CH450623A - Stapling instrument with staple cartridge for suturing hollow organs or the like - Google Patents
Stapling instrument with staple cartridge for suturing hollow organs or the likeInfo
- Publication number
- CH450623A CH450623A CH978166A CH978166A CH450623A CH 450623 A CH450623 A CH 450623A CH 978166 A CH978166 A CH 978166A CH 978166 A CH978166 A CH 978166A CH 450623 A CH450623 A CH 450623A
- Authority
- CH
- Switzerland
- Prior art keywords
- cartridge
- instrument
- sub
- instrument according
- loader
- Prior art date
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
- A61B17/068—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
-
- 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
- A61B17/07207—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 the staples being applied sequentially
-
- 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
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
- A61B2090/038—Automatic limiting or abutting means, e.g. for safety during shipment
Description
Instrument agrafeur avec cartouche d'agrafes pour la suture d'organes creux ou similaires
La présente invention a pour objet un instrument agrafeur avec cartouche d'agrafes pour la suture d'organes creux ou similaires, comprenant un élément portant une branche de mâchoire destinée à venir en contact avec l'organe à suturer, un corps d'instrument destiné à l'actionnement de cet élément et raccordé à celui-ci, un organe chargeur placé sur ledit corps d'instrument et mobile en direction de ladite branche de mâchoire et en sens opposé.
On a déjà mis au point des instruments du type ainsi défini, qui comprennent une cartouche d'acier. amovible, portant un certain nombre d'agrafes en U placées dans une position prédéterminée les unes par rapport aux autres, cette cartouche étant destinée à tre fixée dans le corps d'un instrument actionné manuellement. Ordinairement, l'instrument comporte. une tige d'actionnement à l'extrémité antérieure de laquelle sont disposés un certain nombre de doigts minces ou lames qui, lorsque l'instrument est monté, se placent dans l'alignement des fentes de logement des agrafes dans la cartouche. L'instrument est utilisé en poussant la tige d'actionnement vers l'avant de sorte que les doigts ou lames pénètrent dans les rai nures -correspondantes -et poussent les agrafes vers
L'avant à travers la surface frontale de la cartouche.
Toutefois, on a constaté que les lames ou doigts dirigés vers l'avant se -courbent ou se déforment très facilement au cours de la manipulation nécessaire, d'où il résulte un défaut d'alignement entre le doigt qui est cintré et la fente qui lui correspond se traduisant par un coincement de l'instrument. Ce coincement est très fâcheux, car le chirurgien ne peut prévoir que son instrument va se coincer et cet incident se. produit à un temps critique de l'intenentiDn.
Si le. chirurgien désire utiliser une cartouche prés. en tant des rainures de forme différente:il est nécessaire de remplacer la tige d'actionnement par une autre vint. .la disposition différente des doigts ou lames correspond à la forme des fentes de la cartouche. Une erreur humaine peut alors se produire dans le choix de l'autre tige d'actionnement, ce qui peut aboutir au coincement de l'instrument à un moment critique de l'opération, comme on l'a précédemment indiqué.
Un autre inconvénient est que le nettoyage et la stérilisation de la tige d'actionnement usuelle. exigent un grand soin et demandent beaucoup de temps, du fait des lames délicates qui y sont montées.
Etant donné que les cartouches traditionnelles sont
exécutées en un acier soumis à un traitement de finition. il n'est pas possible pour des raisons économiques de les jeter et il convient de les restériliser et de les charger individuellement après usage.
I1 est maintenant courant dans ce domaine de livrer
les agrafes dans leur propre emballage. Ce n'est qu'au
moment où les agrafes arrivent à leur point d'utilisation qu'elles sont chargées dans la cartouche de l'instrument.
L'usage actuel est d'employer une petite pince ou un instrument analogue pour insérer à la main chaque agrafe
dans une fente de la-cartouche d'acier, jusqu'à ce que
celle-ci soit complètement chargée. On comprendra aisé
ment qu'il s'agit là d'un procédé lent et fastidieux, s'aecompagnant de grands risques d'endommager les
agrafes.
La présente invention vise à remédier aux inconvé
nients ci-dessus mentionnés et l'instrument qui en fait l'objet est caractérisé par un bloc porte-agrafes compre
nant une cartouche d'agrafes et un organe éjecteur
d'agrafes, le bloc étant monté coulissant et amovible sur
l'organe chargeur de façon à pouvoir tre jeté après
usage, en ce.
que la branche de mâchoire présente un tas-
seau muni d'éléments de fermeture des agrafes dont la
disposition correspond à celle des agrafes dans la cartou
che et venant en regard de ses agrafes, en ce que des moyens sont disposés dans le corps d'instrument et sontmobiles par rapport à lui afin de déplacer la cartouche montée sur l'organe à suturer qui est pincé entre ladite cartouche et le tasseau, et en ce que des moyens d'entraî- nement sont montés coulissants dans le corps d'instrument et viennent en prise avec l'organe éjecteur des agrafes lorsqu'ils sont poussés en avant pour effectuer l'éjection des agrafes contenues dans la cartouche.
Le dessin annexé représente, à titre d'exemple, deux formes d'exécution de l'instrument faisant l'objet de la présente invention.
La fig. 1 est une vue en élévation latérale de la première forme d'exécution.
La fig. 2 est une vue en élévation arrière de cette forme d'exécution.
La fig. 3 est une vue en élévation latérale de l'organe de blocage amovible.
La fig. 4 est une vue en élévation frontale du magasin d'agrafes.
La fig. 5 est une vue en élévation frontale de l'organe d'entraînement sur lequel se trouvent les doigts d'entraînement.
La fig. 6 est une coupe en élévation latérale passant par la ligne 6-6 de la fig. 4.
La fig. 7 est une vue partielle éclatée de l'une des fentes du magasin d'agrafes.
La fig. 8 est une vue en élévation frontale d'une variante de magasin, où les fentes de logement des agrafes sont disposées horizontalement.
La fig. 9 est une vue en élévation frontale de l'organe d'entraînement destiné à tre utilisé avec le magasin représenté sur la fig. 8.
La fig. 10 est une coupe en élévation latérale passant par la ligne 10-10 de la fig. 8.
La fig. 1 1 est une vue en plan supérieure de la variante illustrée par la fig. 8.
La fig. 12 illustre la partie mâchoire frontale de l'instrument (partiellement en coupe) sur laquelle est monté le magasin.
La fig. 13 est une vue en plan supérieur, partiellement en coupe, de la partie de l'instrument illustrée par la fig. 12.
La fig. 14 est un plan supérieur en coupe passant par la ligne 14-14 de la fig. 12.
La fig. 15 est une vue en élévation latérale d'un magasin d'agrafes comportant un organe de verrouillage de sécurité correspondant à une autre variante.
La fig. 16 représente le magasin d'agrafes avec encore une variante de l'organe de verrouillage de sécurité.
La fig. 17 est une coupe vue en plan supérieur, passant par la ligne 17-17 de la fig. 16.
La fig. 18 est une vue partielle en élévation latérale de la seconde forme d'exécution, ne représentant que la partie avant de l'instrument.
La fig. 19 est une vue partielle en coupe inférieure, passant par la ligne 19 de la fig. 18.
La fig. 20 est une vue en plan supérieur d'une cartouche entièrement chargée.
La fig. 21 est une vue latérale en coupe et fragmentaire de la cartouche et de l'instrument en cours de fonctionnement.
La fig. 22 est une vue en coupe frontale passant par la ligne-22-22 de -la - fig.-21.-
- La- fig. 23 est une vue en perspective de l'une des plaques-poussoirs de la cartouche illustrée par la fig. 20.
La première forme d'exécution de l'instrument représentée dans les fig. 4, 5, 6 et 7 comprend un bloc portecartouche et éjecteur, désigné dans l'ensemble par 10. Le bloc 10 est composé d'une cartouche porte-agrafes 12, à laquelle est associé un organe 14 d'entraînement des agrafes. La cartouche 12 est exécutée en une matière plastique, par exemple en Texan , nom de marque donné par la General Electric, à une résine thermoplastique de polycarbonate qui peut tre moulée ou extrudée. ou en tout autre matériau peu coûteux mais susceptible d'tre utilisé comme pièce de la pince de l'instrument.
La cartouche 12 présente une face avant plane 16 et des artes verticales biseautées et elle est munie d'un certain nombre de fentes 18 en quinconce qui traversent le corps de la cartouche et qui, dans cette forme d'exécution. sont disposées verticalement en deux colonnes parallèles.
Comme on peut le voir sur la fig. 7, chaque fente comporte un segment central élargi et deux canaux de guidage semi-circulaires 19, opposés l'un à l'autre selon la grande dimension de la fente 18, ces canaux de guidage 19 étant formés de manière à recevoir chaque branche d'une agrafe 20 pour déterminer la direction du mouvement de cette agrafe. La branche de jonction de l'agrafe 20 s'étend d'un bout à l'autre de la partie élargie de la fente 18, à distance de ses parois. Le sommet 22 de la cartouche est plat; par contre, une rainure verticale 24 est formée sur chacune de ses faces latérales; la rainure 24 et le sommet 22 coopèrent avec l'instrument, comme on le verra ultérieurement. Deux trous 26 traversent également la cartouche 12 et sont destinés à recevoir une clavette de sûreté 42 formée en U.
De préférence, L'organe 14 d'entraînement des agrafes est exécuté en métal et comprend un corps arrière vertical 28 et un certain nombre de lames-poussoirs 30 qui s'étendent à partir de la face frontale de ce corps et sont disposés de manière à correspondre et à pénétrer en partie dans chaque fente 18 de la cartouche 12. La dimension de chaque lame 30 est prévue pour qu'elle s'ajuste de façon mobile mais à frottement doux dans la fente 18 correspondante. Du fait du segment élargi de chaque rainure 18, I'épaisseur de chaque lame 30 est quelque peu supérieure à celle de l'agrafe, de sorte que les lames sont plus robustes et moins facilement déformables que celles qui existent actuellement. La longueur
L de chaque doigt (voir fig. 6) est suffisante pour pousser les agrafes en avant de la face 16 de la cartouche quand l'organe poussoir 14 est poussé dans cette direction.
Sur les fig. 1, 2 et 3, on a représenté un bloc 10 complètement chargé, prt à l'expédition dans un emballage stérile usuel (non représenté). Lors de la fabrication et de l'assemblage du bloc 10, un organe 34 de verrouillage de sûreté à trois dents, dont la tte comporte un trou 35 pour l'introduction de la lame, est monté de manière à verrouiller le bloc 10. De préférence, l'organe de verrouillage 34 est en matière plastique et comporte trois branches espacées 36, 38 et 40; les dimensions de ces
branches et les intervalles qui les séparent sont tels que la branche médiane 38 s'ajuste à frottement doux entre le corps arrière 28 et la face postérieure de la cartouche
12, pour éviter que les lames 30 pénètrent davantage
dans la cartouche 12.
Comme on peut le voir sur la fig. 1. la branche postérieure 36 la plus courte recouvre partiellement le corps arrière 28, tandis que. la branche avant est au contact de la face antérieure 16. De cette manière tout mouvement relatif intempestif entre l'organe d'en- traînement 14 et la cartouche 12 est éliminé pendant le transport du bloc chargé. Ainsi, la stérilisation du bloc 10 n'a besoin d'tre faite qu'une seule fois. lors de sa fabrication et de son montage.
Etant donné qu'il existe de nombreuses cartouches dont les fentes sont disposées différemment, chaque bloc 10 est emballé avec le tasseau qui lui est associé et, pour garantir un appariement correct, le bloc et le tasseau associé sont dotés d'un code de couleur. Le tasseau 49 comporte un corps allongé sur la face frontale duquel des dépressions 54 sont placées dans l'alignement des fentes 18 quand l'instrument est prt à l'emploi. Une rainure latérale allongée 51 assure la mise en place du tasseau 49 sur l'instrument et toute disposition usuelle peut tre prise pour maintenir le tasseau 49 en bonne place; par exemple, il peut tre monté sur sa paroi postérieure un ressort à lame qui porte contre la branche avant de la pince en C quand le tasseau est monté.
Sur les fig. 12, 13 et 14, on a représenté la partie avant de l'instrument de suture qui comprend la mâchoire 50 dont la branche avant 52 est munie, à son extrémité supérieure, de deux rebords 15 dirigés vers l'intérieur et destinés à recevoir les rainures correspondantes du tasseau 49. Un corps d'instrument 55, profilé en U, se raccorde à l'autre branche de la mâchoire 50 et comporte, à son extrémité avant, des oreilles verticales 61; sur la face interne de chaque oreille, une rainure longitudinale 63 est formée à des fins qui seront indiquées ci-après. Un tube creux rectangulaire 56 est logé par glissement dans le corps en U 55 et sert à recevoir et à guider la tige d'actionnement 58 qui est mobile axialement dans ce tube.
A la place des lames-poussoirs ou doigts, il est monté, à l'extrémité avant de la tigepoussoir 58, une tte-poussoir en U 60, allongée en direction verticale, visible sur les fig. 13 et 14.
Un organe chargeur 62, dont les parois latérales 64 et 66, à distance l'une de l'autre, comportent des rebords antérieurs élargis 68, se raccordent d'une seule pièce au tube 56 et son extrémité inférieure est profilée pour suivre une piste de guidage 70 formée sur le fond intérieur de la mâchoire 50. Deux trous parallèles 72 s'étendent en direction de l'avant dans la saillie supérieure de l'organe chargeur 62 et leur rôle est de recevoir les branches de la clavette de verrouillage en U 42.
D'une seule pièce avec l'arrière de l'organe chargeur 62 et l'extrémité avant du tube creux 56, une pièce verticale 57 comporte une tige de guidage 59 qui s'étend latéralement et coulisse dans la rainure 63 correspondante de l'oreille 60. Les tiges 59 assurent un mouvement commandé vers l'avant et vers l'arrière de l'organe chargeur 62 et s'opposent à tout mouvement vertical relatif entre cet organe et la mâchoire 50.
Le montage et le fonctionnement de l'instrument décrit sont les suivants. Avant d'tre stérilisée, la cartouche 12 est munie à la machine d'une charge d'agrafes et l'organe 14 d'entraînement des agrafes y est monté, ainsi que l'organe 34 de verrouillage de sûreté, selon le mode indiqué sur la fig. 1. L'ensemble est ensuite empaqueté, en mme temps que le tasseau 49 stérilisé, dans un emballage aseptique usuel d'expédition (non représenté). Tout mouvement relatif intempestif entre l'organe d'entraînement 14 et la cartouche 12 est éliminé par l'organe 34 de verrouillage de sûreté, comme on l'a déjà indiqué. Lorsque l'emballage arrive à l'hôpital, il peut tre emmagasiné jusqu'au moment de son emploi, où il est ouvert, et son contenu est placé dans un champ stérile de façon à tre directement accessible au cours de l'opération.
Une fois que le malade est complètement préparé. l'organe 34 de verrouillage de sûreté est enlevé à la main et jeté. Le tasseau 49 est mis en place sur la branche 52. On introduit alors le bloc porte-agrafes ayant la couleur de code voulue en position opératoire à l'extrémité avant de l'organe chargeur 62. en le faisant glisser dans le sens des flèches qui y sont gravées (voir fig. 12). de sorte que les rainures 24 glissent sur les rebords élargis 68. La position verticale du bloc 10 est déterminée par le contact entre le haut des rebords 68 et le surplomb ou sommet des rainures 24. Une fois que le bloc 10 est complètement en place. les branches de la clavette 42 en U sont introduites dans les trous 72, de sorte que le bloc 10 est verrouillé en position opératoire.
Comme on peut le voir sur la fig. 14, quand le bloc 10 est en position opératoire. le corps arrière 28 de l'organe d'entraînenent 14 se trouve dans l'intervalle entre les parois latérales 64 et 66 de l'organe chargeur 62, dans l'alignement et à distance de la cavité de la tte 60.
Au moment de l'emploi. le tube creux 56 est poussé vers l'avant et la face frontale 16 de la cartouche 12 coopère avec le tasseau 49 pour pincer l'organe à suturer en bonne position. Ensuite, la tige d'actionnement 58 est poussée vers l'avant de sorte que la tte en U 60 embrasse le corps arrière 28 de l'organe d'entraînement 14, lequel entraîne à son tour chacun des doigts 30 vers l'avant dans les fentes 18. De cette manière, chaque agrafe 20 est entraînée depuis sa propre rainure 18 vers l'avant dans l'organe à suturer et, lorsqu'elles entrent en contact avec la dépression 54 qui leur correspond dans le tasseau, les branches de l'agrafe sont rabattues pour prendre une forme d'agrafage définitif. Les agrafes 20 sont entraînées vers l'avant jusqu'à ce que leur partie postérieure se dégage de la face avant de la cartouche 12.
Après quoi, le tube creux 56 est attiré vers l'arrière. ce qui supprime l'effet de serrage exercé sur l'organe suturé entre la face frontale 16 et le tasseau 49. Une fois que l'instrument a été éloigné du malade, le bloc 10 entièrement épuisé et le tasseau 49 sont retirés et jetés.
L'instrument est alors prt à recevoir un autre bloc 10 entièrement chargé, qui peut tre facilement et rapidement monté sur l'organe chargeur 62. selon le mode décrit ci-dessus.
Sur les fig. 15. 16 et 17, on a représenté d'autres variantes de l'organe 42 de verrouillage de sûreté dont il a déjà été fait mention. L'organe 80 de verrouillage de sûreté représenté sur la fig. 15 comporte une tte rectangulaire et est muni d'une clavette en U 82 allongée vers le bas, dont les branches verticales sont noyées dans la partie en matière plastique qui constitue la tte de l'organe de verrouillage 80. La branche avant 84 est au contact de la paroi arrière de la cartouche 12 et la branche arrière 86 prend contact avec la partie avant du corps arrière 28 de l'organe d'entraînement 14. De mme que dans la forme d'exécution décrite à propos de la fig. 1.
L'organe de verrouillage 80 comporte des dents appendues avant et arrière qui prennent respectivement contact avec la face avant de la cartouche 12 et la paroi arrière de l'organe d'entraînement 14. Le mode d'action de la forme d'exécution de la fig. 15 correspond à ce qui a été décrit précédemment.
La cartouche 12 2 et le corps arrière 28 du modèle représenté sur la fig. 17 présentent l'un et l'autre un trou vertical allongé 88 et 90, en position pratiquement centrale. Dans cette forme d'exécution, l'organe de verrouillage 92 est également rectangulaire et présente deux clavettes de fil métallique 94 et 96 s'étendant parallèlement vers le bas à distance l'une de l'autre, dont l'extrémité supérieure est noyée dans la tte de l'organe de verrouillage 92, comme indiqué sur la fig. 16. Les clavettes 94 et 96 sont convenablement espacées pour pouvoir tre reçues par les trous 88 et 90 quand l'organe de verrouillage 92 est assemblé au bloc 10. L'organe de verrouillage 92 présente également une branche avant qui prend contact avec la face frontale du magasin 12 en position d'assemblage.
Le mode d'action de la variante illustrée par les fig.
16 et 17 ressort de la description précédente et il est manifeste que les clavettes 94 et 96 s'opposent à un mouvement relatif intempestif entre l'organe d'entraînement 14 et la cartouche 12. Au moment du montage du bloc 10 sur l'instrument à suturer, L'organe de verrouillage 92 est enlevé comme décrit ci-dessus et le bloc 10 est prt à tre mis en place.
Sur les fig. 8 à 11, on a représenté une variante du bloc 10. les mmes chiffres de référence se rapportant aux mmes éléments. Dans cette variante, les fentes 18 et les doigts 30 correspondants sont disposés horizontalement et alignés en une unique colonne verticale. Le mode de fonctionnement de cette variante et sa coopération avec l'instrument sont les mmes que ci-dessus et l'organe de verrouillage utilisé avec un dispositif de ce type sera celui qui est illustré par les fig. 16 et 17 ; on n'a pas représenté les trous verticaux appropriés dans le corps arrière 28 et la cartouche 12.
Il est bien entendu qu'on peut prévoir tout nombre ou disposition voulus de fentes dans la cartouche 12. Toutefois, la tige d'actionnement doit pouvoir tre utilisée avec toutes les variantes possibles de cartouches, bien que la disposition de leurs fentes puisse différer.
Sur les fig. 18 à 23, on a représenté une autre forme d'exécution de l'instrument, comprenant un bloc porteagrafes et éjecteur désignés dans l'ensemble par 100. Le bloc 100 est composé d'une cartouche 102 profilée en U et allongée, qui est munie d'un certain nombre de fentes 104 parallèlement espacées. traversant l'une et l'autre de ses branches. La cartouche 102 est exécutée en une matière plastique telle que le Texan ou similaire et elle présente un nez élargi 106 qui facilite l'introduction de l'instrument dans l'organe creux à suturer.
Comme on peut mieux le voir sur la fig. 20. chaque fente 104 consiste en une large rainure 108 de positionnement des agrafes. dimensionnnée de manière à recevoir et à guider une agrafe chirurgicale 110. en une fente intermédiaire 112 et en une fente à orifice étroit 114. La rainure et les fentes communiquent entre elles et comportent des parois latérales dirigées verticalement qui sont planes à l'exception de deux butées 116 regardant vers l'intérieur. situées au bas des parois latérales de la fente 114, comme on l'a indiqué sur la fig. 21.
Un organe 118 d'entraînement des agrafes est prévu près du sommet de chaque fente 104, en arrière de l'agrafe 110 qui s'y trouve. Chaque organe d'entraînement présente une plaque-poussoir carrée 120 avec un bouton intermédiaire cylindrique 122 disposé symétriquement sur une face de cette plaque et un bouton de came plus petit 124, coaxial au bouton 122. Comme on le voit sur les figures, l'épaisseur et la largeur de la plaquepoussoir 120 sont telles que sa face arrière soit exactement au contact de la paroi externe de la fente 104, tandis qu'une partie de sa face frontale se trouve en contact à glissement avec les parois avant de la fente 112. Les parties avant des deux parois latérales de la plaquepoussoir 120 glissent au contact des parois latérales de la fente 112.
De cette manière, une plaque-poussoir est activement guidée lors de son mouvement vers le bas dans la fente 104 et le bas de la plaque-poussoir 120 entre en contact avec la branche de jonction de l'agrafe 110 pour pousser cette dernière vers le bas lorsque l'instrument est utilisé. Le bouton intermédiaire 122 coopère avec les parois latérales de la fente 114 et vient heurter les butées 116 lorsque l'organe d'entraînement 118 atteint sa position inférieure. En outre, les butées 116 s'opposent à ce que l'organe 118 d'entraînement des agrafes s'échappe de la cartouche 102. Comme l'indique la fig.
22, les boutons de came 124 ont leur face dirigée vers l'intérieur et s'étendent partiellement dans l'intervalle central 126 de la cartouche en U 102. Les boutons de came 124 sont également à distance de la paroi supérieure 103 de la cartouche 102.
Sur les fig. 18 et 19, on a représenté un instrument médical désigné dans l'ensemble par 128 et comprenant une pince à mâchoire inférieure allongée 130, biseautée vers son extrémité avant et comportant deux parois externes verticales 134 distantes l'une de l'autre de façon à délimiter une rainure allongée 132. La surface supérieure de chaque paroi 134 représente au pincement une surface constituant un tasseau muni de dépressions et d'un certain nombre de dents verticales espacées longitudinalement, qui concourent à la fixation du tissu pincé.
L'instrument 128 comprend également un organe chargeur profilé en U 136, allongé et dirigé vers l'avant, comportant deux doigts 138 aux extrémités inférieures de ses branches opposées. Les dimensions de l'organe en
U 136 sont telles qu'il puisse recevoir par glissement sur sa surface interne le bloc entier 100 qui, complètement positionné. reçoit les doigts 138 dans des entailles 140 de forme correspondante. situées en bas et en arrière du nez 106. Etant donné que le sommet du nez 106 se trouve légèrement au-dessus du sommet 103 de la cartouche 102, le bloc 100 et l'organe en U 136 fournissent, en position d'assemblage, une surface supérieure unie et continue évitant les heurts quand l'instrument est introduit ou extrait de l'organe à suturer (voir fig. 18).
La cartouche 102 présente également une saillie 145 dirigée vers l'arrière, qui s'ajuste dans le canal 147 de l'instrument. Le bloc 100 est fermement maintenu sur l'instrument par la clavette de verrouillage 142 qui traverse des ouvertures 144 dans l'organe en U 136 et pénètre dans des évidements 146 du sommet de la cartouche 102.
L'instrument 128 est également muni d'une tige d'actionnement 148, mobile axialement, disposée dans sa poignée et en position axiale à l'arrière de l'organe en
U 136. Un plan incliné 150 est prévu à l'extrémité antérieure de la tige d'actionnement 148 et présente une surface de came 152 à sa partie inférieure. Une lame 154 présente une arte de coupe antérieure et est montée au-dessous de la tige d'actionnement 148, légèrement en arrière de la surface de came 152. Comme on peut le voir sur la vue inférieure de la fig. 19, la tige d'actionnement 148, la surface de came 152 et la lame 154 sont alignées dans l'intervalle central 126 de la cartouche 102.
.Le reste de l'instrument 128, y compris la poignée et les mécanismes d'actionnement, peut tre d'un quelconque type usuel, correspondant par exemple au modèle décrit dans le brevet américain No 3079606. En ce qui concerne le reste de l'instrument 128, le mode de fonctionnement de ses mécanismes d'assemblage, de pivotement et de verrouillage peut correspondre à ce qui est décrit dans ce brevet américain et ses caractéristiques structurales et fonctionnelles n'entrent pas dans le cadre de la présente invention.
La description suivante concerne le fonctionnement de cette forme d'exécution de l'instrument. Lors de la fabrication et de l'assemblage du bloc 10, toutes ses pièces sont stérilisées et empaquetées dans des emballages aseptiques convenables, utilisés pour le transport du bloc 100 entre son point de fabrication et l'hôpital. Cet emballage peut tre stocké pendant tout le temps voulu à l'hôpital jusqu'à l'emploi: à ce moment, l'emballage est ouvert, le bloc 100 en est extrait puis assemblé sur l'organe en U 136 de l'instrument. La clavette de verrouillage 142 est introduite par les trous 144 dans les évidements 146, afin d'immobiliser le bloc 100 en position de service sur l'instrument.
Etant donné que le nez 106 présente une surface lisse et arrondie, il ne se produit aucun heurt au moment de l'introduction de la mâchoire inférieure dans l'organe creux à suturer. Une fois que la mâchoire supérieure de l'instrument est en place, la mâchoire inférieure 130 subit un mouvement de bas en haut, de sorte que ses surfaces formant tasseaux serrent le tissu en coopérant avec les surfaces inférieures de la cartouche 102. Comme on le voit sur la fig. 21, les deux couches de tissu sont ainsi pincées en position superposée. Lorsque le chirurgien considère que le tissu est convenablement pincé. la tige d'actionnement 148 est poussée vers l'avant par un quelconque moyen usuel, par exemple celui qui est décrit dans le brevet américain No 3079606.
Comme on peut le voir sur la fig. 21, la surface de came 152 du plan incliné 150 prend contact avec tous les boutons de came 124 successifs et ceux-ci sont poussés vers le bas en conséquence du mouvement relatif entre cette surface et ces boutons. De cette manière, chaque plaque-poussoir 120 est poussée vers le bas dans son propre canal 104 et. par suite, son extrémité inférieure pousse l'agrafe correspondante 110 vers le bas dans la fente 108. Après avoir percé les couches du tissu, les branches de l'agrafe 110 prennent contact avec les dépressions de la surface-tasseau des parois 134; les branches sont rabattues en dedans et en bas au fur et à mesure que la plaque-poussoir 120 continue à s'abaisser par suite du mouvement de la surface de came 152.
La lame 154 fait immédiatement suite à la surface de came 152 pendant son déplacement vers l'avant et sectionne les couches de tissu préalablement suturées sur une ligne exactement intermédiaire entre les rangées parallèles d'agrafes.
Une fois que toutes les agrafes sont fixées, la mâchoire inférieure 130 est dégagée et l'instrument est extrait vers l'arrière. Les butées 116 des fentes 104 empchent les organes poussoirs de tomber accidentellement hors des fentes.
Une fois que l'instrument a été extrait de l'organe suturé, le bloc 100 est retiré et jeté. A ce moment, I'ins- trument est prt à recevoir un autre bloc 100 entièrement chargé.
Stapling instrument with staple cartridge for suturing hollow organs or the like
The present invention relates to a stapling instrument with a staple cartridge for suturing hollow organs or the like, comprising an element carrying a jaw branch intended to come into contact with the organ to be sutured, an instrument body intended on actuation of this element and connected to it, a loader member placed on said instrument body and movable in the direction of said jaw branch and in the opposite direction.
Instruments of the type thus defined have already been developed, which comprise a steel cartridge. removable, carrying a certain number of U-shaped clips placed in a predetermined position relative to one another, this cartridge being intended to be fixed in the body of a manually operated instrument. Ordinarily, the instrument has. an actuating rod at the anterior end of which are disposed a number of thin fingers or blades which, when the instrument is mounted, align with the staple accommodation slots in the cartridge. The instrument is used by pushing the actuating rod forward so that the fingers or blades enter the corresponding grooves and push the staples towards
The front through the front surface of the cartridge.
However, it has been found that the blades or fingers facing forward bend or deform very easily during the necessary manipulation, resulting in a misalignment between the finger which is bent and the slot which corresponds to it resulting in jamming of the instrument. This jamming is very unfortunate because the surgeon cannot predict that his instrument will jam and this incident will occur. produced at a critical time in intenentiDn.
If the. surgeon wishes to use a pres cartridge. as different shaped grooves: it is necessary to replace the actuating rod with another came. .the different arrangement of the fingers or blades corresponds to the shape of the slots in the cartridge. Human error can then occur in the choice of the other actuating rod, which can lead to jamming of the instrument at a critical moment in the operation, as previously indicated.
Another disadvantage is that the usual cleaning and sterilization of the actuating rod. require great care and time consuming, due to the delicate blades mounted therein.
Since traditional cartridges are
executed in a steel subjected to a finishing treatment. it is not possible for economic reasons to throw them away and it is advisable to re-sterilize them and load them individually after use.
It is now common in this field to deliver
the staples in their own packaging. It is only at
As the staples arrive at their point of use they are loaded into the instrument cartridge.
The current practice is to use small pliers or the like to insert each staple by hand.
in a slot of the steel cartridge, until
it is fully charged. We will easily understand
ment that this is a slow and tedious process, with great risk of damaging the
staples.
The present invention aims to remedy the drawbacks
nients mentioned above and the instrument which is the subject thereof is characterized by a staple holder unit comprising
with a staple cartridge and an ejector member
staples, the block being slidably mounted and removable on
the loader member so that it can be thrown after
usage, in this.
that the jaw branch presents a pile
bucket fitted with elements for closing the clips, the
arrangement corresponds to that of the clips in the cartridge
che and coming opposite its staples, in that means are arranged in the instrument body and are movable relative to it in order to move the cartridge mounted on the suturing member which is clamped between said cartridge and the cleat, and in that drive means are slidably mounted in the instrument body and engage the staple ejector member when pushed forward to eject staples contained in the cartridge.
The appended drawing represents, by way of example, two embodiments of the instrument forming the subject of the present invention.
Fig. 1 is a side elevational view of the first embodiment.
Fig. 2 is a rear elevational view of this embodiment.
Fig. 3 is a side elevational view of the removable locking member.
Fig. 4 is a front elevational view of the staple magazine.
Fig. 5 is a front elevational view of the drive member on which the drive fingers are located.
Fig. 6 is a section in side elevation taken through line 6-6 of FIG. 4.
Fig. 7 is a partial exploded view of one of the slots in the staple magazine.
Fig. 8 is a front elevational view of an alternative magazine, where the staple accommodation slots are disposed horizontally.
Fig. 9 is a front elevational view of the drive member intended to be used with the magazine shown in FIG. 8.
Fig. 10 is a sectional side elevation taken through line 10-10 of FIG. 8.
Fig. January 1 is a top plan view of the variant illustrated in FIG. 8.
Fig. 12 illustrates the front jaw part of the instrument (partially in section) on which the magazine is mounted.
Fig. 13 is a top plan view, partially in section, of the part of the instrument illustrated by FIG. 12.
Fig. 14 is a sectional upper plane passing through line 14-14 of FIG. 12.
Fig. 15 is a side elevational view of a staple magazine including a safety locking member corresponding to another variant.
Fig. 16 shows the staple magazine with a further variant of the safety locking member.
Fig. 17 is a sectional view in top plan, passing through line 17-17 of FIG. 16.
Fig. 18 is a partial side elevational view of the second embodiment, showing only the front part of the instrument.
Fig. 19 is a partial view in lower section, passing through line 19 of FIG. 18.
Fig. 20 is a top plan view of a fully loaded cartridge.
Fig. 21 is a sectional side view, fragmentary, of the cartridge and instrument in operation.
Fig. 22 is a front sectional view passing through line-22-22 of -la - fig.-21.-
- Fig. 23 is a perspective view of one of the push plates of the cartridge illustrated in FIG. 20.
The first embodiment of the instrument shown in FIGS. 4, 5, 6 and 7 comprises a cartridge holder and ejector unit, designated generally by 10. The block 10 is composed of a staple-holder cartridge 12, with which is associated a member 14 for driving the staples. Cartridge 12 is made from a plastic material, for example Texan, a brand name given by General Electric, to a thermoplastic polycarbonate resin which can be molded or extruded. or in any other inexpensive material which can be used as part of the instrument clamp.
The cartridge 12 has a planar front face 16 and bevelled vertical edges and it is provided with a number of staggered slots 18 which pass through the body of the cartridge and which, in this embodiment. are arranged vertically in two parallel columns.
As can be seen in fig. 7, each slot comprises an enlarged central segment and two semi-circular guide channels 19, opposite to each other along the large dimension of the slot 18, these guide channels 19 being formed so as to receive each branch of a clip 20 to determine the direction of movement of this clip. The junction branch of the clip 20 extends from one end to the other of the widened part of the slot 18, at a distance from its walls. The top 22 of the cartridge is flat; on the other hand, a vertical groove 24 is formed on each of its side faces; the groove 24 and the top 22 cooperate with the instrument, as will be seen later. Two holes 26 also pass through cartridge 12 and are intended to receive a U-shaped safety key 42.
Preferably, the staple driver 14 is made of metal and comprises a vertical rear body 28 and a number of push blades 30 which extend from the front face of this body and are arranged in such a manner. to match and partially penetrate into each slot 18 of the cartridge 12. The dimension of each blade 30 is provided so that it fits movably but gently in the corresponding slot 18. Because of the enlarged segment of each groove 18, the thickness of each blade 30 is somewhat greater than that of the clip, so that the blades are stronger and less easily deformable than those currently in existence. The length
L of each finger (see Fig. 6) is sufficient to push the staples forward of the face 16 of the cartridge when the pusher 14 is pushed in that direction.
In fig. 1, 2 and 3, a fully loaded block 10 is shown, ready for shipment in customary sterile packaging (not shown). During the manufacture and assembly of the block 10, a safety locking member 34 with three teeth, the head of which has a hole 35 for the introduction of the blade, is mounted so as to lock the block 10. De preferably, the locking member 34 is made of plastic and comprises three spaced apart branches 36, 38 and 40; the dimensions of these
branches and the intervals between them are such that the middle branch 38 fits smoothly between the rear body 28 and the rear face of the cartridge
12, to prevent the blades 30 from penetrating further
in cartridge 12.
As can be seen in fig. 1. the shorter posterior branch 36 partially covers the rear body 28, while. the front branch is in contact with the front face 16. In this way, any untimely relative movement between the drive member 14 and the cartridge 12 is eliminated during transport of the loaded block. Thus, the sterilization of the block 10 only needs to be done once. during its manufacture and assembly.
Since there are many cartridges with the slots arranged differently, each block 10 is packaged with the associated cleat and, to ensure correct pairing, the block and associated cleat are color coded. . The cleat 49 has an elongated body on the front face of which depressions 54 are placed in alignment with the slots 18 when the instrument is ready for use. An elongated lateral groove 51 ensures the positioning of the cleat 49 on the instrument and any usual arrangement can be taken to keep the cleat 49 in the correct place; for example, a leaf spring may be mounted on its rear wall which bears against the front branch of the C-shaped clamp when the cleat is mounted.
In fig. 12, 13 and 14, there is shown the front part of the suturing instrument which comprises the jaw 50, the front branch 52 of which is provided, at its upper end, with two flanges 15 directed inward and intended to receive the corresponding grooves of the cleat 49. A U-shaped instrument body 55 is connected to the other branch of the jaw 50 and comprises, at its front end, vertical lugs 61; on the inner face of each ear, a longitudinal groove 63 is formed for purposes which will be indicated below. A rectangular hollow tube 56 is housed by sliding in the U-shaped body 55 and serves to receive and guide the actuating rod 58 which is axially movable in this tube.
Instead of the push blades or fingers, there is mounted, at the front end of the push rod 58, a U-shaped push-button 60, elongated in the vertical direction, visible in FIGS. 13 and 14.
A loader member 62, the side walls 64 and 66 of which, at a distance from each other, have enlarged anterior edges 68, connect in one piece to the tube 56 and its lower end is profiled to follow a track guide 70 formed on the inner bottom of the jaw 50. Two parallel holes 72 extend in the direction of the front in the upper projection of the loader member 62 and their role is to receive the branches of the locking key in U 42.
In one piece with the rear of the loader member 62 and the front end of the hollow tube 56, a vertical piece 57 comprises a guide rod 59 which extends laterally and slides in the corresponding groove 63 of the ear 60. The rods 59 provide a controlled movement forwards and backwards of the loader member 62 and oppose any relative vertical movement between this member and the jaw 50.
The assembly and operation of the instrument described are as follows. Before being sterilized, the cartridge 12 is machine fitted with a load of staples and the staple drive member 14 is mounted therein, as well as the safety locking member 34, according to the mode indicated. in fig. 1. The assembly is then packaged, at the same time as the sterilized cleat 49, in the usual aseptic shipping packaging (not shown). Any untimely relative movement between the drive member 14 and the cartridge 12 is eliminated by the safety locking member 34, as already indicated. When the packaging arrives at the hospital, it can be stored until the time of use, when it is opened, and its contents are placed in a sterile field so as to be directly accessible during the operation.
Once the patient is fully prepared. the safety locking member 34 is manually removed and discarded. The cleat 49 is placed on the branch 52. The staple holder unit having the desired color code is then introduced into the operating position at the front end of the loader member 62 by sliding it in the direction of the arrows. which are engraved there (see fig. 12). so that the grooves 24 slide over the widened flanges 68. The vertical position of the block 10 is determined by the contact between the top of the flanges 68 and the overhang or top of the grooves 24. Once the block 10 is fully in place. the branches of the U-shaped key 42 are introduced into the holes 72, so that the unit 10 is locked in the operating position.
As can be seen in fig. 14, when unit 10 is in the operative position. the rear body 28 of the driver 14 is located in the gap between the side walls 64 and 66 of the loader member 62, in line with and away from the cavity of the head 60.
At the time of employment. the hollow tube 56 is pushed forward and the front face 16 of the cartridge 12 cooperates with the cleat 49 to clamp the organ to be sutured in the correct position. Then, the actuator rod 58 is pushed forward so that the U-shaped head 60 embraces the rear body 28 of the driver 14, which in turn drives each of the fingers 30 forward in the slits 18. In this way, each staple 20 is driven from its own groove 18 forward into the member to be sutured and, when they come into contact with the depression 54 which corresponds to them in the cleat, the branches of the staple are folded back to take a form of final stapling. The staples 20 are driven forward until their posterior part emerges from the front face of the cartridge 12.
Thereafter, the hollow tube 56 is drawn rearward. which eliminates the tightening effect exerted on the sutured organ between the front face 16 and the cleat 49. Once the instrument has been removed from the patient, the fully exhausted block 10 and the cleat 49 are withdrawn and discarded.
The instrument is then ready to receive another fully loaded block 10, which can be easily and quickly mounted on the loader member 62. according to the method described above.
In fig. 15. 16 and 17 show other variants of the safety locking member 42 which has already been mentioned. The safety locking member 80 shown in FIG. 15 has a rectangular head and is provided with a U-shaped key 82 elongated downwards, the vertical branches of which are embedded in the plastic part which constitutes the head of the locking member 80. The front branch 84 is at the bottom. contact with the rear wall of the cartridge 12 and the rear branch 86 comes into contact with the front part of the rear body 28 of the drive member 14. As in the embodiment described with reference to FIG. 1.
The locking member 80 has front and rear hanging teeth which respectively contact the front face of the cartridge 12 and the rear wall of the drive member 14. The mode of action of the embodiment of fig. 15 corresponds to what has been described above.
The cartridge 12 2 and the rear body 28 of the model shown in FIG. 17 both have an elongated vertical hole 88 and 90, in a substantially central position. In this embodiment, the locking member 92 is also rectangular and has two keys of metal wire 94 and 96 extending parallel downwards at a distance from each other, the upper end of which is embedded. in the head of the locking member 92, as shown in FIG. 16. The keys 94 and 96 are suitably spaced so that they can be received by the holes 88 and 90 when the locking member 92 is assembled to the block 10. The locking member 92 also has a front branch which makes contact with the face. front of the magazine 12 in the assembly position.
The mode of action of the variant illustrated by FIGS.
16 and 17 emerge from the preceding description and it is obvious that the keys 94 and 96 oppose an untimely relative movement between the drive member 14 and the cartridge 12. When the block 10 is mounted on the instrument to be sutured, the locking member 92 is removed as described above and the block 10 is ready to be put in place.
In fig. 8 to 11, a variant of block 10 has been shown, the same reference figures relating to the same elements. In this variant, the slots 18 and the corresponding fingers 30 are arranged horizontally and aligned in a single vertical column. The mode of operation of this variant and its cooperation with the instrument are the same as above and the locking member used with a device of this type will be that which is illustrated in FIGS. 16 and 17; the appropriate vertical holes in the rear body 28 and the cartridge 12 have not been shown.
Of course, any desired number or arrangement of slots can be provided in the cartridge 12. However, the actuating rod must be able to be used with all the possible variants of cartridges, although the arrangement of their slots may differ.
In fig. 18 to 23, there is shown another embodiment of the instrument, comprising a staple holder and ejector unit designated generally by 100. The block 100 is composed of a cartridge 102 U-shaped and elongated, which is provided with a number of parallel spaced slots 104. crossing both of its branches. Cartridge 102 is made of a plastic material such as Texan or the like and has an enlarged nose 106 which facilitates the introduction of the instrument into the hollow organ to be sutured.
As can be seen better in fig. 20. each slot 104 consists of a wide groove 108 for positioning the clips. dimensioned to receive and guide a surgical staple 110. into an intermediate slot 112 and a narrow-hole slot 114. The groove and slots communicate with each other and have vertically directed sidewalls which are planar except for two stops 116 looking inwards. located at the bottom of the side walls of the slot 114, as indicated in FIG. 21.
A staple driver 118 is provided near the top of each slot 104, behind the staple 110 therein. Each drive member has a square push plate 120 with a cylindrical intermediate button 122 disposed symmetrically on one face of this plate and a smaller cam button 124, coaxial with button 122. As seen in the figures, the thickness and width of the push plate 120 are such that its rear face is exactly in contact with the outer wall of the slot 104, while part of its front face is in sliding contact with the front walls of the slot 112 The front parts of the two side walls of the push plate 120 slide in contact with the side walls of the slot 112.
In this way, a pusher plate is actively guided as it moves downward through slot 104 and the bottom of pusher plate 120 contacts the junction leg of clip 110 to urge the latter downward. low when the instrument is in use. The intermediate button 122 cooperates with the side walls of the slot 114 and strikes the stops 116 when the drive member 118 reaches its lower position. Furthermore, the stops 116 prevent the staple driver 118 from escaping from the cartridge 102. As shown in FIG.
22, the cam knobs 124 face inwardly and partially extend into the central gap 126 of the U-shaped cartridge 102. The cam knobs 124 are also spaced from the top wall 103 of the cartridge. 102.
In fig. 18 and 19, there is shown a medical instrument designated generally by 128 and comprising an elongated lower jaw clamp 130, bevelled towards its front end and comprising two vertical outer walls 134 spaced from each other so as to delimit an elongated groove 132. The upper surface of each wall 134 represents at the pinching a surface constituting a cleat provided with depressions and a certain number of vertical teeth spaced longitudinally, which contribute to the fixing of the pinched tissue.
The instrument 128 also comprises a U-shaped loader member 136, elongated and directed towards the front, comprising two fingers 138 at the lower ends of its opposite branches. The dimensions of the organ in
U 136 are such that it can receive by sliding on its internal surface the entire block 100 which, completely positioned. receives the fingers 138 in notches 140 of corresponding shape. located at the bottom and behind the nose 106. Since the top of the nose 106 is located slightly above the top 103 of the cartridge 102, the block 100 and the U-member 136 provide, in the assembled position, a smooth and continuous upper surface avoiding bumps when the instrument is introduced or extracted from the organ to be sutured (see fig. 18).
Cartridge 102 also has a rearwardly directed protrusion 145 which fits into channel 147 of the instrument. Block 100 is held firmly to the instrument by locking key 142 which passes through openings 144 in U-shaped member 136 and enters recesses 146 in the top of cartridge 102.
The instrument 128 is also provided with an actuating rod 148, movable axially, disposed in its handle and in the axial position behind the member in
U 136. An inclined plane 150 is provided at the front end of the actuating rod 148 and has a cam surface 152 at its bottom. A blade 154 has an anterior cutting edge and is mounted below the actuating rod 148, slightly behind the cam surface 152. As can be seen in the bottom view of FIG. 19, actuator rod 148, cam surface 152, and blade 154 are aligned in central gap 126 of cartridge 102.
The rest of the instrument 128, including the handle and the actuating mechanisms, can be of any conventional type, corresponding for example to the model described in US Pat. No. 3,079,606. As regards the rest of the instrument Instrument 128, the mode of operation of its assembly, pivoting and locking mechanisms may correspond to what is described in this US patent and its structural and functional characteristics are outside the scope of the present invention.
The following description relates to the operation of this embodiment of the instrument. During the manufacture and assembly of block 10, all of its parts are sterilized and packaged in suitable aseptic packaging, used for transporting block 100 between its point of manufacture and the hospital. This packaging can be stored for as long as desired in the hospital until use: at this time, the packaging is opened, the block 100 is extracted from it and then assembled on the U-shaped member 136 of the instrument. . The locking key 142 is introduced through the holes 144 in the recesses 146, in order to immobilize the block 100 in the service position on the instrument.
Since the nose 106 has a smooth and rounded surface, no bumping occurs when the lower jaw is introduced into the hollow organ to be sutured. Once the upper jaw of the instrument is in place, the lower jaw 130 undergoes upward movement so that its cleat surfaces grip the tissue by cooperating with the lower surfaces of the cartridge 102. As discussed above. see in fig. 21, the two layers of fabric are thus pinched in the superimposed position. When the surgeon considers that the tissue is properly pinched. the actuator rod 148 is pushed forward by any conventional means, for example that described in US Patent No. 3,079,606.
As can be seen in fig. 21, the cam surface 152 of the inclined plane 150 contacts all of the successive cam buttons 124 and these are pushed downward as a result of the relative movement between this surface and these buttons. In this way, each push plate 120 is pushed down into its own channel 104 and. consequently, its lower end pushes the corresponding clip 110 down into the slot 108. After piercing the layers of the fabric, the branches of the clip 110 contact the depressions of the cleat surface of the walls 134; the branches are folded in and down as the pusher plate 120 continues to lower due to the movement of the cam surface 152.
Blade 154 immediately follows cam surface 152 as it moves forward and cuts through previously sutured tissue layers on a line exactly midway between the parallel rows of staples.
Once all of the staples are secured, the lower jaw 130 is released and the instrument is pulled back. The stops 116 of the slots 104 prevent the push members from accidentally falling out of the slots.
Once the instrument has been removed from the sutured organ, block 100 is removed and discarded. At this point, the instrument is ready to receive another fully loaded block 100.
Claims (1)
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US469650A US3315863A (en) | 1965-07-06 | 1965-07-06 | Medical instrument |
Publications (1)
Publication Number | Publication Date |
---|---|
CH450623A true CH450623A (en) | 1968-01-31 |
Family
ID=23864570
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CH978166A CH450623A (en) | 1965-07-06 | 1966-07-06 | Stapling instrument with staple cartridge for suturing hollow organs or the like |
Country Status (5)
Country | Link |
---|---|
US (1) | US3315863A (en) |
CH (1) | CH450623A (en) |
DE (1) | DE1541176B1 (en) |
GB (1) | GB1158111A (en) |
SE (2) | SE390105B (en) |
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DE618922C (en) * | 1931-04-08 | 1935-09-19 | Heinrich C Ulrich | Instrument for applying metal clips, in particular for surgical purposes |
US2632889A (en) * | 1950-03-22 | 1953-03-31 | Robert J Beecroft | Stapling machine |
US3017637A (en) * | 1959-07-10 | 1962-01-23 | Sampson Arnold | Surgical suturing instrument |
US3080564A (en) * | 1959-09-10 | 1963-03-12 | Strekopitov Alexey Alexeevich | Instrument for stitching hollow organs |
FR1278616A (en) * | 1959-09-28 | 1961-12-15 | Apparatus for suturing hollow organs | |
FR1237035A (en) * | 1959-10-06 | 1960-07-22 | Method and device for en bloc ligation of the hilum of the lung | |
FR1237056A (en) * | 1959-10-06 | 1960-07-22 | Apparatus for performing gastrointestinal lateral anastomoses | |
US3079606A (en) * | 1960-01-04 | 1963-03-05 | Bobrov Boris Sergeevich | Instrument for placing lateral gastrointestinal anastomoses |
US3144654A (en) * | 1961-11-22 | 1964-08-18 | Foundation For Medical Technol | Medical staplers |
US3191842A (en) * | 1962-01-26 | 1965-06-29 | Canadian Patents Dev | Suturing instrument |
-
1965
- 1965-07-06 US US469650A patent/US3315863A/en not_active Expired - Lifetime
-
1966
- 1966-07-05 SE SE7215436*3A patent/SE390105B/en unknown
- 1966-07-05 SE SE7408204*3A patent/SE376166B/xx not_active IP Right Cessation
- 1966-07-06 DE DE19661541176 patent/DE1541176B1/en active Pending
- 1966-07-06 CH CH978166A patent/CH450623A/en unknown
- 1966-07-06 GB GB30354/66A patent/GB1158111A/en not_active Expired
Also Published As
Publication number | Publication date |
---|---|
SE376166B (en) | 1975-05-12 |
DE1541176B1 (en) | 1970-03-19 |
US3315863A (en) | 1967-04-25 |
SE7408204L (en) | 1974-06-20 |
SE390105B (en) | 1976-12-06 |
GB1158111A (en) | 1969-07-16 |
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