Abstract
Tying knots in a suture laparoscopically with straight graspers is difficult, time consuming, inefficient, and ineffective. Many instruments have been invented for this purpose, but the common problem that leads to failure is that the first throw in the tie tends to unravel itself before the second throw can be carried out. The current invention consisting of 3 mini-graspers within the same shaft, is capable of quickly producing two loops in the first throw, which is self-locking, leading to the formation of a Surgeon's Knot.
Claims
1. An instrument for laparoscopically making multiple loops in a suture and for tying a surgeon's knot, comprising of two tubular sheaths, an inner sheath inside a main sheath, separated by adaptors at each end, with the lumen of the inner sheath open at both ends and containing the shaft of a removable 5 mm laparoscopic grasper, acting as the axis of rotation, with the said grasper and the said instrument being used together in the same laparoscopic port, with the main sheath further bearing a controllable mechanism capable of attaching or releasing a tail end of the suture at its distal end.
2. A method for laparoscopically making multiple loops in a suture and for tying a surgeon's knot with the instrument of claim 1, comprising the following steps: a) The tail end of a suture is first attached to the distal surface of the main sheath; b) The main sheath is repeatedly rotated, forming multiple loops in the suture surrounding the main sheath; c) These loops are displaced to lie on the exposed portion of the shaft of a 5 mm laparoscopic grasper contained within the central lumen of the inner sheath; d) The head end of the said suture is pulled through the said loops, by the said 5 mm grasper already in place within the said loops; e) The tail end of the suture is grasped by a second grasper; f) The two ends of the suture are pulled apart from each other, thus forming and tightening a surgeon's knot.
Description
DETAILED DESCRIPTION OF THE DRAWINGS
Detailed Description of the Drawings of the Instrument
[0039] Sheet 1—FIG. 1 shows a perspective view of the left side of the entire instrument.
[0040] Sheet 2—FIG. 2 shows the Main Sub-assembly, consisting of the main sheath 1, the front spacer 2, the rear spacer 3, and the chamber with handle 4.
[0041] FIG. 3 is a perspective view of the entire stationary mini-grasper, with 5 the mini-sheath-C.
[0042] FIG. 4 shows the Slidable Mini-Grasper-A.
[0043] FIG. 5 shows the Slidable Mini-Grasper-B, with 6 the mini-sheath-B.
[0044] Sheet 3—FIG. 6 shows an exploded view of the Mini-Grasper A, which resides in the upper left side of the main sheath, showing the Push-Lever-A, 10; the Adaptor-A, 11; the Push-Lever-A2, 12; the Adaptor-A2, 13; the compression spring-A, 14; the mini-sheath A, 15; the mini-rod A, 16; the movable jaw-A, 17.
[0045] FIG. 7 shows an exploded view of the Mini-Grasper-B, which is identical to Mini-Grasper-A, showing the Push-Lever-B, 18; the Adaptor-B, 19; the Push-Lever-B 2, 19; the Adaptor-B 2, 13; the compression spring-B, 22 ; the mini-sheath B, 26; the mini-rod-B, 27; the movable jaw-B, 29.
[0046] Sheet 4—FIG. 9 shows an exploded view of the rear end of Mini-Grasper A, which is exactly the same as Mini-Grasper B, and resides in the left upper side of the main sheath. The Push-Lever-A, 10; the Adaptor-A, 11; the Push-Lever-A2, 12; the Adaptor-A2, 13; the compression spring-A, 14; the mini-sheath-A, 15; the mini-rod A, 16.
[0047] FIG. 10 shows an exploded view of the rear end of Mini-Grasper B, which is exactly the same as Mini-Grasper A, and resides in the left lower side of the main sheath. The Push-Lever-B, 18; the Adaptor-B, 19; the Push-Lever-B2, 20; the Adaptor-B 2, 21; the compression spring-B, 22; the mini-sheath-B, 23; the mini-rod-B, 24.
[0048] FIG. 11 shows an exploded view of the Stationary member of the Stationary Grasper-C, 8. which resides on the right side of the main sheath; showing the mini-sheath-C, 26; the mini-rod- C, 27; the compression spring-C, 30.
[0049] Sheet 5—FIG. 12 shows a perspective view of the Common Tubular Chamber with the Handle, 4, showing the upper long slot of the left side of the chamber, 100; the short slot accommodating the scissors handles, 101; the holes for the Master Screws, 102.
[0050] FIG. 13 is a view of both members of the scissors handles; 8 is the stationary member; 9 is the movable handle; 103 is a through hole for passing the mini-sheath C through the vertical member of the scissors handle; 104 is a thread hole the fixation screw; 105 is a half round knob attached to the back surface of the top of the movable handle, enabling pushing by the thumb.
[0051] Sheet 6—FIG. 14 shows the Main Sub-assembly.
[0052] FIG. 15 shows an exploded view of this, showing the Main Sheath, 1; the Front Spacer, 2; the Rear Spacer, 3.
[0053] Sheet 7—FIG. 16 shows a perspective of the Front Spacer 2, with 108 being the guide channel for mini-grasper-A; 109 for mini-grasper-B, 110 for mini-grasper-C.
[0054] FIG. 17 shows a perspective view of the Rear Spacer 3, which is at the front of the tubular chamber, with 108 being the guide channel for mini-grasper-A; 109 for mini-grasper-B, 110 for mini-grasper-C. 111 is a shoulder on the rear spacer, which abuts the internal shoulder on the front end of the tubular chamber. 112 is the threaded hole for the Master Screws, there being 3 of them, fixing the mini-grasper sub-assembly to the Tubular Chamber.
[0055] Sheet 8—FIGS. 18, 19, and 20 show different views of the Chamber-Handle combination.
[0056] Sheet 9—FIG. 21 shows the Fulcrum Screw for the Scissors Handles.
[0057] FIG. 22 shows the Nut for the Fulcrum screw.
[0058] FIG. 23 is the Fixation Screw for the top of the stationary member of the scissors handle.
[0059] FIG. 24 is the Master Screw, with 3 of them.
[0060] FIG. 25 is the Union Screw which binds the stationary member of the scissors handle to the handle of the Chamber.
[0061] Sheet 10—FIG. 26 shows the Push Lever-A.
[0062] FIG. 27 shows the Adaptor-A.
[0063] FIG. 28 shows the Push Lever-A2.
[0064] FIG. 29 shows the Adaptor-A2. There is an identical set ofthese 4 items for mini-graspers A and B.
[0065] Sheet 11—FIG. 30 shows the Ball at the end of the Rod of the Stationary Grasper C. FIG. 29 shows the male threaded end of the Rod-C for attaching the Ball.
[0066] Sheet 12—FIG. 30 shows the jaws of the stationary grasper, grasper-C, in a closed position.
[0067] FIG. 31 shows the same jaws in an open position. These are regular jaws of prior art. 113 is the stationary jaw, which is a part of the mini-sheath. 114 is a movable jaw.
[0068] Sheet 13—FIG. 32 shows the angled Jaws of a Slidable Grasper, in the closed position.
[0069] FIG. 33 shows these jaws in the open position. These jaws are the same for mini-grasper A, and mini-grasper B. 115 is the stationary jaw. 116 is the movable jaw.
[0070] Sheet 14—FIG. 34 shows how the two loops in the suture are made with the 3 mini-graspers, A, B, & C. 117 is the first loop. 118 is the second loop. It is in this situation when the two loops are being held by the mini-graspers, that the independent separate regular grasper D, comes in, goes through the loops, to pull the tail end of the suture back through the loops.
[0071] Sheet 15—FIG. 37 is a diagram showing the different parts of a suture, with 119 being the Head End, 120 the Head Strand, 121 the Tail Strand, and 122 the Tail End.
[0072] FIG. 38 shows the two loops, with the tail strand pulled through the loops.
[0073] Sheet 16—FIG. 39 shows a separate regular 5 mm grasper, Grasper-D, through a separate port, pulling the Tail End 123 through the two loops, 124, whilst the Head End of the suture, 125, is being held by the mini-grasper-C. This is the reason for mini-grasper-C having a scissors handle, so that the head end of the suture can be firmly gripped and pulled.
[0074] Sheet 17—FIG. 40 shows the Surgeon's Knot, with 2 loops in the first throw.
Sequence of Assembly
[0075] 1. First, the main sheath sub-assembly is created by using 3 pieces of 3 mm guide rods, to line up the 3 lumens in the front spacer, and the rear spacer in the correct orientation within the main sheath. The front spacer and the rear spacer are then joined to the main sheath, using adhesives. The guide rods are then removed. [0076] 2. The 2 slidable mini-graspers with their jaws, push levers, adaptors and compression springs are assembled. [0077] 3. The 2 slidable mini-graspers are inserted in turn into the rear end of the chamber, then through the rear spacer, and out of the front spacer. These mini-graspers are correctly orientated so that their stationary jaws all face the center of the spacers, and their push levers are within their slots. [0078] 4. The shaft of the stationary mini-grasper-C is inserted through the lumen at the top end of the stationary member of the scissors, and temporarily locked in position with the fixation screw. [0079] 5. The stationary member of the scissors handle is then joined to the movable handle with the fulcrum screw and nut, whilst simultaneously assembling the compression spring-C, and placing the ball into the top of the movable handle. [0080] 6. The stationary mini-grasper C is adjusted to achieve the correction orientation. [0081] 7. The shoulder on the rear spacer is then mated to the internal shoulder in the neck of the tubular chamber, with 3 counter-sunken master-screws. [0082] 8. The stationary member of the scissors handle is joined to the handle portion of the chamber, with 2 union-screws.
