Patent Description:
A hernia occurs when an organ, intestine or fatty tissue squeezes through a hole or a weak spot in the surrounding muscle or connective tissue. Hernias often occur at the abdominal wall. Sometimes a hernia can be visible as an external bulge particularly when straining or bearing down.

A hernia mesh is a surgical patch forming a support for supporting damaged tissue around a hernia as it heals. Handling the hernia mesh, poor visibility during mesh handling, implantation and fixation, combined with poor usability and ergonomic limitations when using laparoscopic instrument are challenging tasks for surgeons. Surgeons place the mesh over the hernia region, and the positioned mesh may then be affixed using suitable connecting means such as either stitches, tacks, staples or tissue adhesive in order to prevent its folding or migration.

Fixation using stitches or staples have been reported as leading to nerve injury and acute/chronic postoperative pain. These complications have thus prompted surgeons to evaluate methods of atraumatic fixation such as the use of human fibrin adhesive (for example Tissucol/Tisseel fibrin glue (Baxter Healthcare, Deerfield, IL, USA).

If the adhesive is not correctly applied on the mesh, the mesh may not be conveniently placed and fixed on targeted site. In particular, the surgeon can apply too much adhesive in some areas, or miss adhesive in other areas, which is not desired.

Alternative solution has been developed consisting in self fixating meshes such as Adhesix™ that is a mesh coated with a layer of polyvinyl pyrrolidone (PVP) and PEG.

<CIT> further describes a mesh coated with cross-linkable protein or polypeptide such as gelatin with an enzymatic cross-linker such as transglutaminase and <CIT> describes textile implants having a face at least partially covered with a bio-adhesive composition activatable in a moist or wet medium.

In operation, the mesh, including mesh coated with fixating agent (such as adhesive), is preferably inserted using a trocar having a diameter of about <NUM> to <NUM> with the rolled-up mesh placed therein. This may require that said fixating agent is applied onto the mesh using particular patterns, with specific spacings and designs. It is thus desirable to get tools allowing to produce this type of coated supports.

<CIT> discloses a method and an associated device for the sealing a puncture in a vessel within mammals.

<CIT> discloses and apparatus and methods for delivering compounds into a body, and more particularly to apparatus and methods for delivering bone cement, biomaterials, and/or other flowable compounds into vertebrae, e.g., during a vertebroplasty procedure.

An aim of the present disclosure is to ensure that an adhesive composition is applied in reproducible, standardized, uniform and easy manner on a support such as any substrate having a surface, more particularly a tissue repair support, such as surgical patch, surgical mesh or surgical film.

The kit may comprise the optional feature set forth below, taken alone or combined together whenever it is technically feasible.

The applicator may be configured such that the adhesive composition is forced out of the applicator through the outlet at a rate proportional to a rotational speed of the drive element relative to the body.

The outlet may be arranged to deliver the adhesive composition in a direction parallel to a rotation axis of the drive element relative to the body.

The piston may be mobile in translation relative to the body in a direction parallel to a rotation axis of the drive element relative to the body.

The body may define a passageway connecting the chamber with the outlet, wherein the drive element extends around the passageway.

The drive element may comprise a pinion able to mesh with a rack external to the applicator.

The applicator may comprise a gripping part allowing a user to hold the applicator, and the drive element may be located between the outlet and the gripping part.

The applicator may further comprise a first screw thread, and the drive element may comprise a second screw thread engaged with the first screw thread, wherein a rotation of the second screw thread relative to the first screw thread causes the piston to translate relative to the body.

The applicator may comprise: a gripping part allowing a user to hold the applicator, and a pusher comprising the first screw thread, the pusher being slidably mounted to the gripping part.

The applicator may comprise blocking means preventing the body to rotate relative to the pusher about an axis of translation of the piston relative to the body.

The body and the piston may form a syringe being a replaceable part of the applicator.

The applicator may further comprise the adhesive composition.

The adhesive composition may be a light-curable compound.

The guide may comprise a rack able to mesh with the drive element when the guide and the applicator are in the engaged configuration.

The applicator may comprise a mouthpiece defining the outlet and being able to extend in the elongated hole whenever the applicator and the guide are in the engaged configuration.

The guide may comprise a guiding wall extending along the elongated hole and such that the outlet is aligned with the elongated hole when the drive element is moved along the guiding wall while the guide and the applicator are in the engaged configuration.

The guiding wall may comprise a rack able to mesh with the drive element when the guide and the applicator are in the engaged configuration.

The elongated hole may extend over at least <NUM> degrees around a point and/or forms a portion of a loop extending around a point.

The guide may define a plurality of holes including the first elongated hole, the plurality of holes forming a loop extending around a point.

The guide may define a further plurality of holes forming a second loop extending around a point, wherein the loop and the second loop are concentric.

The guide may comprise a central hole leaving exposed another area of the support while the guide covers the support, and the point may be the center of the central hole.

The guide may comprise a second guiding wall extending along the elongated hole, and wherein the drive element is between the guiding wall and the second guiding wall whenever the guide and the applicator are in the engaged configuration.

The guide may define a second elongated hole leaving exposed a second elongated area of the support when the guide covers the support, and wherein the guide comprises a second guiding wall extending along the second elongated hole and arranged such that the outlet is aligned with the second elongated hole when moving the drive element along the second guide wall while the applicator the guide and are in the engaged configuration.

The second guiding wall may be between the elongated hole and the second elongated hole.

The kit may further comprise the support, and the support may be a surgical mesh, such as a hernia mesh.

The kit may further comprise a container containing the support and the guide assembled together.

It is also proposed a method for applying an adhesive composition on a support using the kit described above. The method comprises: setting the applicator and the guide in the engaged configuration, and moving the drive element along the guide so as to causes the drive element to rotate relative to the body, while the guide and the applicator are in the engaged configuration.

Further details, features and advantages are explained in more detail below with the aid of exemplary embodiments that are illustrated in the figures.

Referring to <FIG> and <FIG>, an applicator <NUM> according to an embodiment comprises a body <NUM>, a piston <NUM>, a drive element <NUM>, a gripping part <NUM> and a pusher <NUM>.

As shown with more details in <FIG>, the body <NUM> is an elongated body extending along a longitudinal axis X from a distal end thereof to a proximal end thereof.

The body <NUM> comprises a cylinder <NUM> defining a chamber <NUM> for storing an adhesive composition (this composition will be detailed later). The chamber <NUM> may have a volume varying from <NUM>,<NUM> to <NUM>, preferably from <NUM> to <NUM>, for instance <NUM>.

The body <NUM> further comprises an outlet <NUM> for delivering the adhesive composition stored in the chamber <NUM> out of the applicator <NUM>.

The outlet <NUM> is arranged axially at the distal end of the body <NUM>. Thus, the adhesive composition flows in a direction parallel to longitudinal axis X when exiting the applicator via the outlet <NUM>. According to one particular embodiment, outlet <NUM> is a luer-lock outlet which can further comprise a cap when the applicator is not in use. In this case, advantageously, the applicator further comprises a locking pin that avoid the drive element to turn while unscrewing the luer-lock cap (<FIG> and <FIG>).

The body <NUM> further comprises a mouthpiece <NUM> defining a passageway <NUM> connecting the chamber <NUM> with the outlet <NUM>. The outlet <NUM> actually forms a distal opening of the passageway <NUM> (and of the applicator <NUM>).

The mouthpiece <NUM> has a smaller diameter than that of the cylinder <NUM>.

The chamber <NUM>, the outlet <NUM> and the passageway <NUM> extend along the longitudinal axis X. The passageway <NUM> is rectilinear. The passageway is located between the chamber <NUM> and the outlet <NUM>. Thus, an adhesive composition stored in chamber <NUM> has to flow in a direction parallel to longitudinal axis X so as to reach the outlet <NUM> and exit the applicator <NUM>.

The body <NUM> further has an inlet <NUM> opposite to the outlet <NUM> relative to the chamber <NUM>. The inlet <NUM> is defined by the cylinder <NUM> at the proximal end of the body <NUM>.

The body <NUM> further comprises two tabs <NUM>, <NUM> protruding radially from an outer surface of the cylinder <NUM>. The tabs <NUM>, <NUM> are opposite to each other relative to the cylinder <NUM>. According to another embodiment, these two tabs are not present and are replaced by a round tab collar (see <FIG>).

The piston <NUM> is mobile in translation relative to the body <NUM> in a direction coaxial to longitudinal axis X. The piston <NUM> actually delimits the chamber <NUM> when inserted in the cylinder <NUM> through the inlet <NUM>. When the piston <NUM> translates relative to the body <NUM> towards the outlet <NUM>, the volume of the chamber <NUM> is reduced; this causes an adhesive composition stored in the chamber <NUM> to exit the chamber <NUM>, then flow in the passageway <NUM> then be forced out of the applicator <NUM> through the outlet <NUM>. When the piston <NUM> is moved away from the outlet <NUM>, the volume of the chamber <NUM> is increased.

The body <NUM> and the piston <NUM> form a medical device such as a syringe. This syringe is a replaceable part of the applicator <NUM> independent from the drive element <NUM>, the gripping part <NUM> and the pusher <NUM>. Thus, it can be replaced by another syringe.

Now referring to <FIG>, the drive element <NUM> comprises a tube <NUM> extending about longitudinal axis X.

The tube <NUM> has an inner surface <NUM> and an outer surface <NUM> opposite to the inner surface <NUM>. The inner surface <NUM> delimits a cylindrical cavity <NUM>.

The tube <NUM> has two opposite openings giving access to the cavity <NUM>: a distal opening <NUM> and a proximal opening <NUM>. The cylinder <NUM> can be inserted in the cavity <NUM> of the tube <NUM> via the proximal opening <NUM>, and positioned therein such that the mouthpiece <NUM> crosses the distal opening <NUM> and protrudes out of the drive element <NUM>.

The drive element <NUM> further comprises a screw thread <NUM>. The screw thread <NUM> is formed in the outer surface <NUM> of the tube <NUM>. The screw thread <NUM> extends from the proximal opening <NUM>.

The drive element <NUM> further comprises a wheel <NUM> affixed to the tube <NUM>. The wheel <NUM> and the tube <NUM> are coaxial (about longitudinal axis X). The wheel <NUM> forms a collar around the distal opening <NUM> and around the tube <NUM>. The wheel <NUM> has therefore a diameter greater than the diameter of the outer surface <NUM>.

The distal opening <NUM> is defined in the wheel <NUM>.

The distal opening <NUM> has a diameter smaller than that of the cylinder <NUM>. Thus, when the body <NUM> is inserted in the tube <NUM>, the cylinder <NUM> abuts against the wheel <NUM>.

In the embodiment shown in <FIG>, the wheel <NUM> is actually a pinion. The pinion <NUM> comprises teeth on its outer circumference.

The drive element <NUM> further comprises a rib <NUM> protruding from the outer surface <NUM>. The rib <NUM> is located between the screw thread <NUM> and the pinion <NUM>. The rib may form a collar extending around the tube <NUM>.

Referring to <FIG> and <FIG>, the gripping part <NUM> of the applicator <NUM> comprises a tube <NUM> extending about longitudinal axis X.

The tube <NUM> has an inner surface <NUM> and an outer surface <NUM> opposite to the inner surface <NUM>. The inner surface <NUM> delimits an inner cavity <NUM>. The outer surface <NUM> is a free surface of the applicator <NUM>. The outer surface can be seized by a hand of a user.

The tube <NUM> has having two opposite openings giving access to the cavity <NUM>: a distal opening <NUM> and a proximal opening <NUM>.

The tube <NUM> of the drive element <NUM> can be inserted in the second tube <NUM> via the distal opening <NUM>, such that both tubes are coaxial and can freely rotate relative to each other about their common axis. As a result, the drive element <NUM> is rotatably mounted on the gripping part <NUM>.

The inner surface <NUM> defines a recess <NUM> able to receive the rib <NUM> when the tube <NUM> of the drive element <NUM> is inserter in the tube <NUM> of the gripping part <NUM>. The recess <NUM> may form a groove extending around the cavity <NUM>. The recess <NUM> and the rib <NUM> form locking means preventing the drive element <NUM> to translate relative to the gripping part <NUM>.

The diameter of the inner surface <NUM> is greater than the diameter of the outer diameter <NUM> of the tube <NUM>, so as to leave an annular gap in the cavity <NUM> between the tubes <NUM>, <NUM>. In particular, the screw thread <NUM> extends this annular gap.

The gripping part <NUM> may further comprises two tabs <NUM>, <NUM> protruding radially from the inner surface <NUM>. The two tabs <NUM>, <NUM> actually define therebetween the proximal opening <NUM>. These two tabs might be replaced by a collar tab protruding radially from the inner surface <NUM>.

The proximal opening <NUM> has a central portion and two peripheral portions opposite to each other relative to the central portion. The central portion is circular and has a diameter substantially equal to the outer diameter of the cylinder <NUM>, and substantially equal to the diameter of inner surface <NUM>.

The gripping part <NUM> further comprises a plurality of pawns <NUM> protruding from the tabs <NUM>, <NUM> in a direction parallel to the axis of the tube <NUM>. The plurality of pawns <NUM> include two first pawns protruding from tab <NUM> and a two second pawns protruding from tab <NUM>. The two first pawns and tab <NUM> form a first recess able to receive tab <NUM>, and the two second pawns and tab <NUM> forms a second recess able to receive tab <NUM> (or vice-versa). The design and number of pawns can be adapted to the design of the tabs <NUM> and <NUM> or of the round tab collar (<FIG>). For example, it can comprise topographic elements avoiding the syringe to turn when engaged.

The drive element <NUM> is locked in the gripping part <NUM> by means of the recess <NUM> and the rib <NUM>. The central portion of the proximal opening <NUM> is aligned with the proximal opening <NUM> of the drive element <NUM>. Besides, the wheel <NUM> remains out of the gripping part <NUM>. Thus, the wheel can engage a guide external to the applicator <NUM> (this guide will be detailed later). Besides, the drive element <NUM> can freely rotate relative to the gripping part <NUM>.

The body <NUM> can then be inserted into the gripping part <NUM> via its proximal opening, then into the drive element <NUM> locked therein. During this insertion, the body <NUM> reaches a position wherein the tabs <NUM>, <NUM> of the body <NUM> abut against the tabs <NUM>, <NUM> of the gripping parts <NUM>, in the two recesses defined by the plurality of paws <NUM>. As a result, tabs <NUM>, <NUM>, <NUM>, <NUM> and pawns <NUM> form blocking means preventing the body <NUM> to rotate relative to the gripping part <NUM>. But alternate blocking means playing this function could be used.

Referring to <FIG>, the pusher <NUM> comprises a base <NUM> and two legs <NUM>, <NUM> protruding from the base <NUM>. The legs <NUM>, <NUM> comprise two inner surfaces facing each other, are and separated by a space. The piston is received in this space.

The pusher <NUM> comprises a screw thread <NUM>. The screw thread <NUM> is formed in the inner surfaces of the two legs <NUM>, <NUM>.

Once the body <NUM> has been locked to the gripping part <NUM> and the piston <NUM> has been inserted in the cylinder <NUM>, the two legs <NUM>, <NUM> are inserted via the two peripheral portions of the proximal opening <NUM> in the annular gap left between the gripping part <NUM> and the drive element <NUM>, such that the screw thread <NUM> engages with the screw thread <NUM>. The tabs <NUM>, <NUM> form means preventing the pusher to rotate relative to the gripping part <NUM> (other means for carrying out this function could be used instead). As a result, the pusher <NUM> is slidably mounted in the gripping part <NUM>. A rotation of the screw thread <NUM> relative to the screw thread <NUM> cause the pusher <NUM> to translate relative to the gripping part <NUM> in a direction parallel to longitudinal axis X.

As shown in <FIG>, the gripping part <NUM> and the pusher <NUM> form together a housing containing the piston <NUM> and the body <NUM>. The pusher <NUM> prevents the piston <NUM> to be moved out of the body <NUM>, since the base <NUM> abuts against the piston <NUM>.

According to special embodiment, the pusher <NUM> is closed all around and does not comprise legs <NUM> and <NUM> (<FIG>). The screw thread <NUM> is formed in the inner surface of the closed pusher. This presents the main advantage of blocking light and preventing deformation of the pusher and piston.

Once, the body <NUM>, the piston <NUM>, the drive element <NUM>, the gripping part <NUM> and the pusher <NUM> have been assembled as described above, the applicator <NUM> is formed, as shown in <FIG>.

The chamber <NUM> is filled with an adhesive composition.

Preferably, the adhesive composition is a light-curable compound. "Light curable compound" refers to compounds that are configured to polymerize or otherwise cure upon receiving radiant energy, more particularly in the form of light from a light source.

The light-curable compound may comprise a pre-polymer and a photoinitiator, said photoinitiator being able to induce polymerization of the said pre-polymer when exposed to light of a specific wavelength.

According to a special embodiment, said photoinitiator is sensitive to ultraviolet (UV) radiations.

Examples of suitable pre-polymers include, but are not limited to pre-polymers described in <CIT> or <CIT> or <CIT>.

Preferably, the polymeric backbone of the pre-polymer comprises a polymeric unit of the general formula (-A-B-)n, wherein A is derived from a substituted or unsubstituted polyol or mixture thereof and B is derived from a substituted or unsubstituted polyacid or mixture thereof; and n represents an integer greater than <NUM>. The polymeric backbone is made up of repeating monomer units of general formula -A-B-. The term "substituted" has its usual meaning in chemical nomenclature and is used to describe a chemical compound in which a hydrogen on the primary carbon chain has been replaced with a substituent such as alkyl, aryl, carboxylic acid, ester, amide, amine, urethane, ether, or carbonyl. Component A of the pre-polymer may be derived from a polyol or mixture thereof, such as a diol, triol, tetraol or greater. Suitable polyols include diols, such as alkane diols, preferably octanediol; triols, such as glycerol, trimethylolpropane, trimethylolpropane ethoxylate, triethanolamine; tetraols, such as erythritol, pentaerythritol; and higher polyols, such as sorbitol. Component A may <NUM> also be derived from unsaturated polyols, such as tetradeca-<NUM>,<NUM>-diene-<NUM>,<NUM>-diol, polybutadienediol or other polyols including macromonomer polyols such as, for example polyethylene oxide, polycaprolactone triol and N-methyldiethanoamine (MDEA) can also be used. Preferably, the polyol is substituted or unsubstituted glycerol. Component B of the pre-polymer is derived from a polyacid or mixture thereof, preferably diacid or triacid. Exemplary acids include, but are not limited to, glutaric acid (<NUM> carbons), adipic acid (<NUM> carbons), pimelic acid (<NUM> carbons), sebacic acid (<NUM> carbons), azelaic acid (nine carbons) and citric acid. Exemplary long chain diacids include diacids having more than <NUM>, more than <NUM>, more than <NUM>, and more than <NUM> carbon atoms. Non-aliphatic diacids can also be used. For example, versions of the above diacids having one or more double bonds can be used to produce polyol-diacid copolymers. Preferably the polyacid is substituted or unsubstituted sebacic acid.

According to preferred embodiment suitable pre-polymers is selected into the group consisting of poly(glycerol sebacate acrylate) or derivative thereof such as for example aminated PGSA ( <CIT>).

Examples of suitable photoinitiators sensitive to UV radiations include, but are not limited to: <NUM>-dimethoxy-<NUM>-phenyl-acetophenone, <NUM>-hydroxy-<NUM>-[<NUM>-(hydroxyethoxy)phenyl]-<NUM>-methyl-<NUM>-propanone (Irgacure <NUM>), <NUM>-hydroxycyclohexyl-<NUM>-phenyl ketone (Irgacure <NUM>), <NUM>-hydroxy-<NUM>-methyl-<NUM>-phenyl-<NUM>-propanone (Darocur <NUM>), <NUM>-benzyl-<NUM>-(dimehylamino)-<NUM>-[<NUM>-morpholinyl) phenyl]-<NUM>-butanone (Irgacure <NUM>), methylbenzoylformate (Darocur MBF), oxyphenyl-acetic acid-<NUM>-[<NUM>-oxo-<NUM>-phenyl-acetoxy-ethoxy]-ethyl ester (Irgacure <NUM>), <NUM>-methyl-<NUM>-[<NUM>-(methylthio)phenyl]-<NUM>-(<NUM>-morpholinyl)-<NUM>-propanone (Irgacure <NUM>), diphenyl(<NUM>,<NUM>,<NUM>-trimethylbenzoyl)-phosphine oxide (Darocur TPO), phosphine oxide, phenyl bis(<NUM>,<NUM>,<NUM>-trimethyl benzoyl) (Irgacure <NUM>), and combinations thereof.

According to another embodiment, said photoinitiator is sensitive to visible light (typically blue light or green light).

Examples of photoinitiators sensitive to visible light include, but are not limited to: diphenyl(<NUM>,<NUM>,<NUM>-trimethylbenzoyl)-phosphine oxide, eosin Y disodium salt, N-Vinyl-<NUM>-Pyrrolidone (NVP) and triethanolamine, and camphorquinone.

Alternatively, the "adhesive composition" might be any composition which have flow characteristics such that they can be applied to the desired area through a syringe or catheter (e.g., relatively low viscosity) but are sufficiently viscous to remain in place at the site of application.

Referring to <FIG>, <FIG> and <FIG>, a kit for applying an adhesive composition on a support such as any substrate having a surface, more particularly a tissue repair support, such as surgical patch, preferably hernia mesh, comprises the applicator <NUM> and a guide <NUM> according to a first embodiment.

The guide <NUM> comprises a lower surface <NUM> and an upper surface <NUM> opposite to the lower surface <NUM>. The lower surface <NUM> is intended to be put in contact with the support.

The guide <NUM> comprises stabilizing means for preventing the guide <NUM> to slide against the support. These stabilizing means may for instance comprise protrusions <NUM> protruding from the lower surface <NUM>. When the support is a mesh, such as a surgical mesh, these protrusions can engage or pick the loosely woven body of mesh thereby preventing this sliding movement.

The guide <NUM> defines a first elongated hole <NUM> opening in both the lower surface <NUM> and the upper surface <NUM>. As a consequence, once the lower surface <NUM> of the guide <NUM> is placed against a support, the first elongated hole <NUM> leaves exposed a first elongated area of the support.

The first elongated hole <NUM> has a first lateral edge <NUM>, a second lateral edge <NUM> opposite to the first lateral edge <NUM>. The first elongated hole <NUM> has a constant width measured as a distance separating the two lateral edges <NUM>, <NUM>.

The first elongated hole <NUM> has two opposite ends <NUM>, <NUM> connecting the two lateral edges <NUM>, <NUM>. The two opposite ends <NUM>, <NUM> are curved such that the first elongated hole <NUM> is oblong.

The first elongated hole <NUM> forms a portion of a first ring having a center C. In other words, the two lateral edges <NUM>, <NUM> are arcuate. The first lateral edge <NUM> has a radius of curvature greater than that of the second lateral edge <NUM>.

The first elongated hole <NUM> extends over at least <NUM> degrees about the center C. In the first embodiment, the first elongated hole <NUM> extends over an angular sector close to <NUM> degrees about center C, typically less than <NUM> degrees.

The guide <NUM> further defines a second elongated hole <NUM> opening in both the lower surface <NUM> and the upper surface <NUM>. As a consequence, once the lower surface <NUM> of the guide <NUM> is placed against one of the two surfaces of the hernia mesh, the second elongated hole <NUM> leaves exposed another elongated area of the support.

The second elongated hole <NUM> has a first lateral edge <NUM> and a second lateral edge <NUM> opposite to the first lateral edge <NUM>. The second elongated hole <NUM> has a constant width measured as a distance separating the two lateral edges <NUM>, <NUM>.

The second elongated hole <NUM> has two opposite ends <NUM>, <NUM> connecting the two lateral edges <NUM>, <NUM>. The two opposite ends <NUM>, <NUM> are curved such that the second elongated hole <NUM> is oblong.

The second elongated hole <NUM> forms a portion of a second ring. In other words, the two lateral edges <NUM>, <NUM> are arcuate. The first lateral edge <NUM> has a radius of curvature greater than that of the second lateral edge <NUM>.

The second elongated hole <NUM> extends over at least <NUM> degrees about the center C. In the first embodiment, the second elongated hole <NUM> extends about center C over an angular sector close to <NUM> degrees, typically less than <NUM> degrees.

The two portions of ring formed by the first elongated hole <NUM> and the second elongated hole <NUM>, respectively, are concentric (they have the same center C).

The guide <NUM> further comprises a central hole <NUM>. The second elongated hole <NUM> is between the central hole <NUM> and the first elongated hole <NUM>. The first elongated hole <NUM> surrounds the second elongated hole <NUM>, and the second elongated hole <NUM> surrounds the central hole <NUM>.

The center of the central hole <NUM> is actually the center C of the two rings above mentioned.

The guide <NUM> further comprises a first guiding wall <NUM> extending along the first elongated hole <NUM>. The first guiding wall <NUM> protrudes from the upper surface <NUM>.

The first lateral edge <NUM> is closer to the first guiding wall <NUM> than the second lateral edge <NUM>. The first guiding wall <NUM> is away from the first elongated hole <NUM> in the sense that there is a non-zero distance between the first lateral edge <NUM> of the first elongated hole <NUM> and the first guiding wall <NUM>. This distance is constant all along the first lateral edge <NUM>.

The first guiding wall <NUM> has a first lateral surface <NUM>, a second lateral surface <NUM> opposite to the first lateral surface <NUM>, and a top surface joining the two lateral surfaces together. The second lateral surface <NUM> faces a first zone located above the first elongated hole <NUM>.

The first guiding wall <NUM> comprises a first rack <NUM> able to mesh with the pinion <NUM>. The first rack <NUM> is formed in the second lateral surface <NUM> of the first guiding wall <NUM>, such that the rotation axis X of the pinion can be perpendicular to the lower surface <NUM> of the guide <NUM> when the pinion <NUM> meshes with the first rack <NUM>.

The guide <NUM> further comprises a second guiding wall <NUM> extending as well along the second elongated hole <NUM>. The second guiding wall <NUM> protrudes from the upper surface <NUM>.

The first elongated hole <NUM> is between the first guiding wall <NUM> and the second guiding wall <NUM>.

The first guiding wall <NUM> and the second guiding wall <NUM> define therebetween a first groove. The first zone discussed above is located in this first groove.

The pinion <NUM> can fit in the first groove. For that purpose, the first groove has a width, measured as a distance between the first guiding wall <NUM> and the second guiding wall <NUM>, which is greater or equal to the diameter of the pinion. When the pinion is meshes with the first rack <NUM>, the outlet <NUM> faces the first elongated hole <NUM> and the pinion is away from the second guiding wall <NUM>.

The first elongated hole <NUM> is closer to the first guiding wall <NUM> than to second guiding wall <NUM>.

The second lateral edge <NUM> of the first elongated hole <NUM> may be closer to the second guiding wall <NUM> than the first guiding wall <NUM>. The first guiding wall <NUM> is away from the second elongated wall in the sense that there is non-zero distance between the second lateral edge <NUM> of the first elongated hole <NUM> and the second guiding wall <NUM>. This distance is roughly constant all along the second lateral edge <NUM>.

The second guiding wall <NUM> has a first lateral surface <NUM>, a second lateral surface <NUM> opposite to the first lateral surface, and a top surface joining the two lateral surfaces together. The first lateral surface <NUM> faces the first zone above the first elongated hole <NUM>, and faces as well the second lateral surface <NUM> of the first guiding wall <NUM>.

Besides, the second guiding wall <NUM> is between the first elongated hole <NUM> and the second elongated hole <NUM>.

The first lateral edge <NUM> of the second elongated hole <NUM> is closer to the second guiding wall <NUM> than the second lateral edge <NUM>. The second guiding wall <NUM> is away from the second elongated hole <NUM> in the sense that there is non-zero distance between the first lateral edge of the second elongated hole <NUM> and the second guiding wall <NUM>. This distance is roughly constant all along the first lateral edge.

The second guiding wall <NUM> comprises a second rack <NUM>, which is able to mesh with the pinion <NUM>. The second rack <NUM> is formed in the second lateral surface <NUM> of the second guiding wall <NUM>. Thus, the teeth of the rack face a second zone located above the second elongated hole <NUM>.

Besides the second elongated hole <NUM> is between the second guiding wall <NUM> and the central hole <NUM>.

The guide <NUM> further comprises a gripping part <NUM> away from the guiding walls <NUM>, <NUM> and away from the holes <NUM>, <NUM>, <NUM>. A user can maintain the guide <NUM> against a support by pressing on the gripping part <NUM> without covering the guiding wall <NUM>, <NUM> or the holes <NUM>, <NUM>, <NUM>.

The guide <NUM> may be obtained by injection molding or 3D printing.

The guide has a height measure in a direction perpendicular to the lower and upper surface, which is preferable less than <NUM> centimeters.

A guide <NUM> according to a second embodiment is illustrated in <FIG> and <FIG>.

The guide <NUM> comprises features corresponding to features of the guide <NUM> described above. By convention, the reference numerals of two corresponding features in guides <NUM>, <NUM> differ by <NUM>. Thus, the guide <NUM> comprises the following features:.

Guide <NUM> differs from guide <NUM> by the number and shape of the elongated holes, and by the shape of the guiding walls. All other features of guide <NUM> are similar to the corresponding features of guide <NUM>.

The first elongated holes <NUM> are distributed around the center C, so as to form together a first loop. The loop is interrupted by first bridges <NUM>. Each first bridge <NUM> extends radially with respect to center C, and separates two adjacent first elongated holes <NUM>. Due to the presence of the first bridges, the plurality of first elongated holes <NUM> extends over an angular sector about center C which is not strictly equal to <NUM> degrees. Nevertheless, the first bridges <NUM> have a small width, such that this angular sector is close to <NUM> degrees, typically greater than <NUM> degrees. In the embodiment shown in <FIG>, the number of first bridges <NUM> is sixteen, but it could be different (two or more).

Similarly, the second elongated holes <NUM> are distributed around the center C, so as to form together a second loop included in the first loop. The second loop is interrupted by second bridges <NUM>. Each second bridge <NUM> extends radially with respect to center C, and separates two adjacent second elongated holes <NUM>. Due to the presence of the second bridges <NUM>, the plurality of second elongated holes <NUM> extends over an angular sector about center C which is not strictly equal to <NUM> degrees. Nevertheless, the second bridges <NUM> have a small width, such that this angular sector is close to <NUM> degrees, typically greater than <NUM> degrees. In the embodiment shown in <FIG>, the number of second bridges <NUM> is eight, but it could be different (two or more).

Besides, the first guiding wall <NUM> and the second guiding wall <NUM> form two other loops extending over <NUM> degrees about center C. Racks <NUM> and <NUM> form two closed circuits extending as well over <NUM> degrees about center C.

In the guide <NUM> shown in <FIG>, the loops formed by the elongated holes <NUM>, <NUM> and by the guiding walls <NUM>, <NUM> form two rings (circular loops). But in other embodiments, these loops could have other closed shapes such as ellipsoids or polygons extending around the central hole <NUM>.

A guide <NUM> according to a third embodiment is illustrated in <FIG>.

Guide <NUM> differs from guide <NUM> in that it has a single elongated hole <NUM> and a single guiding wall <NUM> extending along hole <NUM>. The guiding wall includes a rack <NUM>.

Moreover, the elongated hole <NUM>, the guiding wall <NUM> and the rack <NUM> are rectilinear.

Guide <NUM> further comprises a gripping part <NUM> extending along the guiding wall <NUM>.

The present disclosure provides a kit comprising an applicator <NUM> and any of guides <NUM>, <NUM> and <NUM>.

According to preferred embodiment, the kit comprises a body <NUM> and the chamber <NUM> thereof is filled with an adhesive composition.

The kit including the applicator <NUM> and any of guides <NUM>, <NUM>, <NUM> may further include a support on which the adhesive composition can be applied.

The support has a top surface able to be partially covered by any of the guides <NUM>, <NUM>, <NUM>. It may have any shape (circular, rectangular, etc.).

The support is for example any substrate having a surface, more particularly a tissue repair support, such as surgical patch, a surgical mesh, such as a hernia mesh. The mesh is a screenlike material that is used as a reinforcement for tissue, organ or bone. It can be made of synthetic polymers or biopolymers. Materials used for surgical mesh include:.

The kit including the applicator <NUM> and any of guides <NUM>, <NUM>, <NUM> may further include container, such as a blister. This container can contain the guide <NUM> or <NUM> or <NUM> preassembled with a support, such as any substrate having a surface, more particularly a tissue repair support, such as surgical patch, a surgical mesh a surgical mesh. This container serves different purposes:.

A first method for applying the adhesive composition on a support using the applicator <NUM> and the guide <NUM> comprises the following steps. In the following, it will be assumed that the support is a hernia mesh, which is a particular type of surgical mesh.

A user covers the mesh with the guide, such that the lower surface of the guide contacts an upper surface of the mesh. For this point on, the first elongated hole <NUM> leaves exposed a first elongated area of the mesh, the second elongated hole <NUM> leaves exposed a second elongated area of the mesh, and the central hole <NUM> leaves exposed a circular area of the mesh, whereas other areas of the mesh are masked by the guide.

The chamber <NUM> of the applicator is filled with the adhesive composition discussed above. This step can be a preliminary step performed before assembling the body <NUM> with the other parts of the applicator <NUM>.

The user then seizes the gripping part <NUM> of the applicator <NUM> filled with the adhesive composition.

The user sets the guide and the applicator in a first engaged configuration, which is shown for example in <FIG>.

In the first engaged configuration, the drive element <NUM> is engaged with the guide <NUM>. More precisely, the pinion <NUM> is in the first groove between the first guiding wall <NUM> and the second guiding wall <NUM>, and engages the first rack <NUM>.

In the first engaged configuration, the outlet <NUM> faces a first elongated area of the mesh left exposed by the first elongated hole <NUM>. The mouthpiece <NUM> extends in the first elongated hole <NUM>.

While the applicator <NUM> and the guide <NUM> are in the first engaged configuration, the user translates the applicator <NUM> relative to the guide <NUM> along the first guiding wall <NUM>. During this translation, the outlet <NUM> travels the first elongated area and the pinion <NUM> rotate relative to the rack <NUM>. The coupling between the first rack <NUM> and the pinion <NUM> causes the drive element <NUM> to rotate relative to the gripping part <NUM>, the pusher <NUM> and the body <NUM>. The rotation of the drive element <NUM> relative to the pusher <NUM> causes the pusher <NUM> to translate relative to the body <NUM> in a direction parallel to longitudinal axis X. During this translation, the pusher <NUM> pushes on the piston <NUM>, whereby the volume of the chamber <NUM> is reduced. The adhesive composition stored in the chamber <NUM> flows in the passageway <NUM>, then is forced out of the applicator <NUM> through the outlet <NUM>. Since the outlet <NUM> simultaneously travels the first elongated area, the adhesive composition is gradually and evenly applied on the first elongated area.

Thanks to the design of the applicator <NUM>, the adhesive composition is forced out of the applicator through the outlet <NUM> at a flow rate proportional to the rotational speed of the drive element relative to the body. This property is very advantageous since the adhesive composition can be applied evenly on the mesh even though the user does not translate the applicator <NUM> relative to the guide <NUM> at a constant speed. Thus, the adhesive composition is evenly deposited on the mesh with ease.

The ratio between the rate and the rotational speed depends on various parameters including the diameter of the pinion <NUM> and the width of the chamber <NUM>. Preferably, the flow rate is comprised between <NUM>,<NUM>/cm and <NUM>,<NUM>/cm.

The user moves the applicator <NUM> such that the outlet <NUM> moves from one end of the first elongated hole <NUM> to an opposite end of the first elongated hole <NUM>. As a result, the entirety of the first elongated area of the mesh is coated with the adhesive composition.

During this process, the guide <NUM> acts as a stencil. The adhesive composition is only applied in the first elongated area, having a predefined pattern, which can be reproduced very easily.

During the step described above, the user can use the central hole <NUM> as a visor. The user can for instance draw a mark on the mesh at the center C of the central hole <NUM> using a tool such as a pen. Any movement of the mark in the hole warns the user that the guide <NUM> moves relative to the mesh.

Then the user repeats the steps described above so as to coat the second elongated area of the mesh with the adhesive composition. For this purpose, the user sets the guide <NUM> and the applicator in a second engaged configuration, wherein the pinion <NUM> engages the second rack, and wherein the outlet faces the second elongated hole <NUM> and the second elongated area of the mesh left exposed by the second elongated hole <NUM>. While the applicator <NUM> and the guide <NUM> are in the second engaged configuration, the user translates the applicator <NUM> relative to the guide <NUM> along the second guiding wall <NUM>. The user moves the applicator <NUM> such that the outlet moves from one end of the second elongated hole <NUM> to an opposite end of the second elongated hole <NUM>. As a result, the entirety of the second elongated area of the mesh is coated with the adhesive composition.

Then, the user moves the guide <NUM> away from the mesh, thereby revealing the adhesive composition applied selectively in the first elongated area and the second elongated area.

The first elongated area and the second elongated area extend in a first half of the mesh.

The user folds a second half of the mesh back on the first half around a fold line crossing the mark the user has previously drawn at the center C while the guide <NUM> covered the mesh. By doing so, the adhesive composition is transferred to the second half of the mesh so as to form two concentric loops of adhesive on the support once the mesh is unfolded.

However, the mesh is not immediately unfolded to reveal the two concentric loops.

The folded mesh is rolled in a "taco" like shape then grabbed with graspers, and is then inserted in the body of a patient (e.g. through laparoscopic trocar), for instance inside the abdominal cavity. The mesh is then unrolled and unfolded and placed on the abdominal wall so as to cover a hernia thereon.

When the adhesive composition is a light-curable compound, the adhesive composition is illuminated with light such that the adhesive composition polymerizes. As a result, the adhesive composition, as well as the mesh, can adhere on the abdominal wall.

A second method for applying the adhesive composition on the support uses the applicator <NUM> and the guide <NUM> instead of guide <NUM>. The second method comprises the same steps as the first method. The only difference lies in the fact that the user can move the applicator <NUM> at <NUM> degrees about the center C along guiding walls <NUM>, <NUM>, so as to form two loops of adhesive composition on the support, instead of two portions of loops.

An advantage of the second method over the first method is that folding the support back on itself is no more necessary to form loops of adhesives on the support, it is no longer required to have uniform and symmetric coating on the mesh surface.

A third method for applying the adhesive composition on the support uses the applicator <NUM> and the guide <NUM> instead of guides <NUM> or <NUM>. The third method comprises the same steps as the first method. The only difference lies in the fact that the user can move the applicator along guiding wall <NUM>, so as to form a line of adhesive composition on the support.

The present disclosure is not limited by the embodiments described above in relation with the figures.

Although these features are advantageous, the wheel <NUM> of the drive element is not necessarily a pinion, and the guiding walls do not necessarily include racks. The wheel could have a smooth circumference adhering and rolling on a smooth surface.

The axis of rotation of the wheel <NUM> could be different. It could for instance be perpendicular to longitudinal axis X, such that the wheel <NUM> can roll on the upper surface of any of guides <NUM>, <NUM> or <NUM>, or directly on the surface of the support on which the adhesive composition is to be applied. In the latter case (which does not form part of the claimed invention), the support can be used directly as a guide, which means that using an external guide such as guide <NUM> or guide <NUM> is no more necessary. <FIG> illustrates an applicator <NUM>' which could replace applicator <NUM> in any of the methods described above. Applicator <NUM>' comprise a wheel <NUM> able to roll on the surface of the support, so as to cause an adhesive composition stored therein to be forced out of the applicator <NUM>' through an outlet <NUM>. A valve <NUM> made of a flexible material such as rubber may be arranged at outlet <NUM> so as to close it. The valve is urged to open outlet <NUM> under the effect of the adhesive composition, when the applicator <NUM>' rolls on a surface.

In the applicator <NUM>, the transmission causing the rotational motion of the wheel <NUM> to be converted into a translation motion of the piston <NUM> actually includes screw threads <NUM>, <NUM>, which makes the applicator <NUM> very efficient and robust. Nevertheless, other transmissions, for example including a pulley, a thread and/or a belt could be used instead. For example, <FIG> and <FIG> illustrate an alternate applicator <NUM>" which could replace applicator <NUM> in any of the method described above. Applicator <NUM>" comprises: the body <NUM>, the piston <NUM>, a gripping part <NUM> playing the same function as gripping part <NUM>, a wheel <NUM> playing the same function as wheel <NUM>, a gear <NUM> and a thread <NUM>. The gear <NUM> comprises a drum. The thread <NUM> has a first end attached to gear <NUM> and a second end opposite to the first end and attached to the gripping part <NUM>. A rotation of the wheel <NUM> relative to the gripping part <NUM> causes the thread <NUM> to wrap around the drum and urge the piston <NUM> to slide in the body <NUM>.

The applicator <NUM> is supposed to be perpendicular to the support while applying the adhesive composition on the support. This is due to the fact that the chamber, the passageway and the outlet are aligned along longitudinal axis X. This feature is advantageous, but not mandatory. The passageway could for instance be bent at <NUM> degrees, and such that the chamber extends horizontally when the applicator is set in the engaged configuration. <FIG> and <FIG> illustrates an alternate applicator <NUM>‴ implementing this and which could replace applicator <NUM> in any of the method described above. More specifically, applicator <NUM>‴ comprise the body <NUM> and the piston <NUM> discussed above. Applicator <NUM>‴ further comprise a wheel <NUM> playing the same function as wheel <NUM> of applicator <NUM>. Wheel <NUM> has an axis of rotation perpendicular to the axis of translation of the piston <NUM> relative to the body <NUM>. Furthermore, applicator further comprises a passageway <NUM> which is bent at <NUM> degrees and arrange to extend the passageway <NUM> defined by body <NUM>.

The guides <NUM>, <NUM> could have a different number of elongated holes. Guide <NUM> could have a single arcuate elongated hole. Guide <NUM> could be designed to apply a single loop of adhesive, rather than two. The central hole is advantageous since it can be used as a visor, but it is not mandatory.

Claim 1:
Kit for applying an adhesive composition on a support such as a surgical mesh, wherein the kit comprises:
• an applicator (<NUM>) comprising:
o a body (<NUM>) defining a chamber (<NUM>) for storing an adhesive composition such as a light-curable compound, and an outlet (<NUM>) for delivering the adhesive composition stored in the chamber (<NUM>),
o a piston (<NUM>) mobile in translation relative to the body (<NUM>),
o a drive element (<NUM>) mobile in rotation relative to the body (<NUM>), and configured to be releasably engaged with a guide (<NUM>, <NUM>, <NUM>) external to the applicator (<NUM>), wherein rotating the drive element (<NUM>) relative to the body (<NUM>) causes the piston (<NUM>) to translate relative to the body (<NUM>) so as to reduce a volume of the chamber (<NUM>) and force the adhesive composition out of the applicator (<NUM>) through the outlet (<NUM>); and
• a guide (<NUM>, <NUM>, <NUM>)
wherein:
• the applicator (<NUM>) and the guide (<NUM>, <NUM>, <NUM>) are able to be set in an engaged configuration wherein the drive element (<NUM>) is engaged with the guide and wherein the outlet (<NUM>) faces the support,
• moving the drive element (<NUM>) along the guide (<NUM>, <NUM>, <NUM>) causes the drive element (<NUM>) to rotate relative to the body (<NUM>) while the guide and the applicator (<NUM>) are in the engaged configuration,
characterised in that
the guide defines an elongated hole (<NUM>, <NUM>, <NUM>) leaving exposed an elongated area of the support whenever the guide covers the support.