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WO2009040834A1 - Dispositif fragmentable amélioré pour l'anastomose d'organes creux - Google Patents

Dispositif fragmentable amélioré pour l'anastomose d'organes creux Download PDF

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Publication number
WO2009040834A1
WO2009040834A1 PCT/IT2007/000662 IT2007000662W WO2009040834A1 WO 2009040834 A1 WO2009040834 A1 WO 2009040834A1 IT 2007000662 W IT2007000662 W IT 2007000662W WO 2009040834 A1 WO2009040834 A1 WO 2009040834A1
Authority
WO
WIPO (PCT)
Prior art keywords
intermediate body
fragmentable
tongues
free ends
cavity
Prior art date
Application number
PCT/IT2007/000662
Other languages
English (en)
Inventor
Carlo Rebuffat
Original Assignee
David, Dante
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by David, Dante filed Critical David, Dante
Priority to PCT/IT2007/000662 priority Critical patent/WO2009040834A1/fr
Publication of WO2009040834A1 publication Critical patent/WO2009040834A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B17/1114—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00004—(bio)absorbable, (bio)resorbable or resorptive
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B17/1114—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
    • A61B2017/1117—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus adapted for discharge after necrotisation, e.g. by evacuation, expulsion or excretion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B2017/1132—End-to-end connections

Definitions

  • the present invention relates to an improved fragmentable device for the anastomosis of hollow organs of the human body, such as parts of the digestive tract, the intestine or the ano-rectal cavity.
  • Fragmentable devices for anastomosis are generally made up of an assembly of cylindrical bodies which can be introduced into each other that are used to press the terminal edges of the organs to be anastomized thus forming a constriction such that they necrotize.
  • the surgeon performs a purse-string suture between the organs to be anastomized, then pulls the edges of the organs inside the fragmentable anastomosis device and introduces and locks the cylindrical bodies into each other.
  • the pressure exerted by the tissues pressed inside the device keeps tightly compact and stable the fragmentable bodies which will fragment into sectors when the necrosis has occurred due to the consequent lack of pressure by the tissues thereon and are expelled through natural paths.
  • US patent n 0 5,290,298 discloses a fragmentable anastomosis device comprising three cylindrical bodies which can be inserted into each other.
  • the first cylindrical body, the outer one is bowl-shaped and formed of two parts also bowl-shaped introduced one into the other, whereas the second and third bodies, i.e. the intermediate and inner one, have an annular shape and are formed of a plurality of sectors arranged side by side in the circumferential direction.
  • the device is introduced in the anastomosis site by means of a specific tool and the edges of the hollow organs to be anastomized are introduced into the cavity defined by the outer bowl-shaped body. Subsequently, the intermediate body and the inner body are introduced in the cavity of the outer body.
  • the introducing tool cuts the outer bowl-shaped body at the bottom, dividing its two parts into sectors to facilitate the expulsion through natural paths.
  • the sectors maintain their assembly position thanks to a series of radial protrusions and recesses formed in the peripheral walls of the two parts and which engage one into the other.
  • the necrosis of the tissues may occur in a non-uniform way over time, i.e. some areas may reach the necrosis prior to other areas, causing a premature and undesirable fragmentation of the device.
  • the purpose of the present invention is to provide an improved fragmentable device for the anastomosis of hollow organs free from said drawbacks.
  • Such a purpose is achieved with an improved fragmentable device, whose main characteristics are specified in the first claim and further characteristics are specified in the subsequent claims.
  • the fragmentable anastomosis device includes three cylindrical bodies which can be inserted into each other, an outer bowl-shaped body, an intermediate body and inner body both having an annular shape.
  • the portion of the intermediate body that presses the edges of the hollow organs inside the cavity of the outer body has an external diameter substantially equal to or slightly lower than the cavity diameter and is made of an absorbable and biodegradable material.
  • the main advantage of the fragmentable device according to the present invention is that the particular choice of the diameter of the intermediate body relative to the diameter of the cavity allows to keep the sectors of the bowl-shaped body together regardless of the presence of tissues, thus assuring the success of the anastomosis even with purse-string sutures not perfectly performed along 360° of the connecting region between the hollow organs. Furthermore, thanks to the use of a biodegradable and absorbable material, the fragmentation of the device bodies occurs according to the preset time required for the reabsorption of the material and not to the time required for the necrosis of the tissues, which can only be approximately estimated, thus always assuring to achieve the complete necrosis of the tissues and therefore the full success of the anastomosis intervention.
  • Figures 1 and 2 show perspective exploded views of the fragmentable device according to the present invention
  • Figure 3 shows a front view of the device of Figs. 1 and 2 completely assembled
  • Figure 4 is a cross-sectional view along line IV-IV of Fig. 3;
  • Figures 5 and 6 show perspective views of a sector of the intermediate body of the fragmentable device of Fig.1 ;
  • Figure 7 shows a front and a side view of the intermediate body of Figs. 5 and 6;
  • Figure 8 shows a top plan view of the fragmentable device according to the present invention.
  • Figure 9 is a longitudinal sectional view along line IX-IX of Fig.8.
  • the fragmentable device according to the present invention conventionally includes a bowl-shaped outer body 1, a ring-shaped intermediate body 2 suitable to be inserted into the cavity Ia defined by the bowl- shaped outer body 1, and a ring-shaped inner body 3 suitable to be pressure-inserted into the intermediate body 2.
  • the outer body 1, the intermediate body 2 and the inner body 3 are formed each by a plurality of separable sectors.
  • the outer body 1 is made up of an outer part Ib and an inner part Ic inserted one into the other and having a bowl-shape.
  • Each part Ib, Ic has slots in the radial direction that define a plurality of identical sectors.
  • parts Ib, Ic each have a series of apertures in the bottom that define cut lines suitable to allow the cut of the bottom of the outer body 1 upon completion of the assembly of the fragmentable device.
  • the two parts Ib, Ic, the outer and the inner one maintain their assembly position thanks to a series of radial protrusions Id formed on the outer peripheral wall of the inner part Ic, each engaging recesses Ie formed in the inner peripheral wall of the outer part Ib.
  • protrusions and recesses have a dove-tail cross-section, which is suitable to create an undercut in the radial direction that keeps the sectors of parts Ib, Ic together.
  • the intermediate body 2 consists of a plurality of sectors 4 arranged side by side in the circumferential direction, each of which is provided with a top arcuate profile 4a from which a plurality of tongues 4b extend axially which are suitable to press the edges of the hollow organs inserted in the device against the peripheral wall of cavity Ia of the outer body 1.
  • the inner body 3 consists of a plurality of sectors 5 arranged side by side in the circumferential direction, each of which is provided at the base and at the top with radial projections suitable to allow the abutment and snap-locking of inner body 3 onto the intermediate body 2.
  • the fragmentable device will remain compact even in the absence of tissues between the outer body 1 and the intermediate body 2, thus assuring the success of the anastomosis even with purse-string sutures not perfectly performed along 360° of the connecting region between the hollow organs.
  • the maximum radial play between the intermediate body 2 at the free ends 4c and the diameter of the cavity Ia must never allow the sectors of parts Ib, Ic of the outer body 1 to move in the circumferential direction such to cause the disengagement of the dove-tail protrusions Id from the respective recesses Ie. According to numerous experimental tests carried out by the inventor, it comes out that in order to obtain a radial play meeting the above-mentioned requirement, the ratio between the external diameter of the intermediate body 2 at the free ends 4c and the diameter of cavity Ia must range from 0,9 to 1. Moreover, the free ends 4c of tongues 4b are made of a biodegradable and absorbable material.
  • the free ends 4c of tongues 4b will start to degrade getting progressively thinner up to complete reabsorption. Consequently, the radial play between the intermediate body 2 and the cavity Ia of the outer body 1 will increase enabling a relative movement between the sectors of parts Ib, Ic of the outer body 1 in the circumferential direction up to determining the disengagement of the protrusions Id from the recesses Ie, thus resulting in the fragmentation into sectors of the outer body 1 and therefore also of the intermediate body 2 and the inner body 3 and in their disposal through natural paths.
  • the free ends 4c of biodegradable and absorbable material can be injection co- moulded onto the respective tongues 4b of the intermediate body 2. Alternatively, the free ends 4c can be made as separate components and mechanically fixed to the tongues 4b of the intermediate body 2.
  • the reabsorption time is equal to at least 1,5 times the time estimated for the necrosis of the edges of the hollow organs inserted into the device, such that it is possible to guarantee the complete healing of the anastomized region.
  • biodegradable and absorbable materials examples include polyglycolic acid, polydioxanone, lactic acid, caprolactone and glycolide-lactide copolymers, that have preset degradation and reabsorption times ranging from 5 to 90 days.
  • the free ends 4c of tongues 4b may have a surface texture suitable to increase the grip on the edges of the hollow organs inserted between the outer body 1 and the intermediate body 2.
  • Said texture may be for example a knurling, which also has the effect of increasing the surface area of the free ends 4c thus favouring the degradation and reabsorption process.

Landscapes

  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Physiology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention porte sur un dispositif fragmentable pour l'anastomose d'organes creux qui comporte un corps externe en forme de bol (1), un corps intermédiaire en forme d'anneau (2) approprié pour être introduit dans la cavité (1a) définie par ledit corps externe en forme de bol (1) et un corps interne en forme d'anneau (3), approprié pour être introduit par pression dans ledit corps intermédiaire (2). Le corps externe (1), le corps intermédiaire (2) et le corps interne (3) sont formés chacun par une pluralité de secteurs séparables, et le corps intermédiaire (2) est pourvu d'une pluralité de languettes (4b) appropriées pour presser les bords des organes creux contre la paroi périphérique de la cavité (Ia) du corps externe (1). Le diamètre externe du corps intermédiaire (2) aux extrémités libres (4c) des languettes (4b) est sensiblement égal ou légèrement inférieur au diamètre de la cavité (Ia) du corps externe (1), et les extrémités libres (4c) sont faites en un matériau biodégradable et absorbable.
PCT/IT2007/000662 2007-09-25 2007-09-25 Dispositif fragmentable amélioré pour l'anastomose d'organes creux WO2009040834A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/IT2007/000662 WO2009040834A1 (fr) 2007-09-25 2007-09-25 Dispositif fragmentable amélioré pour l'anastomose d'organes creux

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/IT2007/000662 WO2009040834A1 (fr) 2007-09-25 2007-09-25 Dispositif fragmentable amélioré pour l'anastomose d'organes creux

Publications (1)

Publication Number Publication Date
WO2009040834A1 true WO2009040834A1 (fr) 2009-04-02

Family

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/IT2007/000662 WO2009040834A1 (fr) 2007-09-25 2007-09-25 Dispositif fragmentable amélioré pour l'anastomose d'organes creux

Country Status (1)

Country Link
WO (1) WO2009040834A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2012161627A1 (fr) * 2011-05-23 2012-11-29 Prozeo Vascular Implant Ab Dispositif, moyens d'outil, trousse et procédé pour une anastomose

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0335552A1 (fr) * 1988-03-29 1989-10-04 United States Surgical Corporation Dispositif d'accouplement anastomotique par compression
EP0362163A2 (fr) * 1988-09-28 1990-04-04 Carlo Rebuffat Dispositif de compression pour l'anastomose d'organes creux
US5250058A (en) * 1991-01-17 1993-10-05 Ethicon, Inc. Absorbable anastomosic fastener means
US5290298A (en) * 1990-05-07 1994-03-01 United States Surgical Corporation Fragmentable anastomotic device
US20060085035A1 (en) * 2004-10-18 2006-04-20 Viola Frank J Compression anastomosis device and method
WO2007057933A1 (fr) * 2005-11-21 2007-05-24 Carlo Rebuffat Dispositif fragmentaire perfectionne pour l’anastomose d’organes creux

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0335552A1 (fr) * 1988-03-29 1989-10-04 United States Surgical Corporation Dispositif d'accouplement anastomotique par compression
EP0362163A2 (fr) * 1988-09-28 1990-04-04 Carlo Rebuffat Dispositif de compression pour l'anastomose d'organes creux
US5290298A (en) * 1990-05-07 1994-03-01 United States Surgical Corporation Fragmentable anastomotic device
US5250058A (en) * 1991-01-17 1993-10-05 Ethicon, Inc. Absorbable anastomosic fastener means
US20060085035A1 (en) * 2004-10-18 2006-04-20 Viola Frank J Compression anastomosis device and method
WO2007057933A1 (fr) * 2005-11-21 2007-05-24 Carlo Rebuffat Dispositif fragmentaire perfectionne pour l’anastomose d’organes creux

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2012161627A1 (fr) * 2011-05-23 2012-11-29 Prozeo Vascular Implant Ab Dispositif, moyens d'outil, trousse et procédé pour une anastomose

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