Footed Forceps-Type Surgical Instrument

This invention generally relates to surgical or medical instruments of the forceps-type conventionally used for grasping and manipulating body tissues or organs.

Conventional forceps-type instruments of the character described normally include a pair of forceps blades which function in a tweezer-like action and are used in medical operations or surgery to hold, expose and manipulate tissues. Such instruments normally include two blades joined or jointed at proximal ends for moving their distal ends toward and away from each other in a closing and opening action. The distal ends of the blades comprise functional jaws which either are formed integral with the blades or built and mounted as inlays on the distal ends of the blades. The handle portions of the blades may be straight, angular or offset, take the shape of a bayonet or comprise the handles of a scissor-type instrument.

The success of microsurgery depends on gentle tissue handling, avoidance of trauma and meticulous and accurate approximation and apposition of tissues. It is known that exposing and handling tissue through application of counter-pressure is much more desirable than grasping the tissue between the jaws of a forceps, a tissue forceps or a tweezer-type platform. Such grasping or direct pressure application, regardless of how gentle, more often than not results in microscopic hemorrhages and tissue abrasion and trauma.

This invention is directed to providing a new and improved forceps-type surgical instrument capable of applying smooth atraumatic external or internal counter-pressure with an extended surface on tissues especially those handled in microsurgery, to facilitate manipulation of the tissues, and exposure and passage of needles through the tissues while maintaining proper orientation of the needle for subsequent suturing.

An object, therefore, of the invention is to provide a new and improved forceps-type surgical instrument which can be used for various tissue manipulations, the instrument being capable of delicately holding, restraining and stabilizing tissues by external or internal counter-pressure without requiring tissue grasping.

In the exemplary embodiment of the invention, the forceps-type surgical instrument includes a pair of forceps blades coupled together at their proximal ends and spreadable and closable at their distal ends. The forceps blades may be incorporated in simple spring-loaded V-shaped configurations of different designs, such as straight, angular or offset, or take the shape of a bayonet. The blades also may be incorporated in a hinged or pivoted scissors-like instrument.

Generally, a pair of feet are respectively mounted on the distal ends of the forceps blades, with the feet extending transversely outwardly of the blades to enlarge the working area thereof and to facilitate the application of counter-pressures during surgical operations.

Preferably, the feet are generally flat in a plane generally perpendicular to the forceps blades. The feet have forward or anterior ends or tips, rearward or posterior ends, inwardly facing medial edges and outwardly facing lateral edges. Preferably, the medial edges are generally parallel to each other and may be serrated to enhance the grasping of needles or sutures. The lateral edges are smooth and polished to glide smoothly over tissues, particularly when the forceps is in use in stretching or spreading tissues.

A feature of the invention comprises at least one aperture in at least one of the feet of the forceps blades for receiving and guiding a needle, suture or the like during operations therewith. There are a variety of locations and configurations of apertures disclosed herein for various intended functions.

A further feature of the invention comprises an optional flexible or articulated junction between the blades of the forceps and the feet to permit relative movement in infinite directions or in a plate so as to accommodate the plane of each foot to the surface being sutured.

Other objects, features and advantages of the invention will be apparent from the following detailed description taken in connection with the accompanying drawings.

The features of this invention which are believed to be novel are set forth with particularity in the appended claims. The invention, together with its objects and the advantages thereof, may be best understood by reference to the following description taken in conjunction with the accompanying drawings, in which like reference numerals identify like elements in the figures and in which:

FIG. 1 is a perspective view, partially broken away, illustrating a forceps-type surgical instrument incorporating the concepts of the invention;

FIG. 2 is a horizontal section, on an enlarged scale, taken generally along line 2--2 of FIG. 1, through the distal ends of the forceps blades, illustrating a top plan view of the forceps feet;

FIG. 3 is a fragmented rear elevational view of the distal end of the instrument;

FIG. 4 is a perspective view illustrating one of the feet at the distal end of one of the forceps blades being used to apply counter-pressure to tissue and guiding a needle during a suturing operation;

FIG. 5 is a view of both feet at the distal ends of the forceps blades applying internal counter-pressure to a tubular organ, again guiding the needle during a suturing operation;

FIG. 6 is a perspective view, similar to that of FIG. 1, of the invention incorporated in a different type of forceps instrument;

FIG. 7 is a perspective view illustrating the invention incorporated in a scissors-type forceps instrument;

FIGS. 8-12 are horizontal sectional views similar to that of FIG. 2, through the distal ends of the forceps blades, and illustrating various configurations of feet and various locations for the guiding apertures through the feet;

FIG. 13 is a perspective view illustrating the foot at the distal end of one of the forceps blades being resiliently connected; and

FIG. 14 is a perspective view illustrating the foot at the distal end of one of the forceps blades being connected together by a ball and socket connection with a resilient means for returning the foot to a predetermined orientation.

Referring to the drawings in greater detail, and first to FIG. 1, a forceps-type surgical instrument is illustrated and generally designated 10. The instrument includes a pair of forceps blades 12 fixed together at their proximal ends 14. The blades are fabricated of metal or like material so as to be self-spring-biased toward a spread or open condition as illustrated. Restraining bosses 18 may be provided on the inside faces of the forceps blades to control closing pressure. A pin 20 and aperture 22 restraining device also may be provided on the inside faces of the forceps blades to prevent lateral shifting of the blades when in closed condition.

Generally, the invention contemplates the incorporation of a pair of feet, generally designated 24, mounted on the distal ends 26 of forceps blades 12, the feet extending transversely outwardly of the blades to enlarge the working area thereof and to facilitate the application of counter-pressures during surgical operations, as described hereinafter.

More particularly, referring to FIG. 2, one configuration of feet 24 is shown in greater detail. In this embodiment, the feet are generally flat in a plane generally perpendicular to the distal ends 26 of forceps blades 12. For better reference purposes hereinafter, each foot 24 includes a forward or anterior end or tip 28, a rearward or posterior end or tip 30, an inwardly facing or medial edge 32 and an outwardly facing or lateral edge 34. Preferably, the inwardly facing medial edges of the pair of feet 24 extend generally parallel to each other.

In the embodiment illustrated in FIGS. 1 and 2, feet 24 are mounted to the distal ends 26 of forceps blades 12 close to or at the lateral edges and posterior tip of the feet to allow the instrument to function as a tubal forceps, as described hereinafter, by restraining and stabilizing a tube-like structure or organ between the medial edges 32. Medial edges 32 are serrated, as at 36 (FIG. 1) to facilitate the holding of sutures or less delicate tissues and to make the holding or grasping more secure and less tenuous. The serrations do not extend all the way to the anterior tips of the feet to provide smooth medial edge portions 38 (FIG. 1) for holding more delicate structures with a smooth surface. Lateral edges 34 are smooth and polished to glide smoothly over tissue when the forceps is in use for stretching or spreading tissues, such as in the application of internal counter-pressure. The rounded edges about anterior tips 28 also are smooth and narrow, as shown, to allow access into very small tubes for the purpose of spreading the tubes in a counter-pressure action. Such spreading action also is enhanced by the rearwardly diverging configuration of lateral edges 34.

FIG. 3 shows, somewhat schematically, the inward projection of feet 24 relative to forceps blades 12 for closing beneath a tubular structure 40 for purposes of gently lifting or stabilizing the structure.

Referring to FIGS. 4 and 5 in conjunction with FIG. 2, a feature of the invention is the provision of at least one aperture 42 formed through one or both feet 24. The apertures are provided for guiding needles, sutures and the like during operations therewith. As seen in FIG. 2, the apertures are generally "eye-shaped" and set along th longitudinal axis of the feet 12 so that the central portion of the apertures are wider than either end. The centers of the apertures are wide enough to easily receive needles such as microsurgical needles fitted to sutures from 5-0 to 10-0 size. The pointed or narrowed ends of the apertures are provided for exerting frictional gripping forces on the needles or sutures. In addition, the V-shapes of the aperture ends thereby can accommodate different sizes of needles.

FIG. 4 illustrates the use of the invention as stabilizing and applying counter-pressure to tissue "T" which is being sutured by a needle 44 and suture thread 46. After the needle is passed through the tissue, the needle is directed through aperture 42 and constrained or gripped by the V-shaped end of the aperture. Once secure, the needle is pulled out of tissue "T" and prepared for the following suture. This results in uninterrupted coordination between the two hands of a surgeon. One hand places the needle and suture through the tissue wall or surface which is stabilized by the external counter-pressure function of one or both of feet 24 of the forceps held by the surgeon's second hand. This hand holding the forceps, pulls the needle and suture out of the operative field, maintaining proper orientation of the needle and delivers the needle into the vicinity of a needle holder held by the first hand. The open needle holder then receives the needle positioned in proper orientation and the process is continued and repeated, as is appropriate. This coordination between the two hands keeps unnecessary awkward motions to a minimum and speeds up the operation. This also prevents loss, misplacement or lack of exposure of the needle, maintains proper orientation of the needle, expedites removal of the needle from the operative field and prepares the needle for recapture by the needle holder in one continuous simple motion. These unique features are made possible by the fact that the eye of the forceps designed to capture a microneedle is set in a plane opposite of that of the forceps blades themselves.

FIG. 5 shows both feet 24 at the distal ends of forceps blades 12 being used for spreading a tube-like structure "T'", again by applying counter-pressure using the outer, lateral edges of the feet. The operation of the forceps, the guiding and capturing of the needle, and the coordination between the surgeon's hands and the various instruments are substantially the same as described in relation to FIG. 4.

FIG. 6 illustrates the invention incorporated in another form of forceps-type instrument, generally designated 48. This instrument includes an angular or offset portion 50 in forceps blades 12. Otherwise, the function and operation of feet 24 for use with the instrument is substantially the same as described in relation to FIGS. 1-5, and like numerals have been applied to like components where applicable.

FIG. 7 illustrates the invention incorporated in a further type of instrument, generally designated 52, which is a scissors-type forceps. This instrument includes blades 54 hinged or pivoted, as at 56, intermediate the distal ends 58 and proximal ends 60 thereof. As is conventional, rings 62 are formed on the proximal ends of the blades for receiving a surgeon's thumb and, another finger. Conventional lock means 64 are provided between rings 62. Again, feet 24 are provided on the tips of distal ends 58 and are used for applying counter-pressures and other operations described above.

The illustration of FIG. 7 is shown to emphasize the fact that the use of the term "forceps" in describing a surgical instrument herein is intended to encompass a wide variety of surgical instruments wherein the use of feet 24 is applicable, and it is not intended herein to limit the invention to any particular type of instrument, such as the spring-type forceps instruments shown in FIGS. 1 and 6. For instance, distal ends 58 of the scissors-type instrument in FIG. 7 are effectively the "forceps blades". Furthermore, it is contemplated that feet 24 may be mounted to the distal ends 26 of forceps blades 12 (FIGS. 1 and 6) or distal ends 58 of blades 54 (FIG. 7) by means of jointed constructions, such as ball-and-socket constructions as shown in FIG. 14 or resilient constructions such as shown in FIG. 13.

In FIG. 14 a ball 301 is mounted on the end of blade 12 with a socket 302 mounted on the stub 303 of a blade fixed to the foot 34. Optionally a coil spring 305 could be anchored at one end 306 to the blade 12 and at the other end 307 to the socket 302 in such a way as to orient the foot 34 as hereinbefore described. However, the foot can be articulated in any appropriate direction to accommodate the foot to the surface of the tissue being sutured. The articulation permits the foot to rest flat on the tissue for proper support for the needle as it exits the tissue in line with the aperture or eye 42. Upon lifting the instrument, the spring 305 will return the foot to the proper orientation relative to the blade.

FIG. 13 has a coil spring 310 anchored at one end to the blade 12, bridges the gap 315 between the foot and blade, and is fastened at the other end to the foot 34 or stub 311 on the foot. The spring orients the foot to rest in the normal position heretofore described. Placing the foot against a tissue will orient the foot to the slope of the tissue to provide a planar surface between the foot and the tissue for suturing.

Different types of joints and resilient connections are contemplated within the scope of the invention.

FIGS. 8-12 illustrate various configurations of feet 24, various locations of apertures or eyes 42 and various mounting positions of the feet onto the distal ends of the forceps blades.

More particularly, FIG. 8 shows feet 24A to be substantially narrow through the entire length thereof, with the feet mounted centrally to the forceps blades 12 near the posterior ends of the feet. Apertures 42 are located substantially in line with the forceps blades, forwardly of the blades and generally intermediate the ends of the feet.

FIG. 9 illustrates feet 24B to be substantially wider, with the left-hand foot including a series of apertures 42 extending across the foot, and the right-hand foot having a single, continuous aperture 42' extending substantially across the width of the foot. Continuous aperture 42' is serrated along the front and rear edges thereof to provide V-shaped constraining means similar to the V-shaped front and rear ends of apertures 42. With either the array of apertures in the left-hand foot in FIG. 9, or the continuous aperture 42' in the right-hand foot, multiple locations are provided in a transverse direction for receiving and constraining a needle during a suturing operation.

FIG. 10 illustrates feet 24C of a generally rectangular shape. The forceps blades 12 are mounted to the feet in a generally central location. The left-hand foot has an aperture or eye 42 located generally at each corner of the rectangular shape of the foot, two apertures being in front of the forceps blade and two being behind the blade. The right-hand foot shows a singular aperture 42 both in front of and behind the forceps blade. Again, these alternatives provide different locations for receiving and capturing a needle during a suturing operation.

FIG. 11 shows another rectangular configuration of feet 24D, but both feet are identical with a single aperture located to the right of the point of mounting the forceps blade to the respective foot. Again, this affords the surgeon another array of apertures for accommodating a particular operation.

Lastly, FIG. 12 shows feet 24E which are generally disc-shaped with no apertures in the feet. The medial edges 32' between the feet are generally straight and parallel. Such rounded feet may be used in a given application to apply counter-pressure to a specific localized area to stabilize the tissue in that area.

In all of the embodiments shown in FIGS. 8-12, the feet include generally parallel medial edges, and the feet are generally flat and extend generally transverse to the respective forceps blades.

It will be understood that the invention may be embodied in other specific forms without departing from the spirit or central characteristics thereof. The present examples and embodiments, therefore, are to be considered in all respects as illustrative and not restrictive, and the invention is not to be limited to the details given herein.