US 2286578 A
Descripción (El texto procesado por OCR puede contener errores)
June S, 1942. 5 H SAUTER 2,286,578
SURGICAL INSTRUMENT F'iled Feb. l1, 1942 Gttornegs Patented June 16, 1942 l UNiTED sTATgsrarNT OFFICEv SURGICAL INSTRUMENT Simon H. Sauter, Highland Park, Mich.
Application February 11, 194,2, Serial No. 430,379
11 Claims. (Cl. 12S-340) This invention relates to surgical instruments Figure 3 is a side elevation of the surgical inand in particular to hemostats. strument shown in Figure l, prior to the attach- One object of this invention is to provide a ment of the surgical needle but after the tissue hemostat having a quickly attachable and dehas been clamped.
tachable surgical needle in combination theregf.; Figure 4 is a side elevation similar to Figure 3 with, so that a suture maybe easily and quickly after the attachment of the surgical needle holder inserted in the tissue after the latter has been and needle but prior to its insertion in the tisclamped to halt bleeding. sue. y
Another object is to provide a hemostat as set Figure 5 is a side elevation similar to Figures 3 forth in the preceding object wherein the needle l0: and 4 but showing the surgical needle immediis positively guided relatively to the clamping ately after it has passed through the tissue and jaws of the hemostat so that it will always enter has grasped suture. apart of the tissue located in a definite and ac- Figure 6 is a perspective view of the tip of the curate position relatively to the clamping jaws. surgical instrument, omitting the tissue, and
AnOther Object iS t0 Provide a hemostat 15': showing the position of the parts after the needle equipped with a quickly detachable surgical has drawn the suture upward through the tissue. needle and suture holder such that the hemostat Figure '7 is a longitudinal section through the may first be applied to the tissue to stop the pivot airis of the surgical instrument taken along bleeding, and shifted to another position if the the line 1 1 in Figure 5 and showing the quick bleeding does not stop immediately, after which I20 detachable arrangement for vthe surgical needle.
the needle may be attached and caused to be Figure 8 is a cross-section along the line 8 8 guided accurately into the tissue by the device in Figure '7. without danger of its passing through vthe wrong Figure 9 is a plan view, partly in horizontal part of the tissue, thereby always drawing the section, taken along the line 9 9 in Figure 7. suture through the proper part of the tissue 246 Figure l0 is a perspective View of the tips of without the necessity of guidance on the part of the clamping jaws of a modified form of the inthe operator after the hemostat has once been strument wherein the tips'are provided with end successfully clamped. notches "rather than apertures.
Another object is to provide a hemostat having a surgical needle attachably and detachably 3,0, General arrangement combined therewith in such a manner that the In general, the Surgical instrument of this inneedle may be instantly attached and detached vention consists of a hemostat or surgical clamp merely by turning a small knob, combined with a quickly attachable and detach- Another object is to provide a hemostat eomable-surgical needle holder including a surgical bined with an attachable and detachable surgical 35l needle- The hemostat CenSStS 0f a pair 0f needle wherein the needle is accurately pivoted` Clamping jaws pvoted around apli/Ot pin, and around the pivot axis or the hemostatjaws and having means for guiding a suture along one of caused to pass accurately through apertures or the J'aWS and through an aperture 0r nOtCh tip notches in the ends of the hemostat jaws. thereof. 1
Another object is to provide a hemostat com- 40l The lOVOt Din 0f the instrument iS extended bined with an attachable and detachable surgical laterally t0 provide a pil/'Ot fOr the needle l'lOlCler,
needle such that a series of hemostats are prothe latter being Offset S0 that the needle Will pass vided with means for attaching and guiding the through the apertures in the tips of the clamping needle, whereby a single needle may be successjaws. A quick detachable connection is provided fully employed with several hemostats after 4,5l whereby the needle holder may be instantly atthese have been clamped in position. tached to or detached from the clamping pivot In the drawing: pin, so that the tissue may'rst be clamped and Figure l is a perspective View of the hemostat the' bleeding stopped before the needle is attached portion of the surgical instrument of this invenand used. Hitherto in surgical Operations it tion, with the attachable surgical needle re- 50 has been necessary t0 attach hemostats t0 the moved. tissue which has been cut, so that bleeding will Figure 2 is a perspective view of the needle be stopped. In order to make this stoppage holder portion of the surgical instrument of this permanent, it has been necesary to pass surgical invention separated from the hemostat portion sutures through the tissue and to tie the sutures of Figure l, including the needle. after they have been passed through the tissue.,
It has required exceedingly accurate work on the part of the surgeon to insert the needle at the proper point after the hemostat has been clamped upon the tissue. The use of the surgical needle has demanded skill and concentration on the part of the surgeon.
Moreover, the difficulty has always been present where bleeding and darkness caused the needle to be inaccurately inserted, so that the suture did not properly halt the flow of blood. This occurs frequently in operations in internal cavities of the body, .such as throat operations. Under such circumstances the inaccessibility of the tissue makes accurate insertion of the needle a somewhat diflicult task particularly if it iscomplicated by the presence cf bleeding for it conceals the tissue.
In the present invention, however, ifthe bleeding continues after the jaws of the instrument have been clamped, the instrument may be unclamped and the jaws reclamped in another position. This may be repeated until it is found that the bleeding stops. The surgical needle holder and needle are then instantly attached, Vand the needle is automatically guided into position to pass through the tissue and pick up the suture, without any attention on the part of the operator other than to apply pressure to the handle of the needle holder. When the suture has been withdrawn, the needle holder may instantly be detached and the suture tied. Furthermore, the same needle holder and needle may be used in connection with several hemostats, such as where an abdominal operation is being conducted.
Hemcsta't portion construction Referring to the drawing in detail, Figure '4V shows the surgical instrument of this invention as consisting of a hemostat portion, generally designated Ill, and a needle holder, generally designated II. The hemostat portion Il) `of 'the instrument consists of a pair of clamping arms I2 and `I3 (Fig. l), pivoted around a pivot pin I4 (Fig. '1) and having a pair of clamping jaws I5 'and I6 respectively provided with apertures I1 and vI'Ii in the tips thereof. At their opposite ends the arms I2 and I3 are provided with finger loops I9 and 23, adjacent which are inter-engaging locking portions 25 and 22. The locking portion 2| is provided with a plurality of teeth 23 of ratchet form engageable bya pawl-like tooth 24 upon the locking portion 22.
The arm I3 adjacent the pivot pin I4 is provided with a transverse aperture 25 between the spaced portions 2S of the arm I3.. The arm vI2 is provided with a portion 21 of reduced width adapted to pass through the aperture 25.
The pivot pin I4 passes through aligned apertures 28, 29 and 30 in the arm portions 2'6 and 21 respectively (Fig. '7). The aperture 2B is provided with a flared portion 3l to receive the end 32 of the pivot pin I4 which has been upset or enlarged to prevent withdrawal of the pivot pin I4. The flared portion 32 of the pivot pin I 4 is formed upon a reduced diameter portion 33 at the end thereof (Fig. 7)
Surrounding the pivot pin I4 is a suture guide 34 having a central aperture 35 through which the pivot pin I4 passes, and a peripheral groove 36 adapted to serve as a guide for a surgical suture 31. The opposite ends of the suture 31 are held by cla-mps 38. 35 and' 43, mounted' on the arm I3 (Fig 1). The mid-portion 'of the suture passes through apertures 4I inthe side walls of the clamping jaw I6 adjacent the aperture I 8, so that the suture passes across the aperture I8. The suture guide 36 is provided for the purpose of conducting the suture 31 around the needle holder II and to prevent interference of the one with the other.
Beyond the suture guide disc 34 the pivot pin I4 is provided with an enlarged portion 42 having a pair of flat spots 43 on the periphery thereof (Figs. '1 and 8). The outer `end of the pivot pin I4 is tapered to a conical shape (Fig. 7) as at 44, so as to facilitate the attachment of the needle holder II. The arms I2 and I3 are provided With angled or inclined portions 45 and 45 adjacent the pivot pin I4 serving as stops for limiting the clamping movement of the clamping jaws I5 and I6 (Figs. 8 and 9).
Needle holder construction The needle holder II (Fig. 2) includes an arm 5i) having a bent portion 5I terminating in a transverse portion 52. The'latter is 'provided at its mid-portionY with an 'aperture 53 and continues on the opposite side thereof in a bent portion 54 continuing beyond thel bend in a needle-holding arm 55.
The' needle-holding arm 55 is provided with a longitudinal bore 56 (Fig. 4)* forming a socket for a surgical needle 51 andV having a boss 58 with a threading aperture 59 receiving 'a set screw 60 for holding the needle 51 in the bore 56. The needle 51 is provided with an arcuately bent portion `6I having a needle point 62 and a transverse suture slot 63 adjacent the point 62. The slot 63'is provided with a pair of prongs 64 for preventing the suture from slipping accidently out of the slot. The prongs 54 are separated by a gap, however, so that Vthe needle may be removed from the suture (Fig. 6) after the latter hasbeen drawn through the tissue G5. At its opposite ends the needle holder II is provided with a flat spring secured as at 61 tothe arm 50 (Fig. 2). The arm 50 terminates in 'ahandle l'arranged for convenient grasp by the'surgeon.
Mounted on the enlarged portion 42 of the pivot pin.I4 A(Figs '7 and 9) is a sleevelg having a hub 10 Withan annular groove 1I mating loosely with the aperture 53.in the needle holder II'. The sleeve 69 is provided with a knurled thumb nut portion'1'2 connected to the hub 69 by a n'eck 13 (FigsfSand 9). The neck 13 is cut away at 14 on its 'upper and lower surfaces so as to be of slightl'y"'lessA thickness than the diameter of the pivot `pin I4' between the flat spots 43. U-shaped double spring 16 the arms 11 `of which are adapted to engage the 'atspots 43 'within the notches 18 vformed by these at spots 43. By this means the needle holder VII is quickly attached -or detached from the'hemostat portion I'D, as hereinafter described.
The `hub 15 of th'e'sleeve 69 on the side opposite the Vnotches 18` isseated in a circular recess 19 (Fig. 7)' formed in the suture guide disc 34. The "sleeve 69 is provided with a bore 30 fitting snugly but slideably over the enlarged portion 42 of the pivot pin 4I.
Modified hemostat jaw construction The'modied hemostat jaw construction shown in Figure 10 is generally similar to the hemostat portion I0 shown in Figures l to 5 inclusive.' In the modified construction, however, the clamping jaws I5 and I6 a're provided with upper -and lower notches 8| and 82 instead o'f the" apertures Secured as atv 15 to the neck' 13 is 'a' I1 andV I8 shown in the principal form of the invention. The notches 8| and 82 are open toward the front of the hemostat portion I0, so that after the suture 31 has been drawn through the tissue in the manner analogous to that shown in Figure 6, the hemostat portion I may be drawn toward the surgeon and the upper portion of Vthe suture 31 will merely slip out through the gap between the side portions 83 of the upper jaw |5 adjacent the upper notch 8|. The suture 31, however, passes through slots 84 in the side portions 85 of the clamping jaw I6 adjacent the notch 82. This may be done without previously detaching the needle 6| from the suture 31, as is necessary in the principal form of the invention shown in Figure 6.
Use of the instrument In the use of the invention let it be assumed that the suture 31 has been threaded through the apertures 4| or 84 in the clamping jaws I5 and I6, that the portions thereof entering and leaving the instrument are held by the clips 38, 38 and 48, (Fig. l). The suture 31 at its midportion on one side is threaded through the groove 36 in the suture guide disc 34.
The surgeon now performs the operation, such as the removal of a tonsil indicated by the tissue 65, of which a portion has been removed, leaving a raw end 85 from which bleeding is taking place. The surgeon grasps the hemostat portion I0 and quickly inserts the clamping jaws I5 and I6 on opposite sides of the tissue 65, bringing them into clamping. engagement therewith over the blood vessels and holding them in clamping engagement by means of the interlocking of the clamping portions 2| and 22 adjacent the finger loops I9 and28. If the bleeding does not cease by reason of this clamping action, the clamping jaws I5 and Iii-may be unclamped, shifted to another portion of the tissue 65 and reclamped.
When the bleeding has subsided, the surgeon removes the blood either by swabs or by a vacuum device, whereupon the tissue is ready to be sutured in order to tie the walls of the blood vessels tightly together and permanently prevent bleeding.
The surgeon now grasps the needle holder I| and slips the bore 88 over the pivot pin I4. As the spring arms 11 of the spring 16 pass over the surface of the pivot pin I4 they snap into the notches 18 formed by the at spots 43 (Figs. '7 and 8) temporarily locking the needle holder |I in position upon the pivot pin I4. If necessary, the thumb nut 12 is twirled between the fingers until the parts are in the position of Figure 8 whereby the sides 14 of the neck 13 are substantially parallel to the flat spots 43 upon the pivot pin I4. The parts are now in the position shown in Figure 4.
The surgeon now grasps the handle 68 and pulls it toward the arm I2 (Fig. 5) thereby forcing the tip 62 of the needle portion 6I downward through the tissue 65 and causing the suture 31 to snap into the needle slot 63. The handle 68 is now released, whereupon the spring 66 urges the handle 68 away from the arm I2 (Figs. 4 and 5) causing the needle portion 6I to be drawn back through the tissue 65, bringing with it a loop of the suture 31 (Fig. 6).
The suture 31 is now removed from the needle slot 63 and the needle holder removed from the pivot pin I4. This is accomplished by turning the thumb nut 12 and sleeve 89 through a right angle from the position shown in Figures 1, 8 and 9. When this is done, the neck portions 13 move beneath the spring arms 11, forcing them apart to a distance greater than the separation of the flat spots 43. The sleeve 69, and the remainder of the needle holder mounted thereon, .can now be withdrawn from the pivot pin I4. The suture can now be tied and the hemostat portion I0 unclamped and Withdrawn.
When a large incision is made in certain types of surgical operations, such as abdominal operations, a large number of hemostats are frequently employed. Ordinarily in such instances, it is necessary to insert a separate needle adjacent each hemostat and tie the sutures one by one. With the use of the present instrument, however, one needle holder II may be employed successively with a number of hemostat portions II) and the sutures can be quickly and accurately inserted one after another, without the necessity of careful thought on the part of the surgeon. Thus the instrument of the present invention accomplishes the insertion of the sutures almost automatically with a minimum of thought on the part of the surgeon. The surgeons mindris, therefore, freed from the care ordinarily needed in inserting the sutures, and consequently is able to concentrate on other matters arising during the operation. This advantage is particularly important where an incision unexpectedly discloses pathological conditions the existence of which was not previously known or only slightly suspected. Under these circumstances the surgeon is able to deal with the newly discovered conditions and to perform the additional surgery immediately without losing any time guidingv the suture needles into place.
While a specific embodiment of the invention has been described and illustrated, it will 'be understood that various modifications may be made within the scope of the appended claims without departing from the spirit of the invention.
What I claim is:
1. In a surgical instrument, a hemostat device having pivoted clamping portions engageable with the tissue to be sutured, an attachable and detachable surgical needle holder connectable to the pivot of said device, and a surgical needle arranged to be mounted in said holder, said hemostat device having a notch in one end of at least one of said clamping portions to receive the suture thread and thereby locate the thread in the path of the needle.
2. In a surgical instrument, a hemostat device having clamping portions engageable with the tissue to be sutured, an attachable and detachable surgical needle holder connectable to said device, a surgical needle arranged to be mounted in said holder, said hemostat device having a notch in one end of at least one of said clamping portions, and means for holding a suture therein and extending across said notch in the path of said needle.
3. In a surgical instrument, a hemostat device having vpivoted clamping portions engageable with the tissue to be sutured, an attachable and detachable surgical needle holder connectable to said device at the pivot thereof, and a surgical needle arranged 'to be mounted in said holder, said needle being arcuately curved at its forward portion, and having a transverse suture slot therein for receiving the suture.
4. In a surgical instrument, a hemostat device having clamping portions engageable with the tissue to be sutured, an attachable and vdetachable-surgical -needle holder connectable to said device, and Y a surgical needle Karranged to be mounted in said holder, said needle being arcuately curved at its forward portion, and having a slot with prongs at -the edges thereof for receiving the suture and for preventing the accidental dislodgement thereof.
5. In a surgical instrument, a hemostat device having a pivot pin projecting from one side thereof and provided with indentations and a pair of clamping arms pivotal around said pivot pin, asurgical needle holder detachably mounted on said pivot pin, a surgical needle secured to said needle holder, and means carried by said needle holder'engaging within said indentations for selectively locking said needle holder to said pivot member.
ye. In a surgical instrument, a hemostat device having a pivot member and a pair of clamping arms vpivo'table around said pivot member, said pivot member :projecting beyond `the clamping arms Vand having ndentations 'in the free end thereof for 'holding the suture, one of said arms having a notch, a surgical needle holder detachably mounted on said pivot member, a surgical needle secured to said needle holder having a slot for engaging the suture and looping the same, 4and manually releasable detent carried by the surgical needle -holder for being received in said indentations for detachably connecting said needle holder to said hemostat device.
'i'. In a surgical instrument. a hemostat device having a pivot member and a pair of clamping arms pivotable around said pivot member, means for holding a suture in engagement with one of said arms, a surgical needle holder detachably and pivotally mounted on said pivot member, a surgical needle secured to said needle holder,
said 4pivot member having anotchtheren, and a detent carried by the needle holder releasably engageable with said notch.
8. In a surgical instrument, a hemostat device having a pivot member and a Ypair of clamping arms pivotable around said pivot member, means for holding a suture in engagement With one of said arms, a surgical needle holder detachably mountedgon said pivot member, a surgical needle secured to said needle holder, said needle holder having a hub pivotally mounted on said pivot member and a detent carried by the hub of the needle holder responsive to the rotation of said hub for selectively locking and unlocking said needle holder relatively to said hemostat.
9. In a surgical instrument, a hemostat device having a pivot member and a pair of clamping arms pivotable around said pivot member, means for holding-'a suture in engagement with one of said arms, a surgical needle holder detachably mounted on said pivot member, a surgical needle secured to said needle holder, said needle holder having a hub pivotally mounted on said pivot member with a cut-away portion, said pivot member having a notch alignable with said cutaway portion, and resilient means engaging said notch for releasablylocking said hub to said pivot member.
10. A needle holder for surgical instruments comprising a hub member attachable to a hemostat, a-needle receiver pivotally mounted on said hub, and a latch yieldably mounted on said hub.
ll. A needle holder for surgical instruments comprising a hub member attachable to a hemostat, aineedle receiver pivotally mounted on said hub, and a latch yieldably mounted on said hub, said hub having a bore therethrough adapted to receive the pivot pin of a hemostat.
SIMON H. SAUTER..