WO2016043622A1 - Procédé et dispositif de formation d'anastomoses chirurgicales - Google Patents

Procédé et dispositif de formation d'anastomoses chirurgicales Download PDF

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Publication number
WO2016043622A1
WO2016043622A1 PCT/RU2015/000548 RU2015000548W WO2016043622A1 WO 2016043622 A1 WO2016043622 A1 WO 2016043622A1 RU 2015000548 W RU2015000548 W RU 2015000548W WO 2016043622 A1 WO2016043622 A1 WO 2016043622A1
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WIPO (PCT)
Prior art keywords
needles
threads
organs
needle
housing
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PCT/RU2015/000548
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English (en)
Russian (ru)
Inventor
Сергей Александрович ГРИШАНКОВ
Original Assignee
Сергей Александрович ГРИШАНКОВ
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Priority claimed from RU2014137060/14A external-priority patent/RU2574132C1/ru
Application filed by Сергей Александрович ГРИШАНКОВ filed Critical Сергей Александрович ГРИШАНКОВ
Publication of WO2016043622A1 publication Critical patent/WO2016043622A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/062—Needle manipulators
    • 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

Definitions

  • the present invention relates to medicine, namely to surgery, and is intended for the formation of anastomoses using two-needle surgical sutures.
  • the invention can find application in pediatric surgery, transplantology, cardiovascular surgery, in operations on the liver, pancreas, ureters, urethra, microsurgery, etc.
  • anastomosis is an artificially created message (anastomosis) between the hollow organs, and the invention will allow the formation of a connection between two hollow or tubular structures, or a tubular structure with a hollow organ.
  • Structures can be part of various systems, such as cardiovascular, digestive or genitourinary.
  • the device according to patent US4553543 consists of two rods with many longitudinal grooves for surgical needles.
  • the rods have a complex profile.
  • One of the end sections (distal) of each rod is made cylindrical, the adjacent section is made with a gradually increasing diameter, which in turn is interfaced with a section of a conical shape that passes into an end section (proximal) of a cylindrical shape with a rounded end, intended for insertion into the lumen of a stitched organ.
  • a sleeve is arranged at the distal end portion of the rod that is movable along the said portion of the rod until it mates with a portion that has a gradually increasing diameter, and is also equipped with a plurality of longitudinal grooves for placing needles with surgical threads in them.
  • the sleeve is located with a gap from the adjacent (adjacent) section, and the needles are laid in such a way that the blunt end of each needle is located in the grooves of the sleeve, and the sharp one is in the grooves of the section with increasing diameter.
  • the sharp end of the needles is oriented towards the proximal end of the rod.
  • the sleeve with the needles and threads installed in it is closed outside by an additional casing, which does not allow the needles to carry out independent uncontrolled movement along the rods.
  • the formation of the anastomosis is carried out by alternately introducing the rods with the needles threaded into them into the lumen of the connected organs, followed by the movement of the sleeve (using the pusher) until they mate with the portion of the rod with an increasing diameter, as a result of which the needles, moving in grooves that perform the function of guides, go outside and pierce the wall of the vessels, after which the needles are removed with the subsequent formation of surgical nodes.
  • the extension of the needles with a puncture of the vessel wall is carried out in the opposite direction from the crossed end of the vessel (i.e., deep into the vessel).
  • This circumstance narrows the scope of the device - only for connecting vessels of the "end to end” type, and does not allow to connect the vessels “end to side” or “side to side”, or to stitch the ducts of parenchymal organs, because these types of compounds require the release of the vessel wall from surrounding organs and tissues at the point of exit of the needle from the vessel wall.
  • the probability of the vessel slipping off the rod during and after piercing its wall with needles is high.
  • the design of the device does not provide an orderly laying of threads, which significantly complicates the use of the device in the surgical field, and also does not provide a mechanism for the orderly distribution of threads after flashing vessels, which significantly increases the risk of tangling of the threads during their binding.
  • the process of using the device there is a high probability of changing the relative orientation of both rods relative to each other friend, which violates the alignment of the connected vessels and the accuracy of the connection.
  • the device according to patent US5554162 consists of a cylinder, inside of which on the opposite sides there are two pistons, in which several surgical threads with curved needles are fixed at the ends.
  • the method of flashing hollow organs consists in alternately introducing the ends of the cylinder into the lumen of the hollow organ and conducting surgical needles through the wall of the organ due to the translational movement of the piston inside the cylinder using a special pusher. After flashing both hollow organs, the needles are removed and the threads are connected.
  • This device has the following disadvantages: the use of bent needles and the peculiarity of their placement inside the cylinder does not allow using this device for flashing hollow organs of small diameter (less than 5 mm) and using more than 4 needles to form a reliable connection of organs; the threads between the surgical needles are located outside the cylinder and do not have an ordered arrangement, which increases the likelihood of them becoming entangled during operation of the device; the lack of stock of the length of the threads due to the peculiarities of their location in the device does not allow the surgeon to reliably form a surgical node; the extension of the needles and puncture of the vessel wall is carried out in the opposite direction (forward) from the crossed end of the vessel, which, as in the previous analogue, limits the use of the device only for a certain type of end-to-end vessel connection; there remains a high probability of the vessel slipping off the cylinder during the piercing of its wall with needles, there is no orderly laying of threads in the device, which significantly complicates the use of the device in
  • the device according to patent US6280460 consists of a handle with a mechanical drive and a working rod, including several concentrically arranged hollow cylinders, made with the possibility of moving relative to each other in working condition.
  • the central cylinder the smallest diameter
  • the rod with a tip in which direct surgical needles with threads are fixed with a blunt end.
  • the folded needles are parallel to the axis of the shaft and held by the cylinder.
  • the cylinders move in the rod, which leads to the transition of the needles from the "folded" - axial position to the open, in which the sharp ends of the needles are turned to the opposite side from the end of the rod.
  • the needles penetrate the organ wall around the circumference and are sequentially removed.
  • this device allows you to flash only one hollow organ.
  • the fixation of the needles on the tip of the rod is not reliable, and in the open state does not provide the location of the sharp ends of adjacent needles at an equal distance from each other, which reduces the quality and reliability of the connection of stitched organs.
  • the device contains a base of cylindrical shape with cone-like narrowing on both sides, turning into cylindrical rods with sharp points at the end. On the basis of the grooves are made for surgical sutures, and the grooves are made continuing on a cone-shaped narrowing.
  • the base is connected to two nozzles of a cylindrical shape.
  • the peripheral end of each nozzle has a pointed shape, on which there are holes for installing the blunt ends of straight needles connected to surgical sutures.
  • the base has a removable shell of a cylindrical shape, consisting of two halves, each of which has two wings, located opposite each other in the middle part of the shell in the area of contacting surfaces, and connected by means of removable brackets.
  • the diameter and size of the base are selected taking into account the diameter of the connected structures.
  • Surgical connection of hollow organs for example, of the "end to end” type, is carried out in the following sequence.
  • the pointed end of the nozzle, together with the needles is inserted into the lumen of one of the connected hollow organs.
  • produce a reverse traction (traction) of the device from the lumen of the hollow organ while the tips of the needles pass through the wall of the stitched hollow organ and appear on the outer surface of the organ.
  • the tips of the needles are captured with surgical clamps and, in turn, removed together with the threads from the device to a distance convenient for the surgeon for subsequent manipulations.
  • the nozzle is removed from the lumen of the hollow organ.
  • the needles are inserted into the nozzle openings at a certain angle in such a way that the sharp ends of the needles are facing outward, and the ends of the needles connected to the thread are turned towards the pointed end of the nozzle, while in the “folded” and “working” states of the needle its sharp ends beyond the outer surface of the nozzle.
  • the inventive device does not allow the possibility of re-introducing the tip for the case if the initial introduction was performed with certain inaccuracies (for example, violation of the coaxial location of the tip and the vessel, leading to a decrease in the quality of the connection), because when the tip is removed from the vessel after its initial introduction, the organ walls are automatically flashed.
  • the lack of a handle (base holder) in the design of the device leads to inconvenience during its use, because does not provide the required freedom to manipulate the tip during the surgical operation.
  • the design used a complex pattern of laying the threads in the base volume, which leads to the risk of tangles in the process of binding.
  • the inventive device overcomes the above disadvantages of all analogues and prototype.
  • the objective of the invention is to develop a new device for the formation of anastomoses using surgical sutures with needles at both ends, ensuring the implementation of high quality compounds.
  • the technical result to which the claimed invention is directed is the ability to simplify the process of forming an anastomosis in surgical practice and to obtain a better and more reliable connection of a wide range of hollow organs or hollow or tubular structures, including end-to-end, end-to-end vessel connections side by side or side by side; ducts of parenchymal organs, which are part of the cardiovascular, digestive and genitourinary systems and other systems.
  • the claimed device is characterized by ease of use in connection with the possibility of complementing the design of the claimed device with a holder.
  • the design of the holder provides for the possibility of placing loops of each thread that are formed when the needles are fixed at opposite ends of the device, without the risk of tangling, both when the walls of the organ are stitched with needles and the subsequent formation of the surgical unit.
  • the design of the holder allows the use of threads with a length of 35 - 50 cm, which is optimal for ease of use by the surgeon when forming a high-quality knot.
  • the inventive device allows you to stitch small vessels with a diameter of from Zmm to 5mm, which is important in pediatric surgery, microsurgery and transplantology, as well as form erected sutures, which is especially important in vascular surgery.
  • the claimed device in the case of inaccurate installation of the device in the lumen of the stitched vessel allows you to adjust its position by removing the device from the vessel without punctures or damaging its walls with the sharp ends of the needles and reintroducing the device without extending the needles.
  • the walls are punctured with needles to ensure uniform distribution of puncture points in the stitched vessel, which provides more accurate suturing, and as a result - greater tightness.
  • the device for forming surgical anastomoses by means of threads with two needles at the ends includes a body in the form of an extended body (for example, a sleeve) having end parts (or tips) made with the possibility of introducing into the lumen of the connected organs ; needles located in the ends of the body (or tips), with one needle of each thread located in one end of the body, and the second needle in the opposite; the end parts are provided with needle holes located around the circumference at equidistant distance from each other, and the needles are located in the said end parts so that the blunt end of the needle at the junction with the thread is located closer to the periphery of the end part, and the sharp end is turned to the side the corresponding hole (or directed to the central part of the body) and does not protrude beyond the outer surface of the body, while the needles are made with the ability to move through the holes of the end parts with the exit at To the least, parts of the needle
  • the extended body in the form of a sleeve
  • the end parts of the extended body can be made in the form of tips, which can be made integral with the sleeve in the form of a single part, or removable as separate parts.
  • the housing can be made integral of at least two parts, for example, two bushings.
  • the location of the needles at an acute angle to the longitudinal axis of the extended body is equipped with a displacement means located in the end part of the body and made in the form of a piston with a traction element.
  • the piston is provided with grooves for accommodating needles, the traction element can be made in the form of a cable or it can be a mechanical lever system.
  • the piston can be made with the possibility of "manual" movement or automatic movement, for example, using a spring mechanism associated with the traction element.
  • the device may be provided with guides for moving the needles through the holes in the end parts of the housing; means for placing loops formed by threads from the corresponding pairs of needles after laying them in the end parts of an extended body; holder of an extended body.
  • means for placing loops can be located in it.
  • the holder comprises a housing with a rod located therein, rigidly connected to an extended body in its middle part, while the means for placing the loops is a set of hollow tubes parallel to the rod, and the number of tubes selected is not less than the number of threads used.
  • the holder may be equipped with needle movement controls.
  • the number of holes made in the end part of the body (or tip) is determined by the inner diameter of the stitched organs and must correspond to the number of needles located in the end part.
  • the threads can be made with marking, for example, color.
  • the device can be equipped with at least one latch (distributor) of threads made with the possibility of fixing the threads after removing the needles from stitched organs.
  • the clamp (distributor) of the threads is removable.
  • the latch (distributor) of the threads consists of a spring with tightly arranged coils, fixed in a housing made with compartments for individual threads, providing access to the spring for securing threads and / or needles between the coils of the spring.
  • the device can also be equipped with guides for threads coming out of the holes of the end sections and located on the side of the outer surface of the housing.
  • the guides for the threads are made in the form of a ring with slots along its outer contour.
  • the guides for the threads are grooves made from the outer surface of the housing.
  • each needle is punctured again alternately to the organ wall closer to its edge.
  • FIG.1 shows a General view of the inventive device Assembly, in Fig.2 - "working" part of the device in a disassembled state; in Fig.Z - a surgical needle with two straight needles at the end; figure 4 is an example of a piston, a General view; figure 5 is a piston, side view; in Fig.6 - the "working" part of the device assembly, including two bushings, in the end parts of which there are pistons, the device is presented in a "non-working” state, in which the needles are “hidden” in the device (or in the housing of the working part of the device) ; in Fig.7 - presents the "working" part of the device in position with the needles partially pushed outward as a result of the displacement of the piston from the extreme "inoperative" position to the "working”position; on Fig - a variant of laying surgical sutures in the holder; figure 9 presents a diagram "Manual" button movement on the device
  • the positions in the figures indicate: 1 - an extended body (or body), for example, in the form of a sleeve; 2 - end part of an extended body, for example, a tip; 3 - surgical sutures; 4 - needles of surgical sutures; 5 - holes for needles 4; 6 - the piston; 7 - grooves (grooves) of the piston for laying needles; 8 - holes in the piston for installing the blunt ends of needles with threads; 9 - a piston cable; 10 - grooves for guides located on the side of the inner surface of the sleeve (not shown in the drawings) for moving the piston along them; 1 1 - holder (handle); 12 - holder body; 13 - rod holder; 14 - tube holder; 15 - latch button; 16 spring for the piston cable 9; 17 - scale of the displacement of the piston; 18 - thread lock; 19 - thread lock housing; 20 - spring retainer threads; 21 - compartments of the clamp for threads;
  • the device contains a "working" part, made in the form of an extended hollow body 1 with end parts 2 (making up the body of the "working” part), in which surgical sutures 3 with two needles 4 are located at the ends (Fig.Z), and other structural elements that ensure the execution of anastomoses (see Fig.1 - 22).
  • a "working" part made in the form of an extended hollow body 1 with end parts 2 (making up the body of the "working” part), in which surgical sutures 3 with two needles 4 are located at the ends (Fig.Z), and other structural elements that ensure the execution of anastomoses (see Fig.1 - 22).
  • needles are laid in one end part of the device for piercing one of the organs to be sewn, and the second pair of needles for piercing the second organ are located in the opposite end of the device.
  • the needles 4 are located inside the end parts (“hidden” inside the case), and in the “working” state when piercing the stitched organs, the needles move through the holes 5 in the end parts, piercing the walls of the connected organs. In this case, the needles move with their sharp ends in the direction from the periphery of the device to its central part.
  • the number of threads 3 used in the device is determined by the diameter (size) of the stitched organs. Each thread 3 may have a corresponding color and / or other markings (in full or in separate areas, for example, near the junction with the needles).
  • An extended body (body) in cross section can have a different profile - in the form of a circle, ellipse, polyhedron, etc.
  • the end parts 2 of the extended body 1 are made with the possibility of introducing into the lumen of the connected hollow organs and / or tubular structures. It is preferable to make the housing 1 in the form of a sleeve (which can be composed of two or more parts), and the end parts 2 in the form of tips (or nozzles), which can be made integral with the sleeve, or removable as a separate part connected to sleeve by any known means.
  • the size of the sleeve and tips depends on the diameter of the connected hollow organs.
  • Tips 2 have an end surface, the shape of which ensures its safe introduction into the lumen of the connected organ (vessel). Most preferred is the implementation of the tip with a rounded end, for example, spherical or conical shape.
  • the tip has a cylindrical part mating with a rounded part, while the cylindrical part has geometric dimensions that enable the tip to pair with the opposite “open” end to the device sleeve.
  • the sleeve with the tip is made in the form of a single part, while the housing of the "working" part is composed of two such parts, as shown in figure 2. The diameter of the sleeve 1 depends on the diameter of the hollow or tubular organs for the connection of which the device is intended.
  • the device can be made in the form of a size range with different diameters of the sleeve (working part of the device) to implement the corresponding connection.
  • the minimum possible sleeve size which can be manufactured using modern technical means, and in the tip of which the necessary number of needles can be laid for the formation of anastomoses, today is 3 mm.
  • Such a device will allow stitching of tubular structures (vessels and ducts) with a diameter of 3 mm or more.
  • the end parts 2 (tips) of the claimed device are provided with holes 5 for needles 4.
  • the holes are located around the circumference of the tip at an equidistant distance from each other and from the peripheral end of the tip.
  • the location of the holes 5 from the peripheral end of the tip is determined by the ability to place the needles inside the tip so that the sharp ends of the needles are located in the area of their corresponding holes 5.
  • the number of holes depends on the number of threads used to connect the hollow organs. For example, for organs with a diameter of 3 to 5 mm, it is recommended to use a device with a diameter of an extended body of Zmm, and choose the number of holes equal to 4 - 6.
  • both straight needles and curved can be used, most often used to form surgical anastomoses of tubular structures in a "manual" way.
  • the most preferred is the use of straight needles in the inventive device in connection with the possibility of their most compact arrangement in the device and the implementation of a more controlled and accurate flashing of the organ wall (Fig. 3).
  • the length of the needles and threads can be different and depends on the diameter of the hollow or tubular organs, for the connection of which they are supposed to be used.
  • the surgical thread located between the needles may be in a “folded” state inside or outside the device. Each thread and / or needle may have a corresponding marking (color or other) that distinguishes them from each other.
  • Needles 4 are laid in the tip so that the blunt end the needle, atraumatically connected to the surgical thread, is located closer to the periphery of the tip 2, and the sharp end of the needle is turned in the opposite direction - towards the central part of the device (or sleeve).
  • the needles of each thread, laid in opposite tips are oriented towards each other.
  • the best embodiment of the inventive device is represented by placing the needles at an acute angle to the axis of the sleeve (or tip) in such a way that the sharp end of the needle 4 in the “inoperative” state does not protrude beyond the outer surface of the tip 2, i.e. can be located in its hole 5 or near it.
  • the needle moves beyond the tip, while the movement of the needle can be achieved using any means known from the prior art, for example, with a piston 6.
  • the tool (or mechanism) for moving the needle for example, a piston mechanism
  • the piston mechanism of the device contains two pistons 6 (Fig.4 - 7), each of which is located in its tip and is made with the possibility of movement inside the tip and the sleeve using the traction element.
  • grooves 7 can be made, for example, wedge-shaped (see FIG. 4), into which the needles are placed, and which can serve as guides for the needles when they are moved from the “inoperative” position to the “working” position.
  • the piston 6 can also be equipped with elements or devices for fixing the blunt end of the needles, for example, in the form of holes 8.
  • the end face of the sleeve can serve as a limiter for moving the piston inside the sleeve.
  • the piston can move both inside the tip and inside the sleeve, while other structural elements can perform the function of the limiter for moving the piston.
  • the function of the traction element can be performed, for example, by a cable 7 connected to the piston 6.
  • special devices are provided (for example, grooves 10 on the piston and corresponding ribs on the inner surface of the sleeve of FIG.
  • the device may also include a holder 11 (or handle) (figure 1), connected to the housing of the "working" part (sleeve 1).
  • the holder can be attached to the sleeve at its center or otherwise, while the method and angle of attachment of the holder can be different, ensuring the convenience of its capture and positioning of the "working" part of the device when performing an anastomosis.
  • the holder comprises a housing 12 oriented perpendicular to the sleeve of the inventive device, in which a rod 13 is located, rigidly connected to the sleeve in its center, and hollow tubes 14 for placing loops from surgical sutures in them located around the rod (parallel to the rod ) (Fig. 8).
  • a holder with the number of tubes equal to the number of threads used in the device - one tube contains a loop from one thread laid in it, which ensures that the thread is removed from the tube during organ suturing without the risk of tangling it with adjacent threads.
  • the housing of the device holder may have a different shape, for example, in the form of a parallelepiped or cylinder.
  • the holder can also be equipped with two snap buttons 15, each of which is connected to the free end of the cable 9 of the piston 6, located on the outer surface of the housing (Fig.9).
  • the latch button is configured to "manually" move the piston. In this case, the movement of the latch button is carried out in the housing 12 of the holder 11 in the vertical direction. In the “inoperative” position, the latch button 15 is in its lowest position on the body and holds the cable 9 in a “taut” state, when moving the latch button from the lower position to the upper one, for example, using the surgeon’s finger, the piston 6 is moved in the tip, which in turn “pushes” through the holes 5 the needles 4 threaded into the piston outside the tip. T.O.
  • a scale with marking 17 can be applied to the surface of the housing of the device holder, which allows visually assessing the amount of piston movement.
  • Possible “automatic” embodiment of the movement of the piston 6 (figure 10).
  • the free end of the cable 9 can be fixed in the housing 12 of the device holder 11 from the inside by means of a spring 16 or other device.
  • the latch button 15 mounted on the housing holder blocks the movement of the cable. When this button is pressed, the cable moves under the action of the spring traction and moves the piston from its extreme position in the direction of the hub center.
  • the mechanism for moving the piston 6 There are other possible implementations of the mechanism for moving the piston 6.
  • the device includes at least one removable lock
  • the latch 18 can be placed on the housing 12 of the holder 11 using removable fasteners (the design of the fasteners can be different - mechanical, for example, in the form of a mechanical connector, magnetic, with a sticky surface, etc.) (Fig. 12).
  • the thread lock 18 consists of a housing 19 in which the thread holding device is located.
  • a spring 20 with tight turns or another element fixing the thread for example, adhesive tape, a plate with slots, etc.
  • the housing 19 of the thread retainer 18 may have slots (compartments) 21.
  • the number of slots (compartments) depends on the number of surgical threads installed in the device. Opposite each slot, appropriate marking (for example, color marking) can be made, matching the color marking of the threads and / or needles, ensuring that both ends of one thread in each compartment are exactly aligned.
  • the device can also be equipped with two guides for threads (not shown in the drawings), made, for example, in the form of a ring located on the outer surface of the sleeve or tip on opposite sides of the holder, and provided with slots for threads in an amount equal to the number of threads. Moreover, each slot on the ring is located opposite the corresponding hole of the tip. The surface of the ring (slot for the thread) may also have color and / or other markings for each thread.
  • the guides for the threads ensure their uniform placement on the outer surface of the sleeve of the device in its "idle" state and may have a different design.
  • the inventive device can be made of any materials suitable for the implementation described by each structural element of the function. In this case, it is preferable to perform the elements of the device from a polymer material or plastic.
  • the body parts of the “working” part of the device are manufactured, for example, as shown in FIG. 2, which are assembled in a certain sequence shown in this figure. Then the threads with needles are “tucked” into the appropriate tips. To do this, each of the needles at both ends of the surgical thread is inserted with a blunt end (the end connected to the thread) inside the tip 2 through the corresponding holes 5 and fixed in the piston 6.
  • the sharp end of the needle 4 is inside the tip and does not protrude beyond the outer boundary of the sleeve surface, and the surgical thread, located between the needles inserted into the tips, is formed in the form of a loop on the outside of the device and placed in a separate tube 14 inside the device holder 11 in a moderately tensioned state (see Fig. 8).
  • the device operates as follows (see Fig.13 - 22).
  • Both tips of the device are positioned opposite stitched tubular and / or hollow organs 22 (see Fig. 13).
  • One of the tips is inserted inside the first hollow organ (Fig. 14), after which, by shifting or pressing the first button 15 on the device holder, the sharp ends of the needles 4 are moved from the holes of one tip and the needles are pierced by the walls of the first organ (Fig. 15).
  • the second "free" tip is inserted inside the second hollow organ (Fig. 16).
  • the sharp ends of the needles are moved from the holes of the second tip and the needles are pierced by the walls of the second organ (Fig. 17).
  • the needles passing through the organ wall are alternately removed from the device using a surgical clamp 23 or other instrument, flashing the organ wall.
  • the threads passing through the organ wall are fixed in the latch 18 - in the corresponding compartment 21 in compliance with color and / or other markings, i.e. both ends of the same thread fall into one compartment (Fig. 18). This technique is repeated alternately with each needle and thread in both tips (Fig. 19).
  • Both clamps 18 with threads are removed (disconnected) from the holder 11 of the device and bred into opposite sides (Fig.20).
  • the device is removed from the stitched organs, and the threads are tied in turn until the hollow or tubular organs are fully connected (Fig. 21).
  • the inventive device was tested for the formation of anastomoses between vascular prostheses with a diameter of 5 mm and cadaveric (taken from the corpse) arterial vessels, with an inner diameter of about 5 mm (a fragment of the common hepatic artery) of the "end to end" type.
  • a device was used with an outer diameter of the sleeve 5 mm, a length of 80 mm, the number of threads - 6 and, correspondingly, holes in the tip of 6 on each side.
  • a comparative test was conducted of the formation time of the anastomosis using a manual suture (traditional) and using the above device. It was noted that an anastomosis formed by a manual suture was spent 25 ⁇ 6 minutes more than the formation of a similar anastomosis using the device. In addition, the uneven distribution of the seams relative to each other during its manual formation was noted.

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  • Surgical Instruments (AREA)

Abstract

L'invention concerne le domaine de la médecine et notamment la chirurgie et est destinée à former des anastomoses au moyen de fils chirurgicaux à deux aiguilles. Le dispositif de formation d'anastomoses chirurgicales au moyen de fils avec deux aiguilles à l'extrémité (fils à deux aiguilles) comprend un corps sous la forme d'une partie allongée possédant des parties d'extrémité réalisée de manière à permettre leur introduction dans la lumière des organes à relier; les aiguilles disposées dans les parties d'extrémité du corps, une aiguille de chaque fil étant disposée dans une partie d'extrémité et la deuxième aiguille est disposées du côté opposé; les parties d'extrémité sont munies d'orifices pour les aiguilles disposées à la circonférence à une distance égale, et les aiguilles sont disposées dans les parties d'extrémité de telle manière que l'extrémité obtuse de l'aiguille à l'endroit du raccordement avec le fil est disposée plus près de la périphérie de la partie d'extrémité, et la partie effilée est orienté vers le côté de l'orifice qui lui correspond et ne dépasse pas en dehors des limites de la surface externe du corps, les aiguilles ayant été réalisées de manière à pouvoir se déplacer via les orifices des parties d'extrémité de manière à ce qu'au moins une partie de l'aiguille sorte par les orifices susmentionnés pour assurer le percement des organes à relier.
PCT/RU2015/000548 2014-09-15 2015-09-01 Procédé et dispositif de formation d'anastomoses chirurgicales WO2016043622A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
RU2014137060 2014-09-15
RU2014137060/14A RU2574132C1 (ru) 2014-09-15 Способ и устройство для формирования хирургических анастомозов

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WO2016043622A1 true WO2016043622A1 (fr) 2016-03-24

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN111787870A (zh) * 2018-01-16 2020-10-16 利杜斯医疗有限公司 吻合术的组件

Citations (6)

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US4553543A (en) * 1984-03-05 1985-11-19 Amarasinghe Disamodha C Suturing assembly and method
US5545171A (en) * 1994-09-22 1996-08-13 Vidamed, Inc. Anastomosis catheter
US5554162A (en) * 1994-12-02 1996-09-10 Delange; Gregory S. Method and device for surgically joining luminal structures
JP3867151B1 (ja) * 2006-04-10 2007-01-10 国立大学法人山口大学 外科用吻合器
CN2928006Y (zh) * 2006-06-02 2007-08-01 安徽省立医院 显微血管吻合用管腔内导针栓
RU141181U1 (ru) * 2013-12-13 2014-05-27 Федеральное государственное бюджетное учреждение "Институт хирургии имени А.В. Вишневского" Министерства здравоохранения Российской Федерации Устройство для хирургического соединения полых органов

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4553543A (en) * 1984-03-05 1985-11-19 Amarasinghe Disamodha C Suturing assembly and method
US5545171A (en) * 1994-09-22 1996-08-13 Vidamed, Inc. Anastomosis catheter
US5554162A (en) * 1994-12-02 1996-09-10 Delange; Gregory S. Method and device for surgically joining luminal structures
JP3867151B1 (ja) * 2006-04-10 2007-01-10 国立大学法人山口大学 外科用吻合器
CN2928006Y (zh) * 2006-06-02 2007-08-01 安徽省立医院 显微血管吻合用管腔内导针栓
RU141181U1 (ru) * 2013-12-13 2014-05-27 Федеральное государственное бюджетное учреждение "Институт хирургии имени А.В. Вишневского" Министерства здравоохранения Российской Федерации Устройство для хирургического соединения полых органов

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN111787870A (zh) * 2018-01-16 2020-10-16 利杜斯医疗有限公司 吻合术的组件
CN111787870B (zh) * 2018-01-16 2024-03-29 利杜斯医疗有限公司 吻合术的组件

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