Fixing device for fixing a ligature band

Abstract

Fixing device (100) for fixing a ligature band (200) with a sleeve (110) and a pressure element (120), wherein the pressure element (120) has at least one locking element (122a, 122b), wherein the sleeve (110) has two guide channels (114a, 114b) for receiving a section of the ligature band (200), wherein the sleeve (110) has at least one first counter-locking element (115a, 115b) and at least one clamping element (117a, 117b), and wherein the pressure element (120) is slid into the sleeve (110) in an insertion direction (X) and is arranged in a fixing position in the sleeve (110) such that the locking element (122a, 122b) interacts with the first counter-locking element (115a, 115b), wherein in the fixing position the clamping element (117a, 117b) is actuated in such a way that a ligature band (200) guided through the guide channels (114a, 114b) can be clamped in the guide channels (114a, 114b), characterized in thatthat the sleeve (110) has at least one second counter-locking element (116a, 116b), wherein the pressure element (120) is arranged in the sleeve (110) in an assembly position such that the locking element (122a, 122b) interacts with the second counter-locking element (116a, 116b), and in the assembly position the ligature band (200) guided through the guide channels (114a, 114b) is displaceable in the guide channels (114a, 114b).

Description

[0001] The invention relates to a fixing device for fixing a ligature band.

[0002] During surgical procedures, it is common practice to apply ligatures to treat wounds, for example to tie off a hollow organ or vessel, but also to remove tissue after it has been tied off beforehand. A ligature is used to place a loop around the tissue, hollow organ, vessel, or similar, and then tighten it. It is common practice to knot the two ends of the ligature band together, a time-consuming process. Ligature bands similar to cable ties are also known, in which a ligature band structured on one side is pulled through an eyelet on a free end of the ligature band, where it is held in place in various positions.

[0003] US 2014 / 0081326 A1, US 2015 / 0313656 A1 and WO 2014 / 162428 A1 are cited as prior art.

[0004] The problem here is how the ligature band is guided around the tissue, hollow organ or vessel to be ligated in order to form the loop within the body, since the side of the tissue, hollow organ or vessel to be enclosed that is facing away from the surgeon is difficult to access.

[0005] The object of the invention is therefore to simplify the application and fixation of ligatures and to provide a fixation device for fixing a ligature band.

[0006] The object is achieved according to the invention by a fixing device for fixing a ligature band having the features of patent claim 1.

[0007] Advantageous embodiments and further developments of the invention are specified in the dependent claims.

[0008] The fixing device according to the invention for fixing a ligature band has a sleeve and a pressure element, wherein the pressure element has at least one locking element, wherein the sleeve has two guide channels for receiving a section of the ligature band, wherein the sleeve has at least one first counter-locking element and at least one clamping element, and wherein the pressure element can be pushed into the sleeve in an insertion direction and is arranged in the sleeve in a fixing position in such a way that the locking element interacts with the first counter-locking element, wherein in the fixing position the clamping element is acted upon in particular by the pressure element in such a way that a ligature band guided through the guide channels can be clamped in the guide channels.

[0009] Such a fixation device enables a ligature band to be easily fixed, since after placing the sleeve, the ligature band can first be inserted through one of the guide channels, after bypassing the tissue, hollow organ or vessel to be ligated, it can be guided back through the other channel and tightened, and then the pressure element can be transferred into the fixation position to fix the ligature band in the fixation device.

[0010] Preferably, the sleeve has a longitudinal axis and the pressure element has a longitudinal axis, which are arranged parallel to each other and in particular coincide, wherein the insertion direction of the pressure element is arranged parallel to the longitudinal axis of the pressure element.

[0011] The sleeve has at least one second counter-locking element, wherein the pressure element is arranged in the sleeve in an assembled position such that the locking element interacts with the second counter-locking element, and in the assembled position the ligature band guided through the guide channels can be displaced in the guide channels. The interaction of the locking element and the second counter-locking element enables loss prevention. This enables the sleeve to be positioned together with the pressure element at the desired location in the body without the pressure element having to be subsequently inserted, wherein the pressure element and the sleeve are in particular already aligned relative to one another so that after the ligature band has been inserted through the sleeve, the pressure element can then be easily transferred into the fixing position.

[0012] According to a particularly preferred embodiment of the invention, the second counter-locking element is arranged in front of the first counter-locking element in the insertion direction of the pressure element into the sleeve, so that the pressure element can be easily transferred from the mounting position to the fixing position. In the fixing position, a stop of the pressure element preferably abuts against a stop of the sleeve, preventing further insertion of the pressure element into the sleeve in the insertion direction.

[0013] A particularly preferred embodiment of the invention provides that the sleeve has two first counter-locking elements and, if present, two second counter-locking elements and the pressure element has two locking elements in order to enable a uniform distribution of force.

[0014] According to an advantageous embodiment of the invention, the sleeve has two clamping elements to improve the fixation of the ligature band in both guide channels.

[0015] The guide channels are advantageously arranged parallel to each other to facilitate the insertion of the ligature band.

[0016] According to a preferred embodiment of the invention, the clamping element is designed as a tab, which is arranged with a free end deflectable into the guide channel, which enables a space-saving construction.

[0017] Preferably, the sleeve has at least one release opening on its outer surface, which enables the pressure element to be released from the fixing position.

[0018] The device for inserting and securing a ligature band in a fixation device according to the invention comprises releasable fastening means for securing the fixation device, in particular the sleeve of the fixation device, to the device, as well as a guide element for inserting the ligature band along an insertion direction into one of the guide channels of the sleeve, wherein the guide element is made at least in sections from a shape memory alloy. Such a design of the guide element enables the ligature band to be easily guided around the tissue, hollow organ, or vessel to be ligated. In particular, the distal end of the guide element is made from a shape memory alloy.

[0019] Preferably, the device comprises a shaft tube, wherein the fastening means are arranged at the distal end of the shaft tube and in particular comprise at least one locking element, for example at least one locking projection. Such a configuration of the fastening means enables a simple and space-saving arrangement of the fixation device on the device according to the invention.

[0020] The guide element is preferably made at least in sections of Nitinol, which has good biocompatible properties.

[0021] According to a preferred embodiment of the invention, the guide element has a distal end that is designed such that it curves distally upon exiting one of the guide channels of the sleeve. This allows the ligature band to be easily guided around the vessel, hollow organ, or tissue to be ligated.

[0022] According to a particularly preferred embodiment of the invention, the curvature is designed such that the distal end of the guide element re-enters the other of the guide channels at the distal end. This avoids the use of additional instruments with which the free end of the ligature band must be grasped after it has been guided around the tissue, hollow organ, or vessel to be ligated and guided to the desired position.

[0023] Advantageously, the guide element has at least one, preferably several, carriers, particularly on the side facing the ligature band. These carriers are particularly designed such that, when moving in the insertion direction, they entrain the ligature band in the insertion direction and, when moving counter to the insertion direction, are movable relative to the ligature band. This enables a simple arrangement of the ligature band on the guide element for the desired movements of the ligature band.

[0024] Preferably, the guide element is movable in the insertion direction by means of a first actuating element, arranged particularly at the proximal end of the device, particularly against the force of a first return element. This enables easy actuation of the guide element, particularly during minimally invasive procedures. The return element can enable transfer to a starting position.

[0025] According to a preferred embodiment of the invention, the device comprises tensioning means for engaging the free end of the ligature band and for moving the free end of the ligature band counter to the insertion direction. Additional separate instruments for tensioning or tightening the ligature band are thus unnecessary.

[0026] Advantageously, the tensioning means have at least one driver, preferably a plurality of drivers, which enables a structurally simple design of the tensioning means. Advantageously, the driver of the tensioning means is designed such that, when moved counter to the direction of insertion, it drives the ligature band counter to the direction of insertion and, when moved in the direction of insertion, is movable relative to the ligature band. This enables the ligature band to be tensioned to the desired position in a simple manner. According to a preferred embodiment of the invention, the tensioning means can be moved counter to the direction of insertion, in particular against the force of a second return element, by means of a second actuating element arranged in particular at the proximal end of the device. This enables simple actuation, particularly during minimally invasive procedures. The return element can enable transfer to an initial position.

[0027] An advantageous development of the invention provides that the device has fixing means for transferring the pressure element into the fixing position. Additional separate instruments for fixing the ligature band in the fixing device can thus be eliminated.

[0028] In particular, the invention makes it possible to introduce a ligature band, guide it around the tissue, vessel or hollow organ to be ligated, tighten it and fix it with a single instrument, namely a device according to the invention.

[0029] Advantageously, the fixation means are designed as a rod movable in the insertion direction of the pressure element by means of a third actuating element, which rod can be moved, in particular, against the force of a third return element. This enables simple actuation, particularly during minimally invasive procedures, while also maintaining a compact design of the device. The return element can ensure transfer to a starting position.

[0030] A particularly preferred embodiment of the invention provides that the third actuating element is formed by the first actuating element in order to simplify handling for the user.

[0031] Advantageously, the fixing means are guided along a slotted guide, which enables movement along the insertion direction and additionally transverse to the insertion direction, thus enabling the combination of several functionalities.

[0032] Preferably, the device comprises release means for releasing the fastening of the fixation device, in particular the sleeve of the fixation device, from the device, thereby making it possible to remove the device after the ligature band has been applied and to leave the fixation device in the desired location.

[0033] Preferably, the solvents are formed by the fixing agents, which can simplify the construction of the device.

[0034] A preferred embodiment of the invention provides that the device has separating means for severing the ligature band. This allows the use of a continuous ligature band and the cutting of the ligature band to the desired length after the ligature band has been applied.

[0035] The separating means are advantageously designed as cutting edges, which enables a structurally simple design.

[0036] Particularly preferably, the cutting edge is arranged on the fixing means, which enables a space-saving construction.

[0037] The invention is explained in detail with reference to the following figures. They show: Fig. 1 a perspective view of an embodiment of a device according to the invention for introducing and fixing a ligature band in a fixing device and of an embodiment of a fixing device according to the invention, Fig. 2 a perspective view of an embodiment of the fixing device according to the invention according to Fig. 1 with a sleeve and a pressure element, wherein the pressure element is arranged in a mounting position, Fig. 3 a longitudinal section through the fixing device according to Fig. 2, Fig. 4 a further longitudinal section through the fixing device according to Fig. 2, Fig. 5 the fixing device according to Fig. 2, wherein the pressure element is arranged in a fixing position, Fig. 6 a longitudinal section through the fixing device according to Fig. 5, Fig. 7 a further longitudinal section through the fixing device according to Fig. 5, Fig. 8 a perspective view of the pressure piece of the fixing device according to Fig. 2, Fig. 9 a longitudinal section through the pressure piece according to Fig. 8, Fig. 10 a further longitudinal section through the pressure piece according to Fig. 8, Fig. 11 a perspective view of the sleeve of the fixing device according to Fig. 2, Fig. 12 a longitudinal section through the sleeve according to Fig. 11, Fig. 13 a further longitudinal section through the sleeve according to Fig. 11, Fig. 14 a side view of the device for introducing and fixing a ligature band in a fixing device according to Fig. 1, Fig. 15 a plan view of the device according to Fig. 14, Fig. 16 an enlarged detail from Fig. 14 with a side view of the proximal end of the device according to Fig. 1, Fig. 17 a longitudinal section through the handle according to Fig. 16, Fig. 18 a longitudinal section through a distal section of the shaft tube according to Fig. 14 with inserted fixing device according to Fig. 2, Fig. 19a an enlarged detail of the distal end of the shaft tube according to Fig. 19 with the device in a rest position, Fig. 19b the detail enlargement according to Fig. 19a with the guide element in an extended position, Fig. 19c the detail enlargement according to Fig. 19a with the fixing device in a position removed from the device, Fig. 20 a longitudinal section through Fig. 19a, Fig. 21a an enlarged detail from Fig. 18 of a section of the shaft tube in a rest position, Fig. 21b the detail enlargement according to Fig. 21a with the clamping devices in a clamped position, Fig. 21c the detail enlargement according to Fig. 21a with the fixing means in an ejection position, Fig. 22 a further enlarged section from Fig. 18 of another section of the shaft tube, Fig. 23 a further enlarged detail from Fig. 18 with partially hidden components to show the guide rails of the fixing devices, Fig. 24a Fig. 19a with ligature band displayed in a loaded position, Fig. 24b Fig. 19b with ligature band shown, Fig. 24c Fig. 19c with ligature band displayed and Fig. 25 an enlarged detail of a longitudinal section through the distal end of a shaft tube of a further embodiment of a device for introducing and fixing a ligature band in a fixing device.

[0038] Fig. 1 shows a perspective view of an embodiment of a device 10 according to the invention for introducing and fixing a ligature band 200 (in Fig. 1 not shown) in a fixing device 100 for fixing the ligature band 200. The Fig. 2 to 13 show different views of the fixing device 100, the Fig. 14 to 24 show different views of the device 10. In the Fig. 1 to 23, the ligature band 200 has been omitted for clarity. Furthermore, for clarity, not all reference numbers are shown in all figures.

[0039] The Fig. 2 to 13 show various views of the fixing device 100 with a sleeve 110 and a pressure element 120, which can be inserted into the sleeve 110 in an insertion direction X. The sleeve 110 can have a cylindrical, for example circular cylindrical, or slightly conical basic shape and can have two opposing end faces 112a, 112b, an outer surface 111 and a longitudinal axis lH (cf. in particular Fig. 11 and Fig. 12). The sleeve 110 has an insertion opening 113, which extends through the sleeve 110, in particular from the end face 112a to the opposite end face 112b. The insertion opening 113 extends in particular in the direction of the longitudinal axis lH.

[0040] The sleeve 110 has two guide channels 114a, 114b, in which the ligature band 200 can be guided, as explained in more detail below. The guide channels 114a, 114b can be aligned substantially parallel to one another and, in particular, parallel to the longitudinal axis lH of the sleeve 110. The guide channels 114a, 114b can, in particular, be arranged at an angular distance of 180° from one another relative to the longitudinal axis lH.

[0041] The sleeve 110 has at least one clamping element, in the present embodiment, two clamping elements 117a, 117b. The clamping elements 117a, 117b are arranged in the sleeve 110 such that, upon insertion of the pressure element 120 into the sleeve 110, they can be acted upon in such a way that a section of the ligature band 200 arranged in the guide channels 114a, 114b can be held clamped in the guide channels 114a, 114b until a fixing position is reached upon insertion of the pressure element 120. The clamping elements 117a, 117b can be arranged, for example, in the wall between the insertion opening 113 and one of the guide channels 114a, 114b.For example, clamping elements 117a, 117b can be designed as tabs with a free end 118a, 118b, which, when the pressure element 120 is inserted into the fixing position, are deflected with their free end 118a, 118b into the guide channels 114a, 114b in order to clamp a section of the ligature band 200 (cf. in particular . Fig. 6 and with ligature band 200 displayed in Fig. 24c).

[0042] The pressure element 120 has an end face 127 and an opposite actuating surface 126, as well as a longitudinal axis lD, wherein the longitudinal axis lD can be oriented, in particular, perpendicular to the actuating surface 126. The pressure element 120 is inserted, in particular, with the end face 127 facing forward in the insertion direction X, into the insertion opening 113 of the sleeve 110. Once the pressure element 120 is inserted into the sleeve 110, the longitudinal axis lH and the longitudinal axis lD are oriented, in particular, parallel to one another.

[0043] Between the actuating surface 126 and the end face 127, the pressure element 120 can have at least one wedge-like element 128, which is arranged in particular such that, in the fixing position of the pressure element 120 in the sleeve 110, it acts on the clamping elements 127a, 127b such that a section of the ligature band 200 guided in the guide channels 114a, 114b is clamped in place.

[0044] To fix the pressure element 120 in the sleeve 110 in the fixing position (see in particular Fig. 5 to 7), the pressure element 120 has at least one locking element, in the present embodiment two in particular diametrically opposed locking elements 122a, 122b, which in the fixing position cooperate with first counter-locking elements 115a, 115b arranged in the sleeve 110 (cf. for example Fig. 7). The locking elements 112a, 122b can be designed, for example, as locking projections, while the first counter-locking elements 115a, 115b can be designed as locking receptacles. The first counter-locking elements 115a, 115b are designed, in particular, as recesses extending radially from the insertion opening 113 into the sleeve 110. In the fixing position, a stop of the pressure element 120, which can be designed, for example, as a step adjacent to the actuating surface 126, preferably strikes a stop of the sleeve 110, which can be designed, for example, in the end face 112a of the sleeve 110, so that further insertion of the pressure element 120 into the sleeve 110 in the insertion direction X is prevented (cf. Fig. 7).

[0045] In order to enable the pressure element 120 to be released from the sleeve 110, the sleeve 110 can have at least one release opening 119a, 119b on its outer surface 111, wherein the release openings 119a, 119b for the first counter-locking elements 115a, 115b can be designed in particular as openings extending from the outer surface 111 to the first counter-locking elements 115a, 115b (cf. for example Fig. 13).

[0046] In one embodiment, the sleeve 110 can have at least one second counter-locking element, preferably two second counter-locking elements 116a, 116b, which are arranged in particular in front of the first counter-locking elements 115a, 115b in the insertion direction X. The pressure element 120 is arranged in an assembly position in the sleeve 110 such that the locking elements 122a, 122b interact with the second counter-locking elements 116a, 116b in the sleeve 110 (cf. Fig. 2 to 4). In this mounting position, the pressure element 120 is secured against loss on the sleeve 110. The second counter-locking elements 116a, 116b, which can be designed in particular as locking receptacles, preferably have a chamfer that facilitates the transfer of the pressure element 120 from the mounting position to the fixing position. Release openings 119c, 119d can also be provided for the second counter-locking elements 116a, 116b in a manner analogous to that for the first counter-locking elements 115a, 115b (cf. Fig. 13).

[0047] However, the second counter-locking elements 16a, 116b are arranged relative to the first counter-locking elements 115a, 115b in such a way that when the pressure element 120 is arranged in the assembly position, the clamping elements 117a, 117b are not subjected to any pressure and the ligature band 200 is displaceable in the guide channels 114a, 114b (see in particular Fig. 3). In the assembly position, the ligature band 200 can thus first be guided through one of the two guide channels 114a, 114b through the sleeve 110, after circumventing the tissue, hollow organ, or vessel to be ligated, be guided back through the other of the two guide channels 114a, 114b through the sleeve 110, be tightened as required, and then be clamped in the desired position by transferring the pressure element 120 from the assembly position to the fixation position in the fixation device 100.

[0048] The insertion of the ligature band 200 and the fixing of the ligature band 200 in the fixing device 100 can be carried out in particular with the aid of the Fig. 14 to 25 described in detail device 10.

[0049] The device 10 may comprise a shaft tube 20 with a distal end 21 and a proximal end 22 and a handle element 30 arranged at the proximal end of the shaft tube 20.

[0050] The device 10 has detachable fastening means 40 for fastening the fixing device 100, in particular the sleeve 110 of the fixing device 100, to the device 10 (cf. Fig. 20). The fastening means 40 can be designed in particular as locking elements 42, for example as locking projections, which engage in particular in the release openings 119a, 119b or 119c, 119d of the fixation device 100. In particular, the distal end 21 of the shaft tube 20 can be matched with its inner diameter to the outer diameter of the sleeve 110.

[0051] The device 10 has a guide element 50 for inserting the ligature band 200 along an insertion direction Y into one of the guide channels 114a, 114b (see in particular FIGS. 19a to 19c and 24a to 24c). The guide element 50 has a distal end 51 and a proximal end 52 and can, for example, be band-shaped.

[0052] The guide element 50 can be designed to be movable in the insertion direction Y by means of a first actuating element 60 arranged in particular at the proximal end of the shaft tube 20 of the device 10, in particular against the force of a first return element 62, which is designed, for example, as a spring element (cf. in particular Fig. 16 and Fig. 17). The first actuating element 60 can, for example, be designed as a lever pivotably mounted on the handle element 30. The return element 62 can be arranged between the first actuating element 60 and the handle element 30. In addition, a stabilizing element 65 can be arranged between the first actuating element 60 and the handle element 30, which can improve the lateral stabilization of the first actuating element (see in particular Fig. 16 and Fig. 17).

[0053] The fixation device 100 is arranged relative to the guide element 50 by means of the fastening means 40 such that, upon movement of the guide element 50 in the insertion direction Y, the distal end 51 of the guide element 50, starting from an end of one of the guide channels 114a, 114b facing the proximal end of the device 10, dips into one of the guide channels 114a, 114b, for example, the guide channel 114a. In particular, such a large movement stroke is possible that the distal end 51 of the guide element 50 can emerge from the distal end of the guide channel 114a.In particular, such a large movement stroke is possible that the distal end 51 of the guide element 50 can emerge from the distal end of the guide channel 114a, bypass the tissue, vessel or hollow organ to be ligated and, starting from the distal end of the device 10, can dip into the other of the guide channels 114a, 114b, for example the guide channel 114b, and can pass through it completely (cf. in particular . Fig. 19b and Fig. 24b).

[0054] The guide element 50 is made, at least in sections, from a shape memory alloy, for example, nitinol, wherein, in particular, at least the distal end 51 of the guide element 50 is made of a shape memory alloy. If the guide element 50 is arranged within the shaft tube 20, it is arranged substantially aligned in the longitudinal direction. The distal end 51 of the guide element 50 is designed such that it curves when the guide element 50 is moved so far in the insertion direction Y that the distal end 51 of the guide element 50 emerges from the distal end of the device 10, in particular the distal end 21 of the shaft tube 20, and thus in particular distally from one of the guide channels 114a, 114b, for example, the guide channel 114a.The curvature is designed in particular such that the distal end 51 of the guide element 50 re-enters the other of the guide channels 114a, 114b, for example the guide channel 114b (cf. in particular . Fig. 19b).

[0055] If the ligature band 200 with a free end 201 is arranged at the distal end 51 of the guide element 50, the ligature band is guided through one of the guide channels 114a, 114b from proximal to distal when the guide element 50 is extended in the manner described above and is guided in an arc, which in particular leads around the tissue, hollow organ or vessel to be ligated, to the other of the guide channels 114a, 114b and through this from distal to proximal back again (cf. Fig. 24b). The ligature band 200 can thus be easily positioned in the fixation device 100.

[0056] The guide element 50 can have at least one, preferably several, carriers 54. The carrier 54 is particularly designed such that, when moving in the insertion direction Y, it entrains the ligature band 200 in the insertion direction Y. When moving counter to the insertion direction Y, it is movable relative to the ligature band 200; in other words, it leaves the ligature band 200 in place. The carriers 54 can be designed, for example, as locking teeth or locking hooks. The ligature band 200 can have corresponding recesses, grooves, or ribs that can interact with the carriers 54.

[0057] Such a design of the guide element 50 enables, for example, loading of a ligature band 200 such that the free end 201 of the ligature band 200 is inserted laterally into the interior of the shaft tube 20 through a loading flap 24 arranged in the shaft tube 20, is gripped there by the drivers 54 of the guide element 50 and is conveyed during movement strokes of the guide element 50 in the insertion direction Y, for example in the order of magnitude of the distance between two adjacent drivers 54 from in the direction of the distal end 21 of the shaft tube 20, for example until the free end 201 of the ligature band 200 is arranged approximately flush with the distal end 51 of the guide element 50 (cf. Fig. 24a). Subsequently, by means of a single large movement stroke, the free end 201 of the ligature band 200 with the free end 51 of the guide element 50 can be guided through the fixation device 100, around the tissue, vessel or hollow organ to be ligated and back through the fixation device 100 (cf. Fig. 24b). If the guide element 50 is retracted, the ligature band 200 remains in the position guided by the fixation device 100.

[0058] The device 10 can comprise clamping means 70 for engaging the free end 201 of the ligature band 200 (see, for example, Fig. 24a) and for moving the free end of the ligature band against the insertion direction Y. The tensioning means 70 can have a distal end 71 and a proximal end 72 and are arranged in particular in the shaft tube 20 (cf. for example Fig. 19a).

[0059] In one embodiment, the clamping means 70 have at least one, preferably several drivers 74 (see especially Fig. 19a to 19c). The driver 74 is particularly designed such that, when moving counter to the insertion direction Y, it entrains the ligature band 200 counter to the insertion direction Y and, when moving in the insertion direction Y, is movable relative to the ligature band 200. The drivers 74 can be designed, for example, as locking teeth or locking hooks.

[0060] The clamping means 70 can be designed to be movable against the insertion direction Y by means of a second actuating element 80 arranged at the proximal end 72 of the clamping means 70 and in the region of the proximal end of the device 10, in particular at the proximal end 22 of the shaft tube 20, in particular against the force of a second return element 82 (cf. in particular Fig. 17). The second actuating element 80 can be designed as a lever mounted on the handle element 30 so as to be linearly displaceable, for example along a guide rail 85. The second return element is arranged in particular between the handle element 30 and the second actuating element 80 (see especially Fig. 16 and Fig. 17).

[0061] If the ligature band 200 was introduced into the fixing device 100 by means of the guide element 50, in particular the free end 201 of the ligature band 200 was guided back so far that it came into engagement with the tensioning means 70 (cf. especially Fig. 24b). Subsequently, the tensioning means 70 can be moved proximally by means of the second actuating element 80 until the ligature band 200 is sufficiently tightly tensioned around the tissue, vessel, or hollow organ to be ligated and the ligature has thus been positioned in the desired manner.

[0062] The device 10 may comprise fixing means 90 for fixing the ligature band 200 in the fixing device 100 and in particular for transferring the pressure element 120 of the fixing device 100 into the fixing position, see for example Fig. 20 and Fig. 19c). The fixing means 90 have a distal end 91 and a proximal end 92 and can be designed, for example, as a rod, which is arranged in particular in the shaft tube 20. The fixing means 90 can be designed to be movable in the insertion direction X of the pressure element 120 by means of a third actuating element 93, in particular against the force of a third return element 94 (cf. in particular Fig. 22).

[0063] In the present embodiment, the third actuating element 93 is formed by the first actuating element 60. In this case, a safety mechanism in the manner of a mechanical AND link (cf. in particular Fig. 21 a to 3) are provided in such a way that the fixing means 90 can only be actuated if the clamping means 70 have previously been moved into a clamped position. This prevents the fixing means 90 from being actuated each time the guide element 50 is actuated.

[0064] For this purpose, the fixing means 90 are arranged in the shaft tube 20 via a pin 93 in a guide rail 95 (see in particular Fig. 23) which has at least one section 95a extending in the longitudinal direction and a section 95b arranged at the proximal end of the section 95a and extending obliquely thereto. The fixing means are in the rest position (cf. Fig. 21a) is positioned by means of the third return element 94 such that the pin 93 is arranged in the section 95b, resting against the proximal stop of the slotted guide 95. A first positive guide 96a and a second positive guide 96b are arranged on the fixing means 90.

[0065] In this embodiment, a carriage 76 is arranged on the clamping means 70 for the mechanical AND connection. When the clamping means 70 is clamped and thus moved counter to the insertion direction Y, the carriage 76 slides along the first positive guide 96a and guides the fixing means along the section 95b until the pin 93 is arranged in the longitudinally extending section 95a, in particular at its proximal end. The fixing means thereby undergo a movement transverse to the longitudinal direction of the device 10, in particular transverse to the longitudinal direction of the shaft tube 20 or transverse to the insertion direction Y (cf. Fig. 21b).

[0066] In this embodiment, a carriage 56 is arranged on the guide element 50 for the mechanical AND linkage, which only strikes the second positive guide 96b when the fixing means 90 have been moved along the slotted guide 95 by the clamping means. If the guide element 50 is moved in this position in the insertion direction Y by means of the first actuating element 60, the carriage 56 strikes the second positive guide 96b (see. Fig. 21c) and carries the fixing means 90 in the insertion direction Y and in particular in the insertion direction X until the distal end 91 of the fixing means 90 strikes the pressure element 120, in particular its actuating surface 126, and carries the pressure element 120 further in the insertion direction X and thereby transfers it from the assembly position into the fixing position.

[0067] The device 10 can have release means for releasing the fastening of the fixing device 100, in particular of the sleeve 110, from the device 10. The release means can be formed by the fixing means 90, in that the length of the section 95b of the slotted guide 95 is designed such that the guide element 50 can be moved so far in the distal direction within the framework of the mechanical AND linkage that the distal end of the fixing means 90 can be moved so far in the distal direction that not only is the pressure element 120 transferred into the fixing position, but upon further movement in the insertion direction X, the entire fixing device 100 is pressed out of the distal end of the device 10, in particular the distal end of the shaft tube 20 (cf. Fig. 24c).

[0068] The device 10 may comprise separating means 98 for severing the ligature band 200, particularly in the case that an endless ligature band 200 is fed into the device 10. Fig. 25 shows a second embodiment of a device 10, which differs from the one shown in the Fig. 14 to 24 in that it additionally has the separating means 98. The above statements also apply to the device shown in Fig.25. The separating means 98 can in particular be designed as a cutting edge 99. The separating means 98 are arranged in particular at the distal end 91 of the fixing means 90. In order to be able to sever the ligature band 200, a movement must be carried out transversely to the longitudinal direction of the device 10, in particular of the shaft tube 20. Such a movement can be carried out if the section 95b of the slotted guide 95 of the fixing means 90 at the distal end is adjoined by a further section which runs transversely to the longitudinal direction of the device 10, in particular of the shaft tube 20. List of reference symbols 10 Device 20 shaft tube 21 distal end 22 proximal end 24 tailgate 30 handle element 40 fasteners 42 locking element 50 guide element 52 distal end 52 proximal end 54 drivers 56 sleds 60 first actuating element 62 first return element 65 Stabilizing element 70 clamping devices 71 distal end 72 proximal end 74 drivers 76 sleds 80 second actuating element 82 second return element 85 Scenery guide 90 Fixatives 91 distal end 92 proximal end 93 third actuating element 94 third return element 95 Scenery Section 95a Section 95b 96a first forced guidance 96b second forced guidance 98 release agents 99 cutting edge 100 fixing device 110 sleeve 111 Outer surface 112a Front face 112b frontal surface 113 Insertion opening 114a Guide channel 114b Guide channel 115a first counter-locking element 115b first counter-locking element 116a second counter-locking element 116b second counter-locking element 117a clamping element 117b clamping element 118a free end 118b free end 119a Release opening 119b Release opening 119c Release opening 119d release opening 120 pressure element 122a locking element 122b locking element 126 operating surface 127 frontal area 128 elements 200 ligature bands 201 free end

Claims

[1] Fixing device (100) for fixing a ligature band (200) with a sleeve (110) and a pressure element (120), wherein the pressure element (120) has at least one locking element (122a, 122b), wherein the sleeve (110) has two guide channels (114a, 114b) for receiving a section of the ligature band (200), wherein the sleeve (110) has at least one first counter-locking element (115a, 115b) and at least one clamping element (117a, 117b), and wherein the pressure element (120) can be pushed into the sleeve (110) in an insertion direction (X) and is arranged in a fixing position in the sleeve (110) such that the locking element (122a, 122b) cooperates with the first counter-locking element (115a, 115b), wherein in the In the fixing position, the clamping element (117a, 117b) is loaded in such a way that a ligature band (200) guided through the guide channels (114a, 114b) can be clamped in the guide channels (114a, 114b), characterized byin that the sleeve (110) has at least one second counter-locking element (116a, 116b), wherein the pressure element (120) is arranged in the sleeve (110) in an assembly position such that the locking element (122a, 122b) cooperates with the second counter-locking element (116a, 116b), and in the assembly position the ligature band (200) guided through the guide channels (114a, 114b) is displaceable in the guide channels (114a, 114b). [2] Fixing device according to claim 1, characterized by that the sleeve (110) has a longitudinal axis (lH) and that the pressure element (120) has a longitudinal axis (lD), which are arranged parallel to one another, and wherein the insertion direction (X) of the pressure element (120) is arranged parallel to the longitudinal axis (lD) of the pressure element (120). [3] Fixing device according to one of the preceding claims, characterized bythat the second counter-locking element (116a, 116b) is arranged in the insertion direction (X) of the pressure element (120) in the sleeve (110) in front of the first counter-locking element (115a, 115b). [4] Fixing device according to one of the preceding claims, characterized by that the sleeve (110) has two first counter-locking elements (115a, 115b) and two second counter-locking elements (116a, 116b) and the pressure element (120) has two locking elements (122a, 122b). [5] Fixing device according to one of the preceding claims, characterized by that the sleeve (110) has two clamping elements (117a, 117b). [6] Fixing device according to one of the preceding claims, characterized by that the two guide channels (114a, 114b) are arranged parallel to each other. [7] Fixing device according to one of the preceding claims, characterized bythat the at least one clamping element (117a, 117b) is designed as a tab which is arranged with a free end (118a, 118b) so as to be deflectable into the guide channel (114a, 114b). [8] Fixing device according to one of the preceding claims, characterized by that the sleeve (110) has at least one release opening (119a, 119b, 119c, 119d) on its outer surface (111).

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