DE4323578A1 - Automatic vaginal suturing device to prevent urinary incontinence in women - Google Patents

Description

The invention relates to an automatic vaginal sewing device to prevent urinary incontinence in women, whereby through the device a connection between the Paraharn tube parts of the vagina and the corresponding cartilage of the pubic symphysis by staples or by thread connection gene is produced, so that these parahyroid tube areas the vagina is permanently attached and held up which suppresses urinary incontinence in women becomes.

The device for performing automatic sewing has an elongated body by the surgeon gene is handled itself. At the end of this body is a Head arranged through which the staples are released or in which a needle is operated which passes the thread the tissue corresponding to the parahalne areas of the Vagina and pubic symphysis. To this Way the automatic sewing is achieved, whereby at Using the thread tying each thread to the Automatic suturing is required.

It is known that the urethra has its own mechanism through which an interruption of the pressure wave is achieved which is received by the bladder when the intraabdo minimal pressure occurs suddenly and unexpectedly (for example, when coughing) and acts on the bladder. The Behavior of the anatomical elements affecting the urethra hold their place in very different ways interpreted by specialists.  

In any case, the urethra "sinks" when it relaxes change the appropriate protective mechanisms (childbirth and mainly Lich age), while the pelvic diaphragm becomes thinner where is reduced by urethral resistance, whereupon the Contraction force with which the diaphragm and the sphincter contract, decreases. In this situation he occurs increased wave of bladder pressure through the urethra, and depending on the degree of degradation, there is a larger one or minor leakage of urine.

To correct this type of incontinence, the normal surgery back to aids based on it ren that the urethra is raised and an attachment or a break point is created, this "folding" effect an interruption in the pressure wave emitted by the bladder generated.

There are many advertised surgical procedures, some vaginal and other abdominal, more both vaginal as well also abdominal, so that in all these cases the surgical Surgery is difficult.

The invention is therefore based on the problem urinary incontinence in women through a simple and very effective system to solve that on an attachment of the Side parts of the urethra on the cartilage of the pubic Symphysis is based, so that in a patient in a gynecologist logical position and with the corresponding vaginal separator the vaginal cavity is widened, causing the The roof of this organ is exposed, at which point the urine runs along the tube. The backs of the Examined urethra and vagina, the boundaries between the urethra and vagina and along the Urethra itself. This is followed by a bladder cat ter inserted through the urethra to perform this better to examine and then the mobility of the urine Examine tube. Eventually the cartilage becomes the pubis  grasped by the sublime part which this normally with respect to the bones defining it.

Subsequently, the attachment of each of these be parts of the urethra by means of the invention direction carried out. This device has a bracket device on, the end or the head of which the brackets are released against the back surface the pubis is created so that an actuation of the bracket device the stapling of the staple into the cartilage of the Pubis performs how the urethra is attached is attached by placing the roof of the vagina on each side becomes.

With the end of the stapling device, the cartilage of the Pubis detect or locate the urethra at to fasten the sides. The stapler works pneumatic, d. in other words, it is replaced by com primed air operated. By pressing a The corresponding button is released and in the Cartilage bracketed, on which the wall of the Vagina remains attached.

It goes without saying that the parentheses are when they be clamped at this point, close to loosening to prevent.

Furthermore, the brackets mentioned create in the Ge concerned weave an adequate compression effect to a healing effect in the tissue.

In the area where the parentheses should be used len, is the arrangement of a cut with a scalpel in the mucous membrane of the vagina. That way the clip after inserting it behind the slime membrane the vagina is hidden.  

The cartilage can also be localized by fluoroscopy tion. In this case, the stapler made of a plastic material, where if the Bracket is formed from metal, is the place where the Bracket to be attached yourself, easy to locate. This second type of clip has an external device a pressure effect on a mouth of the staple better against the surface to be clamped press so that the attachment of the brackets more effectively and is safer.

In a second embodiment, the stapler completed by a channel, which at the mouth the stapler is provided to ge the urethra protect against strangulation or damage caused by the bracket action could be caused. The channel he stretches around the urethra once this one guidance of a urinal catheter is expanded.

The channel has the peculiarity that the bottom part remaining end is wider so that it attaches to the funnel is fit, the ge at the transition between bladder and urethra forms is.

It is obvious that this includes the channel mentioned Ending element ver positioning the stapler simple because the urethra is absorbed through the canal and when lifting the clamp device to approach the Pubis, the transition to the bladder is raised and moved around to prevent it from being trapped in the tissue that should be bracketed.

Therefore, in the second embodiment, or the channel with which the stapler complements correct positioning of the stapling device, because a better reference when positioning the bracket  device with respect to the urethra is given, whereby the Bracketing can be carried out more precisely.

In the second embodiment of the stapler continue to provide a double orifice at the same time brace two brackets on each side of the urethra, with an opening of the clamp device on one side of the channel and logically the other on the other Side remains. The mouths are angled with respect to one Center line oriented towards the cartilage of the pubis, which simplifies the operation. In contrast to are with the clamp device with a single mouth two operations to bracket the two corresponding ones Brackets necessary.

On the other hand, the heads of the stapler are next to that Tiltability with respect to the central channel with side grooves or Equipped strips that position the channel in allow different heights. In other words, the Position can be varied to get closer or farther from the Stay pubis to keep the urethra spacious.

In a third embodiment, the automatic works Sewing device with a thread instead of clips. The Device has a semicircular at the end of its head Needle turned on by an internal mechanism becomes. For example, the internal mechanism is a transmission be with chain and sprockets. By manually operating a outer lever turns the needle, and its end describes an arch that extends the vaginal wall and the the tissue forming the pubic symphysis is perforated while in the reverse movement, sewing and pulling the Fa dens takes place. The thread is in a corresponding one beforehand Area of the head of the device. He will grasped by the semicircular needle by the needle has a type of latch at its end. Through this Locking nose is gripping and pulling the thread in one  Direction performed as the return direction when turning the needle is considered. This will thread through the Holes that the needle previously ge during forward rotation did.

This way, when performing the operation on both Sides of the urethra, the two ends of the thread inserted and led out of the openings that the Needle on her way. A knotting of the thread takes place later.

How easy it is to conclude can pull the threads together can be adjusted with the automatic sewing, since the with the ends of the thread are loose before they are knotted. A too can contract with a greater or lesser degree be carried out, whereby the adjustment takes place. This obviously has an advantage over the automati stitching with the stapling device at which no adjustment or advance can be carried out can.

In the following the invention is based on exemplary embodiments play closer in the figures attached to the drawing purifies and describes.

Show it:

Figure 1 is a representation of a widened by a separator vaginal cavity with a section on egg ner side of a urethra, in which section a corresponding clip can be used by the inventive device.

Figure 2 is a perspective view of an inside of the vaginal cavity with one of two clips attached to the pubis on the sides of the urethra;

Figure 3 is a schematic longitudinal view of an inventive metal clip device for performing an automatic surgical suturing.

Figure 4 is a stapling device made of a transparent plastic material having mechanical actuation for the release of the clamps.

Figure 5 is a schematic perspective view of a head of the clamp device according to a second embodiment with a urethra support channel, where are shown at catheter and corresponding bubble.

Fig. 6 is a front view of the clamp device of Figure 5 in support of the urethral attachment channel and with brackets shown in dashed lines.

Figure 7 is a detailed view of a double head of the clamp device according to the preceding figures with corresponding inner strips for positioning the corresponding urethral support channel at different heights.

. 8 is a longitudinal section of a device Fig another embodiment for carrying out the automatic suturing means of a thread, which rotates a semicircular needle in the head of this device, and operated by a mechanism with pinions and an actuated by a manual control chain;

Fig. 9 is a detailed view of a head of the device for displaying the needle shown in Fig. 8 and a possible positioning of the thread to be gripped by one end of the needle;

Fig. 10, 11, 12 and 13 more schematic views of the vagina, urethra and a part of the cartilage of the pubic symphysis, the figures differing che steps for performing the automatic Ver sewn for between the vaginal cavity and the cartilage of the pubic symphysis of the on both sides Represent urethra, the automatic suturing by the device according to FIGS. 8 and 9 it follows.

To carry out the automatic suturing shown in FIGS. 1 and 2, it is necessary to place the patient in a gynecological position. Thereafter, a vaginal cavity 2 is expanded according to FIG. 1 by means of a vaginal separator 1 , which is formed by a body with two pivotally connected arms which are connected to a common positioning element. In this cavity, a roof is exposed, along which the urinary tube 3 runs. Thereafter, the sides of the urethra and vagina, which are the boundaries between the urethra and vagina and run along the urethra 3 , are examined.

Finally, a urinary catheter 4 is inserted through the urethra 3 itself in order to better examine this guidance. Then the mobility of the urethra is examined, which is easier to detect when the catheter 4 is inserted. Cartilage cartilage can be grasped by a raised portion that the cartilage normally has with respect to the bones bounding it.

In Fig. 2 the scan and already a clip 6 attached to one side of the urethra 3 is shown. The Klam mer 6 is recorded by a cut 5 , which is arranged by means of a scalpel in an expedient area. The clip should be hidden in the cut. In Fig. 2 it can be seen how the clip 6 lifts the loading area corresponding to the paraharroid tissue 7 and holds it in the raised position, the other end of the clip 6 in the pubic ligament corresponding to the bone of the pubis 9 , in other words, in the tissue forming the pubic lymphysis is bracketed.

In Fig. 3, a clamp device for performing the above-mentioned automatic sewing is shown. The stapler includes an elongated body having a head 11 at one end thereof. This end forms an extension which is arranged at an angle with respect to a horizontal axis of the body 10 of the Klammervorrich device. The head 11 of this end rests on the above-mentioned, previously localized points that correspond to those at which the cuts 5 are made. For this purpose, the head 11 of the stapling device will slide over the rear wall of the pubis in order to grasp the raised part of the cartilage of the pubic symphysis. Once this has been done and the cartilage has been grasped, the stapling device is removed and the incision 5 is made with a scalpel before the staple 6 is inserted. The cut is made in a mucous membrane of the vagina directly at the point where the mouth of the corresponding head 11 of the Klammervor device 10 rests. The cut is used to insert this behind the clamp 6 behind the mucous membrane of the vagina.

Therefore, the ends 12 of the head 11 of the Klammervor direction are introduced into the section 5 , which goes over the bone of the pubis until the cartilage of the pubic symphysis is found, and at this point the corresponding clip 6 is released by means of a push button 13 and attached or attached the wall itself of the vagina to the cartilage in question.

The stapling device according to Fig. 3, Untitled pneumatically betae. For this purpose, it has an internal gas bottle 14 in its corresponding handle, the pressure of the gas contained in this gas bottle releasing the corresponding clip 6 and bracketing the clip in the mentioned area.

FIG. 4 shows a clamp device 10 which is made of a transparent plastic. This device makes it possible to locate the area in which the clip 6 is to be placed, the clip being made of metal. The localization is carried out by means of a radiographic amplification device, so that the effective end 12 of the clamp device 10 is visible under control of the fluoroscopy. Of course, the clip is located at this end, and since it is made of metal, it is easy to locate. In this way the clip is guided to the transparent space between the bones of the pubis, which corresponds to the cartilage of the pubic symphysis. If this position is reached, an element or mechanism, which is arranged on the clamping device itself and which is designed as a pressure mechanism, is actuated. In this way it is possible to grasp the cartilage of the pubis. The mechanism includes a mounting connection 15 , to which a pressure element 17 is connected. The pressure device is adjustable by means of a manually operable screw.

In a second embodiment according to FIGS . 5, 6 and 7, the clamping device has a head 11 ', which is divided into two parts or identical heads 18 . Each of these heads has an outlet opening for the corresponding clip 6 . In this way, it is possible by means of this embodiment to simultaneously attach two clips, one on each side of the urethra 3 . The inside of the urethra has the corresponding catheter 4 , which continues according to FIG. 5 into the associated bladder 20 .

The heads 18 of Fig. 5, 6 and 7 and therefore the ent speaking orifices 19 remain localized on each side of the channel 21 which is disposed between the heads 18. The channel 21 supports the heads, which are connected to each other by a bearing 22 and have some longitudinal strips 23 on their inner surface, which allow the channel 21 to be positioned higher or lower to move it closer or further from the urethra 3 itself to arrange.

The channel 21 surrounds the urethra 3 , see FIG. 6, an enlargement 24 being formed at the end of the channel to accommodate a funnel 25 at the transition from bladder 20 to urethra 3 .

In this way, two brackets 6 can be brought simultaneously on each side of the urethra 3 with a direction according to FIG. 6. The brackets 6 attach the paraharne tube tissue of the vagina upwards to the pubic symphysis or to the cartilage of the pubis 8 .

From the above it follows that by the Ausführungsbei game according to Fig. 5, 6 and 7, the brackets 6 attached by tion all operations without a constriction or Strangulie take place of the urethra 3, since the channel 21, the rule Zvi the heads 18 is localized, the constriction changed, with an additional two brackets 6 being introduced simultaneously.

In a third embodiment according to FIGS. 8 to 13, as in the previous examples, the device according to the invention comprises an elongated body 26 with a manual operation control 27 , such as a lever. This emerges from a side part of the body 26 , the lever 27 being mounted on a transverse shaft 28 .

The body 26 has a corresponding end head 29 , which is similarly arranged at an angle to the horizontal axis of the body. A semicircular needle 30 is mounted in the head of this end so that it can be rotated in both directions. At one of its ends, the needle extends in a rectilinear section 31 , through which it is attached to a rotary shaft 32 . At the other end of the needle 30 , this has a catch 33 defining a gripping end, which will be described below.

The device has a system for rotating the needle 30 in its interior. This system comprises a number of toothed disks or gears 34 which are operated by a chain 35 , which in turn is guided on a pinion arranged on the shaft 28 itself. The shaft 28 is rotated by actuating the lever 27 and the chain 35 is pulled accordingly. In this way, the Getriebeme mechanism 34 rotates the shaft on which the needle 30 is arranged.

In the embodiment shown in FIGS. 8 and 9, the automatic sewing is carried out by means of a thread 36 which replaces the above-mentioned clips 6 . The thread 36 is appropriately positioned in the head 29 of the device or body 26 . With correct positioning of the head in the manner described above, actuation of the lever 27 causes the needle 30 to rotate in one direction. The needle rotates a section until its end 33 passes the thread 36 . When rotating in the opposite direction, the end 33 of the needle 30 grasps the thread 36 by means of the latching nose formed on it, pulls it and guides it along the path of the needle 30 , in particular the end 33 . The path through each of the areas is followed collaterally to the urethra 3 and through the cartilage 8 of the pubic symphysis, as shown in the various steps in FIGS . 10, 11, 12 and 13.

In other words, the device causes a sewing wire 36 to be passed through the needle 30 in a head 29 through the para-urinary tube region 7 of the vagina 2 and through the cartilage 8 of the pubic symphysis.

According to Fig. 10, 11, 12 and 13, the operation is performed on each side of the urethra 3, so that upon rotation of the needle 30 in one direction and in the other direction, as has been stated above, the thread 36 through the in Holes generated through the end 33 of the needle 30 pass through, leaving the ends of the thread 36 free to be subsequently knotted.

Before the first thread 36 placed on one side of the urethra 3 is knotted, it is necessary to arrange the second thread on the other side of the urethra, as shown in FIG . Only when two threads 36 have been passed through the corresponding areas of the wall of the vagina and cartilage of the pubic symphysis are these knotted. It is possible to pull the to just by simple tensioning more or less by just pulling the ends of the threads 36 . The thread 36 is not knotted before placing the other thread because the urine tube 3 must be moved to the opposite side to perform this operation. This operation can only be performed when the thread is not knotted, since otherwise the lateral movement of the urethra 3 could not take place.

The semi-circular needle 30 can be arranged in the position shown, the needle rotating in a manner such that its end moves along a path from top to bottom. The needle can also be arranged in an opposite position so that its end runs along a path from bottom to top.

Claims (8)

1. Automatic vaginal suturing device to avoid urinary incontinence in women for connecting paraharnoid tube tissue of the vagina and pubic symphysis, in particular connecting cartilage, whereby a vaginal cavity ( 2 ) is widened by means of a separator ( 1 ) and the mobility of the urethra ( 3 ) for grasping the cartilage ( 8 ) of the pubis ( 9 ) can be scanned, and the automatic suturing for fastening the roof of the vaginal wall ( 2 ) on each side of the urethra ( 3 ) with the part of the cartilage ( 8 ) corresponding to the rear surface of the pubis ( 9 ) can be carried out, characterized in that the device has an elongated body ( 10 , 26 ) which extends at one of its ends into a head ( 11 , 29 ) which is arranged at an acute angle to the elongated body , wherein the body is formed for gripping by a hand and a device is arranged in its interior, the actuation by ei NEN push button or lever ( 13 , 27 ) enables adequate movement, by means of which an automatic sewing element ( 6 , 36 ) passes through the paraharroid tissue ( 7 ) of the vagina and through the cartilage ( 8 ) in accordance with the pubic symphysis and the parahalne tubes areas of the vagina ( 2 ) are attached raised. 2. Automatic vaginal suturing device to avoid urinary incontinence in women according to claim 1, characterized in that the elongated body ( 10 ) of the device with its corresponding head ( 11 ) is a pneumatically actuated clamp device, the corresponding clamps being stored in the head ( 11 ) which can be released through the ends ( 12 ) of the head after the push button ( 13 ) in the elongated body ( 10 ) of the clamp device is actuated. 3. Automatic vaginal suturing device to avoid urinary incontinence in women according to claim 2, characterized in that the clamping device ( 10 ) is formed from a transparent plastic material for orientation of the clip ( 6 ) by means of fluoroscopy, a pubis press mechanism on the body ( 10 ) of the clamping device is arranged, which mechanism ei NEN carrier ( 15 ) for connection to the body ( 10 ) of the clamping device, which carrier ( 15 ) has a pressing element ( 17 ) which is adjustable by a manually operable screw ( 16 ). 4. Automatic vaginal suturing device to avoid urinary incontinence in women according to any one of the preceding claims, characterized in that the head of the clamping device has an element ( 11 ') in which two parts or heads ( 18 ) are formed, each of which an outlet mouth ( 19 ) for the corresponding clamp ( 6 ), a channel ( 21 ) for positioning and supporting the corresponding urethra ( 3 ) is formed and the heads ( 18 ) are connected to one another by a base bearing ( 22 ), the orifices ( 19 ) of the heads have converging bevels, whereby the corresponding brackets ( 6 ) can be attached with a specific angle arrangement, which enables the correct fastening of the paraharroid tissue to the cartilage of the pubis. 5. Automatic vaginal suturing device to avoid urinary incontinence in women according to claim 4, characterized in that the channel ( 21 ) between the heads ( 18 ) at its outer end has an enlargement ( 24 ) for receiving a funnel ( 25 ) which on one Approach is formed by a bladder ( 20 ) on the urethra ( 3 ). 6. Automatic vaginal suturing device to avoid urinary incontinence in women according to claims 4 and 5, characterized in that the heads ( 18 ) have on their inside projections ( 23 ) which are designed for positioning and holding the channel ( 21 ) at different heights , whereby a reduction or an increase in the distance of the outlet openings ( 19 ) of the clamps ( 6 ) is possible and the urethra ( 3 ) is held without strangulation. 7. Automatic vaginal suturing device to avoid urinary incontinence in women according to claim 1, characterized in that the head ( 29 ) of the elongated body ( 26 ) has at its end a semicircular needle ( 30 ) which with a straight arm ( 31 ) with inward radial orientation with respect to the arc of the needle ( 30 ) is arranged on a shaft ( 32 ), the needle being movable in sections in both directions, so that when moving in one direction the end ( 33 ) of the needle ( 30 ) through the mouth of the head ( 29 ) emerges and the corresponding Paraharnröh renbereich ( 7 ) of the vagina ( 2 ) and the cartilages ( 14 ) of the pubic symphysis perforated, with rotation in the opposite direction of the needle ( 30 ) at one end of the Needle arranged locking lug grips and pulls the sewing element formed by a thread ( 36 ), which is appropriately located inside the head ( 29 ) of the device ( 26 ) the thread ( 36 ) passing through the holes created by the needle ( 30 ) on its way. 8. Automatic vaginal suturing device to avoid urinary incontinence in women according to claim 7, characterized in that the actuating device of the shaft ( 32 ) of the needle ( 30 ) comprises a system of gears ( 34 ) and a chain ( 35 ) by a on one Rotary shaft of a manually operable lever ( 27 ) is movable on an ordered pinion.