WO2005074817A1

WO2005074817A1 - Instruments for sutureless surgical technique

Info

Publication number: WO2005074817A1
Application number: PCT/AU2005/000163
Authority: WO
Inventors: Rodney Trickett; Peter Maitz; Steven Miller
Original assignee: Avastra Ltd
Priority date: 2004-02-09
Filing date: 2005-02-09
Publication date: 2005-08-18

Abstract

Instruments for joining living tubular tissues and organs using suture-less techniques. The first instrument is a pair of forceps (1) with opposing first and second arms (2a, 2b) joined at one end (3). The arms have head portions (4a, 4b) that cooperate and receive a hollow sleeve of bio-molecular solder (11). The second instrument is a pair of eversion forceps with arms joined at one end and having head portions that form a nose and may be inserted into a tubular organ to aid in eversion of the tubular organ. The third instrument is forceps that weld a sleeve of bio-molecular solder to a living tissue. The head portions receive the sleeve and the instrument is coupled to a source of energy, wherein the energy is directed to the head of the instrument to effect welding of the solder material to the living tissue.

Description

TITLE: INSTRUMENTS FOR SUTURELESS SURGICAL TECHNIQUE

FIELD OF THE INVENTION The present invention relates to instruments for use in joining living tubular tissues and organs. More particularly, the present invention relates to instruments for use in sutureless surgical techniques for joining living tubular tissues and organs.

BACKGROUND OF THE INVENTION Any discussion of the prior art throughout the specification should in no way be considered as an admission that such prior art is widely known or forms part of common general knowledge in the field. In repairing living tissues, sutures or clips are routinely used to close defects, join planes or tissues or to join bodily tubes together. This involves the placing of materials in the body which cause some damage to the tissues involved, but hold those tissues in apposition while the body's own healing processes effect a more permanent join. The damage that various joining materials cause varies but even careful placement of microsutures in the smallest of bodily tubes during an anastomosis produces a fibrous tissue reaction around each of the suture materials left in situ. Joins, however made, take time, and those joins made by placing individual sutures in tubular joins are the most time consuming. Sewing in a ring of sutures to effect such a join inside the body may demand a large incision to obtain the access required to effect enough surgical freedom to manipulate the equipment and instruments required. Mircosuturing requires considerable skill. For tubes such as arteries to function in transporting blood at high pressure, they need to be strong. They are actually active in transporting a pressure wave of blood by expanding and relaxing (systole and diastole) as the bolus of blood passes. Joining such active tubes requires such physiological activity as promoting blood flow to be considered and the design of methods of anastomosis that will allow the activity to continue after the join. Injuries to an artery are potentially very serious for an animal or human, as blood flowing through the artery is at high pressure and blood loss can be rapid. If the intima layer is damaged, then the middle, structural layer, the media, is exposed to blood. This triggers an important repair mechanism which acts to settle the wound and prevent further bleeding by the formation of blood clots on the wound, caused by blood coming into contact with the exposed collagen of the media. Although micro suturing is the standard clinical repair technique for severed artery, it has several disadvantages. A high skill level is required to make between six and 12 separate sutures to repair the artery. The sutures remain in the body acting as a site for fibrous tissue to form due to foreign body reaction, and this fibrous tissue is a point of weakness in the artery even after it is deemed to have healed. Although suturing does not produce a fluid tight seal, surgeons use it usually relied on blood clotting triggered by the mechanism described above to seal the vessel soon after the repair is complete. In recent times a number of laser assisted welding techniques have been explored in order to find a more convenient technique which does not lead to so much scarring. International Patent Application number PCT/AU99/00495 titled Method of Tissue Repair II discloses a novel and advantageous method of joining living tissue by means of a laser soldering technique, as well as the solder for use in such a technique. The instruments of the present invention have been developed primarily for use in such a technique. More particularly, the instruments of the present invention have been designed to aid the manipulation of the solder material and facilitate the bonding between the solder material and the tissue being joined. The disclosures contained in this published patent specification are incorporated herein by way of cross-reference. It is an object of the present invention to provide one or more instruments which aid sutureless surgical techniques for joining living tubular tissues and organs.

SUMMARY OF THE INVENTION To this end, a first aspect of the present invention provides a pair of forceps adapted to hold a hollow sleeve of biomolecular solder material, said forceps comprising opposing first and second arms joined at one end, said first arm including a head portion at a second free end, said second arm including a head portion at a second free end, wherein said head portions are adapted to cooperatively receive and hold said hollow sleeve of biomolecular solder. Preferably the arms of the forceps are biased such that a force is required to be applied to the arms by the user in order to grip the sleeve within the head of the forceps. Preferably, the forceps are adapted to be hand held by a surgeon. Preferably, the head section of said first arm is adapted to contact the sleeve of biomolecular solder at at least two points on its outer surface. More preferably, the head section of said first arm includes a substantially U-shaped or N-shaped recess for receiving the sleeve of biomolecular solder. Preferably, the head section of the includes a pair of substantially planar surfaces angled with respect to one another such as to form a substantially N-shaped recess for receiving the sleeve of biomolecular solder. Preferably, the head section of said second arm includes a planar surface for making at least point contact with an outer surface of the sleeve. The head section of the second arm acts to hold and retain the sleeve within the substantially U-shaped or N-shaped recess of the head section of the first arm. Preferably, the arms are coplanar and extend along a longitudinal axis. Preferably the axis of the head of the forceps is angled with respect to the longitudinal axis of the arms. More preferably the angle between the longitudinal axis of the arms and the axis of the head is of the order of 120°. A second aspect of the present invention provides a pair of eversion forceps, said forceps comprising a pair of arms mutually joined at one end, said first arm including a head portion at a second free end, said second arm including a head portion at a second free end, wherein said head portions of said first and second arms define a nose adapted for insertion into a tubular organ to aid in the eversion of said tubular organ. Preferably, the head section of each arm combine to form a conical nose adapted for insertion into a tubular organ. More preferably the nose has a truncated conical shape. Preferably, the forceps are configured such that the application of a squeezing force to the arms so as to move the arms towards one another causes the head portions of the arms to move away from one another and the nose section to open. Preferably, the first arm includes a neck which extends between the body of the arm and the head portion and the second arm includes an aperture through which the neck of the first arm extends. Preferably, the arms of the forceps are configured and biased such that a force is required to be applied to the arms by the user in order to open the nose of the forceps. A third aspect of the present invention provides a surgical instrument for welding a sleeve of biomolecular solder material to living tissue, said instrument comprising first and second arms joined at one end, said first arm including a first jaw at a free end, said second arm including a second jaw at a free end, wherein said first and second jaws are co-operatively define a head adapted to receive said sleeve of biomolecular solder, said instrument operatively coupled to a source of energy wherein energy is directed to the head of the instrument to effect welding of said solder material and said living tissue. Preferably, the energy source is adapted to provide a predetermined amount of energy to the weld site. Preferably, the energy source may only be activated upon closure of the head of the instrument. Preferably, said first and second jaws each include a semi-circular recess for receiving a portion of said sleeve of solder. Preferably, the arms are biased such that a force is required to be applied to the arms by the user in order to close the head of the instrument. Preferably, the instrument is adapted to be hand held by a user. Preferably, laser energy is conveyed to the head of the instrument by an array of optical fibres. Preferably, one section of the head includes a reflector for directing the laser energy onto the surface of the tissue to be denatured. Preferably, the arm includes a longitudinally extending cavity within which the optical fibres are housed. Preferably, the arms are coplanar and extend along a longitudinal axis. Preferably, the axis of the head is angled with respect to the longitudinal axis of the arms. Preferably, the angle between the longitudinal axis of the arms and the axis of the head is of the order of 120°. Unless the context clearly requires otherwise, throughout the description and the claims, the words 'comprise', 'comprising', and the like are to be construed in an inclusive sense as opposed to an exclusive or exhaustive sense; that is to say, in the sense of "including, but not limited to".

BRIEF DESCRIPTION OF THE DRAWINGS A preferred embodiment of the invention will now be described, by way of example only, with reference to the accompanying drawings in which: Figs, la to lj illustrate a preferred embodiment of the surgical instrument according to the first aspect of the present invention; Figs. 2a to 2c illustrate the instrument being used to position and hold a solder tube in position during the j oining of a blood vessel; Figs. 3a to 3j illustrate a preferred embodiment of the surgical instrument according to the second aspect of the present invention; Figs. 4a to 4m illustrate a preferred embodiment of the surgical instrument according to the third aspect of the present invention; Figs. 5a to 5n illustrate the sequence of steps in joining two ends of a blood vessel by means of a protein solder tube utilizing the instruments according to the first, second and third aspects of the present invention; and Figs. 6a to 61 illustrate the sequence of steps in joining two ends of a blood vessel by means of a protein solder tube utilizing the instruments according to the first and second aspects of the present invention.

PREFERRED EMBODIMENT OF THE INVENTION Figs, la to lj illustrate a preferred embodiment of the surgical instrument 1 according to the first aspect of the present invention. The instrument 1 takes the form of a pair of hand held forceps adapted for holding a solder tube in situ during an operation. The instrument 1 comprises a pair of arms 2a, 2b joined together at a first end 3. The first and second arms 2a, 2b include respective head portions 4a, 4b at their free ends, the head portions being adapted to cooperatively receive and hold a hollow sleeve of biomolecular solder. The arms 2a, 2b of the forceps are biased such that in use a squeezing force is required to be applied to the arms by the user in order to grip and retain the sleeve within the head of the forceps. The head section 4a of the first arm is adapted to contact the cylindrical sleeve of biomolecular solder at at least two points on its outer surface. Preferably, the head section of the first arm includes a substantially U-shaped or N-shaped recess 5 for receiving the sleeve of biomolecular solder, as best illustrated in Figs. Id and lj. More particularly, the head section of the first arm includes a pair of substantially planar surfaces 6, 7 angled with respect to one another such as to form a substantially N-shaped recess for receiving the sleeve of biomolecular solder. The head section of said second arm includes a planar surface 8 for making at least point contact with an outer surface of the sleeve. The head section of the second arm acts to hold and retain the sleeve within the recess of the head section of the first arm. Referring to Fig. If, the arms are substantially coplanar and extend along a common longitudinal axis 9. The head sections of the first and second arms define an axis 10 which is angled with respect to the longitudinal axis of the arms. Preferably the angle between the longitudinal axis of the arms and the axis of the head is of the order of 120°. The instrument may be made from any suitable material, such as stainless steel. Figs. 2a to 2c illustrate the holding instrument in the use. The instrument 1 is held in the hand of the user. A cylindrical solder tube 11 is located between the two opposing head formations 4a, 4b and the arms 2a, 2b gently squeezed towards one another to grip the tube and manipulate it into position over the end of the blood vessel 12. Advantageously, the forceps according to the first aspect of the present invention enable a surgeon to hold a solder tube firmly over a greater surface area than is possible with a standard forceps. In a preferred embodiment, the forceps contact the external surface of the solder tube at at least three points on its external surface. The U or N-shaped recess formation in the head of the forceps assists in locating and retaining the solder tube and enables the forceps to hold and manipulate a range of tube diameters. Figs. 3a to 3j illustrate a preferred embodiment of a surgical instrument 20 according to the second aspect of the present invention. The instrument 20 takes the form of a pair of hand held forceps comprising a pair of arms 21a, 21b joined together at a one end 22. The first and second arms 21a, 21b include respective head portions 23 a, 23b at their free ends; the head portions being adapted to cooperatively define a nose 24 for insertion into a tubular vessel, such as a blood vessel. The head section of each arm combines to form a conical nose 24, and preferably the nose has a truncated conical shape to facilitate insertion into a tubular vessel. As best illustrated in Figs. 3i and 3j, the forcep is configured such that the application of a squeezing force to the arms to move the arms towards one another causes the head portions of the arms to move away from one another and the nose 24 to open. The first arm 21a includes a neck 25 a which extends between the body of the arm and the head portion 23a and the second arm includes an aperture 25b through which the neck of the first arm extends. As illustrated in Fig. 3f, the arms are substantially coplanar and extend along the common longitudinal axis 26. The head sections of the first and second arms define an axis 27 which is angled with respect to the longitudinal axis 26 of the arms. Preferably the angle between the longitudinal axis of the arms and the axis of the head is of the order of 120°. The instrument may be made of any suitable material, such as stainless steel. Advantageously, the forceps according to the second aspect of the present invention enable a surgeon to gently open a tubular vessel, such as a blood vessel, and fold it back over a solder tube. In comparison with conventional forceps, the forceps contact the tubular vessel over a greater surface area so as to minimise damage when manipulating the tissue. Additionally, the conical design of the nose of the forceps enables the forceps to be used for a range of vessel sizes. Figs. 4a to 41 illustrate a preferred embodiment of the surgical instrument 30 according to the third aspect of the present invention. The instrument 30 has been developed to effect the circumferential welding of a tube of biomolecular solder to a tubular vessel of living tissue. The instrument 30 comprises first and second arms 31a, 3 lb joined together at a first end 32. The first and second arms include respective head portions 33 a, 33b at their free ends, wherein the first and second head portions each include a jaw. The jaws 34a, 34b cooperatively define a head adapted to receive a hollow sleeve of biomolecular solder material. Preferably the arms 31a, 31b are biased such that in use a squeezing force is required to be applied to the arms by the user in order to close the head of the instrument. Each jaw 34a, 34b includes a semicircular recess 35a, 35b for receiving a portion of the sleeve of solder, and the in the preferred embodiment depicted when the head is closed a circular recess is defined by the respective jaws. Thus, in use, when the head of the instrument is closed around the sleeve of solder material, the circumference of the solder tube is substantially encapsulated within the jaws of the instrument. A source of energy is operatively coupled to the instrument for providing energy to the weld site. In one possible embodiment laser energy is utilized, although it should be noted that other energy sources, such as for example ultrasonic, electrothermal, electromagnetic or electrosurgical may be utilized. As a safety consideration, the instrument may be configured such that the energy source can only be activated upon closure of the head of the instrument. For example, the instrument may be provided with a switch which forms part of the circuit for the energy source. The switch is closed when the arms of the forceps are brought together, thereby enabling the energy source to be activated by the surgeon. In one preferred embodiment, activation of the energy source to provide energy to the weld site is controlled by the surgeon. As an example, activation of the energy source may be controlled by means of a foot operated pedal controlled by the surgeon. In a further development, the energy source may be configured so as to provide a standardised or predetermined "dose" of energy to the weld site, thereby ensuring consistent and accurate bonding of the solder and the tissue. In a yet further development, an audio or visual signal may be utilized to indicate to the surgeon when the weld is completed. For example, the instrument or energy source may be provided with a light or beeper to indicate when a predetermined amount of energy has been applied to the weld site. In this way, the degree of guesswork that is required to achieve consistent results is reduced. In the embodiment depicted laser energy is provided from a laser source (see Fig. 4a) and is conveyed to the head of the instrument by means of an array of optical fibres. Preferably the fibres are housed within either or both arms of the instrument. In the preferred embodiment depicted, the optical fibres are directed onto a reflector which acts to direct and focus the laser energy onto the surface of the solder material. In the preferred embodiment the arms 31a, 3 lb are of identical design and mirror one another. The arms 31a, 31b of the instrument are substantially coplanar and extend along a common longitudinal axis 36. The jaws of the first and second arms have a common axis 37 which is angled with respect to the longitudinal axis of the arms. Preferably the angle between the longitudinal axis of the arms and the axis of the head is of the order of 120°. Advantageously, the forceps according to the third aspect of the invention enable the surgeon to achieve circumferential welding of the solder tube in one step technique. Additionally, by using the instalment significant time savings may be achieved in comparison to welding utilizing a conventional hand held laser. Furthermore, the safety of such a procedure is improved as the head of the instrument is adapted to enclosing the weld site and focus the energy solely at the weld site. Figs. 5a to 5n illustrate the sequence of steps in joining two ends of a blood vessel by means of a protein solder tube utilising the instruments according to the first, second and third aspects of the present invention. Fig. 5 a illustrates the distal and proximal ends of the vessel to be joined by a hollow protein solder tube. Firstly, the solder tube is placed over one end of the vessel, in this example the proximal end, and positioned along the vessel such that the vessel end extends through the solder tube, with the length of vessel extending through the solder tube being approximately one half the length of the solder tube (see Fig. 5b). Next, the holding forceps according to the first aspect of the invention are used to hold the solder tube in position with respect to the blood vessel whilst the nose section of the eversion forceps according to the second aspect of the invention is placed inside the end of the vessel (see Fig. 5c). A squeezing force is then applied to the eversion forceps to cause the nose section to open thereby opening the mouth of the blood vessel (see Fig. 5d). Next, using the nose of the eversion forceps, the opened end of the vessel is folded back over the solder tube (Figs. 5e and 5f). Laser energy is then applied around the circumference of the everted end to create a bond between the vessel and the solder- tube, hi the example depicted, laser energy is applied by means of the hand held laser tool according to the third aspect of the invention. The jaws of the tool are closed around everted end and laser energy is applied around the circumference thereof to form a bond (see Fig. 5h). Following completion of this step, standard forceps are used to open the mouth of the distal end of the vessel and draw it over the proximal vessel end (see Fig. 5i). Preferably the distal end of the vessel is drawn over the proximal end to the extent that it covers the entire length of the solder tube. With the distal end of the vessel in position, the jaws of the laser tool are closed around the area to be bonded and laser energy is applied to create a bond (see Figs. 51 and 5m). The clamps are released to restore blood flow through the joined vessel (see Fig. 5n). Figs. 6a to 61 depict the sequence of steps in joining a blood vessel by means of a protein solder tube utilising the instruments according to the first and second aspects of the present invention. Fig. 6a illustrates two ends of a vessel to be joined by a protein solder tube. Firstly, the solder tube is placed over the end of the vessel and positioned such that the vessel end extends through the solder tube and a length the vessel approximately half the length of the solder tube extends out from the solder tube (see Fig. 6b). Next, the holding forceps are used to hold the solder tube in position with respect to the blood vessel whilst the nose section of the eversion forceps is placed inside the end of the vessel (see Fig. 6c). A squeezing force is then applied to the eversion forceps to cause the nose section to open thereby opening the mouth of the blood vessel (see Fig. 6d). Next, using the nose of the eversion forceps, the opened end of the vessel is folded back over the solder tube (Figs. 6e and 6f). Laser energy is then applied around the circumference of the everted end to create a bond between the vessel and the solder tube by means of a hand held laser tool (see Fig. 6g), the head of which is located in close proximity to the everted end of the vessel and passed around the circumference thereof to form the bond. Next, using a pair of standard forceps the mouth of the distal end of the vessel is opened and extended over the proximal vessel end (Fig. 6h). Preferably the distal end of the vessel is drawn over the proximal end to the extent that is covers the entire length of the solder tube (see Fig. 6i). With the distal end of the vessel in position, laser energy is applied around the circumference of the area to be bonded by means of the hand held laser tool, (see Fig. 6k). Finally, the clamps are released to restore blood flow through the joined vessel (see Fig. 61). Although the invention has been described with reference to specific examples it will be appreciated by those skilled in the art that the invention may be embodied in many other forms.

Claims

1. A pair of forceps adapted to hold a hollow sleeve of biomolecular solder material, said forceps comprising opposing first and second arms joined at one end, said first arm including a head portion at a second free end, said second arm including a head portion at a second free end, wherein said head portions are adapted to cooperatively receive and hold said hollow sleeve of biomolecular solder.

2. The forceps as claimed in claim 1 wherein the arms of the forceps are biased such that a force is required to be applied to the arms by the user in order to grip the sleeve within the head of the forceps.

3. The forceps as claimed in claim 1 or 2 wherein said forceps are adapted to be hand held by a surgeon.

4. The forceps as claimed in any one of claims 1 to 3 wherein the head section of said first arm is adapted to contact the sleeve of solder at at least two points on its outer surface.

5. The forceps as claimed in any one of claims 1 to 4 wherein the head section of said first arm includes a substantially U-shaped or N-shaped recess for receiving the sleeve of solder.

6. The forceps as claimed in any one of claims 1 to 5, the head section of the first arm includes a pair of substantially planar surfaces angled with respect to one another such as to form a recess for receiving the sleeve of solder.

7. The forceps as claimed in any one of claims 1 to 6 wherein the head section of said second arm includes a planar surface for making at least point contact with an outer surface of the sleeve, said head section of the second arm acting to hold and retain the sleeve within the recess of the head section of the first arm.

8. The forceps as claimed in any one of claims 1 to 7 wherein the arms are coplanar and extend along a longitudinal axis.

9. The forceps as claimed in claim 8 wherein the axis of the head of the forceps is angled with respect to the longitudinal axis of the arms.

10. The forceps as claimed in claim 9 wherein the angle between the longitudinal axis of the arms and the axis of the head is of the order of 120°.

11. A pair of eversion forceps, said forceps comprising a pair of arms mutually joined at one end, said first arm including a head portion at a second free end, said second arm including a head portion at a second free end, wherein said head portions of said first and second arms are adapted to form a nose for insertion into a tubular vessel.

12. The forceps as claimed in claim 11 wherein the head section of each arm combine to form a conical nose adapted for insertion into a tubular vessel.

13. The forceps as claimed in claim 12 wherein the nose is frusto-conical.

14. The forceps as claimed in any one of claims 11 to 13 wherein the forceps are configured such that the application of a squeezing force to the arms so as to move the arms towards one another causes the head portions of the arms to move away from one another and the nose section to open.

15. The forceps as claimed in any one of claims 11 to 14 wherein the first arm includes a neck which extends between the body of the arm and the head portion and the second arm includes an aperture through which the neck of the first arm extends.

16. The forceps as claimed in any one of claims 11 to 15 wherein the arms are coplanar and extend along a longitudinal axis.

17. The forceps as claimed in claim 16 wherein the axis of the head of the forceps is angled with respect to the longitudinal axis of the arms.

18. The forceps as claimed in claim 17 wherein the angle between the longitudinal axis of the arms and the axis of the head is of the order of 120°.

19. A surgical instrument for welding a sleeve of biomolecular solder material to living tissue, said instrument comprising first and second arms joined at one end, said first arm including a first jaw at a free end, said second arm including a second jaw at a free end, wherein said first and second jaws are co-operatively define a head adapted to receive said sleeve of biomolecular solder, said instrument operatively coupled to a source of energy wherein energy is directed to the head of the instrument to effect welding of said solder material and said living tissue.

20. The instrument as claimed in claim 19 wherein said first and second jaws each include a semi-circular recess for receiving a portion of said sleeve of solder.

21. The instrument as claimed in claim 19 or 20 wherein the arms are biased such that a force is required to be applied to the arms by the user in order to close the head of the instrument.

22. The instrument as claimed in any one of claims 19 to 21 wherein the instrument is adapted to be hand held by a user.

23. The instrument as claimed in any one of claims 19 to 22 wherein said energy is provided from a laser source.

24. The instrument as claimed in any one of claims 19 to 22 wherein said energy is provided from an ultrasonic source.

25. The instrument as claimed in any one of claims 19 to 22 wherein said energy is provided from an electro-thermal source.

26. The instrument as claimed in any one of claims 19 to 22 wherein said energy is provided from an electro-magnetic source.

27. The instrument as claimed in any one of claims 19 to 22 wherein said energy is provided from an electrosurgical source, such as bi-polar coagulators.

28. The instrument as claimed in any one of claims 19 to 27 wherein activation of the energy source is controlled by the surgeon.

29. The instrument as claimed in any one of claims 19 to 28 wherein the energy source provides a predetermined amount of energy to the weld site.

30. The instrument as claimed in any one of claims 19 to 29 wherein the energy source may only be activated upon closure of the head of the instrument.

31. The instrument as claimed in any one of claims 19 to 30 wherein the instrument is provided with a switch which forms part of the circuit for the energy source, such that the switch is closed when the arms of the forceps are brought together thereby enabling the energy source to be activated.

32. The instrument as claimed in any one of claims 19 to 31 wherein activation of the energy source is controlled by means of a foot operated pedal.

33. The instrument as claimed in any one of claims 19 to 32 wherein an audio or visual signal indicates to the surgeon when a predetermined amount of energy has been delivered to the weld site.

34. The instrument as claimed in claim 23 wherein said laser energy is conveyed to the head of the instrument by an array of optical fibres.

35. The instrument as claimed in claim 23 or 34 wherein one section of the head includes a reflector for directing the laser energy onto the surface of the tissue to be denatured.

36. The instrument as claimed in claim 34 wherein the arm includes a longitudinally extending cavity within which the optical fibres are housed.

37. The instrument as claimed in any one of claims 19 to 36 wherein the arms are coplanar and extend along a longitudinal axis.

38. The instrument as claimed in any one of claims 19 to 37 wherein the axis of the head is angled with respect to the longitudinal axis of the arms.

39. The instrument as claimed in claim 38 wherein the angle between the longitudinal axis of the arms and the axis of the head is of the order of 120°.

40. A method of welding a sleeve of biomolecular solder material to a vessel of living tissue, said method comprising locating said sleeve over said vessel of living tissue and applying energy simultaneously around the circumference of said sleeve to effect welding of said solder material and said living tissue.

41. The method as claimed in claim 40 wherein said sleeve is located within first and second jaws of a pair forceps, and activating an energy source to effect said welding of said solder material and said living tissue.

42. The method as claimed in claim 40 or 41 wherein activation of the energy source is controlled by the surgeon.

43. The method as claimed in any one of claims 40 to 42 wherein a predetermined amount of energy is provided to the weld site.

44. The method as claimed in any one of claims 40 to 43 wherein activation of the energy source is controlled by means of a foot operated pedal.

45. The method as claimed in any one of claims 40 to 44 wherein an audio or visual signal indicates to the surgeon when a predetermined amount of energy has been delivered to the weld site.

46. A method of welding a sleeve of biomolecular solder material to a vessel of living tissue, said method comprising: (i) locating said sleeve of biomolecular solder material over one end of the vessel; (ii) everting the mouth of the vessel; (iii) folding the opened end of the vessel back over the solder tube; (iv) applying energy around the circumference of the everted end of the vessel to create a bond between the vessel and the solder tube.