Patent Abstract:
A surgical device and method for the retracting, maneuvering, and re-positioning of tissue and/or a body organ during endoscopic and laparoscopic procedures. The surgical apparatus comprises at least one separable grasping device with a detachable head, and an exteriorly-operated handle mechanism, or puppet handle. The disclosed device enables a physician, using a plurality of lengths of sutures simultaneously connected to (a) stems of the exteriorly exposed puppet handle and (b) the detachable head, positioned at clasping points on the organ, to rearrange the orientation of tissue or the organ for better accessibility, analysis, and/or exposure to accompanying surgical instruments in situ. The method presented minimizes the number of bodily incisions required to perform surgery by means of endoscope or laparoscopic equipment.

Full Description:
CROSS-REFERENCES TO RELATED APPLICATIONS 
     This is a Continuation application which claims the benefit of priority from U.S. non-provisional application Ser. No. 12/804,685, filed on Jul. 26, 2010, and said non-provisional application being incorporated herein by reference. This application further claims priority from U.S. Provisional Application, Ser. No. 61/271,842, filed on Jul. 27, 2009, said provisional application being incorporated herein by reference. 
    
    
     FEDERALLY-SPONSORED RESEARCH &amp; DEVELOPMENT 
     There is no federally sponsored research or development in connection with this inventive concept. 
     NAMES OF THE PARTIES TO A JOINT RESEARCH AGREEMENT 
     There is no joint research agreement applicable to this inventive concept. 
     BACKGROUND OF THE INVENTION 
     (1) Field of the Invention 
     The present inventive concept, among other uses and applications, primarily relates to an improved surgical instrument and a method which will enable a physician to perform laparoscopic or endoscopic surgery with a minimum amount of bodily incisions to a patient&#39;s body. The device under consideration is an improvement on what is known in the medical profession as a grasper. 
     Graspers come in a wide of variety of functional designs, which are intended for specific purposes. Various types of graspers include tissue, claw, sharp tooth, endo-clinch, alligator, aggressive, cobra tooth, spoon, cup, babcock, DeBakey, and Allis graspers. 
     (2) Description of the Related Art 
     Graspers are used to clasp bodily tissue or an internal organ and, often to reposition the tissue or organ for better utilization of other instruments which may be required during a laparoscopic surgical process. The grasper is typically inserted into the abdominal cavity by means of insertion through the inner channel of a trocar, said trocar having been initially used to pierce the abdominal wall in the vicinity of the subject organ or tissue. Usually, a second trocar is also required as a means of inserting other surgical instruments to perform operations on the organ or tissue being held by the grasper. 
     Over the years, various surgical instruments and complex trocar designs have been devised to perform separate multiple functions during laparoscopic surgery. A recent patent, U.S. Pat. No. 7,318,802 (Suzuki, 2008), discloses a combination of an endoscope and a grasping, device which, when used together, are suited for operationally treating gastro esophageal reflux disease. The grasping device is specially designed for holding tissue formed at the junction the stomach and esophagus. 
     U.S. patent application publication #2005/0149066 (Stafford, 2005) presents a device for laparoscopally suturing tissue, comprising an elongated shall which, upon being inserted through the abdominal wall, deploys two mechanical arms, each arm having a means of receiving a needle and its respective suture. 
     U.S. patent application publication #2009/0062816 (Weber, 2009), discloses an apparatus comprising a manually operated handle attached to the proximal end of a lengthy shaft. The handle further comprises two separate mechanical operating devices, one being attached to a pair of grasping jaws at the distal end of the shaft and the other device serving to advance suture to two needles, also at the distal end of the shaft. The handle may mechanically advance the suture. 
     U.S. patent application publication #2007/0123914 (Lizardi et al, 2007) presents a needle passer instrument which has a needle engaging cartridge in the upper jaw and a surgical needle with attached suture mounted in the lower jaw. A needle actuation rod engages the surgical needle and pushes the needle through tissue contained between the jaws of the device. 
     BRIEF SUMMARY OF THE INVENTION 
     The present inventive concept, among other uses and applications, relates to an apparatus and method by which a physician may perform laparoscopic or endoscopic surgery within the abdominal cavity of a patient. The device gives the physician/surgeon a unique capability to reposition a body organ or tissue during the surgical procedure. An important object of the disclosed apparatus and method is to minimize the number of incisions and/or trocar placements into the abdominal wall during the course of a surgical procedure, while providing enhanced tissue positioning and retraction capability to the physician. 
     The primary components of the apparatus include a detachable grasping device comprising a detachable head, a grasper handle removably fixed to the detachable head, at least two needles on suture, which needles may be removably attached to the detachable head, and a storage handle, referred to as a “puppet handle,” said handle maintained exteriorly to the abdominal wall. The detachable head may be separated from the grasper handle either exteriorly to the patient or after insertion into a patient proximate the actual operation situs. 
     Initiation of the surgical process is begun with the placement of a trocar through the abdominal wall of the patient. The grasping device is inserted through the channel of the trocar and positioned proximate the organ or tissue to be operated upon. For illustrative and ease of reference purposes only, the object of the surgical manipulations may be interchangeably referred to as “organ” or “tissue.” Once the tissue is grasped by the detachable head of the grasping device, the grasper handle is removed from the detachable head. A secondary grasper is then inserted through the trocar for the purpose of removing the first of the two needles on suture from its retention means on the detachable head. The respective suture remains within its retention mechanism on the detachable head. The secondary grasper is then manipulated to a desired location or exit point on the interior of the abdominal wall, at which exit point the first needle and suture is impelled outwardly through the abdominal wall. 
     The foregoing procedure is repeated with the second needle and suture. Once outside the abdominal wall, the two needles and sutures are inserted into opposite ends of the puppet handle. The storage handle then becomes the means by which the operator may retract or reposition the organ as required for better vision and assessment during the surgical procedure. The puppet/storage handle may move either of the two stored needles/sutures, thereby directly re-positioning the organ at the point where the detachable head is grasping the tissue. 
     The reader is advised that, for the sake of convenience and clarity, the operation of this device has been described primarily with respect to the human body. However, the inventive concept is also suitable for use by veterinarians and other professionals where anatomical procedures internal to a vertebrate body are necessary. Therefore, the descriptions rendered herein are not considered to be restrictive or limiting of the operation of the device. 
    
    
     
       BRIEF DESCRIPTION OF THE VIEWS OF THE DRAWINGS 
       A more thorough understanding of the present invention and fabrication system may be had by reference to the drawings herein, of which a brief summation of each drawing follows: 
         FIG. 1  is an overall view of the general positioning, functions, and maneuvering methods utilized with the basic inventive concept. 
         FIG. 2  depicts a stylized concept of a universal grasper device with a detachable head, the device also referred to as a separable grasping device 
         FIG. 3  illustrates a partial cutaway view of an embodiment of the distal end of a separable grasping device and the detachable grasper head. 
         FIG. 3   a  depicts the proximal end of a separable grasping device, its grasper head detaching means, and its jaws locking means. 
         FIG. 4  presents the open position of the grasper jaws of an embodiment of the detachable head. 
         FIG. 4   a  and  FIG. 4   b  combined illustrate the clutch and clutch housing of a particular embodiment of detaching means of a separable grasping device. 
         FIG. 4   c  depicts the union of the clutch and clutch housing of an embodiment of the separable grasping device. 
         FIG. 5  illustrates a cutaway view of the threaded locking rod, which enables operation of the jaws of an embodiment of a detachable grasper head. 
         FIG. 5   a  presents an end view looking interiorly at the clutch of an embodiment of the separable grasping device. 
         FIG. 5   b  presents a view of the clutch housing. 
         FIG. 6  depicts the method of positioning of two detachable heads onto a bodily organ during a surgical procedure. 
         FIG. 7  is a plan view illustration of an embodiment of a dual puppet handle, as seen from the perspective of the physician holding the instrument. 
         FIG. 7A  is a left (or right) side end view of the dual puppet handle, of  FIG. 7 , above. 
         FIG. 8  illustrates a triple-stem puppet handle. 
         FIG. 9  depicts the stowage of a separable grasper handle onto the upper surface of a dual puppet handle. 
         FIGS. 10   a  through  10   c  present a different embodiment of the separable grasper device wherein the internal operating mechanism is two interconnecting drive shafts. 
     
    
    
     
       
         
               
             
               
               
             
           
               
                   
               
               
                 Numerical Index to Nomenclature of Invention 
               
               
                   
               
             
             
               
                   
               
             
          
           
               
                  1. 
                 Separable grasping device 
               
               
                  2. 
                 Grasping handle 
               
               
                  3. 
                 (a) Grasping handle proximal end 
               
               
                   
                 (b) Grasping handle distal end 
               
               
                  4. 
                 Endoscope 
               
               
                  5. 
                 Detachable head 
               
               
                   
                 (a) Second detachable head 
               
               
                  6. 
                 Upper jaw 
               
               
                  7. 
                 Lower jaw 
               
               
                  8. 
                 Jaws locking means 
               
               
                   
                 (a) Jaws locking mechanism 
               
               
                   
                 (b) Locking rod control 
               
               
                  9. 
                 Head detaching means 
               
               
                   
                 9(a) Head detaching mechanism 
               
               
                 10. 
                 Upper jaw motion linkage 
               
               
                 11. 
                 Lower jaw motion linkage 
               
               
                 12. 
                 Needle one fastening means 
               
               
                 13. 
                 Needle two fastening means 
               
               
                 14. 
                 Needle one 
               
               
                 15. 
                 Needle two 
               
               
                 16. 
                 Suture one 
               
               
                 17. 
                 Suture two 
               
               
                 18. 
                 Suture one harnessing means 
               
               
                 19. 
                 Suture two harnessing means 
               
               
                 20. 
                 Dual puppet handle 
               
               
                   
                 (a) Left handle stem 
               
               
                   
                 (b) Right handle stem 
               
               
                   
                 (c) Extra handle stem 
               
               
                 21. 
                 Triple-stem puppet handle 
               
               
                 22. 
                 Multiple-stemmed puppet handle 
               
               
                 23. 
                 Puppet handle connector means 
               
               
                 24. 
                 Exit point one 
               
               
                 25. 
                 Exit point two 
               
               
                   
                 (a) Exit point three 
               
               
                 26. 
                 Secondary grasping device 
               
               
                 27. 
                 Inner abdominal wall 
               
               
                 28. 
                 Outer abdominal wall 
               
               
                 29. 
                 Body organ 
               
               
                 30. 
                 n/a 
               
               
                 31. 
                 Needle three 
               
               
                 32. 
                 Needle four 
               
               
                 33. 
                 Third Suture 
               
               
                 34. 
                 Fourth Suture 
               
               
                 35. 
                 Working port 
               
               
                 36. 
                 Needle driver 
               
               
                 37. 
                 Compressible material 
               
               
                 38. 
                 Universal grasper device 
               
               
                 39. 
                 Release mechanism 
               
               
                 40. 
                 Needle one retainer 
               
               
                 41. 
                 Needle two retainer 
               
               
                 42. 
                 Pins: a), b), c), d) 
               
               
                 41.-49, 
                 n/a 
               
               
                 50. 
                 Square drive shaft (hollow) 
               
               
                 51. 
                 Driven shaft (square) 
               
               
                 52. 
                 Sleeve 
               
               
                 53. 
                 Circumferential groove 
               
               
                 54. 
                 Spring-loaded ball 
               
               
                 55. 
                 U-joint 
               
               
                 56. 
                 Locking ring 
               
               
                 57. 
                 Control wheel 
               
               
                 58. 
                 Gripping handle 
               
               
                 59. 
                 Grasper head housing 
               
               
                 60. 
                 Housing for detachable head 
               
               
                   
                 (a) Stator 
               
               
                 61. 
                 Threaded receptor 
               
               
                 61  
                 (a) Spring-loaded ball 
               
               
                   
                 (b) Recessed seat 
               
               
                 62. 
                 n/a 
               
               
                 63. 
                 Clutch 
               
               
                 63. 
                 (b) Clutch housing 
               
               
                 64. 
                 Threaded locking rod 
               
               
                 65. 
                 Handle shaft 
               
               
                   
               
             
          
         
       
     
     DETAILED DESCRIPTION OF THE INVENTION 
     The description of this inventive concept will begin with reference to  FIG. 1 , where it can be seen that the general objective of the inventive concept is to attach the distal ends of suture one  16  and suture two  17  to the surgical object, which for illustrative and descriptive purposes only, will be assumed to be a body organ  29 , by means of a detachable grasper head  5 . The proximal ends of the sutures  16 ,  17 , having been attached to needles  14 ,  15 , are removed from the abdominal cavity by piercing, from inside to outside, the abdominal wall  28 . For the sake of convenience and easy reference, said needles  14  and  15  shall be referred to as Keith needles, although any other surgical needle suitable for the purposes herein may also function in this inventive concept. 
     Exterior to the patient&#39;s body, the Keith needles  14 ,  15  are then inserted into the respective stems  20   a ,  20   b  or ends of a dual- or multiple-tube storage handle, referred to as a “puppet handle”  20 . The stems  20   a ,  20   b  of the puppet handles presented may be constructed with a variety of means for retention of the abdominally exiting needles,  14 ,  15 . As shown in  FIGS. 7 and 7A , the preferred embodiment comprises a compressible material  37  firmly compacted into the interior of each stem  20   a ,  20   b  to securely retain the needles  14 ,  15  after exiting the abdominal cavity  28  The dual puppet handle  20  may then be manipulated by the physician, at a variety of gentle pulling angles, to retract or reposition the body organ  29 . An elementary puppet handle  20  is illustrated in  FIG. 1 ,  FIG. 7 , and  FIG. 9 . A multiple-stem puppet handle  21  is shown in  FIG. 8 . 
     Any surgical procedure requiring piercing of a patient&#39;s abdominal cavity may be initiated by the placement of an initial trocar device through the outer and inner abdominal walls  28 ,  27 , respectively. The penetration point of the initial trocar becomes the working port  35  for the surgery. Utilizing the initial trocar, an endoscope  4  may be inserted into the channel of the trocar or through the working port  35  created by the initial trocar. The endoscope  4  is then maneuvered to position the instrument proximate the body organ  29  which is the subject of the surgical procedure. The trocar may need to be gradually pressed to a greater depth, since immediately afterwards, the separable grasping device  1  is inserted, parallel to the tube of the endoscope  4 , through the channel of the initial trocar or through the working port  35 . 
     By turning the attention to  FIG. 6 , it is observed that greater capability for surgical adaptation is provided, with the insertion of a second detachable head  5   a  attached to a different location on the body organ  29 . Thus, the physician may make more accurate, or differently-oriented, placements of the body organ  29  for better access. The second detachable head  5   a  may be manipulated via its own third suture  33 , which will likely be affixed to a third stem of the puppet handle  21  (as depicted in  FIG. 8 ). Either or both the primary detachable head  5  or the second detachable head  5   a  may be constructed with wing clamps so as to remove the detachable heads  5 ,  5   a , as necessary. 
       FIG. 2  depicts a general drawing of a generic universal grasper device  38  which is typical of embodiments of the inventive concept. The device may operate by several differing combinations of means for, and methods of connection. Once the device  38  is inserted through the initial trocar, the grasper&#39;s upper jaw  6  and lower jaw  7  are placed at the desired site on the subject tissue or body organ  29 . The jaws  6 ,  7  must comprise non-traumatic teeth or Babcock type heads. Upper jaw  6  and lower jaw  7  motion control means  10 ,  11  are then operated through a connective means to gently close the grasper&#39;s upper jaw  6  and lower jaw  7  at the selected location. A jaws locking means  8  may be operated, through a jaws locking mechanism  8   a , to securely attach the grasper head  5  to the body organ  29 . The jaws locking means  8  may be an industry-common slide lock ratchet system, a rotary-type mechanism, or other means of securing the jaws  6 ,  7  of the grasper in a locked position. 
     Generally, the detachable grasper head  5  can be separated from its grasping handle  2  by a head detaching mechanism  9   a  which transmits control inputs through linkage to a head detaching means  9 . At the time of separation, the needle one retainer  40  and needle two retainer  41  are also activated so as to release needle one  14  and needle two  15 . Suture-harnessing means  18 ,  19  hold the respective sutures for needle one  14  and needle two  15 . The suture-harnessing means  18 ,  19  may be small eyelets or hook-type retainers with inner diameters somewhat larger than the gauge of suture utilized. The two needles remain close to the grasper head  5  for the ensuing capture by a needle driver which is used to execute a piercing-type exit of each needle  14 ,  15  and its respective suture through the abdominal wall  28 . 
     In turning the attention to a different embodiment,  FIG. 3  and  FIG. 3   a  show a separable grasping device  1  which is observed to be a combination of a grasping handle  2 , disconnected from its detachable grasper head  5 . The detachable grasper head  5  further comprises an upper jaw  6 , lower jaw  7 , an upper jaw motion linkage  10 , a lower jaw motion linkage  11 , a threaded receptor  61 , and a head detaching means  9 . In viewing  FIGS. 3 and 3   a , another embodiment of the inventive concept depicts a jaws locking means accomplished by a threaded locking rod  64 , handle shaft  65 , a locking, rod control  8   b , and two suture harnessing means  18 ,  19 . Provisions may also be made for needle retention mechanisms proximate, or on, the detachable grasper head  5 . 
     At the proximal end of the separable grasping device  1 , as shown in  FIG. 3 , the upper and lower jaw motion control linkages  10 ,  11  are operated by the threaded locking rod  64  so as to open the upper and lower jaws  6 ,  7  of the detachable head  5 . While viewing the operational site through a laparoscope  4 , the upper and lower jaws  6 ,  7 , being in the closed position, are maneuvered into a desired location adjacent to a body organ  29 . The jaws are thereupon opened and then closed upon the organ  29 . Appropriately placed pins  42   a - d , connecting the threaded locking rod  64  and the upper and lower jaw motion linkages  10  and  11  effectuate the opening and closing of both jaws  6 ,  7 . 
     A dual-component threaded receptor  61  consisting of a clutch  63  having internally-embedded spring-loaded balls  61   a , is integral to the grasping handle  2 . The threaded receptor  61  further comprises a coaxial fitting having recessed seats  61   b  corresponding to the circumference of the spring-loaded bails  61   a . A handle shaft  65  culminates in a threaded locking rod  64 . The threads of the locking rod  64  engage compatible threads on the interior surface of a stator  60   a . The stator  60   a  is permanently affixed to a detachable head housing  60 . 
     The threaded receptor  61 , comprising a spring-loaded ball  61 ( a ) and a recessed seat  61 ( b ), prevents further movement of the threaded locking rod  64  at certain rotated extensions of the locking rod control  8   b  and the handle shaft  65 , thereby locking the jaws  6 ,  7  and securely maintaining the body organ  29  within the grasp of the detachable head  5 . If necessary, a second separable grasping device  1 ( a ) may be inserted into the initial trocar with another detachable grasper head  5 ( a ), as shown in  FIG. 6 , and a separate length of a third suture  33  for additional retraction capability. 
     Referring to  FIG. 3   a , at the grasping handle proximal end the head detaching means  9  is activated to disengage the spring-loaded balls  61 ( a ) from their respective recessed seats  61 ( b ), thereby separating the detachable head  5  from the grasping handle  2 . The grasping handle  2  is then removed from the initial trocar and placed in temporary storage within the puppet handle  20  connector means  23 . Suture one  16  and suture two  17 , being previously attached to needle one  14  and needle two  15 , are now prepared for being drawn through suture one harnessing means  18  and suture two harnessing means  19 , respectively. To accomplish this, a specialized grasper or needle driver  36  is inserted into the channel of the initial trocar and maneuvered into position to grasp each needle  14 ,  15 , in sequence. Each needle is then positioned upward toward desired respective abdominal exit point one  24  and exit point two  25 , as illustrated in  FIG. 1 . 
     Again referring to  FIG. 1 , at the exterior of each exit point  24  and  25 , each of the two surgical needles  14 ,  15 , along with their respective sutures  16 ,  17 , are pulled through the outer abdominal wall  28 . The needles  14 ,  15  are then firmly pushed into the compressible material  37  compacted into the respective stems  20 ( a ), ( b ) of the dual puppet handle  20 . After completion of extraction of the needles, the needle driver  36  is then withdrawn upwards through the initial trocar and properly stored. At this point, the operator may place other surgical instruments into the immediate vicinity of the body organ  29 . The respective exteriorly-exposed sutures  16 ,  17  are secured at the dual puppet handle  20  so as to enable a physician, with reference to the endoscope  4  previously inserted, to position and/or retract the body organ  29  as necessary, by well-planned incremental movements of the puppet handle  20 . 
       FIG. 9  demonstrates the manner in which the handle  2  of the separable grasping device  1  is attached for storage to the upper surface of a dual puppet handle  20  while the associated detachable head  5  is in use during the surgical procedure. 
       FIGS. 10   a  through  10   c  illustrate the basic workings of another embodiment of the inventive concept.  FIG. 10   a  depicts an embodiment of the detachable head  5  of a separable grasping device with the upper and lower jaws  6 ,  7  in the closed position. Internal to the detachable head  5 , and coaxially centered with the detachable head  5 , is a driven shaft  51  of square cross-section which, when rotated clockwise along its axis, expands or contracts a tensionally-loaded locking ring  56 . The locking ring  56 , comprised of at least one winding, is affixed at one of its ends to a grasper head housing  59 , and at its opposite end to the driven shaft  51 .  FIG. 10   a  shows the locking ring  56  having been expanded to near its limit, thereby causing the upper and lower jaws  6 ,  7  to close.  FIG. 10   c  depicts the locking ring  56  having been tensionally released by reason of the driven shah  51  having been rotated in the counter-clockwise direction, thereby allowing the upper and lower jaws  6 ,  7  to open. 
     In  FIG. 10   b , the handle  2  of a separable grasping device is seen to comprise a longitudinal sleeve  52 , which expands at its distal end into a circular u-joint  55 . The u-joint  55  contains integral spring-loaded balls  54  symmetrically spaced around the inner perimeter of the u-joint  55 . Contained within the sleeve  52  is a drive shaft  50 , comprising a hollow, square cross-section which runs from the distal end of the sleeve  52  to its juncture, at the proximal end of the sleeve  52 , with a control wheel  57 . The hollow drive shaft  50  is of precise inner cross-sectional dimensions so as to allow a snug fit over the outer walls of the driven shaft  51 . In this manner, when the detachable head  5  and the handle  2  are conjoined via the u-joint  55  and the groove  53  of the detachable head  5 , the drive shaft  50 , by means of the control wheel  57 , can incrementally turn the driven shaft  51 . 
     Also connected at the proximal end of the handle  2  is a gripping handle  58  which, by longitudinal connection means, operates to release the spring-loaded balls  53  from the circumferential groove  53 , thereby disengaging the detachable head  5 . 
     Variations of Equipment and Methods 
     By the nature of the surgical procedures presented herein, it is evident that other variations of the devices and the methods may be utilized, according to the medical requirements of a particular surgical procedure. As an alternative structure or embodiment of the disclosed device, a quadruple stem, or larger, puppet handle may also be utilized. As shown in the accompanying  FIG. 8 , the abdominally exiting needles, needle one  14  and needle two  15  may be stored in a similar compressible material  37  as shown in the triple puppet handle  21 . To improve the versatility of operational use of the puppet handle, the stems may be joined at a common pivoting junction, serving to vary the relative angles between stems during surgery. 
     All embodiments of the puppet handles presented thus far may be constructed with a variety of means for retention of the abdominally exiting needles,  14 ,  15 , said means including, but not limited to, latching, clamping, grasping, hooking, constricting, and clutching. In other words, the compressible material  37  is not the sole means of securely retaining the abdominally exiting needles  14 ,  15  in, or proximate to, the stem of a particular puppet handle. 
     It is recognized that one knowledgeable in the medical industry and skilled in the art, has the capability to design or produce similar, or other embodiments of this inventive concept. However all such variations, alterations, or modifications are entirely conceivable as being within the intent and scope of the present inventive concept. In particular, the essence of the inventive concept is the utilization of at least two surgical graspers comprising a detachable grasper head containing at least one length of suture, combined with the method of performing surgical manipulations with sutures attached to said grasper head and controlled exteriorly of the abdominal wall. Any number of connections, disconnecting methods, operational linkages, functions, and combinations thereof may be used to effectuate the engagement and disengagement of the detachable grasper head from its handle component.

Technology Classification (CPC): 0