FR2906995A1 - MULTI-NEEDLE SURGICAL HANDWOOD FOR HOLLOW MEMBER AND CORRESPONDING SYSTEM - Google Patents

Abstract

The invention relates to a surgical grommet (4) comprising a grommet tube (5) which on the one hand extends longitudinally along an axis of extension and which on the other hand is provided internally with a first channel 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, characterized in that the grommet tube (5) is further provided internally with at least one second channel having a second outlet (9A) located towards the proximal portion (5A) of said tube (5), for the passage of a second needle associated with a second wire, the first and the second outlet (6A, 9A) being angularly offset about the extension axis.Surgical surgical straps.

Description

1 MULTI-NEEDLE SURGICAL HANDWOOD FOR HOLLOW ORGAN AND SYSTEM

  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 mammalian body and in particular of the human being, for particular purpose. to perform 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. More particularly, 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 outlet located towards the proximal portion of said tube, for the passage of a first needle associated with a first wire. The invention also relates to a surgical grommet system comprising: 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 of said tube, for passage of a first needle associated with a first wire, and a first needle associated with a first wire, said first needle being designed to go through the first exit. Conventionally, it is already known in the surgical field to use needle holders generally in the form of conventional surgical forceps, which allow, by direct pinching of the needle, to direct the needle and the wire to and in the area where the anastomosis will be performed. Conventional needle holders, however, are not readily usable in general in all the various types of surgical operations, and their use remains delicate, particularly when it is desired to perform an anastomosis involving at least one hollow organ through which the thread and the needle must transit. Thus, for example, in the case of a radical prostatectomy, it proves difficult and difficult to use conventional needle holders to perform an anastomosis between the bladder and the urethra, for example by 15 ccelioscopic. In addition, because of the difficult operating conditions, the total time required for the anastomosis is relatively long, whereas it is now precisely sought to reduce as much as possible the duration of the surgical operations to reduce the constraints for the patient .

In order to remedy these various problems, it has been proposed, in the prior art, a surgical grommet comprising a grommet tube provided with a channel with an inlet and an outlet situated respectively towards the distal and proximal portions. 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. In operation, the surgeon can proceed to the establishment of the urethro-vesical stitches by introducing the prior art grommet tube into the urethra, so as to make it open near the urethra. vesical collar. After having previously grasped the needle and the corresponding wire in the canal, the surgeon can then, with the aid of the pushing means, ensure the externalization of the needle out of the outlet in the vicinity of the suture zone. The bladder neck is then sutured to the urethra. Such a surgical grommet is likely to greatly facilitate urethrovesical 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 urethra, 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 operational 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 disadvantages listed above and to propose new surgical grommets and surgical grommets which greatly facilitate the production of a multiplicity of sutures at different positions. B60373 / EN 2906995 4 different angles, especially in case of anastomosis, while reducing the total duration of the surgical procedure. Another object of the invention is to provide novel surgical wire and surgical grommet system allowing, by means of particularly simple and inexpensive means, to control the movement of surgical wires and needles. through a hollow body. Another object of the invention is to provide novel surgical grommets and surgical grommets 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 grommets and surgical grommet systems whose positioning relative to the hollow organ in which the grommet is to be threaded can be controlled in a controlled manner. particularly simple and reliable by the surgeon. An additional object of the invention is to provide novel surgical grommets and surgical grommet systems particularly adapted to 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 provided with internally of 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, characterized in that the grommet tube is 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. The objects assigned to the invention are also achieved by means of a surgical thread system comprising: a surgical grommet comprising a grommet tube which on the one hand extends longitudinally along an axis d extension and which, on the other hand, is provided internally with 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, a first needle associated with a first wire, said first needle being adapted to pass through the first outlet, characterized in that the grommet tube is 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, and in that it comprises a B60373 / FR 2906995 6 second needle associated with a second wire, said second needle being adapted to pass through the second output. Other advantages and objects of the invention will be explained in more detail on reading the description which follows, and with the aid of the accompanying drawings provided purely for explanatory and non-limiting purposes, in which: FIG. , schematically, the anatomical context of implementation of a surgical grommet according to the invention in the case of a urethro-vesical anastomosis required by a laparoscopic radical prostatectomy, before removal of the prostate 10 - Figure 2 illustrates the anatomical area of Figure 1 after removal of the prostate. - Figure 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 grommet system according to the invention. FIG. 5 illustrates, in a schematic side view, the embodiment detail illustrated in FIG. 4. FIG. 6 illustrates, in a front view, the detail of embodiment illustrated in FIGS. 4 and 5. FIG. illustrates, in a schematic side view, an embodiment detail of the system illustrated in FIGS. 3 to 6 with the needles almost entirely externalized, whereas their externalization was only beginning in FIGS. 4 to 6. FIG. 8 illustrates, in a front view, the surgical thread system of Figures 3 to 7 without its needles. FIG. 9 illustrates, in a diagrammatic sectional view, the surgical grommet of FIGS. 3 to 8. FIG. 10 illustrates, in a cross-sectional view taken along line BB of FIG. embodiment of the section of the grommet tube of the surgical grommet of FIG. 9. FIG. 11 illustrates, in a cross-sectional view taken along line CC of FIG. 9, a detail of embodiment of the section. a rod mounted to slide axially within the grommet tube to exert an axial thrust on a corresponding needle. FIG. 12 illustrates, in schematic sectional side view, a needle for use with the surgical grommet illustrated in FIGS. 3 to 11 and the suture thread associated therewith. FIG. 13 illustrates, in a schematic side view, an alternative embodiment of a surgical grommet system according to the invention specifically intended for producing a urethro-vesical anastomosis. In the following description, reference will be made more particularly to the production of a surgical grommet particularly suitable for the production of a urethro-vesical anastomosis consisting in connecting, by suturing, the urethra 1 to the bladder 2 after removal of the prostate 3 (see Figures 1 to 3). B60373 / FR 2906995 8 The grommet 14 according to the invention therefore preferably constitutes a urethral grommet. Nevertheless, within the meaning of the invention, 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 bodies, without the invention being considered as being limited to the strict application to a urethro-vesical anastomosis. As illustrated in the figures, 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 from stainless steel or titanium or other metallic materials, or from flexible, rigid or semi-rigid plastic materials. In any case, 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. In general, the grommet tube 5 may have a straight shape. or curve, or any suitable geometric shape combining straight or curved portions. In particular, and advantageously as illustrated in FIG. 13, 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 in the urethra 1, while optimally controlling the geometrical zone of externalization of the needle in the vicinity of the suture zone, as will be described in more detail in what follows. The grommet tube 5 is provided internally, preferably axially (ie along its extension axis X-X '), with a first channel 6 having a first outlet 6A located towards or near the , the proximal portion 5A of said tube 5, for the passage of a first needle 7 associated with a first wire 8. In other words, the first channel 6 is designed to allow the passage therethrough, in an axial progression, of the first needle 7 to 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 forded. Preferably, as illustrated in FIG. 12, 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 a, for example, substantially at 45. The needle 7 may for example have a deformable nature with preferably a shape memory. For this purpose, the needle 7 may for example be made of an elastic or superelastic material, so that it can be deformed according to a rectilinear profile, for example within the channel 6, and then return to a curved conformation, as illustrated. in FIG. 12, when it is exteriorized and is no longer subjected to the mechanical constraint of confinement exerted by the channel 6.

The end 8A of the surgical wire 8 is 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. B60373 / FR 2906995 Preferably the wire 8 is resorbable. According to the invention, 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 thread. Preferably, the second channel 9 has a conformation identical to that of the first channel 6, the second needle 10 and the second wire associated with it being preferentially identical to the first needle 7 and the first wire 8, respectively.

In the examples illustrated in the figures, the first and second channels 6, 9, which are preferably distinct and independent, are thus both formed inside the tube 5 and extend substantially axially, that is to say 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 as well as for the wire associated with each of these needles. In order to ensure this guiding function, it is of course not necessary that 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. According to the invention, the first and second outlets 6A, 9A are angularly offset. around the extension axis X-X ', as can be seen in particular in FIG. 8. In other words, the first and the second outputs 6A, 9A are arranged respectively in a first and a second position. radial angularly offset about the axis of extension of a nonzero angle 33. B60373 / FR 2906995 11 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 X-X' with an angular shift3. In other words, the first and second outlets 6A, 9A are radially offset, and preferably have substantially no axial offset. Thanks to this technical feature, it is possible to guide two distinct needles 7, 10 each associated with a corresponding separate wire in two different radial positions, which makes it possible to ensure respectively a first and a second suture in two angularly separate locations of the perimeter of the urethra 1. The surgeon does not need, to practice these two sutures in angularly separate locations, to perform a displacement operation (rotation) of the tube 5 within the urethra 1.

Advantageously, the grommet 4 according to the invention 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 outlet 6A, 9A corresponding (see Figures 9 and 11). Thus, each propulsion means 11, 12 is adapted to move the corresponding needle 7, 10 within the grommet tube 5, so as to cause the externalization of said corresponding needle 7, 10 by the corresponding output. 6A, 9A. Advantageously, said first and second propulsion means 11, 12 are designed to exert an axial thrust respectively on the first 25 and the second hand 7, 10. More specifically, said first and second propulsion means 11, 12 are advantageously intended to be axially threaded respectively in the channel 6 and the channel 9, by an inlet 6B, 9B of said channel 6, 9 located opposite the outlet 6A, 9A, that is to say towards, or at the adjacent to, 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 in order to slide therein and ensure the thrust of the corresponding needle 7, 10 and its externalization by the corresponding outlet 6A, 9A. Advantageously, each propulsion means 11, 12 comprises a respective control head 11A, 12A which projects out of the grommet tube 5 so as to be accessible to a user. In other words, 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. With this technical arrangement, 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 propelling means 11, 12 corresponding, which forms a pushing means actuated by the surgeon. Preferably, 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. inserted in the corresponding channels 6, 9, as well as the needles 7, 10 with their associated yarns. The axial position of the needles 10 and corresponding propulsion means 11, 12 is such that the needles 7, 10, unlike what is shown in FIGS. 4 and 7, do not project out of the tube 5, on the contrary, they are entirely retracted inside the corresponding channel 6, 9. Once the threaded tube 5 has been brought into its working position, illustrated in FIG. 3, the surgeon only has to exert a thrust on the propulsion means 11, 12 for externalizing the corresponding needle 7, 10 (FIGS. 4 and 7) which will pierce the wall of the urethra 1 in order to suture said urethra to the bladder 2 (in the case of a urethral-vesical anastomosis). Advantageously, 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. Thus, 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 respective channels 6, 9 to come into contact with the base 7A of the corresponding needle, the wire 8 extending from said base 7A being arranged in the longitudinal conduit 13A, 14A formed in the rod 20 correspondingly 13, 14. It is of course quite possible, alternatively, that 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. Preferably, 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 right longitudinal profile or curve of the channel 6, 9 in which they evolve. For example, the rods 13, 14 may be made of a plastic material or a metal material.

Advantageously, each outlet 6A, 9A is shaped to allow the passage of the corresponding rod 13, 14, that is to say that the opening formed by the outlet 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 output 6A, 9A out of the grommet tube 5. This technical measure makes it possible to push back the needle 7, 10 in a controlled manner at a sufficient distance from the grommet tube 5 to externalize a portion of the wire 8 attached to the corresponding needle which the surgeon will then be able to catch, for example at 15 l. using a forceps, in order to continue the suturing process. For example and preferably, the base 7A of the needle 7 has a cross section substantially of the same shape and size 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.

Advantageously, and to favor the exit of the needles 7, 10 out of the corresponding channels 6, 9 in a direction conducive to a good placement of the sutures by the surgeon, the grommet system according to the invention is designed to allow a trajectory of the needles 7, 10 with a radial component. For this purpose, the needles 7, 10 may be made, as previously mentioned, in a curved profile and with an elastic deformation capacity, so that when the needle is no longer subjected to the action for confining the channel 6, 9 it deflects centrifugally in consideration of the extension axis XX 'of the grommet tube 5. It is also conceivable to provide for the use 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 '.

According to a particularly advantageous variant of the invention and as illustrated in FIGS. 1 to 13, the grommet 4 comprises more than two channels 6, 9, and preferably eight channels, each having a corresponding output located towards the part proximal 5A of said tube 5 and angularly distributed uniformly about the extension axis X-X ', for the respective passage of corresponding needles respectively associated with corresponding son, said son being preferably distinct and independent of each other; others and each attached to a single corresponding needle. For example, in accordance with the preferred embodiment illustrated in the figures, 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 preferentially distinct and independent of one another, that is to say that is to say that they do not communicate with each other, and each extend longitudinally substantially parallel to the extension axis XX 'of the grommet tube 5. Advantageously, each of these eight channels is intended to accommodate a means of separate and independent thrust for moving the independent needle / thread subassembly inserted into the channel in question. B60373 / FR 2906995 16 Preferably, 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 using a caméracoelioscopic, the correct positioning of the grommet 4 relative to the urethra 1, 5 prior to the externalization of the needles and the sutures. Preferably, 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 diameter 10 less 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 figure 3) to know that the grommet tube 5 has arrived at its destination. The invention further 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 internally provided 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, 20 - a first needle 7 associated with a first wire 8, said first needle 7 being designed to pass through the first outlet 6A, the grommet tube 5 being further provided internally with 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 25 associated with a second wire, the first and the second output 6A, 9A being angularly offset about the extension axis X-X ', said system B60373 / FR 290699 17 comprising a second needle 10 associated with a second wire, said second needle being adapted to pass through the second output 9A. Preferably, the first and second needles used in the system according to the invention each have a curved shape and are each elastically deformable. Preferably, the system is rechargeable, that is to say that the needles and associated son are replaceable. However, a single-use system, pre-loaded with its needles, is quite possible without departing from the scope of the invention.

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. In operation, the surgeon, after having ablated the prostate 3 and closing the bladder neck 2, proceeds to the placement of the urethro-vesical stitches by introducing the grommet tube 5 into the the urethra by natural means, so as to make it emerge near the bladder neck (see Figure 3). Once the grommet tube 5 is correctly positioned, which the surgeon can control by protruding the boss 16 from the urethra, the surgeon exerts an axial thrust on a first control head 12A, which has the effect of to drive axially sliding the rod 12, 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. 4 and 7) and pierces the wall of the urethra 1 from the inside to the outside, dragging with it the thread 8 which is attached to it. Thanks to the fact that the rod 13 can also be externalized by the outlet 6A in the wake of the needle 7, the surgeon can sufficiently remove the needle 7 from the tube 5 to release a tube from the tube 5. wire 8 can be caught using a laparoscopic forceps. For this purpose, after ensuring the externalizing push allowing the needle 7 to exit through the outlet 6A and to pierce the urethra 1, the surgeon removes the stem 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, but is now in the open air to be caught by the surgeon. The surgeon then proceeds to suture the urethra 1 to the bladder 2 in a conventional manner, using appropriate laparoscopic tools.

The surgeon can then proceed to a second suture of the urethra 1 to the bladder 2 spaced angularly from the first suture made previously. To do this, 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 producing multiple sutures, for example eight in number in the example illustrated in the figures.

20 B60373 / FR

Claims (4)

  1 Surgical thread guide (4) comprising a grommet tube (5) which on the one hand extends longitudinally along an extension axis (X-X ') and which on the other hand is internally provided 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), characterized in that the grommet tube (5) is further internally provided with 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 ').   2 - grommet (4) according to claim 1 characterized in that it comprises a first and a second propulsion means (11, 12) designed to ensure the displacement respectively of the first and second needle (7, 10). ) and its externalization by the corresponding output (6A, 9A). 3 thread-pass (4) according to claim 2 characterized in that said first and second propulsion means (11, 12) are designed to exert an axial thrust respectively on the first and second needle (7, 10). 4 - Grommet (4) according to claim 3 characterized in that each propulsion means (11, 12) comprises a respective control head (11A, 12A) which projects out of the tube (5) so as to be accessible to a user. B60373 / FR 2906995 5 - Grommet (4) according to claim 3 or 4 characterized in that 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), said rod (13, 14) being pierced longitudinally and internally by a reception duct (13A, 14A) of the thread associated with said needle (7, 10); , 10). 6 Grommet (4) according to claim 5 characterized in that each output (6A, 9A) is shaped to allow the passage of the corresponding rod (13, 14). 10 7 -Pass-wire (4) according to one of claims 1 to 6 characterized in that it comprises more than two channels each having a corresponding output located towards the proximal portion (5A) of said tube (5) and angularly distributed in a regular manner around the extension axis (X-X '), for the respective passage of corresponding needles 15 respectively associated with corresponding son. 8 grommet (4) according to one of claims 1 to 7 characterized in that the proximal portion (5A) of said tube (5) is provided with a visual identification means (15). 9 - Grommet (4) according to claim 8 characterized in that said visual identification means (15) comprises a boss (16) projecting from the proximal portion (5A) along the axis of extension (X X '). 10 -Pass-wire (4) according to one of the preceding claims characterized in that it constitutes a urethral pass-wire. 11 -System of surgical wire-holder comprising: a surgical grommet (4) comprising a grommet tube (5) which on the one hand extends longitudinally along an axis of extension (X- X ') and which on the other hand is internally provided 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), a first needle (7) associated with a first wire (8), said first needle (7) being adapted to pass through the first output (6A), characterized in that the grommet tube (5) is further internally provided with 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 second outputs (6A, 9A) being angularly offset around the extension axis (X-X '), and in that it comprises a second needle (10) associated with a second wire, said second needle (10) being adapted to pass through the second output (9A). 12-surgical thread system system according to claim 11 characterized in that the first and second needle (7, 10) each have a curved shape and are each elastically deformable. 13 -System surgical wire system according to claim 11 or 12 characterized in that the system is rechargeable, the needles (7, 10) and the associated son (8) being replaceable. B60373 / EN