EP2822479A1 - Systeme pour realiser une anastomose entre une paroi et un conduit organique - Google Patents
Systeme pour realiser une anastomose entre une paroi et un conduit organiqueInfo
- Publication number
- EP2822479A1 EP2822479A1 EP13715299.7A EP13715299A EP2822479A1 EP 2822479 A1 EP2822479 A1 EP 2822479A1 EP 13715299 A EP13715299 A EP 13715299A EP 2822479 A1 EP2822479 A1 EP 2822479A1
- Authority
- EP
- European Patent Office
- Prior art keywords
- support body
- wall
- suture
- configuration
- orifice
- 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.)
- Withdrawn
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
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
-
- 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
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
-
- 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
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0482—Needle or suture guides
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/1114—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00004—(bio)absorbable, (bio)resorbable, resorptive
-
- 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
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0409—Instruments for applying suture anchors
-
- 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
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0414—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors having a suture-receiving opening, e.g. lateral opening
-
- 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
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
-
- 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
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0464—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors for soft tissue
-
- 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
- A61B2017/047—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery having at least one proximally pointing needle located at the distal end of the instrument, e.g. for suturing trocar puncture wounds starting from inside the body
-
- 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
- A61B2017/0472—Multiple-needled, e.g. double-needled, instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B2017/1103—Approximator
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B2017/1121—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis adapted for performing tissue or graft eversion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B2017/1132—End-to-end connections
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B2017/1135—End-to-side connections, e.g. T- or Y-connections
Definitions
- the present invention relates to the surgical field, and in particular to the fields of urological, visceral and vascular surgery, etc.
- the invention relates to a surgical treatment system for performing an anastomosis between an organic wall having an orifice and a hollow organic conduit, such as the bladder and the urethra of a patient.
- the invention may for example be implemented following a prostatectomy, typically a total vesiculoprostatectomy, or radical prostatectomy, undergone by the patient, with the objective of surgically restoring the communication between the bladder and the terminal orifice of the urethra. , opposite the urethral meatus.
- the anastomosis between the bladder and the urethra of a patient is performed manually by the surgeons by means of one or more suture son set up with the aid of a needle.
- the surgeons must first rebuild the neck of the bladder; for this purpose, they deform the wall of the bladder at the orifice made therein following a prostatectomy, so as to form a neck or a tubular portion intended to be connected to the urethra by means of the suture threads.
- Such a method of treatment has certain advantages, particularly because it allows to carry out an abutment of the urethra and the neck or the tubular portion formed on the wall of the bladder. More specifically, such a method makes it possible to directly make the bank of the neck of the bladder and the bank of the terminal orifice of the urethra directly directly together, that is to say without having to fold one or the other of these banks on themselves. There is thus a direct contact between the respective mucous membranes of the banks, which is particularly advantageous in terms of healing and complete and reliable recovery of the communication between the bladder and the urethra of the patient.
- this manual technique of anastomosis has many disadvantages and is particularly difficult to implement. Indeed, such a technique requires a particularly important intervention time and requires great dexterity on the part of the surgeon, in particular to reconstruct the neck of the bladder and precisely abut the ends of the two conduits to be connected, in this case the terminal orifice of the urethra and the neck or the tubular portion formed on the wall of the bladder.
- Such a manual reconnection operation proves all the more delicate as the intervention zone, situated at the rear of the pubis, is particularly difficult to access and includes the patient's sphincter whose integrity must be preserved throughout the procedure, avoiding its traction, perforation, crushing, etc.
- this method of manual intervention may have the disadvantage of being performed "open", and require to make large incisions on the body wall of the patient to access the area of intervention, involving for the many inconveniences, particularly in terms of length of hospital stay, recovery time and post-operative sequelae.
- a first difficulty consists in forming on the wall a tubular portion at the orifice, and to give this tubular portion a calibrated geometry to be able to precisely abut the end of the organic conduit and bring into contact their respective mucosa.
- the orifice formed in the wall during a prior surgical procedure does not necessarily have a regular geometry, and the wall may have a variable thickness on the circumference of the orifice; thus the abutment of the hollow conduit on the wall and the contacting of their respective mucosa may be particularly difficult. None of the aforementioned techniques offers a satisfactory solution to solve this problem.
- the present invention proposes a system for preparing an orifice arranged on an organic wall, in particular with a view to an anastomosis with a hollow organic conduit, making it possible to form in a reliable and reproducible manner on the wall, at the level of the orifice, a tubular portion having a predetermined geometry.
- the invention aims to provide a mechanized system that offers surgeons the possibility of minimally invasive procedures, in particular via the patient's natural pathways, in order to limit the surgical trauma suffered by the patient, and to prepare reliably and reproducibly an orifice formed in a wall of an organ or a vessel, especially for subsequent anastomosis with a hollow organic conduit or a prosthesis such as a vascular prosthesis.
- the invention relates to a system for preparing an orifice arranged on an organic wall, characterized in that it comprises:
- a support body defining a longitudinal axis and having a proximal portion and a distal portion, said distal portion being adapted to be introduced through the orifice;
- External clamping elements deployable corollary to the support body being distributed in the circumferential direction, and capable of covering, around said orifice, portions of an annular surface of said organic wall, and; - biasing means arranged to constrict and juxtapose said outer clamping elements on said support body to progressively deform said annular surface to, firstly, shape on said organic wall a tubular portion extending along the longitudinal axis and, on the other hand, forming an anchor flange consisting of said outer clamping members.
- the wall of the member can be reliably, accurately and reproducibly prepared so as to form thereon a tubular portion extending from its orifice, said portion having a calibrated geometry, in particular with a view to end-to-end reconnection or butting to a hollow conduit.
- the external clamping elements placed outside the tubular portion of the wall in the radial direction advantageously form an anchor flange that can be used to reconnect the hollow conduit.
- the invention finds a particularly advantageous application in the field of urology, and in particular for reconstructing the wall of the bladder of a patient and forming on this wall a tubular portion of predetermined geometry at an orifice formed in that for example following a prostatectomy, for anastomosis with the patient's urethra.
- tubular portion formed by means of the system according to the invention is used to connect to the wall of the organ a non-organic hollow conduit, belonging for example to a prosthesis, in particular a vascular prosthesis.
- the support body having at least one cylindrical or substantially cylindrical portion
- the biasing means are used to move the outer clamping elements to the support body, said outer clamping elements driving the wall towards the body of support bearing on portions of an annular surface extending around the orifice of the wall.
- the wall is then progressively deformed around its orifice so as to be pressed against the cylindrical portion of the support body and adopt a substantially tubular shape being clamped between said support body and the external clamping elements.
- the external clamping elements may advantageously have at least one fastening and / or fastening tooth adapted to achieve the attachment and / or fixing of said external clamping elements on the portions of the annular surface of the wall extending around of the orifice.
- the system comprises an applicator for setting up the supporting body through the orifice formed in the wall and fixing said support body on said wall.
- This applicator is adapted to be removably connected to the proximal portion of the support body and to control at least part of the biasing means, especially from outside the body of the patient.
- the biasing means comprise connecting elements, each connecting element being adapted to connect an external clamping element to the support body, and a traction device of the connecting elements, said elements of linkage each having a first end connected to said traction device and a second end adapted to be retained on an associated external clamping member, and said pulling device being operable to constrict and juxtapose said outer clamping members to said support body.
- the connecting elements are used to connect the outer clamping elements and the support body through the wall.
- These connecting elements are preferably flexible. They can advantageously be in the form of son, made for example of a bio-resorbable material.
- the traction device may advantageously be housed inside the support body and controlled from the applicator for placing and fixing the support body.
- the traction device can be carried and controlled by the applicator.
- the traction device is provided with a force limitation system for limiting the clamping of the wall on the support body by the external clamping elements.
- a force limitation system for limiting the clamping of the wall on the support body by the external clamping elements.
- a non-return device between the connecting elements and the support body, said device being adapted to prevent loosening of the external clamping elements on the support body when the actuation of the traction device stops.
- the system further comprises a traversing and anchoring device adapted to move the second end of each connecting element between a retracted configuration in which said second end is at a radial distance from the longitudinal axis less than the radius of the orifice and an anchored configuration in which said second end is retained on an associated external clamping element after passing through the wall.
- the traversing and anchoring device comprises support elements adapted to releasably support the second ends of the connecting elements.
- the second ends of the connecting elements are provided with an anchoring element adapted to cooperate with a corresponding anchoring portion provided on the outer clamping elements for retaining said second ends on said external clamping elements when they reach each other. find in anchored configuration, after crossing the wall.
- the support elements of the traversing and anchoring device and / or the anchoring elements equipping the second ends of the connecting elements may advantageously have a tip adapted to perforate the wall when said second ends pass from their retracted configuration to their configuration. anchored.
- each connecting element is at a radial distance from the lower longitudinal axis or substantially equal to the outer radius of the support body.
- the traversing and anchoring device is integrated in the support body, and extends in the distal portion of said body intended to be introduced through the orifice of the wall.
- the connecting elements and the traversing and anchoring device can be housed inside the support body, which in particular minimizes the risk of attaching and damaging tissues or altering the operation of the system according to the invention itself when it is inserted into the body of the patient.
- This traversing and anchoring device may, according to a preferred embodiment of the invention, be controlled by the applicator, for example by means of a cable or a transmission rod.
- the system further comprises a deployment mechanism adapted to move said external clamping elements at least between a retracted configuration in which they are folded towards the longitudinal axis, and a configuration deployed in which they are spaced apart from the longitudinal axis and extend in corolla substantially perpendicular thereto, and the deployment mechanism comprises support members on which the outer clamping members are releasably supported.
- the deployment mechanism is adapted to move the outer clamping elements between the retracted configuration and the deployed configuration either simultaneously or sequentially.
- the outer clamping elements can be moved individually one after the other, in a determined order, for example one after the other in the circumferential direction , or in a more dispersed way. It will also be possible to envisage sequential deployment possibly by subsets of external clamping elements, the external clamping elements belonging to each subassembly being regularly distributed in the circumferential direction.
- the deployment mechanism is provided on the end of a distal portion of the applicator adapted to be connected to the support body, said mechanism being preferably controlled by means of said applicator.
- the applicator and particularly the deployment mechanism arranged on the distal end of said applicator, comprises a stop member adapted to cooperate with the wall to limit the insertion of the support body through the orifice.
- the stop member could be provided directly on the support body.
- the traversing and anchoring device is adapted to move the second end of each connecting element between the retracted configuration and the anchored configuration when the external clamping elements are in the deployed configuration.
- the deployment mechanism is further adapted to move the outer clamping elements between the deployed configuration and a folded configuration in which said outer clamping elements are folded towards the longitudinal axis of the outer side. distal end of the support body, and said deployment mechanism belongs to the biasing means.
- the outer clamping members in the expanded configuration can be moved to a folded configuration by progressively driving and deforming the wall so as to press against the support body and adopt a substantially tubular shape. by being clamped between said support body and the outer clamping elements.
- the deployment mechanism is adapted to move the outer clamping elements between the deployed configuration and the folded configuration either simultaneously or sequentially.
- the traversing and anchoring device is adapted to move the second end of each connecting element between the retracted configuration and the anchored configuration when the external clamping elements are in folded configuration.
- the support body releasably supports internal clamping elements aligned angularly in the circumferential direction with the external clamping elements, and the biasing means are arranged to tighten and juxtapose said elements of external clamping on said inner clamping elements.
- These internal clamping elements when they are retained on the support body, define therewith a substantially cylindrical portion on which the wall is plated via the biasing means, so as to make it adopt a substantially tubular shape.
- the system further comprises an ejection device adapted to move the internal clamping elements between a retracted configuration in which they are at least partially housed inside the support body, and an ejected configuration in which they are extracted. outside said support body.
- the ejection device is integrated with the support body. It can also be controlled by means of the applicator.
- each connecting element comprises a portion associated with a respective internal clamping element, the system further comprising a cutting device adapted to cut the connecting elements between the inner clamping elements and the first ends of said connecting elements.
- the cutting device is integrated in the support body. It can also be controlled by means of the applicator.
- a holding member adapted to maintain the inner clamping elements and / or the outer clamping elements in a circular configuration after removal of the support body.
- the invention also relates to a method for preparing an orifice arranged on an organic wall, a method according to which:
- a support body defining a longitudinal axis and having a proximal portion and a distal portion;
- the distal portion of the support body is introduced through the orifice
- the external clamping elements are unfolded in corolla with respect to the support body, the said external clamping elements being distributed in the direction circumferential, and covering, around said orifice, portions of an annular surface of said organic wall;
- the outer clamping elements are urged to tighten and juxtapose said external clamping elements on said support body so as to progressively deform said annular surface so as, firstly, to shape on said organic wall a tubular portion extending along longitudinal axis and, on the other hand, form an anchor flange consisting of external clamping elements.
- the support body releasably supporting internal clamping elements aligned angularly in the circumferential direction with the external clamping elements, is solicited. the outer clamping members for tightening and juxtaposing said outer clamping elements on said inner clamping elements.
- the internal clamping elements are moved between a retracted configuration in which they are at least partially housed inside the support body, and a ejected configuration in which they are extracted outside said support body.
- each connecting element comprising a portion associated with an associated internal clamping element, the connection elements between the internal clamping elements are cut off and the first ends of said connecting elements.
- Another object of the present invention is to provide an anastomosis system for reliably, reproducibly and minimally invasive the end-to-end connection of a tubular portion formed by means of the previously described system at a orifice arranged on an organic wall and a hollow organic conduit.
- a system for producing an anastomosis between an organic wall having an orifice and a hollow organic conduit comprising:
- a device for connecting said duct and the shaped tubular portion to the wall said device being arranged at least partly in a proximal portion of the support body adapted to be introduced inside the duct and comprising: * Suture elements adapted to connect the inner and outer clamping elements and each having a first end connected to a clamping device and a second end adapted to be retained on an outer clamping member associated, and;
- a suture device adapted to move the second end of each suture element between a retracted configuration in which said second end is at a radial distance from the longitudinal axis less than the inside radius of said duct, and an anchored configuration in which said second end is retained on an associated external clamping element after passing through the conduit from the inside to the outside.
- an end-to-end connection of the hollow organic duct and the tubular portion formed on the organic wall is carried out, so as to establish a direct contact between their respective mucosa, which is particularly advantageous in terms of healing and complete and reliable recovery of communication between the two organs, especially between the bladder and the urethra of the patient.
- the suture elements connect the outer clamping members and the support body through the conduit.
- These suture elements are preferably flexible. They can advantageously be in the form of son, made for example of a bio-resorbable material.
- the system further comprises a control probe of the device for connecting the hollow organic conduit and the tubular portion formed on the wall.
- This probe is adapted to be introduced into the hollow conduit, and to be removably connected to the proximal portion of the support body to at least partially control said device, in particular from outside the body of the patient.
- the clamping device can advantageously be housed inside the support body and controlled from the control probe. Alternatively, the clamping device can be carried and controlled by the probe.
- the clamping device is provided with a force limitation system for limiting the clamping force of the anastomosis.
- a force limitation system for limiting the clamping force of the anastomosis.
- a non-return device between the elements suture and the internal clamping elements, said device being adapted to prevent loosening of the suture elements when the actuation of the clamping device ceases.
- each suture element comprises a portion associated with a respective internal clamping member, the system further comprising a cutting device adapted to sever the suture elements between the inner clamping members and the first ends of said suture elements.
- this cutting device is the same as the cutting device described above in connection with the preparation system and for cutting the connecting elements;
- the suture device is further adapted to move the second end of the suture elements between the retracted configuration and the anchored configuration through an expanded intermediate configuration in which the said second end is opposite a corresponding anchoring portion; provided on the associated external clamping element;
- the suturing device comprises elastically flexible elements, aligned angularly in the circumferential direction with the inner and outer clamping elements, axially movable inside the support body, releasably supporting the second end of a suture element; associated and adapted to cooperate with associated ramps provided in the support body so as to move said second end between the retracted configuration and the anchored configuration;
- the second ends of the suture elements are provided with an anchoring element adapted to cooperate with a corresponding anchoring portion provided on the outer clamping elements to retain said second ends on said external clamping elements when they are located. in anchored configuration, after crossing the conduit;
- the flexible elements and / or the anchoring elements fitted to the second ends of the suture elements have a point adapted to perforate the duct when said second ends pass from their retracted configuration to their anchored configuration;
- the ramps are axially movable inside the support body between a first and a second axial positions, the passage of said ramps from the first axial position to the second axial position causing the passage of the second end of the suture elements from the intermediate configuration to the anchored configuration by elastic return of the flexible elements.
- the invention also relates to a method for producing an anastomosis between an organic wall having an orifice and a hollow organic conduit, a method according to which:
- the orifice arranged on the wall is prepared according to the method according to the first aspect of the invention.
- suture elements are provided adapted to connect the inner and outer clamping elements and each having a first end connected to a clamping device and a second end adapted to be retained on an associated external clamping element, and;
- each suture element is moved between a retracted configuration in which said second end is at a radial distance from the longitudinal axis less than the inside radius of said duct, and an anchored configuration in which said second end is retained on an associated external clamping element after passing through the conduit from the inside to the outside.
- each suture element comprising a portion associated with a respective internal clamping element, the elements of the suturing between the inner clamping members and the first ends of said suture elements.
- the anastomosis carried out by means of the system according to the invention is maintained, after removal of the support body, by means of the suture elements connecting the internal clamping elements to the external clamping elements through the hollow organic conduit. from the inside to the outside in the radial direction and straddling the anastomosis zone, said inner and outer clamping members being held together on the wall by means of the connecting members passing through the wall, to define thereon a tubular portion.
- the respective banks of the hollow organic duct and the tubular portion formed on the organic wall can be made contiguous, in the tubular extension of one another, forming a direct contact interface between their respective mucosa.
- the clamping elements external, the internal clamping elements, the connecting elements and / or the suture elements are made of a bio-absorbable material, that is to say a material that can be resorbed under the physicochemical action of tissues living in contact with which this material is placed.
- the material constituting these elements may be a bio-resorbable polymer, such as polyacetic acid (PLA, PLLA), polyglycolic acid (PGA) or polydioxanone (PDO).
- the elements left in place inside the body of the patient following the preparation of the orifice formed in the organic wall made by means of the system according to the first aspect of the present invention, or following the anastomosis between said wall and the hollow organic conduit made by means of the system according to the second aspect of the present invention will be absorbed by contact with the organic tissues, as well as with the surrounding fluids, and it will not be necessary to provide for a subsequent intervention to remove these elements.
- the invention also provides the case where a tubular portion is formed on the organic wall by another means than by means of the preparation system mentioned above.
- the present invention proposes a system for producing an anastomosis between an organic wall having an orifice and a hollow organic conduit, said system comprising:
- a support body defining a longitudinal axis and adapted to be introduced into the conduit and through the orifice;
- At least one external clamping element defining with said body a tubular portion on the wall and forming an anchoring flange;
- a device for connecting said duct and said defined tubular portion to the wall comprising:
- At least one suture member adapted to connect the outer clamping element to the supporting body and having a first end connected to a clamping device and a second end, said second end being adapted to be retained on the clamping element outside, and;
- a suturing device adapted to move the second end of the suture member between a retracted configuration wherein said second end is located at a radial distance from the longitudinal axis smaller than the inner radius of said duct, and an anchored configuration wherein said second end is retained on the outer clamping element after passing through the conduit from the inside to the outside.
- an end-to-end connection of the hollow organic duct and the tubular portion defined on the organic wall is carried out, so as to establish a direct contact between their respective mucosa, which is particularly advantageous in terms of healing and complete and reliable recovery of communication between the two organs, especially between the bladder and the urethra of the patient.
- the suture member connects the outer clamping member and the support body through the conduit.
- This suture element is preferably flexible. It may advantageously be in the form of a wire, made for example of a bio-resorbable material.
- the suture device is further adapted to move the second end of the suture elements between the retracted configuration and the anchored configuration through an expanded intermediate configuration in which the said second end is opposite a corresponding anchoring portion; provided on the associated external clamping element;
- the suturing device comprises at least one flexible element that is elastically mobile axially inside the support body, releasably releasably supporting the second end of the suture element and adapted to cooperate with a ramp provided in the support body of moving said second end between the retracted configuration and the anchored configuration;
- the ramp is movable axially within the support body between a first and a second axial positions, the passage of said ramp from the first axial position to the second axial position causing the passage of the second end of the suture elements.
- the support body releasably supports at least one inner clamping member, and the suture member is adapted to connect the outer clamping member and said inner clamping member.
- the system further comprises an ejection device adapted to move the inner clamping element between a retracted configuration in which it is at least partially housed inside the support body, and an ejected configuration in which it is extracted in outside said support body.
- each suture element comprises a portion associated with a respective internal clamping member, the system further comprising a cutting device adapted to sever the suture elements between the inner clamping members and the first ends of said suture members;
- the system further comprises at least one connecting element adapted to connect the outer clamping member to the support body to form the anchor flange;
- the system further comprises a traction device of the connecting element and wherein said connecting element has a first end connected to the traction device and a second end adapted to be retained on an external clamping element;
- the system further comprises a traversing and anchoring device adapted to move the second end of the connecting element between a retracted configuration in which said second end is at a radial distance from the longitudinal axis less than the radius of the orifice and an anchored configuration wherein said second end is retained on an associated external clamping member after passing through the wall.
- this system may comprise a single control element adapted to control the different devices during a single anastomosis operating phase.
- This control element will thus include, for example, all the control functionalities of the applicator and of the probe implemented in the context of the first subject of the invention.
- the invention also relates to a method for producing an anastomosis between an organic wall having an orifice and a hollow organic conduit, a method according to which:
- a support body defining a longitudinal axis
- At least one external clamping element defining with said body a tubular portion on the wall and forming an anchoring flange;
- the support body is introduced inside the conduit and through the orifice;
- At least one suture element adapted to connect the outer clamping element to the support body and having a first end connected to a clamping device and a second end, said second end being adapted to be retained on the external clamping element, and;
- the second end of the suture element is moved between a retracted configuration in which said second end is at a radial distance from the longitudinal axis less than the inner radius of said conduit, and an anchored configuration in which said second end is retained on the outer clamping element after passing through the conduit of the inside to the outside.
- FIG. 1 is a schematic sectional view of an organic wall having an orifice, in this case the wall of a bladder of a patient having undergone a prostatectomy, and a hollow organic conduit, in this case the urethra of the patient, between which must be performed anastomosis;
- FIG. 2 is a schematic sectional view of the wall of the bladder on which a tubular portion has been formed at the orifice for an end-to-end anastomosis with the patient's urethra;
- FIG. 3 is a perspective view of a complete anastomosis system comprising a system for preparing the orifice on the wall of the bladder according to a first embodiment of the invention
- FIG. 4 is an exploded perspective view of the support body according to the first embodiment of the invention.
- FIG. 5 illustrates in perspective the system for preparing the orifice on the wall of the bladder according to the first embodiment of the invention, before insertion through the orifice;
- FIGS. 5a to 5f are half views in longitudinal section along the line
- V-V of Figure 5 to illustrate the different successive phases of preparation of the orifice formed on the wall by means of the system according to the first embodiment of the invention
- FIG. 6 is a perspective view of the wall of the bladder on which a tubular portion has been formed at its orifice and ready to be reconnected to the patient's urethra;
- FIG. 7 is an exploded perspective view of the support body according to a second embodiment of the invention.
- FIG. 8 is a view similar to that of FIG. 5, intended to illustrate the system for preparing the orifice on the organic wall according to the second embodiment of FIG. embodiment of the invention, before insertion through the orifice;
- FIGS. 8a to 8f are half longitudinal section views along the line VIII-VIII of FIG. 8, intended to illustrate the different successive phases of preparation of the orifice formed on the wall by means of the system according to the second embodiment of FIG. embodiment of the invention;
- FIG. 9 is a schematic view in elevation and partly in section illustrating a first step of using the anastomosis system according to the invention, associated with a patient's urethra intended to be anastomosed or reconnected to the tubular portion formed on the wall of the bladder by means of the preparation system according to the first embodiment of the invention;
- FIGS. 10a to 10c are half longitudinal sectional views along the line IX-IX of FIG. 9, intended to illustrate the different successive phases of the anastomosis between the bladder and the patient's urethra by means of the system according to FIG. invention, the orifice of the wall of the bladder having been prepared by means of the preparation system according to the first embodiment of the invention;
- FIG. 1 1 is a half longitudinal sectional view along the line IX-IX of Figure 9 similar to those of Figures 10a to 10c and to illustrate the ejection step of the internal clamping elements after anastomosis of the portion tubular formed on the bladder by means of the preparation system according to the first embodiment of the invention and the urethra of the patient, and cutting of the connecting elements and suture elements, allowing the removal of the anastomosis system according to the invention outside the body of the patient;
- FIG. 12 is a half longitudinal sectional view of the wall of the bladder and urethra of the patient after anastomosis by means of the system according to the present invention and removal of said system outside the body of the patient.
- FIG. 1 illustrates an organic wall P having an orifice O, as well as a hollow organic conduit C having an open end E.
- this wall P belongs to a bladder V and that the orifice O arranged thereon was made during a prostatectomy undergone by the patient.
- the hollow organic duct C considered in the context of the present description is the patient's urethra whose open end E, resulting from an anterior resection of the urethra in its membrane zone made in the context of prostatectomy. , must be reconnected to the wall P of the bladder V during an operation of anastomosis to surgically restore the communication between the bladder and the terminal orifice of the urethra, opposite the urethral meatus, opening at this end E.
- FIG. 2 schematically shows in section the wall P of the bladder V which has been deformed so as to form a tubular portion T at the orifice O, said tubular portion T being intended to be reconnected end to end, or abutment, during an operation of anastomosis at the end E of the urethra C opposite the urethral meatus.
- a first objective of the present invention is to propose a system SP, SP 'for preparing the wall P of the bladder V so as to form this tubular portion T at the orifice O.
- a second objective of the present invention is to propose an SA anastomosis system for performing the end-to-end connection of the tubular portion T formed by means of the above-mentioned SP, SP 'system at the orifice O arranged on the wall P of the bladder V, and the urethra of the patient.
- FIG. 3 a complete system SA for making an anastomosis between the bladder and the urethra of a patient.
- the anastomosis system SA comprises an SP system for preparing the orifice O of the wall P of the bladder V according to a first embodiment.
- This SP system includes:
- a support body 1 defining a longitudinal axis X and having a proximal portion 1a and a distal portion 1b, said distal portion 1b being adapted to be introduced through the orifice O, and
- an applicator 8 having a proximal control portion 8b intended to be manipulated by the surgeon, a distal portion 8a on which the proximal portion 1a of the support body 1 is intended to be connected as part of a first phase of operation, or tubularization phase, and an elongate central portion 8c.
- the anastomosis system SA further comprises a probe 9 having a proximal portion 9b of control to be manipulated by the surgeon, a distal portion 9a on which the proximal portion 1a of the support body 1 is intended to be connected in the part of a second operative phase, or anastomosis phase, and an elongate central portion 9c.
- the distal portion 8a of the applicator 8 has a housing 8d designed to receive the proximal portion 1a of the support body 1. Moreover, the distal portion 8a of the applicator 8 is equipped with a deployment device 2 which will be explained in more detail later.
- the distal portion 9a of the probe 9 has a housing 9d provided to receive the proximal portion 1a of the support body 1.
- This distal portion 9a also has a plurality of slots 95 opening into the central housing 9d whose utility will be detailed in the following description.
- the distal portions 8a, 9 of the applicator 8 and the probe 9 are shaped to be assembled. in a complementary manner to the proximal end of the support body 1, 1 ', for control purposes of different devices arranged on or inside said support body 1, 1'.
- Various embodiments can be envisaged for this purpose, as long as the applicator 8 and the probe 9 are able to transmit control movements to these devices since their proximal portion 8b, 9b visible in FIG. 3.
- these proximal portions 8b, 9b is in the form of a manual actuator comprising a handle 84, 94 and various control elements, such as a trigger 81, 91, a manipulable wheel 82, 92 in rotation and in translation or a locking button 83, 93.
- the proximal portion of the applicator 8 and / or the probe 9 is mechanically connected to an interface connected to a robotic arm, allowing control of the computer-controlled system or systems placed under the supervision of the surgeon, particularly in the context of remote and computer-assisted surgery.
- FIG. 4 is an exploded perspective view of the support body 1 belonging to the anastomosis system SA comprising a preparation system SP according to a first embodiment of the invention.
- the support body 1 is made in two parts 101, 102 movable relative to each other along the longitudinal axis X.
- the first part which will here be considered as the fixed part, is in the form of a generally cylindrical element 101 extending along the axis longitudinal X and comprising two hollow cylindrical portions of different outer diameters, namely a proximal portion 105 whose outer diameter substantially corresponds to the inside diameter of the receiving housings 8d, 9d provided at the distal portions 8a, 9a of the applicator 8 and of the probe 9, and a distal portion 103 whose outer diameter is greater than that of the proximal portion 105.
- the proximal portion 105 is axially open on the outside at its proximal end and has on its periphery a plurality of radial slots 1051, here six in number, communicating its interior space with the outside.
- the proximal portion 105 has on its outer surface grooves 1052 that do not open into the internal space of the proximal portion 105 in the radial direction and whose bottom has a longitudinal groove 1053 opening axially to the inside of a corresponding slot 1051 on the proximal side, and inside the inner space of the distal portion 103 on the distal side.
- the distal portion 103 is axially open on the outside at its distal end and defines an interior space communicating with the internal space of the proximal portion 105.
- the grooves 1052 formed in the proximal portion 105 extend axially in a proximal portion 1030 of the distal portion 103 and define a plurality of housing 1031 whose utility will be detailed later. These grooves 1052 stop axially inside the proximal portion 1030 of the distal portion 103.
- the housing 1031 has a through opening in their bottom communicating the interior space of the distal portion 103 with the outside so as to provide a space e passage for each associated connecting wire 33 as visible in particular in Figure 5a.
- the proximal portion 1030 of the distal portion 103 also has on its outer surface notches 1032 extending in the axial extension of the housings 1031.
- the distal portion 103 further has an annular groove 1033 and a distal portion 1034.
- the notches 1032 open axially into a housing 1031 proximal and inside the groove 1033 distally.
- the distal portion 103 also has on its periphery a plurality of radial slots 1035 aligned in the circumferential direction with the slots 1051, communicating in the radial direction the interior space of the distal portion 103 with the outside, and opening axially at the level of the distal end of this distal portion 103.
- the utility of these radial slots 1035 will be described in more detail by the following.
- the proximal portion 1030 of the distal portion 103 has a generally cylindrical outer surface in which the housings 1031 are provided to releasably receive internal clamping members 11 here in the form of inner wafers made of a biological material. resorbable, said pads 1 1 being for example received clamping inside said housing 1031.
- the second part of the support body 102 which will here be considered as the movable part, comprises a generally cylindrical element, those 104 having a ogival-shaped distal end 1041, and a rod 106 extending along the longitudinal axis X whose distal end 1061 is connected to the cylindrical element 104, for example by screwing or by press fitting.
- the rod 106 further has a proximal end 1062 adapted to be inserted along the longitudinal axis X through the fixed portion 101 of the support body 1, so as to protrude in the proximal direction beyond the proximal end of said fixed portion 101, and intended to be connected to the applicator 8 for purposes of controlling the displacement of the movable portion 102 relative to the fixed portion 101.
- the cylindrical element 104 has on its periphery a plurality of radial slots 1042, here six in number, communicating its interior space with the outside and aligned in the circumferential direction with the slots 1035 provided on the fixed part 101 of the body of support 1.
- a traversing and anchoring device 3 is arranged between the fixed part 101 and the movable part 102 of the support body 1.
- This device 3 comprises a plurality of needles 31 whose proximal end releasably supports anchoring elements 32 in the form of hollow cylinders received for example with clamping on the distal end of the needle 31 to which it is associated, and on which are fixed the second ends 332 of the connecting son 33, the first end 331 of said son 33 being connected to a traction device advantageously provided at the applicator.
- the hollow anchoring cylinders 32 are made of a bio-resorbable material.
- Each of the needles 31 is supported in a distal portion by a plurality of links, here a proximal link 34 and two distal links 35, articulated to define a deformable parallelogram mechanism.
- the distal links 35 supporting each needle 31 are hinged on the one hand on the movable portion 102 of the support body 1, and secondly on the distal portion of the needle 31 which they support;
- the proximal link 34 is articulated on the one hand on a slide 36 movable in translation along the rod 106 and on the other hand on the distal portion of the needle 31 that it supports.
- An elastic element here in the form of a frustoconical helical spring 37 is also provided to be compressed at least over part of the axial stroke of the slide 36.
- the slider 36 also has a plurality of radial slots 365 permitting a certain clearance of the proximal links 34.
- the radial slits 1042 provided on the cylindrical member 104 of the movable portion 102 of the support body 1 allow a certain clearance distal links 35.
- the support body 1 concentrically receives a hollow rod 70 adapted to be threaded onto the rod 106 of the movable portion 102 of the support body 1, and to be rotatable about the longitudinal axis X with respect to said rod 106.
- An annular ring 71 having a plurality of through holes 71 1 is threaded on the hollow rod 70 in a crazy manner in rotation.
- the rod 70 is put in place inside the proximal portion 101 of the support body 1, the ring 71 is press-fitted to a corresponding bearing surface of said proximal portion 101.
- this hollow rod 70 is integral with a winding mandrel 72 having a plurality of passage holes and attachment 721 for the suture son 44 (not shown in Figure 4).
- the hollow stem 70 has a distal end 701 and a proximal end 702 adapted to be inserted along the longitudinal axis X through the fixed portion 101 of the support body 1, so as to protrude in the proximal direction to the beyond the proximal end of said fixed portion 101, and intended to be connected to the applicator 8 for the purpose of controlling the rod 70.
- the rod 70 and the winding mandrel 72 belong to a clamping device 7 of which the operation will be detailed later.
- the slider 36 of the traversing and anchoring device 3 is mounted to move in translation along the longitudinal axis on a distal portion of the hollow rod 70, and the compression spring 37 bears on one face. radial winding mandrel 72.
- the support body 1 also concentrically receives a stepped element of generally cylindrical shape 50, which can move in translation along the longitudinal axis X with respect to the portion fixed 101 of the support body 1.
- This stepped element 50 is adapted to be threaded onto the hollow rod 70 and has three cylindrical portions of different outer diameters, namely a proximal portion 501, a central portion 502 and a distal portion 503.
- the proximal portion 501 has a proximal end 5012 adapted to be inserted along the longitudinal axis X through the fixed portion 101 of the support body 1, so as to protrude in the proximal direction beyond the end. proximal to said fixed portion 101, and intended to be connected to the applicator 8 for control purposes of the stepped element 50.
- This distal portion 503 has on its outer surface a plurality of radial through slots 507 aligned in the circumferential direction with the channels 504 and whose proximal ends open axially inside the ramps 505.
- each corner 500 has an ejection face 509 belonging to an ejection device 5 and adapted to cooperate with the inner plates 1 1 to eject them in the radial direction outside their housing 1031 like this will be described in more detail later.
- each of these ejection wedges 500 have two branches separated by a through slot 507 and connected at their distal end by a cutting blade 506 belonging to an ejection device 6.
- the corners 500 are inserted inside the slots 1051 provided in the proximal portion 105 of the fixed part 101 of the body 1 and can move inside thereof by sliding on the bottom of the grooves 1052.
- the support body 1 concentrically receives a hollow sleeve 40 movable in translation along the longitudinal axis X with respect to the fixed portion 101 of the support body 1.
- the sleeve 40 has a proximal end 402 adapted to be inserted along the longitudinal axis X through the fixed portion 101 of the support body 1, so as to protrude in the proximal direction beyond the proximal end. of said fixed portion 101, and intended to be connected to the applicator 8 for purposes of controlling movement of the sleeve along the longitudinal axis.
- This sleeve 40 is adapted to be threaded onto the proximal portion 501 of the stepped element 50 and supports a plurality of elastically flexible needles 41 adapted to be inserted inside the channels 504 of the stepped element 50 and for cooperate in operation with the ramps 505.
- each needle releasably supports anchoring elements 42 in the form of hollow cylinders received for example with clamping on the distal end of the needle 41 with which it is associated, and on which are fixed the second ends 442 of the suture threads 44, the first end 441 of said threads 44 being connected to the clamping device 7, and more precisely at the attachment orifices 721 of the winding mandrel 71.
- the sleeve 40, the needles 41 and the stepped element 50 belong to a suture device 4 which will be detailed later. Furthermore, the ejection and cutting devices 6 are here part of this suture device 4.
- the sleeve 40, the needles 41 and the stepped element 50 are part of a suture device 4 whose operation will be detailed later.
- this diameter is smaller than the diameter of the orifice O present on the wall P so as to allow the insertion of the distal portion 1a of the support body through said orifice O.
- the proximal portion 1 a of the body of 1 is inserted along its longitudinal axis X inside the housing 8d defined in the proximal portion 8a of the applicator 8, and the distal portion 1b of the support body 1 extends in the distal direction from said proximal portion 8a of the applicator 8.
- the distal portion 8a of the applicator supports a deployment mechanism 2 comprising a plurality of support elements 23, particularly visible in FIGS. 5a to 5f, releasably supporting external clamping elements 22 intended to be placed facing respective portions of an annular surface S of the wall P centered around the orifice O.
- This deployment mechanism 2 is adapted to move the external clamping elements 22 between a retracted configuration, illustrated in FIG. 5, in which they are folded towards the longitudinal axis X on the side of the proximal end 1 a of the body. support, and an expanded configuration in which they are spaced apart from the longitudinal axis X and extend corolla substantially perpendicular thereto.
- the distal portion 8a of the applicator 8 thus equipped with the support body 1 in initial configuration, and having external clamping elements 22 in folded configuration, may advantageously be inserted through a TR trocar placed on the abdominal wall of the patient, and the control of the different devices can be achieved by means of the proximal portion 8b of said applicator 8 from outside the body of the patient, typically in the context of endoscopic surgery.
- the applicator 8 equipped with the support body 1 is then manipulated by the surgeon to approach the body 1 of the bladder V until the distal portion is introduced.
- the external clamping elements 22, here six in number, are in the form of outer plates made of a bio-resorbable material and are releasably supported on the support members 23, for example by complementarity of form.
- the distal portion 8a of the applicator 8 and the proximal portion 1a of the support body 1 advantageously have indexing means for fixing said support body 1 to the end of the applicator 8 so that the outer plates, supported by the applicator 8, are aligned angularly in the circumferential direction with the inner plates 1 1 supported by the distal portion 1b of the support body 1.
- the deployment mechanism 2 advantageously has a stop element 20 adapted to cooperate with the wall P to limit the insertion of the support body 14 through the orifice O.
- the assembly formed of the distal portion 8a of the applicator 8 and of the support body 1 has a symmetry in rotation about the longitudinal axis X and can be broken down into a plurality of modules identical elementary elements evenly distributed in the circumferential direction.
- this assembly can be broken down into six elementary modules extending in an angular range of approximately 60 ° and each comprising in particular an inner plate 1 1, an outer plate 22, a connecting wire 33 intended to connect the inner plate 1 1 and the outer plate 22 after passing through the wall P, and a suture 44 provided for connecting the inner plate 1 1 and the outer plate 22 after passing through the urethra.
- Figures 5a to 5f illustrate the different steps of preparation of the orifice O by means of the preparation system SP according to the first embodiment of the invention.
- the SP system is partially illustrated in its initial configuration and placed at the level of the orifice O.
- the deployment mechanism 2 is in folded configuration of the outer plate 22 which is supported by a support member 23, the traversing and anchoring device 3 is in a retracted configuration of the second end 332 of the connecting wire 33, this end 332 being located at a radial distance d1 from the longitudinal axis X less than the radius r1 of the orifice O, the inner plate 1 1 is received inside its housing 1031 provided on the support body and the ejection device 5 and cutting 6, formed here a corner 500 is in an inactive configuration.
- the suture device 4 is also in the retracted configuration of the second end 442 of the suture. This device will be implemented in the frame of the second operative phase, or anastomosis phase, and its operation will be described later in connection with Figures 10a to 10c and 1 1. For the sake of clarity, the suture 44 is not shown in Figures 5a to 5f.
- the abutment element 20 is integral with the distal portion 8a of the applicator 8.
- the abutment element 20 rotatably supports a support element 23 which is in the form of a generally Y-shaped fork having a lower branch 231 rotatably mounted on the element of FIG. stop 20 and two upper branches 232 cooperating with a complementary cavity 222 provided on the outer plate 22 to ensure the releasable support of said plate 22 on the support member 23 and visible in particular in Figure 9.
- a support element 23 which is in the form of a generally Y-shaped fork having a lower branch 231 rotatably mounted on the element of FIG. stop 20 and two upper branches 232 cooperating with a complementary cavity 222 provided on the outer plate 22 to ensure the releasable support of said plate 22 on the support member 23 and visible in particular in Figure 9.
- One of these upper branches 232 , as well as part of the cavity 222 are visible in FIG. 5f.
- the lower branch 231 has on its periphery a plurality of meshing teeth adapted to cooperate with a rack provided on a distal portion of a sleeve 24 mounted to move in translation inside the distal portion 8a of the applicator. 8 and which can be controlled from the proximal portion 8b thereof.
- the sleeve 24 may be subdivided into as many subparts as is contemplated successive sequences of deployment, each of these sub-parts being intended to control the deployment one or more clamping elements between the retracted configuration and the deployed configuration, which can be successively controlled from the proximal portion 8b of the applicator 8.
- the support 23 and the outer plate 22 extend substantially parallel to the longitudinal axis.
- FIG. 5a also shows the path of a connecting wire 33 inside the support body 1.
- This wire 33 has a first end 331 adapted to be connected to a traction device not shown and integrated into the applicator 8.
- the wire 33 passes through the proximal portion 1a of the support body 1 within a space provided for this purpose and extends essentially along the hollow rod 70.
- This wire 33 then opens at a free space e provided in the support body 1 and located under the inner plate 1 1 received in its housing 1031.
- the connecting wire 33 then passes through the inner plate 1 1 through a through hole 1, and bifurcates again along the outer surface of the wafer January 1; it then passes through the notch 1032 and is fixed by its second end 332 on an anchoring element 32 releasably supported by a needle 31.
- the sheath 24 having been moved along the arrow F1 on an axial stroke C1, by appropriate control, caused the pivoting of the support member 23, by cooperation of the teeth carried by it and the rack carried by the sheath, until reaching an expanded configuration of the outer wafer 22 in which it extends substantially perpendicular to the longitudinal axis X, facing a portion of the annular surface S of the wall P visible in FIG.
- an anchoring portion 220 formed in the outer plate 22 and adapted to retain the anchoring cylinder 32 on which is fixed the second end of the connecting wire 33, is at a predetermined radial distance d of the longitudinal axis X.
- a traction along the arrow F2 exerted on the rod 106 causes the moving part 102 of the support body 1 to move relative to the fixed part 101 of this body 1 in a first axial stroke up to that the proximal end 1041 of the cylindrical member 104 and a distal abutment face 361 of the slider 36 come into contact.
- This second axial stroke can be defined in different ways, for example as the stroke necessary to move the spring 37 from its free state, that is to say not subject to any constraint, to a compressed state in which its turns are joined. .
- this second axial stroke is dimensioned so that the second end 332 of the connecting wire 33 and the anchor cylinder 32 which supports it passes right through the wall P, and the outer plate 22 in passing through its anchoring portion 220.
- the needle 31 has on its proximal end a tip 310 adapted to perforate the wall P.
- the expansion of the spring causes the return of the traversing and anchoring device 3 in its configuration shown in Figure 5c.
- the needle 31 drops the anchoring cylinder 32 on which is fixed the second end 332 of the connecting wire 33, the cylinder 32 being anchored in the anchoring portion 220 of the plate 22.
- Non-limiting example illustrates an example of cooperation between the anchoring cylinder 32 and the anchoring portion 220.
- the two aforementioned axial strokes cause a compression of the spring 37; thus, by releasing the rod 106 from the configuration of FIG. 5d, the traversing and anchoring device 3 would be brought directly back into its retracted configuration by the expansion of the spring 37.
- a traction force is exerted along the arrow F5 on the first end 331 of the connecting wire 33 by means of the traction device arranged in the applicator 8.
- the traction exerted on this first end 331 is transmitted by the wire 33 at the second end 332 anchored in the outer plate 22 and causes at first the pivoting of the support member 23 carrying the outer plate 22 in the direction of the longitudinal axis X, the distal side of the support body 1. In doing so, the outer plate 22 begins to deform the wall P by contact with a portion of the annular surface S surrounding the orifice O.
- the outer plate 22 deforms the wall P being tightened on the inner plate 1 1 housed in the support body 1; the wall P is then sandwiched between said inner plate 1 1 and said outer plate 22.
- a non-return device is provided between the connecting wire 33 and the inner plate 1 1, this device for preventing the loosening of the outer plate 22 on the inner plate 1 1 when one stops shooting on the first end 331 of the connecting wire 33.
- the connecting wire 33 may for example have a beaded portion cooperating with the through hole 1 10 provided on the inner plate 1 1 to pass the connecting wire 33 to prevent the portion of wire 33 connecting the outer plate 22 to the inner plate 1 1 to relax.
- the deployment mechanism 2 having dropped the outer plate 22, is brought back into its retracted configuration illustrated in Figure 5a by moving the sleeve in the distal direction.
- the applicator 8 is then disconnected from the support body 1 and can be extracted outside the body of the patient by passing through the TR trocar.
- FIG. 6 shows in perspective the tubular portion T formed on the wall P around the orifice O by means of the preparation system SP according to the first embodiment of the invention.
- This tubular portion T extends here between the outer plates 22 and the cylindrical portion of the support body 1 receiving the inner plates 1 January.
- the solicitation means arranged to tighten and juxtapose the outer plates 22 on the support body, and more precisely on the inner plates 1 1 supported by the support body 1, in order to progressively deform the annular surface S of the wall P centered around the orifice O on the one hand, forming on the organic wall P a tubular portion T extending along the longitudinal axis X, and, on the other hand, forming an anchoring flange consisting of said outer plates 22, consist of link 33 associated with a traction device of these son 33.
- the tubular portion T formed on the wall could then be held in shape by mutual contact of the inner plates 1 1 to each other in a circular configuration, or by means of a holding element, for example in the form of a telescopic ring notched, maintaining the inner plates 1 1 and / or external 22 in a circular configuration, and put in place after removal of the support body 1.
- the first tubularization phase of operation is followed by a second anastomosis operative phase for end-to-end reconnection of the patient's urethra to the tubular portion T formed at the level of the orifice made in the wall P of the bladder, by means of the SA anastomosis system proposed by the invention.
- the ejection and cutting devices 6 will thus be actuated only after this reconnection is performed as will be described in more detail below with reference to FIGS. 9, 10a to 10c, 11 and 12.
- connection wires 33 could be provided to cut the connection wires 33 by means of additional ad hoc tool before proceeding to the second operative phase of anastomosis.
- the invention proposes a second embodiment of a preparation system SP 'of the wall P of the bladder for forming thereon a tubular portion T extending from its orifice O.
- This preparation system SP ' according to the second embodiment implements an applicator 8' identical to the applicator 8 of the first embodiment, with the exception of the deployment device 2 'which differs from that of the first embodiment. and whose operation will be detailed, in particular in relation to FIGS. 8a to 8f.
- the support body 1 ' is made of a single hollow portion and of generally cylindrical shape.
- the sleeve 40 ', the needles 41' and the stepped element 50 ' which appear in this figure 7 belong to a suture device 4', and have substantially the same characteristics as the sleeve 40, the needles 41 and the step element 50 described in the context of the first embodiment, in connection with Figure 4; therefore they will not be described further in the context of this second embodiment.
- the ejection devices 5 'and cutting devices 6' visible in FIG. 7 and forming part of the suture device 4 ' are similar to the ejection and cutting devices 6 and have been described in the context of the first embodiment, in connection with Figure 4; therefore they will not be described further in the context of this second embodiment.
- the support body 1 ' has a proximal portion 105' substantially identical to the proximal portion 105 'of the fixed portion 101 of the support body 1 described in detail in particular in connection with Figure 4 and will not be detailed further in the context of the description of the second embodiment.
- the support body 1 ' has a distal portion 103' comprising a proximal portion 1030 'similar to the proximal portion 1030 of the distal portion 103 described in the context of the first embodiment.
- This proximal portion 1030 ' essentially defines receiving housings 1031' for receiving inner plates 1 'open radially outwardly and communicating with the interior space of the support body so as to provide a passage space e' for each connecting wire 33 'associated as visible in particular in Figure 8a.
- the distal portion 103 'of the support body further has a distal portion 1034' of generally frustoconical shape whose diameter is reduced in the direction distal.
- This frustoconical distal portion 1034 ' has a osseous distal end 1036'.
- This distal portion 103 ' also has a plurality of through radial slots 1033' communicating with the outside the interior space it defined. The utility of these slots 1031 'will be detailed later.
- the support body 1 ' according to the second embodiment concentrically receives the suture device 4', mentioned previously, not described in detail, as well as a clamping device 7 'and a traversing and anchoring device 3 .
- the traversing and anchoring device 3 ' is in the form of a rod 106' extending along the longitudinal axis X and movable in translation along this axis relative to the support body 1 '.
- This rod 106 ' has a distal heel 1061' supporting a plurality of elastically flexible needles 31, said needles 31 each releasably supporting on their proximal end an anchoring element 32 'on which is fixed the second end 332' d ' an associated wire 33 '.
- Each anchoring element 32 ' is here in the form of a cylinder whose proximal end is frustoconical and which has a housing for receiving the proximal end of the needle 31' with which it is associated.
- the rod 106 'further has a proximal end 1062' adapted to protrude in the proximal direction beyond the proximal end of the support body, and to be connected to the applicator 8 'for purposes of movement control of said rod 106 '.
- the traversing and anchoring device 3 ' further comprises an element 36' defining a ramp 360 'for the flexible needles 31'; it is here in the form of an element of revolution having a distal end 361 'of smaller diameter and a proximal end 362' of larger diameter.
- the diameter of the element 36 ' progressively increases in the proximal direction between its distal end 361' and its proximal end 362 '.
- This element 36 ' is integrally mounted on a distal end 701' of a winding mandrel formed in this second embodiment of a hollow rod 70 'terminating at its distal end by an annular collar 72 having a plurality of passage and attachment holes 721 'for the suture threads 44' (not shown in FIG. 7).
- This hollow rod 70 ' is adapted to be threaded onto the rod 106' and to be rotatable thereon about the longitudinal axis. Once in place with the stem 106 'within the support body 1', the proximal end 702 'of this hollow stem 70' protrudes in the proximal direction beyond the proximal end. of the support body 1 ', and is intended to be connected to the applicator 8' for the purpose of controlling the rod 70 '.
- the stepped element 50 ' is adapted to be threaded on the hollow rod 70', and the sleeve 40 'carrying the flexible needles 41' is adapted to be threaded onto the step element 50 .
- the assembly thus formed comprises the traversing and anchoring device 3 ', the clamping device 7' and the suture device 4 '. This assembly is intended to be inserted inside the support body 1 '.
- proximal of the support body 1 ' is intended to be connected to the applicator 8' for the purpose of controlling the suture device 4 '.
- all the elements supported by the support body 1 ' when they are in their initial configurations, fit inside a cylindrical envelope of which the diameter corresponds to the largest outside diameter of the distal portion 103 'of the support body 1'.
- This diameter is preferably smaller than the diameter of the orifice O present on the wall P so as to allow the insertion of the distal portion 1 a 'of the support body through said orifice O.
- the proximal portion 1 a 'of the support body 1' is inserted along its longitudinal axis X inside the housing 8d 'defined in the proximal portion 8a' of the applicator 8 ', and the distal portion 1b' of the support body 1 'extends distally from said proximal portion 8a' of the applicator 8 '.
- the distal portion 8a' of the applicator supports a deployment mechanism 2 'comprising a plurality of elements of FIG. 23 'support, visible in particular in Figures 8a to 8f, releasably support external clamping elements 22' intended to be placed opposite and then in contact with respective portions of an annular surface S of the wall P centered around the orifice O.
- This deployment mechanism 2 ' is adapted to move the outer clamping elements 22' between a retracted configuration, illustrated in FIG. 8, in which they are folded towards the longitudinal axis X on the side of the proximal end 1a. 1 ', a deployed configuration in which they are spaced apart from the longitudinal axis X and extend in a corolla substantially perpendicular thereto, and a folded configuration in which they are folded in the direction of the longitudinal axis X on the side of the distal end of the support body 1 'by deforming the wall P, as will be explained in more detail in connection with Figures 8a to 8f.
- the distal portion 8a 'of the applicator 8' thus equipped with the support body 1 'in initial configuration, and having external clamping elements 22' in folded configuration, can advantageously be inserted through a TR trocar placed on the abdominal wall of the patient, and the control of the different devices can be achieved by means of the proximal portion 8b 'of said applicator 8' from outside the body of the patient, typically in the context of endoscopic surgery.
- the applicator 8 'equipped with the support body 1' is then manipulated by the surgeon to approach the body 1 'of the bladder V, until the distal portion 1a' of said body is introduced through the orifice O formed in the wall P, centering the longitudinal axis X inside this hole O and first engaging the distal end 1036 '.
- the external clamping elements 22 ' are in the form of outer plates made of a bio-resorbable material and are releasably supported on the support members 23', for example by complementarity of shape.
- the distal portion 8a 'of the applicator 8' and the proximal portion 1a 'of the support body 1' advantageously have indexing means for fixing said support body 1 'to the end of the applicator 8 of so that the outer plates 22 ', supported by the applicator 8', are aligned angularly in the circumferential direction with the inner plates 1 'supported by the distal portion 1b' of the support body 1 '.
- the assembly formed of the distal portion 8a 'of the applicator 8' and of the support body 1 ' has a symmetry in rotation about the longitudinal axis X and can be decomposed into a a plurality of identical elementary modules regularly distributed in the circumferential direction.
- this assembly can be decomposed into six elementary modules extending in an angular range of about 60 ° and each including an inner plate 1 ', an outer plate 22', a connecting wire 33 ' provided for connecting the inner wafer 11 'and the outer wafer 22' after passing through the wall P, and a suture 44 'provided for connecting the inner wafer 11' and the outer wafer
- FIGS. 8a to 8f thus illustrate only one of these modules. The reader will understand that what is visible in these figures also applies to each of the other five modules.
- Figures 8a to 8f illustrate the different steps of preparing the orifice O by means of the preparation system SP 'according to the second embodiment of the invention.
- FIG. 8a the system SP 'has been partially illustrated in its initial configuration and put in place at the orifice O.
- the 2 'deployment mechanism is in folded configuration of the outer plate 22' which is supported by a support member 23 ', the crossing device and anchor 3' is in the retracted configuration of the second end 332 'of the wire link 33 ', this end 332' being at a radial distance d1 'of the longitudinal axis X less than the radius r1 of the orifice O, the inner plate 1 1' is received inside its housing 1031 ' provided on the support body 1 'and the ejection device 5' and cutting 6 ', formed here of a corner 500', is in an inactive configuration.
- the suture device 4 ' is also in the retracted configuration of the second end 442' of the suture.
- This device will be implemented as part of the second operative phase, or anastomosis phase, and its operation will be described later in connection with Figures 10a to 10c and 11.
- the suture 44 ' is not shown in Figures 8a to 8f.
- the support body 1 ' has been inserted through the orifice O until a positioning element 20' arrives in the vicinity the outer surface, or proximal surface, of the P-wall.
- the positioning element 20 ' is integral with the distal portion 8a' of the applicator 8 '.
- the positioning element 20 ' rotatably supports a support element 23' which is in the form of a generally Y-shaped fork having a lower branch 231 'rotatably mounted on the positioning element 20 'and two upper branches 232' cooperating with a complementary cavity 222 'provided on the outer plate 22' to ensure the releasable support of said wafer 22 'on the support member 23'.
- a support element 23' which is in the form of a generally Y-shaped fork having a lower branch 231 'rotatably mounted on the positioning element 20 'and two upper branches 232' cooperating with a complementary cavity 222 'provided on the outer plate 22' to ensure the releasable support of said wafer 22 'on the support member 23'.
- One of these upper branches 232 ', as well as part of the cavity 222' are visible in FIG. 8f.
- the lower branch 231 ' has on its periphery a plurality of meshing teeth adapted to cooperate with a rack provided on a distal portion of a sleeve 24' mounted to be movable in translation inside the distal portion 8a 'of the applicator 8 'and which can be controlled from the proximal portion 8b' thereof.
- the sheath 24 can be subdivided into as many subparts as is envisaged for successive deployment sequences, each of these sub-parts being intended to control the deployment of one or more clamping elements between the retracted configuration, the expanded configuration and the folded configuration, and can be successively controlled from the proximal portion 8b of the applicator 8.
- the support 23' and the outer plate 22 ' extend substantially parallel to the longitudinal axis.
- FIG. 8a also shows the path of a connecting wire 33 'inside the support body 1'.
- This wire 33 ' has a first end 331' adapted to be connected to a not shown traction device and integrated into the applicator 8 '.
- the wire 3'3 passes through the proximal portion 1a 'of the support body 1' within a space provided for this purpose and extends essentially along the hollow rod 70 '.
- This wire 33 'then opens at a free space e' provided in the support body 1 'and located under the inner plate 1 1' received in its housing 1031 '.
- the connecting wire 33 'then passes through the inner plate 1 1' passing through a hole 1 10 'through, and bifurcates again along the outer surface of the wafer 1 1'; it then passes through the notch 1032 'and is fixed by its second end 332' on an anchoring element 32 'releasably supported by a flexible needle 31'.
- At least one hooking tooth or hook 223 ' provided on the outer plate 22' hooks a portion of the annular surface S of the wall P visible in FIG. 7.
- the sheath 24 ' having been further moved along the arrow F2' over an axial stroke C2 ', by appropriate control, caused the pivoting of the support member 23', by cooperation of the fitted teeth. by it and the rack carried by the sleeve, to reach a folded configuration of the outer plate 22 'in which it is folded towards the longitudinal axis X on the side of the distal end of the body of support.
- the tooth 223 ' having hooked the wall P, the outer plate 22 drives a portion of the surface annular S of the wall P in its folding movement and the deformed so as to press on the support body, and more precisely on the inner plate 1 1 '.
- the biasing means arranged to tighten and juxtapose the outer plates 22 'on the support body 1', and more precisely on the inner plates 1 1 'supported by the support body 1', in order to progressively deform the annular surface S of the wall P centered around the orifice O so as, on the one hand, to shape on the organic wall P a tubular portion T extending along the longitudinal axis X, and, on the other hand, forming an anchor flange consisting of said outer plates 22 ', comprise the deployment mechanism 2'.
- Figure 8d illustrates a subsequent step of operation of the preparation system SP 'according to the second embodiment of the invention. During this step, it is sought to maintain or lock the outer plate 22 'and the inner plate 1 1' enclosing the wall P in the configuration shown in Figure 8c by means of a connecting wire 33 connecting said inner plates and external 1 1 ', 22'.
- the traversing and anchoring mechanism 3 ' is actuated so as to pass the second end 332' of its retracted configuration in which it is situated at a radial distance d1 'from the longitudinal axis X, visible through example in Figure 8c, its anchored configuration in which it is retained on the outer plate 22 after passing through the wall P.
- This actuation is here carried out by moving the rod 106 'according to the arrow F3' on a stroke C3 '.
- This displacement of the rod 106 ' drives the flexible needle 31' in axial translation via the heel 1061 '.
- the flexible needle 31 ' bends outwardly in the radial direction, passes through a through slot 1033' formed in the support body 1 and obliquely crosses the tubular portion T formed on the wall P, as well as the anchoring portion 220 'provided on the outer plate 22.
- the stroke C3 'of displacement of the rod 106' will be appropriately sized so that the second end 332 'of the connecting wire 33' and the anchor cylinder 32 'which supports it passes right through the wall P, and than the outer plate 22 'passing through its anchoring portion 220'.
- the needle 31 ' has on its proximal end a tip 310' adapted to perforate the wall P.
- the needle 31 Drops the anchoring cylinder 32' on which is fixed the second end 332 'of the connecting wire 33', the cylinder 32 'coming to anchor in the anchoring portion 220 'of the outer wafer 22'.
- a traction force is exerted along the arrow F5 'on the first end 331' of the connecting wire 33 'by means of the traction device arranged in the applicator 8'.
- a non-return device is provided between the connecting wire 33 'and the inner plate 1 1', this device for preventing loosening of the outer plate 22 'on the inner plate 1 1' when stopping pulling on the first end 331 'of the connecting wire 33'.
- the connecting wire 33 ' may for example have a beaded portion cooperating with the through hole 1 10' provided on the inner plate 1 1 'to pass the connecting wire 33' to prevent the portion of 33 'wire connecting the outer plate 22' to the inner plate 1 1 'to relax.
- the sleeve 24 ' is displaced in the distal direction along the arrow F6' so as to cause the pivoting of the support member 23 to a folded position towards the longitudinal axis X, the proximal side of the support body 1 '.
- This pivoting causes the release of the releasable attachment of the outer plate 22 'on the support member 23', the upper branches 232 'of the fork formed by said support member 23' coming out of the complementary cavity 222 'provided on the outer plate 22 '.
- the applicator 8 is then disconnected from the support body 1 and can be extracted outside the body of the patient by passing through the TR trocar.
- the solicitation means arranged to tighten and juxtapose the outer plates 22 'on the support body 1', and more precisely on the inner plates 1 1 'supported by the support body 1', in order to progressively deform the annular surface S of the wall P centered around the orifice O to, on the one hand, shape on the organic wall P a tubular portion T extending along the longitudinal axis X, and, on the other hand, form an anchoring flange consisting of said outer plates 22 ', comprise the connecting son 33' associated with a traction device of these son 33 ', in addition to the deployment mechanism 2'.
- the tubular portion T formed on the wall could then be held in shape by mutual contact of the inner plates 1 '' is kept between them in a circular configuration, or by means of a holding element, for example in the form of a notched telescopic ring, holding the inner plates 1 'and / or outer 22' in a circular configuration, and put in place after removal of the support body 1 '.
- a holding element for example in the form of a notched telescopic ring
- the first tubularization phase of operation is followed by a second anastomosis operative phase for end-to-end reconnection of the patient's urethra to the tubular portion T formed at the level of the orifice made in the wall P of the bladder, by means of the SA anastomosis system proposed by the invention.
- the urethral probe 9 is inserted inside the urethra so that its distal end 9a is at the end E of the urethra C.
- the distal end 9a of the probe is advantageously provided with a domed cap which, once the probe is positioned, is released by the surgeon by an ad hoc additional tool.
- the surgeon then brings the tubular portion T formed on the wall P of the bladder and the end E of the urethra C. closer together.
- the surgeon will be able to pull on the support body 1 or on the outer plates 24 along the arrow F illustrated in Figure 9 to bring the two organs to be anastomosed so that the mucosa of their respective bank are facing in the axial direction.
- the distal portion 9a of the probe 9 and the proximal portion 1a of the support body 1 advantageously have indexing means for fixing said support body 1 to the end of the probe 9 so that the flexible needles 41, supported by the support body 1, are aligned angularly in the circumferential direction with the through slots 95 provided on the distal portion 9a of the probe 9.
- the suture device 4 is in the retracted configuration of the second ends 442 of the suture elements 44, which is here in the form of threads, preferably made of a bio-resorbable material.
- the flexible needles 41 releasably supporting hollow cylinders 42 on which are fixed the second ends 442 of the suture threads 44, are housed inside the longitudinal channels 504 provided in the step element 50 and visible in particular in Figure 4.
- the second ends 442 of the suture son 44 are then at a radial distance d2 (visible in Figure 10c) lower than the inner radius r2 of the urethra C.
- FIGS. 10a to 10c again, only one elementary module has been shown. It will be understood that the description made in connection with this elementary module, apply to the other five, regularly distributed in the circumferential direction.
- the suture device 4 is illustrated after the flexible needle 41 has been displaced along the arrow F6 by acting on the proximal end 402 of the support sleeve 40.
- the flexible needle 41 then bent outward in the radial direction so as to pass through a through slot 1051 formed in the proximal portion 105 of the fixed portion 101 of the support body 1 and then through a through slot 95 formed in the distal portion 9a of the probe 9 and obliquely crossed the end E of the urethra C.
- the axial displacement stroke of the sleeve 40 will be appropriately sized so that the second end 442 of the suture 44 and the anchor cylinder 42 which supports it pass right through the end E of the urethra C.
- the needle 41 has on its proximal end a tip 410 adapted to perforate the wall P.
- the suture device 4 is in an expanded intermediate configuration, in which the second end 442 of the suture 44 is opposite an anchoring portion 224, visible for example on Figure 9, provided on the associated outer plate 22.
- This wire 44 has a first end 441 connected rearwardly in the distal direction of an orifice 721 provided on the winding mandrel 72. The wire 44 then extends in the distal direction and passes successively through the wire. orifice 721, an orifice 71 1 formed on the annular ring 71 integral with the support body 1, passes through the inner plate 1 1 via a passage 120 formed for this purpose therein. The wire 44 then extends to the flexible needle 41 and runs along it until it reaches the level of the anchoring cylinder 42, on which its second end 442 is fixed.
- the wire 44 opens out of the passage 120 on the distal side of the inner plate 1 1, runs inside the through slot 507 formed in the corner 500 and opens inside the channel 504 at the ramp 505.
- step element 50 to which ramp 505 belongs, has been moved along arrow F7 by acting on its proximal end 5012 connected to probe 9, to reach a second axial position.
- the flexible needle 41 is no longer in contact with the ramp 505, folds by springback in the direction of the longitudinal axis; in doing so, the needle 41 slightly deforms the end E of the urethra C and further anchors the anchoring cylinder 42 supporting the second end 442 of the suture within the complementary anchoring portion 224 provided on the outer plate 22.
- the winding mandrel 72 is rotated via the hollow rod 70 connected at its proximal end 702 to the probe 9.
- This mandrel 72 then drives the first end 441 of the suture 44 and the latter is wound on the body of the mandrel 72.
- the end-to-end anastomosis is tightened between the tubular portion T of the wall P of the bladder V and the end E of the urethra C.
- the winding mandrel 72 will be associated with a system torque limiting device, arranged in the probe 9 rotating the hollow rod 70 integral with the mandrel 72, or directly by a torque limiting device, for example a calibrated sliding / friction device arranged between said rod 70 and said mandrel 72
- a torque limiting device for example a calibrated sliding / friction device arranged between said rod 70 and said mandrel 72
- a non-return device is provided between the suture 44 and the inner plate 1 1, this device making it possible to prevent the loosening of the wire 44 and the anastomosis performed when the first end is stopped. 441 of the suture 44.
- the suture 44 may for example have a pearled portion cooperating with the passage 120 provided on the inner plate 1 1 to pass the suture 44 to prevent the portion of wire 44 connecting the outer plate 22 to the inner plate 1 1 via the urethra C to relax.
- Figure 1 1 illustrates a step of ejecting the inner plate 1 1 and cutting the connecting son 33 and suture 44.
- the stepped element 50 is moved axially along the arrow F9 in Figure 1 1, until the ejection face 509 of the wedge 500 comes into contact with the inner plate 1 January.
- the ejection face 509 having a slope, then moves the inner plate 1 1 in the radial direction so as to get it out of its housing 1031 provided in the support body 1.
- the inner plate 1 1 slightly compresses the wall P of the bladder at the tubular portion T as clearly visible in Figure 1 1.
- the wedge 500 engages via its cutting blade 506 with the suture 44 and with the binding wire 33 and then jams them and cuts them against a radial face, belonging by example to the annular ring 71 secured to the support body 1.
- the inner plate 1 1 having been ejected from the support body and the connecting son 33 and suture 44 having been cut behind the inner plate 1 1, the support body 1 can be released from the intervention zone and the patient's body by means of the probe.
- the elements left in place inside the body of the patient are then limited to six inner plates 1 1, six outer plates 22, six son 33 each having at their end an anchoring cylinder 32 and six suture threads 44 each having at their end an anchoring cylinder 42, all of these elements being of preferably made of a bio-resorbable material.
- an external clamping element 22 ' can be considered to define on the wall P a tubular portion, implementing one or more external clamping elements 22 '.
- an external clamping element in the form of an elastically deformable ring having a plurality of anchoring portions regularly distributed in the circumferential direction intended to receive the anchoring elements of the connecting wires. and suture, and set up by threading it around the clad wall P, for example manually on a cylindrical portion of the support body.
- this ring serves as an anchoring flange for the binding and suture threads.
Abstract
Description
Claims
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
FR1200732A FR2987737B1 (fr) | 2012-03-09 | 2012-03-09 | Systeme pour realiser une anastomose entre une paroi et un conduit |
PCT/FR2013/050510 WO2013132200A1 (fr) | 2012-03-09 | 2013-03-11 | Systeme pour realiser une anastomose entre une paroi et un conduit organique |
Publications (1)
Publication Number | Publication Date |
---|---|
EP2822479A1 true EP2822479A1 (fr) | 2015-01-14 |
Family
ID=48083479
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
EP13715299.7A Withdrawn EP2822479A1 (fr) | 2012-03-09 | 2013-03-11 | Systeme pour realiser une anastomose entre une paroi et un conduit organique |
Country Status (4)
Country | Link |
---|---|
US (1) | US20150032133A1 (fr) |
EP (1) | EP2822479A1 (fr) |
FR (1) | FR2987737B1 (fr) |
WO (1) | WO2013132200A1 (fr) |
Families Citing this family (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US10639027B2 (en) * | 2015-10-27 | 2020-05-05 | Ethicon Llc | Suturing instrument cartridge with torque limiting features |
WO2018087769A1 (fr) * | 2016-11-13 | 2018-05-17 | Anchora Medical Ltd. | Dispositif de suture de tissu à invasion minimale |
Family Cites Families (7)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6562052B2 (en) * | 1995-08-24 | 2003-05-13 | Sutura, Inc. | Suturing device and method |
US20020055751A1 (en) * | 2000-11-09 | 2002-05-09 | Schraft Rolf Dieter | Device and procedure for joining hollow organs |
ES2356733T3 (es) * | 2003-04-16 | 2011-04-12 | Tyco Healthcare Group Lp | Aparato para la anastomosis en prostatectomía radical que incluye un anclaje para aplicar un vaso corporal y suturas desplegables. |
US7449024B2 (en) * | 2003-12-23 | 2008-11-11 | Abbott Laboratories | Suturing device with split arm and method of suturing tissue |
US20060253126A1 (en) * | 2005-05-04 | 2006-11-09 | Bernard Medical, Llc | Endoluminal suturing device and method |
US8834498B2 (en) | 2006-11-10 | 2014-09-16 | Ethicon Endo-Surgery, Inc. | Method and device for effecting anastomosis of hollow organ structures using adhesive and fasteners |
US8241305B2 (en) * | 2008-05-08 | 2012-08-14 | Biomet Sports Medicine, Llc | Method for repairing a meniscal tear |
-
2012
- 2012-03-09 FR FR1200732A patent/FR2987737B1/fr not_active Expired - Fee Related
-
2013
- 2013-03-11 EP EP13715299.7A patent/EP2822479A1/fr not_active Withdrawn
- 2013-03-11 WO PCT/FR2013/050510 patent/WO2013132200A1/fr active Application Filing
- 2013-03-11 US US14/383,440 patent/US20150032133A1/en not_active Abandoned
Non-Patent Citations (1)
Title |
---|
See references of WO2013132200A1 * |
Also Published As
Publication number | Publication date |
---|---|
FR2987737A1 (fr) | 2013-09-13 |
US20150032133A1 (en) | 2015-01-29 |
FR2987737B1 (fr) | 2014-04-18 |
WO2013132200A1 (fr) | 2013-09-12 |
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