1,010,656. Surgical or operating-appliances. R. BRUMMELKAMP. Dec. 8, 1961 [Dec. 9, 1960], No. 43996/61. Heading A5R. A surgical instrument for operating upon carcinoma of the rectum is adapted to sever the rectum adjacent the anal sphincter, and, after the section of the rectum containing the tumour has been removed, to effect an anastomosis between the severed ends of the rectum. The instrument comprises a tube 1, the outer end of which is enlarged and the inner end of which is rotatable, but not movable axially, relative to a ring 3. The latter is fixed to a sleeve 34 into which is screwed a sleeve 35 fixed to an inner tube 36. A pin 49 extends inwardly from tube 1 into a slot 48 formed axially in tube 36. A ring 4 is fixed to a sleeve 42 into which is screwed a sleeve 45 fixed to tube 36. A sleeve 32 encloses sleeves 34 and 42, and is also fixed to tube 36. A hollow shaft 18, passing through tube 36, is fixed to a roller 46 which is rotatable, but not movable axially, relative to sleeve 42. A handle 5 is fixed to collar 46. Rotation of ring 3 thereby serves to move tube 1 axially, rotation of ring 4 serves to move shaft 18 axially, and rotation of handle 5 serves to rotate shaft 18. The upper portion of sleeve 32 is formed with spaced apertures 39 selectively engagable by a spring- biased ball 38 carried by sleeve 34. The lower portion of sleeve 32 if formed with spaced apertures 44 selectively engagable by a spring-biased ball 43 carried by sleeve 42. A tubular member 8, resiliently mounted in the upper end of tube 36, comprises two telescopic parts formed with respective radial perforations 33 and respective radial flanges 11 and 16. A spring 40 biases the parts apart to leave a gap 13 between flanges 11 and 16. Hollow shaft 18 is formed with a radial perforation 47 and is provided with a nipple 9 for connection to a Nacuum source. The upper end of shaft 18 has a screwed connection 17 with a cap 2 formed with a double-tapered radial flange 7 adapted to close the open end of tube 1. A circular knife 14, located within flange 7, has a tubular stem having a screwed connection 19 with cap 2 of pitch greater than that of connection 17, and is also keyed at 20 to shaft 18. A ring of fingers 30 is disposed within the enlarged end of tube 1, the inner ends of the fingers being pivoted to a ring 50 fixed to tube 36, and the outer ends of the fingers being biased inwardly by a resilient ring 29. In use, the cap 2, while closing the open end of tube 1, is passed up the rectum until the flange 7 abuts the tumour therein. Tube 1 is then moved downwards by rotating ring 3 until the gap 12 between flanges 7 and 11 is uncovered to expose the upper apertures 33. The wall 10 of the rectum is thereby sucked into contact with tube 8 and is tied thereto. Wall 10 is also secured to flange 7 by V-shaped forceps 61 applied thereto through an abdominal incision. Tube 1 is then moved further downwards to uncover the gap 13 between flanges 11 and 16 and the lower apertures 33 therein. Wall 10 is thereby sucked into contact with tube 8 in gap 13. Shaft 18 is then moved downwards by rotating ring 4 until the gaps 12 and 13 are closed to clamp the wall 10 beteen the respective flanges 7, 11 and 11, 16. Shaft 18 is then rotated by means of handle 5, while head 2 is held stationary, to unscrew shaft 18 from bend 2. Owing to the difference in pitch between the screwed connections 17 and 19, knife 14 will move downwards relative to head 2 and will thus co-operate with flange 11 to sever wall 10 thereat. Continued rotation of shaft 18 disconnects head 2 therefrom. The portion of the rectum containing the tumour is now removed. A plastic ring 22 is then inserted into the inner severed end of the rectum, and the wall 26 of the latter is tied to ring 22 in a circumferential groove 27 formed therein. Ring 22 is closed by a plug 23 having a left-hand screw connection 25 therewith. Plug 22 is also formed with a screwed bore 24 corresponding to the screwed end 17 of shaft 18, and is connected to ring 22 by strings 31. Shaft 18 is then screwed into plug 23 until ring 22 abuts flange 11, wall 10 continuing to be clamped between flanges 11 and 16. Tube 1 is then moved downwards to expose the ring of pivoted fingers 30, and shaft 18 is then moved downwards, whereby ring 22 enters the ring of fingers 30 and spreads the upper ends of the latter till the diameter of spring ring 29 exceeds the diameter of the mouth of tube 1. The latter is then moved upwards until it pushes ring 29 off the fingers 30, whereby ring 29 lodges in groove 27 and clamps the walls 10 and 26 together therein to effect the anastomosis. Plug 23 is then withdrawn from ring 22 by further rotation of shaft 18. When healing of the joined ends of the rectum is complete, ring 22 is removed by pulling upon the strings 31.