CZ293573B6 - Surgical instrument for removing varicose veins - Google Patents

Abstract

In the present invention, there is disclosed a surgical instrument for removing varicose veins having a probe located on a handle (41). The probe comprises a tubular or rod-like stem (42) at the distal end of which there is arranged a surgical tool. The surgical tool having comblike form in the stem (42) extension comprises teeth (44) arranged one after another and directing in one direction. The teeth (44) have a sliding face (46) and a pull side (47). The pull face (47) forms with said stem (42), optionally said surgical tool longitudinal axis an angle {alpha} ranging within 30 degree and 100 degree.

Description

(57)

The surgical instrument for removing varicose veins is provided with a probe positioned or positioned on the handle (41). The probe comprises a tubular or rod shaft (42) at the distal end of which an operating tool is provided. In the extension of the shaft (42), the operating tool is formed as a comb-like. The operating tool comprises successive teeth (44) directed in one direction having a sliding flank (46) and a pulling flank (47). The pulling flange (47) forms an angle (α) between 30 ° and 100 ° with the longitudinal axis of the shaft (42) or the operating tool.

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Surgical tool for varicose veins removal

Technical field

The present invention relates to a surgical instrument for removing varicose veins, with a probe positioned or locatable on a handle, the probe comprising a tubular or rod shaft, at the distal end of which an operating tool is provided, and wherein the surgical tool is formed as a comb-like.

BACKGROUND OF THE INVENTION

WO 94/21177 discloses a surgical instrument with a rod probe mounted on a handle, at the distal end of which several teeth are formed which are evenly spaced around the circumference in several circles. Upon insertion of the instrument into a vein, the vein extends through a relatively thick probe, and as the probe is pulled out, the veins engage the outer wall of the vein and pull the vein out of the tissue. In practice, it has often been the case that the vein tore or could otherwise have been damaged during insertion of the tool, as the ubiquitous jams are difficult to control and the probe has a large thickness due to their amount.

U.S. Pat. No. 3,568,677 discloses a surgical instrument with a loop at the distal end thereof for receiving a loose end of a vein so that the vein thus prepared can be pulled out of the body. For this purpose, however, it is first necessary to separate a large section of vein. Here, too, the cores with the convolutions can be easily torn when pulling out, since great forces are generated.

U.S. Pat. No. 5,346,503 discloses a surgical instrument at the distal end of which a one-sided, radially protruding blade is formed, the cutting edge of which is concave curved. When separating a vein from the surrounding tissue, this tool, despite the skillful use of surgeons, cannot separate the vein cleanly, since the radial blade can be difficult to guide around the vein.

DE 35 25 917 A1 discloses a surgical tool for removing relatively small and preferably superficial varicose veins, which has a short, tubular element with a circular cutting edge which is arranged at the distal end of the thin rod. In this known tool, the free end of the vein removal is inserted into the hollow cylinder, and then the tool is pushed forward along the vein by pivoting to the left and right around its longitudinal axis so that the vein separates from the surrounding tissue. The sufficiently loosened vein can then be pulled out, for example, by means of a fiber fixed at the free end.

In order to guide the surgical instrument of DE 35 25 917 A1 to the vein to be removed, the skin is incised in the region of the vein beginning so that the probe can be inserted. Since the hollow cylinder probe must always be slightly larger than the cores in question, a relatively large incision is required. Furthermore, there is a difficulty that the diseased vein to be removed has, in places, disproportionately large, convex thickenings (the so-called convulants) which cannot be controlled by the probe according to DE 35 25 917 A1. Either these convulsions do not pass through the hollow cylinder, so that the vein splits at this point, or the probe must be selected so large that an unduly large incision is necessary.

From CS 277 383 a surgical instrument is known in which the teeth are arranged on mutually opposite sides and do not point in one direction but in two opposite directions.

SUMMARY OF THE INVENTION It is an object of the invention to provide a surgical instrument by which varicose veins should be removed more quickly, less traumatically and reliably.

SUMMARY OF THE INVENTION

According to a first embodiment, a surgical instrument for removing varicose veins is provided, with a probe positioned or locatable on a handle, the probe comprising a tubular or rod shaft with a surgical tool at the distal end thereof, According to the invention, the operating tool comprises in one direction disposed toothed teeth having a sliding flank and a pulling flank and wherein the pulling flange forms an angle α between 30 ° and 100 with the longitudinal axis of the shaft or the operating tool °.

The surgical instrument constructed according to this embodiment has the advantage that it can be introduced by simple incision into tissue and inserted into a vein. If the comb-shaped tool is located at least partially within the vein, the teeth engage the vein wall from the inside and carry the previously separated vein with it when the surgical instrument is pulled out so that the vein can be easily removed. With only one-sided teeth, the overall circumference of the probe remains small so that the vein is not undesirable.

Preferably, the teeth are offset at least partially backwards, i.e. the angle between the pulling flank and the longitudinal axis of the tool is less than 90 °. This facilitates the engagement of the teeth into the vein wall so that the vein is securely engaged and pulled out.

According to a preferred embodiment of the invention, the tooth has a tip, the tip of the tooth of at least three adjacent teeth lying on a curve such that the apparent upper side of the comb tool is convexly domed. This has the advantage that, for better insertion into the vein of the tool, it rises slightly, and that the teeth fall again after reaching the maximum, so that a relatively open row of teeth is formed. These teeth, which are inclined in the tensile direction and which have a hole due to their arching, ensure that the wall of the core is reliably gripped when the tool is pulled out.

In a further preferred embodiment, the underside of the comb tool is concave concave in accordance with the upper side. This has the advantage that the tool is uniformly thick and the outer diameter of the tool should correspond at most to the inner diameter of the core. This allows a smooth insertion of the surgical instrument into the lumen of the vein.

To facilitate insertion of the instrument into a vein to be removed, the surgical instrument extends at the distal end of the tip.

In order to reliably remove even complicated veins, in another preferred embodiment, the surgical instrument consists of several groups of comb-like teeth. Thereby it offers a larger engagement area with a large number of teeth which extend more or less into the vein wall and thus provide the necessary support for pulling out.

In another preferred embodiment, the tool is curved in the axial direction so that the tool can follow the zigzag position of the vein to be removed.

As a second solution to the above object, it is proposed, according to the invention, to further develop a surgical instrument of the above-mentioned kind in that the instrument has an eyelet as a fitting for the fiber and protrudes into the tip at its distal end; .

The surgical instrument created according to this teaching has the advantage that the vein can be easily pulled out in connection with the fiber. For this purpose, the tool is preferably inserted near the separate end of the vein, but across it into the skin and guided between the vein and the skin so far that the surgical instrument on the other side of the vein pierces the skin again and leads out until the eye is loosened. . Now the fiber is inserted through the eyelet before the surgical instrument is re-inserted under the skin, is guided around the separated vein and is led out again on the other side of the vein so that the fiber

-2GB 293573 B6 winds once around a vein. Now the operating physician can grasp both ends of the filament and pull the vein out with the filament cut by the tool. The distal end of the probe, which is allowed to protrude to the tip, has the advantage that the surgical instrument can be pushed through the skin and / or tissue simply and without much effort.

The cutting edge has the advantage of facilitating the introduction of the surgical instrument into the skin and tissue.

In a preferred embodiment, the eyelet has a centrally formed hole. This has the advantage, in particular of a tool which has been constructed of a small, for the small veins, that the strenuous threading into the loop can be omitted, which is then very small, since the fiber can be inserted very simply into the loop in the middle by an arranged opening.

As a third technical solution according to the invention, it is proposed that the aforementioned surgical instrument be further designed so that the shaft at its distal end is bent to one side, to grip the blade on one side and to make the blade arched.

The surgical instruments for removing varicose veins created according to this technical teaching have the advantage that this blade-fixed one side can be inserted through its free end through a relatively small incision between the vein and the skin to separate the vein from the surrounding tissue. For this, the required cut must be just as wide as the blade. Since the size of the surgical instrument selected depends on the size of the vein to be removed, a small incision of at most 1 to 2 mm is sufficient for small veins. For somewhat larger veins, the cut may then be up to 8 mm.

A further advantage is that the blade is formed on one side open so that the blade can follow the actual contour of the vein to be removed and therefore the convolutions no longer constitute an obstacle.

After the surgical instrument has been introduced into the tissue, the surgical instrument is introduced forward by slightly rotating about the longitudinal axis. To further simplify its operation, in one preferred embodiment, it is proposed that the shaft at its distal end bends to one side to grip the blade on one side so that the blade can be arranged symmetrically transverse to the longitudinal axis. Thereby, the attending physician gains a uniform feel for the surgical instrument as it rotates about the longitudinal axis.

In another preferred embodiment, the blade is provided with a cutting edge both in the pulling direction and in the insertion direction. It has proven to be advantageous for the cutting edge to be concave in the direction of tension and in the direction of insertion convex.

This has the advantage that the surgical instrument according to the invention can be pushed up to the end of the vein removal by separating it from the vein and tissue, and at this point it gets by carefully rotating the vein 180 ° to the underside of the vein to finally withdraw it from the vein. under the veins, the lower half of the vein separating from the underlying tissue. When the surgeon arrives at the beginning of the vein, he or she can swivel the tool by pulling the present incision. Thus, for this operation only a cut is required which corresponds at most to the width of the shaft or the width of the blade, so that the wide cuts known in the art are omitted. With such a short incision, the wound can heal much faster and above all aesthetically, since the risk of scar formation is reduced.

In yet another preferred embodiment, the blade is domed. This has the advantage that the blade adapts to the contour of the vein at the smallest of the enlarged parts, so that a single-line insertion of the tool in the area between the vein and skin and between the vein and muscle can be performed almost perfectly.

Further advantages of the device according to the invention result from the attached drawing and the embodiments described below. It is also possible to use the above-mentioned and further elaborated features according to the invention individually or in any combination with each other. These embodiments are not definitive but merely exemplary.

-3GB 293573 B6

BRIEF DESCRIPTION OF THE DRAWINGS

Giant. show:

Giant. 1 a surgical instrument with a blade inclined at 45 °;

FIG. 2a shows another surgical instrument with a transverse attached blade;

FIG. 2b is a plan view of the tool of FIG. 2a;

FIG. 3a shows another surgical instrument with a laterally arranged blade;

FIG. 3b is a plan view of the tool of FIG. 3a;

FIG. 4a is a side view of another surgical instrument with comb-like teeth;

FIG. 4b is a front view of the tool of FIG. 4a;

FIG. 4c shows an enlargement of the cut-out of the tool according to FIG. 4 and along the line IVc of FIG. 4a;

FIG. 5a is a side view of another surgical instrument with comb-like teeth;

FIG. 5b is a front view of the tool of FIG. 5a;

FIG. 6 shows another surgical instrument with an eyelet;

FIG. 7 shows another surgical instrument with an eyelet with a slit.

DETAILED DESCRIPTION OF THE INVENTION

Surgical instruments 10, 20, 30, 40, 50, 60, 70 shown in Figures 1 to 7 include all handles 11, 21, 31, 41, 51, 61, 71 with shaft 12, 22, 32, 42, 52, 62, 72 arranged thereon, and a corresponding tool is disposed at the distal end of the shaft 12, 22, 32, 42, 52, 62, 72.

All surgical instruments 10, 20, 30, 40, 50, 60, 70 are made of stainless steel or other metal suitable for medical use. The handle 11, 21, 31, 41, 51, 61, 71, like the curettes, is essentially conical-cylindrical and has profiled sections around its periphery so that the operating physician can guide the instrument 10, 20, 30, 40, 50, 60 , 70 reliably in hand. In the embodiments shown here, the handle 11, 21, 31, 41, 51, 61, 71 is mounted in a thread located at the proximal end in the threaded hole provided in the handle H, 21, 31, 41, 51, 61, 71 and secured with the nuts 13.23,33.43, 53.63, 73.

This makes it possible to have a large number of surgical instruments with only one handle and different probes, which is cost-effective. Cost savings are particularly important when using different tools with different dimensions.

The surgical instruments 10, 20, 30, 40, 50, 60, 70 shown in the drawing now differ by a different probe, in particular a tool arranged at the proximal end of the shaft 12, 22, 32, 42, 52, 62.72.

The surgical instrument 10 shown in FIG. 1 has a blade 14 bent at an angle of about 45 ° to the longitudinal axis. A sharp cutting edge 15 is formed on the distal side of the blade 14 by means of which the physician operates

Separates the varicose vein from the surrounding tissue. The probe of the surgical instrument 10 itself has no sharp edges, but rather generously rounded edges to avoid unwanted incisions and injuries. The blade 14 bent from 45 ° is about 6 mm wide, 25 mm long and less than 1 mm thick.

2a and 2b, at its distal end, has a blade 24 disposed transverse to the longitudinal axis having a cutting edge 25 curved convexly in the direction of travel according to arrow S and a cutting edge 25 'curved concave in the direction of tension according to arrow Z The blade 24 is located on one side on the laterally bent end piece 26 of the shaft 22 that the center of the blade 24 lies on a virtual extension along the tool axis 20. This ensures that the blade transversely to the longitudinal axis projects equally far right and left. And, the distal end 26 of the shank 22 and the connecting blade 24 are formed such that no sharp corners and edges are formed. In addition, the blade 24 itself is arcuate so as to at least partially embrace the vein to be separated.

The surgical instruments 30 shown in FIGS. 3a and 3b have a blade 34 located on one side and off-center at the distal end of its straight shaft 32. The blade 24 has a concave cutting edge 36 in the feed direction S and a straight cutting edge 35 'in the Z direction. This blade 34 itself is domed.

In the removal of varicose veins, the surgical instruments 10, 20, 30 shown in FIGS. 1 to 3 are used as so-called separators. Here, the separators, which now have cutting edges, are introduced by a small incision in the skin first between the vein to be removed and the skin and moved along the vein. It separates the vein separator from the surrounding tissue. Once the separator reaches the vein to be removed, the separator is rotated downward, that is, between the vein and the muscle, and then pulled back to the starting position. In this case, the tissue lying above the vein being removed is separated, and the vein almost completely separates, in particular as a result of the blade arching. When the separator reaches the exit point, it is again removed from the patient ' s body and the relaxed vein is now pulled out with the surgical instruments 40, 50, shown as cuvettes of Figs. 4 and 5, or pulled out with the surgical instrument 60 or 70 of Figs. 6 and 7 formed as a fiber withdrawal device.

The surgical instruments 40 and 50 shown in FIGS. 4 and 5 are exhaitors. These exhalators have, at the distal end of the shaft 42, 62, a plurality of teeth 44, 54 measuring in one direction, all having a tip 45, 55, a sliding flank 46, 56 facing the sliding direction S and a pulling flank 47, 57 facing the Z direction. thrust. A plurality of these teeth 44, 54 are joined to form a comb-shaped tool, the pulling flank 47, 57 extending in the direction of the handle 41, 51 so that the teeth 44, 54 are aligned as notches. The angle between the longitudinal axis and the pulling flank 47, 57 is between 50 ° to 80 °, depending on the tooth 44, 54 ·

In the surgical instrument 40 shown in Figures 4a to 4c, the tips 45 of the individual teeth 44, arranged one after the other as a comb, are formed so as to form a seemingly domed upper side of the comb-like instrument. In accordance with this camber, the underside is made concave so that the thickness is observed to be almost constant along its length.

In the surgical instrument 50 shown in Figures 5a and 5b, the teeth 54 are grouped into three mutually spaced groups. In this embodiment, the tool is bent several times in an alternating direction about the longitudinal axis so that the distal end of the shank 52 appears wave-shaped when viewed from above. With this wave form, the operator can easily insert the tool into the often zigzag veins since the tool 40 follows the vein shape at least in parts.

Both the surgical instrument 40 and the surgical instrument 50 have a tip extending distal to the tip 48, 58 to facilitate insertion of the surgical instrument 40, 50 into the vein to be removed.

After the vein to be removed is as described above, the surgical instrument 40 or 50 is exhaitored / cut through the skin into the vein to be removed. In this case, the distal tip 48, 58

-5GB 293573 B6 makes loading easier. Depending on the size and condition of the vein to be removed, the use of an appropriately sized tool 40, 50 is recommended. After the tool 40, 50 has been inserted as far as possible into the lumen of the vein to be separated, the tool 40, 50 is removed again. using a slight upward movement. In doing so, the teeth 44, 54 grip at least at their 5 tips 45, 55 the respective vein wall to be removed and at the same time pull out the entire vein.

In many cases, especially in the small or smallest veins, it is difficult to introduce the curette-shaped tool 40, 50 described above into a vein. In these cases, the vein can be easily removed by the surgical instrument 60, 70 shown in Figures 6 and 7 and the flax fiber.

The surgical instruments 60 and 70 shown in Figures 6 and 7 are also exhaitors, wherein the surgical instrument 60 shown in Fig. 6 has a sharp cutting edge 65 and an eyelet 68 at its distal end, and wherein the instrument 70, 7 has an eyelet 78 and an opening 79 through which the flax fiber can be inserted into the eyelet 78 in a simple manner. The tip of the surgical instrument 15 is made relatively blunt to prevent injury to the patient being treated.

To remove a pre-separated vein by means of a surgical instrument 60 or 70 formed as a fiber carrier, it is first made laterally (obliquely downward) from the vein to be removed as small as possible, thereby introducing the surgical instrument 60, 70 under the skin. Thereafter, the surgical instrument 60, 70, 20 is inserted between the skin and the vein, and is dislodged from the tissue on the opposite side. Now, the operating trap can thread the flax fiber into the loop 68 or guide it through the aperture 79. The tool 60, 70 is then inserted again far enough into the tissue so that the distal end lies on the side of the vein to be removed. A probe is then inserted under the vein and, if possible, the same, on the other side of the vein, cut out, so that the surgeon can always grasp the filament in eyelet 25 68, 78. Finally, the tool 60, 70 is withdrawn again without filament from the body. of the patient, before the vein wrapping the vein is pulled out, is pulled out of the patient's body by the incision made by the tool 60, 70.

With smaller veins branching from the vein of sephena magma or the vein of sephena pava, the rapid removal of the veins can be carried out using the surgical instruments described herein, since the veins can be pulled out whole and not in parts.

At the same time, the incisions to the skin and tissue are less and less frequent, so that this is a significant relief for the patient. Healing without scars is also likely with short cuts.

The surgical instruments mentioned herein are also suitable for invagination.

Claims (14)

PATENT CLAIMS A surgical instrument for removing varicose veins, with a probe positioned or locatable on a handle (41, 51), the probe comprising a tubular or rod shaft (42, 52) on which distal- An operative tool is provided at the end thereof, wherein the operative tool is formed in the extension of the shaft (42, 52) as comb-like, characterized in that the operative tool comprises successive teeth (44, 54) directed in one direction, having a sliding flank (46, 56), and a pulling flank (47, 57), and wherein the pulling flank (47, 57) forms an angle (α) between 30 ° and the longitudinal axis of the shaft (42, 52) or the operating tool 100 °. Surgical instrument according to claim 1, characterized in that the tooth (44, 54) has a tip (45, 55), the tips (45, 55) of at least three adjacent teeth (44, 54) lying on a curve so that the apparent upper the side of the comb tool is convexly domed. -6GB 293573 B6 Surgical instrument according to claim 2, characterized in that the underside of the comb-like tool is concavely concave so that the thickness of the instrument is constant. Surgical instrument according to one of the preceding claims, characterized in that the surgical instrument extends into the tip at its distal end. Surgical instrument according to one of the preceding claims, characterized in that the surgical instrument consists of groups of comb-like teeth (44, 54). The surgical instrument of claim 5, wherein the surgical instrument is curved in the axial direction. A surgical instrument for removing varicose veins, with a probe positioned or locatable on a handle (61, 71), the probe comprising a tubular or rod shaft (62, 72), at the distal end of which an operating tool is provided, the tool comprises a fiber insert eyelet (68, 78) and extends into a tip at its distal end, wherein the surgical tool has a cutting edge (65) at its distal end at least on one side. Surgical instrument according to claim 7, characterized in that the eyelet (68, 78) has an opening (79) arranged centrally. A surgical instrument for removing varicose veins, with a probe positioned or locatable on a handle (21), the probe comprising a tubular or rod shaft (12, 22, 32), at the distal end of which a blade (24) is formed that includes a sharp cutting an edge (15, 25, 25 ', 35, 35') extending transversely to the longitudinal axis of the shaft (12, 22, 32), the blade (14, 24, 34) being fixed on one side of the shaft (12, 22, 32). 22, 32) characterized in that the shank (22) is bent at its distal end to the side for arranging the blades (24) sideways at such a distance from the longitudinal axis of the shank (22) that the center of the blade (24) is aligned an extension of the shank (22), wherein the blade (24) is itself arched. Surgical instrument according to claim 9, characterized in that the blade (14, 24, 34) has a length of 0.5 cm to 4 cm and a width of 1 mm to 8 mm. Surgical instrument according to one of claims 9 and 10, characterized in that the cutting edge (15, 25, 25 ', 35, 35') is curved in the working direction. Surgical instrument according to one of Claims 9 to 11, characterized in that the blade (24, 34) has a cutting edge (25, 25 ', 35) in both the stroke direction (Z) and the stroke direction (S). , 35 '). Surgical instruments according to claim 12, characterized in that the cutting edge (25 ') is concavely curved in the stroke direction (Z). Surgical instrument according to one of claims 12 or 13, characterized in that the cutting edge (25) is concavely curved in the feed direction (S).