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WO2013004270A1 - Raccord pour raccorder un cathéter à un organe creux - Google Patents

Raccord pour raccorder un cathéter à un organe creux Download PDF

Info

Publication number
WO2013004270A1
WO2013004270A1 PCT/EP2011/061118 EP2011061118W WO2013004270A1 WO 2013004270 A1 WO2013004270 A1 WO 2013004270A1 EP 2011061118 W EP2011061118 W EP 2011061118W WO 2013004270 A1 WO2013004270 A1 WO 2013004270A1
Authority
WO
WIPO (PCT)
Prior art keywords
connecting portion
conduit
connector
hollow organ
outlet
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/EP2011/061118
Other languages
English (en)
Inventor
Michele D'arcangelo
Alessandro Pastorelli
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.)
Ethicon Endo Surgery Inc
Original Assignee
Ethicon Endo Surgery Inc
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 Ethicon Endo Surgery Inc filed Critical Ethicon Endo Surgery Inc
Priority to PCT/EP2011/061118 priority Critical patent/WO2013004270A1/fr
Publication of WO2013004270A1 publication Critical patent/WO2013004270A1/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
    • A61B17/11—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, in general, to devices and methods for surgically influencing the digestion of a patient with the aim to treat metabolic disorders, such as morbid obesity and related co-morbidities, such as diabetes, heart disease, stroke, pulmonary disease, and accidents.
  • metabolic disorders such as morbid obesity and related co-morbidities, such as diabetes, heart disease, stroke, pulmonary disease, and accidents.
  • a known minimally invasive bypass system and method for modifying the location at which bile and pancreatic secretions interact with nutrients in a gastrointestinal tract has been discussed in US 2005085787 A1 .
  • the known conduit catheter extends inside the intestine and tend to bundle up and to be displaced by the peristalsis of the intestinal tract so that the distal end of the catheter is frequently relocated far away from the target position intended by the surgeon.
  • the known endoluminal conduit in order to follow the winding path of the intestine, the known endoluminal conduit must have a significant length which undesirably increases the flow resistance and decreases the flow rate of the bile to the distal target location in the Gl tract. Accordingly, the known conduit is not suitable to obtain a significant acceleration of the bile cycling compared to the natural entero-hepatic bile cycling velocity.
  • an aim of the invention is to provide a connecting device for connecting a catheter or conduit to a hollow organ in order to enable a transluminal diversion of bodily fluid between two target locations which obviate undesired relocations of the conduit from the target locations.
  • a further object of the invention is to provide a connecting device which addresses the needs for easy installation also in very small spaces and which reduces the risk of trauma of neighboring tissue adjacent the connecting region of the catheter to the hollow organ.
  • a yet further object of the invention is to provide a connecting device for coupling a catheter to a hollow organ, in which the risk of obstruction of the catheter flow path is reduced.
  • a yet further object of the invention is to device a connector which occupies less space inside the hollow organ in order to reduce e.g. bowel obstruction.
  • a connector for connecting a conduit to a hollow organ comprising:
  • connection portion defining a conduit axis and adapted to be coupled with a conduit end so that the conduit end is aligned parallel to the conduit axis
  • conduit axis is approximately parallel to the connection plane, i.e. the conduit axis and the connection plane include an angle of between 0° and 15°, preferably between 0° and 5° . Even more preferably, the conduit axis is substantially parallel to the connection plane.
  • a connector for connecting a conduit to a hollow organ comprises:
  • annular distal connecting seat formed on the first connecting portion at the distal aperture and adapted to receive a peripheral edge of a distal tissue wall of a hollow organ stump
  • annular proximal connecting seat formed on the first connecting portion at the proximal aperture and adapted to receive a peripheral edge of a proximal tissue wall of a hollow organ stump
  • connection portion defining a conduit axis and adapted to be coupled with a conduit end so that the conduit end extends along the conduit axis
  • the conduit axis lays at least approximately, preferably substantially in a tangent plane to the first connection portion.
  • the tangent plane may be a tangent plane to a surface of a round cylinder generated about the connection axis and having a radius equal to the radial distance of the second connecting portion from the connection axis.
  • the conduit axis intersects (or, in other words, meets) the tangent plane at the second connection portion, defining an angle of from 0° to 15°, preferably between 0° to 5°, even more preferably an angle of 0° therebetween.
  • At least part of the above identified aims are also achieved by a method for connecting a conduit to a hollow organ, the method comprising the steps of:
  • the connecting device having a first connecting portion adapted to be fixated to a section of tissue wall of a hollow organ, a second connection portion adapted to be coupled with a conduit end of the condu it and an internal channel extending from the first connecting portion to the second connecting portion to put the conduit end in flow communication with the hollow organ,
  • connection requires very little space and doesn't involve cumbersome or excessively protruding parts which may cause trauma to neighboring tissue.
  • the conduit may comprise artificially grafted conduits, such as a catheter, or natural conduits, such as a section of a vein, a section of biliary duct or a section of small bowel.
  • the hollow organ may include e.g. any organ of the Gl-tract or the gallbladder.
  • FIG. 1 illustrates a translumenal diversion of bile using a connection device, conduit and method for connecting a conduit to a hollow organ in accordance with embodiments of the invention
  • FIG. 2 through 7 show longitudinal cross-sections of connection devices coupled to a conduit end and to a hollow organ in accordance with embodiments of the invention.
  • figure 1 is a partial view of the abdominal cavity of a patient, depicting the stomach 1 , duodenum 2, jejunum 3, ileum 4 and colon 5, as well as the biliary tree 7 with gall bladder 8, the pancreatic duct 9 and the mayor duodenal papilla of Vater 10 through which the bile and pancreatic fluid normally enter the duodenum 2.
  • Figure 1 shows further a method and a device for diverting biliary fluid translumenally from a biliary fluid flow path, defined by the biliary tree 7 and the gallbladder 8, to a target location in the intestine distal of the papilla of Vater 10.
  • the target location of the intestine may be a portion of the small intestine, e.g. a distal portion of duodenum 2, a portion of jejunum 3 or ileum 4 or a portion of the large intestine 5, such as for example the transverse or sigmoid colon.
  • a conduit 1 1 e.g. an artificially grafted catheter or a tubular section grafted from natural tissue such as a vein or a portion of biliary duct, can be extended from the biliary fluid flow path to the target location of the Gl tract.
  • a proximal end portion of the conduit 1 1 can be anchored inside the biliary tree 7, e.g. inside the common bile duct or connected to the gallbladder e.g. by means of a connector 12.
  • Analogously a similar connector 12 may be used to connect a distal conduit end 19 of conduit 1 1 to the target location of the intestine.
  • the connector 12 comprises a first connecting portion 13 with an annular first connecting seat 14 adapted to receive an edge 15 of a tissue wall of the hollow organ 6 in a connection plane 16.
  • the connector 12 comprises further a (preferably tubular) second connection portion 17 which defines a conduit axis 18 and which is adapted to be coupled with a conduit end 19 so that the conduit end 19 extends along the conduit axis 18.
  • An internal channel 20 extends inside the connector 12 from an inlet at the second connecting portion 17 to an outlet 27 at the first connecting portion 13 to put the conduit end 19 in flow communication with the hollow organ 6.
  • the conduit axis 18 is approximately parallel to the connection plane 16, i.e. the conduit axis 18 and the connection plane 16 include an angle of between 0° and 1 5° , preferably between 0° and 5°. Even more preferably, the conduit axis 18 is substantially parallel to the connection plane 16.
  • the first connecting portion 13 forms a distal wall 21 defining the outlet 27 of the internal channel 20 and arranged or exposed inside the hollow organ 6, and a proximal wall 22 arranged outside the hollow organ when the latter is attached to the first connecting seat 14.
  • the second connecting portion 17 extends from the proximal wall 22 on a side opposite the distal wall 1 and is configured such that the conduit end 19 (fastened to the second connecting portion 17) remains outside the hollow organ 6. This obviates an undesired occupation of the internal space of the hollow organ 6 and reduces the risk of obstruction, particularly in the case of a connection of a catheter to the intestine.
  • the first connecting seat 14 comprises an annular groove formed between the proximal wall 22 and the distal wall 21 of the first connecting portion 13 and which lays in the connecting plane 16.
  • the edge 15 of an otomy performed in the hollow organ 6 can be inserted in the groove and circumferentially cinched and locked by means of a purse string suture.
  • the groove may form a radially external guide portion 24 or flare with an outwardly enlarged cross-section that facilitates the insertion of the tissue wall and the placement of a cinching loop or purse string suture.
  • the coupling of the conduit end 19 with the second connecting portion 17 may be accomplished e.g. by inserting the conduit end 19 over the tubular connecting portion 17 or vice versa, screwing them to one another provided they are threaded, by insertion and additional gluing with an adhesive, by insertion of the conduit end 19 over the tubular connecting portion 17 and additional cinching with a tightening wire or suture, etc..
  • the second connecting portion 17 may be formed monolithically or, in other words, as a single piece with the first connecting portion 13.
  • the second connecting portion 1 7 may be formed in an adapter piece 25 which can be reversibly or irreversibly coupled to the first connecting portion 13, e.g. by means of snap-on or press-fit connecting features. This allows to split the connection procedure in three distinct phases (connecting the conduit end to the second connecting portion of the adapter piece, connecting the first connecting portion to the hollow organ, connecting the adapter piece to the first connecting portion) which can be performed independently from one another and in any sequence deemed appropriate.
  • the adapter piece 25 may be connectable to the first connecting portion 13 in different relative angular positions e.g. about an adjustment axis 42 normal to the connecting plane 16.
  • the adapter piece 25 may be connected or connectable to the first connecting portion 13 such that they may rotate to each other to enable an angular adjustment therebetween e.g. about an adjustment axis 42 normal to the connecting plane 16.
  • the first connecting portion 13, particularly the distal wall 21 forms a unilateral protection wall 26 on at least one leading side of the outlet 27 of the internal channel 20 in a manner to shield and protect the outlet 27 from contents flowing in the hollow organ 6 in a flow direction (arrow 28) parallel to the connection plane 16, while exposing the outlet 27 on an opposite trailing side thereof, such that fluids can exit the outlet 27 in the hollow organ 6 in the direction of flow 28.
  • a flow direction arrow 28
  • the first connecting portion 13 in the distal wall 21 forms a unilateral protection wall 26 on at least one leading side of the outlet 27 of the internal channel 20 in a manner to shield and protect the outlet 27 from contents flowing in the hollow organ 6 in a flow direction (arrow 28) parallel to the connection plane 16, while exposing the outlet 27 on an opposite trailing side thereof, such that fluids can exit the outlet 27 in the hollow organ 6 in the direction of flow 28.
  • undesired backflow of contents from the hollow organ 6 in the internal channel 20 is prevented.
  • the unilateral protection wall 26 has a wall portion 29 which extends opposite the outlet 27 and at a certain distance thereof, thereby protecting and shielding the outlet 27 from contents flowing in the hollow organ 6 in a perpendicular direction to the connection plane 16.
  • an outlet portion of the internal channel 20 defining the outlet 27 extends in an outlet direction 41 approximately parallel to the connection plane 16 and provides only one outlet aperture facing in an approximately parallel direction with respect to the connecting plane.
  • FIGS. 6 and 7 illustrate an alternative connector 30 which also implements many of the above described inventive concepts, but which is particularly adapted to be applied to two opposite stumps of a completely resected hollow organ, such as a resected section of small bowel.
  • the connector 30 for connecting a conduit 1 1 to a hollow organ 6 comprises a tubular first connecting portion 31 extending along a connection axis 32 between a proximal open end 33 and a distal open end 34.
  • the distal open end 34 of the first connecting portion 31 forms an annular distal connecting seat 35 adapted to receive a peripheral edge 36 of a distal tissue wall of a hollow organ stump 37.
  • the connector 30 in figures 6 and 7 comprises a (preferably tubular) second connection portion 17 which defines a conduit axis 18 and which is adapted to be coupled with a conduit end 19 so that the conduit end 19 extends along the conduit axis 18.
  • An internal channel 20 extends inside the connector 30 from an inlet at the second connecting portion 17 to an outlet 27 at the first connecting portion 31 to put the conduit end 19 in flow communication with the hollow organ 6.
  • the conduit axis 1 8 lays at least approximately, preferably substantially in a tangent plane 47 to the first connection portion 31 .
  • the tangent plane 47 may be a tangent plane to a surface of a round cylinder 48 generated about the connection axis 32 and having a radius equal to the radial distance of the second connecting portion 17 from the connection axis 32.
  • the round cylinder 48 generated about the connection axis 32 has a radius equal to the smallest distance between the conduit axis 18 and the connection axis 32.
  • the conduit axis 18 intersects or meets the tangent plane 47 at the second connection portion 17, defining an angle of from 0° to 15°, preferably between 0° to 5°, even more preferably an angle of 0° therebetween.
  • the embodiments of figures 6 and 7 provide an at least approximately tangential extension of the conduit end 19 with respect to the hollow organ 6 and the tubular first connecting portion, thereby reducing the space required by the connection and obviating cumbersome or excessively protruding parts which may cause trauma to neighboring tissue.
  • the first connecting portion 31 forms a generally cylindrical side wall 43 with an internal surface 44 defining the outlet 27 of the internal channel 20 and arranged or exposed inside the hollow organ 6, and an external surface 45 facing towards the outside of the hollow organ 6 when both opposing stumps 37, 40 of it are attached to the distal and proximal connecting seats 35, 38.
  • the second connecting portion 17 extends from the external surface 45 on a side opposite the internal surface 44 and is configured such that the conduit end 19 (fastened to the second connecting portion 17) remains outside the internal lumen formed by the hollow organ 6 together with the connector 30. This obviates an undesired occupation of the internal space of the hollow organ 6 and reduces the risk of obstruction, particularly in the case of a connection of a catheter to the intestine.
  • any of the distal and proximal connecting seats 35, 38 may comprise an annular radially outward projecting retaining shoulder 46 or, alternatively, an annular groove, extending around a circumference of the side wall 43.
  • the annular shoulder 46 lays in a plane substantially perpendicular to the connection axis 32.
  • edges 36, 39 of hollow organ stumps 37, 40 can be inserted over retaining shoulders 46 or grooves and circumferentially cinched and/or locked by means of a purse string suture.
  • the coupling of the conduit end 19 with the second connecting portion 17 may be accomplished as described in connection with the embodiments of Figs 2 to 5.
  • the second connecting portion 17 may be formed monolithically or, in other words, as a single piece with the first connecting portion 31 .
  • the second connecting portion 17 may be formed in an adapter piece 25 which can be reversibly or irreversibly coupled to the first connecting portion 31 , e.g. by means of snap-on or press-fit connecting features.
  • This embodiment allows to split the connection procedure in three distinct phases (connecting the conduit end to the second connecting portion of the adapter piece, connecting the first connecting portion to the hollow organ, connecting the adapter piece to the first connecting portion) which can be performed independently from one another and in any sequence deemed appropriate.
  • the adapter piece 25 may be connectable to the first connecting portion 31 in different relative angular positions e.g. about an adjustment axis 42 with the only condition that the conduit axis 18 remains substantially in the tangent plane 47. Similarly, the adapter piece 25 may be connected or connectable to the first connecting portion 13 such that they may rotate to each other to enable an angular adjustment therebetween while the conduit axis 18 remains substantially in the tangent plane 47.
  • the first connecting portion 31 forms a unilateral protection wall 26 on at least one leading side of the outlet 27 of the internal channel 20 in a manner to shield and protect the outlet 27 from contents flowing in the hollow organ 6 i n a flow d irection (arrow 28) paral lel to the connection axis 32, while exposing the outlet 27 on an opposite trailing side thereof, such that fluids can exit the outlet 27 in the hollow organ 6 in the direction of flow 28 but undesired backflow of contents from the hollow organ 6 in the internal channel 20 is prevented.
  • the unilateral protection wall 26 has a wall portion 29 which extends opposite the outlet 27 and at a certain distance thereof, thereby protecting and shielding the outlet 27 from contents flowing in the hollow organ 6 in a perpendicular direction to the connection plane 16.
  • the unilateral protection wall 26 forms a circumferentially extending annular leading wall portion 49 and an axially extending tubular wall section 50 which define together with the internal surface 44 a ring space 51 closed towards a leading side (against the direction of flow of e.g. intestinal contents) and on a radially internal side, but open on a trailing side (e.g. in an intestinal flow direction) of the outlet 27.

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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)
  • Physiology (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)
  • External Artificial Organs (AREA)

Abstract

L'invention concerne un raccord (12) pour raccorder un conduit (11) à un organe creux (6), lequel raccord comprend une première partie de raccordement (13) ayant un premier siège de raccordement annulaire (14) conçu pour recevoir une paroi (15) d'un organe creux (6) dans un plan de raccordement (6), une seconde partie de raccordement tubulaire (17) définissant un axe de conduit (18) et conçue pour être couplée à une extrémité de conduit (19) de sorte que l'extrémité de conduit (19) s'étende le long de l'axe de conduit (18), un canal interne (20) s'étendant à l'intérieur du raccord (12) d'un orifice d'entrée au niveau de la seconde partie de raccordement (17) à un orifice de sortie (27) au niveau de la première partie de raccordement (13) pour placer l'extrémité de conduit (19) en communication fluidique avec l'organe creux (6), l'axe de conduit (18) étant approximativement parallèle au plan de raccordement (16).
PCT/EP2011/061118 2011-07-01 2011-07-01 Raccord pour raccorder un cathéter à un organe creux Ceased WO2013004270A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/EP2011/061118 WO2013004270A1 (fr) 2011-07-01 2011-07-01 Raccord pour raccorder un cathéter à un organe creux

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/EP2011/061118 WO2013004270A1 (fr) 2011-07-01 2011-07-01 Raccord pour raccorder un cathéter à un organe creux

Publications (1)

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WO2013004270A1 true WO2013004270A1 (fr) 2013-01-10

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PCT/EP2011/061118 Ceased WO2013004270A1 (fr) 2011-07-01 2011-07-01 Raccord pour raccorder un cathéter à un organe creux

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Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4164221A (en) * 1977-07-28 1979-08-14 Bentley Laboratories, Inc. Atraumatic blood access device valve
US20020116018A1 (en) * 1999-05-28 2002-08-22 Stevens Walter J. Anastomosis system and methods for use
US20020161383A1 (en) * 1999-07-28 2002-10-31 Jodi Akin Devices and methods for interconnecting vessels
DE10205997A1 (de) * 2002-02-14 2003-09-04 Hm Medical Engineering Gmbh Vorrichtung zum Verbinden von strangartigem Gewebe
US6843795B1 (en) * 1998-06-10 2005-01-18 Converge Medical, Inc. Anastomotic connector for sutureless anastomosis systems
US20050085787A1 (en) 2003-10-17 2005-04-21 Laufer Michael D. Minimally invasive gastrointestinal bypass

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4164221A (en) * 1977-07-28 1979-08-14 Bentley Laboratories, Inc. Atraumatic blood access device valve
US6843795B1 (en) * 1998-06-10 2005-01-18 Converge Medical, Inc. Anastomotic connector for sutureless anastomosis systems
US20020116018A1 (en) * 1999-05-28 2002-08-22 Stevens Walter J. Anastomosis system and methods for use
US20020161383A1 (en) * 1999-07-28 2002-10-31 Jodi Akin Devices and methods for interconnecting vessels
DE10205997A1 (de) * 2002-02-14 2003-09-04 Hm Medical Engineering Gmbh Vorrichtung zum Verbinden von strangartigem Gewebe
US20050085787A1 (en) 2003-10-17 2005-04-21 Laufer Michael D. Minimally invasive gastrointestinal bypass

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