JP2009514626A - Occlusion device and surgical instrument and method for implanting or explanting them - Google Patents

Abstract

The present invention relates to a closure device comprising a structure (2) in which thin wires or thin wires (2) are interlaced, and the ends of the wires or thin wires (4) converge in a holder (10).
The closure device can be repeatedly connected to a recovery or surgical instrument. The holder (10) has an upper portion (14) at the free end with a small hole (16) in the form of a cross hole that is received and held by the implant or explant instrument (100, 200) to fit the shape. The present invention relates to a surgical instrument (100) for implanting or implanting an implant device having the holder (10). The surgical instrument has a grasping pliers (102) whose jaws (103, 104, 105) can be opened and closed by a push-pull system, the interior of which holds the implant device holder ( 10) surrounding the upper part (14).
[Selection] Figure 6

Description

  The present invention is provided with a suitable shape by a molding and heat treatment procedure and comprises a thin wire offset that is tapered to the diameter of the catheter used in the endovascular implant or explant procedure, A holding area, a distal holding area where the end of the wire or wire converges in the holder, and a cylindrical cross member inserted between the proximal holding area and the distal holding area The two holding regions are located on the two sides of the short circuit that are occluded by the post-implant septum, and the crosspiece relates to the occlusion device across the short circuit. The invention further relates to a surgical instrument for implant devices, in particular implants and explants of the occluding device. Finally, the present invention relates to an implant device, in particular to a method for repeatedly connecting such an occluding device to such a surgical instrument.

  Medical technology has long struggled to occlude septal defects, eg, atrial septal defects, by non-surgical transvenous catheter procedures, ie, without having to perform surgery in a literal sense. A variety of different occlusion systems have been proposed for this purpose, but each has its own pros and cons, and none of the specific occlusion systems are yet widely accepted. In referring to these different systems, the term “occlusion device” is used in the following. In all invasive occlusion systems, a self-expanding umbrella system is introduced intravenously into a defect that is occluded by the septum. This type of system includes two umbrellas, one positioned, for example, on the distal side of the septum (ie, the side farthest from the medial plane of the body / heart), and the other in the middle Located on the proximal side of the septum (ie, the side closer to the midline in the body), the two umbrella prostheses are sequentially secured to the double umbrella with a septal defect. Thus, in the assembled state, the closure system usually consists of two clamped umbrellas connected to each other by a short bolt across the defect. However, it can be seen that the disadvantage of such prior art occlusion devices is a relatively complex and difficult composite implant procedure. Apart from the complex implants of the occlusion system in the septal defect to be occluded, the umbrellas utilized are subject to material fatigue as well as fragment fracture. In addition, thromboembolic complications are often expected.

  In order to be able to introduce the inventive occluding device by means of a surgical insertion instrument and / or guide wire, a holder is provided at the end of the distal holding region which can engage the insertion instrument and / or guide wire. Thus, this engagement is easily separated when the closure device is positioned in the defect. For example, an offset can be devised at the end of the distal retention region of the closure device to thread into the holder and engage the insertion instrument.

  For example, AGA or JEN. In known occlusion devices made of meditec, a nitinol wire assembly, the connection to the insertion wire is configured as a thread. The insertion wire biases the occlusion device back and forth within the catheter tube. When the occlusion device is positioned in the septum of the heart, the insertion wire is removed and eventually the occlusion device is released. After that, no correction is possible.

  Because the insertion wire and connection are relatively robust and the catheter approaches the septum of the heart at a shallow angle in a less invasive implant of the occlusion device via the leg artery for anatomical reasons, the occlusion device tilts when opened And the umbrella cannot touch both sides of the short circuit. Under such circumstances, the operating surgeon cannot identify whether the occlusion device is in a predetermined fit once disconnected. This is particularly uncertain for the surgeon because the only means of repositioning the disconnected occlusion device is a non-minimally invasive procedure.

  The present invention provides for the freedom of movement of the occlusion device to accommodate a septal defect that is open and closed when the occlusion device is positioned in the septum of the heart and released from the insertion port. And by allowing the closure device to be repositioned and retrieved by the insertion device as needed without being pushed by the insertion device into a position that is not automatically taken alone. This is based on minimizing these critical drawbacks of the system.

  Of course, other embodiments are also devised here as well. In another type of occlusion device, the so-called Lock-Clamshell umbrella system, two umbrellas covered with stainless steel, preferably Dacron, are provided, each stabilized by four arms. ing. This type of occlusion device is implanted in a patient via a vein. However, the fact that the insertion instrument required to implant the occlusion device must be of a relatively large size is seen as a problem with the Lock-Clamshell occlusion device. A drawback seen by other systems, for example, the so-called “Amplatz occlusion device”, is that many different occlusion device sizes are required to address the respective dimensions of the septal defect to be occluded. That is. Thus, it can be seen that if the length or diameter of the cross member inserted into the defect is not optimally fitted, the umbrella will not be completely flat when inserted. This results in incomplete endothelialization. Furthermore, many of the systems that are implanted in the patient's body are shown to exhibit material fatigue and failure in the metal structure due to significant mechanical stress over a longer period of time. This is especially the case when permanent stress is applied between the implant device and the septum.

  To overcome these drawbacks, automatic centering occlusion devices have been developed that are introduced into a septal defect that is inserted and occluded by a minimally invasive means, for example, using a catheter and a guide wire into the patient's body. . These designs are based on the principle that the occlusion device tapers with respect to the size of the insertion instrument and / or catheter used in the endovascular procedure. Such a tapered occlusion device is introduced by the catheter into the septal defect to be occluded and to the short circuit of the septal defect to be occluded. The occlusion device is ejected from the catheter, and the self-expanding umbrella and holding plate each open sequentially against the two sides of the septum. The umbrella includes a fiber insert in which the defect / short circuit is occluded, eg, made from or covered with Dacron. Implant devices that remain in the body will grow almost completely ingrowth by the body's own tissue after weeks or months.

  An example of a prior art automatic centering occlusion device of the type identified first is well known from WO 99/12478 A1, as “Amplatz occlusion device” according to US Pat. No. 5,725,552. It is a further development of a known occlusion device. It consists of a plurality of intertwined thin nitinol strands in the shape of a yo-yo. Each offset is manufactured in its original form as a rounded offset with the unclamped ends of the wire at both the leading edge (respectively proximal) and the trailing edge (respectively distal). During subsequent processing of the curled assembly, each of these unfastened ends needs to be collected in a sleeve and welded together. After such proper processing, both the proximal and distal sides of the finished occlusion device will exhibit a protruding collar. The Dacron patch is sewn into the distal holding umbrella, the proximal holding umbrella and the inserted crosspiece. Due to the “memory effect” exhibited by the Nitinol material used, the two holding umbrellas are initially in the middle balloon-like stage, open alone upon exiting the catheter, and finally positioned on the two sides of the septum The umbrella finally takes a flat shape. When the umbrella is opened, the crosspiece automatically centers itself within the closed short circuit. Since the collar protrudes beyond the proximal retention area of the occlusion device, the inserted implant device presents an embolism-related problem, particularly the problem of continuous embolization. Furthermore, complete endothelization of the occlusion device implant is often prevented.

  Furthermore, an occlusion device made of wire offset is well known from WO 95/27448 A1. However, as in the case of the above-mentioned device, this closing device is not guided by the insertion instrument at the time of introduction, and does not have a holder that prevents the seating and retreating from becoming inappropriate again before being disconnected.

  Accordingly, the problem described in the present invention is to improve such an offset self-centering occlusion device well known to the medical art so that the above-cited drawbacks are overcome. A particular object is to provide an occlusion device that is applied to different sized defect occlusions, thereby simplifying the implant of the occlusion device and allowing explants, for example to correct improper seating. .

  Based on the issues raised, the object of the present invention is to isolate the septum when inserted at the proximal end of the septal defect, as flat as possible with respect to the septum and improperly positioned. It is an object of the present invention to provide an occluding device that can be recovered.

  It is a further object of the present invention to provide a corresponding surgical instrument and a method for repeatedly connecting an occluding device to such a surgical instrument.

  These problems are solved by providing an occluding device of the invention of the type initially identified by providing a holder having a head portion at the free end with a small hole in the form of a cross hole that can be press-fitted and held by an implant or explant instrument. It is solved by. Alternatively, the object is to provide a holder having a head portion at the free end which is configured as a hemispherical centering sleeve with a longitudinal section with a small hole in the form of a cross hole that can be held in an implant / explant instrument by passing a fixed loop The invention is solved in an inventive manner by the first identified type of occluding device.

  Alternatively, an object of the procedure described in the present invention is a method of repeatedly connecting an implant device having a holder, in particular an occluding device, to a surgical instrument, wherein a small hole in the holder of the implant device is started before the endovascular procedure is started. Through which the insertion wire or guide wire loop is guided and is thus hooked to a fixed point provided on the gripper tongue, so that the first and second unfastened ends of the insertion wire or guide wire are first gripped The second part of the insertion wire / guidewire with nipple until the head part of the holder of the implant device is gripped by the gripper tongs and is fully accommodated in the gripping jaws. The non-clamped end is tensioned and the second non-clamped end with nipple is loosened, Is released from the head portion of the implant device, the seating of the implant device is confirmed, by inserting fine wires / guide wire, the gripper tongs is solved by a method for re-connecting a holder at any time the implant device.

  Also, an implant device having a holder, in particular a method of repeatedly connecting an occlusive device to a surgical instrument, is provided with an insertion wire or guide guided through an oblique slot in a small hole in the holder of the implant device before initiating the endovascular procedure. A guidewire loop is provided, the insertion wire or the first and second non-clamping ends of the guidewire are held or fixed in the region of the first gripping part, and the gripper tongs allow the head part of the holder of the implant device to The second non-clamped end with the nipple is pinched and the second non-clamped end with the nipple until the head portion is received and held in the gripping jaw When loosening, the gripper tongs are released from the head portion of the implant device and seating of the implant device is verified. By inserting fine wires / guide wire, the gripper tongs can be re-connected to the holder at any time the implant device.

  Finally, an implant device having a holder, in particular a method for repeatedly connecting an occluding device to a surgical instrument, comprises a defined length of a securing loop that is secured to a small hole in the holder of the implant device, the securing loop being a cylinder. Inserted into the cross groove of the sleeve, the knot of the fixed loop is centered on the protrusion, the cross section of the fixed loop located in the cross groove is held along the diameter, and the cross is crossed during the defined forward shift of the hook The cross section of the locking loop of the groove slides on and remains fixed on the hook of the second flute, and when the hook is retracted, the holder of the implant device is pulled and clamped to the proximal front side of the sleeve, Due to the updated and defined anterior displacement of the hook, the fixation loop is again loosened and the proximal front side of the sleeve is loosened from the holder, the implant device Seated was confirmed, the use of fixed loop, the sleeve can be re-connected to the holder at any time the implant device.

  Accordingly, an overall system comprising an implant device in the form of an occlusion device, a surgical instrument applicable thereto, and a corresponding method of using the surgical instrument is disclosed herein as a solution to the problems faced by the present invention. Is done.

  The advantages of the invention are particularly ensured during implant surgery with a correspondingly configured surgical instrument and are released from the surgical instrument to see how the occlusion device is seated, e.g. repositioning Or, it can be seen in the provision of an intravascular occlusion device, particularly for the treatment of septal defects, particularly emphasizing the fact that it can be easily explanted and subsequently easily grasped again.

  Three other embodiments are proposed together with this in order to construct the holder of the closure device according to the invention.

  First, the head portion of the holder is configured as a spherical head, the inside of the jaw of the gripper tongue of the surgical instrument matches the shape of the spherical head, and the spherical head is fitted into the shape by the gripper tongue of the surgical instrument. And can be gripped. When the connection between the surgical instrument and the occlusion device is disconnected, the surgical instrument is looped from the proximal end of the surgical instrument gripper tongue in the delivered state so that the spherical head can be easily and again gripped again. The two non-clamping ends are retained or pre-attached near the hand of the surgeon's surgical instrument. With the insertion wire or guide wire, the gripper tongue of the surgical instrument can be easily and accurately reconnected to the head part of the holder of the closure device, e.g. to re-hold the closure device for repositioning or explant. it can.

  According to the second embodiment of the holder of the closing device, the small hole in the head portion is slit obliquely with respect to the cross hole, and the end of the oblique slot overlaps with the longitudinal direction of the cross hole. This ensures that the insertion wire / guidewire protruding from the looped gripper tongue at the proximal end of the surgical instrument in the delivered state is hooked into the diagonal slot of the small hole in the holder of the occlusion device and the overlapping end of the diagonal slot Can be easily and intentionally removed from the eyelet via the loop's diagonal bearings, especially after the insertion wire / guidewire has not been tensioned by the surgeon and inadvertently released from the eyelet. it can.

  The double hole cut discharge surface of the cross hole is preferably configured to converge to the outer surface of the spherical head towards the free end of the holder. This has the advantage that there are no sharp edges that damage the insertion wire or guide wire, and that the insertion wire / guide wire loop can be easily threaded through the eyelet of the holder of the first embodiment. Last but not least, the converging configuration of the cross hole with respect to the cut discharge surface results in less material and weight.

  According to a third embodiment of the holder of the closure device, the head part is formed as a semispherical centering sleeve with a longitudinal section and likewise comprises small holes in the form of cross holes. In order to connect with a corresponding surgical instrument, for example, a fixed loop made of surgical stitching is fed through a small hole and maintained at a defined width of the fixed loop, the two ends being tied together To be hooked on the hook of a surgical instrument. In the first and second embodiments of the head portion of the holder, when the unclamped end of one or both of the insertion wire or guide wire is manually pulled by the surgeon, the insertion wire or guide wire is tensioned. In the third embodiment, when the hook in the surgical instrument is retracted, tension is applied to the fixed loop.

  In the first and second embodiments, the push-pull system of the surgical instrument preferably extends axially through the following components: a coil spring and the interior thereof, and is sufficiently robust and flexible in the axial direction. Actuator means, a gripper tongue shaft attached to the proximal end, and a first gripping portion attached to the distal end. In addition, the push-pull system includes a tapered sleeve for receiving an axially displaceable gripper tong shaft at the proximal end portion and abuts the stop so that the distal end portion is near the coil spring. The leading edge is received. Also included here is a second gripping portion received by the distal end of the coil spring abutting the stop, wherein the gripping jaw is biased by the coil spring to the outer adjacent proximal front end of the tapered sleeve. Closes by force and opens when the actuator means is advanced. The advantages of this push-pull system are essentially simplicity, the associated reliability of the components, and a reliable grasping and release of the holder of the implant device.

  In the first embodiment of the holder, the insertion wire or the loop of the guide wire protrudes from the gripper tongue at the proximal end in the delivery state of the surgical instrument and ties both through the inside of the tapered sleeve and the inside of the coil spring. The non-removable end is guided to the first gripping portion at the distal end of the surgical instrument and passes through the eyelet of the implant device holder and is attached to the gripper tongue before the implant of the implant device. When tension is applied to the insertion wire or guidewire, the surgical instrument is connected to the holder of the occlusion device, which can be repeated while maintaining the connection.

  Thus, the connection between the surgical instrument and the occlusion device, i.e. to the insertion wire / guidewire, is separated, e.g., to first examine the seating of the implant device, thereby changing the seating of the implant device and thereby the surgery If the instrument needs to grip the holder of the implant device again, it can be easily retrieved using the insertion wire / guidewire. Also, if the implant device needs to be replanted, the connection between the surgical instrument and the implant device can be easily re-established. In contrast, the loop of the second embodiment hangs through the diagonal slot of the small hole and is not guided through the small hole as in the first embodiment.

  In both the first and second embodiments of the holder, the first non-clamping end of the insertion wire or guide wire is fixed in the region of the first gripping part and is attached to the second insertion wire or wire. The non-end is provided with a nipple that is useful when tensioning the insertion wire / guidewire with the implant device connected, or when withdrawing from the surgical instrument after the first end connection has been separated from the grasping portion. In a second embodiment of the holder, when at least one unfastened end of the insertion wire / guidewire is loosened, the insertion wire or guidewire loop exits the eyelet through the diagonal slot.

  The insertion wire or guide wire is preferably made of, for example, a nitinol wire from which the occlusion device itself can be constructed. Nitinol is a proven material in such surgical procedures.

  In a third embodiment of the closure device holder, the surgical instrument is provided with a hook that can be moved axially along the small hole, towards the small hole and away from the small hole by means of a push-pull system. A fixed loop is used that extends and hooks onto the hook, and when the hook moves away from the eyelet, the implant device is held on the surgical instrument by tensioning the fixed loop. It should be noted that the advantage of this embodiment of the surgical instrument is that the insertion wire or guide wire is replaced with a fixed loop, and the insertion wire or guide is used to tension the entire device as described for the other two embodiments. There is no need to pull the unclamped end of the wire, and when the hook is retracted, tension is applied, which can continue from proper operation of the surgical instrument.

  In a third embodiment of the surgical instrument, the push-pull system essentially consists of the following components: a coil spring and an actuator means extending axially therethrough and sufficiently robust and flexible in the axial direction; Receiving the proximal end of the coil spring at the distal end portion by abutting the stop shaft with a shaft of a hook attached to the proximal end, a first gripping portion attached to the distal end, A cylindrical sleeve for axially displaceably receiving the hook shaft and a second gripping portion for receiving the distal end of the coil spring by abutting the stopper, the hook being biased by the coil spring It is displaced in the axial direction so as to move away from the small hole by the applied force, and is moved toward the small hole by advancing the actuator means. Similarly, this push-pull system makes the operation of the occlusion device very simple and reliable before and during the surgical procedure.

  Furthermore, in order to simplify the connection of the fixing loop extending through the eyelet of the holder of the closure device to the push-pull system, the cylindrical sleeve preferably comprises a first proximal groove on the proximal front side and a sleeve A second longitudinal groove on one side of the central portion for guiding the axially displaceable hook without twisting, and a projection extending in the center for receiving the knot of the fixed loop, extending with respect to the longitudinal axis of the sleeve And a cross groove disposed at a right angle to the second vertical groove on one side. By means of the protrusions that receive the knots of the fixed loop, in particular, the fixed loop is seated firmly in the cross groove.

  In order to allow the hook to securely grip the fixed loop, the cross section of the front portion of the hook is configured to be about one third flatter than the cross section of the shaft and when fitted into the second longitudinal groove of the cylindrical sleeve. It is preferable to show play.

  To separate the connection between the surgical instrument and the holder of the implant device, a blade is provided at the distal end of the gap configured behind the hook.

  While it is preferred that the material of the actuator means of the surgical instrument is a wire, any other material that is wholly sufficiently axially robust and sufficiently flexible may also be used.

  The following is a more accurate representation of the three preferred embodiments of the occlusion device, the three associated surgical instruments, and the three different methods of repeatedly connecting the implant device and the occlusion device to the associated surgical instrument, respectively. Reference is made to the drawings for further details. In this regard, Example 1 is shown in FIGS. 1-7, Example 2 is shown in FIGS. 8-14, and Example 3 is shown in FIGS. 15-24.

  1 and 2 show a side detail view of a first embodiment of a surgical instrument 100 for implants and implants of an implant device provided herein as an example of an implant device coupled to an occlusion device 1. The surgical instrument 100 shows a gripper tongue 102 and gripping jaws 103, 104, 105 that are opened and closed by a push-pull system. The internal regions of the gripping jaws 103, 104, 105 are configured such that they can grip the spherically configured head portion 14 of the holder 10 of the implant device in a press-fit lock fashion. The push-pull system essentially consists of the following components: a coil spring 106, an actuator means 107 extending through it, axially robust and sufficiently flexible, and a gripper attached to the proximal end. A shaft 111 of the tongue 102 and a first gripping portion 108 disposed at the distal end. The push-pull system also includes a shaft 111 of the gripper tongue 102 that is axially displaceable at the proximal end portion 112 and a proximal end of the coil spring 106 at the distal end portion 113 by abutting the stop 114. A taper sleeve 109 is provided. In essence, the push-pull system includes a second gripping portion 110 that is received by the distal end of the coil spring 106 abutting the stop, and the gripping jaws 103, 104, 105 are connected to the tapered sleeve 109. Closed by the force biased by the coil spring 106 to the outer adjacent proximal front end 115 and opens when the actuator means 107 is advanced. As a particularly essential component, the surgical instrument 100 extends from the proximal end in the form of a loop 117 from the gripper tongue 102 in the delivered state of the surgical instrument 100 by means of two unfastened ends 118,119. , Having an insertion wire or guide wire 116 that is guided through the interior of the tapered sleeve 109 and the interior of the coil spring 106 to the first gripping portion 108 at the distal end of the surgical instrument 100, and the loop 117 It can be introduced through the eyelet 16 of the holder 10 before the implant of the implant device and attached to the gripper tongue 102 at the fixing point 101. The insertion wire or guidewire 116 shows a first unclamped end 119 that can be attached to the area of the first gripping portion 108 and a second unclamped end 118 with a nipple 120, thereby The insertion wire / guidewire 116 can be retracted from the surgical instrument 100 when the implant device is pulled in connection or the connection between the first end 119 and the first grasping portion 108 is disconnected. The retraction of the insertion wire / guidewire from the surgical instrument 100 does not occur until the implanted occlusion device exhibits correct seating, as required by the surgeon. Otherwise, the insertion wire / guidewire 116 allows the surgeon to easily reconnect the gripper tongue 102 of the surgical instrument 100 to the head portion 14 of the holder 10 of the closure device 1, i.e., the gripping jaws of the gripper tongue 102. 103, 104, 105 grip the spherical head portion 14 of the holder 10 to fit tightly into shape.

  FIG. 3 shows an example of a closure device comprising the holder 10 of the invention. This occlusion device is essentially given a suitable final shape by means of molding and heat treatment procedures and is a thin wire or thin wire 4 offset relative to the diameter of the catheter 5 used in an endovascular implant or explant surgical procedure. 2 is provided. The occlusion device includes a proximal retention region 6, a distal retention region 8 where the end of the wire or wire 4 converges within the holder 10, and between the proximal retention region 6 and the distal retention region 8. With a cylindrical cross member 12, the two holding regions 6, 8 are located on the two sides of the short circuit blocked by the post-implant septum and the cross member 1 crosses the short circuit. The occlusion device is therefore particularly suitable for treating a septal defect using a device that can be introduced into the occlusion defect via the catheter 5. Due to the fact that the proximal holding region 6 of the variant 2 is flat and flat in the form of a single layer towards the proximal end of the occluding device, this makes it particularly advantageous, i.e. relative to the defect to be occluded. Regardless of the specific diameter and regardless of septum thickness, the occlusion device automatically adjusts for septal defects, so that any part of the occlusion device can have a defect proximal to the defect. Do not protrude beyond the partition wall. Thus, the usual complications that commonly occur in such cases do not occur. That is, this means that the occlusion device grows ingrowth by the body's own tissue substantially faster than in the case of known occlusion systems in the prior art.

  The use of an assemblage of thin wires or wires as the starting material for the inventive occlusion device provides the additional advantage of long-term mechanical stability. This mainly prevents structural destruction of the inserted implant device. Furthermore, the uneven structure has sufficient rigidity. Furthermore, the plate-like, hub-free profile for the offset 2 towards the proximal end allows the proximal retention area 6 of the occlusion device to be completely flat against the lateral edge of the defect when inserted. Can be. As a result, the occlusion device can be used for a wide range of different sized septal defects. Since the offset assembly 2 tapers with respect to the diameter of the catheter used in endovascular surgery, an occlusion device can be introduced, for example, via a vein so that it is no longer necessary to perform open surgery in the literal sense. Since the variant 2 is made of a material having a “memory” effect, the occlusion device opens alone upon exiting the catheter so that the two retention regions 6, 8 are located proximal / distal of the defect Also called “self-expanding device”.

  FIG. 4 shows an enlarged side view of a first embodiment of the holder 10 of such a closure device. The holder 10 shows a head portion 14 at the free end having a small hole 16 in the form of a cross hole, which is gripped and held by the surgical instrument 100 to fit the shape.

  FIG. 5 shows a perspective view of the holder according to FIG. This figure shows how the double hole cut discharge surfaces 18, 20 of the cross hole converge toward the outer surface of the spherical head towards the free end of the holder 10.

  FIG. 6 shows an enlarged detail view of the surgical instrument 100 having a guide wire 116 that is hooked in the form of a loop 117 at the axis 111 of the gripper tong 102 (see FIG. 2, fixation point 101) and extends through the eyelet 16. This figure shows how the gripper tongs 102 are tapered outwardly at the front and flutes in the three gripping jaws 103, 104, 105 that close when the tapered shaft is positioned at the proximal forward end 115 of the tapered sleeve 109. Indicates whether it is divided by. The gripping jaws 103, 104, 105 are thereby rotated to show the shape of the bowl for gripping the spherical head portion 14 of the holder 10 in a press-fit manner. The axis 111 of the gripper tongue 102 is in a flat configuration for guiding the loop 117 of the insertion wire / guidewire 116 through the taper sleeve 109. The loop 117 is prepared to protrude from the delivered gripper tongue 102 (see FIG. 7). The non-crimped ends 118, 119 of the insertion wire / guidewire 116 are guided through the slot of the gripper tongue 102 and through the coil spring 106 and secured at the first gripping portion 108 of the grip, The non-crimped end 118 further comprises a nipple 120 that facilitates gripping and pulling of the insertion wire / guidewire.

  FIG. 7 shows a simplified view of the front portion of the surgical instrument 100 comprising a tapered sleeve 109, a gripper tongue 102, a coil spring 106, and an actuator means 107. The loop 117 of the insertion wire / guidewire 116 is seen in front of the gripper tongue 102 and is already fed through the eyelet 16 of the head portion 14 of the holder 10. The portion highlighted by the “A” circle shows an enlarged detail view according to FIG.

  In order to connect the closure device 1, the loop 117 of the insertion wire / guidewire 116 is pulled through the small hole 16 and is thus hooked to the fixing point 101 provided on the shaft 111 of the gripper tongue 102 (see FIG. 2). ). The wire or wire material comprising the loop 117 of the insertion wire / guidewire 116 extends through each slot between the gripping jaws 103, 104, 105 and the return end is a third slot between the gripping jaws 104, 105. Pass through. The loop 117 can no longer be hooked when the gripper tongue 102 retracts within the taper sleeve 109 by pinching the insertion wire / guidewire 116. The loop 117 is pulled toward the nipple 120 until the spherical head portion 14 of the holder 10 sinks into the gripping jaws 103, 104, 105 of the gripper tongue 102. The other end 119 of the insertion wire / guidewire 116 where the nipple 120 is not disposed is properly secured in the region of the second grip portion 108.

  A method of repeatedly connecting the implant device having the holder 10, in particular the closure device 1, to the surgical instrument 100 will be described below.

  In the first stage, before starting the endovascular procedure, the loop 117 of the insertion wire / guidewire 116 is guided through the eyelet 16 of the holder 10 of the implant device, and thus the fixation point 101 provided on the gripper tongue 102. And the first and second non-crimped ends 119, 118 of the insertion wire / guidewire 116 are held or secured in the region of the first gripping portion 108. In the second stage, the gripper tongue 102 grips the head portion 14 of the holder 10 of the implant device. In the third stage, the second unclamped end 118 of the insertion wire / guidewire 116 with the nipple 120 is taut until the head portion 14 is fully received within the gripping jaws 103, 104, 105. . When the second unclamped end 118 with the nipple is loosened, the gripper tongue 102 is released from the head portion 14 of the implant device and seating of the implant device is confirmed. The insertion wire / guidewire 116 allows the gripper tongue 102 to reconnect with the implant device holder 10 at any time.

  FIGS. 8 and 9 show a condensed side view and a detailed view of a second embodiment of a surgical instrument 200 having an occluding device 1 connected thereto, showing a holder 10 of a second embodiment of the present invention. The reference numbers in FIGS. 1 and 2 are repeated again here to identify the same components for the surgical instrument 200 and the occlusion device 100. The difference between this second embodiment of the closure device 1, the second embodiment of the surgical instrument 200 and the same components of the first embodiment is that the configuration of the head portion 14 of the holder 10 of the closure device 1 and the insertion It is how the fine wire / guidewire 116 is used and guided, and this will become apparent when viewing FIG. In this, the loop 117 of the insertion wire / guidewire 116 is not guided through the eyelet 16 of the head portion 14 by two wires or wires, rather, only one wire passes through the eyelet 16 or Two unfastened ends 118, 119 are guided through the interior of the tapered sleeve 109 and the interior of the coil spring 106 to the first grasping portion 108 at the distal end of the surgical instrument 200. The connection of the insertion wire / guidewire 116 to the head portion 14 of the holder 10 will be described below with reference to FIGS.

  10 and 11 show an enlarged side view (FIG. 10) and a perspective view (FIG. 11) of the second embodiment of the holder 10 of the closure device 1, respectively. In the second embodiment, the small hole 16 of the head portion 14 is slit obliquely with respect to the cross hole, and the end portions 22 and 24 of the oblique slot 26 overlap with each other in the longitudinal direction of the cross hole. 4 and 5 is different from the first embodiment. Otherwise, this second embodiment of the head portion 14 likewise shows a spherical head, the double-hole cut-out discharge surfaces 18, 20 of the cross holes preferably being directed towards the free end of the holder 10. Configured to converge to the outer surface. Because the eyelet 16 has an oblique slot 26, the loop 117 of the insertion wire / guidewire 116 does not need to loop through the eyelet 16 at the unattached end 118, 119 of the insertion wire, and moves into the eyelet 16. Alternatively, the entire loop 117 is passed through the small hole 16 and hooked on the shaft 111 of the gripper tongue 102. Accordingly, the loop 117 is easily hooked by the diagonal slot 26.

  The eyelet 16 provides the advantage that the loop 117 is similarly removed from time to time, i.e., if the surgeon determines that the occlusion device 1 has been properly seated, the surgical instrument 200 is eventually removed from the occlusion device 1. To be separated. To do this, one of the unclamped ends 118, 119, preferably the second unclamped end 118 with the nipple 120, is pulled to make the loop 117 as in the first embodiment. Is retracted from the eyelet 16 and from the entire surgical instrument 200.

  FIG. 12 shows a simplified illustration according to a second embodiment of the front part of the surgical instrument 200 having a loop 117 protruding from the tip of the gripper tong 102 and the connected closure device 1.

  FIG. 13 shows an enlarged detail view of the gripper tongue 102 having a loop 117 of insertion wire / guidewire 116 protruding from between the gripping jaws 103, 104, 105 (the gripping jaws 104, 105 are not visible in this view). .

  FIG. 14 shows a view similar to FIG. 12, and FIG. 14 shows the surgical instrument 200 already connected to the closure device 1.

  The push-pull system of the second embodiment of the surgical instrument 200 comprises the same components as described above for the first embodiment.

  A method for repeatedly connecting the implant device having the holder 10 of the second embodiment, in particular, the closure device 1 to the surgical instrument 100 according to the second embodiment will be described below. In the first stage, prior to initiating the endovascular procedure, the loop 117 of the insertion wire / guidewire 116 is guided through the oblique slot 26 of the eyelet 16 of the holder 10 of the implant device, and the insertion wire / guidewire 116 The first and second unfastened ends 119, 118 are held or secured in the region of the first gripping portion 108. In the next stage, the gripper tongs 102 grip the head portion 14 of the holder 10. The second unclamped end 118 of the insertion wire / guidewire 116 with the nipple 120 is tensioned until the head portion 14 is fully received within the gripping jaws 103, 104, 105. When the second unclamped end 118 with the nipple 120 is loosened, the gripper tongue 102 is released from the head portion 14 of the implant device and seating of the implant device can be verified. The insertion wire / guidewire 116 allows the gripper tongue 102 to reconnect with the implant device holder 10 at any time. When the occlusion device 1 is finally separated from the surgical instrument 200, the insertion wire / guidewire 116 is retracted from the surgical instrument by pulling on the second non-clamping end 118 with the nipple 120. . During extraction, it is important that the loop 117 be flexible enough to wrap around a tight radius and have no sharp edges with respect to the point of deflection of the eyelet 16 or gripper tongue 102. With respect to the small hole 16, the loop 117 is configured to converge on the outer surface of the spherical head toward the free end of the holder 10 with respect to the double hole cutting discharge surfaces 18 and 20 of the cross hole as described above. Fixed. Furthermore, it is particularly appropriate to use a thin, superelastic nitinol wire as the insertion wire / guidewire 116 even if surgical sutures are further used.

  15, 16, and 17 are each a compressed cross-sectional view (FIG. 15), a detailed perspective view of the circle “B” in FIG. 15, and a front region of the surgical instrument 300 having the closure device 1, all according to the third embodiment. A cross-sectional view is shown. Surgical instrument 300 essentially includes a hook 302 that is axially movable toward and away from small hole 16 in head portion 14 of holder 10 of closure device 1 by a push-pull system, As 302 moves away from the small hole 16, the implant device is held by the surgical instrument 300 by tensioning the fixation loop 301, thereby extending through the small hole 16 and showing the flexible fixation loop 301 at the hook 302. In this case, the push-pull system essentially consists of the following components: a helical coil 106, an actuator means 107 extending axially through the latter, sufficiently robust and sufficiently flexible in the axial direction, and a proximal end. A hook 302 shaft attached to the part and a first gripping part 108 attached to the distal end. Further, the push-pull system essentially displaces the shaft 303 of the hook 302 in the axial direction for receiving the proximal end of the coil spring 106 at the distal end portion 113 by abutting the stop 114. A cylindrical sleeve 304 is shown in FIG. Finally, the push-pull system of the third embodiment includes a second gripping portion 110 that receives the distal end of the coil spring 106 by abutting the stop, and the hook 302 includes an actuator By advancing the means 107, the means 107 is moved away from the small hole 16 in the axial direction by a force biased by the coil spring 106 that can be moved toward the small hole 16.

  18 and 19 show an enlarged side view and an enlarged perspective view, respectively, of the third embodiment of the holder 10 of the closure device 1. The holder 10 shows the head portion 14 at the free end, which is configured as a centering sleeve having a small hole 16 in the form of a hemispherical cross hole with a longitudinal section, and a fixing loop 301 extending through the small hole 16 causes the holder 10 to become a surgical instrument 300. The third embodiment is different from the other two embodiments in that it can be held in the memory (see FIGS. 16 and 17).

  FIG. 20 shows a perspective view of the cylindrical sleeve 304 of the surgical instrument 300 according to the third embodiment. The cylindrical sleeve 304 has a continuous first longitudinal groove 306 on the proximal front side 304 and a second longitudinal groove on one side of the central portion for guiding the axially displaceable hook 302 without twisting. 307 and a cross groove 308 perpendicular to the second longitudinal groove 307 on one side that extends relative to the longitudinal axis of the sleeve 304 and has a protrusion 309 in the center for receiving the knot 311 of the fixed loop 301. The second vertical groove 307 is configured to cut the circumference of the sleeve 304 from the outer diameter to the inner diameter.

  FIG. 21 shows a perspective view of a hook 302 having a shaft 303. The cross section of the front portion of the hook 302 is configured to be about one third flat than the cross section of the shaft 303 and is indicated by reference numeral 314. The flat front portion of the hook 302 fits with play in the second longitudinal groove 307 of the cylindrical sleeve 304 (FIG. 20). A material free gap 315 is configured behind the tip of the hook 302 and shows a blade 310 at its distal end.

  FIG. 22 shows a perspective view of the front portion of the surgical instrument 300 that is non-fixedly connected to the holder 10 of the closure device 1 by means of a fixing loop 301. The fixed loop 301 is inserted into the cross groove 308 so that the knot 311 of the fixed loop 301 is located at the protrusion 309 of the cross groove 308, and the thin line of the fixed loop 301 extends along the diameter of the cylindrical sleeve 304 within the cross groove 308. Cross. Thus, the cross groove 308 is configured so as not to be released laterally from the fixed loop 301 to which the knot 311 is hooked.

  FIG. 23 shows a view similar to FIG. 22, with the hook 302 inserted into the cylindrical sleeve 304 shown in broken lines. During the defined forward shift of the hook 302, the fixed loop 301 basically slides from the longitudinal groove 307 on the tip of the hook and remains in the gap 315 configured behind the hook. The knot of the fixed loop 301 is located in one of the side chambers formed by the flat portion 314 of the hook 302. When the hook 302 is retracted, the closure device 1 with the holder 10 and the front side 305 of the cylindrical sleeve tight against the surgical instrument 300 is pulled. Therefore, the fixed loop 301 passes along the circumference of the sleeve 304 from the continuous first longitudinal groove 306 on both sides until it is guided again along the cross groove 308 inward and rearward of the hook 302. The occlusion device 1 can thus be connected to the push-pull system of the surgical instrument 300 without play and inserted into the catheter 5 (not shown here).

  In order to finally remove the closure device 1 from the surgical instrument 300, the stoppers 312 and 313 arranged in the second gripping part 110 are released and the hook 302 is pushed further forward by a defined distance. A blade 310 located at the distal end of the gap 315 behind the tip of the hook 302 is activated. By retracting the surgical instrument, the fixed loop 301 in the cross groove 308 can be separated by the blade 310 by tensioning along the diameter, ie, the hook 302 is displaced forward. As a result, the end portion of the fixing loop 301 having no knot is separated from the small hole 16 of the holder 10 when the surgical instrument 300 is retracted, and the other end of the fixing loop 301 having the knot 311 is finally in the cross groove 308. And remains on the hook 302.

  FIG. 24 shows a view similar to FIG. 23, wherein the closure device 1 is also shown in the holder 10 and is attached by the holder 10 and by the fixing loop 301 of the cross groove 308 of the sleeve 304.

  In the following, the method of the third embodiment for repeatedly connecting the implant device having the holder 10, in particular the closure device 1, to the surgical instrument 300 will be described more precisely.

  In the first procedural step, a defined length of the fixation loop 301 is fixed in the eyelet 16 of the holder 10 of the implant device. The fixed loop 301 has a cross groove in the cylindrical sleeve 304 such that the knot 311 of the fixed loop 301 fits centrally into the protrusion 309 and the cross section of the fixed loop 301 located in the cross groove 308 is held along the diameter. 308 is inserted. During the defined forward shift of the hook 302, the cross section of the fixed loop 301 of the cross groove 308 slides over the hook 302 of the second longitudinal groove 307 and remains fixed there. By retracting the hook 302, the holder 10 of the implant device is pulled and clamped to the front side 305 of the sleeve 304. The updated and defined anterior displacement of the hook 302 will again loosen the fixation loop 301 and the proximal anterior side 305 of the sleeve 304 will be loosened from the holder 10 and the seating of the implant device will be confirmed. With the fixation loop 301, the sleeve 304 reconnects to the implant device holder 10 at any time. Unintentional release of the closure device 1 from the surgical instrument 300 is prevented by the following means. First, the fixed loop 301 does not slide off the hook 302 alone under tension. Secondly, since the hook opening is closed by the sleeve 304 surrounding it, the fixed loop 301 does not slide off the hook 302 in the released state. Third, the hook 302 is fixed without being twisted in the second longitudinal groove 307 of the sleeve 304 so that the opening of the hook is not located in front of the cross groove 308. Fourth, the blade 310 remains fixed by the stoppers 312 and 313 behind the cross groove 308 of the second gripping portion 110 and contacts the unfastened or tensioned fixed loop 301. Neither do nor separate. Finally, the blade 310 is retracted slightly from the tensioned fixation loop 301 by conscious and deliberate interaction with the actuator member of the surgical instrument 300 to cut the fixation loop 301. Thus, it is only guided to the gap 315 of the hook 302. Only a defined forward displacement of the hook 302 with the blade 310 causes the anchoring loop 301 to be tensioned along the diameter of the anchoring loop 301 via the cross groove 308 with only a slight retraction of the surgical instrument 300. Can be cut.

FIG. 2 shows a side view of a first embodiment of an occluding device with associated surgical instrument according to embodiment 1. FIG. 2 shows an enlarged cross-sectional view of a partial “A” portion according to FIG. 1. FIG. 3 shows a perspective view of an embodiment of an occluding device. The expanded side view of 1st Example of the holder for obstruction | occlusion apparatuses is shown. FIG. 5 shows a perspective view of the holder according to FIG. 4. FIG. 5 shows an enlarged detail view of a gripper tong of an occluding device including a guide wire and a holder. FIG. 3 shows a view of an occlusion device having a forward portion of a surgical instrument and a loop pulled therethrough. FIG. 9 shows a side view of a surgical instrument having an occlusion device on an insertion wire / guidewire according to a second embodiment. FIG. 9 shows a cross-sectional detail view of the anterior portion of a surgical instrument having an occlusion device on the insertion filament / wire according to FIG. The enlarged side view of the holder of the closure device by Example 2 is shown. FIG. 11 shows a perspective view of the holder according to FIG. 10. FIG. 6 shows a simplified view of the anterior portion of a surgical instrument having a gripper tong, an insertion wire / guidewire, and an occluding device. FIG. 13 shows an enlarged detail view of the “A” part according to FIG. 12. FIG. 9 shows a view of an occlusion device having a forward portion of a surgical instrument having a gripper tong and a hooked guidewire loop. FIG. 4 shows a compressed cross-sectional view of a surgical instrument having a hooked occlusion device according to Example 3. FIG. 16 shows a cross-sectional detail view according to “B” from FIG. 15. Fig. 5 shows a cross section of the front part of a surgical instrument with a connected occlusion device. The enlarged side view of the holder of the closure device by Example 3 is shown. FIG. 19 shows a perspective view of the holder according to FIG. 18. FIG. 6 shows an enlarged perspective view of a cylindrical sleeve according to Example 3. 18 shows an enlarged perspective view of the hook according to FIG. FIG. 6 shows a perspective view of the front part of a surgical instrument having a holder with which a closure device according to a third embodiment is connected. FIG. 23 shows a perspective view similar to FIG. FIG. 6 shows an enlarged perspective view of the front part of a surgical instrument having an occluding device according to a third embodiment for showing the connection through a fixed loop.

Claims (19)

One braid (2) of thin wire and wire (4) tapered to the diameter of the catheter (5) used in the endovascular implant or explant procedure, given the appropriate final shape by the molding and heat treatment procedure The braid (2) comprises a proximal retention region (6), a distal retention region (8) where the end of the wire or wire (4) converges within the holder (10), and the proximal A cylindrical cross member (12) inserted between a holding region (6) and the distal holding region (8),
The two holding regions (6, 8) are positioned on the two sides of the short circuit that are occluded by the post-implant septum, the cross member (12) crosses the short circuit, and the holder (10) is used for implant or explant instrument ( 100, 200) Closure device showing a head portion (14) at the free end in which a small hole (16) in the form of a cross hole is press fitted and held.   2. The closure device according to claim 1, wherein the head portion (14) is configured as a spherical head.   3. A closure device according to claim 1 or 2, wherein the double hole cut discharge surface (18, 20) of the cross hole is configured to converge on the outer surface of the spherical head towards the free end of the holder (10).   The small hole (16) is slit obliquely with respect to the cross hole, and ends (22, 24) of the diagonal slot (26) overlap with the longitudinal direction of the cross hole. The occlusion device according to one. One of the offsets (2) of thin wires and wires (4) tapered to the diameter of the catheter (5) used in the endovascular implant or explant procedure is given a suitable final shape by the molding and heat treatment procedures. The prosthesis (2) includes a proximal retention region (6), a distal retention region (8) where the end of the wire or wire (4) converges in the holder (10), and A cylindrical cross member (12) between a proximal retention region (6) and the distal retention region (8);
The two holding regions (6, 8) are positioned on the two sides of the short circuit that are occluded by the post-implant septum, the cross member (12) crosses the short circuit, and the holder (10) moves the fixation loop (301). Through the small hole (16), the head portion at the free end configured as a semi-spherical centering sleeve with a longitudinal section with a small hole (16) in the form of a cross hole, which can be held in the implant / explant instrument (300). The occlusion device showing (14). Surgical instruments (100, 200) for implant devices, in particular occlusion device implants and implants, with a holder (10), provided with a suitable final shape by means of molding and heat treatment procedures, A variant of one of the fine wires and wires tapering to the diameter of the catheter used in the explant procedure is provided with the proximal holding region and the ends of the wires or wires within the holder. A distal retention region converging to, and a cylindrical cross member inserted between the proximal retention region and the distal retention region,
Two holding regions are located on the two sides of the short circuit that are occluded by the post-implant septum, the cross member crosses the short circuit, and the holder is in the form of a cross hole that is press fit and held in the implant or explant instrument. The head portion is shown at the free end where the eyelet is located, and the surgical instrument (100, 200) is opened and closed by a push-pull system, and the head portion (14) of the holder (10) of the press-fitting lock type implant device is attached. A gripper tongue (102) having a gripping jaw (103, 104, 105) configured to be graspable and a gripper tongue (102) in the delivery state of the surgical instrument from a proximal end in the form of a loop (117) The two non-clamping ends (118, 119) extend from the inside of the tapered sleeve (109) and the coil spring (106). An insertion wire or guide wire (116) that is guided through the distal grasping portion (108) at the distal end of the surgical instrument through the loop (117) before the implant of the implant device. Surgical instruments (100, 200) guided through a small hole (16) in the implant device holder (10) and attached to the gripper tongue (102).   The push-pull system is attached to the proximal end by the following components: a coil spring (106), an actuator means (107) that extends axially therethrough, is axially robust and sufficiently flexible. Of the gripper tongue (102) which is axially displaceable at the proximal end portion (112) and the first gripping portion (108) attached to the shaft (111) and distal end of the gripper tongue (102) A tapered sleeve (109) that receives the shaft (111) and the proximal end of the coil spring (106) at the distal end portion (113) by abutting the stop (114); and the coil spring (106) A second grasping portion (110) received by abutment of the distal end of the retainer against the detent, the grasping jaws (103, 104, 105) being located adjacent the proximal adjacent front of the tapered sleeve (109) Parts and close the force is biased by a coil spring (106) to (115), surgical instrument of claim 6, wherein the opening and advance the actuator means (107) (100, 200).   A first unfastened end (119) of the insertion wire or guide wire (116) can be attached in the region of the first gripping portion (108), and a second of the insertion wire or guide wire (116). The non-crimped end (118) comprises a nipple (120) so that when the connection between the first end (119) and the first gripping portion (108) is separated, an insertion wire or guidewire A surgical instrument (100) according to claim 6 or 7, wherein (116) is pulled with the implant device connected or retracted from the surgical instrument.   Surgical instrument (200) according to claim 6 or 7 for an implant device having a holder (10), in particular an implant and an explant of an occlusive device, wherein the small hole is slit obliquely with respect to the cross hole The ends of the diagonal slots overlap with the longitudinal direction of the cross hole, and the first unattached end (119) of the insertion wire or guide wire (116) is in the region of the first gripping portion (108). The second unattached end (118) of the insert wire or guide wire (116), which is attachable, comprises a nipple (120), whereby the insert wire or guide wire (116) is looped (117). ) Moved through the oblique slot (26) of the eyelet (16) and then pulled in the connected state of the implant device, or When disconnecting the implant device from the surgical device, said loop (117) again becomes loose so it extends from the small hole (16) through the oblique slot (26) surgical instruments (200).   The surgical instrument (100, 200) according to one of claims 6 to 9, wherein the insertion wire or guide wire (116) is made of nitinol wire. Surgical instrument (300) for an implant device, in particular an occluding device implant and an explant, having a holder (10),
An offset of one of the fine wires and wires tapered to the diameter of the catheter used in the endovascular implant or explant procedure, provided with a suitable final shape by the molding and heat treatment procedures, Includes a proximal retention region, a distal retention region where the end of a wire or wire converges within the holder, and a cylindrical cross member between the proximal retention region and the distal retention region ,
Two holding areas are located on the two sides of the short circuit that are occluded by the post-implant septum, the cross member crosses the short circuit, and the holder is held in the implant / explant instrument by passing a fixation loop through the eyelet The surgical instrument (300) is shown axially by means of a push-pull system, the head part being shown at the free end, configured as a longitudinal semi-spherical centering sleeve with a cross-hole shaped small hole A hook (302) toward and away from the small hole (16), and a fixed loop (301) extending through the small hole (16) and hooked on the hook (302), whereby the hook (302 ) Moves away from the small hole (16), tensioning the fixation loop (301) causes the implant device to 300) a surgical instrument (300) that can be held by the instrument. The push-pull system comprises a coil spring (106) and actuator means (107) extending axially therethrough and sufficiently robust and flexible in the axial direction,
The actuator means (107) has a shaft (303) of the hook (302) attached to the proximal end and a first gripping portion (108) attached to the distal end. ,
The proximal end of the coil spring (106) is received at the distal end portion (113) by abutting the stop (114) and accommodates the shaft (303) of the hook (302) for axial displacement. A cylindrical sleeve (304) that receives and a second gripping portion (110) that receives the distal end of the coil spring (106) by abutting the stop;
The hook (302) is axially displaced so as to move away from the small hole (16) by the force urged by the coil spring (106), and the actuator means (107) is advanced to move into the small hole (16). The surgical instrument (300) of claim 11, wherein the surgical instrument (300) is moved toward.   The cylindrical sleeve (304) is a central portion for guiding the first continuous groove (306) on the proximal front side (305) and the axially displaceable hook (302) without twisting. One side having a second longitudinal groove (307) on one side and a longitudinal axis of the sleeve (304) and having a protrusion (309) in the center for receiving the knot (311) of the fixed loop (301) The surgical instrument (300) according to claim 12, further comprising a cross groove (308) disposed at right angles to the second longitudinal groove (307).   The cross section of the front portion of the hook (302) is about one third flatter than the cross section of the shaft (303), and when it is fitted into the second longitudinal groove (307) of the cylindrical sleeve (304), there is no play. A surgical instrument (300) according to claim 13, shown.   The surgical instrument (300) according to one of claims 11 to 14, wherein the blade (310) is disposed in a gap (315) formed at the distal end behind the hook (302).   Surgical instrument (100, 200, 300) according to one of claims 7 to 15, wherein the actuator means (107) is a wire.   A method for repeatedly connecting an implant device having a holder (10), in particular an occlusion device, to a surgical instrument (100), wherein the small hole (16) in the holder (10) of the implant device is opened before the endovascular procedure is started. Through which the loop (117) of the insertion wire or guide wire (116) is guided and thus hooked to a fixing point (101) provided on the gripper tongue (102), the insertion wire or guide wire ( 116) the first and second non-clamped ends (119, 118) are held or fixed in the region of the first gripping part (108), and the gripper tongs (102) make the head of the holder (10) of the implant device Gripping the part (14) and the head part (14) fully within the gripper jaws (103, 104, 105) of the gripper tongue Tightening the second non-clamped end (118) of the insertion wire / guidewire (116) with the nipple (120) until it is received and the gripper tongue (102) to the head portion of the implant device The second unclamped end (118) with the nipple (120) releasing from (14) is loosened to confirm the seating of the implant device and the gripper tongs by means of the insertion wire / guidewire (116) Reconnecting (102) from time to time with said holder (10) of the implant device.   A method for repeatedly connecting an implant device having a holder (10), in particular an occlusive device, to a surgical instrument (200), wherein a small hole (16) in said holder (10) of the implant device is started before the endovascular procedure is started. Guide the loop (117) of the insertion wire or guide wire (116) through the diagonal slot (26) of the first and second unattached ends (119, 118) of the insertion wire or guide wire (116). ) Is held or fixed in the region of the first gripping portion (108), gripping the head portion (14) of the holder of the implant device by the gripper tongue (102), and the head portion (14) Insertion wire or guide wire (116 with nipple (120) until it is received in the gripping jaws (103, 104, 105) The second non-clamped end (118) of the lip, and a second zip with a nipple (120) that releases the gripper tongue (102) from the head portion (14) of the implant device. Unscrew the end (118), confirm seating of the implant device, and reconnect the gripper tongue (102) with the holder (10) of the implant device at any time by an insertion wire / guidewire (116). Enabling. A method comprising: enabling. An implant device having a holder (10), in particular a method for repeatedly connecting an occluding device to a surgical instrument (300), wherein a fixed loop (301) of defined length is inserted into a small hole in the holder (10) of the implant device. (16), the knot (311) of the fixed loop (301) fits the projection (309) centrally, and the cross section of the fixed loop (301) positioned in the cross groove (308) is During insertion of the fixed loop (301) into the cross groove of the cylindrical sleeve (304) to be held along the diameter and a defined forward shift of the hook (302), the second longitudinal groove (307) Sliding the cross section of the fixing loop (301) of the cross groove onto the hook (302) of the cross groove, and fixing the cross section thereto, and the holder (10) of the implant device. Retracting the hook (302) that pulls and clamps to the proximal front side (305) of the sleeve (304) and loosening the locking loop (301) by an updated and defined forward displacement of the hook (302). Loosen the proximal anterior side (305) of the sleeve (304) from the holder (10), confirm seating of the implant device, and implant the sleeve (304) from time to time using the fixation loop (301) Allowing reconnection to the holder (10) of the device;
A method comprising:

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