Patent Publication Number: US-8523817-B2

Title: Veress needle with illuminated guidance and suturing capability

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     This application claims priority of U.S. Provisional Patent Application Ser. No. 61/146,974 filed Jan. 23, 2009, which is incorporated herein by reference. 
    
    
     FIELD OF THE INVENTION 
     This invention relates to an instrument for use in the practice of laparoscopic surgery and more particularly to such a device which has utility in forming an incision, insufflating the underlying body cavity and suturing the incision at the completion of the surgery. 
     BACKGROUND OF THE INVENTION 
     In the practice of minimally invasive laparoscopic surgery it is common to make a small incision through the skin and underlying tissue of the patient adjacent the internal surgical site using a Veress needle. These needles include a tubular outer cannula with a sharpened distal end and an inner hollow cylindrical needle which terminates in a blunt end. A spring assembly urges the needle to a position in which the blunt end of the needle is extended beyond the cutting edge of the cannula. When the instrument is pressed against the skin of the patient the blunt end is resisted by the skin so that the outer cannula moves over the blunt end and forms a small incision in the skin and underlying tissue of the patient. When the pressure on the Veress needle is removed, the needle slides forward, leaving a blunt end within the body of the patient, so that the accidental cutting of underlying organs is avoided. 
     The Veress needle typically includes means for introducing pressurized gas, usually CO 2 , into the proximal end of the needle so that the gas is passed on into the laparoscopic incision and inflates the body cavity to allow easy access to the surgical site. A trocar which surrounds the cannula and frames the proximal side of the incision may be left in place after the cannula is withdrawn to provide an instrument port with a seal to prevent the escape of the insufflating gas. 
     After formation of a first incision and insufflation of the body cavity, a second incision, nearby but spaced apart from the first incision, is formed and typically used for insertion of a remote imaging endoscope to allow the surgeon to visualize the internal surgical site. A third incision allows the insertion of an operating instrument. 
     When the surgery is completed it is necessary to suture one or more of the laparoscopic incisions. Suturing typically involves an instrument that can carry a suture thread into the body cavity and allow the thread to be pulled outwardly through the incision. At the proximal side of the surgical site two ends of the suture are knotted together to secure the incision. 
     One problem associated with the use of such Veress needle assemblies is determining when the needle has progressed through the wall of the body cavity and its distal end has emerged within the cavity. Additionally, there is a need to determine the location of significant blood vessels in the cavity wall so that the incision made by the needle, as well as the additional incisions necessary to perform the surgery, can be made without cutting these vessels. 
     SUMMARY OF THE INVENTION 
     A first embodiment of the invention, which will subsequently be disclosed in detail, comprises a Veress needle in which the central tube or the rod of the needle supports a grasper at its distal end comprising a pair of pivoted forceps jaws which are normally retained in a closed position by a spring, but may be opened by manual pressure applied to a button at the proximal end of the needle. By opening the jaws, positioning them about a suture line, and depressing the button again, to cause the jaws to clamp on the suture line, a suture may be secured and one end of the suture may be carried externally of the incision by withdrawing the needle. 
     In another embodiment of the present invention the distal end of the central tube of the Veress needle terminates in a “crochet hook” end facing the proximal end of the needle. The instrument and the suture may be manipulated so that the suture is caught within the hook and drawn out of the incision when the Veress needle is removed. The distal end also has a needle hole through which a suture thread may be passed to carry it into the body cavity. 
     The preferred embodiment of the invention includes a cam mechanism supported at the proximal end of the instrument which allows the two jaws which make up the hook to be disposed in either an open position, in which the jaws are separated, or a closed position in which the jaws are closed, or closed about a suture. The mechanism includes a button at the proximal end of the instrument which may be depressed to move the hook between its opened and closed positions. With each depression, the hook is moved between its open and closed positions and remains in that state until the button is again depressed, moving the jaws to the other position. This allows a surgeon to manipulate the present instrument with a single hand. 
     Another aspect of the present invention, illustrated in connection with another embodiment of the invention, comprises an illuminating system for incorporation in a Veress needle assembly which allows the surgeon to visualize the progress of the trocar in forming a laparoscopic incision; aids in the visualization of major blood vessels in the incision area; and, in certain embodiments, provides illumination of the insufflated body cavity to aid in endoscopic visualization of the cavity. These illuminating systems can be incorporated in conventional Veress needle devices as well as the version incorporating the suturing capability. 
     The illumination system typically employs a bright, small, illumination source such as an LED, although a conventional laser separated from the needle may provide the illumination through an optical fiber. The LED may be located at the proximal end of the Veress needle and cooperate with a hollow tube of a light-conducting plastic such as Lucite, which may form part of the outer cannula, having an appended sharpened end formed of either metal or the tube plastic at its distal end. 
     In still another embodiment the light source could be located adjacent to the distal end of the cannula and powered by electrical leads passing through the cannula from the proximal end. 
     The illumination at the distal end of the needle allows the position of the distal end to be visualized by the surgeon through the translucent body tissues. That is, the light from the distal end will pass through the body tissues and allow the surgeon to observe the distal tip of the trocar to determine when it clears the inner wall of the body cavity. It will also aid in identification of major blood vessels which might interfere with the formation of additional incisions required for laparoscopic surgery. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Other objects, advantages and applications of the present invention will be made apparent by the following detailed description. The description makes reference to the accompany drawings in which: 
         FIG. 1  is a cross-sectional view through a preferred embodiment of the instrument, with the suture engaging jaws in an open position; 
         FIG. 1A  is a cross-sectional view along line  1 A of  FIG. 1  illustrating the hook opening and closing mechanism; 
         FIG. 2  is a cross-sectional view of the device of  FIG. 1  with the end hook in a closed position; 
         FIG. 2A  is a cross-sectional view through the device of  FIG. 2  along line  2 A, again illustrating the hook unlocking and opening mechanism; 
         FIG. 3  is a cross-sectional view of the device constituting a preferred embodiment of the invention, illustrating its operation as a Veress needle forming an incision through a body cavity; 
         FIG. 4  is a side view of the preferred embodiment of the instrument showing it penetrating wall of a body cavity; 
         FIG. 5  is a side view of the instrument of the present invention showing it grasping a suture; 
         FIG. 6  is a perspective, partially broken-away view of the end hook opening and closing mechanism; 
         FIG. 7  is an exploded perspective view of the hook-actuating mechanism; 
         FIG. 8  is a side view, partially broken away, of an alternative embodiment of the invention, comprising an LED positioned at the proximal end; and 
         FIG. 9  is a side view, partially broken away, of an embodiment of the invention comprising an LED positioned at the distal end. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
     A preferred embodiment of the invention, illustrated in  FIGS. 1 and 2 , acts as a Veress needle to form an incision into a body cavity, as an insufflator to inject gas into the cavity, and as a suture manipulator to close up the incisions made during the endoscopic process. 
     The instrument, generally indicated at  10 , has a handle  12  at the proximal end, which supports one end of the Veress needle, constituting an elongated cannula tube  14  with a sharpened trocar  16  at the distal end. A tubular needle having a diameter complementary to the diameter of the cannula  14  is supported within the cannula. 
     The distal end of the needle  18  carries one fixed jaw  20  of a suture engaging jaw set. The other jaw member  22  is pivotably connected to the jaw  20  at pivot point  24 . A lever arm  26  formed on the jaw  22  connects to one end of a rod  28  which passes through the center of the needle with its proximal end terminating in the handle area  12  at an extension and retraction mechanism which will be subsequently described. When the mechanism extends the rod  28 , the jaw  22  moves into a closed position with respect to the jaw  20 , as is illustrated in  FIG. 2 . When the mechanism retracts the rod  28 , the jaws are opened as shown in  FIG. 1 . 
     The ends of the jaws  20  and  22  are rounded and blunt. The needle  18  is biased toward the distal end of the cannula  14  by a spring  21  supported in the handle area  12  so that the hook formed by the sections  20  and  22  projects out of the distal end of the cannula. When the instrument  10  is pressed against a wall  32  of a body cavity, in the manner illustrated in  FIG. 3  or  FIG. 4 , and the hook ends are closed, they are forced upwardly against the spring  21  by the contact with the surface of the cavity  32 . Thus the sharpened trocar end  16  is forced downwardly beyond the jaws and forms an incision in the body wall  32 , in the manner illustrated in  FIG. 4 . 
     The body cavity  34  may then be insufflated by gas, preferably CO 2 , passed through a valve  38  into the interior of the central needle, through the needle, and out the distal end. 
     The position of the rod  28 , which moves the hook between the open and closed positions, is controlled by an extension-retraction mechanism located within the handle  12 . A button  42  at the proximal end of the instrument may be depressed by the thumb of the surgeon while two fingers are engaged around the wings  44  of the instrument. The button is normally biased toward extension by a spring  46 . The mechanism, which is of the type illustrated in U.S. Pat. No. 4,991,998, the contents of which are hereby incorporated for reference, includes a plunger  50  having an extension  52  at its top end. The plunger moves within a central bore  54  formed in the handle member  12 . The opposite end of the plunger  50  includes six laterally extending guides  56  which interact with rails  58  formed on the interior of the cavity  54 . The interaction between the guides  56  and the rails  58  restrains the plunger toward longitudinal, non-rotational movement within the handle cavity  54 . 
     A ratchet  60  has a hub  62  from which three guides  64  extend radially. The ratchet  60  has a stem portion  66  which fits within a central void  68  in the plunger  50 . Tapered teeth on the upper sides of the three guides  64  engage tapered surfaces on the lower ends of the teeth  58 . Thus, when ratchet  60  is inserted into the bore  68  of the plunger  50 , the tapered teeth of the plunger and of the ratchet will engage each other and align the parts. 
     The design of the teeth on the plunger  50 , the ratchet  60 , and the mechanism on the interior of the interior bore  54  and handle member  12  cause the ratchet  60  to rotate slightly when released from the teeth  58  upon depression of the pushbutton  42  against the upper surface of the plunger  50  and to rotate again when the pushbutton is released so that the teeth  64  engage the teeth  58 . The ratchet teeth alternately move from a first position on the teeth  58  into a second position where the teeth  64  slide into the slots between the teeth  58 . The ratchet rotates slightly when depressed by the plunger  50  and again on the teeth  58  when the plunger is withdrawn, causing a circular movement that permits the rod  28  to be extended and retracted, thus closing and opening the jaws  20  and  22  and retaining them in that position until the next depression of the pushbutton  42 . 
     Another embodiment of the invention is illustrated in  FIG. 8 . This version provides a light source at the lower end of a clear polymer rod or tube  80 , which extends within a stainless steel hollow tube  82  with a sharp tip  84  on its distal end. A spring  86  biases the interior rod  80  into a position in which its distal end extends outwardly from the tip  84 , as illustrated in  FIG. 8 . Again, when the rounded end of the fiber optic tube  80  is pressed against the body cavity, the tube  80  retracts against the spring and allows the sharp tip to cut into a body cavity and reach an operating site. 
     The tip of the polymer rod  80  is formed with a hook “crochet needle” notch  90 , which is adapted to catch a suture and allow it to be withdrawn from the body cavity, as well as a needle hole  91  for carrying a suture into the body cavity. 
     An illumination source  92 , preferably taking the form of an LED, is disposed in the proximal end of the instrument within a housing  94 . 
     A battery  96  is also supported in the housing and is connected by leads  98  to the LED  92  through an on-off switch  99 . The light from the LED is gathered by a surface  100  and transmitted through the polymer rod  80 . The distal end of the rod is polished to produce a light output at that end. The housing  94  is equipped with a gas intake tube  102  and a gas valve  104  to allow the insufflation of a body cavity after penetration by the tube  82 . 
     As the surgeon penetrates the body cavity with the device, the polished tip of the rod  80  will provide illumination that is visible through the translucent walls of the cavity, indicating to the surgeon the location of the tip. The surgeon can use that to determine when the device has penetrated into the body cavity and also to identify any major arteries in the cavity wall which should be avoided in the formation of additional laparoscopic openings. 
       FIG. 9  shows still another embodiment of the invention, generally similar to the device of  FIG. 8 , with the exception of the fact that the LED  110  is located on the distal tip of the rod  80  and is powered through conductors  112  from a battery  114  supported at the proximal end. 
     In alternate embodiments of the invention, not shown, a laser of some form other than an LED can be disposed externally of the laparoscopic instrument and the illumination source can be provided by a fiber optic leading from that laser to the desired location of the illumination source.