WO2023234475A1 - Dispositif pour maintenir la position d'une canule chirurgicale - Google Patents

Dispositif pour maintenir la position d'une canule chirurgicale Download PDF

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Publication number
WO2023234475A1
WO2023234475A1 PCT/KR2022/012559 KR2022012559W WO2023234475A1 WO 2023234475 A1 WO2023234475 A1 WO 2023234475A1 KR 2022012559 W KR2022012559 W KR 2022012559W WO 2023234475 A1 WO2023234475 A1 WO 2023234475A1
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WO
WIPO (PCT)
Prior art keywords
cannula
holder
positioning device
surgical
skin
Prior art date
Application number
PCT/KR2022/012559
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English (en)
Korean (ko)
Inventor
김종호
장동진
Original Assignee
가톨릭대학교 산학협력단
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.)
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Publication of WO2023234475A1 publication Critical patent/WO2023234475A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B50/00—Containers, covers, furniture or holders specially adapted for surgical or diagnostic appliances or instruments, e.g. sterile covers
    • A61B50/20—Holders specially adapted for surgical or diagnostic appliances or instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/02—Holding devices, e.g. on the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/02—Holding devices, e.g. on the body
    • A61M2025/0213—Holding devices, e.g. on the body where the catheter is attached by means specifically adapted to a part of the human body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/02—Holding devices, e.g. on the body
    • A61M2025/024—Holding devices, e.g. on the body having a clip or clamp system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/02—Holding devices, e.g. on the body
    • A61M2025/0253—Holding devices, e.g. on the body where the catheter is attached by straps, bands or the like secured by adhesives
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/02—Holding devices, e.g. on the body
    • A61M2025/0266—Holding devices, e.g. on the body using pads, patches, tapes or the like

Definitions

  • the present invention relates to a cannula position maintenance device, which is an auxiliary device for a cannula used during joint surgery. More specifically, a surgical cannula position that maintains the adjusted posture of the cannula even when the cannula is not held by hand. It's about maintenance devices.
  • Arthroscopic surgery using an arthroscope is a surgery performed while observing the inside of the joint while securing multiple passages to the affected area and inserting the arthroscope and surgical tools through the passages.
  • Such arthroscopic surgery can reduce the burden on patients and minimize the time and cost of surgery.
  • the treatment effect itself is known to be good because it is performed while closely observing the surgical site through an arthroscope.
  • Trocars and cannulas are used to secure passageways for arthroscopic surgery.
  • a trocar is a trocar, a tool that first makes a hole toward the surgical site.
  • the cannula is a hollow tube-shaped member that is guided by a trocar and enters the surgical site. With the cannula set, the trocar is removed.
  • the cannula serves as a guide tube that guides surgical tools such as an arthroscope or shaver to the area of interest.
  • Figure 1 is a diagram showing the installation of a surgical cannula 15 and an arthroscope 11.
  • a cannula 15 is installed in the patient's shoulder joint 101, and the arthroscope 100 is inserted into the body through the cannula 15.
  • the lens at the distal end of the arthroscope 100 passes through the cannula and approaches the surgical target point, and transmits the imaged content of the treatment target area to an external monitor.
  • the arthroscope 10 does not maintain its position during the surgery, but requires movement such as tilting it this way or that, inserting it more deeply, or pulling it back (to accurately identify the area of interest within the joint). do.
  • the cannula since the arthroscope 10 is inserted into the cannula 15, the cannula also moves while the arthroscope is moved. However, since the cannula 15 does not move on its own and maintain its moving posture, the operating doctor must ultimately manually operate the arthroscope 10.
  • Patent Document 1 Domestic Patent Publication No. 10-2020-0014793 (Cannula device for arthroscopic surgery)
  • the present invention was created to solve the above problems, and maintains the position of the surgical cannula by maintaining the set cannula in a controlled position, allowing the doctor to use both hands freely, enabling accurate and rapid surgery.
  • the purpose is to provide a device.
  • the surgical cannula position maintenance device of the present invention as a means of solving the problem for achieving the above object supports the cannula inserted into the affected area for arthroscopic surgery, and is coupled to the cannula while being closely fixed to the skin. And a first position maintenance part that provides support to the cannula; It is coupled to other parts of the cannula and includes a second position maintenance part that maintains the tilting angle when the cannula is tilted.
  • the first position holding unit It has a pressure strap that takes the form of a band and wraps around the cannula to press it, and an adhesive fixing part that is integrated with the pressure strap and is adhesively fixed to the skin.
  • the compression strap A wrapping band having a certain width and thickness and a continuous sawtooth locking portion formed on one side, and a leaf spring type built into the wrapping band and providing an elastic force that allows the wrapping band to elastically wrap around the cannula.
  • a winding spring and a hook are integrally formed with one end of the wrapping band and are hooked to the catching portion to prevent the wrapping band from loosening while the wrapping band is wrapped around the cannula, and the adhesive fixing portion includes; It includes a cover plate that is foldably connected to the wrapping band and has flexibility, and an adhesive tape provided on the cover plate and adhesively fixed to the patient's skin.
  • the second position holding unit A holder portion located on opposite sides of the cannula and including a pair of holder halves that tighten the outer peripheral surface of the cannula to maintain the coupled state, a leg portion connected to the holder portion and providing support to the holder portion, It is connected to the end of the leg portion and has an adsorption fixing portion that is fixed to the patient's skin and allows the leg portion to support the holder portion.
  • the holder part It is integrated with each holder half and extends in the longitudinal direction, and spreads in the direction away from the holder half.
  • a pair of extension bodies are connected to each other by link pins, and an elastic force is applied to the extension bodies, so that the holder half is a cannula. It is provided with an elasticity providing part that bites and fixes.
  • the holder half It takes the shape of a partial cylinder, and an anti-slip pad is provided on the inward surface of each holder half to prevent slipping of the holder half with respect to the cannula.
  • the elasticity providing part is provided with a leaf spring fixed to the rear end of the extension body.
  • leg portion A flexible tube having a constant diameter and extending in the longitudinal direction, a plurality of steel balls arranged in series within the flexible tube, and a curved groove with a curvature corresponding to the curvature of the steel balls are interposed between the steel balls, and a magnetic force is applied. It includes a plurality of angle-maintaining magnets that combine with the steel ball.
  • the adsorption fixing part has a base plate that takes the form of a plate and can be plastically deformed, and a plurality of adsorption members that are provided on the bottom of the base plate and are adsorbed and fixed to the skin.
  • the surgical cannula position maintenance device of the present invention configured as described above maintains the set cannula in an adjusted position, thereby allowing the doctor to use both hands freely, thereby enabling accurate and rapid surgery.
  • Figure 1 is a diagram showing the installation of a surgical cannula and an arthroscope.
  • Figure 2 is an exploded perspective view of a surgical cannula position maintenance device according to an embodiment of the present invention.
  • Figure 3 is an exploded perspective view of the holding device shown in Figure 2.
  • Figures 4 and 5 are plan views of the second position holding portion shown in Figure 2.
  • FIGS. 6 and 7 are diagrams for explaining the internal structure and bending principle of the leg portion of FIG. 2.
  • Figures 8 and 9 are views showing the structure of the adsorption fixture shown in Figure 2.
  • Figure 10 is an exploded view of the first position maintenance part of Figure 2.
  • the surgical cannula position maintenance device of this embodiment supports the cannula inserted into the affected area for arthroscopic surgery and serves to maintain the cannula in an adjusted position. For example, when the doctor tilts the cannula to a desired angle and then removes his hand, the tilted state is maintained.
  • These retainers operate while fixed to the patient's skin. By applying a retainer, the previous problem, i.e., the doctor having to hold the cannula with one hand, can be solved.
  • FIG. 2 is an exploded perspective view of a surgical cannula position maintaining device according to an embodiment of the present invention
  • Figure 3 is an exploded perspective view of the retaining device shown in Figure 2.
  • FIGS. 4 and 5 are plan views of the second position holding portion shown in FIG. 2.
  • FIGS. 6 and 7 are diagrams for explaining the internal structure and bending principle of the leg portion of FIG. 2, and FIGS. 8 and 9 are diagrams showing the structure of the suction fixing portion shown in FIG. 2. Additionally, FIG. 10 is an exploded view of the first position holding portion of FIG. 2.
  • the cannula position maintenance device 20 includes a first position maintenance unit 30 and a second position maintenance unit 50.
  • the first position maintenance part 30 and the second position maintenance part 50 are mounted on different parts of the cannula 15 and maintain the position of the cannula.
  • the first position holding part 30 provides support to the cannula 15 while being closely fixed to the patient's skin.
  • the first position holding part 30 is provided with a compression strap 31 and a plurality of adhesive fixing parts 35.
  • the compression strap 31 takes the form of a band and serves to tighten the cannula.
  • the adhesive fixing part 35 is a part that is integrated with the compression strap and is adhesively fixed to the skin.
  • the first position maintenance unit 30 is shown separately in FIG. 10.
  • Figure 10 is an exploded view of the first position holding part.
  • the first position holding part 30 has a compression strap 31 and three adhesive fixing parts 35.
  • the compression strap 31 includes a wrapping band 31a, a winding spring 31e, and an inner pad 33.
  • the wrapping band 31a is a synthetic resin member with a certain width and thickness and is flexible. In other words, it can be bent by applying force.
  • a locking portion 31c is formed on the outer surface of the wrapping band 31a.
  • the locking portion 31c extends in the longitudinal direction of the wrapping band 31a and is made up of continuous teeth 31d, and serves to hang and support the hook 31b.
  • a hook (31b) is provided at one end of the wrapping band (31a). As shown in FIG. 2, the hook 31b is caught on the teeth 31d of the locking portion 31c to maintain the compression strap 31 clamping the cannula 15. When the pressure strap 31 is tightened in the direction of arrow c, the hook (31b) is pushed and moves along the locking portion (31c) and is caught on the final tooth (31d).
  • the winding spring 31e is a leaf spring built into the wrapping band 31a.
  • the winding spring (31e) is accommodated in the wrapping band (31a) through an insert injection method.
  • the winding spring 31e has a certain width, extends in the longitudinal direction, and has a self-winding property like a spring. If you forcibly unfold the winding spring (31e) and then let go, it will be wound and rolled. By the action of the winding spring 31e, the wrapping band can elastically wrap around the cannula.
  • the inner pad 33 is an elastic member fixed to the inner surface of the wrapping band 31a and prevents the wrapping band 31a from slipping on the cannula 15.
  • the adhesive fixing part 35 consists of a cover plate 35a and an adhesive tape 35b.
  • the cover plate 35a is integrated with one end of the wrapping band 31a in the width direction.
  • the cover plate 35a may be bent relative to the wrapping band 31a. Therefore, with the cannula 15 wrapped around the compression strap 31, the cover plate 35a can be opened outward and brought into close contact with the skin.
  • the cover plate 35a has the same material as the wrapping band 31a.
  • the adhesive tape 35b is a single-sided tape that is fixed to the cover plate 35a and adheres to the patient's skin.
  • a plurality of adhesive tapes 35b are stacked, and when the adhesive strength of the lowest layer adhesive sheet weakens, the lowest layer adhesive sheet is peeled off and the next layer of adhesive tape 35b is used.
  • the first position holding part 30 remains firmly fixed and prevents the cannula 15 from shaking.
  • the second position maintenance unit 50 serves to maintain the angle after tilting when the cannula 15 is tilted.
  • the second position holding part 50 has a holder part 51, a leg part 55, and an adsorption fixing part 57.
  • the holder portion 51 has a pair of holder halves 51a, an extended body 53, and a leaf spring 54.
  • the holder half (51a) has a substantially semi-cylindrical shape and is a member located on the opposite side with the cannula (15) in between.
  • the holder half 21a opens when the pressing portion 53d is pressed in the direction indicated by arrow a in Fig. 4 and enters the state shown in Fig. 5.
  • the external force is removed, it shrinks due to the action of the leaf spring 54 and comes into close contact with the cannula 15 again.
  • leg engaging portion 51d is provided on the outer peripheral surface of each holder half 51a.
  • the leg coupling portion 51d is a so-called cylindrical member with female threads formed on its inner peripheral surface. Since three leg portions 55 are used, one leg coupling portion 51d is formed on one holder half 51a and two leg coupling portions 51d are formed on the other holder half 51a.
  • An anti-slip pad (51b) is provided on the inner opposing surface of the holder half (51a).
  • the anti-slip pad (51b) is in close contact with the cannula (15) and prevents the holder half (51a) from slipping on the cannula (15). This is to prevent the holder half (21a) from slipping in the longitudinal direction of the cannula (15). Silicone or rubber can be used as the anti-slip pad (51b).
  • the extension body 53 is a member that is integrated with each holder half, extends in the longitudinal direction, spreads out in a direction away from the holder half, and is connected to each other by link pins.
  • the extension body 53 is a rod-shaped member that is integrated with the side of each holder half 51a and extends in the longitudinal direction.
  • a hinge portion (53a) is formed at the center of the opposing surfaces of the extension bodies (53) on both sides, and the hinge portion (53a) is connected by a link pin (53c).
  • a leaf spring 54 and a pressing portion 53d are located at the rear end of the extension body 53, that is, at the opposite end of the holder half (51a).
  • the leaf spring 54 is an elasticity providing part that applies elastic force in the direction of opening the rear end of the extension body 53, allowing the holder half 51a to bite and secure the cannula.
  • other elastic support means may be applied instead of the leaf spring 54.
  • the pressing portion 53d prevents slipping when the leaf spring is held by hand.
  • the upper part of the leg part 55 is coupled to the holder half 51a and the lower part is coupled to the suction fixing part 57, and serves to provide support to the holder part.
  • the three legs have an angle of 120 degrees.
  • the leg portion 55 is plastically deformable. For example, if the user applies force to bend it, it stays bent.
  • leg portion 55 is shown separately.
  • the leg portion 55 includes a flexible tube 55a, a steel ball 55c, and an angle maintaining magnet 55e.
  • the flexible tube 55a is a hollow flexible rod made of synthetic resin and having male threads 55b at both ends.
  • the male threaded portion 55b is screwed to the leg engaging portion 51d of the holder half 51a and the leg engaging portion 57c of the suction fixing portion 57, respectively. Since the leg portion 55 is screwed together, the leg portion can be freely replaced. For example, various leg parts 55 of different lengths or bending characteristics can be replaced and operated.
  • the steel ball 55c is a spherical member with a certain curvature and remains attached to the left and right angle maintaining magnets 55e. Steel balls 55c are arranged in series inside the support tube.
  • the angle maintaining magnet 55e is a permanent magnet that is attached to the steel balls 55c while being sandwiched between the steel balls 55c.
  • the angle maintaining magnet 55e takes the shape of a cylinder with a certain diameter and length and has curved grooves 55d at both ends.
  • the curvature of the curved groove portion 55d is the same as the curvature of the surface of the steel ball 55c.
  • the steel ball 55c is in contact with the curved groove 55d.
  • the steel ball 55c always remains attached to the angle maintaining magnet 55e. Therefore, for example, if the leg portion 55 is bent as shown in FIG. 7, it maintains the bent state.
  • the leg portion 55 Being able to bend the leg portion 55 means that the cannula 15 can be tilted. For example, when one of the three leg parts 55 is bent, the holder part 51 is tilted toward the bent leg and the cannula 15 is tilted accordingly. The angle of the cannula 15 can be adjusted as much as desired by bending the leg portion 55.
  • the adsorption fixing part 57 is connected to the end of the leg part 55 and is fixed to the patient's skin so that the leg part supports the holder part.
  • the adsorption fixing part 57 includes a base plate 57a and an adsorption member 57e.
  • the base plate (57a) is a plastically deformable plate-shaped member that takes the shape of a plate, and is provided with a leg joint portion (57c) on its upper surface.
  • the leg coupling portion 57c is a portion screwed to the male thread portion 55b at the end of the flexible tube 55a.
  • the base plate 57a is capable of plastic deformation. In other words, when the base plate 57a is bent, it maintains the bent state. Since the base plate 57a has plasticity in this way, the base plate 57a can be bent to match the curvature of the skin of the affected area to which the cannula 15 is applied.
  • the adsorption member 57e is fixed to the bottom of the base plate 57a and is fixed to the skin by adsorption.
  • the adsorption member 57e is made of soft silicon and has an adsorption space 57f open at the bottom. When the adsorption member 57e is pressed against the skin, the adsorption space 57f is pressed, and a vacuum is formed inside the adsorption space to maintain the adsorption state.
  • each suction member 57e having the above configuration When the suction members 57e having the above configuration are pressed and brought into close contact with the skin, each suction member 57e is adsorbed to the skin and supports the leg portion 55.
  • Arthroscope 15 Cannula 20: Position maintenance device
  • 35a Cover plate 35b: Adhesive tape 50: Second position maintenance part
  • leg joint 53 extension body 53a: hinge portion
  • Adsorption fixing part 57a Base plate 57c: Leg joining part
  • Adsorption member 57e Adsorption space 101: Shoulder joint

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

Abstract

La présente invention concerne un dispositif pour maintenir une position d'une canule chirurgicale. Le dispositif supporte une canule insérée dans une lésion pour une chirurgie arthroscopique, et comprend : une première partie de maintien de position qui est couplée à la canule dans un état en contact étroit avec la peau et fixée à celle-ci et fournit une force de support à la canule ; et une seconde partie de maintien de position qui est couplée à une autre partie de la canule et maintient l'angle d'inclinaison lorsque la canule est inclinée. Le dispositif de maintien de position pour une canule chirurgicale de la présente invention configuré comme décrit ci-dessus permet à la canule définie d'être maintenue à une position ajustée et permet ainsi à un médecin d'utiliser les deux mains librement, ce qui permet une chirurgie précise et rapide.
PCT/KR2022/012559 2022-06-02 2022-08-23 Dispositif pour maintenir la position d'une canule chirurgicale WO2023234475A1 (fr)

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Application Number Priority Date Filing Date Title
KR1020220067314A KR20230167467A (ko) 2022-06-02 2022-06-02 수술용 캐뉼러 위치 유지장치
KR10-2022-0067314 2022-06-02

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WO2023234475A1 true WO2023234475A1 (fr) 2023-12-07

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Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN104857608A (zh) * 2015-04-20 2015-08-26 王才丰 组合式气管插管固定装置
CN105326542B (zh) * 2015-12-16 2017-08-08 无锡市人民医院 带皮肤提取机构的腹腔镜用取路卡
CN211096817U (zh) * 2019-09-18 2020-07-28 重庆市中医院 一种气管插管固定支架
KR20210123537A (ko) * 2020-04-03 2021-10-14 전북대학교산학협력단 소아용 복강경 기구
CN214908288U (zh) * 2021-01-30 2021-11-30 玉林市妇幼保健院 一种腔镜鞘卡限位固定器
CN216090702U (zh) * 2021-05-27 2022-03-22 北京派尔特医疗科技股份有限公司 一种穿刺器辅助装置及穿刺器

Family Cites Families (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE102017112681A1 (de) 2017-06-08 2018-12-13 Ask Chemicals Gmbh Verfahren zur Herstellung von dreidimensional geschichteten Formkörpern

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN104857608A (zh) * 2015-04-20 2015-08-26 王才丰 组合式气管插管固定装置
CN105326542B (zh) * 2015-12-16 2017-08-08 无锡市人民医院 带皮肤提取机构的腹腔镜用取路卡
CN211096817U (zh) * 2019-09-18 2020-07-28 重庆市中医院 一种气管插管固定支架
KR20210123537A (ko) * 2020-04-03 2021-10-14 전북대학교산학협력단 소아용 복강경 기구
CN214908288U (zh) * 2021-01-30 2021-11-30 玉林市妇幼保健院 一种腔镜鞘卡限位固定器
CN216090702U (zh) * 2021-05-27 2022-03-22 北京派尔特医疗科技股份有限公司 一种穿刺器辅助装置及穿刺器

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