DE3607933C2 - - Google Patents
Info
- Publication number
- DE3607933C2 DE3607933C2 DE3607933A DE3607933A DE3607933C2 DE 3607933 C2 DE3607933 C2 DE 3607933C2 DE 3607933 A DE3607933 A DE 3607933A DE 3607933 A DE3607933 A DE 3607933A DE 3607933 C2 DE3607933 C2 DE 3607933C2
- Authority
- DE
- Germany
- Prior art keywords
- outer tube
- inner tube
- wires
- handle
- tube
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
Description
Die vorliegende Erfindung bezieht sich auf einen
Dehnungshalter für Schnittöffnungen für ein Blutgefäß
transplantat, das bei chirurgischen Operationen, insbe
sondere bei der Anastomose, d. h. bei der Vereinigung
von Blut- bzw. Lymphgefäßen oder Nerven untereinander
bzw. bei der operativen Verbindung von Hohlorganen
allgemeiner Art, benutzt wird.
Bisher stützte sich eine Operation, bei der die Anasto
mose eines Blutgefäßes vorgenommen wurde, hauptsächlich
auf die Fingerfertigkeit der Chirurgen im Umgang
mit Pinzette, Nadel und Faden beim Zusammennähen.
Nur ein sogenanntes "Blutgefäßnähgerät", das dazu
dient, Blutgefäße in Längsrichtung zu verbinden,
ist bereits bekannt. Das Gerät dieses Typs kann jedoch
nicht für eine solche Anastomose eines Blutgefäßes
benutzt werden, bei der ein Bypass (eine Umgehung)
zu einer Einschnittöffnung in der Seitenwand genäht
wird.
Bei einer solchen Operation, in der ein Kranzarterien-
Bypass geschaffen wird, der die Kranzarterien durch
ein Venentransplantat verbindet, ist es wesentlich,
daß die zu verbindende Öffnung des Trans
plantats während der Operation offengehalten wird,
um die Operation bei gutem Sehfeld mit dreidimensional
ausgebreiteter Schnittöffnung vorzunehmen. Jedoch
kann es, obwohl der Chirurg versucht, die Schnittöff
nung mit der Pinzette zu öffnen, schwierig sein,
die Öffnung dreidimensional in feststehendem Zustand
zu halten, um ein gutes Sehfeld während der Operation
zu erhalten.
Aus der deutschen Gebrauchsmusterschrift DE-GM 77 36 713
ist zwar bereits ein Dehnungshalter bzw. Gefäßspreizer
bekannt. Dieser Dehnungshalter besteht indes nicht
aus zwei ineinander verschiebbaren Rohren, und es
besteht auch nicht die Möglichkeit, das Gerät einzu
führen, um dann an vorhergesehener Stelle die Spreizung
durchzuführen. Dies bedeutet, daß der Gefäßspreizer
gemäß der Gebrauchsmusterschrift DE-GM 77 36 713 nur in
einem eng begrenzten Umfang eingesetzt werden kann.
Des weiteren ist aus der französischen Patentschrift FR-PS
20 85 427 ein Dehnungshalter bekannt.
Dieser Dehnungshalter bezieht sich eindeutig auf
eine Vorrichtung zur Dehnung des Uterus, der bekanntlich
außerordentlich muskulös und daher weniger verletzbar
ist als das Lumen von Venen. Demgemäß handelt es
sich bei dem vorstehend erwähnten Dehnungshalter
um ein sehr kräftiges, mit Kunststoff überzogenes
Gerät, das nur dazu dient, den Gebärmuttermund zu
öffnen und das dementsprechend auch nur nach zwei
Seiten hin die Dehnung bewirkt. Der Arzt hat somit
ein wesentlich eingeschränkteres Sichtfeld, als wenn
eine dreidimensionale offengehaltene Öffnung vorliegen
würde.
Aufgabe der vorliegenden Erfindung ist es, ein Instru
ment zu schaffen, das in Einschnittöffnungen, z. B.
Blutgefäßtransplantaten oder in das Lumen eines Venen
transplantats eingeführt werden kann, um diese auszu
dehnen und offenzuhalten, ohne sie zu verletzen,
wobei die Ausdehnung dreidimensional erfolgt.
Die Lösung der vorstehend geschilderten Aufgaben
wird durch die Merkmale des kennzeichnenden Teils
des Patentanspruchs verwirklicht.
Die vorliegende Erfindung beschreibt einen Dehnungs
halter für Schnittöffnungen zum Gebrauch bei chirur
gischen Operationen wie z. B. der Anastomose eines
Blutgefäßtransplantats. Er besteht aus einem äußeren
Rohr, das in das Lumen eines Blutgefäßtransplantats
eingeführt werden kann, aus einem inneren Rohr, das
verschiebbar in das äußere Rohr eingelagert ist,
und aus einem Griff, der an einem Ende des inneren
Rohres befestigt ist. Das innere Rohr besitzt mehrere
Drähte, die mit einem Ende an einem Ende des inneren
Rohres befestigt und in dem äußeren Rohr untergebracht
sind. Jeder Draht besitzt Federkraft, z. B. in
Form einer Ausbildung als Feder, um das Blutgefäß
transplantat vom Lumen her auszudehen, wenn er aus
seinem zusammengedrückten Zustand in dem äußeren
Rohr befreit wird, dadurch daß man den Griff betätigt
und das innere Rohr innerhalb des äußeren Rohres
verschiebt, um die Drähte herauszuschnellen. So kann
der Dehnungshalter für Schnittöffnungen, der gemäß
der Erfindung ein schmales äußeres Rohr besitzt,
im Falle einer Kranzarterien-Bypass-Operation, wobei
eine Vene als Transplantat benutzt wird, in das Lumen
eines Blutgefäßes eingeführt werden und, wenn sein
Ende an die Schnittöffnung des Transplantats herange
führt worden ist, das innere Rohr innerhalb des äußeren
Rohres so verschoben werden, daß einige Drähte aus
dem inneren Rohr herausschnellen und sich ausbreiten,
um die Schnittöffnung um mehr als den Durchmesser
des äußeren Rohres auszudehnen.
Um die Drähte in drei Dimensionen auszubreiten, wird
das innere Rohr durch Betätigung des Griffes innerhalb
des äußeren Rohres verschoben, so daß die Drähte
aus dem äußeren Rohr herausschnellen. Jeder Draht
krümmt sich ein wenig in Richtung einer Parallele
zur Mittellinie des Rohres, um zu verhindern, daß
das Lumen des Transplantats verletzt wird.
Der Dehnungshalter für Schnittöffnungen zur Anastomose
gemäß der Erfindung kann leicht und sicher in das
Lumen eines Blutgefäßtransplantats mit einem Durchmesser
von ungefähr 2 bis 6 mm eingeführt werden und kann
das innere Rohr innerhalb des äußeren Rohres in der
Nähe der Schnittöffnung durch Gebrauch eines Griffes
verschieben, wobei gleichzeitig die Drähte heraus
schnellen. Die Drähte, die aus dem äußeren Rohr heraus
schnellen, sind individuell elastisch, um sich drei
dimensional zu öffnen und um die Schnittöffnung in
angemessener Weise auszudehnen. Somit ist die Operation,
die eine akkurate Arbeit mit der Nadel um die Anastomose
öffnung herum voraussetzt, leicht und sicher geworden.
Folglich ist auch eine Anastomoseoperation einer
Seitenwand eines Venentransplantats an der einen
Arterie (Seit-an-Seit-Anastomose) wie eine Kranz
arterien-Bypass-Operation einfach geworden. Nach der
Operation wird das innere Rohr in das äußere Rohr
gezogen, und die Drähte werden wieder in das äußere
Rohr eingepaßt.
Fig. 1 ist eine perspektivische Ansicht, die den
Dehnungshalter für Schnittöffnungen in nicht angewandtem
Zustand gezeigt.
Fig. 2 ist eine perspektivische Ansicht desselben,
wobei die Drähte sich in ausgefahrener Arbeitsstellung
befinden. Die
Fig. 3 bis 5 sind Illustrationen, die ein
Beispiel vom Gebrauch des Dehnungshalters für Schnitt
öffnungen, nämlich bei einer Kranzarterien-Bypass-
Operation, zeigen. Die
Fig. 6 bis 9 sind Draufsichten auf das zerlegte
Gerät, die eine andere Ausführungsform des erfindungs
gemäßen Dehnungshalters zeigen, wobei Fig. 6 eine
Draufsicht auf das äußere Rohr, Fig. 7 eine Draufsicht
auf das innere Rohr, Fig. 8 eine Draufsicht auf
den Griff, teilweise in einer Schnittzeichnung darge
stellt, und Fig. 9 eine Seitenansicht des Griffes
ist.
Fig. 10 ist eine Draufsicht auf das zusammengebaute
Gerät mit herausstehenen Drähten, also in Arbeits
stellung.
Fig. 11 ist eine Seitenansicht desselben.
Die Fig. 1 stellt (1) ein äußeres Rohr, (2) ein
inneres Rohr dar. Das innere Rohr hat fast dieselbe
Länge wie das äußere Rohr und ist verschiebbar in
das äußere Rohr (1) gelagert. Der Durchmesser
des äußeren Rohres beträgt ungefähr 4 mm und seine
Länge ungefähr 150 mm. An einem Ende des inneren
Rohres (2) ist ein Griff (3) befestigt. Der Griff
hat eine solche Größe, daß er im Handteller gehalten
werden kann (vorgeschlagener Durchmesser und Länge
ca. 30 mm bzw. ca. 55 mm). Mehrere Drähte (5) sind
am anderen Ende des inneren Rohres befestigt. Diese
Drähte (5) können in dem äußeren Rohr untergebracht
werden. Sie sind elastisch, um sich in drei Dimensionen
auszudehnen, wenn sie aus dem äußeren Rohr heraus
schnellen bzw. herausgeschoben werden. Diese so ent
stehende Kraft soll die Schnittöffnung des Blutgefäß
transplantats in einem Maße ausdehnen, daß die Operation
erleichtert wird, darf aber natürlich das Blutgefäß
nicht zerreißen. Um der Verletzung des Lumens des
Transplantats vorzubeugen, sind die Drähte ein wenig
in Richtung einer Parallele zur Mittellinie des Rohres
gekrümmt. Zusätzlich soll der abgerundete Teil (6),
vorzugsweise in Kugelform, der am Ende eines jeden
Drahtes (5) angebracht ist, das Lumen des Blutgefäßes
vor Verletzung schützen.
Das innere Rohr (2) ist innerhalb des äußeren Rohres
(1) verschiebbar, und die Drähte, die am Ende des
inneren Rohres befestigt sind, werden dreidimensional
ausgedehnt, wenn sie aus dem äußeren Rohr heraus
schnellen. Das äußere Rohr (1) besitzt eine Einrast
vorrichtung (7) und der Griff (3) eine Sperrvorrich
tung (8). Werden diese beiden (7 und 8) nach dem
Herausschnellen der Drähte ineinandergeschoben, wird
die Drehung des äußeren Rohres verhindert, so daß
ein stabilisierter Gebrauch des Geräts sichergestellt
ist. Ein Beispiel seines Gebrauchs bei einer Kranz
arterien-Bypass-Operation wird in den Fig. 3 bis
5 gezeigt. (9) stellt ein Venentransplantat, (10)
eine Schnittöffnung dar, (11) ist eine erste Anastomose,
(12) stellt einen zweiten zu verbindenden Teil dar,
(13) bezeichnet die Kranzarterie, (14) ist ein Thrombus
(Blutpfropfen) und (15) ein Nähfaden.
Der Dehnungshalter für Schnittöffnungen gemäß der
Erfindung wird, wie in Fig. 3 gezeigt wird, in das
Venentransplantat (9) vom vertikal aufgeschnittenen
Ende her eingeführt. Noch befindet sich das innere
Rohr (2) in einer solchen Stellung, daß die Drähte
in dem äußeren Rohr (1) untergebracht sind. Wenn
das Ende des äußeren Rohres (1) an die Stelle der
Schnittöffnung (10) des Venentransplantats (9) kommt,
wird das innere Rohr (2) verschoben, um die Drähte
(5) aus dem äußeren Rohr zu bringen, um so die Schnitt
öffnung (10) zu erweitern. Folglich kann das Venen
transplantat (9) sowohl an dem ersten zu verbindenden
Teil (11) als auch am zweiten zu verbindenden Teil
(12) angenäht werden und sogar, wenn sich Thromben
(14) in zwei Kranzarterien (13) gebildet haben, kann
eine Bypassoperation leicht mit einem Venentransplantat
erreicht werden.
Die Fig. 6 bis 11 zeigen eine andere Ausführungs
form des Dehnungshalters für Schnittöffnungen gemäß
der Erfindung. Fig. 6 zeigt ein äußeres Rohr (16);
Fig. 7 zeigt ein inneres Rohr (17); die Fig.
8 und 9 zeigen einen Griff (18). Diese Bilder sind
Darstellungen des Geräts in zerlegter Anordnung.
Das innere Rohr (17) ist an seiner Basis (19) in der
Fassung (20) des Griffes (18) befestgt und von dem
äußeren Rohr (16) umschlossen, um das Gerät zu vervoll
ständigen. (21) stellt kurze Drähte dar, die am Ende
des inneren Rohres in 120°-Abständen befestigt sind.
(22) stellt eine Einrastvorrichtung dar, die sich
an dem Griff zugewandten Ende des äußeren Rohres
befindet, und (23) ist eine Sperrvorrichtung am Griff
(18). Wenn die Einrastvorrichtung (22) und die Sperr
vorrichtung (23) ineinandergeschoben werden, wie
in Fig. 10 gezeigt wird, schnellen die Drähte (21),
die an dem inneren Rohr (17) befestigt sind, aus
dem äußeren Rohr (16) und dehnen sich dreidimensional
aus.
Die Länge des äußeren Rohres (16) beträgt ca. 86
bis ca. 206 mm, die des inneren Rohres (17) beträgt
ca. 85 bis 205 mm und die der Drähte (21) beträgt
ca. 10 bis ca. 25 mm. Verschiedene Kombinationen
dieser Einzelteile sind innerhalb der obengenannten
Abmessungsgrenzen möglich. Sie sorgen dafür, daß
die Drähte (21) herausschnellen, wenn das innere
Rohr mit seinem einen Ende (19) in den Griff (18)
eingerastet ist.
Claims (1)
- Dehnungshalter für Schnittöffnungen, insbesondere zur Durchführung einer Anastomose, der aus einem äußeren Rohr (1, 16) besteht, das so ausgebildet ist, daß es in das Lumen eines Blutgefäßtransplantats eingeführt werden kann, sowie einem inneren Rohr (2, 17), das verschiebbar in dem äußeren Rohr (1, 16) eingelagert ist, an dessen einem Ende sich ein Griff (3, 18) befindet, dadurch gekennzeichnet, daß das innere Rohr (2, 17) mehrere, mindestens aber drei, elastische Drähte (5, 21) besitzt, die an dem dem Griff (3, 18) - der eine Sperrvorrichtung (8, 23) und am Ende des äußeren Rohres (1, 16) eine Einrastvor richtung (7, 22) aufweist - gegenüberliegenden Ende des inneren Rohres (2, 17) befestigt und im Ruhezustand in dem äußeren Rohr (1, 16) untergebracht sind und jeder Draht (5, 21) einen abgerundeten (kugelförmigen) Teil (6) an seinem Ende besitzt und jeder Draht (5, 21) ein wenig in Richtung einer Parallele zur Mittelachse des inneren Rohres (2, 17) gekrümmt ist.
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
JP60051352A JPS61209647A (ja) | 1985-03-14 | 1985-03-14 | 血管吻合用の切開口拡開器 |
Publications (2)
Publication Number | Publication Date |
---|---|
DE3607933A1 DE3607933A1 (de) | 1986-09-25 |
DE3607933C2 true DE3607933C2 (de) | 1989-01-26 |
Family
ID=12884533
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
DE19863607933 Granted DE3607933A1 (de) | 1985-03-14 | 1986-03-11 | Dehnungshalter fuer schnittoeffnungen zum gebrauch bei chirurgischen operationen |
Country Status (3)
Country | Link |
---|---|
US (1) | US4654028A (de) |
JP (1) | JPS61209647A (de) |
DE (1) | DE3607933A1 (de) |
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Family Cites Families (11)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
DE7736713U1 (de) * | 1900-01-01 | Aesculap-Werke Ag Vormals Jetter & Scheerer, 7200 Tuttlingen | ||
US2137710A (en) * | 1937-12-13 | 1938-11-22 | Alfred W Anderson | Forceps |
FR2085427A1 (de) * | 1970-04-20 | 1971-12-24 | Soichet Samuel | |
US3858586A (en) * | 1971-03-11 | 1975-01-07 | Martin Lessen | Surgical method and electrode therefor |
DE2326988B2 (de) * | 1973-05-26 | 1977-02-24 | Drägerwerk AG, 2400 Lübeck | Chirurgisches instrument zur sterilisation von frauen durch tubenligatur |
CA1018419A (en) * | 1973-07-04 | 1977-10-04 | Gerald Turp | Instrument for laparoscopic tubal cauterization |
US4174715A (en) * | 1977-03-28 | 1979-11-20 | Hasson Harrith M | Multi-pronged laparoscopy forceps |
US4249533A (en) * | 1977-05-16 | 1981-02-10 | Olympus Optical Co., Ltd. | Laser knife |
US4222380A (en) * | 1977-12-02 | 1980-09-16 | Olympus Optical Co., Ltd. | Celiac injector |
DE3012447C2 (de) * | 1980-03-31 | 1982-04-01 | Harald 7200 Tuttlingen Maslanka | Chirurgisches Greiferinstrument |
US4393872A (en) * | 1980-05-27 | 1983-07-19 | Eder Instrument Co., Inc. | Aspirating surgical forceps |
-
1985
- 1985-03-14 JP JP60051352A patent/JPS61209647A/ja active Granted
-
1986
- 1986-01-29 US US06/823,950 patent/US4654028A/en not_active Expired - Fee Related
- 1986-03-11 DE DE19863607933 patent/DE3607933A1/de active Granted
Also Published As
Publication number | Publication date |
---|---|
DE3607933A1 (de) | 1986-09-25 |
JPS61209647A (ja) | 1986-09-17 |
JPH0237773B2 (de) | 1990-08-27 |
US4654028A (en) | 1987-03-31 |
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