FR2850267A1 - Percutaneous surgical instrument comprises handle extended by two awls separated from each other on handle fixing points and joined at end opposite fixing points - Google Patents

Abstract

The instrument comprises a handle (1) extended by two awls (2,3) separated from each other in their fixing points (4,5) on the handle. The awls are joined at the end (6,7) opposite the fixing points. An Independent claim is included for use of the instrument.

Description

ELASTIC PERCUTANE SURGICAL INSTRUMENT AND USES THEREOF

  The invention relates to an elastic percutaneous surgical instrument and to its different uses.

  This instrument is used in particular in general surgery, and in particular in surgery for prolapse and / or female incontinence.

  To fight against urinary leakage linked to stress in the female sex, surgeons today have different means.

  Among them, we can cite those which consist in placing a wire or a strip of synthetic fabric under the lower part of the urethra to support it.

  Among the various operating care techniques, there is the TVT technique ("Tension free 15 Vaginal Tape") also called the Tension-free vaginal strip technique.

  This technique replenishes the floor of the urethra by providing support to the perineal muscles in order to strengthen normal mechanisms of continence. This support amounts to forming a real hammock, or shoulder, of the urethra. By this technique, which consists of incorporating the support means from the bottom up, a small opening is made in the vagina. Through this opening, a self-gripping strip 25 made of elastic polypropylene (known by the commercial name "Prolene") about 11 mm wide is deposited under the anterior part of the urethra, in order to raise it towards the base. bladder.

  This strip is passed through the tissues of the body on each side of the bladder, by means of two needles placed on either side of the strip. The latter is then inserted up to the skin above the pubis, in two different small openings arranged side by side. The surgeon collects each needle at each of the 10 small openings above the pubis, then cuts each piece of strip flush with the skin.

  However, this technique has various drawbacks. Indeed, it uses two different needles, which pass along two different paths through the tissues of the body. In addition, the needles used, which must be sharp enough to pass through each tissue, have the disadvantage of risking bladder perforations linked to the insertion of the bladder or the bladder neck by the needles, and / or wounds. nerve, and / or vascular wounds.

  Another technique for caring for female incontinence is the "Uretex" technique. Unlike the TVT technique, this technique uses a passage from the surgical instrument from top to bottom, that is to say from the skin located above the pubis towards the vaginal part. This type of passage allows for a more direct journey through the body without leaving the pubic symphysis, thus avoiding bladder wounds.

  However, this technique requires making a larger vaginal incision to introduce a finger to the lower edge of the symphysis, to meet the needle which passes through the skin located above the pubis.

  In addition, these two techniques described above have the major drawback of making blind passages in the body over a portion of the path of the needles, before the surgeon's finger, introduced by the vagina, spots the presence of the needle and can guide it to the exit of the vagina.

  Such blind trips of surgical instruments through human tissue involve the significant risk of vascular and / or nerve wounds, and / or organ perforations.

  Other techniques, such as the so-called Peirera technique, also use two needles intended to pass through the body with portions of the path blind.

  The instrument used in this technique uses two parallel needles, which are never contiguous. Even if this instrument makes it possible to pass two threads through the tissues in a single passage, the space between the distal ends is such that two blind runs are made, and which must be checked simultaneously. two ends during blind time.

  Also there remains the need to have an elastic percutaneous surgical instrument which allows a single passage by elastic wire, by a single path 30 in the organism, from top to bottom or from bottom to top, vaginally with a suprapubic approach. , or trans-obturator, sub urethral, sub vesical or prerectal, while having to control only one perforating end of the surgical instrument, and without having the risk of organic perforations, vascular wounds and / or nerve.

  The subject of the invention is therefore an elastic percutaneous surgical instrument, characterized in that it comprises a handle extended by two awls, said awls being simultaneously separated from each other at their fixing points on the handle, and joined at their terminal ends opposite their fixing points on the handle.

  The instrument according to the invention has the advantage of making surgical procedures easier and faster, and of minimizing the risks of operational complications due to internal wounds.

  Preferably, the awls are spaced from each other at their point of attachment by a distance ranging from about 1 to 2 cm, and preferably from about 1 cm.

  Preferably, each awl has a foam end, and each may include an opening intended for the passage of at least one wire, also called eye.

  The awls can be either of substantially elongated or curved shapes so that they can be easily used in different parts of the human body. The lengths and curvatures of the awls are adapted to the various places in the body from which the surgeon can operate.

  The awls are preferably made of a sterilizable material chosen from stainless steel, plastic composites and their mixture; this material can be sterilized according to the usual known sterilization techniques.

  Another object of the invention relates to a use of the instrument as defined above as a grommet in general surgery.

  The use of this instrument can be done in particular in surgery for human or animal, female or male urogenito-anal prolapse.

  Preferably, the use of this instrument is carried out in vaginal prolapse surgery with a suprapubic and / or trans-obturator approach.

  Another use of this instrument can be done in abdominal surgery.

  The invention will now be illustrated with the aid of the figures which follow, which are given only by way of example of embodiment, and which in no way limit the subject of the invention, and in which: the figure 1 shows a schematic front view of the instrument of the invention, - Figure 2 shows a schematic sectional view of the instrument according to the invention.

  As can be seen in Figure 1, the surgical instrument according to the invention comprises a handle 1 made of a plastic material, extended by two awls 2 and 3 made of stainless steel, spaced from each other by about lcm, at their fixing points 4 and 5 on the handle 1.

  The two awls 2 and 3 have their ends 6 and 7 joined in a flexible and elastic manner. These 5 contiguous ends are located on the opposite side to that of the attachment points to the handle 4 and 5.

  Each end further comprises an opening 8a, 8b, (or eye) which allows the passage of a wire, for its passage through the tissues of the body.

  Figure 1 shows the instrument of the invention in a substantially elongated shape.

  As shown in Figure 2, the instrument of the invention may have a substantially curved shape. The ends of each awl 2 and 3 also each include an opening (or eye) intended for the passage of at least one wire.

  The different curvatures and lengths that the awls 2 and 3 can have of the instrument of the invention are studied so as to be able to easily adapt to the suprapubic and / or transobturator pathways of the body.

  The end of the awls 2 and 3 is foam. This allows the instrument to be able to easily pierce the fascia when it enters the body, without, however, perforating an organ, such as the bladder, or even causing vascular or nerve wounds.

  In fact, the foam tip of this instrument allows it, when it comes into contact with an organ or a vessel, to slide over it and thus avoid the appearance of involuntary wounds.

  When using the instrument according to the invention, the surgeon keeps the ends 6 and 7 of the two awls 2 and 3 apart by a distance of about 1 cm by sliding a finger between the awls, at the time of the penetration of the instrument into the body; the two awls each comprising a thread.

  This spacing operated by the surgeon ensures sufficient aponeurotic support for the knot produced using the thread of each awl 2,3.

  Then, once the aponeurosis has been passed, the surgeon removes the finger which allowed the spacing of the awls 2 and 3. Thus these two awls 2 and 3 become contiguous again, due to their natural elasticity. The surgeon can then insert the awls 2 and 3 of the instrument into the body until the instrument leaves the body.

  The latter being contiguous then form only a single passage, while holding two wires 20 intended to make the knots, thus dividing by two the risk of perforation and / or wounds during the blind passage in the body, compared to systems known so far.

Claims (7)

  1. Elastic percutaneous surgical instrument, characterized in that it comprises a handle (1) extended by two awls (2,3), said awls (2, 3) being separated from one another at their fixing points 5 (4,5) on the handle (1), and being contiguous at their terminal ends (6,7) opposite their fixing points (4,5) on the handle.   2. Instrument according to claim 1, characterized in that the awls (2,3) are spaced from each other at their point of attachment by a distance ranging from about 1 to 2 cm, and preferably about lcm.   3. Instrument according to claim 1, characterized in that the awls (2,3) have a foam end.   4. Instrument according to claim 1, characterized in that the ends (6,7) of the awls (2,3) comprise an opening intended for the passage of at least one wire.   5. Instrument according to claim 1, characterized in that the awls are optionally of substantially elongated or substantially curved shape. 25 6. Instrument according to claim 1, characterized in that the awls (2,3) are made of a sterilizable material chosen from stainless steel, plastic composites and their mixture.   7. Use of the instrument as defined according to one of the preceding claims as a grommet.