An Instrument for the Better Insertion of Sutures in certain Operations on the Intestinal Canal.
Year: 1892

page_text: Date of Application, 6th Apr., 1892
Complete Specification Left, 6th Jan., 1893-Accepted, 18th Feb., 1893
PROVISIONAL SPECIFICATION.
An Instrument for the Better Insertion of Sutures in certain
Operations on the Intestinal Canal.
ROBERT BLAKE MCVITTIE Junior 43 Harcourt Street, Dublin, Ireland, Doctor
of Medicine and Surgeon, do hereby declare the nature of this invention to be as
follows:-
To construct an instrument probably in the form of a tube which will contain in
suitable grooves a number of needles, ready prepared and threaded which can be
inserted in their proper places either simultaneously or in groups whereby much
greater accuracy of position and saving of time may be attained than has hitherto
been deemed possible.
The great objections to this class of operations have always been 1st that the
insertion of the sutures individually necessitates the patient being kept under the
anæsthetic for an unduly long time and 2nd that from the nature of the parts it
frequently is impossible by mere manual dexterity to insert the needles accurately
and hence leakage into the peritoneaum or irregular union results.
Experiments are however necessary to decide upon the most convenient form of
instrument and it is for these experiments and that models may be made that
protection is now sought.
Anil 1002
ROBT. B. MC VITTIE, JNR., M.D.,
43, Harcourt Street, Dublin.
COMPLETE SPECIFICATION.
An Instrument for the Better Insertion of Sutures in certain
Operations on the Intestinal Canal.
I, ROBERT BLAKE MCVITTIE Junior, of 43 Harcourt Street, Dublin, M.D. do
hereby declare the nature of this invention and in what manner the same is to be
performed, to be particularly described and ascertained in and by the following
statement:—
This instrument consists of the following parts, first, a suitable tube fitted with
a piston, the lower end of the tube terminating in a bell which receives a cone
provided with a number of radial grooves for the purpose of receiving curved
needles as hereinafter more fully described.
The bell is formed of two separate parts which are held together by means of a
collar, and steadying pins, which latter also serve the purpose of securing the bell
to the cone.
The piston tube is attached to the bell by a shallow screw.
The accompanying drawings will enable my said invention to be more readily
understood and carried into practice :-
-
Fig. 1, represents the instrument complete ;
Fig. 2, a longitudinal section of same;
Fig. 3, the piston; and
Fig. 4, detail parts as hereinafter more fully described.
a, is the tube in which works the piston b, provided with a shoulder 6', which
comes in contact with the ends of the curved needles as presently described;
c, c, are the two segments of the bell which when in position are held together by
the collar d, into which latter the tube is screwed; e, is the cone provided with the
curved grooves and steadying pins referred to.

page_text: The manner in which the instrument is used is as follows:-The curved needles
having been threaded are placed in the curved radial grooves in the upper part of
the cone, in which they are retained by the bell, the sutures passing out through
the slots f, in the upper part of the bell.
The free ends of the sutures are now threaded in a corresponding set of needles,
similarly arranged in a duplicate instrument to that which we are describing ; care
being taken to prevent tangling of the threads by grouping them round the lower
end of the tube where they are retained by an elastic band.
The cone of the instrument is now passed into the cut end of the bowel and the
particular coat through which the operator desires to pass the suture is taken up
with an ordinary forceps, and hooked upon the projecting point of each needle in
succession, until the whole circumference of the bowel has been dealt with.
The claws g, g, hinged on the bell are now closed down to prevent the bowel
slipping, whereupon a little pressure of the piston will cause its shoulder b¹ to come
in contact with the ends of the needles, driving them through the coats of the
bowel, sufficiently for the sutures to be drawn through, and the needles taken off.
The instrument is now taken to pieces by unscrewing the tube, the collar is
then removed, and each segment of the bell disengaged, and finally the cone
withdrawn from the cut end of the bowel, leaving the sutures in their places.
The duplicate instrument above referred to is now used in a similar manner with
the remaining segment of the bowel, being careful to observe that a line marked
upon the outer surface of the bell is placed in apposition with the corresponding
part of the bowel which was in contact with a corresponding line on the first
instrument. The sutures are now inserted, and the instrument disengaged as in
the case of the first described instrument.
The objections to this class of operation hitherto have been, first, the difficulty
of placing the sutures accurately and correctly, some being passed through all the
coats of the bowel, and thus opening up a channel for septic matter to find its way
from the cavity of the bowel to the peritoneaum, while others have actually been
passed across the lumen of the gut, and again sutures are sometimes spaced so
irregularly that when drawn up and tied, puckering occurs rendering the escape of
the intestinal contents possible; secondly, the protracted time necessary to keep
the patient under an anesthetic, during the effort to manipulate a collapsed and
slippery bowel.
To meet some of these difficulties tubes and discs made of decalcified bone and
other substances have been used, but these are objectionable inasmuch as the
presence of any solid body in the intestine is resented and calculated to arouse
vigorous peristalsis which would in itself be very likely to tear open the fresh
wound with disastrous results.
By the use of my invention these objections are overcome; the positions of the
sutures is accurate, and it is rendered easy to pass them through the peritoneal,
and sub-peritoneal coats, without wounding the mucous, and also to fold in a portion
of the bowel after Lemberts method, thus making a good joint with greater
accuracy and rapidity than is possible in the case of passing each suture individually
by the hand.
Having now particularly described and ascertained the nature of my said inven-
tion and in what manner the saine is to be performed, I would have it understood
that what I claim is.
For the purpose of inserting sutures in certain operations on the intestinal canal,
the use and application of an instrument constructed, arranged and operating in
the manner substantially as herein described and set forth.
D
1
J. K. FAHIE & SON,
9, Westland Row, Dublin, Agents for Applicant.