US 3545444 A
Abstract available in
Claims available in
Description (OCR text may contain errors)
United States Patent  Inventor David T. Green  References Cited Norwalk, Connecticut UNITED STATES PATENTS Ex i 32- 133; 3,079,608 3/1963 Babkin 29/243.57
r Assignee United states surgicalcorporaflon 3,237,290 3/1966 Frank 29/243.57
Baltimore, Md. Primary Examiner-Robert C. Riordan a corporation of Maryland Assistant Examiner-Gary Fl Grafel Atrorney- Fleit. Gipple 8t Jacobson ABSTRACT: A medical suture and cutting instrument including an elongated rail assembly supporting a resilient anvil which extends therefrom. A wire suture carriage assembly and 4 g gfis ggxsfig g INSTRUMENT a pusher are mounted on the rails for reciprocation and are g g separated by a spring force. An anvil finger assists gathering the tubular structure in the anvil bending surface and the  US. Cl 128/305; pusher is driven forward until the wire carriage meets a calcu- 29/243.57, 29/2 I 2; [28/326 lated resistance following which the pusher continues toward ] Int. Cl A6lb [7/12, the anvil to eject an elongated wire suture for shaping by the A6 lb l7/32 anvil bending surface and wrapping or coiling about the tubu-  Field ofSearch 29/33.5, lar structure. The suture carriage includes inclines which en- 243.57, 211,212; 128/305, 318, 319, 326, 334, gage the anvil to automatically adjust the wrapping radius to 346; 227/19 the diameter of the tube.
PATENIED DEC 8 I970 Sam 1 BF 5 INVENTOR 4140 TGZee-EA/ PATENTEU DEC 8 I970 SHEET 2 (IF 5 ll ulllllll'i /27 ,JQW
ATTORNEYS PATENTEDUEC 8I97l] 3 SHEET .3 or s INVENTOR 4140 T685547 'l m TTORNEYS PATENTED BEE 8 I978 sum 5 or 5 INVENT OR 214 06 0 ZGZQFEA/ TTORNEYS WIRE SUTURE WRAPPING INSTRUMENT BACKGROUND OF THE INVENTION The present invention relates to medical instruments for mechanically placing a pair of spaced steel sutures about organic tubular structures such as mesenteric vessels, vagus nerves, or the like, (hereinafter referred to as tube") and cutting the tube between the sutures in the same operation.
Conventional instruments of this type operate to eject a standard U-shaped stainless steel suture such that the legs of the suture pass on opposite sides of the tube following which the legs are bent by the anvil surfaces in crisscross fashion so as to close off the tube. Significant problems exist with these conventional instruments primarily since the instrument has no capability of adjusting the degree to which the suture is closed. Thus, in many cases the suture tears or otherwise damages the tube. If such tearing occurs after surgery is completed, the consequences may be serious. For this reason, the reliability of these conventional instruments is questionable.
It is a primary purpose of the present invention to provide a new and improved instrument of the type described which applies wire sutures about tubular structures based on a completely new principle. Unlike staple suturing, the invention coils or wraps an elongated wire about the tube and automatically adjusts-the tightness of wrap depending upon the tube diameter. Therefore, the invention for the first time provides an instrument that can achieve virtually the results of a tied silk suture.
Briefly stated, the present invention employs elongated wire sutures with a curled front, endand carried in a wire carriage in a precisely alined direction with the anvil. The wire carriage travels on a rail assembly to which the anvil is secured and closes with the anvil to clamp the tube therewith. A pusher rides on the rail assemblies following the carriage and being separated therefrom by a spring of predetermined spring constant. As the carriage and pusher close on the anvil, inclines engage the anvil and press the same downward a distance depending upon the closing distances between the anvil and carriage. This action changes the effective radius of the single bending anvil surface. The carriage continues to close until it meets a predetermined resistance by its clamping action on the tube after which the pusher continues to close relative to the carriage so as to eject an elongated wire suture substantially tangentially into the anvil bend. Side flanges assure the alinement of suture ejection. As the suture travels about the anvil bend, it begins and continues to curl or wrap about the periphery of the tube, closing the interior tube passage. The length of the suture is sufficient to assure that the tubular periphery is completely surrounded. After suturing is completed, the pusher continues forward and drives a knife edge which severs the tube.
It is therefore the object of the present invention to provide a new and improved suture wrapping instrument which avoids the problems and has the advantages outlined above.
Other and further objects of the invention will become apparent with the following detailed description when taken in view of the appended drawings wherein:
FIG. 1 is a side elevation of the instrument including the invention.
FIG. 2 is a front end view of the device shown in FIG. 1.
FIG. 3 is a vertical longitudinal section taken along the line 3-3 of FIG. 2.
FIG. 4 is a horizontal sectional view taken along the line 4-4 of FIG. 3.
FIG. 5 is a vertical transverse sectional view taken along the line 5-5 of FIG. 3.
FIG. 6 is a vertical transverse sectional view taken along the line 6-6 of FIG. 3.
FIG. 9 is a vertical transverse section taken along the line 9-9 of FIG. 7.
FIG. 10 is a sectional view showing the operation of the instrument.
FIGS. 11A and FIG. 118 show the wire suture coiled to different diameters.
FIG. 12 is a side elevation of a wire suture.
DETAILED DESCRIPTION OF THE EMBODIMENTS With reference to the figures, theinstrument 10 according to the invention includes an elongatedsteel rail assembly 12 the back end of which is secured to the trigger guide rod 14 of any suitable manually operated mechanism such as the conventional handle grip 16. Connection is made through a bayonet fitting including stud 13 and slot 15 secured by pins 17. A pair of steel anvils 18 have their elongated rear parts held within a pair of spaced grooves 20 in the rail assembly 12. If desired, the anvils may be. stamped from the same sheet so that a connecting steel piece remains between the anvil heads. A locking tab 22 extends from the side of each anvil 18 to secure the same within respective groove 20 by entering the recess 26 formed in assembly 12. The longitudinal location of tabs 22 should be sufficiently to the rear of the anvil head 28 so as to permit sufficient vertical bending for predetermined upward and downward movement of anvil head 28 for purposes described below. Athumb-engaging pusher bar 30 preferably formed of plastic or the like is secured to the bottom edges of anvils 18 in the vicinity of tabs 22. Upward pressure on bar 30 releases the anvil from assembly 12.
The anvil heads 28 support a resilient cutting block 29 therebetween, and each further includes an upstanding and rearward projecting finger 34 and a rearward facing anvil bending surface 36 the lower part of which is substantially tangential to the suture guide groove 38 formed in the top surface of rail assembly 12. As better seen in FIG. 3, the side flanges 40 forming groove 38 generally follow the shapes of the top surface 42 of rail assembly 12 and the bend of anvil surface 36. In this way, the suture is guided until it has been bent through an arc approximating or approaching if desired during which it is bent beyond its elastic limit for positive and permanent deformation. In addition, the fatty part of the tube is held out of the path of suture travel by side flanges 40.
o A full charge of elongated wire sutures is carried by carriage 44 and the pusher or ejection mechanism is carried by the pusher 46. Carriage 44 and pusher 46 are disposable and preferably formed of plastic and are provided with depending guide legs 48 which cooperate with rail assembly 12 so that carriage 44 and pusher 46 are held for longitudinal reciprocation toward and away from anvil head 28. A connecting rod 50 is securely fastened by any suitable means to the back plate 68 of carriage 44 and extends through the pusher assembly and terminates in a restraining flange 52 to limit the relative dis-p placement distance between carriage 44 and pusher 46. For reasons made clear below, spring 54 with a predetermined spring constant is provided under compression about rod 50 so as to bias carriage 44 and pusher 46 apart. Forward movement of carriage 44 and pusher 46 results from the forward thrust of the actuating rod 60 which urges against the rear face of pusher 46 in response to actuation of the handle grip 16.
It is generally known that instruments of this type must have the capability of housing and automatically reloading a plurality of sutures for rapid ejection. For this purpose, carriage 44 includes a pair of cylindrical openings axially alined with the planes of anvils 18. Each opening has a closed forward end with the exception of an ejection slot 62 alined with groove 38. A steel cylinder 64 removably housed in each opening includes a plurality of longitudinal notches 66 in the periphery thereof and dimensioned to hold a plurality of elongated wire sutures generally as shown. The sutures are factory preloaded and may be held in each groove 66 by any suitable means such as an inert adhesive, the retaining force of which is overcome during ejection. Carriage 44 further includes a removable v backing plate 68 to retain cylinders 64 in the respective openings and yet permit removal and reloading.
The pusher 46 includes a steel pusher member 70 extending a suitable distance from the frontiface of the body of pusher 46. Member 70'may be square in cross section. Rail assembly 12 may be provided with a further set of guide grooves 72 along which pusher members 70 ride for guided penetration into the groove of cylinder 64 indexed for ejection.
The instrument further includes knife 76 having an elongated section 78 riding in a central groove 80 of rail assembly 12 between the pair of anvils 18. The front end of knife 76 forms'an upstanding blade 82 and a top rearward facing cam member 84. The pusher 46 defines a lost motion channel 86 terminating in a knife-operating surface 88 which engages the back edge 90 of the knife for positive cutting action only after the ejection action is completed by pusher member 70.
The turning and indexing of cylinders 64 following each ejection can be accomplished by any suitable means. As one example, a pair of springs 92 having one end 94 securely embedded in the carriage 44 extends across the centerline and back to the axis of the cylinder to form a pair of overlapping cam surfaces 96. The front ends of springs 92 form depending ratchets 100 whichengage and cooperate with the ratchet or cam surface of each groove 66 in cylinder 64. Springs 92 experience neutral bias when ratchets are located along the respective cylinder centerlines so that upon ejection and the forward thrust of knife 76, cam 84 permits cam 92 to return to the topmost groove 66 and upon return of knife 76, springs 92 are again separated by cam 84 so as to rotate cylinders 64 sufficiently to aline the next loaded groove 66 with the ejection groove 62. This action is repeated for every thrust of knife 76 until cylinder 64 has made a complete revolution so as to I presentla'n empty groove 66 in alinement with groove 62 enablinga locking spring 102 to enter'the empty groove and block the 'forvvafd thrust of pusher 70. The blocking action of spring 102 is also a fail-safe check for sensing the loading conditions of cylinders 64 which increases the reliability of the instrument. Blockage of a groove 66 of either right or left cylinder 64 blocks the forward'movement of pusher 46 following which new cylinders can be substituted for those in the instrument. The forward edges of the cylinder are rounded to present a camming surfaceto spring 102 during insertion into carriage 44.
As better seen in FIG. 12, each wire suture is formed of stainless-steel and has a suitable length such as 0.300 inches. To assure curl under during wrapping, the front end 104 of each wire suture is curled a distance D which approximates the diameter D of the suture. The diameter of sutures of this type may run from eight-to-twelve-thousandths of an inch; however, ten-thousandths is preferred. lt is important that sutures 101 be oriented in grooves 66 of cylinder 64 so that the outside rounded curl 104 engages the anvil surface 36 during ejection.
The forward face of carriage 44 forms a first tissue-guiding incline 106 terminating 'in' a clamping groove 108 which cooperates with anvil head 28 to clamp the tube therebetween prior to ejection. As indicated above, instrument 10 has the capability of automatically adjusting the radius of wire coiling iri' accordance with the dimensions of the tube being sutured. To accomplish this, additional camming surfaces or inclines 110 and 112 are alined to engage the rounded tip of the anvil he ad fing'er 34. As carriage 44 closes on head 28, camming tinues to close, finger 34 rides along surface 112 which may be curved for smooth movement of head 28. However, at the 's'ante'time, clamping pressure is being increased. The clamping force: on the tube prior to suturing should be sufficient to "closethe internal tube passageway and tofurther elongate the relative movement between surface 112 and finger 34Stops together with the downward movement of surface 36 leaving the center of curvature at a relatively high level. On the other hand, if a tubular structure of relatively small diameter is being sutured, the necessary resistance to stop the closing of carriage44 is not developed until finger 34 ridesfurther along, incline 112 causing a greater lowering of surface 36 and thus a tighter bending radiusfor the suture. FIG. 11A illustrates the suture of maximum diameter coil and FlG. 11B illustrates an example of a suture of less than maximum diameter coil.
The instrument operates as followsrFingers 34 gather the tube to be sutured and when the surgeon is satisfied that the instrument is properly positioned, handle grip 16 is squeezed to effect ejection and cutting. Rod 60 is driven forward relative rail assembly 12 and in turn drives pusher 46 toward anvil head 28. Carriage 44 also closes on head 28 by virtue of the spring force connection with pusher 46. Knife 76 is carried along with carriage 44 so that edge 90 remains well spaced from abutment 88. As carriage 44 closes, incline 106 may urge the tube into groove 108 and anvil bend 36. Prior to the buildup of clamping pressure, incline 110 engages finger 34 and beginsmoving bend 36 downward. As the clamping pressure begins, finger 34 rides onto incline 112 for further downward movement which continues so long as carriage 44 closes on head 28. At the time the clamping pressure overcomes the .spring 54, carriage 44stopsand the center of curvature for bend 36 is fixed relative to rail assembly 12. As rod 60 continues its forward stroke with carriage 44 stopped, pusher member penetrates the indexed groove 66 of cylinder 64 and ejects the wire guided by groove 38 into and around anvil bend 36 and about the clamped tube. The radius of suture coil relates to the tube diameter as described. After ejection, pusher abutment 88 contacts knife edge and drives knife 76 forward to sever the tube between the suture locations. As cam 84 leaves spring 92, the ratchets engage the topmost groove 66.
Upon releasing handle grip 16, rod .60 returns with pusher 46 in response to well-known spring means (not shown). lnitially, knife abutment 88 moves away from edge 90 and compression is released on spring 54. When pusher 46 again ,engages flange 52 of rod 50, carriage 44 starts to withdraw from head 28. As cam'84 comes back with pusher 46, it cams and separates springs 92 to rotate cylinders 64 to index the next groove 66. With the full release of handle grip 16, carriage 44 is fully returned and the instrument is ready for reuse. After repeated use and after cylinders 64 are spent, springs 102 stop the forward travel of the pusher .46. Anvils 18, carriage 44, and pusher 46 are disposable upon disassembly and replaced by new ones as desired.
Thus, there has been described a suturing instrument for coiling wire sutures about the periphery of tubular structures. It will be appreciated that many and various changes can be made to the herein-disclosed example of the invention without departing from the spirit and scope thereof. It will be also be understood from the foregoing description that in some instances the configuration and operation of only one side of the instrument are described but with the clear understanding that the other side of the instrument is symmetrically similar in construction and operation.
1. A surgical instrument for placing a medical suture about an organic tubular structure comprising an anvil defining a plane and fixing the tubular structure generally perpendicular to the plane, ejection means movable parallel to the plane for clamping the tubular structure with said anvil and feeding a generally linear wire suture within said plane and generally tangential to only one part of the tubular structure, said anvil including a bending surface positioned to operatively deform the wire suture such that it follows the tubular structure periphery until the wire at least substantially extends completely about said periphery, and means responsive to the diameter of said tubular structure for regulating the amount of clamping compression placed on said tubular structure.
. 2. The instrument of claim 1 further including means for operatively changing the arc through which the suture is deformed such that the suture conforms to the periphery of the particular tubular structure being sutured.
3. The instrument of claim 2 wherein said ejection means includes a carriage having a forward face cooperating with the anvil when moved to operative engagement therewith, said carriage carrying a device storing a plurality of said wire sutures, said instrument further including a rail assembly upon which the carriage rides and defining a feed path alined with the anvil bending-surface and indexing means for moving said device to present .one of the stored sutures within said feed path for subsequent ejection therealong following each opera tion of the instrument.
4. The instrument of claim 3 wherein said means further includes a pusher riding on the rail assembly following said carriage, a resilient member having a predetermined spring constantpositioned to bias the pusher and carriage apart, said pusher including an elongated pusher member riding along said feed path to effect ejection; and manually operating means for urging the pusher toward said anvil and exerting a closing force through said spring member to said carriage so the latter closes on said anvil to clamp the tubular structure therewith until the carriage meets predetermined resistance following which the pusher closes on said carriage and said pusher member effects ejection of said wire suture.
5. The instrument of claim 4 wherein an elongated knife guided by said rail assembly includes a knife edge carried forward by said carriage to a position just short of severing the tubular structure across the axis thereof. said knife having an elongated rear part fitting within a lost-motion channel defined by said pusher, said channel terminating in a knife actuating abutment and said channel having a length sufficient to permit full ejection of said suture before said abutment drives said knife to sever said tubular structure.
6. The instrument of claim 5 wherein said indexing means includes a cam surface attached to said knife and means for moving the suture storing device in response to the return of said cam surface to its initial relative position when said pusher and carriage are withdrawn from said anvil.
7. The instrument of claim 1 wherein said wire suture includes a forward tip that is curled generally similar to the arc of the anvil bending surface and in said plane so as to assure that the suture coils more than 360 in the event the suture Patent No. 3,545,444 Dated December 8, 1970 Inventor(s) David T. Green It is certified that error appears in the above-identified patent and that said Letters Patent are hereby corrected as shown below:
On the title page, column 1, after line 2, insert ppln. No. 672,362
Signed and sealed this 30th day of March 1971.
EDWARD M.FLEI'CHER,JR. WILLIAM E. SGHUYLER, JR Attesting Officer Commissioner of Patents FORM 90-1050 (10-69) ..n A