WO2007138284A2

WO2007138284A2 - Knot tying device

Info

Publication number: WO2007138284A2
Application number: PCT/GB2007/001955
Authority: WO
Inventors: James Oliver Brewer Lemoine
Original assignee: James Oliver Brewer Lemoine
Priority date: 2006-05-25
Filing date: 2007-05-25
Publication date: 2007-12-06
Also published as: GB2452214B; WO2007138284A3; GB2452214A; GB0823334D0; GB0610356D0

Abstract

A device (110) for assisting in the tying of knots in a length of suture or the like during surgical procedures is disclosed. In one embodiment the device comprises an inner jaw pair (116) for holding a first length of a suture, the holder being rotatably supported by a rotatable shuttle (114) which accepts a second length of the suture, the shuttle being moveable such that the first and second lengths of the suture are relatively repositionable. The shuttle is rotatable freely under a force exerted by the suture in the recess. Withdraw of the device after one length of suture is passed through the shuttle causes a half knot be to produced.

Description

Knot Tying Device

This invention relates to a knot tying device for assisting the tying of knots intracorporeally during, for example, laparoscopic surgical procedures.

Conventionally, surgeons manipulate one or two pairs of forceps to tie knots in suture during surgery. Such a technique is difficult to perform, particularly during endoscopic procedures. Devices which can manipulate suture threaded needles to assist in tying knots are available commercially although most of these are complicated and not suitable for low cost, disposable use. US5501690 describes a device which employs a driven shuttle to twist together two lengths of suture so as to generate a half knot.

According to a first aspect the present invention provides a device for assisting in the tying of knots in a length of suture or the like during surgical procedures, the device comprising a first holder for holding a first length of a suture, the holder being operationally connected to a rotatable shuttle having at least one recess for accepting a second length of the suture, the shuttle being moveable such that the first and second lengths of the suture are relatively repositionable, characterised in that the shuttle is rotatable freely under a force exerted by the suture in the recess. Preferably the shuttle comprises a cylinder or a segment of a cylinder having an axis of rotation and the recess is in the form of at least one slot extending generally parallel to the axis of rotation and preferably located on an outer surface of the cylinder or segment. Preferably, the holder is adapted to hold suture or the like or a surgical needle. Preferably the shuttle is engageable with a handle and/or with the suture holder at the outer surface, thereof, the or each slot being of sufficient size so that part of the slot is exposed during rotation of the shuttle whilst accommodating the second length of the suture. Preferably the suture holder is pivotably connected to the shuttle.

Preferably the suture holder comprises at least one moveable jaw cooperating with a further jaw. The further jaw may be fixed or movable and if fixed may comprise part of the shuttle.

Preferably the suture holder or the at least one jaw is two pairs of jaws including an inner pair acting together to provide a first suture holding means at the jaw pair's inner facing surfaces, and an outer pair acting on the inner pair to force together or release the inner pair.

Preferably an outer surface of the inner jaw pair and an inner surface of the outer jaw pair define a suture guiding means for guiding a suture toward the recess.

According to a second aspect of the invention there is provided a device for producing at least one half knot in a length of suture or the like during surgical procedures, the device comprising: a handle extending generally along an axis and having a free end; a holder at the other end of the handle adapted for holding suture; and a rotatable member between the free end and the holder which is rotatable under the influence of the suture; the device being operable such that; a length of suture is arranged so that it extends around or through an item to be sutured, providing two free lengths of the suture, a first of the free lengths of the suture is held in the holder, so that the said first length has a first portion which extends initially away from the holder and away from the item, and then forms a loop which loops back to a second portion which then extends toward said item, extending past one side of the handle; and operable such that; after manipulation of a second of the free lengths to a position whereby it extends adjacent the one side of the handle and between the first and second portions, the said second length is caused to engage the rotatable member which moves the second length from a position adjacent the one side of the handle to a position adjacent an opposite side of the handle through the axis of the handle and between the handle's free end and the holder, thereby causing the loop to be moved in the direction of the opposite side of the handle also; and further operable such that; moving the device in the direction of the free end of the handle to cause the

(held) first portion of the suture to extend between the second length and the second portion whilst the loop extends around the second length, thereby produces the half knot.

Preferably the second length of the suture is held in tension whilst it is caused to engage the rotatable member. More preferably the rotatable member of the knot tying device includes a freely rotatable shuttle, which is rotatable e.g. under the influence of the tensioned second length of the thread. The invention extends to a device as defined above mounted to a manipulatable mechanical arm, such as a manually or computer controlled robotic arm.

The invention extends also any novel features described herein or any novel combination of features described herein, whether or not such features are described in combination herein.

Embodiments of the invention will now be described by way of example with reference to the drawings, wherein:

Figures 1 to 4 show a device according to a first embodiment of the invention; Figure 5 shows a detailed view of parts of the device shown in Figures 1 to 4;

Figures 6a, b and c show the device of Figures 1 to 4 in operation during knot tying;

Figure 7 shows a device according to a second embodiment of the invention; Figures 8 to 14 show details of parts of the device shown in Figure 7; Figures 15, 16a and 16b show the operation of the device shown in Figure 7; and Figures 17 and 18 show a third embodiment of the invention.

With reference to Figure 1 a device 10 is illustrated for use in laparoscopic knot tying procedures. This device has an overall width x of about 3 to 25 mm in order that it can be used effectively intracorporeally, although smaller or larger sizes are possible. The device has a handle 12, only part of which is shown, extending generally along an axis z. The handle will be long enough to extend outside a body cavity during use so that head 15 of the device can be manipulated by means of handle 12. At the head 15 of the handle is a rotatable shuttle 14 which is free to rotate about a centre C. The shuttle carries a jaw 16 which may be closed to hold a suture at suture holding area 18. The jaw 16 is closable by pivoting about pivot 26 and is latched into position using a latch 20. The jaw 16 is closable under the action of lever 22 which in turn is caused to pivot about pivot 28 by rod 24 operated by the user of the device holding handle 12. Whilst a pivoting lever 22 is shown in this example, other mechanisms or arrangements could be used.

Referring to Figure 2, lever 22 is shown in its "jaw closing" position as a result of a user pushing forward rod 24 in the direction of arrow P. Such action causes latch 20 to become engaged, thereby holding jaw 16 closed in a suture holding position.

Referring to Figure 3, when the rod 24 is moved in the opposite direction (in the direction of arrow Q) lever 22 is returned to the open position as shown in Figure 1. The lever 22 may be biased into an open position such that no positive movement of the rod 24 is required. However, jaw 16 is now latched in the closed position, held by latch 20. Shuttle 14 is again free to rotate about centre C.

Referring to Figure 4, shuttle 14 is shown rotated by angle y. Shuttle 14 has a slot 30 which in Figures 1 , 2 and 3 is on one side of the axis z extending generally along the length of the handle 12, and in Figure 4 the slot has been moved to the opposite side of the axis. In each case the slot is exposed such that a suture or the like could enter or be removed without obstruction and during the movement of the slot from one side of the handle to the other, the slot remains exposed so that a length of suture can pass from one side of the handle to the other.

Figure 5 shows a detail of the shuttle and handle shown in Figures 1 to 4. In particular, the shuttle 14 has an arcuate groove 32 which extends with a radius L about the centre of rotation C. The shuttle 14 has an identical groove

32 on its lower face (not shown). Handle 12 has a recess 34, into which the shuttle 14 is captively but moveably engaged. On the periphery of the recess 34 are disposed ridges 36 which fit within the grooves 32 to prevent release of the shuttle 14 from the recess 34. Referring to Figures 6a_r b and c, the operation of the knot tying device 10 is shown in detail. For clarity lever 22 is not shown in Figures 6a, b and c. A suture 1 is manipulated such that it extends, in this case around, a vessel V to be closed, and consequently providing two free lengths of suture 2 and 3. One of the lengths 2 is held by jaw 16 operated in the manner described above. Manipulating the suture 2 and device 10 further provides a loop of suture 4 which extends in a direction away from the vessel V. The further free end 3 of the suture is further manipulated such that it is received into slot 30 initially exposed on one side of the device 10 as shown in Figure 6a. The free end 3 of suture 1 is held under slight tension T. This tension T causes rotation of the shuttle 14 in the direction of arrow y. To prevent sliding of the free end 2 of the suture 1 a protrusion 40 extends from the said one side of the handle 12. As shuttle 14 rotates slot 30 carrying suture 3 is displaced from one side of the handle to the other side (as shown in Figure 6b). This rotation causes the suture to move from one side of the handle to the other carrying with it loop 4. Withdrawal of device 10 in the direction of arrow W shown in Figure 6c causes a half knot to be produced in suture 1 , as loop 4 is drawn between free ends 2 and 3. The jaw 16 of the device 10 can be released, for example, by pushing rod 24 in the direction of arrow P (as shown in Figure 2). This action causes the release latch 20 and consequently the release of jaw 16. The device will return to the state shown in Figure 1.

The above operation can be performed again to produce a further half knot and thereby to produce a full surgical knot which can be used to close the vessel V. The withdrawal of the device 10 in the direction of arrow W also causes the shuttle to return to the position shown in Figures 1 to 3.

Referring to Figure 7 there is shown a second embodiment of the invention which operates in a similar manner to that described above.

Handle 112 (only a portion of which is shown) is again long enough to extend out of a body cavity during use. The overall dimensions of the device 110 will be similar to that of the first embodiment. The device includes a head

115 having freely rotatable shuttle 114 captive at one end of the handle 112, and a suture holding mechanism 117 adjacent the shuttle 114. The suture holding mechanism 117 includes an inner pair of jaws 116 and an outer pair of jaws 122 together providing a suture holding area 118. In use a pair of rods 124 are operated by a lever (not shown) in the direction of arrows P and Q to respectively close and open outer jaws 122. The closing of outer jaws 122 brings together inner jaws 116 which are then latched together by means of latch 120. Further force in the direction of arrow P will release latch 120. The rods 124 and jaws 122 are each connected by means of a ball and socket joint 121 and 123 respectively (the ball 121 is shown in Figures 8 to 15). Other mechanisms for opening and closing the outer jaws 122 are envisaged.

As will be described in detail below the general operation of the device 110 is such that a suture can be displaced from the right or left (L, R) hand side of the device to the other side of the device by means of the rotation of shuttle

114,.

An exploded view of the head 115 of the device 110 is shown in Figure 8. Shuttle 114 is illustrated having five slots 130 each for receiving a suture. More or less slots could be employed. Mounted pivotally to the shuttle are the inner jaws 116 provided with a latching mechanism 120. Outer jaws 122 are positionable around the shuttle 114. The shuttle 114 is freely rotatable about axis C in the directional arrows Y and is prevented from axial displacement by means of a circumferential groove 132 which co-operates with a complimentary ridge 136 extending radially inwardly from jaws 122. The assembly 115 is captively receivable within a recess 134 in handle 112. Once assembled, each of the components of the head 115 is free to rotate within the recess 134 about axis C₁ although the outer jaws 122 are restricted in movement by their connection with rods 124.

Figures 9, 10, 11 , 12, 13 and 14 show the head 115 in various positions. In Figures 9 and 10 the head is shown with outer jaws 122 closed against inner jaws 116. This position is achieved by pushing rods 124 in the direction of arrow P so as to force together outer jaws 122 thereby bringing together inner jaws 116. In this position latch 120 will hold together the inner jaws 116. Figures 11 and 12 show a further position of head 115 wherein the outer jaws 120 have been moved apart by moving rods 124 in the direction of arrow

Q. Inner jaws 116 are held together by latch 120 and provide a clamping action, to hold a suture. Two suture accepting areas 119 are thus provided, and two slots 130' and 130" of shuttle 114 are exposed.

Figures 13 and 14 show a position of head 115 after the inner jaws 116 have been brought back together, by moving rod 124 in the direction of arrow P again. Following the movement of the jaws 122 together latch 120 is released due to the force exerted on the inner jaws 116 by the outer jaws 122. The inner jaws 116, in this instance, are forced apart by means of a spring force such that they travel with the outer jaws 122 as the outer jaws are moved apart.

The operation of the device 110 is illustrated in Figures 15, 16a and 16b.

The head 115 is manipulated by rods 124 into the position shown in Figures 11 and 12. In this position the inner jaws 116 are used to clamp one free end of the suture. The needle N is passed through incision I such that the suture provides two free ends T and 3\ The head 115 is further manipulated such that one of the free ends T is looped away from incision I and the other of the free ends 3" is received into slot 130' of the shuttle 114. Slight tension in the direction of arrow T is placed on the free end 3^" so as to cause the shuttle to rotate in the direction of arrow y.

With reference to Figure 16a it can be seen that rotation of the shuttle 114 in the direction of arrow Y causes the shuttle to rotate such that the slot 130' is moved to the new position shown in Figure 16a. In so doing the free end 3^* is now on the opposite side of the axis z of the handle 112. Removal of the handle 112 (with head 115 attached) in the direction of arrow W now causes the suture 1 to form a half knot as shown in Figure 16b.

This half knot can be tightened, and a further half knot produced by repeating the operation described immediately above. The two half knots can be used to stitch the incision I and multiple stitches can be performed with ease.

Figure 17 shows a pictorial view of a third embodiment of the invention. Parts of the third embodiment having an equivalent function to the parts of the second embodiment are referenced with numerals having the same last two digits in each embodiment. Figure 18 is a partially exploded view of the parts shown in Figure 17.

The operation of the third embodiment is substantially the same as described above with reference to the second embodiment. However, there are some differences in the arrangement of the third embodiment as described below.

With reference to Figures 17 and 18, in that embodiment, the outer jaws 222 are rotated by means of extensions 223, in a scissor action. The jaws 222 are rotationally supported in a part circular groove 226 in the head 213 of the device 210, within which complementary central portions 227 of the jaws 222 can slide. The extensions can be rotated remotely by means of push/pull rods

(not shown) similar to rods 124 shown in Figure 7. Movement of such rods in the direction of arrows Q closes the jaws 222 and movement in the direction of arrows P opens the jaws 222.

The shuttle 214 is freely rotatable in the directions of arrow Y about an axis C", within recess 234 in a head 213 of the device 210. The shuttle 214 is prevented from axial movement by a flange 235 at one side of the head 213 and by a closure plate 236 at the other side of the shuttle.

Slots 230 in the shuttle 214 include openings which taper inwardly providing a self locking action for holding suture within the slot. The self locking effect is enhanced by serrations in the sides of the slot extending parallel to the axis C".

Latch 220 is located adjacent the inner area of inner jaws 216, but has the same function as the latch 120 described above. In this embodiment parts

214, 216, 218 and 220 shown assembled together in Figure 18 and are intended to form a removable and disposable cassette, although they can be disassembled further.

Modifications, improvements and alternatives will be readily apparent to the skilled addressee. For example, any suitable material or materials can be used to produce the devices 10, 110 and 210. It is envisaged that the moving parts of the devices will be produced from plastics mouldings with magnetic inserts or fillings if required so that they can be disposed of, although, it is possible to produce the parts from other materials such as metal so that they have a longer life and can be sterilised effectively for reuse.

The slots 30 and 130 may be provided with a self locking mechanism similar to that of slot 230, such that pulling in one direction locks the suture etc into the slot. Such a mechanism will prevent the vessel V or incision I from being pulled when tension T is exerted on the suture for rotating the shuttle 14, 114 or 214. Additionally, the provision of a self locking mechanism allows loop A to be relaxed. Moreover, in the foregoing the jaw 16, or jaws 116, 216 may be replaced by any suitable suture holder for example a tapering slot which will hold the suture when the suture is forced into the slot. Removal of the suture can then be effected by pulling the suture from the tapered slot. The self locking arrangement described in relation to the slots 230 could be modified. Other self locking arrangements are possible, for example, locking cam arrangements could be used.

Where a pair of jaws 116, 216 are used they may be biased apart when not latched together, by spring force e.g. a compression spring between the pair or by means of the jaw pair being made of resilient material and so connected that the pair are sprung apart by the resilience of that material. Magnetic repulsion of the inner jaws could also be employed. Jaw 16 or inner jaws 116, 216 may be urged into a closed position and may be pulled open by outer jaw(s) 22, 122, 222 when the engaged thereby, for example by means of a releasable latch similar in construction to latch 20, 120, 220. The suture accepting area 119, 219 can be maintained by holding latched inner jaws 116, 216 in the middle of the opening which exists when outer jaws 122 are open. Inner jaws 116, 216 can be held in that middle position (shown in Figures 11 , 12 and 17) by magnetic repulsion forces. As an alternative, or as well as, a lead-in, for example lead-in 221 as shown in Figure 17, can be formed on the ends of the outer jaws 122 so that a suture can be used to push open an area 119 when the latched inner jaw pair is touching an outer jaw 122.

One mechanism for opening and closing outer jaws 122 is shown, however, many other mechanisms are possible. In particular the rods 124 can be repositioned so that they are further from the axis of rotation C" and/or positioned further along the axis of the handle 112 in the direction of arrow W (Fig 16a) thus providing greater torque. Alternatively, a gearing system, scissor action, or toggle action can be employed to move the jaws 122. Such a gearing system may be internal to the handle 112. Similar arrangements can be used for the third embodiment.

The shuttles 114 or 214 may have roller bearings at their circumferential periphery to aid its rotation, and either shuttle may have an indexing mechanism such that a slot 130, 230 will present itself at the suture accepting area 119, 219 in use. The shuttles shown are cylindrical in form, and rotate with one degree of freedom. It is possible to have spherical or part spherical shuttles which can rotate in a complementary socket with one or two degrees of freedom. Shuttles 14 and 114 are shown held to their respective handles by means of a groove. Shuttle 214 is held in a cylindrical recess having obstructed ends. However, other means of holding the shuttle to the handle are envisaged, for example the shuttle could have a radially extending flange at each end which captively engages part of a plane bore in the handle.

Outer jaws 122, 222 may have recesses extending along their inner faces, of a dimension such that the inner jaws 166, 216 fall within such recesses either partly or wholly, thereby to provide addition support of the inner jaws 116, 216 when the outer jaws are urged towards the inner jaws.

The removeable cassette shown in figure 18 and mentioned above could be arranged such that special tooling is required to remove and replace it. Such tooling can prevent contamination of a replacement the cassette where no handling of the cassette is required. Where very small cassettes are employed the tooling will assist in removal and replacement of the cassette.

Whilst the devices shown in the embodiments are likely to have a dimension suitable for conventional laparoscopic surgery, it may be that the devices are made much smaller than the 3mm minimum size mentioned above.

The devices may even be of a size viewable in use only by magnification, or even smaller, being produced by so called nano-engineering.

It is envisaged that the embodiments described above may be used for knot tying or stitching intra, or extra corporeally. The knot tying device is of particular use during procedures which employ an endoscope. Further, the device is of benefit in mechanically assisted stitching procedures for example when mounted to a manipulatable mechanical arm, for example a robotic arm manipulated by a human or by computer during a procedure.

Claims

1. A device for assisting in the tying of knots in a length of suture or the like during surgical procedures, the device comprising a first holder for holding a first length of a suture, the holder being operationally connected to a rotatable shuttle having at least one recess for accepting a second length of the suture, the shuttle being moveable such that the first and second lengths of the suture are relatively repositionable, characterised in that the shuttle is rotatable freely under a force exerted by the suture in the recess.

2. A device for assisting in the tying of knots as claimed in claim 1 wherein the shuttle comprises a cylinder or a segment of a cylinder having an axis of rotation and the recess is in the form of at least one slot extending generally parallel to the axis of rotation.

3. A device for assisting in the tying of knots as claimed in claim 2 wherein the or each slot is located on an outer surface of the cylinder or segment.

4. A device for assisting in the tying of knots as claimed in any one of claims

1 ,2 or 3 wherein the holder is adapted to hold suture or the like or a surgical needle.

5. A device for assisting in the tying of knots as claimed in any one preceding claim wherein the shuttle is engageable with a handle and/or with the suture holder at the outer surface thereof, the or each slot being of sufficient size so that part of the slot is exposed during rotation of the shuttle whilst accommodating the second length of the suture.

6. A device for assisting in the tying of knots as claimed in any one preceding claim wherein said suture holder is connected to the shuttle.

7. A device for assisting in the tying of knots as claimed in claim 6 wherein said suture holder comprises at least one moveable jaw cooperating with a further jaw.

8. A device for assisting in the tying of knots as claimed 7 wherein the further jaw is fixed or movable and if fixed comprises part of the shuttle.

9. A device for assisting in the tying of knots as claimed in any one preceding claim wherein said suture holder or the at least one jaw is two pairs of jaws including an inner pair acting together to provide a first suture holding means at the jaw pair's inner facing surfaces, and an outer pair acting on the inner pair to force together or release the inner pair.

10. A device for assisting in the tying of knots as claimed in claim 9 wherein an outer surface of the inner jaw pair and an inner surface of the outer jaw pair define a suture guiding means for guiding the suture in use toward the, or one of the recesses.

11. A device for assisting in the tying of knots as claimed in any one preceding claim wherein the or each recess has a self-locking tapered form.

12. A device for assisting in the tying of knots as claimed in any one preceding claim wherein the holder and shuttle form a removable cassette.

13. A device for producing at least one half knot in a length of suture or the like during surgical procedures, the device comprising : a handle extending generally along an axis and having a free end; a holder at the other end of the handle adapted for holding suture; and a rotatable member between the free end and the holder which is rotatable under the influence of the suture; the device being operable such that; a length of suture is arranged so that it extends around or through an item to be sutured, providing two free lengths of the suture, a first of the free lengths of the suture is held in the holder, so that the said first length has a first portion which extends initially away from the holder and away from the item, and then forms a loop which loops back to a second portion which then extends toward said item, extending past one side of the handle; and operable such that; after manipulation of a second of the free lengths to a position whereby it extends adjacent the one side of the handle and between the first and second portions, the said second length is caused to engage the rotatable member which moves the second length from a position adjacent the one side of the handle to a position adjacent an opposite side of the handle through the axis of the handle and between the handle's free end and the holder, thereby causing the loop to be moved in the direction of the opposite side of the handle also; and further operable such that; moving the device in the direction of the free end of the handle to cause the (held) first portion of the suture to extend between the second length and the second portion whilst the loop extends around the second length, thereby produces the half knot.

14. A device for assisting in the tying of knots as claimed in claim 11 wherein the second length of the suture is held in tension whilst it is caused to engage the rotatable member.

15. A device for assisting in the tying of knots as claimed in claim 12 wherein the rotatable member of the knot tying device includes a freely rotatable shuttle, which is rotatable for example under the influence of the tensioned second length of the thread.

16. A device as claimed in claim any one preceding claim mounted to a manipulatable mechanical arm.

17. A device for assisting in the tying of knots substantially as described herein with reference to Figures 1 to 6, Figures 7 to 16 or Figures 17 & 18.

18. Use of the device claimed in any one of the preceding claims during mechanically assisted stitching procedures.