MXPA06004964A - Sheathless anastomotic ring applier device - Google Patents

Abstract

A surgical tool or applier for deploying an anastomotic ring comprises a handle connected to an elongate shaft that terminates in an anastomotic ring deployment mechanism. The ring deployment mechanism is moveable from an unactuated position to an actuated position. In order to prevent tissue from becoming trapped in the ring deployment mechanism during insertion or extraction of the tool, a plurality of panels are configured to enclose portions of the ring deployment mechanism during insertion and extraction, where the ring deployment mechanism is in the unactuated position. The panels are moveable with the ring deployment mechanism to the actuated position, in which the ring deployment mechanism is able to deploy the anastomotic ring.

Description

APPLICATOR DEVICE FOR ANASTOMOTIC RING WITHOUT COVER FIELD OF THE INVENTION The invention relates, in general, to surgery and, more particularly, to a device for performing a surgical procedure, as in the digestive system.

BACKGROUND OF THE INVENTION The share of the world population that suffers from morbid obesity is growing in a sustained manner. Severely obese people may be susceptible to an increased risk of heart disease, stroke, diabetes, lung disease, and accidents. Due to the effects of morbid obesity in the patient's life, the methods for the morbid obesity framaria have become an object of initial research. A known method for the eradication of morbid obesity includes the use of anasomyomotic rings. The devices for applying the anasomorphic rings are known in the art. Devices of such a nature normally are adapted to insert an anastomotic ring compressed into an anastomical opening formed between proximal walls of gastrointestinal tissue. These applicator devices can utilize a ring deployment mechanism comprising an expansion element that is actuated once the compressed ring is placed in the anastomotic opening, causing the anasyomotic ring to expand from its compressed, cylinder-shaped position. to a driven position in the form of a hollow rivet. With some conventional anasomyomic ring applicator devices that use fingers or similar members to expand the anasyomotic rings, it may be possible for the object to be wrinkled across the fingers of the applicator device when it is inserted adjacent to the proximal walls of gastrointestinal tissue. Similarly, it may be possible for the tissue to be scratched in the deployment mechanism during the removal of the disposition of the anastomosis site. The imprisonment of the tissue between the fingers can result in undesirable consequences, such as flattening or tearing of the bone, or even the integrity of the anastomosis can be compromised. Some applicator devices for anasphomonoic rings that are known in the art, incorporate a tubular cover that is located in sliding form in the elongated date. The tubular cover is normally in position on the ring deployment mechanism while the device is being inserted adjacent to the anastomosis site and during the removal of the projection, and can be refrained to allow the deployment of the ring. It may take time to retract and / or separate said covers from a retraction mechanism. For this reason it could be preferable to have an anastomotic ring applicator device which would imply a reduced possibility that the tissue would be scratched in the ring deployment mechanism of the device, but at the same time would not necessarily require a cover for the fingers of the device. .

BRIEF DESCRIPTION OF THE INVENTION In one embodiment, an applicator device for anastomotic ring comprises a handle attached to an elongated shaft. The elongated arrow comprises a deployment mechanism for anastomotic ring. The ring deployment mechanism comprises a plurality of panels that are adapted to cover portions of the ring deployment mechanism as it is inserted adjacent to the anastomosis site and as it is withdrawn from the site, thus preventing the It is fixed in the ring deployment mechanism. In another embodiment, a disposer device for an anastomotic ring comprises a handle attached to an elongated shaft comprising a proximal portion and a dished portion. The dlsfanie portion of the elongated arrow includes a deployment mechanism for ring. The ring deployment mechanism comprises a plurality of fingers that move from a non-actuated position, in a longitudinal alignment with the elongated arrow, to a second position, in which the fingers are articulated outwardly from a longitudinal axis of the elongated arrow, to drive a portion of the anasyomotic ring. The device also comprises a plurality of panels which are adapted to cover the fingers of the ring deployment mechanism during insertion and removal of the item. The panels are adapted to move with the fingers from the first position, in longiludinal alignment with the elongated arrow, to the second position, in which the fingers are articulated outwardly from the arrow. Therefore, the device can prevent the tissue from becoming wrinkled between the fingers of the applicator during insertion and exfiltration. In another embodiment, a pinning device for anasomyomatic ring may comprise a handle that is connected to a ring deployment mechanism by an elongated arrow. The deployment mechanism for ring comprises a longiform exíremo and a cenral portion. The device comprises a drive mechanism that is adapted to move the longitudinal end of the ring deployment mechanism toward the center portion, thereby actuating a portion of the anasomyomotic ring. The applicator device also comprises a plurality of panels which are adapted to cover portions of the longitudinal length of the ring deployment mechanism. The panels are adapted to move with the long axis towards the center of the device. In this embodiment, the device may allow the surgeon to use a ring deployment mechanism to deploy an anasomyomic ring, while protecting it from the risk of the tissue becoming wrinkled in the ring deployment mechanism during insertion and exudation. of the insfrumenío.

BRIEF DESCRIPTION OF THE FIGURES The accompanying drawings, which are incorporated and incorporated by way of this specification, illustrate several versions of the invention, and, in June, with the general description of the invention provided hereinbefore, and the detailed description of the versions provided below, They serve to explain the principles of the present invention. Figure 1 is a perspective view of an applicator device for anaslomotic ring. Figure 2 is a partial view in perspective of the disialy portion of the applicator device for anasomyomotic ring holding an anastomotic ring in an unactuated position. Figure 3 is a partial perspective view of the distal portion of the device of Figure 2 without panels, holding an anastomotic ring in the actuated position. Figure 4 is a front view of an operated anastomotic ring.

Figure 5 is an exploded perspective view of an anaslomioic ring deployment mechanism of the arrangement of Figure 1. Figure 6 is a perspective view of the anasomioid ring applicator device of Figure 1, having the distal portion of its member actuated. deployment mechanism for ring. Figure 7 is a perspective view of the device of Figure 1, having the distant portion actuated as the proximal portion of its ring deployment mechanism. Figure 8 is an exploded perspective view, in cross section of a proximal portion of the device of Figure 1, with a left housing omitted from the view. Figure 9 is a partial view in cross-sectional section of the distal portion of the device of Figure 1, inserted through an anastomotic aberration. Figure 10 is a partial view in transverse section of the distal portion of the device of Figure 1, forming an anastomorphic junction between proximal walls of the gasiroid fossa. Figure 11 is a partial cross-sectional view of a proximal portion of the device of Figure 1. Figure 12 is a cross-sectional view taken along the plane 12 of Figure 11.

Figure 13 is a cross-sectional view taken along the plane 13 of Figure 11.

DETAILED DESCRIPTION OF THE MODALITIES OF THE INVENTION Returning to the drawings, in which like numerals denote similar components to the various views, FIG. 1 describes an applicator 10 that functions to deploy and actuate an anastomotic ring device (not shown in FIG. 1), from a Generally cylindrical shape has a form that has the properties of a hollow rivet or ring, which is capable of forming an anasyomotic junction with an objective site of anastomosis, as in a bariatric gastric bypass of a patient with morbid obesity. Figure 2 depicts another applicator 12. It will be appreciated that the applicators 10, 12 can be used in various ways, including but not limited to the laparoscopic or endoscopic form. The plunger 12 is shown in Figure 2 with an anastomotic ring 14 in a deployment mechanism 16. In Figure 2, the anastomotic ring 14 is shown in the compressed, cylinder-shaped position. In Figure 3, the deployment mechanism 16 of the plunger 12 has moved the anastomorphic ring 14 to the driven position, in the form of a hollow rivet. Figure 4 is a visia in approach of the anasyomonoic ring 14, in the actuated position. The anasomomotic ring 14 may comprise a shape memory effect (SME) material such as nltinol, by way of example only, which additionally aids in the actuation to a hollow rivet coupling shape. Other suitable materials for the anasyomotic ring 14 will be apparent to those skilled in the art. An exemplary anaslomico ring 14 is described with more detail in the patent application publication of E.U.A. US 2003/0032967 of Park et al. It will be appreciated that the terms "near" and "distal" are used in the present to refer to a cylindrical professional grasping the handle of an applicator 10. It will also be appreciated that for convenience and clarity, the spatial terms such as "right", "left", "vertical" and "horizontal" are used in the present with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting at all. In addition, aspects of the invention have application in surgical procedures that are performed endoscopically and laparoscopically, as well as in an open procedure and in other procedures. The use of these and other similar terms herein should not be considered as limiting the present invention for use only in a category of surgical procedure. Referring again to Figure 1, the applicator 10 of the present example comprises a handle 17 that is connected to an elongated arrow 18, which has a proximal radius 20 and a dissimilar effusion 22. As can be seen in Figure 1, the arrow elongated 18 is flexible. It will be appreciated that the arrow 18 can be flexible either along its entire length or in one or more joints. Of course, the arrow 20 may alternatively be rigid, elastic, malleable, or may have other properties. The distal end 22 of the arrow 18 comprises a deployment mechanism for ring 24. The deployment mechanism 24 can be operated by a bolt or lever which is located on the handle 17. As shown in Figure 1 the handle 17 comprises a pair of actuator members 26, 28. In the present example, the actuator members 26, 28 comprise sliders.

The operation of the exemplary actuating members 26, 28 will now be explained. However, it will be appreciated that the actuating members 26, 28 can be a variety of other shapes and can have a variety of other functions. In the present example, the deployment mechanism for ring 24 is located proximal to a tip 30. The applicator 10 includes a feature that prevents tissue from being caught in the deployment mechanism 24, when the applicator 10 is inserted or removed from the anastomosis site. In figure 1, a plurality of nearby panels are represented 32 and a plurality of distant panels 34, enclosing the deployment mechanism for ring 24. In the closed position the adjacent panels 32 are adjacent to each other, with only a minimal coastal winding thereof. Likewise, in the closed position, the distant panels 34 are adjacent to each other, with a minimum dimension between them. You will hear suitable configurations for panels 32, 34 will be apparent to those skilled in the art.

Referring to Figure 5, the deployment mechanism for ring 24 is shown in an exploded view, demonstrating how the neighboring panels 32 fit over a plurality of proximal fingers 36, and the distant panels 34 fit over a plurality of distant fingers. 38. The deployment mechanism for ring 24 comprises a stationary molded actuator member 40. Of course, the molded actuator member 40 can be formed using any suitable method that is different from molding. In the present example, the molded actuator member 40 comprises proximal fingers 36 and distal fingers 38. The molded actuator member 40 also has a central portion 46, which is fixedly connected to the middle tube 45. The middle tube 45 is fixed at the end 22 of the arrow 18. The proximal fingers 36 were connected to the first actuating slide 26 by means of symmetrical cables 42 of the arrow 18 (FIG. 12). The symmetric cables 42 are in communication with an exuberant tube 43, which is fixedly connected with the proximal fingers 36. The distracting fingers 38 are connected to the second accliver slide 28 by means of inner tubes 44A, 44B of the arrow 18 ( figure 13). The inner tube 44A is fixedly connected to the inner tube 44B. The proximal fingers 36 and the disinated fingers 38 are each in a double-jointed relationship with a central portion 46 of the molded actuating member 40. Other configurations suitable for the deployment mechanism for ring 24 will be apparent to those skilled in the art.

Figures 8 and 11 show exemplary components of the handle 17. In the present example, the disengagement movement of the first actuator slide 26 communicates the distracting movement to the proximal fingers 36 by means of the symmetrical cables 42, thereby making the fingers next 36 are actuated outwardly in the manner of an umbrella, due to their double-jointed relationship with the central portion 46. Similarly, the proximal movement of the second actuating slide 28 communicates a movement close to the distant fingers 38 by means of the inner tubes 44A, 44B causing the dishynished fingers 38 to be driven outwardly due to their double-jointed relationship with the center portion 46. In this manner, in this example the distal movement of the first actuating slide 26 drives a proximal portion of the ring anastomotic 14, from the compressed position to the driven position, while the proximal movement of the The actuating slide 28 operates a disinfector portion of the anasomonous ring 14 from the compressed position to the actuated position. However, it will be appreciated that the handle 17 can be configured in such a way that the first actuating slide 26 drives the distal fingers 38, and the second actuating slide 28 drives the proximal fingers 36. Alternatively any other means can be used., method or mechanism suitable for actuating an anasyomotic ring, from a compressed position to an actuated position. The proximal fingers 36 and the disengaged fingers 38 of the present example comprise gripping grooves 48, each of which includes a retention tip 50 directed to adenine. The gripping slots 48 can help retain the anastomotic ring 14 when it is in the compressed position, as well as during the intermediate steps of the deployment of the ring 14, while the retaining tip 50 can allow the anastomotic ring 14 to be decoupled of the petals 51 of the anastomotic ring 14 after it has been deployed in the actuated position. It will be apparent to those skilled in the art that you will hear configurations of the fingers 36, 38. As best seen in Figure 5, the deployment mechanism for ring 24 comprises spaces 54 encircling the proximal fingers 36 and winding the dishynished fingers 38. adjacent panels 32 are padded to cover the proximal fingers 36, and the distal panels 34 are adapted to cover the distal fingers 38, when the fingers 36, 38 are in the non-actuated position, to prevent tissue from becoming jammed in the spaces 54 during the insertion and removal of the applicator 10. As best seen in Figure 6, the proximal movement of the second actuating slide 28 is adapted to cause the distal fingers 38 to move to the actuated position, forcing the the distant panels 34 to be separated and moved with the fingers 38 to the actuated position. In this way, the distant panels 34 can prevent tissue from being trapped in the spaces 54 during insertion or removal of the applicator 10, without interfering with the deployment of the anastomotic ring 14. Similarly, the actuation of the proximal fingers 36 causes the neighboring panels 32 to move apart and move to the actuated position with the fingers 36. Figure 7 shows fan to the proximal fingers 36 as to the distal fingers 38 in the expanded position, together with the near and far panels 32, 34, respectively, as a result of the coupling of the actuating slides 26, 28. In one embodiment, the adjacent panels 32 can be snapped onto a proximal end 56 of the proximal fingers 36, while the distant panels 34 can be adjusted by pressure similarly on one end distal 58 of the distal fingers 38. However, it will be appreciated that the panels 32, 34 can be fixed, or otherwise, can be coate with fingers 36, 38 in a variety of alternative ways. By way of example only, the proximal and distant panels 32, 34 can be secured to the proximal and distant fingers 36, 38, respectively, by an adhesive, as an adhesive, by mechanical fasteners, or by any other suitable means or means. Although the adjacent panels 32 were depicted as being integral with each other, it will be appreciated that the adjacent panels 32 can be configured in a variety of alternative ways. By way of example only, each of the adjacent panels 32 can be physically separated from each other. In such an embodiment, for example, each individual proximal panel 32 may be configured to fit over an individual proximal finger 36 correspondingly. The disengagement panels 34 and / or the distal fingers 38 may likewise be subject to similar variations. Other suitable configurations for panels 32, 34 will be apparent to those skilled in the art, including, but not limited to, variations that affect their mullet relationship and / or their relation to fingers 36, 38. Panels 32, 34 may comprise the same material of the fingers 32,34, or any other suitable material. Other suitable materials for panels 32, 34 will be apparent to those skilled in the art. In one example of ation, the anastomorphic ring 14 is held in the deployment mechanism for ring 24 by gripping slots 48 of the proximal and distended fingers 36., 38. The applicator 10 is inserted adjacent to the anastomosis site, where an aberration 60 is formed in two proximal gasiroiniminal passages 62, 64, as can be seen in Figure 9. As the applicator 10 is inserted, the proximal and distant panels 32, 34 are in the closed or non-driven position, thus preventing the seal from being pinched in the spaces 54. Of course, the combs 32, 34 can serve many other purposes. Referring now to Figure 10, once the deployment mechanism for ring 24 is inserted into the anastomotic opening the first and second actuating slides 26, 28 can be moved to their respective driven positions. Because the panels 32, 34 do not interfere with the actuation of the fingers 36, 38, the actuation of the fingers 26, 28 will cause the fingers 36, 38 to be pushed outwards. These can expand the anastomotic ring 14 from its cylindrically shaped compressed position to its hollow rivet driven position, forming an anastomotic junction between the walls of the gastrointestinal tissue. When the anastomotic ring 14 has been deployed, the acclioning slides 26, 28 can be actuated to return fingers 36, 38 to a non-actuated position. It will be appreciated that panels 32, 34 would return to the non-actuated position with fingers 36, 38. With fingers 36, 38 and panels 32, 34 in the non-actuated position, applicator 10 can be removed from the patient. During such removal, the panels 32, 34 can reduce the likelihood that the tissue and the like will be scratched on the fingers 36, 38. It will be apparent to those skilled in the art that applications and operating modes of the applicator will be heard. 10. Having demonstrated and described the various embodiments and concepts of the invention, one skilled in the art will be able to achieve other adaptations of the methods and systems described herein, without departing from the scope of the invention. Many such alternatives, modifications and potential variations have been mentioned, and others will be apparent to those skilled in the art in light of the accompanying drawings. Accordingly, the invention is intended to encompass all these alternatives, modifications and variations that fall within the spirit and scope of the following claims, and should not be understood as limiting the boundaries of the structure and the operation that is shown and which is described in FIG. the specification and in the drawings. You will hear advantages can be readily apparent to those skilled in the art.

Claims (20)

NOVELTY OF THE INVENTION CLAIMS

1. - A surgical instrument for implanting an anastomotic ring device, comprising: (i) a handle; (ii) a ring deployment mechanism that is configured to receive an anastomotic ring, wherein the ring deployment mechanism is adapted to move between a generally cylindrical non-driven position and a hollow rivet driven position; (iii) an elongated arrow connecting the handle to the ring deployment mechanism; (V) one or more actuators that function to communicate one or more driving forces to the ring deployment mechanism by means of the elongated arrow; and (v) a plurality of panels that are adapted to cover at least a portion of the ring deployment mechanism during insertion and removal of the instrument, wherein the panels are adapted to move from the non-actuated position.

2. The surgical instrument according to claim 1, further characterized in that said ring deployment mechanism comprises: a proximal portion that moves from the non-actuated position to an actuated position to deploy a proximal portion of the anastomotic ring, and a distending portion that moves from the non-actuated position to the actuated position to deploy a distal portion of the anastomotic ring.

3. The surgical device according to claim 2, further characterized in that it also comprises: a plurality of adjacent panels that are adapted to cover at least a portion of the proximal portion of the ring deployment mechanism, and a plurality of panels which are adapted to cover at least a portion of the distal portion of the ring deployment mechanism.

4. The surgical instrument according to claim 3, further characterized in that it also comprises: a first actuator that functions to communicate one or more actuating forces to the proximal portion of the ring deployment mechanism, and a second actuator that functions to communicate one or more driving forces to the distal portion of the ring deployment mechanism.

5.- The surgical instrument in accordance with the claim 4, further characterized in that the actuation of the first actuator moves the proximal portion of the ring deployment mechanism as well as the neighboring panels from the non-actuated position to the actuated position.

6.- The surgical instrument in accordance with the claim 4, further characterized in that the actuation of the second actuator moves both the distal portion of the ring deployment mechanism and the diseny panels, from the non-actuated position to the actuated position.

7. The surgical device according to claim 1, further characterized in that the panels are fixed by pressure on the ring deployment mechanism.

8. The surgical instrument according to claim 1, further characterized in that the panels comprise a first set of panels and a second set of panels, wherein the panels of the first set are integral with each other.

9. A surgical instrument for implanting an anastomotic ring device, comprising: (i) a handle; (ii) an elongated arrow comprising a disialy portion and a proximal portion that is connected to the handle; (iii) a deployment mechanism for a ring comprising a plurality of fingers that are adapted to receive an anastomotic ring, the fingers move from a first position that is aligned longitudinally with the arrow, to a second position in which the fingers are they act outwardly from a longitudinal axis of the elongated arrow to drive a portion of the anasomonous ring; and (iv) a plurality of panels that are adapted to enclose at least a portion of the fingers of the ring deployment mechanism during insertion and removal of the instrument, the panels move from the first position to the second position together with the fingers.

10. - The surgical instrument according to claim 9, further characterized in that it also comprises spaces between pairs of the plurality of fingers.

11. The surgical instrument according to claim 10, further characterized in that the panels are adapted to cover at least a portion of the spaces between the pairs of the plurality of fingers in the non-actuated position.

12. The surgical instrument according to claim 9, further characterized in that the panels are configured to join at least a portion of the ring deployment mechanism.

13. The surgical instrument according to claim 9, further characterized in that the plurality of combs comprises a first plurality of panels and a second plurality of combs.

14. The surgical instrument according to claim 13, further characterized in that the first plurality of panels are integral to each other, and wherein the second plurality of panels are integral to each other.

15. The surgical instrument according to claim 9, further characterized in that at least a portion of the elongated shaft is flexible.

16. - A surgical instrument for implanting an anasomyomic ring, comprising: (i) a handle; (I) an elongated arrow comprising a distal portion and a proximal portion, wherein the proximal portion is connected to the handle; (ili) a deployment mechanism for a ring comprising a longitudinal longus and a central portion, the deployment mechanism for a ring is located in the longitudinal portion of the elongated shaft, wherein the ring deployment mechanism is configured to receive a ring compressed anastomosis; (iv) an actuator mechanism that operates to move the longitudinal end of the ring deployment mechanism toward the central portion of the ring deployment mechanism to drive a first portion of the anasomolyl ring; and (v) a plurality of panels that are adapted to enclose at least a portion of the longitudinal end of the ring deployment mechanism in a first position during insertion and removal of the insitution, where the panels move to a second position. , wherein the panels are adapted to be separated to allow the ring deployment mechanism to actuate the first portion of the anasomonous ring.

17. The surgical instrument according to claim 16, further characterized in that it also comprises a second longitudinal length that is adapted to move from an initial position to the central portion of the ring deployment mechanism for actuating a second portion of the anaslomotic ring.

18. - The surgical instrument according to claim 17, further characterized in that it also comprises a second plurality of combs which are adapted to enclose at least a portion of the second longitudinal length of the ring deployment mechanism in a first position, wherein the second The plurality of combs also moves to a second position to allow the ring deployment mechanism to actuate a second portion of the anastomotic ring.

19. The surgical insírumenío according to claim 16, characterized in that each of the panels is separated from the other panels.

20. The surgical instrument according to claim 16, further characterized in that the deployment mechanism for ring comprises a plurality of fingers.