WO1997024990A1 - Instrument chirurgical - Google Patents

Instrument chirurgical Download PDF

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Publication number
WO1997024990A1
WO1997024990A1 PCT/EP1997/000069 EP9700069W WO9724990A1 WO 1997024990 A1 WO1997024990 A1 WO 1997024990A1 EP 9700069 W EP9700069 W EP 9700069W WO 9724990 A1 WO9724990 A1 WO 9724990A1
Authority
WO
WIPO (PCT)
Prior art keywords
shaft tube
vascular prosthesis
instrument according
vessel wall
scalpel
Prior art date
Application number
PCT/EP1997/000069
Other languages
German (de)
English (en)
Inventor
Arnold Pier
Jörg HUMMEN
Original Assignee
Arnold Pier
Hummen Joerg
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Arnold Pier, Hummen Joerg filed Critical Arnold Pier
Publication of WO1997024990A1 publication Critical patent/WO1997024990A1/fr

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
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis in a single operation
    • A61B17/1152—Staplers for performing anastomosis in a single operation applying the staples on the outside of the lumen
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B2017/1107—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis for blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B2017/1135—End-to-side connections, e.g. T- or Y-connections
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06—Blood vessels
    • A61F2/064—Blood vessels with special features to facilitate anastomotic coupling

Definitions

  • the invention relates to a surgical instrument according to the preamble of claim 1 and a method for jamming anastomoses according to the preamble of claim 21.
  • Such instruments are used, for example, for laparoscopic surgery, but can also be used for open surgery.
  • the surgical instrument is inserted through a trocar sleeve, e.g. in the abdominal area.
  • Vascular prostheses e.g. are sutured manually at the aorta. Such an operation is therefore only possible when the chest is open.
  • the invention has for its object to provide a surgical instrument and a method with which vascular prostheses can be connected to a vessel wall without suturing.
  • the invention advantageously provides that the shaft tube has a receiving device for a vascular prosthesis, and that a clamp device is arranged on the distal end of the shaft tube with a plurality of clamps uniformly distributed over the circumference for fastening one end of the vascular prosthesis.
  • the clamp device makes it possible to clamp one end of the vascular prosthesis to a vessel wall. Several clamps evenly distributed around the circumference are advanced by a slide in the axial direction of the shaft tube, first penetrating the end of the vascular prosthesis and then the vascular wall.
  • a counter-pressure device for the clamping device which is movable relative to the shaft tube, is likewise mounted in the shaft tube and can clamp the vessel prosthesis with a vessel wall and / or cut the vessel wall with a scalpel, extending the vessel wall through a slot beyond the distal end of the shaft tube in reach behind the vessel wall.
  • a small slot must first be cut into the vessel wall through which the counterpressure device can be inserted.
  • a second actuating device of the surgical instrument allows the position of the counterpressure device to be adjusted relative to the shaft tube.
  • the position of the part of the counterpressure device located behind the vessel wall can be changed with the aid of the second actuating device in such a way that a counterpressure means is created for the shaft tube and for the scalpel.
  • the scalpel is arranged in a linearly movable manner in the shaft tube and has an outer diameter which corresponds essentially to the inner diameter of the vascular prosthesis.
  • the scalpel can protrude from the distal end of the shaft tube and punch out the vessel wall accordingly using the counterpressure device.
  • the receiving device for the vascular prosthesis is surrounded radially on the outside by the clamp device, the vascular prosthesis having a radially outwardly projecting edge on the end face of the shaft tube.
  • the clamps preferably project in the open state with the free ends relative to the end face of the shaft tube and penetrate the outwardly projecting edge of the vascular prosthesis.
  • the free ends run axially parallel to the shaft tube.
  • the counter pressure device consists of a linearly movable and additionally pivotable stored disc exists.
  • a pivotable disc can be inserted into the slot of the vessel wall in the state inclined relative to the longitudinal axis of the shaft tube and can then be pivoted into a position orthogonal to the longitudinal axis of the shaft tube, in which the disc is a counterpressure medium for the end of the shaft tube or Scalpel forms.
  • the second actuating device can clamp the vessel wall between the counterpressure device and the end face of the shaft tube with the edge of the vascular prosthesis clamped in between with a predetermined limited contact pressure.
  • the first actuation device drives the clips of the clip device through the vascular prosthesis and through the vessel wall and clamps the clips with the aid of the counterpressure device.
  • the first actuation device drives the scalpel into the vessel wall to punch out a hole with the inside diameter of the vascular prosthesis.
  • the disk of the counterpressure device in turn serves as a counterpressure medium for the scalpel.
  • the counterpressure device is preferably pivoted again. The punched-out part of the vessel wall remains on the scalpel and is pulled out by the scalpel with the surgical instrument, while the vascular prosthesis remains on the vessel wall and is pulled out of the surgical instrument.
  • an inner tube is provided, the inner wall of which is the ring Chamber for the vascular prosthesis is limited radially outwards and the outside diameter of the clamp device accommodates it.
  • the shaft tube, the slide and the inner tube can preferably have openings distributed uniformly on the circumference, which are connected to the annular chamber for the vascular prosthesis. Through these openings the vascular prosthesis can be filled with liquids e.g. Blood are impregnated to seal the vascular prosthesis.
  • the end face of the shaft tube, and thus also the scalpel, can also run at an angle to the longitudinal axis of the shaft tube, so that the surgical instrument can be placed at an angle against the vessel wall.
  • an elliptical hole is punched out in the vessel wall and clamped onto the vascular prosthesis at an angle to the vessel wall.
  • open receiving pockets for the clips are arranged uniformly distributed over the circumference to the inside of the shaft tube.
  • the clamps which are uniformly distributed over the circumference, can be arranged in two circular rows concentric with one another.
  • the clips can be arranged spirally around the circumference.
  • the clamps can be connected to one another with bridge elements with which the contact pressure between the vascular prosthesis and the vascular wall is distributed more uniformly over the circumference becomes .
  • FIG. 2E is a plan view of the line IIE-IIE in Fig. 2A,
  • Fig. 5 is a partially sectioned plan view of the distal end of the shaft tube
  • the surgical instrument 1 for fastening vascular prostheses 18 has a handle 2 with an actuating device 4 in the form of a two-armed lever, which can move a slide 8 guided in an elongated shaft tube 6.
  • the shaft tube 6 is attached to the handle 2.
  • the shaft tube 6 can alternatively be mounted rotatably in the handle 2.
  • a second actuating device 38 is arranged, by means of which a counterpressure device 26 projecting outward from the distal end 14 of the shaft tube 6 can be actuated.
  • vascular prostheses 18 consist of anastomoses, by means of which bypasses can be placed.
  • the anastomoses are preferably impregnated with blood, as a result of which they have sufficient pressure tightness when exposed to a blood flow and the formation of vascular cells can be accelerated.
  • the distal end of the shaft tube 6 is constructed as follows from the outside in:
  • a tubular slide 8 which is used to actuate a clamp device 12 arranged on the distal end 14 of the shaft tube 6 and a scalpel 34, the slide 8 being mounted between the outer shaft tube 6 and an inner tube 54 which is fixed relative to the shaft tube 6 is.
  • the inner wall of the inner tube 54 delimits an annular chamber 58 for receiving the vascular prosthesis 18.
  • the annular chamber 58 is connected to the openings 66 of the shaft tube 6 for impregnating the vascular prosthesis 18 via corresponding cutouts.
  • the clip device is on the distal outer end of the inner tube 54 12 arranged, which is surrounded by an end sleeve 52 of the shaft tube 6.
  • the annular chamber 58 is delimited radially inward by the scalpel 34, which can likewise be advanced by a predetermined amount by means of the actuating device 4 and the slide 8 coaxially to the shaft tube 6 for punching a hole in the vessel wall 30.
  • the scalpel 34 In the interior of the scalpel 34 there are elements of the second actuating device 38 which allow pivoting and a linear movement of the counterpressure device 26 which is axially parallel to the shaft tube 6.
  • the vascular prosthesis 18 is bent radially outward on the end face 20 of the end sleeve 52 and forms a radially projecting edge 22.
  • the clips 10 from the clip device 12 are already through this edge 22 of the vascular prosthesis 18 before the surgical instrument 1 is used pushed through so that the free ends of the clamps project axially slightly beyond the edge 22 of the vascular prosthesis 18.
  • the distal end of the counterpressure device 26 consists of a disk 42 which can be pivoted relative to the longitudinal axis of the shaft tube 6 and which, in the inclined state, is inserted into the vessel through the slot 32 in the vessel wall 30.
  • a disk 42 On the disk 42, two tension bands 40, 41 are articulated at a distance from one another and can be displaced relative to one another parallel to the longitudinal axis of the shaft tube 6. If the tension band 40 is moved in the proximal direction relative to the tension band 41, the disk 42 straightens up to a position orthogonal to the longitudinal axis of the shaft tube 6.
  • a stop 50 limits the further proximal movement of the tension band 40 by resting against the guide element 45.
  • both drawstrings 40, 41 are moved uniformly in the proximal direction, as a result of which disc 42, as best seen in FIG. 2A, is pressed against the back of vessel wall 30 with a predetermined and limited contact pressure.
  • the disk 42 In its orthogonal position to the longitudinal axis of the shaft tube, the disk 42 first forms a counterpressure medium for the clips 10 of the clip device 12.
  • the clips 10 are moved with the aid of the first actuating device 4 via the slide 8, a sleeve 9 consisting of two halves, and via a thrust element 11 for each clip 10 that presses on the proximal end of the clips 10.
  • the disc 42 has cutouts 43 which facilitate the bending over of the free ends of the clamps 10 and steer them in the correct direction.
  • the stapling device 12 can simultaneously place several, for example six or even more staples evenly distributed on the circumference of the rim 22, which staples the rim 22 circumferentially onto the vessel wall 30.
  • Bridge elements 60 can be provided between the clamps 10, which press the edge 22 of the vascular prosthesis 18 more uniformly against the vessel wall 30 over the entire circumferential area.
  • the scalpel 34 is advanced by the slide 8 only after a certain actuation path of the slide 8. It is thereby achieved that the scalpel 34 is only advanced when the stapling process is complete.
  • the slide 8 has cam elements 80 which engage in a cutout 82 in the scalpel 34 and thereby advance the scalpel 34 only after a time delay.
  • FIG. 2C shows the scalpel 34 in the advanced state, in which a preferably circular hole in the vascular wall 30 is cut, the diameter of the hole corresponding to the inside diameter of the vascular prosthesis 18.
  • the disc 42 is provided with a recess 44 adapted to the scalpel cross-section, so that the scalpel 34 can penetrate the entire vessel wall 30 and thus can carry out a clean cut, a plastic ring 68, for example made of elastomer material, in the recess 44 of the disc 42 serves as a counterpressure to the scalpel.
  • the circular piece 28 of the vessel wall 30 having the slot 32 remains on the scalpel 34.
  • the shaft tube 6 has an elongated hole 62, through which a pin 64 attached to the tubular scalpel 34 indicates the position of the scalpel 34.
  • the surgeon can assess the exact position of the scalpel from the relative position of the pin 64 to the elongated hole 62. For example, markings on the elongated hole 62 can indicate whether the scalpel 34 has penetrated up to the vessel wall 30 or up to the plastic ring 68.
  • the disk 42 can then be pivoted again with the aid of the second actuating device 38, so that it can be removed more easily from the vessel.
  • the disk 42 is moved back to its original starting position.
  • the surgical instrument 1 is withdrawn, the vascular prosthesis 18 is completely pulled out of the annular chamber 58 and the counterpressure device 26 with the disk is removed through the vascular prosthesis 18.
  • What is essential here is the safe removal of the punched-out circular piece 28 of the vessel wall 30.
  • This vessel wall piece 28 remains in the scalpel 34. Even if the punched vessel wall piece 28 would detach from the scalpel 34, it is carried along by the following disk 42 of the counter pressure device 26.
  • the second actuating device 38 shown in section in FIG. 3 essentially consists of a rotary knob 35 which transmits a predetermined maximum torque to a spindle drive 37 with the aid of a slip clutch 36. With the aid of the spindle drive 37, a second push rod 39 can be moved linearly back and forth coaxially to the shaft tube 6, to the slide 8 and to the scalpel 34.
  • the second push rod 39 is moved forward in the distal direction with the aid of the second actuating device 38.
  • a displaceable guide element 45 of the counterpressure device 26 is also moved forward in the distal direction.
  • the drawstring 41 of the disk 42 is fixedly attached to the displaceable guide element 34, while the drawstring 40 is fixed to the push rod 39.
  • the counterpressure device 26 also has a distal guide element 26 at the distal end of the scalpel, which receives and guides the two tension bands 40, 41, and a proximal guide element 47, which receives and guides the second push rod 39.
  • the displaceable guide element 45 slides in the inner cross section of the scalpel 34 between the distal and the proximal guide element 46, 47, the displaceable guide element 45 being supported on the distal and proximal guide element 46, 47 with a spring 48, 49, respectively.
  • the disk 42 is first pivoted, since initially only the tension band 40 moves in the proximal direction.
  • the tension band also becomes 41 entrained by the movement of the second push rod 39 and thus also the movable guide element 45, so that the disc 42 can be moved away from the distal end 14 of the shaft tube 6 in its pivoted position.
  • the disk 42 When the second push rod is moved in the proximal direction, the disk 42 is also initially moved in the proximal direction and then pivoted into a position orthogonal to the longitudinal axis of the shaft tube 6. As a result of the slip clutch 36, the pulling force of the second push rod 39 is limited, so that the disk 42 cannot be pressed against the vessel wall 30 with an excessively high contact pressure.
  • the shaft tube 6, the tubular slide 8 and the inner tube 54 can be provided with recesses, not shown in part, in order to impregnate the vascular prosthesis 18 with liquid, e.g. Blood.
  • FIG. 4 shows a cross section through the distal end 14 of the shaft tube 6 in the region of the closure sleeve 52 and the fixed distal guide element 46, which receives and guides the tension bands 40, 41 in a recess 48.
  • the annular chamber 58 is formed between the scalpel 34 and the inner tube 54 and, as already mentioned, serves to hold the vascular prosthesis 18.
  • FIG. 5 shows a top view of the illustration according to FIG. 4.
  • the brackets 10 protrude and penetrate opposite the end face 20 of the shaft tube 6 or the end sleeve 52 of the shaft tube 6, as already in connection explained with Fig. 2, the edge 22 of the vascular prosthesis 18.
  • the push elements 11 for the brackets 10 In the proximal direction behind the brackets 10 are in the receiving pockets 56, the push elements 11 for the brackets 10, which in turn can be moved forward by a split sleeve 9 in the distal direction.
  • the divided sleeve 9 is in turn pushed forward in the distal direction by the end of the slide 8.
  • FIG. 6 shows a section of a cross section through the receiving pocket 56 in the region of the push element 11.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un instrument chirurgical (1) comprenant une poignée pourvue d'un dispositif d'actionnement (4), une tige tubulaire (6) fixée à ladite poignée (2) dans laquelle un coulisseau (8) peut être déplacé dans le sens longitudinal par le dispositif d'actionnement (4), et un dispositif à agrafes (12) disposé dans la tige tubulaire (6) et contenant plusieurs agrafes (10) qui peuvent être déplacées par le coulisseau (8) dans le sens axial de ladite tige tubulaire (6). Celle-ci comporte un dispositif de retenue (16) servant à recevoir une prothèse de vaisseau sanguin (18). Le dispositif à agrafes (12) est placé à l'extrémité distale (14) de la tige tubulaire (6) de façon que plusieurs agrafes (10) soient régulièrement réparties autour de ladite extrémité pour fixer une extrémité de la prothèse de vaisseau sanguin (18).
PCT/EP1997/000069 1996-01-09 1997-01-09 Instrument chirurgical WO1997024990A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE19600519.1 1996-01-09
DE1996100519 DE19600519A1 (de) 1996-01-09 1996-01-09 Chirurgisches Instrument

Publications (1)

Publication Number Publication Date
WO1997024990A1 true WO1997024990A1 (fr) 1997-07-17

Family

ID=7782361

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/EP1997/000069 WO1997024990A1 (fr) 1996-01-09 1997-01-09 Instrument chirurgical

Country Status (2)

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DE (1) DE19600519A1 (fr)
WO (1) WO1997024990A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2007508869A (ja) * 2003-10-17 2007-04-12 タイコ ヘルスケア グループ リミテッド パートナーシップ 外科用ステープル留めデバイス

Families Citing this family (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB0026236D0 (en) * 2000-10-26 2000-12-13 Anson Medical Ltd Fixation instrument for arterial graft
CA2462536C (fr) * 2001-10-05 2010-03-30 Tyco Healthcare Group Lp Enclume inclinable de dispositif de fixation chirurgicale
GB0207416D0 (en) * 2002-03-28 2002-05-08 Univ London Delivery assembly for use in surgery

Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3193165A (en) * 1962-08-27 1965-07-06 Akhalaya Mikhail Gueorguievich Instrument for suturing esophagus to intestine or stomach
EP0293123A2 (fr) * 1987-05-26 1988-11-30 United States Surgical Corporation Agrafeuse chirurgicale
EP0384647A1 (fr) * 1989-02-24 1990-08-29 Abiomed, Inc. Instrument à agrafer chirurgical
US5188638A (en) * 1992-02-06 1993-02-23 Tzakis Andreas G Apparatus and method for preforming anastomosis fastener securement of hollow organs
EP0539237A1 (fr) * 1991-10-25 1993-04-28 Cook Incorporated Greffe extensible intraluminaire pour la réparation d'aneurismes et procédé pour l'implanter
EP0540010A2 (fr) * 1991-10-29 1993-05-05 The Trustees of Columbia University in the City of New York Endoscope agrafeuse gastronitestinale dirigeable
EP0570915A2 (fr) * 1992-05-19 1993-11-24 United States Surgical Corporation Appareil chirurgical pour délivrer une enclume d'un dispositif pour l'anastomose

Patent Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3193165A (en) * 1962-08-27 1965-07-06 Akhalaya Mikhail Gueorguievich Instrument for suturing esophagus to intestine or stomach
EP0293123A2 (fr) * 1987-05-26 1988-11-30 United States Surgical Corporation Agrafeuse chirurgicale
EP0384647A1 (fr) * 1989-02-24 1990-08-29 Abiomed, Inc. Instrument à agrafer chirurgical
EP0539237A1 (fr) * 1991-10-25 1993-04-28 Cook Incorporated Greffe extensible intraluminaire pour la réparation d'aneurismes et procédé pour l'implanter
EP0540010A2 (fr) * 1991-10-29 1993-05-05 The Trustees of Columbia University in the City of New York Endoscope agrafeuse gastronitestinale dirigeable
US5188638A (en) * 1992-02-06 1993-02-23 Tzakis Andreas G Apparatus and method for preforming anastomosis fastener securement of hollow organs
EP0570915A2 (fr) * 1992-05-19 1993-11-24 United States Surgical Corporation Appareil chirurgical pour délivrer une enclume d'un dispositif pour l'anastomose

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2007508869A (ja) * 2003-10-17 2007-04-12 タイコ ヘルスケア グループ リミテッド パートナーシップ 外科用ステープル留めデバイス
JP2012213645A (ja) * 2003-10-17 2012-11-08 Tyco Healthcare Group Lp 外科用ステープル留めデバイス

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Publication number Publication date
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