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.
Medical devices are already such staples and staplers known.
The known brackets are approximate
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
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
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,
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,
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
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
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
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
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.
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.
Invention is based on the object, a surgical clip
and a surgical stapler
To create species that provide an exact, sufficiently strong assembly of the
to be connected tissue as possible
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
According to the invention
Task solved by
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.
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
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
so that already by
the design of the staple elements the formation of the anastomosis
or stapling supported
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
the base plate or pressure plate, whereby the exact fixation of
Tissue is favored.
This is supported by
arranged facing each other and are formed corresponding.
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.
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
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.
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
adequate adaptation and thus undisturbed blood circulation
a good cure is the prerequisite.
From the conditions of the case, it may be advantageous that the projection
essentially a cone-shaped,
or rectangular section with rounded or blunt point
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
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,
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.
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
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
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
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.
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
an exact mutual positioning of base plate and pressure plate
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.
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
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
Features of the invention and its advantages emerge from the claim
and the rest
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.
- printing plate
- clamping surface
- clamping surface
- retaining pin
- printing plate
- printing plate
- printing plate
- clamping surface
- clamping surface
- head Start
- head Start
- head Start
- head Start
- intestinal end
- Central staff
- instrument head
- staple magazine
- retention sheet
- staple magazine
- retention sheet