SE459465B - Kirurgisk hopsyningsapparat - Google Patents
Kirurgisk hopsyningsapparatInfo
- Publication number
- SE459465B SE459465B SE8704267A SE8704267A SE459465B SE 459465 B SE459465 B SE 459465B SE 8704267 A SE8704267 A SE 8704267A SE 8704267 A SE8704267 A SE 8704267A SE 459465 B SE459465 B SE 459465B
- Authority
- SE
- Sweden
- Prior art keywords
- arm
- clamping arm
- support arm
- closed position
- clamps
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
Landscapes
- Health & Medical Sciences (AREA)
- Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Engineering & Computer Science (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Ophthalmology & Optometry (AREA)
- Surgical Instruments (AREA)
Description
15 20 25 30 35 459 465 2 ken innefattar dels en s.k. klammerarm, försedd med spår för klamrar och med ett skaft på armens ena ände, arm är ledkopplad med en stödarm, böjning av klamrarnas ändar, vilken klammer- försedd med fördjupningar för dels en mekanism för utstötning av klamrarna ur spåren och dels en mekanism för fixering av armarna i slutet läge, varvid, enligt uppfinningen, den led, som,förbin- der armarna, är belägen på klanuuerarmens fria ände och stödarmen är förbunden med leden via en avsina ändar och kan vridas 180° så, att vid apparatens öppna läge utgör denna arm klammerarmens fort- sättning och vid apparatens slutna läge ligger den parallellt till klammerarmen, och apparaten innefattar även en vridmékanism som är utförd i form av en hävstâng, vars ledaxel ligger på klam- merarmens skaft och en draglänk, som är förbunden med hävstân- gen och stödarmen.
Det är ändamålsenligt att utföra mekanismen för fixering av ar- marna i slutet läge i form av en på stödarmen inställd bygel och ett stötorgan beläget på skaftet och vid kraftpâkänning anpassat för samverkan med ett kuggstångsdrev, som är förbundet med kil- formiga element, vilka är så inställda, att de kan glida längs klammerarmen och med hjälp av bygeln kila fast stödarmen i för- hållande till klammerarmen i apparatens slutna läge.
En kirurgisk apparat utförd enligt föreliggande uppfinning gör det möjligt att åstadkomma appendektomioperationer med laparo- skopisk metod utan öppning av bukhålan via genomstickning, vil- ket minskar operationernas skadeverkning.
Apparaten är bekväm att använda och säkerställer en hög pålitlighet vid s.k. kulisnitt, vid appendektomien.
Uppfinningen beskrives närmare nedan under hänvisning till kon- kreta exempel och bifogade ritningar, på vilka fig. 1 visar en perspektivvy av en kirurgisk hopsyningsapparat enligt uppfinnin- gen i öppet läge; fig. 2 visar en perspektivvy av den kirurgiska hopsyningsapparaten i fig. 1 i slutet läge; fig. 3 visar en sido- vy av ett stötorgan i en mekanism för utstötning av klamrar ur spåren; fig. 4,_5, 6, 7 och 8 illustrerar olika stadier vid ap- pendektomien med den i fig_ 1, 2 visade kirurgiska apparaten. 10 15 20 25 30 35 459 465 Den i fig. 1, 2 visade kirurgiska hopsyningsapparaten innefat- tar en klammerarm 1 med ett skaft 2 på sin ena ände och en led 3 på sin motsatta ände samt en stödarm 4 med sin ena ände för- bunden med klammerarmen 1 medelst leden 3. Stödarmen 4 har en vridningsförmåga på 1800 i förhållande till klammerarmen 1 och i sitt ena yttersta läge utgör den klammerarmens 1 förlängning (apparatens öppna läge är visat i fig. 1), medan den i sitt and- ra yttersta läge ligger parallellt med klammerarmen 1 (äppärätens slutna läge är visat i fíg. 2). Stödarmen 4 är försedd med en vridmekanism, vilken är utförd i form av en hävstång 5, vars led- axel 6 ligger på skaftet 2, och en draglänk 7, som med sin ena ände är förbunden med stödarmen 4 och i sin andra ände har ett stift 8, vilket samverkar med hävstångens 5 skära 9. Klammerarmen 1 har en längdskåra 10 med längs dess båda sidor belägna spår 11 för inplacering av f1-formiga klammer av exempelvis tantaltråd i storlek 0,2 x 3 x 4 mm. Stödarmen 4 är försedd dels med tvâ rader av fördjupningar 12 för böjning av klamrarnas ändar vid hopsyning, vilka fördjupningar 12 motsvarar spåren 11 hos klammerarmen 1, och dels med ett längdspår 13, som motsvarar längdskåran 10. En- ligt uppfinningen är apparaten försedd med en mekanism för utstöt- ning av klamrarna ur spåren 11, vilken mekanism är utförd ana- logt med kända mekanismer för samma ändamål. Denna mekanism inklu- derar ett vid ena änden tillspetsat_stötorgan 14 (fig. 1, 3), vilket är försett dels med en kniv 15 och kan flyttas längs längd- skåran 10 (fig. 1), och dels är försett med rörliga plattor (ic- ke visade i figuren), vilka plattor befinner sig inne i längdskâ- ran 10, är vinkelräta mot denna och under inverkan av stötorga- nèts 14 tillspefísaae ände kan förflyttas i sitt plan sen stöta klamrarna ut ur spåren 11. På sin motsatta tillspetsade ände har stötorganet 14 ett stöd 16 och ett stift 17, som befinner sig i skaftets 2 styrspår 18. Den kirurgiska hopsyningsapparaten inne- fattar dessutom en mekanism för armarnas 1, 4 fixering i slutet läge, vilken mekanism är utförd i form av en pâ stödarmens 4 fria ände inställd bygel 19 och av ett stötorgan 20 på skaftet 2 samt ett kuggstângsdrev 21 och kilformiga element 22. Stötorga- net 20 är därvid anpassat att vid kraftpàverkan samverka med kugg- stângdrevets 21_kuggsektor, varvid varje kilformigt element 22 är med sin ena ände fäst vid kuggstångsdrevets 21 kuqqâektor och 10 15 20 25 30 35 459 465 4 inställt med glidningsförmâgan längs klammerarmen 1 och förmå- gan att med sina tillspetsade ändar med hjälp av bygeln 19 fast- kila stödarmen 4 i förhållande till klammerarm en vid apparatens slutna läge.
Den kirurgiska hopsyningsapparaten fungerar på följande sätt.
Användning av apparaten enligt uppfinningen beskrives med ett exempel för utförande av en laparoskopisk appendektomi. Före ope- rationen lägger man klamrarna i armens 1 spår 11. ' I punkten Mac-Burne inleder man laparoskopin och genomför bukhå- Apparaten enligt uppfinningen används om det mask- formiga bihanget ligger fritt eller åtminstone befinne rösa sammanväxningar. lans översyn. r sig i po- I enlighet med laparoskopidata inför man genom instickningen den sârutvidgande anordningens tubulus, och via den för man sedan den kirurgiska hopsyningsapparaten i öppet läge (fig. 4, 5) in i buk- hâlan. ' Efter det fixerar man det maskformiga bihanget i dess främre del med hjälp av tänger 23 (fig. S), vilka inf öres genom operationskanalen, och för vidare hopsyningsapparatens klammer- arm 1 in under basen av det maskformiga bihanget och tarmkäxet.
Därefter trycker man på skaftets 2 hävstâng 5, vrider stödarmen 4 i leden 3 1800 och överför hopsynin läget - stödarmen 4 (fig. 2, armen 1. gsapparaten till det slutna 6) inställs parallellt med klammer- Armarna 1, 4 fixeras i det slutna läget och åstadkommer en kraftpâverkan på stötorganet 20. Kuggstångsdrevets 21 kugg- sektor vrids därvid och stöter de kilformiga elementen 22 fram- åt till apparatens arbetsände; de kilformiga elementen 22 utövar med sina tillspetsade ändar inverkan på bygelns 19 undanböjda av- snitt och trycker armarna 1 och 4 t ätt till varandra. Det mask- formiga bihangets och och tarmkäxet s baser är nu fastklämda mel- lan armarnas 1 och 4 arbetsytor. Genom att sed an trycka på stödet 16 (fig. 1, 2 , 3) skickar man det med kniven 15 försedda stötor- ganet 14 framåt. Stötorganet 14 förflyttas därvid längs längdskä- ran 10, varvid stötorganets tillspetsade ände lyfter plattorna, 10 15 20 25 5 459 465 vilka i sin tur stöter klamrarnas ändar ut ur spåren 11, vilka ändar syr ihop det maskformiga bihangets och båda tarmkäxbladens ihoptryckta väggar. Knivens 15 egg skär det maskformiga bihanget och tarmkäxet mellan klamrarnas 24 tvâ rader (fig. 7). Sedan för man över hopsyningsapparaten i dess öppna läge genom att inver- ka på hävstången 5 (fig. 1) och tar den ut ur bukhålan genom ope- rationstubulus. Det avskurna bihanget borttas ur bukhålan via den laparoskonüàa sârutvidgaranordningen 25 (fig. 8) med hjälp av tängerna 23.
Man har tillverkat prover av denna kirurgiska hopsyningsapparat och provat dem i experiment på människolik och på hundar. Expe- rimenten har bekräftat konstruktionens arbetsduglighet.
Här är ett exempel på tillämpning av den kirurgiska hopsynings- apparaten. Liket av en man K., 34 âr, som avled av en mekanisk asfyxi 06.04.86, användes. Det maskformiga bihanget 7,6 x 0,5 cm befann sig medialt och-var fritt från sammanväxningar. Man genom- förde appendektomien med hjälp av den enligt uppfinningen föreslag- na kirurgiska hopsyningsäpparaten. Man utförde laparotomien och tarmen under mellangärdet ligerades och på den uppâtgâende delen lade man på bitar av sockerbeta utan socker (beet pulp). Inne i blindtarmen höjdes trycket upp till 90 mm kvicksilverpelare och snittets täthet följdes noggrant. Vid dessa värden på trycket för- blev kulisnittet hermetiskt.
Den kirurgiska hopsyningsapparaten enligt uppfinningen möjliggör alltså att man i praktiken kan utföra appendektomi med laparo- skopi på ett säkert sätt.
Claims (2)
1. En kirurgisk hopsy ningsapparat innefattande dels en s.k. klammerarm (1), försedd med spår (11) för klamrar och med ett skaft (2) på armens (1) ena ände, kopplad med en stödarm (4), böjning av klamrarnas ändar, vilken klammerarm (1) är led- försedd med fördjupningar (12) för dels en mekanism för utstötning av klamrarna ur spåren (11) och dels en mekani sm för armarnas (1, 4) fixering i slutet läge, k ä n n e t e c k n a d av att en led (3), som förbinder armarna (1, 4) är belägen på klam- merarmens (1) fria ände, att stödarmen (4) dels är förbunden med leden (3) via en av sina ändar och kan vridas 1800 så, att vid apparatens öppna läge utgör denna arm klammerarmens (1) fort- sättning och vid apparatens slutna läge ligger den parallellt med klammerarmen (1), och dels innefattar en vridmekanism som är utförd i form av en hävstâng (5), vars ledaxel (6) ligger på klammerarmens (1) skaft (2), och en draglänk (7) som är förbun- den med hävstângen (5) och stödarmen (4).
2. En kirurgisk hopsyningsapparat enligt krav 1, t e c k n a d av att mekanismen för armarnas (1, slutet läge är utförd i form av en pâ stödarmen (4 gel (19) och ett stötorgan (20) beläget på skaftet kraftpâverkan anpassad för samverkan med ett kuggst som är förbundet med kilformiga element (22), vilka k ä n n e - 4) fixering i ) inställd by- (2) och vid ângsdrev (21), är så in- ställda, att de kan glida längs klammerarmen (1) och med hjälp av bygeln (19) kila fast stödarmen»(4) i förhållande till klammar- armen i apparatens slutna läge.
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US07/127,031 US4784137A (en) | 1987-11-16 | 1987-11-16 | Surgical suturing instrument |
Publications (3)
Publication Number | Publication Date |
---|---|
SE8704267D0 SE8704267D0 (sv) | 1987-11-02 |
SE8704267L SE8704267L (sv) | 1989-05-03 |
SE459465B true SE459465B (sv) | 1989-07-10 |
Family
ID=22427978
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
SE8704267A SE459465B (sv) | 1987-11-16 | 1987-11-02 | Kirurgisk hopsyningsapparat |
Country Status (5)
Country | Link |
---|---|
US (1) | US4784137A (sv) |
DE (1) | DE3802328A1 (sv) |
FR (1) | FR2622429A1 (sv) |
GB (1) | GB2211779B (sv) |
SE (1) | SE459465B (sv) |
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Publication number | Priority date | Publication date | Assignee | Title |
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US3017637A (en) * | 1959-07-10 | 1962-01-23 | Sampson Arnold | Surgical suturing instrument |
FR1237056A (fr) * | 1959-10-06 | 1960-07-22 | Appareil pour l'exécution d'anastomoses latérales gastro-intestinales | |
SU566574A1 (ru) * | 1975-05-04 | 1977-07-30 | Всесоюзный научно-исследовательский и испытательный институт медицинской техники | Аппарат дл наложени линейного скобочного шва на органы и ткани |
US4402444A (en) * | 1981-04-20 | 1983-09-06 | United States Surgical Corporation | Surgical stapling instrument with automatic frame reinforcement |
US4470533A (en) * | 1982-08-13 | 1984-09-11 | Ethicon, Inc. | Surgical instrument for suturing tissues and organs |
SU1183082A1 (ru) * | 1983-08-19 | 1985-10-07 | Всесоюзный научно-исследовательский и испытательный институт медицинской техники | Хирургический сшивающий аппарат |
US4610383A (en) * | 1983-10-14 | 1986-09-09 | Senmed, Inc. | Disposable linear surgical stapler |
US4566620A (en) * | 1984-10-19 | 1986-01-28 | United States Surgical Corporation | Articulated surgical fastener applying apparatus |
US4573622A (en) * | 1984-10-19 | 1986-03-04 | United States Surgical Corporation | Surgical fastener applying apparatus with variable fastener arrays |
US4648542A (en) * | 1985-11-01 | 1987-03-10 | Senmed, Inc. | Disposable stapler |
-
1987
- 1987-10-30 FR FR8715108A patent/FR2622429A1/fr active Pending
- 1987-11-02 SE SE8704267A patent/SE459465B/sv not_active IP Right Cessation
- 1987-11-04 GB GB8725857A patent/GB2211779B/en not_active Expired - Lifetime
- 1987-11-16 US US07/127,031 patent/US4784137A/en not_active Expired - Fee Related
-
1988
- 1988-01-27 DE DE3802328A patent/DE3802328A1/de active Granted
Also Published As
Publication number | Publication date |
---|---|
SE8704267D0 (sv) | 1987-11-02 |
SE8704267L (sv) | 1989-05-03 |
GB2211779B (en) | 1991-10-02 |
GB8725857D0 (en) | 1987-12-09 |
GB2211779A (en) | 1989-07-12 |
US4784137A (en) | 1988-11-15 |
FR2622429A1 (fr) | 1989-05-05 |
DE3802328A1 (de) | 1989-08-31 |
DE3802328C2 (sv) | 1990-07-05 |
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