Subcutaneous suturing device for closing abdominal wall port of a patient

The present invention relates to an instrument for closing by subcutaneous suture an orifice made in the abdominal wall of a patient.

It also concerns a method for closing by subcutaneous suture from such an outlet.

When surgery is performed by laparoscopy, the patient's abdomen is inflated by a gas and the surgeon operates by Intermediair of trocars.

A trocar is a cylindrical device which through the patient's abdominal wall and through which are introduced or the instruments to to perform the surgery.

To implement these cylindrical trocars, which may have a diameter of 5 to 15 mm, it is necessary performing a skin incision and the trocar is introduced into the abdomen by its end provided with a tip and means of protection. The end of surgery surgery, the trocar is removed and the orifice by which it was introduced, having a length of approximately 12 mm, must be closed for proper healing. For trocars passing holes with a length greater than 10 mm, it is necessary to perform their suture closure of the subcutaneous plane, that is to say, the fascia and the muscle that is the rigid part resistant. Heretofore, such openings were closed by placing a suture at the level of the superficial and deep fascia following the thickness of the abdominal wall of patients. The major difficulty to achieve such a stitch is to remove the skin, the outermost part, and to pick-muscle and fascia that is the most rigid fabric which must put the stitch to be established from the outside to inside. Surgeons often have difficulty close to the deep tissue and the fascia that is, Sometimes, this fabric is not closed. In addition, some complications may result, such non healing and non-closure of the deep hole, can cause hernias. Another complication may arise regarding the incarceration of elements intraabdominal such as for example the small intestine Inside this hole with the risk of lead intestinal obstruction or other complications digestive.

The present invention aims to solve above problems by providing an instrument for effectively close an orifice made in the wall abdominal of a patient to allow good healing of this hole.

For this purpose, the instrument of the invention, for closing by subcutaneous suture an orifice made in the abdominal wall of a patient for the passage of a trocar used for intervention Laparoscopic surgery is characterized by it comprises a rigid cylindrical cannula with a end portion can be inserted into the orifice; a piston extending coaxially into the cannula and actuated from outside by an operator; two needles removably fixed to the ends diametrically opposite a support member itself supported in the end portion of the cannula and being able to occupy, under the action of the piston, a position bent when the needles are returned to the end portion of the cannula and an extended position after introduction of the cannula into the hole and which the needles are completely protrudes from the cannula below the abdominal wall through of respectively two longitudinal windows of the side wall of the cannula being inclined relative to the longitudinal axis of the cannula part and side thereof and directed towards each other; a means of extraction needles slidably mounted in the cannula concentrically to the piston and operable by the operator to move from a low position in the end portion of the cannula to an upper position in the upper end portion thereof so as to enter simultaneously, during this movement, the two needles previously brought into wall abdominal penetrating obliquely towards each other in the opening and the cannula through the windows longitudinal, and to extract them from the support member to route into the cannula with passing concomitant use of a suture into the abdominal wall and the cannula, the wire having its ends secured respectively of the two needles and defining a loop located outside the cannula by passing through the orifice to the outside of the abdominal wall, the ends of the wire can then be captured and sectioned by the operator, after complete withdrawal of the cannula of the orifice to close the latter by making a knot with the two strands of the wire.

Preferably, the piston is a rigid rod Central slidably guided in the extraction means and whose lower end is connected to the body supporting the needles and the top end portion through an upper transverse wall closing of the cannula, the rod being axially retained in the cannula by means of locking manually releasable so as to exert on the body supporting an axial force needle retraction in the cannula to allow insertion thereof in the orifice, the operator can then unlock the locking means for moving the rod in one direction causing the deployment of the support member and Release of the needle of the cannula.

The extracting means includes a portion upper cylindrical sliding in the cannula, a cylindrical lower end portion more small diameter in which is slidably mounted the lower end portion of the rod and a part intermediate link consisting especially of two oblique walls converging towards the end portion less and each comprising a window Longitudinal allowing in low position of the means extraction, the passage of the corresponding needle to its extended position projecting from the cannula, each window terminating above the bottom of the extracting means by two edges shaped in V which can engage the hook-shaped end of the needle upon movement of the extracting means towards the upper part of the cannula.

The extraction means further comprises two legs external integral diametrically opposed gripping of the upper part of the medium by radially through respectively two longitudinal windows in the side wall of the cannula located above the passage windows of the needles and a spring is mounted prestressed between the mean extraction and cannula to recall the way extraction to its lower position.

The needles are curved and located respectively in two planes parallel to the median plane longitudinal of the cannula disposed on either side of said midplane equidistant from the latter so as to allow needles to occupy their retracted position , folding in the end portion of the cannula.

The needles are mounted detachably by their opposite ends to those hook-shaped respectively in two cross section bases circular, triangular, or other, and in solidarity with ends of the support member, the axis of each base being inclined relative to the end support plane corresponding to the support member to facilitate extraction needles during the ascent of the average extraction in the cannula.

The needles are inserted into the wall abdominal, once occupying their position out of the cannula below this wall, by pulling on the cannula to make them penetrate into the wall and then exerting on the piston a force in a direction to retract the needle into the cannula and rub the ends thereof into the hole and in the cannula through the two windows diametrically opposite thereof.

The two planes containing the two respectively needles are situated on either side of the rod piston.

According to one embodiment, the support member is constituted by a flexible blade carrying at its ends of the two needles and maintained in the portion bottom of the cannula perpendicular to the plane longitudinal center of the latter by two pairs parallel support shafts to the blade, arranged either side of the transverse median plane of the blade symmetrically thereto and integral with the body of the cannula perpendicular to its median plane longitudinal, the two axes of each pair being located on each side of the adjacent blade thereof to change the bending radius of curvature of the blade by sliding it between the support pins under the action of the piston rod, the end of bottom is integral with the geometrical center of the blade, and move to the center or down to the top of the cannula to extend or retract, and later partially return the needles or in the cannula.

According to another embodiment, the body support is constituted by two pivoting arms mounted on a common central axis integral with the body of the cannula lower portion thereof and extending perpendicularly to the longitudinal median plane of the cannula, the opposed ends of the two arms carrying the needles, and the piston controls the simultaneous pivoting both arms moving it downwards or upwards to extend or retract the needles or cannula by means of two traction arms connected to a from one to another at the lower end of the rod of the piston by a pivot articulation integral with the piston parallel to the pivot axis of the support arms needles and also at their opposite ends an articulated manner to the two arms respectively of carrier, in the vicinity of the needles.

The stem of the locking means in its position of bending of the support member comprises two lugs diametrically opposed integral with the upper part of the rod projecting radially therefrom and coming to rest in or on the transverse wall closure of the cannula that following the support member is constituted by the flexible blade or both arms pivoted, this wall comprising an oblong hole defined on either side of the central orifice passageway of the stem and allowing the passage of two studs through thereof by rotation of the upper part of the stem in relation to its lower part to unlock the rod and move it axially in the cannula.

The invention also provides a method of subcutaneous suture by closing an orifice in the abdominal wall of a patient for the passage a trocar used for surgical intervention laparoscopically, using the instrument as defined above, and which is characterized in that it consists introducing the cannula into the orifice immediately after extraction of the trocar with the abdomen swollen yet a gas ; moving the piston relative to the cannula in a direction to act on the support member of needles so as to output the needle through windows of the lateral wall of the cannula below the abdominal wall; exert a pulling movement on the cannula for inserting the needles into a thickness portion of the abdominal wall; move new piston in the cannula in reverse order bring the hands to cross the entire party thickness of the abdominal wall and the orifice and back into the cannula through the windows of this and last extracting means; moving means relatively extraction in the cannula part top thereof so that the lower edges V windows of this means seizing respectively Hook the ends of the needles to remove of the support member and introducing them into the cannula; slightly push the cannula into the hole; activate again the piston in the direction to retract the support member without the needles in the cannula; and remove the cannula from the opening to seize and severing both ends of the suture and proceeding with closure of the orifice.

The method also includes, when the member support is constituted by the flexible blade, to move the piston upwardly relative to the cannula to exit the needles of the cannula and downwardly thereof to partially retract the needle into the cannula and subsequently return the blade completely in cannula prior to its withdrawal from the orifice.

Alternatively, the method further includes, when the support member is constituted by the two arms hinged, to move the piston downward with respect to the cannula to exit the needle cannula and to the top thereof to partially retract the needles in the cannula and subsequently return arms completely into the cannula before withdrawal the orifice.

The method further includes, after removal of the cannula port, to shoot the free ends of the suture to tension the loop in the wall Abdominal and then allow to close the orifice tying the cut ends of the wire.

The invention will be better understood and other aims, features, details and advantages thereof will become clearer in the description Explanatory which follows with reference to drawings accompanying schematic given by way of example illustrating two embodiments of the invention and wherein :<ul><li>FIG 1 is an exploded perspective view of the instrument of the invention inserted through a abdominal wall of a patient;</li><li>Figures 2 to 8 show the instrument of Figure 1 at different operating phases for close by subcutaneous suture a hole made in the abdominal wall of the patient;</li><li>9 shows another mode of embodiment of the support member needles in portion of the closure tool of the orifice and occupying its deployed position;</li><li>FIG 10 is a view of the support member of Figure 9 in deployed position; and</li><li>Figure 11 is a top view according to the Arrow XI in Figure 9.</li></ul>

Referring to Figures 1 to 8, the instrument of the invention is designed to permit closure by subcutaneous suture of a 1-hole made through a 2 abdominal wall of a patient for the passage of a trocar having previously served in an intervention surgical laparoscopy.

The instrument includes a rigid cylindrical cannula 3, for example of metal, which may be partially introduced into the orifice immediately after withdrawal 1 trocar when complete surgery that is to say at a time when the patient's abdomen is always inflated by a suitable gas.

Figure 1 shows the instrument in its position initial introduction through port 1 of the wall abdominal 2 and to which the end portion bottom 4 of the instrument is located in the abdomen underneath the wall 2.

The instrument further comprises a central piston 5 shaped cylindrical rigid rod extending coaxially in the cannula 3 and operable manually from the outside of the cannula 3 by via an external handle 6 to slide axially guided manner relative to the cannula 3 as will be seen later.

The instrument further comprises two needles 7 removably secured to the ends diametrically opposite of a support member 8 consisting of a blade flexible supported in the lower end portion 4 of the cannula 3. For this purpose, the flexible strip 8 is maintained in part 4 perpendicular to the plane longitudinal center of the cannula 3 by two pairs of axes support 9 parallel to the blade 8 and disposed on side of the transverse median plane of the blade symmetrically to this plane. The supporting shafts 9 are integral with the body of the lower part 4 of the cannula 3 perpendicularly to the longitudinal median plane of the cannula and the two axes 9 of each pair are located on each side of the blade 8 in the immediate vicinity thereof being offset with respect to one another along the blade 8.

The lower end of the piston rod 5 is secured by any suitable means such as screws fixation, the geometric center of the support blade 8 such that upward movement of the cannula 3 the rod 5 causes an elastic deformation of the blade 8 by sliding thereof between pairs of axes of support 9 to exit the opposite end portions of the blade 8 through two windows respectively 10 diametrically opposite longitudinal rectangular carried out through the side wall of the body of the lower end portion 4 of the cannula 3, so the two needles 7 do completely projection outside of the end portion 4 as shown in Figure 2. A downward movement of the piston rod 5 from its position shown in Figure 2 causes a bending deformation of the blade 8 to the lower end of the cannula 3 and the sliding the blade 8 between the two pairs of support shafts 9 distorting the blade 8 so that its parts end can once again enter the game end 4 of the cannula 3 through the two windows 10 as shown in Figure 7.

The piston rod 5 is locked in its position initial shown in Figure 1 by means of releasable locking manually and consists of two lugs 11 integral with the rod 5 partly 5a top thereof protruding therefrom and diametrically opposed. The two lugs 11 may occupy a position transverse to a light 12 carried out through the circular wall 13 of closing the upper end of the cannula 3 and under which abut the two lugs 11 under the action of the elastic reaction force exerted by the blade 8 of the shaft 5. The upper portion 5a of the rod 5 can be rotated using the handle 6 relatively 5b at the lower portion thereof of about 90 ° for bring the two lugs 11 plumb light 12 unlock the rod 5 of the cannula 3 and allow to exert traction on the rod 5 causing the movement of the blade 8 in a direction causing the 7 needles out of the end portion 4 to through the two windows 10. As spring in particular Figure 4, the upper part 5a of the rod 5 has at its end a circular head 5a1 smaller diameter engaged in a form of countersink conjugated 5b1 formed at the end of the part bottom 5b of the shaft 5 opposite to the blade 8, of so as to allow rotation of the upper part 5a relative to the lower part 5b of the rod 5. The 5a1 head may consist of a screw head whose threaded portion is blocked by screwing in the end the lower part 5a of the shaft 5 coaxially with thereof.

Needles 7 are each mounted at the end corresponding blade 8 in a base 14 fixed the end of the blade 8 and having a section cross which can be circular, triangular, or other. The axis of each base 14 is inclined relative to the end support plane corresponding blade 8 to facilitate extraction the needle 7 as will be seen later. In Alternatively, always to facilitate the extraction of each needle 7, each base 14 may have its axis perpendicular to the corresponding end plane of the blade 8, but have a sloping free end face relatively to the end plane so that the end of the needle 7 engaging the base 14 has a shoulder portion resting on this inclined face.

The needles 7 are identical, curved and directed towards one another being located in respectively in two planes parallel to the median plane longitudinal of the cannula 3, arranged on either side This plane substantially equidistant from it, these two parallel planes being further located on either side of the piston rod 5 so as to allow 7 needles to occupy their original position back in intersecting in the end portion 4 of the cannula 3. Needles 7 are located above the blade 8 Referring to Figure 2. Each needle 7 ends a tip portion shaped hook 7a.

The instrument also comprises means 15 extraction needles 7 slidably mounted in the cannula 3 concentrically to the rod 5 and being operated from outside to move it from a position low in the end portion 4 of the cannula 3, as shown in Figures 1 to 4, to a high position in upper part of the cannula 3 shown in Figure 8 to grip simultaneously, during this movement, the two needles 7 previously brought into 2 abdominal wall obliquely penetrating toward the other in the orifice 1 and the cannula 3 through longitudinal windows 10 and extracting needles 7 of the flexible blade 8 to route up in the cannula 3.

The extracting means 15 thus comprises a portion upper cylinder 16 slidable along the corresponding inner lateral surface of the cannula 3, a lower cylindrical end portion 17 more small diameter in which is slidably mounted the lower portion 5b of the rod 5, and a part intermediate link consists of two walls opposite 18 located on either side of the rod 5, each wall 18 having a straight portion 18a parallel to the rod 5 and an oblique part 18b converging towards the lower end portion 17. Each wall 18 has a longitudinal window 19 allowing the passage of the corresponding needle 7 and ending, above the lower part 17 of the extracting means 15, by two edges 19a of V-shaped the bottom of which can engage the shaped end hook 7a of the needle 7 when the average displacement extraction 15 to the top of the cannula 3. Because needles 7 are shifted from the central longitudinal plane of the cannula 3, the windows 19 are also listed.

To permit rotation of the upper part 5a of the rod 5 in relation to its lower part 5b when the unlocking operation of the rod 5 of the cannula 3 from its initial position shown in 1, the lower part 5b can be fluted committing to slide in the splined bore corresponding to the lower part 17 of the means extraction 15. However, this provision is not mandatory, because the whole constituted by the end of the rod 5, the blade 8 and the pins 9 keeps rotating the lower part 5b of the rod 5 with respect to the cannula.

The extracting means 15 further comprises two external lugs diametrically opposed gripper 20 integral with the upper cylindrical portion 16 projecting radially through respectively two longitudinal windows 21 of the side wall the cannula 3 and which are situated above the windows 10 passage of the needles 7.

The extracting means 15 is biased to its low position in the cannula 3 by a helical spring 22 compression mounted prestressed between the wall upper closure 13 of the cannula 3 and a wall internal cross 23 of the extraction means 15 located in the upper cylindrical portion 16 thereof. The wall 23 includes a circular central opening 24 to through which the rod 5.

A suture 25 has its two free ends respectively integral with the two needles 7 opposite of their hook-shaped ends 7a and has a sufficient length to form a loop 25a located, in the introduction of the instrument in the wall abdominal 2, outside thereof and maintained at outside until the withdrawal of the instrument from the wall 2. Each end of the wire 25 may be attached to the corresponding metal needle 7 by crimping.

The lower part 4 of the cannula 3 has a bulbous end in which the axes lie 9 Blade holder 8 so as to be atraumatic.

The operation of the instrument already spring the description was made above and will be now explained.

In the initial conditions of use the instrument, the extracting means 15 occupies its position low in the cannula 3 by the return spring 22 and the two lugs 20 bearing respectively on both edges lower of the two windows 21 of the cannula 3, and rod 15 is locked at its lowermost position in the cannula 3 so as to exert on the blade 8 a pressure holding the ends of the blade 8 and the two needle 7 within the end portion 4 the cannula 3 as shown in Figure 1.

The instrument is then introduced into the orifice 1 through the wall 2 until part lower end 4 is located in the abdomen below the wall 2. This maneuver is carried out immediately after extraction of the trocar used previously for surgery by with laparoscopic abdominal kept inflated by the gas to avoid damage to internal organs. when the introduction of the instrument through the wall abdominal 2, the surgeon will be careful to maintain 25a the wire loop 25 outside the patient's body with the end portions of the wire passing in port 1 and through the two respectively windows 10 of the end portion 4.

Then, the stem 5 is unlocked from the cannula 3 by turning the top part 5a with the handle 6 until the two lugs 11 come in plumb with the light 12 and the surgeon then applies pulling the rod 5 to move to the top of the cannula 3 the geometric center of the blade 8, and sliding thereof between the two pairs of axes support 9, to tilt the two ends of the blade 8 and the two needles 7 by removing them from each other to the position shown in Figure 2 which the two needles 7 are right in below the internal surface of the abdominal wall 2. Thus, the two needles 7 have moved into their respective parallel planes to cross their position either side of the rod 5 shown in Figure 1 to their position shown in Figure 2 by passing through the windows 19 of the extraction means 15 and the windows 10 of the end portion 4 of the cannula 3.

From the position shown in Figure 2, the surgeon exerts on the tool a tensile stress upwardly to introduce the needle 7 in a thickness portion of the wall of the apanévrose abdominal 2 as shown in Figure 3.

Then, the surgeon pushes back the rod 5 in the cannula 3 so that the lower end of the rod 5 folds by bending the blade that slips between 8 two pairs of pins 9 and needles 7 through completely the thickness portion of the abdominal wall 2 to engage the cannula 3 through windows 10 of the end portion 4 of the cannula 3 and windows 19 of the extraction means 15 as shown in 4.

The surgeon then moves to the top of the cannula 3 the extracting means 15 using the two External tabs 20 until the tabs 20 come abut on the respective upper edges of the two windows 21 of the cannula 3 as shown in Figure 5. This figure shows that during the movement towards the top of the extraction means 15, the lower edges in V-shape of the two windows 19 seized the ends hook 7a needles 7 for disengage from their respective bases 14 with end portions of the wire 25 being pulled by the needles into the cannula 3 through the two windows 10. Figure 5 also shows that the two bases 14 lie substantially just below the wall abdominal 2.

The surgeon then pushes the instrument for bringing the lower end portion 4 of the cannula a distance from the abdominal wall 2 (Figure 6) and allowing, by pressure exerted on the piston rod 5, the folding of the leaf spring 8 until the end portions thereof fall again without needles, in the end portion 4 as shown in Figure 7. The surgeon manipulates the handle 6 to rotate the upper part 5a the rod 5 in relation to its lower part 5b and bringing the two lugs 11 in the locked position the shaft 5 below the upper closure wall 3 of the cannula.

Finally, the instrument is completely removed from port 1 as shown in Figure 8 and the wire 25 solidarity needles 7 is pulled in order to continue to pass through the thickness of the abdominal wall 2 following the same path as the needle 7 until the loop 25a is located substantially at the bottom of port 1 at the inner side of the wall abdominal 2. The surgeon only has to then severing both end portions of the wire 25 and manually perform a node with both strands of the wire for positioning and close the walls vis-à-vis port 1 including apanévrose and muscle- deep, with tension the portion of the wire loop under the wall 2.

Figures 9 to 11 show another embodiment of embodiment of the support member of the needle 7 can be used instead of that formed by the flexible blade 8 of the first embodiment.

In this second embodiment, the body support is constituted by two arms 26 pivotally mounted on a common central axis 27 integral with the body of the in lower cannula part 4 thereof and extending perpendicularly to the longitudinal median plane of the cannula. The axis 27 may be fixed by its ends force-fitted respectively in two holes coaxial opposite made in the side wall of the end portion 4 of the cannula 3 and the two arms 26 are pivotably mounted on the axis 27 in the manner of a hinge joint 28.

Both arms 26 comprise, in solidarity with their opposite ends, the two bases 14 in which are removably mounted both needles 7. To allow two bases 14 to be located in two planes spaced from one another and parallel to the plane longitudinal center of the cannula 3, the two arms 26 have, seen from above, an elongated S-shaped configuration whose curved branches are situated on either side of the axis 27 with the two collars located on a diagonal passing through the geometric center of the axis 27.

The piston rod 5, identical to the rod 5 of first embodiment, controls the pivoting Simultaneous application of two arms 26 by means of two tension arm 29 connected firstly to one another in the lower end of the rod 5 by a pin hinge 30 integral with the rod parallel to the pivot axis 27 and secondly at their ends opposite articulated manner to the two arms respectively holder 26 in the vicinity of the bases 14 for supporting the 7 needles.

When the instrument is introduced through the abdominal wall 2, the two arms 26 occupy their position shown in Figure 10 at which the two arms are raised above the hinge pin 27 in defining an acute angle to house parties end of arms 26 and their associated needles 7 in the lower end portion 4 of the cannula 3.

To deploy the two arms 26 to their position opening projecting through the windows 10 of the lower part 4 of the cannula 3, the surgeon exerts a downward thrust of the cannula of the piston rod 5 so that the two tension arms 29 do pivoting the two arms 26 about the axis 27 in the away from one another until the position at which needles 7 are located below the wall 2 as shown in Figure 2.

Otherwise, the operating principle of the instrument provided with the support member according to the second embodiment is identical to that described above with reference to the first embodiment, except that it is necessary to exert a thrust force on the piston rod 5 to deploy the needles are position projecting outside the cannula 3 and pull the rod 5 to collapse again by bringing one the other two arms 26 and the housing, without the needles, in the end portion 4 of the cannula 3 before complete extraction of the instrument of port 1. The other difference relative to the first mode embodiment is that the locking of the rod 5 in particular to the housing position of the arms 26 and 7 needles in the front end part 4 introduction of the cannula into the wall 2 takes place in causing the two locking lugs 11 of the wall cannula upper closure of the three transversely 12 light and to facilitate the deployment of two arm 26 to their position shown in FIG 9, it is possible to provide a coiled torsion spring on pivot axis 27 and acting on the two arms 26 an elastic force tending to move them apart from one another and maintain their deployed position.

The instrument according to the invention enables effectively closing the trocar through hole and suturing the muscle and fascia of the abdominal wall of a patient.

As an indication, the instrument can have a length of about 20 cm with a maximum external diameter 12 mm at its enlarged portion, the diameter of the cannula to its two-thirds of its length can be 10 mm. In position projecting from the flexible strip 8 or of arms 26 supporting the needles 7, their ends may extend beyond the lower end part 4 the cannula 3 of 5 mm to 7 mm on either side thereof. Of course, these dimensions are given as of non-limiting example.