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WO1999049796A1 - Gaine servant de canal instrumental pour la chirurgie effractive minimale - Google Patents

Gaine servant de canal instrumental pour la chirurgie effractive minimale Download PDF

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Publication number
WO1999049796A1
WO1999049796A1 PCT/EP1999/001561 EP9901561W WO9949796A1 WO 1999049796 A1 WO1999049796 A1 WO 1999049796A1 EP 9901561 W EP9901561 W EP 9901561W WO 9949796 A1 WO9949796 A1 WO 9949796A1
Authority
WO
WIPO (PCT)
Prior art keywords
sleeve
sleeve according
actuator
diameter
structural elements
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
Application number
PCT/EP1999/001561
Other languages
German (de)
English (en)
Inventor
Siegfried Riek
Karl-Heinz Bachmann
Thomas Gaiselmann
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
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 Individual filed Critical Individual
Publication of WO1999049796A1 publication Critical patent/WO1999049796A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B17/3439—Cannulas with means for changing the inner diameter of the cannula, e.g. expandable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00831—Material properties
    • A61B2017/00867—Material properties shape memory effect
    • 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
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
    • A61F2002/3006—Properties of materials and coating materials
    • A61F2002/30092—Properties of materials and coating materials using shape memory or superelastic materials, e.g. nitinol
    • 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
    • A61F2210/00—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2210/0014—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof using shape memory or superelastic materials, e.g. nitinol
    • A61F2210/0023—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof using shape memory or superelastic materials, e.g. nitinol operated at different temperatures whilst inside or touching the human body, heated or cooled by external energy source or cold supply
    • A61F2210/0033—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof using shape memory or superelastic materials, e.g. nitinol operated at different temperatures whilst inside or touching the human body, heated or cooled by external energy source or cold supply electrically, e.g. heated by resistor

Definitions

  • the invention relates to a sleeve serving as an instrument channel for minimally invasive surgery according to the preamble of claim 1.
  • trocars for inserting the sleeves, which consist of a trocar sleeve and a trocar mandrel with a sharp tip arranged in the trocar sleeve.
  • the trocar mandrel with the sharp tip is used to penetrate the tissue and to insert the trocar sleeve.
  • the trocar mandrel is pulled out and the trocar sleeve remains as an instrument channel sleeve in the tissue.
  • the penetration. z. B. the abdominal wall by means of a trocar is associated with a certain risk, since injuries to vessels of the abdominal wall, of internal organs, of organs overgrown with the abdominal wall and of vessels of the posterior abdominal wall cannot be reliably avoided.
  • a dilation set is used for this.
  • the first puncture is made with a trocar of small diameter.
  • a dilation mandrel is inserted through its trocar sleeve.
  • the trocar sleeve is then pulled out and a dilation sleeve of larger diameter is pushed over the dilation mandrel remaining in the tissue in order to enlarge the puncture channel and to position another trocar sleeve with a larger diameter, which remains in position as an instrument channel sleeve.
  • This process requires extensive and complex instruments.
  • the successive insertion and removal of the different mandrels and sleeves is tedious and time-consuming.
  • the traumatic puncture channel corresponds to the diameter of the remaining trocar sleeve.
  • a second method is known from US-5, 431, 676-A.
  • a tube-like sleeve that can be dilated is drawn into the puncture channel in the first puncture by means of a needle with a spring-loaded protective shield, a so-called Veress needle.
  • the Veress needle with the sleeve surrounding it has an outer diameter of approximately 3 to 5 mm. If the tubular sleeve is drawn into the puncture channel, the Veress needle is pulled out and the tubular sleeve is expanded by means of a dilatation trocar, which consists of a trocar mandrel and a trocar sleeve with the necessary. Inside diameter exists.
  • the tube-like sleeve serves to guide the dilatation trocar and has the effect that the tissue surrounding the puncture channel is essentially only displaced radially when the dilatation trocar is inserted and is not traumatically severed.
  • the mandrel of the dilatation trocar is pulled out and the sleeve of the dilatation trocar remains in position as an instrument channel.
  • the sleeve of the dilatation trocar is pulled out, whereupon the tubular sleeve is pressed together by the pressure of the surrounding tissue and can be pulled out of the puncture channel narrowed thereby.
  • An extensive and complex set of instruments is also required for this procedure.
  • the tubular sleeve In a first puncture, the tubular sleeve must be drawn in, while in a second step the trocar sleeve is inserted as an instrument channel using the dilatation trocar.
  • the invention has for its object to provide an instrument channel as an access for minimally invasive surgery with a simpler set of instruments and easier handling.
  • the basic idea of the invention is to assign as an instrument channel has a sleeve with a variable inner cross section to be used and the sleeve at the proximal end of actuator means in ⁇ remain which extracorporeally and enable a change in the internal cross section of the sleeve via provided in the wall of the sleeve movable structural elements.
  • the sleeve is first inserted with a small diameter with only one puncture, for which purpose a Veress needle is preferably used becomes.
  • the risk of the first puncture can in particular be additionally reduced in that a Veress needle is used, in which the puncture can be optically controlled by the Veress needle, as z. B. is described in DE 195 47 246 Cl.
  • the needle used for the puncture is pulled out.
  • the sleeve is then widened by means of the proximal extracorporeally remaining adjusting means without additional instruments being required for this or having to be inserted into the sleeve.
  • the sleeve dilated to the desired internal cross-section itself forms the instrument channel.
  • this also has the advantage that the puncture channel in the tissue only has to be larger in diameter by the wall thickness of the sleeve than the free inside diameter of the sleeve which is required for inserting the surgical elements.
  • the structural elements arranged in the wall of the sleeve do not reduce the free internal cross section of the sleeve available for inserting the instruments.
  • the puncture canal is widened atraumatically.
  • the change in the internal cross section by proximally arranged steep means via structural elements arranged in the wall of the sleeve can be realized in different designs.
  • the sleeve is designed in such a way that it undergoes a diameter dilation during a contraction in length.
  • axially parallel pulling threads are arranged, which are fixed at the distal end of the sleeve in the wall and are attached to an actuator at the proximal end of the sleeve.
  • an axial tensile force is exerted on the tension threads via the actuator remaining extracorporeally, which leads to a contraction in length of the sleeve.
  • the sleeve expands in diameter as a result and displaces the tissue surrounding the puncture channel radially outwards.
  • the pull threads are released again at the proximal end, so that the radial pressure of the tissue surrounding the sleeve compresses the sleeve back to the original small diameter and the sleeve can be pulled out of the puncture channel.
  • a sleeve in which a length contraction is associated with a diameter dilation is preferably a braided sleeve, as is described in US Pat. No. 5,431,676 A.
  • this sleeve has a grid of intersecting, helically extending, non-elastic threads, preferably made of plastic or wire.
  • the axially parallel pulling threads are attached with their distal end to the distal end of the sleeve and run freely movable in the wall of the sleeve to the proximal end, where the pulling threads are attached to the actuator.
  • the inside diameter of the sleeve increases, whereby the sleeve stiffens and can absorb a high radial pressure force through the surrounding tissue.
  • the thread grid is preferably embedded in an elastic jacket which, for. B. consists of a silicone material. Due to its elasticity, the jacket does not hinder the length contraction and diameter dilation of the sleeve. The jacket forms a gas and liquid-tight wall of the sleeve with good sliding properties. These sliding properties promote on the one hand the retraction of the sleeve when the needle is inserted and when the sleeve is withdrawn after the surgical procedure, and on the other hand the insertion of the instruments through the dilated sleeve during the surgical procedure.
  • the elastic properties of the jacket further enable the tissue surrounding the sleeve to be pressed slightly between the threads of the dimensionally stable thread grid when the sleeve is radially dilated, as a result of which the expanded sleeve is stably fixed in the tissue channel during the operation is
  • the sleeve has, as structural elements, a scissor-type grating, which has fixed support rods, which are alternately arranged axially parallel to one another and which act as adjusting means, over the jacket of the sleeve.
  • the support rods and the control rods are each connected by scissor links.
  • the wall of the sleeve as a movable structural element, has a spring leaf made of plastic or metal, which is cylindrically curved axially parallel, so that its longitudinal edges overlap.
  • a spring leaf made of plastic or metal, which is cylindrically curved axially parallel, so that its longitudinal edges overlap.
  • the longitudinal edges of the spring leaf can be pushed over one another to form a greater overlap, so that the inside diameter of the sleeve is reduced. If the longitudinal edges are moved to a smaller overlap, the inner diameter of the sleeve expands.
  • the wall of the sleeve consists of a rubber-elastic tube, in which spring rings which are axially spaced apart in the circumferential direction and which can expand in order to dilate the inner diameter of the sleeve are embedded.
  • the spring rings can be contracted to insert the sleeve to a small diameter and locked in this elastically biased position by adjusting means.
  • the locking in the wall which is parallel to the axis, is released by means of an actuator arranged at the proximal end of the sleeve, so that the spring washers expand under the effect of their elastic prestress and dilate the sleeve.
  • Spring leaf made of a memory metal are used, which have a small diameter at a first temperature and expand to a large diameter at a second temperature.
  • the adjusting means can have heating wires running axially in the wall of the sleeve, by means of which the spring rings or the spring leaf can be heated or cooled from the proximal end of the sleeve.
  • the spring washers or the spring leaf made of memory metal can be designed such that they assume the expanded state with a large diameter at body temperature and contract to the small diameter at a temperature above or below the body temperature.
  • the spring washers or the spring leaf are heated above body temperature or cooled below body temperature and expand as soon as the sleeve assumes body temperature due to the external tissue.
  • the spring rings can optionally be heated or cooled again from the proximal end, so that the sleeve contracts to the narrow diameter.
  • Figure 1 shows a first embodiment of the sleeve with small
  • FIG. 2 this sleeve with an enlarged diameter
  • FIG. 3 shows an axial section through the proximal end of this sleeve
  • FIG. 4 shows an enlarged partial view of this sleeve
  • FIG. 5 shows an enlarged cross section through this sleeve
  • FIG. 6 shows a partial axial section of an instrument smaller diameter guide
  • FIG. 7 shows a partial section corresponding to FIG
  • FIG. 8 shows a partially broken section from a second embodiment of the sleeve with a small diameter
  • FIG. 9 shows a representation corresponding to FIG. 8 of this sleeve with an enlarged diameter
  • Figure 10 shows a section of the sleeve in a third embodiment with a small diameter
  • Figure 11 is a view corresponding to Figure 10 of this sleeve with an enlarged diameter.
  • the sleeve 10 has, as a structural element, a thread grid made of non-elastic threads 12, e.g. B. of Art ⁇ fabric threads or wire.
  • the threads 12 run helically on a cylindrical surface, at least one thread 12 in the sense of a right-hand screw and at least one thread in the sense of a left-hand screw.
  • the threads 12 überkreu ⁇ zen on the type of a plain weave, as seen in FIG. 4
  • Axial parallel to the sleeve 10 are traction threads 14, z. B. eight at the same angular distance over the circumference of the sleeve 10 pulling threads 14.
  • the pulling threads 14 are fastened with their distal end at the distal end of the sleeve 10 to the thread grid of the threads 12, for. B. welded.
  • the drawstrings 14 ver ⁇ pass through the yarns 12 and are guided by these, as can also be seen in FIG. 4
  • the thread grid is in a jacket made of a rubber-elastic material, for. B. embedded from a silicone material.
  • an inner coating 16 is preferably applied to the inside of the thread grid and an outer coating 18 is applied to the outside of the thread grid, which together form a jacket that seals the sleeve 10 on its circumference in a gas- and liquid-tight manner.
  • the sleeve 10 forms a channel that is only open at the distal and proximal ends.
  • a grip part 20 is arranged, which has a centrally through bore 22.
  • the bore 22 has an inner diameter which corresponds to the largest outer diameter of the instruments to be inserted through the sleeve 10.
  • the thread grid of the sleeve 10 is fastened with its proximal end to the handle part 20 coaxially to the bore 22 and to the circumference of the bore 22.
  • Around the bore 22 are arranged at the same mutual angular distance axially parallel to the bore 22 guide bores 24 through which the tension threads 14 are passed.
  • a cylindrical guide projection 26 is formed on the proximal end face of the handle part 20 facing away from the sleeve 10, through which the bore 22 and the guide bores 24 pass coaxially.
  • An actuator 28 is guided axially displaceably on the guide projection 26.
  • the actuator 28 has a centrally through bore 30 which is aligned with the bore 22 of the handle part 20.
  • the pulling threads 14 emerging proximally from the guide bores 24 of the guide projection 26 are fastened with their proximal end to the enlarged inner circumference of the bore 30 of the actuator 28, for. B. welded.
  • the actuator 28 is shown in its release position, in which the actuator 28 on the guide projection 26 has its maximum distance from the handle part 20 in the proximal direction. In this release position, the tension threads 14 run from their attachment to the inner circumference of the actuator 28 directly into the guide bores 24 of the handle part 20. The tension threads 14 thus run undeflected over their full length in the axial direction. 10
  • the actuator 28 is pushed on the guide extension 26 in the distal direction against the handle part 20 into its tensioning position shown in FIG. 2, the proximal ends of the pulling threads 14 are pulled over the edge of the guide extension 26 and pushed outside of the guide extension 26 against the handle part 20.
  • the proximal ends of the pull threads 14 are drawn into the guide bores 24 and thus the distal ends of the pull threads 14 against the handle part 20, and the thread grid of the sleeve 10 is shortened axially.
  • the longitudinal contraction of the thread grid expands it radially, so that the inner diameter of the sleeve 10 is dilated, as shown in FIG.
  • the length of the stroke of the actuator 28 on the guide projection 26 is dimensioned such that, with maximum length contraction of the sleeve 10, the inside diameter thereof is expanded to the inside diameter of the bore 22 of the handle part 20 and the bore 30 of the actuator 28.
  • a sealing valve 38 and a sealing membrane 40 are further arranged in the proximal end of the bore 30 of the steep member 28.
  • the sealing valve 38 has valve tabs opening in the distal direction.
  • the sealing membrane 40 has the form of a rubber-elastic annular disk having a zen ⁇ trical passage opening.
  • the actuator 28 has an instrument guide, which is designed in the manner of a collet. To this end, the instrument guide to a collar 32 which is screwed the manner of a union nut ⁇ on the actuator 28th
  • the adjusting ring 32 pushes guide jaws 34 in an inner cone 36 of the actuating ⁇ member 28, through which the guiding jaws are moved 34 radially against each other, to generate adjustable around a central passage cross-section diameter.
  • the cross-section of the guide jaws 34 is adjusted in accordance with the inside diameter of the sleeve 10, so that an instrument inserted through the sleeve 10 is also guided in a proximally stable manner.
  • the sleeve is used in the following way:
  • the sleeve 10 is first drawn onto a needle for the first puncture.
  • a Veress needle is preferably used for this, in particular a Veress needle as described in DE-195 47 246 Cl, which enables a puncture under visual control.
  • the actuator 28 is in its proximal end position, ie in the release position shown in FIG. 1.
  • the sleeve 10 is locked to the Veress needle and lies close to the outer circumference of the Veress needle, the smallest possible outer diameter of the Veress needle and surrounding sleeve 10, which is preferably only about 3 mm.
  • the abdominal wall is penetrated with the Veress needle and the sleeve 10 surrounding it until the tip of the Veress needle with the distal end of the sleeve 10 is in the abdominal cavity.
  • C0 2 gas can now be insufflated into the abdominal cavity through the Veress needle.
  • the sealing membrane 40 which lies tightly against the circumference of the Veress needle, serves to seal the sleeve 10.
  • Veress needle is then pulled out of the sleeve 10, the sealing valve 38 sealing the sleeve 10 on the actuator 28.
  • the actuator 23 is pushed against the handle part 20.
  • the tension threads 14 are shortened and the sleeve 10 is expanded by contraction in length and diameter dilation.
  • Markings for the stroke of the actuator 28 relative to the handle part 20 allow the sleeve 10 to be expanded to predetermined internal diameter values, e.g. Example, on inner diameter values, the elements to the outer diameters of conventional Instru ⁇ accordance with the minimally invasive surgery, for example. B. on diameters of 5mm, 7mm, 10mm and 12mm. If necessary, detents can also be provided for the actuator 28 which correspond to these usual diameter values. 12
  • the instrument guide is adjusted so that the guide jaws 34 define a passage cross section that corresponds to the inner diameter on which the sleeve 10 is dilated.
  • An instrument can now be inserted through the sleeve 10, the outer diameter of which corresponds to the inner diameter to which the sleeve 10 is expanded and the guide jaws 34 are set.
  • the shaft of this instrument is sealed proximally by the sealing membrane 40, so that the CO 2 gas cannot escape from the abdominal cavity.
  • the guide jaws 34 of the instrument guide guide and hold the shaft of the instrument centrally in the bores 22 and 30 of the handle part 20 or the actuator 28.
  • the widened sleeve 10 forms the instrument channel.
  • the instrument is pulled out of the sleeve 10.
  • the actuator 28 is pushed back into the release position shown in FIGS. 1 and 3, as a result of which the tension threads 14 lie loosely at their proximal end.
  • the tissue surrounding the sleeve 10 can now radially compress the sleeve 10, causing the sleeve 10 to expand again to its original axial length and contract to its original small diameter.
  • the sleeve 10 can now be pulled out of the puncture channel. It remains in the tissue of the insertion channel with a small diameter, since the expansion of the insertion channel is made by the dilatable sleeve 10 by displacement of the atraumatic tissue ⁇ esp.
  • a second embodiment of the sleeve 10 is shown in FIGS. 8 and 9.
  • a scissor grid is provided as movable structural elements of the sleeve 10, which consists of axially parallel support rods 42 and adjusting rods 44 distributed alternately over the circumference of the sleeve 10.
  • the support rods and the adjusting rods 44 are each connected to one another via herringbone scissor links 46.
  • the support rods 42, the adjusting rods 44 and the scissor members 46 are preferably as 13 one-piece plastic part manufactured.
  • the support rods 42, the control rods 44 and the scissor members 46 are dimensionally stable, the connections between the support rods 42 or the control rods 44 and the scissor members 46 permitting mutual movement.
  • the scissor lattice is provided with an inner coating 16 and an outer coating 18, as was explained on the basis of the first exemplary embodiment.
  • the support rods 42 are attached to the handle part 20, while the adjusting rods 44 are attached to an actuator 28 which can be displaced axially against the handle part 20.
  • the adjusting rods 44 are withdrawn against the support rods 42 in the proximal direction, as shown in FIG. 8.
  • the scissor members 46 are pivoted in the direction of an axially parallel position, so that the cross section of the sleeve is reduced.
  • the scissor members 46 are pivoted in the direction of a position perpendicular to the axis of the sleeve 10, as shown in FIG. 9, whereby the sleeve 10 is dilated.
  • FIGS. 10 and 11 A third embodiment of the sleeve 10 is shown in FIGS. 10 and 11.
  • the sleeve 10 has a spring leaf 48 which is rolled into a cylindrical tube, the longitudinal edges 50 parallel to the axis overlapping. At the proximal end of the spring leaf 48, one longitudinal edge 50 is fixed to a handle part, while the other longitudinal edge 50 is fixed to an actuator which can be rotated against the handle part.
  • the spring sheet 48 of metal or plastic can hen best ⁇ .
  • the spring leaf 48 can be enclosed between an inner coating and an outer coating to form the sleeve 10. Likewise, the spring leaf 48 itself can also form the sleeve. 14
  • the actuator If the actuator is rotated in a direction of rotation against the grip part, the overlap between the longitudinal edges 50 of the spring leaf 48 is increased, as shown in FIG. 10, and the inner cross section of the sleeve 10 is reduced.
  • the actuator rotates in the opposite direction relative to the handle part, the overlap of the longitudinal edges 50 decreases, as shown in FIG. 11, and the sleeve 10 is dilated.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Pathology (AREA)
  • Heart & Thoracic Surgery (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

L'invention concerne une gaine (10) servant de canal instrumental pour la chirurgie effractive minimale. La section intérieure de cette gaine est variable. A cet effet, il est prévu, dans la paroi de la gaine (10), des éléments de structure mobiles (12) qui peuvent être déplacés par l'intermédiaire d'éléments de commande (14, 28) pour faire varier la section intérieure. Les éléments de commande (14, 28) peuvent être actionnés au niveau de l'extrémité proximale de la gaine (10), demeurant à l'extérieur du corps.
PCT/EP1999/001561 1998-04-01 1999-03-05 Gaine servant de canal instrumental pour la chirurgie effractive minimale Ceased WO1999049796A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE19814576A DE19814576C2 (de) 1998-04-01 1998-04-01 Als Instrumentenkanal für die minimal invasive Chirurgie dienende Hülse
DE19814576.4 1998-04-01

Publications (1)

Publication Number Publication Date
WO1999049796A1 true WO1999049796A1 (fr) 1999-10-07

Family

ID=7863227

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/EP1999/001561 Ceased WO1999049796A1 (fr) 1998-04-01 1999-03-05 Gaine servant de canal instrumental pour la chirurgie effractive minimale

Country Status (2)

Country Link
DE (1) DE19814576C2 (fr)
WO (1) WO1999049796A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7534250B2 (en) 2002-06-28 2009-05-19 Cook Critical Care Introducer sheath

Families Citing this family (17)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE20022005U1 (de) 2000-12-27 2001-04-12 Bachmann, Karl-Heinz, 78667 Villingendorf Faltbare Instrumentenkanalhülse für die Minimal Invasive Chirurgie
DE10108814A1 (de) * 2001-02-16 2002-09-05 Berlin Heart Ag Vorrichtung zur Verbindung eines Hohlorgans mit einer Kanüle
EP1418850B1 (fr) * 2001-08-01 2010-10-06 Tyco Healthcare Group LP Appareil permettant de pratiquer un acces percutane vers un site chirurgical cible et d'envoyer un medicament vers ce site
US8357085B2 (en) 2009-03-31 2013-01-22 Ethicon Endo-Surgery, Inc. Devices and methods for providing access into a body cavity
DE102009012185A1 (de) * 2009-02-27 2010-09-02 Aesculap Ag Trokarführungshülse und Trokarsystem
US8226553B2 (en) 2009-03-31 2012-07-24 Ethicon Endo-Surgery, Inc. Access device with insert
US8257251B2 (en) 2009-04-08 2012-09-04 Ethicon Endo-Surgery, Inc. Methods and devices for providing access into a body cavity
US8137267B2 (en) 2009-04-08 2012-03-20 Ethicon Endo-Surgery, Inc. Retractor with flexible sleeve
US8419635B2 (en) 2009-04-08 2013-04-16 Ethicon Endo-Surgery, Inc. Surgical access device having removable and replaceable components
US8465422B2 (en) 2009-06-05 2013-06-18 Ethicon Endo-Surgery, Inc. Retractor with integrated wound closure
US8033995B2 (en) 2009-06-05 2011-10-11 Ethicon Endo-Surgery, Inc. Inflatable retractor with insufflation and method
US8241209B2 (en) 2009-06-05 2012-08-14 Ethicon Endo-Surgery, Inc. Active seal components
US8475490B2 (en) 2009-06-05 2013-07-02 Ethicon Endo-Surgery, Inc. Methods and devices for providing access through tissue to a surgical site
US8361109B2 (en) 2009-06-05 2013-01-29 Ethicon Endo-Surgery, Inc. Multi-planar obturator with foldable retractor
US9078695B2 (en) 2009-06-05 2015-07-14 Ethicon Endo-Surgery, Inc. Methods and devices for accessing a body cavity using a surgical access device with modular seal components
US8795163B2 (en) 2009-06-05 2014-08-05 Ethicon Endo-Surgery, Inc. Interlocking seal components
US20100312189A1 (en) * 2009-06-05 2010-12-09 Ethicon Endo-Surgery, Inc. Flexible cannula devices and methods

Citations (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3789852A (en) * 1972-06-12 1974-02-05 S Kim Expandable trochar, especially for medical purposes
US4411655A (en) * 1981-11-30 1983-10-25 Schreck David M Apparatus and method for percutaneous catheterization
DE9102170U1 (de) * 1991-02-23 1991-05-16 Herzberg, Wolfgang, Dr.med., 2000 Wedel Arbeitskanal zur Führung und/oder Versorgung von medizinischen Geräten
US5407430A (en) * 1994-03-21 1995-04-18 Peters; Michael J. Intravenous catheter
US5431676A (en) 1993-03-05 1995-07-11 Innerdyne Medical, Inc. Trocar system having expandable port
US5460170A (en) * 1994-08-23 1995-10-24 Hammerslag; Julius G. Adjustable surgical retractor
WO1996023536A1 (fr) * 1995-02-03 1996-08-08 Inbae Yoon Canule a valve en bout
DE19522301A1 (de) * 1995-06-20 1997-01-02 Daum Gmbh Flexible Trokarhülse
DE19547246C1 (de) 1995-12-18 1997-03-20 Riek Siegfried Medizinische Nadel
US5674240A (en) * 1993-02-04 1997-10-07 Peter M. Bonutti Expandable cannula

Patent Citations (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3789852A (en) * 1972-06-12 1974-02-05 S Kim Expandable trochar, especially for medical purposes
US4411655A (en) * 1981-11-30 1983-10-25 Schreck David M Apparatus and method for percutaneous catheterization
DE9102170U1 (de) * 1991-02-23 1991-05-16 Herzberg, Wolfgang, Dr.med., 2000 Wedel Arbeitskanal zur Führung und/oder Versorgung von medizinischen Geräten
US5674240A (en) * 1993-02-04 1997-10-07 Peter M. Bonutti Expandable cannula
US5431676A (en) 1993-03-05 1995-07-11 Innerdyne Medical, Inc. Trocar system having expandable port
US5407430A (en) * 1994-03-21 1995-04-18 Peters; Michael J. Intravenous catheter
US5460170A (en) * 1994-08-23 1995-10-24 Hammerslag; Julius G. Adjustable surgical retractor
WO1996023536A1 (fr) * 1995-02-03 1996-08-08 Inbae Yoon Canule a valve en bout
DE19522301A1 (de) * 1995-06-20 1997-01-02 Daum Gmbh Flexible Trokarhülse
DE19547246C1 (de) 1995-12-18 1997-03-20 Riek Siegfried Medizinische Nadel

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7534250B2 (en) 2002-06-28 2009-05-19 Cook Critical Care Introducer sheath

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DE19814576C2 (de) 2000-06-08

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