[go: up one dir, main page]

WO1998004195A1 - Appareil pour la formation de sutures en cordon de bourse - Google Patents

Appareil pour la formation de sutures en cordon de bourse Download PDF

Info

Publication number
WO1998004195A1
WO1998004195A1 PCT/IL1997/000253 IL9700253W WO9804195A1 WO 1998004195 A1 WO1998004195 A1 WO 1998004195A1 IL 9700253 W IL9700253 W IL 9700253W WO 9804195 A1 WO9804195 A1 WO 9804195A1
Authority
WO
WIPO (PCT)
Prior art keywords
needles
connectors
pss
needle
distal
Prior art date
Legal status (The legal status 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 status listed.)
Ceased
Application number
PCT/IL1997/000253
Other languages
English (en)
Inventor
Sergey Popov
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
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 Individual filed Critical Individual
Publication of WO1998004195A1 publication Critical patent/WO1998004195A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B17/1114—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B2017/1142—Purse-string sutures

Definitions

  • the invention relates to medical equipment, in particular to apparatuses for purse string suturing of hollow organs.
  • apparatuses for purse string suturing of hollow organs are widely used that include jaws capable of straining hollow organ walls.
  • the jaws have through longitudinal guiding orifices wherein two needles are alternately entered from proximal side, those needles in their tail part are connected to thread ends.
  • auxiliary tool forceps
  • needle ends protrude from the apparatus distal side where they are grasped by auxiliary tool and drawn out of the apparatus, thus drawing the thread ends through hollow organ walls outside.
  • purse string sutured by surgical apparatus with their assistance and tied manually (as a rule, by several knots), thus fastening purse string suture in such a manner that said suturing and tieing occur from the distal side of purse string suture .
  • This apparatus has the drawbacks as follows.
  • An apparatus for purse string suturing of hollow organs is known from the USA patent No. 4915107, wherein needles made of thin resilient wire with sharp pricking tips are mounted on an actuator-equipped drum. Needle ends are fixed in needle tail section. Drum with actuator permit to ease and make more comfortable the needle and thread stitch drawing through serous-muscular tissue of hollow organ wall strained by the apparatus jaws. The process is executed by two needles simultaneously, which decreases labor input. But the apparatus has all above indicated demerits associated with manipulation on the suture distal side, with utilization of auxiliary instruments and with hazard of injuries. So the apparatus actually solves no problems of purse string suturing in endoscopic surgery. Besides, relatively intricate apparatus charging with flexible needles and thread hinders the implementation of the same apparatus for making several purse string sutures in the same surgery, in particular in hollow organ anastomosis.
  • the invention objective is improvement of operation conveniency in hard-to-reach anatomical areas of fixed organs and in intricate surgical situations.
  • Another invention objective is precluded possibility of patient body injury by needle pricking tips.
  • Another invention objective is precluded possibility of a chance pricking and medical personnel infection.
  • Another invention objective is decrease in time consumption for purse string suturing.
  • Another invention objective is potential implementation of the same apparatus for making several purse string sutures during a single surgery.
  • Another invention objective is enhancement in quality and conveniency of endoscopic surgeries.
  • a apparatus for purse string suturing of hollow organ which being mounted inside the apparatus has two lateral sides, comprising:
  • - means for stitch pricking and PSS stitch drawing include piercing means
  • - jaws and working zone have proximal side whereon stitch pricking of the wall of hollow organ originates, and distal side whereon stitch drawing of PSS ends originates;
  • PSS ends are situated from distal side of jaws, whereas piercing means are situated from proximal side of jaws outside working zone.
  • the needles are positioned outside and more proximally of working zone;
  • the needles are partially positioned inside the working zone and pricking tips of needles and finite distal parts of needles are located more distally of working zone and are connected to PSS ends:
  • needles and PSS ends drawn through hollow organ wall are located more proximal of working zone.
  • the apparatus proposed enhances surgeon's work conveniency as PSS ends are drawn to the intestine proximal side that is more accessible for the surgeon and more practicable for further tieing of PSS. It is particularly important for operation on hard-to-reach organs in complicated surgical situations when organ access is limited. Therefore, these apparatus features are appreciable in endoscopic manipulations. Besides, when operating the apparatus, there is no hazard of patient or personnel injuring by pricking tips of piercing means .
  • connecting means are made as two pairs of members, each of them comprising needle finite distal part and connector, wherein distal part is the fixation point of PSS end, whereas proximal part is adapted to engaging with needle finite distal part.
  • proximal part of connector is tubular and operates as female member, whereas needle finite distal part is male member.
  • the apparatuss of such kind are easily manufactured, cheap, compact and user-friendly.
  • engagement means for engaging needles with connectors so that engagement means comprise at least one recess and one protrusion and so that one of them is situated on needle finite distal part, while the other one, on connector.
  • This design modification has enhanced engagement reliability, as it insignificantly depends on substance (for instance, blood) presence on engaging surfaces that may serve as counter-friction coatings.
  • means for disconnection of connectors and needles comprise releasing members for disconnection of connectors and needles.
  • releasing members rigid significantly simplifies and cheapens the design and ensures the apparatus reliable operation.
  • Such design embodiment of releasing members permits working with connectors whose outer diameter does not exceed the needle diameter, and such correlation between diameters makes the design atraumatic for drawing through hollow organ wall .
  • Presence of a special member - stripper - designed for removal of disconnected PSS ends from the apparatus upgrades operation convenience, since the inconveniency of removal of relatively small-size connectors out of the apparatus is eliminated.
  • stripper permits to remove two connectors at once from the apparatus, simultaneously with drawing both thread ends through hollow organ wall. Such operation sequence precludes possible PSS entangelement .
  • cone-shaped channels perform two immediate functions of keeping members and of releasing members, thus making the design straightforward, low-cost, and easy-to-manufacture .
  • interlocking means are made as a ratchet comprising rack and pawl, one of them being spring-loaded.
  • Such design embodiment ensures absolute apparatus reliability, moreover the operation sequence preset by the design cannot be intervened by user.
  • interlocking means is simple, low-cost and failure-proof. No new pieces are introduced even when the available ones become more involved.
  • the locking mechanism actuates automatically thus increasing operation conveniency for surgeon, as he is not distracted by actuation control.
  • actuator is removable and comprises: actuator casing; actuator casing handle; pusher for transmission of effort to piercing means; as well as control means for the jaws.
  • Such apparatus design permits, by using one removable actuator and mounting it onto detachable apparatus units, to implement it during the same surgery for several purse string sutures, thus reducing the surgery costs.
  • Possibility of apparatus recharging by PSS with connectors permits to make several purse string sutures within the same surgery and by the same apparatus .
  • stripper is equipped with knife for cutting PSS and their liberation in manner from stripper and connectors.
  • Fig. 1 shows the proposed purse string suture apparatus in assembly with removed actuator in a before operation position; the apparatus may be used for endoscopic surgery.
  • Fig. 2 shows the 2-2 section of the drawing shown in Fig. 1.
  • Fig. 3 displays the 3-3 section of the drawing shown in Fig. 2, illustrating design of the jaws.
  • Fig. 4 shows the 4-4 section of the drawing shown in Fig. 2, illustrating design of the jaws.
  • Fig. 5 shows the fragment of the apparatus proposed without actuator as a portion of the apparatus shown in Fig. 1.
  • Fig. 6 shows the drawing of detachable actuator in assembly as a portion of the apparatus shown in Fig. 1.
  • Fig. 7 shows the drawing of assembled apparatus proposed with detachable actuator at the initial work stage, in first position; the apparatus may be used for endoscopic surgery.
  • Fig. 7 displays enlarged-scale fragment of Fig. 7 drawing illustrating the connector and PSS layout in the apparatus.
  • Fig. 10 shows the drawing of assembled apparatus proposed with detachable actuator during operation in second position; the apparatus may be used for endoscopic surgery.
  • Fig. 9 displays enlarged-scale fragment of Fig. 10 illustrating needle distal finite sections connection to connectors .
  • Fig. 11, 12 has the drawings of the apparatus alternative embodiment as two branches.
  • Fig. 13 shows 13-13 section of the apparatus shown in Fig.
  • Fig. 14 shows 14-14 section of the apparatus shown in Fig.
  • Fig. 15 displays longitudinal section of the apparatus shown in Fig. 14 with installed stripper.
  • Fig. 16 displays transversal 16-16 section of the apparatus shown in Fig. 13 and illustrates the design of the apparatus jaws.
  • Fig. 17 displays transversal 17-17 section of the apparatus shown in Fig. 13 and illustrates the design of thread bend exit area upon stripper removal.
  • Fig. 18 shows fragment of the apparatus shown in Fig. 15 illustrating stripper with inside connector, thread and needle finite distal section.
  • Fig. 19 shows fragment of the apparatus shown in Fig. 15, illustrating stripper with connector following connector disengagement with needle.
  • Fig. 20 gives general view of the stripper which is the component of the apparatus from Fig. 15.
  • Fig. 21 gives view B of the stripper shown in Fig. 20.
  • Fig. 22 shows 22-22 section of the stripper given in Fig. 21 and illustrates releasing and keeping members located inside the stripper.
  • Fig. 23 shows 23-23 section of the stripper given in. Fig.
  • Fig. 24 shows 24-24 section of the stripper given in Fig. 23 and additionally illustrates design of the knife located inside the stripper.
  • Fig. 25 shows 25-25 section of the stripper given in Fig.
  • Fig. 26 shows apparatus fragments in initial position with inside, located-on-needles stripper, having springy releasing and keeping members .
  • Fig. 27 demonstrates 27-27 section of the apparatus shown in Fig. 26.
  • Fig. 28 shows apparatus fragments in initial position with inside, located-on-needles stripper, having springy releasing and keeping members, and with connectors and needle distal finite sections mounted inside the stripper, before their separation.
  • Fig. 29 shows 29-29 section of the apparatus shown in Fig. 28.
  • Fig. 30 gives the drawing of stripper with spring-loaded releasing and keeping members, with inside stripper located connectors, following their disconnection with the needles.
  • Fig. 31 shows the apparatus fragment with inside, located-on-needles stripper, having keeping members as circular conical protrusion on channel inner surfaces for connector entry; the releasing members are located on the apparatus housing.
  • Fig. 32 shows 32-32 section of the apparatus given in Fig. 31.
  • Fig. 33 shows drawing of the stripper in the modification given in Fig. 31, following connectors and needles disengagement and stripper removal out of the apparatus.
  • Fig. 34, 35 shows general view drawings of PSS with coil and connector assembly as a portion of the apparatus shown in Fig. 13.
  • Fig. 36 shows the housing distal part fragment of the apparatus shown in Fig. 13 and intended for mounting of PSS coil unit and connectors inside it.
  • Fig. 37 shows upper view of the drawing Fig. 36.
  • Fig. 38 shows the 38-38 section of the drawing Fig. 36.
  • Fig. 39, 40 shows the drawings of general view of the needle hub which is the part of the apparatus shown in Fig. 11-15.
  • Fig. 41 shows the 41-41 section of the hub given in Fig. 40.
  • Fig. 1 shows assembled apparatus for purse string suturing of hollow organ with detachable actuator in a before-operation position.
  • the apparatus has the means for stitch pricking of hollow organ wall and stitch drawing of PSS through it comprising a pair of jaws 1 and 2 with indented surfaces 3, 4, intended for hollow organ compression between them.
  • the apparatus working zone 5 is situated between its proximal 6 and distal 7 borders. Stitch pricking of hollow organ wall and stitch drawing of PSS through it is made between borders 6 and 7.
  • Said means also comprise piercing means as needles 8 and 9 with pricking ends 10 and 11, respectively, whereto finite distal sections of needles 12 and 13 are adjoint, respectively.
  • Needles 8 and 9 have on their proximal ends common hub 14.
  • Removable coil 16 with wired PSS 17 as a single thread, having ends 18 and 19, and connectors 20 and 21, wherein distal ends are connected to ends 18, 19 of PSS 17 is situated in jaw 1 more distal of working zone 5 in bucket 15.
  • Connectors 20, 21 are intended for connection of ends 18, 19 of PSS 17 and distal finite sections of needles 12 and 13, respectively.
  • Jaws 1 and 2 have needle ways 22 and 23 with needle guides 24 and 25 so that in needle guide 24 one end 18 of PSS 17 is drawn by one needle 8 whereas in needle guide 25 one end 19 of PSS 17 is drawn by one needle 9. Slits 48, 49 are also made in jaws 1, 2 for PSS bend passing.
  • Jaws 1, 2 and working zone 5 have proximal side indicated by proximal border 6 and distal side indicated by distal border 7.
  • the apparatus proposed has hollow organ stitch pricking direction 50 by needles 8 and 9 from proximal border 6 to distal border 7, as well as stitch drawing direction 51 of ends 18, 19 of PSS 17 through orifices in hollow organ wall generated by said stitch pricking, from distal border 7 to proximal border 6. Therefore, said directions of stitch pricking and stitch drawing of PSS are opposite.
  • the apparatus has housing 26, wherein there are guides 27 for hub 14 as well as guides 28 and 29 for needles 8 and 9 respectively.
  • Hub 14 is ovably mounted in guides 27 and has fixing circular conical protrusion 30 interacting with conical recess 31 in apparatus housing 26 and preventing proximal displacement of hub 14 and needles 8, 9 to the position indicated in Fig. 1, and generating hub 14 and needles 8, 9 resistance to distal displacement.
  • Collet 32 is made on hub 14 proximal end. Housing 26 is connected to jaw 2 by plate spring 58 which in a prestart position holds jaws 1 and 2 disconnected, as shown in Fig. 1.
  • the apparatus is equipped with removable actuator which comprises: actuator housing 33; actuator handle 34 with spring-loaded fixing ball 35 interacting with recess 36 in actuator housing 33; needle pusher 37 which, being mounted in guide 38, transmits the effort from actuator handle 34 to hub 14 and has in its distal part circular protrusion 39 for engagement with collet 31; actuator housing handle 40.
  • Removable actuator also features means for control of jaws 1, 2 comprising: lever 41, rotatingly installed in actuator housing 33 on axle 42 and equipped with working position catch 43, reciprocal spring 44, jaw pusher 45 made as a tube with protrusion 46 for interaction with level 41 and transmitting effort from lever 41 to jaw 2 for its closing.
  • Actuator housing 33 is connected with apparatus housing 26 through threaded connection 47.
  • Actuator housing 33, needle pusher 37 and jaw pusher 45 may have the length sufficient for apparatus implementation in endoscopic surgeries.
  • Fig. 2 shows 2-2 section of Fig. 1 drawing which in enlarged scale shows apparatus design as well as the area for connection to detachable actuator with the denominations of Fig. 1.
  • Figs. 3, 4 show jaw 1 3-3 and 4-4 sections of Fig. 2 in two different points which comprise jaw 3 indented surface, needle guide 24 and slit 48 for PSS bend passing.
  • Jaw 2 (not shown in Figs. 3, 4) has similar members.
  • Fig. 5 shows the proposed apparatus fragment without actuator as a portion of the app ratus shown in Fig. 1.
  • jaws 1 and 2 are disconnected under the effect of spring 58.
  • the embodiment shown in Fig. 5 may be connected to removable actuator by thread 60 at the proximal end of haousing 26 and collet 32.
  • Fig. 6 shows assembled detachable actuator as a part of the apparatus shown in Fig. 1, with appropriate denominations and description.
  • the housing of detachable actuator 33 has at its distal end inner thread 59 for connection to the remaining apparatus .
  • Fig. 7 shows assembled apparatus in its initial position which also is starting working position.
  • lever 41 is pressed against actuator housing handle 40 and locked against displacement by working position lock 43, spring 44 is extended and jaw pusher is distally moved by lever 41, which results into closing of jaws 1 and 2, compression of hollow organ (not shown in the Fig.) between them and fixation of jaws 1 and 2 in working position.
  • Actuator handle 34 is disengaged out of its fixed prestarting position, as its catching ball 35 is removed out of recess 36 and shifted distally, thus resulting into entry of pusher 37 circular protrusion 39 into collet 32 and abutting of pusher 37 distal end into hub 14 of needles 8 and 9.
  • the positions of hub 14 and needles 8 and 9 do not change, as they are locked by circular conical protrusion 30, and engagement force of protrusion 30 and apparatus housing 26 exceeds the force necessary for the entry of circular protrusion protrusion 39 into collet 32.
  • needles 8 and 9 are located beyond and more proximal of working zone 5, whereas ends 18, 19 of PSS 17 are located beyond and more distal of working zone 5.
  • FIG. 8 shows fragment of Fig. 7 in enlarged scale, wherein the arrangement of connectors 20, 21 and PSS 17 in the apparatus initial position is illustrated.
  • Connectors 20 and 21 are sited distally of working zone 5 in jaw 1 in buckets 52, 53, respectively, where they are held by friction forces.
  • Entry section 54, 55 of buckets 52, 53 is shaped conically, thus facilitating the entry of needle finite distal sections 12, 13 into connectors 20, 21 during subsequent apparatus operation.
  • Connectors 20, 21 are tubular shaped. Their distal ends are connected to ends 18, 19 of PSS 17.
  • PSS 17 is located on coil 16.
  • thread.17 is located in a special cavity, for instance, as a channel located inside the body of jaw 1.
  • Fig. 9, 10 shows the apparatus during its operation in second position.
  • all control means of jaws 1, 2, including lever 41 and jaw pusher 45 are in the same situation as in the initial position (see Fig. 5).
  • jaws 1, 2 are closed and hollow organ (not shown in the Fig.) is clamped between them.
  • Actuator handle 34 is displaced by operator into its extreme distal position.
  • needle pusher 37 transmitting the effort from actuator handle 34 to hub 14 disengaged circular conical protrusion 30 out of conical recess 31 and shifted hub 14 and needles 8, 9 into extreme distal position.
  • needles 8 and 9 moving towards stitch pricking direction 50, prick hollow organ and by their finite distal sections 12 and 13 enter into engagement with connectors 20 and 21, respectively.
  • needles 8 and 9 occupy extreme distal position and are partially situated inside jaws 1 and 2, whereas their finite distal sections 12, 13 are located distally of working zone 5 and connected to connectors 20, 21, which, in their turn, are connected to ends 18, 19 of PSS 17. Therefore, upon arrival into the second position needles 8 and 9 are coupled to ends 18, 19 of PSS 17 by connectors 20, 21, respectively.
  • FIG. 7 shows, the coupling of needle finite distal sections 12, 13 and connectors 20, 21 is of male-female type, wherein connector proximal portions are made tubular and serve as female members, whereas the connectors themselves have outer diameter equal to outer diameter of 8 , 9 needles outside their finite distal sections so that the diameter of needle finite distal sections 12, 13 is less compared to remaining needle portion and they serve as male members. Engagement between male and female members results from friction forces.
  • needle finite distal sections are made tubular and serve as female members, while connector proximal portions are male members; finite distal section of one needle is female member, whereas finite distal section of the second needle serves as male member by corresponding execution of connector proximal portions - one of them is male member whereas the second one, female; needle finite distal sections as male members have the same outer diameter as the remaining needle portion; in this, the engagement force between needle finite distal sections 12, 13 and connectors 20, 21 exceeds the engagement force between connectors 20, 21 and connector buckets 52, 53, thus allowing to extract connectors 20 and 21 out of their buckets 52, 53 upon subsequent proximal movement of needles 8 and 9 , but preserve coupling of needles 8, 9 and connectors 20, 21.
  • the apparatus special feature is that in its second position when needles 8 and 9 are in extreme distal position needle 10, 11 pricking tips do not leave the apparatus bounds.
  • needles 8 and 9 and adjoint connectors 20, 21 with ends 18, 19 of PSS 17 are located proximally of working zone 5 owing to the displacement of actuator handle 34 into the initial position by operator.
  • this displacement actuator handle transmits the effort through the actuator pusher 37 and collet 32 onto hub 14 and needles 8, 9, displacing them proximally.
  • stitch drawing of ends 18, 19 of PSS 17 in direction 51 takes place through the orifices in hollow organ walls created by prior stitch pricking of hollow organ in direction 50.
  • the apparatus operation constitutes its transition from prestart position to the first position, and then from the first position into the second one, followed by transition into the third position. Said positions are described above.
  • circular conical protrusion 30 again enters conical recess 31, thus preventing further distal displacement of hub 14 and needles 8, 9 and permitting extraction of circular protrusion 39 out of collet 32 and setting of actuator handle 34 to prestart position shown in Fig. 1.
  • needles 8 and 9 do not prevent jaw disconnection made by down pressing of working position lock 43.
  • this spring 44 returns lever 41 and jaw pusher 45 to the position shown in Fig. 1, and jaw 2 plate spring 58 disconnects jaws 1 and 2.
  • PSS 17 After said disconnection of jaws 1 and 2 by the apparatus proximal movement PSS 17 complete the process of PSS 17 drawing through hollow organ walls. PSS 17, which in the second position was located on coil 16, upon transition from the second position to the third one and said apparatus subsequent proximal movement gradually leaves coil 16 completely and occupies its positon in hollow organ walls.
  • ends 18, 19 of PSS 17 are drawn to the hollow organ proximal side, more accessible for a surgeon and more convenient for further PSS tieing, which is particularly important for endoscopic surgeries. It brings about advanced operation conditions, reduced time consumption and improved surgery qualities. Besides, since needle pricking tips 10 and 11 do not leave the apparatus bounds, it precludes the hazard of patient organ injury and personnel chance pricking.
  • Figs. 11, 12 show alternative embodiment of proposed apparatus destined preferrably for open surgeries on gastrointestinal tract organs. This alternative embodiment does not differ from that described above in the majority of operation concepts and design elements. Therefore, the description below preserves numerical denominations of similar parts and uses basic notions and definitions given above.
  • the apparatus comprises two branches 65 and 66, where branch 65 serves as the apparatus housing. Branches 65 and 66 are rotatingly connected through axis 67. Jaws 1 and ' 2 for hollow organ clamping between them are located in their distal part as well as working zone 5. More distal of the working zone removable block 68 containing coil with PSS and connectors is situated in the apparatus housing 65.
  • the apparatus is equipped with closed position lock 69 of branches 65 and 66, when hollow organ stitch pricking and stitch drawing of PSS ends through hollow organ are made.
  • spring 70 which ensures disconnection of branches 65 and 66 upon unlocking of their closed position, following stitch drawing of PSS ends, and in prestart position.
  • the apparatus features common hub for needles with handle 71 labelled with sign 72 coinciding with sign 73 in the apparatus second position and sign 74 in its third position.
  • the apparatus is equipped with stripper 75 for removal of PSS ends after stitch drawing of PSS ends through hollow organ walls, i.e. in the apparatus third position, and drawing of PSS ends through hollow organ walls.
  • the apparatus has hollow organ stitch pricking direction 50 from the working zone proximal border 6 towards its distal border 7, as well as direction 51 of stitch drawing of PSS ends through orifices in hollow organ walls, generated by said stitch pricking from working zone distal border 7 towards its proximal border 6.
  • the apparatus housing 65 is equipped with handle 76, having rest surface 77. When the apparatus arrives into the second position, surface 77 contacts rest surface 78 of handle 71, this being an additional indication of arrival to the said second position.
  • Fig. 13 shows 13-13 section of the apparatus shown in Fig. 12, whereas Fig. 14 shows 14-14 section of the apparatus shown in Fig. 13.
  • the apparatus shown in Figs. 13, 14 is in its first position.
  • Its block 68 comprises coil 16, PSS 17, and tubular connectors 20 and 21, wherein distal portion is connected to ends 18 and 19 of PSS 17, respectively.
  • Block 68 is easily removable. It is installed into branch 65 by means of mushroom-shaped pins 79 and 80. Besides, thanks to protrusion 81 on block 68 and recess 82 on branch 66, it is locked in its working positions from longitudinal displacement. More proximal of working zone 5 a bucket 82 of stripper (in Figs.
  • Said means made as a ratchet comprise rack 90 situated on housing 65 wall 91 in distal section of hub 14 progress range, as well as pawl 92 on hub 14.
  • Rack 90 is mounted on elastic foot 93, is thus spring-loaded and has knob 94 for ratchet dislocking in case of emergency.
  • pawl 92 extreme distal position (not shown in Fig. 13, 14) it is located dore distal of rack 90 distal end 95.
  • Fig. 15 shows the same apparatus as is seen in Figs. 13, 14 but with stripper 75 mounted inside stripper 82 bucket. In doing so, stripper 99 pin comes into engagement with collet 83 and by it holds stripper 75 in bucket 82.
  • conical channels 100 and 101 are made in stripper 75, wherein connectors 20 and 21 become embedded at the end of their transition into the third position, owing to the fact that outer surface of connectors 20, 21 is also conical. Said embedding of connectors 20, 21 enables their disconnection from needles 8 and 9 and, following this disconnection, confinement of connectors 20, 21 inside the stripper. Therefore, conical channels 100 and 101 serve as releasing and keeping members at the same time.
  • the apparatus operation includes transition from the starting first position into the second one where the male-female type engagement between needles 12, 13 finite distal sections (male members) with connectors 20, 21 takes place. Solidity of said engagement is supported by alignment of signs 72 and 73 (see Fig. 11), and/or by contact of abutting surfaces 77 and 78, and/or by rack 90 and pawl 92 operation. Said measures may be applied both in combination and in separate.
  • stitch pricking of hollow organ by needles 8 and 9 in direction 50 takes place. In doing so, pricking tips of needles 10 and 11 in the second position do not leave the apparatus bounds.
  • needles 8 and 9 move proximally entraining connectors 20, 21 with PSS 17 ends 18, 19. Stitch drawing of PSS 17 through hollow organ walls takes place in direction 51. Disconnection of needles 8, 9 and connectors 20, 21 occurs distally of working zone 5 in stripper 75. Following disconnection of connectors 20 and 21 and needles 8 and 9 and complete transition to the third position, stripper 75 along with connectors 20, 21 and fixed in them ends 18, 19 of PSS 17 are removed out of apparatus by pressing pin 99. Then the operator pulls stripper 75 and thus completes the drawing of PSS 17 through hollow organ walls.
  • jaws 1 and 2 are freed from catching in closed position by proximal pressing lock 69, which results in their disengagement by spring 70 and permits to release hollow organ from the apparatus.
  • PSS also easily leaves the apparatus thanks to lateral notch 84.
  • PSS 17 ends 18, 19 are drawn to hollow organ proximal side easily accessible and convenient for further PSS tieing, thus improving operation conditions, reducing time consumption and upgrading purse string suture quality.
  • the needle pricking tips 10 and 11 do not leave the apparatus bounds, it precludes the hazard of patient organ injury and personnel chance pricking. Additional increase in operation conveniency, reduction in time consumption and surgery costs is achieved through the opportunity of fast and easy replacement of unit 68 with PSS 17 and connectors. It permits to make several purse string sutures in the same surgery with the same apparatus.
  • Fig. 16 shows transversal 16-16 section of the apparatus shown in Fig. 13 which illustrates the design of jaws 1 and 2.
  • Jaws 1 and 2 comprise: their indented surface members - recess 4 on jaw 2 and protrusion 3 on jaw 1; slits 48 and 49 for PSS 17 bend passing; needle guides 24 and 25.
  • Fig. 17 shows 17-17 section of the apparatus shown in Fig. 13 illustrating lateral notch 84 in housing 65 for PSS 17 exit upon stripper removal from the apparatus.
  • the section also demonstrates guides 88 and 89 for needles 8 and 9, as well as closed position lock 69 for branches 65 and 66.
  • Figs. 18, 19 show fragment of the apparatus shown in Fig. 15 illustrating stripper 75 arrangement in the apparatus housing 65. Member denominations and their description coincide with those for Fig. 15.
  • Fig. 18 shows stripper 75 before the termination of transition from the second position into the third one, when connector 20 is already embedded in stripper 75 conical channel 100, but needle 12 distal finite portion is not yet disconnected from connector 20. Following termination of transition to the third position, the needle 12 finite distal section, as is shown in Fig. 19, is disengaged from connector 20, and this latter, together with PSS end 18 remains in stripper 75.
  • Figs. 20...25 show stripper 75 in an alternative embodiment with knife 102 for cutting of PSS ends their release out of the stripper and connectors following termination of PSS drawing through hollow organ walls.
  • Knife 102 is located deep in the recess, which is the only point of access to knife 102. Thanks to it, the personnel is ensured against injury by knife 102, and chance premature PSS cutting is restricted as well.
  • Stripper 75 also comprises pin 99 for stripper locking in the apparatus housing collet, as well as conical channels 100 and 101 for disconnection of needles and connectors and subsequent connector holding in stripper.
  • Figs. 26...30 show alternative embodiment of stripper 104 removably installed in housing 65 on needles 8 and 9. Needles 8 and 9 pass through stripper guides 113 and 114, 115 and 116. Stripper 104 is made slightly wider than housing 65, thus enabling the operator to manipulate stripper, while holding it for its lateral surfaces 118 and 119. Springs 105 and 106 are fixed in stripper 104 and equipped with releasing members 107 and 108 intended for disconnection of needle distal finite portions 12, 13 and connectors 20, 21, and with keeping members 109, 110 intended for keeping connectors 20, 21 in stripper 104 following their disconnection from needle distal finite portions 12, 13. Keeping members 109, 110 are equipped with slots 111, 112 for placing PSS ends 18, 19 in them, following locking of back exit out of stripper 104 for connectors 20, 21 by keeping members 109, 110.
  • Fig. 26 shows apparatus fragment in the first position when releasing members 107, 108 and keeping members 109, 110 are pressed to needles 8 and 9 by elastic forces of springs 105 and 106, respectively, and do not interfere with movement of needles 8 and 9 towards the second position, and partially out of the second position into the third one.
  • Fig. 27 shows 27-27 section of Fig. 26.
  • Fig. 28 shows the apparatus fragment before termination of transition out of the second position into the third one: connectors enter stripper 104 through orifices 113, 114 and their further progress towards the third position (proximally) is prevented by releasing members 107 and 108; keeping members 109 and 110 cover the orifices 113 and 114 and connectors 20 and 21 cannot now leave stripper 104 through them.
  • Fig. 29 shows 29-29 section of Fig. 28, additionally illustrating mutual member arrangement described. Upon further progress of needles 8, 9 towards the third position they disconnect from connectors 20, 21 and those latter, as is shown in Fig. 30, remain in stripper 104 together with PSS ends 18, 19, whereas stripper 104 per se is easily extracted from the apparatus.
  • Figs. 31-33 show alternative embodiment of stripper 117 set inside housing 65 on needles 8 and 9 passing through stripper 117 channels 118 and 119.
  • Each channel 118 and 119 has four protrusions 120 and 121, which serve as keeping members.
  • Protrusions 120 and 121 interact with conical circular protrusions 122 and 123 on connectors 20 and 21, respectively, and keep connectors from distal falling out of stripper 117.
  • the function of releasing members is fulfilled by ends 124 and 125 of needle guides 86 and 87 in housing 65.
  • connectors 20 and 21 have sections with larger diameter than that of guides 86 and 87. These sections abutt ends 124 and 125 upon movement of needles 8 and 9 to the third position.
  • Fig. 31 shows the apparatus fragment before said disconnection
  • Fig. 33 shows stripper 117 following said disconnection. In third position, stripper 117 with connectors 20, 21 and PSS ends 18, 19 is easily taken out of the apparatus .
  • Figs. 34, 35 show removable unit 68 of apparatus shown in Figs. 13...15 on an enlarged scale.
  • Unit 68 comprises coil with PSS and connectors and is equipped with mushroom-shaped pins 79 and 80, as well as protrusion 81 for fixation inside the apparatus.
  • Unit 68 has cover 126, whereunder coil with PSS is placed.
  • Figs. 36...38 show a fragment of jaw 1 of the apparatus shown in Fig. 13, located distally of working zone 5 and comprising unit 68 bucket 127 and geometrical orifices 128 and 129 for inside installation of mushroom-shaped pins 79 and 80, respectively.
  • unit 68 To install unit 68 into bucket 127, mushroom- shaped pins are inserted into orifices 128 and 129, and then unit 68 is sifted distally. In this process, heads of mushroom-shaped pins 79 and 80 enter niches 130 and 131, which results in unit 68 fixation in bucket 127.
  • Fig. 38 demonstrating 38-38 section of Fig. 36.
  • Figs. 39...41 show hub 14 of needles 8 and 9 of the apparatus given in Figs. 13..25 on an enlarged scale.
  • Hub 14 comprises actuator handle 71, pawl 92 for interaction with rack 90 (see Fig. 13), recess 132 for rack 90 passing, protrusion 97 for hub 14 fixation in first and third positions. Hub 14 interaction with other apparatus members is given in the description of Figs. 13...15.

Landscapes

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

Abstract

L'invention concerne un appareil destiné à effectuer des sutures en cordon de bourse et comprenant des lèvres (1, 2) permettant de comprimer et former des organes creux, du fil (17) et des aiguilles (8, 9) conçus pour traverser les parois d'organes creux. Le sens de perçage (50) des aiguilles (8, 9) dans les parois d'organes creux est opposé au sens de passage (51) du fil dans ces parois. Ceci permet d'éviter que les pointes des aiguilles (10, 11) lors de la perforation sortent en dehors des limites de l'appareil et de s'assurer que les extrémités des fils sortent bien dans la partie proximale de l'organe creux. Dans la position de mise en route de l'appareil, les aiguilles (8, 9) se trouvent à proximité de l'organe creux tandis que les extrémités (18, 19) du fil en sont éloignées. L'appareil est pourvu d'un dispositif (20, 21) de raccordement des pointes des aiguilles et du fil lors du déplacement des aiguilles dans leur position distale extrême, d'un dispositif (75) permettant de dégager les extrémités du fil de l'appareil et d'un dispositif permettant de placer rapidement le fil dans l'appareil. Il est possible de faire des modifications en chirurgie ouverte et en endoscopie.
PCT/IL1997/000253 1996-07-29 1997-07-27 Appareil pour la formation de sutures en cordon de bourse Ceased WO1998004195A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
IL11896996A IL118969A0 (en) 1996-07-29 1996-07-29 Purse string suture apparatus
IL118969 1996-07-29

Publications (1)

Publication Number Publication Date
WO1998004195A1 true WO1998004195A1 (fr) 1998-02-05

Family

ID=11069134

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/IL1997/000253 Ceased WO1998004195A1 (fr) 1996-07-29 1997-07-27 Appareil pour la formation de sutures en cordon de bourse

Country Status (2)

Country Link
IL (1) IL118969A0 (fr)
WO (1) WO1998004195A1 (fr)

Cited By (21)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2002036021A3 (fr) * 2000-11-06 2002-07-04 Abbott Lab Systemes, dispositifs et procedes pour suturer un tissu d'un patient
DE10121305A1 (de) * 2001-05-02 2002-12-12 Ethicon Endo Surgery Europe Chirurgisches Instrument
US7390328B2 (en) 2003-12-19 2008-06-24 Abbott Laboratories Device and method for suturing of internal puncture sites
US7445626B2 (en) 1992-12-10 2008-11-04 Abbott Laboratories Device and method for suturing tissue
USRE42625E1 (en) 1990-03-13 2011-08-16 The Regents Of The University Of California Endovascular electrolytically detachable wire and tip for the formation of thrombus in arteries, veins, aneurysms, vascular malformations and arteriovenous fistulas
USRE42662E1 (en) 1990-03-13 2011-08-30 The Regents Of The University Of California Endovascular electrolytically detachable wire and tip for the formation of thrombus in arteries, veins, aneurysms, vascular malformations and arteriovenous fistulas
USRE42756E1 (en) 1990-03-13 2011-09-27 The Regents Of The University Of California Endovascular electrolytically detachable wire and tip for the formation of thrombus in arteries, veins, aneurysms, vascular malformations and arteriovenous fistulas
US8500757B2 (en) 2009-07-28 2013-08-06 Edwards Lifesciences Corporation Surgical puncture cinch and closure system
US8858573B2 (en) 2012-04-10 2014-10-14 Abbott Cardiovascular Systems, Inc. Apparatus and method for suturing body lumens
US8864778B2 (en) 2012-04-10 2014-10-21 Abbott Cardiovascular Systems, Inc. Apparatus and method for suturing body lumens
US8920442B2 (en) 2005-08-24 2014-12-30 Abbott Vascular Inc. Vascular opening edge eversion methods and apparatuses
US8998932B2 (en) 2002-12-31 2015-04-07 Abbott Laboratories Systems for anchoring a medical device in a body lumen
US9155535B2 (en) 2003-09-26 2015-10-13 Abbott Laboratories Device and method for suturing intracardiac defects
US9241707B2 (en) 2012-05-31 2016-01-26 Abbott Cardiovascular Systems, Inc. Systems, methods, and devices for closing holes in body lumens
US9282960B2 (en) 1999-03-04 2016-03-15 Abbott Laboratories Articulating suturing device and method
US9301747B2 (en) 1999-03-04 2016-04-05 Abbott Laboratories Articulating suturing device and method
US9370353B2 (en) 2010-09-01 2016-06-21 Abbott Cardiovascular Systems, Inc. Suturing devices and methods
US9375211B2 (en) 2003-12-23 2016-06-28 Abbott Laboratories Suturing device with split arm and method of suturing tissue
US9456811B2 (en) 2005-08-24 2016-10-04 Abbott Vascular Inc. Vascular closure methods and apparatuses
US9592038B2 (en) 2005-08-08 2017-03-14 Abbott Laboratories Vascular suturing device
US10426449B2 (en) 2017-02-16 2019-10-01 Abbott Cardiovascular Systems, Inc. Articulating suturing device with improved actuation and alignment mechanisms

Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5562686A (en) * 1995-04-19 1996-10-08 United States Surgical Corporation Apparaus and method for suturing body tissue

Patent Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5562686A (en) * 1995-04-19 1996-10-08 United States Surgical Corporation Apparaus and method for suturing body tissue

Cited By (34)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
USRE42625E1 (en) 1990-03-13 2011-08-16 The Regents Of The University Of California Endovascular electrolytically detachable wire and tip for the formation of thrombus in arteries, veins, aneurysms, vascular malformations and arteriovenous fistulas
USRE42662E1 (en) 1990-03-13 2011-08-30 The Regents Of The University Of California Endovascular electrolytically detachable wire and tip for the formation of thrombus in arteries, veins, aneurysms, vascular malformations and arteriovenous fistulas
USRE42756E1 (en) 1990-03-13 2011-09-27 The Regents Of The University Of California Endovascular electrolytically detachable wire and tip for the formation of thrombus in arteries, veins, aneurysms, vascular malformations and arteriovenous fistulas
US7445626B2 (en) 1992-12-10 2008-11-04 Abbott Laboratories Device and method for suturing tissue
US9993237B2 (en) 1999-03-04 2018-06-12 Abbott Laboratories Articulating suturing device and method
US9301747B2 (en) 1999-03-04 2016-04-05 Abbott Laboratories Articulating suturing device and method
US9282960B2 (en) 1999-03-04 2016-03-15 Abbott Laboratories Articulating suturing device and method
US7377927B2 (en) 2000-11-06 2008-05-27 Abbott Laboratories Systems, devices and methods for suturing patient tissue
WO2002036021A3 (fr) * 2000-11-06 2002-07-04 Abbott Lab Systemes, dispositifs et procedes pour suturer un tissu d'un patient
DE10121305A1 (de) * 2001-05-02 2002-12-12 Ethicon Endo Surgery Europe Chirurgisches Instrument
US8998932B2 (en) 2002-12-31 2015-04-07 Abbott Laboratories Systems for anchoring a medical device in a body lumen
US9889276B2 (en) 2002-12-31 2018-02-13 Abbott Laboratories Systems for anchoring a medical device in a body lumen
US10245022B2 (en) 2003-09-26 2019-04-02 Abbott Laboratories Device and method for suturing intracardiac defects
US9155535B2 (en) 2003-09-26 2015-10-13 Abbott Laboratories Device and method for suturing intracardiac defects
US7390328B2 (en) 2003-12-19 2008-06-24 Abbott Laboratories Device and method for suturing of internal puncture sites
US10413288B2 (en) 2003-12-23 2019-09-17 Abbott Laboratories Suturing device with split arm and method of suturing tissue
US9375211B2 (en) 2003-12-23 2016-06-28 Abbott Laboratories Suturing device with split arm and method of suturing tissue
US9592038B2 (en) 2005-08-08 2017-03-14 Abbott Laboratories Vascular suturing device
US8920442B2 (en) 2005-08-24 2014-12-30 Abbott Vascular Inc. Vascular opening edge eversion methods and apparatuses
US9456811B2 (en) 2005-08-24 2016-10-04 Abbott Vascular Inc. Vascular closure methods and apparatuses
US8500757B2 (en) 2009-07-28 2013-08-06 Edwards Lifesciences Corporation Surgical puncture cinch and closure system
US9370353B2 (en) 2010-09-01 2016-06-21 Abbott Cardiovascular Systems, Inc. Suturing devices and methods
US11647997B2 (en) 2010-09-01 2023-05-16 Abbott Cardiovascular Systems, Inc. Suturing devices and methods
US10463353B2 (en) 2010-09-01 2019-11-05 Abbott Cardiovascular Systems, Inc. Suturing devices and methods
US8858573B2 (en) 2012-04-10 2014-10-14 Abbott Cardiovascular Systems, Inc. Apparatus and method for suturing body lumens
US11154293B2 (en) 2012-04-10 2021-10-26 Abbott Cardiovascular Systems, Inc. Apparatus and method for suturing body lumens
US8864778B2 (en) 2012-04-10 2014-10-21 Abbott Cardiovascular Systems, Inc. Apparatus and method for suturing body lumens
US12185938B2 (en) 2012-04-10 2025-01-07 Abbott Cardiovascular Systems, Inc. Apparatus and method for suturing body lumens
US10111653B2 (en) 2012-05-31 2018-10-30 Abbott Cardiovascular Systems, Inc. Systems, methods, and devices for closing holes in body lumens
US10980531B2 (en) 2012-05-31 2021-04-20 Abbott Cardiovascular Systems, Inc. Systems, methods, and devices for closing holes in body lumens
US11839351B2 (en) 2012-05-31 2023-12-12 Abbott Cardiovascular Systems, Inc. Systems, methods, and devices for closing holes in body lumens
US9241707B2 (en) 2012-05-31 2016-01-26 Abbott Cardiovascular Systems, Inc. Systems, methods, and devices for closing holes in body lumens
US12376845B2 (en) 2012-05-31 2025-08-05 Abbott Cardiovascular Systems, Inc. Systems, methods, and devices for closing holes in body lumens
US10426449B2 (en) 2017-02-16 2019-10-01 Abbott Cardiovascular Systems, Inc. Articulating suturing device with improved actuation and alignment mechanisms

Also Published As

Publication number Publication date
IL118969A0 (en) 1996-10-31

Similar Documents

Publication Publication Date Title
WO1998004195A1 (fr) Appareil pour la formation de sutures en cordon de bourse
JP4320061B2 (ja) 内視鏡用の制御装置
US6332888B1 (en) Finger-guided surgical instrument
US7306613B2 (en) Endoscopic instruments
US7156857B2 (en) Endoscopic instruments
US7029435B2 (en) Endoscope having multiple working segments
EP0535906B1 (fr) Dispositif de suture
Levy et al. Finger-guided surgical instrument
CA2430731C (fr) Appareil de mise en place de bandage a ligature
DE60309013T2 (de) Knoten
US8747422B2 (en) Methods for accurately deploying particular medical appliances at a target site
CA2447514C (fr) Dispositif flexible pour transfixer et joindre des tissus
US6988985B2 (en) Tissue piercing device for an endoscope
US5522820A (en) Method and apparatus for suturing tissue
AU2004240645B2 (en) Single intubation, multi-stitch endoscopic suturing system
AU775823B2 (en) Finger-guided surgical instrument
JP2006512108A (ja) 内視鏡とアクセサリの一体型治療装置
AU2002228930A1 (en) Ligating band delivery apparatus
JP2013051977A (ja) 外科手術装置
EP0806911A1 (fr) Instrument de suture chirurgicale
EP1450691A1 (fr) Dispositif de suture de plaies
US20250160625A1 (en) Over the scope clip with repositional capability
US4574805A (en) Instrument for skin surgery and method for using same
CN219661796U (zh) 缝合器、具有缝合器的治疗装置及治疗设备
KR102890836B1 (ko) 재배치 기능을 갖는 오버 더 스코프 클립

Legal Events

Date Code Title Description
AK Designated states

Kind code of ref document: A1

Designated state(s): CN JP RU US

AL Designated countries for regional patents

Kind code of ref document: A1

Designated state(s): AT BE CH DE DK ES FI FR GB GR IE IT LU MC NL PT SE

DFPE Request for preliminary examination filed prior to expiration of 19th month from priority date (pct application filed before 20040101)
121 Ep: the epo has been informed by wipo that ep was designated in this application
122 Ep: pct application non-entry in european phase