Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets 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
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets 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, e.g. tourniquets
  • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
  • A61B2017/00238—Type of minimally invasive operation
  • A61B2017/00274—Prostate operation, e.g. prostatectomy, turp, bhp treatment
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets 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, e.g. tourniquets
  • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets 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, e.g. tourniquets
  • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
  • A61B2017/1142—Purse-string sutures
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
  • A61B2018/00547—Prostate

Definitions

• the present invention relates to the technical field of surgical instruments used to ensure the passage of surgical threads, at the end of which surgical needles are mounted, through hollow organs of the body of mammals and in particular of the human, in particular to performing an anastomosis between said hollow organ and another organ or conduit of the human body.
• the present invention generally relates to a surgical grommet intended to ensure the passage of a surgical needle associated with a surgical suture through a hollow body of the human body, for example to make an anastomosis between said hollow organ and another conduit or organ of the human body.
• the invention relates to a surgical grommet comprising a grommet tube which on the one hand extends longitudinally along an axis of extension and which on the other hand is internally provided with a first channel having a first an outlet located towards the proximal portion of said tube, for the passage of a first needle associated with a first wire, the grommet tube being further provided internally with at least one second channel having a second outlet located towards the proximal portion of said tube, for the passage of a second needle associated with a second wire, the first and the second output being angularly offset about the extension axis X-X ', said surgical lead also having a first and a second means of propulsion, activable each way individualized by a user, designed to respectively move the first and second needle and its externalization by the corresponding output.
• the invention also relates to a surgical thread system
• a surgical grommet comprising a grommet tube which on the one hand extends longitudinally along an axis of extension and which on the other hand is provided internally a first channel having a first outlet located towards the proximal portion of said tube, for the passage of a first needle associated with a first wire and at least a second channel having a second output located towards the proximal portion of said tube, for the passage of a second needle associated with a second wire, the first and the second output being angularly offset about the extension axis X-X '
• said surgical lead also comprising a first and a second means of propulsion, each activatable individually by a user, designed to move the first and second hand respectively and its externalization through the corrective output respondent, one.
• first needle associated with a first wire said first needle being adapted to pass through the first output
• needle holders generally in the form of conventional surgical forceps, which allow, by direct pinching of needle, direct the needle and wire to and into the area where the anastomosis will be performed.
• Conventional needle holders are nevertheless not easily usable in general in all the various types of surgical operations, and their use remains delicate, especially when it is desired to perform an anastomosis involving at least one hollow organ through which the thread and needle must pass.
• a surgical grommet comprising a grommet tube provided with a channel with an inlet and an outlet located respectively towards the distal and proximal portions of said tube, for the passage of a thread associated with a needle.
• This grommet further comprises a thrust means for being inserted axially into the channel through its inlet to slide there and ensure the thrust of the needle and its externalization through the outlet.
• the surgeon can proceed to the establishment of urethro-vesical stitches by introducing the prior art grommet tube into the urethra, so as to make it open near the bladder neck. After having seized the needle and fi! corresponding in the canal, the surgeon can then, with the aid of the pushing means, ensure the externalization of the needle out of the exit in the vicinity of the suture. The bladder neck is then sutured to the urethra.
• a surgical grommet is likely to greatly facilitate the urethroovesical anastomosis, while greatly reducing the total time required for the operation.
• This known surgical grommet does not, however, eliminate some important constraints for the surgeon. In particular, it is necessary, in order to ensure firm and lasting suturing of the urethra, to achieve a multiplicity of stitches distributed over the entire perimeter of the urethra. To this end, the surgeon is therefore obliged to rotate the known surgical wire-pass relative to the urethra, within the latter, to modify the angular orientation of the exit of the needle and thus to ensure sutures according to different angular positions of the perimeter of the urethra. This operation of rotation of the grommet within the urethra is however difficult to perform and constitutes a source of operating risks. In addition, the surgeon must for each suture refill the grommet tube with a new needle and a new wire, which can be relatively difficult and time consuming, especially when the operation is performed laparoscopically.
• the object of the invention is therefore to remedy the various drawbacks listed above and to propose new surgical grommets and surgical grommets which greatly facilitate the production of a multiplicity of sutures in angular positions. different, especially in case of anastomosis, to reduce the total duration of the surgical procedure and to make easily accessible to the surgeon the sutures and the needles.
• Another object of the invention is to propose new surgical wire and surgical grommet system allowing, by means of particularly simple and inexpensive means, to ensure the control of the movement of surgical threads and needles to through a hollow body.
• Another object of the invention is to provide new surgical grommets and surgical grommet system for controlling the movement of needles with particularly simple and inexpensive means.
• Another object of the invention is to propose new surgical wire and surgical grommet system allowing the surgeon to perform a large number of sutures in a particularly simple and fast manner.
• Another object of the invention is to provide novel surgical wire and surgical grommet system allowing a kinematic movement of needles particularly suitable for the establishment of sutures required for anastomosis.
• Another object of the invention is to provide novel surgical thread and surgical passer system whose positioning relative to the hollow member in which the grommet is intended to be threaded can be controlled particularly simple and reliable by the surgeon.
• An additional object of the invention is to provide new surgical grommets and surgical grommets system particularly suitable for the realization of a urethro-vesical anastomosis by the retro-pubic route.
• the objects assigned to the invention are achieved by means of a surgical grommet comprising a grommet tube which on the one hand extends longitudinally along an axis of extension and which on the other hand is internally provided.
• each propulsion means comprises a rod mounted to slide axially within the tube, each outlet being shaped to allow the passage of the corresponding rod, so that the latter can protrude by the corresponding output.
• a surgical grommet comprising a grommet tube which on the one hand extends longitudinally along an axis of extension and which on the other hand is internally provided with a first channel having a first outlet located towards the proximal portion; said tube, for the passage of a first needle associated with a first wire and at least a second channel having a second output located towards the proximal portion of said tube, for the passage of a second needle associated with a second wire, the first and the second output being angularly offset around the axis X-X 'extension, said surgical wire-pass also comprising a first and a second propulsion means, each individually activatable by a user, designed to ensure the displacement of the first and second hand respectively and its externalization by the corresponding output,
• each propulsion means comprises a rod mounted to slide axially within the tube, each outlet being shaped to allow the passage the corresponding rod, so that the latter can project through the corresponding output.
• FIG. 1 schematically illustrates the anatomical context of implementation of a surgical grommet according to the invention in the case of a urethro-vesical anastomosis necessitated by a laparoscopic radical prostatectomy, before removal of the prostate
• FIG. 2 illustrates the anatomical area of Figure 1 after removal of the prostate.
• FIG. 3 illustrates, in a schematic view, a detail (encircled by the dotted circle A) enlarged of Figure 2, with a surgical grommet according to the invention introduced into the urethra.
• FIG. 4 illustrates, in a schematic perspective view, a detail of embodiment of a surgical thread system according to the invention.
• FIG. 5 illustrates, in a schematic side view, the detail of embodiment illustrated in FIG. 4.
• FIG. 6 illustrates, in a front view, the embodiment detail illustrated in Figures 4 and 5.
• Figure 7 illustrates, in a schematic side view, a detail of the system shown in Figures 3 to 6 with the need almost fully externalized, while their externalization was just beginning in Figures 4 to 6.
• Figure 8 illustrates, in a front view, the surgical thread system of Figures 3 to 7 without its needles.
• FIG. 9 is a diagrammatic sectional view of the surgical grommet of FIGS. 3 to 8.
• FIG. 10 illustrates, in a cross-sectional view along the line B-B of FIG. 9, a detail of the section of the grommet tube of the surgical grommet of FIG. 9.
• FIG. 11 illustrates, in a cross-sectional view taken along the line CC of Figure 9, a detail of embodiment of the section of a rod mounted to slide axially within the grommet tube to exert an axial thrust on a corresponding needle.
• FIG. 12 illustrates, in a schematic side sectional view, a needle to be implemented with the surgical grommet illustrated in Figures 3 to 11 and the suture associated with it.
• FIG. 13 is a diagrammatic side view of an alternative embodiment of a surgical grommet system according to the invention specifically intended for performing a urethroovesical anastomosis.
• the grommet of the present invention is particularly adapted to be inserted and to progress, by natural means, in a biological conduit for the purpose of suturing said conduit to an organ.
• the grommet 4 according to the invention therefore preferably constitutes a urethral grommet.
• the surgical grommet and the surgical grommet system according to the invention could be used and applied in other types of surgical operations, preferably of the anastomosis type, requiring the passage of surgical threads and needles inside hollow body, without the invention can be considered as being limited to the strict application to a urethro-vesicaie anastomosis.
• the surgical instrument according to the invention is formed by a surgical grommet 4 which comprises a grommet tube 5, of generally tubular or pseudo-tubular shape, forming a sheath made for example to from stainless steel or titanium or other metallic materials, or from flexible, rigid or semi-rigid plastic materials.
• a surgical grommet 4 which comprises a grommet tube 5, of generally tubular or pseudo-tubular shape, forming a sheath made for example to from stainless steel or titanium or other metallic materials, or from flexible, rigid or semi-rigid plastic materials.
• the material used will be compatible with any surgical use and will meet the standards and constraints required in the field.
• the grommet tube 5 for example with a mean diameter of the order of 8 millimeters in the case of application to a urethro-vesical anastomosis, extends longitudinally along an extension axis XX 'between a portion proximal 5A and a distal portion 5B.
• the extension axis is rectilinear in the case of the variant illustrated in FIGS. 3 to 11, and curve in the case of the variant illustrated in FIG. 13.
• the grommet tube 5 may have a straight or curved shape, or any suitable geometric shape combining straight or curved portions.
• the proximal portion 5A has a curved terminal portion, so that the general shape of the grommet 4 corresponds globally to that of a blessed, in order to facilitate the manipulation by the surgeon during the passage through the urethra 1, while optimally controlling the geometrical area of externalization of the needle in the vicinity of the suture area, as will be described in more detail in the following.
• the grommet tube 5 is internally provided, preferably axially (ie along its extension axis X-X '), with a first channel 6 having a first outlet 6A located towards or in the vicinity of, the proximal portion 5A of said tube 5, for the passage of a first needle 7 associated with a first wire 8.
• the first channel 6 is designed to allow the passage therein, in axial progression, of the first needle 7 which is preferably attached by one of its ends 8A, the wire 8, as shown in Figure 12.
• the needle 7 may be of any conventional type, such as those used in surgical material, and be for example straight, or slightly bent at the end, or even forks.
• the needle 7 extends longitudinally between a base 7A and a tip 7B, said tip 7B having, with respect to the orientation of the base 7A, an inclination of angle ⁇ , for example substantially equal to 45 °.
• the needle 7 may for example have a deformable nature with preferably a shape memory.
• the needle 7 may for example be made of an elastic or superelastic material, so as to be deformed according to a rectilinear profile, for example within the channel 6, and then to find a curved conformation, as illustrated in FIG. FIG. 12, when it is exteriorized and is no longer subject to the mechanical constraint of confinement exerted by the channel 6.
• the end 8A of the surgical wire 8 is in turn attached to the base 7A by any known means, and possibly removably, while the opposite end 8B of said wire 8 remains free.
• the wire 8 can be of any conventional type, such as those usually used in surgery.
• the wire 8 is resorbable.
• the grommet tube 5 is further internally provided with at least one second channel 9 having a second outlet 9A located towards or near the proximal portion 5A of said tube 5, for the passage of a second needle 10 associated with a second wire.
• the second channel 9 has a conformation identical to that of the first channel 6, the second hand 10 and the second thread associated with it being meanwhile preferably identical to the first needle 7 and the first wire 8, respectively.
• the first and the second channel 6, 9, which are preferably distinct and independent, are thus both formed inside the tube 5 and extend substantially axially, that is to say substantially parallel to the axis of extension XX 'of said tube 5.
• the first and the second channel 6, 9 respectively form a guide channel for the first needle 7 and the second needle 10 and for the wire associated with each of these needles.
• the first and the second channel 7, 9 extend over the entire length of the tube 5. It is thus conceivable that said channels 6, 9 are not extend only on a fraction, possibly very small and for example concentrated towards the outlets 6A, 9A, of the length of the grommet tube 5.
• the first and the second output 6A, 9A are angularly offset about the extension axis X-X ', as can be seen in particular in FIG. 8.
• the first and the second output 6A, 9A are disposed respectively in a first and a second radial position angularly offset about the axis of extension of a non-zero angle ⁇ .
• the first and the second output 6A, 9A both belong to the same plane perpendicular locally to the axis X-X ', but they are positioned relative to said axis XX' with an angular offset ⁇ .
• the first and second outputs 6A, 9A are radially offset, and preferably have substantially no axial shift.
• the grommet 4 comprises a first and a second propulsion means 11, 12 designed to move the first and the second hand 7, 10 respectively and its externalization through the corresponding output 6A, 9A (FIG. see Figures 9 and 11).
• each drive means 11, 12, operating in an individualized and independent manner is designed to move the corresponding needle 7, 10 within the grommet tube 5, so as to provoke the externalization of said corresponding needle. 7, 10 by the corresponding output 6A, 9A.
• each propulsion means 11, 12 is individually activatable by the operator (the surgeon) who can individually manipulate each propulsion means 11, 12 without causing the other propulsion means 11 to move, 12.
• said first and second propulsion means 11, 12 are designed to exert an axial thrust respectively on the first and the second needle 7, 10. More specifically, said first and second propulsion means 11, 12 are advantageously intended to be threaded. axially respectively in the channel 6 and the channel 9, by an input 6B, 9B of said channel 6, 9 located opposite the output 6A, 9A, it is at to or near the distal portion 5B of the grommet tube 5 (see Figures 9 and 13).
• Each propulsion means 11, 12 is thus preferably intended to be slid axially into the corresponding channel 6, 9 to slide there and ensure the thrust of the corresponding needle 7, 10 and its externalization by the corresponding outlet 6A, 9A.
• each propulsion means 11, 12 comprises a respective control head 11A, 12A which protrudes out of the grommet tube 5 so as to be accessible to a user.
• each control head 11A, 12A is accessible externally to the grommet tube 5, that is to say is located outside said tube 5, to be actuated, preferably manually, by the user so that the latter can generate a displacement of the corresponding propulsion means 11, 12 and therefore a displacement of the corresponding needle 7, 10.
• each control head 11A, 12A thus allows individualized activation of the propulsion means 11, 12 corresponding by a user, in particular by the surgeon.
• the threaded tube 5 allows, after its introduction into the urethra 1 (for example by the natural channels), to make transit extremely simple, safe and fast the needles 7, 10 in the channel corresponding 6, 9 through the thrust performed directly or indirectly on the needle 7, 10 by the means of propulsion 11, 12 corresponding, which forms a pushing means actuated by the surgeon.
• the grommet tube 5 will be pre-loaded with the propulsion means 11, 12, the needles 7, 10 and their associated wires, that is to say that the propulsion means 11, 12 will be pre-loaded.
• the axial position of the needles 7, 10, and propulsion means 11, 12 is such that the needles 7, 10, contrary to what is illustrated in Figures 4 and 7, do not protrude from the tube 5, but instead are fully retracted within the corresponding channel 6, 9 .
• each propulsion means 11, 12 comprises a rod 13, 14 mounted to slide axially within the tube 5 to exert an axial thrust on the corresponding needle 7, 10.
• Each rod 13, 14 is preferably hollow, that is to say that it is pierced longitudinally and internally of a conduit 13A, 14A home wire associated with said needle 7, 10.
• the invention relates to a ready-to-use surgical grommet system in which the needles 7, 10 are inserted in a retracted position into the corresponding channels 6, 9, said propulsion means 11, 12 also being inserted into their channels respective 6, 9 to come, in contact with the base 7A of the corresponding needle, the wire 8 extending from said base 7A being in turn disposed in the longitudinal conduit 13A, 14A formed in the corresponding rod 13, 14.
• the rods 13, 14 are not hollow but are for example solid, the corresponding wire being wound around the rod. It is also conceivable, according to another embodiment, that the rods are provided with a longitudinal groove formed at their periphery, said groove forming a housing for the corresponding wire.
• the rods 13, 14 forming propulsion means 11, 12 are made of a material of rigidity and flexibility sufficient to provide the necessary or indirect mechanical thrust of the corresponding needle 7, 10 while adapting to the straight or curved longitudinal profile of the channel 6, 9 in which they evolve.
• the rods 13, 14 may be made of a plastic material or a metal material.
• each output 6A, 9A is shaped to allow the passage of the rod 13, 14 corresponding, that is to say that the opening formed by the output 6A, 9A is sufficient to allow not only the externalization of the corresponding needle 7, 10 but also the externalization of the rod 13, 14 pushing on said needle, so that said rod 13, 14 can project from the corresponding outlet 6A, 9A out of the grommet tube 5.
• This measure technique allows to repel in a controlled manner the needle 7, 10 at a sufficient distance from the threaded tube 5 to externalize a portion of the wire 8 attached to the corresponding needle that the surgeon can then catch, for example with the aid of a forceps, in order to continue the suturing process.
• the base 7A of the needle 7 has a cross section substantially of the same shape and dimension as those of the cross section (illustrated in Figure 11) of the rod 14, so that the rod 14 s extends in the extension and continuity of the needle 7.
• the grommet system is designed to allow a trajectory of the needles 7, 10 with a radial component.
• the needles 7, 10 can be made, as previously mentioned, according to a curved profile and with a capacity of elastic deformation, so that when the needle is no longer subject to the action of confinement of channel 6, 9 she deflects centrifugally in consideration of the extension axis XX 1 of the grommet tube 5. It is also conceivable to provide the implementation of needles 7, 10 rectilinear but with channels 6, 9 whose outputs 6A , 9A open substantially radially in consideration of the main axial direction X-X '.
• the grommet 4 comprises more than two channels 6, 9, and preferably eight channels, each having a corresponding outlet located towards the proximal portion. 5A of said tube 5 and angularly distributed regularly around the extension axis X-X ', for the respective passage of corresponding needles respectively associated with corresponding son, said son preferably being distinct and independent of each other and each attached to a single corresponding needle.
• the eight outputs corresponding to the eight channels are arranged with an angular spacing of 45 ° between each of them. This allows the surgeon to perform in a particularly simple manner eight sutures arranged at regular intervals on the perimeter of the urethra 1.
• the eight channels of the variant illustrated in the figures are preferably distinct and independent of each other, that is to say they do not communicate with each other, and each extend longitudinally substantially parallel to the axis of extension XX 'of the grommet tube 5.
• each of these eight channels is intended to accommodate a separate thrust means. and independent for moving the independent needle / thread subassembly inserted into the channel in question.
• the surgeon can perform a complete suture of the Urethra to the bladder without having to refill needles and sutures and / or externalize the surgical grommet.
• the surgeon introduces the surgical grommet once, preferably by natural means, completely sutures the urethra to the bladder and removes the surgical grommet.
• the grommet of the invention comprises a plurality of channels, uniformly distributed and angularly offset about the extension axis X-X ', present in sufficient number to allow the complete suture of the urethra to the bladder in a single introduction, by the surgeon, of the grommet.
• the proximal portion 5A of said tube 5 is further provided with a visual identification means 15, intended to allow the surgeon to visualize, for example by means of a laparoscopic camera, the correct positioning of the grommet 4 relative to the urethra 1, prior to the externalization of the needles and the sutures.
• a visual identification means 15 intended to allow the surgeon to visualize, for example by means of a laparoscopic camera, the correct positioning of the grommet 4 relative to the urethra 1, prior to the externalization of the needles and the sutures.
• this visual identification means 15 comprises a boss 16 which protrudes from the proximal portion 5A towards the outside of the tube 5, along the axis of extension X-X '.
• This boss 16 preferably formed by a cylindrical pin of smaller diameter than that of the grommet tube 5, allows the surgeon to know when he sees said boss 16 protrude from the opening of the urethra (see FIG. ) to know that the grommet tube 5 has arrived at its destination.
• the invention furthermore relates as such to a surgical thread system comprising:
• a surgical grommet 4 comprising a grommet tube 5 which on the one hand extends longitudinally along an extension axis XX 'and which on the other hand is provided internally with a first channel 6 having a first outlet 6A located towards the proximal portion 5A of said tube 5, for the passage of a first needle 7 associated with a first wire 8, and of at least one second channel 9 having a second outlet 9A located towards the proximal portion 5A of said tube 5 for the passage of a second needle 10 associated with a second wire, the first and the second output 6A, 9A being angularly offset about the extension axis X-X ', said surgical lead 4 also comprising a first and second propulsion means 11, 12, each individually activatable by a user, designed to move the first and second needles 7, 10 respectively and its externalization through the corresponding outlet 6A, 9A,
• first needle 7 associated with a first wire 8, said first needle 7 being designed to pass through the first output 6A,
• each propulsion means 11, 12 comprising a rod 13, 14 mounted to slide axially within the tube 5, each output 6A, 9A being shaped to allow the passage of the rod 13, 14 corresponding, so that the latter can project through the corresponding output 6A, 9A.
• the first and second needles implemented in the system according to the invention each have a curved shape and are each elastically deformable.
• the system is rechargeable, i.e. the needles and associated wires are replaced.
• the operation of the surgical grommet according to the invention is as follows, in the case of a urethro-vesical anastomosis following a radical prostatectomy.
• the surgeon In operation, the surgeon, after having ablated the prostate 3 and closing the bladder neck 2, proceeds to the introduction of urethro-vesical stitches by introducing the grommet tube 5 into the Ureter by natural means, so as to make it open near the bladder neck (see Figure 3).
• the grommet tube 5 Once the grommet tube 5 is correctly positioned, which the surgeon can control thanks to the protrusion of the boss 16 out of the urethra, the surgeon exerts an axial thrust on a first control head 12A, which has the effect of the axially sliding rod 13, which itself pushes on the corresponding needle 7. Under the effect of this thrust, the needle 7 protrudes progressively out of the tube 5 (see FIGS.
• the rod 13 can also be externalized by the outlet 6A in the wake of the needle 7, the surgeon can move the needle 7 sufficiently away from the tube 5 to clear out of the tube 5 a portion of the wire 8 may to be caught using a laparoscopic forceps.
• the surgeon removes the rod 13 so that the portion of wire 8 located near the base 7A of the needle 7 is no longer located inside the conduit 13A 1 but is now "in the open air" to be caught by the surgeon.
• the surgeon can then proceed to a second suture of the urethra 1 to the bladder 2 spaced angularly from the first suture performed previously.
• the surgeon has to operate in the same way as previously another control head 11A so as to repeat the process that has been described above.
• the invention thus makes it possible, in its preferred embodiment which corresponds to a urethral pass for the urethro-vesical anastomosis, to greatly reduce the total time required for the operation, because of the assistance provided to the surgeon for the production of multiple sutures, for example eight in number in the example illustrated in the figures.
• the invention finds its industrial application in the design and manufacture of a surgical instrument used to ensure the passage of surgical son, in particular to perform an anastomosis between a hollow organ and another organ or conduit of the human body.

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