Source: https://patents.google.com/patent/EP0869740B1/en
Timestamp: 2020-01-29 20:26:41
Document Index: 763411379

Matched Legal Cases: ['art 3', 'art 42', 'art 42', 'art 43', 'art 25', 'art 25', 'art 22', 'art 25', 'art 25', 'art 22', 'art 25']

EP0869740B1 - An instrument for the application of surgical material - Google Patents
An instrument for the application of surgical material Download PDF
EP0869740B1
EP0869740B1 EP96940081A EP96940081A EP0869740B1 EP 0869740 B1 EP0869740 B1 EP 0869740B1 EP 96940081 A EP96940081 A EP 96940081A EP 96940081 A EP96940081 A EP 96940081A EP 0869740 B1 EP0869740 B1 EP 0869740B1
elongated unit
EP96940081A
EP0869740A1 (en
1995-12-13 Priority to DE19546438 priority Critical
1995-12-13 Priority to DE19546434 priority
1996-03-18 Priority to DE19610542 priority
1996-12-13 Priority to PCT/IB1996/001431 priority patent/WO1997021383A1/en
1996-12-13 Application filed by Nycomed Arzneimittel GmbH filed Critical Nycomed Arzneimittel GmbH
1998-10-14 Publication of EP0869740A1 publication Critical patent/EP0869740A1/en
2000-09-20 Publication of EP0869740B1 publication Critical patent/EP0869740B1/en
238000002324 minimally invasive surgery Methods 0 abstract description 28
The present invention relates to an instrument for the application of surgical material and comprising an elongated unit, a material applicating member pivotally connected to the distal end of the elongated unit, so as to allow movement of the applicating member relative to the elongated unit, means for retaining the applicating member in a desired angular position during surgical intervention. In particular, an instrument according to the invention is suited for the application of surgical sheet repair material such as, e.g., TachoComb3. An instrument according to the invention is designed for use in minimally invasive surgery and/or endoscopic surgery, but it may also be employed during conventional surgery.
The present invention relates to an instrument for the application of a surgical material. The instrument has been developed for use in surgery, especially in the so-called minimally invasive surgery, and is suitable for use in connection with an application of a surgical material such as, e.g., a wound-healing material or a material adapted for stopping or reducing bleeding during or after an operation.
An important tool in the minimally invasive surgery is also fibrin adhesives which are important for tissue management. For the application of such adhesives, rigid and flexible double lumen hollow needles were developed by the present inventors for liquid adhesion. As something new, spray adhesion is also possible in minimally invasive surgery. A very advantageous surgical material for use in traditional surgery as well as in minimally invasive surgery is a material called TachoComb® which is manufactured by Nycomed Austria GmbH and which is a fibrin glue-impregnated fleece (EP-B-0 059 265). After introducing TachoComb® material into conventional surgery, the use of this important contribution to surface management also in the field of minimally invasive surgery has turned out to be most helpful. As minimally invasive surgery stitching methods are very costly and often do not meet the surgical requirements, the particular properties of a fleece-adhesive like TachoComb® seem to be very advantageous in the field of minimally invasive surgery (TachoComb® has indeed proved to be a very useful and beneficial tool in any kind of surgical intervention. Tests concerning liquid adhesion employed in minimally invasive surgery have shown that with regard to capacity, indication width, and reliability, the advantages of a fleece-bound fibrin adhesive have been far from reached. In minimally invasive surgery, intracorporal coating of a carrier with fibrin adhesive, as it is conventionally often performed, is not contemplated, as the handling would be too time-consuming and uncertain. An extracorporal self-coating followed by a trocar passage is also dropped, as this would result in huddling of the fleece due to the folding of the carrier material. The fabrication of TachoComb® as a ready-to-use product in dry condition therefore seems to be the choice for minimally invasive surgery application.
The introduction of TachoComb® in the minimally invasive surgery has been very advantageous. After application, the TachoComb® material resides as an internal biodegradable plaster and it is useful as a styptic agent as well as for tissue compression, tissue sealing and tissue healing. The TachoComb® material has made a remarkable contribution to surgery as operations which previously would have been inconceivable or impracticable are now made possible through the application of TachoComb® (or the like). An example is the application of TachoComb® in the case of pneumothorax. In the following, TachoComb® material is used as an example of a surgical material. It is of course within the scope of the invention that other surgical materials than TachoComb® may be applied by use of an instrument according to the invention.
The application of a surgical material like e.g. TachoComb® during minimally invasive surgery can be made without any specialized equipment. Originally, TachoComb® was used tightly rolled up in its ordinary size of 9.8 x 4.8 cm along a short distance resulting in a kind of carpet roll with a diameter of 10 mm and a length of 50 mm. This roll was extracorporally introduced in a 10/12' trocar sleeve. In a trocar pre-perforation into the body cavity in question, the thus armoured trocar sleeve could now be introduced, the TachoComb® roll could be "stamped out" by means of the trocar pin and be taken over by forceps for further positioning and application.
This method is no doubt practicable, however, combined with obstacles due to the fact that i) a further trocar is necessary, ii) when introducing a fresh trocar sleeve armoured with TachoComb®, wound secretion can be pressed into the sleeve and may, thus, activate the adhesive too soon, iii) the handling of the fleece-roll with two forceps for positioning and final application requires a high degree of handiness and endurance as every unintended tissue contact will result in activation and make the rolling-up of the roll difficult and impossible, respectively, and iv) a "modelling" of the fleece under tension onto the parenchyme surface by the use of two forceps is difficult, as the fleece pulls out under too heavy tension.
In order to overcome at least some of the above-mentioned disadvantages, the ENDOdock® applicator was developed (EP-A-0 750 885). This applicator is especially designed for application of relatively small sized surgical material (such as, e.g., 3 x 2 cm). A pleural sealing using the ENDOdock® applicator, e.g. in the case of pneumothorax, is more difficult to thoracoscopy, as, due to an enormous surface tension, the stability offered by the fleece is not sufficient. The same applies to laparoscopy when dealing with a liver or spleen rupture where a larger adhesive surface must also be available. Indications for sealing of the gallbladder's bed at the liver, where at least in regard to the size, an effort might be contemplated, are rare, as bleedings and small gall leaks will coagulate easily.
Moreover, the ENDOdock® system has some deficiencies with regard to a reliable application in that; i) the plastic screen does not always unfold sufficiently effectively, especially if it has been in the applicator for several minutes; ii) stripping of the fleece may be difficult as the adhesive strength of the adhesive can be lower than the strength of the fleece-holding device; and iii) in some cases, the plastic screen may work loose from the applicator and will only be found in the body cavity with difficulty (not X-ray detectable, transparent).
As it appears from the above, there is a demand for the development of an instrument for the application of a surgical material, notably a material like TachoComb®, during surgery especially during minimally invasive surgery without one or more of the above-mentioned problems. An object of the present invention is therefore such a novel instrument. The development of an instrument according to the invention is based on the following optimal requirements for such an instrument:
An instrument according to the invention is advantageous with respect to at least one or more of the above-mentioned requirements compared with the prior art (e.g. ENDOdock® applicator).
The present invention provides an instrument for the application of surgical material fulfilling at least some of the above mentioned requirements. Thus, the present invention provides an instrument which is an improvement of the instrument of US 4,872,456. The document discloses a surgical device for use in laser surgery. The device comprises an elongated unit with a handle and a sheet material applicating member connected to the distal end of the elongated unit, the applicating member comprising two jaws for clamping a tissue therebetween. The jaws are pivotally connected to the distal end of the elongated unit, so as to allow movement of the applicating member relative to the elongated unit. The instrument of US 4,872,456 further comprises retaining means for retaining the applicating member in a desired angular position. The retaining means comprise manoeuvring means for the pivotal movement of the applicating member and operating means in the form of a knob at the proximal end of the elongated unit for operating the manoeuvring means. The operating means are connected to the applicating member through force transmission means comprising control rods.
Another prior art instrument is disclosed in US 5,147,387. The document discloses a surgical instrument for use in laparoscopy surgeries, useful for implanting prosthetic sheet repair materials when surgical repair of body membranes or wall structures is required. The instrument of US 5,147,387 comprises an elongated unit in the form of a shaft with a handle and a sheet material applicating member connected to the distal end of the shaft. The two part form of claim 1 is based on this disclosure. More particular, the present invention provides an instrument for the application of surgical material and comprising an elongated unit, a material applicating member pivotally connected to the distal end of the elongated unit, so as to allow movement of the applicating member relative to the elongated unit, and retaining means for retaining the applicating member in a desired angular position during surgical intervention.
The retaining means comprise manoeuvring means for the pivotal movement of the applicating member. The retaining means further comprise operating means for operating the manoeuvring means and being positioned at the proximal end of the elongated unit. The operating means are connected to the applicating member through force transmission means comprising a spindle which is mounted rotatably about its longitudinal axis and coextends with the elongated unit, and which has first threads formed thereon. The force transmission means further comprise at least a first longitudinally displaceable member defining second threads engaging with the first threads, the displaceable member being interconnected with the applicating member. Thus, rotation of the spindle causes displacement of the first displaceable member and a pivoting movement of the applicating member around its pivot at the distal end of the elongated unit.
The major advantage of the instrument according to the invention over prior art instruments, in particular those of US 5,147,387 and US 5,370,650, is that it allows intracorporal manoeuvring of the applicating member while, at the same time, it may be retained in any position within the range of its movement. This both facilitates the handling of the instrument, and makes the surgical intervention more safe, as the applicating member will not perform an uncontrolled movement when returning to its original position.
Alternative means for retaining the applicating member of an instrument in an angular position during surgical intervention may comprise mechanical means and/or magnetic means, including electromagnetic means. The mechanical means may comprise a friction hinge connection interconnecting the applicating member and the elongated unit and/or mechanical locking means, such as spring loaded locking means, means locking by engagement between two or more mechanical parts or any other means for retaining the applicating member in a desired position. The magnetic means may comprise permamagnets as well as electromagnets permanently activated or electromagnets activated by electrical signals from an extracorporeal position. The angular range of the applicating member may be infinitely variable, or a finite number of steps in the angular direction or directions may be predefined, e.g., by friction means, spring loaded means, magnetic means etc.
More particular, the present invention relates to an instrument, wherein the applicating member comprises a rod-shaped portion so as to allow a sheet of surgical material such as, e.g., TachoComb® to be rolled up to form a carpet-like roll of surgical material on the rod-shaped portion of the applicating member. The rod-shaped portion may further comprise sensing devices and/or any other optional devices useful during surgical intervention.
At least the rod-shaped portion of the applicating member may further define a slit extending longitudinally over at least part of the length of the applicating member, so as to provide a cavity for anchoring a surgical material, e.g., TachoComb®. Other mechanical means for anchoring the surgical material are possible, friction means, spring loaded or other force loaded mechanisms, as well as means where an adhesive effect of the surgical material such as, e.g., TachoComb® is used for retaining the material on the rod-shaped part of the elongated member.
The instrument may further comprise a first sleeve member having a bore allowing the applicating member and at least the distal portion of the elongated unit to pass therethrough. The sleeve member is adapted to be received in a trocar during surgical intervention, but the instrument may also be employed in surgical interventions where no trocar is used. The sleeve member, which preferably may have a tube-like form with a through-going bore in its longitudinal direction, preferably has an outer diameter fitting the sizes of standard trocars. At least a portion of the elongated unit is surrounded by the sleeve member during surgical intervention, while the applicating member and at least the proximal part of the elongated unit is not surrounded by the sleeve member. Handle and/or manoeuvring means and/or other means may be positioned at the proximal end of the elongated unit, as will be further described below.
Though the abutment surface defined in the bore of the sleeve member may have any shape such as a polygonal or a curved shaped, it preferably is an annular abutment surface having an inner diameter increasing in the direction of the proximal end of the sleeve member. Preferably the annular abutment surface is positioned adjacent to the proximal end of the sleeve member. However, dependent on the specific use of the instrument according to the invention, it may also be positioned any where else within the length of the sleeve member.
A preferred embodiment of an instrument according to the invention concerns an instrument, wherein the applicating member is pivotal about one axis only. Though this might seem like a limitation in the mobility of the applicating member, this feature in fact establishes a great advantage compared to prior art instruments having pivotally mounted applicating means. As the instrument as such and thereby both the sleeve member and the elongated unit may rotate about their longitudinal axis, the plane of the pivoting movement of the applicating member may be rotated 360° around the axis of the elongated unit, whereby the range of the applicating member becomes three-dimensional. At the same time, the instrument according to the invention may have a well-define pivoting point, whereby its manoeuvring and control becomes easier, more accurate and safe than the manoeuvring and control of instruments having no well-defined pivoting point. Thus, a cheap, easy-to-use system comprising a very limited number of parts is obtained. Obviously, many other configurations, wherein the pivoting movement of the applicating member is not restricted to one plane are possible, e.g, configurations comprising one or more ball-and-socketjoints, elastic members interconnecting the applicating member and the elongated unit, as well as configurations allowing pivoting movements in a restricted number of planes.
The instrument according to the invention comprises manoeuvring means for the pivotal movement of the applicating member, and operating means operating the manoeuvring means positioned at the proximal end of the elongated unit. Though it is possible to manoeuvre the applicating member by means of other tools, such as forceps, e.g., introduced via other trocars, the manoeuvring and control of the applicating member is made considerably easier and more accurate by providing manoeuvring means for the pivotal movement of the applicating member. The manoeuvring means may comprise force transmitting mechanical means, such as a Bowden cable, one or more worm wheels, a rack/toothed wheel configuration, a system of stiff rods, a wire system, a spindle/nut configuration and/or combinations thereof or any other mechanism. The mechanical means may be activated by hand or they may be combined with electrical activation means, such as an electromotor.
The manoeuvring means for manoeuvring and controlling the applicating member comprise force transmission means interconnecting the operating means and the applicating member. While the operating means are positioned at an extracorporal position, the applicating member is positioned at an intracorporal position at a considerable distance from the position of the operating means. As described above, the force transmitting means may comprise different kinds of configurations.
As mentioned above, the manoeuvring and force transmitting means may comprise different mechanical systems. In the most preferred embodiment of the instrument, the force transmission means comprise a spindle, which is mounted rotatably about its longitudinal axis and coextend with the rod member, and which has first threads formed thereon, and at least a first longitudinally displaceable member defining second threads engaging with the first threads, the displaceable member being interconnected with the applicating member, whereby rotation of the spindle member causes displacement of the first displaceable member and a pivoting movement of the applicating member. The use of a rotatable spindle and one or more longitudinally displaceable members provides a mechanism for transforming the rotating movement of the operating means and thereby of the spindle into a linear movement, which again may be transformed into a pivoting movement around an axis perpendicular to the rotational axis of the spindle.
Preferably, the force transmission means further comprise third threads formed on the spindle, the first and third threads being right and left handed, respectively, or vice versa, and a second displaceable member defining fourth threads cooperating with the third threads and being interconnected with the applicating member. By interconnecting the two displaceable members by a stretched wire forming at leat one close loop around a pivoting sleeve of the applicating member at the distal end of the elongated unit, the applicating member may be pivoted around its pivot by displacing the displaceable members. Thereby the straight portions of the wire performs a linear movement, while the looped portion of the wire performs an angular movement causing the applicating member to pivot, as at least part of the wire loop engage with the pivoting sleeve of the applicating member. Because the wire is stretched between the two displaceable member, which are provided with counterdirected threads engaging with corresponding threads on the spindle, the wire will be subjected to tension irrespective the direction of the rotational movement of the spindle and the direction of the linear movement of the displaceable members.
A particular embodiment of an instrument according to the invention further comprises a sleeve member having a trumpet-shaped enlargement at its proximal end, and wherein the elongated unit comprises a shaft with a handle. The interconnection between the elongated unit and the applicating member may comprise a contact member, which is movable connected to the elongated unit, and which may pivot at an angle of up to about 135° to each side from its straight position, and which is connected to the elongated unit by means of a tension bolt, and wherein the contact member comprises connection means, which are guided through the elongated unit to the upper exterior of the first portion of the elongated unit. Further, the applicating member with a stopping means and a sheet holding means is pivotally connected to the contact member.
The stop for the pivoting movement of the applicating member is optional, however means clearly defining the angular range of the pivoting movement of the applicating member are desired in order to obtain an optimal control the applicating member during surgical intervention.
As described in the introduction an instrument according to the invention is suitable for use in connection with application of a surgical material, preferably in connection with surgical intervention such as minimally invasive surgery. In this connection, a surgical material of particular importance is TachoComb®.
The TachoComb® material is primarily used for the sealing of body tissue. The possibilities within the minimally invasive surgery comprise e.g. selective sealing of parenchyme organs (lungs, liver, spleen, kidneys), organs like the gastrointestinal tract and the urogenital tract and structures like the lymphoglandular system, the spinal cord, and the nerves. Due to the characteristics of TachoComb®, an effective imperviousness to all body fluids (blood, lymph, gall, urine) as well as gases will exist after application. By using an instrument according to the invention, both elective surgery (e.g. Hodgkin-Staging) and emergency surgery (e.g. pneumothorax, splenotomy) may be performed by TachoComb® application in minimally invasive surgery.
The benefit to the patient when using this method is significant. Minimally invasive surgery itself reduces the need for analgesics and the period of hospitalisation of the patient. Infections are minimized as the surface area exposed to surgical intervention is reduced, and cosmetic advantages are obtained. By combining minimally invasive surgery with the application of TachoComb®, these effects become more evident, and safe management of body tissue for blood sealing and imperviousness of resection areas are obtained.
Furthermore, due to reduced secretion with a reduced rate of infection, fewer drainage days is a further result of the application of TachoComb® by minimally invasive surgery in patients suffering from cystic fibrosis.
Fig. 1 shows an assembly of a first preferred embodiment of an instrument according to the invention,
Fig. 8 shows a detail of the interconnection between the applicating member and the manoeuvring means in the preferred embodiment of the invention,
Fig. 9 is a diagrammatic top view illustrating the working principle of the preferred embodiment of the instrument according to the invention,
Fig. 10 is a diagrammatic side view illustrating the working principle of the preferred embodiment of the instrument according to the invention.
Fig.1 shows a preferred embodiment of an instrument 1 according to the invention. The instrument 1 comprises a sleeve member or a first sleeve member 15, shown in figs. 3, 12 and 20, and a body assembly 2, shown in fig. 2. The body assembly 2, shown in fig. 2, comprises a second sleeve member or sleeve member 6, shown in fig. 5, and an inner assembly 11 and an applicating member 20 pivotally connected to the inner assembly 11 at the distal end of the inner assembly. A unit comprising the body assembly 2 except the applicating member is referred to as an elongated unit (not shown separately in the drawings).
Preferably, at least part of the first portion 6a of the second sleeve member 6 forms a handle 3. The handle 3 may have any cross sectional shape. In a preferred embodiment of the invention, the cross section of the handle is circular over its upper and lower part 3a and linear over its right and left part, so as to form a pleasant and secure handle for the operator.
Though in the preferred embodiment of the invention, the rotating movement of the shaft 27 is activated by hand, it could also be activated by other means, e.g., an electromotor.
The inner assembly further comprises force transmission means for transmitting and transforming the rotating movement of the roll 5 into a rotating movement of the applicating member 20 around its pivot. The force transmission means comprise a threaded spindle 28 (fig. 4) serially connected to the shaft 27. Preferably, the threaded spindle is formed on the shaft 27 itself. The shaft may be surrounded by an outer, stationary part 42, which is stabilised in relation to the shaft 27 by a preferably flexible muff 29. As shown in figs. 6, 9 and 10, the threaded spindle 28 of the shaft 27 is divided into two portions 28a and 28b, wherein one of them has a right-handed thread, and wherein the other has a left-handed thread. In the preferred embodiment of the invention, the first portion 28a is provided with a left-handed thread and the second portion with a left-handed thread. A displaceable or nut-like member 40, 41 is mounted on each portion of the spindle 28. Each of the nuts has an inner thread fitting the outer thread of the corresponding portion of the spindle. In the example shown in the figures, the nut 40 thus has a left-handed inner thread and the nut 41 has a right-handed inner thread. A wire or cable 46 is stretched between the two nuts, as shown clearly in figs. 8, 9 and 10. The wire extends from the first nut to the second nut around a pivot 21 of the applicating member 20, where it engages with the applicating member 20, and where it forms at least one closed loop around the pivot 21, which in a preferred embodiment comprises a screw or bolt 21a. A pivot pawl 21c extends through a hinge sleeve 21b comprised in a contact member 25. The pivot pawl 21c may preferably be formed from a portion of the screw 21a. In order to obtain a safe engagement of the wire 46 with the hinge sleeve 21b, the wire is guided through a bore 21d extending perpendicular to the longitudinal direction of the instrument 1 through the hinge sleeve 21b. The nuts are radially fixed in the outer, stationary part 42, whereby any rotation of the roll 5 and thus of the shaft 27 and the spindle 28 will result in a linear movement of the nuts 40 and 41 due to the tension in the wire 46. As the nuts are mounted on contrary directed threads, they will either move toward each other or from each other, when the shaft 27 is being rotated, while one of them will pull the wire 46, whereby the wire will always be subjected to tension. As the wire forms a closed loop around the pivot 21, the linear movement of the wire will result in a pivoting movement of the applicating member around the pivot 21.
As illustrated by an arrow 45 in figs. 6 and 10, the applicating member may pivot at an angle of up to about 135° to each side from its straight position, when the roll 5 is rotated as indicated by an arrow 40a. The angular range of the pivoting movement may be controlled by a stopping means or knob 26, which allows the applicating member 20 to pivot until the knob 26 hits the distal part 43 of the inner assembly. The rotating movement of the rotatable part 25 of the applicating member about its longitudinal axis is indicated by an arrow 35 in figs. 4 and 10.
As shown in figs. 3, 4 and 6, the applicating member 20 preferably comprises a rod-shaped portion 22 provided with a sheet holding means in the form of a slit 23 for retaining a sheet of surgical sheet material 50 such as TachoComb®, as illustrated in fig. 7. At its proximal end it may have an outer part 25 comprising a cavity 24 for receiving one end of a roll of a sheet of surgical material rolled around the rod-shaped part 22, also referred to as sheet holding means. Preferably the outer part 25 is rotatably mounted on the contact member 25a.
Prior to performing a surgical intervention using an instrument according to the invention, a sheet of surgical material 50 is rolled around the rod-shaped portion 22 of the applicating member. An edge of the sheet is introduced into the slit 23 in the rod-shaped portion of the applicating member, and is then rolled around the rod-shaped portion 22.
During minimally invasive surgical intervention, the first sleeve member 15 is inserted into the body of a patient through a trocar. The body assembly 2 is then inserted into the body of the patient through the bore 16 of the first sleeve member 15. The radial extension of the bore 16 adjacent to the proximal end of the first sleeve member 15 provides a funnel for easy introduction of the applicating member with a sheet of surgical material rolled up thereon. The unrolling of the sheet of surgical material 50 is preferably performed by catching the surgical material with one or more forceps and unrolling the surgical material, whereby the outer part 25 and the rod-shaped part 22 of the applicating member will rotate relative to the stationary part 25a.
The surface of the bore 16 and/or the outer surface of the second portion 6b of the sleeve member 6 may be provided with at least one and preferably with at least two O-rings received in grooves in the respective surfaces. Thereby it is avoided that any gas or liquid may ooze out of the body of the patient through the surgical opening, e.g., during lung or abdomen surgery. This or any other kind of proofing arrangement will create friction between the assembly 2 and the first sleeve member 15. An effect thereof, which might be an advantage in some cases is that the operator will have to apply force in order to move the assembly 2 through the bore 16 of the first sleeve member 15, whereby a more accurate control of the instrument in its longitudinal direction may be obtained. This applies also for a second and third embodiment of the invention described below. Obviously, in the second and third embodiment of the invention, the O-ring or O-rings may be received either in grooves in the surface of the bore 16 or in grooves in the outer surface of second portions 63 of a rod-shaped member 60 (figs. 13 and 21).
20 mm < A < 60 mm, 220 mm < B < 310 mm, 20 mm < C < 80 mm, while their ratios preferably are as follows:
0.06 < A/B < 0.3, 0.25 < A/C < 3, 2.75 < B/C < 15.5
A = 40 mm, B = 265 mm, C = 48 mm, so that:
A/B = 0.15, A/C = 0.83, B/C = 5.52.
Diameter d22 of the rod-shaped portion 22 of the applicating member: 1 mm < d22 < 8 mm
Diameter d3a of the circular portion 3a of the handle: 10 mm < d3a < 20 mm
Outer diameter d19 of the straight portion of the first sleeve member: 6 mm < d19 < 14 mm
d22 = 4 mm, d3a = 15 mm, d19 = 10 mm.
The instruments according to the invention are preferably made from medical certified steel, including stainless steel. Other materials suitable for medical application would be plastics, teflon or titanium or combinations thereof. Some parts may be made from hardened plastic, e.g., the bearing parts of the applicating member. Some parts, e.g., the wire material may also be made from special materials, e.g., titanium so as to reduce wear.
Instrument (1) for the application of surgical sheet material (50) and comprising:
an elongated unit (2) with a handle (3);
a sheet applicating member (20) pivotally connected to the distal end of the elongated unit (2), so as to allow movement of the applicating member (20) relative to the elongated unit; and
retaining means for retaining the applicating member in a desired angular position during surgical intervention;
characterised in that the retaining means comprises:
manoeuvring means for the pivotal movement of the applicating member; and
operating means (5) for operating the manoeuvring means and being positioned at the proximal end of the elongated unit (2), the operating means (5) being connected to the applicating member (20) through force transmission means;
said force transmission means comprising:
a spindle (28) which is mounted rotatably about its longitudinal axis and coextends with the elongated unit (2), and which has first threads (28a) formed thereon; and
at least a first longitudinally displaceable member (40) defining second threads (28b) engaging with the first threads (28a), the displaceable member (40) being interconnected with the applicating member (20), whereby rotation of the spindle (28) causes displacement of the first displaceable member (40) and a pivoting movement of the applicating member (20) around its pivot (21) at the distal end of the elongated unit (2), and whereby the applicating member (20) may be retained in a desired angular position during surgical intervention.
An instrument according to claim 1, wherein the force transmission means further comprise third threads (28b) formed on the spindle (28), the first and third threads (28a;28b) being right and left handed, respectively, or vice versa, and a second displaceable member (41) defining fourth threads cooperating with the third threads (28b) and being interconnected with the applicating member (20).
An instrument according to claim 1 or 2, wherein the operating means (5) are releasably connected to the manoeuvring means.
An instrument according to any of claims 1-3, wherein the elongated unit comprises an elongated rod member (11,60), which is mounted rotatably about its longitudinal axis in relation to the handle (3,61), the spindle (28) being mounted on or forming part of the rod member (11,60).
An instrument according to any of claims 1-4, wherein the applicating member (20) comprises a rod-shaped portion (22).
An instrument according to claim 5, wherein at least the rod-shaped portion (22) of the applicating member (20) defines a slit (23) extending longitudinally over at least part of the length of the applicating member (20).
An instrument according to any of claims 1-6, further comprising a first sleeve member (15) having a bore (16) allowing the applicating member (15) and at least the distal portion of the elongated unit to pass therethrough, the sleeve member (15) being adapted to be received in a trocar during surgical intervention.
An instrument according to claim 7, wherein a radial abutment surface is defined within the bore (16) of the first sleeve member (15) for cooperating with a corresponding abutment surface (7) defined on the elongated unit so as to allow easier control of the elongated unit during surgical intervention.
An instrument according to claim 8, wherein the abutment surface defined in the bore (16) is an annular abutment surface having an inner diameter increasing in the direction of the proximal end of the sleeve member (15).
An instrument according to claim 9, wherein the annular abutment surface is positioned adjacent to the proximal end of the sleeve member (15).
An instrument according to any of claims 1-10, wherein the applicating member (20) is pivotal about one axis only.
An instrument according to any of claims 7-10, wherein the applicating member (20) is mounted on the elongated rod member (11,60), and further comprising a second sleeve member (6) surrounding the rod member and having the handle formed at its proximal end.
An instrument according to any of claims 8-12, wherein the abutment surface (7) of the elongated unit is formed at the distal end of the handle (3,61).
An instrument according to any of claims 5-13, wherein at least the rod-shaped portion (11,60) of the applicating member (20) is mounted rotatably about its longitudinal axis about the contact member (25a), the contact member (25a) constituting a non-rotatable, proximal part of the applicating member (20).
EP96940081A 1995-12-13 1996-12-13 An instrument for the application of surgical material Expired - Lifetime EP0869740B1 (en)
DE19546438 1995-12-13
DE19546434 1995-12-13
DE19610542 1996-03-18
EP0869740A1 EP0869740A1 (en) 1998-10-14
EP0869740B1 true EP0869740B1 (en) 2000-09-20
EP96940081A Expired - Lifetime EP0869740B1 (en) 1995-12-13 1996-12-13 An instrument for the application of surgical material
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1998-11-11 17Q First examination report despatched
Free format text: AL PAYMENT 19980713;LT PAYMENT 19980713;LV PAYMENT 19980713;SI PAYMENT 19980713
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