RU2244516C1 - Surgical stapler for placing cylindrical spiral-shaped clamp - Google Patents

Abstract

FIELD: medical engineering.

SUBSTANCE: device has clamp casing like elongated tube having rotor mounted inside and handle enclosing worm shaft. The shaft is coaxially arranged with the clamp casing. The handle is joined to the clamp casing with detachable unit and has power drive to worm shaft. The worm shaft is connected to the rotor enabling one to set clamp in rotary translation motion. Detachable magazine shaped as cylindrical tube is available in the stapler having internal right-hand thread near the outlet opening on the distal end containing cylindrical spiral-shaped clamps arranged between thread coils and internal left-hand thread on its proximal end for fastening the distal end of the clamp casing.

EFFECT: simplified design; multiple-use clamp casing and single-use magazine; high reliability in fixing network prosthesis.

4 cl, 14 dwg

Description

The invention relates to medicine and can be used, in particular, for fixing a mesh prosthesis with a laparoscopic brace during laparoscopic hernia repair.

Known [1] is a surgical apparatus - the Solni-11 herniostapler, containing a working part with a handle, a persistent sponge with a matrix for bending the brackets, a slide bracket pusher. This device is designed to fix the mesh prosthesis during laparoscopic hernia repair and with its help a titanium U-shaped bracket is applied. The constructive implementation of the apparatus provides the possibility of its multiple use and requires charging with a bracket immediately before setting it.

The disadvantage of this design is the low speed of brackets due to extraction, the large diameter of the working part.

Known [2] surgical apparatus for hernioplasty "MULTIFIRE END HERNIA". The device is rechargeable, contains a pen, bracket case and is equipped with a disposable store with titanium brackets.

Common disadvantages of surgical herniostaplers using U-shaped brackets are the large diameter of the working part, including the brace body and magazine, the unreliability of brace fixation in dense tissues, the complexity and the impossibility of slightly traumatic removal of the superimposed brace in case of incorrect placement.

To some extent, the concept of constructing surgical staplers used to impose cylindrical spiral brackets, proposed by Origin MedSystems, Inc and the United States Surgical Corporation in a number of patents [3-6], is to some extent free of these disadvantages.

Currently, on the basis of this concept, serial production of a disposable multiply charged apparatus for hernioplasty has been established [7].

Before describing the nature of the prototype, we note that according to the existing GOST [8], the concept of the working part of the staplers includes the concepts of a bracket body and a magazine.

Closest to the claimed invention in technical essence is the surgical stapler proposed in [6]. It contains a working part, including a bracket case in the form of an elongated tube with a rotor and a load spring placed inside and a magazine for cylindrical spiral brackets made at the distal end of the bracket case, as well as a handle with a worm shaft enclosed in it and placed coaxially with the working part. The handle is connected to the proximal end of the working part using a detachable node and is equipped with a power drive to the worm shaft, which is connected with the rotor.

For each cylindrical spiral bracket, the proximal part has a rectilinear section oriented orthogonal to its axis of symmetry and having a length not exceeding half the diameter of the bracket.

The store has an internal thread, structurally corresponding to the shape of cylindrical spiral brackets, which serves for the longitudinal fixation of the brackets placed in it. The angular orientation of the cylindrical spiral brackets is ensured by introducing their proximal parts into a blind longitudinal groove on the rotor.

The loading spring provides the flow of cylindrical spiral brackets to the outlet of the store. The power drive serves to impart rotational movement to the rotor, which leads to rotational-translational movement of these brackets from the outlet of the magazine into the patient’s body tissue.

The constructive implementation of the working part of this surgical stapler affects its cost. Since the bracket case and the store are combined in a single design, this obviously excludes any possibility of reusable use of the working part. As our experiments showed, an attempt to execute a store in this surgical stapler in the form of a removable structure leads to failure. This is a consequence of the fact that the connection of the rotor with cylindrical spiral brackets implemented in the stapler leads to the transfer of not only the main lateral force, but also a noticeable longitudinal force from the action of the compression spring on the proximal part of these brackets. The use of the rotor in the distal part having the “D” profile, due to asymmetric influence, leads to radial bending of the proximal portion of the cylindrical spiral bracket, which entails jamming of this bracket in the magazine. In addition, the constructive implementation of the proximal part of the cylindrical spiral brace does not exclude the possibility of unwanted migration of this bracket through the mesh prosthesis into the tissue of the patient’s body.

The objective of the invention is the creation of a surgical stapler with a reusable brace body and a disposable magazine with cylindrical spiral brackets, simplifying the design of its working part, increasing the reliability of fixation of the mesh prosthesis, expanding the functionality and reducing the cost of a separate surgical operation.

The solution to this problem is achieved by the fact that the inventive surgical stapler for applying a cylindrical spiral bracket, like the prototype, contains a bracket case in the form of an elongated tube with a rotor placed in it, a handle with a worm shaft enclosed in it, placed coaxially with the bracket case, connected to the specified a bracketed body with a detachable unit and equipped with a power drive to the worm shaft connected to the rotor with the possibility of imparting rotational-translational motion to the specified bracket. Unlike the prototype, a removable magazine is additionally introduced in it, made in the form of a cylindrical tube with an internal right-hand thread on the side of the outlet at its distal end, with cylindrical brackets placed between the turns of the thread and an internal left-hand thread at its proximal end for attachment to the distal end bracket body.

Moreover, in a preferred embodiment, the proximal part and the distal end of the cylindrical helical bracket lie in a plane passing through its axis of symmetry, and the proximal part is made in the form of a rectilinear section oriented orthogonally to the specified axis and having a length equal to the inner diameter of the specified bracket.

The surgical stapler has the best reliability indicators for fixing the mesh prosthesis when performing a through longitudinal groove in the distal part of the rotor to accommodate the rectilinear portion of the proximal part of the cylindrical spiral bracket.

The implementation of the proximal part of the cylindrical spiral brackets according to the claimed invention reduces the possibility of its migration into the patient’s body tissue, which improves the reliability of fixation of the mesh prosthesis.

The implementation of the rotor two-link extends the functionality through the use of disposable magazines with various design parameters of cylindrical spiral brackets in accordance with the tasks.

The use of a removable store in the inventive surgical stapler solves the problem of reusable use of its structurally most complex elements. This, ultimately, leads to a significant reduction in the cost of a single surgical operation. Another advantage of the proposed implementation of the store is the ability to fill its internal volume with medicinal formulations, providing, for example, a gradual aseptic.

In contrast to the prototype, the implementation in the distal part of the rotor of the through longitudinal groove with a length not exceeding the length of the magazine, as well as the indicated structural design of the proximal part of the cylindrical spiral bracket solves the problem of transferring mainly longitudinal force from the rotor to the cylindrical spiral bracket.

The implementation in the surgical stapler of a rotor of two links interconnected by a spline connection, simplifies the process of bringing it into working condition and increases the life of the tool due to the single use of the second link of the rotor containing a through longitudinal groove.

Further, the invention is illustrated by figures of graphic images and photographs of the main components of the apparatus.

Figure 1 presents a General view of the stapler for imposing spiral brackets.

Figure 2 shows the bracket housing with a rotor located inside it.

Figure 3 shows the store placed inside the cylindrical spiral brackets.

Figure 4 illustrates a section AA of the distal end of the rotor.

Figure 5 shows a section bB store.

Figure 6 shows a side view of a cylindrical spiral bracket.

7 illustrates a top view of a cylindrical spiral brace.

Fig. 8 shows the features of securing the mesh prosthesis using a cylindrical spiral bracket.

Figure 9 shows the bracket housing with the first rotor link located inside it.

Figure 10 illustrates a side view of a disposable store with cylindrical spiral brackets located inside and a second rotor link.

Figure 11 presents a bottom view of the store depicted in figure 10.

On Fig side view of a structural embodiment of the second link of the rotor.

On Fig presents the main nodes of a specific implementation of the inventive apparatus: a cylindrical handle connected to a bracket body; the first link of the two-link rotor connected to the worm shaft and the store with the second link of the rotor.

Fig. 14 illustrates the movement of a cylindrical spiral bracket from an outlet window of a magazine.

A surgical stapler for applying cylindrical spiral brackets comprises a handle 1, a bracket body 2, a magazine 3. The handle 1 of the reusable application has a cylindrical shape. A worm shaft 4 is coaxially placed inside it. The power drive to the worm shaft 4 includes a slider pusher 5, a retainer 6, a compression spring 7, a lever 8, an eccentric 9. The proximal end 12 of the worm shaft 4 is fixed using a figured nut 10, and the distal end 11 has blind hole for spline connection with the slot 22 of the rotor 14.

The reusable housing bracket 2 is made in the form of an elongated tube with an external left-hand thread 15 at the distal end, with a rotor 14 located inside and a collet nut 13 that serves for detachable connection with the handle 1.

The disposable store 3 consists of a plastic case made in the form of a tube with an internal left-hand thread 16 at the proximal end and an internal right-hand thread 17 on the remaining part for placement inside several cylindrical spiral brackets 18.

The cylindrical spiral bracket 18 has a pointed distal end 19 and a proximal part in the form of a rectilinear section 20, orthogonal to the axis of symmetry of the cylindrical spiral bracket 18 and placed in a plane containing the specified axis and the distal end 19, and the length of the rectilinear section of the proximal part is equal to the inner diameter of the specified bracket 18 The proximal part of the cylindrical spiral bracket 18 is inserted into the through longitudinal groove at the distal end 21 of the rotor 14, which ensures the conversion of careful movement of the worm shaft 4 in the rotational-translational movement of the spiral bracket 18.

The rotor 14 is made of two links 23 and 25, and at the distal end 24 of the link 23 there is a blind hole for splined connection with the slot 26 of the link 25.

A surgical stapler for applying a cylindrical spiral bracket operates as follows.

To bring the device into action, it is necessary to transfer the lever 8 from the neutral position “H” to the working position “P”, thereby ensuring the engagement of the latch 6 with the thread of the worm shaft 4, and push the slide pusher 5 all the way to the stroke length, while the worm shaft 4 will make a certain number of revolutions, corresponding to the number of turns of the helical bracket, necessary for it to exit from the distal end of the magazine 3 into the body tissue to fix the mesh prosthesis.

Transferring the lever 8 to the neutral position “H” and thereby releasing the latch 6 from engagement with the worm shaft 4, you should move the slide pusher 5 to its original position.

In a similar way, the subsequent spiral brackets are superimposed.

For subsequent disinfection and sterilization of the apparatus units, it is necessary to unscrew the nut 13 of the collet clamp, disconnect the bracket body 2 from the handle 1, unscrew the curly nut 10 of the handle 1 and pull out the worm shaft 4 from the handle 1, then unscrew the magazine 3 for its subsequent disposal.

The design of the stapler described above for applying cylindrical spiral brackets increases the reliability of fixing the mesh prosthesis during laparoscopic hernia repair by increasing the length of the rectilinear section in the proximal part of the bracket. The use of a one-time magazine of brackets reduces the cost of one operation. The implementation of the rotor with a two-link extends the functionality of the stapler through the use of disposable magazines with various design parameters of the brackets themselves.

SOURCES OF INFORMATION TAKEN INTO ACCOUNT

1. Organ stapler laparoscopic single-sided “SOLO-11”. Prospect of the manufacturing company “Axiom”, St. Petersburg. (http: / www. aksioma.spb.ru, www.aksioma.com.)

2. Devices for hernioplasty - rechargeable devices for laparoscopic hernia repair for fixation by a titanium U-shaped brackets of a polypropylene mesh. MULTIFIRE ENDO HERNIA. Company prospectus AUTO SUTURE. TYCO Healthcare Corporation. (http: /www.autosuture.com.)

3. Bolduc L., Kramer T.A., Hodges B.A., McCoy T., Lunsford J. Surgical helical fastener with applicator. Pat. USA No. 5582616, IPC A 61 B 17/00, publ. 12/10/1996.

3. Bolduc L., Kramer T.A., Hodges B.A., McCoy T., Lunsford J. Surgical helical fastener with applicator and method of use. Pat. USA No. 5810882, IPC A 61 B 17/00, publ. 09/22/1998.

4. Bolduc L., Lunsford J. Surgical helical fastener with applicator. Pat. No. 6296656 USA, IPC A 61 B 17/00, publ. October 2, 2001.

5. Stein J. et al. Coil fastener applier. Pat. USA No. 5830221, IPC A 61 B 017/08, publ. November 3, 1998.

6. Bolduc L., Kramer T.A., Hodges B.A., McCoy T., Lunsford J. Applicator for attaching fastener to tissue. Pat. USA No. 5964772, IPC A 61 17/00, publ. 10/12/1999.

7. The device herniostapler PRO TACK - 5 mm. Disposable multiply-charged apparatus for fixing polypropylene mesh with titanium spiral brackets. Company prospectus AUTO SUTURE. TYCO Healthcare Corporation. (http: /www.autosuture.com.)

8. Medical staplers and staplers. General specifications. GOST 21643-82.

Claims (4)

1. A surgical stapler for applying a cylindrical spiral bracket, comprising a brace body in the form of an elongated tube with a rotor placed in it, a handle with a worm shaft enclosed in it, coaxially with the brace body, connected to the bracket with a detachable assembly and provided with a power drive to the worm a shaft connected to the rotor with the possibility of imparting rotational-translational motion to the indicated bracket, characterized in that a removable magazine is made in it, made in the form of a cylindrical ubki with the inner right-hand thread on the part of the outlet opening at its distal end, with the placed between the threads cylindrical spiral brackets and the inner left-hand thread at its proximal end for attachment to the distal end of the bracket body. 2. The surgical stapler according to claim 1, characterized in that the proximal part and the distal end of the cylindrical helical bracket lie in a plane passing through its axis of symmetry, and the proximal part is made in the form of a rectilinear section oriented orthogonally to the specified axis and having a length equal to the inner the diameter of the specified bracket. 3. The surgical stapler according to claim 2, characterized in that a through longitudinal groove is made in the distal part of the rotor to accommodate a rectilinear portion of the proximal part of the cylindrical spiral bracket. 4. The surgical stapler according to claim 3, characterized in that in it the rotor is made of two links interconnected by a spline connection.

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