US 2895478 A
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July 21, 1959 c. R. POST Y 2,895,478
SUTURE-TYING INSTRUMENT Filed March 18, 1954 2 Sheets-Sheet l INVENTOR. I'm Char/es Russell Past ATTUR/YEY July 21, 1959 c. R. POST 2,895,478
SUTURE-TYING INSTRUMENT Filed March 18, 1954 2 Sheets-Sheet 2 INVENTOR. fiar/es PusselPosf United States Patent C SUTURE-TYING INSTRUMENT Charles Russell Post, Andover, N .1. Application March 18, 1954, Serial No. 417,050
3 Claims. (Cl. 128-334) The invention here presented is a suture-tying instrument adapted to use by a surgeon for the placing of stitches or sutures after accidental injury or surgical intervention by which a loop is formed behind a withdrawable pin and the needle end of the suture thread passed either once or twice through the loop, according to the material used, whereafter the knot is pushed up closely against the tissues by pushing the instrument down against the tissues and simultaneously pulling on theneedle end of the suture thread to produce a tight, non-opening knot in the suture close to the tissues but without undue tension tending to pull the knot through the tissues.
In any surgery it is of the essence that the incisions shall be closed and held closed by stitches, and a wide variety of materials is offered to the surgeon for use as suture threads, including gut threads, silk threads, cotton threads, and many other filaments. Usually the needle is swaged onto the end of the suture thread so that there is always but a single thread, without doubling, and-usually the needle is curved or bent. In using this device, a sizeable or substantial knot is thrown on the free end of the thread, by making a loop and passing the end once or twice through the loop, cutting ofif the excess thread beyond the knot. The needle may then be passed through the tissues which are to be held together, drawing the knot on the free end of the thread up to the tissues, but the forming of the second knot, close to the tissue surface but without undue tension on the tissues, is much more difiicult, so much so that the ability to tie a tight knot close to the tissues is the distinguishing characteristic between a skilled surgeon and an unskilled one.
Because of the difliculty of producing the second knot with proper tension, most surgeons, especially the relatively inexperienced ones, prefer to draw the ends of the thread together and form a square knot over the edges of the tissues to be joined. This, however, is only slightly less difiicult and a square knot can slip under even minor tension, especially when the thread is moist gut.
The present invention provides a simple tool for tieing the second knot when a single strand of thread is to be passed through the tissues and knotted at each end, in the use of which a loop is first formed manually in the soft, moist suture thread and the needle end, with or without the needle attached, passed once or twice through the loop, depending upon the thread material; then a removable pin on the end of a push-rod passing between jaws is inserted in the loop, positioned close to the tissues, and the thread pulled tight, reducing the loop to the size of the pin, whereupon the pin is moved slightly and tension maintained on the knot to draw it tight, necessarily very close to the tissues i t e p is ru ed d wn fi l against the iss es, t e kn t a e for ed tis l under the tissue surface, whereafter the encess thread is cut off leaving a tight, non-slipping knot close to or practically in the tissue surface.
By the device and process of the present invention, it is found possible to tie a knot deep in a Wound without the necessity of passing the surgeon's fingers into the wound,
2,895,478 Patented July 21, 1959 as a separate tool, or may readily be made a part of a needle holder as desired. The device is conveniently usable for the production of successive separate stitches,
. or a series of continuous stitches may be formed with knots on each side of each pass through the tissues. Also, the removable pin in the knotter may be withdrawn enough to be inserted within the loop of thread, but it usually is preferable to pass the needle behind the withdrawable pin, since the procedure is more certain in the hands of a surgeon and is closely similar to the procedure of passing the needle through the tissues and the similarity is helpful under the stress of surgical work. Other objects and details of the invention will be apparent from the following description when read in connection with the accompanying drawings, wherein:
Fig. 1 is a side view of the device incorporated in a pliers type of needle holder and shows the method of operation and the formation of loop and knot;
Fig. 2 shows the device applied to a standard type of needle holder;
Fig. 3 shows a tweezer type of knotter as a single, simple, instrument, independent of needle holders;
Fig. 4 is a diagrammatic showing of the formation of a two-pass knot;
Fig. 5 shows a diagrammatic representation of the formation of a single pass knot; and
Fig. 6 shows a modified form of a knotter and needle holder.
Referring to Figs. 1 and 2, the first form of knotter consists of a pair of plier type lever members 1v and 2 hinged on a pivot 3 with jaws 4 and 5 suitable for holding a needle. On one side of the jaw 5 there is provided a notched block 6 having a cut-out portion which forms a recess 7 with the plier jaw 5. A knotting lever 8 is provided and carried on a pivot 9 attached to the jaw 5. A spring member 11 is likewise provided pushing the handle end of the lever 8 outward to bring the active end 12 of the lever 8 against the block 6. A pin member 14 attached to the active end 12 of the lever 8 passes through a hole in the block 6 and into the recess 7 between block 6 and the plier jaw 5. Ample space is allowed between the pin 14 and the bottom of the recess 7 for the largest suture thread which will be used, and the pin 14 is brought as close to the end of the plier jaw 5 as is structurally con venient.
In the operation of this embodiment, a knot is manually placed in the end of the suture thread in the usual manner, this probably being by the throwing of a loop in the suture and the passing of the end through that loop twice, which is most conveniently done by rolling the two threads where they cross to make the loop, between thumb and finger; then by tension on the thread on opposite sides of the loop a tight, non-slipping loop is produced. The needle may then be grasped between the plier jaws 4 and 5 and held firmly therein by manual pressure on the holders 1 and 2, whereupon theneedle may be passed through the tissues which are to be sutured, the projecting end of the needle grasped by the pliers and drawn through bringing the suture thread with it until the knot on the end is snugly against the under side of the tissues. The needle may then be passed behind the withdrawable pin in the suture-tieing instrument to form a similar loop as in tieing the first knot and the needle end passed twice h u e o as b f e h ne d e d ll ein llowed to pass through to produce the loop necessary to form the knot. Theneedle end of the suture thread may hen e e d o e e is u ei g u e o b i g a small amount of tension onto the loop, whereupon a downward movement of the instrument will bring the withdrawable pin to the bottom of the loop and further downward movement towards the suturable tissues will carry the loop downward until the bottom of the loop is in contact with the tissues. Meanwhile, an appropriate tension uponthe needle endof the thread will reduce the size of the. loop until, as the; withdrawable pin. brings the" depressed, withdrawing the. pin 14.from the: recess 7 and,
leaving atight knot in place. Alternatively, the. loop may be formed without the aid of the. knotting instrument and the needle end passed twice through the loop, where,- upon the'pin 14- may be withdrawn from the recess 7 and. the double thread portion of the loop brought to the bottom of the recess 7 and the levers released, whereupon-the spring 11 brings the pin 14 to, the bottom of the recess17 and withinthe loop whichv is to form the. knot. The needle may then be grasped by fingers or another needle. holder and the whole drawn out straight but without substantially reducing the, size of the knot. Downward move.- ment of the jaws 4 and 5 of, the needle holder will carry the pin 14 in the recess 7 down towards the. tissues, during which movement light tension on the needle end of the. suture will reduce the size of the loop as it approaches the surface of the tissues. The needle holder jaws, recess 7, and pin 14 may be brought down into contact with the suture surface or may be gently pressed into the suture surface according to the tightness desired in the loop, and further tension on the needle end of the suture thread draws the loop down to the stage where it is tightly held against the pin 14. The pin may then be withdrawn slowly with tension on the. knot, whereupon the loopis completely closed as the pin 14, which is preferably tapered to a needle point, is withdrawn, resulting, in a mechanically produced knot, mechanically placed with exactly the right tension or spacing against the sutured tissues. The threadv may then be cut off as close to the knot as seems desirable to the surgeon and a new knot formed in the end preparatory to the next suture, whereupon the procedure is repeated until a sufiicient number of sutures is placed or the available amount of suture thread is exhausted and a new needle and thread are required.
It may be noted that, when a moist, slippery thread such as gut is used, the needle must be passed twice through the loop to get a tight, non-slipping knot, as is shown in Pig. 4, whereas, if silk or other threads which do not become slimy from the presence of moisture are used, a satisfactory knot may be obtained by passing the needle only once through the loop.
It will be observed that this device is readily sterilized and is simple, not subject to breakage or failure, and that it ties a wholly satisfactory knot the equal. of the best tied by any surgeon.
Referring to Fig. 2, an alternative embodiment is shown utilizing a standard needle holder, in which the same numbers indicate corresponding parts to the embodiment of Fig. 1, except that the members 1 and 2 are terminated in finger rings 15 and 16 and latching members 17 are provided as a convenience inholding the needle during insertion. The method of operation is substantially identical in every respect.
In some instances it is desired to have the knotter separate from the needle holder, and such an embodiment isshown in Fig. 3. In this embodiment, standard tweezers consisting of spring members 21 and 22 welded together at the outer ends-in a weld-23 (or riveted, screwed, or otherwise fastened together) are provided. As usual, these members Zland 22 cross at an intersection 24 to yieldtweezer ends 25 and 26. To one ofthc tweezer ends there is fastened a block member 27 having a recess. 28. To the other tweezer end 26 there is attached a pinmember 29.
ln the operation of thisembodiment the procedure; is.
, to the proper place.
substantially identical with that of the previously described embodiments. The initial loop and knot are formed in the end of the suture thread as usual, the needle is inserted into the tissues, and the first knot drawn up A similar loop is then formed as before and the needle end passed twice through the loop. When this is done, the handle members 21 and 22 of i the tweezer structure are pressed together, thereby withdrawing the pin 29' from the recess 28,. whereupon the doubled portion of the loop is inserted into the recess and the pin 29 allowed to return under the spring pressure of. the tweezer members 21 and 22 to bring, the
pin 29 within the loop. The suture is then drawn out straight as before. and the tweezer member carried downward along the line of the suture thread into contact with or adjacent to the tissues, during which movement light tension on the needle end of the thread will reduce the size. of. the'loop, until, as the tweezers reach the tissues,
the loopis drawn down almost to the diameter of the with the use of the standard needle holder, and accords ingly it is conveniently possible to put the pin member at the. end of one needle holder jaw, bore a hole through the other needle holder jaw to permit passage of the pin, and provide the auxiliary member on the outside of the. second jaw to form a notch for entrance of. the knotter pin as above described.
Accordingly, in the operation of this embodiment, the needle is seized between. the jaws of the needle holder in the usual way, passed through the tissues, released, and seized by the needle holder on the other side of the tissues, and drawn through together with the thread, The needle is then released, passed through the notch behind the knotter pin as previously described, and a loop formed as before with one or two passages through the loop to providev an appropriate knot which is then pushed down to the tissues as previously described.
By the structure and process of the invention it is thus possible to tie, mechanically, a very high grade knot: in a suture thread and simultaneously to place it as closeto the tissue surface as desired in as deep an incision as, may be needed with such tension or lack of tension as may be indicated.
While. there are above disclosed but a limited number of embodiments of the apparatus and process of, thepresent invention, it is possible to provide still other em.- bodiments without departingfrom the inventive concept, herein disclosed, and it is therefore desired that only such limitations be imposed on the appended claims as are stated therein or required by the prior art.
The invention claimed is:
1. A combined needle holder and knotter comprising,. in combination, a pair of plier levers, one thereof having in the end thereof a recess parallel to the length of the plier jaws and an auxiliary member pivoted on one plier jaw, one end. thereof having a pin passing. into said notch, the other end being adapted to manual manipulation.
.2. A combined needle holder and. knotter comprising, incombination, a pair of plier levers, one thereof having in the end thereof a recess parallel to the length of'the: plier jaws and an auxiliary member pivoted on oneplier: jaw, one end thereof having a pin passing into said notch, the other end: being. adapted to. manual manipulation, the plier members having finger loops.
'3. A combined needle holder and knotter comprising, incornbination, a pair of plier levers, one thereof having; in, the end thereof a, recess. parallel te-the. length; of the 5 6 plier jaws and an auxiliary member pivoted on one plier 750,033 Horlacher J an. 19, 1904 jaw, one end thereof having a pin passing into said notch, 1,635,066 Wells July 5, 1927 the other end 'being adapted to manual manipulation, 1,933,024 Nagelmann Oct. 31, 1933 the plier members having finger loops and locking t h t 5 OTHER REFERENCES Wharton: Minor and Operative Surgery Including References Cited In the file of thls Patent Bandaging, 1905 textbook, page 223 cited. (Copy in UNITED STATES PATENTS Div. 55.) 7 665,052 Bernard Jam 1, 1901 Bickham: Operative Surgery, vol. VIlI, 1933 textbook,
715, 2 Schisgal D 9 10 P 88 cited- PY in