Device for intracorporal application of medical aids

p0001The invention relates to a device for the intracorporal application of medical aids, in particular plastics and wound dressings, with a hollow application tube for introducing the medical aid into the surgical area.

p0002In various fields of surgery, in particular endoscopic surgery, it is necessary to introduce medical aids such as, for example, wound dressings or plastics, into the surgical area and to apply it in situ under cramped conditions.

p0003For example, it is known in hernia surgery (groin fracture surgery) to bridge the fascial gap to be occluded by means of a reticular tissue, which is introduced into the surgical area via a trocar sleeve. For this purpose, the tissue network is rolled up or folded by hand and inserted into the trocar sleeve and pushed to the operating area by means of a forceps. A disadvantage of this described method is, in addition to the great manual effort for the rolling or folding and subsequent introduction of the thus reduced tissue into the trocar sleeve, the danger that the tissue is damaged when inserted into the trocar sleeve.

p0004The invention is based on this <b>task</b> To provide a device for the intracorporal application of medical aids, which ensures a safe application of the medical device in the surgical area in the case of simple handling.

p0005According to the invention, the solution of this task position is characterized by a winding insert which can be inserted into the hollow application tube and is displaceable in the longitudinal direction of the application tube and onto which the medical aid to be applied can be wound.

p0006By the use according to the invention of the winding insert insertable into the application tube, it is possible for the first time to dispense with manual rolling or folding of the medical aid to be applied. The winding insert, together with the medical aid wound onto the wound insert, is furthermore displaceable in the longitudinal direction of the application tube in order to move the medical aid toward the operative region.

p0007With a practical embodiment of the invention, it is proposed that the winding insert and the application tube can be rotated relative to one another in the inserted state about the longitudinal axis of the instrument. This mutual rotatability of the components facilitates the winding and unwinding of the medical aid onto the winding insert or the winding insert.

p0008In order to determine the medical aid on the winding insert, a first embodiment of the invention proposes that the medical aid can be fixed to the winding insert, for example by forming a slot in the winding insert for receiving an end of the medical aid.

p0009According to an alternative embodiment, the medical aid is fixed to the wound insert via a through-through slot, which is formed in the wound insert, into which the medical device can be inserted.

p0010According to a practical embodiment of the invention, it is proposed that at least the winding insert is designed as a wire pin, preferably made of a Ni-Ti material, which can be inserted into the application tube in the region which receives the medical aid.

p0011In order to facilitate the handling of the device according to the invention, it is further proposed with the invention that the winding insert can be inserted in the axial direction into the application tube in predetermined latching steps. These latching stages represent predetermined insertion depths of the winding insert into the application tube, for example an insertion and an application position, and thus enable safe and uniform operation of the device.

p0012Furthermore, the invention proposes that at least one opening extending in the axial direction for introducing the medical aid is formed in the application tube. This window-like opening in the application tube makes it possible to fix the medical aid on the winding insert with the coil insert inserted into the application tube. For this purpose, the medical aid is guided through the opening into the interior of the application tube and fixed, for example, with one end in the slot of the winding insert. By subsequent twisting of the winding insert and / or the application tube, the medical aid is drawn into the application tube and wound around the wound insert.

p0013According to a practical embodiment of the invention, two openings, which are arranged approximately opposite one another and extend in the axial direction, are formed in the application tube. Particularly in the case of large and long medical auxiliaries, this embodiment is advantageous since it allows the medical aid to be wound up more quickly on the wound insert. For this purpose, the medical aid is guided through an opening into the interior of the application tube and is pulled through the continuous slot of the winding insert until the medical aid emerges from the application tube's opposite opening of the application tube. By subsequent twisting of the winding insert and / or of the application tube, the medical aid is drawn into the application tube and wound double-wise around the wound insert.

p0014The operation of the application tube and of the winding insert, in particular during mutual rotation of the components, can be facilitated according to the invention in that a handle is arranged at the proximal end of the application tube and / or the winding insert.

p0015Finally, the invention proposes that the medical device be a network plastic for a hernia surgery or the like. In the hernia surgery, the netplastics or mesh implants, which are made of body or body, are used to bridge the corresponding fascia gap.

p0016Further features and advantages of the invention can be gathered from the accompanying drawing in which two exemplary embodiments of a device according to the invention for the intracorporal application of medical aids are shown by way of example only, without restricting the invention to these exemplary embodiments. In the drawing: FIG.<dl id="dl0001"><dt>FIG</dt><dd>5 shows a side view of an apparatus according to the invention for the intracorporal application of medical aids;</dd><dt>FIG</dt><dd>11 is a longitudinal section along the line II-II according to FIG <figref idrefs="f0001">FIG</figref>;</dd><dt>FIG</dt><dd>3 is an enlarged cross-sectional view taken along the line III-III in FIG <figref idrefs="f0001">FIG</figref>;</dd><dt>FIG</dt><dd>a <figref idrefs="f0003">FIG</figref> Corresponding sectional view, but illustrating a second embodiment according to the invention;</dd><dt>FIG</dt><dd>7 shows a schematic representation of the winding of the medical aid onto a winding insert according to FIG <figref idrefs="f0003">FIG</figref> and</dd><dt>FIG</dt><dd>7 shows a schematic representation of the winding of the medical aid onto a winding insert according to FIG <figref idrefs="f0003">FIG</figref>.</dd></dl>

p0017The in the pictures <figref idrefs="f0001">FIG</figref> and <figref idrefs="f0002">2</figref> Is essentially composed of a hollow outer application tube 1 and a winding insert 2 which can be inserted into the application tube 1 and is displaceable in the longitudinal direction of the application tube 1. The device according to the invention,

p0018As in particular <figref idrefs="f0004">FIGS. 5 and 6</figref> , The winding insert 2 is used to hold a medical aid 3, which is introduced into the operating region via the application tube 1. For this purpose, the medical aid 3 is fixed on the winding insert 2 and wound onto the winding insert 2 before the medical aid 3 is subsequently fed into the operating region through the application tube 1 in this state wound on the winding insert 2.

p0019The medical aid 3 is fixed on the winding insert 2 in the embodiment shown in FIG <figref idrefs="f0003">FIG</figref> , Through a continuous slot 4 formed in the winding insert 2, through which the medical aid 3 is pushed until the medical aid 3 protrudes from the slot 4 on both sides, preferably with the same length. By turning the winding insert 2, the medical aid 3 can now be wound up on the winding insert 2 in a double-acting manner, as shown schematically in FIG<figref idrefs="f0004">FIG</figref> Is shown.

p0020According to the embodiment shown in FIG <figref idrefs="f0003">FIG</figref> The fixing of the medical aid 3 on the winding insert 2 is effected in such a way that a slot 5 is formed in the winding insert 2 into which one end of the medical aid 3 can be inserted. By turning the winding insert 2, the medical aid 3 can now be wound up on the winding insert 2 in a simple manner, as shown schematically in FIG<figref idrefs="f0004">FIG</figref> Is shown.

p0021The medical aids 3 can, for example, be wound dressings or plastics which are introduced into the operating area in a combined form and are only spread in situ on the operating area and applied to the corresponding application site.

p0022An application area for this device is, for example, hernia surgery in which the medical device is designed as a net plastic or mesh implant consisting of body-borne or non-body tissue in order to bridge the corresponding fascia gap.

p0023However, in principle, all surgical fields of application in which a wound site or opening is to be bridged and / or closed by means of a flat medical aid 3, as for example in the case of surgery in the abdominal cavity during gastric or intestinal breakthroughs, or in fetoscopy for closing the spina bifida . However, the intracorporal treatment of wounds, for example fetal head wounds, with patches and similar flat wound dressings, is also possible with this device.

p0024In addition to the possibility of winding the medical aid 3 outside the application tube 1 onto the winding insert 2 and only subsequently inserting the winding insert 2 wrapped with the medical aid 3 into the application tube 1, the preferred one is shown in the figures <figref idrefs="f0001 f0002 f0003 f0004">FIG. 1 to FIG. 6</figref> , The medical aid 3 can only be fixed to the winding insert 2 in the state of the winding insert 2 inserted in the application tube 1 and wound onto the winding insert 2.

p0025For this purpose, at least one window-like opening 6 extending in the axial direction of the application tube 1 is formed in the jacket surface of the application tube 1, through which the medical aid 3 can be introduced into the application tube 1 for the purpose of being fixed on the winding insert 2, <figref idrefs="f0001">FIG</figref> Is shown. In the case of the<figref idrefs="f0001">FIG</figref> , The window-like opening 6 is designed as a gap 6, but other embodiments are also possible which make it possible to insert the medical aid 3 into the application tube 1 for fixing on the winding insert 2. In the embodiment shown in FIG.

p0026For the <figref idrefs="f0003">FIG</figref> and <figref idrefs="f0004">6</figref> , In which the medical aid 3 is wound in a single loop around the winding insert 2, it is sufficient to form only one gap 6 in the application tube 1. The in the pictures<figref idrefs="f0003">FIG</figref> and <figref idrefs="f0004">6</figref> Shown differ, however, with regard to the slots 4 and 5 formed in the winding insert 2 <figref idrefs="f0003">FIG</figref> In the winding insert 2, only one slot 5 is formed, into which one end of the medical aid 3 can be inserted, in the embodiment according to FIG <figref idrefs="f0004">FIG</figref> A continuous slot 4 is formed in the winding insert 2, through which the medical aid 3 can be inserted. This embodiment provides a better support for the medical aid 3 fixed to the winding insert 2 than the use of the non-continuous slot 5.

p0027In the <figref idrefs="f0002">FIG</figref> and <figref idrefs="f0004">5</figref> With the continuous slot 5 formed in the winding insert 2 and the double-wound medical aid 3 requires two gaps 6 in the application tube 1 so that the medical aid 3 can also project out of the application tube 1 on both sides after being fixed in the slot 5 of the winding insert 2.

p0028The winding of the medical aid 3 thus fixed on the winding insert 2 onto the winding insert 2 is subsequently effected by rotating the winding insert 2 and / or the application tube 1 around the longitudinal axis 7 of the instrument, the application tube 1 being rotated in the event that both components 1 and 2 are rotated And the winding insert 2 must be rotated in opposite directions. By means of this rotation of at least one component 1 or 2 relative to the other component 2 or 1, the medical aid 3 fixed on the winding insert 2 is drawn into the application tube 1 and wound in layers around the winding insert 2.

p0029In order to ensure that the winding insert 2 can also be axially displaced with the medical aid 3 wound up thereon in the application tube 1, the winding insert 2 is designed at least in the area receiving the medical aid 3 as a wire pin reducing the diameter of the winding insert 2, as shown in FIG <figref idrefs="f0002">FIG</figref> Can be found. Differing from the illustrated shape of the wire pin with a circular cross-section, other cross-sectional shapes can, of course, also be implemented.

p0030In the other partial regions, the winding insert 2 is advantageously designed in the form of a tube, the outer diameter of the winding insert 2 essentially corresponding to the inner diameter of the application tube 1 in order to ensure good and cantilever-free guidance of the winding insert 2 in the application tube 1.

p0031The operation of the application tube 1 and of the winding insert 2, in particular the twisting of the components 1 and 2, is facilitated in the illustrated embodiment in that a handle handle 8, which is designed as ergonomically as possible, is arranged at the proximal end of both the application tube 1 and the winding insert 2.

p0032The assembly and operation of the device for the intracorporal application of medical aids as described above is as follows:<ul><li>In the first working step, the winding insert 2 with the distal end is inserted from the proximal end into the hollow application tube 1 until the winding insert 2 reaches the position shown in FIG <figref idrefs="f0001">FIG</figref> , In which the continuous slot 4 formed in the winding insert 2, or else only the one-sided slot 5, is arranged in the region of the at least one window-like gap 6 of the application tube 1.</li></ul>

p0033In order to keep the correct insertion depth of the winding insert 2 into the application tube 1 for this first working step and also the subsequent working steps, as shown in FIG <figref idrefs="f0001">FIG</figref> In the illustrated embodiment, different detent stages 9 are formed on the winding insert 2, each detent stage 9 corresponding to a certain insertion depth of the winding insert 2 into the application tube 1 and marking a corresponding working step.

p0034After insertion of the winding insert 2 into the application tube 1 up to the previously described first detent stage, the medical aid 3 is subsequently fixed on the winding insert 2, for example by being passed through the through-through slot 4, as shown in FIG <figref idrefs="f0002">FIG</figref> Is shown. Subsequently, the winding insert 2 and / or the application tube 1 are rotated relative to one another about the instrument longitudinal axis 7, as a result of which the medical aid is drawn into the application tube 1 and is wound onto the winding insert 2.

p0035In the next step, the wound insert 2 provided with the wound medical aid 3 is pushed further into the application tube 1 in the distal direction until a second detent stage 9 is reached in which the medical aid 3 is arranged inside the application tube 1, At least one gap 6 of the application tube 1 can be unwound from the winding insert 2.

p0036In this working position, the application tube 1 with the inserted coil insert 2 is introduced, for example via a trocar sleeve, into the operating region. In the operating region, the winding insert 2 is now pressed into the application tube 2 as far as the third latching stage 9, in which the coil insert 2, which is wrapped with the medical aid 3 to be applied, emerges again from the application tube 1 on the distal side. The medical aid 3 can now be detected, for example, by means of a gripping forceps. By rotating the winding insert 2, the medical aid 3 can now be unwound simply and securely in place from the winding insert 2 and applied to the surgical site to be supplied.

p0037A device of this kind for the intracorporal application of medical aids 3 is distinguished by the fact that, with simple construction and simple handling, it ensures a safe and gentle transport of the medical device 3 to be applied to the surgical site.

<u>Reference list</u>

p0038<dl id="dl0002"><dt>1</dt><dd>Application tube</dd><dt>2</dt><dd>Wrap insert</dd><dt>3</dt><dd>medical tool</dd><dt>4</dt><dd>Slot (through)</dd><dt>5</dt><dd>slot</dd><dt>6</dt><dd>Opening / gap</dd><dt>7</dt><dd>Instrument longitudinal axis</dd><dt>8th</dt><dd>Hand grip</dd><dt>9</dt><dd>Locking stage</dd></dl>