DE2639413C3 - Vorrichtung zum Setzen von chirurgischen Klammern - Google Patents
Vorrichtung zum Setzen von chirurgischen KlammernInfo
- Publication number
- DE2639413C3 DE2639413C3 DE2639413A DE2639413A DE2639413C3 DE 2639413 C3 DE2639413 C3 DE 2639413C3 DE 2639413 A DE2639413 A DE 2639413A DE 2639413 A DE2639413 A DE 2639413A DE 2639413 C3 DE2639413 C3 DE 2639413C3
- Authority
- DE
- Germany
- Prior art keywords
- openings
- locking
- mandrels
- holding
- pins
- 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.)
- Expired
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B17/0643—Surgical staples, i.e. penetrating the tissue with separate closing member, e.g. for interlocking with staple
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B2017/0641—Surgical staples, i.e. penetrating the tissue having at least three legs as part of one single body
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)
- Materials For Medical Uses (AREA)
Description
50
Die Erfindung betrifft eine Vorrichtung zum Setzen von chirurgischen Klammern, die aus zwei miteinander
verrastbaren und das zu verbindende Gewebe zwischen sich festklemmenden Halteteilen aus vom Körper
absorbierbarem Material bestehen, von denen das eine mit Rastöffnungen versehen ist, die der Aufnahme der
mit Rastköpfen versehenen Dorne des anderen Halteteils dienen.
Um bei Operationen Körpergewebe, wie Gewebe des Magens, des Darms oder anderer Organe, schnell und
genau miteinander verbinden zu können, werden in zunehmendem Maße chirurgische Klammern, hämoslatische
Klemmen und ähnliche Festlegeeinrichtungcn verwendet.
Aus der US-PS 33 78 010 ist eine chirurgische >>5
Klammer bekannt, deren Material gegen eine Auflösung oder Korrosion durch die Körperflüssigkeiten weitgehend
beständig ist, die aber auch nach einer gewissen
Eine aus der DE-PS 8 53 499 bekannte veterinärmedizinische Wundklammer, die insbesondere zur
Verwendung bei Kastrationen dient und aus zwei Halteteilen besteht, von denen das eine mit Öffnungen
versehen ist, die das zwischen den Halteteilen eingeklemmte Gewebe durchdringende Dorne des
anderen Halteteils aufnehmen, hält die Gewebeteile zusammen, bis nach erfolgter Heilung das tote, zwischen
den Halteteilen befindliche Gewebe mit diesen vom verheilten Körperteil abfällt, und läßt sich zum Nähen
innerer Organe nicht verwenden.
Aus der GB-PS 9 72 731 ist eine Arterienklemme bekannt, die aus zwei miteinander verrastbaren und das
zu verbindende Gewebe zwischen sich festklemmenden Halteteilen aus von dem Körper absorbierbarem
Material besteht, von denen das eine mit Rastöffnungen versehen ist, die der Aufnahme der mit Rastköpfen
versehenen Dorne des anderen Halteteils dienen.
Aus physiologischen oder anderen medizinischen Gründen ist es häufig erwünscht, zürn Nähen von
inneren Organen Klammern aus einem Material zu verwenden, das im Laufe der Zeit von dem Körper
vollständig absorbiert werden kann, so daß nachfolgende Operationen zur Entfernung der Klammern nicht
erforderlich sind. Vom Körper absorbierbares Material ist aber so weich, daß sich aus diesem keine Halteteile
mit Dornen herstellen lassen, die steif genug wären, um das zu nähende Gewebe zu durchdringen.
Aufgabe der vorliegenden Erfindung ist es daher, eine Vorrichtung zum Setzen von chirurgischen Klammern
zu schaffen, deren mit Rastköpfen versehene Dorne trotz der Weichheit ihres vom Körper absorbierbaren
Materials das miteinander zu verbindende Gewebe zu durchdringen vermögen.
Diese Aufgabe wird bei einer Vorrichtung der eingangs angegebenen Art erfindungsgemäß gelöst
durch ein das mit Rastöffnungsn versehene Halteteil aufnehmendes und festlegendes Widerlagerteil mit die
Rastöffnungen im Abstand umgebenden Öffnungen, die den Rastköpfen den Durchtritt gestatten, und ein mit
Stiften versehenes Druckteil, die die mit axialen Öffnungen versehenen Dorne durchdringen und bis zu
ihrer Verrastung mit den Rastöffnungen steifhalten. Mit der erfindungsgemäßen Vorrichtung lassen sich chirurgische
Klammern aus einem weichen, vom Körper absorbierbaren Material setzen, deren Dorne an sich
nicht genug sind, um zur Herstellung der klemmenden Verbindung das Gewebe zu durchdringen.
Vorteilhafte Ausgestaltungen der Erfindung sind in den Unteransprüchen 2 bis 7 beschrieben worden.
Ein Ausführungsbeispiel der Erfindung wird nachstehend anhand der Zeichnung näher erläutert. In dieser
zeigt
F i g. 1 einen Teil einer chirurgischen Klammer aus absorbierbarem Material mit dem zugehörigen Teil der
Vorrichtung zu deren Setzen in perspektivischer und auseinandergezogener Darstellung,
Fig.2 einen Querschnitt durch das mit Stiften versehene Druckteil der Vorrichtung nach F i g. 1 mit
dem aufgesetzten, mit Dornen versehenen Halteteil,
F i g. 3 einen Querschnitt durch das Widerlagerteil mit dem eingesetzten, mit Rastöffnungen versehenen
Halteteil,
F i g. 4 einen Querschnitt durch die Vorrichtung nach F i g. 1 sowie die miteinander zu verbindenden Gewebeteile
im miteinander verrasteten Zustand der Halteteile und
Fig.5 eine der Fig,4 entsprechende Darstellung
nach Entfernen der dem Setzen d«r Klammer dienenden Vorrichtung.
In F i g. 5 ist gezeigt« wie eine Festlegeeinrichtung 10 gemäß der Erfindung zwei weiche Körpergewebeteile
11,12 miteinander verbindet
Die Festlegeeinrichtung 10 besitzt ein langgestrecktes Halteband 13, das aus einem biologisch abbaubaren
oder vom Kc .-per absorbierbaren Material besteht und
auf einer Seite eines festzulegenden. Gewebeteils, z. B. des Gewebeteils 12, angeordnet ist Je nach der Länge
der herzustellenden Naht kann das Halteband 13 jede geeignete Länge haben. In dem dargestellten Ausführungsbeispiel
besitzt das Halteband mehrere öffnungen 14, die das Halteband quer durchsetzen und in der
Längsrichtung in Abständen voneinander angeordnet sind, wie dies am besten aus der F i g. 1 hervorgeht Im
Rahmen der Erfindung kann jedoch »uch ein Halteband
13 verwendet werden, das so kurz ist, daß es nur eine
derartige öffnung 14 besitzt
Die Festlegeeinrichtung 10 umfaßt ferner ein
langgestrecktes Festlegeband 16, das ebenfalls aus biologisch abbaubarem oder absorbierbarenj Harzmaterial
besteht und im wesentlichen dieselbe Länge hat wie das Halteband 13. Das Befestigungsband 16 ist mit
mehreren Zinken 17 versehen, die vorzugsweise mit dem Band einstöckig und die in der Längsrichtung des
Bandes in denselben Abständen voneinander angeordnet sind wie die öffnungen 14 des Halltebandes 13. Wenn
das Band 13 so kurz ist, daß es nur eine einzige öffnung
14 besitzt hat das Festlegeband 16 auch nur eine einzige Zinke 17.
Das Festlegeband 16 und das Halteband 13 sind so angeordnet daß sie gemeinsam in eine Stellung
bewegbar sind, in der sie an zwischen Ihnen angeordneten Gewebelagen 11 und 12 festlegend
angreifen. Während des Nähvorganges treten die Spitzen 27a der Stifte und die Zinken 17 so weit durch
die miteinander zu verbindenden Gewebeteile und die öffnungen 14 hindurch, wie dies angesichts der Dicke
der zwischen den Bändern befindlichen Gewebeteile erforderlich ist. Die Zinken 17 sind mit Rastmitteln zum
Verrasten der Zinken in den öffnungen 14 in der erforderlichen Stellung versehen. In der dargestellten
Ausführungsform umfassen diese Rastmittel einen oder mehrere Widerhaken 18,19 am Ende jeder der Zinken
17. Wie am besten aus der Fig. 4 hervorgeht, sind die oberen Flächen 18a, 19a der Widerhaken 18, 19 so
angeordnet, daß sie wahlweise an der Unterseite 13ö des Bandes 13 angreifet! können, um ein Herausziehen
der Zinken 17 aus den öffnungen 14 zu verhindern.
Damit üie Bänder 13,16 während des Nähvorganges
richtig miteinander fluchten und bis zum Ineinandergreifen zueinander hin bewegt werden können, ist zum
Abstützen des Haltebandes 13 ein langgestreckter r> Amboß 21 vorgesehen, der aus einem starren Material,
beispielsweise Metall oder dergleichen, besteht. Wie am besten aus der F i g. 3 hervorgeht, wird der aus Metall
bestehende Amboß 21 so angeordnet, daß er an der Unterseite \3b des Haltebandeü 13 angreift. Gemäß m>
Fig. 1 kann der Amboß 21 seitlich mit profilierten Längsflanschen 22 und 23 versehen sein, die eine
Verschiebung des Bandes 13 auf dem Amboß 21 in der Längs- und Querrichtung verhindern. Der Amboß 21 ist
vorzugweise mit mehreren öffnungen 24 versehen, die in der Längsrichtung in denselben Abständen voneinander
angeordnet sind wie die öffnungen 14 des Haltebandes 13. Die öffnungen 24 dienen zur Aufnahme
der Endteile der Zinken 17, wenn diese Endteile über die Unterseite 13Z>des auf dem Amboß liegenden Bandes 13
hinaus vorstehen.
Zum Ausrichten und Abstützen des Festlegebandes 16 während des Nähvorganges ist ein Stößel 30
vorgesehen, der am besten in F i g, 1 erkennbar ist und vorzugsweise aus einer langgestreckten Leiste 26 aus
starrem Material, beispielsweise Metall oder dergleichen, besteht und geeignet ist, an der oberen Fläche 16a
des Festlegebandes 16 anzugreifen. Der Stößel 30 ist mit mehreren Stiften 27 versehen, die in der Längsrichtung
in denselben Abständen voneinander angeordnet sind wie die Zinken 17.
Gemäß F i g. 2 können die Stifte 27 in entsprechende zentrale axiale Kanäle 28 eingeführt werden, welche die
Zinken 17 des Festlegebandes 16 durchsetzen. Damit die Zinken 17 beim Nähvorgang die zu verbindenden
Gewebeteile leicht durchdringen können, sind die Stifte 27 an ihren äußeren Enden mit scharfen Spitzen 27a
versehen. Die Länge der Stifte 271. ■■«J der Zinken 17 ist
so gewählt, daß in der in Fig.3 dargestellten
Eingriffsstellung die Leiste 26 an dem Band 16 angreift und den Axialschub aufnimmt
Zur Durchführung eines Nähvorganges wird das Festlegeband 16 so an dem Stößel 30 angebracht, daß
die Stifte 27 in die Kanäle 28 eingreifen und dadurch die Zinken 17 während des Nähvorganges starr halten. Es
versteht sich, daß man das Band 16 und die Zinken 17 aus einem Kunststoff herstellen kann, der nicht so starr
ist, daß er die Zinken 17 mit den öffnungen 14 des Bandes 13 ausgerichtet hält während die Zinken 17 die
zu verbindenden Gewebeteile durchdringen, um diese zwischen den Bändern 13,16 festzulegen. Wenn jedoch
die Metallstifte 27 in den zentralen Kanälen 28 der Zinken 17 angeordnet sind und die scharfen Spitzen 27a
der Stifte 27 aus den Zinken 17 vorstehen, sind diese so wenig biegsam, daß sie mit den Bandöffnungen 14
fluchtend gehalten werden. Die scharfen Spitzer. 27a der Stifte 27 erleichtern das Durchdringen der Gewebeteile.
Wenn das an dem Amboß 21 angebrachte Halteband si h gemäß F i g. 3 auf der einen Seite der Gewebelage
12 und das an dem Stößel 30 angebrachte Festlegeband 16 sich gemäß Fig.2 auf der anderen Seite der zu
verbindenden Gewebeteile, z.B. der Gewebelage 11, befindet, werden die Bänder 13, 16 zueinander hin
bewegt. Dabei durchdringen die Spitzen 27a und die Zinken 17 die Gewebelagen 11, 12. Danach tritt der
Widerhaken 18 an jeder der Zinken 17 in die ihm zugeordnete öffnung 14 des Bandes 13 ein. Je nach der
Dicke der zu verbindenden Gewebeteile kann man die Zinken 17 so weit durch die öffnungen 14 bewegen, daß
die Widerhakenfläche 11a die Fläche 13£>des Haltebandes
H -jntergreift Dies wird durch die öffnungen 24 des
Ambosses ermöglicht Wenn die zu verbindenden Gewebeteile so dick sind, daß die Zinken 17 weiter
durch die öffnungen 14 hindurch bewegt werden müssen, treten auch die Widerhaken 19 durch die
öffnungen 14, worauf die Flächen 19a der Widerhaken 19 die Fläche \3b Jes Haltebandes untergreifen.
In der in F i g. 4 gezeigten Stellung sind die beiden Bänder 13, K5 so miteinander verbunden, dafl sie die
zwischen ihnen angeordneten Gewebeieile festlegen. Dies ist in Fig.4 dargestellt. Danach werden der
Amboß 21 und der Stößel 30 abgezogen, während die eingesetzten Bänoe/ 13, 16 in der Stellung zum
Festlegen der Gewebeteile 11, 12 bleiben. Dies ist in F i g. 5 gezeijjt.
biologisch abbaubare Festlegeeinrichtungen verwendet werden können, gehören Catgut (von Submukosa von
Schafen gewonnenes Kollagen); Polyglykolsäure; PoIymilchsäure, Mischpolymerisatgcmi^chc der Polyglykol-
und Polymilchsäure; wiederhergestelltes Kollagen; erodierbare Metallegierungen; Polyester; Polyaminsäuren.
wie Casein, Albumin und dergleichen; Polymerisate mehrwertiger Alkohole, wie Polyvinylalkohol, CeIIuIoseglycolsäureester;
sowie Ester der a-Cyanacrylsäure, wie das Methyl-Λ -cyanacrylat. Die Polyglykolsäure is
in den US-PS 34 63 158, 37 39 773 und 37 72 421 beschrieben. Geeignete Polymilchsäuren sind in de
US-PS 36 36 956. Beispiele von absorbicrbaren Poly estern in den US-PS 32 25 766 und 38 8 3 901, absorbier
bare Celluloseglykolsäureester in der US-PS 27 64 15' und Beispiele von geeigneten Estern der fvCyanacryl
säure in den US-PS 35 27 841, 35 64 078 und 37 59 26· angegeben.
Hierzu 1 Blatt Zeichnungen
Claims (7)
- Patentansprüche:t. Vorrichtung zum Setzen von chirurgischen Klammern, die aus zwei miteinander verrastbaren und das zu verbindende Gewebe zwischen sich festklemmenden Halteteilen aus vom Körper absorbierbarem Material bestehen, von denen das eine mit Rastöffnungen versehen ist, die der Aufnahme der mit Rastköpfen versehenen Dorne des anderen Halteteils dienen, gekennzeichnet durch ein das mit Rastöffnungen (14) versehene Halteteil(13) aufnehmendes und festlegendes Widerlagerteil (21) mit die Rastöffnungen (14) im Abstand umgebenden Öffnungen (24), die den Rastköpfen (18,19) den Durchtritt gestatten, und ein mit Stiften g7) versehenes Druckteil (26), die die mit axialen ffnungen (28) versehenen Dorne (17) durchdringen und bis zu ihrer Verrastung mit den Rastöffnungen(14) steifhalten.
- 2. Vornciitung nach Anspruch 1, dadurch gekennzeichnet, daß die Stifte (27) ein spitzes Endteil (27a) aufweisen, mit dem sie die Dorne (17) überragen.
- 3. Vorrichtung nach Anspruch 1 oder 2, dadurch gekennzeichnet, daß das Widerlagerteil (21) mit seitlichen Stegen (23) und Einbuchtungen (22) zum Festlegen des Halteteils (13) versehen ist
- 4. Vorrichtung nach Anspruch 1, dadurch gekennzeichnet, daß die Halteteile aus langgestreckten Haltebändern (13,16) bestehen, die mit miteinander fluchtenden Rastöffnungen (14) und Dornen (17) versehen sir-d.
- 5. Vorrichtung nach Anspruch 1 oder 4, dadurch gekennzeichnet, daß die Dorne (17) an ihren Enden mindestens ein widerhakenförrsiges Rastteil (18,19) aufweisen.
- 6. Vorrichtung nach Anspruch 1 oder 4, dadurch gekennzeichnet, daß die Öffnungen (14) in dem Halteteil (13) konusförmig ausgebildet sind.
- 7. Vorrichtung nach einem der Ansprüche 1 bis 6, dadurch gekennzeichnet, daß die Halteteile (13,16) aus Catgut, Polyglykolsäure, Polymilchsäure, wiederhergestelltem Kollagen, erodierbaren Metalllegierungen, absorbierbaren Polyestern, Polyaminosäuren, Polymerisaten von mehrwertigen Alkoholen, Celluloseglykolsäureestern oder Estern der Cyanoarylsäure bestehen.
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US05/609,949 US4060089A (en) | 1975-09-03 | 1975-09-03 | Surgical fastening method and device therefor |
Publications (3)
Publication Number | Publication Date |
---|---|
DE2639413A1 DE2639413A1 (de) | 1977-07-21 |
DE2639413B2 DE2639413B2 (de) | 1979-04-26 |
DE2639413C3 true DE2639413C3 (de) | 1979-12-13 |
Family
ID=24443006
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
DE2639413A Expired DE2639413C3 (de) | 1975-09-03 | 1976-09-01 | Vorrichtung zum Setzen von chirurgischen Klammern |
Country Status (9)
Country | Link |
---|---|
US (1) | US4060089A (de) |
JP (1) | JPS5233391A (de) |
CA (1) | CA1082551A (de) |
DE (1) | DE2639413C3 (de) |
FR (1) | FR2322578A1 (de) |
GB (1) | GB1520956A (de) |
HK (1) | HK57980A (de) |
IT (1) | IT1067306B (de) |
SU (1) | SU704429A3 (de) |
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US719475A (en) * | 1902-02-12 | 1903-02-03 | George Knight | Eyeleting-machine. |
NL36595C (de) * | 1932-09-21 | |||
GB972731A (en) * | 1961-05-31 | 1964-10-14 | Mihaly Gerendas | Improvements in or relating to artery clamps |
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US3363628A (en) * | 1964-09-28 | 1968-01-16 | Peter B Samuels | Hemostatic clip |
US3500829A (en) * | 1968-02-09 | 1970-03-17 | Herbert Abramowitz | Earhole piercing and treating apparatus |
US3641804A (en) * | 1969-10-20 | 1972-02-15 | Theodorus Antonio Gerardus Oud | Tool for placing marks in the ears of animals |
US3744495A (en) * | 1970-01-02 | 1973-07-10 | M Johnson | Method of securing prolapsed vagina in cattle |
JPS5033989B2 (de) * | 1971-12-24 | 1975-11-05 | ||
JPS5033989U (de) * | 1973-07-21 | 1975-04-11 | ||
US3879783A (en) * | 1974-02-11 | 1975-04-29 | Minnesota Mining & Mfg | Paper binding machine |
-
1975
- 1975-09-03 US US05/609,949 patent/US4060089A/en not_active Expired - Lifetime
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1976
- 1976-08-31 FR FR7626226A patent/FR2322578A1/fr active Granted
- 1976-08-31 CA CA260,254A patent/CA1082551A/en not_active Expired
- 1976-09-01 GB GB36195/76A patent/GB1520956A/en not_active Expired
- 1976-09-01 DE DE2639413A patent/DE2639413C3/de not_active Expired
- 1976-09-02 IT IT26787/76A patent/IT1067306B/it active
- 1976-09-02 SU SU762393660A patent/SU704429A3/ru active
- 1976-09-03 JP JP51105702A patent/JPS5233391A/ja active Granted
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1980
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---|---|
DE2639413B2 (de) | 1979-04-26 |
FR2322578A1 (fr) | 1977-04-01 |
CA1082551A (en) | 1980-07-29 |
GB1520956A (en) | 1978-08-09 |
HK57980A (en) | 1980-10-16 |
IT1067306B (it) | 1985-03-16 |
FR2322578B1 (de) | 1982-10-15 |
JPS541115B2 (de) | 1979-01-20 |
JPS5233391A (en) | 1977-03-14 |
DE2639413A1 (de) | 1977-07-21 |
SU704429A3 (ru) | 1979-12-25 |
US4060089A (en) | 1977-11-29 |
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