JP2004089442A - Surgical anastomotic device - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a surgical anastomotic device capable of cutting the tissue credibly using a cutter and preventing the application of excess force on a staple. <P>SOLUTION: A staple cartridge 16 accommodating a plurality of staples 70 and a cylindrical cutter 72 is arranged on the front end side of an inserting part 14. The staple cartridge is further provided with a pusher 68 for pressing and displacing the staples 70 and the cylindrical cutter 72 from the end face of the front end side of the staple cartridge 16 to an anvil part 18 in accordance with the operation of an operation part. The cylindrical cutter 72 is provided with a cam groove 72a, and a cutter rotation drive member 74 fixed within the staple cartridge 16 is provided with a cam projection 74a for engaging with the cam groove 72a. When the pusher 68 presses the cylindrical cutter 72, the cylindrical cutter 72 moves toward the anvil part 18 while being rotated by the cutter rotation drive member 74. <P>COPYRIGHT: (C)2004,JPO

Description

[0001]
TECHNICAL FIELD OF THE INVENTION
The present invention relates to a surgical anastomosis device for performing an anastomosis of a hollow organ such as a colon or an esophagus, for performing simultaneous cutting and stapling of tissue.
[0002]
[Prior art]
2. Description of the Related Art Conventionally, as a surgical anastomosis device, for example, a device described in Japanese Patent Application Laid-Open No. 8-66406 is known. As a basic configuration of this type of surgical anastomosis instrument, an operation section provided with a handle, an insertion section extending from the operation section, and a staple and a cylindrical cutter provided at a distal end of the insertion section are housed. A staple cartridge unit; and an anvil unit detachably connected to the insertion unit and facing a tip end side surface of the staple cartridge unit. By operating the operation unit, the anvil unit can be moved toward and away from the staple cartridge unit. The anvil part is inserted into the cut end of one of the cut hollow organs, and the operating part, the insertion part and the staple cartridge part are inserted up to the cut end of the cut other hollow organ. After the anvil part is connected to the insertion part with the part and the staple cartridge part facing each other, the anvil part is moved in the axial direction so as to approach the staple cartridge part. By sandwiching the tissue in between, and further operating the operating section, a number of staples and the cylindrical cutter in the staple cartridge section are pressed against the anvil section, and thus the tissue is cut by the cylindrical cutter. Staples can be driven along the cutting line. Thereafter, by pulling out the entire insertion portion, staple cartridge portion and anvil portion from the hollow organ, suturing of the cut hollow organs is completed.
[0003]
[Problems to be solved by the invention]
In the above-described conventional configuration, the cylindrical cutter advances straight along with the staples toward the anvil portion, and therefore pushes the tissue vertically. However, there is a risk that uncut portions may be generated by push-cutting to cut elastic tissue such as visceral tissue, and in order to prevent this, it is necessary to set the pressing force of the cutter high. However, setting a high pressing force of the cutter means setting a high pressing force of the staple, and an excessive force acts on the staple, which may cause staple driving failure.
[0004]
The present invention has been made in view of the above problems, and an object of the present invention is to provide a surgical anastomosis apparatus which can surely cut tissue by a cutter and can prevent an excessive force from being applied to staples or the like. It is to be.
[0005]
[Means for Solving the Problems]
In order to achieve the above-described object, the present invention provides an operation section, an insertion section extending from the operation section, and a staple cartridge section provided on a distal end side of the insertion section and containing a large number of staples and a cylindrical cutter. A slide member disposed movably in the longitudinal direction of the insertion portion by operating the operation portion, and an anvil portion detachably connected to the slide member and opposed to a distal end side end surface of the staple cartridge portion. The staple cartridge unit further includes a pusher that presses and moves the staple and the cylindrical cutter stored in the staple cartridge unit from the distal end side of the staple cartridge unit to the anvil unit side by operating the operation unit. In surgical anastomosis,
When the cylindrical cutter is pressed by the pusher, there is provided a rotation driving means for moving the cylindrical cutter toward the anvil portion while rotating the cylindrical cutter.
[0006]
In the present invention, the cylindrical cutter moves to the anvil side while rotating, instead of moving straight, that is, the cylindrical cutter moves spirally. Therefore, when cutting the tissue sandwiched between the anvil portion and the staple cartridge portion, the tissue is cut not by push-off but by pull-off. Thereby, elastic tissue can be cut cleanly, and the cut surface can also be cleaned. Since a large pressing force is not required unlike simple push-off, staples can be properly driven without applying excessive force to staples or the like.
[0007]
The rotation driving means can be performed by any means, and a cam groove formed in one of the cylindrical cutter or a cutter rotation driving member fixed in the staple cartridge portion, and the cylindrical cutter or the cutter. And a cam projection provided on one of the other rotation driving members and fitted into the cam groove.
[0008]
Further, the cutting edge of the cylindrical cutter may be formed in a wave shape or a saw shape. With this, the wavy or saw-shaped protruding part of the cutting edge is pierced into the tissue, creating a trigger for cutting, and then the oblique part following the protruding part of the cutting edge, the tissue By cutting diagonally, an ideal operation as a blade can be performed.
[0009]
BEST MODE FOR CARRYING OUT THE INVENTION
Hereinafter, embodiments of the present invention will be described with reference to the drawings. The following embodiments do not limit the present invention. In the description, the operator side is referred to as a proximal side, and the side away from the operator is referred to as a distal side.
[0010]
FIG. 1 is an overall perspective view of a surgical anastomosis device according to the present invention. The surgical anastomosis apparatus 10 mainly includes an operation section 12, an insertion section 14 that is extended from the operation section 12 so as to be slightly curved, a staple cartridge section 16 provided at a distal end of the insertion section 14, and an insertion section. The staple cartridge 16 has an anvil portion 18 which is detachably connected to a slide plate (slide member) 44 extending in the inside 14 and which faces the distal end side end surface of the staple cartridge portion 16.
[0011]
As shown in FIG. 1, the operation unit 12 includes a main body 22 serving as an operator's grip, a rotation knob 24 rotatably attached to the main body 22 at a base end side of the main body 22, and a main body 22. And a lever 26 pivotally attached to the lever. Although a detailed structure inside the operation unit 12 is not shown, the rotation knob 24 is screwed with a slide shaft arranged inside the operation unit 12 and prevented from rotating. By rotating the rotation knob 24, the slide shaft can be moved to the proximal side or the distal side in the axial direction according to the rotation direction. Further, by pressing the lever 26 in a direction approaching the main body 22, the staple 70 can be driven in and cut by the cylindrical cutter 72 as described later.
[0012]
As shown in FIGS. 2 to 6, the insertion portion 14 is slightly curved, and has a base end connected to the main body 22 and a pipe 42 (comprising pipe members 42 </ b> A and 42 </ b> B) and a pipe 42. A slide plate 44 connected to a slide shaft screwed to the rotary knob 24, a drive pipe 46 (see FIG. 7) disposed around the slide plate 44, and an outer side of the drive pipe 46. And reinforcing plates 48, 48 to be provided. The drive pipe 46 is connected to the lever 26 via a slider 28 (see FIG. 7). When the lever 26 is pulled, the drive pipe 46 moves through the slider 28 to the tip of the pipe 42 in the axial direction. It has become.
[0013]
As shown in FIGS. 2 to 6 and 9, the staple cartridge section 16 includes a cylindrical holder 62, a substantially conical intermediate holder screwed to the holder 62 and connecting the holder 62 and the pipe 42. 64. A number of staple chambers 62a for accommodating the staples 70 are formed on a side peripheral portion of the holder 62. The staple chambers 62a are arranged concentrically in two rows, as can be seen from FIG. 3, and each staple chamber 62a is open from the front end side of the holder 62, and the base end side is the internal space of the holder 62. (See FIG. 9 and the like).
[0014]
A pusher 68 connected to a distal end 46a of the drive pipe 46 via a joint 66 is provided in the internal space of the holder 62 and the intermediate holder 64 (see FIG. 7). As shown in FIG. 8, the pusher 68 has a concentric inner diameter portion 68a and an outer diameter portion 68b at the distal end portion, and the outer diameter portion 68b is further arranged concentrically in two rows. And a number of pusher pieces 68c corresponding to the staple chamber 62a. The pusher piece 68c of the pusher 68 is inserted into the staple chamber 62a from the base end side of the staple chamber 62a, holds the staples 70 housed therein, and plays a role of pressing the staples 70 during operation. Things. Further, a protrusion 68d is formed on the inner diameter portion 68a of the pusher 68. The cylindrical cutter 72 disposed inside the holder 62 is engaged with the projection 68d to prevent the cylindrical cutter 72 from dropping and to press the cylindrical cutter 72.
[0015]
A cutter rotation driving member 74 is arranged between the cylindrical cutter 72 and the inner peripheral surface of the holder 62. The cutter rotation driving member 74 is fitted in a groove formed on the inner peripheral surface of the holder 62, and the base of the cutter rotation driving member 74 is received by a ring receiver 76 provided in the intermediate holder 64. Therefore, it is fixed in the holder 62 and the intermediate holder 64.
[0016]
As shown in FIG. 14A, the cylindrical cutter 72 has a wave-shaped or saw-shaped blade at the tip, and a cam groove 72a extending obliquely in the axial direction is formed on the peripheral surface. ing. A cam projection 74 a is formed on the inner peripheral surface of the cutter rotation driving member 74 so as to fit into the cam groove 72 a of the cylindrical cutter 72. The cam groove 72a and the cam projection 74a constitute the rotation driving means of the present invention. Conversely to this example, it is also possible to provide a cam projection on the cylindrical cutter 72 and form a cam groove on the cutter rotation drive member 74 into which the cam projection fits, thereby constituting a rotation drive means. At the base end of the cylindrical cutter 72, a bent portion 72b bent in the inner diameter direction is formed. Inside the bent portion 72b, the bent portion 72b moves integrally with the cylindrical cutter 72, and A cutter table 78 rotatable around 68a is provided.
[0017]
As shown in FIG. 14B, the cutting edge shape of the cylindrical cutter 72 may be a wave shape or a saw shape having a large period. Preferably, as shown in FIGS. 14A and 14B, the protruding end is pointed. However, as shown in FIG. 14 (c), the cutting edge may have no irregularities at all. This is because, even in the case of FIG. 14C, a large number of irregularities are formed in the micro.
[0018]
A guide 50 is connected to the distal end of the slide plate 44 extending inside the insertion portion 14, and an anvil receiver 52 is further connected to the guide 50. The guide 50 and the anvil receiver 52 are movable in the longitudinal direction of the insertion portion 14 together with the slide plate 44 by rotating the rotary knob 24 of the operation portion 12, and move in the longitudinal direction. When this is done, the anvil receiver 52 can protrude more distally than the holder 62 of the staple cartridge unit 16.
[0019]
Next, as shown in FIG. 13, the anvil part 18 has an anvil shaft 82 detachably connected to the anvil receiver 52 and an anvil head 84 disposed on the distal end side of the anvil shaft 82. I have. The anvil shaft 82 is connected to the anvil receiver 52 with its circumferential position regulated. The proximal end surface of the anvil head 84 is a staple forming surface 84a. The staple forming surface 84a has a staple chamber 62a of the staple cartridge unit 16 in a state where the anvil portion 18 is connected to the insertion portion 14. Are formed in a large number of staple forming grooves 84b facing each other. Further, a concave portion 84c for receiving the cylindrical cutter 72 is formed on the inner diameter side of the staple forming surface 84a.
[0020]
The surgical anastomosis instrument 10 configured as described above operates as follows. First, the hollow organ is cut, and the cut end of one of the cut hollow organs is purse-sewn. Then, the anvil head 84 of the anvil portion 18 is inserted from the cut end. At this time, the anvil shaft 82 is not inserted into the hollow organ, and at least a part thereof is projected outside from the cut end.
[0021]
After the cut site is cut, the other cut hollow organ is also subjected to purse string suture, and the staple cartridge unit 16 and the insertion unit 14 are inserted from another insertion opening with the staple cartridge unit 16 at the head. At this time, the anvil receiver 52 protrudes from the staple cartridge section 16, and the anvil receiver 52 is protruded from the cut end of the other hollow organ.
[0022]
Next, the anvil shaft 82 protruding from the cut end of the hollow organ and the anvil receiver 52 are connected (FIG. 9), and the rotation knob 24 of the operation unit 12 is rotated to move the slide plate 44 toward the base end in the longitudinal direction. Move. In this manner, the anvil part 18 is brought closer to the staple cartridge part 16, the staple forming surface 84 a of the anvil head 84 is opposed to the distal end surface of the holder 62 of the staple cartridge part 16, and the tissue is sandwiched between them (FIG. 10). ). When the lever 26 of the operation unit 12 is pulled so as to approach the main body 22, the drive pipe 46 moves to the distal end side, and pushes the pusher 68 to the distal end side via the joint 66 (FIG. 11). Thus, the pusher piece 68c of the pusher 68 presses the staple 70 toward the distal end, and the inner diameter portion 68a presses the cylindrical cutter 72 toward the distal end. At this time, since the cam projection 74a that fits into the cam groove 72a of the cylindrical cutter 72 is fixed, the cylindrical cutter 72 advances to the distal end side while rotating helically. For this reason, when the protruding end of the wave-shaped or saw-shaped blade tip pierces the tissue, the cylindrical cutter 72 thereafter moves obliquely with respect to the tissue. As a result, the tissue is cut rather than pushed, so that the elastic tissue can be cut cleanly even with a small pressing force, and the cut surface can be cleaned. Therefore, the cutting feeling detected by the surgeon via the lever 26 can be improved. In particular, since the cutting edge of the cylindrical cutter 72 is corrugated or saw-shaped, the corrugated or saw-shaped protruding portion of the cutting edge is pierced into the tissue to create a trigger for cutting. In addition, the oblique portion following the protruding portion in the cutting edge cuts the tissue obliquely, so that an ideal operation as a blade can be performed. There is no need to apply excessive force to the staple 70, and suture failure can be prevented.
[0023]
Thus, when the driving of the staple 70 and the cutting of the tissue are completed (FIG. 12), the lever 26 is returned to the original position, the cylindrical cutter 72 is retracted to the original position, and then the rotation knob 24 is rotated. After the anvil part 18 is separated from the staple cartridge part 16, the surgical anastomosis device 10 is pulled from the side having the operation part 12, the anvil part 18 is passed through the opening formed by the cylindrical cutter 72, the insertion part 14, the staple The anastomosis is completed by pulling out the cartridge section 16 and the anvil section 18 from the hollow organ. At this time, since the opening is reliably formed by the cylindrical cutter 72, the anvil portion 18 can be smoothly passed through the opening. In addition, even after the operation, the contents can smoothly pass through the anastomotic hollow organ.
[0024]
【The invention's effect】
As described above, according to the present invention, since the cylindrical cutter moves toward the anvil portion while rotating, when cutting the tissue sandwiched between the anvil portion and the staple cartridge portion, it is not push-cutting. Then, the tissue will be cut by cutting off. Thereby, elastic tissue can be cut cleanly, and the cut surface can also be cleaned. Unlike a simple push-off, a large pressing force is not required, so that staples can be properly driven without applying excessive force to staples and the like, and suturing failure can be prevented. Thus, since the opening is reliably formed by the cylindrical cutter, it is possible to smoothly pass the anvil portion through the opening after the staple driving, and also to smoothly pass the contents through the hollow organ after the operation. it can.
[Brief description of the drawings]
FIG. 1 is an overall perspective view of a surgical anastomosis device of the present invention.
FIG. 2 is an exploded perspective view of an insertion portion, a staple cartridge portion, and an anvil portion of the surgical anastomosis device of the present invention, but a base end portion of the insertion portion is partially omitted.
FIG. 3 is a partially cutaway perspective view of an insertion portion and a staple cartridge portion, showing a state where a staple and a cylindrical cutter are not pressed.
FIG. 4 is a partially cutaway perspective view of an insertion portion and a staple cartridge portion, showing a state where a staple and a cylindrical cutter are pressed.
FIG. 5 is a partial sectional view corresponding to FIG.
FIG. 6 is a partial sectional view corresponding to FIG.
FIG. 7 is an exploded perspective view illustrating a connection relationship between a drive pipe, a joint, and a pusher.
FIG. 8 is a perspective view of a pusher.
FIG. 9 is a longitudinal sectional view of a base end of the insertion section, a staple cartridge section, and an anvil section, showing a state where the anvil section is connected to the insertion section.
FIG. 10 is a longitudinal sectional view of a base end portion of an insertion portion, a staple cartridge portion, and an anvil portion, showing a state in which the anvil portion is close to the staple cartridge portion.
FIG. 11 is a longitudinal sectional view of a base end portion of an insertion portion, a staple cartridge portion, and an anvil portion, showing a state where a pusher presses a staple and a cylindrical cutter.
FIG. 12 is a longitudinal sectional view of a base end portion of an insertion portion, a staple cartridge portion and an anvil portion, showing a state where a pusher completely presses a staple and a cylindrical cutter.
FIG. 13 is a perspective view of an anvil part.
14A to 14C are various examples of a cylindrical cutter.
[Explanation of symbols]
Reference Signs List 10 surgical anastomosis device 12 operation unit 14 insertion unit 16 staple cartridge unit 18 anvil unit 44 slide plate (slide member)
68 pusher 70 staple 72 cylindrical cutter 72a cam groove 74 cutter rotation drive member 74a cam protrusion

Claims (3)

An operation section, an insertion section extending from the operation section, a staple cartridge section provided on the distal end side of the insertion section to store a large number of staples and a cylindrical cutter, and the inside of the insertion section is operated in the longitudinal direction by operating the operation section. A movably disposed slide member, and an anvil portion detachably connected to the slide member and opposed to a tip end side end surface of the staple cartridge portion. In a surgical anastomosis device, which has a pusher for pressing and moving the staple and the cylindrical cutter stored in the staple cartridge portion from the distal end surface of the staple cartridge portion to the anvil portion side,
A surgical anastomosis apparatus comprising: a rotation driving means for moving a cylindrical cutter toward an anvil portion while rotating the cylindrical cutter when the cylindrical cutter is pressed by the pusher. The rotation drive means is provided on a cam groove formed on one of the cylindrical cutter or the cutter rotation drive member fixed in the staple cartridge unit, and on the other of the cylindrical cutter or the cutter rotation drive member. 2. The surgical anastomotic device according to claim 1, further comprising a cam projection fitted into said cam groove. 3. The surgical anastomosis device according to claim 1, wherein the cutting edge of the cylindrical cutter has a wave shape or a saw shape.

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