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WO2013004269A1 - Dispositif et procédé pour acheminer de la bile vers un emplacement cible dans l'intestin - Google Patents

Dispositif et procédé pour acheminer de la bile vers un emplacement cible dans l'intestin Download PDF

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Publication number
WO2013004269A1
WO2013004269A1 PCT/EP2011/061117 EP2011061117W WO2013004269A1 WO 2013004269 A1 WO2013004269 A1 WO 2013004269A1 EP 2011061117 W EP2011061117 W EP 2011061117W WO 2013004269 A1 WO2013004269 A1 WO 2013004269A1
Authority
WO
WIPO (PCT)
Prior art keywords
catheter
pump
pushing
fluid
conduit
Prior art date
Application number
PCT/EP2011/061117
Other languages
English (en)
Inventor
Douglas Ned Ladd
Michele D'arcangelo
Mark Steven Ortiz
Martin Fried
Original Assignee
Ethicon Endo-Surgery, Inc.
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 Ethicon Endo-Surgery, Inc. filed Critical Ethicon Endo-Surgery, Inc.
Priority to PCT/EP2011/061117 priority Critical patent/WO2013004269A1/fr
Publication of WO2013004269A1 publication Critical patent/WO2013004269A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • 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
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2002/041—Bile ducts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/80—Suction pumps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2202/00—Special media to be introduced, removed or treated
    • A61M2202/04—Liquids
    • A61M2202/0403—Gall; Bile

Definitions

  • the present invention relates, in general, to devices and methods for surgically influencing the digestion of a patient with the aim to treat metabolic disorders, such as morbid obesity and related co-morbidities, such as diabetes, heart disease, stroke, pulmonary disease, and accidents.
  • metabolic disorders such as morbid obesity and related co-morbidities, such as diabetes, heart disease, stroke, pulmonary disease, and accidents.
  • a known minimally invasive bypass system and method for modifying the location at which bile and pancreatic secretions interact with nutrients in a gastrointestinal tract has been discussed in US 2005085787 A1 .
  • the known system comprises a conduit having a first end which diverts bile and pancreatic secretions from the ampulla of Vater to a location downstream in the gastrointestinal tract and a second end attached to the ampulla of Vater.
  • the known conduit can divert only the amount of bile which has been released through the sphincter of ODDI and the flow rate of bile through the known conduit might not be sufficient to obtain a significant acceleration of the bile cycling compared to the natural entero-hepatic bile cycling velocity.
  • a method for diverting biliary fluid from a biliary fluid flow path to a target location in the intestine distal to a duodenal papilla of Vater comprising the steps of:
  • Arranging the pump inside the intraperitoneal space allows to extend the catheter along a shortest possible direct path from the biliary tree, including the gall bladder, to a distal section of the small intestine and to approximate the target section of the intestine to the biliary tree inside the abdominal space, in order to keep the entire catheter length short.
  • the short catheter length together with the pumping action reduces the time it takes for the diverted bile to flow from the biliary tree through the catheter to the target location in the intestine.
  • Arranging the pump inside the gallbladder allows to extend the catheter along a shortest possible direct path from the biliary tree to a distal section of the small intestine and to approximate the target section of the intestine to the biliary tree or even in direct contact to each other, in order to keep the entire catheter length short.
  • the short catheter length together with the pumping action reduces the time it takes for the diverted bile to flow from the biliary tree through the catheter to the target location in the intestine.
  • a method for diverting biliary fluid from a biliary fluid flow path to a target location in the intestine distal to a duodenal papilla of Vater comprising the steps of:
  • Extending the catheter strictly intraluminally and arranging the pump inside the small intestine allows to place the entire device with an endoluminal procedure in an ambulatory surgery center, thereby greatly reducing the cost.
  • the method comprises the step of feeding a diluting liquid into the biliary tree and pumping the biliary fluid mixed with the diluting liquid through the catheter.
  • the dilution of the biliary fluid facilitates the transport into the pump and through the catheter and reduces the risk of stone formation and clogging both in the catheter and in the biliary tree.
  • the method comprises:
  • the catheter can be routed along a shortest possible direct path from the biliary tree to a distal section of the small intestine, in order to keep the entire catheter length short, while the pump can be arranged in a more appropriate location remote from the catheter. Also in this case, the short catheter length together with the pumping action reduces the time it takes for the diverted bile to flow from the biliary tree through the catheter to the target location in the intestine.
  • a further aim of the invention is to provide a device for conveying bodily fluid, particularly biliary fluid from a biliary fluid flow path to a target location in the intestine distal to a duodenal papilla of Vater, the device comprising:
  • a catheter having a proximal end portion and a distal end portion and a duct portion extending between the proximal end portion and the distal end portion, said duct portion having a flexible wall which delimits an internal channel of the catheter,
  • the pushing conduit being connected with the duct portion of the catheter such that the flexible wall separates the internal channel from the pushing fluid
  • a pump connected to the pushing conduit and operable to pulsatingly displace the pushing fluid inside the pushing conduit, thereby pulsatingly deforming the flexible wall of the catheter.
  • one way valves are provided in the internal channel of the catheter to convert the pulsating deformation of the flexible wall in an unidirectional flow of a fluid through the internal channel.
  • the pushing conduit comprises a closed loop conduit and the pump is adapted to pulsatingly circulate the pushing fluid, particularly a saline solution, in a d irection wh ich , at the flexible wall, corresponds to an unidirectional flow direction in the internal channel.
  • FIG. 1 through 5 illustrate methods for translumenally pumping bile towards a target location in the intestine in accordance with embodiments of the invention
  • FIG. 6 illustrates a further method and a device for pumping bile towards a target location in the intestine in accordance with an embodiment of the invention
  • FIG. 7 illustrates a device for conveying a bodily fluid in accordance with an embodiment of the invention
  • FIG. 8 to 10 illustrate cross-sectional views in plane X-X in figure 7 in accordance with embodiments of the invention.
  • FIG. 1 1 illustrates a method for intraluminally pumping bile towards a target location in the intestine in accordance with an embodiment of the invention.
  • figure 1 is a partial view of the abdominal cavity of a patient, depicting the stomach 1 , duodenum 2, jejunum 3, ileum 4, colon 5, as well as the biliary tree 6 with gall bladder 7, the pancreatic duct 8 and the mayor duodenal papilla of Vater 9 through which the bile and pancreatic fluid normally enter the duodenum 2.
  • Figure 1 shows further a method and a device 10 for diverting and conveying biliary fluid from the biliary fluid flow path to a target location 12 in the intestine 3, 4 distal of the papilla of Vater 9.
  • the method comprises the steps of extending a catheter 1 1 translumenally from the biliary fluid flow path through the abdominal cavity (particularly the intraperitoneal space) to the target location 12 in the intestine 3, 4 distal to the duodenal papilla of Vater 9, connecting a pump 13 to the catheter 1 1 and operating the pump 13 to accelerate a bile flow through the catheter 1 1 , and arranging the pump 13 within the intraperitoneal space inside the abdominal cavity.
  • the catheter 1 1 can be extended along a shortest possible direct path from the biliary tree 6, e.g. the gall bladder 7 or the common bile duct, to a distal section of the small intestine 3, 4 and to approximate the target location 12 of the intestine to the biliary tree 6 inside the abdominal space, in order to keep the entire catheter length short.
  • the short catheter length together with the pumping action reduces the time it takes for the diverted bile to flow from the biliary tree 6 through the catheter 1 1 to the target location 12 in the intestine.
  • a proximal end portion 15 of the catheter 1 1 forms an inlet opening 20 and is arranged within the gallbladder 7 by inserting it through a previously created cholecystomy 16 which may be purse stringed around the catheter 1 1 .
  • a distal end portion 17 of the catheter 1 1 forms an outlet opening 19 and is arranged within the intestine by inserting it through a previously created enterotomy 18 which may be purse stringed around the catheter 1 1.
  • the pump 13 may be operated in response to a contraction of the gall bladder 7, e.g. by means of a pressure sensor 21 connected to the catheter 1 1 and adapted to sense a pressure inside the catheter proximal (upstream) of the pump 13 and a pump control adapted to operate the pump 13 when the pressure sensed by the pressure sensor 21 exceeds a predetermined threshold value.
  • a pressure sensor 21 connected to the catheter 1 1 and adapted to sense a pressure inside the catheter proximal (upstream) of the pump 13 and a pump control adapted to operate the pump 13 when the pressure sensed by the pressure sensor 21 exceeds a predetermined threshold value.
  • the catheter 1 1 may be provided with a mesh shaped flange 22 protruding radially outward from a tubular catheter wall and adapted to form a serosal ingrowth media to assure a reliable tissue adherence and seal.
  • Figure 2 illustrates a further exemplary embodiment which differs from the embodiment of figure 1 in that the proximal end portion 15 of the catheter 1 1 is arranged within the duodenum 2 at the papilla of Vater 9 by inserting it through a previously created proximal enterotomy 23 in the duodenum 2 near the papilla of Vater 9 and by connecting the inlet opening 20 from inside the duodenum 2 to the sphincter of ODDI in a flow communication with the common bile duct 14 and, preferably, isolating the common bile duct 14 from the duodenum.
  • the proximal enterotomy 23 can be purse stringed around the catheter 1 1 and serosal ingrowth can be promoted by a mesh shaped flange 22.
  • the proximal end portion 15 of the catheter 1 1 is arranged within a hepatic duct 24, i.e. within the right or left or common hepatic d uct, for instance by means of a laparoscopic transhepatic cholangiography.
  • a thin needle is inserted laparoscopically through the liver 25 (transhepatic) into the hepatic duct 24 or further down in the bile duct 14.
  • contrast media x-ray dye
  • a small guide wire is guided through the needle, into the hepatic duct 24 and possibly into the common bile duct while watching the wire and ducts on x-ray.
  • the proximal catheter end portion 15 is then inserted and fixated in the hepatic duct 24 to allow the bile to be drained from the liver, thereby avoiding manipulation of the very delicate and fragile common bile duct.
  • the proximal end portion 15 of the catheter 1 1 may be fixated in the hepatic duct 24 by means of suture or an anchoring member, such as for example a metal stent, an inflatable balloon or a barbed anchoring portion.
  • the common bile duct 14 may be blocked by clipping or transection in order to route the entire flow of bile through the catheter 1 1.
  • the pump instead of arranging the pump 13 inside the intraperitoneal space, the pump is connected to the proximal end portion 15 of the catheter 1 1 and arranged within the gallbladder 7, while the catheter 1 1 can be inserted and positioned as described in relation with the embodiment of figure 1 .
  • the pump 13 directly inside the gallbladder 7 it is possible to extend the catheter 1 1 along a short and direct path from the biliary tree to a distal section of the small intestine and to approximate the target section of the intestine to the biliary tree or even in direct contact to each other, in order to keep the entire catheter length short.
  • the latter may be attached to the target section of intestine by means of a choledochoenterostomy, wherein the catheter 1 1 is extended from inside the gallbladder 7 directly through the choledochoenterostomy into the intestine.
  • the method may comprise an operation of the pump 13 at regular time intervals such that:
  • a substantial accumulation of bile in the biliary tree 6 and gall bladder 7 is prevented, thereby obviating the need to passively preventing the bile from flowing through the sphincter of ODDI into the duodenum, e.g. by blocking the common bile duct, or - an accumulation of bile in the biliary tree 6 and gall bladder 7 is maintained within a predetermined limit, such that, in response of a contraction of the gall bladder 7 during chyme transit through the intestine, only a reduced volume of bile is released through the sphincter of ODDI into the duodenum.
  • the method comprises arranging a catheter 1 1 isolated from the intraperitoneal space and intraluminally from inside the biliary tree 6 through the papilla of Vater 9 to the target location 12 in the intestine distal to the papilla of Vater 9, connecting a pump 13 to the catheter 1 1 and operating the pump 13 to accelerate a bile flow through the catheter 1 1 , in which the pump 13 is arranged within the small intestine.
  • a diluting liquid 26 e.g. saline solution or water
  • a diluting liquid 26 may be fed into the biliary tree 6, particularly in the gallbladder 7 and the biliary fluid mixed with the diluting liquid 26 is pumped through the catheter 1 1 .
  • the dilution of the biliary fluid facilitates its transport into the pump 13 and through the catheter 1 1 and reduces the risk of stone formation and clogging both in the catheter and in the biliary tree.
  • the device 1 0 may comprise a diluting conduit 29 with a discharge opening 30, a reservoir 27 connected to the diluting conduit 29 and adapted to receive and hold a volume of the diluting liquid 26, and diluting pump means 28 connected to the diluting conduit 29 and adapted to convey the diluting liquid 26 from the reservoir 27 through the diluting conduit 29 and out of the discharge opening 30.
  • the diluting pump means 28 are adapted to operate in dependency of or in synchrony with the operation of the pump 13.
  • the discharge opening of the diluting conduit 29 can be arranged translumenally inside the biliary tree 6, particularly inside the gallbladder 7 (using e.g. the same surgical techniques described for the placement of the proximal catheter end portion 15 in the embodiment of Figure 1 ), while the reservoir 27 and the diluting pump means 28 can be advantageously placed subcutaneously or intramurally in the abdominal wall.
  • the pump 13 is connected to the catheter 1 1 by connecting the pump 13 to a closed pushing conduit 31 containing a pushing fluid and connecting a portion of the pushing conduit 31 with a flexible wall 33 of the catheter 1 1 , and operating the pump 13 to pulsatingly displace the pushing fluid inside the closed pushing conduit 31 , thereby pulsatingly deforming the flexible wall 33 of the catheter 1 1 .
  • the catheter 1 1 can be routed along a shortest possible direct path from the biliary tree to a distal section of the small intestine, in order to keep the entire catheter length short, while the pump 13 can be arranged in a more appropriate location remote from the catheter 1 1 .
  • the pump 13 and also a possible pushing liquid reservoir 38 connected with the pump 13 can be e.g. placed in the intraperitoneal space or subcutaneously or intramurally in the abdominal wall.
  • FIGS 7 through 10 illustrate a device 10 for conveying bodily fluid, particularly for conveying biliary fluid from a biliary fluid flow path to a target location in the intestine distal to a duodenal papilla of Vater.
  • the device 10 comprises a catheter 1 1 having a proximal end portion 15 and a distal end portion 17 and a duct portion 32 extending between the proximal end portion 15 and the distal end portion 17.
  • the duct portion 32 forms a flexible wall 33 which delimits an internal channel 34 of the catheter 1 1 .
  • a closed pushing conduit 31 contains a pushing fluid and is connected with the duct portion 32 of the catheter 1 1 such that the flexible wall 33 separates the internal channel 34 from the pushing fluid.
  • a pump 13 is connected to the pushing conduit 31 and operable to pulsatingly displace the pushing fluid inside the pushing conduit 31 , thereby pulsatingly deforming the flexible wall 33 of the catheter 1 1.
  • one way valves 35 may be provided in the internal channel 34 of the catheter 1 1 to convert the pulsating deformation of the flexible wall 33 in an unidirectional flow of a fluid through the internal channel 34.
  • the pushing conduit 31 comprises a closed loop conduit and the pump 13 is adapted to pulsatingly circulate the pushing fluid, particularly a saline solution, in a direction which, at the flexible wall 33, corresponds to an unidirectional flow direction in the internal channel 34 of the catheter 1 1.
  • the generated circulating wave of pushing liquid facilitates the unidirectional transport of bodily fluid through the catheter 1 1 .
  • the device 10 may comprise a single piece dual lumen tube 36 forming the duct portion 32 and a portion of the pushing conduit 31 extending parallel adjacent to the duct portion 32, as well as the flexible wall 33 separating the internal channel 34 of the duct portion 32 from the portion of the pushing conduit 31.
  • the duct portion 32 of the catheter 1 1 and the adjacent portion of the pushing conduit 31 are arranged side by side and contained by a substantially non extensible external tubular wall 37 which delimits both lumens.
  • the duct portion 32 of the catheter 1 1 extends substantially coaxially inside the adjacent portion of the pushing conduit 31 which defines a substantially ring shaped space contained by the non extensible external tubular wall 37.
  • the portion of the pushing conduit 31 extends substantially coaxially inside the adjacent duct portion 32 of the catheter 1 1 which defines a substantially ring shaped space contained by the non extensible external tubular wall 37.
  • the non extensible external wall 37 assures that the expansion of the pushing conduit 31 effectively compresses the internal catheter channel 34.
  • the pump 13 may comprise an onboard power source with an inductive rechargi ng u n it adapted to be energized by an extracorporeal charging station configured to operate a transcutaneous energy transfer (TET).
  • TET transcutaneous energy transfer
  • the pumping operation can be automatically or manually controlled, adjusted and activated by means of an extracorporeal magnetic pump controller which may be integrated in the above mentioned charging station or distinct from the latter.
  • the pump controller is adapted to generate and transmit to the pump 13 a control signal by magnetic induction in a near-field propagation mode and the pump 13 is adapted to pump the bile in response to and in accordance with the control signal.

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  • Health & Medical Sciences (AREA)
  • Gastroenterology & Hepatology (AREA)
  • Pulmonology (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • External Artificial Organs (AREA)

Abstract

L'invention concerne un dispositif (10) pour acheminer un fluide corporel, lequel dispositif comprend un cathéter (11) ayant une partie de conduit (32) formant une paroi souple (33) qui délimite un canal interne (34) du cathéter (11), un conduit de poussée fermé (31) contenant un fluide de poussée et étant relié à la partie de conduit (32) du cathéter (11) de sorte que la paroi souple (33) sépare le canal interne (34) du fluide de poussée, et une pompe (13) reliée au conduit de poussée (31) et apte à déplacer par pulsation le fluide de poussée à l'intérieur du conduit de poussée (31), permettant ainsi de déformer par pulsation la paroi souple (33) du cathéter (11).
PCT/EP2011/061117 2011-07-01 2011-07-01 Dispositif et procédé pour acheminer de la bile vers un emplacement cible dans l'intestin WO2013004269A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/EP2011/061117 WO2013004269A1 (fr) 2011-07-01 2011-07-01 Dispositif et procédé pour acheminer de la bile vers un emplacement cible dans l'intestin

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/EP2011/061117 WO2013004269A1 (fr) 2011-07-01 2011-07-01 Dispositif et procédé pour acheminer de la bile vers un emplacement cible dans l'intestin

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WO2013004269A1 true WO2013004269A1 (fr) 2013-01-10

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PCT/EP2011/061117 WO2013004269A1 (fr) 2011-07-01 2011-07-01 Dispositif et procédé pour acheminer de la bile vers un emplacement cible dans l'intestin

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN106073954A (zh) * 2016-06-14 2016-11-09 广州市番禺区中心医院 肝内外胆管体外互联装置
CN119174850A (zh) * 2024-11-04 2024-12-24 江苏万略医药科技有限公司 一种动物胆汁长期收集装置

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20040220516A1 (en) * 2002-11-04 2004-11-04 Stephen Solomon Food extraction apparatus and method
US20040249362A1 (en) * 2003-03-28 2004-12-09 Gi Dynamics, Inc. Enzyme sleeve
US20050085787A1 (en) 2003-10-17 2005-04-21 Laufer Michael D. Minimally invasive gastrointestinal bypass
US20090264808A1 (en) * 2005-10-24 2009-10-22 Andrew Young Biliary/Pancreatic Shunt Device and Method for Treatment of Metabolic and Other Diseases
WO2012007045A1 (fr) * 2010-07-16 2012-01-19 Ethicon Endo-Surgery, Inc. Dispositif et procédé de détournement sous-cutané de la bile

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20040220516A1 (en) * 2002-11-04 2004-11-04 Stephen Solomon Food extraction apparatus and method
US20040249362A1 (en) * 2003-03-28 2004-12-09 Gi Dynamics, Inc. Enzyme sleeve
US20050085787A1 (en) 2003-10-17 2005-04-21 Laufer Michael D. Minimally invasive gastrointestinal bypass
US20090264808A1 (en) * 2005-10-24 2009-10-22 Andrew Young Biliary/Pancreatic Shunt Device and Method for Treatment of Metabolic and Other Diseases
WO2012007045A1 (fr) * 2010-07-16 2012-01-19 Ethicon Endo-Surgery, Inc. Dispositif et procédé de détournement sous-cutané de la bile

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN106073954A (zh) * 2016-06-14 2016-11-09 广州市番禺区中心医院 肝内外胆管体外互联装置
CN119174850A (zh) * 2024-11-04 2024-12-24 江苏万略医药科技有限公司 一种动物胆汁长期收集装置

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