DE102004015223A1 - Surgical staple assembled of two elements and appropriate stapler in particular for joining outer ends of intestine segments - Google Patents

Surgical staple assembled of two elements and appropriate stapler in particular for joining outer ends of intestine segments

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Publication number
DE102004015223A1
DE102004015223A1 DE200410015223 DE102004015223A DE102004015223A1 DE 102004015223 A1 DE102004015223 A1 DE 102004015223A1 DE 200410015223 DE200410015223 DE 200410015223 DE 102004015223 A DE102004015223 A DE 102004015223A DE 102004015223 A1 DE102004015223 A1 DE 102004015223A1
Authority
DE
Germany
Prior art keywords
characterized
staple
base plate
surgical
tissue
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
DE200410015223
Other languages
German (de)
Inventor
Gert Otten
Original Assignee
Otten, Gert, Prof. Dr.med.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Otten, Gert, Prof. Dr.med. filed Critical Otten, Gert, Prof. Dr.med.
Priority to DE200410015223 priority Critical patent/DE102004015223A1/en
Publication of DE102004015223A1 publication Critical patent/DE102004015223A1/en
Withdrawn legal-status Critical Current

Links

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115Staplers for performing anastomosis in a single operation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064Surgical staples, i.e. penetrating the tissue
    • A61B17/0643Surgical staples, i.e. penetrating the tissue with separate closing member, e.g. for interlocking with staple
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/1114Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00004(bio)absorbable, (bio)resorbable, resorptive
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064Surgical staples, i.e. penetrating the tissue
    • A61B2017/0641Surgical staples, i.e. penetrating the tissue having at least three legs as part of one single body
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064Surgical staples, i.e. penetrating the tissue
    • A61B2017/0647Surgical staples, i.e. penetrating the tissue having one single leg, e.g. tacks

Abstract

Surgical staple and surgical stapler, in particular for forming an anastomosis in bowel surgery and for forming an approximately linear staple in soft tissue, bowel and lung surgery. DOLLAR A solution is provided that organic tissue to be connected between separate clip elements made of resorbable material is positionable and the clip elements are under pressure of the positioned tissue by means of at least one fixing means associated with the clip elements fixed to each other.

Description

  • The The invention relates to a surgical clip according to the preamble of claim 1 and a surgical stapler according to the Preamble of claim 21, applicable in particular for training Anastomosis in bowel surgery and the formation of a linear stapling in soft tissue, bowel and lung surgery.
  • Out Medical devices are already such staples and staplers known. The known brackets are approximate U-shaped and are made of metal. Two parallel legs extend from a base. For the preparation of an anastomosis or rectilinear Staples perforate these legs first to be joined Tissue. Subsequently the legs are bent towards each other and in the direction of the base, similar to at paper staples, so that the perforated tissues between the bent legs and the base the clip pressed together becomes. The deformation of the legs is essentially dependent on the Thickness of the fabric to be joined. The disadvantage here is that in the actual area the staple suture blood circulation is at least partially significantly limited, if not even excluded and the metal braces in the tissue as a foreign body remain.
  • Known Staplers to form an approximately circular Staple seam, referred to as anastomosis, or a rectilinear Staple seam are so-called Circular Stapler or Linear Stapler ( z. Proximate ILS, ETHICON, Advances in Surgery). These wise two separate halves of the device, namely a central rod and a corresponding thereto formed Instrument head, which are formed according to circular or linear. The central rod and instrument head are mutually displaceable but also fixable. In the case of the circular stapler, which is described in more detail below, is a device half with a coaxial guide sleeve provided in the one coaxial guide pin the other half of the device, guided and can be locked. In the starting position of the device halves, ie in front of the anastomosis, these are at a mutual distance in the axial direction separated from each other, such that the central rod and instrument head from one end of the intestine or hollow organ to be connected is included and enclosed. The respective ends of the intestine enclose the central rod or instrument head and are on each other facing sides near the axis of symmetry by an auxiliary seam drawn together. One of the device halves points a staple magazine for receiving the medical staples made of metal on, with the legs of the magazinierten brackets in the open state or the starting position extend parallel to the other half of the device. The staples are in the staple cartridge on two adjacent coaxial circular Railways, d. H. arranged in two rows, the brackets of the one row are positioned so overlapping to that of the other row, that gaps between The brackets of one row are covered by brackets of the adjacent row become. The other device head By contrast, as an abutment for deforming the staples from the open formed in the closed position. To become anastomosis the device halves coaxial moved toward each other until extending in the radial direction of the stapler Ends of the intestine abut each other and pressed against each other. First, perforate the initial parallel legs of the metal surgical clips both Ends of the hollow organ. Upon further axial displacement of the device halves come the protruding tips of the brackets to rest against as abutments serving half of the device. As a result the further displacement of the device halves are the legs to about B-shaped Form bent so that the radially inwardly facing bowel ends are pressed against each other and it comes to the formation of the anastomosis. In the radial direction, so to the inside of the intestine, over the Clasps or the anastomosis extending outward ends of the intestine finally become cut off by means of a razor associated with the stacker, which is axially displaceable within the truck. By the Cut can be the inevitable constriction of the formation of the anastomosis Clear width of the intestine can be minimized.
  • Of the Linear stacker, is in terms of structure as well as the mode of action almost identical with the Circular Stacker. The for holding the brackets or serving as an abutment device halves, however, are straight trained and arranged parallel to each other, movable as well fixable. He therefore serves in particular for settling and closing a hollow organ.
  • Significant disadvantages result from the known stapler. To ensure an exact seal of the interface, the brackets must be pressed firmly together, resulting in poor blood flow to the tissue and thus significant impairment of healing in the anastomosis. This is additionally adversely affected by the fact that the brackets must be arranged in a double row to ensure an accurate seal or avoidance of leaks including the blood vessels. Because of the remaining of the metal staples in the seam area, there are often scarring and thus narrowing of the width of the anastomosis, the constitute a passage obstacle and not infrequently require a repeated surgery for the expansion of the anastomosis.
  • Of the Invention is based on the object, a surgical clip and a surgical stapler the aforementioned To create species that provide an exact, sufficiently strong assembly of the to be connected tissue as possible low impairment to allow the circulation and thus wound healing disorders and Scar contractures largely avoid the passage of fluid safe by the staple seam and also easy to manufacture and manageable.
  • According to the invention Task solved by that too connecting organic tissue between at least two separate ones Clamping elements positioned at least one clip and the clip elements under pressure of the positioned tissue by means of at least a fixation device associated with the stapling elements permanently can be connected. This makes it possible with simple means to make the brackets diverse, the respective Use to adapt and thereby the exclusion of leaks and to ensure good healing.
  • Advantageous is it that the Clamping elements by a trained as a base plate bracket half and formed as a pressure plate formed other clip half and both are made of resorbable material. This is on the one hand a high functionality of the brackets in the simplest way and on the other hand the permanent retention of the clamp in the patient as a foreign body locked out.
  • Preferably The base plate and / or pressure plate extend in their longitudinal direction corresponding to the desired one Form of anastomosis rectilinear, arcuate, circular or circular section or zig-zag, so that already by the design of the staple elements the formation of the anastomosis or stapling supported can be.
  • In Further training is provided that the base plate and pressure plate in each case at least one clamping surface between which the organic tissue is securely fixed can. The clamping surface extends beyond the whole length the base plate or pressure plate, whereby the exact fixation of Tissue is favored. This is supported by that the clamping surfaces arranged facing each other and are formed corresponding.
  • Especially It is advantageous, at least one of the clamping surfaces with a profiling to provide and thereby the contact pressure held on the between the clamping surfaces Tissue can vary.
  • Conveniently, the healing is favored and leakage excluded when profiling the clamping surface through a projection is formed, which is in the region of an inner Edge of the clamping surface, which runs close to the interior of the organ to be anastomosed by the clamping surface rises and over the entire length the edge or clamping surface extends. The projection runs thus parallel and adjacent to a deposition line, along that over to the inside of the organ the staples protruding tissue after formation of the staple is separated by a knife.
  • In a simple way to vary the contact pressure by sizing of the projection can be achieved, so that on the one hand the tissue in the area of the projection is pressed against each other such that the passage of liquid is excluded by the chamber seam and on the other hand, the lower Pressure on the tissue in the area of the rest, essentially flat clamping surface adequate adaptation and thus undisturbed blood circulation allows the for a good cure is the prerequisite.
  • In dependence From the conditions of the case, it may be advantageous that the projection essentially a cone-shaped, arcuate or rectangular section with rounded or blunt point having.
  • For sure and just can the clip elements together or the base plate with the pressure plate positively and / or positively connected by means of the fixing device become.
  • The Fixing device is in the simplest way by a retaining pin and a corresponding recess formed, wherein the recess the base plate and the retaining pin of the printing plate, or vice versa, assigned.
  • So that the connection can be initiated in time by means of the fixing device and can be reliably realized upon reaching the end position, the retaining pin rises from the pressure plate in the direction of the base plate, while the recess is arranged coaxially to the retaining pin in the base plate. The connection is due to the movement of the base plate and pressure plate from its original position in which they are separated from each other, in their final position in which they are permanently connected to each other with the tissue positioned between them by the retaining pin is inserted into the recess.
  • Is appropriate it further, that the Retaining pin and / or the recess in one piece with the respective base plate or pressure plate are formed and made of absorbable material exist, so that no Components of the clamp remain in the organism. After the wound healing These organic braces are due to metabolism of the organism added. Foreign body reactions can not occur The positive connection between Retaining pin and recess becomes particularly easy and effective by a profiling of an outer surface of the retaining pin and / or a corresponding profiling of an inner surface of the Realized recess, including both provided with an external or internal toothing could be. By the outside and internal teeth, d. H. the distance of the teeth in the longitudinal direction of the retaining pin or the recess, a certain locking grid can be specified. Within this grid, the retaining pin in the recess can be variable be fixed so that different and correspondingly variable distances between the pressure plate and base plate in their mutual end position are feasible. This is useful to different Thickness of the tissue to be joined both a secure seal as well as injuries of the blood vessels due to excessive squeezing exclude them.
  • In Another embodiment, the adhesion of the fixing device with low effort and high security by appropriate dimensioning the retaining pin and the recess are achieved in such a way that between a press fit is realized.
  • in the Meaning of the invention is that at least two of the fixators are present, which are longitudinally the base plate or pressure plate in a row on a line but also be arranged laterally offset on parallel lines can, if this for an exact mutual positioning of base plate and pressure plate makes sense.
  • Especially is appropriate it that the Fixing device in the longitudinal direction the base plate and pressure plate at a distance from the respective ends thereof is arranged. As a result, the gapless arrangement of several Staples one after another favors, but have caused by the fixing perforations of the fabric then also a mutual distance.
  • perforations of the tissue can in the area where the tissues are well supplied with blood and heal is to be ruled out, characterized in that the fixing of the Base plate or pressure plate in the profiling or the Projection of the clamping surface assigned.
  • at the stapler for use of the staples according to the invention is both the central rod as well as the instrument head with a Recording or a magazine for holding at least one of the separated Clamp elements of the clip, d. H. the base plate or pressure plate, provided and the clip elements due to the displaceability of the Instrument head to the central rod from the starting to the end position connectable with each other and with the formation of the anastomosis to each other fixable.
  • Further Features of the invention and its advantages emerge from the claim and the rest Description.
  • The Invention will be explained in more detail below with reference to some embodiments. In the associated Drawing show in a schematic and enlarged representation:
  • 1 : the front view of a medical staple, partly in section,
  • 2 : the side view of another embodiment of the medical clip, partly in section,
  • 3 FIG. 2: the side view of a third embodiment of the medical clip, partly in section,
  • 4 FIG. 2: the plan view of the base plate of a further embodiment of the medical staple, FIG.
  • 5 FIG. 2: the plan view of the base plate of a further embodiment of the medical staple, FIG.
  • 6 : The side view of a specific embodiment of the medical clip after 2 , partly in section,
  • 7 : the plan view of the base plate of a medical staple for an arcuate anastomosis,
  • 8th : the side view of another embodiment of the medical clip, partly in section,
  • 9 : the front view of the medical staple behind 8th , partly in section,
  • 10 : the front view of a special one Embodiment of the medical clip after 8th , partly in section,
  • 11 an anastomosis partially and in section, with staple elements in the starting position,
  • 12 : the cut after 11 with the clip elements in the final position,
  • 13 FIG. 3: a perspective view of a stapler in the starting position, FIG.
  • 14 : The front view of a stapler with staple cartridge for forming an anastomosis, in partial view and
  • 15 : The front view of a stapler with staple cartridge for forming a straight staple.
  • A medical staple 1 . 1 , has two clip elements, namely a base plate 2 and pressure plate 3 on. The base plate 2 and pressure plate 3 each have a predominantly flat clamping surface 4 . 5 , Which are arranged facing each other and formed substantially equal or corresponding. Between the clamping surfaces 4 . 5 the tissue of the intestine or organ to be anastomosed can be clamped, wherein between the clamping surfaces 4 . 5 the anastomosis or staple seam is formed. The longitudinal direction of the base plate 2 and pressure plate 3 outer ends may be rounded or square. It is important that several of the parentheses 1 can be arranged in close succession in series and leaks between the base plate 2 and pressure plate 3 but also in the area of the gap between two brackets 1 excluded are.
  • The base plate 2 and pressure plate 3 as well as the tissue clamped between them are by means of a fixing device 6 permanently connectable when the base plate 2 and pressure plate 3 from their initial position, in which they have a great mutual distance, to an end position in which they are close to each other and the tissue is compressed between them. During this movement, a retaining pin penetrates with simultaneous perforation of the tissue 7 the fixing device 6 in a recess 8th the same one. To facilitate the perforation of the tissue is the retaining pin 7 provided with a sharp point. The retaining pin 7 rises vertically from the pressure plate 3 and penetrates into the coaxially arranged recess 8th the base plate 2 one, with the retaining pin 7 and the recess 8th may also be associated with the respective other clip element.
  • All elements of the bracket 1 namely, the base plate 2 , Printing plate 3 but also the fixer 6 with the retaining pin 7 and the recess 8th consist of absorbable material, so that the clip 1 after complete healing of the anastomosis completely dissolves and does not remain as a foreign body in the organism.
  • A clamp 9 . 2 Also, two of the fixators can 6 have, in the longitudinal direction of the clip 9 arranged one behind the other. Also three consecutive fixation devices 6 like a clip 10 . 3 , are conceivable. The number of fixators 6 and their arrangement is arbitrarily variable depending on the particular anastomosis to be formed.
  • With a clip 11 respectively. 12 in which 4 respectively. 5 only the base plate 13 respectively. 14 is shown, are the fuser 6 in the longitudinal direction of the clip 11 . 12 arranged one behind the other and additionally laterally offset, depending on the strength of the fabric to be joined.
  • The retaining pin 7 is in the recess 8th until absorption of the clamp 1 fixed in a positive and / or positive manner. To realize a positive connection, the retaining pin 7 with an external toothing and the recess 8th with a corresponding internal toothing, 6 be provided. A frictional connection can be achieved by the retaining pin 7 and the recess 8th are designed with a corresponding interference fit.
  • Although the brackets 1 . 9 . 10 . 11 . 12 Preferably, for a rectilinear anastomosis, so can be used in connection with a so-called linear stacker, the clip elements are varied according to the shape of the desired anastomoses formed. They can also extend in a curved or circular but also in a zigzag shape.
  • A circle-shaped bracket 15 . 7 , with a base plate 16 and pressure plate 17 By contrast, it can preferably be used in the formation of a circular or annular anastomosis by means of a so-called circular stapler.
  • A clamp 18 . 8th and 9 , has a base plate 19 and pressure plate 20 on. Their clamping surfaces 21 . 22 are formed substantially flat and corresponding to each other, so that between them the tissue of the organ to be anastomosed evenly, ie can be clamped with approximately uniform contact pressure. From an edge 23 . 24 the base plate 19 or printing plate 20 , which runs near the interior of the organ to be anastomosed, rises in the direction the opposite clip element a projection 25 respectively. 26 , This extends over the entire length of the edge 23 . 24 and thus the base plate 19 and pressure plate 20 , The projections 25 . 26 come during the mutual movement of the base plate 19 and pressure plate 20 from their initial position to the end position, first on the tissue arranged between them. They squeeze the tissue with the reaching of the end position against each other and from so that Gewebeflüssigkeitss- and blood leakage into the interior of the organ or intestine are excluded. Otherwise flat area of the clamping surfaces 21 . 22 In contrast, the tissue is only pressed against each other so that it is securely fixed to each other and is sufficiently supplied with blood and can heal well together. By appropriate dimensioning of the projection 25 . 26 ie the measure with which it extends from the clamping surface 21 . 22 As well as its cross-section, depending on the thickness of the respective tissue and the other conditions of the individual case defined on the safe exclusion of leaks combined with good healing of the anastomosis influence can be taken. The cross section of the projection 25 . 26 has approximately the shape of an isosceles triangle, wherein the tip between the legs is rounded. The cross section may, for example, but also have the shape of a bow or rectangle.
  • The clip 18 are in the longitudinal direction one behind the other on a line two of the fixing 6 assigned, with their retaining pin 7 from the flat area of the clamping surface 21 the printing plate 22 rises while the recess 8th coaxial with the retaining pin 7 in the clamping area 21 the base plate 19 is arranged.
  • But it is also conceivable that only the base plate 19 or pressure plate 20 with the lead 25 respectively. 26 is provided and the clamping surface 21 respectively. 22 the other clip element is completely flat.
  • With a clip 24 . 10 , is the fixator 6 a lead 25 . 26 assigned. This can be advantageous in cases in which a perforation of the tissue in the well-perfused area should be avoided and the frictional connection of the fixing device 6 and the compression of the tissue in the area of the projection should be increased. The secure frictional connection is additionally favored by the fact that the active axial connection of the recess 8th and the associated retaining pin 7 are extended.
  • In the in 11 and 12 schematically illustrated junction of two bowel ends are the clip elements of the clip 18 once in its starting position and on the other in its final position. It can be clearly seen that the tissue to be anastomosed to the interior of the organ strongly pressed together and squeezed to a certain extent and thus leakage is excluded with certainty. On the other hand, it can be seen that the tissue in the remaining area of the clamping surfaces 21 . 22 the base plate 19 or printing plate 20 only as far as pressed together, on the one hand, a secure fixation of intestinal ends 30 secured to each other and on the other hand, the required circulation for the circulation is ensured.
  • At the in 13 schematically illustrated stapler 31 it is a so-called circular stapler. This has two device halves, namely a central rod 32 and an instrument head 33 on. Both are coaxially arranged and axially displaceable with each other from an initial position in which they have a large mutual distance to an end position in which they are close to each other. On the to the central staff 32 pointing end face is the instrument head 33 with a staple magazine 34 for receiving one of the clamp halves, namely the base plates 16 or printing plates 17 the bracket 15 Mistake, 14 , The central staff 32 is analogously provided with a magazine for receiving the respective other clip halves, wherein the clip halves are held in the magazines such that during the movement of the clip elements from the starting to the end position, the retaining pins 7 the fixing device 6 in their recesses 8th can intervene. The track 35 and associated clip elements are on the one hand so dimensioned that a number of staple elements in the form of a closed circle can be stored in close succession and without gap behind each other to form a corresponding anastomosis. On the other hand, the width of the tracks 36 . 37 and base plate 16 or printing plate 17 designed so that the clamping elements during the movement of the central rod 32 and instrument head 33 and thus the base plate 16 and pressure plate 17 are held securely from the initial to the final position and are easily released after reaching the end position and formation of the anastomosis.
  • An unspecified device for forming a rectilinear anastomosis is analogous to the stapler 31 trained and also works in an analogous way. Their elements, such as the mutually movable device halves and the like. Are formed only correspondingly rectilinear. So is a staple magazine 36 this so-called linear stacker and its track 37 for holding the brackets 9 designed in the form of a straight line.
  • The formation of an anastomosis takes place when using the stapler 31 and under Ver use of the bracket 15 as follows.
  • After both the staple magazine 34 of the instrument head 33 and analogously the magazine of the central staff 32 with the elements of the bracket 15 are fitted, is of the two Darmenden to be connected 30 one each over the central rod 32 and one over the instrument head 33 slipped. Subsequently, the respective bowel ends 30 summarized at their extreme ends in the region of the center line of the respective device element so that both the central rod 32 and instrument head 33 enclosed and the facing faces with the brackets positioned 15 are completely covered by tissue. Then, the axial displacement of the bone and staple elements from the starting to the end position begins. First perforate the retaining pins 7 the fuser 6 that between the base plate 16 and pressure plate 17 positioned tissue before moving into the recesses 8th enter. This axial movement continues until the base plate 16 and pressure plate 17 have reached their final position and in this position the position of the two to each other as well as the tissue positioned between them by means of the fixing device 6 is fixed. Subsequently, they are directed towards the interior of the intestine 30 cut off over the thus formed anastomosis protruding tissue sections means of a ring knife. Finally, the removal of the stapler takes place 31 and the previously separated tissue sections.
  • 1
    clip
    2
    baseplate
    3
    printing plate
    4
    clamping surface
    5
    clamping surface
    6
    fixing
    7
    retaining pin
    8th
    recess
    9
    clip
    10
    clip
    11
    clip
    12
    clip
    13
    baseplate
    14
    printing plate
    15
    clip
    16
    baseplate
    17
    printing plate
    18
    clip
    19
    baseplate
    20
    printing plate
    21
    clamping surface
    22
    clamping surface
    23
    edge
    24
    edge
    25
    head Start
    26
    head Start
    27
    clip
    28
    head Start
    29
    head Start
    30
    intestinal end
    31
    stapler
    32
    Central staff
    33
    instrument head
    34
    staple magazine
    35
    retention sheet
    36
    staple magazine
    37
    retention sheet

Claims (27)

  1. Surgical staple, in particular for forming an anastomosis in bowel surgery, and for forming an approximately linear staple in the soft tissue, bowel and pulmonary surgeons, characterized in that organic tissue to be joined is positionable between separate staple members and the staple members are pressed against one another of the positioned tissue by means of at least one fixing device associated with the clamping elements ( 6 ) are fixable to each other.
  2. Surgical staple according to claim 1, characterized in that a staple element is provided as a base plate ( 2 . 13 . 16 . 19 ) trained clamp half and a clamping element by a pressure plate ( 3 . 14 . 17 . 20 ) trained other clip half are formed.
  3. Surgical staple according to claim 1 or 2, characterized characterized in that all Clamping elements made of resorbable material and these at least until the conclusion of the Healing of the anastomosis or staple suture are fixable to each other.
  4. Surgical clip according to one of claims 1 to 3, characterized in that the base plate ( 2 . 13 . 16 . 19 ) and / or pressure plate ( 3 . 14 . 17 . 20 ) extend in their longitudinal direction corresponding to the desired shape of the anastomosis straight, arcuate, circular or circular section or zigzag-shaped.
  5. Surgical clip according to one of claims 1 to 4, characterized in that the base plate ( 2 . 13 . 16 . 19 ) and pressure plate ( 3 . 14 . 17 . 20 ) at least one clamping surface ( 4 . 5 . 21 . 22 ), between which the organic tissue is fixable, the clamping surface ( 4 . 5 . 21 . 22 ) over the entire length of the base plate ( 2 . 13 . 16 . 19 ) or pressure plate ( 3 . 14 . 17 . 20 ) and the clamping surfaces ( 4 . 5 . 21 . 22 ) arranged facing each other and are formed corresponding.
  6. Surgical clamp according to one of claims 1 to 5, characterized in that at least one of the clamping surfaces ( 4 . 5 . 21 . 22 ) provided with a profiling and the contact pressure on the tissue held between them is variable.
  7. Surgical clip according to one of claims 1 to 6, characterized in that the profiling of the clamping surface ( 4 . 5 . 21 . 22 ) by a projection ( 25 . 26 ) formed in the region of an inner edge ( 23 ) of the clamping surface ( 21 . 22 ), which runs close to the interior of the organ to be anastomosed, of the clamping surface ( 21 . 22 ) and over the entire length of the edge ( 23 ) or clamping surface ( 21 . 22 ).
  8. Surgical clip according to one of Claims 1 to 8, characterized in that the projection ( 25 . 26 ) is dimensioned so that the tissue in the region of the projection ( 25 . 26 ) is pressed against each other such that the passage of tissue fluid and blood is excluded in the anastomosed organ and by the lower pressure against each other in the region of the remaining, substantially flat clamping surface ( 21 . 22 ) the necessary for a good healing circulation of the tissue is given.
  9. Surgical clip according to one of Claims 1 to 8, characterized in that the projection ( 25 . 26 ) has a substantially conical, arcuate or rectangular cross section with a rounded or blunt tip.
  10. Surgical clip according to one of claims 1 to 9, characterized in that the extent to which the projection ( 25 . 26 ) of the clamping surface ( 21 . 22 ) in the direction of the opposite clamping surface ( 21 . 22 ), depends on the thickness of the tissue to be anastomosed dependent variable.
  11. Surgical clip according to one of claims 1 to 10, characterized in that the connection of the clip elements to one another or to the base plate ( 2 . 13 . 16 . 19 ) with the pressure plate ( 3 . 14 . 17 . 20 ) by means of the fixing device ( 6 ) takes place by force and / or positive engagement.
  12. Surgical clip according to one of claims 1 to 11, characterized in that the fixing device ( 6 ) by a retaining pin ( 7 ) and a corresponding recess ( 8th ) is formed, wherein the recess ( 8th ) of the base plate ( 2 . 13 . 16 . 19 ) and the retaining pin ( 7 ) of the printing plate ( 3 . 14 . 17 . 20 ), or vice versa.
  13. Surgical clip according to one of claims 1 to 12, characterized in that the retaining pin ( 7 ) from the pressure plate ( 3 . 14 . 17 . 20 ) in the direction of the base plate ( 2 . 13 . 16 . 19 ) and coaxial with the retaining pin ( 7 ) in the base plate ( 2 . 13 . 16 . 19 ) the recess ( 8th ) is arranged, wherein due to the movement of the base plate ( 2 . 13 . 16 . 19 ) and pressure plate ( 3 . 14 . 17 . 20 ) from its initial position in which they are separated from each other, in their end position in which they are permanently connected to each other with the tissue positioned between them, the retaining pin ( 7 ) in the recess ( 8th ) is insertable.
  14. Surgical clip according to one of claims 1 to 13, characterized in that the retaining pin ( 7 ) and / or the recess ( 8th ) in one piece with the respective base plate ( 2 . 13 . 16 . 19 ) or pressure plate ( 3 . 14 . 17 . 20 ) are formed and made of resorbable material.
  15. Surgical clip according to one of claims 1 to 14, characterized in that the positive locking of the fixing device ( 6 ) by a profiling of the outer surface of the retaining pin ( 7 ) and / or a corresponding profiling of the inner surface of the recess ( 8th ) is realized.
  16. Surgical clip according to one of claims 1 to 15, characterized in that the profilings of the retaining pin ( 7 ) and the recess ( 8th ) are formed by an internal or external toothing.
  17. Surgical clip according to one of claims 1 to 16, characterized in that the frictional connection of the fixing device ( 6 ) by appropriate dimensioning of a press fit of the retaining pin ( 7 ) and the recess ( 8th ) given is.
  18. Surgical clip according to one of claims 1 to 17, characterized in that the base plate ( 13 . 16 . 19 ) and pressure plate ( 14 . 17 . 20 ) at least two of the fixation devices ( 6 ) assigned.
  19. Surgical clip according to one of claims 1 to 18, characterized in that the fixing devices ( 6 ) in the longitudinal direction of the base plate ( 2 . 13 . 16 . 19 ) or pressure plate ( 3 . 14 . 17 . 20 ) but also in addition laterally offset from each other can be arranged.
  20. Surgical clip according to one of claims 1 to 19, characterized in that the fixing device ( 6 ) a bracket ( 27 ) the area of a projection ( 28 . 29 ) assigned.
  21. Surgical clip according to one of claims 1 to 20, characterized in that the fixing device ( 6 ) at a distance from the respective ends of the base plate ( 2 . 13 . 16 . 19 ) or pressure plate ( 3 . 14 . 17 . 20 ) are arranged.
  22. Surgical stapler for use with surgical staples according to claims 1 to 21, in particular for digestive tract anastomosis, comprising a central rod and an instrument head which are mutually displaceable and fixable, the instrument head being connected to the central rod from a starting position in which they have a large mutual axial position Have a distance, in an end position in which they are close to each other, are axially displaceable and between them the tissue to be anastomosed fixable and in the final position, the anastomosis or staple seam can be formed, characterized in that both the central rod ( 32 ) as well as the instrument head ( 33 ) with a staple magazine ( 34 . 36 ) for holding and holding at least one of the separated staple elements of one of the staples ( 1 . 9 . 10 . 11 . 12 . 15 . 27 ) and the clip elements due to the displaceability of the instrument head ( 33 ) to the central rod ( 32 ) can be connected to one another from the starting position to the end position and can be permanently fixed to form the anastomosis.
  23. Surgical stapler according to claim 22, characterized in that the respective separated stapling element in the staple cartridge ( 34 . 36 ) of the instrument head ( 33 ) or central rod ( 32 ) is held until reaching the end position and released after formation of the anastomosis.
  24. Surgical stapler according to claim 22 or 23, characterized in that the separated staple element is closed by force and / or positive locking in the staple cartridge ( 34 . 36 ) is held.
  25. Surgical stapler according to one of claims 22 to 24, characterized in that the frictional connection by press fitting between narrow surfaces of a retaining track ( 35 . 37 ) of the staple magazine ( 34 . 36 ) and narrow surfaces of the clamping element or the base plate ( 2 . 13 . 16 . 19 ) or pressure plate ( 3 . 14 . 17 . 20 ) given is.
  26. Surgical stapler according to one of claims 22 to 25, characterized in that the retaining track ( 35 . 37 ) Have for the clip elements one of the future anastomosis corresponding course and are correspondingly circular, circular segment, arcuate, rectilinear or zigzag-shaped.
  27. Surgical stapler according to one of Claims 22 to 26, characterized in that the staple elements in the retaining track ( 35 . 37 ) are arranged in a row close to each other and substantially without spacing, such that with a linear stapler a staple or anastomosis in the form of a finite line or with a circular stapler of a closed infinite line can be formed.
DE200410015223 2004-03-24 2004-03-24 Surgical staple assembled of two elements and appropriate stapler in particular for joining outer ends of intestine segments Withdrawn DE102004015223A1 (en)

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DE200410015223 DE102004015223A1 (en) 2004-03-24 2004-03-24 Surgical staple assembled of two elements and appropriate stapler in particular for joining outer ends of intestine segments

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WO2008028725A1 (en) * 2006-09-08 2008-03-13 Ethicon Endo-Surgery, Inc. Surgical instrumentation for performing endoluminal and/or transluminal anastomosis
DE202012001672U1 (en) 2012-02-16 2012-03-30 Anja Honnefelder Surgical clip
DE102012003334A1 (en) 2012-02-16 2013-08-22 Anja Honnefelder Surgical clip
US9375218B2 (en) 2006-05-03 2016-06-28 Datascope Corp. Systems and methods of tissue closure
WO2017085893A1 (en) * 2015-11-20 2017-05-26 オリンパス株式会社 Treatment instrument and suture member
US10299842B2 (en) 2013-12-20 2019-05-28 Crossroads Extremity Systems, Llc Bone plates with dynamic elements
US10485545B2 (en) 2013-11-19 2019-11-26 Datascope Corp. Fastener applicator with interlock
US10492841B2 (en) 2014-07-10 2019-12-03 Crossroads Extremity Systems, Llc Bone implant and means of insertion

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DE3249678C2 (en) * 1981-10-09 1986-04-03 United States Surgical Corp., Norwalk, Conn., Us
DE9211975U1 (en) * 1992-09-05 1992-11-12 Redmann, Thomas, Dr.Med., 5800 Hagen, De
DE3877227T2 (en) * 1987-02-11 1993-05-27 Avant Odis L Staple device for anastomosis, especially for urine tube-urban bladder anastomosis.
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US3166072A (en) * 1962-10-22 1965-01-19 Jr John T Sullivan Barbed clips
DE3249678C2 (en) * 1981-10-09 1986-04-03 United States Surgical Corp., Norwalk, Conn., Us
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DE3877227T2 (en) * 1987-02-11 1993-05-27 Avant Odis L Staple device for anastomosis, especially for urine tube-urban bladder anastomosis.
DE69124444T2 (en) * 1990-09-17 1997-06-12 United States Surgical Corp Device for attaching two-part surgical clips
DE9211975U1 (en) * 1992-09-05 1992-11-12 Redmann, Thomas, Dr.Med., 5800 Hagen, De

Cited By (13)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9375218B2 (en) 2006-05-03 2016-06-28 Datascope Corp. Systems and methods of tissue closure
US10595861B2 (en) 2006-05-03 2020-03-24 Datascope Corp. Systems and methods of tissue closure
US8617159B2 (en) 2006-09-08 2013-12-31 Ethicon Endo-Surgery, Inc. Surgical instrumentation for performing endoluminal and/or transluminal anastomosis
EP1915956A1 (en) * 2006-09-08 2008-04-30 Ethicon Endo-Surgery, Inc. Surgical instrumentation for performing endoluminal and/or transluminal anastomosis
WO2008028725A1 (en) * 2006-09-08 2008-03-13 Ethicon Endo-Surgery, Inc. Surgical instrumentation for performing endoluminal and/or transluminal anastomosis
DE202012001672U1 (en) 2012-02-16 2012-03-30 Anja Honnefelder Surgical clip
DE102012003334A1 (en) 2012-02-16 2013-08-22 Anja Honnefelder Surgical clip
WO2013120477A2 (en) 2012-02-16 2013-08-22 Honnefelder, Anja Surgical clip and device for applying the clip
US9706995B2 (en) 2012-02-16 2017-07-18 Brigitte Otten Surgical clip and device for applying the clip
US10485545B2 (en) 2013-11-19 2019-11-26 Datascope Corp. Fastener applicator with interlock
US10299842B2 (en) 2013-12-20 2019-05-28 Crossroads Extremity Systems, Llc Bone plates with dynamic elements
US10492841B2 (en) 2014-07-10 2019-12-03 Crossroads Extremity Systems, Llc Bone implant and means of insertion
WO2017085893A1 (en) * 2015-11-20 2017-05-26 オリンパス株式会社 Treatment instrument and suture member

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