Suture assist device

Abstract: A surgical instrument including a handle, an end effector including jaws, an elongated tube connecting the handle to the end effector, a connector within the tube connecting the handle to the jaw members; and a first slot in the first jaw and a second slot in the jaw wherein the first and second slots are arranged such that only a portion of the slots overlap when the first and second jaws are closed to create a hole in the jaw which may be used for positioning a suture in the tissue. The first slot in the first jaw extends to a side of the first jaw and the second slot in the second jaw extends to a side of the second jaw creating pathways for removing the suture when the jaws are opened. The surgical instrument may also include a retractable tying pin adjacent the end effector and a knot pusher at the distal end of the end effector. A method of using the surgical instrument described above includes closing the first and second jaws on tissue; passing a surgical needle with a suture attached thereto through the overlapping portion of the first and second slots; opening the first and second jaws and releasing the suture by passing the suture through the first and the second slots.

Description: FIELD OF THE INVENTION The present invention relates, in general, to an improved surgical instrument and, more particularly, to a grasper including an opening in the grasper jaws for use in positioning a surgical needle and suture in tissue. BACKGROUND OF THE INVENTION In many surgical operations, including both open and minimally invasive operations, surgeons must use sutures to join tissue. Accurately positioning surgical needles is, at times, difficult. Accurately positioning surgical needles is particularly important where a grasper or other instrument is used to stabilize or to hold tissue layers prior to placing the needle. In order to enhance a surgeon's ability to position a needle in tissue, it would be advantageous to design a grasper which includes an opening in the jaws which opening may be used to position a surgical needle. When using such a device, the grasper would be used to grasp and hold one or more layers of tissue. The surgical needle could then be passed through the grasper jaws and the tissue layer(s). However, once the needle has been passed through the grasper jaws it is difficult to remove the suture from the opening in the jaws. Therefore, it would be advantageous to design an instrument such as a grasper including an opening in the jaws wherein the suture could be easily removed when the jaws are opened. Once the suture is placed, a knot may be tied in the suture. Once the knot is tied, it must be pushed against the tissue and tightened. Once the knot is pushed against the tissue, it may be held in place by flattening the knot. Thus, it would be further advantageous to design a grasper as described including a knot tying post wherein the knot, once tied, could be pushed against the tissue and flattened. US 5,383,877 discloses a laparoscopic instrument having two jaws, one of which is moveable, and a groove through the ends of both jaws transverse to the pivotal axis of the moveable jaw. US 5,222,962 discloses an end effector according to the preamble of claim 1, in particular an endoscopic surgical instrument having a pair of opposed moveable jaws. The first jaw has a channel extending from the top portion through the body of the jaw and culminating at the inner surface of the first jaw and the second jaw has a groove in its inner surface. SUMMARY OF THE INVENTION The invention provides an end effector according to the appended claims 1-7, and a a surgical instrument according to the attached claims 8, 9. BRIEF DESCRIPTION OF THE DRAWINGS The novel features of the invention are set forth with particularity in the appended claims. The invention itself, however, both as to organization and methods of operation, together with further objects and advantages thereof, may best be understood by reference to the following description, taken in conjunction with the accompanying drawings in which: Figure 1 is a perspective drawing of a surgical instrument according to one embodiment of the present invention. Figure 2 is a perspective drawing of an end effector according to one embodiment of the present invention. Figure 3 is a top view of the end effector illustrated in Figure 2. Figure 4 is a side view of the end effector illustrated in Figures 2 and 3. Figure 5 is a perspective view of one embodiment of a tying pin for use in a surgical instrument according to the present invention. Figure 6 is a perspective view of one embodiment of the connection between the tying pin and the tying pin trigger for use in a surgical instrument according to the present invention. Figure 7 is a side view of the tying pin illustrated in Figure 5 in a retracted position. Figure 8 is a side view of the tying pin illustrated in Figure 5 in an extended position. Figure 9 illustrates a first step in a method of tying a suture knot using an instrument according to the present invention wherein the suture is passed through an opening in the end effector jaws. Figure 10 illustrates a second step in a method of tying a suture knot using an instrument according to the present invention wherein the jaws are opened to release the suture. Figure 11 illustrates a third step in a method of tying a suture knot using an instrument according to the present invention, wherein the suture is wound around the instrument shaft. Figure 12 illustrates a fourth step in a method of tying a suture knot using an instrument according to the present invention wherein the suture is grasped by the end effector. Figure 13 illustrates a fifth step in a method of tying a suture knot using an instrument according to the present invention wherein the tying pin is retracted and the suture and needle are pulled through the loops created by winding the suture around the instrument shaft. Figure 14 is a perspective view of one embodiment of a retractable tying pin for use in a surgical instrument according to the present invention in its partially extended position. Figure 15 is a perspective view of the retractable tying pin of Figure 14 in its fully extended position. Figure 16 is a perspective view of one embodiment of a retractable tying pin for use in a surgical instrument according to the present invention in its retracted position. Figure 17 is a perspective view of the retractable tying pin illustrated in Figure 16 in its fully extended position. Figure 18 illustrates a method of pushing a suture knot using a knot pusher in a surgical instrument according to one embodiment of the present invention. Figure 19 illustrates a further step in the method illustrated in Figure 18. Figure 20 illustrates a further step in the method according to the present invention. DETAILED DESCRIPTION OF THE INVENTION Figure 1 is a perspective drawing of a surgical instrument 15 which may be referred to as a "grasper". In Figure 1, handle 10 includes first grip member 12, second grip member 14, tying pin trigger 11 and connector 22. Connector 22 may be, for example a ball and joint connector. Elongated hollow tube 20 is connected to handle 10 by rotation knob 16. End effector 30 is connected to handle 10 and second grip member 14 by jaw actuator 18 which passes through tube 20 to connector 22 on grip member 14. As illustrated in Figure 6, tying pin trigger 11 is connected to retractable tying pin 24 by tying pin connector 32 which passes through tube 20. End effector 30 includes first jaw 26 and second jaw 28. First jaw 26 includes slot 27. Second jaw 28 includes slot 29. Handle 10 may also include a conventional releasable ratchet mechanism 17 to assist the surgeon in grasping and holding tissue. In Figure 1, movement of second grip member 14 relative to first grip member 12 is translated to end effector 30 by connector 22 and jaw actuator 18. Thus, when second grip member 14 is moved in direction A, jaw members 26 and 28 close along path AA. Trigger 11 is connected to tying pin 24 as illustrated in Figure 6, therefore, moving trigger 11 in direction B extends and retracts tying pin 24 along path BB. End effector 30, being attached to tube 20 by support members 34, rotates with respect to handle 10 when rotation knob 16 is turned. Figure 2 is a perspective drawing of an end effector according to one embodiment of the present invention. In Figure 2, end effector 30 is open with jaws 26 and 28 separated to receive tissue. Tube 20 includes movable jaw actuator 18 which is attached to jaws 26 and 28 through connector rods 42 and 44 respectively. Jaw 26 includes slot 27 and notch 36. Notch 36 is formed in the distal end of jaw 26. Jaw 26 further includes tissue grasping surface 19 and external surface 21. The intersection of tissue grasping surface 19 and external surface 21 forms outside edge 23. Slot 27 extends through jaw 26 from external surface 21 to tissue grasping surface 19 and from a central region 25 of jaw 26 to outside edge 23. Jaw 28 includes slot 29 and notch 38. Notch 38 is formed in the distal end of jaw 28. Jaw 28 further includes tissue grasping surface 31 and external surface 35. The intersection of tissue grasping surface 31 and external surface 35 forms outside edge 37. Slot 29 extends through jaw 28 from external surface 35 to tissue grasping surface 31 and from a central region 41 of jaw 28 to outside edge 37. Jaws 26 and 28 are adapted to pivot around pivot pin 46 in response to forces applied by jaw actuator 18 through connector rods 42 and 44. Thus, when jaw actuator 18 is moved distally, connector rods 42 and 44 force jaws 26 and 28, respectively, to pivot around pivot pin 46, opening end effector 30 as illustrated in Figure 2. When jaw actuator 18 is moved proximally, connector rods 42 and 44 force jaws 26 and 28, respectively, to pivot around pivot pin 46, closing end effector 30 as illustrated in Figure 4. First jaw 26 and second jaw 28 include ridges 48 which assist in gripping tissue when jaws 26 and 28 are closed. Jaw support members 34 connect jaws 26 and 28 to tube 20 through pivot pin 46. Figure 3 is a top view of the end effector illustrated in Figure 2. In Figure 3, jaws 26 and 28 are closed. When closed, a portion of slot 27 overlaps with a portion of slot 29, creating needle opening 40 which extends through end effector 30. Opening 40 is generally large enough to pass a surgical needle and suture. Figure 4 is a side view of the closed end effector illustrated in Figure 3. As illustrated in Figure 4, when jaws 26 and 28 are closed, needle opening 40 passes through end effector 30 from external surface 21 to external surface 35. Figure 5 is a perspective view of a tying pin for use in a surgical instrument according to the present invention. Tying pin 24 may be extended to assist in forming suture loops as illustrated in Figure 11. Figure 6 is a perspective view of the connection between tying pin 24, tying pin trigger 11 and tying pin connector 32. Rotation coupler 33 in Figure 6 which is part of tying pin connector 32 is adapted to transmit longitudinal motion from trigger 11 to pin 24 without restraining pin 24 from rotating cooperatively with end effector 30 when, for example, tube 20 is rotated to position end effector 30. As illustrated in Figure 7, moving trigger 11 and, thus, tying pin connector 32 distally, moves tying pin 24 into a retracted position. As illustrated in Figure 8, moving trigger 11 and, thus, tying pin connector 32 proximally, moves tying pin 24 into an extended position. Figure 9 illustrates a first step in a method of tying a suture knot using an instrument according to the present invention. In Figure 9, tissue 54 is grasped between jaws 26 and 28 of end effector 30. Needle 50 and suture 52 are passed through needle opening 40 and tissue 54. Figure 10 illustrates a second step in a method of tying a suture knot using an instrument according to the present invention. After surgical needle 50 and suture 52 are passed through tissue 54, end effector 30 may be opened, opening jaws 26 and 28. Once jaws 26 and 28 are opened, suture 52 may be removed from needle opening 40 through slots 27 and 29. Figure 11 illustrates a third step in a method of tying a suture knot using an instrument according to the present invention. In Figure 11, tying pin 24 is extended and suture 52 is wound around hollow tube 20 by, for example, turning tube 20 in direction C to create one or more suture loops 56. Figure 12 illustrates a fourth step in a method of tying a suture knot using an instrument according to the present invention. In Figure 12, needle 50 is removed and suture 52 is grasped by end effector 30 as illustrated. Once grasped, suture 52 may be pulled through suture loops 56 as illustrated in Figure 13. Figure 13 illustrates a fifth step in a method of tying a suture knot using an instrument according to the present invention wherein tying pin 24 is retracted the suture 52 is pulled through suture loops 56 to tie a surgical knot. Figures 14 and 15 illustrate an alternate embodiment of a tying pin according to the present invention. As illustrated in Figures 1-13, tying pin 24 comprises a single element which is extended and retracted by moving tying pin connector 32 as illustrated in Figures 5-8. In Figures 14 and 15, tying pin 24 comprises tying pin element 58 and tying pin element 59 which are connected by pivot pin 62. Tying pin element 58 is pivotally connected to tying pin connector 32, while tying pin element 59 is pivotally connected to pivot pin 60 such that distal movement of tying pin connector 32 forces tying pin elements 58 and 59 up and out of tying pin slot 64 as illustrated in Figure 14. In Figure 15 tying rod 24 is in its fully extended position with tying rod elements 58 and 59 forming tying rod element 24. Figures 16 and 17 illustrate a further alternate embodiment of a tying pin according to the present invention. In Figure 16, tying pin 24 comprises a flexible rod 66 which may be made of, for example Nylon wire or other suitable material. Flexible rod 66 is sufficiently rigid to provide a stop for sutures 52 when forming suture loops 56. In the embodiment of Figures 16 and 17, tying pin connector 32 may be, for example, an extension of flexible rod 66. In this embodiment, support 68 acts to change the direction of motion of flexible rod 66. Therefore, moving tying pin connector 32 in a distal direction will extend flexible rod 66 to form tying rod 24. Alternatively, moving tying pin connector 32 in a proximal direction will retract flexible rod 66, retracting tying rod 24. Figures 18 and 19 illustrate a method of tying off a knot using the notches in the end effector according to one embodiment of the present invention. When end effector 30 is closed, notches 36 and 38 form knot pusher 39. Once knot 70 is formed, for example as illustrated in Figures 9-13, pusher 39 may be placed against knot 70 and used to force knot 70 against tissue 54. As illustrated in Figure 20, knot 70 may then be flattened by opening jaws 26 and 28 while maintaining pressure on knot 70. While preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the invention. Accordingly, it is intended that the invention be limited only by the scope of the appended claims.

Claims: An end effector (30) for a surgical instrument wherein said end effector (30) comprises: first tissue grasping means having a first tissue grasping surface (19) and a first exterior surface (21); second tissue grasping means having a second tissue grasping surface (31) and a second exterior surface (35), said first tissue grasping surface (19) being positioned opposite said second tissue grasping surface (31), said first and second tissue grasping means being adapted to move from an open position to a closed, tissue grasping, position; and a first opening extending from said first tissue grasping surface (19) to said first exterior surface (21), characterised in that the end effector further comprises: a second opening extending from said second tissue grasping surface (31) to said second exterior surface (35), wherein only a portion of said first and said second openings overlap when said first and second tissue grasping means are in said closed position. An end effector (30) according to claim 1, wherein: said first tissue grasping means is a first jaw (26); said second tissue grasping means is a second jaw (28); said first opening is a first hole and a first slot (27); said second opening is a second hole and a second slot (29); said first hole is aligned with said second hole when said first and second jaws are in said closed position; said first jaw is moved from said open position to said closed position by a first connector (42); and said second jaw is moved from said open position to said closed position by a second connector (44). An end effector (30) according to claim 2, wherein said first slot in said first jaw extends from said first hole to a first side (23) of said first jaw and said second slot in said second jaw extends from said second hole to a second side (37) of said second jaw. An end effector (30) according to claim 3, wherein said first slot is not aligned with said second slot when said first and second jaws are closed. An end effector (30) according to claim 4, wherein said first jaw (26) includes a first notch (36) at a distal end of said first jaw and said second jaw (28) includes a second notch (38) at a distal end of said second jaw and wherein said first and second notches are aligned when said jaws are closed. An end effector (30) according to claim 1, wherein: said first tissue grasping means is a first jaw (26); said second tissue grasping means is a second jaw (28); said first opening is a first slot (27); and said second opening is a second slot (29). An end effector (30) according to claim 6, wherein: said first slot extends to one side (23) of said first jaw; said second slot extends to one side (37) of said second jaw; and the end effector further comprises a pivot point (46) wherein said first and said second jaws pivot around said pivot point such that at least a portion of said first and said second jaws overlap when said jaws are closed. A surgical instrument (15) including a proximal end and a distal end, said instrument comprising: a handle (10) comprising first and second gripping members (12,14) at said proximal end of said instrument; an end effector (30) according to any of claims 1 to 7; an elongated tube (20) connecting said handle (10) to said end effector (30); and a connector (22) within said tube (20) connecting at least one of said gripping members (12,14) to said tissue grasping means. A surgical instrument (15) according to claim 8, wherein said instrument includes a retractable tying pin (24) adjacent said proximal end of said end effector.

Inventors: MEASAMER JOHN P, NOLAN LEO J, STALEY JAMES D, WELCH ROBERT F, MEASAMER, JOHN P., NOLAN, LEO J., STALEY, JAMES D., WELCH, ROBERT F.
Applicants: ETHICON ENDO SURGERY INC, ETHICON ENDO-SURGERY, INC.
Application year: 1997
Main classification: A61B17
IPC codes: A61B17