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WO2002038053A2 - Dispositif et procede d'assemblage d'organes creux - Google Patents

Dispositif et procede d'assemblage d'organes creux Download PDF

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Publication number
WO2002038053A2
WO2002038053A2 PCT/EP2001/012780 EP0112780W WO0238053A2 WO 2002038053 A2 WO2002038053 A2 WO 2002038053A2 EP 0112780 W EP0112780 W EP 0112780W WO 0238053 A2 WO0238053 A2 WO 0238053A2
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WO
WIPO (PCT)
Prior art keywords
needle
holder
needles
opening
hollow organ
Prior art date
Application number
PCT/EP2001/012780
Other languages
German (de)
English (en)
Other versions
WO2002038053A3 (fr
Inventor
Rolf Dieter Schraft
Andrea Hiller
Jochen Klenk
Joachim-Gerd Rein
Alexander Horke
Original Assignee
Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V.
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
Priority claimed from DE10118138A external-priority patent/DE10118138B4/de
Application filed by Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. filed Critical Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V.
Publication of WO2002038053A2 publication Critical patent/WO2002038053A2/fr
Publication of WO2002038053A3 publication Critical patent/WO2002038053A3/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
    • A61B17/08—Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0482—Needle or suture guides
    • 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
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0491—Sewing machines for surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06061—Holders for needles or sutures, e.g. racks, stands
    • 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
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
    • A61B2017/00252—Making holes in the wall of the heart, e.g. laser Myocardial revascularization for by-pass connections, i.e. connections from heart chamber to blood vessel or from blood vessel to blood vessel
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0406—Pledgets
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A61B2017/0472—Multiple-needled, e.g. double-needled, instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B2017/0496—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials for tensioning sutures
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B2017/06057—Double-armed sutures, i.e. sutures having a needle attached to each end
    • 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
    • A61B2017/1107—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis for blood vessels
    • 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
    • A61B2017/1135—End-to-side connections, e.g. T- or Y-connections
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/30—Surgical pincettes, i.e. surgical tweezers without pivotal connections
    • A61B2017/306—Surgical pincettes, i.e. surgical tweezers without pivotal connections holding by means of suction

Definitions

  • the present invention relates to a device and a method for connecting hollow organs.
  • the sewing process can be mechanized and thereby accelerated and simplified. This is particularly important in coronary surgery for performing operations on the beating heart.
  • a repeatable and high-quality connection process can be carried out by means of such devices and methods, so that the risk is minimized that the vessels are not tight, or, for example, the back wall of the vessel in question is also sewn on in coronary surgery.
  • Anastomoses ie operative connections of Hollow organs, one end of the vessel being sewn on to the other in the bypass surgery of the coronary arteries.
  • the devices and methods according to the invention can also be used for sewing on vessels in all other areas of vascular surgery.
  • the manual process can be divided into the following operational steps, in particular the connection in the anastomosis suture being the task that can be performed by mechanical devices and corresponding methods.
  • the first is a thoracotomy and a sternotomy (opening and severing the sternum).
  • the graft e.g. vein
  • an incision is made into the artery as
  • Coupling systems pursue another approach to connecting vessels, as described in "Review of Facilitated Approaches to Vascular Anastomosis Surgery", Werker, P. et al., The Society of Thoracic Surgeons, 1997. Coupling systems of this type are mostly used in the intestine or connect the vessels end-to-end.
  • a third group of methods for connecting vessels is based on conventional sewing technology, which has been mechanized.
  • One such system is the U.S. ArthroSew TM Suturing System. Surgical Dynamics.
  • the object of the present invention is therefore to provide a method and a device for closing an opening of a vessel or for connecting hollow organs, in particular for applying anastomoses, with which two hollow organs gane can be connected in a simple, safe, high quality and repeatable manner.
  • both the proximal and distal anastomoses during a coronary artery bypass operation (CABG) as well as anastomoses with the internal mammary artery can be created as a transplant. They can also be used to close (close) a vessel.
  • CABG coronary artery bypass operation
  • the basic functional principle of the device according to the invention and of the method according to the invention is based on the simultaneous piercing of a plurality of needles with thread through a vessel, wherein at the other end of the thread there are also needles which are simultaneously pierced through a second vessel.
  • This design of the device and the method solves the task of connecting hollow organs, in particular the application of anastomoses, in a simple and safe and repeatable manner.
  • the area of application is primarily bypass surgery on the heart for coronary ischemia, but also operations on other organs in the case of stenoses, occlusions, veins and thrombosis, for example in peripheral arteries.
  • the quality of the seam is increased, the rear wall is protected, for example by a needle holder designed as a shoe, and the operation can in most cases be carried out on the beating heart.
  • the device for connecting hollow organs has several individual elements, namely on loan
  • a needle holder which is arranged at one end of the holder, the needle holder protruding radially to form a protrusion over the circumference of the elongate holder, so that a plurality of needles, for example ring-shaped, can be arranged on this protrusion pointing away from the end of the holder so that they stand upright with their respective ends connected by threads.
  • the needle holder is designed as a shoe that protects the rear wall of the vessel from the needles when the holder is inserted into the incision of the vessel. The needles can then be spread apart at a predetermined angle and pushed through the vessel wall along the circumference of the incision with the aid of a needle receptacle located on the outside of the vessel wall.
  • the second container to be connected to the first container can also be sewn along its circumference of incision in this way, so that the two openings can then be tightened and connected along their circumference be connected to each other.
  • the two hollow organs are thus securely connected to one another with their openings in a form-fitting and sealing manner.
  • the holder can be designed as a table stand, for example for one end of the graft when the graft is still loose, or as a handle, for example for the second end of the graft or for the internal artery. Furthermore, the holder with an insertion aid for the
  • Transplant for example the vessel to be anastomosed.
  • This insertion aid can be an expansion of the elongated holder or can also be attached in the elongated holder in such a way that after the graft has been pulled over the holder and the insertion aid, this insertion aid is expanded, so that the graft also has a larger size.
  • the graft can be widened to a circumference which projects beyond the circumference of the needle arrangement, so that the needle is then moved longitudinally in the direction of the holder. yours can be pushed through the graft wall.
  • the holder can also be connected to a sleeve, for example a cylindrical hollow body.
  • the sleeve can be provided with a suction device. If the graft is now inserted into the sleeve, its outer wall is sucked onto the inner wall of the sleeve and fixed there.
  • the end of the graft is cut off to shape.
  • the sleeve can have a surface that is not oriented parallel to its direction of passage, for example perpendicularly or obliquely at a predetermined angle, as the cut surface.
  • the sleeve Spaced from this cut surface, the sleeve has variable pressure pads along its circumference, through which the graft can be compressed. Then the graft has a larger cross-section in the area of the cut surface than in the area of the pressure pads and narrows like a funnel in the transition to the area of the pressure pads.
  • the needles can be moved in the direction of the graft in the axial direction of the sleeve until they start in the funnel-shaped area from the inside of the graft through the vessel wall press the graft and be picked up by a needle holder on the outside of the graft. Since only the outside of the graft lies against the inside of the sleeve, the inside endothelial layers of the graft cannot be damaged. This means that distal and proximal anastomoses as well as anastomoses with the internal artery can be performed.
  • this can be aspirated in a ring by means of a suction device before the incision is made.
  • the incision is then made in a length corresponding to the circumference of the graft within the aspirated area, and the shoe with the needles is then inserted without the artery walls being able to collapse after the incision has been made in the artery.
  • a needle cap can be put over the needles and needle tips as insertion protection for the needles or for the vessel in front of the needles, which is pulled off the needles immediately before the needles are spread apart or before the needles are pushed through the vessel wall. In this way, the vessel is protected from the pointed needles and injuries as long as possible.
  • the needles can be folded out in the direction of the lateral vessel wall immediately before being pushed through the vessel wall by pushing a sleeve between the needles and the elongate holder and thus spreading the needles outward.
  • All movements for example the needle cap or the sleeve or the split receptacle for pushing the needles through the vessel wall, can be done using a handle attached to the holder ⁇ ⁇ *
  • CD 0 ⁇ H is 3 ⁇ ⁇ H ⁇ rt ⁇ ⁇ cn 0 ⁇ ⁇ - 0 ⁇ Q ⁇ ⁇ - rt ⁇ - s: ⁇ ⁇ H- > cn rr P " ⁇ 0 O ⁇ , 0 ⁇ .. H Hi. ⁇ - ⁇ 0 ⁇ P ⁇ ⁇ ö ⁇
  • the instrument For sewing on an internal mammary artery (artery that is already close to the heart and is only sutured on one side), it is conceivable to use the instrument as a minimally invasive surgical instrument and to open and close it through small accesses without opening the chest sew.
  • the part of the instrument on the arterial and transplant side would be inserted into the body through a trocar and handled endoscopically.
  • the handles of the tool can also be designed so that they can be manipulated by a robot.
  • the graft-side procedure could continue to be carried out by hand and only the artery-side procedure with the robot.
  • a flange would be attached on the artery side, which is attached to a robot flange.
  • the movement of the needle cap, the sleeve and the split receptacle are then controlled electrically, hydraulically or pneumatically or by other drives.
  • the graft-side part can also be handled by a second robot arm for suturing the internal artery.
  • the handle would be flanged to a robot with a needle holder and insertion aid.
  • the split holder would have to be pushed open manually or by another robot arm and pulled out with the needles.
  • the needle holder split holder
  • Figure 2 shows an inventive device
  • Figure 3 shows an artery with an inserted needle holder
  • FIG. 4 shows an inserted needle holder with the needle cap raised
  • Figure 5 shows the arrangement of Figure 4 in cross section
  • FIG. 6 shows a cross section through an artery with an inserted needle holder when piercing the vessel wall
  • FIG. 7 an artery with a sewn vessel wall
  • Figure 8 shows another device according to the invention
  • FIG. 9 shows the device from FIG. 8 with vasodilation
  • FIG. 10 shows the device according to FIG. 9 with a drawn vein
  • FIG. 11 shows the device according to FIG. 10 with needle holder
  • FIG. 12 shows the device according to FIG. 11 with the vessel wall sewn
  • FIG. 13 shows the device according to FIG. 12 with the needle holder removed
  • FIG. 14 a set according to the invention.
  • FIG. 15 shows the diagram of a set according to the invention during the sewing of the vessels
  • FIG. 16 the set according to FIG. 15 with the needle receptacles removed;
  • Figure 17 shows a needle holder
  • FIG. 18 shows a detail of the needle holder from FIG. 17 with the needle holder inserted
  • FIG. 19 the holder according to FIG. 18 with two inserted needle holders
  • FIG. 20 the holder according to FIG. 19 with needle receptacles inserted one above the other;
  • FIG. 21 shows a device for clipping thread ends
  • FIG. 22 shows a further device for clipping threads
  • FIG. 23 another device according to the invention.
  • FIG. 24 another set according to the invention
  • FIG. 25 shows the diagram of the set from FIG. 24 during the sewing of the vessels
  • FIG. 26 shows a further diagram of the set from FIG. 24 during the sewing of the vessels.
  • FIG. 1 shows schematically the sewing of end-to-side anastomoses.
  • An artery 10 and a vein 11 are shown in FIG. 1A.
  • the vein 11 is a graft that is to be sutured onto the artery 10.
  • similar components are designated with similar reference symbols.
  • FIG. 1B an incision 12 was made in the artery 10. The .
  • the end of the vein 11 was cut obliquely, so that there is a corresponding opening 13, the diameter of which corresponds approximately to the diameter of the opening 12.
  • FIG. IC shows how the two openings 12 and 13 of artery 10 and vein 11 are then connected to one another and sutured, so that an end-to-side anastomosis has now been produced.
  • FIG. 2 shows a device according to the invention which can be used in the manufacture of anastomoses shown in FIG. 1.
  • This device has a handle 1, at the end of which a shoe 2 is designed as a needle carrier for needles.
  • This shoe 2 is covered by a needle cap 9 together with the needles standing upright on it.
  • Above the needle cap 9 there is a needle holder 3, the function of which will be explained later.
  • sections of threads 4 are shown, which are connected to the ends of the needles.
  • FIG. 2B shows the lower part of the device from FIG. 2C in an enlarged representation in a lateral cross section. Again, the shoe 2 can be seen, on which needles 7, which are arranged in a ring around a holder 20, stand upright.
  • needles 7 are connected to threads 4 by their end facing the shoe 2.
  • a sleeve 8 which can be moved along the holder 20 via a sleeve linkage 23.
  • the entire arrangement of needles 7 and sleeve 8 is covered by a needle cap 9, which can also be moved along the holder 20 via a linkage 21 and, in the lowered state, covers the needles 7 and the sleeve 8 in a protective manner.
  • a needle holder 3 which can also be moved along the holder 20 by a suitable mechanism (not shown here).
  • FIG. 2A now shows, in a cross section offset by 90 ° to FIG. 2B, a needle holder 2 which is introduced into an artery 10.
  • the needle holder or shoe 2 was introduced into the artery 10 via a corresponding incision (not shown in cross section) and then, as shown in FIG. 2A, the needle cap 9 was pulled up.
  • the needle tips are now free within the artery, but the rear wall of the artery is protected against the needles 7 by the shoe 2.
  • Both the sleeve 8 and the needle cap 9 are through their respective linkages 23 and 21 through
  • Figure 3 shows the same arrangement as in Figure 2B, but in an external view of the artery 10. It is co ro ⁇ >
  • P EP ⁇ cn ⁇ P) ⁇ ⁇ . 0 ⁇ 0 '0 ⁇ 0 * s: ⁇ ⁇ O lJ rt P ⁇ ⁇ ⁇ - iJ 0 ⁇ P 0 lJ lJ iQ ⁇ ! ⁇ ß K Hi
  • This step completes the first half of anastomosis. Now the end of the opening of the vessel to be sutured, for example a vein, is sutured.
  • Figure 8 shows a corresponding device, but here instead of a handle a table stand 30 is used, which has a central rod 31 and a needle holder 32, in which 31 needles 37 are arranged in a ring around the central rod. These needles 37 are connected to threads 34 at their end. It should be noted that, in accordance with the oblique cut at the opening of the vein, as shown in FIG. 1, the needle holder 32 is beveled in the same way.
  • FIG. 9 shows the device from FIG. 8, a pulling aid or insertion aid 35, which partially has a thickening, being pulled onto the central rod 31.
  • the insertion aid can also be borrowed, e.g. be thickened by appropriate inflation.
  • FIG. 10 shows a further detail from a device according to FIGS. 8 and 9, a vein 11 now being drawn over the insertion aid 35. This is now also greatly expanded in the thickened area of the insertion aid, the diameter of the vein in the expanded area being larger than the diameter of the needle arrangement with the needles 37.
  • FIG. 10 also shows that a O
  • FIG. 14C and the detail from FIG. 14D show an alternative to the table stand 30.
  • the needle holder 32 with the needles 37 is fastened to a handle 40, the handle ending in a tip over which the vein can be drawn in a corresponding manner.
  • Pulling aids or insertion aids, as described above, can also be arranged here.
  • FIG. 15 shows the illustration in FIG. 14B in an enlarged form.
  • the threads are shown in two examples 4a, 4b and 34a and 34b. Otherwise, the representations correspond to the figures in FIG. 4 and FIG. 12.
  • FIG. 16 the representation takes place with the split receptacles 3a, 3b and 33a, 33b removed, again only two threads 4a, 34a and 4b, 34b being shown here as examples. Otherwise, the representation in FIG. 16 corresponds to the representations in FIGS. 7 and 13.
  • FIG. 17 shows a holder 31 for the divided needle receptacles from FIG. 16.
  • This holder 41 has slit-like openings 42, the spacing of which corresponds to the distance between the threads that originate from the divided holders 3a, 3b or 33a, 33b.
  • FIG. 18 shows how a holder 33b is inserted into the holder 41.
  • the slot-like openings here bear the reference symbols 42a to 42e, only the thread 34b which runs through the slot 42e being provided with reference symbols.
  • FIG. 19 shows how a half 3b of a needle holder and a half 33b of a further needle holder are placed next to one another in the holder 41.
  • the holder 33b is now placed in a suitable manner over the holder 3b (FIG. 20).
  • the two ends of the same thread for example denoted by 4b, 34b, are automatically located in each of the slots 42.
  • FIG. 21 shows such an auxiliary instrument, the entire instrument 45 with handle 46 and handle 47 being shown in FIG. 21B, while FIG. 21A only drives the end of the handle 47.
  • a clip holder 48 is arranged, which receives a total of five clips 49. The respective thread ends can be connected to one another with the aid of these clips 49.
  • FIG. 22 shows a further auxiliary instrument 45, which however has a clip holder 48 for only one clip 49. Instead, the instrument 45 from FIG. 22 has a plier-like abutment 50, so that with this instrument 45 two thread ends of the same thread can be clipped together in a simple manner.
  • the threads of the artery side and the graft side are tightened before the respective thread ends are clipped, so that the opening of the vein lies completely and finally on the incision in the artery. Then the threads can then this tight position can be clipped together.
  • the thread ends can of course also be knotted conventionally or other methods such as gluing, thermoforming and the like can be used. Clips made of Nitinol (Coalescent Industrial Inc.) can also be used.
  • FIG. 23 shows a further exemplary embodiment for a device which corresponds to that from FIG. 8.
  • This device has a handle 40 on which a base 61 is arranged.
  • the base 61 serves as a holder for the needle holder 32, in which needles 37 are arranged in an annular arrangement.
  • a needle receptacle 62 Arranged in the axial direction of this annular needle arrangement 37 is a needle receptacle 62 which has through openings which extend in the axial direction of the individual needles and through which the needles are guided when the needle arrangement 37 is axially moved.
  • a needle receptacle 33A and 33B is again arranged adjacent to the receptacle 62, into which the needles are inserted during axial movement.
  • This receptacle 33 is a divided receptacle, which can consequently be divided into two halves 33a and 33b with the needles 37 then inserted therein and removed.
  • Both the receptacle 62 and the needle receptacle 33 are designed as hollow bodies with through openings lying in the axial direction of the needle arrangement 37.
  • the receptacle 62 and the needle receptacle 33 are fastened to the base 61 via an external rod-shaped holder 65.
  • the receptacle 62 and the needle receptacle 33 are designed in such a way that the cross section of their through opening can be narrowed. This can be done, for example, by forming air cushions.
  • FIG. 23B shows how a graft 11 is inserted into the through opening of the receptacles 62 and 33.
  • 23C shows how the receptacles 33 and 62, the cross section of the through opening and thus also the diameter of the graft 11, are now narrowed in regions so that the cross section of the graft is retained only on the surface of the receptacle 62. This consequently narrows in a funnel shape starting from this surface 67 in the axial direction of the needles 37.
  • the largest diameter of the through opening of the receptacle 62 is now set so that it is larger than the diameter of the ring of the needle arrangement 37.
  • the narrowing by the pressure pads in the receptacles 33 and 62 takes place to a diameter which is smaller than the diameter of the Needle arrangement 37.
  • the receptacle 62 and / or the needle receptacle 33 are provided with a device for applying a negative pressure to the inner surface of their through opening.
  • the graft 11 can be sucked on its outside and thus fixed.
  • FIG. 24 shows the connection of the device for suturing the graft and the artery.
  • the needles in both devices are connected to one another via threads 34, only some of the threads being shown here in the same way as in FIG. 14.
  • threads 34 only some of the threads being shown here in the same way as in FIG. 14.
  • FIG. 25 shows this arrangement of the two devices according to the invention, the needle ends of which are each connected via threads 4A, 34a and 4B, 34b.
  • FIG. 26 shows the same arrangement after the needles 7 and 37 have been pulled through the artery 10 or the graft 11.
  • the needles 7 and 37 are then pressed into the needle receptacles 3 and 33 and fixed there.
  • the needle receptacles are now divided into two partial needle receptacles 3a, 3b or 33a and 33b and removed with tweezers 69, the ends of which are adapted to the receptacle.
  • the needle receptacles 3a, 3b, 33a, 33b can then be placed in corresponding holder and the graft of the artery fastened and thus sewn on by tightening the threads.
  • FIG. 27 shows the exact procedure for suturing the graft. It will o -H 1 1 -H -d 1
  • CM 4P r- 3 U cd 0 ⁇ to -H rH ⁇ 0 ⁇ • d 40 ⁇ ⁇ cd n 0 rH K rH ⁇ M rj r ⁇ 3: H -d 0 ⁇ ⁇ O 0 0> ⁇ ü 0 4- > -H rH: 0 • d 0 ⁇ -H cd CM 0 cd -P CO ⁇ -H ⁇ 4-1 0 cö C ⁇ -d ⁇ m M CO
  • the instruments and devices presented could also be designed as minimally invasive surgical instruments, so that there is no opening of the chest and the instrument is introduced into the body via small accesses, for example through a trocar.
  • handles 1 can also be designed such that they can be manipulated by a robot. This would allow extensive automation of the sewing process.
  • the device according to the invention or sets according to the invention with two or more such devices make it possible to connect hollow organs to one another in a simple and safe manner.

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  • 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)
  • Separation Using Semi-Permeable Membranes (AREA)

Abstract

L'invention concerne un dispositif d'assemblage d'organes creux. Ce dispositif comprend un support allongé, une fixation à aiguilles agencée sur une extrémité du support, le logement à aiguilles dépassant radialement de la périphérie du support pour former une saillie, ainsi qu'une pluralité d'aiguilles agencées verticalement sur la saillie du logement à aiguilles de manière à entourer le support.
PCT/EP2001/012780 2000-11-09 2001-11-05 Dispositif et procede d'assemblage d'organes creux WO2002038053A2 (fr)

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
DE10055472.5 2000-11-09
DE10055472 2000-11-09
DE10118138.8 2001-04-11
DE10118138A DE10118138B4 (de) 2000-11-09 2001-04-11 Vorrichtung zum Verbinden von Hohlorganen

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DE4137218C1 (fr) * 1991-11-13 1993-02-11 Heidmueller, Harald, 5000 Koeln, De
US6036699A (en) * 1992-12-10 2000-03-14 Perclose, Inc. Device and method for suturing tissue
US5545171A (en) * 1994-09-22 1996-08-13 Vidamed, Inc. Anastomosis catheter
US6280460B1 (en) * 1998-02-13 2001-08-28 Heartport, Inc. Devices and methods for performing vascular anastomosis

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