WO2002038053A2 - Device and method for connecting hollow bodies - Google Patents

Abstract

The invention relates to a device for connecting hollow bodies, comprising a longitudinal mounting and a needle mounting, arranged on one end of said mounting, whereby the needle holder forms a projection, extending radially over the circumference of the mounting and a number of needles which are arranged on the projection of the needle holder, standing upright around the mounting.

Description

 Device and method for connecting

hollow organs

The present invention relates to a device and a method for connecting hollow organs. With such devices and methods, for example for sewing on vessels, the sewing process can be mechanized and thereby accelerated and simplified. This is particularly important in coronary surgery for performing operations on the beating heart. Furthermore, a repeatable and high-quality connection process can be carried out by means of such devices and methods, so that the risk is minimized that the vessels are not tight, or, for example, the back wall of the vessel in question is also sewn on in coronary surgery.

An essential area of application for such devices and processes is the sewing of end-to-side

Anastomoses, ie operative connections of Hollow organs, one end of the vessel being sewn on to the other in the bypass surgery of the coronary arteries. However, the devices and methods according to the invention can also be used for sewing on vessels in all other areas of vascular surgery.

Today, around 70,000 bypass operations are performed in Germany alone each year. The most difficult discipline is anastomoses on the coronary arteries. They require a great deal of skill and experience from the surgeon, since the vessels here are very small with an average arterial diameter of 2 mm and an average venous diameter of 4 mm, and the other graft diameters, for example internal artery, are often only 2 mm. In particular, no leakage or sewing on of the posterior wall of the vessel may occur.

The manual process can be divided into the following operational steps, in particular the connection in the anastomosis suture being the task that can be performed by mechanical devices and corresponding methods. The first is a thoracotomy and a sternotomy (opening and severing the sternum). At the same time, the graft (e.g. vein) is obtained and prepared for connection to the artery with an appropriate oblique incision. In the next step, an incision is made into the artery as

Longitudinal opening carried out. The vein and artery openings are then connected. This can be simplified and improved by a mechanical device. Finally, the thorax is closed again. According to the prior art, several types of so-called stackers are currently known which, like a tacker, place a clip instead of a seam. The systems are mainly used for larger vessels or for sealing open vessels. Leakage is a particular problem with end-to-side trucks. Such stackers are known for example from US 5,732,872, US 4,930,674 or US 5,285,945.

Coupling systems pursue another approach to connecting vessels, as described in "Review of Facilitated Approaches to Vascular Anastomosis Surgery", Werker, P. et al., The Society of Thoracic Surgeons, 1997. Coupling systems of this type are mostly used in the intestine or connect the vessels end-to-end.

A third group of methods for connecting vessels is based on conventional sewing technology, which has been mechanized. One such system is the U.S. ArthroSew ™ Suturing System. Surgical Dynamics.

A disadvantage of all these from the prior art

Systems known in the art are that they often offer no possibility of end-to-side anastomosis or are not suitable for small vessels with a diameter of approximately 2 mm. In particular, they are often also not suitable for bypass surgery.

The object of the present invention is therefore to provide a method and a device for closing an opening of a vessel or for connecting hollow organs, in particular for applying anastomoses, with which two hollow organs gane can be connected in a simple, safe, high quality and repeatable manner.

This object is achieved by the device according to claim 1 and by the set according to claim 23 and by the method according to claim 25. Advantageous further developments of the device according to the invention, the set according to the invention and the method according to the invention are given in the respective dependent claims.

With the device according to the invention or the method according to the invention, both the proximal and distal anastomoses during a coronary artery bypass operation (CABG) as well as anastomoses with the internal mammary artery can be created as a transplant. They can also be used to close (close) a vessel.

The basic functional principle of the device according to the invention and of the method according to the invention is based on the simultaneous piercing of a plurality of needles with thread through a vessel, wherein at the other end of the thread there are also needles which are simultaneously pierced through a second vessel. By tightening the two thread ends, depositing the thread ends in the holder and connecting the thread ends, the two vessels are then securely connected to one another.

This design of the device and the method solves the task of connecting hollow organs, in particular the application of anastomoses, in a simple and safe and repeatable manner. The area of application is primarily bypass surgery on the heart for coronary ischemia, but also operations on other organs in the case of stenoses, occlusions, veins and thrombosis, for example in peripheral arteries.

In contrast to manual sewing or conventional methods, there is no risk that the rear wall of the vessel will be sewn on or that the connection will leak. With the device according to the invention and the method according to the invention, most operations can now also be carried out not only on the heart that has been shut down, so that additional traumatization for the patient through the use of the heart-lung machine is avoided. In particular, very small vessels with a diameter of approx. 2 mm can be sewn on safely.

Due to the mechanized sewing process, the quality of the seam is increased, the rear wall is protected, for example by a needle holder designed as a shoe, and the operation can in most cases be carried out on the beating heart.

According to the invention, the device for connecting hollow organs has several individual elements, namely on loan

an elongated bracket,

a needle holder which is arranged at one end of the holder, the needle holder protruding radially to form a protrusion over the circumference of the elongate holder, so that a plurality of needles, for example ring-shaped, can be arranged on this protrusion pointing away from the end of the holder so that they stand upright with their respective ends connected by threads. To this The needle holder is designed as a shoe that protects the rear wall of the vessel from the needles when the holder is inserted into the incision of the vessel. The needles can then be spread apart at a predetermined angle and pushed through the vessel wall along the circumference of the incision with the aid of a needle receptacle located on the outside of the vessel wall.

If the other side of the threads is connected with needles in a similar holder, the second container to be connected to the first container can also be sewn along its circumference of incision in this way, so that the two openings can then be tightened and connected along their circumference be connected to each other. The two hollow organs are thus securely connected to one another with their openings in a form-fitting and sealing manner.

The holder can be designed as a table stand, for example for one end of the graft when the graft is still loose, or as a handle, for example for the second end of the graft or for the internal artery. Furthermore, the holder with an insertion aid for the

Transplant, for example the vessel to be anastomosed. This insertion aid can be an expansion of the elongated holder or can also be attached in the elongated holder in such a way that after the graft has been pulled over the holder and the insertion aid, this insertion aid is expanded, so that the graft also has a larger size. In this way, the graft can be widened to a circumference which projects beyond the circumference of the needle arrangement, so that the needle is then moved longitudinally in the direction of the holder. yours can be pushed through the graft wall.

Instead of being pulled over an insertion aid, the holder can also be connected to a sleeve, for example a cylindrical hollow body. The sleeve can be provided with a suction device. If the graft is now inserted into the sleeve, its outer wall is sucked onto the inner wall of the sleeve and fixed there.

In the next step, the end of the graft is cut off to shape. For this purpose, the sleeve can have a surface that is not oriented parallel to its direction of passage, for example perpendicularly or obliquely at a predetermined angle, as the cut surface.

Spaced from this cut surface, the sleeve has variable pressure pads along its circumference, through which the graft can be compressed. Then the graft has a larger cross-section in the area of the cut surface than in the area of the pressure pads and narrows like a funnel in the transition to the area of the pressure pads.

If the diameter of the needle arrangement is chosen such that it lies between the diameter of the two cross sections, the needles can be moved in the direction of the graft in the axial direction of the sleeve until they start in the funnel-shaped area from the inside of the graft through the vessel wall press the graft and be picked up by a needle holder on the outside of the graft. Since only the outside of the graft lies against the inside of the sleeve, the inside endothelial layers of the graft cannot be damaged. This means that distal and proximal anastomoses as well as anastomoses with the internal artery can be performed.

On the artery side, too, this can be aspirated in a ring by means of a suction device before the incision is made. In such a fixed state, the incision is then made in a length corresponding to the circumference of the graft within the aspirated area, and the shoe with the needles is then inserted without the artery walls being able to collapse after the incision has been made in the artery.

A needle cap can be put over the needles and needle tips as insertion protection for the needles or for the vessel in front of the needles, which is pulled off the needles immediately before the needles are spread apart or before the needles are pushed through the vessel wall. In this way, the vessel is protected from the pointed needles and injuries as long as possible.

The needles can be folded out in the direction of the lateral vessel wall immediately before being pushed through the vessel wall by pushing a sleeve between the needles and the elongate holder and thus spreading the needles outward.

All movements, for example the needle cap or the sleeve or the split receptacle for pushing the needles through the vessel wall, can be done using a handle attached to the holder ω μ *

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In addition to straight needles, curved needles are also conceivable.

For sewing on an internal mammary artery (artery that is already close to the heart and is only sutured on one side), it is conceivable to use the instrument as a minimally invasive surgical instrument and to open and close it through small accesses without opening the chest sew. For this purpose, the part of the instrument on the arterial and transplant side would be inserted into the body through a trocar and handled endoscopically.

The handles of the tool can also be designed so that they can be manipulated by a robot. In the first step, the graft-side procedure could continue to be carried out by hand and only the artery-side procedure with the robot. For this purpose, instead of the handle, a flange would be attached on the artery side, which is attached to a robot flange. The movement of the needle cap, the sleeve and the split receptacle are then controlled electrically, hydraulically or pneumatically or by other drives.

The graft-side part can also be handled by a second robot arm for suturing the internal artery. Here the handle would be flanged to a robot with a needle holder and insertion aid. The split holder would have to be pushed open manually or by another robot arm and pulled out with the needles. The needle holder (split holder) is then hung by the robot in the holder and the tightening and connecting is done manually. Some examples of devices and methods according to the invention are given below.

Show it:

1 shows the creation of an anastomosis;

Figure 2 shows an inventive device;

Figure 3 shows an artery with an inserted needle holder;

FIG. 4 shows an inserted needle holder with the needle cap raised;

Figure 5 shows the arrangement of Figure 4 in cross section;

FIG. 6 shows a cross section through an artery with an inserted needle holder when piercing the vessel wall;

FIG. 7 an artery with a sewn vessel wall;

Figure 8 shows another device according to the invention;

FIG. 9 shows the device from FIG. 8 with vasodilation;

FIG. 10 shows the device according to FIG. 9 with a drawn vein;

FIG. 11 shows the device according to FIG. 10 with needle holder; FIG. 12 shows the device according to FIG. 11 with the vessel wall sewn;

FIG. 13 shows the device according to FIG. 12 with the needle holder removed;

FIG. 14 a set according to the invention;

FIG. 15 shows the diagram of a set according to the invention during the sewing of the vessels;

FIG. 16 the set according to FIG. 15 with the needle receptacles removed;

Figure 17 shows a needle holder;

FIG. 18 shows a detail of the needle holder from FIG. 17 with the needle holder inserted;

FIG. 19 the holder according to FIG. 18 with two inserted needle holders;

FIG. 20 the holder according to FIG. 19 with needle receptacles inserted one above the other;

FIG. 21 shows a device for clipping thread ends;

FIG. 22 shows a further device for clipping threads;

FIG. 23 another device according to the invention;

FIG. 24 another set according to the invention; FIG. 25 shows the diagram of the set from FIG. 24 during the sewing of the vessels;

FIG. 26 shows a further diagram of the set from FIG. 24 during the sewing of the vessels; and

Figure 27, the operation of the sewing transplant ^"tats with a device according to FIG 23rd

Figure 1 shows schematically the sewing of end-to-side anastomoses. An artery 10 and a vein 11 are shown in FIG. 1A. The vein 11 is a graft that is to be sutured onto the artery 10. Here, as in all of the following illustrations, similar components are designated with similar reference symbols. In FIG. 1B, an incision 12 was made in the artery 10. The . The end of the vein 11 was cut obliquely, so that there is a corresponding opening 13, the diameter of which corresponds approximately to the diameter of the opening 12. In

FIG. IC shows how the two openings 12 and 13 of artery 10 and vein 11 are then connected to one another and sutured, so that an end-to-side anastomosis has now been produced.

FIG. 2 shows a device according to the invention which can be used in the manufacture of anastomoses shown in FIG. 1. This device has a handle 1, at the end of which a shoe 2 is designed as a needle carrier for needles. This shoe 2 is covered by a needle cap 9 together with the needles standing upright on it. Above the needle cap 9 there is a needle holder 3, the function of which will be explained later. Furthermore, sections of threads 4 are shown, which are connected to the ends of the needles. FIG. 2B shows the lower part of the device from FIG. 2C in an enlarged representation in a lateral cross section. Again, the shoe 2 can be seen, on which needles 7, which are arranged in a ring around a holder 20, stand upright. These needles 7 are connected to threads 4 by their end facing the shoe 2. Above the needle tips there is a sleeve 8 which can be moved along the holder 20 via a sleeve linkage 23. The entire arrangement of needles 7 and sleeve 8 is covered by a needle cap 9, which can also be moved along the holder 20 via a linkage 21 and, in the lowered state, covers the needles 7 and the sleeve 8 in a protective manner. Above this protective cover 9 there is a needle holder 3, which can also be moved along the holder 20 by a suitable mechanism (not shown here).

FIG. 2A now shows, in a cross section offset by 90 ° to FIG. 2B, a needle holder 2 which is introduced into an artery 10. The needle holder or shoe 2 was introduced into the artery 10 via a corresponding incision (not shown in cross section) and then, as shown in FIG. 2A, the needle cap 9 was pulled up. As a result, the needle tips are now free within the artery, but the rear wall of the artery is protected against the needles 7 by the shoe 2.

Both the sleeve 8 and the needle cap 9 are through their respective linkages 23 and 21 through

Push buttons 5 and 6 on the handle 1, as shown in Figure 2C, movable up and down.

Figure 3 shows the same arrangement as in Figure 2B, but in an external view of the artery 10. It is co ro μ ^>

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through the corresponding puncture opening into the interior of the artery and then along the holder 20 out of the incision.

This step completes the first half of anastomosis. Now the end of the opening of the vessel to be sutured, for example a vein, is sutured.

Figure 8 shows a corresponding device, but here instead of a handle a table stand 30 is used, which has a central rod 31 and a needle holder 32, in which 31 needles 37 are arranged in a ring around the central rod. These needles 37 are connected to threads 34 at their end. It should be noted that, in accordance with the oblique cut at the opening of the vein, as shown in FIG. 1, the needle holder 32 is beveled in the same way.

FIG. 9 shows the device from FIG. 8, a pulling aid or insertion aid 35, which partially has a thickening, being pulled onto the central rod 31. Alternatively, the insertion aid can also be borrowed, e.g. be thickened by appropriate inflation.

FIG. 10 shows a further detail from a device according to FIGS. 8 and 9, a vein 11 now being drawn over the insertion aid 35. This is now also greatly expanded in the thickened area of the insertion aid, the diameter of the vein in the expanded area being larger than the diameter of the needle arrangement with the needles 37. FIG. 10 also shows that a O

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right of the artery and out through a puncture opening in the vascular wall of the artery.

FIG. 14C and the detail from FIG. 14D show an alternative to the table stand 30. Here, the needle holder 32 with the needles 37 is fastened to a handle 40, the handle ending in a tip over which the vein can be drawn in a corresponding manner. Pulling aids or insertion aids, as described above, can also be arranged here.

FIG. 15 shows the illustration in FIG. 14B in an enlarged form. The threads are shown in two examples 4a, 4b and 34a and 34b. Otherwise, the representations correspond to the figures in FIG. 4 and FIG. 12.

In FIG. 16, the representation takes place with the split receptacles 3a, 3b and 33a, 33b removed, again only two threads 4a, 34a and 4b, 34b being shown here as examples. Otherwise, the representation in FIG. 16 corresponds to the representations in FIGS. 7 and 13.

FIG. 17 shows a holder 31 for the divided needle receptacles from FIG. 16. This holder 41 has slit-like openings 42, the spacing of which corresponds to the distance between the threads that originate from the divided holders 3a, 3b or 33a, 33b.

FIG. 18 shows how a holder 33b is inserted into the holder 41. The slot-like openings here bear the reference symbols 42a to 42e, only the thread 34b which runs through the slot 42e being provided with reference symbols. FIG. 19 shows how a half 3b of a needle holder and a half 33b of a further needle holder are placed next to one another in the holder 41. In order to properly link the ends of the respective threads, the holder 33b is now placed in a suitable manner over the holder 3b (FIG. 20). As a result, the two ends of the same thread, for example denoted by 4b, 34b, are automatically located in each of the slots 42.

The thread ends can then be clipped together using an auxiliary instrument. FIG. 21 shows such an auxiliary instrument, the entire instrument 45 with handle 46 and handle 47 being shown in FIG. 21B, while FIG. 21A only drives the end of the handle 47. At the end of the stem 47 a clip holder 48 is arranged, which receives a total of five clips 49. The respective thread ends can be connected to one another with the aid of these clips 49.

FIG. 22 shows a further auxiliary instrument 45, which however has a clip holder 48 for only one clip 49. Instead, the instrument 45 from FIG. 22 has a plier-like abutment 50, so that with this instrument 45 two thread ends of the same thread can be clipped together in a simple manner.

It should be noted in the method according to the invention that the threads of the artery side and the graft side are tightened before the respective thread ends are clipped, so that the opening of the vein lies completely and finally on the incision in the artery. Then the threads can then this tight position can be clipped together.

As an alternative to an auxiliary instrument, as shown in FIGS. 20 and 21, the thread ends can of course also be knotted conventionally or other methods such as gluing, thermoforming and the like can be used. Clips made of Nitinol (Coalescent Industrial Inc.) can also be used.

FIG. 23 shows a further exemplary embodiment for a device which corresponds to that from FIG. 8. This device has a handle 40 on which a base 61 is arranged. The base 61 serves as a holder for the needle holder 32, in which needles 37 are arranged in an annular arrangement. Arranged in the axial direction of this annular needle arrangement 37 is a needle receptacle 62 which has through openings which extend in the axial direction of the individual needles and through which the needles are guided when the needle arrangement 37 is axially moved. A needle receptacle 33A and 33B is again arranged adjacent to the receptacle 62, into which the needles are inserted during axial movement. This receptacle 33 is a divided receptacle, which can consequently be divided into two halves 33a and 33b with the needles 37 then inserted therein and removed.

Both the receptacle 62 and the needle receptacle 33 are designed as hollow bodies with through openings lying in the axial direction of the needle arrangement 37. The receptacle 62 and the needle receptacle 33 are fastened to the base 61 via an external rod-shaped holder 65. As can be seen in FIGS. 23B and 23C, the receptacle 62 and the needle receptacle 33 are designed in such a way that the cross section of their through opening can be narrowed. This can be done, for example, by forming air cushions. FIG. 23B shows how a graft 11 is inserted into the through opening of the receptacles 62 and 33. FIG. 23C shows how the receptacles 33 and 62, the cross section of the through opening and thus also the diameter of the graft 11, are now narrowed in regions so that the cross section of the graft is retained only on the surface of the receptacle 62. This consequently narrows in a funnel shape starting from this surface 67 in the axial direction of the needles 37. The largest diameter of the through opening of the receptacle 62 is now set so that it is larger than the diameter of the ring of the needle arrangement 37. The narrowing by the pressure pads in the receptacles 33 and 62 takes place to a diameter which is smaller than the diameter of the Needle arrangement 37. This creates a transition region 70 of the graft, in which the graft narrows in a funnel shape. If the needles are now pierced through the graft in the axial direction, they enter the graft in the enlarged area along the cutting edge 67 and are pushed through the graft in the funnel-shaped area 70.

It is now advantageous if the receptacle 62 and / or the needle receptacle 33 are provided with a device for applying a negative pressure to the inner surface of their through opening. In this case, the graft 11 can be sucked on its outside and thus fixed. By fixing the trans- Damage to the inside of the graft, especially the endothelium, is avoided by suction from the outside.

FIG. 24 shows the connection of the device for suturing the graft and the artery.

The needles in both devices are connected to one another via threads 34, only some of the threads being shown here in the same way as in FIG. 14. For further explanation, reference is made to the corresponding FIG. 14-, with only the device there for sewing the graft being replaced by the device according to FIG. 23 for sewing the graft.

FIG. 25 shows this arrangement of the two devices according to the invention, the needle ends of which are each connected via threads 4A, 34a and 4B, 34b.

FIG. 26 shows the same arrangement after the needles 7 and 37 have been pulled through the artery 10 or the graft 11. The needles 7 and 37 are then pressed into the needle receptacles 3 and 33 and fixed there. The needle receptacles are now divided into two partial needle receptacles 3a, 3b or 33a and 33b and removed with tweezers 69, the ends of which are adapted to the receptacle. The needle receptacles 3a, 3b, 33a, 33b can then be placed in corresponding holder and the graft of the artery fastened and thus sewn on by tightening the threads.

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The further process of sewing then takes place as described in the previous examples.

In a further example, the instruments and devices presented could also be designed as minimally invasive surgical instruments, so that there is no opening of the chest and the instrument is introduced into the body via small accesses, for example through a trocar.

In further examples, the handles 1 can also be designed such that they can be manipulated by a robot. This would allow extensive automation of the sewing process.

In summary, it can be stated that the device according to the invention or sets according to the invention with two or more such devices, in each case at least one for the arterial and one for the venous side, make it possible to connect hollow organs to one another in a simple and safe manner.

Claims

claims

1. Device for connecting hollow organs with an elongated holder, a needle holder, which is arranged at one end of the holder, the needle holder protruding radially projecting over the circumference of the holder, and a plurality of needles on the projection of the needle holder the bracket are arranged standing upright surrounding.

2. Device according to the preceding claim, characterized by a device for deflecting the needles at a predetermined angle to the longitudinal direction of the holder in the radial direction.

3. Device according to the preceding claim, characterized in that the device for

Deflecting the needles in the radial direction is an expansion sleeve which surrounds the holder and is movable between the needles and the holder such that the needles are inclined outwards.

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9. Device according to one of the preceding claims, characterized in that an annular device for generating a negative pressure is provided in the axial direction of the needles above the needle tips.

10. The device according to the preceding claim, characterized in that the device for generating a negative pressure is formed annularly around the axial direction of the holder.

11. The device according to the preceding claim, characterized in that the insertion aid or the sleeve in a straight line continuation to the individual needles or radial incisions

Has holes for the passage of the respective needles.

12. Device according to one of the preceding claims, characterized by a needle cap which removably covers the needles.

13. Device according to one of the preceding claims, characterized by an above the needle tips surrounding the holder can be arranged

Needle holder which can be pressed onto the needle tips or onto which the needle tips can be pressed.

14. Device according to one of the two preceding claims, characterized in that the needle cap and / or the needle receptacle can be divided and / or opened along its circumference.

15. The device according to the preceding claim, characterized in that the needle cap and / or the needle holder along its circumference can be divided into two sections.

16. Device according to one of the preceding claims, characterized by a pulling device for pulling off the needle cap from the needles and / or a movement device for moving the expansion sleeve between the needles and the holder and / or a pressing device for pressing the needle holder onto the Needle tips or the needle tips on the needle holder.

17. The device according to the preceding claim, characterized in that the holder has controls for moving the puller, the moving device and / or the pressing device.

18. Device according to the preceding claim, characterized in that the operating elements have push buttons which are arranged on the end of the holder opposite the needle holder.

19. Device according to one of the preceding claims, characterized in that a stand is arranged on the holder below the shoe.

20. Device according to one of the preceding claims, characterized by a separate needle holder for one or two needle holders.

21. Device according to one of the preceding claims, characterized by a separate connecting device for connecting the thread ends of a thread.

22. Device according to the preceding claim, characterized in that the respective thread ends can be connected by means of a clip by the connecting device.

23. Set with at least two devices according to one of the preceding claims.

24. Set according to the preceding claim, characterized in that one needle end each

Needle of one device is connected to a needle end of a needle of the other device by a thread.

25. A method for connecting a first opening of a first hollow organ to a second opening of a second hollow organ, that is to say a first arrangement of the first opening in the first opening

Needles is inserted a second array of needles is inserted into the second opening with the needle ends leading, the end of each needle of the first array being connected by a thread to the end of a needle of the second array, the needles of each array for each array together with the needle tips is pressed through the wall of the respective hollow organ along its opening and then the threads are tightened and the two ends of each thread are connected to one another.

26. The method according to the preceding claim, characterized in that the needles of one or both arrangements are arranged in a ring shape.

27. The method according to any one of the two preceding claims, characterized in that the needles at least one of the arrangement after insertion into the opening of the hollow organ are spread apart with their tips in the radial direction.

28. The method according to any one of the three preceding claims, characterized in that the opening of at least one hollow organ is widened in such a way that the hollow organ with the region giving the opening via one of the arrangements of the

Needles can be brushed or one of the arrangements of the needles with a movement in the axial direction device can be pressed through the region of the hollow organ surrounding the opening.

29. Device according to one of claims 25 to 27, characterized in that the area of the hollow organ facing away from the opening of at least one hollow organ is narrowed in such a way that the hollow organ can be grazed with the region surrounding the opening via one of the arrangements of the needles or one of the arrangements of needles with one

Movement in the axial direction can be pressed through the region of the hollow organ surrounding the opening.

30. The device according to the preceding claim, characterized in that the region facing away from the opening is compressed.

31. The device according to one of the two preceding claims, characterized in that the hollow organ is sucked onto the inner wall of a sleeve and fixed there.

32. The method according to any one of claims 25 to 31, characterized in that for pushing through the

Needle tips of at least one arrangement are pressed by the wall of the hollow organ on the side of the wall opposite the needle tips, a needle holder onto the wall and the needle tips and / or the needle tips onto the

Wall and into a needle holder arranged on the side opposite the needle tips. O

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