CA1124156A - Instrument for circular surgical stapling of hollow body organs and disposable cartridge therefor - Google Patents
Instrument for circular surgical stapling of hollow body organs and disposable cartridge thereforInfo
- Publication number
- CA1124156A CA1124156A CA304,047A CA304047A CA1124156A CA 1124156 A CA1124156 A CA 1124156A CA 304047 A CA304047 A CA 304047A CA 1124156 A CA1124156 A CA 1124156A
- Authority
- CA
- Canada
- Prior art keywords
- staple
- anvil
- carrying part
- assembly
- tissue
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
- A61B17/1155—Circular staplers comprising a plurality of staples
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07257—Stapler heads characterised by its anvil
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
Abstract
ABSTRACT
Apparatus for circular surgical stapling of hollow organs comprising an instrument and disposable cartridge. The instrument comprises a housing with a throughbore in which a tube is received for reciprocation by means of a manually operable squeeze handle. A rod reciprocates within the tube by means of a wing nut cooperating with a threaded part of the rod. A two-part disposable cartridge assembly comprised of an anvil carrying part and a staple carrying part are detachably mounted on the rod and housing, respectively. A key is provided to hold the housing and rod in rotational orientation. Mutually coacting stops on the tube and rod determine the extent of reciprocation which is variable in dependence upon the position of the rod which in turn is dependent upon the juxtaposition of the anvil carrying part with the staple carrying part when the apparatus is closed on tissue preparatory to effecting a circular anastomoses.
Apparatus for circular surgical stapling of hollow organs comprising an instrument and disposable cartridge. The instrument comprises a housing with a throughbore in which a tube is received for reciprocation by means of a manually operable squeeze handle. A rod reciprocates within the tube by means of a wing nut cooperating with a threaded part of the rod. A two-part disposable cartridge assembly comprised of an anvil carrying part and a staple carrying part are detachably mounted on the rod and housing, respectively. A key is provided to hold the housing and rod in rotational orientation. Mutually coacting stops on the tube and rod determine the extent of reciprocation which is variable in dependence upon the position of the rod which in turn is dependent upon the juxtaposition of the anvil carrying part with the staple carrying part when the apparatus is closed on tissue preparatory to effecting a circular anastomoses.
Description
f~ ii6 This inven-tion relates to an instrumen-t Eor circular ---surgical stapling of hollow body organs and more particularly, to an ins-trument for effecting end-to-end anastomoses, side--to-side and side-to-end anastomoses and a disposab]e cartridge therefor.
Presently in the prior art, several instruments are ,,~,, known for circular joining by staples of hollow body organs.
United States Patents Nos. 3,638,652, 3,552,626, 3,388,487 and 3,193,165 all relate to instruments of this type, which are useful in surgical procedures involving the colon and the .; ,j:
esophagus. Despite the fact that these instruments are known in the prior art, they have never been introduced into practical use in the United States apparently for their lack of versatility.
For example, these instruments, which are disclosed in the ~-aforementioned patents, have the important drawback requiring i~c~A
hand loading of the suturing staples into the staple magazine r.
of the instrument after each use of the instrument. This means ~r~
that once the instrument is actuated and its staples ejected and clinched, it must then be set aside and the magazine must --then be refilled wi~h staples by hand. While refilling, the ,~
instrument, of~course, is inoperative and may not be further used in the on-going surgical operation. The aforementioned U.S. Patent No. 3,552,626 discloses a form of the instrument in which the staple magazine and associated anvil of the instrumen-t i~
are interchangeable so that different sizes may be mounted on the ~2 same instrument body but this arrangement is solely for the purpose of accommodating hollow body organs of different sizes.
The present invention is directed -to an ins-trument of the type generally described and was developed to overcome `
E~F
the drawbacks and disadvantages whiah one experiences when a-ttempting to use similar instruments according to prior art 5~ -teachings and most notably, those teachings which are contained in the a~orementioned patents.
Accordin~ly, the present lnvention provides a two-part assembly fo~ staplin~ a closed geometric pattern in disconnected sections of hollow oryans made of tissue, each of said disconnec-ted sections having an end portion, the assembly comprising an anvil-carrying part having a first tissue-receiving space defined therein; a staple-carrying part having a second tissue-receiving space defined therein, said staple--carrying part associated with said anvil-carrying part for clamping said disconnnected sections of said organs therebetween with said end portions being re-ceived in said first and second spaced, said first and second spaces, during said clamping~ de~ining a closed cavity; and relief means in at least one of said anvil-carrying and staple-carrying parts for communicating said closed cavity with the exterior of said assembly.
An instrument body is also described which is specially designed to accommodate the staple-carrying part and staple clinching part in areadily detachable fashion so that these parts ~0 can be fabricated as a disposable cartridge. Accordingly, suc-cessive uses of an instrument during a surgical procedure are easily attained simple by detaching a spent cartridge and replac-ing with a fresh cartridge. Proper connection and keying to the disposable cartridge to -the body of the instrument is also a feature of the invention to ensure that all parts are in the correct orien-tation and properly indexed; hence when the instru-ment is actuated, the staples are ejected through the tissue ofthe hollow body organ and clinched to effect the desired staple line.
The instrument may be used for effecting end-to-end ana-stomoses or end~to-side anastomeses by means of a pair of concen-tric circles of staples of high secu~ity in maintaining the desir-ed tissue joining. ~ariations in staple dimensions and array pat-terns are easily p~ovided by a variet~ o~ cartridge designs.
~ urthe~ ad~antages and detai~ls ~ the pXesent in~ention will ~ecome more ev~dent from a consideratlon of the following descriptive text w~hen taken in conjunction ~ith the appended drawings in which:
Figure 1 is a view in side elevation showing the novel instrument assembled with a disposable cartridge;
~ - 3a -Figure 2 is an end view of the disposable cartridge illustrated in Figure 1; ~ej F--Figure 3 is a sectional view ta]cen along line 3-3 of Figure l;
Figure 4 is a sectional view -taken along line 4-4 of Figure l; ~ ,~
Figure 5 is an end view of the instrument looking F
at the adjustable wing nut;
Figure 6 is a view partly in section through the main body of the instrument showing the manner in which the instrument is assembled and the handle is manipulated to cause the reciprocating motion of the driver;
Figure 7 is a sectional view of Figure 6 taken along line 7-7; ~, Figure 8 is a view in section through the body of ~,~s~, the instrument showing the stop arrangement in detail;
Figure 9 is a view in top plan partly in section of the staple carrying part of the disposable cartridge showing the keying arrangement;
Figure ].0 is a view in section through the staple carrylng part of the disposable cartridge; ~;
Figure 11 is a view in sec-tion taken along line 11-11 of Figure 10;
Figure lla is a view in section through the keying arrangement illustrating positions following staple ejection;
Figure 12 is a front end view of the staple carrying part of the disposable cartridge showing the pusher and knife;
~
Figure 13 is a detail section showing safety detent ' ' arrangement; ~ I
Fi~ure 14 is a front end view showing the pusher and staple guide; !'~
Figure 15 is a side elevational view showing coaction between staple and pusher;
Figure 16 is a side view, partly in section showing the anvil part of the disposable cartridge; ~; ~
Figure 16a is a -top view in section along line F~-16a-16a of Figure 16;
Figure 17 is a view of Figure 16, with anvil removed;
Figure 18 is a side elevational view of the anvil;
Figure 19 is an elevational view of the anvil;
Figure 20 is a view in section through the anvil;
Figure 21 is a view in section through the anvil illustrating the manner in which a staple is clinched; and Figure 22 is a view in section through the anvil part of the disposable cartridge showing the staple line ~ r~r~.
and knife cutting of tissue. r`~
Referring now to the drawings in detail, a preferred ~
embodiment of the instrument with disposable cartridge mounted thereon according to the teachings of the present invention is depicted in Figures 1 and 6. As shown, the instrument comprises a main body or housing defining a throughbore 11 and having an integrally formed rear handle part 12. Projecting ,~
, ~ ~,.. .
from the body 10 is a pivotally mounted handle part 14, pivotably mounted to the body lO by means of pivot pin 16. The handle part 12 is received in the palm of the hand of the operator and the handle part 14 is grasped by the fingers of the same hand. When the fingers are squeezed toward the palm, handle part 14 is pivoted about pin 16 and~brought toward handle part 12. A conventional safety bar 18, terminating in a knob ~2~3.~
20 hearing agains-t the pivo-table handle part 14 and which, ---in turn, is pivo-tally mounted on a pin 22 set into the body ,,~!
10, serves as a safe-ty to prevent the accidental actuation of handle part 14. Safety 18 is conventional in both ~unction and structure.
Projecting from the forward end of the body or housina ,~
10 is an ou-ter tube 30 which extends forwardly and terminates at a substantial distance from housing 10. Received on -the remote end of tube 30 is a disposable cartridge referred to generally by the reference numeral 40. Attachmen-t of disposable cartridge 40 to the tube 30 is effected by means of a threaded coupling sleeve 42 in a manner which will be described herein- -after. The disposable cartridge 40 comprises a staple carrying member 44 and an anvil carrying member 46. Concentrically mounted within the tube 30, is a driver tube 50 and a rod 52.
Driver tube 50 reciprocates within tube 30 and serves as a pusher for ejecting staples; the rod 52 reciprocates independent of driver tube 50 and serves to posit:ion the anvil carrying ?
member 46 relative to the staple carrying member 44. The rod 52 20 extends entirely through the instrument with one end projecting -out of the fron~ o~ the instrument to receive and carry the anvil carrying member 46 and the other end projec-ting out of r~
the back of the instrument through a wing nu-t 60. The rear end of the rod 52 is threaded as indicated to the right of Figure 1 and is in threaded engagement wi-th an internally threaded sleeve extension 110 of wing nut 60.
As illustrated in Figure 3, -the inside diameter of tube 50 ls slightly enlarged at i-ts remote end, for the purpose of relieving the contact between the rod 52 and driver tube ;
30 50 over a substantial area without any loss of function.
~s shown in Figure 5, an end cap 62 is applied to the rear of the ins-trument and effects a closure of throughbore '.~ `
11. Cap 62 secures stepped bushing 304 agains-t shoulder 306 in throughbore 11. The smallest bore -through bushing 304 supports reduced part 106 of the rod 52 and terminates in bevelled shoulder 130. Holes 64 are provided in the cap 62 ~.:!';~' in order to accommodate a suitable spanner wrench to enable ~~
the attachment oE the cap 62 into a suitably threaded terminal part of throughbore 11 at the rear of the instrumen-t. The cap 62 contains an external thread on its flange part that ! `
coacts or threadedly engages with the thread formed in the P,~
F~
terminal part of throughbore 11.
Referring now to Figures 6, 7, and 8, the internal arrangement for the body or housing 10 will now be described in detail. As already noted, the cap 62 contains an external ~, thread which threadedly engages with an internal thread suitably formed in the terminal part of the throughbore 11. This -threaded engagement is i,den-tified generally by the reference ,' numeral 66. Throughbore 11, at its end proximal to the disposable cartridge mounting, receives the outer tube 30 which extends r into the throughbore 11 terminating at the entry to an enlarged region 70 of the bore 11. The body 10 and the tube 30 are rigidly interconnec-ted in the bore 11 so that there is no relative motion between them. The driver tube 50 extends ' coaxially within the sleeve 30 and projects therefrom into E~
the enlarged region 70 where upon it is threadedly connected at its end by means of threads 74 with a short thicker sleeve 72. This sleeve 72 in turn is connected by means of threads '' 76 wi-th a terminating cap 78. This terminating cap 78 defines , on its inner surface an inclined stop shoulder 81. The driver tube 50 together with -the short sleeve 72 and the cap 78 being '~-L~ 6 threadecl together all move as a unit. The short sleeve 72 beiny somewhat thicker than the driver tube 50 accommodates on ~`
either side a roller 80 which is moun-ted on a shor-t stub shaft '~~~
88 pressed into a recess deEined in the shor-t sleeve 72.
Rollers 80 are provided on diametrically opposed sides of the short sleeve 72 and serve as the means by which the driver l~ Y~ ' tube 50 is reciproca-ted in the instrument. Also, -the underneath r~-side of the short sleeve 72 is provided with a sui-table -tapped hole 84 into which is threaded a projection 82. The stub or projection 82 extends downwardly, as protrayed in Figure 6 of the drawings, and terminates in the plane of a slot 84 defined in the body 10. The purpose of the stub or projection 82 is to maintain a proper orientation for the driver tube 50 as its reciprocates back and forth; hence, stub or projection 82 in _--cooperation with slot 84 prevents driver -tube 50 from rotating during reciprocation.
The arrangement for reciproca-ting the driver tube p~-50 is illustrated best in Figures 6 and 7. As already noted, .
the short sleeve 72 carries rollers 80 on diametrically ~
opposed sides, the rollers 80 being moun-ted for free rotation L', by means of short stubs 88 which are pressed into the short sleeve 72 in the manner best illustrated in Figure 7.
The handle part 14 is provided at its lower end with a ~
bifurcated member 90, the legs of which are identified by ~t the reference numeral 92. These legs 92 are fashioned as forks 94 which engage the rollers 80. The bifurca-ted member 90 is designed with an upstanding central projection 96 which fits into a slot 97 defined in the lower part of the handle part 14. Pins 98 projecting through holes formed in projec-tion '~
96 hold the bifurcated member 90 to~the handle part 14. Handle B~
part 14 pivots about pin 16 as shown in Figure 6, and forks 94 ~ ~5~
cooperating with rollers 80 cause dri.ver tube 50 to reciprocate in tube 30. A spring 56 received around tube 50 in region ~, ;
70 biases sleeve 72 against the reciprocation produced by handle part 14. The left end of spring 56 is held agains-t the end of tube 30.
The rod 52 extends completel.y through the tube 30 ,,-"~".....
and body 10 of the instrument. As will be evident from Figure 8, the rod is provided with a bevelled shoulder 100 connecting the main portion of the rod 52 with a reduced portion 102 which in turn defines a bevelled shoulder 104 with a further reduced part 106 of the rod 52. The extreme right end of the rod is ;,~
a further reduction in diame-ter, this portion being identified by the reference 108, and this reduced section 108 is -threaded throughout its length.
The wing nut 60, which appears a-t the rear of the instrument, is provided with a sleeve extension 110. A reduced portion 112 interconnec-ts sleeve 110 with the hub of nut 60, which reduction defines a groove into which a retaining ring ~-~
124 is received for the purpose of securing the wing nut 60 and its sleeve extension llO onto the end cap 62. The sleeve ',-extension 110 as well as nu-t 60 define a throughbore through which rod ~2 passes. The bore within the sleeve extension 110 is threaded to threadedly engage with the threads defined on .~.
the reduced portion 108 of the rod 52. By the arrangemen-t described, when the cap 62 is threaded into the body 10 with the wing nut 60 held thereon hy means of the retaining ring 124, the wing nut 60 will not translate when rotated because of being secured to the end cap 62 in the manner described.
Accordingly, sleeve extension 110, acting as a nut on the threaded l-.,.ji part of rod 108, will cause the rod 52 to reciprocate. p~
The bevelled shoulder 104 acts as a stop working agaillst a bevelled shoulder l30 deEined in the bushing 3 4 The furthest posi~ion of the rod 52, tha-t it may assume when driven to the ri-~ht by means oE sleeve extension 110, is ~~
illustrated in Figure 8 with -the bevelled shoulder 104 and the bevelled shoulder :L30 in contact. This also represents the closes-t approach of the anvil-carrying part 46 -to -the staple-carrying part 44 of -the disposable cartridge. This position of closest approach is illustrated in Figure 1 and is selected to define a space between the two parts of the disposable cartridge that is equal to the minimum spacing required to accommodate tissue from whatever hollow body organs are to be stapled by the instrument of the present invention.
Referring now to Figures 9, 10 and 11, the staple-carrying part 44 of the disposable cartridge will now be described r in detail. The part 44 is an assemb]y comprised of a main body portion 140 having an hemi-ovate shape terminating a-t its right end in a small diameter neck 141 having external -threads 142. These threads 142 cooperate with an internally threaded coupling sleeve 42 which is retained on the end of the tube 30 by means of shoulder 146. A guide member 148 provided with a slot 150 coacting wi-th a projection 152 defined on the main body part 140 for orientation is secured to the main body part 140 by an adhesive or the like, the area of securement being '`~`~
identified by the reference numeral 154. The guide member 148 forms a guide Eace 156 which defines two concentric circular C
series of spaced staple-receiving slots 158. Received within the guide member 148 and -the main body part 140 is a staple ejection member 160, which fits concentrically within the main body part 140, terminates in a long nec~. 161 and is adapted r;"`~''' to be contacted by the end of driver tube 50. The forward ;~-end of the staple ejector 160 is defined with two concentric 56 :-rings of periphera.l.ly spaced fingers 162, each one of which --is recei.ved within a staple-receiving slot 158. Hence, upon '~
advancing the staple ejector 160 by driver tube 50, the fingers 162 will pass further in-to the s-taple-receiving slo-ts 158, ejecting staples contained therein axially outwardly. The staple ejec-tor 160 is reinforced with a plurality of rihs 164 at .
leas-t two of which are provided with suitable plastic projec-tions or bosses 166. A ]cnife 168 in -the form of an open cup wi-th the rim defining the knife edge 170 is moun-ted within the staple ejector 160 by means of holes 173 through which the bosses 166 projec-t. In mounting, the bosses 166 are "hot staked" to .~
fasten the knife 168 onto the staple ejector 160 so that ~--advancement of the staple ejector 160 also advances knife 168.
A two-headed key 180 is press fit-ted into an opening or slot defined in the outer tube 30. The outer head 182 of the key is somewhat enlarged and coacts with a slot defined ~-in the small neck of the main body part 140 -to maintain -this body part 140 and the associa-ted guide member 148 in a predetermined indexed orientation with respect to the double- ~.
headed key 180. The driver tube 50 is provided with an elongated ' slot through which the key 180 passes in a loose fashion and the rod 52 is provided with a close fitting slot 184 into which the other end of the key 180 is received.
~7hen initially assembled, the guide member 148 and !~
the staple ejector 160 which define mutually opposed detents C
190 and 192, respectively, are orientated such -that de-tent 192 formed on -the outer periphery of the staple ejector 160 is to the right of the detent 190 as shown in Figure 13. ~~
The purpose of -these mu-tually opposed detents is to prevent any outward motion of -the staple ejector 160 and its associated knife 168, that is outward from the face 156, and thereby prevent any acciclental discharge of staples or accidenta]
projection of the knife, before assembly onto tube 30.
When the staple carrying part of the disposable ~-cartridge is assembled onto the end of the outer tube 30 by means of the sleeve 42 and -the mutua]ly engaging threads of the sleeve and -the small neck of the main body part 140, the ~ O! f ~, ' main body part 140 will be drawn to a position such that the staple ejector 160 will engage the free end of the driver tube 50 and then be moved sligh-tly outwardly relative to the main body part 140. This will cause the detents 190 and 192 to reverse themselves from the position shown in Figure 13 to the position shown in Figure 10. The staple-carrying part 44 will then be ready for use.
The rod 52 is provided a-t its free end with a key 200 for the purpose of indexing the anvil-carrying part 46 to the rod 52. The rod 52, is also provided at i-ts free end with a tapped hole 202 for the purpose of detachably mounting the c,~
anvil-carrying part 46.
The anvil carrying part 46 is illustrated in Figures ,-16-22 inclusive and comprises a plastic body portion 210 of cup shape with a central hub 212 defining a bore 214. A stud 216 is received through the bore 214 and is characterized by knob 48 at one end and a screw thread 220 at its other end with a t.. ~' reduced section 222 defined between its ends. The threading 220 matches the internal threading of the bore at the end j~__~
of rod 52. Clips 224 defined by the portion 210 project into the bore 214 and engage the shoulder defined by the reduced section 222 to hold stud 216 captive in bore 214 but allowing it to rotate freely. The body portion 210 in the vicinity of bore 214 is '~`~
- 30 cutout 226 to accommodate the key 200 at the end of rod 52.
Holes 49 provide venting for the anvil carrying part 46. Metal L~L ~ 516 anvil 230 having two concentric circular arrays of spaced staple clinching grooves 232 and a central hole 233, is mounted `~
onto body portion 210 by "hot s-takiny". Body por-tion 210 defines a plurality of ribs 234 at least two of which are provided wi-th projections or bosses 236. Anvil 230 defines rnatching holes 238 and after mounting, bosses 236 are melted to form rivets 240 to lock anvil 230 on, see particularly Figure 22. Anvil 230 is also provided with punched out lips 242 to secure a cutting block 244 of annular configuration, that cooperates wi-th knife 168. Cutting block 244 is rubber, soft plas-tic or the like. Anvil 230 defines a cutout or keyway 231 as an extension of hole 233 that coacts with key 200 to insure the proper '~`-~
orientation and indexing for grooves 232 of the anvil 230 rela-tive to slots 158 of the staple carrying part 44. Anvil 230 has vent holes 47 which communica-te with vent holes 49 in body 210.
In operation, wing nu-t 60 :Ls rotated to advance rod 52 out from the end of tube 30. A staple carrying part 44 of a disposable cartridge 40 is fitted over rod 52 and -tube 30 and attached to -tube 30 by sleeve 42. The geometry of these parts is such that key 180 engages the neck of staple carrying part 44 before the threading engages to draw part 44 onto tube 30 to its seated position. During the last turns of sleeve 42, the end of driver tube 50 engages the staple ejector 160 to reverse the deten-ts 190 and 192 from the position shown in ~r~
Figure 13 to -the position shown in Figure 10.
Next, the anvil carrying part 46 is assembled in-to the end of projec-ting rod 52. To this end, the knob 43 is grasped and the pointed threaded end of stud 216 is introduced into the `~
tapped hole in the end of rod 52. ~Cey 200 is received a-t this time in keyway 231 of anvil 230 before -the threading engages, 5~
whereafter knob 48 is ro-tated to sea-t threaded end 220 of stud 216 into the tapped hole at the end oE rod 52 and draw the key f'~t 200 into the keyway 231. Keys 180 and 200 assure that slots 158 and grooves 232 are properly aligned. Wing nu-t 60 is -then rotated to retrac-t rod 52 and thus bring anvil part 46 close to s-taple carrying part 44. ~", In this condition, -the instrumen-t is inserted into the patient through the hollow organ that is -to be stapled.
At this time, the patien-t has been prepared such tha-t the hollow organ to be stapled has been cut and there are two cut ends to be joined -together by means of the instrument of the '~
1~' present inventionO The instrument is inserted through the hollow organ until it projects from one of the cut ends. The wing nut 60 is rotated to extend the rod 52, thereby creating a ~~
substantial gap between the anvil-carrying part 46 and the ~;, staple-carrying part 44.
Now, the cut end of the hollow organ through which the instrument is protruding is fashioned with a drawstring suture and drawn over the staple-carrying part 44 about the ~`
rod 52. The other cut end o~ the hollow organ is pulled over the anvil-carrying part 46 and by means of a drawstring suture is tied closely about -the rod 52. Thus, the two cut ends o~
-the hollow organ will be interposed between the anvil part 46 and the staple-carrying part 44. At this time, the wing nut 60 is rotated to cause retraction of the rod 52 whereupon the ~v_~
anvil-carrying part 46 will be brought into close pro~imity with the staple-carrying part 44. Wing nut 60 is turned until a sufficient back pressure is felt caused by squeezing the ~ ~-tissue interposed between the staple carrying part 44 and the ~
~' anvil-carrying part 46.
At this time, the rod 52 will occupy a position ......
within the bocly l0 of the instrument ei-ther as shown in solid lines in Figure 8 with the stop 104 bearing against ;' the stop 130, or due to a yrea-ter than minimum -thickness of entrapped tissue, the stop 104 will be axially displaced off of -the stop 130 to the leEt as shown in phantom.
With -the apparatus in the condition described, -that is, with the cut ends of the hollow organ -to be stapled drawn around the two disposable parts of -the cartridge, the safety 18 is released hy pivoting away from the handle part 14 toward the handle part 12 in the manner shown in phantom in Figure 6 and the handle i5 grasped with the handle part 12 res-ting ln the palm of the hand and -the fingers curled about the handle part 14. ~hen -the fingers are drawn toward the palm of the hand in the manner of making a fist, the handle part 14 will be rotated about its pivot pin 16 clockwise as shown in Figure 6 toward the handle par-t 12. This causes the forks 94 to advance the rollers 80 and -the sleeve 72 axially to the left as shown in Figure 6 and as indicated by the ~I
arrow. This action will force the driver tube 50 which is ,-- 20 threaded into the sleeve 72 to the left as viewed in Figure 6 against the ~ias of spring 56. Advancement of driver tube 50 will in turn produce an advancement of the staple ejector 160 since the neck 161 of this part is in contac-t with the end of the driver tube 50. Advancemen-t of the staple ejector 160 will cause -the fingers 162 to move through the respective slots 158 ejecting the staples 159 contained therein. The ac-tion of the fingers 162 against the staples 159 is depicted ln Figure 15; the forward faces of the fingers 162 are all provided with a V-groove 163 in which the crossbar of -the U-P~
shaped staple 159 is received. This^ assures a better contact be-tween the finger 162 and the staple 159 during ejection.
.2~56 Re~er~ing to Figure 21, the action that -takes place during ejecting of the staple 159 is generally depicted; as ;~
the staples 159 are advanced or ejected out Erom the slots 158, they are contacted by grooves 232 of the anvil 230 and bent into a conventional B-shape as depicted in Figure 21.
Simultaneously with the advancement of the staple ejec-tor 160, ;
the knife 168, which is carried by the s-taple ejector 160, is axially advanced toward the anvil-carrying part and -the knife edge 170 of the knife 168 will in-tersect with the interposed tissue ends of the trapped hollow organs (shown in phantom in Figure 22 at 300 and 302). The cutting edge 170 of the ~`
knife 168, which is circular in configuration, cuts through the tissues 300 and 302 and into the annular cutting block 244, which is held within the anvil 230 by means of the punched-our parts 242, as previously described. The advancing of driver ~, tube 50 continues until stop 80 engages stop lO0 on rod 52, ~_~
the location of stop lO0 being variable in dependence upon tissue ~4`'i W~ ' '-' ~' thickness. ~owever, regardless of the variable location of stop lO0, driver tube 50 will travel whatever distance is necessary to bend the staples always into the same configuration.
There is, of course, a maximum limit to tissue thickness which a specific staple length can accommodate. Figure 22 depicts - in phantom the two concentric circular arrays of staples 159 which join together the ends of the hollow organ to be joined.
The excess portion of the ends of the hollow organ to be joined are severed by the action of knife edge 170. The vent holes 47 in anvil 230 and vent holes 49 formed in the body 210 allow for relief of gas, fluid or excess tissue trapped within the instrument on account of the procedure of stapling. The severed P~
ends 300 and 302 of the hollow organ are retained within the cavity clefined betweerl t~e anvil-carrying part and the s-taple-carrying part. "~
The next step in the procedure would be to ro-tate wing nu-t 60 -to slightly increase the spacing between -the anvil-carrying part and the staple-carrying part to allow the stapled part of the hollow organ to be wi-thdrawn from between these ~"L' I
instrument parts and passed over the anvil-carryiny part 46 so that the ins-trument may be withdrawn. To this end, the anvil-carrying part 46 is provided with an external configura-tion of dish~shape to facilitate -the removal of the stapled organ from between the two par-ts 46 and 44 and passing of -the stapled part ,'~
of the organ over part 46.
This removal is best accomplished when the perimeter of the profile, in section -through the axis as shown in Figure 16, an anvil-carrying part 46 is equal to or less than the circumference of the inner ring of staples represented by the ` inner circular array of spaced staple clinching grooves 232 in ~4".
Figure 19.
~lthough the present invention has been shown and described in terms of a preferred embodlment, it will be appreciated that various changes may be made without departing from the spirit of the concept. For example, the attachment of the anvil-carrying part 46 and the staple-carrying part 44 -has been shown as a threaded engagement or at-tachment. It is important that -the at-tachment be one that may be easily performed in an opera-ting theater and under difficult or extreme conditions.
~ccordingly, any known technique for effecting connection between the parts 44 and 46 and the outer tube 30 and the rod 52, respectively, which would enable quick attachment and detachment would be suitable, for example, bayonet types of connections. ~-
Presently in the prior art, several instruments are ,,~,, known for circular joining by staples of hollow body organs.
United States Patents Nos. 3,638,652, 3,552,626, 3,388,487 and 3,193,165 all relate to instruments of this type, which are useful in surgical procedures involving the colon and the .; ,j:
esophagus. Despite the fact that these instruments are known in the prior art, they have never been introduced into practical use in the United States apparently for their lack of versatility.
For example, these instruments, which are disclosed in the ~-aforementioned patents, have the important drawback requiring i~c~A
hand loading of the suturing staples into the staple magazine r.
of the instrument after each use of the instrument. This means ~r~
that once the instrument is actuated and its staples ejected and clinched, it must then be set aside and the magazine must --then be refilled wi~h staples by hand. While refilling, the ,~
instrument, of~course, is inoperative and may not be further used in the on-going surgical operation. The aforementioned U.S. Patent No. 3,552,626 discloses a form of the instrument in which the staple magazine and associated anvil of the instrumen-t i~
are interchangeable so that different sizes may be mounted on the ~2 same instrument body but this arrangement is solely for the purpose of accommodating hollow body organs of different sizes.
The present invention is directed -to an ins-trument of the type generally described and was developed to overcome `
E~F
the drawbacks and disadvantages whiah one experiences when a-ttempting to use similar instruments according to prior art 5~ -teachings and most notably, those teachings which are contained in the a~orementioned patents.
Accordin~ly, the present lnvention provides a two-part assembly fo~ staplin~ a closed geometric pattern in disconnected sections of hollow oryans made of tissue, each of said disconnec-ted sections having an end portion, the assembly comprising an anvil-carrying part having a first tissue-receiving space defined therein; a staple-carrying part having a second tissue-receiving space defined therein, said staple--carrying part associated with said anvil-carrying part for clamping said disconnnected sections of said organs therebetween with said end portions being re-ceived in said first and second spaced, said first and second spaces, during said clamping~ de~ining a closed cavity; and relief means in at least one of said anvil-carrying and staple-carrying parts for communicating said closed cavity with the exterior of said assembly.
An instrument body is also described which is specially designed to accommodate the staple-carrying part and staple clinching part in areadily detachable fashion so that these parts ~0 can be fabricated as a disposable cartridge. Accordingly, suc-cessive uses of an instrument during a surgical procedure are easily attained simple by detaching a spent cartridge and replac-ing with a fresh cartridge. Proper connection and keying to the disposable cartridge to -the body of the instrument is also a feature of the invention to ensure that all parts are in the correct orien-tation and properly indexed; hence when the instru-ment is actuated, the staples are ejected through the tissue ofthe hollow body organ and clinched to effect the desired staple line.
The instrument may be used for effecting end-to-end ana-stomoses or end~to-side anastomeses by means of a pair of concen-tric circles of staples of high secu~ity in maintaining the desir-ed tissue joining. ~ariations in staple dimensions and array pat-terns are easily p~ovided by a variet~ o~ cartridge designs.
~ urthe~ ad~antages and detai~ls ~ the pXesent in~ention will ~ecome more ev~dent from a consideratlon of the following descriptive text w~hen taken in conjunction ~ith the appended drawings in which:
Figure 1 is a view in side elevation showing the novel instrument assembled with a disposable cartridge;
~ - 3a -Figure 2 is an end view of the disposable cartridge illustrated in Figure 1; ~ej F--Figure 3 is a sectional view ta]cen along line 3-3 of Figure l;
Figure 4 is a sectional view -taken along line 4-4 of Figure l; ~ ,~
Figure 5 is an end view of the instrument looking F
at the adjustable wing nut;
Figure 6 is a view partly in section through the main body of the instrument showing the manner in which the instrument is assembled and the handle is manipulated to cause the reciprocating motion of the driver;
Figure 7 is a sectional view of Figure 6 taken along line 7-7; ~, Figure 8 is a view in section through the body of ~,~s~, the instrument showing the stop arrangement in detail;
Figure 9 is a view in top plan partly in section of the staple carrying part of the disposable cartridge showing the keying arrangement;
Figure ].0 is a view in section through the staple carrylng part of the disposable cartridge; ~;
Figure 11 is a view in sec-tion taken along line 11-11 of Figure 10;
Figure lla is a view in section through the keying arrangement illustrating positions following staple ejection;
Figure 12 is a front end view of the staple carrying part of the disposable cartridge showing the pusher and knife;
~
Figure 13 is a detail section showing safety detent ' ' arrangement; ~ I
Fi~ure 14 is a front end view showing the pusher and staple guide; !'~
Figure 15 is a side elevational view showing coaction between staple and pusher;
Figure 16 is a side view, partly in section showing the anvil part of the disposable cartridge; ~; ~
Figure 16a is a -top view in section along line F~-16a-16a of Figure 16;
Figure 17 is a view of Figure 16, with anvil removed;
Figure 18 is a side elevational view of the anvil;
Figure 19 is an elevational view of the anvil;
Figure 20 is a view in section through the anvil;
Figure 21 is a view in section through the anvil illustrating the manner in which a staple is clinched; and Figure 22 is a view in section through the anvil part of the disposable cartridge showing the staple line ~ r~r~.
and knife cutting of tissue. r`~
Referring now to the drawings in detail, a preferred ~
embodiment of the instrument with disposable cartridge mounted thereon according to the teachings of the present invention is depicted in Figures 1 and 6. As shown, the instrument comprises a main body or housing defining a throughbore 11 and having an integrally formed rear handle part 12. Projecting ,~
, ~ ~,.. .
from the body 10 is a pivotally mounted handle part 14, pivotably mounted to the body lO by means of pivot pin 16. The handle part 12 is received in the palm of the hand of the operator and the handle part 14 is grasped by the fingers of the same hand. When the fingers are squeezed toward the palm, handle part 14 is pivoted about pin 16 and~brought toward handle part 12. A conventional safety bar 18, terminating in a knob ~2~3.~
20 hearing agains-t the pivo-table handle part 14 and which, ---in turn, is pivo-tally mounted on a pin 22 set into the body ,,~!
10, serves as a safe-ty to prevent the accidental actuation of handle part 14. Safety 18 is conventional in both ~unction and structure.
Projecting from the forward end of the body or housina ,~
10 is an ou-ter tube 30 which extends forwardly and terminates at a substantial distance from housing 10. Received on -the remote end of tube 30 is a disposable cartridge referred to generally by the reference numeral 40. Attachmen-t of disposable cartridge 40 to the tube 30 is effected by means of a threaded coupling sleeve 42 in a manner which will be described herein- -after. The disposable cartridge 40 comprises a staple carrying member 44 and an anvil carrying member 46. Concentrically mounted within the tube 30, is a driver tube 50 and a rod 52.
Driver tube 50 reciprocates within tube 30 and serves as a pusher for ejecting staples; the rod 52 reciprocates independent of driver tube 50 and serves to posit:ion the anvil carrying ?
member 46 relative to the staple carrying member 44. The rod 52 20 extends entirely through the instrument with one end projecting -out of the fron~ o~ the instrument to receive and carry the anvil carrying member 46 and the other end projec-ting out of r~
the back of the instrument through a wing nu-t 60. The rear end of the rod 52 is threaded as indicated to the right of Figure 1 and is in threaded engagement wi-th an internally threaded sleeve extension 110 of wing nut 60.
As illustrated in Figure 3, -the inside diameter of tube 50 ls slightly enlarged at i-ts remote end, for the purpose of relieving the contact between the rod 52 and driver tube ;
30 50 over a substantial area without any loss of function.
~s shown in Figure 5, an end cap 62 is applied to the rear of the ins-trument and effects a closure of throughbore '.~ `
11. Cap 62 secures stepped bushing 304 agains-t shoulder 306 in throughbore 11. The smallest bore -through bushing 304 supports reduced part 106 of the rod 52 and terminates in bevelled shoulder 130. Holes 64 are provided in the cap 62 ~.:!';~' in order to accommodate a suitable spanner wrench to enable ~~
the attachment oE the cap 62 into a suitably threaded terminal part of throughbore 11 at the rear of the instrumen-t. The cap 62 contains an external thread on its flange part that ! `
coacts or threadedly engages with the thread formed in the P,~
F~
terminal part of throughbore 11.
Referring now to Figures 6, 7, and 8, the internal arrangement for the body or housing 10 will now be described in detail. As already noted, the cap 62 contains an external ~, thread which threadedly engages with an internal thread suitably formed in the terminal part of the throughbore 11. This -threaded engagement is i,den-tified generally by the reference ,' numeral 66. Throughbore 11, at its end proximal to the disposable cartridge mounting, receives the outer tube 30 which extends r into the throughbore 11 terminating at the entry to an enlarged region 70 of the bore 11. The body 10 and the tube 30 are rigidly interconnec-ted in the bore 11 so that there is no relative motion between them. The driver tube 50 extends ' coaxially within the sleeve 30 and projects therefrom into E~
the enlarged region 70 where upon it is threadedly connected at its end by means of threads 74 with a short thicker sleeve 72. This sleeve 72 in turn is connected by means of threads '' 76 wi-th a terminating cap 78. This terminating cap 78 defines , on its inner surface an inclined stop shoulder 81. The driver tube 50 together with -the short sleeve 72 and the cap 78 being '~-L~ 6 threadecl together all move as a unit. The short sleeve 72 beiny somewhat thicker than the driver tube 50 accommodates on ~`
either side a roller 80 which is moun-ted on a shor-t stub shaft '~~~
88 pressed into a recess deEined in the shor-t sleeve 72.
Rollers 80 are provided on diametrically opposed sides of the short sleeve 72 and serve as the means by which the driver l~ Y~ ' tube 50 is reciproca-ted in the instrument. Also, -the underneath r~-side of the short sleeve 72 is provided with a sui-table -tapped hole 84 into which is threaded a projection 82. The stub or projection 82 extends downwardly, as protrayed in Figure 6 of the drawings, and terminates in the plane of a slot 84 defined in the body 10. The purpose of the stub or projection 82 is to maintain a proper orientation for the driver tube 50 as its reciprocates back and forth; hence, stub or projection 82 in _--cooperation with slot 84 prevents driver -tube 50 from rotating during reciprocation.
The arrangement for reciproca-ting the driver tube p~-50 is illustrated best in Figures 6 and 7. As already noted, .
the short sleeve 72 carries rollers 80 on diametrically ~
opposed sides, the rollers 80 being moun-ted for free rotation L', by means of short stubs 88 which are pressed into the short sleeve 72 in the manner best illustrated in Figure 7.
The handle part 14 is provided at its lower end with a ~
bifurcated member 90, the legs of which are identified by ~t the reference numeral 92. These legs 92 are fashioned as forks 94 which engage the rollers 80. The bifurca-ted member 90 is designed with an upstanding central projection 96 which fits into a slot 97 defined in the lower part of the handle part 14. Pins 98 projecting through holes formed in projec-tion '~
96 hold the bifurcated member 90 to~the handle part 14. Handle B~
part 14 pivots about pin 16 as shown in Figure 6, and forks 94 ~ ~5~
cooperating with rollers 80 cause dri.ver tube 50 to reciprocate in tube 30. A spring 56 received around tube 50 in region ~, ;
70 biases sleeve 72 against the reciprocation produced by handle part 14. The left end of spring 56 is held agains-t the end of tube 30.
The rod 52 extends completel.y through the tube 30 ,,-"~".....
and body 10 of the instrument. As will be evident from Figure 8, the rod is provided with a bevelled shoulder 100 connecting the main portion of the rod 52 with a reduced portion 102 which in turn defines a bevelled shoulder 104 with a further reduced part 106 of the rod 52. The extreme right end of the rod is ;,~
a further reduction in diame-ter, this portion being identified by the reference 108, and this reduced section 108 is -threaded throughout its length.
The wing nut 60, which appears a-t the rear of the instrument, is provided with a sleeve extension 110. A reduced portion 112 interconnec-ts sleeve 110 with the hub of nut 60, which reduction defines a groove into which a retaining ring ~-~
124 is received for the purpose of securing the wing nut 60 and its sleeve extension llO onto the end cap 62. The sleeve ',-extension 110 as well as nu-t 60 define a throughbore through which rod ~2 passes. The bore within the sleeve extension 110 is threaded to threadedly engage with the threads defined on .~.
the reduced portion 108 of the rod 52. By the arrangemen-t described, when the cap 62 is threaded into the body 10 with the wing nut 60 held thereon hy means of the retaining ring 124, the wing nut 60 will not translate when rotated because of being secured to the end cap 62 in the manner described.
Accordingly, sleeve extension 110, acting as a nut on the threaded l-.,.ji part of rod 108, will cause the rod 52 to reciprocate. p~
The bevelled shoulder 104 acts as a stop working agaillst a bevelled shoulder l30 deEined in the bushing 3 4 The furthest posi~ion of the rod 52, tha-t it may assume when driven to the ri-~ht by means oE sleeve extension 110, is ~~
illustrated in Figure 8 with -the bevelled shoulder 104 and the bevelled shoulder :L30 in contact. This also represents the closes-t approach of the anvil-carrying part 46 -to -the staple-carrying part 44 of -the disposable cartridge. This position of closest approach is illustrated in Figure 1 and is selected to define a space between the two parts of the disposable cartridge that is equal to the minimum spacing required to accommodate tissue from whatever hollow body organs are to be stapled by the instrument of the present invention.
Referring now to Figures 9, 10 and 11, the staple-carrying part 44 of the disposable cartridge will now be described r in detail. The part 44 is an assemb]y comprised of a main body portion 140 having an hemi-ovate shape terminating a-t its right end in a small diameter neck 141 having external -threads 142. These threads 142 cooperate with an internally threaded coupling sleeve 42 which is retained on the end of the tube 30 by means of shoulder 146. A guide member 148 provided with a slot 150 coacting wi-th a projection 152 defined on the main body part 140 for orientation is secured to the main body part 140 by an adhesive or the like, the area of securement being '`~`~
identified by the reference numeral 154. The guide member 148 forms a guide Eace 156 which defines two concentric circular C
series of spaced staple-receiving slots 158. Received within the guide member 148 and -the main body part 140 is a staple ejection member 160, which fits concentrically within the main body part 140, terminates in a long nec~. 161 and is adapted r;"`~''' to be contacted by the end of driver tube 50. The forward ;~-end of the staple ejector 160 is defined with two concentric 56 :-rings of periphera.l.ly spaced fingers 162, each one of which --is recei.ved within a staple-receiving slot 158. Hence, upon '~
advancing the staple ejector 160 by driver tube 50, the fingers 162 will pass further in-to the s-taple-receiving slo-ts 158, ejecting staples contained therein axially outwardly. The staple ejec-tor 160 is reinforced with a plurality of rihs 164 at .
leas-t two of which are provided with suitable plastic projec-tions or bosses 166. A ]cnife 168 in -the form of an open cup wi-th the rim defining the knife edge 170 is moun-ted within the staple ejector 160 by means of holes 173 through which the bosses 166 projec-t. In mounting, the bosses 166 are "hot staked" to .~
fasten the knife 168 onto the staple ejector 160 so that ~--advancement of the staple ejector 160 also advances knife 168.
A two-headed key 180 is press fit-ted into an opening or slot defined in the outer tube 30. The outer head 182 of the key is somewhat enlarged and coacts with a slot defined ~-in the small neck of the main body part 140 -to maintain -this body part 140 and the associa-ted guide member 148 in a predetermined indexed orientation with respect to the double- ~.
headed key 180. The driver tube 50 is provided with an elongated ' slot through which the key 180 passes in a loose fashion and the rod 52 is provided with a close fitting slot 184 into which the other end of the key 180 is received.
~7hen initially assembled, the guide member 148 and !~
the staple ejector 160 which define mutually opposed detents C
190 and 192, respectively, are orientated such -that de-tent 192 formed on -the outer periphery of the staple ejector 160 is to the right of the detent 190 as shown in Figure 13. ~~
The purpose of -these mu-tually opposed detents is to prevent any outward motion of -the staple ejector 160 and its associated knife 168, that is outward from the face 156, and thereby prevent any acciclental discharge of staples or accidenta]
projection of the knife, before assembly onto tube 30.
When the staple carrying part of the disposable ~-cartridge is assembled onto the end of the outer tube 30 by means of the sleeve 42 and -the mutua]ly engaging threads of the sleeve and -the small neck of the main body part 140, the ~ O! f ~, ' main body part 140 will be drawn to a position such that the staple ejector 160 will engage the free end of the driver tube 50 and then be moved sligh-tly outwardly relative to the main body part 140. This will cause the detents 190 and 192 to reverse themselves from the position shown in Figure 13 to the position shown in Figure 10. The staple-carrying part 44 will then be ready for use.
The rod 52 is provided a-t its free end with a key 200 for the purpose of indexing the anvil-carrying part 46 to the rod 52. The rod 52, is also provided at i-ts free end with a tapped hole 202 for the purpose of detachably mounting the c,~
anvil-carrying part 46.
The anvil carrying part 46 is illustrated in Figures ,-16-22 inclusive and comprises a plastic body portion 210 of cup shape with a central hub 212 defining a bore 214. A stud 216 is received through the bore 214 and is characterized by knob 48 at one end and a screw thread 220 at its other end with a t.. ~' reduced section 222 defined between its ends. The threading 220 matches the internal threading of the bore at the end j~__~
of rod 52. Clips 224 defined by the portion 210 project into the bore 214 and engage the shoulder defined by the reduced section 222 to hold stud 216 captive in bore 214 but allowing it to rotate freely. The body portion 210 in the vicinity of bore 214 is '~`~
- 30 cutout 226 to accommodate the key 200 at the end of rod 52.
Holes 49 provide venting for the anvil carrying part 46. Metal L~L ~ 516 anvil 230 having two concentric circular arrays of spaced staple clinching grooves 232 and a central hole 233, is mounted `~
onto body portion 210 by "hot s-takiny". Body por-tion 210 defines a plurality of ribs 234 at least two of which are provided wi-th projections or bosses 236. Anvil 230 defines rnatching holes 238 and after mounting, bosses 236 are melted to form rivets 240 to lock anvil 230 on, see particularly Figure 22. Anvil 230 is also provided with punched out lips 242 to secure a cutting block 244 of annular configuration, that cooperates wi-th knife 168. Cutting block 244 is rubber, soft plas-tic or the like. Anvil 230 defines a cutout or keyway 231 as an extension of hole 233 that coacts with key 200 to insure the proper '~`-~
orientation and indexing for grooves 232 of the anvil 230 rela-tive to slots 158 of the staple carrying part 44. Anvil 230 has vent holes 47 which communica-te with vent holes 49 in body 210.
In operation, wing nu-t 60 :Ls rotated to advance rod 52 out from the end of tube 30. A staple carrying part 44 of a disposable cartridge 40 is fitted over rod 52 and -tube 30 and attached to -tube 30 by sleeve 42. The geometry of these parts is such that key 180 engages the neck of staple carrying part 44 before the threading engages to draw part 44 onto tube 30 to its seated position. During the last turns of sleeve 42, the end of driver tube 50 engages the staple ejector 160 to reverse the deten-ts 190 and 192 from the position shown in ~r~
Figure 13 to -the position shown in Figure 10.
Next, the anvil carrying part 46 is assembled in-to the end of projec-ting rod 52. To this end, the knob 43 is grasped and the pointed threaded end of stud 216 is introduced into the `~
tapped hole in the end of rod 52. ~Cey 200 is received a-t this time in keyway 231 of anvil 230 before -the threading engages, 5~
whereafter knob 48 is ro-tated to sea-t threaded end 220 of stud 216 into the tapped hole at the end oE rod 52 and draw the key f'~t 200 into the keyway 231. Keys 180 and 200 assure that slots 158 and grooves 232 are properly aligned. Wing nu-t 60 is -then rotated to retrac-t rod 52 and thus bring anvil part 46 close to s-taple carrying part 44. ~", In this condition, -the instrumen-t is inserted into the patient through the hollow organ that is -to be stapled.
At this time, the patien-t has been prepared such tha-t the hollow organ to be stapled has been cut and there are two cut ends to be joined -together by means of the instrument of the '~
1~' present inventionO The instrument is inserted through the hollow organ until it projects from one of the cut ends. The wing nut 60 is rotated to extend the rod 52, thereby creating a ~~
substantial gap between the anvil-carrying part 46 and the ~;, staple-carrying part 44.
Now, the cut end of the hollow organ through which the instrument is protruding is fashioned with a drawstring suture and drawn over the staple-carrying part 44 about the ~`
rod 52. The other cut end o~ the hollow organ is pulled over the anvil-carrying part 46 and by means of a drawstring suture is tied closely about -the rod 52. Thus, the two cut ends o~
-the hollow organ will be interposed between the anvil part 46 and the staple-carrying part 44. At this time, the wing nut 60 is rotated to cause retraction of the rod 52 whereupon the ~v_~
anvil-carrying part 46 will be brought into close pro~imity with the staple-carrying part 44. Wing nut 60 is turned until a sufficient back pressure is felt caused by squeezing the ~ ~-tissue interposed between the staple carrying part 44 and the ~
~' anvil-carrying part 46.
At this time, the rod 52 will occupy a position ......
within the bocly l0 of the instrument ei-ther as shown in solid lines in Figure 8 with the stop 104 bearing against ;' the stop 130, or due to a yrea-ter than minimum -thickness of entrapped tissue, the stop 104 will be axially displaced off of -the stop 130 to the leEt as shown in phantom.
With -the apparatus in the condition described, -that is, with the cut ends of the hollow organ -to be stapled drawn around the two disposable parts of -the cartridge, the safety 18 is released hy pivoting away from the handle part 14 toward the handle part 12 in the manner shown in phantom in Figure 6 and the handle i5 grasped with the handle part 12 res-ting ln the palm of the hand and -the fingers curled about the handle part 14. ~hen -the fingers are drawn toward the palm of the hand in the manner of making a fist, the handle part 14 will be rotated about its pivot pin 16 clockwise as shown in Figure 6 toward the handle par-t 12. This causes the forks 94 to advance the rollers 80 and -the sleeve 72 axially to the left as shown in Figure 6 and as indicated by the ~I
arrow. This action will force the driver tube 50 which is ,-- 20 threaded into the sleeve 72 to the left as viewed in Figure 6 against the ~ias of spring 56. Advancement of driver tube 50 will in turn produce an advancement of the staple ejector 160 since the neck 161 of this part is in contac-t with the end of the driver tube 50. Advancemen-t of the staple ejector 160 will cause -the fingers 162 to move through the respective slots 158 ejecting the staples 159 contained therein. The ac-tion of the fingers 162 against the staples 159 is depicted ln Figure 15; the forward faces of the fingers 162 are all provided with a V-groove 163 in which the crossbar of -the U-P~
shaped staple 159 is received. This^ assures a better contact be-tween the finger 162 and the staple 159 during ejection.
.2~56 Re~er~ing to Figure 21, the action that -takes place during ejecting of the staple 159 is generally depicted; as ;~
the staples 159 are advanced or ejected out Erom the slots 158, they are contacted by grooves 232 of the anvil 230 and bent into a conventional B-shape as depicted in Figure 21.
Simultaneously with the advancement of the staple ejec-tor 160, ;
the knife 168, which is carried by the s-taple ejector 160, is axially advanced toward the anvil-carrying part and -the knife edge 170 of the knife 168 will in-tersect with the interposed tissue ends of the trapped hollow organs (shown in phantom in Figure 22 at 300 and 302). The cutting edge 170 of the ~`
knife 168, which is circular in configuration, cuts through the tissues 300 and 302 and into the annular cutting block 244, which is held within the anvil 230 by means of the punched-our parts 242, as previously described. The advancing of driver ~, tube 50 continues until stop 80 engages stop lO0 on rod 52, ~_~
the location of stop lO0 being variable in dependence upon tissue ~4`'i W~ ' '-' ~' thickness. ~owever, regardless of the variable location of stop lO0, driver tube 50 will travel whatever distance is necessary to bend the staples always into the same configuration.
There is, of course, a maximum limit to tissue thickness which a specific staple length can accommodate. Figure 22 depicts - in phantom the two concentric circular arrays of staples 159 which join together the ends of the hollow organ to be joined.
The excess portion of the ends of the hollow organ to be joined are severed by the action of knife edge 170. The vent holes 47 in anvil 230 and vent holes 49 formed in the body 210 allow for relief of gas, fluid or excess tissue trapped within the instrument on account of the procedure of stapling. The severed P~
ends 300 and 302 of the hollow organ are retained within the cavity clefined betweerl t~e anvil-carrying part and the s-taple-carrying part. "~
The next step in the procedure would be to ro-tate wing nu-t 60 -to slightly increase the spacing between -the anvil-carrying part and the staple-carrying part to allow the stapled part of the hollow organ to be wi-thdrawn from between these ~"L' I
instrument parts and passed over the anvil-carryiny part 46 so that the ins-trument may be withdrawn. To this end, the anvil-carrying part 46 is provided with an external configura-tion of dish~shape to facilitate -the removal of the stapled organ from between the two par-ts 46 and 44 and passing of -the stapled part ,'~
of the organ over part 46.
This removal is best accomplished when the perimeter of the profile, in section -through the axis as shown in Figure 16, an anvil-carrying part 46 is equal to or less than the circumference of the inner ring of staples represented by the ` inner circular array of spaced staple clinching grooves 232 in ~4".
Figure 19.
~lthough the present invention has been shown and described in terms of a preferred embodlment, it will be appreciated that various changes may be made without departing from the spirit of the concept. For example, the attachment of the anvil-carrying part 46 and the staple-carrying part 44 -has been shown as a threaded engagement or at-tachment. It is important that -the at-tachment be one that may be easily performed in an opera-ting theater and under difficult or extreme conditions.
~ccordingly, any known technique for effecting connection between the parts 44 and 46 and the outer tube 30 and the rod 52, respectively, which would enable quick attachment and detachment would be suitable, for example, bayonet types of connections. ~-
Claims (17)
PROPERTY OR PRIVILEGE IS CLAIMED ARE DEFINED AS FOLLOWS:
1. A two-part assembly for stapling a closed geometric pattern in disconnected sections of hollow organs made of tissue, each of said disconnected sections having an end portion, the assembly comprising an anvil-carrying part having a first tissue-receiving space defined therein; a staple-carrying part having a second tissue-receiving space defined therein, said staple-carrying part associated with said anvil-carrying part for clamping said disconnected sections of said organs therebetween with said end portions being received in said first and second spaces, said first and second spaces, during said clamping, defining a closed cavity; and relief means in at least one of said anvil-carrying and staple-carrying parts for communicating said closed cavity with the exterior of said assembly.
2. The assembly of claim 1, wherein the closed geometric pattern is circular.
3. The assembly of claim 1, wherein said relief means comprises first vent holes extending from an interior surface of said first tissue-receiving space to an exterior surface of said anvil-carrying part.
4. The assembly of claim 1, 2 or 3, wherein said relief means comprises second vent holes extending from an interior surface of said second tissue-receiving space to an exterior surface of said staple carrying part.
5. The assembly of claim 1, wherein said anvil-carrying part comprises an anvil-receiving body and an anvil mounted on said anvil-receiving body for providing a closed geometric array of staple-clinching grooves.
6. The assembly of claim 5, wherein said staple-carrying part comprises a guide body defining a closed geometric array of staple-holding grooves.
7. The assembly of claim 6, further comprising means adapted to mount said anvil-carrying part and said staple-carrying part in an opposed relationship on a surgical instrument so that said staple clinching grooves are aligned with said staple-holding grooves.
8. The assembly of claim 5, wherein said first vent holes are in said anvil-carrying part and in said anvil.
9. The assembly of claim 6, further comprising a staple ejector means mounted in said guide body for movement relative thereto.
10. The assembly of claim 9, further comprising a knife carried by said ejector means.
11. The assembly of claim 1, 2 or 3, wherein the perimeter of the profile, in a section through the axis of the part, of one of the parts is equal to or less than the circumference of the inner diameter of said closed geometric pattern.
12. Apparatus for stapling a closed geometric pattern in disconnected sections of hollow organs made of tissue, each of said disconnected sections having an end portion, the apparatus comprising a two-part assembly accordingly to any one of claims 1,2 or 3; a body; means for mount-ing the staple-carrying part on said body; an elongated member mounted for reciprocating movement relative to said body; means for mounting the anvil-carrying part on said member; and means for reciprocating said member to cause said anvil-carrying part and said staple carrying part to move one towards the other to define said closed cavity.
13. Apparatus for stapling a closed geometric pattern in disconnected sections of hollow organs made of tissue, each of said disconnected sections having an end portion, the apparatus comprising a two-part assembly accord-ing to claim 9 or 10; a body; means for mounting the staple-carrying part on said body; an elongated member mounted for reciprocating movement relative to said body; means for mounting the anvil-carrying part on said member; means for reciprocating said member to cause said anvil-carrying part and said staple-carrying part to move one towards the other to define said closed cavity; and means for activating said ejector means.
14. Apparatus for stapling a closed geometric pattern in hollow organs comprising a body having a bore therethrough; a tubular member received within the bore arranged for reciprocating motion relative to the body;
means for reciprocating said tubular member; a second member mounted to reciprocate within said tubular member; means for reciprocating said second member; and a two-part assembly according to claim 1, there being provided means for detachably mounting said first part of the cartridge assembly in a predetermined indexed orienta-tion on one of the tubular member and the second member, means for detachably mounting the staple-carrying part in a predetermined indexed orientation on the body to be actuated by reciprocation of the other of the tubular member and the second member, means keying the body and said one of the tubular member and the second member into a fixed orientation, and mutually coacting stop means defined on the tubular member and the second member so that the extent of reciproca-tion of said other of the tubular member and the second member is variable in dependence upon the position of said one of the tubular member and the second member which in turn is dependent upon the juxtaposition of the first part with the staple-carrying part of the two-part assembly when the two-part assembly is closed on tissue preparatory to a stapling operation.
means for reciprocating said tubular member; a second member mounted to reciprocate within said tubular member; means for reciprocating said second member; and a two-part assembly according to claim 1, there being provided means for detachably mounting said first part of the cartridge assembly in a predetermined indexed orienta-tion on one of the tubular member and the second member, means for detachably mounting the staple-carrying part in a predetermined indexed orientation on the body to be actuated by reciprocation of the other of the tubular member and the second member, means keying the body and said one of the tubular member and the second member into a fixed orientation, and mutually coacting stop means defined on the tubular member and the second member so that the extent of reciproca-tion of said other of the tubular member and the second member is variable in dependence upon the position of said one of the tubular member and the second member which in turn is dependent upon the juxtaposition of the first part with the staple-carrying part of the two-part assembly when the two-part assembly is closed on tissue preparatory to a stapling operation.
15. Apparatus according to claim 14, wherein said mutually coacting stop means are defined by mutually engaging bevelled surfaces.
16. Apparatus according to claim 14, wherein the extent of reciprocation of the tubular member is variable in dependence upon the position of the second member.
17. Apparatus according to claim 14, 15 or 16, wherein the second member is a rod.
Priority Applications (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CA000392747A CA1138286A (en) | 1977-05-26 | 1981-12-18 | Instruments for circular stapling of hollow body organs and disposable cartridge therefor |
| CA000392746A CA1137378A (en) | 1977-05-26 | 1981-12-18 | Instruments for circular stapling of hollow body organs and disposable cartridge therefor |
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US80096577A | 1977-05-26 | 1977-05-26 | |
| US800,965 | 1977-05-26 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA1124156A true CA1124156A (en) | 1982-05-25 |
Family
ID=25179837
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA304,047A Expired CA1124156A (en) | 1977-05-26 | 1978-05-25 | Instrument for circular surgical stapling of hollow body organs and disposable cartridge therefor |
Country Status (7)
| Country | Link |
|---|---|
| JP (3) | JPS53148190A (en) |
| CA (1) | CA1124156A (en) |
| DE (3) | DE2822803C2 (en) |
| FR (1) | FR2391702A1 (en) |
| GB (3) | GB1602562A (en) |
| HK (3) | HK99185A (en) |
| IT (1) | IT1095540B (en) |
Families Citing this family (27)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| DE2947107A1 (en) * | 1978-12-07 | 1980-06-26 | United States Surgical Corp | ACCURATELY ALIGNED CARTRIDGE AND INSTRUMENT FOR CLAMPING ANASTOMOSES |
| JPS5578950A (en) | 1978-12-09 | 1980-06-14 | Takasago Ika Kogyo Kk | Suture device of duct portion in body |
| SU886900A1 (en) * | 1979-03-26 | 1981-12-07 | Всесоюзный научно-исследовательский и испытательный институт медицинской техники | Surgical apparatus for applying line sutures |
| SU1088712A1 (en) * | 1979-11-14 | 1984-04-30 | Всесоюзный научно-исследовательский и испытательный институт медицинской техники | Apparatus for circular suture of blood vessels |
| SU942719A1 (en) * | 1979-11-23 | 1982-07-15 | Всесоюзный научно-исследовательский и испытательный институт медицинской техники | Surgical suturing apparatus for application of linear sutures |
| US4319576A (en) * | 1980-02-26 | 1982-03-16 | Senco Products, Inc. | Intralumenal anastomosis surgical stapling instrument |
| US4576167A (en) * | 1981-09-03 | 1986-03-18 | United States Surgical Corporation | Surgical stapler apparatus with curved shaft |
| JPS59500949A (en) * | 1982-05-28 | 1984-05-31 | ユナイテツド ステイツ サ−ジカル コ−ポレ−シヨン | surgical stapler with flexible shaft |
| JPS591327U (en) * | 1982-06-24 | 1984-01-06 | 東芝熱器具株式会社 | electric pot |
| DE3300768C2 (en) * | 1983-01-12 | 1985-04-04 | Kurt Dr. med. 4030 Ratingen Groeben | Surgical instrument for connecting two hollow organs by means of clamps |
| JPS60113007U (en) * | 1983-12-29 | 1985-07-31 | 高砂医科工業株式会社 | Suture device for internal ducts |
| JPS60116943U (en) * | 1984-01-17 | 1985-08-07 | オルゴ株式会社 | electric pot |
| JPH01112564U (en) * | 1988-01-26 | 1989-07-28 | ||
| JPH05338516A (en) * | 1991-11-13 | 1993-12-21 | Rikio Miyamoto | Structure of double type wiper rubber and blade fixing part |
| US5522534A (en) * | 1993-10-01 | 1996-06-04 | United States Surgical Corporation | Anvil for surgical stapler |
| AU2015200658B2 (en) * | 2007-05-25 | 2017-03-02 | Covidien Lp | Staple buttress retention system |
| US8038045B2 (en) | 2007-05-25 | 2011-10-18 | Tyco Healthcare Group Lp | Staple buttress retention system |
| US8453913B2 (en) * | 2009-02-06 | 2013-06-04 | Covidien Lp | Anvil for surgical stapler |
| US8858590B2 (en) | 2011-03-14 | 2014-10-14 | Ethicon Endo-Surgery, Inc. | Tissue manipulation devices |
| US10709452B2 (en) | 2013-09-23 | 2020-07-14 | Ethicon Llc | Methods and systems for performing circular stapling |
| US10980542B2 (en) | 2016-11-14 | 2021-04-20 | Ethicon Llc | Circular surgical stapler with recessed deck |
| WO2015065484A1 (en) * | 2013-11-04 | 2015-05-07 | Covidien Lp | Surgical fastener applying apparatus |
| US10542991B2 (en) | 2016-04-01 | 2020-01-28 | Ethicon Llc | Surgical stapling system comprising a jaw attachment lockout |
| US11284890B2 (en) | 2016-04-01 | 2022-03-29 | Cilag Gmbh International | Circular stapling system comprising an incisable tissue support |
| US10307159B2 (en) | 2016-04-01 | 2019-06-04 | Ethicon Llc | Surgical instrument handle assembly with reconfigurable grip portion |
| USD837373S1 (en) | 2016-11-14 | 2019-01-01 | Ethicon Llc | Surgical stapler |
| USD833608S1 (en) | 2016-11-14 | 2018-11-13 | Ethicon Llc | Stapling head feature for surgical stapler |
Family Cites Families (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CH470170A (en) * | 1968-02-02 | 1969-03-31 | Vnii Khirurgicheskoi Apparatur | Device for applying round anastomoses |
| US3552628A (en) | 1969-05-02 | 1971-01-05 | Rayrivet Inc | Fluid actuated riveting apparatus |
| US3638652A (en) * | 1970-06-01 | 1972-02-01 | James L Kelley | Surgical instrument for intraluminal anastomosis |
| JPS4735676U (en) * | 1971-05-19 | 1972-12-20 |
-
1978
- 1978-05-19 GB GB35761/80A patent/GB1602562A/en not_active Expired
- 1978-05-19 GB GB35762/80A patent/GB1602563A/en not_active Expired
- 1978-05-19 GB GB20869/78A patent/GB1602561A/en not_active Expired
- 1978-05-24 DE DE2822803A patent/DE2822803C2/en not_active Expired
- 1978-05-24 DE DE2858033A patent/DE2858033C2/en not_active Expired
- 1978-05-24 DE DE2858032A patent/DE2858032C2/en not_active Expired
- 1978-05-25 CA CA304,047A patent/CA1124156A/en not_active Expired
- 1978-05-25 FR FR7815650A patent/FR2391702A1/en active Granted
- 1978-05-25 IT IT23790/78A patent/IT1095540B/en active
- 1978-05-26 JP JP6323978A patent/JPS53148190A/en active Granted
-
1982
- 1982-02-24 JP JP57028712A patent/JPS60857B2/en not_active Expired
- 1982-02-24 JP JP57028711A patent/JPS5918058B2/en not_active Expired
-
1985
- 1985-12-12 HK HK991/85A patent/HK99185A/en not_active IP Right Cessation
- 1985-12-12 HK HK993/85A patent/HK99385A/en not_active IP Right Cessation
- 1985-12-12 HK HK992/85A patent/HK99285A/en not_active IP Right Cessation
Also Published As
| Publication number | Publication date |
|---|---|
| IT7823790A0 (en) | 1978-05-25 |
| HK99185A (en) | 1985-12-20 |
| JPS57183843A (en) | 1982-11-12 |
| DE2858032C2 (en) | 1985-08-22 |
| DE2858033C2 (en) | 1986-09-25 |
| FR2391702A1 (en) | 1978-12-22 |
| GB1602561A (en) | 1981-11-11 |
| JPS60857B2 (en) | 1985-01-10 |
| JPS57183842A (en) | 1982-11-12 |
| DE2822803C2 (en) | 1982-12-23 |
| JPS53148190A (en) | 1978-12-23 |
| JPS5918058B2 (en) | 1984-04-25 |
| DE2822803A1 (en) | 1978-12-07 |
| HK99385A (en) | 1985-12-20 |
| IT1095540B (en) | 1985-08-10 |
| JPS5755421B2 (en) | 1982-11-24 |
| HK99285A (en) | 1985-12-20 |
| GB1602562A (en) | 1981-11-11 |
| GB1602563A (en) | 1981-11-11 |
| FR2391702B1 (en) | 1982-12-10 |
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Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| MKEX | Expiry |