Note: Descriptions are shown in the official language in which they were submitted.
CA 02382384 2002-02-18
' WO 01/17434 PCT/DE00/03118
Arrangement for guiding at least two sutures through a
wall, in particular of an artery of an individual, in
the vicinity of the edge region of an opening provided
therein.
The invention relates to an arrangement for guiding at
least two sutures through a wall of a membrane, of a
balloon or of a surface, in particular of an artery of
an individual, in the vicinity of the edge region of an
opening provided therein, and formed if appropriate by
cutting in and/or cutting out, and for drawing back out
of the abovementioned opening the suture ends guided
through the relevant edge region, having a shaft-like
suture-guide device in which the sutures fastened on
needles are guided in guide and/or accommodating
openings such that, by means of the relevant suture-
guide device, they can be guided through the
abovementioned wall, in the vicinity of the edge region
of the relevant opening, and drawn back out of the
abovementioned opening again such that, by virtue of
the suture ends being drawn together, and if
appropriate knotted, outside the relevant opening, the
latter can be closed.
An arrangement of the abovementioned type is used
mainly in cases in which there is provided in the wall
of a membrane, of a balloon or of a surface an opening
which is to be closed and for the closure of which
access from both sides of the relevant wall is not
possible. This is the case, in particular, when the
wall containing the opening which is to be closed
belongs to an artery of an individual. In these cases,
it is only possible for access to the opening which is
to be closed in each case to be gained from the
outside.
WO 94/08516 has already disclosed a suturing device of
the type mentioned in the introduction in which up to
CA 02382384 2002-02-18
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four needles connected to sutures can be guided, by
means of a pushing device, through a wall of a blood
vessel in the vicinity of the edge region of an opening
located therein and accommodated by an accommodating
device located within the relevant blood vessel in the
region of the abovementioned opening. This
accommodating device is formed by an intercepting-cage-
like needle-accommodating device which first of all is
guided through the relevant opening in the collapsed
state and then is widened in the relevant opening, in
order thereafter to butt against the edge region of the
relevant opening within the blood vessel. The needles
guided through the edge region of the abovementioned
opening can be accommodated by said intercepting-cage-
like needle-accommodating device, which is then rotated
about its longitudinal axis in order to secure the
relevant needles. Thereafter, the relevant
intercepting-cage-like needle-accommodating device,
with the needles contained in it, is collapsed in order
to be drawn out in its entirety through the
abovementioned opening. During this operation, the
sutures connected to the needle ends are drawn out of
supply magazines, drawn through the insertion locations
of the abovementioned needles, in the vicinity of the
edge region of the abovementioned opening, and drawn
out of the relevant opening again. Outside the
abovementioned opening, the suture ends may then be
drawn together, and if appropriate knotted, in order to
close the relevant opening.
Although the known arrangement considered above is, in
principle, of relatively straightforward construction,
problems may nevertheless arise in the case of the
needles guided through in the vicinity of the edge
region of the respective opening being accommodated and
secured in the intercepting-cage-like needle-
accommodating device if one or more needles cannot be
secured by said needle-accommodating device. In such
cases, complicated intervention is then necessary in
CA 02382384 2002-02-18
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order for the needles contained in the blood vessel to
be removed again.
Also known, from WO 94/13211, is an arrangement which
is intended for guiding two sutures through a wall of a
blood vessel in the vicinity of the edge region of an
opening formed therein and contains a needle carrier,
which is to be introduced into the relevant opening,
and a needle-accommodating device, which is located
outside the relevant opening. The needle carrier is
provided with sutures, of which the ends are connected
to needles. During use, first of all, the
abovementioned needle carrier is introduced in its
entirety through the abovementioned opening into the
blood vessel which is to be closed, and then the
needles are guided through the edge regian of the
relevant opening from the inside to the outside. In
this case, the rest of the needle-carrier parts
initially still remain in the blood vessel. Thereafter,
these needle-carrier parts are drawn out of the blood
vessel through the abovementioned opening, with the
result that merely the suture connected to the needles
which have already been guided out remains in the
relevant blood vessel. By virtue of the needles being
drawn back further, the relevant suture, finally, is
tensioned in the interior of the relevant blood vessel,
with the result that the suture ends can then be
knotted. The relevant opening is then consequently
closed.
The known arrangement being considered here does indeed
allow, in principle, sutures to be guided through the
wall of a blood vessel in the vicinity of the edge
region of an opening provided therein; however, it is
also the case here that the reliability in conjunction
with the needle ends being accommodated in the needle-
accommodating device is at least critical. This is
because, if one or other of the needles is not
accommodated reliably by the needle-accommodating
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device, additional intervention is also necessary in
this case in order to avoid complications. For
dimensioning reasons, the access to the artery has to
be widened here. The relevant known arrangement is thus
not minimally invasive.
Also known, from WO 95/13021, is an arrangement for
guiding at least one suture through the wall of a blood
vessel of an individual in the vicinity of the edge
region of an opening provided therein. This known
arrangement has a shaft-like suture-guide device, at
the tip of which there is provided a nose piece which
has a needle-deflecting path and is connected to the
shaft-like suture-guide device via a region of reduced
cross section. Provided in this shaft-like suture-guide
device is a needle-feed opening which is aligned in
relation to the inlet side of the needle-deflecting
path in the nose piece. Also provided in the shaft-like
suture-guide device is a second needle-guide opening,
which is aligned in relation to the outlet side of the
needle-deflecting path in the nose piece. On account of
this construction, the known arrangement being
considered here functions as follows. First of all the
entire arrangement is introduced into that opening of
the blood vessel of an individual which is to be closed
to such an extent that the wall of the relevant opening
butts against the abovementioned region of reduced
cross section, via which the nose piece is connected to
the shaft-like suture-guide device. A needle connected
to a suture is then moved forwards through the needle-
feed opening of the shaft-like suture-guide device in
the direction of the nose piece, the relevant needle
here piercing the wall of the blood vessel in the
vicinity of the edge region of the abovementioned
opening and then being deflected in the deflecting path
of the nose piece such that it then pierces the edge
region of the relevant vessel wall from the inside to
the outside. Thereafter, the relevant needle is guided
back through the abovementioned further needle-guide
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opening of the shaft-like suture-guide device again,
with the result that the edge region of the
abovementioned opening thus has a suture passing
through it at two diametrically opposite locations.
This suture then has to be guided out of the deflecting
path via a suture-release slot arrangement connected to
said path, with the result that, thereafter, the entire
arrangement can be drawn out of the opening of the
abovementioned blood vessel.
The known arrangement considered above does indeed, in
principle, allow at least one suture to be guided
through the wall of blood vessel, in the vicinity of
the edge region of an opening provided therein, at two
diametrically opposite locations; however, the
abovementioned needle-deflecting design occasionally
poses problems in practice since, as a result of the
relatively pronounced curvature of the deflecting path
provided in the abovementioned nose piece, it is only
possible to use flexible needles or small needles,
which meanwhile can cause problems in terms of guiding
such needles through vessel walls.
Finally, US 5,860,990 has also already disclosed a
suturing arrangement for guiding the ends of a suture
through the wall of a blood vessel of an individual in
the vicinity of the edge region of an opening provided
therein. In this known arrangement, a suture supply
with loop-like suture ends is introduced, by means of a
shaft-like suture-feed device, through the relevant
opening into the blood vessel. Provided outside the
relevant shaft-like suture-feed device, at two
diametrically opposite locations, are needle-like
suture-accommodating means which, following piercing of
the vessel wall in the vicinity of the edge region of
the relevant opening, are to accommodate the loop-like
suture ends and then to draw them outwards out of the
blood vessel.
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Although the last-considered known arrangement allows,
in principle, loop-like ends of a suture to be guided
through a blood-vessel wall in the vicinity of the edge
region of an opening provided therein, this design is
nevertheless also problematic to use in terms of the
abovementioned loop-like suture ends being
accommodated. This is because reliable accommodation of
the relevant loop-like suture ends is only ensured when
the relevant suture ends are secured by the shaft-like
suture-feed device in a defined position in which the
needle-like suture-accommodating means can also grip
these loop-like suture ends. In practice, this can only
be achieved from time to time with considerable
difficulty.
Accordingly, the object of the invention is to find a
way in which, in the case of an arrangement of the type
mentioned in the introduction, the at least two sutures
provided can be guided through the wall of a membrane,
of a balloon or of a surface, in particular of an
artery of an individual, in the vicinity of the edge
region of an opening provided therein in a relatively
straightforward but nevertheless reliable manner.
The above object is achieved according to the
invention, in the case of an arrangement of the type
mentioned in the introduction, in that the suture-guide
device, in its longitudinal direction, has a rear
suture-feed part, a front suture-accommodating part and
a central suture-release/suture-clamping part located
therebetween, and in that the abovementioned central
suture-release/suture-clamping part can be rotated at
least relative to the front suture-accommodating part
and has such a cross section that, in at least one
rotary position, it allows the sutures fed from the
rear suture-feed part to be introduced into
accommodating openings exposed in the front suture-
accommodating part and, in a rotary position differing
from the abovementioned rotary position, it allows the
CA 02382384 2002-02-18
, ... 7 _
sutures accommodated in the relevant accommodating
openings together with the needles to be secured for
drawing the entire suture-guide device out of the
abovementioned opening.
The invention has the advantage that, with relatively
low outlay, it ensures that at least two sutures are
guided reliably through the wall of a membrane, of a
balloon or of a surface, in particular of an artery of
an individual, in the vicinity of the edge region of an
opening provided therein and that the sutures guided
through in the vicinity of the abovementioned edge
region are drawn back out of the relevant opening. For
effective use of the arrangement according to the
invention, the relevant opening may, if appropriate, be
cut out for the introduction of said arrangement. In
this case, the present invention utilizes a relatively
straightforward design principle according to which
merely the central suture-release/suture-clamping part
need be rotatable relative to the other arrangement
parts in order in one rotary position, a suture-release
position, to allow the sutures to be guided through in
the vicinity of the edge region of the abovementioned
opening and in another rotary position, a suture-
clamping position, for the needles accommodated with
the sutures in the front suture-accommodating part to
be clamped firmly such that the entire arrangement can
be drawn out of the relevant opening. In this case, the
sutures are drawn along through the abovementioned wall
in the vicinity of the edge region of the
abovementioned opening in order then to be drawn
together, and if appropriate knotted, outside said
opening. A knot pusher known per se may then be used
for this operation, which will not be described in any
more detail here. Surgical sutures are suitable for use
as sutures for the case where the arrangement according
to the invention is an arrangement for closing arteries
or blood vessels in general. Eversion seams may then
consequently be produced. The advantage of minimally
CA 02382384 2002-02-18
invasive closure is achieved in the case of using the
present invention for closing an artery.
Expedient developments of the invention are included in
the subclaims.
The rear suture-feed part, that is to say that provided
at the proximal end of the arrangement, the central
suture-release/suture-clamping part and the front
suture-accommodating part, that is to say that provided
at the distal end of the arrangement, each expediently
have an oval-shaped cross section. This allows optimal
functioning of the relevant arrangement, which is
beneficial, in particular, in the case where the
abovementioned opening is located in an artery wall of
an individual, human or animal. This artery wall may
then be positioned in its entirety against the oval-
shaped cross section of the relevant arrangement parts.
The central suture-release/suture-clamping part serves
in this case, as will become clear hereinbelow, as a
wound-edge tensioner in the artery-wall opening which
is to be closed.
It is sufficient here on occasion if the rear suture-
feed part, the central suture-release/suture-clamping
part and the front suture-accommodating part of the
suture-guide device each have the same oval-shaped
cross section at least in their adjacent regions. This
advantageously allows the entire arrangement to be
easily introduced into the respective opening and
guided out of the same, in the vicinity of the border
region of which at least two sutures are to be guided
through the wall containing the relevant opening.
It is particularly advantageous, furthermore, if the
cross section of the central suture-release/suture-
clamping part has a smaller thickness than the cross
sections of the rear suture-feed part and of the front
suture-accommodating part. As a result, the relevant
CA 02382384 2002-02-18
_ g _
suture-release/suture-clamping part may be positioned
against the edge of the abovementioned opening, in the
vicinity of the edge region of which at least two
sutures are to be guided through the wall containing
the relevant opening, so that the penetration locations
for guiding the relevant sutures through are located as
far away as possible from the edge of the
abovementioned opening. This is quite considerably
advantageous for the closure of an opening provided in
an artery wall.
It is also particularly advantageous if the rear
suture-feed part, the central suture-release/suture-
clamping part and the front suture-accommodating part
of the suture-guide device can all be rotated relative
to one another. This rotatability of the individual
arrangement parts relative to one another allows very
flexible functioning, which is beneficial, in
particular, in the cases where more than two sutures
are to be guided through the wall of a membrane, of a
balloon or of a surface, in particular of an artery of
an individual, in the vicinity of the edge region of an
opening provided in said wall.
A particularly straightforward arrangement design is
achieved when the central suture-release/suture-
clamping part is formed by a region of reduced cross
section of the rear suture-feed part. This
advantageously makes it possible to manage with just
two arrangement parts which can be rotated relative to
one another.
In the case of this arrangement design being considered
here, the region of reduced cross section of the rear
suture-feed part may expediently be formed by a
separate part, which is connected to the rear suture-
feed part. This makes it possible to produce the
relevant arrangement parts relatively easily.
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The central suture-release/suture-clamping part
preferably has a thickness which corresponds to the
thickness of the wall of a membrane, of a balloon or of
a surface, in particular of an artery of an individual.
This makes it optimally possible for at least two
sutures to be guided through the abovementioned wall in
the vicinity of the edge region of an opening provided
in said wall.
Expediently provided in the rear suture-feed part and
in the front suture-accommodating part are m groups,
where m >_ 2 in each case, of n longitudinal and
accommodating holes located one beside the other, where
n ? 1. This measure has the advantage that a relatively
large number n of sutures in groups m can be guided
through the wall of a membrane, of a balloon or of a
surface, in particular of an artery of an individual,
in the vicinity of the border region of an opening
provided in said wall.
In a particularly straightforward arrangement design,
the guide openings of the rear suture-feed part are
formed by longitudinal holes in which the sutures
fastened on the needles can be displaced by means of
separate pushers and can be introduced, via the central
suture-release/suture-clamping part, into elongate
accommodating holes aligned with the longitudinal holes
and forming the abovementioned accommodating openings,
said accommodating holes belonging to the front
accommodating part located in its one position
mentioned above. The relevant pushers advantageously
allow the abovementioned needles to be reliably and
easily guided through the wall of a membrane, of a
balloon or of a surface in the vicinity of the edge
region of the opening provided in the relevant wall.
In this case, the accommodating holes of the front
suture-accommodating part preferably have such a depth
that at least the needles located at the front ends of
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the sutures can be accommodated in their entirety in
said accommodating holes. In this case, the relevant
accommodating holes may preferably be configured such
that they only allow the needles, once introduced, to
be drawn out with difficulty, if at all.
In order for the needles to be secured reliably in the
abovementioned accommodating holes, it is possible for
said accommodating holes in the front suture-
accommodating part expediently to have their respective
longitudinal axis running at an angle in relation to
the longitudinal axis of the longitudinal holes of the
rear suture-feed part. This measure allows the needles
to be clamped firmly in a relatively straightforward
and reliable manner in the relevant accommodating
holes.
In order for it to be possible for the sutures to be
guided through as far away as possible from the edge
region of the opening provided in the abovementioned
wall, the abovementioned longitudinal holes are
preferably located at the edge of the suture-feed part
and are covered by a sheeting part secured on said
suture-feed part. This has the advantage of a
particularly low level of design outlay for the desired
determination of the longitudinal holes.
In this case, the longitudinal holes in the rear
suture-feed part are expediently positioned in the
direction of the outer circumference thereof to such an
extent that part of the outer circumference of the
needles is located outside the outer circumference of
the rear suture-feed part. This measure also helps to
position the lead-through openings for the
abovementioned sutures as far away as possible from the
edge of the abovementioned opening.
Preferably located in the suture-feed part, alongside
the longitudinal holes, are supply chambers in which
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there are accommodated additional needles which are
connected to further sutures and, once the needles
initially provided in the abovementioned longitudinal
holes have been introduced into the accommodating holes
provided in the front suture-accommodating part and the
pushers advanced for said introduction operation have
subsequently been drawn back into a withdrawal
position, in which the relevant supply chambers are
released, pass into the abovementioned longitudinal
holes, in which they can be introduced, by means of the
abovementioned pushers, into accommodating holes
provided in the front suture-accommodating part. This
measure is advantageously used when more than two
sutures are to be guided through the wall of a
membrane, of a balloon or of a surface, in particular
of an artery of an individual, in the vicinity of the
edge region of an opening provided in said wall.
For accommodating the abovementioned further needles,
use is expediently made of the same accommodating holes
in which the needles which were initially located in
the longitudinal holes are accommodated. For this
purpose, the relevant accommodating holes may each have
such a length that they allow two needles to be
accommodated one behind the other. It is also possible,
however, for the relevant accommodating holes to be
configured such that they are capable of accommodating
in each case two needles firmly one beside the other.
In order for it to be possible for the abovementioned
further needles to be guided out of the abovementioned
supply chambers in a straightforward manner, a spring
force is utilized. This may be produced, for example,
by compression springs or helical springs.
If further accommodating holes are provided in the
front suture-accommodating part, before the further
needles accommodated in the abovementioned supply
chambers are introduced into the abovementioned further
CA 02382384 2002-02-18
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accommodating holes of the front suture-accommodating
part, the latter is rotated relative to the rear
suture-feed part such that the further accommodating
holes provided in the front suture-accommodating part
are then aligned in relation to the longitudinal holes
provided in the rear suture-feed part. It is thus
possible, for example, for four sutures to be guided
through a wall at equal intervals from one another
around the edge region of the abovementioned opening.
Before the abovementioned further needles are
introduced into the accommodating holes of the front
suture-accommodating part, the rear suture-feed part
and the front suture-accommodating part are expediently
rotated relative to the central suture-release/suture-
clamping part. This gives the advantage that, for
example, four sutures are guided through a wall at
equal intervals from one another around the edge region
of the abovementioned opening.
The central suture-release/suture-clamping part is
expediently connected to a hand grip by means of a
sleeve which passes through the rear suture-feed part
in a rotatable manner, and the rear suture-feed part
and the front suture-accommodating part are expediently
connected to rotary adjustment wheels, if appropriate,
via a sleeve arrangement arranged coaxially with the
abovementioned sleeve. This has the advantage of a
relatively straightforward design for the adjustment
and movement of the individual arrangement parts.
The abovementioned rotary adjustment wheels are
expediently connected to latching catches which allow
the relevant rotary adjustment wheels, and thus the
rear suture-feed part and front suture-accommodating
part connected thereto, to be adjusted into determined
angle positions relative to the hand grip, and thus to
the central suture-release/suture-clamping part. This
gives the advantage of an adjustment device, for the
CA 02382384 2002-02-18
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individual arrangement parts, which can be adjusted
particularly straightforwardly, but nevertheless
effectively.
The rotary adjustment wheels for the rear suture-feed
part and for the front suture-accommodating part are
expediently coupled to a locking/release mechanism such
that the displacement of the needles by the respective
pusher is released only with the suture-feed part and
suture-accommodating part aligned in relation to one
another. This has the advantage that reliable
displacement of the needles by the respective pusher
can only take place when the suture-feed part and the
suture-accommodating part are aligned in relation to
one another, which is quite particularly beneficial
from the point of view of preventing any risks or
accidents. It is only in this relative position of the
suture-feed part and of the suture-accommodating part
that it is ensured that the needles cannot be guided
out of the arrangement unintentionally or incorrectly.
It is advantageous here for the displacement of the
needles to be released in the case where the central
suture-release/suture-clamping part is located in its
suture-release position. This measure ensures that,
with the suture-feed part and suture-accommodating part
aligned in relation to one another, the abovementioned
needles can only be displaced when the suture-
release/suture-clamping part located therebetween is
located in its suture-release position, that is to say
in the position which is actually provided for guiding
the needles with the sutures connected thereto through
a wall of a membrane, of a balloon or of a surface, in
particular of an artery of an individual.
The rear suture-feed part and the front suture-
accommodating part preferably have a guide element
passing through them, said guide element serving for
introducing the entire arrangement into the
CA 02382384 2002-02-18
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abovementioned opening. It is expediently possible
here, with the aid of the relevant guide element, for
the front suture-accommodating part to be rotated
relative to the rear suture-feed part. This has the
advantage that the relevant guide element, in addition
to its guide function, can also be utilized as a rotary
element. In this case, the abovementioned guide element
may preferably be formed by a guide wire.
In the case of the arrangement construction being
considered here, the rear suture-feed part expediently
has a sleeve part, which encloses the guide element,
passing through it, it being possible for the central
suture-release/suture-clamping part to be rotated
relative to the rear suture-feed part by means of said
sleeve part. In the case of the arrangement design
being considered here, this allows relatively
straightforward rotatability of the arrangement parts
considered.
Finally, on its surface directed towards the central
suture-release/suture-clamping part, it is also
possible for the front suture-accommodating part to
have swing-open and swing-in spring elements which,
with rotation of the front suture-accommodating part
from its starting position relative to the central
suture-release/suture-clamping part, swing open in a
first direction such that the surface of the relevant
front suture-accommodating part is correspondingly
increased in size in the direction of the central
suture-release/suture-clamping part, and which, with
guidance of the suture-accommodating part back into its
abovementioned starting position, can be moved back
into their swung-in state again. This gives the
advantage that, in a relatively straightforward manner,
there is an increase in size of the surface by which
the front suture-accommodating part butts against the
inside of the wall through the opening of which the
front suture-accommodating part is guided, which is
CA 02382384 2002-02-18
' - 16 -
associated with greater reliability during use of the
arrangement according to the invention.
The invention is explained in more detail hereinbelow,
by way of example, with reference to drawings in which
the same designations are used in each case for the
same or mutually corresponding parts and/or elements.
Figure 1 shows a sectional view of a first embodiment
of the invention of an arrangement embodying
the invention.
Figure 2 shows a plan view of a rear suture-feed part
of the arrangement illustrated in Figure 1 in
accordance with the section line A-A
indicated therein.
Figure 3 shows a plan view of a central suture-
release/suture-clamping part of the
arrangement illustrated in Figure 1 in
accordance with the section line B-B
indicated therein.
Figure 4 shows a plan view of a front suture-
accommodating part of the arrangement
illustrated in Figure 1 in accordance with
the section line C-C indicated therein.
Figure shows a plan view of the central suture-
5
release/suture-clamping part and the front
suture-accommodating part of the arrangement
according to Figure 1 in a starting position.
Figure 6 shows the arrangement parts illustrated in
Figure 5 in a rotary position differing from
the rotary position therein.
Figure 7 shows the arrangement parts illustrated in
Figure 5 in another rotary position.
Figure 8 shows the arrangement parts illustrated in
Figure 5 in yet a further rotary position.
Figure 9 shows the arrangement parts illustrated in
Figure 5 once again in their starting
position, once needles with sutures have
previously been guided through holes in the
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vicinity of the edge region of an opening
provided in an indicated wall in accordance
with the rotary positions of the arrangement
parts according to Figures 7 and 8.
Figure 10 shows a side view which illustrates that the
front suture-accommodating part is provided
with swing-open and swing-in spring elements,
of which only one can be seen in Figure 10.
Figure 11 shows a plan view of the arrangement parts
illustrated in Figure 10 with the two spring
elements swung open.
Figure 12 shows a modification of the arrangement
illustrated in Figure 1.
Figure 13 shows an arrangement according to a further
embodiment of the invention.
Figure 14 shows a sectional view of the arrangement
illustrated in Figure 13 along the section
line D-D indicated therein.
Figure 15 shows yet a further embodiment of the
arrangement according to the invention.
Figure 16 shows a sectional view of the arrangement
illustrated in Figure 15 along the section
line E-E indicated therein.
Figure 17 shows a partially sectional view of yet a
further embodiment of the arrangement
according to the invention.
Figure 18 shows a bottom view of a rotary plate
belonging to a locking/release mechanism.
Before the specifics of the details illustrated in the
drawings are discussed, it should first of all be
pointed out, in general terms, that, within the context
of the present application, in conjunction with the
feed and accommodation of sutures, it is meant that the
needles connected to the relevant sutures are also
included in these operations.
Figure 1 shows a largely rotationally symmetrical
sectional view, in detail form, of a first embodiment
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of an arrangement according to the invention. The
arrangement illustrated in Figure 1 comprises a suture-
guide device 1, which is illustrated in the bottom part
of the relevant Figure 1, and an operating or actuating
device 2, which is illustrated in the top part of
Figure 1 and has a series of operating or actuating
elements which will be explained in more detail
hereinbelow. This arrangement is to be regarded as
being illustrated on a vastly enlarged scale for the
case where it serves for closing an opening provided in
the wall of an artery of an individual, that is to say
where it is used as a device for closing arteries. In
the case of such an artery-closing arrangement, the
dimension of the suture-guide device 1 in the cross-
sectional direction is merely a few millimetres; a
typical value, for example, is 4 mm.
According to Figure 1, the suture-guide device 1
contains, as seen in the longitudinal direction of the
relevant suture-guide device, a rear suture-feed part
3, a front suture-accommodating part 4 and a central
suture-release/suture-clamping part 5 located
therebetween. In the present case, these three
arrangement parts 3, 4 and 5 are connected to one
another in a rotatable manner via a double-tube or
double-sleeve arrangement. The relevant sleeve
arrangement contains an inner sleeve 6 and an outer
sleeve 7 arranged coaxially therewith. According to
Figure l, the inner sleeve 6 is fixed to the front
suture-accommodating part 4, that is to say that
provided at the distal end of the three arrangement
parts 3, 4 and 5. The outer sleeve 7 is fixed to the
central suture-release/suture-clamping part 5 and can
be rotated relative to the inner sleeve 6 and also
relative to the rear suture-feed part 3, that is to say
that provided at the proximal end of the three
arrangement parts 3, 4 and 5. This rotation is brought
about by various elements of the abovementioned
CA 02382384 2002-02-18
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actuating device 2, which will be discussed in more
detail hereinbelow.
In the case where the entire arrangement is an artery-
closing arrangement, the central suture-release/suture-
clamping part 5 has a thickness which corresponds to an
artery-wall thickness. A typical value is approximately
2 mm. In this case, the length of the front needle-
accommodating part 4 is typically approximately 6 mm.
The rear suture-feed part 3 has two longitudinal holes
8, 9 Which, in the present case, are located at the
edge of the suture-feed part 3 and are each covered
here by a sheeting part 10 and 11, respectively, which
may be adhesively bonded, for example, to the outer
edge of the suture-feed part 3. It is thus possible for
the relevant longitudinal holes 8, 9 to be positioned
as far as possible in the outward direction, to be
precise preferably to such an extent that part of the
outer circumference of needles 12, 13 accommodated in
said longitudinal holes 8, 9 is located outside the
circumference of the rear suture-feed part 3. This is
quite particularly beneficial for the case where the
abovementioned needles are to act as far away as
possible from the centre of the suture-guide device 1,
which will become clearer hereinbelow.
Connected to the abovementioned needles 12, 13 are
sutures 14, 15 which each come from a suture supply
contained in an associated suture magazine 16 and 17,
respectively. The abovementioned sutures 14, 15 are
guided in the abovementioned longitudinal holes 8, 9 by
pushers 18, 19 which can be forced by means of an
actuating key 43, counter to the spring force of
springs 20, 21, in the direction of the front suture-
accommodating part 4. The relevant pushers 18, 19 are
formed here by tubular pushers.
CA 02382384 2002-02-18
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Located in the front suture-accommodating part 4 are
accommodating holes 22, 23 for accommodating the
abovementioned needles 12, 13. In the present case, the
accommodating holes 22, 23 in the front suture-
s accommodating part 4 have their respective inlet
opening aligned in relation to the longitudinal holes 8
and 9, respectively, provided in the rear suture-feed
part 3. According to Figure 1, the accommodating holes
22, 23 have their respective longitudinal axis angled
in relation to the longitudinal axis of the
longitudinal holes 8, 9 in adaptation to the outer
shape of the suture-accommodating part 4. It should
also be pointed out here that the accommodating
openings 22, 23 each have such a length that they are
capable of accommodating in each case two needles,
corresponding to the needles 12 and 13 respectively,
one behind the other. This means that the accommodating
openings 22, 23 each have a length which is at least
twice the size of the length of each of the needles 12
and 13, respectively. In addition, the accommodating
openings 22, 23 may be configured such that the needles
12 and 13, respectively, introduced into them in each
case cannot readily be drawn out again. For this
purpose, anchoring mechanisms known per se may be
provided in the accommodating openings 22, 23.
Before the construction of the arrangement illustrated
in Figure 1 is discussed further, first of all the
cross sections and/or shapes of the rear suture-feed
part 3, of the front suture-accommodating part 4 and of
the central suture-release/suture-clamping part 5
should be considered. The cross sections and/or shapes
of these arrangement parts 3, 4 and 5 are illustrated
in Figures 2, 3 and 4 in accordance with the section
lines A-A and B-B and C-C, respectively, depicted in
Figure 1. Accordingly, the rear suture-feed part 3, the
front suture-accommodating part 4 and the central
suture-release/suture-clamping part 5 each have an
oval-shaped cross section and/or an oval shape, in the
CA 02382384 2002-02-18
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present case the cross section and/or the shape of the
central suture-release/suture-clamping part 5 having a
smaller width than the cross sections and/or shapes of
the rear suture-feed part 3 and of the front suture-
s accommodating part 4, as can be seen clearly by
comparing Figure 3 with Figures 2 and 4. In principle,
therefore, all the arrangement parts 3, 4 and 5 each
have an oval-shaped or elliptical cross section and/or
a corresponding shape, in any case at least in the
respectively adjacent regions. The longitudinal holes
8, 9 and the accommodating holes 22, 23 are located
here in each case at diametrically opposite locations
of the suture-feed part 3 and of the suture-
accommodating part 4, respectively, to be precise on
the longitudinal axis of the respective shaped body. In
the case where the arrangement illustrated in Figure 1
is used for closing an artery-wall opening, the suture-
release/suture-clamping part 5 acts as a wound-edge
tensioner which tensions the edge of the artery-wall
opening, which constitutes a wound, such that, in the
transverse direction of this tensioning, the needles
12, 13, and/or the needles 26, 27 which are yet to be
considered, with their sutures can be guided through
the artery wall.
Figures 5 and 6 show plan views of the central suture-
release/suture-clamping part 5 and the front suture-
accommodating part 4 in two different relative rotary
positions. In the rotary position according to Figure
5, which may be regarded as the starting position of
the arrangement, the accommodating openings 22 and 23
contained in the front suture-accommodating part 4 are
covered by the central suture-release/suture-clamping
part 5. The left-hand suture-feed part 3 is located
here in the same rotary position as the front suture-
accommodating part 4. In the rotary position
illustrated in Figure 6, the relevant accommodating
openings 22, 23 are freely accessible. As far as the
arrangement illustrated in Figure 1 is concerned, this
CA 02382384 2002-02-18
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means that, in the case of rotation of the central
suture-release/suture-clamping part 5 relative to the
front suture-accommodating part 4 - this relative
position is illustrated in Figure 6 - the needles 12
and 13 contained in the longitudinal holes 8, 9 can be
guided in the direction of the accommodating openings
22 and 23, respectively, since their movement is
released, rather than obstructed, in this position by
the central suture-release/suture-clamping part 5.
Coming back to the arrangement illustrated in Figure 1,
it should be pointed out that in the rear suture-feed
part 3, in addition to the already considered needles
12 and 13 with associated sutures, said arrangement
also has additional needles 26 and 27 which are
connected to further sutures 24 and 25, respectively,
and are respectively provided in supply chambers 28 and
29 alongside the abovementioned longitudinal holes 8
and 9, respectively. The relevant supply chambers 28,
29 contain pressure-exerting plates 30 and 31,
respectively, which are subjected to loading by
compression springs and by means of which the
additional needles 26 and 27, respectively, are forced
in the direction of the abovementioned longitudinal
holes 8 and 9, respectively. In that position of the
arrangement which is illustrated in Figure 1, this
exertion of pressure as yet has no further effect; the
addition needles 26 and 27 remain in the supply
chambers 28 and 29, respectively. It is only when the
pushers 18 and 19, once the needles 12 and 13 initially
provided in the longitudinal holes 8 and 9,
respectively, have been introduced into the
accommodating openings 22 and 23, respectively, are
drawn back to such an extent that the abovementioned
supply chambers 28 and 29, respectively, are exposed
that the abovementioned exertion of pressure results in
the additional needles 26 and 27 then passing into the
abovementioned longitudinal holes 8 and 9,
respectively, in order then to be pushed into the
CA 02382384 2002-02-18
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respective accommodating openings 22 and 23 by the
abovementioned pushers 18 and 19, respectively.
The further sutures 24 and 25 connected to the
abovementioned additional needles 26 and 27,
respectively, belong to suture supplies which are
accommodated in separate suture magazines 32 and 33,
respectively, in the rear suture-feed part 3.
The operating and/or actuating device 2 which belongs
to the arrangement and is illustrated in Figure 1 will
now be considered in more detail. This actuating device
2 contains a hand grip 34 which is fixed to the
abovementioned outer sleeve 7 of the arrangement. The
entire arrangement according to Figure 1 can be held
using this hand grip. The actuating device 2 also
contains a rotary adjustment wheel 35, which is fixed
to the abovementioned inner sleeve 6, and a further
rotary adjustment wheel 36, which is fixed to the rear
suture-feed part 3. On its side which is located at the
top in Figure l, the hand grip 34 has, at certain
locations, latching holes 37 in which a latching catch
38, connected to the rotary adjustment wheel 35, is
capable of engaging. This latching catch 38, which is
merely schematically indicated by a spring-loaded rod
arrangement, can be raised out of its respective
latching position by means of an actuating lever 39,
with the result that, following this raising-out
operation, a relative rotation between the rotary
adjustment wheel 35 and the hand grip 34 is possible.
On its side which is located at the bottom in Figure 1,
the hand grip 34 likewise has one or more latching
holes 42 in which a latching catch 40, likewise merely
schematically indicated as a spring-loaded rod
arrangement, is capable of engaging. Actuation of an
actuating lever 41 allows the latching catch 40 to be
raised out of the respective latching opening 42 of the
hand grip, with the result that relative rotation
CA 02382384 2002-02-18
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between the rear suture-feed part 3 and the hand grip
34 is then made possible.
As will become clear hereinbelow, the latching openings
37 and 42 in the hand grip 34 are provided in each case
at quite specific locations, which allow a quite
specific discharge of the needles 12, 13 and 26, 27
contained in the rear suture-feed part 3, as will be
explained hereinbelow with reference to Figures 7 to 9.
Figure 7 shows the relative rotation of the front
suture-accommodating part 4 in relation to the central
suture-release/suture-clamping part 5 in a first
operation position, in which the accommodating openings
22, 23 are located on a straight line which encloses an
angle of 45° in relation to the longitudinal axis
running in the longitudinal direction of the suture-
release/suture-clamping part 5. It should be pointed
out here that the rear suture-feed part 3 of the
arrangement is located congruently with the front
suture-accommodating part 4. This means that, in this
position or piercing plane, the longitudinal holes 8, 9
of the rear suture-feed part are aligned in relation to
the accommodating openings 22, 23 of the front suture
accommodating part 4.
Figure 8 shows the relevant arrangement in a second
operating position or piercing plane, in which the
front suture-accommodating part 4 has been rotated
further through 90° in relation to the central suture-
release/suture-clamping part 5. It goes without saying
that, in this second operating position, it is also the
case that the rear suture-feed part 3, which is not
illustrated in Figure 8, is located in the same
position in relation to the central suture-
release/suture-clamping part 5 as the front suture-
accommodating part 4.
CA 02382384 2002-02-18
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Whereas the needles 12 and 13 with their sutures 14 and
15, illustrated in Figure 1, are accommodated by the
accommodating openings 22 and 23, respectively, in the
first operating position of the individual arrangement
parts, said first position being illustrated in Figure
7, the additional needles 26 and 27 with their sutures
24 and 25, respectively, are introduced into the
accommodating openings 22 and 23, respectively, in the
second operating position, which is illustrated in
Figure 8. It is thus possible, as is illustrated in
Figure 9, for four suturing holes 51, 52, 53, 54 to be
pierced by the relevant needles in a wall 50 of a
membrane, of a balloon or of a surface, which may be in
particular an artery of an individual, in which there
is located an opening which has its cut surface
positioned against the outer circumference of the
central suture-release/suture-clamping part 5. These
needles are introduced, together with their sutures,
into the accommodating openings 22 and 23 of the front
suture-accommodating part 4. The suturing holes 51, 52
and 53, 54 are located on a straight line in each case,
the resulting straight lines intersecting one another,
for example, at an angle of 90°.
Latching holes which correspond to the rotary positions
explained above with reference to Figures 7 to 9 and to
further determined adjustment positions (e.g. rest or
starting position) of the front suture-accommodating
part 4 and of the rear suture-feed part 3 relative to
the central suture-release/suture-clamping part 5 are
provided in the hand grip 34 illustrated in Figure 1.
In conjunction with the abovementioned latching catches
38 and 40, it is thus possible for the adjustment
wheels 35 and 36 connected to the arrangement parts 3
and 4 to be easily moved into the respectively desired
rotary positions.
Figures 10 and 11 illustrate an added development of
the above-explained arrangement according to the
CA 02382384 2002-02-18
- 26 -
invention. According to this added development, on its
surface directed towards the central suture-
release/suture-clamping part 5, the front suture-
accommodating part 4 has swing-open and swing-in spring
elements 60, of which in the present case - as can be
seen clearly from Figure 11 - two are provided. The two
spring elements 60 each have a fastening surface 61,
which is attached to the front suture-accommodating
part 4, and swing-out and swing-in surfaces 62. The
relevant spring elements 60 are configured here such
that, with rotation of the front suture-accommodating
part 4 from its starting position (as is illustrated,
for example, in Figure 5) relative to the central
suture-release/suture-clamping part 5, they swing open
in a first direction and thus increase the size of the
surface of the front suture-accommodating part 4 in the
direction of the central suture-release/suture-clamping
part. With rotation of the front suture-accommodating
part 4 back into its abovementioned starting position,
the relevant spring elements 60 can have their surfaces
62 moved back into the swung-in state again. This
measure of providing additional spring elements 60 may
thus increase the size of the surface by which the
front suture-accommodating part 4 butts against a wall
through which the relevant front suture-accommodating
part 4 is inserted. This allows, if appropriate,
reliable functioning of the arrangement according to
the invention considered.
Figure 12 illustrates a modification, in detail form,
of the arrangement according to the invention
illustrated in Figure 1. According to Figure 12,
additional needles 80, 81 are accommodated in supply
chambers 82 and 83, respectively, formed alongside the
longitudinal holes 8 and 9, respectively, on the
outside of the overall arrangement. With the aid of
pressure-exerting plates 84 and 85, which are connected
to helical springs, the relevant needles 80 and 81,
respectively, are forced in the direction of the
r
r
CA 02382384 2002-02-18
- 27 -
abovementioned longitudinal holes 8 and 9,
respectively. Sutures 86 and 87 running on the outside
of the arrangement are connected here to the
abovementioned needles 80 and 81, respectively.
Provided in the front suture-accommodating part 4
according to Figure 12, in contrast to the conditions
illustrated in Figure 1, are two accommodating openings
88, 89 which are each respectively capable of
accommodating two needles 12, 80 and 13, 81 one beside
the other. In order for the needles 12 and 13
introduced first of all into the accommodating openings
88, 89 to be moved out of the introduction path for the
additional second needles 80 and 81, respectively,
Figure 12 provides magnets 90 and 91 in the
accommodating openings 88 and 89, respectively, for the
case where at least the needles 12, 13 are magnetically
attractable needles. These magnets attract the needles
12 and 13 introduced into the relevant accommodating
openings and secure them.
The rest of the construction and configuration of the
arrangement illustrated in Figure 12 corresponds to the
arrangement explained with reference to Figure 1.
Figures 13 and 14 illustrate a further embodiment of
the arrangement according to the present invention.
This embodiment differs from the embodiment considered
above in that the arrangement contains merely two
needles 12, 13, to which sutures 14 and 15,
respectively, are connected. In contrast to the
embodiment considered according to Figure 1 or 12, it
is nevertheless the case, in the case of the embodiment
according to Figures 13 and 14, that the cross section
of the rear suture-feed part 3, of the front suture-
accommodating part 4 and the central suture-
release/suture-clamping part 5 is of oval-shaped design
in each case, this oval-shaped cross section, more
CA 02382384 2002-02-18
- 28 -
specifically, being provided at least in the adjacent
regions of the respectively adjacent parts.
In contrast to the conditions illustrated in more
detail in Figures 1 and 12, the embodiment according to
Figures 13 and 14 provides a guide element which is
formed by a guide wire 100, is connected to the front
suture-accommodating part 4 and allows the latter to be
rotated relative to the rear suture-feed part 3 and the
central suture-release/suture-clamping part 5. The
abovementioned central suture-release/suture-clamping
part 5 is fixed to a sleeve part 101 which can be
rotated relative to the guide element 100 and the rear
suture-feed part 3.
In conjunction with the arrangement according to the
invention illustrated in Figures 13 and 14, it should
also be pointed out that the length L3 of the
accommodating openings 22 and 23 which is depicted in
Figure 13 is at least equal to the dimension L1, that
is to say the length of one of the needles 12, 13. The
dimension L2 corresponds at least to the thickness of
the wall through whose opening the arrangement
illustrated is guided, in order for it to be possible
for the needles 12 and 13 with the sutures 14 and 15,
respectively, connected thereto to be guided through
the relevant wall in the vicinity of the edge region of
said opening.
Figures 15 and 16 illustrate yet a further embodiment
of the arrangement according to the present invention.
This most straightforward embodiment of the embodiments
of the arrangement according to the invention which are
explained here illustrates that the present invention
also functions, in principle, when the rear suture-feed
part 3 and the front suture-accommodating part 4 each
have a circular cross section and when the central
suture-release/suture-clamping part 5 has a smaller
cross section in comparison. It may be sufficient here
CA 02382384 2002-02-18
- 29 -
for said central suture-release/suture-clamping part 5
to be fixed to the rear suture-feed part 3, as a part
of the latter, or even to be formed together therewith.
Figures 15 and 16 illustrate, as in Figures 13 and 14,
a guide wire passing through all the arrangement parts,
with the aid of which the front suture-accommodating
part 4 can be rotated relative to the central suture-
release/suture-clamping part 5, and thus relative to
the rear suture-feed part 3. In the present case, this
rotatability also realizes the same functions as have
been mentioned above in conjunction with Figures 5
and 6.
As far as the lengths L1, L2 and L3 are concerned, what
has been said in relation to Figures 13 and 14 applies
here.
To conclude, it should also be pointed out that it is
also possible for the guide elements in the form of
guide wires which are mentioned in conjunction with the
arrangements according to Figures 13 to 16 to be
provided in the embodiments illustrated in Figures 1 to
12, although in the latter case merely as
straightforward guide elements with no associated
rotary function as has been explained in conjunction
with Figures 13 to 16.
Figure 17 illustrates yet a further embodiment of the
arrangement according to the invention. Largely a half-
section has been selected for the relevant illustration
here, although a full section is provided in the top
part of Figure 17. The relevant illustration here is on
a vastly enlarged scale, to be precise in the bottom
part in particular, in order to illustrate details
which will be discussed more specifically hereinbelow.
Since the half-section illustration only illustrates
the specifics of the construction in one half of the
relevant arrangement, it is also just this construction
CA 02382384 2002-02-18
' - 30 -
which will be described in more detail hereinbelow. It
goes without saying that, in its other half which is
not illustrated in section, the arrangement is
constructed at least largely correspondingly. In
addition, it should also be pointed out that it is
basically the case in Figure 17 that those elements
which correspond to the elements which have a
comparable or the same function and are illustrated in
Figure 1 have the same designations as in Figure 1.
In the same way as the arrangement illustrated in
Figure 1, the arrangement 1 illustrated in Figure 17
has, in its suture-guide device 1, a suture-feed part
3, a suture-release/suture-clamping part 5 and a
suture-accommodating part 4 in the relevant sequence
from the proximal end to the distal end of the
arrangement illustrated. The relevant parts 3, 4, 5
here each have an oval-shaped or elliptical cross
section, as is indicated by chain-dotted lines in
Figure 17. Located in the suture-feed part 3 are
longitudinal holes 8, 108 for accommodating the sutures
16 and 24 connected to the needles 12 and 26,
respectively, as well as corresponding longitudinal
holes for accommodating the sutures 17, 25 connected to
needles which cannot be seen. In this case, the needle
26 is accommodated in an accommodating chamber in the
bottom region of the suture-feed part 3 in a manner
corresponding to that which has already been shown in
Figure 1. Accordingly, by means of a pressure-exerting
plate 30, the needle 26 is subjected to pressure
directed towards the left in Figure 17. This pressure
comes from a spring 109 which is accommodated in an
accommodating chamber 110 which is formed in the bottom
part of the suture-feed part 3 and, according to Figure
17, is closed in the direction of the suture-
release/suture-clamping part 5 by a closure part 111.
According to Figure 17, the suture-accommodating part 4
likewise has accommodating holes, of which merely the
CA 02382384 2002-02-18
- 31 -
accommodating hole 22 is illustrated specifically. This
accommodating hole 22 and its corresponding
accommodating hole in the other region of the
arrangement illustrated are designed in fish-trap form
in the present case. This has the advantage that a
needle, once introduced into the relevant accommodating
hole, cannot readily be drawn out of said accommodating
opening again since - as is usually the case - it is no
longer located in this accommodating hole in the
position in which it was introduced. This applies, in
particular, to the case where the suture connected to
the relevant needle is connected laterally to said
needle in relation to the longitudinal direction of the
same.
Provided at the top, that is to say in this case
proximal, end of the arrangement section which
comprises the parts 3, 4, 5 is a displacement part 112
which, on its inner circumference, has a pushing
element 113 formed by a flat plate. Fixed to said
pushing element 113 is a pusher which is formed, in
particular, by a spring wire 114 and with the aid of
which the needle 12 or 26 located in the longitudinal
hole 8 in each case can be displaced in the
longitudinal direction, that is to say downwards in
Figure 17. For this purpose, the displacement part 112
can be displaced in the longitudinal direction of the
suture-feed part 3, that is to say downwards according
to Figure 17. For this purpose, the longitudinal holes
8 and 108 accommodating the sutures 16, 24 are slotted
such that they are capable of accommodating the
relevant pushing element 113. It should be pointed out
here that, in practice, the arrangement is such that
the relevant pushing element 113 enters into slots of
the material parts bounding the longitudinal holes 8,
108 at right angles to the position illustrated in
Figure 17. The respective slot depth is selected here
so as to ensure that the respective needle 12, 26 can
pass into the accommodating hole 22.
CA 02382384 2002-02-18
- 32 -
The displacement part 112 considered above is indeed,
as has been described, longitudinally displaceable in
the direction of the distal end of the arrangement
illustrated in the direction of rotation, however, it
is fixed to the rotary adjustment wheel 36 directly
adjacent to it. For this purpose, an outer sleeve 115,
which is accommodated by a fastening part 107 in the
rotary adjustment wheel 36, is provided according to
Figure 17, as it were, as part of the extension of the
suture-feed part 3.
Provided above the adjustment wheel 36 considered
above, according to Figure 17, is an adjustment wheel
134 that corresponds to the hand grip 34 in Figure 1
and is fixed to a sleeve 7, although, in contrast to
the conditions illustrated in Figure 1, it is a central
sleeve here. In the present case, suture reels 116,
132, which correspond to the suture magazines 16, 32
illustrated in Figure 1, are arranged in a rotatable
manner in the rotary adjustment wheel 134, it being
possible for the abovementioned sutures 16 and 24,
respectively, to be drawn off from said reels. In the
present case, the suture-release/suture-clamping part 5
can be rotated in relation to the suture-feed part 3
and the suture-accommodating part 4 by means of the
rotary adjustment wheel 134, which corresponds to the
conditions which have already been explained in
conjunction with Figure 1.
The rotary adjustment wheel 35, which is also provided
in Figure 1, is shown in the top part of Figure 17 and
is connected to the inner sleeve 6, via which the
suture-accommodating part 4 can be rotated relative to
the suture-feed part 3 and the suture-release/suture-
clamping part 5. The inner sleeve 6 in this case, as is
also illustrated in Figure 1, is a hollow sleeve
through which a guide wire, such as the guide wire 100,
can be guided as guide element.
CA 02382384 2002-02-18
- 33 -
In order for it to be possible for the rotary
adjustment wheels 35, 134, 36 illustrated in Figure 17
to be adjusted relative to one another with latching
action into respectively desired positions, it is the
case, as with the embodiment illustrated in Figure 1,
that latching catches 38 and 40 are provided between
the rotary adjustment wheel 134 and the two adjacent
rotary adjustment wheels 35 and 36. According to Figure
17, however, these latching catches, rather than being
provided in the longitudinal direction of the
arrangement illustrated, are provided in the radial
direction between the relevant rotary adjustment
wheels.
In addition to the elements considered above, by way of
which the arrangement illustrated in Figure 17
corresponds in principle to the arrangement illustrated
in Figure 1, Figure 17 also provides a separate
locking/release mechanism, with the aid of which it is
ensured that the rotary adjustment wheels 35 and 36 for
the suture-feed part 3 and for the suture-accommodating
part 4 only release a displacement of the needles by
the respective pushers when the suture-feed part 3 and
the suture-accommodating part 4 are aligned in relation
to one another. In the present case, this
locking/release mechanism contains a rotary plate 120
which is connected to the rotary adjustment. wheel 35
and has an L-shaped cutout 121 in which there is
accommodated a locking rod 122 which is fixed to the
displacement part 112. Figure 18 illustrates the
relevant rotary plate 120 as seen from beneath. It can
be seen here that this rotary plate 120 has a recess
123 at a certain position, in the present case in its
central position, in the region of the L-shaped cutout
121 which runs concentrically with the outside of the
relevant rotary plate, it being possible, in the region
of said recess, for the abovementioned locking rod 122
to be guided out of its locking position, that is to
CA 02382384 2002-02-18
- 34 -
say released. It is only in this position that the
displacement part 112 according to Figure 17 can be
displaced downwards. As has already been mentioned
above, this position is that position in which the
suture-feed part 3 and the suture-accommodating part 4
are aligned in relation to one another and in which,
moreover, the suture-release/suture-clamping part 5 is
also preferably in its suture-release position.
The locking/release mechanism considered above has been
explained in conjunction with the insertion of the
needles in a single piercing plane. This piercing plane
and/or its position is defined here by the
determination of the recess 123. It should be possible
to appreciate, however, that in the case where a
plurality of piercing planes are provided, as has been
explained, for example, with reference to Figures 7 to
9, a number of recesses, corresponding to the recess
123, which corresponds to this number of piercing
planes will be provided at such locations of the L-
shaped cutout 121 as correspond to the abovementioned
piercing planes and/or the positions thereof. It is
also possible here for the angles between the
individual piercing planes to have values other than
those which have been explained in conjunction with
Figures 7 to 9, for example a value of 60° in each
case.
As an addition to the arrangement 1 illustrated in
Figure 17, it should also be pointed out that, in the
case of this arrangement, the longitudinally running
outsides of the rotary adjustment wheels 35, 36 and 134
more or less have a common outer line, whereas the
displacement part 112 has its outside offset inwards in
comparison. In contrast to this, however, it is also
possible to use other configurations.
In the region between the displacement part 112 and the
rotary adjustment wheel 36 directly adjacent thereto,
CA 02382384 2002-02-18
- 35 -
the sutures 17, 25 are also indicated in Figure 17 in
addition to the sutures 16, 24 and the locking rod 122.
In this case, the region between the displacement part
112 and the rotary adjustment wheel 36 is illustrated
as an open region. In practice, however, this region
may be closed in the outward direction by corresponding
screening parts which are connected, for example,
telescopically to the rotary adjustment wheel 36 and
the displacement part 112.
In addition, it should also be pointed out that, rather
than the invention being restricted to the embodiments
described, it is possible to provide in the rear
suture-feed part 3 and in the front suture-
accommodating part 4 in each case m groups, where
m >_ 2, of n longitudinal and accommodating holes
located one beside the other, where n >_ 1. Where m > 2,
this results in geometrical arrangements for the
individual arrangement parts which differ from the
geometrical arrangements illustrated in the drawings.
Where m = 3, for example, this results in a triangular
cross-sectional configuration for the arrangement
according to the invention.
