WO1993008747A1

WO1993008747A1 - Method and device for holding a celiotomy wire

Info

Publication number: WO1993008747A1
Application number: PCT/FR1992/001012
Authority: WO
Inventors: Jean-Marc Nouaille
Original assignee: Nouaille Jean Marc
Priority date: 1991-10-29
Filing date: 1992-10-29
Publication date: 1993-05-13
Also published as: FR2682867A1

Abstract

A method for holding at least one celiotomy wire by means of an instrument (16). The method comprises inserting at least one holding device (1) consisting of a projecting portion (2) and a socket portion (3) into the body of a patient by means of said instrument (16); using the instrument (16) to control the sliding movement of the projecting portion (2) relative to the socket portion (3) so that the former fits into the latter and fixes the wire; and operating the instrument (16) to disengage the holding device (1) therefrom.

Description

METHOD AND DEVICE FOR LOCKING A COELOSURGERY THREAD

TECHNICAL AREA :

The present invention relates to the field of apparatus, devices or means designed to enable blocking of a wire during the practice of surgical techniques and, more particularly, of laparoscopic surgery.

Generally speaking, laparoscopic surgery concerns an operating technique which is freed from making incisions or openings made to give access to the part to be treated of a person's organism. This technique requires the implementation of suitable instruments for crossing the abdominal wall in order to authorize the performance of specific interventions, for example at the level of the appendix or the gallbladder. These instruments generally have a passage section of the order of 5. 10 mm and a length of 400 mm. These instruments are intended to be manipulated by the surgeon from outside the body, in order to perform specific surgical operations inside the body of a person.

These operations generally require the realization of stitches or Ligature, via one or more threads. A particularly difficult problem to solve is that of stopping or blocking the suture or ligature thread or threads. In the same direction, the realization of nodes using known instruments of laparoscopy is difficult, if not impossible.

PRIOR TECHNIQUE:

Patent application WO 90/04 357 proposed a surgical instrument for deep sutures or ligatures, comprising operating handles capable of ensuring the movement of a cable on which are hung, on the one hand, transport cabins for a needle provided with a surgical thread and, on the other hand, a system allowing the tightening of a knot made outside the instrument. It appears that the practical implementation of such an instrument proves difficult to carry out. In addition, this instrument makes it possible to make a single knot, which does not make it possible to obtain a lasting blocking of the wire.

Patent application EP 0012 360 has, furthermore, proposed a button for blocking a surgical thread, comprising a disc or a housing in which a slot is made for the introduction of the thread. The housing is articulated to a disc segment intended to pivot so as to wedge the wire between the walls of the housing and the faces of the disc segment.

The blocking button described by this document is not able to be used in the laparoscopic technique and does not appear to be able to ensure effective and lasting blocking of a surgical thread.

PRESENTATION OF THE INVENTION:

The object of the invention is to remedy the drawbacks set out above by proposing a suitable method for allowing, in laparoscopic surgery, the blocking of the wires used to ensure a ligature or a suture, for example.

The object of the invention also aims to propose a method capable of dispensing with the making of knots, by making it possible to link together at least two terminal parts of a wire or of two wires.

To achieve this objective, the method according to the invention consists in: - introducing into the body of a person, using the instrument, at least one blocking device formed of a male part and a female part, - control by the instrument, the relative sliding of the male part with respect to the part female to ensure their nesting, with a view to jamming the fi L,

- and act on the instrument to allow the locking device to be detached from the instrument.

According to an advantageous characteristic of the invention, the method provides, before proceeding to the complete nesting of the parts, to engage the wire or wires to be blocked inside a notch. The object of the invention also aims to propose a device for blocking at least one wire comprising:

a male part and a female part intended to delimit between them at least one wedging zone for the wire, when the male and female parts are nested one inside the other,

- And at least one notch ensuring the grip of the wire.

The device according to the invention comprises male and female parts each provided with at least one complementary surface with an inclined profile delimiting between them at least one jamming zone When the male and female parts slide together notch arranged in a direction substantially perpendicular to the direction of nesting of the parts. Various other characteristics appear from the description given below with reference to the appended drawings which show, by way of non-limiting examples, embodiments of the subject of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS:

Fig. 1 is an exploded perspective view of a first alternative embodiment of a locking device according to the invention. Fig- 2 is a sectional view taken substantially along Line II-II of fig. 1. showing The device according to the invention in the wire locking position.

Fig. 3 is a perspective view, partially broken away, showing a locking device produced according to a different structure.

Fig. 4 is a general view of an exemplary embodiment of an instrument adapted to ensure the establishment of the blocking device by the technique of laparoscopic surgery.

Fig. 5 is a view of another embodiment of an instrument ensuring the establishment of a blocking device in laparoscopic surgery.

BEST WAY TO IMPLEMENT THE INVENTION:

Figs. 1 and 2, illustrate a device 1 according to the invention, used in coeLiosurgery and intended to ensure the blocking of at least one thread, in the general sense, to produce, for example the overlock, a suture or a ligature. The blocking device 1 according to the invention comprises a male part 2, intended to be fitted at least partially inside a female part 3. The parts 2 and 3 are adapted to provide for each other, during their fitting by translation, at least one zone 4 ensuring the jamming of at least one and, in the illustrated example, of two terminal parts 5 .. of one or two wires 5. In the example illustrated in FIGS. 1 and 2, the male part 2 is produced in the form of a truncated cone, for example of circular base, while the female part 3 has a bore 6 of shape complementary to the envelope or to the outer surface of revolution 7 of the male part 2. After the interposition of the wires 5, between the male 2 and female 3 parts, the relative displacement in translation of the parts 2 and 3 leads, by wedge effect, to a blocking of the wires placed in the zones In this example, the wires 5 extend on either side of the diameter of the part 2, so that the wires 5 are trapped by two zones 4 which are delimited by surfaces with an inclined profile or at slopes complementary, namely the external surface of revolution 7 of the male part 2 and the surface of the bore 6.

Of course, the male 2 and female 3 parts can be produced in other forms than those shown in FIGS. 1 and 2. By way of example, FIG. 3 illustrates The parts 2 and 3 having complementary trapezoidal shapes, each comprising at least one face with a slope of the same inclination. In the example illustrated, the two opposite main flat faces 8 and 9, respectively of the parts 2 and 3, delimit two wedging zones 4. For this purpose, the two main faces 8 of the male part 2 each have a slope of the same inclination as the slope of the faces 9 of the female part 3. As shown in FIG. 3, the wires are wedged between the two sloping faces 8, 9. According to an advantageous characteristic of the invention, the male 2 and female 3 parts are equipped with means ensuring their relative immobilization when these parts are fitted one into the 'other. These immobilization means are constituted, for example, by elements of complementary structures carried by the male and female parts, such as, for example, clearances, lights or grooves 12 made, at least locally, on the surface peripheral of the part 2 and intended to cooperate with notches, lugs or projections 13 formed inside the part 13. IT can also be provided to produce an annular bead ^' on the nesting end of the part male 2, so that the bead, by elastic deformation, comes to open and extend along the transverse face of the female part.

According to another advantageous characteristic of the invention, one of the parts, namely, for example, the male part 2 in the example illustrated, comprises at least one notch or a slot 14 facilitating the gripping of the wire, in order to its jamming in the zone 4. The notch 14 is formed according to the diameter of the male part 2, in a direction substantially perpendicular to the direction of interlocking or translation of the parts, represented by the arrow f. Male part 2 holds thus the son 5 during the introduction of the male part 2 inside the female part 3. Of course, the notch 14 can be formed in the female part. In this case, in order to facilitate the insertion of the wires into the female part, during the nesting of the male part, the nesting end of the latter has a U-shape ensuring the gripping of the wires.

The method or method for blocking a fî L in laparoscopic surgery by the device according to the invention follows directly from the above description. As shown more precisely in FIG. 4, The positioning of this blocking device is effected by means of an instrument 16 ^′ comprising a piston 18 controlled to slide in a sleeve 19 by means of a rod 20.

It is recalled that the sheath generally has a section of the order of 10 mm and a length of the order of 400 mm. The instrument defines, at its end intended to be inserted inside the body of a person, a well 22 for loading and ejection for at least one blocking device 1. For example, The piston 18 maintains, in cooperation with an elastic member 25 carried by the sheath 19, the male 2 and female 3 parts partially nested one inside the other. After the introduction of the lower end of the instrument 16, inside the organism, the instrument is moved to allow the thread (s) to be engaged, inside the notch 14 .

The piston 18 is then moved in sliding to ensure a relative translation between the male 2 and female 3 parts, so as to ensure the interlocking and, consequently, the jamming or blocking by wedge effect of the wire or wires in the zones 4. The piston 18 is moved so that the notches 13 cooperate with the grooves 12, in order to obtain a final relative immobilization of the two parts. The piston 18 is then pushed back, so that the locking device 1, preferably but not exclusively resiliently biased by element 25 is detached from the instrument to be left in place inside the organism.

The jamming of the wire L by the zones 4, combined with the means 12, 13 making it possible to immobilize the two parts 2 and 3 together, ensures obtaining an effective and lasting blocking of the wire or wires 5. Such a device offers the 'advantage of allowing the easy realization of nodes by the jamming of the two end parts of one or two wires. The jamming of the wire or wires is greatly facilitated by the implementation of the notch 14 which makes it possible to position and guide the wire or wires during the entire blocking operation.

Of course, the device 1 is made of a material capable of being supported or absorbed by the body of a person and can have a length of up to 10 mm. In addition, provision can be made for a disposable instrument after the installation of a single device or capable of receiving a battery of blocking devices in accordance with the invention, successively brought to the level of well 22.

Fig. 5 illustrates, by way of example, another alternative embodiment of an instrument 16 capable of being used in laparoscopic surgery to ensure the establishment of a blocking device 1 according to the invention. According to this variant, the male 2 and female 3 parts are held together during their introduction into the interior of the body, by means of the piston 18 comprising a shoulder 23 for centering the female part 3 and using a Link 26 fixed to the male part 2 and on the outer sheath 19. The relative movement of the sheath 19 relative to the piston 18 makes it possible to ensure the engagement of the male part 2 inside the female part 3 The rupture of the Link 26 after the complete fitting of the two parts allows the locking device according to the invention to be left in place. POSSIBILITY OF INDUSTRIAL APPLICATION:

The device according to the invention makes it possible, in laparoscopic surgery, to block at least one thread to perform, for example, an overlock, a suture or a ligature.

The invention is not limited to the examples described and shown, since various modifications can be made thereto without departing from its scope.

Claims

CLAIMS:

1 - Method for blocking at least one wire (5) in laparosurgery, via an instrument (16), characterized in that it consists of: - introducing into the body of a person using of the instrument (16), at least one blocking device (1) formed of a male part (2) and a female part (3),

- control by the instrument (16), the relative sliding of the male part (2) in relation to the female part (3) to ensure their nesting, with a view to trapping the wire,

- and to act on the instrument (16) to enable the blocking device (1) to be separated from the instrument.

2 - Method according to claim 1, characterized in that it consists of wedging the wire (5) between at least two surfaces with complementary slope (7, 8 - 6, 9) presented by the male ⁽ 2) and female ( 3). 3 - Method according to claim 1, characterized in that it consists, before proceeding with the complete nesting of the parts, to engage the wire or wires (5) to be blocked, inside a notch (14) .

4 - Method according to claim 1, characterized in that it consists of separating the blocking device (1) from

The instrument (16), by the breakage of a Link (26) connecting the male part to a fixed sheath (19) of the instrument (16).

5 - Device used more particularly in laparosurgery to block at least one thread (5), The device comprising:

- a male part ⁽ 2) and a female part

(3) intended to delimit between them at least one wedging zone (4) for the wire, when the male and female parts are fitted one inside the other, - and at least one notch (14) ensuring gripping of the wire (5), characterized in that the male (2) and female (3) parts each comprise at least one complementary surface ⁽ 7, 8 - 6, 9) to inclined profile delimiting between them at least one wedging zone (4) during nesting by relative sliding (f) of the male and female parts, and in that the notch ⁽ 14) is arranged in a direction substantially perpendicular to the direction of nesting Cf) of the parts.

6 - Device according to claim 5, characterized in that the notch (14) is arranged on the male part (2).

7 - Device according to claim 5, characterized in that the male (2) and female (3) parts are provided with means (12,13) to immobilize them relatively, consisting of complementary structural elements provided on the male and female and intended to cooperate together at the end of their nesting.