WO1990004357A1

WO1990004357A1 - Surgical instrument for deep sutures or ligatures

Info

Publication number: WO1990004357A1
Application number: PCT/FR1989/000543
Authority: WO
Inventors: Claude Suissa
Original assignee: Claude Suissa
Priority date: 1988-10-25
Filing date: 1989-10-19
Publication date: 1990-05-03
Also published as: FR2638085B1; FR2638085A1; AU4491589A

Abstract

Device allowing the remote transport of a needle mounted on a surgical thread and the making of surgical knots at its extremity. The device is comprised of a fixed handle (5) and a movable handle (1) which, acting on a serrated wheel (7), rotates by reaction an overlying wheel (10) which advances a cable or pinions (11) to which are hooked magnetized transport cabins (24-29 and 30-35) as well as a knot making system (18, 23). These cabins (24-35) are used to transport in both directions a needle (35) on which is mounted a surgical thread (43). The system (18-23) is used to transport at the extremity (41) of the fixed part of the device (15) the knot (42) which has been made outside and allows its tightening by spacing apart the branches (19, 20) of the system (18-23) on the stop (40).

Description

SURGICAL INSTRUMENT FOR DEEP SUTURES OR LIGATIONS

One of the criticisms made of percoelioscopic surgery consists in the use of laser or electrosurgical unit to cut or ensure hemostasis: this creates a source of heat in a closed peritoneal environment, which sometimes leads to organic lesions (in particular digestive) direct or by radiant heat, with the problem of pressure ulcers falling a few days later leading to peritonitis for example. The device described in the present patent proposes to partially respond to this problem by allowing the transportation back and forth of a needle mounted on a surgical thread, then the fabrication of knots to ensure proper ligation or hemostasis without cauterization. Further details on the operation of said device will appear during the description which follows (drawings given only by way of example).

Figure 1 shows, seen from its upper part, the device. The handle of the device consists of two parts: one (5) is fixed and secured to the lower support (6) of the device; the other (1) can be mobilized in a channel (4) hollowed out in the support (6). The moving part

(2) of the clamp (1) therefore slides in the channel (4): its internal part is provided with toothed pinions (3) which will act on a wheel (7) also provided with pinions (8). This wheel (7) slides around a central axis (9) fixed at the bottom on the fixed part (6). The wheel (7) is secured to an overlying wheel (10) which will rotate at the same time and in the same direction or not when the manipulator acts on the clamp (1) to bring it closer or away from the clamp ( 5). The wheel (10) is also provided with pinions (11) (these pinions can be replaced by a cable sliding along the device). The wheel

(10) will consist either of a disc (as drawn here) or, to reduce the size of the device, of an ellipse of two to several turns around which the cable or the series of gears (11) will slide. The front of the fixed part (6) supporting the clamps (1,5) and the knobs (7,10) is extended by ^* another fixed part (15) going to the end of the device. At the junction of the fixed part (6), the wheel (10) and the rod (15), we see two protruding or advanced parts (12) from the area (15) towards the wheel (10). These zones (12) are intended to ensure the extension of the path of the pinions (11) passing from the wheel (10) to the zone (15). A small bilateral space (13) therefore separates the wheel (10), which is mobile, from the zone (15), which is fixed. On the upper part of the area (15), there are two lugs (16,17) from top to bottom used to fix the surgical thread already transported to allow ligation. Below, a lug (18) fixed to the transport system by pinions or cable (11) supports two axes (19,20) terminated by two pulleys (21,22) whose role we will see below. These axes (19,20) are manufactured either from a shape memory metal, or connected by a tension spring or other return system (23). The pinions or the transport cable (11) are also connected to two transport cabins (24,25) of the needle (45) mounted on surgical wire. The two cabins (24,25) are magnetized, holding the needle (45), and are slightly separated: the needle (45) placed on these two cabins (24,25) will be easily gripped at the end of its transport channel (37) by taking in the middle of the two cabins (24,25) . Each cabin (24,25) is provided with a cover (28,29) which closes automatically at the entrance to the channel (37) and opens at its exit thanks to a spring (28,29). The automatic closing of the covers (28,29) at the entry into the channel (37) is due to the spiral shaping of the covers forcing them to perform a 180 ° rotation when entering the channel (37). Also shown in Figure 1, in dotted lines, the location of the cabins (30,31) with their covers (32,33) and their springs (34,35) ensuring after passage in the channel (36) the ascent of the needle (45) mounted after use at the end of the device (15). The channel (38) covers the entire area (15) below and two channels (36,37) where the transport cabins (24,25 and 30,31) pass, each going in opposite directions: if the 'one goes from the handle to the end the other goes up from the end towards the handle, and vice-versa. Figure 2 shows in section and from back to front the upper part of the device: the fixed part (6) passes under the knobs (7 and 10) and supports the fixed clamp (5); she

^" î is hollowed out of a cavity (4) in which can move o back and forth the movable part (2) of the clamp (1). The axis

¹ of rotation (9) around which turn the knobs (7,10) is fixed on the bottom (39) of the fixed part (6). By action on the clamp (1), mobilizing its mobile part (2), the pinions (3) of said part (2) will act on the pinions

10 (8) of the wheel (7). This is secured to the wheel (10) which will also be mobilized; in the same direction or not. The pinions or cable (11) will thus be mobilized in one direction or another, passing from the wheel (10) to the front part (15) of the device by

15 through a space (13) and projections (12) described in Figure 1. There are also the lugs for fixing the surgical thread (16,17), as well as the magnetic cabins for transporting the needle mounted (24, 25, 26, 27, 28, 29, 45). Finally the device ensuring the progression of the nodes

20 downwards and their tightening (18,19,20,21,22,23). Note that the diameter of the wheel (10) will be proportional to the length desired for the path of the cabins (24,25) and (30, 31) from their departure until their arrival at the bottom of the fixed part (15) .

FIG. 3 shows in cross section seen in a row the middle part of the device. The channel (38) covers the entire area (15) to protect it and avoid any accident during the progression of the cabins (24, 30) or the wire clamp (18, 19, 20, 21, 22). Each cabin (24) or (30)

30 is protected by its individual cover (26) or (32) held by the channel (37) or (36); the springs (28, 34) tend to push the covers (26, 32) outwards. The magnetic transport cabins (24, 30), they are connected to the pinions or the transport cable (11) and

35 progress with them (him). Similarly, the device which causes n ^{1 to} descend the nodes (18 to 23) is connected to these pinions (11).

We see on the run the spacing branches (19, 20) as well as the pulleys for transporting the thread (21, 22) and the di spos iti f (40) allowing the spacing of the branches

40 (19, 20). Figure 4 shows, seen from above, the lower part of the device, 'near its end. At the exit of the protection channel (38) fixed under the fixed part (15), we can see the channels (36, 37) from which emerge or will engulf the transport cabins (24 to 29 and 30 to 35) . The end (41) of the part (15) is rounded so as to be atraumatigue and to allow to press on the knot (42) as shown in the figure. The right (43) and left (44) branches of the wire are kept pulled by the lugs (16, 17) at the top of the device (15) and slide in the grooves of the pulleys (21, 22) of the spacer branches (19 , 20). These branches (19, 20) descended thanks to the joining of their origin (18) with the conveyor (11), are discarded after having come up against a corner area (40); this ensures the tightening of the knot (42) formed by the wires (43, 44).

The operating principle of such a device is as follows: used in percoelioscopic surgery or in a reduced model in conventional surgery to make deep knots in inaccessible areas, it allows (through a trocar previously introduced by a counter-incision in in the case of operative laparoscopy) to bring a needle mounted (45) on a surgical thread (43) within reach of a gripper. The needle (45) is placed outside straddling the transport cabins (24, 25); by bringing the handle (1) closer to the other (5) by a manual movement of closing the pliers, the surgeon will, via the branch (2) of the handle (1) provided with its pinions (3 ), mobilize the wheel in rotation

(7) by its pinions (8); the wheel (10) integral with the underlying wheel (7) will also rotate: this movement will cause the pinions or the connecting cable

(11) which will advance the cabins (24, 25) towards the end of the device (15). When entering the channel

(37), the cabins (24, 25) have their covers (28, 29) rotate 180 ° by simple mechanical effect; the needle (45) mounted (43) is thus isolated during transport to the end of the device (15); at the exit of the channel (37), the covers (26, 27) of the transport cabins (24, 25) will open automatically under the action of the springs (28, 29); the mounted needle (45), fixed by the magnets, is available for gripping by the jaws of a gripper entering the cabins (24) and (25). Once the needle (45) has been used, passed in single or overlock, etc., it is rested on the magnetic cabins (30, 31) (to be noted that during the movement from top to bottom, either from the handle towards the end of the cabins (24, 25), the cabins (30, 31) are raised from the bottom up; it is therefore necessary to move the clamps apart or open (1) and (5) to bring the cabs back (30, 31) in the low position to bring the needle up (45); the mobilization of the clamps (1) and (5) in closing will advance the cabins (30, 31) from bottom to top; passing through the channel

(36), their covers (32, 33) will close, protecting the needle during the ascent; at the outlet of the channel (36), the covers (32, 33) will open under the action of the return springs (34, 35); the mounted needle (45) is then accessible: the wire (43) which is attached thereto has therefore gone back and forth by passing over the anatomical location chosen; the branches (43, 44) of the wire are then knotted outside the body, near the handle of the device, then placed in the grooves of the pulleys (21, 22) before being fixed on the gripping lugs (16 , 17). A new mobilization of the clamp (1) towards the clamp (5) in closing will advance the flat knot thus prepared from top to bottom, from the handle towards the end (41) of the device (15). The stop (40) located at the end of the travel of the spacer branches (19, 20) will, by its configuration, separate the pulleys (21, 22), stretching the branches of the wire (43, 44) while the end (41) will press on the knot

(42) as would the finger and the hands of an operating aid. The first knot thus made, by removing the clamps (1) and (5), we reassemble the device (18 to 23) whose branches (19, 20) are made of memory metal or are connected by a system of reminder (23) to bring them up. We repeat the operation as many times as desired before cutting the branches with a chisel

(43, 44) of the wire and repeat the operation in another place. Such a device is more particularly intended for the practice of laparoscopic surgery.

Claims

REVENDICA IONS

1) Surgical device usable in deep visceral surgery and especially in laparoscopic surgery characterized by the presence on the same instrument of transport cabins back and forth (24 to 29 and 30 to 35) intended for a mounted needle (45) and d '' a system (18 to 23) allowing the shaping and tightening of surgical nodes (42) at a distance from a chosen area.

2) Device according to claim 1 characterized by the presence on its handle of a fixed part and a movable part (1) acting by its longitudinal branch (2) provided with pinions (8) itself mobilizing another wheel ( 10) circular or ellipsoidal.

3) Device according to claims 1 and 2 characterized in that the mobilization of the wheel (10) will act on pinions or a cable (11) moving back and / or return of the magnetic transport cabins (24 to 29 and 30 to 35) going two by two, each in the opposite direction to the others.

4) Device according to claim 3 characterized in that the cabins (24,25 and 30, 31) will have their covers (28, 29 and 32, 33) close automatically when entering the transport channels (37,36) and open automatically when exiting under the effect of springs (28,29 and 34,35).

5) Device according to claims 1, 2, 3 characterized by the fact of a concomitant mobilization of the cabins (24 to 39 and 30 to 35) with the pushing / tightening device of the nodes (18 to 23).

6) Device according to claims 3 and 4 characterized in that the magnetic cabins (24, 25) and (30, 31) are separated from each other by a space allowing the gripping at its location of the needle (45) previously arranged on said cabins.

T 7) Device according to claims 3 and 5 characterized in that the device (18 to 23) pushing the son-tightening of the nodes will abut at the end of the fixed part (15) on a region shaped so that it will spread the branches (19,20) terminated by the pulleys (21,22) in the grooves through which the strands of the surgical thread pass

(43,44) fixed at the top on the lugs (16,17), allowing the tightening of the knot (42) on which the end (41) of the fixed part (15) rests (these branches (19,20) being made of memory metal or with a recall system (23)).

8) Device according to claims 1 to 5 characterized in that the diameter of the wheel (10) is directly proportional to the length of the journey made back and forth by the cabins (24,25 and 30,31) or the device tightening the knots (18 to 23).

P CEMENT