CN101657162B - An anastomotic applier and method for performing endoluminal and/or transluminal anastomosis - Google Patents
An anastomotic applier and method for performing endoluminal and/or transluminal anastomosis Download PDFInfo
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- CN101657162B CN101657162B CN2007800528222A CN200780052822A CN101657162B CN 101657162 B CN101657162 B CN 101657162B CN 2007800528222 A CN2007800528222 A CN 2007800528222A CN 200780052822 A CN200780052822 A CN 200780052822A CN 101657162 B CN101657162 B CN 101657162B
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- 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
- A61B17/1114—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00477—Coupling
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
- A61B2017/00557—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated inflatable
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Abstract
An anastomotic ring applier system (30) for deploying a first compression ring (36) and a second compression ring (39) comprises an anastomotic applier (32) with a second ring carrier (38) adapted to hold the second compression ring (39), a ring approximation device (37) with a first portion (42) connectable to an external first ring carrier device (31) which supports the first compression ring (36) and a second portion (43) connected to the second ring carrier device (38), wherein the first portion (42) forms a first thread (47) and the second portion (43) forms a second thread (48) meshing the first thread (47). A rotary device (49) is configured to rotate the first and second portions (42, 43) to one another so that they translate to one another to approximate and interconnect the compression rings (36, 39).
Description
Technical field
Present invention relates in general to be used for changing the apparatus and method of organ and vascular in the surgery mode, especially relate to by dispensing comprise two rings that can be connected anastomotic ring device, be used to carry out particularly gastral intracavity and/or through the surgery device and the method for chamber anastomosis, such as gastrojejunostomy, jejunojejunal anastomsis or picture for example coloproctosomy, jejunocolostomy or relate to the similar intervening modes such as anastomosis of bile pipe.
Background technology
Be used for carrying out the known surgical method and the utensil of above-mentioned anastomosis by the dispensing anastomotic ring device, comprise traditional open surgery or laparoscopic surgery technology, these technology have suitable invasive and require to use surgical device very complicated and trouble.As a result, the risk height of post-operative complication, this is undesirable.
And known devices and method are not suitable for by pure or carry out anastomosis to the endoscope or the intracavity approach of small part.
This intracavity approach if be aided with suitable instrument, can reduce the shortcoming of traditional open surgery and laparoscopic procedures significantly.Particularly, intracavity operation can reduce the invasive of this intervening mode, has reduced the risk of complication thus and has shortened patient's postoperative course of treatment.
Although the endoscope of anastomosis and intracavity approach are very promising, but, be difficult to use in practice this approach at present, for example be used for carrying out the alimentary tract anastomosis art because instrument and method all be not sophisticated to for example be enough to guarantee in layoutprocedure loop mapping fully, controlled tissue near and ring aim at reliably and be connected.As a result, can not get rid of operation and post-operative complication.
Summary of the invention
Therefore, the purpose of this invention is to provide a kind of is to carry out digestive tract intracavity particularly or through the special exploitation of chamber anastomosis and the surgery device, particularly anastomotic applier adjusted by the intracavity approach.
Further aim of the present invention provides and a kind ofly is used for carrying out digestive tract intracavity particularly or through the method for chamber anastomosis by intracavity or endoscopic approach, and it is little that the open surgery of this method and present employing and peritoneoscope approach are compared invasive.
These and other purposes are by realizing according to the identical pressure ring applicator systems of claim 1 and by the method for describing in the description of back.Useful embodiment is claimed in the dependent claims.
Description of drawings
In order to understand the present invention better and to understand associated advantages, with reference to accompanying drawing provide for embodiment in detail but be not restrictive description, in the accompanying drawing:
Fig. 1 is the cutaway view of intracavity Anastomolic ring applier according to an embodiment of the invention;
Fig. 2 is the perspective view of the detail content of intracavity Anastomolic ring applier among Fig. 1;
Fig. 3 is the cutaway view of detail content among Fig. 2;
Fig. 4 is the perspective view of the further detail content of intracavity Anastomolic ring applier among Fig. 1;
Fig. 5 is the perspective view of the inflatable linking portion of hookup mechanism in the intracavity anastomosis ring carrier arrangement according to an embodiment of the invention;
Fig. 6 is that intention is utilized the perspective view according to the identical pressure ring device of anastomotic applier configuration of the present invention;
Fig. 7, Fig. 8 and Fig. 9 show utilization, and the Anastomolic ring applier system in Fig. 1～6 carries out series of steps through the method for chamber anastomosis according to the present invention;
Figure 10 is the perspective view that separates the inflatable linking portion of hookup mechanism in the anastomotic applier system of configuration according to an embodiment of the invention;
Figure 11 is the perspective cut-away schematic view of hookup mechanism in engagement configuration of Figure 10;
Figure 12 is according to the unitary sketch map of the general function of identical pressure ring configuration-system of the present invention;
Figure 13 shows the formation of guide chase ring when preparing anastomosis (gastrojejunostomy);
Figure 14 shows the formation of anastomosis (gastrojejunostomy).
The specific embodiment
For the purpose of clear, and in order to indicate technique effect better according to anastomotic applier system features of the present invention, with and with the interaction of specific application environment, following detailed description of the present invention will at first be handled the surgical method that the inventor finds out, and then describe anastomotic applier and the surgery device that is used for implementing this method.
Carry out the overall process of anastomosis
Be used to carry out picture for example these classes such as gastrojejunostomy, jejunojejunal anastomsis, coloproctosomy, jejunocolostomy or bile pipe anastomosis intracavity or through the method for chamber anastomosis, comprise following step substantially:
-by in patient's body, placing filar guide 88, form the filar guide circle, the modes of emplacement of filar guide 88 is, it is from external near-end 88 ' put in the body, it is passed in first tissue part 45 of the nearside that plan is combined in the anastomosis and second tissue part 44 in distally in vivo, reaches the health outside then up to external far-end 88 ".
In the back the part in, if not other explanation is arranged, term " closely " and " far " refer to along guide chase ring point to its near-end 88 defined above ' with far-end 88 " direction.
-with nearside first ring 36 of anastomotic ring device be fixed to the near-end 88 of filar guide 88 ', " arrive first tissue part 45 of nearside up to first ring 36 of nearside; nearside first ring 36 is sent to first tissue part 45 of nearside and by draw the external far-end 88 of filar guide 88 along direction distad
-second ring 39 in the distally of anastomotic ring device is connected to slidably the far-end 88 of filar guide 88 ", and arrive second tissue parts 44 in distally up to it along second ring 39 that filar guide 88 proximads push away the distally.
-meanwhile, first pressure ring 36 of nearside is distad drawn, distally second pressure ring, 39 proximads are pushed away, so that the ring in nearside and distally is close, tear first, second tissue part 45,44 that on filar guide 88, encircles mutual crimping between 36,39 thus at first, second
-the tissue that will be suspended on the anastomotic ring device in inside is widened, opening identical inner chamber,
-connect first, second ring 36,39, thus first, second tissue part is clamped between the two,
The near-end 88 of-La filar guide 88 ', to remove filar guide 88 from health.
The circle of filar guide 88 begins and ends at or natural aperture, as mouth, nose, anus, and perhaps mode as an alternative, the artificial opening that generates on the health is such as colonic diversion, abdominal incision, wound or fistula.Preferably, filar guide is through natural conduit (for example mouth, Figure 13 and Figure 14) turnover health.
Though filar guide can comprise one or more one flexible guidewire, preferably, only provide a single seal wire that penetrates nearside and distal tissue part.
Form the circle of filar guide
The circle of filar guide 88 can utilize following disposal step to generate:
-introducing elongated insertion device through the nearside of filar guide inlet (for example mouth) through chamber mode (for example passing the oral cavity), and will insert device from the health outside and distad push proximal tissue partly (for example intestinal anastomosis position) to,
-far-end of filar guide is transported to the proximal tissue part through the one or more silk guide passages that form in inserting device, and the perforate on the proximal tissue part with seal wire end or needle guide silk end.Mode as an alternative, proximal tissue are partly come perforate with radio frequency (RF) needle device with sheath independently, and this sheath can insert along silk guide passage, and defines two or more inner passage (is used for the RF pin, and is used for seal wire).
In this manner, wire distal (for example enters into and blows into CO in advance from the proximal tissue part is distad outstanding
2Intraperitoneal),
-pull out nearside inlet (for example mouth) by inserting device from nearside, remove from health and insert device, and filar guide is stayed put,
Enter the mouth to introduce grabbing device through the distally that is used for filar guide through the chamber mode, this distally inlet can but do not need consistent with nearside inlet (for example mouth), then towards the distal tissue part, coat of the stomach tissue for example, push away grabbing device from health outside proximad (with respect to the circle direction)
-for example utilize radio frequency pin or equivalent piercing device on the distal tissue part, to form the hole, and preferably, widen this hole with ductus bursae, ductus bursae preferably is transported to the distal tissue part through the work raceway groove of grabbing device.
-making the hole (gastrostomy) of grabbing device by being widened in advance in the distal tissue part, the same space that enters the wire distal place (for example blows into CO in advance
2The abdominal cavity), and grabbing device is pushed to the far-end of filar guide.
-transmit passage through the work that in grabbing device, forms or utensil to insert snare, and snare is distad advanced, come out and arrive wire distal from grabbing device up to it.
-on wire distal, supply with snare and around filar guide closed or tension snare to hold filar guide, the perforate of passing through distal tissue part (for example coat of the stomach) is subsequently distad drawn the far-end of snare and filar guide together, and distad grabbing device and wire distal is withdrawn from the health outside together through distally inlet (for example through the oral cavity).
Useful is that introducing through the chamber of grabbing device and snare is to be undertaken by pure endoscope or intracavity approach.Mode as an alternative, this disposal step is carried out under peritoneoscope monitors.In this case, do not need to widen the hole, have only snare (preferably being suitable for piercing through the radio frequency snare of coat of the stomach) to form this hole and enter the abdominal cavity by this hole.Wire distal then is supplied in the snare hole in the peritoneoscope mode and is held by the latter.
In the situation of gastrojejunostomy, inserting device need advance in the duodenum to pass through the esophagus stomach function regulating through the oral cavity mode and to pass pylorus, and duodenum is not always to aim at easily.In this disposal step process, protection or guide wire can advance gastric along esophagus through patient mouth, and the insertion device can advantageously be guided up to pylorus inside protection or guide wire and cross pylorus.
The proximal ring of anastomotic ring device is sent to anastomotic position and make nearside and the distal tissue part close
Disposal step below first ring 36 of nearside utilizes is sent to anastomotic position:
But-with proximal ring and patient external preferably independently support element 33 be connected with separating type.
-for example by support element 33 (this support element 33 is keeping proximal ring) being inserted on single seal wire and preventing that support element 33 from locking support element 33 along the mode that filar guide slides, and external with support element 33 link the near-end 88 of filar guide 88 '.Support element 33 is preferably used locking member, and all clips that if can clamp and be suitable for the slip of holdback carrier member around seal wire lock.Support element is connected to after the seal wire near-end, and it is introduced into endoscope's inlet of nearside and " is pulled to anastomotic position, i.e. first tissue part of nearside (for example intestinal wall 45) by distad drawing wire distal 88.
Mode as an alternative, by being integrated in the lock-in feature on the support element, for example clamping part can be realized support element is locked onto seal wire.According to another embodiment, support element is processed and is distributed in together with seal wire, perhaps be connected to seal wire in advance, ways of connecting is to finish the guide chase ring metapedes so that support element and proximal ring are introduced nearside inlet (for example mouth and esophagus) together and " sent it to proximal tissue part 45 by distad drawing wire distal 88.
Mode as an alternative, support element can slide into the organized layer of nearside along seal wire always, and wherein, seal wire is as the guide rails of support element.
-subsequently, by distad drawing wire distal 88 "; make support element impel proximal ring particularly its distal tissue contact surface lean against on the proximal tissue part; and make the proximal tissue part distad shift to and contact the distal tissue part, proximal tissue part 45 (for example intestinal tissue) is able to be relied on distal tissue part 44 (for example coat of the stomach) up to they close contacts like this.
The distally of anastomotic ring device ring is sent to anastomotic position and connect the distally, proximal ring distally ring utilizes following disposal step to be sent to identical part:
-at wire distal 88 " on therefore insert second pressure ring 39 in distally and push second pressure ring, 39 proximads to anastomotic position and push first pressure ring 36 of nearside to along filar guide 88.Under the effect of guide chase ring and the further guiding device of possibility, first, second pressure ring 36,39 and first, second tissue part 45,44 aim at together vertically at anastomotic position.
According to an embodiment, utilize suitable anastomotic applier to push away the distally pressure ring along seal wire.If necessary, this anastomotic applier advantageously is suitable for relative nearside pressure ring the distally pressure ring is carried out the angle location, can interconnect for them.Mode as an alternative, pressure ring is provided with connection features, and these features can make them by different angular position or be independent of their mutual angular position and interconnect.
-push away by proximad that the distally pressure ring makes it to engage with the nearside pressure ring or the side pressure ring that distad furthers makes it to engage with the distally pressure ring, these pressure rings and the tissue part that therefore is clipped between them are coupled together.For this purpose, the anastomotic applier system comprises hookup mechanism 1 and close device 37.In this way, the carrier of first pressure ring can be linked (preferably surgical site or near) near device 37 (this close device then is connected to second pressure ring), and mutual thrust or pulling force can be applied on the pressure ring.
According to an embodiment, be suitable for engaging these two pressure rings and keep the independently locking device that they connect by dispensing by the phase mutual edge distance of hope, connect pressure ring.
The method that pressure ring is connected with each other can additionally comprise step: tissue part is fixed to pressure ring, with in order to prevent to organize the pinch engagement that radially slips away with pressure ring effectively.This other step can or side by side be carried out with it before the dispensing locking device.Preferably by the tissue part between distally and the proximal ring device is exerted pressure, and drive that a plurality of pins enter and pass loop device and tissue part makes pin provide above-mentioned fixing in addition, carry out this other fixing step.
According to an embodiment of this method, when considering that locking device and this are organized pin (if providing) when being sent to anastomotic position, locking device is at wire distal 88 " to be gone up and is pushed to anastomotic position and nearside pressure ring from external insertion and along seal wire 88 proximads.Preferably, distally pressure ring and locking device (and pin group independently, if provide) far-end that is disposed in anastomotic applier is (here, term " far " refers to from the angle of surgeon to be seen rather than guide chase ring), and utilize anastomotic applier to shift anastomotic position onto to engage with the nearside pressure ring.
Mode as an alternative, and in contrast with the previous embodiment, first pressure ring of nearside and independently locking device (and pin group, if provide) the two all be fixed to proximal ring carrier arrangement 33 and be transported to anastomotic position, and impelled with the distally pressure ring and engaged.
Widen the tissue at anastomotic position place
Intention bonded distally and proximal tissue in anastomosis utilize following disposal step to widen:
-in tissue part near after being in contact with one another, but preferably in the distally with before the nearside pressure ring is connected definitely, by cutting or force tissue extension, widen filar guide in the tissue part, preferably single seal wire, the via hole that is passed through.According to a useful embodiment, the via hole of tissue part is widened with capsule dilator 11, and the capsule dilator can also be as the expandable anchorage head 4 (will be further described below) of hookup mechanism 1.Capsule dilator 11 can be inserted on the seal wire 88, and passed to and pass via hole in the tissue part to small part.Next, capsule dilator 11 is blown the degree that it roughly fills distally pressure ring centre bore of annotating, and the inner chamber that will coincide is thus widened basic identical degree, carries out the binding action between the first ring carrier and the anastomotic applier simultaneously.
According to a useful embodiment, before the capsule dilator 11 of hookup mechanism 1 expands or after, first pressure ring of nearside (locking device and pin group preferably fit together with one of pressure ring together in advance) inserts on the part of capsule dilator 11, the capsule dilator after make expanding for pressure ring next near and aligning guiding is provided.
Remove instrument and filar guide from patient body
After pressure ring connected, the capsule dilator was deflated and separates from the part 3 that holds of anastomotic applier.Having the anastomotic applier that holds part 3 withdraws from from patient body.The support element 33 that has a linking portion 2 also separates from first pressure ring of nearside, and preferably by draw seal wire near-end 88 ' and come along with seal wire 88 and to remove along the direction of proximad.
When first ring of nearside locks onto distally when ring with being determined, in the process of proximad traction seal wire 88, support element (its by more weak connection for example frictional fit receive proximal ring) from remaining attached to the nearside pressure ring separation of distally pressure ring.
Be described and diagram with reference to the gastrojejunostomy that begins from jejunum although carry out the method for anastomosis,, such gastrojejunostomy also can begin to carry out from stomach.In this case, advantageously, preventer is incorporated in the jejunum, to pierce through and the relative intestinal wall of intestinal wall that will carry out anastomosis in order to prevent.
Possible situation is the compactness of using methylene blue can test anastomotic position.
Said method can advantageously carry out with intracavity mode or part intracavity mode in the gastrojejunostomy process.Formed the situation that the part that is used for generating gastrointestinal bypass is disposed at said method, can be by also above-mentioned steps being applied to further anastomosis in a similar manner, can then carrying out the further anastomosis (for example jejunojejunal anastomsis or ileum intestinal anastomosis art) that relates to small intestinal.
From aforementioned to the general step of this method and the description of the concrete application of gastrojejunostomy, it will be understood by those skilled in the art that this method can control the location of anastomotic ring device single part continuously and impose on the power of anastomotic ring device single part in layoutprocedure.This method further allows to carry out anastomosis at intracavity, helps and peritoneoscope or part peritoneoscope step when carrying out anastomosis even be not precluded within.
Said method, especially use and have the anastomotic applier that links feature and the close feature of ring, not only help gastrojejunostomy and jejunojejunal anastomsis, and help carrying out for example coloproctosomy, jejunocolostomy or relate to the anastomosis of bile pipe.
In subsequent section, will the Anastomolic ring applier system that develop specially and be suitable for carrying out according to the method that is proposed anastomosis be described.
This instrument advantageously comprises one or more in the following parts:
-first, second anastomosis ring 36,39;
-locking pin 81;
-the first ring support element 33;
-locking device 82;
-insertion device (not illustrating among the figure);
-grabbing device (not illustrating among the figure);
-anastomotic applier 32;
-anchorage head 14/ capsule dilator 11;
-seal wire 88;
-snare (not illustrating among the figure),
Wherein some will utilize illustrated embodiment to describe in further detail below.
Generality to the Anastomolic ring applier system is described
With reference to Figure 12, Anastomolic ring applier system 30 comprises the first pressure ring carrier arrangement 31 (dotted line--) and anastomotic applier 32 (chain-dotted line--).The first pressure ring carrier arrangement 31 comprises first (for example jejunum) ring carrier 33, and it is suitable for keeping first pressure ring 36, and can be connected to or be connected to filar guide 88.The first ring carrier 33 can be connected to capsule dilator 11, capsule dilator 11 makes up round seal wire, and can for example utilize discrete bond point that the fluid that can not hinder from the fluid line of capsule dilator to its expansion-head is communicated with (or more generally, lock part 35), be connected near the seal wire of outside or capsule dilator expansion-head.
The first pressure ring carrier arrangement 31 can utilize ring that above-mentioned hookup mechanism 1 (double dot dash line among Figure 12---) is attached to anastomotic applier 32 (will be described below) near device 37 and from the ring of anastomotic applier 32 near device 37 separately.
Ring is near device first, second part the 42, the 43rd of 37, can be so that first, second ring carrier arrangement 31,38 close mode move toward one another, make thus two organized layers (for example gastric tissue layer 44 and jejunum organized layer 45) of remaining between these two pressure rings 36,39 near and make pressure ring 36,39 interconnection, identical to finish.
According to the present invention, the ring of anastomotic applier 32 comprises screw drives device 46 near device 37, wherein, first 42 forms first screw thread 47, second portion 43 forms second screw thread 48 with 47 engagements of first screw thread, and at least one cooperates so that it relatively rotates in rotary apparatus 49 and first, second part 42,43.Relatively rotating of first, second part 42,43 impels their translations in opposite directions, make first, second ring carrier arrangement 31,38 and remain between two pressure rings 36,39 two organized layers (for example gastric tissue layer 44 and jejunum organized layer 45) near and make pressure ring 36,39 interconnection.
As previously mentioned, Anastomolic ring applier system 30 may further include hookup mechanism 1 as a whole, therefore, anastomotic applier 32 can comprise the linking portion 2 of this hookup mechanism 1 or hold part 3, with allow surgical site or near anastomotic applier 32 reversibly is attached to the first ring carrier arrangement 31 (contrast Figure 12).
Embodiment to the hookup mechanism 1 of Anastomolic ring applier system 30 describes
According to an embodiment, what hookup mechanism 1 comprised linking portion 2 and can entangle and keep linking portion 2 holds part 3.Linking portion 2 comprise be used for linking portion 2 be connected to the first ring carrier arrangement 31 first adapter 5 and can expansible anchorage head 4 and starting drive 6, starting drive 6 is connected to anchorage head 4 and is applicable to and makes anchorage head 4 distortion (blow and annotate and discharge), makes anchorage head 4 can take expanded configuration (Figure 10) and contracted configurations (Fig. 5,7).
Hold part 3 and comprise second adapter 58,7, be used for being connected to anastomotic applier 32 with holding part 3, especially intention is with the second ring carrier arrangement 38 of the first ring carrier arrangement, 31 banded anastomotic appliers 32.Hold part 3 and further comprise anchorage 8, anchorage 8 defines and is used to receive to the reception space 9 of small part anchorage head 4 and near hole 10.By near hole 10, anchorage head 4 can inject from the outside that holds part 3 and receive in the space 9.Allow anchorage head 4 to insert and withdraw from the time of can working as anchorage head 4 withdrawals near hole 10, the anchorage head 4 that allows near small part to insert when anchorage head 4 expansions locks onto and holds part 3.
According to an embodiment, anchorage head 4 comprises described ductus bursae or capsule dilator 11.Capsule dilator 11 can be activated by the fluid pump device, and the fluid pump device is connected with capsule dilator 11 in the mode that fluid is communicated with through preferably flexible pressure fluid pipeline 12.As Fig. 1,5,10 respectively shown in, capsule dilator 11 can present elongated basically thread withdrawal shape, and if be subjected to the effect of fluid pressure, then present elongated basically column expanded configuration.
According to an embodiment, capsule dilator 11 has by flexibility (on diastrophic meaning) is arranged but the inside expansion chamber 14 that inextensible wall 13 limits, make capsule dilator 11 can adapt to the shape of anchorage 8, if even and especially capsule dilator 11 just partly inject and receive in the space 9.Capsule dilator 11 has the distally (from surgical angle) of taper and inserts end 15, insert end 15 preferably obviously projection and narrow down towards the end, for example sharp domeshape, insert pin shape terminal 16 or pin that end 15 can further have the center, with inserted tissue part for the ease of anchorage head and enter the holding section divide 3 near hole 10.
According to an embodiment, first adapter of hookup mechanism 2 comprises elongate channels 17, and it can receive for example seal wire 88 of the first ring carrier arrangement 31.Seal wire raceway groove 17 is advantageously coaxial with the column expanded configuration of capsule dilator 11, and can be directly bonded to seal wire 88, perhaps, mode as an alternative, capsule dilator 11 can be by being locked into seal wire 88 such as clamping devices such as clips.
Hold part 3 again, according to one embodiment of present invention, hold part 3 and comprise housing 18, housing 18 has preferred but needn't be columniform sidewall 19 and distally end wall 20, and sidewall 19 and end wall 20 define together to small part reception space 9.End wall 20 has defined recited above near hole 10, and by near hole 10, anchorage head 4 can be introduced at least in part and receive in the space 9, near the edge in hole 10 at anchorage head 4 expansion back constraint anchorage heads 4.
According to an embodiment, end wall 20 has inner locking surface 21, locking surface 21 faces and receives in the space 9, and the direction of insertion of perpendicular anchorage head 4 (X), perhaps define circumferential shoulder, circumferentially shoulder tilts to the inside that receives space 9, makes it be locked to expansion and bound anchorage head 4 that small part is introduced, with slippage when preventing that in a single day anchorage head 4 is subjected to pull strength.
According to an embodiment, internal lock surface 21 defines anchorage head 4 slippages that are used to prevent to blow behind the notes and holds the bottom cutting portion that part 3 engages.
Preferably, the outer surface 22 of distally end wall 20 defines and is used to make things convenient for anchorage head 4 to inject the guide member of anchorage 8.
Detailed description to the embodiment of Anastomolic ring applier system
According to the embodiment shown in Fig. 1～9 (term " closely " and " far " refer to from surgical angle), 37 first 42 is embodied as rotor assembly 50 near device, have the opening 52 that defines the distally and nearside coupling part 53 be with externally threaded shell body 51.Moment of torsion adapter 54 will be turned round the coupling part 53 that cable or swingle 55 are connected to nearside.Turn round cable or swingle 55 and can pass through the work raceway groove of endoscope's (for example gastroscope is not shown), and have near-end, this near-end reaches outside, in outside, and suitable moment of torsion and rotatablely move and can be imposed on near-end by the surgeon.Moment of torsion adapter 54 can comprise attachment cap or plug (Fig. 2,3), attachment cap or plug are connected to the tubulose ring wall 57 of shell body 51 by connecting pin 56 radially, make it transmit moments of torsion and (have but be not necessarily to have) pull strength to threaded shell body 51 from turning round cable or swingle 55.
In this embodiment, the part 3 that holds of hookup mechanism 1 is disposed in shell body 51 the insides and can freely rotating by opposite shell body 51.What hold part 3 is arranged to aim at distal surface near hole 10, and preferably coaxial with the distal openings 52 of shell body 51.
For convenience the shell body 51 of rotor assembly relatively hookup mechanism 1 hold part 3 and so freely rotate relative to the anchorage head 4 that is entangled, at shell body 51 with hold the rolling bearing 58 of can planting between the part 3.
According to an embodiment, what hold part 3 is by the short tube shape, preferably the endless tube of column limits near hole 10, and its diameter is less than the diameter or the horizontal span that receive space 9.The tubular ring pipe has outer cylinder, and this outer cylinder engages the inner surface of rolling bearing 58, and rolling bearing 58 is connected to this shell body 51 (comparison diagram 1 and Fig. 3) again near the distal openings 52 of shell body 51.
In this embodiment, ring is implemented as lift-bolt formula device 59 near the second portion 43 of device 37.Lift-bolt formula device 59 comprises tubular support structure 60, for example rigidity or to small part be flexible pipe, its have nearside basic coupling part 61, distally ring connector part 64 and can with the female thread 48 of external screw thread 47 engagements of rotor assembly 50.
Coupling part 61, basis is suitable for supporting structure 60 is connected to endoscope's (for example gastroscope is not shown), makes endoscope transmit thrust and/or pulling force and moment of torsion to supporting structure 60.Mode as an alternative, supporting structure 60 can reach outside, and basic coupling part 61 can be kept at direction of twist with axially or is connected on the basis external.
The ring connector part 64 in distally can for example pass through interlock cooperation, interference fit or frictional fit and move and keep second (for example stomach) pressure ring 39, and these cooperations can provide by the Elastic Teeth top shown in Fig. 4 and 7.
By partly inserting and subsequently anchorage head 4 blown notes holding part 3 the insides, and provide simultaneously tissue widen means and near and be connected in the process at the cylindricality guide member (anchorage head after the expansion-capsule dilator 11) of pressure ring, hookup mechanism 1 is able to securely rotor assembly 50 is attached to the first ring carrier arrangement 33.The first ring carrier arrangement is attached to after the rotor assembly, turn round shell body that rotatablely moving of cable can make rotor assembly relative to rotating at blocked supporting structure 60 axially and on the direction of twist, thus, cause rotor assembly 50 and hold part 3 together translation and therefore making coincide pressure ring 36,39 near and interconnection.
According to further embodiment, tubular support structure 60 is to small part, preferably all transparent, to observe by endoscope's (for example gastroscope) for the tubular wall that can also see through supporting structure.
For disclosed integrity, with reference to Fig. 6, will the illustrated embodiment of anastomotic ring device and locking device be described, anastomotic ring device and locking device can utilize according to anastomotic applier configuration of the present invention.
Fig. 6 is the perspective view that the anastomotic ring device of first (jejunum) ring, 36 and second (stomach) ring 39 is arranged.This anastomotic ring device is not only to be suitable for but to be particularly suitable for carrying out gastrojejunostomy according to previously described method.First pressure ring 36 (or " intestinal ring " 36) is suitable for withstanding in first tissue part 45 (jejunum tissue), and second pressure ring 39 (or " stomach ring " 39) is suitable for withstanding in second tissue part 44 (gastric tissue) relative with first ring 36 with first tissue part 45.
Corresponding to acting at least one of different compression ratios in the tissue part 44,45 that is clipped between the ring, preferably two or more latched positions place, first and second rings 36,39 are suitable for locking together.
The pressure surface that is used for contacting and clamp first, second ring 36,39 of first, second tissue part 45,44 is the plane basically, and perhaps periphery is wavy to increase the girth of the inner chamber that coincide for outer shroud girth (not illustrating among the figure) relatively.Useful is, pressure surface is coarse or local configuration is arranged, with in order to prevent to organize 45,44 radially to be extruded loop device in response to axial compressive force.
According to a preferred embodiment, second pressure ring 39 (stomach ring) comprise be applicable to by second the ring carrier 38 engage the shape of (for example by interlock cooperation, frictional fit, form fit or interference fit) or special interaction part.
Two pressure rings all advantageously partially or completely can absorb or the Biodegradable material manufacturing with biology.
For tissue part extra fixing with respect to pressure ring 36,39 is provided, skid off and the engaging of loop device to prevent to organize, one group of pin 81 or nail are provided, be anchored at least one in the pressure ring and be suitable for piercing through the tissue that is clipped between pressure ring.
Pin and needle ring are all advantageously but needn't be can absorb or the Biodegradable material manufacturing with biology.
Refer now to locking device itself, according to an embodiment (for example Fig. 6, Fig. 7), locking device 82 comprises: the shoulder 84 of annular nearside, and it has the composition surface 85 in the distally that is applicable to the proximal end face that engages first (jejunum) pressure ring 36; With piped longitudinal component 86, its shoulder 84 from nearside is distad outstanding.The shape of longitudinal component 86 is suitable for being inserted into through first, second pressure ring 36,39 these central openings of two, and formation is suitable for one or the how flexibly mounted tooth engaged 87 (in the description to locking device 82, term " closely " and " far " refer to the direction of configuration) at the corresponding surface or the edge of engage in snap engagement second (stomach) pressure ring 39.
The independently requirement of locking device permission pressure ring specialized designs to satisfy transmission and to coincide is provided, avoids thus between these requirements and those pressure ring connection requests, compromising.
The tubular form of locking device 82 has been stablized the shape of identical inner chamber, and to provide be to be clipped in tissue part 45,44 between pressure ring coincide from the flowing through fluid of inner chamber and the protection lining that content is kept apart during the wound healing at least.
Locking device 82 advantageously partly or entirely can absorb or the Biodegradable material manufacturing with biology.
Understandable as the description from the front, Anastomolic ring applier system 30 has lot of advantages.Its hookup mechanism allow surgical site or near make the first ring carrier arrangement link and separate in the intracavity mode with respect to the second ring carrier arrangement, screw drives allows pressure ring close in mode that can fine control near device, does not need to apply push-pull effort along whole utensil path up to anastomosis ring from outside.Further, the extendible anchorage head of hookup mechanism is widened the guiding device that device also is used as pressure ring as tissue simultaneously.
Although described the preferred embodiments of the present invention in detail,, the applicant does not want the scope of claim is restricted to this specific embodiment, but will cover all modifications that drops in the scope of the invention and replace structure.
Claims (17)
1. an Anastomolic ring applier system (30) is used to dispose first pressure ring (36) and second pressure ring (39), and described Anastomolic ring applier system comprises anastomotic applier (32), and described anastomotic applier (32) comprising:
The second ring carrier arrangement (38), the described second ring carrier arrangement is suitable for keeping described second pressure ring (39);
Ring is near device (37), described ring has the first (42) of the first ring carrier arrangement (31) that can be connected to the outside of supporting described first pressure ring (36) near device (37) and is connected to the second portion (43) of the described second ring carrier arrangement (38), wherein, described first (42) forms first screw thread (47), described second portion (43) forms second screw thread (48) with described first screw thread (47) engagement
Rotary apparatus (49), described rotary apparatus acts on in described first (42) and the described second portion (43) at least one, and described first (42) and described second portion (43) are relatively rotated with respect to each other, make and described first (42) and described second portion (43) translation toward each other make described first pressure ring (36) and described second pressure ring (39) near also interconnection.
2. Anastomolic ring applier system as claimed in claim 1 (30), further comprise the described first ring carrier arrangement (31), described first encircles carrier arrangement (31) comprises the first ring carrier (33) that is suitable for keeping described first pressure ring (36), and can be attached to the close device of described ring (37) of described anastomotic applier (32) and install (37) separately from the described ring of described anastomotic applier (32) is close.
3. Anastomolic ring applier system as claimed in claim 2 (30) further comprises hookup mechanism (1), and described hookup mechanism (1) comprising:
Linking portion (2), described linking portion (2) are connected to the described first ring carrier (33) and have can expansible anchorage head (4),
Hold part (3), the described part (3) that holds is connected to described ring near device (37), and limit the reception space (9) of at least a portion that is used to receive described anchorage head (4) and near hole (10), described anchorage head (4) can inject described reception space (9) near hole (10) from the described outside that holds part (3) by described
Starting drive (6), described starting drive (6) is connected to described anchorage head (4), and can make described anchorage head (4) distortion, makes described anchorage head (4) can take expanded configuration and retracted configuration,
Wherein, describedly when described anchorage head (4) is withdrawn, can allow the insertion of described anchorage head (4) and withdraw near hole (10), the described anchorage head (4) that allows near small part to insert when described anchorage head (4) is expanded locks onto and describedly holds part (3), encircles carrier arrangement thereby securely described ring is attached to described first near device.
4. Anastomolic ring applier system as claimed in claim 3 (30), wherein, described anchorage head (4) comprises capsule dilator (11), described starting drive (6) comprises the fluid pump device that is communicated with described capsule dilator (11) fluid.
5. Anastomolic ring applier system as claimed in claim 4 (30), wherein, described anchorage head (4) can present elongated basically thread withdrawal shape, if be subjected to fluid pressure, then presents elongated basically column expanded configuration.
6. Anastomolic ring applier system as claimed in claim 3 (30), wherein, described ring comprising near the described first (42) of device (37):
Rotor assembly (50), described rotor assembly (50) have is with externally threaded shell body (51), described shell body (51) to limit the coupling part (53) of the opening (52) and the nearside in distally,
Moment of torsion adapter (54), described moment of torsion adapter (54) will be turned round the coupling part (53) that cable (55) is connected to described nearside,
Wherein, the described part (3) that holds is received in described shell body (51) inside in the mode that can rotate, describedly holds the described of part (3) and is arranged near the distal surface of described shell body (51) near hole (10).
7. Anastomolic ring applier system as claimed in claim 6 (30), wherein, described moment of torsion adapter (54) comprises attachment cap, described attachment cap is connected to the tubulose ring wall (57) of described shell body (51) by connecting pin (56) radially.
8. as claim 6 or 7 described Anastomolic ring applier systems (30), wherein, arrange rolling bearing (58) at described shell body (51) and described holding between the part (3), so that described shell body (51) and the described part (3) that holds can relatively rotate with respect to each other.
9. Anastomolic ring applier system as claimed in claim 8 (30), wherein, described hold the part the described of (3) limit by the tubulose endless tube near hole (10), the diameter of described endless tube is less than the horizontal span in described reception space (9), the inner surface of the described rolling bearing of described tubular ring pipe joint (58), described rolling bearing (58) are connected to the position that described shell body (51) is gone up the distal openings (52) of close described shell body (51).
10. as claim 6 or 7 described Anastomolic ring applier systems (30), wherein, described ring comprises the lift-bolt formula device (59) with piped supporting structure (60) near the second portion (43) of device (37), and described supporting structure (60) has the basic coupling part (61) of nearside, the ring connector part (64) in distally and the female thread (48) that can mesh with the external screw thread (47) of described rotor assembly (50).
11. Anastomolic ring applier system as claimed in claim 10 (30), wherein, described basic coupling part (61) is suitable for described supporting structure (60) is connected to endoscope, makes endoscope transmit thrust and pulling force and moment of torsion to described supporting structure (60).
12. Anastomolic ring applier system as claimed in claim 10 (30), wherein, the ring connector part (64) in described distally can keep described second pressure ring (39) by frictional fit.
13. Anastomolic ring applier system as claimed in claim 10 (30), wherein, described piped supporting structure (60) is partially transparent at least.
14. Anastomolic ring applier system as claimed in claim 8 (30), wherein, described ring comprises the lift-bolt formula device (59) with piped supporting structure (60) near the second portion (43) of device (37), and described supporting structure (60) has the basic coupling part (61) of nearside, the ring connector part (64) in distally and the female thread (48) that can mesh with the external screw thread (47) of described rotor assembly (50).
15. Anastomolic ring applier system as claimed in claim 14 (30), wherein, described basic coupling part (61) is suitable for described supporting structure (60) is connected to endoscope, makes endoscope transmit thrust and pulling force and moment of torsion to described supporting structure (60).
16. Anastomolic ring applier system as claimed in claim 14 (30), wherein, the ring connector part (64) in described distally can keep described second pressure ring (39) by frictional fit.
17. Anastomolic ring applier system as claimed in claim 14 (30), wherein, described piped supporting structure (60) is partially transparent at least.
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| PCT/EP2007/054318 WO2008135083A1 (en) | 2007-05-03 | 2007-05-03 | An anastomotic applier and method for performing endolumenal and/or transluminal anastomosis |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CN101657162A CN101657162A (en) | 2010-02-24 |
| CN101657162B true CN101657162B (en) | 2011-08-10 |
Family
ID=41319918
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN2007800528222A Expired - Fee Related CN101657162B (en) | 2007-05-03 | 2007-05-03 | An anastomotic applier and method for performing endoluminal and/or transluminal anastomosis |
Country Status (6)
| Country | Link |
|---|---|
| EP (1) | EP2139406A1 (en) |
| JP (1) | JP2010525844A (en) |
| CN (1) | CN101657162B (en) |
| AU (1) | AU2007352913A1 (en) |
| CA (1) | CA2685778A1 (en) |
| WO (1) | WO2008135082A1 (en) |
Families Citing this family (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US10130368B2 (en) | 2016-04-01 | 2018-11-20 | Ethicon, Inc. | Expandable compression rings for improved anastomotic joining of tissues |
Citations (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US4055186A (en) * | 1976-02-11 | 1977-10-25 | Leveen Harry H | Anastomosis button |
| EP1719458A1 (en) * | 2005-05-05 | 2006-11-08 | Ethicon Endo-Surgery, Inc. | Anastomolic ring applier with double motion actuation |
Family Cites Families (7)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US4319576A (en) * | 1980-02-26 | 1982-03-16 | Senco Products, Inc. | Intralumenal anastomosis surgical stapling instrument |
| US5425738A (en) * | 1992-04-08 | 1995-06-20 | American Cyanamid Company | Endoscopic anastomosis ring insertion device and method of use thereof |
| JP3926831B2 (en) * | 1992-06-04 | 2007-06-06 | オリンパス株式会社 | Tissue suture ligator |
| US5814062A (en) * | 1994-12-22 | 1998-09-29 | Target Therapeutics, Inc. | Implant delivery assembly with expandable coupling/decoupling mechanism |
| US6569173B1 (en) * | 1999-12-14 | 2003-05-27 | Integrated Vascular Interventional Technologies, L.C. | Compression plate anastomosis apparatus |
| US7282057B2 (en) * | 2004-03-30 | 2007-10-16 | Wilson-Cook Medical, Inc. | Pediatric atresia magnets |
| ITMI20042131A1 (en) * | 2004-11-05 | 2005-02-05 | Ethicon Endo Surgery Inc | DEVICE AND METHOD FOR OBESITY THERAPY |
-
2007
- 2007-05-03 EP EP07728771A patent/EP2139406A1/en active Pending
- 2007-05-03 WO PCT/EP2007/054317 patent/WO2008135082A1/en active Application Filing
- 2007-05-03 CN CN2007800528222A patent/CN101657162B/en not_active Expired - Fee Related
- 2007-05-03 JP JP2010504463A patent/JP2010525844A/en active Pending
- 2007-05-03 CA CA002685778A patent/CA2685778A1/en not_active Abandoned
- 2007-05-03 AU AU2007352913A patent/AU2007352913A1/en not_active Abandoned
Patent Citations (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US4055186A (en) * | 1976-02-11 | 1977-10-25 | Leveen Harry H | Anastomosis button |
| EP1719458A1 (en) * | 2005-05-05 | 2006-11-08 | Ethicon Endo-Surgery, Inc. | Anastomolic ring applier with double motion actuation |
| CN1857168A (en) * | 2005-05-05 | 2006-11-08 | 伊西康内外科公司 | Anastomolic ring applier with double motion actuation |
Also Published As
| Publication number | Publication date |
|---|---|
| WO2008135082A1 (en) | 2008-11-13 |
| JP2010525844A (en) | 2010-07-29 |
| CN101657162A (en) | 2010-02-24 |
| EP2139406A1 (en) | 2010-01-06 |
| AU2007352913A1 (en) | 2008-11-13 |
| CA2685778A1 (en) | 2008-11-13 |
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