FR2622429A1 - Appareil de suture chirurgicale - Google Patents
Appareil de suture chirurgicale Download PDFInfo
- Publication number
- FR2622429A1 FR2622429A1 FR8715108A FR8715108A FR2622429A1 FR 2622429 A1 FR2622429 A1 FR 2622429A1 FR 8715108 A FR8715108 A FR 8715108A FR 8715108 A FR8715108 A FR 8715108A FR 2622429 A1 FR2622429 A1 FR 2622429A1
- Authority
- FR
- France
- Prior art keywords
- branch
- staples
- staple
- surgical suture
- branches
- Prior art date
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- Pending
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Ophthalmology & Optometry (AREA)
- Surgical Instruments (AREA)
Abstract
L'invention concerne un appareil de suture chirurgicale. Selon l'invention, il comporte, en jonction articulée, une branche à agrafes 1 avec des encoches 11 pour les agrafes et une branche de butée 4 avec des alvéoles 12 pour le pliage des pattes des agrafes, un mécanisme de propulsion des agrafes hors des encoches 11 et un mécanisme de fixation des branches 1, 4 en position fermée. La branche de butée 4 est installée à l'extrémité de la branche à agrafes 1 et a la possibilité de pivoter dans la charnière 3 sur 180degre(s); la branche de butée 4 est munie d'un mécanisme de rotation, ayant la forme d'un levier 5 et d'un tirant 7. L'invention s'applique notamment aux opérations chirurgicales.
Description
i
L'invention a trait au domaine médical, et plus pré-
cisément, elle se rapporte à un appareil de suture chirur-
gicale, destiné principalement à l'appendicectomie laparos-
copique. Au cours des dernières années, les interventions chi- rurgicales laparoscopiques ont trouvé une large application
(cholécystectomie, gastrostomie, stérilisation, appendicec-
tomie). On connaît bien, par ailleurs, la large utilisation des appareils de suture chirurgicale dans la chirurgie
cardio-vasculaire et pulmonaire, ainsi que dans lesinter-
ventions portant sur le tube digestif, lesdits appareils assurant la résistance de la suture et la réduction de la durée de l'intervention. Cependant, aucun des appareils de suture chirurgicale connus ne peut être utilisé pour les
interventions laparoscopiques.
On connaît, en particulier, un appareil de suture chirurgicale pour la pose d'anastomoses gastro-jéjunales
latérales(SU, A, 125867). Ledit appareil comporte deux bran-
ches réunies par charnière, dont la branche à agrafes est pourvue d'encoches pour les agrafes, et porte, à une des extrémités,une poignée, et dont la branche de butée est pourvue d'alvéoles pour le pliage des pattes des agrafes, un mécanisme de propulsion des agrafes de leurs encoches et un mécanisme de fixation des branches en position fermée. Dans l'appareil connu, la charnière qui réunit les branches se
trouve au bout de la poignée de la branche à agrafes. En posi-
tion ouverte de l'appareil, les branches se placent sous un
certain angle l'une par rapport à l'autre, et pour cette rai-
son ledit appareil de suture chirurgicale ne peut pas être
utilisé dans des manipulations laparoscopiques.
Le problème posé dans la présente invention consiste à mettre au point un appareil de suture chirurgicale, dont la construction permettrait de l'introduire dans la zone de
l'intervention chrirurgicale par le biais du tube d'un spécu-
lum pour réaliser des interventions chirurgicales laparosco-
piques, ce qui donnerait la possibilité de réduire le trau-
matisme de l'intervention.
Ce problème se voit résolu par le fait, que,dans l'ap-
pareil de suture chirurgicale, comportant deux branches réu-
nies par une charnière, dont l'une est à agrafes avec des
encoches pour les agrafes et porte à une extrémité une poi-
gnée, et l'autre est de butée avec des alvéoles pour le pliage des pattes des agrafes, un mécanisme de propulsion
des agrafes hors de leurs encoches et un mécanisme de fixa-
tion des branches en position fermée, selon l'invention, la charnière qui réunit les branches se trouve à l'extrémité
libre de la branche à agrafes, la branche de butée est réu-
nie à la charnière par l'une de ses extrémités en étant ins-
tallée avec une possibilité de rotation sur 180 de façon à ce qu'en position ouverte de l'appareil, la branche de butée forme le prolongement de la branche à agrafes, alors qu'en position fermée, elle se place parallèlement à la branche à
agrafes, et elle est munie d'un mécanisme de rotation réa-
lisé sous la forme d'un levier dont l'axe d'oscillation se situe sur la poignée de la branche à agrafes, et d'un tirant
réuni au levier et à la branche de butée.
Il est avantageux de réaliser le mécanisme de fixation des branches en position fermée sous la forme d'un collier, placé sur la branche de butée, et d'un poussoir, disposé sur la poignée et adapté, lorsque l'on y applique un effort, à coopérer avec la crémaillère qui est reliée à des éléments cunéiformes, disposés avec possibilité de glissement le long de la branche à agrafes et de calage, au moyen du collier,
de la branche de butée par rapport à celle à agrafes en posi-
tion fermée de l'appareil.
L'appareil de suture chirurgicale, réalisé suivant la présente invention, permet de réaliser l'appendicectomie par vie laparoscopique par le biais de ponctions, sans ouverture de la cavité abdominale, ce qui réduit le traumastisme de ladite intervention. L'appareil est d'un usage commode et
assure une haute fiabilité d'occlusion du moignon dans l'ap-
pendicectomie. L'invention sera mieux comprise d'autres buts, caractéristiques détails et avantages de celle-ci apparaîtront mieux à la
lumière de la description explicative qui va suivre d'un
mode de réalisation donné uniquement à titre d'exemple non limitatif, avec références aux dessins non limitatifs annexés dans lesquels:
- la figure 1 montre l'appareil de suture chirurgi-
cale, selon l'invention, en position ouverte, en isométrie; - la figure 2 est une vue de l'appareil représenté à la figure 1, en position fermée;
- la figure 3 montre le poussoir du mécanisme de pro-
puision des agrafes hors de leurs encoches, en vue laté-
rale; et - les figures 4, 5, 6, 7 et 8 montrent les étapes de réalisation d'une appendicectomie en utilisant l'appareil de suture chirurgicale, selon l'invention, représenté aux
figures 1 et 2.
L'appareil de suture chirurgicale, selon l'invention,
représenté aux figures 1 et 2, comporte une branche à agra-
fes 1 avec une poignée 2 à l'une de ses extrémités et une charnière 3 à l'autre, et une branche de butée 4, reliée par l'une de ses extrémités à la branche à agrafes 1 par le
biais de la charnière 3. La branche de butée 4 a la possibi-
lité de tourner sur 180 par rapport à la branche à agrafes
1, et dans l'une de ses positions extrêmes,elle forme le pro-
longement de la branche à agrafes 1 (en position ouverte de l'appareil, représentée à la figure 1), alors qu'à son autre position extrême, elle se place parallèlement à la branche
à agrafes 1 (la position fermée de l'appareil est représen-
tée à la figure 2). La branche de butée 4 est munie d'un mécanisme de rotation, exécuté sous la forme d'un levier 5, dont l'axe d'oscillation 6 se situe sur la poignée 2, et d'un tirant 7 qui se joint, par l'une des extrémités, à la
branche de butée 4, et dont l'autre extrémité porte une gou-
pille 8 qui coopère avec une fente 9 du levier 5. La branche
à agrafes 1 porte une rainure longitudinale 10 et des enco-
ches 11, des deux côtés de laditerainures dé O10, qui reçoivent des
agrafes en U, par exemple en fil de tantale, ayant pour di-
mensions 0,2 x 3 x 4 mm. Conformément aux encoches 11 de la branche à agrafes 1, deux rangées d'alvéoles 12 sont prévues
sur la branche de butée 4 pour le pliage des pattes des agra-
fes au moment de la suture, et conformément à la rainure 10, est prévue une rainure longitudinale 13. L'appareil selon
l'invention est muni d'un mécanisme de propulsion des agra-
fes hors des enoches 11, qui est analogue aux mécanismes
connus de même destination. Ce mécanisme comporte un pous-
soir 14 effilé à l'un de ses bouts (figures 1, 3) et muni d'un bistouri 15, et qui est installé avec possibilité de déplacement dans la rainure 10 (figure 1), et des lamelles mobiles (non représentées aux figures) disposées dans la rainure 10, perpendiculairement à celle-ci et qui peuvent, sous l'action du bout effilé du poussoir 14, se déplacer dans leur plan et propulser les agrafes hors des encoches 11. Au bout opposé à celui qui est effilé, le poussoir 14 porte une butée 16, ainsi qu'une goupille 17 qui se place
dans une rainure de guidage 18, exécutée dans la poignée 2.
Par ailleurs, l'appareil de suture chirurgicale selon l'in-
vention comporte un mécanisme de fixation des branches 1 et 4 en position fermée, lequel a la forme d'un collier 19, qui se place à l'extrémité libre de la branche de butée 4, d'un poussoir 20, situé sur la poignée 2, d'une crémaillère 21 et
d'éléments cunéiformes 22. Le poussoir 20 est adapté à coo-
pérer, lorsqu'on lui applique un effort, avec le secteur denté de la crémaillère 21, les éléments cunéiformes 22 étant fixés par l'un de leurs bouts sur le secteur denté de la crémaillère 21 et étant disposés avec possibilité de glissement le long de la branche à agrafes 1 et de calage par leurs bouts effilés au moyen du collier 19 de la branche de butée 4 par rapport à la branche à agrafes 1 en position
fermée de l'appareil.
On utilise l'appareil de suture chirurgicale, selon
l'invention, à la façon suivante.
Le mode d'utilisation de l'appareil selon l'invention
est illustré par l'exemple d'un appendicectomie laparosco-
pique. Avant l'intervention, on charge d'agrafes les enco-
ches 11 de la branche 1.
On introduit le laparoscope au point de Mac-Burney et on réalise la révision de la cavité abdominale. l'appareil selon l'invention sera utilisé dans les cas o l'appendice vermiforme est libre de toute adhérence ou, à la rigueur,
se trouve dans des adhérences lâches.
En se référant aux données de la laparoscopie, on introduit, par le biais d'une seconde ponction, dans la cavité abdominale, le tube d'un spéculum, à travers lequel on fait passer l'appareil de suture chirurgicale selon l'invention, en position ouverte (figures 4 et 5). Par
suite, au moyen d'une pince 23 (figure 5), introduite à tra-
vers le canal opérationnel du laparoscope, on fixe le bout libre de l'appendice vermiforme et on conduit la branche à agrafes 1 de l'appareil de suture chirurgicale sous la base de l'appendice et du méso-appendice. Puis en pressant sur le levier 5 de la poignée 2, on fait pivoter la branche de butée 4 dans la charnière 3 à 180 en mettant l'appareil en
position fermée, la branche de butée 4 (figure 2, 6) se pla-
çant parallèlement à la branche à agrafes 1. On fixe les branches 1, 4 en position fermée en appliquant un effort sur le poussoir 20. Il s'ensuit que le secteur denté de la crémaillère 21 pivote et pousse en avant, vers l'extrémité
active de l'appareil, les éléments cunéiformes 22, qui agis-
sent par leurs bouts effilés sur les parties rabattues du
collier 19 en serrant fermement les branches 1, 4 l'une con-
tre l'autre. la base de l'appendice vermiforme et du méso-
appendice s'avère comprimée entre les parties actives des
branches 1, 4. En exerçant une pression sur le taquet de bu-
tée 16 (figures 1, 2, 3), on fait avancer le poussoir 14 avec le bistouri 15. Le poussoir 14 se déplace alors dans
la rainure 10 et soulève, par son bout effilé, les lamel-
les, qui expulsent les agrafes hors des encoches 11, dont les pattes suturent les parois comprimées de l'appendice et les deux feuillets du méso-appendice. La lame du bistouri 15 excise l'appendice et le mésoappendice entre les deux rangées d'agrafes 24 (figure 7). Ensuite, en actionnant le levier 5 (figure 1), on transfère l'appareil de suture chirurgicale selon l'invention en position ouverte et on le
retire de la cavité abdominale à travers le tube du spécu-
lum. On extrait, de la cavité abdominale, par le biais de l'écarteur laparoscopique 25 (figure 8), l'appendice excisé,
au moyen de la pince 23.
Des prototypes de l'appareil de suture chirurgicale selon l'invention ont été préparés et ont été mis à l'épreuve sur des cadavres humains et chez des chiens. Les
expériences ont confirmé l'aptitude à fonctionner de la cons-
truction. Un exemple d'application expérimentale de l'appareil de suture selon l'invention sera maintenant donné. Cadavre
d'un homme de 34 ans, ayant succombé à la suite d'une asphy-
xie mécanique le 06/04/86. laparoscopie: l'appendice vermi-
forme de 7,6 x 0,5 cm est en position médiale, libre de tou-
te adhérence. Appendicectomie au moyen de l'appareil de suture chirurgicale selon l'invention. Puis, laparotomie, ligature de la partie terminale de l'iléum et pose d'un écraseur sur le colon ascendant. Hausse de la pression dans
le caecum jusqu'à 120 mbars avec vérification de l'étanchéi-
té de la coupe. Pour la valeur mentionnée de pression, la
coupe du moignon restait étanche.
Ainsi donc, l'appareil de suture chirurgicale selon
l'invention permet d'introduire, dans la pratique chirurgi-
cale, le procédé laparoscopique d'appendicectomie en respec-
tant sa sécurité.
262.2429
RE V END I CATION S
1. Appareil de suture chirurgicale, du type comportant deux branches réunies par une charnière, dont l'une, une
branche à agrafes avec des encoches pour les agrafes, por-
te à l'une de ses extrémités une poignée, et l'autre, une branche de butée,comporte des alvéoles pour le pliage des pattes des agrares, un mécanisme de propulsion des agrafes hors de leurs encoches et un mécanisme de fixation des
branches en position fermée, caractérisé en ce qu'une char-
nière (3), qui réunit les branches (1, 4), se trouveà l'ex-
trémité libre de la branche à agrafes (1), la branche de butée (4) est jointe à la charnière (3) par l'une de ses extrémités et est installée avec possibilité de rotation sur 180 , de façon qu'à la position ouverte de l'appareil, la branche de butée (4) forme le prolongement de la branche à agrafes (1), alors qu'en position fermée, elle se place parallèlement à la branche à agrafes, et elle est munie d'un mécanisme de rotation, ayant la forme d'un levier (5), dont l'axe d'oscillation (6) se situe sur la poignée (2) de la branche à agrafes (1), et d'un tirant (7) relié au levier
(5) et à la branche de butée (4).
2. Appareil de suture chirurgicale selon la revendica-
tion 1, caractérisé en ce que le mécanisme de fixation des branches (1, 4) en position fermée a la forme d'un collier (19), disposé sur la branche de butée (4), et d'un poussoir
(20), installé sur la poignée (2), et qui est adapté, lors-
qu'on lui applique un effort, à coopérer avec une crémail-
lère (21), qui est reliée à des éléments cunéiformes (22),
disposés avec possibilité de glissement le long de la bran-
che à agrafes (1) et de calage au moyen d'un collier (19) de la branche de butée (4) par rapport à la branche agrafes (1)
en position fermée de l'appareil.
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US07/127,031 US4784137A (en) | 1987-11-16 | 1987-11-16 | Surgical suturing instrument |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| FR2622429A1 true FR2622429A1 (fr) | 1989-05-05 |
Family
ID=22427978
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| FR8715108A Pending FR2622429A1 (fr) | 1987-11-16 | 1987-10-30 | Appareil de suture chirurgicale |
Country Status (5)
| Country | Link |
|---|---|
| US (1) | US4784137A (fr) |
| DE (1) | DE3802328A1 (fr) |
| FR (1) | FR2622429A1 (fr) |
| GB (1) | GB2211779B (fr) |
| SE (1) | SE459465B (fr) |
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| FR1237056A (fr) * | 1959-10-06 | 1960-07-22 | Appareil pour l'exécution d'anastomoses latérales gastro-intestinales | |
| US3017637A (en) * | 1959-07-10 | 1962-01-23 | Sampson Arnold | Surgical suturing instrument |
| EP0101310A1 (fr) * | 1982-08-13 | 1984-02-22 | Ethicon, Inc. | Appareil chirurgical de suture pour tissus et organes |
| EP0140552A2 (fr) * | 1983-10-14 | 1985-05-08 | Ethicon, Inc. | Appareil jetable pour la pose de sutures linéaires à agrafes |
| US4566620A (en) * | 1984-10-19 | 1986-01-28 | United States Surgical Corporation | Articulated surgical fastener applying apparatus |
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|---|---|---|---|---|
| SU566574A1 (ru) * | 1975-05-04 | 1977-07-30 | Всесоюзный научно-исследовательский и испытательный институт медицинской техники | Аппарат дл наложени линейного скобочного шва на органы и ткани |
| US4402444A (en) * | 1981-04-20 | 1983-09-06 | United States Surgical Corporation | Surgical stapling instrument with automatic frame reinforcement |
| SU1183082A1 (ru) * | 1983-08-19 | 1985-10-07 | Всесоюзный научно-исследовательский и испытательный институт медицинской техники | Хирургический сшивающий аппарат |
| US4573622A (en) * | 1984-10-19 | 1986-03-04 | United States Surgical Corporation | Surgical fastener applying apparatus with variable fastener arrays |
| US4648542A (en) * | 1985-11-01 | 1987-03-10 | Senmed, Inc. | Disposable stapler |
-
1987
- 1987-10-30 FR FR8715108A patent/FR2622429A1/fr active Pending
- 1987-11-02 SE SE8704267A patent/SE459465B/sv not_active IP Right Cessation
- 1987-11-04 GB GB8725857A patent/GB2211779B/en not_active Expired - Lifetime
- 1987-11-16 US US07/127,031 patent/US4784137A/en not_active Expired - Fee Related
-
1988
- 1988-01-27 DE DE3802328A patent/DE3802328A1/de active Granted
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US3017637A (en) * | 1959-07-10 | 1962-01-23 | Sampson Arnold | Surgical suturing instrument |
| FR1237056A (fr) * | 1959-10-06 | 1960-07-22 | Appareil pour l'exécution d'anastomoses latérales gastro-intestinales | |
| EP0101310A1 (fr) * | 1982-08-13 | 1984-02-22 | Ethicon, Inc. | Appareil chirurgical de suture pour tissus et organes |
| EP0140552A2 (fr) * | 1983-10-14 | 1985-05-08 | Ethicon, Inc. | Appareil jetable pour la pose de sutures linéaires à agrafes |
| US4566620A (en) * | 1984-10-19 | 1986-01-28 | United States Surgical Corporation | Articulated surgical fastener applying apparatus |
Also Published As
| Publication number | Publication date |
|---|---|
| SE459465B (sv) | 1989-07-10 |
| DE3802328C2 (fr) | 1990-07-05 |
| DE3802328A1 (de) | 1989-08-31 |
| GB8725857D0 (en) | 1987-12-09 |
| GB2211779B (en) | 1991-10-02 |
| SE8704267L (sv) | 1989-05-03 |
| SE8704267D0 (sv) | 1987-11-02 |
| US4784137A (en) | 1988-11-15 |
| GB2211779A (en) | 1989-07-12 |
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