WO2020059839A1 - Guide de suture - Google Patents

Guide de suture Download PDF

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Publication number
WO2020059839A1
WO2020059839A1 PCT/JP2019/036882 JP2019036882W WO2020059839A1 WO 2020059839 A1 WO2020059839 A1 WO 2020059839A1 JP 2019036882 W JP2019036882 W JP 2019036882W WO 2020059839 A1 WO2020059839 A1 WO 2020059839A1
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WO
WIPO (PCT)
Prior art keywords
suturing
guide
aorta
mark
suture
Prior art date
Application number
PCT/JP2019/036882
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English (en)
Japanese (ja)
Inventor
重之 尾崎
Original Assignee
重之 尾崎
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 重之 尾崎 filed Critical 重之 尾崎
Publication of WO2020059839A1 publication Critical patent/WO2020059839A1/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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges

Definitions

  • the present invention relates to an instrument for assisting suturing during surgery.
  • the sutured cusp may be May not function properly, but skill is required to reach an ideal suture.
  • ⁇ ⁇ This will be described in detail with reference to FIGS.
  • the surgeon looks into the inside of the aorta 7 from the incised surface of the incised aorta 7, and first removes the calcified leaflets. Subsequently, the size of the valve annulus is measured using a device called a leaflet sizer, and a leaflet having a size to be sutured is cut out from the pericardium according to the measured size, thereby creating the leaflet material 6.
  • the prepared leaflet material 6 is sewn to the annulus on the inner wall of the aorta 7, and finally, the adjacent leaflets are sewn.
  • the outside of the virtual line is a seam allowance for sewing to the aorta 7.
  • the surgeon sutures the aorta 7 with a thread around the mark 4A in a state where the valve leaflet material 6 is folded in the valley line L1 when viewed from above, and sequentially sews the position of the mark 4B from the mark 4A toward the commissure. Proceed.
  • the operator advances the sewing near the commissure, the operator projects the needle out of the aorta 7 from the mark 4B closest to the mark 4C.
  • the operator uses a thread 8 having a needle at both ends, which is a thread different from the thread sewn from the start position of the suture to the commissure.
  • a needle (not shown) at one end is penetrated from the position of the mark 4C to the position of the mark 4C of the adjacent leaflet material 6.
  • the needle at one end penetrating the adjacent leaflet material 6 is projected out of the aorta 7 from the position of the mark 4D on the adjacent leaflet material 6, and the needle (not shown) at the other end of the thread 8 is It is projected out of the aorta 7 from the position of the mark 4D on the leaflet material 6.
  • the surgeon applies a pledget to the outside of the aorta 7, sewn from the start position of the suturing, passes through the mark 4 ⁇ / b> B to the outside of the aorta 7, and passes through the mark 4 ⁇ / b> B of the adjacent leaflet material 6. Then, the thread 9B that has come out of the aorta 7 is tied on the pledget, and the thread 8 that has both ends out of the blood vessel through the mark 4D is tied on the pledget to fix the leaflet material 6 to the aorta 7.
  • the aorta 7 does not always have a clear mark. It is difficult to accurately grasp the suture position on the inner wall of the aorta in a state where the viewpoint and the visual field are restricted.
  • the shape of the leaflets often deviates from the ideal arc, and it is not easy to determine the ideal suture position according to the case. For example, if the stitch intervals are not uniform, an unexpected force is applied to the leaflet material 6 and the aorta 7, and the shape of the leaflet material 6 may be bent, which may adversely affect the function as a valve.
  • the purpose of the present invention is to assist in positioning a suture.
  • the present invention in one aspect, provides a suture guide that has a mark indicating a suture position on a surface of a deformable wire rod and can be fixed to a living body.
  • sharp portions are provided at a plurality of locations on the wire.
  • the mark is a scale indicating a distance based on a center in a length direction of the wire.
  • the length of the wire corresponds to the size of the annulus of the patient, the interval between the scales is a first interval from the center to a first distance, and the distance from the first distance to the end is Up to the second interval is larger than the first interval.
  • the positioning of the suture is supported.
  • FIG. 3 is a diagram for explaining a surgical method using the suturing guide 10. The figure for demonstrating a valve annulus. The figure which shows the modification of the suturing guide 10.
  • the figure (the 1) for explaining the method of the conventional aortic valvuloplasty.
  • the figure (the 2) for explaining the method of the conventional aortic valvuloplasty.
  • FIG. 1 is a view of the incised aorta 7 as viewed from above (from the longitudinal direction), and (b) and (c) are views of the aorta 7 as viewed from the lateral direction.
  • the annuluses F1, F2, F3 are formed on the inner wall of the aorta 7 from the commissure C1 to the commissure C3, from the commissure C2 to the commissure C1, from the commissure C2 to the commissure C3, respectively. It is formed.
  • FIG. 2 is an external view of the suturing guide 10.
  • (A) shows a state in which the suture guide 10 is appropriately bent, and (b) shows a state in which the suture guide 10 is straightened.
  • the suturing guide 10 is in the form of a wire (string) having a total length L and being freely deformable.
  • Scales M0 to M6 are formed at predetermined positions on the suture guide 10.
  • the scales M0 to M6 are formed in colors different from the color of the suture guide 10. The coloring may be performed by printing using a dye or by chemical treatment.
  • the suture guide 10 can be formed of, for example, a polymer material, but the material is not limited. More specifically, the suture guide 10 is flexible enough to conform to the three-dimensional shape of the target body part, but expands and contracts more than necessary at least in the length direction (direction perpendicular to the scale line). Preferably not.
  • the scale M0 is formed at the center in the length direction, and indicates a position where the thread is first passed.
  • the scales M1 to M6 indicate the positions where the thread is passed in that order. That is, the scale M1 is a position where the thread is passed next to the scale M0, and the scale M2 is a position where the thread is passed next.
  • the scale M0 has a different shape, line width, line type, and / or color to distinguish it from the scales M1 to M6. In the figure, reference numerals are shown only on the right side from the center, but the scale is similarly formed on the left side.
  • sharp portions P are formed on the surface of the suture guide 10.
  • the sharp portion P is a means for fixing the suture guide 10 by piercing a living body (the aorta 7 in this example) and having a sharp tip.
  • the sharp portion P is formed by, for example, a chemical treatment, but the material and the forming method are not limited.
  • FIG. 3 shows a state in which the suture guide 10 is fixed to the aorta 7.
  • the surgeon turns the surface on which the aorta 7 is formed toward the suturing guide 10 and presses the suturing guide 10 against the aorta 7 while bending the suturing guide 10 along the annulus on the inner wall of the aorta 7.
  • the suture guide 10 is fixed to the aorta 7 near the annulus along the shape of the annulus.
  • FIG. 4 shows an example of the leaflet material 6 corresponding to the suturing guide 10.
  • a mark 4A, a mark 4B, a mark 4C, and a mark 4D indicating the suturing position are formed on the leaflet material 6 in advance.
  • the length (L) of the suturing guide 10 and the position and number of the scales M are set corresponding to the leaflet material 6. That is, the suturing guide 10 is prepared in advance for each size of the leaflet material 6, and when the operator first determines the size of the leaflet material 6, the operator selects and uses the suturing guide 10 that matches the size.
  • FIG. 1 An operation method using the suturing guide 10 will be described with reference to FIG.
  • the detailed form of the suturing guide 10 such as the scale and the marks attached to the leaflet material are omitted for convenience.
  • the operator first folds the suturing guide 10 into a desired shape, and the inner wall of the aorta 7. Fixed to. Specifically, it is fixed along the shape of the valve annulus just below the valve annulus to be newly formed, which is the place where the valve leaflet material 6 is to be sewn (back side as viewed from the operator).
  • the fixing position is a position where the suturing guide 10 can be detached after the suturing is completed, so that the suturing guide 10 can be visually recognized as a positioning mark without obstructing the suturing operation. If the number of leaflet materials 6 to be sutured is three (three leaflets), three suture guides 10 corresponding to each leaflet (not necessarily the same size) are prepared, The three suturing guides 10 are fixed at positions corresponding to positions where the annulus is to be formed.
  • the suturing is performed at an ideal position without examining the eyes. This is particularly noticeable when the annulus is asymmetrical.
  • FIG. The figure shows an example in which the valve annulus F3 from the commissure part C2 to the commissure part C3 is asymmetric.
  • the sewing start position (the scale M0 corresponding to the mark 4A) is different from the top T1 and the position E1 on the line connecting the commissure C2 and the commissure C3 with a straight line.
  • the apex T1 or E1 may be illusioned as a position where sewing is started. If the sewing is started from the sharp portion P2, the interval between the right stitches (up to the commissure C3) is reduced, while the interval between the left stitches (up to the commissure C2) is too large. The later leaflet material 6 may not function as expected.
  • the suturing guide 10 when used, the suturing guide 10 is fixed along the shape of the valve annulus F3, so that the suturing start position is indicated by the scale M0. be able to. Further, since the suturing guide 10 is formed bilaterally symmetrically, the gap between the stitches between the portion from the center to the commissure portion C3 and the portion from the center to the commissure portion C2 can be reduced by passing the thread through the scales M1 to M6. There will be no irregularities.
  • the formation of the sharp portion P illustrated in FIG. 2 is only an example.
  • two sharp portions P may be formed in the same cross section on the suturing guide 10A.
  • a plurality of (in this example, four marks) sharp portions P may be formed in the same cross section in the suture guide 10B.
  • the surgeon does not need to check the orientation of the suture guide 10 at the time of attachment.
  • the sharp portions P need not be arranged in a straight line in the length direction of the suture guide 10.
  • adjacent sharp portions P may be spirally arranged in the suturing guide 10C.
  • the positional relationship between each scale M and the sharp part P is arbitrary, and the scale M may be formed on the sharp part P.
  • the suture guide according to the present invention is not limited to aortic valvuloplasty, and can be used for suturing any living tissue. Further, the suture guide 10 may be fixed to at least one side of the two suturing objects, and the other side may or may not have another mark. Further, regarding the fixing of the suturing guide 10 to the living body, a mechanism that adheres to the living body may be employed instead of a mechanism that pierces like the sharp portion P. For example, a material that is adhesive enough to be removable may be applied to all or part of the surface of the suture guide 10. In short, the suture guide according to the present invention only needs to have a function of fixing to the living body.
  • 4A, 4B, 4C, 4D mark, 6: leaflet material, 7: aorta, 10A, 10B, 10C: suture guide, M: scale, C1, C2, C3 ... commissible part, T, T1 ... top part, F ... annulus, P ... sharp part

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

Abstract

Dans ce guide de suture (10), des gradations (M0-M6) indiquant des positions de couture sont prévues sur la surface d'un fil. Avant la suture, le guide de suture (10) est fixé à l'aorte (7) par une partie pointue (P1) formée sur sa surface.
PCT/JP2019/036882 2018-09-21 2019-09-20 Guide de suture WO2020059839A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
JP2018-177473 2018-09-21
JP2018177473A JP6523540B1 (ja) 2018-09-21 2018-09-21 縫合ガイド

Publications (1)

Publication Number Publication Date
WO2020059839A1 true WO2020059839A1 (fr) 2020-03-26

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/JP2019/036882 WO2020059839A1 (fr) 2018-09-21 2019-09-20 Guide de suture

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JP (1) JP6523540B1 (fr)
WO (1) WO2020059839A1 (fr)

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH0223540B2 (fr) * 1981-05-01 1990-05-24 Chisso Corp
JPH03101922U (fr) * 1990-02-06 1991-10-23
WO2002028321A2 (fr) * 2000-10-05 2002-04-11 Edwards Lifesciences Corporation Anneau de suture a bas profil pour valve cardiaque et son procede d'utilisation
US20050010283A1 (en) * 2003-07-11 2005-01-13 Vedic Biotechnology, Inc. Heart failure mitral annuloplasty ring with multiple sets of suture placement indicia
US20160256270A1 (en) * 2015-03-06 2016-09-08 Boston Scientific Scimed, Inc. Tavi anchoring assist device

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH0223540B2 (fr) * 1981-05-01 1990-05-24 Chisso Corp
JPH03101922U (fr) * 1990-02-06 1991-10-23
WO2002028321A2 (fr) * 2000-10-05 2002-04-11 Edwards Lifesciences Corporation Anneau de suture a bas profil pour valve cardiaque et son procede d'utilisation
US20050010283A1 (en) * 2003-07-11 2005-01-13 Vedic Biotechnology, Inc. Heart failure mitral annuloplasty ring with multiple sets of suture placement indicia
US20160256270A1 (en) * 2015-03-06 2016-09-08 Boston Scientific Scimed, Inc. Tavi anchoring assist device

Also Published As

Publication number Publication date
JP2020044282A (ja) 2020-03-26
JP6523540B1 (ja) 2019-06-05

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