WO2010133215A1 - Dispositif d'application destiné à l'application, en particulier endoscopique, d'une agrafe médicale dans ou sur le corps d'un sujet - Google Patents

Dispositif d'application destiné à l'application, en particulier endoscopique, d'une agrafe médicale dans ou sur le corps d'un sujet Download PDF

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Publication number
WO2010133215A1
WO2010133215A1 PCT/DE2010/000568 DE2010000568W WO2010133215A1 WO 2010133215 A1 WO2010133215 A1 WO 2010133215A1 DE 2010000568 W DE2010000568 W DE 2010000568W WO 2010133215 A1 WO2010133215 A1 WO 2010133215A1
Authority
WO
WIPO (PCT)
Prior art keywords
clip
coupling device
sleeve
application
coupling
Prior art date
Application number
PCT/DE2010/000568
Other languages
German (de)
English (en)
Other versions
WO2010133215A4 (fr
Inventor
Jörg BRAKE
Frank Brennecke
Original Assignee
Medi-Globe Gmbh
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 Medi-Globe Gmbh filed Critical Medi-Globe Gmbh
Publication of WO2010133215A1 publication Critical patent/WO2010133215A1/fr
Publication of WO2010133215A4 publication Critical patent/WO2010133215A4/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
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
    • A61B17/1285—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips 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
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/122—Clamps or clips, e.g. for the umbilical cord
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B17/0643—Surgical staples, i.e. penetrating the tissue with separate closing member, e.g. for interlocking with staple

Definitions

  • Application device for applying, in particular for the endoscopic application of a medical clip in or on the body of an individual
  • the present invention relates to an application device for applying, in particular for the endoscopic application of at least two clip legs which can be expanded around a joint region with medical clips in or on the body of an individual having clip claws formed with their distal ends, with a tubular receiving device in which a clip arrangement is provided a clip sleeve and the clip can be received, which is folded together with its clip legs at the distal Ap ratessvor therapiessende in the non-applied initial state, and with an actuatable from the proximal end of the Ap ratesvoriquess actuator which is connected in the tubular receiving device by means of a coupling device with the clip assembly and by moving the Clip sleeve with the clip from the distal end of the tubular receiving device and the clip from the clip sleeve under spreading his clip legs for an application herau
  • the clip legs can be brought together again with their clip claws by the clip sleeve guided over them after application, and the connection between the coupling device and the clip arrangement can be interrupted by exerting a tens
  • the clip sleeve of the clip assembly has a protruding outwardly from her projection with which it is received in the non-applied state in the tubular receiving device.
  • a fracture portion exhibiting elongated hook element is added, at the distal end of the clip is hooked and at the proximal end of an arrow-shaped hook is provided. This hook is received by the actuator, and it is displaced by this in the tubular receiving device.
  • the clip sleeve together with the clip by means of the actuating device as far pushed out of the tubular receiving device that spreads the clip with his clip legs and the protruding projection of the clip sleeve on the distal end face of the tubular receiving device comes into abutment. If the actuating device is then withdrawn to the proximal end of the applicator device, the clip legs of the clip are closed again by pulling into the clip sleeve. However, the clip sleeve itself can not now be withdrawn into the tubular receiving device. By further pulling the actuator toward the proximal end of the applicator with a tensile force exceeding the rupture strength of the elongated hook member, this fracture portion will eventually rupture.
  • the clip with the surrounding clip sleeve are then separated from the tubular receiving device and the actuating device.
  • a backup of the clip in his clip sleeve is not provided, so that the closed position of the clip in its applied state is not safe to look at.
  • an application device for applying a clip which can be closed reversibly by means of a clip sleeve is also known (US Pat. No. 7,094,245 B2).
  • the clip which in each case has a latching hole in its two clip legs, is connected by means of a control wire to the clip sleeve accommodated by an outer sleeve at its distal end.
  • the clip By pulling the control wire toward the proximal end of the applicator device, the clip, which is initially in the spread state, can be pulled into its clip sleeve until its clip legs close until latching lugs located in the detent holes of the clip legs engage the distal inner edge of the respective clip sleeve.
  • the invention is therefore based on the object to show a way, as in an application device of the type mentioned in a relatively simple manner, the closed position of the clip in its applied state can be made safer than in the previously considered known application devices.
  • the coupling device and the clip sleeve are formed as elements of a locking device which is unlocked in the un-applied state of the clip and the exerting a below the predetermined threshold or a the traction force corresponding to the respective threshold value or is locked to the coupling device by the actuating device.
  • the invention has the advantage that a safe closed position of the clip is ensured in its applied state in a relatively simple manner, namely by the formation of the coupling device and the clip sleeve as elements of a locking device.
  • the locking device is irreversibly lockable. This results in the advantage of a very secure closed position of the clip in its applied state.
  • the locking device is formed in that the coupling device has a conical section tapering towards the proximal end of the applicator device and an undercut region adjoining the distal end of the applicator device, and the clip sleeve has a through-opening with a proximal contact surface and the proximal end have such a size that the coupling device after passing through its conical section by this passage opening with its undercut region abuts against the contact surface.
  • the locking device has a limiting device limiting the movement of the coupling device in the clip sleeve toward the proximal end of the application device.
  • the abovementioned limiting device is formed by a conically shaped outer part of the coupling device and by a matching, conically shaped inner part of the clip sleeve. This brings the advantage of a particularly low design effort for the realization of the limiting device with it.
  • the coupling device is received with its distal end part by a proximal end part of the clip. This results in the advantage of a relatively simple connection between the clip and the coupling device.
  • a structurally particularly easy to realize connection between the clip and the coupling device results in an advantageous manner in that the distal end portion of the coupling device has an at least approximately spherical end portion which is connected by a reduced in thickness relative to the end portion web portion with the coupling device, and that the proximal end portion of the clip has an opening for receiving the at least approximately spherical end portion.
  • the coupling device is connected to the actuating device by a releasable clamping connection device. This has the advantage that when parts of the actuating device are disconnected from the coupling device, no parts are destroyed and thus have to be disposed of.
  • the clamping connection device is formed by a plug-element plug-element receptacle connection device that is releasable by the actuating device when the tensile force exceeds the said threshold value, the plug element and plug element receptacle of which are at least approximately connected. gel-shaped or ball socket-shaped. This results in the advantage of a structurally relatively easy to implement clamping connection device.
  • the actuating device in the non-applied initial state of the clip can be locked in such a way that its removal from the tubular receiving device is blocked.
  • FIG. 1 is a sectional view of an application device according to the invention in approximately scale size for applying a medical clip in or on the body of an individual, wherein the clip is received in a tubular receiving device
  • Fig. 2 is a sectional view of the application device of FIG tubular receiving device at its distal end led out clip
  • FIG. 3 is a greatly enlarged partial sectional view of the distal end portion of the application device shown in FIG. 1 according to the invention with a clip assembly having a clip, a clip sleeve receiving the same and a coupling device.
  • Fig. 4 is a greatly enlarged partial sectional view of the distal end portion of the application device shown in Fig. 2 according to the invention with the clip, this receiving clip sleeve and the coupling device comprehensive clip assembly in a position in which the clip assembly is led out of the tubular receiving device and 5 shows a greatly enlarged partial sectional view of the distal end region of the application device according to the invention shown in FIG. 4 with the clip sleeve still toward the distal end of the device.
  • FIG further led out and even more spread clip in a position in which the clip is also applied in or on the body of an individual
  • FIG. 6 shows a greatly enlarged partial sectional view of the distal end region of the application device according to the invention shown in FIG. 5 with the clip withdrawn to the proximal end of the application device and closed again with its clip legs in a position after its application in or on the body of an individual, and FIG a greatly enlarged partial sectional view of the distal end portion of the application device shown in Fig. 6 according to the invention after the separation of an actuator from the clip assembly.
  • FIG. 1 shows a sectional view of an application device 1 according to an embodiment of the invention for applying a medical clip 2 in or on the body of an individual to approximately scale.
  • This clip 2 which has at least two clip legs 3, 4 (only shown in FIGS. 2 to 7) which are elastic about a joint area and have clip claws 5, 6 formed at their distal ends (also shown only in FIGS. 2 to 7), 1 in the distal end region (this is the end of the applicator device shown on the left in FIG. 1) of a tubular receiving device 7, which can be passed through an instrument channel of an endoscope (not shown), in particular if it is of appropriate length.
  • the tubular receiving device 7 is received towards the proximal end of the application device by a retaining ring 8, which in its distal end region can have a threaded part, in particular a luer-lock threaded part, with which the application Device 1 can be attached to a correspondingly shaped counter-threaded part of a receiving device, for example in the instrument channel of an endoscope.
  • the retaining ring 8 is further adjoined by a handle ring 9 with a connecting tube 10 toward the proximal end of the application device (this is the application device end shown on the right in FIG. 1).
  • a connecting tube 10 On this connecting tube 10 sits a slider 11, which is displaced in FIG. 1 towards the proximal end of the applicator device and retains the clip 2 in the tubular receiving device 7 in this position.
  • This slider 11, which - as will be seen, is part of an actuator - is in this position in its proximal end position.
  • the slider 11 presses a pressure spring 12, which is accommodated in the connecting tube 10 immediately before the gripping ring 9, in FIG. 1.
  • the slider 11 can be locked by a locking device and in Fig. 1 also locked.
  • This locking device is indicated here by a locking pin 13 and by a transverse opening 14 in the slider 11 at right angles to its direction of displacement and by a matching opening 15 in the connecting tube 10; By this locking device thus any movement of the slider 11 is locked in Fig. 1.
  • FIG. 2 shows the application device 1 explained with reference to FIG. 1, after the locking pin 13 has been pulled out of the opening 15 of the connecting tube 10. In this state, the slider 11 is in its distal
  • FIGS. 3 to 7 which are enlarged approximately ten times compared to the sectional views of FIGS. 1 and 2, the structure of the application device 1 at its distal end portion and the operations explained starting from the post 1 and 2 of the application device 1 when applying the clip 2 in or run on an individual.
  • FIG. 3 the enlarged partial sectional view according to FIG. 3 is described, in which the situation at the distal end region of the application device 1 is clarified, as is also illustrated in FIG.
  • a clip assembly having the clip 2 and a clip sleeve 16 receiving this and a coupling device 17, retracted in the tubular receiving device 7, so that the clip 2, as in Fig. 1, with its clip legs 3, 4 and the associated clip claws 5 and 6 is closed.
  • the coupling device 17 is formed here by a coupling rod.
  • the coupling device 17 is, as will be seen in more detail below, taken with its distal end portion 30 of a proximal end portion 31 of the clip 2.
  • the distal end region 30 of the coupling device 17 here has an at least approximately spherical end part, which is connected to the remaining part of the coupling device 17 by a web part which is reduced in thickness relative to the distal end region 30.
  • the proximal end part 31 of the clip 2 may, for example, have a slot attached to it laterally for receiving said web part and to the slot in question thereafter an opening for receiving the at least approximately spherical end part.
  • This opening has a size such that the respective spherical end part can not pass through this opening.
  • the above-mentioned opening may alternatively be dimensioned such that, in the case of clip legs 3, 4 which are not yet connected to the clip 2, they can receive the spherical end part of the coupling device 17 and allow it to pass through it.
  • the clip sleeve 16 has at its distal end on an expandable end portion 18 which comes after removing the clip sleeve 16 from the distal end of the tubular receiving device 7 at the distal edge 19 to the plant, as can be seen from Figs. 4 to 7 ,
  • the expandable end portion 18 may be formed by a sleeve portion of the clip sleeve 16 superior edge portion which, according to Fig. 3 by appropriate pressure in the tubular receiving device 7 can be pressed.
  • the coupling device 17 is connected at its proximal end to the actuating device by a releasable clamping connection device.
  • This clamping connection device is formed here by a tensile force exceeding the predetermined set threshold value by the actuating device releasable plug element plug element connection device with a plug element 20 and a plug element receptacle 21, which is located in a coupling holder 22, as shown in FIGS. 4 to 7 is more apparent.
  • the plug-in element 20 and the plug-in element receptacle 21 are in this case at least approximately spherical or ball-socket-shaped.
  • the plug element receptacle 21 can be slotted transversely to the longitudinal direction of the plug element 20, for example with one or more slots.
  • the coupling holder 22 is connected in the tubular receiving device 7 with a sliding element 23, which is displaceable by the slide 11 shown in FIGS. 1 and 2.
  • the coupling device 17 and the clip sleeve 16 are, as is more apparent from FIGS. 4 to 7, formed as elements of a locking device which is unlocked in the non-applied state of the clip 2 (see FIGS. 4 and 5) and the exercise a below the specified threshold value or a threshold value corresponding to or exceeding this tensile force by means of the slide 11 of the actuator to the coupling device 17 to the proximal End Ap impactssvoriquess out irreversibly locked (see Fig. 6 and 7).
  • This locking device is formed by the coupling device 17 having a conical section 24 tapering towards the proximal end of the applicator device and an undercut section 25 provided towards the distal end of the applicator device and the clip sleeve 16 having a through opening 26 with a proximal contact surface 27 and such a size at the proximal end. that the coupling device 17 after passing through Ren their conical portion 24 rests by this passage opening 26 with its undercut region 25 on the contact surface 27. As a result, after locking of the coupling device 17 in the clip sleeve 16, a return movement of the coupling device 17 to the distal end of the application device is prevented.
  • the locking device furthermore has a limiting device limiting the movement of the coupling device 17 in the clip sleeve 16 toward the proximal end of the application device.
  • This limiting device is formed here by a cone-shaped outer part 28 of the coupling device 17 and by a matching cone-shaped inner part 29 of the clip sleeve 16 near the proximal end portion of the clip sleeve 16.
  • the coupling device 17 with its distal end region 30 is received by a proximal end part 31 of the clip 2.
  • This distal end portion 30 of the coupling device 17 is at least approximately spherical and received in a slotted opening of the proximal end portion 31 of the clip 2.
  • the positions of the application device 1 shown in FIGS. 4 and 5 are the positions in which the clip 2 can be applied in or on an individual.
  • the degree of spreading of the clip legs 3, 4 of the clip 2 may depend on the size of the tissue opening of the individual to be occluded.
  • Slider 11 of the tubular receiving device 7 containing part of the application device 1 remains in the direction of the tissue opening to be closed advanced by the individual.
  • the actuator comprising the slider 11
  • the connection between the coupling device 17 and the coupling holder 22 is interrupted, so that the clip assembly is separated from the remaining part of the application device 1, as shown in FIG. 7 can be seen.
  • application device 1 is not limited to the embodiment shown in FIGS. 1 to 7, but may be modified in many ways and designed differently than shown here.
  • connection between the clip 2 and the coupling device 17 may be formed by a permanent connection, for example by a force-locking connection.
  • connection between the coupling device 17 and the coupling holder 22 can be realized differently than illustrated and illustrated, for example, by a frictional pinch connection having a pin and a pin receptacle which can be released when a tensile value exceeding a predetermined threshold value occurs, thereby interrupting the connection.
  • the locking elements of the clip sleeve 16 and the coupling device 17 comprehensive locking device may be provided in a different order than explained.
  • the clip 2 may be formed in a different manner than shown in the drawing figures.
  • the clip claws may be formed by end regions that continuously overlap the clip legs.
  • the clip 2 may have more than two clip legs with clip claws provided thereon, for example three or more clip legs and clip claws.
  • the clip 2 is a medical clip, it is made of a biocompatible material, such as stainless steel.
  • the other elements of the application device 1 preferably also consist of biocompatible materials. LIST OF REFERENCE NUMBERS

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Vascular Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Reproductive Health (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

Dispositif d'application destiné à l'application, en particulier endoscopique, d'une agrafe (2) médicale comportant au moins deux branches (3, 4) pouvant être écartées autour d'une zone d'articulation et comportant une griffe (5, 6) formée à leur extrémité distale, dans ou sur le corps d'un patient. Ledit dispositif d'application comporte, dans la zone terminale distale d'un dispositif de réception (7) tubulaire, un ensemble agrafe (2, 16, 17) pourvu d'un manchon (16) pour agrafe, de l'agrafe (2) et d'un dispositif d'accouplement (17) relié de manière libérable à un dispositif d'actionnement (11) par l'intermédiaire d'un élément de retenue d'accouplement (22) et permettant la sortie de l'ensemble agrafe (2, 16, 17) du dispositif de réception tubulaire par l'écartement des branches (3, 4) de l'agrafe (2). Le dispositif d'accouplement (17) et le manchon d'agrafe (16) sont conçus comme des éléments d'un dispositif de verrouillage qui est déverrouillé en situation de non-application de l'agrafe et qui peut être verrouillé lorsqu'une force de traction inférieure à une valeur de seuil prédéfinie ou correspondant à la valeur de seuil concernée ou dépassant ladite valeur de seuil est exercée par le dispositif d'actionnement (11) sur le dispositif d'accouplement (17).
PCT/DE2010/000568 2009-05-22 2010-05-20 Dispositif d'application destiné à l'application, en particulier endoscopique, d'une agrafe médicale dans ou sur le corps d'un sujet WO2010133215A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102009022271A DE102009022271A1 (de) 2009-05-22 2009-05-22 Applikationsvorrichtung zum Applizieren, insbesondere zum endoskopischen Applizieren eines medizinischen Clips im oder am Körper eines Individuums
DE102009022271.5 2009-05-22

Publications (2)

Publication Number Publication Date
WO2010133215A1 true WO2010133215A1 (fr) 2010-11-25
WO2010133215A4 WO2010133215A4 (fr) 2011-02-24

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PCT/DE2010/000568 WO2010133215A1 (fr) 2009-05-22 2010-05-20 Dispositif d'application destiné à l'application, en particulier endoscopique, d'une agrafe médicale dans ou sur le corps d'un sujet

Country Status (2)

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DE (1) DE102009022271A1 (fr)
WO (1) WO2010133215A1 (fr)

Cited By (5)

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WO2014181676A1 (fr) * 2013-05-07 2014-11-13 オリンパスメディカルシステムズ株式会社 Instrument de traitement endoscopique
WO2014181675A1 (fr) * 2013-05-07 2014-11-13 オリンパスメディカルシステムズ株式会社 Unité de pince
WO2014181678A1 (fr) * 2013-05-07 2014-11-13 オリンパスメディカルシステムズ株式会社 Instrument de traitement endoscopique
CN109788958A (zh) * 2016-09-22 2019-05-21 波士顿科学有限公司 具有可重装夹持机构的止血夹具
US10820904B2 (en) 2016-09-29 2020-11-03 Boston Scientific Scimed, Inc. Sacrificial coupler for reloadable hemostasis clipping device

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WO2012151415A1 (fr) * 2011-05-04 2012-11-08 Boston Scientific Scimed, Inc. Pince à libération d'élément de tension par voie endoscopique
CA3032608C (fr) * 2016-10-06 2020-07-21 Boston Scientific Scimed, Inc. Capsule partiellement ovale pour dispositif de clippage hemostatique rechargeable

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US20040176784A1 (en) * 2002-07-19 2004-09-09 Olympus Corporation Clip manipulating device
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EP1829489A1 (fr) * 2004-12-24 2007-09-05 Olympus Corporation Dispositif a ligature

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US7049245B2 (en) * 2003-09-12 2006-05-23 Promos Technologies, Inc. Two-step GC etch for GC profile and process window improvement

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US3958576A (en) * 1973-11-14 1976-05-25 Olympus Optical Co., Ltd. Surgical instrument for clipping any affected portion of a body cavity
DE10150829A1 (de) 2000-10-16 2002-10-02 Olympus Optical Co Clipvorrichtung für Physiologisches Gewebe, Clipverfahren und Befestigungsverfahren für eine Clipeinheit
DE10211049A1 (de) 2001-03-14 2002-10-02 Olympus Optical Co Vorrichtung zum Ligieren lebenden Gewebes
US7094245B2 (en) 2001-10-05 2006-08-22 Scimed Life Systems, Inc. Device and method for through the scope endoscopic hemostatic clipping
US20040176784A1 (en) * 2002-07-19 2004-09-09 Olympus Corporation Clip manipulating device
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CN104869917A (zh) * 2013-05-07 2015-08-26 奥林巴斯株式会社 内窥镜处理器具
CN104936537B (zh) * 2013-05-07 2017-03-15 奥林巴斯株式会社 夹具单元
WO2014181678A1 (fr) * 2013-05-07 2014-11-13 オリンパスメディカルシステムズ株式会社 Instrument de traitement endoscopique
JP5750619B2 (ja) * 2013-05-07 2015-07-22 オリンパス株式会社 クリップユニット
JP5750620B2 (ja) * 2013-05-07 2015-07-22 オリンパス株式会社 内視鏡処置具
JP5750624B2 (ja) * 2013-05-07 2015-07-22 オリンパス株式会社 内視鏡処置具
WO2014181675A1 (fr) * 2013-05-07 2014-11-13 オリンパスメディカルシステムズ株式会社 Unité de pince
CN104936537A (zh) * 2013-05-07 2015-09-23 奥林巴斯株式会社 夹具单元
WO2014181676A1 (fr) * 2013-05-07 2014-11-13 オリンパスメディカルシステムズ株式会社 Instrument de traitement endoscopique
US9662113B2 (en) 2013-05-07 2017-05-30 Olympus Corporation Endoscope treatment tool
US9687248B2 (en) 2013-05-07 2017-06-27 Olympus Corporation Endoscope treatment tool
US9949740B2 (en) 2013-05-07 2018-04-24 Olympus Corporation Clip unit
US10842500B2 (en) 2013-05-07 2020-11-24 Olympus Corporation Clip unit
CN109788958A (zh) * 2016-09-22 2019-05-21 波士顿科学有限公司 具有可重装夹持机构的止血夹具
US10820904B2 (en) 2016-09-29 2020-11-03 Boston Scientific Scimed, Inc. Sacrificial coupler for reloadable hemostasis clipping device

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Publication number Publication date
DE102009022271A1 (de) 2010-11-25
WO2010133215A4 (fr) 2011-02-24

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