DE19711288B4 - Applicator to hold and close a surgical clip - Google Patents
Applicator to hold and close a surgical clip Download PDFInfo
- Publication number
- DE19711288B4 DE19711288B4 DE1997111288 DE19711288A DE19711288B4 DE 19711288 B4 DE19711288 B4 DE 19711288B4 DE 1997111288 DE1997111288 DE 1997111288 DE 19711288 A DE19711288 A DE 19711288A DE 19711288 B4 DE19711288 B4 DE 19711288B4
- Authority
- DE
- Germany
- Prior art keywords
- applicator
- clip
- closing
- receiving
- arm
- 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.)
- Expired - Fee Related
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets 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, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B2017/1107—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis for blood vessels
Abstract
Applikator zum Aufnehmen und Schließen einer chirurgischen Klammer, dadurch gekennzeichnet, daß der Applikator zwei Stößel (38, 39) besitzt, welche über Betätigungselemente (34,37) betätigt werden und jeweils auf einen Arm einer Klammer wirken, wobei die Klammer über eine rückwärtige Verlängerung (13) in der Mitte der Klammer und eine Ausnehmung (14) in der Mitte der Klammer distalwärts verfügt die jeweils beim Schließen in eine Ausnehmung (41) und einen Haltestift (40) eingreifen um die asymmetrische Schließkraft aufzunehmen mit der die jeweiligen Klammerarme unabhängig voneinander betätigt werden.applicator for picking up and closing a surgical clip, characterized in that the applicator two plungers (38, 39), which over actuators (34.37) actuated and act on one arm of a clip, the clip over a rear extension (13) in the middle of the bracket and a recess (14) in the middle of the Brace distally has which each when closing in a recess (41) and a retaining pin (40) engage around the asymmetrical closing force with which the respective clamp arms are operated independently of each other.
Description
Zum
Abklemmen von Gefäßen und
zusammenhalten von Wunden werden heute in der Medizin viele verschiedene
Formen von Klammern und Clips eingesetzt, die entsprechend ihrer
Anwendung gestaltet sind. So wird z. B. das Schließen von
Wunden, insbesondere an der Haut mit Klammern bewerkstelligt, welche
das Gewebe beim Schließen
gleichzeitig zusammenraffen und die Wundränder zusammendrücken z.B.
Zur
Anastomose am Darm gibt es spezielle Klammern, welche reihenweise
in einem Applikator angeordnet sind und nach entsprechender Vorbereitung
der Darmenden mit einem Werkzeug im Applikator geschlossen werden,
sodaß die
Gefäßränder zusammengehalten
werden. Klammer und Applikator müssen
aufeinander abgestimmt sein um ein optimales Ergebnis zu erzielen.
Bei diesen Klammern und Clips wird die Schließung mechanisch durch eine entsprechende
Vorrichtung bewerkstelligt, wobei die beiden Arme symmetrisch gebogen
bzw. durch ein Werkzeug im Applikator verformt werden und so den gewünschten
Klammer- bzw. Halteeffekt bewirken. In
In
In der Koronarchirurgie werden Anastomosen d. h. Nahtverbindungen zwischen einer Vene oder der Arterie mammaria interna und einem Koronargefäß angelegt. Die konventionelle Verbindung zwischen zwei Blutgefäßen, d. h. die Anastomose, wird durch eine fortlaufende, überwendliche Naht erzielt.In coronary surgery anastomoses d. H. Seam connections between a vein or internal mammary artery and a coronary artery. The conventional connection between two blood vessels, i.e. H. the anastomosis, is characterized by a continuous, overworkable Seam achieved.
Sobald die Koronaroperation auf endoskopischem Weg, d. h. ohne Eröffnung des Brustbeines, und nur über seitlich und vorne am Brustkorb angebrachte kleine Zugangslöcher, ausgeführt werden soll, ist eine manuell durchgeführte direkte Nahtverbindung von Koronargefäß mit Vene bzw. Arterie mammaria interna technisch nur schwer möglich. Gründe für die hohe technische Schwierigkeit einer Nahtvereinigung bei limitiertem Zugang sind die Tiefe des Operationszielgebietes und die begrenzte Möglichkeit, eine Nadel sowohl durch Venenwand wie auch Arterienwand mit der typischen Nadelhalterbewegung zu führen.As soon as endoscopic coronary surgery, d. H. without opening the Sternum, and just over small access holes on the side and front of the chest should be made, is a manual one direct connection of the coronary vessel with the vein or artery mammaria internally technically difficult. Reasons for the high Technical difficulty of joining seams with limited access are the depth of the surgical target area and the limited possibility a needle through both the vein wall and the artery wall with the typical needle holder movement.
Hier bietet es sich an, die Vereinigung beider Gefäße durch eine Klammernaht herzustellen. Entscheidend für eine erfolgreiche Klammernahttechnik ist die rasche Durchführbarkeit, der sichere Sitz jeder Klammer und die Dichtigkeit der Anastomose.Here it makes sense to unite both vessels by means of a staple. Crucial for a successful stapling technique is quick feasibility, the secure fit of each clip and the tightness of the anastomosis.
Aber auch in der offenen Chirurgie hat ein Klammergerät Vorteile, da das Setzen von Klammern weniger Zeit in Anspruch nimmt als die Naht.But Even in open surgery, a stapler has advantages because the setting of Staples take less time than the seam.
Der in der nachfolgenden Erfindung beschriebene Applikator dient der Anastomose von koronaren Blutgefäßen welcher z.B. bei einer Bypassoperation angewendet wird. Auch für diese Applikation sind Klammern bekannt, welche über die mit einer Pinzette zusammengehaltenen Gefäßränder geschoben und dann zusammengedrückt werden, wodurch die Gefäßränder zusammengehalten werden. Diese Klammern haben aber den Nachteil, daß sie relativ leicht wieder abgehen und damit ernste Komplikationen z. B. die einer Blutung auftreten können.The Applicator described in the following invention serves the Anastomosis of coronary blood vessels which e.g. is used in a bypass operation. For this too Appliqué brackets are known which can be used with tweezers pushed together vessel edges and then squeezed which keeps the edges of the vessels together become. However, these brackets have the disadvantage that they are relative easily come off again and thus serious complications z. B. the bleeding may occur.
Die Aufgabe der Erfindung ist es, einen Applikator und eine dazu passende Klammer zu entwickeln, welche die oben beschriebenen Nachteile ausschaltet und koronare Blutgefäße fest und sicher verbindet. The The object of the invention is an applicator and a matching one To develop bracket that eliminates the disadvantages described above and coronary blood vessels and safely connects.
Die Aufgabe wird durch den gattungsgemäßen Applikator und die zu ihm passende Klammer durch die im kennzeichnenden Teil des Anspruchs 1 angegebenen Merkmale gelöst. Vorteilhafte Ausgestaltungen sind in den Unteransprüchen angegeben.The task is performed by the generic ß applicator and the matching bracket solved by the features specified in the characterizing part of claim 1. Advantageous refinements are specified in the subclaims.
Im Gegensatz zur konventionellen Klammer, die im geöffneten Zustand einem abgeflachten U entspricht, ist es für die Gefäßanastomose entscheidend, daß die Klammer asymmetrisch aufgebaut ist. Entsprechend sollte ein Arm des U länger als der andere sein. Der kürzere Arm wird zuerst geschlossen. Zunächst hakt man mit dem kürzeren Arm das Bypassgefäß, d. h. die Bypassvene oder die Arterie mammaria interna an und führt diese an den Gefäßrand der zu anastomosierenden Koronararterie und durchsticht diese ebenfalls. Die beiden Gefäßwände werden aneinander adaptiert und der kürzere Arm wird geschlossen. Der längere, noch offene Arm wird jetzt unter der individuellen nötigen Anspannung in das epikardiale Fettgewebe eingeführt, dann geschlossen und trifft sich dort mit der Spitze des bereits geschlossenen kürzeren Armes. Danach wird die Klammer aus dem Applikator gelöst.in the Contrary to the conventional clamp, which is flattened when open U corresponds, it is for the vascular anastomosis crucial that the Bracket is constructed asymmetrically. Accordingly, an arm should of the U longer than be the other. The shorter one Arm is closed first. First one hooks with the shorter one Arm the bypass vessel, d. H. the bypass vein or the internal mammary artery and guides them to the rim of the vessel to anastomosing coronary artery and punctures it as well. The two vessel walls will adapted to each other and the shorter one Arm is closed. The longer one still open arm is now under the individual necessary tension inserted into the epicardial adipose tissue, then closed and struck there with the tip of the already closed shorter arm. The clip is then released from the applicator.
Entscheidend und neu ist somit ein schrittweises, sukzessives Schließen zunächst des einen, dann des anderen Armes der asymmetrisch geformten Klammer. Im ersten Schritt wird nur die Vene bzw. Mammaria an die Koronararterie approximiert und eingehakt, im zweiten wird die Klammernaht durch Einbringen des längeren Armes in das epikardiale Fett geschlossen und die Klammer in diesem fest verankert. Dies setzt vorraus, daß der Mechanismus, der die Schließbewegung der beiden Branchen konsekutiv zuläßt, fein dosiert werden kann. Die zweite Spitze trifft sich mit der ersten Spitze in diesem Fettgewebe, sodaß nach dem Schließen quasi ein geschlossener Ring entsteht, indem die Spitzen aneinander vorbeigleiten, durch den versetzten, einseitigen Anschliff der Spitze.critical and what is new is a gradual, successive closing of the first one, then the other arm of the asymmetrically shaped bracket. In the first step, only the vein or mammary is attached to the coronary artery approximated and hooked, in the second the staple is made by inserting it of the longer one Armes closed in the epicardial fat and the brace in this firmly anchored. This presupposes that the mechanism that the closing movement of the two branches consecutively, can be finely dosed. The second tip meets the first tip in this adipose tissue, so after the closing quasi a closed ring is created by putting the tips together glide past, through the offset, one-sided bevel of the tip.
Durch den asymmetrischen Aufbau der Klammer sowie durch die schrittweise Auslösung des Klammerschließmechanismus im Applikator wird die konventionelle Nahtabfolge mit Nadel und Faden imitiert, bei der entsprechend der Stichrichtung zuerst die Vene von außen nach innen angestochen wird und an die Arterienwand geführt, die von innen nach außen durchstochen wird.By the asymmetrical structure of the bracket as well as the gradual release of the clamp closing mechanism the conventional seam sequence with needle and Imitation thread, in which the direction of the stitch first Vein from the outside is pierced inside and led to the artery wall, the from the inside to the outside is punctured.
Gerade die Möglichkeit des getrennten Schließens ermöglicht es die Spannung der Vene zum Koronargefäß hin entsprechend einzustellen und durch einhaken des zweiten Armes im umgebenden Epikardfettgewebe zu verankern. Dadurch wird ein fester Sitz der Klammer und somit das feste Aufeinanderpressen der Gefäßränder für die geforderte die Dichtigkeit der Anastomose erreicht. Die Bahn der Arme der Klammer vollführen dabei, wie bereits erwähnt, im wesentlichen einen geschlossenen Umlauf und dieser hat dann etwa dieselbe Bahn wie dies bei der herkömmlichen Nahttechnik, welche sich inzwischen bei tausenden von Operationen bewährt hat, der Fall ist. Hierzu ist es erforderlich, daß der Applikator diese Schließfunktionen erfüllt.Just the possibility of separate closing allows adjust the tension of the vein towards the coronary vessel accordingly and by hooking the second arm into the surrounding epicardial fat tissue to anchor. This creates a tight fit of the bracket and thus the firm pressing together of the vessel edges for the required tightness the anastomosis reached. Make the path of the arms of the clip As already mentioned, essentially a closed circulation and then this has about the same path as this with the conventional seam technique, which has proven itself in thousands of operations, the case is. This requires that the applicator have these locking functions Fulfills.
Zum Aufnehmen der asymmetrischen Schließkraft muß die Klammer in einer Aufnahme im Applikator fest verankert sein, was durch die rückwärtige Verlängerung und die distale Ausnehmung an der Klammer entsprechend einer Vertiefung und eines Haltestiftes im Applikator bewerkstelligt wird. Eine Querschnittsverjüngung am Beginn eines jeden Klammerarmes gibt die Biegestelle beim Schließen vor.To the To absorb the asymmetrical closing force, the clamp must be in one holder be firmly anchored in the applicator, which is due to the rear extension and the distal recess on the clip corresponding to a recess and a holding pin in the applicator. A cross-sectional taper on The bending point specifies the beginning of each clamp arm when closing.
Der zur Klammer passende Applikator zum Schließen der Klammer hat zwei unabhängig voneinander arbeitende Schließwerkzeuge, sodaß zuerst die Gefäßseite eingehakt und geschlossen werden kann und danach die Verankerung in dem die Koronargefäße umgebenden epikardialen Gewebe durchgeführt wird. Vorteilhafterweise wird der Applikator so ausgeführt, daß er sowohl bei der bisher üblichen offenen Chirurgie, als auch bei einem minimal invasiven Eingriff eingesetzt werden kann. Hierbei könnte es erforderlich sein, den Applikator mit einem zusätzlichen Gelenk auszustatten um die Anpassung der Spitze an die anatomische Gegebenheit der zu verbindenden Gefäße besser zu gestatten.The Applicator for closing the clip has two independently of one another working locking tools, so first the Vessel side hooked on and can be closed and then the anchorage in which the Surrounding coronary vessels epicardial tissue performed becomes. The applicator is advantageously designed so that it both with the previously usual open surgery, as well as a minimally invasive procedure can be used. This may require the applicator with an additional one Equip joint to adapt the tip to the anatomical To better allow the condition of the vessels to be connected.
Weiterhin ist der Applikator so ausgeführt, daß er ein abnehmbares Magazin mit verschiedenen Größen bis zur maximal benötigten Anzahl, ca. 20 Klammern aufnehmen kann. Nach dem kompletten Schließen und Auwerfen einer Klammer wird eine weitere Klammer aus dem Magazin manuell nachgeschoben, in die Klammer-Aufnahmeposition, wobei die restlichen Klammern im Magazin alle um eine Position vorgeschoben werden. Dieses Vorschieben kann auch so ausgestaltet werden, daß es nach dem Auswerfen einer geschlossenen Klammer automatisch erfolgt wodurch sich die Bedienung des Gerätes vereinfacht.Farther the applicator is designed so that it is a removable magazine with different sizes up to the maximum required number, can hold approx. 20 brackets. After closing completely and Ejecting a clip will make another clip from the magazine manually pushed into the bracket-receiving position, the rest Brackets in the magazine are all advanced by one position. This Pushing can also be designed so that after ejecting one closed bracket is done automatically which makes the operation of the device simplified.
Die Form der Klammer selbst ist bevorzugt asymmetrisch, wobei der in das Gefäß eingreifende Arm der kleinere und der sich im Gewebe verankernde der größere ist. Zur Fixierung während des Schließens im Applikator hat die Klammer an ihrem proximalen Ende eine Verlängerung und in der Mitte nach distal eine kleine Ausnehmung um sie beim einseitigen Schließen im Applikator zu fixieren und die einseitige Schließkraft aufzunehmen. Das Schließen der Arme erfolgt jeweils durch einen sich vorschiebenden Stößel, welcher an seinem distalen Ende eine nutförmige Ausnehmung hat, in welcher der Klammerarm aufliegt und gleitetund das seitliche Abrutschen verhindert. Durch vorwärtsschieben des Stößels wird der Arm an der durch Quer erreicht hat.The The shape of the bracket itself is preferably asymmetrical, the in arm engaging the vessel the smaller one and the larger one anchored in the tissue. For fixation during of closing the clip has an extension in the applicator at its proximal end and in the middle distally a small recess around it in the one-sided closing fix in the applicator and absorb the one-sided closing force. The closing the arms are made by a pushing plunger, which has a groove-shaped recess at its distal end, in which the clamp arm rests and slides and the side slipping prevented. By pushing forward of the pestle Arm on which has reached through cross.
Nachstehend
wird die Erfindung näher
beschrieben und durch die
Es zeigen:It demonstrate:
Beim
Schließen
beschreiben die vorgeformten Arme
Zur
vollständigen
dichten Verbindung der Gefäße werden
mehrere Klammern
Eine
zweite Verjüngungsstelle
Nun
werden mit dem kürzeren
Arm entsprechend die Gefäßränder erfaßt, welcher
danach durch das Betätigungselement
Ebenso
wird nach dem Setzen des zweiten Armes verfahren, indem das Betätigungselement
Eine
weitere Ausführungsform
ist ein automatisch arbeitender Applikator, welcher im wesentlichen
nur noch die Bedienelemente
Nachdem
das Betätigungselement
Zum
Schließen
der Klammern mit mehreren Verjüngungen,
also mehreren Biegestellen pro Arm ist es erforderlich, daß der Schließer seitlich
auf den Arm der Klammer nach der Verjüngung drückt um die erste Biegung zu
bewerkstelligen wie
Eine
weitere Ausführungsform
der Niederhalterung und Auslösung
der Klammer ist in
Das
Auslösen
der Klammer wird in diesem Fall mit einem federnden Niederhalter über ein
Absenken des Haltestiftes
Die aufgezeigten Möglichkeiten zum Schließen der Klammer durch den Applikator können durch Kombinationen der angegebenen Lösungen noch eine größere Vielfalt erreichen die ebenfalls im Sinne dieser Erfindung ist.The shown possibilities to close the bracket through the applicator can be made by combinations of the given solutions even more variety achieve which is also within the meaning of this invention.
Claims (15)
Priority Applications (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE29723736U DE29723736U1 (en) | 1997-03-18 | 1997-03-18 | Surgical clamp for connecting tissue parts |
DE1997111288 DE19711288B4 (en) | 1997-03-18 | 1997-03-18 | Applicator to hold and close a surgical clip |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE1997111288 DE19711288B4 (en) | 1997-03-18 | 1997-03-18 | Applicator to hold and close a surgical clip |
Publications (2)
Publication Number | Publication Date |
---|---|
DE19711288A1 DE19711288A1 (en) | 1998-10-01 |
DE19711288B4 true DE19711288B4 (en) | 2004-11-04 |
Family
ID=7823797
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
DE1997111288 Expired - Fee Related DE19711288B4 (en) | 1997-03-18 | 1997-03-18 | Applicator to hold and close a surgical clip |
Country Status (1)
Country | Link |
---|---|
DE (1) | DE19711288B4 (en) |
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USD611144S1 (en) | 2006-06-28 | 2010-03-02 | Abbott Laboratories | Apparatus for delivering a closure element |
US7806910B2 (en) | 2002-11-26 | 2010-10-05 | Abbott Laboratories | Multi-element biased suture clip |
US7806904B2 (en) | 2000-12-07 | 2010-10-05 | Integrated Vascular Systems, Inc. | Closure device |
US7819895B2 (en) | 2000-01-05 | 2010-10-26 | Integrated Vascular Systems, Inc. | Vascular sheath with bioabsorbable puncture site closure apparatus and methods of use |
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