US 3238942 A
Description (OCR text may contain errors)
March 8, 1966 Filed Oct. 19, 1964 H. A. LINCOFF 3,238,942
SURGICAL NEEDLE 2 Sheets-Sheet z INVENTOR. /V 4/Pr:r /4- Z/A/COFF BY 4 %M WM United States Patent 3,238,942 SURGICAL NEEDLE Harvey A. Lincotf, Manhattan, Nill. (510 E. 23rd St, New York, NY.) Filed Oct. 19, 1964, Ser. No. 464,532 11 Claims. (Cl. 128-439) This invention has to do with improved surgical needles and, more specifically, is directed to needles adapted for ophthalmic use.
In suturing during surgical operations, the surgical needle is grasped by a needle holder between the point of the needle and the rear of the needle to which the suture is attached, and the needle is positioned at an angle of approximately 90 relative to the jaws of the needle holder. The point of the needle is inserted in tissue to be sutured and the needle is pushed through the tissue. During insertion of the needle in tissue, a conventional needle, which has one or more fiat surfaces or is round at the portion grasped by the needle holder, tends to move in an angular manner with respect to the jaws of the needle holder and to rotate about its longitudinal axis, particularly if the serrated jaws of the needle holder are worn and if the needle is being passed through tough tissue. Angular and rotational movements of the needle in the needle holder during suturing detract from the surgeons control of the placement of the needle and reduce the speed and efficiency of suturing; such movements are obviously deleterious since they increase the operating time and since they can be hazardous during delicate surgery such as ophthalmic and cardiovascular surgery.
In the repair of retinal detachment, one serious problem associated with the full thickness, scleral buckling procedure-generally referred to as the Custodis Procedure For Retinal Detachmenthas been the absence of a suitable surgical needle. To date, needles used in this procedure have been deficient in one or more characteristics. In this procedure a broad, securely anchored mattress suture is required to hold a silicone or other implant securely in place. And it is desirable for the intrascleral portions of the suture to be about 6 mms. in length. Surgical needles, hitherto available, are curved too extensively to permit such a long pass, and the cutting edge customarily on the base of the needle blade tends to injure choroid. Most of the needles are excessive in thickness for safe scleral surgery, since the thickness of the sclera varies between about 0.3 mm. under the muscle tendon to about 1 mm. in the thicker part at the posterior pole. Grieshaber needles developed for this procedure have such delicate tips that the tips are prone to be damaged and developed burrs with repeated use.
It has now been found that superior surgical needles, particularly well adapted for the Custodis procedure, comprise A point,
A portion formed by four cutting edges extending from the point toward a suture attaching means positioned at one end of said needle, two of said cutting edges being positioned along the horizontal mid-line of said needle and extending up to about of the total length of the needle, and an upper and lower cutting edge comprising two of said four cutting edges and being positioned along the vertical mid-line of said needle and being shorter in length than said horizontal cutting edges, and having a substantially rhomboidal cross-section formed by said four cutting edges,
A next portion beyond said rhornboidal cross-section having a cross-section approximating a hexagon, all sides of which are substantially straight, the upper side of said hexagon forming the concave surface of said needle, the upper and lower parallel sides of the hexagon being of substantially equal length and longer than the remaining substantially equally long four sides, and the remaining four sides forming two opposed edges along the horizontal mid-line of said needle.
A plurality of advantages are realized with the new surgical needle of this invention. The needles are symmetrical about their points, substantially flat on their top and bottom portions, of greater width than thickness and flatter or less curved than conventional needles, such that the needles tend to find a scleral lamellar plane and dissect their way through the sclera with a feeling somewhat like that experienced with a blunt dissection, rather than perforating the sclera. Half-thickness sclera sutures are achieved with greater safety than previously possible. Flat surfaces top and bottom throughout the major portion of the needle length insure secure grasp of the needle by a needle holder, and these fiat surfaces serve to maintain the needle in the scleral plane.
It is now possible with the new needles to obtain the long mattress sutures required for full-thickness buckling with greater safety than heretofore possible. There have been no instances of scleral perforation or of prolapse of the implant due to the tearing free of the intra-scleral portion of the mattress suture. The thinness of the needles has greatly facilitated sutures in the thinner anterior portions of the sclera.
Examples of a needle according to the present invention are shown in the accompanying drawings in which:
FIGURE 1 is an edge view of the plane of curvature of a quarter-circle needle, and at a right angle to the axis about which the needle is curved;
FIGURE 2 is a perspective view of the same needle at a right angle to FIGURE 1, showing the plane of curvature;
FIGURE 3 is a fragmental detail of the left-hand portion of the needle as shown in FIGURE 2;
FIGURE 4 is a section of the needle on the line 4-4 of FIGURE 2;
FIGURE 5 is a section of the needle on the line 55 of FIGURE 2;
FIGURE 6 is a section of the needle on the line 6-6 of FIGURE 2;
FIGURE 7 is another edge view of the plane of curvature of a needle having a lesser radius of curvature than that of the needle of FIGURES 1-6, taken at a right angle to the axis about which the needle is curved. FIGURE 8 is a perspective view of the same needle at a right angle to FIGURE 7, showing the plane of curvature.
Referring now to FIGURES 16 in more detail, needle 10 is curved in an arc of a circle, substantially a quartercircle, having a radius of curvature not less than about 4.4 mms., and is characterized by portions of different cross-sections which facilitate its passage through tissue. Extending from point 11 are sharp cutting edges 12, 13, I4 and 15. Upper and lower cutting edges 12 and 13, respectively, are positioned along the vertical mid-line of needle 10. Side cutting edges 14 and 15 are positioned along the horizontal mid-line of needle 10. Cutting edges 14 and 15 are up to about of the total length of needle 10, generally up to about 1.5 mms. in length for a needle of 7.8 mms. total length. Cutting edges 12 and 13 are much shorter in length than cutting edges 14 and 15, i.e. up to about 0.15 mm. in length. Thus, the cross-section of needle It near its point 11 is substantially rhomboidal as illustrated in FIGURE 4.
Since cutting edges 12 and 13 are shorter than side cutting edges 14 and 15, the cross-section of the next portion extending from point 10 is of different configuration, namely substantially that of a hexagon. This is illustrated by FIGURE 5. The top side 16 of the hexagon is parallel to the axis of curvature of the needle. The bottom side 17 of the hexagon is substantially equal in width to a side 16. Sides 18, 19, 20 and 21 are the remaining sides of the hexagon and are of substantially equal length. Sides 18 and 19 meet to form cutting edge 14, and sides 20 and 21 meet to form cutting edge 15. The depth of needle 10 is the distance between sides 16 and 17, and is less than /2 the thickness of the sclera, from about 0.15 mm. to about 0.5 mm.; preferably, it is less than about 0.3 mm. All sides of the hexagon 16 through 21, inclusive, are substantially fiat. Thus, handling of the needle by a surgeon is facilitated by the opposed flat sides, particularly 16 and 17.
The remaining length of needle 10 is substantially rectangular in cross-section with all sides being substantially flat as shown in FIGURE 6. The absence of cutting surfaces along the length of the needle beyond the cutting edge portion, protects against the slicing type of perforation inherently in previous needles.
At the other end of the needle 10, away from point 10, there is located suture attaching means 22 in the form of a channel. Channel 22 receives and securely holds one end of a suture to be used by a surgeon. Suitable sutures are 5/0 chromic and mersilene.
The needle is continuously tapered as shown by the greater width from side cutting edges 14 and 15 to the section of the needle approaching channel 22 as indicated by numeral 23.
Needle 10 illustrated by FIGURES l-6 is particularly advantageous for the Custodis procedure referred to above.
A preferred needle 10 has the following dimensions, in millimeters:
Length 7.8 Distance across are 7.2 Body width 0.389 Blade width 0.559
Reference is now made to FIGURES 7 and 8, which show a needle of particular value for eye muscle surgery. Needle 30 is similar in all respects to needle 10 except for a smaller radius of curvature. Thus, needle 30 has a radius of curvature of about 2.4 mms., and a chord of about 5.1 mms. as measured from point 31 to channel 32. Needle 30 is suitable for scleral sutures that are required deep in the orbit. The smaller radius makes it easier for the surgeon to work with when the space between the globe and the orbital wall is limited.
A suture may be attached to the needle by swaging into a channel or in a hole drilled into the end of the needle.
In attaching sutures to the needles of this invention, any
conventional method can be used, including swaging the suture into a channel or into a hole drilled into the end of the needle.
The needles are thinner than conventional needles. They are formed from Wires less in width than the sclera. Thus, an advantageous thickness for the needle is less than about 0.3 mm.; needles of 0.228 mm. have proven to be suitable.
A suitable technique for forming needles of this invention is as follows. A raw wire is fed through a straighening device and is cut to a blank length; and a short length at the tail end of the blank is bent 90 to allow holding in a needle-making machine. A basic point shape is swaged on the blank. The point is shaped further by grinding so that the point fills a bayonetting die which follows at a later operation. A channel (by which the suture is eventually attached to the finished needle) is formed in the blank. The end of the suture channel nearest the point of the needle is constricted to guarantee an acceptable needle shape after the suture is attached to the needle. The ground point shape and the main portion of the needle body are now formed into a bayonet shape in a bayonetting die. The bayonetted blank is now flattened throughout. The needle blank is discharged from the needle-making machine. The needle blank is cleaned and Car heat treated. The needle blank is then electropolishcd in bulk. Only that portion of the blank which is to be the finished needle is electropolished.
The needle blank is then loaded onto a finishing machine where the following operations are performed automatically. The edges of the needle are ground to remove the metal flash (the flash is the thin protrusion of metal which is squeezed out between the faces of the forming die produced when the bayonet shape is formed). The needle cutting edges are then honed to a very high degree of sharpness. The forward extremity of the needle (the point and the length immediately following the point) is curved. This is the first step in the curving of the needle to its final shape. The body of the needle is then curved further, leaving a straight tangent section in the channel area to allow the future attaching of the suture to the needle by swaging the walls of the channel around the suture. The needle blank is then cut, separating the finished needle from the tail. The tail is scrap material. The suture is attached to the needle by swaging the sides of the channel around the suture. The needle with suture attached is then curved to the final curvature required by the surgeon.
While the structure of the needles of this invention has been described in terms of the preferred embodiments, minor modifications of this structure may result from manufacturing variations and such modifications are within the scope of the appended claims.
1. A curved scleral surgical needle having an inner concave surface and an outer convex surface and adapted for ophthalmic use consisting essentially of a point,
a suture attaching means positioned at the end of said needle distant from said point,
a portion formed by four cutting edges extending from the point toward said suture attaching means, two of said cutting edges being positioned along the horizontal mid-line of said needle and extending substantially beyond an upper and a lower cutting edge positioned along the vertical mid-line of said needle, and having a substantially rhomboidal cross-section formed by said four cutting edges, next portion beyond said rhomboidal cross-section having a cross-section approximating a hexagon, all sides of which are substantially straight, the upper side of said hexagon forming the inner concave surface of said needle, the upper and lower parallel sides of the hexagon being of substantially equal length and longer than each of the remaining substantially equally long four sides, and the remaining four sides forming two opposed edges along the horizontal mid-line of said needle,
a next portion beyond said hexagonal cross-section having a cross-section approximating a rectangle, all sides of which are substantially straight,
said needle being of greater width than depth and substantially fiat throughout its length from said rhomboidal cross-section to said suture attaching means, and
said needle tapering inwardly from the widest portion thereof formed by said hexagonal cross-section horizontal mid-lines up to said suture attaching means.
2. A needle defined by claim 1 wherein the depth thereof is substantially uniform from said hexagonal cross-section up to said suture attaching means.
3. A needle defined by claim 1 wherein said horizontal cutting edges are about 1.5 mms. in length, measured from said point, and the needle is about 7.8 mms. in length.
4. A needle defined by claim 1 having a depth from about 0.15 mm. to about 0.5 mm. between said hexagonal cross-section and said suture attaching means.
5. A needle defined by claim 1 having a depth of about 0.2 mm. between said. hexagonal cross-section and said suture attaching means.
6. A needle defined by claim 1 wherein said horizontal cutting edges extend up to about /5 of the total length of the needle.
7. A needle defined by claim 1 continuously tapering inwardly from said widest portion thereof up to said suture attaching means.
8. A needle defined by claim 1 having a radius of curvature not less than about 4.4 mms.
9. A needle defined by claim 1 having a radius of curvature of about 2.4 mms.
10. A needle defined by claim 1 wherein said rectangular cross-section has no cutting edges.
11. A needle defined by claim 1 having the two cutting edges on said vertical mid-lines up to about 0.15 mm. in length,
the two cutting edges on said horizontal mid-lines up to about 1.5 mms. in length,
a width of about 0.6 mm. at said widest portion thereof,
References Cited by the Examiner UNITED STATES PATENTS Turner 128-339 Slater.
Riall 128339 Orcutt 128-339 Kurtz 128--339 X RICHARD A. GAUDET, Primary Examiner.
DALTON L. TRULUCK, Examiner.