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WO2007018520A1 - Dispositif porteur de ligature rétropubienne de vessie - Google Patents

Dispositif porteur de ligature rétropubienne de vessie Download PDF

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Publication number
WO2007018520A1
WO2007018520A1 PCT/US2005/026991 US2005026991W WO2007018520A1 WO 2007018520 A1 WO2007018520 A1 WO 2007018520A1 US 2005026991 W US2005026991 W US 2005026991W WO 2007018520 A1 WO2007018520 A1 WO 2007018520A1
Authority
WO
WIPO (PCT)
Prior art keywords
trocar
stand
retropubic
rod
triangular
Prior art date
Application number
PCT/US2005/026991
Other languages
English (en)
Inventor
M.D. Darius Samimi
Original Assignee
Samimi M D Darius
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 Samimi M D Darius filed Critical Samimi M D Darius
Priority to PCT/US2005/026991 priority Critical patent/WO2007018520A1/fr
Publication of WO2007018520A1 publication Critical patent/WO2007018520A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
    • A61B17/12013—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0482—Needle or suture guides
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/062—Needle manipulators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00743—Type of operation; Specification of treatment sites
    • A61B2017/00805—Treatment of female stress urinary incontinence
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A61B2017/0472—Multiple-needled, e.g. double-needled, instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B2017/06052—Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06066—Needles, e.g. needle tip configurations
    • A61B2017/061—Needles, e.g. needle tip configurations hollow or tubular

Definitions

  • the present invention relates generally to surgery apparatuses and devices which a physician utilizes to perform an operation through bodily tissues, especially in the treatment of female urinary incontinence.
  • the present invention is directed to a bladder saver retropubic ligature carrier device having a stand or base and a trocar or needle with a cutting tip for cutting into bodily tissue.
  • the bladder saver retropubic ligature carrier device of this invention is compact, easily adaptable to a variety of surgical procedures, and represents a cutting-edge surgical tool capable of being used in traditional as well as newly pioneered operations for treating female urinary incontinence disorders.
  • the superior wall of the vagina is sutured to the abdominal wall rather than sutured in the retropubic region.
  • the modified Pereyra procedure involves the use of a ligature carrier having a brace to guide a retractable needle for extension and retraction.
  • the brace includes a generally flat serrated or striated brace handle from which parallel guides extend back, away from the needle tip.
  • the needle's end is angulated and has an eye at its tip. The needle slides through a hole in the brace handle.
  • the vaginal fascia used to elevate the urethro-vesical angle and the vaginal fascia near the urethra are sutured to Cooper's ligament and the ilecpectineal ligament after dissection in retzius space.
  • Endoscopic suspension was first described in 1973 by Stamey.
  • the innovation was to emphasize the use of the cystoscope to control accurate placement of the suspending sutures.
  • a T-shaped vaginal incision is made in the anterior vaginal wall and the periurethral tissue exposed.
  • the specially designed Stamey needle is introduced through the rectus fascia.
  • Cystoscopic inspection is performed with movement of the needle.
  • Small dacron buttresses are used to prevent suture pull through.
  • Dacron tubes are used to buttress the endopelvic fascia.
  • the present invention is utilized to anchor the bladder neck with suspending sutures to the edge of pubic bone on the Scarpa fascia and rectus abdominus tendinous plus Cooper ligament. It is recognized that the present invention has been specially adapted to serve as a necessary apparatus for successfully performing the new procedure. As a result of employing the present invention in combination with the new procedure, a surgeon should expect patients to exhibit increased support and remarkable scarification after the operations.
  • a special long suspension needle is passed through the anterior Scarpa fascia, then the rectus tendinous abdorninus and the Cooper ligament, toward the undersurface of the symphysis pubis, the retropubic fat pad and the endopelvic fascia and the vaginal wall into the vagina, lateral to the urethrovesical junction, under direct finder guidance.
  • a No.2 monofilament nylon suture is threaded through the needle's eye, withdrawn to a suprapubic port, and tagged with a hemostat clamp.
  • the vaginal side tail of the nylon suture is loaded with a Mayo or curve needle.
  • the suture is placed in a circular or spiral fashion incorporating full thickness in the vaginal wall 1-1.5 cm. on the lateral side of the urethrovesical level.
  • the suture end is replaced on the long needle eye and withdrawn through the second puncture on the junction of the Scarpa fascia and the edge of the symphysis pubis, 1.0 cm. from the first puncture and tagged with a hemostat.
  • the rigid cystoscopy assists in confirming that adequate support has been given to the urethra and bladder neck. If the suspension sutures have unintentionally penetrated the bladder wall, such a case is noticed at the time so the cystoscope and suture can be pulled out and the operation can be repeated. Also, the lateral aspect at 3 and 9 o'clock of the urethrovesical junction and the lower bladder must be seen clearly with no oozing or bleeding and no suture violation. If there is suture violation, the surgeon can pull it out and re-attempt correct placement.
  • a suprapubic catheter with memory must be placed under the supervision of the cystoscopy surgeon. The catheter must be fixed with several sutures for prevention of dislodging or extravasation. Care must be taken to ensure that the catheter functions satisfactorily.
  • the monofilament sutures are tied over a reinforced 1-1.5 cm. Scarpa fascia and the rectus abdominus tendinous attached to the pubic bone. After pushing or bringing the urethrovesical junction to the retropubic space or normal position, moderate tension is required to furnish the support necessary to treat urinary stress incontinence.
  • a surgeon utilizing the present invention restores the anatomical and physiological position of the proximal urethra, in such a fashion, as to allow transmission of intra-abdominal pressure.
  • Urethral closure pressure is enhanced at least to the same degree and sometimes to a greater degree than normal.
  • a bladder saver retropubic ligature carrier device for the carrying out procedures to treat female urinary incontinence.
  • the present invention includes a double-pronged stand and a special trocar.
  • one of the objects of the present invention is to provide a bladder saver retropubic ligature carrier device for reducing the duration of operation procedures by up to 53 percent, while preventing bladder violation.
  • Another of the objects of the present invention is to provide a bladder saver retropubic ligature carrier device which is capable of granting the surgeon increased dexterity and greater surgical accuracy.
  • Yet another of the objects of the present invention is to provide a bladder saver retropubic ligature carrier device which is capable of facilitating the operation's sling procedure.
  • Still another of the objects of the present invention is to provide a bladder saver retropubic ligature carrier device which provides overall better operational results because less repeat procedures are required.
  • a further object of the present invention is to a provide bladder saver retropubic ligature carrier device which assists the surgeon in maintaining low morbidity and complications.
  • Another object of the present invention is to provide a bladder saver retropubic ligature carrier device for the purposes described which has a mechanism to avoid needle stick of the surgeon's fingers.
  • FIG. 1 is an elevational perspective view of one embodiment of the present invention, showing a stand next to a modified trocar.
  • FIG. 2 is an exploded elevational perspective view of FIG. 1, illustrating one method of handling of the present invention.
  • the present invention will be seen to relate to a bladder saver retropubic ligature carrier device 10 of unique design.
  • the present invention is comprised primarily of a cast metal stand 20 and one or a plurality of trocar rods 40 or 42.
  • the bladder saver retropubic ligature carrier device 10 has a primary purpose of enabling a surgeon to pass through retropubic anatomy (not shown) without posing a danger of bladder (not shown) and vessel (not shown) injury.
  • the stand 20 is designed to serve as a bridge for the trocar 30 during an operation. hi a preferred embodiment of the present invention, as shown in FIG. 1, the stand 20 is composed of a base portion 21 of a cubical conical configuration with an exaggerated planar member 25. Base portion 21 serves as a holder for the surgeon's fingers 27, as shown in FIG. 2. The surgeon's fingers 27 are placed above and below the planar member 25 to allow a premium of movement for the stand 20.
  • Apertures or passageways 22 extend downward through base portion 21 for receiving a pair of metal trocar rods 40.
  • rods 40 emerge from corresponding apertures or outlets (not shown) located on the bottom side of base portion 21.
  • Rods 40 are set parallel to one another and joined together via brace 50 near the upper end of stand 20.
  • Brace 50 is a fixed connection between rods 40, thus forming a stint or stylet in combination with rods 40.
  • Metal rods 40 have cutting tips 45 disposed below the lower end of stand 20. Each cutting tip 45 comprises a planar angular slash across the lower end of the trocar rod 40 for providing a smooth knife-like shape for enabling the trocar rod 40 to cut directly into bodily tissue.
  • the planar member 25 extends at approximately a 20 degree angle from the plane of trocar rods 40 when rods 40 are resident in passageways 22 . During operation procedures, the surgeon can reliably manipulate the stand 20 by placing fingers 27 above and below planar member 25 and rods 40 in the manner shown in FIG. 2.
  • a modified trocar 30 may replace one or both trocar rods 40 in base portion 21, such that modified trocars 30 extend through passageways 22.
  • a modified trocar 30 can be accurately guided inside a patient's body as the surgeon employs stand 20.
  • Modified trocar 30 has a cutting tip 60 which has a spiral shape resembling a screw thread for screwing into bodily tissues, as opposed to cutting directly into such tissues. Spiral tip 60 creates a less invasive entrance than a trocar tip having a knife-like shape. Unlike a knife-like trocar, modified trocar 30 can be twisted as it penetrates bodily tissue so that spiral tip 60 makes a gradual entrance. Modified trocar 30 has a striated handle 70 which assists the surgeon in maintaining his grip as modified trocar 30 is twisted or rotated. Striated handle 70 is of general cylindrical shape with a series or parallel ridges 82 running the length of its cylindrical shape for providing improved gripability.
  • Modified trocar 30 has an eye (passageway)80 located above spiral tip 60 for receiving a suture (not shown).
  • Trocar rods 40 may also be provided with similar eyes located above their cutting tips 45 for receiving sutures (not shown).

Landscapes

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

Abstract

La présente invention se rapporte à un appareil porteur (10) de ligature rétropubienne destiné à effectuer une opération à travers les tissus de l’organisme, en particulier dans le traitement de l’incontinence urinaire féminine. L’appareil (10) comprend un trocart (30) et un statif (20), servant comme un pont pour le trocart (30). Le statif (20) est muni d’une voie s’étendant verticalement (10) pour recevoir le trocart (30) et d’une partie de base (21) avec deux côtés de forme triangulaire et un membre plan (25) s’étendant après la partie de base (21) entre les deux côtés de forme triangulaire à un angle du plan du trocart (30), lorsqu’il réside dans ledit passage (22). Lors de l’utilisation, le médecin positionne ses doigts au-dessus et au-dessous dudit membre plan (25) pour guider doucement et précisément le trocart (30) dans le tissu de l’organisme.
PCT/US2005/026991 2005-07-28 2005-07-28 Dispositif porteur de ligature rétropubienne de vessie WO2007018520A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/US2005/026991 WO2007018520A1 (fr) 2005-07-28 2005-07-28 Dispositif porteur de ligature rétropubienne de vessie

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/US2005/026991 WO2007018520A1 (fr) 2005-07-28 2005-07-28 Dispositif porteur de ligature rétropubienne de vessie

Publications (1)

Publication Number Publication Date
WO2007018520A1 true WO2007018520A1 (fr) 2007-02-15

Family

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2005/026991 WO2007018520A1 (fr) 2005-07-28 2005-07-28 Dispositif porteur de ligature rétropubienne de vessie

Country Status (1)

Country Link
WO (1) WO2007018520A1 (fr)

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP2138108A1 (fr) * 2008-06-24 2009-12-30 Tyco Healthcare Group LP Outil d'assistance pour aiguille de perforation
US8500758B2 (en) 2007-02-20 2013-08-06 Covidien Lp Auxiliary device for a puncture needle
US8663278B2 (en) 2004-10-06 2014-03-04 Covidien Lp Organ fixing equipment
US8672955B2 (en) 2005-12-26 2014-03-18 Covidien Lp Medical suturing device
US8876840B2 (en) 2006-10-05 2014-11-04 Covidien Lp Medical suturing tool with multiple puncture needles

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5391156A (en) * 1992-06-30 1995-02-21 Ethicon, Inc. Flexible encoscopic surgical port
US5637112A (en) * 1992-06-08 1997-06-10 Orthopedic Systems, Inc. Apparatus for attaching suture to bone
US5817062A (en) * 1996-03-12 1998-10-06 Heartport, Inc. Trocar

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5637112A (en) * 1992-06-08 1997-06-10 Orthopedic Systems, Inc. Apparatus for attaching suture to bone
US5391156A (en) * 1992-06-30 1995-02-21 Ethicon, Inc. Flexible encoscopic surgical port
US5817062A (en) * 1996-03-12 1998-10-06 Heartport, Inc. Trocar

Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8663278B2 (en) 2004-10-06 2014-03-04 Covidien Lp Organ fixing equipment
US8672955B2 (en) 2005-12-26 2014-03-18 Covidien Lp Medical suturing device
US8876840B2 (en) 2006-10-05 2014-11-04 Covidien Lp Medical suturing tool with multiple puncture needles
US8500758B2 (en) 2007-02-20 2013-08-06 Covidien Lp Auxiliary device for a puncture needle
EP2138108A1 (fr) * 2008-06-24 2009-12-30 Tyco Healthcare Group LP Outil d'assistance pour aiguille de perforation
US8968343B2 (en) 2008-06-24 2015-03-03 Covidien Lp Puncturing needle assisting tool

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