Laparoscopic surgical system
A laparoscopic port closure device is described. The device allows for the deployment of a suture internally into an abdominal wall and the subsequent use of that deployed suture to effect a closing of the wound that was used for the port. The deployed suture may be used during the surgical procedure to effect a securing or anchoring of the device.
1. A suture closure system configured for engagement with an aperture provided in an abdominal wall, the system comprising:
a housing defining a lumen for receipt of a trocar, the housing comprising an abdominal wall engaging portion and an outer resting portion which in use will rest against an outer surface of the abdominal wall, the abdominal wall engaging portion extending circumferentially about and being separate to the lumen;
the housing further comprising a first needle guide channel provided in a side wall of the abdominal wall engaging portion and a second needle guide channel provided in a side wall of the abdominal wall engaging portion, each of the first needle guide channel and the second needle guide channel enclosed within the side wall of the abdominal wall engaging portion, each of the first needle guide channel and the second needle guide channel being provided on opposite sides of the lumen respectively and having a diameter smaller than a diameter of the lumen, each of the needle guide channels having an entry port for receiving a needle driver, the entry port being positioned above the abdominal wall engaging portion, and an exit port being located above a distal end portion of the abdominal wall engaging portion, the exit port providing an exit from the needle guide channel through which a suture may exit the housing and into the abdominal wall, the entry and exit ports for each needle guide channel being provided on the same side of the lumen, the guide channels providing a convex surface proximal to the lumen such that the suture will exit the side wall of the abdominal wall engaging portion away from the lumen and into the abdominal wall on being displaced out of the needle guide channel.
2. The system of claim 1 wherein the lumen is dimensioned for receiving a trocar.
3. The system of claim 1 wherein the housing is provided in a multi-part construction comprising first and second parts that are co-operable with one another to encapsulate a third central part.
4. The system of claim 3 wherein the third part comprises a shoulder element that is seatable within a channel provided in inner surfaces of each of the first and second parts.
5. The system of claim 4 wherein on bringing the first and second parts together the channel defines a continuous surface that extends circumferentially about the third part retaining the shoulder therein and restricting vertical movement of the third part relative to the first and second parts.
6. The system of claim 1 comprising a suture securement feature for securing a suture relative to the housing.
7. The system of claim 6 wherein the housing is provided in a multi-part construction comprising first and second parts that are co-operable with one another to encapsulate a third central part and wherein the suture securement feature comprises two opposing faces formed in each of the first and second parts which when brought together form a cleat.
8. The system of claim 1 wherein the abdominal wall engaging surface comprises first and second cut-away portions provided in faces transverse to the exit ports of the needle guide channels, the cut away portions defining a tissue invagination zone within the abdominal wall engaging portion into which tissue may extend inwardly towards the lumen.
9. The system of claim 1 configured for engagement with an aperture provided in the abdominal wall, the housing comprising an abdominal wall piercing or engaging portion and an outer resting portion which in use will rest against an outer surface of the abdominal wall and wherein the abdominal wall engaging portion comprises a sealing surface which provides a curved surface extending circumferentially about the housing and which in use is located against the abdominal wall.
10. The system of claim 9 wherein the sealing surface is an arcuate curved surface which operably presents a concave surface to the skin against which it contacts, under a compressive force provided by tightened sutures, thereby sealing against the skin.
11. The system of claim 1 wherein the housing defines an O-ring channel within the lumen, the O-ring channel providing a seat for an O-ring whose dimensions are selected to provide a compression fit against inserted surgical instrumentation such that on providing the surgical instrumentation through the lumen its outer surface will compress against a retained O-ring thereby sealing the lumen.
12. The system of claim 1 wherein the needle guide channels are tapered such that a needle will exit at a fixed angle between 5 and 30°.
13. The system of claim 1 comprising a needle driver by which an operator may operably apply a downward pressure onto a needle.
14. The system of claim 1 wherein the exit port is located such that operably a needle will pass into a subcutaneous layer of the abdominal wall on exiting the needle guide channel.
15. The system of claim 1 comprising a trocar, the trocar being receivable into an abdominal cavity through the lumen.
16. A laparoscopic surgical method comprising:
a. making an incision and providing a system as claimed in claim 1 ;
b. providing the surgical instrument through the lumen of the housing;
c. inserting the combined surgical instrument and housing assembly into the incision;
d. insufflating the abdomen;
e. using a needle driver to drive suture needles inside the abdominal cavity, and then withdrawing the needle drivers;
f. anchoring the housing by tautening the sutures, and drawing the needles flush against the peritoneum, at which point the suture is locked;
g. completing the required surgery, at the end of which the housing is removed by unlocking the suture; and
h. tying one or multiple knots in the suture pushing the knot subcutaneously.