, 3 denotes a knob, 4 denotes a disk head, 5 denotes a needle holding portion, 6 denotes a suture needle, 7 denotes a rod, 8 denotes a small diameter rod, 9 denotes a pipe, 12 denotes a needle receiving bed, 13 denotes a spring plate, 16 denotes a needle locking plate and 23 denotes a groove. A first embodiment of the present invention will be described with reference to Figures 1 to 4 of the drawings. Fig. 1(a) is a side view of the entire structure. Fig. 1(b) and Fig. 2 are a top view of an end needle-holding portion. Fig. 3 is a sectional view taken on line III-III of Fig. 2. Fig. 4 is a sectional view taken on line IV-IV of Fig. 3. In Figs. 1(a) and 1(b), reference character A designates a near-by holder portion gripped by hand for operation, which comprises a main holder 1, a handle 2 having a return mechanism by means of a spring 2a and a knob 3 having a spring 3a. Reference character B designates an end needle-holding portion which comprises a disk head 4 and a needle holding portion 5 rotated integral with the disk head 4. Reference character C designates a connection portion, for connection between the near-by holder portion A and the end needle-holding portion B, comprising an operating rod 7 axially slidable within a hollow pipe 9 with a small diameter rod 8 inserted. In Figs. 2 and 3, an arm bed 10 is fixedly supported on pipe 9 and disk head 4 is rotatably supported on a pin 11 vertically mounted on the arm bed 10. A needle receiver 12 of the needle holding portion 5 is integrally mounted on one end of the disk head 4. A needle locking plate 16 is provided to be pressed so that an end 16a is placed in contact with a projection 12a of the needle receiver 12 so as to hold the suture needle 6 by means of a plate spring 13 in the form of a resilient body which is slidably moved in directions indicated at arrows E and F within the groove provided in the disk head 4 in an extending direction of the needle receiver 12 on the upper surface thereof. In order to rotate the disk head 4, a pin 17 is provided at a radial position of the disk head 4 and a link 20 as a connecting mechanism curved into a J-shape so as to avoid contact with pin 11 is rotatably connected to the pin 17 and a pin 19 provided on the end of the rod 7 connected to the handle 2 through a connecting mechanism 18. By this mechanism, the needle holding portion 5 integral with the disk head 4 is rotated from a position indicated at two-dot line in Fig. 2 to a position indicated at solid line in coincidence with the axial direction of the suturer. At the position indicated at the solid line, a hook 16b at the end of the needle locking plate 16 is engaged with a hook 8a at the end of the small diameter rod 8 connected to the knob 3 through a connecting mechanism 3b to push the knob 3 and cause the needle locking plate 16 to be slidably moved from the small diameter rod 8 through the hooks 8a and 16b against the bias of the spring plate 13 in a direction as indicated at arrow E on the needle receiver 12, whereby the needle groove 12b for holding the suture needle 6 formed between the projecting portion 12a of the needle receiver 12 and the end 16a of the needle locking plate 16 is opened. When the finger is released from the knob 3, the needle groove 12b is closed by the spring force. In this manner, holding and releasing of the suture needle 6 with respect to the needle groove 12b can be effected. In the needle groove 12b, a projection 16c for receiving and supporting the rail portion of the needle is provided integral with the side of the needle locking plate 16 so as to block one end of the needle groove 12b. In Fig. 4, reference numeral 9 designates a pipe by which the near-by holder portion A and the end needle-holding portion B are connected. Within the pipe 9 is axially slidably inserted a rod 7 having an outer diameter which is smaller than or substantially equal to the inner diameter of the pipe 9 and also axially slidably inserted a small diameter rod 8 having a circular section so as to be inscribed in an axial slot 23 formed in the upper portion of the rod 7. The operation of the thus configured suturer of the present inveniton will be described hereinafter. First, when he main holder 1 is gripped and the handle 2 is pulled by the finger against the spring force, the rod 7 is pulled this side and the disk head 4 is rotated counterclockwise, in the figure, through the link 20. Accordingly, the needle holding portion 5 integral with the disk head 4 is also rotated counterclockwise and rotated from the position indicated at two-dot line to the solid line position in Fig. 2. When the direction of the needle holding portion is coincident with the axis of the rod 7, the hooks 8a and 16b are placed in engagement with each other. Next, when the knob 3 is pushed by the thumb of the right hand against the spring force or rotated by the left hand, the small diameter rod 8 is pulled this side through the connecting mechanism 3b, and the hooks 8a and 16b are engaged with each other. The needle locking plate 16 is then pulled in a direction as indicated at arrow E through the hooks 8a and 16b against the bias of the spring plate 13. Accordingly, the needle groove 12b formed between the projecting portion 12a of the needle receiving bed 12 and the end 16a of the needle locking plate 16 is opened and the rail portion of the suture needle 6 is placed in the needle groove 12b so that the rail is supported by the projection 16c provided on one end of the needle groove 12b. In this state, when the knob 3 is released, the small diameter rod 8 is returned to its original position by means of the spring force to release engagement between the hooks 8a and 16b. The needle locking plate 16 is also subjected to the pressing force of the spring plate 13 and moves in a direction as indicated at arrow F. The needle groove 12b is closed to lock the suture needle 6. Further, when the handle 2 is pulled and the finger is released, the rod 7 is returned to its original position by means of the spring force. The disk head 4 is then rotated to move the needle holding portion 5 from the solid-line position to the two-dot line position. After the suture needle 6 has been locked to the needle holding portion 5 by the operation as described above, that is, when after insertion into the suture portion, the handle 2 is pulled to impart counterclockwise rotation to the needle holding portion 5 to which the suture needle 6 is locked. The suture needle 6 is mounted at an angle in which the tangential line of the rear end of the needle is inclined at 30° to 80° with respect to the center line of the needle receiving bed 12 and the extreme end thereof is directed outwardly and curved inwardly. Therefore, the rotating suture needle 6 can easily pierce the tissue. Subsequently, in that state, the knob 3 is pushed to release the suture needle 6 from the needle holding portion 5 to pull out the suturer. Thereafter, the extreme end of the suture needle 6 is held by the needle holder to pull it out of the tissue to complete a stitch of suturation. Similar operation is repeatedly continued. A second embodiment of this invention will be described hereinbelow with reference to the drawings, in which Fig. 5(a) is a side view showing the entirety of this embodiment, Figs. 5(b) and 6 are a top view of an end needle-holding portion and Fig. 7 is a sectional view taken on line VII-VII of Fig. 6. This embodiment has the same structure as that of the first embodiment except that a connecting mechanism is connected to the handle 2 and the knob 3 in the first embodiment. Therefore, parts in the second embodiment similar to those of the first embodiment are indicated by the same reference numerals and a description thereof will be omitted. In Fig. 5, the near-by holder portion A comprises a handle 2 connected through a connecting mechanism 21 to a small diameter rod 8 being applied with a biasing force by means of a spring 3a together with a main holder 1 and a knob 3 connected to a rod 7 through a connecting mechanism 24 having a spring 22 for applying a biasing force. Accordingly, the suture needle is fixed and when the knob 3 is first turned, the disk head 4 is rotated through the rod 7 from the connecting mechanism 24, similar to the case of the first embodiment, so that the suture is carried out. Next, when the handle 2 is pulled under the aforesaid state, the needle locking plate 16 is pulled through the small diameter rod 8 from the connecting mechanism 21, similar to the case of the first embodiment, to open the needle groove 12b and release the holding of the suture needle. Thereafter, the needle is pulled out to complete a stitch of suture. It is convenient that, in order that the main holder 1 may be operated by the thumb of the hand gripping the same, in case of the right-handed person, the mounting position of the knob 3 is set to the left side as viewed from the top and, in the case of the left-handed person, it is set to the right side whereby the operation of the handle can be done simultaneously while holding it by one hand. While in the aforementioned embodiment, the small diameter rod 8 has been inserted into the groove 23 provided in the rod 7, it is to be noted that it can be provided externally of the pipe separately from the rod 7. Preferably, however, it may be inserted into the pipe 9 as in the embodiment in terms of protecting the small diameter rod 8. Alternatively, the pipe 9 may be made to have a slightly larger diameter or to have an egg-like sectional shape, and the rod 7 and the small diameter rod 8 may be juxtaposed and inserted therein. As the resilient body 13 for pressing the needle locking plate 6 of the needle holding portion 5 so as to hold the needle 6, a spring plate and a spring rod are provided interiorly and exteriorly in the first and second embodiments, respectively, as shown in Figs. 6 and 7, but the shape and mounting position of the spring are not limited thereto. As for the materials used to form the suturer, there can be preferably mentioned those excellent in corrosion resistance, living body adaptability, heat resistance during sterilization and radiation resistance. As described above, according to the present invention, the rotation of the needle holding portion of the end needle-holding portion is operated by the handle of the near-by holder portion through the rod. This brings forth effects that: there is no slip in interlocking and positive and tight transmission is obtained; as the case may be, there can be used a large rotational angle close to 180°; and even deep and narrow portions of the tissue to be sutured can be positively sutured. Moreover, the handle and the knob are provided close to the near-by holder portion whereby the disk head of the needle holding portion is rotated by either handle or knob through the connecting mechanism and the rod and the needle locking plate of the needle holding portion is operated to be opened and closed by the other through the connecting mechanism and the small diameter rod. With this arrangement, there provides an effect that the operation of the handle and the knob can be made by fingers of the hand by which the main holder is gripped and the other hand can be used for other operations. Furthermore, the holding and releasing of the suture needle of the needle holding portion of the end needle-holding portion is effected by pushing the near-by holder portion connected through the small diameter rod by the finger to rotate it. This also brings further effects that it can be freely operated even by the left hand and that the knob can be operated by the thumb in combination with the handle operation while gripping the main holder by the right hand. Moreover, since the projection for receiving and supporting the tail portion of the suture needle is provided in the needle groove on which the suture needle is mounted, a large piercing force is obtained. The mounting angle of the suture needle is inclined so that the tangential line of the rear end of the needle is in the range of 30° to 80° with respect to the center line of the needle receiving bed and the extreme end of the needle is directed outwardly and curved inwardly. This brings forth the effect that even a deep and narrow tissue can be easily sutured.

Claims: A deep suturer comprising: an end needle-holding portion (B) for holding a suture needle; a holder portion (A) for operating said end needle-holding portion (B); and a connection portion (C) for operatively connecting said end needle-holding portion (B) and said holder portion (A), wherein: said end needle-holding portion (B) is provided with a disk head (4) which is rotatable integrally with a needle-holding portion (5); said holder portion (A) is provided with a handle (2) or knob (3); said connection portion (C) is provided with a rod (7) having one end connected to said handle (2) or knob (3) through a connecting mechanism (18) and the other end connected to said disk head (4) through a link (20); the rotational angle of said disk-head (4) of said end needle-holding portion (B) is in the range of 90° to 180°; said rod (7) can be returned to its original position by means of a spring force; and said rod (7) is axially slidable to rotate said diskhead. A deep suturer according to claim 1, wherein said rod (7) is positioned within a tubular connecting portion which forms part of said connection portion (C) and said rod (7) contains an axial groove (23) along its length which receives therein a smaller diameter rod (8) which is axially slidable within said groove (23), said smaller diameter rod (8) operatively interconnecting the end needle holder portion (B) and the holder portion (A) to operate said end needle holding portion (B) between a gripping position and a non-gripping position for holding a suture needle (6). A deep suturer according to claim 1, wherein the needle holding portion (5) for locking a suture needle (6) of the end holding portion (B) is provided with a needle locking plate (16) which is slidably moved by being pressed by a resilient body (13) on a needle receiving bed (12), the holder portion (A) is provided with a knob (3) or handle (2) for operating, holding and releasing of the suture needle (6) with respect to the needle holding portion (6) and the connection portion (C) is provided with the small-diameter rod (8) having one end connected to said needle locking plate (16) through hooks (8a, 16b) and the other end connected to said knob (3) or handle (2) through a connecting mechanism, said rod (8) can be returned to its original position by means of a spring force and said rod (8) is axially slidably inserted by said spring force. A deep suturer according to any one of claims 1 to 3 wherein a needle groove (12b) for holding the suture needle (6) formed between a projecting end (12a) of the needle receiving bed (12) of said needle holding portion (5) and an end (16a) of the needle locking plate (16) is provided with a projection for receiving and supporting a tail portion of the suture needle (6). A deep suturer according to claim 4 wherein said needle groove (12b) is inclined between a center line of the needle-receiving bed (12) and the perpendicular direction of said center line.

Inventors: ABE HIROSHI, ASAHARA TOMOHIKO, ABE, HIROSHI, ASAHARA, TOMOHIKO
Applicants: ETHICON INC, ETHICON INC.
Application year: 1991
Main classification: A61B17
IPC codes: A61B17