CN102018545A - Operation suture device - Google Patents
Operation suture device Download PDFInfo
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- CN102018545A CN102018545A CN2009101737226A CN200910173722A CN102018545A CN 102018545 A CN102018545 A CN 102018545A CN 2009101737226 A CN2009101737226 A CN 2009101737226A CN 200910173722 A CN200910173722 A CN 200910173722A CN 102018545 A CN102018545 A CN 102018545A
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Abstract
The invention relates to an operation suture device comprising a thin and long main body with a near end part and a far end part, and a head part which is located near the far end part of the thin and long main body. The head part comprises a casing assembly and an anvil assembly which can move between a non-approach position and an approach position relative to the casing assembly. The anvil assembly comprises a center rod and an anvil head connected to the center rod. The center rod comprises at least one hole horizontally penetrating through the center rod, and the hole is designed with a size capable of holding a flexible member so that the flexible member horizontally penetrates through the center rod.
Description
The cross reference of related application
The interests that the present invention requires is that submit in JIUYUE in 2008 10 days, application number is 61/095,647 U.S. Provisional Application and submit on July 22nd, 2009, application number is the interests of 61/227,464 U.S. Provisional Application.The full content of above-mentioned application is incorporated herein by reference.
Technical field
Relate generally to of the present invention is used for surgical fasteners is put on systemic operation stitching device.The invention particularly relates to and be suitable for implementing the ring sealed type anastomosis and/or treat for example operation stitching device of the inwall of the organ of the hollow of hemorrhoidal tissue.
Background technology
Anastomosis is meant the operation with isolating hollow organ's part joint.Usually, coincideing operates in after the operation, and the ill or damaged part of hollow tissue is removed and remaining end portion will be engaged in described operation.Depend on desired identical operation, end portion can engage by ring sealed type, organ transformation method end-to-end or the side offside.
In ring sealed type coincide operation, the two ends of organ part are engaged by suture instruments, the suturing nail that suture instruments drives annular array passes the end of each organ part and side by side removes any tissue of the suturing nail inside of driven annular array, so that tubular conduit is unimpeded.In the patent No. is 7,303,106,6,053,390,5,588,579,5,119,983,5,005,749,4,646,745,4,576,167 and 4,473, the example of the apparatus of the ring sealed type anastomosis of implementing the hollow organ has been described in 077 the United States Patent (USP).Usually, these apparatuses comprise slender axles, and described slender axles have and are arranged on near-end with handle portion that activates apparatus and the suturing nail holding element that is arranged on far-end.The anvil assembly that comprises the anvil center rod that is connected with anvil head, the far-end that is mounted to apparatus is close to the place of suturing nail holding element.The opposed end of the hollow organ's that will be sewn tissue is clamped between anvil head and the suturing nail holding element along with the approaching of anvil head and suturing nail holding element.Pass the suturing nail groove and make the end of suturing nail pass tissue and the anvil block nest eye by anvil head is out of shape the end of suturing nail by driving in the suturing nail holding element one or more suturing nails, thereby the tissue of clamping is sewn.Ring knife is advanced simultaneously to remove the tissue that has the hollow organ so that the tubular conduit in the organ is unimpeded.
Outside the coincideing of a good appetite suddenly appearing in a serious disease pocket official, the operation stitching device that is used for implementing the ring sealed type anastomosis also is used to treat the internal hemorrhoid of rectum.Hemorrhoid are the piece of tissue that comprise the blood vessel of increase in the anus.Internal hemorrhoid is in the inboard of anal canal; External hemorrhoid is positioned at the outside of anal canal.In hemorrhoidectiomy, hemorrhoid are removed.Sewing up hemorrhoid (stapled hemorrhoidopexy) is operation technique, and stitching devices is used to remove tissue directly over the hemorrhoid hemorrhoid are retracted the inboard and mitigation symptoms of rectum in this operation technique.The blood flow of arterial branch cuts off the blood supply of tissue on the suturing nail blocking-up hemorrhoid, therefore causes hemorrhoid to be dwindled.
Between the operating period of the ring sealed type stitching devices that is used for hemorrhoid treating, the anvil head of device and suturing nail holding element are in anvil head and the suturing nail holding element is shown in an open position or be not inserted into and pass rectum under the situation of approximated position.Afterwards, the purse string suture art is used for interior hemorrhoidal tissue and/or mucosal tissue are pulled to anvil stem.Then, anvil head and suturing nail holding element are approaching mutually to be clamped in hemorrhoidal tissue and/or the mucosal tissue between anvil head and the suturing nail holding element.Start stitching devices to remove the tissue that hemorrhoidal tissue and/or mucosal tissue and stitching are cut open.
Use the purse string suture art to be known prior art with the various technology that interior hemorrhoidal tissue pulled to center-pole.For example, the patent No. of authorizing Longo etc. is 6,102,271 United States Patent (USP), the self-contained unit that is inserted into stitching devices by use has been discussed has been grasped and proximad pulling purse string suture line.
The publication number of Rebuffat etc. is that the international application of WO 2008/107918 discloses the purse string suture line is placed the one or more cannelures that are formed on anvil center rod.
Therefore, expectation be, a kind of operation stitching device is provided, it comprises and is configured and is sized to the structure that improves purse string suture line retentivity on center-pole.
In some operation, can expect to provide a kind of longer center-pole (anvil shaft) of anvil assembly.Therefore, additional, it is favourable that a kind of operation stitching device that is connected that strengthens anvil shaft and stiching instrument is provided.
Summary of the invention
According to a scheme of the present invention, a kind of operation stitching device is disclosed, it comprises: the elongate body portion with close end and distal portion; And the localized head of distal portion of contiguous described body.Described head comprise housing unit and with respect to described housing unit at mobilizable anvil assembly between approximated position and the approximated position not.Described anvil assembly comprises center-pole and anvil head.Described center-pole comprises at least one aperture of laterally running through described center-pole, and described aperture is configured and is sized to and holds flexure member and make flexure member laterally run through described center-pole.
According to one embodiment of present invention, at least one aperture in described center-pole comprises several lateral aperture along described center-pole longitudinal separation, for example first, second and third aperture of longitudinal separation.
It is contemplated that described center-pole is greater than or equal to three inches distance from described anvil head proximad extension.
Described operation stitching device preferably further comprises: has to small part and runs through the near-end of described body and the drive screw of far-end, and the anvil block keeper that operatively is associated with drive screw.Described anvil block keeper preferably has near-end and far-end, and is configured and is sized to and hold described center-pole at least in part.
In one embodiment, described anvil block keeper can be connected directly to described drive screw.Optionally, described anvil block keeper can be fixed to described drive screw via adapter, first extension that adapter comprises central body, extends from described central body proximad, and second extension that distad extends from described central body.In one embodiment, described first extension is configured and is sized in the far-end that is arranged on described drive screw and described second extension is configured and is sized in the near-end that is arranged on described anvil block keeper.Preferably, the far-end of described first extension and described drive screw comprise be configured and be sized to hold first the pin corresponding perforation, described first extension is connected to the far-end of described drive screw, and described second extension and described anvil block keeper comprise be configured and be sized to hold second the pin corresponding perforation, so that described second extension is connected to described anvil block keeper.
In one embodiment, described center-pole comprises first annular construction member and is positioned at second annular construction member in the described first annular construction member distally, and described stitching devices comprises the anvil block keeper, and wherein said anvil block keeper is configured and is sized to and holds described center-pole and described first annular construction member at least in part.The motion of described anvil block keeper makes described anvil assembly not move between approximated position and the approximated position.In one embodiment, the housing unit of described operation stitching device comprises projection (boss), and described second annular construction member engages described projection.Described center-pole preferably includes and is used to make center-pole and aligned several splines of described housing unit.
In another scheme of the present invention, provide a kind of anvil assembly, comprise that anvil head reaches from the extended center-pole of described anvil head.Described center-pole comprise the first annular engagement member and with the described first annular engagement member away from the second annular engagement member.The described first annular engagement member is constructed to engage the anvil block keeper of operation stitching device, and the described second annular engagement member is constructed to engage the housing unit of described operation stitching device.Preferably, described center-pole comprises several apertures of laterally running through center-pole, and described aperture is configured and is sized to and holds the stitching thread that passes the aperture.In one embodiment, described aperture is between described first annular construction member and described second annular construction member.Described center-pole preferably includes several splines between described first annular construction member and described second annular construction member.
Operation stitching device can use with the anoscope instrument.The anoscope instrument can comprise and limits the port pass longitudinal opening wherein, comprises the anoscope that limits the longitudinal axis and be configured and be sized to the slender body that is arranged in described port, and be configured and be sized to the dilator of the body that is arranged in described anoscope.The body of anoscope can comprise first opening with the second opening longitudinal separation, and wherein said first opening and described second opening are arranged along the longitudinal axis.
Description of drawings
Accompanying drawing is described various embodiments of the present invention below this reference, wherein:
Fig. 1 is the side isometric view according to the operation stitching device of principle of the present invention, and described operation stitching device comprises being shown as and is in the not anvil assembly and the housing unit of approximated position;
Fig. 2 is the part exploded view of the operation stitching device of Fig. 1, comprises Handleset;
Fig. 3 is the side isometric view of the anvil assembly and the housing unit of operation stitching device;
Fig. 4 is the exploded view of housing unit;
Fig. 5 is the longitdinal cross-section diagram of an embodiment of the anvil block keeper that uses with operation stitching device;
Fig. 6 is the longitdinal cross-section diagram in conjunction with the operation stitching device of Fig. 1 of the anvil block keeper among Fig. 5;
Fig. 7 is for to use operatively the anvil block keeper is connected to the side view of the adapter of drive screw with anvil block keeper shown in Figure 5;
Fig. 8 and Fig. 9 are the side isometric view of anvil assembly;
Figure 10 is the side isometric view of anvil assembly, and wherein parts are isolating;
Figure 11 is the enlarged drawing in the zone of concrete indication among Figure 10, and the tissue contact surface of anvil assembly is shown;
Figure 12 A and Figure 12 B are the local longitdinal cross-section diagram of anvil assembly, and the anvil assembly of distortion front and back is shown respectively, and described anvil assembly distortion is to be fixed on anvil block in the anvil head;
The longitdinal cross-section diagram of the operation stitching device of Fig. 1 when Figure 13 is in approximated position not for anvil block;
Figure 14 is the enlarged drawing in the zone of concrete indication among Figure 13, is illustrated in the not distal portion of the operation stitching device of approximated position;
Figure 15 is the enlarged drawing in the zone of concrete indication among Figure 14, and the anvil head element of anvil assembly is shown;
Figure 16 is the side isometric view of anvil assembly according to an alternative embodiment of the invention;
Figure 16 A is the view in transverse section that engages that anvil assembly with the optional embodiment of the housing projection of housing unit of Figure 16 are shown;
Figure 17 is the vertical view that is formed on the exemplary slit in the housing unit, and this slit is configured and is sized to and holds surgical fasteners;
Figure 18 and Figure 19 are the side view of the screw rod stopping element of operation stitching device;
Figure 20 is the side isometric view of the screw rod retainer shown in Figure 18 and Figure 19;
Figure 21 A and Figure 21 B are side view, and the pad (washer) that uses with the screw rod retainer shown in Figure 18 and Figure 19 is shown;
Figure 22 is the side isometric view of sliding component element of the indicating mechanism of operation stitching device;
Figure 23 is the enlarged drawing in the zone of concrete indication among Figure 13, illustrates to be positioned at the not indicating mechanism and the drive screw of approximated position;
Figure 24 is for using the top perspective view with the latch members that prevents accidental activation with operation stitching device;
Figure 25 is the enlarged drawing in the zone of concrete indication among Fig. 2, and the pedestal element of sense of touch indicating mechanism is shown;
Figure 26 is the side isometric view of the pedestal member shown in Figure 25;
Figure 27 is the front perspective view of the anoscope instrument that comprises packer (obturator), anoscope and port that uses with operation stitching device;
Figure 28 is the side isometric view of the anoscope instrument of assembling;
Figure 29 is the longitdinal cross-section diagram of anoscope instrument that is positioned at the assembling of patient inside;
Figure 30 is for removing packer and using the longitdinal cross-section diagram that the purse string suture art is positioned at the anoscope instrument of patient inside afterwards;
Figure 31 to Figure 33 illustrates the pocket threading operation that stitching thread is connected to destination organization for removing the proximal end view that packer is positioned at the anoscope instrument of patient inside afterwards;
Figure 34 shows the purse string suture line that is attached to anvil assembly for the longitdinal cross-section diagram of the port element of the anvil assembly element of operation stitching device that is positioned at patient inside after the pocket threading and anoscope instrument;
Figure 35 is the longitdinal cross-section diagram of the port element of the anvil assembly element of the operation stitching device that is positioned at patient inside after the anvil block keeper that is connected to operation stitching device at pocket threading and anvil assembly and anoscope instrument;
Figure 36 is a longitdinal cross-section diagram, is illustrated in anvil assembly and the housing unit far-end near the operation stitching device of the port element that is arranged in the anoscope instrument afterwards; And
Figure 37 is the longitdinal cross-section diagram of the operation stitching device after removing operation stitching device and remove the anvil assembly adhere to from the port element of anoscope instrument, and is illustrated in the destination organization of the removal in the housing unit of stitching devices.
The specific embodiment
Describe operation stitching device of the present invention in detail below with reference to Figure of description, wherein similar Reference numeral refers to identical or corresponding ingredient in each accompanying drawing.In the description, term " nearside " relate to operation stitching device or its element in suitable more close clinician's part between the operating period, and term " distally " relate to operation stitching device or its element suitably between the operating period away from clinician's part.In addition, term " hemorrhoidal tissue " and similar word relate to hemorrhoidal tissue, also relate to being positioned near the tissue of hemorrhoidal tissue, comprise mucosal tissue.Though operation stitching device of the present invention can be used for other operation, be particularly suitable for the hemorrhoid operation operation.Term " hemorrhoid operation " is construed as and comprises hemorrhoid resection operation (surgi cal hemorrhoidectomies), hemorrhoid fixing operation (hemorrhoidopexies), mucosa operation, is used for the treatment of the operation of colon prolapsus, reaches and above-mentioned relevant operation.
Fig. 1 illustrates operation stitching device of the present invention, is usually referred to by Reference numeral 10.Concisely, operation stitching device 10 comprises Handleset 12, comprises the central body portion 14 of outer tube 14A, and distally head 16.Handleset 12 comprises fixed handle 18, emission trigger 20, rotating subglobular handle (approximation knob) 22 and is positioned at indicator 24 on the fixed handle 18, whether indicator 24 is ready to start for the clinician provides about stitching devices 10, and just anvil block has been as the approaching information of expectation.It is contemplated that fixed handle 18 can be formed by independently handle portion 19A, 19B (Fig. 2), handle portion 19A, 19B are that the inner member in the Handleset 12 limits shell together.As shown in Figure 1, fixed handle 18 and trigger 20 can comprise respectively that the 18A of damping and slide-prevention portion, 20A are beneficial to the clinician and grip and control crank assembly 12 during operation technique.Trigger lock 26 pivotally is mounted to Handleset 12, and can optionally be resetted to prevent the accidental activation of stitching devices 10 by the clinician.To describe the structure and the operation of trigger lock 26 afterwards in detail.
The head 16 of operation stitching device 10 comprises anvil assembly 30 and housing unit 31.Except particularly pointing out, the element of stitching devices 10 is usually by the thermoplastic that comprises Merlon and comprise rustless steel and the metal of aluminum forms.The selected strength demand that will depend on particular element with the special material that forms particular element.For example, anvil assembly 30 can be formed by for example stainless metal, yet the part of Handleset 12 can be formed by the thermoplastic of for example Merlon.Optionally, the other materials with the necessary strength demand used of being suitable for performing the operation can be used to form the element of stitching devices 10.
Referring now to Fig. 1 to Fig. 4, comprise subglobular handle 22, drive screw 32, pivotable sleeve 33 and be configured and be sized to the anvil block keeper 38 that holds anvil assembly 30 according to mode described below securely near mechanism.
Pivotable sleeve 33 (Fig. 2) comprises the body 40 of cylindrical hollow substantially, also has cylindric substantially installing ring (collar) 42, and body 40 and installing ring 42 limit centre bore 33a together.Installing ring 42 comprises the structure that is configured and is sized to the corresponding construction (Fig. 1) that forms on the joint fixed handle 18.For example, among the embodiment, installing ring 42 comprises formation cannelure 44 in its vicinity shown in figure 2, and cannelure 44 is configured and is sized to the flange that extends internally 46 that holds on the inwall that is formed on fixed handle 18.Engage the motion to axial that has stoped between sleeve 33 and the fixed handle 18 between groove 44 and the flange 46, and allow sleeve 33 to rotate with respect to fixed handle 18.
The proximal extension of the body 40 of pivotable sleeve 33 passes the opening 18B (Fig. 2) of the near-end that is positioned at fixed handle 18.Body 40 also comprises one or more rib 48, and rib 48 is arranged on the outer surface of body 40 and is located at a pair of inside groove 49a that subglobular handle 22 forms.Engaging between rib 48 and the groove 49a stops relatively rotating between sleeve 33 and the subglobular handle 22, makes the rotation of subglobular handle 22 cause the corresponding rotation of sleeve 33.
Drive screw 32 is slidably located among the centre bore 33a of pivotable sleeve 33.Screw rod 32 comprises the close end (Fig. 2) with spiral channel 50, and spiral channel 50 engages with the pin 52 of the installing ring 42 that radially extends through sleeve 33.Because sleeve 33 is with respect to fixed handle 18 axial restraints, the rotation that sleeve 33 centers on screw rod 32 causes pin 52 to move to produce the axially-movable of screw rod 32 in the fixed handle 18 along the conduit 50 of screw rod 32.At far-end, screw rod 32 further comprises axial groove 54 and holds the perforation 34 of pin 64 (Fig. 2).Though the structure that is referred to by Reference numeral 52 and 64 refers to pin and illustrates as pin, be to be understood that to any can reach disclosed interactional structure and can use, for example bolt, rivet or the like.
With reference to Fig. 4, anvil block keeper 38 has the near-end 38A that wherein is formed with perforation 267.Pin 64 (Fig. 2) is held in perforation 267.Be positioned at by near-end 38A in the axial groove 54 of screw rod 32, and will sell 64 and be positioned in the perforation 34 of screw rod 32 and in the perforation 267 of anvil block keeper 38, anvil block keeper 38 is connected to screw rod 32 anvil block keeper 38.Anvil block keeper 38 also comprises cannelure being bonded on the corresponding annular protuberance 280 (Fig. 3, Figure 10) on the anvil assembly 30, and axial groove 268 (Fig. 3) is formed on the spline (spline) 270 of the respective numbers on the center-pole 154 of anvil assembly 30 with joint.Axial groove 268 is divided into flexible finger (finger) 272 with anvil block keeper 38.Other details that engage with anvil assembly 30 about anvil block keeper 38 are provided below.Be shown as and comprise three finger bars 272 although be construed as anvil block keeper 38, and center-pole 154 is shown as and comprises three splines 270, can present more or less quantity at optional embodiment middle finger bar 272 of the present invention and spline 270.
With reference to Fig. 5 to Fig. 7, in optional embodiment of the present invention, stitching devices 10 comprises the general anvil block keeper by Reference numeral 36A (Fig. 5) expression.Anvil block keeper 36A is similar to anvil block keeper described above 38 substantially, therefore, and with the difference of only discussing with respect to anvil block keeper 38.
Anvil block keeper 36A is configured and is sized to via adapter 35 and operatively is connected to drive screw 32 (Fig. 6).Adapter 35 comprises the central body 35A with near-end extension 35B and far-end extension 35C, and the groove (not shown) that described near-end extension 35B is used for for example forming via the far-end that is positioned at the drive screw 32 with relative configurations and size engages the far-end of drive screw 32.In the far-end of near-end extension 35B and drive screw 32 each all is defined for the cross-perforating (not shown) of 39A (Fig. 6) such as holding pin, rivet, bolt, regularly adapter 35 is fixed to the far-end of drive screw 32.Far-end extension 35C is sized to by cannelure 36F (Fig. 5) and is contained in wherein, and cannelure 36F is formed among the near-end 36B of body 36D of anvil block keeper 36A.The far-end extension 35C of adapter 35 comprises and is formed on the perforation (not shown) of the aligned pair of separated of perforation 36G among the anvil block keeper 36A, to hold 39B (Fig. 6) such as pin, bolt, rivet thus regularly anvil block keeper 36A is fixed to the near-end extension 35B of adapter 35.Though anvil block keeper 36A and adapter 35 are disclosed as via 39A, 39B such as pin, bolt, rivets and are connected, and also it is contemplated that other known tightening technologies, include, but are not limited to welding, shrinkage compacting (crimping) and interlock.
Referring again to Fig. 1 to Fig. 4, between the operating period of stitching devices 10, the rotation of subglobular handle 22 (Fig. 1, Fig. 2) causes the corresponding rotation of pivotable sleeve 33 around the near-end of screw rod 32, thereby makes pin 52 (Fig. 2) motion through spiral channel 50.Because sleeve 33 is axially fixed to fixed handle 18, so sell 52 cause the withdrawal of screw rod 32 in fixed handle 18 through the proximal movement of spiral channel 50, and sell 52 distal movement and cause screw rod 32 advancing in fixed handle 18 through spiral channel 50.The joint of anvil assembly 30 and anvil block keeper 38 (Fig. 1) makes the rotation of subglobular handle 22 impel anvil assembly 30 with respect to housing unit 31 motions, thereby the head 16 (Fig. 1) of operation stitching device 10 is moved between not near (separation) position and approximated position.
In particular with reference to Fig. 1 and Fig. 2, stitching devices 10 comprises that further trigger mechanism is beneficial to for example ejaculation of the securing member 230 of suturing nail (Figure 14).Especially, trigger mechanism comprises above-mentioned emission trigger 20, emission connecting rod 72, and elongated pushing tow connecting rod (pusher link) 74 (also can with reference to Fig. 4).Trigger 20 comprises body 76 (Fig. 2), and trigger cover 80.The body 76 of trigger 20 pivotally is connected to the coupling component 86 (Fig. 2) that is fixed to the near-end of pushing tow connecting rod 74 by pivot pin 84.But, in an optional embodiment of the present invention, it is contemplated that coupling component 86 can be fixedly connected to pushing tow connecting rod 74, for example integrally formed with pushing tow connecting rod 74.
The body 76 of trigger 20 further comprises a pair of pedestal (abutment) 89,91 (Fig. 2), and it is positioned as the end 26A that engages trigger lock 26, thus prevent device 10 near before trigger 20 activate.
The coupling component 86 (Fig. 2,4) that is positioned at the near-end of elongated pushing tow connecting rod 74 comprises flange 104.The position that between the inwall or pedestal and flange 104 of spring 106 in fixed handle 18, is retracted, does not launch so that pushing tow connecting rod 74 proximads are biased to.Coupling component 86 comprises a pair of fin 108 that extends radially outwardly from coupling component 86, is used for being sliding engaged to the conduit 111 (Fig. 2) that forms along the inwall of fixed handle 18.Fin 108 makes at stitching devices between 10 starting periods that with engaging of conduit 111 the pushing tow connecting rod 74 in the fixed handle 18 keeps suitable location.
Pushing tow connecting rod 74 is arranged in the outer tube 14A of body 14, and comprises and be configured and be sized to the structure that is beneficial to pushing tow backboard (pusher back) 186 (Fig. 4) fixed engagement.Pushing tow backboard 186 forms the part of housing unit 31 (Fig. 1), below with detailed description.In shown embodiment, for example, pushing tow connecting rod 74 comprises that a pair of joint at its far-end refers to bar 110 (Fig. 4), and described joint refers to that bar 110 is configured and is sized to regularly with member 220 in the near-end that is formed on pushing tow backboard 186 and engage, for example with the relation of interlocking.In addition, pushing tow connecting rod 74 limits the hollow conduit 75 that runs through wherein, with hold slidably assembling near mechanism.
When emission trigger 20 activated, emission trigger 20 pivoted around pivot member 84, caused launching connecting rod 72 proximal motion and engaged the pedestal face that is formed on the screw rod retainer 306 (Fig. 2,13,14) until pivot member 79.To describe screw rod retainer 306 below and be connected to screw rod 32 according to the mode that prevents axially-movable relative between screw rod retainer 306 and the screw rod 32.The distal movement of emission trigger 20 causes pushing tow connecting rod 74 (Fig. 2,4) to overcome the corresponding distal movement of the biasing that spring 106 applies.Because the far-end of pushing tow connecting rod 74 is connected to pushing tow backboard 186, so the actuating of emission trigger 20 is distad advanced the pushing tow backboard 186 in the housing unit 31, from housing unit 31, to penetrate securing member 230.
Referring now to Fig. 8 to Figure 15, anvil assembly 30 will be described.Anvil assembly 30 comprises anvil head assembly 120 and anvil center rod or anvil shaft 152.Anvil head assembly 120 comprises post 122 (Figure 10), anvil head 124, cut ring (cutting ring) 128 and anvil block 129.
With reference to Figure 10 and Figure 15, cut ring 128 is an annular construction member, is located in the internal annular groove 135 that forms in the anvil head 124.Cut ring 128 comprises near-end 128A and far-end 128B (Figure 15) respectively, and limits the inner annular shoulder 128C towards nearside, also has the outside ring surface 128D towards nearside.The inner annular shoulder 128C of cut ring 128 and ring surface 128D engage anvil head 124, make cut ring be maintained in the groove 135.For example, with reference to Figure 15, anvil head 124 can comprise the inwall of the finger bar 131A that having stretches out engages with inner annular shoulder 128C, and the outer wall with the finger bar 131B that engages with outside ring surface 128D of extending internally.Between 10 operating periods, in case start, cutter 188 (Fig. 4) passes cut ring 128 at stitching devices.
As shown in figure 11, the tissue contact surface 252 of anvil block 129 comprises several nest eyes (pocket) 255 that are arranged in several annular arrays, to hold and to make the annular array distortion of respective seam dowel.In the embodiment of the anvil block shown in Figure 10 and Figure 11 129, for example, anvil block 129 comprises the nest eye 255 of two annular arrays.But, can be understood as, in the optional embodiment of anvil block 129, the array of nest eye 255 can present quantity more or still less.
In an embodiment of anvil block 129, though optionally structure does not exceed scope of the present invention, illustrate as Figure 11 the best, it is contemplated that cavity 256 can be sphere substantially textural.Substantially spheric structure has increased cavity 256 and has been used for the surface area that contacts with the supporting leg of securing member 230.
As mentioned above, cavity 256 is connected with linear portion 257.More particularly, at least a portion of the outer rim 256A of each cavity 256 and linear portion 257 intersects, for example, the supporting leg that limits surgical fasteners 230 substantially from cavity 256 to motion that forming face 258 contacts any interruption.Linear portion 257 limits the definite length " L " of specific dimensions that will form based on securing member 230.Therefore, the length of linear portion 257 " L " can change in the optional embodiment of anvil block 129 based on the particular configuration and the size of the securing member 230 in the housing unit 31 of packing into.
Forming face 258 is arcual in textural length along linear portion 257 " L ", and initial curve is away from tissue contact surface 252, then towards tissue contact surface 252.This curve impels the supporting leg of securing member 230 to change direction and distortion, makes securing member 230 can finish the structure that expectation forms.In the embodiment of the anvil block shown in Figure 10 and Figure 11 129, for example, forming face 258 is positioned, constructs and be sized to " B shape " structure that makes securing member 230 finish standard.But, in the optional embodiment of anvil block 129, the location of forming face 258, structure and/or size can be conditioned to change the structure that securing member 230 is shaped, and for example, forming face 258 can be positioned, constructs and be sized to and make that finishing monocycle when securing member 230 is shaped constructs.
Securing member nest eye 255 further comprises the pair of sidewalls 259 that extends to tissue contact surface 252 from forming face 258.Sidewall 259 is configured and is sized to the suitable shaping of further guaranteeing surgical fasteners 230.For example, it is contemplated that sidewall 259 can limit the structure of general planar, the transverse movement of supporting leg in securing member nest eye 255 of restriction surgical fasteners 230 that is to say, by arrow 1 indicated direction.Limit contacting between supporting leg that such motion keeps securing member 230 and the forming face 258, finish until the shaping of securing member 230.
With reference to Figure 12 A and Figure 12 B, anvil block 129 further comprises outer steps 129A, and to the longitudinal axis X-X angled side walls 129B of anvil assembly 30 (can also with reference to Fig. 9).Between erecting stage, anvil block 129 is arranged in the outer annular groove 136 that is formed on anvil head 124 (can also with reference to Figure 10), makes the annular shoulder 124A that outer steps 129A contact is limited by anvil head 124.Afterwards, anvil head 124 for example by press forging, to longitudinal axis X-X distortion, makes the inner surface 136A of outer annular groove 136 contact the sidewall 129B of anvil block 129, shown in the transformation between Figure 12 A and Figure 12 B to internal strain.After distortion, anvil head 124 is orientated as with the tissue contact surface 252 of anvil block 129 and is flushed, and makes anvil assembly 30 (Fig. 1) qualification be configured to the nearest side 120A (Figure 12 A, 12B) of even substantially and general planar.
With reference to Fig. 8 to Figure 10, Figure 13 and Figure 14, anvil center rod assembly 152 will be described especially.Anvil center rod assembly 152 comprises anvil center rod 154, it has enough length to allow when the suitable location of hemorrhoid operation operating period anvil center rod 154, anvil center rod 154 can be stretched out from the outer surface of patient tissue, for example stretches out from patient's anus.For example, though long or short center-pole 154 does not exceed scope of the present invention, for the application of hemorrhoid operation, anvil center rod 154 can have the length of about 13.5cm (approximate 5.3 inches).The realization that anvil center rod 154 is stretched out from patient's anus allows to improve the visuality of the interface between anvil center rod 154 and the anvil block keeper 38.
The close end 274 of center-pole 154 comprises the trocar 278 with tapered proximal end.Annular protrusion 280, it is configured and is sized to the corresponding annular groove 282 (Figure 14) that forms at the far-end of anvil block keeper 38 and engages releasedly.The outside lateral dimension that annular protrusion 280 limits greater than the inner transversal dimension of anvil block keeper 38.Therefore, during anvil center rod assembly 152 was connected to anvil block keeper 38 (Figure 14), center-pole 154 proximads advanced and pass engaging between flexible finger 272 (Fig. 3) that anvil block keeper 38 causes anvil block keeper 38 and the annular protrusion 280.Therefore this joint impels flexible finger 272 radially outward, and is beneficial to engaging between annular protrusion 280 and the cannelure 282 (Figure 14).Engage the relative longitudinal motion that stops between center-pole 154 and the anvil block keeper 38 between annular protrusion 280 and the cannelure 282, until when expecting center-pole 154, predetermined force is put on anvil assembly 30 on direction distad from 38 disengagings of anvil block keeper.
Return with reference to Fig. 8 to Figure 10, the central part 284 of center-pole 154 has the outside lateral dimension greater than the inner transversal dimension that is limited by anvil block keeper 38, inserts anvil block keeper 38 with restriction center-pole 154.That is to say that central part 284 prevents that with the engaging of far-end of anvil block keeper 38 center-pole 154 from inserting anvil block keeper 38 constantly.
The distal portion 276 of center-pole 154 is included in one or more aperture that is positioned at perforation 160 nearsides that wherein forms, for example aperture 286A, 286B, 286C.Comprise three apertures though be depicted as, be construed as in the optional embodiment of center-pole 154, can comprise the aperture of more or smaller amounts.Though the aperture is shown as equidistant interval substantially, also can consider other intervals in aperture.Aperture 286A-286C runs through center-pole 154, and is configured and is sized to and hold the flexure member that passes wherein, and the stitching thread of a segment length for example described below " S " (Figure 34).In the illustrated embodiment, aperture 286A-286C makes the clinician control the amount of drawing in the tissue in the housing unit 31 along center-pole 154 longitudinal separations like this.Especially, compare and be drawn into the amount of the tissue in the housing unit 31 by the aperture 286C that stitching thread " S " is attached to distal-most end, to draw in the housing unit 31 amount of tissue more by stitching thread " S " is set in the 286A of the aperture of most proximal end.
In one embodiment of the invention, consider that center-pole 154 may further include labelling (marker), for example the ring between aperture 286A and 286B 287 will be implemented the interlock of a large amount of tissues attached to the stitching thread in the aperture of most proximal end with the indication clinician.
The distal portion 276 of center-pole 154 further comprises spline 270, its be configured and be sized to anvil assembly 30 and housing unit 31 near during be formed on housing unit 31 in corresponding axial groove (not shown) engage slidably.Joint between the axial groove of spline 270 and housing unit 31 makes anvil assembly 30 and housing unit 31 suitable aiming at, and makes that the securing member anvil block nest eye 255 in the tissue contact surface 252 that is formed on anvil block 129 is aimed at the slit 228 (Fig. 4) in being formed on securing member guide channel 192.
In the optional embodiment shown in Figure 16 and Figure 16 A, disclose center-pole (anvil shaft) 154 '.Center-pole 154 ' cardinal principle is similar to center-pole described above 154, therefore, only describes both differences in detail.With the corresponding center-pole 154 of the element of center-pole 154 ' element with apostrophe " ' " labelling.Therefore, for example, center-pole 154 ' have aperture 286A ', 286B ', 286C ', be mounted to anvil head assembly 120 ' and have trocar 278 '.
Center-pole 154 ' comprise outer annular member (protuberance) 280 similar in appearance to the annular protrusion 280 of Fig. 9 '.For with anvil assembly 30 ' be connected to anvil block keeper 38, center-pole 154 ' (being similar to center-pole 154) is positioned in (Fig. 1 and Fig. 5) in the anvil block keeper 38, and proximad advances, make center-pole 154 ' annular protrusion 280 ' engage with the flexible finger 272 of anvil block keeper 38.When annular protrusion 280 ' when engaging with flexible finger 272, flexible finger 272 is forced outwardly, therefore be beneficial to annular protrusion 280 ' with the cannelure 282 of anvil block keeper 38 between engage, with stop according to the identical mode of the above description of being correlated with the protuberance 280 of Figure 10 center-pole 154 ' and anvil block keeper 38 between relative longitudinal motion.
Center-pole 154 ' comprise second protrudes annular ring or interference rib 290, its be configured and be sized to strengthen center-pole 154 ' with the frictional engagement of housing unit 31 (Fig. 1), with further enhanced stability.For reach with housing unit 31 ' frictional engagement, annular construction member 290 ' be configured and be sized to when anvil assembly 30 ' be connected to anvil block keeper 38 and near the time, engage housing unit 31 ' the projection 37 of protrusion.Shown in Figure 16 A, the housing projection 37 that annular construction member 290 ' joint protrudes.As shown, member 290 is positioned at the nearside of stitching thread aperture 286A ', 286B ', 286C, and contiguous in the illustrated embodiment nearest 286A ' location, aperture.Also can consider other position.Note except when anvil shaft 154 ' when being connected to operation stitching device 10 outside the projection 37 of the protrusion of engagement annular member 290, housing unit 31 ' substantially is identical with housing described herein 31.This interference provides additional joint to strengthen when anvil shaft 154 ' stability of anvil assembly when being connected to operation stitching device 10.The spline 270 of several processing of anvil shaft 154 ' also comprise ', be used for according to the mode identical and housing unit 31 with spline described above 270 ' groove aim at.Alternatively, spline can be at the moulding one-tenth of center-pole 154 ' patrix.
Referring now to Fig. 1 and Fig. 4, will describe housing unit 31 in detail.Housing unit 31 comprises housing 182, pushing tow backboard 186, cylindric cutter 188 and securing member guide channel 192.Housing 182 has the housing department 194 of perforation of limiting 198, and comprises far-end columnar portion 200, center circle tapering 202 and near-end columnar portion 204.Several openings 206 are formed in the conus portion 202, and described several openings 206 are configured and are sized to and allow liquid and tissue to pass wherein between the operating period of stitching devices 10 (Fig. 1).A pair of flexible engagement member 207 is formed on the near-end columnar portion 204 of housing 182.As shown, engagement member 207 relative setting on diameter.But, also can consider the optional structure of engagement member 207.Engagement member 207 is positioned among the opening 207A on the far-end that is formed on outer tube 14A, so that housing 182 is fixed to slender body 14.Pair of openings 211 is formed in the near-end of outer tube 14A, only illustrates one, and it is configured and is sized to the protuberance (not shown) that holds on the inwall that is formed on fixed handle 18, is beneficial to outer tube 14A and is connected to handle portion 12.
Pushing tow backboard 186 is slidably disposed in the housing 182, and comprise the perforation 208A, be configured and be sized to far-end columnar portion 210, center circle tapering 212, near-end columnar portion of holding slidably by the far-end columnar portion 200 of housing 182 214 and the accepter 215 (Figure 14) that holds cut tissue.Accepter 215 is constructed to limit the degree of depth within the extremely about 0.79cm (near 2.0 inches) of about 0.275cm (near 0.75 inch) substantially.For example, in one embodiment, accepter 215 is constructed to limit the degree of depth of about 0.52cm (near 1.33 inches).
Referring again to Fig. 4, cylindric cutter 188 is maintained among the perforation 208A of pushing tow backboard 186, with regularly that cutter 188 is fixing with respect to pusher 190.Cutter 188 can be maintained in the pushing tow backboard 186 by any way, includes, but are not limited to stick, the use of shrinkage compacting, pin, friction tool etc.
As mentioning previously, pushing tow backboard 186 comprises above-mentioned member 220, and member 220 is configured and is sized to the jerk-finger bar 110 that engages pushing tow connecting rod 74 regularly.Member 220 is fastened to pushing tow backboard 186 with engaging of bar 110 of finger with pushing tow connecting rod 74, makes the distal face of pushing tow connecting rod 74 be close to the proximal end face of pushing tow backboard 186.At far-end, pushing tow backboard 186 comprises the pusher 190 that is combined with several finger bars 226 that distad extend, and refers to that bar 226 is slidably disposed in the securing member holding tank 228 that is formed in the securing member guide channel 192, with emission securing member 230.
With reference to Figure 17, description is formed on groove 228 in the securing member guide channel 192 (can also with reference to Fig. 4).In an embodiment who illustrates, each groove 228 all has the first side wall 228A, the second sidewall 228B and is separately positioned on the first side wall 228A and the rectangular groove 228C of a pair of cardinal principle of the second sidewall 228B opposite end, 228D.The first side wall 228A is convex surface substantially, and comprises first end that is connected to groove 228C and second end that is connected to groove 228D.The second sidewall 228B comprises the side wall portion 228E with longitudinal axis parallel with the longitudinal axis of slit 228, and a pair of angled side wall portion 228F.Each angled side wall portion 228F interconnects one among the end of side wall portion 228E and groove 228C, the 228D.The supporting leg that among groove 228C, the 228D each all is configured and is sized to frictionally securing member 230 (Figure 14) remains on wherein.The structure that can be understood as slit 228 in optional embodiment of the present invention can change or change.
Referring now to Fig. 4, between the operating period of stitching devices 10, when the actuating of pushing tow connecting rod 74 response emission triggers 20 (Fig. 1) was distad advanced, pushing tow backboard 186 was distad advanced in housing 182.Advancing of pushing tow backboard 186 causes being arranged on the corresponding slit 228 that advances and pass securing member guide channel 192 of the finger bar 226 on the pusher 190, to advance securing member 230 and securing member 230 is launched to go in the securing member distortion nest eye 255 that forms in the tissue contact surface 252 of anvil block 129 from securing member guide channel 192.Because cutter 188 is fixed to pushing tow backboard 186, so cutter 188 distad advances with the tissue of excision between anvil assembly 30 and housing unit 31.
With reference to Fig. 2 and Figure 18 to Figure 20, cam adjustment member 400 is fixed on the sidewall 306A of screw rod retainer 306 via bolt 312.Especially, cam adjustment member 400 is arranged in the groove 306B that is formed on sidewall 306A.Cam adjustment member 400 comprises having perforation 404 disk 402, and it passes disk 402 and forms prejudicially, and is sized to and holds bolt 312.Small-sized recess or hole 406 also are formed in the disk 402, and are sized to the top that holds the adjustment means (not shown).Groove 306B comprises anterior pedestal face 306C and rear portion pedestal face 306D, and is sized to and holds disk 402, makes the contiguous corresponding anterior pedestal face 306C of outer rim and the rear portion pedestal face 306D of disk 402.During assembling, bolt 312 runs through disk 402 and screw rod retainer 306.
Cam adjustment member 400 allows the axial location of the screw rod retainer 306 on the adjusting screw(rod)s 32, therefore, allows the air-gap of qualification between the adjustment housings assembly 31 and anvil assembly 30 during manufacture.More particularly, loosen bolt 312 and allow disk 402 in the groove 306B of screw rod retainer 306, to rotate, still remain fixed to screw rod 32 simultaneously.Because disk 402 is installed around bolt 312 prejudicially, and engage with anterior pedestal face 306C and the rear portion pedestal face 306D of groove 306B respectively, so the lead-screw retainer 306 axially around the rotation of the disk 402 of fixed bolt 312 along screw rod 32 is with the axial location of the screw rod retainer 306 on the adjusting screw(rod) 32.For example, when disk 402 clockwise directions, just, in Figure 19 when arrow " B " indicated direction is rotated, in response to engaging between the rear portion pedestal face 306D of the outer rim of disk 402 and groove 306B, screw rod retainer 306 will be with respect to screw rod 32 along being moved axially by arrow " C " indicated direction.On the contrary, when disk 402 counter clockwise directions, just, when arrow in Figure 18 " D " indicated direction is rotated, in response to engaging between the anterior pedestal face 306C of the outer rim of disk 402 and groove 306B, screw rod retainer 306 will be with respect to screw rod 32 along being moved axially by arrow " E " indicated direction.
In optional embodiment, disk 402 can be by the rectangular member 402 shown in Figure 21 A or Figure 21 B ' substitute, the size of the air-gap that limits between rectangular member 402 ' default housing unit 31 and the anvil assembly 30, and do not provide adjusting for the screw rod retainer 306 on the screw rod 32.Rectangular member 402 ' comprise opening 404 ', opening 404 ' be configured and be sized to the bolt 302 that holds Fig. 2, so that screw rod retainer 306 suitably is positioned on the screw rod 32.Select rectangular member 402 ' on opening 404 ' the position think that the securing member of specific dimensions provides the air-gap of appropriate size, and change based on the securing member of the specific dimensions that is placed in for example 3.5mm in the housing unit 31 or 4.8mm.One or more recess 406 of rectangular member 402 ' comprise ' with discern during manufacture suitable rectangular member 404 ', with the securing member of the size that is used to be loaded into stitching devices to guarantee to be provided with the air-gap of appropriate size.
Referring now to Fig. 1, Fig. 2, Figure 22 and Figure 23, stitching devices 10 can be further combined with indicating mechanism, and described indicating mechanism provides stitching devices 10 also not approaching for the clinician, and does not carry out the indication that starts preparation.Indicating mechanism comprises above-mentioned indicator 24, also comprises lens cap 24A, and sliding component 500.The patent No. is to describe indicator in detail in 7,303,106 the United States Patent (USP), and it is incorporated herein by reference in full.
The sliding component 500 of indicating mechanism comprises the body 504 that has therein the elongated slot 506 that forms, far-end pedestal member or to upper lip shape portion (upturned lipportion) 508, and near-end extension 510.Sliding component 500 is slidably disposed between handle portion 19A, the 19B of device 10, and near-end extension 510 is supported in the fixed handle 18 slidably by supporting construction 516.For example the biasing member 512 of disc spring is pressed between the body 504 of supporting construction 516 and sliding component 500 around near-end extension 510, distad to promote sliding component 500 in fixed handle 18.
As mentioned above, screw rod retainer 306 is attached to screw rod 32 regularly.Screw rod retainer 306 comprises first engagement member 522 (Fig. 2), its be set to stitching devices 10 near during move through the slit 506 that is formed in the sliding component 500 (Figure 22), and the near-end 506A of engagement slot 506.When the near-end 506A of engagement member 522 adjacent slots 506, the further approaching of stitching devices 10 makes sliding component 500 overcome the biasing proximal motion of spring 512 in fixed handle 18, what make sliding component 500 engages the protuberance 518,520 of indicators 24 to upper lip shape portion 508, as shown in Figure 23.It serves as that axle is switched to the second position with pivot member 502 that engaging between protuberance 518,520 and the lip shape portion 508 causes indicator 24, provides stitching devices 10 enough approaching in this indicator 24 for the clinician, and the indication that is ready to start.
Referring now to Fig. 2, Figure 24 and Figure 25, the emission blocking mechanism will be described.The emission blocking mechanism comprises above-mentioned trigger lock 26, also comprises latch members 530.Trigger lock 26 pivotally is supported in the through hole 532 that is formed among handle portion 19A, the 19B (Fig. 2), for example, and around pivot member 534.Pivot member 534 extends from the upper limb of trigger lock 26, and is T shape, makes pivot member 534 frictionally engage the inwall of through hole 532, to prevent freely rotating of trigger lock 26.Trigger lock 26 is arranged on and is formed between the pedestal 89,91 of emission on the trigger 20, to prevent the actuating when trigger lock 26 trigger 20 during in latched position.
Latch members 530 (Figure 24) comprises body 536, near-end extension 538, a pair of front leg strut 540A, a pair of rear support leg 540B, and pedestal member or to lower lip shape portion 542.Latch members 530 is slidably disposed between first retainer 544 on the inwall that is formed at handle portion 19A, 19B (Fig. 2) respectively and second retainer 546 (Figure 23).Retainer 544 is configured, determines size and orientates the extension 538 of engage latch member 530 as, and the front leg strut 540A of latch members 530.Biasing member 549 is arranged between retainer 544 and the rear support leg 540B locking 530 is pushed into the highest distance position of supporting leg 540A in abutting connection with retainer 546 around near-end extension 538.In this position, the extension 26B (Fig. 2) of trigger lock 26 is positioned at the below of lip shape portion 542 of latch members 530 preventing the pivoting action of trigger lock 26, thereby prevents the actuating of stitching devices 10.
During use, when anvil assembly 30 and housing unit 31 near the time, screw rod 32 (Fig. 2) proximal motion in fixed handle 18, and the front leg strut 540A of one or more engagement member 548 contiguous latch members 530 that form on screw rod retainer 306, so that the biasing proximal motion that latch members 530 overcomes member 549 is to the isolating position of extension 26B of lip shape portion 542 proximads and trigger lock 26 wherein.In this position of latch members 530, trigger lock 26 can be switched to the position that does not stop trigger 20 operations, makes stitching devices 10 to be activated.
With reference to Figure 25 and Figure 26, stitching devices 10 may further include sense of touch indicating mechanism.Sense of touch indicating mechanism is arranged in the fixed handle 18 (Fig. 1), and comprises pedestal member 580, and it is slidably disposed in the vertical channel 582 that is limited among handle portion 19A, the 19B.Pedestal member 580 comprises projection (protuberance) 580A and guiding rib 580B.Projection 580A is configured and is sized to by one among two ratchet 582A, the 582B forming along the wall of groove 582 and is contained in wherein.Pedestal member 580 is moveable to extension (making progress) position from regaining (downwards) position, and projection 580A is set among the ratchet 582A in withdrawal (downwards) position, and projection 580A is set among the ratchet 582B in extension (making progress) position.Joint between projection 580A and the ratchet 582A remains on to upper/lower positions pedestal member 580, and engaging between protruding 580A and the ratchet 582B remains on the position that makes progress with pedestal member 580.Vertical channel 582 may further include ratchet 582C, and it is configured, determines size and orientate as and hold guiding rib 580B slidably, thereby keeps contacting of pedestal member 580 and groove 582.
Before stitching devices 10 started, pedestal member 580 was positioned at withdrawal (downwards) position.When stitching devices 10 was activated, the extension 590 (Fig. 2) of emission connecting rod 72 engaged pedestal member 580, and makes pedestal member 580 move to its extended position from its retrieving position.At extended position, pedestal member 580 extends in the conduit 111 (Fig. 2) of fixed handle 18.
As mentioned above, though stitching devices 10 can be used for other operation, stitching devices 10 is specially adapted in the hemorrhoid operation operation.In such operation, the hole that enters that enters hole (access port) 1300 shown in Figure 27 can be inserted into patient's anus and be beneficial near destination organization, and for example Tuo Chui colon is extremely shown in Figure 33 as Figure 30.Then, the flexure member of purse string suture line " S " for example shown in Figure 30 is placed into the top of destination organization or on every side, and anvil assembly 30 is inserted into and enters the hole and enter anus and rectum.Included spherical component 126 makes anvil assembly 30 smooth apertures by health on anvil head 124, and through purse string suture line S.Afterwards, the purse string suture line is inserted among the aperture 286A-286C that is formed in the center-pole 154, as Figure 34 and shown in Figure 35.
With before anvil block keeper 38 combines, stitching devices 10 is in not approximated position at anvil assembly 30.In this position, the biasing member 106 (Fig. 2) that engages with coupling component 86 is pushed into pushing tow connecting rod 74 position of the nearside of the 86 contiguous screw rod retainers 306 of coupling component wherein, and biasing member 512 engages the position that engages with the protuberance 518 (Figure 23) of indicator 24 so that sliding component 500 is placed with the sliding component 500 (Fig. 2) of indicating mechanism, thereby indicator 24 is rotated along clockwise direction, as Fig. 2 and shown in Figure 23.In addition, biasing member 549 (Figure 23) engages with the body 536 of latch members 530 latch members 530 is pushed into the position of its farthest side, be positioned at the top of the extension 26B (Fig. 2) of trigger lock 26 in the lip shape portion 542 of this latch members 530, move to the position of release to prevent trigger lock 26.Biasing member 82A (Fig. 2) also engages with pivot member 79 pivot member 79 being pushed into the bottom of the vertical channel 82 that is formed between handle portion 19A, the 19B, and tactile indicators 580 be positioned at regain or to upper/lower positions simultaneously protuberance 580A locate by ratchet 582A.
For anvil assembly 30 is connected to anvil block keeper 38, the center-pole 154 of anvil assembly 30 (Fig. 8, Fig. 9) is set in the anvil block keeper 38 (Fig. 1 and Fig. 5), and proximad advances the flexible finger 272 that makes the annular protrusion 280 of center-pole 154 engage anvil block keeper 38.When annular protrusion 280 engages with flexible finger 272, flexible finger 272 is forced to outwardly, therefore is beneficial to the joint of the cannelure 282 of annular protrusion 280 and anvil block keeper 38, to prevent the relative longitudinal motion between center-pole 154 and the anvil block keeper 38.
With after anvil block keeper 38 (Fig. 1) engages, stitching devices 10 can be moved into the approximated position at anvil assembly 30.For this reason, rotate subglobular handle 22 so that anvil assembly 30 towards housing unit 31 proximal motion, because the rotation of subglobular handle 22 causes the corresponding rotation of cylindrical sleeve 33, therefore along spiral channel 50 motion pin 52 (Fig. 2).Pin 52 causes screw rod 32 proximad in sleeve 33 to move along moving of spiral channel 50.When the far-end operation of screw rod 32 when being connected to anvil block keeper 38, the withdrawal of the screw rod 32 in the sleeve 33 is changed into the proximal movement of anvil block keeper 38, subsequently, changes the proximal movement of the anvil assembly 30 that is connected into.During the proximal movement of anvil assembly 30, destination organization is drawn in the housing unit engaging of locating of aperture 286A-286C (Figure 35,36) via stitching thread " S " and center-pole 154.
Because screw rod retainer 306 is connected to screw rod 32 by bolt 312 (Fig. 2), so the withdrawal of the screw rod 32 in the sleeve 33 causes the remote location of screw rod retainer 306 from fixed handle 18 to move to proximal location.Between this moving period, be formed on the near-end 506a of the slit 506 of first engagement member, the 522 contiguous slide plates 500 on the screw rod retainer 306, and make slide plate 500 overcome the biasing proximal motion of spring 512.Along with slide plate 500 proximal motion, the protuberance 520 (Figure 23) that the lip shape portion 508 of sliding component 500 engages on the indicator 24 is with the indicator 24 that pivots along counter clockwise direction, as Fig. 2 and shown in Figure 23.
Along with screw rod retainer 306 moves to proximal location from remote location, second engagement member 548 (Figure 20) of screw rod retainer 306 engages with the far-end supporting leg 540A (Figure 24) of latch members 530, so that latch members 530 proximal motion are to the isolating position of extension 26B (Fig. 2) of lip shape portion 542 proximads and trigger lock 26.In this position, trigger lock 26 can be switched to unlocked position to allow the startup of stitching devices 10.
When moving to its proximal most position in fixed handle 18 along with screw rod retainer 306, the pedestal face 307 of screw rod retainer 306 is configured to engage the pivot member 79 (Fig. 2) of emission connecting rod 72.At stitching devices between 10 starting periods, pedestal face 307 engages pivot members 79, and as the backstop (backstop) of pivot member 79.
Between 10 starting periods, along with trigger 20 is compressed towards fixed handle 18, pivot member 79 (Fig. 2) engages the pedestal face 307 (Figure 18) on the screw rod retainer 306, and emission trigger 20 is distad promoted at operation stitching device.Because the far-end of emission trigger 22 is connected to the near-end of pushing tow connecting rod 74 by coupling component 86, the distal movement of therefore launching trigger 20 causes the 74 corresponding motions of pushing tow connecting rod to carry out pushing tow backboard 186 (Fig. 4) advancing in housing unit 31 (Fig. 1).When pushing tow backboard 186 advances, refer to that bar 190 (Fig. 4) engages and emission securing member 230 (Fig. 4 and Figure 14) from securing member guide channel 192 in housing unit 31.Cutter 188 and pushing tow backboard 186 move to simultaneously with cut ring 128 (Figure 10) thereby engage the tissue " H " that cuts off between anvil assembly 30 and housing unit 31, as shown in figure 36.
When trigger 20 activated, just when fixed handle 18 is compressed, the extension 590 (Fig. 2) of emission connecting rod 72 pivots towards pedestal member 580 (Figure 25, Figure 26), and is switched to pedestal member 580 and engages, so that pedestal member 580 moves to extended position from retrieving position.At extended position, pedestal member 580 stops the conduit 111 that is formed in the fixed handle 18.
After device started, anvil assembly 30 (Fig. 1) separated with housing unit 31.When anvil assembly 30 distal motion, the fin 584 of screw rod retainer 306 (Fig. 2, Figure 20) engages tactile indicators 580 (Figure 25), so tactile indicators 580 provides the indication of the tactile and/or audition that center-pole 154 (Fig. 8, Figure 19) can break away from from anvil block keeper 38 (Figure 10) for the clinician.
Referring now to Figure 27 and Figure 28, the anoscope instrument 1000 that is used for stitching devices 10 described above (Fig. 1) use is shown.In the process of operation technique, anoscope instrument 1000 is beneficial near interior tissue.For example, during the description below, will describe anoscope instrument 1000 and suture tissue 10 in the situation of hemorrhoid operation operation, wherein hemorrhoidal tissue " H " (Figure 35) is removed from patient's anal canal.Notice that stitching devices 10 described herein can use with other anoscope instrument or other ports, is perhaps directly inserted the opening of health.
The sleeve 1204 of anoscope 1200 distad extends from flange 1202, and limits the inside dimension that allows removably to hold packer 1100.Sleeve 1204 comprises that cone shape distal tip 1212 is beneficial to make for example organization grows of patient's anal canal substantially, and therefore, is beneficial to the insertion of anoscope 1200, in case also be beneficial to the rotation of anoscope 1200 in positioned internal.
For helping the layout of purse string suture line, sleeve 1204 can comprise labelling 1222.When comprising labelling 1222, labelling 1222 is beneficial to the purse string suture line and is arranged in certain depth in the anal canal.
Sleeve 1204 further comprises along axle " X " longitudinal extension and passes wherein open area 1214, and strides across the bridge part 1216 of open area 1214, therefore open area 1214 is divided into proximal openings 1218 and distal openings 1220 respectively.It is contemplated that bridge part 1216 can extend across sleeve 1204 to limit the radian of any appropriate size.For example, it is contemplated that the radian that is limited by bridge part 1216 can be less than 180 degree.But also can consider radian greater than 180 degree.
The structure of bridge part 1216 can change in optional embodiment or change satisfy any suitable axial length.In a certain embodiments, bridge part 1216 limits the axial length of about 1.5cm (near 0.59 inch), and be provided so that the near-end 1216A of bridge part 1216 and far-end 1216B lay respectively at near-end 1206 about 3cm (near 1.18 inches) and the about 4.5cm (near 1.77 inches) apart from sleeve 1204, just, 1204 points that radially extend apart from flange 1202 from sleeve.In this embodiment, when anoscope 1200 inserts in patient's anal canal, distal openings 1220 will be positioned at the linea anocutanea top, linea anocutanea is arranged in patient's anal canal apart from the about 2cm of anus (near 0.78 inch), for example makes the purse string suture of the stitching devices 10 by Fig. 1 and removal subsequently organize also and all takes place above linea anocutanea.
The port element 1300 of anoscope instrument 1000 limits and allows removably to hold the inside dimension of anoscope 1200, and comprises with respect to the longitudinal axis " X " from port element 1300 outward extending a pair of fins 1302.Fin 1302 is configured and is sized to the manual engagement by the clinician, is beneficial to processing and manipulation at hemorrhoid operating process middle port 1300.In order to be beneficial to the fixing of port one 300, fin 1302 can comprise pair of apertures 1304, and described aperture 1304 is configured and is sized to and holds for example sutural flexure member (not shown) that can be fixed to patient tissue.
Referring now to Figure 29 to Figure 37, will using and operating of the anoscope instrument 1000 relevant with the stitching devices 10 of Fig. 1 be described.Before inserting, anoscope instrument 1000 fitted to be shown in Figure 28.Especially, anoscope 1200 is arranged in the port one 300 coaxially, and packer 1100 is arranged in the sleeve 1204 of anoscope 1200 coaxially.The anoscope instrument 1000 that assembles is then inserted patient (Figure 29) by translation ground, makes bridge part 1216 be positioned at the top of linea anocutanea.Afterwards, packer 1100 is removed, and the anoscope 1200 that stays is arranged in the port one 300 that stretches out from patient's anus (Figure 30).Before anoscope instrument 1000 assembling or afterwards, port one 300 can selectively be fixed to patient tissue by flexure member (not shown) described above.For the purpose of reaffirming, flexure member can be arranged in the aperture 1304 on the fin 1302 that is included in port one 300, and can be fixed to the patient.
With reference to Figure 31 to Figure 33, after removing packer 1100, destination organization, for example in hemorrhoidal tissue " H " (Figure 35), (Figure 27, Figure 30) holds by the distal openings in the sleeve 1,204 1220, makes tissue be arranged in the sleeve 1204 of anoscope 1200.Then, the clinician is with reference to being commonly referred to as the program of " purse string suture ", and the stitching thread " S " of a segment length is connected in destination organization " H ".Afterwards, anoscope 1200 (Figure 27) can turn to one or more a plurality of position subsequently that changes that is exemplified as between Figure 31, Figure 32 and Figure 33 in port one 300, make other interior hemorrhoidal tissue, if any, can in distal openings 1220 (Figure 27, Figure 30), be received and be sewn or purse string suture.
After purse string suture was finished, anoscope 1200 (Figure 27) was removed from patient's anus.The anvil assembly 30 of the stitching devices 10 of Fig. 1 is inserted into patient's anal cavity (analcavity) then, and draw in the amount of the tissue of housing unit 31 based on clinician's expectation, one among the aperture 286A-286C that is formed in the center-pole 154 is passed at the two ends of stitching thread " S ", as shown in figure 34.The length of stitching thread " S " is extended from port one 300 after making stitching thread " S " locate in aperture 286A-286C (Figure 34).
Start suture tissue 10 then to cut off and fastening destination organization " H ".Cutting off tissue " H " afterwards, suture tissue 10 can be removed from port one 300, and tissue " H " is arranged in housing unit 31 simultaneously, as shown in figure 37.
Although in description and/or the accompanying drawing some embodiments of the present invention have been shown herein, do not represent limitation of the invention, it is the same with the scope that this area allows and description is put down in writing to be construed as scope of the present invention.Therefore, foregoing description should not be construed as restriction, but only is the signal of specific embodiment.Those skilled in the art will contemplate other improvement in the scope and spirit of the claim of being attached.
Claims (16)
1. operation stitching device comprises:
Elongate body portion with close end and distal portion; And
The localized head of distal portion of contiguous described body, described head comprise housing unit and with respect to described housing unit at mobilizable anvil assembly between approximated position and the approximated position not, described anvil assembly comprises center-pole and anvil head, described center-pole comprises at least one aperture of laterally running through described center-pole, and described aperture is configured and is sized to and holds flexure member and make described flexure member laterally run through described center-pole.
2. operation stitching device according to claim 1, wherein described at least one aperture in described center-pole comprises along several apertures of the length direction longitudinal separation of described center-pole.
3. operation stitching device according to claim 2, wherein described at least one aperture in described center-pole comprises first, second and third aperture of longitudinal separation.
4. operation stitching device according to claim 1 and 2 further comprises the labelling that is positioned at distally, near-end aperture.
5. according to aforementioned any described operation stitching device of claim, wherein said center-pole is greater than or equal to three inches distance from described anvil head proximad extension.
6. according to aforementioned any described operation stitching device of claim, further comprise having to small part and run through the near-end of described body and the drive screw of far-end, and has an anvil block keeper of near-end and far-end, described anvil block keeper is operably connected to described drive screw, and be configured and be sized to and hold described center-pole at least in part, wherein said drive screw makes described anvil assembly move between described not approximated position and approximated position.
7. according to aforementioned any described operation stitching device of claim, wherein said center-pole comprises several splines that can engage with described anvil block keeper, and the interference member that can engage with described housing unit.
8. according to claim 6 or 7 described operation stitching devices, wherein said housing unit comprises projection, and described interference member comprises annular ring, annular ring can with bump bond.
9. operation stitching device according to claim 6, wherein said anvil block keeper is fixed to described drive screw via adapter, first extension that described adapter comprises central body, extends from described central body proximad, and second extension that distad extends from described central body, wherein said first extension is positioned in the far-end of described drive screw and described second extension is positioned in the near-end of described anvil block keeper.
10. according to aforementioned any described operation stitching device of claim, wherein said center-pole comprises first annular construction member and is positioned at second annular construction member in the described first annular construction member distally, and described stitching devices comprises the anvil block keeper, described anvil block keeper is configured and is sized to and holds described center-pole and described first annular construction member at least in part, and the motion of wherein said anvil block keeper makes described anvil assembly not move between approximated position and the approximated position.
11. operation stitching device according to claim 10, wherein said housing unit comprises projection, and described second annular construction member engages described projection.
12. according to claim 10 or 11 described operation stitching devices, wherein said center-pole comprises and is used for described center-pole and aligned several splines of described housing unit that described spline is between described first annular construction member and described second annular construction member.
13. anvil assembly, comprise that anvil head reaches from the extended center-pole of described anvil head, described center-pole comprise the first annular engagement member and with the described first annular engagement member away from the second annular engagement member, the described first annular engagement member is constructed to engage the anvil block keeper of operation stitching device, and the described second annular engagement member is constructed to engage the housing unit of described operation stitching device.
14. anvil assembly according to claim 13, wherein said center-pole comprise several apertures of laterally running through center-pole, described aperture is configured and is sized to and holds the stitching thread that passes the aperture.
15. anvil assembly according to claim 14, wherein said aperture is between described first annular construction member and described second annular construction member.
16. according to claim 13,14 or 15 described anvil assemblies, wherein said center-pole comprises aligned several splines of the housing unit that is used for described center-pole and operation stitching device, and described spline is between described first annular construction member and described second annular construction member.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN2009101737226A CN102018545A (en) | 2009-09-10 | 2009-09-10 | Operation suture device |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN2009101737226A CN102018545A (en) | 2009-09-10 | 2009-09-10 | Operation suture device |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CN102018545A true CN102018545A (en) | 2011-04-20 |
Family
ID=43860612
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN2009101737226A Pending CN102018545A (en) | 2009-09-10 | 2009-09-10 | Operation suture device |
Country Status (1)
| Country | Link |
|---|---|
| CN (1) | CN102018545A (en) |
Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN106983532A (en) * | 2017-05-05 | 2017-07-28 | 江苏孜航精密五金有限公司 | Disposable anorectal selects the selective nail bin groupware of Endo-GIA |
| CN110461253A (en) * | 2017-03-23 | 2019-11-15 | 柯惠有限合伙公司 | Circular stapling device with alignment spline |
| JP2020189154A (en) * | 2012-04-09 | 2020-11-26 | コヴィディエン リミテッド パートナーシップ | Surgical fastener applying apparatus |
-
2009
- 2009-09-10 CN CN2009101737226A patent/CN102018545A/en active Pending
Cited By (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| JP2020189154A (en) * | 2012-04-09 | 2020-11-26 | コヴィディエン リミテッド パートナーシップ | Surgical fastener applying apparatus |
| CN110461253A (en) * | 2017-03-23 | 2019-11-15 | 柯惠有限合伙公司 | Circular stapling device with alignment spline |
| CN110461253B (en) * | 2017-03-23 | 2023-03-10 | 柯惠有限合伙公司 | Circular suturing device with aligned splines |
| CN106983532A (en) * | 2017-05-05 | 2017-07-28 | 江苏孜航精密五金有限公司 | Disposable anorectal selects the selective nail bin groupware of Endo-GIA |
| CN106983532B (en) * | 2017-05-05 | 2024-01-16 | 江苏孜航精密五金有限公司 | Selective nail bin assembly of disposable anorectal selective cutting anastomat |
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Application publication date: 20110420 |