EP3145417A1

EP3145417A1 - Laparoscopic spray applicator and adapter

Info

Publication number: EP3145417A1
Application number: EP15719450.7A
Authority: EP
Inventors: Beat Mathys; Andy Greter
Original assignee: Medmix Systems AG
Current assignee: Medmix Systems AG
Priority date: 2014-05-22
Filing date: 2015-04-22
Publication date: 2017-03-29
Also published as: WO2015176905A8; US20170100115A1; WO2015176905A1; CH709684A1; CN106535778A

Abstract

The invention relates to an applicator (1) for spraying at least two components using a compressed gas in the interior of the body of a patient, said applicator being suitable in particular for laparoscopic applications. The applicator has a connecting piece (3) for connection of the applicator to two reservoirs for the components and for delivery of a compressed gas. A multi-lumen tube (4) extends from the connecting piece to a spray head (5). A flexible wire is fixed in a first lumen which extends off-centre. The applicator has at least one adapter (7). Said adapter has two tube connectors which are introduced into two further lumina. These two further lumina likewise extend off-centre and are offset in the circumferential direction from the lumen which receives the wire. A further lumen can optionally extend centrally and can receive a second wire. Identical adapters can be provided at both ends of the multi-lumen tube.

Description

TITLE

Laparoscopic spray applicator and adapter

TECHNICAL FIELD The present invention relates to an applicator for spraying at least two components using a pressurized gas inside the body of a patient and an adapter for use in such an applicator.

STATE OF THE ART

Minimally invasive surgical procedures have become indispensable in medical practice. In such procedures, surgical instruments are inserted through small incisions in the body. An important class of minimally invasive procedures are laparoscopic procedures. In these procedures, surgical instruments are inserted through the abdominal wall into the abdominal cavity of the patient to perform procedures on organs accessible from the abdominal cavity.

A particular challenge in minimally invasive surgical procedures is the ability to stop bleeding that may occur inside the body as part of the surgical procedure. In particular, it is very difficult to close incisions and other internal body lesions by a surgical suture, as is common in traditional surgical procedures.

In recent years, it has become increasingly established to use tissue glue to stop bleeding. Most such tissue adhesive consist of two or more components that react very quickly with each other and therefore need to be kept separate from each other until immediately before their application. A well-known example is fibrin glue containing the components thrombin and fibrinogen. As soon as the Components of such a tissue adhesive are mixed, they coagulate very quickly and then can no longer be applied.

Tissue adhesives can be applied by spraying using a spray nozzle. The components of the tissue adhesive should preferably be mixed with each other just before the spray nozzle, in the spray nozzle itself or even after leaving the spray nozzle.

Another important task in minimally invasive procedures is to prevent tissue areas inside the body from growing together uncontrollably (adhesion). Adhesion is one of the most common complications after abdominal surgery. Effective adhesion prevention is therefore essential even in laparoscopic surgery. Adhesion barriers can be used for adhesion prevention. These are (often gelatinous) substances that are applied to affected tissue areas to prevent growth of other tissues. Adhesion barriers can, like tissue adhesives, be advantageously applied by spraying. Adhesion barriers can also be formed from two components, which are preferably mixed only immediately before or during the application. In this respect, the application of adhesion barriers poses tasks similar to the application of tissue adhesives.

Various applicators for the spraying of two-component systems in laparoscopic use have become known from the prior art. A first example of a laparoscopic spray applicator is disclosed in US 7,682,336. Here are two rigid tubes surrounded by a rigid, cylindrical sleeve. The two components of a tissue adhesive are passed through the tubes to a replaceable spray head while a pressurized gas is passed through the gap between the tubes and the sleeve to the spray head. The components are mixed in the spray head and sprayed by means of the compressed gas. This applicator has the disadvantage that it is completely rigid. As a result, it is only possible to spray in the direction of the longitudinal axis of the sleeve. Hard to reach areas inside the body may therefore not be reached with this applicator. Another example of a spray applicator for laparoscopic applications is disclosed in US 8,303,531. The applicator has a sleeve in which a flexible multi-lumen tube is arranged. The multi-lumen tube protrudes distally beyond the sleeve. The multi-lumen tube has a central lumen and, distributed over the circumference, four decentralized lumens. In the central lumen a flexible wire is inserted. Ports are provided at the proximal end of the sleeve to connect the applicator to a multiple syringe and a pressurized gas source. From there, the components of the spray and the pressurized gas are passed through the lumens of the multi-lumen tube to a spray head at the distal end of the multi-lumen tube. In the spray head, the components are mixed with the compressed gas and sprayed. The distal portion of the multi-lumen tube, which extends beyond the sleeve, can be bent. This makes it possible to spray with this applicator in a direction that does not extend along the longitudinal axis of the sleeve. However, it is difficult to precisely adjust the orientation of the bent portion with respect to rotation about the longitudinal axis of the sleeve (ie, the azimuthal angle of the bent portion). In addition, it has been shown that the bent region can abruptly change its azimuthal orientation when torsional forces act on the distal end of the applicator. The document also does not show in detail how the connector housing and the spray head are connected to the flexible multi-lumen tube. It can be difficult to make a reliable connection at these locations.

SUMMARY OF THE INVENTION In a first aspect, the invention provides an applicator for spraying at least two components using a pressurized gas in the bodyimaging of a patient, which despite its compact dimensions can be easily manufactured and enables reliable operation. The proposed applicator has:

a connector for connecting the applicator with reservoirs for the components and for supplying a pressurized gas to the applicator;

a multi-lumen tube defining a central longitudinal axis with a proximal end connected to the fitting and a distal end; a spray head disposed at the distal end of the multi-lumen tube, and

at least one first flexible wire disposed in a first lumen of the multi-lumen tube.

To facilitate assembly, the applicator has at least one adapter located at the proximal or distal end of the multi-lumen tube to connect the multi-lumen tube to the fitting or to the spray head. The adapter has two hose connectors inserted into a second and a third lumen of the multi-lumen tube. The second and the third lumen serve for fluid guidance. These are preferably those lumens which carry the components to be sprayed. Each of these lumens preferably communicates with a respective reservoir connection on the connection piece. These two lumens are decentralized with respect to the longitudinal axis. They also preferably extend diametrically opposite each other with respect to the longitudinal axis. The first lumen, in which the first flexible wire is arranged, according to the invention also extends decentrally with respect to the longitudinal axis. It also extends circumferentially offset to the second and third lumens. This decentralized and circumferentially offset arrangement of the wire-guiding first lumen makes it possible to provide a sufficiently large cross-section for the component-guiding lumina without excessively enlarging the outer diameter of the multi-lumen tube.

The second and third lumens preferably each have a larger cross-section than the first lumen. When the second and third lumens are diametrically opposite each other, the first lumen preferably extends about 90 ° (eg, 80 ° - 100 °) about the longitudinal axis offset from the second and third lumens. In other words, the second and third lumens together define, in a diametrically opposed arrangement, a first plane containing the central axes of these two lumens and the central longitudinal axis of the multi-lumen tube. Then, the central axis of the first lumen preferably extends in a second plane which contains the central longitudinal axis of the multilumen tube and which is perpendicular to the first plane. In addition, further lumens may be provided, in particular a fourth lumen for the compressed gas guide, which communicates with a compressed gas connection on the connection piece. The lumen for the compressed gas guide preferably runs diametrically opposite the first lumen, which receives the wire.

The invention solves a dilemma between the demand for simple manufacture and the requirement for compact dimensions. Although the adapter facilitates production, reliable fluid guidance is achieved. On the other hand, the cross-section of those lumens of the multi-lumen tube, which are provided for fluid guidance, must be large enough to accommodate the hose connections of the adapter. This in turn is contrary to the requirement that the multi-lumen tube should have the smallest possible outside diameter. This outer diameter determines the size of the body opening, which must be created to introduce the applicator inside the body. By placing the wire-guiding lumen in a decentralized manner, space is created for an enlarged cross-section of the component-guiding lumens, without enlarging the outer diameter of the multi-lumen tube.

Preferably, the applicator on two adapters, which are the same structure and preferably even completely identical. In this case, one of the two adapters is located at the proximal end of the multi-lumen tube to connect the multi-lumen tube to the fitting, and the other adapter is positioned at the distal end of the multi-lumen tube to connect the multi-lumen tube to the spray head. This construction of the applicator assembly and storage are additionally facilitated because on the one hand can be used at both ends with adapters and on the other hand, only a single type of adapter is required.

The first flexible wire is preferably at least partially fixed in the multi-lumen tube (ie secured against any movements such as rotation or displacement relative to the multi-lumen tube), in particular glued to the multi-lumen tube or poured into the multi-lumen tube or extruded. When the wire is bonded to the multilumen tube, a suitable adhesive may be present along at least one or more portions of the wire between the wire and the shell wall of the first lumen. The adhesive is preferably a UV-curing adhesive, and the multi-lumen tube is in this case preferably transparent to UV light. The wire is preferably fixed at least at its ends, particularly preferably substantially along its entire length in the multi-lumen tube. The fixation ensures that the bent portion of the multi-lumen tube maintains its orientation relative to the fitting even when torsional forces are applied to the distal portion of the applicator.

Such a fixation of the wire in the lumen is advantageous regardless of whether the applicator has an adapter of the type shown above, and regardless of how the lumens of the multi-lumen tube are arranged.

In some embodiments, the applicator may include a second flexible wire disposed in another lumen of the multi-lumen tube. The second wire is preferably also fixed at least in sections, preferably at least at its ends, particularly preferably along its entire length in the multilumen tube, as described above. The further lumen can run centrally along the longitudinal axis. In this case, although this lumen requires additional space in the center between the lumens for fluid guidance; but other benefits are achieved, which compensate for this disadvantage a bit. Thus, by the presence of two parallel wires, in particular, it is achieved that the bending moment required to bend the multi-lumen tube is different in different directions (i.e., anisotropic with respect to the azimuthal direction). The bending moment is greater for bending movements that take place in a plane passing through both wires than for movement in a plane perpendicular thereto. This can e.g. can be specifically exploited before the application to bend the multi-lumen tube only in the last-mentioned level targeted. For this purpose, a relatively low bending moment, ie a relatively small force is required, which can be easily applied by the user. Unwanted lateral movements of the bent portion in the plane passing through both wires are then minimized during application due to the much higher bending moment required for this.

In particular, the adapter can be constructed as follows: it has a base body, which defines a first side and a second side with respect to a longitudinal direction. The mentioned first and second hose connection are on the first side of the base body (preferably substantially parallel to the longitudinal direction). The adapter also has first and second inlet / outlet ports. These stand on the second side of the base body (preferably substantially parallel to the longitudinal direction). They are each designed to be inserted into an opening of another element. A first component channel passes through the base body and connects the first hose connection to the first inlet / outlet port. Similarly, a second component passage also passes through the base body and connects the second hose port to the second inlet / outlet port. In addition, the adapter has at least one compressed gas channel which connects the first side and the second side of the base body. This is designed to communicate with a decentralized lumen for pressurized gas guidance. When such an adapter is positioned at the distal end of the multi-lumen tube to connect the multi-lumen tube to the spray head, the applicator in this region may be formed as follows: The spray head may include a spray head insert and a spray head cap. The spray head insert then has a first component inlet into which the first inlet / outlet port of the adapter is inserted and a second component inlet into which the second inlet / outlet port of the adapter is inserted. The spray head insert can also have at least one lateral recess, which is formed such that the spray head insert in the region of the lateral recess defines, together with the spray head cap and the adapter, a cavity into which the pressurized gas passes from the pressurized gas channel of the adapter after it has exited exits the spray head. In this way, a clean guidance of the components are achieved by the spray head and a uniform pressure gas distribution.

The jacket wall of the spray head cap can radially surround the multi-lumen tube at its distal end. It is advantageous if the spray head cap is glued in the region of the jacket wall by means of an adhesive with the multi-lumen tube. The adhesive is preferably UV-curing. At least the jacket wall of the spray head cap is then preferably transparent to UV light. The component and gas routing at the tip of the spray head is preferably as follows: The spray head insert has a first component channel which is connected to the first component inlet and forms a first component outlet at the spray head tip. Accordingly, the spray head insert has a second component channel which is connected to the second component inlet and forms a second component outlet at the spray head tip. Between the spray head insert and the spray head cap a plurality of gas outlet channels are formed, which open out of the spray head in a region adjacent to the component outlets.

When an adapter of the above type is arranged at the proximal end of the multi-lumen tube to connect the fitting to the multi-lumen tube, the applicator in this region may be formed as follows: The fitting has first and second reservoir ports for connection to the reservoirs and one Compressed gas connection for supplying the compressed gas. The adapter then connects the reservoir ports to the multi-lumen hose. The connection piece can have a tubular holding region with an open distal end and a proximal end. The compressed gas connection opens in this case into the interior of the tubular holding area. The multi-lumen tube is then inserted from the open distal end into the tube-like holding area. The fitting has at the proximal end of the retention portion a first component supply port communicating with the first reservoir port and into which the first inlet / outlet port of the adapter is inserted. Accordingly, the fitting at the proximal end of the holding portion also has a second component supply port which communicates with the second reservoir port and into which the second inlet / outlet port of the adapter is inserted. The multi-lumen hose has a lateral opening in the area of the compressed gas connection which connects the compressed gas connection with one of the lumens of the multi-lumen hose. In this way, a simple and clean feeding of the components are achieved to Multilumenschlauch and a reliable compressed gas supply.

It is advantageous if the multi-lumen tube and the adapter are fixed in an area located proximally of the lateral opening by an adhesive in the holding area. In addition, it is advantageous if the multi-lumen tube is fixed gas-tight in the holding region in a region located distally of the lateral opening, preferably likewise by an adhesive. In this way it is prevented that compressed gas can escape from the holding area to the outside or can get into the lumens provided for the components.

The applicator may also include a sleeve extending from the fitting in the distal direction and radially surrounding at least a portion of the multi-lumen tube, as is well known in the art. In this case, it is advantageous if the sleeve is also fixed in a region located distally of the lateral opening by the adhesive in the holding region.

In order to supply the adhesive to the region located proximally of the lateral opening, the connection piece may have an adhesive channel which is accessible from the outside and leads into said area. The adhesive is again preferably UV-curing, and the connector is then advantageous at least in an area in which the adhesive is present, permeable to UV light.

In a third aspect, the present invention provides an adapter that enables easy fabrication and reliable construction of a spray applicator for laparoscopic applications.

The adapter according to the invention is used in an applicator for spraying at least two components using a compressed gas inside the body of a patient, in particular in an applicator of the type described above.

a base body defining a first side and a second side with respect to a longitudinal direction;

a first and second hose fitting, each of the hose fittings on the first side extending from the base body (preferably substantially parallel to the longitudinal direction) and adapted to be plugged into a lumen of a multi-lumen hose,

a first and second inlet / outlet port, each of the inlet / Outlet ports on the second side of the base body protrudes (preferably substantially parallel to the longitudinal direction) and is adapted to be inserted into an opening of another element,

a first component passage which passes through the base body and connects the first hose connection with the first inlet / outlet port,

a second component passage that passes through the base body and connects the second hose connection with the second inlet / outlet port, and

at least one compressed gas channel connecting the first side and the second side of the base body.

The base body may have a lateral recess on the first side, and the compressed gas channel may then end on the first side of the base body in the region of the lateral recess. In preferred embodiments, the adapter has two pressurized gas channels. The base body then has two lateral recesses, which are arranged diametrically opposite each other, and both compressed gas channels terminate on the first side of the base body in the region of the lateral recesses. At least one retention structure may be formed on each of the first and second hose connections, which hinders retraction of the respective hose connection from the multi-lumen hose. At each of the first and second inlet / outlet ports, a sealing bead may be formed to seal between the respective inlet Z outlet port and the further element.

BRIEF DESCRIPTION OF THE DRAWINGS

Preferred embodiments of the invention will be described below with reference to the drawings, which are given by way of illustration only and are not to be interpreted as limiting. In the drawings show:

1 shows a discharge device with a laparoscopic spray applicator according to a first embodiment; FIG. 2 is a detailed view of the spray applicator in an exploded view; FIG.

3 shows a cross section of the multi-lumen tube of the spray applicator;

Fig. 4 is an enlarged view of the area A in Fig. 2;

Fig. 5 is an enlarged view of the area B in Fig. 2;

6 shows a first perspective view of an adapter of the spray applicator;

7 shows a second perspective view of an adapter of the spray applicator;

8 shows a front view of the spray applicator in the proximal direction;

Fig. 9 is a longitudinal section of the spray applicator in the plane A-A of Fig. 8;

Fig. 10 is a longitudinal section of the spray applicator in the plane B-B of Fig. 8;

Fig. 11 is an enlarged view of the area X of Fig. 9;

Fig. 12 is an enlarged view of the area Z of Fig. 10;

Fig. 13 is a perspective view of the spray insert of the spray applicator;

14 is an enlarged view of the area Y of FIG. 9 (distal

End portion);

Fig. 15 is an enlarged view of the area W of Fig. 10;

16 is a longitudinal section of the distal end portion in a sectional plane, the order

45 ° relative to the plane A- A is rotated about the longitudinal axis in the direction of the plane B- B;

17 shows a cross-section of the multi-lumen tube of a spray applicator according to a second embodiment in the region of the wires running therein; and

18 is a detailed view of the distal end of the spray applicator according to the second embodiment in an exploded view. DESCRIPTION OF PREFERRED EMBODIMENTS

FIGS. 1-16 illustrate a first exemplary embodiment of a spray applicator according to the invention for laparoscopic applications.

The basic structure of the spray applicator 1 is shown in FIG. 1. The spray applicator 1 has a connection piece 3, from which a flexible multi-lumen tube 4 with four parallel, decentrally extending lumens extends along a longitudinal direction L in the distal direction. At the distal end of the multi-lumen tube 4, a spray head 5 is attached. A tubular sleeve 6 (in other words, a cladding tube) surrounds a proximal portion of the multi-lumen tube 4, the multi-lumen tube 4 extending distally beyond the distal end of the sleeve 6 and being exposed between the distal end of the sleeve 6 and the spray head 4 ,

With the spray applicator 1, a discharge device 2 is detachably connected. The dispensing device 2 comprises a syringe holder 21 and two syringes 22, 23. Each of these syringes forms a reservoir for a component of a substance to be laparoscopically administered, e.g. a tissue adhesive or an adhesion barrier. The syringe holder 21 holds the two syringes 22, 23 parallel to each other and couples the pistons of the two syringes such that they can only be advanced simultaneously in the two syringe reservoirs. For the construction of the discharge device 2, reference is otherwise made to US Pat. No. 8,240,511 B2 (Greter et al.), The contents of which are incorporated by reference in their entirety into the present disclosure.

The connecting piece 3 has a main body 31, on which two reservoir ports 32, 33 and a compressed gas port 34 are formed. The outlets of the two syringes are each connected to one of the reservoir ports 32, 33. Locking sleeves 321, 331 (see Fig. 5) secure the syringes to the fitting 3. For the structure and function of the lock sleeves, reference is made to US 2013/0023833 A1 (Kayser), the contents of which are incorporated herein by reference in their entirety.

In order to spray the components from the reservoirs, a compressed gas is supplied to the compressed gas connection 34 via a suitable compressed gas hose. A securing sleeve 341 (see FIG. 11) secures the compressed gas hose at the connection piece 3. The compressed gas is guided through one of the lumens of the multi-lumen hose 4 to the spray head 5. By pressure on the syringe plunger, the components are discharged from the syringes 22, 23 and arrive separated from each other through the reservoir ports 32, 33 and through two more lumens of the multi-lumen tube 4 to the spray head 5. There, the components, as before separated from each other, individually the spray head and are mixed and sprayed by the also exiting the spray head compressed gas. 2, the structure of the spray applicator 1 in an exploded view is further illustrated. The spray head 5 is composed of two separate parts, namely a spray head insert 51 and a spray head cap 52. An adapter 7 is provided both at the proximal end of the multi-lumen tube 4 and at its distal end. The two adapters 7 are constructed identically. At the proximal end of the multi-lumen tube 4, the adapter 7 serves to connect one of the reservoir connections 32, 33, each with one lumen of the multi-lumen tube 4. At the distal end, the adapter 7 serves to connect the lumens of the multi-lumen tube 4 to the spray head insert 51. This will be described below described in more detail.

In Fig. 3 is a cross section through the multi-lumen tube 4 is shown. The multi-lumen tube 4 has four lumens 41-44. In the first lumen 41 a flexible wire is received. This will be described in more detail below in connection with FIG. 14. Two further diametrically opposed (i.e., 180 ° longitudinally staggered) lumens 42, 43 are provided for guiding the components. These lumens are arranged offset by +/- 90 ° relative to the first lumen 41 around the longitudinal direction. They have a larger cross-section than the first, wire-guiding lumen 41. Another lumen 44, which is diametrically opposite the first lumen 41, serves to guide the compressed gas.

4, the connection of the lumens 41-44 of the multi-lumen tube 4 with the spray head 5 is illustrated.

For this purpose, reference is first made to Figures 6 and 7, which show the adapter 7 in an enlarged view. The adapter 7 has a base body 71 which defines, with respect to the longitudinal direction, a first side which in FIG. 4 points in the proximal direction (to the right) and defines a second side, that in the distal direction in FIG (to the left) points. From the first side of the base body 71 are two identical hose connections 72, 73 from, preferably parallel to the longitudinal direction. Each of the hose connections 72, 73 has at its free end a cone region 721, 731, which tapers towards the free end. The conical region 721, 731 is closed to the base body 71 in each case cylindrical area on. The maximum diameter of the respective cone region 721, 731 is slightly larger than the diameter of the corresponding cylindrical region. Between cone area and cylindrical area a sharp edge is formed. If the respective hose connection is inserted into the lumen of a multi-lumen hose, the sharp edge prevents the hose connection from unintentionally slipping out of the multi-lumen hose. In this respect, the sharp edge acts as a retention structure.

From the second side of the base body 71 are two inlet / outlet ports 74, 75 from, preferably again parallel to the longitudinal direction. The direction in which these terminals extend is opposite to the direction of the hose connections 72, 73. The inlet / outlet ports 74, 75 are of cylindrical basic shape. They each have a sealing bead 741, 751 on their lateral surface. A first component channel connects the first hose port 72 to the first inlet / outlet port 74 through the base body 71. Similarly, a second component port connects the second hose port 73 to the second inlet / outlet port 75. The component ports are radially opposite each other with respect to the longitudinal direction. in other words, offset by 180 ° about the longitudinal direction to each other.

In the base body 71 are also offset by 90 ° to the component channels offset two also radially opposite pressure gas channels 76 available. These are relatively short. They end on the first side of the base body 71 in each case in the region of a lateral recess 713 of the base body. On the second side of the base body 71, these channels terminate at the end face of the base body. The base body may be conceptually divided into a circular disk-shaped main portion 711 and a reduced-diameter portion, which may be referred to as a spacer 712. In this case, the compressed gas channels 76 extend only through the main portion 711. The spacer 712 is provided with the lateral recesses 713 and thereby has a smaller cross-sectional area than the main portion 711. The lateral recesses 713 are arranged radially opposite each other. Overall, this results in the present example, a cross-sectional shape of the spacer 712, which corresponds approximately to a recumbent eight. As will be seen below, the spacer 712 serves with its recesses 713 for better gas guidance in the area of the spray head.

Overall, the adapter 7 is constructed symmetrically with respect to a rotation through 180 ° about the longitudinal direction. It is also mirror-symmetrical with respect to a horizontal mirror plane passing through the terminals 72-75 and with respect to a mirror plane perpendicular thereto which contains the longitudinal direction. Due to the symmetrical design of the adapter 7, the assembly of the applicator is greatly facilitated, since it does not depend on a 180 ° rotation of the adapter about the longitudinal direction. Referring again to FIG. 4, it can be seen that during assembly of the applicator, each of the tube connections 72, 73 is inserted into one of the lumens 42, 43 of the multi-lumen tube 4. Each of the inlet / outlet ports 74, 75 is also plugged into a component inlet of the spray head insert 51. This will be explained in more detail below in connection with FIG. 15. Then, the spray head cap 52 is pushed in the proximal direction of the multi-lumen tube 4. The spray head cap 52 has a cylindrical jacket wall 521 and a distal end wall 522. In the distal end wall, an axial spray opening 523 is formed centrally. The spray head cap 52 is advanced in the proximal direction until the distal end wall 522 abuts the spray head insert 51. In this case, the tip of the spray head insert 51 projects distally out of the spray opening 523 of the spray head cap. The spray head cap 52 is then fixed in the region of its jacket wall 521 by an adhesive on the multi-lumen tube 4. Preferably, this is a UV-curing adhesive, and the spray head cap 52 is made of a UV-transparent plastic.

Overall, the adapter thereby establishes a connection between the lumens 42, 43 of the multi-lumen tube 4 and the spray head insert 51. In addition, pressurized gas from the lumen 44 in the region of one of the recesses 713 of the adapter 7 and from there further through the compressed gas channel 76 in the region of a corresponding recess of the spray head insert 51, from where it is passed in the gas outlet channels described in more detail below. This will be explained in more detail below in connection with FIG. 14. As a result, the adapter 7 additionally establishes a connection from the lumen 44 to the spray head insert 51. 5, the connection of the connecting piece 3 with the proximal end of the multi-lumen tube 4 and the proximal end of the sleeve 6 is illustrated. The main body 31 of the connector 3 has a tubular, cylindrical holding portion 35 which forms an axial insertion opening 36. The likewise tube-like compressed gas connection 34 projects obliquely from this holding region 35. The multi-lumen tube 4 has a lateral opening 45, which establishes a lateral access to the lumen 44. The multi-lumen tube 4 is surrounded by the sleeve 6 only in a region which begins distally from the lateral opening 45, so that the proximal end of the multi-lumen tube 4 protrudes from the sleeve 6. During assembly, first the hose connections 72, 73 of the adapter 7 are inserted into the lumens 42, 43 of the multi-lumen hose 4. Then the proximal end of the multi-lumen tube 4 together with the adapter 7 and the proximal end of the sleeve 6 are inserted in the proximal direction into the axial insertion opening 36. As will be explained in more detail below, the multi-lumen tube 4, the adapter 7 and the sleeve 6 are fixed in the holding region 35 by an adhesive.

FIGS. 11 and 12 illustrate the state of this region after assembly.

As can be seen from FIG. 11, in the inserted state, the lateral opening 45 of the multi-lumen tube 4 comes to lie in the extension of the bore of the compressed gas connection 34, so that the pressurized gas can be fed into the lumen 44 from the compressed gas connection. In a proximal region, the connecting piece 3 has an adhesive channel 37 which is open toward the lateral direction in order to bring a UV-curing adhesive into the interior of the holding region 35. There, the adhesive fixes the proximal end of the multi-lumen tube 4 and the adapter 7. In this case, the amount of adhesive is adjusted so that no adhesive reaches the region of the lateral opening 45 in order not to block the compressed gas supply. In order to allow the curing of the adhesive by the action of UV light, the connector 3 is made of a UV-transparent plastic. In addition, adhesive is introduced in the region of the insertion opening 36 between the holding region 35 and the sleeve 6 in order to fix the sleeve 6 to the holding region 35. Overall, the interior of the holding region 35 is sealed in the distal and proximal direction by the adhesive so that no compressed gas can escape during operation. In FIG. 12 it can be seen that the inlet / outlet ports 74, 75 of the adapter 7 are inserted into two openings in a proximal end wall of the holding area 35. Through these openings, the inlet / outlet ports 74, 75 of the adapter 7 communicate proximally with the reservoir ports 32, 33. Through component channels 77, 78 in the interior of the adapter 7, they also communicate with the inlet / outlet ports 74, 75 in the distal direction Overall, in this way, the components of the reservoir ports 32, 33 reach into the lumens 42, 43. It can also be seen from FIG. 12 that the connection piece 3 in each case has a check valve 38 between the reservoir connections 32, 33 and the inlet / outlet connections 74, 75 of the adapter 7. This prevents inadvertent compressed air from passing through the lumens 42, 43 to the reservoir connections 32, 33 in the event of a malfunction, for example in the event of an occlusion of the spray head.

The structure of the distal end of the applicator with the spray head 5 is illustrated in Figures 13-16.

The spray head insert 51 has a cylindrical main portion 511. Starting from the main section 511, a spray head tip 515 protrudes in the distal direction. The latter has two inclined surfaces 516 arranged at an angle to one another at its distal end, in each of which a component outlet 551, 552 is arranged (see FIGS. 13 and 15). In the spray head insert 51 two component inlets 531, 532 are formed, which are open to the proximal side of the spray head insert 51. In these component inlets 531, 532, the inlet / outlet ports 74, 75 of the adapter 7 are inserted. Through the main section 511 and the spray head tip 515, starting from the component inlets 531, 532, two parallel component channels 541, 542 extend in the distal direction, which open outwardly at the component outlets 531, 532 (see FIG. 15). In this way, the components from the lumens 42, 43 of the multi-lumen tube 4 can pass through the adapter 7 to the component outlets 531, 532 at the spray head tip. In the proximal direction, the main section 511 is followed by a spacer 512 with a reduced cross-section. In the area of the spacer 512, there are radial recesses 513 lying opposite one another. The recesses 513 are formed so that the spacer 512 defines a cavity 53 in the region of these recesses, together with the main section 511, the spray head cap 52 and the adapter 7. After leaving the compressed gas channel 76 of the adapter, the compressed gas enters one of these cavities 53 (see FIG. 14). In order to forward the compressed gas from there to the spray head tip, two radially opposite, shallow depressions 514 are formed on the lateral surface of the main section 511. These recesses 514, together with the spray head cap 52, form two channels 54 which connect distally to the cavities 52 in order to forward the compressed gas to the spray head tip 515.

Between main section 511 and spray head tip 515, spray head insert 51 has a reduced diameter tapered region 517. This forms together with the spray head cap 52 an annular space 55 (see Figures 14-16). This annulus 55 receives the gas passing through the channels 514.

Between the tapered region 517 and the oblique surfaces 516, the spray head tip 515 has four axially extending webs 518, which rest on the inside on the end wall 522 of the spray head cap 52 which runs conically obliquely to the longitudinal axis (see FIGS. 14 and 15). Between these webs 518 four recesses 519 are formed. These depressions 519, together with the spray head cap 52, form four gas outlet channels 56, which lead from the annular space 55 in the direction of the distal end of the spray head tip 515 (see FIG. 16). In each case, one of the webs 518 is arranged directly proximate to one of the inclined surfaces 516. As a result, the pressurized gas does not flow directly beyond the component outlets 531, 532 as it exits the gas outlet ducts, but bypasses them. This promotes good mixing of the components during spraying and a clean spray pattern. Like the adapter 7, the spray head insert 5 is symmetrical with respect to a 180 ° rotation about the longitudinal direction and mirror-symmetrical with respect to a horizontal and vertical plane. This additionally facilitates the assembly of the applicator. The guidance of the components and gas at the spray head tip largely conforms to the principles set forth in US Pat. No. 8,534,575 B2. The content of this document is incorporated herein by reference in its entirety. In particular, the spray head tip can be constructed according to any of the variants disclosed in this document.

As can be seen from FIG. 14, a flexible wire 8 is inserted into the first lumen 41. This wire is fixed along its entire length with an adhesive in the lumen 41. Alternatively, the wire may also be fixed in that it was cast or extruded into the multi-lumen tube directly during the production of the multi-lumen tube 4. As a result, the region of the multi-lumen tube 4 projecting beyond the sleeve 6 can be bent very precisely in a desired direction. Since the wire is fixed in the lumen, the bent portion of the multi-lumen tube 4 maintains its direction relative to the sleeve 6 even when the applicator is twisted in its entirety about the longitudinal direction of the sleeve 6, even if there is some resistance (ie, some torsional force). should act on the bent area. The related stability is considerably higher than if the wire 8 were only loosely inserted into the multi-lumen tube 4. If necessary, it is also sufficient to fix the wire only in regions in the multi-lumen tube 4, e.g. at its ends. By the lumen 41, in which the wire is arranged distributed decentralized from the longitudinal axis, (for a given diameter of the multi-lumen tube 4), the cross section of the lumens 42, 43, which are intended for the guidance of the components, larger than at a central Arrangement of the wire-guiding lumen 41 can be selected. This makes it easier on the one hand to design the adapter 7, since the hose connections 72, 73 may have a larger diameter than in a central arrangement of the wire-guiding lumen 41. On the other hand, pressure losses over the length of the multi-lumen tube are minimized.

FIGS. 16 and 17 illustrate a second exemplary embodiment of a spray applicator. Like or equivalent parts are designated by the same reference numerals as for the first embodiment. The second embodiment differs from the first embodiment only by the design of the multi-lumen tube 4 'and by the number and arrangement of the recorded therein Wires 8, 8 '. The multi-lumen tube 4 'of the second exemplary embodiment has five instead of four lumens, wherein in addition a central (ie running on the central longitudinal axis of the tube) lumen 40 is present, which is surrounded by four decentralized (ie offset to the longitudinal axis) lumens 41-44 , While in the first embodiment, a single wire 8 is present and this wire is received in a decentralized lumen 41, in the second embodiment, in addition a further wire 8 'is present, which is received in the central lumen 40. Both wires are in turn fixed in the respective lumen at least area wise, preferably along its entire length. As a result, the region of the multi-lumen tube 4 ', which protrudes from the sleeve 6, has an anisotropic bending moment, ie the bending moment depends on the direction in which this region is to be bent. The area is stiffer for bending movements that take place in a plane El passing through both wires 8, 8 'than for movements in a plane E2 perpendicular thereto.

The invention has been described above by way of example by way of example. Of course, the invention is not limited to these embodiments, and a variety of modifications are possible. For example, the spray head can be designed differently than shown here. In particular, it can be provided that the spray head first mixes the components in its interior before the components thus mixed get to the spray head tip. Of course, the connector may be configured differently than the connecting piece 3 shown here by way of example, wherein the configuration may depend greatly on the type of discharge device, the components are provided, and how the compressed gas is supplied. The sleeve 6 may also be longer or shorter than shown here. If the sleeve 6 is flexible, it can also extend over the entire area from the connector to the spray head.

Instead of laparoscopic applications, the applicator design described above can also be used for other minimally invasive applications or for general endoscopic applications. LIST OF REFERENCE NUMBERS

1 applicator

2 discharge device

3 connection piece

31 basic body

32 first component connection

321 locking sleeve

33 second component connection

331 locking sleeve

34 compressed gas connection

35 import area

36 import opening

37 adhesive channel

38 check valve

4, 4 'multi-lumen hose

40 central lumens

41 first lumen

42 second lumen

43 third lumen

44 fourth lumen

45 lateral opening

5 spray head

51 Spray head insert

511 main section

512 spacer

513 lateral recess

514 recess

515 Spray head tip

516 inclined surface 17 area of reduced diameter 18 bar

19 deepening

2 spray head sleeve

21 jacket wall

22 front wall

23 spray opening

3 cavity

4 channel

5 annulus

6 gas outlet channel

31 first component inlet

532 second component inlet

541 first component channel

542 second component channel

551 first component outlet

552 second component outlet

6 sleeve / cladding tube

7 adapters

71 base body

711 main section

712 spacers

713 lateral recess

72 first hose connection

721 retention structure

73 Second hose connection 731 Retention structure

74 first inlet / outlet port

741 sealing bead

75 second inlet / outlet port

751 sealing bead 76 Compressed gas duct L longitudinal direction

Claims

An applicator for spraying at least two components using a pressurized gas inside the body of a patient, comprising: a connector (3) for connecting the applicator to reservoirs (22, 23) for the components and for supplying a pressurized gas to the applicator; a multi-lumen tube (4) defining a central longitudinal axis with a proximal end connected to the fitting (3) and a distal end;

a spray head (5) disposed at the distal end of the multilumen tube (4), and

at least one first flexible wire (8) arranged in a first lumen (41) of the multi-lumen tube (4),

characterized in that the applicator comprises at least one adapter (7) arranged at the proximal or distal end of the multi-lumen tube (4) for connecting the multi-lumen tube (4) to the fitting (3) or to the spray head (5),

in that the adapter (7) has two tube connections (72, 73) which are inserted into a second and a third lumen (42, 43) of the multilumen tube, wherein the second and the third lumen (42, 43) extend decentrally with respect to the longitudinal axis .

and that the first lumen (41) in which the first flexible wire (8) is disposed also extends decentrally with respect to the longitudinal axis and circumferentially offset from the second and third lumens (42, 43).

Applicator according to Claim 1, which has two adapters (7) of identical construction.

wherein one of the two adapters is disposed at the proximal end of the multi-lumen tube (4) for connecting the multi-lumen tube (4) to the fitting (3), and

the other adapter being located at the distal end of the multi-lumen tube (4) to connect the multi-lumen tube (4) to the spray head (5) connect.

3. The applicator of claim 1 or 2, wherein the second and the third lumen (42, 43) extend diametrically opposite each other with respect to the longitudinal axis.

4. Applicator according to one of the preceding claims, wherein the first flexible wire (8) is at least partially fixed in the multi-lumen tube (4), preferably at least at its ends, more preferably substantially along its entire length.

5. An applicator according to any one of the preceding claims, further comprising a second flexible wire (8 ') disposed in another lumen (40) of the multilumen tube (4).

The applicator of claim 5, wherein the further lumen (40) extends centrally along the longitudinal axis of the multi-lumen tube (4).

7. An applicator according to any one of the preceding claims, wherein the adapter comprises:

a base body (71) defining a first side and a second side with respect to a longitudinal direction, wherein the first hose fitting (72) and the second hose fitting (73) on the first side project from the base body (71) have a first inlet Z outlet port (71); 74) and a second inlet / outlet port (75), each of the inlet / outlet ports on the second side projecting from the base body (71) and adapted to be plugged into an opening of another element,

a first component passage (77) passing through the base body (71) and connecting the first hose fitting (72) to the first inlet / outlet port (74),

a second component passage (78) passing through the base body and connecting the second hose port (73) to the second inlet / outlet port (75), and

at least one compressed gas channel (76), the first side and the second Side of the base body (71) connects.

8. An applicator according to claim 7, wherein the adapter (7) connects the multi-lumen tube (4) with the spray head (5),

the spray head (5) having a spray head insert (51) and a spray head cap (52),

the spray head insert (51) having a first component inlet (531) into which the first inlet / outlet port (74) of the adapter (7) is inserted,

the spray head insert (51) having a second component inlet (532) into which the second inlet / outlet port (75) of the adapter (7) is inserted,

and wherein the spray head insert (51) has at least one lateral recess (513) which is formed such that the spray head insert (51) forms a cavity in the region of the lateral recess (513) together with the spray head cap (52) and the adapter (7) (53) limited, in which the compressed gas after its exit from the compressed gas channel (76) of the adapter (7) passes before it emerges from the spray head (5).

9. An applicator according to claim 8, wherein the spray head cap (52) has a jacket wall

(521) which radially surrounds the multi-lumen tube (4) at its distal end, and wherein the spray head cap (52) in the region of the jacket wall (521) by means of an adhesive with the multi-lumen tube (4) is glued.

10. An applicator according to claim 9, wherein the adhesive is UV-curing, and wherein at least the jacket wall of the spray head cap is transparent to UV light.

11. Applicator according to one of claims 8-10,

the spray head insert (51) having a first component channel (541) connected to the first component inlet (531) and forming a first component outlet (551) at the spray head tip,

wherein the spray head insert (51) has a second component channel (542) connected to the second component inlet (532) and on the spray head tip forms a second component outlet (552), and between the spray head insert (51) and the spray head cap (52) a plurality of gas outlet channels (56) are formed in a region adjacent to the component outlets (551, 552) from the spray head (5 ).

12. An applicator according to claim 7,

wherein the connecting piece (3) has a first and a second reservoir connection (32, 33) for connection to the reservoirs and a compressed gas connection (34) for supplying the compressed gas,

the adapter (7) connecting the reservoir connections (32, 33) of the connection piece (3) to the multi-lumen tube (4),

wherein the fitting (3) has a tubular holding portion (35) with an open distal end and a proximal end,

wherein the compressed gas port (34) opens into the interior of the tubular holding portion;

wherein the multi-lumen tube (4) is inserted from the open distal end into the tube-like holding region (35),

wherein the fitting (3) has at the proximal end of the holding portion (35) a first component supply port communicating with the first reservoir port (32) and into which the first inlet / outlet port (74) of the adapter (7) is inserted;

wherein the fitting (3) has at the proximal end of the holding portion (35) a second component supply port communicating with the second reservoir port (33) and into which the second inlet / outlet port (75) of the adapter (7) is inserted; and

wherein the multi-lumen tube (4) in the region of the compressed gas connection (34) has a lateral opening (45) which connects the compressed gas connection (34) with one of the lumens of the multi-lumen tube (4).

13. An applicator according to claim 12,

wherein the multi - lumen tube (4) and the adapter (7) are in a region located proximally of the lateral opening (45) by an adhesive in the Holding area (35) are fixed, and

wherein the multi-lumen tube (4) is fixed in a gas-tight manner in the region located distally of the lateral opening (45) in the holding region (35), preferably also by an adhesive.

The applicator of claim 13, wherein the applicator comprises a sleeve (6) extending from the fitting (3) in the distal direction and radially surrounding at least a portion of the multi-lumen tube (4), and wherein the sleeve (6) in a region located distally of the lateral opening (45) is fixed by an adhesive in the holding area (35).

15. An applicator according to claim 13 or 14, wherein the connector (3) has an adhesive channel (37) for supplying the adhesive to the region proximal of the lateral opening (35).

16. An applicator according to any one of claims 13-15, wherein the adhesive is UV-curing, and wherein the connector (3) at least in a region in which the adhesive is present, is transparent to UV light.

17. An adapter (7) for use in an applicator (1) for spraying at least two components using a compressed gas inside the body of a patient, comprising:

a base body (71) defining a first side and a second side with respect to a longitudinal direction;

a first hose fitting (72) and a second hose fitting (73), each of the hose fittings on the first side projecting from the base body (71) and adapted to be inserted into a lumen (42, 43) of a multi-lumen hose (4),

a first inlet / outlet port (74) and a second inlet / outlet port (75), each of the inlet / outlet ports on the second side projecting from the base body (71) and adapted to be plugged into an opening of another element become,

a first component channel (77) passing through the base body (71) extends and connects the first hose connection (72) to the first inlet Z outlet port (74),

a second component passage (78) passing through the base body and connecting the second hose port (73) with the second inlet / outlet port to the second inlet / outlet port (75), and

at least one compressed gas channel (76) connecting the first side and the second side of the base body (71).

18. Adapter (7) according to claim 17, wherein the base body (71) has a lateral recess (73) on the first side, and wherein the compressed gas channel (76) on the first side of the base body (71) in the region of the lateral recess (71). 73) ends.

19. Adapter (7) according to claim 17,

the adapter (7) having two compressed gas channels (76),

wherein the base body (71) has two lateral recesses (73) diametrically opposed to each other, and

wherein both pressure gas channels (76) on the first side of the base body in

End of the lateral recesses (73).