JPS5886152A - Surgical device - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

DETAILED DESCRIPTION OF THE INVENTION The present invention relates to surgical instruments for closing incisions or wounds.

Closing an incision or wound where the restraining element is a thick clamp-like block or footplate containing a V-shaped recess for receiving the thread and a relatively wide flat support surface that rests against the lip of the wound. A ninth surgical instrument that does this is known from Hegermann, US Pat. No. 3,541,591. This surgical instrument for closing an incision or wound is characterized in that the restraining elements are attached to the thread in pairs, the thread and the connecting rod between the pairs of restraining elements are separated, and The piece of thread made with one free end can be rethreaded through the lip of the wound;
A block or footle on the other end of that thread piece.
The block or foot plate is unsuitable for use on the body because it has a flat surface that can be applied to the wound, although the foot plate has a flat surface that can be applied to the wound. It is. Because such a flat surface rests against the lip of the wound evenly over its entire length, it impedes blood circulation within the tissue, especially if additional pressure is exerted by a bandage placed over the wound.
Delays wound healing. Separation of the connecting rods of the restraint pair in the immediate vicinity of the wound is inappropriate, since shearing of such connecting rods could result in debris entering the wound and causing infection. It is. Removal of the restraining element or block after the wound has healed is difficult since it is practically impossible to spread the block, and access to the threads held in the block or footplate is very difficult and easy to cut. Because you can't do it, it becomes even more difficult.

The object of the invention is a restraining element or clamp with a physiologically more favorable shape, which is easier and more rational to handle, both when suturing a wound and when removing the suture hook after the wound has healed. It is an object of the present invention to provide a pressing element or flange which can be easily manufactured. This purpose is primarily achieved by providing a knurled, zigzag or toothed shape to the edge or surface of the clamp or restraining element that is applied against the wound. By means of such a shaped clamp, the wound liss is supported with optimal blood circulation, which significantly speeds up the healing of the wound and makes the scar clean and smooth.

The clamp or pressure element of the invention preferably has a stepped or beveled edge portion for application to the lip of the wound, for example in the case of two shanks of the clamp, one of the shanks having a corrugated surface or It has a knurled or toothed edge portion and extends beyond the other shank. This allows the clamp, in the flat shank variant, to tighten the skin near the lip of the wound, but without applying uniform pressure to the lip of the wound. Therefore, there is no problem even if a bandage is placed over the wound.

Furthermore, rubbing of the skin or tissue against the thread is avoided when gripping the restraining element or clamp against the lip of the wound.

It is known from numerous experiments that it is only possible to make the restraining elements or clamps thin and, in a preferred embodiment, flat so that the edge portion of each clamp rests against the lip of the wound. 1. Suppressing elements or.

The clamp can be fabricated by punching a sheet of bendable material from a metal die and then folding it into a generally V-shape. Each clamp preferably has a normally open shape and includes two shanks. One shank has an opening and the other shank has a tongue that can be passed through the opening. The rope can then be fixed to the thread by passing the thread between the shanks, inserting the tongue into the opening, and then bending and pressing it against one of the shanks. The tongue not only identifies the thread to the shank, but also serves as a stop when the thread is threaded through the open clamp. Thus, when the thread is gripped between the shanks, it hits part of the tongue and the thread can be easily passed through the widest opening of the open clamp, yet remains in place in the center of the clamp. . Even when the threaded clamps are wrapped around the lips of the wound, the blood circulation is not obstructed and cut off due to the uniform pressure on both sides of these wound litz. Circulation! is easily done. The structure of the clamp allows threads of various thicknesses to be used without problems.

The simple construction of the glue 2 pumps according to the invention, which are made from sheets or strips, can be preferably inserted in pairs into the forceps in the open position and gripped onto the thread by the forceps, so that a particularly efficient handling is possible. Moreover, the clamps can be removed from the thread by spreading the shank of each clamp with suitable equipment, so that there is no need to cut the thread. They are therefore particularly suited to be stored in a clamp dispenser and removed from the clamp dispenser by means of forceps or the like. This is not only rational, but also completely eliminates It can be done hygienically.

As already mentioned, it is particularly economical to manufacture the restraining elements or devices by stamping the clamps from a strip or sheet and then folding them into the required shape. Since the clamps are attached to the thread in pairs spaced a suitable distance from each other, the thread only needs to be held between the clamps, which means that the thread can be gripped between the clamps and the thread can be cut. This greatly facilitates the use of forceps and reduces the force required to do so.

Suppression Jj made from sheets or strips! ! It is known from German Patent No. 382.357 to hold threads or clamps at each end of surgical thread, but those clamps of the patent are merely intended as end parts of the thread to facilitate tying. It is only used as. Also, these clamps are not shaped to be suitable for use as a sling suppressing element.

Yet another disadvantage of the German patent clamp is that the thread must first be threaded through a narrow hole. Therefore, rational handling as in the present invention is not possible.

BRIEF DESCRIPTION OF THE DRAWINGS In order to provide a thorough understanding of the nature and objectives of the present invention, the detailed description continues below in conjunction with the accompanying drawings.

FIG. 1 shows a wound 1 which is already partially closed following the upper section of the drawing. The suture is composed of a plurality of individual strands of thread 2 carrying restraining elements in the form of clamps or clips 3 that are applied against each litz of the wound. As shown in Figure 2, the outer shank of each clamp 3 extends laterally beyond its inner shank, thereby providing contact between the clamp 3 and its wound glue tab against the skin of the lip of the wound. The optimal one is K. 1st
As can be clearly seen in the figures, and especially in Figure 6, K.

The outer edge portion of the clamp 3 is knurled, for example toothed or corrugated. This brings the edges into intermittent contact with the lip of the wound, thus meeting the physiological requirement of good blood circulation.

In addition to the commonly used thread 2 and a needle 4 for passing this thread through the lip of the wound, a clamp actuator is provided.

As shown in FIG. 1, this clamp actuator is shaped like special forceps with a surface structure similar to ordinary surgical grasping scissors, and has a pair of handles. Each lever is formed with a grip and a locking device, such as a toothed stop device 5, which holds the forceps in a locked position. The forceps can be manually released from its locked position. The purpose of the forceps is to grasp two clamps 3 at the same time and to attach them vertically to the thread 2 in a tension-proof manner. This will be explained in detail later. The forceps further comprises a cutting device such as a knife 6 (not shown in FIG. 1 but visible in FIG. 3) which is operated by a lever 7 to cut the thread 2 between the two clamps 3. At the beginning of the suturing operation, a first clamp 3 is attached to the end of the thread 2 opposite the needle 4. The thread 2 is then threaded through the lip of the wound in a known manner by means of the needle 4 until the clamp 3 is in position relative to one lip of the wound. The thread 2 is then introduced into the next two open V-shaped shanks forming another clamp, which are placed in the open forceps as shown in FIG. The position of the thread 2 in each clamp 3 is determined by the nine tongues 8 K, made from the lower shank of the clamp, as shown in FIG. 4, and initially K in the transverse direction p3. IC is positioned. The forceps are then moved across the stretched thread 2 towards the lip of the wound until one clamp 3 within the forceps contacts the lip of the wound. During this movement of the forceps towards the lip of the wound, the clamps will already be compressed to such an extent that the thread can just slide within one clamp 3. The nine forceps with the open or half-closed clamp 3t are stretched along the circular thread 2 towards the lip of the wound until the pair of clamps 3 is pressed with the required pressure against the lip of the wound. The optimal pressing pressure of the two clamps against the lip of the wound can be very finely determined by moving the two clamps to the lip of the wound. The clamp is then closed using forceps. This ensures that the two lances 3 are each fixed to the thread 2 in the correct position relative to the lip of the wound. This is K
Thus, one stitch of the suture consisting of one girth of thread 2 and two clamps 3 is completed, and lever 7 forces the knife against the force of a spring (not shown). By operating 6 and cutting the thread between another pair of clamps 3 in the forceps, a new thread end combined with the clamps 3 is created. The next stitch can then be started immediately by passing the needle 4 through the two litz of the wound from the same or opposite directions until the clamp 3 on the thread 2 comes into contact with the lip of the wound. In the meantime the forceps are opened and receive another pair of open clamps 3. This other pair of clamps 3 is then gripped onto the thread 2, the thread 2 is cut between the clamps 3, and the suturing continues. This process is repeated as often as necessary until the sutures are complete and the wound is closed.

As mentioned above, this suturing method is rational and can be performed quickly. Because the six pairs of opposing clamps press both lips of the wound evenly along their length together, the suture barbs can be applied at a relatively large distance from each other. This not only increases the speed of work, but also creates a favorable structure for the healing and formation of a wound scar.

Following a description of the main elements and techniques of suturing, we then detail the accessory instruments used. Clamp 3 for the thread
The surgical thread or wire may be of any material that can be applied in a sufficiently stress-resistant manner. As shown in FIG. 4, the inner surface of the clamp 3 is knurled, corrugated, or textured. Also, good adhesion of the clamp is obtained by appropriate selection of materials. A malleable and non-irritating material, such as pure aluminum, is suitable for use.

Such a lamp has less tendency to open after being pressed. The reliability of the gripping action is increased by the tongue 8 of the lower clamp shank entering the opening 9 of the upper clamp shank when both shanks of the clamp are pressed together by the forceps. A suitably shaped recess 10 (FIG. 5) in the upper arm or handle of the forceps bends the tongue 8 over the upper clamping shank, thus allowing the tongue 8 to rest on its upper clamping shank as shown in FIG. be pressed against. The upper arm of the forceps serves as a bending device for the tongue 8.

The lower arm or corner of the forceps has two flat lateral recesses, each of which has a front stop or undercut 11 for receiving one lower clamp shank and a ramp positioning device. Prepare (see Figure 4).

The outer edge of the lower clamp shank is flush with the side of the lower arm or knob of the forceps, and the edge portion of the upper clamp shank projects laterally from the forceps. This ensures the contact between the clamp in the forceps and the lip of the wound and also makes the clamp's grip on the thread 2 accurate in that position. The two planar recesses receiving the lower clamp shank are separated by a planar middle, central recess 12. A knife 6 is pressed against this rib 12 to cut the thread 2.

The side surface 12a of the central groove 12 becomes the end stop of the clamp 3, so that the clamp 3Fi is pressed against the lip of the wound even when the forceps are opened. The forceps are equipped with two resilient U-bolts 13 which hold the clamp 3 in the stop or undercut 11 when the forceps are opened (FIG. 4).

The upper arm or handle of the forceps has a U-shape at the root 13.
The free end of the lamp is provided with a recess which accommodates the lamp holding device. The U-shaped port 13 comprises a helical spring end placed symmetrically around the forceps axis 14. The undercut or stop surface 11 forming the clamp positioning device within the forceps is undercut, as can be seen in FIG. 5, in order to improve retention of the clamp 3 within the forceps. Although not shown in detail, the knife 6 is also supported along with its operating lever T along the forceps axis 14'.

The gripping portion of the forceps is equipped with JiW-15. The inner surfaces of the jaws 15 are knurled in order to effectively grip the needle 4 when it is passed through the lip of the wound.

In order to perform the surgery at optimal speed, it is not only important to streamline the suturing process as already mentioned, but also to ensure that the forceps are always loaded with new clamps quickly and safely. .

This is made possible by a lamp loading device such as a clamp dispensing station (FIGS. 6-10). Two magazines or clamp storage units 1 in which the paces 16 are inserted into retaining devices such as dovetail grooves 17
8 can be provided. These magazines hold stocks of clamps 3.

The engine 18 is held in the operating position by releasable detents or locks and can be easily removed when the detents or locks are disconnected. 8th
9 and 9 show how, in each magazine 18, the slider 19 acts against a spring 20 with spiral ends to maintain a stack of clamps 3 that remains constant regardless of the length of this stack. Shows how to send it forward with the force of. The outermost clamp 3a of each stack is fed forward on the clamp guide 21 until it reaches a ramp arrester such as the end stop 22. In that position, the clamp 3a is completely separated from the no-clamp 18a or outer guide of the jaw 18, where it is grasped by the forceps and pulled out transversely to the longitudinal axis of the magazine 18. Cover lugs 21a each hold a clamp 3a fed on the guide 21. Two magazines 18 shown in FIG.
have respective end stops 22 which are operatively juxtaposed, and the clamps 3a, as shown in FIG.
Fit the clamps within the forceps, operatively spaced apart from each other by the required distance within the forceps. The leaf spring 23 is the clamp 3
Provided below the release point of &. As shown in FIG. 7, when the lower arm or handle of the forceps is inserted between the stops 220, the two clamps 3 are received on the forceps, and the spring 23 causes the lower arm or handle of the forceps to
The lower shank of each clamp 3 engages the undercut or stop surface 11 by pressing against the clamp 3aK to be removed from the jin 18. The insertion movement of the forceps is limited by stop pins 24, as best shown in FIG. As soon as the forceps are fully inserted with their end stop 24t, they are pulled back again, drawing the clamp 3a through the end of the stop 11. The clamp 3a is now further held in place within the forceps by a resilient U-bolt 13. In this way, yet another pair of clamps is fed into the loading station or release position of the clamp distributor, and the forceps again place two new clamps on the thread 2.
Can be installed on top.

To remove the suture thread and clamp from the healed wound, K cuts the thread piece with scissors between one side of the scar and the clamp on this side, removes one clamp, and uses the other clamp. The suture can also be pulled out from the lip of the wound. However, it is more preferred to use special equipment such as a clamp remover to open and remove the clamp. FIGS. 11 to 13 show such devices,
That is, the bin set 25 and its operating method will be shown.

The first set 25 is attached to one arm or handle.
2 and 131% iI, it is provided with a notch 26 which serves as a support for the existing end of the clamp 3. The other arm of the set 25, as shown in FIG. 13, is provided with a knife 27 which can be passed under the sloping front surface 28 of the upper shank to spread the shank. - That arm of the set 25 is also provided with a stop 29. This stop limits the insertion depth of the knife 27 between the shanks of the clamp 3 so that the thread 2 is released but not gripped by the knife 27. The clamp 3tj thus spread out is pulled out towards the side of the thread, whereupon the opposite clamp can be removed along the thread piece. Tweezers 25 are also limited to stop 30
and 31. These stops are arranged so that, in the open state of the set, the knife 2T just contacts the extended lower shank of the clamp 3 and engages under the sloping front face 28 of the upper shank of the clamp. The number of routes is limited to 270. At the same time, it makes it impossible for the bin set to close with such force that it would over-bend the upper clamp shank. Furthermore, there is no risk of the knife 27 engaging the underside of the clamp 3, thus preventing the lip of the wound from being damaged thereby.

Various types or embodiments of the clamp are possible. The design of the clamp or restraint element can vary and different materials can be used. The clamp or restraining element may, for example, be of cylindrical or prismatic shape, made of non-irritating plastic, compatible with human skin, with a device for threading the thread through the tissue and allowing strain-free grasping of the thread. It can be a rondo. The clamp or restraining element can also each consist of two metal or plastic parts connected to each other by a snap cover and suitable to press against the thread in a tension-proof manner. A forceps or similar device as described above for attaching another constraining element or clamp to a thread may be designed to attach only one constraining element to the thread. Cutting the thread can also be done with scissors, so a knife or other cutting device is not essential, as opposed to forceps. Cutting the thread may be omitted, but in this case the clamps or pressing elements must be spaced appropriately from each other in order to be able to remove the thread section between them without tension after the suturing is completed. No.

If the clamps are handled using forceps of the type described above, and the clamps are not too far apart from each other, K.
ii. Instead of the knife 60, a device could be used which loops the thread between the clamps before they are gripped onto the thread.

To reduce wear from clamping or needle handling, the forceps jaws may be hardened or coated with hard alloy plates.

The rounded clamp dispenser can be equipped with special supports or guides for the forceps to facilitate introduction of the forceps into the correct position for clamp pick-up.

Such a design could also include a device controlled by the forceps to prevent the clamp from being ejected from the magazine until the forceps are inserted. This prevents the clip from being held in the wrong position or being lost. The clamps may also be joined in a stack by a suitable physiologically acceptable adhesive, or simply joined at special easily separable points. The clamp dispenser can also have only one storage unit or muzzle with devices for delivering the clamps from both the left and right sides of the release point. Such a table design could also include one common spring feeding both stacks of clamps.

The forceps of the modified embodiment shown in an inverted view in FIG.
It has two handles with ring-shaped ends and lugs 40.

Each of these lugs 40#1 is provided with locking teeth 5 for locking the forceps in a stationary position.

As best seen in FIG.
This contact restricts movement of the forceps beyond the fully closed position. As can be clearly seen in FIGS. 16 and 17, the forceps includes a thread cutter K in the form of a movable blade 6, a suture cutter Fi, and a lever 7 connected thereto.
Equipped with.

The lever T is pivoted on a lever 42 provided on the upper handle of the forceps, as shown in FIG. Lock stop *5
When the forceps are separated from each other, the forceps are maintained in the open position by a compressible bottle elastic device such as spring 43. Spring 431-t also maintains the cutter in the non-cutting open position tK as shown in FIG. Pivoting the cutter counterclockwise causes the blade 6 to advance toward an opposing blade (not shown) in the lower jaw of the forceps, in conjunction with which the thread or suture 2
cut.

In the vicinity of the cutter, the jaws of the forceps are designed to pick up and hold one clamp 3 on each side thereof.

Figure 22 shows details of how the wear plates 44 and 45 are inserted into the forceps.

Clamp f3 is held between the six pairs of plates such that its longer lower shank rests on stop m48. The clamp SFi is thus slightly elastically deformed from its original shape and is therefore held firmly within the open forceps. A recess 10 is provided in each upper plate 45 for receiving and bending the tongue 8 when the forceps are closed.

The gripping end of the forceps is provided with jaws 15, as seen in FIGS. 14 and 15, these jaws are also fitted with wear-resistant plates 47
and 48, and grips the needle 4 as the stiffener is passed through the lip of the wound. The suturing process 11 has already been fully described and does not require further detailed explanation. However, further information will only be provided regarding each phase of the suturing process regarding how to operate the forceps.

As previously mentioned, FIG. 14 shows the forceps in a fully open condition or position. In this position, the clamp 3 is fed from the machine. A detailed explanation of the structure of the magazine follows. FIG. 19 shows 30 pairs of clamps installed relatively adjacent to each other on each holding par 49. This is illustrated in FIGS. 21 and 22. A flat rib in the center of each holding par 49 determines the distance separating the clamps 3. Therefore,
To grasp a pair of clamps, open forceps may be inserted from the open front of the storage unit or magazine onto the two clamps or holding pars 49, as shown in FIG. When the forceps are withdrawn, each stop surface takes out a clamp, so that the forceps is loaded with a pair of clamps 3 suitably spaced apart from each other. This is the 14th
In the figure, the part of the thread 2 which has just been passed through the wound gland is at the stage of being moved between the jaws of the forceps and thus between the fingers of the clamp 3, until it touches the tongue 8. Soζ
The forceps are then closed into the first locking position of FIG. 16, in which the first pair of teeth of the locking device 5 engage with each other. The forceps are now maintained in that position by the elastic spreading force of the clamp 3 or by the force of the spring 43 which pushes the forceps open. The forceps can then be easily slid along the thread 2 to the lip of the wound. One clamp 3 is attached to the wound glue
As soon as you come in contact with it and apply pressure to it,
The forceps have a first pair of teeth in which the second pair of teeth of the locking device 5 engage with each other.
7 is closed to the second locked position shown in FIG. Clamp 3
is then firmly fixed to the thread 2.

When the handle of the forceps is further pushed to the third locking position as shown in FIG. 18, the lug on the lever T is lifted by the lower handle of the forceps. This, in conjunction with the opposing blade at the cutting position, effectively cuts the thread 2 between the two clamps 30. Thus, the thread or suture is completely severed at the final locking position [FIG. 18]. A new thread is then made with the clamp 3 attached to one end and the needle attached to the other end.

The needle is again passed through the wound lip. When the clamp 3 fixed to the end of the suture 2 reaches the position shown in FIG. 14 against the lip of the wound, the forceps remove two new clamps 3 and the same operation is repeated.

As shown in FIGS. 19 and 21, two two-stick covers 50 are welded or glued together in a known manner.
and 51, a magazine casing-like lamp dispensing device is provided. Towards the rear of each shroud, a groove 52 is provided which extends upwardly to a certain height and serves to securely load the magazine into the magazine holder. cover 50
and 5N- are both open at one end to allow access to the clamp inserted inside. 50 each cover
The flat sides of and 51 are provided with vertical rows of holes 53 in which flexible retaining tongues 54 are formed integrally with the shroud. As shown in FIG. 21, the flexible retaining tongue 5
4 is provided with inwardly directed projections which engage with teeth formed on the outer surface of the clamp 3, so that the clamp 3 is securely retained within the magazine. Clamp 3II
i. It is installed on the clamp holding bar 4S of the magazine insert as already explained in FIG. 21.

Each retaining par 49 has a cover 50 and 5 of the magazine casing.
1 by a vertical insert member 55 held between them. When withdrawing the pair of clamps with the forceps, the flexible retaining tongues 54 are moved elastically outwards, thereby releasing the clamps 3. When loading or reloading the magazine, the clamp 1'3 is pushed in, where the flexible retaining tongues 54 are first pushed outwards and then snapped into place between the teeth of the clamp 3. Get into it. The forceps can receive the clamp 3 through the inlet of the casing.

The holding par 49 of the magazine insert is provided with a recess 59 for receiving the tongue 8 of the clamp 3. These recesses serve as guides when the clamp 3 is inserted, so they are slightly tapered in the depth direction.

FIG. 19 shows that the magazine can be installed in a holding device such as a magazine holder. The side 7 flange of the magazine holder is provided with inwardly bent edges 52 as shown in FIG. 21, thereby engaging grooves 52 formed in the magazine covers 50 and 51. to hold the magazine in place. FIG. 19 shows the Z-shaped upper element 56 of the magazine holder inserted into the L engraving element 57. The horizontal legs of the lower element 57 are connected to the work table 6
It is adapted to act as a leaf spring 57' which allows the magazine holder to be attached to the edge of a motor or the like.

If desired, the 2-shaped upper element of the magazine holder can be inserted into the lower element 58 shown in FIG. The horizontal legs of this lower element 58 are provided with screws 58' for gripping the magazine or storage unit to the edge of the worktable.

In a preferred embodiment, the clamp 3 is made of stainless steel and its bent portion is thinner than the rest of the clamp. The thickness of the majority of the clamp is approximately 0.3 m, and the thickness of the thinner area is approximately 1 m. The width of the clamp is 6 to 4 ta, and the length of the upper shank shown in FIG. 3 is approximately 7 mm. The length of the lower shank is approximately 8.05 m. The upper shank will be bent upward near its end and sharpened to give it a thinner cross-section than the rest of the clamp. The rib-like design facilitates insertion of the wedge or knife 27 of the bin set 25 to spread the shank of the clamp. The teeth on the upper shank each have two edges forming an angle of about 600 degrees and a height of about 1111+, and the teeth extend from the starting point of one edge to the edge of the other edge. Approximately 5m to the starting point of the section
separated. In the area of the tongue 8 where the threads are curled as shown in FIG. 3, the shank may be provided with an uneven surface. This improves thread grip considerably. The clamp can also be made of aluminum of substantially the same thickness and width. In this case, it is necessary to make the bent part of the clamp thinner than the other parts.

It is to be understood that the invention is not limited to the details of construction shown and described herein, but that many variations are possible that will be apparent to those skilled in the art.

[Brief explanation of drawings]

Fig. 1 is a drawing showing the process of suturing a wound, Fig. 2 is a partially enlarged sectional view of the completed sutured part, Fig. 3 is a partially enlarged perspective view of the sutured part, and Fig. 4 shows two clamps and threads. FIG. 5 is a partial longitudinal sectional view of a closed forceps according to the invention; FIG. 6 is a perspective view of one embodiment of a clamp delivery device; FIG. FIG. 8 is a perspective view of the magazine housing; FIG. 9 is a perspective view of the clamp guide in the housing; FIG. 10 is a perspective view of the forceps partially inserted into the clamp distributor; FIG. 11 is an elevational view of a bin set according to the invention for separating the clamp from the thread; FIG. FIG. 13 is an enlarged side view of the at or knife of the forceps set after expanding the shank of the clamp; FIG. 14 is an enlarged side view of another embodiment of the forceps according to the invention. A top view and a schematic diagram showing the suturing process, FIG. 15 is a sectional view of the locking mechanism of the other embodiment of the forceps, and FIG. 16 is a detailed side of the other embodiment of the forceps. 17 is an inverted view of another detail of said other embodiment of the forceps in one operating position; FIG. 18 is an inverted view of the embodiment of FIG. 17 of the forceps in yet another operating position; FIG. 19 is a perspective view of the magazine housing of the clamp; FIG. 20 is a perspective view of the first embodiment of the magazine holding device that can be attached to a work table; FIG. 21 is a perspective view of the first embodiment of the magazine holding device that can be attached to a work table; , a perspective view of a second embodiment of the magazine holding device, and FIG. 22 is an enlarged horizontal sectional view of the magazine.

Claims (1)

[Scope of Claims] (1) A surgical instrument for closing a wound by passing the thread through the lip of the wound, the wound suturing needle being used in conjunction with a tied thread; A combination of two clamps are placed on each side to firmly fix the thread, each clamp having a knurled edge portion applied against the lateral side of each lip of the wound, the clamps The jagged edge portion can be positioned on the chain thread so that it rests against the lip of the wound from both sides, thereby facilitating blood circulation within the lip since the lip is not subject to uniform pressure throughout. Surgical instruments such as those used to close wounds. (2. The surgical instrument according to claim 1, in which the edge portion has a wavy surface. (3) Percentage In the surgical instrument according to claim 1, the edge portion (4) The surgical instrument according to claim 1, wherein the edge portion is formed with teeth. (5) Claims The surgical instrument of claim 1, wherein each of the clamps has an outer surface and the edge portions form an angle with each other. Put it in the utensil,
each said clamp having opposed interconnected shanks between which a chain thread is received and gripped, one said shank extending beyond the other;
and a surgical instrument with a knurled edge. (Force) In the surgical instrument of claim 6, the shanks abut each other when the clamp is in the closed position and have a recess near one end and a wedge in the recess. (8) The surgical instrument according to claim 1, in which each clamp is normally open and the chain thread is removed. Surgical instrument, 1, further comprising a device capable of receiving and fixing the chain thread in the closed state, and further comprising a device for maintaining the clamp in the closed state. In the surgical instrument, each said clamp comprises two shanks, one shank having an opening and the other shank being provided with a tongue which passes through said opening when said clamp is closed. , the tongue being moved to engage the one shank when the clamp is in the closed position, thereby securing the clamp to the second shank.Ql Claim 8. in surgical instruments,
A surgical instrument, wherein each clamp is stamped from a piece of foldable sheet and then folded into a substantially V-shape. [υ The surgical instrument according to claim 8, which is movable between an open position and a closed position) in combination with a forceps having a handle, the retaining device being able to move from an unlocked position to a locked position. a surgical instrument comprising a portion foldable into the open position, the forceps receiving the normally open clamp in the open position and folding the retainer from the unlocked position to the locked position; . (I) The surgical instrument according to claim 11, wherein the forceps is provided with a device for cutting a thread. 0 The surgical instrument according to claim 11, wherein the forceps a surgical instrument comprising jaws for gripping each needle, the jaws having end portions for gripping the needle. I. The surgical instrument of claim 11, wherein the handle of the forceps is movable along a path between an open position and at least one closed position; A surgical instrument further comprising a stop device for limiting movement along. (151%) The surgical instrument of claim 11, comprising: a cutting device capable of moving between a non-operating position and an operating position and cutting the blade in the operating position; and a handle of the forceps. 12. The surgical instrument of claim 11, further comprising a compressible elastic device i for pushing the cutting device t towards the open position and pushing the cutting device t towards the inoperative position. A surgical instrument, wherein a handle of the forceps is movable along a path between an open position and at least one closed position, and comprising a device for locking the nuclear forceps in the at least one closed position. 17. The surgical instrument of claim 16, wherein each lanzo is normally opened and received in the forceps in its open condition, but compressed when the forceps is in the one closed position. , thereby allowing the clamp to slide along the first position before it is fixed in the proper position. In the instrument,
A handle of the forceps is movable along a path to a second closed position, and the clamp is compressed and secured in the second position by the forceps when in the second closed position. , surgical instruments. (11% permissible range for surgical instruments in item 18,
A handle of the forceps is movable along a path to a third closed position, and further comprising a device actuated by the handle near the sixth closed position to cut the third in the sixth closed position. , surgical instruments. (To) The surgical instrument according to claim 19,
A handle of the forceps further moves between the open position and the second and third positions.
movable between closed positions, and the locking device is operable to lock the forceps in the second and third closed positions, the forceps being manually releasable from the closed position; Surgical instruments. 0a % The surgical instrument of claim 19, wherein each handle of the forceps is formed with a grip and further comprises a lever coupled to the cutting device, the handle of the forceps being moved from the second closed position to the second closed position. (6) one of the handles actuates the lever to disconnect the second when moved (closed position);
Surgical instruments. (23%) The surgical instrument of claim 20, wherein the handles are elastically deformable, and when the handles are moved from the second closed position to the third closed position, at least one of the handles A surgical instrument that is elastically deformed. (c) The surgical instrument according to claim 11,
The forceps receives two clamps 7" at the same time in its open position and closes these two clamps at the same time, thereby gripping them simultaneously against the thread on one side of the wound. 124) The surgical instrument of claim 7, wherein the surgical instrument has opposed arms, one arm forming an abutment and the other arm forming an abutment. The liI! is provided near the end, and when the wedge engages the recess, the closed clamp is opened, and with the clamp held between the wedge of the bin set and the abutment, both arms are opened. A surgical instrument in which one of the arms is moved toward the other arm by a force applied therebetween.(c) The surgical instrument of claim 24,
the arms are movable along paths toward and away from each other during the bin setting, and further comprising a stop device for limiting movement along the cough path in either direction;
Surgical instruments. (2) The surgical instrument according to claim 1, which is combined with a clamp dispensing device f for storing the clamps in a row, the clamp dispensing device having a base and moving on the base so as to store the clamps in one row. A surgical instrument comprising a clamp distributor dispensing at least one clamp, wherein forceps grasping the one clamp remove the one clamp from the clamp distributor. @ The surgical instrument of claim 1, which is combined with a clamp dispensing device for storage in the Cranzo T-1 row, the clamp dispensing device being movable on the base and the pace; a clamp dispenser for storing and dispensing at least one clamp at a time, forceps grasping the one clamp and then operating the clamp to remove the one clamp from the clamp dispenser; The clamp delivery device also includes a device mounted on the base to guide the forceps to the one clamp. @ In the surgical instrument set forth in claim 27,
The forceps includes a lower jaw and an upper jaw, and the guide device includes a leaf spring mounted on the base to guide the lower jaw to a position below the cough lance, and A surgical instrument comprising a stop fixed to the base for positioning the one clamp within the kneading jaws to limit movement of the jaws beyond the base. (21) In the surgical instrument of claim 27,
The dispenser includes a housing having an opening, a clamp guide located partially within the housing and projecting beyond the opening from the opening, and a clamp guide for each clamp so as to limit the distribution of clamps to one at a time. A surgical instrument comprising a clamp movement restriction device placed on the clamp guide at a distance corresponding to the width. (to) The surgical instrument of claim 27, further comprising a device coupled to at least one of the base and the restriction device for exchangeably retaining the distributor. 6υ In the surgical instrument according to claim 27,
The forceps comprises two jaws, at least one of the clamps having an undercut, and further provided with an elastic device in the other jaw for removing one clamp from the dispensing device. a surgical instrument, the clamp being received and held in place between the undercut and the resilient device. (to) A surgical instrument according to claim 1, comprising a casing having an opening, and a ninth clamp holding part inserted into the casing to store the pair of clamps thereon. a clamp dispensing device for storage in position; and a clamp dispensing device having a jaw threaded through the opening and stored on a retaining par in the clamp dispensing device.
A surgical instrument comprising a complete forceps combination for receiving and removing at least one of a pair of clamps from the received clamp t-clamp delivery device. The surgical instrument of claim 32, wherein the casing has an aperture, the edge portion is toothed, and further comprising a resilient tongue disposed at least partially within the casing. 1.1+, a surgical instrument having end portions normally located substantially within the casing but partially passing through the chain aperture, each of the end portions having an abutment removably engaged with one of the line drawings. The surgical instrument of paragraph 62, wherein the casing comprises two interconnected covers and an insert member held between the covers, and wherein the clamp retaining member is A surgical instrument coupled to a cough insert. (G) Scope of % Pestle Haruyuki In the surgical instruments set forth in item 32,
A surgical instrument further comprising a retaining device securable to a table and configured to removably retain the clamp delivery device. (to) The surgical instrument of claim 1, wherein the pair of clamps is configured to be stored in a clamp delivery device, each edge portion being toothed, the clamp delivery device comprising: having resilient retaining tongues with means for removably engaging one line drawing, the line drawings being spaced apart from each other at a predetermined interval, each said tongue extending into the space and generally between two line drawings; A surgical instrument that is manipulated so that it flexes and separates from the line drawing when pushed outward. 57. The surgical instrument of claim 56, wherein each line drawing has a predetermined height and the line spacing exceeds the height by at least four times. (To) The surgical instrument according to claim 66,
A surgical instrument in which the line drawing has two edges that are at an angle of about 60 degrees to each other. (To) Claim No. 1! In the surgical instrument of paragraph 16, each lanzo is stamped from a foldable elongated sheet and has a thickness over a majority of its length, and a generally central area of the clamp has a thickness of a surgical instrument having a thickness that is less than the thickness of the surgical instrument, whereby the clamp is easily folded from the sheet in the area into a substantially V-shape; - The surgical instrument of claim 36, wherein each lanzo has a generally V-shape and comprises two horn shank, one of the shank being provided with an opening in a predetermined area and the other shank being provided with an opening in a predetermined area. The area is provided with a tongue which is adapted to be passed through the mosquito opening, where the thread is passed between the two line areas and the cough shanks are pressed towards each other. and a surgical instrument, the second being firmly secured between the two mosquito regions. (4υ The surgical instrument of claim 69, wherein the sheet is made of stainless steel and has a chain thickness of about 0.
．． 3.3 mm and the thickness of the area is about 0.1 mm. (4) The surgical instrument of claim 56, wherein the clamp is stamped from a bendable sheet of aluminum approximately 0.3 ws thick. 03 Needle for wound closure In a method for preparing a suture material for closing the lip of a wound by means of tied threads and forceps, the method comprises: bending an IJ tube into a substantially V-shaped clamp; then holding the two clamps spaced apart from each other in good condition within the forceps; then causing the clamps to be gripped by the forceps against the first; Retained by! cutting the thread between the clamps, thereby fixing one of the clamps on one end of the thread piece and a number of threads on the other end of the thread piece. is attached and by means of this needle the substitute thread piece is passed through the litz of the wound until the clamp is applied to one lip of the wound. (4) In the method of claim 43, each lance has a knurled edge portion, and the clamp is moved such that the knurled edge portion is applied to the outside of one lip of the wound. (c) positioning the lip of the wound by means of a plurality of clamps initially open and having one jagged edge and the other edge and a thread tied to the needle; In a surgical method for the closure of: (a) adjacent pairs of clamps with the edges of the other facing each other by securing successive pairs of said clamps spaced apart from each other on said thread; (b) by cutting the thread between a pair of said clamps, one clamp is secured to one end of the piece of thread and the needle is tied to the other end; (C) By passing a needle to which an iron nail is tied through a portion of the lip of the wound, the jagged edge of one clamp is folded to one side. (d) #gripping another clamp on the other end of the thread piece and removing the serrations of the other clamp; Edge t-vertical against the lip of the square; (e) during step) t-repeat, repeat step (C) on other parts of the lip of the wound, and step (d) t-repeat. to substantially close the wound by applying force within the lips, since the lips are not subjected to uniform pressure between them. Then, when the wound has at least partially healed, one of successive pairs of the clamps A surgical method comprising the steps of: prying open the clamp; (g) withdrawing a corresponding suture from the wound, thereby allowing the wound to heal without leaving any sutures.