EP2139405A1 - Dispositif d'accouplement pour chirurgie endoluminale et/ou transluminale - Google Patents

Dispositif d'accouplement pour chirurgie endoluminale et/ou transluminale

Info

Publication number
EP2139405A1
EP2139405A1 EP07728770A EP07728770A EP2139405A1 EP 2139405 A1 EP2139405 A1 EP 2139405A1 EP 07728770 A EP07728770 A EP 07728770A EP 07728770 A EP07728770 A EP 07728770A EP 2139405 A1 EP2139405 A1 EP 2139405A1
Authority
EP
European Patent Office
Prior art keywords
anchoring head
ring
coupling device
coupling
guide wire
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Withdrawn
Application number
EP07728770A
Other languages
German (de)
English (en)
Inventor
Alessandro Pastorelli
Roberto Tacchino
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Ethicon Endo Surgery Inc
Original Assignee
Ethicon Endo Surgery Inc
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by Ethicon Endo Surgery Inc filed Critical Ethicon Endo Surgery Inc
Priority claimed from PCT/EP2007/054317 external-priority patent/WO2008135082A1/fr
Publication of EP2139405A1 publication Critical patent/EP2139405A1/fr
Withdrawn legal-status Critical Current

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
    • A61B17/1114—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus

Definitions

  • the present invention relates, in general, to devices and methods for surgically modifying organs and vessels and more particularly to a surgical coupling device and method for performing an endoluminal and or transluminal surgery, e.g. an anastomosis, particularly of the digestive tract, such as gastro-jejunostomy, jejuno- jejunostomy or similar interventions as for example colo-proctostomy, jejuno-colostomy or anastomoses involving the Chole duct, by applying an anastomotic ring device comprising two snap-connectable rings.
  • an anastomotic ring device comprising two snap-connectable rings.
  • anastomoses by applying anastomotic ring devices involve traditional open surgery or laparoscopic surgical techniques, which are rather invasive and require the use of quite complex and cumbersome surgical devices. As a result the risk of post-operative complications is undesirably high.
  • the known devices and methods are not suitable to perform the anastomosis by a pure or at least partially endoscopic or endolumenal approach.
  • Such an endolumenal approach if assisted by a suitable instrumentation, would sensibly reduce the disadvantages of the traditional open surgery and laparoscopic methods.
  • endolumenal operations would reduce the invasiveness of the intervention, thereby reducing the risk of complications and shortening the post operative course of the patient.
  • the object of the present invention is therefore to provide a reliable and preferably releasable coupling device which can be used also in connection with balloon dilators and which can be both engaged and disengaged inside the body of the patient during a surgical intervention.
  • a further object of the invention is to provide a surgical method for performing an endoluminal or transluminal anastomosis, particularly of the digestive tract, by an endoluminal or endoscopic approach which involves the use of the surgical coupling device.
  • Figure 1 is a perspective view of an inflatable coupling portion of a coupling device in a disengaged configuration according to an embodiment of the invention
  • FIG. 2 is a perspective view of a catching portion of the coupling device in a disengaged configuration according to an embodiment of the invention
  • Figure 3 is a perspective, sectioned view of the coupling device in an engaged configuration
  • FIG. 4 is a sectioned view of a catching portion of the coupling device according to a further embodiment of the invention.
  • FIG. 5 is a sectioned view of a catching portion of the coupling device according to a further embodiment of the invention.
  • FIG. 6 is a sectioned view of the coupling device implemented in an endoluminal anastomotic ring applier according to an embodiment of the invention
  • FIG. 7 is a perspective view of a detail of the endoluminal anastomotic ring applier in figure 6;
  • FIG. 8 is a sectioned view of the detail in figure 7;
  • FIG. 9 is a perspective view of a further detail of the endoluminal anastomotic ring applier in figure 6;
  • FIG. 10 is a perspective view of the inflatable coupling portion of the coupling device implemented in an endoluminal anastomotic ring carrier device according to an embodiment of the invention
  • Figure 11 is a perspective view of an anastomotic compression ring device intended to be deployed by means of an anastomotic applier coupled by the coupling device according to the invention
  • FIGS 12, 13 and 14 illustrate a series of steps of a method for performing a transluminal anastomosis by means of a compression ring deployment system in figures 6 to 11 and the coupling device according to the invention
  • FIG. 15 is a perspective view of the coupling device implemented in an endoluminal anastomotic ring applier according to a further embodiment of the invention.
  • Figure 16 is a sectioned view of a portion of the endoluminal anastomotic ring applier in figure 15;
  • FIG. 17 is a sectioned view of a detail of the endoluminal anastomotic ring applier in figure 15;
  • FIG. 18 is a sectioned perspective view of a further detail of the endoluminal anastomotic ring applier in figure 15;
  • FIG. 19 is a schematic illustration of the general functional units of an anastomotic compression ring deployment system
  • FIG. 23 illustrates a creation of a guide wire loop during in preparation of an anastomosis (gastrojejunostomy) ;
  • FIG. 24 illustrates a creation of an anastomosis (gastro-jejunostomy) ;
  • a coupling device for coupling a first surgical device to a second surgical device during endoluminal and transluminal surgery is denoted by reference numeral 1.
  • the coupling device 1 comprises a coupling portion 2 and a catching portion 3 configured to trap and hold the coupling portion 2.
  • the coupling portion 2 comprises a first connector 5 for connecting the coupling portion 2 to the first surgical device and an inflatable anchoring head 4, as well as an activating device 6 connected to the anchoring head 4 and suitable to deform (insufflate and deflate) the anchoring head 4 such that it can take on an expanded configuration (fig. 1) and a retracted configuration (fig. 10) .
  • the catching portion 3 comprises a second connector 58, 7 for connecting the catching portion 3 to the second surgical device which is intended to be coupled with the first surgical device.
  • the catching portion 3 further comprises an anchoring seat 8 which defines a receiving space 9 for receiving at least part of the anchoring head and an access aperture 10 through which the anchoring head 4 can be inserted from outside the catching portion 3 into the receiving space 9.
  • the access aperture 10 is configured to allow insertion and withdrawal of the anchoring head 4 when it is retracted and to lock the at least partially inserted anchoring head 4 to the catching portion 3 when it is expanded.
  • the anchoring head 4 comprises a balloon catheter or balloon dilator 11 which can be actuated by a fluid pump device which is connected in fluid communication with the balloon dilator 11 through a preferably flexible pressure fluid duct 12.
  • the balloon dilator 11 can assume a substantially elongate filiform retracted shape and, if subject to fluid pressure, a substantially elongate cylindrical expanded shape.
  • the balloon dilator 11 has an internal inflatable chamber 14 defined by a flexible (in the sense of bending deformation) but inextensible wall 13 such that it can adapt to the shape of the anchoring seat 8 even and particularly if it is only partially inserted into the receiving space 9.
  • the balloon dilator 11 has a tapered distal (from a surgeons point of view) insertion end 15 which is preferably substantially convex and narrowed towards the end, e.g. ogive shaped, and which can further have a central pin shaped tip 16 or needle in order to facilitate the insertion of the anchoring head through tissue portions and into the access aperture 10 of the catching portion 3.
  • the first connector 5 of the coupling portion 2 comprises a longitudinal channel 17 which is configured to receive for instance a guide wire 88 of the first surgical device.
  • the guide wire channel 17 is advantageously coaxial to the cylindrical expanded shape of the balloon dilator 11 and can be directly glued to the guide wire 88 or, alternatively, the balloon dilator 11 can be latched to the guide wire 88 by clamping devices such as clips etc.
  • the catching portion 3 comprises a housing 18 with a preferably but not necessarily cylindrical side wall 19 and a distal end wall 20 which define together at least part of the receiving space 9.
  • the end wall 20 delimits the above said access aperture 10 through which the inflatable anchoring head 4 can be at least partially introduced into the receiving space 9 and the edge of which constricts the anchoring head 4 after it has been expanded.
  • the end wall 20 has an internal locking surface 21 which faces into the receiving space 9 and which is substantially perpendicular to the direction of insertion (X) of the anchoring head 4 or defines a circumferential shoulder inclined towards the inside of the receiving space 9 so that it locks the partially introduced, expanded and constricted anchoring head 4 in order to prevent slippage of the latter once it undergoes traction forces .
  • the internal locking surface 21 defines an undercut for preventing the insufflated anchoring head 4 from slipping out of engagement with the catching portion 3.
  • An external surface 22 of the distal end wall 20 defines a guide for facilitating the insertion of the anchoring head 4 into the anchoring seat 8.
  • the external surface 22 is substantially funnel shaped around the preferably circular central access aperture 10 and its radially internal edge forms a constriction portion 23 which is narrower than the receiving space 9.
  • the external surface 22 has preferably a double curvature with a concave portion 24 near the outer circumference and a convex portion 25 near the constriction portion 23, so that the external surface 22 converges at least approximately to a longitudinal direction parallel to the insertion direction X both approaching the outer circumference and the constriction edge 23 (Fig. 5) .
  • This particular shape of the external surface 22 makes it possible that the housing of the catching portion 3 together with the portion of the insufflated balloon dilator 11 which protrudes outside the catching portion 3 (dashed line in figure 5) defines a approximately continuous cylindrical guide body for e.g. a guided approximation of anastomotic compression rings.
  • the catching portion 3 is connected or connectable to a surgical device or instrument.
  • the housing of the catching portion 3 comprises or forms portions which enable the catching portion 3 to be snap connected, friction connected, interference connected or shape connected to the second surgical instrument, for instance a crown of elastic snapper teeth 26 formed at a proximal end of the catching portion 3 and configured to connect the catching portion to a visualization device such as a gastroscope 89 (Fig. 2) .
  • the catching portion can be partially housed or encapsulated within the surgical device intended to be coupled to another instrument .
  • the catching portion 3 is at least partially transparent in order to enable visualization by means of a visualization device
  • a method for performing an endoluminal or transluminal anstomosis comprises generally the following steps:
  • proximal and distal are referred to the directions along the guide wire loop and to the above defined proximal 88' and distal ends 88'' thereof.
  • a proximal first ring 36 of an anastomotic ring device to the proximal end 88' of the guide wire means 88 and delivering the proximal first ring 36 to the proximal first tissue portion 45 by pulling the distal extracorporeal end 88'' of the guide wire means 88 in a distal direction until the proximal first ring 36 reaches the proximal first tissue portion 45, - Slidably connecting a distal second ring 39 of the anastomotic ring device to the distal end 88'' of the guide wire means 88 and pushing it proximally along the guide wire means 88 until it reaches the distal second tissue portion 44.
  • the loop of the guide wire means 88 starts and ends either in natural orifices, like mouth, nose, anus or, alternatively, in artificially created openings in the body, such as colostomy, abdominal incisions, wound or fistulas.
  • the guide wire means enters and exits the body through natural ducts (e.g. mouth, Figs. 23 and 24) .
  • the guide wire means can comprise one or more single flexible guide wires, it is preferable to provide only one single guide wire which penetrates the proximal and distal tissue portion. Creation of the loop of the guide wire means
  • the loop of the guide wire means 88 can be created by means of the following procedural steps:
  • Transluminally e.g. transorally introducing an elongate insertion device through the proximal inlet port (e.g. mouth) for the guide wire means and pushing the insertion device from outside the body distally towards the proximal tissue portion (e.g. a jejunal anstomotic site) , - Transporting the distal end of the guide wire means to the proximal tissue portion through one or more guide wire canals formed in the insertion device and perforating the proximal tissue portion with the guide wire end or needle guide wire end.
  • proximal inlet port e.g. mouth
  • the proximal tissue portion e.g. a jejunal anstomotic site
  • the proximal tissue portion is perforated by a distinct radio frequency needle device having a sheath which is insertable along the guide wire canal and which defines two or more internal canals (one for the RF needle and one for the guide wire) .
  • the distal guide wire end protrudes distally from the proximal tissue portion (e.g. into the previously CO2 insufflated abdominal space) ,
  • proximal inlet port e.g. mouth
  • guide wire means e.g. a grasping device through the distal inlet port for the guide wire means which might but need not coincide with the proximal inlet port
  • the grasping device e.g. mouth
  • the grasping device pushing the grasping device from outside the body proximally (with reference to the loop direction) towards the distal tissue portion, e.g. the gastric wall tissue
  • Creating a hole in the distal tissue portion e.g. by means of a radiofrequency needle or equivalent penetration devices and, preferably, widening the hole with a balloon catheter which is preferably transported to the distal tissue portion through a working channel of the grasping device.
  • the transluminal introduction of the grasping device and the snare is performed by a pure endoscopic or endolumenal approach.
  • this procedural step is performed under laparoscopic supervision.
  • the hole does not need to be widened and only the snare (preferably a radio frequency snare adapted to pierce through the gastric wall) creates the hole and is passed through it into the abdominal space.
  • the distal guide wire end is then laparoscopically fed into the snare hole to be caught by the latter.
  • the insertion device In case of a gastro-jejunostomy, the insertion device needs to be advanced transorally through the esophagus and the stomach and across the pylorus into the duodenum, which is not always easy to point at.
  • a protective or guiding tube might be pushed through the patients mouth down the esophagus into the stomach and the insertion device can be advantageously guided inside the protective or guiding tube up to and across the pylorus.
  • the proximal first ring 36 is delivered to the anastomotic site by means of the following procedural steps :
  • proximal ring Detachably connecting the proximal ring with a, preferably distinct, carrier member outside the body of the patient.
  • the carrier member which holds the proximal ring
  • the carrier member is preferably locked by means of locking elements, such as clips which can be clamped around the guide wire and which are adapted to provide an obstacle against sliding of the carrier member.
  • the locking of the carrier member to the guide wire might be obtained by locking features, for instance clamping portions, integrated in the carrier member.
  • the carrier member has been fabricated and distributed together with the guide wire or previously connected to it in a manner that, after completion of the guide wire loop, it is sufficient to introduce the carrier member together with the proximal ring into the proximal inlet port (e.g. mouth and esophagus) and deliver it to the proximal tissue portion 45 by pulling the distal guide wire end 88' distally.
  • the proximal inlet port e.g. mouth and esophagus
  • the carrier member can be slid along the guide wire up to the proximal tissue layer, wherein the guide wire acts as a guide rail for the carrier member.
  • proximal tissue portion 45 e.g. intestinal tissue
  • distal tissue portion 44 e.g. gastric wall
  • the carrier member urges the proximal ring, particularly a distal tissue contact surface thereof, against the proximal tissue portion and moves the latter distally towards and in contact with the distal tissue portion.
  • the distal ring is delivered to the anastomotic site by means of the following procedural steps: - Inserting the distal second compression ring 39 over the distal guide wire end 88'' and pushing it proximally along the guide wire means 88 towards the anastomotic site and, hence, towards the proximal first compression ring 36. Thanks to the guide wire loop, the first and second compression rings 36, 39, together with the first and second tissue portions 45, 44 are axially aligned in the anastomotic site.
  • the distal compression ring is pushed along the guide wire by means of an apposite anastomotic applier which is advantageously adapted to perform an angular positioning, if required, of the distal compression ring with respect to the proximal compression ring in order to enable their mutual connection.
  • the compression rings are provided with connecting features which enable their mutual connection in different angular positions or independently from their reciprocal angular position. - Connecting the compression rings and, hence the tissue portions clamped between them, by pushing the distal compression ring proximally in engagement with the proximal compression ring.
  • the anastomotic device includes the coupling device 1 according to the present invention and an approximation device 37.
  • the compression rings are connected by applying a distinct locking device adapted to engage both compression rings and to maintain them connected at a desired reciprocal distance.
  • one of the compression rings is firstly pushed against the other compression ring and successively the locking device is pushed in connecting engagement with both the compression rings to connect them.
  • the method of connecting the compression rings to another can additionally comprise the step of fixating the tissue portions to the compression rings in order to effectively prevent the tissue from radially slipping out of the grip engagement with the compression rings.
  • This additional step might be performed before or contemporaneously with the application of the locking device.
  • This additional fixation step is preferably performed by compressing the tissue portions between the distal and proximal ring device and by driving a plurality of needles into and across the ring device and the tissue portions so that the needles provide the above said additional fixation.
  • the locking device is inserted extracorporeally over the distal guide wire end 88' and pushed proximally along the guide wire 88 towards the anastomotic site and towards the proximal compression ring.
  • both the distal compression ring and the distinct locking device (and, if provided, the needle group) are arranged on a distal end (here the term "distal” is referred to the surgeons viewpoint and not to the guide wire loop) of the anastomotic applier and pushed by means of the latter to the anastomotic site and in engagement with the proximal compression ring.
  • both the proximal first compression ring and the distinct locking device are fixed to the proximal ring carrier device and transported to the anastomotic site and in engagement with the distal compression ring. Widening the tissue at the anastomotic site The distal and proximal tissue portions intended to be joined in anastomosis are widened by means of the following procedural steps:
  • the passage openings of the tissue portions are widened by the same balloon dilator 11 which acts as expandable anchoring head 4 of the coupling device 1.
  • the balloon dilator 11 can be inserted over the guide wire 88 and delivered towards and at least partially across the passage openings in the tissue portions.
  • the balloon dilator 11 is insufflated to an extent that it fills approximately a central aperture of the distal compression ring, thereby widening the anastomotic lumen to substantially the same extent and at the same time performing the coupling action between the anchoring head and the catching portion.
  • the proximal first compression ring prior to or after the inflation of the balloon dilator 11 of the coupling device 1, the proximal first compression ring
  • the locking device together with the needle group is preferably preassembled with one of the compression rings
  • the locking device together with the needle group is preferably preassembled with one of the compression rings
  • the balloon dilator is deflated and detached from the catching portion 3.
  • the anastomotic applier with the catching portion 3 are withdrawn from the body of the patient.
  • the carrier member with the coupling portion 2 are detached from the proximal first compression ring and removed, preferably together with the guide wire 88, by pulling the proximal guide wire end 88' in proximal direction.
  • the carrier member which received the proximal ring by a weaker connection, e.g. by friction fit
  • the above described method can be advantageously performed endolumenally or partially endolumenally during a gastro-jejunostomy .
  • the above described method forms part of a procedure for creating a gastrointestinal bypass, it is possible to proceed with a performance of a further anastomosis involving the small intestine (e.g. a jejuno-jejunostomy or an ileo- jejunostomy) , possibly by applying the above described steps in analogous manner also to the further anastomosis .
  • an anastomotic ring applier system 30 comprises a first compression ring carrier device 31 (dashed line - - -) and an anastomotic applier 32 (dotted dashed line - .
  • the first compression ring carrier device 31 comprises a first (e.g. jejunal) ring carrier 33 adapted to hold a first compression ring 36 and connectable or connected to the guide wire device 88, preferably to a single guide wire, by means of a locking portion 35 which is configured to prevent the first (jejunal) compression ring 36 from sliding along the guide wire device in a direction opposite the ring approximation direction.
  • the first ring carrier 33 can be connected to a balloon dilator 11 which is built up around the guide wire and which can be connected to the guide wire outside the body of the patient or near an inflatable head of the balloon dilator, e.g.
  • the first compression ring carrier device 31 can be coupled to and uncoupled from the ring approximation device 37 of the anastomotic applier 32 (which will be described below) by means of the surgical coupling device 1 (double dotted dashed line in figure 22) according to the invention.
  • the anastomotic applier 32 further comprises a second (gastric) ring carrier 38 adapted to hold a second compression ring 39 for instance by means of a ring connecting portion 40 which is configured to engage the second (gastric) compression ring 39 by snap-fit or friction-fit or press-fit.
  • a second (gastric) ring carrier 38 adapted to hold a second compression ring 39 for instance by means of a ring connecting portion 40 which is configured to engage the second (gastric) compression ring 39 by snap-fit or friction-fit or press-fit.
  • the anastomotic applier 32 further comprises a ring approximation device 37 with a first portion 42 connectable by means of the coupling device 1 to the first ring carrier device 31 and a second portion 43 connected or connectable to the second ring carrier device 38.
  • the first and second portions 42, 43 of the ring approximation device 37 are movable to one another in a way to approximate the first and second ring carrier devices 31, 38 thereby approximating the two tissue layers (e.g. gastric tissue layer 44 and jejunal tissue layer 45) held between the two compression rings 36, 39 and interconnecting the compression rings 36, 39 to complete the anastomosis.
  • tissue layers e.g. gastric tissue layer 44 and jejunal tissue layer 45
  • the inflatable anchoring head 4 of the coupling device 1, particularly the balloon dilator 11 has, in its expanded (insufflated) configuration an approximately cylindrical shape, except of the constriction caused by the access aperture 10 of the catching portion 3. Thanks to this feature, the anchoring head 4 is adapted not only to connect the first ring carrier device 31 to the anastomotic applier 32, but also to widen the anastomotic lumen in the tissue layers 44, 45 and to provide guidance for both compression rings 36, 39 during approximation and deployment.
  • the coupling device 1 connects the first compression ring carrier device 31 and the anastomotic applier 32 at or near the anastomotic site
  • the ring approximation device 37 can be advantageously arranged inside the anastomotic applier 32, thereby obviating an extracorporeal guide wire pulling and counter-pushing with the anastomotic applier.
  • the ring approximation device 37 of the anastomotic applier 32 can be embodied as a guide wire pulling device, such as a guide wire slidably received in a working channel of an endoscope, e.g. a gastroscope, wherein the pulling action can be exerted either by pulling the guide wire with respect to the scope or by pulling the entire scope together with the guide wire and contemporaneously counter-pushing the support structure of the second ring carrier.
  • a guide wire pulling device such as a guide wire slidably received in a working channel of an endoscope, e.g. a gastroscope
  • the second (gastric) ring carrier device 38 can be embodied by means of a ring connector portion which is arranged at a distal end (surgeons point of view) of a flexible tube, such as a gastric protection tube.
  • the preferably transparent tube in turn defines an internal working space which can house the gastroscope.
  • the second (gastric) ring carrier device 38 comprises a ring connector portion formed at or connected to a distal end portion of the gastroscope.
  • the surgical coupling device 1 can be at least partially arranged within the second (gastric) ring carrier device 38.
  • the ring approximation device 37 of the anastomotic applier 32 comprises a screw drive device 46, wherein the first portion 42 forms a first thread 47 and the second portion 43 forms a second thread 48 meshing the first thread 47 and a rotary device 49 cooperates with at least one of the first and second portions 42, 43 to rotate them to one another.
  • the relative rotation of the first and second portions 42, 43 causes them to translate to one another and to approximate the first and second ring carrier devices 31, 38 and the two tissue layers (e.g. gastric tissue layer 44 and jejunal tissue layer 45) held between the two compression rings 36, 39 and to interconnect the compression rings 36, 39.
  • tissue layers e.g. gastric tissue layer 44 and jejunal tissue layer 45
  • the terms "proximal” and “distal refer to the surgeons point of view)
  • the first portion 42 of the approximation device 37 is embodied as a rotor assembly 50 with an externally threaded outer housing 51 which defines a distal opening 52 and a proximal connecting portion 53.
  • a torque connector 54 connects a torsional cable or rotary rod 55 to the proximal connecting portion 53.
  • the torsional cable or rotary rod 55 can be passed through a working channel of an endoscope (e.g. gastroscope) and has a proximal end extending outside the patients body where an appropriate torque and rotary movement can be applied to it by the surgeon.
  • the torque connector 54 can comprise a connecting cap or plug (Fig. 7, 8) connected by radial connecting pins 56 to a tubular ring wall 57 of the outer housing 51 so that it can transmit torque and traction from the torsional cable or rotary rod 55 to the threaded outer housing 51.
  • the catching portion 3 of the coupling device 1 is arranged inside the outer housing 51 and free to rotate with respect to the latter.
  • the access aperture 10 of the catching portion 3 is arranged in alignment with a distal end surface and preferably coaxial to the distal opening 52 of the outer housing 51.
  • a rotational bearing 58 can be interposed between the outer housing 51 and the catching portion 3.
  • the access aperture 10 of the catching portion 3 is defined by a short tubular, preferably cylindrical collar having a diameter which is smaller than the diameter or transversal extension of the receiving space 9.
  • the tubular collar has an outer cylindrical surface which engages an internal surface of the rotational bearing 58 which, in turn, is connected to the outer housing 51 near its distal opening 52 (compare Figs. 6 and 8) .
  • the second portion 43 of the ring approximation device 37 is embodied as a jackscrew device 59.
  • the jackscrew device 59 comprises a tubular support structure 60, e.g. a rigid or at least partially flexible tube, with a proximal grounding portion 61, a distal ring connector portion 64 and an internal thread 48 which is configured to mesh with the external thread 47 of the rotor assembly 50.
  • the grounding portion 61 is adapted to connect the support structure 60 to an endoscope (e.g. gastroscope not illustrated in the figures) so that the endoscope can transmit push and/or pull forces and torque to the support structure 60.
  • the support structure 60 can extend outside the body of the patient and the grounding portion 61 can be extracorporeally torsionally and axially held or grounded.
  • the distal ring connector portion 64 is configured to hold the second (e.g. gastric) compression ring 39, e.g. through a snap-fit, press-fit or friction-fit action which can be provided by a crown of elastic teeth, as has been illustrated in Fig. 9 and 12.
  • the screw drive device 46 makes it possible to firmly couple the rotor assembly 50 to the first ring carrier device 33 by partially inserting and subsequently insufflating the anchoring head 4 inside the catching portion 3 and contemporaneously providing both a tissue widening means and a cylindrical guide (expanded anchoring head - balloon dilator 11) for the compression rings during approximation and snap- connection.
  • a rotary movement of the torque cable can rotate the outer housing of the rotor assembly with respect to the axially and torsionally locked support structure 60, thereby causing the rotor assembly 50 together with the catching portion 3 to translate and, hence, to approximate and interconnect the anastomotic compression rings 36, 39.
  • the tubular support structure 60 is at least partially, preferably completely transparent in order to enable a visualization by the endoscope (e.g. gastroscope) also across the tubular wall of the support structure.
  • the ring approximation device 37 of the anastomotic applier 32 comprises a fluid pressure device 65.
  • the first portion 42 and the second portion 43 of the ring approximation device 37 are connected to one another by a piston-cylinder thrust unit 66.
  • a pressure chamber 67 of the piston-cylinder thrust unit 66 is connected through a fluid duct 68 with a fluid pump (not illustrated) .
  • operation of the fluid pump raises the fluid pressure inside the pressure chamber 67 and causes the first and second portions 42, 43 to translate to one another, thereby approximating the first and second ring carrier devices 31, 38 and the two tissue layers (e.g. gastric tissue layer 44 and jejunal tissue layer 45) held between the two compression rings 36, 39 and interconnecting the compression rings 36, 39.
  • tissue layers e.g. gastric tissue layer 44 and jejunal tissue layer 45
  • the first portion 42 of the approximation device 37 is embodied as a cylinder device 69.
  • the cylinder device 69 forms a tubular support structure 70, e.g. a rigid or at least partially flexible tube, with a proximal grounding portion 71, the catching portion 3 of the coupling device 1 and a distal pressure chamber 67 in fluid communication with the fluid duct 68 and configured to slidably receive a piston portion 72 of the second portion 43 (which will be described below) .
  • the grounding portion 71 is adapted to connect the support structure 70 to an endoscope (e.g. gastroscope not illustrated in the figures) so that the endoscope can transmit push and/or pull forces to the support structure 70.
  • the support structure 70 can extend outside the body of the patient and the grounding portion 71 can be extracorporeally held or grounded.
  • the tubular support structure 70 can be at least partially, preferably completely transparent in order to enable a visualization by the endoscope (e.g. gastroscope) also across the tubular wall of the support structure.
  • endoscope e.g. gastroscope
  • the second portion 43 of the approximation device 37 is embodied as a piston device 73 (Figs. 16, 17) .
  • the piston device 73 comprises a distal ring connector portion 74 and the above mentioned proximal piston portion 72.
  • the ring connector portion 74 is configured to hold the second (e.g. gastric) compression ring 39, e.g. through a snap-fit, press-fit or friction-fit action which can be provided by a crown of elastic snapper teeth, as has been illustrated in Fig. 15 and 17.
  • the piston portion 72 is slidably housed in the pressure chamber 67 of the cylinder device 69 so that a fluid pressure increase inside the pressure chamber 67 (generated by the fluid pump) causes the piston device 73 to translate with respect to the catching portion 3, thereby approximating the first and second ring carrier devices 33, 38.
  • the pressure chamber 67 has a generally annular shape and is delimited by an outer tubular wall 75, an inner tubular wall 76 and a proximal base wall 77 which define a distally open cup shaped pressure chamber 67 in which the complementary shaped proximal tubular piston portion 72 of the piston device 73 is slidably received to hermetically close the pressure chamber 67.
  • both the tubular walls 75, 76 and the tubular piston portion 72 have circular ring shaped cross sections.
  • the proximal base wall 77 is embodied as a circular ring and defines a circumferential distally facing connecting slot 78 which receives a proximal ring shaped edge 79 of the catching portion 3 of the coupling device 1, so that the cylindrical side wall 19 (Fig. 5) of the catching portion 3 acts as the above said inner tubular wall 76.
  • the catching portion 3 can be embodied as previously described with reference to fig. 5. This makes it possible to use the distal end portion of the catching device 3 together with the insufflated anchoring head 4 (balloon dilator 11) as a guide for the anastomotic rings during approximation and snap connection .
  • the catching portion 3 and particularly the receiving space 9 can be proximally open so that the partially introduced balloon dilator 11 can be directly visualized by the endoscope (e.g. gastroscope) .
  • the fluid duct 68 which is not necessarily but preferably integrated in or arranged along a side wall of the tubular support structure 70 can be put in communication with the pressure chamber 67 by means of a passage 80 defined in the proximal base wall 77.
  • FIG. 11 is a perspective view of an anastomotic ring device with the first (jejunal) ring 36 and the second
  • the (gastric) ring 39 which is not only but particularly adapted to perform a gastro-jejunostomy according to the previously described method.
  • the first compression ring 36 (or "bowel ring” or “intestinal ring” 36) is adapted to bear against the first tissue portion 45 (jejunal tissue), while the second compression ring 39 (or
  • gastric ring 39 is adapted to bear against the second tissue portion 44 (gastric tissue) opposite the first tissue portion 45 and the first ring 36.
  • the first and second rings 36, 39 are adapted to be latched together in at least one, preferably two or more locking positions corresponding to different compression rates acting on the tissue portions 44, 45 clamped between the rings .
  • Both the first 36 and second compression ring 39 have a preferably closed circular annular shape (Fig. 11, 12) in order to enable their mutual alignment and connection independently from their relative angular position.
  • the pressure surfaces of the first and second rings 36, 39 destined to contact and clamp the first and second tissue portions 45, 44 are substantially plane or circumferentially wavy in order to increase the circumference of the anastomotic lumen with respect to the external ring circumference (not shown in the figures) .
  • the pressure surfaces are roughened or locally profiled in order to prevent the tissue 45, 44 to squeeze radially out of the ring device in response to the axial pressure.
  • the second compression ring 39 (gastric ring) comprises a shape or a specific interaction portion suitable to be engaged (e.g. by snap-fit, friction-fit, shape-fit or press-fit) by the second ring carrier 38.
  • Both compression rings are advantageously at least partially made of bio-absorbable or bio- fragmentable material .
  • a group of needles 81 or staples is provided which is anchored in at least one of the compression rings and adapted to pierce through the tissue clamped therebetween .
  • the needles 81 can be directly fixed to a compression ring or to a ring locking device 82 or, as shown in figure 11, the group of needles 81 comprise a self supporting needle ring 83 which can be e.g. received by an apposite seat defined at the locking device 82 in order to anchor the needles 81 reliably to the ring device during and after its deployment.
  • the locking device 82 comprises an annular proximal shoulder 84 with a distal engaging surface 85 suitable to engage the proximal end surface of the first (jejunal) compression ring 36 and a tubular longitudinal portion 86 which protrudes distally from the proximal shoulder 84.
  • the longitudinal portion 86 has a shape adapted to be inserted through the central openings of both the first and second compression rings 36, 39 and forms one or more elastically supported snapper teeth 87 adapted to snap engage a corresponding edge or surface of the second (gastric) compression ring 39 (in the description of the locking device 82 the terms "proximal” and “distal” are referred to the direction of deployment) .
  • the provision of a distinct locking device allows the compression rings to be designed specifically to meet the requirements of the delivery and anastomosis, thereby avoiding compromises between these requirements and those of the connection of the compression rings.
  • the tubular shape of the locking device 82 stabilizes the shape of the anastomotic lumen and provides a protective lining which isolates the tissue portions 45, 44 clamped between the compression rings from fluids and contents passing through the anastomotic lumen at least during the period of wound healing.
  • the locking device 82 is advantageously at least partially made of bio-absorbable or bio- fragmentable material .
  • the coupling device allows to couple and uncouple surgical devices endoluminally and in particular near the operational site. It can act at the same time as tissue widening device and as guide device, e.g. in endoluminal and transluminal anastomoses.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Physiology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention porte sur un dispositif d'accouplement (1) d'un premier dispositif chirurgical à un deuxième dispositif chirurgical comprenant une pièce d'accouplement (2) raccordable au premier dispositif chirurgical et comprenant: une tête d'ancrage gonflable (4), une partie préhensile (3) raccordable au deuxième dispositif chirurgical et délimitant un espace récepteur (9) d'au moins une partie de la tête d'ancrage (4), une ouverture d'accès (10) par laquelle la tête d'ancrage (4) peut s'insérer dans l'espace récepteur (9), un dispositif d'activation (6) relié à la tête d'ancrage (4) et la déformant pour qu'elle puisse prendre une configuration expansée et une configuration rétractée. L'ouverture d'accès (10) sert à introduire ou retirer la tête d'ancrage (4) à l'état rétracté, et lorsqu'elle est partiellement introduite, à la verrouiller à la partie préhensile (3) é l'état expansé.
EP07728770A 2007-05-03 2007-05-03 Dispositif d'accouplement pour chirurgie endoluminale et/ou transluminale Withdrawn EP2139405A1 (fr)

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/EP2007/054317 WO2008135082A1 (fr) 2007-05-03 2007-05-03 Dispositif d'accouplement pour chirurgie endoluminale et/ou transluminale

Publications (1)

Publication Number Publication Date
EP2139405A1 true EP2139405A1 (fr) 2010-01-06

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Family Applications (1)

Application Number Title Priority Date Filing Date
EP07728770A Withdrawn EP2139405A1 (fr) 2007-05-03 2007-05-03 Dispositif d'accouplement pour chirurgie endoluminale et/ou transluminale

Country Status (5)

Country Link
EP (1) EP2139405A1 (fr)
JP (1) JP2010525843A (fr)
CN (1) CN101668489B (fr)
AU (1) AU2007352912A1 (fr)
CA (1) CA2685772A1 (fr)

Family Cites Families (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4319576A (en) * 1980-02-26 1982-03-16 Senco Products, Inc. Intralumenal anastomosis surgical stapling instrument
EP0568774A1 (fr) * 1992-04-08 1993-11-10 American Cyanamid Company Dispositif endoscopique d'anastomose pour insérer un anneau
US5425738A (en) * 1992-04-08 1995-06-20 American Cyanamid Company Endoscopic anastomosis ring insertion device and method of use thereof
JP3926831B2 (ja) * 1992-06-04 2007-06-06 オリンパス株式会社 組織縫合結紮器
US5814062A (en) * 1994-12-22 1998-09-29 Target Therapeutics, Inc. Implant delivery assembly with expandable coupling/decoupling mechanism
US7282057B2 (en) * 2004-03-30 2007-10-16 Wilson-Cook Medical, Inc. Pediatric atresia magnets

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See references of WO2008135082A1 *

Also Published As

Publication number Publication date
CA2685772A1 (fr) 2008-11-13
AU2007352912A1 (en) 2008-11-13
CN101668489B (zh) 2011-06-08
JP2010525843A (ja) 2010-07-29
CN101668489A (zh) 2010-03-10

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