Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
  • A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
  • A61B17/12013—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot for use in minimally invasive surgery, e.g. endoscopic surgery
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
  • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
  • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
  • A61B2017/1205—Introduction devices

Definitions

• Ligating assembly for endoscopic surgery, ligation and ligation manipulation instrument for this assembly
• the present invention relates to a ligating assembly for endoscopic surgery.
• Endoscopic surgery is a mode of intervention, typically used in intra-abdominal surgery, in which the surgeon operates without incising the abdominal wall, passing instruments inside the trocars passing through this abdominal wall.
• the manipulations are controlled by an endoscope inserted into one of the trocars, the abdominal cavity having been previously distended by blowing a gas such as C02 to allow observation and manipulations inside the abdominal cavity .
• ligatures intra-abdominally. This manipulation consists in passing a link around an organ or tissue, then to tie and tighten this link; ligatures are thus placed to close internal wounds, around adhesions before or after resection, etc.
• the most basic technique consists in making the knotting entirely intracorporeally, by
• a loop is prepared in advance with a slip knot which is threaded into the trocar, then the loop is passed around the part to be tied, it is shrunk by pulling the slip knot, then the end of the remaining wire is cut.
• this technique can only be applied when the loop can be passed around the part to be tied, that is to say in fact when it constitutes a prominent part of an organ or tissue ( typical case of an adhesion that has just been resected, and which one wishes to ligate the remaining part to avoid any effusion of blood).
• the third technique consists of introducing a thread into the trocar, passing the free end of this thread around the part to be tied, reintroducing this free end into the trocar to bring it out at the other end outside the abdominal cavity, form a noose from this free end around the part of the wire entering the trocar, introduce the loop thus formed in the trocar so as to bring it out at the other end, in the abdominal cavity in the vicinity of the part to be tied, carry out the final tightening of the knot and finally cut the end of the remaining thread.
• One of the objects of the invention is to propose an assembly to be ligated which is quick and simple to implement, and which can be used whatever the shape of the part to be
• the invention proposes an assembly to be ligated comprising a trocar and a monobloc element consisting of a body, nestable at the end of this trocar, and of a wire adjoining this body and forming a link, the body comprising a threading channel receiving the free end of the wire at one of its ends and opening inside the trocar at the other of its ends, the wire and the channel being provided with clamping means retaining the wire in place it once at least partially introduced into the canal.
• the clamping means comprise cooperating toothed regions formed on the outer surface of the wire and on the inner surface of the threading channel.
• the assembly to be tied up further comprises means, insertable into the trocar, for gripping and pulling the free end of the thread passed through the threading channel and emerging from it in the trocar, so as to achieve the narrowing of the ligature by pulling this free end.
• these gripping and pulling means comprise for example two telescopic elements movable axially ent relative to each other, one of the elements being provided with gripping and clamping jaws.
• the assembly to be ligated can also include means, insertable into the trocar, for severing the free end of the wire after it has been drawn; these sectioning means advantageously include, for example, a movable guillotine inside the trocar, means for transversely guiding this guillotine and actuation means causing the guillotine in its transverse movement after the free end of the wire has been fully drawn.
• the free end of the latter is cut off, which protrudes from the body of the one-piece element; the sectioning is carried out from inside the trocar which avoids, as was always the case until now, from using a separate cutting instrument introduced into another trocar and the placement and actuation of which had to be controlled by endoscopy.
• FIG. 1 is a view, partially in section, of the assembly to be ligated according to the invention
• FIG. 4 illustrates the means for gripping and drawing the free end of the wire
• FIG. 5 illustrates the means for cutting off the free end of the wire
• FIG. 1 shows the ligature 10, inserted at the end of a trocar 20 introduced into the patient's body, for example in his abdominal cavity.
• the ligature 10 comprises a body 11 provided with a shoulder 12 abutting against the end of the trocar 20, so that a part 13 penetrates with friction inside of it.
• the surgeon does not need a separate instrument to bring the ligature in the vicinity of the part to be ligated, since it suffices to guide the trocar 20 carrying the ligature 10 immobilized at its end.
• the ligature 10 comprises a wire 14, flexible, adjoining this body and forming the link itself.
• this wire 14 may extend relative to the body 11 in a direction substantially parallel to the axis of the trocar 20 (case of Figure 2) or in a direction perpendicular to this axis (case of Figure 3); the choice of one or the other ligature configuration will depend essentially on the shape and dimensions of the part to be ligated.
• the free end 15 of the wire 14 is intended to be introduced into a threading channel 16 passing right through the body 11 in a substantially axial direction; this free end 15, introduced into the channel 16, can come out on the other side, inside the trocar 20.
• REPLACEMENT SHEET dimensions and shape of the notched parts 17, 18 being chosen so as to appropriately achieve this anti-recoil effect).
• the part of the wire close to the free end 15 is not provided with these notches 18, but with simple reliefs 19, less accentuated, which will have the function of keeping the wire inside the channel 16 in l 'preventing slipping (the reliefs 19 cooperating with the notches 17), but without preventing it from turning back under the effect of a traction exerted on the wire.
• the surgeon may, after having passed the wire around the part to be tied, partially introduce the latter into the threading channel with the possibility, if necessary, of widening the loop, for example to allow movement of the latter. this. Once the loop is exactly positioned, its complete, irreversible narrowing can then be achieved.
• the ligation 10 is made of a material (generally a plastic material) biologically inert or even, if necessary, bioabsorbable.
• the free end 15 can be grasped by an instrument manipulated by the surgeon, introduced into the channel 16 and pushed into the latter until narrowing and complete tightening of the loop.
• FIG. 4 illustrates these means 30, which are formed of an instrument made up of two parts 31, 32 telescopically fitted one inside the other and inserted in the trocar 20.
• the element 31 is a straight cylindrical tube and the element 32 is formed by a tube of smaller diameter, placed inside the outer tube 31, and flared at 33 at the part opening out of the tube 31.
• the end of this inner tube 32 is configured in the form of a jaw 34,34 each provided internally with notches 35 having a shape similar to that of the notches 18 of the wire 14. These jaws are placed in line with the channel 16, so as to be able to grasp
• the surgeon can then cut the part of the wire protruding from the threading channel, on the opposite side of the loop. It can perform this operation manually, in a conventional manner, using a cutting instrument manipulated under endoscopic control.
• FIG. 5 illustrates such cutting means.
• These means 40 essentially comprise a guillotine 41, that is to say an element sliding in a transverse direction relative to the axis of the trocar, this guillotine 41 being provided with a cutting edge 42 carrying out the actual cutting and being guided in its transverse movement by grooves 43.
• This guillotine 41 is operated by a slide 44. provided with a ramp-shaped part 45 initially housed in a cavity 46 formed in the body 11 of the monobloc element.
• sectioning means of FIG. 5 have been shown in isolation, they can be combined with the gripping and drawing means of FIG. 4 in a single instrument thus making it possible to carry out all of the operations necessary for the installation of the ligature.

Landscapes

• Health & Medical Sciences (AREA)
• Surgery (AREA)
• Life Sciences & Earth Sciences (AREA)
• Heart & Thoracic Surgery (AREA)
• Molecular Biology (AREA)
• Vascular Medicine (AREA)
• Engineering & Computer Science (AREA)
• Biomedical Technology (AREA)
• Reproductive Health (AREA)
• Medical Informatics (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
• Public Health (AREA)
• Veterinary Medicine (AREA)
• Surgical Instruments (AREA)
• Endoscopes (AREA)

Applications Claiming Priority (2)

Publications (1)

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ID=9372829

Family Applications (1)

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Families Citing this family (88)

Family Cites Families (11)

• 1988
  • 1988-12-12 FR FR8816311A patent/FR2640131B1/fr not_active Expired - Lifetime
• 1989
  • 1989-12-07 CA CA002004874A patent/CA2004874C/fr not_active Expired - Lifetime
  • 1989-12-11 WO PCT/FR1989/000641 patent/WO1990006725A1/fr not_active Application Discontinuation
  • 1989-12-11 JP JP2501073A patent/JP2922638B2/ja not_active Expired - Lifetime
  • 1989-12-11 AU AU48074/90A patent/AU630142B2/en not_active Expired
  • 1989-12-11 EP EP90900221A patent/EP0399025A1/fr not_active Withdrawn
  • 1989-12-11 BR BR898907244A patent/BR8907244A/pt not_active IP Right Cessation
  • 1989-12-12 ZA ZA899485A patent/ZA899485B/xx unknown
  • 1989-12-12 AR AR89315651A patent/AR243758A1/es active
• 1990
  • 1990-07-26 US US07/548,943 patent/US5196022A/en not_active Expired - Lifetime
• 1991
  • 1991-09-03 AU AU83573/91A patent/AU635153B2/en not_active Expired
  • 1991-09-03 AU AU83574/91A patent/AU635154B2/en not_active Expired

Non-Patent Citations (1)

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