DE1766037A1 - Stapling machine for joining living tissue and cartridge for this - Google Patents

Description

Cologne, March 23, 1968 Eg / Ax

Codman & Shurtleff, Inc., Randolph, Massachusetts "USA

Stapling machine for joining living tissues and cartridge therefor

This invention relates to small stapling machines of the type used by surgeons to join living tissues and replaceable cartridges for these staplers.

The main object of the invention is a stapling machine which attaches a single miniature staple with each actuation, has the two legs and a middle piece connecting the legs. The stapling machine according to the invention enables it allows the surgeon to remove two or more layers of tissue by applying a plurality of staples, one at a time be placed one after the other, quickly connect

Complicated operations on blood vessels, bronchi, large J Pulmonary blood vessels, intestines, etc. require similar suturing. This problem becomes more difficult for the surgeon as the size of the vessel decreases. The stapler according to The invention enables the surgeon to work quickly with great Precision to set a single bracket or a large number of brackets in the shortest possible time.

A stapler that can be used to set a variety of miniature staples in sequential order is Subject of applicant's U.S. Patent β 3,225,996. the However, the stapler and cartridge according to the invention work

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different and offer the surgeon a significant advantage in that the tip of the stapler is small and provides excellent insight precisely at the point that the surgeon must see clearly during the stapling "

The surgical stapling machine according to the invention operates with precision. It's foolproof, reliable to use and has a narrow tip that allows a good view of the surgical site. Each time you press this Machine a series of individual miniature clamps is placed one after the other.

The invention also relates to a staple cartridge which is disposable and interchangeable and mechanically with a plurality can be loaded by miniature clips

The invention is explained below with reference to the figures.

Pig.1 shows, as a side view and partially in section, an embodiment of the invention.

Pig. 2 shows a reverse view of the in eq. 1 Stapling machine shown along line 2-2 of Pig.1.

Pig.3 shows a longitudinal section along the line 3-3 of Pig. 1.

Pig. 4 shows an end view in the direction of line 4-4 of FIG Pig.1, with certain parts omitted for the sake of clarity.

Pig.5 is a vertical section along line 5-5 of Pig. 1.

Pig.6 is a top view of the anvil of the stapler on a larger scale.

Pig.7 is a cross section through the anvil along the line 7-7 of Pig. 6

Pig. 8 shows the cartridge shark in perspective and pulled apart t sr and the associated slider.

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FIG. 9 is a vertical section taken along line 9-9 of FIG Fig. 2.

10 shows a staple cartridge in perspective, from the end of the tear seen here.

FIG. 11 is an inverted perspective view of FIG Fig. 10 cartridge shown.

Fig.12 shows in perspective and exploded the Cartridge and the staple pusher from the insertion end of the Cartridge seen

Fig. 13 is a top plan view of those in Figs. 10, 11 and 12 illustrated cartridge

Fig. 14 is a side view of this cartridge.

FIG. 15 is an end view of that shown in FIG Cartridge on the outlet end

Fig x 16 is a vertical section along line 16-16 of Fig _# i4.

Fig.17 is a longitudinal section taken along line 17-17 of Fig.13 with inserted brackets »

FIG. 18 is a top plan view taken along line 18-18 of FIG.

Fig. 19 shows the first bracket in the one shown in Fig. 17 Cartridge·

FIG. 20 shows part of the cartridge shown in FIG with the pestle, a clamp and the anvil in working position.

Fig.21 is a modification of that shown in Fig.1 Stapler with one cartridge ready to use.

Fig. 22 is a side view of this stapler.

Fig. 23 is a longitudinal cross-section on an enlarged scale the line 23-23 of Figure 21.

FIG. 24 shows in perspective a spring which is used in the case of the FIG and 22 were used

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Fig. 25 1st tine enlarged plan view of a cartridge » at the some · parts for the clearer Veranaohauliohu ^ g the way of working are exaggerated

fig · 26 is a sonity through this cartridge along the line 26-26 yon FIg * 25 »with the ram and the anvil in the Position for pressing a bracket are "

Fig. 27 is a front view, seen in direction of the Line 27-27 of Figure 26.

The construction and operation of the stapler according to the invention will now be made with reference to FIGS Embodiments described, which are shown in the figures "are shown.

Trefoil staple sole

1, 2, 3 and 20 show a surgical stapling machine 21, that of a clamp with stapling arm 22, which ends in a ram, .and an anvil arm 24, which is in an anvil 25 expires, consists. The arms 22, 24 are for pressing a clip 26, which is located in a cartridge 28 above the Anvil 25 is located, relative to each other and movable from each other. Both arms are knurled 30 on the outside to improve the Handles provided. A cartridge holder 32 is attached to the staple arm 22 with a leaf spring 34.

W The two arms 22 and 24 are elastic and form a leaf spring. In the rest position, the arms are spread apart, as shown in Fig. 1 *

As best shown in Fig. 3, θ and 9, one engages Limiting shaft 36 a slider 36, the task of which will be described below * This limit stop is attached to the cartridge holder 32. The upward movement of the upper arm 22 relative to the cartridge holder 32 is limited by the head 40 of a screw 42 which duroh a Cutout 44 in the boundary sole 36 protrudes. This is

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the stapling arm 22 pretensioned,

The lower arm 24 of the clamp terminates in an anvil 25, which is provided with two bending grooves 27 and 29

The cartridge holder 32 (Pig. 3 and 8-11) is provided with two fork arms 45 and 47 which are arranged at a distance from one another are and sioh with a friction fit in two lateral grooves 49 and 51 of the staple cartridge 28, the slider 38 becomes through shoulders 53 and 55 at the limit stop 36 held at the top of the cartridge holder 32. The movement of the slider is parallel in one direction limited to the longitudinal axis of the cartridge holder by the projection 52 I, which slides between the fork arms 45 and 47. The slide is normally in its forward position, which is shown in Pig.1, by the tension of the Spring 54 held, which the shoulders 57 and 59 of the slider 38 against the back of the limiting shoe 36 presses.

Staple cartridge

As best shown in Figure 10 to 19, the staple cartridge may be made of plastic, with a centrally arranged Sohieberschaoht 60 is provided which extends from the rear end 62 of the cartridge to the SiOH countertransference g lying parallel clamp Rails 63 and 65 streokt at the front end (exit end) of the cartridge. The parallel grooves are formed by the side walls of the shell 60 and the walls of the parallel projections 77 and 79. These projections run perpendicular to the longitudinal axis of the cartridge and the shaft. The cartridge is preferably molded in one piece at the front end of the sohaohtes with a center piece 64, the end face 66 of which is arranged between the grooves 63 and parallel to the inner surfaces of the projections 77 and 79 which are at a distance therefrom "that of the dioco tine single bracket" ntsprioht. Di · Thicken a bracket

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depends on the diameter of the wire used to make the bracket and is about 0.15 to 0.23 mm A multitude of miniature clips are located in the sihaoht of the cartridge, and each clip consists of two legs 67 and 69 connected by a central part 68 (Fig. 19). As best shown in Fig. 17, the series is from Staples aligned parallel in the shaft, with the center of each staple in rubbing contact with the top 70 of the Schaohtes and the free ends 71 and 73 of each bracket are in rubbing contact with the tip guides 61 and 72 are located and in a direction perpendicular to the longitudinal axis the cartridge show

A U-shaped clip slide 74 is provided, the Cross-section corresponds to the cross-section of the clamps and the shaft «The slide slides in the shaft in the direction of the Longitudinal axis of the cartridge and is aligned with the row of staples it contains. When the clip pusher is pushed toward the front end of the cartridge, the row of clips is pushed forward so that the first clip 26 of the row is pressed against the outer walls 77 and 79 of the parallel grooves.

A protrusion 80 on the top 82 of the cartridge has a front face 84 that is parallel to the protrusions 77 and 79 is perpendicular and aligned with the first bracket 26. The projection 80 lies against the The plunger 23, as shown in Fig.9, and has the two gilben, the cartridge against the pressure of the spring 54 on the Hold cartridge holder and align the cartridge and bracket 26 with the plunger and anvil. The vertical ! Areas 81 and 82 at the front end of the cartridge have a distance that is slightly larger than the width of the plunger 23, and prevent lateral movement of the ram if it is moved near the bottom to press in the clamp.

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The markings 83 and 85 are provided, which indicate the position of the clamp and represent an aid for the surgeon, the instrument and position the cartridge in relation to the tissue to be stapled. As shown in the pictures, can have serrated gripping surfaces 86 and 88 on the back of the Cartridges can be provided where obstruction of the surgeon's view is not a problem.

Regarding the clamp sizeji that come in embossing when there is the following examples of desirable sizes are important:

2 mm- 3 mm-

Wire diameter (thickness of the bracket), 0.15 0.23

IHTTl

Length of the middle section 68 (width of the clamps), mm 2.03 3.05

Length of leg 69 (clip height) mm 2.54 3.56

Each cartridge 28 can be hand loaded · Preferably a filling machine is used for this. To facilitate machine loading of the cartridges with a variety of clamps and to see the clips when they are all in place, an opening 90 can be made on the underside 92 the cartridge. The width of the opening 90 f corresponds to the width of the shaft 60. Each cartridge 28 with brackets are used in any suitable manner sterilized and kept packaged in a sterilized state until use.

Way of working of Stapler

Removed for use of the stapling machine, the nurse or the surgeon sterile cartridge from the sealed container, whereby they grasped at the toothed gripping edges 86 and 88 and in the direction of the arrow (Fig.1) on the Patro-

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holder is pushed. While the cartridge is on the Holder 32 is pushed, the Klainme slide 74 is against the projection 52 of the slide 38 is pressed · This moves the slide in the direction of the arrow against the tension of the Spring 54 is pressed · At the same time, the plunger 23 is pushed through the sawn-off surface of the projection 80 at the front end the cartridge is pushed upwards, whereby iar is returned to its normal rest position, which is shown in Fig.9 is after the edge 84 of the protrusion is the end of the Has exceeded the plunger · The cartridge can then be released because they are in their fixed position duroh the tension. the spring 54 is held, which is the edge 84 of the projection ™ 80 presses against the plunger 23. An angular movement of the Cartridge relative to the cartridge holder is prevented by the fork arms 45 and 47 of the holder from getting into the longitudinal grooves 49 and 51 on the cartridge

The lower arm or anvil spring 24 is weaker than the preloaded plunger spring 22, so that when the two arms 22 and 24 are pressed against each other by the surgeon Anvil 25 first rises into a position which is shown in dashed lines in FIG. 9 · This makes it easier for the surgeon possible, the tissue between the anvil and the underside the cartridge before depressing the clip.

P With further pressure, the plunger moves in a wide arc

pressed against the tension of the spring 34 downwards. While the downward movement of the plunger he lays against the Area 66 of the Mittelstüoks 64 and is in the plane of the Grooves 63 and 65 steered, whereby he presses the first clamp 26 out of the cartridge through the tissue and a · on the amboe « When the clamp is in place and the surgeon releases the pressure exerted, "the arms return to their" preexcited position, the solid lines throughout is shown in Fig.9, and the spring 54 moves the slide 38 and its end projection 52 forwards, whereby the Klammereohiiber 74 is advanced in Sohaoht 60 · The B · -

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movement of the row of brackets as the Clip slider in the shaft is understandable from Pig »25 to 27 · Each bracket in the row is in sliding contact with the top 70 and side walls 75 and 76 of the Well 60. While the plunger 25 lifts from the surface 70 of the Sohachtes, the next clamp in the row between the top of the sole 70 and the top of the center piece 64 against the shoulders 77 and 79 pushed under the plunger 23 in the position for insertion. From the above it follows that there is always a clamp between the ram and the anvil during use of this instrument until j the staple supply in the cartridge has been used up.

Stapling machine with ring handle

In Fig. 21 and 22 is a modified stapling instrument of the scissors type, which differs from the surgical stapler described above in the shape of the lever arms and accordingly differentiates in the location of the hinge 120. It can be seen that the stapling machine shown in Pig.21 and 22 in most of the other features of the in Fig.1 to 7 is similar to the illustrated stapler and operates in the same manner. Therefore, for identical parts the same reference numerals are used, while only corresponding parts are provided with different Yor numerals. ^

The modified surgical stapling machine shown has a pair of lever handles with a staple arm 122 running into a ram 23 and an anvil arm 124 running into an anvil 25. The pinger grips 102 and 104 at the opposite ends of the arms 122 and 104 124 facilitate accurate placement and operation of the stapler deep within a body cavity. Am cartridge

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- ίο - 176603

holder 32 is attached to the staple arm 122 with a spring 134-.

As best shown in Figure 23, a limit stop 136 is attached to the cartridge holder 32. This attack encompasses a slider 38, the function of which has already been described. The upward movement of the upper arm 122 relative to the cartridge holder 32 is limited by the stop 136. Due to the tension of the spring 134, the plunger and the cartridge holder is normally held in the spread position shown in the figures Way, the staple arm 122 is biased. The stop 136 simultaneously limits the distance between the cartridge holder 32 and the plunger 23 and ensures that the cartridge by the pressure of the plunger against the end face 84 of the cartridge projection 80 is retained on the holder.

In the modified stapler as described above, the cartridge holder 32 is with two fork arms 45 and 47 provided, the distance between which is dimensioned so that they slide against the lateral grooves 49 and 51 on the staple cartridge 28 place. The slider 38 is by the projections 153 and 155 on the limit stop 136 against the Top of the cartridge holder 32 is depressed, and the movement of the slide is in a direction parallel to the longitudinal axis of the cartridge holder is limited by the projection 52 which slides between the fork arms 45 and 47. The slider is normally held in its front position shown in Fig. 22 by the tension of the spring 54

The cartridges for the stapler shown in Fig. 21 and 22 are identical in all features to the cartridges described above and * shown in Figs. 10 to 20. As previously mentioned, the cartridge is preferably disposable and can be made of plastic or some other inexpensive material that can be treated, such as the plastic known ^{under the trade name "Delrin w."}

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The operation of the modified instrument is similar like that of the stapler described above. A sterile staple cartridge is placed on the cartridge holder until behind the Plunger pushed and released. The spring-loaded slide holds the end face 84 of the cartridge projection 80 against the inside of the plunger, which brings the cartridge into the correct position on the holder in which the first clamp is located directly under the plunger. The surgeon then grasps the stapling tissue between the The anvil and the bottom of the cartridge and sets the clamp by applying pressure to the pinger handles that hold the lever handles close, which pushes the KLanmer out of the cartridge

The spring 134 causes the plunger to be returned to the position shown in FIGS. 21 and 23 when the surgeon

relieves the pressure on the finger grips, whereupon a new clip in the cartridge is advanced through the clip pusher as described above.

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Claims (1)

Claims A cartridge characterized by a centrally located well (60) extending from one end (62) of the cartridge and having two opposite parallel shoulders (77t79) && front end perpendicular to the longitudinal axis of the cartridge (28) and to the top of the The shaft (60) is connected, a number of miniature clips inserted into the cartridge (28) which each have two legs (67, 69) and a central piece (68) connecting the bottom handles and are aligned parallel to one another in the shaft 60, the first bracket (26) in the series being in contact with the shoulders (77 »79) and swelling at the front end of the chute (60), the legs (67,69) of this bracket (26) in sliding contact therewith the side surfaces of the shaft (60) is located, the center piece (68) of all other brackets in the row is in sliding contact with the top of the bracket (60) and the free ends (71,73) of each bracket in a direction perpendicular to the L. show the longitudinal axis of the cartridge (28); a U-shaped slider (74) which has the same luer cut as the clamps and the jtohaoht (60), is aligned with the clamps and slides in the Sohaoht (6O) in the direction of the longitudinal axis of the cartridge (28) and thereby the Clamps one after the other towards the front end of the cartridge (28) and against the wall of the parallel shoulders (77,79) a Klammeretofiel (23) which is slidable in a Riohtung perpendicular to the cartridge socket and slightly narrower (distance A) than the distance between the shoulders (77i79) B, but wider (distance 0) than the Diameter of the staple (middle piece 68), distance A 109821/0664 2) cartridge according to Anspmoh 1, characterized by two opposite longitudinal grooves (49 »51) ι those on opposite Sides of the cartridge (28) are arranged and the cartridge in a plane perpendicular to the legs Halve (67,69) the brackets. 3) cartridge according to Anspruoh 2, characterized in that the longitudinal grooves (49,51) at the front end of the cartridge in end a shoulder (77,79), 4) cartridge according to claim 2, characterized in that the opposite sides of the cartridge, which protrude beyond the longitudinal grooves (59,51), are toothed (86,88). i 5) cartridge according to claim 1, characterized duroh a ' rectangular opening (90) on the underside of the shaft (60), which has the same width as the shaft (60) and runs smoothly with this. 6) cartridge according to claim 1, characterized by a Protrusion 80 at the front end that goes over the top (82) of the cartridge (28) protrudes, and its leading edge to the inner walls of the opposite straight line parallel shoulders (77,79) has a distance that corresponds to the dioke of a bracket and aligned with this is. I. 7) cartridge according to claim 6, characterized by a central piece (64) formed in one piece with the cartridge at the front end of the shaft (60), the front end face (66) of the central piece lying in the plane of the front edge of the projection (80) 8) stapling machine, which serves to attach a single miniature staple with two side parts (67,69) each time it is pressed and a central cover (68) connecting the side parts fasten au, marked duroh 109821/0664 a) a clamp with two mutually movable arms (22,24), b) a cartridge holder (32) which mixes the two arms (22,24) of the clamp arranged, ο) a slider (32) which is attached to the cartridge holder (32) and is spring-loaded, d) a removable cartridge (28) which can be inserted into a certain position on the holder (32) and which is attached to the front End with opposite straight parallel shoulders (77,79) perpendicular to the plane of the holder (32) is provided, a number, of miniature clips, each of which contains two legs (67,69) and one die Having a middle piece (68) connecting legs, and which are parallel to one another in a centrally located Sohaoht (60) are arranged, which extends from one end of the cartridge (28) to the parallel shoulders (77,79) extends with the first bracket (26) in the series in contact with the shoulders (77,79) and between the walls of the shaft (60) floats, the middle piece (68) of all remaining clamps in the row is in sliding contact with the top of the shaft (60) and the free ends (71,73) of each clamp are in show a direction perpendicular to the longitudinal axis of the cartridge (28), e) a U-shaped slider (74), which is in. Manhole (60) the cartridge (28) slides, has the same cross-section as the clips and the well (60) and in Vertical alignment on the brackets and in contact with the spring-loaded slide (28) is aligned, what about a Druok, which by the slide (38) on the slider (74) is exercised, transferred to the row of staples and the first staple (26) in the Row against the outer wall of the parallel shoulder shoulders (77, 79) and at the front end of the shoulder (60) is held in the weave, 109821/0664 f) an anvil (25) which is opposite the free end (7t »73) of the legs (67,69) of the levitated Bracket (26) located when cartridge (28) is in place and has two curved bending grooves (27,29) is provided, and g) a plunger (23) * which is at one end of the other Arms (22) and is located opposite the position assumed by the middle section (68) of the first clamp (26), when the cartridge (28) is inserted and is arcuately movable to and from the anvil (23) and so actuated can be that it pushes against the middle piece (68) and presses and thereby the first bracket (26) in rectilinear movement to the bending grooves (27 * 29) abuts. 9) stapling machine according to claim 8, characterized in that the ram (23) is narrower than a clip (26) 10) stapling machine according to claim 8, characterized in that the plunger (23) is thicker than a clamp (26), 13) stapling machine according to claim 8, characterized in that that the lever arms (22,24-) are provided with ring handles (102,104) 109821/0664 Blank page