Endoscopic Sewing Instrument

The invention relates to an endoscopic sewing instrument.

In conventional endoscopic sewing instruments, such as that shown in European Patent Document EP-A1 0 482 881, a curved needle is passed through tissue and turned in the direction of its bow to make a stitch. The needle is removed from the tissue using a forceps and the needle is taken out of the sewing instrument after use.

A problem with conventional sewing instruments is that the forceps are used after each stitch to remove the needle from the tissue. To make a plurality of stitches therefore requires multiple operations for each stitch, that of moving the needle through the tissue and then grasping the needle with forceps to remove the needle from the tissue. These multiple manipulations for each stitch can lead to fatigue on the part of the surgeon and extend the length of the surgery.

There is therefore a need for an endoscopic sewing instrument that allows several stitches to be performed serially, without requiring the additional steps of grasping the needle with forceps after each stitch.

This and other needs are fulfilled by the present invention which provides an endoscopic sewing instrument comprising a plurality of rolls with at least one of the rolls being drivable, and a helical :needle connectable to a thread and having at least one winding. The needle is positionable between at least two of the rolls so as to be driven by rotation of the rolls.

Other objects, advantages and novel features of the present invention will become apparent from the following detailed description of the invention when considered in conjunction with the accompanying drawings.

FIG. 1 shows a sewing instrument constructed in accordance with an embodiment of the present invention;

FIG. 2a shows a needle constructed in accordance with an embodiment of the present invention with an atraumatically attached thread;

FIG. 2b illustrates an exemplary atraumatic needle-thread connection;

FIG. 3a shows an end view of a distal end of the sewing instrument with a needle in place and with rolls in position for introduction;

FIG. 3b is a view similar to FIG. 3a, but with the needle in place and the rolls in sewing position;

FIG. 3c illustrates another embodiment of the rollhead with three rolls and a needle in place;

FIG. 4 is a cross-sectional view of a distal end and rollhead;

FIG. 5 illustrates endoscopic use of the sewing instrument of the present invention;

FIG. 6 is a detailed view of a part of tissue sutured with the sewing instrument; and

FIG. 7 illustrates another embodiment of the present invention.

FIG. 1 shows a sewing instrument 2, comprising a handle 4, a shaft 6, a tiltable distal instrument head 7 and a rollhead 8. At the handle 4, levers 10 are provided for rotating rolls 12, 14. A pusher 16 controls opening and closing of the rolls 12, 14. A knob 18 is provided to control tilting of the distal instrument head 7. A further knob 20 is provided to control rotating of the rollhead 8.

FIG. 2a illustrates an embodiment of a needle 22 which is a helical coil having multiple windings. At the needle 22 a thread 24 is attached which has at its end a knot 26 or a knot clip 26.

FIG. 2b shows an exemplary atraumatic connection between needle 22 and thread 24. The thread 24 is squeezed at a crimping part 23 of the needle 22. In a well known manner, the thread 24 could also be glued within the needle 22.

To operate the sewing instrument, the helical needle 22 with the firmly attached thread 24 is pressed between the two rotating rolls 12, 14. The rollhead 8 is then rotated by the driven rolls 12, 14 as shown in FIGS. 3a and 3b, and thereby rotates the needle 22. As the needle 22 is rotated, its tip pierces the tissues 21 being sewed (FIG. 5 and 6). With further movement the needle 22 screws itself into the tissue 21 being sewed and connects the tissue. By proper guidance of the distal instrument head 7, the point where the tip of the needle 22 pierces the tissue 21 can be selected. The suture can be finished after the stitching, by sliding out the tip of the needle 22 from the tissue 21.

The tissues 21 to be sewed can be held together using forceps 50 and 52 and placing the tip of the needle 22 at the desired point for the first stitch as well as for the following stitches. Multiple stitches can also be made without correction if the tissue edges being sewed and the axis of the needle 22 (rolls) are correctly positioned relative to each other and are approximately parallel.

The thread 24 is also driven by the two rolls 12 and 14, which are coated with a soft plastic 13, 18, such as silicon, to provide the necessary friction between needle 22, thread 24 and the rolls 12, 14 for the rotation. The thread 24 is looped by this driving through the tissues 21. When the needle 22 has pierced the tissue layers with the desired number of stitches, the tip of the needle 22 is directed out of the tissue and the needle 22 screws itself out, so that only thread 24 remains within the tissue. The thread 24 is pulled tight using a forceps and the end is fastened using a clip or manual knot.

As FIGS. 3a-3c show, the needle 22 is driven between the rolls 12, 14 or the three rolls 30, 32 and 34 (in an alternate embodiment), where the rolls are mounted on rollhead 8. The rollhead 8 can be turned by 180.degree. so that the needle 22 is within the lumen of the instrument when the instrument is introduced through a trocar sleeve.

For removal of the needle 22, the rolls 12 and 14 are opened like a scissors (FIG. 4) by pusher 16. The open position is shown in FIG. 4 at 17 with the dotted line. The distal instrument head 7 of the unit is tiltable by knob 18 through a conventional tilt mechanism which operates as a fine ratchet positioning or locking device to fix the head 7 in each position and to bring the roll axis into the sewing direction, This makes the endoscopic sewing easier. The opening of roll 12 is accomplished by spring 38. The roll 12 is carried at its proximal end in a ball shaped disc 36 and fixed by a screw 37 so that it performs a rotating motion, A wedge 45 which is operated by rod 44 coupled to the pusher 16 presses pin 46 and roll 12 downwards against roll 14. The rolls 12 and 14 are respectively coupled to engageable wheels 28 and 29.

The rotating of the rollhead 8 is performed by toothed wheel 27 which is directly coupled to the rollhead 8 and a driving wheel 35 that is connected to a rod 42. The rollhead 8 can be rotated by 180.degree. as mentioned before, for introducing the instrument together with the needle 22. The rod 44 is connected via a flexible cable to pusher 16 and rod 42 is connected with knob 20 by which the rollhead 8 could be turned.

The rotation of the rolls 12, 14 is accomplished by rod 40 which is directly coupled to roll 14. The rotation could also be made by an electric motor M (as seen in the embodiment of FIG. 7) or by the hand lever 10 where the hand lever 10 is operated over a ratchet so that one movement of the lever cause one rotation or portion thereof of the needle, One rotation of the needle 22 corresponds to one stitch. The operator can rotate the needle 22 controlled by himself and position it to the desired pier(ting point. In the embodiment of FIG. 7, each of the different controlled movements are motorized and under the control of the surgeon through control panel CP.

The manual method has the advantage that during the suture the physician can control the instrument himself and is not left only to an automatic mechanical process, e.g., using motor driven needles which may sometimes be difficult to control. The endoscopic suture operation is shown in FIG. 5. For the operation,, besides the sewing instrument 2, an endoscopic optic with video camera 51 as well as grasping forceps 50 and 52 are used. The tissue to be sutured is held by grasping forceps 50 and 52 as illustrated in FIG. 6. The sewing instrument with its needle 22 and thread 24 is introduced through the trocar sleeve. After introduction, the rollhead 8 is turned via knob 20 by 180.degree. so that the needle 22 is positioned in its working position. The axis of the rolls 12, 14 is brought parallel to the suture direction by rotating knob 18, adjusting the tilting angle of the sewing instrument 2. The needle 22 is then brought to the tissue 21 to be sutured. By operating handle 10, the rolls 12, 14 are rotated to thereby rotate the needle 22. Directing the tissue with the forceps and the sewing instrument itself will influence the progress of the suture.

To adapt the suture to medical requirements it is necessary to have needles with different pitches to provide the proper distance between the stitches of multiple stitches. The pitch of the needle should be between 3 and 8 mm. The distance of the stitches can also be corrected within a certain range by manually moving the sewing instrument. The number of windings of the needle 22 should be such that the position of the needle 22 within the rolls 12, 14 is stable, requiring at least two windings within the rolls 12, 14. The needle 22 is thereby prevented from turning in the direction of the rolls 12, 14. Two windings of the needle 22 also result in a higher driving moment transmitted by friction to the needle 22.

A needle 22 having a number of windings between 1.25 and 1.5 also could be used. Such a needle 22 is only stable if the overlapping part is between the rolls 12, 14 and could be used for single stitches. For making a longer suture, a needle having 2 to 5 windings will be advantageous, whereby the number of windings should not be greater than the number of stitches being made, otherwise the needle does more stitches in the tissue than desired.

Although the invention has been described and illustrated in detail, it is to be clearly understood that the same is by way of illustration and example, and is not to be taken by way of limitation. The spirit and scope of the present invention are to be limited only by the terms of the appended claims.