CN1993083A - Instrument for effecting anastomosis of respective tissues defining two body lumens - Google Patents

Abstract

The instrument (10) disclosed comprises a tube assembly (500) supporting an end effector that may be adapted for insertion into and through the urethra into the bladder lumen or into the bladder lumen through incisions in the abdomen and bladder wall and adapted for use in effecting the anastomosis of a patient's bladder and urethra following a prostatectomy. The instrument (10) may include an end effector having a positioner (400), an anchor driver (300) and anchor system (700) comprising a shaft (720) with a lodging structure (730), and/or a combined balloon harness (94) and catheter (96). The instrument (10) urges the bladder wall to the pelvic floor and drives an anchor (700) through the bladder wall into the pelvic floor, thereby connecting a balloon harness (94) within the bladder to the pelvic floor that presses the bladder wall against the pelvic floor; maintaining the balloon catheter (96) in place and draining the bladder during the time required for the tissues to effectively knit; and then deflating and withdrawing the balloon catheter (96) and disconnecting and withdrawing the balloon harness (94).

Description

Be used to make the identical apparatus of tissue that limits two body cavitys respectively

[0001] related application

[0002] the application requires the priority of the applying date of one or more U.S. Provisional Applications: the serial number of submitting on May 7th, 2004 is 60/569,195 " METHODS ANDDEVICE FOR ANASTOMOSIS "; The serial number of submitting on June 23rd, 2004 is 60/582,302 " METHODS AND DEVICE FOR ANASTOMOSIS "; And the serial number of December in 2004 submission on the 28th is 60/639,836 " METHODSAND INSTRUMENT FOR EFFECTING ANASTOMOSIS OFRESPECTIVE TISSUES DEFINING TWO BODY LUMENS ".

[0003] technical field

[0004] the present invention relates generally to coincideing of two hollow organs, hollow organ and a vascular or two vasculars, is specifically related to realize in Wicresoft's mode the embodiment of described identical method and apparatus.More specifically, the invention still further relates to the particularly cut coinciding machine and the method for coincideing that is used for bladder and urethra afterwards of patient's prostate in prostatectomy.

[0005] background technology

[0006] carcinoma of prostate is the common cancer of second after the malignant tumour of skin among the male, and is the second the most common inducement of cancer mortality among the U.S. male.Carcinoma of prostate is the principal disease of elderly men, estimates that the absolute number of this case can increase along with the increase of global life expectancy.

[0007] method after Millin has introduced as the pubis of the prostatectomy of prostate cancer therapy in nineteen forty-seven.The remarkable advantage that this operation is compared with perineal prostatectomy is, dissects behind the more familiar pubis of urologist.Pubis method for the carcinoma of prostate radical correction also provides the advantage of carrying out the ability of abdomen adventitia pelvic lymph node dissection stage by stage.In the past during the decade, the introducing of the improvement of carcinoma of prostate radical correction technology and identical neuroprotective method causes the rapid decline of relevant with this operation two kinds of sickness rate-incontinences that attract people's attention most and sexual impotence behind the pubis.

[0008] behind pubis in the carcinoma of prostate radical correction, the doctor excises patient's all or most prostate.Because urethra passes prostate and advances, the top of urethra is cut in surgical operation.In order to recover normal urinary function, bladder and urethra must be reconnected.

[0009] because the limited work space and the reduced size of urethra provide this connection difficulty especially.The size of urethra makes that being difficult to accurately to pass urethral wall is provided with stitching thread.So far, the suture operation that the doctor requires great effort uses miniature very thin pin to reconnect bladder and urethra.Have been found that the sutural use that is used for this purpose has caused some problems aspect rehabilitation.These problems comprise that the gangrene of suture tissue, obstruction fluid are connected with the urethra-bladder that does not have fluid-tight through its mobile urethral stricture.In addition, when urethra was sewn onto bladder, the doctor may puncture near neurovascular bundle because of carelessness, and this can cause incontinence and sexual impotence.Find that also sewing process itself is very loaded down with trivial details, before carrying out meticulous stitching, need the doctor to grip and bladder and urethra are stretched to together.Stitching thread also may be torn urethra, causes further complication.

[0010] the carcinoma of prostate radical correction becomes more and more general behind the use pubis, thereby needs rapider easier mode reconnect bladder and urethra.May further advantageously provide does not need to use the sutural identical urethra that may damage and the instrument of bladder.

[0011] in addition, exist other need connect the surgical operation of the tissue of blood vessel, hollow organ and other body cavity of qualification.Though some in these structures are bigger, and operated by the doctor easilier, the organizational structure that limits other body cavity is littler, more is difficult to operate after crosscut operation for example and is being connected it and is held in place in terminal.Therefore, the quicker easier mode of other tissue of connection blood vessel, hollow organ and qualification body cavity will be advantageously.

[0012] description of drawings

[0013] accompanying drawing that is included in the description and forms the part of description has been explained aspects more of the present invention, and with describe one and be used from and explain principle of the present invention, wherein:

[0014] Fig. 1 is the partial vertical generalized section of the position relation of human male's bladder, prostate and urethra and pelvic floor on every side before prostatectomy;

[0015] Fig. 2 is the partial vertical generalized section of the position relation of human male's bladder, prostate and urethra and pelvic floor on every side after prostatectomy;

[0016] Fig. 3 is the perspective view according to the coinciding machine with actuator handle, actuator assembly and localizer assembly of one embodiment of the present invention;

[0017] Fig. 4 is the profilograph of the actuator handle of the coinciding machine that shows among Fig. 3;

[0018] Fig. 5 is the amplification profilograph of the actuator handle near-end of the coinciding machine that shows among Fig. 3;

[0019] Fig. 6 is the amplification profilograph of the actuator handle far-end of the coinciding machine that shows among Fig. 3;

[0020] Fig. 7 is the profilograph of pipe assembly, localizer assembly and the actuator assembly of the apparatus that shows among Fig. 3;

[0021] Fig. 8 is the amplification profilograph of the bridge assembly part of the pipe assembly that shows among Fig. 7;

[0022] Fig. 9 is the amplification drawing in side sectional elevation of the bridge assembly part of the pipe assembly that shows among Fig. 8;

[0023] Figure 10 is the amplification profilograph of the bridge assembly part of the pipe assembly that shows among Fig. 8;

[0024] Figure 11 is the amplification profilograph of the localizer assembly part of the coinciding machine that shows among Fig. 3;

[0025] Figure 12 is the profilograph of the actuator assembly part of the coinciding machine that shows among Fig. 3;

[0026] Figure 13 is the perspective view of the embodiment of the localizer assembly of the coinciding machine that shows among Fig. 3 and actuator assembly;

[0027] Figure 14 is the localizer assembly of the coinciding machine that shows among Fig. 3 and the perspective view of actuator assembly, and wherein localizer and actuator assembly are shown as and are shown in an open position;

[0028] Figure 15 is the localizer of the coinciding machine that shows among Figure 14 and the cross-sectional plan view of actuator assembly, and display driver arm and localizer arm are shown in an open position;

[0029] Figure 16 is the enlarged perspective of the actuator assembly of the coinciding machine that shows among Figure 14, display driver arm, actuator pin and anchoring piece;

[0030] Figure 17 is the profilograph according to the another kind of embodiment of coinciding machine of the present invention;

[0031] Figure 18 is the drawing in side sectional elevation of the actuator assembly part of the coinciding machine that shows of Figure 17;

[0032] Figure 19 is the profilograph of the coinciding machine that shows among Figure 17, and wherein driver and localizer lobe assembly are shown as and are in the position that is opened;

[0033] Figure 20 is the profilograph of the coinciding machine that shows among Figure 17, shows that the localizer lobe contacts and anchoring piece actuator pin and anchoring piece partly are deployed in the tissue with organizing;

[0034] Figure 21 is the profilograph of the coinciding machine that shows among Figure 17, shows that the localizer lobe contacts and anchoring piece actuator pin and anchoring piece are driven in the tissue with organizing;

[0035] Figure 22 is the profilograph of the another kind of optional embodiment of coinciding machine of the present invention;

[0036] Figure 23 is the profile of the actuator assembly part of the coinciding machine that shows among Figure 22;

[0037] Figure 24 is the profilograph of the coinciding machine that shows among Figure 22, and wherein the localizer lobe is shown as and is in the position that is opened;

[0038] Figure 25 is the profilograph of the coinciding machine that shows among Figure 22, and wherein localizer lobe and actuator assembly are shown as and are in the position that is opened;

[0039] Figure 26 is the profilograph of the coinciding machine that shows among Figure 22, shows that the localizer lobe contacts and anchoring piece actuator pin and anchoring piece are driven in the tissue with organizing;

[0040] Figure 27 is the vertical view of the localizer assembly of the coinciding machine that shows among Figure 24, wherein for illustrated purpose actuator assembly is removed, and shows that the localizer lobe is in the position that is opened;

[0041] Figure 28 is the perspective view of the optional coinciding machine that shows among Figure 17, is shown as make position;

[0042] Figure 29 is the perspective view of the optional coinciding machine that shows among Figure 17, is shown as open position;

[0043] Figure 30 is the perspective view of the optional coinciding machine that shows among Figure 22, is shown as make position;

[0044] Figure 31 is the diagram that also is inserted into the coinciding machine in the bladder behind prostatectomy through patient's urethra fully;

[0045] Figure 32 is the diagram that also is inserted into the coinciding machine in the bladder behind the demonstration prostatectomy through patient's urethra fully, and wherein driver and localizer assembly are opened;

[0046] Figure 33 is the diagram that also is inserted into the coinciding machine in the bladder behind the demonstration prostatectomy through patient's urethra fully, and wherein localizer assembly is forced into wall of urinary bladder with pelvic floor and contacts, and the opening in bladder and the urethra is aligned;

[0047] Figure 34 shows the diagram that is fully inserted into and enters the coinciding machine in the bladder through patient's urethra behind the prostatectomy, and wherein actuator assembly activated and anchoring piece is driven through wall of urinary bladder and goes forward side by side into pelvic floor;

[0048] Figure 35 shows the diagram of inserting and inject the coinciding machine in the bladder through urethra, and wherein actuator assembly and actuator pin are bounced back and withdraw from from anchoring piece, and this anchoring piece still keeps entering pelvic floor by wall of urinary bladder;

[0049] Figure 36 is the diagram that is fully inserted into and enters the coinciding machine in the bladder through patient's urethra behind the demonstration prostatectomy, and wherein driver and localizer assembly are returned to initial advanced position after anchoring piece is installed;

[0050] Figure 37 is presented at anchoring piece to be installed and to be removed bladder after the coinciding machine that is used to carry out described installation and the diagram of urethra, and this diagram also shows to stay and wherein is used for conduit is passed through the seal wire that urethra directs into bladder;

[0051] Figure 38 is presented at anchoring piece to be installed and to be removed bladder after the coinciding machine that is used to carry out described installation and the indicative icon of urethra, and this diagram also shows the ductus bursae system that urethra is inserted in the bladder and leads to urine collecting bag of passing through;

[0052] Figure 39 is the perspective view of the embodiment of anchoring piece;

[0053] Figure 40 is the perspective view of the optional embodiment of anchoring piece;

[0054] Figure 41 is the perspective view of the optional embodiment at anchoring piece axle and tip;

[0055] Figure 42 is the perspective view of the optional embodiment at anchoring piece axle and tip;

[0056] Figure 43 is the perspective view of the optional embodiment at anchoring piece axle and tip;

[0057] Figure 44 is the perspective view of the optional embodiment at anchoring piece axle and tip;

[0058] Figure 45 is the perspective view of the optional embodiment at anchoring piece axle and tip;

[0059] Figure 46 is the perspective view of the optional embodiment at anchoring piece axle and tip;

[0060] Figure 47 is the perspective view of the optional embodiment at anchoring piece axle and tip;

[0061] Figure 48 is the perspective view of the optional embodiment at anchoring piece axle and tip;

[0062] Figure 49 is the perspective view of the optional embodiment at anchoring piece axle and tip;

[0063] Figure 50 is the perspective view of the optional embodiment at anchoring piece axle and tip;

[0064] Figure 51 is the perspective view of the optional embodiment at anchoring piece axle and tip;

[0065] Figure 52 is the sketch map of activation button assembly, and it is shown as to be in waits (cocked) position;

[0066] Figure 53 is the sketch map of activation button assembly, and it is shown as and is in the off-position;

[0067] Figure 54 is the sketch map of activation button assembly, and it is shown as and is in riding position forward;

[0068] Figure 55 is the perspective view according to direct motion bladder of the present invention-ureter coinciding machine;

[0069] Figure 56 is the partial illustration of the apparatus that shows in Figure 55, comprises the swan-neck assembly and the identical end effector that are inserted in patient's bladder, as according to used in the present invention;

[0070] Figure 57 is the partial illustration of the apparatus that shows in Figure 55, comprises the localizer assembly of opening, as according to used in the present invention;

[0071] Figure 58 is the partial illustration of the apparatus that shows in Figure 55, comprises the anchoring piece assembly of opening, as according to used in the present invention;

[0072] Figure 59 is the partial illustration of the apparatus that shows among Figure 55, shows according to the present invention that localizer arm is actuated wall of urinary bladder to contact with pelvic floor;

[0073] Figure 60 is the partial illustration of the apparatus that shows among Figure 55, and it is for being driven diagram after entering pelvic floor through wall of urinary bladder according to the present invention at anchoring piece;

[0074] Figure 61 is the partial illustration of the apparatus that shows among Figure 55, its for according to the present invention with the diagram of anchoring piece actuator pin after the anchoring piece that is mounted withdraws from;

[0075] Figure 62 is the partial illustration of the apparatus that shows among Figure 55, and it is for partly to bounce back apparatus to open fixation clamp (harness) diagram afterwards according to the present invention;

[0076] Figure 63 is the partial illustration of the apparatus of Figure 55, and it is for withdrawing from them preparing at closed anchoring piece assembly and localizer assembly according to the present invention, thus the diagram after capsule assembly and conduit waited behind;

[0077] Figure 64 is the partial illustration of the apparatus of Figure 55, the diagram after its removal for localizer assembly used according to the invention and anchoring piece assembly has begun;

[0078] Figure 65 is the partial illustration of the apparatus of Figure 55, and it is for localizer assembly used according to the invention and the anchoring piece assembly is removed afterwards and capsule used according to the invention and that be connected by the fixation clamp of anchoring expansion diagram afterwards;

[0079] Figure 66 is the perspective view of the fixation clamp part of the apparatus that shows among Figure 55, for when its diagram that can be connected with anchoring piece through fixation clamp anchoring ring;

[0080] Figure 67 is the profilograph that can be suitable for the embodiment of capsule assembly used according to the invention;

[0081] Figure 68 is the drawing in side sectional elevation of conduit that can be used according to the invention;

[0082] Figure 69 be can be used according to the invention duct cover and the profilograph of a kind of embodiment of urine collecting bag;

[0083] Figure 70 is the exploded view of embodiment of the end effector assembly of the apparatus that shows among Figure 55;

[0084] Figure 71 is the perspective view of biopsy cavity marker devices longitudinally of the embodiment of the end effector assembly that shows among Figure 55, shows anchoring piece assembly of opening and the localizer assembly that partially opens;

[0085] Figure 72 be the coinciding machine that for example in Figure 55, shows the transition conduit part vertically and perspective section view, show exemplary connector as actuate tube;

[0086] Figure 73 is the profilograph of the closure tube locking circle part of the apparatus that shows among the Figure 55 that is in the close position;

[0087] Figure 74 is the profilograph of the closure tube locking circle part of the apparatus that shows among the Figure 55 that is shown in an open position;

[0088] Figure 75 is the sectional side view of embodiment of the Handleset of the apparatus that shows among Figure 55;

[0089] Figure 76 is the decomposition diagram of the Handleset that shows among Figure 75;

[0090] Figure 77 is the profile of the coupling part of the localizer assembly that shows among Figure 55 and Handleset, is presented at localizer assembly related element in service;

[0091] Figure 78 is the perspective view of the localizer assembly of the apparatus of reality among Figure 55, and open the display part;

[0092] Figure 79 is the profile of the coupling part of the anchoring piece assembly that shows among Figure 55 and Handleset, is presented at element related in the open and close of anchoring piece assembly;

[0093] Figure 80 is the closure tube locking circle of the apparatus that shows among Figure 55 and the decomposition diagram of related elements;

[0094] Figure 81 is the profile of the coupling part of the anchoring piece assembly that shows among Figure 55 and Handleset, is presented at element related when driving anchoring piece;

[0095] Figure 82 is the profile of the coupling part of the curved ridges pipe that shows among Figure 55 and Handleset, demonstrates the fixed framing structure of apparatus;

[0096] Figure 83 is the far-end of another embodiment of coinciding machine of the present invention and the perspective view of near-end, shows that it is in the pre-deployment position of retraction, has wherein removed mid portion for the purpose that is easy in the accompanying drawings illustrate;

[0097] Figure 84 is the profilograph of the far-end of the apparatus that shows among Figure 83, shows that it is in the pre-deployment position of retraction;

[0098] Figure 85 is the profilograph that is suitable for the embodiment of the Handleset that uses at the near-end of coinciding machine of the present invention;

[0099] Figure 86 is the partial cross-sectional view of the apparatus that shows among Figure 84, the 86-86 place of Figure 84 is shown, shows the profile of the outside actuator assembly pipe, anchoring piece actuator pin, inboard actuator assembly pipe, location organ pipe and the anchoring piece that are loaded in the apparatus that is in the pre-deployment position;

[0100] Figure 87 is the side view of element forward of the anchoring piece of the apparatus that can be used for showing among Figure 83, shows to be in the pre-deployment position when contacting with the anchoring piece actuator pin;

[0101] Figure 88 is the profilograph of the apparatus that shows among Figure 83, shows that its urethra through the patient of prostate excision postoperative inserts also to enter the pre-deployment position that is in retraction after the bladder;

[0102] Figure 89 is the profilograph of the apparatus that shows among Figure 83, shows its insertion and inserts and enter after the bladder and localizer has been moved to profilograph after the expanded position through patient's urethra;

[0103] Figure 90 is the profilograph of the embodiment of the apparatus that shows among Figure 83, the urethra that shows its insertion and process patient inserts and enters after the bladder, be moved to after the expanded position with localizer, and wall of urinary bladder be urged into contact with pelvic floor and bladder and urethra in the aligned profilograph of opening;

[0104] Figure 91 is the profilograph of the apparatus that shows among Figure 83, the urethra that shows its insertion and process patient inserts and enters after the bladder, be moved to after the expanded position with localizer, and wall of urinary bladder be urged into contact with pelvic floor and bladder in opening with after urethra is aimed at, thereby and activate the anchoring piece actuator assembly with the tissue that drives anchoring piece and enter pelvic floor and the wall of urinary bladder profilograph after aligned urethra opening and the bladder opening;

[0105] Figure 92 is the profilograph of the apparatus that shows among Figure 83, the urethra that shows its insertion and process patient inserts and enters after the bladder, be moved to after the expanded position with localizer, and wall of urinary bladder be urged into contact with pelvic floor and bladder with after the opening in the urethra is aimed at, and after anchoring piece has been mounted, and the anchoring piece actuator assembly begun to bounce back in case localizer and location organ pipe waited behind so as between rehabilitation and healing stage the profilograph after bladder is urinated;

[0106] Figure 93 is the profilograph of another optional embodiment of coinciding machine of the present invention, and it shows that localizer has been moved to expanded position, comprises the optional structure of actuator pin and outside actuator assembly pipe;

[0107] Figure 94 is the profilograph of another optional embodiment of coinciding machine of the present invention, show that localizer has been moved to after the expanded position, comprise the optional structure of actuator pin and outside actuator assembly pipe, and the optional pre-deployment that shows the Connection Element of element and anchoring piece backward towards;

[0108] Figure 95 is according to the far-end of another embodiment of coinciding machine of the present invention and the perspective view of near-end, shows the pre-deployment position that is in retraction, has wherein removed mid portion for the purpose that is easy in the accompanying drawings illustrate;

[0109] Figure 96 is the profilograph of the far-end of the apparatus that shows among Figure 95, shows that it is in the pre-deployment position of retraction;

[0110] Figure 97 is the partial cross-sectional view of the apparatus that shows among Figure 96, the 97-97 place of Figure 96 is shown, shows second anchoring piece guiding circle, first anchoring piece guiding circle, the location organ pipe and first anchoring piece that is loaded in the apparatus that is in the pre-deployment position and draw sutural profile;

[0111] Figure 98 is the partial cross-sectional view of the apparatus that shows among Figure 96, the 98-98 place of Figure 96 is shown, shows outside actuator assembly pipe, anchoring piece guiding circle, anchoring piece actuator pin, inboard actuator assembly pipe, the location organ pipe and second anchoring piece that is loaded in the apparatus that is in the pre-deployment position and draw sutural profile;

[0112] Figure 99 is the enlarged perspective of embodiment of first anchoring piece of the apparatus that can be used for showing among Figure 95, shows that it is in expansion shape;

[0113] Figure 100 is the amplification front view of embodiment of second anchoring piece of the apparatus that can be used for showing among Figure 95, shows that it is in expansion shape;

[0114] Figure 101 is the enlarged side view of second anchoring piece that shows among Figure 100;

[0115] Figure 102 is the profilograph of the apparatus that shows among Figure 95, shows prostate excision its insertion of postoperative and also enters the pre-deployment position that is in retraction after the bladder through patient's urethra;

[0116] Figure 103 is the profilograph of the apparatus that shows among Figure 95, shows its insertion and inserts and enter after the bladder and localizer has been moved to profilograph after the expanded position through patient's urethra;

[0117] Figure 104 is the profilograph of the embodiment of the apparatus that shows among Figure 95, the urethra that shows its insertion and process patient inserts and enters after the bladder, be moved to after the expanded position with localizer, and wall of urinary bladder be urged into contact with pelvic floor and bladder and urethra in the aligned profilograph of opening;

[0118] Figure 105 is the profilograph of the apparatus that shows among Figure 95, the urethra that shows its insertion and process patient inserts and enters after the bladder, be moved to after the expanded position with localizer, and wall of urinary bladder be urged into contact with pelvic floor and bladder with after the opening in the urethra is aimed at, and the anchoring piece actuator assembly activates for the first time to drive first anchoring piece and enters profilograph after the wall of urinary bladder tissue of bladder opening;

[0119] Figure 106 is the profilograph of the apparatus that shows among Figure 95, the urethra that shows its insertion and process patient inserts and enters after the bladder, be moved to after the expanded position with localizer, and wall of urinary bladder be urged into contact with pelvic floor and bladder with after the opening in the urethra is aimed at, and the anchoring piece actuator assembly activates for the first time to drive first anchoring piece and enters after the wall of urinary bladder tissue of bladder opening and reorientate the anchoring piece actuator pin and prepare to drive profilograph after second anchoring piece;

[0120] Figure 107 is the profilograph of the apparatus that shows among Figure 95, the urethra that shows its insertion and process patient inserts and enters after the bladder, be moved to after the expanded position with localizer, and wall of urinary bladder be urged into contact with pelvic floor and bladder with after the opening in the urethra is aimed at, and the anchoring piece actuator assembly activates for the first time to drive first anchoring piece and enters after the wall of urinary bladder tissue of bladder opening and activate the second time of anchoring piece actuator pin to drive the profilograph of second anchoring piece after entering in the tissue of urethra opening;

[0121] Figure 108 is the profilograph of the apparatus that shows among Figure 95, the urethra that shows its insertion and process patient inserts and enters after the bladder, be moved to after the expanded position with localizer, and wall of urinary bladder be urged into contact with pelvic floor and bladder with after the opening in the urethra is aimed at, and anchoring piece to be connected stitching thread and be mounted, and the anchoring piece actuator assembly has begun to bounce back so that localizer and location organ pipe are waited behind so that at the profilograph after bladder is discharged urine and other fluid between rehabilitation and healing stage;

[0122] Figure 109 is the profilograph of the apparatus that shows among Figure 95, show after the anchoring piece actuator assembly retraction and after anastomosis operation finished, the localizer that wherein is in advanced position prepares from bladder downwards that the process urethra withdraws from the remainder of apparatus and withdraws from patient's body;

[0123] Figure 110 is according to the far-end of another embodiment of coinciding machine of the present invention and the perspective view of near-end, has wherein removed mid portion for the purpose that is easy in the accompanying drawings illustrate;

[0124] Figure 111 is the profilograph of the apparatus that shows among Figure 110, shows that the prostate excision postoperative inserts and through patient's urethra and after entering bladder, it is in retraction and pre-deployment position;

[0125] Figure 112 is the profilograph of the apparatus that shows among Figure 110, show to insert and through patient's urethra and after entering bladder, and localizer has been moved to the profilograph after the expanded position;

[0126] Figure 113 is the profilograph of the embodiment of the apparatus that shows among Figure 110, the urethra that shows its insertion and process patient inserts and enters after the bladder, be moved to after the expanded position with localizer, and the dilator circle has been drawn in the fastener driver assembly with the profilograph after the expansion securing member group;

[0127] Figure 114 is the profilograph of the apparatus that shows among Figure 95, the urethra that shows its insertion and process patient inserts and enters after the bladder, be moved to after the expanded position with localizer, the dilator circle has been drawn in the fastener driver assembly with after the expansion securing member group, and wall of urinary bladder be urged into contact with pelvic floor and bladder and urethra in the profilograph of opening after being aligned;

[0128] Figure 115 is the profilograph of the apparatus that shows among Figure 110, the urethra that shows its insertion and process patient inserts and enters after the bladder, be moved to after the expanded position with localizer, and wall of urinary bladder be urged into contact with pelvic floor and bladder and urethra in opening be aligned after, and the profilograph of the actuating of fastener driver assembly after having begun;

[0129] Figure 116 is the profilograph of the apparatus that shows among Figure 110, the urethra that shows its insertion and process patient inserts and enters after the bladder, be moved to after the expanded position with localizer, and wall of urinary bladder be urged into contact with pelvic floor and bladder and urethra in opening be aligned after, and the fastener driver assembly has activated fully so that the profilograph after the securing member group to be installed;

[0130] Figure 117 is the profilograph of the apparatus that shows among Figure 110, the urethra that shows its insertion and process patient inserts and enters after the bladder, be moved to after the expanded position with localizer, and wall of urinary bladder be urged into contact with pelvic floor and bladder and urethra in opening be aligned after, the fastener driver assembly has activated fully installing after the securing member group, and the dilator circle has moved and broken away from the fastener driver assembly to allow the fastener driver assembly to present can to allow it through the profilograph after the more minor diameter of the securing member group retraction installed;

[0131] Figure 118 is the profilograph of the apparatus that shows among Figure 110, the urethra that shows its insertion and process patient inserts and enters after the bladder, be moved to after the expanded position with localizer, and wall of urinary bladder be urged into contact with pelvic floor and bladder with after the opening in the urethra is aimed at, and after the securing member group has been mounted, and the fastener driver assembly withdraws from and localizer and location organ pipe is waited behind so that the profilograph after discharging urine and other fluid from bladder between rehabilitation and healing stage from the patient;

[0132] Figure 119 is the enlarged perspective of the securing member group of the apparatus that can be used for showing among Figure 110, show be in expansion and install before its shape that can have;

[0133] Figure 120 is the enlarged perspective of the securing member group of the apparatus that can be used for showing among Figure 110, show be in expansion and install after its shape that can have;

[0134] Figure 121 is the enlarged perspective of end cap of the actuator rod of the apparatus that can be used for showing among Figure 110;

[0135] Figure 122 is the profilograph of another kind of embodiment that is in the coinciding machine of the present invention of pre-deployment advanced position;

[0136] Figure 123 is the profilograph of the apparatus that shows among Figure 122, after showing that the prostate excision postoperative inserts and entering in the bladder through patient's urethra;

[0137] Figure 124 is the profilograph of the apparatus of reality among Figure 122, show to insert and enter after the bladder through patient's urethra, and localizer has been moved to after the expanded position;

[0138] Figure 125 is the profilograph of the apparatus of reality among Figure 122, show and insert and enter after the bladder through patient's urethra, localizer has been moved to after the expanded position, with wall of urinary bladder be actuated contact with pelvic floor and bladder and urethra in opening be aligned after;

[0139] Figure 126 is the profilograph of the apparatus that shows among Figure 122, the urethra that shows its insertion and process patient inserts and enters after the bladder, localizer has been moved to after the expanded position, and wall of urinary bladder be urged into contact with pelvic floor and bladder and urethra in opening be aligned after, and the lodge element has been moved to after the expanded position;

[0140] Figure 127 is the enlarged perspective of end cap of the localizer actuator lever of the apparatus that can be used for showing among Figure 122;

[0141] Figure 128 is the sketch map of the apparatus that shows among Figure 122, shows to be inserted among the patient that localizer is in expanded position, and wherein apparatus is connected with urine collecting bag with its near-end;

[0142] Figure 129 is the profilograph of the another kind of embodiment of apparatus of the present invention, and it is configured to the direct motion anastomosis operation, is shown as to be in expanded position;

[0143] Figure 130 is the profilograph of the another kind of embodiment of apparatus of the present invention, and it is configured to the direct motion anastomosis operation, is shown as to be in expanded position;

[0144] Figure 131 is the perspective view with embodiment of the perforation and the lodge element (lodging member) of projection;

[0145] Figure 132 is the profilograph of the lodge element that shows among Figure 131;

[0146] Figure 133 is the profilograph with another kind of embodiment of the perforation and the lodge element of projection;

[0147] Figure 134 is the perspective view of coinciding machine, and according to one embodiment of the present invention, it has actuator handle, pipe assembly and end effector assembly;

[0148] Figure 135 is the profilograph according to the end effector assembly of the coinciding machine of one embodiment of the present invention, is shown as to insert and enter in the bladder opening through patient's urethra;

[0149] Figure 136 is the profilograph according to the end effector assembly of the coinciding machine of one embodiment of the present invention, show insertion and enter bladder cavity through patient's urethra, wherein localizer assembly and anchoring piece actuator assembly are opened, and localizer assembly is actuated wall of urinary bladder and contacted with pelvic floor;

[0150] Figure 137 is the profilograph according to the end effector assembly of the coinciding machine of one embodiment of the present invention, show insertion and enter bladder cavity through patient's urethra, wherein localizer assembly is opened, and actuator assembly has driven anchoring piece and goes forward side by side after the pelvic floor through wall of urinary bladder;

[0151] Figure 138 is the profilograph according to the end effector assembly of the coinciding machine of one embodiment of the present invention, show insertion and enter bladder cavity through patient's urethra, wherein localizer assembly is opened, and actuator assembly has driven anchoring piece and has gone forward side by side after the pelvic floor through wall of urinary bladder, after actuator pin has been withdrawed from from anchoring piece;

[0152] Figure 139 is the profilograph according to the end effector assembly of the coinciding machine of one embodiment of the present invention, show insertion and enter bladder cavity through patient's urethra, wherein localizer assembly is opened, and actuator assembly has driven anchoring piece and has gone forward side by side after the pelvic floor through wall of urinary bladder, after actuator pin has withdrawed from from the anchoring piece that is driven to pelvic floor, and actuator assembly is after the closure;

[0153] Figure 140 is the profilograph according to the end effector assembly of the coinciding machine of one embodiment of the present invention, show insertion and enter bladder cavity through patient's urethra, wherein localizer assembly is opened, and actuator assembly has driven anchoring piece and has gone forward side by side after the pelvic floor through wall of urinary bladder, after actuator pin has withdrawed from from the anchoring piece that is driven to pelvic floor, and actuator assembly and localizer assembly are after the closure;

[0154] Figure 141 is the profilograph according to the element of the end effector assembly of the coinciding machine of one embodiment of the present invention, show insertion and enter bladder cavity through patient's urethra, after anchoring piece is installed, withdrawed from and end-cap assembly is stayed at localizer and anchoring piece actuator assembly, the assembly that is mounted enters after pelvic floor and capsule fixation clamp be connected therebetween through wall of urinary bladder;

[0155] Figure 142 is the profilograph according to the element of the end effector assembly of the coinciding machine of one embodiment of the present invention, show insertion and enter bladder cavity through patient's urethra, after anchoring piece is installed, withdrawed from and end-cap assembly is stayed at localizer and anchoring piece actuator assembly, the assembly that is mounted enters after pelvic floor and capsule fixation clamp be connected therebetween through wall of urinary bladder, and inserts after the ductus bursae assembly;

[0156] Figure 143 is the profilograph according to the element of the end effector assembly of the coinciding machine of one embodiment of the present invention, show insertion and enter bladder cavity through patient's urethra, after anchoring piece is installed, withdrawed from and end-cap assembly is stayed at localizer and anchoring piece actuator assembly, the assembly that is mounted enters after pelvic floor and capsule fixation clamp be connected therebetween through wall of urinary bladder, inserts after the ductus bursae assembly and after capsule expands;

[0157] Figure 144 is the element profilograph according to the end effector assembly of the coinciding machine of one embodiment of the present invention, show insertion and enter bladder cavity through patient's urethra, after anchoring piece is installed, withdrawed from and end-cap assembly is stayed at localizer and anchoring piece actuator assembly, the assembly that is mounted enters after pelvic floor and capsule fixation clamp be connected therebetween through wall of urinary bladder, insert after the ductus bursae assembly, and after the capsule expansion, show a kind of possible optional embodiment;

[0158] Figure 145 is the profilograph according to the element of the end effector assembly of the coinciding machine of one embodiment of the present invention, after showing that anastomosis operation has been finished fully, after the ductus bursae assembly withdraws from, and withdraw from the process progressively location at end-cap assembly and capsule fixation clamp;

[0159] Figure 146 is the perspective exploded view of illustrative embodiments of the catheter end plug portion of end-cap assembly, capsule fixation clamp and ductus bursae assembly; With

[0160] Figure 147 is horizontal (level) of people masculine pelvis and pelvic floor structure (top) view of bowing, and the optimum position that anchoring piece is installed is shown.

[0161] will describe the various optional embodiment of method and apparatus of the present invention illustrated in the accompanying drawings and various selectable unit thereof now in detail as a reference.

[0162] specific embodiment

Before the embodiment of disclosure and description method and apparatus of the present invention, should be understood that [0163] the present invention is not limited to disclosed in this article specific process step and material, these processing steps and material can change to a certain extent.Scope of the present invention it will also be appreciated that the term that uses in this article only is used to describe the purpose of specific implementations, rather than wants to limit, because will only be limited by appending claims.

[0164] except as otherwise noted, all technology of using in this article and scientific terminology have the identical implication of implication with those skilled in the art institute common sense.Although similar or be equal to herein those any method, apparatus and the material of describing and when practice or check are of the present invention, also can use, the specific implementations of describing method, apparatus and material now.

[0165] must be noted that as using in this description and the appending claims, singulative " a ", " an " and " the " comprise plural object, are not like this unless described content clearlys show.

[0166] when describing and requiring right of the present invention, following term will be used according to the definition of elucidated hereinafter.

[0167] term that uses the in this article surgery that refers to qualification body cavity and each self-organizing of other hollow body structure that " coincide " is connected, and particularly the connection of hollow pipe, passage or organ is interconnected to set up between them.

[0168] term " patient " that uses in this article refers to the mankind or the animal that it is carried out anastomosis.

[0169] term " bio-compatible " that uses in this article comprises any material, and it does not cause toxicity or injury substantially and does not cause immunologic rejection and compatible with patient's living tissue or system." biocompatibility " comprise will biocompatible material trend.

[0170] term " biology can absorb " that uses in this article comprises that material is dissolved by health and/or the also absorbed ability of degrading.

[0171] term " shape memory " that uses in this article is included in the trend that returns to the material of reservation shape after described warpage, such as but not limited to suitably prepd Nitinol (" Nitinol ").

[0172] term " one " that uses in this article refers to described two or more parts by bonding, fastening or link together, so that move together or work as a complete integrated part." one " includes but not limited to successive parts aspect sensation (they are formed by identical continuous material), and comprise by any way be connected, the fastening or parts that bond together so that become Immobile substantially be bonded to each other and in aggregates substantially.

[0173] term " nearside " (perhaps its any form) that uses in this article with respect to the element of apparatus, refers to the componentry of general the most close doctor when using, the perhaps the most close apparatus end portion that is gripped by the doctor; And, refer to when using towards generally the most close doctor's apparatus far-end, perhaps the apparatus end that grips by the doctor with respect to the direction that the element of apparatus is advanced.

[0174] term " distally " (perhaps its any form) that uses in this article with respect to the element of apparatus, refers to when using general away from doctor's componentry, perhaps away from the apparatus end portion that is gripped by the doctor; And, refer to and when using, leave generally the most close doctor's apparatus far-end, perhaps the apparatus end that grips by the doctor with respect to the direction that the element of apparatus is advanced.

[0175] term " laterally " (or its any form) that uses in this article with respect to axle, refers to along the line that passes described axle, plane or direction and extends, and that is to say, not with its conllinear or parallel." laterally " of Shi Yonging is not limited to " vertically " in this article.

[0176] term " longitudinal axis " that uses in this article, with respect to apparatus, refer to the accurate or approximate center axis that limits to near-end (perhaps opposite) along its large-size (promptly along its length) from its far-end by described apparatus, and do not want it simply is defined as a straight line, wherein, for example, apparatus comprises angle of bend as described in this article, " longitudinal axis " of Shi Yonging is applicable to described angle of bend in this article, when being used in combination with end effector, term " longitudinal axis " refers to by extending along its large-size that described end effector limits, promptly along its length from far-end to near-end or opposite extend accurately or the approximate center axis.

[0177] coincideing of the method and apparatus of the present invention tissue that utilizes simple and effective mechanical arrangement to carry out to limit two body cavitys respectively for example connects bladder and urethra after prostatectomy.Owing to do not need more efforts and loaded down with trivial details suturing skill, this has improved anastomosis.In order in disclosed operation, to use, provide be used under the aligned situation of opening of bladder and urethra the wall of urinary bladder tissue contacted with the pelvic floor tissue and with their fix in position so that their in conjunction with and the various embodiments of healing improvement apparatus together.

[0178] disclosed technology of the application of the invention and apparatus, the number of steps in the anastomosis operation can be reduced, and has reduced cost and has shortened the required time of performing the operation.The present invention also can eliminate and other anastomosis complications associated with arterial system that needs manual suture.

[0179] the invention provides the apparatus that allows for example to use process urethra (along the direction of driving in the wrong direction) to be inserted in the bladder bladder is connected with urethra, do not operate and activate apparatus and do not need to enter bladder inside.Optionally, system and apparatus can be constructed such that it can be inserted in the bladder through the little otch of patient's abdominal part and bladder upper surface along the direct motion direction and be inserted in the urethra then.Equally, the operation of apparatus and activate and to carry out in that the patient is external by the doctor.

[0180] now in detail with reference to the accompanying drawings, wherein identical Reference numeral is represented components identical in institute's drawings attached, and Fig. 1 schematically shows the location of human male's bladder 1, wall of urinary bladder 2, prostate 3, pelvic floor 7 and urethra 5 before prostatectomy along vertical section.In the carcinoma of prostate radical correction, the bottom of prostate 3, wall of urinary bladder 2 and the top of urethra 5 are cut, and the fluid of having removed between the remainder of bladder cavity 8 and urethra connects.The dotted line of approximate horizontal schematically shows prostate and adjacent bladder and urethral tissue along its cut line among Fig. 1.

[0181] Fig. 2 shows the carcinoma of prostate radical correction dissection section in abdominal cavity afterwards, and wherein the excision of the part of wall of urinary bladder 2 forms bladder opening 4, and prostatic excision forms urethra opening 6 in urethra 5.After this operation, bladder opening 4 is usually by mode minification well known in the art, for example " tennis racket " suturing skill.

[0182] Unscrew embodiment

[0183] Fig. 3-16 has shown the embodiment of apparatus 10, and this apparatus can be used for carrying out anastomosis operation, for example, and the operation that behind prostatectomy, patient's bladder and urethra is coincide.

[0184] structure that uses in the mode of driving in the wrong direction as shown in Figure 3, a kind of embodiment according to anastomotic applier tool 10 of the present invention can comprise elongated pipe assembly 500, be connected the actuator assembly 300 on the far-end of managing assembly 500, can be used for making wall of urinary bladder and pelvic floor organize very near or the optional localizer assembly 400 that contacts and be used to carry out opening and the driving of anchoring piece and the actuator handle 100 of laying of localizer and actuator assembly.Generally speaking, described apparatus is used in behind the pubis in the carcinoma of prostate radical correction prostate and carries out bladder-ureter coincide (seeing Fig. 1-2) after cut.This connection is necessary for the urethral function that recovers the patient behind prostatectomy.

[0185] Fig. 4 has shown the embodiment of the actuator handle 100 of the coinciding machine that shows among Fig. 3.Handle 100 operationally is connected with the near-end of elongated tubular assembly 500, and this elongated tubular assembly will be operated localizer assembly 400 and the actuator assembly 300 that is transferred to the far-end of pipe assembly 500 with actuation force from handle 100.Two pipes, outer tube 510 and middle actuator pipes 280 are drawn handle 100 at the far-end of handle.Outer tube 510 is connected to handle casing 112 by any suitable manner and becomes one substantially with it, and shell 112 and outer tube 510 are static and as skeleton with respect to other moving component of handle 100 and pipe assembly 500 substantially.Middle actuator pipes 280 is rotated and lengthwise movements with respect to outer tube 510 in response to doctor's input (will be described later), thereby 500 transmission of process pipe assembly are rotated and vertical actuation force.

[0186] in the embodiment that shows in Fig. 4-6, handle 100 can comprise the shell 112 with the actuating mechanism (will be described later) that is arranged on wherein.Shell 112 can comprise two or more parts, has the pin 105 of collimation and mating holes so that assembling and make parts form integral body after assembling.

[0187] shell 112 comprises that actuating mechanism is to apply rotation and vertically actuation force and motion in middle actuator pipes 280.Referring to Fig. 5, actuator (knob) 110 can be the actuation element by doctor's operation, and can be suitable for distad being advanced by the doctor, and actuates proximad by actuator back-moving spring 150 with respect to shell 112 and return.Actuator 110 also can be suitable for by the doctor with respect to shell 112 rotations.Therefore, when its end stops the lengthwise movement of actuator 110 by contact actuator edge 111, in the restriction of the vertical stroke that limits by the actuator track 116 in the shell 112, but actuator 110 can in shell 112, rotate with lengthwise movement.Actuator 110 can also be a hollow, wherein has silk guide passage 114.Can one or more vertical keyways 115 in the silk guide passage 114 of actuator 110.Keyway 115 can be slidingly matched with one or more key bar 185 of nearside roll tube 180.Therefore, be appreciated that actuator 110 can be connected with respect to rotatablely moving with nearside roll tube 180, but do not connect that therefore, they are longitudinal sliding motion toward each other with respect to lengthwise movement.The rotation of Gou Zao actuator 110 can influence the corresponding rotation of nearside roll tube 180 thus.And then, actuator pipes 280 in the middle of nearside roll tube 180 can be fixedly connected to.Therefore, the corresponding rotation of actuator pipes 280 in the middle of the rotation of actuator 110 can influence, and the lengthwise movement of actuator 110 does not influence the lengthwise movement of middle actuator pipes 280.

[0188] before, move, open actuator assembly 300 and localizer assembly 400 (will be described below) thus thereby actuator 110 can be rotated the corresponding rotation that influences in the middle actuator pipes 280 at firing handle assembly (will be described below).

[0189] Fig. 5 and 6 illustrates and is in the not handle 100 of the pre-deployment position of percussion.As will be as described in after this, a kind of embodiment of anchoring piece actuator assembly of the present invention (for example in Fig. 3 300 shown in) need and move so that drive anchoring piece along the longitudinal force of proximal direction.Should and move and to apply through middle actuator pipes 280 by handle 100 along the power of proximal direction.Middle actuator pipes 280 proximal direction along the longitudinal furthers by the mechanism that will be described below, and promptly pulls back in the handle 100.

[0190] driving spring 160 can compressive state be comprised in the shell 112, as shown in Fig. 5 and 6.The near-end of driving spring 160 contacts and against 140 effects of nearside connection tube, actuates connection tube 140 and move with respect to shell 112 along proximal direction.The near-end of connection tube 140 is around internal spindle 117 rotation of actuator 110 and be slidingly matched and rely on the shaft shoulder 118 to place.

[0191] in the position that shows in Fig. 5 and 6, driving tube 120 is in the shell 112 in forward the distal position.Driving tube 120 is connected with nearside roll tube 180 through antelabium 123 at its far-end, nearside roll tube 180 is rotated freely in driving tube 120, but the setting shown in passing through, driving tube 120 and nearside roll tube 180 are configured to be connected and in a longitudinal direction as a unit motion.Can be connected the pin 128 that engages with driving tube cotter way 129 in the shell 112 by one or more and prevent driving tube 120 rotations, thereby not disturb the actuating of activation button pawl 205.At the top of Fig. 6, activation button 202 can become one with activation button pawl 205 as can be seen, and activation button 202 and corresponding activation button pawl 205 be by spring 235 bias voltage in the counterclockwise direction, make pawl 205 by biased downward in driving tube percussion groove 210.

[0192] (its motion can be used for driving anchoring piece in order to make the handle shown in Fig. 5 and 6 be ready to make middle actuator pipes 280, will be described later) carry out vertical proximal movement, the doctor longitudinally distal direction in shell 112 by voltage regulator 110 (for Fig. 5, being the right side).Because shoulder 118 contact with the near-end of connection tube 140, this motion of actuator 112 can make connection tube 140 corresponding direction of motion and distances, and accordingly vertically compression also make driving spring 160 loads thus.Connection tube 140 connects one or more driving tube adapters 170 at its near-end, and described driving tube adapter can and have through the inwardly outstanding locked end 171 of the groove in the connection tube 140, as shown in the figure by the inside bias voltage of spring.When owing to depressing actuator 110 and make connection tube 140 along the distal direction lengthwise movement, in case driving tube 120 is released (will be described below), locked end 171 longitudinally backward proximal direction the locking shoulder 126 of engages drive pipe 120 and locking be thereon movably in response to be applied to power on the connection tube 140 by driving spring 160.Therefore, as doctor during along distally longitudinal direction (being the right side for Fig. 5) compression adjustment device 110, driving spring 160 loads and handle are ready to drive anchoring piece (will be described later) thus.After being ready to, actuator 110 is conditioned device back-moving spring 150 and actuates and return its nearside (backward) position.But actuator back-moving spring 150 separates with driving spring 160 coaxial alignment and by spring drive 130.

[0193] as doctor's engages drive button 202 and (with respect to Fig. 6) when actuating it forward, driving tube 120 is released and is driven with respect to shell 112 by nearside (backward) direction along the longitudinal.This rotates activation button 202, and correspondingly, pawl 205 turns clockwise around pin 230, and driving tube percussion groove 210 is left in pawl 205 liftings.Under the effect that affacts the power that is applied by driving spring 160 on the connection tube 140 that connects driving tube 120 through driving tube adapter 170, driving tube 120 is released thus so that (be the left side for Fig. 5 and 6) backward and drives.When driving tube 120 by to rear drive the time, actuator pipes 280 corresponding distances in the middle of it correspondingly pulls back through antelabium 123.This actuating " percussion " handle 100 is moved middle actuator pipes 280 to nearside (backward) direction longitudinally and be can be used for driving in the handle 100 of anchoring piece (will be described below).

[0194] behind handle 100 " percussion ", the other lengthwise movement of actuator pipes 280 in the middle of it can carry out so that cause and further lay anchoring piece, and is withdrawed from anchoring piece actuator pin (will be described below) from anchoring piece backward.Referring to Fig. 6, after the percussion, the driving tube retraction groove 225 in the driving tube 120 moves to the position of activation button pawl 205 belows, and pawl 205 moves under the actuating of torsionspring 235 and/or doctor's applied pressure in the retraction groove 225.The doctor is applied to nearside and downward pressure (with respect to Fig. 6) on the activation button 202 then, it remains on pawl 205 in the retraction groove 225, also actuated peg 230 downwards and break away from rocking bar ratchet 238 in the activation button groove 225, make the doctor further proximad actuate driving tube 120, thereby allow further to drive anchoring piece one segment distance in the activation button groove 240 by extension 220 is placed in, and/or further anchoring piece is placed in the tissue, as described below.This layout also can relevant much pressure be applied in tactile feedback to drive and to lay anchoring piece for the doctor transmits by activation button 202.

[0195] after anchoring piece drives and lays, the doctor can turn back to its initial position with the medium drive pipe and withdraw from anchoring piece actuator pin (will be described below) from anchoring piece by what describe below then.The doctor is applied to also distad directed pressure on the activation button 202 downwards, and described downward pressure remains on pawl 205 in the retraction groove 225 and keeps selling 230 and breaks away from rocking bar ratchets 238, distad actuates driving tube 120 (with respect to the right side of Fig. 6) simultaneously.When driving tube 120 was distad actuated, medium drive pipe 280 was distad actuated respective distance through the driving tube antelabium 123 that acts on the nearside actuator pipes 180 that is connected with medium drive pipe 280.This return motion is activated the restriction away from degree of button groove 240.When pin 230 arrives this degree, the pressure that the doctor is discharged on the activation button 202 will allow pin 230 upwards to be actuated (with respect to Fig. 6) under the effect of the power that is applied by torsionspring 235 in the ratchet 245 that stretches out.

[0196] after anchoring piece is installed, rotatable actuator 110 is to rotatablely move accordingly in middle actuator pipes 280, so that retraction or closed actuator assembly 300 and localizer assembly 400 (will be described below).

Can expect that [0197] each part of Handleset can be the overall structure that is formed by a plurality of elements, perhaps these parts can be by such as the plastic or other material integrated molding, so that form single overall structure.Handleset can be formed by the common used material structure that is used for surgical instruments, for example metal (such as rustless steel) or plastics.Apparatus can be formed by metal or constructed in plastic material commonly used at first, and it is cheap that it is made, and can be disposable.Apparatus can also be to be used for the package form sale that surgery uses with sterilization.

[0198] shell 112, activation button 202, spring separator 130 and actuator 110 can be formed by plastics or any suitable material with desirable strength, hardness and formability characteristic.Be ideally, keyway 115 is to have the hardness of improvement and wear-resistant suitable metal, makes keyway 115 can be used as a part that forms the metal insert of actuator 110 around it.Nearside actuator pipes 180, connection tube 140 and actuator tube adapter 170, driving tube 120, middle actuator pipes 280 and outer tube 510 can be made by rustless steel, plastics or any suitable material with desirable strength, hardness and stiffness characteristics.Spring 150,160 and 235 can be made by spring steel or any suitable material that can have suitable formability, shape memory, rigidity (spring constant) and a strength characteristics.Though being shown as, nearside actuator pipes 180, connection tube 140, driving tube 120, middle actuator pipes 280 and outer tube 510 have tubular in shape, when apparatus of the present invention needs, they also can have any be suitable for vertically and revolving force and motion be transferred to the shape of far-end.

What [0199] can expect for a person skilled in the art is, can construct various mechanism, they are suitable for transmission vertically (advance and bounce back) and revolving force and motion, move to far-end so that apply required power and the motion of actuating apparatus of the present invention from the proximal handle assembly.What can expect for a person skilled in the art is, supply can be other bias voltage or driving device also by the mechanism of the driving force that driving spring 160 provides, and includes but not limited to that any other in bar, gear, gas-pressurized/fluid and this area is used for the mechanism that selectivity applies linear driving force.

[0200] uses description to the optional embodiment of the activation button assembly that shows among Fig. 6 now.Referring to Figure 52-54, activation button 202 is connected with mechanism by the activation button pin 230 of being caught by activation button pin sleeve 206.Activation button 202 comprises activation button pawl 205, drive pin axle sleeve 206, drives trigger 204 and retraction element 207.Activation button 202 is moved around being driven the activation button pin 230 that pin sleeve 206 catches angledly, and activation button pin 230 is longitudinally ridden slidably with respect to the length of apparatus and is located in the activation button groove 240 that comprises rocking bar ratchet 238.One or more springs 235 are provided, act in two ways on the activation button 202: first, when driving trigger 204 is not compressed, upwards actuate activation button 202 make activation button pin 230 with respect to Figure 52-54 towards upwards being actuated, and drive pin 230 is urged in the rocking bar ratchet 238; The second, actuate activation button 202 in the counterclockwise direction, driving trigger 204 and activation button pawl 205 are actuated around activation button pin 230 in the counterclockwise direction with respect to Figure 52-54, thereby keep activation button pawl and driving tube to keep groove 210 to engage.Should be understood that structure also can be used for realizing required result with the single torsionspring (torsionspring 235) that for example mode shown in Fig. 6 acts on activation button 202, and spring that other is suitable or bias mechanism or structure also are possible.Alternatively, activation button pawl 205 be suitable for with guarantee the driving tube retraction groove 225 of holding groove 210 and driving tube 120 in the identical mode engages drive of activation button pawl 205 that is used for shown in Fig. 6.

[0201] operation of the embodiment of the activation button assembly shown in Figure 52-54 will be described now.When apparatus such as actuator assembly 300 (Fig. 3) has loaded anchoring piece and be in the advanced position of preparing insertion and using subsequently, activation button assembly 200 will be in the position that shows among Figure 52.Activation button 202 upwards and in the counterclockwise direction centers on activation button pin 230 bias voltages by one or more springs, make activation button pin 230 keep being bonded in the rocking bar ratchet 238, activation button pawl 205 keeps being bonded on driving tube and keeps in the groove 210, the fexible bias pressure restriction driving tube 120 of resistant function on driving tube 120 more fully described as top.

[0202] in case the position shown in Figure 14 has been inserted and be opened to applicator, driving tube 120 is released and is driven by the driving trigger of depressing 204.Figure 53 show by make the activation button pawl from driving tube keep groove to break away from depressing driving trigger 204 with discharge after the driving tube 120, activation button 202 is with respect to localized " snapshot " of driving tube 120.About Figure 53, as can be seen, act on the downward pressure that drives on the trigger 204 and cause that activation button 202 turns clockwise around activation button pin 230, cause that activation button pawl 205 moves upward and keep groove 210 to break away from driving tube.Activation button pawl 205 keeps groove 210 disengagings to discharge driving tube 120 from driving tube, allows it to move to left side (with respect to Figure 52-54) under the actuating of spring, more fully describes above seeing.This drives actuator pin and anchoring piece, and face is more fully described as follows.

[0203] Figure 54 shows when mechanism prepares from the anchoring piece retraction actuator pin of installing, and activation button 202 is with respect to the location of driving tube 120.Be appreciated that by Figure 53 and 54 being applied to the continuous downward pressure actuated activation button pawl 205 that drives on the trigger 204 by the doctor enters in the driving tube retraction groove 225 downwards.Simultaneously, activation button pin sleeve 206 is actuated downwards, and correspondingly, activation button pin 230 is actuated downwards and broken away from rocking bar ratchet 238.When activation button 202 is in this position shown in Figure 54, the doctor can engage retraction element 207 then so that activation button 202 moves to right side (with respect to Figure 54), correspondingly moves driving tube 120 to right side by activation button pawl 205 with engaging of groove 225 of driving tube retraction.In this mode, drive pin can withdraw from from the anchoring piece of present installation, as follows the face more detailed description.

[0204] returns reference, can expect managing assembly 500 for arc and flexible, so that be inserted in patient's body to Fig. 3 and 7-9.Therefore, can expect making the element of some pipe assemblies 500, comprise outer tube 510, middle actuator pipes 280, distally roll tube 580 and central canal 590, material by the biocompatibility with appropriate combination, intensity, rigidity, flexibility, elasticity and shape memory is made, so that the balance of intensity, rigidity and the shape memory of the flexibility being convenient to insert and handled easily is provided, so as will be vertically and revolving force be transferred to localizer assembly 400 and actuator assembly 300 from Handleset 100.The inventor has been found that suitable processing, and the Nitinol with described characteristic and the endoscopic surgical instrument that is used to have identical needs known in the art is suitable material.But other material for example styrene or other polymer also is gratifying for some elements.

[0205] Fig. 7-the 10th comprises the diagram of the part pipe assembly of bridge assembly 600.Pipe assembly and bridge assembly provide isolate and from middle actuator pipes 280 to the rotation of localizer assembly 400 and actuator assembly 300 and the transmission of lengthwise movement and retraction force and motion.In one embodiment, middle actuator pipes 280 is rotatable, and vertically advances and bounce back with respect to it in outer tube 510, and operationally is connected to localizer assembly 400 and actuator assembly 300 through bridge assembly 600.Bridge assembly 600 provides being operatively connected of middle actuator pipes 280 so that limit and rotatablely move, and rotatablely moves and lengthwise movement all is transferred to distally roll tube 580 limited, and is suitable for allowing the rotation of effective dose and vertically advances.Bridge assembly 600 also provides being operatively connected of middle actuator pipes 280 and central canal 590, lengthwise movement is moved to central canal 590.

[0206], has one or more bridge joint groove 640 in the middle actuator pipes 280, and end in the bridge assembly 600 referring to Fig. 9 and 10.Bridgeware 610 has the cover joint 650 that is arranged in the middle actuator pipes 280, with one or more blade 620, it is outstanding in middle actuator pipes 280 through bridge joint groove 640, and vertically rides and be located in one or more vertical bridge joint track 670 that cuts in bridgeware guiding piece 660 or form.Bridgeware guiding piece 660 connects and thereby is incorporated in the outer tube 510.Therefore, blade 620 and therefore bridgeware 610 can longitudinal sliding motion in bridgeware guiding piece 660 and outer tube 510, but can not rotate.

[0207] is appreciated that by Fig. 9 and 10 middle actuator pipes 280 is subjected to the restriction of the circumferential size of the bridge joint groove 640 in the middle actuator pipes 280 with respect to the scope of outer tube 510 rotations, and between bridge joint groove 640 and blade 620, contacts.But the circumferential size of the bridge joint groove 640 in the actuator pipes 280 can change according to the rotating range that activates the apparatus needs.Vertically bridge joint track 670 can long enough, and allowing the four corner of the lengthwise movement of roll tube 280 in the middle of blade 620 longitudinal sliding motions, the four corner of this lengthwise movement can be that to activate apparatus required.

[0208] central canal 590 are connected becomes integral body in the bridge joint cover joint 650 and with it.Therefore, lengthwise movement moves to bridge joint blade 620 and corresponding bridge joint cover joint 650 from the interaction of middle actuator pipes 280 between bridge joint groove 640 and bridge joint blade 620.Correspondingly, the lengthwise movement of bridge joint cover joint 650 is moved to central canal 590, because bridge joint cover joint 650 and central canal 590 are one.Therefore, the lengthwise movement of middle actuator pipes 280 is become the lengthwise movement of the central canal 590 of correspondence by translation.

[0209] simultaneously, rotatablely moving of middle actuator pipes 280 do not moved to central canal 590.As mentioned, central canal 590 and bridge joint cover joint 650 become one, and bridge joint cover joint 650 positions by the bridge joint blade 620 in the bridge joint track 670 of transferring to become one with outer tube 510 prevent rotation.

[0210] referring to Figure 10, distally roll tube 580 connects and becomes one with rotation spacer 280, rotation spacer then actuator pipes 280 and in aggregates with it in the middle of being connected to.Therefore, the lengthwise movement of middle actuator pipes 280 and rotation are all become the corresponding lengthwise movement and the rotation of distally roll tube 580 by direct translation.But as previously mentioned, the scope that rotatablely moves of middle actuator pipes 280 is subjected to the restriction of the circumferential size scope of bridge joint groove 640, and therefore, the scope that rotatablely moves of distally roll tube 580 correspondingly also is restricted.

[0211] central canal 590 and distally roll tube 580 are not connected to each other, so distally roll tube 580 can be with respect to central canal 590 rotations.

[0212] funnel guiding piece 606 can be connected with the near-end 608 of central canal 590, is easy to supply with the lead that upwards passes through middle actuator pipes 280 and enter central canal 590 thereby provide.Funnel guiding piece 606 can not be connected with middle actuator pipes 280, and can be therein vertically and rotatablely move.

[0213] but distally roll tube 580 central canal 590 can be arranged in the bending of pipe in the assembly and supported by roll tube regulator 530 by it, the near-end of described roll tube regulator 530 shows that on the right side of Fig. 8 and 10 whole roll tube regulator is presented among Fig. 7.

[0214] referring now to Figure 11-16, the pipe assembly operationally is connected with localizer assembly 400.Nearside localizer bearing 410 connects and is incorporated in the outer tube 510.Distally localizer bearing 440 connects by localizer bearing connecting element 412 and makes an integral body with nearside localizer bearing 410.Therefore, when making integral body with outer tube 510, nearside localizer bearing 410 and distally localizer bearing 440 are for providing static reference and mounting points with the moving component of describing now.

[0215] referring to Figure 11 and 12, as top mention and as described in, central canal 590 can be with respect to outer tube 510 lengthwise movements, but can not rotate, therefore, can be with respect to nearside localizer bearing 410 and distally localizer bearing 440 lengthwise movements but do not rotate.Central canal 590 are connected with distal cap 390 with its far-end and are in aggregates with it.Distally actuator support 340 is connected with the fin 392 of distal cap 390 and integrates.Nearside actuator support 310 is connected with distally actuator support 340 and makes integral body through actuator support connecting element 314.Therefore, distal cap 390, distally localizer bearing 340, actuator support connecting element 314 and nearside actuator support 310 and central canal 590 become one and as a unit with respect to outer tube 510 lengthwise movements, but with respect to outer tube 510 rotation.

[0216] as can be seen, center, the process of silk guide passage 114 process Handlesets 100 are managed assembly 500 (and in middle actuator pipes 280), process central canal 590, are guided and pass from distal cap 390 through localizer assembly 400 and actuator assembly 300 by Fig. 3-14.

[0217] as above mention and as described in, distally roll tube 580 can be directly rotates (see Fig. 9 and 10) around central canal 590 corresponding to the rotation of middle actuator pipes 280 in the circumferential size institute restricted portion of the bridge joint groove 640 of middle actuator pipes 280.In actuator assembly 300, distally roll tube 580 stops and is integrally connected to distally roll tube collar 394 and gear tubes 380.Therefore, the rotation of distally roll tube 580 directly causes the corresponding rotation of gear tubes 380.In Figure 11 and 12, as can be seen, gear tubes 380 directly rests on distally roll tube 580 outsides and extends to nearside localizer bearing 410 from distally actuator support 340 proximads.In Figure 11, as can be seen, exist headroom in the roll tube regulator 530 to allow gear tubes 380 nearside lengthwise movement therein.

[0218] refer again to Figure 12, and referring to Figure 14, as can be seen, distally driver gear 360 and nearside driver gear 320 rest in the actuator assembly 300.Coaxial and the one of distally driver gear 360 and nearside driver gear 320 is connected to gear tubes 380.Arcuate recess 361 in the distally driver gear 360 and the arcuate recess 321 in the nearside driver gear 320 are contained in the passage of actuator support connecting element 314 therebetween, also allow distally driver gear 360 and nearside driver gear 320 axle rotation certain limit, and do not disturb actuator support connecting element 314 around gear tubes 380.

[0219] referring to Figure 11, distally localizer gear 460 and nearside localizer gear 420 rest in the localizer assembly 400.Distally localizer gear 460 and nearside localizer gear 420 and gear tubes 380 are coaxial and longitudinally cooperate with key with it, thereby distally localizer gear 460 and nearside localizer gear 420 are linked together for rotation with gear tubes 380, but for relative lengthwise movement, do not link together.Therefore gear tubes 380 can lengthwise movement in localizer assembly 400, and can not influence the corresponding lengthwise movement of localizer assembly 400 or its any parts.Arcuate recess 461 in the distally driver gear 460 and the arcuate recess 421 in the nearside driver gear 420 are contained in the passage of actuator support connecting element 412 therebetween, and allow around the axle rotation certain limit of gear tubes 380 and not interference locator bearing connecting element 412 of distally localizer gear 460 and nearside localizer gear 420.

[0220] therefore, be appreciated that by above-mentioned explanation, actuator pipes 280 has correspondingly been rotated distally roll tube 580 and gear tubes 380 in the middle of the rotation, has rotated distally driver gear 360, nearside driver gear 320, distally localizer gear 460 and nearside localizer gear 420 at last.It can also be seen that central canal 590 cause the corresponding lengthwise movement of actuator assembly 300 with respect to outer tube 510 with respect to the lengthwise movement of outer tube 510, but do not cause the lengthwise movement of localizer assembly 400 with respect to outer tube 510.

[0221] referring now to Figure 11,13 and 14, distally localizer pinion 462 becomes one with the pinion shaft (not shown) and can center on its rotation, and described pinion shaft rotatably is supported in the distally localizer bearing 440.Distally localizer pinion 462 meshes together with distally localizer gear 460, and can be driven therefrom.Distally localizer pinion 462 also becomes one with distally localizer arm 470.Similarly, nearside localizer pinion 422 becomes one with the pinion shaft (not shown) and can center on its rotation, and described pinion shaft rotatably is supported in the nearside localizer bearing 410.Nearside localizer pinion 422 meshes together with nearside localizer gear 420, and can be driven therefrom.Nearside localizer pinion 422 also becomes one with nearside localizer arm 430.

[0222] therefore, referring to Figure 11,13 and 14, as can be seen, the rotation of distally roll tube 580 is swing pinion pipe 380 correspondingly, then drive the distally of distally and nearside localizer pinion 462 and 422 and nearside localizer gear 460 and 420 and cause that localizer arm 470 and 430 outwards swing (position that shows in Figure 14) or inwardly swing (position that shows in Figure 13) therefore.Be appreciated that the position that shows among Figure 13 be insert the patient and from patient's retraction process localizer assembly 400 will be set at wherein position.Should also be understood that the position that shows among Figure 14 is that localizer assembly 400 is prepared to be used for and will be centered on the wall of urinary bladder tissue and the pelvic floor position contacting (will be further described below) of wall of urinary bladder opening.At last, be appreciated that alternately by the explanation (and again referring to Fig. 8-10) of explaining above and extend or the restriction that rotatablely moves of the arm 470 of retraction localizer assembly 400 and 430 desired gear tubes 380 is limited by the interaction of the circumferential size of middle roll tube 280 jackshaft access slots 640 and they and bridge joint blade 620.

[0223] referring now to Figure 12-16, distally driver pinion 362 becomes one with the pinion shaft 316 that rotatably is supported in the distally actuator support 340.Distally driver pinion 362 meshes together with distally driver gear 360, and can be driven therefrom.Distally driver pinion 362 also becomes one with distally drive arm 470, this distally drive arm 370 and then become one with actuator pin 376.Similarly, nearside driver pinion 322 be supported on rotatably that pinion shaft 316 becomes one in the nearside actuator support 310.Nearside driver pinion 322 meshes together with nearside driver gear 320, and can be driven therefrom.Nearside driver pinion 322 is also integrated with nearside drive arm 330, this nearside drive arm and then become one with other actuator pin 376.

[0224] therefore, referring to Figure 12-16, as can be seen, the rotation of distally roll tube 580 is swing pinion pipe 380 correspondingly, and then drive the distally of distally and nearside driver pinion 362 and 322 and nearside driver gear 360 and 320 and cause that drive arm 370 and 330 outwards swing (position that shows in Figure 14) or inwardly swing (position that shows in Figure 13) therefore.Be appreciated that the position that shows among Figure 13 be insert the patient and from patient's retraction process actuator assembly 300 will be set at wherein position.Should also be understood that the position that shows among Figure 14 is the position (will be further described below) that actuator assembly 300 prepares to be used to drive anchoring piece.At last, be appreciated that alternately by the explanation (and again referring to Fig. 8-10) of explaining above and extend or the restriction that rotatablely moves of the arm 370 of retraction actuator assembly 300 and 330 desired gear tubes 380 is limited by the interaction of the circumferential size of middle roll tube 280 jackshaft access slots 640 and they and bridge joint blade 620.

[0225] referring to Figure 14, one or more actuator pin 376 are connected with 370 with drive arm 330.One or more actuator pin 376 be each adapted to the anchoring piece 700 that keeps having anchoring piece head 710, for example by frictional fit or other suitable manner.The thorax chamber that can have hollow in the anchoring piece 700, their head 710 has opening, extend on their length substantially in the thorax chamber, actuator pin 376 can be extended its total length substantially at described thorax intracavity, make the front-end driven anchoring piece 700 of the far-end of actuator pin 376 at anchoring piece, if drive near head 710 places, when anchoring piece may deflection or turned to suddenly, prevent anchoring piece 700 deflections or turn to suddenly in the rear end of anchoring piece.

[0226] still referring to Figure 10-14, longitudinal force and motion can be moved to drive arm 370, alternately anchoring piece 700 is driven in the tissue and then withdraws from actuator pin 376 after they are installed in the tissue from anchoring piece 700.Arrive and describe as prerequisite, longitudinal force and motion are directly moved to central canal 590 from middle actuator pipes 280 through bridge assembly 600.As mentioned above, central canal 590 become one with distal cap 390, distally actuator support 340, actuator support connecting element 314 and nearside actuator support 310.Because drive arm 330 and 370 operationally is installed in actuator support 310 and 340, the longitudinal force that applies and moved to central canal 590 through middle actuator pipes 280 is also become the longitudinal force and the motion of drive arm 330 and 370 (and whole actuator assembly 300) by direct translation with motion, thereby moves to actuator pin 376 and anchoring piece 700.As to understand by top description, gear tubes 380 will the lengthwise movement in response to the lengthwise movement of central canal 590 and actuator assembly 300.As mentioned above, allow gear tubes 380 to be connected gear tubes 380 with 460 longitudinal key bar with respect to localizer assembly 400 and pass through localizer assembly 400, and do not influence its corresponding lengthwise movement by nearside and distally localizer gear 420.

[0227] should be appreciated that by above-described mechanism and enough nearside lengthwise movement can be provided and it is delivered to drive arm 330 and 370 and actuator pin 376, so that carry and drive anchoring piece 700 by localizer assembly 400 and enter destination organization.For anchoring piece also is placed in anchoring piece in the destination organization fully by localizer, vertical stroke distances of advancing/bouncing back of actuator assembly 300 generally can be greater than the length of anchoring piece 700.In the embodiment that shows so far and describe, the position of anchoring piece can be parallel with the longitudinal axis of actuator assembly 300 substantially in the time of in being installed in tissue, but the position of anchoring piece also can with its at angle.In addition, in the embodiment that shows so far and describe, when they are positioned device assembly 400 when keeping, anchoring piece can enter substantially and they vertical destination organizations.

It will also be appreciated that [0228] the various integrated components of above-mentioned localizer and actuator assembly can be used as integral body, successive structure forms, is shaped or processes.For example, drive arm 330 can become whole with actuator pin 376 with 370 and be connected, rather than the element of assembling.

[0229] existing referring to Fig. 3 and 31-38, the doctor can use the embodiment of just having described along the direction of driving in the wrong direction in the following manner.When needs, actuator assembly 300 can load one or more anchoring pieces 700 before use.Apparatus can be inserted into then in the urethra and along the direction of driving in the wrong direction and advance, and up to the far-end process urethra 5 (Figure 31) of apparatus 10, through bladder opening 4, actuator assembly 300 and localizer assembly 400 place bladder cavity 8 inside.

[0230] after being inserted in the bladder 1, apparatus 10 beginning can activated by rotary actuator 110, and localizer and actuator assembly are opened to initial expanded position, as shown in Figure 32 (also can referring to Figure 14).Whole then apparatus can bounce back through urethra 5 pulling handles 100 downwards along proximal direction, the localizer assembly of opening is contacted with the wall of urinary bladder 2 that centers on bladder opening 4, and actuate around the wall of urinary bladder 2 of bladder opening 4 and contact with pelvic floor 7 around urethra opening 6, and with each opening aligning, as shown in Figure 33.In case be in the position, apparatus just can be prepared further to activated by pulling handle mechanism then by compression adjustment device 110, as mentioned above.Then, it can further activated to drive anchoring piece 700 by compressible drive button 202, this activation button 202 will activate the mechanism in the previously described Handleset 100 so that spur actuator assembly 300 with respect to localizer assembly 400 along proximal direction, be driven into anchoring piece 700 in the wall of urinary bladder 2 and pass through wall of urinary bladder and enter in the position that centers on aligned opening 4 and 6 in the following pelvic floor 7 position that shows among arrival Figure 34.As mentioned above, use activation button 202, the doctor may wish that then further actuation handle assembly 100 is further to be placed to anchoring piece 700 in the tissue.Then, still use above-mentioned activation button 202, the doctor can promote actuator assembly 300 along distal direction, withdraws from actuator pin 376 from the anchoring piece of installing 700, arrives the position that shows among Figure 35.At last, actuator 110 can be rotated once more, and actuator assembly 300 and localizer assembly 400 are closed into the position that shows among Figure 36 again.In this make position, apparatus 10 can be return then and break away from urethra 5.Randomly, before apparatus was withdrawed from from urethra, seal wire 80 can pass through apparatus (through silk guide passage) and insert and enter in the bladder cavity, and waits behind after apparatus withdraws from the purposes that is used to describe below, and sees Figure 36 and 37.

[0231] referring to Figure 38, seal wire 80 can be used for ductus bursae system 90 is directed in the bladder cavity 8 then.As shown in Figure 38, a kind of embodiment provides ductus bursae system 90.Wherein capsule 94 expands so that conduit is remained in its position.Porus excretorius 92 allows urine to be excreted to the urine collecting bag 98 through conduit 96 from bladder 1.

[0232] in another embodiment of the invention, see Fig. 3 and 4, at first compressive activation device actuator 110 is to open actuator.The revolving actuator actuator causes the collaborative rotation of distally roll tube then, thereby localizer and drive arm and anchoring piece are opened to the distance of the outer approximately 2-8mm of actuator assembly and parallel with the longitudinal axis of actuator assembly.

[0233] it will be appreciated by persons skilled in the art that localizer and actuator assembly can have optional structure, provide to be suitable for above-mentioned retrograde mode or the apparatus that uses in the direct motion mode.

[0234] it will be understood by those skilled in the art that, localizer assembly can have various optional structures, the embodiment that includes but not limited to describe herein (thereby include but not limited to have localizer lobe 830 feather sphere member 800 (Figure 17-21), have the umbrella shape assembly 900 (Figure 22-27) of inverted orientation device lobe 930, localizer assembly 1440 (Figure 56-64 with localizer arm 1441; 70,71,77,78), perhaps localizer 2017 (Figure 122-126), 2090 (Figure 110-118), 2122 (Figure 95,96,103-109) with 2168 (Figure 83,84,89-94) (all these will be described below)), but provide the device that optionally can bounce back with horizontal expansion, referring to Fig. 2, be used for being inserted into advanced position and entering bladder opening 4 along the direction of driving in the wrong direction through urethra 5, in bladder cavity 8, extend or expansion, be captured in the bladder opening 4 and handle to actuate and contact with pelvic floor 7 around urethra opening 6 around the wall of urinary bladder 2 of bladder opening 4, and with separately opening aligning; Perhaps alternatively, be inserted in the advanced position along the direct motion direction through the otch of abdominal part and the upper surface of bladder 1, be captured in the bladder opening 4 and operation contact with pelvic floor 7 around urethra opening 6 to actuate around the wall of urinary bladder 2 of bladder opening 4, and with separately opening aligning.Generally speaking, localizer assembly can comprise and use the optional extensible of any number and can bounce back projection, lobe, arm, pawl or other clamping or capture element, to catch and to obtain the control around the wall of urinary bladder 2 of bladder opening 4.Localizer assembly can have at least one element that operationally is connected with the stave of apparatus, and can alternately bounce back from its longitudinal axis horizontal expansion with towards its longitudinal axis in the input of the near-end of apparatus in response to the doctor.

[0235] alternatively, it will be appreciated by those skilled in the art that, open and make time spent (as described herein), localizer assembly or the localizer shown in can not having in some cases through what wall of urinary bladder entered pelvic floor when the anchoring piece actuator assembly is included in to play in the apparatus with the rear drive anchoring piece.For example, referring to Figure 32 and 33, be appreciated that, when opening and spur downwards when the far-end of anchoring piece 700 also can puncturing to it with the wall of urinary bladder 2 that centers on bladder opening 4, actuator assembly 300 can fully be used to catch wall of urinary bladder 2 and its pulling downwards is connected with pelvic floor 7 contacts and with it, and make bladder opening 4 and urethra opening 6 aim at the localizer assembly 400 shown in not needing in some cases.Therefore, the actuator assembly 300 with anchoring piece 700 can be used as localizer and the anchoring piece actuator assembly plays dual function.

[0236] " feather sphere " embodiment

[0237] Figure 17-21 shows the another kind of embodiment of method and apparatus of the present invention.Shown in Figure 17-19, provide " feather sphere " assembly 800.(term of Shi Yonging " feather sphere " purpose of described present embodiment that only is used to be convenient for reference in this article is because itself and feather sphere have similar part as shown in drawings.But this term is not to mean any restriction relevant with outward appearance or others.It will be understood to those of skill in the art that the apparatus that comprises described part and function can be similar with the feather sphere, can be not similar with it yet.) be connected central canal 590 end be distal cap 390.Central canal 590 can be arranged in the localizer lobe retainer actuator pipes 810, and localizer lobe retainer actuator pipes 810 can be arranged in the actuator pin actuator pipes 820, and are appreciated that by Figure 17 and 18 three pipes 590,810,820 can be coaxial substantially.Pipe 590,810 and 820 also lengthwise movements toward each other.

[0238] actuator pin 376 can at one end be connected to the far-end of actuator pin actuator pipes 820.Actuator pin 376 can be made by elastica or other the suitable material with shape memory, and can comprise shorter length that is connected actuator pin actuator pipes 820, sweep 377 and the longer length of holding detachable hollow anchoring piece 700.Before instrumentation, anchoring piece 700 can be loaded on the actuator pin 376, and can keep thereon releasedly by frictional fit or other suitable manner.When assembly 800 was in as shown in Figure 17 advanced position, the actuator pin 376 that length is longer can remain on advanced position, roughly kept flat along pipe 820, as shown in the figure.When assembly 800 is in as shown in figure 19 open position, fexible bias pressure in the sweep 377 of actuator pin 376 can cause the bigger length and the free end of actuator pin 376, correspondingly, the open position shown in the anchoring piece 700 on the actuator pin 376 outwards moves to.The thorax chamber that can have hollow in the anchoring piece 700, their head 710 has opening, extend on their length substantially in the thorax chamber, actuator pin 376 can be extended its total length substantially at described thorax intracavity, make the far-end of actuator pin 376 apply driving force near the front end of anchoring piece 700, if drive near head 710 places, when anchoring piece may deflection or turned to suddenly, so that prevent anchoring piece 700 deflections or turn to suddenly in the rear end of anchoring piece.

[0239] each localizer lobe 830 all can be connected to distal cap 390 at the one end.Localizer lobe 830 can be made by elastic metallic or other the suitable material with shape memory, it is subjected to bias voltage, so that when unrestricted, outwards be bound at the open position shown in Figure 19, but perhaps ride to simple passive the top that is located at actuator pin 376 and anchoring piece 700, flexibly connected or be hinged to distal cap 390.When assembly 800 is in advanced position shown in Figure 17, the advanced position shown in localizer lobe 830 is in, and arrive the outside of actuator pin 376 and anchoring piece 700.When assembly 800 was in open position shown in Figure 19, the open position shown in the tip 835 of localizer lobe 830 has outwards moved to approximately can be 15 to spend by localizer lobe 830 and pipe 590,810 and 820 angles that form wherein.

[0240] when assembly 800 is in advanced position shown in Figure 17, localizer lobe 830 and actuator pin 376 and anchoring piece 700 can keep by the pushing of the spring bias voltage in the localizer lobe retainer 860 opposing actuator pin 376.As shown in figure 18, localizer lobe retainer 860 be connected with localizer lobe retainer actuator pipes 810 by localizer lobe cage pin 862 and with its formation integral body.As mentioned above, localizer lobe retainer actuator pipes 810 can be with respect to central canal 590 and 820 lengthwise movements of actuator pin actuator pipes.

[0241] as shown in figure 19, when localizer lobe retainer 860 made progress towards distal cap 390 motions (also referring to Figure 29), actuator pin 376 and localizer lobe 830 were allowed to move to their open position.Because localizer lobe retainer 860 and localizer lobe retainer actuator pipes 810 become one by localizer lobe cage pin 862, promote localizer lobe retainer actuator pipes 810 towards distal cap 390, keep central canal 590 and actuator pin actuator pipes 820 static simultaneously, make localizer lobe retainer 860 towards distal cap 390 motions, release also allows localizer lobe 830 and actuator pin 376 and anchoring piece 700 to be opened to the position shown in Figure 19 (also referring to Figure 28,29).Be appreciated that by Figure 18 the location of localizer lobe cage pin 862 between each localizer lobe 830 allows this relative motion.

[0242] as shown in Figure 17, whole feather sphere member 800 comprises central canal 590, localizer lobe retainer actuator pipes 810 and actuator pin actuator pipes 820, all locatees in the central by outer tube 510 carryings and by the terminal collar 805 of outer tube.It will be understood by those skilled in the art that pipe 590,810,820 and 510 can keep static, and/or by the optionally lengthwise movement toward each other of any suitable nearside actuating mechanism.

[0243] will be described in this embodiment of prostate excision postoperative now coincide to connect patient's bladder and using and operating of urethra in the mode of driving in the wrong direction.Referring to the Fig. 2 that is used for the anatomy reference, feather sphere member 800 (is in advanced position, Figure 17 for example) is inserted into patient's urethra, and process urethra 5 is upwards guided, enter bladder cavity 8 through bladder opening 4, arrive complete on position, thereby feather sphere member 800 can be opened the description of face as follows in bladder.

[0244] in case assembly 800 is in complete on position, get back to Figure 17 and 19, open localizer lobe 830 and have the actuator pin 376 of anchoring piece 700 by following manner, promptly, promote localizer lobe retainer actuator pipes 810 towards distal cap 390, keep central canal 590 and actuator pin actuator pipes 820 static simultaneously.The localizer lobe retainer 860 that becomes one by localizer lobe cage pin 862 and localizer lobe retainer actuator pipes 810 is thus towards distal cap 390 motions, and then the actuator pin 376 that allows localizer lobe 830 and have an anchoring piece 700 outwards is bound in as shown in figure 19 the open position.

[0245] referring again to the Fig. 2 that is used for the anatomy reference, the whole assembly 800 that now is shown in an open position in patient's bladder is return and is spurred towards urethra opening 6 by managing 590,810,820 and 510 downward process urethras then.This makes localizer lobe tip 835 contact with the inside of wall of urinary bladder 2 around the position of bladder opening 4, and actuates wall of urinary bladder 2 around bladder opening 4 towards the pelvic floor 7 around urethra opening 6, makes these tissues contact and make opening 4 and 6 alignings.

[0246] in case wall of urinary bladder 2 contacts with pelvic floor 7, next step is to keep remaining pipe 590 and the 810 static anchoring pieces 700 that drive simultaneously by retraction actuator pin actuator pipes 820.Retraction actuator pin actuator pipes 820 causes that the actuator pin 376 of connection is driven into anchoring piece 700 in the wall of urinary bladder 2, as shown in figure 20, and enters pelvic floor 7 then through wall of urinary bladder 2, as shown in figure 21.Be appreciated that the agnail 730 on the anchoring piece 700 causes that anchoring piece 700 is fixed in the pelvic floor 7, and the head 710 of anchoring piece 700 works and keep wall of urinary bladder 2 and pelvic floor 7 position contacting, make bladder opening 4 keep being communicated with urethra opening 6.

[0247] when using first kind of embodiment describing herein, randomly, before apparatus was withdrawed from from urethra, seal wire can pass through apparatus (through silk guide passage) and insert and enter in the bladder cavity, and after apparatus withdraws from, wait behind to be used for above-described use, see Figure 37 and 38.

[0248] puts upside down the above-mentioned steps order then in patient's body, to withdraw from the spherical apparatus 800 of feather.Promote actuator pin actuator pipes 820, keep remaining pipe 590 and 810 static simultaneously, cause that actuator pin 376 is from passing anchoring piece 700 retractions of wall of urinary bladder 2 lodges pelvic floor 7 now.Still the whole assembly 800 that is shown in an open position in bladder cavity 8 slightly further is pushed in the bladder cavity then, and upwards returns and leave urethra by promoting pipe 590,810,820 and 510 together.Keep central canal 590 and actuator pin actuator pipes 820 static simultaneously by retraction localizer lobe retainer actuator pipes 810 then, apparatus 800 enters make position.Therefore move to the position of leaving distal cap 390 along proximal direction with localizer lobe retainer actuator pipes 810 by the localizer lobe retainer 860 that localizer lobe cage pin 862 becomes one, this so actuate localizer lobe 830 and actuator pin 376 inwardly enters advanced position (but not having anchoring piece 700 now), as shown in figure 17.In advanced position, whole assembly 800 can withdraw from and leave the patient through urethra downwards then.

[0249] it will be understood by those skilled in the art that above-mentioned feather sphere member can be optional structure, provide to be suitable for above-described mode backward or the apparatus that uses of mode forward.

[0250] it will be appreciated by those skilled in the art that, the mechanism that comprises the localizer lobe and carry out its bladder positioning function can have various optional structures, the embodiment that includes but not limited to describe herein (thereby include but not limited to above-mentioned localizer assembly 400 (Figure 11,13-14), have the umbrella shape assembly 900 (Figure 22-27) of inverted orientation device lobe 930, the localizer assembly 1440 (Figure 56-64 with localizer arm 1441; 70,71,77,78), perhaps localizer 2017 (Figure 122-126), 2090 (Figure 110-118), 2122 (Figure 95,96,103-109) with 2168 (Figure 83,84,89-94) (all these will be described below)), the device that can laterally bounce back and extend is provided, referring to Fig. 2, be used for being inserted into advanced position and entering bladder opening 4 along the direction of driving in the wrong direction through urethra 5, in bladder cavity 8, extend or expansion, be captured in the bladder opening 4 and handle to actuate and contact with pelvic floor 7 around urethra opening 6 around the wall of urinary bladder 2 of bladder opening 4, and with separately opening aligning; Perhaps alternatively, be inserted in the advanced position along the direct motion direction through the otch of abdominal part and the upper surface of bladder 1, be captured in the bladder opening 4 and operation contact with pelvic floor 7 around urethra opening 6 to actuate around the wall of urinary bladder 2 of bladder opening 4, and with separately opening aligning.Generally speaking, localizer assembly can comprise and use the optional extensible of any number and can bounce back projection, lobe, arm, pawl or other clamping or capture element, to catch and to obtain the control around the wall of urinary bladder 2 of bladder opening 4.Localizer assembly can have at least one element that operationally is connected with the stave of apparatus, and can alternately bounce back from its longitudinal axis horizontal expansion with towards its longitudinal axis in the input of the near-end of apparatus in response to the doctor.

[0251] alternatively, it will be appreciated by those skilled in the art that, when the anchoring piece actuator assembly be included in play in the apparatus open and with the rear drive anchoring piece through wall of urinary bladder when entering pelvic floor (as described herein), localizer assembly or the localizer shown in can not having in some cases.For example, referring to Figure 32 and 33, be appreciated that, anchoring piece actuator pin 376 can fully be used to catch wall of urinary bladder 2 with anchoring piece 700 and its pulling downwards is connected with pelvic floor 7 contacts and with it when the far-end of anchoring piece 700 also can puncture to it with the wall of urinary bladder 2 that centers on bladder opening 4 when opening in bladder cavity and spurring downwards, and make bladder opening 4 and urethra opening 6 aim at the localizer lobe 800 shown in not needing in some cases.Therefore, the actuator pin 376 with anchoring piece 700 can be used as localizer and the anchoring piece actuator assembly plays dual function.

[0252] " umbrella shape " embodiment

[0253] Figure 22-27 shows the another kind of embodiment of method and apparatus of the present invention.Shown in Figure 22-25, provide " umbrella shape " assembly 900.(term of Shi Yonging " umbrella shape " purpose of described present embodiment that only is used to be convenient for reference in this article is because itself and umbrella have similar part as shown in drawings.But this term " umbrella shape " is not to mean any restriction relevant with outward appearance or others.It will be understood to those of skill in the art that the apparatus that comprises described part and function can be similar with umbrella, can be not similar with it yet.) be connected central canal 590 end be distal cap 390, central canal 590 and distal cap 390 forms whole.Central canal 590 can be arranged in actuator pin dilator (spreader) pipe 893, and actuator pin dilator tube 893 can be arranged in the inverted orientation device lobe pipe 935, and are appreciated that by Figure 22 three pipes 590,893,935 can be coaxial substantially.Pipe 590,893,935 also lengthwise movements toward each other.

[0254] actuator pin 376 with pedestal 395 can be connected with end cap 390.Actuator pin 376 can be made by elastic wire or other the suitable material with shape memory, and can comprise length and the free end that holds dismountable hollow anchoring piece 700.Before instrumentation, hollow anchoring piece 700 can be loaded on the actuator pin 376, and can keep thereon releasedly by frictional fit or other suitable manner.When assembly 900 was in as shown in Figure 22 advanced position, the actuator pin 376 that length is longer can remain on advanced position by fexible bias pressure in the actuator pin 376 or shape memory, and is roughly parallel with 935 with pipe 590,893.When assembly 900 was in as shown in figure 25 open position, the length of actuator pin 376 and free end had outwards been actuated open position as shown in the figure.The thorax chamber that can have hollow in the anchoring piece 700, their head 710 has opening, extend on their length substantially in the thorax chamber, actuator pin 376 can be extended its total length substantially at described thorax intracavity, make the far-end of actuator pin 376 apply driving force near the front end of anchoring piece 700, if drive near head 710 places, when anchoring piece may deflection or turned to suddenly, so that prevent anchoring piece 700 deflections or turn to suddenly in the rear end of anchoring piece.

[0255] as by Figure 24 relatively and 25 understandable, the actuator pin 376 with anchoring piece 700 can move to open position towards the motion of distal cap 390 from advanced position by actuator pin dilator 890.The actuator pin dilator be hollow and become one with actuator pin dilator tube 893, and can be with respect to central canal 590 and 935 lengthwise movements of inverted orientation device lobe pipe.Therefore, actuator pin dilator tube 893 is towards distal cap 390 motions, and the top dilator face 891 of the actuator pin dilator 890 of inclination is actuated anchoring piece 700, correspondingly, actuates actuator pin 376 and radially outward arrives the open position that shows among Figure 25.

[0256] pass through 23 and 24 as can be seen, inverted orientation device lobe 930 becomes one with inverted orientation device lobe pipe 935.Inverted orientation device lobe 930 is made by elastic metallic or other suitable material with shape memory, and and the open position of bias voltage to take to show among Figure 24.Therefore, promoting inverted orientation device lobe pipe 935 towards distal cap 390 keeps other pipe 590,893 and 510 static simultaneously, promote localizer lobe 930 and break away from outer tubes 510, and allow them to be opened to their biased position that in Figure 24 and 25, shows through the terminal collars 805 of outer tubes.

[0257] in Figure 22 as can be seen, whole umbrella shape assembly 900 comprises central canal 590, drive pin dilator tube 893 and inverted orientation device lobe pipe 935, by outer tube 510 carrying and by the terminal collar of outer tube 805 location in the central.The technical staff of mechanical design field will be understood that, pipe 590,893,935 and 510 can keep static or by any suitable nearside actuating mechanism lengthwise movement toward each other.

[0258] will be described in now behind the pubis that this embodiment coincide to connect patient's bladder and using and operating of urethra behind the carcinoma of prostate radical correction.Referring to the Fig. 2 that is used for the anatomy reference, umbrella shape assembly 900 (is in advanced position, as shown in figure 22) be inserted into patient's urethra, and process urethra 5 is upwards guided, enter bladder cavity 8 through bladder opening 4, arrive complete on position, thereby umbrella shape assembly 900 can be opened the description of face as follows in bladder.

[0259] in case assembly 900 is in complete on position, gets back to Figure 22 and 24,, keep central canal 590 and actuator pin dilator tube 893 static simultaneously, extend and open inverted orientation device lobe 930 by promote inverted orientation device lobe pipe 935 towards distal cap 390.Then, static referring to Figure 24 and 25 by keep central canal 590 and inverted orientation device lobe pipe 935 simultaneously towards distal cap 390 promotion actuator pin dilator tube 893, open actuator pin 376 with anchoring piece 700.Therefore assembly 900 is in a fully open position, as shown in figure 25.

[0260] referring again to the Fig. 2 that is used for the anatomy reference, the whole assembly 900 that now is shown in an open position in patient's bladder cavity 8 is return and is spurred towards urethra opening 6 by managing 590,893,935 and 510 downward process urethras then.This makes inverted orientation device lobe 930 contact with the inside of wall of urinary bladder 2 around the position of bladder opening 4, and actuates wall of urinary bladder 2 around bladder opening 4 towards the pelvic floor 7 around urethra opening 6, makes these tissues contact and make opening 4 and 6 alignings.

[0261] in case wall of urinary bladder contacts with pelvic floor, next step is to keep remaining pipe 893 and the 935 static anchoring pieces 700 that drive simultaneously by pulling central canal 590.Pulling central canal 590 cause that actuator pin 376 is driven into anchoring piece 700 in the wall of urinary bladder 2, enters pelvic floor 7, as shown in figure 26 then.Be appreciated that the agnail 730 on the anchoring piece 700 causes anchoring piece 700 lodges in pelvic floor 7, and the head 710 of anchoring piece 700 works and keep wall of urinary bladder 2 and pelvic floor 7 position contacting, make bladder opening 4 keep being communicated with urethra opening 6.

[0262] when using first kind of embodiment describing herein, randomly, before apparatus was withdrawed from from urethra, seal wire can pass through apparatus (through silk guide passage) and insert and enter in the bladder cavity, and after apparatus withdraws from, wait behind to be used for above-described use, see Figure 37 and 38.

[0263] puts upside down the order of above-mentioned steps then in patient's body, to withdraw from umbrella shape apparatus 900.Promote central canal 590, keep remaining pipe 893 and 935 static simultaneously, cause actuator pin 376 from present through anchoring piece 700 retractions of wall of urinary bladder 2 lodges pelvic floor 7.Still the whole assembly 900 that is shown in an open position in patient's bladder slightly further is pushed in the bladder cavity then, and turns back to and leave urethra in the urethra by promoting pipe 590,893,935 and 510 together.Apparatus 900 enters advanced position in the following manner then: pulling actuator pin dilator tube 893 keeps central canal 590 and inverted orientation device lobe pipe 935 static simultaneously, the position that actuator pin dilator 890 is shown from Figure 25 moves to the position that shows among Figure 24, allows actuator pin 376 to turn back at their advanced position (but not having anchoring piece 700 now) of normal bias voltage shown in Figure 24.Then, spur reverse lobe pipe 935 and keep central canal 590 and actuator pin dilator tube 893 static simultaneously, inverted orientation device lobe 930 is retreated into the outer tube 510 as shown in figure 22 their advanced position from as shown in figure 24 their open position of normal bias voltage.In the advanced position shown in Figure 22, assembly 900 can withdraw from and leave the patient through urethra downwards then.

[0264] it will be understood by those skilled in the art that above-mentioned feather sphere member can be optional structure, provide to be suitable for above-described mode backward or the applicator used of mode forward.

[0265] it will be appreciated by those skilled in the art that, the mechanism that comprises the localizer lobe and carry out its bladder positioning function can have various optional structures, and the embodiment that includes but not limited to describe herein (thereby includes but not limited to above-mentioned localizer assembly 400 (Figure 11,13,14) or above-mentionedly has the feather sphere member 800 (Figure 17-21) of localizer lobe 830, the localizer assembly 1440 (Figure 56-64 with localizer arm 1441; 70,71,77,78), perhaps localizer 2017 (Figure 122-126), 2090 (Figure 110-118), 2122 (Figure 95,96,103-109) with 2168 (Figure 83,84,89-94) (all these will be described below)), the device that can laterally bounce back and extend is provided, referring to Fig. 2, be used for being inserted into advanced position and entering bladder opening 4 along the direction of driving in the wrong direction through urethra 5, in bladder cavity 8, extend or expansion, be captured in the bladder opening 4 and handle to actuate and contact with pelvic floor 7 around urethra opening 6 around the wall of urinary bladder 2 of bladder opening 4, and with separately opening aligning; Perhaps alternatively, be inserted in the advanced position along the direct motion direction through the otch of abdominal part and the upper surface of bladder 1, in bladder cavity 8, extend or expansion, be captured in the bladder opening 4 and operation contact with pelvic floor 7 around urethra opening 6 to actuate around the wall of urinary bladder 2 of bladder opening 4, and with separately opening aligning.Generally speaking, localizer assembly can comprise and use the optional extensible of any number and can bounce back projection, lobe, arm, pawl or other clamping or capture element, to catch and to obtain the control around the wall of urinary bladder 2 of bladder opening 4.Localizer assembly can have at least one element that operationally is connected with the stave of apparatus, and can alternately bounce back from its longitudinal axis horizontal expansion with towards its longitudinal axis in the input of the near-end of apparatus in response to the doctor.

[0266] alternatively, it will be appreciated by those skilled in the art that, when the anchoring piece actuator assembly be included in play in the apparatus open and with the rear drive anchoring piece through wall of urinary bladder when entering pelvic floor (as described herein), localizer assembly or the localizer shown in can not having in some cases.For example, referring to Figure 25 and 26, be appreciated that, anchoring piece actuator pin 376 can fully be used to catch wall of urinary bladder 2 with anchoring piece 700 and its pulling downwards is connected with pelvic floor 7 contacts and with it when the far-end of anchoring piece 700 also can puncture to it with the wall of urinary bladder 2 that centers on bladder opening 4 when opening in bladder cavity and spurring downwards, and make bladder opening 4 and urethra opening 6 aim at the inverted orientation device lobe 930 shown in not needing in some cases.Therefore, the actuator pin 376 with anchoring piece 700 can be used as localizer and the anchoring piece actuator assembly plays dual function.

[0267] capsule/fixation clamp embodiment

[0268] Figure 55-64 shows the another kind of embodiment (be shown as and be in the direct motion structure) of the method according to this invention and device, and described apparatus has Handleset 1100, straight tube assembly 1200, swan-neck assembly 1300 and end effector assembly 1400.In one embodiment of the invention, but apparatus 1000 endoscope types be inserted in the patient abdominal cavity with the coincideing of the urethra of carrying out the patient and bladder, thereby the fluid that rebulids between bladder 1 and the urethra 5 connects.

[0269] Figure 56 shows swan-neck assembly 1300 and the end effector assembly 1400 after being inserted in patient's bladder cavity 8 through patient's abdominal part and bladder (not shown) upper surface.Can make opening, and for example apparatus is inserted abdominal part by following manner, that is, the sleeve pipe (not shown) of the band trocar is inserted into abdominal part and, withdraws from the trocar and apparatus is inserted in the bladder cavity through sleeve pipe along its arrival of direct motion direction guiding roughly and through the bladder upper surface.Swan-neck assembly 1300 can be flexible and can provide bias voltage angle of bend (it is suitable spending about 90 degree from about 55), to be provided at the required curvature that is inserted into end effector assembly 1400 in the urethra 5 in the direct motion operation and activates apparatus.The angle of bend of swan-neck assembly 1300 can be depending on the specific needs of operation or doctor's use and changes.

[0270] Figure 57 shows the end effector assembly 1400 with localizer arm 1441 of opening in bladder cavity 8.After being inserted into capsule assembly 1410 in the bladder opening 4, distally location organ pipe 1445 is distal motion also downwards, causes that localizer arm 1441 is opened to and the vertical position of the longitudinal axis of end effector assembly 1400.Localizer arm 1441 is suitable for being used to effectively catching and towards the wall of urinary bladder 2 of actuating around the pelvic floor 7 of urethra opening 6 around bladder opening 4.

[0271] Figure 58 shows the end effector assembly with anchoring piece actuator assembly 1460 of opening in bladder cavity.Be inserted in the process that arrives the position that shows among Figure 56 in the bladder at end effector assembly 1400, the anchoring piece pivotal arm 1461 of anchoring piece actuator assembly 1460 is by closed collar 1330 parcels of anchoring piece, and be limited in along the make position of location, distally organ pipe 1445, as what seen by comparison Figure 57 and 58.When the closed collar 1330 of anchoring piece moves upward with respect to distal anchors actuator tube 1450, anchoring piece pivotal arm 1461 is not wrapped, allow them under the bias voltage of spring, outwards to swing to the position that shows among Figure 58, make anchoring piece 700 arrive the position of preparing driving.

[0272] Figure 58 also shows the location of distally capsule assembly 1410 in urethra opening 6.Have end 1413 urethra opening 6 the location and far-end 1413 be inserted into guarantee in the urethra opening 6 that urethra opening 6 and bladder opening 4 are with rough alignment when localizer arm 1441 contact and when pelvic floor 7 is actuated wall of urinary bladder 2.

[0273] Figure 59 shows the location of end effector assembly 1400, wall of urinary bladder 2 and pelvic floor 7, thereby it has been actuated localizer arm 1441 downwards for apparatus 1000 and has been actuated the wall of urinary bladder 2 downward location afterwards that contact with pelvic floor 7, realizes by promote whole apparatus towards pelvic floor.When being actuated around the wall of urinary bladder 2 of bladder opening 4 when contacting with the pelvic floor 7 that centers on urethra opening 6, capsule assembly 1410 is urged in the urethra opening 6.

[0274] Figure 60 shows anchoring piece actuator assembly 1460 and has been driven in the pelvic floor 7 with fixing through wall of urinary bladder 2 and contacts apparatus afterwards around the wall of urinary bladder 2 of bladder opening 4 with pelvic floor 7 around urethra opening 6, and wherein bladder opening 4 and urethra are opened 6 and be aligned.Open and ready position in case be in, shown in Figure 58, anchoring piece 700 can be driven in the pelvic floor through wall of urinary bladder by transporting distal anchors actuator tube 1450 along distal direction (towards the far-end of apparatus), this correspondingly makes anchoring piece pivotal arm 1461, anchoring piece actuator pin pedestal 1462, anchoring piece actuator pin (in anchoring piece 700 by hidden, motion as shown in the figure), thus make anchoring piece 700 motions.Drive anchoring piece 700 and the distal part of capsule assembly 1410 is positioned in the urethra 5 to guarantee that anchoring piece 700 is mounted, make bladder opening 4 and urethra opening 6 keep aligned in general through wall of urinary bladder 2 pelvic floor 7 of going forward side by side.

[0275] Figure 61 shows anchoring piece actuator pin 1463 is withdrawed from apparatus afterwards from the anchoring piece of installing 700, and the present lodge of the anchoring piece of described installation is connected to pelvic floor 7 with wall of urinary bladder 2 in pelvic floor 7.Anchoring piece 700 can provide agnail or other is suitable for the suitable construction of anchoring piece 700 lodges in tissue.Like this, when anchoring piece actuator assembly 1460 kept the location, distally organ pipe 1445 is roughly static withdrawing from by remote control pulling distal anchors actuator tube 1450 simultaneously, anchoring piece 700 kept lodges in tissue.Before using apparatus, anchoring piece 700 remains on the anchoring piece actuator pin 1463 releasedly by prestrain and by frictional fit or other suitable manner, simultaneously when anchoring piece 700 lodges in tissue and anchoring piece actuator pin 1463 allow when wherein withdrawing to discharge.

[0276] Figure 62 show end effector 1400 part retraction with the end effector assembly 1400 after capsule assembly 1410 being installed in the bladder cavity 8.When end effector assembly 1400 retractions, fixation clamp 1430 is opened and exposes.Fixation clamp 1430 can become one with fixation clamp collar 1433 and can be connected with anchoring piece 700 at anchoring piece head 710 places with anchoring ring, and described anchoring ring can be by forming along the suture material of anchoring piece head 710 and fixation clamp 1430.When end effector assembly 1400 retractions, fixation clamp 1430 is opened when fixation clamp collar 1433 moves upward.End effector assembly 1400 can bounce back up to fixation clamp 1430 owing to itself and being connected of anchoring piece head 710 are resisted retraction.

[0277] Figure 63 show localizer assembly 1440 localizer arm 1441 by making organ pipe 1445 retractions in location leave apparatus after the pelvic floor 7 and anchoring piece pivotal arm 1461 by making the closed collar 1330 of anchoring piece towards the pelvic floor motion keeps conduit 1420 simultaneously and distal anchors actuator tube 1450 is static substantially after being closed apparatus.What can expect to those skilled in the art is, the step of closed orientation device arm 1441 and closed anchoring piece pivotal arm 1461 can be in operation process any suitable time or order finish.

[0278] Figure 64 shows at them and has begun anchoring piece actuator assembly 1460 and the localizer assembly 1440 after the retraction from bladder 1.Remove anchoring piece actuator assembly 1460 and localizer assembly 1440 stays conduit 1420, also keep and being communicated with of capsule assembly 1410.Conduit 1420 can be to stay original position up to the conduit that coincide and finish, so that can urinate between rehabilitation and healing stage.

[0279] Figure 65 shows the capsule 1411 of the capsule assembly 1410 after gas that capsule assembly 1410 has been pumped into by the expansion chamber 1423 in conduit 1420 (seeing Figure 67,68) or fluid expand.Capsule 1411 can be inflated up to it and be subjected to fixedly carrying secretly 1432 restrictions, described fixedly carrying secretly then against organizing depressor 1411 so that enough pressure to be provided around bladder opening 4, so that keep around the wall of urinary bladder 2 of bladder opening 4 with around the contact between the pelvic floor 7 of urethra opening 6, realization is knitted the seam of separately tissue, thereby realizes coincideing.

[0280] between rehabilitation and healing stage, can discharge through the porus excretorius 1421 that is communicated with conduit 1420 (seeing Figure 67,68) from the urine of patient's bladder.Porus excretorius 1421 for example can be positioned in the far-end on the conduit 1420, perhaps is positioned at any other suitable position.Pressure by in expansion chamber 1423 monitorings and adjusting capsule 1411 keeps suitable gas or fluid in the capsule 1411, finishes up to coincideing.Can reduce the probability of the pressure necrosis in the tissue of capsule below by following manner, promptly, described mode for example comprises the rib 1415 on capsule 1411 downsides or other agglomerate, joint knot, projection or other part, and this can reduce the blood flow that flows to the tissue that contact with capsule 1411 effectively and lose.These parts can be solid or have uniform wall thickness.

[0281] in addition, capsule 1411 can be designed to have following feature, and this feature influences its shape when expanding, thereby influences the shape and the area of the lower surface that contacts with wall of urinary bladder 2 of capsule 1411 when expanding.For example, can design and make capsule 1411, make it have the thinner wall in thicker bottom, make the bottom of capsule 1411 be pre-arranged downward and upwards expansion between fixedly carrying secretly, thereby present the bigger surface area that contacts with wall of urinary bladder 2 on top.As an alternative, capsule 1411 can be designed to have and cause the feature that it takes specific favourable shape when expanding.

[0282] capsule assembly 1410, fixation clamp 1430 and conduit 1420 can be by removing fixation clamp anchoring ring 1435 and anchoring piece head 710 and fixedly carrying 1432 be connected and remove secretly.As shown in Figure 66, fixedly carry secretly 1432 can by one or more pass be positioned at fixedly carry secretly 1432 with anchoring piece head 710 in the fixation clamp anchoring ring 1435 in hole be connected with anchoring piece head 1432.As understandable by Figure 66-69, the free end of fixation clamp anchoring ring 1435 is extensible to arrive its near-end by conduit 1420.Therefore, capsule assembly 1410 can be removed by following manner, that is, the clamping ring plug 1485 that pulling is connected with the free end of each fixation clamp anchoring ring 1435 also spurs clamping ring plug 1485, is removed from apparatus fully up to fixation clamp anchoring ring 1435.From anchoring piece head 710 with fixedly carry 1432 secretly and remove fixation clamp anchoring ring 1435 anchoring piece 700 is separated with fixation clamp 1430, allow capsule assembly 1410 to be bounced back.Figure 67 shows anchoring ring passage 1436, and in one embodiment of the invention, fixation clamp anchoring ring 1436 can pass in the anchoring ring cavity 1424 that anchoring ring passage 1436 enters conduit 1420 (Figure 68).Fixation clamp anchoring ring 1435 can comprise suture material.

[0283] Figure 67 and 68 shows the method for apparatus and the embodiment of structure, and this apparatus is suitable for making the capsule 1411 according to capsule assembly 1410 of the present invention to expand.Conduit 1420 can comprise the distad expansion chamber 1423 of extend past capsule module body 1412.Expansion hatch 1414 provides the passage between expansion chamber 1423 and the capsule cavity, with expand, venting and bag pressure power regulates.When needs influence capsule and are applied to structural pressure, provide and pressure in the capsule 1411 be adjusted and be regulated to the gas regulated or fluid pressure can by expansion hatch 1414 through expansion chamber 1423.In one embodiment of the invention, capsule 1411 can be inflated, and fixedly carries 1432 restriction secretly up to what be subjected to fixation clamp 1430.Capsule 1411 can be formed by the elastomeric materials that centers on capsule module body 1412 fully.The nearside of capsule 1411 and distal part can be gluing or bonding with other any suitable manner and capsule module body 1512.

[0284] Figure 68 shows the embodiment according to conduit 1420 of the present invention, and it has atria 1422, at least one anchoring ring cavity 1424 and expansion chamber 1423.What can expect for a person skilled in the art is, various types of chambeies are included in the scope of the present invention, and the cross section of described chamber or conduit can remain in single conduit or be received respectively, and this depends on user's needs.Conduit 1420 can have any diameter.

[0285] Figure 69 shows the embodiment of the near-end of conduit 1420, as being connected to urine collecting bag 1500.Gas or fluid can be carried through the adverse current stop valve 1483 that is positioned in collecting bag (as shown in the figure) and/or the conduit.For example, this can open adverse current stop valve 1490 or exert pressure and realize by insert pin through valve by applying enough positive pressure.

[0286] still referring to Figure 68 and 69, provide duct cover 1480, it is connected with urine collecting bag 1500 through urinary catheter 1482.Urinary catheter 1482 can be provided with urine adverse current stop valve 1483 and prevent the urine adverse current.Duct cover 1480 can be detachably connected to conduit 1420 by for example screw 1481.

[0287] Figure 66-69 shows a kind of like this mode: one or more fixation clamp anchoring ring 1435 can be provided with the path or be included in the apparatus in apparatus in this mode, and be provided with the path in be included in the pipe, for example such as in the conduit 1420.It will be understood to those of skill in the art that other structure also is possible, for example with anchoring piece head 710 with fixedly carry 1432 alternate manners that are connected and dismantle secretly.Conduit 1420 can be by having biocompatibility substantially or being applicable to that any material structure of human body forms, for example such as latex, other suitable polymers, Nitinol or their combination.

[0288] referring to Figure 58,59,64 and 70, conduit 1420 can be arranged in distally location organ pipe 1445 and the localizer assembly 1440.But the fixation clamp collar 1433 of the far-end butt fixation clamp 1430 of localizer assembly 1440.When distally location organ pipe 1445 when distal direction is driven with respect to conduit 1420, the localizer arm 1441 of localizer assembly 1440 is opened, against fixation clamp collar 1433 vertical compression set organ pipes 1445.Location, distally organ pipe 1445 can be connected with localizer assembly 1440 by for example pin or other suitable bindiny mechanism.

[0289] referring to Figure 58,59,63,64 and 70, location, distally organ pipe 1445 can be arranged in the distal anchors actuator tube 1450.When anchoring piece pivotal arm 1461 is opened (as shown in Figure 58 and 59), can make 1450 motions of distal anchors actuator tube, thereby distad drive anchoring piece actuator assembly 1460 (thus in use downwards towards pelvic floor), enter in the pelvic floor 7 so that drive anchoring piece 700 through wall of urinary bladder 2.Distal anchors actuator tube 1450 is connected with the anchoring piece pivotal arm yoke piece 1467 of anchoring piece actuator assembly 1460.Anchoring piece pivotal arm yoke piece 1467 can be connected with anchoring piece pivotal arm 1461 by for example pin or any other suitable manner, and by anchoring piece pivotal arm spring 1466 or other suitable biasing member bias voltage and outside the swing.Anchoring piece pivotal arm 1461 can hingedly connect anchoring piece actuator pin pedestal 1462 with the anchoring piece actuator pin 1463 that is connected.Other suitable link of pin or any permission oscillating motion can be used for anchoring piece actuator pin pedestal 1462 is connected to anchoring piece pivotal arm 1461, and anchoring piece pivotal arm 1461 and actuator pin pedestal 1462 can have suitable coordination shape, the range of movement of the relative swing between them is limited in suitable angle, as by Figure 59 understood.Can comprise the open position bias voltage anchoring piece pivotal arm 1461 of anchoring piece pivotal arm spring 1466 in Figure 59, to show.By distal motion anchoring piece closure tube 1220, anchoring piece actuator assembly 1460 can be set to make position (in Figure 63, showing), and anchoring piece pivotal arm 1461 roughly keeps flat along location, distally organ pipe 1445, distal motion anchoring piece closure tube 1220 correspondingly distad promotes swan-neck with ribbing 1325 and the closed collar 1330 of anchoring piece with respect to distal anchors actuator tube 1450, cause that the closed collar 1330 of anchoring piece contacts with anchoring piece pivotal arm 1461, actuate their and arrive make position, surround then and limit them.This motion is inverted so that allow anchoring piece pivotal arm 1461 to open.

[0290] distal anchors actuator tube 1450 can be arranged in the curved ridges pipe 1305 by coaxial substantially.Curved ridges pipe 1305 works as a part of skeleton, and other element can rest on described skeleton, wherein or around described skeleton also move.Can expect that for the operability of apparatus and the purpose of use, curved ridges pipe 1305 is inflexible substantially, perhaps has elasticity slightly, and it can be formed by Nitinol or any material that other has desirable characteristics.

[0291] still referring to Figure 59,63,64 and 70, curved ridges pipe 1305 can be positioned in the deflection pipe 1325.Deflection pipe 1325 can be formed by any suitable material structure, for example has abundant elasticity to allow deflection pipe 1325 above curved ridges pipe 1305 and with respect to the polymer that has biocompatibility substantially of its lengthwise movement.Deflection pipe 1325 can be provided with rib, as shown in the figure, perhaps gives or increase other suitable part of flexibility.Deflection pipe 1325 can be connected to anchoring piece closure tube 1220 through deflection tube connector 1225 by its near-end, and is connected with the closed collar 1330 of its far-end and anchoring piece by pin or other suitable link.The closed collar 1330 of anchoring piece can be suitable for contacting, actuating the closed of anchoring piece pivotal arm 1461 and surround and restriction anchoring piece pivotal arm.Therefore, anchoring piece pivotal arm 1461 and anchoring piece actuator assembly 1460 can be arranged on make position with respect to distal anchors actuator tube 1450 distal motion by making anchoring piece closure tube 1220, are arranged on open position by making anchoring piece closure tube 1220 with respect to distal anchors actuator tube 1450 proximal motion.

[0292] Figure 71 is the partial cross section view of the axis of centres of the far-end of the apparatus that shows in Figure 55, and the anchoring piece of apparatus and mode and the particular exemplary element of localizer assembly are shown, and they can be connected with actuate tube in described apparatus and mode.Distally location organ pipe 1445 is the inside tube that show among Figure 71, and ends at localizer nearside collar 1442 places, itself and localizer nearside collar 1442 can be become one by suitable components.Localizer arm 1441 can be hingedly connected together with their near-end and localizer nearside collar 1442, can be hingedly connected together with their far-end and localizer distally collar 1443.Inspection by Figure 64 and 70 is appreciated that when apparatus is assembled fully conduit 1420 (not showing) can be arranged on location, distally organ pipe 1445, localizer distally collar 1442 and localizer nearside collar 1443 inside in Figure 71.Be further appreciated that when apparatus is assembled fully that by Figure 64 and 70 fixation clamp collar 1433 is set on the conduit 1420 contiguous with localizer distally collar 1443.Refer again to Figure 71, be appreciated that distally location organ pipe 1445 with respect to and cause that towards the distally lengthwise movement of fixation clamp collar 1433 localizer assembly 1440 vertically compresses against fixation clamp collar 1433, and then causing localizer arm 1441 from the longitudinal axis of assembly as part Figure 71 shows and perpendicularly outwards open towards the fully open position, this can find out among the cardon 58-62.The structure of localizer assembly 1440 can be observed more in detail in Figure 78 in this embodiment.As can be seen, vertical compression of localizer assembly 1440 causes that localizer arm 1441 stretches out, and is realized as shape and the nearside of localizer arm 1441 and the hinge between the distal part 1444 by them.As shown in the figure, localizer assembly 1440 can comprise localizer nearside collar 1442, localizer arm 1441 and localizer distally collar 1443, can be by having the single integrated part that biocompatibility and flexible polymeric material form substantially, when opening localizer assembly 1440, needs are suitable for allowing to integrate hinge 1444 deflections, as shown in the figure, and when needs closed orientation device assembly 1440, turn back to not deflected position.

[0293] referring to Figure 58 and 59, at open position, localizer assembly 1440 is applicable to be captured in bladder opening 4 and to actuate around the wall of urinary bladder 2 of bladder opening and contacts with pelvic floor 7 downwards.Embodiment shown in localizer assembly 1440 can comprise or any other suitable mechanism, but these one or more elements of mechanism's horizontal expansion, in response to from the doctor in the input of the portions of proximal of apparatus and the power and the motion that transmit, be captured in the bladder opening 4 and be used for actuating wall of urinary bladder downwards and contact with pelvic floor, then when the needs drawing-out mechanism, in response to the power and motion retraction or the closed described element that transmit from doctor's input.

[0294] refer again to Figure 71, distal anchors actuator tube 1450 can be connected with anchoring piece pivotal arm yoke piece 1467 and form as one.Anchoring piece pivotal arm 1461 can be connected with pivotal arm yoke piece 1467 by pin or other suitable components as shown in the figure, thereby and by the outwards swing of spring 1466 bias voltages.Anchoring piece pivotal arm 1461 can be limited by the suitable adapted shape of pivotal arm yoke piece 1467 with anchoring piece pivotal arm 1461 by its angle of outwards swinging.Anchoring piece actuator pin pedestal 1462 can be connected with anchoring piece pivotal arm 1461 pivotly by pin or other suitable components as shown in the figure.Anchoring piece actuator pin pedestal 1462 can be limited by the suitable adapted shape of anchoring piece pivotal arm 1461 and pin pedestal 1462 with respect to anchoring piece pivotal arm 1461 motion angle by it.Anchoring piece actuator pin 1463 is connected with pin pedestal 1462 and can forms as one with it.

[0295] anchoring piece 700 can be a hollow, so that be engaged on the anchoring piece actuator pin 1463, and keeps thereon releasedly by frictional fit or other suitable releasing parts.The thorax chamber that can have hollow in the anchoring piece 700, their head has opening, extend on their length substantially in the thorax chamber, actuator pin 1463 can be extended its total length substantially at described thorax intracavity, make actuator pin 1463 apply driving force near the front end of anchoring piece 700, if drive near head 710 places, when anchoring piece may deflection or turned to offset direction suddenly, prevent anchoring piece 700 deflections or turn to offset direction suddenly in the rear end of anchoring piece.When anchoring piece 700 was inserted in the tissue, the agnail on it or any other suitable lodge structure caused that anchoring piece 700 lodges are in tissue.After anchoring piece 700 was inserted in the tissue, anchoring piece actuator pin 1463 can bounce back from anchoring piece 700 by retraction distal anchors actuator tube 1450 then.Should be understood that ideally, distal anchors actuator tube 1450 is flexible.Distal anchors actuator tube 1450 can be formed by any suitable material, for example such as Nitinol.Anchoring piece pivotal arm spring for example can be leaf spring or any other suitable biasing member, is used for anchoring piece actuator assembly 1460 is biased into open position when not wrapped up by the closed collar 1330 of anchoring piece.

[0296] still referring to Figure 71, the closed collar 1330 of anchoring piece can be connected with the far-end one of deflection pipe 1325.Referring to Figure 70, the near-end of deflection pipe 1325 can be connected with anchoring piece closure tube one through deflection tube connector 1225.Refer again to Figure 71, deflection pipe 1325 is not connected with the ridge pipe 1305 of anchoring piece pivotal arm yoke piece 1467 with bending with the closed collar 1330 of the anchoring piece that becomes one, and can be with respect to they lengthwise movements.Therefore, be appreciated that, the far-end lengthwise movement of anchoring piece closure tube 1220 is also static with 1450 maintenances of distal anchors driving tube, can cause the corresponding distally lengthwise movement of the closed collar 1330 of anchoring piece, cause that it contacts with anchoring piece pivotal arm 1461, actuate them to the make position that roughly is provided with along distally location organ pipe 1445, and with their parcels and for example be limited in can be in Figure 57 and 63 observed position.On the contrary, along move anchoring piece closure tube 1220 and distal anchors actuator tube 1450 kept static of proximal direction, the closed collar 1330 of anchoring piece is drawn on the anchoring piece pivotal arm 1461 or with its disengaging, allow them to be bound to the open position that shows among Figure 58 and 71 for example.

[0297] location, distally organ pipe 1445 is not connected each other with distal anchors actuator tube 1450, thereby lengthwise movement toward each other.This makes that for example distal anchors actuator tube 1450 quilts are towards distal movement, and location, distally organ pipe is static simultaneously, is taken place when contacting through the immobilized wall of urinary bladder of maintenance and with pelvic floor as device assembly 1440 drivings that are positioned when anchoring piece 700.

[0298] thus Figure 72 show the actuation element that can be used to transmit Handleset 1100 effectively/between relative power and the representative configuration of the transition assembly of motion actuation end actuator assembly 1400, as shown in Figure 55.Location, distally organ pipe 1445 becomes one with localizer pipe connections 1206, and then becomes one with straight location organ pipe 1209, and described straight location organ pipe 1209 operationally is connected with Handleset 1100, as shown in Figure 55,72 and 77.Therefore, the longitudinal force of the straight location organ pipe 1209 that is applied by Handleset and motion directly are passed to location, distally organ pipe 1445 through localizer pipe connections 1206.Refer again to Figure 72, distal anchors actuator tube 1450 becomes one with anchoring piece actuator tube connector 1207, and then become one with straight anchoring piece actuator tube 1208, described straight anchoring piece actuator tube 1208 is operably connected to Handleset 1100, as can be from shown in Figure 55,72 and 82.Therefore, the longitudinal force of the straight anchoring piece actuator tube connector 1207 that is applied by Handleset and motion directly are passed to distal anchors actuator tube 1450 through anchoring piece actuator tube connector 1207.Referring to Figure 72 and 82, crooked ridge pipe 1305 becomes one with ridge 1201, and then becomes one with handle casing 1101, so the relative immobilized skeleton of curved ridges pipe 1305, ridge 1201 and handle casing 1101 formation apparatuses, and actuation element is around its motion.As what observe in Figure 73 and 74, other suitable mechanism's overall co-ordination that ridge pipe 1201 can become one by ridge stop structure 1190 or with handle casing also is connected to handle casing.At last, still referring to Figure 72, and referring to Figure 55 and 79, deflection pipe 1325 becomes one with deflection pipe connections 1225 and the anchoring piece closure tube 1220 that is operably connected to Handleset 1100.Therefore, the longitudinal force and the motion of the anchoring piece closure tube 1220 that is applied by Handleset are directly transferred to deflection pipe 1325, and are delivered to the closed collar 1330 of anchoring piece thus.For what those of ordinary skills can expect be, structure shown in Figure 72 can be sent to the example of the element in the end effector as just being applied to the power in the element by Handleset and moving, and this transmission can variety of way according to the present invention be finished.

[0299] Figure 82 shows and can be bonded to the exemplary configurations that skeleton (" frame ") is provided in the apparatus, and other element can and activated around its motion, and it can provide support the structure as the operation of unitary whole apparatus.As previously mentioned, curved ridges pipe 1305 becomes one with ridge 1201.Ridge 1201 becomes one with handle casing 1101.This three elements thereby become one substantially.Shell 1101 can or form by suitable rigid polymer material injection moulding.Can wish that ridge 1201 and curved ridges pipe 1305 are roughly inflexible, have suitable hardness and intensity and act on applying of action required power on the apparatus to support the doctor, applying of this operating physical force is inserted into apparatus patient's abdominal part, location bladder opening, actuates bladder and contact with pelvic floor and keep that bladder contacts with pelvic floor with the driving anchoring piece in the apparatus actuation process.Ridge 1201 and curved ridges pipe 1305 can be formed by rustless steel, Nitinol or any other suitable material.Curved ridges pipe 1305 can or be connected to ridge 1201 by any suitable manner connection, includes but not limited to pin connection, welding, punching press cooperation, matching thread, and is bonding etc.

[0300] Figure 73,74,79 and 80 shows the exemplary mechanisms that can be attached in the Handleset, by this structure anchor spare closure tube 1220 can be used as alternative, optionally along nearside or distal direction lengthwise movement and keep, so that as an alternative, optionally the anchoring piece assembly is opened or is closed into for example selectable location shown in Figure 57 and 58.Anchoring piece closure tube 1220 can be connected with closure tube locking collar 1180 by pin or any other suitable manner as shown in Figure 80, makes two elements as a unit lengthwise movement together.Closure tube locking pedestal 1179 can become one with handle casing 1101, thereby can be used as the part of apparatus skeleton.Closure tube locking collar 1180 is freely ridden and is located on the closed tubular axis 1183, guarantees that closure tube locking collar suitably aims at locking pedestal 1179, and supports the near-end of closure tube spring 1181.Closure tube locking collar 1180 comprises and being suitable for and the interactional blocking element 1182 of the collaborative part of closure tube locking pedestal 1179, so that as an alternative, optionally proximad promotes and rotation, thereby locking and vertically being limited in the locking pedestal 1179 that is in the position shown in Figure 74, perhaps rotatably not locking and being discharged to take the position shown in Figure 75 from locking pedestal 1179.When being in from position that locking pedestal 1179 discharges, closure tube locking collar 1180 is closed pipe spring 1181 towards the distal position bias voltage.Closure tube locking collar 1180 can be limited away from closure tube rotating shaft 1183 separation by working in coordination with flange or antelabium or other suitable components (not shown).Therefore, be appreciated that, by shown in the exemplary configurations of element, anchoring piece closure tube 1220 is biased in the distal position in (therefore, by above-mentioned exemplary mechanisms the closed collar 1330 of anchoring piece is biased into and keeps anchoring piece actuator assembly 1460 to be in the close position in the distal position) by closure tube 1181.When the doctor wishes to open the anchoring piece assembly, he or she can promote closure tube locking collar 1180 with respect to the handle casing proximad, combine up to the collaborative part of closure tube blocking element 1182, closure tube locking collar 1180 is transferred to being latched in the closure tube locking pedestal 1179 then with closure tube locking pedestal 1179.This proximad pulling anchoring piece 1220, proximad spurs closed collar 1330, thereby the anchoring piece pivotal arm is discharged in the open position.

[0301] Figure 75-77 shows the exemplary mechanisms that can be attached in the apparatus, and transmit force keeps to open according to localizer assembly of the present invention and to it with motion to apply also.Localizer bar 1110 is pivotably mounted on the wheel shaft 1113 that becomes one with shell 1101 and can centers on its pivot.Localizer bar 1110 has long part and shorter part; Has localizer bar tooth 1111 on the short part.Location organ pipe actuator tooth bar 1160 vertically ride be located at and guiding piece or track that shell 1101 becomes one between, but and proximad and distally lengthwise movement.Have tooth 1159 on the localizer control actuator tooth bar 1160.Laying of localizer bar 1110 and location organ pipe actuator tooth bar 1160 makes location organ pipe actuator rack tooth 1159 and localizer bar tooth 1111 mesh.Therefore, for Figure 75-77, be understandable that localizer bar 1110 is converted into the distally linear movement of locating organ pipe actuator tooth bar 1160 around the counterclockwise angular movement of wheel shaft 1113, vice versa.The far-end of location organ pipe actuator tooth bar 1160 can be connected with straight location organ pipe 1209 by collaborative flange or the antelabium that forms annular collar or other suitable components, make two parts as a unit lengthwise movement, and directly locate organ pipe 1209 and can become one via localizer pipe connections 1206 and location, distally organ pipe 1445, see before and state.Therefore, be appreciated that location, distally organ pipe 1445 is distad actuated when the doctor of gripping handle assembly 1100 pulling or extruding localizer bar 1110.Referring to Figure 77, be appreciated that, assembled and localizer distally collar 1443 is by capsule assembly (for example referring to Figure 56,57) when being limited in far-end when whole apparatus, the distally lengthwise movement of location, distally organ pipe 1445 causes vertical compression of localizer assembly 1440, cause that localizer arm 1441 outwards opens from longitudinal axis, vice versa.The location organ pipe spring 1161 that is in compressive state is towards proximal position bias voltage location organ pipe actuator tooth bar 1160.Therefore, be appreciated that by Figure 77 distally location organ pipe 1445 biased result in proximal position allows localizer arm 1441 and localizer assembly 1440 to take make position.Driver/localizer securing rod 1170 can be pivoted on the pin 1176 and can pivot around it, and this pin 1176 can become one with shell 1101 and by the spring 1171 that is in compressive state (with respect to Figure 75) bias voltage in the counterclockwise direction.Driver/localizer securing rod 1170 comprises driver/localizer locking breech lock 1178.Assembled and when prepare using when Handleset, the lower surface of driver/localizer locking breech lock 1178 is shelved on the upper surface of near-end 1177 of location organ pipe actuator tooth bar 1160 and against it and is actuated.When along (with respect to Figure 75) pulling counterclockwise or extruding localizer bar 1110, as previously mentioned, make location organ pipe actuator tooth bar 1160 distal motion, notch 1174 on the near-end 1177 of location organ pipe actuator tooth bar 1160 moves below the locking breech lock 1178 of driver/localizer securing rod 1170, and locking breech lock 1178 moves in the notch 1174 by actuating of spring 1171.This is locked in actuator tooth bar 1160 in the distal position.As a result, as intelligible by Figure 77, localizer arm 1141 and localizer assembly 1440 can be locked in the open position.Then, for closed orientation device assembly 1140, the doctor can oppress driver/localizer securing rod 1170, will lock breech lock and promote from notch 1174, allows location organ pipe actuator tooth bar 1160 to turn back to proximal position under the actuating of spring 1161.

[0302] Figure 75,76 and 81 show according to of the present invention be combined in apply in the apparatus and transmission power and motion to drive the exemplary mechanisms of anchoring piece assembly.Anchoring piece drive rod 1120 is pivotably mounted on the wheel shaft 1113 that becomes one with shell 1101 and can centers on its pivot.Anchoring piece drive rod 1120 has long part and shorter part; Has anchoring piece drive rod tooth 1121 on the short part.In the middle of the anchoring piece driver tooth bar 1122 vertically ride be located at and guiding piece or track that shell 1101 becomes one between, but and proximad and distally lengthwise movement.Have nearside tooth 1127 and distally tooth 1128 on the tooth bar 1122 in the middle of the anchoring piece driver.When anchoring piece drive rod 1120 is moved counterclockwise through suitable angle (with respect to Figure 75), laying of tooth bar 1122 makes rack tooth 1127 and 1121 combinations of anchoring piece drive rod tooth in the middle of the anchoring piece driver in the middle of anchoring piece drive rod 1120 and the anchoring piece driver.Grapnel firmware driver pinion 1123 and big anchoring piece driver pinion 1124 become one with the pin 11 that is supported by the axle sleeve in the shell 1101 and can center on its rotation.Laying of tooth bar makes grapnel firmware driver pinion 1123 and tooth 1128 engagements of the middle tooth bar of anchoring piece driver distally in the middle of grapnel firmware driver pinion 1123 and the anchoring piece driver.Anchoring piece driver rack bar 1125 is vertically ridden and is located at and locatees between the guiding piece or track that organ pipe actuator tooth bar 1160 becomes one, and the length of anchoring piece driver rack bar 1125 and far-end may extend into and are supported in the ridge 1201, shown in Figure 75.Has anchoring piece driver tooth 1129 on the anchoring piece driver rack bar 1125.Laying of anchoring piece driver rack bar 1125 and anchoring piece drive rod 1120 makes anchoring piece driver tooth 1129 and big anchoring piece driver pinion 1124 engagements.Anchoring piece driver rack bar 1125 is connected with straight anchoring piece actuator tube 1208 by any suitable components.Therefore, by aforementioned content and Figure 75,76 and 81 check is appreciated that, make 1120 motions of anchoring piece drive rod and be rotated counterclockwise the point that (with respect to Figure 75 and 81) meshes to the nearside tooth 1127 on drive rod tooth 1121 and the medium drive tooth bar 1122 so that cause it, this will distad drive medium drive tooth bar 1122, and then cause that grapnel firmware driver pinion and big anchoring piece driver pinion 1123 and 1124 are rotated counterclockwise, and then distad drive anchoring piece driver rack bar 1125, straight anchoring piece actuator tube 1208, anchoring piece actuator tube connector 1207, distal anchors actuator tube 1405, thereby distad drive anchoring piece actuator assembly 1406.As what understood by for example Figure 59 and 60, when apparatus was assembled fully and is used, this distal movement of anchoring piece actuator assembly 1460 was driven into anchoring piece 700 in the tissue.

[0303] localizer bar 1110 and anchoring piece drive rod 1120 are against each other with side by side relationship, and all are installed on the wheel shaft 1113 also around its pivot.Form localizer bar 1110 and anchoring piece drive rod 1120 so that have collaborative part, the corresponding counterclockwise motion (with respect to Figure 75) that makes the counterclockwise motion of localizer bar 1110 produce anchoring piece drive rod 1120 at their butt places.Be between the junction point on the short part that drive rod spring 1126 under the tensioning state is connected other suitable junction point in hook or the shell 1101 and anchoring piece drive rod 1120, as shown in the figure.Therefore, anchoring piece drive rod 1120 is along clockwise direction biased (with respect to Figure 75).

[0304] in addition, before activating anchoring piece localizer bar 1110, prevent that anchoring piece drive rod 1120 is pressed.Drive rod lock hook 1172 is pivotably mounted on the pin that supports in the shell 1101 and can centers on its rotation, as shown in the figure, by the spring 1171 that is in compressive state along the counter clockwise direction bias voltage, make it be hooked in from the outstanding pin 1169 of the shorter parts transversely of anchoring piece drive rod 1120 as shown in the figure position, prevent that drive rod 1120 from move counterclockwise and (directly do not show and sell; It is from the dorsal part outstanding (with respect to Figure 75) of element).But, when localizer bar 1110 is pressed, lock hook releasing member 1112 on it is actuated (with respect to Figure 75) in conjunction with lock hook 1172 and along clockwise direction to it, cause that it combines with pin 1169 disengagings, thereby discharge anchoring piece drive rod 1120, it can be moved along counter clockwise direction.

[0305] in addition, when apparatus prepare to use but before launching, the locking breech lock 1178 of anchoring piece driver rack bar 1125 (thus, the anchoring piece actuator assembly 1460) by driver/localizer securing rod 1170 engages with driver rack bar notch 1173 and is locked in the proximal position.When by pulling and when being rotated counterclockwise localizer bar 1110 thus and activating apparatus, make location organ pipe actuator tooth bar 1160 distal motion, as previously mentioned, notch 1174 on the near-end 1177 of location organ pipe actuator tooth bar 1160 moves below the locking notch 1178 of driver/localizer securing rod 1170, and will lock breech lock 1178 and move in the notch 1174 by actuating spring 1171.When locking breech lock 1178 moved in the notch 1174, its motion broke away from driver rack bar notch 1173, and release actuator tooth bar 1125 can be driven it by pulling anchoring piece drive rod 1120, as previously mentioned.

[0306] therefore, be appreciated that by top description and Figure 73-82, assembled and when prepare using when apparatus, localizer assembly 1440 is in the close position, anchoring piece actuator assembly 1460 is remained closed and is locked in the proximal position with respect to localizer assembly 1440 by the closed collar 1330 of anchoring piece, apparatus is arranged on is convenient to insert the intravital position of patient.Apparatus is being inserted into after position suitable in patient's body and end effector assembly place intracavity, can begin to be actuated into such position by pulling localizer bar 1110, it can open localizer assembly 1440 in this position, and is locked in the described position by driver/localizer securing rod 1170 under the actuating of spring 1171.When driver/localizer securing rod 1170 lock in place device bars 1110, it can will be driven anchoring piece driver rack bar 1125 and discharge along distal direction by the driver localizer being locked breech lock and 1173 disengagings of driver rack bar notch and opening anchoring piece driver rack bar 1125 simultaneously.Anchoring piece actuator assembly 1140 can combine with breech lock pedestal 1179 up to it by distad spurring closure tube breech lock collar 1180 then, and breech lock collar 1180 rotated to is locked in the breech lock pedestal 1179 and opens.Drive anchoring piece driver rack bar (to drive anchoring piece) by pulling anchoring piece drive rod 1120 along distal direction then.After anchoring piece is driven, be in spring 1126 under the tensioning state and actuate anchoring piece drive rod 1120 and return, thereby cause that anchoring piece driver rack bar 1125 and corresponding anchoring piece actuator assembly 1460 turn back to their initial proximal position (and pull out the anchoring piece actuator pin anchoring piece that is installed in the tissue).Can break away from breech lock pedestal 1179 by rotation and with closure tube breech lock collar 1180 then anchoring piece actuator assembly 1460 is turned back to make position, closure tube breech lock collar 1180 breaks away from latch enable collar 1180 with breech lock pedestal 1179 and turn back to its distal position under the actuating of spring 1181, makes closed collar 1330 distal motion and causes its closed anchoring piece actuator assembly 1460.At last, can pass through compressed drive/localizer securing rod 1170 closed orientation device assemblies 1440, compressed drive/localizer securing rod 1170 promotes the driver/notch 1174 of localizer locking breech lock 1178 from the near-end 1177 of location organ pipe actuator tooth bar 1160 come out, allow location organ pipe actuator tooth bar 1160 under the actuating of location organ pipe spring 1161, to turn back to proximal position, closed orientation device assembly 1440.Therefore, apparatus is returned to make position, prepares to withdraw from patient's body.

[0307], is appreciated that conduit 1420 can advance by Handleset 1100, and passes whole apparatus and arrive capsule assembly 1410 that it can be connected to fixation clamp collar 1433 herein referring to Figure 55,64,65 and 75.In one embodiment, conduit 1420 can be through extension of Handleset 1101 proximads and the rear portion of stretching out apparatus 1000, shown in Figure 75.Anchoring piece driver rack bar 1125 can be a hollow, perhaps can have passage and " U " shape cross section, and driver/localizer securing rod 1170 and handle casing 1101 can have suitable hole or further feature, thereby the passage of conduit 1420 is contained in therebetween.When apparatus is prepared to be used to anchoring piece is installed, conduit 1420 can be clamped in Handleset 1110 places or wherein releasedly by any suitable manner, so that keep static with respect to handle casing 1101, when localizer assembly 1440 is vertically compressed based on fixation clamp collar 1433, it is arranged to tensioning state with respect to localizer assembly 1440, thereby causes localizer assembly 1440 to be opened.After apparatus had activated the driving anchoring piece and has been returned to make position, conduit 1420 can be released then, allows all elements to withdraw from, but except conduit 1420 and the capsule assembly 1410, to be used to finish above-mentioned anastomosis operation.

[00308] bar 1110,1120 and 1170 and location organ pipe actuator tooth bar 1160 can make by any material with suitable intensity, hardness and formation property or molded Performance Characteristics, comprise polymeric material.

[00309] tooth bar 1122, anchoring piece driver rack bar 1125, location organ pipe actuator tooth bar 1160 and drive rod lock hook 1172 all can be made by any material with the proper strength that is used for the small-sized machine element in the middle of grapnel firmware driver pinion 1123, big anchoring piece driver pinion 1124, the anchoring piece driver, comprise steel or high-strength polymer.

[00310] above-mentioned embodiment only is an example describing the part apparatus, described apparatus can be used for once or repeatedly bladder is contacted with pelvic floor and keep this contact, and the opening in bladder and the urethra is aimed at, the driving anchoring piece enters pelvic floor through wall of urinary bladder and fixation clamp is connected in the bladder cavity, capsule is expanded, thereby pressure is applied to wall of urinary bladder to carry out the woollen yarn knitting of wall of urinary bladder and pelvic floor, and discharge urine in rehabilitation with in required time period of healing, after prostatectomy, between bladder and urethra, coincide.

[00311] it will be understood by those skilled in the art that said elements can have optional structure and the embodiment that is used to carry out same steps as.It will be understood by those skilled in the art that said elements is provided with alternatively and constructs, carry out above-mentioned steps for use in the retrograde direction in edge, rather than above-mentioned direct motion direction.

[00312] it will be understood by those skilled in the art that, the apparatus that comprises localizer assembly 1440 and carry out its bladder positioning function can have various optional structures, include but not limited to that the embodiment of describing (thereby includes but not limited to localizer assembly 400 herein, feather sphere member 800 (Figure 17-21) with localizer lobe 830, above-mentioned umbrella shape assembly 900 (Figure 22-27) with inverted orientation device lobe 930, perhaps localizer 2017 (Figure 122-126), 2090 (Figure 110-118), 2122 (Figure 95,96,103-109) with 2168 (Figure 83,84,89-94) (all these will be described below)), the device that can laterally bounce back and extend is provided, referring to Fig. 2, be used for being inserted into advanced position and entering bladder opening 4 along the direction of driving in the wrong direction through urethra 5, in bladder cavity 8, extend or expansion, be captured in the bladder opening 4 and handle to actuate and contact with pelvic floor 7 around urethra opening 6 around the wall of urinary bladder 2 of bladder opening 4, and with separately opening aligning; Perhaps alternatively, be inserted in the advanced position along the direct motion direction through the otch of abdominal part and the upper surface of bladder 1, in bladder cavity 8, extend or expansion, be captured in the bladder opening 4 and operation contact with pelvic floor 7 around urethra opening 6 to actuate around the wall of urinary bladder 2 of bladder opening 4, and with separately opening aligning.Generally speaking, localizer assembly can comprise and use the optional extensible of any number and can bounce back projection, lobe, arm, pawl or other clamping or capture element, to catch and to obtain the control around the wall of urinary bladder 2 of bladder opening 4.Localizer assembly can have at least one element that operationally is connected with the stave of apparatus, and can alternately bounce back from its longitudinal axis horizontal expansion with towards its longitudinal axis in the input of the near-end of apparatus in response to the doctor.

[00313] it will be appreciated by those skilled in the art that, alternatively, open and make time spent (as described herein), localizer assembly or the localizer shown in can not having in some cases through what wall of urinary bladder entered pelvic floor when the anchoring piece actuator assembly is included in to play in the apparatus with the rear drive anchoring piece.For example, referring to Figure 58 and 61, be appreciated that, contact with wall of urinary bladder 2 also can puncture the time when in bladder cavity, opening and spur downwards it around bladder opening 4 up to the far-end of anchoring piece 700, anchoring piece actuator pin 1463 can fully be used to catch wall of urinary bladder 2 with anchoring piece 700 and it is promoted downwards to be connected with pelvic floor 7 contacts and with it, and make bladder opening 4 and urethra opening 6 aim at the localizer assembly 400 shown in not needing in some cases.Therefore, the anchoring piece actuator assembly 1460 with anchoring piece 700 can be used as localizer and the anchoring piece actuator assembly plays dual function.

[00314] optional capsule/fixation clamp embodiment

[00315] Figure 136 shows the another kind of illustrative embodiments of apparatus 3000 of the present invention, and according to the present invention, it is applicable to behind the carcinoma of prostate radical correction bladder and urethral tissue are coincide.Described apparatus has Handleset 3100, pipe assembly 3200 and end effector assembly 3400.End effector assembly 3400 is suitable for being convenient to being inserted in patient's urethra 5 and through patient's urethra along the direction of driving in the wrong direction and enters in the bladder cavity 8 by bladder opening 4.It will be understood to those of skill in the art that, as an alternative, identical substantially step in the mode of inserting along the direct motion direction that apparatus 3000 can be provided with and be configured to carry out effectively with those are described in this article in one embodiment, that is to say, through the otch of abdominal part and bladder upper surface (not shown), and enter in the urethra opening 6 through bladder opening 4 downwards.The example of such embodiment is shown in 60/639,836 and 60/582,302 the U.S. Patent application common co-pending in patent application serial numbers and describes.

[00316] Figure 135 is the profilograph of end effector assembly 3400 after insertion and process patient urethra 5 enter in the bladder opening 4.As can be seen, end effector assembly 3400 can comprise distal cap assembly 3410, capsule fixation clamp 3430, anchoring piece actuator assembly 3460 and localizer assembly 3440.End effector assembly 3400 and comprise only as identification assembly can through the pipe assembly 3200 be operably connected to Handleset 3100 (in Figure 136, showing) and controlled by it, described pipe assembly can comprise ridge pipe 3210, center rod or seal wire 3230, positioned internal organ pipe 3240, outer locator pipe 3241, anchoring piece driver closure tube 3260 and anchoring piece actuator tube 3261.These pipes and the bar length that can in anchoring piece driver closure tube 3260, pass apparatus, and can be connected with end cap 3411 and in aggregates with it by any suitable manner.Anchoring piece driver closure tube 3260 can be with respect to center rod or seal wire 3230 lengthwise movements, and can be connected and become integral body with it by any suitable manner and the closed collar 3464 of anchoring piece.Anchoring piece driver closure tube 3260 can be arranged in the anchoring piece actuator tube 3261, and can be with respect to its lengthwise movement.Anchoring piece actuator tube 3261 can be connected with anchoring piece pivotal arm yoke piece 3467 and becomes one with it by any suitable manner.Anchoring piece actuator tube 3261 can be arranged in the positioned internal organ pipe 3240, and can be with respect to its lengthwise movement.Positioned internal organ pipe 3240 can be connected with localizer distally collar 3443 and becomes one with it by any suitable manner.Positioned internal organ pipe 3240 can be arranged in the outer locator pipe 3241, and can be with respect to its lengthwise movement.Outer locator pipe 3241 can be connected with ridge pipe 3210 with localizer nearside collar 3442 and becomes one with it by any suitable manner.Pipe 3210,3241,3240,3261 and bar 3230 can be made by Nitinol or any material that other has the appropriate combination of following characteristic: intensity, hardness and biocompatibility, and needed as purpose for present embodiment.Apparatus also comprises capsule fixation clamp 3430, and it is connected with end-cap assembly 3410 with far-end, and is releasably connected to anchoring piece 700 with near-end.Anchoring piece 700 can discharge maintenance (description of face as follows) by apparatus.The present embodiment that to describe apparatus now is used for carrying out the use and the operation thereof of patient's bladder and urethra behind the carcinoma of prostate radical correction.

[00317] as previously mentioned, and shown in Figure 135, end effector assembly 3400 can insert and enter into bladder opening 4 through patient's urethra along retrograde direction, is inserted into then in the bladder cavity, as from Figure 136 understood.Figure 136 shows the end effector assembly, it is for after being inserted in the bladder cavity 8 fully, anchoring piece actuator assembly 3460 and localizer assembly 3440 have been opened so that after using, and localizer assembly 3440 has contacted with wall of urinary bladder 2 and is used to actuate around the wall of urinary bladder 2 of bladder opening and diagram after pelvic floor 7 contacts.In order to open localizer assembly 3440, the doctor keeps ridge pipe 3210 and outer locator pipe 3241 static, and uses Handleset 3100 (showing in Figure 136) proximad to withdraw from positioned internal organ pipe 3240.This is towards localizer collar 3442 pulling localizer distally collars 3243.Localizer arm 3441 has by the hinged top part of any suitable manner and localizer distally collar 3443 with by the hinged bottom part of any suitable manner and localizer nearside collar 3442, and the two is also hinged by any suitable manner.Therefore, drive localizer distally collar 3443 towards localizer nearside collar 3442 in the above described manner and cause that localizer arm 3441 is outside and laterally folded with respect to the longitudinal axis of apparatus, as what understand by the comparison of Figure 135 and 136.

[00318] in case the localizer arm 3441 of localizer assembly 3440 is opened, actuates wall of urinary bladder 2 and contact with pelvic floor 7 downwards, as by Figure 136 understood but doctor's operating apparatus causes localizer arm 3441.It can also be appreciated that in bladder and the urethra that by Figure 136 opening separately is aligned.

[00319] doctor can open anchoring piece actuator assembly 3460 by keeping anchoring piece driver closure tube 3260 static while proximads to withdraw from anchoring piece actuator tube 3261, perhaps as an alternative, again, by using Handleset 3100 (being shown among Figure 136), open anchoring piece actuator assembly 3460 by keeping anchoring piece 3261 static whiles of the actuator tube anchoring piece driver closure tube 3260 of distad advancing.As mentioned above, anchoring piece pivotal arm yoke piece 3467 becomes one with anchoring piece actuator tube 3261, and the closed collar 3464 of anchoring piece becomes one with anchoring piece driver closure tube 3260.Anchoring piece pivotal arm 3461 can pivot with anchoring piece pivotal arm yoke piece 3467 and be connected, and the outwards swing by anchoring piece pivotal arm spring 3466 bias voltages.As shown in Figure 135, when anchoring piece actuator assembly 3460 was in the close position, the closed collar 3464 of anchoring piece wrapped up and anchoring piece pivotal arm 3461 is limited in the advanced position.When anchoring piece pivotal arm yoke piece 3467 is actuated downwards when leaving the closed collar 3464 of immobilized anchoring piece by proximad, perhaps as selecting, when the closed collar 3464 of anchoring piece is upwards distad actuated when leaving golden anchoring piece pivotal arm yoke piece 3467, anchoring piece pivotal arm 3461 is released and allows outwards swing under the actuating of spring 3466 from the closed collar 3464 of anchoring piece, as what understood by comparison Figure 135 and 136.The above-mentioned anchoring piece pivotal arm 3461 outwards angle of swing can be limited by the suitable collaborative shape of for example pivotal arm 3461 and anchoring piece pivotal arm yoke piece 3467, perhaps as an alternative, for example limit by the relatively vertically stroke between collaborative shape and closed collar 3464 of restriction anchoring piece and the anchoring piece pivotal arm 3461.

[00320] referring to Figure 136, anchoring piece actuator pin pedestal 3462 can pivot with anchoring piece pivotal arm 3461 and be connected as can be seen, and can be biased with respect to its inside swing by any suitable manner, so that take downward substantially orientation, shown in Figure 136.Anchoring piece actuator pin 3463 can be connected with anchoring piece actuator pin pedestal 3462 and become one with it.But anchoring piece 700 can be loaded on the anchoring piece actuator pin 3463 and by frictional fit or any other suitable delivery mode and keep thereon.Anchoring piece 700 can comprise fixation clamp hook 760 (as in Figure 141 can more detailed observation).As what understood by Figure 135 and 136 relatively, anchoring piece 700 can outwards move and enters the position of preparing driving by anchoring piece actuator assembly 3460, as mentioned above.

[00321] referring now to Figure 136 and 137, use Handleset 3100 (seeing Figure 136), the doctor can drive anchoring pieces 700 downwards and goes forward side by side in the tissue of pelvic floor 7 through wall of urinary bladder 2 by withdrawing from anchoring piece actuator tube 3261, withdrawing from of anchoring piece actuator tube 3261 spurs anchoring piece pivotal arm yoke piece 3467, correspondingly spurs anchoring piece pivotal arm 3461, anchoring piece actuator pin pedestal 3462, anchoring piece actuator pin 3463 and anchoring piece 700 downwards.Anchoring piece pivotal arm 3461 and anchoring piece actuator pin pedestal 3462 can be placed on the apparatus, when being driven downwards, make not interference locator arm 3441 of anchoring piece 700, and are driven downwards between localizer arm.Anchoring piece 700 can comprise be positioned at they the axle on agnail or other suitable lodge structure (not shown) so that cause they by lodge in the tissue of pelvic floor and stop its from the tissue withdraw from.

[00322] referring now to Figure 137 and 138, the doctor can be by the anchoring piece 700 retraction actuator pin 3463 of anchoring piece actuator tube 3261 from present installation of distad advancing, this will make 3467 motions of anchoring piece pivotal arm yoke piece, cause that correspondingly anchoring piece pivotal arm 3461, anchoring piece drive pin pedestal 3462 and anchoring piece actuator pin 3463 distad move upward.If anchoring piece 700 is by lodge or remain in the tissue of pelvic floor 7, but anchoring piece 700 keeps anchoring piece actuator pin 3463 thereon to discharge from anchoring piece 700 by releasing parts, stay and be mounted and the anchoring piece 700 of lodge in tissue, shown in Figure 138.

[00323] refers again to Figure 138 and 139, use Handleset 3100 (seeing Figure 136), by distad being advanced, anchoring piece actuator tube 3261 keep anchoring piece driver closure tube 3260 static simultaneously, the doctor can closed anchoring piece actuator assembly and it is turned back to initial position, so that withdraw from from the patient.As an alternative, anchoring piece driver closure tube 3260 keeps anchoring piece actuator tube 3261 static simultaneously but doctor's proximad bounces back.Both orders all will make anchoring piece pivotal arm yoke piece 3467 and corresponding anchoring piece pivotal arm 3461 place the closed collar 3464 of anchoring piece, cause that anchoring piece pivotal arm 3461 upwards and inwardly moves with respect to the closed collar 3464 of anchoring piece, thereby coated and be restricted, as shown in Figure 139.

[00324] in the last set-up procedure that anchoring piece driver and localizer assembly withdraw from, referring to Figure 139 and 140, the doctor can keep outer locator pipe 3241 and the ridge pipe 3210 static localizer arm 3441 that bounce back simultaneously by the positioned internal organ pipe 3240 of distad advancing.This makes localizer distally collar 3443 distal motion and away from localizer nearside collar 3442, localizer arm 3441 inwardly is drawn to the position shown in Figure 140.

[00325] uses anchoring piece driver and the localizer assembly that retracts to the position that shows among Figure 140, the doctor can be by withdrawing from ridge pipe 3210, outer locator pipe 3241, positioned internal organ pipe 3240, anchoring piece actuator tube 3261 and anchoring piece driver closure tube 3260 as one group and these assemblies withdrawed from patient's body together, and end-cap assembly 3410, fixation clamp 3430 and anchoring piece 700 are stayed, as by Figure 140 and 141 relatively as can be seen.Referring to Figure 141, as can be seen, capsule fixation clamp 3430 is connected with the wall of urinary bladder 2 that centers on bladder opening 4, and then can keep by the anchoring piece of installing 700 contacting with the tissue of the pelvic floor 7 that centers on urethra opening 6.The afterbody 3433 of fixation clamp 3430 can by anchoring piece 700 by as shown in the figure hook 760 or by any other suitable manner maintenance.Center rod 3230 can be used as seal wire (will be described below) now, and can be used for performing the operation and withdraw from the remainder of apparatus after finishing.

What [00326] can expect for a person skilled in the art is, various apparatuses can be comprised and are configured and are suitable for vertically (advance and bounce back) power and motion are transferred to end effector assembly 3400 by Handleset 3100, so that apply and transmit required power and the motion of the above-mentioned illustrative embodiments of actuating.

[00327] Figure 146 shows end-cap assembly 3410 and capsule fixation clamp 3430 in greater detail.End-cap assembly 3410 can comprise drains extension 3413, has fixation clamp on it and connects neck 3415 and one or more porus excretorius 3414.End-cap assembly 3410 also can comprise can integrated formation or the fastening collar 3412 and the end cap 3411 of assembling.End cap 3411 can or be attached to center rod or seal wire 3230 by any suitable manner connection.Capsule fixation clamp 3430 can comprise connection collar 3431, keeps thereon to cooperate around fixation clamp connection neck 3415 and by their collaborative shape and size separately.Capsule fixation clamp 3430 also can comprise afterbody 3433, wherein has anchoring piece dog hole 3432, and anchoring piece hook 760 can pass described anchoring piece dog hole, thereby capsule fixation clamp 3430 is connected to anchoring piece 700 (referring again to Figure 141).Capsule fixation clamp 3430 can be made by any suitable biocompatible polymer, and described polymer has flexibility but effective limited resilience characteristic, so that make it be suitable for remaining in the position and be used for capsule restriction (will be described below).

[00328] get back to Figure 141, and with reference to Figure 142, the next step in the illustrative methods of Miao Shuing is that the doctor is inserted into ductus bursae assembly 3500 among the patient and through center rod 3230 and is inserted in the capsule fixation clamp 3430 in this article, as seal wire.

[00329] center rod 3230 as seal wire can be provided with one or more labelling along its length (not shown), makes the doctor determine that the ductus bursae assembly is inserted into the distance among the patient.Length by indicating the ductus bursae assembly and with respect to the position of one or more labelling on center rod or the seal wire 3230, the doctor can determine whether conduit tube component is inserted into the degree of depth correct in patient's body with respect to fixation clamp and distal cap assembly.

[00330] referring to Figure 142,143 and 146, ductus bursae assembly 3500 can comprise conduit 3510, connected capsule 3520 and catheter end plug 3530.Conduit 3510 can comprise expansion chamber 3511 and expansion hatch 3512.Capsule 3520 can have nearside and the distal part that is connected with the distally joint with the mode that is roughly gas and/or fluid-tight and nearside on the conduit 3510, and to be annular when expanding or to have conduit 3510 and pass wherein centre gangway, as what can from Figure 143, be understood.Catheter end plug 3530 can comprise fastening button 3531, one or more porus excretorius 3414 and the conduit plug-in unit 3534 with stop collar 3535.

[00331] refer again to Figure 142, when ductus bursae assembly 3500 activated, the fastening button 3531 of catheter end plug 3530 was worked in coordination with and is buckled into wherein with the fastening collar of distal cap assembly 3,410 3412, thereby is maintained.Referring to Figure 142 and 143, capsule 3520 can be inflated then, and has the internal pressure that expansion chamber 3511 in conduit 3510 and expansion hatch 3512 are regulated.Referring to Figure 143, capsule 3520 can outwards expand between the band of fixation clamp 3430 when expanding as can be seen, and can be used for pressure is applied on the wall of urinary bladder 2 of bladder opening, contact with the tissue of pelvic floor 7 so that all push wall of urinary bladder 2, and seal with respect to urine or other material that is collected in the bladder in rehabilitation and healing stage chien shih bladder opening, pelvic floor and urethra.Between rehabilitation and healing stage, urine and be collected in the bladder other material respectively the porus excretorius 3414 and 3533 in distal cap assembly 3410 and catheter end plug 3530 be excreted in the conduit 3510.Between rehabilitation and healing stage, conduit 3510 can be connected to the urine collecting bag (not shown) by near-end.

[00332] is appreciated that as shown in the figure and the combination of the fixed folder structure that anchors to pelvic floor of the restriction described in this article and the swelling bag that keeps ductus bursae has in the required time period that coincide and conduit to be restricted in urethra axially or the ideal effect of lengthwise movement.

[00333] can keep suitable gas or fluid pressure in the capsule 3520 by the pressure in expansion chamber 3511 monitorings and adjusting capsule 3520, finish up to coincideing.It is suitable that pressure in the capsule is approximately 1-6p.s.i., is preferably about 1.5-2.5p.s.i..The probability that pressure coincide in the capsule below tissue can reduce by comprising rib or agglomerate, joint knot, projection or other part (not shown) on capsule 3520 outsides for example, can reduce effectively arrive with tissue that capsule 3520 contacts in blood flow.These parts can be solid or have the wall thickness of homogeneous.In addition, capsule 3520 can be designed to have influences the feature that it takes expansible shape, thereby influences the shape and the area of the lower surface of the capsule 3520 of contact wall of urinary bladder 2 when expanding.For example, capsule 3520 can design and produce so that have the thin wall in thicker bottom, top, makes the bottom of capsule 3520 be predisposed to also outside expansion the between fixedly carrying secretly downwards, thereby presents the more high surface area that contacts with wall of urinary bladder 2.As an alternative, capsule 3520 can be provided with and make like this, so that it has the thin wall in thicker top, bottom, the top of capsule 3520 is predisposed at first expands in bladder cavity, thereby the remainder of capsule is upwards moved in the bladder cavity, and before the complete expansion of bottom, broken away from the pelvic floor zone substantially.As an alternative, capsule 3520 can be designed to have the feature that causes that it takes other specific favourable shape, so that for example fill most of by fixedly carrying the space that limits secretly when expanding.

[00334] for the ease of expanding and helping to keep suitable gas or fluid pressure in the capsule 3520, can double check valve be installed along expanding gas with expansion chamber 3511 or fluid passage.For example, double check valve can comprise and pressure relief valve's bonded " duckbilled " type valve or other valve, described " duckbilled " type valve or other valve play and allow gas or fluid to enter expansion chamber 3511 but prevent gas or effect that fluid returns, if the pressure in capsule 3520 and/or the fluid passage surpasses predetermined maximum, the effect that allows gas or fluid outflow system is played by described pressure relief valve.

[00335] Figure 144 shows the alternative that capsule 3520 is connected to the far-end of conduit 3510.With at the capsule shown in Figure 143 3520 more as can be seen, in Figure 144, the flaky material that forms the upper wall of capsule 3520 has been connected to the far-end of conduit 3510 along reverses direction, capsule keeps the ability of gas or fluid pressure when can be used for being increased in the sealing at junction point place and improving expansion.

After anastomosis operation is finished substantially, that is to say that [00336] with wall of urinary bladder with after the tissue woollen yarn knitting of the pelvic floor of the opening separately of bladder and urethra, capsule can be deflated and ductus bursae assembly 3500 is withdrawed from patient's body.This stays end-cap assembly 3410, fixation clamp 3430 and anchoring piece 700, as what seen by comparison Figure 144 and 145.Withdraw from after the ductus bursae assembly, can withdraw from center rod or seal wire (well afoot in Figure 145) withdraws from end-cap assembly 3410 and fixation clamp 3430 in patient's body by proximad.In Figure 145 as can be seen, the afterbody 3433 of fixation clamp 3430 can be removed, and by the position of reversing fixation clamp 3430 and the nearside tension force that is applied thereto subsequently, fixation clamp hook 760 from anchoring piece 700 under the influence of withdrawing from distal cap assembly 3230 discharges, and causes that 3433 slips of fixation clamp afterbody are connected with hook 760 disengagings.Anchoring piece 700 can be left in patient's body.

[00337] as mentioned above, center rod or seal wire 3230 can be connected to end cap 3411 and become one with it by any suitable manner.When center rod or seal wire 3230 and end cap 3411 became one, it became one with other element of the end-cap assembly of describing in this article 3410 substantially, therefore also becomes one with the collar 3431 that is connected of capsule fixation clamp 3430.Like this, center rod or seal wire 3230 are used in anastomosis operation and withdraw from capsule fixation clamp 3430 after finishing substantially.

[00338] above-mentioned embodiment only is an example describing the part apparatus, described apparatus can be used for once or repeatedly bladder is contacted with pelvic floor and keep this contact, and the opening in bladder and the urethra is aimed at, the driving anchoring piece enters pelvic floor through wall of urinary bladder and fixation clamp is connected in the bladder cavity, capsule is expanded, thereby pressure is applied to wall of urinary bladder to carry out the woollen yarn knitting of wall of urinary bladder and pelvic floor, and discharge urine in rehabilitation with in required time period of healing, after prostatectomy, between bladder and urethra, coincide.

[00339] it will be understood by those skilled in the art that said elements can have optional structure and the embodiment that is used to carry out same steps as.It will be understood by those skilled in the art that said elements is provided with alternatively and constructs, for use in carrying out above-mentioned steps along the direct motion direction, rather than above-mentioned retrograde direction.

[00340] it will be understood by those skilled in the art that, the apparatus that comprises localizer assembly 3440 and carry out its bladder positioning function can have various optional structures, include but not limited to that the embodiment of describing (thereby includes but not limited to localizer assembly 400 herein, feather sphere member 800 (Figure 17-21) with localizer lobe 830, above-mentioned umbrella shape assembly 900 (Figure 22-27) with inverted orientation device lobe 930, perhaps localizer 2017 (Figure 122-126), 2090 (Figure 110-118), 2122 (Figure 95,96,103-109) with 2168 (Figure 83,84,89-94) (all these will be described below)), the device that can laterally bounce back and extend is provided, referring to Fig. 2, be used for being inserted into advanced position and entering bladder opening 4 along the direction of driving in the wrong direction through urethra 5, in bladder cavity 8, extend or expansion, be captured in the bladder opening 4 and handle to actuate and contact with pelvic floor 7 around urethra opening 6 around the wall of urinary bladder 2 of bladder opening 4, and with separately opening aligning; Perhaps alternatively, be inserted in the advanced position along the direct motion direction through the otch of abdominal part and the upper surface of bladder 1, in bladder cavity 8, extend or expansion, be captured in the bladder opening 4 and operation contact with pelvic floor 7 around urethra opening 6 to actuate around the wall of urinary bladder 2 of bladder opening 4, and with separately opening aligning.Generally speaking, localizer assembly can comprise and use the optional extensible of any number and can bounce back projection, lobe, arm, pawl or other clamping or capture element, to catch and to obtain the control around the wall of urinary bladder 2 of bladder opening 4.Localizer assembly can have at least one element that operationally is connected with the stave of apparatus, and can alternately bounce back from its longitudinal axis horizontal expansion with towards its longitudinal axis in the input of the near-end of apparatus in response to the doctor.

[00341] alternatively, it will be appreciated by those skilled in the art that, open and make time spent (as described herein), localizer assembly or the localizer shown in can not having in some cases through what wall of urinary bladder entered pelvic floor when the anchoring piece actuator assembly is included in to play in the apparatus with the rear drive anchoring piece.For example, referring to Figure 135 and 136, be appreciated that, contact with wall of urinary bladder 2 also can puncture the time when in bladder cavity, opening and spur downwards it around bladder opening 4 up to the far-end of anchoring piece 700, anchoring piece actuator pin 3463 can fully be used to catch wall of urinary bladder 2 with anchoring piece 700 and it is promoted downwards to be connected with pelvic floor 7 contacts and with it, and make bladder opening 4 and urethra opening 6 aim at the localizer assembly 400 shown in not needing in some cases.Therefore, the anchoring piece actuator assembly 3460 with anchoring piece 700 can be used as localizer and the anchoring piece actuator assembly plays dual function.

[00342] " H " anchoring piece embodiment

[00343] Figure 83 is the perspective view that is in the another kind of embodiment of the coinciding machine of the present invention 2150 in its pre-deployment position, and Figure 84 is the profilograph of the far-end of described apparatus, is shown as equally to be in its pre-deployment position.Described apparatus can comprise anchoring piece actuator assembly 2151, described anchoring piece actuator assembly 2151 can comprise the outside actuator assembly pipe 2152 with far-end 2154, distad terminates in the anchoring piece actuator tube 2155 of anchoring piece actuator pin 2156 and distad terminates in inboard actuator assembly pipe 2158 in the anchoring piece track collar 2159.The embodiment of described apparatus also can comprise location organ pipe 2167, the localizer 2168, bar 2170 and the bowl cover 2171 that are connected with the far-end of location organ pipe 2167.Assembled and when prepare using when apparatus, anchoring piece actuator assembly 2151 can load one or more anchoring piece 700, and each anchoring piece all can comprise forward element 750, axle 720 and element 710 backward.

[00344] referring to Figure 84, also can in Figure 86, find out in more detail, location organ pipe 2167, distad terminate in inboard actuator assembly pipe 2158 in the anchoring piece track collar 2159 and outside actuator assembly pipe 2152 and can be assembled into and make them roughly coaxial.Anchoring piece track collar 2159 and inboard actuator assembly pipe 2158 can have in their outer surface one or more vertically towards anchoring piece track 2160, described anchoring piece track upwardly and outwardly radial finger to, and from distad lengthwise movement of nearside.Outside actuator assembly pipe 2152 has one or more anchoring piece storage groove 2153 on the surface within it, is oppositely arranged with anchoring piece track 2160.Assembled and when prepare using when apparatus, having the inboard actuator assembly pipe 2158 of anchoring piece track collar 2159 and outside actuator assembly pipe 2152 relative to each other becomes one by any suitable manner.

[00345] Figure 87 is the enlarged drawing of the front end of the anchoring piece that can use in the present embodiment.Anchoring piece 700 has the element forward 750 that can have sharp front end 751, and have is connected with element 710 backward (in Figure 87, showing) spools 720.Anchoring piece 700 can be manufactured, have shape memory and take " H " shape so that be biased into, and the level with element formation vertical leg and Connection Element formation " H " backward is connected forward, and can be by having suitable intensity, elasticity, shape memory, making with bodily tissue and fluidic material non-reacted and the biocompatibility characteristic.Anchoring piece 700 also can be made by one or more dissolved bioabsorbable materials.As an alternative, anchoring piece 700 can be manufactured into multiple suitable shape, and shown in Figure 40-51, one of embodiment of the apparatus of Miao Shuing is applicable to described anchoring piece substantially herein, and is as described below.

[00346] Figure 84 and 86 shows and prepares unfolded anchoring piece 700 in the apparatus that is loaded into present embodiment.By accompanying drawing as can be seen, when loading, anchoring piece 700 is retained in the space that is limited by anchoring piece track 2160 and anchoring piece storage groove 2153.As understandable by accompanying drawing, the spatial constraints anchoring piece 700 that when anchoring piece is loaded onto in the apparatus, limits by anchoring piece track 2160 and anchoring piece storage groove 2153, they are kept, the lodge element 750 of lodge forward and puncture limiting element 710 are located along Connection Element 720 1 side vertical equities.

[00347] as in Figure 84 and 86, being seen, when apparatus is prepared to use, anchoring piece actuator pin 2156 also rests in the anchoring piece track 2160, and their far-end is stayed lodge element 750 back (will be described later) that are in the lodge forward in the position of preparing driving anchoring piece 700.Anchoring piece actuator pin 2156 becomes one with the far-end of anchoring piece actuator tube 2155 (showing in Figure 83).Anchoring piece actuator tube 2155 can be with respect to outside actuator assembly pipe 2152 and inboard actuator assembly pipe 2158 lengthwise movements.Anchoring piece actuator pin 2156 is made by suitable flexibility, shape-memory material, Nitinol for example, and biased so that in their position itself, be straight substantially.

[00348] in Figure 87 as can be seen, the end of anchoring piece actuator pin 2156 can have groove 2157 or any other suitable feature, is used to hold and keeps element 750 forward in the anchoring piece actuation step process that will be described below.

[00349] described apparatus can comprise one or more anchoring piece, and above-mentioned related track, groove and anchoring piece actuator pin, they are laid around the apparatus that is in the position, when the apparatus direction of rotation is correct, make anchoring piece can along preferential direction upwardly and outwardly radial drive to the tissue in, avoid nerve and/or blood circulation bundle or other sensitizing range.

[00350] refer again to Figure 84, the apparatus of present embodiment also comprises location organ pipe 2167.What be connected location organ pipe 2167 far-ends is localizer 2168, shows that in Figure 83 and 84 it is in its pre-deployment shape.The pre-deployment shape of the localizer 2168 that shows in Figure 83 and 84 makes things convenient for apparatus to be inserted among the patient.Localizer 2168 can be made by suitable elasticity and flexible polymeric material with shape memory, and it is manufactured so that be biased into when bar 2170 retraction and take normal transversal orientation shape, for example such as the shape that shows in Figure 89.As shown in Figure 89, localizer 2168 can have one or more porus excretorius 2169 around its periphery, can allow urine, fluid or condensed material to be discharged in the organ pipe 2167 of location after apparatus is unfolded.Localizer 2168 alternately moves to its pre-deployment position that shows in Figure 83 and 84, perhaps allow by the lengthwise movement of bar 2170 and the lengthwise movement of corresponding end cap 2171, be returned to normal (expansion) position that shows among Figure 89 through shape memory, described end cap is connected with bar 2170 one.Location organ pipe 2167 is with respect to inboard actuator assembly pipe 2158 lengthwise movements, and vice versa.

[00351] outside actuator assembly pipe 2152, anchoring piece actuator tube 2155, inboard actuator assembly pipe 2158, location organ pipe 2167 and bar 2170 can be made by one or more materials, described material has the combined characteristic of suitable shape memory, flexibility, intensity and hardness, the combination of these characteristics all makes pipe and bar in being inserted into patient body and pass through during the urethra all deflections (will be described below), but in use also can prevent their shrinkages, kink, bonding or break.Selected materials can also be roughly non-reactedly with body fluid or tissue, and is roughly biocompatibility.The inventor is definite well known in the art to be applicable to that the Nitinol of various surgical devices and pipe is an example of suitable material.

[00352] is to be understood that, when needs make bar 2170 coaxial settings, hollow pipe can be used as location organ pipe 2167 in apparatus, perhaps when location organ pipe 2167 was used as conduit, example still ought not need catheter functions or coaxial setting as will be described further below, thereby when not needing to manage, bar can replace locating organ pipe 2167 and be used to the mechanical function that provides roughly the same, and promptly conveying capacity to be activating localizer, thereby can use bar.Therefore, for the purpose of illustrated claims, unless specialize in the claims, be operably connected or link or contact the place of localizer at described element, term " pipe " means and comprises and relate to bar, and vice versa.

[00353] will describe the prostate excision postoperative now and be used for the method for using above-mentioned apparatus to coincide in the mode of driving in the wrong direction.The prostate excision postoperative, patient's bladder 1 and urethra opening 6 are separated by the space that is occupied by prostate in the past, as shown in Figure 2.Bladder 1 need be connected with urethra 5, and bladder opening 4 and urethra opening 6 are aimed at, so that after rehabilitation and healing, recover urinary function.

[00354] shown in Figure 88, coinciding machine is upwards inserted and enter in the bladder 1 through patient's urethra 5, process bladder opening 4.Doctor's bar 2170 that bounces back then, end cap 2171 correspondingly bounces back.Allow localizer 2168 to take its normal transversal orientation shape, shown in Figure 89 through shape memory.The present transversal orientation of localizer 2168 prevent its retraction and not along with its pulling around the wall of urinary bladder 2 of bladder opening 4.

[00355] then, the doctor through the urethra whole apparatus that bounces back, causes that localizer 2168 pullings contact with pelvic floor 7 around the wall of urinary bladder 2 of bladder opening 4, and bladder opening 4 is aimed at urethra opening 6 downwards, arrives the position as shown in Figure 90.

[00356] then with reference to Figure 91, upwards also distad lengthwise movement of anchoring piece actuator tube 2155, cause that correspondingly anchoring piece actuator pin 2156 makes progress and distal motion arrives in the anchoring piece track 2160, then upwards also radially outward, upwards also radially outward drive the lodge element 750 of the lodge forward of anchoring piece 700, at first enter and pass through around the tissue of the pelvic floor 7 of urethra opening 6, enter then and pass through around the tissue of the wall of urinary bladder 2 of bladder opening 4, and enter bladder, shown in Figure 91.As can be seen, when the lodge element 750 of lodge was driven in the tissue forward, the lodge element 750 of the lodge forward of Connection Element 720 traction back entered the position in the tissue in Figure 91.Anchoring piece actuator tube 2155 and corresponding anchoring piece actuator pin 2156 retract in the apparatus then, discharge the lodge element 750 of anchoring piece 700.When the lodge element 750 of anchoring piece 700 is released by anchoring piece actuator pin 2156 retractions, they no longer are limited in their normal biased position, lodge element 750 moves to substantially perpendicular to the position of the axle of Connection Element 720 under bias voltage and contacts wall of urinary bladder, as shown in Figure 92, make lodge element 750 prevent anchoring piece 700, thereby be used for the anchoring piece lodge at tissue through the hole that forms in tissue by lodge element 750 in the actuation step processes and retraction backward.Similarly, when the limiting element 710 that will puncture is pulled out apparatus, they no longer are limited in their normal biased position, puncture limiting element 710 moves to substantially perpendicular to the position of the axle of Connection Element 720 under bias voltage and contacts wall of urinary bladder, as shown in Figure 92, make puncture limiting element 710 can not be pulled the hole that forms in tissue by lodge element 750 through in the actuation step process, further anchoring piece 700 is punctured to tissue thereby be used for restriction.When the installation of anchoring piece 700, as can be seen, anchoring piece 700 keeps contacting with the tissue of the pelvic floor 7 that centers on urethra opening 6 around the tissue of the wall of urinary bladder 2 of bladder opening 4, and bladder opening 4 is aimed at urethra opening 6 from Figure 92.Thereby the tissue that keeps wall of urinary bladder 2 and pelvic floor 7 contacts and aligned bladder opening and urethra opening woollen yarn knitting and healing can be in the same place.

[00357] then, whole anchoring piece actuator assembly, comprise inboard actuator assembly pipe 2158 and anchoring piece track collar 2159, anchoring piece actuator tube 2155 and outside actuator assembly pipe 2152, can be used as a unit (in Figure 92, carrying out) and from urethra, bounce back downwards and leave patient's body, will locate organ pipe 2167, localizer 2168 and bar 2170 and stay.Remaining localizer 2168 and location organ pipe 2167 can be used for auxiliary downward pressure is applied on the wall of urinary bladder 2 of bladder opening 4 now, so that strengthen around the tissue of the wall of urinary bladder 2 of bladder opening 4 with around contact and woollen yarn knitting between the tissue of the pelvic floor 7 of urethra opening 6.In addition, perhaps as an alternative, localizer 2168 comprises porus excretorius 2169, and location organ pipe 2167 can be used for sealing joint between bladder and the urethra now, and discharges urine and other fluid between rehabilitation and healing stage.Be used for this purpose, location organ pipe 2167 will be connected to the urine collecting bag (not shown) through middle pipe fitting.After rehabilitation and the healing, bar 2170 and corresponding end cap 2171 are with respect to upwards also distad lengthwise movement of location organ pipe 2167, thereby actuate localizer 2168 and enter its pre-deployment position, shown in Figure 83 and 84, and make these remainder of apparatus break away from bladder through retraction downwards, and leave patient's body.

[00358] Figure 93 and 94 shows optional embodiment and the optional anchoring piece loading position that is used for apparatus of the present invention.As can be seen from the figure, in this embodiment, anchoring piece actuator pin 2156 comprises rear drive device step 2172, when the distally of anchoring piece actuator pin drove the lodge element 750 of lodge forward of anchoring piece 700, rear drive device step played the effect of the puncture limiting element 710 that drives anchoring piece 700.The geometry of outside actuator assembly pipe 2152, anchoring piece storage groove 2153 and/or anchoring piece track 2160 is suitable for correspondingly revising.Use this optional embodiment, the tension force in the actuation step process axle 720 can be avoided, and anchoring piece can be easy to from the driving and the emission of apparatus.In addition, shown in Figure 94, in this optional embodiment, anchoring piece 700 can be loaded onto in the directed in opposite direction puncture limiting element 710 of lodge element 750 neutralizations of lodge forward, as shown in the figure, can be used for strengthening the anchoring piece actuator assembly and activate after backward element 710 in urethra the location and drive anchoring piece.

[00359] it will be understood to those of skill in the art that, when above-mentioned steps needs, can be in the near-end structure or the suitable various simple mechanical device of apparatus, operate and control outside actuator assembly pipe 2152 and inboard actuator assembly pipe 2158, anchoring piece actuator tube 2155, location organ pipe 2167 and bar 2170, so that motion and maintenance apparatus include but not limited to now with the Handleset of describing in each pre-deployment and/or retraction and the expansion and first and second actuated positions.

[00360] Figure 83 and 85 right-hand side show the example of simple proximal handle assembly 2200, and it is designed and is configured to that the doctor can be controlled and the various embodiments of control instrument.Handleset 2204 comprises bar 2201, described bar 2201 have connection actuator 2202, the 4th pipe 2203, have the stop collar 2204 of one tee pipe 2204, have second pipe 2207 of the stop collar 2209 of one and first pipe 2210.The pipe 2210,2207,2204 and 2203 and bar 2201 can be roughly coaxial.Bar 2201 can be with respect to 2203 longitudinal sliding motions of the 4th pipe.The 4th pipe 2203 can be with respect to tee pipe 2204 and 2205 longitudinal sliding motions of stop collar, and vice versa.First pipe 2210 can be connected with tee pipe 2204 through connecting pin 2211, thereby first pipe 2210 and tee pipe 2204 are become one.2207 are positioned between first pipe 2210 and the tee pipe 2204 vertically, and longitudinal sliding motion therein is to the restriction that is limited around pin 2211 by the cannelure 2208 in second pipe 2207.

[00361] therefore, be appreciated that by Figure 84 and 85, bar 2201 and 2170, the 4th pipe 2203 and location organ pipe 2167, tee pipe 2204 and inboard actuator assembly pipe 2158, second pipe 2207 and the anchoring piece actuator tube 2155 by connection or one, and first pipe 2210 and outside actuator assembly pipe 2152, Handleset 2200 can be connected and is used for handling and operation coinciding machine 2150 by the doctor.When such structure, grip pipe actuator collar 2209 by the doctor, second pipe 2207 can be with respect to the remainder longitudinal sliding motion of assembly, thereby advances or bounce back anchoring piece actuator tube 2155 and corresponding anchoring piece actuator pin 2156, thereby activates anchoring piece actuator assembly 2151.After anchoring piece is installed, grip and spur first pipe 2210 by the doctor, whole anchoring piece actuator assembly 2151 can bounce back from patient body, thereby also make tee pipe 2204 and second pipe, 2207 retractions through connecting pin 2211, correspondingly, make outside actuator assembly pipe 2152, inboard actuator assembly pipe 2158 and anchoring piece actuator tube 2155 retractions.This can be implemented simultaneously the 4th pipe 2203 and bar 2201 are stayed, thereby will locate organ pipe 2167 and bar 2170 stays, as mentioned above.

[00362] technical staff of mechanical surgical device design field will be understood that, localizer does not need to be restricted to the illustrative embodiments of being made by above-mentioned flexibility and elastomeric polymer shape-memory material, the alternate design that is used for described localizer also is possible, it causes that localizer selectively takes advanced position and expanded position, in response to the power that is applied or transmitted by pipe or other element, described expanded position is suitable for being captured in the bladder opening and actuates bladder and contacts with pelvic floor.Localizer can comprise, for example shown in Figure 14,19,24 and 57 and above-described any localizer assembly.Similarly, the technical staff of machinery surgical device design field will be understood that, the anchoring piece actuator assembly does not need to be restricted to exemplary tee pipe assembly described herein, the alternate design that is used for such assembly also is possible, when concentrating in together in response to the power that is applied or transmitted by pipe or other element, it is installed to one or more anchoring pieces in the bladder and urethral tissue that centers on opening separately effectively.

[00363] as previously mentioned, the combination of pipe, localizer and actuator assembly can be built in the apparatus that is applicable to the anastomosis operation that drives in the wrong direction, and as mentioned above, perhaps is built in the apparatus that is applicable to the direct motion operation.In the direct motion operation, as upwards inserting and insert through urethra near substituting in the bladder opening at prostate excision position, apparatus can insert downwards through the little otch of patient's abdominal part, be inserted in the bladder through the little otch on the upper surface of patient's bladder, be inserted in the urethra opening through the bladder opening.The little otch of abdominal part and bladder upper surface can use sleeve pipe and trocar assembly to form and stay open, and is used to pass and wherein inserts apparatus.

[00364] connects the anchoring piece embodiment

[00365] Figure 95 is the perspective view that is in the another kind of embodiment of the coinciding machine of the present invention 2100 in its pre-deployment position, and Figure 96 is the profilograph of the far-end of described apparatus, is shown as equally to be in its pre-deployment position.Described apparatus can comprise anchoring piece actuator assembly 2101, described anchoring piece actuator assembly 2101 can comprise the outside actuator assembly pipe 2102 with far-end 2104, the second anchoring piece track collar 2105 distad terminates in the anchoring piece actuator tube 2109 of anchoring piece actuator pin 2108 and distad terminates in inboard actuator assembly pipe 2110 in the first anchoring piece track collar 2112.Present embodiment also can comprise location organ pipe 2121, the localizer 2122, bar 2124 and the bowl cover 2125 that are connected with the far-end of location organ pipe 2121.Assembled and when prepare using when apparatus, it is right that anchoring piece actuator assembly 2101 can load one or more anchoring piece, and every pair of anchoring piece all can comprise first anchoring piece 700 and second anchoring piece 701 of the connection length with stitching thread 2117.

[00366] referring to Figure 96, also can find out in more detail at Figure 89 7 and 98, location organ pipe 2121, distad terminate in inboard actuator assembly pipe 2110 in the first anchoring piece track collar 2112 and outside actuator assembly pipe 2102 and can be assembled into and make them roughly coaxial, and the first anchoring piece track 2111, the second anchoring piece track 2106 and anchoring piece actuator pin 2108 are vertically aimed at.The first anchoring piece track collar 2112 can have on its outer surface one or more comprise stitching thread spacing track 2113 vertically towards the first anchoring piece track 2111, it is radial directed upwardly and outwardly, from distad lengthwise movement of nearside.The second anchoring piece track collar 2105 can have on its outer surface one or more vertically towards the second anchoring piece track 2106, it is radial directed upwardly and outwardly also, from distad lengthwise movement of nearside.The second anchoring piece track 2106 also has stitching thread spacing track 2107 on the surface within it, it is arranged on and the relative position of stitching thread spacing track 2113 in the first anchoring piece track collar 2112, has one or more stitching thread storage groove 2103 on its outer surface.The far-end 2104 of outside actuator assembly pipe 2102 can have on its outer surface one or more vertically towards stitching thread storage groove 2103, they are stored groove 2103 with the stitching thread on the second anchoring piece track collar 2105 and aim at, thereby from its extension.Assembled and when prepare using when apparatus, having the inboard actuator assembly pipe 2110 of the first anchoring piece track collar 2112 and the second anchoring piece track collar 2105 and outside actuator assembly pipe 2102 relative to each other becomes one by any suitable manner.

[00367] Figure 99-the 101st, the enlarged drawing of the front end of the anchoring piece that can use in the present embodiment.First anchoring piece 700 can have agnail 730 and suture hole 735.Suture hole 735 can be used for the sutural length of traction or other suitable Connection Element are connected with first anchoring piece of preparing to use 700.Second anchoring piece 701 has agnail 731 and stitching thread notch 752.The shape of stitching thread notch 752 and size are set to catch effectively and can bonding maintenance stitching thread or the free end (will be described later) of other suitable Connection Element.Anchoring piece 700 and anchoring piece 701 can be manufactured into can be biased, so that take among Figure 99-101 shape that shows, and can make by material with following appropriate characteristics: length, flexibility, shape memory, with bodily tissue and fluidic non-reacted and biocompatibility.Anchoring piece 700 and 701 also can be made by soluble bioabsorbable material, perhaps can be made by the Nitinol or the surgery rustless steel of suitable processing.

[00368] Figure 96-98 shows and prepares unfolded anchoring piece first anchoring piece 700 and second anchoring piece 701 in the apparatus that is loaded into present embodiment.By accompanying drawing as can be seen, when loading, first anchoring piece 700 is retained in the space that the inner surface by the first anchoring piece track 2111 and the second anchoring piece track collar 2105 limits.Similarly, second anchoring piece 701 is retained in the space that the inner surface by the second anchoring piece track 2106 and external drive organ pipe 2102 limits.As understandable by accompanying drawing, spatial constraints anchoring piece 700 that when anchoring piece is loaded onto in the apparatus, limits and 701 agnail 730 and 731 by anchoring piece track 2111 and 2106.Stitching thread 2117 or other suitable Connection Element can be connected to the rear portion of first anchoring piece 700 and upwards pass through stitching thread spacing track 2107 from the rear portion of first anchoring piece 700 through suture hole 735 (showing in Figure 99), outward radial also is positioned on the second track collar 2105, enter downwards in the stitching thread storage groove 2103, end at free end.

[00369] as what seen in Figure 84 and 86, when apparatus was prepared to use, anchoring piece actuator pin 2108 rested in the anchoring piece track 2111, and their far-end prepares to be used to drive anchoring piece 700 (will be described later) after being positioned at anchoring piece 700.Anchoring piece actuator pin 2108 becomes one with the far-end of anchoring piece actuator tube 2109 (showing in Figure 95).Anchoring piece actuator tube 2109 can be with respect to outside actuator assembly pipe 2102 and inboard actuator assembly pipe 2110 lengthwise movements.Anchoring piece actuator pin 2108 is made by suitable flexibility, shape-memory material, Nitinol for example, and biased so that make their far-end outward radial elasticity location, prepare to drive second anchoring piece 701 (will be described below).

[00370] described apparatus can comprise a pair of or many to anchoring piece, every pair comprises first anchoring piece and second anchoring piece, and above-mentioned related track, groove and anchoring piece actuator pin, they are laid around the apparatus that is in the position, when the apparatus direction of rotation is correct, make anchoring piece can along preferential direction upwardly and outwardly radial drive to the tissue in, avoid nerve and/or blood circulation bundle or other sensitizing range.

[00371] refer again to Figure 96, the apparatus of present embodiment also comprises location organ pipe 2121.What be connected location organ pipe 2121 far-ends is localizer 2122, shows that in Figure 95 and 96 it is in its pre-deployment shape.The pre-deployment shape of the localizer 2122 that shows in Figure 95 and 96 makes things convenient for apparatus to be inserted among the patient.Localizer 2122 can be made by suitable elasticity and flexible polymeric material with shape memory, and it is manufactured so that be biased into when bar 2124 retraction and take normal transversal orientation shape, for example such as the shape that shows in Figure 103.As shown in Figure 103, localizer 2111 can have one or more porus excretorius 2123 around its periphery, can allow urine, fluid or coagulation material to be discharged in the organ pipe 2121 of location after apparatus is unfolded.Localizer 2122 alternately moves to its pre-deployment position that shows in Figure 95 and 96, perhaps allow by the lengthwise movement of bar 2124 and the lengthwise movement of corresponding end cap 2125, be returned to normal (expansion) position that shows among Figure 103 through shape memory, described end cap is connected with bar 2170 one.Location organ pipe 2121 is with respect to inboard actuator assembly pipe 2110 lengthwise movements, and vice versa.

[00372] outside actuator assembly pipe 2102, anchoring piece actuator tube 2109, inboard actuator assembly pipe 2110, location organ pipe 2121 and bar 2124 can be made by one or more materials, described material has the combined characteristic of suitable shape memory, flexibility, intensity and hardness, the combination of these characteristics all makes pipe and bar in being inserted into patient body and pass through during the urethra all deflections (will be described below), but in use also can prevent their shrinkages, kink, bonding or break.Selected materials can also be roughly non-reactedly with body fluid or tissue, and is roughly biocompatibility, perhaps has a non-biocompatible material of the coated thing of biocompatibility.The inventor is definite well known in the art to be applicable to that the Nitinol of various surgical devices and pipe is an example of suitable material.

[00373] is to be understood that, when needs make bar 2124 coaxial settings, hollow pipe can be used as location organ pipe 2121 in apparatus, perhaps when location organ pipe 2121 was used as conduit, example still ought not need catheter functions or coaxial setting as will be described further below, thereby when not needing to manage, bar can replace locating organ pipe 2121 and be used to the mechanical function that provides roughly the same, and promptly conveying capacity to be activating localizer, thereby can use bar.Therefore, for the purpose of illustrated claims, unless specialize in the claims, be operably connected or link or contact the place of localizer at described element, term " pipe " means and comprises and relate to bar, and vice versa.

[00374] will describe the prostate excision postoperative now uses above-mentioned apparatus to carry out patient's the bladder and the method for urethra anastomosis.The prostate excision postoperative, patient's bladder 1 and urethra opening 6 are separated by the aforementioned interspace that is occupied by prostate, as shown in Figure 2.Bladder 1 need be connected with urethra 5, and bladder opening 4 and urethra opening 6 are aimed at, so that after rehabilitation and healing, recover urinary function.

[00375] shown in Figure 102, coinciding machine is upwards inserted and enter in the bladder 1 through patient's urethra 5, process bladder opening 4.Doctor's bar 2124 that bounces back then, the end cap 2125 that correspondingly bounces back allows localizer 2122 to take its normal shape through shape memory, shown in Figure 103.The present transversal orientation of localizer 2122 prevent its retraction and not along with its pulling around the wall of urinary bladder 2 of bladder opening 4.

[00376] then, the doctor through the urethra whole apparatus that bounces back, causes that localizer 2122 pullings contact with pelvic floor 7 around the wall of urinary bladder 2 of bladder opening 4, and bladder opening 4 is aimed at urethra opening 6 downwards, arrives the position as shown in Figure 104.

[00377] then with reference to Figure 105, distad lengthwise movement of anchoring piece actuator tube 2109, correspondingly cause anchoring piece actuator pin 2108 upwards and distal motion in the first anchoring piece track 2111, drive first anchoring piece 700 and radially outward enter wall of urinary bladder 2 tissue on every side, shown in Figure 105.When anchoring piece 700 is driven when retreating, they no longer are limited in their normal bias voltage shape, thereby the anchoring piece 700 of agnail 730 shown in can flexibly leaving, make anchoring piece 700 by lodge in tissue.After anchoring piece 700 has been driven in the wall of urinary bladder tissue, the stitching thread 2117 that connects pulls out the rear end of anchoring piece 700 and organizes the back, and the free end that makes them continues to be retained in the stitching thread storage groove 2103 outlet of passing the second anchoring piece track 2106.

[00378] then, referring to Figure 106, but anchoring piece actuator tube 2109 and corresponding anchoring piece actuator pin 2108 proximads vertically bounce back.When the far-end retraction of anchoring piece actuator pin 2108 passes the near-end of the second anchoring piece track collar 2105, the shape memory bias voltage of anchoring piece actuator pin 2108 will cause that their far-end outward radial moves in the position of second anchoring piece, 701 back, enter the position that shows among Figure 106, prepare to drive anchoring piece 701 upwardly and outwardly through the second anchoring piece track 2106.

[00379] then, referring to Figure 107, anchoring piece actuator tube 2109 and corresponding anchoring piece actuator pin 2108 can distad vertically be promoted once more, the far-end distal motion that will cause anchoring piece actuator pin 2108 simultaneously to and through the second anchoring piece track 2106, and outward radial drives second anchoring piece 701 and enters tissue around the pelvic floor 7, shown in Figure 107.When the front end of second anchoring piece 701 is driven when retreating, stitching thread notch 752 (seeing Figure 100) passes contact the drawing length of the stitching thread 2117 of the second anchoring piece track 2106 (seeing Figure 106), when being driven in the tissue, second anchoring piece 701 catches and these drawing lengths of bonding maintenance, as shown in Figure 107.Therefore, for the anchoring piece of the every pair of installation that comprises first and second anchoring pieces 700 and 701, stitching thread 2117 (perhaps other suitable Connection Element) can be anchored at the tissue of wall of urinary bladder 2 and organizing in the position contacting of the pelvic floor 7 that centers on urethra opening 6 that keeps around bladder opening 4, and bladder opening 4 and urethra opening 6 are aimed at.Thereby the tissue of wall of urinary bladder 2 that keeps in touch and pelvic floor 7 can be knitted and heal together and bladder opening and urethra opening aligning.

[00380] then, whole anchoring piece actuator assembly, comprise the inboard actuator assembly pipe 2110 and the first anchoring piece track collar 2112, anchoring piece actuator tube 2109, the second anchoring piece track collar 2105 and outside actuator assembly pipe 2152, can be used as a unit (in Figure 108, carrying out) and from urethra, bounce back downwards and leave patient's body, will locate organ pipe 2121, localizer 2122 and bar 2124 and stay.Remaining localizer 2122 and location organ pipe 2121 can be used for auxiliary downward pressure is applied on the wall of urinary bladder 2 of bladder opening 4 now, so that strengthen around the tissue of the wall of urinary bladder 2 of bladder opening 4 with around contact and woollen yarn knitting between the tissue of the pelvic floor 7 of urethra opening 6.In addition, perhaps as an alternative, localizer 2122 comprises porus excretorius 2123, and location organ pipe 2121 can be used for sealing joint between bladder and the urethra now, and discharges urine and other fluid between rehabilitation and healing stage.Be used for this purpose, location organ pipe 2121 will be connected to the urine collecting bag (not shown) through middle pipe fitting.After rehabilitation and the healing, bar 2124 and corresponding end cap 2125 are with respect to upwards also distad lengthwise movement of location organ pipe 2121, thereby actuate localizer 2122 and enter its pre-deployment position, shown in Figure 109, and make these remainder of apparatus break away from bladder through retraction downwards, and leave patient's body.

[00381] technical staff of mechanical surgical device design field will be understood that, when above-mentioned steps needs, can be in the near-end structure or the suitable various simple mechanical device of apparatus, operate and control outside actuator assembly pipe 2102 and inboard actuator assembly pipe 2110, anchoring piece actuator tube 2109, location organ pipe 2121 and bar 2124, so that motion and maintenance apparatus comprise in Figure 83 and 85 showing and above-mentioned Handleset or their distortion in each pre-deployment and/or retraction and the expansion and first and second actuated positions.

[00382] technical staff of mechanical surgical device design field will be understood that, localizer does not need to be restricted to the illustrative embodiments of being made by flexibility described herein and elastomeric polymer shape-memory material, the alternate design that is used for described localizer also is possible, it causes that localizer selectively takes advanced position and expanded position, in response to the power that is applied or transmitted by pipe or other element, described expanded position is suitable for being captured in the bladder opening and actuates bladder and contacts with pelvic floor.Localizer can comprise, for example shown in Figure 14,19,24 and 57 and above-described any localizer assembly.Similarly, the technical staff of machinery surgical device design field will be understood that, the anchoring piece actuator assembly does not need to be restricted to tee pipe assembly described herein, the alternate design that is used for such assembly also is possible, when concentrating in together in response to the power that is applied or transmitted by pipe or other element, it is installed to one or more anchoring pieces in the bladder and urethral tissue that centers on opening separately effectively.

[00383] as previously mentioned, the combination of pipe, localizer and actuator assembly can be built in the apparatus that is applicable to the anastomosis operation that drives in the wrong direction, and as mentioned above, perhaps is built in the apparatus that is applicable to the direct motion operation.In the direct motion operation, as upwards inserting and insert through urethra near substituting in the bladder opening at prostate excision position, apparatus can insert downwards through the little otch of patient's abdominal part, be inserted in the bladder through the little otch on the upper surface of patient's bladder, be inserted in the urethra opening through the bladder opening.The little otch of abdominal part and bladder upper surface can use sleeve pipe and trocar assembly to form and stay open, and is used to pass and wherein inserts apparatus.

[00384] deformable securing member embodiment

[00385] Figure 110 is the perspective view that is in the another kind of embodiment of the coinciding machine of the present invention 2050 in its pre-deployment position, Figure 111 is the profilograph of the far-end of described apparatus, be shown as equally and be in its pre-deployment position, and the profilograph after being inserted into patient's urethra and inserting in the bladder 1 through urethra.Described apparatus can comprise fastener driver assembly 2152, and described fastener driver assembly 2152 comprises the outer tube 2051 and second pipe 2060.Outer tube 2051 can end at flexibility and refer to 2053, and then ends at nearside securing member anvil block 2054.Second pipe 2060 can be also coaxial with it substantially near the inboard of outer tube 2051.Second pipe 2060 can end at flexibility and refer to 2061, and then ends at distally securing member anvil block 2062, and described distally securing member anvil block can vertically be aimed at nearside securing member anvil block 2054 and can be vertically relative with it.

When [00386] it used when the 2052 assembled preparations of fastener driver assembly, the securing member group 2070 that will be in its pre-deployment shape (showing with enlarged perspective) in Figure 119 placed above second pipe 2060 and in flexibility and refers to move on 2061 the wherein position of the close top of the top pin anvil block 2062 of the securing member 2072 of securing member group 2070.Then, outer tube 2051 can be above second pipe 2060 and is upwards slided, in lower anvil 2054 is in position near the bottom pin of the securing member 2072 of securing member group 2070, thereby securing member group 2070 is being prepared launch through the actuating of fastener driver assembly in the position on the fastener driver assembly of (as shown in Figure 110) (will be described below).

[00387] therefore, as can be seen, fastener driver assembly 2052 can comprise that having flexibility refers to 2053 and the outer tube 2051 of lower anvil 2054 in Figure 110 and 111, has flexibility and refers to 2061 and second pipe 2060 of top anvil block 2062.When fastener assembly 2052 assemblings and preparation use, it can comprise the securing member group 2070 that is in the pre-deployment shape, is provided with as shown in the figure.

[00388] Figure 119 shows the exemplary fasteners group that is in the pre-deployment position.One or more stand-alone fastener 2072 can have the upper and lower pin of the end that band slightly outwards changes, and can link together through spiral type connector 2071.Figure 120 has shown the securing member group 2070 when it can show following the installation.In it installed shape, the circumference of securing member group 2070 and diameter were expanded through the distortion of spiral type connector 2071, and securing member 2072 has been pushed and is out of shape so that be hooked in the tissue.But securing member group 2070 can be made by the material of suitable permanent deformation substantially, described material is in body fluid and organize and do not react, and is roughly biocompatibility.The inventor determines that suitably the surgery stainless steel material of handling is an example of suitable material.As an alternative, the securing member group is a Bioabsorbable if desired, then can select suitably distortion biocompatibility substantially and bioabsorbable material.The inventor determined, (polydioxanone polymer for example perhaps contains the polymer of lactide, Acetic acid, hydroxy-, bimol. cyclic ester, lactide glycolide copolymer, for example from Johnson﹠amp to flexible absorbable polymer; The commodity that Johnson and/or Ethicon Inc. sell are the polymer of " Vicryl " and " PSDII "), the securing member group can be absorbed in the patient body after identical finishing.If selected materials is may not fully keep the material of its position after being out of shape during installation, can revise the design of securing member group so that on pin, have agnail or lodge element that other is suitable, perhaps comprise and cause that when mounted pin cooperates or crosslinked part, forms closed hoop substantially.

[00389] get back to Figure 110 and 111, the apparatus of present embodiment also can comprise tee pipe 2080, and it can end at expander collar 2081.Be connected expander collar 2081 far-end be localizer 2090, in Figure 110 and 111, show to be in the pre-deployment shape.

[00390] shows that in Figure 110 and 111 localizer 2090 that is in the pre-deployment shape can promote apparatus to be inserted in patient's body.Localizer 2090 can be made by suitable elasticity and flexible polymeric material, and described material has shape memory, when actuator rod 2092 retractions, so that manufacture the biased normal transversal orientation shape of taking as shown in Figure 112.As shown in Figure 112, localizer 2090 can be laid around one or more porus excretorius 2091, and after apparatus was unfolded, described porus excretorius allowed urine, fluid or agglutinator are discharged in the tee pipe 2080.As an alternative, localizer 2090 is moveable to the pre-deployment position that shows in Figure 110 and 111, perhaps allow to be returned to the normal position that shows among Figure 112 by the lengthwise movement of bar 2092 and corresponding end cap 2093 through shape memory, described end cap can link into an integrated entity with bar 2092.

[00391] as shown in Figure 121, end cap 2093 can have one or more groove 2094 therebetween, it can be used for allowing urine or other fluid to discharge bladder, through the porus excretorius 2091 in the localizer 2090, pass end cap 2093 and also enter downwards in the tee pipe 2080, it is external that they can be discharged from the patient by these parts.

[00392] outer tube 2051, second pipe 2060, tee pipe 2080 bars 2092 can be made by one or more materials, described material has the combined characteristic of suitable shape memory, flexibility, intensity and hardness, the combination of these characteristics all makes pipe and bar in being inserted into patient body and pass through during the urethra all deflections (will be described below), but in use also can prevent their shrinkages, kink, bonding or break.Selected materials can also be non-reacted with body fluid or tissues in general, and be roughly biocompatibility, perhaps has the non-biocompatible material of the coated thing of biocompatibility.The inventor is definite well known in the art to be applicable to that the Nitinol of various surgical devices and pipe is an example of suitable material.

[00393] is to be understood that, when needs make bar 2090 coaxial settings, hollow pipe can be used as tee pipe 2080 in apparatus, perhaps work as tee pipe 2080 as conduit (example as will be described further below), but do not need catheter functions or coaxial setting, thereby when not needing to manage, bar can replace tee pipe 2080 and be used to the mechanical function that provides roughly the same, be conveying capacity activating localizer, thereby can use bar.On the contrary, pipe can be used for the purpose of bar 2092.Therefore, for the purpose of illustrated claims, unless specialize in the claims, be operably connected or link or contact the place of localizer at described element, term " pipe " means and comprises and relate to bar, and vice versa.

[00394] referring to Figure 110, that apparatus 2050 also can comprise is movable, can remove or releasable collar or sleeve (not shown), interval between its parcel fastener driver assembly 2052 and/or expander collar 2081 and the fastener driver assembly 2052, so that for apparatus provides more slick vertical section profile, be convenient to insert apparatus and/or from patient's apparatus that bounces back.

[00395] will describe the prostate excision postoperative now uses above-mentioned coinciding machine to carry out patient's the bladder and the method for urethra anastomosis.The prostate excision postoperative, patient's bladder 1 and urethra opening 6 are separated by the space that is occupied by prostate before, as shown in Figure 2.Bladder 1 need be connected with urethra 5, and bladder opening 4 and urethra opening 6 are aimed at, so that after rehabilitation and healing, recover urinary function.

[00396] shown in Figure 111, coinciding machine is upwards inserted and enter in the bladder 1 through patient's urethra 5, process bladder opening 4.Doctor's bar 2092 that bounces back then, the end cap 2093 that correspondingly bounces back allows localizer 2090 to take its normal shape through shape memory, shown in Figure 112.Localizer 2090 present transversal orientations prevent its retraction and not along with its pulling around the wall of urinary bladder 2 of bladder opening 4.

[00397] then, the tee pipe 2080 but doctor's proximad bounces back, the expander collar 2081 that correspondingly bounces back, expander collar 2081 is drawn in the distally securing member anvil block 2062 and between in the position that shows of Figure 113.In distally securing member anvil block 2062 and between pulling expander collar 2081 will actuate distally securing member anvil block 2062, correspondingly radially outwards actuate flexibility and referred to for 2061 (in Figure 110, showing), as shown in Figure 113.Flexibility refers to that 2061 this motion radially outwards forces the securing member group 2070 that is retained in that flexibility below the securing member anvil block 2062 of distally refers on 2061 and refers to around flexibility radially and adjacent circumferential expansion through the distortion of spiral connecting piece 2071 (showing in detail) in Figure 119.

[00398] then, the doctor can be downwards through the urethra whole apparatus that bounces back, cause that localizer 2090 pullings contact with pelvic floor 7 around the wall of urinary bladder 2 of bladder opening 4, and bladder opening 4 aimed at urethra opening 6, move the position as shown in Figure 114 to.

[00399] then, distad lengthwise movement of outer tube 2051 keeps the remainder of second pipe 2060 and apparatus stable simultaneously.Be appreciated that by Figure 115 and 16, this motion correspondingly makes nearside securing member anvil block 2054 towards 2062 motions of distally securing member anvil block, make their relative contacts, actuate and make the upper and lower pin distortion of the securing member of securing member group 2070, make them be pushed to wall of urinary bladder and pelvic floor tissue on every side, formed in the tissue separately they morning connect an individual hook substantially relatively, even may form annular shape (also referring to Figure 120).The securing member of An Zhuaning can be used for the tissue near the wall of urinary bladder 2 of bladder and urethra opening is connected with the tissue of pelvic floor 7 therefrom, and with these openings alignings.

[00400] then, the doctor makes outer tube 2051 proximad lengthwise movements, keep second pipe 2060 and the remainder of apparatus stable simultaneously, cause that nearside securing member anvil block 2054 and distally securing member anvil block 2062 discharge them for the clamping of securing member 2072 and separately, to the position shown in Figure 117.The doctor makes tee pipe 2080 and corresponding expander collar 2081 distal motion then, keep second pipe static simultaneously, promotion expander collar 2081 distad leaves top anvil block 2062 and flexibility refers between 2061, allow flexible pipe 2061 and top anvil block 2062 to turn back to their pre-deployment position, limit the circle of the little diameter of the diameter of the present amplification expansion fasteners group of ratio, thereby allow the fastener driver assembly by its retraction.

[00401] then, whole fastener driver assembly 2052, comprise that outer tube 2051, flexibility refer to 2053, nearside securing member anvil block 2054, second pipe 2060, flexibility refer to 2061 and distally securing member anvil block 2062, can in patient's body, bounce back, tee pipe 2080, expander collar 2081, localizer 2090, bar 2092 and end cap 2093 are stayed, shown in Figure 118.Remaining localizer 2090 and tee pipe 2080 can be used for auxiliary downward pressure is applied on the wall of urinary bladder 2 of bladder opening 4 now, so that strengthen around the tissue of the wall of urinary bladder 2 of bladder opening 4 with around contact and woollen yarn knitting between the tissue of the pelvic floor 7 of urethra opening 6.In addition, perhaps as an alternative, localizer 2090 comprises porus excretorius 2091, and tee pipe 2080 can be used for sealing the joint between bladder and the urethra now, and discharges urine and other fluid between rehabilitation and healing stage.Allow the groove 2094 of fluid in end cap 2093 to flow through end cap 2093 (in Figure 121, showing).Be used for this purpose, location organ pipe 2080 will be connected to the urine collecting bag (not shown) through middle pipe fitting.After rehabilitation and the healing, bar 2090 and corresponding end cap 2093 are with respect to distad lengthwise movement of tee pipe 2080, thereby actuate localizer 2090 and enter its pre-deployment position, shown in Figure 110 and 111, and make these remainder of apparatus break away from bladder through retraction downwards, and leave patient's body.

[00402] technical staff of mechanical surgical device design field will be understood that, when above-mentioned steps needs, can be in the near-end structure or the suitable various simple mechanical device of apparatus, operate and keep outer tube 2051, second pipe 2060, tee pipe 2080 and bar 2092, so that motion and maintenance apparatus comprise in Figure 83 and 85 showing and above-mentioned Handleset or their distortion in each pre-deployment and/or retraction and the expansion and first and second actuated positions.

[00403] technical staff of mechanical surgical device design field will be understood that, localizer does not need to be restricted to the illustrative embodiments of being made by flexibility described herein and elastomeric polymer shape-memory material, the alternate design that is used for described localizer also is possible, it causes that localizer selectively takes advanced position and expanded position, in response to the power that is applied or transmitted by pipe or other element, described expanded position is suitable for being captured in the bladder opening and actuates bladder and contacts with pelvic floor.Localizer can comprise, for example shown in Figure 14,19,24 and 57 and above-described any localizer assembly.Similarly, the technical staff of machinery surgical device design field will be understood that, the fastener driver assembly does not need to be restricted to two pipe assemblies described herein, the alternate design that is used for such assembly also is possible, when concentrating in together in response to the power that is applied or transmitted by pipe or other element, it is installed to one or more securing members in the bladder and urethral tissue that centers on opening separately effectively.

[00404] as previously mentioned, the combination of pipe, localizer and actuator assembly can be built in the apparatus that is applicable to the anastomosis operation that drives in the wrong direction, and as mentioned above, perhaps is built in the apparatus that is applicable to the direct motion operation.In the direct motion operation, as upwards inserting and insert through urethra near substituting in the bladder opening at prostate excision position, apparatus can insert downwards through the little otch of patient's abdominal part, be inserted in the bladder through the little otch on the upper surface of patient's bladder, be inserted in the urethra opening through the bladder opening.The little otch of abdominal part and bladder upper surface can use sleeve pipe and trocar assembly to form and stay open, and is used to pass and wherein inserts apparatus.

[00405] lodge element embodiment

[00406] Figure 122 is the perspective view that is in the another kind of embodiment of the coinciding machine of the present invention 2010 in its pre-deployment position.Pipe 2011, outer tube 2012 and bar 2011 in described apparatus can comprise, pipe 2011 can be arranged in the outer tube 20112 and also can move therein in the big I of described bar was configured such that, and in can being arranged on, bar 2019 moves about coaxial setting in the pipe 2011 and therein.Interior pipe 2011, outer tube 2012 and bar 2019 can be made by the material of the combined characteristic with suitable shape memory, flexibility, intensity and hardness, the combination of these characteristics all makes pipe and bar in being inserted into patient body and pass through during the urethra all deflections (will be described below), but in use also can prevent their shrinkages, kink, bonding or break.Selected materials can also be roughly non-reactedly with body fluid or tissue, and is roughly biocompatibility.The inventor is definite well known in the art to be applicable to that the Nitinol of various surgical devices and pipe is an example of suitable material.

[00407] shown in Figure 122, apparatus 2010 comprises localizer 2017.In its pre-deployment position, localizer 2017 can be roughly cylindrical, has the radius radius little or that equate substantially than first pipe 2012, and can have circular far-end.The pre-deployment shape of localizer 2017 can make things convenient for apparatus to insert the patient.Localizer 2017 can be made by elasticity with shape memory and flexible polymeric material, and it is manufactured so that be biased into when bar 2019 retraction and take normal transversal orientation shape, as shown in Figure 124.As shown in Figure 124, localizer 2017 can have one or more porus excretorius 2018 around its periphery, after apparatus is unfolded, can allow urine, fluid or coagulation material be discharged in the pipe 2011 in.

[00408] apparatus 2010 also can comprise lodge element 2013.Lodge element 2013 can also be a tube element, and its near-end 2015 is connected with the far-end of outer tube 1012, and far-end 2014 is connected with the far-end of interior pipe 2011.In the present embodiment, lodge element 2013 can be operated to form rib or other projection of horizontal expansion when launching, and it suitably is being provided with and vertically during compression in the urethra of lodge the patient.Shown in Figure 126, lodge element 2013 can have a series of preformed circumferentially pleated 2016, when promote along distal direction outer tube 2012 simultaneously in pipe 2011 maintenances when stablizing, lodge element 2013 is vertically compressed.Therefore, when vertical compression, lodge element 2013 can be folded into the accordion shape, forms rib or other projection of horizontal expansion in the time of in the position in being in patient's urethra, can be used for the apparatus lodge in the position.Lodge element 2013 can be formed by polyurethane, but also can be formed by any other suitable material.

[00409] refer again to Figure 122, bar 2019 is by end cap 2020 cappings, and described end cap can be circular and the power that is suitable for relying on the internal delivery of localizer 2017 to be applied by bar 2019, so that anti-stopping bar 2019 punctures localizer 2017.Referring to Figure 127, referring to Figure 127, end cap 2020 can have around one of them or a plurality of groove 2021, can allow urine, fluid or agglutinator to flow through end cap 2020 when bar 2019 retractions.When being connected with bar 2019, end cap 2020 roughly with its formation one.

[00410] is to be understood that, when needs are coaxial when being provided with, perhaps when one or more these elements are used as conduit, example as will be described further below, but the alternative pipe of one or more bar also is used to the mechanical function that provides roughly the same, when to be conveying capacity to activate localizer and lodge element do not need to manage, therefore can use bar.Therefore, for the purpose of illustrated claims, unless specialize in the claims, be operably connected or link or contact the place of localizer at described element, term " pipe " means and comprises and relate to bar.

[00411] method that the prostate excision postoperative uses above-mentioned retrograde coinciding machine that patient's bladder and urethra coincide will be described now.The prostate excision postoperative, patient's bladder 1 and urethra opening 6 are separated by the space that is occupied by prostate before, as shown in Figure 2.Bladder 1 need be connected with urethra 5, and bladder opening 4 and urethra opening 6 are aimed at, so that after rehabilitation and healing, recover urinary function.

[00412] shown in Figure 123, coinciding machine is upwards inserted and enter in the bladder 1 through patient's urethra 5 (can understand), process bladder opening 4 by Figure 127.Doctor's proximad retraction then is connected with the bar 2019 of end cap 2020, allows localizer 2017 to take its normal shape, extends beyond the diameter of bladder opening 4 at intravesical perpendicular to the longitudinal axis of apparatus, shown in Figure 124.The present transversal orientation of localizer 2017 prevent its retraction and not along with its pulling around the wall of urinary bladder 2 of bladder opening 4.

[00413] then, the doctor is close to the urethra whole apparatus that bounces back, and causes that localizer 2017 pullings contact with pelvic floor 7 around the wall of urinary bladder 2 of bladder opening 4, and bladder opening 4 is aimed at urethra opening 6, in the position as shown in Figure 125.

[00414] then, distad lengthwise movement of outer tube 2012, interior simultaneously pipe 2011 is maintained fixed.Be appreciated that by Figure 126, because the near-end of lodge element 2013 is connected with an A with the far-end of outer tube 2012, the far-end of the far-end of lodge element 2013 and interior pipe 2011 with shown in some B be connected, outer tube 2012 will cause vertical compression of lodge element 2013 with respect to this distal movement of pipe 2011 in fixing.Preformed circumferentially pleated 2016 cause that lodge element 2013 compresses with concertina style in lodge element 2013, cause the manifesting of horizontal expansion rib as shown in the figure, make lodge element 2013 thereby whole apparatus lodge position as shown in Figure 126 in urethra.

[00415] as an example and as shown in unrestricted Figure 131-133, lodge element 2013 can shown in various embodiments structure, for example comprise that thereby the radial stress that can be used for reducing in the material makes things convenient for unfolded punching, when vertical compression, strengthens the effectiveness of its lodge in urethra.Can expect designing the lodge element all is restricted any lodge projection that strengthens the effectiveness of its lodge in urethra on length, so that roughly do not puncture or the tissue around puncturing, cause the minimizing possibility of sensitizing range permanent injury in the tissue thereby make.

[00416] technical staff of mechanical surgical device design field will be understood that, when above-mentioned steps needs, can be in the near-end structure or the suitable various simple mechanical device of apparatus, pipe 2011, outer tube 2012 and bar 2019 in the near-end of apparatus is operated and kept, so that at each advanced position, be to launch and motion of lodge position and maintenance apparatus then, comprise in Figure 83 and 85 showing and above-mentioned Handleset or their distortion.

[00417] in the lodge position shown in Figure 126, in during the time period that these tissues are knitted and normal healing is required together, apparatus can be used for keeping the wall of urinary bladder 2 around bladder opening 4 to contact with the pelvic floor 7 that centers on urethral orifice 6, and bladder opening 4 is aimed at urethra opening 6.

[00418] though in required time period of healing apparatus by lodge in the position shown in Figure 126, urine, fluid and/or agglutinator can be discharged bladder through the porus excretorius in the localizer 2,013 2018, and flow through the end cap 2020 of bar 2019 through the groove 2021 in the end cap 2020 (in Figure 127 with enlarged perspective show), it is external generally to be discharged to the patient through interior pipe 2011.As shown in Figure 128, apparatus can be connected to urine collecting bag 2023 through pipe fitting.

[00419] technical staff of mechanical surgical device design field will be understood that, localizer does not need to be restricted to the illustrative embodiments of being made by flexibility described herein and elastomeric polymer shape-memory material, the alternate design that is used for the described localizer of polyurethane also is possible, it causes that localizer selectively takes advanced position and expanded position, in response to the power that is applied or transmitted by pipe or other element, described expanded position is suitable for being captured in the bladder opening and actuates bladder and contacts with pelvic floor.Localizer can comprise, for example shown in Figure 14,19,24 and 57 and above-described any localizer assembly.Similarly, the technical staff of machinery surgical device design field will be understood that, the lodge element does not need to be restricted to folding in advance hollow corrugated element described herein, the alternate design that is used for the lodge element also is possible, it causes that the lodge element alternately takes advanced position and expanded position, described expanded position presents one or more ribs or projection, make the lodge element responds in by pipe or other element power lodge of applying or transmitting in urethra.

[00420] as previously mentioned, the combination of pipe, localizer and lodge element can be built in the apparatus that is applicable to the anastomosis operation that drives in the wrong direction, and as mentioned above, perhaps is built in the apparatus that is applicable to the direct motion operation.In the direct motion operation, as upwards inserting and insert through urethra near substituting in the bladder opening at prostate excision position, apparatus can insert downwards through the little otch of patient's abdominal part, be inserted in the bladder through the little otch on the upper surface of patient's bladder, be inserted in the urethra opening through the bladder opening.The little otch of abdominal part and bladder upper surface can use sleeve pipe and trocar assembly to form and stay open, and is used to pass and wherein inserts apparatus.

[00421] as shown in Figure 129, direct motion coinciding machine 2030 can comprise pipe 2034 in outer tube 2031, the first interior pipe 2032 and second.Similar with previously described retrograde coinciding machine, the big I of these pipes is arranged to make the first interior pipe 2032 can be arranged in the outer tube 2031 and lengthwise movement therein, and pipe 2034 can be arranged in the first interior pipe 2032 and lengthwise movement therein in second.The far-end of pipe 2032 can have one or more drain passage 2033 in first.The far-end of pipe 2034 can have one or more drain passage 2035 in second.

[00422] end cap 2036 can be connected to the far-end of pipe 2034 in second.As shown in the figure, end cap 2036 can have rounded distal that makes things convenient for the apparatus insertion and the extension 2037 that terminates in 2038 places, edge.

[00423] shown in Figure 129, apparatus 2030 also can comprise lodge element 2013, and it is similar to the lodge element of previously described retrograde coinciding machine, for example also can be configured to the structure shown in Figure 131-133 as an example.Refer again to Figure 129, lodge element 2013 can its near-end be connected to the far-end (at some A place as shown in the figure) of pipe 2032 in first, is connected (at some B place as shown in the figure) with the extension 2037 of the end cap 2036 of 2038 belows, edge with its far-end.Therefore, be appreciated that, pipe 2034 will cause the longitudinal extension of lodge element 2013 or vertical compression as an alternative with respect to the lengthwise movement of the first interior pipe 2032 in second, this longitudinal extension of lodge element 2013 will cause rib or the projection that presents, thereby retract in the pre-deployment position, the compression of lodge element 2013 causes rib or the projection that presents, thereby extend to expanded position (showing in Figure 129), its mode is similar to the mode of the lodge element of previously described retrograde coinciding machine.

[00424] direct motion coinciding machine 2030 also comprises localizer 2017.Similar with the localizer of previously described retrograde direction coinciding machine, in its pre-deployment position, localizer 2017 can be roughly cylindrical, has the radius radius little or that equate substantially than first pipe 2012.The pre-deployment shape of localizer 2017 can make things convenient for apparatus to insert.Localizer 2017 can be made by elasticity with shape memory and flexible polymeric material, and its manufactured being biased into during with respect to outer tube 2031 retraction with pipe 2032 in the box lunch first is taked normal transversal orientation shape, as shown in Figure 129.Localizer 2017 is connected to the far-end (at the some C place shown in Figure 129) of outer tube 2031 with its near-end, and can its far-end be connected to the far-end (at the some A place shown in Figure 129) of pipe 2032 in first.

[00425] therefore, be appreciated that outer tube 2031 will cause that with respect to the lengthwise movement of pipe 2032 in first localizer 2017 takes the cylindrical position of pre-deployment (being similar to shown in Figure 122) or its expanded position of its retraction, as shown in Figure 129.

[00426] shown in Figure 129, localizer 2017 can have around one of them or a plurality of porus excretorius 2018, can allow urine, fluid or agglutinator to drain, be excreted in the second interior pipe 2034 through the drain passage 2035 in the second interior pipe 2034 through the drain passage 2033 in the first interior pipe 2032.

[00427] now with reference to Fig. 2 of the part that is used to differentiate that the patient coincide be used to differentiate and describe Figure 129 of the part of apparatus the prostate excision postoperative and use above-mentioned direct motion coinciding machine to carry out the method for coincideing of patient's bladder and urethra.Behind prostatectomy, patient's bladder 1 and urethra opening 6 are separated by the gap that is occupied by prostate in the past, as shown in Figure 2.Bladder 1 need be connected with urethra 5 and bladder opening 4 and urethra opening 6 aimed at, after rehabilitation and healing, recover urinary function.

[00428] will be inserted into also process patient's bladder upper surface of abdominal part with the sleeve pipe (not shown) of the trocar.The trocar bounces back and sleeve pipe is stayed in the position then.The direct motion coinciding machine that will be in its expanded position inserts in the sleeve pipe, is arranged in bladder cavity up to whole localizer 2017.The doctor then can be along distal direction with respect to the outer tube 2031 that moves of pipe 2032 in first, perhaps as an alternative or simultaneously, along the nearside longitudinal direction with respect to outer tube 2031 pipe 2032 in first that moves.This relative motion of pipe 2032 will allow localizer 2017 to take its transversal orientation direction in the outer tube 2031 and first, as shown in Figure 129.The doctor can do apparatus location bladder opening 4 and end cap 2036 by grass then, and inserts end cap 2036 through bladder opening 4.The localizer 2017 that is in its expanded position will contact wall of urinary bladder 2 and catch bladder opening 4, but can not pass wherein.But doctor's operating apparatus then actuates wall of urinary bladder 2 around bladder opening 4 towards pelvic floor 7 downwards, the single stepping apparatus of going forward side by side location urethra opening 6, and end cap 2036 is inserted in the urethra opening 6.Therefore, the wall of urinary bladder 2 that centers on bladder opening 4 can be actuated with the pelvic floor 7 that centers on urethra opening 6 and contact, and bladder opening 4 is aimed at urethra opening 6.Then, keep managing in outer tube 2031 and first 2032 and fix, but pipe 2034 in doctor's proximad retraction second.Vertical compression that this will cause lodge element 2013 make it can take the position that shows among Figure 129, and lodge is in urethra.

[00429] technical staff of mechanical surgical device design field will be understood that, when above-mentioned steps needs, can construct various simple mechanical device, activate by near-end and to operate and keep managing 2034 in the pipe 2032 and second in the outer tube 2031, first at apparatus, so that operating apparatus also keeps it to be in the lodge position, comprise in Figure 83 and 85 showing and above-mentioned Handleset or their distortion.

[00430] in during the time period that these tissues are knitted and normal healing is required together, in the lodge position, apparatus can be used for keeping the wall of urinary bladder 2 around bladder opening 4 to contact with the pelvic floor 7 that centers on urethral orifice 6, and bladder opening 4 is aimed at urethra opening 6.

[00431] though in required time period of healing apparatus by lodge in the position, urine and other fluid can be discharged bladder through the porus excretorius in the localizer 2,017 2018, and through drain passage 2033 and 2035, generally managing 2034 through second in, to be discharged to the patient external.As shown in Figure 129, apparatus can be connected to urine collecting bag 2023 through pipe fitting.

[00432] Figure 130 shows the optional embodiment of apparatus 2030, compares with the embodiment shown in Figure 129, and the radius of the first interior pipe 2032 can reduce, and the second interior pipe 2039 can be a bar.Pipe 2039 can terminate in end cap 2036 places with edge 2038 and extension 2037 by its far-end in second.The use of the apparatus shown in Figure 130 and function can be substantially with the use of the apparatus shown in Figure 129 and function class seemingly, but after apparatus expansion and lodge, urine and other fluid can directly be discharged to the outer tube 2031 from bladder through the porus excretorius 2018 in the localizer 2017, described outer tube 2031 is connected with urine collecting bag 2023, has eliminated the needs as drain passage other in the inner tube in Figure 129 instrument shown 2033,2035.

[00433] other details

[00434] illustrative embodiments of describing herein according to apparatus of the present invention comprises one or more pipes and/or bar, be used for power and move being sent to one or more assemblies of close apparatus far-end from the proximal handle assembly, and in other purpose, also possibly as conduit, gas or fluid pressure are carried, and discharge urine and other fluid in rehabilitation and agglutination.As an example, the inventor determines that when suitably handling and forming, Nitinol has the combined characteristic of intensity, flexibility, elasticity, rigidity, hardness and biocompatibility, and it is suitable for as the material that is used for described element.Other material can satisfy, particularly when one or more above-mentioned characteristics be not when needing so especially.Therefore, for example, when not needing for example to transmit power and motion (for example such as when pipe when conduit works), also can use polymer, such as styrene.Certainly, any other material with desirable characteristics all can use for application-specific.

[00435] about being designed for the apparatus of the prostate excision postoperative bladder urethra anastomosis operation of driving in the wrong direction, example is apparatus as described in this article, can expect, it has the angle of bend in the pipe assembly, for example at pipe assembly 500 (Fig. 3), in pipe assembly 3200 (Figure 134) or other pipe assembly supporting member and the end effector.Near about 80 to 90 degree of end effector assembly (end effector of expression pipe assembly away from from the portions of proximal of the pipe assembly angle of the d-axis knee of projection distad), the bendings of 85 degree (its intermediate tube assembly defines the obtuse angles of about 95 degree) preferably approximately is ideal.Such angle of bend can be used for making things convenient for better the operation of apparatus in the anatomical structure that operation relates to, and makes things convenient for the positioning control of end effector assembly in bladder cavity, and anchoring piece can be driven with respect to pelvic floor with angle needs or that select.

[00436] in order to operate most effectively in the confined space that provides in anatomical structure so that carry out coincideing of prostate excision postoperative bladder and urethra by design in performing the operation, need the confinement end actuator assembly, comprise the length of any localizer assembly, anchoring piece actuator assembly and/or end cap or fixation clamp assembly.Preferably, but as restriction, the length of end effector assembly after localizer is opened (when opening from the proximal face of apparatus to distal surface) can be more preferably less than about 1- inch less than about 2 inches.For similar reason, for being designed for the operation of the driving in the wrong direction apparatus of the present invention of (relate to through urethra and upwards inserting), the size of urethra and other identical part makes its preferred end effector and pipe assembly be restricted to about 28 French or about 9.3 millimeters diameter.

[00437] inventor has also determined, inserts for being configured to drive in the wrong direction for the apparatus of (upwards insert and through urethra), has detachable and the end effector assembly that can reconnect or dismounting and attachable end effector assembly may be advantageously.For example, if the end effector assembly (comprises localizer assembly and anchoring piece actuator assembly, localizer 400 that for example shows among Fig. 3 and anchoring piece driver 300, the shuttlecock assembly 800 that shows among Figure 17, the end effector assembly 3400 of reality among the umbrella shape assembly 900 that shows among Figure 22 or Figure 134) pull down or can be connected with it from the stave assembly of stay pipe assembly or other support, the end effector assembly can separate or pull down from it from supporting component before inserting.Supporting component can insert through urethra then, and does not need the end effector assembly, can be easy to insert the element that does not need to connect in addition the end actuator assembly, has eliminated to catch in urethra in the insertion process or cause tissue injury.When inserting, and the far-end of supporting component by urethra and/or pelvic floor above after, the end effector assembly can adopt any guiding instrument (for example endoscope, outside imaging technique and/or sense of touch) to be connected so that use in anastomosis operation with supporting component through passing the sleeve pipe of stomach wall.Be appreciated that supporting component and end effector assembly can have various designs, make the operation that can be connected that is operatively connected of their each self-structures and executive component with the end effector assembly.

[00438] in the anastomosis operation process, will be inserted into and/or be retained in pipe, bar or other element of a very long time in patient's body, such as but not limited to center rod or seal wire 3230, conduit 3510 (Figure 141-144) and/or other element can provide antimicrobial coating, for example in publication number is 2004/0220614 U.S. Patent application common co-pending description are arranged.In addition or as an alternative, described element can provide hydrophilic or other coating than friction.

[00439] is used for behind prostatectomy, carrying out some embodiments of the method for bladder and urethra anastomosis, anchoring piece is driven in the pelvic floor as illustrating in this article and describe, relating to.In such operation, can need anchoring piece to be driven in the position of avoiding the sensitizing range in the pelvic floor, thereby reduce the probability of complication.For example, referring to Figure 147, can avoid anchoring piece is driven in the zone of close vena dorsalis penis D, other neurovascular bundle N, rectum R, perhaps the identical feature of other sensitivity.Therefore, referring to Figure 147, the inventor determines that anchoring piece preferably is driven to the position and the position at about 2 to about 4 o'clock of arriving about 10 o'clock in the pelvic floor around about 8 of urethra U, is shown as " A " and " B " in Figure 147 respectively.More preferably, for example can be this situation, the fixation clamp system that uses capsule or illustrate in this article and describe, two anchoring pieces can be driven to the position that centers on about 9 o'clock of urethra and about 3 o'clock in the pelvic floor.

[00440] when using apparatus of the present invention that anchoring piece is installed, avoid with anchoring piece through or to pass in the ureteric orifice of bladder also be important.The various embodiments of the apparatus of Miao Shuing help avoiding this situation herein.

[00441] anchoring piece

[00442] as described herein, anchoring piece 700 or other suitable fasteners are carried out and are kept function, and wall of urinary bladder is remained to pelvic floor and/or fixation clamp is remained to wall of urinary bladder and/or pelvic floor.Each anchoring of Tao Luning and/or fastenings only are the possible within the scope of the invention a large amount of designs and the example of structure herein.

[00443] anchoring piece 700 or other securing member can have one or more suitable lodge structure, are used for causing the anchoring piece lodge at tissue after being driven in the tissue, withdraw from from tissue so that prevent.Described lodge element can comprise agnail, circumferential ridge, projection or cause anchoring piece lodge any other part in tissue in being driven into tissue the time effectively.Size, shape and the number of suitable lodge structure can change.In addition, the inventor determines, no matter when agnail is included on the anchoring piece, be ideally when producing such anchoring piece, need make the projecting end (observing) of agnail become circle or make it slick and sly from the front end of anchoring piece, so that agnail draws and hangs over the structural probability of lax wall of urinary bladder during being reduced in insertion and opening the anchoring piece actuator assembly, anchoring piece is loaded on the described anchoring piece actuator assembly in bladder inside.

[00444] anchoring piece or other securing member also can have head or other suitable puncture limiting structure, and can be used for limiting anchoring piece or other securing member can driven degree of depth, and can be used for helping proximal tissue is connected to following remote organization.Should be appreciated that such puncture limiting structure does not need to be arranged on the rear end that is performed the anchoring piece axle.

[00445] can expect, the front end of anchoring piece be fine away or have chisel-shape, tissue so that more effective and/or injury is punctured littlelyr.In addition, the inventor determines, the tip that comprises three clinoplains in the plane that intersects each other with equal angles that forms on the front end of cylindrical anchoring piece axle is convenient to anchoring piece and is punctured in the tissue, and its mode is for departing from objectives anchoring piece during driving or the minimizing possibility of offset direction.

[00446] when being used for wall of urinary bladder is connected with pelvic floor, wishes the length that anchoring piece has to be enough to through the fascia layer puncture of wall of urinary bladder and pelvic floor.For example but as restriction, the length of described anchoring piece is not preferably about  inch to 2  inches.For near the anchoring piece will being installed in rectum, wish that they are positioned at the less end value place of the preferable range of length.

[00447] anchoring piece 700 or other suitable fasteners can be by biocompatible polymer or metal are made substantially.When needs shape memory and elasticity, can use the element of making by elastomeric material to produce anchoring piece, for example elastic metallic alloy or thermal actuation or actuatable alloy, such as Nitinol (for example Nitinol) or stainless steel alloy, make anchoring piece or other securing member preform and be subjected to bias voltage, have shaping end or agnail along axle, anchoring piece can be launched, when they enter target tissue, make them in target tissue, take their shape by they being pulled out apparatus.

[00448] biocompatibility if desired, anchoring piece 700 or other suitable fasteners can be roughly biocompatibility and biological absorptive material is made by suitable.The inventor has determined that (polydioxanone polymer for example perhaps contains the polymer of lactide, Acetic acid, hydroxy-, bimol. cyclic ester, lactide glycolide copolymer etc., for example from Johnson﹠amp to flexible absorbable polymer; The commodity that Johnson and/or Ethicon Inc. sell are the polymer of " Vicryl " and " PSDII ") be potential suitable material.Other bioabsorbable material with required physical characteristic also can use.

[00449] when the anchoring piece that is used for capsule or fixation clamp system is fixedly carried secretly, for example illustrate in this article and describe, biology can absorb anchoring piece and can be used for providing biology can absorb the fixation clamp relieving mechanism, avoids mechanically fixation clamp being connected to anchoring piece and discharges the needs of the structure of fixation clamp or device or reduce its importance from anchoring piece then.As an example but not as restriction, referring to Figure 145, be appreciated that, if the fixation clamp hook 760 on structure example such as the anchoring piece 700 is biological absorbable, and have a time time corresponding degraded feature required with anastomosis operation, fixation clamp hook 760 will be used to discharge fixation clamp 3430 through bio-absorbable degraded and dissolving, promote to discharge from the patient.

[00450] in addition, may need control degradation and absorption distribution and/or the biological fission particle size that can absorb anchoring piece or other suitable fasteners in some cases.For example, if one or many biologies can absorb anchoring piece (such as the anchoring piece head) after the expansion along with the anchoring piece material degradation under big part fracture, may cause obstruction.Therefore, can be provided with and make biology as follows and can absorb anchoring piece or other suitable fasteners, wherein the big I of degradation rate and fission particle is controlled.For example, biology can absorb anchoring piece or other securing member can use cut layout (machined-in arrangement of scoring) in casting, injection moulding, embossing or the processing, punching or grooving formation, part formation thickness in select location reduces the zone with the stress increase, for the purpose that reduces the size of departing part when the material degradation, can promote near the fracture more early of described zone.As an alternative or additional, biological anchoring piece or other securing member of can absorbing can or comprise that binding member makes by the bond material with different degraded/absorptions distributions, making that zone faster and degraded more slowly can be formed in the parts, making even as big as form blocking or the part of the probability of other unfavorable effect breaks away from body cavity and the probability that discharges reduces.

[00451] the anchoring piece axle can be a hollow, so that be snug fit at the actuator pin top, and keeps thereon releasedly substantially by frictional fit or other suitable manner.As an alternative, anchoring piece can have solid shafting, and wherein actuator pin promotes based on the near-end of anchoring piece, perhaps as an alternative, is matched with the near-end top of anchoring piece and releasedly it is carried out clamping by frictional fit or any other suitable manner.

What [00452] can expect for a person skilled in the art is, multiple design is arranged for anchoring piece, can effectively bladder be anchored on the pelvic floor of urethra opening top.Anchoring piece can be provided has had a plurality of axles that are operatively coupled to actuator assembly, agnail and tip.Not needing anchoring piece is anchoring piece independently, if the size and dimension of each anchoring piece separately or combination be enough to realize or keep contact between nearside and below in suitable time period, the distally target tissue.

[00453] in another embodiment, anchoring piece can be formed by two kinds of metals or other combination with two kinds of materials of different expansion feature at least, and described material can cause the shape of for example being taked needs by its parts that form after heating by patient's body.Under these circumstances, anchoring piece can be provided under cold or room temperature state, then in the shape that allows to reach final needs after the installation when heating by patient body.

[00454] because its physical characteristic and the long history aspect implantable medical device thereof, Nitinol can be used to this service, because it is using or conceiving together comprehensive suitability of using with NMR (Nuclear Magnetic Resonance)-imaging (MRI) technology, it is also applicable to as anchoring piece.

[00455] generally speaking, the many benefits that adopt design of the present invention to produce are tangible.For explaining and purpose of description, an aforementioned clock or multiple embodiments of the present invention have been represented.This is not intended to limit or limits the invention to described precise forms.According to above-mentioned instruction, the modification that can expect or variation are possible.In order to explain principle of the present invention and application in practice thereof, select and describe these embodiments, make those skilled in the art utilize the present invention in the various embodiments better, and the various modification specific use that is suitable for expecting.Scope of the present invention is only limited by appending claims.

Claims (130)

1, a kind of apparatus that is used to realize bladder and urethra anastomosis comprises:

Pipe assembly with longitudinal axis, it comprises first pipe and second pipe, the coaxial substantially setting of wherein said pipe, and described second pipe can be with respect to the described first pipe lengthwise movement;

The end effector assembly is operationally supported by described pipe assembly, and described end effector assembly also comprises:

Localizer, operationally support by described first pipe, described localizer also comprises having link and free-ended lobe, and described link is operably connected to described first pipe, wherein said free end can around described link away from or towards the motion of described longitudinal axis;

Spring element, it operationally is connected with described pipe assembly, acts on described lobe, and described free end is actuated away from described longitudinal axis;

With the lobe stop of described lobe sliding-contact, operationally be connected and therewith lengthwise movement with described second pipe;

The anchoring piece driver that operationally supports by described pipe assembly; With

Anchoring piece is kept releasedly by described anchoring piece driver, and described anchoring piece comprises the lodge structure.

2, apparatus according to claim 1, wherein, described pipe assembly comprises angle of bend, wherein said angle of bend is spent between about 90 degree about 80.

3, apparatus according to claim 1, wherein, described anchoring piece comprises the puncture limiting structure.

4, a kind of apparatus that is used to carry out bladder and urethra anastomosis comprises:

Pipe assembly with longitudinal axis, it comprises first pipe and second pipe, the coaxial substantially setting of wherein said pipe, wherein said second pipe can be with respect to the described first pipe lengthwise movement;

The end effector assembly is operationally supported by described pipe assembly, and described end effector assembly also comprises:

Localizer is operationally supported by described first pipe;

The anchoring piece driver comprises actuator pin, and described actuator pin has link and the free end that operationally is connected with described first pipe, thereby the lengthwise movement of described first pipe will cause the corresponding sports of described link;

Can discharge the anchoring piece of maintenance by the described free end of described actuator pin, described anchoring piece comprises the lodge structure;

Spring element, it operationally is connected with described pipe assembly, acts on the described actuator pin, and described free end is actuated away from described longitudinal axis; And

Stop operationally is slidingly connected with described actuator pin, and is operably connected to its described free end and therewith lengthwise movement.

5, apparatus according to claim 4, wherein, described pipe assembly comprises angle of bend, wherein said angle of bend is spent between about 90 degree about 80.

6, apparatus according to claim 4, wherein, described a plurality of anchoring pieces comprise the puncture limiting structure respectively.

7, apparatus according to claim 4, wherein, described actuator pin comprises elastic metallic, and it is biased to actuate described free end away from described longitudinal axis, and described actuator pin and described spring element are identity elements.

8, a kind of apparatus that is used to carry out bladder and urethra anastomosis comprises:

Pipe assembly with longitudinal axis comprises first pipe, second pipe and the tee pipe, the coaxial substantially setting of wherein said pipe;

Wherein said second pipe can be with respect to the described first pipe lengthwise movement; And

Wherein said tee pipe can be with respect to the described first pipe lengthwise movement;

The end effector assembly is operationally supported by described pipe assembly, and described end effector assembly also comprises:

Localizer, can operate support by described first pipe, described localizer also comprises having link and free-ended lobe, and described link is operably connected to described first pipe, wherein said lobe free end can around described link away from or towards the motion of described longitudinal axis;

First spring element, it operationally is connected with described pipe assembly, acts on the described lobe, and described lobe free end is actuated away from described longitudinal axis;

With the lobe stop of described lobe sliding-contact, operationally be connected and therewith lengthwise movement with described second pipe;

The anchoring piece driver further comprises actuator pin, and described actuator pin has link and the actuator pin free end that operationally is connected with described tee pipe, and the lengthwise movement of described tee pipe will cause the corresponding sports of the described link of described actuator pin;

Second spring element, it operationally is connected with described pipe assembly, acts on the described actuator pin, and described actuator pin free end is actuated away from described longitudinal axis; With

The actuator pin stop operationally is slidingly connected with described actuator pin, and is operably connected to described second pipe and the therewith lengthwise movement.

9, apparatus according to claim 8, wherein, described actuator pin rests on described lobe below.

10, apparatus according to claim 9, wherein, described lobe stop and described actuator pin stop are identity elements.

11, apparatus according to claim 8, wherein, described actuator pin comprises elastic metallic, and it is biased to actuate described actuator pin free end away from described longitudinal axis, and described first spring element and described second spring element are identity elements.

12, a kind of apparatus that is used to realize bladder and urethra anastomosis comprises:

Pipe assembly with longitudinal axis, it comprises bar with far-end and the pipe that defines the chamber, wherein said bar is positioned at described tube chamber, described bar and the lengthwise movement relative to each other of described pipe;

Can operate the localizer of support by described pipe, described localizer also comprises the deformable wall that is formed by elastomeric material,

Described deformable wall defines the hollow body with inner space, wherein being in not, the described hollow body of deformation state keeps the profile of horizontal expansion away from described longitudinal axis, described deformable wall also defines opening, be operably connected to described pipe at the described wall of described opening part, the described inner space of described hollow body is continuous with described tube chamber substantially

Wherein said bar can lengthwise movement in described tube chamber, make the described far-end of described bar from the described inner space of described hollow body, promote described deformable wall, thereby can make described wall be out of shape and spur the described profile of described hollow body towards described longitudinal axis; And

Can operate the lodge element of support by described pipe assembly.

13, apparatus according to claim 12, wherein, described wall limits second opening.

14, apparatus according to claim 12, wherein, described pipe assembly comprises angle of bend.

15, apparatus according to claim 14, wherein, described angle of bend is spent between about 90 degree about 80.

16, a kind of apparatus that is used to realize bladder and urethra anastomosis comprises:

Pipe assembly with longitudinal axis comprises first pipe and second pipe, the coaxial substantially setting of wherein said pipe, and lengthwise movement relative to each other;

Can operate the localizer of support by described pipe assembly; With

The lodge element, described lodge element comprises the columniform main body of being roughly of hollow, it is placed in the outside of described first pipe and has first end that operationally is connected with described first pipe, with second end that is operably connected to described second pipe, thereby make described second pipe will vertically compress or elongate described lodge element with respect to the lengthwise movement of described first pipe.

17, apparatus according to claim 16, wherein, described lodge element comprises circumferential fold.

18, apparatus according to claim 17, wherein, described lodge element also comprises punching.

19, apparatus according to claim 16, wherein, one or more projection when described lodge element also is included in vertical the compression.

20, apparatus according to claim 16, wherein, described lodge element also comprises coarse outer surface.

21, apparatus according to claim 16, wherein, described pipe assembly comprises angle of bend.

22, apparatus according to claim 21, wherein, described angle of bend is spent between about 90 degree about 80.

23, a kind of apparatus that is used to realize bladder and urethra anastomosis comprises:

Pipe assembly with longitudinal axis comprises the bar with far-end and defines first of chamber and manage that wherein said bar is positioned at described first tube chamber, the coaxial substantially setting of described bar and described pipe, and lengthwise movement relative to each other;

Can operate the localizer of support by described first pipe, described localizer also comprises the deformable wall that is formed by elastomeric material,

Described deformable wall defines the hollow body with inner space, wherein being in not, the described hollow body of deformation state keeps the profile of horizontal expansion away from described longitudinal axis, described deformable wall also defines opening, be operably connected to described first pipe at the described wall of described opening part, the described inner space of described hollow body is continuous with described first tube chamber substantially

Wherein said bar can lengthwise movement in described tube chamber, make the described far-end of described bar from the described inner space of described hollow body, promote described deformable wall, thereby can make described wall be out of shape and spur the described profile of described hollow body towards described longitudinal axis; With

The lodge element, described lodge element comprises the columniform main body of being roughly of hollow, it is placed in the outside of described first pipe and has first end that operationally is connected with described first pipe, with second end that is operably connected to described second pipe, thereby make described second pipe will vertically compress or elongate described lodge element with respect to the lengthwise movement of described first pipe.

24, the apparatus that uses in a kind of operation that behind prostatectomy patient's bladder and urethra is coincide comprises:

The pipe assembly comprises bar, first pipe and second pipe, the coaxial substantially setting of wherein said bar and described pipe, and relative to each other lengthwise movement;

The end effector assembly is operationally supported by described pipe assembly, further comprises:

Can operate the localizer of support by described first pipe, its operationally with described bar mechanical connection so that can activate by of the motion of described bar with respect to described first pipe; With

Can operate the lodge element of support by described first pipe, its operationally with the described second pipe mechanical connection so that can activate by of the motion of described second pipe with respect to described first pipe.

25, apparatus according to claim 24, wherein, described pipe assembly comprises the angle of bend near described end effector assembly.

26, apparatus according to claim 25, wherein, described angle of bend is spent between about 90 degree about 80.

27, the apparatus that uses in a kind of operation that behind prostatectomy patient's bladder and urethra is coincide comprises:

The pipe assembly comprises first pipe, second pipe and the tee pipe, the coaxial substantially setting of wherein said pipe, and can move relative to each other;

The end effector assembly is operationally supported by described pipe assembly, and it further comprises:

Localizer can be operated support by described first pipe, and it operationally manages mechanical connection with described second, so that can activate by the motion of described second pipe with respect to described first pipe;

The anchoring piece driver, it is operationally supported by described tee pipe, and manages mechanical connection with described second in operation, so that can activate by the motion of described second pipe with respect to described tee pipe; With

Can discharge the anchoring piece of maintenance by described anchoring piece driver, described anchoring piece comprises the lodge structure.

28, apparatus according to claim 27, wherein, described pipe assembly comprises the angle of bend near described end effector assembly.

29, apparatus according to claim 28, wherein, described angle of bend is spent between about 90 degree about 80.

30, the apparatus that uses in a kind of operation that behind prostatectomy patient's bladder and urethra is coincide comprises:

The pipe assembly comprises bar, first pipe, second pipe and the tee pipe, the coaxial substantially setting of wherein said bar and described pipe, and can move relative to each other;

The end effector assembly is operationally supported by described pipe assembly, and it further comprises:

Localizer can be operated support by described first pipe, its operationally with described bar mechanical connection so that can activate by of the motion of described bar with respect to described first pipe;

Fastener driver, it is operationally supported by described second pipe, and in operation with described tee pipe mechanical connection so that can activate by of the motion of described tee pipe with respect to described second pipe; With

The deformable securing member that keeps releasedly by described fastener driver.

31, apparatus according to claim 30, wherein, described pipe assembly comprises the angle of bend near described end effector assembly.

32, apparatus according to claim 31, wherein, described angle of bend is spent between about 90 degree about 80.

33, the apparatus that uses in a kind of operation that behind prostatectomy patient's bladder and urethra is coincide comprises:

The pipe assembly comprises bar, first pipe, second pipe and the tee pipe, the coaxial substantially setting of wherein said bar and described pipe, and can move relative to each other;

The end effector assembly is operationally supported by described pipe assembly, and it further comprises:

Localizer can be operated support by described first pipe, its operationally with described bar mechanical connection so that can activate by of the motion of described bar with respect to described first pipe;

The anchoring piece driver, it is operationally supported by described second pipe, and in operation with described tee pipe mechanical connection so that can activate by of the motion of described tee pipe with respect to described second pipe; With

By the anchoring piece that described anchoring piece driver keeps releasedly, described anchoring piece comprises the lodge structure.

34, apparatus according to claim 33, wherein, described pipe assembly comprises the angle of bend near described end effector assembly.

35, apparatus according to claim 34, wherein, described angle of bend is spent between about 90 degree about 80.

36, the apparatus that uses in a kind of operation that behind prostatectomy patient's bladder and urethra is coincide comprises:

The pipe assembly comprises first pipe, second pipe, tee pipe and the 4th pipe, the coaxial substantially setting of wherein said pipe, and can move relative to each other;

The end effector assembly is operationally supported by described pipe assembly, and it further comprises:

Localizer can be operated support by described first pipe, and it operationally manages mechanical connection with described second, so that can activate by the motion of described second pipe with respect to described first pipe;

The anchoring piece driver, it is operationally supported by described tee pipe, and manages mechanical connection with the described the 4th in operation, so that can activate by the motion of described the 4th pipe with respect to described tee pipe; With

Can discharge the anchoring piece of maintenance by described anchoring piece driver, described anchoring piece comprises the lodge structure.

37, apparatus according to claim 36, wherein, described pipe assembly comprises angle of bend.

38, according to the described apparatus of claim 37, wherein, described angle of bend is spent between about 90 degree about 80.

39, a kind of method that is used for will comprising patient's urethra anastomosis that patient's bladder of the wall of urinary bladder that defines bladder cavity and bladder opening and pelvic floor by the patient center on behind prostatectomy comprises the following steps:

The apparatus that will have longitudinal axis, localizer and anchoring piece driver is inserted in the bladder cavity, places bladder cavity inside up to described localizer and described anchoring piece driver;

Make described localizer in bladder cavity with respect to described longitudinal axis extending transversely locator element;

Described locator element is contacted with wall of urinary bladder, cause that the wall of urinary bladder that described locator element is actuated near the bladder opening enters near the pelvic floor, and with bladder opening and urethra rough alignment; With

Cause that described anchoring piece driver drives its anchoring piece with lodge structure in the bladder cavity and enters pelvic floor near urethra through wall of urinary bladder, described anchoring piece lodge in pelvic floor, and is discharged described anchoring piece from described anchoring piece driver.

40,, comprise the steps: also to cause that described localizer makes described locator element laterally bounce back with respect to described longitudinal axis, and withdraw from described localizer and described anchoring piece driver from the patient according to the described method of claim 39.

41,, after described localizer and anchoring piece driver withdraw from step, also comprise the following steps: according to the described method of claim 40

Swelling bag on the ductus bursae in bladder cavity;

Roughly seal the bladder opening with described capsule; With

Use described ductus bursae from bladder cavity, to urinate.

42, according to the described method of claim 41, wherein, described anchoring piece actuation step comprises uses described anchoring piece that the capsule fixation clamp is connected with pelvic floor near the bladder opening, also is included in its expansion and uses described capsule fixation clamp to limit described capsule near the bladder opening afterwards.

43,, also comprise the steps: effectively during required together time period of woollen yarn knitting, described capsule fixation clamp and described expansible ductus bursae to be remained on original position at wall of urinary bladder and pelvic floor tissue according to the described method of claim 42.

44, according to the described method of claim 43, also comprise step to described capsule venting, described capsule fixation clamp and described anchoring piece are broken away from, withdraw from described capsule fixation clamp and withdraw from described ductus bursae from the patient from the patient.

45, according to the described method of claim 44, wherein, but described anchoring piece has the biology absorption portion that keeps the capsule fixation clamp to be connected with pelvic floor, after the described time period, but described biology absorption portion is dissolved in patient's body effectively, thereby realizes the step that described capsule fixation clamp breaks away from.

46, method according to claim 24, wherein, described anchoring piece comprises the puncture limiting structure, described puncture limiting structure helps to keep the tissue of wall of urinary bladder tissue near pelvic floor.

47, a kind of method that is used for will comprising patient's urethra anastomosis that patient's bladder of the wall of urinary bladder that defines bladder cavity and bladder opening and pelvic floor by the patient center on behind prostatectomy comprises the following steps:

The apparatus that will have longitudinal axis, localizer and anchoring piece driver is inserted in the bladder cavity, places bladder cavity inside up to described localizer;

Wherein said apparatus comprises the conduit that defines catheter lumen and far-end, and described localizer comprises the deformable wall that is formed by elastomeric material, and it defines the hollow body that has substantially with the successive inner space of described catheter lumen, described hollow body with

Described conduit near described far-end connects, and has scavenge port in the described localizer,

Make described hollow body that the described deformable wall by described localizer limits in bladder cavity with respect to described longitudinal axis horizontal expansion;

Described localizer is contacted with wall of urinary bladder, cause that the wall of urinary bladder that described localizer is actuated near the bladder opening enters near the pelvic floor, and with bladder opening and urethra rough alignment;

Make described anchoring piece driver that one or more anchoring pieces that have the lodge structure on it are driven into wall of urinary bladder and near in the pelvic floor tissue of urethra, and discharge described one or more anchoring piece from described anchoring piece driver;

Described localizer is remained in the position, apply the pressure of effective size to wall of urinary bladder, thereby roughly seal the bladder opening near the wall of urinary bladder opening; With

Urinate from bladder cavity through described scavenge port and described conduit.

48, a kind of method that is used for will comprising patient's urethra anastomosis that patient's bladder of the wall of urinary bladder that defines bladder cavity and bladder opening and pelvic floor by the patient center on behind prostatectomy comprises the following steps:

The apparatus that will have longitudinal axis, localizer and lodge element is inserted in the bladder cavity, places bladder cavity inside up to described localizer;

Wherein said apparatus comprises the conduit that defines catheter lumen and far-end, described localizer comprises the deformable wall that is formed by elastomeric material, this deformable wall defines the hollow body that has substantially with the successive inner space of described catheter lumen, described hollow body is connected with the described conduit of close described far-end, has scavenge port in the described localizer

Make described hollow body that the described deformable wall by described localizer limits in bladder cavity with respect to described longitudinal axis horizontal expansion;

Described localizer is contacted with wall of urinary bladder, cause that the wall of urinary bladder that described localizer is actuated near the bladder opening enters near the pelvic floor, and with bladder opening and urethra rough alignment;

Described localizer is remained in the position, thereby roughly seal the bladder opening to the pressure that applies effective size near the wall of urinary bladder of wall of urinary bladder opening;

In urethra, activate described lodge element, thus with described apparatus lodge in described position; With

Urinate from bladder cavity through described scavenge port and described conduit.

49, a kind of method that is used for will comprising patient's urethra anastomosis that patient's bladder of the wall of urinary bladder that defines bladder cavity and bladder opening and pelvic floor by the patient center on behind prostatectomy comprises the following steps:

To have longitudinal axis and comprise that the retrograde direction of apparatus of localizer, anchoring piece driver and capsule fixation clamp enters and pass patient's urethra, be inserted in the bladder cavity through the bladder opening, place bladder cavity inside up to described localizer and described anchoring piece driver;

Make described localizer in bladder cavity with respect to described longitudinal axis horizontal expansion locator element;

Described locator element is contacted with wall of urinary bladder in that bladder cavity is inboard, and cause described locator element that wall of urinary bladder is pressed near the pelvic floor;

Make described anchoring piece driver in bladder cavity, drive the anchoring piece that has the lodge structure on it, enter pelvic floor through wall of urinary bladder, described anchoring piece lodge in pelvic floor, and is discharged described anchoring piece from described anchoring piece driver,

Wherein said anchoring piece actuation step comprises uses described anchoring piece with described capsule

Fixation clamp is connected with pelvic floor near the bladder opening;

Cause that described localizer is with respect to the described locator element of the horizontal retraction of described longitudinal axis;

Withdraw from described localizer and described anchoring piece driver from the patient;

After described localizer and anchoring piece driver withdrawed from step, the ductus bursae that will have a capsule was inserted in patient's bladder cavity and inserts in the described capsule fixation clamp;

The described capsule that expands in bladder cavity and in described capsule fixation clamp is with described capsule sealed bladder opening and push the wall of urinary bladder tissue of close bladder opening to the pelvic floor tissue substantially;

Use described ductus bursae from bladder cavity, to urinate;

Effectively knit the position that keeps described capsule fixation clamp and described ductus bursae in the required together time period in wall of urinary bladder and pelvic floor tissue; With

To described capsule venting, withdraw from described ductus bursae from the patient, described capsule fixation clamp is broken away from described anchoring piece be connected, and withdraw from described capsule fixation clamp from the patient.

50, according to the described method of claim 49, wherein, but described anchoring piece has the biology absorption portion that described capsule fixation clamp is remained to described anchoring piece, but described biology absorption portion is dissolved in patient's body in the described time period, thereby realizes that described capsule fixation clamp breaks away from step.

51, a kind of apparatus that is used to realize bladder and urethra anastomosis comprises:

Pipe assembly with longitudinal axis comprises first pipe and second pipe, the coaxial substantially setting of wherein said pipe, wherein said first pipe and the lengthwise movement relative to each other of described second pipe;

Can operate the end effector of support by described pipe assembly, described end effector also comprises:

The localizer that comprises localizer arm, described localizer arm has first fragment that can be operatively connected with described first pipe, described first fragment has the joint that is connected with second fragment, described second fragment operationally is connected with described second pipe, thereby makes described first pipe will cause that with respect to the lengthwise movement of described second pipe described localizer arm is with respect to described longitudinal axis horizontal expansion or retraction;

Anchoring piece driver by described pipe assembly support; With

By the anchoring piece that described anchoring piece driver keeps releasedly, described anchoring piece comprises the lodge structure.

52, according to the described apparatus of claim 51, wherein, described pipe assembly comprises angle of bend.

53, according to the described apparatus of claim 52, wherein, described angle of bend is spent between about 90 degree about 80.

54, a kind of apparatus that is used to realize bladder and urethra anastomosis comprises:

Pipe assembly with longitudinal axis comprises first pipe and second pipe, the coaxial substantially setting of wherein said pipe, wherein said first pipe and the lengthwise movement toward each other of described second pipe;

Can operate the end effector of support by described pipe assembly, described end effector also comprises:

The localizer that operationally supports by described pipe assembly;

The anchoring piece driver that comprises drive arm, described drive arm has link and movable terminal, described link and described second pipe can be operatively connected, thereby the lengthwise movement that makes described second pipe will cause the corresponding sports of described link, described movable end can around described link towards or away from the motion of described longitudinal axis;

By the anchoring piece that described anchoring piece driver keeps releasedly, described anchoring piece comprises the lodge structure;

The spring element that is connected with described pipe assembly operationally, it acts on described drive arm, and described movable end is actuated away from described longitudinal axis; With

Operationally be connected with described first pipe and with the closed collar of described drive arm sliding-contact, thereby make described first pipe selectively actuate the movable end of described drive arm towards described longitudinal axis with respect to the lengthwise movement of described second pipe, perhaps the described result who actuates as described spring element allows described movable terminal motion away from described longitudinal axis.

55, according to the described apparatus of claim 54, wherein, described pipe assembly comprises angle of bend.

56, according to the described apparatus of claim 55, wherein, described angle of bend is spent between about 90 degree about 80.

57, a kind of apparatus that is used to realize bladder and urethra anastomosis comprises:

Have longitudinal axis and comprise the pipe assembly of seal wire;

By the end effector assembly that described pipe assembly operationally supports, described end effector assembly also comprises:

The localizer that operationally supports by described pipe assembly;

The anchoring piece driver that operationally supports by described pipe assembly;

The anchoring piece that keeps releasedly by described anchoring piece driver; Described anchoring piece comprises the lodge structure; With

The capsule fixation clamp has anchoring piece end that is releasably connected to described anchoring piece and the guide end that is operably connected to described seal wire.

58, according to the described apparatus of claim 57, wherein said pipe assembly comprises angle of bend.

59, according to the described apparatus of claim 58, wherein, described angle of bend is spent between about 90 degree about 80.

60, according to the described apparatus of claim 57, wherein, but described anchoring piece has the biology absorption portion.

61, according to the described apparatus of claim 60, wherein, but the described biology absorption portion of described anchoring piece keeps the described anchoring piece end of described capsule fixation clamp.

62, according to the described apparatus of claim 57, also comprise a plurality of anchoring pieces that can discharge maintenance by described anchoring piece driver, each anchoring piece all comprises the lodge structure, wherein said capsule fixation clamp comprises a plurality of anchoring piece ends, and each anchoring piece end is releasably connected in described a plurality of anchoring piece.

63, a kind ofly be used for being installed in the anchoring piece that coincide that is used to realize patient's bladder and urethra in pelvic floor tissue and the operation behind prostatectomy, comprise:

Axle, the about  of length has front-end and back-end to about 2  inches;

Driver interface near described rear end;

Be positioned at the lodge structure on the described axle;

Be positioned at the shape of being convenient to puncture on the described front end; With

But biology absorption portion.

64, according to the described anchoring piece of claim 63, wherein, but described biology absorption portion comprises two kinds of bonded bioabsorbable materials with different degraded scattergrams.

65, according to the described anchoring piece of claim 63, but also comprise the surface that is positioned on the described biology absorption portion, wherein have groove.

66, according to the described anchoring piece of claim 64, but also comprise the surface that is positioned on the described biology absorption portion, wherein have groove.

67, according to the described anchoring piece of claim 63, wherein, the shape of being convenient to puncture comprises the tip that is limited by three flat faces that intersect.

68,, also comprise the puncture limiting structure that is positioned on the described axle according to the described anchoring piece of claim 63.

69, according to the described anchoring piece of claim 63, wherein, described driver interface comprises the hollow space along the part of described length of described axle.

70, a kind ofly be used for being installed in the anchoring piece that coincide that is used to realize patient's bladder and urethra in pelvic floor tissue and the operation behind prostatectomy, comprise:

Axle, the about  of length has front-end and back-end to about 2  inches;

Driver interface near described rear end;

Be positioned at the lodge structure on the described axle;

Be positioned at the puncture limiting structure on the described axle; With

Be positioned at the shape of being convenient to puncture on the described front end.

71,, but also comprise the biology absorption portion according to the described anchoring piece of claim 70.

72, according to the described anchoring piece of claim 71, but also comprise the surface that is positioned on the described biology absorption portion, wherein have groove.

73, according to the described anchoring piece of claim 70, wherein, the described shape of being convenient to puncture comprises the tip that is limited by three flat faces that intersect.

74, according to the described anchoring piece of claim 70, wherein, described driver interface comprises the hollow space along the part of described length of described axle.

75,, also comprise the part that mainly constitutes by Nitinol according to the described anchoring piece of claim 70.

76, a kind ofly be used for being installed in the anchoring piece that coincide that is used to realize patient's bladder and urethra in pelvic floor tissue and the operation behind prostatectomy, comprise:

Axle, the about  of length has front-end and back-end to about 2  inches;

Driver interface near described rear end;

Be positioned at the lodge structure on the described axle;

The part that comprises metal alloy;

Be positioned at the shape of being convenient to puncture on the described front end.

77, according to the described anchoring piece of claim 77, wherein, the described shape of being convenient to puncture comprises the tip that is limited by three flat faces that intersect.

78, according to the described anchoring piece of claim 77, wherein, described driver interface comprises the hollow space along the part of described length of described axle.

79, according to the described anchoring piece of claim 77, wherein, described metal alloy is a Nitinol.

80, according to the described anchoring piece of claim 77, wherein, described metal alloy is a rustless steel.

81,, also comprise at least two kinds of different bonded metal alloys with different expansion characteristics according to the described anchoring piece of claim 77.

82,, also comprise the puncture restricted part that is positioned on the described axle according to the described anchoring piece of claim 77.

83, a kind of apparatus that is used to realize bladder and urethra anastomosis comprises:

Pipe assembly with longitudinal axis comprises first pipe and second pipe, the coaxial substantially setting of wherein said pipe, the lengthwise movement toward each other of wherein said pipe;

The localizer that comprises the localizer lobe has operationally the link and the free end that are connected with described first pipe, wherein said free end can around described link away from or move towards described longitudinal axis;

The localizer lobe spring element that is connected with described pipe assembly operationally, it acts on described localizer lobe, and described free end is actuated away from described longitudinal axis;

By described second pipe operationally support and with the collar of described localizer lobe sliding-contact, thereby make described first pipe carry out lengthwise movement with respect to described second pipe, so that make described localizer lobe motion through described collar, thereby selectively actuate described localizer lobe free end towards described longitudinal axis, perhaps the described result who actuates as described spring element allows described localizer lobe free end motion away from described longitudinal axis;

By managing the anchoring piece driver that assembly operationally supports; With

By the anchoring piece that described anchoring piece driver keeps releasedly, described anchoring piece comprises the lodge structure.

84,3 described apparatuses according to Claim 8, wherein, described localizer lobe is made by the material with shape memory, and biased, make described free end motion away from described longitudinal axis, described localizer lobe and described localizer lobe spring element are combined into discrete component therefrom.

85,4 described apparatuses according to Claim 8, wherein, the described a plurality of localizer lobes and described first tubular being integral.

86,3 described apparatuses according to Claim 8, wherein, described pipe assembly comprises angle of bend, wherein said angle of bend is spent between about 90 degree about 80.

87,4 described apparatuses according to Claim 8, wherein, described pipe assembly comprises angle of bend, wherein said angle of bend is spent between about 90 degree about 80.

88,5 described apparatuses according to Claim 8, wherein, described pipe assembly comprises angle of bend, wherein said angle of bend is spent between about 90 degree about 80.

89, a kind of apparatus that is used to realize bladder and urethra anastomosis comprises:

Pipe assembly with longitudinal axis comprises first pipe and second pipe, the coaxial substantially setting of wherein said pipe, the lengthwise movement toward each other of wherein said pipe;

The localizer that operationally supports by described pipe assembly;

The anchoring piece driver that comprises actuator pin, described actuator pin have link and the free end that operationally is connected with described first pipe, and the lengthwise movement of wherein said first pipe can cause the corresponding sports of described link;

By the anchoring piece that described actuator pin keeps releasedly, described anchoring piece comprises the lodge structure;

The actuator pin spring element that is connected with described pipe assembly operationally, it acts on described a plurality of actuator pin at least one, and described free end is actuated towards described longitudinal axis; With

Operationally be connected with described second pipe and with the actuator pin dilator of described actuator pin sliding-contact, thereby the lengthwise movement of described second pipe can cause the corresponding sports of described actuator pin dilator.

90,9 described apparatuses according to Claim 8, wherein, described actuator pin comprises elastic metallic, and biased, and described free end is moved towards described longitudinal axis, described actuator pin and described actuator pin spring element are combined into discrete component therefrom.

91,9 described apparatuses according to Claim 8, wherein, described pipe assembly comprises angle of bend, wherein said angle of bend is spent between about 90 degree about 80.

92, according to the described apparatus of claim 90, wherein, described pipe assembly comprises angle of bend, and wherein said angle of bend is spent between about 90 degree about 80.

93, a kind of apparatus that is used to realize bladder and urethra anastomosis comprises:

Pipe assembly with longitudinal axis comprises first pipe, second pipe, tee pipe and the 4th pipe, the coaxial substantially setting of wherein said pipe;

Wherein said first pipe, second pipe and tee pipe can be with respect to the 4th pipe also mutually

For lengthwise movement each other;

The localizer that comprises the localizer lobe, described localizer lobe has link and the free end that operationally is connected with described tee pipe, wherein said free end can around described link away from or towards the motion of described longitudinal axis;

The localizer spring element that is connected with described pipe assembly operationally, it acts on described localizer lobe, and described free end is actuated away from described longitudinal axis;

By described the 4th pipe operationally support and with the collar of described localizer lobe sliding-contact, thereby make described tee pipe manage lengthwise movement with respect to the described the 4th, make described localizer lobe motion pass described collar, thereby selectively actuate described localizer lobe free end towards described longitudinal axis, perhaps the described result of actuating as described spring element allows described localizer lobe free end motion away from described longitudinal axis;

Manage the anchoring piece driver that operationally supports by described first, described anchoring piece driver also comprises actuator pin, it has operationally link and the free end that is connected with described first pipe, thereby makes the lengthwise movement of described first pipe cause the corresponding sports of the described link of described actuator pin;

The actuator pin spring element that is connected with described pipe assembly operationally, it acts on described actuator pin, and described free end is actuated towards described longitudinal axis; With

Operationally be connected with described second pipe and with the actuator pin dilator of described actuator pin sliding-contact, thereby the lengthwise movement of described second pipe will cause the corresponding sports of described actuator pin dilator.

94, according to the described apparatus of claim 93, wherein, described actuator pin comprises elastic metallic, and biased, and described free end is moved towards described longitudinal axis, and described actuator pin and described actuator pin spring element are combined into discrete component therefrom.

95, according to the described apparatus of claim 93, wherein, described localizer lobe is made by the material with shape memory, and biased, described localizer lobe free end is moved away from described longitudinal axis, and described localizer lobe and described localizer lobe spring element are combined into discrete component therefrom.

96, according to the described apparatus of claim 93, wherein, described pipe assembly comprises angle of bend.

97, according to the described apparatus of claim 96, wherein, described angle of bend is spent between about 90 degree about 80.

98, according to the described apparatus of claim 94, wherein, described pipe assembly comprises angle of bend.

99, according to the described apparatus of claim 98, wherein, described angle of bend is spent between about 90 degree about 80.

100, according to the described apparatus of claim 95, wherein, described pipe assembly comprises angle of bend,

101, according to the described apparatus of claim 100, wherein, described angle of bend is spent between about 90 degree about 80.

102, a kind of apparatus that is used to realize bladder and urethra anastomosis comprises:

Pipe assembly with longitudinal axis comprises first pipe and second pipe, the coaxial substantially setting of wherein said pipe, and wherein said second pipe can be with respect to the described first pipe lengthwise movement;

By the end effector that described pipe assembly operationally supports, described end effector also comprises:

By the localizer that described first pipe operationally supports, described localizer comprises the localizer arm with the described second pipe mechanical connection, thereby makes the rotation of described second pipe will cause that described localizer arm is with respect to described longitudinal axis horizontal expansion or retraction;

Described mechanical connection between wherein said second pipe and the described localizer arm is by the localizer gear that is rotated around described second pipe and corresponding to the rotation of described second pipe and be operably connected to described localizer arm and provide with the localizer pinion of described localizer gears engaged; With

The anchoring piece driver that operationally supports by described pipe assembly.

103, according to the described apparatus of claim 102, wherein, described pipe assembly comprises angle of bend, and wherein said angle of bend is spent between about 90 degree about 80.

104, according to the described apparatus of claim 102, also comprise the anchoring piece that keeps releasedly by described anchoring piece driver, wherein said anchoring piece comprises the lodge structure.

105, according to the described apparatus of claim 104, wherein, described pipe assembly comprises angle of bend, and wherein said angle of bend is spent between about 90 degree about 80.

106, according to the described apparatus of claim 104, wherein, described anchoring piece comprises the puncture limiting structure.

107, a kind of apparatus that is used to realize bladder and urethra anastomosis comprises:

Pipe assembly with longitudinal axis comprises first pipe and second pipe, the coaxial substantially setting of wherein said pipe, and wherein said second pipe can be with respect to the described first pipe lengthwise movement;

By the end effector that described pipe assembly operationally supports, described end effector also comprises:

The localizer that operationally supports by described pipe assembly; With

Manage the anchoring piece driver that operationally supports by described first, the drive arm of described anchoring piece driver and the described second pipe mechanical connection, thus make the rotation of described second pipe will cause that described drive arm is with respect to described longitudinal axis horizontal expansion or retraction;

Described mechanical connection between wherein said second pipe and the described drive arm is by the localizer gear that is rotated around described second pipe and corresponding to the rotation of described second pipe and be operably connected to described localizer arm and provide with the localizer pinion of described localizer gears engaged; With

The anchoring piece driver that operationally supports by described pipe assembly; With comprise lodge structure and the anchoring piece that keeps releasedly by described drive arm.

108, according to the described apparatus of claim 107, wherein, described pipe assembly comprises angle of bend, and wherein said angle of bend is spent between about 90 degree about 80.

109, according to the described apparatus of claim 107, wherein, described anchoring piece comprises the puncture limiting structure.

110, a kind of apparatus that is used to realize bladder and urethra anastomosis comprises:

Pipe assembly with longitudinal axis comprises first pipe, second pipe and the tee pipe, the coaxial substantially setting of wherein said pipe;

Wherein said second pipe can be with respect to the described first pipe rotation; With

Wherein said tee pipe can be with respect to the described first pipe lengthwise movement;

By the end effector that described pipe assembly operationally supports, described end effector also comprises:

By the localizer that described first pipe operationally supports, described localizer comprises the localizer arm with the described second pipe mechanical connection, thereby makes the rotation of described second pipe will cause that described localizer arm is with respect to described longitudinal axis horizontal expansion or retraction; With

The anchoring piece driver that operationally supports by described tee pipe, described anchoring piece driver comprises the drive arm with the described second pipe mechanical connection, thereby makes the rotation of described second pipe cause that described drive arm is with respect to described longitudinal axis horizontal expansion or retraction.

111, according to the described apparatus of claim 110, wherein, described pipe assembly comprises angle of bend.

112, according to the described apparatus of claim 111, wherein, described angle of bend is spent between about 90 degree about 80.

113, a kind of hand-operating device that is used to grip and realize the lengthwise movement of driving relatively and retraction between two elements of medical apparatus and instruments comprises:

Handle component, have longitudinal guide spare that defines the vertical line of advancing and the longitudinal groove that comprises the apparent surface that a pair of and described travel line is parallel, described longitudinal groove also has the first and second terminal and using pawl to brake sheets in one of described apparent surface;

Cooperate and remain on motor element in the described longitudinal guide spare, it can be with respect to described handle component along the lengthwise movement therein of described travel line, have in the described motor element along with the first and second pawl holding tanks of second circuit of described travel line almost parallel;

Drive and trigger element, further comprise:

Be retained in the longitudinal groove of described handle component and can be along the point element that wherein moves, it is suitable for being caught releasedly by described using pawl to brake sheet,

Near the pawl of described motor element, it one of is suitable for being inserted in the described pawl holding tank when described motor element moves in described longitudinal guide spare, thereby one of pawl holding tank is aimed at and the trigger part with described pawl in operation;

Wherein said pawl and described trigger partly move around described point element,

Described pawl around described point element towards or away from the motion of described motor element;

The pawl actuation spring, it operationally is connected with described handle component and described driving triggering element, so that actuate described pawl towards described motor element;

Ratchet spring, it operationally triggers element with described handle component and described driving and is connected, and operationally on time, actuates described point element towards described using pawl to brake sheet with the described point element of box lunch and described using pawl to brake sheet;

Driving spring, it operationally is connected with described motor element with described handle component, moves along described travel line in described longitudinal guide spare so that actuate described motor element.

114, according to the described device of claim 113, wherein, described pawl actuation spring and described ratchet spring comprise single spring.

115, according to the described device of claim 114, wherein, described single spring is a torsionspring.

116, according to the described device of claim 113, wherein, described trigger part also comprises retraction element.

117, a kind of method that is used for will comprising patient's urethra anastomosis that patient's bladder of the wall of urinary bladder that defines bladder cavity and bladder opening and pelvic floor by the patient center on behind prostatectomy comprises the following steps:

To have longitudinal axis and comprise that the apparatus of capsule assembly, localizer and anchoring piece driver is inserted through the otch of patient's abdominal part along the direct motion direction, enter and pass the otch of wall of urinary bladder and enter bladder cavity, place bladder cavity inside up to described capsule assembly, described localizer and described anchoring piece driver;

By described localizer make locator element in bladder cavity with respect to described longitudinal axis horizontal expansion;

Described locator element is contacted with wall of urinary bladder in that bladder cavity is inboard, cause that described locator element actuates wall of urinary bladder and enter near the pelvic floor;

Make described anchoring piece driver pass wall of urinary bladder and enter pelvic floor, described anchoring piece lodge in pelvic floor, and is discharged anchoring piece from described anchoring piece driver from its anchoring piece of bladder cavity internal drive with lodge structure,

Wherein said anchoring piece actuation step comprises uses anchoring piece that the capsule fixation clamp part of described apparatus is connected with pelvic floor near the bladder opening;

Make described localizer with respect to the described locator element of the horizontal retraction of described longitudinal axis;

Withdraw from described localizer and described anchoring piece driver from the patient;

After described localizer and anchoring piece driver withdraw from step, the capsule that is comprised by described capsule assembly that is arranged in described capsule fixation clamp is expanded, thereby use described capsule roughly to seal the bladder opening;

The conduit that use is included in the remainder of described apparatus is urinated from bladder cavity;

Effectively knit the position that keeps described capsule fixation clamp, described capsule and described conduit in the required together time period in wall of urinary bladder and pelvic floor tissue; With

To described capsule venting, described capsule fixation clamp is broken away from described anchoring piece be connected, and withdraw from described capsule, described conduit and described capsule fixation clamp from the patient.

118, according to the described method of claim 117, wherein, but described anchoring piece has the biology absorption portion that keeps described capsule fixation clamp, but described biology absorption portion after the described time period, be dissolved in patient's body, thereby realize described disengaging step of connecting.

119, a kind of apparatus that is used to realize bladder and urethra anastomosis comprises:

Pipe assembly with longitudinal axis comprises first pipe and second pipe, the coaxial substantially setting of wherein said pipe, the lengthwise movement relative to each other of wherein said pipe;

By the end effector that described pipe assembly operationally supports, described end effector also comprises:

The localizer that comprises localizer arm, described localizer arm has first fragment that can be operatively connected with described second pipe, described first fragment also has the joint that is connected with second fragment, described second fragment is operationally supported by described first pipe, thereby makes described second pipe cause that with respect to the lengthwise movement of described first pipe described localizer arm is with respect to described longitudinal axis horizontal expansion or retraction;

The anchoring piece driver that operationally supports by described pipe assembly; With

By the anchoring piece that described anchoring piece driver keeps releasedly, described anchoring piece comprises the lodge structure.

120, according to the described apparatus of claim 119, wherein, described pipe assembly comprises angle of bend.

121, a kind of apparatus that is used to realize bladder and urethra anastomosis comprises:

Pipe assembly with longitudinal axis comprises first pipe and second pipe, the coaxial substantially setting of wherein said pipe, and wherein said pipe can carry out lengthwise movement relative to each other;

By the end effector that described pipe assembly operationally supports, described end effector also comprises:

The localizer that operationally supports by described pipe assembly;

The anchoring piece driver that comprises drive arm, described drive arm has the link that is operably connected with described first pipe, thereby the lengthwise movement that makes described first pipe will cause the corresponding sports of described link, described drive arm also has movable end, its can around described link towards or away from the motion of described longitudinal axis;

By the anchoring piece that described drive arm keeps releasedly, described anchoring piece comprises the lodge structure;

The spring element that is connected with described pipe assembly operationally, it acts on described drive arm is actuated away from longitudinal axis described movable end; With

Operationally be connected with described second pipe and with the closed collar of described drive arm sliding-contact, thereby make described second pipe selectively actuate described movable end towards described longitudinal axis with respect to the lengthwise movement of described first pipe, perhaps the described result of actuating as described spring element allows described movable terminal motion away from described longitudinal axis.

122, according to the described apparatus of claim 121, wherein, described pipe assembly comprises angle of bend.

123, a kind of apparatus that is used to realize bladder and urethra anastomosis comprises:

Have longitudinal axis and comprise the pipe assembly of pipe;

By the end effector assembly that described pipe assembly operationally supports, described end effector assembly also comprises:

The localizer that operationally supports by described pipe assembly;

By the anchoring piece driver that described pipe assembly operationally supports, comprise the anchoring piece that keeps releasedly by described anchoring piece driver;

The capsule fixation clamp has the guide end and the anchoring piece end that are operably connected to described pipe.

124, according to the described apparatus of claim 123, wherein, the described anchoring piece end of described capsule fixation clamp is kept releasedly by described anchoring piece.

125, according to the described apparatus of claim 123, wherein, described pipe assembly comprises angle of bend.

126, according to the described apparatus of claim 123, wherein, described anchoring piece comprises the lodge structure.

127, according to the described apparatus of claim 124, wherein, described anchoring piece comprises the lodge structure.

128, according to the described apparatus of claim 123, wherein, but described anchoring piece comprises the biology absorption portion.

129, according to the described apparatus of claim 124, wherein, but described anchoring piece comprises the biology absorption portion.

130, according to the described apparatus of claim 129, wherein, but the described biology absorption portion of described anchoring piece keeps the described anchoring piece end of described capsule fixation clamp.

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