EP0043837A4 - Chirurgisches heft- und schneidgerät. - Google Patents
Chirurgisches heft- und schneidgerät.Info
- Publication number
- EP0043837A4 EP0043837A4 EP19810900401 EP81900401A EP0043837A4 EP 0043837 A4 EP0043837 A4 EP 0043837A4 EP 19810900401 EP19810900401 EP 19810900401 EP 81900401 A EP81900401 A EP 81900401A EP 0043837 A4 EP0043837 A4 EP 0043837A4
- Authority
- EP
- European Patent Office
- Prior art keywords
- staple
- tissue
- actuator
- elements
- stapler
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Withdrawn
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
- A61B17/1152—Staplers for performing anastomosis in a single operation applying the staples on the outside of the lumen
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B2017/1125—Forceps, specially adapted for performing or assisting anastomosis
Definitions
- My invention improves on surgical staplers for end-to-end anastomoses of tubular tissue such as bowel, bile duct, and vascular arteries and veins. It accomplishes an end-to-end, rather than a side-to-side, anastomosis; and it uses several features that shorten the time and reduce the trauma of tubular tissue anastomosis while improving the accuracy and reliability of the tissue stapling.
- My stapler can accommodate different sized tissue, can operate in cramped quarters, and generally simplifies and reduces the cost of stapling anastomoses.
- My surgical stapler is for end-to-end anastomoses of tubular tissue; and it includes a two part clamp actuator that grips the tissue, holds its ends in everted orientation, and brings the everted ends into juxtaposed registry as the clamp actuator parts are interconnected.
- My stapler uses a four part disposable staple cartridge formed as two mating pairs of elements that include staple holders and staple folding pads formed in curves that fit around the everted ends of the tissue.
- Each part of the clamp actuator has one pair of jaws for clamping the tissue and another pair of jaws for holding mating pairs of elements of the staple cartridge.
- Each part of the staple cartridge has pins for holding the everted tissue, and a pair of curved knives are arranged in staple holding elements of the staple cartridge to be positioned radially inward from the tissue holding pins and radially outward from the array of staples and are shaped to encircle the staple array.
- Actuator wedges are movably disposed in the staple holding elements of the staple cartridge, and actuator pliers on the part of the clamp actuator that holds the staple holding elements are arranged to engage and operate the wedges to drive the staples and knives to secure the staple array in place and trim off the tissue around the staple array.
- Figures 1-9 show one preferred embodiment of my stapler including a two part clamp actuator with actuator pliers on each part for driving staples through from both sides of the intended anastomosis;
- Figure 1 is a side elevational view of one part of a clamp actuator;
- Figure 2 is a plan view of the clamp actuator part of FIG. 1;
- Figure 3 is a side elevational view of the clamp actuator of FIG. 1 loaded with disposable staple cartridge elements
- Figure 4 is a side elevational view of the other part of a clamp actuator loaded with the other mating pairs of elements of a disposable staple cartridge;
- Figure 5 is a plan view of both clamp actuators interconnected to accomplish an anastomosis;
- Figure 6 is a side elevational view of a preferred embodiment of an element of a staple cartridge used in the embodiment of FIGS. 1-9;
- Figure 7 is a rear elevational view of the cartridge element of FIG. 6;
- Figure 8 is a partially cross sectioned end elevational view of the cartridge element of FIG. 6;
- Figure 9 is a partially cross sectioned end elevational view of both clamp actuators loaded with cartridge elements and interconnected for operation;
- Figures 10 and 11 are respective plan and side elevational views of an alternative plierless clamp actuator for use with a mating clanp actuator having actuator pliers such as shown in FIG. 4;
- FIGS. 12-15 show an alternative embodiment of clamp actuators having an angle between handles and working jaws, with FIGS. 12 and 13 showing plan views of interconnectable parts of the clamp actuator and FIGS. 14 and 15 showing respective fragmentary elevational views of the jaws of the actuators of FIGS. 12 and 13 loaded with cartridge elements; and
- Figure 16 is a partially schematic, elevational cross-sectional view of an end-to-end anastomosis made with my surgical stapler.
- DETAILED DESCRIPTION My tool uses two interconnectable parts that clamp end regions of tubular tissue, hold the tissue ends in everted orientation, and interconnect to position the everted ends in juxtaposed registry. Actuator pliers then drive staples through the everted tissue ends and operate curved knives that trim off tissue around the staple array.
- FIG. 16 The form of end-to-end anastomosis made with my stapler is shown in FIG. 16.
- Two lengths of tubular tissue 10 and 11 have their respective ends 12 and 13 everted and fastened by a double row of staples 15.
- the anastomosis is completed along a seam line 14 where the tissue scars together to join elements 10 and 11 in the position maintained by staples 15.
- the stapled tissue is shaped like a flange extending around tubes 10 and 11, and excess tissue radially outward from the outer row of staples 15 is neatly trimmed away.
- My stapler uses a pair of clamp actuators that hold four parts of a disposable staple cartridge and fasten to the tissue to be anastomosed.
- the clamp actuators clamp to and hold the tissue ends in everted orientation and interconnect to position the everted ends for stapling.
- Actuator pliers then drive the staples through the tissue and against staple folding pads and simultaneously operate the trimming knives to cut away excess tissue.
- the embodiment of FIGS. 1-9 includes actuator pliers on each part of the clamp actuator and drives staples through the tissue from both sides of the anastomosis, and the alternative embodiments of FIGS. 10 and 11 and FIGS. 12-15 drive staples through tissue in one direction only with a single set of actuator pliers. In the double actuator embodiment of FIGS.
- clamp actuators 20a and 20b are respectively shown separately in FIGS. 1 and 4 and interconnected for operation in FIGS. 5 and 9.
- Each clamp actuator 20 includes both a double jawed tissue clamp and staple cartridge holder 21a and 21b and also actuator pliers 22a and 22b.
- the clamps 21 hold the tissue and the staple cartridge elements in proper positions for stapling, and the pliers 22 drive the staples through the tissue and against staple folding pads and also operate the trimming knives.
- Clamps 21 have conventional handles 23, a pair of tissue clamping jaws 24, and a pair of cartridge element holder jaws 25.
- An optional nose pin 26 accurately registers the noses of holder jaws 25 by extending through one jaw 25 and into a recess in the mating jaw 25.
- Tissue clamping jaws 24a and 24b are disposed to clamp tubular tissue a short distance from the ends to be joined and also close off or occlude the lumen of the tissue.
- Holder jaws 25a and 25b have projections 27 positioned for fitting recesses 28 in staple cartridge elements that are mounted for operation on jaws 25.
- Closing clamps 21 both clamps the tissue to be joined with jaws 24 and also brings cartridge elements into a mating relationship surrounding the tissue end regions.
- Staple cartridge 30 is disposable after a single use and has four parts formed as two mating pairs of elements 30a, a' and 30b, b' respectively held on jaws 25a and 25b for closing around tissue to be joined.
- Cartridge elements 30 are formed partly of molded plastic and partly of stainless steel and can be made in several sizes that fit a single clamp actuator tool 20.
- each staple cartridge element 30 includes a curved array of staples 35 and a corresponding curved array of staple folding pads 36 so that staples can be driven through tissue from both sides.
- Cartridge elements 30a and a' have staples 35a on an inner curve and staple folding pads 36a on an outer curve
- cartridge elements 30b and b' have folding pads 36b on an inner curve for folding staples 35a from cartridge elements 30a and a' and also have a curved array of staples 35b on an outer curve to be folded by the pads 36a of cartridge elements 30a and a'.
- Curved trimming knives 34b and b' are arranged in cartridge elements 30b and b' to extend around the curved array of staples 35b.
- Knives 34b push against knife pads 34a and a' in a corresponding curve around the outer ring of staple folding pads 36a of cartridge elements 30a and a'. As knives 34b and b' press against pads 34a and a', they trim off the tissue cleanly and neatly around the staple array.
- Staples 35a and 35b and knives 34b are driven by wedges 37 that are movably trapped in each staple cartridge 30.
- a staple and knife pusher element 38 as best shown in FIG. 8 is movable laterally within each cartridge element 30 and engages staples and knives.
- a ramp 39 guides wedge 37 to move laterally against pusher 38 as wedge 37 is pressed radially inward toward the clamped tissue. Wedge 37 thus drives pusher 33 to press staples 35 into position and push knives 34 to trim away excess tissue.
- Each staple element 30 has radial pins 40 spaced around the staple array for holding the everted ends of the clamped tissue. The surgeon pulls the tissue ends radially outward and hooks them over pins 40 to evert the tissue ends for stapling.
- clamp actuators 20 When clamp actuators 20 are secured to the tissue and the tissue ends are everted and held on pins 40, the clamp actuators 20 are interconnected as shown in FIG.
- Locator pin 26b can be screwed against pin 42 to help accomplish the interconnection of clamp actuators 20 as shown in FIG. 5.
- Wedges 37 that operate staple cartridge 30 are in turn operated by actuator pliers 22, which have jaws 32 disposed to engage wedges 37.
- actuator pliers 22 With clamp actuators 20 interconnected as shown in FIG. 5 to hold tissue in proper position, the surgeon squeezes pliers 22a and 22b to close jaws 32a and 32b and drive wedges 37 radially inward. This forces pushers 38 laterally to drive staples 35 and knives 34 as previously explained.
- the result is a double row of staples passing through the anastomosis from both sides and folded securely in position, with the excess tissue neatly trimmed around the outer staple row.
- the excess tissue that is trimmed away remains on pins 40; and when the surgeon loosens and removes clamp actuators 20, the anastomosis is complete.
- Clamp actuators 20 are preferably formed of stainless steel and are relatively simple and partially conventional so they can be cleaned conveniently. Cartridge elements 30 are discarded after a single use to achieve several advantages. Cartridge elements 30 have tiny openings and would be difficult to clean; they are also relatively small and can be made at low cost from molded plastic. Staple folding pads 36 operate only once and do not become worn, and knives 34 need not be resharpened.
- Cartridge elements 30 can be made in several sizes to fit a single set of clamp actuators 20. This is done conveniently by changing the curvature of the staple array and knives from circular to oval along the axis of jaws 25. This maintains a constant relationship between wedges 37 and plier jaws 32 for uniform actuation, with a circular shaped cartridge 30 fitting a small sized tissue tube and increasingly elongated oval shapes fitting successively larger tissue tubes. Different sized cartridges 30 can all have appropriate recesses 28 to mate with projections 27 on jaws 25.
- Safety locks 46a and 46b immobilize the handles of actuator pliers 22a and 22b to prevent any premature movement of staples or knives as the tools are manipulated before stapling.
- Locks 46 rotate clear of plier handles to allow stapling.
- Springs 47 trapped within the plier handles hold pliers 22 in the open position and return the pliers to this position after stapling.
- the embodiment of FIGS. 10 and 11 differs from the embodiment of FIGS. 1-9 in driving all the staples through from one side of the anastomosis against staple folding pads located on the opposite side and using only a single pair of actuator pliers 22. This allows a double jawed clamp 50 such as shown in FIGS. 10 and 11 to cooperate with a clamp actuator such as shown in FIG.
- FIGS. 10 and 11 operate as previously described.
- FIGS. 12-15 is similar to the embodiment of FIGS. 10 and 11 in using only a single pair of actuator pliers 22 and driving all the staples from cartridge elements 30a and a' through the tissue from the same side and against staple folding pads 36 on cartridge elements 30b and b'.
- the difference in the embodiment of FIGS. 12-15 is the angle between the jaws and the handles allowing the stapler to reach into confined places such as required for resection of the low interior of the rectum. Staplers with jaws that are angled relative to their handles may also be more convenient for other uses.
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Molecular Biology (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
- Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
- Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US11294580A | 1980-01-17 | 1980-01-17 | |
US112945 | 1980-01-17 |
Publications (2)
Publication Number | Publication Date |
---|---|
EP0043837A1 EP0043837A1 (de) | 1982-01-20 |
EP0043837A4 true EP0043837A4 (de) | 1983-03-15 |
Family
ID=22346702
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
EP19810900401 Withdrawn EP0043837A4 (de) | 1980-01-17 | 1981-01-15 | Chirurgisches heft- und schneidgerät. |
Country Status (7)
Country | Link |
---|---|
EP (1) | EP0043837A4 (de) |
JP (1) | JPS57500052A (de) |
BE (1) | BE889237A (de) |
BR (1) | BR8106033A (de) |
DK (1) | DK412481A (de) |
NO (1) | NO813160L (de) |
WO (1) | WO1981001958A1 (de) |
Families Citing this family (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CH662263A5 (de) * | 1983-09-13 | 1987-09-30 | Gegauf Fritz Ag | Hysterektomium. |
US5188638A (en) * | 1992-02-06 | 1993-02-23 | Tzakis Andreas G | Apparatus and method for preforming anastomosis fastener securement of hollow organs |
US5163943A (en) * | 1992-03-12 | 1992-11-17 | Mohiuddin Mohammed M | Circumcision instrument with staple means |
JP2014110822A (ja) * | 2011-03-24 | 2014-06-19 | Terumo Corp | 吻合器 |
CN106419986B (zh) * | 2016-10-28 | 2023-10-27 | 何文武 | 一种外翻式环形吻合器 |
Family Cites Families (10)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US2940451A (en) * | 1958-02-26 | 1960-06-14 | Canadian Patents Dev | Suturing apparatus |
US2965900A (en) * | 1958-09-30 | 1960-12-27 | Risaburo Aoki | Instrument for joining blood vessels |
US3144654A (en) * | 1961-11-22 | 1964-08-18 | Foundation For Medical Technol | Medical staplers |
US3176896A (en) * | 1962-09-19 | 1965-04-06 | Foundation For Medical Technol | Medical stapler |
FR1461464A (fr) * | 1965-08-20 | 1966-02-25 | Niiex Khirurgicheskoi Apparatu | Appareil chirurgical de suture des organes |
CH470170A (de) * | 1968-02-02 | 1969-03-31 | Vnii Khirurgicheskoi Apparatur | Gerät zum Anbringen von Rundanastomosen |
US3606888A (en) * | 1969-06-30 | 1971-09-21 | Jack E Wilkinson | Stapling apparatus for anastomosis of hollow viscera |
US3638652A (en) * | 1970-06-01 | 1972-02-01 | James L Kelley | Surgical instrument for intraluminal anastomosis |
DE2509105C3 (de) * | 1975-03-03 | 1978-11-16 | Vsesojuznyj Nautschno-Issledovatelskij I Ispytatelnyj Institut Medicinskoj Techniki, Moskau | Chirurgisches Nähgerät zum Verbinden von zwei inneren Körper-Organen durch Metallklammern |
US4242902A (en) * | 1978-05-11 | 1981-01-06 | United States Surgical Corporation | Surgical clip applicator |
-
1981
- 1981-01-15 BR BR8106033A patent/BR8106033A/pt unknown
- 1981-01-15 EP EP19810900401 patent/EP0043837A4/de not_active Withdrawn
- 1981-01-15 WO PCT/US1981/000054 patent/WO1981001958A1/en not_active Application Discontinuation
- 1981-01-15 JP JP56500665A patent/JPS57500052A/ja active Pending
- 1981-06-16 BE BE0/205108A patent/BE889237A/fr unknown
- 1981-09-16 NO NO813160A patent/NO813160L/no unknown
- 1981-09-16 DK DK412481A patent/DK412481A/da not_active Application Discontinuation
Also Published As
Publication number | Publication date |
---|---|
NO813160L (no) | 1981-09-16 |
JPS57500052A (de) | 1982-01-14 |
EP0043837A1 (de) | 1982-01-20 |
BE889237A (fr) | 1981-12-16 |
DK412481A (da) | 1981-09-16 |
WO1981001958A1 (en) | 1981-07-23 |
BR8106033A (pt) | 1981-11-24 |
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Legal Events
Date | Code | Title | Description |
---|---|---|---|
PUAI | Public reference made under article 153(3) epc to a published international application that has entered the european phase |
Free format text: ORIGINAL CODE: 0009012 |
|
17P | Request for examination filed |
Effective date: 19810917 |
|
AK | Designated contracting states |
Designated state(s): AT CH DE FR GB LU NL SE |
|
RAP1 | Party data changed (applicant data changed or rights of an application transferred) |
Owner name: AMERICAN CYANAMID COMPANY |
|
STAA | Information on the status of an ep patent application or granted ep patent |
Free format text: STATUS: THE APPLICATION IS DEEMED TO BE WITHDRAWN |
|
18D | Application deemed to be withdrawn |
Effective date: 19840801 |
|
RIN1 | Information on inventor provided before grant (corrected) |
Inventor name: LEE, SUKOO |