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WO2008028972A1 - Noeud, procédé et dispositif pour le réaliser - Google Patents

Noeud, procédé et dispositif pour le réaliser Download PDF

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Publication number
WO2008028972A1
WO2008028972A1 PCT/EP2007/059428 EP2007059428W WO2008028972A1 WO 2008028972 A1 WO2008028972 A1 WO 2008028972A1 EP 2007059428 W EP2007059428 W EP 2007059428W WO 2008028972 A1 WO2008028972 A1 WO 2008028972A1
Authority
WO
WIPO (PCT)
Prior art keywords
free end
thread
proximal
loop
distal
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/EP2007/059428
Other languages
German (de)
English (en)
Inventor
Marc Kraft
David Hochmann
Wulf Wulff
Wolfram Rossdeutscher
Martin GÖRDES
Rainer Reichel
Ulrich Wegener
Peter Diesing
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.)
Technische Universitaet Berlin
Original Assignee
Technische Universitaet Berlin
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 Technische Universitaet Berlin filed Critical Technische Universitaet Berlin
Publication of WO2008028972A1 publication Critical patent/WO2008028972A1/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
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0491—Sewing machines for surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0483—Hand-held instruments for holding sutures
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A61B2017/0475—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery using sutures having a slip knot
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06066—Needles, e.g. needle tip configurations
    • A61B2017/06076—Needles, e.g. needle tip configurations helically or spirally coiled

Definitions

  • the invention relates to a knot, in particular for medical use for suturing wounds.
  • the invention also relates to a method and apparatus for generating the node.
  • Nodes the species affected here, are used for medical sutures.
  • the aim of the medical suture is to protect the sewn structures in the phase of wound healing sufficiently by acting forces and to unify the separated tissue. Once wound healing has reunited the separated tissues, the surgical suture has done its job.
  • a surgical thread having two free ends, one free end forming a proximal end and the other free end forming a distal end
  • Tightening of the knot by exerting a tensile force between the first loop and the proximal free end of the thread.
  • a bay is formed when a thread is laid in hairpin form as shown in Fig. 15:
  • FIG. 22 A node of the type claimed is shown in Figures 1 and 22. As can be seen in particular from FIG. 22, the claimed node differs from the node depicted in FIG. from EP 0 870 469 B1, FIG. 5 or from EP 0 887 045, also FIG. 5 is known.
  • a method according to the invention for producing a surgical node comprises the steps:
  • a surgical thread having two free ends, one free end forming a proximal end and the other free end forming a distal end
  • Tightening of the knot by exerting a tensile force between the first loop and the proximal free end of the thread.
  • a separate aspect of the invention is a device for generating a surgical node with means for:
  • a surgical thread having two free ends, one free end forming a proximal end and the other free end forming a distal end
  • Tightening of the knot by exerting a tensile force between the first loop and the proximal free end of the thread.
  • the device further comprises means for:
  • Loop forming thread section stretches and the first strand thus dissolves, while at the same time a distal thread portion forms a second loop, which is enclosed by the two loops.
  • the device preferably comprises
  • a helical thread guide which is formed by a hollow body which is open at least at one of the two front ends and has an interior space for the thread which is formed into the HeNx and which is rotatable about the longitudinal axis of the HeNx,
  • a rod-shaped first thread manipulator arranged within the HeNx and rotatable about its own longitudinal axis parallel to the longitudinal axis of the HeNx and longitudinally displaceable relative to the HeNx, which has a cavity enclosed on the front face of the first thread manipulator and enclosed by a circumferential wall, wherein the circumferential wall a longitudinal slot extending up to its front side, two notches for receiving the thread on its front side and remote from the front side has a transverse slot extending transversely to the longitudinal slot, which is deeper than the wall thickness of the peripheral wall
  • a second thread manipulator which is arranged inside the cavity and can be displaced longitudinally relative to the first thread manipulator, with a thread take-up extending transversely to the end face thereof and one for
  • End face of the second thread manipulator towards open extending between opposite lateral surfaces of the second thread manipulator transverse to the thread receiving transverse groove, which is seen from the end face of the second thread manipulator from deeper than the Fadenholz- would take.
  • a groove is recessed, which extends in at least approximately two turns helically from one of the two notches to the transverse slot.
  • Loose end The part of the thread that is not fixed and that is used to make a knot. An example of a fixed and loose end can be seen in FIG.
  • FIG. 1a is an illustration of the preferred knot according to the invention in the case of an overlapping knotted technique
  • FIG. 1 b an illustration of the preferred knot according to the invention with uniform tension at both ends;
  • FIG. 2 a shows a representation of an alternative node in overlapping / overdrawn node technique
  • Fig. 2b a representation of the alternative node with uniform
  • Figures 3a to c an illustration of the two stages for making a medical throw-over knot
  • FIG. 4 shows an illustration of the method steps for producing the knot according to the invention until the formation of a loop
  • FIG. 5 shows an illustration of the production of a finished knot starting from a thread with a loop produced according to FIG. 3;
  • Fig. 6 a schematic illustration of a to be sewn by
  • FIG. 8 shows a preferred device according to the invention for automatically generating the node according to the invention
  • Fig. 9 a first alternative device for automatically generating the node according to the invention.
  • Fig. 1 1 a and b respectively a detailed view of a thread guide as part of the device of Fig. 7;
  • FIGS. 12a to c each show a detailed view of a first thread manipulator as part of the device according to FIG. 7;
  • FIGS. 13a to c each show a detailed view of a second thread manipulator as part of the device according to FIG. 7;
  • Fig. 14 an explanation of the operation of the device according to
  • Fig. 7 and 10 to 12 based on the method steps of an operating method for operating that device.
  • Fig. 15 an illustration of a bay
  • Fig. 16 an illustration of a round turn
  • Fig. 17 an illustration of an eye
  • FIG. 18 another illustration of a bay
  • Fig. 19 is another illustration of a turn
  • Fig. 20 an illustration of a loose end
  • Fig. 21 an illustration of a stitch
  • Fig. 22 an illustration of the knot according to the invention.
  • Fig. 23 an illustration of one known from the prior art
  • Figures 1 a and 1 b show the knot of the invention formed by a distal portion of a suture 10, each having a distal free end 12.
  • Fig. 1 a formed by the thread bay 14 and two formed by one turn loops 16 can be seen.
  • Figures 2a and 2b show another node, which can be used in principle as an alternative to the claimed node, but is characterized by less advantageous properties.
  • the node has three properties that make it particularly suitable for automation:
  • the knot gets by with only one stitch; the loop knot at the proximal end is made entirely without a stitch.
  • the only stitch of the knot is made with the distal end of the thread through the loop of the loop knot.
  • the force for wound adaptation is separated from the force for node fixation. Wound adaptation is controlled by the distal thread, which transfers force to fix the knot via the proximal thread.
  • the knot contracts very evenly.
  • the turns of the loop knot do not cross, as in the first variant of the double knot
  • the endoscopic union node is formed in two stages. A loop knot is first knotted in the proximal thread part, see FIG. 3a, with the aid of which the distal thread is passed through in the second step (FIG. 3b) and fixed, see FIG. 3c.
  • FIG. 4 shows how the thread for generating the node of FIG. 1 a can be placed.
  • the result is a thread with a loop formed by a bay in the region of the distal end of the thread 10.
  • a loop knot is completed and the knot is prepared for joining the two loose thread ends.
  • the further steps illustrated in FIG. 4 are necessary.
  • Figs. 6 and 7 show the process steps for producing the node according to the invention when it is generated by a machine.
  • the thread has a thread entry point and a thread exit point, and a proximal and a distal end. At the latter, the needle is usually attached.
  • the proximal thread portion extends from the proximal end to the thread entry point and the distal thread portion from the distal end to the thread exit point.
  • a proximal thread part in the form of a straight line that is perpendicular stands to the wound level.
  • the bearing forces are represented by a character common in mechanics, the closed side of the comb points in the direction of the applied force, see FIG. 6.
  • FIG. 7 shows the partial steps of knotting the endoscopic throw-over knot.
  • the substeps include either dynamic functions that move the thread or static hold or support functions. Simultaneous steps carry the same step number and are divided by a) and b). Once described, bearing forces are no longer shown in the following step for the sake of clarity, but continue to apply. Dropping forces are marked with a corresponding character (see Figure 6). The description is made with the help of the introduced with Figure 6 coordinate system.
  • the steps 1 to 6 depicted in FIG. 7 show the generation of the loop node up to the state depicted in FIG. 1 a or in the last illustration in FIG. 4.
  • the steps 7a to 8 shown in Fig. 7 finally show the closing of the knot.
  • Fig. 8 shows the essential components of a preferred device 20 for automatically generating a knot of the type according to the invention. These components are a thread guide 22, a first thread manipulator 24 and a second thread manipulator 26. These components are explained in more detail below with reference to FIGS. 11 to 13 below.
  • the thread guide 22 is a hollow spiral through which the suture passes. This spiral winds two turns around the tubular first yarn manipulator 24.
  • the yarn is located in the yarn guide 22 from the beginning. Counterclockwise rotation brings the yarn into the center of the yarn guide 22.
  • the first yarn guide 24 is provided with a groove 54. which holds the turns axially and at the same time serves the translational propulsion of the first thread guide 24 itself. A notch on the front of the tube grips the thread on the spiral exit and holds it firmly.
  • the thread guide 22 winds in the following turns on propulsion, the first thread guide 24 from. The last turn is placed in a transverse slot 48 so that the second thread manipulator 26 can grip the thread 10 and push it forward to form the bay 14.
  • Figures 9 and 10 show the essential components of alternative devices for producing the knot of the invention.
  • the embodiment according to FIG. 9 comprises a spool of thread 60, which is fastened to a disc 62 and moves in a circular path around a tube 64.
  • the tube 64 has two lumens 66 and 68, each slotted to engage the thread.
  • a thread catcher 70 In a lumen 66 is a thread catcher 70.
  • the operation is as follows: The tube 64 moves out and takes the thread in a notch 72 on its front side. Meanwhile, the disc 62 rotates with the spool of thread 60 above the tube 64 and deposits turns thereon. The last coil is placed in a proximal notch 74 in the tube so that the thread follower 70 can grasp the thread with its nose and push it forward to form the bay. The disc 62 is slotted to slide over the proximal portion of the thread and release the knot. By return When the disc 62 is moved, the distal portion of the thread is pulled through the knot. Finally, the tube 64 is withdrawn.
  • the embodiment according to FIG. 10 comprises a flexible hollow spiral 80, which due to the material, such as, for example, a flexible preformed PE tube or a shape memory alloy, can also be brought into a straight shape in addition to the depicted helical shape.
  • the hollow spiral (more precisely: -helix) 80 assumes its helical shape.
  • the thread runs in the interior of the hollow spiral 80 and is placed in the middle of the helix during the sliding out through the hollow spiral 80 itself. If the hollow spiral 80 is fully extended, a tube 84 is inserted on the in the following step, the turns are unwound.
  • the thread is held at the end face of the tube 84 by a helically circumferential groove 86. Axially, the thread is fixed by a thread.
  • a hook 88 brings the bay through the tube.
  • FIGS. 11 to 13 show details of the preferred embodiment according to FIG. 8.
  • an essential component of the thread guide 22 illustrated in FIG. 11 is a hollow body 30 which has an interior 32 for receiving the thread 10.
  • the thread guide 22 serves to guide the thread spirally around an object.
  • the hollow body 30 is designed as an inwardly open U and the thread is guided only by four webs 34 per turn, see Figure 1 1 b.
  • FIG. 12 shows that the first thread manipulator 26 arranged within the helix formed by the thread guide 24 has a peripheral wall 40 which encloses a cavity 42.
  • the peripheral wall 40 has a longitudinal slot 44 extending to its front side.
  • two notches 46 are provided on the front side of the peripheral wall 40, which serve to receive the thread 10.
  • a bit away from the front of the fangswandung 40 runs a transverse slot 48 in the longitudinal slot 44. It should be noted that it is not essential for the function that a longitudinal slot 44 runs exactly parallel to the longitudinal axis of the first yarn manipulator 24.
  • a groove 54 extends, which extends in two Helixwindened from one of the notches 46 to the transverse slot 48.
  • the first thread manipulator 24 has the function of keeping the unwound turns open and holding the thread during unwinding.
  • the notches 46 (see Fig. 12c) on its front face serve to grasp and hold the thread.
  • the helical groove 54 running on the outside of the outer wall 40 of the first thread manipulator 24 serves to hold the turns axially. After two turns, the groove opens into the transverse slot 48 (see FIG. 12b), which allows the second thread manipulator 26 to grasp the thread.
  • FIG. 12b shows the transverse slot 48 in detail.
  • FIG. 12 c shows details of the front side of the first thread manipulator 24.
  • FIG. 13 shows details of the second yarn manipulator 26.
  • the second yarn manipulator 26 is arranged longitudinally displaceably in the cavity 42 of the first yarn manipulator 24.
  • FIG. 13a is a perspective view
  • FIG. 13b is a side view
  • FIG. 13c is a plan view of the second thread manipulator 26.
  • a thread take-up 50 runs transversely to the end face of the second thread manipulator, and in FIG. 13 a the bay of the thread 10 is inserted into this thread take-up 50.
  • Transverse to the thread take-up 50 runs a transverse groove 52, which is open toward the end face of the second thread manipulator 26 and has a bottom formed by a bore 56, which is farther from the distal end of the second thread manipulator 26 than the bottom of the thread take-up 50.
  • the second thread manipulator 26 has the function of pushing the bay 14 of the loop knot forward. With its beak-shaped end face (see FIG. 13b), it picks up the thread and pushes it through the cavity 42 of the first thread manipulator 24.
  • a hole 56 is formed through the top second yarn manipulator 26 is provided, which forms the bottom of the open towards the end transverse groove 52, see Fig. 13c).
  • two thread guide channels 58 for the thread are provided on two opposite longitudinal sides of the second thread manipulator 26.
  • FIG. 14 shows in detail how the yarn guide 22, the first yarn manipulator 24 and the second yarn manipulator 26 cooperate in order to automatically tie the knot according to the invention.

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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

Prendre un fil chirurgical dont les deux extrémités sont libres, l'une des extrémités libres formant une extrémité proximale et l'autre une extrémité distale; former avec l'extrémité libre distale deux boucles orientées vers l'extrémité libre proximale de manière qu'elles entourent deux fois le fil chirurgical dans la direction de l'extrémité libre proximale; former avec l'extrémité libre distale une anse et faire passer cette anse à travers les deux boucles formées de telle sorte que, sur le côté des deux boucles opposé à l'extrémité libre proximale, se forme une première boucle alors que l'extrémité libre distale se trouve en fin de compte sur le côté orienté vers l'extrémité proximale des deux premières boucles et est orientée vers l'extrémité libre proximale; tirer le noeud par application d'une force de traction entre ladite première boucle et l'extrémité libre proximale du fil.
PCT/EP2007/059428 2006-09-08 2007-09-07 Noeud, procédé et dispositif pour le réaliser Ceased WO2008028972A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE200610043114 DE102006043114A1 (de) 2006-09-08 2006-09-08 Knoten sowie Verfahren und Vorrichtung zum Erzeugen desselben
DE102006043114.6 2006-09-08

Publications (1)

Publication Number Publication Date
WO2008028972A1 true WO2008028972A1 (fr) 2008-03-13

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PCT/EP2007/059428 Ceased WO2008028972A1 (fr) 2006-09-08 2007-09-07 Noeud, procédé et dispositif pour le réaliser

Country Status (2)

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DE (1) DE102006043114A1 (fr)
WO (1) WO2008028972A1 (fr)

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2010094730A1 (fr) * 2009-02-20 2010-08-26 Commissariat A L'energie Atomique Et Aux Energies Alternatives Dispositif de connexion par suture de deux tissus biologiques creux
DE102015122493A1 (de) * 2015-12-22 2017-06-22 Karl Storz Gmbh & Co. Kg Hilfsvorrichtung für das Bilden eines chirurgischen Knotens

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0719521A2 (fr) * 1994-11-29 1996-07-03 Olympus Optical Co., Ltd. Instrument de ligature
EP0870471A1 (fr) * 1997-04-08 1998-10-14 Ethicon Endo-Surgery, Inc. Noeud chirurgical pré-formé
US20020049458A1 (en) * 2000-08-28 2002-04-25 Wamis Singhatat Intracorporeal knot tier
US20060036265A1 (en) * 2004-08-16 2006-02-16 Zimmer Spine, Inc. Helical suturing device

Family Cites Families (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4008912A (en) * 1972-12-15 1977-02-22 Ilijus Kotov Self-tightening knot
DE3413744C2 (de) * 1984-04-12 1986-08-28 Richard Wolf Gmbh, 7134 Knittlingen Applikator zum Verknoten von Nähfäden
DE4342177A1 (de) * 1993-11-19 1995-05-24 Goran Dr Vidovic Verfahren und Vorrichtung zur Herstellung von Nähten in der minimalinvasiven Chirurgie
US5728109A (en) * 1997-04-08 1998-03-17 Ethicon Endo-Surgery, Inc. Surgical knot and method for its formation

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0719521A2 (fr) * 1994-11-29 1996-07-03 Olympus Optical Co., Ltd. Instrument de ligature
EP0870471A1 (fr) * 1997-04-08 1998-10-14 Ethicon Endo-Surgery, Inc. Noeud chirurgical pré-formé
US20020049458A1 (en) * 2000-08-28 2002-04-25 Wamis Singhatat Intracorporeal knot tier
US20060036265A1 (en) * 2004-08-16 2006-02-16 Zimmer Spine, Inc. Helical suturing device

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2010094730A1 (fr) * 2009-02-20 2010-08-26 Commissariat A L'energie Atomique Et Aux Energies Alternatives Dispositif de connexion par suture de deux tissus biologiques creux
FR2942392A1 (fr) * 2009-02-20 2010-08-27 Commissariat Energie Atomique Dispositif de connexion par suture de deux tissus biologiques creux.
DE102015122493A1 (de) * 2015-12-22 2017-06-22 Karl Storz Gmbh & Co. Kg Hilfsvorrichtung für das Bilden eines chirurgischen Knotens
DE102015122493B4 (de) 2015-12-22 2023-01-19 Karl Storz Se & Co. Kg Hilfsvorrichtung für das Bilden eines chirurgischen Knotens

Also Published As

Publication number Publication date
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