Surgery – Internal organ support or sling
Patent
1998-12-23
2000-09-26
Hindenburg, Max
Surgery
Internal organ support or sling
A61F 200
Patent
active
061236632
DESCRIPTION:
BRIEF SUMMARY
DESCRIPTION
The present invention relates to a surgical appliance for the treatment of pulmonary emphysema, and in particular to a surgical appliance which, once applied onto the lungs of an emphysematous, remarkably improves his breathing functionality without resorting to traumatic surgical operations, such as for instance the partial removal or the plication of the pulmonary parenchyma.
It is acknowledged that pulmonary emphysema has always been considered a disease that mainly, if not exclusively, relates to internal medicine and pneumology. The medical therapy of pulmonary emphysema, based upon breathing rehabilitation and use of specific medicines, is effective both as a therapeutic approach and in the preparation for a possible surgical operation. Surgery of pulmonary emphysema, preferably based upon bullectomy and pulmonary transplant, has had so far an absolutely secondary role in the therapy of this disease.
Recently Cooper has instead proposed, with great success, a surgical operation that revolutionizes the treatment of pulmonary emphysema thereby resuming a procedure developed by Brantigan in 1959 and forgotten for many years. This operation, known as lung volume reduction, consists of a reduction of the volume occupied by the emphysematous lung through surgically removing 20 to 25% of the total mass of parenchyma, in particular its functionally hypoactive peripheral areas. While the lung volume reduction seems to be illogical for the treatment of patients affected by breathing insufficiency, this kind of operation is based upon precise physiopathological fundamentals which justify the execution and the good clinical results. Indeed, the lung with a reduced volume exerts a higher elastic retraction force against the thoracic cage, thereby improving both the volumetric balance of the lung/thoracic cage system and the efficiency of the inspiratory muscles. Such an improvement is due to the fact that the emphysematous lung, less elastic than a healthy lung, tends to expand more than the usual, especially in the apical areas, causing the expansion of the thoracic cage, which is no longer subject to the elastic retraction force of the lung.
The surgical operation for the lung reduction is carried out with the assistance of linear suturing devices which automatically section the pulmonary tissue and suture it by means of metal clamps. However, the quality of such a suture, with respect to haemostasis and aerostasis, is frequently insufficient because of the fragility of the tissue altered by emphysema. Recent proposals recommend the interposition of stripes of bovine pericardium between the clamps and the pulmonary parenchyma in order to reduce the traumatic effect of the suture. The latter measure does not however eliminate the postoperatory complications such as hemorrhage and copious air losses from the sectioned and sutured pulmonary parenchyma, which often confine the patient to extensive hospitalization periods.
To reduce the frequency and the gravity of said complications it has been proposed, as an alternative to said pulmonary parenchyma partial removal technique, the plication-suture technique by means of linear suturing devices with bladeless clamps. However, such a technique cannot be performed at all times and presently there is no sufficient information confirming its effective validity.
Therefore, object of the present invention is to provide a surgical appliance for the treatment of pulmonary emphysema which reduces the volume of the emphysematous lungs without resorting to traumatic surgical operations, such as the partial removal or the plication of the pulmonary parenchyma. Said object is achieved by means of a surgical appliance whose features are disclosed in claim 1.
Thanks to the surgical appliance according to the present invention, it is possible to restore elasticity in the pulmonary parenchyma, thereby opposing the emphysematous hyperexpansion as well as helping the recovery of the physiological partial retraction state of the thoracic cage.
Moreover, the surgical operati
REFERENCES:
patent: 4633873 (1987-01-01), Dumican et al.
patent: 5011493 (1991-04-01), Belykh et al.
Hindenburg Max
Szmal Brian
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