WO1993025149A1 - Bilio-digestive anastomosis device requiring no circular suture of the bile duct - Google Patents
Bilio-digestive anastomosis device requiring no circular suture of the bile duct Download PDFInfo
- Publication number
- WO1993025149A1 WO1993025149A1 PCT/FR1993/000506 FR9300506W WO9325149A1 WO 1993025149 A1 WO1993025149 A1 WO 1993025149A1 FR 9300506 W FR9300506 W FR 9300506W WO 9325149 A1 WO9325149 A1 WO 9325149A1
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- WO
- WIPO (PCT)
- Prior art keywords
- channel
- suturing
- branches
- groove
- bilio
- 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.)
- Ceased
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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
- A61B17/11—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
- A61B17/11—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
- 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
Definitions
- the present invention relates to a device for restoring bile continuity after a low section of fine main channel.
- the sections of the main channel are conventionally repaired by end-to-end suturing of the canal ends or by implantation in an intestinal loop and the uncontrollable scarring of these fine circular sutures exposes them, for years, to the risk of stenosis.
- the device according to the invention makes it possible to separate the termination of the canal into two short valves and then to fix them, in inverted T, on the posterior face of a Y-shaped loop, without suturing - therefore without scar activity - at the level of the mouth. .
- the device comprises:
- Anchors (1) whose diameters correspond to the different sizes of the main track. They present:
- a frame (10) whose two horizontal branches (1 1) are spaced in the middle for the passage of a dowel (1) and are articulated at their ends by two lugs and two screws (1 2) adjustable the request by two threaded and knurled nuts (1 3).
- the open frame extends beyond the surface of the key. Its progressive screwing brings its two branches below it. It is held in the open position by two springs (14) interposed between its two branches (1 1) and crossed by the two screws (12).
- your ankles (1) can be more or less long and curved, have more circular grooves (5), the keys have inclined branches, in the form of a circumflex accent ...
- the use of the device includes 4 successive times.
- the main line is sectioned at the upper edge of the duodenum without underlying dissection.
- the dowel (1) corresponding to its size is fixed on its lower edge by a thread passed through the slot (4) of the dowel and knotted laterally in one of the grooves (5) of the body (3) of the dowel.
- the second 1.5 cm below the throat (2) of the ankle.
- the longest key (7) is closed on the groove (2) of the ankle and held by its lock (8).
- Anchors 4 to 7 millimeters in diameter and keys 3 and 4 centimeters long by 0.6 to 0.8 centimeters wide were the most used during anatomical research.
- a long Y handle is prepared. Its anterior wall is incised, at the union of its upper 2/3 and its lower 1/3, on 6 to 7 centimeters from its end which has not been closed. 3) The open handle, spread out, is presented on the point (6) of the ankle, in the middle of its serous face then it is mounted perpendicular to the ankle which pierces it and leaves the handle until the key (7) protrudes under the digestive wall.
- a plastic catheter inserted into the tip (6) of the ankle allows it to be slightly stretched while the other hand slides the digestive wall between thumb and index finger.
- the frame (10) is placed on the relief of the key (7) then closed below it ensuring a firm grip and good exposure of the biliary termination on a flat and stable digestive surface.
- a scalpel blade is slid into the slot (4) in the ankle and separates the two valves.
- the incision limited in height by the ankle cleft, respects a short bile segment below the digestive wall ( ⁇ 2 mm).
- the valves are fixed by two overlockings, anterior and posterior, of fine, smooth wire, set with two needles. The first point of each suture is passed transversely into the bile wall above the valve incision.
- the two needles then cross vertically the contiguous digestive wall, from inside to outside, then lead the slightly taut overlock from the origin to the end of the lateral edge of each valve where it is stopped.
- the valves are taken from the inside in order to flare them on the digestive wall.
- the suture is completed with a few separate stitches on their distal edge.
- the frame is removed.
- the unlocked key releases the ankle.
- the handle is sutured.
- a radiological control is carried out by the cystic.
- the device according to the invention is intended for the indications of this anastomosis which relate to the deliberate low sections of the liver transplants, of certain duodeno-pancreatectomies and the secondary repairs of long main tracks, after accidental section or traumatic rupture, to avoid the greater risks.
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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)
Abstract
Description
Dispositif pour anastomose bilio-digestive sans suture circulaire sur la voie principale Device for bilio-digestive anastomosis without circular suturing on the main channel
La présente invention concerne un dispositif pour rétablir la continuité biliaire après une section basse de voie principale fine.The present invention relates to a device for restoring bile continuity after a low section of fine main channel.
Les sections de la voie principale sont classiquement réparées par suture bout à bout des extrémités canalaires ou par implantation dans une anse intestinale et la cicatrisation incontrôlable de ces sutures circulaires de fin calibre les expose, pendant des années, au risque de sténose.The sections of the main channel are conventionally repaired by end-to-end suturing of the canal ends or by implantation in an intestinal loop and the uncontrollable scarring of these fine circular sutures exposes them, for years, to the risk of stenosis.
Le dispositif selon l'invention permet de séparer la terminaison du canal en deux courtes valves puis de les fixer, en T inversé, sur la face postérieure d'une anse en Y, sans suture - donc sans activité cicatricielle - au niveau de la bouche.The device according to the invention makes it possible to separate the termination of the canal into two short valves and then to fix them, in inverted T, on the posterior face of a Y-shaped loop, without suturing - therefore without scar activity - at the level of the mouth. .
Les dessins annexés illustrent l'invention :The accompanying drawings illustrate the invention:
- la planche 1/3 représente le dispositif, • - la planche 2/3 sa mise en place,- the 1/3 plate represents the device, • - the 2/3 plate its installation,
- la planche 3/3 son utilisation.- the board 3/3 its use.
En référence à ces dessins, le dispositif comporte :With reference to these drawings, the device comprises:
1 ) Des chevilles (1 ) dont les diamètres correspondent aux différents calibres de la voie principale. Elles présentent :1) Anchors (1) whose diameters correspond to the different sizes of the main track. They present:
• Une extrémité supérieure avec une gorge (2) circulaire.• An upper end with a circular groove (2).
• Un corps cylindrique (3) avec :• A cylindrical body (3) with:
- une fente verticale (4) médiane dans laquelle peut glisser une lame de bistouri et dont l'extrémité supérieure n'atteint pas le bord inférieur de la gorge (2) ;- a vertical slit (4) in the middle in which a scalpel blade can slide and the upper end of which does not reach the lower edge of the groove (2);
- trois rainures circulaires (5) à 1 , 1 ,5 et 2 centimètres au-dessous de la gorge (2).- three circular grooves (5) at 1, 1, 5 and 2 centimeters below the groove (2).
• Une extrémité inférieure (6) effilée à pointe mousse.• A tapered lower end (6) with a foam tip.
2) Des clavettes (7) à deux branches articulées avec chanfrein de matage dont la fermeture, maintenue par un verrou (8), ménage un orifice (9) médian pour retenir la gorge (2) d'une cheville sans la serrer et solidariser les deux pièces perpendiculairement. Plusieurs clavettes de taille différente peuvent être refermées sur la même cheville.2) Keys (7) with two articulated branches with a bevelling chamfer, the closure of which, held by a bolt (8), provides a medial orifice (9) for retaining the groove (2) of an ankle without tightening and securing it the two pieces perpendicularly. Several keys of different sizes can be closed on the same ankle.
3) Un cadre (10) dont les deux branches horizontales (1 1 ) sont écartées en leur milieu pour le passage d'une cheville (1 ) et s'articulent à leurs extrémités par deux ergots et deux vis (1 2) réglables à la demande par deux écrous (1 3) filetés et molletés. Le cadre ouvert déborde la surface de la clavette. Son vissage progressif rapproche ses deux branches au-dessous d'elle. Il est maintenu en position d'ouverture par deux ressorts (14) intercalés entre ses deux branches (1 1 ) et traversés par les deux vis (12).3) A frame (10) whose two horizontal branches (1 1) are spaced in the middle for the passage of a dowel (1) and are articulated at their ends by two lugs and two screws (1 2) adjustable the request by two threaded and knurled nuts (1 3). The open frame extends beyond the surface of the key. Its progressive screwing brings its two branches below it. It is held in the open position by two springs (14) interposed between its two branches (1 1) and crossed by the two screws (12).
Selon des variantes non illustrées, tes chevilles (1 ) peuvent être plus ou moins longues et incurvées, présenter plus de rainures circulaires (5), les clavettes avoir des branches inclinées, en forme d'accent circonflexe ...According to variants not illustrated, your ankles (1) can be more or less long and curved, have more circular grooves (5), the keys have inclined branches, in the form of a circumflex accent ...
FEUILLE DE REMPLACEMENT Ces variantes, données à titre d'exemple, ne limitent pas le domaine de l'invention dont on ne sortirait pas en remplaçant les détails d'exécution par tous autres équivalents. Les trois produits peuvent être fabriqués en acier inox ou en tout autre matière.REPLACEMENT SHEET These variants, given by way of example, do not limit the field of the invention from which one would not depart by replacing the execution details with any other equivalent. The three products can be made of stainless steel or any other material.
L'utilisation du dispositif comprend 4 temps successifs. Une cheville (1 ) et une clavetteThe use of the device includes 4 successive times. An ankle (1) and a key
(2) sont initialement disposées sur la voie principale. Une anse intestinale est ensuite préparée avant la mise en place du dispositif qui permet de réaliser l'anastomose.(2) are initially arranged on the main track. An intestinal loop is then prepared before the installation of the device which makes it possible to perform the anastomosis.
1 ) La voie principale est sectionnée au bord supérieur du duodénum sans dissection sous-jacente. La cheville (1 ) correspondant à son calibre est fixée sur son bord inférieur par un fil passé dans la fente (4) de la cheville et noué latéralement dans une des rainures (5) du corps (3) de la cheville. De préférence, la seconde, à 1 ,5 centimètre au-dessous de la gorge (2) de la cheville. La clavette (7) la plus longue, selon les possibilités d'exposition, est refermée sur la gorge (2) de la cheville et maintenue par son verrou (8). Les chevilles de 4 à 7 millimètres de diamètre et les clavettes de 3 et 4 centimètres de long sur 0,6 à 0,8 centimètre de large ont été les plus utilisées au cours des recherches anatomiques.1) The main line is sectioned at the upper edge of the duodenum without underlying dissection. The dowel (1) corresponding to its size is fixed on its lower edge by a thread passed through the slot (4) of the dowel and knotted laterally in one of the grooves (5) of the body (3) of the dowel. Preferably, the second, 1.5 cm below the throat (2) of the ankle. The longest key (7), depending on the exposure possibilities, is closed on the groove (2) of the ankle and held by its lock (8). Anchors 4 to 7 millimeters in diameter and keys 3 and 4 centimeters long by 0.6 to 0.8 centimeters wide were the most used during anatomical research.
2) Une anse en Y longue est préparée. Sa paroi antérieure est incisée, à l'union de ses 2/3 supérieurs et de son 1/3 inférieur, sur 6 à 7 centimètres à partir de son extrémité qui n'a pas été refermée. 3) L'anse ouverte, étalée, est présentée sur la pointe (6) de la cheville, au milieu de sa face séreuse puis elle est montée perpendiculairement à la cheville qui la perfore et sort de l'anse jusqu'à ce que la clavette (7) fasse saillie sous la paroi digestive. Un cathéter en plastique enfoncé dans la pointe (6) de la cheville permet de la tendre légèrement tandis que l'autre main fait glisser la paroi digestive entre pouce et index.2) A long Y handle is prepared. Its anterior wall is incised, at the union of its upper 2/3 and its lower 1/3, on 6 to 7 centimeters from its end which has not been closed. 3) The open handle, spread out, is presented on the point (6) of the ankle, in the middle of its serous face then it is mounted perpendicular to the ankle which pierces it and leaves the handle until the key (7) protrudes under the digestive wall. A plastic catheter inserted into the tip (6) of the ankle allows it to be slightly stretched while the other hand slides the digestive wall between thumb and index finger.
Le cadre (10) est posé sur le relief de la clavette (7) puis refermé au-dessous d'elle assurant une prise ferme et une bonne exposition de la terminaison biliaire sur une surface digestive plane et stable. 4) Une lame de bistouri est glissée dans la fente (4) de la cheville et sépare les deux valves. L'incision, limitée en hauteur par la fente de la cheville, respecte un court segment biliaire au-dessous de la paroi digestive (≠≠2 mm). Les valves sont fixées par deux surjets, antérieur et postérieur, de fil fin, lisse, serti de deux aiguilles. Le premier point de chaque surjet est passé transversalement dans la paroi biliaire au-dessus de l'incision des valves. Les deux aiguilles traversent ensuite verticalement la paroi digestive contiguë, de dedans en dehors, puis conduisent le surjet légèrement tendu de l'origine à l'extrémité du bord latéral de chaque valve où il est arrêté. Les prises des valves sont effectuées de dehors en dedans afin de les évaser sur la paroi digestive. La suture est complétée par quelques points séparés sur leur bord distal.The frame (10) is placed on the relief of the key (7) then closed below it ensuring a firm grip and good exposure of the biliary termination on a flat and stable digestive surface. 4) A scalpel blade is slid into the slot (4) in the ankle and separates the two valves. The incision, limited in height by the ankle cleft, respects a short bile segment below the digestive wall (≠≠ 2 mm). The valves are fixed by two overlockings, anterior and posterior, of fine, smooth wire, set with two needles. The first point of each suture is passed transversely into the bile wall above the valve incision. The two needles then cross vertically the contiguous digestive wall, from inside to outside, then lead the slightly taut overlock from the origin to the end of the lateral edge of each valve where it is stopped. The valves are taken from the inside in order to flare them on the digestive wall. The suture is completed with a few separate stitches on their distal edge.
Le cadre est retiré. La clavette déverrouillée libère la cheville. L'anse est suturée. Un contrôle radiologique est réalisé par le cystique.The frame is removed. The unlocked key releases the ankle. The handle is sutured. A radiological control is carried out by the cystic.
L'utilisation du dispositif permet d'exécuter une anastomose bilio-digestive :The use of the device makes it possible to perform a bilio-digestive anastomosis:
- solide, sur une ligne de suture plus longue que celle d'une suture orificielle (3 fois plus pour deux valves de un centimètre) et plus résistante,- solid, on a suture line longer than that of an orifice suture (3 times more for two valves of one centimeter) and more resistant,
- perméable, avec ouverture à plein canal de la voie principale dans l'anse, - dont l'étanchéité, assurée sans interstice par les deux surjets, dispense de drainage intra canalaire et tolère des contrôles radiologiques et des moulages sous pression sans fuite,- permeable, with full-channel opening of the main track in the loop, - whose watertightness, ensured without gaps by the two overhangs, dispenses with intra-canal drainage and tolerates radiological checks and leak-free pressure moldings,
- et surtout, sans activité cicatricielle au niveau de la bouche.- and above all, without scar activity in the mouth.
Le dispositif selon l'invention est destiné aux indications de cette anastomose qui concernent les sections délibérées basses des transplantations hépatiques, de certaines duodéno-pancréatectomies et les réparations secondaires de voies principales longues, après section accidentelle ou rupture traumatique, pour éviter les risques plus importants de sténose auxquels sont exposées les sutures circulaires de fin calibre sur des extrémités canalaires remaniées ou infectées. Son utilisation pourrait également être envisagée pour implanter un autre canal fin dans une cavité. Par exemple, un uretère dans une vessie, en rappelant que le principe de l'anastomose a été décrit, entre autres, lors des premières tentatives d'urétéro- cystonéostomies. The device according to the invention is intended for the indications of this anastomosis which relate to the deliberate low sections of the liver transplants, of certain duodeno-pancreatectomies and the secondary repairs of long main tracks, after accidental section or traumatic rupture, to avoid the greater risks. stenosis to which fine gauge circular sutures are exposed on altered or infected canal ends. Its use could also be envisaged for implanting another fine channel in a cavity. For example, a ureter in a bladder, recalling that the principle of anastomosis was described, among other things, during the first attempts at ureterocystoneostomy.
Claims
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| FR92/07132 | 1992-06-12 | ||
| FR9207132A FR2692135B1 (en) | 1992-06-12 | 1992-06-12 | Device for performing a bilio-digestive anastomosis without circular suturing on the main track. |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| WO1993025149A1 true WO1993025149A1 (en) | 1993-12-23 |
Family
ID=9430683
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| PCT/FR1993/000506 Ceased WO1993025149A1 (en) | 1992-06-12 | 1993-05-25 | Bilio-digestive anastomosis device requiring no circular suture of the bile duct |
Country Status (2)
| Country | Link |
|---|---|
| FR (1) | FR2692135B1 (en) |
| WO (1) | WO1993025149A1 (en) |
Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| RU2465842C1 (en) * | 2011-08-18 | 2012-11-10 | Государственное бюджетное образовательное учреждение высшего профессионального образования "Тверская государственная медицинская академия" Министерства здравоохранения и социального развития Российской Федерации | Method for pancreatic resection in chronic pancreatitis |
| RU2465845C1 (en) * | 2011-08-18 | 2012-11-10 | Государственное бюджетное образовательное учреждение высшего профессионального образования "Тверская государственная медицинская академия" Министерства здравоохранения и социального развития Российской Федерации | Method for creating invaginated pancreatojejunoanastomosis |
Citations (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US1982207A (en) * | 1933-12-29 | 1934-11-27 | Henry D Furniss | Clamping instrument and process of using the same |
| GB1006854A (en) * | 1963-04-25 | 1965-10-06 | Canadian Patents Dev | Vascular everting device |
| US3683925A (en) * | 1970-09-04 | 1972-08-15 | Leon A Frankel | Method and apparatus for anastomosing and incising |
| GB2081099A (en) * | 1980-08-04 | 1982-02-17 | Senco Products | Instrument for placing purse-string sutures |
| US4747407A (en) * | 1985-09-03 | 1988-05-31 | The Field Surgery Research Department of the Third Military Medical University | Blood vessel anastomat |
-
1992
- 1992-06-12 FR FR9207132A patent/FR2692135B1/en not_active Expired - Fee Related
-
1993
- 1993-05-25 WO PCT/FR1993/000506 patent/WO1993025149A1/en not_active Ceased
Patent Citations (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US1982207A (en) * | 1933-12-29 | 1934-11-27 | Henry D Furniss | Clamping instrument and process of using the same |
| GB1006854A (en) * | 1963-04-25 | 1965-10-06 | Canadian Patents Dev | Vascular everting device |
| US3683925A (en) * | 1970-09-04 | 1972-08-15 | Leon A Frankel | Method and apparatus for anastomosing and incising |
| GB2081099A (en) * | 1980-08-04 | 1982-02-17 | Senco Products | Instrument for placing purse-string sutures |
| US4747407A (en) * | 1985-09-03 | 1988-05-31 | The Field Surgery Research Department of the Third Military Medical University | Blood vessel anastomat |
Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| RU2465842C1 (en) * | 2011-08-18 | 2012-11-10 | Государственное бюджетное образовательное учреждение высшего профессионального образования "Тверская государственная медицинская академия" Министерства здравоохранения и социального развития Российской Федерации | Method for pancreatic resection in chronic pancreatitis |
| RU2465845C1 (en) * | 2011-08-18 | 2012-11-10 | Государственное бюджетное образовательное учреждение высшего профессионального образования "Тверская государственная медицинская академия" Министерства здравоохранения и социального развития Российской Федерации | Method for creating invaginated pancreatojejunoanastomosis |
Also Published As
| Publication number | Publication date |
|---|---|
| FR2692135B1 (en) | 1994-08-26 |
| FR2692135A1 (en) | 1993-12-17 |
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