Medical instrument for avoiding intraoperative bleeding
Patent Information
- Application Number
- EP2022843693
- Authority / Receiving Office
- EP · EP
- Patent Type
- Applications
- Current Assignee / Owner
- Priority Date
- 2021-12-22
- Filing Date
- 2022-12-21
- Publication Date
- 2024-12-25
Smart Images
Figure 1.1
Abstract
Description
[0001] Medical instrument for preventing intraoperative bleeding
[0002] The invention relates to a medical instrument for preventing intraoperative bleeding, which can be used to reduce or stop the blood flow from an injured blood vessel in a human or animal. This instrument can also be used in other fields, such as emergency and / or military medicine for temporarily ligating extremities or organs, or for partial removals such as bowel resections and / or partial hysterectomies. Furthermore, such an instrument can be used to tension tissue during plastic surgery.
[0003] The medical instrument comprises a relatively rigid but highly flexible strap element that is attached to a handling unit via a connection area and has a strap section that is movable relative to the connection area. The movable strap section is guided in an adjustment unit with an actuating element, which is at least indirectly attached to the handling unit, forming a loop. Upon actuation of the actuating element, the strap section can be moved relative to the connection area, thus changing the size and / or shape of an area enclosed by the loop.
[0004] Various solutions are known in the art for reducing or completely stopping blood flow from an injured blood vessel in a human or animal after an accident or during surgery. Typically, the affected blood vessels are compressed or tied off to close the existing opening in the blood vessel.
[0005] In this context, DE 10 2012 013 153 A1 discloses a device for tying off a blood vessel in an extremity. The instrument comprises a belt loop that can be wrapped around the extremity like a loop, a fastener to keep the belt taut as needed, and a pressure body accommodated in the area of the belt loop that exerts a compressive force on the extremity when the belt is taut. Furthermore, a pressure plate is provided to increase the pressure exerted by the pressure body on the blood vessel located within the extremity. The key feature of the described technical solution is that a belt loop is combined with a pressure body and a pressure plate, so that the extremity is not tethered across its circumference, but rather targeted pressure is also exerted on the injured blood vessel.Furthermore, CH 70342 A discloses an instrument for tying injured blood vessels during surgery or after an accident. The described medical instrument has a drum rotatably mounted in a housing, to which bands are attached. The ends of the bands extending from the housing can be connected to a ligation loop by means of a hook element. One of the bands is attached to a winding element in the drum in such a way that rotation of the winding element tightens the loop. The winding element can be locked in a desired position by means of a locking mechanism, which can be released by pressing a push button.The main disadvantage of the technical solution described is that it has a comparatively complex structure and a large number of different mechanical components. Furthermore, it is not possible to move the straps in a controlled manner in order to achieve both a targeted tightening and loosening of the loop.
[0006] With regard to potential risks of intraoperative bleeding, special demands are placed on the surgeon, particularly during operations, and especially when performing caesarean sections. More than 30 million caesarean sections are performed worldwide every year. In the period between 2002 and 2015 alone, the number of caesarean sections performed worldwide increased from around 16 million to 29.7 million per year. It can be assumed that the number of caesarean sections performed in the future will continue to rise, as an increasing caesarean section rate will also lead to an increase in the number of caesarean sections performed after a first caesarean section has already been performed. Furthermore, in obstetrics, a further caesarean section is always recommended and performed in the next pregnancy after two previous caesarean sections have been performed.Due to this development, it is also expected that the number of peri- and postoperative complications, particularly bleeding complications during a procedure, will increase. Especially when opening the uterus and after the fetus has developed, there is often a risk of significant blood loss. The goal is always to minimize this loss, primarily by closing the opened blood vessel as quickly as possible. However, this is often difficult, as unforeseeable circumstances such as vascular injuries to the uterus, particularly to the two uterine arteries or the branches of these arteries, can lead to significant blood loss within seconds.Likewise, antonia of the uterus, i.e. the poor contraction of the uterine muscles, is a feared event during a cesarean section, which can lead to the uterus having to be removed as an emergency despite all available support measures.
[0007] Based on the solutions known from the prior art and the problems described above, the object of the invention is therefore to provide a medical instrument with which the blood flow escaping through an injured vessel can be at least significantly reduced, and ideally stopped, in a comparatively simple and rapid manner. The instrument to be specified should preferably also be suitable for use in a cesarean section, and in this case in particular for sealing the two uterine arteries and / or their branches, in particular by clamping the lower uterine segment below the cesarean section in a ring. At the same time, the handling of the medical instrument should be intuitive for the surgeon, above all without requiring unfamiliar movement patterns.Furthermore, the surgeon should have the option of being able to reopen an injured blood vessel in a controlled manner after closing it, in particular to check whether the blood flow has stopped in the meantime.
[0008] The medical instrument should be able to be operated with simple manual movements without this having a negative impact on reliable hemostasis. A further object of the invention is to provide a corresponding medical instrument that can be manufactured in a comparatively simple manner and preferably has only a few components. Furthermore, it is desirable for the medical instrument to be designed in such a way that it can be used multiple times on a patient, but can otherwise be easily disposed of, particularly with regard to the associated costs. Among other things, this should at least create the possibility of using a suitable medical instrument without the mandatory requirement for complex cleaning or sterilization steps.
[0009] The above-described object is achieved by means of a medical instrument according to claim 1 and a set for producing a medical instrument according to claim 14. Advantageous embodiments of the invention are the subject of the dependent claims and are explained in more detail in the following description with partial reference to Fig. 1en.
[0010] The invention relates to a medical instrument for largely preventing intraoperative bleeding, in particular for reducing the blood flow through an injured blood vessel of a human or an animal, comprising a band element which is fastened to a handling unit by means of a connection area and which has a band section which is movable relative to the connection area and which is guided to form a loop in an adjustment unit with an actuating element which is fastened at least indirectly to the handling unit, such that due to an actuation of the actuating element, the movable band section can be moved relative to the connection area and thus a size and / or shape of an area enclosed by the loop can be changed.The medical instrument according to the invention is characterized in that at least one fixation means is provided for at least temporarily locking the movable band section relative to the connection area, and that by actuating the actuating element, the movable band section can be selectively moved from the locking position into a position for both increasing and decreasing the area enclosed by the loop. Of particular importance for the invention is therefore that it is possible for a surgeon to either open or close an existing or formed loop, which may have already been locked, as needed.This allows a controlled movement of the movable band section in both opposite directions, so that the surgeon can, for example, check whether bleeding has stopped by slightly loosening the loop and then, depending on the result of the check, either tighten the loop again or loosen it further.
[0011] Essential to the technical solution according to the invention is the suitable combination of an adjustment unit, which has an actuating element, with a band element that can, on the one hand, be locked in a desired position using fixing means, and, on the other hand, can be moved in a targeted manner in opposite directions by actuating the actuating element. Due to this technical design, the loop formed by the band element, in particular the area enclosed by the loop, can be both specifically enlarged and reduced. By actuating the actuating element, the movable band section can be moved in opposite directions within its guide and relative to the connection area fixed to the handling unit, in a controlled manner such that a surgeon can easily tighten the loop as needed or enlarge it again by the required amount.In this way, not only can the blood flow be stopped in a particularly targeted manner, but it is also possible to release the loop in a targeted manner, making it easy to check whether blood flow has already been stopped in another way or has come to a standstill, or whether the loop needs to be tightened again.
[0012] Preferably, the instrument according to the invention is pre-configured with a band element, the movable band section of which is located within the guide of the adjustment unit (Fig. 1), such that it is available with a loop already produced in a sufficiently large size. If necessary, the surgeon only needs to grasp the instrument, guide the loop over the blood vessel to be closed and, if necessary, also over neighboring organs or other structures of the patient's body, and in a next step quickly tighten the loop manually, in particular by pulling on the free end of the band element and / or on an eyelet provided in this area. Following this, it is easily possible to bring about a further targeted tightening of the loop in a further step by actuating the actuating element, for example in the form of a rotary wheel or a rocker lever.Once the blood flow has stopped, the surgeon can now devote his or her full attention to the necessary treatment or surgical step. Unintentional opening is reliably prevented by the fixation devices provided on the band element in the area of the movable band section, such as depressions, notches, or grooves, which are operatively connected to at least one adjusting element of the adjustment unit, e.g., a gear.
[0013] Opening or loosening the loop formed by the band element of the medical instrument according to the invention can be made possible in a targeted manner by repeatedly actuating the actuating element of the adjusting unit, so that an adjusting element moves the movable band section at least in sections and the loop can be enlarged in a targeted manner by a desired amount and the surgeon can check whether the blood flow has already been stopped.
[0014] Advantageously, the band element has, in the region of the end opposite the connection area, i.e. at its free end, an element such as an eyelet, a ring, a handle, a hook or an insertion part that is inserted into a pre-formed groove, wherein the element can be easily and safely grasped by a surgeon and thus enables rapid tightening of the loop formed by the band element and a comparatively rapid reduction of the area enclosed by the band element. In a special embodiment of the invention, it is provided that the fixation means on the band element has locking lugs, locking teeth, grooves, balls, holes, notches and / or hooks formed at least in sections.The band element thus has suitable structures on its movable band section as fixing means, into which an adjusting and / or locking element of the adjustment unit engages, which is moved by actuating the actuating element such that the movable band section of the band element can be moved relative to the connection area and also locked in the desired position. The fixing means of the band element as well as the adjusting and / or locking element of the adjustment unit, which is at least temporarily operatively connected to the actuating element, are designed such that both a controlled movement and a reliable locking of the band element are ensured. In this context, it is particularly advantageous if the fixing means are at least partially operatively connected to the adjustment unit, in particular the actuating element.
[0015] Preferably, the adjustment unit, in particular the actuating element, has an adjusting, locking, and / or arresting element that can be moved in a targeted manner by actuating the actuating element and that engages at least partially with the fixing means of the strap element. In this way, the strap element can be moved within the guide provided in the adjustment unit relative to the fixed connection area, in such a way that a movement can lead to both an enlargement of the area enclosed by the loop formed by the strap element and a reduction of the area.
[0016] According to another embodiment of the invention, the fixing means comprises or cooperates with a sliding and / or clamping mechanism. In this context, it is conceivable that a clamping connection is established at least indirectly between the strap element and the actuating element, provided that the movable strap section is to be locked relative to the fixed connection area. The clamping mechanism preferably has suitable elements that can be moved by actuating the actuating element and which can be selectively transferred into a position in which the strap element is clamped in the guide and thus locked, the strap element is displaced by a movement of the clamping mechanism, or the clamping mechanism is released so that the strap element can be moved, for example by pulling or pushing the free end.
[0017] Furthermore, it is preferably conceivable that the sliding and / or clamping mechanism is designed in such a way that by successive actuation of the actuating element, a clamping of the movable band section of the band element is produced and, at the same time, a movement is carried out so that the band element is displaced by a desired distance in the clamped position, in particular due to friction existing between the band element and a moving actuating element of the clamping mechanism.
[0018] According to a preferred embodiment, the clamping mechanism is formed by at least part of the adjustment unit. The clamping mechanism preferably has at least one wheel movable relative to the connection area of the strap element. This wheel, at least in a first position, at least temporarily clamps the strap element in such a way that it is locked in this position, while the clamped strap element is displaced within the guide of the adjustment unit upon a movement, in particular a rotational movement, brought about by actuation of the actuating element, so that the area enclosed by the loop formed by the strap element is selectively enlarged or reduced in size.
[0019] It is also conceivable for the actuating element to have a rotary knob and / or a rocker arm. If a rocker arm is used, it is preferably designed and mounted in such a way that tilting the rocker arm can either lock the hinge element in place or cause it to move in a targeted manner.
[0020] In a particular development of the invention, the strap element, the handling unit, and the adjustment unit are made of a plastic. In this context, it is particularly advantageous for the medical instrument to be made of a disposable plastic article, which can be used multiple times on a patient during a treatment or operation, but is discarded after the respective treatment.
[0021] In a further development of the invention, the handling unit has at least one gripping area with a recess, a stop, and / or with a surface that is structured, in particular roughened, at least in some areas. The gripping area is designed in such a way that it is ensured at all times that a surgeon can hold the medical instrument securely when grasping the handling unit, and above all that slipping during actuation of the actuating element and / or the strap element is reliably prevented. Furthermore, it is conceivable that the adjustment unit and the fixation means are designed in such a way that the size and / or shape of the area enclosed by the loop can be changed in discrete steps.In this context, discrete steps mean that individual locking positions are provided, which are usually located at equal distances from one another and into which the movable belt section can be brought and locked. In this context, it is conceivable, for example, for the adjusting unit to have a wheel with external teeth as the adjusting element and for the belt element to have corresponding recesses, grooves or webs, at least in the movable belt section, so that movement of the movable belt section occurs depending on the size of the teeth and / or the recesses and their spacing. It is further advantageous if a locking mechanism is provided which reliably prevents unwanted movement of the wheel.Such a locking mechanism has, for example, a locking pin which, when the desired locking position is reached, is pushed into the outer toothing of the wheel and can be pulled out again to release it or moved out by pressing a push button.
[0022] Furthermore, it is advantageous if the connection area of the strap element is designed such that it can be detached from the handling unit together with the strap element without the need for tools. Preferably, a hook is provided on the handling unit, into which a loop provided in the connection area of the strap element can be hooked or suspended. It is also possible to slide a pin-like structure, which is preferably attached in a shaped manner to the end of the strap, via a groove preformed in the handling unit. If necessary, it is thus possible to detach the strap element from the handling unit and pull it out of the guide of the adjustment unit in order to replace it, for example, with another strap element of the same type or of a different design.
[0023] The guide channel of the adjustment unit preferably has a rectangular shape, in which the movable band section of the band element is securely guided and reliably protected against twisting and kinking, while also being lockable as required. Generally, other cross-sectional shapes (oval, round, semicircular, or combinations thereof in one band) are also conceivable, ensuring secure guidance of the band element, especially the movable band section.
[0024] According to a specific development of the invention, it is conceivable that a surface of the band element facing the blood vessel to be sealed after positioning the medical instrument has a structured, particularly roughened, surface layer to impede and, if possible, prevent slipping on the tissue, for example, the uterine tissue. Furthermore, due to the adjustable tension, only the venous limb of a blood vessel could be blocked, for example, to allow intravenous medication to take effect.
[0025] Preferably, the medical instrument, in particular the handling unit and / or the strap element, is made at least partially of polyethylene or propylene. A preferred width of the strap element, regardless of the material used, is between 0.8 and 1.2 cm, particularly preferably approximately 1 cm. However, this value can also vary depending on the application.
[0026] According to another specific embodiment of the invention, the movable band portion of the band element is located at least partially within a curved and / or flexible guide channel. In this case, the material forming the guide channel, such as a suitable plastic, is preferably deformable, so that the guide channel with the band element arranged therein can be deformed as needed, thus simplifying the operation of the medical instrument and / or its approach to a blood vessel to be ligated, or the wrapping of the loop around a blood vessel and / or an organ.
[0027] Furthermore, according to a particular development, it is conceivable for the guide channel of the medical instrument to have an opening at the end through which the movable band section of the band element emerges at least almost in a straight line and is thus arranged at least approximately parallel to the guide channel in the region of the opening, or for the opening to be arranged laterally, in particular on the outer circumference of the guide channel, so that the movable band section is at least slightly bent in the region of the opening, particularly preferably in front of or through the opening itself, with respect to the direction of movement in the guide channel. In this case, it is again conceivable for the guide channel itself to be straight or curved or curvable.
[0028] Furthermore, the invention also relates to a set for producing a medical instrument which is designed according to at least one of the previously described embodiments and essentially has a handling unit and at least two band elements. With the aid of such a set, a medical instrument designed according to the invention can be provided so that, on the one hand, it can be used quickly and, on the other hand, the band element can be replaced if necessary. In this context, it is generally conceivable that in particular the handling unit, to which the band element with its application area is attached, is designed as a reusable article made of metal or plastic and / or that all parts are designed as plastic and thus as so-called disposable or single-use articles.
[0029] In the following, the invention is explained in more detail without limiting the general inventive concept using exemplary embodiments with reference to Fig. 1. Herein:
[0030] Fig. 1: first embodiment of a medical instrument designed according to the invention for preventing or reducing intraoperative bleeding with an adjustment unit for adjusting the size of a ligation loop in discrete steps,
[0031] Fig. 2: second embodiment of a medical instrument designed according to the invention for preventing or reducing intraoperative bleeding with an adjustment unit for continuously adjusting the size of a ligation loop and
[0032] Fig. 3: Representations of a third, fourth and fifth embodiment of a medical instrument designed according to the invention for preventing or reducing intraoperative bleeding with an adjustment unit for adjusting the size of a ligation loop in discrete steps.
[0033] Fig. 1 shows a sectional view of a medical instrument 1 designed according to the invention for reducing or preventing bleeding during a surgical procedure. In a particularly preferred manner, the medical instrument 1 shown in Fig. 1 can be used during a Caesarean section to quickly and efficiently stop bleeding in the event of vascular injuries to the uterus, in particular to the two uterine arteries or their branches. This is of considerable importance, as vascular injuries in this area can lead to significant blood loss within a few seconds. Likewise, uterine atony, i.e. the comparatively poor contraction of the uterine muscles, is a feared event, as this can also lead to severe bleeding.
[0034] Other operations in which the medical instrument 1 shown in Fig. 1 can be advantageously used include hysterectomies, various endoscopic procedures, as well as procedures in intestinal surgery, emergency medicine, and military medicine. Last but not least, the described instrument is also suitable for clamping surgical areas during plastic surgery.
[0035] The medical instrument 1 shown in Fig. 1, in particular its individual components explained in more detail below, are made of plastic, so that the instrument 1 shown is fundamentally intended for single use. This means that the instrument 1 can be used multiple times on a patient during a procedure, but can be easily disposed of afterwards. Alternatively, it is conceivable to manufacture, in particular, the handling unit 4 with the adjustment unit 7 and the actuating element 8 as a reusable instrument 1, for example, at least partially from a metal, preferably from a precious metal.
[0036] The medical instrument 1 designed according to the invention has a handling unit 4 and a strap element 2, which is fastened to the handling unit 4 in a connection area 3. According to the embodiment shown in Fig. 1, the handling unit 4 has a hook and the strap element 2 has a loop in the connection area 3, so that the strap element 2 is fastened to the handling unit 4 with its connection area 3 in a tool-free, detachable manner. Furthermore, the strap element 2 has a movable strap section 5, which is guided at least partially in the handling unit 4 and the adjustment unit 7 in a guide channel 13 such that the strap element 2 forms a loop 6 outside the handling unit 4.The movable band section 5 of the band element 2 is movable relative to the fixed connection area 3 such that the size and / or shape of an area 9 enclosed by the loop 6 formed can be changed as needed, here both enlarged and reduced. At an end opposite the fixed connection area 3, the band element 2 has a gripping element 11, which in the illustrated case is designed as a ring eyelet. The ring size is designed such that a surgeon can securely grasp it during a surgical procedure and relatively quickly change the size of the loop 6 formed by the band element 2, in particular tighten the loop 6.
[0037] Furthermore, the handling unit 4 has an adjustment unit 7, via which a targeted movement of the movable band section 5 of the band element 2 relative to the fixed connection area 3 can be realized. The adjustment unit 7 has an actuating element 8, which according to the embodiment shown is designed in the form of a rotary knob, and an adjusting element 14, here in the form of a gear wheel, which is moved when the rotary wheel is actuated, the teeth of which engage in the fixing means 10 designed as grooves of the band element 2. Due to the actuation of the rotary wheel, the movable band section 5 is thus moved in a targeted manner into a desired position and, at the same time, the loop 6 or the area 9 surrounded by it is reduced or enlarged to the desired size.Of particular importance here is that a movement of the movable band section 5 in opposite directions along the guide channel 13 is possible, so that both a targeted enlargement and a reduction of the loop 6 can be carried out by the surgeon.
[0038] If the adjustment unit 7 or the actuating element 8 is not actuated, the movable strap section 5 of the strap element 2 is in a locked position and is reliably held in this position. In addition, it is conceivable for the adjustment unit 7 to have a locking mechanism 15, upon activation of which the actuating element 5, here the rotary wheel, is transferred to a locked position and thus unintentional opening of the loop 6 is reliably prevented. If the surgeon wishes to carefully open the loop 6 in this case, he first actuates the push button 16 provided for deactivating the locking mechanism 15, in order to then turn the actuating element 8, designed as a rotary wheel, in the desired direction and thus move the movable strap section 5 of the strap element 2 gradually downwards as shown in Fig. 1.By providing individual teeth in the area of the adjustment unit 7 and grooves as fixing means 10 on the band element 2, which are arranged on a side of the band element 2 facing away from the vessel to be tied off, an adjustment of the band element 2 and the associated change in the size of the loop 6 can be carried out in discrete steps.
[0039] Fig. 2 shows an alternative embodiment of a medical instrument according to the invention, wherein the components not mentioned below correspond in terms of their design and function to the components explained in connection with Fig. 1. As a possible alternative, it is conceivable for the adjustment unit 7 to have a clamping mechanism 17 that is operatively connected to the actuating element 8, so that the movable band section 5 of the band element 2 can be clamped, at least in part, between the guide channel 13 and a clamping element 19. With a suitable movement of the clamping element 19, which is operatively connected to the actuating element 8, the clamped part of the movable band section 5 is moved relative to the guide channel 13 due to the friction existing between the clamping element 19 and the band section 5, in particular is displaced in the desired direction.If the actuating element 8 with the clamping element 19 is no longer moved, the movable band section 5 is again reliably locked within the guide channel 13, reliably preventing any unwanted movement of the band element 2. With this solution, the movable band section 5 can be locked at any position, i.e., not only in discrete positions that are equidistant from one another. In general, the medical instruments 1 shown in Figures 1 and 2 can be used for the same purposes, in particular for the same surgical procedures.
[0040] At the start of an operation, in particular before a Caesarean section, the band element 2 is preferably already in a position fastened to the handling unit 4 and the movable band section 5 is positioned within the adjustment unit 7 such that the loop 6 formed by the band element 2 surrounds an area 9 with an average diameter of approximately 15 cm. The medical instrument 1 prepared in this way can, if necessary, be pulled over the uterus tilted towards the pubic bone, is then guided to the desired location behind the source of bleeding and then tightened, with the surgeon first grasping the gripping element 13 designed in the form of a ring eyelet and pulling on the band element 2 in order to tighten the loop 6. If necessary, he can also use the actuating element 8, here either the rotary wheel according to Fig. 1 or the operating element 18 according to Fig.2, to achieve a targeted further tightening of the loop 6. In this way, the bleeding is initially stopped or at least a significantly reduced bleeding is ensured. During this time, life-sustaining and other measures for treating the patient can be carried out. As soon as the corresponding measures or treatment steps have been completed, the surgeon can actuate the actuating element 8, for example a rotary wheel or a rocker lever, and thus move the band element 2 and carefully open the loop 6. In this way, the tendency to bleeding prevailing at that time can be checked. If necessary, it is possible to tighten the loop 6 again.
[0041] A medical instrument 1 designed according to the invention thus enables both the closing and controlled opening of a loop 6 intended to prevent intraoperative bleeding. Thus, the source of bleeding can be monitored at any time after patient care by carefully opening the loop 6. If necessary, the loop 6 can be retightened, thus stopping the bleeding once again. In this way, sources of bleeding can be detected and stopped safely and easily, or manipulations of the uterus, such as administering medication to the uterine wall, suturing, etc., can be performed.By providing a hook mechanism 18 to which the fixed connection area 3 of the band element 2 can be attached, it is not absolutely necessary to place a band element 2 over the uterus, but it is possible to first place it around the vessels to be supplied and then to attach it to the handling unit 4.
[0042] Additionally, in this case, using an appropriately designed medical instrument 1, it is possible, after positioning the first medical instrument 1, to position a second one in front of the first toward the cervix. In this way, all potential sources of bleeding proximal and distal to the cesarean section can be temporarily stopped.
[0043] Fig. 3 shows, in illustrations a), b) and c), a third, fourth and fifth embodiment of a medical instrument 1 designed according to the invention for preventing or reducing intraoperative bleeding, with an adjustment unit 7 for adjusting the size of a ligation loop 6 in discrete steps. Essential for the medical instruments 1 shown in Fig. 3 is the different design of an opening 20 of the guide channel 13 arranged at the distal end of the instrument 1, through which opening the movable band section 5 of the band element 2 exits the guide channel 13. What is essential here is that the movable band section 5 exits the opening 20 in a straight line or undergoes at least a partial bend before or during its exit from the opening 20.
[0044] Different configurations of the guide channel 13 are shown below, which can be either straight or curved, or even flexible as required. The individual aforementioned features can be combined with one another in different ways as needed. Furthermore, the medical instruments 1 shown in Fig. 3 also have the features essential to the invention and can be further developed according to at least one of the embodiments described above.
[0045] Fig. 3 a) shows a medical instrument 1 designed according to the invention, in which a loop 6 can be locked in one position and an area 9 enclosed by the loop 6 can be controlled and enlarged or reduced as needed. The medical instrument 1 has a curved guide channel 13 in which the movable band section 5 of the band element 2 is located at least partially. At the distal end of the guide channel 13, an opening 20 is provided through which the band element 2 emerges in a straight line according to this embodiment, so that the orientation of the band element 2 does not change in the region of the opening 20. The connection area 3 is located on the lateral surface that delimits the outer circumference of the guide channel 13, so that the band element 2 is attached to the handling unit 4 in this area and fixed relative to it.By moving the movable band section 5, the area 9 enclosed by the loop 6 can be either reduced (i.e., tightened) or enlarged (i.e., loosened) as needed. The curvature of the guide channel allows for simplified handling of the instrument 1.
[0046] In contrast to the embodiment shown in Fig. 3 a), Fig. 3 b) shows a medical instrument 1 designed according to the invention, which has a straight guide channel 13 and an opening 20 through which the movable band section 5 of the band element 2 exits laterally from the guide channel 13 in the region of the circumferential surface. Compared to the orientation of the band element 2 within the guide channel 13, it undergoes a deflection in the region of the opening 20, here by at least almost 90°. The opening 20 is in the form of a through-hole through which the movable band section 5 of the band element 2 exits to the outside. The fixed end of the band element 2 is fastened to the handling unit 4 in the connection area 3 at the distal end, which delimits the guide channel in the longitudinal direction, according to Fig. 3 b), and is fixed in the connection area 3 relative to the movable band section 5.The embodiment of a medical instrument 1 shown in Fig. 3 c) differs from the design according to Fig. 3 b) in that the guide channel 13 is bent or kinked at its distal end, so that the end of the guide channel 13 forms the opening 20, which, however, is inclined by at least approximately 90° relative to the main direction of extension of the guide channel 13. Thus, in this case, too, the movable band section 5 of the band element 2 is bent by at least approximately 90° in the region of the opening 20.
[0047] The opening 20 shown in Fig. 3 c) can be advantageously produced by making the wall delimiting the guide channel 13 in the region of the distal end of the guide channel 13 longer in a first region 21 than in a second region 22 and by bending the first region 21 of the wall of the guide channel, as shown in Fig. 3 c).
[0048] 1 Medical instrument
[0049] 2 band element
[0050] 3 Connection area
[0051] 4 Handling unit
[0052] 5 movable belt section
[0053] 6 loop
[0054] 7 Adjustment unit
[0055] 8 Actuating element
[0056] 9 Area enclosed by loop
[0057] 10 Fixatives
[0058] 11 Gripping element
[0059] 12 Grip area
[0060] 13 Guide channel
[0061] 14 Control element
[0062] 15 Locking mechanism
[0063] 16 push button
[0064] 17 Clamping mechanism
[0065] 18 Hook mechanism
[0066] 19 clamping element
[0067] 20 Opening
[0068] 21 first area of the wall of the guide channel
[0069] 22 second area of the wall of the guide channel
Claims
Patent claims 1. Medical instrument (1) for reducing blood flow through a blood vessel of a human or animal, comprising a band element (2) attached to a handling unit (4) by a connection area (3) and having a band section (5) movable relative to the connection area (3), which is guided in an adjustment unit (7) with an actuating element (8) forming a loop (6) such that, by actuating the actuating element (8), the movable band section (5) is movable relative to the connection area (3) and thus the size and / or shape of an area (9) enclosed by the loop (6) can be changed, characterized in thatthat at least one fixing means (10) is provided for at least temporary locking of the movable strap section (5) and that by actuating the actuating element (8) the movable strap section (5) can be selectively moved from the locking position into a position for both increasing and decreasing the area (9) enclosed by the loop (6).
2. Medical instrument according to claim 1, characterized in that the fixing means (10) on the band element (2) has locking lugs, locking teeth, grooves, holes, notches and / or hooks formed at least in sections.
3. Medical instrument according to claim 1 or 2, characterized in that the fixing means (10) is in operative connection with the adjusting unit (7), in particular the actuating element (8), at least in certain areas.
4. Medical instrument according to one of the preceding claims, characterized in that the adjusting unit (7) has a clamping mechanism (17).
5. Medical element according to claim 4, characterized in that the clamping mechanism (17) is formed by at least a part of the actuating element (8).
6. Medical instrument according to claim 4 or 5, characterized in that the clamping mechanism has at least one wheel movable relative to the attachment area (3) of the band element (2).
7. Medical instrument according to one of the preceding claims, characterized in that the actuating element (8) has a rotary wheel and / or a rocker arm.
8. Medical instrument according to one of the preceding claims, characterized in that the strap element (2) has a gripping element (11) in the form of an eyelet and / or a hook at an end opposite the fixed attachment area (3).
9. Medical instrument according to one of the preceding claims, characterized in that the strap element (2), the handling unit (4) and the adjustment unit (7) are made of a plastic.
10. Medical instrument according to one of the preceding claims, characterized in that the handling unit (4) has at least one grip area (12) with a recess, a stop and / or with a surface that is structured at least in some areas.
11. Medical instrument according to one of the preceding claims, characterized in that the adjusting unit (7) and the fixing means (10) are designed such that the size and / or shape of the area enclosed by the loop (6) can be changed in discrete steps.
12. Medical instrument according to one of the preceding claims, characterized in that a fastening between the connection area (3) of the band element (2) can be produced and detached without tools.
13. Medical instrument according to one of the preceding claims, characterized in that the movable belt section (5) is guided in a guide channel (13) with at least partially a square cross-section.
14. Medical instrument according to any of the preceding claims, 19 characterized in that the band element (2) is roughened on a surface which is in contact with the patient in the position of use.
15. Medical instrument according to one of the preceding claims, characterized in that the band element (2) has at least partially a plastic-coated wire, in particular made of stainless steel or nitinol.
16. Medical instrument according to one of the preceding claims, characterized in that one surface of the band element (2), which in the position of use rests against the patient, has a width perpendicular to the direction of movement of 0.8 to 1.2 cm, preferably of about 1 cm.
17. Medical instrument according to one of the preceding claims, characterized in that the guide channel (13) has an opening (20) at the distal end which is designed such that the movable band section (5) of the band element (2) is deflected relative to its orientation in the guide channel (13).
18. Set for the manufacture of a medical instrument (1) according to at least one of the preceding claims comprising a handling unit (4) and at least two strap elements (2).