WO1993008747A1 - Method and device for holding a celiotomy wire - Google Patents

Method and device for holding a celiotomy wire Download PDF

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Publication number
WO1993008747A1
WO1993008747A1 PCT/FR1992/001012 FR9201012W WO9308747A1 WO 1993008747 A1 WO1993008747 A1 WO 1993008747A1 FR 9201012 W FR9201012 W FR 9201012W WO 9308747 A1 WO9308747 A1 WO 9308747A1
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WO
WIPO (PCT)
Prior art keywords
male
instrument
female
wire
parts
Prior art date
Application number
PCT/FR1992/001012
Other languages
French (fr)
Inventor
Jean-Marc Nouaille
Original Assignee
Nouaille Jean Marc
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 Nouaille Jean Marc filed Critical Nouaille Jean Marc
Publication of WO1993008747A1 publication Critical patent/WO1993008747A1/en

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/122Clamps or clips, e.g. for the umbilical cord
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0483Hand-held instruments for holding sutures
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0487Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00349Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0448Additional elements on or within the anchor
    • A61B2017/045Additional elements on or within the anchor snug fit within the anchor
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0454Means for attaching and blocking the suture in the suture anchor the anchor being crimped or clamped on the suture
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0487Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
    • A61B2017/0488Instruments for applying suture clamps, clips or locks

Definitions

  • the present invention relates to the field of apparatus, devices or means designed to enable blocking of a wire during the practice of surgical techniques and, more particularly, of laparoscopic surgery.
  • laparoscopic surgery concerns an operating technique which is freed from making incisions or openings made to give access to the part to be treated of a person's organism.
  • This technique requires the implementation of suitable instruments for crossing the abdominal wall in order to authorize the performance of specific interventions, for example at the level of the appendix or the gallbladder.
  • These instruments generally have a passage section of the order of 5. 10 mm and a length of 400 mm.
  • These instruments are intended to be manipulated by the surgeon from outside the body, in order to perform specific surgical operations inside the body of a person.
  • Patent application WO 90/04 357 proposed a surgical instrument for deep sutures or ligatures, comprising operating handles capable of ensuring the movement of a cable on which are hung, on the one hand, transport cabins for a needle provided with a surgical thread and, on the other hand, a system allowing the tightening of a knot made outside the instrument. It appears that the practical implementation of such an instrument proves difficult to carry out. In addition, this instrument makes it possible to make a single knot, which does not make it possible to obtain a lasting blocking of the wire.
  • Patent application EP 0012 360 has, furthermore, proposed a button for blocking a surgical thread, comprising a disc or a housing in which a slot is made for the introduction of the thread.
  • the housing is articulated to a disc segment intended to pivot so as to wedge the wire between the walls of the housing and the faces of the disc segment.
  • the blocking button described by this document is not able to be used in the laparoscopic technique and does not appear to be able to ensure effective and lasting blocking of a surgical thread.
  • the object of the invention is to remedy the drawbacks set out above by proposing a suitable method for allowing, in laparoscopic surgery, the blocking of the wires used to ensure a ligature or a suture, for example.
  • the object of the invention also aims to propose a method capable of dispensing with the making of knots, by making it possible to link together at least two terminal parts of a wire or of two wires.
  • the method according to the invention consists in: - introducing into the body of a person, using the instrument, at least one blocking device formed of a male part and a female part, - control by the instrument, the relative sliding of the male part with respect to the part female to ensure their nesting, with a view to jamming the fi L,
  • the method provides, before proceeding to the complete nesting of the parts, to engage the wire or wires to be blocked inside a notch.
  • the object of the invention also aims to propose a device for blocking at least one wire comprising:
  • male part and female part intended to delimit between them at least one wedging zone for the wire, when the male and female parts are nested one inside the other,
  • the device according to the invention comprises male and female parts each provided with at least one complementary surface with an inclined profile delimiting between them at least one jamming zone When the male and female parts slide together notch arranged in a direction substantially perpendicular to the direction of nesting of the parts.
  • Fig. 1 is an exploded perspective view of a first alternative embodiment of a locking device according to the invention.
  • Fig- 2 is a sectional view taken substantially along Line II-II of fig. 1. showing The device according to the invention in the wire locking position.
  • Fig. 3 is a perspective view, partially broken away, showing a locking device produced according to a different structure.
  • Fig. 4 is a general view of an exemplary embodiment of an instrument adapted to ensure the establishment of the blocking device by the technique of laparoscopic surgery.
  • Fig. 5 is a view of another embodiment of an instrument ensuring the establishment of a blocking device in laparoscopic surgery.
  • Figs. 1 and 2 illustrate a device 1 according to the invention, used in coeLiosurgery and intended to ensure the blocking of at least one thread, in the general sense, to produce, for example the overlock, a suture or a ligature.
  • the blocking device 1 according to the invention comprises a male part 2, intended to be fitted at least partially inside a female part 3.
  • the parts 2 and 3 are adapted to provide for each other, during their fitting by translation, at least one zone 4 ensuring the jamming of at least one and, in the illustrated example, of two terminal parts 5 .. of one or two wires 5.
  • the male part 2 is produced in the form of a truncated cone, for example of circular base, while the female part 3 has a bore 6 of shape complementary to the envelope or to the outer surface of revolution 7 of the male part 2.
  • the relative displacement in translation of the parts 2 and 3 leads, by wedge effect, to a blocking of the wires placed in the zones
  • the wires 5 extend on either side of the diameter of the part 2, so that the wires 5 are trapped by two zones 4 which are delimited by surfaces with an inclined profile or at slopes complementary, namely the external surface of revolution 7 of the male part 2 and the surface of the bore 6.
  • FIG. 3 illustrates The parts 2 and 3 having complementary trapezoidal shapes, each comprising at least one face with a slope of the same inclination.
  • the two opposite main flat faces 8 and 9, respectively of the parts 2 and 3, delimit two wedging zones 4.
  • the two main faces 8 of the male part 2 each have a slope of the same inclination as the slope of the faces 9 of the female part 3.
  • the wires are wedged between the two sloping faces 8, 9.
  • the male 2 and female 3 parts are equipped with means ensuring their relative immobilization when these parts are fitted one into the 'other.
  • immobilization means are constituted, for example, by elements of complementary structures carried by the male and female parts, such as, for example, clearances, lights or grooves 12 made, at least locally, on the surface peripheral of the part 2 and intended to cooperate with notches, lugs or projections 13 formed inside the part 13.
  • IT can also be provided to produce an annular bead ' on the nesting end of the part male 2, so that the bead, by elastic deformation, comes to open and extend along the transverse face of the female part.
  • one of the parts namely, for example, the male part 2 in the example illustrated, comprises at least one notch or a slot 14 facilitating the gripping of the wire, in order to its jamming in the zone 4.
  • the notch 14 is formed according to the diameter of the male part 2, in a direction substantially perpendicular to the direction of interlocking or translation of the parts, represented by the arrow f.
  • Male part 2 holds thus the son 5 during the introduction of the male part 2 inside the female part 3.
  • the notch 14 can be formed in the female part.
  • the nesting end of the latter has a U-shape ensuring the gripping of the wires.
  • the method or method for blocking a fî L in laparoscopic surgery by the device according to the invention follows directly from the above description. As shown more precisely in FIG. 4, The positioning of this blocking device is effected by means of an instrument 16 ′ comprising a piston 18 controlled to slide in a sleeve 19 by means of a rod 20.
  • the sheath generally has a section of the order of 10 mm and a length of the order of 400 mm.
  • the instrument defines, at its end intended to be inserted inside the body of a person, a well 22 for loading and ejection for at least one blocking device 1.
  • the piston 18 maintains, in cooperation with an elastic member 25 carried by the sheath 19, the male 2 and female 3 parts partially nested one inside the other. After the introduction of the lower end of the instrument 16, inside the organism, the instrument is moved to allow the thread (s) to be engaged, inside the notch 14 .
  • the piston 18 is then moved in sliding to ensure a relative translation between the male 2 and female 3 parts, so as to ensure the interlocking and, consequently, the jamming or blocking by wedge effect of the wire or wires in the zones 4.
  • the piston 18 is moved so that the notches 13 cooperate with the grooves 12, in order to obtain a final relative immobilization of the two parts.
  • the piston 18 is then pushed back, so that the locking device 1, preferably but not exclusively resiliently biased by element 25 is detached from the instrument to be left in place inside the organism.
  • Such a device offers the 'advantage of allowing the easy realization of nodes by the jamming of the two end parts of one or two wires.
  • the jamming of the wire or wires is greatly facilitated by the implementation of the notch 14 which makes it possible to position and guide the wire or wires during the entire blocking operation.
  • the device 1 is made of a material capable of being supported or absorbed by the body of a person and can have a length of up to 10 mm.
  • provision can be made for a disposable instrument after the installation of a single device or capable of receiving a battery of blocking devices in accordance with the invention, successively brought to the level of well 22.
  • Fig. 5 illustrates, by way of example, another alternative embodiment of an instrument 16 capable of being used in laparoscopic surgery to ensure the establishment of a blocking device 1 according to the invention.
  • the male 2 and female 3 parts are held together during their introduction into the interior of the body, by means of the piston 18 comprising a shoulder 23 for centering the female part 3 and using a Link 26 fixed to the male part 2 and on the outer sheath 19.
  • the relative movement of the sheath 19 relative to the piston 18 makes it possible to ensure the engagement of the male part 2 inside the female part 3
  • the rupture of the Link 26 after the complete fitting of the two parts allows the locking device according to the invention to be left in place.
  • the device according to the invention makes it possible, in laparoscopic surgery, to block at least one thread to perform, for example, an overlock, a suture or a ligature.

Abstract

A method for holding at least one celiotomy wire by means of an instrument (16). The method comprises inserting at least one holding device (1) consisting of a projecting portion (2) and a socket portion (3) into the body of a patient by means of said instrument (16); using the instrument (16) to control the sliding movement of the projecting portion (2) relative to the socket portion (3) so that the former fits into the latter and fixes the wire; and operating the instrument (16) to disengage the holding device (1) therefrom.

Description

PROCEDE ET DISPOSITIF POUR BLOQUER UN FIL EN COELIOCHIRURGIEMETHOD AND DEVICE FOR LOCKING A COELOSURGERY THREAD
DOMAINE TECHNIQUE :TECHNICAL AREA :
La présente invention concerne Le domaine des appareils, des dispositifs ou des moyens conçus pour permettre d'assurer Le blocage d'un fil lors de la pratique des techniques de chirurgie et, plus particulièrement, de coeliochirurgie.The present invention relates to the field of apparatus, devices or means designed to enable blocking of a wire during the practice of surgical techniques and, more particularly, of laparoscopic surgery.
D'une manière générale, La coeliochirurgie concerne une technique opératoire s'affranchissant de la réalisation d'incisions ou d'ouvertures pratiquées pour donner accès à la partie à traiter de l'organisme d'une personne. Cette technique impose la mise en oeuvre d'instruments adaptés pour traverser la paroi abdominale en vue d'autoriser la réalisation d'interventions spécifiques, par exemple au niveau de l'appendice ou de la vésicule biliaire. Ces instruments présentent, généralement, une section de passage de l'ordre de 5 . 10 mm et une Longueur de 400 mm. Ces instruments sont destinés à être manipulés par le chirurgien de l'extérieur du corps, en vue d'assurer des opérations de chirurgie spécifiques à l'intérieur de L'organisme d'une personne.Generally speaking, laparoscopic surgery concerns an operating technique which is freed from making incisions or openings made to give access to the part to be treated of a person's organism. This technique requires the implementation of suitable instruments for crossing the abdominal wall in order to authorize the performance of specific interventions, for example at the level of the appendix or the gallbladder. These instruments generally have a passage section of the order of 5. 10 mm and a length of 400 mm. These instruments are intended to be manipulated by the surgeon from outside the body, in order to perform specific surgical operations inside the body of a person.
Ces opérations nécessitent, généralement, La réaLisation de points de suture ou de Ligature, par l'intermédiaire d'un ou de plusieurs fils. Un problème particulièrement difficile à résoudre est celui visant à arrêter ou à bloquer le fil ou les f Ls de suture ou de ligature. Dans Le même sens, La réalisation de noeuds à L'aide des instruments connus de coeliochirurgie s'avère difficile, voire impossible.These operations generally require the realization of stitches or Ligature, via one or more threads. A particularly difficult problem to solve is that of stopping or blocking the suture or ligature thread or threads. In the same direction, the realization of nodes using known instruments of laparoscopy is difficult, if not impossible.
TECHNIQUE ANTERIEURE :PRIOR TECHNIQUE:
La demande de brevet W0 90/04 357 a proposé un instrument chirurgical pour sutures ou ligatures profondes, comportant des poignées de manoeuvre aptes à assurer le déplacement d'un câble sur Lequel sont accrochés, d'une part, des cabines de transport d'une aiguille pourvue d'un fil chirurgical et, d'autre part, un système permettant Le serrage d'un noeud réalisé en dehors de l'instrument. Il apparaît que la mise en oeuvre pratique d'un tel instrument s'avère délicate à mener à bien. De plus, cet instrument permet de réaliser un unique noeud, ce qui ne permet pas d'obtenir un blocage durable du fil.Patent application WO 90/04 357 proposed a surgical instrument for deep sutures or ligatures, comprising operating handles capable of ensuring the movement of a cable on which are hung, on the one hand, transport cabins for a needle provided with a surgical thread and, on the other hand, a system allowing the tightening of a knot made outside the instrument. It appears that the practical implementation of such an instrument proves difficult to carry out. In addition, this instrument makes it possible to make a single knot, which does not make it possible to obtain a lasting blocking of the wire.
La demande de brevet EP 0012 360 a, par a lleurs, proposé un bouton de blocage d'un fil chirurgical, comportant un disque ou un boîtier dans lequel est ménagée une fente pour L'introduction du fil. Le boîtier est articulé à un segment de disque destiné à pivoter pour venir coincer le fil entre les parois du boîtier et les faces du segment de disque.Patent application EP 0012 360 has, furthermore, proposed a button for blocking a surgical thread, comprising a disc or a housing in which a slot is made for the introduction of the thread. The housing is articulated to a disc segment intended to pivot so as to wedge the wire between the walls of the housing and the faces of the disc segment.
Le bouton de blocage décrit par ce document n'est pas en mesure d'être utilisé dans La technique de coeliochirurgie et n'apparaît pas être en mesure d'assurer un blocage efficace et durable d'un fil chirurgical.The blocking button described by this document is not able to be used in the laparoscopic technique and does not appear to be able to ensure effective and lasting blocking of a surgical thread.
EXPOSE DE L'INVENTION :PRESENTATION OF THE INVENTION:
L'objet de L'invention vise à remédier aux inconvénients énoncés ci-dessus en proposant un procédé adapté pour permettre, en coeliochirurgie, le blocage des fils mis en oeuvre pour assurer une Ligature ou une suture, par exemple.The object of the invention is to remedy the drawbacks set out above by proposing a suitable method for allowing, in laparoscopic surgery, the blocking of the wires used to ensure a ligature or a suture, for example.
L'objet de l'invention vise, également, à proposer un procédé apte à s'affranchir de la réalisation de noeuds, en permettant de Lier ensemble au moins deux parties terminales d'un fil ou de deux fils.The object of the invention also aims to propose a method capable of dispensing with the making of knots, by making it possible to link together at least two terminal parts of a wire or of two wires.
Pour atteindre cet objectif, le procédé selon L'invention consiste à : - introduire dans L'organisme d'une personne, à l'aide de l'instrument, au moins un dispositif de blocage formé d'une pièce mâle et d'une pièce femelle, - commander par l'instrument, le coulissement relatif de La pièce mâle par rapport à la pièce femelle pour assurer Leur emboîtement, en vue du coincement du fi L,To achieve this objective, the method according to the invention consists in: - introducing into the body of a person, using the instrument, at least one blocking device formed of a male part and a female part, - control by the instrument, the relative sliding of the male part with respect to the part female to ensure their nesting, with a view to jamming the fi L,
- et à agir sur L'instrument pour permettre de désolidariser le dispositif de blocage de l'instrument.- and act on the instrument to allow the locking device to be detached from the instrument.
Selon une caractéristique avantageuse de L'invention, Le procédé prévoit, avant de procéder à L'emboîtement complet des pièces, à engager le ou Les fils à bloquer à l'intérieur d'une échancrure. L'objet de l'invention vise également à proposer un dispositif de blocage d'au moins un fil comportant :According to an advantageous characteristic of the invention, the method provides, before proceeding to the complete nesting of the parts, to engage the wire or wires to be blocked inside a notch. The object of the invention also aims to propose a device for blocking at least one wire comprising:
- une pièce mâle et une pièce femelle destinées à délimiter entre-elles au moins une zone de coincement pour le fil, lorsque les pièces mâle et femelle sont emboîtées l'une dans l'autre,a male part and a female part intended to delimit between them at least one wedging zone for the wire, when the male and female parts are nested one inside the other,
- et au moins une échancrure assurant la préhension du fil.- And at least one notch ensuring the grip of the wire.
Le dispositif selon l'invention comporte des pièces mâle et femelle pourvues chacune d'au moins une surface complémentaire à profil incliné délimitant entre-elles au moins une zone de coincement Lors de l'emboîtement par coulisse ent relatif des pièces mâle et femelle et une échancrure aménagée selon une direction sensiblement perpendiculaire à la direction d'emboîtement des pièces. Diverses autres caractéristiques ressortent de La description faite ci-dessous en référence aux dessins annexés qui montrent, à titre d'exemples non limitatifs, des formes de réalisation de l'objet de l'invention.The device according to the invention comprises male and female parts each provided with at least one complementary surface with an inclined profile delimiting between them at least one jamming zone When the male and female parts slide together notch arranged in a direction substantially perpendicular to the direction of nesting of the parts. Various other characteristics appear from the description given below with reference to the appended drawings which show, by way of non-limiting examples, embodiments of the subject of the invention.
BREVE DESCRIPTION DES DESSINS :BRIEF DESCRIPTION OF THE DRAWINGS:
La fig. 1 est une vue en perspective éclatée d'une première variante de réaLisation d'un dispositif de blocage conforme à l'invention. La fig- 2 est une vue en coupe prise sensiblement selon La Ligne II-II de La fig. 1. montrant Le dispositif selon l'invention en position de blocage du fil.Fig. 1 is an exploded perspective view of a first alternative embodiment of a locking device according to the invention. Fig- 2 is a sectional view taken substantially along Line II-II of fig. 1. showing The device according to the invention in the wire locking position.
La fig. 3 est une vue en perspective, en partie arrachée, montrant un dispositif de blocage réalisé selon une structure différente.Fig. 3 is a perspective view, partially broken away, showing a locking device produced according to a different structure.
La fig. 4 est une vue générale d'un exemple de réaLisation d'un instrument adapté pour assurer la mise en place du dispositif de blocage par la technique de coeliochirurgie.Fig. 4 is a general view of an exemplary embodiment of an instrument adapted to ensure the establishment of the blocking device by the technique of laparoscopic surgery.
La fig. 5 est une vue d'un autre exemple de réalisation d'un instrument assurant La mise en place d'un dispositif de blocage en coeliochirurgie.Fig. 5 is a view of another embodiment of an instrument ensuring the establishment of a blocking device in laparoscopic surgery.
MEILLEURE MANIERE DE REALISER L'INVENTION :BEST WAY TO IMPLEMENT THE INVENTION:
Les fig. 1 et 2, illustrent un dispositif 1 conforme à l'invention, utilisé en coeLiochirurgie et destiné à assurer le blocage d'au moins un fil, au sens général, pour réaliser, par exempLe un surjet, une suture ou une ligature. Le dispositif de blocage 1 selon l'invention comporte une pièce mâle 2, destinée à être emboîtée au moins partiellement à l'intérieur d'une pièce femelle 3. Les pièces 2 et 3 sont adaptées pour ménager entre elles, Lors de Leur emboîtement par translation, au moins une zone 4 assurant Le coincement d'au moins un et, dans L'exemple iLlustré, de deux parties terminales 5.. d'un ou de deux fils 5. Dans l'exemple illustré aux fig. 1 et 2, la pièce mâle 2 est réalisée sous la forme d'un tronc de cône, par exemple de base circulaire, tandis que la pièce femelle 3 comporte un alésage 6 de forme complémentaire à l'enveloppe ou à La surface de révolution extérieure 7 de la pièce mâle 2. Après L'interposition des fils 5, entre les pièces mâle 2 et femelle 3, le déplacement relatif en translation des pièces 2 et 3 conduit, par effet de coin, à un blocage des fils placés dans les zones de coincement 4. Selon cet exemple, les fils 5 s'étendent de part et d'autre du diamètre de La pièce 2, de sorte que les fils 5 sont coincés par deux zones 4 qui sont délimitées par des surfaces à profil incliné ou à pentes complémentaires, à savoir la surface de révolution extérieure 7 de La pièce mâle 2 et la surface de l'alésage 6.Figs. 1 and 2, illustrate a device 1 according to the invention, used in coeLiosurgery and intended to ensure the blocking of at least one thread, in the general sense, to produce, for example the overlock, a suture or a ligature. The blocking device 1 according to the invention comprises a male part 2, intended to be fitted at least partially inside a female part 3. The parts 2 and 3 are adapted to provide for each other, during their fitting by translation, at least one zone 4 ensuring the jamming of at least one and, in the illustrated example, of two terminal parts 5 .. of one or two wires 5. In the example illustrated in FIGS. 1 and 2, the male part 2 is produced in the form of a truncated cone, for example of circular base, while the female part 3 has a bore 6 of shape complementary to the envelope or to the outer surface of revolution 7 of the male part 2. After the interposition of the wires 5, between the male 2 and female 3 parts, the relative displacement in translation of the parts 2 and 3 leads, by wedge effect, to a blocking of the wires placed in the zones In this example, the wires 5 extend on either side of the diameter of the part 2, so that the wires 5 are trapped by two zones 4 which are delimited by surfaces with an inclined profile or at slopes complementary, namely the external surface of revolution 7 of the male part 2 and the surface of the bore 6.
Bien entendu, les pièces mâle 2 et femelle 3 peuvent être réalisées sous d'autres formes que celles représentées aux fig. 1 et 2. A titre d'exemple, La fig. 3 illustre Les pièces 2 et 3 présentant des formes trapézoïdales complémentaires, comportant chacune au moins une face à pente de même inclinaison. Dans l'exemple illustré, les deux faces planes principales opposées 8 et 9, respectivement des pièces 2 et 3, délimitent deux zones de coincement 4. A cet effet, les deux faces principales 8 de la pièce mâle 2 présentent chacune une pente de même inclinaison que la pente des faces 9 de La pièce femelle 3. Tel que cela ressort de la fig. 3, Les fils sont coincés entre Les deux faces à pente 8, 9. Selon une caractéristique avantageuse de l'invention, les pièces mâle 2 et femelle 3 sont équipées de moyens assurant leur immobilisation relative lorsque ces pièces sont emboîtées l'une dans l'autre. Ces moyens d'immob lisation sont constitués, par exemple, par des éléments de structures complémentaires portés par les pièces mâle et femelle, tels que, par exemple, des dégagements, des lumières ou des rainures 12 réalisés, au moins localement, sur la surface périphérique de La pièce 2 et destinés à coopérer avec des crans, des ergots ou des saillies 13 ménagés à l'intérieur de la pièce 13. IL peut être prévu aussi de réaliser un bourrelet annulaire 'sur L'extrémité d'emboîtement de la pièce mâle 2, de sorte que le bourrelet, par déformation élastique, vienne déboucher et s'étendre selon la face transversale de la pièce femelle.Of course, the male 2 and female 3 parts can be produced in other forms than those shown in FIGS. 1 and 2. By way of example, FIG. 3 illustrates The parts 2 and 3 having complementary trapezoidal shapes, each comprising at least one face with a slope of the same inclination. In the example illustrated, the two opposite main flat faces 8 and 9, respectively of the parts 2 and 3, delimit two wedging zones 4. For this purpose, the two main faces 8 of the male part 2 each have a slope of the same inclination as the slope of the faces 9 of the female part 3. As shown in FIG. 3, the wires are wedged between the two sloping faces 8, 9. According to an advantageous characteristic of the invention, the male 2 and female 3 parts are equipped with means ensuring their relative immobilization when these parts are fitted one into the 'other. These immobilization means are constituted, for example, by elements of complementary structures carried by the male and female parts, such as, for example, clearances, lights or grooves 12 made, at least locally, on the surface peripheral of the part 2 and intended to cooperate with notches, lugs or projections 13 formed inside the part 13. IT can also be provided to produce an annular bead ' on the nesting end of the part male 2, so that the bead, by elastic deformation, comes to open and extend along the transverse face of the female part.
Selon une autre caractéristique avantageuse de l'invention, l'une des pièces, à savoir, par exemple, la pièce mâle 2 dans l'exemple illustré, comporte au moins une échancrure ou une fente 14 facilitant La préhension du fil, en vue de son coincement dans la zone 4. L'échancrure 14 est ménagée selon le diamètre de la pièce mâle 2, selon une direction sensiblement perpendiculaire au sens d'emboîtement ou de translation des pièces, représentée par La flèche f. La pièce mâle 2 maintient ainsi les fils 5 lors de L'introduction de La pièce mâle 2 à L'intérieur de La pièce femelle 3. Bien entendu, L'échancrure 14 peut être ménagée dans La pièce femelle. Dans ce cas, afin de faciliter l'insertion des fils dans la pièce femelle, lors de l'emboîtement de la pièce mâle, l'extrémité d'emboîtement de cette dernière présente une forme en U assurant la préhension des fils.According to another advantageous characteristic of the invention, one of the parts, namely, for example, the male part 2 in the example illustrated, comprises at least one notch or a slot 14 facilitating the gripping of the wire, in order to its jamming in the zone 4. The notch 14 is formed according to the diameter of the male part 2, in a direction substantially perpendicular to the direction of interlocking or translation of the parts, represented by the arrow f. Male part 2 holds thus the son 5 during the introduction of the male part 2 inside the female part 3. Of course, the notch 14 can be formed in the female part. In this case, in order to facilitate the insertion of the wires into the female part, during the nesting of the male part, the nesting end of the latter has a U-shape ensuring the gripping of the wires.
La méthode ou le procédé pour bloquer un fî L en coeliochirurgie par le dispositif selon l'invention découle directement de la description qui précède. Tel que cela apparaît plus précisément à La fig. 4, La mise en place de ce dispositif de blocage s'effectue par l'intermédiaire d'un instrument 16' comportant un piston 18 commandé en coulissement dans un fourreau 19 par L'intermédiaire d'une tige 20.The method or method for blocking a fî L in laparoscopic surgery by the device according to the invention follows directly from the above description. As shown more precisely in FIG. 4, The positioning of this blocking device is effected by means of an instrument 16 comprising a piston 18 controlled to slide in a sleeve 19 by means of a rod 20.
IL est rappelé que le fourreau présente, généralement, une section de L'ordre de 10 mm et une Longueur de L'ordre de 400 mm. L'instrument délimite, à son extrémité destinée à être insérée à l'intérieur de l'organisme d'une personne, un puits 22 de chargement et d'éjection pour au moins un dispositif de blocage 1. A titre d'exemple, Le piston 18 maintient, en coopération avec un organe élastique 25 porté par le fourreau 19, les pièces mâle 2 et femelle 3 partiellement emboîtées L'une dans L'autre. Après l'introduction de L'extrémité inférieure de L'instrument 16, à L'intérieur de L'organisme, L'instrument est déplacé pour permettre d'engager le ou les fils à bloquer, à l'intérieur de L'échancrure 14.It is recalled that the sheath generally has a section of the order of 10 mm and a length of the order of 400 mm. The instrument defines, at its end intended to be inserted inside the body of a person, a well 22 for loading and ejection for at least one blocking device 1. For example, The piston 18 maintains, in cooperation with an elastic member 25 carried by the sheath 19, the male 2 and female 3 parts partially nested one inside the other. After the introduction of the lower end of the instrument 16, inside the organism, the instrument is moved to allow the thread (s) to be engaged, inside the notch 14 .
Le piston 18 est alors déplacé en coulissement pour assurer une translation relative entre Les pièces mâle 2 et femelle 3, de manière à assurer l'emboîtement et, par suite, le coincement ou Le blocage par effet de coin du ou des fils dans les zones 4. Le piston 18 est déplacé de manière que les crans 13 coopèrent avec les rainures 12, en vue d'obtenir une immobilisation relative définitive des deux pièces. Le piston 18 est alors repoussé, de sorte que Le dispositif de blocage 1, de préférence mais non exclusivement sollicité élastiquement par l'élément 25, est désolidarisé de L'instrument pour être Laissé en place à l'intérieur de L'organisme.The piston 18 is then moved in sliding to ensure a relative translation between the male 2 and female 3 parts, so as to ensure the interlocking and, consequently, the jamming or blocking by wedge effect of the wire or wires in the zones 4. The piston 18 is moved so that the notches 13 cooperate with the grooves 12, in order to obtain a final relative immobilization of the two parts. The piston 18 is then pushed back, so that the locking device 1, preferably but not exclusively resiliently biased by element 25 is detached from the instrument to be left in place inside the organism.
Le coincement du fi L par Les zones 4, combiné aux moyens 12, 13 permettant d'immobiliser ensemble les deux pièces 2 et 3, assure l'obtention d'un blocage efficace et durable du ou des fils 5. Un tel dispositif offre l'avantage de permettre La réaLisation aisée de noeuds par Le coincement des deux parties terminales d'un ou de deux fils. Le coincement du ou des fils est grandement facilité par la mise en oeuvre de l'échancrure 14 qui permet de positionner et de guider Le ou Les fils pendant toute l'opération de blocage.The jamming of the wire L by the zones 4, combined with the means 12, 13 making it possible to immobilize the two parts 2 and 3 together, ensures obtaining an effective and lasting blocking of the wire or wires 5. Such a device offers the 'advantage of allowing the easy realization of nodes by the jamming of the two end parts of one or two wires. The jamming of the wire or wires is greatly facilitated by the implementation of the notch 14 which makes it possible to position and guide the wire or wires during the entire blocking operation.
Bien entendu, le dispositif 1 est réalisé en un matériau apte à être supporté ou résorbé par L'organisme d'une personne et peut présenter une Longueur pouvant aller jusqu'à 10 mm. De plus, il peut être prévu de réaliser un instrument jetable après La mise en place d'un unique dispositif ou capable de recevoir une batterie de dispositifs de blocage conformes à L' invenlion, amenés successivement au niveau du puits 22.Of course, the device 1 is made of a material capable of being supported or absorbed by the body of a person and can have a length of up to 10 mm. In addition, provision can be made for a disposable instrument after the installation of a single device or capable of receiving a battery of blocking devices in accordance with the invention, successively brought to the level of well 22.
La fig. 5 illustre, à titre d'exemple, une autre variante de réalisation d'un instrument 16 susceptible d'être utilisé en coeliochirurgie pour assurer la mise en place d'un dispositif de blocage 1 conforme à L'invention. Selon cette variante, les pièces mâle 2 et femelle 3 sont maintenues ensemble Lors de leur introduction à L'intérieur de l'organisme, par l'intermédiaire du piston 18 comportant un épaulement 23 de centrage de La pièce femelle 3 et à L'aide d'un Lien 26 fixé à La pièce mâle 2 et sur le fourreau extérieur 19. Le déplacement relatif du fourreau 19 par rapport au piston 18 permet d'assurer l'engagement de la pièce mâle 2 à L'intérieur de La pièce femelle 3. La rupture du Lien 26 après L'emboîtement complet des deux pièces permet de laisser en place Le dispositif de blocage selon l'invention. POSSIBILITE D'APPLICATION INDUSTRIELLE :Fig. 5 illustrates, by way of example, another alternative embodiment of an instrument 16 capable of being used in laparoscopic surgery to ensure the establishment of a blocking device 1 according to the invention. According to this variant, the male 2 and female 3 parts are held together during their introduction into the interior of the body, by means of the piston 18 comprising a shoulder 23 for centering the female part 3 and using a Link 26 fixed to the male part 2 and on the outer sheath 19. The relative movement of the sheath 19 relative to the piston 18 makes it possible to ensure the engagement of the male part 2 inside the female part 3 The rupture of the Link 26 after the complete fitting of the two parts allows the locking device according to the invention to be left in place. POSSIBILITY OF INDUSTRIAL APPLICATION:
Le dispositif selon l'invention permet d'assurer, en coeliochirurgie, un blocage d'au moins un fil pour réaliser, par exemple, un surjet, une suture ou une ligature.The device according to the invention makes it possible, in laparoscopic surgery, to block at least one thread to perform, for example, an overlock, a suture or a ligature.
L'invention n'est pas limitée aux exemples décrits et représentés, car diverses modifications peuvent y être apportées sans sortir de son cadre. The invention is not limited to the examples described and shown, since various modifications can be made thereto without departing from its scope.

Claims

REVENDICATIONS :CLAIMS:
1 - Procédé pour bloquer au moins un fil (5) en coeliochirurgie, par L'intermédiaire d'un instrument (16), caractérisé en ce qu'il consiste à : - introduire dans l'organisme d'une personne à l'aide de l'instrument (16), au moins un dispositif de blocage (1) formé d'une pièce mâle (2) et d'une pièce femelle (3),1 - Method for blocking at least one wire (5) in laparosurgery, via an instrument (16), characterized in that it consists of: - introducing into the body of a person using of the instrument (16), at least one blocking device (1) formed of a male part (2) and a female part (3),
- co mmander par l'instrument (16), Le coulissement relatif de la pièce mâle (2) par rapport à La pièce femelle (3) pour assurer leur emboîtement, en vue du coincement du fil,- control by the instrument (16), the relative sliding of the male part (2) in relation to the female part (3) to ensure their nesting, with a view to trapping the wire,
- et à agir sur L'instrument (16) pour permettre de désolidariser le dispositif de blocage (1) de l'instrument.- and to act on the instrument (16) to enable the blocking device (1) to be separated from the instrument.
2 - Procédé selon La revendication 1, caractérisé en ce qu'il consiste à coincer le fil (5) entre au moins deux surfaces à pente complémentaire (7, 8 - 6, 9) présentées par les pièces mâle (2) et femelle (3). 3 - Procédé selon la revendication 1, caractérisé en ce qu'il consiste, avant de procéder à L'emboîtement complet des pièces, à engager Le ou les fils (5) à bloquer, à L'intérieur d'une échancrure (14).2 - Method according to claim 1, characterized in that it consists of wedging the wire (5) between at least two surfaces with complementary slope (7, 8 - 6, 9) presented by the male ( 2) and female ( 3). 3 - Method according to claim 1, characterized in that it consists, before proceeding with the complete nesting of the parts, to engage the wire or wires (5) to be blocked, inside a notch (14) .
4 - Procédé selon la revendication 1, caractérisé en ce qu'il consiste à désolidariser le dispositif de blocage (1) de4 - Method according to claim 1, characterized in that it consists of separating the blocking device (1) from
L'instrument (16), par La rupture d'un Lien (26) reliant la pièce mâle à un fourreau fixe (19) de l'instrument (16).The instrument (16), by the breakage of a Link (26) connecting the male part to a fixed sheath (19) of the instrument (16).
5 - Dispositif utilisé plus particulièrement en coeliochirurgie pour bloquer au moins un fi L (5), Le dispositif comportant :5 - Device used more particularly in laparosurgery to block at least one thread (5), The device comprising:
- une pièce mâle (2) et une pièce femelle- a male part ( 2) and a female part
(3) destinées à délimiter entre-elles au moins une zone de coincement (4) pour le fil, lorsque les pièces mâle et femelle sont emboîtées l'une dans l'autre, - et au moins une échancrure (14) assurant la préhension du fil (5), caractérisé en ce que les pièces mâle (2) et femelle (3) comportent chacune au moins une surface complémentaire (7, 8 - 6, 9) à profil incliné délimitant entre-elles au moins une zone de coincement (4) lors de l'emboîtement par coulissement relatif (f) des pièces mâle et femelle, et en ce que l'échancrure (14) est aménagée selon une direction sensiblement perpendiculaire à la direction d'emboîtement Cf) des pièces.(3) intended to delimit between them at least one wedging zone (4) for the wire, when the male and female parts are fitted one inside the other, - and at least one notch (14) ensuring gripping of the wire (5), characterized in that the male (2) and female (3) parts each comprise at least one complementary surface ( 7, 8 - 6, 9) to inclined profile delimiting between them at least one wedging zone (4) during nesting by relative sliding (f) of the male and female parts, and in that the notch ( 14) is arranged in a direction substantially perpendicular to the direction of nesting Cf) of the parts.
6 - Dispositif selon la revendication 5, caractérisé en ce que l'échancrure (14) est aménagée sur la pièce mâle (2).6 - Device according to claim 5, characterized in that the notch (14) is arranged on the male part (2).
7 - Dispositif selon la revendication 5, caractérisé en ce que les pièces mâle (2) et femelle (3) sont pourvues de moyens (12,13) pour les immobiliser relativement, constitués par des éléments de structures complémentaires ménagés sur Les pièces mâle et femelle et destinés à coopérer ensemble à La fin de leur emboîtement. 7 - Device according to claim 5, characterized in that the male (2) and female (3) parts are provided with means (12,13) to immobilize them relatively, consisting of complementary structural elements provided on the male and female and intended to cooperate together at the end of their nesting.
PCT/FR1992/001012 1991-10-29 1992-10-29 Method and device for holding a celiotomy wire WO1993008747A1 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR9113593A FR2682867A1 (en) 1991-10-29 1991-10-29 METHOD AND DEVICE FOR LOCKING A WIRE IN CORE SURGERY.
FR91/13593 1991-10-29

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WO1993008747A1 true WO1993008747A1 (en) 1993-05-13

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PCT/FR1992/001012 WO1993008747A1 (en) 1991-10-29 1992-10-29 Method and device for holding a celiotomy wire

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FR (1) FR2682867A1 (en)
WO (1) WO1993008747A1 (en)

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