WO2008028972A1

WO2008028972A1 - Knots and method and device for generating the same

Info

Publication number: WO2008028972A1
Application number: PCT/EP2007/059428
Authority: WO
Inventors: Marc Kraft; David Hochmann; Wulf Wulff; Wolfram Rossdeutscher; Martin GÖRDES; Rainer Reichel; Ulrich Wegener; Peter Diesing
Original assignee: Technische Universität Berlin
Priority date: 2006-09-08
Filing date: 2007-09-07
Publication date: 2008-03-13
Also published as: DE102006043114A1

Abstract

The invention relates to a surgical thread with two free ends, one free end forming a proximal end and the other forming a distal end, then forming two turns with the distal free end, lying in the direction of the proximal free end, such as to pass around the surgical thread twice in the direction of the proximal free end, forming a bow with the distal free end and passing the bow through both loops formed by the two turns such as to form a first noose on the side of the two loops away from the proximal free end such that the distal free end as a result is on the side of the two loops facing the proximal end and points in the direction of the proximal free end and then tightening the knot by exerting a tensile force between the first noose and the proximal free end of the thread.

Description

Node and method and apparatus for producing the same

The invention relates to a knot, in particular for medical use for suturing wounds. The invention also relates to a method and apparatus for generating the node.

Nodes, the species affected here, are used for medical sutures. The aim of the medical suture is to protect the sewn structures in the phase of wound healing sufficiently by acting forces and to unify the separated tissue. Once wound healing has reunited the separated tissues, the surgical suture has done its job.

Fundamentally, various types of seams and seams as well as suture materials for medical sutures are known.

Usually, the free ends of the suture used to create the medical suture are knotted together. For this purpose, a variety of surgical knots are known. It is an object of the present invention to specify a medical node suitable in particular for laparoscopic and / or endoscopic application, and a method and a device for automatically generating the node. According to the invention, this object is achieved by a surgical node which is generated by:

Presenting a surgical thread having two free ends, one free end forming a proximal end and the other free end forming a distal end,

Forming two turns with the distal free end placed towards the proximal free end so as to loop around the surgical thread twice towards the proximal free end,

Forming a bay with the distal free end, and

Passing the bight through the two loops formed by the two turns such that a first loop forms on the side of the two loops facing away from the proximal free end, while the distal free end is in effect on the proximal end facing side of the two loops Slings and points towards the proximal free end,

Tightening of the knot by exerting a tensile force between the first loop and the proximal free end of the thread.

According to common usage, a bay is formed when a thread is laid in hairpin form as shown in Fig. 15:

When a thread describes a full circle around an object as shown in Fig. 16, this is a (round) turn, as commonly used.

Preference is given to a node which is characterized by the further steps: Passing the distal free end through the first loop and

Exerting a pulling force on the proximal free end of the thread such that the first loop is pulled back towards the proximal free end by the two loops and the thread portion originally forming the first loop stretches and the first loop thus dissolves while at the same time a distal one Thread section forms a second loop, which is enclosed by the two loops,

is formed.

A node of the type claimed is shown in Figures 1 and 22. As can be seen in particular from FIG. 22, the claimed node differs from the node depicted in FIG. from EP 0 870 469 B1, FIG. 5 or from EP 0 887 045, also FIG. 5 is known.

A method according to the invention for producing a surgical node comprises the steps:

Forming two turns with the distal free end laid towards the proximal free end so that they wrap around the surgical thread twice in the direction of the proximal free end,

Forming a bay with the distal free end

Passing the bight through the two loops formed by the two turns such that a first loop forms on the side of the two loops facing away from the proximal free end, as a result the distal free end faces on the proximal end - A -

Side of the two loops and points towards the proximal free end,

and preferably the further steps:

Passing the distal free end through the first loop and

Exerting a pulling force on the proximal free end of the thread such that the first loop is pulled back towards the proximal free end by the two loops and the thread portion originally forming the first loop stretches and the first loop thus dissolves while at the same time a distal one Thread section forms a second loop, which is enclosed by the two loops.

A separate aspect of the invention is a device for generating a surgical node with means for:

Forming a bay with the distal free end, and

Passing the bay through the two loops formed by the two turns such that a first loop forms on the side of the two loops facing away from the proximal free end, while as a result, distal free end is located on the proximal end facing side of the two loops and facing towards the proximal free end,

Preferably, the device further comprises means for:

Passing the distal free end through the first loop and

Exerting a pulling force on the proximal free end of the thread such that the first loop is retracted towards the proximal free end by the two loops and is originally the first one

Loop forming thread section stretches and the first strand thus dissolves, while at the same time a distal thread portion forms a second loop, which is enclosed by the two loops.

In particular, the device preferably comprises

a helical thread guide, which is formed by a hollow body which is open at least at one of the two front ends and has an interior space for the thread which is formed into the HeNx and which is rotatable about the longitudinal axis of the HeNx,

and a rod-shaped first thread manipulator arranged within the HeNx and rotatable about its own longitudinal axis parallel to the longitudinal axis of the HeNx and longitudinally displaceable relative to the HeNx, which has a cavity enclosed on the front face of the first thread manipulator and enclosed by a circumferential wall, wherein the circumferential wall a longitudinal slot extending up to its front side, two notches for receiving the thread on its front side and remote from the front side has a transverse slot extending transversely to the longitudinal slot, which is deeper than the wall thickness of the peripheral wall

and a second thread manipulator, which is arranged inside the cavity and can be displaced longitudinally relative to the first thread manipulator, with a thread take-up extending transversely to the end face thereof and one for

End face of the second thread manipulator towards open, extending between opposite lateral surfaces of the second thread manipulator transverse to the thread receiving transverse groove, which is seen from the end face of the second thread manipulator from deeper than the Fadenauf- would take.

Preferably, in the peripheral wall of the first yarn manipulator, a groove is recessed, which extends in at least approximately two turns helically from one of the two notches to the transverse slot.

The claimed and alternative embodiments of the invention will be explained in more detail below.

For an explanation of the terms used, an overview of common terms in connection with nodes is given below:

Eye: If a thread is laid, as in Fig. 17, so that it intersects itself, an eye is formed.

Bay: If a thread is laid in hairpin form as in FIG. 18, a bay is created.

Turn: If a thread describes a full circle around an object, as seen in Fig. 19, this is a (round) turn. Loose end: The part of the thread that is not fixed and that is used to make a knot. An example of a fixed and loose end can be seen in FIG.

Stitch If one leads a loose end through an eye or a bay as shown in Fig. 21, one speaks of a sting.

Of the figures:

FIG. 1a is an illustration of the preferred knot according to the invention in the case of an overlapping knotted technique; FIG.

FIG. 1 b: an illustration of the preferred knot according to the invention with uniform tension at both ends; FIG.

FIG. 2 a shows a representation of an alternative node in overlapping / overdrawn node technique; FIG.

Fig. 2b: a representation of the alternative node with uniform

Train at both ends;

Figures 3a to c: an illustration of the two stages for making a medical throw-over knot;

4 shows an illustration of the method steps for producing the knot according to the invention until the formation of a loop;

5 shows an illustration of the production of a finished knot starting from a thread with a loop produced according to FIG. 3; Fig. 6: a schematic illustration of a to be sewn by

Fabric passed through fades with two free ends to be knotted;

7 shows an explanation of the method steps and occurring

Lagerkräfte when generating de node according to the invention in a schematic representation according to;

8 shows a preferred device according to the invention for automatically generating the node according to the invention;

Fig. 9: a first alternative device for automatically generating the node according to the invention;

10 shows a second alternative device for producing the node according to the invention;

Fig. 1 1 a and b: respectively a detailed view of a thread guide as part of the device of Fig. 7;

FIGS. 12a to c each show a detailed view of a first thread manipulator as part of the device according to FIG. 7;

FIGS. 13a to c each show a detailed view of a second thread manipulator as part of the device according to FIG. 7;

Fig. 14: an explanation of the operation of the device according to

Fig. 7 and 10 to 12 based on the method steps of an operating method for operating that device.

Fig. 15: an illustration of a bay;

Fig. 16: an illustration of a round turn; Fig. 17: an illustration of an eye;

Fig. 18: another illustration of a bay;

Fig. 19 is another illustration of a turn;

Fig. 20: an illustration of a loose end;

Fig. 21: an illustration of a stitch;

Fig. 22: an illustration of the knot according to the invention; and

Fig. 23: an illustration of one known from the prior art

Node.

Figures 1 a and 1 b show the knot of the invention formed by a distal portion of a suture 10, each having a distal free end 12. In Fig. 1 a formed by the thread bay 14 and two formed by one turn loops 16 can be seen.

Figures 2a and 2b show another node, which can be used in principle as an alternative to the claimed node, but is characterized by less advantageous properties.

The node has three properties that make it particularly suitable for automation:

The knot gets by with only one stitch; the loop knot at the proximal end is made entirely without a stitch. The only stitch of the knot is made with the distal end of the thread through the loop of the loop knot. The force for wound adaptation is separated from the force for node fixation. Wound adaptation is controlled by the distal thread, which transfers force to fix the knot via the proximal thread.

The knot contracts very evenly. The turns of the loop knot do not cross, as in the first variant of the double knot

Schotsteks is the case. This ensures that the knot achieves high strength and safety by pulling on the proximal end and simultaneously counteracting the knot.

The endoscopic union node is formed in two stages. A loop knot is first knotted in the proximal thread part, see FIG. 3a, with the aid of which the distal thread is passed through in the second step (FIG. 3b) and fixed, see FIG. 3c.

Fig. 4 shows how the thread for generating the node of FIG. 1 a can be placed. The result is a thread with a loop formed by a bay in the region of the distal end of the thread 10. With the last step shown in FIG. 3, a loop knot is completed and the knot is prepared for joining the two loose thread ends. Finally, in order to be able to close the wound by means of a thread with a knot according to FIG. 1a, the further steps illustrated in FIG. 4 are necessary.

Figs. 6 and 7 show the process steps for producing the node according to the invention when it is generated by a machine.

It is assumed that a situation in which the suture with simple strength is drawn through the wound edges, see Figure 6. The thread has a thread entry point and a thread exit point, and a proximal and a distal end. At the latter, the needle is usually attached. The proximal thread portion extends from the proximal end to the thread entry point and the distal thread portion from the distal end to the thread exit point. As an initial situation, assume a proximal thread part in the form of a straight line that is perpendicular stands to the wound level. The bearing forces are represented by a character common in mechanics, the closed side of the comb points in the direction of the applied force, see FIG. 6.

For a further differentiation of the sub-steps of the method for the automatic generation of the node according to the invention, it is expedient to introduce a card-based coordinate system in order to clearly describe the movements and forces. The origin of the coordinate system lies in the thread entry point, see Figure 6. The positive y-axis runs along the proximal portion of the thread, the z-axis is parallel to the wound edges. The Fadenaustrittstel- Ie is on the positive x-axis. To distinguish the two thread ends, the proximal end of the thread is marked with an "X" in the drawings.

FIG. 7 shows the partial steps of knotting the endoscopic throw-over knot. The substeps include either dynamic functions that move the thread or static hold or support functions. Simultaneous steps carry the same step number and are divided by a) and b). Once described, bearing forces are no longer shown in the following step for the sake of clarity, but continue to apply. Dropping forces are marked with a corresponding character (see Figure 6). The description is made with the help of the introduced with Figure 6 coordinate system.

The steps 1 to 6 depicted in FIG. 7 show the generation of the loop node up to the state depicted in FIG. 1 a or in the last illustration in FIG. 4. The steps 7a to 8 shown in Fig. 7 finally show the closing of the knot.

Fig. 8 shows the essential components of a preferred device 20 for automatically generating a knot of the type according to the invention. These components are a thread guide 22, a first thread manipulator 24 and a second thread manipulator 26. These components are explained in more detail below with reference to FIGS. 11 to 13 below.

The thread guide 22 is a hollow spiral through which the suture passes. This spiral winds two turns around the tubular first yarn manipulator 24. The yarn is located in the yarn guide 22 from the beginning. Counterclockwise rotation brings the yarn into the center of the yarn guide 22. The first yarn guide 24 is provided with a groove 54. which holds the turns axially and at the same time serves the translational propulsion of the first thread guide 24 itself. A notch on the front of the tube grips the thread on the spiral exit and holds it firmly. The thread guide 22 winds in the following turns on propulsion, the first thread guide 24 from. The last turn is placed in a transverse slot 48 so that the second thread manipulator 26 can grip the thread 10 and push it forward to form the bay 14.

Figures 9 and 10 show the essential components of alternative devices for producing the knot of the invention.

The embodiment according to FIG. 9 comprises a spool of thread 60, which is fastened to a disc 62 and moves in a circular path around a tube 64. The tube 64 has two lumens 66 and 68, each slotted to engage the thread. In a lumen 66 is a thread catcher 70.

The operation is as follows: The tube 64 moves out and takes the thread in a notch 72 on its front side. Meanwhile, the disc 62 rotates with the spool of thread 60 above the tube 64 and deposits turns thereon. The last coil is placed in a proximal notch 74 in the tube so that the thread follower 70 can grasp the thread with its nose and push it forward to form the bay. The disc 62 is slotted to slide over the proximal portion of the thread and release the knot. By return When the disc 62 is moved, the distal portion of the thread is pulled through the knot. Finally, the tube 64 is withdrawn.

The embodiment according to FIG. 10 comprises a flexible hollow spiral 80, which due to the material, such as, for example, a flexible preformed PE tube or a shape memory alloy, can also be brought into a straight shape in addition to the depicted helical shape. When sliding out of an outer tube 82, the hollow spiral (more precisely: -helix) 80 assumes its helical shape. The thread runs in the interior of the hollow spiral 80 and is placed in the middle of the helix during the sliding out through the hollow spiral 80 itself. If the hollow spiral 80 is fully extended, a tube 84 is inserted on the in the following step, the turns are unwound. The thread is held at the end face of the tube 84 by a helically circumferential groove 86. Axially, the thread is fixed by a thread. A hook 88 brings the bay through the tube.

FIGS. 11 to 13 show details of the preferred embodiment according to FIG. 8.

As can be seen from FIG. 11, an essential component of the thread guide 22 illustrated in FIG. 11 is a hollow body 30 which has an interior 32 for receiving the thread 10. The thread guide 22 serves to guide the thread spirally around an object. To reduce the frictional forces between the thread and the hollow body 30, the hollow body 30 is designed as an inwardly open U and the thread is guided only by four webs 34 per turn, see Figure 1 1 b.

FIG. 12 shows that the first thread manipulator 26 arranged within the helix formed by the thread guide 24 has a peripheral wall 40 which encloses a cavity 42. The peripheral wall 40 has a longitudinal slot 44 extending to its front side. In addition, two notches 46 are provided on the front side of the peripheral wall 40, which serve to receive the thread 10. A bit away from the front of the fangswandung 40 runs a transverse slot 48 in the longitudinal slot 44. It should be noted that it is not essential for the function that a longitudinal slot 44 runs exactly parallel to the longitudinal axis of the first yarn manipulator 24.

In addition, on the outside of the circumferential wall 40, a groove 54 extends, which extends in two Helixwindungen from one of the notches 46 to the transverse slot 48.

The first thread manipulator 24 has the function of keeping the unwound turns open and holding the thread during unwinding. The notches 46 (see Fig. 12c) on its front face serve to grasp and hold the thread. The helical groove 54 running on the outside of the outer wall 40 of the first thread manipulator 24 serves to hold the turns axially. After two turns, the groove opens into the transverse slot 48 (see FIG. 12b), which allows the second thread manipulator 26 to grasp the thread.

Fig. 12b shows the transverse slot 48 in detail. FIG. 12 c shows details of the front side of the first thread manipulator 24.

FIG. 13 shows details of the second yarn manipulator 26. The second yarn manipulator 26 is arranged longitudinally displaceably in the cavity 42 of the first yarn manipulator 24. FIG. 13a is a perspective view, FIG. 13b is a side view, and FIG. 13c is a plan view of the second thread manipulator 26.

A thread take-up 50 runs transversely to the end face of the second thread manipulator, and in FIG. 13 a the bay of the thread 10 is inserted into this thread take-up 50. Transverse to the thread take-up 50 runs a transverse groove 52, which is open toward the end face of the second thread manipulator 26 and has a bottom formed by a bore 56, which is farther from the distal end of the second thread manipulator 26 than the bottom of the thread take-up 50. The second thread manipulator 26 has the function of pushing the bay 14 of the loop knot forward. With its beak-shaped end face (see FIG. 13b), it picks up the thread and pushes it through the cavity 42 of the first thread manipulator 24. In order to be able to push the distal thread through the bay, a hole 56 is formed through the top second yarn manipulator 26 is provided, which forms the bottom of the open towards the end transverse groove 52, see Fig. 13c). On two opposite longitudinal sides of the second thread manipulator 26 are two thread guide channels 58 for the thread, which pass into the thread receiving 50.

Finally, FIG. 14 shows in detail how the yarn guide 22, the first yarn manipulator 24 and the second yarn manipulator 26 cooperate in order to automatically tie the knot according to the invention.

Claims

claims

1. Surgical node, produced by:

Forming a bay with the distal free end, and

Passing the bay through the two formed by the two turns

Looping so as to form a first loop on the side of the two loops facing away from the proximal free end, as a result the distal free end being located on the side of the two loops facing the proximal end and pointing in the direction of the proximal free end,

2. surgical node according to claim 1, produced by the further steps:

Passing the distal free end through the first loop and

Exerting a pulling force on the proximal free end of the thread such that the first loop is pulled back towards the proximal free end by the two loops and the thread portion originally forming the first loop stretches and the first loop thus dissolves while at the same time a distal one Thread section a second

Forms a loop, which is enclosed by the two loops.

3. A method of creating a surgical node comprising the steps of:

Forming a bay with the distal free end

Passing the bight through the two loops formed by the two turns so that a first loop forms on the side of the two loops facing away from the proximal free end while the distal free end is on the proximal end facing side of the two loops and pointing in the direction of the proximal free end,

Tighten the knot by exerting a tensile force between the first

Loop and the proximal free end of the thread.

4. The method according to claim 3, characterized by the further steps:

Passing the distal free end through the first loop and

5. Apparatus for generating a surgical knot with means for: Presenting a surgical thread having two free ends, one free end forming a proximal end and the other free end forming a distal end,

Forming a bay with the distal free end, and

6. Apparatus according to claim 5, characterized by means for:

Passing the distal free end through the first loop and

7. Device according to claim 5 or 6, characterized in that the device

a helical thread guide (22), which is formed by a hollow body (30) which is open at least at one of the two ends and has an interior space (32) for sewing the thread, which is shaped to the HeNx and is rotatable about the longitudinal axis of the HeNx,

as well as one within the HeNx arranged and parallel to

Longitudinal axis of the HeNx about its own longitudinal axis rotatable and relative to the HeNx longitudinally displaceable, rod-shaped first thread manipulator (24),

the one on the front side of the first thread manipulator (24) open, enclosed by a peripheral wall (40)

Having cavity (42),

wherein the peripheral wall (40)

a reaching to its front longitudinal slot (44)

on its front side two notches (46) for receiving the

thread

and remote from the front side has a transversely to the longitudinal slot (44) extending transverse slot (48) which is deeper than the wall thickness of the circumferential wall

and a second thread manipulator (26) arranged inside the cavity (42) and longitudinally displaceable relative to the first thread manipulator (24).

with a thread take-up (50) extending transversely to its end face

and an open towards the end face of the second yarn manipulator, between the opposite Mantelflä- Chen the second thread manipulator transverse to the thread receiving (50) extending transverse groove (52), which is seen from the end face of the second thread manipulator (26) from deeper than the thread take-up (50).

8. The device according to claim 7, characterized in that in the circumferential wall of the first thread manipulator (24) a groove (54) is embedded, which in at least approximately two turns helically from one of the two notches (46) to the transverse slot ( 48).