EP2037863A1 - Gastrostomy tube, production methods thereof and insertion tool - Google Patents

Gastrostomy tube, production methods thereof and insertion tool

Info

Publication number
EP2037863A1
EP2037863A1 EP07787194A EP07787194A EP2037863A1 EP 2037863 A1 EP2037863 A1 EP 2037863A1 EP 07787194 A EP07787194 A EP 07787194A EP 07787194 A EP07787194 A EP 07787194A EP 2037863 A1 EP2037863 A1 EP 2037863A1
Authority
EP
European Patent Office
Prior art keywords
tube
bulb
wall
distal end
lamellae
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.)
Granted
Application number
EP07787194A
Other languages
German (de)
French (fr)
Other versions
EP2037863B1 (en
Inventor
Stéphane Regnault
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by Individual filed Critical Individual
Priority to PL07787194T priority Critical patent/PL2037863T3/en
Publication of EP2037863A1 publication Critical patent/EP2037863A1/en
Application granted granted Critical
Publication of EP2037863B1 publication Critical patent/EP2037863B1/en
Active legal-status Critical Current
Anticipated expiration legal-status Critical

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61J—CONTAINERS SPECIALLY ADAPTED FOR MEDICAL OR PHARMACEUTICAL PURPOSES; DEVICES OR METHODS SPECIALLY ADAPTED FOR BRINGING PHARMACEUTICAL PRODUCTS INTO PARTICULAR PHYSICAL OR ADMINISTERING FORMS; DEVICES FOR ADMINISTERING FOOD OR MEDICINES ORALLY; BABY COMFORTERS; DEVICES FOR RECEIVING SPITTLE
    • A61J15/00—Feeding-tubes for therapeutic purposes
    • A61J15/0026—Parts, details or accessories for feeding-tubes
    • A61J15/003—Means for fixing the tube inside the body, e.g. balloons, retaining means
    • A61J15/0034—Retainers adjacent to a body opening to prevent that the tube slips through, e.g. bolsters
    • A61J15/0038—Retainers adjacent to a body opening to prevent that the tube slips through, e.g. bolsters expandable, e.g. umbrella type
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61J—CONTAINERS SPECIALLY ADAPTED FOR MEDICAL OR PHARMACEUTICAL PURPOSES; DEVICES OR METHODS SPECIALLY ADAPTED FOR BRINGING PHARMACEUTICAL PRODUCTS INTO PARTICULAR PHYSICAL OR ADMINISTERING FORMS; DEVICES FOR ADMINISTERING FOOD OR MEDICINES ORALLY; BABY COMFORTERS; DEVICES FOR RECEIVING SPITTLE
    • A61J15/00—Feeding-tubes for therapeutic purposes
    • A61J15/0026—Parts, details or accessories for feeding-tubes
    • A61J15/0053—Means for fixing the tube outside of the body, e.g. by a special shape, by fixing it to the skin
    • A61J15/0065—Fixing means and tube being one part
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61J—CONTAINERS SPECIALLY ADAPTED FOR MEDICAL OR PHARMACEUTICAL PURPOSES; DEVICES OR METHODS SPECIALLY ADAPTED FOR BRINGING PHARMACEUTICAL PRODUCTS INTO PARTICULAR PHYSICAL OR ADMINISTERING FORMS; DEVICES FOR ADMINISTERING FOOD OR MEDICINES ORALLY; BABY COMFORTERS; DEVICES FOR RECEIVING SPITTLE
    • A61J15/00—Feeding-tubes for therapeutic purposes
    • A61J15/0015—Gastrostomy feeding-tubes

Definitions

  • the invention relates to a gastrostomy tube which has at its distal end a deformable bulb between a stable configuration called retention where the bulb is too wide to pass through a passage ("stoma") formed through the skin and the gastric wall and a configuration called retaining, caused by the action of appropriate stress, where the bulb is sufficiently reduced to pass in said passage, the bulb elastically resuming its stable configuration when the solicitation is removed, and a laying instrument of gastrostomy tube.
  • stomy tube which has at its distal end a deformable bulb between a stable configuration called retention where the bulb is too wide to pass through a passage (“stoma") formed through the skin and the gastric wall and a configuration called retaining, caused by the action of appropriate stress, where the bulb is sufficiently reduced to pass in said passage, the bulb elastically resuming its stable configuration when the solicitation is removed, and a laying instrument of gastrostomy tube.
  • EP 0742 708 discloses an embodiment in which the distal end of the tube is open and has been expanded and bent to form a hollow retaining bulb around the end of the tube, this end remaining projecting in front of the bulb.
  • the material of the bulb is chosen so that the bulb is elastically deformable from one configuration to another under the effect of an action exerted on the bulb from the outside of the skin.
  • this deformation can be caused by a pull on the tube. It may happen that this traction is exerted by the patient inappropriately.
  • the present invention aims to avoid such an accident. It is achieved according to the invention with a gastrostomy tube which has at its distal end a bulb adapted to retain the tube in the gastric cavity and adapted to be elastically reduced on demand to allow the introduction or extraction of the tube by the stoma, characterized in that the bulb is constituted by wall lamellae formed in an area of the wall of the tube remote from the end of the distal end, these lamellae being separated by slots in the wall of the tube but remaining attached to this wall at each end of the lamella, in that the lamellae have been curved outwards to form the bulb, and in that the end of the distal end of the tube is recessed in the bulb, so that it is necessary to push this end out of the bulb so that the lamellae are stretched and return to their original positions, which eliminates the bulb and allows the tube to be inserted or withdrawn by the stoma.
  • FIG. 1 is a longitudinal diagram of an exemplary embodiment of a gastrostomy tube according to the invention, during a preparatory phase for the formation of a bulb at one end of the tube;
  • Figure 1a is an axial section of the tube of Figure 1; • Figure 2 is a similar diagram during the formation of the bulb;
  • Figure 2a is a horizontal section of the bulb
  • Figure 3 is an end view of the formed bulb; • Figure 4 shows the diagrams of the bulb in vertical section during different phases of a pull on the tube;
  • FIG. 5 shows diagrams of the tube during an operation of introducing the tube into the stoma
  • Figure 6 shows schematic drawings of the tube during a tube extraction operation out of the stoma
  • FIGS. 7a and 7b are front and side views of an instrument for fitting a gastrostomy tube according to the invention, the instrument not having a sleeve;
  • FIGS. 8a and 8b are a partial profile view of the distal end of the gastrostomy tube fitting instrument of FIGS. 7a and 7b showing the mounting of the sleeve; and FIGS. 9a to 9f are three-dimensional views of the various steps of use of the gastrostomy tube insertion instrument of FIGS. 7a to 8b with a gastrostomy tube according to the invention.
  • the gastrostomy tube shown in the figures is a rectilinear cylindrical tube (1) which has at its distal end a closed end (2).
  • the end is completely closed but, in variants, it could include orifices provided that they do not compromise the possibility of pushing the end by means of a mandrel introduced by the other end (3). (open) of the tube.
  • slots (4) (FIG. 1), have been produced in an area (5) of the wall of the tube, at a distance, but preferably not far from the closed end (2), so as to determine in the wall of the tube of the wall slats, each slat (6) being determined by two successive slits and remaining adjacent to the tube at each end (6a, 6b) of the slat.
  • the slots (4) can be directed parallel to the axis of the tube, which is the simplest case, or be oblique with respect to this axis.
  • the slots can be made by cutting or molding.
  • the ready-to-use tube therefore has the bulb at its closed end.
  • a stoma (9) into the gastric cavity (7), it is stretched by means of a mandrel (8) introduced into the tube to push the closed end (2) and return the lamellae in the wall of the tube ( Figure 5A).
  • each lamella (6) before being connected to the tube near the closed end (2) has an inflection (10) which constitutes a pre-bend opposite the elongation so that a force exerted on the tube ( Figure 4) would lead the bulb to contract without being reduced enough to allow extraction of the tube by the stoma.
  • the tube has been shown in a simplified manner, especially with regard to its open end (3) which will remain outside the skin in a manner known per se.
  • the number of lamellae (6) which are like the petals of the bulb is chosen on demand and it is for example four. The invention is not limited to the embodiment which has been described.
  • polyurethane tube or the like is used.
  • Polyurethane is a thermoplastic material that is injected into a mold or extruded at temperatures of 170 to 200 ° C. It can also be formed hot in an oven at 150 ° C.
  • the polyurethane material is best suited for this use, because of its resistance to gastric juices, bacteria (candida albicans), its biocompatibility, its elasticity.
  • the laying instrument (100) comprises a body (110) and a mandrel (8).
  • the mandrel (8) comprises a rod (122) extending along a longitudinal axis X of the delivery instrument (100), a distal end (123) and a proximal end bent at about 90 ° comprising a sleeve (121) .
  • the body (110) is of cylindrical shape which can be of revolution about the longitudinal axis X. It comprises at a proximal end a handle (115). Further, at a distal end (130), the body (110) has a thread (133) extending along a length in the direction of the longitudinal axis X, and two flats (134) which are diametrically opposed to each other according to the longitudinal axis X.
  • the distal end (130) of the body (110) comprises a groove (131) circumferential and oriented substantially perpendicular to the axis X, which is adapted to receive a circlip (132).
  • the thread (133) extends approximately distally from the groove (131) proximally to a rim (135) forming a stop. Between the handle (115) and the thread (133), the body (110) has a slot
  • the body (112) substantially perpendicular to the longitudinal axis X and extending about 90 ° along a circumference of the body (110), and a series of slits (111) inclined relative to the longitudinal axis X and substantially parallel between them.
  • This series of slots (111) like the slot (112), extend over substantially 90 ° along a circumference of the body (110).
  • the body (110) has a longitudinal slot
  • the body (110) has a longitudinal hole of X axis extending from the distal end (130) to at least the slot (112).
  • the distal end (123) of the mandrel shank (122) is inserted into the longitudinal X-axis hole through the slot (113). of the body (110).
  • the shank (122) is threaded into this X-axis longitudinal hole until the angled proximal end of the mandrel (8) can be inserted into the slot (112) of the body (110).
  • a nut (141) is screwed onto the distal end (130) to engage the threads (133) of the body (110).
  • the circlip (132) is mounted in the groove (131) of the distal end (130) of the body (110).
  • This circlip (132) serves as a stop to the nut (141), when the latter is screwed or unscrewed towards the distal end of the body (110).
  • a sleeve (142) is fitted onto the nut (141) to provide an assembly (140).
  • the sleeve (142) is screwed onto the nut (141) or welded or glued.
  • the sleeve (142) has at a distal end (144) two bayonets (145) diametrically opposite one another along the longitudinal axis X of the laying instrument (100).
  • the gastrostomy tube (1) Prior to the use of the delivery instrument (100), the gastrostomy tube (1) according to the invention is equipped with a base (20) having mounting means (23) on the gastrostomy tube (1). ) located on a lower face of the base (20). On an upper face of the base (20), the latter has an opening (21) on the periphery of which are located, diametrically opposed to the longitudinal axis X, notches (24), here at the number of two. Finally, the base (20) has a plug (22) adapted to come into the orifice (21) to close the gastrostomy tube sealingly. Further information concerning the base (20) and its mounting on the gastrostomy tube (1) are contained in the French patent application No. FR 0606140, to which it is possible to refer.
  • the assembly (140) formed of the sleeve (142) and the nut (141) is screwed onto the body (110) of the laying instrument (100) towards a distal end until the nut (141) comes into abutment against the circlip (132).
  • the proximal end bent of the mandrel (8) is placed in the slot (112) of the body (110) of the delivery instrument (100), the distal end (123) of the mandrel (8) protruding from the distal end of the sleeve (142).
  • the distal end (123) of the mandrel (8) is introduced into the gastrostomy tube (1) through the orifice (21) of the base (20) along the longitudinal axis X in the direction of the Arrow Fl.
  • a movement according to the arrow Fl is performed until the distal end (144) of the sleeve (142) is inserted into the orifice (21) of the base (20), the bayonets (145). passing through the notches (24).
  • the sleeve (140) is then locked in the base (20) during a rotational movement T1 around the axis X in order to make the base (20) and the laying instrument (100) integral with one another.
  • Bayonet mount as shown in Figure 9b.
  • the bent proximal end of the mandrel (8) is extracted from the slot (112) to the longitudinal slot (113). Therefore, the mandrel (8) can slide in a movement F2 while the bent proximal end moves within the longitudinal slot (113).
  • the movement F2 is carried out lightly until the distal end (123) of the mandrel (8) comes into contact with the closed end (2) of the gastrostomy tube (1), the bulb (10) of the tube gastrostomy (1) is then formed at rest.
  • the bent proximal end of the mandrel (8) is then inserted into one of the slots (111) which are then facing, in a rotational movement T3. Therefore, the body (110) is rotated along T4 which has the effect of screwing the body (110) into the assembly (140) by engagement of the nut (142) of the assembly (140) on the thread (133) of the distal end (130) of the body (110) of the delivery instrument (100) . This screwing movement takes place over a predetermined and limited distance (d).
  • the nut (142) of the assembly (140) then abuts at a proximal end of the thread (133) on the flange (135), as illustrated in FIG. Figure 9f.
  • the distal end (123) of the mandrel (8) pushes the closed end (2) of the gastrostomy tube (1) out of the bulb (10) until the latter disappears. the blades forming the bulb (10) being completely stretched, the distance (d) traveled.
  • the gastrostomy tube (1) can be either removed from the patient or introduced into the patient through the stoma.
  • the laying instrument (100) which has just been described and its use avoids having to push the mandrel manually and directly to stretch the lamellae forming the bulb and thus avoid the risk of perforating the wall opposite of the stomach if the mandrel passes through or escapes from the closed end of the gastrostomy tube.
  • the laying instrument (100) is adjustable according to the length of the gastrostomy tube with which it is intended to cooperate and this laying instrument then allows a thrust stroke always identical, necessary for stretching the lamellae forming the bulb. The controlled realization of this race assures the user that the gastrostomy tube is ready to be placed or removed.
  • the laying instrument (100) according to the invention allows manipulation with optimum safety of a gastrostomy tube according to the invention.
  • the invention is not limited either to the embodiment which has been described or to the material which has been recommended.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Pulmonology (AREA)
  • Medical Preparation Storing Or Oral Administration Devices (AREA)
  • Orthopedics, Nursing, And Contraception (AREA)
  • Media Introduction/Drainage Providing Device (AREA)
  • Materials For Medical Uses (AREA)

Abstract

The invention relates to a gastrostomy tube, to the production methods thereof and to an insertion tool. The distal end (2) of the tube (1) is provided with a bulb (10) formed by parallel strips (6) which are provided in an area of the wall of the tube at a distance from the tip (2) at the distal end, said strips being separated by slits (4) in the wall, but being joined at each end (6a, 6b) to the tube wall. The strips curve outwards to form the bulb with the tip of the tube retracted inside the bulb, such that said tip must be pushed back out of the bulb in order to for the strips to be stretched, thereby eliminating the bulb and enabling the tube to be pulled through the stoma. The invention is suitable for use in gastrostomy.

Description

TUBE DE GASTROSTOMIE, ET PROCEDES POUR LE FABRIQUER ET GASTROSTOMY TUBE, AND METHODS OF MANUFACTURING AND
INSTRUMENT DE POSEINSTRUMENT OF INSTALLATION
L'invention concerne un tube de gastrostomie qui présente à son extrémité distale un bulbe déformable entre une configuration stable dite de retenue où ce bulbe est trop large pour passer dans un passage (« stoma ») formé à travers la peau et la paroi gastrique et une configuration dite de retenue, provoquée par l'action d'une sollicitation appropriée, où ce bulbe est suffisamment réduit pour passer dans ledit passage, le bulbe reprenant élastiquement sa configuration stable lorsque la sollicitation est supprimée, ainsi qu'un instrument de pose de tube de gastrostomie.The invention relates to a gastrostomy tube which has at its distal end a deformable bulb between a stable configuration called retention where the bulb is too wide to pass through a passage ("stoma") formed through the skin and the gastric wall and a configuration called retaining, caused by the action of appropriate stress, where the bulb is sufficiently reduced to pass in said passage, the bulb elastically resuming its stable configuration when the solicitation is removed, and a laying instrument of gastrostomy tube.
La publication EP 0742 708 divulgue une réalisation dans laquelle l'extrémité distale du tube est ouverte et a été épanouie et courbée pour former un bulbe de retenue creux autour du bout du tube, ce bout restant en saillie en avant du bulbe.The publication EP 0742 708 discloses an embodiment in which the distal end of the tube is open and has been expanded and bent to form a hollow retaining bulb around the end of the tube, this end remaining projecting in front of the bulb.
La publication WO 95/18640 (= US 5 356 391) décrit une réalisation dans laquelle l'extrémité distale du tube est ouverte et a été épanouie et courbée pour constituer un bulbe de retenue au bout du tube, ce bout restant en saillie en avant du bulbe.Publication WO 95/18640 (= US 5,356,391) describes an embodiment in which the distal end of the tube is open and has been expanded and curved to form a retaining bulb at the end of the tube, this end remaining protruding forward. of the bulb.
Dans les deux cas, le matériau du bulbe est choisi pour que le bulbe soit élastiquement déformable d'une configuration à l'autre sous l'effet d'une action exercée sur le bulbe depuis l'extérieur de la peau. De fait, dans les exemples susdits, cette déformation peut être provoquée par une traction exercée sur le tube. II peut arriver que cette traction soit exercée par le patient de façon inopportune.In both cases, the material of the bulb is chosen so that the bulb is elastically deformable from one configuration to another under the effect of an action exerted on the bulb from the outside of the skin. In fact, in the aforementioned examples, this deformation can be caused by a pull on the tube. It may happen that this traction is exerted by the patient inappropriately.
La présente invention vise à éviter un tel accident . On y parvient selon l'invention avec un tube de gastrostomie qui présente à son extrémité distale un bulbe apte à retenir le tube dans la cavité gastrique et apte à être réduit élastiquement à la demande pour permettre l'introduction ou l'extraction du tube par le stoma, caractérisé en ce que le bulbe est constitué par des lamelles de paroi formées dans une zone de la paroi du tube à distance du bout de l'extrémité distale, ces lamelles étant séparées par des fentes de la paroi du tube mais restant attenantes à cette paroi à chaque extrémité de la lamelle, en ce que les lamelles ont été incurvées vers l'extérieur pour constituer le bulbe, et en ce que le bout de l'extrémité distale du tube est en retrait dans le bulbe, en sorte qu'il soit nécessaire de repousser ce bout hors du bulbe pour que les lamelles soient étirées et reprennent leurs positions d'origine, ce qui supprime le bulbe et permet d' introduire ou de retirer le tube par le stoma.The present invention aims to avoid such an accident. It is achieved according to the invention with a gastrostomy tube which has at its distal end a bulb adapted to retain the tube in the gastric cavity and adapted to be elastically reduced on demand to allow the introduction or extraction of the tube by the stoma, characterized in that the bulb is constituted by wall lamellae formed in an area of the wall of the tube remote from the end of the distal end, these lamellae being separated by slots in the wall of the tube but remaining attached to this wall at each end of the lamella, in that the lamellae have been curved outwards to form the bulb, and in that the end of the distal end of the tube is recessed in the bulb, so that it is necessary to push this end out of the bulb so that the lamellae are stretched and return to their original positions, which eliminates the bulb and allows the tube to be inserted or withdrawn by the stoma.
Pour repousser le bout du tube on utilise un mandrin que l'on introduit à la demande dans le tube. II a été proposé (brevet US 5 248 302) d'utiliser un mandrin pour pousser la tête d'une pièce de retenue rapportée à l'extrémité d'un tube de gastrostomie en vue d'allonger la pièce pour lui permettre de passer dans le stoma, mais la forme de la pièce de retenue n'interdisait pas que le même résultat soit obtenu par l'effet d'une traction exercée par le tube. On décrira ci-après un exemple de réalisation d'un tube de gastrostomie conforme à l'invention, en référence aux figures du dessin joint sur lequel :To push the end of the tube is used a mandrel that is introduced on demand in the tube. It has been proposed (US Pat. No. 5,248,302) to use a mandrel to push the head of a retaining piece attached to the end of a gastrostomy tube in order to lengthen the workpiece to allow it to pass into the stoma, but the shape of the retaining piece did not prohibit the same result being obtained by the effect of a pull exerted by the tube. An embodiment of a gastrostomy tube according to the invention will be described below, with reference to the figures of the attached drawing in which:
• la figure 1 est un schéma longitudinal d'un exemple de réalisation d'un tube de gastrostomie conforme à l'invention, au cours d'une phase préparatoire à la formation d'un bulbe à une extrémité du tube ;FIG. 1 is a longitudinal diagram of an exemplary embodiment of a gastrostomy tube according to the invention, during a preparatory phase for the formation of a bulb at one end of the tube;
• la figure 1 bis est une coupe axiale du tube de la figure 1 ; • la figure 2 est un schéma analogue au cours de la formation du bulbe ;• Figure 1a is an axial section of the tube of Figure 1; • Figure 2 is a similar diagram during the formation of the bulb;
• la figure 2 bis est une coupe horizontale du bulbe ;• Figure 2a is a horizontal section of the bulb;
• la figure 3 est une vue de bout du bulbe formé ; • la figure 4 représente des schémas du bulbe en coupe verticale au cours de différentes phases d'une traction exercée sur le tube ;Figure 3 is an end view of the formed bulb; • Figure 4 shows the diagrams of the bulb in vertical section during different phases of a pull on the tube;
• la figure 5 représente des schémas du tube au cours d'une opération d'introduction du tube dans le stoma ;FIG. 5 shows diagrams of the tube during an operation of introducing the tube into the stoma;
• la figure 6 représente des schémas du tube au cours d'une opération d'extraction du tube hors du stoma ;Figure 6 shows schematic drawings of the tube during a tube extraction operation out of the stoma;
• les figures 7a et 7b sont des vues de face et profil d'un instrument de pose d'un tube de gastrostomie selon l'invention, l'instrument ne présentant pas de manchon ;FIGS. 7a and 7b are front and side views of an instrument for fitting a gastrostomy tube according to the invention, the instrument not having a sleeve;
• les figures 8a et 8b sont une vue partielle de profil de l'extrémité distale de l'instrument de pose d'un tube de gastrostomie des figures 7a et 7b montrant le montage du manchon ; et • les figures 9a à 9f sont des vues tridimentionnelles des différentes étapes d'utilisation de l'instrument de pose d'un tube de gastrostomie des figures 7a à 8b avec un tube de gastrostomie selon l'invention.FIGS. 8a and 8b are a partial profile view of the distal end of the gastrostomy tube fitting instrument of FIGS. 7a and 7b showing the mounting of the sleeve; and FIGS. 9a to 9f are three-dimensional views of the various steps of use of the gastrostomy tube insertion instrument of FIGS. 7a to 8b with a gastrostomy tube according to the invention.
Le tube de gastrostomie représenté sur les figures est un tube cylindrique rectiligne (1) qui présente à son extrémité distale un bout fermé (2) . Dans cet exemple, le bout est intégralement fermé mais, dans des variantes, il pourrait comporter des orifices à condition que ceux-ci ne compromettent pas la possibilité de pousser le bout au moyen d'un mandrin introduit par l'autre extrémité (3) (ouverte) du tube.The gastrostomy tube shown in the figures is a rectilinear cylindrical tube (1) which has at its distal end a closed end (2). In this example, the end is completely closed but, in variants, it could include orifices provided that they do not compromise the possibility of pushing the end by means of a mandrel introduced by the other end (3). (open) of the tube.
Conformément à l'invention, des fentes (4), (figure 1), ont été réalisées dans une zone ( 5) de la paroi du tube, à distance mais de préférence non loin du bout fermé (2), de façon à déterminer dans la paroi du tube des lamelles de paroi, chaque lamelle (6) étant déterminée par deux fentes successives et restant attenante au tube à chaque extrémité (6a, 6b) de la lamelle .According to the invention, slots (4), (FIG. 1), have been produced in an area (5) of the wall of the tube, at a distance, but preferably not far from the closed end (2), so as to determine in the wall of the tube of the wall slats, each slat (6) being determined by two successive slits and remaining adjacent to the tube at each end (6a, 6b) of the slat.
Les fentes (4) peuvent être dirigées parallèlement à l'axe du tube, ce qui est le cas le plus simple, ou être obliques par rapport à cet axe. Les fentes peuvent être réalisées par découpage ou par moulage.The slots (4) can be directed parallel to the axis of the tube, which is the simplest case, or be oblique with respect to this axis. The slots can be made by cutting or molding.
Le bout fermé (2) du tube est ensuite repoussé axialement en direction de l'extrémité ouverte (3) du tube, ce qui force les lamelles (6) à se courber vers l'extérieur du tube en formant un bulbe (10) à l'intérieur duquel se trouve le bout fermé (2) qui a été repoussé (figures 2 et 3) . Lors de cet écrasement, le bout du tube a tourné sur lui-même en sorte que les lamelles qui constituent le bulbe ont subi un certain vrillage.The closed end (2) of the tube is then pushed axially towards the open end (3) of the tube, which forces the slats (6) to bend outwardly of the tube forming a bulb (10) to inside which is the closed end (2) which has been pushed back (Figures 2 and 3). During this crash, the tip of the tube turned on itself so that the lamellae that constitute the bulb have undergone some twisting.
Pour figer le bulbe dans sa forme, on chauffe l'extrémité du tube.To freeze the bulb in its shape, the end of the tube is heated.
Le tube prêt à l'emploi présente donc le bulbe à son extrémité fermée. Pour introduire le tube par un stoma (9) jusque dans la cavité gastrique (7), on l'étiré au moyen d'un mandrin (8) introduit dans le tube pour repousser le bout fermé (2) et ramener les lamelles dans la paroi du tube (figure 5A) .The ready-to-use tube therefore has the bulb at its closed end. To introduce the tube by a stoma (9) into the gastric cavity (7), it is stretched by means of a mandrel (8) introduced into the tube to push the closed end (2) and return the lamellae in the wall of the tube (Figure 5A).
On retire ensuite le mandrin (figure 5B) et le bulbe reprend élastiquement sa configuration initiale (figure 5C) . On remarquera sur la figure 5C que chaque lamelle (6), avant de se raccorder au tube à proximité du bout fermé (2) présente une inflexion (10) qui constitue une précourbure opposée à l'allongement en sorte qu'un effort exercé sur le tube (figure 4) conduirait le bulbe à se contracter sans pouvoir être suffisamment réduit pour permettre une extraction du tube par le stoma.The mandrel is then removed (FIG. 5B) and the bulb elastically resumes its initial configuration (FIG. 5C). It will be noted in FIG. 5C that each lamella (6) before being connected to the tube near the closed end (2) has an inflection (10) which constitutes a pre-bend opposite the elongation so that a force exerted on the tube (Figure 4) would lead the bulb to contract without being reduced enough to allow extraction of the tube by the stoma.
Pour que cette extraction soit possible, il faut réintroduire un mandrin dans le tube pour repousser le bout fermé et allonger le tube jusqu'à supprimer le bulbe (figure 6) .In order for this extraction to be possible, a mandrel must be reintroduced into the tube in order to push the closed end and lengthen the tube until the bulb is removed (FIG. 6).
Sur les figures 4 à 5, le tube a été représenté de façon simplifiée, notamment en ce qui concerne son extrémité ouverte (3) qui restera hors de la peau de façon en soi connue. Le nombre des lamelles (6) qui constituent comme les pétales du bulbe est choisi à la demande et il est par exemple de quatre. L'invention n'est pas limitée à la réalisation qui a été décrite .In FIGS. 4 to 5, the tube has been shown in a simplified manner, especially with regard to its open end (3) which will remain outside the skin in a manner known per se. The number of lamellae (6) which are like the petals of the bulb is chosen on demand and it is for example four. The invention is not limited to the embodiment which has been described.
De préférence, on utilise un tube en polyuréthane ou similaire. Le polyuréthane est un matériau thermoplastique qu'on injecte dans un moule ou qu'on extrude à des températures de 170 à 2000C. On peut aussi le former à chaud dans un four à 1500C.Preferably, a polyurethane tube or the like is used. Polyurethane is a thermoplastic material that is injected into a mold or extruded at temperatures of 170 to 200 ° C. It can also be formed hot in an oven at 150 ° C.
Dans l'estomac et à la température ambiante, il garde sa forme et est élastique. Quand on le déforme, il reprend sa forme dès la cessation de l'effort.In the stomach and at room temperature, it keeps its shape and is elastic. When it is deformed, it resumes its form at the end of the effort.
Le matériau polyuréthane est le mieux adapté à cette utilisation, de part sa résistance aux sucs gastriques, aux bactéries (candida albicans) , sa biocompatibilité, son élasticité.The polyurethane material is best suited for this use, because of its resistance to gastric juices, bacteria (candida albicans), its biocompatibility, its elasticity.
En référence aux figures 7a à 8b, nous allons décrire un instrument de pose (100) d'un tube de gastrostomie selon l'invention.With reference to FIGS. 7a to 8b, we will describe an instrument for fitting (100) a gastrostomy tube according to the invention.
L'instrument de pose (100) comporte un corps (110) et un mandrin (8) .The laying instrument (100) comprises a body (110) and a mandrel (8).
Le mandrin (8) comporte une tige (122) s' étendant selon un axe longitudinal X de l'instrument de pose (100), une extrémité distale (123) et une extrémité proximale coudée à 90° environ comprenant un manchon (121) .The mandrel (8) comprises a rod (122) extending along a longitudinal axis X of the delivery instrument (100), a distal end (123) and a proximal end bent at about 90 ° comprising a sleeve (121) .
Le corps (110) est de forme cylindrique qui peut être de révolution autour de l'axe longitudinal X. Il comporte à une extrémité proximale une poignée (115) . En outre, au niveau d'une extrémité distale (130), le corps (110) comporte un filetage (133) s'étendant sur une certaine longueur selon la direction de l'axe longitudinal X, ainsi que deux méplats (134) qui sont diamétralement opposés l'un par rapport à l'autre selon l'axe longitudinal X. De plus, l'extrémité distale (130) du corps (110) comprend une gorge (131) circonférentielle et orientée sensiblement perpendiculairement à l'axe X, qui est apte à recevoir un circlips (132). Le filetage (133) s'étend depuis distalement environ la gorge (131) jusqu'à proximalement un rebord (135) formant butée. Entre la poignée (115) et le filetage (133), le corps (110) comporte une fenteThe body (110) is of cylindrical shape which can be of revolution about the longitudinal axis X. It comprises at a proximal end a handle (115). Further, at a distal end (130), the body (110) has a thread (133) extending along a length in the direction of the longitudinal axis X, and two flats (134) which are diametrically opposed to each other according to the longitudinal axis X. In addition, the distal end (130) of the body (110) comprises a groove (131) circumferential and oriented substantially perpendicular to the axis X, which is adapted to receive a circlip (132). The thread (133) extends approximately distally from the groove (131) proximally to a rim (135) forming a stop. Between the handle (115) and the thread (133), the body (110) has a slot
(112) sensiblement perpendiculaire à l'axe longitudinal X et s' étendant sur environ 90° selon une circonférence du corps (110), ainsi qu'une série de fentes (111) inclinées par rapport à l'axe longitudinal X et sensiblement parallèles entre elles. Cette série de fentes (111), comme la fente (112), s'étendent sur sensiblement 90° selon une circonférence du corps (110). De plus, le corps (110) comporte une fente longitudinale(112) substantially perpendicular to the longitudinal axis X and extending about 90 ° along a circumference of the body (110), and a series of slits (111) inclined relative to the longitudinal axis X and substantially parallel between them. This series of slots (111), like the slot (112), extend over substantially 90 ° along a circumference of the body (110). In addition, the body (110) has a longitudinal slot
(113) sensiblement parallèle à l'axe longitudinal X, selon une génératrice du corps (110) qui relie entre elles les extrémités situées d'un même côté des fentes (112) et (111). D'autre part, le corps (110) comporte un trou longitudinal d'axe X s' étendant de l'extrémité distale (130) à au moins la fente (112) .(113) substantially parallel to the longitudinal axis X, according to a generatrix of the body (110) which interconnects the ends located on the same side of the slots (112) and (111). On the other hand, the body (110) has a longitudinal hole of X axis extending from the distal end (130) to at least the slot (112).
Lors d'un montage de l'instrument de pose (100), l'extrémité distale (123) de la tige (122) du mandrin (8) est introduite dans le trou longitudinal d'axe X à travers la fente (113) du corps (110) . La tige (122) est enfilée dans ce trou longitudinal d'axe X jusqu'à ce que l'extrémité proximale coudée du mandrin (8) puisse être introduite dans la fente (112) du corps (110) . Un écrou (141) est vissé sur l'extrémité distale (130) de manière à ce qu'il soit en prise avec les filets (133) du corps (110). Ensuite, le circlips (132) est monté dans la gorge (131) de l'extrémité distale (130) du corps (110). Ce circlips (132) sert de butée à l'écrou (141), lorsque ce dernier est vissé ou dévissé vers l'extrémité distale du corps (110) . Un manchon (142) est emmanché sur l'écrou (141) afin de réaliser un ensemble (140) . Dans une variante de réalisation, le manchon (142) est vissé sur l'écrou (141) ou soudé ou collé. Le manchon (142) présente à une extrémité distale (144) deux baïonnettes (145) diamétralement opposées l'une par rapport à l'autre selon l'axe longitudinal X de l'instrument de pose (100) .When mounting the delivery instrument (100), the distal end (123) of the mandrel shank (122) is inserted into the longitudinal X-axis hole through the slot (113). of the body (110). The shank (122) is threaded into this X-axis longitudinal hole until the angled proximal end of the mandrel (8) can be inserted into the slot (112) of the body (110). A nut (141) is screwed onto the distal end (130) to engage the threads (133) of the body (110). Then, the circlip (132) is mounted in the groove (131) of the distal end (130) of the body (110). This circlip (132) serves as a stop to the nut (141), when the latter is screwed or unscrewed towards the distal end of the body (110). A sleeve (142) is fitted onto the nut (141) to provide an assembly (140). In an alternative embodiment, the sleeve (142) is screwed onto the nut (141) or welded or glued. The sleeve (142) has at a distal end (144) two bayonets (145) diametrically opposite one another along the longitudinal axis X of the laying instrument (100).
En référence aux figures 9a à 9f, nous allons décrire l'utilisation de l'instrument de pose (100).Referring to Figures 9a to 9f, we will describe the use of the delivery instrument (100).
Préalablement à l'utilisation de l'instrument de pose (100), le tube de gastrostomie (1) selon l'invention est équipé d'une embase (20) présentant des moyens de montage (23) sur le tube de gastrostomie (1) situé sur une face inférieure de l'embase (20) . Sur une face supérieure de l'embase (20), cette dernière présente une ouverture (21) à la périphérie de laquelle se situent, de manière diamétralement opposée par rapport à l'axe longitudinal X, des encoches (24), ici au nombre de deux. Enfin, l'embase (20) présente un bouchon (22) apte à venir dans l'orifice (21) pour fermer le tube de gastrostomie de manière étanche. De plus amples renseignements concernant l'embase (20) et son montage sur le tube de gastrostomie (1) sont contenus dans la demande de brevet en France n° FR 0606140, à laquelle il est possible de se référer.Prior to the use of the delivery instrument (100), the gastrostomy tube (1) according to the invention is equipped with a base (20) having mounting means (23) on the gastrostomy tube (1). ) located on a lower face of the base (20). On an upper face of the base (20), the latter has an opening (21) on the periphery of which are located, diametrically opposed to the longitudinal axis X, notches (24), here at the number of two. Finally, the base (20) has a plug (22) adapted to come into the orifice (21) to close the gastrostomy tube sealingly. Further information concerning the base (20) and its mounting on the gastrostomy tube (1) are contained in the French patent application No. FR 0606140, to which it is possible to refer.
Dans un premier temps, l'ensemble (140) formé du manchon (142) et de l'écrou (141) est vissé sur le corps (110) de l'instrument de pose (100) vers une extrémité distale jusqu'à ce que l'écrou (141) vienne en butée contre le circlips (132) . L'extrémité proximale coudée du mandrin (8) est placée dans la fente (112) du corps (110) de l'instrument de pose (100), l'extrémité distale (123) du mandrin (8) dépassant de l'extrémité distale du manchon (142) . Ensuite, l'extrémité distale (123) du mandrin (8) est introduite dans le tube de gastrostomie (1) à travers l'orifice (21) de l'embase (20) selon l'axe longitudinal X dans le sens de la flèche Fl. Un mouvement selon la flèche Fl est effectué jusqu'à ce que l'extrémité distale (144) du manchon (142) soit introduite dans l'orifice (21) de l'embase (20), les baïonnettes (145) passant par les encoches (24). Le manchon (140) est alors bloqué dans l'embase (20) lors d'un mouvement de rotation Tl autour de l'axe X afin de rendre solidaires l'embase (20) et l'instrument de pose (100) par un montage dit « baïonnette », tel qu'illustré en figure 9b.Firstly, the assembly (140) formed of the sleeve (142) and the nut (141) is screwed onto the body (110) of the laying instrument (100) towards a distal end until the nut (141) comes into abutment against the circlip (132). The proximal end bent of the mandrel (8) is placed in the slot (112) of the body (110) of the delivery instrument (100), the distal end (123) of the mandrel (8) protruding from the distal end of the sleeve (142). ). Then, the distal end (123) of the mandrel (8) is introduced into the gastrostomy tube (1) through the orifice (21) of the base (20) along the longitudinal axis X in the direction of the Arrow Fl. A movement according to the arrow Fl is performed until the distal end (144) of the sleeve (142) is inserted into the orifice (21) of the base (20), the bayonets (145). passing through the notches (24). The sleeve (140) is then locked in the base (20) during a rotational movement T1 around the axis X in order to make the base (20) and the laying instrument (100) integral with one another. Bayonet mount, as shown in Figure 9b.
Puis, selon un mouvement de rotation T2, l'extrémité proximale coudée du mandrin (8) est extraite de la fente (112) jusqu'à la fente longitudinale (113). Dès lors, le mandrin (8) peut coulisser selon un mouvement F2 alors que l'extrémité proximale coudée se déplace au sein de la fente longitudinale (113) . Le mouvement F2 est effectué de manière légère jusqu'à ce que l'extrémité distale (123) du mandrin (8) vienne en contact avec le bout fermé (2) du tube de gastrostomie (1), le bulbe (10) du tube de gastrostomie (1) étant alors formé au repos. Une fois l'extrémité distale (123) du mandrin (8) en appui de contact avec le bout fermé (2), l'extrémité proximale coudée du mandrin (8) est alors insérée dans l'une fentes (111) se trouvant alors en regard, selon un mouvement de rotation T3. Dès lors, le corps (110) est mis en mouvement de rotation selon T4 qui a pour conséquence de visser le corps (110) dans l'ensemble (140) par coopération de l'écrou (142) de l'ensemble (140) sur le filetage (133) de l'extrémité distale (130) du corps (110) de l'instrument de pose (100). Ce mouvement de vissage s'effectue sur une distance prédéterminée et limitée (d) . Une fois la distance (d) parcourue, l'écrou (142) de l'ensemble (140) vient alors en butée au niveau d'une extrémité proximale du filetage (133) sur le rebord (135), comme cela est illustré en figure 9f. Lors de ce mouvement de vissage, l'extrémité distale (123) du mandrin (8) repousse le bout fermé (2) du tube de gastrostomie (1) en dehors du bulbe (10) jusqu'à ce que ce dernier disparaisse, les lames formant le bulbe (10) étant complètement étirées, la distance (d) parcourue. Dès lors, le tube de gastrostomie (1) peut être soit retiré du patient ou introduit dans le patient à travers le stoma .Then, in a rotational movement T2, the bent proximal end of the mandrel (8) is extracted from the slot (112) to the longitudinal slot (113). Therefore, the mandrel (8) can slide in a movement F2 while the bent proximal end moves within the longitudinal slot (113). The movement F2 is carried out lightly until the distal end (123) of the mandrel (8) comes into contact with the closed end (2) of the gastrostomy tube (1), the bulb (10) of the tube gastrostomy (1) is then formed at rest. Once the distal end (123) of the mandrel (8) bears in contact with the closed end (2), the bent proximal end of the mandrel (8) is then inserted into one of the slots (111) which are then facing, in a rotational movement T3. Therefore, the body (110) is rotated along T4 which has the effect of screwing the body (110) into the assembly (140) by engagement of the nut (142) of the assembly (140) on the thread (133) of the distal end (130) of the body (110) of the delivery instrument (100) . This screwing movement takes place over a predetermined and limited distance (d). Once the distance (d) has been traveled, the nut (142) of the assembly (140) then abuts at a proximal end of the thread (133) on the flange (135), as illustrated in FIG. Figure 9f. During this screwing movement, the distal end (123) of the mandrel (8) pushes the closed end (2) of the gastrostomy tube (1) out of the bulb (10) until the latter disappears. the blades forming the bulb (10) being completely stretched, the distance (d) traveled. As a result, the gastrostomy tube (1) can be either removed from the patient or introduced into the patient through the stoma.
L'instrument de pose (100) qui vient d'être décrit et son utilisation évitent d'avoir à pousser de manière manuelle et directe le mandrin afin d'étirer les lamelles formant le bulbe et de ce fait évitent le risque de perforer la paroi opposée de l'estomac si le mandrin traverse ou échappe du bout fermé du tube de gastrostomie. De plus, grâce à la série de fentes (111), l'instrument de pose (100) est réglable en fonction de la longueur du tube de gastrostomie avec lequel il est destiné à coopérer et cet instrument de pose permet ensuite une course de poussée toujours identique nécessaire à l'étirage des lamelles formant le bulbe. La réalisation contrôlée de cette course assure l'utilisateur que le tube de gastrostomie est prêt à être posé ou enlevé. Ceci est surtout important lors d'un retrait du tube de gastrostomie, car l'utilisateur ne voit pas l'état de déformation du bulbe dans l'estomac avant le retrait. De ce fait, l'instrument de pose (100) selon l'invention permet une manipulation avec une sécurité optimale d'un tube de gastrostomie selon l'invention.The laying instrument (100) which has just been described and its use avoids having to push the mandrel manually and directly to stretch the lamellae forming the bulb and thus avoid the risk of perforating the wall opposite of the stomach if the mandrel passes through or escapes from the closed end of the gastrostomy tube. In addition, thanks to the series of slots (111), the laying instrument (100) is adjustable according to the length of the gastrostomy tube with which it is intended to cooperate and this laying instrument then allows a thrust stroke always identical, necessary for stretching the lamellae forming the bulb. The controlled realization of this race assures the user that the gastrostomy tube is ready to be placed or removed. This is especially important when removing the gastrostomy tube because the user do not see the state of deformation of the bulb in the stomach before removal. Therefore, the laying instrument (100) according to the invention allows manipulation with optimum safety of a gastrostomy tube according to the invention.
L'invention n'est pas limitée ni à la réalisation qui a été décrite ni au matériau qui a été préconisé. The invention is not limited either to the embodiment which has been described or to the material which has been recommended.

Claims

REVENDICATIONS
1. Tube de gastrostomie (1) qui présente à son extrémité distale un bulbe (10) apte à retenir le tube dans la cavité gastrique (7) et apte à être réduit élastiquement à la demande pour permettre l'introduction ou l'extraction du tube par le stoma, caractérisé en ce que le bulbe (10) est constitué par des lamelles (6) formées dans une zone de la paroi du tube située à distance du bout (2) de l'extrémité distale, ces lamelles étant séparées par des fentes (4) de la paroi mais restant attenantes à la paroi du tube à chaque extrémité (6a, 6b) de la lamelle, en ce que les lamelles ont été incurvées vers l'extérieur pour constituer le bulbe (10) et en ce que le bout (2) du tube est en retrait à l'intérieur du bulbe en sorte qu'il soit nécessaire de repousser le bout du tube hors du bulbe pour que les lamelles soient étirées, ce qui supprime le bulbe et permet d' introduire ou de retirer le tube par le stoma.1. Gastrostomy tube (1) which has at its distal end a bulb (10) adapted to retain the tube in the gastric cavity (7) and adapted to be elastically reduced on demand to allow the introduction or extraction of the tube by the stoma, characterized in that the bulb (10) consists of lamellae (6) formed in an area of the wall of the tube located at a distance from the tip (2) of the distal end, these lamellae being separated by slits (4) of the wall but remaining adjacent to the wall of the tube at each end (6a, 6b) of the lamella, in that the lamellae have been curved outwards to form the bulb (10) and in that that the end (2) of the tube is recessed inside the bulb so that it is necessary to push the end of the tube out of the bulb so that the lamellae are stretched, which eliminates the bulb and allows to introduce or remove the tube by the stoma.
2. Tube selon la revendication 1 dont les lamelles (6) qui constituent le bulbe sont vrillées.2. Tube according to claim 1, the slats (6) constituting the bulb are twisted.
3. Tube selon la revendication 1 ou 2 dans lequel chaque lamelle (6), avant de se raccorder au tube à proximité du bout (2) de l'extrémité distale présente une inflexion (10) qui constitue une précourbure opposée à l'allongement en sorte qu'un effort exercé sur le tube (figure 4) conduirait le bulbe à se contracter sans pouvoir être suffisamment réduit pour permettre une extraction du tube par le stoma.3. Tube according to claim 1 or 2 wherein each strip (6), before connecting to the tube near the tip (2) of the distal end has an inflection (10) which is a prebending opposite to the elongation so that a force exerted on the tube (Figure 4) would lead the bulb to contract without being reduced enough to allow extraction of the tube by the stoma.
4. Tube selon l'une des revendications 1 à 3 dont les fentes (4) de la paroi du tube sont parallèles à la paroi du tube. 4. Tube according to one of claims 1 to 3, the slots (4) of the wall of the tube are parallel to the wall of the tube.
5. Tube selon l'une des revendications 1 à 4 dont ledit bout (2) est fermé.5. Tube according to one of claims 1 to 4, said end (2) is closed.
6. Tube selon l'une des revendications 1 à 5 dont la matière est le polyuréthane ou similaire. 6. Tube according to one of claims 1 to 5 whose material is polyurethane or the like.
7. Procédé pour fabriquer un tube selon l'une des revendications 1 à 6, qui comprend les opérations consistant à fendre un tube fermé à un bout pour constituer dans la paroi du tube lesdites lamelles de paroi, à écraser le bout fermé du tube pour repousser les lamelles vers l'extérieur et former le bulbe et à chauffer le tube pour stabiliser le bulbe.7. A method for manufacturing a tube according to one of claims 1 to 6, which comprises the operations of splitting a tube closed at one end to form in the wall of the tube said wall slats, to crush the closed end of the tube for push the lamellae outwards and form the bulb and heat the tube to stabilize the bulb.
8. Procédé pour fabriquer un tube selon l'une des revendications 1 à 6, dans lequel on moule le tube par injection de matière plastique polyuréthane ou similaire dans un moule qui crée le tube, son bout fermé et lesdites fentes, puis on écrase le bout du tube pour former le bulbe et on chauffe le tube pour stabiliser le bulbe .8. A method for manufacturing a tube according to one of claims 1 to 6, wherein the tube is molded by injection of polyurethane plastic material or the like into a mold which creates the tube, its closed end and said slots, then crushes the end of the tube to form the bulb and the tube is heated to stabilize the bulb.
9. Instrument de pose (100) d'un tube de gastrostomie (1) selon l'une des revendications 1 à 6, comportant un mandrin (8) dont une extrémité distale (123) est apte à venir en appui contre le bout (2) du tube de gastrostomie (1), caractérisé en ce qu'il comporte des moyens d'entraînement progressifs (111, 133, 140) du mandrin (8) sur une distance limitée prédéterminée (d) afin que, lors d'une mise en œuvre, l'extrémité distale (123) repousse le bout (2) du tube (1) hors du bulbe (10) pour que les lamelles (6) soient étirées.9. Instrument for fitting (100) a gastrostomy tube (1) according to one of claims 1 to 6, comprising a mandrel (8) whose distal end (123) is able to bear against the tip ( 2) of the gastrostomy tube (1), characterized in that it comprises progressive drive means (111, 133, 140) of the mandrel (8) over a predetermined limited distance (d) so that, during a implementation, the distal end (123) pushes the tip (2) of the tube (1) out of the bulb (10) so that the slats (6) are stretched.
10. Instrument de pose selon la revendication 9, caractérisé en ce que les moyens d'entraînement comportent un écrou (142) en prise avec des filets (133) et apte à se visser/dévisser uniquement le long de la distance (d) . 10. Installation instrument according to claim 9, characterized in that the drive means comprise a nut (142) engaged with threads (133) and adapted to screw / unscrew only along the distance (d).
11. Instrument de pose selon l'une des revendications à 10, caractérisé en ce que, le mandrin ayant une extrémité proximale coudée, les moyens d'entraînement comportent une série de fentes (111) aptes à recevoir l'extrémité proximale coudée. 11. Installation instrument according to one of claims 10, characterized in that, the mandrel having a proximal end bent, the drive means comprise a series of slots (111) adapted to receive the bent proximal end.
EP07787194A 2006-07-06 2007-07-06 Gastrostomy tube, production methods thereof and insertion tool Active EP2037863B1 (en)

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FR0606139A FR2903301B1 (en) 2006-07-06 2006-07-06 GASTROSTOMY TUBE AND METHODS OF MANUFACTURING THE SAME
PCT/EP2007/056912 WO2008003784A1 (en) 2006-07-06 2007-07-06 Gastrostomy tube, production methods thereof and insertion tool

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WO2008003784A1 (en) 2008-01-10
CA2656512A1 (en) 2008-01-10
FR2903301A1 (en) 2008-01-11
EP2037863B1 (en) 2012-05-16
ES2384896T3 (en) 2012-07-13
PT2037863E (en) 2012-06-26
FR2903301B1 (en) 2008-08-29
CA2656512C (en) 2014-08-26
DK2037863T3 (en) 2012-08-13
JP5273267B2 (en) 2013-08-28
JP2012115705A (en) 2012-06-21
PL2037863T3 (en) 2012-09-28
US20090306600A1 (en) 2009-12-10
JP2009542270A (en) 2009-12-03

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