DE102015205083A1 - Surgical tissue fusion instrument - Google Patents

Abstract

The invention relates to a surgical tissue fusion instrument (100; 200) having two gripping structures (110; 130; 210; 230) which are movable relative to one another and adapted for gripping and joining together biological tissue sections to be fused, wherein at least one gripping structure (110; 210, 230) is associated with a heat generating means (114; 134; 214; 234) which effects tissue fusion between the biological tissue sections by heat generation, the heat generating means (114; 134; 214; 234) and / or at least one of the gripping structures (114; 110; 130; 210; 230) at least partially comprise a surface-treated, tissue fusion assisting or conveying surface, and / or a tissue fusion assisting or conveying material is contained within pores of the heat generating means (114; 134; 214; 234). The invention also relates to a surgical tissue fusion kit.

Description

Field of application and state of the art

The invention relates to a surgical tissue fusion instrument and a surgical tissue fusion kit.

For connecting body tissue, it is known, in particular in end-to-end anastomoses, to connect the tissue sections to be joined together by means of staplers by means of staples.

However, the use of staplers has the fundamental disadvantage that the staples usually remain in the body of a patient. In addition, bleeding may occur along the staple line. In the worst case, this leads to the manifestation of anastomotic leakage.

In order to reduce the frequency and severity of such complications, it is known that staplers are used in combination with, for example, hemostatic or wound healing enhancing adjuncts. The combined use of Klammernahtinstrument and additives, however, is perceived on the surgeon's side as very cumbersome. There is also the risk that the additives are perforated during stapling together with the body tissue to be joined, whereby the expected effects can be omitted.

It is also known to coagulate body tissue with RF current (high-frequency current), for example, by the body tissue between two RF electrodes is supplied with an RF current. A corresponding surgical tissue fusion instrument, for example, from DE 10 2010 020 664 A1 known. In order to assist and promote the connection of the body tissue, a disc of a medically acceptable material is provided, which is sandwiched between the tissue sections to be joined when the grasping structures of the tissue fusion instrument are brought together. Potentially problematic in the in the DE 10 2010 020 664 A1 approach described is that the disc during the tissue fusion process, in particular when subjected to a corresponding instrument pressure, dislocate, whereby the material can not fulfill its desired function.

Task and solution

It is therefore an object of the present invention to provide a surgical tissue fusion instrument as well as a surgical tissue fusion kit which allow for improved bonding of biological tissue sections to be joined together. In particular, the tissue fusion instrument and the tissue fusion kit should enable a secure and easier connection of body tissue.

This object is achieved by a surgical tissue fusion instrument according to independent claim 1 and by a surgical tissue fusion kit according to independent claim 22. Preferred embodiments of the tissue fusion instrument are defined in the dependent claims 2 to 21. The wording of all claims is hereby incorporated by express reference into the content of the present specification.

According to a first aspect, the invention relates to a surgical tissue fusion instrument with two relatively movable gripping structures, which are designed for gripping and joining together to be fused biological tissue sections.

At least one of the two gripping structures has a heat generating means. The gripping structure in question can therefore also be used, within the meaning of the present invention, as a carrier for the heat-generating means, i. referred to as a so-called heat generating medium carrier. If the heat generating means is, for example, an electrode, which will be discussed in more detail below, the gripping structure can be referred to as an electrode carrier.

The heat generating agent causes tissue fusion between the biological tissue sections by heat generation.

The surgical tissue fusion instrument is characterized in particular in that the heat generating means and / or at least one of the gripping structures at least partially have a tissue fusion supporting or conveying surface produced by a surface treatment. Alternatively or additionally, a tissue fusion promoting or promoting material is included in pores of the heat generating agent.

The surgical tissue fusion instrument according to the invention preferably provides a material connection between the biological tissue sections without additional mechanical connection means such as staples, threads or the like. Such a surgical tissue fusion instrument is therefore executed in particular without a staple. The compound is thus preferably based exclusively on a denaturation of tissue proteins, in particular collagen. For this purpose, the tissue sections during the Fusion process by the heat generating means or preferably by a plurality, ie at least two heat generating means, which will be discussed in more detail below, heated to temperatures above the denaturation temperature of the tissue proteins and brought together with the intracellular and extracellular matrix in a gelatinous state. After merging the tissue sections, the liquefied tissue cools to a fused mass, causing a secure connection of the tissues.

However, it can also be provided according to the invention, in addition to the heat generating means, for a tissue fusion instrument according to the invention, to provide devices for supplementary introduction of mechanical connection means, in particular staples, in order to support or reinforce the tissue fusion through a staple seam or another mechanical connection seam. Corresponding staples are preferably driven into the tissue sections in a simultaneous or previous or subsequent operation. A tissue fusion instrument according to the invention may have clamping functional areas alternately or parallel to corresponding functional surfaces of the heat generating means, to which memory or magazines for storing the staples are assigned.

Depending on the nature of the tissue fusion supporting or promoting surface or the tissue fusion promoting or promoting material, the tissue fusion performance of the surgical tissue fusion instrument may be positively enhanced in various ways. For example, a positive influence or improvement in the tissue fusion performance can be achieved by avoiding tissue adhesions to the gripping structures, promoting wound healing, increasing the strength of the tissue fusion, improving the electrical or thermal conductivity in the area of heat generation, thermal or electrical insulation in the area outside the heat generation, based on a leveling of the tissue influence and / or on a reduction of the thermal tissue damage.

The term "surface treatment", for the purposes of the present invention, defines a treatment which is suitable for imparting tissue fusion promoting or promoting properties to a surface or for improving already existing tissue fusion promoting or promoting properties of a surface. Suitable treatment methods will be explained in more detail below.

For the purposes of the present invention, the singular term "tissue fusion assisting or promoting material" may comprise not only a tissue fusion promoting or promoting material (singular), but also a variety of different tissue fusion promoting or promoting materials (plural), i. define at least two different tissue fusion promoting or promoting materials, preferably in the form of a mixture. Suitable materials will be explained in more detail below.

According to one embodiment, the heat generating means and / or at least one of the gripping structures only partially has a tissue fusion supporting or conveying surface produced by a surface treatment.

According to an alternative embodiment, the heat generating means and / or at least one of the gripping structures has a continuous, by means of a surface treatment, tissue fusion supporting or conveying surface. In other words, it is preferable in the invention that the surface of the heat generating means and / or at least one of the gripping structures has continuous tissue fusion promoting or promoting properties generated by a surface treatment of the heat generating means and / or at least one of the gripping structures.

The tissue fusion assisting or conveying surface of the heat generating means in a preferred embodiment forms part of an end face of the gripping structure.

Alternatively, the tissue fusion assisting or promoting surface of the heat generating means may define an end face of the gripping structure.

In a further embodiment, the tissue fusion supporting or conveying surface of the gripping structure forms a part, in particular a heat generating agent-free part, of an end face of the gripping structure.

Alternatively it can be provided that the tissue fusion supporting or conveying surface of the gripping structure defines a part, in particular a heat generating means free part, of an end face of the gripping structure.

In a preferred embodiment, the tissue fusion assisting or conveying surface of the heat generating means defines an end face of the gripping structure together with the tissue fusion assisting or conveying surface of the grasping structure.

In a further embodiment, the tissue fusion supporting or conveying surface of the gripping structure is a gripping structure surface which is formed outside an end face of the gripping structure.

In a further embodiment, the tissue fusion supporting or conveying surface of the gripping structure is a part of an end face of the gripping structure and a surface outside the end face.

The end face mentioned in the previous embodiments may also be referred to as the contact surface of the gripping structure, which is preferably provided for gripping and bringing together the biological tissue sections to be fused together.

Furthermore, the end face mentioned in the previous embodiments may be (substantially) strip-shaped, (substantially) U-shaped or (substantially) circular-ring-shaped.

The end face mentioned in the previous embodiments may be planar, i. feather-free, or uneven, i. with projections or projections, be formed. For example, the end face may already have protrusions or protrusions of 0.2 mm to 1 mm as a result of heat generation.

Preferably, the heat generating means is associated with the end face mentioned in the previous embodiments. The heat-applying means can be integrated in particular in the end face.

In a particularly preferred embodiment, both gripping structures each have a heat generating means, wherein the heat generating means each cause a tissue fusion between the biological tissue sections by heat generation and each have at least partially produced by a surface treatment, tissue fusion-supporting or -fördernde surface. The gripping structures can therefore also be used in the context of the present invention as a carrier for the heat generating means, i. be referred to as so-called heat source carrier. If the heat generating means are, for example, electrodes, which will be discussed in more detail below, the gripping structures may be referred to as electrode carriers.

According to the invention, provision can furthermore be made for the heat-generating means to each have only partially a tissue-fusion-supporting or -promoting surface produced by a surface treatment.

Alternatively, it may be provided according to the invention that the heat generating means each have a surface produced by a surface treatment, tissue fusion supporting or -fördernde surface. In other words, according to the present invention, it may be provided that the surfaces of the heat generating means each have continuous tissue fusion promoting or promoting properties generated by a surface treatment of the heat generating means.

In a preferred embodiment, the tissue fusion supporting or conveying surfaces of the heat generating means each form part of an end face of the gripping structures.

Alternatively, the tissue fusion assisting or conveying surfaces of the heat generating means may respectively define an end face of the gripping structures.

According to the invention, it can further be provided that both gripping structures each only partially have a tissue fusion supporting or conveying surface produced by a surface treatment.

Alternatively, it can be provided according to the invention that both gripping structures each have a surface produced by a surface treatment, tissue fusion supporting or -fördernden surface. In other words, it may be provided according to the invention that the surfaces of the gripping structures each have continuous tissue fusion-supporting or -fördernde properties, which are generated by a surface treatment of the gripping structures.

In a further embodiment, the tissue fusion supporting or conveying surfaces of the gripping structures each form part of an end face of the gripping structures.

Alternatively, the tissue fusion assisting or conveying surfaces of the grasping structures may each define an end face of the grasping structures.

In a further embodiment, end faces of the gripping structures are respectively defined by a tissue fusion-supporting or -promoting surface of the heat-generating means and by a tissue fusion-supporting or -promoting and preferably heat-generating-agent-free surface of the gripping structures.

The end surfaces mentioned in the previous embodiments may also be referred to as contact surfaces of the gripping structures, which are preferably provided for gripping and merging the biological tissue sections to be fused together.

The end surfaces mentioned in the previous embodiments are preferably facing each other. In other words, it is preferred according to the invention if the gripping structures of the surgical tissue fusion instrument have mutually facing end faces. Particularly preferably, each end face is assigned a heat generating means. Particularly preferably, a heat generating means is integrated in each end face.

The end faces mentioned in the previous embodiments can furthermore each be (substantially) strip-shaped, (substantially) U-shaped or (substantially) circular-shaped.

The end surfaces mentioned in the previous embodiments may be planar, i. feather-free, or uneven, i. with projections or projections, be formed. For example, the end surfaces may already have heat-generating projections or protrusions of 0.2 mm to 1 mm.

In a further embodiment, both gripping structures each comprise a heat generating means, wherein a tissue fusion supporting or promoting material is contained in pores of each heat generating means.

According to a particularly preferred embodiment, the tissue fusion assisting or conveying surface of the heat generating means / means and / or the gripping structure (s) is a surface of a coating of the heat generating means / means and / or the gripping structure (s). According to the invention, it can be provided that the heat generating means / the heat generating means and / or the gripping structure / the gripping structures at least partially, in particular only partially, or completely, i. continuous or full surface, are provided with the coating.

The term "coating" for the purposes of the present invention defines a layer which is applied to an untreated surface of the heat generating means / the heat generating means and / or the gripping structure / the gripping structures. The term "untreated surface" in this context means a surface of the heat generating means / means and / or the gripping structure / gripping structures which has not been subjected to any surface treatment, in particular for the purpose of forming or improving tissue fusion promoting or promoting properties.

The coating is preferably bonded to the heat generating means / the heat generating means and / or the gripping structure / gripping structures.

In particular, the coating may be covalent, i. via atomic bonds, or non-covalently, for example via van der Waals forces, dipole-dipole interactions and / or hydrogen bonds, to the heat generating means / means and / or the gripping structure (s).

The coating may furthermore have a layer thickness of 5 μm to 500 μm, in particular 10 μm to 250 μm, preferably 10 μm to 200 μm.

The coating can furthermore be porous, in particular open-pored.

The coating may, for example, pores having a mean pore diameter of 5 .mu.m to 1 mm, in particular 10 .mu.m to 0.2 mm.

In a preferred embodiment, the coating comprises a tissue fusion promoting or promoting material.

The tissue-supporting or -fördernden material may in particular be an additive or an additive of the coating.

In a further embodiment, the tissue-fusion-supporting or -fördernde material, preferably as an additive or additive, contained in pores of the coating.

In another embodiment, the tissue fusion promoting or promoting material is in particulate form. The tissue fusion supporting or promoting material may, for example, have an average particle diameter of 10 μm to 2 mm, in particular 50 μm to 1 mm, preferably 100 μm to 0.5 mm.

In a further embodiment, the coating, preferably exclusively, is formed from a tissue fusion promoting or promoting material.

The tissue fusion promoting or promoting material may be basically resorbable, partially absorbable or non-resorbable.

In a preferred embodiment, the tissue fusion assisting or promoting material is selected from the group consisting of metal, ceramics, salt such as inorganic salt, wax, fat, fatty acid, alcohol, synthetic polymer, biopolymer (naturally occurring polymer), technical biopolymer (industrially produced biopolymer). , Protein, extracellular protein, serum protein, glycoprotein, polyamino acid, polyhomoamino acid, polyheteroamino acid, oligopeptide, amino acid, polysaccharide, mucopolysaccharide, oligosaccharide, monosaccharide, lipid, glycolipid, medicament, medicinal agent, growth factor, cyanoacrylate, and mixtures thereof.

The metal may be selected from the group consisting of magnesium, titanium, zirconium, tantalum, copper, silver, gold, chromium, hard chrome, and alloys thereof.

The ceramic may be selected from the group comprising calcium phosphate, hydroxyapatite, alumina, titanium nitride and mixtures thereof.

The salt may be selected from the group comprising alkali metal halide, alkaline earth metal halide, phosphate, alkali metal phosphate, alkaline earth metal phosphate and mixtures thereof.

In particular, the salt may be selected from the group comprising sodium chloride, potassium chloride, barium chloride, magnesium chloride, calcium chloride, sodium phosphate, potassium phosphate, barium phosphate, magnesium phosphate, calcium phosphate, mixed phosphates thereof, and mixtures thereof.

The synthetic polymer may in principle be a resorbable polymer or non-absorbable polymer. A preferred resorbable polymer may be selected, for example, from the group comprising polyglycolide, polylactide, polytrimethylene carbonate, poly-ε-caprolactone, poly-3-hydroxybutyrate, poly-4-hydroxybutyrate, poly-5-hydroxybutyrate, poly-6-hydroxybutyrate and mixtures thereof , A preferred non-resorbable polymer is a fluorochemical, especially perfluorinated, polymer such as polytetrafluoroethylene.

The protein may be selected from the group comprising collagen, gelatin, elastin, reticulin, laminin, fibronectin, fibrillin, albumin, derivatives thereof, peptide fragments thereof, subunits thereof, and mixtures thereof.

In particular, the protein may be collagen selected from the group consisting of Type I collagen, Type II collagen, Type III collagen, Type VI collagen, derivatives thereof, peptide fragments thereof, subunits thereof, and mixtures thereof.

The polysaccharide may be selected from the group comprising starch, modified starch, amylose, amylopectin, dextran, hyaluronic acid, heparin, heparan sulfate, chondroitin 4-sulfate, chondroitin 6-sulfate, dermatan sulfate, keratan sulfate, derivatives thereof, and mixtures thereof.

The drug may be selected from the group consisting of antibiotic, cytostatic, anticonvulsant, antiplatelet, anticoagulant, hormone, gastrointestinal, local anesthetic, antihypertensive, antiphlogistic, analgesic, and mixtures thereof.

The medicinal or pharmaceutical active substance may be selected from the group consisting of antimicrobial, in particular antibiotic, active ingredient, haemostatic agent (hemostyptic), anti-inflammatory agent, wound healing agent, analgesic agent, growth-stimulating agent and mixtures thereof.

The antimicrobial agent may be selected from the group consisting of silver, silver salt, antibiotic, polyhexamethylene biguanide and mixtures thereof.

The growth factor may be selected from the group comprising fibroblast growth factor (FGF), transforming growth factor (TGF), platelet-derived growth factor (PDGF), epidermal growth factor (EGF), GMCSF (Granulocyte-macrophage colony stimulating factor), vascular endothelial growth factor (VEGF), insulin-like growth factor (IGF), hepatocyte growth factor (HGF), interleukin, nerve growth factor (NGF, Nerve Growth Factor), hematopoietic growth factor and mixtures thereof.

In an embodiment which is advantageous under antiadhesive aspects, the tissue fusion promoting or promoting material is an antiadhesive material, ie a so-called anti-adhesive agent. The anti-adhesive material can be present as a solid and its anti-adhesive effect only when liquefied as a result of heat generation by the heat generating agent (s).

The anti-adhesive material is preferably selected from the group comprising fluorine-containing, in particular perfluorinated, polymer and release agent. The anti-adhesive material may be, for example, polytetrafluoroethylene or, alternatively, a release agent, preferably a lubricant, especially a silicone-containing or fluoropolymer-containing lubricant. A suitable fluoropolymer-containing lubricant is commercially available, for example under the name Electrolube ^®.

In an embodiment which is advantageous in terms of tissue fusion strength and / or tissue fusion sealing, the tissue fusion promoting or promoting material is a surgical tissue adhesive. The surgical tissue adhesive can be present as a solid and show its adhesive effect only when liquefied due to heat generation by the heat generating means / the heat generating means. The surgical tissue adhesive may be selected from the group comprising cyanoacrylate adhesive, fibrin glue and mixtures thereof. Preferably, the surgical adhesive is N-butyl cyanoacrylate or a N-butyl cyanoacrylate-containing tissue adhesive.

In a further embodiment, the tissue fusion promoting or promoting material is a heat generating and / or tissue injecting material preferably selected from the group consisting of collagen, gelatin, elastin, reticuline, laminin, fibronectin, fibrillin, albumin, derivatives thereof, Peptide fragments thereof, subunits thereof, and mixtures thereof. The collagen may be selected from the group consisting of Type I collagen, Type II collagen, Type III collagen, Type VI collagen, derivatives thereof, peptide fragments thereof, subunits thereof, and mixtures thereof.

In an embodiment which is advantageous in terms of conductivity, the tissue-fusion-promoting or promoting material is a salt, preferably an inorganic salt. For example, the tissue fusion assisting or promoting material may be selected from the group consisting of alkali metal halide, alkaline earth metal halide, phosphate, alkali metal phosphate, alkaline earth metal phosphate, and mixtures thereof. In particular, the tissue fusion promoting or promoting material may be selected from the group consisting of sodium chloride, potassium chloride, barium chloride, magnesium chloride, calcium chloride, sodium phosphate, potassium phosphate, barium phosphate, magnesium phosphate, calcium phosphate, mixed phosphates thereof, and mixtures thereof.

In a further embodiment, the aforementioned coating is a solid coating, in particular a powder or plasma coating.

In a further embodiment, the coating is a spray coating.

In a further embodiment, the coating is a gel-like, in particular hydrogel-shaped, coating.

In a further embodiment, the coating is in lyophilized or freeze-dried form.

In another embodiment, the coating is a protein coating or proteinaceous coating. With regard to suitable proteins, reference is made to the previous description.

In another embodiment, the coating is a polysaccharide coating or polysaccharide-containing coating. With regard to suitable polysaccharides, reference is made to the previous description.

In a further embodiment, the coating is a polymer coating or polymer-containing coating. Preferably, the coating is a polytetrafluoroethylene coating or polytetrafluoroethylene-containing coating.

In a further embodiment, the coating is a metal coating or metal-containing coating. For example, the coating may be selected from the group consisting of titanium coating, titanium-containing coating, hard chrome coating, hard chrome-containing coating, gold coating and gold-containing coating.

In a further embodiment, the tissue fusion supporting or promoting material is contained in pores of a metal coating, in particular a titanium coating, preferably a microporous titanium coating.

The surface treatment in another embodiment is selected from the group consisting of wetting, spraying, dipping, pressing, embossing, rolling, and brushing.

In an alternative embodiment, the surface treatment is a chemical vapor deposition. The chemical vapor deposition is preferably selected from the group comprising plasma enhanced chemical vapor deposition, hot wire activated vapor deposition, chemical vapor deposition at low pressure, chemical vapor deposition at atmospheric pressure and metalorganic chemical vapor deposition.

In an alternative embodiment, the surface treatment is a physical vapor deposition. The physical vapor deposition is preferably selected from the group consisting of thermal evaporation, electron beam evaporation, laser beam evaporation, arc evaporation, molecular beam epitaxy, sputtering, ion beam assisted deposition, ion plating, and ion-assisted physical vapor deposition.

The heat generating means / heat generating means is / are preferably formed as a heat introducing means.

The heat generating means / heat generating means may basically be an electrode or electrode arrangement / electrodes or electrode arrangements, in particular high-frequency electrode (HF electrode) or high-frequency electrode arrangement (HF electrode arrangement) / high-frequency electrodes (HF electrodes) or high-frequency electrodes. Electrode arrangements (RF electrode arrangements) or radio-frequency electrode (RF electrode) or radio-frequency electrode arrangement (RF electrode arrangement) / radio-frequency electrodes (RF electrodes) or radio-frequency electrode arrangements (RF electrode arrangements), a laser or a laser arrangement / laser or laser arrays, a sonotrode or sonotrode arrangement / sonotrodes or sonotrode arrangements, a microwave generator / microwave generators or a resistance heating element / resistance heating elements such as cautery.

It is particularly preferable according to the invention for the heat generating means / the heat generating means to be designed as an electrode or electrode arrangement / electrodes or electrode arrangements. The electrode (s) may be configured as strip-shaped electrode (s), horseshoe-shaped electrode (s), or ring electrode (s). The electrode (s) can in particular be subdivided into electrode segments, in particular into strip-shaped, horseshoe-shaped or ring-shaped electrode segments. The electrode (s) is preferably an HF electrode / HF electrodes.

The surgical tissue fusion instrument is designed in a further embodiment as a linear tissue fusion instrument. The tissue fusion instrument preferably has two forceps-like gripping structures, which cause a linear clamping of the corresponding biological tissue sections as soon as the tissue fusion instrument is closed by merging the gripping structures. Between the gripping structures, the biological tissue sections in this embodiment are connected together along a linear junction.

In an alternative embodiment, the surgical tissue fusion instrument is configured as a circular tissue fusion instrument. Such a tissue fusion instrument is intended to connect biological tissue sections in the form of hollow organ sections, i. to merge. The tissue fusion instrument preferably has a gripping structure in the form of a base part and a gripping structure in the form of an anvil part, which effect a circular clamping of the hollow organ sections as soon as the tissue fusion instrument is closed by merging the gripping structures. Between the gripping structures, the biological tissue sections in this embodiment are connected together along a circular junction.

In a second aspect, the invention relates to a surgical tissue fusion kit.

The surgical tissue fusion kit includes a surgical tissue fusion instrument having two relatively movable gripping structures configured to grip and merge biological tissue sections to be fused together, and a tissue fusion promoting or promotional material that is in a sprayable form.

At least one of the two gripping structures has a heat generating means, which causes a fusion between the biological tissue sections by heat generation.

The fabric-fusion-supporting or -fördernde material is intended to be sprayed onto the heat generating means and / or at least one of the two gripping structures, in particular an end face of one of the two gripping structures.

In a preferred embodiment, the gripping structures each have a heat generating means. The heat generating means are thereby preferably associated with each other facing end faces of the gripping structures. In particular, the heat generating means may be integrated in mutually facing end faces of the gripping structures. In this embodiment, the fabric-fusion-supporting or -fördernde material may be provided in particular to be sprayed on both heat generating means and / or both gripping structures, in particular on facing end faces of the gripping structures.

The tissue fusion promoting or promoting material is preferably an anti-adhesive material, ie, an anti-adhesion agent. The anti-adhesion agent may in particular be a fluorine-containing, in particular perfluorinated, polymer, such as, for example, polytetrafluoroethylene, or a release agent or lubricant, in particular a silicone-containing or fluoropolymer-containing release agent or lubricant. A suitable fluoropolymer-containing lubricant is commercially available, for example under the name Electrolube ^®.

With regard to further features and advantages of the kit according to the invention, in particular of the heat generating means and of the tissue fusion supporting or conveying material, reference is made to avoid repetition to the statements made in the context of the first aspect of the invention.

Further advantages and features of the invention will become apparent from the claims and from the following description of preferred embodiments of the invention, which are illustrated by the drawings.

The figures show schematically the following:

1 FIG. 1 shows a linear embodiment of an embodiment of a surgical tissue fusion instrument according to the invention, FIG.

2 : An enlarged plan view of an end face of the lower gripping structure of the tissue fusion instrument 1 .

3 : An enlarged plan view of an end face of the lower gripping structure of the tissue fusion instrument 1 with a segmented electrode,

4 FIG. 1 shows a circular embodiment of a surgical tissue fusion instrument according to the invention. FIG

5 in an enlarged view a head region of the tissue fusion instrument 4 in open position and

6 : An enlarged plan view of an end face of the lower gripping structure of the tissue fusion instrument 4 and 5 with a segmented electrode.

A surgical tissue fusion instrument 100 according to 1 is intended to connect biological tissue sections, preferably without additional mechanical connection means by merging, clamping and heat generation, ie to fuse. The surgical tissue fusion instrument 100 according to 1 is designed as a linear tissue fusion instrument. The tissue fusion instrument 100 is denoted by a reference numeral 104 indicated power cable supplied with power. The linear tissue fusion instrument 100 has two relatively movable gripping structures 110 . 130 on, of which a lower gripping structure 110 stationary, ie stationary, relative to a base part 115 of the tissue fusion instrument 100 is held. In the 1 shown upper gripping structure 130 is at a relative to the base part 105 liftable top 135 arranged so that the two gripping structures 110 . 130 in the vertical direction relative to each other linearly to each other or can be moved away from each other. The gripping structures 110 . 130 therefore cause a linear clamping of the corresponding biological tissue sections as soon as the tissue fusion instrument 100 by merging the gripping structures 110 . 130 closed is. Between the gripping structures 110 . 130 biological tissue sections are interconnected along a linear junction.

The gripping structures 110 . 130 each have an end face 111 . 131 and an electrode 114 . 134 on. The faces 111 . 131 are facing each other and form contact surfaces for gripping and merging biological tissue sections to be joined together. The electrodes 114 . 134 are identical and (essentially) U-shaped. The electrode surfaces each form part of the end surfaces 111 . 131 ,

The electrodes 114 . 134 are electrically energized to generate heat in the biological tissue sections in the region of the joint, in particular to introduce a heat input into the biological tissue sections in the region of the joint. Heat generation via the electrodes 114 . 134 causes the desired tissue fusion. The electrodes 114 . 134 are preferably designed as HF electrodes (high-frequency electrodes).

To avoid tissue adhesion, the electrode surfaces are provided with an anti-adhesive coating, for example made of polytetrafluoroethylene. Such a coating is in the 2 with the reference number 140 Mistake. The surface 142 the coating 140 defines a tissue fusion supporting or promoting surface in the sense of the present invention. Additionally or alternatively, electrode-free regions 118 . 138 the faces 111 . 131 be provided with such a coating (not shown).

The electrodes 114 . 134 can be subdivided in particular into electrode segments. A corresponding structure of the electrodes 114 . 134 will be exemplified in connection with 3 by the electrode 114 described in more detail.

The electrode 114 For example, total 30 electrode segments 120 in each case 15 Electrode segments offset from each other in two rows of electrodes 122 . 124 parallel to each other along each electrode section 126 arranged and electrically isolated from each other. The electrode segments 120 are straight and strip-shaped. The electrode segments 120 form an electrode surface 116 , The electrode segments 120 define an electrode centerline between them 127 that is the shape of the electrode 114 is also U-shaped accordingly. In the area of the electrode section 128 are two more electrode segments 121 arranged, each row of electrodes 122 respectively. 124 the electrode sections 126 to complete. The electrode segments 120 and 121 are thus in one of the electrode centerline 127 defined direction offset from each other.

Around the electrode segments 120 . 121 be subjected to a current, they are each electrically conductive with a corresponding power connector in the proximal end of the gripping structures 110 . 130 arranged. The power connections can be connected to a power generator using appropriate connection cables or cables.

After merging the gripping structures 110 . 130 are due to the identical formation of the electrodes 114 . 134 equal or substantially equal sized electrode segments 120 respectively. 121 opposite each other and point towards each other. They form a whole pair of electrode segments. Overall, the tissue fusion instrument in this embodiment thus comprises 32 electrode segment pairs.

The electrode segments 120 . 121 form part of the face 111 , The electrode segments are preferred 120 . 121 in the face 111 integrated.

To avoid tissue adhesions in this embodiment, the surfaces of the electrode segments 120 . 121 with an anti-adhesive coating 140 For example, from polytetrafluoroethylene, provided. The surface 142 the coating 140 defines a tissue fusion supporting or promoting surface in the sense of the present invention. Such a coating is in the 3 also with the reference numeral 140 Mistake. Additionally or alternatively, electrode-free regions 118 the face 111 be provided with such a coating (not shown).

It is understood that the surfaces of the electrodes 114 . 134 and / or the electrode-free areas 118 . 138 may also be coated with another tissue fusion supporting or promoting material. In that regard, reference is made to the statements made in the general description.

A surgical tissue fusion instrument 200 according to the 4 is like the previously described tissue fusion instrument 100 intended to connect biological tissue sections, preferably without additional mechanical connection means by merging, clamping and heat generation, ie to fuse. The surgical tissue fusion instrument 200 according to 4 is designed as a circular tissue fusion instrument, which can connect biological tissue sections in the form of hollow organs with each other.

The surgical tissue fusion instrument 200 is preferably intended for carrying end-to-end anastomoses. The tissue fusion instrument 200 has an unspecified grip area, which is for operation of the tissue fusion instrument 200 is graspable by hand. The grip area is an actuating handle 205 associated with activation and control of the tissue fusion instrument 200 allows. The tissue fusion instrument 200 is denoted by a reference numeral 204 indicated power cable supplied with power. From the grip area, a head area of the tissue fusion instrument protrudes over an elongated neck 200 from which a gripping structure 210 in the form of a base part and a gripping structure 230 in the form of an anvil part. The anvil part 230 is by means of an anvil shaft 236 coaxial with a central longitudinal axis M of the neck of the head portion in the base part 210 mounted longitudinally displaceable. By means of a drive system, not shown, is the anvil part 230 along the central longitudinal axis M between a Opening position according to 5 and a closed position according to 4 relative to the base part 210 traversable.

The base part 210 and the anvil part 230 each have an end faces 211 . 231 and an electrode 214 . 234 on. The faces 211 . 231 are facing each other and form contact surfaces for gripping and merging biological tissue sections to be joined together. The electrodes 214 . 234 are identical and (essentially) circular. The surfaces of the electrodes 214 . 234 each form part of the faces 211 . 231 ,

The electrodes 214 . 234 serve to be electrically applied and so to generate heat via current heat in the biological tissue sections in the region of the junction, in particular to introduce a heat input to the biological tissue sections to be joined together. The between the front surfaces 211 . 231 In the closed position defined contact area is referred to as a connection area or as a connection point for the tissue sections. The electrodes 214 . 234 allow focused and directed heat generation within the joint region, in particular a focused and directed heat input into the tissue sections to be joined together, thereby effecting the desired tissue fusion between the tissue sections.

The electrodes 214 . 234 are preferably designed as HF electrodes (high-frequency electrodes).

Furthermore, the electrodes 214 . 234 preferably subdivided into electrode segments. The structure of the electrodes 214 . 234 will be exemplified in connection with 6 by the electrode 214 described in more detail.

The electrode 214 For example, in four electrode segments 220 be divided, which are electrically isolated from each other. The electrode segments 220 are strip-shaped or substantially strip-shaped. The four electrode segments 220 define two electrode rows 222 . 224 , Each electrode row in each case comprises a part of the four electrode segments 220 , In this case, each electrode segment 220 a first electrode segment section 223 on which a part of the first electrode row 222 forms, and a second electrode segment section 225 which forms part of the second electrode row 224 forms. The two electrode rows 222 . 224 are curved overall, wherein the electrode segment sections 223 . 225 each define electrically conductive circular ring sections. Overall, the two rows of electrodes 222 . 224 passing through each four electrode segment sections 223 respectively. 225 be defined, closed in a ring-shaped. Around the electrode segments 220 to be able to contact in the desired manner is each electrode segment 220 with a connection contact 226 electrically connected, which in a connection region between the electrode segment sections 223 . 225 is arranged.

The electrode segments 220 form part of the face 211 the gripping structure 210 , The electrode segments are preferred 220 in the face 211 integrated.

To reduce the generation of heat and to equalize the tissue influence are the electrode segments 220 with a heat-generating and fabric-in-fl uencing coating 240 , for example made of collagen. The surface 242 the coating 240 defines a tissue fusion supporting or promoting surface in the sense of the present invention. Additionally or alternatively, electrode-free regions 218 the face 211 be provided with such a coating (not shown).

It is understood that the surfaces of the electrodes 214 . 234 and / or electrode-free areas of the end faces 211 . 231 may also be coated with another tissue fusion supporting or promoting material. In that regard, reference is made to the statements made in the general description.

QUOTES INCLUDE IN THE DESCRIPTION

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Cited patent literature

• DE 102010020664 A1 [0005, 0005]

Claims (22)

Surgical tissue fusion instrument ( 100 ; 200 ) with two relatively movable gripping structures ( 110 ; 130 ; 210 ; 230 ), which are designed for gripping and merging biological tissue sections to be fused together, wherein at least one gripping structure ( 110 ; 130 ; 210 ; 230 ) a heat generating agent ( 114 ; 134 ; 214 ; 234 ), which causes tissue fusion between the biological tissue sections by heat generation, characterized in that the heat generating means ( 114 ; 134 ; 214 ; 234 ) and / or at least one of the gripping structures ( 110 ; 130 ; 210 ; 230 ) at least partially comprise a surface-treated, tissue fusion supporting or promoting surface, and / or a tissue fusion promoting or promoting material in pores of the heat generation agent ( 114 ; 134 ; 214 ; 234 ) is included. Surgical tissue fusion instrument ( 100 ; 200 ) according to claim 1, characterized in that the tissue fusion supporting or conveying surface of the heat generating means ( 114 ; 134 ; 214 ; 234 ) a part of an end face ( 111 ; 131 ; 211 ; 231 ) of the gripping structure ( 110 ; 130 ; 210 ; 230 ). Surgical tissue fusion instrument ( 100 ; 200 ) according to claim 1 or 2, characterized in that the tissue fusion supporting or conveying surface of the gripping structure ( 110 ; 130 ; 210 ; 230 ) a part of an end face ( 111 ; 131 ; 211 ; 231 ) of the gripping structure ( 110 ; 130 ; 210 ; 230 ). Surgical tissue fusion instrument ( 100 ; 200 ) according to one of the preceding claims, characterized in that, in the tissue fusion supporting or conveying surface of the gripping structure ( 110 ; 130 ; 210 ; 230 ) around a surface outside of an end face ( 111 ; 131 ; 211 ; 231 ) of the gripping structure ( 110 ; 130 ; 210 ; 230 ). Surgical tissue fusion instrument ( 100 ; 200 ) according to one of the preceding claims, characterized in that both gripping structures ( 110 ; 130 ; 210 ; 230 ) each a heat generating means ( 114 ; 134 ; 214 ; 234 ), which causes tissue fusion between the biological tissue sections by heat generation, wherein the heat generating means ( 114 ; 134 ; 214 ; 234 ) each have at least partially a tissue fusion supporting or promoting surface produced by a surface treatment. Surgical tissue fusion instrument ( 100 ; 200 ) according to one of the preceding claims, characterized in that both gripping structures ( 110 ; 130 ; 210 ; 230 ) each have at least partially a tissue fusion supporting or promoting surface produced by a surface treatment. Surgical tissue fusion instrument ( 100 ; 200 ) according to one of the preceding claims, characterized in that both gripping structures ( 110 ; 130 ; 210 ; 230 ) each a heat generating means ( 114 ; 134 ; 214 ; 234 ), wherein a tissue fusion promoting or promoting material in pores of each heat generating agent ( 114 ; 134 ; 214 ; 234 ) is included. Surgical tissue fusion instrument ( 100 ; 200 ) According to one of the preceding claims, characterized in that it is in tissue fusion promoting or -fördernden surface (the surface of a coating 140 ; 240 ) of the heat generating agent ( 114 ; 134 ; 214 ; 234 ) / the heat generating agent ( 114 ; 134 ; 214 ; 234 ) and / or the gripping structure ( 110 ; 130 ; 210 ; 230 ) / the gripping structures ( 110 ; 130 ; 210 ; 230 ). Surgical tissue fusion instrument ( 100 ; 200 ) according to claim 8, characterized in that the coating ( 140 ; 240 ) comprises a tissue fusion promoting or promoting material. Surgical tissue fusion instrument ( 100 ; 200 ) according to claim 9, characterized in that the fabric-supporting or -fördernden material to an additive or an additive of the coating ( 140 ; 240 ), which preferably in pores of the coating ( 140 ; 240 ) is included. Surgical tissue fusion instrument ( 100 ; 200 ) according to any one of claims 8 to 10, characterized in that the tissue fusion promoting or promoting material is selected from the group consisting of metal, ceramics, salt such as inorganic salt, wax, fat, fatty acid, alcohol, synthetic polymer, biopolymer, technical biopolymer, Protein, extracellular protein, serum protein, glycoprotein, polyamino acid, polyhomoamino acid, polyheteroamino acid, oligopeptide, amino acid, polysaccharide, mucopolysaccharide, oligosaccharide, monosaccharide, lipid, glycolipid, medicament, medicinal agent, growth factor cyanoacrylate and mixtures thereof. Surgical tissue fusion instrument ( 100 ; 200 ) according to one of claims 8 to 11, characterized in that it is the tissue fusion-supporting or -fördernden material to an anti-adhesive, preferably polytetrafluoroethylene or a lubricant, in particular silicone or fluoropolymer-containing lubricant. Surgical tissue fusion instrument ( 100 ; 200 ) according to any one of claims 8 to 12, characterized in that the tissue fusion promoting or promoting material is a surgical tissue adhesive, preferably N-butyl cyanoacrylate. Surgical tissue fusion instrument ( 100 ; 200 ) according to any one of claims 8 to 13, characterized in that the tissue fusion promoting or promoting material is a heat-generating and / or tissue-inflating material which is preferably selected from the group comprising collagen, gelatin, elastin, reticulin, laminin, Fibronectin, fibrillin, albumin, derivatives thereof, peptide fragments thereof, subunits thereof, and mixtures thereof. Surgical tissue fusion instrument ( 100 ; 200 ) according to any one of claims 8 to 14, characterized in that the tissue fusion promoting or promoting material is a salt which is in particular selected from the group comprising alkali metal halide, alkaline earth metal halide, phosphate, alkali metal phosphate, alkaline earth metal phosphate and mixtures thereof. Surgical tissue fusion instrument ( 100 ; 200 ) according to one of claims 8 to 15, characterized in that the coating is a solid coating, in particular a powder or plasma coating. Surgical tissue fusion instrument ( 100 ; 200 ) according to one of claims 8 to 16, characterized in that the coating is selected from the group comprising polytetrafluoroethylene coating, titanium coating, hard chrome coating and gold coating. Surgical tissue fusion instrument ( 100 ; 200 ) according to one of the preceding claims, characterized in that the surface treatment is selected from the group comprising wetting, spraying, dipping, pressing, embossing, rolling and brushing. Surgical tissue fusion instrument ( 100 ; 200 ) according to one of the preceding claims, characterized in that the surface treatment is a chemical vapor deposition, which is preferably selected from the group comprising plasma enhanced chemical vapor deposition, hot wire activated vapor deposition, chemical vapor deposition at low pressure, chemical vapor deposition at atmospheric pressure and metalorganic chemical vapor deposition , Surgical tissue fusion instrument ( 100 ; 200 ) according to one of claims 1 to 17, characterized in that the surface treatment is a physical vapor deposition, which is preferably selected from the group consisting of thermal evaporation, electron beam evaporation, laser beam evaporation, arc evaporation, molecular beam epitaxy, sputtering, ion beam deposition, ion plating and Ion-assisted physical vapor deposition method. Surgical tissue fusion instrument ( 100 ; 200 ) according to one of the preceding claims, characterized in that the heat generating means ( 114 ; 134 ; 214 ; 234 ) / the heat generating means ( 114 ; 134 ; 214 ; 234 ) is designed as an electrode / electrodes, preferably as an RF electrode / RF electrodes, is / are. Surgical tissue fusion kit comprising a surgical tissue fusion instrument ( 100 ; 200 ) with two relatively movable gripping structures ( 110 ; 130 ; 210 ; 230 ), which are designed for gripping and merging biological tissue sections to be fused together, wherein at least one gripping structure ( 110 ; 130 ; 210 ; 230 ) a heat generating agent ( 114 ; 134 ; 214 ; 234 ), which causes tissue fusion between the biological tissue sections by heat generation, and a tissue fusion promoting or promoting material which is in a sprayable form.

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