WO2000015118A1 - Element de retenue plat pour parties du corps - Google Patents

Element de retenue plat pour parties du corps Download PDF

Info

Publication number
WO2000015118A1
WO2000015118A1 PCT/EP1999/001419 EP9901419W WO0015118A1 WO 2000015118 A1 WO2000015118 A1 WO 2000015118A1 EP 9901419 W EP9901419 W EP 9901419W WO 0015118 A1 WO0015118 A1 WO 0015118A1
Authority
WO
WIPO (PCT)
Prior art keywords
retaining element
element according
network
pockets
pocket
Prior art date
Application number
PCT/EP1999/001419
Other languages
German (de)
English (en)
Inventor
Letterio Barbera
Manfred Dworschak
Theodor Lutze
Original Assignee
Aesculap Ag & Co. Kg
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 Aesculap Ag & Co. Kg filed Critical Aesculap Ag & Co. Kg
Publication of WO2000015118A1 publication Critical patent/WO2000015118A1/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
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for 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
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
    • A61B2017/0225—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery flexible, e.g. fabrics, meshes, or membranes

Definitions

  • the invention relates to a flat retaining element for body parts, in particular for intestinal loops.
  • Small and large intestine retractors are also known, which hold back the intestinal loops by means of flat, rigid sheets, but these retractors are not optimally suited for endoscopic surgical techniques, since only very narrow accesses to the interior of the body are available in the endoscopic surgical technique inserted instruments etc. must be passed through trocar sleeves inserted into the body.
  • retractors are known which have fingers that can be folded together in a fan-like manner. These fingers can be spread out after insertion into the body and thus form a retention surface.
  • it is disadvantageous with these retractors that the areas which can be produced are relatively small and that such a retractor occupies a body access, so it is necessary to provide an additional body access.
  • the retaining element can be introduced into the body interior in the rolled-up state through a trocar sleeve, is unrolled there by means of suitable grasping instruments which are introduced into the body interior through other trocar sleeves, and is applied in the unrolled state to the intestinal loops to be retained.
  • this network can be fixed by means of fixation means attack on the one hand on the edge area of the net and on the other hand on solid body structures, for example on the abdominal wall. This temporary definition of the network is maintained during the operation, so that the intestinal loops are reliably retained during the operation by the network. Since the mesh is flexible, the risk of injury to the retained intestinal loops is extremely low, and the mesh can also be so large that the entire body cross section is covered, so that there is no risk that body parts slide past the retaining element laterally.
  • the retaining element is surrounded by a wide edge strip, the width of which is large compared to the webs forming the net.
  • the wide edge strips impart a certain stability to the mesh, while in the central mesh area an optimal adaptation to the structure of the restrained parts of the body is possible.
  • the webs forming the network can preferably cross at right angles.
  • the mesh size of the net is between 10 and 30 mm. Such a size is particularly suitable to enable partial immersion of the retained body parts in the mesh of the net without the body parts completely penetrating through the mesh. As a result, the parts of the body are fixed relative to the mesh and cannot slide away to the side. important because they are very smooth and easily slide past each other.
  • the net can consist of a textile material, and it has turned out to be particularly favorable if the net consists of cotton.
  • This substance not only has the advantage that it can be sterilized, but the surface structure of a cotton fabric acts as a slip protection for the adjacent parts of the body, and finally such a material has an absorbency so that body secretions are sucked up.
  • the retaining element prefferably consist of plastic, in particular of a sterilizable plastic.
  • the fixation means can in particular be threads with which the retaining element is fixed to solid body structures, for example these threads can be passed through the abdominal wall and knotted on the outside, in other cases the retaining element is fixed to the peritoneum.
  • fixation means are staples which are applied with an endoscopic stapler.
  • the fixation means can be removed again, it is then possible to pull the flat retaining element out of the inside of the body through a trocar sleeve.
  • the retaining element can be Suitable tools can be rolled up, but this is not absolutely necessary, because due to its flexible structure, the retaining element can be pulled through the trocar sleeve without first rolling up.
  • a frame part is embedded in the edge region, the stability of which is greater than that of the edge region, but which can nevertheless be rolled up. This increases the stability of the unrolled retaining element.
  • the frame part can be formed by a bendable wire.
  • the frame part is designed as an inflatable tube which is filled with a pressure medium, for example with air, after the unrolling of the retaining element, so that a certain stability of the frame part is achieved, which unrolled the retaining element in the clamped Position stabilized.
  • a pressure medium for example with air
  • At least one pocket having an insertion opening for a holding instrument is provided in the edge region.
  • a holding instrument for example a retractor, can be inserted into the pocket through this insertion opening, and by means of this holding instrument the edge region of the pocket can be positioned in the body and optionally also held. It is particularly advantageous if such a pocket is arranged on opposite edge regions, so that the mesh can then be stretched inside the body with two such holding instruments.
  • this pocket can be formed by two adjacent layers of the net which are connected to one another along the boundary lines of the pocket.
  • the pockets extend parallel to the edge of the net, in particular if the pockets extend over the entire width or the entire length of the net.
  • the pockets can have a constant cross-section over their entire length, but it is particularly advantageous if the pockets expand from their insertion opening. It is thereby possible to insert holding instruments into these pockets, which can be expanded inside the pocket and can thus be fixed in the pocket in the longitudinal direction.
  • Such instruments are known per se as retractors, for example there are so-called fan retractors in which arms which are parallel to one another can be pivoted apart. The network can thus be held largely immovable in the longitudinal direction on such a holding instrument.
  • the pockets widen, in particular, only at a distance from the insertion opening can be provided that the pockets have the shape of a narrow strip following the insertion opening. This results in a good fixation of the net in the transverse direction in the insertion area, in the expanded area, however, fixation in the longitudinal direction when the holding instrument is expanded.
  • the net can only be double-layered in the area of the pockets, but it is also possible, according to another preferred embodiment, to design the net as a double layer overall and to form the pockets by connecting the two layers along a pocket boundary line.
  • a protruding tab is arranged on the insertion opening on one side of the pocket, which facilitates the opening of the insertion opening.
  • This rag can consist of a textile material, for example.
  • the two layers of the network have a different mesh size.
  • FIG. 1 an unrolled, reticular element in the contact position on retracted intestinal loops
  • Figure 2 is a side view of the retention element of Figure 1;
  • FIG. 3 a schematic representation of an operating area with two trocar sleeves inserted into the body, which receive a barrel instrument or a rolled-up retaining element;
  • FIG. 4 a plan view of a further preferred exemplary embodiment of a reticular retaining element with side pockets;
  • Figure 5 is a view of the network of Figure 4 in the direction of arrow A;
  • Figure 6 a view similar to Figure 4 in a further preferred embodiment of a network with side pockets and
  • Figure 7 a side view of the network of Figure 6 in the direction of arrow B.
  • the flat retaining element 1 shown in FIGS. 1 to 3 comprises an essentially rectangular edge strip 2 with corners rounded on one side.
  • the area surrounded by the edge strip 2 is filled like a net by narrow webs 3 which intersect at a right angle.
  • the entire retention element consists of cotton fabric, the mesh size is between 10 mm and 30 mm.
  • the outer dimensions of the retaining element 1 are selected so that the retaining element 1 essentially fills the entire cross section of the abdominal cavity when it is arranged transversely to the abdominal cavity, so that a barrier wall is created in the abdominal cavity.
  • a barrel instrument 6 or the rolled-up retention element 1 is inserted into the interior of the body through a trocar sleeve 4 and a further trocar sleeve 5 inserted into the interior of the body, so that the barrel instrument 6 can completely roll up the retention element 1 pull into the interior of the body (Figure 3).
  • the retaining element 1 is unrolled in the interior of the body, this can be done with the aid of the barrel instrument 6.
  • the patient is preferably placed in a low-lying position so that the intestinal loops 7 are shifted upwards against the diaphragm.
  • the unrolled retaining element 1 is placed on the bowel loops 7 which have fallen back in this way, in such a way that essentially the entire cross section of the abdominal cavity is covered.
  • the retaining element 1 is fixed by fixing elements. These can be threads 8, which are pierced, for example, from the outside of the body through the abdominal wall, passed through the edge strip 2 and then led out of the body again Body.
  • the edge strip 2 is fixed to the peritoneum by staples, this can be done with the help of an endoscopic stapler.
  • the reticular retention element 1 After the retention element 1 has been fixed in this way, the patient can be moved back into the normal operating position, the reticular retention element 1 remains in its fixed position in the body and thus retains the intestinal loops 7, an operation area free of intestinal loops 7 remains.
  • the intestinal loops 7 can enter the meshes between the crossing webs 3 slightly, without passing through them, so that lateral fixation of the intestinal loops 7 occurs at the net-like areas. This additionally prevents the intestinal loops 7 from shifting laterally relative to the retaining element 1 and possibly penetrating laterally past the latter into the reserved operating room.
  • the threads 8 are cut and removed, or the clips are released and removed from the body.
  • the retaining element 1 can then be pulled out of the body again by means of a trocar sleeve by means of a grasping instrument.
  • the retaining element 1 shown in FIGS. 4 and 5 is constructed similarly to that of FIGS. 1 to 3, and parts which correspond to one another therefore have the same reference numerals.
  • two pockets 9 are formed along the edge strip 2 on two opposite narrow sides of the retaining element 1 in that a second layer 11 of a net-shaped material is placed on a lower, net-shaped layer 10, which is longitudinal its edge areas is connected to the lower layer 10, for example sewn.
  • the connection is made on three sides, so that on the fourth side, on which no such connection is made, an insertion opening 12 is created which leads into the interior of the pocket 9.
  • a laterally projecting tab 13 is arranged on the lower layer 10 on the edge strip 2, so that the edges of the pocket 9 are offset from one another in the area of the insertion opening 12. This facilitates the insertion of objects through the insertion opening 12, for example the insertion of a retractor 14 which can be inserted into the pocket 9 and which serves to position and hold the retaining element 1 in the region of the pocket 9 inside the body.
  • the mirror-image pockets 9 extend along the edge strip 2 on two opposite sides over its entire length, immediately after the insertion opening 12, the pocket 9 has the shape of a narrow strip 15, so that a channel-shaped configuration of the pocket is achieved, however, the pocket 9 widens at a distance from the insertion opening 12 and thus forms a widened end region 16. It is thereby possible to use retractors 14 which after the insertion into the pocket 9 can be widened by swiveling out individual parts, as shown in FIG. 4. This spreading of the retractors leads to the fact that the retractors are fixed in the area of the narrow strip 15 relative to the retaining element 1 in the transverse direction, in addition in the end area 16 also in the longitudinal direction.
  • the lower layer 10 and the upper layer 11 are designed in the form of a net and have different mesh sizes, it would in principle also be possible to form the pockets on one or both sides with a textile material and to provide a net-like configuration of the retaining element 1 only between the pockets.
  • the embodiment of Figures 6 and 7 differs only in that it has two layers 10 and 11 over its entire extent and that the pockets 9 are separated by a linear connection 17.
  • the retaining element 1 between the pockets 9 is thus formed in one layer, in the embodiment of Figures 6 and 7, however, two layers.
  • the retractors 14 required for clamping and positioning the retaining element 1 can be inserted into the body through trocar sleeves 4 and 5, and with the aid of these retractors, it is then also possible to change the position of the retaining element 1 at any time during the operation and to adapt it to the requirements.

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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

Pour permettre d'avoir, avec un élément de retenue pour parties du corps, en particulier pour anse intestinale, un maintien optimal d'une zone libre d'opération, même pour des opérations endoscopiques, il est proposé que ledit élément de retenue se présente sous la forme d'un filet souple enroulable et comporte une zone marginale à laquelle peuvent être accrochés des moyens de fixation qui fixent cet élément de retenue déroulé à des structures fixes du corps.
PCT/EP1999/001419 1998-09-11 1999-03-04 Element de retenue plat pour parties du corps WO2000015118A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE19841652A DE19841652A1 (de) 1998-09-11 1998-09-11 Flächiges Rückhalteelement für Körperteile
DE19841652.0 1998-09-11

Publications (1)

Publication Number Publication Date
WO2000015118A1 true WO2000015118A1 (fr) 2000-03-23

Family

ID=7880663

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/EP1999/001419 WO2000015118A1 (fr) 1998-09-11 1999-03-04 Element de retenue plat pour parties du corps

Country Status (2)

Country Link
DE (2) DE19841652A1 (fr)
WO (1) WO2000015118A1 (fr)

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2003038394A2 (fr) * 2001-10-29 2003-05-08 Hydac Electronic Gmbh Dispositif et procede de determination de la qualite d'une substance, en particulier d'un lubrifiant et/ou d'une huile de coupe
WO2010094799A1 (fr) * 2009-02-23 2010-08-26 Neosurgical Limited Dispositif écarteur pour chirurgie laparoscopique
EP2691027A2 (fr) * 2011-03-28 2014-02-05 Ahluwalia, Prabhat K. Écarteur d'organe
CN103767795A (zh) * 2014-01-20 2014-05-07 钱建民 手术用组织器官隔离器
CN104473666A (zh) * 2014-12-08 2015-04-01 钱建民 体腔内扩张器

Families Citing this family (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20100292540A1 (en) * 2009-05-12 2010-11-18 Hess Christopher J Surgical retractor and method
GB2479179A (en) * 2010-03-31 2011-10-05 Neosurgical Ltd Laparoscopic surgical retraction device
US8801734B2 (en) * 2010-07-30 2014-08-12 Ethicon Endo-Surgery, Inc. Circular stapling instruments with secondary cutting arrangements and methods of using same

Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3372696A (en) * 1965-01-22 1968-03-12 Peter S. Rudie Abdominal pad used in surgery
US3983863A (en) * 1975-06-02 1976-10-05 American Hospital Supply Corporation Heart support for coronary artery surgery
US4973300A (en) * 1989-09-22 1990-11-27 Pioneering Technologies, Inc. Cardiac sling for circumflex coronary artery surgery
US5301658A (en) * 1992-04-27 1994-04-12 Loma Linda University Medical Center Membrane endoscopic retractor
US5337736A (en) * 1992-09-30 1994-08-16 Reddy Pratap K Method of using a laparoscopic retractor
US5368602A (en) * 1993-02-11 1994-11-29 De La Torre; Roger A. Surgical mesh with semi-rigid border members
EP0702934A1 (fr) * 1994-09-26 1996-03-27 Ethicon, Inc. Dispositif d'attache pour tissus, comprenant une partie élastomère
US5803902A (en) * 1994-10-06 1998-09-08 United States Surgical Corporation Surgical retractor

Family Cites Families (4)

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Publication number Priority date Publication date Assignee Title
DE4138100A1 (de) * 1991-11-19 1993-05-27 Wisap Gmbh Adhaesionsprophylaxe
US5304187A (en) * 1992-06-30 1994-04-19 United States Surgical Corporation Surgical element deployment apparatus
US5582577A (en) * 1995-02-13 1996-12-10 Vance Products Incorporated Surgical retractor including central elastic member
US6036640A (en) * 1996-04-29 2000-03-14 Medtronic, Inc. Device and method for repositioning the heart during surgery

Patent Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3372696A (en) * 1965-01-22 1968-03-12 Peter S. Rudie Abdominal pad used in surgery
US3983863A (en) * 1975-06-02 1976-10-05 American Hospital Supply Corporation Heart support for coronary artery surgery
US4973300A (en) * 1989-09-22 1990-11-27 Pioneering Technologies, Inc. Cardiac sling for circumflex coronary artery surgery
US5301658A (en) * 1992-04-27 1994-04-12 Loma Linda University Medical Center Membrane endoscopic retractor
US5337736A (en) * 1992-09-30 1994-08-16 Reddy Pratap K Method of using a laparoscopic retractor
US5368602A (en) * 1993-02-11 1994-11-29 De La Torre; Roger A. Surgical mesh with semi-rigid border members
EP0702934A1 (fr) * 1994-09-26 1996-03-27 Ethicon, Inc. Dispositif d'attache pour tissus, comprenant une partie élastomère
US5803902A (en) * 1994-10-06 1998-09-08 United States Surgical Corporation Surgical retractor

Cited By (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2003038394A2 (fr) * 2001-10-29 2003-05-08 Hydac Electronic Gmbh Dispositif et procede de determination de la qualite d'une substance, en particulier d'un lubrifiant et/ou d'une huile de coupe
WO2003038394A3 (fr) * 2001-10-29 2004-03-25 Hydac Electronic Gmbh Dispositif et procede de determination de la qualite d'une substance, en particulier d'un lubrifiant et/ou d'une huile de coupe
US7104117B2 (en) 2001-10-29 2006-09-12 Hydac Electronic Gmbh Device and method for determining the quality of a medium, particularly of a lubricant and/or coolant
WO2010094799A1 (fr) * 2009-02-23 2010-08-26 Neosurgical Limited Dispositif écarteur pour chirurgie laparoscopique
US20120046525A1 (en) * 2009-02-23 2012-02-23 Neosurgical Limited Laparoscopic surgical retraction device
EP2691027A2 (fr) * 2011-03-28 2014-02-05 Ahluwalia, Prabhat K. Écarteur d'organe
EP2691027A4 (fr) * 2011-03-28 2015-03-25 Prabhat K Ahluwalia Écarteur d'organe
US9326760B2 (en) 2011-03-28 2016-05-03 Prabhat Kumar Ahluwalia Organ retractor
US9795369B2 (en) 2011-03-28 2017-10-24 Prabhat Kumar Ahluwalia Organ retractor
CN103767795A (zh) * 2014-01-20 2014-05-07 钱建民 手术用组织器官隔离器
CN104473666A (zh) * 2014-12-08 2015-04-01 钱建民 体腔内扩张器

Also Published As

Publication number Publication date
DE19841652A1 (de) 2000-03-30
DE29903943U1 (de) 1999-07-01

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