TWI551261B - An in vitro knotting device and method for laparoscopic surgery - Google Patents

Description

In vitro knotting device and method for laparoscopic surgery

The present invention relates to a surgical knotting device and method, and more particularly to an in vitro knotting device and method for laparoscopic surgery.

Press, abdominal surgery is the mainstream of minimally invasive surgery, but it is quite difficult to knot the surgical site in the abdominal cavity. Therefore, there is a technique of in vitro knotting. At present, the commonly used laparoscopic in vitro knotting technique is divided into two categories: static Knots and sliding Knots. The static knot is a surgical knotting method similar to the traditional open surgery, that is, the two-wire end of the suture that has not been knotted after suturing is pulled out from a catheter (Trocar) and half-knotted (Half Hitch), and then One hand grasps the end of the main line and another line that works around the main line end, and the other hand pushes the secondary end with the half-knot into the abdominal cavity with a pusher, and moves the half-knot To the suture, push the other half of the sub-segment in the same way; or, exchange the main and secondary segments of the grip, and change the sub-line segment that was originally pushed into the main line segment, so that the original The grasped main line segment becomes the secondary line segment and is pushed into the other half of the knot so that any knot that the physician wants to hit can be played. However, when pushing the half-sleeve according to the above sequence, it is necessary to push the semi-typhage more than six times in order to form a firm surgical knot. Because the instrument repeatedly enters and exits the catheter port, the abdomen of the ablation will be easily leaked, and The main inconvenience caused by the looseness of the first push-in half and the premature separation of the pusher and the suture are affected, which affects the knotting quality.

In order to avoid the inconvenience of the static knot, another way is to change the suture pulled out of the body into a complicated sliding knot, so that the sliding knot can be pushed into the suture in the abdominal cavity by the push rod from the catheter mouth at a time. And tighten the stitching force to complete the knotting.

Although the sliding knot is convenient, the general sliding knot strength is insufficient, so many sliding joints with different structures have been invented, in order to find the best balance between convenience and knot strength, among which Roeder's four flat knots (4s Roeder Knot) It is recommended as a preferred example, but the strength of the knot is only equivalent to the static knot formed by pushing the 4th half of the knot, and the strength is still insufficient, which is the laparoscopic in vitro knotting method currently used. There is no perfect way to combine the convenience of a sliding knot with the highest knot strength of a static knot.

The main object of the present invention is to provide an in vitro knotting device and method for laparoscopic surgery, which enables an operator to complete the knotting of the surgical site by simple operation in laparoscopic surgery.

Another object of the present invention is to provide an in vitro knotting device and method for laparoscopic surgery, which has a knot formed with the convenience of a sliding knot and the highest knot strength of a static knot.

The in vitro knotting device for laparoscopic surgery provided by the present invention comprises: a knotting component and a manipulation device; the knotting composition comprises: a body; a channel running through the two ends of the body; a small tube body; a hole penetrating the two ends of the small pipe body; the small pipe system penetrates into the passage of the body and is displaceable, and the front end of the small pipe body forms a a sleeve portion having a first end, a second end and an active knot, the movable knot being sleeved on the sleeve portion; the second end of the suture is threaded through the small tube body a through hole; the line segment between the movable knot and the sleeve portion forms a snare, and the slit can change the size of the loop when displaced in the small tube; a threaded segment is formed in the slit Between the first end of the line and the active knot, the length of the threaded section is such that the first end of the suture is inserted from the outside of the human body into the body to be sutured, and then passed out of the body; The utility model comprises: a main body, a handle and a sleeve disposed at the front end of the handle; a linkage member disposed in the main body and displaceable; a control member disposed on the grip to drive the linkage member Displacement along the sleeve; the knotting component is mounted on the front end of the sleeve of the main body; the linkage member can drive the suture to be displaced in the small tube; when the knot is formed, the sleeve portion of the small tube body When moving into the body, the active knot of the suture drops from the sleeve.

The in vitro knotting method for laparoscopic surgery provided by the present invention is operated by the above-mentioned in vitro knotting device, which comprises the following steps: (A) preparing the knotting device; when suturing the wound, the stitching The first end enters the human body through a casing mouth and sutures the wound, and then the first end of the suture is passed through the original casing mouth; (B), the first end of the suture is passed through The snare of the suture; (C), the knotted composition is moved into the human body through the sleeve opening, and moved to the wound; (D), the first end of the suture is pulled, and the wound is tightened to Properly, and maintain the tension of the suture to tighten the wound; (E) pulling the second end of the suture by the external manipulation device and simultaneously relaxing the first end of the suture, so that the active knot of the suture is separated from the sleeve and forming a fixed knot; (F), shearing Break the suture.

Thereby, when the wound is sutured by laparoscopic surgery, the front end of the suture is inserted into the human body and pulled through the wound to the outside of the body, and then the snare is applied through the snare and a simple pulling force is applied to make the active knot Detach from the set and transform into a fixed double sailor knot, the strength of the fixed knot is better than the traditional surgical knot, and has the convenience of sliding knot and the highest knot strength of the static knot.

10‧‧‧ knotted composition

20‧‧‧ body

21‧‧‧ channel

22‧‧‧Insert Card Department

25‧‧‧Small tube

26‧‧‧through hole

27‧‧‧The Great Trails Department

28‧‧‧Setting parts

30‧‧‧ Drives

32‧‧‧Connecting Department

321‧‧‧First lap

322‧‧‧ Second lap

40‧‧‧ stitching

41‧‧‧Double circle activity knot

42‧‧‧ snare

44‧‧‧ fixed knot

45‧‧‧ stitches

47‧‧‧Wearing the line segment

50‧‧‧Control devices

51‧‧‧ Subject

52‧‧‧Handle

54‧‧‧Guide

541‧‧‧ Positioning Department

60‧‧‧ casing

62‧‧‧Clamping body

63‧‧‧ eye hole

64‧‧‧ 挡缘

65‧‧‧Inlay

70‧‧‧ linkages

72‧‧‧Combination Department

75‧‧‧Control parts

76‧‧‧ dial

77‧‧‧ Slider

80‧‧‧ conduit

90‧‧‧ needle holder

95‧‧‧ wounds

For a better understanding of the objects, features and advantages of the present invention, the present invention will be described in detail with reference to the accompanying drawings. A perspective view of an in vitro knotting device.

The second diagram is the majority of the first map.

The third figure is a perspective view of a knotted composition of a preferred embodiment of the present invention in which the drive member is not completely penetrated into the knotted composition.

The fourth figure is an exploded perspective view of the third figure, and the stitches with the needles are not shown.

The fifth drawing is a longitudinal sectional view of the third figure.

The sixth drawing is a partially enlarged perspective view of the third figure and shows the double smoothing of the present invention.

Figure 7 is a partially enlarged perspective view of the front end of the knotting device of the first figure.

8(A) to (E) are schematic views showing the operation of the present invention, which are used to show the operation mode of the knotting device, and do not show human organs; wherein, the eighth figure (C) is the first Partially enlarged view of Figure 8 (B); and eighth (A) to (E) omitted edge.

The ninth diagrams (A) to (I) show schematic diagrams of the actuation process of the knotting composition of the present invention for knotting, and some of the drawings are only for drawing a specific configuration for the purpose of understanding the focus.

Please refer to the first and second figures, which are an in vitro knotting device for laparoscopic surgery according to a preferred embodiment of the present invention, which is used by a physician to perform a knotting operation outside the patient during laparoscopic surgery. The device comprises a handling device 50 and a knotting component 10, the knotting component 10 is detachably mounted on the steering device 50, and is interlocked by the operating device to complete the knotting operation. The structural design of the present invention will be described below.

Referring to Figures 3 to 5, the knotting composition 10 includes a tubular body 20, a small tubular body 25 and a driving member 30, and further having a suture 40 having a suitable length. With needle stitching.

The body 20 can be made of plastic or metal and has a channel 21 extending through the two ends. A card portion 22 is disposed on the outer peripheral surface of the body 20 and adjacent to the front end of the body 20.

The small tubular body 25 is made of metal and has a length greater than the length of the body 20 and has an axial through hole 26. The small tubular body 25 can penetrate into the passage 21 of the body 20 and can be displaced in the passage. When the small tubular body 25 penetrates the body 20 and is located at a set point, the front end of the small tubular body 25 passes through the front end of the body 20. A sleeve portion 28 is provided for the suture 40 to be placed. In this embodiment, one of the large diameter portions 27 provided at the rear end of the small tubular body 25 contacts the rear end of the body 20 as a set point of the small tubular body 25.

The driving member 30 is a thin rod, and the rear end thereof is formed with an S shape. The connecting portion 32 includes a first ring portion 321 and a second ring portion 322. The front end of the driving member 30 penetrates into the through hole 26 of the small pipe body 25, and the rear end thereof extends out of the small pipe body 25.

The suture 40 used in this embodiment is a usp "o" black multi-strand wax-coated needle black silk suture commonly used in an operating room, and has a needle 45 at a first end thereof. The suture 40 is disposed in the through hole 26 of the small tubular body 25, and the second end thereof is connected to the first loop portion 321 of the connecting portion 32 of the driving member 30. Referring to the sixth figure, the body of the suture 40 is pre-knotted with a double-loop active knot (knot) 41, and the double-loop movable knot 41 is sleeved on the sleeve portion 28 of the small tubular body 25, having a first One turn 411 and one second turn 412. The suture 40 forms a snare 42 between the double-loop movable knot 41 and the front end of the small tubular body 25, and the snare 42 is movable and can be enlarged or reduced.

The driving member 30 and the suture 40 are disposed together in the through hole 26 of the small tube body 25. Since the suture 40 is a fabric, and the driving member 30 is closely spaced through the through hole. In the hole 26, the driving member 30 and the suture 40 have friction/friction property. When the driving member 30 is displaced in the through hole 26, the suture 40 is in the through hole along the driving member. The displacement, while the suture is displaced, can change the size of the snare 42.

Referring to the first and second figures, the control device 50 mainly includes: a main body 51, a linkage member 70 and a manipulation member 75.

The main body 51 has a handle 52 and an elongated sleeve 60 disposed at the front end of the handle 52. The sleeve 60 is made of metal in the embodiment, and the front end is U in a cross section. The clamping tube body 62 is formed with an opening, and the two side walls of the clamping tube body 62 have elasticity of opening and closing, and the front end edge thereof is blunt-circular to avoid injury to human tissue. The clamping tube body 62 further has an eyelet 63, a retaining edge 64 and a locking portion 65. The eyelet 63 is disposed at the blunt front end of the clamping tube body 62. The retaining edge 64 and the latching portion 65 are disposed on one side edge of the front end of the clamping tube body 62, and the retaining edge 64 is located in front of the latching portion 65. The clamping tube 62 is such that the front end of the sleeve 60 forms a mounting portion for the knotting assembly 10 to be mounted or removed.

The handle 52 is hollow, and the outer peripheral mask has a guiding groove 54. The longitudinal direction of the guiding groove 54 is located in the longitudinal direction of the handle 52 (also in the longitudinal direction of the steering device 50), and is along the front end thereof. A positioning portion 541 is recessed in the radial direction of the handle 52 (also in the radial direction of the steering device 50).

The control member 75 has a button 76 and a cylindrical slider 77. The button 76 is located outside the handle 52. The slider 77 is disposed in the handle 52. The button 76 is traversed. The guide groove 54 is connected to the slider 77, and the button 76 and the slider 77 can be displaced back and forth along the guide groove 54.

The linkage member 70 is an elongated member such as a steel wire or a thin metal rod having a joint portion 72 at its front end, and the joint portion 72 is hook-shaped. The linkage member 70 is disposed in the main body 51 and slidable. The front end of the linkage member 70 extends through the clamping tube body 62 of the sleeve 60. The rear end of the linkage member extends through the handle 52 and the control member. The slider 77 of the 75 is connected such that the linkage 70 can be displaced back and forth with the manipulation member 75.

The knotted component 10 is mounted at the gripping pipe body 62, as in the seventh drawing, and the linking member 70 is coupled to the driving member 30.

Referring to the second and eighth figures (A), a sealing member 58 is disposed between the handle 52 and the sleeve 60 so that gas does not flow from the sleeve 60 to the grip 52. The linkage 70 extends through the sealing member 58 and maintains an airtight effect.

The present invention sutures and knots in a laparoscopic operation with the above-described knotting device. The principle of the knotting method of the present invention is that the knotting composition 10 is prepared in advance prior to surgery, and the knotting composition 10 includes a double-turn sliding knot made by a suture 40; one end of the suture is passed through the sliding After the knot is closed, the suture is simply pulled Force to deform the sliding knot into a firm double sailor knot. Using this principle, the knotting component 10 is mounted on the front end of the steering device 50, and the long needle stitching 40 is extended from the outside of the body through a catheter opening into the abdominal suture wound, and then the suture is separated from the original The catheter port is pulled out of the body, passes through the snare of the double-loop sliding knot composed of knotting, and the latter side pulls the needle suture, and the instrument is inserted into the suture of the abdomen through the same catheter port, and then pulled by the external body. The needle is sutured until the wound is tightened to a proper extent by the stitching loop, and then the other hand quickly pulls the button 76, and the driving member 30 and the small tubular body 25 are pulled outwardly, and at the same time, the tension of the needle stitch is relaxed. The knotted double-loop sliding knot will automatically fall off and automatically form a firm double sailor knot to complete the knot at the wound.

The steps of the in vitro knotting method of the laparoscopic surgery of the present invention are described below.

Step (A): Referring to FIG. 8(A), the dial 76 of the operating member 75 is first positioned at the positioning portion 541 of the guide groove 54. The knotted component 10 of the double-loop active knot 41 is mounted on the front end of the gripping tube 62 of the sleeve 60 of the steering device 50. As shown in the eighth figure (B), the knot is composed of the body 20 of the 10 The clamping portion 65 of the clamping body 62 is fastened to the engaging portion 22 of the body 20, so that the knotting composition can be firmly connected to the clamping portion. The front end of the body 62. The retaining edge 64 of the front end of the clamping body 62 is located in front of the double-loop movable knot 41 of the suture 40. As shown in the seventh figure, the double-loop movable knot 41 is restricted by the retaining edge 64, and does not The sleeve portion 28 slides down. The second loop portion 322 of the connecting portion 32 of the driving member 30 is hooked to the joint portion 72 of the linking member 70, so that the driving member 30 and the linking member 70 can be interlocked due to the button 76 of the operating member 75. The positioning portion 541 of the guiding groove 54 is positioned, and the linking member 70 cannot be displaced backward.

Referring to the seventh figure and the eighth figure (A), the knot 40 forming the knot 10 forms a threaded wire segment 47 between the needle 45 and the movable knot 41. The length of the line segment 47 allows the needle 45 to be inserted out of the body from the wound that extends into the body in vitro.

Referring to FIG. 9(A), when a wound 95 is sutured in a laparoscopic operation, the suture 40 and the needle 45 are passed through a trocar 80 to enter the abdomen of the human body, and the wound 95 is sutured. The needle 45 and the suture 40 are passed through the catheter port 80.

Step (B): After that, referring to FIG. 9(B) and FIG. 8(C), the first end of the needle 45 and the suture 40 is passed through the snare 42 of the movable knot 41 by a needle holder 90. And an eyelet 63 of the clamping tube body 62 adjacent to the snare 42.

Step (C): Referring to Figure 9 (C), the first end of the suture 40 is then pulled outwardly, that is, the threaded section 47 is taken over, and the other hand passes the manipulation device 50 through the catheter. The mouth 80 extends into the body such that the knotted composition 10 moves closer to the wound 95. Since the suture passes through the eyelet 63 of the manipulation instrument 50, the suture 40 is easily controlled when the manipulation instrument 50 is extended into the human body.

Step (D): When the knotted composition 10 is moved to the wound 95, as shown in the ninth diagram (D). The stitching ring before the knotting shown in the ninth figure (D) forms a hybrid structure with the double-loop sliding knot. The first end of the suture 40 is pulled back so that the suture tightens the wound 95 to an appropriate degree, as in the ninth diagram (E), and the tension of the suture is maintained and stabilized.

Step (E): Next, an operation of converting the movable knot into a fixed knot is performed. Referring to FIG. 8(D), the button 76 of the operating member 75 is moved away from the positioning portion 541, and the manipulation member is guided along the guide. The slot 54 moves rapidly backwards and simultaneously relaxes the tension of the needle stitching. At this time, the linking member 70 is interlocked by the operating member 75 and drives the driving member 30 and the suture 40 to move backward. When the driving member 30 starts to pull the second end of the suture 40 backward, the snare 42 is reduced. When the snare 42 is contracted to the minimum, as shown in the ninth (F), the driving member 30 is displaced backward. Through the seam The wire 40 pushes the small tube backwards to slide the sleeve portion 28 into the passage 21 of the body 20. As shown in the eighth (D) and ninth (G), the double-loop movable knot 41 The sleeve portion 28 is detached from the sleeve portion and automatically converted into a double sailor knot to form a fixed knot 44. As shown in Fig. 9(H), the knotting step of the wound is completed. The strength of this double sailor knot is far better than the traditional external knot.

Step (F): After the fixed knot (44) is completed, refer to the eighth figure (E), and the control member 75 is pushed forward, and the suture in the body 20 is removed to remove a certain length, so as to cut off the suture and complete The knotting procedure of the laparoscopic surgery removes the knotting device from the human body.

After the operation, the used knotting component 10 is removed from the handling device 50, and the new knotting composition 10 is installed according to the process of the step (A), and the preparation work of the knotting device can be completed. Used for one operation. The knotting composition 10 is easy to assemble and disengage the clamping tube body 62, and the connecting portion 72 of the linking member 70 and the connecting portion 32 of the driving portion 30 are also easily connected and separated, so that the knotting composition 10 has an easy replacement. effect. It can be understood that the knotting composition 10 and the steering device 50 can have different combinations and disassembly modes, which are not limited to the embodiment.

The in vitro knotting device and method for laparoscopic surgery of the present invention can easily, simply and quickly complete the in vitro knotting of the surgical site, and the knotting success rate is extremely high and the strength of the finished knot (double sailor knot) is good. It is better than the current general use of external knots or flat knots, so that the knotting of laparoscopic surgery is no longer a problem that plagues the doctor, and the knotting effect is improved, which also contributes to the rapid healing of the tissue.

The in vitro knotting device of the present invention is designed for laparoscopic surgery and is very suitable for such minimally invasive surgery.

The above-mentioned embodiments are merely illustrative of the invention and are not to be construed as limiting the scope of the invention. The invention is the first structure and technology in the prior art, and has the improvement of practical functions, and is submitted according to law. please.

10‧‧‧ knotted composition

20‧‧‧ body

30‧‧‧ Drives

40‧‧‧ stitching

45‧‧‧ stitches

50‧‧‧Control devices

52‧‧‧Handle

54‧‧‧Guide

541‧‧‧ Positioning Department

60‧‧‧ casing

62‧‧‧Clamping body

70‧‧‧ linkages

75‧‧‧Control parts

76‧‧‧ dial

Claims (14)

An in vitro knotting device for laparoscopic surgery, comprising: a knotting component and a manipulation device, wherein: the knotting composition comprises: a body; a channel extending through the two ends of the body; a small tube body; a through hole Arranging along the axial direction of the small pipe body and penetrating the two ends of the small pipe body; the small pipe system penetrates into the passage of the body and is displaceable in the passage, and the front end of the small pipe body forms a set when the body is pierced a portion; a suture having a first end and a second end; a movable knot formed by the suture and located between the first end and the second end, the active knot The second end of the suture is threaded through the through hole of the small pipe body; the line of the suture between the movable knot and the sleeve portion forms a snare, the stitch When the small tube is displaced, the size of the loop can be changed; a threaded segment is formed between the first end of the stitch and the movable knot, and the threaded segment has a length for the stitch One end is inserted into the human body from the outside of the human body to a place to be sutured, and then worn out of the human body; The control device comprises: a body having a handle and a sleeve disposed at the front end of the handle; a linkage member disposed in the body and displaceable in the body; a control member disposed on the grip The handle can drive the linkage to be displaced back and forth along the sleeve; the knotting component is mounted on the front end of the sleeve of the main body; the linkage can drive the suture to be displaced in the small tube; when the knot is composed When the sleeve portion of the small tube body is displaced into the body, the active knot of the suture is detached from the sleeve portion. The in vitro knotting device according to claim 1, wherein the knotting composition further comprises: a driving member is in the shape of a rod, the front end of which is inserted into the through hole through the rear end of the small tube body, and is displaceable in the through hole; the displacement of the driving member drives the suture displacement in the small tube; the linkage The front end of the piece is coupled to the rear end of the drive member to drive the drive member. The in vitro knotting device according to claim 1, wherein: the front end of the sleeve has a U-shaped clamping tube body, and the front end of the clamping tube body is blunt-circular; The system is detachably mounted to the clamping body. The in vitro knotting device of claim 2, wherein: the knotting component is detachably mounted to the clamping tube; the front end of the linking member is located in the sleeve; the rear end of the driving member is Removably connected to the linkage. The in vitro knotting device of claim 3, wherein: an eyelet is provided at a front end of the sleeve. The in vitro knotting device of claim 3, wherein: a retaining edge is disposed at a front end of the sleeve, and the active knot of the suture is located behind the retaining edge and is limited by the retaining edge. The in vitro knotting device according to claim 3, wherein the length of the small tubular body is greater than the length of the body; the large diameter portion is disposed at a rear end of the small tubular body, and the large diameter portion is opposite to the rear end of the body The sleeve portion of the front end of the small tube body passes through the body. The in vitro knotting device according to any one of claims 1 to 7, wherein: the active knot is a double-loop active knot; the loop is passed through the loop at the first end of the suture, and the active knot is detached from the sleeve After the site, the double-loop active knot is converted into a fixed knot. An in vitro knotting method for laparoscopic surgery, which uses the in vitro knotting device according to claim 1, which sutures the suture and completes the knotting, and comprises the following steps: (A) preparing the knotting device; suturing one When the wound is wound, the first end of the suture is introduced into the human body, and after suturing the wound, the suture is first The end is pierced out of the body; (B) the first end of the suture is passed through the snare of the suture; (C), the first end of the suture is pulled outward, and the knot is composed Entering the human body and moving toward the wound; (D) pulling the first end of the suture to tighten the wound to an appropriate degree; (E), separating the active knot of the suture from the set portion, and Form a fixed knot; (F), cut the suture, and complete the knotting of the laparoscopic surgery. The in vitro knotting method according to claim 9, wherein: the step (E) is: pulling the second end of the suture from the outside by the knotting device and simultaneously relaxing the first end of the suture to make the active knot Get out of the set. The in vitro knotting method according to claim 9, wherein: the front end of the manipulation device of the step (A) further has an eyelet; the first end of the suture of the step (B) passes through the snare and the Eye hole. The in vitro knotting method according to claim 9, wherein in the step (E), the second end of the suture is pulled to form the fixed knot. The in vitro knotting method according to claim 9, wherein the suture is removed from the small tube by a distance before the step (F) is cut. The in vitro knotting method according to claim 9, wherein: the active knot of the suture of the step (A) is a double loop active knot; and the fixed knot of the step (E) is a double sail knot.