• 专利附录
  • 专利说明
  • 权利要求
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    • 专利摘要:
    orogastric tube for longitudinal gastrectomy. The present invention relates to an orogastric probe for a longitudinal gastrectomy. the purpose of the invention is to provide an orogastric probe that constitutes an advantageous alternative to the poorly adapted probes used until today, facilitating the work of a surgeon. this new orogastric probe is characterized by the fact that this distal part carries a balloon (25) presenting, in the inflated state, a shape that is significantly complementary to that of the pyloric cave (4), so that it can be housed in this pyloric cave (4) , the end of the inflated balloon (25) is then preferably abutting against the pylorus (5) and the distal end of the probe body (20) is preferably anchored over the pyloric cave (4), while the body part (21) of the probe (20) arranged above the inflated balloon (25) is supported against the wall of the small curvature (6) of the stomach (1) and thus allows: to determine the positioning of the beginning of the resection line- closure at the level of the pyloric cave (4); define the resection-closure line; and calibrate the pyloric cave (4) and the gastric glove to be preserved.
    公开号:BR112012033006B1
    申请号:R112012033006-3
    申请日:2011-06-22
    公开日:2021-08-10
    发明作者:David Nocca
    申请人:Medical Innovation Developpement；
    IPC主号:
    专利说明:

    field of invention
    [0001] The field of the invention is that of surgical instruments useful to practitioners in the exercise of gastric surgery techniques. The instruments most particularly referred to are orogastric tubes aimed at assisting the surgeon in the scope of the bariatric surgery technique of longitudinal gastrectomy or sleeve gastrectomy or sleeve gastrectomy. technological planning
    [0002] The orogastric probes are presented in the form of transparent flexible tubes, for example, in silicone, open at its two ends proximal and distal. The distal part of these probes has a series of lateral holes, allowing the passage of liquid and gas flows in both directions. Classically, gastric tubes have annotated markings along their entire length, allowing to accurately assess their position in vivo.
    [0003] These probes can be designed to drain the stomach contents (air secretions) to feed the patient, to need a diagnosis, to perform a lavage or, in the case of a bariatric surgery operation of longitudinal gastrectomy, to drain the contents of the stomach and to assist the surgeon in performing the longitudinal gastrectomy.
    [0004] This surgical operation aims to reduce gastric capacity (approximately resection of the two-thirds of the stomach) to cause an early feeling of satiety and act on weight loss.
    [0005] When this intervention is performed under general anesthesia and in most cases by celioscopy, one or several gastric tubes are introduced through the patient's mouth and are descended via the esophagus to the level of the stomach cave. The interest in using these different tubes is, in the chronological order of the intervention: 1) ex-blowing the stomach, in case of air distension induced by intubation maneuvers, during anesthesia; 2) calibrate the gastric glove, keeping it with the help of the tubular body of the probe; 3) give the surgeon anatomical markings to perform a quality resection, avoiding stenosis of the remaining part of the gastric tube (the surgeon leaning against the tube body to perform the stapling); 4) inject, then withdraw liquid (methylene blue) in the patient's stomach, after stapling, to check the tightness of the stapling line.
    [0006] It should be noted that there are mainly two methods of performing the so-called "selleve gastrectomy" intervention. The description of these two methods is made below with reference to the attached figure 1 which shows a schematic of the stomach.
    [0007] The first method, called "with preservation of the gastric cave" consists of making a stapling line -LAi- on the patient's stomach in a straight line, from the His-2- angle to a point - 3- of the cave. gastric gland -4- distant (a1) 6 to 8 cm from the pylorus -5-. The second method, known as "without gastric cave conservation", consists of making a stapling line - LA2 - initially concentric to the small curvature 6 of the stomach 1, from the angle of His -2- to the angle or small tuberosity (cf stop point at the distal end of the probe in figure 1) -7- of the stomach -1-, then oblique to a point 8 located 2 cm (a2) from the pylorus -5- (symbolized by a dotted line in the figure 1).
    [0008] It is known to use a "Salem tube" type gastric probe for the removal of air present in the patient's stomach (step 1), a "Faucher tube" type probe to calibrate the gastric glove, before the operation of resection - closure (stapling - suture) (steps 2 & 3) and finally a "Salem probe" type probe for the injection and removal of gastric fluid at the end of the intervention (step 4). This last probe can be left in place for a few days according to the habits of the surgical teams.
    [0009] This "Faucher's tubi" is shown in figure 2. It consists of a silicone tube 114 open at its two ends and whose wall has oblong openings 115 at its distal part. This probe is fitted with 10 graduated positioning markings.
    [00010] This Faucher tube is introduced into the stomach until its distal end comes to a stop over the great curvature - 7 - of the stomach. The body of the Faucher tube rests on the small curvature - 6 - of the stomach. The surgeon thus has anatomical markings and a guide to be able to perform a resection - closure (stapling), leaning on this Faucher 114 tube (steps 2 & 3). It should be noted that the combined resection-closure operation is performed, in a manner known per se, with the aid of a surgical instrument designed to incise and then close by stapling the two edges of the wound.
    [00011] It is evident that it would be much more convenient for practitioners to have to use only a single probe adapted for all intervention steps. And this is all the more so since the Salem tubes or Faucher tubes are not specially designed for this longitudinal gastrectomy and therefore suffer from several inconveniences.
    [00012] In particular, these utensils, usually in silicone, lose their rigidity due to body heat. Thus, they do not retain their position in the stomach and thus make the resection operation difficult - stapling closure.
    [00013] On the other hand, if the longitudinal gastrectomy is performed, with or without preservation of the gastric cave, the probes and Salem or the Faucher tubes do not provide any articular assistance, especially in relation to the calibration of the remaining part of the stomach to be preserved extremely delicate for the surgeon.
    [00014] Another inconvenience of classic probes is that they run the risk of being stapled during the intervention. In fact, these probes are hardly visible by the surgeon through the stomach wall in celioscopy. It may, therefore, happen that the surgeon does not sufficiently accurately mark the placement of the probe, before performing the stomach section with the aid of his resection-stapling instrument and that he staples this probe with the stomach wall, sometimes going to the complete probe section. The consequences of this avatar are potentially serious, as the risk of gastric leakage, such as associated peritonitis, is very important there, when ablation of the poorly stapled probe.
    [00015] It is known, on the other hand, an orogastric tube used for placement of gastric rings. This probe, represented in Figure 3, comprises a silicone tube 13, which is provided with graduated positioning markings 10, which is open at its two ends and whose wall has oblong openings 115 in its distal part. The latter is also equipped with a balloon 11, surrounding the tube 13, i.e. this balloon 11 is diametrically crossed by the tube 13. This balloon 11 can be inflated by means of the conduit 12 arranged outside the tube 13 and connecting this balloon 11 to a filling means 14 (bellows closed by a valve that also allows the injection of air) disposed in the proximal part of the calibration probe. Once the distal part of the calibration probe was introduced into the esophagus just upstream of the stomach, the surgeon fills the balloon 11 and uses the tumescence thus created as a mark to place the gastric ring in this connection area of the abdominal part of the esophagus. and the stomach.
    [00016] In this state of fact, it is clear that there is a clear need for a new orogastric tube perfectly adapted to assist the surgeon, when performing longitudinal gastrectomy interventions.
    [00017] The specifications of this new probe would be that it only allows it: 1 - to remove air from the patient's stomach; 2 - calibrate the remaining part of the stomach, regardless of the technique with or without preservation of the gastric cave, to know the exact volume of the remaining stomach. The choice of the type of cut then belongs to the surgeon, at the time of the intervention; 3 - allow the surgeon to consider anatomical markings and guide him to perform the gastric section, in an easy way, according to the technique chosen by electrons, without risk of sectioning the probe; 4 - allow injection or removal of liquid to check the tightness of the suture
    [00018] Another specification of this new orogastric tube would be to have a tubular body of shape and rigidity adapted to a correct and stable position in the stomach, in relation to the patient's body temperature, which makes the tube flexible, to facilitate the resection operation -clipping.
    [00019] Another expectation of the practitioners for this new orogastric tube would be that it would be perfectly visible to avoid being stapled during the intervention. TECHNICAL PROBLEM - Purposes of the invention
    [00020] The technical problem that proposes to solve the present invention is to satisfy at least one of the objectives listed below: - provide a new orogastric tube, allowing to improve the assistance offered to the surgeon, when the intervention of longitudinal gastrectomy; - provide a new orogastric tube for the longitudinal gastrectomy that allows it to only perform the four steps 1-4 mentioned above: ex-stomach blow, calibration of the stomach part to be preserved, orientation and consideration of anatomical markings, then injection and withdrawal of liquid, notably to check the tightness of the suture line; - provide a new orogastric tube for longitudinal gastrectomy that can be perfectly supported in the stomach, in order to facilitate the resection-closure operation by stapling, guiding the surgeon; - provide a new orogastric tube for the longitudinal gastrectomy that is perfectly visible and visible to the surgeon, in order to avoid incidents such as clipping the tube; - provide a new orogastric tube for longitudinal gastrectomy, which can be easily placed in the stomach, which can thus be durably positioned without moving, without filling, without moving, and which can be easily removed; - provide a new orogastric tube that allows to know the residual volume of the remaining stomach to perform a quality resection; - provide a new multifunctional, sterilizable orogastric probe; - provide a new orogastric tube for longitudinal gastrectomy that is economical and simple to manufacture and use. BRIEF DESCRIPTION OF THE INVENTION
    [00021] All or part of these objectives, among others, are achieved by the present invention, which refers to a new orogastric probe, comprising a body, whose distal part is notably intended, within the scope of the bariatric surgery technique of longitudinal gastrectomy, to guide the surgeon to resection a part of the stomach and define the closing line (stapling - suture) after resection.
    [00022] This probe is characterized by the fact that this distant part carries a balloon that presents, in the inflated state, a shape substantially complementary to that of the pyloric cave -4-, so that it can be housed in this pyloric cave -4-, the end of the inflated balloon being then preferably braced against the pylorus -5- and the distal end of the probe body preferably resting on the pyloric cavern -4-, while the part of the probe body is arranged above the inflated balloon, it is supported against the wall of the small curvature -6- of the stomach -1-, thus allowing: - to determine the positioning of the beginning of the resection-closure line at the level of the pyloric cave -4-; - define the resection-closure line; and - calibrate the pyloric cave -4- and the gastric glove to be preserved.
    [00023] This new gastric tube allows to perform effectively and safely longitudinal gastrectomy, reducing the gastric capacity of two-thirds and thus causing the patient a feeling of early satiety, giving a weight loss.
    [00024] This new gastric tube prevents past difficulties in calibrating the part of the stomach to eliminate. These difficulties could have the consequence that, in the absence of having sufficiently reduced the stomach, it dilates in time and deprives the effect of the longitudinal gastrectomy, leaving the problem of weight overload of the patient complete.
    [00025] This new orogastric tube has, therefore, a distal part that, once introduced into the stomach, can take outside the pyloric cave -4- by filling the balloon.
    [00026] This distal appendage that forms the balloon is intended to support itself over the pylorus - 5 - leaning on the pyloric cave -4- and allow the propping of this distal part of the probe and, therefore, its correct and stable positioning, aiming at resection - closure, preferably by stapling.
    [00027] This new multifunction orogastric tube remarkably improves this technique of bariatric surgery, providing invaluable assistance to the surgeon. Intervention is done more easily, faster, safer and more effectively in terms of the intended outcome.
    [00028] According to an advantageous modality of the invention, the dimensions of the probe body in straight cross section, that is, the outer diameter When the body is a circular tube, determine the preserved stomach volume -1- after resection , and the dimensions or volume of the inflated balloon determine the pyloric cave volume -4- preserved after resection.
    [00029] To better assume the shape of the anatomy of the lower part of the stomach, the inflated distal balloon preferably has a general (tron) conical shape, preferably an asymmetric and distorted frustoconical shape with a terminal diameter Dt, a diameter at base Db and a diameter Dm of the middle part, such as Dt < Db < Dm; one end offset from the axis of the base of the balloon, upwards, towards the part of the body of the probe disposed above the inflated balloon, such that the upper face of the inflated balloon intended to be disposed in front of the angular incision -9 - of the stomach -1-, it presents a less pronounced curvature than that of the inferior surface.
    [00030] Likewise, to make the complementarity of shape with the anatomy of the pyloric cave -4-, it is preferable, according to the invention, that the upper face of the distal balloon inflated, the face intended to be disposed in relation to the angular incision -9- of the stomach -1-, forms with the body of the probe (preferably tubular with a circular section), an angle α comprised between 70 and 110 o, preferably between 80 and 100 o, and more preferably of the order of 90 o.
    [00031] In order to optimize the propping of the distal part of the probe in the stomach -1-, it is particularly advantageous, according to the invention, that the distal balloon is mounted on the external face of the wall of the probe body (preferably, tubular straight circular cross section), such that the distance d between the distal end of the probe body and the point of the base of the inflated balloon closest to this distal end is less than or equal to 30 mm, preferably less than or equal to 20 mm, and more preferably is comprised between 1 and 15 mm.
    [00032] To improve the visibility of the probe, it is provided, according to the invention, that the body, preferably tubular with a straight, circular cross section of the probe, is provided with a marking, allowing the surgeon to correctly position the balloon in the stomach - 1- of the patient, so that once inflated, this balloon can be housed in a stop in the pyloric cave -4-, this marking preferably comprising a line coaxial to the body and arranged over the whole or part of its length, advantageously the entire length, of the body wall, on the same side as the balloon.
    [00033] Advantageously, the probe body is tubular and open at its two proximal and distal ends, it is preferably equipped with a tip with a rounded shape, to facilitate insertion in the mouth and esophagus of the patient.
    [00034] To ensure its function of transferring liquid or gaseous fluids (steps 1 and 4 of the intervention), between the interior and exterior of the stomach, the preferably tubular body of the probe defines a fluid circulation channel between the proximal opening and the distal opening, this being preferably formed by a plurality of lateral and/or terminal holes.
    [00035] Inflate and deflate, the distal balloon provided with the probe, according to the invention, preferably comprises a conduit that connects the balloon to the proximal end of the body and allowing filling / deflation of this balloon from that proximal end.
    [00036] In a preferred embodiment, the probe, according to the invention, comprises: - a tubular silicone body of a length comprised between 600 and 1200 mm, preferably between 700 and 1100 mm and, more preferably, still between 850 and 950 mm and with an external diameter of between 24 Fr and 75 Fr (either between 8 mm and 25 mm), and preferably between 30 Fr and 40 Fr (either between 10 mm and 13.33 mm) , this body also being provided in its distal part with a rounded distal tip and lateral holes intended to put the interior of the stomach in communication with the exterior of the digestive tube through the opening of the tubular body; - an inflated balloon 25 with a diameter at the base Db of between 35 and 60 mm, and of a height H of 50 +/- 10 mm, preferably +/-5 mm, and even more preferably +/-3 mm; - a positioning marking formed by a contrasting line along the entire length of the body wall, on the same side as the balloon 25, in the diametrical plane common to the body and balloon 25; and - optionally means for deflating the distal part of the probe 20.
    [00037] Ideally, the probe is characterized by the fact that H + De = 50 to 100 mm, and better still 60 to 80 mm.
    [00038] Optional means of deflection of the distal part of the probe can be provided to allow for a curve to be made over the distal part of the probe, in order to follow the anatomy of the stomach -1-, provided that this distal part is introduced inside this last. Such deflection means may, for example, comprise one or more control cables or trace(s) maneuverable by traction and arranged along the tubular body of the probe.
    [00039] In other words, the probe, according to the invention, is designed to: (I) be introduced in the patient's mouth until its distal end reaches the patient's stomach; (II) extracting fluids from the stomach, notably gaseous, for example, the air in case of air distension induced by intubation maneuvers, during anesthesia; (III) inflate the balloon and place it in the pyloric cave -4- acting so that the end of the inflated balloon is in stop against the pylorus -5-, that the distal end of the probe body is in stop over the pyloric cave -4-, preferably at a distance of 5 to 10 cm, better still 6 to 8 cm from the pylorus -5-, and that the part of the probe body above the inflated balloon is supported against the wall of the small curvature -6- of the stomach -1-; (IV) on the one hand, guide the surgeon to resection a part of the stomach -1-, determining the position of the beginning of the resection and closing line (stapling - suture) at the level of the pyloric cave -4- and, by on the other hand, define the resection-closure line, giving it anatomical markings and support for its instruments, during these resection-closure acts, (V) calibrate the gastric glove and the pyloric cave -4- to be preserved; (VI) inject, then withdraw the colored liquid in the patient's stomach -1- after closing, to check the tightness of the closing line (suture); (VII) and eventually introduce -1- means of visualization (light source) in the middle of the stomach.
    [00040] The invention also relates to a surgical method of longitudinal gastrectomy (or sleeve gastrectomy) consisting of using steps (I) to (VII) described above.
    [00041] The introduction of visualization means, such as an optical fiber, can be performed at any time during the intervention, and preferably from the beginning of the intervention, using a coaxial channel provided in the wall or in the opening of the tubular body of the probe. DETAILED DESCRIPTION OF THE INVENTION
    [00042] The invention described below is an example of the realization of the new orogastric probe, according to the invention, with reference to the attached drawings, in which: - figures 1 to 3 represent, respectively, the anatomy of the stomach and two elements of the prior art; - general figure 4 shows the bride orogastric tube formed by a tubular body with a circular section in silicone, whose distal end is equipped with an inflated balloon, destined to come to be lodged in the pyloric cave; figure 5 represents a side view and a detail view of the distal part of the probe on which the inflated balloon is mounted; figure 6 represents a front view of figure 5; figure 7 represents a side view of the distal part of the probe with the balloon in the deflated state; figure 8 represents an enlargement of figure 7, in a perspective view from above; - figure 9 represents a diagram, showing the implantation of the probe in the stomach.
    [00043] The orogastric tube shown in its entirety in Figure 4 is designated by the general reference 20 comprises a tubular body 21 in silicone with a straight circular cross section. This tubular body 21 has an open proximal end 22 and a distal end 23, provided with a distal tip 24. The outer diameter D shown in figures 5 to 8 of this tubular body 21 is, for example, 12.5 mm, ie 37.5 Fr (French bougies). This outer diameter De calibrates the volume of the stomach -1- to be preserved. Thus, various diameters D of this tubular body 21 and, therefore, various gauges can be proposed to the surgeon.
    [00044] The total length of the tubular body 21, from the proximal end 22 to the distal end 23 is, for example, 900 mm.
    [00045] The tubular body 21 advantageously has a sufficient total length so that its distal part, in particular the inflated balloon 25, can be placed in the pyloric cave -4- of the stomach -1- (cf. figures 1 and 9). The tubular body 21 is preferably made of transparent silicone elastomer. Its structure, its mechanical characteristics, notably its elasticity, are chosen so that the rigidity of the probe is sufficient so that it can be introduced through the patient's mouth to the stomach, passing through the esophagus, without damaging the walls of the digestive tract, preserving a substantially straight shape to assume the shape of the anatomical morphology of the patient's stomach -1-, in particular of the small gastric curvature -6- in the case of the tubular body 21 and the pyloric cave -4- in the case of the inflated balloon 25 . Thus, the tube, for example, in silicone elastomer forming the body of the probe, this advantageously has a SHORE hardness of 65 + 10.
    [00046] Advantageously, the tubular body 21 of the probe 20 is graduated from 5 cm by 5 cm (gradations 10) from the distal end 23..
    [00047] On the other hand, the distal part of the tube 21 of the probe 20 carries a balloon 25 which, in the inflated state, has a shape substantially complementary to that of the pyloric cave -4-. This balloon 25 is mounted on the external face (straight anatomical face - figure 9) of the wall of the tubular body 21, in such a way that the median longitudinal plane of the inflated balloon 25 substantially corresponds to the median longitudinal plane of the tubular body 21. These longitudinal planes medians of the inflated balloon 25 and tube 21 roughly equivalent to the frontal plane of the anatomical cut (figure 9).
    [00048] This inflated balloon 25 has a general asymmetrical and distorted frustoconical shape with, on the one hand, a terminal diameter Dt, a base diameter Db, and a diameter Dm of the middle part, such as Dt < Db <Dm, and, on the other hand, an end 26 offset, with respect to the axis 27 of the base of the inflated balloon 25, upwards towards the part of the tubular body 21 of the probe 20 arranged above the inflated balloon 25, such that the upper face of the The inflated balloon 25, designed to be placed in front of the angular incision -9- of the stomach -1-, has an upper curvature 29 {between the points Cst and Csb in figure 5} of the upper face 28, less pronounced than the lower curvature 30 {between the points Cit and Cib in figure 5} from the bottom face. The radius of curvature of the upper curvature 20 (Cst-Csb) is greater than that of the lower curvature 30 (Cit-Cib).
    [00049] The height H of the inflated balloon 25 is measured in the median longitudinal plane of the tubular body 21 and the inflated balloon 25, from the edge of the tubular body 21 located just upstream of the distal tip 24 and downstream of the balloon 25 (side stomach) to the top of the inflated balloon 25 (see figure 5).
    [00050] For example: Db = 40 mm; H=50mm; Dm = 50 mm and Dt = 10 mm.
    [00051] In other words, the dimensions and elasticity of the balloon 25 are such that the volume of the inflated balloon can, for example, be 75 cm3 +/- 25 cm3.
    [00052] According to another feature of the invention, the upper face 28 of the inflated balloon 25 intended to be disposed in front of the angular incision -9- (cf. figures 1 and 9) of the stomach -1- forms a tubular body 21 of the probe 20, an angle α equal, in this example, to approximately 90 o (cf. figure 5).
    [00053] As it stands out from this figure 5, the angle α is defined by the straight line that passes through the two points Csb and Cst of the inflated balloon (25) and by the tubular body 21 - generatrix G.
    [00054] This balloon 25 is constituted by a membrane, for example, in silicone elastomer, preferably made of several annular segments 31 superimposed, solidary to each other, and of dimensions chosen to give the inflated balloon 25, the shape described above and shown in figures 4, 5, 6 and 9.
    [00055] The base of the balloon 25 has a protrusion 32 welded and/or glued on the tube 21 of the probe 20. As shown in figures 7 and 8, the base 32 of the balloon 25 surrounds the tube 21 in a large part of its circumference .
    [00056] On the other hand, as shown in figure 7, the distance d between, on the one hand, the distal end of the tube 21 corresponding to the distal end 23 of the tip 24 and, on the other hand, the cock of the inflated balloon base 25 the closest to this distal end 23 is, for example, in the 10 mm species. It is advantageous for d to be as small as possible in order to adapt as much as possible to the anatomical shape of the pyloric cave -4-.
    [00057] This rounded distal tip 24 is perforated in its center having a hole 33 that communicates the opening of tube 21 with the outside, in the same way as the oblong side holes 34 present in the distal part of tube 21, upstream of the balloon 25. These orifices 33, 34 allow the withdrawal and injection of gaseous fluids or liquids from the stomach.
    [00058] According to the invention, the calibration of the stomach part to be preserved is not only ensured by the external diameter De of the tubular body 21, but also by the volume of the inflated balloon 25. Several balloon inflation volumes 25 give the surgeon so many calibers.
    [00059] The probe 20 is also provided with a positioning mark 36. This marking 36 is formed by a line contracted along the entire length of the wall of tube 21 from the proximal end 22 to the distal end 23. It is perpendicular to the axis 27 of the inflated balloon 25 in the median longitudinal plane common to this inflated balloon 25 and the tube 21. It is placed on the right side of the stomach, ie the side on which balloon 25 can be inflated in the pyloric cave -4-. It notably indicates to the surgeon the external face of the tube wall 21 on which the balloon 25 is mounted (right anatomical side in figure 9). This face is then supported on the small curvature. The placement of the inflated balloon 25 in the pyloric cave -4- is thus greatly facilitated by this contrast marking 36.
    [00060] The probe 20, according to the invention, is also equipped with a conduit 37 that connects the balloon 25 to the proximal end 22 of the tubular body 21 and allowing the inflation / deflation of this balloon 25 from that proximal end, through an inflation means which can be, for example, a cuff 38 provided at the proximal end 37 connected to the outside by means of a valve 39, and/or a fluid injector (for example air) such as a syringe that can be introduced in the end of the conduit 37 upstream of the valve 39. The inflation conduit 37 of the balloon 25 runs in the thickness of the wall of the tubular body 21 on the same side as the positioning marking 36 or on the other side. The distal end of the inflation conduit 37 opens into the distal balloon 25.
    [00061] Figure 9 shows the stable positioning of the distal part of the tubular body 21 against the small curvature -6- and the locking of the inflated cuff 25 and the distal part of the tubular body 21, shown in Figure 9, allows the surgeon to have anatomical markings and a guide to proceed with the resection - stapling the left part of the stomach -1- to be eliminated (mixed line in figure 9), according to the calibration also defined by the inflated cuff and the distal part of tube 21 in support against the smallest curvature -6-.
    [00062] Optional deflection means capable of allowing the bending of the distal part of the solder, for example, 88 mm to the distal end part, at an angle, for example, of approximately 90°, comprise a cable or dash system inserted in a channel coaxial to tube 21 on the right side of the stomach, where balloon 25 is located. Above the cable attachment point, of the distal tip 24 of the probe 20, a notch of an angle of approximately 45° is made in the body 21 of the probe 20, so as to create a fold line. A membrane is glued over the notch to ensure the tightness of the probe body. Once the probe is in place on the patient's stomach -1-, the cable can be stretched by the action of the surgeon's hand at the level of the proximal part of the probe, and this action must therefore trigger the bending or deflection of the distal part. end of the tubular body 21 which forms an angle, for example of 90°, with the upper part of this tubular body 21.
    [00063] The opening of the tubular body 21 can allow the introduction of display means such as a light source, for example, a flexible optical fiber.
    [00064] It is possible to provide a surface treatment of the external face of the tubular body 21 and balloon 25, in order to reduce the friction coefficient and thus facilitate the sliding of the probe 20 against the internal tissues of the patient's digestive tract.
    [00065] As shown in figure 9, this orogastric tube 20 can be introduced, prior to the longitudinal gastrectomy, in the patient's mouth until its distal end 13 reaches the stomach -1-. The longitudinal gastrectomy sequence then consists of emptying the stomach, in case of air distension induced by intubation maneuvers, during anesthesia, then inflating the balloon 25 and lodging it in the pyloric cave-4-, acting in such a way that: - the end 26 of the inflated balloon 25, for example, in a stop against the pylorus -5- (symbolized in dotted lines in Figure 9), than the distal end 23 of the tubular body 21, for example, in a stop over the pyloric cave -4-, for example approximately 5 to 10 cm from the pylorus -5-; and - the tubular body part 21 of the probe 20 arranged above the inflated balloon 25, is supported against the wall of the small curvature of the stomach 6.
    [00066] The surgeon can then proceed, with the aid of an appropriate instrument, to a resection-stapling of the left part of the stomach (mixed line in figure 9) being guided by the inflated balloon 25 and the distal part of the tube 21, which it indicates the beginning of the resection / closure line and this resection - closure line itself, also providing, in addition to these anatomical markings, a support for your resection-closure instrument. The inflated balloon 25 and the distal part of the tube 21 also calibrate the gastric glove and the pyloric cave 4 to be preserved.
    [00067] After resection of the left part and stapling, it is possible to inject colored liquid into the patient's stomach 1 to check the tightness of the closing line.
    [00068] The light source that allows viewing the interior of the stomach can be introduced into the tubular body 21 at any time during the intervention.
    [00069] The surgeon thus has a multifunction orogastric tube, allowing him to quickly perform a quality longitudinal gastrectomy and with complete safety for the patient.
    权利要求:
    Claims (20)
    [0001]
    1. Orogastric probe (20) comprising a body (21) of which a distal part is intended, within the scope of the bariatric surgery technique of longitudinal gastrectomy, to guide the surgeon to the resection of a part of the stomach and to define the line of closure after resection, in which the body (21) extends between a distal end (23) over the distal part and a proximal end (22), and has an external face, the distal part carrying a balloon (25) presenting a deflated state and an inflated state, characterized by the fact that the balloon (25) extends transversely from a base on the outer face of the body (21) to an end (26), at a distance d from the distal end (23) of the body (21), in which, in the inflated state, the balloon has a complementary shape to that of the pyloric cave (4), the inflated balloon (25) having an asymmetric and deformed frustoconical shape with a terminal diameter Dt at the end (26) of the balloon (25), a diameter Db at the base of the balloon and a diameter Dm of a median part of the balloon between the base and the end of the balloon (25), so that: Dt<Db<Dm; the end (26) of the balloon being offset in relation to an axis of the base of the balloon (25), upwards, towards a portion of the body of the probe (20) disposed above the inflated balloon (25), such that an upper face of the inflated balloon (25) facing the proximal end (22) of the body intended to be disposed in front of the angular incision of the stomach has a less pronounced curvature than that of a lower face of the balloon (25) facing the distal end (23) of the body (21), so that the balloon can be housed in the pyloric cave (4), the end (26) of the inflated balloon (25) being configured to be in abutment against the pylorus (5) and the end distal portion of the probe body (20) being configured to be braced over the pyloric cave (4), while the portion of the body (21) of the probe (20) disposed above the inflated balloon (25) is configured to be braced against the wall of the small curvature (6) of the stomach (1).
    [0002]
    2. Probe (20) according to claim 1, characterized in that the inflated balloon (25) has dimensions in a straight cross section that determine the volume of the pyloric cave (4) preserved after resection, and in which the body (21) has dimensions in straight cross-section that determine the volume of the stomach (1) preserved after resection.
    [0003]
    3. Probe (20) according to any one of the preceding claims, characterized in that the upper face (28) of the inflated balloon (25) intended to be arranged in front of the angular incision (9) of the stomach (1) form with the body (21) of the probe (20) an angle α comprised between 70° and 110°.
    [0004]
    4. Probe (20) according to claim 1 or 2, characterized in that the angle α is between 80° and 100°.
    [0005]
    5. Probe (20) according to claim 3, characterized in that the angle α is 90°.
    [0006]
    6. Probe (20) according to any one of claims 1 to 5, characterized in that the distance d between the distal end (23) of the body (21) of the probe (20) and a point at the base of the balloon ( 25) inflated closer to said distal end (23), is less than or equal to 30 mm.
    [0007]
    7. Probe (20) according to claim 6, characterized in that the distance d is less than or equal to 20 mm.
    [0008]
    8. Probe (20) according to claim 6, characterized in that the distance d is comprised between 1 mm and 15 mm.
    [0009]
    9. Probe (20) according to any one of claims 1 to 8, characterized in that the body (21) is provided with a marking (36) that allows the surgeon to correctly position the balloon (25) in the patient's stomach , so that, once inflated, this balloon (25) can be housed in a stop in the pyloric cave (4).
    [0010]
    10. Probe (20) according to claim 9, characterized in that the marking (36) comprises a line coaxial to the body and disposed and disposed over all or part of the length of a wall of the body (21) of the same side than the balloon (25).
    [0011]
    Probe (20) according to any one of claims 1 to 10, characterized in that it comprises a duct that connects the balloon (25) to the proximal end of the body and an inflation means that allows to inflate/deflate said balloon (25) from this proximal end through the conduit.
    [0012]
    Probe (20) according to any one of claims 1 to 11, characterized in that it comprises: - a tubular silicone body with a length of between 600 mm and 1200 mm and an external diameter of between 8 mm and 25 mm, this the body also being provided, in its distal part, with a rounded distal tip and with lateral holes intended to put the interior of the stomach in communication with the exterior of the digestive tube through the opening of the tubular body; - an inflated balloon (25) with a diameter at the base Db of between 35 mm and 60 mm and a height H between 40 mm and 60 mm; - a positioning mark formed by a contrasting line over the entire length of the body wall, on the same side as the balloon (25), in the diametrical plane common to the body and the balloon (25).
    [0013]
    13. Probe (20) according to claim 12, characterized in that the length of the tubular body is comprised between 700 mm and 1100 mm.
    [0014]
    14. Probe (20) according to claim 12, characterized in that the length of the tubular body is comprised between 850 mm and 950 mm.
    [0015]
    15. Probe (20) according to claim 12, characterized in that the outer diameter De of the tubular body is comprised between 10 mm and 13.33 mm.
    [0016]
    16. Probe (20) according to claim 12, characterized in that the height H of the inflated balloon (25) is between 45 mm and 55 mm.
    [0017]
    17. Probe (20) according to claim 12, characterized in that the height H of the inflated balloon (25) is between 47 mm and 53 mm.
    [0018]
    Probe (20) according to claim 12, characterized in that it comprises means for deflecting the distal part of the probe (20).
    [0019]
    19. Probe (20) according to claim 12, characterized in that the height H of the inflated balloon (25) and the external diameter De of the tubular body are such that H + De = 50 mm to 100 mm.
    [0020]
    20. Probe (20) according to claim 19, characterized in that the height H of the inflated balloon (25) and the external diameter De of the tubular body are such that H + De = 60 mm to 80 mm.
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    同族专利:
    公开号 | 公开日
    US20130165774A1|2013-06-27|
    BR112012033006A2|2016-12-20|
    JP5855096B2|2016-02-09|
    MX339905B|2016-06-15|
    RU2571324C2|2015-12-20|
    CA2803871C|2018-11-06|
    RU2013102870A|2014-07-27|
    FR2961703A1|2011-12-30|
    US20190224030A1|2019-07-25|
    CO6680606A2|2013-05-31|
    SG186813A1|2013-02-28|
    US10898361B2|2021-01-26|
    FR2961703B1|2012-07-13|
    WO2011161148A1|2011-12-29|
    EP2585006B1|2015-08-26|
    EP2585006A1|2013-05-01|
    KR101906411B1|2018-10-10|
    JP2013529487A|2013-07-22|
    CL2012003660A1|2013-04-19|
    AU2011269023B2|2014-10-02|
    KR20130138172A|2013-12-18|
    AU2011269023A1|2013-01-31|
    IL223772A|2017-06-29|
    MX2013000144A|2013-03-05|
    CA2803871A1|2011-12-29|
    ES2554676T3|2015-12-22|
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    法律状态:
    2018-12-26| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|
    2019-09-03| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|
    2020-03-17| B06G| Technical and formal requirements: other requirements [chapter 6.7 patent gazette]|
    2020-08-04| B07A| Application suspended after technical examination (opinion) [chapter 7.1 patent gazette]|
    2021-02-02| B06A| Patent application procedure suspended [chapter 6.1 patent gazette]|
    2021-06-15| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|
    2021-08-10| B16A| Patent or certificate of addition of invention granted [chapter 16.1 patent gazette]|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 22/06/2011, OBSERVADAS AS CONDICOES LEGAIS. PATENTE CONCEDIDA CONFORME ADI 5.529/DF, QUE DETERMINA A ALTERACAO DO PRAZO DE CONCESSAO. |
    优先权:
    申请号 | 申请日 | 专利标题
    FR1054996|2010-06-23|
    FR1054996A|FR2961703B1|2010-06-23|2010-06-23|OROGASTRIC PROBE OF LONGITUDINAL GASTRECTOMY|
    PCT/EP2011/060428|WO2011161148A1|2010-06-23|2011-06-22|Orogastric catheter for longitudinal gastrectomy|
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