ES2346554T3 - Instrumento quirurgico de fijacion de tejido blando. - Google Patents
Instrumento quirurgico de fijacion de tejido blando.Info
- Publication number
- ES2346554T3 ES2346554T3 ES06024129T ES06024129T ES2346554T3 ES 2346554 T3 ES2346554 T3 ES 2346554T3 ES 06024129 T ES06024129 T ES 06024129T ES 06024129 T ES06024129 T ES 06024129T ES 2346554 T3 ES2346554 T3 ES 2346554T3
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- stapling
- tube
- organ
- distal
- tissue
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- Expired - Lifetime
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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
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
- A61B17/1285—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/122—Clamps or clips, e.g. for the umbilical cord
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B17/0643—Surgical staples, i.e. penetrating the tissue with separate closing member, e.g. for interlocking with staple
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/30—Surgical pincettes without pivotal connections
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00243—Type of minimally invasive operation cardiac
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00353—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery one mechanical instrument performing multiple functions, e.g. cutting and grasping
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00743—Type of operation; Specification of treatment sites
- A61B2017/00778—Operations on blood vessels
- A61B2017/00783—Valvuloplasty
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/08—Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound
- A61B2017/081—Tissue approximator
-
- 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/30—Surgical pincettes without pivotal connections
- A61B2017/306—Surgical pincettes without pivotal connections holding by means of suction
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
- A61B2090/037—Automatic limiting or abutting means, e.g. for safety with a frangible part, e.g. by reduced diameter
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- General Health & Medical Sciences (AREA)
- Veterinary Medicine (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Public Health (AREA)
- Engineering & Computer Science (AREA)
- Reproductive Health (AREA)
- Vascular Medicine (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Pathology (AREA)
- Surgical Instruments (AREA)
- Prostheses (AREA)
- Media Introduction/Drainage Providing Device (AREA)
- Materials For Medical Uses (AREA)
Abstract
Instrumento quirúrgico (1), que permite, por vía percutánea, fijar entre sí dos zonas de tejido blando, principalmente distantes entre sí, que comprende - al menos un tubo (2), que puede ser introducido por vía percutánea a través del cuerpo de un paciente hasta que su extremidad distal esté situada en la proximidad de las dos zonas de tejido a ser unidas; - dos órganos alargados (4) insertados en este tubo, cada uno de los cuales comprende una extremidad distal (10a) propia para sujetar una de las dos zonas de tejido a ser unidas, siendo desplazables dichos órganos alargados hacia una posición de extensión, en la que las dos extremidades distales se extienden más allá de dicha extremidad distal de dicho tubo; - medios que permiten desplazar las porciones de extremidad distales (4a) de estos órganos alargados, entre una posición de aproximación mutua, en la que estas porciones no constituyen obstáculo para la introducción del tubo y que permite, tras su sujeción, aproximar dichas zonas de tejido, y una posición de alejamiento mutuo, en la que cada una de dichas extremidades distales es apta para sujetar la zona correspondiente del tejido; - al menos un órgano de engrapado (22, 25), dotado con medios de engrapado (22a, 25a) para cada uno de los tejidos a ser unidos, permitiendo este órgano de engrapado fijar las dos zonas de tejido cuando sean aproximadas entre sí mediante el desplazamiento de dichas porciones de extremidad distales hasta dicha posición de aproximación mutua; - un vástago (15, 16) conectado con cada órgano de engrapado y que puede ser manipulado desde el exterior del cuerpo del paciente para desplazar axialmente dicho órgano de engrapado, siendo separable este vástago de este órgano de engrapado y - un órgano (17a) que forma tope, contenido en el tubo o en los tubos, que permite inmovilizar axialmente cada órgano de engrapado cuando se realice una tracción sobre dicho vástago con el fin de presionar al órgano de engrapado contra dicho órgano que forma tope, hasta la realización de la separación del vástago y del órgano de engrapado.
Description
Instrumento quirúrgico de fijación de tejido
blando.
La presente invención se refiere a un
instrumento quirúrgico, que permite, por vía percutánea, la fijación
entre sí de dos zonas de tejido blando, principalmente distantes
entre sí. Este instrumento está destinado, en particular, a la
"reconstrucción" de válvulas cardiacas, principalmente de la
válvula mitral, o al tratamiento de cualquier malformación de un
tabique cardíaco.
Una patología de la válvula mitral de un
corazón, denominada "insuficiencia mitral", consiste en que la
válvula no se cierra correctamente, es decir de manera estanca y,
por lo tanto, ésta ya no juega su papel de chapaleta antirreflujo
entre la aurícula izquierda y el ventrículo izquierdo.
En este caso, es necesario proceder a una
cirugía de reparación de esta válvula. Según la técnica actual, el
esternón es aserrado (esternotomía) y la caja torácica es abierta,
para abordar el corazón. El paciente se dispone entonces en
circulación sanguínea extracorporal y, una vez detenido el corazón,
se abren las cavidades cardiacas para acceder directamente a la
válvula mitral, en general a través de la aurícula izquierda.
En este caso se lleva a cabo un tratamiento
adecuado de esta válvula, principalmente por anuloplastia o, más
recientemente, por sutura del borde libre de la válvula denominado
"anterior" con el borde libre de la válvula denominado
"posterior" en la zona que corresponde a la insuficiencia
mitral.
Esta técnica operatoria presenta los
inconvenientes de ser particularmente compleja y de realización
difícil, la necesidad de una anestesia general del paciente, una
esternotomía y una parada del corazón, reemplazado por una
circulación extracorporal. Ésta última implica la utilización de
anticoagulantes a elevadas dosis en el transcurso de la
intervención. Por otra parte, esta técnica induce un riesgo
operatorio seguro, en particular un riesgo de infarto de miocardio
y de hemorragia.
La publicación EP 0558031 divulga un aparato
quirúrgico que sirve para llevar a cabo la fijación entre sí de dos
porciones de tejido cutáneo corporal, que se compone de: un par de
órganos alargados opuestos, que están dotados con mandíbulas, que
pueden ser aproximados entre sí en una posición de aproximación
mutua, con el fin de enganchar dos porciones de tejido corporal
colocadas en el seno de las membranas, y una pluralidad de
ligaduras amovibles semejantes a un vástago para penetrar en los
tejidos corporales con vistas a llevar a cabo la fijación de las
porciones de tejido corporal entre sí.
La publicación WO 94/18893 divulga un retractor
y un disector que deben ser utilizados en el caso de un paciente,
que tiene uno o varios órganos articulados aptos para sujetar y para
estirar el tejido.
La presente invención trata de remediar estos
inconvenientes proporcionando un instrumento quirúrgico que
permite, de una manera general, fijar por vía percutánea dos zonas
de tejido blando normalmente distantes entre sí y, en la aplicación
particular precitada, que consiste en la fijación de una zona del
borde libre de la válvula mitral anterior con una zona del borde
libre de la válvula mitral posterior.
De conformidad con la presente invención, se
proporciona un instrumento tal como el que está descrito en la
reivindicación 1.
De este modo, el instrumento según la invención,
permite sujetar, aproximar y fijar, por vía percutánea, las dos
zonas de tejido, simplemente manipulando, desde el exterior del
cuerpo del paciente, los diferentes órganos que comprenden este
instrumento.
Preferentemente, el tubo, los órganos alargados
y el o los vástagos anteriormente citados presentan una flexibilidad
tal, que el instrumento puede ser introducido, por vía percutánea,
hasta el interior de un corazón para permitir el tratamiento de las
válvulas de una válvula cardiaca, principalmente la válvula mitral;
cada uno de dichos órganos alargados está realizado con un material
que presenta una flexibilidad elástica, y comprende una porción de
extremidad distal que diverge normalmente del eje longitudinal del
órgano alargado; los dos órganos alargados son móviles axialmente
con relación al tubo, entre una posición de retracción en este tubo,
en la que dichas porciones de extremidad distales están deformadas
elásticamente de tal manera, que las extremidades distales de
dichos órganos están aproximadas entre sí y, una posición de
extensión, en la que estas porciones de extremidad distales
recuperan su forma neutra y, como consecuencia, son divergentes
entre sí, con el fin de llegar hasta la proximidad de los tejidos,
con vistas a llevar a cabo la sujeción de los mismos.
Ventajosamente, los órganos alargados comprenden
medios que permiten que sus extremidades distales sean bien
activas, con vistas a la sujeción de las zonas del tejido, o bien
inactivas, para impedir esta sujeción y facilitar, de este modo, la
introducción, el desplazamiento o la retirada del instrumento.
Cada órgano alargado puede estar constituido por
un vástago de material elástico, con extremidad distal recurvada
y/o conformada en forma de arpón, y por una vaina insertada y que
puede deslizarse axialmente sobre este vástago, pudiendo recubrir
dicha vaina, en una posición avanzada, dicha extremidad distal y ser
reculada con relación a esta extremidad distal, para, en una
posición reculada, descubrirla.
Según una variante de realización, cada órgano
alargado puede estar constituido por un tubo conectado con un
dispositivo para la puesta bajo depresión al volumen interno de este
tubo. Esta puesta en depresión permite sujetar la zona del tejido
correspondiente, mientras que la conexión al aire libre de este
volumen permite liberar el tejido, sin lesión del mismo. La
extremidad distal del órgano alargado presenta, ventajosamente, en
este caso una forma abocardada, que asegura una superficie de
sujeción de dimensiones eficientes.
Según una variante de realización, el
instrumento comprende dos órganos de engrapado, el primero de los
cuales está colocado con el fin de ser fijado por el lado distal de
los tejidos y el segundo de los cuales, destinado a ser fijado por
el lado proximal de los tejidos, está situado entre dicho primer
órgano de engrapado y el órgano que forma tope.
Los dos órganos de engrapado pueden colocarse,
así, a uno y otro lado de los tejidos a ser unidos y pueden ser
presionados contra dicho órgano de tope, para asegurar la perfecta
fijación de los tejidos.
Para su buena comprensión, la invención se ha
descrito de nuevo a continuación con referencia al dibujo
esquemático, adjunto, que representa, a título de ejemplos no
limitativos, dos formas de realización preferidas del instrumento
al que se refiere.
La figura 1 es una vista en sección longitudinal
de un corazón, cuya válvula mitral no se cierra correctamente y
debe ser tratada por medio de este instrumento;
la figura 2 es una vista en planta de la válvula
mitral antes del tratamiento;
la figura 3 es una vista de una válvula mitral,
similar a la de la figura 2, después del tratamiento por sutura,
según la técnica clásica;
la figura 4 es una vista, similar a la de la
figura 1, de un corazón, en el que se ha introducido el instrumento
según la invención;
la figura 5 es una vista de la extremidad distal
del instrumento, a escala agrandada y en sección longitudinal;
la figura 6 es una vista de esta extremidad
distal, según la línea VI-VI de la figura 5;
las figuras 7 y 8 son vistas similares a la de
la figura 5, en dos fases diferentes de utilización del
instrumento;
la figura 9 es una vista similar a la de la
figura 2 de la válvula mitral, después del tratamiento realizado
por medio de dicho instrumento;
la figura 10 es una vista de esta válvula según
la línea X-X de la figura 9, y
la figura 11 es una vista similar a la de la
figura 5 del instrumento según una segunda forma de realización.
La figura 1 muestra un corazón C, cuya válvula
mitral M presenta una mala coaptación de las válvulas M1, M2, de
tal manera que esta válvula M no se cierra correctamente, es decir
de manera estanca, y por lo tanto ya no juega su papel de chapaleta
antirretroceso entre la aurícula izquierda O y el ventrículo
izquierdo V.
Según una técnica de tratamiento clásico, tras
esternotomía y apertura de la caja torácica, el paciente es
colocado en circulación sanguínea extracorporal. El corazón es
detenido y las cavidades cardiacas son abiertas para abordar
directamente la válvula M con el fin de suturar los bordes libres
opuestos de las dos válvulas M1, M2, como se ha mostrado en las
figuras 2 y 3.
Esta fijación de las válvulas M1, M2 entre sí
permite restaurar una coaptación satisfactoria de estas válvulas
M1, M2, y por lo tanto la restauración de la estanqueidad de la
válvula M.
Las figuras 4 a 8 muestran un instrumento 1, que
permite operar, por vía percutánea, una fijación de este tipo de
las válvulas M1, M2 entre sí.
Este instrumento 1 comprende un tubo exterior 2,
un hilo axial de guía 3, dos órganos alargados 4 y un dispositivo
de engrapado 5. El conjunto presenta una flexibilidad suficiente,
para poder ser introducido, por vía percutánea, hasta el interior
del corazón C, a través de la vena cava Ve y a través del septum
intraauricular S, de tal manera que el hilo 3 sea introducido a
través de la válvula M y que la extremidad distal del tubo 2 se
encuentre situada en la aurícula izquierda 0, frente a esta válvula
M.
Cada uno de los órganos alargados 4 presenta una
porción de extremidad distal 4a, que tiene, normalmente, una forma
curva y que comprende un vástago 10, de material relativamente
rígido pero elástico, principalmente de metal, y una vaina 11,
principalmente de material sintético.
La extremidad distal 10a y el vástago 10 está
acerada y está conformada más o menos con forma de arpón.
La vaina 11 está insertada en el vástago 10 y
puede deslizarse con relación a ésta de tal manera, que en una
posición avanzada, mostrada en la parte izquierda de la figura 5,
recubra la extremidad 10a y, en una posición reculada, mostrada en
la derecha de la figura 5, descubra esta misma extremidad 10a.
Los órganos alargados 4 tienen una longitud tal,
que se extienden más allá de la extremidad próxima al del tubo 2.
Éstos pueden ser desplazados, de este modo, axialmente con relación
al tubo 2 entre una posición de retracción, que permite una
aproximación mutua de las extremidades 10a (figuras 7 y 8) y una
posición de extensión, que permite un alejamiento mutuo de estas
mismas extremidades 10a (figura 5).
El dispositivo de engrapado 5 comprende tres
vástagos tubulares concéntricos 15, 16, 17 insertados sobre el hilo
3, que puede deslizarse con relación a éste y los unos con relación
a los otros.
El vástago interior 15 está unido con un disco
20 a través de una zona divisible 21, siendo el conjunto de materia
sintética moldeada. Este disco 20 está horadado axialmente para
permitir el paso del hilo 3 y comprende una grapa 22. Las ramas
laterales 22a de esta grapa 22 sobresalen de la cara proximal 20a
del disco 20 y la rama central 22b, que comprende un anillo central
para el paso del hilo 3 está incrustada en la materia que
constituye el disco 20.
El vástago intermedio 16 está unido, igualmente,
a través de una zona divisible 23 con un disco 24, que comprende
dos grapas 25. Las ramas laterales 25a de estas grapas sobresalen de
la cara distal 24a de este disco 24 y sus ramas centrales están
incrustadas en la materia que constituye el disco 24.
Éste último comprende, además, dos muescas
laterales 26 diametralmente opuestas, para permitir el paso de los
órganos alargados 4.
El vástago exterior 17 presenta, por su parte,
una extremidad distal alargada 17a adecuada para apoyarse contra la
cara proximal del disco 24.
Cada uno de estos vástagos 15, 16, 17 sobresale
más allá de la extremidad proximal del tubo 2, de manera que pueda
ser desplazada por el operador. Se han previsto medios de
posicionamiento, de desplazamiento relativo y de tracción de estos
vástagos, tales como empuñaduras o sistemas con
tornillos-tuercas sobre las extremidades proximales
de estos vástagos, para permitir realizar una tracción sobre el
vástago 15 al mismo tiempo que se mantiene el vástago 17 en una
posición determinada con relación al tubo 2, y a continuación sobre
el vástago 16, manteniéndose igualmente el vástago 17 en una
posición determinada con relación al tubo 2.
En la práctica, el hilo 3 es introducido, en
primer lugar, a través de la vena cava Ve, el septum intraauricular
S y a continuación a través de la válvula mitral M, bajo control
ecográfico o radioscópico, y a continuación el tubo 2 y los
diferentes órganos, que están contenidos en el mismo, son insertados
en la vena Ve, a través del septum S, hasta que la extremidad
distal del tubo 2 se encuentre frente a la válvula mitral
M.
M.
En el momento de esta introducción, el disco 20
se encuentra mantenido sensiblemente a la altura de la abertura del
tubo 2, permitiendo su cierre, estando retractados los órganos 4 de
tal manera que sus extremidades distales están situadas en las
muescas 26.
Cuando la extremidad distal del tubo 2 está en
posición adecuada, el vástago 15 es desplazado para conducir el
disco 20 más allá de las válvulas M1, M2, y a continuación los
órganos 4 son deslizados hacia su posición de extensión, como se ha
mostrado en la figura 5. Estos órganos 4 se despliegan entonces por
elasticidad, de tal manera, que sus porciones de extremidad
distales 4a se alejan entre sí. Las extremidades distales 10a de
los vástagos 10 se encuentran entonces en la proximidad de las
válvulas M1, M2.
Las vainas 11 son reculadas entonces con
relación a los vástagos 10, para descubrir las extremidades 10a, y
a continuación éstas últimas son clavadas respectivamente en la
válvula M1 o M2 correspondiente.
Entonces se hace avanzar el tubo 2 hacia la
válvula mitral M, lo que tiene por efecto, tal como lo muestra la
figura 7, la aproximación de las porciones 4a entre sí y, por lo
tanto, la aproximación de los bordes libres de las dos válvulas M1,
M2.
Se realiza una tracción a través del vástago 15
manteniéndose el vástago 17 en posición con relación al tubo 2,
sucesivamente con el fin de hacer penetrar las ramas 22a y 25a de
las grapas 22, 25, en las válvulas M1, M2, deformar estas ramas 22a
y 25a contra las paredes respectivas enfrentadas 20a, 24a de los
discos 20, 24 y romper la zona divisible 21. Esta rotura
corresponde a una deformación suficiente de las ramas de las grapas
para asegurar una fijación perfecta mutua de las válvulas M1,
M2.
Las vainas 11 son desplazadas a continuación con
relación a los vástagos 10 para apoyarse contra las válvulas M1,
M2, con el fin de permitir la separación fácil de las extremidades
10a y de las válvulas M1, M2, y a continuación se opera una
tracción sobre el vástago 16 al mismo tiempo que se mantiene el
vástago 17 en posición, con el fin de romper la zona 23.
Las válvulas M1, M2 se encuentran entonces
engrapadas entre sí por su borde libre, tal como se ve en las
figuras 9 y 10.
La figura 11 muestra una variante de realización
en la que los vástagos 10 y las vainas 11 han sido reemplazados por
dos catéteres 40, cuyas extremidades distales 40a están abocardadas.
Estos catéteres 40 sobresalen de la extremidad proximal del tubo 2
y están conectados con jeringuillas para poner en depresión a su
volumen interno. La sujeción o la liberación de las válvulas M1, M2
se opera entonces respectivamente por puesta en depresión o en
sobrepresión del volumen interno de los catéteres 40. Las
extremidades abocardadas 40a permiten asegurar una superficie de
prensión suficiente sobre las válvulas M1, M2. Éstas son de
estructura flexible con el fin de poderse insertar, replegándose
ligeramente, entre la pared del tubo 2 y dos paneles cortados
laterales del disco 20. En cuanto al resto, los otros elementos de
este instrumento son similares a los que ya han sido descritos, y
se han designado con los mismos números de referencia.
Debe indicarse, que la invención no está
limitada a la forma de realización descrita anteriormente a título
de ejemplo. De este modo, las extremidades 10a pueden estar
recurvadas en forma de "J" en su forma neutra, para enganchar
los tejidos, permitiendo, entonces, las vainas 11, cuando recubren
estas extremidades, su deformación para mantenerlas en un estado no
recurvado; pudiendo estar colocados los órganos 4 y los medios de
fijación en tubos separados; pudiendo ser introducido el
instrumento 1 por vía tanto venosa como arterial.
Claims (1)
1. Instrumento quirúrgico (1), que permite, por
vía percutánea, fijar entre sí dos zonas de tejido blando,
principalmente distantes entre sí, que comprende
- \bullet
- al menos un tubo (2), que puede ser introducido por vía percutánea a través del cuerpo de un paciente hasta que su extremidad distal esté situada en la proximidad de las dos zonas de tejido a ser unidas;
- \bullet
- dos órganos alargados (4) insertados en este tubo, cada uno de los cuales comprende una extremidad distal (10a) propia para sujetar una de las dos zonas de tejido a ser unidas, siendo desplazables dichos órganos alargados hacia una posición de extensión, en la que las dos extremidades distales se extienden más allá de dicha extremidad distal de dicho tubo;
- \bullet
- medios que permiten desplazar las porciones de extremidad distales (4a) de estos órganos alargados, entre una posición de aproximación mutua, en la que estas porciones no constituyen obstáculo para la introducción del tubo y que permite, tras su sujeción, aproximar dichas zonas de tejido, y una posición de alejamiento mutuo, en la que cada una de dichas extremidades distales es apta para sujetar la zona correspondiente del tejido;
- \bullet
- al menos un órgano de engrapado (22, 25), dotado con medios de engrapado (22a, 25a) para cada uno de los tejidos a ser unidos, permitiendo este órgano de engrapado fijar las dos zonas de tejido cuando sean aproximadas entre sí mediante el desplazamiento de dichas porciones de extremidad distales hasta dicha posición de aproximación mutua;
- \bullet
- un vástago (15, 16) conectado con cada órgano de engrapado y que puede ser manipulado desde el exterior del cuerpo del paciente para desplazar axialmente dicho órgano de engrapado, siendo separable este vástago de este órgano de engrapado y
- \bullet
- un órgano (17a) que forma tope, contenido en el tubo o en los tubos, que permite inmovilizar axialmente cada órgano de engrapado cuando se realice una tracción sobre dicho vástago con el fin de presionar al órgano de engrapado contra dicho órgano que forma tope, hasta la realización de la separación del vástago y del órgano de engrapado.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
FR9711600A FR2768324B1 (fr) | 1997-09-12 | 1997-09-12 | Instrument chirurgical permettant, par voie percutanee, de fixer l'une a l'autre deux zones de tissu mou, normalement mutuellement distantes |
FR9711600 | 1997-09-12 |
Publications (1)
Publication Number | Publication Date |
---|---|
ES2346554T3 true ES2346554T3 (es) | 2010-10-18 |
Family
ID=9511195
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
ES06024129T Expired - Lifetime ES2346554T3 (es) | 1997-09-12 | 1998-09-14 | Instrumento quirurgico de fijacion de tejido blando. |
Country Status (8)
Country | Link |
---|---|
US (8) | US6461366B1 (es) |
EP (2) | EP1011468B1 (es) |
JP (1) | JP3995413B2 (es) |
AT (2) | ATE472975T1 (es) |
DE (2) | DE69836489D1 (es) |
ES (1) | ES2346554T3 (es) |
FR (1) | FR2768324B1 (es) |
WO (1) | WO1999013777A1 (es) |
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-
1997
- 1997-09-12 FR FR9711600A patent/FR2768324B1/fr not_active Expired - Lifetime
-
1998
- 1998-09-14 ES ES06024129T patent/ES2346554T3/es not_active Expired - Lifetime
- 1998-09-14 JP JP2000511411A patent/JP3995413B2/ja not_active Expired - Lifetime
- 1998-09-14 EP EP98943979A patent/EP1011468B1/fr not_active Expired - Lifetime
- 1998-09-14 DE DE69836489T patent/DE69836489D1/de not_active Expired - Lifetime
- 1998-09-14 DE DE69841758T patent/DE69841758D1/de not_active Expired - Lifetime
- 1998-09-14 WO PCT/FR1998/001960 patent/WO1999013777A1/fr active IP Right Grant
- 1998-09-14 EP EP06024129A patent/EP1815800B1/fr not_active Expired - Lifetime
- 1998-09-14 AT AT06024129T patent/ATE472975T1/de not_active IP Right Cessation
- 1998-09-14 AT AT98943979T patent/ATE345738T1/de not_active IP Right Cessation
-
2000
- 2000-03-10 US US09/523,018 patent/US6461366B1/en not_active Expired - Lifetime
-
2002
- 2002-07-24 US US10/202,599 patent/US6770083B2/en not_active Expired - Lifetime
-
2004
- 2004-06-24 US US10/877,279 patent/US7288097B2/en not_active Expired - Lifetime
-
2006
- 2006-02-14 US US11/354,612 patent/US7682369B2/en not_active Expired - Fee Related
-
2010
- 2010-02-03 US US12/699,768 patent/US7981123B2/en not_active Expired - Fee Related
-
2011
- 2011-06-09 US US13/156,760 patent/US8740918B2/en not_active Expired - Fee Related
-
2014
- 2014-04-23 US US14/259,772 patent/US9510837B2/en not_active Expired - Fee Related
-
2016
- 2016-11-03 US US15/342,580 patent/US20170049455A1/en not_active Abandoned
Also Published As
Publication number | Publication date |
---|---|
US20020183766A1 (en) | 2002-12-05 |
ATE345738T1 (de) | 2006-12-15 |
DE69836489D1 (de) | 2007-01-04 |
US20060135993A1 (en) | 2006-06-22 |
US20170049455A1 (en) | 2017-02-23 |
JP2001517464A (ja) | 2001-10-09 |
JP3995413B2 (ja) | 2007-10-24 |
US8740918B2 (en) | 2014-06-03 |
EP1815800A1 (fr) | 2007-08-08 |
EP1011468B1 (fr) | 2006-11-22 |
US9510837B2 (en) | 2016-12-06 |
FR2768324B1 (fr) | 1999-12-10 |
US7288097B2 (en) | 2007-10-30 |
US20100191256A1 (en) | 2010-07-29 |
EP1011468A1 (fr) | 2000-06-28 |
US7682369B2 (en) | 2010-03-23 |
DE69841758D1 (de) | 2010-08-19 |
US20040236354A1 (en) | 2004-11-25 |
WO1999013777A1 (fr) | 1999-03-25 |
US20110238165A1 (en) | 2011-09-29 |
EP1815800B1 (fr) | 2010-07-07 |
ATE472975T1 (de) | 2010-07-15 |
FR2768324A1 (fr) | 1999-03-19 |
US20140236187A1 (en) | 2014-08-21 |
US6770083B2 (en) | 2004-08-03 |
US6461366B1 (en) | 2002-10-08 |
US7981123B2 (en) | 2011-07-19 |
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