Microsurgical instrument for anastomosis or suturing of blood vessels and lymphatic vessels

Abstract

The invention relates to the technical field of microsurgical instruments, in particular to a microsurgical instrument for anastomosis or suturing of blood vessels and lymphatic vessels. Comprising microscopic tweezers, the microscopic tweezers comprise a tweezers handle and two tweezers arms connected with the tweezers handle, the two tweezers arms are used for opening a tube wall, strip-shaped grooves are formed in the opposite sides of the two tweezers arms, and the strip-shaped grooves extend in the length direction of the tweezers arms and penetrate from the head ends of the tweezers arms to the tail ends of the tweezers arms. The microneedle is used for being matched with a pair of microscopic tweezers to achieve suturing. The head end of the microscopic tweezers is a tilting arc-shaped semi-cylinder, a small-diameter semicircular groove penetrates through the center of the tilting arc-shaped semi-cylinder, and a 1 / 8 radian microneedle with a 10-degree back angle needle tip is matched, so that when lymphatic vessel-vein anastomosis is carried out under an ultra-microscopic condition, effective support and protection on a blood vessel wall can be realized, and the operation is simple and convenient. And safe and flexible migration of the suture needle in the blood vessel cavity is ensured, the clinical operation efficiency and success rate are greatly improved, and wide clinical application prospects are achieved.

Description

Technical Field

[0001] The present invention relates to the technical field of microsurgical instruments, and specifically to a microsurgical instrument for vascular and lymphatic vessel anastomosis or suture. Background Art

[0002] Lymphaticovenular anastomosis is mainly clinically applied to the treatment of limb lymphedema, neurodegenerative diseases such as Alzheimer's or Parkinson's. This surgery requires operating on small venous blood vessels and lymphatic vessels with a diameter of only about 0.5 - 1.2 mm under a high-power microscope, and the difficulty is extremely high.

[0003] When performing microvascular anastomosis or lymphaticovenular anastomosis, it is necessary to insert a needle, enter the needle through the blood vessel wall and move the needle within the blood vessel lumen. Since the target blood vessel wall is extremely thin, if not careful during the operation, it may puncture the opposite blood vessel wall or damage the inner wall of the blood vessel, resulting in anastomosis failure. Existing conventional microsurgical instruments (such as ordinary microsurgical forceps) are difficult to provide accurate and stable guidance and protection for the suture needle within the narrow blood vessel lumen; conventional micro needles can only meet general suture requirements and cannot balance flexible movement and safety within the blood vessel lumen. Therefore, there is an urgent need for a microsurgical instrument that can improve the safety and efficiency of lymphaticovenular anastomosis surgery. Summary of the Invention

[0004] In view of the above situation, in order to overcome the defects of the prior art, the present invention provides a microsurgical instrument for vascular and lymphatic vessel anastomosis or suture to solve the problems involved in the background art.

[0005] To achieve the above object, the present invention provides the following technical solution: A microsurgical instrument for vascular and lymphatic vessel anastomosis or suture, the microsurgical forceps include a forceps handle, and forceps arms connected to the forceps handle. One or more forceps arms are provided, and the forceps arms are used to be placed inside the blood vessel or lymphatic vessel wall to serve as a guide for the micro needle. A strip-shaped groove is provided on one side of the forceps arm, and the strip-shaped groove penetrates from the head end of the forceps arm and extends along the length direction of the forceps arm.

[0006] Further, two forceps arms are provided, including a first forceps arm and a second forceps arm;

[0007] A strip-shaped groove is provided on one side of the first forceps arm or the second forceps arm. The opposite side of the first forceps arm and the second forceps arm is a plane, and the opposite side is an arc surface. The strip-shaped groove is provided in the plane.

[0008] Further, two forceps arms are provided, including a first forceps arm and a second forceps arm;

[0009] Strip-shaped grooves are provided on one side of both the first forceps arm and the second forceps arm.

[0010] On the first tweezers arm, a side close to the second tweezers arm is a plane, and a side away from the second tweezers arm is an arc-shaped surface, and the strip-shaped groove is arranged in the plane;

[0011] The second forceps arm has a side close to the first forceps arm as an arc surface, and a side away from the first forceps arm as a plane, and the strip-shaped groove is arranged in the plane.

[0012] Furthermore, the tweezers arm is provided with a strip-shaped groove, one side of the tweezers arm is a plane, and the other side is an arc-shaped surface, and the strip-shaped groove is provided in the plane;

[0013] Furthermore, the strip-shaped groove is semi-cylindrical or semi-pillar-shaped.

[0014] Furthermore, the forceps arm gradually becomes thicker from the head end to the tail end;

[0015] The head end of the tweezers arm is provided with a section perpendicular to the length direction of the tweezers arm.

[0016] Furthermore, the head end of the tweezers arm is provided with an arc-shaped tilting structure, and the tilting direction is toward the side where the strip-shaped groove is provided.

[0017] Furthermore, it also includes a microneedle, which is used to cooperate with micro forceps to achieve suturing.

[0018] Furthermore, the diameter of the microneedle is smaller than the diameter of the strip-shaped groove, so that the microneedle moves along the strip-shaped groove.

[0019] Furthermore, the microneedle is an arc-shaped structure.

[0020] Furthermore, a bending portion inclined toward the bending direction of the microneedle is provided at the needle tip of the microneedle.

[0021] Furthermore, the method of using micro-tweezers and micro-needles is as follows: during the operation, one of the tweezers can be inserted into the blood vessel cavity by about 5 mm; then the micro-needle holder is used to insert the micro-needle from the outer wall of the blood vessel, and the micro-needle is pushed forward along the strip groove in the center of the tweezers head; when the needle tip passes through the blood vessel opening, the needle tip is clamped by tweezers or other instruments, and the micro-needle pierces one or more severed lymphatic vessel walls. The needle tip follows the groove of the tweezers that extends into the blood vessel cavity to the vicinity of the needle insertion point, pierces the blood vessel wall, and finally pulls the severed lymphatic vessel into the blood vessel cavity and withdraws the tweezers. The micro-needle pierces the blood vessel wall and is knotted and fixed to complete the anastomosis.

[0022] Compared with the prior art, the present invention has the following beneficial effects:

[0023] The present invention uses the arc-shaped tilted structure and the strip-shaped groove at the tip of the micro-tweezers to enable the surgeon to advance the microneedle along the guidance of the strip-shaped groove when performing the "locking method" to insert the needle and navigate within the blood vessel cavity. The microneedle obtains more effective support and guidance, protects the blood vessel wall, and greatly reduces the risk of puncturing the blood vessel wall or damaging the inner wall of the blood vessel, thereby improving the safety and success rate of lymphatic-venous anastomosis and reducing the difficulty of surgical operation. BRIEF DESCRIPTION OF THE DRAWINGS

[0024] Figure 1 Schematic diagram of the three-dimensional structure of microscopic tweezers according to an embodiment of the present invention;

[0025] Figure 2 This is a schematic diagram of the enlarged structure of position B of the microscopic tweezers head according to an embodiment of the present invention;

[0026] Figure 3 Schematic diagram of the side view of the microscopic tweezers head according to an embodiment of the present invention;

[0027] Figure 4 AA side cross-sectional structure schematic diagram of the micro tweezers according to an embodiment of the present invention;

[0028] Figure 5 Schematic diagram of the three-dimensional structure of the microneedle according to an embodiment of the present invention;

[0029] Figure 6 This is a schematic diagram of the enlarged structure of the microneedle head at position C in an embodiment of the present invention;

[0030] Figure 7 This is a schematic diagram of the main structure of the microtweezers of Example 1 of the present invention when the first forceps arm is placed in a blood vessel;

[0031] Figure 8 This is a left-side structural schematic diagram of the microscopic forceps of Example 1 of the present invention when the first forceps arm is placed into a blood vessel;

[0032] Figure 9 This is a schematic diagram of the main structure of the second forceps arm being placed into a blood vessel when the micro forceps according to Example 1 of the present invention are used;

[0033] Figure 10 This is a left-side structural schematic diagram of the second forceps arm being placed into a blood vessel when the micro-tweezers according to Example 1 of the present invention are in use;

[0034] Figure 11 This is a schematic diagram of the main structure of the microscopic forceps of Example 2 of the present invention when placed in a blood vessel;

[0035] Figure 12 This is a left-side structural schematic diagram of the microscopic forceps of Example 2 of the present invention when placed in a blood vessel;

[0036] Figure 13 This is a schematic diagram of the main structure of the microscopic forceps of Example 3 of the present invention when placed in a blood vessel;

[0037] Figure 14 This is the left view structural schematic diagram of the microsurgical forceps when used and inserted into a blood vessel in Embodiment 3 of the present invention;

[0038] In the figure:

[0039] Forceps handle 1, forceps arm 2, flat surface 21, arc surface 22, cutting surface 23, arc-shaped upturned structure 24, strip-shaped groove 25, micro-needle 3, bent portion 31. Specific embodiments

[0040] Next, the technical solutions in the embodiments of the present invention will be clearly and completely described in conjunction with the accompanying drawings in the embodiments of the present invention. Obviously, the described embodiments are only a part of the embodiments of the present invention, rather than all the embodiments; based on the embodiments of the present invention, all other embodiments obtained by those of ordinary skill in the art without creative efforts shall fall within the protection scope of the present invention.

[0041] Embodiment 1:

[0042] As shown by Figure 1-4 A microsurgical instrument for blood vessel and lymphatic vessel anastomosis or suture includes microsurgical forceps, and materials with high-temperature and high-pressure sterilization performance, good elasticity and toughness such as medical stainless steel or titanium alloy can be selected to manufacture the microsurgical forceps. The microsurgical forceps include a forceps handle 1 and two forceps arms 2 connected to the forceps handle 1, and the closing degree and coaxiality of the two forceps arms 2 meet the requirements of microsurgical operation; there are two forceps arms 2, including a first forceps arm and a second forceps arm; on the first forceps arm, the side close to the second forceps arm is a flat surface 21, and the side far from the second forceps arm is an arc surface 22; on the second forceps arm, the side close to the first forceps arm is an arc surface 22, and the side far from the first forceps arm is a flat surface 21. The forceps arms 2 can expand the blood vessel wall to leave enough space for the micro-needle to pass through.

[0043] The head end of the forceps arm 2 is a frustum of a cone shape, gradually becoming thicker from the head end to the end, with the diameter of the frontmost end gradually transitioning from about 0.3 mm to about 0.5 mm at the end. A cutting surface 23 perpendicular to the length direction of the forceps arm 2 is provided at the head end. An arc-shaped upturned structure 24 with a length of about 2 cm and a smooth transition is provided at the head end. When the forceps are inserted into the blood vessel cavity by about 5 mm, the blood vessel can be moderately "lifted" or expanded, providing a larger activity space and visual range for needle insertion and pulling operations; at the same time, it can also play a certain role in supporting and protecting the blood vessel wall.

[0044] On one side of the center line of the upper plane 21 of the first tweezer arm and the second tweezer arm, a strip-shaped groove 25 is provided, and the tilting direction of the arc-shaped tilting structure 24 faces the side where the strip-shaped groove 25 is provided. The strip-shaped groove 25 penetrates from the head end to the end of the tweezer arm 2 and extends along the length direction of the tweezer arm 2. The strip-shaped groove 25 is semi-cylindrical or semi-trapezoidal; the diameter of the strip-shaped groove 25 is 0.2 mm. The strip-shaped groove 25 forms a "guide rail" to help the micro-needle advance along the strip-shaped groove 25, obtain stable guidance in the blood vessel cavity, and the blood vessel wall is better supported, making the needle insertion and wandering processes smoother and more controllable, and as much as possible avoiding scratching or puncturing the blood vessel wall. The operator can complete the "locking method" and subsequent suture operations faster, reducing the probability of rework or failure.

[0045] The micro tweezers of the present application have a chamfer design, with a round and flat shape at each part and not sharp, so it will not cut the blood vessel.

[0046] The micro tweezers of the present application can play a role in supporting and protecting blood vessels. The semi-trapezoidal shape at the head end of the tweezer arm 2 protects the blood vessel wall and is not easy to pierce the blood vessel wall. The strip-shaped groove 25 can help protect the opposite arm of the blood vessel and reduce the friction of the needle tip against the inner wall when wandering in the blood vessel lumen. The arc-shaped tilting structure 24 of the micro tweezers "stretches" the blood vessel, enabling the operator to more clearly see the needle insertion point under a high-power microscope. The strip-shaped groove 25 can make the micro-needle "fit" and move forward along the strip-shaped groove, improving the stability of the needle insertion and "locking method" operations.

[0047] As Figures 7-10 shown, it is a schematic diagram of the micro tweezers when the first tweezer arm or the second tweezer arm is placed in the blood vessel, where the arrow indicates the needle insertion direction and angle of the micro-needle.

[0048] Embodiment 2:

[0049] The same parts as those in Embodiment 1 will not be described in detail. The differences are as follows:

[0050] There are two tweezer arms 2, including a first tweezer arm and a second tweezer arm; a strip-shaped groove 25 is provided on one side of the first tweezer arm or the second tweezer arm. The opposite side of the first tweezer arm and the second tweezer arm is a plane 21, and the opposite side is an arc surface 22. The strip-shaped groove 25 is provided in the plane 21 of the first tweezer arm or the second tweezer arm. When in use, one tweezer arm provided with the strip-shaped groove 25 is inserted into the blood vessel.

[0051] As Figures 11-12 shown, it is a schematic diagram of the tweezer arm provided with the strip-shaped groove 25 on the micro tweezers when placed in the blood vessel, where the arrow indicates the needle insertion direction and angle of the micro-needle.

[0052] Embodiment 3:

[0053] The same parts as those in Embodiment 1 will not be described in detail. The differences are as follows:

[0054] The forceps arm 2 is provided with one. There is a strip-shaped groove 25 on the forceps arm 2. One side of the forceps arm 2 is a plane 21, and the other side is an arc surface 23. The strip-shaped groove 25 is arranged in the plane.

[0055] As Figures 13-14 shown, a schematic diagram of the forceps arm of the micro forceps after being placed in a blood vessel, where the arrow indicates the needle insertion direction and angle of the micro needle.

[0056] Example 4:

[0057] The same parts as in Example 1 will not be described in detail. The differences are as follows:

[0058] As Figures 5-6 , it further includes a micro needle 3, which is made of stainless steel or alloy steel. The micro needle 3 is used to cooperate with the micro forceps to achieve suture. The diameter of the micro needle is about 80μm of the needle body diameter, which is smaller than the diameter of the strip-shaped groove 25, so that the micro needle advances along the strip-shaped groove 25. The micro needle 3 is an arc structure, specifically in the shape of a 1 / 8 circular arc, with a needle arc length of about 4mm, matching a 10-0 suture line with a length of about 10cm. There is a bending part 31 inclined towards the bending direction of the micro needle at the needle tip of the micro needle. The bending part is set at about 1mm away from the needle tip, with an inclination angle of 10°, so as to ensure that when moving in the blood vessel, the needle tip can advance along the strip-shaped groove 25 and avoid scratching the blood vessel wall as much as possible. This design enables the needle to have the ability to pierce the blood vessel wall and is not easy to cause excessive damage to the inner wall of the blood vessel.

[0059] This application can be applied to the deep cervical lymphatic vessel - jugular vein anastomosis, the lymphatic vessel - jugular vein anastomosis for limb lymphedema, and other ultra-micro surgical fields that require anastomosis or suture of blood vessels with a diameter of about 0.5 - 1.2mm.

[0060] The combined surgical method of the micro forceps and the micro needle in this application is as follows:

[0061] I. Preoperative preparation

[0062] Routinely evaluate the patient's cardiopulmonary function, coagulation function, blood routine, and relevant imaging (such as neck ultrasound, ICG fluorescence lymphography, etc.). Clearly define the course, caliber, etc. of the deep cervical lymphatic vessels and jugular veins to be anastomosed. Prepare the anastomosis materials such as micro forceps, high-power microscope (20 - 30 times, or higher magnification), micro needle, and 11-0 / 10-0 suture.

[0063] Generally, general anesthesia or a combined general anesthesia - local anesthesia mode is adopted to ensure that the patient is painless and stress-free during the operation. Take the supine position, turn the head slightly to one side and tilt the head backward appropriately to moderately expose the neck, which is beneficial to exposing the neck lymphatic vessels and veins.

[0064] Generally, a small oblique incision about 4 cm is made in the third and fourth regions of the cervical lymph nodes (the middle and lower thirds of the anterior border of the sternocleidomastoid muscle). Identify the branches of the external jugular vein or internal jugular vein, and carefully isolate the deep cervical lymphatic vessels and lymph nodes under the cooperation of indocyanine green (ICG) fluorescence imaging or magnifying glass. Select the target vein and free up a vascular segment about 1-2 cm; for the lymphatic vessels, a segment of 0.5-1 cm can be moderately freed up for subsequent anastomosis operations.

[0065] II. Operation of Micro Forceps

[0066] Preparation before inserting into the vascular lumen: Under 20-30 times magnification of the microscope, gently retract the surrounding tissues with conventional small forceps or other blunt instruments, being careful not to damage the thin-walled lymphatic vessels and veins. Ensure that the anastomotic site (or transection site) is in the center of the field of view.

[0067] Gently insert the head end of the curved structure 24 of one forceps arm 2 of the micro forceps into the target blood vessel or lymphatic vessel lumen, about 3-5 mm, and slightly expand the vessel wall. During the insertion process, the curved structure 24 can gently "lift" the vessel wall to better expose the inner lumen of the blood vessel or lymphatic vessel;

[0068] If mild traction of the blood vessel is required, the modified forceps can be used in conjunction with another ordinary micro forceps: The modified forceps is placed inside the blood vessel lumen to expand and protect, while the other forceps is used to pull or adjust the blood vessel angle outside the blood vessel to facilitate the entry and exit of suture needles in different directions.

[0069] III. Operation of Micro Needle

[0070] Use a micro needle holder (or a small needle holder of equivalent specification) to hold the middle and posterior third of the curved structure of the micro needle 3, avoiding directly pinching the tip or the back angle to prevent deformation. When inserting the needle, try to make the back angle of the tip face "downward" or "away from" the blood vessel wall, so as to make full use of the cooperation between the 10° back angle and the strip-shaped groove.

[0071] Insert the micro needle 3 from the outer wall of the blood vessel (or lymphatic vessel). After the tip enters the blood vessel lumen, it naturally adheres to the strip-shaped groove 25 at the head end of the forceps arm 2; keep the tip "fitted" with the strip-shaped groove 25 and move forward to reduce the random flipping of the tip inside the blood vessel wall.

[0072] When the tip advances to an appropriate position in the lumen, the needle holder can be moderately rotated to change the direction of the tip, piercing the other side or the appropriate point of the blood vessel to complete the "lasso".

[0073] If traction of the lymphatic vessel is required, the tip can first pass through the severed lymphatic vessel walls on one side, and several lymphatic vessels can be lassoed and pulled into the venous lumen.

[0074] After the "lasso" is completed, slightly rotate the tip, pierce the venous wall or return to the outside, and withdraw the needle body;

[0075] Tie a knot outside the blood vessel, or perform continuous suture or interrupted suture according to the surgical design. When pulling out the needle tip, make sure that no extra blood vessel wall or lymphatic vessel wall is accidentally entangled. If necessary, use modified micro forceps to open the blood vessel cavity again to clearly observe the suture point.

[0076] Embodiment 3:

[0077] This embodiment comprises the microscopic forceps of embodiment 1 and the microneedle of embodiment 2,

[0078] The application steps of microtweezers and microneedles in the treatment of neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease through modified deep cervical lymphatic-venous anastomosis:

[0079] 1. Locate and expose the anastomosis

[0080] A small incision is used to expose the deep neck lymphatic vessels and the internal / external jugular veins. The function and direction of the lymphatic vessels are determined under ICG fluorescence imaging. The target vein is cut off.

[0081] 2. Insert the micro forceps into the vein cavity

[0082] Gently slide the arc-shaped lifting structure 24 at the tip of the forceps arm 2 into the vein cavity for about 3 to 5 mm to lift the blood vessel wall;

[0083] Use the micro needle holder to insert the micro needle 3 from the outside of the vein → enter the vein cavity → move forward along the strip groove 25 of the improved micro forceps → then continuously pierce the walls of multiple unilateral lymphatic vessels to form a group of multiple lymphatic vessels;

[0084] Insert the micro forceps into the blood vessel from the cut end of the blood vessel for about 3-5 mm. Use the micro needle holder to insert the special micro needle 3 into the vein from the vein opening along the groove of the modified forceps, pierce the blood vessel wall on the opposite side of the last insertion point, and remove the needle.

[0085] Tie a loose knot and secure the lymphatic vessel.

[0086] Although embodiments of the present invention have been shown and described, it will be appreciated by those skilled in the art that various changes, modifications, substitutions and variations may be made to the embodiments without departing from the principles and spirit of the present invention, and that the scope of the present invention is defined by the appended claims and their equivalents.

Claims

1. A microsurgical instrument for anastomosis or suturing of blood vessels or lymphatic vessels, comprising microtweezers, wherein the microtweezers comprise a tweezer handle and a tweezer arm connected to the tweezer handle, characterized in that: The forceps arm is provided with one or more than one device, and the forceps arm is used to be placed into the wall of a blood vessel or lymphatic vessel as a guide for the microneedle. A strip groove is provided on one side of the forceps arm, and the strip groove passes through the head end of the forceps arm and extends along the length direction of the forceps arm.

2. The microsurgical instrument for anastomosis or suturing of blood vessels and lymphatic vessels according to claim 1, characterized in that: The forceps arms are provided with two, including a first forceps arm and a second forceps arm; A strip groove is arranged on one side of the first forceps arm or the second forceps arm. The opposite side of the first forceps arm and the second forceps arm is a plane, and the opposite side is an arc surface. The strip groove is arranged in the plane.

3. The microsurgical instrument for anastomosis or suturing of blood vessels or lymphatic vessels according to claim 1, characterized in that: The forceps arms are provided with two, including a first forceps arm and a second forceps arm; One side of the first forceps arm and the second forceps arm are both provided with a strip groove. On the first tweezers arm, a side close to the second tweezers arm is a plane, and a side away from the second tweezers arm is an arc-shaped surface, and the strip-shaped groove is arranged in the plane; The second forceps arm has a side close to the first forceps arm as an arc surface, and a side away from the first forceps arm as a plane, and the strip-shaped groove is arranged in the plane.

4. The microsurgical instrument for anastomosis or suturing of blood vessels or lymphatic vessels according to claim 1, characterized in that: The tweezers arm is provided with a strip-shaped groove, one side of the tweezers arm is a plane, and the other side is an arc-shaped surface, and the strip-shaped groove is arranged in the plane.

5. The microsurgical instrument for anastomosis or suturing of blood vessels and lymphatic vessels according to claim 1, characterized in that: The strip-shaped groove is semi-cylindrical or semi-pillar-shaped.

6. The microsurgical instrument for anastomosis or suturing of blood vessels or lymphatic vessels according to claim 1, characterized in that: The forceps arm gradually becomes thicker from the head end to the tail end; The head end of the tweezers arm is provided with a section perpendicular to the length direction of the tweezers arm.

7. The microsurgical instrument for anastomosis or suturing of blood vessels or lymphatic vessels according to any one of claims 2 to 4, characterized in that: The head end of the tweezers arm is provided with an arc-shaped tilting structure, and the tilting direction is toward the side where the strip-shaped groove is provided.

8. The microsurgical instrument for anastomosis or suturing of blood vessels or lymphatic vessels according to claim 1, characterized in that: It also includes a microneedle, which is used to cooperate with micro forceps to achieve suturing.

9. The microsurgical instrument for anastomosis or suturing of blood vessels or lymphatic vessels according to claim 7, characterized in that: The diameter of the microneedle is smaller than the diameter of the strip-shaped groove, so that the microneedle moves along the strip-shaped groove.

10. The microsurgical instrument for anastomosis or suturing of blood vessels or lymphatic vessels according to claim 7, characterized in that: The microneedle is an arc-shaped structure; The needle tip of the microneedle is provided with a bending portion inclined toward the bending direction of the microneedle.

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