DE2338065A1 - DEVICE FOR REPLACING VOLUME ORGANS AND DEVICE EQUIPPED WITH IT FOR CLAMPING BLOOD VESSELS - Google Patents

Description

BE CAREFUL FOR REVOLVING HOLLOW ORGANS XJKD EQUIPPED WITH IT GERA *! FOR OCCLUSION OF BLOOD VESSELS

The invention relates to medicine, namely to surgery, in particular a device for eversion of hollow organs and a device equipped with this device for clumping blood vessels.

It is known that for the eversion of hollow organs ζ · Β · when the blood vessels join together "end-to-end", the entire eversion of a hollow organ made manually with the help of a sleeve is, into which the inverted end of the hollow organ is introduced and then the whole inverting process like on a mandrel is carried out.

The sleeve provided for the eversion is of this type trained to introduce the end of the

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ORiGlNAL iNSPECTED

Everting hollow organ easily allows; In detail this is Sleeve divided in a plane running through its longitudinal axis and is made up of two halves of the sleeve

Such a sleeve, which is carried out in various ways can be and is used to carry out all turning over processes, represents a known device for everting hollow elnos organs of all structural details of the sleeves, which are used for the eversion serve and thus known devices for everting hollow organs represent, preserved the above-described split Sleeve made of two halves is best.

The process of turning inside out takes place, for example, when the blood vessels are sutured "End-to-end" using said known device as follows. The sleeve halves are taken apart and the end of the blood vessel is inserted between them.

After that, the assembly of the sleeve takes place by removing both of them Halves are connected to each other. Here, the blood vessel is securely clamped inside the sleeve in such a way that it is to be turned inside out End protrudes from the sleeve. In the cloud, this end of the blood vessel is manually everted using of tweezers by turning its intlma outward and then the end of the blood vessel is drawn onto the specified sleeve

In the end, the blood vessel probe turned inside out in this catfish becomes fixed to the sleeve by tying it off at its edge with a ligature or tightening it with a cuff clamping device will.

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It is evident here that when the blood vessels are everted to inhibit the bleeding in these blood vessels hemostatic Clamps must be applied at the beginning

Furthermore, a device for clamping blood vessels is known which contains a device for turning them inside out, which is designed as a split sleeve consisting of two halves for each end of the blood vessel (copyright of the USSR, No. 127 ^ 61, cl. 30a, 8q ₆ , dated October 9, 1958). The inversion of the blood vessels, which precedes the suturing of these vessels, is carried out in the order described above.

The known device for eversion described above of hollow organs has a number of more serious aftereffects, the their use in the UmstÜlpung of hollow organs, in particular limit of blood vessels.

One of these disadvantages lies in a high workload, which must be applied when inverting hollow organs and primarily blood vessels. The inversion is also Tiring and exhausting to end up performing the operation Surgeons. This comes from the inversion of small blood vessels to expression.

The other disadvantage is that the device does not Reversion and thus no suturing of heavily calcified vessels permitted.

Obviously, the disadvantages discussed also apply to the device for clamping blood vessels described above,

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. which contains such a device for everting the blood vessels, which is designed as a split sleeve consisting of two halves _e

The invention aims to be a straightforward and Reliable device for the eversion of hollow organs, including of any blood vessels, even if they are severely calcified, which do not require a great deal of time and effort on the part of the die The surgeon performing the operation requires one with this as well Device equipped device for clamping blood vessels Develop "end-to-end".

The invention is based on the technical solution that in the device for the eversion of hollow organs most of them manual operations in the eversion of the hollow organs on the Sleeve through the world's most extensive mechanization of the entire turning over process lets give up · In addition, includes the besegtö technical solution the possibility of easy installation the device developed on its basis for everting hollow organs into respective devices for holding hollow organs, namely in devices for clamming blood vessels · The idea was given that such a device

^{for the} eversion of hollow organs either as a single block (eversion block), which is a component of the specified device for the seam closure of hollow organs, or as an assembly kinematically coupled with other assemblies of this device _t one

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Desired sequence of .working steps of the seam closure in The course of the operation is guaranteed and carried out can be·

This is achieved in that the device is turned inside out of hollow organs that have a sleeve for introducing the end contains a hollow organ to be inverted, is provided according to the invention with spikes which are used to attach the edge of the specified Serve hollow organ and are located on a support part above the outline of the envelope of the rare surface of the mentioned Sleeve, whereby the support part can move along the sleeve

In the proposed device for everting hollow organs, those for fastening the edge of the hollow organ provided sting be rigidly connected to the discussed support part

It is convenient for the attachment of the edge of the Hollow organ serving spines on the specified support part ßo abzufedorn that the diameter of the outline over which the spines are arranged in front of the eversion, bomessen smaller 1st as the diameter of the respective outline at the end of the eversion

It is desirable that for fastening the edge of the to be inverted hollow organ provided spikes on the supporting part by means of joints to be slidably attached so that the Spines can approach each other before they are everted.

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It is advisable to equip the device for the inversion of hollow organs with the spines in the form of S-shaped two-armed levers, for each of which the above-mentioned joint serves as a support point, which ensures the movable attachment of the spike on the trunk, The smaller arm represents a wedge-shaped extension located at the bottom close to the joint, which faces the said sleeve, and the larger arm is located above the joint and has a point at its end on which the edge of the hollow organ to be inverted when it is attached is pricked on the spines, the supporting part with the movably attached spikes encompassing the lower part of the sleeve and being able to move along this sleeve, the upper part of the sleeve being removable , the inner diameter of which is approximately equal to the outer diameter of the end of the hollow organ to be inverted by the lower end face of the removable sleeve part the shape of the wedge-shaped lugs in such a way Given that the larger arms press the spikes in the upper end position against the upper band of the removable tool of the case.

It makes sense to provide the proposed device for everting hollow organs with a hand drive, because

has at least one lever with a support point immovable with respect to the sleeve, one arm of which carries the movably arranged support part with the spikes, while the other is designed so that one can act on it by hand, around the support plate when the hollow organ is turned inside out, its edge by means of the

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attached to the spines located on the support part, in motion to put.

It is also desirable in the proposed device for everting hollow organs that the sleeve has, which is composed of two halves of the sleeve and divided in one plane which is parallel to the longitudinal axis of the sleeve, the support part with the spines attached to it as two rings design, each of which has one of the sleeve halves umgrolft and by means of the joint with the respective lever of the manual drive is connected.

For parents, it is appropriate to use the proposed device for everting blood vessels with a hemostatic clamp to be provided, which is attached to her foot inside the sleeve is.

The indicated hemostatic clamp with which the proposed Device for everting the blood vessels is equipped, can be designed as a Splralblattfedor, whose The outer end of the sleeve is fixed and the inner end of which remains.

It is advisable to create a device for clamping blood vessels "end-to-end" ¹¹ , which has a support plate, a device J ₄₁₁₁ , the inversion of blood vessels to be closed, which rests on said support plate and at least one sleeve with grooves for opening of the staples, and a device that is responsible for advancing and bending the staples during the stapling.

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The device is responsible for the growth of the blood vessels sui eversion of the blood vessels to be closed is formed according to the invention.

The proposed device for everting hollow organs Is structurally simple and handy

It can be used in any device for vascular obstruction use, well the incorporation of this device in a respective Device does not result in complicated development work or technological difficulties.

In the specified device are practically all Mechanized work in the eversion of the hollow organs, see above that is the eversion and thus the surgical intervention in which the respective ends of the hollow organs are sewn together have to use a lot less tent

With the proposed device for everting hollow organs Equipped vascular suturing devices including devices for clamping blood vessels are safe and easy to use and allow vessels of different diameters to be sewn together regardless of their condition, even if it is strong calcified blood vessels

The presence of the peculiar hemostatic as one Spiral leaf spring formed terminal, which is in the sleeve of the before ge If the device is built in, it indicates the area of application of a respective device for clamping blood vessels

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to be expanded considerably, as there is now the possibility of surgical interventions even with short ends to be closed Blood vessels carry through.

The following is a detailed description of the invention, the embodiments of the device for eversion of hollow organs and the devices equipped with this device for clamping blood vessels on the basis of the drawings; Show in the drawings

FIG. 1 shows a longitudinal section through a known sleeve which

serves as a mandrel for the eversion of the end of a hollow organ;
FIg · 2 ditto (the end of a hollow organ to be inverted is inserted into the sleeve)?

Flg. 5 ditto (the end of the hollow organ is turned inside out); Flg. 4 ditto (the one turned-up end of the hollow organ and the other ones wound on it are ready to be sewn together);

Flg. 5 shows a known sleeve with a longitudinal slot; Flg. 6 a known split sleeve in axonometry two halves connected by a hinge (the sleeve halves are moved apart)}

ilg. 7 ditto (the sleeve halves are brought together); Flg. 8 a known sleeve which is mechanically interconnected in two nljoJit connected sleeve halves divided 1st (the halves of the sleeve are moved apart);

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Flg. 9 ditto (the sleeve halves are brought together);

Pig. 10 branches with attached to their work ends

. according to Flg. 8 executed sleeve half tone (overall view );

Flg. 11 a device according to the invention for unsfculpung hollow organs with a longitudinally slotted one
Sleeve;

12 shows a device according to the invention for turning inside out Hollow organs with a halftone split into two halves Sleeve (top view);

Flg. 13 ditto (Lleaentej located on one of the branches Rare view);

Flg. 14 ditto (the ends of a hollow organ to be closed before their eversion);

Flg. 15 ditto (at the end of the eversion);

Fig. 16 shows an embodiment of the device for eversion of hollow organs, in which the spines with their Support plates are rigidly connected (top view);

Flg. 17 ditto (the elements of the larger sleeve half, side view );

* Sg · 18 an «embodiment of the device for the eversion of hollow organs, in which the spines are spring-loaded with respect to your tasselle (looking above);

flg · 19 ditto (the elements of the larger sleeve half } side view ) |

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i'lg. 20 shows an embodiment of the device for eversion of hollow organs in which the spines can be folded down are executed (top view);

Pig. 21 ditto (the elements of the larger sleeve half, side view);

Flg. 22 an additional embodiment of the device for Eversion of hollow organs, in which the spines are designed to be foldable (top view);

Flg. 25 ditto (the elements of the larger sleeve half rare view) ;

Flg. 24 the collapsible sting of the device for turning over pung of hollow organs according to FIG. 23;

Flg. 25 in axonometry the sleeve dor device for

Eversion of blood vessels, which according to the invention is provided with a hemostatic clamp;

Flg. 26 ditto (a blood vessel of small diameter is inserted; Cross-section );

Flg. 27 ditto (the blood vessel, however, has a large diameter);

Flg. 28 ο3Ji Device for occlusion of blood vessels with the device according to the invention for everting blood vessels is provided (side view);

Flg. 29 the device for occluding blood vessels with the device according to the invention for turning inside out Blood vessels provided 1st (top view);

Fig. 30 the device for closing blood vessels, which with

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the device according to the invention is provided for everting blood vessels (section along the line XTEV-XXIV in FIG. 23); and

· 31 the device for suturing blood vessels, which comes with the device according to the invention for Umstülxjung of Blood vessels are provided (view from arrow A in FIG. 24-).

In the practice of vascular surgery, hollow organs are sewn together must be, the inversion of these organs, so the

Eversion of theirs. Imienschlcht (the intima near the blood vessels) attached particular importance to the outside world.

The eversion of a hollow organ is known to take place on a sleeve 1 (Fig. 1) _# which is designed as a thin-walled hollow cylinder with an inner diameter that is approximately equal to the diameter of the hollow organ to be inverted, this sleeve serving as a mandrel on which the entire eversion process voi goes.

Here, the end 2 (Fig. 2) of a hollow organ to be turned inside out inserted into the sleeve 1 so that it is out of said Sleeve 1: protrudes 5 to 6 mm horizontally.

Then the end of the hollow organ is turned inside out and, as shown in FIG. 3 is shown, pulled onto the sleeve 1 with the inner slit turned outwards, after which the end is attached to the sleeve in any manner and V / else, for example tied with a ligature.

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The eversion process ends here.

Furthermore, depending on the method for sewing the Hollow organ traded

According to one of these procedures, the two will land of the hollow organ by applying a circular staple suture the kink tunnel of the everted 2nds of the hollow organ unites. Here, the two ends of the hollow organ are attached to the pre-conditioning tunnel perforated, and the edges bent over · The second end of the hollow organ is, as explained above, on the second sleeve turned inside out. In this way the inversion takes place of hollow organs in all known devices including the devices for suturing vessels and the one described above Device for suturing blood vessels according to the copyright of the USSR No. 127361.

In another case, the end 3 (panel 4) is a hollow organ over the sleeve 1 with the turned inside out End 2 of the hollow organ pulled and attached »

As highlighted above. the eversion of hollow organs and in particular small vessels using such simple devices in the form of sleeves results in difficulties; the Umatülpun "let" tit consuming and very exhausting for the chlrjgea who carries out the respective operation.

In view of this has been used by the professionals who deal with

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deal with the development of surgical equipment, looking for a perfect design for a device for turning inside out special importance attached.

Here, of course, one worked primarily au oinei ' Change in the design of the sleeve

If the sleeve (Fig. 5) is to be provided with a longitudinal slit 4- is, introducing the end of a turn inside out The hollow organ is simplified and, what is particularly important, that

The sewn end can be removed without pulling along the sleeve.

The sleeve (Fig. 6, 7) is tolled and is composed of two sleeve halves 5 and 6 connected to one another by means of a joint 7. When the sleeve halves 5 and 6 have moved apart, the sleeve can be inserted into the end of the hollow organ to be inverted and securely fastened to the sleeve after the sleeve halves have been brought together. It is clear that such a sleeve is better and easier to handle in the return portion of a hollow organ as dl "above described solid sleeve or a slotted sleeve.

However, βloh has enforced the sleeve, which in two without joint old connected to each other "Hul" "is divided between

The sleeve can be divided into two sleeves either through a plane passing through, the longitudinal axis of the sleeve ▼ runs, or over *, a plane extending from the longitudinal axis of the sleeve something is offset "

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In the first case, the transverse dimensions are the same Sleeve half tone detectable, while in the second EaIl form a larger and a smaller sleeve

Well d3e sleeve halves 8 and 9 do not have a connecting Joint verselion are, their handling is in the course of the eversion a hollow organ difficult. These sleeve halves can therefore, for example, be attached to the work ends of branches 10 and 11 (Flg. be attached.

When the branches 10 and 11 have been moved apart, go the sleeve halves 8 and 9 apart, giving the possibility give the end of a hollow organ to be inverted into the sleeve to insert between the sleeve halves 8 and 9.

All the technical solutions described that are based on a perfecting of the device for everting hollow organs Aiming through usual development work basically does not achieve your main objective, which is a considerable relief which involves eversion when performing an operation by a surgeon. Only the technical solution that according to the invention on the basis of full mechanization the eversion of hollow organs was realized, makes it possible according to the goal and the task described above to achieve considerable efficiency.

According to one of the embodiments of the invention, the device for everting hollow organs has a sleeve £ 12 (Flg. 11) with a longitudinal shell, spines 12, a support part

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for the spikes 13, which includes the sleeve 12 and a longitudinal slot the width of which is equal to the width of the longitudinal section of the sleeve 12.

The support plate 14 of the spikes 13 is on the sleeve 12 ao arranged that its longitudinal slot corresponds to the corresponding longitudinal slot the sleeve 12 is opposite. So that a rotation of the support part 14 around the sleeve 12 is avoided and this support plate 14 only can move along the sleeve 12, this has longitudinal grooves 15. The support plate 14 of the spikes 13 is with a locking screw provided, whereby the support plate 14 can be fixed in its upper and lower end position.

By the fact that the end of the locking screws 16 in the called longitudinal groove protrudes, the rotation of the Tragtellos 14 prevented by the sleeve 12.

The eversion process runs in the device described as follows.

The end of a hollow organ to be inverted is through the Longitudinal slit is guided into the sleeve 12. Leave the carrying plate 14 wander with the spikes 13 in the upper end position, where he is fastened by means of the locking screws 16 ".

The end of said hollow organ is opened with forceps pierced on the spines 13 at its edge. after the Locking screw 16 is loosened, the Tragtell 14 with the Spines 13 offset in the lower end position. Here is the End of the hollow organ turned inside out.

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With the Slcherungsschraube 16 of the support member 14 _n is then fixed it the spikes 13 in the lower end position. Here, the everted end of the hollow organ is also reliably oriented on the sleeve, so that it enables the further course of the operation.

According to another embodiment of the invention, the device for inverting hollow organs has two branches 17 and 18 (Flg. 12, 13) »which are connected to one another by an axis 19, a sleeve 20, which consists of a larger sleeve half 20 'which is attached to the ArboItsende the branch 17 is attached, and a smaller HÜlsenhKlfte 20 "" _f, which is attached to the Jkrbeltsendo the branch 18 and 22 ', and the sleeve half 20' with the spikes 21 attached to it or the sleeve half 20 »* with the spike 21 * surrounds a manual drive in the form of a two-armed lever 23, which by means of an axis 24 serving as a support point at the end of the work the branch 17 is attached, as well as in the form of a two-armed plane 23 * »which is attached to the work end of the branch 18 by means of an axis 24 * serving as a support point. One arm of the two-armed lever 23 connects old movable by means of a joint 25 to Ha your ing 22, while the same arm of the two-armed lever 23 * by means of a (in drawings not shown) joint is movably coupled to the half-ring 22 * ·

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other arms of the two-armed levers 23 and 23 'v / elsen at their free ends as (upper) buttons 26, 26 'and (lower) buttons 27, 27' designed enlarged surfaces. the (lower) buttons 27 and 27 'are in Flg. 12 of the (upper) Keys 26 and 26 * hidden, which is why the respective reference lines are shown in dashed lines

Hollow organs are turned inside out with the aid of the device described as follows. . Pressing the upper buttons 26 and 26 'causes the levers 22 and 23 * to rotate clockwise. 1st consequence migration of the half-ring 22 with the spikes 21 and the Halbrin _o it 22 'with the stinger 21' in the upper end position, wherein the spines are arranged * 21 and 21 to the sleeve 20th If the branches 17 and 18 are moved apart, the sleeve halves 20 »and 20 '» attached to these branches also open. One of the ends 28 '(Fig. 14) of the hollow organ 28 is between the sleeve halves

11
20 'and 20 so swept that it protrudes from them.

Now the Branch are "17 and 18 together, thereby attached to these industries shell halves go together 20" and 20 · and the end 28 'of the hollow organ clamp · tilt HiIf ₀ Pedal "r tweezers are first end 20' and then the second End 28 "dos Hohlofganes 28 impaled on dl · spines 21 and 21 * (Flg. 12, 13). By pressing the lower buttons 27 and 27 '1 * 31 at the same time, the levers 23 and 23' can be swiveled counterclockwise ·

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As a result, the half-ring 22 with the spikes 21 and the K _a lring 22 'with the spike 21 * move into the lower end position.

Here the one = end. 28 * (S ¹ Is · 1 ⁶ ) the hollow organ 28 turned inside out and the other end 28 ″ of the hollow organ 28 pulled onto the inverted end 28 *

The edges of the ends 28 'and 28 "of the hollow organ are securely held on the sleeve 20 by means of the spikes 21 and 21 *

Another surgical procedure can then be performed by, for example, the ends 28 'and 28' of the hollow organ 28 by applying a circular line to the united edges of the mentioned ends 28 'and 28' 'are sewn

After the hollow organ has been sutured, the levers 25 and 23 'are rotated clockwise by pressing the upper buttons 26 and 26'. As a result, the half-ring 22 with the spikes 21 and the half-ring 22 'with the spike 21 * assume the upper end position. The spines 21 and 21 * with the impaled thereon edges of the sewn-together ends 28 * and 28- ^{1 f} are now located under the sleeve 20 is then carried out with tweezers dai hollow organ 28 of the spines 21 and 21 'down, leaves the Branchei 17 and 18 diverge and remove the hollow organ 28 from the sleeve 20.

In describing the embodiments of the invention Devices for everting hollow organs were not sufficiently detailed. explained the questions that relate to the

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Formation dor spines relate, of which the perfection the entire device for everting hollow organs is essentially dependent.

The spikes can be attached to your support plate in such a way that that they are either rigidly connected to it or spring-loaded or can be folded down.

These types of spines are described below, which rest on a support plate, which consists of two half-rings, which the corresponding sleeve halves, so a larger and a smaller sleeve half.

According to one embodiment of the device according to the invention for everting hollow organs, in which the spines are rigidly connected to their carrying case, the spines 29 (3? Ig 16, 17) are made in one piece with the valley ring 30 'of the carrying ring J> 0 and the Spike 29 * formed from one piece with the half-ring 30 'of the same support plate.

Here, the spines 29 are arranged and 29'auf a circle whose diameter corresponds to the outer diameter of a ^UE from two älften 51 ^f and 31 ^lf existing sleeve 31st The distance L between the diametrically opposed spikes 29 is equal to the outer diameter of the sleeve 31 and remains constant during the eversion.

The embodiment discussed, in which the spines are rigidly attached to their support plate, is characterized by their simplicity in terms of manufacture and operating

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security off; However, when inverting hollow organs, some difficulties in relation to small vessels, preferably detectable when they are impaled on the spines

According to the embodiment. of the device for everting hollow organs with the spines spring-loaded with respect to their supporting table, each spike 32, 32 * (Fig. 18, 19) is made of an elastic steel sheet (a leaf spring) which, together with another steel sheet 33 pressing it, is made with the support part 34 is connected by a screw. Here, the Tragtell 34 is executed as two half-rings of soft a 34 _'mlt the spikes 32 a HüJsenhHlfte 36' and the other 3 * · "a Hülsenhalfte 36 'with the spines 32'" surrounds.

Before the eversion process, where the spikes 32 and 32 ' are above the sleeve and are supported against its band they are arranged on a circle, the diameter of which corresponds to the inner diameter the sleeve matches · The distance 1 between the diametrically opposed spines32, 32 'is equal to that Inner diameter of the sleeve 36. This is the impaling of the End of a hollow organ to be inverted onto the spines 32 and 32 * relieved.

With dtr inversion, wtnn dl · spine 32, 32 * together «according to the support part 34 are displaced downward, they diverge and has finally been arranged on a circle, the diameter of which corresponds to the outer diameter of the sleeve 36. on

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this catfish takes a reliable fixation of the on the spines 32, 32 * impaled ends of a hollow organ.

According to an export forum. In the device for turning hollow organs with foldable spines of the simplest type (JlQ. 20, 21), the foldable spines 37, 37 * QIt are attached to your trolley by means of Golenken39.

Here, the support part is designed as two halves, of which one 38 * with the spikes 37, a sleeve half 40 * and the other 38 ' ^f with the spike. 37 'comprises a sleeve half 4-O ^11.

Before the eversion process, the foldable spikes 37 9 37 * protrude over the sleeve

When impaling the end of a hollow organ to be turned inside out on the spines 37, 37 'these are the largest possible! .litte brought closer, which simplifies and speeds up this operation and, most importantly, the possibility of injury the wall of the corresponding hollow organ is reduced will.

When turned inside out, the spines 37, 37 'migrate down, go apart and eventually become on top of one

Arranged in a tie, Durohmee eggs mill the outer Durohaesse * der Sleeve 40 corresponds. This achieves a secure fixation the ends of the hollow organ impaled onto the spikes 37, 37 '. An improvement of the latter execution form of the inven-

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The device according to the invention with the foldable spines represents a device for everting hollow organs, which contains a sleeve 41 (panels 22 to 24) divided into two sleeve halves 4-1 », 41". Each of the sleeve halves 41 »and 41" has respectively an upper interchangeable part 42 *, 42 "and a lower base part 45 ', 43" · The folding spines 44, 44 ¹ are slidably mounted on the support means Gelenken45 Toll 46th The support part 46 is designed as two half rings, of which one 46 * with the spikes 44, the one lower base part 43 * of the sleeve half 41 * and the other 46 "with the spikes 44 - oil the other lower base part 43" of the sleeve half 41 " encompasses.

Each spike 44, 44 * is designed as an S-double arm lever whose base is the joint 45, which is for a movable Attachment of the specified spike to the: Carrying part 46 is used

The smaller arm of the aforementioned S-Zwelarmhebels forms a wedge-shaped projection 47, which is close to the joint; 45 is located and with its narrowing part of the sleeve 41 facing 1st. Of the the other larger arm of the S-Zwelarm lever is located above the Joint 45 and ends just like all of the above-described spines old a point on which the end of a to be turned inside out Hollow organ is pierced when it is attached to the spines 44, 44 *. The wedge-shaped attachment 47 of each spike 44, 44 * contributes to such an effect on the replacement

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^{visible parts} 42 "and 42 '" of the respective sleeve half 41 ", 41 lf that the spines 44, 44 * approach each other as they migrate into the initial position (into the upper end position).

The in Flg. 22 to 24 v / leather-given device for everting hollow organs works as follows · First, the interchangeable parts 42 * and 42 ¹ * of the sleeve halves 41 », 41" are assembled. These replaceable parts of the sleeve halves 42 * and 42 * ^{f are} selected so that its diameter corresponds to the diameter of the hollow organ to be turned inside out. Then move the trolley 46 with the spikes 44, 44 »In the (upper) starting position»

Here, a mutual approaching is carried out of the spines 44 and 44 '· This is an action of the spikes 44, 44' on the replaceable parts 42 ', 42 "of the sleeve halves 41', thanks to 41 ^lf, whereby the distance 1 between the opposite spines 44 equal to the inner diameter of the exchangeable part 42 'of the sleeve half 41',

The discussed action of the spikes 44, 44 "on the interchangeable parts 42 'and 42 ^{1 f of} the corresponding sleeve halves 41", 41 "takes place in the following order:

When the support member 46 is in the lower position, the spikes 44, 44 'occupy any position can (usually they are completely folded, ie · moved apart at a greatest possible distance) · Once the "the Stacheli 44 _f 44" carrying Tragtell 46 approaches its upper end position,

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The wedge-shaped projections 47 of the spikes 44, 44 ' ^{press against the end faces 48 of the interchangeable parts 42' and 42 1} 'of the sleeve shafts 41', 41 lf and begin to rotate in the joints 45 and towards each other. approach

The end face 48 of the replaceable part is each The sleeve half is bevelled in such a way that after installing the replaceable parts £ 2 », 42 ** of the sleeve halves 41 ', 41" in the device for eversion, the spikes 44, 44 * in their upper position are arranged so that the distance between the diametrically opposed spikes 44, 44 is equal to the inner diameter of the exchangeable part 42 'of the sleeve half 41'.

The device for everting hollow organs (Flg. 22 to £ 4) is characterized by a not particularly complicated design due to a considerable operational safety and handiness from, thanks to the use of interchangeable parts for the sleeves, it can be used to evert various hollow organs, in particular Vessels of different diameters can be used. According to this embodiment of the "device for eversion of Hollow organs practically the entire eversion process is mechanized, whereby the eversion process and the associated surgical The operation, e.g. the clamping of the vessels, is much easier and performing said surgical operation for whom art is less strenuous

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There are considerable difficulties in the invagination of small vessels, primarily small blood vessels.

Here is an end of the at least 20 ma long Gofäßes required, then a blood brain end!.! Ansehettenl: loL: no used or it can be tied with a ligature. For this reason, the invention is made according to the device for everting blood vessels with a blood hecimendon clamp provided which are built into the sleeve on their ti foot will.

In Flg. 25 is a new type of blood vessel Terminal shown, which is filled out as a spiral leaf feeder 49 and a sleeve half 51 is introduced at the foot 50. Here If the outer end 52 of the spiral leaf spring 49 is rigid, e.g. Welding (in Fig. 25 the welding stud is through pos. 535 indicated) attached to the smaller sleeve half 51, while the inner end of the spiral leaf spring bulges freely.

A blood vessel to be turned inside out is placed between the larger sleeve half 33 and the smaller sleeve half 51. When the sleeve halves are brought together, the blood vessel is pressed by the surface 56 of the spiral leaf spring 49 against the inner surface 57 of the larger sleeve halves 33 . Such a construction of the blood-inhibiting clamp and its introduction within the sleeve of the device for supporting blood vessels make it possible to carry out a surgical

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OfNGiNAL

Glschen procedure with short (approx. 4 to 5 mm long) vessel ends get along.

This biutheturning clamp has a high degree of elasticity and reliably breastfeeds regardless of the diameter of a Blood vessel the bleeding without the ϊ / andung of between the To injure sleeve halves 51 and 55 of the blood vessel located

If the blood vessel 58 (Fig. 26) has a small diameter has, the spiral leaf spring 49 is at the union of the sleeve halves 51 and 55 subjected to a relatively small deformation, so that it acts on the blood vessel 58 only with a relatively moderate force. However, this power is completely sufficient to stop the bleeding.

In contrast, when the blood vessel 59 (ßl'o · 27) has a large diameter, 45 learns the spiral spring at the union of the llülsenhälften 51 and ^ 3 a relatively large deformation, whereby it acts on the blood vessel 59 RiIt a relatively large force and the bleeding inhibits.

In the case of the illustrated in FIGS. 22 to 24 Solution-designed device for everting blood vessels the hemostatic clamp is at the bottom of the (^ round part of the sleeve 41 in the ' Section 60 (Fig. 23) introduced.

The devices considered above for everting hollow organs including the various vessels, e.g. blood vessels, which also belong to the hollow organs, can

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- 28 can be built independently of other surgical devices.

Various types of execution are available here of the devices to be discussed, which are based on the above Executions are based.

However, the proposed device UiIg ^{31 for the} eversion of hollow organs as components of various sewing devices for the closure of hollow organs is of particular importance.

It should be noted that the device for eversion of hollow organs to the devices mentioned for suturing the hollow organs as an independent block (eversion block), its Elemeni? cannot take part in any other interventions other than the eversion of a hollow organ, or belong as an assembly, kinematically with other assemblies of the sewing devices mentioned coupled 1st and a necessary order of work of all Ensures elements of the corresponding sewing device. Individual elements of the assembly can also be turned inside out participate in other interventions that result in the eversion of the respective Hollow organ do not meet.

Particularly ; What is important are the gadgets for gumming of blood vessels "end-to-end" based on the proposed Device for everting hollow organs were developed.

According to one of the embodiments, the device according to the invention for pre-clamping blood vessels "end-to-end"

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two branches 61 and 62 (Flg. 28, 29), which with an axis 63 are connected to one another, a device 64 for eversion of blood vessels, a device for advancing and bending the staples when suturing the blood vessels

The branches 61 and 62 are provided with a lock 66, which they after merging (as shown in drawings is) locked and their automatic separation prevented.

The sector 61 has a Arbeltsteil 67 and a handle 68. The branch 62 also has a Arboltstell 69 and a handle 70 · ^D le handles 68 and 70 of the branches are formed as genannton hand rings ·

The device 64 for inverting blood vessels is on the ends of the arbelt place built up and set by the branches from a smaller sleeve half 71 »a larger sleeve half 72, a hemorrhagic clamp 7 *>, a half-ring 74 and egg nem half ring 76 with spikes 77 and smaller levers 78 and 79i which as a hand drive of the device for everting blood organs serve, together · The smaller sleeve half 71 is on Work part 67 of the branch 61 and the larger sleeve half 72 on Work part 69 of branch 62 attached; the half-ring 74 comprises the smaller sleeve half 71 »while the half-ring 76 the larger Sleeve half 72 engages around; the smaller lever 7β is by means of a Axis 80 on the work part 67 of the branch 61 and the smaller lever 79 by means of an axis 81 on the work place 69 of the branch

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_ 30 -

62 attached.

The ^ ndon of arms 82 and 83 of smaller levers 73 and 79 are grooved over axes84 and 85 each

the support ring 74 or the half ring 76.

The frelo end of arm 86 from smaller lever 78 ends with one (upper) key 88 and one (lower; l'aste 89, while the free end of arm 87 of smaller planer 79 does an (upper) key 90 and a (lower) key 91 ends. the lower buttons 89 and 91 in flg. 29 are located under the olerci Keys 88 and 90 and are entered with dashed lines.

The shape of the said keys is handy for manual actuation of the smaller levers 78 and 79. It is easy to press two upper keys 88 and 90 or zv / el lower keys 89 and 91 with one finger at the same time, whereby the smaller levers 76 and 79 pivot about their axes 80 and 81 clockwise and counterclockwise at the same time . The device 65 for advancing and bending the Klamcorn is usually on the surfaces 92 and 93 of the corresponding Arbeltstellon 67 and 69 of the branches 61 and 62 and includes slides 94 (Fl £ · 30 ₁ 31), each of which is dewelligen Groove 95 along which receives this slide, can migrate. The grooves 95 are provided in the specified surfaces 92 and 95 radially with respect to the sleeve center, this sleeve being composed of the sleeve halves 71 and 72. Each slide 94

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has cine attached to it movably by means of an axle 97 Bar 96.

The strips 96 have longitudinal grooves $ 8 which receive specific clips for the seam closure of blood vessels (not shown in the drawings).

^ between the strips 96 and the corresponding slides, cylindrical springs 99 are arranged, which ^{hold the strips 9 6} at a certain angle.

When the clamps are inserted into the groove 98 the bar 96 on the angle at which the Bracket is bent, creating the opportunity for fixation this bracket with respect to the sleeve (. the drawings illustrate only the sleeve halves 71 and 72) given 1st.

In their lower part the slides 9 ^ are dovetail-shaped The hats 95, which form the lower part of the respective slide 94 recordJ) aby means that the slide is only In Langer, you can freely shift your movements in transverse (horizontal and vertical) direction (thanks to the games) maximum 'are limited.

The free end of the slide 94 is horizontal Que ^ locfi, 100 provided · By means of these transverse holes a movable one becomes Connection of the slide rushes to the drive of the device 65 (Fig. 28, 29) for advancing and bending the sewing

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32 staples serving the blood vessels secured.

• ·

The drive of the device for feeding and bending the Clamping is done by hand and holds one by means of an axis 102 Lever 101 movably fastened on the work part 67 of the branch 61, one by means of an axis 104 on the work part 69 the branch 62 movably attached lever 103, a leaf spring 10 ^, which loads the lever 101, a leaf spring 106 which the Lever 103 loaded, one by means of an axis 108 on the free one End of the lever 101 can be pushed forward attached fork 107 and a displaceable by means of an axis 110 at the free end of the lever 103 attached fork 109. The ends of forks 107 and 109 protrude into the holes 100 (FIG. 30) of the slides 94- and thereby cause a kinematic connection of the said slide with the manual drive. The end faces of the free ends of the forks 107 and IO9 (Flg. 29) carry screws 111, whereby the slider 94 moves from the center of the sleeve to the hand area bol the movement of levers 101 and 103 to their starting position can move under the action of springs IO5 and 106.

According to the embodiment of the device described earlier a lock is provided to clamp blood vessels, which a certain order of work of its main components ensures; E.g. the device for the advance and original filing of the staples can only be installed after the end of the eversion of the blood vessels to be closed are actuated. The locking takes place with the use of one

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non-complex and reliable means, namely by a lengthening and thickening of the ends of the axles 84 and 85, the brace themselves in the course of eversion of the to be occluded blood vessels respectively against the H _e l b _e 101 and 103 ·

The suturing of the blood vessels using the sewing device described is carried out as follows:

The branches 61 and 62 are moved apart. Go there the smaller sleeve half 71 and the larger sleeve half 72, the Jewellsi; on jobs 67 and 69 of branches 61 and 62 are attached, away from each other, the smaller levers and 79 are rotated counterclockwise, the half ring 74 with take the sting 75 and the half-ring 76 with the spikes 77 the lower end position, the device 65 for advance and The bending of the brackets is in their starting position (the Levers 101, 103 are withdrawn under the action of the springs, the slides 94 are furthest away from the center of the sleeve). The clips are inserted into the grooves 38 of the strips 96.

By pressing the upper buttons 88 and 90 you can pivot the smaller levers 78 and 79 clockwise. Here move the half-ring 74 with the spike 75 and the half-ring 76 with the spikes 77 in their upper end position. Now it is common the shorter end of the blood vessel to be closed is inserted into the larger sleeve half 72. By doing the handles 68 and 70 are actuated, branches 61 and 62 are combined

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led · Dlo smaller sleeve half 71 and. the larger sleeve half 72 close and encompass the said endo of the blood vessel. In this position, the branches 61 and 62 are fixed thanks to the lock 66. The halves of the sleeve 71 and 72 surrounded end of the blood vessel are securely clamped by the blood zoom end clamp 73 from the side of the Adventltla forth protruding part of the blood vessel to impales evenly on at the spines 75, 77th then the edge of the other end of the blood vessel is pierced on the same spikes 75-77. The ends of the blood vessel to be closed are pierced onto the spikes 75 »77, usually with the help of tweezers, which is not particularly difficult for the surgeon performing a particular operation.

Thereafter, simultaneously presses on the lower keys 89 and 91. The smaller lever 78, 79 rotate ge ^ en-clockwise, and the ä _a ibringe 74 and 76 with the pricked on the spines 75 »77 ends of the blood vessels Sonken in their lower end position. Here, one end of the blood organ to be closed is turned inside out and the other end is pulled onto this turned inside blood vessel end.

As when the blood vessels to be closed are turned inside out the half-rings 74 and 76 go down, also go down dlo Axles 84 and 85, the elongated and thickened ends of which make the device 65 enable for feeding and bending of the clamps,

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To the device 65 for advancing and bending the clamps to operate and thereby sew the blood vessel together, will open dl «lever ΙΟΙ and 103 pressed. By turning these levers to your Rotate axes 102 and 104, move them to the stop, approach each other, leaving the forks 107 and hike.

The kinematically with the levers 101 and 103 over the forks 107, 109 connected slide 94 · move in the grooves Towards the sleeve tube (in the drawings the larger Sleeve half 72 and smaller sleeve half 71 shown).

The strips 96, in the grooves 98 of which (in the drawings not shown) brackets are inserted, turn and wear thereby to bend the clamps so that the blood vessel is clamped.

Then you let the levers 101 and 103 free, which is under the Effect of leaf springs 105 and 106 "In Hire starting position hike·

The slider 94 kinematically connected to the levers 101, 103 via the forks 107, 109 move accordingly in the hats 95 in the direction of the middle of the sleeve (in the drawing, its smaller sleeve half 71 and larger sleeve half 72 are shown). By pressing the buttons 89 and you can move the smaller levers 78, 79 clockwise. Here, the half-ring 74 with the sting 75 and the ilalbrlni ver. 76 with the spines 77 m your upper end position.

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Then you lift the blood vessel from the spikes 75f 77 with a pair of tweezers, move the branches 61, 62 apart and leave the sewn blood vessel free

BgI the described embodiment of the device sur VerklaciKierung of blood vessels, the device is used to evert blood vessels that are rigidly connected to the supporting part has spines formed as two half rings.

The other embodiments of the device for jamming of blood vessels can obviously also be the other above Reference to the accompanying drawings treated embodiments the device for everting hollow organs (with the spring-loaded or folding baron with respect to their supporting part Spines) contain

It goes without saying that with the help of what has been described Device for clamping blood vessels also others, e.g. Lymph vessels can be sutured

The proposed device for everting hollow organs and the device for clamping blood vessels were tested on all sides under experimental conditions. It is there it has been found that the claim according to the invention "Device contributes to the eversion of hollow organs including the blood vessels and thus surgical interventions in which hollow organs have to be sewn together, can be made considerably easier and faster, for example, a surgeon with intermediate specialist knowledge

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using the device for the scaling up of blood vessels, with the device according to the invention for turning inside out Hollow organs, a blood vessel (in one place this blood vessel) depending on the complexity of the operation Sew within 1 to 2 minutes, turning inside out not over 0.5mm, objects.

In contrast, the same surgical procedure takes place using another EaIt _{4 of} a previously known device for the eversion of hollow organs provided with a device for suturing the sutures of blood vessels J> up to 5 minutes (depending on the duration of the operation), the eversion process takes 2.5 to 4, 5 Hin

The experiments also gave the opportunity to use the proposed device short (approx. 4 to 5 mm long) To turn the ends of the vessels inside out and, consequently, to sew them together, whereas devices known up to now are only at least 20 πα long The ends can be turned inside out individually and then sewn. the Experiments have confirmed the ilögllchkolt by means of the inventive Device to invert various vessels including the thinnest and heavily calcified vessels

The device for clarifying blood vessels that is connected to the equipped according to the device for their eversion 1st, was in the Organ Transplant Laboratory of the Skllfassowskl Institute for first aid (Koskau) on dogs

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maize tested.

The device was tried out in the most difficult conditions Operations. For example, such operations were performed using this device like home transplantation of a head, a liver, performed by kidneys and a whole group of organs

Severed arteries and veins were also sutured. Overall, in the first stage 40 ITahtvorschlüsse of blood vessels were performed · In all cases reported here, the liähto high quality and resulted in the Nahtllnie no ^f J ^l hrDmbosG.

At this stage it was observed around the animals. 2 Mon _a te long ·

Another series of experiments was carried out in the later tent room done on animals by undergoing various surgical procedures Regarding the clinging of the blood vessels to the corresponding with the proposed device for Umstüipung device equipped with hollow organs.

Of 28 attempts' (15 ° anastomoses) which one under L'msatz of the specified device carried out, 16 attempts were the Organ transplant laboratory allocated · In all cases, regardless of the observation tent (up to 1.5 years), none were

Complications, not a single thrombosis or narrowing of the clear width of a vessel determined.

At the moment the proposed device for turning inside out of hollow organs as well as the device for clamping blood vessels equipped with this device has been clinically tested

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Claims (9)

PATENT CLAIMS: Τ) Device for inverting hollow organs, which contains a sleeve for introducing the end of a hollow organ to be inverted, characterized in that it is provided with spikes (13, or 21, 21 ^f , or 29, 29 *, or 32, 32 », or 37 , 37 ', or 44, 44 *) is provided, which serve to attach the edge of the specified hollow organ and are on a support plate (14 or 22, or 50, or 34, or 38, or 46) on the circumference: which corresponds to the envelope of the rare surface of the mentioned sleeve (12 or 20, or 31, or 36, or 40 or 41), the support plate (14 or 22, or 30, or 3 ^ h ° äer 38, or 46] is displaceable along said sleeve (12 or 20, or 31 »or 36, or 40 or 41). 2. Apparatus for inverting hollow organs according to claim 1, finriii-pnh ^ filrnnnznichnfit _t ^{that the spines (29, 29 5} ) provided for the attachment of the edge of a hollow organ are rigidly connected to the mentioned Tragtoil (30). 3. Device for everting hollow organs according to claim 1, cladurph ^ plronnzsich . n et that the spikes (32, 32 ') used for fastening the edge of the hollow organ to be inverted are cushioned on the specified support plate (34) so that the diameter of the circumference. on which the spines (32, 32 ') are arranged in front of the inversion, is smaller than the diameter 509807/0097 knife of the respective circumference at the end of the eversion. 4. Device for turning a product inside of hollow organs according to claim 1, Findur ol · {jnknnnznlehnet _T since ?, which for the attachment of the R _a of the umzustülpenden hollow organ NDOS provided spines (37, 37 ') on said Tragtell (38) by means of joints (39 ) are slidably attached so that the spines (37, 37 ') can approach one another before they are everted ^ 5. Device for everting cabbage organs according to claim j and 4, characterized frekennsglehnet that the spines (^ i 44 ') are designed as S-Zv / elarrn levers, for each of which serves as a support point d _a s named joint (45), the ensures that the spike (44, 44 ') is securely fastened to the specified support part (4G), the smaller arm representing a wedge-shaped extension located at the bottom close to the joint (45), which faces the said sleeve (41) and which faces the larger arm over the gel. (15) is located and ends at a point on which the land of the hollow organ that is not to be inverted is pierced when it is fastened to the stems (44, 44 '), the support part (46) with fi (> n movably fastened spikes (44, 44 ') encompasses the underneath Toll (13', 13C) of the sleeve (41) and can slide along this sleeve (41), the upper part (42 '»42 ^ff ) of the Ilüüse (41) is removable, the diameter of which is approximately equal to the outer diameter of the end of the hollow organ to be inverted, in that the original end face (48) of the removable part 509807 / Ü097 (42, ¹ 42 '') of the sleeve (41) the shape of the dome-like extensions (47) of the spines (44, 44 ') is given in such a way that the larger arne of the spikes (44, 44 *) located in the upper end position press against the upper edge of the removable part (42 *, 42 '') of the sleeve (41). 6, device for everting hollow organs according to claim 1 and according to one of claims 2 to 5, characterized in that it has a manual drive which has at least one lever (23, 23 *) with a relative to the sleeve (20) immovable Support point (24, 24 *), one arm of which carries the movably arranged support part (22, 22 *) with the spikes (21, 21 »), while the other is designed so that you can act on it by hand to Support part (22, 22 *) to be set in motion when the hollow organ is turned inside out, the band of which is attached by means of the spikes (21, 21 ') located on the support part (22, 22 *). 7. Device for everting hollow organs according to Ansprucl 1, one of claims 2 to 5 and claim 6, which the said sleeve is divided into two sleeve halves in a plane which runs parallel to its longitudinal axis, characterized in that the support plate ( 22 or 350, or 34, or 38, or 46) with the spines attached to it (21, 21 "or 29, 29 *" or 32, 32 *, or 37, 37 *, or 44, 44 ") as _z v / el half rings (22 *, 22 "or 30", 30 ", or 34 *, 24", or 38 V, 38 ' ^f , or 46', 46 * ^f ) are designed, each of which 509807/0097 one of the sleeve halves (20 *, 20 ", or 31 ', 31", or 36', 3S "or 40 ', 4O ¹¹ , or 41', 41") engages around and by means of the joint (25) with the respective arm of the plane (23, 23 *) of the manual drive is connected. 8. Device for everting blood vessels according to claim 1, one of claims 2 to 5, claim 6 and 7, characterized qt; _t that they are clamped (49) is provided inside the sleeve (51 »55) at its foot (50) is appropriate. 9. Device for ^{everting B} lutgefä.3en according to claim. 8, fiacjnvc.h c-nknnn ^ qlnhnfi ^ j that the blood-inhibiting clamp is designed as a spiral leaf spring (49), the outer end (52) of which is attached to the sleeve (51, 35) and the inner end (54) remains free 10 »Device for the bonding of blood vessels" end-to-end ", which has a support part, a device for inverting blood vessels to be closed, which rests on the said ^ ragtell and at least one sleeve with hats to accommodate the Has clamps, and a device for feeding and bending of the clamps while the blood vessels are clamped, tf that said device for converting closure of blood vessels to be closed according to claim 1, eJ4em the claim from 2 to 5 and the claims from 6 to is executed. 509807/0097 Blank