Source: https://patents.google.com/patent/WO1993001750A1/en
Timestamp: 2019-05-22 12:10:28
Document Index: 66754550

Matched Legal Cases: ['arts 2', 'art 3', 'art 3', 'art 2', 'art 2', 'art 3', 'art 3', 'arts 2', 'art. 2', 'art 2', 'art 2', 'art 3', 'art 3', 'arts 2', 'art 2', 'art 2', 'art\n6', 'art\n8', 'art\n12', 'art 3']

WO1993001750A1 - Surgical stitching instrument - Google Patents
WO1993001750A1
WO1993001750A1 PCT/DE1992/000589 DE9200589W WO9301750A1 WO 1993001750 A1 WO1993001750 A1 WO 1993001750A1 DE 9200589 W DE9200589 W DE 9200589W WO 9301750 A1 WO9301750 A1 WO 9301750A1
PCT/DE1992/000589
1991-07-23 Priority to DEP4124381.1 priority Critical
1991-07-23 Priority to DE19914124383 priority patent/DE4124383C1/en
1991-07-23 Priority to DE19914124381 priority patent/DE4124381C1/en
1991-07-23 Priority to DEP4124383.8 priority
1991-11-30 Priority to DEP4139628.6 priority
1991-11-30 Priority to DE19914139628 priority patent/DE4139628C1/de
1992-07-21 Application filed by Kernforschungszentrum Karlsruhe Gmbh filed Critical Kernforschungszentrum Karlsruhe Gmbh
1992-07-21 Priority claimed from DE1992504778 external-priority patent/DE59204778D1/en
1993-02-04 Publication of WO1993001750A1 publication Critical patent/WO1993001750A1/en
Described is a surgical stitching instrument of small dimensions which is coupled through drives (13, 14, 15) to remote grippers (10) and which enables sutures and knots to be placed in tissue or in blood-vessel walls using only simple hand movements. Stitching is done with one hand. Backward movement of the needle is controlled by means of a foot-switch (12) coupled to the grippers (10). The free hand is always available to control the stitching head.
The invention relates to a surgical suturing instrument, with the suture at a surgical site from a distance and / or ene-dos can be placed opisch.
The purpose of such instruments is the limit for engagement on required to be operated body injury to a necessary minimum and to further relieve the surgeons in its operational activities. This technique is referred to collectively as minimally invasive surgery (MIS).
From EP 0174843 A2 a sewing and stitching machine is be¬ known which is tienten an instrument channel into the body of a Pa¬ insertable and can be operated from the outside. The sewing head of the machine is opened to the side. There, a Saug¬ pipe ends can be drawn over the fabric so that a Ge webefalte comes about. A needle with attached Nähfa¬ the then moves parallel to the machine axis and durch¬ pierces the tissue. The entrained thread can be held device via a Fang¬ loop-forming. A knotting is done separately.
The US 4,935,027 discloses a surgical instrument and a method may be sewn with the remote position of or en- doskopisch. The pliers of the instrument are hollow and form in the closed state an eyelet through which suture thread or a schieb- is transportable. The Zan¬ gene ligands are designed such that they endure despite cavity to nä¬ rising substances. After each sewing operation or the sewing operation at all the nodes is carried out, for example, applying from the outside and is then pushed to the nodes. In any case, additional instruments are required for this.
The acceptance of such a suturing instrument through the Chirur¬ is determined, inter alia, operability significantly by the degree of rapid habituation to this and by the slight, conflict-free as possible loading gen.
The invention has the object of providing a strumentenkanal insertable through a In¬ and manageable suturing instrument, can be carried out with the suture to tissue or vessels and Knotungen largely without additional instruments. This object is solved by the features characterized in claim 1.
For this purpose, the suturing instrument at its distal end a mouth area on the stationary of a union and a beweg¬ jaw part is that can be used by this constructive element Auf¬ construction at a non-clamped suture needle as Greifinstru-.
Klemmvorrich¬ obligations are incorporated in the form- a sewing needle at the free ends of the two jaw parts and defined frictionally clamped and / or can be clamped. The sewing needle is clamped either to an end and / or at both ends or may be implemented by a clamping device to the other.
The movement of the movable jaw part is carried out by the surgeon with one hand on the movable grip part of the grip handle and therefore also the pulling or pushing of the needle from or the same in the clamping device.
By contrast, the clamping or releasing of the suture needle to or from the pneumatic clamping device switches over a Pedal¬ by the foot of the surgeon is effected. For this purpose, a pneumatic feed line is connected to the pedal switch of the leads from a pneumatic line to the connection piece of a Minia¬ turpneumatik-cylinder on the grip handle, the interlocking depending on the pressure condition in it a Hebelumlenkeinrichtung and ei¬ nem drive tube through the instrument channel, one half, and defined frictionally presses or ent thereof removed.
The engraving operation by the tissue to be sutured or vessel part and the Nähnadelumsetzvorgang are thereby separated from each other clearly. The surgeon thus has the other hand kept free for any necessary updating of the suturing instrument at the surgical site.
The dependent claims an advantageous embodiment of the suturing instrument and the grip pliers again.
Both clamping devices on the jaw parts, have so vor¬ partakers of the negative mold of the sewing needle end, which are made of lace, bead and waist. The transition from the bead to the waist is carried frustoconical or pyramidenstumpfför- mig corresponding to the needle tip shape. The pulling out and pushing the needle tip and carried in the clamping device on the movable jaw part without damage and thereby force determined or power limited. The same is for the Ein¬ bias the needle tip to the clamping device of the festste¬ Henden jaw part given, since the pressure in Miniaturpneumatik¬ can be kept cylinder limited and the Ausle¬ the Hebelumlenkeinrichtung supply the pressing force of bewegli¬ chen half against the fixed half of the clamping device is adjustable.
For Knotungen on Nähort it is also advantageous if the movable grip pliers part of Griffzange be determined by a freigeb¬ bare latch and pull back over a pressure point by Über¬ can be released.
Depending on the operation to be carried out while durchzuführendem sewing, it is also advantageous to have two structurally different embodiments of the mouth area available. One is characterized in that the Maulbe¬ is rich of the suturing instrument of two ducks axis similarly perpendicular to the Nähinstru stationary jaw parts, wherein the movable jaw member can be slid axially over the gripping tongs towards and away from the stationary jaw so that one or both sides clamped needle is parallel to the instrument axis. Conveniently, the needle used with this form of the suturing instrument is just for overall webs- or vessel parts only pricked by the needle and thereby can not be touched.
The clamping device on the stationary jaw part consists of a fixed half and the other half foldable. This foldable half is incorporated for this purpose in a rotatably mounted therein by a predetermined angle lever, which is actuated by the pedal switch.
The other constructive embodiment of the suturing instrument is comprised of the aligned in the direction of the instrument axis mouth region. The movable jaw member is senk¬ about an axis right-rotatably mounted to the instrument axis, and can be up to a predetermined angle unfolded or folded onto the festste¬ rising jaw part. The clamping devices unter¬ do not differ to those above. Only the bewegli¬ che half on the stationary jaw is now not work on the other stationary half, but to-the authorization or pushed away from her. The drive to go above from the pedal switch.
This structure of the suturing instrument is particularly suitable as gripping instruments. the free ends of the jaw parts are therefore suitable ribbed.
To avoid tearing tissue or vessel with this suturing instrument at the sewing operation, the sewing needle used for this purpose is curved so that its axis coincides with the path of the clamping device coincides on the movable jaw part. The two forms, that is, the two halves of jeweili¬ gen clamping device are interchangeable and can Sprit¬ Zenform the needle used be used accordingly. This has the economic advantage that a suturing instrument with various needle types can be handled.
This advantage of the removal and installation of various Klemmvor¬ directions is expandable in the way that the suturing instrument can be used instead of suturing and for clamping of vessel or tissue parts, provided that the clamping devices can be replaced by a clamp holding device and an associated Gesenkvor¬ direction.
1, the suturing instrument rich with laterally attached Maulbe¬;
2, the suturing instrument rich with directed forward Maulbe¬;
3, the grip handle for actuating the suturing instrument;
Figure 4 is a driven crown wheel and pinion Maul¬ part of the suturing instrument of Figure 2;
5 shows a needle for the suturing instrument of Figure 1;
6 shows a longitudinal section through the needle;
7, the clamped in a clamping device needle.
In Figure 1 of the sewing head 1 of the suturing instrument is shown in side view. It consists of the two foot parts 2,3 rectified project perpendicularly from the axis 20 of the suturing instrument.
At the free end of the jaw part 3, the use of the clamping device 6.7, which is arrowhead-shaped deepened located. The axis 25 of this clamping device 6,7 is parallel to the Nähinstrumentenachse 20. The clamping device 6,7 may be off from the free head side at the jaw part 3 and be installed. It consists of two halves 6.7. One half 6 is fixed. An pushes via a spring 7 with a predetermined spring constants of the other movable half 7 and forms pressed together, the negative shape of the needle tip 5. As a result, the needle is positively and non-positively clamped einge¬. It is thus an axial and radial force effect is applied to the entire circumference of the clamped needle tip. The needle can be pulled out over a certain axia¬ len force of this clamping device. The jaw member 3 is fixedly connected to the coaxial tube 16 and reciprocated in the axial direction and reciprocally movable. is effected by operating the movable part of the gripping tongs (see Figure 3).
Opposite to the fixed jaw part 2, is the an¬ particular stationary clamping device 8.9 for the needle 4. This clamping device 8.9 can be closed via the pivoted lever 21 or opened. The lever 21 thereby rotates about the rotation axis 22, whereby the movable half 9 of the clamping device is 8.9 or pressed to the fixed half 8 turned away from it. the lever 21 via the pipe 16, which in turn is moved by the drive means 13, 14, 15 on the grip forceps 10 is operated.
This configuration thereby enables effortless reacting the sewing needle 4 of a clamping device in the other 6.7 8.9 or even a simultaneous trapping of both needle tips 5. shape and defined force fit in both Klemmvorrichtun- gen 6.7; 8.9 hold the needle in any case in the vorgese¬ Henen location.
Structurally the sewing head 1 in figure is oriented differently 2. The opening of the jaw members 2,3 are seen from the instrument axis directed forwards. The rigid jaw part 2 is connected in parallel, that is, next to the instrument axis 20. The other, movable jaw part 3 can be open and close, and is mounted on the hinge axis 22nd It can be rotated around a α konstruk¬ tiv predetermined angle. For this purpose, a coaxial tube 16 must be back in the instrument tube 28 and fro, which is coupled at the end of a bolt 29,30 with the jaw member. 3 Is in one of the clamping devices 6.7; 8.9 clamped no needle 4, so the movable mouth part 3 can be folded so zu¬, that the two ribbed surfaces 30 interengaging positively place. The sewing head 1 of the suturing instrument can therefore be used as a gripping device. The dashed outline of the jaw portion 3 is drawn in this position.
At the far end of the two jaw parts 2,3, immediately behind the ribbed surfaces 30, one each, at any time separately lös¬ bare clamping device 6.7; 8.9 installed. Both Klemmvorrich¬ obligations 6.7; have 8.9, delspitze corresponding to the negative shape of the Na¬ 5, a recess having a round or gene dreiecki¬ or polygonal cross-section. The latter are, in particular, a safeguard against axial rotation of the clamped in the clamping device needle.
The clamping device 8.9 is be¬ in the fixed jaw 2, as in FIG 1 of the two halves 8,9. One half 8 is fixedly connected to the jaw part. 2 The other half 9 is processing at the head of the tube 16 via the SchiebeVorrich¬ 31 is mounted and can ben with this back and herschie¬, so that this clamping device and can be opened 8.9 geschlos¬ sen. The sewing needle 4 can be interlocked friction clamped so here. The prosecution is carried out by the Griffzange 10 ago, as already explained for FIG. 1 It has also been found convenient, and 27 cover the pushing device 31 between the moving half 9 end of the drive tube to the space between the two jaw parts with a sheet 32nd
The clamping device 6.7 to the movable jaw 3 is iden¬ table constructed with the corresponding jaw member in Figure 1 and therefore in function and effect the same.
The broken line needle 4 is in this design straight. This is problematic from the surgical point of view for small maximum opening angle a max un¬. For larger Öff¬ opening angle α max, which bil¬ the two jaw parts to each other the can, in order to avoid tissue or vessel cracks, advantageous if the sewing needle is curved 4 (see below part of the description to Figure 4).
The sewing heads of the described figures 1 and 2 can be operated via a handle pliers 10th An¬ thereof are drive motions, proceeding from the grip handle, on Rohran¬ drives through a trocar thereby to the sewing head 1 defined and converted into the sewing and transfer movements.
It is advantageous for the surgeon when the actually sewing can be carried out with one hand and can with the other hand while steering movements, take place if necessary. Thus, the Nadelumsetzvorgang must be decoupled confusion free. This is possible through the foot-operated, pneumatic mechani¬ rule drive on the grip pliers.
For this purpose a Minia¬ tur-pneumatic cylinder 13 is at the top of the grip forceps 10 mounted, the piston rod paral¬ lel to the instrument axis 20 to the rear over recessed into the cylinder, compressed air is moved. The piston rod presses on a rotatably mounted to the handle top tong part He¬ bel 15 which pushes with one of its lever part by a bolt 29, the tube 16 in the opposite direction to the front. The clamping device 8.9 to the rigid jaw part 2 of Figure 1 is closed thereby so that forming and Kraft¬ circuit with the clamped needle 4 is composed. Such was Zu¬ can weren maintained when compressed air is always acting on the piston in the cylinder. 13 This condition may be helpful. The surgeon can then namely ben aufschie¬ tissue on the clamped only on the rigid jaw part 2 needle. 4 To be able to maintain this state, the compressed air supply line via a snap-pedal switch 12, the surgeon or an assistant immediately standing the surgeon can operate with a foot. From this Pe¬ dalschalter 12, the compressed air line leading to the further attached to the top of the grip forceps 10 Druckluftanschluß¬ clip 33 leads from the matikzylinder from a compressed air line to Pneu¬. 13
If the pedal switch 12 further depressed somewhat than the engagement position, so he goes back and the compressed air supply is blocked. The compressed air in the pneumatic cylinder 13 can then escape. A through pipe 16 at the near end when the grip forceps 10 and turned-anchored return spring, the tube is then withdrawn and the self-16 clamped on the rigid jaw part 3 needle tip 5 is released.
The fulcrum of the lever 15 between the axis of the piston-rod and the instrument axis 20 and the active lever between the piston rod and fulcrum and lever pivot and pin 29 are adjustable. Thus, the force is limited to the tube 16 and unnecessary force on the head of the suturing instrument is avoided.
For more opening angle a max modification is presented by figure 2 in Figure 4 again.
At the rotatably mounted end of the movable jaw part 3 befin¬ det there concentric with the rotation axis 22, a ring gear 23 which is engaged by a reciprocating rack 24 and depending on the movement length and direction of movement of the bewegli¬ che jaw member within the maximum aperture angle α max more or less wide open and snaps shut. Since the angle a max can be set constructively very large, is necessary for such suturing instrument that this curved suture needle 4 can be used. The needle has a curvature 4 as the web 25 of the clamping device 6.7, then it stands by only the tissue or the vessel wall and not to tear it additionally one or on.
In Figure 5,6 and 7, the dashed lines in Figures 1 and 2 an¬ interpreted needle 4 in top view, longitudinal section and Spitzenaus¬ cut is shown.
The sewing needle 4 itself is schiffchenformig and symmetrically to its longitudinal axis 25. At both ends it has uniform tips 5 which connect to the bead-like needle body 36th In the needle body 34 itself is a longitudinal cavity 35 with the transverse bore on the ground, the eye of the needle 26. There, in particular the one edges are all rounded. The sewing thread ends at this point and is knotted there without it survives. he further places in the sewing process in the longitudinal recess 35, thereby tissue tearing are avoided during piercing.
Figure 7 highlights the enclosure of the needle tip 5 through the two halves of 6.8; 7.9 of the clamping devices produced. set¬ by the ke- gelstumpfförmigen transition from bead 18 to the needle body zen there is no excessive forces, so that on the one hand, a defined orientation of the needle 4 is achieved by the form-and frictional connection and on the other hand, a pulling or pushing of the needle 4 with a predeterminable force er¬ can follow. The illustrative force acting directions around the waist 19 of the clamped needle 4 are indicated by the arrows F perpendicular to each other standing. Next, a sewing operation will be described and the Nadelum¬-setting process thereby are explained:
First, the angeknotete at one end of the suture needle is Näh¬ 4 longitudinally placed between the two folded or nearly folded jaw parts 2, 3 and eventu¬ ell on one of its tip between the two corrugated surfaces 30 Flä¬ clamped. Then performed the suturing instrument through the In¬ strumentenkanal the Nähort. Here, the Nähfa¬ is traced with the through the tubes 16, 27th On Nähort the movable jaw 3 is opened and the needle 4 is inserted by means of an inserted through another instrument channel holding instrument in one of the clamping devices, preferably in the rigid jaw part 2, since this is to be incorporated from the outside and zuklappbar. Now a first stitch can be performed by nä¬ to Hendes tissue. Thereafter, the movable jaw part is folded in the direction of the jaw part 2 3 until schließ¬ Lich the still free needle tip snaps into the clamping device 6, 7. 5 The needle 4 is then released by the clamping device 8, 9 on actuation of the pedal switch 12 and completely pulled along with the suture through the stitch. The sewing process can be continued accordingly by stitch and needle reacting. If required, a notching can be carried out after each stitch, and yarn passage, wherein the snubbing of the node may be performed using a zusätzli¬ chen instrument.
The dimensions of the sewing head of a finished Proto¬ types of the described invention could be desirably kept small. Thus, the length of the sewing head was 17 mm. The length of the rotatable jaw member was 12 mm. Here, had the two jaw parts in each case only a thickness of about 1.5 mm. The sewing head was feasible and successfully operated through an instrument channel, the clear width was 5 mm. The expected benefit of easy handle sequence of the Tongs and the decoupling of the sewing and Nadelumsetz-Vor¬ gangs has erfült itself.
Bezuσszeichenliste
1 mouth area, the sewing head
3 movable jaw part
6 stationary half clamp on
7 pressed-on spring force half movable jaw part
8 stationary half clamp on fixed-
9 movable half stationary jaw
10 Griffzange
11 movable part
12 pedal switch
13 miniature pneumatic cylinder drive means
14 the axis of the miniature pneumatic cylinder
20 Nähinstrumentenachse, the tube axis, axis
23 sprocket
25 web axis
28 instrument tube
30 ribbed surface
31 pusher
33 connecting branch
34 needle body longitudinal recess bottleneck
1. A surgical suturing instrument and the handle clamp for Durchfüh¬ tion of a surgical suture to tissues and / or vessels, thread with a sewing needle and a needle's eye on angeknoteten Näh¬, wherein the suturing instrument at the distal end of a An¬ is placed in the drive device and, together with the Maul¬ portion of the suturing instrument inserted or clamped sewing needle through an instrument channel of the surgical site can be guided and placed on the grip pliers, at the near end of the drive means is operated remotely from the surgical site and outside of the instrument channel, characterized in that
- the suturing instrument in its mouth region (1) of a festste¬ Henden jaw part (2) and an on this to and away from the movable jaw part (3) is made;
- at the distal end of both jaw parts (2,3) each have a Klemmvor¬ device (6.7; 8.9) is incorporated, into which the sewing needle (4) having their ends (5) on one side and / or on both sides form-locking and force-locking can be clamped;
- the clamping device (6,7) on the movable jaw part (3) of a fixed half (6) and a over a predetermined spring (26) to them pressed other half (7), and the clamping device (8,9) on festste ¬ Henden jaw part (2) of a fixed half (8) and another via the gripping tongs (10) movable back and her¬ half (9);
- the movement of the movable jaw part (3) with one hand on the movable part (11) on the grip handle (10) is carried out;
- the movement of the movable half (9) of the Klemmvor¬ carried out direction (8,9) via a pedal switch (12) attached at its output to one of the grip chuck (10), force coordinated drive means (13,14,15) connected is. - on the grip chuck (10) is brought an¬ at its rigid part a Minia¬ turpneumatik-cylinder (13) with its axis (14) pa¬ rallel to the incoming axis (20) of the tube (16) and (between the two axles 14 , 20) a Um¬ steering lever (15) is mounted rotatable such that the An¬ the push rod of the miniature pneumatic Zy¬ Linders (13) point of attack on the reversing lever (15) and the point of attack of the proximal end of the tube (16) on the reversing lever ( 15) in each case there is a specified effective lever arm,
- in the miniature pneumatic cylinder (13) air admitted predetermined pressure, the tube (16) pushes forward and thus the needle holder (8,9) closes or keeps closed, and in the case of out of the cylinder (13) exhausted air, the piston rod the cylinder (13) via a built-in spring there and the tube (16) via a fitted over them return spring (17) pulls zurück¬ and thus the needle holder (8,9) opens or keeps open.
2. A surgical suturing instrument and Tongs according to claim 1, characterized in that the bead (18) and waist (19) on the negative form for the clamping device (6,7; 8,9) are rounded and over a short Kegelstumpfmantel¬ surface smoothly merge into one another whereby the hen Herauszie¬ and pushing the needle (4) without damage and force determined is feasible.
3. A surgical suturing instrument and grip pliers according to claim 1, characterized in that the movable grip pliers part (11) for moving the beweg¬ union jaw part (8) can be locked, whereby a fixed position of the jaw parts can be adjusted to each other, and is released again.
4. A surgical suturing instrument and Tongs according to one of claims 1 to 3, characterized in that I /
- both jaw parts (2,3) from the axis perpendicular Instrumenten¬ (20) facing away; the axis (25) of a clamped straight needle (4) to the instrument axis parallel (20);
- the movable half (9) of the clamping device (8.9) on the stationary jaw part (2) via a rotatable thereon ge superimposed lever (21), pressed an¬ to the stationary half (8) or of it's wegdrehbar.
5. A surgical suturing instrument and grip pliers according to claim 1 to 3, characterized in that the stationary jaw part (2) ment axis in extension for Instru¬ (20) and the movable jaw part (3) about an axis of rotation (22) is mounted perpendicular thereto, so that this rich via a lever in a predetermined Winkelbe¬ to the fixed jaw (2) increasing or aufklapp¬ bar.
6. A surgical suturing instrument and grip pliers according to claim
5, characterized in that the movable jaw part (3) on its axis of rotation (22) is provided with a concentric toothed rim (23) engages in the an axially displaceable toothed rack (24).
7. A surgical suturing instrument and grip pliers according to claim
6, characterized in that the curvature of the needle (4) corresponding to the track (25) of the clamping device (6,7) on the movable jaw part (3).
8. A surgical suturing instrument and grip pliers according to any one of the preceding claims characterized in that the clamping devices (6,7; 8,9) of interchangeable sets Ein¬ (6.7; 8.9) are made that form the impression of the Nähnadelspitze used in closed form.
9. A surgical suturing instrument and grip pliers according to claim 5 to 8, characterized in that instead of the two clamping devices (6,7; 8,9) on a jaw part (2 or 3) a clamp holding device, and (at the other jaw part 3 and 2 ) a die apparatus can be installed, so that tissue or parts of vessels can be clamped surgically NEN kön¬.
PCT/DE1992/000589 1991-07-23 1992-07-21 Surgical stitching instrument WO1993001750A1 (en)
DEP4124381.1 1991-07-23
DEP4124383.8 1991-07-23
DEP4139628.6 1991-11-30
JP50252593A JPH0767457B2 (en) 1991-07-23 1992-07-21 Surgical instruments
EP19920915550 EP0595892B1 (en) 1991-07-23 1992-07-21 Surgical stitching instrument
DE1992504778 DE59204778D1 (en) 1991-07-23 1992-07-21 A surgical suturing
WO1993001750A1 true WO1993001750A1 (en) 1993-02-04
PCT/DE1992/000589 WO1993001750A1 (en) 1991-07-23 1992-07-21 Surgical stitching instrument
WO2004105620A1 (en) * 2003-05-21 2004-12-09 Boston Scientific Limited Remotely-reloadable suturing device
ITGE20020056A1 (en) * 2002-06-26 2003-12-29 Sergio Capurro Atraumatic needle two surgical tips.
US7942707B2 (en) * 2009-04-28 2011-05-17 Tyco Electronics Corporation Electrical contact with locking barb
1992-07-21 WO PCT/DE1992/000589 patent/WO1993001750A1/en active IP Right Grant
1992-07-21 JP JP50252593A patent/JPH0767457B2/en not_active Expired - Fee Related
1992-07-21 EP EP19920915550 patent/EP0595892B1/en not_active Expired - Lifetime
1994-03-16 US US08/213,732 patent/US5389103A/en not_active Expired - Lifetime
AU2009204417B2 (en) * 2008-01-03 2013-05-09 Cook Medical Technologies Llc Medical systems and devices for endoscopically suturing perforations
US5389103A (en) 1995-02-14
JPH0767457B2 (en) 1995-07-26
JPH06504222A (en) 1994-05-19
EP0595892A1 (en) 1994-05-11
EP0595892B1 (en) 1995-12-20
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