WO2021181041A1

WO2021181041A1 - Body for clamping a suture thread and kit comprising such a body

Info

Publication number: WO2021181041A1
Application number: PCT/FR2021/050398
Authority: WO
Inventors: Denis Deperne
Original assignee: Peters Surgical
Priority date: 2020-03-09
Filing date: 2021-03-09
Publication date: 2021-09-16
Also published as: FR3107825B1; FR3107825A1

Abstract

Disclosed is a body (1) for clamping a suture thread, the body (1) being wound on itself around a clamping space (45) suitable for receiving the thread, the body (1 ) having an outer surface (2) and an inner surface (4) opposite the outer surface (2), the outer surface (2) having a convex portion (48, 50), and the inner surface (4) having a concave portion (34, 38), the convex and concave portions being designed to come into contact with one another and then slide against one another when the body (1) is compressed between two jaws (104, 106), the convex and concave portions having respective curvatures such that their sliding against one another causes a clamping of the body (1) around the thread received in the clamping space (45).

Description

Device for tightening a suture and kit comprising such a device

DESCRIPTION FIELD OF THE INVENTION

The present disclosure relates to a member for tightening a suture thread, and a tightening device adapted to cooperate with such a member.

STATE OF THE ART

A member for tightening a suture is known from document US Pat. No. 6,099,553. This member comprises a base, a first component connected to the base, and a second component also connected to the base, and opposite to the first component relative to the base. The base, the first flap and the second flaps are flat. The two flaps are foldable relative to the base. To tighten a thread using such a member, the member is opened so that the two flaps and the base together form a U. A thread is positioned against the base, between the two flaps. Then, the first component is folded over the wire, which has the effect of confining the wire in an oblong cavity formed between the base and the first component and of tightening it. The second flap is then folded over the first flap, so as to urge the first flap towards the base, thus causing additional tightening of the wire. The organ is then closed.

Having to manipulate the two components one after the other is not in itself easy. In addition, the above steps are carried out using an applicator comprising a housing for receiving the organ. An applicator mechanism urges the two flaps, one after the other, to close the organ. However, to be able to implement two stages successively, the mechanism has a very complex structure.

Furthermore, it should be noted that the wire is liable to undergo a clamping force in one direction (perpendicular to the base and to the two flaps folded over one another). This comes from the flat shape of the base and the flaps. The wire may in fact be located at a distance from the fold line forming a junction between the base and the first flap, and at a distance from the fold line forming a junction between the base and the second flap. Consequently, the cavity in which the wire is confined has a shape which is also flat.

DISCLOSURE OF THE INVENTION

An object of the invention is to provide an organ for tightening a suture which is simpler to use.

For this purpose, it is proposed, according to a first aspect, a member for tightening a suture thread, the member being wound on itself around a tightening space suitable for receiving the thread, the member having an outer surface and an inner surface opposite to the outer surface, the outer surface having a convex portion, and the inner surface having a concave portion, the convex and concave portions being arranged to come into contact with one another 'other then slide against each other when the member is compressed between two jaws, the convex and concave portions having respective curvatures such that their sliding against each other causes a tightening of the member around the wire received in the clamping space.

The member according to the first aspect has the advantage of being able to be placed in a clamping configuration in a single step, by compressing the member between the two jaws.

The relative sliding of the convex and concave portions further allows to obtain a reduction in the dimensions of the organ, during its compression, not in a single direction of space, but in two different directions of space.

The member according to the first aspect may further include the following characteristics, taken alone or combined with one another when it makes sense.

Preferably, the outer surface and the inner surface define a spiral cavity, and are such that the spiral cavity is reduced when the member is compressed between the two jaws.

Preferably, the clamping space is part of the spiral cavity.

Preferably, the convex portion has a radius of curvature less than or equal to that of the concave portion.

Preferably, the convex portion has a radius of curvature of between 0.2 millimeters and

1 millimeter.

Preferably, the convex portion extends over an angular sector of at least 180 degrees.

Preferably, the concave portion has a radius of curvature of between 0.8 millimeters and

2 millimeters.

Preferably, the concave portion extends over an angular sector of at least 180 degrees.

Preferably, the organ has a thickness between the outer surface and the inner surface of between 0.1 millimeters and 0.5 millimeters.

Preferably, the organ further comprising:

- two arms wrapped around themselves around the clamping space, the two arms being at distance from each other,

- a shearing element arranged to be positioned between the two arms so as to apply a shear stress on the wire received in the clamping space, when the member is compressed between the two jaws.

Preferably, the member includes a first bridge connecting one of the arms to the other arm, the shear member protruding from the first bridge.

Preferably, the shear member forms a folded tongue against the first bridge.

Preferably, the member further comprises a second bridge connecting one of the arms to the other arm, the second bridge being arranged at a distance from the first bridge.

Preferably, the member defines at least at least one groove and / or one rib opening into the clamping space, each groove or rib being oriented so as to be able to extend transversely to the wire received in the clamping space.

Preferably, the organ is made of a material comprising titanium, the material being, for example, Grade 1 type titanium.

It is also proposed, according to a second aspect, a tightening device suitable for cooperating with a member according to the first aspect. This clamping device comprises two jaws configured to compress a clamping member according to the first aspect.

The clamping device according to the second aspect can further comprise the following characteristics, taken alone or combined with one another when it makes sense.

Preferably, at least one of the jaws has a concave bearing surface suitable for coming into contact with the outer surface of the organ and then causing the outer surface of the organ to slide against the concave bearing surface, when the The organ is compressed by the two jaws.

Preferably, the concave bearing surface comprises:

- a first concave portion having a first radius of curvature, and

- a second concave portion extending the first portion and having a second radius of curvature smaller than the first radius of curvature, the first and second concave portions being arranged so that the first surface portion comes into contact and slides against the second front surface portion that the second surface portion does not come into contact and slide against the outer surface of the organ, when the organ is compressed by the two jaws. Preferably, the second radius of curvature is greater than a radius of curvature of the outer surface of the organ.

Preferably, at least one of the jaws has a bearing surface defining a clean shoulder to come into abutment against the member, so as to prevent sliding of the member relative to this jaw, when the member is compressed by both jaws.

Preferably, the jaws define between them a compression space suitable for receiving the organ and define a distal opening of the clamping device, and the jaws are suitable for allowing insertion of the organ into the compression space via the opening. distal.

Preferably:

- the member defines lateral access from the outside of the member to the clamping space,

- the jaws together define two sides of the clamping device which are opposite to each other with respect to the compression space, and define lateral access to the compression space from outside the clamping device by one of the two sides,

- The respective lateral accesses of the member and of the clamping device are suitable for being aligned with one another to allow, after insertion of the member into the compression space, the insertion of at least one portion of suture in the clamping space by successively crossing the two lateral accesses.

Preferably, the clamping device comprises a casing adjacent to the jaws, the two jaws being movable relative to the casing, the casing defining complementary access to the compression space from outside the clamping device, the additional access extending the lateral access defined by the jaws.

Preferably, the complementary access crosses a median plane of the clamping device located midway between the two side edges.

Preferably, the additional access includes:

- a first portion extending the lateral access defined by the jaws,

- a second portion connected to the first portion by an elbow, the second portion defining a bottom of the complementary access and crossing the median plane between the elbow and the bottom, and in which the envelope defines an obstacle between the first portion and the second portion.

Preferably, the jaws are mounted to be movable in rotation relative to one another about an axis of rotation via a pivot connection, and in which the clamping device comprises anti-drive-in means for limiting, or even preventing, bending of the jaws between the pivot connection and the bearing surfaces resulting in mutual separation of the bearing surfaces parallel to the axis of rotation of the jaws.

It is also proposed, according to a third aspect, a kit comprising the member according to the first aspect and the clamping device according to the second aspect.

It is also proposed, according to a fourth aspect, a method of tightening a suture thread by means of a member according to the first aspect, or even by means of a kit according to the second aspect. This process comprises the following steps:

- engage the wire in the clamping space of the component,

- compress the organ between two jaws so that the convex and concave portions come into contact with each other and then slide against each other.

Two portions of the wire connected together by a loop can be engaged simultaneously in the clamping space.

DESCRIPTION OF FIGURES

Other characteristics, aims and advantages of the invention will emerge from the following description, which is purely illustrative and not limiting, and which should be read with reference to the accompanying drawings in which:

Figure 1 is a top view of a body of an organ according to one embodiment.

Figure 2 is a bottom view of the body already shown in Figure 1.

Figures 3 to 6 are perspective views of a member for tightening a suture, according to one embodiment.

Figure 7 is a side view of the member already shown in Figures 3 to 6.

Figure 8 is a sectional view of the member already shown in Figures 3 to 7, in the plane A-A shown in Figure 7.

Figure 9 is a side perspective view of a clamping device according to one embodiment.

FIG. 10 is a sectional view of the clamping device already shown in FIG. 9, at the level of two jaws of this applicator.

Figure 11 is a sectional view of the clamping device shown in Figures 9 and 10 in a median plane of this applicator, while the clamping device is in an open state. Figure 12 is a sectional view of the clamping device shown in Figures 9 and 10 in the same midplane, while the clamping device is in a closed state.

Figure 13 is a sectional view of the clamping device shown in Figures 9 and 10 in the same median plane, of the member shown in Figure 3, and of a suture.

Figure 14 is a sectional view of the clamping device already shown in Figure 9, in the same sectional plane as Figure 10, while the member shown in Figure 3 is inserted into the clamping device.

Figures 15 to 17 are perfective views of the organ of Figure 3, at different stages of compression.

In all of the figures, similar elements bear identical references.

DETAILED DESCRIPTION OF THE INVENTION Organ for suture

There is shown in Figures 1 and 2 a body 1 for clamping member of a suture thread.

The body 1 has a flattened shape, insofar as it has a relatively thin thickness, compared to its length and width.

The body 1 comprises an upper surface 2 (visible in FIG. 1) and a lower surface 4 opposite to the upper surface 2 with respect to the body 1 (visible in FIG. 2). In the flattened configuration of FIG. 1, these two surfaces 2, 4 are plane and parallel to each other.

The body 1 has a thickness, measured between the external surface and the internal surface, which is between 100 micrometers and 500 micrometers, for example 300 micrometers.

The body 1 extends in a longitudinal direction (horizontal in Figures 1 and 2) from a first transverse edge 6 to a second transverse edge 8 opposite the first transverse edge 6. The first transverse edge 6 and the second transverse edge 8 each connect the first surface 2 to the lower surface 4 of the body 1. The two transverse edges 6, 8 each extend in a transverse direction perpendicular to the longitudinal direction.

The body 1 has a length, measured in the longitudinal direction as the distance separating the first transverse edge 6 from the second transverse edge 8, which is between 3 millimeters and 10 millimeters, preferably between 5 millimeters and 9 millimeters, for example 7.7 millimeters. Furthermore, the body 1 extends in a transverse direction from a first longitudinal edge 10 to a second longitudinal edge 12 opposite to the first longitudinal edge 10. The first longitudinal edge 10 and the second longitudinal edge 12 each connect the upper surface 2. to the lower surface 4 of the body 1. The two longitudinal edges 10, 12 each extend in the longitudinal direction.

The body 1 has a width, measured in the transverse direction as the distance separating the first longitudinal edge 10 from the second longitudinal edge 12, which is between 1.5 millimeters and 5 millimeters, preferably between 2.5 millimeters and 3.5 millimeters , for example 2.8 millimeters.

The body 1 comprises three portions: a first end portion 14 defining the first transverse edge 6, a second end portion 16 defining the second transverse edge 8, and an intermediate portion 18 connecting the first end portion to the second end portion. The second end portion 16 is opposite the first end portion 14 from the intermediate portion 18.

The first end portion 14 includes a first bridge 20 extending from the first longitudinal edge 10 to the second longitudinal edge 12, in the transverse direction.

The first bridge 20 has an upper surface 22 and a lower surface 24 opposite the upper surface 22. The surfaces 22, 24 of the first bridge 20 are respective portions of the upper 2 and lower 4 surfaces of the body 1.

The first bridge 20 comprises a boss 25 projecting from the upper surface 22. The boss has a convex shape, for example in the shape of a dome.

The first end portion 14 further comprises a shear element 26 connected to the first bridge 20. The first transverse edge 6 of the body 1 is defined by the shear element 26. The shear element 26 forms a tongue connected to a first side of the first bridge (this first side being represented in FIG. 1 by a vertical dotted line to the left of the boss 25).

The intermediate portion 18 comprises a first arm 28 and a second arm 30 arranged at a distance from the first arm 28. The second arm 30 is separated from the first arm 28 by a through opening 31, opening into the upper surface 2 and into the lower surface 4 body 1. The through opening 31 has a width, measured in the transverse direction from the first arm 28 to the second arm 30, which is greater than or equal to the width of the shear member 26, measured in the same direction.

The first arm 28 defines a portion of the first longitudinal edge 10. The first arm 28 has an upper surface 32 and a lower surface 34 opposite the upper surface 32. The surfaces 32, 34 of the first arm 28 are respective portions of the upper surfaces. 2 and lower 4 of the body 1.

The second arm 30 defines a part of the second longitudinal edge 12, opposite to the first longitudinal edge 10. The second arm 30 has an upper surface 36 and a lower surface 38 opposite the upper surface 36. The surfaces 36, 38 of the second arm 30 are respective portions of the upper 2 and lower 4 surfaces of the body 1.

The two arms extend parallel in the longitudinal direction.

The first arm 28 and the second arm 30 are connected to each other by the first bridge 20. The two arms 28, 30 are connected to a second side of the first bridge, which is opposite to the first side of the bridge to which the bridge is connected. The shear member 26 is connected (this second side being at the dotted line to the right of the boss 25 in Figure 1).

The second end portion 16 includes a second bridge 40 extending from the first longitudinal edge 10 to the second longitudinal edge 12, in the transverse direction. The first arm 28 and the second arm 30 are connected to each other by the second bridge.

The second bridge 40 is at a distance from the first bridge 20, and more precisely separated from the latter by the two arms 28, 30 and the through opening 31. Ultimately, the through opening is defined by the two arms and the two bridges. 20, 40.

The second bridge 40 has an upper surface 42 and a lower surface 44 opposite to the upper surface 42. The surfaces 42, 44 of the second bridge 40 are respective portions of the upper 2 and lower 4 surfaces of the body 1.

The body 1 is preferably made of a ductile material, that is to say a material capable of deforming plastically without breaking. For example, this material includes titanium. Preferably, this material is grade 1 titanium.

Referring to Figures 3 to 6, a member for tightening a suture is obtained by plastic deforming the body 1 discussed previously in a rest position in which the body 1 is wound on itself, around an axis central parallel to the transverse direction. In what follows, the characteristics and properties of this member 1 in this rest position are detailed.

In general, the member 1 defines a receiving space suitable for receiving a suture. This receiving space comprises in particular a clamping space 45. As will be seen in more detail later, the member in its rest position can be compressed by an external bias, such that the clamping space 45 is reduce, and thus allow clamping by the member 1 of a wire received in the clamping space 45.

The first longitudinal edge 10 defines a first access to the reception space, and the second longitudinal edge 12 defines a second access to the reception space.

The reception space runs in a spiral around a central axis parallel to the transverse direction. The clamping space 45 is located at the center of this spiral. The second end portion 16 externally defines a transverse access 47 to the receiving space (and therefore to the clamping space 45). A wire kept taut and parallel to the transverse direction can be introduced into the reception space through this transverse access 47.

The upper surface 2 of the body 1 forms an external surface of the organ 1, while the lower surface 4 of the body 1 forms an internal surface of the organ 1.

The two arms 30, 32 are curved, so as to bring the second end portion 16 closer to the first end portion 14. The through opening 31 formed between the arms 30, 32 is therefore also curved.

The upper surface 32 of the first arm 28 is convex, and facing outwards from the member 1. The lower surface 34 of the first arm 28 is concave, and defines the clamping space 45.

The concave surface 34 extends over an angular sector of at least 90 degrees around the central axis, preferably at least 135 degrees around such an axis.

The concave surface 34 has a radius of curvature of between 0.8 millimeters and 2 millimeters, for example 1.1 millimeters. This radius of curvature is preferably constant over the aforementioned angular sector. However, the radius may vary over the aforementioned angular sector, within the aforementioned range.

The upper surface 36 of the second arm 28 is turned towards the outside of the member 1. The lower surface 38 of the second arm 30 is concave, and also defines the clamping space 45. The concave surface 38 extends over an angular sector identical to that of the concave surface 34. The concave surface 38 has a radius of curvature identical to that of the concave surface 34.

In the rest position of the member, the first end portion 14 is closer to the second end portion 16 than in the flattened position shown in Figures 1 and 2, due to the curvature of the two arms 28, 30. The receiving space is provided between the first end portion 14 and the second end portion 16, more precisely between the first bridge 20 and the second bridge 40.

The shear member 26 is folded back against the first bridge 20, so that the first transverse edge 6 extends into the through opening 31. The shear member 26 then meets opposite the through opening 31

The outer surface 2 comprises a first convex surface portion 46. The clamping space 45 extends between this convex surface portion 46 and the concave surfaces 34, 38. This convex surface 46 is located at the junction of the first bridge 20. with the shear element 26.

The transverse access 47 is provided between the concave surface 44 and the convex surface 46. The convex surface 46 extends over an angular sector of 180 degrees due to the folding of the shear element 26 against the first bridge 20, being understood that this angular sector may be different, for example by at least 90 degrees, in particular when the shearing element is absent from the member or of a different shape.

The convex surface 46 has a radius of curvature less than or equal to that of the concave surfaces 34, 38. This radius of curvature is for example constant over this angular sector of 180 degrees. The radius of curvature of the first surface portion is for example between 0.2 millimeters and 0.5 millimeters, for example 0.3 millimeters.

The first bridge 20 is bent relative to the first arm 28. Consequently, the external surface 2 furthermore comprises a second portion of convex surface 48, located at the junction of the first bridge 20 with the arm 28.

The convex surface 48 extends over an angular sector of at least 90 degrees, due to the bend formed by the first bridge 20 with respect to the arm 28.

The convex surface 48 has a radius of curvature less than or equal to that of the concave surfaces 34, 38. This radius of curvature is for example constant over the aforementioned angular sector of at least 90 degrees formed by bending the first bridge 20. The radius curvature of the convex surface 48 is for example between 0.2 millimeters and 1 millimeter, for example 0.4 millimeters.

The first bridge 20 is also bent relative to the second arm 30. Consequently, the external surface 2 comprises a third portion of convex surface 50, located at the junction of the first bridge 20 with the second arm 30.

The convex surface 50 is of the same shape as the convex surface 48, already discussed above.

Moreover, the second bridge 40 is for its part also curved around the same axis as the two arms 30, 32. The upper surface 42 is convex, and turned towards the outside of the member 1. The lower surface 44 of the second bridge 40 is concave, and delimits the clamping space 45.

The concave surface 44 preferably has a radius of curvature identical to that of the concave surfaces 34, 38. For example, the concave surfaces 44, 34 and 38 together form a concave surface extending over an angular sector of at least 180 degrees. around an axis parallel to the transverse direction.

The member may define at least one groove and / or one rib (not shown) opening into the clamping space 45, each groove or rib being oriented so as to be able to extend transversely to the wire received in the space of. clamping 45. The grooves and ribs are formed alternately in at least one of the concave surfaces 34, 38, 44 and extend perpendicular to the axis around which the member 1 is wound on itself. In the flattened position of the body 1 shown in Figures 1 and 2, these grooves or ribs extend in the longitudinal direction.

Clamping device

There is shown in Figures 9 to 14 a clamping device 100 according to one embodiment, suitable for cooperating with the member 1.

The clamping device 100 constitutes a distal part of an applicator. This distal part can typically be assembled to a proximal part comprising a handle graspable by a user, so as to form the applicator. The clamping device 100 may constitute a separable element from the proximal part of the applicator.

Generally, the clamp 100 has an elongated shape in a proximal-distal direction, and terminates with a distal opening 102 of the clamp 100. The clamp 100 extends along a parallel X axis. to this distal direction, axis which will be called the “main” axis hereinafter (this axis X being in particular shown in FIGS. 11 to 13).

Referring to Figure 9, the clamping device 100 comprises two jaws 104, 106 for compressing the member 1. The two jaws 104, 106 define between them a compression space 105 suitable for receiving the member 1.

The two jaws 104, 106 together define the distal opening 102. The distal opening 102 provides access to the compression space 105. The jaws 104, 106 are suitable for allowing the organ 1 to be inserted into the space of. compression 105 via the distal opening by translation of the organ parallel to the main axis.

The two jaws 104, 106 together form two lateral sides 108, 110 of the clamping device 100, these two lateral sides 108, 110 being opposite to each other with respect to the compression space 105. In other words, the two lateral sides 108, 110 are opposed to each other. two lateral sides 108, 110 are located on either side of the compression space 105.

The lateral side 108 defines a lateral access 109 to the compression space 105. The lateral side 110 defines another lateral access to the compression space 105. There is therefore in addition to the distal opening 102, two lateral accesses to the compression space. the compression space 105, which are located on either side of this compression space 105.

In what follows, we will focus on a median plane of the clamping device 100 passing through the main axis and located midway between the two lateral edges of the two jaws 104, 106. FIGS. 11 to 13 are cross sections. of the clamping device 100 in this median plane. Assuming that jaw 104 is an upper jaw 104, and jaw 106 is a lower jaw 106, then this midplane is a vertical plane.

Jaws 104, 106 are movable relative to each other between an open position and a closed position.

In the open position, the compression space 105 is crossed by the main axis of the clamping device 100. The upper jaw 104 can then be found above this main axis, and the lower jaw 106 below this axis. main.

In the closed position, the two jaws 104, 106 are closer to each other than in the open position, and the compression space 105 is reduced compared to the open position.

The upper jaw 104 is for example movable in rotation with respect to the lower jaw 106 about an axis of rotation. This axis of rotation is perpendicular to the main axis of the clamping device 100. This axis of rotation is for example normal to the median plane. The two jaws 104, 106 are typically mounted on two arms connected to one another by a pivot connection (not illustrated).

The upper jaw 104 has a so-called upper support surface 112 against which the member 1 is able to bear once the one has been inserted into the compression space 105.

The upper bearing surface 112 is concave. This concave surface 112 is curved around the main axis of the clamping device 100, over an angular sector of at least 90 degrees, typically of the order of 180 degrees.

The lower jaw 106 also has a so-called lower bearing surface 114, against which the member 1 bears once inserted into the compression space 105.

When the compression space 105 is unoccupied, in particular by the member 1, the upper 112 and lower 114 bearing surfaces are facing each other.

The lower bearing surface 114 is concave. This concave surface 14 is curved around the main axis of the clamping device 100, over an angular sector of at least 90 degrees, typically of the order of 180 degrees.

Referring to Figure 10, the upper bearing surface 112 comprises a first surface portion 116 having a radius of curvature substantially equal to the radius of curvature of the convex surfaces 32, 36 of the arms 28, 30 of the member 1.

The upper bearing surface 112 also comprises a second surface portion 118 having a radius of curvature smaller than that of the first portion 116, therefore more curved than the surface 116. In other words, the radius of curvature of the surface portion 118 is less than that of the convex surfaces 32, 36.

The two surface portions 116, 118 are connected to each other tangentially. They occupy two distinct angular sectors around the main axis of the clamping device 100.

The upper bearing surface 112 also comprises an axial shoulder 120, said upper, delimiting a bottom of the compression space 105, and limiting the insertion stroke of the member 1 in the clamping device 100 according to the main axis. The upper axial shoulder 120 extends perpendicularly to the first surface portion 116 and to the second portion 118, and is connected thereto by a curved ridge.

The lower bearing surface 114 comprises a first surface portion 122 having a radius of curvature equal to the radius of curvature of the convex surface 42 of the second portion. end 16 of the member 1, or even equal to the radius of curvature of the convex surfaces 32, 36 of the arms 28, 30 of the member 1.

The lower bearing surface 114 also comprises an anti-rotation shoulder 124 forming a stop limiting a rotational travel of the member 1 in the compression space 105 around the main axis relative to the two jaws 104 , 106, by sliding the member against the two bearing surfaces.

The anti-rotation shoulder 124 is connected to the first surface portion 122 by an edge, for example a rectilinear edge. When the convex surface 42 of the second end portion 16 of the member 1 is in contact with the lower bearing surface 114, the second transverse edge 8 of the member 1 can abut against the shoulder of anti rotation 124.

The lower bearing surface 114 also comprises an axial shoulder 126, called lower, also delimiting the bottom of the compression space 105, and limiting the insertion stroke of the member 1 in the clamping device 100 according to l main axis. The lower axial shoulder 126 extends perpendicular to the first portion, and is connected thereto by a curved ridge.

The axial shoulders 120, 126 are substantially coplanar.

Returning to Figure 9, the clamp 100 further comprises a hollow casing 128 extending around the main axis. The envelope 128 has, for example, the shape of a tube.

The casing 128 has an outer surface 130, giving the outside of the clamping device 100, and an inner surface 131 (visible in FIGS. 11 to 13) opposite to the outer surface 130. The inner surface 131 defines a traversed cavity. by the main axis.

The envelope 128 also has a distal opening 132 giving access to the cavity defined by the internal surface 131.

The two jaws 104, 106 protrude at least in part from the casing 128 via the distal opening 132, and extend this casing 128 towards the distal opening 102 of the clamp 100.

The clamping device 100 further comprises an actuating mechanism (not shown) adapted to position the jaws 104, 106 in their open position and in their closed position. The actuation mechanism is further adapted to move the two jaws 104, 106 in translation in translation parallel to the main axis. The two jaws 104, 106 are further retracted in the casing 128 in the closed position, compared to their open position. Consequently, the compression space 105 defined between the two jaws 104, 106 can be found at least partially in the cavity defined by the envelope 128.

The actuating mechanism is suitable for mechanically cooperating with a gripping element forming part of the proximal part with which the tightening device 100 can form an applicator, such that a movement of the gripping element causes opening or closing. jaws 104, 106. The gripping element is for example a trigger that can be manipulated by a user holding the proximal part of the applicator.

The casing 128 defines a complementary access 134 to the compression space 105 from the outside of the clamping device 100. This complementary access 134 extends the lateral access 109 defined by the jaws 104, 106. The complementary access 134 extends also the distal opening of the envelope 128.

The complementary access 134 opens into the outer surface 130 (leading to the outside of the clamp 100) and into the inner surface 131 of the casing 128 (leading into the compression space 105).

The complementary access 134 has a shape adapted to intersect the median plane of the clamping device 100. The complementary access has a shape of a non-rectilinear slot.

The complementary access 134 includes a first part 136 extending the distal opening of the casing 128. The first part 136 is rectilinear and extends parallel to the main axis of the clamping device 100.

The complementary access 134 further comprises a second part 138 connected to the first part 136 by an elbow 140. The second part extends around the main axis so as to cross the median plane of the clamping device 100. The second part extends around the main axis. part extends from the elbow 140 to a bottom 142 of the complementary access 134.

The second part 138 of the complementary access 134 extends over an angular sector of at least 90 degrees around the main axis of the clamping device 100.

Preferably, the bottom 142 is closer to the distal opening 132 of the envelope than is the elbow 140. In other words, the elbow 140 formed between the first part 136 and the second part 138 is protruding. Said yet in another way, when we browse the complementary access 134 from the distal opening 132 towards the bottom 142, passing successively through the first part 134, then the elbow 140, then the second part 138, we move away from the distal opening 132, then we move away from approach it again once crossed the elbow 140.

The clamping device also comprises anti-drive-in means for limiting, or even preventing, bending of the jaws between their pivot connection and the bearing surfaces 112, 114 causing the bearing surfaces 112, 114 to move apart from each other in parallel. to the axis of rotation of the jaws 104, 106.

In general, the anti-driving means comprise at least one groove defined by the casing, and at least one pin attached to one of the jaws.

Each pawn protrudes into a groove associated with it. Each pin is arranged between the pivot connection between the jaws 104, 106 and the distal opening 102.

Each groove is oblong parallel to the main axis X of the clamping device, so as to allow the pin projecting inside to slide in the groove during a translational movement of the jaws relative to the casing 128 parallel to the main axis X.

In the embodiment illustrated in the figures, in particular Figures 9, 11 and 12, the anti-pulling means comprise a first groove 144 and a second groove 146, the two grooves 144, 146 being defined by the casing 128 and each opening into the internal surface 131, and two pins 148, 150, including a first pin 148 fixed to the upper jaw 104 and a second pin fixed to the lower jaw 106. The second groove 146 is opposite the first groove 144 with respect to the main axis X.

Method of tightening a suture

A method of suturing tissue includes the following steps. In what follows, the non-limiting example of the suturing of biological tissues will be taken, it being understood that the method is also applicable to synthetic (non-biological) tissues.

A user engages a suture S in biological tissue to be sutured, such that a central portion of this S thread passes through the biological tissue to be sutured. The suture S thus comprises two end portions opposite to each other with respect to the central portion, these end portions being outside the biological tissues.

A method of tightening the organ 1 on such a suture S comprises the following steps. The member 1 initially rests on a support (not shown). The second longitudinal edge 12, oriented downwards, is in contact with an upper surface of this support. A user positions the clamping device 100 vertically above the member 1 such that the distal opening 102 of the clamping device 100 is opposite the first longitudinal edge 10 of the member 1. The user interacts with it. the actuating mechanism of the clamping device 100 so as to place the jaws 104, 106 in their open position, for example by pressing on the aforementioned trigger using its index finger. During the opening of the jaws 104, 106, the latter deploy outside the casing 128 and move away from each other.

While the jaws 104, 106 are in the open position, the user brings the clamping device 100 closer to the member 1, so that the member 1 enters the compression space 105 formed between the two jaws 104, 106 , via the distal opening 102 of the clamp 100.

The user orients the jaws 104, 106 relative to the member such that the member 1 occupies a specific position in the compression space 105 relative to the jaws, called the inserted position, and which will now be described. .

In the inserted position, the first longitudinal edge 10 abuts against at least one of the upper axial shoulder 120 and the lower axial shoulder 126, thus limiting the insertion stroke of the member 1 in the device. tightening 100 in the main direction, and in a distal to proximal direction.

Furthermore, the jaws 104, 106 exert a residual pressure on the member 1 suitable for preventing the member 1 from leaving the compression space 105.

In the inserted position, the convex surface 42 of the second bridge 40 is in contact with the first portion of concave surface 122 of the lower bearing surface 114. The second transverse edge 8 of the member 1 abuts against the shoulder. anti-rotation 124. The anti-rotation shoulder 124 therefore limits the travel of rotation of the member 1 around the main axis with respect to the two jaws 104, 106 in a direction of rotation (which is a clockwise, if we adopt the point of view of figure 14).

In the inserted position, the convex surfaces 32, 36 of the arms 28, 30 are in contact with the two bearing surfaces 112, 114. More precisely, these convex surfaces 32, 36 are in contact with the first concave portion 122 and with the first concave portion 116. The convex surfaces 48, 50 forming junctions between the arms 28, 30 and the first bridge 20 may also be partially in contact with the first concave portion 116 of the upper bearing surface 112. On the other hand, the second concave portion 118 of the upper bearing surface 112 may be free, at a distance from the member 1.

In the inserted position, the transverse access 47 to the receiving space (and in particular to the clamping space 45) defined by and between the first bridge 20 and the second bridge 40 is aligned with the lateral access 109 defined. by the jaws 104, 106 and which is extended by the additional access 134 defined by the envelope 128.

The user grasps the two end portions of the suture S, and positions them side by side so as to form a loop with the central portion of the thread.

The user then inserts the two end portions of the wire S side by side in the clamping device 100, then in the member 1 located inside the clamping device 100, so that the loop formed by the wire emerges from the clamping device 100 through its distal opening.

To insert these two end portions of wire into the clamping device 100, the user passes through the lateral access 109 defined by the jaws 104, 106 and the complementary access 137 which extends this lateral access 109. The user maintains the jaws. portions of thread stretched side by side, and insert them in the direction of the width. Such an insertion is much easier than an insertion which would consist in threading the two end portions of the wire S lengthwise, via the distal opening 102 of the clamping device 100. The two portions of the wire S then enter into the receiving space defined by the member 1 passing through the transverse access 47 extending between the first bridge 20 and the second bridge 40, and which is aligned with the lateral access defined by the two jaws 104, 106 The fact that the complementary access extends the lateral access 109 facilitates the insertion of the portions of the thread S inside the member 1. In fact, when the user holds the two portions of threads stretched side by side. -Side, the crossing of the lateral access 109 by these portions of wire S is naturally accompanied by a crossing of the complementary access 134 by the same portions of wire S from the external surface 130 to the internal surface 131.

During the insertion, the two end portions of the suture S are brought back by the user towards the median plane of the clamping device 100. For this, the user moves the end portions of the suture S in the complementary access. 134 from its first rectilinear part 136 towards its end part 138, crossing the elbow 140. At least one of the two portions of wire inserted inside the clamping device 100 can thus be entirely in the median plane of the clamping device 100. The complementary access 134 which extends the lateral access 109 defined by the jaws 104, 106, makes the insertion of the portions of the wire S even easier. It is also noted that the envelope 128 forms an obstacle between the bottom 142 and the mouth of the complementary access 134 at the level of the axial orifice 132. The casing 128 therefore contributes to maintaining the end portions of the wire S in the median plane of the clamping device 100. Like the median plane is midway between the two lateral edges 108, 110 defined by the two jaws 104, 108, the fact of bringing the end portions of the wire S towards this median plane makes it possible to obtain a better alignment of the wires with the member 1 located inside the clamp 100.

The two end portions of the wire S are positioned in the clamping space 45 so as to extend between the shearing element 26 and the two arms 28, 30. The two portions of wires emerge from the member via the two. opposite accesses defined respectively by the longitudinal edges 10 and 12 of the member 1.

Then, the user pulls on the two portions of the wire S emerging from the clamping device 100 by the complementary access 134 in the direction indicated by the arrow illustrated in FIG. 13, so as to bring the clamping device 100 closer to the biological tissues passed through. by the central portion of the wire. In doing so, the loop formed by the wire is reduced. The user typically pulls on the two end portions of the wire S so that the distal end of the clamping device 100 abuts against the biological tissues, or is at least in the immediate vicinity thereof.

Then, the user actuates the clamping device 100 so that the actuating mechanism closes the jaws 104, 106. During this closure, the two bearing surfaces approach each other and exert a compressive force on the member 1. Under the effect of this compression by the jaws 104, 106, the member 1 is deformed. Figures 15 to 17 show the member at different stages of deformation during compression by the jaws 104 and 106 of the clamping device 100 (the clamping device 100 and the wire S are not, however, shown in these figures for more readability).

Due to the anti-rotation shoulder 124, the member 1 remains substantially stationary relative to the lower bearing surface 122 and is forced to slide against the upper bearing surface 112. The convex surfaces 32, 36 arms 28, 30 therefore slide on the first portion 116 of the upper bearing surface 112, then slide against the second portion 118. The fact that the bearing surface 118 is more curved than the bearing surface 116 tends to promote additional winding of the member 1 on itself. The convex surfaces 46, 48, 60 of the concave surfaces approximate the concave surfaces 34, 38, 44.

The shearing element 26 engages the through opening 31 separating the two arms 28, 30 from one another. The convex surface 46 forming the junction between the shear element 26 and the first bridge 20 may optionally come into contact with the surface. concave 44 of the second bridge 40. If this happens, the convex surface 46 slides against the concave surface 44, so that the shear member 26 moves away from the second transverse edge 8 and approaches the opening 31, then engages in this opening 31. Thus, it can be seen that the second bridge 40 has the effect of guiding the shearing element 26 in the through opening 31, in the event that this shearing element does not enter it directly.

The engagement of the shear element 26 in the through opening 31 results in a reduction of the clamping space 45. The end portions of the wire S are thus clamped between and by the shear element 26 and the two arms 28. , 30. In particular, the shearing element 26 applies a shear force to the two portions of wires, which are thus bending stress at four points.

As previously indicated, the member 1 coils more on itself when it is compressed by the jaws 104, 106. At a certain stage of coiling, the boss 14 contacts the concave surface 44 and slides against it. this one. At a later stage of winding, the convex surface 48 contacts and slides against the concave surface 44. Likewise, the convex surface 50 contacts and slides against the concave surface 44. If the dimensions of the member 1 allow, the convex surface 48 can then slide against the concave surface 34, and the convex surface 50 slide against the concave surface 38. These slides result in further reduction of the clamping space. 45, and therefore an increase in the clamping and shearing force applied to the wire S. This reduction in the clamping space 45 takes place not in a single direction of space, in the manner of a simple flattening, but takes place in two directions of space perpendicular to the transverse direction, otherwise in a plane normal to the portions of wires, as illustrated in Figures 15 to 17. Figure 17 shows in particular the member 1 closed as much as possible, that is to say rolled up as much as possible on itself.

When the organ is fully wound on itself, the boss 25 extends into the through opening 31.

At this stage, organ 1 firmly grips the S thread. As a result, the biological tissues crossed by the S thread are held firmly in place.

The member 1 and the clamping device 100 discussed above can be the subject of variants. In particular, the following characteristics, although advantageous, remain optional: • The two arms 28, 30 separated by the opening 31. The member could in fact only comprise a single arm connecting the two end portions 14 and 16 of the member.

• The axial shoulders 120, 126 and the anti-rotation shoulder 124. The clamping device 100 could be such that the member slides on the two bearing surfaces 112, 114 defined by the jaws 104, 106, and not just one of these two surfaces.

• The specific shape of the complementary access 138 shown in the figures, and in particular the fact that this complementary access 138 crosses the median plane of the clamping device 100.

• Anti-hunting methods could take other forms.

Claims

1. Body (1) for tightening a suture, the member (1) being wound on itself around a clamping space (45) suitable for receiving the thread, the member (1) having a surface outer (2) and an inner surface (4) opposite to the outer surface (2), the outer surface (2) having a convex portion (48, 50), and the inner surface (4) having a concave portion (34, 38), the convex and concave portions being arranged to come into contact with one another and then slide against each other when the member (1) is compressed between two jaws (104, 106), the portions convex and concave having respective curvatures such that their sliding one against the other brings about a tightening of the member (1) around the wire received in the clamping space (45).

2. Body (1) according to claim 1, wherein the outer surface (2) and the inner surface (4) define a spiral cavity, and are such that the spiral cavity is reduced when the member (1) is. compressed between the two jaws (104, 106).

3. Body (1) according to one of the preceding claims, wherein the clamping space (45) is part of the spiral cavity.

4. Body (1) according to one of the preceding claims, wherein the convex portion (48, 50) has a radius of curvature less than or equal to that of the concave portion (34, 38).

5. Body (1) according to one of the preceding claims, wherein the convex portion (48, 50) has a radius of curvature of between 0.2 millimeters and 1 millimeter.

6. Body (1) according to one of the preceding claims, wherein the convex portion (48, 50) extends over an angular sector of at least 180 degrees.

7. Body (1) according to one of the preceding claims, wherein the concave portion (34, 38) has a radius of curvature of between 0.8 millimeters and 2 millimeters.

8. Body (1) according to one of the preceding claims, wherein the concave portion (34, 38) extends over an angular sector of at least 180 degrees.

9. Body (1) according to one of the preceding claims, wherein the member (1) has a thickness between the outer surface (2) and the inner surface (4) of between 0.1 millimeters and 0.5 millimeters. .

10. Body (1) according to the preceding claim, comprising:

- two arms (28, 30) wound on themselves around the clamping space (45), the two arms (28, 30) being at a distance from each other, - a shearing element (26) arranged to be positioned between the two arms (28, 30) so as to apply a shear stress on the wire received in the clamping space (45), when the member (1) is compressed between the two jaws (104, 106).

11. Body (1) according to the preceding claim, further comprising a first bridge (20) connecting one of the arms to the other arm, the shear element (26) projecting from the first bridge (20).

12. Body (1) according to the preceding claim, wherein the shear element (26) forms a tongue folded against the first bridge (20).

13. Body (1) according to one of claims 11 and 12, further comprising a second bridge (40) connecting one of the arms (28) to the other arm (30), the second bridge (40) being arranged at a distance from the first bridge (20).

14. Body (1) according to one of the preceding claims, wherein the member (1) defines at least one groove and / or one rib opening into the clamping space (45), each groove or rib being oriented so that it can extend transversely to the wire received in the clamping space (45).

15. Body (1) according to one of the preceding claims, which is made of a material comprising titanium, the material preferably being of Grade 1 type titanium.

16. Kit comprising a member (1) according to one of claims 1 to 15, and a clamping device (100) comprising two jaws (104, 106) configured to compress the clamping member (1).

17. Kit according to the preceding claim, wherein at least one of the jaws (104) has a concave bearing surface (112) suitable for coming into contact with the outer surface (2) of the member (1) and then causing a sliding of the outer surface (2) of the member (1) against the concave bearing surface (112), when the member (1) is compressed by the two jaws (104, 106).

18. Kit according to the preceding claim, wherein the concave bearing surface (112) comprises:

- a first concave portion (116) having a first radius of curvature, and

- a second concave portion (118) extending the first portion and having a second radius of curvature smaller than the first radius of curvature, the first and second concave portions being arranged so that the first surface portion comes into contact and slides against the second portion surface before the second surface portion does not come into contact and slides against the outer surface (2) of the member (1), when the member (1) is compressed by the two jaws (104, 106).

19. Kit according to the preceding claim, wherein the second radius of curvature is greater than a radius of curvature of the outer surface of the member (1).

20. Kit according to one of claims 16 to 19, wherein at least one of the jaws (106) has a bearing surface (114) defining a shoulder (124) suitable for abutting against the member (1). , so as to prevent the member (1) from sliding relative to this jaw (10), when the member (1) is compressed by the two jaws (104, 106).

21. Kit according to one of claims 16 to 20, wherein the jaws (104, 106) define between them a compression space (105) suitable for receiving the member (1) and define a distal opening (102) of the clamping device (100), and the jaws (104, 106) are suitable for allowing insertion of the member (1) into the compression space (105) via the distal opening (102).

22. Kit according to one of claims 16 to 21, wherein:

- the member (1) defines a lateral access (47) from the outside of the member (1) to the clamping space (45),

- the jaws (104, 106) together define two sides (108, 110) of the clamping device (100) which are opposite to each other with respect to the compression space (105), and define an access lateral (109) to the compression space (105) from the outside of the clamping device (100) by one of the two sides,

- The respective lateral accesses (47, 109) of the member (1) and of the clamping device (100) are suitable for being aligned with one another to allow, after insertion of the member (1) in the compression space (105), the insertion of at least a portion of suture (S) in the clamping space (45) by successively crossing the two lateral accesses (47, 109).

23. Kit according to the preceding claim, wherein the clamping device (100) comprises a casing (128) adjacent to the jaws (104, 106), the two jaws (104, 106) being movable relative to the casing (128 ), the casing (128) defining a complementary access (134) to the compression space (105) from the outside of the clamping device (100), the complementary access (134) extending the lateral access (109 ) defined by the jaws (104, 106).

24. Kit according to the preceding claim, wherein the complementary access (134) crosses a median plane of the clamping device (100) located midway between the two side edges (108, 110).

25. Kit according to the preceding claim, wherein the additional access (134) comprises:

- a first portion (136) extending the lateral access (109) defined by the jaws (104, 106),

- a second portion (138) connected to the first portion by an elbow (140), the second portion (138) defining a bottom of the complementary access and crossing the median plane between the bend and the bottom, and in which the envelope (128) defines an obstacle between the first portion and the second portion.

26. Kit according to one of claims 16 to 25, in which the jaws are mounted to be movable in rotation relative to one another about an axis of rotation via a pivot connection, and in which the clamping device comprises anti-drive-in means for limiting, or even preventing, bending of the jaws between the pivot connection and the bearing surfaces (112, 114) resulting in mutual separation of the bearing surfaces (112, 114) parallel to the axis of rotation of the jaws (104, 106).

27. A method of tightening a suture (S), comprising the following steps:

- engage the wire (S) in the clamping space (45) of a member (1) according to one of claims 1 to 15,

- compress the member (1) between two jaws (104, 106) so that the convex and concave portions come into contact with each other and then slide against each other.

28. Method according to the preceding claim, wherein two portions of the wire (S) interconnected by a loop are simultaneously engaged in the clamping space (45).