DE19924311A1 - Klammerschneidegerät und Zusatzvorrichtung für ein solches - Google Patents
Klammerschneidegerät und Zusatzvorrichtung für ein solchesInfo
- Publication number
- DE19924311A1 DE19924311A1 DE1999124311 DE19924311A DE19924311A1 DE 19924311 A1 DE19924311 A1 DE 19924311A1 DE 1999124311 DE1999124311 DE 1999124311 DE 19924311 A DE19924311 A DE 19924311A DE 19924311 A1 DE19924311 A1 DE 19924311A1
- Authority
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- clamp
- clip
- pressure plate
- cutting device
- head
- 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.)
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Links
- 238000005520 cutting process Methods 0.000 title claims abstract description 35
- BWGVNKXGVNDBDI-UHFFFAOYSA-N Fibrin monomer Chemical compound CNC(=O)CNC(=O)CN BWGVNKXGVNDBDI-UHFFFAOYSA-N 0.000 title claims abstract description 21
- 108010073385 Fibrin Proteins 0.000 title claims abstract description 19
- 102000009123 Fibrin Human genes 0.000 title claims abstract description 19
- 229950003499 fibrin Drugs 0.000 title claims abstract description 19
- 102000008186 Collagen Human genes 0.000 title claims abstract description 18
- 108010035532 Collagen Proteins 0.000 title claims abstract description 18
- 229920001436 collagen Polymers 0.000 title abstract description 14
- 239000000463 material Substances 0.000 claims abstract description 20
- 239000007788 liquid Substances 0.000 claims description 16
- 239000003566 sealing material Substances 0.000 claims 9
- 239000000969 carrier Substances 0.000 claims 1
- 210000002414 leg Anatomy 0.000 description 10
- 238000001356 surgical procedure Methods 0.000 description 9
- 238000007789 sealing Methods 0.000 description 7
- 239000000306 component Substances 0.000 description 6
- 238000002324 minimally invasive surgery Methods 0.000 description 5
- 238000002271 resection Methods 0.000 description 4
- 239000008280 blood Substances 0.000 description 3
- 210000004369 blood Anatomy 0.000 description 3
- 238000013461 design Methods 0.000 description 3
- 230000023597 hemostasis Effects 0.000 description 3
- 210000004072 lung Anatomy 0.000 description 3
- 238000000034 method Methods 0.000 description 3
- 210000000056 organ Anatomy 0.000 description 3
- 238000009958 sewing Methods 0.000 description 3
- OKTJSMMVPCPJKN-UHFFFAOYSA-N Carbon Chemical compound [C] OKTJSMMVPCPJKN-UHFFFAOYSA-N 0.000 description 2
- 206010052428 Wound Diseases 0.000 description 2
- 208000027418 Wounds and injury Diseases 0.000 description 2
- 229910052799 carbon Inorganic materials 0.000 description 2
- 239000000246 fibrin derivative Substances 0.000 description 2
- 230000002439 hemostatic effect Effects 0.000 description 2
- 238000003780 insertion Methods 0.000 description 2
- 230000037431 insertion Effects 0.000 description 2
- 230000002093 peripheral effect Effects 0.000 description 2
- 230000002980 postoperative effect Effects 0.000 description 2
- 108010034963 tachocomb Proteins 0.000 description 2
- 238000012549 training Methods 0.000 description 2
- 230000029663 wound healing Effects 0.000 description 2
- 108010080379 Fibrin Tissue Adhesive Proteins 0.000 description 1
- 108010049003 Fibrinogen Proteins 0.000 description 1
- 102000008946 Fibrinogen Human genes 0.000 description 1
- 241000282412 Homo Species 0.000 description 1
- 230000006978 adaptation Effects 0.000 description 1
- 239000000654 additive Substances 0.000 description 1
- 230000000996 additive effect Effects 0.000 description 1
- 239000000853 adhesive Substances 0.000 description 1
- 230000001070 adhesive effect Effects 0.000 description 1
- 230000003444 anaesthetic effect Effects 0.000 description 1
- 229940030225 antihemorrhagics Drugs 0.000 description 1
- 238000013459 approach Methods 0.000 description 1
- 230000015572 biosynthetic process Effects 0.000 description 1
- 239000012503 blood component Substances 0.000 description 1
- 230000036770 blood supply Effects 0.000 description 1
- 210000000038 chest Anatomy 0.000 description 1
- 229960005188 collagen Drugs 0.000 description 1
- 239000000515 collagen sponge Substances 0.000 description 1
- 238000010276 construction Methods 0.000 description 1
- 238000011109 contamination Methods 0.000 description 1
- 238000010586 diagram Methods 0.000 description 1
- 229940079593 drug Drugs 0.000 description 1
- 239000003814 drug Substances 0.000 description 1
- 230000003203 everyday effect Effects 0.000 description 1
- 239000004744 fabric Substances 0.000 description 1
- 210000003195 fascia Anatomy 0.000 description 1
- 229940012952 fibrinogen Drugs 0.000 description 1
- 210000001035 gastrointestinal tract Anatomy 0.000 description 1
- 239000002874 hemostatic agent Substances 0.000 description 1
- 229940106780 human fibrinogen Drugs 0.000 description 1
- 238000007912 intraperitoneal administration Methods 0.000 description 1
- 238000004519 manufacturing process Methods 0.000 description 1
- 239000002184 metal Substances 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 230000017074 necrotic cell death Effects 0.000 description 1
- 238000003825 pressing Methods 0.000 description 1
- 238000000926 separation method Methods 0.000 description 1
- 238000004904 shortening Methods 0.000 description 1
- 239000000126 substance Substances 0.000 description 1
- 210000002435 tendon Anatomy 0.000 description 1
- 210000000115 thoracic cavity Anatomy 0.000 description 1
- 229960003766 thrombin (human) Drugs 0.000 description 1
- 210000000689 upper leg Anatomy 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
- A61B17/0684—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil having a forming anvil staying above the tissue during stapling
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- 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
- A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis, e.g. in a single operation
- A61B17/1155—Circular staplers comprising a plurality of staples
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- 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
- A61B17/07292—Reinforcements for staple line, e.g. pledgets
Landscapes
- 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)
- Surgical Instruments (AREA)
Abstract
Klammerschneidegerät (1) zum Durchtrennen von Körpergewebe (T) und zum Legen einer Klammernaht mindestens auf einer Seite der Trennlinie, welches zwei aufeinander zu bewegbare Teile (5, 7) aufweist, zwischen denen das Körpergewebe ergriffen wird und von denen das eine einen Klammerkopf (5) mit einer Mehrzahl von Nahtklammern (5a) und das andere eine Klammerandruckplatte (7) zum Umlegen der Nahtklammern am Körpergewebe aufweist, wobei mindestens der Klammerkopf oder die Klammerandruckplatte eine sich über die Anordnung der Mehrzahl von Nahtklammern erstreckende Lage (13) eines flüssigkeits- und luftdichtenden Materials, insbesondere eines Fibrin- und/oder Kollagenvlieses oder funktionell einem solchen entsprechenden Materials, trägt.
Description
Die Erfindung betrifft ein Klammerschneidegerät nach dem Ober
begriff des Anspruchs 1 sowie eine Zusatzkomponente für ein
solches.
Zur Durchtrennung von Körpergewebe bei gleichzeitiger Gewähr
leistung der Blutstillung im durchtrennten Gewebe sind ver
schiedene Nähapparate vorgeschlagen worden, von denen einer der
ersten der chirurgische Nähapparat nach Petz ist. Modifika
tionen dieses Nähapparates werden heute - insbesondere als
sogenannte "Einmalgeräte" (zur Verwendung in nur einer
Operation) - von verschiedenen Firmen angeboten, sind im
alltäglichen chirurgischen Einsatz und haben dort einen weiten
Anwendungsbereich gefunden. Sie erleichtern in vielfältigen
Anwendungsfällen das Mobilisieren, Resezieren, Anastomosieren
sowie den Verschluß von Haut und Faszie auf sehr flexible Weise
und erfordern gegenüber früher praktizierten Techniken vielfach
nur minimale Änderungen der chirurgischen Vorgehensweise. Sie
bieten wesentliche Vorteile hinsichtlich einer signifikanten
Verkürzung der Operationszeit und der Anästhesiedauer sowie
einer Verringerung des Blutverlustes und einer Erleichterung
der postoperativen Wundheilung. Die bekannten Klammernaht- bzw.
Klammerschneidegeräte sorgen insbesondere für einen ausgezeich
neten Wundverschluß vor der Resektion, wodurch intra-perito
neale Verunreinigungen vermieden werden. Durch spezielle
Klammerformen wird zum einen eine Blutstillung gewährleistet,
andererseits jedoch eine weitere Blutversorgung der Schnitt
ränder durch die Klammerreihe gewährleistet, wodurch die
Wundheilung gefördert wird und Nekrosen verhindert werden.
Diese Geräte waren ursprünglich für die Durchtrennung von
Hohlorganen, speziell im Bereich des Magen-Darm-Traktes,
entwickelt worden, werden jedoch mittlerweile auch zur Durch
trennung von parenchymatösen Organen und für Resektionen im
Bereich der Lunge angewandt. Bei diesem Einsatz der genannten
Geräte, also auf dem Gebiet der Thorax-Chirurgie, hat sich
gezeigt, daß die Klammernahtreihe auf dem im Organismus ver
bleibenden Organabschnitt durchlässig für Blutbestandteile und
- was im Falle einer Lungenresektion besonders kritisch ist -
für Luft ist. Eine mit den bekannten Geräten erzeugte Klammer
nahtreihe ist also unmittelbar nach der Operation nicht primär
dicht, so daß bei Operationen im Bereich der Lunge die Einlage
einer Thoraxdrainage erforderlich wird und sich der stationäre
Verlauf verlängern kann.
Aus diesem Grunde kann in der offenen Chirurgie seit längerem
die Wundfläche zusätzlich mit aus körpereigenen Materialien
gewonnenen Substanzen, wie Fibrin und/oder Kollagen, versiegelt
werden. In der entsprechenden Praxis hat sich gezeigt, daß zwar
die Schnittfläche selbst in der Regel durch die Klammernaht
reihe blut- und luftdicht verschlossen wird, aber die Klammer
nahtreihe selbst, also die Eintrittsstelle der Klammern in das
Gewebe, einen besonders kritischen Bereich bildet, der einer
zusätzlichen Sicherung bedarf. In der offenen Chirurgie läßt
sich diese Sicherung durch Auflegen eines Fibrin- bzw.
Kollagenschwammes (kommerziell erhältlich zum Beispiel unter
der Produktbezeichnung TachoComb®) noch relativ leicht aus
führen, jedoch sind die erwähnten Probleme in der minimal
invasiven Chirurgie nicht ohne weiteres zu lösen.
Zur Applikation von Kollagen-, Fibrin- oder kombinierten bzw.
ähnlichen Materialien nach Anlegen einer Klammernahtreihe bei
der minimal invasiven Chirurgie wird daher in R. Carbon et al:
"Aktuelle Aspekte thorakoskopischer Fibrinklebung in der
Kinderchirurgie", Minimal Invasive Medizin 7(2), S. 55-64
(1996), sowie in R. Carbon: "Minimal invasives Gewebemanagement
in der Kinderchirurgie", Medical Tribune 35(1/2), S. 8-10
(1998) ein spezieller Applikator beschrieben. Dieser Applikator
wird nach dem Anlegen einer Klammernahtreihe mittels eines
herkömmlichen Klammerschneidegerätes (auch bezeichnet als
"Linear Cutter" oder "Stapler") eingesetzt, wobei ein fibrin
ogen-imprägniertes Kollagenvlies zu der zu versiegelnden Stelle
geführt und über dieser abgerollt wird. Dieser Applikator und
das mit ihm mögliche Vorgehen haben gegenüber ersten Ansätzen,
bei denen ein Stück mit Kleber beschichtetes Kollagenvlies
zunächst mittels eines ersten Applikators zur Applikationstelle
gebracht und dort anschließend mittels zweier Faßzangen
abgerollt wurde, eine deutliche Vereinfachung gebracht und die
nachträgliche Versiegelung von Klammernähten in der minimal
invasiven Chirurgie praktikabel gemacht.
Gleichwohl ist die nachträgliche Versiegelung von Klammer
nahtreihen von Hand in der offenen Chirurgie, aber insbesondere
unter Anwendung eines zusätzlichen, speziellen Applikators in
der minimal invasiven Chirurgie, noch relativ umständlich, da
sie jedenfalls zusätzliche Handhabungen während der Operation
und in der minimal invasiven Chirurgie zu dem ein zusätzliches
Gerät erfordert.
Bei den bekannten Verfahren wird zudem das Fibrin- oder
Kollagenvlies nicht oder nur relativ unvollkommen fixiert,
weshalb sekundäre Dislokationen des Vlieses nicht sicher
auszuschließen sind.
Der Erfindung liegt daher die Aufgabe zugrunde, eine Vor
richtung anzugeben, mit der eine Versiegelung einer mit einem
Klammerschneidegerät erzeugten Nahtreihe auf einfachere Weise
erfolgen kann.
Diese Aufgabe wird durch ein Klammerschneidegerät mit den
Merkmalen des Anspruchs 1 bzw. durch eine Zusatzkomponente mit
den Merkmalen des Anspruchs 10 gelöst.
Die Erfindung schließt den wesentlichen Gedanken ein, eine
zuverlässige Versiegelung einer Klammernahtreihe zugleich mit
deren Anlegen, statt wie bisher in einem nachträglichen Ver
siegelungsschritt, vorzunehmen. Sie schließt weiterhin den
Gedanken ein, zu diesem Zweck die bekannten Klammerschneide
geräte so weiterzuentwickeln, daß sie diese gleichzeitige
Versiegelung leisten können. Die vorgeschlagene Weiterbildung
der Konstruktion der bekannten Klammerschneidegeräte kann zum
einen die Form eines verbesserten Klammerschneidegerätes und
zum anderen die Form einer Zusatzkomponente zu einem bekannten
Gerät dieser Art haben.
Die konstruktive Fortbildung sieht vor, eine Lage eines
flüssigkeits- und luftdichten sowie insbesondere blutstillenden
Materials, speziell ein Fibrin- oder Kollagenylies oder ein
funktionell gleichwertiges synthetisches oder biodegradierbares
Material, unmittelbar am Klammerkopf und/oder der Klammeran
druckplatte anzubringen, so daß dieses beim Ausstoßen der
Klammern aus dem Klammerkopf und beim Umlegen an der Klammer
andruckplatte zusammen mit dem Gewebe von den Klammern durch
stoßen und durch diese am Gewebe fixiert wird.
Bevorzugt werden sowohl der Klammerkopf (das Klammermagazin)
als auch die Klammerandruckplatte mit der genannten Zwischen
lage versehen. Die Klammern treten durch die am Klammerkopf
befindliche erste Zwischenlage, erfassen dann das Gewebe und
treten beim Austritt aus demselben durch die zweite Zwischen
lage, die sich an der Klammerandruckplatte befindet. Es wird
also beim Schließen des Klammerschneidegerätes auf beide Seiten
des zu klammernden und zu durchtrennenden Gewebes in der bevor
zugten Ausführung je eine Lage des flüssigkeits- und luftdich
tenden Materials aufgebracht und zuverlässig fixiert. Indem die
Klammern an ein und denselben Punkten durch die Zwischenlagen
und das Gewebe hindurch treten, werden die Durchtrittspunkte
allseitig primär blut- und luftdicht versiegelt, wodurch die
Hämostase und Pneumostase am Durchtrennungsbereich entscheidend
gefördert wird. Hiermit wird letztlich die Komplikationswahr
scheinlichkeit deutlich gesenkt und eine wesentliche Verkürzung
der Nachoperations-Periode erreicht.
Bei der bevorzugten Ausführung mit je einer Lage des Kollagen-
bzw. Fibrinvlieses oder ähnlichen Materials am Klammermagazin
und der Klammerandruckplatte sind die beiden Lagen insbesondere
V-förmig miteinander verbunden oder einstückig gefertigt und
V-förmig gefaltet und werden in dieser Form in die geöffneten
Schenkel des Klammerschneidegerätes eingesetzt. Hierzu haben
die beiden Schenkel des V-förmigen Materials zweckmäßigerweise
jeweils ein Halte- oder Tragelement, die auf die freien Enden
des Klammerkopfes bzw. der Klammerandruckplatte aufsetz- bzw.
aufsteckbar ist.
Speziell bei einem von Anfang an entsprechend der vorge
schlagenen Lösung konstruierten Klammerschneidegerät kann der
eine Schenkel der V-förmigen Zwischenlage auch fest am Klammer
magazin angebracht sein, während nur der andere Schenkel einen
Halter zum Fixieren an der Klammerandruckplatte aufweist.
Die vorgeschlagene Lösung ist in bevorzugten Ausführungen an
bekannte Klammerschneidegeräte für die offene sowie die minimal
invasive Chirurgie angepaßt. In einer ersten, besonders viel
fältig einsetzbaren Ausführung sind die aufeinander zu bewegba
ren Teile des Gerätes um einen gemeinsamen Drehpunkt schwenk
bare Schenkel, von denen einer ein langgestrecktes Klammer
magazin trägt und der andere eine an dessen Form angepaßte
Klammerandruckplatte bildet bzw. trägt, und die Lage des
flüssigkeits- und luftdichtenden Materials hat eine der Form
des Klammermagazins entsprechende Streifenform. In einer
seltener eingesetzten, aber gleichwohl für bestimmte Eingriffe
unverzichtbaren Ausführung sind die aufeinander zu bewegbaren
Teile rotationssymmetrisch und längs einer gemeinsamen Mitten
achse verschieblich und das Klammermagazin sowie - daran
angepaßt - die Lage des flüssigkeits- und luftdichtenden
Materials haben im wesentlichen eine Ringform.
Die Erfindung schließt auch die Bereitstellung einer Zusatz
komponente zur Ausrüstung vorhandener Klammerschneidegeräte mit
der erwähnten Zwischenlage bzw. den Zwischenlagen ein. Für die
erwähnte weit verbreitete Ausführung eines Klammerschneide
gerätes mit zwei langgestreckten Schenkeln hat diese Zusatz
komponente zweckmäßigerweise die bereits erwähnte Form einer
V-förmig gefalteten oder verbundenen Materiallage mit je einer
Haltekappe bzw. -klammer an jedem der Schenkel des "V". Für ein
Klammerschneidegerät mit ringförmigen Klammerkopf wird die
Materiallage (wie oben bereits erwähnt) ebenfalls Ringform
haben und zweckmäßigerweise auch einen mindestens ringsegment
förmigen Halter aufweisen, mit dem sie an dem Klammerkopf bzw.
der Klammerandruckplatte fixiert wird.
Diese Zusatzkomponenten sind sowohl für Klammerschneidegeräte
für die offene als auch für die minimal invasive Chirurgie
ausführbar, und zwar insbesondere in Anpassung an bekannte und
bewährte Konstruktionen und Abmessungen. Die erwähnten Kappen
bzw. Halter - die in der Ausführung zum Aufschieben auf die
Schenkel eines V-artig öffnenden Klammerschneidegerätes auch
als "Schlitten" bezeichnet werden können - bestehen bevorzugt
aus Kunststoff oder Metall und sind mit der Zwischenlage (dem
Vlies) derart verbunden, daß sie sich nach dem Legen der
Klammernaht von der Zwischenlage trennen und am Klammer
schneidegerät verbleiben, so daß sie mit diesem wieder aus
dem Körper entfernt werden.
Als Material für die flüssigkeits- und luftdichtende und ins
besondere blutstillende Zwischenlage werden für diesen Zweck an
sich bekannte Materialien verwendet, speziell Kollagen oder
Fibrin bzw. Fibrinderivate und insbesondere Kombinationen aus
diesen, wie sie in dem oben erwähnten Produkt TachoComb® (im
wesentlichen bestehend aus Pferdesehnen-Kollagen und Fibrinogen
vom Menschen) bzw. ähnlichen Produkten realisiert sind. Es
versteht sich, daß das Material mit geeigneten, insbesondere
blutstillenden Wirkstoffen versehen sein kann, zudem kann auf
der dem Körpergewebe zugewandten Oberfläche zusätzlich ein
Fibrin-Kleber, beispielsweise im wesentlichen aus Human
fibrinogen und Humanthrombin bestehend, vorgesehen sein. Neben
den genannten natürlichen sind auch funktionsgleiche syntheti
sche Materialien einsetzbar.
Vorteile und Zweckmäßigkeiten der Erfindung ergeben sich
im übrigen aus den Unteransprüchen sowie der nachfolgenden
Beschreibung bevorzugter Ausführungsbeispiele anhand der
Figuren.
Von diesen zeigen:
Fig. 1a-d Skizzen zur Erläuterung von Aufbau und
Funktionsweise einer ersten Ausführungsform,
Fig. 2 eine Darstellung zur Erläuterung einer zweiten
Ausführungsform und
Fig. 3 eine Darstellung zur Verdeutlichung einer
dritten Ausführungsform der Erfindung.
In Fig. 1a-1d sind Aufbau und Funktionsweise eines mit
einem Zusatzteil zur Ausführung der Erfindung nachgerüsteten
endoskopischen Klammerschneidegerätes 1 skizziert. Fig. 1a
zeigt den vorderen Teil des Klammerschneidegerätes 1 mit einem
Schaft 3, aus dem ein Klammerkopf (Klammermagazin) 5, das dort
auswechselbar befestigt ist, zusammen mit einer Klammerandruck
platte 7 ausfahrbar ist. Beim Ausfahren des Klammerkopfes 5 und
der Klammerandruckplatte 7 aus dem Schaft 3 wird die Klammer
andruckplatte gegenüber dem Klammerkopf nach oben in die in
Fig. 1a gezeigte Öffnungsstellung ausgeschwenkt. In dieser
Stellung kann mit dem Klammerschneidegerät 1 ein Körpergewebe
abschnitt zwischen Klammerkopf 5 und Klammerandruckplatte 7
ergriffen und durch Zurückziehen beider Schenkel in den Schaft
3 erfaßt werden. Durch Auslösen des - insoweit bekannten und
dem Chirurgen in seiner Handhabung vertrauten - Gerätes wird
anschließend durch ein im Klammerkopf 5 angeordnetes Messer das
Gewebe durchtrennt und durch Ausdrücken der Klammern aus dem
Klammermagazin gegen die Klammerandruckplatte beidseits des
Schnittes eine Klammernaht gelegt.
Fig. 1b zeigt ein Klammernaht-Zusatzteil 9 für das Klammer
schneidegerät 1 aus Fig. 1a. Das Zusatzteil 9 umfaßt ein
V-förmig gefaltetes Kollagen-/Fibrin-Vlies 13, an dessen freien
Enden jeweils eine Halteklammer 11a, 11b angebracht ist, die
zum Aufstecken auf den Klammerkopf 5 bzw. die Klammerandruck
platte 7 des Klammerschneidegerätes 1 nach Fig. 1 ausgebildet
sind und das Kollagen-/Fibrin-Vlies 13 dort beim Einführen des
Schaftes 3 in den Körper eines Patienten sicher halten. Die
Verbindung zwischen dem Kollagen-/Fibrin-Vlies 13 und den
Halteklammern 11a, 11b einerseits sowie zwischen den Halte
klammern und dem Klammerkopf 5 bzw. der Klammerandruckplatte 7
andererseites ist derart ausgebildet, daß sich nach dem Legen
einer Klammernaht unter Einsatz des Zusatzteiles 9 das Vlies 13
von den Halteklammern 11a, 11b löst, während diese am Klammer
schneidegerät 1 verbleiben und mit diesem zusammen wieder aus
dem Körper des Patienten herausgeführt werden.
In Fig. 1c ist skizziert, wie das Zusatzteil 9 in die V-förmige
Öffnung zwischen dem Klammerkopf 5 und der Klammerandruckplatte
7 des Klammerschneidegerätes 1 eingesetzt wird.
In Fig. 1d ist schematisch dargestellt, wie das Fibrinvlies 13
durch eine Nahtklammer 5a aus dem Klammermagazin 5 beidseits
eines Körpergewebsabschnittes T fixiert wird und dabei die - in
der Figur mit Pfeilen bezeichneten - Ein- bzw. Durchtritts
stellen der Klammer 5a im Körpergewebe T flüssigkeits- und
luftdicht versiegelt.
Fig. 2 zeigt ein modifiziertes Klammermagazin zum Einsetzen in
ein Klammerschneidegerät 1, wie es in Fig. 1a dargestellt ist.
Es ist zu erkennen, daß hier eine zu Fig. 1b ähnliche V-förmige
Ausbildung eines Kollagen-/Fibrinvlieses 15.1 vorgesehen ist,
wobei der eine Schenkel des "V" ohne zusätzliches Halteelement
unmittelbar mit einem Grundkörper 15.2 des Klammermagazins
verbunden ist, während der freie Schenkel eine ringförmige
Halteklammer 15.3 trägt, die zum Aufschieben auf die Klammer
andruckplatte 7 (Fig. 1a) ausgebildet ist. Auch bei dieser
Ausführung ist das flüssigkeits- und luftdichtende Vlies 15.1
so am Klammermagazin 15 bzw. der Halteklammer 15.3 fixiert,
daß es nach dem Legen der Klammernaht durch die Klammern am
Körpergewebe fixiert ist und sich beim Entfernen des Klammer
schneidegerätes 1 vom Klammermagazin-Grundkörper 15.2 bzw. von
dem (an der Klammerandruckplatte verbleibenden) Haltering 15.3
löst.
In Fig. 3 ist skizzenartig ein anderes, an sich bekanntes
Klammernaht- bzw. Klammerschneidegerät 21 dargestellt, bei
dem die Erfindung in einer anderen Ausführung angewandt wird.
Dieses Klammerschneidegerät 21 zur Herstellung kreisförmiger
Schnitte und Klammernähte umfaßt - grundsätzlich ähnlich wie
das Klammerschneidegerät 1 nach Fig. 1a - einen Schaft 23, in
dem ein zweiteiliger zentraler Führungsstab 24a, 24b angeordnet
ist, über den ein Klammerkopf (Klammermagazin) 25 gegenüber am
distalen Ende des Schaftes 23 angebrachten Klammerandruckplatte
27 verschieblich geführt ist. Die Funktion dieses Klammer
schneidegerätes ist grundsätzlich ähnlich wie beim oben be
schriebenen Klammerschneidegerät 1, wobei beim hier gezeigten
Gerät 21 die ringförmige Gestalt des Klammerkopfes 25 und der
Klammerandruckplatte 27 (und eine entsprechende Ausbildung des
hier nicht dargestellten Trennmessers) die erwähnte Ausbildung
kreisförmiger Schnitte und Klammernähte ermöglicht.
In der Figur ist gezeigt, wie zwei Kollagen- bzw. Fibrin-Ringe
29a, 29b, die auf jeweils einem elastischen Kunststoff-
Haltering 28a bzw. 28b angebracht sind, in das geöffnete
Klammerschneidegerät 21 eingesetzt werden. Die Halteringe 28a,
28b sind so ausgebildet und mit den Vliesringen 29a, 29b
verbunden, daß sie über die Umfangsränder des Klammerkopfes 25
bzw. der Andruckplatte 27 geschoben werden können und sich dort
aufgrund ihrer Elastizität, insbesondere im Zusammenwirken mit
einer entsprechenden Ausformung der Umfangsränder (die jedoch
keine notwendige Voraussetzung einer korrekten Funktion ist),
festhalten und nach dem Legen der Klammernaht von den Vlies
ringen 29a und 29b lösen, so daß letztere auf der Klammernaht
verbleiben, die Halteringe 28a, 28b jedoch mit dem Klammer
schneidegerät 21 wieder aus dem Körper entfernt werden.
Die Ausführung der Erfindung ist nicht auf die beschriebenen
Ausführungsbeispiele beschränkt, sondern auch in einer Vielzahl
von Abwandlungen, insbesondere hinsichtlich der konkreten Ge
stalt des Klammerschneidegerätes - insbesondere von dessen
Klammermagazin und Klammerandruckplatte - möglich. Auch bei
einem Klammerschneidegerät mit ringförmigen oder andersartig
gestaltetem Klammerkopf kann die Zwischenlage bzw. eine der
Zwischenlagen fest am Klammermagazin angebracht sein und
zusammen mit diesem ausgeliefert werden.
1
;
21
Klammerschneidegerät
3
;
23
Schaft
5
;
25
Klammerkopf (Klammermagazin)
5
a Nahtklammer
7
;
27
Klammerandruckplatte
9
Klammernaht-Zusatzteil
11
a,
11
b Halteklammer
13
Kollagen-/Fibrin-Vlies
15
Klammermagazin
15.1
Kollagen-/Fibrin-Vlies
15.2
Klammermagazin-Grundkörper
15.3
Haltering
24
a,
24
b geteilter zentraler Führungsstab
28
a,
28
b Haltering
29
a,
29
b Vliesring
T Körpergewebsabschnitt
T Körpergewebsabschnitt
Claims (13)
1. Klammerschneidegerät (1; 21) zum Durchtrennen von Körper
gewebe (T) und zum Legen einer Klammernaht mindestens auf
einer Seite der Trennlinie, welches zwei aufeinander zu
bewegbare Teile (5, 7; 15; 25, 27) aufweist, zwischen denen
das Körpergewebe ergriffen wird und von denen das eine
einen Klammerkopf (5; 15; 25) mit einer Mehrzahl von Naht
klammern (5a) und das andere eine Klammerandruckplatte (7;
27) zum Umlegen der Nahtklammern am Körpergewebe aufweist,
dadurch gekennzeichnet,
daß mindestens der Klammerkopf oder die Klammerandruck
platte eine sich über die Anordnung der Mehrzahl von Naht
klammern erstreckende Lage (13; 15.1; 29a, 29b) eines
flüssigkeits- und luftdichtenden Materials, insbesondere
eines Fibrin- und/oder Kollagenvlieses oder funktionell
einem solchen entsprechenden Materials, trägt.
2. Klammerschneidegerät nach Anspruch 1,
dadurch gekennzeichnet,
daß die aufeinander zu bewegbaren Teile (5, 7; 15) als um
einen gemeinsamen Drehpunkt schwenkbare Schenkel ausge
bildet sind, die einen langgestreckten Klammerkopf (5; 15)
bzw. eine an diese angepaßte Klammerandruckplatte (7) auf
weisen, und daß die Lage (13; 15.1) des flüssigkeits- und
luftdichtenden Materials Streifenform hat.
3. Klammerschneidegerät nach Anspruch 1,
dadurch gekennzeichnet,
daß die aufeinander zu bewegbaren Teile einen rotations
symmetrischen Klammerkopf (25) und eine längs einer
gemeinsamen Mittenachse diesem gegenüber verschiebliche
Andruckplatte (27) aufweisen und die Lage (29a, 29b)
flüssigkeits- und luftdichtenden Materials im wesentlichen
Ringform hat.
4. Klammerschneidegerät nach einem der vorangehenden
Ansprüche,
dadurch gekennzeichnet,
daß an dem Klammerkopf (5; 15; 25) und der Klammerandruck
platte (7; 27) jeweils eine Lage (13; 15.1; 29a, 29b) des
flüssigkeits- und luftdichtenden Materials fixiert ist.
5. Klammerschneidegerät nach Anspruch 2 und 4,
dadurch gekennzeichnet,
daß die an Klammerkopf (5; 15) und Klammerandruckplatte (7)
fixierten Lagen (13; 15.1) des flüssigkeits- und luftdich
tenden Materials V-förmig zusammenhängen, insbesondere mit
einander einstückig ausgebildet sind.
6. Klammerschneidegerät nach einem der vorangehenden
Ansprüche,
dadurch gekennzeichnet,
daß die Lage oder Lagen (13; 15.1) des flüssigkeits- und
luftdichtenden Materials an einem auf den Klammerkopf
(5) und/oder die Klammerandruckplatte (7) aufsetzbaren
Träger (11a, 11b; 15.3) befestigt ist/sind.
7. Klammerschneidegerät nach Anspruch 5 und 6,
dadurch gekennzeichnet,
daß an den freien Enden der V-förmigen Lage (13) je ein
Träger (11a, 11b) vorgesehen ist, der auf den Klammerkopf
(5) bzw. die Klammerandruckplatte (7) aufsetzbar, insbeson
dere in Richtung ihrer Längserstreckung aufschiebbar, ist.
8. Klammerschneidegerät nach einem der Ansprüche 1-6,
dadurch gekennzeichnet,
daß die Lage (15.1) des flüssigkeits- und luftdichtenden
Materials mit einem auswechselbaren Klammermagazin (15)
derart fest verbunden ist, daß sie sich beim Legen der
Klammernaht zusammen mit den Klammern von diesem löst.
9. Klammerschneidegerät nach Anspruch 3 und Anspruch 6,
dadurch gekennzeichnet,
daß die ringförmige Lage (29a, 29b) des flüssigkeits- und
luftdichtenden Materials einen mindestens ringsegment
förmigen Träger (28a, 28b) zum Fixieren am rotations
symmetrischen Klammerkopf (25) und/oder der rotations
symmetrischen Klammerandruckplatte (27) aufweist.
10. Zusatzkomponente (9; 29a, 29b) für ein Klammerschneidegerät
(1; 21) zum Durchtrennen von Körpergewebe (T) und zum Legen
einer Klammernaht mindestens auf einer Seite der
Trennlinie, welches zwei aufeinander zu bewegbare Teile (5,
7; 25, 29) aufweist, zwischen denen das Körpergewebe er
griffen wird und von denen das eine einen Klammerkopf (5;
25) mit einer Mehrzahl von Nahtklammern und das andere eine
Klammerandruckplatte (7; 27) zum Umlegen der Nahtklammern
(5a) am Körpergewebe aufweist,
gekennzeichnet durch
eine mindestens mit dem Klammerkopf oder der Klammer
andruckplatte verbindbare, sich über die Anordnung der
Mehrzahl von Nahtklammern erstreckende Lage (13; 29a, 29b)
eines flüssigkeits- und luftdichtenden Materials,
insbesondere eines Fibrin- und/oder Kollagenylieses oder
funktionell einem solchen entsprechenden Materials, und
einen mit der Lage verbundenen und an die Form des
Klammerkopfes bzw. der Klammerandruckplatte angepaßten, auf
diesen bzw. diese aufsetzbaren Träger (11a, 11b; 28a, 28b).
11. Zusatzkomponente nach Anspruch 10,
gekennzeichnet durch
durch eine streifenförmige, V-förmig gefaltete oder
aus zwei Streifen V-förmig verbundene Lage (13) des
flüssigkeits- und luftdichtenden Materials und jeweils
einen an den freien Enden der Lage angebrachten Träger
(11a, 11b).
12. Zusatzkomponente nach Anspruch 11,
dadurch gekennzeichnet,
daß die Träger (11a, 11b) zum Aufschieben auf den
Klammerkopf (5) bzw. Klammerandruckplatte (7) eines
Klammerschneidegerätes (1) ausgebildet sind, bei dem
Klammerkopf und Klammerandruckplatte als um einen gemein
samen Drehpunkt schwenkbare Schenkel ausgeführt sind.
13. Zusatzkomponente nach Anspruch 10,
dadurch gekennzeichnet,
daß der Träger (28a, 28b) einer ringförmigen Lage (29a,
29b) aus flüssigkeits- und luftdichtendem Material ring-
oder ringsegmentförmig ausgebildet ist.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| DE1999124311 DE19924311A1 (de) | 1999-05-27 | 1999-05-27 | Klammerschneidegerät und Zusatzvorrichtung für ein solches |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| DE1999124311 DE19924311A1 (de) | 1999-05-27 | 1999-05-27 | Klammerschneidegerät und Zusatzvorrichtung für ein solches |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| DE19924311A1 true DE19924311A1 (de) | 2000-11-30 |
Family
ID=7909360
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| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| DE1999124311 Withdrawn DE19924311A1 (de) | 1999-05-27 | 1999-05-27 | Klammerschneidegerät und Zusatzvorrichtung für ein solches |
Country Status (1)
| Country | Link |
|---|---|
| DE (1) | DE19924311A1 (de) |
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