WO2002011623A1

WO2002011623A1 - Surgical operation instrument for temporarily squeezing a blood vessel mechanically on each side of a bleeding injury to a vessel

Info

Publication number: WO2002011623A1
Application number: PCT/SE2001/001731
Authority: WO
Inventors: Stefan Sehlstedt; Staffan TERNSTRÖM
Original assignee: Stille Surgical Ab
Priority date: 2000-08-10
Filing date: 2001-08-09
Publication date: 2002-02-14
Also published as: SE0002883L; AU2001280382A1; EP1307146A1; SE515385C2; SE0002883D0

Abstract

A surgical operation instrument for temporarily squeezing a blood vessel mechanically on each side of a bleeding injury to the vessel consists of a handle 1 with an open ring 12, 13, the handle being arranged at an angle to the ring of about 115 °.

Description

Surgical operation instrument for temporarily squeezing a blood vessel mechanically on each side of ¹ bleeding injury to a vessel

Field of the Invention

The present invention relates to a surgical operation instrument for temporarily squeezing a blood vessel mechanically on each side of an injury to the vessel. In connection with operations, bleeding from an injured vessel may occur during operations. In order to repair the vascular lesion, it is necessary to stop the bleeding, which can be done by squeezing the vessel on each side of the injury. It is previously known to use an instrument having a ring arranged on a shaft in order to illuminate and stop the blood supply to an area of operation in conjunction with minor operations. This is known from US 3774614. However, this prior-art instrument is neither intended for nor particularly suitable for stopping bleeding in connection with injuries that have been caused to the blood vessel since this instrument is relatively difficult to handle. Furthermore, the accessibility to the area of operation is limited, which makes it difficult to reach and to restore a blood vessel therein.

Background Art

An object of this invention is to provide an instrument of the type stated in the introduction which pre- vents restoration of a bleeding vessel to the smallest extent possible.

This object is achieved by means of a surgical operation instrument in accordance with the appended claims . According to a first aspect of the invention, a surgical operation instrument is provided for temporarily squeezing a blood vessel mechanically on each side of an injury to the vessel, the surgical operation instrument comprising a shaft and a blood-flow stopping means, which means is arranged on said shaft and extends in a plane at an angle to the shaft, in which plane said means at least to a certain degree encloses an open area of treatment . Moreover, the blood-flow stopping means has an opening, which is arranged in the plane of extension towards the area of treatment .

Due to the opening, the accessibility to the area of treatment is radically increased and for example threads and the like can easily be introduced into and removed from the area of treatment while at the same time the blood-flow stopping means is constantly kept in position and carries out its blood-flow stopping function.

Preferably, the blood-flow stopping means with the opening arranged therein can consist of an open ring. However, by the expression ring is to be understood in this context not only a circular shape but also other shapes which result in an open area of treatment that is at least partly enclosed, such as an elliptic, rectangu- lar or triangular shape.

Furthermore, the angle between the plane of the blood-flow stopping means and the shaft is preferably 105-130°. Owing to this arrangement, the instrument can be conveniently manipulated in the area of the wound while at the same time satisfactory accessibility to the area of treatment is provided. In addition, this angle allows sufficient force to be transferred from the shaft to the blood-flow stopping means easily and efficiently and thus it becomes possible to stop the blood flow in the damaged vessel easily and efficiently.

However, the blood-flow stopping means may also be movably applied to the shaft, so that the angle can be varied, i.e. by means of a hinge arrangement.

The blood-flow stopping means can also be arranged in such a manner that its central opening, which encloses the area of treatment, as well as the peripheral opening towards the area of treatment can be varied, i.e. by the shanks being applied to the shaft individually in a hinged manner, or by the shanks being made from a plastic material in such a manner that they can be permanently deformed in order to be adapted to the current surgical situation.

The blood-flow stopping means can also be bowl- shaped having a central opening, as well as a peripheral one. The convex side is placed in abutment against the vessel. One advantage of this embodiment is that perpen- dicular abutment of the means against the injured vessel is avoided, a position which results in higher compression of the middle parts of the vessel than against the vessel periphery (the vessel seen in cross-section) and thus unnecessary compression with consequential risk of damage to the external sides of the vessel is avoided, said external vessel sides being those having the smallest radius. Besides, this curved shape is advantageous if it is desirable to insert the blood-stopping means underneath the damaged vessel . According to another aspect of the invention, a surgical operation instrument for temporarily squeezing a blood vessel mechanically is provided on each side of an injury to the vessel. This operation instrument comprises a blood-flow stopping means, preferably in the form of an open ring that is attached to a shaft extending at an angle of 105-130° to the blood-flow stopping means. Owing to this arrangement, the instrument can be conveniently manipulated in the area of the wound while at the same time satisfactory accessibility to the area of treatment is provided, as mentioned previously. Furthermore, this angle allows sufficient force to be transferred from the shaft to the blood-flow stopping means easily and efficiently and thus it becomes possible to stop the blood flow in the damaged vessel easily and efficiently. Besides, it is preferred that the surgical operation instrument comprises one blood-flow stopping means at each end of the shaft, each with a different dimension. Thus, the same instrument can be used in many different situations and for various types of interventions.

According to another aspect of the invention, it further relates to a set of such surgical operation in- struments, the largest blood-flow stopping means on a first instrument enclosing an area of treatment of essentially the same size as a smaller blood-flow stopping means on a second instrument .

According to yet another aspect of the invention, a surgical operation instrument is provided for temporarily squeezing a blood vessel mechanically on each side of an injury to the vessel, the surgical operation instrument comprising a shaft and a first blood- flow stopping means, which means is arranged on said shaft and extends in a plane at an angle to the shaft, in which plane said means at least to a certain degree encloses an open area of treatment. This instrument further comprises a second blood-flow stopping means which is movably arranged on the shaft such that it may be moved towards and away from the first blood-flow stopping means.

In use of the instrument according to this aspect of the invention, one of the blood-flow stopping means can be inserted underneath the blood vessel to be treated while the other one is placed above the same. As the blood-flow stopping means are moved against one another, efficient squeezing or compression of the blood vessel is thus achieved. By thus arranging a steady and stiff abutment stop or support underneath the blood vessel, considerably lesser force is required in order to squeeze the blood vessel together. Besides, it results in increased control and facilitates the surgical work since one hand may be kept free in the area of operation. In addition, the instrument can also be used for lifting the section of the blood vessel that is to be treated up from the ad- jacent tissue, which increases the accessibility to the injured area and makes it easier to carry out the treatment . The movable blood-flow stopping means can be pivo- tally mounted on the shaft, which results in a construction similar to that of pliers, or be arranged in a dis- placeable manner on the shaft. In the latter case, the movable blood-flow stopping means can suitably be displaced parallel to the first means.

Naturally, the movable blood-flow stopping means could be located either uppermost or lowermost and it is likewise possible to arrange both the blood-flow stopping means movably on the shaft.

According to yet another aspect of the invention, a combination of the movable and the pivoting device in accordance with the above, a surgical operation instrument, here designated part A, is provided for temporarily squeezing a blood vessel mechanically on each side of an injury to the vessel, the surgical operation instrument comprising a shaft and a first blood-flow stopping means, which means is arranged on said shaft and extends in a plane at an angle to the shaft, in which plane said means at least to a certain degree encloses an open area of treatment . This instrument further comprises a second blood-flow stopping means which is arranged on a shaft, here designated part B. By means of a coupling arrangement to be described in more detail in the description section, part A and part B can easily be coupled together. In this case, part B will be movably arranged on the shaft of part A in such a manner that it can be moved towards and away from the first blood-flow stopping means, and be pivotally arranged in order to be able to form an angle between the shaft of the two parts, allowing the two blood-flow stopping means to be moved apart and together.

When in use, part A or part B can first be applied on top of the vessel or underneath it, after which the second part is applied to the opposite side of the vessel and subsequently the parts are interconnected and adjusted. Alternatively, they may be interconnected already when the first blood-flow stopping means is applied. Owing to this, a support is obtained for the second blood- flow stopping means as the latter is being applied.

Brief Description of the Drawings

For exemplifying purposes, the invention will now be described in more detail by means of embodiments and with reference to the accompanying drawings, in which:

Fig. 1 is a side view of an instrument according to one embodiment of the invention,

Fig. 2 is a perspective view of the instrument in Fig. 1,

Fig. 3 is a side view of an instrument according to another embodiment of the invention, Fig. 4 is a side view of an instrument according to one embodiment of the invention,

Figs 5 a-c show a further instrument according to another embodiment of the invention,

Figs 6 a-h show top views of examples of different alternative embodiments of blood-flow stopping means according to the invention, and

Fig. 7 shows the arms of the blood-flow stopping means which are configured as parts of a bowl -shaped means .

Description of Shown and Preferred Embodiments

The invention relates to a surgical operation instrument for temporarily squeezing a blood vessel mechanically on each side of an injury to the vessel. The instrument comprises a shaft 11 and a blood-flow stopping means 12, 13, which means is arranged on said shaft and extends in a plane at an angle to the shaft, in which plane said means at least to a certain degree encloses an open area of treatment 14. Moreover, the blood-flow stop- ping means preferably has an opening 15, which is arranged in the plane of extension towards the area of treatment. The blood-flow stopping means is preferably formed as an open ring. However, it will be understood that many modifications are possible, as will be discussed in more detail in the following, and in this application such alternative shapes are also considered to include open rings as long as they distinctly define a partly enclosed internal area of treatment .

A first embodiment of the invention is shown in Figs 1 and 2. The shown instrument or tool comprises a handle or a shaft 11, which conveniently is about 2.5 dm long. It is made of stainless steel and has a diameter of 10 mm with conically tapering ends. At each end, an open stainless ring 12, 13 is welded to the handle at an angle of about 115°. The rings are suitably circular as shown and are formed of a 3 mm diameter wire. The instrument is smoothened and polished and the ends of the rings are softly rounded. The thread can also be ground in such a manner that its cross-section can vary along its length, conveniently so that it tapers off towards the opening.

One of the rings 12 can have an internal diameter of 15-25 mm and an opening of 10-18 mm and the other ring can have a larger internal diameter amounting for example to 25-35 mm, and an opening of 10-18 mm. One single instrument then covers most vein sizes. As regards the largest veins, it is possible to use an instrument having larger rings. The most convenient is to use three instruments and three different sizes of rings, of which the largest ring of one instrument has a diameter-size equalling that of the smallest ring of the next instrument. For example, it is possible to use one instrument having ring-diameter sizes of 18 and 28 mm, one instrument with the sizes of the ring being 28 and 38 mm and a third instrument with the sizes of the ring being 38 and 48 mm.

An angle of 105-130°, and preferably of 105-125°, between the shaft and the ring is suitable. If the angle is larger, it may be difficult to reach into a deep area of operation and if the angle is smaller, the hand that holds the instrument may be too much in the way. The technique of use is very simple. The ring which has the most suitable size is placed with the centre of the ring above the area of bleeding and a suitable pressure is applied via the shaft in such a manner that the bleeding is stopped. The instrument can be handled by the assistant or by the operating surgeon, depending on the current situation. Once the bleeding has stopped, it is possible to clean the area of operation by suction in a comparatively controlled and orderly manner, to apply the stitches that are often required to seal the vascular wall . The advantage of the not completely closed ring is in this context that it diminishes the risk that by mistake the instrument is fastened in the stitching-up operation in such a manner that the thread has to be cut off and there is a risk that the stitches come loose. If a loop of the thread should happen to be placed round the ring, it may be gently worked out through the opening in the ring .

The instrument can be cleaned according to the usual procedures for surgical instruments, i.e. after the operation it can be washed and, subsequently, autoclaved at 135°. Of course, alternatively the instrument can be made as a disposable instrument of plastic, but polished stainless steel is preferable since then the instrument can more easily be worked gently out of a loop of the thread.

However, the material of the shaft, as well as of the blood-flow stopping means, can be both non-plastic and plastic, or elastic. Thus, the instrument can be adapted to different surgical situations, such as small and large vessels, veins and arteries (which have different wall structures and different blood pressure) , and healthy as well as arteriosclerosic, fibrosic or partly thrombosic vessels. In a second (Fig. 3) and a third (Fig. 4) embodiment of the invention, the surgical operation instrument comprises, like in the previously discussed embodiment, a shaft 11 and a first blood-flow stopping means 12, which means is arranged on said shaft and extends in a plane at an angle to the shaft, in which plane said means at least to a certain degree encloses an open area of treatment 14. Furthermore, the instrument of this embodiment comprises a second blood-flow stopping means 16, which is movably arranged on the shaft 11 such that it may be moved towards and away from the first blood-flow stopping means. The second blood-flow stopping means is arranged ^■ for pivotal movement and is, preferably, attached to the shaft via a pivot shaft. Moreover, a lever 17 can advantageously be connected to the blood-flow stopping means in order to allow simple and efficient manual control of the pivotal movement . Alternatively, the movable blood-flow stopping means 16 can be arranged in a displaceable manner on the shaft 11, as shown in the embodiment of Fig. 4. For example, the movable blood-flow stopping means can in this case be connected to a second shaft 18 which in a displaceable manner is coupled to the shaft 11 by means of a guide bar arrangement, a rail construction or the like.

Advantageously, the second blood-flow stopping means can have a shape that corresponds to the shape of the first blood-flow stopping means. In addition, it is preferred that the second blood-flow stopping means, at least to a certain degree, encloses an open area of treatment which essentially coincides with the area of treatment of the first blood-flow stopping means when the second blood-flow stopping means is moved towards the first blood-flow stopping means. However, it is also pos- sible to let the lower blood-flow stopping means cover all and, thus, only constitute a stop or support against which the second means can operate . Besides, advantageously one or, preferably, both the blood-flow stopping means can have an opening towards the area of treatment and/or be arranged at an angle, as previously mentioned. In a fourth embodiment of the invention, the surgical operation instrument comprises, as mentioned before, two separate parts which comprises a shaft and a blood- flow stopping means, part A and part B, Fig. 5. The parts can be interconnected by a coupling, Figs 5 b-c, after which the parts can be displaced axially relative to one another and be rotated in the coupling.

The connection between part A and part B can, for example, consist of a profile-shaped groove 19 in the shaft of part A. In this groove, a profile-shaped pin 20 runs which can be moved into a transverse hole 21 extending through the shaft of part B. In its upper part, the groove can have an entrance opening for reception of the pin 20. A screw 23 through the hole for the pin locks the parts relative to one another. The abutment between the screw and the shaft of part B may be resilient, i.e. by means of a spring 24 in such a manner that the screw can be turned further after the parts have been interconnected, whereby the tip 25 of the screw, which tip extends through the pin, is brought into contact with the material in the groove. Owing to this arrangement, the axial displacement between the parts can also be prevented and the blood-flow stopping means be fixed in a desired position relative to one another.

In all the embodiments described above, the blood- flow stopping means can be designed in a large number of alternative ways. Fig. 6 shows examples of such alternative shapes, where Fig. 6a shows a circularly annular shape, Fig. 6b shows a rhombic shape, Fig. 6c shows an octahedral shape, Fig. 6d shows an elliptic shape, Fig. 6e shows a rectangular shape, Fig. 6f shows a shape of a standing triangle and Fig. 6g shows a shape of an inverted triangle. Moreover, the arms of the blood-flow stopping means do not need to have a uniform width, but this can vary, as illustrated in the embodiment shown in Fig. 6h.

Fig. 7 shows the arms of the blood-flow stopping means formed as parts of the shape of a bowl similar to the bowl shape of a conventional obstetrical forceps. As mentioned above, the arms can also be made of a plastic material, so that they may be shaped according to wish.

The invention has now been described by way of exam- pie. However, it will be understood that many other modifications are possible. For instance, unless otherwise explicitly stated, the features described above with respect to the different embodiments are interchangeable. Furthermore, the blood-flow stopping means can be shaped in many different ways, have an opening or not, be arranged at different angles relative to the shaft etc. The invention can further be made in many different materials and sizes. Such modifications and other similar modifications of the invention must be considered to be comprised by the invention, such as it is defined by the appended claims .

Claims

1. A surgical operation instrument for temporarily squeezing a blood vessel mechanically on each side of an injury to the vessel, the surgical operation instrument comprising a shaft (11) and a blood-flow stopping means, which means is arranged on said shaft and extends in a plane at an angle to the shaft, in which plane said means at least to a certain degree encloses an open area of treatment, c h a r a c t e r i s e d in that the blood- flow stopping means further comprises an opening, which is arranged in the plane of extension towards the area of treatment .

2. A surgical operation instrument as claimed in claim 1, the blood-flow stopping means comprising an open ring.

3. A surgical operation instrument as claimed in claim 1 or 2 , the angle between the plane of the blood- flow stopping means and the shaft being 105-130°.

4. A surgical operation instrument for temporarily squeezing a blood vessel mechanically on each side of an injury to the vessel, c h a r a c t e r i s e d by a blood-flow stopping means which is preferably in the form of an open ring (12, 13) that is attached to a shaft (11) extending at an angle of 105-130° to the blood-flow stopping means .

5. A surgical operation instrument as claimed in any one of the preceding claims, c h a r a c t e r i s e d in that said angle is 105- 125°, and preferably about 115°.

6. A surgical operation instrument as claimed in any one of the preceding claims c h a r a c t e r i s e d in that the shaft (11) sup- ports one blood-flow stopping means (12, 13) at each end of the shaft, each with a different dimension.

7. A surgical operation instrument as claimed in any one of the preceding claims, c h a r a c t e r i s e d in that it is made from smoothened and polished stainless steel.

8. A set of operation instruments as claimed in claim 6, c h a r a c t e r i s e d in that the largest blood-flow stopping means of a first instrument encloses an area of treatment of essentially the same size as a smaller blood-flow stopping means of a second instrument.

9. A set as claimed in claim 8, c h a r a c t e r i s e d in that the largest blood-flow stopping means of the second instrument encloses an area of treatment of the same size as a smaller blood-flow stopping means of a third instrument .

10. A surgical operation instrument for temporarily squeezing a blood vessel mechanically on each side of an injury to the vessel, the surgical operation instrument comprising a shaft (11) and a first blood-flow stopping means, which means is arranged on said shaft and extends in a plane at an angle to the shaft, in which plane said means at least to a certain degree encloses an open area of treatment, c h a r a c t e r i s e d in that it further comprises a second blood-flow stopping means which is movably arranged on the shaft such that it may be moved towards and away from the first blood-flow stopping means .

11. A surgical operation instrument as claimed in claim 10, the second blood-flow stopping means being piv- otally mounted on the shaft.

12. A surgical operation instrument as claimed in claim 10, the second blood-flow stopping means being arranged in a displaceable manner on the shaft .

13. A surgical operation instrument as claimed in any one of claims 10-12, the second blood-flow stopping means having a shape which corresponds to the shape of the first blood-flow stopping means.

14. A surgical operation instrument as claimed in any one of claims 10-13, the second blood-flow stopping means, at least to a certain degree, enclosing an open area of treatment which essentially coincides with the area of treatment of the first blood-flow stopping means when the second blood-flow stopping means is moved towards the first blood-flow stopping means.

15. A surgical operation instrument as claimed in any one of claims 10-14, at least one of the blood-flow stopping means, and preferably both, comprising an opening which is arranged in its plane of extension towards an area of treatment enclosed by the means .