JP2000166932A - Automatic anastomotic instrument and guide balloon mountable to this anastomotic device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a guide balloon for rapid and safe insertion of the insertion portion of an automatic anastomotic device into the biotissue and the automatic anastomotic device having this guide balloon. SOLUTION: A guide balloon 1 includes a cylindrical base part 2 which allows the insertion of a trocal 73 mounted at a distal end of a ligature head assembly 60 of the automatic anastomotic instrument, a balloon part 3 which is held folded at the outside surface of this base part 2 at the time of nonuse and is deformable when dilated, a tube which allows the flow of the gas or the like packed into this balloon part 3 and a pump 5 which supplies or discharges the gas in the balloon part 3 via this tube. There is no need for the tube and pump when the gas, etc., are packed into the balloon part 3 before mounting and the convergent shape may be maintained. The balloon part 3 is directly fixed to the trocal 73 in the case the guide balloon 1 is integrally mounted to the distal end of the ligature head assembly 60.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an automatic anastomosis device for anastomosis of tissues or organs of a living body using staples, and a guide balloon attachable to the automatic anastomosis device.

[0002]

2. Description of the Related Art Conventionally, in a surgical operation on a digestive tract, end-to-end anastomosis, end-side anastomosis, and side-to-side anastomosis are used. As an example of end-to-end anastomosis, when the entire stomach is removed due to the onset of gastric cancer or the like, the end of the esophagus and the end of the jejunum are each bent inward in the radial direction to surround the tubular organ. The stitches are stitched along the direction, and the center of the stitched portion is cut off with a circular scalpel to anastomose the two.

However, unlike the esophagus, in the small intestine or large intestine such as the jejunum, nutritional blood vessels run along the circumferential direction.
When the vein is sewn in the extending direction, the blood flow is deteriorated, and in the worst case, the blood vessel may fall into a necrotic state.
For this reason, in recent years, it has been considered that end-to-end anastomosis is preferable to end-to-end anastomosis. That is, in the end-side anastomosis, in the above-described example, an opening is formed in a wall near the end of the jejunum, and the opening and the esophagus end are anastomosed in a circular shape. The effect of blood flow inhibition is small.

[0004] In the above-described operation, an automatic anastomosis device capable of performing anastomosis quickly and hygienically is used. As such an automatic anastomosis device, for example, one having a configuration shown in FIG. 5 (Japanese Patent Application Laid-Open No. Hei 5-212204) is known.

[0005] The automatic anastomosis device 50 shown in FIG. 5 includes a ligating head assembly 60 that projects an anastomosis staple from the distal end, a long supporting shaft assembly 70 connected to the ligating head assembly 60, And a handle assembly 80 for controlling the discharge of staples from the distal end of the ligating head assembly 60. The ligation head assembly 60 includes a cylindrical housing 61 serving as a staple housing for accommodating staples for suturing living tissue and a cylindrical scissor 69 for cutting living tissue. A trocar 73 as a trocar that is detachably engaged with an anvil shaft 104 of an anvil assembly 100 to be described later is disposed at the center of the distal end of the housing 61.

According to the automatic anastomosis device 50 having such a configuration, the distal end of the ligating head assembly 60 is inserted into a living tissue, the trocar 73 is exposed from a place to be anastomosed, and the surrounding trocar 73 is exposed. After ligating the living tissue to the base of the trocar 73, exposing the anvil shaft 104 from the other anastomosis site corresponding to the ligated portion, and ligating the surrounding living tissue to the base of the anvil shaft 104 The trocar 73 and the anvil shaft 104 are engaged, the distance between them is reduced, and the distal end of the ligating head assembly 60 and the anvil assembly 100 are brought into contact with each other and stapled circumferentially with staples. By incising the inside with a scissor 69, a series of anastomosis operations can be completed.

[0007]

As described above, the use of the above-described automatic anastomosis device 50 enables the anastomosis operation to be performed quickly and hygienically. When the distal end of the ligating head assembly 60 is inserted, the peripheral edge of the distal end of the ligating head assembly 60 strongly contacts the living tissue, which may cause serious damage to the living tissue. . For this reason, the surgeon must carefully and gently push the ligation head assembly 60, and furthermore, the surface of the living tissue becomes slippery due to bodily fluids, etc. There have been problems such as longer time and increased burden on patients.

Japanese Patent Application Laid-Open No. Hei 9-19501 includes a tubular shaft, a tissue contacting part that is at least partially transparent to the end of the shaft, and an inflatable balloon attached to the shaft. And Japanese Patent No. 1008181 discloses a form of a conical insertion tool which is attached to the distal end of an anastomotic instrument to assist in introducing the anastomotic instrument into a smooth digestive tract. I do. These publications merely disclose the background art or forms of the present invention.

SUMMARY OF THE INVENTION The present invention has been made to solve the above problems, and has as its object to provide a guide balloon for quickly and safely inserting an insertion portion of an automatic anastomosis device into a living tissue. And

Another object of the present invention is to provide an automatic anastomosis device provided with the above-mentioned guide balloon.

[0011]

SUMMARY OF THE INVENTION The present invention relates to a guide balloon which can be attached to the distal end side of an insertion portion of an automatic anastomosis device for inserting an elongated insertion portion into living tissue to perform anastomosis between living tissues. In addition, it has a balloon portion that can be deformed when inflated, and a base portion that supports the balloon portion and can be engaged with the distal end side of the insertion portion of the automatic anastomosis device.

The present invention relates to an automatic anastomosis device for performing anastomosis between living tissues by inserting a long insertion portion into living tissues, comprising a guide balloon that can be attached to a distal end side of the insertion portion. The guide balloon has a balloon portion that can be deformed when inflated, and a base portion that supports the balloon portion and is engageable with the distal end side of the insertion portion.

The present invention relates to an automatic anastomosis device for performing anastomosis between living tissues by inserting a long insertion portion into living tissues, and includes a guide balloon integrally provided at a distal end side of the insertion portion. The guide balloon has a balloon portion that can be deformed when inflated, and a gas flow tube connected to the balloon portion.

Here, the above-mentioned "guide balloon" refers to a balloon which can be attached to and detached from a conventional automatic anastomosis device, and is in a state in which the insertion portion of the automatic anastomosis device is inflated when inserted into living tissue. A balloon portion that secures the safety of the living tissue by ensuring smooth insertion at the same time, and a base portion that supports the balloon portion during expansion or contraction and is detachably fixed to the distal end side of the insertion portion. The balloon has a basic configuration and is integrally provided on the distal end side of the insertion portion of the automatic anastomosis apparatus. The balloon portion directly fixed to the distal end side of the insertion portion, and the balloon portion And a gas flow tube for expanding or contracting the tube. Further, the term “guide balloon” includes both a state where the balloon portion is inflated and a state where the balloon portion is contracted before and after the inflation. The `` tip side of the insertion portion '' refers to the entire portion of the automatic anastomosis device that is directly inserted into the living tissue, and more specifically, a trocar, which is a trocar described later, It includes a disk-shaped distal end surface of a cylindrical housing to be supported, an inner wall surface and a bottom surface of a space formed between a cylindrical scissor and the trocar.

The above-mentioned "living tissue" refers to a living tissue or organ that can be anastomosed by an automatic anastomosis device, and more specifically includes a small intestine such as the jejunum, a large intestine, and a tubular organ such as the esophagus. Shall be.

[0016] Further, the "integrally" means that the insertion portion and the guide balloon are connected to each other before the anastomosis operation so that the guide balloon does not fall out of the insertion portion even if mechanical means is taken at least during the anastomosis operation. Refers to a state that is fixed directly or indirectly.

[0017]

An embodiment of the present invention will be described below with reference to the drawings. Embodiment 1 FIG. 1 (a) and 1 (b) are schematic front views showing an embodiment of the guide balloon of the present invention, and FIG. 1 (a) shows a state before the balloon portion of the guide balloon is inflated. FIG. 1B shows a state in which the balloon portion of the guide balloon is inflated. FIG.
The same reference numerals are given to the same components as those of the conventional automatic anastomosis device shown in (1), and the description of those portions will be omitted.

In FIGS. 1A and 1B, reference numeral 1 denotes a guide balloon. The guide balloon 1 has a cylindrical base 2 into which a trocar 73 attached to the distal end of the ligation head assembly 60 of the automatic anastomosis device 50 shown in FIG. For example, a balloon portion 3 which is folded at the time of use and can be deformed at the time of inflation and has a tapered shape, and a tube 4 for supplying gas to the inside of the balloon portion 3 or exhausting gas from the inside of the balloon portion 3 And a pump 5 for supplying or exhausting the gas in the balloon portion 3 through the tube 4.

The inner surface of the base 2 is formed to be complementary to the outer surface shape of the trocar 73, as shown in FIG.
As shown in the figure, the base 2 and the trocar 7 are securely fixed to the automatic anastomosis device 50 in the living tissue, and from the viewpoint of ensuring safety such as avoiding the danger of falling off.
3 is preferably configured to be detachably engaged.
That is, the concave portion 73 formed on the outer surface of the trocar 73
a and the convex portion 2b formed on the inner surface 2a of the base 2 are detachably engaged. The form of engagement in the present embodiment may utilize the complementarity of the two forms as described above, or may utilize a biasing force on both or one side such as a leaf spring. . Further, by utilizing a member made of a shape memory alloy that transforms at a temperature in the living tissue in consideration of being used in the living tissue, a pressure contact force is generated between the two members, thereby guiding the guide balloon. Can be more reliably prevented from falling off. The outer diameter of the base 2 is desirably set to be substantially equal to the maximum diameter of the trocar 73 and the like. This is the same for the guide balloon 1 shown in FIG. 2 and thereafter.

As shown in FIG. 1B, the guide balloon 1
Although the balloon portion 3 is tapered as described above, it has a conical shape in terms of guiding the automatic anastomosis device into the living tissue, facilitating insertion into the living tissue, and preventing damage to the living tissue. It is preferred that In particular, it is preferable that the vertical cross-sectional shape is a substantially equilateral triangle. For this reason, the height of the trocar 73 is adjusted by the ligation head assembly 60 of the automatic anastomosis device 50.
The trocar 73 is adjusted as appropriate by operating the handle assembly 80 or the like so as to advance or retreat so as to be a vertex of an equilateral triangle having a length of one side as a diameter at the tip of the trocar 73. The maximum diameter of the balloon portion 3 when inflated is set to be the same as or slightly larger than the maximum diameter of the distal end portion of the ligating head assembly 60. That is, the difference L between the maximum diameters of the two is 0 (mm) ≦ L
≤ Max (mm). In particular, L is preferably 0 mm. This is because the outer surface of the balloon portion 3 and the outer surface of the ligating head assembly 60 are flush with each other, so that friction and the like at the time of insertion into a living tissue can be suppressed, and smooth guiding can be performed. Max is a positive value, and the upper limit is the upper limit of the ligating head assembly 60.
Is determined in consideration of, for example, an allowable dimension of the living tissue into which the distal end portion is inserted when the living tissue is expanded. That is, when the balloon portion 3 is forcibly pushed, the living tissue excessively expands. If the living tissue exceeds the allowable dimension when the living tissue is expanded, the expanded living tissue is cracked, which is not preferable.

The mounting position of the balloon section 3 on the trocar 73 is determined by appropriately judging the degree of exposure of the distal end of the trocar 73, such as the shape and size of the balloon section 3.

Further, the cross-sectional shape of the balloon portion 3 when inflated is a so-called donut shape, such as a true circular or elliptical cross-sectional shape from the trocar 73 to the outside of the ligating head assembly 60 in the radial direction. There may be. That is, as described above, the cross-sectional shape of an equilateral triangle is most preferable. However, the present invention is not limited to this, and the shape of the leading end on the guide side may be a flat shape instead of a tapered shape.

As shown in FIG. 1A, the lower portion of the trocar 73 of the automatic anastomosis device 50 has a recess 7 for engaging with the anvil shaft 104 of the anvil assembly 100.
3b is formed. The formation position of the concave portion 73b is
The lower side of the base 2 of the guide balloon 1 attached to the trocar 73 is located further below. This is because even after the use of the guide balloon 1, the anvil shaft 10
This is to secure the fixation of No. 4 to the trocar 73.

Embodiment 2 FIG. 2 (a) to 2 (c)
FIG. 2 is a schematic front view showing an embodiment of the automatic anastomosis apparatus according to the present invention, and FIG. FIG. 2B shows a state before mounting, and FIG. 2B shows a state after mounting.
2C shows an inflated state of the balloon portion, and FIG. 2D is a plan view of the inflated balloon portion and the like shown in FIG. FIG. 2E is a partial cross-sectional view schematically showing a state in which the automatic anastomosis device provided with the guide balloon shown in FIG. 2C is inserted into a living tissue. Note that the same components as those of the conventional automatic anastomosis device shown in FIG. 5 are denoted by the same reference numerals, and description thereof will be omitted.

First, in FIGS. 2 (a) to 2 (e),
The constituent material of the balloon portion 3 is a silicone elastomer which does not show rejection to human living tissue, has anti-perforation properties, and exhibits flexibility, flexibility, lubricity and the like when inflated. Is preferred. Further, various lubricants may be applied to the surface of the balloon portion 3 to improve the anti-friction property.
This is the same for the constituent material of the tube 4.

The pump 5 is preferably of a type that can switch between gas supply and exhaust. Here, as the gas, air that does not affect living tissue even if leaked during surgery is preferable. It is preferable that a gas is contained to maintain the tapered shape of the balloon portion 3. However, as long as it does not adversely affect the living tissue, the content of the balloon portion 3 other than the gas is shock absorbing, It may be a liquid, a solid solution or a solid such as a physiological saline having flexibility, viscosity and the like.

In the present embodiment, the inside of the balloon portion 3 is formed as a single room having a tapered shape. However, the present invention is not limited to this, and the balloon portion 3 is divided into a plurality of rooms. It may be a configuration. Note that the “configuration divided into a plurality of rooms” includes not only a case where the balloon unit 3 is configured with one balloon having a plurality of rooms, but also a case where the balloon unit 3 is configured with a plurality of balloons. And When the balloon portion 3 is composed of a plurality of balloons, for example, by arranging a plurality of balloons such that the maximum diameter when inflated gradually increases from the distal end side to the rear end side of the trocar 73, When the balloons are inflated, the balloons can have a tapered shape as a whole. By dividing into a plurality of rooms in this way, even if the room at the distal end is crushed during insertion into the living tissue, the room behind it is not as crushed as the room at the distal end,
Rather, as a result of the balloon portion 3 protruding outward in the radial direction, the ligation head assembly 60
Can cover the peripheral portion of the distal end portion, thereby preventing damage to the living tissue.

Further, among a plurality of rooms, adjacent rooms may be brought into contact with each other via a partition wall, and a wall may be provided with a valve that allows only gas to move from the front end room to the rear room. It is possible. That is, when the room at the distal end is crushed during insertion into the living tissue, the gas in the room at the distal end moves to the rear room by the valve, so the internal pressure of the rear room increases, and the pressure in the rear room increases. The shape is maintained, and the periphery of the distal end of the ligating head assembly 60 can be prevented from being exposed to the living tissue.

The guide balloon 1 having the above-described configuration.
The ligating head assembly 60 of the automatic anastomosis device 50
When the ligature head assembly 60 is disposed between living tissues to be anastomosed after being attached to the tip of the living body and guiding the living tissue, etc., the trocar 73 breaks through the living tissue. In this case, the guide balloon 1 is unnecessary.
Therefore, the guide balloon 1 which can be detachably attached to the conventional automatic anastomosis device 50 is more suitable for the end-to-end anastomosis which does not need to penetrate the living tissue than the above-mentioned end-side anastomosis and side-to-side anastomosis. In the end-to-end anastomosis, the guide balloon 1 may be removed when the distal end of the ligation head assembly 60 reaches the end of a living tissue such as the intestinal tract.

In the above embodiment, the balloon 3
Is folded on the outer surface of the base 2, but may be accommodated in the base 2. In the above embodiment, the tube 4 and the pump 5 connected to the balloon unit 3
Has been described as a basic component. However, if the balloon portion 3 is already filled with gas before mounting and the tapered shape of the balloon portion 3 can be maintained, the tube or the like need not be provided.

According to the present embodiment, for example, FIG.
Automatic anastomosis device 1 equipped with guide balloon 1 as shown in FIG.
Is pushed into the intestinal tract C as a living tissue,
The automatic anastomosis device 50 can be smoothly and easily inserted into the living tissue without damaging the inner wall surface of the body. Particularly, since the outer surface of the balloon portion 3 of the guide balloon 1 and the outer surface of the ligating head assembly 60 of the automatic anastomotic apparatus 1 are substantially flush, the load on the living tissue can be suppressed.

In the present embodiment, a silicone elastomer that can maintain the outer diameter even when pressed, etc., is used as a material forming the balloon portion 3. However, if the outer diameter of the balloon portion 3 is slightly smaller than the outer periphery of the distal end of the ligating head assembly 60 due to the degree of the pressing force, the distal end peripheral portion of the ligating head assembly 60 is moved to the living tissue. Even if it is slightly exposed, the deformed balloon portion 3 allows the living tissue to come into contact with the periphery of the distal end of the ligating head assembly 60 in a curved manner, and the living tissue can be protected.

Embodiment 3 3 (a) to 3 (c) are cross-sectional views showing a main part of an embodiment of the automatic anastomosis device of the present invention. This embodiment is characterized in that the distal end portion of the ligation head assembly 60 of the conventional automatic anastomosis device shown in FIG.
(A) to FIG. 2 (c) is that the present invention does not stop at the point where the guide balloon 1 is integrally mounted.

An improvement in the present embodiment is that the dedicated base of the balloon portion 3 is removed, the balloon portion 3 is directly fixed to the lower portion of the trocar 73, and the folded balloon portion 3 is connected to the trocar 73. It is fixed to the bottom of a donut-shaped space between the cylindrical scissors 69 and the tube 4 for supplying and exhausting the gas of the balloon portion 3 penetrates through the housing 61 and the stapling device 62. is there. As shown in FIG.
By supplying the gas from the pump 5 into the balloon portion 3 through the, the balloon portion 3 can be inflated to a tapered shape. Conversely, as shown in FIG.
By evacuating the gas from the balloon portion 3, the compressed balloon portion 3 can be accommodated in the above-described donut-shaped space bottom.

In the present embodiment, since the balloon portion 3 can be accommodated in the donut-shaped space, the balloon portion 3 is positioned when the distal end of the ligating head assembly 60 reaches the diseased part of the living tissue such as the intestinal tract. After the portion 3 is housed in the above-mentioned donut-shaped space, the balloon portion 3 is attached to the scissors 69 even when the trocar 73 pierces the side wall portion of the living tissue, which is the affected portion, and performs an end-side anastomosis or a side-side anastomosis. The living tissue can be reliably anastomosed without being pinched.

Embodiment 4 FIG. 4 (a) to 4 (c) are cross-sectional views showing a main part of another embodiment of the automatic anastomosis apparatus of the present invention, and FIG. 4 (d) is a schematic view showing the overall configuration of the present embodiment. FIG.

In this embodiment, the guide balloon 1 is provided integrally with the automatic anastomosis device 50 as in the third embodiment, and the feature thereof is that the tube 4 of the guide balloon 1 is inserted into the automatic anastomosis device 50. It is in the point which did. That is, FIGS.
As shown in (d), one end of the tube 4 is connected to the trocar 7.
The inside of the trocar 73 is connected to the balloon portion 3 from the inside, and the other end is directly connected to the outside of the trocar 73 through the rim (not shown) formed at the rear end of the support shaft assembly 70 and the staple operating lever 86. Connected to pump 5. Therefore, since the tube 4 does not directly contact the living tissue during the anastomosis operation, the degree of freedom of the material constituting the tube 4 is increased.

In the present embodiment, as shown in FIG. 4A, the trocar 73 of the automatic anastomosis device 50 has an outer shape with few irregularities, and the outer surface of the trocar 73 is Is provided with a bag-shaped balloon portion 3 which is folded. A desired gas or the like is supplied to the balloon portion 3 from the pump 5 via the tube 4 described above, and the gas or the like can be forcibly removed from the balloon portion 3 at the end of use as necessary.

In this embodiment, at the time of anastomosis, the distal end of the trocar 73 of the ligation head assembly 60 can be inserted into the anvil shaft 104 of the anvil assembly 100 and engaged therewith. However, the balloon part 3 folded on the outer surface of the base part 2 by the anvil shaft 104
May be protected. That is, the anvil shaft 104
The inner diameter of the anvil shaft 104 is set to be large enough to cover the folded balloon portion 3 and smaller than the inner diameter of the scissors 69. It is configured to be engaged. For example, as shown in FIG. 4A, the engagement position of the base 2 is preferably within the scissors 69. That is, by making the tip of the anvil shaft 104 enter the scissors 69, the balloon portion 3 covered by the anvil shaft 104 can be prevented from coming into contact with the scissors 69. Therefore, according to such a configuration, at the time of anastomosis, the staples and the scissors 69 do not come into contact with the balloon portion 3 and are not pinched, so that leakage or the like from the anastomosis site can be reliably prevented.

In this embodiment, after the guidance is completed,
By forcibly removing gas and the like in the balloon portion 3 by the pump 5, the balloon portion 3 is adsorbed on the outer surface of the trocar 73 as the base 2 to save space, and the anvil is attached to the trocar 73. This is to prevent an obstacle when the shaft 104 is fixed.

Next, referring to FIG. 5 to FIG. 47, the configuration other than the main part of the automatic anastomosis apparatus of the present invention and the method of use will be described.
In the following drawings, the configuration of the automatic anastomosis device to which the guide balloon according to the first embodiment can be attached will be shown for convenience.

Referring to FIG. 5, there is shown an embodiment of an automatic anastomosis device (hereinafter also referred to as a surgical annular anastomosis prosthesis device or simply a prosthesis device) of the present invention, generally designated 50. This comprises a longitudinally curved support shaft assembly 7.
0, the distal ligature head assembly 60 connected to the mesial actuator handle assembly 80
including. Prosthetic device 50 includes an anvil assembly 100 that is slidable longitudinally relative to ligating head assembly 60. A rotatable adjustment knob 82 is provided at the mesial end of the actuator handle assembly 80 to adjust the spacing between the ligating head assembly 60 and the anvil assembly 100. A movable indicator 84 is visible through a window 85 at the top of the handle assembly 80 and indicates the height of the selected staple by turning the adjustment knob 82. As shown in FIG. 19, the indicator 84 can be moved along a scale 87 indicating that the anvil gap is within the desired operating range of the prosthetic device 50. The position of the indicator 84 also indicates whether the height of the selected staple is large or small.

The needle activation lever 86 is used to drive the surgical needle from the ligating head assembly 60 to provide the desired needle height when the anvil assembly 100 is closed. It is mounted on the handle assembly 80 so as to be pivotable. An axially rotating latch member 88 is mounted on the handle assembly 80 to lock the staple operating lever 86 so as not to move, and prevents the ligating head assembly 60 from differentially moving when the anvil gap is outside a predetermined range. .

Referring to FIGS. 6 and 20, the ligating head assembly 60 includes a cylindrical housing 61, which can be advanced or retracted by probing the actuator and handle assembly 80. 62 is slidably received. The staple ejection device 62 includes a plurality of fingers 63 for engaging and ejecting a plurality of staples 90 from a needle holder 68 mounted on the distal end of the housing 61. The needle holder 68 has a plurality of staple receiving slots 6 into which the staples 90 are inserted.
5 is included. Further, the staple ejecting device 62 includes the staple ejecting device 6.
2 support a ring-shaped knife or scissor 69 which is advanced and retracted.

The ligating head assembly 60 includes a hollow tubular spigot 64 at the mesial end of the housing 61, which receives the distal end of the support shaft assembly 70. The receiving tube or sleeve 72 covers the connection between the tubular plug 64 and the distal end of the support shaft assembly 70. The receiving tube 72 is compressed or contracted radially inward by, for example, an electromagnetic deformation process, and tightly joins the cylindrical plug 64 to the distal end of the support shaft assembly 70. Similarly, the support shaft assembly 70
Mesial end of actuator / handle assembly 80
At its distal end. A receiving tube or sleeve 76 overlies the junction between the mesial end of the support shaft assembly 70 and the distal end of the tubular extension 74. The receiving tube 76 is compressed or contracted inward in the radial direction by, for example, a magnetic deformation process, and tightly joins the support shaft assembly 70 to the actuator / handle assembly 80.

Referring to FIGS. 6 and 35, the anvil assembly 100 extends in the form of a hollow shaft removably secured to a trocar 73 slidably supported by a ligation head assembly 60. Includes a generally annular anvil 102 mounted on an anvil shaft 104. The trocar 73 is formed on the cylindrical housing 61 so as to operate in the longitudinal direction with respect to the needle holder 68 provided at the distal end of the housing 61, and a central support tube 66 (FIG. 6). Is slidably received within. The needle receiving slots 65 in the needle holder 68 are arranged in an annular row to receive a surgical needle 90. The staple receiving slots 65 are preferably arranged in concentric annular rows with slight spacing. Anvil 102 includes an annular rim 106 having a plurality of staple forming grooves 108 (FIG. 44) for forming staples 90 when ejected against anvil 102.

The anvil assembly 100 includes a trocar 73
Is inserted into the anvil shaft 104 when the trocar tip 7
A pair of long spring-like retaining clips 110 extending longitudinally along anvil axis 104 to engage
including. As shown in FIG. 36, the retaining clip 110 extends longitudinally through the anvil shaft 104 and extends outwardly to be received in longitudinal slots 114 disposed along opposite sides of the anvil shaft 104. Portion 112. The outwardly extending portion 112 of each retaining clip 110 is bent radially inward to provide a pawl 116 for capturing the trocar tip 75 therebetween. The elongated slot 114 allows the enlarged portion 112 of the retaining clip 110 to flex radially outward when the trocar tip 75 is inserted into the anvil shaft 104 and advanced between the pawls 116.

[0048] To facilitate insertion of the trocar 73 into the interior of the anvil shaft 104, the trocar tip 75 has a reduced force profile. The trocar tip 75 preferably forms a shallow wedge to reduce the force required to spread the retaining clip 110. For example, trocar tip 75
Is formed in a trapezoidal shape with a wedge of 30 degrees or less with respect to the trocar axis to facilitate insertion of the trocar 73 between the retaining clips 110. In a preferred embodiment, the trocar tip 75 pushes the retaining clip 110 as the trocar 73 is inserted into the anvil shaft 104, with the trapezoidal point 77 being wedge-shaped at a 30 degree angle at the distal end. Adjacent trapezoidal surface 79 wedge-shaped at 9 degrees for spreading
Having.

When the prosthetic device 50 is in the open position (FIG. 6), the retaining clips 110 allow the anvil assembly 100 (FIG. 35) to be attached to and detached from the trocar 73 by being pushed and withdrawn on the anvil assembly 100, respectively. It has been done. When the prosthetic device is in the closed position (FIG. 8), the trocar 73 is drawn into the central support tube 66, which limits the radial movement of the retaining clip 110 and the pawl 116 To stay in the position relative to. As a result, the anvil assembly 100 is locked with the trocar 73, allowing the anvil 102 to resist the maximum firing power of the prosthetic device without disengaging the retaining clip 110 from the trocar tip 75.

As shown in FIG. 38, each holding clip 1
10 is a flange 121 at the distal end of the anvil shaft 104 and an enlarged cusp 118 that provides one or more lateral overhangs or shoulders 120 to tension the anvil 102
At the distal end. A pair of inner surfaces 12 on the anvil shaft 104
2 (FIG. 39) engage opposite ends of the retaining clip 110. Inner surface 122 locates keyway 123 (FIG. 40) inside anvil shaft 104 to align long slot 114 on the opposite side of anvil shaft 104 with outwardly extending portion 112 of retaining clip 110. Stipulate.

Referring to FIG. 36, the trocar 73 has a long cylindrical shape having a first conically tapering portion 132 ending in a reduced diameter long portion 134 supporting the trocar tip 75 at the distal end. A body 130 is included. The second conically tapering portion terminates in a reduced diameter cylindrical neck 138 that defines the outwardly extending shoulder portion 140 behind the trocar tip 75. Shoulder portion 140 is trocar tip 7
5 is inserted between the retaining clips 110 when the pawl 116 is inserted.
Engaged.

As shown in FIG. 37, the cylindrical trocar body 130 is offset inward at a position adjacent to the first conically tapering portion 132, and An edge 142 is provided. The lip 142 causes the sleeve 105 to slide when the trocar 73 is inserted into the hollow anvil shaft 104.
With the end of the The sleeve 105 is a trocar body 130
Has an inner angled portion 124 for receiving a tapered 132. The outwardly chamfered portion 126 at the mesial end of the sleeve 105 provides a peripheral thin edge 128 for engaging a peripheral edge 142 of the trocar body 130. The chamfered portions 126 and 144 facilitate the transfer of tissue over the junction between the trocar body 130 and the sleeve 105 as the trocar 73 is pulled into the ligating head assembly 60. The peripheral thin edge 128 of the sleeve 105 preferably has a slightly smaller diameter than the peripheral edge 142 to facilitate the transfer of tissue from the trocar 73 to the anvil shaft 104.

Referring to FIG. 39, an anvil shaft 104 is composed of a metal hollow sleeve 105 made of, for example, stainless steel, and a thin hollow cylindrical cover 150 made of plastic and fixed to the outer surface of the metal sleeve 105. Having a structure. The cylindrical cover 150 is slightly larger in diameter than the anvil shaft 104 and the remainder of the cover 150 and has an enlarged peripheral portion 152. The widened peripheral portion 152 is dimensioned to fit tightly into the distal end of the support tube 66 (FIG. 8) when the trocar 73 and the anvil shaft 104 are pulled inside the ligating head assembly 60. I have. The purpose of peripheral portion 152 is anvil 102
And to provide accurate alignment of the needle holder 68.

A spiral wire (hereinafter referred to as an external wire) 154 (FIG. 38) disposed on a plurality of outer peripheral portions extends longitudinally from the expanded peripheral portion 152 toward the mesial end of the cylindrical cover 150. Exist. A plurality of spiral filaments (hereinafter, referred to as internal filaments) 156 (FIG. 34) arranged in the inner peripheral portion are formed inside the support tube 66. As the anvil shaft 104 is pulled inside the support tube 66, the outer filament 154 is received between the inner filaments 156 to provide accurate peripheral alignment of the anvil 102 and the needle holder 68. As a result of the precise alignment of the shaft and the periphery, the staple forming groove 108 of the anvil 102 is precisely aligned with the staple receiving slot 65 in the staple receiving slot needle holder 68.

Another purpose of the widened peripheral portion 152 is to position a peripheral notch 158 on the anvil shaft 104 for convenient purse string suturing of the tubular tissue. As shown in FIG. 6, when the purse string is sutured to the anvil shaft 104 at the peripheral notch 158 located in the distal direction beyond the spread peripheral portion 152 in the distal direction, the purse string-stitched tissue is expanded to the spread peripheral portion 152. It won't slide out easily beyond. As a result, the purse string sutured tissue is confined to the distal region of the anvil shaft 104 beyond the widened perimeter, and the anvil shaft 104 does not slide back through the purse string sutured tissue.

As shown in FIG. 34, it is desirable that the inner filament 156 be separated from the distal end of the support tube 66 and be spaced apart in the mesial direction. With this arrangement of the inner filament 156,
As the anvil shaft 104 is pulled, the purse string sutured tissue is less likely to be pinched between the outer striated line 154 and the inner striated line 156 and prevents tissue from being drawn into the support tube 66. Also, as shown in FIG.
The distal end of 6 is connected to a needle holder 68 for pushing the tissue over the outer filament 154 as the anvil shaft 104 is pulled to prevent tissue from being drawn into the hollow interior of the housing 61. It has a flat annular edge 67 located adjacent to it. The central support tube 66 provides increased visibility so that the anvil shaft 104 is pulled into the ligating head assembly 60.

Referring to FIGS. 38 and 44, the anvil assembly 100 includes a backing washer 160 installed within the anvil 102 to provide a tissue cutting surface from which the purse-string suture is cut. Backing washer 1
Reference numeral 60 denotes an annular structure, and an annular rim 106 of the anvil 102 is provided.
Mounted concentrically inside. An annular groove 162 (FIG. 44) extends inwardly from its distal end into washer 160 and terminates short of its mesial end. Groove 1
According to 62, the washer 160 includes an outer annular wall 164 and an inner annular wall 166 joined at the mesial end of the washer 160 by a thin girder 168. Girder 16
8 provides a backing surface from which the purse string suture is cut by the circular knife 69. An annular collar 165 extends radially inward from the distal end of the inner annular wall 166 and leans over the anvil 102 to secure the washer 160.
Of the inner wall 166 is reinforced.

As shown in FIGS. 38 and 41, the backing washer 160 includes a plurality of claws 170 projecting radially outward at the distal end of the outer annular wall 164. For example, the three claws 170 are uniformly spaced around the washer 160. Annular recess or groove 172
(FIGS. 19 and 20) show the pawl 170 on the washer 160.
And is formed in the distal direction inside the anvil rim 106 to receive the fluid. The pawl 170 is hooked into the annular recess 172 to fix the washer 160 to the anvil 102. The pawl 170 and annular recess 172 provide a friction fit to prevent the washer 160 from accidentally disengaging from the anvil 102 during shipping or storage.

The backing washer 160 includes a first pair of semi-circular cutouts 173 (FIG. 41) formed in the outer annular wall 164 thereof, which includes the inner annular wall 1.
66, a second pair of semicircular cutouts 1
74 so that the position is the same. Notch 17
3 and 174 are disposed at positions diametrically opposed to each other with the washer 160, and a pair of holes 176
And the position is aligned. Notches 173 and 174 provide sufficient clearance to receive the formed ends of a pair of locking pins 177 used to attach tip 178 (FIG. 38) to anvil 102.

Referring to FIG. 11, the support shaft assembly 70 transmits the necessary compression force and movement from the actuator and handle assembly 80 to operate the stapling device 62 in the ligating head assembly 60. And a member 92. In addition, the support shaft assembly 70 transmits a necessary tension from the actuator / handle assembly 80 to the anvil assembly 100 so as to oppose a compressive force applied to the anvil assembly 100, and a pair of long flexible tension belts 95 and Tension member 9 consisting of 96
4 inclusive. Flexible tension belts 95 and 96 transmit movement from actuator and handle assembly 80 so that anvil assembly 100 can be adjusted to a position relative to ligating head assembly 60. The long flexible spacer belt 98 is used to support the support shaft assembly 70.
And the flexible tension belts 95 and 96 are included in the space.

Referring to FIG. 24, the compression member 92 is preferably made of a plastic material and includes a straight mesial portion 200 merging a central curved portion 202 that continues to a straight sleeve 204 at the distal end. It consists of a long member. In contrast to the support shaft assembly 70, which has a substantially uniform curvature over its entire length, the central curved portion 202 of the compression member 92 varies between the straight mesial portion 200 and the straight sleeve 204 at the distal end. Radius of curvature. The compression member 92 is made of a flexible material having a curvature opposite the hollow cylindrical support shaft assembly 70, for example, a carbon fiber or glass fiber filled plastic material.

As shown in FIGS. 24 and 25, the mesial extension 206 is determined by the offset 208 of the compression member 92. The mesial extension 206 is provided with an outwardly extending pin 210 to provide a compression member 92 and actuator
The connection of the handle assembly 80 is facilitated.
The elongated groove 212 extends longitudinally from the mesial extension 206 along a straight mesial portion 200 and terminates short of the intermediate curved portion 202 of the compression member 92.
As shown in FIG. 26, the intermediate curved portion 202 is not solid cylindrical, providing an upstanding guide surface or ramp 214 extending longitudinally along substantially the entire length of the curved portion 202. Has a cross section. The ramp 214 provides an integral guide surface on the compression member 92 for engaging and supporting the flexible tension belts 95 and 96 of the tension member 94 included in the curved support shaft assembly 70.

Referring to FIGS. 24 and 30, a sleeve 204 at the distal end of the compression member 92 is suitable for securely tightening the staple ejection device 62, and the compression member 92 is sewn relative to the needle holder. Needle ejection device 62 can be advanced or retracted. Sleeve 204 includes an extension 220 that extends beyond a collar 222 formed at the distal end of sleeve 204 (FIG. 28). The distal extension 220 is provided with a first set of four radially projecting projections 224 spaced equally in the circumferential direction. The centrifugally extending portion 220 also includes a second set of projections 226 that are spaced apart at equal intervals in the surrounding direction and that are four radially projecting and that are wider than the first set of radially projecting projections 224. Have. As shown in FIG. 27, the first set of projections 224 extend radially outward at substantially the same distance as the collar 222. The second set of protrusions 226 is smaller in size than protrusions 224, and protrusions 226 extend radially outward a shorter distance than protrusions 224. Desirably, the distal extension 220 has an internally chamfered surface 228 (FIG. 28) to facilitate movement of the trocar 73 into the sleeve 204 as the anvil assembly 100 is retracted.

Referring to FIG. 30, the needle ejection device 62 includes a set of four mesial-extending four long locating fingers 230 separated by a longitudinal slot 232. As shown in FIG. 31, the slots 232 are circumferentially arranged on the staple ejection device 62 at intervals of 90 degrees. As also shown in FIG. 32, each locating finger 230 includes an inwardly projecting pawl 234 provided with an inwardly chamfered surface 236 adjacent the mesial end of the locating finger 230. The staple ejecting device 62 includes a compression member 92.
When the positioning finger 2 is mounted on the sleeve 204,
30 is temporarily deflected so that the claw 234 is
6 makes it easier to move on. The claw 234 is hooked at a position between the protrusion 226 and the flange 222 to fix the staple ejecting device 62 to the sleeve 204. The flange 222 transmits the compressive force from the compressing member 92 to advance the staple ejecting device 62. The staple ejection device 62 is formed by the projections 226 and the claws 234.
Can be pulled by the compression member 92.

Referring to FIG. 21, tension member 94 includes a pair of flexible tension belts 95 and 96, which increase the flexibility of tension member 94 while maintaining tensile strength. The narrow distal ends of the flexible tension belts 95 and 96 are connected to the trocar 73 by a set of pins 240. The narrow mesial ends of the flexible tension belts 95 and 96 are
2 actuator / handle assembly 80
Connected to the control rod 300 contained therein. Flexible tension belts 95 and 96 include long central portions 245 and 246, respectively, which are substantially wider than the narrow mesial and distal ends of flexible tension belts 95 and 96. Because the compression member 92 has a non-cylindrical structure that is open substantially along its entire length, the tension member 94 is not disposed within or surrounded by the compression member 92. As a result, the long intermediate portions 245 and 246 of the flexible tension belts 95 and 96 are substantially the same width as the inside diameter of the support shaft assembly 70. This widened width corresponds to the actuator and handle assembly 8
The tendency of flexible tension belts 95 and 96 to expand and contract when tension is transmitted from zero to anvil assembly 100 via tension member 94 is minimized.

As shown in FIGS. 11 and 22, the flexible spacer belt 98 has a long flexible strip 250.
, The strip protruding perpendicularly thereto and engaging the inner surface of the support shaft assembly 70 with the longitudinal blades 2.
Includes 52 columns. At the top of the flexible spacer belt 98, a pair of long protrusions 254 are provided with flexible strips 250.
Extend along opposite ends of the Protrusion 254 engages central portion 246 of flexible tension belt 96 to reduce sliding friction between flexible tension belt 96 and flexible spacer belt 98. To receive the control rod 300 included in the actuator and handle assembly 80,
A long groove 256 is formed at the mesial end of the flexible spacer belt 98.

Referring to FIG. 23, the actuator and handle assembly 80 includes a pair of long handle portions 81.
, Which fit together to form a generally cylindrical handle. Each of the handle portions 81 is provided with a dependent core 83 which is arranged so that the staple operating lever 86 is pivoted.
Is included. A control rod 300 is included between the handle portions to move longitudinally along the actuator and handle assembly 80. The adjustment knob 82 is located on the handle portion 8
It is rotatably supported by one mesial end and threadedly engages a long threaded shaft 302 at the mesial end of the control rod 300. The threaded shaft 302 is threadedly connected to the internally threaded sleeve 304 at the distal end of the adjustment knob 82. The threaded sleeve 304 is rotatably received in an annular wall 305 formed in each handle portion 81. The cylindrical cover 89 is provided with the hollow adjustment knob 8.
2 fixed inside the mesial end. The distal end of the control rod 300 is a long groove 21 in the mesial portion 200 of the compression member 92.
2 is slidably received. The control rod 300 is connected at its distal end to the tension member 94 by a pin 242.

As shown in FIG. 23, the U-shaped clip 3
06 and the screw 308 prevent the control rod 300 from rotating around its axis. U-shaped clip 306 has a long slot 310 for receiving screw 308 (FIG. 12).
On each of its opposite sides. For the purpose of calibrating the indicator and the safety release mechanism described later, the slot 31 is used.
0 allows the U-shaped clip 306 to adjust its position in the longitudinal direction of the control rod 300.

Turning control knob 82 in a counterclockwise direction as shown in FIG.
Moves forward, moving the tension member in the distal direction, opening the gap between the anvil assembly 100 and the ligating head assembly 60. Step 30 in one of the handle portions 81
7 (FIG. 12) engage with the screw 308 to limit the movement of the control rod 300 in the centrifugal direction. By rotating the adjustment knob 82 in the opposite direction, that is, clockwise, the control rod 30 is rotated.
The 0 retracts, causing the tension member to move mesially, closing the gap between the anvil assembly 100 and the ligating head assembly 60. The step 309 of the lid 89 is the control rod 300
Restrict mesial travel of.

Actuator and handle assembly 8
0 includes a safety release bracket 312 slidably supported on each of the handle portions 81. The safety release bracket 312 includes a long rectangular plate 314 slidably received between a pair of longitudinal beams 315 and 316 formed on each of the handle portions 81 below the screw shaft 302 of the control rod 300. . The screw shaft 302 extends through an upstanding collar 318 formed at the mesial end of the square plate 314. The coil springs 320 are located between the collar 318 of each handle portion 81 and the annular wall 305,
Usually, the flange 318 is pressed toward the beam 315 in the centrifugal direction. The distal end of the safety release bracket 312 is an arm 322 projecting in the distal direction, ending with a finger 324 that is inclined upward and projects laterally, and controls the movement of the indicator 84.

As shown in FIG. 12, the indicator 84 has a support lever 326 mounted on a pair of rotary shaft pins 328 (only one is shown) formed on the handle portion 81 so as to rotate about the axis. Located at the top. The arm 322 extends in the distal direction along the indicator lever 326 and the finger 32
4 is located on the distal side of the indicator lever 326. The coil spring 320 (FIG. 23) is provided so that the indicator lever 326 is pushed in the centrifugal direction so that the indicator 84 is located at the distal position of the window 85 (FIG. 19).

6 and 12, the prosthetic device 50
Is shown with the anvil assembly 100 fully open and the actuator and handle assembly 80 fully advanced. Anvil assembly 100
When the safety release bracket 312 is completely opened, the safety release bracket 312 is pressed to the distal side by the coil spring 320 to urge the upright flange 318 toward the beam, and the finger 324 is released.
Advances in the centrifugal direction and is disengaged from the indicator lever 326. When the control rod 300 is retracted, the clip 306 on the control rod 300 moves in a mesial direction to engage the flange 318 as shown in FIG.
Move 12 in mesial direction. When the anvil assembly 100 first begins to tighten, the safety release bracket 312
The upper finger 324 is still disengaged from the indicator lever 326 (FIG. 17). Anvil assembly 10
When the gap between the ligature head assembly 60 and the ligating head assembly 60 is adjusted within the predetermined range of the device, the finger 324 engages the indicator lever 326 and pivots as shown in FIG. Move mesially along the scale 87 of the prosthesis 50 to provide an indication of the selected height of the staple made when the prosthesis 50 is fired.

The safety latch member 88 is arranged to pivot about a pivot pin 330 extending between the handle portions 81 below the safety release bracket 312. The safety latch member 88 includes a bar 332 that is horizontally positioned below the safety release bracket 312 in the latched position (FIG. 12). If the anvil gap is outside, that is, equal to or greater than a predetermined range of the prosthetic device 50, the safety release bracket 31
A two square plate 314 overlies the bar 332 of the safety latch member 88 to prevent the safety latch from being disengaged from the staple operating lever 86. When the anvil gap is within the predetermined range, the safety release bracket 312 is pulled, and the bar 332 of the safety latch member 88 is disengaged from the square plate 314 of the safety release bracket 312. Safety latch member 8
8 is rotated to the position where the latch is released, and the staple operating lever 8 is rotated.
6 can be operated (FIG. 13).

As shown in FIG. 23, the staple operating lever 8
Reference numeral 6 includes a trigger arm 340 which is covered with a plastic covering 342 and connected to the subsidiary core 83 of the handle portion 81 by a pivot pin 344, and is formed by bending one member. Trigger spring 3
Reference numeral 46 is attached to the shaft rotation pin 344, and normally presses the staple operating lever 86 to the non-cooperative position (FIG. 12). The trigger arm 340 includes a pair of bars 348 that engage the safety latch member 88 in the latched position. Trigger arm 340 also includes a pair of actuator fingers 350 for operating compression member 92 of prosthetic device 50. Trigger arm 340 is coupled to compression member 92 by a firing clip 352 that fits over cylindrical extension 206 and engages offset 208 at the mesial end of compression member 92. The firing clip 352 has a hole 3 for receiving the pin 210 on the cylindrical extension 206.
54. The firing clip 352 has the trigger arm 34.
A notch 356 is provided on the opposing side thereof to receive the zero actuator finger 350. A firing clip 352 is provided for transmitting both distal and mesial movement from the actuator finger 350 to the compression member 92. The notch 356 prevents the actuator finger 350 from expanding and bypassing the arm 355 under load and from bypassing the core 358 during towing.

Referring to FIG. 45, the detachable trocar 1
80 is provided for use with anvil assembly 100. Removable trocar 180 includes a trocar body 181 that is long and generally cylindrical and has a trocar tip 182 at its mesial end in the shape of a trapezoid. A pair of depressed recesses 183 are formed on opposite sides of the cylindrical body 181 to facilitate handling of the trocar 180.
The tubular body 181 has a first conical tapered portion 184 which is a reduced diameter long portion 18.
5 which terminates in a narrow cylindrical neck 187
To a conically tapered section 186 of A long head 188 is provided at the distal end of cylindrical neck 187.
The head 188 has the claw 116 of the trocar 180
0 of the holding clip 110 when inserted between
And a pair of mesial end shoulders 189 for engaging the shoulder. Head 1
Numeral 88 has a pair of flat opposing sides 190 peripherally disposed at an angle of 90 degrees to the depressed finger rest 183 of the trocar body 181.

When the removable trocar 180 is inserted into the hollow anvil shaft 104, as shown in FIG. 46, the sleeve 105 at the mesial end of the anvil shaft 104 tapers to the conical shape of the trocar 180. Engagement with the bent portion 184. In the boosted position of the trocar 180 with the flat side 190 oriented vertically,
As shown in FIG. 46, the head 188 is
The pawl engages the shoulder 189 to hold the trocar 180 within the anvil shaft 104. Trocar 18
0 is released from the anvil shaft 104, the trocar body 1
Rotate 81 by 90 degrees to the reduced position shown in FIG.
Align the flat side 190 of the head 188 with the pawl 116 in the shape of the retaining clip 110. The trocar 180 is moved to the anvil shaft 104
When the claw 116 and the flat side 190 are aligned when withdrawn from the trocar 180, the trocar 180 turns the flat side 190 of the head 188 at a right angle to the claw 116.
Can be disengaged from the holding clip 110 with a smaller force than the force required to pull out the clip.
Further, when the trocar 180 is moved to the reduced force position, the trocar 180 can be moved with a small force, for example, by using an endoscope clamp.
And can be engaged with the retaining clip 110.

Referring to FIG. 20, the support shaft assembly 70 is offset inward at the distal end so that the adjacent annular groove 36 on the tubular extension 360 can be removed.
4 provides a small diameter tubular extension having an upstanding annular collar 362 for positioning the same. Similarly, the housing tubular fitting 64 includes a mesially extending sleeve 370 with one or more upstanding annular collars 372 separated by adjacent annular grooves 374. Sleeve 370 is slightly larger in diameter and is adapted to slidably receive tubular extension 360 therein. The extension 360 has a longitudinal slot 366,
This provides a key path for receiving a longitudinal helical thread or key 376 formed inside sleeve 370 to circumferentially align housing 61 with support shaft assembly 70. Annular collars 362 and 37
The purpose of the two and annular grooves 364 and 374 is to provide a series of alternating protrusions and indentations adjacent to the point of connection between the cylindrical housing 61 and the support shaft assembly 70, on which the receiving tube 72 is provided. A connection that is deformed and strong and does not slip
1 and the support shaft assembly 70.

Actuator and handle assembly 8
To facilitate the connection of the support shaft assembly 70 to the support shaft assembly 70, the mesial end of the support shaft assembly 70 has a cylindrical extension 38 having a small diameter and providing an annular collar 382 at the mesial end.
There is an offset for positioning 0. The annular collar 382 is an annular recess 3 inside each handle portion 81.
84 (FIG. 23). A pair of guide rods 386
(Only one is shown in FIG. 23)
Are formed at positions opposed to each other in the diametrical direction in the annular concave portion 384. The guide bar 386 is received in a pair of holes 388 (FIG. 20) formed at diametrically opposite positions of the collar 382. Each handle portion 81 includes a semi-cylindrical sleeve 390 at the distal end, which supports the support shaft assembly 70.
Receive a cylindrical extension 380 at the mesial end. The receiving tube 76 (FIG. 5) covers the connection point between the support shaft assembly 70 and the actuator / handle assembly 80,
The radially inward deformation provides a strong connection between the support shaft assembly 70 and the actuator and handle assembly 80.

Using the surgical annular anastomotic prosthetic device 50,
An intraluminal anastomosis can be performed in which two pieces of tissue are interconnected by a row of needles. As an example,
A technique for end-to-end anastomosis of cut ends of a pair of luminal tissues using a plurality of surgical needles arranged in an annular row around the lumen between tissue cutting planes is described in detail. In preparation for an anastomosis,
A suture is passed through the luminal tissue to be anastomosed by a purse string suture. For example, as shown in FIG. 2, the cut surfaces 52 and 54 of the two tubular tissues may each include a drawstring suture 56 and 58 adjacent the open ends of the tubular tissue cut surfaces 52 and 54, respectively. Ready by passing through the ceremony.

When the surgical procedure is performed using the double purse string suturing technique, the prosthetic device 50 is connected to the ligature head assembly 60 with the anvil assembly 100 completely closed. The device is inserted into the first tubular tissue section 52 by insertion into the opening. Prior to insertion of the prosthetic device 50 into the case, the adjustment knob 82 is rotated clockwise to retract the trocar 73 into the support tube 66 and to bite the anvil 102 into the needle holder 68.
The ligating head assembly 60 is located adjacent the purse-string suture end of the tubular tissue cutting surface 52. The anvil assembly 100 is then moved to its fully open position by rotating the adjustment knob 82 counterclockwise and advancing the control rod 300 and tension member 92 until the trocar 73 is fully advanced. (FIG. 2). When the trocar 73 is fully advanced, the purse string suture end of the tubular tissue cutting surface 52 falls together toward the cylindrical trocar body 130 by pulling and tightening the purse string suture 56. The purse-stringed tissue falls down toward the trocar body 130, and the purse-string suture 56 is ligated to secure the tissue to the trocar body 130.

The tissue is drawn together toward the anvil shaft 104 by inserting the anvil assembly 100 inside the purse string suture end of the tubular tissue cutting surface 54 and pulling and tightening the purse string suture 58. Preferably, the purse string suture is drawn toward the anvil shaft 104 into the distally adjacent ligating protrusion of the peripherally upright portion 152 on the anvil shaft 104 and the purse string suture 58 is fastened together. Anvil assembly 1 if desired
00 can be detached from the trocar 73 to facilitate insertion of the anvil assembly 100 into the tubular tissue cutting surface 54. After ligating the end of the drawstring suture of the tubular tissue cut surface 54 to the anvil shaft 104 with the drawstring suture 58, the anvil assembly 100 is reattached to the trocar 73.

After ligating the purse-string suture ends of the tubular tissue cut surfaces 52 and 54, the adjustment knob is rotated clockwise to draw the trocar 73 into the support tube 66, and the anvil 102 toward the needle holder 68. Move. When the trocar 73 is retracted, the trocar body 130 slides mesially through the purse-string sutured end of the tissue cutting surface 52 to draw the anvil shaft 104 into the support tube 66 via the purse-string sutured tissue. The chamfered portions 126 and 144 (FIG. 37) facilitate movement of the transition between the trocar body 130 and the sleeve 105 via the purse string suture. As described above, the sleeve 10
5 has a slightly smaller diameter than the peripheral edge 142 of the trocar body 130 so that when the trocar 73 is retracted, the purse string suture tissue transitions from the chamfered portion 144 to the chamfered portion 126. You can easily migrate.
When the anvil shaft 104 enters the support tube 66, the anvil shaft 1
An outer line 154 (FIG. 38) on 04 is received and guided between the inner line 156 (FIG. 34) of the support tube 66 to align the anvil 102 with the needle holder 68 at the periphery. The annular rim 67 of the support tube 66 presses the purse string suture tissue against the transition between the trocar 73 and the anvil shaft 104 and against the outer filament 154. Also, the upright peripheral portion 152
Is closely received in the support tube 66 to axially align the anvil 102 with the needle holder 68. As a result of the peripheral and axial alignment, the staple forming groove 108 (FIG. 44) of the anvil 102 is inserted into the staple receiving slot 65 of the needle holder 68.
(FIG. 30).

When the gap between the anvil 102 and the needle holder 68 is set to produce the desired staple height within the operating range of the prosthetic device 50, the safety latch member 88 pivots clockwise. Then, the engagement of the staple operating lever 86 is released as shown in FIG. The prosthetic device 50 grips and rotates the staple operating lever 86 in a clockwise direction, and ligates the staple operating lever 86 by moving the staple operating lever 86 to its operating position as shown in FIG. As a result, the actuator finger 350 of the trigger arm 340 ejects the firing clip 352 in a centrifugal direction to advance the compression member 92 longitudinally along the support shaft assembly 70. The compression member 92 advances the staple ejection device 62 to move the ejection finger 63 in the centrifugal direction to the staple receiving slot 65 so that the staple 90 is fitted. The compression member 92 transmits the necessary movement and compression force from the trigger arm 340 to the needle ejection device 62 to eject the needle 90 from the needle holder 68 into the tissue and toward the anvil 102. As shown in FIG. 10, each staple 90 is shaped into a B-shape to bind the tissue sections 52 and 54 together. Further, the annular knife 69 is pushed out by the staple ejecting device, and cuts the tissue toward the backing washer 160. As shown in FIG.
Divides the backing washer 160 into two annular sections.

After the binding and cutting of the tissue are completed,
The staple operating lever 86 is pushed to the inoperative position by the spring 346 (FIG. 13). When the actuator finger 350 of the trigger arm 340 turns counterclockwise, as shown in FIG.
The firing clip 352 and the compression member 92 are moved in a mesial direction so as to be visible. As a result, the positioning fingers 23
0 and the annular knife 69 connected to the compression member 92 by the ligating head assembly 60.
It is towed inside. If staples, tissue, or other debris is captured between the needle holder 68 and the ejection fingers 63, the ligation head may be pulled from the tissue by traction of the needle ejection device 62 before removing the prosthetic device 50 from the case. Release the assembly 60. If a boost is required, the staple operating lever 86 is manually flipped to its inoperative position and the staple ejection device 62
Can be towed.

Next, the tissue bound between the anvil 102 and the needle holder 68 is rotated by turning the adjustment knob 82 counterclockwise to advance the anvil assembly 100 away from the ligating head assembly 60. Be released. The anvil 102 can be moved through the luminal tissue by handling the bound tissue in an appropriate manner and sliding the anvil through the bound lumen. Thereafter, the prosthetic device 50 is removed from the case leaving behind a closed lumen between the tubular tissue sections 52 and 54.

Preferred embodiments are described below. (1) The guide balloon according to claim 1, wherein a pump that supplies or exhausts gas through a tube is connected to the balloon unit. (2) The guide balloon according to claim 1, wherein the balloon portion has a tapered shape. (3) The guide balloon according to the embodiment (2), wherein the balloon portion has a conical shape. (4) The guide balloon according to claim 1, wherein the balloon section has a plurality of rooms, and a front room is compressed independently of a rear room. (5) In the balloon section, the front room and the rear room are in contact with each other via a partition, and the partition has a valve that allows only the movement of gas from the front room to the rear room. The guide balloon according to the embodiment (4). (6) The automatic anastomosis device according to claim 2, wherein a pump that supplies or exhausts gas through a tube is connected to the balloon portion. (7) The automatic anastomosis device according to claim 2, wherein a maximum diameter of the balloon portion is larger than a maximum diameter of the insertion portion. (8) The automatic anastomosis device according to claim 2, wherein the balloon portion has a tapered shape. (9) The balloon portion has a conical shape.
The automatic anastomosis device as described. (10) The automatic anastomosis device according to claim 2, wherein the balloon section has a plurality of rooms, and a front room is compressed independently of a rear room. (11) In the balloon portion, the front room and the rear room are in contact with each other via a partition, and the partition has a valve that allows only the movement of gas from the front room to the rear room. The automatic anastomosis device according to the embodiment (10). (12) The automatic anastomosis device according to claim 3, wherein a pump that supplies or exhausts gas through the gas flow tube is connected to the balloon portion. (13) The automatic anastomotic device according to claim 3, wherein a maximum diameter of the balloon portion is larger than a maximum diameter of the insertion portion. (14) The automatic anastomosis device according to claim 3, wherein the balloon portion has a conical shape. (15) The automatic anastomosis device according to claim 3, wherein the balloon portion has a conical shape. (16) The automatic anastomosis device according to claim 3, wherein the balloon portion has a plurality of rooms, and a front room is compressed independently of a rear room. (17) In the balloon portion, the front room and the rear room are in contact with each other via a partition, and the partition has a valve that allows only the movement of gas from the front room to the rear room. The automatic anastomosis device according to the embodiment (16).

[0087]

As described above, according to the present invention,
By mounting a guide balloon having a balloon portion that can be deformed at the time of inflation on the distal end side of the insertion portion of the automatic anastomosis device, it guides the automatic anastomosis device into the living tissue, facilitates insertion into the living tissue, and reduces the Can be prevented.

[Brief description of the drawings]

FIGS. 1A and 1B are schematic front views showing an embodiment of a guide balloon according to the present invention, and FIG. 1A shows a state before inflation of a balloon portion of the guide balloon. (B) shows the state of the balloon portion of the guide balloon when inflated.

FIGS. 2A to 2C are schematic front views showing an embodiment of a guide balloon according to the present invention, and FIG. 2D is a plan view of FIG. (E) is a partial cross-sectional view schematically showing a state in which the automatic anastomosis device equipped with the guide balloon shown in (c) is inserted into a living tissue.

FIGS. 3A to 3C are cross-sectional views showing a main part of an embodiment of the automatic anastomosis apparatus of the present invention.

4 (a) to 4 (c) are cross-sectional views showing a main part of another embodiment of the automatic anastomosis device of the present invention, and FIG. 4 (d) schematically shows the entire configuration of the present embodiment. It is a schematic front view shown.

FIG. 5 is a perspective view of a surgical prosthesis made in accordance with the present invention, illustrating the general appearance of the device.

6 is a longitudinal longitudinal sectional view of the ligating head assembly of the device of FIG. 5, showing the anvil fully open.

FIG. 7 is an enlarged longitudinal cross-sectional view of the ligating head assembly showing the anvil in a partially closed position.

FIG. 8 shows the anvil in a closed position in an enlarged longitudinal sectional view of the ligating head assembly.

FIG. 9 is an enlarged longitudinal cross-sectional view of the ligating head assembly showing the needle ejection device in the firing position.

FIG. 10 is a partially enlarged view of a staple formed on the anvil.

FIG. 11 is an enlarged longitudinal sectional view showing the shaft assembly of the prosthetic device.

FIG. 12 is a longitudinal cross-sectional view of the actuator and handle assembly of the prosthetic device of FIG. 1 in a locked position.

FIG. 13 is a longitudinal cross-sectional view of the actuator and handle assembly in an unlocked position.

FIG. 14 is a longitudinal longitudinal sectional view of the actuator / handle assembly in an injection position.

FIG. 15 is a perspective view of the safety release member in a latch position.

FIG. 16 is a perspective view of the safety release member in a latch release position.

FIG. 17 is a perspective view showing a centrifugal position of the indicator lever activated by the safety release member.

FIG. 18 is a perspective view showing a mesial position of an indicator lever.

FIG. 19 is a partially enlarged view of an indicator window at an upper portion of the actuator / handle assembly.

FIG. 20 is an exploded perspective view of a ligating head assembly and a support shaft of the prosthetic device.

FIG. 21 is an enlarged perspective view showing a tension member and a compression member provided in a support shaft of the prosthetic device.

FIG. 22 is a cross-sectional view of the support shaft assembly taken along line 24-24 of FIG.

FIG. 23 is an exploded perspective view of members of the actuator / handle assembly.

FIG. 24 is a partially cut-away side view of a compression member of the shaft assembly.

FIG. 25 is a mesial end view of the compression member.

FIG. 26 is a cross-sectional view of the compression member taken along line 26-26 of FIG.

FIG. 27 is a distal end view of the compression member.

FIG. 28 is a partial cross-sectional view of a distal end face of a compression member enlarged in a longitudinal direction.

FIG. 29 is a bottom view of the compression member.

FIG. 30 is an exploded perspective view of a needle holder, a binding needle ejection device, and a distal end of a compression member.

FIG. 31 is an end view of the staple ejection device.

FIG. 32 is a longitudinal sectional view of the staple ejection device taken along line 32-32 in FIG. 31;

FIG. 33 is a side view of the staple ejection device.

FIG. 34 is a longitudinal sectional view of a housing for a ligating head assembly.

FIG. 35 is a perspective view of the anvil of the prosthetic device, showing the anvil shaft removed from the trocar contained within the ligating head assembly.

FIG. 36 is an enlarged partial cross-sectional side view showing an anvil shaft mounted on a trocar.

FIG. 37 is a partially enlarged view showing the connection between the anvil shaft and the trocar.

FIG. 38 is an exploded perspective view showing a pair of retaining clips and a backing washer included in the anvil assembly.

FIG. 39 is an enlarged longitudinal sectional view of the anvil assembly without a washer.

FIG. 40 is a cross-sectional view of the anvil assembly with the retaining clips removed.

FIG. 41 is a bottom view of the backing washer of the anvil assembly.

FIG. 42 is a side view of a backing washer.

FIG. 43 is a cross-sectional view of the backing washer taken along line 42-42 of FIG. 41.

FIG. 44 is an enlarged partial cross-sectional perspective view showing holding of a backing washer by an anvil.

FIG. 45 is a perspective view showing a removable trocar for use with the anvil assembly.

FIG. 46 is a cross-sectional view showing the removable trocar inserted into the anvil shaft in the boost position.

FIG. 47 is a cross-sectional view showing the removable trocar inserted into the anvil shaft in the reduced force position.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Guide balloon 2 Base part 3 Balloon part 4 Tube 5 Pump 50 Prosthetic device (auto anastomosis device) 60 Ligation head assembly 61 Housing 62 Stitching needle ejection device 63 Plural fingers 64 Cylindrical plug 68 Needle holder 69 Ring-shaped Knife or scissor 70 Support shaft assembly 72 Receiving tube or sleeve 74 Extension 80 Actuator handle assembly 82 Adjustment knob 84 Indicator 86 Staple operating lever 87 Scale 88 Latch member 90 Stapling needle 100 Anvil assembly

Claims (3)

[Claims] 1. A guide balloon that can be attached to the distal end side of an insertion portion of an automatic anastomosis device that inserts a long insertion portion into living tissue to perform anastomosis between living tissues, and is deformable when inflated. A guide balloon, comprising: a balloon portion; and a base portion that supports the balloon portion and is engageable with a distal end side of the insertion portion of the automatic anastomosis device. 2. An automatic anastomosis device for performing an anastomosis between living tissues by inserting a long insertion portion into a living tissue, comprising a guide balloon attachable to a distal end side of the insertion portion.
The guide balloon, a balloon portion that can be deformed when inflated,
An automatic anastomosis device having a base portion that supports the balloon portion and is engageable with a distal end side of the insertion portion. 3. An automatic anastomosis device for performing an anastomosis between living tissues by inserting a long insertion portion into a living tissue, comprising a guide balloon integrally provided on a distal end side of the insertion portion. The automatic anastomosis device, wherein the guide balloon has a balloon portion that can be deformed when inflated, and a gas flow tube connected to the balloon portion.