US 3191842 A
Description (OCR text may contain errors)
June 29., 1965 c. FISCHER ETAL SUTURING INSTRUMENT 2 Sheets-Sheet 1 Filed Jan. 26, 1962 I: INVENTORS alowa lll hlll lllll .0. Cormack J. \logelF g PATENT AGENT June 29, 1965 c. FISCHER ETAL SUTURING INSTRUMENT 2 Sheets-Sheet 2 Filed Jan. 26, 1962 PATENT AGENT i 5 mm I I l 1 l l l I l l I I I I l I l I MW W United States Patent 3,191,842 SUTURING INSTRUMENT Christopher LLFischer, Belmont, Calif., and Antoni J.
Smialowski, Sidney H. G. Connock, and Isaac J. Vogelfanger, Ottawa, Ontario, Canada, assignors to Canadian Patents and Development Limited, Ottawa, Ontario, Canada Filed Jan. 26, 1962, Ser; No. 168,945 Claims. (Cl. 227-155) This invention relates to a suturing instrument.
It is well recognized that the suturing of blood vessels in the course of surgical operations should be effected as rapidly as possible inorder to minimize danger to the patient. However, the suturing step is of delicate nature and its effectiveness, as wellas the time involved in completing it, requires highly specialized skill on the part of the surgeon particularly in respect of 'blood vessels of small diameter. Frequently, access to the severed blood vessel is restricted, thereby rendering the suturing act even more inconvenient and prolonged.
In prior United States Patent No. 2,940,451 a suturing apparatus is disclosed which renders it possible to conduct the suturing step in a more rapid and convenient manner. v a
An object of the present invention is to provide a suturing instrument which may be employed to conduct a suturing operation in a more rapid and convenient manner and to produce sutures. which will be uniformly satisfactory and efliective.
The invention will be described with reference to the accompanying drawings, in which-- FIGURE 1 is a plan view of an instrument in accordance with the invention,
FIGURE 2 is aside elevation of the instrument, FIGURE 3 is a side elevation of one part of the instrument on line 3-3 of FIGURE 1,
FIGURES 4, 5, 6 and 7 are sections on lines 44, 5-5, 6-6 and 7--7, respectively, of FIGURE 2,
FIGURE 8 is a sectional end elevation of the instrument headand illustrating a step in the suturing operation,
' FIGURE 9 is a perspective View of one element of the instrument,
FIGURE 10 is a side elevation, partly in section of a staple-driving bushing section of the instrument,
FIGURE 11 is anend view of a staple-driving bushing forming partof the instrument, 7
FIGURE 12 is a side elevation of a staple-driving bushing section,
FIGURE 13 is an elevation of the bushing section shown in FIGURE 12,
FIGURE "14 is a side elevation of an anvil bushing section,
FIGURE 15 is anend view of an anvil bushing,
FIGURE 16 is an enlarged section on line 16-16 of FIGURE 15,
FIGURE 17 is a side elevation of a staple or' clip for use with the instrument of the invention,-
FIGURE 18 is a plan view of a portion of the instrument with parts removed for clarity of illustration,
FIGURE 19 is a perspective view of the jaw end portion of one of the assembly arms, and
FIGURE 20 is a plan view of another portion of the instrument with parts removed for clarity of illustration.
Referring to the drawing, the instrument comprises i a pair of associated but readily separable and'connectable parts 1 and 2, part 1 being a staple holding and driving assembly and part 2 being a staple anvil assembly.
The staple holding and driving assembly comprises a pear of pincers-like bushing clamping arms 3 and 4 3,191,842 Patented June 29, 1965 having respective jaws 5 and 6 and spaced handles 7 and 8. A flat spring 9 has opposed portions recessed in handles 7, 8. It will be apparent that the spring 9 urges squeeze them towards each other will separate the arms and jaws against the action of the spring.
Each jaw 5, 6 has an arcuate inner edge portion 10, and a groove 11 in such inner edge portion.
Arms 3, 4 have respective engageable flanges 12, 13 fixed to the meeting edges thereof. Each arm 3, 4 has a spring strip 14, 15 mounted thereon as by means of mounting plates 16 adjacent the inner ends thereof. The free ends of strips 14, 15 each has a jaw 17, 18 overlying jaws 5, 6 and laterally aligned therewith Each jaw 17, 18 terminates at a planed end edge 19, and has an arcuate inner edge portion 20, and a groove 21 in such inner edge portion. It will be apparent that each strip 14, 15 normally lies flat in engagement with arms 3, 4 and with groove 21 in parallel relation with nates adjacent the jaw ends of arms 3, 4 and strips 14, 15 and carries at its free end an inwardly directed lug 25 which extends between strips 14, 15 and arms 3, 4 and through a notch 26 in strips 14, 15. Notch 26 (see FIGURES 1 and 18) has an inclined cam surface ;27. Each lug 25 has, as shown a flange 28 which extends through a slot 29 in arms 3, 4. It will be observed that, in response to a pull exerted on the legs 23, 24 by means of pull 22, the lugs 25 will react with the inclined surfaces 27 to swing the jaw ends of strips 14, 15 outwardly from jaws 5, 6 and arms 3, 4.
A staple holding and driving bushing 30 is arranged for clamping between the jaws 5, 6 of assembly 1. Such bushing (FIGURES 10, 11) is of generally cylindrical tubular form but is composed of two part-cylindrical sections 31, 32. The bushing has a radially outwardly directed flange 33 at one end thereof, an interior wall surface 34 of substantially uniform diameter from end to end of the bushing, and an exterior wall portion 35 adjacent the other end thereof of greater diameter than the exterior intermediate wall portion 36. Portion 35 thus forms an annular shoulder 37. Extending through shoulder 37 is a plurality of staple-receiving uniform and uniformly spaced arcuate slots 38. The walls of slots 38 are parallel to the axis of the bushing, the inner surfaces 39 thereof being aligned with and forming a continuation of the exterior surface of wall portion 36. Each slot is fully closed the latter direction thereof, i.e;, it has an outer wall surface 40 opposite surface 39 and end wall surfaces 41 joining surfaces 39 and 40. Shoulder 37 is preferably provided with an outwardly directed end flange 42 of minor extent compared with flange 33.
Reciprocally mounted on wall portion 36 of bushing 30 is a tubular member 43 also formed in two partcylindrical sections 45, 46 and having a sliding fit engagement with wall 36. Member 43 has an outwardly directed radial flange 47 at its end adjacent flange 33 and a plurality of axially directed arcuate fingers 48 at its other end. Member 43 has a retracted position definediby engagement-of a shoulder 49 on member 43 and a shoulder 50 on bushing 30, in which position flange 47 is in slightly spaced relation to flange 33 and fingers 48 are disposed in slightly entrant relation to the mounts of slots 38, as shown in FIGURE 8. It will be apparent that the cross-sectional area of each finger 48 is approximately equal to that of each slot 38 whereby the finger has a sliding fit engagement with the walls of the slot. It will also be apparent that reciprocation of member 43 in a direction to separate flanges 47 and 33 will cause the fingers 48 to traverse the slots 38.
It will be observed that the bushing and member 43 as a unit may be clamped between jaws 5, 6 and 17, 18. Thus, with the jaws open, they may be applied to the bushing whereby, on closing movement of the jaws 5, 6 and 17, 18 to bring them into engagement, the flanges 33 and 74 will enter grooves 11 and 21, respectively, bushing 30 having its shoulder 50 in engagement with shoulder 49 of tubular member 43. The arcuate positioning of the bushing in the jaws is defined by reception of pins 71, carried by jaws 5, 6, in notches 72 in flange 33.
The staple anvil assembly 2 is somewhat similar in general structure to assembly 1 and comprises a pair of pincers-like bushing clamping arms 51, 52 having respective jaws 53, 54 and spaced handles 55, 56. A flat spring 57 having portions recessed in handles 55, 56 urges the arms and jaws towards each other. Each jaw 53, 54 has an arcuate inner edge portion 59, and a groove 60 is in such inner edge portion. Arms 51, 52 have respective engageable flanges 61, 62 fixed to the meeting edges thereof.
A staple anvil bushing 63 is arranged for clamping between the jaws 53, 54 of assembly 2. Bushing 63 (FIGURES 14, 15, 16) is of generally cylindrical tubular form but is composed of two part-cylindrical sections 64, 65. The bushing has a radially outwardly directed flange 66 at one end thereof, an interior wall surface 67 of substantially uniform diameter from end to end of the bushing, and a radial outer flange 68- of minor extent compared with flange 66 at the other end thereof. A plurality of piars of staple-clinching grooves 69 are formed in the flanged end 68 of the bushing. The bottom surfaces of the grooves 69 are smoothly curved, and such surfaces of, each pair terminate at a substantially common apex 70. Each such bottom surface, as shown, has a relatively large radius section and a smaller radius section adjacent its inner terminus.
Bushing 63 is arranged to be clamped as a unit between jaws 53, 54 of assembly 2 flange 66 being received in grooves 60 of the jaws. The accurate positioning of the bushing in the jaws is defined by the reception of pins 73, carried by the jaws in notches 74 in flange 66.
Means for releasably and positively locking assemblies 1 and 2 together in a convenient manner comprises a projection 75 fixed to flange 62 of arm 52, flange 61 being appropriately recessed at 76 to receive the projection in the closed position of arms 51, 52. Projection 75 has a relatively wide groove 77 in the side surface thereof adjoining arm 51, such groove having side walls 78 and 79 inclined towards the jaw end of the instrument (see FIGURE 19).
Projection 75 is receivable in mating recesses 80 and 81 in arms 3, 4. A locking bar 82 is slidably mounted in a recess 83 in the inner surface of flange 13 of arm 4, the bar having a handle 84 for imparting sliding movement thereto. The bar is mounted and retained in the recess by means of a pin 85 on the flange 13 and a keyhole slot 86 in the bar. The stroke of the bar is determined at one end by engaging shoulders 87 on flange 13 and 88 on the bar and at the other end by engaging shoulders 89 on the flange and 90 on the bar. The bar 82 has anend portion 91 complementarily inclined with respect to groove 77 in the projection 75. In the retracted position of the bar 82 as determined by engagement of shoulders 89, 90, the projection 75 of assembly 2 is receivable in recesses 80, 81 of assembly 1. Thereafter, sliding movement of bar 82 will cause end portion 91 of the bar to traverse the groove 77 and engagement of the inclined edges of portion 91 with the side walls 78, 79 of the groove will draw the assemblies towards each other to place flanges 42, 68 of the bushings 30, 63 in spaced substantially parallel proximity. Recess 81 is slightly shorter than recess 80 to receive the somewhat narrower outer end of projection 75 (see FIGURE 20).
Assembly 1 is also provided with a positioning and retaining lug 92 carried by a block 93 fixed to spring member 9 and receivable in a recess 94 in a block 95 fixed to spring member 57 of assembly 2.
In FIGURE 17, there is illustrated a staple or clip 96 for use in connection with the instrument described. The staple as shown has a pair of legs 97 and a bridge 98. The ends of the legs are bevelled as indicated at 99.
The staples 96 are made of suitable metal wire. The various parts of the instrument are made of metal, plastic composition, or combinations thereof.
A haemostatic clamp 100 is indicated as removably mounted on the outer surface of each assembly 1 and 2. As shown, each clamp has a pin 101 receivable in a hole 102, 103 in the assemblies and a second pin 104 receivable in a groove 105, 106 in respective blocks 93, 95.
In operation, the assemblies 1 and 2 are separated and have bushings 30 and 63 mounted therein, bushing 30 having a supply of staples 96 therein, one in each of slots 38 with the base of each staple position for engagement by the end of a finger 48 (-see FIGURE 8).
Haemostatic clamps 100 having been previously applied to the severed end portions 107, 108 of the blood vessel, the assemblies 1 and 2 are applied to such end portions, which are everted over the ends of the respective bushings 30, 63, as shown in FIGURE 8. The everting operation may be carried out by means of an instrument such as disclosed in United States Patent 2,940,452, A. J. Smialowski, or United States Patent 3,057,355, A. J. Smialowski et al.
The assemblies 1 and 2 are now connected together in the manner previously described to place the bushings in substantially accurate axial alignment with the blood vessel ends clamped between the ends of the bushings, it being understood that the pressure applied to the vessel by the bushings is not such as to cause injury thereto. It will also be apparent that such pressure is variable in accordance with the length of stroke of bar 82, and that the instrument can be designed to provide any desirable maximum extent of such stroke.
With the various elements in position as shown in FIG- URE 8, the surgeon applies a full pulling stroke to the pull 22. Such a stroke swings spring strips 14, 15 away from arms 3, 4 until flange 47, carrying with it tubular member 43, engages the shoulder 37 of the bushing 30. It will, however, be apparent that, during this axial movement of member 43, relative to the bushing 30, fingers 48 will drive the staples 96 through the slots 38 and through the blood vessel ends. As the ends 99 of each staple engage the surfaces of a pair of depressions 69, the legs 97 of the staples are folded into clinched relation with respect to the vessel.
An important feature of the invention resides in the fact that the structure described results in uniformly clinched staples with a minimum of injury to the vessel.
= Thus, since the slots 38 are closed, the legs of each staple are in engagement with wall surfaces 39, 40 and 41 of the slot and are thus prevented from being bowed or otherwise deformed as a result of pressure thereon during engagement of the staple ends with the walls of depressions 69.
Another important feature of the invention resides in the fact that the extent of the staple-clinching stroke may be positively determined by the structure of the instrument is thus not subject to variations in pressure applied by the surgeon. It will be obvious that if the staple-clinching pressure were too great, serious injury to the vessel could result. The present invention removes any variable human choice of pressure in the operation. On the contrary, the extent of the staple-clinching stroke is positively determined by the instrument structure itself.
When the staple-clinching stroke has been effected, the instrument is detached from the vessel by pressing together the handles 7, 8 and 55, 56, thus opening jaws 5, 6, 17, 18 and 53, 54. ()pening of the jaws separates the sections of the bushings 3t), 63 and tubular member 43, and therefore permits removal of the same from the vessel, the clamps 100 remaining in place. The suturing operation is then complete with removal of the clamps 100.
1. A suturing instrument comprising a staple-driving assembly, a staple-anvil assembly, each said assembly comprising a pair of swingably connected arms, a spring urging said arms towards each other, a handle on each arm for swinging said arms apart, each said arm having a jaw mating with the jaw of the other arm, a pair of independent tubular bushings each having two part-cylindrical sections, said jaws having a closed position defined by clamping engagement with said bushings and an open position defined by disengagement from said bushings, a first one of said bushings having an outwardly directed annular flange at one end thereof, a wall portion adjoining the other end thereof of greater external diameter than that of the remaining wall portion thereof and form ing an annular shoulder in opposed relation to said flange, and a plurality of axially directed circurnferentially arranged staple-receiving slots extending from said shoulder to said other end of said bushing, the second one of said bushings having a plurality of pairs of staple-clinching grooves therein, each pair of said grooves being axially aligned with one of said slots, a staple-driving tubular member slidably mounted in said slotted bushing and having a plurality of axially directed circumferentially arranged staple-engageable fingers, each said finger being disposed in one of said slots and in constant engagement with the walls of said slot, means releasably securing said assemblies together with said bushings in axial alignment, and means carried by said staple-driving assembly for effecting a staple-driving stroke of said tubular member.
2. A suturing instrument as defined in claim 1, said tubular member having a first shoulder engageable with said bushing shoulder and a second shoulder engageable with said bushing flange to define the limits of a stroke thereof.
3. A suturing instrument as defined in claim 1, each said slot having a constant cross-sectional area from end to end thereof approximately equal to the cross-sectional area of one of said fingers.
4. A suturing instrument comprising a staple-driving assembly, a staple-anvil assembly, each said assembly comprising a pair of swingably connected arms, a spring urging said arms towards each other, a handle on each arm for swinging said arms apart, each said arm having a jaw mating with the jaw of the other arm, and a tubular bushing having two part-cylindrical sections, one of said sections being arranged for releasable mounting in one of said jaws, one of said bushings having a plurality of axially directed circumferentially arranged staple-receiving slots, the other of said bushings having a plurality of pairs of staple-clinching grooves therein, each pair of said grooves being axially aligned with one of said slots, a staple-driving tubular member slidably mounted in said slotted bushing, said tubular member and said slotted bushing having interengageable shoulders defining the limits of a stroke thereof, means releasably securing the said assemblies together with said bushings in axial alignment, and means carried by said staple-driving assembly for eifecting a staple-driving stroke of said tubular member comprising a pair of spring strips each having a jaw embracing said tubular member, each said strip being mounted on one of said arms of said staple-driving as sembly and having a cam surface engageable to swing said strip away from said arm, and a pull slidably mounted on said arms of said staple-driving assembly and having a pair of legs, each said leg having a cam engageable with one of said cam surfaces.
5. A suturing instrument comprising a staple-driving assembly, a staple-anvil assembly, each said assembly comprising a pair of swingably connected arms, a spring urging said arms towards each other, a handle on each arm for swinging said arms apart, each said arm having a jaw mating with the jaw of the other arm, and a tubular bushing having two part-cylindrical sections, one of said sections being arranged for releasable mounting in one of said jaws, one of said bushings having a plurality of axially directed circumferentially arranged staple-receiving slots, the other of said bushings having a plurality of pairs of staple-clinching grooves therein, each pair of said grooves being axially aligned with one of said slots, a staple-driving tubular member slidably mounted in said slotted bushing, said tubular member and said slotted bushing having interengageable shoulders defining the limits of a stroke thereof, means releasably securing the said assemblies together with said bushings in axial alignment, and means carried by said staple-driving assembly for effecting a staple-driving stroke of said tubular member comprising a pair of spring strips each having a first end fixed to one of said arms of said staple-driving assembly, a second end swingable away from said arm, and a jaw on said second end embracing said tubular member, and means for swinging said strips away from said arms, comprising a member slidably mounted on said arms of said staple-driving assembly and engaging said strips.
References Cited by the Examiner UNITED STATES PATENTS 2,965,900 12/60 Inkouchi 1-349 X GRANVlLLE Y. CUSTER, JR., Primary Examiner.