JP2013517836A - Stapling device for anastomosing a hollow organ - Google Patents

Abstract

An automated full proof surgical stapler that provides sufficient unimpeded access to a surgical area and provides guaranteed stapling of the end of a hollow organ without causing any of the staples to fail. To provide.
A stapling apparatus includes a clip holding device and a staple holding device. Each instrument is provided with a handle and a C-shaped jaw. In the combined configuration, the C-shaped jaws of the clip holder are positioned below the C-shaped jaws of the staple holder with the staples aligned with the clips. The C-shaped jaw provides a gap. By operating the staple firing mechanism, pressure is applied uniformly and simultaneously to the tops of all the staples to force the staples to pass from the holding socket to the end of the hollow organ and into the staple holding clip and staple engagement state. To.
[Selection] Figure 9

Description

  The present invention relates to the field of medicine, and more particularly to surgery. More specifically, the present invention generally relates to a hollow organ, such as a gastrointestinal tract or vascular organ, such as a fastener for joining their ends and ends or ends and sides. It relates to a surgical suturing instrument and method for performing an anastomosis using a fixation technique.

  End-to-end anastomosis is a surgical procedure that connects the end of one hollow organ to the end of another hollow organ. End-to-end anastomoses are typically performed on vascular and / or visceral tissues. Microvascular anastomoses are commonly performed to create the ends of blood vessels, for example, in the process of rejoining disjointed body parts and / or transplanting organs. Microvascular anastomosis is generally performed by hand under a microscope and is a time-consuming and laborious operation. As such, it can take hours to complete the microvascular anastomosis itself required to rejoin the dissected body parts or to transplant the organ.

  In such surgical procedures, the speed at which the surgery is performed can be extremely critical. For example, in transplant surgery, it is very important to reconnect the blood supply to the organ as soon as possible to minimize damage to the transplanted organ. Such blood vessels are now anastomosed end to end or end to side, usually by suturing techniques. Such suture anastomosis procedures generally take 10-20 minutes for a skilled surgeon to complete for each anastomosis and for many organs where multiple such connections are required.

  Currently, there is no known anastomotic stapling instrument or technique or fastener fixing instrument or technique for the vasculature that is truly failsafe and foolproof.

  Thus, the main objective of the present invention is to allow sufficient unhindered access to the surgical area and ensure the end of the hollow organ without any loss of staples. It is to provide such a full proof surgical stapler for automated hollow organ anastomosis that provides stapling. Accordingly, the anastomosis stapler of the present invention provides ease of use, access to the surgical site, and consistency and reliability in operation, all in as short a time as possible using prior art techniques. In addition, the stapler of the present invention is reusable.

  The stapling apparatus of the present invention for anastomosing a hollow organ generally consists of two separate stapling instruments that can be combined to form the stapler of the present invention. The two combinable instruments consist of an L-shaped clip retainer instrument and an L-shaped staple retainer instrument.

  The L-shaped clip retainer instrument includes an elongated clip retainer handle with a clip retaining foot extending laterally from the lower distal end of the handle. This clip holding foot consists of a C-shaped clip jaw positioned in a plane generally transverse to the extending direction of the clip retainer handle. The C-shaped jaw has a side surface that defines an organ exit gap and provides an upwardly facing upper surface that faces upward in the same direction as the extending direction of the clip retainer handle.

  The clip jaw is provided with a clip retainer that is fitted on the upper upper surface of the retainer and is disposed circumferentially along the upper upper surface or in the same direction as the upper surface of the C-shaped clip jaw. A series of staple receiving and holding clips. The clip retainer may be a single piece or a single piece of a C-shaped clip jaw, or may be a ring-shaped member that can be removed from the C-shaped clip jaw.

  The second instrument component of the stapler of the present invention is an L-shaped staple retainer instrument that includes an elongated staple retainer handle with a staple retaining foot laterally from the lower distal end of the staple retaining handle. It extends. The staple holding foot also comprises a C-shaped staple jaw positioned in a plane generally transverse to the staple retainer handle. The C-shaped staple jaw also has a side surface that provides an organ exit gap and provides a downwardly lower surface that faces downward in a generally downward extending direction of the staple holding handle. A staple retainer is provided on the staple jaw, and the staple retainer has a series of sockets along the lower surface that hold the series of staples with the penetrating tips of the staples exposed from the lower lower surface of the staple retainer. It is arranged in the circumferential direction. By combining the two instruments and clamping together, the staples are positioned in stapled alignment relative to the staple retaining clip that is fitted within the clip retainer, and the organ exit gap of both retainers is also clip retained. Aligned with the lower surface of the staple retainer jaws aligned with the aforementioned upper surface of the jaws and positioned in stapled alignment with the upper surface.

  The C-shaped jaws are spaced apart by each of the C-shaped jaws to pierce and hold the respective hollow organ ends with the organ ends stretched over the upper and lower surfaces of the retainer for stapling, respectively. A series of pins extends. Thus, the two stapling instruments that each hold the hollow organ ends to be stapled are C-shaped in a stapled aligned state with the hollow organ ends attached respectively on the upper and lower surfaces of the retainer. Both jaws are clamped with their upper and lower surfaces positioned. Thereafter, the staple firing mechanism was actuated to engage the staple from the top surface of the staple retainer (via :) and at the same time pushed the staple downward into its respective staple socket, sandwiching the end of the hollow organ between them. The staple is engaged with each of the staple holding clips.

  The L-shaped configuration of the clip retainer instrument and the staple retainer instrument provides excellent unhindered access and visibility of the anastomosis surgical site, and this same L-shaped configuration of the instrument allows the firing mechanism to move the upper end of all staple heads. The ability to engage downwards at the same time further makes it possible to ensure firing of all staples.

  Another embodiment of the stapling apparatus of the present invention for anastomosing a hollow organ holds each of the ends in aligned alignment so that the hollow organ ends are stapled together to form the anastomosis. It consists of a pair of adjacently aligned stapling jaws. Each of these stapling jaws consists of opposing hinged hemostatic forceps jaws operable to sandwich the end of each hollow organ prior to stapling. The hemostatic forceps jaw includes a stapling mechanism that staples the retained hollow organ ends together.

  The stapling device of this embodiment of the present invention not only has the stapling mechanism serving to staple the hollow organ ends together, but in addition, the end of the blood vessel to be anastomosed by the surgeon or other A hemostatic forceps jaw that makes it easier to attach or pre-fix the hollow organ end to the stapling mechanism, which only allows for quick and easy initial fixation of the stapling mechanism In addition, it provides a significant advantage over prior art anastomotic surgical staplers in that it includes a hemostatic forceps jaw that stops blood flow in the blood vessel during the procedure.

  The stapler's hemostatic forceps jaws are provided with a series of spaced apart pins that pierce and retain each clamped hollow organ end that extends over the stapling mechanism. The forceps jaws extend laterally outward from the outside.

  A stapling apparatus of the present invention is preferably provided in which a pair of stapling jaws are separable from one another for operation that is guided into and out of stapling alignment. This allows each hollow organ end to be stapled together to be easily attached to their stapling jaws before they are secured together in the stapled alignment state.

  Other objects and advantages will be apparent in the following description and claims. The accompanying drawings show, for the sake of clarity, specific practical embodiments of the invention without limiting the scope of the invention or the appended claims.

FIG. 4 is a perspective view of the L-shaped clip retainer instrument portion of the stapler of the present invention before the hollow organ end is secured. It is an enlarged view which shows the detail A of FIG. FIG. 2 is a perspective view of the clamp rod removed from the handle of the L-shaped clip retainer device of FIG. 1. FIG. 5 is a perspective view of the L-shaped staple retainer instrument portion of the stapler of the present invention that does not include the hollow organ end to be attached. FIG. 4 is an enlarged view of detail B of the apparatus shown in FIG. 3. FIG. 5 is a side view of the L-shaped staple retainer device shown in FIG. 4. FIG. 5 is an enlarged view of detail C of the instrument shown in FIG. 4. FIG. 2 is a perspective view of the L-shaped clip retainer device of FIG. 1 with the first hollow organ end to be anastomosed attached thereon prior to combining the two L-shaped retainer devices for stapling. FIG. 6 is an enlarged view of detail D of the L-shaped clip retainer device shown in FIG. 5. FIG. 6 is a perspective view of the L-shaped stapler retainer instrument portion of the stapler of the present invention with the second hollow organ end to be anastomosed attached thereon. FIG. 7 is an enlarged view of detail E of the staple retainer device shown in FIG. 6. 2 shows two L-shaped clip retainer devices and L-shaped staple retainer devices combined and clamped together with opposing hollow organ ends attached and joined in preparation for stapling. It is a bottom view of an anastomosis stapler. FIG. 8 is a central cross-sectional view of the stapler shown in FIG. 7 taken along section line FF, with the hollow organ end to be stapled uncut. FIG. 8 is a side view of the stapler shown in FIG. 7 just prior to stapling the end of the hollow organ. FIG. 10 is an enlarged cross-sectional view of the stapler shown in FIG. 9 as viewed along section line GG. It is an enlarged view of the detail H of FIG. FIG. 8 is a side view of the anastomosis stapler shown in FIG. 7 after actuation showing the end of a hollow organ stapled together. FIG. 13 is an enlarged cross-sectional view of the stapler shown in FIG. 12 taken along section line II. FIG. 14 is an enlarged view of detail J in FIG. 13. FIG. 3 is a perspective view of an L-shaped clip retainer device with the L-shaped staple retainer device removed after stapling together the hollow organ ends. FIG. 16 is an enlarged perspective view of the end of the anastomotic organ removed from the L-shaped retainer device of FIG. FIG. 17 is a perspective view of the end of the anastomotic hollow organ shown in FIG. 16 from the opposite side. FIG. 2 is a perspective view of the clip retaining foot of the L-shaped clip retainer device shown in FIG. 1 illustrating another embodiment of the anastomotic stapler of the present invention. FIG. 6 is a perspective view of yet another embodiment of the clip retaining foot portion of the C-shaped clip jaws of the L-shaped clip retainer device shown in FIG. FIG. 6 is a perspective view of another embodiment of the stapling apparatus of the present invention incorporating a pivoting jaw for insertion and removal of hollow organ tissue ends and a variation of the staple actuation mechanism. FIG. 6 is a perspective view of another embodiment of the stapling apparatus of the present invention incorporating a pivoting jaw for insertion and removal of hollow organ tissue ends and a variation of the staple actuation mechanism. FIG. 6 is a perspective view of another embodiment of the stapling apparatus of the present invention incorporating a pivoting jaw for insertion and removal of hollow organ tissue ends and a variation of the staple actuation mechanism. FIG. 6 is a perspective view of another embodiment of the stapling apparatus of the present invention incorporating a pivoting jaw for insertion and removal of hollow organ tissue ends and a variation of the staple actuation mechanism. FIG. 6 is a perspective view of yet another embodiment of the stapling apparatus of the present invention incorporating a hemostatic forceps pivoting jaw that holds and clamps the end of each hollow organ prior to stapling. FIG. 6 is a perspective view of yet another embodiment of the stapling apparatus of the present invention incorporating a hemostatic forceps pivoting jaw that holds and clamps the end of each hollow organ prior to stapling. FIG. 6 is a perspective view of yet another embodiment of the stapling apparatus of the present invention incorporating a hemostatic forceps pivoting jaw that holds and clamps the end of each hollow organ prior to stapling. FIG. 6 is a perspective view of yet another embodiment of the stapling apparatus of the present invention incorporating a hemostatic forceps pivoting jaw that holds and clamps the end of each hollow organ prior to stapling. FIG. 6 is a perspective view of yet another embodiment of the stapling apparatus of the present invention incorporating a hemostatic forceps pivoting jaw that holds and clamps the end of each hollow organ prior to stapling. FIG. 6 is a perspective view of yet another embodiment of the stapling apparatus of the present invention incorporating a hemostatic forceps pivoting jaw that holds and clamps the end of each hollow organ prior to stapling.

  Referring to FIGS. 1-17, FIGS. 7-14 show the anastomotic stapling apparatus 10 of the present invention in its fully assembled form. The stapling apparatus 10 consists of two separate combinable instruments in the form of an L-shaped clip retainer instrument 11 and an L-shaped staple retainer instrument 12. Referring first to the L-shaped clip retainer device 11 shown in FIGS. 1 and 1A, the clip retainer device 11 includes an elongate clip retainer handle 13 from a lower distal end 15 of the handle 13 to a clip retaining foot 14. Extends sideways. The clip retaining foot 14 consists of a C-shaped clip jaw 16 positioned in a plane generally transverse to the clip retainer handle 13 as shown in FIG. The C-shaped clip jaw 16 defines an organ exit gap 17 for removing the stapled hollow organ end after stapling, as will be described in more detail below.

  A side surface 18 of the C-shaped clip jaw 16 provides an upwardly upper surface 22. A clip retainer 20 is provided on the clip jaw 16, and the clip retainer 20 is fitted in the upward upper surface 22 of the retainer 20 and is arranged in a circumferential direction along the upward upper surface 22. A holding clip 21 is provided. In this embodiment, the clip retainer 20 is an integral part of the C-shaped clip jaw 16. However, as will be described with respect to another possible embodiment of the present invention, the clip retainer 20 may be a separate piece that is removably and slidably fitted into the C-shaped jaw 16.

  The second instrument component of the stapling apparatus 10 of the present invention is the L-shaped staple retainer instrument 12 shown in FIGS. 3 and 3B. The L-shaped staple retainer instrument 12 includes an elongated staple retainer handle 23 with a staple holding foot 24 extending laterally from a lower distal end 25 of the staple holding handle 23. The staple holding foot 24 comprises a C-shaped staple jaw 26 positioned in a plane substantially transverse to the staple holding handle 23 as shown. The C-shaped staple jaw 26 defines an organ exit gap 27 and its side 28 provides a downwardly facing lower surface. A staple retainer 29 is provided on the staple jaw 26, and the staple retainer 29 holds a series of staples 31 with their penetrating tips 32 (see FIG. 11) exposed from the downwardly lower surface 28. A staple socket 30 is disposed along the lower surface 28 in the circumferential direction. As can be seen more clearly in FIG. 11, the staples 31 consist of nails composed of surgical stainless steel, these nails being seated bushes 33 made of a suitable plastic material such as Teflon. Within each accepted.

  The staple retaining clip 21 of the L-shaped instrument 11 as shown in FIGS. 1 and 1A is a metal push nut made from a suitable surgical metal such as surgical stainless steel. As in the case of conventional push nuts, each clip 21 has an opening therein that receives a corresponding tip 32 of the staple 31, which engages and grips the nail of the staple 31. Opposing metal teeth 37 are provided so as not to be detached after penetration.

  With reference to FIGS. 1 and 1A and FIGS. 3 and 3A, a series of spaced pins 34 extend laterally outwardly from the outside of the C-shaped jaws 16 and 26. These pins 34 are provided for drilling and holding the respective hollow organ ends 35 and 36 as shown in FIGS. 5 and 5B and FIGS. 6 and 6E. These hollow organ ends 35 and 36 are secured to the L-shaped clip retainer device 11 and the L-shaped staple retainer device 12, respectively, prior to assembly of the devices and prior to stapling the hollow organ ends together. Shown as a thing.

  FIGS. 7-11 show the L-shaped clip retainer 11 and the L-shaped staple retainer device 12 in a combined configuration ready to staple the respective hollow organ ends 35 and 36 together. FIGS. 12, 13 and 14 show the combined L-shaped clip retainer device 11 and L-shaped staple retainer device 12 after firing or activation of the stapling apparatus 10, and thus the hollow organ 35 in the stapled state. And 36 are shown.

  A clamp 40 (see FIGS. 1, 2, and 8) that clamps the two instruments 11 and 12 together is provided in the form of a clamp rod 41, which is screwed into the upper end 43 of the handle 13. It has a clamp knob 42 secured to the upper end of the clamp rod 41, which can be received. The screw stem 44 of the knob 42 is removably received in the female screw socket 45 at the upper end 43.

  The handle 13 of the L-shaped clip retainer device 11 is provided with a bifurcated or branched lower end 46, and the bifurcated or branched lower end 46 is opposed to project inwardly inside the branched portion 46. A pair of guide pins 47 is provided.

  Each of these guide pins 47 is received in a side guide slot 48 of the bifurcated base 49 of the L-shaped staple retainer device 12. In this way, the bifurcated base portion 49 of the L-shaped staple retainer device 12 is inserted between the branches of the lower end 46 of the L-shaped clip retainer device 11 by sliding the guide slot 38 downward relative to the guide pin 47. Since the L-shaped clip retainer device 11 and the L-shaped staple retainer device 12 are coupled together, the staples 31 can be stapled to and against each of the staple retaining clips 21 of the clip retainer 20. Positioned in alignment, the respective organ exit gaps 17 and 27 of the respective instruments are aligned. Accordingly, the lower surface 28 of the staple holding jaw 26 is aligned with the upper surface 22 of the clip holding jaw 16 and is positioned with respect to the upper surface 22 in a stapled alignment state. To hold the two instruments 11 and 12 in this coupled manner as shown in FIGS. 7-14, the clamping knob 42 is turned clockwise and screwed down into the screw socket 45 at the upper end 43 of the handle 13. The lower end 48 of the clamp rod 41 is engaged with the upper surface 49 of the jaw stem 58 by making the engagement possible.

  When two L-shaped instruments 11 and 12 are combined in this manner with their respective hollow instrument ends 35 and 36 secured together as shown in FIGS. The staple device 10 can be fired or actuated by simultaneously driving the staple 31 downward by a downward driving force of a drive piston 54 provided with a plurality of staple drive pins 51 each received. Accordingly, the drive pin 51 of the drive piston 54 engages the exposed head or upper end 53 of the staple 31, thereby penetrating the organs of the joined hollow organ ends 35 and 36 all simultaneously with the staple 31 downward. To drive. This stapling action is caused by pressing the staple push rod 60 downward against the upper surface 58 of the piston stem 50 that is rigidly secured to the staple drive piston 54. A screwdriver in the form of a driver knob 63 is threadably secured to the upper end 65 of the drive rod 60 and is threadably received at 64 on the upper end 65 of the staple retainer handle 12. When the staple firing knob 63 is turned clockwise, the firing rod 60 is moved into the underlying clip retainer 20 for simultaneous penetration into and with the corresponding underlying staple retaining clip 21. The staple 50 is pressed downward against the upper surface 49 of the stem 50, and the staple piston 54 pushes all the staples 31 downward simultaneously.

[Stapling procedure]
The procedure for stapling the hollow organ ends 35 and 36 together will be described with reference to the drawings.

  First, referring to FIG. 1 and FIG. 1A, the holding clip 21 is loaded into the respective pocket of the clip retainer 20. 4 and 4C, the firing drive rod 60 is manipulated by the knob 63 and the stem 50 so that the stapler piston 54 is positioned with the stem 50 in the loading position indicated by the indicator 70. Adjustment is also performed by direct operation (FIG. 8). When the indicator 70 indicates that the stapling piston 54 is in the loading position, the staples 31 are inserted into their respective sockets 30 with their surrounding bushings 33, as best shown in FIGS. To do.

  The hollow organ end 35 is then connected to the staple clip retainer foot 16 by passing it through the C-shaped slot in the C-shaped jaw 16 and attached to the retaining pin 34 as shown in FIGS. 5 and 5D. 6 and 6E, the other hollow organ end 36 is then connected to the foot 24 by attaching it to the retaining pin through the central opening of the C-shaped foot 24 of the staple holding device 12. To do.

  Thereafter, as previously described and disclosed, the staple holding device 12 to which the hollow organ end 36 is attached is slidably guided to be combined with the clip holding device 11 to which the organ end 35 is attached, and then The clamp rod 41 is inserted into the top of the handle 13 to engage the upper surface 49 of the stem 50 of the staple drive piston 54, and the knob 42 is rotated clockwise into its screw socket 45 to staple the clip retaining foot 16 and the staple Clamp the stapling foot 24 firmly in alignment.

  Thus, the firing action of the stapling apparatus 10 is achieved by clamping the two instruments 11 and 12 together with the organ ends 35 and 36 attached and the two instruments being stapled in alignment. Ready.

  Next, the stapling actuation knob or firing knob 63 is rotated clockwise so that the stapling piston 54 brings the two organ ends 35 and 36 together as shown in FIGS. The drive rod 60 is pressed down against the stem 50 of the piston 54 until the indicator 70 indicates that it has been pushed down to a sufficient extent to staple. When this is done, the stapler piston 54 penetrates the staple 31 through the hollow organ ends 35 and 36 as shown in FIGS.

  After completing the stapling, the clamp rod 41 is removed and the clamp engagement between the instruments 11 and 12 is released. The hollow organ end 36 is then cut and released from the retaining pin 34. Thereafter, the stapling knob 63 is further turned clockwise to cause the bushing 33 to protrude completely from its respective staple socket 52.

  The L-shaped staple retainer instrument 12 is then removed from the instrument 11 and also from the organ end 36 through the gap 27 of the instrument 12, and similarly, the organ end 35 is separated from the pin 34, The jaws are removed from the organ end 35 via the instrument gap 17 to leave the anastomosed hollow organ end as seen in FIGS. Additional hand suturing may be required at opposite ends 80 of the connected hollow organ ends 35 and 36.

  Prior to any given surgery, more than a sufficient number of stapling devices 10 are pre-loaded, sterilized and ready for use.

  Two important advantages of the stapling apparatus 10 of the present invention are that the L-shaped configuration of the instrument provides excellent unimpeded access to the surgical site where the anastomosis is to be performed. . In addition, the L-shaped configuration of the stapling apparatus 10 allows the staple driving mechanism to be actuated by the instrument handle so that the staples are uniform enough to be applied by the applied stapling pressure. Since the clamping pressure can be simultaneously applied downward to all of the staple heads, reliable fail-safe operation of all the staples and fail-safe operation of the stapler mechanism are possible. This is in contrast to prior art stapling devices that cannot apply a stapling pressure that begins in time with the staples. In prior art stapling instruments, the stapling pressure is generally initially a sliding stapling mechanism that slides stepwise relative to the staple head, with its ramped surface stepping the stapling pressure on the staple head. By means of an applied sliding stapling mechanism (see U.S. Pat. No. 5,188,638 to Tzakis) or alternatively, the clamping jaws are positioned in a plane transverse to the instrument actuator handle axis Applied by an arc applied pressure in a clamping mechanism positioned in a plane axially aligned with the handle axis (see U.S. Pat. No. 4,917,090). .

[Alternative Embodiment]
The embodiment described above is a preferred example of the stapling apparatus of the present invention, and there are other possible alternative embodiments encompassed by the present invention and the following claims.

  For example, the configuration of the C-shaped clip jaws 16 and the C-shaped staple jaws 24 need not have a flat configuration as shown in the previous figure. The jaws 16 and 24 may have an elliptical configuration, or even a circular shape as shown in FIG. 18 where the C-shaped clip jaw 16 is shown including a circular and circular clip retainer 20. It may have a configuration. Similar elements are denoted by the same reference numerals.

  In addition, as shown in FIG. 19, the C-shaped clip jaws 16 and C-shaped staple jaws 26 are also pivotable as shown, so that before stapling and after stapling The jaws can be opened and closed to provide better attachment and removal of the hollow organ ends.

  In the main embodiment described, each of the staple holding clips 21 and each of the corresponding staples 31 are independent. In other words, the staple holding clips 21 are not connected to each other, and the staples 31 are not connected to each other. Thus, after the anastomosis process is completed, each fixed staple 31 and clip 21 can be repositioned in the natural annular configuration of the hollow organ ends that are fixed together. However, due to the C-shaped configuration of clip retainer 20 and staple retainer 30, this generally requires the use of additional hand stitches at opposite ends of the anastomosis as shown at 80 in FIGS. And

  To avoid the need for these additional stitches 80, the staple retainer 20 can be provided in the form of a continuous annular ring, so that all of the staple retainer clips 21 are part of the clip retainer ring 20 and one piece. Each of the staple holding clips 21 is an integral part of the clip retainer ring 20 so as to be interconnected as follows. Similarly, the staple retainer ring 29 can also consist of a continuous annular ring that receives the staples 31 within the respective socket so that the staple retainer ring 29 has stapled hollow organ ends 35 and 36. It is permanently stapled to the staple clip retaining ring 20 while being sandwiched therebetween.

  In this latter described embodiment, the staple retaining ring 29 and clip retaining ring 20 are the same as the fastening means 5a and 5b of US Pat. No. 4,917,090 remain part of the anastomotic connection. The hollow organ ends 35 and 36 remain the permanent part of the anastomosis. Also with respect to this latter described embodiment, the respective annular clip retaining ring 20 and staple retaining ring 29 of the present invention are best shown in FIGS. 1, 2 and 5 of the above patent. Just as the fastening means 5a and 5b are removable from their respective C-shaped jaws 2 and 3, they are slidably removable via the end gaps 17 and 27 of the respective jaws 16 and 26. Accordingly, the retainer rings 20 and 29 of the present invention may exhibit the same configuration and function as the fastening means 5a and 5b, and the jaws 16 and 26 of the stapling apparatus 10 of the present invention are described in US Pat. , 917,090, the configuration of elements 2 and 3, such as the jaws. Thus, the contents and description of US Pat. No. 4,917,090 are hereby incorporated by reference in their entirety to illustrate this possible alternative embodiment.

  The staple 31 may also have a configuration different from the disclosed staple nail. For example, the staple 31 may have a U-shaped configuration like a conventional staple. The staple retainer clip 21 may have a configuration different from the illustrated push nut type. For example, the retaining clip may be just a small solid plastic block that is not perforated and that retains the staple tip therein by penetration of the staple tip. In order to provide a more secure attachment in this configuration, the staple tips are ribbed so that they do not easily dislodge as they pass through the solid staple retaining block, and remain fixed thereby. May be.

  Referring now to the embodiment shown in FIGS. 20, 21, 22 and 23, another embodiment of the stapling apparatus 10 of the present invention is shown. In this embodiment, clip jaws 16 and staple jaws 26 are open to provide easy unhindered loading and unloading of the hollow organ tissue end from the normal closed position for stapling. Can pivot to entry position. In addition, an alternative mechanism is shown that clamps the two instruments 11 and 12 together and activates the stapling mechanism. Similar elements are denoted by the same reference numerals.

  20 and 21, respectively, in this embodiment, the right jaw arm 80 of clip retainer jaw 16 and the right jaw arm 81 of staple jaw 26 are pivotable outwardly at their respective bases. (Pivotable). This allows unimpeded initial attachment and removal of the hollow organ tissue ends 35 and 36 for loading and unloading before and after stapling.

  The slide lock 83 is slidable along the handle 13 to an open position as shown in FIG. 20 to prevent the jaw arm 80 from pivoting outward, and then the clip jaw 16 is moved to its The handle 13 can be slid down to a closed position as shown in FIGS. 22 and 23 to engage and maintain the normal closed position. Similarly, the staple retainer instrument 12 is slidably inserted into the clip retainer 11 from the initial insertion point as shown in FIG. 22 to the final insertion position shown in FIG. The arm 81 of the staple jaw 26 can be maintained in the closed position by the slide lock 84 provided by the side arm of the clip retainer device 11. Therefore, the slide lock 84 prevents the jaw arm 81 from opening again. In order to maintain the staple retainer 12 in aligned stapling alignment with the clip retainer 11, the lower end of the staple retainer instrument 12 is a downward projecting stud that is received in a guide retaining hole 86 at the lower end of the clip retainer 11. 85 is provided.

  In this embodiment, the clamp 40 shown in the previous embodiment operates in a completely different manner in this embodiment, so the clamp is shown in this embodiment as a clamp 40 '. In this embodiment, the retainer handles 13 and 23 have spaced apart upper handle ends 13 ′ and 23 ′ that extend adjacently, respectively, and the staple handle end 23 ′ is the upper proximal ends 43 and 65 of the handles 13 and 23. Are positioned above the clip retainer handle end 13 'in the lateral direction. Thus, this arrangement provides handle ends 13 'and 23' for gripping and clamping together, thereby clamping the instrument together with a human hand in a stapled alignment to provide a clamp 40 '.

  Also, in this embodiment, stapling by the device 10 is activated by further squeezing the handle ends 13 'and 23' together instead of using the screw knob mechanism of the previous embodiment.

  In this embodiment, the staple firing rod 60 is provided by the staple retainer handle 23 itself. Accordingly, when the handle ends 13 'and 23' are squeezed together by hand, this causes the staple retainer handle 23 to move downward relative to the handle 13 of the clip retainer instrument 11, and further the lower end of the handle 23 is stapled. By pushing the drive piston 54 downward, the hollow organ ends 35 and 36 are stapled together as described above. When the stapling operation is complete, the staple retainer release 87 is operated to fully release the stapler instrument 12 so that it can be removed from the clip retainer 11 without disturbing the stapled ends 35 and 36 of the hollow organ end. The staple head is completely released from the staple retainer 32 by grasping with a hand and pulling it upward with respect to the staple retainer handle 23.

  Referring now to FIGS. 24-27, in the illustrated embodiment, the hinged jaws 16 and 26 clamp the respective organ ends 35 and 36 in the same manner that conventional hemostats clamp. The configuration and operation are the same as the stapler device shown in FIGS. 20-23 except that the hemostatic forceps jaws 16 ′ and 26 ′ are provided as described above. Accordingly, the elements of FIGS. 24-27 are numbered identically except that spaced apart pivotable jaws 16 and 26 have been renumbered as hemostatic forceps jaws 16 ′ and 26 ′, respectively. Yes.

  The hemostatic forceps jaws 16 'and 26' allow the surgeon to attach the respective hollow organ ends 35 and 36 to the instrument prior to assembling the instruments 11 and 12 for stapler alignment. In addition, in situations where the hollow organ to be stapled is a vessel, blood flow is stopped during the stapling procedure by attaching a hemostatic forceps to the respective instruments 11 and 12.

Claims (24)

A stapling device for anastomosing a hollow organ,
An L-shaped clip retainer device including an elongated clip retainer handle, the clip retaining foot extending laterally from the lower distal end of the handle;
The clip retaining foot comprises a C-shaped clip jaw in a plane generally transverse to the clip retainer handle, defining an organ exit gap, and the side surface of the C-shaped clip jaw provides an upwardly upper surface; A clip retainer is provided on the clip jaw, and the clip retainer has a series of staple receiving and holding clips that are fitted on the upper upper surface of the retainer and are arranged circumferentially along the upper upper surface. And
An L-shaped staple retainer instrument comprising an elongate staple retainer handle, the staple retaining foot extending laterally from a lower distal end of the staple retainer handle;
The staple retaining foot comprises a C-shaped staple jaw in a plane generally transverse to the staple retainer handle, defining an organ exit gap, wherein the side surface of the C-shaped staple jaw provides a downwardly facing lower surface; A staple retainer is provided on the staple jaw, and the staple retainer has a series of staple sockets along the lower surface for holding the series of staples with the penetrating tips of the staples exposed from the lower lower surface of the staple retainer. When the lower surface of the staple holding jaw is aligned with the upper surface of the clip holding jaw and positioned in a stapled alignment with the upper surface, the staple is The staple clip in the retainer The organ outlet gap while being positioned respectively and stapling alignment of flops are aligned,
The C-shaped jaws for piercing and holding a respective hollow organ end by each of the C-shaped jaws for stapling with the organ ends extended over the upper and lower surfaces of the retainer, respectively. A series of spaced pins extending from
A clamp that clamps the instrument together with the upper and lower surfaces of the C-shaped jaws in a stapled aligned condition, wherein the hollow organ ends are respectively attached to the retainer upper surface and the retainer lower surface;
A staple firing mechanism that engages the staple from the top surface of the staple retainer and pushes the staple downward into the staple socket to enter a staple-engaging state with each of the clips;
A stapling apparatus comprising: The staple firing mechanism includes:
An exposed upper end of the staple held in the staple retainer on the upper surface of the staple jaw so as to simultaneously drive the staple downward and penetrate organ tissue into each of the clips; An engaging staple drive piston;
A push rod that is received for axial movement within the staple retainer handle, the lower end of the push rod engaging the upper surface of the staple drive piston so as to drive the staple downward together with the staple drive piston To push rod,
The stapling apparatus of claim 1, comprising a driver on the staple retainer handle for driving the push rod downward in the axial direction to staple the hollow organ ends together.   The clamps guide the instrument together to position the jaws in a stapled aligned state, and the staple retainer device and the clip retainer on the clip retainer handle with the jaws stapled aligned. The stapling apparatus according to claim 2, comprising a clamp drive for engaging and clamping the instrument.   The stapling apparatus according to claim 3, wherein the pin extends laterally outwardly from the outside of the C-shaped jaw.   The screwdriver includes a threaded staple push plug that is threadably received at an upper proximal end of the staple retainer handle and engages an upper end of the push rod to axially drive the push rod downwards. The stapling apparatus according to claim 3.   The clamp drive is threadably received in the upper proximal end of the clip retainer handle and is threadedly clamp push engaged with the upper end of a clamp push rod having a lower end engaged with the staple holder for clamping. The stapling apparatus according to claim 3, comprising a plug.   The clamp drive includes the retainer handle having a spaced upper handle end extending adjacently, the staple retainer handle end being laterally above the clip retainer handle end, respectively, from the upper proximal end of the handle. The stapling apparatus according to claim 3, wherein the instrument can be clamped together in a stapled alignment state by providing a handle end for manual gripping and clamping together. .   The stapling apparatus according to claim 7, wherein the stapling push rod comprises the staple retainer handle, whereby the staple firing mechanism is activated when the handle ends are squeezed together.   The clip jaws and the staple jaws each pivot from a normally closed position for stapling to an open loading position to provide unhindered initial attachment and final removal of hollow organ tissue The stapling apparatus according to claim 3, which is possible.   The stapling apparatus according to claim 9, further comprising slide lock means on the instrument for engaging and maintaining the jaws closed.   The stapling apparatus according to claim 3, wherein the staples are independent of each other.   The stapling apparatus according to claim 3, wherein the clips are independent of each other.   The stapling apparatus according to claim 3, wherein the staple retainer is an integral part of the staple jaw.   The stapling apparatus according to claim 13, wherein the clip retainer is an integral part of the clip jaws.   The stapling apparatus according to claim 3, wherein the staple comprises a surgical nail.   The C-shaped clip jaw comprises a hinged hemostatic forceps clip jaw that clamps and holds the first hollow organ end, and the C-shaped staple jaw clamps and holds the second hollow organ end. The stapling apparatus of claim 1, comprising a hinged hemostatic forceps staple jaw. A stapling device for anastomosing a hollow organ,
A pair of adjacent aligned stapling jaws that respectively hold the ends together in aligned alignment so as to staple the hollow organ ends together to form an anastomosis;
The stapling jaw includes a stapling mechanism for stapling together the retained hollow organ ends;
The stapling apparatus, wherein each pair of said stapling jaws includes opposing hinged hemostatic forceps jaws operable to sandwich a respective hollow organ end prior to stapling.   18. The stapling jaw has a series of spaced apart pins extending from the stapling jaw that pierce and hold the clamped respective hollow organ ends that extend over the stapling mechanism. The stapling apparatus as described.   The stapling apparatus according to claim 18, wherein the pin extends laterally outwardly from the outside of the stapling jaw.   The stapling apparatus according to claim 18, wherein the pair of stapling jaws are separable from each other for an operation that is guided into and out of stapling alignment. A stapling device for anastomosing a hollow organ,
A pair of adjacent aligned stapling jaws each holding the ends together in aligned alignment so as to staple the hollow organ ends together to form an anastomosis;
Each of the stapling jaws consists of opposing hinged hemostatic forceps jaws operable to sandwich the end of each hollow organ before stapling;
The stapling device, wherein the hemostatic forceps jaw includes a stapling mechanism for stapling together the held hollow organ ends.   22. The hemostatic forceps jaw has a series of spaced apart pins extending from the hemostatic forceps jaws that pierce and hold the respective pinched hollow organ ends that are stretched over the stapling mechanism. Stapling device.   The stapling apparatus according to claim 22, wherein the pin extends laterally outwardly from the outside of the hemostatic forceps jaw.   23. The stapling apparatus according to claim 22, wherein the pair of stapling jaws are separable from each other for an operation that is guided into and out of stapling alignment.

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