Device for intracorporal application of medical aids

p0001The invention relates eine_Vorrichtung for intracorporeal application of medical devices, in particular sculptures and wound dressings, with a hollow application tube for introducing the medical device into the surgical area.

p0002In various fields of surgery, particularly endoscopic surgery, it is necessary medical aids, such as wound dressings or sculptures, engage in the surgical field and to apply on site in confined spaces.

p0003It is known for example in hernia operations (hernia surgery) the bridge to be closed fascia by a net-like web, which is introduced through a trocar into the surgical area. For this purpose, the fabric mesh is rolled by hand or folded and inserted into the trocar sleeve and pushed by means of a forceps to the operating area. A disadvantage of this procedure described is next to the large manual effort for the rolling or folding and subsequent insertion of the thus reduced tissue into the trocar sleeve is a risk that the tissue is damaged when inserted into the trocar.

p0004<patcit id="pcit0001" dnum="EP0625334A1"><text>EP 0625334 A1</text></patcit>. <patcit id="pcit0002" dnum="US5464403A"><text>US 5464403</text></patcit>. <patcit id="pcit0003" dnum="US5814058A"><text>US 5814058</text></patcit>. <patcit id="pcit0004" dnum="US5263969A"><text>US 5263969</text></patcit>. <patcit id="pcit0005" dnum="EP0581036A1"><text>EP 0581036 A1</text></patcit> and <patcit id="pcit0006" dnum="WO2007056297A2"><text>WO 2007/056 297 A2</text></patcit> disclose applicators with adjustable winding operations without resting stages.

p0005Proceeding from this, the invention, <b>task</b> seeks to provide a device for intracorporeal application of medical devices, which is a secure application of the medical aid guaranteed with simple handling at the surgical site.

p0006The solution of this task is represented in claim. 1

p0007The inventive use of insertable into the application tube winding insert is the first time possible to dispense with a manual rolling or folding of the to be administered medical aid. The winding unit and all the medical aids wound on the winding insert is also displaced in the longitudinal direction of the application tube to move the medical device to the operating area down.

p0008With a practical embodiment of the invention it is proposed that the winding insert and the application tube in the nested state the instrument longitudinal axis are rotated in opposite directions. This mutual rotatability of the components facilitates down the winding and unwinding of the medical device on the winding insert or from the winding insert.

p0009For fixing the medical accessory at the winding insert is provided with a first embodiment of the invention that the medical tool at the winding insert can be fixed, for example by forming a slot in the winding insert for receiving an end of the medical aid.

p0010In an alternative embodiment, the setting of the medical aid on winding insert a formed in the winding insert through slot in the medical device can be used is carried out.

p0011According to a practical embodiment of the invention it is proposed that the winding insert, at least in the medical device receiving region than can be inserted into the application tube wire pin, preferably made of a Ni-Ti-material, is formed.

p0012In order to facilitate handling of the device according to the invention, the winding insert can be inserted in predetermined latching steps in the axial direction into the application tube. These catch levels provide predetermined insertion depths of the winding insert into the application tube, for example, a male and an application position, is, enabling a safe and smooth operation of the device.

p0013It is also proposed with the invention that the application tube has at least one axially extending opening is formed for insertion of the medical aid. This window-like opening in the feed pipe allows the setting of the medical device on the winding use in winding insert is inserted into the application tube. To this end, the medical device is passed 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 rotation of the winding insert and / or of the application tube, the medical device is drawn into the application tube and wound around the winding insert.

p0014According to a practical embodiment of the invention in the application tube in about two mutually opposite, axially extending openings are formed. In particular for large long respectively medical goods This embodiment is advantageous because it allows a faster winding of the medical device on the winding insert. To this end, the medical device is guided through an opening in the interior of the application tube and drawn through the through slot of the winding insert, until the medical device from the opposite opening of the application tube emerges again from the application tube. By subsequently turning the winding insert and / or the application tube, the medical device is drawn into the application tube and wound double continuously around the winding applications.

p0015The operation of the application tube and the winding insert, especially during mutual rotation of the components, can according to the invention are relieved that the proximal end of the application tube and / or the winding insert is arranged a handle.

p0016Finally, the invention proposes that the medical device is a mesh repair for hernia surgery or the like. In hernia surgery which consists of autologous or alien to the body fabric mesh sculptures or mesh implants are used to bridge the corresponding fascia.

p0017Further features and advantages of the invention will be apparent from the accompanying drawings, which illustrate only by way of example in which two embodiments of a device for intracorporeal application of medical devices, without restricting the invention to these embodiments. In the drawings:<dl id="dl0001"><dt>Fig. 1</dt><dd>a side view of a device for intracorporeal application of medical devices;</dd><dt>FIG. 2</dt><dd>a longitudinal section along the line II-II according to <figref idrefs="f0001">Fig. 1</figref>;</dd><dt>Fig. 3</dt><dd>an enlarged cross-section along the line III-III in <figref idrefs="f0001">Fig. 1</figref>;</dd><dt>Fig. 4</dt><dd>a <figref idrefs="f0003">Fig. 3</figref> corresponding sectional view but illustrating a second inventive embodiment depicting;</dd><dt>Fig. 5</dt><dd>a schematic representation of the winding of the medical device according to a winding insert <figref idrefs="f0003">Fig. 3</figref> and</dd><dt>Fig. 6</dt><dd>a schematic representation of the winding of the medical device according to a winding insert <figref idrefs="f0003">Fig. 4</figref>,</dd></dl>

p0018The pictures in the <figref idrefs="f0001">Fig. 1</figref> and <figref idrefs="f0002">2</figref> illustrated apparatus for intracorporeal application of medical aids essentially consists of a hollow outer tube 1 and an insertable application into the application tube 1 and movable in the longitudinal direction of the application tube winding insert 1 second

p0019In particular from <figref idrefs="f0004">FIGS. 5 and 6</figref> seen, the winding insert 2 serves for holding receiving a medical device 3 that is introduced via the feed pipe 1 into the operating area. To this end, the medical device 3 is set on winding insert 2 and wound onto the winding insert 2 before the medical device is 3 subsequently fed into this wound on the winding insert 2 status by the application tube 1 through the surgical area.

p0020Setting the medical device 3 on the winding insert 2 takes place at the in <figref idrefs="f0003">Fig. 3</figref> first embodiment shown a formed in the winding insert 2 through slot 4 through which the medical device 3 is pushed, until the medical device 3, preferably protrudes on both sides with the same length from the slot. 4 By rotating the winding insert 2 can be now the medical device 3 double continuously wound onto the winding insert 2, as shown schematically in<figref idrefs="f0004">Fig. 5</figref> is shown.

p0021According to the in <figref idrefs="f0003">Fig. 4</figref> second embodiment shown takes place to set the medical device 3 on the winding insert 2 such that the winding insert 2, a slit 5 is formed in the one end of the medical device 3 can be inserted. By rotating the winding insert 2 can be now the medical device 3 catchy wound onto the winding insert 2, as shown schematically in<figref idrefs="f0004">Fig. 6</figref> is shown.

p0022The medical goods 3 can be for example, wound dressings or sculptures, which are introduced in collapsed form in the surgical field and will only spread in place at the surgical site and applied to the appropriate application site.

p0023One application for this device provide example illustrates hernia operations in which the medical aid as from body or alien to the body tissue is existing network or plastic mesh implant Trained to bridge the corresponding fascia.

p0024In consideration but in principle all surgical applications, on which to a wound site or opening by means of a planar medical device 3 bridges and / or closed, such as in surgery in the abdominal cavity in the stomach or intestine breakthroughs or in Fetoscopy for closing the spina bifida , But the intracorporeal treatment of wounds, for example, fetal head wounds, plasters and the like area wound contact is possible with this device.

p0025Besides the possibility of the medical device 3 wound onto the winding insert 2 out of the application tube 1 and only subsequently to introduce the wound with the medical device 3 winding insert 2 into the application tube 1, the preferred and Figures <figref idrefs="f0001 f0002 f0003 f0004">FIG. 1 to FIG. 6</figref> illustrated possibility of establishing the medical device 3 only when inserted into the application tube 1 state of the winding insert 2 at the winding insert 2 and wound onto the winding insert. 2

p0026For this purpose, the application tube 1 is in the outer surface formed at least one axially extending the application tube 1 window-like opening 6 through which the medical device 3 for Fixed Set the winding insert 2 into the application tube 1 is inserted, as in <figref idrefs="f0001">Fig. 1</figref> is shown. When in<figref idrefs="f0001">Fig. 1</figref> Embodiment of the application tube 1 shown, the window-like opening 6 is designed as a gap 6, but other embodiments are possible, which allow to insert the winding-resistant insert 2 insert the medical device 3 into the application tube first

p0027For in <figref idrefs="f0003">Fig. 4</figref> and <figref idrefs="f0004">6</figref> illustrated embodiment in which the medical device 3 is wound around the winding catchy insert 2, it is sufficient to form only a gap 6 in the application tube first The pictures in the<figref idrefs="f0003">Fig. 4</figref> and <figref idrefs="f0004">6</figref> Illustrated embodiments, however, differ in terms of formed in the winding insert 2 slots 4 and 5. While according <figref idrefs="f0003">Fig. 4</figref> is formed in the winding insert 2 only, a slot 5, in the one end of the medical device 3 is inserted, according to the embodiment <figref idrefs="f0004">Fig. 6</figref> a continuous slot 4 formed in the winding insert 2 through which the medical device 3 can be pushed. This embodiment provides the set on winding insert 2 medical device 3 a better grip than the use of non-through slot. 5

p0028In the <figref idrefs="f0002">FIG. 2</figref> and <figref idrefs="f0004">5</figref> illustrated embodiment, the formed in the winding insert 2 through slot 5 and the double continuous coiled medical device 3 requires to go against two column 6 the feed pipe 1 so that the medical device 3 after setting the slot 5 of the winding insert 2 can also protrude from both sides of the feed pipe. 1

p0029Winding the thus on the winding insert 2 fixed medical device 3 to the winding insert 2 given hereinafter by turning the winding insert 2 and / or of the application tube 1 about the instrument longitudinal axis 7, where in the case, that both components are rotated 1 and 2, the feed pipe 1 and the winding insert 2 must be rotated in opposite directions. By this rotation, at least one component 1 or 2 relative to the other component 2 or 1 that was specified on winding insert 2 medical device 3 is drawn into the application tube 1 and layer by layer wrapped around the application. 2

p0030To ensure that the winding insert 2 also is not axially displaceable with the wound thereon medical device 3 in the feed pipe 1, the winding insert 2, at least in the medical device 3 receiving portion is formed as the diameter of the winding insert 2 reducing wire pin, as the figure <figref idrefs="f0002">FIG. 2</figref> Instructions. Notwithstanding the illustrated shape of the wire pin with a circular cross section are of course other cross-sectional shapes executable.

p0031In the remaining parts of the winding insert 2 is formed advantageously tubular, the outer diameter of the winding insert 2 corresponds substantially to the inner diameter of the application tube 1, in order to ensure a good and tilt-free guidance of the winding insert 2 in the application tube first

p0032The operation of the application tube 1 and the winding insert 2, in particular the rotation of the members 1 and 2 is facilitated in the illustrated embodiment that is disposed at the proximal end of both the application tube 1 and of the winding insert 2 each represents a possible ergonomically Enriched handle eighth

p0033The assembly and operation of the apparatus constructed as described above for intracorporeal application of medical aids is done as follows:<ul><li>In the first step of the winding insert 2 to the distal end is preceded inserted from the proximal end into the hollow application tube 1 until the winding insert 2 in the <figref idrefs="f0001">Fig. 1</figref> occupies the position shown, is arranged in the formed in the winding insert two continuous slot 4, or only the one-sided slot 5, in the region of at least one window-like gap 6 of the application tube first</li></ul>

p0034To always be observed for this first step and the subsequent steps the correct insertion depth of the winding insert 2 into the application tube 1, are, as of <figref idrefs="f0001">Fig. 1</figref> seen in the illustrated embodiment, various click stops 9 formed in the winding insert 2, wherein each locking step 9 a certain insertion depth of the winding insert 2 corresponds in the application tube 1 and marks a corresponding operation step.

p0035After insertion of the winding insert 2 into the application tube 1 up to the above-described first locking step the medical device 3 is subsequently fixed on the winding insert 2, for example by passing through the plug through slot 4, as in <figref idrefs="f0002">FIG. 2</figref> is shown. Subsequently, the winding insert 2 and / or the application tube 1 relative to each other are rotated about the instrument longitudinal axis 7, whereby the medical device is drawn into the application tube 1 and winds up on the winding insert second

p0036In the next step, provided with the coiled medical device 3 winding insert 2 is further pushed in the distal direction into the application tube 1, to a second latching step 9 is reached, in which the medical device 3 is arranged in the interior of the application tube 1 and not again on the at least one gap 6 of the application tube 1 can be unwound from the winding insert second

p0037In this working position the application tube 1 together with the inserted winding insert 2, for example via a trocar into the surgical area is introduced. In operation field of winding insert 2 is forced now to the third locking step 9 into the application tube 2, in which the distal side emerges with the wound to be administered medical aid 3 winding insert 2 out of the feed pipe. 1 Now the medical device 3 can for example be detected by means of a forceps. By rotating the winding insert 2, the medical device 3 can now be easily and safely handled on the spot by the winding insert 2 and apply to be supplied surgical site.

p0038A thus designed apparatus for intracorporeal application of medical aids 3 is characterized in that it comprises a secure and safe transport of the to be applied medical device 3 ensures a simple structure and ease of use toward the surgical site.

<u>LIST OF REFERENCE NUMBERS</u>

p0039<dl id="dl0002"><dt>1</dt><dd>feed pipe</dd><dt>2</dt><dd>winding insert</dd><dt>3</dt><dd>medical aid</dd><dt>4</dt><dd>Slot (continuous)</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>handle</dd><dt>9</dt><dd>latching step</dd></dl>