FR2815842A1 - Pince-agrafeuse mecanique pour chirurgie du rectum - Google Patents

Pince-agrafeuse mecanique pour chirurgie du rectum Download PDF

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FR2815842A1
FR2815842A1 FR0014025A FR0014025A FR2815842A1 FR 2815842 A1 FR2815842 A1 FR 2815842A1 FR 0014025 A FR0014025 A FR 0014025A FR 0014025 A FR0014025 A FR 0014025A FR 2815842 A1 FR2815842 A1 FR 2815842A1
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jaw
staples
stapler
crosspiece
staple holder
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FR2815842B1 (fr
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Marc Regimbeau
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Assistance Publique Hopitaux de Paris APHP
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/3209—Incision instruments
    • A61B17/3211—Surgical scalpels, knives; Accessories therefor
    • A61B2017/32113—Surgical scalpels, knives; Accessories therefor with extendable or retractable guard or blade

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

Abstract

Pince-agrafeuse pour chirurgie du rectum, caractérisée en ce qu'elle comporte deux branches reliées entre elles par un axe d'articulation (8), chacune des branches (6, 7) comportant de part et d'autre de l'axe d'articulation, une première partie (10, 12) pourvue de poignées (14, 16) et une seconde partie (18, 20) formant mâchoire de serrage, en ce que chaque mâchoire de serrage comporte un mors (21, 22), un premier desdits mors (21) formant organe d'appui pour des agrafes et un second (22) desdits mors formant dispositif de distribution d'agrafes lors de son serrage contre ledit organe d'appui (21) sous l'effet du rapprochement desdites mâchoires (18, 20).

Description

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La présente invention concerne les pinces médicales et se rapporte plus particulièrement aux pinces-agrafeuses pour rectum.
Avec dix mille nouveaux cas chaque année, le cancer du rectum représente un important problème de santé publique.
Une enquête a révélé que 80% des patients ont eu une résection de leur cancer.
La technique chirurgicale pour des besoins du tiers moyen et du tiers inférieur du rectum fait appel à : - une libération du colon gauche, - une section du colon à la jonction du colon iliaque et du colon pelvien le plus souvent à l'aide d'une agrafeuse mécanique linéaire coupante de type "GIA", fabriquée et vendue par la société Autosuture-TYCO.
- une dissection du rectum emportant le tissu graisseux et lymphatique périrectal (mésorectum) jusqu'à 5 cm sous la lésion, - une section du rectum à 5 cm sous la lésion après application d'un coup d'agrafeuse mécanique non-coupante de type"TA", fabriquée et vendue par la société Autosuture-TYCO ou"TX"de la société Ethicon, puis - une anastomose colo-rectale mécanique effectuée par application d'un coup d'agrafeuse mécanique circulaire coupante de type"PCEA"de la société Autosuture-TYCO ou"ILS"de la société Ethicon.
L'introduction du rectum dans les mors d'une pince connue telle qu'une pince de type"TA"ou"TX"se fait latéralement.
Il faut donc que l'espace latéro-rectal permette le positionnement de la pince.
Ce geste est souvent difficile parfois impossible à réaliser surtout dans le cas d'un bassin étroit, notamment chez l'homme, dans le cas d'une grosse tumeur ou d'une tumeur située très bas.
L'introduction de la pince est parfois traumatique et risque d'entraîner l'ouverture accidentelle du rectum dans le pelvis, ce qui a des conséquences septiques et carcinologiques.
Afin de remédier à ce réel problème, on a mis au point une pince mécanique linéaire non coupante mais articulée.
Cependant, cette pince doit également recevoir le rectum latéralement.
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L'invention vise à remédier aux inconvénients des pinces à rectum classiques, qui puissent recevoir la partie du colon à retirer, par un mouvement le long du colon.
Elle a donc pour objet une pince-agrafeuse pour chirurgie du rectum, caractérisée en ce qu'elle comporte deux branches reliées entre elles par un axe d'articulation, chacune des branches comportant de part et d'autre de l'axe d'articulation, une première partie pourvue de poignées et une seconde partie formant mâchoire de serrage, en ce que chaque mâchoire de serrage comporte un mors, un premier desdits mors formant organe d'appui pour des agrafes et un second desdits mors formant dispositif de distribution d'agrafes lors de son serrage contre ledit organe d'appui sous l'effet du rapprochement desdites mâchoires.
Suivant d'autres caractéristiques de l'invention : - le premier mors comporte une traverse fixée à l'extrémité de la mâchoire correspondante et une platine d'appui pour les agrafes, ladite platine d'appui étant pourvue d'empreintes de pliage des extrémités desdites agrafes, - le second mors comporte une traverse fixée à l'extrémité de la mâchoire correspondante, un porte-agrafes monté déplaçable en translation par rapport à ladite traverse le long de guides portés par celle-ci lorsqu'il est en butée contre le premier mors, ledit porte-agrafes comprenant des logements pour des agrafes et des organes de déplacement desdites agrafes vers des fentes de sortie des agrafes sous l'action d'un poussoir solidaire de la traverse du second mors, - des ressorts de rappel interposés entre le second mors et le porteagrafes sont disposés sur chacun des guides portés par la traverse du second mors, - le premier mors comporte des orifices de réception et de guidage des extrémités libres des guides portés par la traverse du second mors lors de la venue du porte-agrafes en butée contre le premier mors, - la traverse du premier mors comporte des butées d'extrémité pour le porte-agrafes définissant entre celui-ci et la traverse du premier mors, un espace de réception d'une épaisseur de tissus à agrafer, - le porte-agrafes comporte une chambre de réception du poussoir, les parois latérales de ladite chambre comportant des rebords rentrants coopérant avec des bourrelets latéraux dudit poussoir pour former avec ces derniers des
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moyens de maintien du porte-agrafes sur le poussoir lorsque ladite pince est en position ouverte, - entre le poussoir et les organes de déplacement des agrafes est interposé un coulisseau monté dans ladite chambre de réception du poussoir, - le porte-agrafes comporte un rebord latéral parallèle à la traverse du second mors et dans lequel est montée à coulissement une lame de coupe des tissus agrafés, - ladite lame portée par un curseur muni d'un bouton de manoeuvre traverse une fente de guidage ménagée dans le rebord latéral du porte-agrafes et la platine du premier mors comporte une rainure de guidage de ladite lame lorsque la pince est en position d'agrafage, - les branches terminées par les poignées de la pince comportent des portions incorporant les poignées faisant un angle de 140 à 1600 par rapport au plan de la pince.
L'invention sera mieux comprise à la lecture de la description qui va suivre, donnée uniquement à titre d'exemple et faite en se référant aux dessins annexés, sur lesquels : - la Fig. 1 est une vue en perspective d'une pince-agrafeuse suivant l'invention appliquée à une opération d'agrafage du colon en vue du traitement du cancer du rectum ; - la Fig. 2 est une vue en coupe à plus grande échelle des mors de la pince en position ouverte ; - la Fig. 3 est une vue en coupe analogue à celle de la Fig. 2 montrant la pince en position fermée d'agrafage ; et - la Fig. 4 est une vue en coupe à plus grande échelle suivant la ligne 4-4 de la Fig. 3.
Sur la figure 1, on a représenté une partie du colon sigmoïde 1 qui aboutit au rectum 2 au niveau du petit bassin 3 d'un patient sur lequel il s'agit de pratiquer une intervention d'ablation d'une tumeur du rectum.
A cet effet, on utilise une pince-agrafeuse suivant l'invention.
Cette pince 5 comporte deux branches 6,7 reliées entre elles par un axe d'articulation 8 qui peut être démontable d'une manière en soi connue afin de faciliter dans certains cas la pose de la pince.
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De part et d'autre de l'axe d'articulation 8, chaque branche comporte une première partie 10, 12 terminée par des poignées respectives 14, 16 et une seconde partie 18,20 formant mâchoire de serrage.
Chaque mâchoire de serrage 18,20 comporte un mors 21,22.
Comme représenté plus en détail à la figure 2, le mors 21 de la mâchoire 18 forme organe d'appui pour des agrafes 24 contenues dans le mors 22 fixé à la mâchoire 20 et formant dispositif de distribution d'agrafes lors de son serrage contre l'organe d'appui constitué par le mors 21, sous l'effet du rapprochement des mâchoires 18 et 20.
Le mors 21 fixé à la mâchoire 18 comporte une traverse fixée à l'extrémité de la mâchoire 18 par exemple par soudage et portant une platine 25 d'appui pour les agrafes 24.
La platine 25 est pourvue d'empreintes 26 de pliage des extrémités des agrafes 24.
Aux extrémités de la traverse formant le mors 21, sont prévues des butées 27 contre lesquelles vient prendre appui le mors 22 porté par la mâchoire 20 lors du rapprochement des mâchoires 18 et 20 afin de délimiter un intervalle 28 visible sur la figure 3 dans lequel peuvent se loger les tissus T de l'organe soumis à une opération d'agrafage.
Enfin, la traverse formant le mors 21 comporte à ses extrémités, à proximité des butées 27, des trous 30 de réception de tiges de guidage correspondantes du mors 22 solidaire de la mâchoire 20.
Le mors 22 comporte une traverse fixée à l'extrémité de la mâchoire 20, un porte-agrafes 32 monté déplaçable en translation par rapport à la traverse formant le mors 22 le long de guides ou tiges de guidage 34 portés par les extrémités de la traverse formant le mors 22 et disposés en regard des trous de réception et de guidage 30 ménagés dans la traverse formant le mors 21 fixée à la mâchoire 18.
Entre le porte-agrafes 32 et la traverse définissant le mors 22, sont interposés des ressorts de rappel 35 montés sur les tiges de guidage 34.
Le porte-agrafes 32 comporte des logements 36 pour les agrafes 24 et des organes 38 de déplacement desdites agrafes vers des fentes 39 de sortie des agrafes 24 sous l'action d'un poussoir 40 solidaire de la traverse formant le mors 22.
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Les organes 38 d'entraînement des agrafes sont des étriers à deux ou trois doigts 38a d'entraînement des agrafes 24 pourvues de rainures d'extrémité 38b de maintien des agrafes par leur âme (Fig. 4).
Le porte-agrafes 32 comporte une chambre de réception 42 du poussoir 40.
Comme représenté à la figure 4, les parois latérales 44 de la chambre 42 comportent des rebords rentrants 45 coopérant avec des bourrelets latéraux 46 dudit poussoir 40 pour former avec ces derniers des moyens de maintien du porte-agrafes 32 sur le poussoir 40 lorsque la pince est en position ouverte.
Entre le poussoir 40 et les organes 38 de déplacement des agrafes 24, est interposé un coulisseau 48 monté dans la chambre 42 de réception du poussoir 40.
Ainsi qu'on le voit sur la figure 4, le porte-agrafe 32 comporte deux rangées parallèles d'organes 38 d'entraînement d'agrafes.
Ainsi, il est possible de poser d'un seul coup de pince deux rangées d'agrafes 24 dans les tissus T de l'organe à traiter.
Le porte-agrafes 32 est muni d'un rebord latéral 50 tourné vers l'axe d'articulation de la pince et dans lequel est monté à coulissement un curseur 52 muni d'un bouton de manoeuvre 54 et portant une lame de coupe 55 qui traverse une fente de guidage 56 ménagée dans le rebord latéral et fait saillie dans l'intervalle 28 ménagé par les butées 27 entre les mors 21 et 22 de la pince lorsque celle-ci est en position de fermeture.
L'extrémité de la lame 55 est engagée dans une rainure 57 parallèle au rebord latéral 50, ménagée dans la platine 25 et assurant le guidage de la lame 55 lors d'une opération de coupe des tissus agrafés au préalable.
En se reportant à nouveau à la figure 1, on voit que les branches 6 et 7 terminées par les poignées 14 et 16, comportent des portions 60,62 faisant un angle de par exemple 140 à 1600 par rapport au plan de la pince de manière à faciliter la mise en place de celle-ci le long du colon.
En outre, la pince comporte un dispositif 64 d'arrêt de la pince avant sa fermeture définitive, de manière à permettre, avant de procéder à la pose des agrafes, de vérifier le positionnement correct de la pince par rapport à l'organe à traiter.
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Le dispositif d'arrêt 64 comporte une butée escamotable 65 montée à rotation sur l'une des branches 7 de la pince et coopérant avec l'intérieur de l'au- tre branche 6.
Enfin, les deux branches 6 et 7 de la pince sont munies de butées 66,67 d'arrêt de la pince en position de fermeture totale.
Pour procéder à la pose d'agrafes à l'aide de la pince suivant l'invention, on engage le rectum entre les mâchoires 18 et 20 de la pince initialement en position ouverte.
Dans le cas où l'axe d'articulation 8 de la pince est démontable, il est également possible de présenter les branches de la pince séparément de part et d'autre du rectum et de les assembler ensuite à l'aide de l'axe d'articulation 8.
Les mors 21 et 22 de la pince se trouvent alors dans la position représentée à la figure 2.
On procède alors au rapprochement des mâchoires 18 et 20 par action sur les poignées 14 et 16.
Les mors 21 et 22 se rapprochent l'un de l'autre jusqu'à ce que le porte-agrafes 32 soit appliqué contre les butées 27 du mors 21.
Dans cette position, la butée escamotable 65 du dispositif d'arrêt 64 est en position sortie, les branches 6 et 7 de la pince sont momentanément immobilisées pour permettre au praticien de vérifier la bonne position des mors 21 et 22 par rapport à l'organe sur lequel il doit intervenir.
Ensuite, la butée 64 étant escamotée vers l'intérieur, il est possible de procéder au serrage de la pince en vue de la pose des agrafes 24.
Au cours de cette opération, la traverse 22 se déplace par rapport au porte-agrafes 32 qui est immobilisé contre les butées 27 de la traverse 21, à l'encontre de l'action des ressorts de rappel 35.
Les extrémités libres des guides 34 pénètrent dans les trous de réception et de guidage 30 de la traverse 21 et assurent le maintien en ligne du porteagrafes 32 par rapport à la platine 25.
Au cours du mouvement relatif entre le porte-agrafes 32 et la traverse définissant le mors 22, le poussoir 40 agit sur les organes 38 de déplacement des agrafes par l'intermédiaire du coulisseau 48 et provoque progressivement la sortie des agrafes 24 hors du porte-agrafes 32 et leur pénétration dans les tissus T de l'organe à traiter.
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A la fin de l'opération, la pince se trouve dans la position représentée à la figure 3 dans laquelle les organes 38 d'entraînement des agrafes poussés par le poussoir 40 par l'intermédiaire du coulisseau 48 provoquent la sortie des agrafes hors du porte-agrafes 32 et le repliement de leurs extrémités par coopération avec les empreintes 26 de la platine 25.
Les agrafes étant posées, il est possible de procéder à la coupe des tissus à l'aide de la lame 55 par déplacement de celle-ci à l'aide du bouton 54 d'entraînement du curseur 52 portant ladite lame, ce déplacement ayant lieu sur pratiquement toute la largeur des mors 21,22.
On peut ensuite dégager la pince en écartant les poignées 14 et 16, ce qui provoque tout d'abord l'écartement du mors 22 par rapport au porte-agrafes 32 sous l'action des ressorts de rappel 35, puis l'écartement de l'ensemble du mors 22 par rapport au mors 21.
La pince peut être munie d'un ressort d'ouverture provoquant l'écartement des poignées 14,16 dès leur relâchement.
Les moyens de maintien du porte-agrafes 32 sur la traverse formant le mors 22 formé par les rebords rentrants 45 des parois latérales 44 de la chambre de réception 42 du poussoir 40 et par les renflements latéraux 46 de ce poussoir permettent de retirer le porte-agrafes 32 après son utilisation et après stérilisation de la pince de le remplacer par un porte-agrafes neuf.
Grâce à l'agencement qui vient d'être décrit, il est possible de procéder à l'agrafage linéaire du rectum avec une introduction dans l'axe des mors de la pince du rectum dans ces mors.
Une telle marche à suivre permet de contourner le problème de l'exiguïté du bassin.
La pince suivant l'invention permet un agrafage plus facile grâce au positionnement plus distal de la pince, au contact du plan des muscles releveurs de l'anus, ce qui facilite considérablement la tâche du chirurgien dans le cas d'un bassin difficile d'accès.
La pince suivant l'invention est applicable à toutes les tumeurs du rectum ainsi qu'aux protectomies réalisées pour des lésions inflammatoires avec reconstruction secondaire par anastomose iléoanale.

Claims (11)

  1. REVENDICATIONS 1. Pince-agrafeuse pour chirurgie du rectum, caractérisée en ce qu'elle comporte deux branches reliées entre elles par un axe d'articulation (8), chacune des branches (6,7) comportant de part et d'autre de l'axe d'articulation, une première partie (10,12) pourvue de poignées (14,16) et une seconde partie (18,20) formant mâchoire de serrage, en ce que chaque mâchoire de serrage comporte un mors (21,22), un premier desdits mors (21) formant organe d'appui pour des agrafes (24) et un second (22) desdits mors formant dispositif de distribution d'agrafes (24) lors de son serrage contre ledit organe d'appui (21) sous l'effet du rapprochement desdites mâchoires (18,20).
  2. 2. Pince-agrafeuse suivant la revendication 1, caractérisée en ce que le premier mors (21) comporte une traverse fixée à l'extrémité de la mâchoire (18) correspondante et une platine (25) d'appui pour les agrafes (24), ladite platine d'appui étant pourvue d'empreintes (26) de pliage des extrémités desdites agrafes (24).
  3. 3. Pince-agrafeuse suivant l'une des revendications 1 et 2, caractérisée en ce que le second mors (22) comporte une traverse fixée à l'extrémité de la mâchoire (20) correspondante, un porte-agrafes (32) monté déplaçable en translation par rapport à ladite traverse le long de guides (34) portés par celle-ci lorsqu'il est en butée contre le premier mors (21), ledit porte-agrafes (32) comprenant des logements (36) pour des agrafes (24) et des organes (38) de déplacement desdites agrafes (24) vers des fentes (39) de sortie des agrafes (24) sous l'action d'un poussoir (40) solidaire de la traverse du second mors (22).
  4. 4. Pince-agrafeuse suivant l'une des revendications 1 à 3, caractérisée en ce que des ressorts de rappel (35) interposés entre le second mors (22) et le porte-agrafes (32) sont disposés sur chacun des guides (34) portés par la traverse du second mors (22).
  5. 5. Pince-agrafeuse suivant l'une des revendications 1 à 4, caractérisée en ce que le premier mors (21) comporte des orifices (30) de réception et de guidage des extrémités libres des guides (34) portés par la traverse du second mors (22) lors de la venue du porte-agrafes (32) en butée contre le premier mors (21).
  6. 6. Pince-agrafeuse suivant l'une des revendications 1 à 5, caractérisée en ce que la traverse du premier mors (21) comporte des butées d'extrémité (27)
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    pour le porte-agrafes (32) définissant entre celui-ci et la traverse du premier mors (21), un espace (28) de réception d'une épaisseur de tissus (T) à agrafer.
  7. 7. Pince-agrafeuse suivant l'une des revendications 1 à 6, caractérisée en ce que le porte-agrafes (32) comporte une chambre (42) de réception du poussoir (40), les parois latérales (44) de ladite chambre comportant des rebords rentrants (45) coopérant avec des bourrelets latéraux (46) dudit poussoir pour former avec ces derniers des moyens de maintien du porte-agrafes (32) sur le poussoir (40) lorsque ladite pince est en position ouverte.
  8. 8. Pince-agrafeuse suivant l'une des revendications 1 à 7, caractérisée en ce qu'entre le poussoir (40) et les organes (38) de déplacement des agrafes (24) est interposé un coulisseau (48) monté dans ladite chambre (42) de réception du poussoir (40).
  9. 9. Pince-agrafeuse suivant l'une des revendications 1 à 8, caractérisée en ce que le porte-agrafes (32) comporte un rebord latéral (50) parallèle à la traverse du second mors (22) et dans lequel est montée à coulissement une lame (55) de coupe des tissus (T) agrafés.
  10. 10. Pince-agrafeuse suivant la revendication 9, caractérisée en ce que ladite lame (55) portée par un curseur (52) muni d'un bouton de manoeuvre (54) traverse une fente de guidage (56) ménagée dans le rebord latéral du porteagrafes et la platine (25) du premier mors (21) comporte une rainure (57) de guidage de ladite lame (55) lorsque la pince est en position d'agrafage.
  11. 11. Pince-agrafeuse suivant l'une des revendications 1 à 10, caractérisée en ce que les branches (6,7) terminées par les poignées (14,16) de la pince comportent des portions (60,62) incorporant les poignées (14,16) faisant un angle de 140 à 1600 par rapport au plan de la pince.
FR0014025A 2000-10-31 2000-10-31 Pince-agrafeuse mecanique pour chirurgie du rectum Expired - Fee Related FR2815842B1 (fr)

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Cited By (490)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
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