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WO2008117307A1 - Dispositif de protection de l'urètre - Google Patents

Dispositif de protection de l'urètre Download PDF

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Publication number
WO2008117307A1
WO2008117307A1 PCT/IN2008/000167 IN2008000167W WO2008117307A1 WO 2008117307 A1 WO2008117307 A1 WO 2008117307A1 IN 2008000167 W IN2008000167 W IN 2008000167W WO 2008117307 A1 WO2008117307 A1 WO 2008117307A1
Authority
WO
WIPO (PCT)
Prior art keywords
lumen
guard
probe
urethra
surgery
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/IN2008/000167
Other languages
English (en)
Inventor
Mangesh Patankar
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 WO2008117307A1 publication Critical patent/WO2008117307A1/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
    • A61B17/0493—Protective devices for suturing, i.e. for protecting the patient's organs or the operator
    • 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
    • A61B17/06109—Big needles, either gripped by hand or connectable to a handle
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/42—Gynaecological or obstetrical instruments or methods
    • A61B17/4241—Instruments for manoeuvring or retracting the uterus, e.g. during laparoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00743—Type of operation; Specification of treatment sites
    • A61B2017/00805—Treatment of female stress urinary incontinence

Definitions

  • the present invention relates generally to surgical instrument for protecting the lumen such as urethra during surgery such as sling procedure or any other surgery performed close to the lumen. More particularly, the invention provides a device to prevent inadvertent injury to the lumen during the surgical procedure such as sling surgery for stress urinary incontinence, anterior repair or vaginal vault repair, posterior sling, uterine suspension, cholecystectomy, transgastric procedure.
  • Urinary incontinence is caused by anatomical defect function in the tissues or ligaments connecting the vagina wall with the pelvic muscles and pubic bone. Urinary incontinence not only affects number of female patients worldwide but also disturbs their normal day-to-day lifestyle and social appearances. Such a defect results in an improperly functioning urethra.
  • retropubic space means that region of the female body that is posterior to the pubic bone (i.e. the region that is posterior to the pubic ramus and pubic symphysis). This is an area of loose connective tissue between the bladder with its related fascia and the pubis. It includes endopelvic fascia.
  • the retropubic space extends upward to the rectus fascia, but does not include the suprapubic area with the rectus fascia itself. The retropubic space does not extend beyond the sacrum.
  • space of Retzius or "cave of Retzius” is also used to describe portions of the retropubic space.
  • endopelvic fascia means tissue that covers the pelvic organs and surrounds vessels and nerves in the pelvic region (e.g. in the subperitoneal space). Endopelvic fascia includes collagen, elastin and smooth muscle. These structures surround and support the viscera in the pelvic cavity and extend from the pelvic floor to the rectus fascia and respiratory diaphragm. As used herein, endopelvic fascia can include pubocervical fascia and periurethral fascia. Endopelvic fascia is also referred to as visceral pelvic fascia.
  • Pubocervical fascia means a sheet of thick fibrous tissue that is located on the vagina underneath the bladder. Pubocervical fascia is anterior vaginal fascia that fuses with vaginal tissue, providing a hammock for the urethra and bladder. Projrimally, the pubocervical fascia attaches to the cervix; distally it extends beneath the urethra and fuses with the perineal membrane of the ureogenital triangle; and laterally, it is connected to the pelvic wall at the fascial white line (arcus tendineus fasciae pelvis).
  • the pubocervical fascia forms a horizontal platform that supports the bladder, and its anterior portion supports the urethra With increased abdominal pressure, the lower urinary tract is forced inferiorly and compressed against the pubocervical fascia while this fascial layer displaces to a lesser degree because of its elastic suspensory characteristics.
  • US Patent No. 5,1 12,344 discloses a method for treating female urinary incontinence without the necessity of opening the abdomen, which would require hospital care for may be four days.
  • a filamentary element or mesh tape
  • the tape is left in the body in order that fibrous ⁇ ssue shall develop around the tape, said scar tissue functioning as a supporting ligament in the soft tissue.
  • the tape is removed from the body when such scar tissue has developed, which may take about two months.
  • posterior sling which is useful for vault suspension wherein a sling in passed through the posterior fornix in vaginal to para-rectal tissue.
  • the surgeon needs to be careful not to damage the lumen of the rectum as this will create a major surgical complication.
  • the present invention provides a device, which when used during the surgical procedure is expected to reduce such inadvertent injuries to a significant extent.
  • a device to prevent accidental injury to lumen is disclosed.
  • the surgical instrument is used for protecting the lumen during surgery such as sling surgery or any other surgery performed close to any lumen. More particularly, the invention provides a device to prevent inadvertent injury to the urethra during the surgical procedure such as sling surgery for stress urinary incontinence, anterior repair or vaginal vault repair.
  • the device comprises of lumen probe or a shaft or a rod, a guard or a plate and mechanism to synchronize die said probe and said guard.
  • die said guard has wings which insert into the incision to keep the incision open during the surgery
  • the said lumen probe and Ae guard has handles which are designed in such a way that there is less interference with the surgical site.
  • the device when held with reference to anatomical landmark such as pubic bone, the guard is parallel to the lumen protecting it.
  • the said guard guides the deployment device or instrument so as to achieve particular angle of deployment
  • the guard is made into two smaller guards, which can be approximated to hold the lumen.
  • the device can be used with any surgical approach such as transobturator, retropubic or smaller mesh used in procedures like TVT - Secur, Gyneideas or such like.
  • Fig 1 is an isometric view of the first embodiment of lumen protection device. This figure shows construction of the device, lower and upper arm.
  • Fig 2 is a side view representation of the first embodiment showing the direction of working of the device
  • Fig 3 is an isometric view of the second embodiment of the lumen protection device.
  • Fig 4 is a schematic representation of the use of second embodiment of the device in lithotomy position of human female pelvis
  • Fig 5 is a schematic representation of the use of first embodiment of the device in sectional view of human female pelvis
  • the device to protect the anatomical lumen such as urethra from damage during surgery is disclosed.
  • the device will be useful in protecting the lumen even during other surgeries such as anterior repair, stress urinary incontinence procedure, vaginal repair, vault repair, cholecystectomy, or vessel harvesting.
  • the device comprises of a lumen probe and mechanism to protect the lumen during passage of the instrument around the lumen.
  • the device construction may comprise of a urethral probe, a thin sheet of tough material such as steel to guard the urethra and a clip like mechanism to control the movement of urethra probe with respect to the guard so as to protect the urethra during sling surgery.
  • the device comprises of lumen probe 1 and lumen guard 5.
  • the lumen probe and lumen guard is hinged at pin 25.
  • Spring can be attached in hole 30 to keep the two arms close to each other under tension.
  • the handle 15 of the lumen probe and handle 20 of the guard is pinched to open the device.
  • the probe 1 is inserted in the lumen and guard 5 is placed around the lumen.
  • the distance 35 between the lumen probe and lumen guard is sufficient to keep the two probes parallel or as desired. The distance 35 can be adjusted in another embodiment.
  • an incision is made of the anterior vaginal wall.
  • the lumen guard acting as urethral guard 5 is placed under the urethra after the incision.
  • the urethral guard 5 has wing projections 10. These projections may be used to locate the incision or may also be used to keep the incision open.
  • the wings 10 can be used to guide the needle during sling surgery. Also, the wings 10, can be modified further to have specific shape to guide the needle during the sling surgery.
  • Fig 5 shows the schematic representation of the use of device in human female pelvic cross-section.
  • 75 is the vaginal opening and 85 is the urethral opening.
  • the needle 70 may be inserted past the guard in the pelvic tissue 90. Once the needle is passed on both the sides, the urethral guard may be removed before further tensioning the mesh. The needles may then be removed as per the specific design of the sling procedure.
  • device is made of urethral probe 50 and urethral guard 45. They are attached to handle 105 and 100 respectively.
  • Spring 55 may be attached to produce tension between the two arms 50 and 45 is required.
  • the device may be used in a vertical position. As described earlier, the urethral probe and urethral guard is inserted into the urethra and vagina respectively.
  • the device when placed in the urethra and vagina can be of help to understand the relative position of urethra, vagina and the incision. This helps the surgeon to maneuver the needles for the sling surgery to avoid the urethra.
  • the device is pushed to the left side 110 when the right needle is being inserted.
  • the guard covers more of the right paraurethral space and hence allows for safer insertion of the needle in the right space. The same may be applied to left paraurethral space.
  • the device may be used to protect the rectum during the sling surgery wherein the lumen probe as a anal probe and guard is either placed in the vagina or on the dorsal side of the patient.
  • the device comprises of lumen probe and a mechanism to guide the instrument such as needles around the lumen wherein there is no specific guard to protect the lumen but the needles are guided in such as fashion as to not injure the lumen during passage.
  • the lumen probe may act as a locator and an elaborate deployment mechanism may be build to deploy the needles in pre-guided direction and location.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Molecular Biology (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • Engineering & Computer Science (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Gynecology & Obstetrics (AREA)
  • Pregnancy & Childbirth (AREA)
  • Reproductive Health (AREA)
  • Surgical Instruments (AREA)

Abstract

La présente invention concerne un dispositif servant à protéger la lumière lors d'une chirurgie et à minimiser des blessures accidentelles. Le dispositif est utile à une lumière anatomique subissant une chirurgie telle que l'urètre ou le rectum pour éviter des blessures et guider l'instrument. Le dispositif comprend une sonde de lumière et un mécanisme pour protéger la lumière des blessures.
PCT/IN2008/000167 2007-03-23 2008-03-19 Dispositif de protection de l'urètre Ceased WO2008117307A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
IN542/MUM/2007 2007-03-23
IN542MU2007 2007-03-23

Publications (1)

Publication Number Publication Date
WO2008117307A1 true WO2008117307A1 (fr) 2008-10-02

Family

ID=39579956

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/IN2008/000167 Ceased WO2008117307A1 (fr) 2007-03-23 2008-03-19 Dispositif de protection de l'urètre

Country Status (1)

Country Link
WO (1) WO2008117307A1 (fr)

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2013140818A1 (fr) * 2012-03-23 2013-09-26 Terumo Kabushiki Kaisha Appareil de perforation
WO2015041170A1 (fr) * 2013-09-20 2015-03-26 テルモ株式会社 Outil d'introduction et procédé pour introduire l'outil d'introduction

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1998040114A1 (fr) * 1997-03-14 1998-09-17 Medworks Corporation Gabarit chirurgical et procede chirurgical employant ce gabarit
US6099547A (en) * 1997-02-13 2000-08-08 Scimed Life Systems, Inc. Method and apparatus for minimally invasive pelvic surgery

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6099547A (en) * 1997-02-13 2000-08-08 Scimed Life Systems, Inc. Method and apparatus for minimally invasive pelvic surgery
WO1998040114A1 (fr) * 1997-03-14 1998-09-17 Medworks Corporation Gabarit chirurgical et procede chirurgical employant ce gabarit

Cited By (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2013140818A1 (fr) * 2012-03-23 2013-09-26 Terumo Kabushiki Kaisha Appareil de perforation
CN104203124A (zh) * 2012-03-23 2014-12-10 泰尔茂株式会社 穿刺装置
US8911464B2 (en) 2012-03-23 2014-12-16 Terumo Kabushiki Kaisha Puncture apparatus
JP2015512657A (ja) * 2012-03-23 2015-04-30 テルモ株式会社 穿刺装置
US9439676B2 (en) 2012-03-23 2016-09-13 Terumo Kabushiki Kaisha Puncture apparatus
CN104203124B (zh) * 2012-03-23 2017-05-03 泰尔茂株式会社 穿刺装置
WO2015041170A1 (fr) * 2013-09-20 2015-03-26 テルモ株式会社 Outil d'introduction et procédé pour introduire l'outil d'introduction

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