Abdominal Wound Closure Forceps
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- Johnathan Bradford
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1 Inventor: Crlson, Mrk A. My 25, 2007 Adominl Wound Closure Foreps Astrt. The devie is modifition of stndrd tissue foreps for use during losure of dominl wounds mde for surgil proedure. The modifition onsists of soop on the hndle end of the foreps; the soop funtions s needle th during suturing, therey proteting the underlying viser. Bkground. Despite the dvent of lprosopi surgery, open surgil proedures on the domen still re performed with widely vrile frequeny. There hs een no indition tht open surgery will e phsed out in the foreseele future. Wound losure fter n open surgil proedure involves repetitive pssge of lrge suture needle through the dominl wll (Figure 1). In long, liner inision, this losure typilly is done y suturing from oth ends of the inision with two seprte threds until they meet in the middle (Figure 2). At this point the two threds my e tied together to omplete the losure. Not infrequently, the finl portion of the inision tht is losed etween the two threds (Figure 2d) is diffiult to ess with the suture needle. This prt of the inisionl losure often is done with suoptiml visuliztion of the underlying owel, whih puts the owel t risk for perfortive injury y the needle (Figure 3). In order to minimize this risk, the surgeon uses vriety of surfes (suh s dominl wll retrtor, or even the surgeon s own fingers) to serve s needle th (or guide) to protet the viser from the losure needle. There is no speifi devie whih omines the funtion of hevy tissue foreps with tht of needle th/guide. Purpose. The purpose of the proposed devie is to provide the surgeon with foreps tht n e used to gr the dominl wll fsi during wound losure, ut lso to provide the surgeon with soop tht funtions s needle th, thus proteting the underlying intestines when the suture needle is pssed through the fsi. Desription. The proposed devie is modifition of onventionl hevy tissue foreps (lso known s Ferris-Smith foreps; see Figure 4). The onventionl foreps onsists of reltively lrge hndle so tht the surgeon n pply fore to the thik, strong tissue whih typilly is mnipulted during dominl inision losure. The gripping end of the foreps is equipped with teeth to filitte holding of the tissue. The proposed devie (i.e., the Adominl Wound Closure Foreps) hs soop or th oming off the hndle end of onventionl hevy tissue foreps (see Figure 5). This soop hs uilt-in urve whih ommodtes the urving pth of suture needle. In ddition, the soop hs longitudinlly-oriented groove whih prevents the needle from slipping wy s it is pssed into the soop. During the initil phses of losure of long, liner inision, the surgeon would employ the Adominl Wound Closure Foreps in the sme mnner s onventionl Ferris-Smith foreps. During the finl phses of wound losure (when exposure of the underlying viser is poor), the surgeon would flip the Adominl Wound Closure Foreps round in his/her nondominnt hnd, suh tht the soop ould e pled underneth the fsi, etween the perforting tip of the needle nd the underlying owel. The soop then ould th the needle s it is pssed through the tissue (Figure 6). Employment of the soop of the Adominl Wound Closure Foreps in this mnner would llow sfe pssge of the needle during the finl throws of the suture. Pge 1 of 7
2 Adominl Wound Closure Foreps d f e Figure 1: Suturing of n dominl inision. The left hnd of the surgeon is shown holding onventionl hevy tissue foreps (). The right hnd of the surgeon (not shown) is holding needle driver (), whih holds suture needle (, in prtil phntom view) tht is tthed to the suture thred (d). The open re of inision whih remins to e losed (e) is held open with the foreps in ntiiption of needle pssge. The portion of the inision whih lredy hs een losed (f) is shown with over-n-over loops of suture. Pge 2 of 7
3 Adominl Wound Closure Foreps d Figure 2: Typil method of wound losure for long, liner inision. The inision () is losed y suturing from oth ends of the inision, therey hving the two suture threds meet in the middle of the inision. The rrows indite the diretion of sewing for eh respetive thred. The suture is pled with ontinuous over-nd-over tehnique, whih results in loops of suture () holding the inision together s shown. The suture needles () re shown tthed to their respetive threds. The re mrked with n sterisks (d) is the finl portion of the inision tht needs to e sutured; euse of the onfined spe, this portion of the inision often is diffiult to ess with suture needle. Pge 3 of 7
4 Adominl Wound Closure Foreps f e d e Figure 3: Mehnism of viserl injury during dominl inision losure. During losure of the finl portion of long, liner inision, the plement of the lst few suture loops often is done with suoptiml visuliztion of the underlying viser (e.g., intestine). The suture needle () is pssed ross the gp () etween the two lyers of fsi (); ut this possily my e done lindly euse t this point in the wound losure, there is little spe left in whih to work. It is ommon to hve loops of intestine (d) present in the peritonel vity (e) diretly eneth the suture needle. If the surgeon is not extremely reful, then the suture needle my e pssed indvertently into the lumen of the intestine (f) during these finl losure steps.
5 Adominl Wound Closure Foreps A B C Figure 4: onventionl hevy tissue ( Ferris-Smith ) foreps. A = lengthwise view, flt side; B = lengthwise view, on edge; C = olique view. Sle losest to the instrument is in m. Pge 5 of 7
6 Adominl Wound Closure Foreps Figure 5: the Adominl Wound Closure Foreps. The devie onsists essentilly of Ferris-Smith foreps modified on the hndle end with soop or th for the suture needle. A = lengthwise view, on edge. The soop () is shown oming off the hndle end (to the left). B = lengthwise view, flt side. Inside the soop is groove () whih prevents needle slippge. C = olique view of hndle end, showing the soop () nd suture needle imed into the soop (). Pge 6 of 7
7 Adominl Wound Closure Foreps left right Figure 6: Tehnique with the Adominl Wound Closure Foreps. In this mok-up, the surgeon s right hnd is driving n (imginry) needle into the reeiving soop of the Adominl Wound Closure Foreps (here represented y onventionl Ferris-Smith foreps, held in the surgeons left hnd). The diretion of needle pssge is indited y the rrow. Pge 7 of 7
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